Evaluating the impact of Laws Regulating Illicit Drugs on Health and Society

The leximetric is a quantitative analysis method that can be applied to any law, with the aim of evaluating the policy objectives of the study and its effects. It is also used to compare policies adopted in the same state over the years or in different states and the different impacts they have on social factors. In the present work, we apply this methodology for the first time to the laws on the sale and consumption of psychotropic substances to quantitatively assess the a priori level of repression that they express. The subjects of this study are the three different ‘anti-drug’ laws in force in Italy in the period 1991-2018. We first choose the variable that can express in the abstract the degree of severity of these laws, then we elaborate a neutral scale in which we explain how we assign every score (on a decimal or binary system) and lastly, we evaluate the laws using the variable chosen.

Given that the legalization of marijuana is escalating in many parts of the world, the impact of Initiative-502 (I-502) in the state of Washington is appraised using the NERA model (N: Nonuser, E: Experimental user, R: Recreational user, A: Addict). Data available [12-15], on the prevalence of marijuana use, are used for analysis. To calibrate the model, genetic algorithm is performed for the periods prior to and post I- 502. A rise in the peer pressure that recreational and experimental users exert on nonusers to try drugs in the post legalization period, is noted. The simulations show good agreement with the observed data, depicting the efficiency of NERA. Additional numerical investigations are conducted and the experiments show a growing tendency towards the population of marijuana users post I-502. The concept of targeted campaigns of prevention is explained and the effect of implementing such campaigns of prevention 1 year before I-502 on both the experimental and recreational users is examined. The numerical illustrations demonstrate a decline in the proportion of marijuana users when such campaigns of prevention are enacted 1 year prior to I-502. The present study provides a more feasible insight into the impact of I-502 and furnishes valuable perspectives to assist the health authorities in addressing the complex issue related to the rise of marijuana consumption. These findings can be useful to other states and countries considering changing the legality of marijuana use.

 This chapter examines the historical development of heroin-assisted treatment from the early twentieth century to the present day. It sketches the philosophical underpinnings of those controversies surrounding the treatment, and the ways in which they have shaped the political and related drug-control environments in which debates over heroin-assisted treatment, and maintenance prescribing more broadly, have taken place. Within this rhetorical context, it argues that most of the notoriety of heroin and the harms with which it is associated stem, in fact, from the policies and controls about the drug, and contend that HAT mixes progressive intentions and methods with elements taken over from the repressive modalities of prohibitive drug control, rendering it a conflicted treatment that remains problematic for people who use heroin.

Opioid overdoses have dramatically increased throughout the past 20 years. Overdoses and other harms associated with the use of the unregulated opioid supply have resulted in a consortium of approaches to reduce drug-related harms, which for decades has included heroin-assisted treatment, although there remains widespread reticence to implement this approach in spite of ample evidence to support its effectiveness. Heroin-assisted treatment is often reserved for persons who have attempted standard opioid agonist treatments - such as methadone - unsuccessfully in order to be eligible for heroin-assisted treatment in countries and regions where available. To date, heroin-assisted treatment is only available in nine countries, mostly in Europe. Heroin-assisted treatment has higher retention rates than other forms of opioid agonist treatments, is cost-effective, reduces overdose morbidity and mortality, and improves public order. Nonetheless, regulatory structures impede its implementation. The present chapter herein presents further details of the evidence on heroin-assisted treatment and newer treatment modality iterations, such as injectable opioid agonist treatment and safe opioid supply programs. 

Drug use-associated health problems are a complex phenomenon changing over time. Published studies regarding drug-related diseases are mainly based on emergency rooms data; moreover, most of these studies focus only on diseases related to injecting drug use (i.e. HIV, B and C Hepatitis).

This chapter presents a study based on an exhaustive nationwide source on hospitalizations in Italy: the National Hospital Discharge Database (NHDB). The hospitalization risk profile of opioids user was studied, in terms of hospitalization rates and observed comorbidities; age and gender differences were taken into account.

