Midterm 2 Notes on Drug Use Patterns (PDF)

lecture 9 and 10 - patterns of drug use and surveys Created @November 7, 2024 5:19 PM Tags lecture surveys the big picture: illegal drug use patterns correlation is not causation...

lecture 9 and 10 - patterns of drug use and surveys Created @November 7, 2024 5:19 PM Tags lecture surveys the big picture: illegal drug use patterns correlation is not causation! the big picture: illicit drug use patterns survey interpretation: issues and examples coverage error in drug surveys underreporting, social desirability monitoring the future survey MTF cannabis nicotine/cigarettes cigarettes nicotine heroin other narcotics latitudinal (aka cross-sectional) v. longitudinal studies national survey on drug use and health NSDUH opioids surveys general concepts important to survey interpretation two key drug surveys monitoring the future lecture 9 and 10 - patterns of drug use and surveys 1 national survey on drug use and health loots of graphs focus on learning how to read these graphs the big picture: illegal drug use patterns what we know based mostly on several large scale surveys and compilations of law enforcement and health stats correlates things that are associated with each other in a way that suggest a connection or pattern variables that show a statistical relationship when one changes the other tends to change in a predictable way correlation is not causation! lecture 9 and 10 - patterns of drug use and surveys 2 but there could still be some predictive value when two variables are correlated we can sometimes use one of them to predict the other simply based on the observed pattern of association even if we don’t understand the undelrying reason of it there is no causal link between them the big picture: illicit drug use patterns widely known correlates age use of drugs in much more common in late adolescene and early adulthood than at any other point sex males are much more likely than females to use illegal drugs lecture 9 and 10 - patterns of drug use and surveys 3 race and ethnicity white people use illegal drugs at rates that are comparable to or exceed use patterns for racial and ethnic minorities class race and ethnicity difference in substance use is a function of social class economic prosperity and educational attainment residental location most drugs are used most frequently in the west and in urban areas survey interpretation: issues and examples self report surveys have been essential to the study of unusual social behavior since the 1940s and 1950s they have several problems coverage error some of the people most likely to use and abuse illegal drugs are alsmo among the most difficult to contact example During WW2: analyst examined planes returning from combat, noticed they were damaged by bullets Did these areas need more armor? Abraham Wald (statistician) realized that they were only seeing planes that had survived—planes with bullet holes in non- critical areas Had Wald not seen this coverage error, decision might have been to reinforce the areas where bullets hit most— survivorship bias lecture 9 and 10 - patterns of drug use and surveys 4 But Wald realized planes that didn’t return were likely hit in other critical areas that prevented them from making it back coverage error in drug surveys the most widely used sources of information on substance use by adolescents are based on middle and high school populations valuable data but they are based on student populations in school and therefore exclude high school dropouts and are more likely to exclude kids who just skip school about 6% of students drop out permanently and dropouts are more likely to use harder drugs and use them daily dropout and absenteeism rates vary according to other demographic characteristics we’re undercounting drug use among hispanic people and native americans underreporting, social desirability underreproting tendency of respondents to lie, minimize, or fail to answer questions that are perceived to be threatening social desirability tendency to reply to sensitive questions in ways that are believed to be more socially appropriate people are less likely to report sensitive and illegal behavior especially as anonymity decreases or as they feel like they’re loosing control of the survey process underreporting is likely to vary not only by survey mode lecture 9 and 10 - patterns of drug use and surveys 5 but also by sociodemographic variables and type of substance distrust of authority figures monitoring the future survey MTF most commonly used source of information on legal and illegal drug use by adolescents (especially) and adults surveys use of various drugs as well as alcohol, tobacco, and psychoactive substances in the last 30 days and lifetime age at first use of drugs, frequency and quantity, perceived availability, peer norms, expected future use first implemented in 1975 as a cross national survey of high school seniors 1991 extended study to include 8th and 10th graders 2018 about 15k each in 8th, 10th, and 12th graders 400 public and private schools 8th and 10th annonymous 12th not anonymous for follow ups follow ups now have data on folks up to age 60 examine association of adolescent substance use