Restrictive Drug Policy Research Articles

Regulation of Antidepressant Prescription for the Effective Treatment of Mental Disorders in Turkey: A Narrative Review.

This non-systematic narrative review aims to summarize the results of clinical studies evaluating the effectiveness of antidepressants used to treat mental illnesses including major depressive disorder, obsessive-compulsive disorder, somatization disorder, and anxiety disorders in Turkey. Conclusions drawn from this article can guide ongoing efforts by Turkish health policymakers to improve public health development in the country by further regulating the prescription of antidepressants. Relevant articles regarding the effectiveness of antidepressant use were collected in June 2021 using Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus and Academic Search Complete online databases. The collected articles were then appraised using the Critical Appraisal Skills Programme to determine the reliability and quality of each article and to assess the risk of bias in each article. The summary of key findings/evidence, Critical Appraisal Skills Programme appraisal summary results, funding, study designs applied, settings covered, period covered (years), and additional comments were extracted from each article for analysis. The inclusion criteria involved articles that recounted adverse effects and effectiveness of antidepressant use in Turkey to treat mental illnesses, including anxiety disorders, major depressive disorder, somatization disorder, and obsessive-compulsive disorder. The exclusion criteria consisted of articles that included participants who resided outside of the geographic region of Turkey, abstracts, the pharmacology of antidepressant use, antidepressant off-label use, and alternative treatments. A total of 15 articles out of the 104 derived from the databases were included in the study that fell into 1 of the following main themes, "adverse effects" and "mixed results," which accounted for 53% (8 articles) and 40% (6 articles), respectively. One outlying article was identified (7%). Totally 8 out of 15 articles that recounted antidepressants prescribed for mental illnesses produced adverse effects without treatment success and 6 out of 15 articles recounted adverse effects with treatment success. One outlying article found a confound that precluded determining whether an adverse effect was caused by antidepressant use or confounded by pre-existing conditions. Given that 14 out of 15 articles recounted adverse effects associated with antidepressant use and 6 out of 15 articles recounted antidepressant treatment success, Turkish policymakers are encouraged to adopt a restrictive drug policy strategy. To sum up, antidepressant prescription and consumption should be conducted with caution to limit unnecessary risk of exposure to adverse effects associated with antidepressant use. Limitations in the research included using a non-systematic tool instead of conducting a systematic review, a limited number of articles (15 out of 104), and risk of bias was detected from appraising the articles via Critical Appraisal Skills Programme.

Understanding Vietnam’s drug policy for amphetamine-type stimulants misuse

IntroductionThe emergence of widespread amphetamine-type stimulants (ATSs) usage has created significant challenges for drug control and treatment policies in Southeast Asian countries. This study analyses the development of drug policies and examines current treatment program constraints in Vietnam to deal with ATS misuse. The aim was to gain insights that may be useful for national and international drug-related policy development and revision.MethodsA desk review of national policy documents and 22 in-depth key informant interviews were conducted from 2019 to 2021. Thematic content analysis was employed to identify key themes and their connections.ResultsAnalysis identified Vietnam’s 30-year history of developing policies and formulating strategies to reduce supply, demand, and harm from illicit drugs. With the increasing number of people who use ATS (PWUA), Vietnam has recently promoted harsh policy and law enforcement to deter drug use and supply. This policy trend prevails in many Asian countries. The three main constraints in dealing with ATS misuse emerged from punitive and restrictive drug policies. First, the general public believed that Centre-based compulsory treatment (CCT) is the only appropriate treatment for all types of illicit drug addiction despite its low-quality service provision. The rigid drug policy has led to social persuasion with impractical expectations for CCT effectiveness. Second, the emphasis on punishment and detention has hampered new drug treatment service development in Vietnam. CCT has become monopolistic in the context of impoverished services. Third, people who use drugs tend to hide their needs and avoid formal treatment and support services, resulting in declined social coherence.ConclusionWhile new drugs are constantly evolving, the current law enforcement approach potentially constrains expertise to adopt effective treatment services. This study suggests that the top-down policing mechanism presently hinders the development of an appropriate intervention strategy for ATS misuse and diminishes social support to service providers.

