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Lecture 1 Class Introduction and Exoticizing the Familiar Professor Jonathan M Wender Average 32 Overlying Concepts Everything directly and indirectly relate to drugs When people in NY say fuck you they mean hi when people in Seattle say hi they mean fuck you Problem versus Predicaments Beyond bumper stickers The issue of drugs is not a problem that can be solved Rather it is an ineradicable predicament that only admits of limited amelioration improvement The Tragedy of Power The tragedy of legal and political power all decisions and choices are imperfect and inherently flawed We must have the intellectual and moral honesty to ask and answer hard questions and the courage not to shy away from uncomfortable facts Exoticizing the Familiar A reflective process of deeply and critical questioning ordinary ideas and social practices It enables us to reveal what is extraordinary about the ordinary Become a tourist at home by being surprised and fascinated with that the locals take for granted Treat your everyday life as a series of exotic phenomena Don39t take ideas and actions for granted trace them to their hidden roots Archaeology of the Present Ex Jonathan39s First Grade Art Project o An ashtray Lecture 2 Universality of Drug Use Exoticizing the Familiar Be a tourist at home Dangerous Lyrics 0 Rollin down the street smokin Indo sippin on gin and juice Smoking weed okay but not drinking and driving Today39s Topics What are psychoactive substances and how can we explain their universal presence in virtually all societies What motivates people to use drugs How should we differentiate between using and abusing drugs Inciardi amp McErath Preface About the Editors Introduction and skim Chapter 1 for general background material Drugs Any natural or artificial substances aside from food that by their chemical nature alters the functioning of the body Psychoactive Drug Legal and illegal substances that alter the mind and consciousness Psychoactive drug use it a universal social phenomenon Reflect on your own patterns of use Drug Abuse Use of psychoactive substances contrary to a specific set of social norms Remember these norms are constantly changing Misuse Vs Abuse The sprain ankle scenario What would you do 0 We are all drug dealers opiates are a felony Set Personal expectations of the effects of drug use Setting The physical and social environment contextualizing a given act of drug use 0 There is a social mental and cultural component to drinking Basic Types of Drug Users Experimenters Isolated incidents usually only once or twice and then total cessation Social Recreational Occasional use when the opportunity presents itself SEVERE IMPACT THRESHOLD Involved Users Actively seek their drug of choice Major life impacts family friends work school etc but still in control Dysfunctional Abusers Drug use have become the central focus of life Major loss of control These people are the primary focus of this class and pose the greatest policy challenge How and why do people move from experimentation to abuse UNODC 2013 World Drug Report 37 o of all people ages 1564 used an illegal drug during the past year 211000 deaths 1013 of these people are problem users 1540 Millions Use rates for alcohol and tobacco are much higher than for iHegadrugs Prohibition of illegal drugs does affect use rates To what extent and at what cost General correlates of higher use young male and urban dwelling Through Rx drug abuse is higher among women 0 Just like UW college kids Illegal drug use in the US is disproportionately high compared to the most of the rest of the world Andrew Wei Why people take drugs IampM Ch 3 UNODC World Drug Report 2013 Lecture 3 Theories of Addiction and Dependency Today39s Topics Wei How can we define and explain addiction and dependency What is the difference between having an addictiondependency and being an addict Why People Take Drugs Drug use is ubiquitous across time and culture o Addiction creates revenue o Drug use perpetuates its own culture Because all people desire to alter their state of consciousness Drugs are only one way of doing so Early childhood experiences of play and altered consciousness whirling choking etc Are those your experiences Our lifelong fascination with altered consciousness the boundary between wakefulness and sleep etc o Sniffing chemicals Illegal drug use is merely a logical continuation of early childhood exploration Do you agree with Well or not The drive itself must not be equated with its forms of expression 47 We need to reflect on altered states of consciousness and what makes them good or bad Does Weil cross a line between valid description and self justification Use vs Experience Set and setting are greater than pharmacological effects alone Does using certain drugs automatically make one an abuser Be a critical reader what issues does Weil overlook Friedman Sociopharmacoogy of Drug Use Key Theories of Addiction o Theory as Narrative Each theory tells a different story Recognize implicit assumptions o Progression from abuse to addiction a loss of control o Biologicalgenetic theories It is a physical phenomenon Of the body In flesh and bones o Psychological Mental phenomenon Isn39t primarily in body but in head Behavior or cognitive phenomenon o Sociological Social phenomenon Whatever the mentalphysical difference among people rooted in social context 0 MoralSpiritual Normative or charecterorological phenomenon People have free will and addiction has a moral or