En12 Research Paper Draft Final Drugs.docx

Supervised Drug Injection Sites to Treat Drug Addiction

[Title Here, up to 12 Words, on One to Two Lines] Rodriguez, Carl Matthew D. Student of Ateneo de Manila University

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Abstract The war on drugs has been a pressing issue in numerous countries around the world, including the Philippines. In most cases, narcotics are the drugs most commonly concerned with the issues of addiction. The long-standing approach to the issues on drugs have been mainly prevention, detention, and rehabilitation through stricter implementations of drug policies promulgated around the world. However, these methods have yielded more problems economically and socially for nations rather than drastic improvements to community welfare. Despite these common, conservative approaches to drug-related issues, some European countries and a few states of the US have opted to try supervised drug injection sites as a means to alleviate or cure addiction in communities (Kral & Davidson, 2017). Given this newfound and unconventional method, the study aims to analyze how it can be used as a more beneficial alternative to the current programs for drug-related problems. The study made use of various research done in the past. First, the concepts of drug addiction and the psychology of drug users are evaluated. Likewise, the current and most common implementations done for drug policies are evaluated based on its problems and benefits to society. Finally, research on how supervised injection sites have faired in resolving the issues on drugs was divulged to understand how it could be a viable alternative to the drug war. The study found that the problems brought about by the current methods of prevention, detention, and rehabilitation outweighed the incremental improvements, while supervised injection sites yielded greater improvements to the quality of life in affected communities. The study concludes with a recommendation for lawmakers to approve the establishment of supervised drug sites, especially in underdeveloped areas.

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[Title Here, up to 12 Words, on One to Two Lines] Introduction For the past few decades, the war on drugs has led to thousands of arrests around the world. In America alone, arrests had tripled between 1980 and 2000, mostly due to drug-related conduct (Patten, 2017). This rise in incarceration happened in line with former US President Richard Nixon’s administration associating drugs with crime, and in doing so, he had initiated the war on drugs. His strict demeanor towards law enforcement, especially in drug prevention, led to drug users and addicts being permanently associated with danger since they had been treated with the same prejudice as criminals. This was because of his approach to treating abusers being parallel to managing prisoners (Raz, 2017). America’s approach to drug abusers had been followed around the world in matters of drug policy, including the Philippines. Currently, the Philippine government under Pres. Rodrigo Duterte has opted to murder anyone associated with drugs with extreme prejudice. In fact, the police had killed nearly 2500 people for the sake of drug suppression. (KINE, 2017) However, some countries in Europe as well as a few states in the US have opted instead to distribute controlled doses of recreational drugs, as well as designating safer facilities for recreational drug usage. (Kennedy & Kerr, 2017) This study hopes to tackle how not banning drugs is the key to solving drug addiction. To do so, various studies done in the past will be reviewed to create an in-depth analysis of the issue. The history of the war on drugs will introduced, along with the current procedures on handling drug users, but it will be coupled afterwards with the psychology of addiction and drug abuse to understand the implications of drugs on behavior. Then, reviews of recent studies made on programs of government-sanctioned drug injection sites will be divulged and juxtaposed to what is done instead. In this study, the implementation of sanctioned drug sites will be

Supervised Drug Injection to Treat Drug Addiction highlighted as an alternative solution to the war on drugs. It also hopes to bring clarity on the situations of drug users and addicts.

Drugs and the Psychology of a Drug Addict To begin, Chapman (1962) defines addiction in the book, Problems with Addiction: “Drug addiction, though encompassing by definition the repetitive and compulsive use of some natural or synthetic substance to the detriment of self or society, is usually limited to the use of drugs of the opium family – the narcotics.” Narcotics refer to drugs that are meant to numb the body, in order that pain is not felt when administered. For some individuals though, their bodies react with pleasurable sensations, described as something of a calming effect. (Chapman, 1962, p.157) That being said, the most common drugs used illegally in recent times include marijuana, heroin, cocaine, and methamphetamine. (Kilmer, 2012) What is interesting to note is how drug addiction is not so much a safety problem for communities but a social problem concerning the addicts. Chapman’s study shows that most drug addicts begin young and come from difficult circumstances. Their dependence on drugs as their vice stems from problems in their emotional development, especially growing up. (Chapman, 1962, p.159) What goes on in the mind of a drug-user who turns addict is best explained in Adams’ (p.21, 1978) book Psychoanalysis of Drug Dependence: “Rado (1931, 1933) recognized the important role that frustration of gratification plays in addiction to drugs and alcohol (‘morbid

