Drug courts: a primer for the family physician.
(17/254)
BACKGROUND: Drug courts are a judicial response to drug-related crimes. They combine the coercive powers of the judiciary with drug treatment. This article is intended to familiarize physicians with the reasons why drug courts exist, what they are, and how physicians can assist their patients who are clients of a drug court. METHODS: Methods for this article are based upon personal experience and a search of the literature using the key words "drug rehabilitation," "drug abuse," and "criminal justice system." RESULTS: Using a three-phase approach, drug courts emphasize urine drug testing, rapid punishment for specific infractions, and therapeutic interventions. Drug courts have greatly reduced criminal and drug-using recidivism. CONCLUSION: Drug courts are effective in resolving the criminal and drug-using behaviors in drug-only, nonviolent offenders. Family physicians can become involved in the drug court process by providing treatment for patients with both drug addiction and mental health diagnoses. In addition, as patients withdraw from drugs, it is important to treat withdrawal symptoms to prevent recidivism and encourage participation in the program. (+info)
Collaboration between public health and law enforcement: new paradigms and partnerships for bioterrorism planning and response.
(18/254)
The biological attacks with powders containing Bacillus anthracis sent through the mail during September and October 2001 led to unprecedented public health and law enforcement investigations, which involved thousands of investigators from federal, state, and local agencies. Following recognition of the first cases of anthrax in Florida in early October 2001, investigators from the Centers for Disease Control and Prevention (CDC) and the Federal Bureau of Investigation (FBI) were mobilized to assist investigators from state and local public health and law enforcement agencies. Although public health and criminal investigations have been conducted in concert in the past, the response to the anthrax attacks required close collaboration because of the immediate and ongoing threat to public safety. We describe the collaborations between CDC and FBI during the investigation of the 2001 anthrax attacks and highlight the challenges and successes of public health and law enforcement collaborations in general. (+info)
Reductions in injury crashes associated with red light camera enforcement in oxnard, california.
(19/254)
OBJECTIVES: This study estimated the impact of red light camera enforcement on motor vehicle crashes in one of the first US communities to employ such cameras-Oxnard, California. METHODS: Crash data were analyzed for Oxnard and for 3 comparison cities. Changes in crash frequencies were compared for Oxnard and control cities and for signalized and nonsignalized intersections by means of a generalized linear regression model. RESULTS: Overall, crashes at signalized intersections throughout Oxnard were reduced by 7% and injury crashes were reduced by 29%. Right-angle crashes, those most associated with red light violations, were reduced by 32%; right-angle crashes involving injuries were reduced by 68%. CONCLUSIONS: Because red light cameras can be a permanent component of the transportation infrastructure, crash reductions attributed to camera enforcement should be sustainable. (+info)
Rearrest rates after incarceration for DWI: a comparative study in a southwestern US county.
(20/254)
OBJECTIVES: This study was undertaken to assess a 28-day detention and treatment program's effect, in a multiethnic county with high rates of alcohol-related arrests and crashes, on first-time offenders sentenced for driving while impaired (DWI). METHODS: We used comparison of baseline characteristics, survival curves of subsequent arrest, and Cox proportional hazards regression to examine probability of rearrest of those sentenced and those not sentenced to the program. RESULTS: Probability of not being rearrested was significantly higher for the treatment group after adjustment for covariates. At 5 years, probability of not being rearrested for the treatment vs the nontreatment group was 76.6% vs 59.9%. CONCLUSIONS: Results suggest that this county's program has significantly affected rearrest rates for Native Americans, Hispanics, and non-Hispanic Whites. (+info)
Impact of supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: investigation of a massive heroin seizure.
