Tag Archives: health/medicine: drugs

Should Drug Treatment Aim to End Use or Reduce Harm?

In the wake of Philip Seymour Hoffman’s sad death, many are calling for various “harm reduction” approaches to substance use. Proponents of harm reduction have identified lots of ways to reduce the social and personal costs of drugs, but they often require us to shift our focus from the prevention of drug use itself to the prevention of harm. Resistance to such approaches often hinges on the notion that they somehow tolerate, facilitate, or even subsidize risky behavior.

This tension emerged clearly in my new article with Sarah Shannon in Social Problems. We re-analyzed an experimental jobs program that randomly assigned a basic low-wage work opportunity to long-term unemployed people as they left drug treatment. In some ways, the program worked beautifully. The job treatment group had significantly less crime and recidivism, especially for predatory economic crimes like robberies and burglaries. After 18 months, about 13 percent of the control group had been arrested for a new robbery or burglary, relative to only 7 percent of the treatment group. Put differently, 87 percent of those not offered the jobs survived a year and a half without such an arrest, relative to 93 percent of the treatment group who were offered jobs.

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A randomized experiment that shows a 46 percent reduction in serious crime is a pretty big deal to criminologists, but the program has still been considered a failure. In part, this is because the “treatment” group who got the jobs relapsed to cocaine and heroin use at about the same rate as the control group. After 18 months, about 66 percent of the control group had not yet relapsed, relative to about 63 percent in the treatment group. So, there’s no evidence the program helped people avoid cocaine and heroin.

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From an abstinence-only perspective, such programs look like failures. Nevertheless, even a crummy job and a few dollars clearly helped people avoid recidivism and improved the public safety of their communities. So, did the program work? From a harm reduction perspective, a jobs program for drug users surely “works” if it reduces crime and other harms, even if it doesn’t dent rates of cocaine or heroin use.

Chris Uggen is a professor of sociology at the University of Minnesota and the author of Locked Out: Felon Disenfranchisement and American Democracy, with Jeff Manza. You can follow him at his blog and on twitter. This post originally appeared at Public Criminology.

Marijuana Policing as a Civil Rights Issue

Young black adults are less likely than whites to use marijuana, but extraordinarily more likely to be arrested for its use, according to a new report by the ACLU.  This is old news, but the data never fails to stun.

First, notice that arrests for marijuana possession have grown over the past 15 years, even relative to arrests for other types of drugs.  The first chart is total marijuana possession arrests, the second is the percent of all drug arrests that were for marijuana (note that in neither chart does the vertical axis start at zero and truncated axes tend to make data look more dramatic, as if that were necessary here).

Screenshot (11) Screenshot (12)This rise in arrests has disproportionately affected African Americans.  The arrest rate for blacks has consistently been substantially higher than that of whites, but it increased, even so, over the 2000s.
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According to the report:

…in every state the Black arrest rate is disproportionate to Blacks’ percentage of the population.  In fact, in 42 states the Black percentage of marijuana possession arrests is more than double the Black percentage of the population, while in 18 states Blacks account for more than three times the percentage of marijuana possession arrests than they do of the population.  In four states, the difference is a factor of at least four.

Most of these arrests are of young people.  Almost half (46%) involve 18 to 24 year olds:

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The black arrest rate cannot be attributed to different rates of use.  Overall, blacks and whites have very similar rates of marijuana use (the first figure below), but among 18 to 25 year olds — the population being arrested the most — whites have slightly higher rates than blacks (second figure):
Screenshot (15) Screenshot (16)This is a long-standing, well-documented Civil Rights issue.  The war on drugs is a war on black people.  These practices are harmful to individuals, their families, and their communities.  It functions to further the disadvantage faced by black Americans in a society rife with institutions already stacked against them.

More than half of Americans would like to see marijuana legalized.  Legalizing or decriminalizing marijuana would relieve this egregious attack on black communities and save states billions of dollars.  There is little downside.  Relative to other substances, it’s a minor problem.

Screenshot (19)Cross-posted at Pacific Standard.

 

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.