High risk of severe child abuse and poly‐victimisation in families with parental substance misuse – results from a swedish school‐based survey

AbstractChild abuse is a widespread public health problem, potentially leading to long‐term consequences for the exposed individuals and society. By learning more about the major risk factors, child abuse can be prevented. The objective of this study was to examine the pattern and severity of maltreatment in adolescents reporting parental alcohol and/or other drug problems. Cross‐sectional data from a Swedish national school survey including 4,741 pupils (15‐ and 17‐year‐olds) conducted in 2016 were analysed using univariate tests (chi‐squared) and binomial logistic regression models. Results showed that parental alcohol or other drug misuse, reported by the adolescents, was significantly associated with all types of child maltreatment. There was a particularly increased risk of severe child abuse, including witnessing recurrent physical intimate partner violence (adjusted odds ratio (adj. OR) 11.01; confidence interval (CI) 6.61–18.35) and poly‐victimisation (adj. OR 7.82; CI 5.50–11.13), in families with parental alcohol and/or other drug problems compared to families without these problems. These results call for preventive measures, such as restrictive alcohol and drug policies, and early recognition of alcohol or other drug misuse among parents. In addition, professionals working with children and with substance‐using parents need to identify and support these children.Key Practitioner Messages Children and adolescents commonly grow up with parents misusing alcohol and/or other drugs. Parental alcohol and other drug misuse strongly increases the risk of severe child abuse, particularly witnessing recurrent physical intimate partner violence and poly‐victimisation. Early recognition and support for families with parental alcohol and other drug misuse is important to prevent child maltreatment.

Shadow Committees: On “Drug User Voice,” Representation, and Mobilization in a Norwegian Drug Policy Reform

Until recently, Norway remained immovable on its conservative policy that illegal drug use is a crime. In 2018, the Health Minister appointed an inquiry commission to design a less restrictive drug policy, which included two “drug user representatives.” But the Minister’s choices for these posts met massive dissatisfaction from some drug users who contended that the representatives “are not real drug users” and do not “speak for” nor “act on the behalf” of their experiences and opinions. They mobilized to establish an alternative organization, the Shadow Committee, to propose a drug policy reform shaped by “the user voices” and “not polluted by political compromises.” Yet, while performing a labor of difference, this committee, too, became caught in conflicting landscapes of representation with some members contesting strategic solidarity. Based on this case, and an ethnographic fieldwork among the protesters, this article investigates the concept of representation as understood, contested and applied by “drug users.” Exploring how they relate to “user voices” and question the authenticity of some of “user representatives,” I highlight how changing political landscapes affect understandings of representation and shape political, individual and collective forms of involvement. I draw on Pitkin’s political philosophy and apply the classical categorization of political representation to suggest reconsidering the governing assumptions regarding “user representatives” that increasingly inform drug and treatment policies in Norway. I ask if the concept of representation itself may be a barrier to meaningful involvement.

Factors influencing inappropriate use of antibiotics in outpatient and community settings in China: a mixed-methods systematic review

BackgroundFor decades, antibiotics have been excessively consumed around the world, contributing to increased antimicrobial resistance (AMR) and negatively impacting health outcomes and expenditures. Antibiotic use in China accounts for half...

Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework.

The burden of hepatitis C infection is considerable among people who inject drugs (PWID), with an estimated prevalence of 39%, representing an estimated 6.1 million people who have recently injected drugs living with hepatitis C infection. As such, PWID are a priority population for enhancing prevention, testing, linkage to care, treatment and follow-up care in order to meet World Health Organization (WHO) hepatitis C elimination goals by 2030. There are many barriers to enhancing hepatitis C prevention and care among PWID including poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low hepatitis C testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. On 5 September 2017, the International Network of Hepatitis in Substance Users (INHSU) held a roundtable panel of international experts to discuss remaining challenges and future priorities for action from a health systems perspective. The WHO health systems framework comprises six core components: service delivery, health workforce, health information systems, medical procurement, health systems financing, and leadership and governance. Communication has been proposed as a seventh key element which promotes the central role of affected community engagement. This review paper presents recommended strategies for eliminating hepatitis C as a major public health threat among PWID and outlines future priorities for action within a health systems framework.

