Public opinion about syringe exchange programmes in the USA: an analysis of national surveys

Background: Despite scientific evidence demonstrating their effectiveness, syringe exchange programs (SEPs) have not been as widely embraced by policy-makers in the USA as in some other nations. One reason for this disjunction between science and policy may be the effect of public opinion.Methods: To better understand the role of public opinion in shaping SEP policies, we undertook a systematic search for all reported U.S. national surveys asking about support or opposition to SEPs. Relevant polls were identified through a national database of public opinion questions, and a similar search of a newspaper database. We present the survey findings. The wording of poll questions and the agenda of organisations sponsoring the polls are also examined.Results: Twenty-one questions from 14 different polls conducted from 1987 to 2000 were identified. Support for SEPs ranged from 29 to 66%. Surveys conducted by organisations with a public health agenda were more likely to suggest support for SEPs than those sponsored by organisations with a “family values” perspective. Question wording appeared to strongly influence support for SEPs. Poll questions that referred to “drug addicts” were less likely to indicate majority support for SEPs than those that avoided loaded terms or that provided public health information to respondents.Discussion: Public opinion regarding SEPs is very malleable, strongly affected by question wording or other biases of organisations sponsoring the polls. Therefore, there may be no clear national consensus on the desirability of SEPs. Our findings are particularly relevant for national policy, such as federal funding for SEPs.     

Capitalising upon political opportunities to reform drug policy: A case study into the development of the Australian “Tough on Drugs-Illicit Drug Diversion Initiative”

BackgroundThe introduction of political “war on drug” strategies and Prime Ministerial advisory groups increase opportunities for drug policy reform. Yet the strengths and limitations of capitalising upon political opportunities remain unclear. This paper provides a unique insight into the development of an Australian reform, the “Tough on Drugs-Illicit Drug Diversion Initiative.” This reform was one of the major policies to emerge out of the Federal Coalition “Tough on Drugs” strategy. In spite of the rhetoric the Illicit Drug Diversion Initiative (IDDI) has diverted minor drug users away from the traditional criminal justice system.MethodsThis paper draws upon interviews with 16 expert policy makers involved in the advocacy and negotiations leading up to the adoption of the IDDI to examine what drove the reform and how and why a pragmatic reform emerged.ResultsThe IDDI culminated from the presence of five main drivers: a crisis in relation to heroin and crime, antagonism towards the government, a weak but growing evidence-base on the merits of drug diversion, a shift in law enforcement attitudes and persuasive advocacy by a group of non-government experts. This paper contends that the Prime Minister's new “Tough on Drugs” strategy and expanded governance arrangements created new space for policy actors to intervene in the policy formulation process and to convert the governments proposed “zero tolerance” response into a more humane and potentially effective response.ConclusionThis paper concludes that contrary to popular opinion political venues and politicisation may offer valuable opportunities for drug policy reform. The challenge for researchers and policy advocates is to see how they can best utilise political venues to obtain pragmatic reform.