The Racial Empathy Gap

In graduate school at the University of Wisconsin-Madison, I proctored law school exams to earn extra money.  At the end of one exam, while I was collecting the final papers, I overheard two students discussing their answers on an essay question about sentencing.  One said to the other: “I gave the rich guy a lesser sentence because I figured, since he had such a cushy life, it would take less punishment to get through to him.”  There’s your next crop of lawyers, I thought, doling out the prison sentences to the poor and letting the rich off with a slap on the wrist.

Well, it turns out that there is a well-documented psychological phenomenon behind what I’d overheard.  Morten B. sent along an essay by Jason Silverstein in which he reviews the literature on the racial empathy gap.  All things being equal, if you show a person an imagine of a dark- and a light-skinned person being harmed, they will most likely react more strongly to the latter.  Studies have found evidence of this using both self-report and measures of brain activity.  Notably, both Black and White people  respond similarly.

Here are the results of six studies using self-report; in the first four, the relationship between race and how much pain subjects attributed to the target was statistically significant:

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What’s going on?

Silverstein explains that this isn’t necessarily about racial animosity or even identification with one’s own group (remember that both Black and White people show this response). Instead, it appears to be related to the perception that Black people have already had to cope with a great deal of pain — from racism, poverty, poor health, etc — and, as a result, have a greater pain threshold.  In other words, they are less sensitive to pain because they’ve been hardened.

Efforts to parse out whether this effect is due to race specifically or perceptions of whether a person has lived a hard life suggest that it might be primarily the latter.  But, as Silverstein points out, we tend to homogenize the Black population and assume that all Black people face adversity.  So, whether the phenomenon is caused by race or status gets pretty muddy pretty fast.

In any case, this is perfectly in line with the soon-to-be-lawyer I overheard at Wisconsin.  He gave the “hardened criminal” a harsher sentence than the person convicted of a white-collar crime because he believed that a greater degree of suffering was required to make an impact.  That was just a hypothetical case, but Silverstein reviews research that shows that the racial empathy gap has real world consequences: undertreatment of pain (even in children) and, yes, harsher sentences for African Americans convicted of crimes.

Cross-posted at Racialicious and Pacific Standard.

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.

The War on Blacks: Arrests for Marijuana Possession

Black Americans are 3.7 times more likely than Whites to be arrested for marijuana possession, despite having equivalent use rates.  It’s a war on what again?

Screenshot_2New York Times, via Gin and Tacos, one of my favorite blogs.

Cross-posted at Racialicious.

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.

The Failure of Racial Profiling

Jay Livingston at Montclair SocioBlog discussed the two figures below (full report here).  The first shows that Black and Hispanic drivers are more likely to be stopped by Los Angeles Police than White drivers.  The second shows that, when stopped, if searched, police are more likely to find weapons and drugs on Whites than on either Blacks or Hispanics.  Conclusion: Blacks and Hispanics are being racially profiled by the L.A.P.D. and racial profiling does not work.  Data from New York City in 2008 tells a similar story.

The New York Civil Liberties Union reports that the NYPD stopped 161,000 people in the first quarter of 2011. A record number.  Eighty-four percent of those stopped were Black or Latino.  The Civil Liberties Union has filed a lawsuit, claiming that the practice is unconstitutional.

Originally posted in 2011. Re-posted in solidarity with the African American community; regardless of the truth of the Martin/Zimmerman confrontation, it’s hard not to interpret the finding of not-guilty as anything but a continuance of the criminal justice system’s failure to ensure justice for young Black men.

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.

On Horse Racing, “Break Downs,” and Our Humanity

Originally posted in 2012; re-posted because tomorrow is the 145th Belmont Stakes, the 3rd and final leg of the Triple Crown in thoroughbred horse racing. This is the dark side of the sport.

In humans you never see someone snap their leg off running in the Olympics. But you see it in horse racing.

These words, spoken by the equine medical director for the California Racing Board, summarize the truly terrifying absurdity that is horse racing today.  A team of investigative reporters at the New York Times has found that over 1,200 horses die at race tracks every year in the U.S.  Many of them die immediately after a race, euthanized after their bodies literally crumble underneath them.  Their legs break, unable to withstand the forces that the horses exert upon their bodies.  People in the industry call it, euphemistically, a “break down.” It occurs 1 out of every 200 times a horse starts a race.