with outcomes later in life college enrollment, marriage, parenthood, and so on lecture 9 and 10 - patterns of drug use and surveys 6 despite limitations still the best source of information use on prevalence and incidence of substance use lecture 9 and 10 - patterns of drug use and surveys 7 lecture 9 and 10 - patterns of drug use and surveys 8 mostly male and female surveyed mostly white and hispanic surveyed most straight survyed we are undercounting things!!!!!!! american indian native hawaiian etc lecture 9 and 10 - patterns of drug use and surveys 9 most used substence was alcohol second most was cannibas ciggaretes used to be a lot more popular lecture 9 and 10 - patterns of drug use and surveys 10 most alcohol second most nicotine unlike young adults cannabis slowly follows cannabis lecture 9 and 10 - patterns of drug use and surveys 11 12 month prevalence, age use of annabis among adults 19-20 starting around 30% then dipped but reained steady until early 2010s increased again with LEGALIZATION lecture 9 and 10 - patterns of drug use and surveys 12 30 day prevelence, age increase is same, but just less pattern is same, but just less rate of use in year is higher than month lecture 9 and 10 - patterns of drug use and surveys 13 daily use, age pattern is about the same lecture 9 and 10 - patterns of drug use and surveys 14 12 month, by race and ethnicity white people more, and more steadadly same bump tied to legalization however, similar lines for each race lecture 9 and 10 - patterns of drug use and surveys 15 30 day by race and ethnicity hispanic is rising the most nicotine/cigarettes cigarettes lecture 9 and 10 - patterns of drug use and surveys 16 12 month, age downward trend start to see decline after 03 less steep decline for 35-50 decline also in conjunction with increase of vaping lecture 9 and 10 - patterns of drug use and surveys 17 30 day period, age same trend, MUCH steeper decline lecture 9 and 10 - patterns of drug use and surveys 18 30 day period, age, half a pack or more per day same decline also steep nicotine lecture 9 and 10 - patterns of drug use and surveys 19 any nicotine use, 12 months, age most is 19-30 heroin lecture 9 and 10 - patterns of drug use and surveys 20 12 month, age heroin increased in ‘13 but it highley declined afterward in conjuction with other narcaotics becoming more prevalent other narcotics lecture 9 and 10 - patterns of drug use and surveys 21 12 month, by age experienced huge bump in early 21st century 19-30 slowly decline 35-50 less of a decline latitudinal (aka cross-sectional) v. longitudinal studies lecture 9 and 10 - patterns of drug use and surveys 22 MTF is longitudinal cross sectional gives up snapshot longitudinal allows us to track how people do over the years national survey on drug use and health NSDUH most representative source of data on drug use in the US sampled from the general US population aged 12 and above about 2% excluded military correctional facillities residential treatment programs homeless but not in shelters annual sample of about 65K cross sectional sample lecture 9 and 10 - patterns of drug use and surveys 23 lifetime, past year, past month of drug use age of first exposure and age of first use last use perceptions of availability of drugs and their risks consequences of use opioids their annual report lecture 9 and 10 - patterns of drug use and surveys 24 12 month, age 12 and older 75% say no 25% say yes extrapolative the data from who they ask to general US population most common drug by far is weed third is pain reliveer misuse (opioids lecture 9 and 10 - patterns of drug use and surveys 25 misuse of stimulant relatively more common for 18-25 misusue of tranquilier is all similar except for 12-17 misuse of pain is highest lecture 9 and 10 - patterns of drug use and surveys 26 top 4 have continued to been most commonly missued lecture 9 and 10 - patterns of drug use and surveys 27 where did you get it from most from the doctors second most from people they know lecture 9 and 10 - patterns of drug use and surveys 28 while heroin use is important, there is a bigger picture that adds perscription and other drugs lecture 9 and 10 - patterns of drug use and surveys 29 lecture 10 - correlates of illegal drug use Created @November 12, 2024 5:13 PM Tags lecture age gender/sexual orientation race/ethnicity Black adolescences hispanics class age patterns of drug use increase quickly during adolescence, peak in early adulthood (18-25), and decline as people go into middle and late adulthood reasons for peak? independence from parental authority relative lack of serious commitments meeting new people unstructured time experimentation recent trend increase in substance use and abuse among older adults lecture 10 - correlates of illegal drug use 1 abuse of alcohol, prescription drugs, marijuana reasons? free time, relief form other commitments isolation especially: loss of partner expected to increase gender/sexual orientation big gap in the reasearch tons of focus on biological sex, not a lot on gender males are more likely than females to use and abuse illegal drugs but during middle and high school, rate of sue is about the same or a little higher for females when it comes