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Drug Use in America, Problem in Perspective
INDEX OF SECOND YEAR RECOMMENDATIONS
Drug Use in America: Problem in Perspective
(Second Report of the National Commission on Marihuana and Drug Abuse)
RECOMMENDATIONS FOR PUBLIC INSTITUTIONS
Government Organization
Federal
1. Congress should create a Single Federal Agency similar in its legal and political status to the Atomic Energy Commission. The agency, which might be called the Controlled Substances Administration, would establish, administer and coordinate all drug policy at the federal level and would be the principal, if not sole, point of contact with the state drug programs. The Single Agency would remain separate from all other federal departments and agencies and would be responsible for its own organization and fiscal management.' (Page 293)
2. The appropriate Committees of Congress, in reviewing authorizations and appropriations of funds for all federal departments and agencies with drug-related functions, particularly the Special Action Office for Drug Abuse Prevention, should consider this year the feasibility of such a reorganization. (Page 293)
3. The Single Agency should have the authority and capability to do the following:
Commissioners Hughes, Senator from Iowa, and Javits, Senator from New York, do not concur in the recommendation. See pages 291-292
4. In assuming these tasks, the single agency would absorb the following functions and agencies:
5. To avoid institutionalizing the drug "problem," the concept and accomplishments of the Single Agency should be reexamined four years after its creation; and the agency itself, by law, should disband within five years, its surviving components being reassigned to the agencies or departments from which they came (or into others more appropriate), and integrated with the larger social concerns of those organizations. (Page 293).
6. Congress should establish a commission four years hence, with the specific responsibility to: Evaluate the social response to drug use during the preceding four years.
State
1. Each state should establish a unified drug agency on the same model as that proposed for the federal government. The single state agency should be equipped to provide information about programs and drug use patterns, and to assume joint responsibility for evaluating federally funded programs. (Page 292).
2. Each state agency should have sufficient powers to coordinate all drug programs at the state level and provide guidance and funding to community programs. The agency should have the responsibility of monitoring implementation of the state plan, as well as all programs operating under it, and should be required to report yearly to the designated state authority on the progress of the state effort, measured against the enunciated objectives. All state plans should budget adequate funds for these managerial functions. (Page 292).
Community
Each community with a significant drug use problem should create a coordinating council to insure communication and concert of action between the various drug-related functions in the community. (Page 300).
Legal Controls
International
1. The State Department, in conjunction with the Department of Justice, should immediately undertake a comprehensive review of existing extradition treaties dealing with drug offenses with a. view toward expanding the scope of extraditable offenses and facilitating the extradition process. (Page 231).
2. The United States should encourage law enforcement agencies in all concerned countries to increase both formal and informal exchanges of information concerning drug traffic and traffickers. (Page 231)
3. The membership of the Commission on Narcotic Drugs should be expanded to permit representatives of the health authorities of member nations equal participation in its deliberations and decisions. Further, the United States should convene, in cooperation with the United Nations, a world-wide conference to consider the issues surrounding prevention of demand for drugs. (Page 233).
4. Both the Single Convention and the proposed Psychotropic, Convention should be redrafted to make clear that each nation is free to determine for itself which domestic uses for controlled substances it will allow, provided only that each nation prevent diversion and prohibit exportation and production for exportation for illegal use in other countries. (Page 233).
5. The United States should take the necessary steps to remove cannabis from the Single Convention on Narcotic Drugs (1961), since this drug does not pose the same social and public health problems associated with the opiates and coca leaf products. Similarly, the proposed Psychotropic Convention should be revised to include all cannabis substances, but not under Schedule I, since cannabis products are used for medicinal or self -medicating purposes in many parts of the world. (Page 235).
6. The United States should work through diplomatic channels to persuade other countries not to manufacture cocaine for export. (Page 219).
