Structural and functional changes in an Australian high-level drug trafficking network after exposure to supply changes.

BACKGROUND: Illicit drug markets and associated supply changes (including changes in availability and purity) have been studied for many years but with limited attention to how drug trafficking networks adapt to such changes and the consequences thereof: the aim of this study. METHODS: A longitudinal social network analysis was applied to a high-level drug trafficking network which supplied methamphetamine and other drugs over 15 years in Melbourne, Australia (1993-2007). Data were extracted from judges' sentencing comments, a biography, and mainstream media. Five time periods were devised, and supply changes (distinguishing between law-enforcement-caused and non-law-enforcement-caused) were coded in each period. Then, the associated structural and functional changes in the network were analysed within and between periods. RESULTS: Thirty-two supply changes were identified, of which 59% were law-enforcement-caused and 41% not. Temporally associated structural and functional changes included a shift from mostly international trafficking to mostly domestic manufacture (and vice versa), recruiting corrupted public officials, decentralisation, as well as changes in network density, roles, and size. Despite 32 supply changes, the network continued to sell large quantities of drugs for at least 15 years. CONCLUSION: This research highlighted the complex adaptive nature of the illicit drug trade and its resilience to market change. Supply changes were associated with a variety of structural and functional changes in the network, some of which resulted in negative consequences such as corruption or the increased domestic manufacture of methamphetamine.

The price and mark up of pharmaceutical drugs supplied on the black market.

BACKGROUND: Research examining illicit drug markets has shown that price affects consumption and mark ups are extremely high. However, the economics of black market pharmaceutical supply remains unknown, despite increasing harms due to pharmaceuticals. METHODS: Semi-structured, telephone interviews were conducted in Australia with 51 people involved in supplying pharmaceuticals in the previous six months. Interviews were audio-recorded, transcribed and quantitative information on costs, sale price, quantity and frequency of supply were coded and used to calculate the mark up ratio for each drug transaction 'cycle', accounting for distribution via selling, gifting and trading. Mixed effects gamma regressions were used to identify predictors of price and mark up, clustering by participant. RESULTS: There were 29 drugs supplied over 111 cycles, including hypnotic-sedatives (38%), pharmaceutical opioids (32%), stimulants (18%) and others (12%). Sedatives were sold at lower prices than opioids and there was a negative relationship between unit price and transaction size, consistent with a discount effect. For every dollar spent acquiring the drugs, the supplier earned a median of $3.19. Cycles involving the distribution of drugs sourced via intermediaries (e.g. friends/family) had lower mark up than drugs sourced directly from the medical system. CONCLUSION: To our knowledge, this is one of few studies to analyse economic aspects of the pharmaceutical black market from a supply perspective. There were a small number of cycles that realised large profits that may warrant different types of policy responses, however for most suppliers in our sample gross revenue and gross profit was modest.

What factors contributed to the misconduct of health practitioners? An analysis of Australian cases involving the diversion and supply of pharmaceutical drugs for non-medical use between 2010 and 2016.

INTRODUCTION AND AIMS: Increasing quantities of pharmaceutical drugs are used non-medically around the world, including in Australia, resulting in rising harms. This study examines the role of health practitioners (HP) in diversion and the circumstances surrounding their misconduct in Australia. DESIGN AND METHODS: Tribunal decisions were obtained from the Australasian Legal Information Institute for 117 complaints against HPs for inappropriately prescribing/supplying or misappropriating drugs, representing a comprehensive search of cases from 2010 to 2016. Bivariate and multivariate logistic regressions were used to examine patterns of misconduct by demographics, drug type, scale and contributors. RESULTS: Cases involving inappropriate prescribing/supply (73%) had greater odds of involving doctors (adjusted odds ratio [AOR] 48.18, 95% confidence interval [CI] 3.63-640.11) and pharmacists (AOR 85.59, 95% CI 5.08-1443.05) and HPs over 50 years (AOR 16.54, 95% CI 2.80-97.60) and lower odds of being attributed to individual circumstances (AOR 0.06, 95% CI 0.01-0.57). Cases involving misappropriation (31%) had greater odds of involving nurses (AOR 19.86, 95% CI 2.50-157.93), HPs under 40 years (AOR 5.08, 95% CI 1.24-20.90) and being attributed to individual circumstances (AOR 7.96, 95% CI 1.52-41.75). Subgroup analyses indicated that doctors were more likely to inappropriately prescribe pharmaceutical opioids, sedatives and Schedule 8 drugs, and their misconduct was attributed to lacking the skills and temperament to manage complex patient groups, while pharmacists were more often involved in pseudoephedrine supply for financial reasons. DISCUSSION AND CONCLUSIONS: Strategies to reduce diversion should be multifaceted and may include better supporting HPs to manage complex patient groups and removing barriers to substance use treatment for HPs.

