US Drug Policy Research Articles

Cannabis Policy in the 21st Century: Mandating an Equitable Future and Shedding the Racist Past

The cannabis legalization movement in the United States has experienced unprecedented success in the past decade due to a wave of grassroots reforms in states across the country. The current legalization movement began in 2012, when Colorado and Washington became the first two states to legalize the use and sale of cannabis for adults aged ≥ 21 years. Since then, the use of cannabis has been legalized in 21 states, Guam, the Northern Mariana Islands, and Washington, DC. Many of these states have explicitly framed the law change as a rejection of the War on Drugs and its harms, felt disproportionately in Black and Brown communities. However, racial inequities in cannabis arrests have increased in states that have legalized cannabis for adult use. Moreover, states working to implement social equity and community reinvestment programs have made little progress toward their goals. This commentary describes how US drug policy, racist in intention, gave way to drug policy that perpetuates racism, even when its ostensible or stated goal is equity. As the United States prepares for national legalization of cannabis, it is critical that we break away from past legislation and mandate equity in cannabis policy. Developing meaningful mandates will require us to acknowledge our history of using drug policy for the racist goals of social control and extortion, study the experience of states that are trying to implement social equity programs, listen to Black leaders and other leaders of color who have developed guidance for equity-focused cannabis policy, and commit to a new paradigm. If we are willing to do these things, we may be able to legalize cannabis in an anti-racist way that will stop causing harm and enable us to effectively implement reparative practices.

Militarization and privatization of security: From the War on Drugs to the fight against organized crime in Latin America

AbstractFifty-two years ago, in 1971, President Nixon declared the “War on Drugs”, identifying drug abuse as a public enemy in the United States. Since then, US drug policy has been militarized and, more recently, privatized. Every year, the US government increasingly contracts private military and security companies to provide intelligence, logistical support and training to armed forces in drug-producing or drug-transit States. In Latin America, this militarization and privatization has increased the intensity of violence and has complexified domestic situations, to the extent that the existing international legal regimes now seem inappropriate to respond to the challenges posed by the War on Drugs. On the one hand, human rights law does not adequately address situations where the State faces organized crime groups that are able to control territory. On the other hand, international humanitarian law (IHL) was not created to address law enforcement situations, which the War on Drugs and the fight against organized crime ostensibly are.This article examines the situation in Latin America, looking at examples of different types of situations through the lens of intensity and organization of the group involved and, in some cases, the group's control over territory. It discusses the application of IHL and human rights law (focusing on the inter-American system of human rights) in these situations and their complementarity, and debates how these bodies of law are adapting or may need to be adapted.

Persistent Criminalization and Structural Racism in US Drug Policy: The Case of Overdose Good Samaritan Laws.

The US overdose crisis continues to worsen and is disproportionately harming Black and Hispanic/Latino people. Although the "War on Drugs" continues to shape drug policy-at the disproportionate expense of Black and Hispanic/Latino people-states have taken some steps to reduce War on Drugs-related harms and adopt a public health-centered approach. However, the rhetoric regarding these changes has, in many cases, outstripped reality. Using overdose Good Samaritan Laws (GSLs) as a case study, we argue that public health-oriented policy changes made in some states are undercut by the broader enduring environment of a structurally racist drug criminalization agenda that continues to permeate and constrict most attempts at change. Drawing from our collective experiences in public health research and practice, we describe 3 key barriers to GSL effectiveness: the narrow parameters within which they apply, the fact that they are subject to police discretion, and the passage of competing laws that further criminalize people who use illicit drugs. All reveal a persisting climate of drug criminalization that may reduce policy effectiveness and explain why current reforms may be destined for failure and further disadvantage Black and Hispanic/Latino people who use drugs. (Am J Public Health. 2023;113(S1):S43-S48. https://doi.org/10.2105/AJPH.2022.307037).

International Reference Pricing in the Context of US Drug Policy.