7. The United States should not ratify the Psychotropic Convention in its present form. If, however, for diplomatic or other reasons, the United States Government does adopt the Convention, the instrument of ratification should include the following declarations:
Federal
1. The American Medical Association should survey the medical profession to determine what, if any, unique therapeutic benefits cocaine has. At the same time, the United States, working through the United Nations and the World Health Organization, should encourage worldwide discussions on the therapeutic uses of cocaine and on its dangers. Taking into account the AMA survey and the results of the international deliberations, the federal government should reduce legitimate cocaine production in this country (including import of coca leaves for purposes of extracting cocaine) to the minimum quantities needed for domestic research and medical uses. If no unique therapeutic use of the drug remains, the government should eliminate manufacture altogether. (Page 218).
2. At this time, none of the barbiturate drugs, including the short acting barbiturates, should be placed in Schedule II of the Federal Controlled Substances Act. Instead, the AMA should immediately design and furnish to physicians guidelines on the prescribing of barbiturates and actively encourage state medical societies and individual practitioners to respect these guidelines. (Page 222).
3. Since, unlike the barbiturates, methaqualone does not have large scale medical uses, and does present a significant problem of misuse, it should be placed in Schedule II, along with the amphetamines. Page 222).
4. Appropriate federal agencies should conduct studies on all other ethical hypno-sedative drugs not presently covered by the Controlled Substances Act to determine whether or not further controls are required. (Page 223).
5. Except where the Commission has specifically recommended a change, the present levels of control on availability of psychoactive substances established by the Federal and State Controlled Substances Laws should be maintained. (Page 213).
6. The National Institute on Alcohol Abuse and Alcoholism should devote substantial effort to the development of better non-prohibitory means of controlling the availability of alcohol. In particular, society should alter availability controls to minimize the social costs of alcohol use. (Page 225).
7. With respect to the drug trafficking laws, the trafficking offenses and penalty structure presently in force under the 1970 Comprehensive, Drug Abuse Prevention and Control Act should be retained. (Page 239).
Federal and State
1. The Commission reaffirms its recommendations concerning marihuana as set out in its First Report.3
2. The unauthorized possession of any controlled substance except marihuana for personal use should remain a prohibited act. As a matter of statutory or enforcement policy, assertion of control over the consumer should not be tied to concepts of criminal accountability but rather to concepts of assistance appropriate in the individual case. The primary purpose of enforcement of the possession laws should be detection and selection of those persons who would benefit by treatment or prevention services. (Page 273)
3. For those drug-dependent persons who are apprehended for consumption-related offenses, including possession, one of the following dispositions should be mandatory:
(a) Diversion to a treatment program in lieu of prosecution
(b) Diversion to a treatment program after conviction but before entry of judgment by the court. Failure by an individual to comply with the conditions of treatment would result in his return to the court for prosecution or sentencing. In that event, he should be subject to punishment by up to one year imprisonment, a fine of up to $500, or both. For those non-drug-dependent persons who are apprehended for consumption-related offenses, including possession, one of the following dispositions should be mandatory:
(a) Diversion to a prevention services program in lieu of prosecution;
(b) Diversion to a prevention services program after conviction but before entry of judgment by the court;
(c) A fine of up to $500; or
(d) Probation with appropriate conditions. Failure by an individual to comply with the conditions of prevention services under alternatives (a) or (b) would result in his return to the court for prosecution or sentencing. In that event, he should be subject to punishment by up to one year's imprisonment, a fine of up to $500 or both. (Page 274)
State
1. All states should attempt to rationalize the operation of the criminal justice system as a process for identifying drug-dependent persons and for securing their entry into a treatment system. The states should establish, as part of the comprehensive prevention and treatment program, a separate treatment process which runs parallel to the criminal process and which may be formally or informally substituted for the criminal process. (Page 267)
'The first year recommendations are set out on Pages 455-61 of this Report.
2. States which have not already done so should adopt the Uniform Controlled Substances Act, with the modifications suggested in our Report. (Page 242)
3. Each state should review its penalty structure for trafficking offenses and determine whether the penalties are commensurate with the relative severity of the offenses. The Commission endorses the criminal provisions in the 1970 Federal Controlled Substances Act and recommends that the states use them as a model for their own trafficking penalties. (Page 242)
Law Enforcement
Federal
1. Federal criminal investigative agencies should concentrate primarily on the top level of the illegal drug distribution network: importation, exportation, and large scale foreign and domestic trafficking. (Page 236.)
