A Report that Should Become A Well‐Thumbed Desk Companion

About time! The National Research Council’s report is a long-overdue and cogent exposition of how the dearth of empirical data makes evidence-based drug policy in the United States impossible. Law enforcement, which receives the lions’ share of government drug budgets, has the least substantiated strategies, in terms of both effectiveness and cost-effectiveness. There is an urgent need not only to improve routine data collections to monitor trends, but also to better understand underlying mechanisms through targeted investigations and by taking advantage of natural ‘experiments’, such as droughts in drug availability. Both specific programmes and broader-scale approaches suffer from the gaping holes in knowledge. Why has this situation been allowed to arise? Reuter (2001) suggests three general reasons why little research has been funded and why the research results that do exist have been largely ignored. First is that toughness against the perceived evil and danger of drug use does not need justification. Secondly, the drug problem is perceived as one of crime and morality, not primarily health and addiction. Thirdly, the measures such as reductions in drug use and other crime and in illness, which researchers tend to favour as realistic outcomes, strike many others as half measures at best. The politicization of drug issues in the United States also means that any questioning of current drug policy is dismissed easily as an attack on prohibition and a clarion-call for legalization. The task now is to ensure that the National Research Council’s report becomes a well-thumbed desk companion, rather than mouldering forgotten on the occasional bookshelf. Not only do the various interest groups need to be alerted to the findings, but they need to participate in developing a vision for future drug policy, including the role of an evidence base. The report, quite rightly, recognizes that research cannot be the sole determinant of drug policy. However, researchers can and should reach out to engage other relevant players to set research in the broader context and to contribute their specialist skills to defining, understanding and analysing that context. Researchers do not usually see it as their role to initiate engagement with the various interest groups; indeed this is generally seen as the job of policy makers. But policy makers are often quite constrained in their ability to bring on board all the relevant players—both for political and practical reasons. Given the highly charged nature of US drug policy, a case can be made for researchers initiating a series of activities with relevant interest groups. The value of interaction between researchers and policy makers is largely self-evident, as each can inform the other, but policy makers are not the only group with whom researchers should interact. Practitioners should also be involved. This includes police and other law enforcement agents, treatment and other service providers and educators and others involved in prevention. Practitioners not only provide valuable perspectives on drug issues, but also have an important interface with research. Data can be collected efficiently and inexpensively as part of the practitioner–drug user interaction, for example, as part of arrests made by police or during the provision of treatment or other services. Yet practitioners generally have little enthusiasm for collecting such data and rarely know how to use it to inform their own practice and agency policies. Researchers need to collaborate with practitioners to demonstrate the value of evidence-based practice and policy on a local scale and then, by extension, on national and international levels. For example, my colleagues and I worked with the local methadone clinic to analyse data that had been collected for over a decade but never examined. We showed that dropout before stabilization on methadone was an important problem for the programme and could be influenced by both programme policy and staff action (Bammer et al. 2000). As well as policy makers and practitioners, researchers should also interact with the community. In the drugs area this has three main dimensions. First are community groups closely affected by drug use. These include drug user groups, parents and other family members, residents of affected neighbourhoods and victims of crime. Second is the general public and third is the media, which plays a major role in both reflecting and influencing public opinion. As part of an investigation into the feasibility of a trial to use prescription heroin to treat dependent heroin users, we engaged the range of community groups through surveys, work-shops and formal and informal discussions (Bammer 1997). We found that those closely affected by drugs have unique understanding to contribute, as well as insights into unexplored problems and new interpretations of existing findings. Their involvement alerted us to inherent values and biases and helped avoid entrenching misinformation. For example, we expected that ex-users and families would uniformly oppose heroin prescription but instead found that opinion was evenly divided. User advocates were also unexpectedly sensitive to concerns about potential risks, such as increased public nuisance if users congregated outside clinics, and alerted us to the possibilities of violence between those who were successful in obtaining a place on a trial and those who were not. In the end government support for a trial was overturned, largely as a result of a concerted campaign by a section of the media (Lawrence et al. 2000). The role of the media as a source of information and misinformation about drugs, its influence on public opinion and policy and its reliance on sensational stories about drugs and drug-related crime for profitability are important research areas that the National Research Council’s report has missed. In order for evidence-based policy to be implemented, we need to better understand how the views of the public are informed and how accurate information can be communicated in a way that is interesting and has impact. Recognizing the lack of evidence is the first step. This report has done that and made significant strides in defining what evidence should be gathered and how. Now we need both a more comprehensive framework and implementation. The real challenge lies ahead.