LSJ 376 Class Notes
LSJ 376 Class Notes LSJ 376
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This 21 page Study Guide was uploaded by Katie Vail on Monday February 9, 2015. The Study Guide belongs to LSJ 376 at University of Washington taught by Dr. Wender in Fall. Since its upload, it has received 212 views. For similar materials see Notes for Drugs & Society in Social Work at University of Washington.
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Date Created: 02/09/15
LSj 376 Drugs amp Society 10302014 Marijuana Starting Points Every legal and policy reform leads to unintended effects both good and bad It is impossible to predict these effects let alone completely mitigate them For better or worse marginalized people feel the effects of reform rst and foremost Always have a safety net in place big enough to handle unforeseen impacts Mariiuana Overview Hemp Plant Cannabis Sativa Hashish Dried and pressed resin and owers Smoked or ingested Hashish Oil Lique ed resin Smoked or ingested THC Delta9tetrahydrocannabionaol the key psychoactive ingredient in cannabis Levels have risen sharply since he 1980 s 19 million Mj users in the past 30 days 7 of the 12 population Accounts for 80 of all current illicit drug use 60 of illegal users only use Mj NHSDUH 2012 40 of US adults have tried Mj at some point in their lives Historical Background Pure Food amp Drug Act 1906 established federal control over content purity and safety of medicine and food 1st effort of government control of food and medicine due to increase in population thus there were more safety problems with canneries freezing food etc Harrison Narcotics Tax Act 1914 taxed the manufacture sale and distribution of opiates and cocaine Effectively criminalized addiction by reducing prescription At the time there was a serious cocaine and opiate addiction around the world growing public health concern This law made it so companies had to pay taxes to sell products companies didn t like this decreases in these drugs being prescribed l increase in people going to the street to nd these drugs 1st government act to try to criminalize drug use these Marijuana Tax Act 1937 effectively began national criminalization Due to growing concern with marijuana use Banned marijuana made it illegal marijuana laws on the The books today came from the Marijuana Tax Act Roots of current Mj laws lie in the fear of quototherquot races cultures and ethnicities Economic factors as well paper vs hemp etc Example of Ebola disease from a 3rd world country Single Convention on Narcotics Drugs 1961 Controlled Substances Act of 1970 consolidated and updated all existing federal drug laws Started the drug war took all existing drug laws and put them into one Anslinger amp Cooper quotMarijuana Assassin of Youthquot Notice the racial cultural and religious prejudice at work here quottamale vendorsquot Harlem jazz Middle Eastern assassins etc We must maintain quotunceasing watchfulnessquot against danger and evil A vivid example of drug scares and moral panic Compare current antidrug messages how much has really changed Trends in use sharp increases in the 605 and 705 followed by decreases in the 805 and 905 and now more large increases again Remember the key factor of culture Taking encouragement from tobacco Issue of Legal Reform Remember marijuana remains an illegal Schedule 1 drug under US federal law and also remains illegal under international drug treaties Lawful actions under state medical Mj laws and new laws in WA and CO still violate federal law Federal Schedule 1 classi cation creates a quotCatch22 that largely limits research on clinical use US government says there is nothing you can do with marijuana that is not dysfunctional Gonzales v Raich 545 US 1 2005 the US government can enforce federal Mj laws under the commerce clause Federal government can go after medical marijuana laws Smoked marijuana vs Marinol and Savitex Marinol synthetic THC prescription medication used to help patients with nausea Savitex real THC to help asthma bronchitis patients Only available in some EU countries Back to the great contradiction legitimate medical use vs recreation Regulation When does harm merit state intervention Compare the risks from common OTC over the counter medications ls marijuana a big enough deal to try to control Marijuana doesn t kill people but over the counter aspirin does Tylenol in the long run kills you The cautionary tale of current medical Mj laws public response can rapidly eclipse legislative intent How do we avoid simply visiting a different set of harms on the same people who have been disproportionately harmed by needlessly punitive Mj laws A disproportionate percentage of legal Mj sales will be to vulnerable marginalized people Those people most likely to use larges amounts of Mj will be disproportionately able to afford it in ever sense economic social medical etc How much do we regulate How do we change the laws Get marijuana out of a schedule 1 drug this