Drug sourcing and motivations among a sample of people involved in the supply of pharmaceutical drugs in Australia.

BACKGROUND: The non-medical use (NMU) of pharmaceuticals is increasing internationally, along with mortality. Previous research indicates that end-users access pharmaceuticals through social networks, however little is known about supplier sources particularly outside the US. This study examined sourcing and motivations among a sample of people involved in pharmaceutical diversion and supply in Australia. METHODS: Semi-structured, telephone interviews were conducted with 51 people involved in supplying pharmaceuticals in the previous six months. Multi-stage recruitment involved the distribution of flyers to participants of two Australian drug-monitoring programs: the Ecstasy and related Drugs Reporting System (capturing regular psycho-stimulant users) and the Illicit Drug Reporting System (capturing people who regularly inject drugs), followed by a screening of interested participants. Interviews were audio-recorded, transcribed and analysed using a mixed methods approach. First, correlates of drug sourcing and motivations were examined including demographics, frequency and quantity of supply. Second, thematic analysis of the qualitative data was undertaken on strategies for obtaining the drugs and motivating factors. RESULTS: Drug supplies were sourced from a variety of medical and non-medical sources, primarily legitimately obtained prescriptions (47%), friends or family (18%) and dealers (14%). Suppliers using medical sources were more likely to be unemployed/retired and reported supplying for therapeutic purposes, while suppliers using non-medical sources were more likely to be employed/students, earned higher incomes and reported supplying for recreational purposes. Those who sourced via doctor shopping (IRR = 47.5) and friends and family (IRR = 10.1) distributed higher quantities, while those who sourced legitimately obtained prescriptions (IRR = 0.1) and from illicit drug dealers (IRR = 0.0) distributed lower quantities. Similar proportions supplied for financial (65%) and altruistic (61%) reasons, however the latter supplied lower quantities (IRR = 0.1). CONCLUSION: This study offers novel insight into the diversion of pharmaceuticals from the supplier perspective. A nuanced policy approach is required to address varied supply practices by source and motive.

Using the Advocacy Coalition Framework and Multiple Streams policy theories to examine the role of evidence, research and other types of knowledge in drug policy.

BACKGROUND AND AIMS: The prevailing 'evidence-based policy' paradigm emphasizes a technical-rational relationship between alcohol and drug research evidence and subsequent policy action. However, policy process theories do not start with this premise, and hence provide an opportunity to consider anew the ways in which evidence, research and other types of knowledge impact upon policy. This paper presents a case study, the police deployment of drug detection dogs, to highlight how two prominent policy theories [the Advocacy Coalition Framework (ACF) and the Multiple Streams (MS) approach] explicate the relationship between evidence and policy. METHODS: The two theories were interrogated with reference to their descriptions and framings of evidence, research and other types of knowledge. The case study methodology was employed to extract data concerned with evidence and other types of knowledge from a previous detailed historical account and analysis of drug detection dogs in one Australian state (New South Wales). Different types of knowledge employed across the case study were identified and coded, and then analysed with reference to each theory. A detailed analysis of one key 'evidence event' within the case study was also undertaken. RESULTS: Five types of knowledge were apparent in the case study: quantitative program data; practitioner knowledge; legal knowledge; academic research; and lay knowledge. The ACF highlights how these various types of knowledge are only influential inasmuch as they provide the opportunity to alter the beliefs of decision-makers. The MS highlights how multiple types of knowledge may or may not form part of the strategy of policy entrepreneurs to forge the confluence of problems, solutions and politics. CONCLUSIONS: Neither the Advocacy Coalition Framework nor the Multiple Streams approach presents an uncomplicated linear relationship between evidence and policy action, nor do they preference any one type of knowledge. The implications for research and practice include the contestation of evidence through beliefs (Advocacy Coalition Framework), the importance of venues for debate (Advocacy Coalition Framework), the way in which data and indicators are transformed into problem specification (Multiple Streams) and the importance of the policy ('alternatives') stream (Multiple Streams).

Alternate policing strategies: Cost-effectiveness of cautioning for cannabis offences.