2. The federal regulatory effort should concentrate on preventing diversion of drugs at the manufacturing and wholesale levels, leaving to the states primary responsibility for supervising retail pharmacies, hospitals and physicians. (Page 237.)
3. To deal more effectively with the higher levels of the illegal distribution systems, federal law enforcement agencies must develop long-range strategies. The degree to which an investigation can penetrate the illegal market depends directly on how long it remains undercover before surfacing to make arrests and obtain convictions. (Page 237)
4. Criminal investigation activities at the federal level should not have regional offices, as BNDD and Customs have now but instead should deploy strike forces, not tied to any one region, which are able to follow the illicit distribution networks wherever they lead. (Page 236.)
5. Federal agencies should give high priority to recruitment of qualified drug investigative agents. Screening of recruits should include testing to insure suitability for this type of enforcement. (Page 238.)
6. Federal drug law enforcement personnel should receive more intensive training. Career agents should periodically take refresher courses to keep them abreast of current trends. (Page 238.)
7. Federal agencies should encourage skilled criminal investigators to remain in the field. giving them equal promotion opportunities within the investigative area, (Page 238.)
8. To minimize corruption and the appearance of corruption, a separate unit should be established to maintain internal security among Federal drug law enforcement agencies. This unit should be distinct from all other drug law enforcement activities and report directly to the Attorney General of the United States. (Page 238.)
9. A separate evaluation unit., distinct from both criminal and regulatory investigative units, also should be created to monitor performance of all operational units. (Page 238.)
10. All federal law enforcement agencies, especially the Bureau. of Narcotics and Dangerous Drugs and the Bureau of Custom, should use uniform reporting forms to the maximum extent possible so that the information can be combined, studied, and shared. (Page 238.)
11. The federal government should provide state and local agencies technical and funding assistance necessary for the development of a national uniform reporting system on drug arrests and case dispositions which can provide reliable, valid and comparable data. (Page 239.)
12. The federal government should also make available to state and local law enforcement, through the Law Enforcement Assistance Administration, substantial amounts of "buy money" to enable them to make better quality cases and reach the higher echelons of the illicit drug traffic. (Page 228.)
State
1. In order to complement the federal effort, state enforcement should concentrate on the lower levels of both licit and illicit distribution networks. State criminal investigative agencies should focus on middle-level illicit trafficking within the states. State regulatory agencies, to insure compliance with laws and regulations, should concentrate on inspecting pharmacies, hospitals, physicians and researchers. Both regulatory and investigatory state agencies should work on the problem of pharmacy drug thefts, developing standards to minimize this serious problem. (Page 241)
2. Every state should systematically review and evaluate the operations of its boards of pharmacy and medicine, to ensure that they are adequately enforcing the provisions of state and federal law. Professionals who knowingly or repeatedly violate state drug regulations and laws should lose their licenses to practice, in addition to being prosecuted under criminal statutes. Each state should also establish an advisory medical body to act as liaison between the state medical society and law enforcement officials, giving advice and assistance on matters within their area of medical expertise. (Page 242)
3. State and local enforcement agencies should actively recruit younger men and women into their drug investigation units, in order to broaden and update the agencies' perspective. Recruits should be carefully screened and receive extensive training. Federal agencies should continue to provide technical and financial training assistance to state and local police. (Page 241)
4. Each state with a substantial trafficking problem should have a separate unit, responsible to the state attorney general, charged with the responsibility of investigating any evidence of corruption in drug law enforcement agencies. (Page 241)
Community
1. Local police departments should participate with other community institutions in the development of a preventive services program. As part of this program, the departments should formulate precise guidelines for non-arrest dispositions of persons apprehended for consumption-related offenses and for their referral to appropriate prevention or treatment services. Each police department should consider using citations, or other formal means of directing persons into the appropriate program. (Page 276) Those states which have not already done so should authorize law enforcement officials or public health officers to make non-criminal referrals of persons under the influence of controlled substances or in possession of controlled substances for personal use. (Page 276)
