Having presented a synthesis of the 17 national reports, which are all included in the published document, the co-ordinator of the project, Richard Muscat, draws two main conclusions.

 

The common denominator among all the national policies is an overarching concern with health: this is the prime factor guiding most policy choices. To help analysis and understanding of the policy options, Muscat suggests that, in future, it may be appropriate to frame substance use policy within the context of health, and that the Council of Europe should take a lead in developing such a global policy framework.

 

Muscat proposes that the model used to analyse the 17 national policies on illicit drugs, alcohol and tobacco should be developed further in order to support the operation of such a framework. The model is based on the assumption that policy formulation in the area of substance use is influenced by three ‘proximal’ factors – civil society, science and practice – and that these in turn may be modified by six ‘distal’ factors – public opinion, political ideology, theory, experiment, evidence base and outcomes (see diagram).

  

The Irish case study contained in the report2 illustrates how the model can enhance our understanding of the nature of the policy issues.

 

°         Civil society reflects the standpoint of citizens of a country, which in turn reflects public opinions and political ideologies. The Irish case study contains examples of the contradictory views that can be taken. For example, while public opinion and political ideology converge regarding the nature of the illicit drug problem, they differ regarding how to respond. Although there is public support for a combined illicit drugs and alcohol strategy, there is continuing political reluctance to combine illicit drugs and alcohol in the one substance-use policy.

 

°         Science comprises two main disciplines that are beginning to yield evidence that needs to be taken into account in formulating policy – epidemiology, which studies the incidence and prevalence of drug use, and neuroscience, which explores why psychoactive substances seem so attractive. Like the majority of countries, Ireland mainly considers the evidence from epidemiological studies. Muscat does not regard this as surprising as the questions posed by politicians are principally about the size of the problem and whether it is growing. Since 2004, data on problem alcohol use and on alcohol-related deaths in Ireland have been included alongside data on illicit drugs in the two national epidemiological databases administered by the Health Research Board (the National Drug Treatment Reporting System and the National Drug-Related Deaths Index). This new departure has the potential to influence the future development of illicit drugs and alcohol policy.

 

°         Practice refers to the day-to-day management of problemsassociated with substance use: health, psychological, social or matters within the justice system. Modern practice is based on ‘good practice’, i.e. practice based on evidence and on the achievement of specific outcomes. Practice and policy may not always coincide, as demonstrated by the ongoing debate, in Ireland as elsewhere, as to whether harm-reduction practices are contrary to the 1988 UN Convention on Drug Abuse, and as to their appropriateness and acceptability.  

 

Tobacco control is another interesting example of the interface between practice and policy. The Irish case study cites the conclusions of the Tobacco-Free Policy Review Group that reported in 2000 and which has determined the shape of Ireland’s tobacco policy ever since. While acknowledging that tobacco products, when used in the manner intended by the manufacturers, cause addiction followed by illness and premature death, the review group argues that prohibition is not an option: ‘A complete ban would, in our opinion, lead to the emergence of a substantial black market in smuggled products with its associated criminality.’

The policy model focuses on information inputs to the policy process. It does not factor in constraints, which may also influence policy. The Irish case study outlines how factors such as cultural attitudes, political processes, and structural and resourcing arrangements can restrict the options available to policy makers.

Muscat found that science plays a minor role in the decision-making process. In order to support the better use of research evidence in policy and practice, and thus facilitate the development of evidence-based policy, he identifies three issues that need to be addressed: the co-ordination of research efforts, access to information and the communication of findings in a format that is digestible by policy-makers and the public at large. He outlines steps that the Research Platform of the Pompidou Group is taking in this regard: it has launched a second version of the Research Register, which aims to provide information on who is doing what in drug research, and in 2008 held a first summer workshop for young drug researchers on communicating results.3

 

1. Muscat R and Members of the Pompidou Group Research Platform (2008) From a policy on illegal drugs to a policy on psychoactive substances. Strasbourg: Council of Europe Publishing.

2. Pike B (2008) Irish drug policy and its link with alcohol and tobacco policies. In R Muscat et al., see Note 1 above, pp. 91–107.

3. Information on the work of the Pompidou Group Research Platform, and the Research Register, may be found at www.coe.int/t/dg3/pompidou/Activities/research_en.asp