The NHDB collects data regarding all patients discharged from any Italian hospital, recording their demographic and clinical data. Cases analysed in the study: all the patients diagnosed with conditions related to opioid use during the study period 2005- 2019.

To perform a more detailed analysis, opioids users also using other substances “polyusers” were studied too.

Main findings: i) Pathologies with the highest risk of hospitalization among opioid users: infectious diseases (i.e. infectious intestinal diseases, HIV, viral diseases with rash, chlamydia and other viral pathologies). ii) Risks are greater in women than in men. iii) In women, excesses of risk were also observed for Ischaemic heart diseases, cerebrovascular and respiratory diseases (this excess is also present in men), and diseases of the digestive and urinary system.

This nationwide study provides relevant information in terms of public health, giving indications to public services about the burden of diseases to keep under observation the opioid users.

Researchers have recognized, for more than half a century, the similarities between the modes of spread of drug use and those of infectious diseases. Such an assumption allows one to model the consequences of drug use and epidemiological indicators and, using available data, to make impact assessments of drug policies and short- and medium-term predictions of interventions, which modify visible and hidden aspects, such as prevalence and/or incidence to be estimated.

A crucial issue concerns models with “closed populations” or with “open populations.” The former consider fixed populations, with no inputs (births, immigration, etc.), only deaths can occur, and allow only short-term predictions; the open population models, more complex, allow medium- and long-term predictions of policy interventions, providing information to decision-makers. Recent data on the visible consequences of heroin/opioid use (overdoses, emergency interventions, etc.) and Eurostat's recent European estimates of the rapidly growing heroin market (in Italy, over 64% growth between 2011 and 2019) show that a second epidemic wave of heroin use is currently underway. In contrast, in Denmark, as well as in Switzerland, there is definitely an 'endemic' behavior of heroin use, confirmed by the data on overdose deaths, which is very low in Denmark and decreasing for young people in Switzerland. The main cause of this is the so-called Heroin Assisted Treatment (HAT), used in Switzerland for more than 25 years, and in Denmark for more than 12 years, which can be called the antiprohibitionist approach to treatment. The dynamic model, shown here, mathematically demonstrates the effectiveness of HAT.

The chapter regards new drug use indicators that have been proposed and applied since 2014 to measure individual levels of harm from drug use also considering poly-drug use. Such behaviour has been increasing since 2000. Indicators are based on the frequency of drug use within a specific time period and expert groups’ harm scores for the various substances used. The indicators allow the estimation of risk profiles for selected groups of individuals and comparisons over time and between populations. Recent advances in the classification of drug harms allow refinement of these indicators, separating harm consequences on self and effects on others. The new indicators have been applied to many datasets of problematic or adolescent populations (ESPAD survey for example) allowing comparisons among countries and populations in the framework of international projects. Using ESPAD-Italy survey information also related to personal behaviour, it was shown that high values of poly-drug use indicators are linked to specific behaviours related to interest in school, relationship with parents and use of leisure time. These results are consistent with previous analyses based on surveys among high school students in Italy. The most recent applications illustrate how the new approach can be used to assess the link between drug use and personal behaviour among adolescents with school drop-out in order to design proper prevention policies.

Although the human right of individuals around the world has been recognised and enshrined in the United Nations 1966 Convention, global drug policies continue to debate the prevailing philosophies of treatment and practice and often fail to monitor, evaluate, and inform these policies with the best international evidence on what works, for whom, and when.

This chapter will introduce the need to evaluate treatment policy with an overview of treatment philosophies; discuss methodological considerations; measure outcomes and implementation; and finally, outline the future of treatment policy evaluation.

There is a widespread availability of a diverse range of drugs worldwide that are increasing in potency and purity with adverse consequences for individuals, families, communities, and societies. Due to the prevalence and complexity of drug use and marketing globally, along with the rights of individuals to receive appropriate treatment, there is a need for evidence-based information and research to develop the best international practice to ensure good treatment evaluation and outcomes.

Methodological considerations were discussed and examples of case studies, across a range of countries that measured outcomes were outlined, highlighting the importance of monitoring and evaluating the implementation of treatment modalities and philosophies.