2. Local police should receive appropriate training in dealing with the medical needs of drug-dependent persons, including alcoholics. In particular, guidelines should be developed for diverting such persons to treatment facilities for emergency care, and, if necessary, for formal treatment. (Page 276)
3. Local police should act as an early warning system on emerging patterns of drug use in the community, including changes in at-risk populations and non-drug developments which may be relevant to drug-using trends. For example, a constant analysis of drugs on the street can be extremely useful in preparing other community agencies to launch specifically-targeted preventive efforts. (Page 276)
Treatment and Rehabilitation
Federal
1. Through block and formula grants to the states, the federal government should have major responsibility for funding treatment and rehabilitation services administered by the states. However, the federal government should retain discretionary funds for direct funding of demonstration and special projects in the field of treatment and rehabilitation. Such funds should be used for innovative and experimental programs, as well as for providing services to communities not receiving sufficient funding from the state. (Page 338)
2. Except for offenders within federally-operated correctional institutions, the federal government should not have direct operating responsibility for providing treatment and rehabilitation services. Services provided to persons entering treatment on a voluntary basis or through involuntary civil commitment proceedings should be provided only at the state level. Services provided to persons charged with or convicted of federal criminal offenses who are not in a federal correctional facility should be provided through state-operated programs and facilities on a reimbursable basis. The public health hospital operated by the federal government in Lexington, Kentucky should continue to be utilized for clinical research purposes only and the fifty bed clinical research unit of the facility should be maintained for only research. (Page 338)
3. The federal government should sponsor a program to evaluate existing drug treatment and rehabilitation programs to see whether they (1) are cost effective; (2) are designed to deal effectively with their client populations; and (3) have established suitable criteria and objectives. After such an evaluation the federal government should establish performance criteria for state drug treatment and rehabilitation programs. (Page 339)
4. All drug treatment and rehabilitation programs receiving federal funds should demonstrate effective efforts consistent with the performance criteria established, and undergo an annual evaluation by independent agencies having no vested interest in either the funding agency or the service delivery agency. (Page 339)
Federal and State
1. To avoid destroying program effectiveness, federal and state regulations concerning maintenance programs should emphasize treatment flexibility, coupled with reasonable controls to curtail diversion. (Page 217)
2. Opiate antagonists, or similar chemical agents, should not be administered involuntarily under any circumstances, either as a method of treatment or as a method of prevention. (Page 324)
3. The government should continue to prohibit heroin maintenance, as a treatment modality. (Page 337)
State
1. Each state should establish a comprehensive statewide drug dependence treatment and rehabilitation program including integrated health, education, information, welfare and treatment services, which should be administered as part of the state's broader health care delivery and human resources development systems. The program should: (a) Provide a full range of treatment and rehabilitation services throughout the state, including emergency, residential, and outpatient services for drug-dependent persons, persons incapacitated by controlled substances or persons under the influence of controlled substances. (b) Include medical, psychiatric, psychological and social service care; vocational and rehabilitation services; job training and career counseling; corrective and preventive guidance; and any other rehabilitative services, including maintenance, designed to aid the person to gain control over or eliminate his dependence on controlled substances and to make him less susceptible to dependence on controlled substances in the future. (c) Emphasize the development of community-based emergency, outpatient and follow-up support services. (d) Utilize and coordinate all appropriate public and private resources, wherever possible utilizing the facilities of and coordinating services with community mental health services and general hospitals. (e) Allocate services within the state according to an overall plan based on the estimated size and location of the current and potential populations of drug-dependent persons in various communities. (Page 339)
2. The state administrator of such a comprehensive drug dependence treatment program should have statutory responsibility to: (a) Establish standards and guidelines for effective drug dependence treatment services provided by public and private agencies participating in the program. (b) Evaluate, on a continuing basis, all public and private treatment services included in the program, in order to assure, that such services are adequate and effective according to defined objectives and standards. (c) Prepare, publish and distribute annually a list of all public facilities and those private facilities to which public agencies are authorized to refer individuals for treatment services. (d) Assure that the courts of each jurisdiction within the state are periodically notified of facilities through which services are available within the jurisdiction and of the types of treatment offered at each facility, thereby assuring that formal control is not asserted over a person for purposes of treatment when appropriate facilities are not available. (e) Assure that the services offered within each community include drug-free programs as well as maintenance programs, thereby assuring that persons seeking or referred for treatment have to option of participating in a drug-free program. (Page 340)
