The movement and translation of drug policy ideas: The case of ‘new recovery’

Introduction'New recovery' can be conceptualised as both a social movement and a broader policy agenda to restructure treatment service systems towards 'recovery-oriented systems of care'. Emerging initially out of the United States, new recovery has gained currency as a policy agenda in other jurisdictions - perhaps most distinctly in the United Kingdom. In 2012, the ideas behind 'new recovery' were debated in the Australian alcohol and other drug field as the Victorian government sought to incorporate recovery principles into policy and service design. This paper uses the policy transfer and policy translation literature to understand how international policy ideas about 'new recovery' were negotiated in the Australian context, focusing specifically on the role of non-government actors in the process.MethodsThis paper draws on an analysis of policy documents, organisational documents and interviews with representatives from the Australian non-government alcohol and other drug sector to consider how new recovery was translated into Victorian drug policy.ResultsThe interactions between organisations and actors — including bureaucrats, governmental agencies and policy entrepreneurs — facilitated the circulation and translation of policy ideas in the Victorian context. Despite this, the analysis suggests that policy transfer was largely a symbolic exercise: overall, some of the key features of new recovery policy from the United States and the United Kingdom, such as encouraging peer-led recovery and mutual aid, were not incorporated in the Victorian policy. NGOs resisted what they considered to be some of the more problematic elements of 'new recovery', and informed the local translation of the policy.DiscussionThe results have implications for understandings of the relationship between social movements, non-government organisations and the state, as well as the dynamics of knowledge transfer in drug policy.     

Explaining trends in addictive behaviour policy—The role of policy coherence

This article analyses addictive behaviour policy regimes – focusing on illegal drugs and gambling – in 19 countries over a period of 50 years. It compares how these countries have combined rules on the consumption and possession of cannabis and on the participation in sports betting with sanctions for violations of these rules. While theories of policy convergence can explain dominant trends in the way the combination of these policy instruments have changed, they cannot account for all of the empirical variation observed. Turning to Portugal, a case which deviates in both illegal drug and gambling policy from the expected trend, we show that explanations of policy change improve substantially when taking the concept of policy coherence into account. Specifically, we argue that changes of the policy status quo are facilitated when policy entrepreneurs succeed in shaping a perception of policy incoherence. In turn, when relevant actors are able to maintain a perception of policy coherence, the policy status quo is stabilized.     

Challenges and opportunities of ‘good governance’ for drug policy: the case of the development of Belgian drug policy between 1996 and 2003

Aims: Studying the characteristics of the science-policy nexus in the field of drugs emerged in parallel with an interest in the principles of good governance. Centre-stage is the processes through which policy is informed, especially with regard to the role of non-government actors, contrasting with the widely accepted view that drug policymaking is a prerogative of governments. Through the lens of what is defined as good governance in drug policy, this article examines the processes underpinning the drug-policy change in Belgium between 1996 and 2003. Methods: The paper is based on an analysis of 164 policy documents and 1067 newspaper articles, and 55 interviews with a range of stakeholders including policymakers, professionals, scientists and journalists. Findings: Some distinctive features were found relating to the mechanisms through which evidence was mobilised and eventually informed policy change in Belgium. Evidence-imbued leadership, evaluation, coordination, the engagement of different stakeholders and the role of the parliament played key roles. Conclusions: Several characteristics of good governance make the use of evidence more likely. However, governance processes seem to be challenged in highly sensitive discussions (e.g. on cannabis policy). Another challenge may be how the principles of good governance can be consolidated in the long term.     

The economics of orphan drug policy in the US. Can the legislation be improved?

This review of the US Orphan Drug Act (ODA) 1983 outlines how the ODA is intended to stimulate orphan drug research and development of drugs for rare diseases. We also evaluate the effectiveness of the ODA in the past decade and provide recommendations for ODA improvements in the future. The economic incentives embedded in the ODA are presented in a simple economic model, in which a guarantee of market exclusivity plays a central role in encouraging firms to pursue the development of orphan products. Some evidence suggests that this provision has been a major impetus for the rise in orphan drug applications and designations in the last decade. Market exclusivity is the key incentive for orphan drug research, and should be retained. Concerns about a limited number of highly successful 'blockbuster' orphan drugs should be evaluated in terms of the useful economic incentives. In the future, exceptionally high profits could be limited by more precise evaluation of disease prevalence, elasticity of demand, and the other uses of orphan compounds. We further recommend an expansion of the ODA tax credits and research grants programme and targeting of 'priority' diseases. We conclude that the ODA has been a valuable legislative initiative, but it can be strengthened with some simple extensions of the current incentives that it contains.     

