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CORK Bibliography: Drug Laws



71 citations. January 2012 to present

Prepared: December 2012



Agius R; Nadulski T; Kahl HG; Dufaux B. Significantly increased detection rate of drugs of abuse in urine following the introduction of new German driving licence re-granting guidelines. Forensic Science International 215(1-3): 32-37, 2012. (24 refs.)

In this paper we present the first assessment of the new German driving licence re-granting medical and psychological assessment (MPA) guidelines by comparing over 3500 urine samples tested under the old MPA cut-offs to over 5000 samples tested under the new MPA cut-offs. Since the enzyme multiplied immunoassay technique (EMIT) technology used previously was not sensitive enough to screen for drugs at such low concentrations, as suggested by the new MPA guidelines, enzyme-linked immunosorbent assay (ELISA) screening kits were used to screen for the drugs of abuse at the new MPA cut-offs. The above comparison revealed significantly increased detection rates of drug use or exposure during the rehabilitation period as follows: 1.61, 2.33, 3.33, and 7 times higher for 11-nor-delta-9-tetrahydrocannabinol- 9-carboxylic acid (THC-COOH), morphine, benzoylecgonine and amphetamine respectively. The present MPA guidelines seem to be more effective to detect non-abstinence from drugs of abuse and hence to detecting drivers who do not yet fulfil the MPA requirements to regain their revoked driving licence.

Copyright 2012, Elsevier Science


Agius R; Nadulski T; Moore C. Validation of LUCIO (R)-Direct-ELISA kits for the detection of drugs of abuse in urine: Application to the new German driving licence re-granting guidelines. Forensic Science International 215(1-3): 38-45, 2012. (21 refs.)

LUCIO (R)-Direct-enzyme linked immunosorbent assay (ELISA) tests were validated for the screening of drugs of abuse cannabis, opiates, amphetamines and cocaine in urine for the new German medical and psychological assessment (MPA) guidelines with subsequent gas chromatographic-mass spectrometric (GC-MS) confirmation. The screening cut-offs corresponding to 10 ng/mL 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH), 50 ng/mL amphetamine, 25 ng/mL morphine and codeine and 30 ng/mL benzoylecgonine were chosen at the point where the number of false negatives was lower than 1%. Due to their accuracy, ease of use and rapid analysis, these ELISA tests are very promising for cases where a large proportion of the tests are expected to be negative such as for abstinence monitoring as part of the driving licence re-granting process.

Copyright 2012, Elsevier Science


Bewley-Taylor D; Jelsma M. Regime change: Re-visiting the 1961 Single Convention on Narcotic Drugs. International Journal of Drug Policy 23(1): 72-81, 2012. (46 refs.)

Background: March 2011 marked the 50th anniversary of the Single Convention on Narcotic Drugs. This legal instrument, the bedrock of the current United Nations based global drug control regime, is often viewed as merely a consolidating treaty bringing together the multilateral drug control agreements that preceded it; an erroneous position that does little to provide historical context for contemporary discussions surrounding revision of the international treaty system. Method: This article applies both historical and international relations perspectives to revisit the development of the Convention. Framing discussion within the context of regime theory, a critique of the foundational pre-1961 treaties is followed by detailed content analysis of the official records of the United Nations conference for the adoption of a Single Convention on Narcotic Drugs and, mindful of later treaties, an examination of the treaty's status as a 'single' convention. Results: The Single Convention on Narcotic Drugs represents a significant break with the regulative focus of the preceding multilateral treaties; a shift towards a more prohibitive outlook that within international relations terms can be regarded as a change of regime rather than the straightforward codification of earlier instruments. In this respect, the article highlights the abolition of drug use that for centuries had been embedded in the social, cultural and religious traditions of many non-Western states. Further, although often-overlooked, the Convention has failed in its aim of being the 'single' instrument within international drug control. The supplementing treaties developed in later years and under different socio-economic and political circumstances have resulted in significant inconsistencies within the control regime. Conclusion: Having established that a shift in normative focus has taken place in the past, the article concludes that it is timely for the international community to revisit the Single Convention on Narcotic Drugs with a view to correcting past errors and inconsistencies within the regime, particularly those relating to Scheduling and traditional drug use.

Copyright 2012, Elsevier Science


Bostwick JM. Blurred boundaries: The therapeutics and politics of medical marijuana. Mayo Clinic Proceedings 87(2): 172-186, 2012. (111 refs.)

For 5 millennia, Cannabis sativa has been used throughout the world medically, recreationally, and spiritually. From the mid-19th century to the 1930s, American physicians prescribed it for a plethora of indications, until the federal government started imposing restrictions on its use, culminating in 1970 with the US Congress classifying it as a Schedule I substance, illegal, and without medical value. Simultaneous with this prohibition, marijuana became the United States' most widely used illicit recreational drug, a substance generally regarded as pleasurable and relaxing without the addictive dangers of opioids or stimulants. Meanwhile, cannabis never lost its cachet in alternative medicine circles, going mainstream in 1995 when California became the first of 16 states to date to legalize its medical use, despite the federal ban. Little about cannabis is straightforward. Its main active ingredient, delta-9-tetrahydrocannabinol, was not isolated until 1964, and not until the 1990s were the far-reaching modulatory activities of the endocannabinoid system in the human body appreciated. This system's elucidation raises the possibility of many promising pharmaceutical applications, even as draconian federal restrictions that hamstring research show no signs of softening. Recreational use continues unabated, despite growing evidence of marijuana's addictive potential, particularly in the young, and its propensity for inducing and exacerbating psychotic illness in the susceptible. Public approval drives medical marijuana legalization efforts without the scientific data normally required to justify a new medication's introduction. This article explores each of these controversies, with the intent of educating physicians to decide for themselves whether marijuana is panacea, scourge, or both. PubMed searches were conducted using the following keywords: medical marijuana, medical cannabis, endocannabinoid system, CB1 receptors, CB2 receptors, THC, cannabidiol, nabilone, dronabinol, nabiximols, rimonabant, marijuana legislation, marijuana abuse, marijuana dependence, and marijuana and schizophrenia. Bibliographies were hand searched for additional references relevant to clarifying the relationships between medical and recreational marijuana use and abuse.

Copyright 2012, Mayo Foundation for Medical Education and Research


Caulkins JP; Kilmer B; MacCoun RJ; Pacula RL; Reuter P. Design considerations for legalizing cannabis: Lessons inspired by analysis of California's Proposition 19. Addiction 107(5): 865-871, 2012. (29 refs.)

Aims: No modern jurisdiction has ever legalized commercial production, distribution and possession of cannabis for recreational purposes. This paper presents insights about the effect of legalization on production costs and consumption and highlights important design choices. Methods Insights were uncovered through our analysis of recent legalization proposals in California. The effect on the cost of producing cannabis is largely based on existing estimates of current wholesale prices, current costs of producing cannabis and other legal agricultural goods, and the type( s) of production that will be permitted. The effect on consumption is based on production costs, regulatory regime, tax rate, price elasticity of demand, shape of the demand curve and non- price effects ( e. g. change in stigma). Results: Removing prohibitions on producing and distributing cannabis will dramatically reduce wholesale prices. The effect on consumption and tax revenues will depend on many design choices, including: the tax level, whether there is an incentive for a continued black market, whether to tax and/ or regulate cannabinoid levels, whether there are allowances for home cultivation, whether advertising is restricted, and how the regulatory system is designed and adjusted. Conclusions: The legal production costs of cannabis will be dramatically below current wholesale prices, enough so that taxes and regulation will be insufficient to raise retail price to prohibition levels. We expect legalization will increase consumption substantially, but the size of the increase is uncertain since it depends on design choices and the unknown shape of the cannabis demand curve.

Copyright 2012, Wiley-Blackwell


Collin J. Tobacco control, global health policy and development: Towards policy coherence in global governance. Tobacco Control 21(2): 274-280, 2012. (100 refs.)

The WHO Framework Convention on Tobacco Control (FCTC) demonstrates the international political will invested in combating the tobacco pandemic and a newfound prominence for tobacco control within the global health agenda. However, major difficulties exist in managing conflicts with foreign and trade policy priorities, and significant obstacles confront efforts to create synergies with development policy and avoid tensions with other health priorities. This paper uses the concept of policy coherence to explore congruence and inconsistencies in objectives, policy, and practice between tobacco control and trade, development and global health priorities. Following the inability of the FCTC negotiations to satisfactorily address the relationship between trade and health, several disputes highlight the challenges posed to tobacco control policies by multilateral and bilateral agreements. While the work of the World Bank has demonstrated the potential contribution of tobacco control to development, the absence of non-communicable diseases from the Millennium Development Goals has limited scope to offer developing countries support for FCTC implementation. Even within international health, tobacco control priorities may be hard to reconcile with other agendas. The paper concludes by discussing the extent to which tobacco control has been pursued via a model of governance very deliberately different from those used in other health issues, in what can be termed 'tobacco exceptionalism'. The analysis developed here suggests that non-communicable disease (NCD) policies, global health, development and tobacco control would have much to gain from re-examining this presumption of difference.

Copyright 2012, BMJ Publishing


Coulson C; Caulkins JP. Scheduling of newly emerging drugs: A critical review of decisions over 40 years. (review). Addiction 107(4): 766-773, 2012. (40 refs.)

Aims: Decisions on whether and how to 'schedule' drugs (i.e. to determine their legal status and penalties to be applied for sale or possession) are often heavily criticized. We sought to assess more comprehensively the results of such decisions for newly emerging drugs. Methods: Through analysis of legislation and secondary sources, we identified 63 substances that have emerged since 1971, including all that have been added to the most restrictive schedule by the United Nations, United States, United Kingdom, Canada, Australia and/or New Zealand. Measurements: For each jurisdiction we recorded whether, when, and how the substance was scheduled and note what decisions engendered substantial criticism or controversy within the international treaties' framework of balancing medical benefits with risk of abuse. Findings: (i) The rate of emergence of new drugs has been fairly steady. (ii) There is broad cross-national agreement on what should be scheduled. (iii) The United States often acts first. (iv) Temporary bans that delay final decisions by 12-18 months can sometimes allow final decisions to be grounded on a substantially expanded research base. (v) It appears that no more than seven of the decisions reached by the United States with respect to the 63 substances are candidates for being considered errors, and arguably the United States has committed at most one serious Type I and one serious Type II error. Results for other countries are broadly similar. Conclusions: The process for determining the legal status of new psychoactive substances appears to function reasonably well, within the framework of international treaty obligations. Most criticisms relate to one or a few substances (e. g. 3,4-methylenedioxymethamphetamine) and/or complaints that the decisions discount benefits that are not recognized by the treaties (e. g. recreational or religious use).

Copyright 2012, Society for the Study of Addiction to Alcohol and Other Drugs


Daynard RA; LeGresley E. Product liability. Tobacco Control 21(2): 227-228, 2012. (3 refs.)

Product liability litigation has made important contributions to tobacco control, especially by uncovering incriminating industry documents and publicizing product dangers and industry misconduct. WHO Framework Convention on Tobacco Control (FCTC) Article 19 encourages Parties to strengthen legal procedures to facilitate these lawsuits and to establish mechanisms for mutual assistance. Creative lawyers will continue to find ways to bring the tobacco industry to justice in forums around the world.

Copyright 2012, BMJ Publishing


DiFranza JR. Which interventions against the sale of tobacco to minors can be expected to reduce smoking? (review). Tobacco Control 21(4): 436-442, 2012. (70 refs.)

Objective: Signatories of the Framework Convention on Tobacco Control have committed themselves to prohibiting the sale of tobacco to minors. The tobacco industry has a long history of legal challenges to such restrictions claiming that they cannot be expected to reduce youth smoking. The object of this study was to determine if disrupting the sale of tobacco to minors can be expected to reduce tobacco use by youths. Methods: A comprehensive literature search was conducted for studies that evaluated the impact on youth tobacco use of efforts to disrupt the sale of tobacco to youths. Results: There was little evidence that merely enacting a law without sufficient enforcement had any impact on youth tobacco use. There was no evidence that merchant education programmes had any impact on youth older than 12 years of age. There was no evidence that enforcement efforts that failed to reduce the sale of tobacco to minors had any beneficial impact. All enforcement programmes that disrupted the sale of tobacco to minors reduced smoking among youth. Conclusions: Government officials can expect that enforcement programmes that disrupt the sale of tobacco to minors will reduce adolescent smoking.