3. Each state should review its current statutory mechanisms regarding the process by which drug-dependent persons are permitted or compelled to enter treatment. Those states which have not already done so should modify existing legislation to encourage drug-dependent persons to seek treatment voluntarily. In order to maximize the attractiveness of voluntary programs, formal legal processes should be avoided entirely and absolute confidentiality of the treatment records should be assured. (Page 340)
4. Whenever a state chooses to exert formal control over a drug dependent person for purposes of treatment, either through the criminal process or an involuntary civil process, treatment services should be administered in accordance with the following standards: (a) Each person has a right to receive such individual treatment as will give him a realistic opportunity to overcome his dependence on controlled substances. (b) An individual treatment plan, guided by sound medical and clinical judgment and maximizing freedom of choice of the patient, shall be prepared and maintained on a current basis for each person. (c) No person should be required to receive chemical treatment or maintenance services without his consent, and in the case of a person under 18 years of age, without additional consent of his parents or legal guardian. (d) Each individualized treatment plan should employ methods which restrict the drug-dependent person's liberty only when less restrictive alternatives would be inconsistent with necessary and effective treatment. (e) No person should be required to be a subject for experimental research without his expressed and informed consent. (f) All persons should be required, as a condition of participation in a treatment program, to comply with reasonable conditions, including surveillance techniques such as urinalysis. (Page 341)
5. The state, through legislation or administrative action, should assure that private and public hospitals do not discriminate in either admission or treatment policy against any person on the grounds of use of or dependence on controlled substances. (Page 341)
6. Every state should have confidentiality-of-treatment laws, modeled after the provision in the Uniform Drug Dependence Treatment and Rehabilitation Act, currently before the National Conference of Commissioners on Uniform State Laws. (Page 377)
7. In connection with the above recommendations, the Commission supports the adoption of the Uniform Drug Dependence Treatment and Rehabilitation Act presently being considered by the National Conference of Commissioners on Uniform State Laws. (Page 341)
Emergency Treatment
1. With respect to drug emergency victims, the federal government should fully enforce Section 407 of the Drug Abuse Office and Treatment, Act of 1972, which provides that drug abusers who are suffering from emergency medical conditions shall not be refused admission or treatment, solely because of their drug abuse, or drug dependence, by any private or public general hospital which receives support in any form from any program supported in whole, or in part by funds appropriated to any Federal department or agency. (Page 344)
2. At the state level, emergency services should be provided as an integral part of a comprehensive drug-related treatment and rehabilitation program. Where necessary, state funds should be expended to assure the availability of such services. Emergency treatment facilities should always be associated with a general hospital, though they need not be physically located in one. (Page 345)
3. The states should provide by law for emergency detention and treatment of persons so incapacitated by use of a psychoactive drug that they cannot intelligently determine whether they are in need of treatment. Such detention should not exceed 48 hours, unless further restraint is ordered by a court, in accordance with other applicable law. (Page 345)
General
1. Drug use prevention strategy, rather than concentrating resources and efforts in persuading or "educating" people not to use drugs, should emphasize other means of obtaining what users seek from drugs, means that are better for the user and better for society. The aim of prevention policy should be to foster the conditions of fulfillment and instill the necessary skills to cope with the problems of living, particularly the life concerns of adolescents. Information about drugs and the disadvantages of their use should be incorporated into more general programs, stressing benefits with which drug consumption is largely inconsistent. (Page 353)
2. Drug dependence prevention services should include educational and informational guidance for all segments of the population; job training and career counselling; medical, psychiatric, psychological and social services; family counselling; and recreational services. (Page 366)
