Saturday, February 20, 2010

Looking for good resources on international drug policy?

International perspectives on drug policy are helpful for a few reasons.  First, some of the most interesting and progressive policies are happening outside the U.S.  Second, we need global strategies to meaningful address the worldwide problem of drug-related harm.  We certainly seem to have no problem conceiving of the 'war on drugs' as an effort that crosses international borders.  Why not start learning from our global neighbors about new approaches harm reduction, treatment and prevention?  The International Drug Policy Consortium isn't a bad place to start.  In addition to a library of more than 200 publications, they offer a great set of principles to guide best practices in national drug policy.  Imagine what U.S. drug policy would look like if we took these principles seriously:

Overarching principles:

1) Human Rights Principles
Articulating how the protection and promotion of human rights principles can be incorporated into national drug strategies and programmes, and issuing challenges under human rights legislation and procedures where these obligations are breached.
2) Harm Reduction Principles
Articulating how proven harm reduction concepts and programmes can be integrated into effective drug policy.
3) Social Inclusion Principles
Articulating how the most effective approaches to reducing the demand for drugs should focus on finding ways to counter the stigmatisation and marginalisation of drug users, and offer those who need it help to reintegrate into society.
4) Civil society engagement
Advocating to national governments the benefits of engaging with civil society. All too often, due to the political sensitivity in this field of policy, policy makers have viewed civil society as a problem to be avoided. If constructive mechanisms can be created for respectful engagement, however, NGOs (including user and family representatives) are an invaluable source of expertise, particularly in their understanding of what is happening in drug markets and drug using communities.
5)  Objective Setting and Data Gathering
To propose a structured approach to the assessment of priorities for national drug policies, focusing on the real health and social harms to individuals and communities.  To describe how a range of high level objectives can be articulated that are relevant to the particular situation, and examine the options open to policy makers for establishing systems to measure progress against those objectives.

Criminal justice:

1)  Better drug laws
Articulating the problems with the creation of harsh and unsophisticated drug laws, and the need for better legal frameworks, for example, for proportionate sentencing, diversion to treatment, and support for harm reduction. Building on the existing work of the Canadian HIV/AIDS Legal Network (who have developed and are piloting some of these materials), we hope eventually to be able to articulate and promote model legislation to governments around the world, who are developing or reviewing their domestic legislation.
2) A new role for law enforcement
Articulating a new role for drug law enforcement in the 21st century, moving away from a singular focus on arrest, seizure and punishment, and towards a contribution to tackling the consequences of drug markets in terms of crime and violence, community harms, public health and drug dependence treatment.
3)  Reducing incarceration
Articulating the evidence that widespread incarceration of drug users does not reduce prevalence, is expensive, and can increase health and crime problems. Producing ‘tool kits’ for national governments on the legal and criminal justice approaches that they can take to reduce incarceration.
4)  Effective policy for prisons
Looking at how prison administrations can implement best practices in supply reduction, prevention, treatment, and harm reduction in custodial institutions.

Health and social programmes

To promote systems of effective drug prevention and drug dependence treatment and care, based on the experience of humane and effective practice around the world.  Drug education and prevention will be based on models which have been shown to achieve meaningful outcomes. Drug dependence treatment should be delivered through an integrated system using evidence-based models. Harm reduction and other public health measures should be fully integrated into the treatment and care system.

Strengthening Communities / Community safety

To examine the ways that drug distribution at national and local level can cause crime and social problems for law abiding communities, and promote creative ways for policy makers, law enforcement agencies and communities to respond, focusing on the reduction of violence and intimidation experienced by citizens and communities. The exact nature of markets, and the related violence and disorder, varies in different parts of the world, but there is a common theme of ruthless protection of turf and profits, and some important lessons from experience of the authorities in attempting to tackle it.

Monday, February 15, 2010

The Neuroscientific Construction & Embodiment of Addiction

Because I can't get enough rejection, I submitted this abstract today in response to a call for papers about the sociology of neuroscience.  Whether or not I write something for this volume, I can't wait until it's published, since I really do think our love affair with neuroscience is under examined.  Actually, before we got to the abstract, here's one my favorite quotes illustrating the brave new world of the 'brain disease' model of addiction.

It’s all hypothesis at this point yet because we haven’t sliced open anyone’s brain yet, but it seems that normalizing the GABA receptor takes away the craving and anxiety that one would typically experience in the absence of the drug.  And it doesn’t appear to be happening because of will power, love, God, discipline, family support, or anything else.  It seems to be happening because the protocol resets a faulty mechanism in the brain.
-- Sanjay Sabani of Hythiam Corporation talking about a new pharmaceutical treatment for cocaine addiction (as quoted in The New York Times, 2006).

