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...on policy issues
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www.ProjectCork.org
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Winter 2006
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Guidelines and challenges for estimating the economic costs and benefits of adolescent substance abuse treatments.
Zavala SK; French MT; Henderson CE; Alberga L; Rowe C; Liddle HA. Journal of Substance Abuse Treatment 29(3): 191-205, 2005. (98 refs.)
Many economic evaluations have been conducted for adult substance abuse treatments, but only a few have been conducted for adolescent-specific treatments. This is the first article to present rigorous methodological guidelines for estimating the economic costs and benefits of adolescent substance abuse treatments while also addressing the potential challenges associated with such research activities. A representative case study of two adolescent substance abuse treatment programs (one residential and one outpatient) is presented to show some of the initial steps of a comprehensive economic evaluation (e.g., cost analyses, selection of treatment outcome measures, and valuation of outcome measures via monetary conversion factors). Cost data were collected and analyzed using the Drug Abuse Treatment Cost Analysis Program. Monetary conversion factors were obtained and presented for a variety of treatment outcomes. The methodological guidelines, discussion of analytic challenges, and recommendations set forth in this article provide a foundation for future economic studies on adolescent substance abuse treatments. Copyright 2005, Elsevier Science Inc.
A comparative review of best practice guidelines for the diversion of drug related offenders. (review).
Bull M. International Journal of Drug Policy 16(4): 223-234, 2005. (77 refs.)
In recent decades rates of imprisonment have increased throughout the industrialised world as has the proportion of people whose imprisonment is linked to their use of illicit drugs. While the relationship between drug use and crime remains unclear, it has been argued that punitive responses alone are unsuccessful in reducing illegal drug use and associated crime. Disillusionment with traditional criminal justice approaches to drug-using offenders has renewed interest in programmes diverting drug related offenders from the criminal justice system. In the 1990s a number of diversion best practice guidelines became available, largely preceding the emerging evaluation literature. This represents a challenge for policy makers committed to evidence-based standards of best practice. This paper is a comparative analysis of best practice guidelines for various diversionary programmes delivered in different parts of the world. Consistent themes running through the guidelines and the relationship between these themes and the available evaluation literature were identified. The results of this qualitative meta-analysis suggest that sufficient evidence exists to support the principles outlined in these guidelines. Copyright 2005, Elsevier Science BV.
Recent trends in smoking and the role of public policies: Results from the SimSmoke tobacco control policy simulation model.
Levy DT; Nikolayev L; Mumford E. Addiction100(10): 1526-1536, 2005. (42 refs.)
Aims: After a period of steady decline in smoking prevalence, smoking rates leveled off in the United States between 1990 and 1997, but began falling between 1997 and 2003. Trends in smoking prevalence, and the role of tobacco control policies in affecting those rates, are examined. Design: A computer simulation model is used in which smoking prevalence evolves through initiation and cessation, which are in turn influenced by tobacco control policies. Methods: The results of the model are compared to smoking prevalence measures from the US National Health Interview Survey between 1993 and 2003. We also consider the role of tax/price, clean air laws, media campaigns and youth access policies in influencing these rates. Findings: Both the SimSmoke model and data for recent years indicate that adult smoking prevalence changed little between 1993 and 1997, and even increased among youth. Between 1997 and 2003, smoking prevalence has been declining. Most age, gender and racial-ethnic groups show patterns similar to that of the entire population, with differences for those aged 18-24 years. The predominant trends were explained mainly by changes in price, with some residual effect of clean air laws, media campaigns and youth access laws. Conclusions: Among public tobacco control policies, price had the dominant effect on smoking prevalence between 1993 and 2003, because few states implemented other policies to the degree necessary to affect much change. Through continued tax increases, stronger clean air laws, extensive media campaigns and broader cessation treatment programs, there is the potential to have much larger reductions in smoking prevalence. Copyright 2005, Society for the Study of Addiction to Alcohol and Other Drugs.
Attitudes and practices regarding the use of methadone in US State and federal prisons.
