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...on policy issues
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www.ProjectCork.org
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Summer 2006
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Fighting a tobacco-tax rollback: A political analysis of the 1994 cigarette contraband crisis in Canada.
Breton E; Richard L; Gagnon F; Jacques M; Bergeron P. Journal of Public Health Policy 27(1): 77-99, 2006. (34 refs.)
We identify factors that led a regional government (Quebec, Canada) to opt for a reduction of its tobacco tax to combat tobacco smuggling. Then we explore the fallout of Quebec's tobacco-tax rollback on its tobacco control policy. We conducted qualitative research using a case-study design and multiple sources of data. We applied the Advocacy Coalition Framework in respect of data collection and analysis. Advocates of the tobacco-tax rollback framed the contraband problem in a way that won the support of an array of actors. However, anti-tobacco activists succeeded in convincing the government to invest more in tobacco control. The new resources were instrumental in enhancing the activists' ability to promote legislative measures. Our approach sheds light on the tobacco industry's strategy to have governments reducing their tobacco tax. Quebec offers an example of how tobacco control activists can transform defeat into the cornerstone of a comprehensive tobacco control policy. Copyright 2006, Palgrave MacMillan Ltd.
Harm reduction by a "user-run" organization: A case study of the Vancouver Area Network of Drug Users (VANDU).
Kerr T; Small W; Peeace W; Douglas D; Pierre A; Wood E. International Journal of Drug Policy 17(2): 61-69, 2006. (30 refs.)
The Downtown Eastside of Vancouver has experienced ongoing epidemics of HIV infection and illicit drug overdoses since the mid 1990s. In 1997, in response to the emerging health crisis among injection drug users (IDU) and government inaction, individuals gathered in Vancouver to Form a drug user-run organization. This group eventually became known as the Vancouver Area Network of Drug Users (VANDU). Because of the growing interest in drug user organizations, this case study was conducted to document the genesis, structure, and activities of VANDU. In accordance with VANDU's philosophy of "user involvement and empowerment," we employed a community-based case study methodology to achieve these aims. The findings demonstrate that through years of activism, advocacy, and public education, VANDU has repeatedly voiced the concerns of drugs users in public and political arenas. VANDU has also performed a critical public health function by providing care and support programmes that are responsive to immediate needs of their peers. This study indicates that greater efforts should be made to promote the formation of drug user organizations, and that health authorities and policy makers should explore novel methods for incorporating the activities of drug user organizations within existing public health, education, and policy making frameworks. Copyright 2006, Elsevier Science.
How much can treatment reduce national drug problems? (review).
Reuter P; Pollack H. Addiction 101(3): 341-347, 2006. (34 refs.)
Treatment of drug addiction has been the subject of substantial research and, in contrast to several other methods of reducing drug use, has been found to be both effective and cost-effective. This review considers what is known about how much a nation can reduce its drug problems through treatment alone and what is known at the aggregate level about the effectiveness of prevention and enforcement. The literature on the effectiveness of treatment, prevention and enforcement are reviewed, and set in a policy analytical framework. Many studies have found treatment to have large effects on individuals' consumption and harms. However, there is an absence of evidence that even relatively well-funded treatment systems have much reduced the number of people in a nation who engage in problematic drug use. For prevention, the scientific literature shows useful and modest effects at the individual level but there is little support for substantial aggregate effects. For enforcement, research has failed almost uniformly to show that intensified policing or sanctions have reduced either drug prevalence or drug-related harm. Nor-outside the UK-is there more than a modest effort to improve the evidence base for making decisions about the appropriate level of enforcement of drug prohibitions. Treatment can justify itself in terms of reductions in harms to individuals and communities. However, even treatment systems that offer generous access to good quality services will leave a nation with substantial drug problem. Finding effective complementary programs remains a major challenge. Copyright 2006, Society for the Study of Addiction to Alcohol and Other Drugs.
Organizational survival in the outpatient substance abuse treatment sector, 1988-2000.
Wells R; Lemak CH; D'Aunno TA. Medical Care Research and Review 62(6): 697-719, 2005. (54 refs.)
