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Wednesday, August 18, 2010

Drug Addiction Demand Reduction (Research) Funding Getting Shortchanged?

The Public Policy Forum at the recent CPDD Annual Meeting in Scottsdale included a fascinating discussion about the ways our government and most western governments approach substance abuse.  Dr. John Strang of King’s College London, Dr. Peter Reuter, from the University of Maryland, Robin Room of the Turning Point Alcohol and Drug Center at the University of Melbourne, Australia, and Dr. Tom Babor of the University of Connecticut discussed different control strategies and evidence for their efficacies.

The discussion covered a number of interesting facts including that government funds are allocated primarily to supply side reduction (~75%, roughly the same in most westernized countries), such as eradication of drugs at their sites of production (e.g., burning coca fields in Columbia) and interdiction (finding and confiscating drug shipments before distribution).  This leaves about 25% for demand reduction programs including research and treatment.

The big problem with this math, according to these experts, is that there is very little evidence available demonstrating efficacy of most supply side methods.  In fact, two of the most obvious measurements of supply side efficacy, street prices for cocaine or heroin, are the lowest they have been in years, meaning that there is no apparent supply shortage.  The United States Drug Enforcement Agency reports that drug purity is down, which could in part explain price reductions, but other statistics support the idea that supply side reduction is not particularly effective.

By contrast, there is recent evidence documenting that good research, when turned into good treatment, is effective at reducing substance abuse and dependence.  For example, each dollar invested in substance abuse treatment has been estimated to save taxpayers $7 in overall costs (healthcare, insurance, crime, etc.).

So, where does this leave us?  In this era when its been harder than ever to obtain federal research funding, wouldn’t it be nice if we could find ways to persuade congress to shift a small fraction of federal resources from supply side to demand side efforts, including research?

Imagine shifting a modest 5% of the total supply side funding (a 7% decrease) to demand side funding (a 20% increase)—how many innovative research and treatment programs would be stabilized, how many new programs would be enabled, and how many $7 returns per dollar of federal treatment investment would be accrued?

In his CPDD Plenary Session address several days before the Public Policy Forum, Dr. Tom McLellan, Deputy Director for Demand Reduction in the White House Office of National Drug Control Policy noted that ONDCP is devoting substantial effort to coordinate substance abuse intervention efforts by different federal agencies.  Perhaps efficiencies that result from this program might make modest funding redistributions from supply to demand side a zero-sum gain for research.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

1 comment:

  1. I attended this symposium and was dismayed by factual errors presented as "facts" by some of the speakers. Others in the audience who access federal government data shared my views that this symposium was not balanced and replete with inaccurate statements, factual errors on the demand and supply side; e.g. the 75% distribution of federal dollars for supply reduction is wrong.

    For the past 6 years, in both administrations, the breakdown has been approximately 65%:35% and does not include Medicare and Medicaid substance abuse treatment outlays. If included, this would shift the ratio significantly to the demand side. The current Demand Reduction distribution is based primarily on SAMHSA block grants (SAPT), the NIDA budget, and a few other federal agency sources of money. Unfortunately, and omitted, is that the block grant (SAPT), the lion's share of federal dollars for prevention and treatment, was evaluated by OMB through the PART process and found to be ineffective. SAMHSA has endeavored to make some corrective changes but these have not been subjected to a recent OMB comprehensive review, making justification of an increase in the treatment budget a challenge.

    If one peruses a summary of the 14,000 or so treatment facilities and their services in this nation, weaknesses in our treatment centers become readily apparent. Concerted efforts to reward effective programs and penalize ineffective programs have not gained traction in Congressional budget appropriations because of special interests opposing these measures. Also running into steep opposition are measures to medicalize intervention and treatment. The issues are far more complex than presented in this symposium, the inaccurate statements, and lack of counterpoint to the presentations, combine to render this symposium a disservice to the CPDD attendees and community.

    As long as drugs are scheduled and illegal to protect public health, it will be necessary to maintain effective balanced supply and demand policies and programs. Without correction, the inaccuracies presented at CPDD seep into the collective memories of professionals who may not have the time or inclination to excavate the primary sources by themselves, and may incorporate misinformation into their personal views or advocacy.

    Bertha K. Madras

    ReplyDelete

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