Rich JD; Boutwell AE; Shield DC; Key RG; McKenzie M; Clarke JG et al. Journal of Urban Health 82(3): 411-419, 2005. (51 refs.)
In the United States, vigorous enforcement of drug laws and stricter sentencing guidelines over the past 20 years have contributed to an expanded incarcerated population. with a high rate of drug use. One in five state prisoners reports a history of injection drug use, and many are opiate dependent. For over 35 years, methadone maintenance therapy has been an effective treatment for opiate dependence; however, its use among opiate-dependent inmates in the United States is limited. In June 2003, we conducted a survey of the medical directors of all 50 US states and the federal prison system to describe their attitudes and practices regarding methadone. Of the 40 respondents, having jurisdiction over 88% (n =1,266,759) of US prisoners, 48% use methadone, predominately for pregnant inmates or for short-term detoxification. Only 8% of respondents refer opiate-dependent inmates to methadone programs upon release. The results highlight the need to destigmatize the use of methadone in the incarcerated setting, expand access to methadone during incarceration, and to improve linkage to methadone treatment for opiate-dependent offenders who return to the community. Copyright 2005, Oxford University Press, Inc.
Estimating the dollar value of the illicit market for cannabis in New Zealand.
Wilkins C; Reilly JL; Pledger M; Casswell S. Drug and Alcohol Review 24(3): 227-234, 2005. (18 refs.)
New data collected on the procurement and purchase of cannabis in the 2001 New Zealand National Drug Survey are used to estimate the dollar value of the illicit market for cannabis as well conduct other economic analyses of the illicit purchase of cannabis in New Zealand. Eighty-four per cent of last-year cannabis users received at least some of their cannabis `free', 38% `bought' at least some of their cannabis, while only 8% grew any of their supply. By proportion of the total dollar value of the cannabis market, sales of `tinnies' (1.5 g) had the biggest share of the market (30%), followed closely by $50 bags (4 g) (29%) and ounces (28 g) (26%). The average price paid per gram of cannabis fell steadily from $20.50 per gram for a joint to $5.63 per gram for a pound ($ NZ). The distribution of spending on cannabis was positively skewed ( average $ 1313, median $400, mode $ 100, range $5-55200, interquartile range $100-1200) ($NZ). The bottom 50% of cannabis buyers spent a median amount on cannabis of $ 100 a year while the top 5% spent a median amount of $ 7425 a year ($ NZ). The dollar value of the illicit cannabis market was estimated to be $ 190 million ($131-249 million) ($ NZ). Three limitations are acknowledged with the market estimate calculated: (i) the truncated age range of the survey data (13-45 years); (ii) the likely underestimation of heavy cannabis use in household drug surveys; (iii) a degree of 'double-counting' when the same cannabis is bought and sold a number of times. Copyright 2005, Taylor & Francis Ltd.
Factors that influence staffing of outpatient substance abuse treatment programs.
Lemak CH; Alexander JA. Psychiatric Services 56(8): 934-939, 2005. (32 refs.)
Objective: This study examined whether and how various organizational and environmental forces influence staffing in outpatient substance abuse treatment programs. Methods: The authors used data from the 1995 and 2000 waves of the National Drug Abuse Treatment System Survey (NDATSS), a telephone survey of unit directors and clinical supervisors. Multivariate analyses with generalized estimating equations were conducted. Two measures of staffing were modeled: the number of weekly treatment hours per client, and active caseload. Results: Managed care activity influenced active caseloads but not the number of treatment hours per client. Significant differences were noted in staffing levels among private for-profit, private nonprofit, and public treatment programs, with public units offering fewer hours per client and having larger caseloads. Units accredited by the Joint Commission on Accreditation of Healthcare Organizations offered more treatment hours per client. Conclusions: The results of this study contribute to the understanding of various influences on treatment staff time and caseloads. Understanding these relationships is critical for policy makers, managed care companies, and managers, because staffing levels have the potential to affect both the cost and the quality of treatment. Copyright 2005, American Psychiatric Association.
The public health and social impacts of drug market enforcement: A review of the evidence. (review).