Interesting, isn't it, that that notion of addiction co-exists with 'war on drugs' approach to addiction?  Can you say... holy incoherent drug policy?

Here's the abstract:

Addiction is unique among medicalized social problems in that responses to addiction that frame it as a disease continue to co-exist uneasily with behavioral and legal responses that frame it as a crime or as a failure of will.  Recently, however, neuroscientific representations and technologies have begun to change the ways in which we understand, respond to, and treat drug addiction.  Increasingly, addiction and addiction treatment are being embodied and located in the human brain and materialized at the level of biochemical processes.  Concomitant with the ascendancy of the “brain disease” model of addiction has been an increased effort to find and promote neuroscientific “fixes” for the problem of addiction.  

The National Institute on Drug Abuse (NIDA) has been the most visible and active proponent of a neuroscientific model of addiction in the U.S.  Since its founding 1989, the Medications Development Program of NIDA has tested more than fifty medications to treat cocaine dependence, obtained FDA approval for two medications to treat opiate dependence, and has most recently developed an “depot” form of naltrexone in which reservoirs of a medication that blocks the effects of alcohol and opiates are implanted subcutaneously and released over a period of several weeks or months.  In 2004, the National Research Council and the Institute of Medicine (at the request of NIDA) produced a report on the use of immunotherapies, vaccines, and a variety of depot and sustained release formulations of medications to prevent and/or treat addiction most of which target neurochemical processes in the brain.  In addition, for the first time in seven decades, medical doctors in the U.S. have been granted the right to treat addiction with certain pharmaceuticals in office-based settings, a legislative change that many hope heralds the movement of addiction treatment into the medical mainstream and the triumph of a neuroscientific model of addiction. 

Relying on a review of the scientific literature as well as materials produce by NIDA and pharmaceutical companies selling addiction treatments, I argue that new neuroscientific drug treatment technologies are part of larger social, cultural, political and economic trends, including the increasing medicalization of social problems, the corresponding proliferation of pharmaceutical solutions, the rise of the medical industrial complex, and the movement away from carceral regimes of discipline towards new forms of self-governmentality.  I also argue that recently developed drug treatment technologies based on a neuroscientific understanding of addiction represent a renewed effort to move addiction fully into the realm of biomedicine and simultaneously shore up the tenuous boundaries between addict and patient, drug and medicine, drug dealer and doctor.  Finally, through an analysis of 37 interviews with patients being medically treated for opioid dependence, I explore how a new biochemical treatment technology (buprenorphine) and the neuroscientific representations that surround it are embodied and experienced in ways that are both constraining and offer new possibilities for autonomy. 

Thursday, February 4, 2010

New approach or more of the same?

On Monday,  the Office of National Drug Control Policy announced its 20100 budget proposal.  I had hoped new leadership in the White House would mean a new approach to drug policy --  one that focused on reducing drug-related harm, rather than on failed interdiction, law enforcement, and criminal justice approaches. Indeed, the press release announcing the budget proposal says:

"Funding for prevention measures under the President's proposal would increase 13.4 percent over the level of funding for the current fiscal year, and expenditures for treatment programs would be increased by 3.7 percent."

This is a step in the right direction, but with a total increase of 3.5%, one wonders just how many dollars are being wasted on failed drug war policies --  policies that do little stop the flow of drugs but do have a deleterious effect on our neighbors to the south.   I had hope for bolder leadership from the new drug czar, Kerlikowske.  Let's hope he's just getting started.

Wednesday, February 3, 2010

Some fabulous libraries for research

A lot of really interesting stuff has been written about drugs.  In fact, one the things I like most about the study of drugs is how many disciplines it crosses.  It seem that everyone has an opinion about the subject. 

Fortunately for those of us who can't get enough scholarship about drugs, the Drug Policy Alliance has the Lindesmith Library.  This collection is search-able online by going here and is well maintained by talented staff.  Those of us lucky to in or near New York City can make arrangements to visit the hard copy collection.  I've had many meetings in their library, and there is lots of enticing stuff.

For those of you with a passion for the history of medicine, my work place, The New York Academy of Medicine has a really interesting historical collection in a beautiful space.  They are doing a lot of work on digitizing parts of the collection.  You can see some of their digital exhibits here.