way we can do research on it The way the law was written many people are getting their marijuana not from the state because its expensive but rather they are going to medical dispensaries that are more potent and cheaper State needs to be more competitive Chicken Coop Model ldealistiC De facto decriminalization of for possession of 13 ounces of dried Mj andor several growing plants Proactive public health measures campaign to discourage underage use Bottom line quottolerate don t celebratequot Let people grow their pot and use it in their own private use don t turn it into a large consumer market LS 376 Drugs amp Society 11042014 Heroin amp Other Opiates m Diacetylmorphine Synthesized from morphine in 1898 by Henrich Dresser Bayer who also invented aspirin Several times more powerful than morphine fat soluble Heroin is known as a t initial quotrushquot followed by lethargy Originally used to treat pneumonia and tuberculosis because it is fat soluble you are instantly getting a rush Illegal use after synthesis mixed with quotcutquot such as starch powder milk powder quinine etc for distribution and sale White primarily Asian vs Brown Tar primarily Mexican 335 600K current US heroin users This is up from 166000 in 2002 Why Link this with Rx opiates 80 of new heroin users with illegal use of Rx pain meds They go to cheaper and easier to nd started heroin because it is Illegal Rx Opiate Use 68 million current illegal users of Rx drugs 70 opiate abuse 533 increase in legal opiate prescriptions from 1997 2005 10x increase in illegal Rx opiate use since 1990 500K vs 5M today 4K overdose deaths in 1999 vs 16K deaths in 2012 Opiates account for 70 of all pharmaceutical overdose deaths in the US most of the rest are benzodiazepines Hydrocodone Vicodin etc synthesized from codeine and thebaine Oxycodone Oxycontin etc synthesized form thebaine opium derivative diversion of pharmaceuticals to illicit use and markets The greater the legal use the greater the leakage Repeats patterns from the 19th and 20th centuries How can we balance legitimate medical care with caution It is a hard question to ask because there is so much leakage Can schedule ranking of opiates right now they are schedule 2 ampamp 3 while marijuana and heroin are schedule 1 Treat it as a public health issue Directtoconsumer marketing and aggressive sales back to the great contradiction Sales to doctors Push items into market overdoses and huge heroin market Complex spectrum of diversion from highlevel bulk theft to doctor shopping robbery etc Rx opiates as a gateway for heroin and patterns of overlapping demand No surprise heroin deaths doubled 2010 2012 in 28 states with available data Highest risk for opiate overdose working class white males 205405 Taking Care of Business Preble amp Casey Article A classic study of poor inner city heroin users that questions the escapist theory of addiction Addiction as a career a full time job with an underlying set of skills and pro ciencies Heroin addiction provides meaningful activities and relationships seven days a week The enormous socioeconomic complexity of heroin trafficking and distribution Growers I Processor International trafficker l kilo dealer l midlevel dealer l street dealer l addict dealer l addict With each step price increases and purity decreases The supply chain is a major underground economy jobs customers and large revenue High prices weak product lack ofjobsskills necessity of crime to support addiction quotThe heroin user is in a way like the compulsively hardworking executive whose ostensible goal is the acquisition of money but whose real satisfaction is in meeting the inordinate challenges he created for himselfquot 189 LS 376 Drugs amp Society 11072014 Cocaine amp Methamphetamine From last week Opiates Great illustration of the Great Contradiction legitimate vs illegitimate use What do we classify as which Cocaine Overview Coca Plant Erythroxylum coca Native to the Andes Unrefined coca leaves contain 12 cocaine 500 kilos of leaves yields 1 kilo of cocaine Coca leaves are soaked in solvent pits mixed with sulfuric acid and limecaustic soda to make coca paste pasta quotbazucoquot Coca paste is processes with more sulfuric acid plus potassium permanganate and ammonia to make coca base Coca base is processed with ether acetone etc to make cocaine hydrochloride a watersoluble salt Purity range 4090 Explored uncut to world markets Extreme environmental damage production and eradication Cocaine Products Cocaine HCI powder cocaine Inhaled or injected Legally manufactures cocaine HCI for medical use topical anesthetic Decocainized leaves go to CocaCola Cocaine HCI cooked with baking soda quotcrackquot cocaine Same substance but has a lower melting point and is therefore quotsmokablequot Crack is much cheaper than powder because it contains less cocaine by weight Freebase cocaine Cocaine HCI ether Smoked very pure Extremely dangerous to make and use High burnexplosion risk 16 million current cocaine users