Kerr T; Small W; Wood E. International Journal of Drug Policy 16(4): 210-220, 2005. (150 refs.)
The primary response to the harms associated with illicit injection drug use in most settings has involved intensifying law enforcement in an effort to limit the supply and use of drugs. Policing approaches have been increasingly applied within illicit drug markets since the 1980s despite limited scientific confirmation of their efficacy. On the contrary, a growing body of research indicates that these approaches have substantial potential to produce harmful health and social impacts, including disrupting the provision of health care to injection drug user, increasing risk behaviour associated with infectious disease transmission and overdose, and exposing previously unaffected communities to the harms associated illicit with drug use. There are, however, alternatives to traditional targeted enforcement approaches that may have substantially less potential for negative health and social consequences and greater potential for net community benefit. Some of these approaches involve modifying policing practices, fostering partnerships between policing and public health agencies, and developing systems to monitor policing practices. Other alternatives involve the provision of harm reduction services, such as safer injecting facilities, that help to minimize drug-related harms, and addiction treatment services which ultimately help to reduce the demand for illicit drugs. Copyright 2005, Elsevier Science BV.
Tobacco industry price-subsidizing promotions may overcome the downward pressure of higher prices on initiation of regular smoking.
Pierce JP; Gilmer TP; Lee L; Gilpin EA; de Beyer J; Messer K. Health Economics 14(10): 1061-1071, 2005. (66 refs.)
Real cigarette prices in the US increased from the early 1980s to early 1990s. Holding all else equal, adolescent initiation of regular smoking should have declined during this period. Using national population-based surveys (n = 336 343) conducted in the 1990s, we present trends (early 1960s to mid-1990s) in the initiation of regular smoking among 14-17-year-old adolescents and 18-21-year-old young adults. We also present trends in consumer-price-index adjusted cigarette price and tobacco-industry expenditures for price-subsidizing promotions. We relate price and price-subsidizing tobacco industry expenditures to trends in initiation in the two age groups, using autoregressive integrated moving average models (ARIMA). From the model results, we conclude that price-subsidizing promotions may provide the tobacco industry with an effective way to segment the market. That is, they effectively offer lower prices to population subgroups that are more price-sensitive (e.g. young smokers not yet addicted), countering the depressing effect of general price increases on smoking. Thus, we find that the relationship of cigarette price to smoking behavior is more complex than previously described. Copyright 2005, John Wiley & Sons, Inc.
Neurobiology of addiction: Treatment and public policy ramifications. (editorial).
Dackis C; O'Brien C. Nature Neuroscience 8(11): 1431-1436, 2005. (50 refs.)
In the United States, efforts to treat addiction are hampered by prejudice and a public view that treats it as a disorder of self-control, not a disease. We highlight select advances in addiction research that, if disseminated to the public, could reverse these misconceptions and facilitate changes in policy to improve treatment access and care delivery for this highly prevalent disease. Copyright 2005, Nature Publishing Group.
Tobacco industry consumer research on socially acceptable cigarettes. (review).
Ling PM; Glantz SA. Tobacco Control 14(5): E3, 2005. (206 refs.)
Objective: To describe tobacco industry consumer research to inform the development of more "socially acceptable'' cigarette products since the 1970s. Methods: Analysis of previously secret tobacco industry documents. Results: 28 projects to develop more socially acceptable cigarettes were identified from Philip Morris, RJ Reynolds, British American Tobacco, and Lorillard tobacco companies. Consumer research and concept testing consistently demonstrated that many smokers feel strong social pressure not to smoke, and this pressure increased with exposure to smoking restrictions. Tobacco companies attempted to develop more socially acceptable cigarettes with less visible sidestream smoke or less odour. When presented in theory, these product concepts were very attractive to important segments of the smoking population. However, almost every product developed was unacceptable in actual product tests or test markets. Smokers reported the complete elimination of secondhand smoke was necessary to satisfy non-smokers. Smokers have also been generally unwilling to sacrifice their own smoking satisfaction for the benefit of others. Many smokers prefer smoke-free environments to cigarettes that produce less second-hand smoke. Conclusions: Concerns about secondhand smoke and clean indoor air policies have a powerful effect on the social acceptability of smoking. Historically, the tobacco industry has been unable to counter these effects by developing more socially acceptable cigarettes. These data suggest that educating smokers about the health dangers of secondhand smoke and promoting clean indoor air policies has been difficult for the tobacco industry to counter with new products, and that every effort should be made to pursue these strategies. Copyright 2005, B M J Publishing Group.