Integrating hepatitis C and addiction care for people who inject drugs in the era of direct-acting antiviral therapy

As new, more tolerable and effective hepatitis C virus (HCV) treatments are available, there is a global need to consider how to maximize treatment access for groups who are most affected by HCV. A substantial number of people who inject drugs (PWID) are living with HCV, yet only a minority have received treatment. HCV treatment programs that are integrated into community-based addiction care may be a successful way to overcome barriers and increase access and uptake of HCV treatment for this population. Examples of successful HCV and addiction care integration in the community have been documented. However, potential challenges to integration exist and include changing healthcare provider roles, lack of stimulant use research and restrictive drug policies. Successful engagement of PWID in HCV care is critical step towards the elimination of HCV infection. Further research and efforts are needed in order to reach this goal.

Great expectations: The bureaucratic handling of Swedish residential rehabilitation in the 21st century.

Background and aims:Increasingly, efforts to counteract perceived problems in drug treatment at residential rehabilitation centres have come to rely on measures drawing on evidence-based practice (EBP). However, the Swedish media, government inquiries, and international research have identified a number of problems regarding both residential rehabilitation and EBP. This suggests that caution should be exercised when placing expectations on EBP. The aim of this study is to investigate how the responsible authorities have handled increasing demands for EBP with administrative control while facing critical evaluations of their steering and implementation efforts. The study examines the maturation of a widespread treatment ideology, which aims to be based on evidence, in a country known for its restrictive drug policy and its goal of becoming a drug-free society.Methods:Through a qualitative textual analysis of 17 years (2000–2016) of inquiries, directives, and authority archives we have traced the interplay between problem descriptions, intended goals, and implemented solutions.Findings:The analysis shows that the ambition to provide care and welfare based on EBP is still an ambition. Also, the authorities’ control over the care actually provided still leaves room for improvement. Recurring criticism and the empirical material indicate that the expectations have not been met.Conclusions:We would like to suggest that continued frustration can be traced to the misconception that EBP is the opposite of values and ideology, and hence preferable. As drug treatment strives for scientific credibility to give it legitimacy, some types of “evidence” are preferred above others. We would like to suggest that we need to bring ideology to the fore, and openly discuss our restrictive policy goals and choices of “evidence”.

Elimination of HCV as a public health concern among people who inject drugs by 2030 - What will it take to get there?

Introduction: Globally, there is a considerable burden of HCV and HIV infections among people who inject drugs (PWID) and transmission of both infections continues. Needle and syringe programme (NSP) and opioid substitution therapy (OST) coverage remains low, despite evidence demonstrating their prevention benefit. Direct-acting antiviral therapies (DAA) with HCV cure >95% among PWID provide an opportunity to reverse rising trends in HCV-related morbidity and mortality and reduce incidence. However, HCV testing, linkage to care, and treatment remain low due to health system, provider, societal, and patient barriers. Between 2015 and 2030, WHO targets include reducing new HCV infections by 80% and HCV deaths by 65%, and increasing HCV diagnoses from <5% to 90% and number of eligible persons receiving HCV treatment from <1% to 80%. This commentary discusses why PWID should be considered as a priority population in these efforts, reasons why this goal could be attainable among PWID, challenges that need to be overcome, and key recommendations for action.Discussion: Challenges to HCV elimination as a global health concern among PWID include poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low HCV testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. Key recommendations for action include reforming drug policies (decriminalization of drug use and/or possession, or providing alternatives to imprisonment for PWID; decriminalization of the use and provision of sterile needles-syringes; and legalization of OST for people who are opioid dependent), scaling up and improving funding for harm reduction services, making health services accessible for PWID, supporting community empowerment and community-based programmes, improving access to affordable diagnostics and medicines, and eliminating stigma, discrimination, and violence against PWID.Conclusions: The ambitious targets for HCV elimination set by WHO are achievable in many countries, but will require researchers, healthcare providers, policy makers, affected communities, advocates, the pharmaceutical and diagnostics industries, and governments around the world to work together to make this happen.

