Journal of Drug Policy Analysis

A Review of Ohio’s Treatment Capacity in Addressing the State’s Opiate Epidemic

R. Thomas Sherba et al. — Thu, 19 Jan 2012 10:43:27 PST

Ohio is currently in the midst of an opiate epidemic. Persons seeking treatment for opiate addiction are now inundating treatment centers in every region of the state. To understand further the capacity of Ohio’s treatment system to address the needs of opiate abusing and dependent clients, the Ohio Department of Alcohol and Drug Addiction Services (ODADAS) surveyed all treatment providers regarding service wait times and treatment barriers. Nearly 80 percent of providers statewide participated (N = 193). Results concluded that the proportion of clients accessing services across Ohio with an opiate abuse/dependence diagnosis has increased over the past 12 months. Almost a third of providers reported that opiate addicted clients now make up more than a quarter of all clients served. The state’s current treatment system is challenged in addressing the needs of Ohio’s rapidly increasing number of opiate addicted clients. Nearly 80 percent of providers reported wait times for assessment services; providers most frequently reported wait times of several weeks for residential treatment; and practically half of referring providers to Suboxone^®, and the majority of those referring to methadone programs, indicated difficulty in getting clients enrolled in medication-assisted treatment, citing capacity issues such as no program openings for methadone and lack of licensed physicians for Suboxone^®. The opiate epidemic has increased wait times for treatment services across the state, further straining Ohio's treatment capacity in an already challenged behavioral healthcare system. New policies are needed to expand treatment capacity and to limit nonmedical use of prescription opiates.

Marijuana Legalization: Certainty, Impossibility, Both, or Neither?

Jonathan P. Caulkins et al. — Tue, 10 Jan 2012 00:22:42 PST

Legalization has been debated for decades, but California’s Fall 2010 vote on Proposition 19 makes passage seem suddenly more plausible. Proposition 19, which would have legalized not only personal consumption but also production and distribution to supply recreational use, was defeated narrowly (53.5% to 46.5%). This article synthesizes several threads of evidence concerning public support for legalization in the U.S. to shed light on the likelihood some similar effort will pass in the future. The overall conclusion is noncommittal, but the exercise generates a number of insights. In particular, simple what-if exercises suggest that the effects of generational turnover and voting occurring in a presidential vs. an “off” year may be smaller than some thought. The concluding section translates some of the observations into implications for both proponents and opponents of marijuana legalization.

Inferring Cocaine Flows across Europe: Evidence from Price Data

Siddharth Chandra et al. — Sun, 07 Aug 2011 23:19:50 PDT

Price data for cocaine in Europe reported in the World Drug Report of 2010 are analyzed with the aim of inferring patterns of transnational cocaine flows across the continent. The concepts of market integration and price gradients are combined to identify the existence and directionality of flows, on the basis of which a geographic characterization of the movement of cocaine is constructed. The findings are broadly consistent with anecdotal data on cocaine flows reported in the World Drug Report. The methodology is, therefore, a simple and promising methodology that can supplement existing efforts by researchers and policy-makers to identify trouble spots with a view to managing the growing cocaine problem in Europe and drug problems in general.

An Analysis of Applicants Presenting to a Medical Marijuana Specialty Practice in California

Helen Nunberg et al. — Mon, 28 Feb 2011 11:01:32 PST

While 15 states and the District of Columbia provide allowances for medical marijuana, little is known about the individuals who seek a physician’s recommendation to use marijuana. This study provides descriptive information about 1,655 applicants in California who sought a physician’s recommendation for medical marijuana, the conditions for which they sought treatment, and the diagnoses made by the physicians. It presents a systematic analysis of physician records and questionnaires obtained from consecutive applicants seen during a three-month period at nine medical marijuana specialty practices operating throughout the state. The analysis yields insights that may be useful for future research on medical marijuana and marijuana policy, including: 1) very few of those who sought a recommendation had cancer, HIV/AIDS, glaucoma, or multiple sclerosis; 2) most applicants presented with chronic pain, mental health conditions, or insomnia; and 3) half of the applicants reported using marijuana as a substitute for prescription drugs.

Rational Addiction Theory: A Survey of Opinions

Hans O. Melberg et al. — Mon, 13 Dec 2010 07:14:08 PST

This paper reports on results from a survey of views on the theory of rational addiction among academics who have contributed to this research. The topic is important because if the literature is viewed by its participants as an intellectual game, then policy makers should be aware of this so as not to derive actual policy from misleading models. A majority of the respondents believe the literature is a success story that demonstrates the power of economic reasoning. At the same time, they also believe the empirical evidence to be weak, and they disagree both on the type of evidence that would validate the theory and the policy implications. These results shed light on how many economists think about model building, evidence requirements and the policy relevance of their work.