to gender and orientation…. NSDUH classes folks into “sexual minority” and “sexual minority” and focuses on orientation lecture 10 - correlates of illegal drug use 2 lecture 10 - correlates of illegal drug use 3 shows sexual minority is a lot more likely for every category lecture 10 - correlates of illegal drug use 4 only main difference is female minority more than male while opposite is true for majority minority more lecture 10 - correlates of illegal drug use 5 more even lecture 10 - correlates of illegal drug use 6 overall shows some groups are more vulnerable race/ethnicity consistently low rates of use reported by Black people through adolescene and young adulthood distress and abuses of Black communities is tied toward this lecture 10 - correlates of illegal drug use 7 highest rates reported by folks who idenitfy as “multiracial” and “American Indians/Alaska Natives” but what about dropout rates? underreporting? lack of trust in the system? remember these issues with surveys Black adolescences less likely to report use of illegal substances extremely low rate of reportinf cocaine use hispanics reporting in patterns similiar to white and black people but how reliable are these kinds of conclusions? class social class is more throughly studied than race/ethnicity as a correlate of drug use many studies white people from more privaledged backgroundes are far more likely to consume illicit substances age 26 and older with highest level of schooling are least likely to report using illicit drugs followed by folks with only high school degrees lecture 10 - correlates of illegal drug use 8 lecture 11, 12, 13 - drug law and policy Created @November 14, 2024 4:41 PM Tags lecture part 1 review! how do we approach drug us US law 101 state and federal law common law (US, mostly) vs civil law civil law common law big picture: authority and focus federal law state level regulation and approval of pharmaceuticals origins pure food and drug act of 1906 sulfanilamide food, drug, and cosmetic act of 1938 the FDA approval process the most important bit: control of the process prozac approval of prozac required clinical trials conflicts of interest additional serious issues concealment aggressive expansion off label uses lecture 11, 12, 13 - drug law and policy 1 part 2 big pharma is big political economy political economy of the pharmaceutical industry lobbying pharma lobbying lobbying is expensive relationship with federal agencies legal cases against pharma companies example let’s remember.. (and review) oxycontin richard sackler turning point: settlement not just purdue oklahoma litigation - example national prescription opiate litigation first wave explosion consolidation key moments: Bellwether trials key moments: public nuisance key moments: other developments key moments: Purdue Pharma key moments: 2024 supreme court part 3 scenario origins of anti drug laws 1960s federal response trend: prelude to mass incarceration contemporary anti-drug law the War on Drugs trend: targeting escalation trend: targeting + escalation of mass incarceration how effective is it other consequences lecture 11, 12, 13 - drug law and policy 2 housing welfare student aid always remember the most important lesson PCD can teach you review social construction and opioid legality for 2nd midterm part 1 review! Drugs and drug scares are socially constructed AND they have real physiological effects Whether a drug is legal or illegal is a product or factor of that social construction not necessarily an unavoidable consequence of anything inherent to the substance Categorizations of drugs embody features of their social construction Laws can get passed to create tools for the oppression or rejection of others Drug laws have been weaponized to target individual populations deemed threatening by group in power Surveys are not the truth and are subject to a lot of issues regarding who they count and how Big-picture accounts of drug patterns cannot fully capture the lived realities, subtleties, or correlates of drug use Law and justice are different things. lecture 11, 12, 13 - drug law and policy 3 “Legal” and “good” are different things. “Illegal” and “bad” are different things. how do we approach drug us thinking about legal and illegal as interrelated but treated differently that distinction is socially constructed but so are laws by focusing as much on the existence of laws, policies, and regulations as we do about the lack of such things US law 101 state and federal law federal law made by government applies to all states state laws made by states and govern certain aspects of life within those tstaes both always apply at the same time, depending on where you are, and if there is a conflict, then federal law takes precedence lecture 11, 12, 13 - drug law and policy 4 3 branches of govt exist at federal level and at the state level subject to pressure at all times never isolated from the world even if they pretend to be legislative make laws us congress executive president judicial court system common law (US, mostly) vs civil law civil law court opinions are not binding (or not as much) and previous opinions are not vey influential each new case decided based on the comprehensive