International reference prices (IRP), also called external reference prices, are widely used across developed nations. IRP uses the prices paid in other countries to either inform negotiations with the pharmaceutical industry or as a cap on market prices. The authors review the application of IRP to cap the prices of negotiated outcomes in the context of US proposals for changing the way prescription drug prices are established for the Medicare program. They examine the economic, political, and administrative issues associated with the use of IRP, and they summarize the evidence on the impacts of IRP.

US Drug Policy and Perpetual War against the Drug Trade in Mexico

Abstract Globalization of drug consumption has generated a highly lucrative market for illegal traffickers. The US launched a worldwide campaign against illicit drug use, forcing many countries to comply with the ‘War on Drugs.’ We describe this historical process as a perpetual war resulting in violence, criminality, forced displacement, and disappearances in Mexico and other countries. For instance, despite economic, political, and military coercion in Mexico, the “drug problem” shows little sign of going away, unless a new approach regarding drug production and trade is adopted.

The unmaking of 'evil': claiming space for rational discourse on US drug policy.

The unmaking of 'evil': claiming space for rational discourse on US drug policy.

History and its contribution to understanding addiction and society.

This paper provides a personal memoir of historical work at the Addiction Research Unit, in particular the genesis of the book Opium and the People. This topic had policy significance for US drug policy and a competing US study was funded. The development of the substance use history field is surveyed, and its expansion in recent times through a focused professional association and a critical mass of researchers in the area, covering a wide range of topics. The politics of using history in this area can be problematic. History now sits at the policy table more easily, but there is still a tendency for professionals in the field to use (and misuse) it, rather than calling on the interpretive and challenging approach they would obtain from professional historians. The paper calls for historians and others to move beyond a substance specific focus and to avoid the tendency for 'naive history' implicit in using only digitized industry archives as the sole source.

Grounded in evidence or a puritanical legacy: a critique of twenty-first-century US drug policy

The federal government of the USA asserts that its national drug policy is based on empirical and scientific evidence rather than ideology. However, the recently published ‘War on Drugs’ (2011) report declared that the global war on drugs has failed, producing devastating consequences for individuals and societies around the world. Accordingly, this paper focuses on a number of key positions that are embedded in the US drug policy and seeks to reconcile these with the empirical evidence that exists; such as it is. In the absence of supporting empirical evidence to underpin a policy goal, one must logically consider that there are alternative, hidden drivers and the authors can detect (at least) three such drivers of US drug policy. The first of these is the influence of religion; US drug policy is influenced by a Puritanical legacy. The second is that of societal views of drugs and drug users per se and how such views invariably associate certain drugs with specific ethnic minority groups. The third is th...

Why Has US Drug Policy Changed So Little over 30 Years?

AbstractThough almost universally criticized as overly punitive, expensive, racially disparate in impact, and ineffective, American drug policy remained largely unchanged from 1980 to 2010. Marijuana is an important exception: policy and law underwent many changes, with the strong likelihood of more, involving increased legal access to the drug, in the near future. For cocaine, heroin, and methamphetamine there has been an almost relentless increase in the numbers incarcerated for drug offenses, rising from about 50,000 in 1980 to 500,000 in 2010. The disparities in African American imprisonment rates are higher for drug offenses than for other types of crime; some of this disparity results from unjustifiably harsher sentences for crack than for powder cocaine offenses. The battles necessary to achieve even modest reductions in these disparities and other overly severe sentencing regimes at the state and federal levels demonstrate how difficult it is to achieve changes in drug policy. Recent reforms in he...

United States drug prohibition and legal highs: How drug testing may lead cannabis users to Spice

Aims: At the time of the study, the synthetic cannabinoid K2/K3, which is sold as ‘Spice’ incense, was legal in many states in the US. Because the US Drug Enforcement Agency has emergency scheduled ‘Spice’, the producers of these synthetic substances have altered their chemical compounds to remain legal and on the market. This study seeks to understand the reasons for use of these substances and the role US drug policy plays in encouraging use.Methods: Employed a mixed-methods approach. We surveyed 374 undergraduate students in a Southern California University and conducted 25 qualitative interviews of users who answered a newspaper or flyer advertisement of the study.Findings: Most of the users in the qualitative sample sought a legal alternative to cannabis (their drug of choice) to avoid positive drug test screenings and criminal sanctions. Many were attending abstinence-only drug treatment programmes, under community corrections, or were seeking a career in the US military. These individuals were randomly drug tested and knew that the metabolites of synthetic cannabis are not detected in standard urine drug screenings.Conclusions: US drug policies – the prohibition of marijuana and the proliferation of drug testing – have led users to seek out legal highs.

