Since the early twentieth century, the United States has led a global prohibition effort against certain drugs in which production restriction and criminalization are emphasized over prevention and ...treatment as means to reduce problematic usage. This “war on drugs” is widely seen to have failed, and periodically decriminalization and legalization movements arise. Debates continue over whether the problems of addiction and crime associated with illicit use of drugs stem from their illegal status or the nature of the drugs themselves. In The Long War on Drugs Anne L. Foster explores the origin of the punitive approach to drugs and its continued appeal despite its obvious flaws. She provides a comprehensive overview, focusing not only on a political history of policy developments but also on changes in medical practices and understanding of drugs. Foster also outlines the social and cultural changes prompting different attitudes about drugs; the racial, environmental, and social justice implications of particular drug policies; and the international consequences of US drug policy.
The Drug Wars in America, 1940–1973 argues that the US government has clung to its militant drug war, despite its obvious failures, because effective control of illicit traffic and consumption were ...never the critical factors motivating its adoption in the first place. Instead, Kathleen J. Frydl shows that the shift from regulating illicit drugs through taxes and tariffs to criminalizing the drug trade developed from, and was marked by, other dilemmas of governance in an age of vastly expanding state power. Most believe the 'drug war' was inaugurated by President Richard Nixon's declaration of a war on drugs in 1971, but in fact his announcement heralded changes that had taken place in the two decades prior. Frydl examines this critical interval of time between regulation and prohibition, demonstrating that the war on drugs advanced certain state agendas, such as policing inner cities or exercising power abroad.
Society's drug problem will persist, and debates over how to solve it will continue, getting nowhere, until we define our terms. This book is an effort to do just that--to parse the legal, moral, and ...philosophical underpinnings for any discussion of.
Drugs, Crime and Public Health provides an accessible but critical discussion of recent policy on illicit drugs. Using a comparative approach - centred on the UK, but with insights and complementary ...data gathered from the USA and other countries - it discusses theoretical perspectives and provides new empirical evidence which challenges prevalent ways of thinking about illicit drugs. It argues that problematic drug use can only be understood in the social context in which it takes place, a context which it shares with other problems of crime and public health. The book demonstrates the social and spatial overlap of these problems, examining the focus of contemporary drug policy on crime reduction. This focus, Alex Stevens contends, has made it less, rather than more, likely that long-term solutions will be produced for drugs, crime and health inequalities. And he concludes, through examining competing visions for the future of drug policy, with an argument for social solutions to these social problems.
1. Starting Points: Drugs, Values and Drug Policy 2. ‘Afflictions of Inequality’? The Social Distribution of Drug Use, Dependence and Related Harms 3. Beyond the Tripartite Framework: The Subterranean Structuration of the Drug-Crime Link 4. Telling Policy Stories: Governmental Use of Evidence and Policy on Drugs and Crime 5. The Ideology of Exclusion: Cases in English Drug Policy 6. The Effects of Drug Policy 7. International Perspectives: Does Drug Policy Matter? 8. Towards Progressive Decriminalisation
Alex Stevens is a Professor in Criminal Justice at the University of Kent. He has worked on issues of drugs, crime and health in the voluntary sector, as an academic researcher and as an adviser to the UK government, and has published extensively on these issues.
Illicit drugs are an emerging class of environmental contaminants and mass spectrometry is the technique of choice for their analysis. This landmark reference discusses the analytical techniques used ...to detect illicit drugs in wastewater and surface water, details how to estimate the levels of contaminants in the environment, and explores the behavior, fate, and toxic effects of this new class of contaminants, now a ubiquitous presence in wastewater and surface water. The book details how an estimate of illicit drug consumption in a given population can be developed from an analysis of the residues of illicit drugs in wastewater. An important resource for analytical chemists, environmental researchers, forensic scientists, biologists, and toxicologists.
ADA Standards of Medical Care considers 14-day CGM-based GMI an A1c surrogate for clinical management. To date, supporting evidence is from T1D or insulin-treated T2D populations. As CGM demand and ...access grows, quantifying A1c-GMI discordance in diverse T2D populations can inform practice. We evaluated this discordance, stratified by T2D drugs and A1c. CGM-wearing adults with T2D, an overlapping A1c and GMI date (10/2019 to 3/2022), and CGM data sufficiency (DS) ≥ 70% were included. Prior 3 month pharmacy claims defined drug histories. We calculated the Pearson correlation coefficient (r) and A1c-GMI differences by subgroup. A1c-GMI pairs existed for 2,760 people (mean SD age 55 9; 46% F; 58% had A1c <7%). Overall, pairs highly correlated (56% differed by <0.5%; r=0.80). Non-insulin T2D drug users (N=1,674) had slightly higher concordance than basal insulin (N=437) and basal-bolus insulin users (N=317), with 58%, 50%, and 56% discordance <0.5% (r=0.79, 0.77, 0.77). On average, A1c underestimated GMI for non-insulin users and overestimated GMI for basal and basal-bolus insulin users. Concordance decreased at A1c extremes, with 61-76% concordance for A1cs from 5.7% to 8%. Sensitivity analyes with lower DS had similar results. A1c-GMI discordance varied by T2D drug class and A1c, highlighting how CGM-derived measures can provide personalized insights for diverse T2D populations.