3. From both cost-benefit and philosophical-constitutional standpoints, the government role should be limited to assuring the availability of accurate information regarding the likely consequences of the different patterns of drug-using behavior. With this basic determination in mind, the Commission recommends the following actions as essential to assure the production and the dissemination of accurate information:
(a) That the Federal Government establish a procedure for screening all Federally-sponsored or funded information materials for accuracy. (Page 355)
(b) That, after institution of the clearance procedure, a single agency, such as the National Clearinghouse for Drug Abuse Information, coordinate dissemination of information. This agency should also maintain up-to-date lists and critiques of all information materials and make them available, together with the federal guidelines for accuracy, to state and local governments as well as to interested private groups. (Page 355)
(c) That a moratorium be declared on the production and dissemination of new drug information materials. This step, presently being considered by SAODAP, will enable the federal government to develop necessary standards for accuracy and concept, and allow sufficient time to conduct a critical inventory of presently existing materials. (Page 355)
(d) That policy makers, in recognition of ignorance about the impact of drug education, seriously consider declaring a moratorium on all drug education programs in the schools, at least until programs already in operation have been evaluated and a coherent approach with realistic objectives has been developed. At the very least, state legislatures should repeal all statutes which now require drug education courses to be included in the public school curriculum. (Page 357)
4. Government should not interfere with private efforts to analyze the quality and quantity of drugs anonymously submitted by street users and to publicize the news about market patterns and dangerously contaminated substances. (Page 364)
5. The government should not support, sponsor or operate programs which compel persons, directly or indirectly, to undergo chemical surveillance, such as urinalysis, unless the person is participating in treatment services, is a prospective or actual public employee, is charged with a crime or is a member of the military. (Page 365)
Federal
The federal government should fund prevention services through block and formula grants to the states, and sponsor basic research in the prevention area. The federal government should also retain discretionary funds for direct assistance to innovative and experimental programs, as well as to programs in communities receiving insufficient aid from the state. (Page 367)
State
1. The primary responsibility for designing a prevention strategy and operating appropriate programs should reside at the state and local levels. Each state should establish a comprehensive) statewide drug dependence prevention program including a full range of prevention services attuned to the needs of local communities and designed to reduce the likelihood that an individual or class of individuals will become drug dependent. (Page 367)
2. The state should assist local communities and institutions (such as universities, business and youth groups) to develop prevention services attuned to their respective needs; specifically, state agencies should help communities to select appropriate services and referral procedures and develop evaluative criteria. (Page 367).
Community
1. Prevention requires community-wide strategy, in which all members of a community, and not merely the schools, acquire information about drug use, so that all can work at improving the situation. (Page 360).
2. Community-based prevention services should be initiated only after local policy planners have assessed the needs of their particular target populations. (Page 367).
3. Each community should give high priority to the development of crisis-intervention services for particular populations as part of its overall prevention services. (Page 367).
4. Local communities, with federal assistance and perhaps regional cooperation, should ensure that "hot line" information programs have qualified people running them and that the information they dispense is reliable. (Page 365).
Research
1. Congress should provide SAODAP now, and the Single Agency when and if it is created, with sufficient funds to design and direct an extensive program of research covering all studies touching on drug use. The Department of Health, Education, and Welfare should participate in the design of the research plan to avoid overlap and maximize the cost-effectiveness of federal research efforts. The research design itself should deal not only with the immediate information needed but also with requirements of future and long-term policy making. It should fund not only projects which produce quick results, but also those, often overlooked, requiring several years to generate useful data. (Page 370).
2. Money should also be available for non-directed research projects, not included in the plan. These should be handled separately from the directed research, but coordinated -with it to avoid duplication of effort.. (Page 370).
3. SAODAP (or the Single Agency) should continually monitor all reports of independent research in the biological, behavioral, or social sciences, for further leads in understanding drug-taking behavior. (Page 370).
