Health and human rights organizations have endorsed drug decriminalization to promote public health-oriented approaches to substance use. In the US, policymakers have begun to pursue this via ...prosecutorial discretion—or the decision by a prosecutor to decline criminal charges for drug possession in their jurisdiction. This study characterizes drivers of adoption, policy design and implementation processes, and barriers to impact and sustainability of this approach to inform evolving policy efforts promoting the health of people who use drugs (PWUD).
We conducted n=22 key informant interviews with policymakers and national policy experts representing 13 jurisdictions implementing de facto drug policy reforms. Analyses were informed by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and analyzed using a hybrid inductive-deductive approach.
Drivers of policy adoption included racial inequities, perceived failures of criminalization, and desires to prioritize violent crime given resource constraints. Three distinct policy typologies are described with varying conditions for eligibility, linkage to services, and policy transparency and dissemination. Public misinformation, police resistance and political opposition were seen as threats to sustainability.
Given evidence that criminalization amplifies drug-related harms, many policymakers are adopting de facto drug policy reforms in the absence of formal legislation. This is the first study to systematically describe relevant implementation processes and emerging policy models. Findings have implications for designing rigorous evaluations on health outcomes and informing sustainable evidence-based policies to promote health and racial equity of PWUD in the US.
•Arrest and incarceration of people who use drugs are linked to negative health outcomes.•Prosecutorial discretion can be used to enact de facto decriminalization of drug possession.•Little is known about how these nascent policies are developed and implemented in the U.S.•We describe shared and distinct features of emerging policies in 14 jurisdictions nationally.•Findings have implications for evaluating impacts on health and racial equity.
Objectives
To assess the long‐term effects of the introduction of China's zero‐markup drug policy on hospitalisation expenditure and hospitalisation expenditures after reimbursement.
Methods
An ...interrupted time series was used to evaluate the impact of the zero‐markup drug policy on hospitalisation expenditure and hospitalisation expenditure after reimbursement at primary health institutions in Fufeng County of Shaanxi Province, western China. Two regression models were developed. Monthly average hospitalisation expenditure and monthly average hospitalisation expenditure after reimbursement in primary health institutions were analysed covering the period 2009 through to 2013.
Results
For the monthly average hospitalisation expenditure, the increasing trend was slowed down after the introduction of the zero‐markup drug policy (coefficient = −16.49, P = 0.009). For the monthly average hospitalisation expenditure after reimbursement, the increasing trend was slowed down after the introduction of the zero‐markup drug policy (coefficient = −10.84, P = 0.064), and a significant decrease in the intercept was noted after the second intervention of changes in reimbursement schemes of the new rural cooperative medical insurance (coefficient = −220.64, P < 0.001).
Conclusions
A statistically significant absolute decrease in the level or trend of monthly average hospitalisation expenditure and monthly average hospitalisation expenditure after reimbursement was detected after the introduction of the zero‐markup drug policy in western China. However, hospitalisation expenditure and hospitalisation expenditure after reimbursement were still increasing. More effective policies are needed to prevent these costs from continuing to rise.
Objectifs
Evaluer les effets à long terme de l'introduction de la politique chinoise de zéro augmentation du prix des médicaments sur les dépenses d'hospitalisation et les dépenses d'hospitalisation après le remboursement.
Méthodes
Une analyse de séries chronologiques interrompues a été utilisée pour évaluer l'impact de la politique de zéro augmentation du prix des médicaments sur les dépenses d'hospitalisation et les dépenses d'hospitalisation après le remboursement dans les établissements de soins primaires du Comté de Fufeng, dans la Province du Shaanxi, dans l'ouest de la Chine. Deux modèles de régression ont été développés. Les dépenses mensuelles moyennes d'hospitalisation et les dépenses mensuelles moyennes d'hospitalisation après le remboursement dans les établissements de soins de santé primaires ont été analysées pour la période allant de 2009 à 2013.
Résultats
Pour les dépenses mensuelles moyennes d'hospitalisation, la tendance à la hausse a été ralentie après l'introduction de la politique de zéro augmentation du prix des médicaments (coefficient: −16.49; P = 0.009). Pour les dépenses mensuelles moyennes d'hospitalisation après le remboursement, la tendance à la hausse a été ralentie après l'introduction de la politique de zéro augmentation du prix des médicaments (coefficient: −10.84; P = 0.064) et une diminution significative de l'ordonnée à l'origine (intercept) a été notée après la deuxième intervention de changements dans les schémas de remboursement de la nouvelle assurance maladie de coopérative rurale (coefficient = −220.64; P < 0.001).