Copyright 2012, BMJ Publishing Group


Dresler C; Lando H; Schneider N; Sehgal H. Human rights-based approach to tobacco control. Tobacco Control 21(2): 208-211, 2012. (6 refs.)

The Framework Convention for Tobacco Control (FCTC) is currently the most potent tool for implementation of tobacco control laws across the globe. The FCTC is derivative from previously constructed international human rights conventions. These previous conventions have enforcement mechanisms, unlike the FCTC. However, the FCTC relies on state parties to report periodically on its implementation rather than on a continuous monitoring system. The Human Rights and Tobacco Control Network proposes that abiding by the principles of human rights delineated by international treaties, citizens across the globe can demand effective action for tobacco control. This paper explains the link between fundamental human rights and the right to tobacco control. Mechanisms are described to link the FCTC and its principles with human rights-based monitoring reports, which are provided to oversight committees for the other human rights conventions. The initial work of the Human Rights and Tobacco Control Network is summarised and considers the future directions for the human rights-based approach to tobacco control.

Copyright 2012, BMJ Publishing


Dupont RL; Voas RB; Walsh JM; Shea C; Talpins SK; Neil MM. The need for drugged driving per se laws: A commentary. Traffic Injury Prevention 13(1): 31-42, 2012. (72 refs.)

Objective: Triggered by the new federal commitment announced by the Office of National Drug Control Policy (ONCDP) to encourage states to enact drugged driving per se laws, this article reviews the reasons to establish such laws and the issues that may arise when trying to enforce them. Methods: A review of the state of drunk driving per se laws and their implications for drugged driving is presented, with a review of impaired driving enforcement procedures and drug testing technology. Results: Currently, enforcement of drugged driving laws is an adjunct to the enforcement of laws regarding alcohol impairment. Drivers are apprehended when showing signs of alcohol intoxication and only in the relatively few cases where the blood alcohol concentration of the arrested driver does not account for the observed behavior is the possibility of drug impairment pursued. In most states, the term impaired driving covers both alcohol and drug impairment; thus, driver conviction records may not distinguish between the two different sources of impairment. As a result, enforcement statistics do not reflect the prevalence of drugged driving. Conclusions: Based on the analysis presented, this article recommends a number of steps that can be taken to evaluate current drugged driving enforcement procedures and to move toward the enactment of drug per se laws.

Copyright 2012, Taylor & Francis


Fass JA; Fass AD; Garcia AS. Synthetic cathinones (bath salts): Legal status and patterns of abuse. Annals of Pharmacotherapy 46(3): 436-441, 2012. (36 refs.)

Objective: To review the current legal status and patterns of abuse of bath salts. Data Sources: A literature search was conducted through MEDLINE (1950-December 2011), PubMed (1966-December 2011), EMBASE (1966-December 2011), and International Pharmaceutical Abstracts (1970-December 2011) using the search terms bath salts, mephedrone, and methylenedioxypyrovalerone to identify articles on the legal status of bath salts and on studies focusing on patterns of abuse of bath salts. The GovTrack.us Web site was searched to determine the status of federal bills regarding bath salts. The National Association of Boards of Pharmacy and Drug Enforcement Administration Web sites and the Federal Register were also examined to identify legislation on bath salts. Study Selection And Data Extraction: Case reports and studies regarding bath salts were examined. Federal laws involving bath salts were also evaluated. Data Synthesis: The Department of Justice issued a final order in the Federal Register, temporarily placing the 3 synthetic stimulants, mephedrone, methylenedioxypyrovalerone, and methylone, under Schedule I of the Controlled Substances Act. Literature evaluated included case reports, retrospective studies, surveys, toxicology data, and chemical analyses studies. Information in the literature demonstrated that bath salts are highly abused, and common adverse effects include hypertension, tachycardia, and psychiatric symptoms. Conclusions: Psychoactive substances recently sold as bath salts have been placed in Schedule I of the Controlled Substances Act. Pharmacists can play an important role in raising awareness on the dangers of bath salts abuse through patient counseling and community outreach programs. The evidence on legal status and patterns of abuse clearly demonstrates that bath salts contain dangerous substances that should be permanently controlled.

Copyright 2012, Harvey Whitney Books


Fathallah N; Maurel-Donnarel E; Baumstarck-Barrau K; Lehucher-Michel MP. Three-year follow-up of attitudes and smoking behaviour among hospital nurses following enactment of France's national smoke-free workplace law. International Journal of Nursing Studies 49(7): 803-810, 2012. (43 refs.)

Objective: This study evaluated among hospital nurses the smoking status, knowledge and attitudes regarding smoking cessation services, and smoking behaviour 3 years after the implementation of smoke-free workplace law (decree no. 2006-1386). Methods: A descriptive study was undertaken in a public referral hospital in the South of France. Between February and April 2010, a questionnaire was distributed to the nurses. Data on demographic information, smoking status, behaviour and attitudes regarding smoking addiction, and knowledge regarding smoking cessation services were collected. Changes in nurses' smoking habits were studied through a former study conducted in this hospital a year after the law had come into effect. Results: Three years after the enactment of the smoking ban, 30% (30% in 2008) reported themselves as current smokers, 26% (25% in 2008) as ex-smokers and 44% (45% in 2008) as non-smokers. Among smokers, 72% (68% in 2008) declared they had decreased tobacco consumption during working hours and 50% (29% in 2008) daily cigarette consumption. The majority of nurses (88%) supported the smoke-free law. A higher percentage of smokers than non smokers have knowledge of smoking cessation services. The smoking prevalence among hospital nurses seemed to have remained constant between 2008 and 2010 despite a better compliance with the law. Conclusions: France's national smoke-free workplace law is associated with a reduction in tobacco consumption and exposure to second-hand smoke in nurses but not smoking prevalence. The other measures of the MPOWER package have to be reinforced.

Copyright 2012, Elsevier Science


Ferrara MM. The disparate treatment of addiction-assistance medications and opiate pain medications under the law: Permitting the proliferation of opiates and limiting access to treatment. Seton Hall Law Review 42: 741-767, 2012. (238 legal refs.)

Summary: ... Our legal system, charged with striking a balance between adequate access to pain medications and the prevention and treatment of potentially corresponding drug abuse, has severely restricted access to addiction-assistance medications while, at the same time, has placed much more relaxed limitations on access to opiate pain medications. ... Although the DEA has scheduled methadone and OxyContin identically, and despite the DEA scheduling buprenorphine in a less restrictive schedule than OxyContin, the addiction-assistance medications are subject to dosage restrictions, patient limitations, and special physician registration requirements that do not apply to OxyContin and its prescribers. ... In sum, localities create targeted zoning restrictions that are discriminatory and not based on empirical evidence to impede methadone facilities, governing agencies proffer no evidence of special skills or complexities in methadone treatment to substantiate additional physician registration requirements, and methadone dosage restrictions are draconian. ... Following the recommendation of the Department of Health and Human Services, the DEA classified buprenorphine and the products containing the drug as Schedule III controlled substances. ... Just as pain-management patients deserve access to their medications and should consult practitioners with expertise in their ailment, so too should addicts.

Copyright 2012, Seton Hall University School of Law


Fitzpatrick E. Cochran v. Commonwealth: Revising whether Kentucky should charge, commit, or cure pregnancy substance abusers. University of Louisville Law Review 50(Spring): 551-576, 2012. (213 legal refs.)

Summary: ... Civil Commitment instead of permitting criminal prosecution of drug-abusing pregnant women, three states have enacted legislation which permit involuntary civil commitment of pregnant women who are substance abusers: Minnesota, South Dakota, and Wisconsin. ... Of the three, Minnesota law is the narrowest because its scope is limited to pregnant women who abuse only the drugs listed in the second sentence of the definition of a chemically dependent person: "Chemically dependent person" also means a pregnant woman who has engaged during the pregnancy in habitual or excessive use, for a nonmedical purpose of any of the following controlled substances or their derivatives: opium, cocaine, heroin, phencyclidine, methamphetamine, amphetamine, tetrahydrocannabinol, or alcohol. ... One of the first times the Kentucky General Assembly addressed the problem, it passed the Maternal Health Act of 1992, which provides in part: P unitive actions taken against pregnant alcohol or substance abusers would create additional problems, including discouraging these individuals from seeking the essential prenatal care and substance abuse treatment necessary to deliver a healthy newborn, and WHEREAS, the General Assembly finds it is necessary to treat the problem of alcohol and drug use during pregnancy solely as a public health problem by seeking expanded access to prenatal care and to alcohol and substance abuse education and treatment programs. ... Thus, they argued, the civil commitment statute inappropriately lowers the evidentiary standard by allowing the judge discretion to decide if there is a "substantial risk" of danger to the fetus's health by the woman's "habitual and severe substance abuse," based on equivocal evidence. ... Allocating more funding for these programs, thereby increasing the availability of treatment for these women, will result in the best outcomes for both mothers and children.

Copyright 2012, The University of Louisville


Flacks S. Deviant disabilities: The exclusion of drug and alcohol addiction from the Equality Act 2010. Social and Legal Studies 21(3): 395-412, 2012. (68 refs.)

The Equality Act 2010, in keeping with the Disability Discrimination Act 1995, excludes those identified as drug and alcohol 'addicted' from the scope of provisions prohibiting discrimination against disabled people. This article addresses the significance of, and justification for, this exclusion. It begins with a legislative background to the relevant limitation and subsequently examines its rationale according to prevailing legal, medical and sociological discourses. The article then considers the relevance of the discussion for disability rights. Although 'addiction', or the preferred term, 'substance dependence', is classified as a disability for international systems of disease classification, the relevance of substance dependence for discussion on disability rights, and of disability for discussion on substance dependence, has largely escaped critical comment.

Copyright 2012, Sage Publications


Gieringer D. Practical experience with legalized cannabis. (editorial). Addiction 107(5): 875-876, 2012. (6 refs.)


Glantz SA. Pinocchio shows how to end the tobacco epidemic. (commentary). Tobacco Control 21(2): 296-297, 2012. (32 refs.)

This commentary speaks to the possibilities for ending the epidemic of smoking, and idea which was unimaginable when this journal was introudced 20 years ago. The author cites a variety of ways in which this might be accomplished. The Pinocchio reference becomes clear at the close of the commentary. "In early 2011, a friend showed her 2 and a half-year-old granddaughter Walt Disney's 1940 Pinocchio, a cartoon filled with smoking. The little girl did not know what the characters were doing. She had to have it explained. That would not have happened in 1992."

Copyright 2012, Project Cork


Glynn TJ. The tobacco industry is not a 'normal' business, so let us stop treating it that way: Invited commentary. (editorial). Tobacco Control 21(2): 170-171, 2012. (1 refs.)


Gonzalez M; Green LW; Glantz SA. Through tobacco industry eyes: Civil society and the FCTC process from Philip Morris and British American Tobacco's perspectives. Tobacco Control 21(4): e-article 1, 2012. (161 refs.)

Objective: To analyse the models Philip Morris (PM) and British American Tobacco (BAT) used internally to understand tobacco control non-governmental organizations (NGOs) and their relationship to the global tobacco control policy-making process that resulted in the Framework Convention for Tobacco Control (FCTC). Methods: Analysis of internal tobacco industry documents in the Legacy Tobacco Document Library. Results: PM contracted with Mongoven, Biscoe, and Duchin, Inc. (MBD, a consulting firm specialising in NGO surveillance) as advisors. MBD argued that because NGOs are increasingly linked to epistemic communities, NGOs could insert themselves into the global policy-making process and influence the discourse surrounding the treaty-making process. MBD advised PM to insert itself into the policy-making process, mimicking NGO behaviour. BAT's Consumer and Regulatory Affairs (CORA) department argued that global regulation emerged from the perception (by NGOs and governments) that the industry could not regulate itself, leading to BAT advocating social alignment and self-regulation to minimise the impact of the FCTC. Most efforts to block or redirect the FCTC failed. Conclusions: PM and BAT articulated a global policy-making environment in which NGOs are key, non-state stakeholders, and as a result, internationalised some of their previous national-level strategies. After both companies failed to prevent the FCTC, their strategies began to align. Multinational corporations have continued to successfully employ some of the strategies outlined in this paper at the local and national level while being formally excluded from ongoing FCTC negotiations at the global level.