Protecting Prohibition

During recent years, political discussions about how to deal with cannabis use have become increasingly centered on harm reduction and liberalization in large parts of the Western world. In Sweden, however, no such re-framing of the issue has occurred. There has been political status quo with emphasis on prohibition and zero tolerance. This study aims to elucidate how the cannabis policy discourse in Sweden is characterized today to legitimize restrictive drug policy and counter global changes. Two symposia dedicated to dissemination of cannabis information in Sweden were analyzed to understand how policy players, service providers, and other professionals invited to speak at these events argue to maintain cannabis use a high-profile societal problem that necessitates prohibition. With the help of Carol Bacchi’s theoretical approach “What’s the Problem Represented to be,” we critically analyzed how cannabis is constructed in the material. This meant focusing on what policy and service provision that is described as meaningful and effective as a way to understand what the problem of cannabis is represented to be. Our analysis showed, among other things, that cannabis-positive attitudes are seen as utterly problematic, that youth users are portrayed as extremely vulnerable, and that current government responses are perceived as righteous and compassionate. It also showed how speakers at symposia construct a morally upright “us” who promote “reliable” scientific evidence about the dangers of cannabis. In this way, the choice between keeping prohibition and trying liberalization stands out as one between letting reliable or unreliable research guide drug policy. We conclude that youth becomes a perfect category to rationalize current problematizations; a vessel that may carry and protect drug prohibition in a globalized world where cannabis is increasingly handled like an ordinary commodity.

Does it matter how you ask? The forbid–allow asymmetry in the measurement of attitudes towards drug policies

BackgroundIt is important to know whether the public opinion on drug policies can be measured in a reliable and valid way. One of the threats to the validity of surveys on attitudes toward drug policies are wording effects, of which the most well-known is the forbid–allow asymmetry, i.e., people are often more willing to not allow something than to forbid it. The aim of the present study was to estimate the size of the allow–forbid asymmetry when measuring attitudes toward drug policy issues in the Norwegian adult population. MethodsThe data derive from a sample of 2182 adult Norwegian, aged 18–70, drawn from a large online panel comprising more than 50,000 Norwegian citizens (55% response rate). According to a 2 (allow vs. forbid)×2 (question vs. statement) between-subjects design, participants indicated support for the following three restrictive drug policies: (i) to allow/forbid wine in grocery stores, (ii) to allow/forbid smoking in parks and other public places and (iii) to allow forbid cannabis for recreational purposes. ResultsThere was not a significant difference between the framing conditions (forbid–allow) across the three policies, with an estimated difference of 2 percentage points (95% confidence intervals 0–5). ConclusionThe results suggest that survey research in the present context of drug policy is indeed more of a fact-finding enterprise than a process of constructing data.

PSY108 - Top 20 Orphan Drugs Availability, Pricing and Reimbursement In Slovakia: 2005-2012 Review

Orphan drugs are highly priced and top 20 orphan drugs create almost 2,5% of total drug expenditure in Slovakia. We conducted 8 years review of government and literature sources to provide insight into pricing, reimbursement and availability situation surrounding top 20 orphan drugs in Slovakia from the health care payer perspective. We provide analysis of official prices, reimbursement status and availability of top 20 orphan drugs in Slovakia from 2005 till 2012. Data were obtained from government sources. We considered orphan drugs list (Cote and Keating, 2012) that exceeded 1 billion $ sales in 2008 (globally) and compared molecules' availability in Slovakia. Same molecules are among best selling 20 orphan drugs in Slovakia, with highest sale of 95 million EUR (Bevacizumab, 2005-2012) compared to lowest sale of 19 million EUR (Tacrolimus, 2005-2012). It took from 1 (Imatinib) to 19 years (Glatiramer acetate) to be launched in Slovakia after orphan designation. Top 20 orphan drugs had average DOT 472 EUR compared to total pharma market DOT average 0,43 EUR. From selected orphan drugs 60% had full (100%) reimbursement status and 40% were fully covered by hospital budgets. Only 4 of them were launched in Slovakia since 2005 (included), 16 of them were launched from 1990 till 2004. Prices ranged from 330 EUR to 5800 EUR (ex-factory, one package, 2012). There are highly valuable incentives for industry to invest in to development of orphan drugs in EU. Current context of economic constraints in EU however justifies the need to pay close attention to the rationale of maintaining such incentives in the context of potential return on investments of companies offering high priced drugs. Top 20 orphan drugs in Slovakia have prices high above average and also full reimbursement status. We expect more restrictive drug policy measures in this field.

