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Pike, Brigid (2010) Using scientific knowledge to inform drug policy. Drugnet Ireland, Issue 34, Summer 2010, pp. 11-12.

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Evidence-based, or more accurately, evidence-informed, policy is now an accepted norm, even if there is debate about how the evidence translates into policy. Equally important but not so widely debated are the questions (1) What is the evidence? and (2) How do policy makers know they are using the best evidence available?
 
For five years between 2004 and 2009, a group of 12 addiction scientists from different disciplines and with affiliations to academic institutions in Australia, Canada, Nigeria, Norway, Qatar, Sweden, the UK and the USA, collaborated to answer these two questions. The result is a 300-plus-page book Drug policy and the public good.1
 
To answer the second question first, what constitutes the ‘best’ evidence is determined by the purpose of the policy – ‘policy for whom and for what?’ – and the nature of the ‘drug problem’. The authors regard securing the ‘public good’ as the purpose of drug policy. They suggest that the concept of the public good includes public health aspirations but is not restricted to them. Public health is defined as ‘the management and prevention of adverse health conditions in groups of people, formally termed “populations”.’ It can benefit large numbers of people at the level of the community or country. The authors regard a public health approach as useful in managing the consequences of the use of psychoactive substances in a population as it emphasises the need to change both the environment and the behavior of the individual. However, the authors argue that this approach on its own is not enough: it focuses on health indicators to the exclusion of broader social indicators such as loss of self-esteem or increased anxiety or isolation caused by exposure to drug-related problems.
 
The purpose of drug policy therefore is seen by the authors as heavily influenced by public health concerns but not limited to them: ‘… concerns about justice, freedom, morality and other issues beyond the health domain have an important place in drug policy formation and should not be ignored by public health experts.’
 
The ‘best’ evidence is also determined by the nature of the drug problem, which is determined by the manner of use of the different substances and the various problems associated with their use. In the diagram below, the authors summarise how the three mechanisms by which harm may be inflicted – toxic effects, intoxication and dependence – are related to drug dose, use patterns and mode of drug administration, and how they mediate the consequences of drug use for the individual drug users. The impact of the harm mechanisms may also be affected by contextual factors such as the setting in which the drug is used and the user’s expectations.
 
 
The authors argue that classifying drugs according to their chemical composition alone, and using this as the basis for criminal penalties, policing, prevention, and treatment programmes, is not a sufficiently robust approach. The risks associated with different substances vary according to the drug’s health effects, its safety ratio (i.e. how much constitutes a lethal dose), intoxicating effects, general toxicity, social ‘dangerousness’ (e.g. aggressive and uncontrolled behavior induced by or associated with the use of a drug), dependence potential, the environment/context of use, and social stigma. The authors conclude, ‘Policies on substance use must reflect the social and pharmacological complexities of psychoactive substances as well as the relative differences among them.’ They point out that using such a rating system indicates that legal substances such as tobacco and alcohol are at least as dangerous as many illicit substances.
 
Having established a conceptual basis for a ‘rational drug policy’, which provides a context within which the ‘best evidence’ may be more readily recognised, the authors provide a critical review of the cumulative scientific evidence in five general areas of drug policy:
 
·         prevention
·         supply reduction
·         treatment and harm reduction
·         criminal sanctions and decriminalisation
·         control of the legal market through prescription drug regimes.
 
Acknowledging that policy making should not be solely a technocratic endeavour entrusted to scientists, the authors came to a consensus that the evidence reviewed in the book supported the following conclusions:
 
·         There is no single drug problem, and neither is there a magic bullet that will solve ‘the drug problem’.
·         Many policies that affect drug problems are not considered drug policy, and many specific drug policies have large effects outside the drug domain.
·         Once a drug is made illegal, there is a point beyond which increases in enforcement and incarceration yield little added benefit.
·         Substantial investments in evidence-based services for opiate-dependent individuals usually reduce drug-related problems.
·         School, family, and community prevention programmes have a collectively modest impact, the value of which will be appraised differently by different stakeholders.
·         The drug policy debate is often dominated by four false dichotomies (law enforcement vs health services; targeting drug use vs damage caused by drug use; ‘good’ vs ‘bad’ drugs; the interests of heavy drug users vs the interests of the rest of society) that can mislead policy makers about the range of legitimate options and their expected impacts.
·         Perverse impacts of drug policy are prevalent.
·         The legal pharmaceutical system can affect the shape of a country’s drug problem and its range of available drug policy options.

1. Babor T, Caulkins J, Edwards G, Fischer B, Foxcroft D, Humphreys K et al. (2010) Drug policy and the public good. Oxford: Oxford University Press

Item Type
Article
Publication Type
Irish-related, Open Access, Article
Drug Type
Substances (not alcohol/tobacco)
Intervention Type
Policy
Issue Title
Issue 34, Summer 2010
Date
2010
Page Range
pp. 11-12
Publisher
Health Research Board
Volume
Issue 34, Summer 2010
EndNote
Accession Number
HRB (Available)

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