Copyright 2012, BMJ Publishing Group


Gruning T; Weishaar H; Collin J; Gilmore AB. Tobacco industry attempts to influence and use the German government to undermine the WHO Framework Convention on Tobacco Control. Tobacco Control 21(1): 30-38, 2012. (114 refs.)

Background: Germany has been identified as one of a few high-income countries that opposed a strong Framework Convention on Tobacco Control (FCTC), the WHO's first global public health treaty. This paper examines whether the tobacco industry had influenced the German position on the FCTC. Methods: Analysis of previously confidential tobacco industry documents. Results: The tobacco industry has identified Germany as a key target within its global strategy against the FCTC. Building on an already supportive base, the industry appears to have successfully lobbied the German government, influencing Germany's position and argumentation on key aspects of the FCTC. It then used Germany in its efforts to weaken the FCTC. The evidence suggests that the industry enjoyed success in undermining the Federal Health Ministry's position and using Germany to limit the European Union negotiating mandate. The tactics used by the tobacco industry included the creation of controversy between the financial, trade and other ministries on one side and the health ministry on the other side, the use of business associations and other front groups to lobby on the industry's behalf and securing industry access to the FCTC negotiations via the International Standardization Organization. Conclusion: The evidence suggests that Germany played a major role in the tobacco industry's efforts to undermine the FCTC. Germany's position consistently served to protect industry interests and was used to influence and constrain other countries. Germany thus contributed significantly to attempts to weaken an international treaty and, in doing so, failed in its responsibility to advance global health.

Copyright 2012, BMJ Publishing


Guerrero EG. Organizational characteristics that foster early adoption of cultural and linguistic competence in outpatient substance abuse treatment in the United States. Evaluation and Program Planning 35(1): 9-15, 2012. (55 refs.)

Recent years have seen an increased interest in developing culturally and linguistically responsive systems of care in substance abuse treatment in the United States. This study examines the extent to which external and internal organizational pressures contributed to the degree of adoption of culturally and linguistically responsive practices in the nation's outpatient substance abuse treatment system early in the period of development of this system of care. Findings show that a higher degree of adoption of culturally competent practices was most likely in treatment programs with high dependence on external funding and regulation. Internally, programs with a larger number of professionals were associated with the lowest degree of adoption, while managers' cultural sensitivity contributed significantly to a high degree of adoption of these responsive practices. Considering the passage of recent legislation enforcing the use of cultural and linguistic competence in health care, implications of these baseline findings on early adoption patterns are discussed for future research and health care policy evaluation.

Copyright 2012, Elsevier Science


Hammond D. Tobacco packaging and labeling policies under the US Tobacco Control Act: Research needs and priorities. Nicotine & Tobacco Research 14(1): 62-74, 2012. (120 refs.)

Introduction: The Family Smoking Prevention and Tobacco Control Act (the "Act"), enacted in June 2009, gave the U. S. Food and Drug Administration authority to regulate tobacco products. The current paper reviews the provisions for packaging and labeling, including the existing evidence and research priorities. Methods: Narrative review using electronic literature search of published and unpublished sources in 3 primary areas: health warnings, constituent labeling, and prohibitions on the promotional elements of packaging. Results: The Act requires 9 pictorial health warnings covering half of cigarette packages and 4 text warnings covering 30% of smokeless tobacco packages. The Act also prohibits potentially misleading information on packaging, including the terms "light" and "mild," and provides a mandate to require disclosure of chemical constituents on packages. Many of the specific regulatory provisions are based on the extent to which they promote " greater public understanding of the risks of tobacco." As a result, research on consumer perceptions has the potential to shape the design and renewal of health warnings and to determine what, if any, information on product constituents should appear on packages. Research on consumer perceptions of existing and novel tobacco products will also be critical to help identify potentially misleading information that should be restricted under the Act. Conclusion: Packaging and labeling regulations required under the Act will bring the United States in line with international standards. There is an immediate need for research to evaluate these measures to guide future regulatory action.

Copyright 2012, Oxford University Press


Harper S; Strumpf EC; Kaufman JS. Do medical marijuana laws increase marijuana use? Replication study and extension. Annals of Epidemiology 22(3): 207-212, 2012. (17 refs.)

PURPOSE: To replicate a prior study that found greater adolescent marijuana use in states that have passed medical marijuana laws (MMLs), and extend this analysis by accounting for confounding by unmeasured state characteristics and measurement error. METHODS: We obtained state-level estimates of marijuana use from the 2002 through 2009 National Survey on Drug Use and Health. We used 2-sample t-tests and random-effects regression to replicate previous results. We used difference-in-differences regression models to estimate the causal effect of MMLs on marijuana use, and simulations to account for measurement error. RESULTS: We replicated previously published results showing higher marijuana use in states with MMLs. Difference-in-differences estimates suggested that passing MMLs decreased past-month use among adolescents by 0.53 percentage points (95% confidence interval [CI], 0.03-1.02) and had no discernible effect on the perceived riskiness of monthly use. Models incorporating measurement error in the state estimates of marijuana use yielded little evidence that passing MMLs affects marijuana use. CONCLUSIONS: Accounting for confounding by unmeasured state characteristics and measurement error had an important effect on estimates of the impact of MMLs on marijuana use. We find limited evidence of causal effects of MMLs on measures of reported marijuana use.

Copyright 2012, Elsevier Science


Harris JK; Carothers BJ; Luke DA; Silmere H; McBride TD; Pion M. Exempting casinos from the Smoke-free Illinois Act will not bring patrons back: They never left. Tobacco Control 21(3): 373-376, 2012. (34 refs.)

Objective: The Smoke-free Illinois Act was implemented in January 2008, one month after the beginning of a national recession. In December 2010, the Illinois legislature proposed new legislation that would provide an exemption for casinos from the act until neighbouring states also implement smoke-free casino policies. Lobbyists and gaming commission representatives argued that Illinois casinos were losing patrons to casinos in neighbouring states that allow smoking. This study examined the influence of the act on casino admissions in Illinois and neighbouring states in light of the economy. Methods: A multilevel model was developed to examine monthly casino admissions from January 2007 to December 2008. Results: There was no difference in changes in admissions across the four states over time after accounting for the economic downturn. Conclusions: The Smoke-Free Illinois Act did not have a detectable effect on Illinois casino admissions.

Copyright 2012, BMJ Publishing


Hatsukami DK; Biener L; Leischow SJ; Zeller MR. Tobacco and nicotine product testing. (review). Nicotine & Tobacco Research 14(1): 7-17, 2012. (58 refs.)

Introduction: Tobacco product testing is a critical component of the Family Smoking Prevention and Tobacco Control Act (FSPTCA), which grants the Food and Drug Administration the authority to regulate tobacco products. The availability of methods and measures that can provide accurate data on the relative health risks across types of tobacco products, brands, and subbrands of tobacco products, on the validity of any health claims associated with a product, and on how consumers perceive information on products, toxicity or risks is crucial for making decisions on the product's potential impact on public health. These tools are also necessary for making assessments of the impact of new indications for medicinal products (other than cessation) but more importantly of tobacco products that may in the future be marketed as cessation tools. Objective: To identify research opportunities to develop empirically based and comprehensive methods and measures for testing tobacco and other nicotine-containing products so that the best science is available when decisions are made about products or policies. Methods: Literature was reviewed to address sections of the FSPTCA relevant to tobacco product evaluation; research questions were generated and then reviewed by a committee of research experts. Results: A research agenda was developed for tobacco product evaluation in the general areas of toxicity and health risks, abuse liability, consumer perception, and population effects. Conclusion: A cohesive, systematic, and comprehensive assessment of tobacco products is important and will require building consensus and addressing some crucial research questions.

Copyright 2012, Oxford University Press


Hecht SS. Research opportunities related to establishing standards for tobacco products under the Family Smoking Prevention and Tobacco Control Act. (editorial). Nicotine & Tobacco Research 14(1): 18-28, 2012. (50 refs.)

Introduction: This paper was written in response to a request from the U. S. National Cancer Institute. The goal is to discuss some research directions related to establishing tobacco product standards under the Family Smoking Prevention and Tobacco Control Act, which empowers the U. S. Food and Drug Administration to regulate tobacco products. Potential research related to tobacco product ingredients, nicotine, and harmful or potentially harmful constituents of tobacco products is discussed. Discussion: Ingredients, which are additives, require less attention than nicotine and harmful or potentially harmful constituents. With respect to nicotine, the threshold level in tobacco products below which dependent users will be able to freely stop using the product if they choose to do so is a very important question. Harmful and potentially harmful constituents include various toxicants and carcinogens. An updated list of 72 carcinogens in cigarette smoke is presented. A crucial question is the appropriate levels of toxicants and carcinogens in tobacco products. The use of carcinogen and toxicant biomarkers to determine these levels is discussed. Conclusions: The need to establish regulatory standards for added ingredients, nicotine, and other tobacco and tobacco smoke constituents leads to many interesting and potentially highly significant research questions, which urgently need to be addressed.

Copyright 2012, Oxford University Press


Henriksen L. Comprehensive tobacco marketing restrictions: Promotion, packaging, price and place. (review). Tobacco Control 21(2): 147-153, 2012. (91 refs.)

Evidence of the causal role of marketing in the tobacco epidemic and the advent of the WHO Framework Convention on Tobacco Control have inspired more than half the countries in the world to ban some forms of tobacco marketing. This paper briefly describes the ways in which cigarette marketing is restricted and the tobacco industry's efforts to subvert restrictions. It reviews what is known about the impact of marketing regulations on smoking by adults and adolescents. It also addresses what little is known about the impact of marketing bans in relation to concurrent population-level interventions, such as price controls, anti-tobacco media campaigns and smoke-free laws. Point of sale is the least regulated channel and research is needed to address the immediate and long-term consequences of policies to ban retail advertising and pack displays. Comprehensive marketing restrictions require a global ban on all forms of promotion, elimination of packaging and price as marketing tools, and limitations on the quantity, type and location of tobacco retailers.

Copyright 2012, BMJ Publishing


Homenko H. Rehabilitating opioid regulation: A prescription for the FDA's next proposal of an opioid risk evaluation and mitigation strategy (REMS). Health Matrix: Journal of Law Medicine 22: 273-313, 2012. (231 legal refs.)

This Note explores current opioid-related drug problems in the United States and makes recommendations for how the FDA should proceed with developing an opioid REMS. Part I of this Note discusses the current problems associated with opioids, including (1) misuse and abuse, (2) drug diversion, and (3) under-treatment of chronic and acute pain. Part II explains the FDA's authority before and after Congress enacted the FDAAA, specifically describing the new three-tiered regulatory strategy that the FDA can employ to regulate drugs after the approval process. Part II also explains the benefits of having a general opioid REMS, which include improved efficiency of the FDA's drug approval process and increased manufacturer compliance with REMS requirements. Part III identifies why both the initial opioid REMS proposal and the FDAAA fell short of addressing the problems discussed in Part I. Finally, Part IV recommends that the next opioid REMS proposal contain a mandatory training program, funded by manufacturers, for the purpose of educating doctors about the risks of prescribing opioids. Part IV will also outline an approach for improving opioid regulation outside of REMS by encouraging FDA collaboration with the states, since state medical boards have the authority to directly regulate doctors who prescribe opioids. Through reater collaboration with regulatory agencies at the state level, the FDA can successfully reduce opioid risks without sacrificing the availability of chronicand acute pain relief.

