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|Miscellaneous Statements on Drug Policy|
Medicalization of Drug Abuse Control:
Pharmacy Based Voluntary Drug Users Co-operatives
Tod H. Mikuriya. M.D.
Reinvolve Medicine in Drug Policy
To bring medicine back to involvement with issues of drug dependence, the laws need revision to make the treatment of addicts a medical matter.
Redefine an addict as ill rather than criminal in substantive terms.
The doctrine of prohibiting physicians from maintaining opiate and cocaine addicts must
be eliminated. Transfer control of treatment protocols and standards from the Department
of Justice to the Department of Health Services. Mandate development of maintenance or
drug hygiene standards with participation of the California Medical Association.
A joint California Medical Association and California Bar Association committee to
draft legislation to revise laws to optimize freedom to appropriately treat substance
abuse, safeguard patient's rights, and protect the public health. Safeguards must be
included to discourage excessive consumption or abuse.
Pharmacy Based Voluntary Drug Users' Co-operatives
A new category of legal non-therapeutic users of controlled substances is created.
Include all drugs listed in the Controlled Substances Act of 1970 et seq. for actual
controlled use. Users would obtain these drugs at participating pharmacies utilizing
special ID. Entry to the program at the age of majority would be by written test. No
intervention by the program unless there is a problem. Supported by transaction fees,
community treatment resources would be paid for by the program.
Success of the program is based on the premise that the rate of morbidity will be acceptably low in an informed group of users. Chronic users learn to develop functional stable use patterns that may continue for long periods without disruption. Dysfunctional behavior associated with use would result in being dropped from the program.
Reacting to some adversity a chronic user will increase his/her dose in an effort to suppress adverse emotions through distracting analgesia. The consequent psychosocial dysfunction, health problems, or financial crisis motivates seeking of treatment or results in external intervention.
Upon entering a detoxification program the habitual user typically forswears the habit, vowing to stay "clean" from now on. The rare dependent will truthfully admit to an authentic treatment goal of reducing a habit to manageable levels.
Even with success in completing detoxification and maintaining a period of abstinence, drug dependence is a chronic relapsing illness.
The mission of VDUC is to control, treat, and prevent drug abuse in a flexible and appropriate fashion. The dispensing of controlled substances through participating pharmacies to registered users is included.
Price structure based upon abuse/use ratio of a substance would encourage the use of less toxic or dangerous products. A harmfulness tax is an idea that has been recently proposed by Grinspoon.
The VDUC would be somewhat more controlled than differential toxicity tax rates because written and physical tests would be required for entry into a pharmacy-based program using an identification card.
Another VDUC goal is to institutionalize connections between cost/benefit or actuarial facts with social policy and the marketplace. These connections only dimly exist for alcohol and tobacco industries and their users. Unlike these hazardous substances, drugs sold through VDUC would not be granted exemption from product liability laws.
Transaction fees and all taxes would be earmarked to support the administration of the
co-operative and contracting community treatment providers for users needing services.
Different from the British "System"
The contemporary British "system" derives from their national health service that is represented by local health councils which manage medical resources. The availability of physicians who are addiction specialists and priorities of local councils determines whether the addict will obtain appropriate treatment.
The rapid increase of heroin addicts and small numbers of addiction specialists has overwhelmed that system. The illicit free market filled the drug needs of the users the National Health Service could not meet.
Substance abuse treatment services in Great Britain are just as fragmented as that in the United States but with differences in dynamics of control, economics, and influences of special interest groups. Both are ill-equipped and overwhelmed by the impact of problems connected with substance abuse.
But at least they don't turn the addicts into criminals as we do in the United States.
Unlike prescriptive medical clinic models the proposed Voluntary Drug Users Co-operative is not vulnerable to oversubscription with waiting lists.
Users are dispersed to pharmacies and only come to a treatment program if there is a problem.
Since the scheme is transaction fee supported, the larger the number of users, the more money becomes available for treatment, prevention, and education.
Since there would be no intervention unless there was evidence of dysfunction, costs would be lower than a clinic or physician visit type of maintenance program. This lower level of control and services for problem-free users would support a spectrum of services for those suffering drug-related illness or dysfunction. Flexibility and range of response is based on the principle that control is exerted from within or imposed from without.
More importantly, the program would provide an ongoing source of reliable data on which
to refine policies and develop products that would optimize use/morbidity patterns.
The age of majority would permit the taking of a written test on drug effects, side effects as well as the conditions of the VDUC program including consequences of misuse or violation of conditions. Passing of these tests would constitute informed consent.
An entry medical evaluation including physical examination and laboratory tests would be required to screen for conditions that would preclude or restrict access such as mental illness, epilepsy, or substance abuse.