Conclusions
Une diminution absolue statistiquement significative du niveau ou de la tendance des dépenses mensuelles moyennes d'hospitalisation et des dépenses mensuelles moyennes d'hospitalisation après le remboursement a été observée après l'introduction de la politique de zéro augmentation du prix des médicaments dans l'ouest de la Chine. Cependant, les dépenses d'hospitalisation et les dépenses d'hospitalisation après le remboursement étaient toujours en augmentation. Des politiques plus efficaces sont nécessaires pour éviter que ces coûts continuent d'augmenter.
Mots‐clés
politique nationale des médicaments essentiels, politique de zéro augmentation du prix des médicaments, dépense d'hospitalisation, analyse des séries chronologiques interrompues, Chine
Objetivos
Evaluar los efectos a largo plazo de la introducción de la política China “zero markup drug policy” (ZMDP) sobre el gasto de hospitalización y el gasto de hospitalización después del reembolso.
Métodos
Se utilizó una serie de tiempo interrumpida para evaluar el impacto de la política ZMDP sobre el gasto de hospitalización y el gasto de hospitalización después del reembolso en instituciones sanitarias de atención primaria del Condado de Fufeng, Provincia de Shaanxi, China occidental. Se desarrollaron dos modelos de regresión. Se analizaron el gasto medio mensual de hospitalización y el gasto medio mensual de hospitalización después del reembolso de instituciones sanitarias de atención primaria, durante el periodo comprendido entre el 2009 ‐ 2013.
Resultados
Para el gasto medio mensual hospitalario, la tendencia creciente se ralentizaba después de la introducción de la política ZMDP (coeficiente = −16.49, P = 0.009). Para el gasto medio mensual de hospitalización después del reembolso, la tendencia creciente se ralentizaba después de la introducción de la política ZMDP (coeficiente = −10.84, P = 0.064) y se notaba una disminución significativa en el intercepto después de la segunda intervención de cambios en el esquema de reembolsos del nuevo seguro médico rural cooperativo (coeficiente = −220.64, P < 0.001).
Conclusiones
Se detectó una disminución absoluta estadísticamente significativa en el nivel o tendencia del gasto mensual medio de hospitalización y del gasto mensual medio de hospitalización después del reembolso tras la introducción de la política ZMDP en China occidental. Sin embargo, el gasto de hospitalización y el gasto de hospitalización después de reembolso aún aumentaban. Se requieren políticas más efectivas para prevenir que estos costes continúen aumentando.
Palabras clave
Política nacional de medicamentos esenciales, zero markup drug policy, gasto de hospitalización, análisis de series de tiempo interrumpidas, China
The practice of prescription opioid (PO) diversion remains highly controversial and has been characterized as a source of significant drug-related harm by physicians and public health officials. We ...critically analyze the “problem” of diversion through an examination of the perspectives of people who divert POs during an overdose epidemic to better understand the practice, including benefits and challenges, as well as how diversion is shaped by structural contexts. Qualitative semi-structured interviews were conducted with 21 participants recruited from ongoing cohort studies involving people who use drugs in Vancouver, Canada. Prohibitive prescribing policies made accessing POs difficult, leading some to smuggle drugs out of clinics. Others would buy POs in bulk or do trades to acquire them. Participants risked having their prescriptions terminated, but rationalized this risk as a protective measure that allows them to provide safer drugs to others (e.g., to prevent overdose or treat withdrawal). Poverty also framed diversion, with some participants diverting their POs to generate income to pay for expenses including food and sometimes illicit fentanyl (perceived as a stronger alternative). However, diversion was shaped by other constraints, including criminalization, negative health impacts from not consistently consuming POs, and supplies running out, which led some participants to rely on other illegal means to generate income. This study highlights the intricate means by which POs are acquired and diverted and how environmental contexts frame how participants negotiated risk and rationalized diversion. Our study provides an alternative perspective on the “problem” of diversion and demonstrate a positive effect in providing a safer drug supply to others during an overdose crisis. Given that drug policy, criminalization, and poverty created challenges, our findings demonstrate the need for strategies that engender greater safety, reduce harm, and alleviate the effects of these constraints, including through policies promoting safer drug supplies, decriminalization, and employment.
