Rejecting a single strategy in the war against drugs, researchers recommend emphasizing law enforcement at the early stage of a new drug epidemic, then shifting funds to treatment when drug use flattens, according to a study published in a journal of the Institute for Operations Research and the Management Sciences (INFORMS®).
Societal use of many drugs passes through stages of explosive spread, plateau, and slow decay, say the authors.
"Early in an epidemic, drug use begets more use and grows very quickly," explains Dr. Jonathan Caulkins, an operations researcher at Carnegie Mellon University and RAND. "Ideally society would catch a new epidemic early, intervene very aggressively on both the demand and supply side, and short-circuit the drug outbreak. Very quickly, however, an epidemic can become sufficiently established that the best policy is to moderate the epidemic, rather than to seek immediate eradication."
Initially, he says, this should be done primarily with enforcement in order to keep drug prices high and suppress the growth in the number of new drug addicts. Among all types of drug control interventions, enforcement is uniquely capable of focusing its effect in the present.
As use grows over time, enforcement spending should increase, but not in proportion to use and not as fast as treatment spending. So treatment should receive a larger share of control resources when a drug problem is mature than when it is first growing. If initiation rates subsequently decline, for example because the drug is universally recognized as dangerous, then enforcement's budget share can drop further without reigniting the epidemic - as long as a reasonably stringent regime is maintained. Professor Caulkins is an expert in modeling societal problems pertaining to drugs, crime, and violence. He has testified before Congress and state legislatures on the effectiveness of drug control programs and has briefed senior policy makers at the federal, state, and local level.
The study, "Optimal Dynamic Allocation of Treatment and Enforcement in Illicit Drug Control," appears in the current issue of Operations Research, an INFORMS publication. The authors are three operations researchers: Dr. Caulkins, and Gernot Tragler and Gustav Feichtinger of the Vienna University of Technology.
Lessons from Cocaine Epidemic
The authors based their model on data from the U.S. cocaine epidemic. Sources include the Office of National Drug Control Policy, the Department of Health and Human Services, and other recent studies. They examined figures such as the average annual rate of initiation of cocaine addiction between 1972 - 1992 (averaging about 1 million new addicts a year, but varying widely over time), the baseline price of cocaine (about $110 per pure gram in base year 1992), and the average number of users in 1992 and 1993 (6.5 million). The authors referred to a report that cocaine-related health and productivity costs in 1992 were $20 billion. They cite an average of $1,700 - $2,000 spent per admission to treatment along with a 13% chance of ceasing heavy use.
The authors developed their model by focusing on the role of markets and prices, taking into account several parameters:
· Enforcement: The authors note the importance of law enforcement aimed at sellers rather than users. In the long run, enforcement against black markets doesn't work primarily by removing people from the population, they note, because incarcerated street dealers are easily replaced. Instead, enforcement is believed to act more like a tax, raising risks and, as a result, the costs of distributing drugs, which drives up the price.
· Initiation, Cessation and Use: The authors' model reflects how driving up price both reduces the number of users (by moderating initiation and spurring cessation) and rates of consumption for those who continue to use.
· Treatment: The authors note that over time users quit, many of their own accord, some with the assistance of treatment. They examine the limitation of treatment, noting that many patients relapse. The study models two hypothetical alternatives: unrestricted funding - offering whatever level of treatment and enforcement is optimal - and a restricted model - in which total spending is constrained to be proportional to the number of users.
Risking Political Capital
The authors argue that the tendency to discuss the relative merits of different drug control interventions in static terms - claiming that treatment is better than enforcement or vice versa, without reference to the stage of the epidemic - is simplistic. Their model recommends optimal solutions that involve substantially varying the mix of interventions over time.
They explain that when policy makers become aware of the existence of a new drug problem, they must decide whether to pursue a policy of moderating its growth or more aggressively attempt to eradicate the use of the new drug.
Eradication carries a heavy political burden, they write. For it to succeed, policy makers must have the political capital needed to obtain massive funding - even if the specific drug problem is still relatively small - and the will to do so, although they may never receive recognition for averting an epidemic that remained invisible to the public eye.
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