NHSDUH 2012 Powder vs Crack Sentencing Antidrug abuse act of 1986 1001 federal sentence length ratio for crack vs powder cocaine 5year mandatory minimum for 5 grams of crack or 500 grams of powder cocaine 10 years for 50 grams of crack or 5 kilos of powder 85 of people convicted of federal crack offenses are black Fair sentencing act of 2010 Ratio changed to 181 eg 28 grams of crack or 500 grams of powder 5 years 280 grams of crack or 5 kilos of powder 10 years No mandatory minimum for simple possession of 5 grams Increased sentences for violence and trafficking Retroactivity issue resolved June 2011 sentence changes pending for some defendants Methamphetamine Overview 440K current users NHSDUH 2012 Does not include Rx stimulant abuse Ritalin Adderall etc The high socioeconomic demand for stimulants once again back to Adam Smith and IceT Boeri et al Suburban meth use as an effort to keep and cope with a successful lifestyles Stimulant use patterns at UW and beyond Where should we draw legal and ethical boundaries quotCombat Methamphetamine Act of 2005quot photo ID and log signature required to purchase pseudoephedrine anywhere in US 2 year log retention for law enforcement inspection and investigation Meth as a quothard casequot scenario for policy makers compare reduced enforcement effects for M Amphetamines are synthetic central nervous system stimulants First manufactured in 1889 Methamphetamine was rst synthesized in 1919 Similar to ephedrine the active ingredient in Ephedra sinica ma huang The quotSudafed uttersquot a glimpse of meth s effects Amphetamines primarily pharmaceutical grade products eg Ritalin and Adderall Meth methamphetamine hydrochloride Legally sold as Desoxyn tablets Swallowed inhaled or injected Ice quotglassquot methamphetamine puri ed with extra solvent processing Very low melting point and thus smokable Extremely powerful and addictive MDMA ecstasy made from meth PCP phencyclidine quotangel dustquot developed as early IV anesthetic Never approved for use 19305 19605 The heyday of amphetamine and methamphetamine Decline of pharmaceutical production and the rise of the clandestine labs The crisis of predictable purity Illicit manufacture ephedrine reduction RedP P2P and Nazi methods LS 376 Drugs amp Society 11132014 Medicalizing Misery amp Prescribing Good Behavior Misery basic part of human condition l taken this and treat as a discrete medical phenomenon can we even do this How rapid increase in prescribing medication in childrenwhat does it mean to be a good kid l redrawing of boundaries of what normal is if there is so much abnormality is that normal Spending on prescription medications in US more than doubled from Most common Rx meds asthma medicines for kids CNS stimulants for adolescents antidepressants for middleaged adults and cholesterol lowering and high blood pressure drugs for older Americans 20112012 4 of US children 417 years diagnosed with ADHD amp 61 of US children 47 years were taking medication for ADHD more and more diagnosis of ADHD in young adults Use of anti depressants increased 400 from 19941998 amp 20052008 Shaping the Intimate David Healey 2004 Chronic worrying headaches tension fatigue insomnia sweating nausea etc Undeniany real phenomenon and a constant part of the human condition But while those phenomena are constant the stones we use to explain them vary across time and culture See Walter s article The stones we face about emotional distress and mental crisis are re exively created These phenomenon mean different things to different people What is included and excluded in DSM is cultural as well as medical Are we just renaming what is always there or are we nding new as the DSM has grown Where do we draw the lines The early stuff from melancholy to medication what does it mean to be sad As culture changes the way we think about emotion shifts as well Fit of anxiety vs Panic attack l categories through which we understand experience has changed Anxiety Psychosocial head meets society problem and thus is controlled in therapy Panic neurobiological problem and thus is controlled with drugs DSM III 1980 pharmaceutical marketing psychiatric revolution Subdividing of anxiety into panic disorders GAD social phobia A basic transformation of some of our most intimate experiences 1980 s Benzodiazepine tranquilizers Valium Librium etc Mothers itte helper falls from grace over addiction fears If mixed with alcohol it is very dangerousdeadly combo 1990 s SSRI revolution Prozac Paxil Zoloft etc Culturally attuned to think of emotional condition as bio psychological The Era of Depression 223 Marketing Diseases shift from anxiety to depression Move from psychobabble to biobabble terms from popularized pharmacology Uses super cial jargon to give a meaning they don t have The World Health Organization report on depression a global epidemic or change in narrative of sadness LS 376 Drugs amp Society 11182014 Drugs Crime amp Violence There is a relationship between drugs and violence