What is good governance in the context of drug policy?

The concept of governance is applied in a wide range of contexts, but this paper focuses on governance in relation to public administration, i.e. states and how they take action, and specifically governance of particular policy areas. In the current context of financial austerity and an era of globalisation, policy-makers face pressures and challenges from a growing range of interests and local, national and supranational actors. Drug policy is an example of a particularly contentious and polarised area in which governance-related challenges abound. In response to these challenges, interest has grown in developing agreed policy governance standards and processes and articulating policy-making guidelines, including the use of available evidence to inform policy-making. Attempts have been made to identify ‘policy fundamentals’ – factors or aspects of policy-making apparently associated with successful policy development and implementation (Hallsworth and Rutter, 2011, Laughrin, 2011) and, in the drug policy field, Hughes et al. (2010) reflecting on the co-ordination of Australian drug policy highlighted some of what they considered principles of good governance. But how useful is the concept of ‘good governance’; how well can it be defined, and to what purpose?As part of a wider project considering the governance of drug policy, RAND Europe and the UK Drug Policy Commission undertook a targeted review of other research and sought expert views, from within and beyond drug policy, on principles, processes, structures and stakeholders associated with good drug policy governance. From this emerged some perceived characteristics of good governance that were then used by the UK Drug Policy Commission to assess the extent to which drug policy making in the UK fits with these perceived good governance characteristics, and to suggest possible improvements. Particular consideration was given to the range of interests at stake, the overarching aims of drug policy and the development and inclusion of an evidence base where possible. This paper draws on findings of the study to highlight challenges associated with defining good governance, provides an example of a framework for assessing drug policy governance and discusses the feasibility, transferability and potential benefits of such an undertaking.     

The misuse of the ‘Gateway Theory’ in US policy on drug abuse control: A secondary analysis of the muddled deduction

Much research (mostly from general population surveys) suggests that people typically use alcohol, tobacco and then marijuana, so called ‘gateway drugs’, prior to any potential use of ‘hard drugs’ like cocaine powder, crack and heroin. Other research (mostly with surveys of special populations) indicates that hard-drug use is associated with numerous social problems such as crime, routine violence, and lower productivity. A muddled interpretation of these separate findings has been widely misused in support of the US drug abuse prevention policies to suggest that gateway drugs cause hard-drug use and its associated problems. This paper superimposes secondary analyses of data from the National Household Survey on Drug Abuse (NHSDA) and the Arrestee Drug Abuse Monitoring (ADAM) program. The findings indicate that (1) extremely few members of the general population become persistent daily hard-drug-using criminal offenders; and (2) an increasing percentage of daily hard-drug-using criminal offenders did not follow the gateway sequence of substance use progression. These results strongly suggest that the use of gateway drugs by youths is not the central cause of hard-drug use and its associated problems. Thus, fighting the use of gateway drugs by youths may not be a particularly appropriate approach to drug abuse prevention.     

The importance of drug–drug interactions as a cause of adverse drug reactions: a pharmacovigilance study of serotoninergic reuptake inhibitors in France

Purpose  

To quantify the importance of drug–drug interactions (DDIs) in the occurrence of adverse drug reactions (ADRs) reported with serotoninergic reuptake inhibitors in a pharmacovigilance database.     

How risky are heroin markets? A multi-site study of self-reported risk perceptions among police detainees in Australia

BackgroundThere has long been an international interest in the eradication of drug markets—particularly heroin markets—given their documented connection to the deterioration of local community and social amenity. Recent interest in focused drug law enforcement strategies has reinvigorated debate about the potential for deterrence; however, there exists no large-scale effort to document the risk perceptions of those who transact in heroin markets.MethodsWe use data from 2,257 police detainees interviewed as part of the Australian Institute of Criminology's (AIC) Drug Use Monitoring in Australia (DUMA) program. We employ a multilevel generalised ordinal logistic regression model to explore the geographical and temporal heterogeneity of risk, controlling for individual demographic covariates.ResultsWith one exception, we find a surprising degree of homogeneity at the high end of the risk perception scale, with between 30 and 35 percent of respondents rating their local heroin market as very risky. At the low end, there was greater geographical and temporal variability with between 15 and 30 percent of respondents rating their market as not at all risky. One location stands out as anomalous, being perceived as considerably more risky. Of the demographic and drug-use covariates, only age and gender were statistically significant. Neither the length nor frequency of association with the heroin market predicted lower levels of risk perception.ConclusionA little over half of all heroin market participants consider transacting in their local market to be somewhat or very risky—the others consider it not at all or only a little risky. With few exceptions, this broad pattern appears consistent over time and between geographical locations, although an individual's personal perception is not tied to their degree of exposure to the heroin market. The policy implications of these findings are discussed.     

