Implementation Of Harm Reduction Strategies Criminology Essay

Implementation Of Harm Reduction Strategies Criminology Essay The Central Intelligence Agency (CIA) identifies five categories for illicit drugs: narcotics, stimulants, depressants (sedatives), hallucinogens, and cannabis. These categories include many drugs legally produced and prescribed by doctors as well as those illegally produced and sold outside of medical channels (CIA World Fact Book, 2012). In the United Kingdom, the term illicit drugs is used to describe those drugs that are controlled under the Misuse of Drugs Act 1971. Globally, the illicit drugs trade (also referred to as the illegal drugs trade or drug trafficking) is one of the largest businesses and some 210 million people use illicit drugs each year, and almost 200,000 deaths can be attributed as a direct result of these drugs (UNODC, 2011). Illicit drugs are a substantial threat to the public good, not only because they adversely affect public health, but also because they can generate crime, disorder, family breakdown, and community decay (Strang et al., 2012). } Proportion of 16 to 59 year olds reporting use of any drug by age group and sex in the last year, 2010/11 BCS CHAPTER 2 EPIDEMIOLOGY AND REIVEW OF THE LITERATURE 2.1 Epidemiology of illicit drug use Drug misuse is a global social problem and, along with poverty and infectious disease, is one of the most challenging issues for personal and community health in many parts of the world (Donmall, 2001).The task of drug abuse epidemiology is to better understand patterns and trends in drug use, such as the characteristics of persons abusing drugs and how this may change over time. Drug abuse epidemiology is one of the more challenging areas of epidemiology. One of the basic reasons for this is the nature of substance use and the circumstances around it- the illegal nature of most drug abuse means that it remains hidden from view to some extent, and thus difficult to quantify (Donmall, 2001, WHO, 2000). Since the 1980s there have been major changes in trends and patterns of drug use including: global increases in the production and use of drugs; new forms of old drugs (eg. smokeable crack cocaine); changes in way drugs are taken (eg. transitions from opium smoking to heroin injection); and the introduction and proliferation of new drugs (eg. MDMA ecstasy and other amphetamine-type stimulants)(WHO, 2000). Drug use behaviours range from occasional, sporadic or experimental use, through regular low risk recreational use, to high risk, daily dependence that is often associated with a variety of financial, health and social problems (Donmall, 2001). However not all drug use is equally harmful, just as not all drugs have the same negative effects. This creates another challenge for drug abuse epidemiology- not all behaviours or substances pose the same risk. However, it has been recognised that drug injection is of specific importance as it has become a major transmission route for HIV (WHO, 2000). 2.2 Illicit drugs In the United Kingdom, the Misuse of Drugs Act 1971, with amendments, is the main law regulating drug control UK. It divides controlled substances into 3 Classes (A, B, C) based on harm, with Class A being the most harmful. An overview of the main drugs are found in table 1, along with their classification. Table 1: Drug classification Source: Home Office 2011 The detailed information on the different drugs found below is derived from the following sources: World Health Organisations Guide to Drug Abuse Epidemiology (2000), DrugScope (2012) and the Talk to Frank Home Office initiative (2012) to provide accurate and reliable information on drugs for young people (WHO, 2000, DrugScope, 2012, FRANK, 2012). Cocaine Cocaine and its derivative crack cocaine provide an example of both the globalization of substance use and the cyclical nature of drug epidemics. Traditionally coca leaves have been chewed by people in the Andean countries of South America for thousands of years. The main alkaloid of the coca leave, cocaine, was isolated relatively recently in about 1860. Cocaine was then used in patent medicines, beverages and tonics in developed countries in Europe, North America and in Australia until the early 1900s. Laws restricting the availability of cocaine saw a decrease in consumption in these countries until the 1960s. From that time cocaine use became popular among certain groups of young people in some developed countries and in the producer countries of South America. Cocaine became widely available in North America in the 1970s and Europe in the 1980s (WHO, 2000). Ecstasy Ecstasy is an illegally manufactured drug that usually comes in tablet or capsule form. The chemical name of pure ecstasy is 3,4 methylenedioxymethamphetamine (MDMA) (DrugScope, 2012). Ecstasy is a stimulant drug which also has mild hallucinogenic effects. It has been described as being like a mix of amphetamine and a weak form of LSD. The effects of taking a moderate dose start after 20-60 minutes (longer if on a full stomach) and can last for up to several hours. Ecstasy was first made by two German chemists in 1912 and patented in 1914, in case it turned out to be a useful drug. It didnt. During