All of these horses are being ridden by a jockey who is pitched off when the horse falls.  Moving at upwards of 50 miles an hour, and in the midst of many other horses running at top speed, jockeys are often seriously injured and sometimes killed.  Currently there are over 50 permanently disabled jockeys receiving financial assistance from their professional trade association.  Jacky Johnson, for example, was paralyzed from the neck down after his horse, Phire Power, broke its leg during a race.  He will need a respirator for the rest of his life; Phire Power was euthanized on the track.

Why is this happening?

Because we are making it so.

First, race horses are bred in order to run as fast as possible.  Short legs and thick bones slow a horse down, while longer, more delicate legs give them longer strides.  Breeders, then, have an incentive to build horses who are both faster and more fragile.

Second, owners may be putting these horses on the track too young.  Horses typically start getting raced at 2 to 3 years old, very young for an animal with a lifespan of 30 years.  Some argue that the bodies of young horses are not ready to handle the physical demands of racing.  This 2-year-old horse, Teller All Gone, broke its leg during a race; it is about to be euthanized:

The owners dumped his body at a junkyard:

Third, there is the drug problem.  Many trainers illegally give their horses performance-enhancing drugs.  Many of them are experimental and are not yet or cannot be tested for.  These include “chemicals that bulk up pigs and cattle before slaughter, cobra venom, Viagra, blood doping agents, stimulants and cancer drugs.”

Built for speed and not safety, on the track too young, and amped up on steroids and other performance-enhancers, these horses are pushed to their limits.  Just this week Doug O’Neill, the trainer of I’ll Have Another, the horse set to win this year’s Triple Crown, was fined after his horse tested positive for performance enhancing drugs.

Even more problematic than the doping is the legal practice of giving horses pain-relieving drugs, including cocaine.  These mask the pain signals that would otherwise tell a horse to slow down or be careful on the track and also increase that chances that the track veterinarian will miss an injury when clearing the horse to race. The NYT reports that “[a]s many as 90 percent of horses that break down had pre-existing injuries” and they argue pain-masking drugs “pose the greatest risk to horse and rider.” The Louisiana Racing Commission call it “a recipe for disaster.”

The drugs detailed below are what were given to Coronado Heights in the week before he collapsed and was euthanized on the track:

Horse racing is subject to regulation, but these vary by state and are typically very poorly enforced, bringing us to the fourth reason why we see so much tragedy on race tracks. The punishment for violations is insignificant, sometimes only a warning:

Trainers in New Mexico who overmedicate horses with Flunixin get a free pass on their first violation, a $200 fine on the second and a $400 fine on the third, records show… [the state also] wipes away Flunixin violations every 12 months… To varying degrees, the picture is similar nationwide. Trainers often face little punishment for drug violations, and on the rare occasions when they are suspended, they are allowed to turn their stables over to an assistant.

When it comes down to it, many owners and trainers are willing to risk a horse’s life for the chance at the prize money and the less likely a horse is to win, the less they’re worth to the owner, so the harder they’re willing to push it.

The economic incentive to run horses till they die may seem to apply to the highest stakes racing but, in fact, it’s at the lowest end that we see the most disregard for the safety of horses and their jockeys. In the backyards of those casinos where racetracks are now part of the attraction (often referred to as “racinos”), horses and jockeys are a dime a dozen, and the money gives people a reason to break the rules. Meanwhile, the casino tracks are low profile, so they receive even less regulatory attention.

The use of the phrase “break down” to describe a horse who has snapped its own bones in the process of entertaining and enriching human beings is an indication of how nonchalantly industry figures approach this problem.  It suggests that these animals, and perhaps their jockeys as well, have been thoroughly objectified: cars break down, air conditioners break down, we break down boxes.  The language entirely fails to capture what is happening to these horses.  It may very well, however, describe what has happened to the industry and to the basic humanity of its most culpable beneficiaries.

Death at the Track:

Visit the New York Times to watch “The Rise of the Racinos” and “A Jockey’s Story.”

Lisa Wade and Gwen Sharp are professors of sociology. You can follow Gwen on Twitter and Lisa on Twitter and Facebook.  They have also written about the abuse of Tennessee Walking Horses.