Clinical disposition,metabolism and in vitro drug–drug interaction properties of omadacycline

1.?Absorption, distribution, metabolism, transport and elimination properties of omadacycline, an aminomethylcycline antibiotic, were investigated in vitro and in a study in healthy male subjects.

2.?Omadacycline was metabolically stable in human liver microsomes and hepatocytes and did not inhibit or induce any of the nine cytochrome P450 or five transporters tested. Omadacycline was a substrate of P-glycoprotein, but not of the other transporters.

3.?Omadacycline metabolic stability was confirmed in six healthy male subjects who received a single 300?mg oral dose of [¹⁴C]-omadacycline (36.6 μCi). Absorption was rapid with peak radioactivity (～610 ngEq/mL) between 1–4?h in plasma or blood. The AUC_last of plasma radioactivity (only quantifiable to 8?h due to low radioactivity) was 3096 ngEq?h/mL and apparent terminal half-life was 11.1?h. Unchanged omadacycline reached peak plasma concentrations (～563?ng/mL) between 1–4?h. Apparent plasma half-life was 17.6?h with biphasic elimination. Plasma exposure (AUC_inf) averaged 9418?ng?h/mL, with high clearance (CL/F, 32.8?L/h) and volume of distribution (Vz/F 828?L). No plasma metabolites were observed.

4.?Radioactivity recovery of the administered dose in excreta was complete (>95%); renal and fecal elimination were 14.4% and 81.1%, respectively. No metabolites were observed in urine or feces, only the omadacycline C4-epimer.     

The nature of the stimulatory action of γ-aminobutyric acid in the isolated perfused dog adrenals

Summary The effect of -aminobutyric acid (GABA) on catecholamine (CA) release from adrenal medulla was investigated. GABA and GABA agonists, 3-amino-1-propanesulfonic acid and imidazole-4-acetic acid caused CA release from isolated perfused dog adrenals in a dose-dependent manner, and no tachyphylaxis to GABA was observed. CA release elicited by GABA was antagonized by bicuculline and picrotoxin. This antagonism was specific for GABA-and GABA agonist-induced responses, response to acetylcholine being unaffected. Pretreatment with atropine plus hexamethonium did not affect the response to GABA. GABA-induced CA release was abolished by the removal of Ca²⁺ from perfusion medium, but not by the removal of Na⁺ or Cl^–. Verapamil, CoCl₂ and dibucaine blocked the effect of GABA. A Na⁺ channel blocker, tetrodotoxin did not reduce GABA-evoked CA release. These results suggest that GABA may interact with its receptor to evoke CA release from adrenal medulla in a fashion of Ca²⁺-dependence and independence on external Na⁺ or Cl^–.     

The stigmatisation of ‘ice’ and under-reporting of meth/amphetamine use in general population surveys: A case study from Australia

Background and aimsStigmatisation of illicit drug use is known to discourage people from reporting their use of illicit drugs. In the context of Australia's two recent “ice-epidemics” this study examines whether rapid increases in community concern about meth/amphetamine concurrent with increased stigmatising media reporting about meth/amphetamine “epidemics” are associated with increased under-reporting of its use in population surveys.MethodsWe examined the relationship between general population trends in self-reported lifetime use of and attitudes towards meth/amphetamine between 2001 and 2013, contextualised against related stimulants and heroin, using five waves of Australia's National Drug Strategy Household Survey (NDSHS), alongside trends in print media reporting on meth/amphetamine from 2001 to 2014.ResultsAnalysis of NDSHS data showed significant increases in community concern about meth/amphetamine between 2004 and 2007, and 2010 and 2013 in all birth cohorts and age groups. In both periods self-reported lifetime use of meth/amphetamine fell in many birth cohorts. The falls were only statistically significant in the first period, for birth cohorts from 1961–1963 to 1973–1975. Falls in lifetime use within a cohort from one period to the next are incongruous and we did not observe them in the other drugs considered. Equally, increases in concern were specific to meth/amphetamine. We counted substantial and rapid increase in the number of newspaper reports about meth/amphetamine in both periods, particularly reports including the term ‘epidemic’.ConclusionsRapid increases in the quantum of media reporting stigmatising a drug (through its construction as an ‘epidemic’) accompanying increased general public concerns about the drug may increase the tendency to under-report lifetime use. This may make it difficult to rely upon household surveys to observe trends in patterns of use and suggests that policy makers, media and others in the AOD sector should avoid stigmatisation of drugs, particularly during periods of heightened concern.     