BACKGROUND: There is increasing international interest in alternatives to the use of arrest for minor drug offences. While Australia has been at the forefront in the provision of diversionary programs for minor drug offences there remain key gaps in knowledge about the cost-effectiveness of different approaches. Here we set out to assess the cost-effectiveness of cannabis cautioning schemes whereby police refer minor cannabis use and possession offenders to education and/or treatment instead of arresting and charging them. METHODS: This study used a purpose built nation-wide online survey to evaluate cost-effectiveness of cannabis cautioning versus a traditional response for minor cannabis offences (arrest). The survey was completed by a self-selected group of detected cannabis offenders. The outcome measure was self-reported cannabis use days in the previous month post-intervention. Cost data included costs of policing, court, penalties, assessment, treatment and educational sessions. Propensity score weighting and doubly robust regression analyses were utilised to address differences between the groups. RESULTS: There were 195 respondents who reported being arrested for a cannabis possession/use offence and 355 who reported receiving a formal cannabis caution. After matching on a range of characteristics (age, prior criminal conviction, cannabis consumption, employment status, self-reported criminal activity prior to detection, severity of dependence) there was no statistically significant difference in cannabis use pre- and post-police intervention between the two groups(N=544). After matching and bootstrapping the costs there was a significant difference in costs; the mean cost for the charge group (net of fines) was $733 (SD 151) and $388 (SD 111) for the caution group. CONCLUSION: These results indicate that after matching on a range of relevant characteristics there were no differences across groups in the change in self-reported cannabis use days, but cannabis cautioning was less costly than charge/arrest. These results add to the evidence about the efficacy and desirability of alternatives to arrest both within Australia and abroad.

The deterrent effects of Australian street-level drug law enforcement on illicit drug offending at outdoor music festivals.

BACKGROUND: Australian and international street-level drug law enforcement deploy many strategies in efforts to prevent or deter illicit drug offending. Limited evidence of deterrence exists. This study assessed the likely impacts of four Australian policing strategies on the incidence and nature of drug use and supply at a common policing target: outdoor music festivals. METHODS: A purpose-built national online survey (the Drug Policing Survey) was constructed using five hypothetical experimental vignettes that took into account four policing strategies (High Visibility Policing, Riot Policing, Collaborative Policing, and policing with Drug Detection Dogs) and a counter-factual (no police presence). The survey was administered in late 2015 to 2115 people who regularly attend festivals. Participants were block-randomised to receive two vignettes and asked under each whether they would use, possess, purchase, give or sell illicit drugs. RESULTS: Compared to 'no police presence', any police presence led to a 4.6% point reduction in engagement in overall illicit drug offending: reducing in particular willingness to possess or carry drugs into a festival. However, it had minimal or counterproductive impacts on purchasing and supply. For example, given police presence, purchasing of drugs increased significantly within festival grounds. Offending impacts varied between the four policing strategies: Drug Detection Dogs most reduced drug possession but High Visibility Policing most reduced overall drug offending including supply. Multivariate logistic regression showed police presence was not the most significant predictor of offending decisions at festivals. CONCLUSIONCONCLUSION: The findings suggest that street-level policing may deter some forms of drug offending at music festivals, but that most impacts will be small. Moreover, it may encourage some perverse impacts such as drug consumers opting to buy drugs within festival grounds rather than carry in their own. We use our findings to highlight trade-offs between the goals of public health promotion and crime control in street-level enforcement.

The Going Out In Sydney App: Evaluating the Utility of a Smartphone App for Monitoring Real-World Illicit Drug Use and Police Encounters Among Festival and Club Goers.

Gaining accurate information on illicit drug use and policing in real-world settings is a challenge. This study examines the utility of a smartphone app ('Going Out In Sydney') to prospectively follow up illicit drug use and policing encounters at music festivals and licensed entertainment precincts in Sydney, Australia. In all, 38 regular festival and licensed entertainment venue attendees used the app to log nights out over a 3-month period, including (1) where they went (eg, festival, nightclub), (2) the prevalence of illicit drug use, and (3) the incidence and nature of police encounters. A survey and interview were then conducted about the utility of the app. The app enabled rich data collection (n = 353 entries) about illicit drug use and policing at both target settings. Follow-up surveys indicated that most participants were extremely satisfied with the ease of use of the app and privacy afforded, and compared with other data collection modes, such as paper-based logs and online surveys, rated the app the most desirable method of data collection. This suggests smartphone apps may be a viable option for future studies on illicit drug use and policing of drugs.