4. In particular, the directed research plan should include:
(a) A continuing series of projects similar to the two Commission sponsored National Surveys, as well as other studies to provide a longitudinal data -base on public attitudes and drug-taking behavior. (Page 373).
(b) Etiological research focused on populations exhibiting low, as well as high, incidence of use. It is of equal importance for policy purposes to examine and understand those groups who explicitly disavow drug use and faithfully abide by this norm. Techniques, such as meditation, which have been employed as alternatives to drug use should also be studied. (Page 371).
(c) Continued support of the basic clinical research program at the NIMH Addiction Research Center in Lexington, Kentucky. (Page 372).
(d) Examination of how well drug offenders perform while on conditional release, including bail, parole, probation and treatment, so that the criminal justice system can better design and implement diversion programs. Also of importance are studies to determine the effect of incarceration for drug offenses on users, especially young users and first offenders. (Page 372).
(e) Longitudinal studies of persons who have completed treatment, comparing them to those who left treatment programs before completion and those who never entered treatment. (Page 373).
(f) Systematic study of the dynamics and consequences of systems in other countries where heroin is freely available. (Page 373).
(g) Study of synergistic effects of various psychoactive substances currently used, whether licitly or illicitly. In particular, the National Institute of Alcohol Abuse and Alcoholism should perform ongoing research into the effects of taking alcohol with other drugs, since alcohol is legally available and of-ten used this way. (Page 374).
(h) Research on the effects of drug use on driving. For both research and traffic safety purposes, simple and quick methods for detecting presence of drugs in the body must be refined. (Page 374).
5. The federal government should provide technical assistance and necessary funding to establish a uniform reporting system, together with necessary laboratory support, on drug morbidity and mortality statistics. The current absence of reliable and comparable data in this area has left serious gaps in effective planning with respect to prevention, treatment and control. (Page 374).
6. Government should remove legal and bureaucratic obstacles to research into the possible therapeutic uses of currently prohibited substances, such as marihuana and hallucinogens. (Page 371)
RECOMMENDATIONS FOR PRIVATE INSTITUTIONS
Health Professions
1. Schools of medicine. pharmacy, nursing, and public health should include in their curricula a block of instruction dealing with the social and medical aspects of drug use. This instruction should be so designed that health professionals are adequately informed of the problems and possibilities of treating drug use and dependence and understand as well the wider social implications of both licit and illicit drug use. (Page 375)
2. The medical profession should prepare criteria for use of all psychoactive drugs in medical practice. These guidelines should stress restraint in use of such drugs, emphasizing that they are not a treatment of first resort and that when prescribed, they should be given in the smallest dosage units and doses possible. Medical societies should see that the guidelines are widely distributed among health professionals and, in simplified form, made available to patients themselves. Professional organizations should also conduct continuing education courses in the uses and dangers of psychoactive substances. (Page 379)
3. Both doctors and pharmacists should expressly warn patients of the risks of dependence, overdose, and use in conjunction with similar drugs such as alcohol, when prescribing or preparing psychoactive drug medication. (Page 379)
Pharmaceutical Industry
Manufacturers
1. Manufacturers of psychoactive substances should undertake a major campaign to educate, both health professionals and the public about the appropriate role of these drugs in treatment of conditions of anxiety, tension, and depression. Information and advertising aimed at physicians should: emphasize the need for restraint in use of these drugs, particularly the more powerful ones; point out alternative therapies; and plainly disclose harmful side-effects, risks in prolonged use, and dangers in combining use with that of other drugs, including alcohol. In non-technical language, a series of public service advertisements should carry the same message to the lay public. (Page 381)
2. Drug companies should end the practice of sending doctors unsolicited samples of psychoactive drugs. (Page 381)
3. Manufacturers should contribute a significant part of their considerable research capacity to exploring the technical side of the drug use problem: the nature of drug dependence, the development of less harmful substitutes for those substances most often associated with disruptive use patterns, and the search for "anti-drugs"--chemical correctives to dependent and chronic use of psychoactive substances. In particular, the industry should continue to pool its knowledge and researchers in the search for effective opiate antagonists. (Page 381)