drugs and crime If we legalize drugs the problem will go awayFALSE Criminality quality or state of being a criminal Tendencies qualities or predispositions that lead a person to commit crimes Everyone has committed a crime why do we do this Do drugs in uence crime or crime in uence drugs 1 Correlation does not equal Causation Drugs use can in uence crime and vice versa but this relationship is contextually complicated 2 For the most part most drug use neither causes nor accompanies crime people can use a given drug and not be accompanied with criminalviolence however there is a strong and persistent relationship 3 The things that in uence drug use and crimeviolence vary across individuals life span situations and wider sociohistorical conditions Difference between drinking with family versus with friends in what you drink how you behave etc More than just chemical reaction of alcoholcontext needs to be recognized 4 Law and Policy do have an impact in drugs and violencecrime can be positive and negative Ex what will legalizing marijuana in Colorado do to drug related crime we don t know 5 Alcohol is involved in more acts of crime and violence than all other drugs combined From a policy standpoint this is very important to look at We need to revise and re ne Goldstein s tripartite model in an effort to develop optimal policies Social and cultural context are decisive people with addiction are not a homogeneous population Addiction careers value quotthe chicken and the eggquot question which came rst drug addiction or crime Is it some synergy between the two But this isn t the only question to ask Do addiction and criminality arise out of similar psychosocial and cultural patterns and contexts Breaking the law while being prosocial ex Adderall Distinguishing between selfrationalizing and actual impact ls someone an addiction acting under the in uence or acting on the basis of preexisting criminality ex college binge drinking The case of heroin and counting quotcrime daysquot to no surprise periods of increased use correlate with increases in criminal activity Increased drug use increased pattern of criminality Variations in drug market character and violence Crack high violence vs Marijuana relatively nonviolent Drugs are a consumer products there is a consumer vibe around every product The political challenges of quothard casesquot heroin meth coke etc We want to deal with early cases marijuana l use is not conducive to crime like alcohol Trying to Break Cycle of Prison at Street Level Moore 2007 The Criminal behavior among people with addictions is continuous and persistent Crime among these sub populations is disproportionately high 71 million US resident on probation parole or in custody 31 or population Probation not in custody legally under supervision of criminal justice system checkins Parole conditional release or quotcommunity custodyquot release in community for rest of prison sentence if you were a model prisoner Marginalized highcrime highdysfunction neighborhoods receive disproportionate numbers of people on probation and parole Moore talks about revolving door how do we break this cycle Notice the fatalistic attitude This is ultimate hard challenge for law and policy The least sympathetic people require the most resources Drugs Violence Nexus Paul Goldstein 1985 This model has long been the quotgold standardquot for describing the complex relation between drugs and violence There is always overlap among the three kind of violence not mutually exclusive Psychopharmacological Violence Results from the acute and or the chronic use of a drug Most common with alcohol and stimulants cocaine and meth Use by victims and suspects is a factor ex the role of alcohol in sexual assaults domestic violence street robberies bar ghts etc EconomicCompulsive Violence crime committed to raise money to buy drugs I if we legalize and make it cheaper will it help Systematic Violence quottraditionally aggressive patterns of interactionquot inherent to drug culture drug traf cking and the life of the street Mistrust disrespect and normalization as catalysts for violence and revenge The phenomenon of quotcrime against criminalsquot Vuspect todays victim is tomorrows suspect LS 376 Drugs amp Society 11202014 The Pro t amp Politics of Drug Traf cking amp From Pro t to Prohibition Continuum of Drug Access Current United States Federal Law Pure Prohibition No manufacturing sale or use of drug ex schedule one drugs LSD marijuana etc Prohibitory Prescription strictly limited to medical use ex cocaine Maintenance Rx for addiction treatment ex methadone Regulatory Prescription unsupervised selfadministration ex oxycodone Restricted Adult Access No Rx but limited availability ex alcohol amp pseudoepheddne Unrestricted adult access age alone access tobacco Universal access anybody anywhere ex caffeine Courtwright In addition to providing pro ts and taxes drugs help to pacify miserable workers Poor workers earn miserable wages doing miserable