Copyright 2012, Case Western Reserve University


Hughes CE; Stevens A. A resounding success or a disastrous failure: Re-examining the interpretation of evidence on the Portuguese decriminalization of illicit drugs. Drug and Alcohol Review 31(1): 101-113, 2012. (59 refs.)

In this Harm Reduction Digest two observers and scholars of the 2001 Portuguese drug policy reform consider divergent accounts of the reform which viewed it as a resounding success or a disastrous failure. Acknowledging from their own experience the inherent difficulties in studying drug law reform, Caitlin Hughes and Alex Stevens take the central competing claims of the protagonists and consider them against the available data. They remind us of the way all sides of the drug policy debates call upon and alternatively use or misuse evidence to feed into discussions of the worth, efficacy and desirability of different illicit drug policies. In doing so they provide pause for thought for those of us who operate as drug policy researchers and drug policy advocates.

Copyright 2012, Wiley-Blackwell


Hunter S; Douard J; Green S; Bembry L. New Jersey's drug courts: A fundamental shift from the war on drugs to a public health approach for drug addiction and drug-related crime. Rutgers Law Review 64(Spring): 795-833, 2012. (306 legal refs.)

Summary: ... We now suggest that, because drug courts address drug addiction as a disease that has a powerful impact on the public's health, New Jersey should also be in the forefront of framing drug offenses as a public health problem. ... When enacting the Comprehensive Drug Reform Act of 1986 hereinafter CDRA the Legislature declared it to be public policy to provide for the strict punishment, deterrence and incapacitation of the most culpable and dangerous drug offenders, and to facilitate where feasible the rehabilitation of drug dependent persons so as ultimately to reduce the demand for illegal controlled dangerous substances and the incidence of drug-related crime. ... It is also the policy of this State to afford special protection to children from the perils of drug trafficking, to ensure that all schools and areas adjacent to schools are kept free from drug distribution activities, and to provide especially stern punishment for those drug offenders who operate on or near schools and school buses, who distribute to juveniles, or who employ juveniles in a drug distribution scheme. ... The mandatory incarceration provision of the school zone law simply did not distinguish between major drug traffickers, a student handing a CDS pipe to another in a dorm room, or a drug addict who may actually want help to end the cycle of addiction. ... In 1997, the National Association of Drug Court Professionals ("NADCP") defined drug courts as having the following ten key components: 1. Drug courts integrate alcohol and other drug treatment services with justice system case processing ... . 2. Using a nonadversarial approach, prosecution and defense counsel promote public safety while protecting participants' due process rights ... . 3. Eligible participants are identified early and promptly placed in the drug court program ... . 4. Drug courts provide access to a continuum of alcohol, drug, and other related treatment and rehabilitation services ... . 5. Abstinence is monitored by frequent alcohol and other drug testing ... . 6. A coordinated strategy governs drug court responses to participants' compliance ... . 7. Ongoing judicial interaction with each drug court participant is essential ... . 8. Monitoring and evaluation measure the achievement of program goals and gauge effectiveness ... . 9. Continuing interdisciplinary education promotes effective drug court planning, implementation, and operations ... . 10 Forging partnerships among drug courts, public agencies, and community-based organizations generates local support and enhances drug court program effectiveness. ... Relying specifically on Matthews, the prosecutor argued that Meyer could not be admitted to drug court without meeting all the requirements of the special probation statute. ... The court additionally endorsed the Manual's interpretation of the sentencing laws and its two-track admission format for drug court, finding that the special probation statute was not intended to govern drug court, but rather was a sentencing option available for individuals who could not be sentenced to drug court under the general sentencing laws. ... In his evaluation, "the evaluator noted that there was a high likelihood that Clarke would relapse to the use of drugs without close outpatient monitoring and structured therapeutic services." ... If we construe drug courts as public health measures, drug courts as a form of therapeutic jurisprudence are compatible with a strong commitment to protection of the due process rights of defendants. ... Strengthen Drug Courts' Community Partnerships A public health model of drug court emphasizes both the treatment resources available to defendants admitted to drug court and the ancillary services available in the communities where defendants live: employment, housing, religious institutions, and other social resources.

Copyright 2012, Rutgers University, The State University of New Jersey


Jarvis MJ; Sims M; Gilmore A; Mindell J. Impact of smoke-free legislation on children's exposure to secondhand smoke: Cotinine data from the Health Survey for England. Tobacco Control 21(1): 18-23, 2012. (21 refs.)

Objective: To examine the impact of the ban on smoking in enclosed public places implemented in England in July 2007 on children's exposure to secondhand tobacco smoke. Design Repeated cross-sectional surveys of the general population in England. Setting: The Health Survey for England. Participants: Confirmed non-smoking children aged 4-15 with measured saliva cotinine participating in surveys from 1998 to 2008, a total of 10 825 children across years. Main outcome measures: The proportion of children living in homes reported to be smoke-free; the proportion of children with undetectable concentrations of cotinine; geometric mean cotinine as an objective indicator of overall exposure. Results: Significantly more children with smoking parents lived in smoke-free homes in 2008 (48.1%, 95% CI 43.0% to 53.1%) than in either 2006 (35.5%, 95% CI 29.7% to 41.7%) or the first 6 months of 2007, immediately before the ban came into effect (30.5%, 95% CI 19.7% to 43.9%). A total of 41.1% (95% CI 38.9% to 43.4%) of children had undetectable cotinine in 2008, up from 34.0% (95% CI 30.8% to 37.3%) in 2006. Geometric mean cotinine in all children combined was 0.21 ng/ml (95% CI 0.20 to 0.23) in 2008, slightly lower than in 2006, 0.24 ng/ml (95% CI 0.21 to 0.26). Conclusions: Predictions that the 2007 legislative ban on smoking in enclosed public places would adversely affect children's exposure to tobacco smoke were not confirmed. While overall exposure in children has not been greatly affected by the ban, the trend towards the adoption of smoke-free homes by parents who themselves smoke has received fresh impetus.

Copyright 2012, BMJ Publishing


Johnson MB; Kelley-Baker T; Voas RB; Lacey JH. The prevalence of cannabis-involved driving in California. Drug and Alcohol Dependence 123(1-3): 105-109, 2012. (19 refs.)

Background: Various national surveys suggest that cannabis use is rising nationally and many States have passed legislation that has potential to increase usage even further. This presents a problem for public roadways, as research suggests that cannabis impairs driving ability. Methods: Anonymous oral fluid samples and breath tests were obtained from more than 900 weekend nighttime drivers randomly sampled from six jurisdictions in California. Oral fluid samples were assayed for the presence of Schedule I drugs. Drivers also completed information on self-reported drug use and possession of a medical cannabis permit. Data from the 2007 National Roadside Survey (collected using comparable methods) were used as a comparison. Results: Using the 2010 data, a total of 14.4% of weekend nighttime drivers tested positive for illegal drugs, with 8.5% testing positive for delta-9-tetrahydrocannabinol (THC). THC-positive rates varied considerably among jurisdictions, from a low of 4.3% in Fresno to a high of 18.3% in Eureka. A comparison with the 2007 NRS data found an increase in THC-positive drivers in 2010, but no increase in illegal drugs other than cannabis. Drivers who reported having a medical cannabis permit were significantly more likely to test positive for THC. Conclusions: Cannabis-involved driving has increased in California since 2007. Nearly 1-in-10 weekend, nighttime drivers tested positive for THC, and in some jurisdictions, the rate was nearly 1-in-5. The possible contribution of cannabis legislation, such as decriminalization and medical cannabis usage, is discussed.

Copyright 2012, Elsevier Science


Kazanga I; Tameni S; Piccinotti A; Floris I; Zanchetti G; Polettini A. Prevalence of drug abuse among workers: Strengths and pitfalls of the recent Italian Workplace Drug Testing (WDT) legislation. Forensic Science International 215(1-3): 46-50, 2012. (22 refs.)

Background: In 2008 a Workplace Drug Testing (WDT) law became effective in Italy for workers involved in public/private transportation, oil/gas companies, and explosives/fireworks industry with the aim to ensure public safety for the community. Aims: To examine and elaborate WDT data collected on a large group of workers (over 43, 500) during March 2009-February 2010 in order to highlight pros and cons and to draw suggestions for policies in the field. Setting: Northern Italy. Methods: After <= 24 h notification, workers provided a urine sample screened for opiates, methadone, buprenorphine, cocaine, amphetamines, ecstasy, and cannabinoids (THC) by immunoassay. Positives were confirmed by GC-MS. Results: The positive rate was 2.0%, THC being most frequent drug (1.3%; cocaine, 0.4%; opioids, 0.3%). 6.9% of the positive workers tested positive for >= 2 classes (most often THC + cocaine). Gender ratio and mean age were significantly lower in positives (F/M = 0.007; 35.5 +/- 8.3 years) than negatives (0.016 and 40.7 + 9.5, respectively). No decline in rates of positives and an increase of diluted samples over time were observed. The highest rates of positives were detected when sampling was performed just before/after weekend and during morning hours. Possible correlation between job type and drugs used were observed (e.g. more cocaine positives among road vehicle-drivers than among lift truck-drivers). Declared use of medicine/illicit drugs during the preceding week showed that illicit drug use was likely not always detected in urine and that almost 4% workers declared use of medicine drugs possibly affecting performance. Conclusions: This survey enabled to evidence relevant pitfalls of the law and to define strategies to improve the outcomes of WDT policies.

Copyright 2012, Elsevier Science


Kreiner ER. Whose applicable guideline range is it anyway? Examining whether nominal career offenders can receive sentence modifications based on retroactive reductions in the crack cocaine guidelines. Columbia Law Review 112(4): 870-911, 2012. (6 refs.)

The recent reductions in the guideline range for federal crack cocaine offenses have spurred tens of thousands of motions for sentence modifications under 18 U.S.C. 3582(c)(2) by individuals sentenced pursuant to the old, harsher crack cocaine guidelines. This deluge of 3582(c)(2) motions has forced courts to grapple with difficult eligibility questions far many defendants whose sentences were impacted by the old crack cocaine guidelines. These eligibility questions revolve around the requirement that amendments to the United States Sentencing Guidelines ("Guidelines") reduce a defendant's "applicable guideline range" in order to qualify for a retroactive sentence modification. This Note examines a circuit split regarding the eligibility for 3582(c)(2) sentence modifications of "nominal career offenders"-defendants who were subject to the increased penalties of the Guidelines' career offender provision, but received sentences within the crack cocaine guideline range because career offender status significantly overstated the seriousness of their criminal history. After examining this complex circuit split, this Note argues that nominal career offenders are not eligible for 3582(c)(2) sentence modifications because their applicable guideline range is the career of range, not the crack cocaine range.

Copyright 2012, Columbia Journal Transnational Law Association


Labate BC; Feeney K. Ayahuasca and the process of regulation in Brazil and internationally: Implications and challenges. International Journal of Drug Policy 23(2): 154-161, 2012. (56 refs.)

Background: This paper provides a summary and analysis of the regulation of ayahuasca in Brazil, from its prohibition in the mid-eighties to the recent adoption of CONAD's (Conselho Nacional de Politicas sobre Drogas) 2010 Resolution, which established a set of rules, norms and ethical principles to be applied to religious and ritual uses of ayahuasca. Brazil's regulatory process is used as a starting point to explore emerging international regulatory themes as various nations respond to the global expansion of the Santo Daime and UDV (Uniao do Vegetal) ayahuasca religions. Methods: The text reviews the primary legislative and court documents, academic literature, as well as solicited expert opinions. Results: Three prominent themes have emerged internationally. The first concerns the scope of international treaties regarding plant-based psychoactive substances, as well as the responsibilities of individual nations to adhere to said treaties. The second concerns the scope of religious liberty and how to determine religious legitimacy. The final theme addresses the potential dangers of ayahuasca to health and public safety. Conclusion: Over the past 20 years the Brazilian ayahuasca religions have established a global presence, with congregations in the USA, Canada, Japan, South Africa, Australia, and throughout Europe and Latin America. As a result, many nations are faced with the predicament of balancing the interests of these religious minorities with the international "war on drugs." The regulatory process applied in Brazil exemplifies a progressive approach, one which considered issues of anthropology and involved representatives of ayahuasca religions, and which provided a degree of deference to the principle of religious liberty. The Brazilian process has influenced judicial and administrative decisions internationally, and stands as a model worthy of further consideration.

