Drug Policy Alliance

Refining the Food and Drug Administration's Public Communications, Research Priorities, and Policy Evaluation Ethan Nadelmann JD, PhD Affiliation Ethan Nadelmann is the founder and former executive director (2000–2017) of the Drug Policy Alliance, New York, NY.CopyRightCorrespondence should be sent to Ethan Nadelmann, 117 W 74th St, #1C, New York, NY 10023 (e-mail: ethan@nadelmann.net). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints" link. https://doi.org/10.2105/AJPH.2020.305673 Accepted: March 16, 2020 Published Online: May 06, 2020

Though few clinicians are trained on how to influence policy, the policy environment has an enormous impact on patient health. Government policies – whether federal, state, or municipal – shape everything from the delivery of healthcare to the patient’s physical and social environment. From insurance reimbursement to food quality and access to clean air and water, health is affected daily by the decisions of policymakers. Another policy arena that profoundly impacts health – one that should be of great concern to medical providers – is drug policy. Historically, battles over drug policy have been framed by two, often competing, ideologies: one which sees drug use a moral failing and a crime that should be punished and another which sees it as an illness or disease requiring compassion and treatment. The question of who “owns” the problem of drug use – law enforcement or medicine – has been debated for decades. More recently, harm reduction – an approach that seeks to minimize the harms associated with drug use and our drug policies – has gained some traction. Because they are well respected, knowledgeable, highly credentialed, and can speak directly to the impact of policies on their patients, the voices of physicians as drug policy advocates are both powerful and desperately needed. Unfortunately, few physicians are equipped or have the time to engage in policy advocacy. Can physicians become effective policy advocates? And if so, how?

Harm reduction policies and attitudes in the United States have advanced substantially in recent years but still lag behind more advanced jurisdictions in Europe and elsewhere. The Obama administration, particularly in its last years, embraced some harm reduction policies that had been rejected by previous administrations but shied away from more cutting edge interventions like supervised consumption sites and heroin-assisted treatment. The Trump administration will undermine some of the progress made to date but significant state and local control over drug policies in the US, as well as growing Republican support for pragmatic drug policies, motivated in part by the opioid crisis, ensures continuing progress for harm reduction.

AffiliationsHelena Hansen is with the departments of Anthropology and Psychiatry, New York University, New York, NY, and the Nathan Kline Institute for Psychiatric Research, Orangeburg, NY. Julie Netherland is with the Office of Academic Engagement, Drug Policy Alliance, New York.

Citation (2012), "Advances in Medical Sociology", Netherland, J. (Ed.) Critical Perspectives on Addiction (Advances in Medical Sociology, Vol. 14), Emerald Group Publishing Limited, Bingley, p. iii. https://doi.org/10.1108/S1057-6290(2012)0000014017 Publisher: Emerald Group Publishing Limited Copyright © 2012, Emerald Group Publishing Limited Book Chapters Critical Perspectives on Addiction Advances in Medical Sociology Advances in Medical Sociology Copyright Page List of Contributors Acknowledgments Introduction: Sociology and the Shifting Landscape of Addiction Medicalization and Biomedicalization: Does the Diseasing of Addiction Fit the Frame? De-Medicalizing Addiction: Toward Biocultural Understandings Pharmaceutical Incursion on Cigarette Smoking at the Birth of the Brain Disease Model of Addiction Two Tiers of Biomedicalization: Methadone, Buprenorphine, and the Racial Politics of Addiction Treatment Intervention: Reality TV, Whiteness, and Narratives of Addiction Drawing the Line at Drinking For Two: Governmentality, Biopolitics, and Risk in State Legislation on Fetal Alcohol Spectrum Disorders Into the Light: Evangelical Rehab and the Seduction of New Life Making Addicts of the Fat: Obesity, Psychiatry and the ‘Fatties Anonymous’ Model of Self-Help Weight Loss in the Post-War United States “I Just Couldn’t Keep it in Control Anymore:” Weight Loss Surgery, Food Addiction, and Anti-Fat Stigma Video Game Addiction: User Perspectives

Résumé Les États-Unis présentent un ensemble de paradoxes dans (1) leur conception de l’addiction et son étiologie, (2) les tendances dans le traitement de l’addiction, (3) la prévalence probable de l’addiction au siècle prochain. Au moment où la science américaine réduit l’addiction aux impulsions cérébrales résultant de la consommation de drogue, une tendance tout aussi forte consiste pour les Américains à voir les investissements compulsifs de tous types (par exemple, dans les jeux vidéo) comme potentiellement addictifs. Bien que le modèle neurobiologique de l’addiction promette une pharmacothérapie et d’autres traitements médicaux, les pratiques de traitement en plus fortes augmentations (outre l’approche en douze étapes, qui n’est elle-même pas médicale) sont les approches environnementales, cognitives et comportementales. Bien que l’espoir de remèdes médicaux et de vaccinations prédomine, quasiment personne aux États-Unis ne croit que l’addiction sera vaincue, ou même réduite.

MDMA (3,4-methylenedioxymethamphetamine) was first used as a legal adjunct to psychotherapy in the 1970s. By the early 1980s, “Ecstasy” had become a tiny part of the recreational American drug scene, and was ultimately criminalized in 1986. For a decade use continued, but remained quiet. By the end of the 1990s, increased supply, demand, seizures of pills, arrests of distributors associated with organized crime, adverse reactions, and government repons of problematic brain changes created an Ecstasy media frenzy. The government's reaction led to a public education campaign and proposals for exponential penalties for production, distribution and use of MDMA. This article looks at the history, epidemiology, and politics of Ecstasy, the media's response, and the ways in which media and government reaction will compromise harm reduction and safety.