legal codes labor code administration code etc legal change requires legislative action common law lecture 11, 12, 13 - drug law and policy 5 most of the US except louisiana and some fields of state law that have adopted civil-like procedures court opinions are binding judges need to consider previous court opinions when deciding a new case judges play an active role in shaping law through their rulings legal change occurs also through the accumulation of judicial decisions big picture: authority and focus federal law state level controlled substances act (CSA) individual state statues and constitutions drug enforcement administration (DEA) and FBI state and local law enforcement focus focus large scale local drug use cross state medical use of substances controlled substances recreational use of substances federal scheduling system states may adopt CSA schedules (schedules 1-5 review them!) or make their own prescriptions regulated through states may impose additional FDA and DEA regulations or monitoring programs regulation and approval of pharmaceuticals lecture 11, 12, 13 - drug law and policy 6 origins first federal law regulating pharmaceutical products went into effect in 1848 patent drug era banned import of adulterated drugs which were causing a lot of health issues did not have impact on domestically produced drugs which were often adulterated no real domestic control sold just like any other good without requirement to disclose contents growing sense of danger! pure food and drug act of 1906 series of exposes published in early 1900s showed unsanitary conditions in meat packing plants and documented dangers of patent medicines 1906 law prohibits interstate and foreign commerce in adulterated and misbranded food and drug products requires manufacturers to list ingredients did not regulate purchase or the concentration of a drug] sulfanilamide very powerful antibiotic, known as such since the early 1930s patent medicine quickly became known as a “miracle drug” lecture 11, 12, 13 - drug law and policy 7 a drug that can resolve a medical issue quickly effectively, and consistently popularity led to very high demand so the SE Messengill Company of Tennessee created a liquid version of it in 1937 Elixir Sulfanilamide elixir was diluted with diethylene glycol, a type of alcohol that gave it a sweet and pleasant raspberry flavor (clear, colorless, orderless) but it happens to be highly toxic to humans severe organ damage (kidneys and liver), depression, death nowadays used in antifreeze, break fluid, cosmetic 1937 elixir gets distributed reports of severe illness and death 100+ people included children died after consuming it revealed the great oversight of 1906 pure food and drug act companies were required to list the ingredients on the lebls but not required to test a drug’s safety before marketing it intense public outcry → quick government action food, drug, and cosmetic act of 1938 still active, amended over the years 1906 law had empowered the department of agriculture (executive) to address food safety the food drug and insecticide administration 1930 lecture 11, 12, 13 - drug law and policy 8 renamed as the FDA (removed the i) enforcing labels and inspecting for contamination 1938 empowered the FDA oversee drug safety testing regulate cosmetics and medical devices remove unsafe products from the market later in 1962, oversee effectiveness the FDA approval process the most important bit: control of the process ideally, the FDA would conduct its own independent studies of drugs but that is not how it works at all drug approval studies are constructed, supervised, and paid for by the drug companies themselves pharma companies will do everything they can to make their studies turn out right prozac approved by the FDA in 1987 treatment of major depressive disorder later widely prescribed for wide array of mental health conditions, including anxiety and OCD approval of prozac lecture 11, 12, 13 - drug law and policy 9 eli lilly manufactuerer FDA allowed lilly to use “placebo washout” experiment to test it all participants are given placebos for 1 week and those patients who improved in their symptoms were removed from the study study continued with two groups placebo and drug group comparing symptom improvement but this is a problem some of the patients who reacted positively to placebos at the start could have reacted negatively to prozac, no way of knowing study excluded individuals with suicidal tendencies, children, and elderly adults and nowadays psychiatrists are increasingly prescribing prozac to people in these categories even though initial approval didn't test in these groups the total number of individuals who completed the 6 week clinical trial was just 286 so approval was not a thorough study a trial that potentially missed people who may react negatively to the mediation had a very small sample size did not address the groups for whom the medication would later be prescribed FDA gives drug companies plently of leeway to design trials in ways that may benefit them lecture 11, 12, 13 - drug law and policy 10 required clinical trials typically focus on the short term effect of the drug not required to test products against