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Psychoactive drugs: modelling their harm and policies for their control

This study explores the harm of psychoactive drugs through multi-criteria decision analysis (MCDA) and proposes policies for their control. It includes the development of an MCDA model to evaluate drug harms and testing its potential. The study also examines the correlation between drug harm scores and classification systems.

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Psychoactive drugs: modelling their harm and policies for their control

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  1. Psychoactive drugs: modelling their harm and policies for their control Professor Lawrence Phillips London School of Economics & Political Science and Facilitations Ltd Operational Research Society Criminal Justice Special Interest Group 18 November 2015

  2. March 2007 Nutt, D., King, L. A., Saulsbury, W., & Blakemore, C. (2007). Development of a rational scale to assess the harm of drugs of potential misuse. [Journal]. The Lancet, 369, 1047-1053.

  3. May 2007 • Blakemore, Nutt and Phillips meet for first time • Phillips explains MCDA, multi-criteriadecision analysis, as a possibleapproach to modelling drug harms • We draft research project proposal • March & June 2009 • Medical Research Council andHome Office co-sponsor research project • Advisory Council on the Misuse of Drugs, (ACMD), David Nutt as Chair, meets to develop an MCDA model and to test its potential for evaluating drug harms

  4. July 2009

  5. October 2009

  6. January 2010 • Nutt sets up the Independent Scientific Committee on Drugs ISCD • June 2010 • ISCD builds on the ACMD work by completing the evaluation of harms; this is reported here • July 2010 • ACMD publishes the MCDA framework developed in 2009 • http://www.homeoffice.gov.uk/publications/drugs/acmd1/ACMD-multi-criteria-report

  7. Nutt, D. J., King, L. A., Phillips, L. D., & on behalf of the Independent Scientific Committee on Drugs. (2010). Drug harms in the UK: a multicriteria decision analysis. The Lancet, 376(1558-65).

  8. Decision Conference • A one-to-three-day workshop • To resolve important issues of concern • Attended by key players who represent the diversity of perspectives on the issues • Facilitated by an impartial specialist in group processes & decision analysis • Using a requisite (just-good-enough)model created on-the-spot to helpprovide structure to thinking

  9. Decision conference + MCDA • A methodology for a group of key players to appraise options on multiple criteria, and combine them into one overall appraisal • MCDA converts all input evaluations of decision outcomes into the common currency of value added

  10. MCDA provides a way to compare apples and oranges, provided there is a context that establishes added value.For the ISCD, it was negative value: physical, psychological and social harm

  11. PrOACT-URL framework

  12. Methods • Study design • 16 harm criteria developed by ACMD  • 20 drugs • ISCD members plus 2 external experts • Meeting facilitated as a decision conference

  13. The 20 drugs

  14. Scoring the drugs • The most harmful drug on each criterion was scored at 100. • All other drugs were scored relative to that drug. • E.g., a drug considered half as harmful was given a score of 50. • This creates a unique ratio scale for each criterion.

  15. 15

  16. Weighting the criteria • Some criteria represent more harm than others. • Swing-weights equate the units of harm on all the criteria: the swing in harm from the ‘no harm’ pointto the ‘most harmful’ drug. • The group considered this question to compare the levels of ‘most harm’ on the criteria: • “How big is the difference in harm and how much do you care about that difference?”

  17. ISCD UK results 2010

  18. European replication May 2013

  19. UK 2010 vs. Europe 2013 r = 0.993 UK Supports the reliability of judgements Europe

  20. Correlations of ISCD scores with... ...van Amsterdam population ...van Amsterdam individual linear r = 0.84 Reference: van Amsterdam, J. G. C., Opperhuizen, A., Koeter, M., & van den Brink, W. (2010). Ranking the harm of alcohol, tobacco and illicit drugs for the individual and the population. European Addiction Research, 16, 202-207.

  21. 211 Correlation of UK Drugs Act classification with ISCD results linear r = 0.04 without the un-classified drugs: linear r = 0.38 U

  22. Alcohol  Harm to Others Harm to Users

  23. Conclusions • High correlations among the UK, EU and Dutch studies establish the validity of the MCDA approach to modelling the harm of drugs. • The improved scoring and weighting in MCDA increases the differentiation between most and least harmful drugs. • The present UK drug classification system is not simply based on considerations of harm. • Targeting alcohol harms is a valid and necessary public health strategy.

  24. Nicotine ProductsDecision Conference DrugScience 18-19 July 2013

  25. 255 MCDA for 12 nicotine products

  26. ISCD results 17-18 July 2013

  27. Drug PolicyDecision Conference DrugScience 10 September 2015

  28. Context • DrugScience collaboration • Frisch Centre and SIRUS - the Norwegian Institute for Alcohol and Drug Research (Ole Rogeberg is the lead researcher) • Funded by the Norwegian Research Council. • Purpose • Develop an analytic framework for describing, measuring, assessing and discussing drug policy • Decision conference • 10-11 September in London • Develop MCDA model for comparative analysis of different policies

  29. Four policy options to test MCDA model • Options constructed from combinations of policy features • Production • Sale/distribution • Purchase • Purchase volume (for legal users) • Possession • Use • Options • Absolute Prohibition • State Control • Decriminalisation • Free Market

  30. The drug policy MCDA model Seven impacts Health Social Political Public Crime Economic Costs 27 Policy criteria (e.g. Health) Harm to user Harm to others More harmful substance Encourages treatment Product quality

  31. Results for alcohol State control most preferred Key impacts Health (harm to user) Public (protects children, young & vulnerable) Crime (like Free Mkt) Free market least preferred

  32. State control vs. Free market State control better Free market better

  33. State control vs. Decriminalisation State control better Decriminalisationbetter

  34. State control vs. Absolute prohibition State control better Prohibition better

  35. Next steps • Decision Conference, 20-21 January 2016 • Test on other substances • Add criteria that are substance specific (ketamine) • Delete criteria that don’t discriminate very well • Refine policy options • Test with other groups of experts • Use model to compare policies of other countries • …..

  36. A guide to further reading Harvard University Press, 1992.Shows how to articulate values and make wise decisions. CRC Press , 2014.Overview of B-R assessment across the R&D spectrum. Chapter 5 describes methods & applications, including MCDA. Dodgson, J., Spackman, M., Pearman, A., & Phillips, L. (2000). Multi-Criteria Analysis: A Manual. London: Department of the Environment, Transport and the Regions, republished 2009 by the Department for Communities and Local Government. Download free at http://eprints.lse.ac.uk/12761. MCDA is described in Chapter 6.

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