Poly-drug trafficking: Estimating the scale, trends and harms at the Australian border.

BACKGROUND: International drug law enforcement agencies have identified an apparent rise in high level drug traffickers choosing to deal in multiple different drugs. It is hypothesised that this may be a "deliberate modus operandi" and that the formation of "portfolios of trades" may make such traffickers more profitable, harmful and resilient to changes in drug supply and policing. In this paper we provide the first exploration of the extent, nature and harms of poly-drug trafficking at Australian borders. METHODS: Two different methods were used. First, we used Australian Federal Police (AFP) data on all commercial level seizures at the Australian border from 1999 to 2012 to identify the proportion of seizures that were poly-drug and trends over time. Second, we used unit-record data on a sub-set of 20 drug trafficking cases and linked-cases (defined as the original drug trafficking case and all other criminal cases that were connected via common offenders and/or suspects) to compare the profiles of poly-drug and mono-drug traffickers, including: the total weight and type of drug seized, the value of assets seized, and the level of involvement in other crime (such as money laundering and corruption). RESULTS: Between 5% and 35% of commercial importations at the Australian border involved poly-drug trafficking. Poly-drug trafficking occurred in almost every year of analysis (1999-2012), but it increased only slightly over time. Compared to mono-drug traffickers poly-drug traffickers were characterised by: larger quantities of drugs seized, larger networks, longer criminal histories and more involvement in other types of serious crime. CONCLUSION: Some fears about poly-drug traffickers may have been overstated particularly about the inherent escalation of this form of trafficking. Nevertheless, this suggests poly-drug traffickers are likely to pose added risks to governments and law enforcement than mono-drug traffickers. They may necessitate different types of policy responses.

Legislating thresholds for drug trafficking: a policy development case study from New South Wales, Australia.

BACKGROUND: Legal thresholds are used in many parts of the world to define the quantity of illicit drugs over which possession is deemed "trafficking" as opposed to "possession for personal use". There is limited knowledge about why or how such laws were developed. In this study we analyse the policy processes underpinning the introduction and expansion of the drug trafficking legal threshold system in New South Wales (NSW), Australia. METHODS: A critical legal and historical analysis was undertaken sourcing data from legislation, Parliamentary Hansard debates, government inquiries, police reports and research. A timeline of policy developments was constructed from 1970 until 2013 outlining key steps including threshold introduction (1970), expansion (1985), and wholesale revision (1988). We then critically analysed the drivers of each step and the roles played by formal policy actors, public opinion, research/data and the drug trafficking problem. RESULTS: We find evidence that while justified as a necessary tool for effective law enforcement of drug trafficking, their introduction largely preceded overt police calls for reform or actual increases in drug trafficking. Moreover, while the expansion from one to four thresholds had the intent of differentiating small from large scale traffickers, the quantities employed were based on government assumptions which led to "manifest problems" and the revision in 1988 of over 100 different quantities. Despite the revisions, there has remained no further formal review and new quantities for "legal highs" continue to be added based on assumption and an uncertain evidence-base. CONCLUSION: The development of legal thresholds for drug trafficking in NSW has been arbitrary and messy. That the arbitrariness persists from 1970 until the present day makes it hard to conclude the thresholds have been well designed. Our narrative provides a platform for future policy reform.

Drug policy coordination: identifying and assessing dimensions of coordination.

BACKGROUND: Coordination has been recognised as a critical ingredient for successful drug policy governance. Yet what coordination means and how we assess the processes, outputs and outcomes of drug policy coordination is seldom defined. In this article we explore the utility of internationally recognised principles of good governance for examining aspects of drug policy coordination. We describe the development of an assessment tool, and pilot it in one context that has been both praised and criticised for its approach to drug policy coordination: Australia. METHODS: Eight good governance principles of the United Nations Economic and Social Commission for Asia and the Pacific (which specify the need for policy processes to be participatory, responsive, equitable etc.), were adapted to drug policy coordination. A pilot survey was created to enable assessment of their perceived importance and perceived application and administered to 36 stakeholders from peak Australian advisory bodies. RESULTS: The instrument was shown to have high internal reliability and high face validity. Application to the Australian context suggested that the eight principles differed in importance, and that the most important principles were 'accountability' and 'participation'. Application also revealed perceived strengths and weaknesses in coordination, most notably, an apparent need to increase 'accountability' for stakeholder actions. CONCLUSION: The instrument requires further assessment of reliability and validity. Yet, at least within the Australian context, it starts to unpack normative statements about coordination to show perceptions of what coordination is, areas where improvement may be warranted and the degree of contestation amongst different players. Further application of the good governance lens within this and other contexts will progress the assessment of a fundamental yet neglected policy process and foster a more nuanced consideration of the possibilities for coordination in the drug policy "soup".