Prevention, treatment and care of hepatitis C virus infection among people who inject drugs

People who inject drugs (PWID) represent the core of the hepatitis C virus (HCV) epidemic in many countries. HCV transmission continues among PWID, despite evidence demonstrating that high coverage of combined harm reduction strategies, such as needle syringe programs (NSP) and opioid substitution treatment (OST), can be effective in reducing the risk of HCV transmission. Among infected individuals, HCV-related morbidity and mortality continues to grow and is accompanied by major public health, social and economic burdens. Despite the high prevalence of HCV infection, the proportion of PWID who have been tested, assessed and treated for HCV infection remains unacceptably low, related to systems-, provider- and patient-related barriers to care. This is despite compelling data demonstrating that with the appropriate programs, HCV treatment is safe and successful among PWID. The approaching era of interferon-free directly acting antiviral therapy has the potential to provide one of the great advances in clinical medicine. Simple, tolerable and highly effective therapy will likely address many of these barriers, thereby enhancing the numbers of PWID cured of HCV infection. However, the high cost of new HCV therapies will be a barrier to implementation in many settings. This paper highlights that restrictive national drug policy and law enforcement are key drivers of the HCV epidemic among PWID. This paper also calls for enhanced HCV treatment settings built on a foundation of both prevention (e.g. NSP and OST) and improved access to health care for PWID.

Shifting Focus in Substitution Treatment in the Nordic Countries

The article compares the development of substitution treatment in Denmark, Finland, Norway and Sweden. The focus is on the official guidelines: under what conditions, for whom and by whom should substitution treatment be organised? For many years, substitution treatment was fiercely opposed in Finland, Norway and Sweden, all of which had a restrictive drug policy and relied on social work rather than medicine. The debate cut through the professions and was at times the main political issue. Methadone treatment started in Denmark and Sweden in the 1960s, and while Finland and Norway did not give the go-ahead until the latter part of the 1990s, they have today expanded their substitution treatment considerably. In all four countries, substitution treatment has become an accepted and established part of treatment responses to abuse problems. The guidelines have become less strict even if the regimes in practice include various kinds of control measures. The thresholds of substitution treatment have remained the lowest in Denmark where this treatment mode is more geared toward harm reduction than in the other countries.

‘More cure and less control’ or ‘more care and lower costs’? Recent changes in services for problem drug users in Stockholm and Sweden

This article deals with the development of drug services in Stockholm, Sweden since the mid-1990s. Initially, data were collected as part of a European Union comparative study of the development of drug services in six major European cities. However, the present article uses these data to analyse to what extent the traditional ‘Swedish model’ of dealing with narcotic drugs can be said to have come to a crossroad. The article describes and analyses changes in drug use, and in the structure, organization and utilization of social services based, as well as healthcare-based drug services in Stockholm during the past decade. As pointed out in the article, the ‘drug-free society’ is still the ultimate goal of Swedish drug policy. However, as the Stockholm example hints, when it comes to the care and treatment of individual drug problems, there seems to be an on-going shift, from in-patient treatment towards measures such as substitution treatment, outpatient care and housing. The article discusses whether these changes signify a softening of Sweden's restrictive drug policy, or whether they rather point to a ‘re-medicalization’ of drug services, and shift in focus from ‘cure’ and social re-integration towards a focus on ‘care’ and on attempts to avoid ‘public nuisance’.

Changes in rates of upper gastrointestinal hemorrhage after the introduction of cyclooxygenase-2 inhibitors in British Columbia and Ontario

Population rates of upper gastrointestinal (GI) hemorrhage have been observed to increase with the introduction and rapid uptake of selective cyclooxygenase-2 (COX-2) inhibitors. Changes in COX-2 inhibitor use and upper GI bleeding rates in regions with relatively restrictive drug policies (e.g., British Columbia) have not been compared with changes in regions with relatively less restrictive drug policies (e.g., Ontario). We collected administrative data for about 1.4 million people aged 66 years and older in British Columbia and Ontario for the period January 1996 to November 2002. We examined temporal changes in the prevalence of NSAID use and admissions to hospital because of upper GI hemorrhage in both provinces using cross-sectional time series analysis. During the period studied, the prevalence of NSAID use in British Columbia's population of older people increased by 25% (from 8.7% to 10.9%; p < 0.01), as compared with a 51% increase in Ontario (from 10.9% to 16.5%; p < 0.01). Hospital admissions because of upper GI hemorrhage increased significantly in Ontario by about 16% on average, or about 2 admissions per 10 000 elderly people, above expected values (p < 0.01). A similar increase was not observed in British Columbia. More restrictive drug coverage policies, although limiting access to drugs and their potential benefits, may protect the population from adverse drug effects.

