Professor Larry Phillips London School of Economics and Facilitations Limited OR58 Annual Conference 7 September 2016 Context Collaboration DrugScience Frisch Centre DrugScience Professor David Nutt is founder and Chair ID: 809143
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Slide1
An MCDA framework for evaluating and appraising government policy for psychoactive drugs
Professor Larry Phillips London School of Economics and Facilitations Limited
OR58 Annual
Conference
7 September 2016
Slide2Context
Collaboration: DrugScience + Frisch CentreDrugScience (Professor David Nutt is founder and Chair)Ragnar Frisch Centre for Economic Research (Ole Rogeberg is the lead researcher)
Funded by the Norwegian Research Council.PurposeDevelop an analytic framework for describing, measuring, assessing and discussing drug policy Decision conferences
10-11 September 2015 and 20-21 January 201618 participants, various backgroundsPhillips & Nutt facilitatingThree models to test framework: alcohol, cannabis and heroin
2
Slide3Policy (Strategy) Table
3
Production
Sale/distributionPurchase
Purchase volume (for legal users)
Possession
Use
Illegal (strong sanctions)
Illegal (strong sanctions)
Illegal (strong sanctions)
None - illegalIllegal (strong sanctions)Illegal (strong sanctions)Illegal (weak sanctions - de jure or de facto decriminalized)Illegal (weak sanctions - de jure or de facto decriminalized)Illegal (weak sanctions - de jure or de facto decriminalized)Per person quotasIllegal (weak sanctions - de jure or de facto decriminalized)Illegal (weak sanctions - de jure or de facto decriminalized)Legal with restrictions for individuals (e.g, legal to brew wine, not spirits; grow cannabis, not more than 5 plants, grow "magic mush-rooms" in limited volume)Only gifting between individuals (no money involved)Only adult licensed users (e.g., tested for knowledge of harms and principles of safe use)Per purchase quotasLimited quantity per person (e.g., for personal use)Only in specific, certified venues (e.g. pubs or on-site consumption with monitoring such as user rooms or use retreats)Legal with restrictions for groups (e.g., cannabis clubs where users combine to finance growing for members)State-run retail stores (e.g., state alcohol monopolies)Only adults (age restrictions)Self set quotas changeable with lagNo restrictionsOnly in private homesState controlled State-licensed retail stores or pharmaciesNo restrictionsNo restrictionsOnly in specific licensed venues or private homesNo restrictions for companiesOnly mail-orderAnywhere except certain public spaces (e.g, indoor smoking bans)No restrictions for companies or individualsNo restrictions - any retail storeNo restrictions
34,300 combinations
Slide4Policy (Strategy) Table
4
Production
Sale/distributionPurchase
Purchase volume (for legal users)
Possession
Use
Illegal (strong sanctions)
Illegal (strong sanctions)
Illegal (strong sanctions)
None - illegalIllegal (strong sanctions)Illegal (strong sanctions)Illegal (weak sanctions - de jure or de facto decriminalized)Illegal (weak sanctions - de jure or de facto decriminalized)Illegal (weak sanctions - de jure or de facto decriminalized)Per person quotasIllegal (weak sanctions - de jure or de facto decriminalized)Illegal (weak sanctions - de jure or de facto decriminalized)Legal with restrictions for individuals (e.g, legal to brew wine, not spirits; grow cannabis, not more than 5 plants, grow "magic mush-rooms" in limited volume)Only gifting between individuals (no money involved)Only adult licensed users (e.g., tested for knowledge of harms and principles of safe use)Per purchase quotasLimited quantity per person (e.g., for personal use)Only in specific, certified venues (e.g. pubs or on-site consumption with monitoring such as user rooms or use retreats)Legal with restrictions for groups (e.g., cannabis clubs where users combine to finance growing for members)State-run retail stores (e.g., state alcohol monopolies)Only adults (age restrictions)Self set quotas changeable with lagNo restrictionsOnly in private homesState controlled State-licensed retail stores or pharmaciesNo restrictionsNo restrictionsOnly in specific licensed venues or private homesNo restrictions for companiesOnly mail-orderAnywhere except certain public spaces (e.g, indoor smoking bans)No restrictions for companies or individualsNo restrictions - any retail store
No restrictions
Slide5Policy options
Production
Sale/distribution
Purchase
Purchase volume (for legal users)
Possession
Use
Illegal (strong sanctions)
Illegal (strong sanctions)
Illegal (strong sanctions)
None - illegalIllegal (strong sanctions)Illegal (strong sanctions)Illegal (weak sanctions - de jure or de facto decriminalized)Illegal (weak sanctions - de jure or de facto decriminalized)Illegal (weak sanctions - de jure or de facto decriminalized)Per person quotas
Illegal (weak sanctions - de jure or de facto decriminalized)
Illegal (weak sanctions - de jure or de facto decriminalized)
State controlled
State-licensed retail stores or pharmacies
Only adults (age restrictions)