spiritual component 0 Synergistic Addiction is the result of multiple combined factors Interdisciplinary perspective Human being is body heart and soul 0 The Practical Stakes Is addiction a behavior disease andor choice Theory determines policy options 0 Dependence does not equal addiction Insulin chemotherapy etc Addiction is characterized by a lack of self control You cannot stop Things have become totally dysfunctional Addiction as a Disease 0 Chronic intoxication is an ancient concept however the idea of addiction as a disease is modern 0 There is no universal standard of tolerance dependence addiction or abuse 0 Moral and medical discourse on addiction are inseparable o Addiction as a complex chronic and relapsing disease 0 DSM IV TR Behavioral criteria more important than tolerance and dependence 0 Addiction involves compulsive use despite sever negative consequences 0 Addiction as a career Spend most of life figuring out how to get high 0 Agent drug host user environment context O Brien 1996 0 Management of addiction vs cure Questioning ong hed moral medical and policy assumptions Once and addict always an addict 0 Measuring success beyond the metaphor of clean and dirty Does addiction have to be an eitheror condition 0 Understanding addiction as a cultural construct Stanton Peee s critique 0 Being an addict vs having an addiction protecting against effacement Lindesmith A Sociological Theory of Addiction Lecture 4 The Great Contradiction IllLegitimate Misery Today39s Topics What factors create the sociopolitical legal and moral distinctions between dopers and human beings in crisis What are moral panics and how do they affect our thinking about drugs Today39s Exoticizing the Familiar Should it be acceptable for police officers to provide a dangerous addictive drug to suspects in order to help calm them down and win their cooperation 0 Jonathan and Cigarettes Lindesmith Dope Fiend Mythology IampM Ch16 19401941 Mythology influences our dominant responses to drug addicts and addiction The amazing consistency of trends and myths across 70 years 0 Myths and panics spawn bad laws and policies The myth of the addict as violent monster or fiend Remember that Lindesmith is largely talking about opiate users and addicts o Sever withdrawals Heroin Opiates Alcohol and Benzodiazepine 392 Xanex Vallium Possible for Caffeine and Tobacco Unlikely for meth and none for coke Lindesmith says that such users and addicts are overwhelmingly nonviolent Is this do with other drugs cocaine meth and alcohol The price of illegal drugs drives addict s crimes Three main funding sources theft prostitution and low level deaHng Patterns of gun use and violence Relative non vioence of opiate addicts Newer ideas about dangers of driving while high and recognizing effects of opiate use DRE Programs There is no intrinsic connection between drug use and moral degeneration A vice for the poor and a disease for the rich The total effects of drug useaddiction vary according to life circumstances Early trends in the Drug War making a bad situation worse If we were to set about deliberately to produce thieves and prostitutes we could scarcely improve on the situation 148 Punishing people for what we think they have addictions fundamentally changes what they practically are Drug Policy alliance Reinarman The Social Impact of Drugs and the War on Drugs IampM Ch7 Drug scares are generally separate from drug use Drug scares need to be treated as a social cultural and political phenomenon in their own right A recurring feature of American culture for 200 years 0 More than conspiracy A Recipe for Drug Scares Take a Kernel of Truth Add media magnification poitico mora entrepreneurs and professional interest groups Why we love drug scares generic scapegoats temperance culture and mass consumption culture Back to the great contradiction between A temperance culture that insists on self control and a mass consumption culture which renders sef contro problematic 60 Lyrics Jefferson Airplane White Rabbit and The Rolling Stones Mother s Little Helper Lecture 5 How Did We Get Here Today39s Topics 0 What historical dynamics led to the global spread of the big three alcohol tobacco and caffeine and the little three opium cannabis and coca David Courtwright Forces of Habit Introduction and Chapters 13 0 O The story of Anthony Colombo an example of how cheap universally available psychoactive substances have radically changed patterns of drug use Always drunk or high The psychoactive revolution the refining and mass commodification of drugs Some psychoactive substances became global commodities while others did not eg khat kava peyote betel etc Psychoactive substances went from being rare expensive medicines for elites to cheap sources of pleasure available to everyone Two present day examples duty free stories and convenience stores as de facto pharmacies of pleasure Drive through liquor stores The modem distinction between medicinal use and non medicinal abuse became the moral and legal foundation of drug regulations There is a distinction that we make that came out of the psychedelic era There are profound sociopolitical medical cultural and moral challenged in managing the conflict between danger and profit Digestive aids Grandmother drinking to dull pain Many habit forming drugs fit the profit demands of modern market economies addiction to drugs feeds the addiction to money Drugs became a source of massive private wealth and enormous tx revenue but also led to the proliferation of massive