the 1950s, the American military experimented with a whole range of drugs, including ecstasy, for use in chemical warfare, to extract information from prisoners and to immobilise armies. In the 1960s, the drug was rediscovered by an American research chemist Alexander Shulgin who experimented with it on himself (DrugScope, 2012). LSD Lysergic acid diethylamide (LSD) is an hallucinogenic drug that is derived originally from ergot, a fungus found growing wild on rye and other grasses. It is a white powder, but as a street drug, it is a liquid either on its own or absorbed into paper sheets. The sheets are cut into tiny squares like postage stamps or transfers and often have pictures or designs on. LSD is also sometimes dropped on to sugar cubes or formed into tablets or small capsules (DrugScope, 2012). Magic Mushrooms Psilocin-based magic mushrooms (PBMMs) in prepared forms (e.g. dried or extracted) have been illegal in the UK since the 1971 Misuse of Drugs Act. But fresh or unprepared PBMMs were legal to possess and traffic until the 2005 Drugs Act, UK (Riley, 2010). Meth Methamphetamine (crystal meth) is a central nervous system stimulant with a high potential for misuse and dependence. A synthetic drug, it is closely related chemically to amphetamine (speed) but produces greater effects on the central nervous system. Cannabis Cannabis is a Class B drug derived from the cannabis plant, a bushy plant found wild in most parts of the world and easily cultivated in Britain. There are three varieties of the plant, Cannabis sativa, indica and ruderalis. In Western countries it is generally used as a relaxant and mild intoxicant. In the UK, cannabis is generally smoked with tobacco in a joint or spliff, but can also be smoked in a pipe, brewed into a drink or cooked into food (DrugScope, 2012). Poppers Poppers are usually found in the form of a liquid chemical (a nitrite) sold in a small bottle. Commonly, the chemical is alkyl nitrite. Other nitrites like amyl nitrite (and butyl nitrite and isobutyl nitrite) have also used been used. Nitrites dilate the blood vessels and allow more blood to get to the heart ((FRANK, 2012). Heroin Heroin use has become increasingly common in North-America and Europe since the 1960s. Increases in heroin use are often cyclical in these countries. In the United Kingdom, for example, there was a well reported heroin epidemic in the mid-1980s, following a period in the 1970s when the heroin using population was generally stable and ageing (Power, 1994). The UK epidemic in the 1980s was in part the result of the availability of cheap, high purity heroin from South-west Asia notably Pakistan. This form of heroin could be smoked and became attractive to young non-injecting users (Pearson, 1987).(WHO, 2000) Since heroin is commonly used by injecting, the health risks including that of HIV and hepatitis transmission are substantial. A number of drugs used commonly for their therapeutic efficacy in health care are also being abused all over the world. These include barbiturates, benzodiazepines, other sedatives and some stimulant drugs .The epidemiology of this use is difficult to study, because of difficulties in distinguishing medical and non-medical use (WHO, 2000). 2.3 Data on Drug users United Kingdom In the United Kingdom, primary sources of information about prevalence of illegal drugs among the adult population are derived from representative household surveys. In England and Wales, the British Crime Survey (BCS) has been a continuous survey since 2002 (EMCDDA, 2012). The BCS collects a rich set of information on the personal, household, area characteristics and lifestyle factors of respondents that can be used to explore differences in drug use. This information, together with other information from representative surveys feeds into the latest report on the statistics of drug misuse in England and Wales (NHS Information Centre, 2011). The following data is extracted from the 2011 report Statistics on Drug Misuse: England published by the NHS Information Centre and the 2011 Home Office report on Drug misuse in England and Wales (Home Office, 2011, NHS Information Centre, 2011). According to this report, the prevalence of ever having taken illicit drugs in England and Wales has increased from 30.5% in 1996 to 36.3% in 2010/11. As can be seen in figure 1 in 2010/2011, 12 per cent of men, versus 5.7 per cent of women reported using any type of drug in the last year. There is a clear downward trend in any drug use in the past year as age increases for all adults. Specifically for Class A drugs, there is a slight increase in use for the 20-24 age group, after which use decreases with age as well. Figure 1: Proportion of adults reporting use of the most prevalent drugs in the last year, by age, 2010/11 BCSBCR home office drugs.PNG Source: Home Office 2011 A total of 8.8 per cent of adults had used one or more illicit drug within the last year (figure 1), compared with 8.6 per cent in 2009/10, which indicates a slight increase in any drug use for adults in the past year. However, as can be seen in figure 2, there has been a general downward trend in the use of any drug in the past decade, whereas there has been little change in the