Contrasting effects of d-methamphetamine, 3,4-methylenedioxymethamphetamine, 3,4-methylenedioxypyrovalerone, and 4-methylmethcathinone on wheel activity in rats

BackgroundReports from US, UK and European drug policy entities, and ongoing media accounts, show increasing recreational use of 4-methylmethcathinone (4-MMC, mephedrone) and 3,4-methylenedioxypyrovalerone (MDPV). Severe sympathomimetic symptoms, hallucinations, psychoses, and even deaths have been reported, yet little scientific information is available on the effects of these compounds in laboratory models. Available studies on the neurochemistry of these drugs show that 4-MMC and MDPV enhance DA neurotransmission, while 4-MMC additionally enhances 5-HT neurotransmission – a pattern much like that reported for methamphetamine versus 3,4-methylenedioxymethamphetamine (MDMA). As is the case for designer amphetamines, these neurochemical distinctions may predict differential potential for repetitive versus episodic abuse and distinct lasting toxicities. MethodsThis study determined relative locomotor stimulant effects of 4-MMC (1–10mg/kg, s.c.) and MDPV (0.5–5.6mg/kg, s.c.), in comparison with d-methamphetamine (MA; 0.5–5.6mg/kg, s.c.) and MDMA (1–7.5mg/kg, s.c.) on a measure of locomotor activity – voluntary wheel running – in male Wistar rats (N=8). ResultsCompared to counts of wheel rotations after saline, a biphasic change in the pattern of counts was observed after injections of MA and MDPV, with relatively higher counts following lower doses and lower counts following the highest dose. However, monophasic, dose-dependent reductions in counts were observed in response to injections of MDMA and 4-MMC. ConclusionThus, voluntary wheel running yielded the same categorical distinctions for these drugs as did prior experiments testing the effects of these drugs on monoaminergic neurotransmission. These data indicate that MDPV produces prototypical locomotor stimulant effects whereas 4-MMC is more similar to the entactogen MDMA.

Focusing on abuse, not use: A proposed new direction for US drug policy

How professionals and societies deal with drugs and drug consumption is premised on how abuse is defined. The “War on Drugs” approach promotes the belief that “any use is abuse” where the currently illicit drugs are concerned. Regrettably, any distinction between use and abuse has been notably absent from most public policy decisions on drug issues. Even a cursory review of both supply and demand reduction policies of the past century reveals a startling lack of awareness of this distinction. The failure of differentiation undermines prevention, treatment, and the criminal justice system. Treatment, thus, tends to show a bias toward ineffective models such as “boot camps” and “tough love”. It has contributed to controversy over maintenance treatments, such as methadone, buprenorphine, and heroin, which have proven to be highly effective for some addicted persons. It leads to treatment options for the addictions being far more limited and constrained than is typical in other areas of health care. Admittedly, studying non-problematic drug use has been a challenge, but clearly the use of illegal drugs is often not harmful, any more than is moderate alcohol use. Addiction is a fatal disease for some and that disease should be the focus of our policies.

The short life of a race drug

The headlines back in June, 2005, read “FDA approves a heart drug for African Americans”. The decision that gave the company NitroMed approval for its drug BiDil exclusively to a “racial group” represented a milestone in US drug policy. The decision ignited a debate that polarised the African American community, confounded proponents of personalised medicine, and dismayed groups opposed to reinscribing racial categories into science. Ever since Ashley Montagu published Man's Most Dangerous Myth: The Fallacy of Race in 1964, scientists have reached a broad consensus that “race” applied to human populations has no standing in science.