Is Medicinal Opium Production Afghanistan's Answer?: A Reply To Comments

Victoria A. Greenfield et al. — Tue, 18 May 2010 07:06:00 PDT

Poppy for Medicine: An Essential Part of a Balanced Economic Development Solution for Afghanistan's Illegal Opium Economy

Romesh Bhattacharji et al. — Tue, 18 May 2010 07:01:49 PDT

Given the current desperate state of both the counter-narcotics and counter-insurgency efforts in Afghanistan, there is little to lose in trying to implement Poppy for Medicine in the country. This proposal foresees the local production of an Afghan brand of morphine to boost the rural economy and diversify it over time. Poppy for Medicine does not pretend to completely wipe out illegal opium production. Instead, it aims to integrate as many poppy farmers as possible within the legal economy and cut off the biggest possible amount of income from the Taliban's funding base. The system would borrow successful elements from similar poppy licensing schemes in India and Turkey, and should reduce diversion to illegal channels over time while stressing compulsory economic diversification. By focusing on the unmet needs of morphine around the world, Poppy for Medicine would provide much needed painkillers to those people with little or no access to them – currently about 80 per cent of the world's population. In Afghanistan, you have to start somewhere and you have to start with something that works. Counter arguments focusing on corruption or a lack of institutional capacity to run or control these projects, should not be used to prevent us from testing whether the current situation (100 per cent diversion of opium towards illegal channels and into the pockets of the Taliban) can be considerably improved. Instead, Poppy for Medicine and similar economic development projects should be implemented to see whether they can boost the rural economy and build capacities and new skills at the same time.

Review of The World Heroin Market

Philip Keefer — Thu, 25 Mar 2010 11:39:34 PDT

For decades, international policies towards heroin have not deviated from an intense focus on cutting supply. Few analysts have supported this position, observing that suppliers respond to successful interdiction by developing new routes; and to aggressive efforts to curb production by changing production techniques and shifting production to new areas. Policy advocates have defended their position by emphasizing tons of drugs seized and hectares eradicated, while highlighting some of the apparent successes of policies targeted at supply: Thailand's elimination of opium production and the dramatic fall in opium cultivation in Afghanistan following prohibition by the Taliban. In their meticulous analysis, with new data on supplier responses to these policies, Paoli, Greenfield and Reuter (2009) cast substantial doubt on these defenses.

Behavioral Triage: A New Model for Identifying and Treating Substance-Abusing Offenders

Angela Hawken — Fri, 05 Feb 2010 12:21:53 PST

Over the last decade there have been several large-scale efforts to leverage the law to encourage substance-abusing offenders to enter treatment. A routine practice has developed in most states in which offenders undergo an assessment for drug abuse or dependence, and based on their self-reported behavior, those deemed to have a substance use disorder are referred to treatment programs. The problem with applying the assessment-treatment model in correctional systems is that both components of this approach are seriously flawed. An alternative model, using regular random testing coupled with modest sanctions, relies on offender observed behavior rather than self report, to signal need for treatment services. Many offenders are able to desist from drug use without treatment. This reallocation of resources creates greater opportunity to provide more-intensive treatment services to those who really need it. This paper proposes replacing the traditional assess-and-treat approach with an alternative model that bases treatment decisions on observed behavior: the behavioral triage model.

Is Medicinal Opium Production Afghanistan's Answer?: Lessons From India and the World Market

Victoria A. Greenfield et al. — Mon, 02 Nov 2009 14:37:36 PST

Poverty and corruption are pervasive in Afghanistan and opium production is rampant, especially in the country's most insecure southern regions. Afghanistan's opium production now accounts for the overwhelming majority of the world's heroin supply. The International Council on Security and Development, a European think tank formerly known as the Senlis Council, is advocating a policy response that it refers to as "Poppy for Medicine." Under the Council's proposal, poppy farmers in Afghanistan would gain access to the world's legal pharmaceutical market through a two-tiered licensing program. A careful examination of India's experience as the world's sole licensed exporter of raw opium and of the world market for legal opiates casts serious doubt on this proposal. Legal medicinal opium production is an improbable answer for at least five reasons: first, illegal production will continue; second, diversion from the legal market to the illegal market is inevitable; third, diversion will involve further corruption; fourth, there may not be a market; and fifth, Afghanistan lacks the institutional capacity to support a legal pharmaceutical industry.