Substance abuse remains one of the most pressing health issues in the United States today, yet treatment supply continues to lag far behind need. Given the hostile enviroments treatment facilities face, their survival is a matter of pressing policy concern. Results from analyses of National Drug Abuse Treatment System Survey (NDATSS) data from 1988 through 2000 suggest that organizational attributes such as age, size, and client severity and resource dependencies such as reliance on government revenue affect survival, but their effects change over time. By the mid-1990s, director involvement in state and local policy making was positively associated with subsequent survival; later that decade, directors' professional credentials affected survival as well. Results also show that serving clients with multiple substance abuse problems became a survival liability by the late 1990s. Facilities that treat clients with multiple addictions may need additional financial support to serve these particularly vulnerable clients. Copyright 2005, Sage Publications Inc.
Point of purchase cigarette promotions before and after the Master Settlement Agreement: Exploring retail scanner data.
Loomis BR; Farrelly MC; Nonnemaker JM; Mann NH. Tobacco Control 15(2): 140-142, 2006. (28 refs.)
Background: Evidence indicates that point of purchase (POP) advertising and promotions for cigarettes have increased since the Master Settlement Agreement (MSA). Retail promotions have the potential to offset the effects of cigarette tax and price increases and tobacco control programmes. Objective: To describe the trend in the proportion of cigarette sales that occur as part of a POP promotion before and after the MSA. Design: Scanner data were analysed on cigarette sales from a national sample of grocery stores, reported quarterly from 1994 through 2003. The proportion of total cigarette sales that occurred under any of three different types of POP promotions is presented. Results: The proportion of cigarettes sold under a POP promotion increased notably over the sample period. Large increases in promoted sales are observed following implementation of the MSA and during periods of sustained cigarette excise tax increases. Conclusions: The observed pattern of promoted cigarette sales is suggestive of a positive relationship between retail cigarette promotions, the MSA, and state cigarette tax increases. More research is needed to describe fully the relationship between cigarette promotions and tobacco control policy. Copyright 2006, BMJ Publishing Group.
What drug policies cost. Estimating drug policy expenditures in Sweden, 2002: Work in progress.
Ramstedt M. Addiction 101(3): 330-338, 2006. (12 refs.)
To estimate drug policy expenditures in Sweden for 2002. The various governmental agencies with drug policy responsibilities were identified and then requested to provide information on their actual spending on these activities. For most agencies additional information was obtained from special studies or expert opinion. Drug policy expenditures are not easily identified in Swedish official statistics. The results have a very wide range between 500 and 1400 million Euros during 2002, with 950 million Euros as a baseline estimate. Two items each account for almost 60% of the total-police (including customs and courts) and corrections-whereas treatment expenditures and income support represent about one-fifth, respectively. Comparison with the most recent previous estimate (1991) shows a substantial higher level in 2002. The findings suggest that a great deal of money is invested in drug policy measures in Sweden today and that it has most probably increased since the early 1990s. This development probably reflects the increase in number of problematic drug users in Sweden as well as increasing attention paid to the drug problem, foremost in the criminal justice system. More work is needed in developing a drug budget that is more easily available and in producing more reliable estimates both across sectors and across time. The need to develop the conceptualization of drug policy measures is also discussed. Copyright 2006, Society for the Study of Addiction to Alcohol and Other Drugs.
Simulation modeling and tobacco control: Creating more robust public health policies.
Levy DT; Bauer JE; Lee HR. American Journal of Public Health 96(3): 494-498, 2006. (32 refs.)
Although previous empirical studies have shown that tobacco control policies are effective at reducing smoking rates, such studies have proven of limited effectiveness in distinguishing how the effect of policies depend on the other policies in place, the length of adjustment period, the way the policy is implemented, and the demographic groups considered. An alternative and complementary approach to purely statistical equations is simulation models. We describe the SimSmoke simulation model and how we used it to assess tobacco control policy in a specific case study. Simulation models are not only useful for policy prediction and planning but also may help to broaden our understanding of the role of different public health policies within a complex, dynamic social system. Copyright 2006, American Public Health Association.
The evolution of drug policy in Vancouver, Canada: Strategies for preventing harm from psychoactive substance use.