Community attitudes towards cannabis law and the proposed Cannabis Infringement Notice scheme in Western Australia.
Fetherston J; Lenton S. Drug and Alcohol Review 24(4): 301-309, 2005. (27 refs.)
Western Australia (WA) became the fourth Australian jurisdiction to adopt a prohibition with civil penalties scheme for minor cannabis offences when its Cannabis Infringement Notice (CIN) scheme became law on 22 March 2004. Previous criminological research has demonstrated the importance of public attitudes towards the law in determining the effectiveness of legislation. This survey represents the first phase of a pre-post study that attempted to gauge public attitudes towards the legal status of cannabis, the proposed legislative reforms surrounding the drug and their likely effects. A random telephone survey of 809 members of the WA population was conducted prior to the implementation of the new laws with a view to exploring contemporary views of the existing legal status of cannabis, attitudes to the proposed legislative model and respondent perceptions of its likely effects. Despite cannabis being viewed negatively by large numbers of the sample, criminal penalties for minor cannabis offences were viewed as inappropriate and ineffective. Once explained, the proposed civil penalty scheme was viewed as 'a good idea' by 79% of the sample, despite significant differences due to personal experience of cannabis use, political affiliation, religiosity and age of offspring. Most believed that the legislative change would not result in changes to levels of cannabis use (70%) or ease of obtaining cannabis (59%). These data suggest that prior to its implementation the new legislation was highly acceptable to the majority of the community. These baseline data will be compared with data to be collected at the post-change phase of the study to allow empirical observations of attitudinal and behavioural changes occurring in the community. Copyright 2005, Taylor & Francis Ltd.
Effect of the New York State cigarette fire safety standard on ignition propensity, smoke constituents, and the consumer market.
Connolly GN; Alpert HR; Rees V; Carpenter C; Wayne GF; Vallone D et al. Tobacco Control 14(5): 321-327, 2005. (15 refs.)
Objectives: This study examines empirical evidence from tNew York's experience testing tobacco industry arguments in opposition to fire safety standards for cigarettes. Design: Percentages of cigarettes exhibiting full length burns (FLBs), cigarette sales before and following the implementation of the New York standards, a sample of retail cigarette prices, brand availability, and selected smoke constituent yields were compared between cigarettes sold in New York and two other states. Cigarette paper analysis was conducted on cigarettes sold in New York. Results: New York cigarette brands averaged 10.0% FLBs as compared to 99.8% for California and Massachusetts brands. Reduced ignition propensity (RIP) appears to have been achieved by cigarette paper banding. Cigarette sales, prices, and brand availability do not appear to have been affected by the New York standards. Yields of the majority of smoke constituents tested did not differ substantially between RIP cigarettes sold in New York as compared to the same brands sold in Massachusetts. Average yields of tar, carbon monoxide, and two compounds were slightly higher, the yields of seven compounds were higher for one brand only, and nicotine was lower, among New York brands tested. Conclusions: RIP cigarette brands have been designed to meet the New York fire safety standards. Their introduction has not affected cigarette sales or prices in New York. There is no evidence that the small increases in smoke constituent yields affect the already highly toxic nature of cigarette smoke. Data on smoking caused fires, deaths, and injuries dating from after the change in law are not yet available. Such data will be able to address the question of whether the demonstrated reduced ignition standards are associated with reduced fires and injuries. Based on the New York experience, prior industry objections to producing RIP cigarettes are unfounded. Other states and nations should adopt similar standards. Copyright 2005, B M J Publishing Group.
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