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cravings’) and the ‘special types’ of emotional reaction that individuals are prone to addiction have to frustration that he designated ‘tense depression.’ In simple terms, drug addiction represented to Rado the attempt by the individual to overcome the state of ‘tense depression’ by seeking a state of ‘elation’ artificially induced by the effects of the drug.” Given the information on the context of drug users, the effects of popular narcotics, and the state of mind involved in drug dependence, the idea can be drawn that drug-addicts are not all dangerous criminals but perhaps people who need help. Chapman (p.160, 1962) mentions that one of the biggest misconceptions of drug-addicts is that they are killers, but in reality, the knowledge of the relaxing effects of common narcotics contradicts the kind of violent behavior associated with the addicts. Although addiction to drugs also does a part in crime rates, it is the same for alcohol. Furthermore, these cases of crime by drug addicts account only for the minority of drug addicts who are actually violent, in contrast to the rest of drug users that are a mix of all kinds of people. Chapman further explains that the drug users involved in criminal mishaps are often those with psychopathic traits and tendencies. In fact, most criminal acts occur during withdrawal, in which aggressive addicts react violently during withdrawal, especially when access to drugs is greatly out of reach (Chapman, p.160, 1962).

Problems in Drug Policy and Prevention around the World The most propagated approaches to drug-addicts around the world, particularly in the US and a number of Asian nations, are briefly detention and rehabilitation (Tanguay et al., 2015). According to the study by Tanguay (2015), many countries, such as the Philippines, have opted

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to arrest any offenders of the current drug laws, mostly dealers and abusers. Aside from detention, offenders are sent to mandatory centers for rehabilitation through either methadone therapy or pure abstinence to relieve their dependence. Furthermore, the study explains that the approach is aimed at alleviating unease within communities in which drugs-related activities occur. However, the researchers have also found that despite the hundreds of thousands each behind bars in several nations, not much improvement has been observed in terms of drugrelated cases such as traffickers, dealers, and abusers. (Tanguay et al, 2015) Although Tanguay’s study briefly mentions the redundancy observed from the current approach to drugs, the study by Kilmer (2012) goes further into detail on the results of the detention-rehabilitation treatment. The effects are mainly economic and social. (Kilmer et al., 2012) The first is the weight of expenses allocated to drug-alleviation, especially in from national funds. To put into perspective, the National Drug Intelligence Center mentioned in Kilmer’s study mentioned that nearly $200 billion was spent on drug policy implementations in 2007. These losses in funds are not so much from an excess of resources used by drug-abusers but by the cost to implement the drug policies themselves, such as the rehabilitation facilities, the equipment, the detention centers (prisons), and the departments in-charge of action, such as the police. Although the government’s expenses bear the heaviest on national financial losses, the drug-abusers and dealers themselves also contribute to the money lost. This part is mostly due to the lack of productivity of the drug-users who do not perform much function in their respective communities. (Kilmer et al., 2012) On a social aspect, the implementation of current drug policies has brought about widespread violence in various sectors. For example, research has shown 0.15% of the