4. Advertising of proprietary, mood-altering drugs should omit suggestions that the substances can result in pleasurable mood alteration or deal with malaise caused by stress or anxiety. Proprietary drug producers should develop clearly defined standards, which reflect correct use of home-medications, and establish a procedure for insuring industry-wide compliance with these standards. At a minimum, the procedure should contain the following elements: (1) An independent mechanism to review any advertisement for compliance with the advertising standard. (2) Opportunity for any member of the public to submit an advertisement for review. (3) Specific sanctions to be imposed on advertisers who do not abide by decisions of the review board. (Page 390)
Retail Pharmacies
1. At the retail level, all pharmacists should verify the identity of persons seeking prescription psychoactive drugs. They must also vigorously enforce the regulations which apply to over-the-counter cough preparations containing codeine. (Page 382)
2. Steps should be taken to reinvolve the community pharmacist in the consumption decision, particularly with respect to psychoactive substances. (Page 382)
Alcohol Industry
1. The alcohol beverage industry should take the lead in funding research into the nature of compulsive alcohol-using behavior and the relation between alcohol use and traffic accidents violent crimes, and domestic difficulties. (Page 383)
2. Manufacturers and distributors of alcoholic beverages should inform the public that compulsive use of alcohol is the most destructive drug-use pattern in this nation. Advertising should emphasize moderate, responsible use and point out the dangers of excessive consumption. (Page 383) 3. The industry should reorient its advertising to avoid making alcohol use attractive to populations especially susceptible to irresponsible use, particularly young people. (Page 383)
Legal Profession
1. Bar associations should conduct seminars and courses on handling criminal drug cases. Law schools should develop courses dealing with drug use and behavior as part of the wider socio-legal problems confronting the legal profession. (Page 384).
2. Lawyers, operating both individually and through bar associations, must point out to the public the need for alternatives to the legal response and the urgency of involving other social institutions in the effort to control drug-using behavior. By the same token, the bar has an equally important obligation to discourage any violations of the law. (Page 384).
Industry
1. Management and unions, supported by the Departments of Labor and Commerce, should cooperatively undertake a comprehensive study of employee drug use and related behavior. (Page 386).
2. The business community should not reject an applicant solely on the basis of prior drug use or dependence, unless the nature of the business compels doing so. When pre-employment screening is necessary, companies should establish appropriate screening procedures, including physical examination, for job applicants and keep the results confidential. (Page 387).
3. Industry should consider alternatives to termination of employment for employees involved with drugs. Where the nature of the business allows, employees should be referred to company-run or other public and private rehabilitation or counseling programs. (Page 386).
4. The business community should consider adopting employee programs patterned after the "troubled employee" or "employee assistance" concept. This program consists of a management control system based on impaired job performance, determined by minimum company standards. It seeks to determine and treat the underlying causes of poor performance-whatever they may be--rather than limiting itself to the standard responses. (Page 386).
5. The fact of treatment and rehabilitation should be confidential to encourage employees to accept counseling and other assistance. No record of the employee's drug problem should be carried in any file which is open to routine inspection. If treatment requires a temporary absence, the company should attempt to keep the employee's job open for that person. (Page 386).
1. College and universities should make their policies and practices regarding drug use, including alcohol, explicit, unambiguous, and readily available to all students. (Page 388.)
2. Even those colleges and universities which strongly disapprove of student drug-use behavior should expand their counseling service& rather than rely upon disciplinary measures alone. (Page 389.)
3. Counseling, treatment and rehabilitation programs on campus should ensure confidentiality to their student clients. Specific rules should be set up indicating to whom confidentiality will be extended and under what circumstances. (Page 388.)
1. Since government intervention is inappropriate here, the media, on their own initiative, must reexamine the impact of informational messages on youthful interest in psychoactive drugs. They should look not only at advertising but also at anti-drug public service announcements, at program content, and at news coverage of "drug stories." (Page 390.)
2. In conjunction with their self-appraisal, the media should sponsor and support long-term, longitudinal research into effects of various communications on behavior. (Page 390.)
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