Tough on Drugs: Law and Order Dominance and the Neglect of Public Health in U.S. Drug Policy

Neill, Katharine A.

doi:10.1002/wmh3.123

Cited by 14 publications

(12 citation statements)

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“…This finding demonstrates that SIFs may be an effective approach to reduce the high rate of fentanyl-attributable fatal overdoses observed in Rhode Island and in other regions throughout the USA [ 54 , 55 ]. For decades, United States drug policy has focused on combating drug trafficking, yet illicit drug prices have decreased, rates of drug use (specifically heroin use) are increasing, and overdose mortality rates are at an all-time high [ 26 , 36 ]. Further exacerbating overdose risk is the increasing presence of potent contaminants (notably fentanyl) in heroin, counterfeit pills, and other drugs [ 32 , 56 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

“…Further exacerbating overdose risk is the increasing presence of potent contaminants (notably fentanyl) in heroin, counterfeit pills, and other drugs [ 32 , 56 , 57 ]. In this context, it is very unlikely that continuing to pursue “supply side” interventions and zero tolerance/abstinence-based policies will address this public health issue in an effective way [ 36 , 58 ]. Rather, robust harm reduction programming and increased access to evidence-based treatment services are more paramount than ever to address the rising incidence of fentanyl-attributable overdose deaths [ 32 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

“…In Rhode Island, a wide array of stakeholders has collaborated to facilitate community responses to the overdose and fentanyl epidemic and to increase access to naloxone and to treatment and recovery services, but more efforts are needed to prevent overdose morbidity and mortality [ 35 ]. In general, while important successes have been achieved in the drug policy reform and harm reduction movements, drug policy in the USA has until very recently been framed as having zero tolerance/abstinence as the goal, with addiction largely treated as a criminal justice issue instead of as a public health one [ 36 ]. Despite the mounting evidence that harm reduction interventions such as syringe services programs are highly effective at preventing an array of drug-related harms, the implementation of many evidence-based programs, including SIFs, is non-existent or lacking in the USA [ 36 ].…”

Section: Introductionmentioning

confidence: 99%

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Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study

et al. 2017

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BackgroundSupervised injection facilities (SIFs) are legally sanctioned environments for people to inject drugs under medical supervision. SIFs currently operate in ten countries, but to date, no SIF has been opened in the USA. In light of increasing overdose mortality in the USA, this study evaluated willingness to use a SIF among youth who report non-medical prescription opioid (NMPO) use.MethodsBetween January 2015 and February 2016, youth with recent NMPO use were recruited to participate in the Rhode Island Young Adult Prescription Drug Study (RAPiDS). We explored factors associated with willingness to use a SIF among participants who had injected drugs or were at risk of initiating injection drug use (defined as having a sex partner who injects drugs or having a close friend who injects).ResultsAmong 54 eligible participants, the median age was 26 (IQR = 24–28), 70.4% were male, and 74.1% were white. Among all participants, when asked if they would use a SIF, 63.0% answered “Yes”, 31.5% answered “No”, and 5.6% were unsure. Among the 31 participants reporting injection drug use in the last six months, 27 (87.1%) reported willingness to use a SIF; 15 of the 19 (78.9%) who injected less than daily reported willingness, while all 12 (100.0%) of the participants who injected daily reported willingness. Compared to participants who were unwilling or were unsure, participants willing to use a SIF were also more likely to have been homeless in the last six months, have accidentally overdosed, have used heroin, have used fentanyl non-medically, and typically use prescription opioids alone.ConclusionsAmong young adults who use prescription opioids non-medically and inject drugs or are at risk of initiating injection drug use, more than six in ten reported willingness to use a SIF. Established risk factors for overdose, including homelessness, history of overdose, daily injection drug use, heroin use, and fentanyl misuse, were associated with higher SIF acceptability, indicating that young people at the highest risk of overdose might ultimately be the same individuals to use the facility. Supervised injection facilities merit consideration to reduce overdose mortality in the USA.Electronic supplementary materialThe online version of this article (doi:10.1186/s12954-017-0139-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study

et al. 2017

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“…Since the latter part of the twentieth century, the war on drugs has primarily been the paradigm in which our government has responded to eradicating drugs and punishing offenders (Neil, 2014). The punitive focus on zero-tolerance policies, increased penalties, and incarceration became a substitute for treatment, leaving the needs of drug users unmet (Neil, 2014). Even in the realm of corrections, mainly prisons, the focus on offenders was more about punishment rather than rehabilitation (Balboni, 2013).…”