Marijuana: A Short History of Changes in Law and Public Opinion

A guiding principle driving the sociological understanding and analysis of deviance is the recognition that behaviors themselves are not inherently deviant; rather it is the social perceptions and reactions to a behavior that makes a particular behavior deviant.  This explains why opinions and attitudes towards different forms of supposedly deviant behaviors regularly change.  A notable change in one type of deviance, using marijuana, is revealed in a report compiled by the Pew Research Center.

According to David F. Musto, a century ago marijuana was an obscure drug used almost exclusively by Hispanics in the Southwest.  Its limited association with this ethnic group is largely why marijuana initially became illegal.  With the onset of the Great Depression, both federal and state governments sought ways to expel nonwhites from the country as their cheap labor was no longer necessary.  Making one of this group’s pastimes illegal was a way to stigmatize Hispanics and rally public support for a population transfer.  With a populace stirred into a moral panic by racism, nativism and propaganda movies like Reefer Madness, there was little resistance to the 1937 Marijuana Tax Act which effectively made cannibas illegal.

In the 1960s marijuana experienced a cultural comeback when it became the drug of choice for baby-boomers who saw the drug as a safer alternative to the alcohol and methamphetamine that plagued their parents’ generation.  Marijuana was even legal for a brief period after the Supreme Court found the 1937 marijuana act unconstitutional.  However, because of widespread concern that drugs were corrupting the moral fabric of America’s youth, in 1970 marijuana was one of many drugs outlawed by President Nixon’s Comprehensive Drug Abuse Prevention and Control Act.  Interestingly, marijuana was the only drug targeted by this act that did not include a medical exception.  In the 1980s, President Reagan increased penalties for breaking drug laws, and subsequently the prison population in the United States swelled to a size seemingly unimaginable in a wealthy democracy.

The graph below from PEW’s report captures how federal action came during times of heightened public support to make marijuana illegal.

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Yet, the graph also captures how in the early 1990s, support for the legalization of marijuana started to increase.  According to the PEW report, around this time California pioneered using the drug for medicinal purposes; seventeen other states (including D.C.) have since followed California’s lead while six other states decriminalized possession of small amounts.  In 2012, citizens in Colorado and Oregon voted to completely legalize marijuana despite federal law.  This relaxing and even elimination of marijuana laws mirrors favorable opinions of marijuana and growing support for its legalization.

It is difficult to tell if legalization, medical or otherwise, drives public opinion or vice-versa.  Regardless, an especially noteworthy finding of the PEW report is that right now, more than half of the United States’ citizens think marijuana should be legal.  Sociologists always take interest when trend lines cross in public opinion polls because the threshold is especially important in a majority-rule democracy; and the PEW report finds for the first time in the history of the poll, a majority of U.S. citizens support marijuana legalization.

This historical research data on opinions about marijuana reveals how definitions of deviance, and in many cases the ways those definitions are incorporated into the legal system, grow out of shared social perceptions.  Although there have been some notable genetic and cultivation advances, marijuana has changed relatively little in the last forty years; yet our perceptions of this drug (and therefore its definitions of use as deviant) regularly evolve and we can expect opinions, and therefore our laws, to further change in the future.

Jason Eastman is an Assistant Professor of Sociology at Coastal Carolina University who researches how culture and identity influence social inequalities.

The U.S. #1 in Early Deaths

The Institute of Medicine and the National Research Council released some damaging numbers this month: Americans ranks startlingly low in life expectancy, compared to 16 other similarly developed countries.  This is especially true for younger Americans. Indeed, among people 55 and under, we rank dead last.  Among those 50-80 years old, our life expectancy is 3rd or 2nd to last.

Sabrina Tavernise at the New York Times reports that the “major contributors” to low life expectancy among younger Americans are high rates of death from guns, car accidents, and drug overdoses.  We also have the highest rate of diabetes and the second-highest death rate from lung and heart disease.

Americans had “the lowest probability over all of surviving to the age of 50.”  The numbers for American men were slightly worse than those for women. Overall, life expectancy for men was 17 out of 17; women came in 16th.  Education and poverty made a difference too, as did the more generous social services provided by the other countries in the study.

What isn’t making a difference?  Apparently our incredible rate of health care spending.

Via Citings and Sightings.

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.