Copyright 2012, Elsevier Science


Lawrence JR, III. "Let Us Now Try Liberty": Freeing the private sector to tackle North Carolina's tobacco addiction by reinstating employment freedom of contract. North Carolina Law Review 90(January): 511-550, 2012. (179 legal refs.)

Summary: ... It maintains that the Smoker's Protection Act is an affront to freedom of contract in the labor market, that it unjustifiably limits the ability of North Carolina firms to pursue health and wellness programs, and that it gives tobacco addiction the support of North Carolina law. ... As a self-insured firm, Scotts could (1) continue to try to absorb the costs of rising health insurance premiums at the risk of compromising its competitive position in the marketplace, (2) require employees to make an increased contribution to their health insurance premium, or (3) attempt to make Scotts's workforce a more attractive, low-risk pool of employees to insure by pursuing a health and wellness program with the goal of limiting the cost of unhealthy lifestyle choices. ... Table 2: Financial Impact of Smoking on an Averaged- Sized North Carolina Firm (Costs Indexed to Rate of Rising Health Care Costs) Average annual cost of smoking per employee (adjusted for $ 6,791.82 rising health care costs in 2011 USD) Average size of a North Carolina employer (number of workers) 20 Estimated percentage of North Carolinians who smoke 20% cigarettes Average number of North Carolina employees who smoke per firm 4 Average annual cost of smoking to North Carolina employers $ 27,167.28 (adjusted for rising health care costs in 2011 USD) Table 1 and Table 2 together suggest that employees who use tobacco impose approximately $ 18,000 to $ 27,000 in additional costs on average-sized North Carolina firms. ... As these North Carolina employers implemented discriminatory policies against tobacco users, the North Carolina General Assembly began to look at anti-discrimination employment laws more generally. ... The Act shields cigarette smokers from North Carolina's traditional at-will employment doctrine by placing smokers in a protected class and making firings based on the "lawful use of lawful products" an illegal employment practice. ... If a bold, enterprising North Carolina firm were to challenge the Smoker's Protection Act under the fundamental objectives exception, it would have to demonstrate that limits on tobacco use relate to the firm's objectives.

Copyright 2012, North Carolina Law Review Association


Lewy J. Limited to no responsibility: Addiction, alcoholism and the law in modern Germany. History of Psychiatry 23(2): 169-181, 2012. (46 refs.)

In Germany, a perpetrator had to be of sound mind to be convicted of a crime throughout the nineteenth and twentieth centuries. The criminal code was clear, but reality was not. From the moment that physicians accepted alcoholism and drug addiction as diseases of mind and body, the question of what to do with alcoholic and addicted criminals troubled legal theorists. How were judges to maintain the balance of justice if, on the one hand, a potential perpetrator chose to be of unsound mind by drinking or using drugs, but on the other, he was sick, unable to control his actions? As this article demonstrates, the legal system was lenient towards inebriated perpetrators as a by-product of the insistence of German doctors that alcoholism and addiction were diseases.

Copyright 2012, Sage Publications


Liberman J. Four COPs and counting: Achievements, underachievements and looming challenges in the early life of the WHO FCTC Conference of the Parties. Tobacco Control 21(2): 215-220, 2012. (35 refs.)

As the governing body of the WHO Framework Convention on Tobacco Control (FCTC), the Conference of the Parties (COP) is mandated to 'keep under regular review the implementation of the Convention and take the decisions necessary to promote its effective implementation'. The COP has a range of critical roles to play spanning the setting of normative standards, the building and dissemination of knowledge, the monitoring of implementation, the facilitation of international cooperation and the mobilisation of resources to support implementation. The COP has met four times to date. It has made significant achievements in the setting of normative standards, with the adoption of a number of high-standard implementation guidelines and a declaration recording the commitment of Parties to prioritise the implementation of health measures in the context of concerns about the effect of international trade and investment obligations. Less progress has been made in other areas, including a general lack of support for the conduct of needs assessments by developing countries -- though needs assessments have been designated as a prerequisite to the mobilisation of funding support -- and a reluctance to consider the adoption of a robust system of implementation review. Much remains to be done to build the FCTC's implementation support structure. Other looming challenges include maintaining the voice and influence of developing countries against priorities being overly dictated by wealthier Parties and in the face of recent cutbacks to travel support pushed by the European Union, and managing the likely resource demands and other risks of the proposed illicit trade protocol.

Copyright 2012, BMJ Publishing


Lopez MJ; Nebot M; Schiaffino A; Perez-Rios M; Fu M; Ariza C et al. Two-year impact of the Spanish smoking law on exposure to secondhand smoke: Evidence of the failure of the 'Spanish model'. Tobacco Control 21(4): 407-411, 2012. (28 refs.)

Objective: Studies evaluating the long-term impact of smoking laws on secondhand smoke (SHS) exposure using airborne markers are scarce. This study aimed to assess the long-term impact of the Spanish smoking law on SHS levels, using a specific and objective marker. Methods: Follow-up study, measuring vapour-phase nicotine levels before the implementation of the law and 6, 12 and 24 months after the initial assessment. A total of 443 samples were taken at baseline in eight different regions in offices in the public administration, private sector, universities and hospitality venues. Results: Two years after the law was implemented, the nicotine concentration decreased by a minimum of 60% in public administration, university and private sector offices, as well as in venues where smoking was totally banned. However, nicotine levels significantly increased by 40% in hospitality venues allowing smoking. No significant differences were found in hospitality venues with areas for smokers and non-smokers or in pubs and discotheques. Conclusions: Two years after the smoking law came into force, levels of SHS exposure in the workplace were significantly lower than before the law was implemented. Importantly, however, SHS levels were even higher than before the law was implemented in venues still allowing smoking. The data obtained in this study clearly show that the 'Spanish model' is not protecting the health of hospitality workers and that a complete ban is required. Furthermore, this study highlights the importance of long-term monitoring of compliance with smoking laws over time.

Copyright 2012, BMJ Publishing Group


Lyons RA. Florida's disregard of due process rights for nearly a decade: Treating drug possession as a strick liability crime. St. Thomas Law Review 24(Spring): 350-381, 2012. (206 legal refs.)

Summary ... Oedipus is held strictly liable for the murder of his father and incestuous relations with his mother without any inquiry into his mens rea. ... As public welfare offenses gained momentum, courts became progressively confused as to when a public welfare offense is permissible and not overreaching and when mens rea should be a fundamental requirement for federal crimes adopted from the common law. ... Florida's Drug Abuse Prevention and Control Law -- Since the issue of mens rea and strict liability crimes has yet to be resolved by the United States Supreme Court, it comes as no surprise that state criminal statutes lacking the element of mens rea are constantly challenged as unconstitutional. ... The Element of Mens Rea in Section 893.13 Florida's Drug Abuse Prevention and Control Law, Florida Statutes, section 893.13 provides, inter alia: (6) (a) It is unlawful for any person to be in actual or constructive possession of a controlled substance unless such controlled substance was lawfully obtained from a practitioner or pursuant to a valid prescription... . ... For example, since Shelton, Judge Milton Hirsch, from the Eleventh Judicial Circuit of Florida, dismissed forty-two drug possession cases and Judge Scott Brownell, from the Twelfth Judicial Circuit, dismissed forty-two drug possession cases. ... The State in Shelton argued that Morissette and Staples did not apply the Due Process Clause of the United States Constitution, in relation to strict liability offenses.

Copyright 2012, St. Thomas Law Review


Mackay DF; Nelson SM; Haw SJ; Pell JP. Impact of Scotland's smoke-free legislation on pregnancy complications: Retrospective cohort study. PLoS Medicine 9(3): e-article 1001175, 2012. (28 refs.)

Background: Both active smoking and environmental tobacco smoke exposure are associated with pregnancy complications. In March 2006, Scotland implemented legislation prohibiting smoking in all wholly or partially enclosed public spaces. The aim of this study was to determine the impact of this legislation on preterm delivery and small for gestational age. Methods and Findings: We conducted logistic regression analyses using national administrative pregnancy data covering the whole of Scotland. Of the two breakpoints tested, 1 January 2006 produced a better fit than the date when the legislation came into force (26 March 2006), suggesting an anticipatory effect. Among the 716,941 eligible women who conceived between August 1995 and February 2009 and subsequently delivered a live-born, singleton infant between 24 and 44 wk gestation, the prevalence of current smoking fell from 25.4% before legislation to 18.8% after legislation (p<0.001). Three months prior to the legislation, there were significant decreases in small for gestational age (-4.52%, 95% CI -8.28, -0.60, p = 0.024), overall preterm delivery (-11.72%, 95% CI -15.87, -7.35, p<0.001), and spontaneous preterm labour (-11.35%, 95% CI -17.20, -5.09, p = 0.001). In sub-group analyses, significant reductions were observed among both current and never smokers. Conclusions: Reductions were observed in the risk of preterm delivery and small for gestational age 3 mo prior to the introduction of legislation, although the former reversed partially following the legislation. There is growing evidence of the potential for tobacco control legislation to have a positive impact on health.

Copyright 2012, Public Library Science


Mark TL; Vandivort-Warren R; Miller K. Mental health spending by private insurance: Implications for the Mental Health Parity and Addiction Equity Act. Psychiatric Services 63(4): 313-318, 2012. (12 refs.)

Objective: The study developed information on behavioral health spending and utilization that can be used to anticipate, evaluate, and interpret changes in health care spending following implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA). Methods: Data were from the Thomson Reuters' Market Scan database of insurance claims between 2001 and 2009 from large group health plans sponsored by self-insured employers. Annual rates in growth of total health spending and behavioral health spending and the contribution of behavioral health spending; to growth in spending for all diseases were determined. Separate analyses examined behavioral health and total health spending by 135 employers in 2008 and 2009, and simulations were conducted to determine how increases in use of mental health services after implementation of parity would affect overall health care expenditures. Results: Across the nine years examined, behavioral health expenditures contributed .3%, on average, to the total rate of growth in all health expenditures, a contribution that fell to .1%, on average, when prescription drugs were excluded. About 2% of employers experienced an increased contribution by behavioral health spending of more than 1%. More than 90% of enrollees used well below the maximum 30 inpatient days or outpatient visits typical of health insurance plans before parity. Simulations indicated that even large increases in utilization would increase total health care expenditures by less than 1%. Conclusions: The MHPAEA is unlikely to have a large effect on the growth rate of employers' health care expenditures. The data provide baseline information to further evaluate the implementation effect of the MHPAEA.

Copyright 2012, American Psychiatric Association


Marsh L; Gray A; McGee R; Newcombe R; Patterson R. Access to cigarettes by young New Zealand smokers: Little change from 2000 to 2008. Australian and New Zealand Journal of Public Health 36(5): 415-420, 2012. (39 refs.)

Objective: To examine trends in young New Zealanders access to cigarettes from 2002 to 2008. Methods: Self-reports of young smokers commercial sources of cigarettes, requests for proof of age and being refused a sale, and the amount spent on cigarettes, were analysed from the 2002 and 2004 Youth Lifestyles Surveys and 2006 and 2008 Year in-depth Surveys of 14 to 15 year olds in New Zealand (NZ). Results: Most young smokers obtain cigarettes through non-commercial sources; however, one-third bought their cigarettes from shops in 2008, with no evidence of a change in proportions purchasing from major retail outlets since 2000. Few young smokers were asked to show proof of age when purchasing cigarettes, with no evidence over time of more young smokers being asked for proof of age, but reports of being refused the sale of cigarettes decreased from 2000. Participants reporting being asked for proof of age had nearly six times the odds of being refused sale. The amount spent on cigarettes did not change over the study period. Conclusion: Many young smokers continue to purchase cigarettes from commercial outlets, with no evidence of change in purchasing from major outlets such as dairies, service stations, supermarkets or liquor stores since 2000. The fact that few young smokers reported being asked to show proof of age suggests the need for stronger measures to ensure that retailers comply with New Zealand legislation regarding under-age sales of tobacco. Implications: With an infringement notice scheme being implemented and tobacco price rises, there may be an increase in accessing cigarettes through social sources. It remains important to monitor commercial tobacco sales to young people to determine the efficacy of policy change.