percentage of any Class A drugs used by adults in this same time period. Figure 2: Proportion of 16 to 59 year olds reporting use of any illicit drug or any Class A drug in the last year, 1996 to 2010/11 BCS Source: Home Office 2011 drugs 2.PNG The prevalence of young adults (16-24 years) ever having taken drugs has decreased from 48.6 per cent in 1996 to 40.1 per cent in 2010/11. Findings from the 2009/10 BCS suggest that falls in illicit drug use have occurred in the youngest age groups (16-29 year olds), where use is highest. For example, around one in three (31.6%) of 16-19 year olds used an illicit drug in the last year in 1996 compared with around one in five (22.3%) in 2009/10. Figure 3: Proportion of adults reporting use of the most prevalent drugs in the last year, by age, 2010/11 BCS As can be seen in figure 3, in 2010/11 cannabis is the type of drug most likely to be used by adults (6.8%) followed by powder cocaine (2.1%), which is consistent with findings from previous years. Similarly, for young adults (16-24 years) cannabis is the most prevalent drug followed by powder cocaine and ecstasy. The 2010/11 BCS reported that single adults had higher levels of any (18.1%) or Class A (6.5%) drug use in comparison with all other marital groups (for example, 2.7% and 0.6% were the equivalent figures for married adults). In addition, adults from a White ethnic group had higher levels of any (9.4%) or Class A (3.2%) drug use than those from a non-White background (that is, ethnic groups other than White; 5.1%, any drug use; 1.0% Class A). Adults living in a household in the lowest income group ( £10,000 or less) had the highest levels of any drug use (12.9%) compared with all other income groups (e.g. 7.7% of adults living in a household with an income of  £50,000). In addition, a clear urban-rural disparity exists, with 9.3 per cent of adults in urban areas had taken any illicit drug in the last year compared with 7.0 per cent of those in rural areas. This was the case for both Class A drug use as well as any other drug use among adults (Home Office, 2011). Similar to the data collected by the British Crime Survey , the NHS also collects data on smoking, drinking and drug use among secondary school pupils aged 11 to 15(NHS, 2011). Overall, this report shows that drug use has declined since 2001. In 2010, 18 per cent of pupils said they had ever dused drugs, 12 per cent had taken any drugs in the last year and 7 per cent had taken drugs in the last month (compared to 29 %, 20 % and 12% respectively in 2001). This decreasing trend can be seen in figure 4. Girls were less likely than boys to have taken drugs in the last year (odds ratio= 0.74), the odds of having taken drugs in the last year also increased with age (odds ratio=1.13 for each additional year) (NHS, 2011). In terms of ethnicity, pupils of Asian ethnicity were more likely to have taken drugs in the last year than white pupils (odds ratio= 1.13). As is not unexpected, both smoking and drinking alcohol were associated with drug use in the last year. When looking at the type of drugs used, cannabis is the most prevalent- 8.2 per cent of pupils reported taking it in the last year. This compares with 8.9 per cent in 2009 and continues the decline seen since 2001. As can be seen in figure 5, 3.8 per cent of pupils reported sniffing collative substances such as glue, gas, aerosols etc, which shows a decrease from 5.5 per cent in 2009. Sniffing poppers has fallen from a high in 2007 to 1.5 per cent in 2010 (NHS, 2011). Figure 4 Source: NHS 2011 Figure 5 Source: NHS 2011 A team of researchers recently found higher than expected rates of HIV and hepatitis C infection in a study in London. They suggested that this was due to high risk injecting practices, associated with newer injectors and the injection of crack (Judd et al. 2005).4 They found higher rates of hepatitis C in their sample than in many other cities internationally (Hope et al. 2001). 2.4 Country comparison Compared to Scotland, data from 2010/11 show that illicit drug use ever among 16-59 year olds was lower in Scotland (33.5%) than in England and Wales (36.4%). Whereas the percentage taking any illicit drug in Scotland in the last year (9.8%) or last month (5.8%) was higher than across England and Wales (8.6% in the last year and 5.0% in the last month.) Another barrier to the accuracy of survey estimates is that household and school surveys are likely to miss those people who are amongst the heaviest users of illicit drugs: the homeless, prisoners and school truants. Dependent users of cocaine and heroin may also be of unstable residence, and less likely to be found in their residence at a given time (reuter). 2.3 What is harm reduction Three separate facets of physical harm can be identifi ed. First, acute physical harm-ie, the immediate eff ects (eg, respiratory depression with opioids, acute cardiac crises with cocaine, and fatal poisonings). Second, chronic physical harm-ie, the health consequences of repeated use (eg, psychosis with stimulants, possible lung disease with cannabis). Finally, there are specifi c problems associated with intravenous drug use.