•The “problem” of prescription opioid diversion is examined.•Diversion was rationalized as a protective measure for others.•Social and structural contexts framed motivations for diversion.•Strategies are needed to reduce harms and alleviate contextual constraints.•Policies promoting decriminalization and a safer drug supply are needed.
The War on Drugs Turns 50 Campbell, Emily B.
Contexts (Berkeley, Calif.),
08/2022, Letnik:
21, Številka:
3
Journal Article
A discussion of major developments since the war on drugs launched in 1971 including mass incarceration, the overdose crisis, and the Mexican drug war. Challenges are described and solutions ...considered.
Introduction
In 2000, the Portuguese minority socialist government decriminalized the possession and consumption of drugs. This law made Portugal unique in having a formal system that directs the ...person using drugs to a panel under the purview of the Ministry of Health, as opposed to the Ministry of Justice, and hence constitutes an ‘original innovation’. In this article, we ask under which conditions such kinds of reforms are introduced and successfully implemented.
Aims and design
After discussing the limitations of the existing literature, we present a new theoretical framework: the ‘six‐stars’ framework. We argue that successful policy innovation in democracies will only occur and persist when six institutional and individual ‘stars’ are aligned: attention, motivation to innovate, a new solution, political strategies, quality and legitimacy of the decision‐making process and guarantees for full implementation. We then apply this framework to the Portuguese Drug Policy Case through theory‐testing/process‐tracing. Relying upon a qualitative analysis of three different types of data—primary and secondary sources, official documents emitted by key actors and interviews—we identify the presence of the six aligned ‘stars’.
Conclusions
The proposed ‘six‐stars’ framework of successful drug policy innovation shows the importance of electoral mandates, communication, inclusion, transparency, deliberation and evaluation when designing innovative drug policies. It also illustrates the importance of ensuring the support of implementing agents and quickly creating visible, positive policy feedback.
Aims
To (1) assess trends and variation in the market share of product types and potency sold in a legal cannabis retail market and (2) estimate how potency and purchase quantity influence price ...variation for cannabis flower.
Design
Secondary analysis of publicly available data from Washington State's cannabis traceability system spanning 7 July 2014 to 30 September 2016. Descriptive statistics and linear regressions assessed variation and trends in cannabis product variety and potency. Hedonic regressions estimated how purchase quantity and potency influence cannabis flower price variation.
Setting
Washington State, USA.
Participants
(1) A total of 44 482 176 million cannabis purchases, including (2) 31 052 123 cannabis flower purchases after trimming price and quantity outliers.
Measurements
Primary outcome measures were (1) monthly expenditures on cannabis, total delta‐9‐tetrahydrocannabinol (THC) concentration and cannabidiol (CBD) concentration by product type and (2) excise tax‐inclusive price per gram of cannabis flower. Key covariates for the hedonic price regressions included quantity purchased, THC and CBD.
Findings
Traditional cannabis flowers still account for the majority of spending (66.6%), but the market share of extracts for inhalation increased by 145.8% between October 2014 and September 2016, now comprising 21.2% of sales. The average THC‐level for cannabis extracts is more than triple that for cannabis flowers (68.7% compared to 20.6%). For flower products, there is a statistically significant relationship between price per gram and both THC coefficient = 0.012; 95% confidence interval (CI) = 0.011–0.013 and CBD (coefficient = 0.017; CI = 0.015–0.019). The estimated discount elasticity is −0.06 (CI = −0.07 to −0.05).
Conclusions
In the state of Washington, USA, the legal cannabis market is currently dominated by high‐THC cannabis flower, and features growing expenditures on extracts. For cannabis flower, both THC and CBD are associated with higher per‐gram prices, and there are small but significant quantity discounts.
O objetivo deste artigo é analisar como se estrutura e se transforma o debate público sobre a política de drogas no Brasil entre os anos de 2003 e 2016. Para responder a essa problematização, foram ...analisados 306 materiais publicados no jornal Zero Hora. A análise demonstra que houve mudanças significativas na configuração do debate público sobre o "problema das drogas" no país na última década. Mais especificamente, é demonstrado que o debate público tende a ser mais heterogêneo, em termos de agentes e de enquadramentos, do que aquilo que se expressa na política de drogas vigente. Identificar e analisar essa heterogeneidade é importante para a compreensão das controvérsias e das posições em disputa sobre a política de drogas.
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