work And they try to lessen their misery with drugs which they buy from the same socioeconomic groups that already employ them Exoticize the familiar convenience story and casino parking lot ethnography The quotlabor treadmill people work but never make real economic progress because their surplus income goes to buying drugs quotHowsoever poor a man may be he does not leave the use of tobacco Sanskrit verse quoted by Courtwright pg138 Consider the quotconvenience store regular quotwho is often disproportionately unable to afford hisher habits 7 x sixpacks of beer 6 each 42 per week 7 x packs of cigarettes 8 each 56 per week 98 per week x 52 5096year WA state 2014 minimum wage 932hr x 2080 hours 19385year 26 of gross pre0tax income spent on legal drugs How will marijuana legalization in uence this equation Remember out claim of disparate impact who suffers or bene ts the most from policy and legal changes Drugs constitute an impediment to upward mobility 138 by wasting resources that could go to family saving education better food better housing etc None of this is a grand conspiracy following the logic of Adam Smith and lceT it is the byproducts of civilized life Coping with misery exhaustion and fear the militarydrug use connection Present military addiction crises in theater at home and postdeployment From grog and cigarettes to opiate pain medications Drug use and prostitution another tragic case of extreme dangers and extreme suffering Find people working in the sex trade and you will nd addiction A brutal cycle of trade New England rum to Africa Slaves to the Caribbean Molasses to New England distilleries New England rum to Africa Drugs high pro ts and high tax revenues In recognition of this fact early suppression yielded to taxation but not without extremely high costs quotexternalitiesquot Regressive taxes sin taxes and the state encouragement of abuse regressive taxes impact the poor a lot more than the rich regressive tax everyone pays the same no matter how much they make Depending on Dependence Government and the public get addicted to the tax revenue generated by drugs But how can we balance revenue against public welfare Not just an issue for drugs gambling lotteries etc The highlow tax problem why ending the drug war isn t a panacea if we lower taxes on a product use goes up Low taxes l higher use but less smugglingillegal sales High taxes l lower use but more smugglingillegal sales The Paradox of Prohibition Late 19t Early 20th centuries momentous aboutface on drugs Why would governments want to move from sales and taxation to prohibition Because the social and economic costs of abuse and addiction started to vastly outweigh the revenue The psychoactive revolution gains momentum factories did for drugs what canning did for vegetables lt democratized them 173 The moved from farms to factories intoxicated workers become a crisis A convergence of improbable sociopolitical interests For management drugs lead to inefficiency sickness and accidents which lower pro ts For labor drugs disempower workers by perpetuating poverty and limiting upward mobility Other factors pharmaceutical progress medical progress emphasis on public health Drugs come to be seen as risk factors for public health and insurance LSj 376 Drugs amp Society 11252014 The quotWar On Drugsquot The Magnitude of the Crisis 40 billion spent annually on the drug war 15 billion deferral 25 billion state and local 16 million drug arrests annually more than for any other offense 50 of all drug arrests are for marijuana possession Caution arrest conviction and incarceration are not the same What is the political and moral mindset at the heart of the idea of a quotWar on Drugsquot Dehumanize objects and people ls war the best metaphor with dealing drugs De ning victory beyond rhetoric what can we actually achieve via enforcement and how do we measure success There are complex ques ons We could achieve success through uni cation Durkheim s idea of unifying a inner group and ghting against the out group Victory is inde nable how do we de ne victory Magnitude of the effort vs the outcomes quotshoveling sand off the beachquot The pool of illegal drug users is holding steady at 2225 million Remember that most of this population consists of marijuana and prescription drug users Policy implications Large sophisticated TCO s transnational criminal organizations and cartels control most international drug markets Thousands of tons of drugs enter the US ever year Domestic productive mostly Mj and Rx is also huge Cocaine Decreased seizures and interdictions and intel suggest lower supply and decreased production Est 2009 production 290 metric tons of pure cocaine Prices are increasing purity is decreasing Heroin Huge increase in Mexican heroin production 8 tons in 2004 vs 50 tons in 2009 Rising demand among Rx opiate abusers SW border seizures up 232 from 20082012 Methamphetamine Sharp increase in purity sharp decrease in price User population holding steady