Evidence-based drug policy is a phrase you don’t read that often. Many searches for this phrase return articles that explore why we don’t have evidence-based policies for illicit drugs and why the evidence base is weak in this area.
A group of international researchers and policy makers (including two UK-based professionals) are trying to buck this trend by publishing a paper in The Lancet which summarises the evidence for making drugs less available, reducing violence in drug markets, lessening misuse of legal pharmaceuticals, preventing drug use initiation in young people, and reducing drug use and its consequences in established drug users.
The authors have been involved with various public sector, academic, commercial and charity initiatives around UK drug and alcohol policy and research for many years. They state that this paper is very much their own personal view and is in no way linked to government policy or any other specific organisational viewpoint.
The paper covers supply control, prescription regimens to control pharmaceutical drugs, prevention, health and social services for drug users, and drug policy to promote the public good.
Key messages from the paper are:
- Drug policy should aim to promote the public good by improving individual and public health, neighbourhood safety, and community and family cohesion, and by reducing crime
- The effectiveness of most drug supply control policies is unknown because little assessment has been done, and very little evidence exists for the effectiveness of alternative development programmes in source countries
- Supply controls can result in higher drug prices, which can reduce drug initiation and use but these changes can be difficult to maintain
- Wide-scale arrests and imprisonments have restricted effectiveness, but drug testing of individuals under criminal justice supervision, accompanied by specific, immediate, and brief sentences (eg, overnight), produce substantial reductions in drug use and offending
- Prescription regimens minimise but do not eliminate non-medical use of psychoactive prescription drugs. Prescription monitoring systems can reduce inappropriate prescribing
- Screening and brief intervention programmes have, on average, only small effects, but can be widely applied and are probably cost-effective
- The collective value of school, family, and community prevention programmes is appraised differently by different stakeholders
- The provision of opiate substitution therapy for addicted individuals has strong evidence of effectiveness, although poor quality of provision reduces benefit. Peer-based self-help organisations are strongly championed and widely available, but have been poorly researched until the past two decades
- Health and social services for drug users covering a range of treatments, including needle and syringe exchange programmes, improve drug users’ health and benefit the broader community by reducing transmission of and mortality due to infectious disease
The paper is available in free full-text, but you have to register on The Lancet website to read it. Registration is free.
Prof John Strang MD, Prof Thomas Babor PhD, Prof Jonathan Caulkins PhD, Prof Benedikt Fischer PhD, Prof David Foxcroft PhD, Prof Keith Humphreys PhD. Drug policy and the public good: evidence for effective interventions. The Lancet, 7 Jan 2012, Vol.379, Issue 9810, Pages 71-83. DOI: 10.1016/S0140-6736(11)61674-7.