MacPherson D; Mulla Z; Richardson L. International Journal of Drug Policy 17(2): 127-132, 2006. (3 refs.)
In December of 2000, the City of Vancouver released its Four Pillars Drug Strategy in response to a serious public health crisis driven by illicit drug use in Vancouver. Following initial actions in the area of harm reduction and enforcement, in June 2005 the City of Vancouver developed its draft prevention plan titled "Preventing Harm from Psychoactive Substance Use". The plan is based on a synthesis of international research and evaluation, examples of successful programs from other jurisdictions, and a community dialogue process. Its recommendations fall under five key prevention priorities, including reducing risk factors and increasing protective factors across the life course, community centred interventions, addressing impacts on communities, legislative and public policy change and regulated markets. Together, these prevention priorities form an integrated plan to prevent harm from substance use. This article provides a description of the process leading to the development of the plan and seeks to articulate its key strategies. Copyright 2006, Elsevier Science.
A rational approach to formulating public policy on substance abuse.
Trunkey DD; Bonnono C. Journal of Trauma 59(3, Supplement): s61-s66, 2005. (17 refs.)
Unlike alcohol, which is legal and regulated, current public policy makes drugs such as heroin, cocaine, methamphetamines, and marijuana illegal. This article summarizes the history of drug and alcohol use in the United States, compares our public policies on alcohol to those on drugs, and shows the direct link between alcohol or drug use and crime, corruption, violence, and health problems in other countries and in our own. A rational approach to formulating a workable public policy is presented. Copyright 2005, Lippincott, Williams & Wilkins.
To legalize or not to legalize? Economic approaches to the decriminalization of drugs.
Bretteville-Jensen AL. Substance Use & Misuse 41(4): 555-565, 2006. (32 refs.)
Drug legalization is gaining ever-widening support in most Western societies. A liberalization of current drug laws will most probably lead to a fall in drug prices. The present article focuses on recent economic studies examining the effects of a fall in prices on quantities consumed and recruitment. Estimates of price elasticities indicate that a substantial increase in consumption by current drug users should be expected if prices decrease, whereas estimates of participation elasticities suggest all increase in the number of users. Tests of the so-called gateway theory (i.e., whether the use of a less harmful drug increases the risk of future use of more harmful drugs) offers less unambiguous results. Copyright 2006, Marcel Dekker, Inc.
Knowledge and use of the internet as a source of controlled substances.
Gordon SM; Forman RF; Siatkowski C. Journal of Substance Abuse Treatment 30(3): 271-274, 2006. (10 refs.)
Despite growing evidence that the internet is a source of controlled substances for nonmedical use, there is a lack of information about who is using it to obtain these drugs. One hundred adult drug-dependent inpatients in a private residential treatment program participated in a semistructured interview regarding how they obtained their drugs. Twenty-nine percent reported knowledge of the internet as a source of drugs, and 11% reported that they had used the internet to either buy drugs or locate a drug dealer. The results of this preliminary study suggest that the internet has become a source of controlled substances for some addicted individuals. Considerations for future research and clinical practice are described. Copyright 2006, Elsevier Science Ltd.
Marijuana markets: Inferences from reports by the household population.
Caulkins JP; Pacula RL. Journal of Drug Issues36(1): 173-200, 2006. (37 refs.)
Generally more is known about drug use and demand than about markets and supply, in large part because population survey data are available while market data are not. Although the household population represents a relatively small proportion of users of hard drugs, it represents a large proportion of the population using marijuana and participating in marijuana markets. This paper provides a description of marijuana market and acquisition patterns as reported by participants in the 2001 National Household Survey on Drug Abuse. We find that most respondents obtain marijuana indoors (87%), from a friend or relative (89%), and for free (58%). Retail marijuana distribution appears to be embedded in social networks rather than being dominated by "professional" sellers. Despite these contrasts with stereotypical street markets for cocaine and heroin, there are also similarities, such as evidence of quantity discounts and a minority of users accounting for the majority of purchases. We estimate that there are on the order of 400 million retail marijuana purchases in the U.S. each year and that the average purchase size is small, about six or seven joints. Copyright 2006, Journal of Drug Issues Inc.
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