for now Marijuana Production has more than doubled in Mexico since 2005 Large increases in domestic production More than 10 million live plants seized just in 2010 Huge rise in illegal prescription drug use 4K opiate overdose deaths in 1999 vs 16K in 2012 Increased street gang and OMG outlaw motorcycle gang involvement RX overdose is now the leading cause of accidental death ahead of traf c collisions Money laundering the other half of the traf cking process To make a pro t must get back to the cartels Bulk cash export electronic remittance BMPE black market peso exchange etc Mexico and Colombian cartels make 18 38 billion annually Consider this 1 kilo cocaine bought for Colombia for 2K sells for 10K in Mexico 30K in the US and then 100K in retail street sales Attacking nancial assets Counterlaundering and asset seizureforfeiture Attacking wholesale vs retail supply how should we allocate limited resources LSj 376 Drugs amp Society 12022014 Imperfect Choices Part I Decriminalization Relaxes existing drug laws but still restricts access via civil penalties compulsory diversion to treatment etc Legalization General access under a governmentcontrolled or regulated private distribution model De jure Reform quotMatter of Lawquot eg statelevel medical marijuana laws or alcohol prohibition Hard to accomplish politically but offer greater legal certainty De Facto Reform quotMatter of Factquot eg Dutch marijuana policy and Obama administration s early policy on medical marijuana Easier to accomplish politically but offers les legal certainty Bevond Enforcement Prevention amp Treatment Reality 1 Risk factors and protective factors are primarily family related They set the stage for wider socialization processes that shape drug useabuse See ACESAdverse Childhood Experiences Study Reality 2 Only a small percentage of people whom tryuse any given drug become addiction remember the quotFunnel Modelquot Money spent on effective prevention and treatment pays higher dividends than enforcement and with longerterm effects But prevention and treatment are less politically appealing than enforcement Major Treatment Models Detoxi cation 13 weeks of inpatient treatment Breaks physiological dependence Temporary with high relapse rates Methadone Maintenance Heroin substitute Reduces highslows and IV risks Oncedaily oral dose Ideally allows return to stability when combined with theraIDY etc SubutexSuboxone Buprenorphine HCIBuprenorphine HCI naloxone Can work with less severe opiate addictions DrugFree Outpatient Treatment Widely varying nonresidential programs Largely therapybased Limited success primarily in less severe cases SelfHelp Groups 12step programs AA NA etc Faith in a higher power admission of wrongdoing helplessness in the face of addiction Strong evidence of positive effects in many cases Pitfall of fatalism once you are addicted you are always addicted Residential Therapeutic Communities quotIt s the person not the drugquot Lifestyle transformation to address broader social and psychological dysfunctions Often staffed by people recovering from addictions Coerced vs Voluntary Treatment Voluntary has higher success rate but coerces treatment is still better than prison for nonviolent people with severe addictions Drug Courts and Aggressive Probation Models Exam Themes 1 Medicalizing Misery Healy relationship among psychiatry pharmacology and culture etc 2 Pro tProhibition tension Coutwright Chps 710 3 DrugsViolence relationship Goldstein Jacobs etc 4 If you could make only one change to improve current drug policy what would it be explain and justify your policy recommendation using key concepts and readings from our class and at least one outside scholarlyauthoritative source LS 376 Drugs amp Society 12042014 Teacher Recommendations Consequentialist Ethics Deontological Ethics We have to do what is right the principal counts more than the outcome Paternalism Prevention Side What Jonathan Thinks Strengthen Families Give people the ability to bounce back Stabilize the families Treatment Side Radically rethink what Healthcare looks like National Health Care System Comprehensive Health Care System Not just detox multi step addiction treatment Possession of Drugs People who are selling just to support your habit Treat as a public health issue Criminal justice system keep for people who are dealing large quantities armed dealing upper and middle supply chains Keep price high and supply low Stop arresting low level dealers Don t legalize hard drugs too harmful to too many disadvantaged people Chicken Coop Model of Marijuana if adults want to grow a little bit of Marijuana go ahead its not worth it to be spending tax money on locking people up Tolerate don t celebrate Enforcement Stop gun violence get guns off the street l way to start trust between police and people Culture Culture can and must change Binge drinking culture must change drinking till you vomit cant be seen as funny
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