Hosted by LSE Works: LSE IDEAS Drug Policies Beyond the War on Drugs Dr Joanne Csete Dr John Collins Professor Lawrence Commissioner, Lancet Executive Director, International Phillips Commission on Drug Policy Drug Policy Project, LSE Emeritus Professor of Decision Sciences, LSE Dr Michael Shiner Dr Mary Martin Head of Teaching, IDPP and Chair, LSE Associate Professor of Social Policy, LSE Hashtag for Twitter users: #LSEworks
Public health as smoke ‐ screen in drug policy reform Joanne Csete PhD, MPH Columbia University Feb. 2017
Public health approach to drug control?
Health pillar of drug policy? China
Public health approach to drug control? 8
Is “non ‐ adversarial” better?
HIV incidence linked to injection remains high
Prevalence of HIV infection: people who inject drugs vs. general population
U.S. federal prisoners by type of conviction, 2014
Incarceration and TB epidemics, Europe & C. Asia: Net ↑ in incarcera � on 2/3 of increase in TB incidence (Stuckler et al., Proc Natl Acad Sci 105(36):13281, 2008) 15
Modelled incidence of HCV among people who inject drugs from effects of incarceration in several settings (Vickerman et al. for Lancet Commission)
Methadone and HIV incidence in Iranian prisons HI V I ncidence MMT Expansion 41,111 40,952 3.83 38,256 3.24 3.12 3.05 28,826 2.83 2.78 25,407 25,000 2.01 19,539 1.81 1.71 1.56 1.54 1.37 1.28 1.01 8,040 2,800 1,400 300 0 0 0 100 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Proportion of people who inject drugs living with HIV who receive ART, by region
Opioid overdose hits the middle ‐ class white population Case & Deaton, Proc Natl Acad Sci USA 2015; 112: 15078–83 19
Missing out on a good investment Nguyen et al., AIDS Behav. 18(11):2144, Nov. 2014 20
Rich research base for consumption rooms: overdose ↓ , needle sharing ↓ , link to other services ↑
Punitive drug policy undermines measures to address overdose
Missed research opportunities on drugs?
Opioid overdose and medical marijuana: Will NIDA fund the obviously needed research? • Bachhuber et al., JAMA Int Med 2014; 174 (11): ecological study: lower opioid overdose rates in states with medical marijuana • Boenhke et al., J Pain (epub 2016 Mar 18, doi: 10.1016/j.jpain.2016.03.002): cross ‐ sectional survey of pain patients: Patients with chronic pain in Michigan are replacing opioids with cannabis
Lancet Commission: What really is a public health approach? Lancet 387(10026): 1427–1480, 2 April 2016
Timing of accelerated U.S. drug war no accident: Putting blacks in their place following passage of civil rights laws
D. Baum, Harper’s , Apr 2016: from the horse’s mouth Top Nixon aide J. Erlichman (1994): “The Nixon White House had two enemies: the antiwar left and black people….We knew we couldn’t make it illegal to be against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes…, vilify them night after night on the evening news…. Did we know we were lying about the drugs? Of course we did.” 31
Hosted by LSE Works: LSE IDEAS Drug Policies Beyond the War on Drugs Dr Joanne Csete Dr John Collins Professor Lawrence Commissioner, Lancet Executive Director, International Phillips Commission on Drug Policy Drug Policy Project, LSE Emeritus Professor of Decision Sciences, LSE Dr Michael Shiner Dr Mary Martin Head of Teaching, IDPP and Chair, LSE Associate Professor of Social Policy, LSE Hashtag for Twitter users: #LSEworks
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