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Abstract

Reducing substance use among individuals subject to community supervision is an important goal for many judges and community corrections officers. Some jurisdictions have had success by ordering justice-involved individuals to frequent substance use testing with swift, certain, and fair (SCF) sanctions for non-compliance. South Dakota’s 24/7 Sobriety program is one example of a SCF program that has also been adopted statewide in Montana, North Dakota, and other jurisdictions. As other entities outside the Great Plains attempt to adopt the 24/7 approach, there is a need to examine how the program is implemented. This paper examines a 24/7-inspired pilot program that was implemented in a southwestern county in the US in 2018. Data on participation rates and testing results for the 6-month pilot program were examined. Using a semi-structured interview protocol with questions that were adapted from the Consolidated Framework for Implementation Research (CFIR) interview guide, we interviewed nine individuals from six stakeholder groups: 1) Court, 2) District Attorney, 3) Public Defender, 4) Probation, 5) Sheriff, and 6) the non-profit organization that administered the testing. There were important differences in how the program was implemented in the county versus South Dakota’s 24/7 program—namely, there was a different target population, participation was voluntary, and testing was conducted in a different setting which increased costs. While county stakeholders decided to discontinue the program after the pilot period, it was able to implement a SCF program and overcome many of the challenges it confronted. There is some interest in exploring implementation of the SCF with those arrested for driving under the influence of alcohol in the county. For jurisdictions considering the implementation of an SCF program, it makes sense to start with a pilot program with pre-determined objectives and timeline for consistency. It is also crucial to hold regular meetings with all relevant stakeholders before and during the pilot to address context-specific challenges. Conducting an implementation analysis of this process based on the CFIR guide can be useful for understanding why the pilot was a success or failure, and how it may be improved.

Abstract

Motivated by the historical components of the ongoing U.S. opioid epidemic, this study examines how public support for redistributive drug treatment changes with awareness that someone’s opioid addiction started with a legally acquired prescription. Using different versions of a vignette, we vary in a randomized design whether someone’s addiction to painkillers started with a legally acquired prescription or with the decision to take pills from a friend. After reading the vignette, participants expressed their level of support for a policy that uses income redistribution to fund a program that provides the person in the vignette with drug treatment. We find that participants are less likely to support redistributive drug treatment when a prescription precipitates the addiction. The results imply that emphasizing the medical establishment’s role in the opioid epidemic may actually make people less likely to favor using redistributive drug treatment to provide support.

Abstract

Background and Aims

Drug policy reforms typically seek to improve health among people who use drugs (PWUD), but flawed implementation impedes potential benefits. Mexico’s 2009 drug policy reform emphasized public health-oriented measures to address addiction. Implementation has been deficient, however. We explored the role of municipal police officers’ (MPOs) enforcement decision-making and local systems as barriers to reform operationalization.

Methods

Between February-June 2016, 20 semi-structured interviews were conducted with MPOs in Tijuana. Interviews were transcribed, translated and coded using a consensus-based approach. Emergent themes, trends and frameworks were analyzed through a hermeneutic grounded theory protocol.

Results

In conceptualizing their orientation towards municipal (not state) law, MPOs reported prioritizing enforcement of nebulous anti-vice ordinances to control PWUD activity. Local laws were seen as conflicting with drug policy reforms. Incentives within the police organization were aligned with ordinance enforcement, generating pressure through quotas and reinforced by judges. Driven by discretion, fuzzy understanding of procedures, and incentives to sanitize space, detention of PWUD for minor infractions was systematic.

Conclusions

Failure to harmonize policies and priorities at different levels of government undermine effective operationalization of health-oriented drug policy. Implementation must address local priorities and administrative pressures shaping MPO decision-making and enforcement practice.

Abstract

There is a growing consensus that acknowledges the failings of the prohibitionist ‘war on drugs’ model of international drug policy. Concomitant drug policy reform literatures have been characterized by the advocacy of policy pluralism, experimentation, evidence gathering/evaluation and the avoidance of drug fetishization. This paper builds upon these literatures and explores some of the complexities of drug policy pluralization, including challenges associated with drug policy asymmetries and repatriation and the, largely unexplored, potentials of deploying drug policies in combination. It argues that the drug policy reform literature has tended to favour evaluation of policy alternatives over discussion of their geographical deployment under a more plural international policy regime. It considers models to inform the deployment of plural drug policies. Conceptually this paper draws on geographical literatures and attempts to rethink drug markets and drug policy reform in geographically sensitive, regional and relational ways, highlighting scalar and relational challenges to drug policy pluralization. It concludes by outlining an extensive set of research priorities that speak directly to the challenges identified through this geographical lens.