Copyright 2012, Wiley-Blackwell


McConnell KJ; Gast SHN; Ridge MS; Wallace N; Jacuzzi N; Rieckmann T et al. Behavioral health insurance parity: Does Oregon's experience presage the national experience with the Mental Health Parity and Addiction Equity Act? American Journal of Psychiatry 169(1): 31-38, 2012. (20 refs.)

Objective: The Mental Health Parity and Addiction Equity Act of 2008 prohibits commercial group health plans from imposing spending and visit limitations for mental health and substance abuse services that are not imposed on medical-surgical services. The act also restricts the use of managed care tools that apply to behavioral health benefits in ways that differ from how they apply to medical-surgical benefits. The only precedent for this approach is Oregon's state parity law, which was implemented in 2007. The goal of this study was to estimate the effect of Oregon's parity law on expenditures for mental health and substance abuse treatment services. Method: The authors compared expenditures for commercially insured individuals in four Oregon health plans from 2005 through 2008 and a matched group of commercially insured individuals in Oregon who were exempt from parity. Using a difference-in-differences analysis, the authors analyzed the effect of comprehensive parity on spending for mental health and substance abuse services. Results: Increases in spending on mental health and substance abuse services after implementation of Oregon's parity law were almost entirely the result of a general trend observed among individuals with and without parity. Expenditures per enrollee for mental health and substance abuse services attributable to parity were positive, but they did not differ significantly from zero in any of the four plans. Conclusions: Behavioral health insurance parity rules that place restrictions on how plans manage mental health and substance abuse services can improve insurance protections without substantial increases in total costs.

Copyright 2012, American Psychiatric Association


McConnell KJ; Ridgely MS; McCarty D. What Oregon's parity law can tell us about the federal Mental Health Parity and Addiction Equity Act and spending on substance abuse treatment services. Drug and Alcohol Dependence 124(3): 340-346, 2012. (13 refs.)

Background: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires commercial group health plans offering coverage for mental health and substance abuse services to offer those services at a level that is no more restrictive than for medical-surgical services. The MHPAEA is notable in restricting the extent to which health plans can use managed care tools on the behavioral health benefit. The only precedent for this approach is Oregon's 2007 state parity law. This study aims to provide evidence on the effect of comprehensive parity on utilization and expenditures for substance abuse treatment services. Methods: A difference-in-difference analysis compared individuals in five Oregon commercial plans (n = 103, 820) from 2005 to 2008 to comparison groups exempt from parity in Oregon (n=19, 633) and Washington (n = 39, 447). The primary outcome measures were annual use and total expenditures. Results: Spending for alcohol treatment services demonstrated statistically significant increase in comparison to the Oregon and Washington comparison groups. Spending on other drug abuse treatment services was not associated with statistically significant spending increases, and the effect of parity on overall spending (alcohol plus other drug abuse treatment services) was positive but not statistically significant from zero. Conclusions: Oregon's experience suggests that behavioral health insurance parity that places restrictions on how plans manage the benefit may lead to increases in expenditures for alcohol treatment services but is unlikely to lead to increases in spending for other drug abuse treatment services.

Copyright 2012, Elsevier Science


Mitchell AD; Studdert DM. Plain packaging of tobacco products in Australia: A novel regulation faces legal challenge. (editorial). Journal of the American Medical Association 307(3): 261-262, 2012. (6 refs.)


Moeller K. Estimating drug policy expenditures: Direct costs of policing cannabis in Copenhagen 2000-2009. Drugs: Education, Prevention and Policy 19(5): 379-386, 2012. (47 refs.)

Aim: To establish estimates for the direct costs of policing cannabis in Copenhagen. Methods: Policing is disaggregated into the two tactical components of retail-level policing and crackdowns. Costs for retail-level policing are estimated using a micro-costing and gross-costing approach. Crackdowns are estimated on the basis of data contained in memorandum. Findings: Retail-level policing is found to require between 0.1 and 2.2% in low-intensity years and 0.25 and 5.7% in high-intensity years. Crackdowns are found to cost upwards of 10% of available annual resources. These estimates illustrate the variations in policing cannabis from year-to-year, depending on enforcement intensity and choice of tactical components between retail-level and crackdowns. Conclusions: Estimating drug policy expenditures is an exploratory endeavour in Denmark. The scopes of the presented estimates are found to be congruent with international estimates to the extent that conditions are comparable.

Copyright 2012, Informa Healthcare


Mohamed S. Mandatory assessment of drug users in Malaysia: Implications on human rights. Drugs: Education, Prevention and Policy 19(3): 227-233, 2012. (18 refs.)

Aim: The study is founded upon a critical analysis of the extent to which the mandatory drug assessment in funneling drug users under Malaysia's compulsory treatment and rehabilitation programme is consistent with the principles of human rights guaranteed under the Malaysian Constitution. Method: Empirical qualitative data from a case study encompassing direct observations of natural sites, a focus group comprising former and recovering drug users, secondary data from official documents and case files. Results: Findings show that the mandatory drug assessment of drug users is subject to arbitrary arrest, unnecessary prolonged detention, lack of medical assistance and non-compliance to due process. Conclusions: The mandatory drug assessment of drug users in Malaysia entails serious infringements of the principles of human rights.

Copyright 2012, Informa HealthCare


Mons U; Nagelhout GE; Guignard R; McNeill A; van den Putte B; Willemsen MC et al. Comprehensive smoke-free policies attract more support from smokers in Europe than partial policies. European Journal of Public Health 22(Supplement 1): 10, 2012. (34 refs.)

Background: Support for smoke-free policies increases over time and particularly after implementation of the policy. In this study we examined whether the comprehensiveness of such policies moderates the effect on support among smokers. Methods: We analysed two waves (pre- and post-smoke-free legislation) of the International Tobacco Control (ITC) surveys in France, Germany, and the Netherlands, and two pre-legislation waves of the ITC surveys in UK as control. Of 6,903 baseline smokers, 4,945 (71.6%) could be followed up and were included in the analyses. Generalised Estimating Equations (GEE) were used to compare changes in support from pre- to post-legislation to the secular trend in the control country. Multiple logistic regression models were employed to identify predictors of individual change in support. Findings: In France, the comprehensive smoking ban was associated with sharp increases in support for a total smoking ban in drinking establishments and restaurants that were above secular trends. In Germany and the Netherlands, where smoke-free policies and compliance are especially deficient in drinking establishments, only support for a total smoking ban in restaurants increased above the secular trend. Notable prospective predictors of becoming supportive of smoking bans in these countries were higher awareness of cigarette smoke being dangerous to others and weekly visiting of restaurants. Conclusions: Our findings suggest that smoke-free policies have the potential to improve support once the policy is in place. This effect seems to be most pronounced with comprehensive smoking bans, which thus might be the most valid option for policy-makers despite their potential for creating controversy and resistance in the beginning.

Copyright 2012, Oxford University Press


Nagelhout GE; de Vries H; Boudreau C; Allwright S; McNeill A; van den Putte B et al. Comparative impact of smoke-free legislation on smoking cessation in three European countries. European Journal of Public Health 22(Supplement 1): 4, 2012. (32 refs.)

Background: Little is known about the differential impact of comprehensive and partial smoke-free legislation on smoking cessation. This study aimed to examine the impact of comprehensive smoke-free workplace legislation in Ireland and England, and partial hospitality industry legislation in the Netherlands on quit attempts and quit success. Methods: Nationally representative samples of 2,219 adult smokers were interviewed in three countries as part of the International Tobacco Control (ITC) Europe Surveys. Quit attempts and quit success were compared between period 1 (in which smoke-free legislation was implemented in Ireland and the Netherlands) and period 2 (in which smoke-free legislation was implemented in England). Results: In Ireland, significantly more smokers attempted to quit smoking in period 1 (50.5%) than in period 2 (36.4%) (p < 0.001). Percentages of quit attempts and quit success did not change significantly between periods in the Netherlands. English smokers were significantly more often successful in their quit attempt in period 2 (47.3%) than in period 1 (26.4%) (p = 0.011). In the first period there were more quit attempts in Ireland than in England and fewer in the Netherlands than in Ireland. Fewer smokers quitted successfully in the second period in both Ireland and the Netherlands than in England. Conclusion: The comprehensive smoke-free legislation in Ireland and England may have had positive effects on quit attempts and quit success respectively. The partial smoke-free legislation in the Netherlands probably had no effect on quit attempts or quit success. Therefore, it is recommended that countries implement comprehensive smoke-free legislation.

Copyright 2012, Oxford University Press


Nagelhout GE; van den Putte B; de Vries H; Crone M; Fong GT; Willemsen MC. The influence of newspaper coverage and a media campaign on smokers' support for smoke-free bars and restaurants and on secondhand smoke harm awareness: Findings from the International Tobacco Control (ITC) Netherlands Survey. Tobacco Control 21(1): 24-29, 2012. (29 refs.)

Objective: To assess the influence of newspaper coverage and a media campaign about Dutch smoke-free legislation on smokers' support for smoke-free bars and restaurants and on secondhand smoke (SHS) harm awareness. Design and main outcome measures: A content analysis was conducted of 1041 newspaper articles on the smoke-free legislation published in six Dutch newspapers from March 2008 to April 2009. Smokers who were regular readers of at least one of these newspapers (n=677) were selected from the pre-ban and post-ban waves of the International Tobacco Control Netherlands Survey. Exposure to newspaper coverage and the implementation campaign was correlated with changes in smokers' support for smoke-free bars and restaurants and SHS harm awareness. Results: Most newspaper coverage was found to be negative towards the smoking ban (57%) and focused on economic aspects (59%) rather than health aspects (22%). Exposure to this coverage had a small but significantly negative effect on support for smoke-free bars and restaurants (beta=-0.09, p=0.013). Among higher educated smokers, exposure to positive newspaper coverage had a more positive effect on support for smoke-free bars and restaurants. In addition, exposure to the implementation campaign had a small but significantly positive effect on SHS harm awareness (beta=0.11, p=0.001). Conclusions: Media attention on smoke-free legislation can influence smokers' support for the legislation and SHS harm awareness. Tobacco control advocates should aim to establish positive media attention that puts forward the health arguments for the legislation.

Copyright 2012, BMJ Publishing


O'Connor RJ. Postmarketing surveillance for "modified-risk" tobacco products. (review). Nicotine & Tobacco Research 14(1): 29-42, 2012. (113 refs.)

Introduction: The U.S. Food and Drug Administration (FDA) acquired authority to regulate tobacco products in 2009. This authority will provide a structured process for manufacturers to introduce products that may have "modified-risk" for morbidity or mortality relative to traditional tobacco products, with post-marketing surveillance and studies a condition of marketing. Method: A narrative review approach was taken. The author searched and integrated publicly accessible literature on tobacco product surveillance as well as drug and medical device post-market activities currently performed by FDA. Results: FDA relies on active and passive methods for post-market surveillance and can require specific studies and risk evaluation and mitigation strategies for certain products, including those with abuse liability. Past efforts at examining the individual and population effects of reduced harm tobacco products provide an example of integrating different data streams. Discussion: Post-market surveillance can be viewed in terms of the Agent-Host-Vector-Environment model, and concepts from diffusion of innovations are relevant to understanding factors associated with the adoption of new products by the population. Given that active and passive surveillance approaches have different strengths and weaknesses, multiple approaches may be necessary to evaluate population-level effects. Assuring that required studies are properly conducted and reported and that data indicating significant public health harms are quickly recognized will be important going forward. Conclusions: The advent of broad regulatory authority over tobacco provides opportunities for policy evaluation research. The research community can provide FDA with the independent science it needs to evaluate the public health impact of novel tobacco products.