social harms Drug profits were built on the back of slaves servants and laborers tobacco coffee and sugar plantations The Big Three Alcohol Tobacco and Caffeine 0 General pattern of proliferation love potency naturally occurring botanical psychoactive substances become refined and pu ed Alcohol and the transition from fermentation to distillation Distillation technology enables the conversion of perishable crops into high purity high profit drugs with an indefinite shelf life 0 Wine is to brandy as opium is to morphine coca is to cocaine or shag tobacco is to the modern cigarette 14 0 Increased potency more abuse and greater risk of social and personal harms o The global spread of tobacco Columbian exchange 0 The modern cigarette as a nicotine delivery device Same now with e cigarettes o The four major caffeine plants coffee tea cacao theobromine and kola cola Note cacao is no coca The Little Three Opium Coca and Cannabis o Opium Opium poppy Papaver Somniferum Raw commercia grade opium contains 10 o morphine and 5 o codeine Medical and social uses of opium date back to the ancient world Commodification of opium by British and American traders Illegal export of opium to China by the British to offset trade deficits The Opium Wars 183942 and 185660 Morphine was isolated in 1805 by Friedrich Serturner commercially manufactured by Merck in 1827 Hypodermic Injection 1853 and measured dosage as major advantages in medical treatment 1874 Synthesis of diacetylmorphine trademarked in 1895 by Bayer as heroin after German herolsch heroic Heroin proliferated with the rise of production in Mexico and South America and the advent of cheap air shipment Cocaine synthesized from the layers of the coca plant First manufactured by 1862 by Merck The spread if cocaine tonics and Effaced manufacturing huge price drop and rising demand Global epidemic 1890 192039s The Cycle of Drug Epidemics Musto enthusiasm gt increases use lt rising negative effects gt concern and decline in use Memories fade fast the cocaine boom of the 198039s was merely repeating an older cycle 0 Marijuana Marijuana Cannabis Sativa Brought to South America by Angolan slaves ater spread to the Caribbean and Central America Vera Rubin The ganja complex vs the marijuana compex recreational only Early 20 century marijuana enters the US via Mexico Mainstreaming and global proliferation 196039s 197039s Marijuana and the culture of gratification a natural fit for US society Future directions will changing patterns of use and evolving attitudes lead to large scale change Lecture 6 From Illegality to Recreation The cure all approach versus therapeutic specificity Tobacco as an early wonder drug vermifuge plague antidote curative etc But there were already parallel concerns about health Simon Paui s treatise on tobacco moral distinctions between good and bad drug use and a foretaste of the modern logic of prohibition Drug X harms users their families and communities Drug X wasted persona and public resources Drug X is a foreign vice associated with demonic others Aqua Vitae or poison The stories of the brandy gin and absinthe The rapid growth of psychoactive choices isolation cocaine and morphine semi synthesis heroin synthesis amphetamines and hypodermic injection Leakage from medical to popular use the cases of opiates and amphetamines The gaze of authority and the definition of legitimate drug use Therapeutic conservatism clashes with compassion and the profit motive When to perspective or not The creationdiscover of new diseases Lyrica and fibromyalgia Ritalin and ADHD Paxil and SAD The wonder and curse of sef perpetuating demands the double edge sword of drug marketers Lecture 7 No Class Today Lecture 8 Alcohol and Tobacco amp Gateway Theory Today39s Topics How does cultural context influence the use and effects of psychoactive substances How have patterns of nicotine distribution and consumption changed over time What if anything do these trends suggest about other drugs Pause and Reflect How does likely widespread discomfiture over today39s lecture illustrate one of the greatest Background Facts Alcohol 0 52 o 131 Million Americans 12 YOA currently drink 24 o 60 Million Binge Drinkers 5 drinks on one occasion past 30 days 7 o 17 Million Heavy Drinkers 5 drinks on 5 occasions past 30 days 100000 Acoho reated deaths per year homicide suicide diseases accidents etc What are some of the acoho reated crises that you have witnessed during the past year in the UW community Drunk students What broader social and cultural factors influence drinking patterns Montesquieu The Spirit of Laws 1748 drunkenness increases with latitude as does the social tolerance of it A bit simplistic but compare George Vaiant s Natural History of Alcoholism 1983 40year longitudinal study of drinking habits among Boston men Findings the tolerancetaboo pattern may help to explain widely varying alcoholism rates between Irish American and ItalianAmerican men Drinking Habits Ethnicity culture and family history are all crucial influences on drinking patterns Genetic factors How malleable is culture Does dinner make a difference Background Facts Tobacco WHO Tobacco is the leading cause of preventable death 5 million per year tobacco reated deaths NHSDUH 2009 28 o 70 Million of US population over age 12 uses tobacco 24 o cigarettes 50o cigars 3 o smokeless tobacco 1 o pipes 440000 tobacco related deaths each year in the US including deaths from secondhand smoke More deaths than traffic accidents alcohol illegal drugs homicides suicides