What America's Users Spend on Illegal Drugs, 2006-2016


Book Description

Substance use and drug policy are clearly in the national spotlight. Provisional data from the Centers for Disease Control and Prevention suggest that drug overdose deaths in 2018 exceeded 68,000, of which more than 47,000 involved opioids. Although heroin, prescription opioids, and synthetic opioids (such as fentanyl) receive most of the attention, deaths involving methamphetamine and cocaine are both on the rise. In addition, more than 25 percent of the U.S. population lives in states that have passed laws that allow for-profit firms to produce and sell marijuana for nonmedical purposes to adults ages 21 and older. To better understand changes in drug use outcomes and policies, policymakers need to know what is happening in the markets for these substances. This report updates and extends estimates of the number of users, retail expenditures, and amount consumed from 2006 to 2016 for cocaine (including crack), heroin, marijuana, and methamphetamine in the United States, based on a methodology developed by the RAND Corporation for the Office of National Drug Control Policy. The report also includes a discussion of what additional types of data would help quantify the scale of these markets in the future, including the new types of information produced by the legalization of marijuana at the state level.




Pain Management and the Opioid Epidemic


Book Description

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.




Disease Control Priorities, Third Edition (Volume 4)


Book Description

Mental, neurological, and substance use disorders are common, highly disabling, and associated with significant premature mortality. The impact of these disorders on the social and economic well-being of individuals, families, and societies is large, growing, and underestimated. Despite this burden, these disorders have been systematically neglected, particularly in low- and middle-income countries, with pitifully small contributions to scaling up cost-effective prevention and treatment strategies. Systematically compiling the substantial existing knowledge to address this inequity is the central goal of this volume. This evidence-base can help policy makers in resource-constrained settings as they prioritize programs and interventions to address these disorders.







Ending Discrimination Against People with Mental and Substance Use Disorders


Book Description

Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.




Cocaine


Book Description

The contributors to Cocaine analyze the contemporary production, transit, and consumption of cocaine throughout the Americas and the illicit economy's entanglement with local communities. Based on in-depth interviews and archival research, these essays examine how government agents, acting both within and outside the law, and criminal actors seek to manage the flow of illicit drugs to both maintain order and earn profits. Whether discussing the moral economy of coca cultivation in Bolivia, criminal organizations and drug traffickers in Mexico, or the routes cocaine takes as it travels into and through Guatemala, the contributors demonstrate how entire ways of life are built around cocaine commodification. They consider how the authority of state actors is coupled with the self-regulating practices of drug producers, traffickers, and dealers, complicating notions of governance and of the relationships between economic and moral economies. The collection also outlines a more progressive drug policy that acknowledges the important role drugs play in the lives of those at the urban and rural margins. Contributors. Enrique Desmond Arias, Lilian Bobea, Philippe Bourgois, Anthony W. Fontes, Robert Gay, Paul Gootenberg, Romain Le Cour Grandmaison, Thomas Grisaffi, Laurie Kain Hart, Annette Idler, George Karandinos, Fernando Montero, Dennis Rodgers, Taniele Rui, Cyrus Veeser, Autumn Zellers-León




Medications for Opioid Use Disorder Save Lives


Book Description

The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already existâ€"like evidence-based medicationsâ€"are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.




The Health Effects of Cannabis and Cannabinoids


Book Description

Significant changes have taken place in the policy landscape surrounding cannabis legalization, production, and use. During the past 20 years, 25 states and the District of Columbia have legalized cannabis and/or cannabidiol (a component of cannabis) for medical conditions or retail sales at the state level and 4 states have legalized both the medical and recreational use of cannabis. These landmark changes in policy have impacted cannabis use patterns and perceived levels of risk. However, despite this changing landscape, evidence regarding the short- and long-term health effects of cannabis use remains elusive. While a myriad of studies have examined cannabis use in all its various forms, often these research conclusions are not appropriately synthesized, translated for, or communicated to policy makers, health care providers, state health officials, or other stakeholders who have been charged with influencing and enacting policies, procedures, and laws related to cannabis use. Unlike other controlled substances such as alcohol or tobacco, no accepted standards for safe use or appropriate dose are available to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively. Shifting public sentiment, conflicting and impeded scientific research, and legislative battles have fueled the debate about what, if any, harms or benefits can be attributed to the use of cannabis or its derivatives, and this lack of aggregated knowledge has broad public health implications. The Health Effects of Cannabis and Cannabinoids provides a comprehensive review of scientific evidence related to the health effects and potential therapeutic benefits of cannabis. This report provides a research agendaâ€"outlining gaps in current knowledge and opportunities for providing additional insight into these issuesâ€"that summarizes and prioritizes pressing research needs.




Substance Use and Misuse, Third Edition


Book Description

The revised third edition of the formerly titled Substance Use and Abuse retains its comprehensive, holistic examination of the field of substance use and misuse from a Canadian perspective. Now organized into seven sections, the 30 chapters examine the nature of addiction; explore biological, psychological, and social theories that attempt to explain addiction; discuss drugs that produce addiction, along with a review of prevention, treatment, and treatment system options; and consider the legal and ethical issues that those working in substance use and addiction frequently encounter. Thoroughly updated to reflect contemporary issues and recent advances in the field of addiction counselling, Rick Csiernik’s much-loved text features new content on the changes to cannabis law and culture in Canada, the opioid crisis and public response, as well as expanded content on cultural competence, non-substance use addictive behaviours, motivational interviewing, and relapse prevention. Substance Use and Misuse is an essential and timely resource for counsellors treating individuals dealing with addiction, and for courses across social work, human services counselling, psychology, and mental health and addictions programs. FEATURES: - Now divided into seven sections with 30 chapters to enhance student comprehension and learning - Contains new information on contemporary themes including the opioid crisis, e-cigarettes and vaping, risks and benefits of THC and CBD, principles of good family skills training, sample dialectical behavioural therapy (DBT) activities, and a sample intervention script - Includes an enhanced treatment section with updates on harm reduction, traumainformed care, the transtheoretical model of change, and motivational interviewing




The Struggle for Natural Resources


Book Description

The Struggle for Natural Resources traces the troubled history of Bolivia's land and commodity disputes across five centuries, combining local, regional, national, and transnational scales. Enriched by the extractivism and commodity frontiers approaches to world history, the book treats Bolivia's political struggles over natural resources as long-term processes that outlast immediate political events. Exploration of the Bolivian case invites dialogue and comparison with other parts of the world, particularly regions and countries of the so-called Global South. The book begins by examining three Bolivian resources at the center of political dispute since the early colonial period, namely land, water, and minerals. Carmen Soliz, Rossana Barragán, and Sarah Hines show that, as in the colonial and early republican past, these resources have remained the focus of political contention to the present day. Until the end of the nineteenth century, Bolivia's battle over natural resources was primarily concentrated in the highlands and inter-Andean valleys. Beginning in the 1860s, the bicycle and soon the automobile industries triggered demand for natural rubber found in the heart of the Amazon. José Orsag analyzes the impact of this extractive economy at the turn of the twentieth century. The book concludes by examining two resources that are central to understanding the last century of Bolivia's history. Kevin Young examines the fraught business of hydrocarbons, and Thomas Grisaffi analyzes the coca/cocaine circuit. Each chapter studies the social dynamics and political conflicts that shaped the processes of extraction, exchange, and ownership of each of these resources