A resounding success or a disastrous failure: re-examining the interpretation of evidence on the Portuguese decriminalisation of illicit drugs.

In this Harm Reduction Digest two observers and scholars of the 2001 Portuguese drug policy reform consider divergent accounts of the reform which viewed it as a 'resounding success' or a 'disastrous failure'. Acknowledging from their own experience the inherent difficulties in studying drug law reform, Caitlin Hughes and Alex Stevens take the central competing claims of the protagonists and consider them against the available data. They remind us of the way all sides of the drug policy debates call upon and alternatively use or misuse 'evidence' to feed into discussions of the worth, efficacy and desirability of different illicit drug policies. In doing so they provide pause for thought for those of us who operate as drug policy researchers and drug policy advocates.

How do Australian news media depict illicit drug issues? An analysis of print media reporting across and between illicit drugs, 2003-2008.

BACKGROUND: Media reporting on illicit issues has been frequently criticised for being sensationalised, biased and narrow. Yet, there have been few broad and systematic analyses of the nature of reporting. Using a large sample and methods commonly adopted in media communications analysis this paper sought to identify the dominant media portrayals used to denote illicit drugs in Australian newspapers and to compare and contrast portrayals across drug types. METHODS: A retrospective content analysis of Australian print media was carried out over the period 2003-2008 from a sample comprised of 11 newspapers. Articles that contained one or more mention of five different drugs (or derivatives) were identified: cannabis, amphetamines, ecstasy, cocaine and heroin. A sub-sample of 4397 articles was selected for media content analysis (with 2045 selected for full content analysis) and a large number of text elements coded for each. Key elements included topic, explicit or implicit messages about the consequences of drugs/use and three value dimensions: overall tone, whether drugs were portrayed as a crisis issue and moral evaluations of drugs/use. RESULTS: The dominant media portrayals depicted law enforcement or criminal justice action (55%), but most articles were reported in a neutral manner, in the absence of crisis framings. Portrayals differed between drugs, with some containing more narrow frames and more explicit moral evaluations than others. For example, heroin was disproportionately framed as a drug that will lead to legal problems. In contrast, ecstasy and cocaine were much more likely to emphasise health and social problems. CONCLUSION: Media reporting on illicit drugs is heavily distorted towards crime and deviance framings, but may be less overtly sensationalised, biased and narrowly framed than previously suggested. This is not to suggest there is no sensationalism or imbalance, but this appears more associated with particular drug types and episodes of heightened public concern.

Capitalising upon political opportunities to reform drug policy: a case study into the development of the Australian "Tough on Drugs-Illicit Drug Diversion Initiative".

BACKGROUND: The introduction of political "war on drug" strategies and Prime Ministerial advisory groups increase opportunities for drug policy reform. Yet the strengths and limitations of capitalising upon political opportunities remain unclear. This paper provides a unique insight into the development of an Australian reform, the "Tough on Drugs-Illicit Drug Diversion Initiative." This reform was one of the major policies to emerge out of the Federal Coalition "Tough on Drugs" strategy. In spite of the rhetoric the Illicit Drug Diversion Initiative (IDDI) has diverted minor drug users away from the traditional criminal justice system. METHODS: This paper draws upon interviews with 16 expert policy makers involved in the advocacy and negotiations leading up to the adoption of the IDDI to examine what drove the reform and how and why a pragmatic reform emerged. RESULTS: The IDDI culminated from the presence of five main drivers: a crisis in relation to heroin and crime, antagonism towards the government, a weak but growing evidence-base on the merits of drug diversion, a shift in law enforcement attitudes and persuasive advocacy by a group of non-government experts. This paper contends that the Prime Minister's new "Tough on Drugs" strategy and expanded governance arrangements created new space for policy actors to intervene in the policy formulation process and to convert the governments proposed "zero tolerance" response into a more humane and potentially effective response. CONCLUSION: This paper concludes that contrary to popular opinion political venues and politicisation may offer valuable opportunities for drug policy reform. The challenge for researchers and policy advocates is to see how they can best utilise political venues to obtain pragmatic reform.