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population in Mexico had been killed in drug-apprehension operations since 2006. (Kilmer et al., 2012) Even in the Philippines, the police have murdered as many as 2500 and counting due to the war on drugs. (KINE, 2017) Aside from the punishments done on offenders of drug laws, action is also taken towards prevention around the world, mainly through the spread of awareness and tackling the supply of drugs themselves. First of all, schools are the primary venue for informative lecture. It has been made mandatory for various schools to allot time for lectures on the issues on drugs. However, Kilmer comments on how the implementation of these lectures has been quite poor, due to the insufficient funding, the narrow scope of information dispersed, as well as several other aspects vital to executing this successfully. Likewise, he kinds of activities executed in schools were limited and equally ineffective in informing the students (Kilmer et al., 2012). The other mode of prevention is by addressing the source, or the supply, of drugs. According again to Kilmer (2012) a large fraction of imprisoned drug law offenders had a connection to delivering, sharing, or supplying illegal drugs, so reducing drug transporting could potentially reduce the growing number of incarcerations. Within a country, the reduction of drug supplies is done by drastically increasing the costs for trafficking drugs between different states, as well as by sequestering large amounts of the illegal drugs themselves. On one hand, the increase in costs to discretely distribute drugs becomes highly cost-ineffective, with expenses ranging from $10,000 for a kilogram of substances. On the other hand, acquisition of the drugs themselves in large amounts does cause incremental decrease in the net usage of drugs all around. (Kilmer et al., 2012) Despite the observable results, Kilmer comments on the same inefficiency in this method because of how incremental and counter-intuitive it is in the long-run.

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The costs to implement increased distribution expenses and sequester large supplies of drugs results in relatively insignificant rates of improvement to the drug situation, namely the vast number of drug dealers and abusers.

Supervised Drug Administration Facilities as a Progressive Alternative With the continued rise in death counts related to the war on drugs, entering the 21st century, a new, more progressive approach to alleviating drug addiction is introduced in the form of supervised drug-administration sites, also known as supervised injection sites. (Kennedy & Kerr, 2017) In her study, Potier (2014) explains what exactly supervised drug facilities are and how they work. To begin, this method had first arisen in the last two decades of the twentieth century, parallel to the rise of HIV cases particularly in European nations, primarily because of the usage of unsterilized or reused syringes to apply injected drugs (Potier et al., 2014). Drug prevention policies at the time were not quite effective in resolving the issue, so to address this, some countries in Europe came up with facilities that provided a medically supervised environment with sanitized equipment, with the aim of drastically reducing the risks that come with taking drugs. (Potier et al., 2014) These facilities were more focused on servicing the more rural areas with the less fortunate who were more susceptible to disease, and by doing so, the overall health of communities would vastly improve. Among the nations that have recently adopted these supervised drug sites include the Netherlands, Spain, Switzerland, Canada, Germany, Norway, and Australia. (Kral & Davidson, 2017) Despite the growing support for this method of approaching the issues on drugs, the most pressing concern is in acquiring the approval of the governments in question. Kennedy and Kerr

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(2017) describe the situation in the US, in which legislators highly doubt the benefits of these supervised injection sites. When the first supervised injection site called Insite in Vancouver was established, the state government gave conditional approval, such that the establishment be observed, whether it does indeed improve the situation of drugs in the community or not. As many as forty studies were published showcasing the positive effects brought about by Insite to the community. For one, the community had seen more than 30% decreased in the number of deaths from substance-overdose. There was also an indirect improvement to the situation on HIV due to a great decrease in shared needles and improperly disposed injections and equipment. Contrary to the assumptions made initially about supervised drug sites, the community around Insite did not experience any rise in addiction and crime, nor an increase in beginning drug users. In fact, various sectors of the Canadian government, such as the Federal Minister of Health and the Canadian Medical Association, praised Insite for the quality of their facilities and equipment, which have prevented many deaths. The government of Canada even commissioned several more supervised injection sites to be established around Vancouver and other communities around the country. Despite the outcome of Insite, as well as what has been done in numerous European nations prior, senators and legislators persistently refuse to sanction these kinds of drug sites in America. (Kennedy & Kerr, 2017) The study by Ng (2017) laid out the outcomes of the supervised injection site in Vancouver more specifically. For one, deaths by overdose were reduced to 165 from 253 per year. Before the establishment of the site, 35% of drug users were confined in hospitals for illnesses due to improper injection usage in the course of three years. However in the four years following the establishment of the supervised injection site, the number was reduced to 9% as more drug users made use of the site. Likewise, the study showed a 67% decrease in risk of

