J. Rehm (TU Dresden)

Person goes up in a hot air balloon; itgets cloudy; he doesn’t know where he is; finally there is a break in the clouds, luckily, someone else is nearby:

“Excuse me, can you tell me where I am?”

“You’re in a hot air balloon.”

“Are you a researcher?”

Why yes.  How did you know?”

Because you gave me factually correct information that was completely useless

“Are you a policy maker?”

“Why yes.  How did you know?”

“Because you don’t know where you are, where you’re going, or how to get there.”

What are the information needs of modern societies with respect to drug use?

What is the extent of drug use? Prevalence Incidence Trends

What is the harm attributable to drug use (short-term and long-term)? Inherent to substance Caused by circumstances of use

What are the costs to society? What are the effects of potential interventions?

Effectiveness and cost-effectiveness

Or, why standard methodology fails?

Representative general population survey techniques Too many drug users outside sampling

frame for drugs except cannabis Non response problems of users Cost-ineffective for rare events

Triangulation with sales data (as for alcohol or tobacco)

Capture re-capture techniques Representative snowball sampling

techniques

Scientists can be creative, but the solutions are often based on potentially problematic assumptions, which are costly and developed for science rather than for daily practice or sustained monitoring (which country could do extensive studies with modern techniques yearly?)

Scientists could be most helpful if we would not pretend to have solutions which will not change over time

Campbell, D.T. (1969). Reforms as experiments, American Psychologist, 24, 409-429.Campbell, D.T. (1976). Assessing the Impact of Planned Social Change. December 1976

Policy formulation Experimental design wherever possible

(e.g., within EU by randomizing countries or by different starting dates for different countries; within countries by randomizing regions)

Evaluation Adaptation of policy if necessary “Final” implementation Continuous evaluation and changes

We know relatively little about complex interventions and their effects. Experimentation would help us understand.

The very nature of integrated drug policy hinders causal conclusions

Situation of “open drug scene” was perceived as insupportable within Swiss society and threatening to politicians. Drug overdose deaths were high.

Often policy changes are triggered by crises.

Interventions were sought to change the situation -> Swiss four pillar concept.

General four pillar strategy (repression, treatment, harm reduction, prevention) with multiple parallel changes

Supervised injection rooms Heroin-assisted treatment Extreme widening of MMT Introduction of other treatment options New style of policing More $s for social integration. Decentralization

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1992/93/94: integrated Swiss drug policy implemented ->

sustained success in reducing mortality

Success: but what is causal?

It does, or do we believe that the exact same package would have the exact same success in Toronto? Or that it could be implemented politically in exactly the same way?

We need to identify causal impacts of policy This could be done by experimentation including so-

called natural experiments such as by staggered introduction of measures (example: Reagan’s policy of changing legal drinking age to 21 in the US -> different times of implementation in different states -> control conditions -> clear demonstration that whenever the laws was introduced it lead to a reduction in highway fatalities among 18-21 year olds).

Giving and taking

Policy makers should accept solutions as temporary -- to be tested

Experimentation should be introduced wherever possible

Routine monitoring should be constructed as to allow answering evaluative questions

Scientists should become more practical and innovative

Solutions should involve the civil society!