fires and HIVAIDs combined 80 of smokers started before Age 20 average is 154 years old Lecture 9 Gateway Theory Continued What is the gateway theory and how does it exemplify the inseparability of politics ethics and social science Remember Correlation and causation are not the same Binge Drinking 2007 CASA Report on College Student Substance Abuse 0 An intensified culture of abuse of addictive substances primarily alcohol Steep increases in Rx opiate and stimulant abuse FT college students 1822 44 are binge drinking and 16 are heavy drinkers NUSDUH 2009 Uncomfortable correlations race Greek system alumnifaculty and parental behavior Key risk factors family history and genetics parental attitudesbehavior high school abuse patterns expectations of positive effects mental health problems social influences and general environment Distinguishing between drug panics and legitimate concern always entail moral judgments Remember the kernel of truth in Reinarman s model CASA s recommendations for universities smoking bans alcohol bans in dorms and at events no promotions or advertising greater facultystaff accountability community cooperation to limit access The Gateway Theory Use of alcohol tobacco and marijuana leads to the use of hard drugs Gateway is a highly controversial theory that exemplifies the inseparability of politics ethics and social science Gateway is also a sociopolitical and scientific narrative about he roots of addition to hard drugs Proponents Nearly all users of hard drugs began as users of alcohol tobacco and marijuana Opponents Temporal precedence does not prove causality Gateway theory falls prey to the logical fallacy of post hoc ergo propter hoc After this because of this Wender s Funnel Model The prevalence and intensity of drug use tapers drastically from experimental use to crisis eve addiction What explains the funnel effect and what mechanisms can be used to intensify its positive outcomes Maccoun and Reuter s Seven Versions of the Gateway Theory The First Step 0 Most hard drug users began with marijuana The gateway effect is real and goes beyond mere precedence Marijuana use is substantively linked with higher probability of hard drug addiction The Second Step 0 Spurious Correlation o The problem of isolating statistical correlations Can the marijuana hard rug link be isolated from other factors If so what is the remaining connection The Third Step 0 The Early Warning 0 Even is no strong correlation exists marijuana use is gin of real risk Just because it doesn39t cause hard drug use it still has predictive power Avoiding false positive and wasting resources vs proactive measures The Fourth Step 0 The Trap 0 If gateway is true then 75 of marijuana users would eventually start using hard drugs A weak straw man argument What is a reasonable threshold for triggering concern and action The Firth Step 0 The Tantalizer o Marijuana entices users into trying bigger and better things A neurophysiological version of gateway By the brain exists in a wider context The Sixth Step 0 The Toe in the Water 0 Social rather than neurophysiological effects Marijuana isn39t so bad and I did not get caught show why not movie on The Seventh Step 0 The Foot in the Door 0 Breaking the gateway link by tolerating marijuana use At what cost Netherlands is not the US Effects of new legahza on o Pushing people underground causes them to interact with those who do sell harder drugs Lecture 8 Midterm 1 See Other Document Lecture 11 Marijuana Starting Points Remember to think beyond bumper stickers 0 Can39t reduce the discussion Look beyond your personal experience horizon what is a silly transient pastime for some of you might be catastrophic for others who are less resilient o Whoooo Your in class 0 Resilience The ability to bounce back Deflated tire metaphor Those without resilience cannot handle life39s impacts Emotionally physically financially Drug users tend to lack resilience Resilience is most needed where it is often most lacking Every legal and policy reform leads to unintended effects both good and bad For better or worse marginalized people feel the effects of reform first and foremost Always have a safety net in place big enough to handle unforeseen impacts OOOO Marijuana Overview Hemp Plant Cannabis Sativa Marijuana leaves flowers and twigs SmokedIngested Hashish Dried and pressed resin and flowers Smoked or Ingested Hashish Oil Liquefied resin Smoked or Ingested THC Deta 9 tetrahydro cannabino the key psychoactive ingredient in cannabis Levels have risen sharply since the 198039s 19 Millions MJ users past 30 days 7 o of the 12 populations Accounts for around 80 of all current illicit drug use 60 of illegal users only use MJ Landmarks in Drug Regulation Pure Food and Drug Act 1906 0 Established federal control over content purity and safety of medicine and food Harrison Narcotics Tax Act 1914 o Taxed the manufacture sale and distrubtion of opiates and cocaine Effectively criminalized addiction by reducing prescription Marijuana Tax Act 1937 o Effectively began national criminalization of MJ Roots of current MJ laws lie in the fear of other races cultures and ethnicities Economic factors as well paper v hemp etc Single Convention on Narcotics and Drugs 1961 Controlled Substances Act of 1970 Ansligner and Cooper Marijuana Assassin of Youth Notice the racial cultural and religious prejudice at work here tamae vendors Harlem jazz Middle Easter assassins etc We must maintain unceasing watchfuness against danger and evil A vivid example