other substances already used to treat medical conditions, just against placebos 1992 drug use fee act (don’t need to know) pharma companies pay $300k for approval application in exchange for speedier process increased steadily - upwards of $2m per application nowadays conflicts of interest many physicians and medical professionals who serve on drug approval boards have received financial compensations from pharma companies study out of 107 such professionals, 40 received at least $10k from either phama companies they voted to approve “pay later” conflict of intrest voted yes so got money additional serious issues concealment pharmaceutical companies have a history of concealing information from the FDA often revealed only after a lawsuit forces a discovery process lecture 11, 12, 13 - drug law and policy 11 aggressive expansion think about what happened with Oxy pharmaceutical companies panning extensive expansions even though they are away of serious issues review those lectures for paper 2 and midterm 2 review Oxy off label uses sometimes very good thing but dangerous once a drug is approved by the FDA for a specific use it can be prescribed for any use part 2 big pharma is big 2002 combined profits for the 10 drug companies in the fortune 500 index were more than the profits for the other 490 combined ($35.9B vs $33.7b) 2006-2015 sales revenues for pharma and biotech companies increased from $534B to $775B 2017 report from government accountability office: 2006-2015 25 largest drug companies’ profit margins ranged from 15% to 20% whereas the profit margin across all other companies in the largesrt 500 globally ranged between 4% and 9% lecture 11, 12, 13 - drug law and policy 12 industry spending on research and development only increased by 8.5% over 2008-2014 ($82b to $89b political economy very big term in the social sciences means different things for peoples/disciplines for us: relationships between political and economic forces useful refinement relationships between industries and government institutions political economy of the pharmaceutical industry lobbying act of attempting to influence the decisions, policies, or actions of government officials, legislators, or regulatory agencies often carried out by individuals, groups, or organizations (lobbyists) who advocate for specific outcomes that align with their interests or the interests they represent legal, but regulated very common meeting with policymakers to present arguments or data supporting a position drafting proposed legislation amendments for lawmakers to consider lecture 11, 12, 13 - drug law and policy 13 what would it take for you to sponser my bill? providing expert testimony at hearings or public forums engaging in public relations campaigns to sway public opinion, indirecting influencing decision-makers well paid sometimes require tons of education or 8-10 years of work or experience every industry has them pharma lobbying one of the most powerful and well funded forms of lobbying, especially in the US legislative influence shape laws that govern drug approval, patent protections, pricing regulations, access FDA and regulatory processes streamline drug approval process reduce testing requirements favorably interpret data medicare and medicaid older people, people with disabilities (care) low income (caid) oppose reforms to allow government to negotiate prices trade and patents reduce generic competition public and political campaigns lecture 11, 12, 13 - drug law and policy 14 fund campaigns donate to lawmakers run PSAs to sway public opinion lobbying is expensive 1997-2002 pharms spent close to $500m in lobbying in 2002 congressional campaigns drew more than $30m in donations 2018 (by october) lobbying group for pharma spent about $27.5m on lobbying individual firms in pharma and health products spent an additional $194m relationship with federal agencies 2004 LA Times investigation at least 530 government scientists with the NIH had taken fees or stock options from biomedical/pharma firms over a 5 year period real connections Dr. Bryan Brewer received $31k from AstraSeneca and wrote favorable articles about the use of Crestor (for cholesterol) Dr. Trey Sutherland received $50k from Pfizer and publicly endorsed the company’s alzheimers medications Daniel Troy (chief counsel of FDA appointed by George W. Bush in 2001 IMPORTANT apparently/allegedly invited drug companies to inform him of potential lawsuits against them so that he could assist in their defence lecture 11, 12, 13 - drug law and policy 15 as head of FDA, field briefs defending four drug companies after leaving in 2008, Troy became senior vice president and general counsel for GSK other FDA connections experts who create clinical guidelines sometimes have ties to pharma companies (up to 4/5) advisors who consider whether drug should be taken off the market have ties (up to 10/32) legal cases against pharma companies most common violation up to late 2010s as far as we can tell drug pricing draud against Medicaid programs another common violation unlawful promotion of drugs substantial fines, but very small in comparison to company profits a few pharma executives have been jailed but they are few and far