(21/254)
BACKGROUND: More than 93% of the nearly $500 million spent annually on Canada's drug strategy goes toward efforts to reduce the illicit drug supply. However, little is known about the effectiveness of this strategy. On Sept. 2, 2000, Canadian police seized approximately 100 kg of heroin in one of the nation's largest-ever seizures of this drug. An ongoing prospective cohort study of injection drug users afforded an opportunity to evaluate the impact of this seizure. METHODS: The Vancouver Injection Drug User Study is a prospective cohort study of injection drug users that began in 1996. The present study relied primarily on data acquired from participants who were seen during the 30-day periods immediately before and after the seizure. We compared drug use and behavioural characteristics, heroin and cocaine prices, and participants' reports of whether law enforcement had affected their source of drugs or the types of drugs available on the street, as well as overdoses, in these 2 periods. RESULTS: The 138 participants seen before the seizure were similar to the 123 participants seen after the seizure with respect to age, sex, ethnic background, education, HIV serostatus, neighbourhood residence, instability of housing, employment status, use of methadone maintenance therapy and all other measured potential confounders (all p > 0.10). We found no difference in the extent to which participants in the 2 groups reported daily use of heroin, frequency of nonfatal overdoses, or whether law enforcement had affected their source of drugs or the types of drugs available on the street (all p > 0.10). Although we detected no difference in the price of cocaine, the median reported price of heroin went down after the seizure (p = 0.034), which suggests that other shipments compensated for the seizure. External evaluations of deaths from overdoses and heroin purity indicated that the seizure had no impact, nor was any impact seen when the periods of analysis were extended. INTERPRETATION: The massive heroin seizure appeared to have no measurable public health benefit. Closer scrutiny of enforcement efforts is warranted to ensure that resources are delivered to the most efficient and cost-effective public health programs. (+info)
Epidemiologic clues to bioterrorism.
(22/254)
Public health investigators have successfully carried out epidemiologic investigations of outbreaks of disease for many years. By far the majority of these outbreaks have occurred naturally. With the recent illnesses resulting from deliberate dissemination of B. anthracis on an unsuspecting population, public health investigation of diseases must now include consideration of bioterrorism as a potential cause of outbreaks of disease. The features of naturally occurring outbreaks have a certain amount of predictability in terms of consistency with previous occurrences, or at least biological plausibility. However, with a deliberately introduced outbreak or infection among a population, this predictability is minimized. In this paper, the authors propose some epidemiologic clues that highlight features of outbreaks that may be suggestive of bioterrorism. They also describe briefly the general process of involvement of agencies at various levels of government, public health and non-public health, depending on the extent of an outbreak or level of suspicion. (+info)
Civil money penalties: procedures for investigations, imposition of penalties, and hearings. Interim final rule; request for comments.
(23/254)
This interim final rule establishes rules of procedure for the imposition, by the Secretary of Health and Human Services, of civil money penalties on entities that violate standards adopted by the Secretary under the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). We intend that this be the first installment of a rule that we term the "Enforcement Rule." The Enforcement Rule, when issued in complete form, will set forth procedural and substantive requirements for imposition of civil money penalties. In the interim, we are issuing these rules of procedure to inform regulated entities of our approach to enforcement and to advise regulated entities of certain procedures that will be followed as we enforce the Administrative Simplification provisions of HIPAA. (+info)
Substance abuse treatment effectiveness of publicly funded clients in Tennessee.
(24/254)
The Tennessee Outcomes for Alcohol and Drug Services (TOADS) in collaboration with the Bureau of Alcohol and Drug Abuse Services at the Tennessee Department of Health evaluated the effectiveness of publicly funded substance abuse treatment programs in Tennessee by collecting and analyzing data from clients treated between 1998 and 2000. Using a structured questionnaire, TOADS staff conducted telephone interviews with clients 6 months after their admission to treatment facilities. The sample populations for these follow-up interviews ranged from 1,150 to 1,350 clients over the 3 years, and each year, post-treatment abstinence rates were around 60%, which suggests that treatment in Tennessee has been successful in reducing substance abuse. In addition, the follow-up interview data suggest that treatment also helped drastically reduce both unemployment and arrests among clients. These findings in Tennessee are comparable to treatment outcomes in other states. In addition to the positive effects that treatment has on clients, treatment is also cost-effective for state budgets since treatment reduces many of the burdens substance abuse places on the criminal justice system, the healthcare system, and other state-supported services. (+info)