Per purchase quotasLimited quantity per person (e.g., for personal use)Only in specific licensed venues or private homesNo restrictions for companies or individualsNo restrictions - any retail storeNo restrictionsNo restrictionsNo restrictionsNo restrictions
Absolute Prohibition State Control Decriminalisation Free Market
5
Slide67 impacts
Health
Social
Political
Public
Crime
Economic
Costs
27 e
valuation criteria (with clear definitions)
Drug Harm Policy Value Tree6
Slide77
Cluster
Criterion
DefinitionHealth
Harm to user
Prevents medical harms to a user resulting from consumption of intended substance; includes blood-borne viruses (BBV)
Harm to others
Prevents health harms (including BBVs) to third parties due to either indirect exposure (e.g., second hand smoking) and behavioural responses to consumption (e.g., injury due to alcohol induced violence)
More harmful substances
Decreases consumption of more harmful substances or increases consumption of less harmful substances (e.g., cannabis prohibition leading to synthetic cannabinoids)
Encourages treatmentEncourages treatment of substance-use problemsProduct qualityAssures the quality of products due to mislabelled or counterfeit/adulterated product, unknown dose/puritySocial Education Improves education about drugsMedical usePolicy does not impede medical useResearchPolicy does not impede researchHuman rightsPolicy does not interfere with human rights as distinct from the individual’s right to use.Individual libertyPolicy does not interfere with individual liberty (individual’s right to use)Community cohesion Policy does not undermine social cohesion in communitiesFamily cohesionPolicy does not undermine family cohesionPolitical International development & securityPolicy does not undermine international development and securityIndustry influence on governmentsImpedes drug industry influence on governments (less lobbying is preferable)Public Promotes well-beingPromotes social and personal well-beingChildren and youngProtects children and young peopleProtects vulnerableProtects vulnerable groups other than children and young peopleReligious/cultural value
Respects religious or cultural values
Crime
Criminalises users
Does not criminalise users
Reduces acquisitive crime
Reduces acquisitive crime to finance useReduces violent crimeReduces violent crime due to illegal marketsPrevents corporate crimePrevents corporate crime, e.g. money-laundering, tax evasionPrevents criminal industryExtent to which the policy discourages illegal market activityEconomic Generates state revenueGenerates state revenueReduces economic costsReduces public financial costs not directly related to the enforcement policy (e.g., spillover effects on health policy budgets)CostIntroductionFinancial costs of introducing the policyMaintenanceFinancial costs of enforcing the policy
Slide8Scoring the options
8Direct scoring of harm
100
Least harm
80
60 RelativeStrengthofHarm 40
20
0 Most harm
Slide99
But, the four policies are allhypothetical states about the future.There are no data about the future.
So, how reliable (repeatable)and valid (represent actual harm)are direct preference judgements?
Slide10ISCD results 2010
UK drug harms: 2010
Slide11Europe results 2013
Europe drug harms: 2013
Slide12UK 2010 vs. Europe 2013
Europe
UK
r = 0.993Direct preference judgements are reliable and valid in a decision conference if:Criteria are defined clearly
Group members represent differing perspectives
Peer review occurs face-to-face
Group is properly facilitated
Slide13Swing-weighting the criteria
13
“How big is the difference between most and least preferred options and how much do you care about it?”
1. Weight swings below each node, e.g., Health Impacts.…….Economic Impacts.…………………..Costs2
. Weight most important swings across the nodes.
Purpose of weights:
To ensure comparability of units of preference across the model. (They do not represent absolute importance.)
Slide14MCDA results
Alcohol
Cannabis
14For both drugs, a legal but strictly regulated market is judged to yield the best outcomes
overall.
Slide15Alcohol
State control vs.Decriminalisation
State control better
Decriminalisationbetter
15
Slide16Cannabis
State control vs.Decriminalisation
State control better
Decriminalisationbetter16
Slide17Sensitivity analyses at each node
17
State Control remains most preferred option over a wide range of weights.
Also for alcohol.
cannabis
Slide18Current state
Alcohol results confirm current public health and medical opinion. Not so for cannabis.For both substances, a legal but strictly regulated market is
judged to yield the best outcomes overall.Was there a ‘reformist bias’ in the group?Need further research by other teams.We
now have the beginnings of a coherent analytic framework for describing, measuring, assessing and discussing drug policy18
Slide19A guide to further reading
UIT Cambridge Ltd, 2012
Explains the harms of misusing psychoactive legal & illegal drugs.19
Multi-criteria analysis: a
manual, 2000
(
Dodgson
, Spackman, Pearman &
Phillips)
Chapter 6 is an MCDA tutorial.
Cambridge University Press, 1993The book that introduced MCDA in 1976 (Wiley).