Plasma levels and β-blocking effect of α-hydroxymetoprolol—Metabolite of metoprolol—in the dog

The plasma levels and the - blocking effect of metoprolol and its active metabolite - hydroxymetoprolol have been studied after i.v. bolus injections of the substances to dogs. For both substances the - blockade increased with the dose, and there was a linear relationship between percent reduction in exercise heart rate and the logarithm of plasma concentration. The dose of the metabolite, however, had to be 5 times higher than that of metoprolol to induce the same degree of - blockade. Because of differences in the volume of distribution, 2.0 liters/kg for - OH-metoprolol and 3.5 liters/kg for metoprolol, the 5 times higher dose of - OH-metoprolol resulted in 10 times higher plasma levels of the metabolite than of metoprolol. - OH-Metoprolol was more slowly eliminated (t_1/27.0 hr, total body clearance 3.5 ml-kg^–1-min^–1) than metoprolol (t_1/22.0 hr, total body clearance 20.0 ml-kg^–1-min^–1). Approximately 5% of an i.v. dose of metoprolol was metabolized to - OH-metoprolol. The half-life of the endogenously formed metabolite was the same as after an i.v. dose of the compound.     

The diverse drivers of relative changes in excise taxes on beer and spirits in Australia, 1902–2012

In Australia there have been calls for volumetric alcohol taxation, or some variant of this, to eliminate the complexities and inequalities of the existing system. While the arguments have been made on economic rationality and evidence-based public health grounds, this article examines the historical drivers of alcoholic beverage excise tax changes in order to facilitate a more informed debate about how to achieve alcohol taxation reform. Excise taxation on spirits and beer (wine has almost never been taxed through excise taxes in Australia) was examined in greater detail using primary data sourced from national excise taxation schedules from 1902 to 2012. Interpretation of this data was based on primary sources such as Hansard speeches and Government reports, and secondary sources provided by historians. Australia had a long history of not taxing spirits more heavily than beer except in the early part of the twentieth century; this changed after 1988. Setting alcohol excise taxes in Australia has been a balancing exercise between industry protection, revenue raising and political expediency, as well as public health. The historical instances examined in this article support the conclusion that while public health has been a driving force for some excise taxation changes, it has not been the only driver. These findings should inform policy making on excise taxation on alcoholic beverages in Australia.     

The safety of studies with intravenous Δ9-tetrahydrocannabinol in humans, with case histories

Rationale

Delta-9-tetrahydrocannabinol (THC) is one of the few cannabinoid receptor ligands that can be used to probe the cannabinoid system in humans. Despite increasing interest in the cannabinoid receptor system, use of intravenous THC as a research tool has been limited by concerns about its abuse liability and psychoactive effects.

Objectives

This study aims to evaluate the safety of all intravenous THC studies conducted at this center for the past 13?years.

Methods

Included were 11 studies with 266 subjects (14 schizophrenia patients and 252 healthy subjects, of whom 76 were frequent cannabis users), 351 active THC infusions, and 226 placebo infusions. Subjects were monitored for subjective and physical adverse events and followed up to 12?months beyond study participation.

Results

There was one serious and 70 minor adverse events in 9.7% of subjects and 7.4% of infusions, with 8.5% occurring after the end of the test day. Nausea and dizziness were the most frequent side effects. Adverse events were more likely to be associated with faster infusion rates (2?C5?min) and higher doses (>2.1?mg/70?kg). Of 149 subjects on whom long-term follow-up data were gathered, 94% reported either no change or a reduction in their desire to use cannabis in the post-study period, 18% stated that their cannabis use decreased, and 3% stated that it increased in the post-study period.

Conclusions

With careful subject selection and screening, risk to subjects is relatively low. Safeguards are generally sufficient and effective, reducing both the duration and severity of adverse events.