Disclosure
A.Jhuang: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group. S.Bacon: Employee; Optum Labs, Research Support; Level2. S.Kamrudin: Employee; UnitedHealth Group. N.Thompson: Employee; Level2, Stock/Shareholder; UnitedHealth Group. C.Clark: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group.
Primary care providers need effective strategies for substance use screening and brief counseling of adolescents. We examined the effects of a new computer-facilitated screening and provider brief ...advice (cSBA) system.
We used a quasi-experimental, asynchronous study design in which each site served as its own control. From 2005 to 2008, 12- to 18-year-olds arriving for routine care at 9 medical offices in New England (n = 2096, 58% females) and 10 in Prague, Czech Republic (n = 589, 47% females) were recruited. Patients completed measurements only during the initial treatment-as-usual study phase. We then conducted 1-hour provider training, and initiated the cSBA phase. Before seeing the provider, all cSBA participants completed a computerized screen, and then viewed screening results, scientific information, and true-life stories illustrating substance use harms. Providers received screening results and "talking points" designed to prompt 2 to 3 minutes of brief advice. We examined alcohol and cannabis use, initiation, and cessation rates over the past 90 days at 3-month follow-up, and over the past 12 months at 12-month follow-up.
Compared with treatment as usual, cSBA patients reported less alcohol use at follow-up in New England (3-month rates 15.5% vs 22.9%, adjusted relative risk ratio aRRR = 0.54, 95% confidence interval 0.38-0.77; 12-month rates 29.3% vs 37.5%, aRRR = 0.73, 0.57-0.92), and less cannabis use in Prague (3-month rates 5.5% vs 9.8%, aRRR = 0.37, 0.17-0.77; 12-month rates 17.0% vs 28.7%, aRRR = 0.47, 0.32-0.71).
Computer-facilitated screening and provider brief advice appears promising for reducing substance use among adolescent primary care patients.
Introduction
People with mental illness are overrepresented throughout the criminal justice system. In Italy, an ongoing process of deinstitutionalization has been enacted: the Judicial Psychiatric ...Hospitals are now on the edge of their closure in favor of small-scale therapeutic facilities (Residenze per l’Esecuzione delle Misure di Sicurezza - REMS). Law 81/2014 prescribes that a patient cannot stay in a REMS for a period longer than a prison sentence for the same index offense. Therefore, when patients end their duty for criminal behaviors, their clinical management moves back to outpatient psychiatric centers. Elevated risks of violent behavior are not equally shared across the spectrum of psychiatric disorders. In the past several years, multiple studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse.
Objectives
In order to broaden the research in this area, we analyzed sociodemographic, clinical and forensic variables of a group of psychiatric patients with a history of criminal behaviors, attending an outpatient psychiatric service in Milan, with a focus on substance abuse.
Methods
This is a cross-sectional single center study, conducted in 2020. Seventy-six subjects with a history of criminal behaviors aged 18 years or more and attending an outpatient psychiatric service were included. Demographic and clinical variables collected during clinical interviews with patients were retrospectively retrieved from patients’ medical records. Appropriate statistical analyses for categorical and continuous variables were conducted.
Results
Data were available for 76 patients, 51,3% of them had lifetime substance abuse. Lifetime substance abuse was significantly more common in patients with long-acting injectable antipsychotics therapy, >3 psychiatric hospitalizations, history of previous crimes and economic crime (Table 1). Additionally, this last potential correlation was confirmed by logistic regression.
Table 1.
Lifetime substance abusers (N=39)
Non-lifetime substance abusers (N=37)
Proportion Difference
P-value
N
%
N
%
Depot administration
Yes
11
(28,9%)
0
(0%)
28,9%
0,02
Hospitalizations
Four or more
25
(64,1%)
5
(33,3%)
30,8%
0,04
Economic crime
Yes
15
(40,5%)
1
(6,7%)
33,8%
0,02
Previous crimes
Yes
17
(51,4%)
2
(13,3%)
38,1%
0,02
Conclusions
Data emerging from this survey provide new information about offenders in an Italian mental health service with a focus on lifetime substance abuse in these patients. Our preliminary results should be confirmed in larger sample sizes.
Disclosure of Interest
None Declared
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