Drug treatment policies and philosophies vary across countries due to practice, finances, resources, vested interests, resistance to change, and other constraints. Current practices need ongoing evaluation in terms of needs, process, outcome, client satisfaction, and economics in order to ensure that treatments are ethical and personcentred, meeting the goals of individuals rather than imposing perceived successful outcomes.

Interventions to tackle the supply of drugs, are seen as standard components of illicit drug policies and drug market-related administrative data, such as seizures, price, purity and drug-related offending, are widely used for policy monitoring and evaluation. However, these data are not primarily collected for this purpose, which makes interpretation and analysis difficult. Examples of limitations of these data sources include: the extent to which they reflect operational priorities rather than impact on drug supply; question marks over the robustness of and consistency in data collection methods; and issues around the timeliness of data availability. Making sense of such data is therefore challenging and extreme care needs to be taken when using it. Nevertheless, given the considerable resources invested in drug supply reduction, understanding the impact of these interventions is essential, so improving the quality of the data collected and expanding its scope should be a priority for those seeking to understand or monitor drug markets and supply reduction. In addition to highlighting some of the potential pitfalls in using supply indicators for policy evaluation, this chapter presents some options for improvements based on the current European Monitoring Centre for Drugs and Drug Addiction programme of work to develop their supply-related monitoring and analysis. The conceptual framework developed to underpin this work may have wider applications and has the potential to provide a richer picture of drug markets, at both national and international levels, to aid efforts to evaluate drug supply reduction policies. 

Both policymakers and the public are interested in the size of the drug market. However, often both the origin and the veracity of estimates made in this area are unclear. To help understand this topic, this chapter summarizes the findings from a literature review of studies that have attempted to produce an estimate of the size of the drug market. Different methodological approaches and the challenges inherent in estimating the size of drug markets are discussed. The greatest attention is given to demand side approaches as they have been most commonly used; however, the supply side and some more recent innovative approaches are also considered. The chapter concludes by making some recommendations for future studies intended to improve the evidence base in this area. 

This chapter looks into the economic costs of drug control to the criminal justice systems in four European countries, Italy, Poland, Portugal and Spain as a contribution to the debate on the costs of illicit drugs to society suggesting paths for investigation. At the global level, extensive evidence has been collected and research has been carried out on the importance of estimating the costs of crime to society [1]. However, there is still little evidence on some aspects of the criminal justice costs considered in relation to the laws and regulations for which they were incurred. The study of Farrell and Clark [2] is one example of an empirical estimate of the direct cost of public expenditure on the global criminal justice system. Using six different regression models, the study found that there was a direct relationship between the wealth of nations and the amount spent on criminal justice: richer countries spend more GDP per capita than less developed countries. Italy, Poland, Portugal and Spain show both differences and commonalities in terms of their geographical position, economic development and criminal justice system organization in relation to drug control. All four countries are based on a civil law system and have old judicial traditions. The analysis shows that drug-related costs for the three sectors considered (police, courts and prisons) as a share of GDP, from 2010 to 2018, have increased only for Poland, while for Italy, there has been a slight decrease and for Portugal and Spain drug-related justice expenditure has sharply decreased.

Non-transparency, i.e., widespread corruption in public administrations, favours organized crime in all its activities. This chapter shows that this is not only an ethical-philosophical statement but is also statistically verifiable and it is possible to estimate the damage that the level of corruption causes to the legal economy and other sectors. Corruption is measured here through the index elaborated by Transparency International, whose reliability is verified by comparison with two other indices, recently proposed at the international level. The most important result is the significant link between the turnover of “drugs”, in various countries and in various years, and the corruption index, in the same countries and in the same years, as verified based on official data and official estimates, showing quantitatively how the earnings of criminal organizations are largely invested in corruption. It then highlights specific aspects that are related to the level of corruption such as the link, very significant, between transparency and competitiveness, the latter measured by the World Economic Forum indices, showing how corruption negatively affects the legal economy of the country and, using additional indicators, other important aspects as Life Satisfaction, Education etc.