Copyright 2012, Oxford University Press


Phan HM; Yoshizuka K; Murry DJ; Perry PJ. Drug testing in the workplace. (review). Pharmacotherapy 32(7): 649-656, 2012. (20 refs.)

Congress passed the Drug-Free Workplace Act in April 1988, which resulted in the Mandatory Guidelines for Federal Workplace Drug Testing Programs. The intent was to establish a substance-free work environment for all federal workers by requiring that all federal employees pass a urine drug test before employment. These guidelines specifically, and exclusively, focus on testing urine specimens for metabolites of marijuana, cocaine, phencyclidine, opiates (focusing on heroin metabolites), and amphetamines (including Ecstasy). Since then, there have been many scientific, technical, and legal challenges to the validity of urine drug testing. In response, the Substance Abuse and Mental Health Services Administration, a division operating under the executive branch of the United States Department of Health and Human Services, put forth, through many revisions, strict procedural guidelines and specimen validity-testing criteria to manage suspicious or adulterated samples during and after urine collection. This review focuses on the legal ramifications, the procedural process, and the sensitivity and specificity of the two urine drug tests used for workplace drug testing: immunoassay and gas chromatographymass spectrometry. Moreover, we dissect the problematic issue of cross-sensitivity between illicit and prescription drugs, and how this affects the validity of future urine drug testing.

Copyright 2012, Wiley-Blackwell


Ribisl KM. Research gaps related to tobacco product marketing and sales in the Family Smoking Prevention and Tobacco Control Act. (review). Nicotine & Tobacco Research 14(1): 43-53, 2012. (92 refs.)

This paper is part of a collection that identifies research priorities that will help guide the efforts of the U. S. Food and Drug Administration (FDA) as it regulates tobacco products. This paper examines the major provisions related to tobacco product advertising, marketing, sales, and distribution included in Public Law 111-31, the "Family Smoking Prevention and Tobacco Control Act". This paper covers 5 areas related to (a) marketing regulations (e. g., ban on color and imagery in ads, ban on nontobacco gifts with purchase); (b) granting FDA authority over the sale, distribution, accessibility, advertising, and promotion of tobacco and lifting state preemption over advertising; (c) remote tobacco sales (mail order and Internet); (d) prevention of illicit and cross-border trade; and (e) noncompliant export products. Each of the 5 sections of this paper provides a description and brief history of regulation, what is known about this regulatory strategy, and research opportunities.

Copyright 2012, Oxford University Press


Ridgely MS; Pacula RL; Burnam MA. Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Washington DC: Department of Health & Human Services, 2012. (12 refs.)

The Interim Final Rules (IFR) implementing the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 went into effect on July 1, 2010. This report describes the findings from short-term studies commissioned by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services (HHS) and undertaken by the RAND Corporation. These studies were focused on two issues in the IFR, where HHS felt that further research would be useful in informing the implementation of the MHPAEA. The two issues are the use of "non-quantitative treatment limitations" (NQTLs) by self-insured employers, insurers, health plans and managed behavioral health organizations and the identification of a "scope of services" in behavioral health to which parity applies. This paper summarizes interviews with managed behavioral health industry experts and the discussion by a panel comprised of well-known researchers and practitioners with clinical expertise in MH/SUD treatment as well as general medical treatment, experience in developing evidence-based practice guidelines, and knowledge of how plans use NQTLs. The information provided by managed behavioral health industry experts and the deliberations of the Technical Expert Panel were focused on how NQTLs are used by plans and insurers to manage MH/SUD benefits and any clinical justifications for variations in how NQTLs apply to MH/SUD benefits compared to medical benefits. justifiable considerations identified by the panel included evidence of clinical efficacy, diagnostic uncertainties, unexplained rising costs, availability of alternative treatments with different costs, variation in provider qualifications and credentialing standards, high utilization relative to benchmarks, high practice variation, inconsistent adherence to practice guidelines, whether care is experimental or investigational, and geographic variation in availability of providers. The panel also discussed how the standard in the IFR requires that these considerations be applied in a comparable way to MH/SUD benefits and medical-surgical benefits. This paper includes an analysis of the Thomson Reuters MarketScan data that offers several insights into the extent to which employer plans included coverage for these services prior to the implementation of the MHPAEA and at what cost. Descriptive analyses showed that the average cost per member per month (PMPM) for all plan-provided health care was found to be $268. Almost all of these costs are for medical-surgical services and related prescription drugs. Behavioral health services accounted for $12, or 4.6% of total PMPM costs. Furthermore, the vast majority of the cost for behavioral health was for behavioral health prescriptions ($7.46). Intermediate behavioral health services -- those that lie between inpatient and outpatient care -- were provided by employer plans in 2008, although the results differed greatly for each service. Examples of such intermediate services are non-hospital residential treatment, partial hospitalization, and intensive outpatient treatment. Almost all of the employer-based plans had claims for intensive outpatient treatment (98%), most had claims for partial hospitalization (59%), but few had claims for non-hospital residential treatment (18%). Together the additional cost of providing these three services represented a very small fraction of the average total plan cost in 2008 ($2.40 PMPM or 0.9%). Data is summarized in 7 tables and 1 figure.

Public Domain


Rutkow L; Vernick JS; Mojtabai R; Rodman SO; Kaufmann CN. Legal challenges for substance abuse treatment during disasters. (editorial). Psychiatric Services 63(1): 7-9, 2012. (12 refs.)

Certain groups with preexisting mental and behavioral health conditions, such as substance use disorders, may be especially vulnerable during and shortly after disasters. Researchers have found that substance abuse treatment programs and the individuals they serve experienced major disruptions after the September 11, 2001, attacks on the World Trade Center and the Pentagon and after Hurricane Katrina. This column considers legal challenges that may arise when a rapid influx of licensed providers is needed for substance abuse treatment during disasters and reviews specific legal issues that disasters may raise for opioid treatment programs. Opportunities to mitigate legal challenges and facilitate substance abuse treatment during disasters are discussed.

Copyright 2012, American Psychiatric Association


Shechtman M. Joint authority? The case for state-based marijuana regulation. Tennessee Journal of Law & Policy 8(Winter): 45-97, 2012. (197 legal refs.)

Over the past several decades the United States government has cast an intimidating shadow over the states in the drug policy arena. Congress inaugurated the "War on Drugs" in 1970 through the Controlled Substances Act, banning the possession, consumption, and distribution of a host of narcotic substances, including marijuana. The past decade, however, brought a revolution in the form of state-based marijuana regulation. Ranging from decriminalization to medical licensing, more than a dozen states have enacted laws contradicting the blunt legalist strictures of the CSA. ... Relying on the tenets of public choice theory and jurisdictional competition for law, this article addresses a range of regulatory frameworks for marijuana regulation, concluding that decentralization in favor of the states provides the most efficient and pragmatic mechanism for marijuana policy. ...With state experimentation comes the possibility for competition between states in the enactment of innovative marijuana regulatory schemes and legalization policies. ... This drug regime also confuses the citizenry and retail merchants as to how the federal government will react to marijuana use, possession, and distribution. ... Though federal legislators may lose the political soapbox federal regulation so conveniently provides, repeal of the CSA (as it relates to marijuana) will lead to the same benefits we saw following enactment of the Twenty-First Amendment: reduced corruption and organized crime, job creation, and invigorated addiction support programs. ... The "Competitive Alternative" also cogently points to the problems inherent in the federal framing of the drug issue to the American public The federal propaganda machine and its "War on Drugs" distorts the issues surrounding marijuana legislation and pits reform groups against politicians responding to the federal anti-drug stance. ...Beyond the alcohol regulatory analogy, the past generations of over-enforcement; billions of dollars of federal taxpayer money; seeming absence of a "Race to the Bottom" or substantial negative externalities; exceedingly high violent crime rates associated with illicit drugs; and unclear federal enforcement policy lead to the conclusion that decentralization is the best regulatory stance for marijuana laws. ... The United States system of federalism is premised on extensive state autonomy, leading to experimentation and innovation in policymaking, concurrent with the citizenry's ability to choose the laws they want applied by locating in a jurisdiction with the bundle of laws they find most appealing..

Copyright 2012, University of Tennessee School of Law


Stevenson C. Cannabis use: What's law got to do with it? Perceptions and knowledge of cannabis policy from the user perspective in Northern Ireland. Drugs: Education, Prevention and Policy 19(2): 129-136, 2012. (34 refs.)

Aims: The past several years have seen changes and additions to drug policy in the UK; however, the opinion and attitude of those who use the drug is rarely discussed. The aim of this article is to examine attitudes to cannabis policy among adults who use the drug in Northern Ireland. The article also aims to consider these opinions in the context of the UK generally and draws parallels with other international regions. Methods: Data were collected through semi-structured interviews with 38 adults aged 18-59 with a range of levels of cannabis experience. The sample included 22 males and 16 females. Respondents were recruited using a snowball sampling procedure from both urban (city and small town) and rural locations in Northern Ireland. Findings: The findings illustrate that the majority of the sample had some knowledge of cannabis policy but were unaware of the implications of possession for users. The results showed that people who used cannabis were relatively unconcerned about legal penalties. Conclusion: Cannabis users tend to consume the drug irrespective of policy. The reclassification of cannabis resulted in confusion as to what the penalties were, users continued to use cannabis irrespective of the law prior to and following reclassification and they felt that policy was irrelevant to use.

Copyright 2012, Informa Healthcare


Strobbe S; Hobbins D. The prescribing of buprenorphine by advanced practice addictions nurses. Journal of Addictions Nursing 23(1): 82-83, 2012. (10 refs.)

In order to increase safe access to buprenorphine treatment for patients with opioid dependence, it is the position of the International Nurses Society on Addictions (IntNSA) that the Drug Addiction Treatment Act of 2000 (DATA 2000) be amended to allow for the prescribing of buprenorphine by qualified advanced practice nurses who have both prescriptive authority and specialty certification in addictions nursing.

Copyright 2012, Informa Healthcare


Tan YL; Foong K. How the Malaysian tobacco industry exploits loopholes in pictorial health warnings. (editorial). Tobacco Control 21(1): 55-56, 2012. (3 refs.)

Copyright 2012, BMJ Publishing


Tipparat P; Natakankitkul S; Chamnivikaipong P; Chutiwat S. Characteristics of cannabinoids composition of cannabis plants grown in Northern Thailand and its forensic application. Forensic Science International 215(1-3): 164-170, 2012. (27 refs.)

The Thai government has recognized the possibility for legitimate cultivation of hemp. Further study of certain cannabinoid characteristics is necessary in establishing criteria for regulation of cannabis cultivation in Thailand. For this purpose, factors affecting characteristics of cannabinoids composition of Thai-grown cannabis were investigated. Plants were cultivated from seeds derived from the previous studies under the same conditions. 372 cannabis samples from landraces, three different trial fields and seized marijuana were collected. 100 g of each sample was dried, ground and quantitatively analyzed for THC, CBD and CBN contents by GC-FID. The results showed that cannabis grown during March-June which had longer vegetative stages and longer photoperiod exposure, had higher cannabinoids contents than those grown in August. The male plants grown in trial fields had the range of THC contents from 0.722% to 0.848% d.w. and average THC/CBD ratio of 1.9. Cannabis in landraces at traditional harvest time of 75 days had a range of THC contents from 0.874% to 1.480% d.w. and an average THC/CBD ratio of 2.6. The THC contents and THC/CBD ratios of cannabis in second generation crops grown in the same growing season were found to be lower than those grown in the first generation, unless fairly high temperatures and a lesser amount of rainfall were present. The average THC content in seized fresh marijuana was 2.068% d.w. while THC/CBD ratios were between 12.6 and 84.09, which is 10-45 times greater than those of similar studied cannabis samples from the previous study. However, most Thai cannabis in landraces and in trial fields giving a low log(10) value of THC/CBD ratio at below 1 may be classified as intermediate type, whereas seized marijuana giving a higher log(10) value at above 1 could be classified as drug type. Therefore, the expanded information provided by the current study will assist in the development of criteria for regulation of hemp cultivation in Thailand.