between (powerful expensive lawyers → probation, fines) 1991-2017 473 settlements (pay to drop suit), about $38b in penalities example Bayer required to pay $257m fine because of a scheme Cipro (antibiotic) lecture 11, 12, 13 - drug law and policy 16 Bayer was selling it cheaper at Kasier Permanent than it sold it to Medicaid violation of federal law requiring manufactueres to give Medicaid the lowest price availible depression medication called Celexa, which regulates mood forest laboratories fined $313m obstruction of justirce (hinder FDA inspection) distribution unaproved drug (for hypothyroidism) market celexa for children (only approved for used in adults at the time) let’s remember.. (and review) oxycontin Most pain medications lasted for about 4 hours, but OxyContin could last for up to 12 hours Active substance: oxycodone (Sch II) Previous pills with oxycodone (like Percocet) had about 5 mg of oxycodone mixed with some 500mg of some over-the-counter pain reliever like aspirin richard sackler Head of Purdue (Sackler Family controlled the company) “The launch of OxyContin will be followed by a blizzard of prescriptions that will bury the competition. The prescription blizzard will be so deep, dense, and white.” (Think snow—coverage) lecture 11, 12, 13 - drug law and policy 17 turning point: settlement 2007 Three top executives plead guilty to criminal misdemeanor (less severe punishment) for roles in misbranding and deception. Purdue ordered to pay $600M in fines; execs fined $35M, 3 years’ probation, 400 hours of community service Illegal pill mills (prescribing indiscriminately) punished with more than a decade in prison not just purdue Distributors! Pharmacies! Doctors! Other manufacturers! oklahoma litigation - example june 2017 OK sued several pharmaceutical companies for their role in opiod crisis march 2019 Purdue and members of the Sackler family paid $270m settlement with the state no admission of wrongdoing….. WHERE THE MONEY WENT created Oaklahoma State University Center for Health Sciences ($177m, focused on treating and researching addiction) lecture 11, 12, 13 - drug law and policy 18 litigation costs pay the lawyers! state initiatives prevention education treatment to combat addiction may 2019 Teva Pharmaceuticals to pay $85m for role in epidemic no admission of wrongdoing……… then the state went after Johnson and Johnson who responded that OK could not specifically demonstrate that deaths were related to their products fentanyl patch and a discontinued drug J and J ultimately appealed to state supreme court and won national prescription opiate litigation bringing together 100s of lawsuits against pharma companies first wave 2010s millions of Americans were addicted, and overdose deaths surged communities faced devastating impacts increased health care costs lecture 11, 12, 13 - drug law and policy 19 law enforcement expenses lost productivity local governments, overwhelmed with financial and social toll, seek legal accountability municipalities, counties, states, suing opiod manufacturers allegations (accusations/claims) companies downplayed addictive risks of opioids in their marketing distributers failed to monitor and report suspicious orders of opioids pharmacies dispensed opioids irresponsibly seeking compensation for the public health costs of the crisis explosion 2017 number of lawsuits explodes around the country hundreds of cases targeting manufactures, distributors, and relaters (pharmacies, Walmart, etc) big problem how do we handle this in a common aw system? consolidation Judicial Pannel on Multidistrivtion Litigation when there are a lot of cases across several federal courts, the Panel consolidates them all in a single case to reduce inconsistency and reduce the burden on the legal system 2017 consolidated all cases in the Northern District of Ohio lecture 11, 12, 13 - drug law and policy 20 under Judge Aaron Polster reputation as a mediator and experience with settlements over prolonged legislation largest and most complex multi-district litigation in US history key moments: Bellwether trials story way too complicated and still unfolding Bellwether Trial go through one trial to get a sense of how the others will go test legal arguments encourage settlements 2018 (Ohio) counties suing manufacturers, distributors, retailers alleging negligence, violation of consumer protection laws ended in settlement big for the counties small for the distributors key moments: public nuisance public nuscance idea that the companies had been responsible for creating damaging environments in the towns themselves 2019 Oklahoma case J and J ordered to pay $572m for its role in the crisis claim lecture 11, 12, 13 - drug law and policy 21 J and J had played a significant role in creating and prepetuating the opioid crisis through marketing and distribution 2021 OK supreme court overturns it (J and J wins) but cases keep coming 2021 J and J pays $5B settlement (to local governments) to resolve public nuisance and other opioid-related claims financial certainty (stop increasing costs), reputation management key moments: other developments distributions, 2021 collective agree to pay $21B in settlements multidistrict litigation allows