Abstract

Mark A.R. Kleiman and his colleagues (hereafter Kleiman) have done the public a service by highlighting the problem of “driving while stoned.” Drug-impaired driving is a serious national problem. Numerous drugs other than alcohol, whether legal or illegal—such as opioids, cocaine, tranquilizers, sleep aids, hallucinogens, and marijuana—degrade driving performance and increase the risk of highway morbidity and mortality. Other than alcohol, marijuana is the biggest problem because it is the most commonly used drug, and its use is increasing, given marijuana legalization. Two facts aggravate that problem: (1) marijuana is often combined with alcohol and (2) a marijuana-alcohol cocktail has an enhanced debilitating effect on safe motor vehicle handling. As the U.S. Office of National Drug Control Policy has noted, driving while impaired is a major public health problem. Kleiman is correct that identifying impairment attributable to substances other than alcohol is a difficult problem. Two twentieth century developments helped society reduce the number of alcohol-related crashes, injuries, and deaths: the passage of 0.08 g/dL blood-alcohol content laws, and the development of reliable, easily operated, hand-held Breathalyzers for roadside use. Unfortunately, we cannot successfully use that approach for impairing drugs other than alcohol. We do not know what amount of THC impairs a majority of drivers. In any event, we do not have a measurement device comparable to a Breathalyzer. Kleiman argues that, given those enforcement problems, we should use only administrative measures to penalize marijuana-impaired driving. I think that there is room for the criminal justice system. People who use marijuana and drive put others at risk of injury or death. Just as legislatures can force a factory to bear the risk of pollution-related injury, so too can a legislature force marijuana users to internalize any costs of their drug use. If you use marijuana, don’t drive for at least eight hours. Use public transportation. Take a cab. Call Uber. Walk. Ask a friend for a lift. Or just remain where you are. No one has a constitutional right to drink alcohol, to smoke marijuana, or to drive an automobile. Society hardly asks too much of its citizens to demand that they not do all three simultaneously or to delay driving for eight hours after either of the first two activities. That is not all. States should test every driver involved in a crash, particularly one involving a fatality, not only for alcohol but also for legal and illegal impairing drugs. Moreover, all 50 states fix 21 as the minimum drinking age and the minimum age for recreational marijuana use. Whatever administrative penalty the states impose for underage drinking and driving—such as license suspension—should apply as well to everyone under that age who tests positive for any illegal drug use. States should also report on a regular basis the data regarding motorists’ use of impairing drugs, including marijuana. There is also room for Congress to act. Because U.S. highways are arteries of interstate commerce, Congress can protect their use by commercial and non-commercial drivers alike by preventing interstate highways from being used by drivers who increase the morbidity and mortality risks of others. Congress can demand that the states use a portion of their federal highways funds to adopt safety or information-gathering measures like the ones suggested above. At a minimum, Congress should force states to fund the cost of learning what their marijuana legalization measures have wrought.

Abstract

Despite being the global legislative reality for more than half a century, when it comes to the control and management of illicit drugs, there is still a sharp academic divide between strict prohibitionists and open access legalisers, with both sides claiming supremacy in their ability to reduce the harms drug users face. Spanning these opposing academic extremes, governments around the world have experimented with, or put into practice a range of alternatives to prohibition that generally hold harm reduction as a centrally guiding principle. However, in the realm of drugs control, harm reduction is not a simple utilitarian problem and is often clouded by a number of moral aspects that will seemingly continue to frustrate the prospects for consensus among the various drug control stakeholders for the near future. Moreover, while proponents of reform and legalisation have put forth seemingly plausible and well considered theories for the regulation and control of drugs in lieu of prohibition, it has become rather clear in the wake of the recent United Nations Special Assembly on Drugs in 2016 that a significant top-down change in international drugs control policy is unlikely for the foreseeable future. This is not to say the global prohibitionist framework is destined to remain predominant, and clear lines are emerging for the practical evolution of international drugs control policy. With an ever expanding variety of novel alternative methods being implemented by countries around the world to reduce the harm from illicit drug use, especially with regards to the unique challenges faced by intractable, chronic users of ’hard’ drugs such as heroin, coupled with a softening of hard-line attitudes, a path towards sensible drug reforms is becoming clearer. This short article examines a number of those alternative methods, where it is argued that medicalised harm reduction for ’hard’ drugs is the most likely to find broad acceptance under the international drug regime and the growing tolerance and liberalisation of cannabis laws will likely continue because of its relatively low risk profile and high cost of prohibition.