United States Government Oversight and Regulation of Medication Assisted Treatment for the Treatment of Opioid Dependence

Thomas F. Kresina et al. — Sun, 25 Oct 2009 11:02:30 PDT

The federal government has a fundamental as well as critical role in the successful development, implementation and utilization of controlled medications for the treatment of opioid abuse and dependence. The development and implementation of a federal regulatory structure establishes minimum standards which provide the basis for the development of treatment policies and medical best practices for the treatment of drug abuse and dependence. In the United States, the use of pharmacotherapies in combination with counseling, behavior therapies and other core services including primary medical care provide a comprehensive therapeutic approach termed as an evidence-based best practice termed "Medication Assisted Treatment" (MAT). Federally supported research studies have shown that the most efficacious treatment for opioid abuse and dependence comprises treatment programs that utilize pharmacotherapies and include psychosocial counseling, financial, legal, educational services as well as wrap around social services (NIDA, 2000). Federal programs catalogue such evidence-based best medical practices and promote their implementation in the care and treatment of patients to optimize good medical outcomes. In a non regulatory role, federal programs can also mandate medical education and training as well as support the piloting of treatment improvement projects to develop national implementation strategies. Drug treatment programs that utilize MAT are regulated by the federal government in their adherence to treatment standards through accreditation and in their record keeping requirements for use of controlled pharmaceuticals. Thus, multiple federal agencies combine to support MAT in the treatment of opioid dependence throughout the treatment continuum from drug discovery to patient care and treatment outcome. Salient policy issues that involve MAT as a direct result of the federal regulatory structure(s) include the provision and integration of medical services into Opioid Treatment Programs (OTPs), infectious diseases prevention counseling, the availability of opioid treatment using either buprenorphine or methadone, the limited use of Suboxone/Subutex in OTPs and which health care providers can prescribe as well as the number of patients prescribed Suboxone/Subutex in an office based setting.

Is Objective Risk All That Matters When It Comes to Drugs?

Jonathan P. Caulkins et al. — Wed, 25 Mar 2009 12:41:09 PDT

Many more people die each year from alcohol and tobacco use than from illicit substance use, yet the American public appears far more concerned about illegal drugs. This paper suggests that some of this mismatch in concern may stem from differences in the types of deaths created, with deaths associated with illicit drugs being, on average, "scarier" to the public than are the deaths associated with legal substances. Hence, the mismatch between actual risks and public concern is not necessarily entirely wrong or irrational, but rather may embody stable preferences.

An Administrative Remedy for the Crack Mandatory Sentencing Problem

Mark A. R. Kleiman — Thu, 09 Oct 2008 10:14:38 PDT

Current Federal laws over-punish minor crack dealers. A legislative fix for the problem has proven politically infeasible. Drug, form, and quantity, which form the basis of the existing sentencing schema, are relatively poor proxies of the dangerousness of the offender or the harm created by the conduct-pattern underlying the case. An administrative requirement that low-level crack prosecutions be approved centrally could ensure that the five-years-for-five-grams mandatory sentence is not over-used, while keeping that sentence available for the relatively rare cases (e.g., as part of crackdowns on gang violence) in which it is justified.

A Free Lunch

Philip J. Cook — Thu, 09 Oct 2008 09:20:12 PDT

Federal and state excise taxes on alcoholic beverages have declined sharply in real value over the last 50 years. The result is cheaper alcohol, more alcohol abuse, and more alcohol-related problems of all sorts than would otherwise have occurred. Frequently voiced concerns that such taxes are regressive, or that they penalize the majority who drink moderately and safely, are off base. An increase in the federal alcohol taxes could provide almost everyone but the heaviest drinkers with a net financial gain even if there were no behavioral effects; the evidence that there are behavioral effects that improve health and safety is an important bonus. In a sense, alcohol taxes are the proverbial free lunch.

The Future of DIRECT Surveillance: Drug and alcohol use Information from REmote and Continuous Testing

Beau Kilmer — Thu, 09 Oct 2008 09:04:55 PDT

It is now possible for probation officers to detect probationer alcohol use remotely and continuously. This essay describes three devices intended to collect Drug and alcohol use Information from REmote and Continuous Testing, or what I call DIRECT surveillance. It also highlights some of the major questions associated with the implementation, consequences, and future of DIRECT surveillance. While most of the focus is on alcohol use among probationers and parolees, the essay does discuss the use of these technologies in other settings, and for other drugs. It also addresses issues related to other types of electronic monitoring which can be used separately or in conjunction with DIRECT surveillance (e.g., GPS).