plaintiffs (people accusing) of pooling resources and legal strategies unified agreements resolve throusands of cases at once settlement funds distributed to affected communities for prevention, treatment, and recovery key moments: Purdue Pharma 2019 filed for bankruptcy amid mounting lawsuits means you can’t pay off all the debts freed them from settling each lawsuit “maybe you can pay a little bit still cause you’re bankrupt” lecture 11, 12, 13 - drug law and policy 22 key move to benefit firm shift focus from having to settle each individual lawsuit to collective settlements through bankruptcy court still in business, operating fully key moments: 2024 supreme court pivotal opinion concerning the Sackler family (owners of Purdue) 5-4 opinion one vote made all the difference rejected a bankruptcy settlement that would’ve shielded the Sacklers from civil lawsuits related to their role in the opioid cris part 3 progressive intensification of sentencing and targeting in drug laws! overtime drug laws increase their penalties, targeted people more directly certain communities are disproportionally affected scenario A young man appears for sentencing on a conviction for selling 2/10ths of a gram of cocaine within 1,000 feet of a school bus stop. He trades his services as a middleman in the deal for a small amount for personal use doesn’t actually sell a lot of among he uses his drugs lecture 11, 12, 13 - drug law and policy 23 trades plumbing for drugs doesn’t get significant economic gain Standard-range sentence for this first-time drug offense is 45-51 months. Scenario disproportionately affects Black youths. Contrast: Robber takes property by threat of force, has prior offense. Sentence is between 12-14 months. Executives spread drugs through misinformation and harm millions of people. No jail time. origins of anti drug laws just know what laws did origins of drug regulation in the US date back to the early 20th century we’ve thought about drug laws before at the city/state level (opium) we’ve also thought about the 1906 pure food and drug act - federal scattered federal laws in the first half of the century (don’t need to know name, just what they do) 1941 Harrison Narcotics Act regulates and taxes the production, importation, and distribution of opiates and coca products; criminalizes non-medical use 1937 Marijuana Tax Act effectively bans cannabis by imposing prohibitively expensive taxes on its sale and distribution 1951 Boggs Act and 1956 Narcotic Control Act introduce mandatory minimum sentences for drug offenses lecture 11, 12, 13 - drug law and policy 24 in first half of 20th century, drug laws scattered however mandatory minimum sentences began 1960s transformative period for drug use and perceptions in the US substances between intertwined with cultural rebellion, political movements, evoling health concerns psychedelics! woooooo also marijuana, heroin and others began a drug scare (Reinarman style!) scapegoat for viet war federal response just know what laws did when drug use became rampent, govt began to pass laws to control drug use first did this by expanding and intensifying what was already there 1965 Drug Abuse Control Amendments expand FDA authority to regulate stimulants, depressants, hallucinogens → criminalization of recreational drug use 1968 Buraru of Narcotics and Dangerous Drugs intensification of anti-drug efforts, precursor to current Drug Enforcement Administration trend: prelude to mass incarceration lecture 11, 12, 13 - drug law and policy 25 1960s early federal drug policies disproportionately affected Black and Latino neighborhoods cannabis and psychedelics used among white countercultural groups but enforcement efforts focused on Black and Latino neighborhoods arrests for drug related offenses rose especially for marijuana possession Black individuals disporportionally targeted despite comparable drug use rates across racial groups building toward mass incarceration not just because of text of law, but how laws were being enforced law didn’t carry bias areas law enforcement officials focused on were based contemporary anti-drug law the War on Drugs what we know as drug laws now started in 70s president Richard Nixon (republican, 1969-1974) 1971 declared drug abuse “public enemy number one” formal start of the War on Drugs administration supports intensification of anti-drug efforts, including massive legislative change 1970 Controlled Substances Act (CSA) ★ centralized federal drug policy under one law lecture 11, 12, 13 - drug law and policy 26 creates the schedules!! schedule 1 drugs (marijuana, heroin) declared to have no accepted medical use and a high potential for abuse even though there was a history of medical uses for them classified because of social construction establishes the Drug Enforcement Administration 1971 declaration launched a comprehensive national drug control strategy emphasizing enforcement, treatment and prevention mostly focused on enforcement increased several funding for rehabilitation programs, although enforcement was the focus strengthened international drug control efforts including “eradication” programs targeting coca and opium in Latin America failed misserably trend: targeting