Abstract

THC is the most commonly detected intoxicant in US drivers, with approximately 13 % of drivers testing positive for marijuana use, compared to the 8 % that show a measurable amount of alcohol . Because cannabis use remains detectable for much longer than alcohol, and also for long after the driver is no longer impaired, the difference in rates does not show that stoned driving is more common than drunk driving. Nonetheless, cannabis intoxication while driving is on the rise and has been shown to impair reaction time and visual-spatial judgment. Many states, including those where cannabis sales are now permitted by state law, have laws against cannabis-impaired driving based on the drunk-driving model, defining criminally intoxicated driving as driving with more than a threshold amount of intoxicant in one’s bloodstream—a per se standard—as opposed to actual impairment. That approach neglects crucial differences between alcohol and cannabis in their detectability, their pharmacokinetics, and their impact on highway safety. Cannabis intoxication is more difficult to reliably detect chemically than alcohol intoxication. A breath alcohol test is (1) cheap and reliable; (2) sufficiently simple and non-invasive to administer at the roadside; and (3) a good proxy for alcohol in the brain, which in turn is (4) a good proxy for subjective intoxication and for measurable driving impairment. In addition, (5) the dose-effect curve linking blood alcohol to fatality risk is well-established and steep. None of those things is true for cannabis. A breath test remains to be developed. Oral-fluid testing can demonstrate recent use but not the level of impairment. A blood test requires a trained phlebotomist and therefore a trip to a medical facility, and blood THC levels drop very sharply over time-periods measured in minutes. Blood THC is not a good proxy either for recency of use or for impairment, and the dose-effect curve for fatality risk remains a matter of sharp controversy. The maximum risk for cannabis intoxication alone, unmixed with alcohol or other drugs, appears to be more comparable to risks such as talking on a hands-free cellphone (legal in all states) than to driving with a BAC above 0.08, let alone the rapidly-rising risks at higher BACs. Moreover, the lipid-solubility of THC means that a frequent cannabis user will always have measurable THC in his or her blood, even when that person has not used recently and is neither subjectively intoxicated nor objectively impaired. That suggests criminalizing only combination use, while treating driving under the influence of cannabis (however this is to be proven) as a traffic offense, like speeding.

Abstract

Illicit substance misuse has become a serious problem in contemporary China. The number of officially registered illicit substance misusers totals close to 3 million, having increased every year since the government’s first annual report on drug control in 1998. In recent years, synthetic drugs such as methamphetamine and ketamine, have become more popular than heroin which was previously dominant. However, illicit substance use continues to receive little  sympathy from the public, despite government’s efforts to move towards treatment and rehabilitation. For many years, compulsory detoxification centers and “education-through-labor” camps were the only treatment options. More humane approaches are emerging, including methadone maintenance, therapeutic communities, and faith-based halfway houses. Government response to drug trafficking remains draconian. Drug distribution and trafficking are among the dwindling number of criminal offenses that qualify for the death penalty. For future drug control policy, China appears willing to accelerate its experiment with decriminalizing substance abuse and applying a public health approach to the treatment of substance misusers. Evidence-based treatment programs through scientific research and rigorous evaluation should be the norm, and harm reduction needs to be seriously explored as an alternative to the harsh criminal justice regime. More importantly, reliable and multi-faceted forecast systems need to be established to monitor and estimate the size of substance misuser population and trends in illicit drug consumption. Finally, China should continue to expand its international collaboration and insulate its counter-narcotic programs from global politics.

Abstract

A Federal tax on cannabis requires answers to several questions: 1. What should we tax? What should be the “base” or bases of a cannabis tax? (Possible bases include: price; weight of various product types [like flower, trim, and concentrate]; and THC content.) 2. Given any base, what should the tax rate be? 3. Should medical cannabis bear full tax? 4. Should marijuana advertising and selling expenses become deductible for federal income tax purposes? (That would treat cannabis businesses like other businesses; current Internal Revenue Code section 280E bars such deductions.) Recently introduced federal legislation provides answers, some more aligned with drug policy than others, to those questions.

Abstract

Background

In 2006 the country of Georgia implemented Article 45 of the Administrative code and Article 273 of the Criminal Code of Georgia, a public policy that enable police to detain any individual, anywhere, at any time on grounds of suspicion of drug use; and require them to submit to urine screening to test for the presence of illegal drugs and their metabolites. This policy is referred to as the street drug testing policy. Positive drug screening results in fines and potential jail time. The purpose of this paper is to conduct a cost analysis of this policy and assess the execution of the policy and the extent to which the policy meets its stated aims.

Methods

This study employed cost analysis methodology to calculate annual direct material and labor costs associated with carrying out Georgia’s street level drug testing policy. These costs encompassed law enforcement, drug testing, associated judicial processes, imprisonment and income offset through fines collected during the two years covered in this study (2008 and 2014). In addition, we measured: fidelity of the execution of the policy measured by the accuracy of the percentage of people detained who were found to actually have used drugs; and the policy’s effectiveness in deterring drug use among those who tested positive. Impact on drug use behavior was measured through impact analysis interviews conducted with a national sample of 500 detainees who tested positive for drugs under Article 45 and Article 273.

Results

Using conservative financial estimates the cost of carrying out the policy offset by fine revenues broke even in 2008 (−111,889 GEL); however, by 2014 the costs increased 20 % in conjunction with an 18 % increase in the number of people detained for testing. However, the percentage of people who tested positive for drugs declined 39 % indicating decreased fidelity in the execution of the policy; accompanied by a financial imbalance of −10,277,909 GEL. Moreover, effectiveness analysis revealed that within one month of being detained and having tested positive for drug use, over 90 % of individuals had returned to pre-detention drug use levels, and within 12 months 100 % of detainees had resumed prior drug use behaviors.

Conclusion

The financial costs associated with Georgia’s street level drug screening policy has rapidly increased while becoming decreasingly accurate and efficient in its execution. Moreover, data indicates that the policy is not effective in reducing or stopping drug use among those who tested positive. In conclusion, it is fiscally unsustainable to continue the policy as it is being executed and the policy is ineffective in changing drug use behavior among people who use illegal substances.