Treatment Given High Priority in New White House Drug Control Policy

JUST A FEW MONTHS AFTER HIS APpointment by President Obama as the new director of the White House Office of National Drug Control Policy (ONDCP), R. Gil Kerlikowske, former chief of the Seattle Police Department announced that after 4 decades, the “war on drugs” was over. “It’s time to recognize drug abuse and addiction for what it is—not just a criminal justice issue, but also a very complex and dynamic public health challenge, one that demands a systematic, comprehensive, and evidenceled approach if we are going to be equal to the task,” Kerlikowske said in a December speech (ht tp : / /www .whitehousedrugpolicy.gov/news /speech09/121009_Stockholm.pdf). Such statements and the appointment of a 35-year veteran of addiction treatment research, A. Thomas McLellan, PhD, as deputy director of ONDCP have lead to optimism that drug treatment would play a larger role in US drug policy. McLellan, cofounder of the Treatment Research Institute, a nonprofit organization that promotes the translation of addiction research into therapy, and editor in chief of the Journal of Substance Abuse Treatment from 20002009, recently discussed with JAMA the new direction at ONDCP. JAMA: There has been considerable progress in understanding the biological underpinnings of addiction in recent years. What role will this science play in the new policy? Dr McLellan: On the demandreduction side of the ONDCP strategy, we are going to be pushing prevention, early intervention, treatment, and recovery. Across all of those areas, the emphasis is evidence-based practice.

US Intervention in Colombia: The Role of Transnational Relations

In July 2000, US President, Bill Clinton, signed into law the aid package popularly known as ‘Plan Colombia’. Foreign policy analysts examining the ‘US drug war’ have generally focused upon the perceived national security interests of the US state and/or the intermestic nature of domestic politics, or the economic interests of an imperial US state in explaining US drug policy. I posit that the development, initiation and implementation of Plan Colombia cannot solely be understood through these various nation‐state paradigms, as this process was aided by, and facilitated through, an incipient transnational state. The emergence and consolidation into power of a neoliberal state within Colombia, the role of transnational lobbying by US and Colombian policy‐makers, as well as the influence of transnational corporations all played instrumental roles in the initiation, development and implementation of Plan Colombia.

Lord of drug lords: One life as lesson for US drug policy

Lord of drug lords: One life as lesson for US drug policy

National women's health network and the US FDA: Two decades of activism

The National Women's Health Network (NWHN) in the United States works for more power for women at all levels of health care decision-making. This paper describes some of the campaigns carried outby the Network since the 1970s to influence US Food and Drug Administration (FDA) guidelines and policy. These include: requirements for patient package inserts for oral contraceptives, oestrogen during menopause, and drugs for pregnant women. The Network has also consistently taken up the safety and efficacy of drugs and devices used by women. It has opposed approval of Depo Provera, supported approval of the Prentif cervical cap and the female condom, opposed a large trial of tamoxifen for prevention of breast cancer in healthy women because of its risks, and supported studies on the safety ofbreast implants.

When science and medicine are ignored: the case of US drug policy

themselves at that period (Worboys, 1988; Petty, 1989). In the UK context, nutrition science had an important role in redefining the dietary effects of unemployment as simple vitamin deficiencies; in the colonies, the 'dietary survey' helped suppon a view of malnutrition based on native 'ignorance' and backwardness. Scientific knowledge here also shaped and was shaped by wider political debates. The eclipse in knowledge about the harmful effects of alcohol was much more than a simple reaction against temperance science. We need to look outside that primary alcohol focus, for modes of scientific enquiry and explanation are rooted in their social context, gaining their legitimacy through the policy interests they express.

Global Crime Connections: Dynamics and Control.

Crime's global reach, Michael Woodiwiss all about Eve - the many faces of US drug policy, Bruce Bullington after Mr Bennett and Mr Bush - US foreign policy and the prospects for drug control, Nicholas Dorn and Nigel South defending the mountaintop - organized crime and the disposal of toxic waste, Alan Block the Camorra - Clean capital and organized crime, Vincenzo Ruggiero EEC fraud - a suitable case for treatment, Michael Clarke US capital versus the Third World - union carbide and bhopal, Frank Pearce and Steve Tombs the politics of corporate crime control, Laureen Snider.