Nixon administration intentionally linked drugs to radicalized fears of crime and unrest Nixon aide John Ehrlichman: 1994 “We knew we couldn’t make it illegal to be either against the war or Black, but by getting the public to associate the hippies with marijuana and Blacks with heroin, and then criminalizing them both heavily, we could disrupt those communities.” escalation lecture 11, 12, 13 - drug law and policy 27 Ronald Regan (1981-1989) prioritized strict law enforcement and severe penalties for drug offense 1984 Comprehensive Crime Control Act ★ allows governments to seize assets linked to drug crimes drug lord and bought stuff with drug money govt can take it introduce mandatory minimum sentences for drug offenses introduced unavoidable consequences to possesing drugs 1986 Anti-Drug Abuse Act ★ increases mandatory sentences we’ve seen it before, remember crack cocaine? 5 year mandatory minimum sentence applying to 5.01g of crack cocaine but 500g of powder cocaine 5 paper clips of crack vs 1 pound of powder carried SAME sentence essentially the same substance pharmacologically, with same effects and consequences 1988 Anti-Drug Abuse Act introduces even harsher penalties for drug-related offenses, including death penalty death penalty involvement in drug trafficking + committing murder kingpings operating large scale enterprises that led to intentional killing murdering law enforcement officers trend: targeting + escalation of mass incarceration lecture 11, 12, 13 - drug law and policy 28 crack cocaine wasmore common in urban Black communities got harsher punishment 100:1 disparity between crack and powder cocaine → disparity in possession of crack between Black urban neighborhoods and white settings Black communities carried more crack white communities carried more powder prison populations skyrockets by 1990 incarceration rate for Black Americans was 6x that of white Americans driven largely by drug-related arrests and convictions studies by United States Sentencing Commision 1992 16 states (including Connecticut and Illinois) had never prosecuted a single white person under federal crack laws 1994 Black people accounted for 90% of federal prosecutions for crack offenses white people for less than 1% another USSC study in the Central District of Californai (including LA) the first charge against a white defendant under federal crack cocaine laws came in 1995 nine years after the distinction was created 1993 across the country 88.3% of those sentenced under federal crack statutes were Black 95.4% were not white lecture 11, 12, 13 - drug law and policy 29 how effective is it TLDR- not very 2009 the most serious traffickers (high level importers) represented only about 11% of federal drug offenders lower level offenders (street dealers, couriers, mules) represented about half Judge Mark Bennet, Northern District, Iowa “These mandatory minimums are so incredibly harsh, and they’re triggered by such low levels of drugs that they snare at these non-violent, ow-level addicts who are involved in drug distribution mostly to obtain drugs to feed their problem....”...they have a problem. It’s called addiction, and they’re going to be faced with 5- and 10- and 20-year and sometimes life mandatory minimum sentences. I think that’s a travesty...Does it really make sense to treat a for-profit seller and a not-for- profit user the same? I don’t think so because Congress has also said we’re supposed to look at the nature and circumstances of the offense and the history and characteristics of the defendant.” these laws are targeting essentially the weakest people in the chain by design have a bias and carry assumptions of what communities will be policed lecture 11, 12, 13 - drug law and policy 30 other consequences housing Anti Drug Abuse Act requires public housing agencies to evict tenant if the tenant, a member of their family, or guests are involved in “drug related criminal activities” harsh penalties in structure support a 1990 law (National Affordable Housing Act) expanded this to add that if an infidivual was evicted, they could not receive public housing passed on the grounds that drug dealers “are increasing imposing a reign of terror on public and other federally assisted low-income housing tenants” welfare 1996 Federal Welfare Reform Act debated in congress for about 2 minutes any individual convicted of a felony drug offense can be denied federal welfare benefits, including food stamps and temporary aid to needy families for life 1996-2002 92K+ women denied welfare for this reason student aid 1998 Higher Education Act folks applying for federal financial aid are required to answer a question regarding their prior drug conviction in they indicate they have one or refuse to answer, they are asked follow up questions lecture 11, 12, 13 - drug law and policy 31 conviction for drug offenses, including possession of marijuana, or who don’t answer, can be denied aid first for a year, and then increasingly until it’s permanent always remember the most important lesson PCD can teach you law and justice are different things “legal” and “good” are different things “illegal” and “bad” are different things lecture 11, 12, 13 - drug law and policy 32