of drug scares and moral panic Compare current anti drug messages how much has really changed Trends in use Sharp increases in the 60s and 70s followed by decreases in the 80s and 90s and now more large increases again The Issue of Legal Reform Remember Marijuana remains an illegal Schedule I drug under US federal law and also remains illegal under international drug treaties Thus lawful actions under state medical MJ laws and new laws in WA and CO still violate federal law Federal Schedule I classification creates a Catch22quot that largely limits research on clinical use Gonzales v Raich 545 US 1 2005 The US government can enforce federal MJ laws under the commerce clause Smoked marijuana vs Marinol and Savitex When Should We Intervene When does harm merit state intervention Compare the risks from common OTC medications The cautionary tale of current medical MJ laws practical interpretation of laws and public response to them can over take 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 vulnerable marginalized people Those people most likely to use large amounts of MJ will be disproportionately able to afford it in every sense economic social and medical Lecture 12 Heroin and Other Opiates Today39s Topics o How do patterns of opiate use vary among different segments of society o What bearing do these differing patterns have on interventions legal medical social and otherwise o What are some of the factors driving the huge increase in prescription drug abuse Preble and Case Taking Care of Business IampM Ch 17 Inciardi et al Prescription Opioid Abuse and Diversion in an Urban Community IampM Ch 19 o 10 of the US population uses an illegal drug Moving beyond stalemate o The Single Convention Vienna Convention and other international treaties effectively limit all legalization efforts o Total harms justify strong regulation 10 o dependence rate risks of physical mental and social problems etc Marijuana o However the current costs of prohibition are hard to justify and the deterrent effect is very limited o Recommendation end conviction and incarceration for possession and use No reason to be as punitive as we are today o Limits of legalization efforts continued legalization efforts continued illegal market to control regressive tax problem cultural message and public health Policy Levers Price information and availability 0 Keeping the logic of the market at bay Remember Adam Smith and Ice T o Pareto s Law 80 of the effect comes from 20 of the cause Example Most sales come from just a few customers Same with marijuana o Jonathan39s suggestion pilot experiments with de factor non enforcement for possession of 13 ounces of dried marijuana and or several growing plants o Proactive public health measures campaign to discourage underage use Opiates o Heroin Diacetylmorhine Synthesized from morphine in 1898 by Heinrich Dresser Bayer Pharma who invented aspirin Several times more powerful than morphine fat soluble Euphoric depressant initial rush followed by lethargy Originally used to treat pneumonia and Tuberculosis Illegal use after synthesis mixed with cut such as starch powder milk powder quinine etc for distribution and sale White Primarily Asian vs browntar heroin primarily Mexican 335 600K current US heroin users NHSDUH 2012 UP from 166k in 2002 Why Link with Rx opiates 80 of new heroin users started with illegal Rx pain meds Illegal Rx Opiate Use 0 O 68 million current illegal users of Rx drugs 70 opiate abuse NHSDUH 2012 10x increase in illegal Rx opiate use since 1990 Around 500k vs around 5M today 4K overdose deaths 1999 vs 166 deaths in 2010 Pain killers Anti anxiety ADHD Meds Adderall Hydrocodone Vicodin synthesized from codeine and thebaine Oxycodone Oxycontin synthesized from thebaine opium derivative Complex spectrum of diversion from high eve bulk theft to doctor shopping robbery etc Rx opiates as a gateway for heroin and patterns of overlapping demand Lecture 12 Cocaine and Drug Trafficking Taking Care of Business Preble amp Casey 1969 o A classic study of poor inner city heroin users that questions the escapist theory of addiction 0 Addiction as a career a fill time job with an underlying set of skills and proficiencies o Heroin addiction socioeconomic complexity of heroin trafficking and distribution 0 Grower to processor to international trafficker to kilo dealer to midlevel dealer to street dealer to addict to dealer addict 0 With each step price increases and purity decreases o The supply chain is a major underground economy jobs customers and large revenue 0 High prices weak product lack ofjobsskills necessity of crime to support addiction 0 THE MOST IMPORTANT SENTENCE IN THIS ARTICLE The heroin user is in a way like the compulsively hard working executive whose sensible goal is the acquisition of money but whose real satisfaction is in meeting the inordinate challenged he creates for himself 0 The tragic flaw of pleonexia enough is never enough 0 Back to Adam Smith and Ice T the scandal of aberrance Cocaine Overview 0 Coca plant Eyrthroxyium coca Native to Andes o Unrefined coca leaves contain 1 2 o cocaine 500 kilos of leaves yields 1 kilo of cocaine 0 Coca leaves are soaked in solvent pits mixed with sulfuric acid and limecaustic soda to make coca paste 0 Coca paste is processed with more sulfuric acid plus potassium permanganate and ammonia to make coca base 0 Coca base is processed with either acetone ether etc to make Cocaine hydrochloride a water soluble sale Purity ranges from 4090 purity Exported to world markets 