Drug Policy

Introduction

This particular discussion has the goal of comparing both the United States and Afghanistan and their policies revolving around opioids. The main objective is to see how institutions in these countries try and reduce harm related to opioid use and the impact these drugs have on communities, individuals, and social institutions. I thought it would be interesting to focus on the United States and Afghanistan because these two countries are among a list with the highest overdose death rates.

The United States Opioid Statistics

The statistics surrounding opioid use in the United States are harrowing. In 2017 alone, there were 70,237 recorded drug overdose deaths, and of those deaths, 47,600 involved an opioid (Scholl et., al 2018). Currently, an estimated 130 people every day in the United States die from an opioid-related drug overdose (Assistant Secretary of Public 2017). Something that I learned and found fascinating was the demographics to those who use these drugs. Those addicted to opioids, both legal and illegal, are increasingly young, white, and female, with 1.2 million women addicted compared to 0.9 million men in 2015 (Assistant Secretary of Public 2017).

Federal Opioid Policies in the United States

Both the federal and state governments have implemented various policies that aim to reduce the harm related to opioid use throughout the United States. With regard to federal policies, several intervention methods have been introduced to many communities across the nation. In July of 2016, President Barack Obama signed into law the Comprehensive Addiction and Recovery Act, which expands opioid addiction treatment with buprenorphine and authorizes millions of dollars in funding for opioid research and treatment (American Society of Addicted Medicine). Other policies include educational initiatives delivered in school and community settings, supporting consistent use of prescription drug monitoring programs or PDMPS, diverting individuals with substance use disorders to Drug Courts and aggressive law enforcement efforts to address doctor shopping (Volkow 2015). When thinking of educational initiatives being delivered in schools and community settings, the first thing I thought of was the DARE program. This program stands for Drug Abuse Resistance Education and every year, the entire 5th grade class had to participate in the program. Guest speakers such as police officers and individuals who have recovered from addiction came in to talk about the potential consequences that can occur when you engage in drug use.

State Opioid Policies in the United States

On top of various federal policies/intervention, state governments have also tried to take action to reduce harm associated with opioid use. In 2018, Arizona’s governor signed the Arizona Opioid Epidemic Act which provides $10 million for treatment and limits an initial opioid prescription to five days with only few exceptions. With this law and a new strategy adopted for prescription drug monitoring programs, the number of opioid prescriptions filled dropped nearly forty percent (Magtibay 2018). Having the 5th highest rate of drug overdose deaths in the United States, Ohio government officials knew they had to act. In 2011, Governor John Kasich created the The Governor’s Cabinet Opiate Action Team (GCOAT) which suggests regulations in three main categories: 1) to promote the responsible use of opioids, 20) to reduce the supply of opioids, and 3) to support overdose prevention and expand access to naloxone (Penm et. al., 2017). These are just a few state policies that exist throughout the nation that revolve around opioid use treatment and prevention. However, when looking at the numbers of deaths each year in the United States that are related to opioid use, it is clear that more needs to be done in the future to combat this epidemic.

Afghanistan Opioid Statistics

When researching statistics on the prevalence of opioid users in Afghanistan, it was incredibly difficult to find. This is largely due to various factors such as the fact that the country as been in a constant state of war and the many of population is illiterate, making it extremely hard to conduct studies and collect research. However, the United Nations reported that from an estimated 200,000 opioid and heroin addicts in 2005, the number rose to nearly a million in 2009 and reached between 1.9 million to 2.4 million in 2015 (Hadid and Ghani 2019). Despite not being able to find many statistics, there were many sources that discussed opioid production in the country. From what I read, Afghanistan has been the world’s leading illicit opium producer since 2001 (UNODC 2010). In fact, the country’s opium poppy harvest produces more than 95% of the European opioid supply, with more land used for opium than is used for coca cultivation (Bowman, 2016). (wiki references 1 and 3)