Copyright 2012, Elsevier Science


Tovino SA. Mental Health Symposium: Reforming State mental health parity law. Houston Journal of Health Law & Policy 11(symposium): 455-504, 2012. (218 legal refs.)

Summary: ... Except for the increasing coinsurance amounts that individual health plans and group contracts covering employees of small employers are permitted to impose on mental health and substance abuse services, no health insurance policy or contract in Maryland may impose separate or otherwise lower lifetime maximums for treatment of mental illness, separate or otherwise higher deductible or coinsurance amounts for treatment of mental illness, or separate or otherwise higher out-of-pocket limits for treatment of mental illness. ... In 2009, the Nevada Legislature repealed these provisions, replacing them with one generic provision that requires an insurer or other organization providing health coverage through a group health plan, nonprofit corporation for hospital, medical, and dental services, or HMO, among other methods of insurance delivery, to comply with the provisions of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and its implementing regulations. ... Maryland law should be revised to require non-small group health plans and qualified health plans to establish complete parity between physical and mental health benefits in all rates, terms, and conditions, including inpatient day limitations, outpatient visit limitations, and coinsurance amounts. ... In the following sections, I would like to think more broadly and propose the expansion of mental health parity law to: (i) regulate all health plans that are subject to state regulation; (ii) mandate the inclusion of mental health and substance use disorder benefits in all such health plans; and (iii) protect individuals with all psychiatric, neurological, substance abuse, intellectual, and developmental disorders and disabilities, not just those currently labeled as "biologically-based disorders" or "severe mental illnesses." ... Because research does not show higher costs associated with mental health parity laws that contain mandated mental health and substance use disorder benefit provisions (compared to mental health parity laws with mandated offer provisions and compared to mental health parity laws that require neither the provision nor offer of mental health and substance use disorder benefits), I argue that all state mental health parity laws should contain a mandated mental health and substance use disorder benefit.

Copyright 2012, Houston Journal of Health Law & Policy


Ulmer A; Lamy D; Reisinger M; Haraldsen M; Maremmani I; Newman R. How should methadone and buprenorphine treatment be organized and regulated? A comparison between two systems in the context of a EUROPAD Conference in Brussels. Heroin Addiction and Related Clinical Problems 14(1): 5-9, 2012. (0 refs.)

Opiate Agonist Treatment (OAT-providing) physicians and pharmacists from the southwest region of Germany and the Wallonian part of Belgium came together with international experts to compare their two different sets of OAT regulations. Both countries mostly rely on methadone, but with an increasing use of buprenorphine, besides a much less frequent recourse to other opioids. German OAT is rather strictly regulated. The aim of these regulations was to ensure quality. That effect is, however, questionable. The regulations make it difficult and legally dangerous to provide OAT. Physicians and patients suffer from these regulations. Most doctors avoid getting involved. No successors are available. The future scenario will be OAT provision at only a few clinics, with a large array of controls and with a customary setting of crowds of addicted people. The Belgian system runs without these regulations. The consequence is not greater chaos, but a much more normal integration of patients into normal medical practice and into society itself. The take-home message of the conference held under the auspices of EUROPAD was that most special regulations point in the wrong direction, and lead into a costly dead end. The whole treatment procedure works better and much more effectively if we treat the patients as normally as possible, with nothing more complicated than normal diligence. Connection with a good support system, networking, regular education and periodic evaluation of how the system functions - all these factors go to constitute a guarantee of the best possible outcome for patients.

Copyright 2012, Pacini Editore


Vindenes V; Jordbru D; Knapskog AB; Kvan E; Mathisrud G; Slordal L et al. Impairment based legislative limits for driving under the influence of non-alcohol drugs in Norway. (review). Forensic Science International 219(1-3): 1-11, 2012. (138 refs.)

Aims: When non-alcohol drugs are detected in blood samples from apprehended drivers in Norway, individualised expert opinions are required to evaluate degree of impairment. For alcohol, legislative limits have been in use since 1936. To harmonize the current practice for driving under the influence of alcohol and non-alcohol drugs, a judicial reform with legislative limits for non-alcohol drugs has been suggested. Methods: Impairment limits, representing drug concentrations in blood likely to be accompanied by a degree of impairment comparable to a blood alcohol concentration (BAC) of 0.02%, were proposed for 20 psychotropic drugs, including the most prevalent benzodiazepines, cannabis, GHB, hallucinogens and opioids. Limits for graded sanctions, representing drug concentrations in blood likely to induce impairment comparable to BACs of 0.05% and 0.12%, were defined for 13 of the 20 substances. The suggested limits were based on assessments of impairment after single doses of the drugs in naive individuals. The proposed limits will not apply to individuals with valid prescriptions for medicinal drugs, where the present system with individualised expert evaluations will be maintained. Conclusion: Norway is the first country planning to implement legislative limits for non-alcohol drugs corresponding to impairment seen at increasing BACs. The background and justification for the suggested limits are presented herein.

Copyright 2012, Elsevier Science


Volkmann T; Shin SS; Garfein RS; Patterson TL; Pollini RA; Wagner KD et al. Border crossing to inject drugs in Mexico among injection drug users in San Diego, California. Journal of Immigrant and Minority Health 14(2): 281-286, 2012. (30 refs.)

We examined correlates of ever injecting drugs in Mexico among residents of San Diego, California. From 2007 to 2010, injecting drug users (IDUs) in San Diego underwent an interviewer-administered survey. Logistic regression identified correlates of injection drug use in Mexico. Of 302 IDUs, 38% were Hispanic, 72% male and median age was 37; 27% ever injected in Mexico; 43% reported distributive syringe sharing there. Factors independently associated with ever injecting drugs in Mexico included being younger at first injection, injecting heroin, distributive syringe sharing at least half of the time, and transporting drugs over the last 6 months. One-quarter of IDUs reported ever injecting drugs in Mexico, among whom syringe sharing was common, suggesting possible mixing between IDUs in the Mexico-US border region. Prospective studies should monitor trends in cross-border drug use in light of recent Mexican drug policy reforms partially decriminalizing drug possession.

Copyright 2012, Springer


Warren CW; Erguder T; Lee J; Lea V; Sauer AG; Jones NR et al. Effect of policy changes on cigarette sales: The case of Turkey. European Journal of Public Health 22(5): 712-716, 2012. (19 refs.)

Background: In 1996, Turkey made tobacco control a health priority. The tobacco control effort was extended in July 2009 with the expansion of the smoke-free law to include all enclosed workplaces and public places and, in January 2010, with a 20% increase in the Special Consumption Tax on Tobacco. Methods: Sales data were averaged, by month, for the period January 2005 through June 2009 to establish an 'expected' monthly sales pattern. This was the period when no new tobacco control measures were implemented. The overall monthly average was then calculated for the same period. The expected monthly sales pattern was then graphed against the overall monthly sales average to delineate a seasonal sales pattern that was used to evaluate the divergence of actual monthly sales from the 'expected' pattern. Results: A distinct seasonal pattern was found with sales above average from May through August. Comparison of actual cigarette sales to the 'expected' monthly sales pattern following the implementation of the expanded smoke-free law in July resulted in a 5.2% decrease. Cigarettes sales decreased by 13.6% following the January 2010 Special Consumption Tax. Since the implementation of the expanded smoke-free law in July 2009 and the tax increase in January 2010, cigarette sales in Turkey decreased by 10.7%. Conclusion: The effect of recent Turkish tobacco control policies could contribute to a reduction in the number of premature deaths related to tobacco use. Evidence has shown that periodic tax increases and strong enforcement of all tobacco control policies are essential to further decrease tobacco consumption.

Copyright 2012, Oxford University Press


Weissenborn R; Nutt DJ. Popular intoxicants: What lessons can be learned from the last 40 years of alcohol and cannabis regulation? Journal of Psychopharmacology 26(2): 213, 2012. (53 refs.)

In this paper we discuss the relative physical, psychological and social harms of the two most frequently used intoxicant drugs in the UK, namely cannabis and alcohol. Over the past 40 years, the use of both drugs has risen significantly with differential consequences. It is argued that increased policing of cannabis use under the current drug classification system will lead to increased criminalization of young people, but is unlikely to significantly reduce the rates of schizophrenia and psychosis. In comparison, increases in alcohol drinking are related to significant increases in liver cirrhosis hospital admissions and mortality, at a time when mortality rates from other major causes are on the decline. A recent expert-led comparison of the health and social harms to the user and to others caused by the most commonly used drugs in the UK showed alcohol to be more than twice as harmful as cannabis to users, and five times as harmful as cannabis to others. The findings underline the need for a coherent, evidence-based drugs policy that enables individuals to make informed decisions about the consequences of their drug use.

Copyright 2012, Sage Publications


York NL; Pritsos CA; Gutierrez AP. Legislators' beliefs on tobacco control policies in Nevada. Journal of Community Health 37(1): 89-95, 2012. (39 refs.)

The purpose of this study was to identify Nevada legislators' views on comprehensive smoke-free (SF) policy development. The Nevada Clean Indoor Air Act (NCIAA) is a weak law that prohibits smoking in most indoor public places, excluding stand-alone bars and casino gaming areas. Nevada's state senators and assembly members were contacted to participate in the study. A literature review guided modifications of an instrument previously used to measure county-level officials' policy views in Kentucky. Descriptive statistics were conducted for selected variables, while independent t tests and one-way analysis of variance were used to examine differences between various groups. 23 of 63 legislators participated. Even though the majority of officials recognized smoking as a health hazard and nicotine as addictive, there was not overwhelming support for strengthening the NCIAA, raising cigarette excise taxes or providing cessation benefits to citizens. Officials believed that the NCIAA was having a negative economic impact on smaller gaming businesses, but not on the casino industry. Democrats were more likely than Republicans to agree that raising the excise tax by $1 is important for needed state revenues. 63% of legislators believed that they would be persuaded to strengthen the NCIAA regardless of its financial impact on small businesses, if their constituents supported such a move. No other state relies on gaming revenues as much as Nevada. Given that legislators are strongly influenced by their constituents' views, policy advocates need to establish grassroots support for strengthening the current NCIAA and also tobacco control laws in general.

Copyright 2012, Springer


Yunker JA. Estimated optimal drug law enforcement expenditures based on US annual data. Journal of Policy Modeling 34(3): 356-371, 2012. (30 refs.)

This research develops and implements a simple model for the determination of optimal national expenditures on drug law enforcement. The key components of the model are an econometrically estimated linear drug violations equation relating drug violations to drug enforcement expenditures and other factors, a parameter measuring per capita costs of drug violations, and a Cobb-Douglas function relating social welfare to: (1) net consumption after drug costs and drug enforcement expenditures, and (2) benefits to users of illegal drugs. The parameters of the model are estimated from annual time series data for the United States from 1981 through 2007. It is determined that if the parameters of the social welfare function are such that the elasticity of social welfare with respect to net consumption (alpha) is near to unity and the elasticity of social welfare with respect to user benefits (beta) is near to zero, the estimated optimal expenditures on drug law enforcement are in the vicinity of the actual expenditures. However, comparative statics analysis of the optimum demonstrates two situations in which significantly reduced expenditures might be indicated: (1) if the alpha parameter in the social welfare function is significantly below unity and/or the beta parameter is significantly above zero; (2) if the drug cost parameter delta is in fact significantly less than estimates based on 1992-2002 data. The latter possibility might be the more relevant, because it seems more likely that society might be incorrectly estimating the costs of drug use (a positive issue) than that society is misperceiving its social welfare values (a normative issue).

Copyright 2012, Society for Policy Modeling


Zeller M. Three years later: An assessment of the implementation of the Family Smoking Prevention and Tobacco Control Act. (editorial). Tobacco Control 21(5): 453-454, 2012. (3 refs.)