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Monitoring Drug Policy Outcomes: The measurement of drug related harm

The Report explores the methodologies to measure drug-related harm developing since the early 1990s and the shift from evaluation focused on prevalence to a more sophisticated approach aimed at harm minimisation. The report highlighted methodological weaknesses (lack of data, limited institutional capacity, difficulty of disaggregating impact assessments, etc.) while stressing the importance of dedicating resources to of evaluation and monitoring in order to improve implementation and efficacy.

There has been considerable progress since the early 1990s in developing methodologies to measure drug-related harm. A number of highly infl uential studies have been produced, contributing to a more evidence-based approach to drug policy, and a shift in the evaluative emphasis from simple prevalence measures to a more sophisticate harm minimisation approach. It is not clear to what extent the fi ndings of these studies are being used by governments and relevant international agencies to target their scarce drug policy resources effi ciently, and maximise the impact of their investment on drug-related harm. While there has been progress, the development of methodologies for measuring drug-related harm is in its infancy. Economic and social cost studies have been undertaken in only a handful of countries. The development of a Drug Harm Index in the UK is pioneering work, which will not necessarily be replicable elsewhere. Most countries lack the sophisticated research and data infrastructures to undertake cost studies or produce drug harm indexes. Where detailed studies have been undertaken their authors have highlighted methodological problems (for example, in placing a value on the intangible costs of drug abuse, such as pain and suffering) and the lack of data on key drug related harms in even the most advance drug policy research institutions. If these forms of analysis are to be used to routinely inform policy decisions, policymakers must be aware of the scale and nature of the costs of different patterns of drug use to their citizens, the costs (and collateral costs) of the policies and programmes designed to reduce drug problems, and the impact and effectiveness of these policies and programmes. To illustrate this process, we can use the example of drug related property crime committed by heroin addicts to fund their drug purchases. Policymakers, if their policies are to be evidence based, will need to know how much of this type of crime is committed by heroin addicts, and the costs of these crimes to individuals, communities and the authorities. They will then need to assess the public expenditure costs of programmes (such as diversion to addiction treatment, or arrest and imprisonment) that are designed to reduce these crimes. Once they have implemented their chosen intervention, they should measure its success in reducing crime, and compare the costs of implementation with the crime reduction benefi ts achieved. The same analytical process, if applied to all areas of drug policy, would go a long way to resolving some of the longstanding disputes in this fi eld. While the analysis of costs of drug use, and benefi ts of interventions, can be (and is) used to inform local decisions on particular issues, the development of cost studies and harm indexes as a framework for national and international comparison should be viewed as a useful ‘exploratory tool’, and not as an ‘exact decision-making model’. If cost analysis and indexes are to serve this function then it is vitally important to continue to develop and disseminate methodologies and results; to improve data collection and build better evidence bases (which will require a proper investment in capacity building support for developing countries) and to agree to and comply with international standards to enable meaningful comparisons to be made across different jurisdictions. If this is to happen on anything approaching a global scale, then it will require a signifi cant further investment of resources and it will need to be guided and supported by an appropriate international infrastructure. We therefore recommend that the UNODC, in the context of its ongoing work on the IDI, draws together an expert group to review existing work in this area, and develop methodologies for future cost analyses and harm indices. If this work is adequately designed and supported, it will lay the foundations for future policy to be informed by a much greater understanding of drug related harms, and how they can be successfully tackled.