Culture as an explanation for substance-related problems: A cross-national study among French and Dutch adolescents

Our main goal was to establish whether French and Dutch adolescents differ in rates of substance-related adverse events (e.g. fights, robbery), problems with peers or socializing agents even when controlling for pattern of substance use. For problems with peers and socializing agents due to alcohol we hypothezised that, because of stronger informal control of drinking in France, French adolescents are more likely to report problems with peers and socializing agents. For adverse events due to alcohol no difference was expected after controlling for consumption patterns. For drug-related problems, the hypothesis was that, due to the more restrictive drug policy in France, French adolescents are more likely to report problems with peers, socializing agents and adverse events. Comparable surveys based on samples of adolescent schoolchildren in France ( n=9646) and the Netherlands ( n=4291) were used. Data were analysed using multilevel logistic regression in which school, age and gender, indicators of substance use and country were used as predictors of substance-related problems. The outcomes show that French adolescents are more likely to report problems with peers and socializing agents due to alcohol even when consumption pattern is controlled for. For adverse events due to alcohol no difference was found between French and Dutch adolescents. For drug-related problems the expected differences were found; i.e. French adolescents are more likely to report problems with peers, socializing agents and adverse events even when controlling for pattern of drug use. It is concluded that there are culturally embedded differences in the rates of some types of problems due to alcohol or drug use. With respect to alcohol use, these differences are most likely due to culturally embedded differences in the informal social control of alcohol use. The differences in rates of drug-related problems are interpreted in the context of national differences in drug policy.

Finnish Newspapers' Positions on Drug Policy between 1993 and 2000

Based on an analysis of editorials published in five Finnish newspapers from 1993 to 2000, this article discusses the role of the print press in the 1990s efforts to bridge the gap between restrictive drug policy and drug-harm-minimization policy in Finland. The analysis shows that from 1993 to 2000 there was a tone of “moral panic” in Finnish newspapers’ assessment that drug trafficking originating from abroad and the related crime were the prime challenge for Finnish drug policy. However, none of the five newspapers considered a restrictive drug policy sufficient. They maintained that while police control was necessary, further steps were needed so that the problem could be properly tackled as the internal national problem that it in fact constituted. The editorials recommended three lines of action: (1) an extensive drug treatment system should be developed, (2) young people, families, and communities should be urged to support a drug-free way of life, and (3) the authorities should be cautious in the introduction of drug testing. However, the analysis shows that the newspapers did not actually deal with the ideological ruptures and tensions that the promotion of drug-harm-reduction techniques caused for the dominant restrictive drug policy. The papers just pragmatically stated that more resources needed to be allocated to the strategy of prohibition as well as to the techniques of harm reduction.

On writing a white paper on drug policy

In February 1997, the Norwegian government presented a white paper to Stortinget (the Norwegian Parliament) on drug policy. Two quite different aspects related to the white paper are discussed in this article—and more questions are raised than will be answered. First, to what degree has a country with a restrictive drug policy—such as Norway—political leeway to “soften” drug policy measures without this being interpreted as a signal that the authorities have given up the fight? Do politicians necessarily believe in their defense of a strict drug policy, or do they feel forced to defend the existing policy? Second, what about role conflicts when a person normally working as a researcher is engaged by a ministry to take part in the production of a white paper on drug policy? To what extent can a researcher expect to have any influence on the political content?

Drug legalization, harm reduction, and drug policy.

The current U.S. policy options on drug use are reviewed in the context of the history of drug policy in the United States. A restrictive drug policy is a deterrent to drug use and helps reduce drug-related costs and societal problems. Although legalization or decriminalization of drugs might reduce some of the legal consequences of drug use, increased drug use would result in harmful consequences.