Opioid Policies in Afghanistan

When researching policies regarding opioids in Afghanistan, I found some striking information that is somewhat disturbing when looking at the statistics that were stated above. In the academic journal article “Drug use and harm reduction in Afghanistan,” the authors discuss current opium laws that currently exist within the country. In 2002, Hamid Karzai, at the time the appointed interim leader of the Transitional Islamic State of Afghanistan, issued decrees banning cultivation, production, drug abuse and trafficking of narcotic drugs. The use of opioid products is illegal in Afghanistan with conviction resulting in a three-month prison sentence (Todd, Safi & Strathdee 2005). My first question after learning about these opioid laws is how could these farmers be getting away with cultivating crops when it is illegal in the country? Well, according to Afghan farmers, corrupt officials may be guilty of undermining the government’s enforcement efforts. Afghan farmers claim that government officials take bribes for turning a blind eye to the drug trade while punishing poor opium growers (Smith 2008). This shows how the government is working. Yes, they are trying to use their positions to help stop the spread of opioid use, but corruption is allowing them to turn their heads. Not only does this show the lack of structure within their government, but how corruption can aid in the spread of this epidemic.

Harm Reduction

With all of these being said, it is clear that more needs to be done to combat the opioid epidemic that is plaguing the world and this is where harm reduction comes in. Finding much such in Europe, harm reduction is an approach that is used that aims to reduce negative health, social and legal impacts associated with drug use, policies abd laws (Harm Reduction International 2020). The whole foundation of this policy is recognition that many people are unable or unwilling to stop using illicit drugs. Because of this, it aims to keep people alive and encourage positive change in their lives, reduce the harms of drug laws and policy and offer alternatives to approaches that seek to prevent or end drug use (Harm Reduction International 2020). Although met with opposition from individuals, this treatment has been proven effective and I feel as though it wouldn’t hurt to implement in both of the countries that have been discussed.

Works Citied

American Society of Addiction Medicine. (n.d.). Retrieved April 21, 2020, from https://www.asam.org/advocacy/issues/opioids/summary-of-the-comprehensive-addiction-and-recovery-act

Bowman, T. (2016, July 6). Afghan Governor Wants Government To Control Poppy Crop. Retrieved April 23, 2020, from https://www.npr.org/2016/07/06/484894669/afghan-governor-wants-government-to-control-poppy-crop

Hadid, D., & Ghani, K. (2019, October 29). Women And Children Are The Emerging Face Of Drug Addiction In Afghanistan. Retrieved April 23, 2020, from https://www.npr.org/sections/goatsandsoda/2019/10/29/771374889/women-and-children-are-the-emerging-face-of-drug-addiction-in-afghanistan

Magtibay, J., & Cronkite News. (2018, January 26). Ducey signs plan to confront Arizona opioid crisis into law: Cronkite News. Retrieved April 23, 2020, from https://cronkitenews.azpbs.org/2018/01/26/ducey-signs-sweeping-plan-confront-arizona-opioid-crisis-law/

Penm, J., Mackinnon, N. J., Boone, J. M., Ciaccia, A., Mcnamee, C., & Winstanley, E. L. (2017). Strategies and policies to address the opioid epidemic: A case study of Ohio. Journal of the American Pharmacists Association, 57(2). doi: 10.1016/j.japh.2017.01.001

Public Affairs. (2018, January). What is the U.S. Opioid Epidemic? Retrieved April 22, 2020, from https://www.hhs.gov/opioids/about-the-epidemic/index.html

Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Baldwin, G. (2019, January 3). Drug and Opioid-Involved Overdose Deaths – United States, 2013–2017. Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm?s_cid=mm675152e1_w

Smith, G. (2008, March 22). Portrait of the enemy . Retrieved April 23, 2020, from http://www.militaryphotos.net/forums/showthread.php?t=131245

Todd, C. S., Safi, N., & Strathdee, S. A. (2005, September 7). Drug use and harm reduction in Afghanistan. Retrieved April 23, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1262742/

Volkow, N. D. (2015, May 1). What is the Federal Government Doing to Combat the Opioid Abuse Epidemic? Retrieved April 22, 2020, from https://archives.drugabuse.gov/testimonies/2015/what-federal-government-doing-to-combat-opioid-abuse-epidemic

What is harm reduction? (n.d.). Retrieved April 23, 2020, from https://www.hri.global/what-is-harm-reduction