0 Extreme environmental damage Cocaine Products 0 Cocaine HCI powder cocaine which is inhaled or injected O 0 Legally manufactured cocaine HCI for medical use topical anesthetic Decocainized leaves go to Coca Cola Cocaine HCI cooked with baking soda Crack cocaine Same substance but had a lower melting point and is therefore smokeabe Crack is much cheaper than powder because it contains less cocaine by weight Freebases cocaine Cocaine HCI ether Smoked very pure which is extremely dangerous to make and use High burn and explosion risk 16 million current cocaine users NHSDUH 2012 America39s First Cocaine Epidemic David Musto O O Prolific use in the late 19 and 20 centuries Widely used and touted as a general curative and as an antidote to opiate and alcohol addiction Praised by Sigmund Freud On Coca 1884 Like tobacco and unlike opiates cocaine s stimulant effects seems to fit the fast pace of modern life But growing patterns of addiction caused strong reactions Mustos cycle acceptance proliferation ill effects prohibition Increase in state eve prohibition and educational programs but initially little federal action Growing national and international concerns led to federal action State Departments report to Congress The illicit sale of cocaine and the habitual use of it temporality raises the power of the criminal to a point where in resisting arrest there is no hesitation to murder It is more appalling in its effects than any other habit forming drug in the United States 1910 Cocaine use decreases and went underground only to reappear in the 197039s and 198039s Another cycle occurred What the does future hold Power vs Crack Sentencing O O Anti Drug Abuse Act of 1986 1001 federal sentence length ration for crack vs powder cocaine 5 year mandatory minimum for 5 grams of crack or 500 grams of powder cocaine 10 years for 50g crack or 5 kilos of powder 0 Around 85 of people convicted of federal crack offenses are black o Fair Sentencing Act of 2010 Ration changed to 181 28g crack or 500g powder 5 years and 280g crack or 5K powder 10 years No mandatory minimums for simple possession of 5g Increased sentences for violence and trafficking Retroactivity issue resolved in lune 2011 sentence changed pending got some defendants Lecture 13 Methamphetamine Methamphetamine Overview 0 ONE OF THE 2quotd MIDTERM TOPICS If you could do one thing only to improve societies response to drug use what would it be 0 Get everyone high so that they see it isn39t harmful 440k current users of meth Does not include Rx stimulant abuse Ritalin Adderall etc o PET model Prevention Enforcement and Treatment The high socioeconomic demand for stimulants once again back to Adam Smith and Ice T 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 o Combat methamphetamine act of 2005 Photo ID and log sig required to purchase pseudoephedrine anywhere in US 2 year log retention for law enforcement inspection and investigation 0 Meth is a hard case scenario for policy makers compare reduced enforcement effects for M o Amphetamines are synthetic central nervous system stimulants First manufactured in 1889 Methamphetamine was first synthesized in 1919 Similar to ephedrine the active ingredient in ephedra sinica The Sudafed flutters a glimpse of meths effects 0 Amphetamines primarily pharmaceutical grade products eg Ritalin and Adderall o Methmethamphetamine hydrochloride Legally sold as desoxyn tablets Swallowed inhaled or injected ice methamphetamine purified with extra solvent processing Very low melting point and thus smokable Extremely powerful and addictive MDMAecstasy 34 methlyendioxymethamphetamine PCPphencycidinedeveoped as early IV anesthetic Never approved for use 1930 s 1960 s the heyday of amphetamine and methamphetamine o Decline of pharmaceutical production and the rise of clandestine labs The crisis of predictable purity o Illicit manufacture ephedrine reduction Red P P2P and nazi methods Domestic lab production facs legal and logistical pressure Mexican cartels largely replace domestic production with superlabs that make larger and purer quantities of meth o Unintended consequence of prohibition efforts forcing small producers out of business leads to huge new market for international cartels Medicaizing misery and prescribing good behavior 0 What is the relation among cultural narratives of nervousness modern psychiatry and the pharmaceutical industry 0 What is the relation between widespread faith in pharmacological rememdies for everyday human predicaments and the logic of the war on drugs Healy Shaping the intimate influences on the experience of everyday nerves 0 Shaping the intimate influences on the experience of everyday nerves Chronic worrying headaches tension fatigue distraction insomnia sweating nausea etc o Undeniably real phenomena and a constant part of the human condition But while these phenomena are constant the stories we use to explain them vary across time and culture 0 The stories we tell about emotional distress and mental crisis are reflexively created The same phenomenon means different things to different people 0 The early shift from melancholy to medication what does it mean to be sad anxiety psychosocial problem and thus is controlled via therapy panic neurobiological problem and thus is controlled via drugs 0 DSM III 1980 pharmaceutical marketing psychiatric revolution The subdividing of anxiety into panic disorder social phobia ptsd etc A basic transformation of some of our most intimate experiences 198039s Benzodiazepine tranquilizers valium