Substance misuse control
To: Lawrence Montreuil
From: Amber Johnson
Date: January 19, 2018
Re: Revised substance misuse control
Statement of Issue: Substance misuse, including use of illegal drugs and tobacco, overuse of alcohol and misuse of prescription medication, is a serious public health challenge. There are about 23.5 million Americans with a drug or alcohol problem. In 2015, only overdoses of opioids killed more than 15,000 persons. Substance misuse costs America $232 billion in health care and $740 billion overall. Although there are some encouraging improvements in some areas in substance misuse, there are some areas even worsening in recent years, such as misuse of prescription medication has kept to increase in adolescents. Since the war on drugs in the 1980s, it has been showed that the public changed the opinion and would not prefer criminal penalties. Government funds much less for substance misuse than other chronic diseases. Current policies need to be improved.
Education is always important, but the rigid education model should be replaced by diversified, vivid and impressive mode.
Prevention is better than treatment by avoiding serious sufferings and injuries and lowering the cost. As other diseases, there are primary prevention (detecting and dealing with related risk factors, such as family history of substance misuse, lack of related knowledge, adolescents with friends with substance misuse, certain pre-existing psychiatric conditions, and recent exposure to a socioeconomic pressure), secondary prevention (screening and finding substance misuse in the early stage), and tertiary prevention (avoiding disabilities and complications).
Modification of criminal penalties and treatment to put the patients more in the social settings such as homes instead of prisons and other isolated units.
Policy Options
Funding should primarily focus on diversified regular education programs for high risk populations such as adolescents including inviting substance misusers to tell their stories and visiting them in prisons or hospitals, and primary prevention to detect high risk persons and provide consultation, supplemented with secondary prevention, tertiary prevention, treatment, and criminal penalties.
Advantages: Avoids serious sufferings and injuries most effectively, and lowing the cost without future medical care.
Disadvantages: It is hard to convince stakeholders since the cost is increased immediately and the effects will only show after a long term.
Funding should primarily focus on secondary prevention to screen and find substance misuse in the early stage, and tertiary prevention to avoid disabilities and complications, supplemented with education, treatment, and criminal penalties.
Advantages: It is easy to convince stakeholders since the immediate cost is not high and there will be some obvious effects in the near future. In addition, it will produce the benefit to avoid more sufferings and injuries and lowing the cost without possible progressive medical care in the future.
Disadvantages: It is not so cost-efficient as the first option in the prevention of sufferings and injuries.
Funding should primarily focus on the modification of criminal penalties and treatment, supplemented with education and prevention.
Advantages: It is easy to convince stakeholders since the immediate cost is not high and there could be some obvious effects in the near future.
Disadvantages: It is the least cost-efficient and will lead to many sufferings and injuries and high cost in the future.
Policy Recommendation: The policy that primarily focuses funding on diversified regular education programs for high risk populations and primary prevention is the best choice due to its highest cost-efficiency. More studies and efforts need to be made to convince stakeholders.
Sources:
US Department of Health and Human Services (HHS), Office of Disease Prevention and Health Promotion. Healthy People 2010 midcourse review: Focus area 26, substance abuse. Washington: HHS; 2006. Available from: http://www.healthypeople.gov/2010/Data/midcourse/pdf/FA26.pdf
National Institutes of Health, National Institute on Drug Abuse (NIDA). Prescription Drug Abuse: A Research Update from the National Institute on Drug Abuse. Bethesda, MD: NIDA; 2011. Available from: https://www.drugabuse.gov/sites/default/files/prescription_1.pdf
National Institutes of Health, National Institute on Drug Abuse (NIDA). NIDA topics in brief: Substance abuse among the military, veterans, and their families. Bethesda, MD: NIDA; 2009. Available from: http://www.drugabuse.gov/tib/vet.html
https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/symptoms-causes/syc-20376813