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opioid overdose, as shown by the number of ambulances called per month for opioid-drug overdose being reduced by two-thirds. The study also claims that as many as 57 HIV cases were prevented yearly because of the site (Ng et al., 2017). Aside from the medical benefits, the study done by Irwin (2017) shows that supervised injection sites are also cost-efficient because of cheaper facility maintenance and saved expenses due to reduced cases of illness. This study focuses on the costs saved by a single supervised injection site in a year in terms of five categories: facility maintenance, HIV and HCV cases, skin and tissue infections, and deaths by overdose. In terms of cost, findings showed that a supervised injection site would cost $2.6 million a year, compared to the average rehabilitation or medical facility costing just $2 million. However, the finances saved due to the medical benefits help to outweigh the losses from maintenance expenses. First, roughly 5-6% of the total cases of HIV and HCV infections, involving 22 types of HIV and HCV, were reduced, saving about $1.3 million. By providing sterilized equipment and professional supervision for drug administration, the site reduced hospital confinements due to skin and tissue related infections, saving around $2.5 million in a year. Finally, overdose deaths went down from 120 a year to 13 a year over the course of a decade, saving ann estimated $425 000. In conclusion, the study showed that a single supervised drug injection site could save a state in America between $2-3 million a year. (Irwin et al., 2017)

Conclusion Although the current, conservative methods of drug alleviation have yielded gradual improvements to communities in various nations, it has been shown to be mostly impractical and counterintuitive due to the economic and social detriments outweighing the incremental benefits

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yielded. Likewise, lawmakers, especially in Third-World countries such as the Philippines, should consider establishing and legalizing supervised drug sites, as well as making progressive reforms on drug laws to focus on promoting care in communities rather than fear-mongering with debunked stigma.

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BIBLIOGRAPHY Adams, J. W. (1978). Psychoanalysis of drug dependence : the understanding and treatment of a particular form of pathological narcissism. New York : Grune & Stratton , c1978. Chapman, K. W. (1962). Aspects of Drug Addiction: The General Problem. In Problems in Drug Addiction (pp. 153-164). W. C. Bier, SJ (Ed.). New York: Fordham University Press. Irwin, A., Josaghi, E., Bluthenthal, R. N., & Kral, A. H. (2017). A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA. Journal of Drug Issues, 47(2), 164-184. DOI: 10.1177/0022042616679829 Kennedy, M. C., & Kerr, T. (2017). Overdose Prevention in the United States: A Call for Supervised Injection Sites. American Journal Of Public Health, 107(1), 42-43. Kilmer, B., RAND Drug Policy Research, C., & Rand, C. (2012). Drug Policy Landscape in the United States. The U.S. Drug Policy Landscape: Insights and Opportunities for Improving the View (pp.3-9). Santa Monica, CA: RAND Corporation. KINE, P. (2017). PHILIPPINE PRESIDENT RODRIGO DUTERTE'S 'WAR ON DRUGS'. Harvard International Review, 38(3), 24-27. Kral, A. H., & Davidson, P. J. (2017). Addressing the Nation's Opioid Epidemic: Lessons from an Unsanctioned Supervised Injection Site in the U.S. American Journal Of Preventive Medicine, 53(6), 919-922. doi:10.1016/j.amepre.2017.06.010 Patten, D. (2017). The mass incarceration of nations and the global war on drugs: comparing the United States' domestic and foreign drug policies. Social Justice, (1), 85. Potier, C., Laprévote, V., Dubois-Arber, F., Cottencin, O., & Rolland, B. (2014). Review: Supervised injection services: What has been demonstrated? A systematic literature review. Drug And Alcohol Dependence, 14548-68. doi:10.1016/j.drugalcdep.2014.10.012

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Raz, M. (2017). Treating Addiction or Reducing Crime? Methadone Maintenance and Drug Policy Under the Nixon Administration. Journal Of Policy History, 29(1), 58-86. doi:10.1017/S089803061600035X Tanguay, P., Kamarulzaman, A., Aramrattana, A., Wodak, A., Thomson, N., Ali, R., & ... Chabungbam, A. (2015). Facilitating a transition from compulsory detention of people who use drugs towards voluntary community-based drug dependence treatment and support services in Asia. Harm Reduction Journal, 12(1), 1-5. doi:10.1186/s12954-0150071-0