Librium etc mothers little helper falls from grace falls from grace over addiction fears 1990 s the ssri revolution Prozac paxil Zoloft etc The era of depression Marketing diseases the shift from anxiety to depression but mostly in US and UK The move from psychobabble to biobabble The WHO report on depression a global epidemic or change in narratives of sadness Lecture 15 Drugs Crime and Violence Today39s Topics What are some of the key dynamics that shape the relation between drugs and crime Is drug related crime only a function of high prices and restricted access or is there a deeper intrinsic relation between drug use and criminality McCoun et al Research on Drugs Crime Linkages N13 2003 Moore Trying to Break Cycle of Prison at Street Level NYT 2007 The relationship among drugs crime and violence is far more complex then we tend to think it is But there are some major areas of agreement among experts o 1 Correlation does not equal causation Drug use can influence criminality and vice versa but always in complex relation to other factors eg Set and setting 0 2 Even though most drug use neither causes nor accomplishes crime the influence of drugs on crime and violence is persistent and profound o 3 These influence vary across individuals lifespan situations and wider socio historica conditions 0 4 Law and policy can influence drug related crime both positively and negatively o 5 Alcohol is involved in more acts of crime and violence than all other drugs combined We need to revise and refine Godstein s tripartite model in an effort to develop optimal policies Social and cultural context are decisive people with addictions are not a homogeneous population Social environment is ultimately more influential than pharmacology Parker and Auerhahn 1998 Addiction careers raise the chicken and egg question which came first drug addiction or crime Lindesmith But this isn39t the only question to ask Do addiction and criminality arise out of similar psychosocial and cultural patterns and contexts Distinguishing between self rationalizing and actual impact Is someone supporting an addiction acting under the influence or acting on the basis of a pre existing criminality The case of heroin and counting crime days to no surprise periods of increases use correlate with increases in criminal activity Variations in drug market character and violence crack high violence vs marijuana relatively nonviolent The political challenges of hard cases heroin meth coke etc The DrugsViolence Nexus Paul Goldtien 1985 This model has long been the gold standard for describing the complex relation between drugs and violence There is always overlap among the three kinds of violence they aren39t mutually exclusive Psychopharmacological violence Results from the acute andor chronic use of a drig Most common with alcohol and stimulants cocaine and meth Use by victim and suspects in a factor role of alcohol in sexual assaults domestic violence street robberies bar fights etc Economic compusive violence crime committed to raise money to buy drugs Systemic violence Traditionally aggressive patterns of interaction inherent to drug culture drug trafficking and the life of the street Mistrust disrespect and humiliation as catalysts for violence and revenge The phenomenon of crime against criminals Dealers policing neighborhoods to avoid loss of business and law enforcement attention Treating addiction or attacking supply cannot change an entire lifestyle and culture Criminality The quality or state of being a criminal The tendencies qualities or predispositions that lend a person to commit comes Lecture 16 No Class Today Lecture 17 The War on Drugs Today39s Topics 0 40 billion spent annually on the drug war 15 billion federal 25 billion state and local 0 16 million drug arrests annually more than for any other offense 50 o of all drugs arrests are for MJ possession o What is the political and moral mindset at the heart of the idea on the War on Drugs 0 Defining victory beyond rhetoric what can we actually achieve via enforcement and how do we measure success These are more complex questions 0 Magnitude of the effort vs the outcomes shoveling sand off the beach 0 Large sophisticated TOC s Transnational Criminal Organizations and carters control international drug markets 0 Thousands of TONS of drugs enter the US every year Domestic production mostly MJ and Rx is also huge o Cocaine Record seizures and interdictions which creates some sustained shortages Coca eradication efforts are also UP 0 Est 2009 production 290 metric tons of pure cocaine Prices are increasing purity is decreasing o Heroin Huge increase in Mexican heroin production 8 tons in 2004 vs 50 tones in 2009 Rising demand among Rx opiate abusers o Methamphetamine Sharp rise in purity decline in price The resurgence of small domestic labs o Marijuana Production has more than doubled in Mexico since 3005 Large increases in domestic production More than 10 million live plants sized just in 2010 Huge rise in illegal prescription drug use 4K opiate overdose deaths in 1999 vs 15K in 208 Increase street gang and OMG involvement Rx overdoes is not the lease cause of accidental death Lecture 18 No Class Today Drugs and Society 6914 904 PM Lecture 19 Imperfect Choices Part I Some Key Policy models Decriminalization Replaces existing drug laws but still restricts access via civil penalties compulsory diversion to treatment Legalization General access under a government controlled or regulated private distribution model Deiure Reform