Section: Policy Implicationsmentioning

confidence: 99%

Confronting the opioid epidemic: public opinion toward the expansion of treatment services in Virginia

Cook

Worcman

2019

Health Justice

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Background Public opinion polls have consistently shown Americans prefer treatment over arrest policies for opioid users. As the opioid epidemic remains a major health problem in the United States, it is important to determine the type of treatment policies the public would support. Theoretically, government should take into consideration the opinion of its constituents when deciding how to act. As such, the 2018 Virginia Commonwealth Public Policy Poll determined levels of support for the expansion of community-based treatment in one’s community. Results Overall, the results showed 80% of Virginians ( n = 788) supported the expansion of community-based treatment centers in their neighborhood, 69% supported the use of housing in their community, while less than half supported the provision of clean needles to IV drug users so they do not use dirty needles that could spread infection. Multivariate analyses revealed education, sex, and political party affiliation are significant factors in predicting support for the expansion of services. Conclusions Given the lack of progress made by the government in reducing the supply and demand of drugs over the course of the war on drugs, it is time to move away from punitive policies to responsible and pragmatic approaches that include the expansion of community-based treatment.

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“…The social construction of drug users as a target population arises in a number of studies from the US, UK and Australia (Amundson, Zajicek, & Kerr, 2015;Lybecker, McBeth, Husmann, & Pelikan, 2015;Neill, 2014;MacGregor, 2013;Stevens, 2011;Hudebine, 2005;Elliott & Chapman, 2000). Influenced by the works of Schneider and Ingram (1997) and notions of 'deservedness', these studies focus on the impact on policy of the negative construction of drug users as a deviant population.…”

Section: Target Populationsmentioning

confidence: 99%

Ideation, social construction and drug policy: A scoping review

Gstrein

2018

International Journal of Drug Policy

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Within drug policy scholarship there is a growing body of literature applying ideational and social constructionist approaches to address the complexity of drug policy making and the apparent failure of the evidence-based policy paradigm to free the process from controversy and contestation. Ideational approaches are concerned with the roles played by ideas and beliefs in policy making, while social construction explores the way policy problems are constructed, and agendas are set and delineated by dominant frames and narratives. Interest in these approaches has developed over the last two decades, but has rapidly gained momentum over the last five years. There has been limited reflection on the state of the field, therefore it is timely to conduct a review of the literature to assess the value of these approaches, capture emerging themes and issues, and identify gaps in the literature to support future research directions. Using the Arksey and O'Malley framework, a scoping review was conducted to survey the breadth of the field. Following database and hand searching, 48 studies from 1996 to 2016 were selected for inclusion in the review. A narrative synthesis was undertaken and the literature was grouped into five broad theoretical approaches: ideational policy theory, problem construction, narratives and frames (including media analysis), construction of target populations, and policy transfer and mobilities. The majority of the studies are focused on single countries and drug policy issues, with few studies undertaking comparative work or reflecting on general theoretical developments in the literature. This study found that the Arksey and O'Malley framework was effective in capturing a potentially diverse field of literature and demonstrates the importance of ideational and social constructionist approaches to drug policy scholarship. Further research is required to achieve expanded geographic coverage, test policy making models and undertake comparative work.

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Tough on Drugs: Law and Order Dominance and the Neglect of Public Health in U.S. Drug Policy

Cited by 14 publications

References 16 publications

Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study

Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study

Confronting the opioid epidemic: public opinion toward the expansion of treatment services in Virginia

Ideation, social construction and drug policy: A scoping review

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