These high risk individuals if allowed access would be more closely supervised by
Non-profit community board
A non-profit community board would be mandated to protect the users from exploitation as well as the public from health and safety risks. Users, pharmacists, public Health, legal and the general community should be represented.
Abusers referred to treatment or enforcement
All transactions are reported to the executive office of the VDUC and any patterns of unusual or exceptional use are investigated in addition to any reports of medical, surgical, or antisocial incidents.
Privileges are suspended and the abuser is referred to police or district attorney if
the drugs are furnished to a minor, used to poison, incapacitate, or impair someone else.
Driving while intoxicated, endangering others, fighting, or being a danger to others would
be generally handled by enforcement.
If the user exhibits dysfunctional behavior or impaired health that does not directly harm someone else, then he/she is referred to an appropriate substance abuse program. Reports from hospitals, emergency rooms, physicians offices, health facilities, workplace, family, dispensing pharmacy, or other source would initiate intervention. The program identification card would be suspended and the abuser referred to the assessment team.
Experienced substance abuse specialists would be utilized for "triage" to determine the type of intervention appropriate to the individual problem. Intervention would be the least intrusive or restrictive possible.
Referral for specialized treatment
A spectrum of outpatient and in-patient service would be available as contractors to the program for intervention in cases of drug abuse.
Continuing research and education
The continuing study at Framingham, Massachusetts provided us with definitive information concerning the connection between smoking, lung cancer, heart, and other circulatory diseases. Unbiased and extensive morbidity information would be collected from participating health resources for policy refinement.
In order to restore a source of legitimate and undistorted medical information as to
the connections between drugs and their hazards, treatments, and prevention, ongoing study
is required on a large scale.
Funding for Treatment and Prevention
Treatment would be available if needed since the current salient problem is the lack of
money for treatment. Nine out of ten substance abusers voluntarily asking for treatment
are turned away for lack of a way to pay for treatment. The earmarking of taxes combined
with transaction fees would provide an ongoing source for funding that has been heretofore
2 U.S. Studies Criticize Plan To Ease Access to Methadone Associated Press in the New York Times A11, August 4, 1989
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Dole, V.P. and Nyswander, M. Heroin Addiction- A Metabolic Disease, Archives of Internal Medicine 120 July 1967 19-20.
Goodman and Gilman's The Pharmacological Basis of Therapeutics 7th Edition Macmillan New York 1985 1839 pp
Grinspoon, L. The Harmfulness Tax: A proposal for regulation and taxation of Drugs Unpublished. Address to International Meeting on Antiprohibitionism Brussels September 29, 1989 11 pp.
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Nadelmann, E.A. Drug Prohibition in the United States: Costs, Consequences, and Alternatives Science 245: September 1, 1989, 939-947
Report of the Indian Hemp Drugs Commission 1893-94 Simla, India: Government Central Printing House, 1894, 7 Vols 3,281 pp.
_____________ Supplementary Vols 1 & 2: 417 pp (Classified military data published separately)
Syllabus for the Psychopharmacology Course Harvard Medical School Sept 30 Oct 2, 1988 Harvard Medical School Department of Continuing Education, Boston, MA 514 pp.
Terry, C.E. and Pellens, M. The Opium Problem. Bureau of Social Hygiene New York 1928 1045 pp (Reprinted by Patterson Smith, Montclair NJ 1970)
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____________ The Great Drug War Macmillan, New York 1987 401 pp
Contents | Feedback | Search | DRCNet Home Page | Join DRCNet
DRCNet Library | Schaffer Library | Miscellaneous Statements on Drug Policy
Schaffer Library of Drug Policy
Major Studies of Drug and Drug Policy
Marihuana, A Signal of Misunderstanding - The Report of the US National Commission on Marihuana and Drug Abuse
Licit and Illicit Drugs
Short History of the Marijuana Laws
The Drug Hang-Up
Congressional Transcripts of the Hearings for the Marihuana Tax Act of 1937
Frequently Asked Questions About Drugs
Basic Facts About the Drug War
Charts and Graphs about Drugs
Information on Alcohol
Guide to Heroin - Frequently Asked Questions About Heroin
LSD, Mescaline, and Psychedelics
Drugs and Driving
Children and Drugs
Drug Abuse Treatment Resource List
American Society for Action on Pain
Let Us Pay Taxes
Marijuana Business News
Reefer Madness Collection
Medical Marijuana Throughout History
Drug Legalization Debate
Legal History of American Marijuana Prohibition
Marijuana, the First 12,000 Years
DEA Ruling on Medical Marijuana
Legal References on Drugs
GAO Documents on Drugs
Response to the Drug Enforcement Agency
|Drug Information Articles|
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