Matter of law eg state eve medical marijuana laws or alcohol prohibition Hard to accomplish politically but offers greater legal certainty Defacto Reform Matter of fact eg Obama administration39s early policy on medical marijuana Easier to accomplish politically but offers less legal certainty Philosophical Underpinnings Maccoun and Reuter The world of business and government is haunted by unrecognized theoretical ghosts Philosophical positions are not always explicit in policy debate but they nevertheless shape the politics of drug policy formation Empirical vs Moral arguments Empirical Arguments Evaluations of data or prediction of future outcomes Moral Arguments Claims of principle that frame and ground empirical arguments Consequentialist Ethics Consequences determine what is moral or immoral Deontological Ethics What39s right is right the principle counts more than the consequence Liberalism and JS Mill39s Harm Principle A key moral theory in decriminalization and legalization debates The only purpose for which power can be rightfully exercised over any member of a civilized community against his will is to prevent harm to others o The Harm Principle Who does it hurt The illusion of isolation Is drug use truly a victimless crime Put another way is drug use truly harmless to others and to society Risk of harm vs Actual Harm Most drug use never harms anyone Not all harm merits state intervention let alone criminal sanctions Legal Paternalism The state should intervene to save people from themselves Soft vs Hard Paternalism Intervene with minors and the incompetent Soft vs intervene in all cases of drug use Hard Legal Moralism The state should intervene to prevent inherently evil acts even where they are not harmful Commonsense Drug Policy Accept that reality that drugs are here to stay and work to minimize their harms Focus on the twofold harms of abuse and prohibition don39t focus on use per se o Don39t focus on the top of the funnel Try to reduce demand also work to reduce harms for those who do use drugs Harm reduction is not legalization Risks of increased use Key Strategies Policy reform disease control HIV Hep BC expanded methadone and other treatment responsible use 9Safe injection sites etc decriminalize cannabis Lecture 12 Imperfect Choices Part II Today39s Topics 0 How might we imagine otherwise in trying to face the crisis of pandemic drug abuse 0 The 10 Ton Elephant Universal Healthcare 2 Those who are suffering from addiction should be able to get treatment 0 Beyond Enforcement Prevention and Treatment 0 Reality 1 Risk factors and protective factors are primarily family related They set the stage for wider socialization processes that shape drug useabuse 0 Reality 2 Only a very small percentage of people who tryuse any given drug develop a serious addiction 0 Money spent on effective prevention and treatment pays higher dividends than enforcement and with onger term effects Family stabilization 0 But prevention and treatment are less politically appealing than enforcement Major Treatment Models 0 Detoxification 13 weeks of inpatient treatment Breaks physiological dependence Temporary with high relapse rates 0 Methadone Maintenance Heroin substitute Reduces highslows and iV risks Once daily oral dose Ideally allows return to stability when combined with therapy 0 SubtexSuboxobe Buprenorphine HCIBuprenorphine HCI naloxone Can work with less severe opiate addictions 0 Drug Free Outpatient Treatment Widely varying nonresidential programs Largely therapy based Limited success primarily in less severe cases 0 Self Help Groups O 12 Step 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 Residential Therapeutic Communities It39s the person not the drug 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 coerced treatment is better than prison for non violent people with severe addictions Drug courts and aggressive prohibition models Eight Questions Wender s Imperfect Choices 0 Reform in the truest sense means re forming social and cultural practices and beliefs This is why I keep pushing the idea of Exoticizing the familiar it keeps us from taking for granted what could or should be changed Family Stabilization Is the cornerstone of addiction inoculation Provide long term social services for highest risk families and neighborhoods Parenthood as a revered vocation and economically viable process Universal voluntary treatment on demand and diversion to court ordered treatment for non vioent felony possession cases and aggressive probation What are the actual positive effects of prohibition on use rates How does changing laws for one drug impact use of other drugs Can balanced probation programs such as HOPE reduce criminal offenders illegal drug use Can programs such as 247 Sobriety reduce criminal offender39s alcohol use How concentrated is hard drug use among active criminals What is the evidence od evidence based principles What treats stimulant status What reduces drug market violence Defacto decriminalization of marijuana possession lt40 grams No legalization but allow adults to grow a few plants for personal use Chicken coop model Continue to arrest and prosecute high eve traffickers Refocus criminal justice resources on gun violence No good time for gun cases Increase DUI sentences mandatory booking streamline field processing and close loopholes Long term goal cultural transformation to break the Adam SmithIce T logic Never give up hope and always strive to imagine otherwise
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