(Nutt et al., 2007) Harm reduction refers to policies and programmes that aim to reduce the harms associated with the use of drugs (Power, 1994). One widely-cited conception of harm reduction distinguishes harm at different levels individual, community and societal and of different types health, social and economic (Donmall, 2001). These distinctions give a good indication of the breadth of focus and concern within harm reduction. As such, harm reduction should not be considered as a service type, or something delivered within a single tier, but should be subject to a whole system approach to reduce or eliminate the harms associated with drug use (NHS, 2009/10). Health related harm resulting from the use and abuse of drugs vary. This is dependent on the type of substance being used, its frequency, its dosage and circumstances of use (Department of Health and National Treatment Agency, 2011b, Department of Health and National Treatment Agency, 2011a). There is a wide-ranging group of health related harms associated with high levels of illicit drug use and misuse. These include, but are not limited to drug dependence (psychological and physical); withdrawal syndromes; tolerance; substance related deaths which can result from poisoning/overdose, violent attacks, and suicides; as well as the development of other medical illnesses such as HIV/AIDS or hepatitis (AGENCY, 2007, Equal Partners: Health and Human Rights, 2007). At the community level, drug use can cause nuisance as a result of people discarding drug related litter such as used needles and syringes (Power, 1994). High levels of drug use and drug dealing can contribute more generally to problems in neighbourhoods and communities with little cultural capital and high levels of poverty, and considerable affects crime levels (Power, 1994).The economic burden of health harms related to drug use and misuse is alarming with the National Health Service (NHS) spending close to  £500 million annually on drug misuse associated harms and drug related crime costing the country an estimated  £13.32 billion (Department of Health and National Treatment Agency, 2007). Recent trends among drug users, particularly injecting drug users (IDU), suggest that drug-related harms have increased in recent years. The Health Protection Agency (HPA) report, Shooting Up: Infections among injecting drug users in the United Kingdom 2006, an update: October 2007 (Pearson, 1987) describes the high levels (48%) of sharing injecting equipment amongst current injecting drug users, with mixing containers such as spoons being the most commonly shared items (NHS, 2011). 2.4 What is health related harm Some of the main concerns about health related harm and drug use related to blood borne viruses, such as hepatitis and HIV. Hepatitis C is the most significant infection affecting injecting drug users (IDUs) with 41% of IDUs having been infected. There is marked regional variation with a prevalence of 22% in the North East to a prevalence of 57% and 60% in London and the North West regions respectively. Alcohol use and misuse is the single biggest contributory factor to those with hepatitis C infection developing fatal liver disease (NHS, 2011, Pearson, 1987). In the UK, hepatitis B is usually acquired in adulthood, with sexual activity or injecting drug use being the most commonly reported routes of infection. Infection with the hepatitis B virus typically causes an acute infection, with a small number of those infected going on to develop chronic disease. Infection with hepatitis B is preventable using a safe and effective vaccine, but continues to cause serious ill health in IDUs and their communities. In 2005, the percentage of IDUs with evidence of past or current hepatitis B infection was 19% (613 of 3,175), which is similar to rates since 1995. There is substantial variation between regions, with North West having the highest rates of 31% (221 of 777), and the lowest in the Yorkshire and the Humber region at 5.5% (14 of 253) (NHS, 2011, Pearson, 1987). HIV infection among drug users remains relatively uncommon in the United Kingdom but there is some evidence of both increasing prevalence and transmission. The prevalence of HIV infection in current IDUs in England and Wales in 2005 was 2.1%, the highest prevalence ever seen. In London the prevalence in current IDUs was 4.3%, which is similar to recent years, but elsewhere in England and Wales the prevalence in current injectors was 1.6% which is more than double the prevalence in 2004 (Pearson, 1987, NHS, 2011). In addition to the infectious diseases mentioned above, site infections are also considered health related harm. There are continuing problems with infections associated with injecting including tetanus and wound botulism. These can result from poor skin hygiene, environmental conditions, and/or poor injecting practice (NHS, 2011, Pearson, 1987). 2.5 Role of community pharmacy and needle exchange Open access drug services, such as needle exchange, can provide a crucial interface with drug users who are not currently engaged in structured drug treatment and who are often, by definition, at greater risk of drug-related harm (NHS, 2009/10). For this reason, this aspect of drug-related harm reduction is highlighted here. In recent years, there has been an increased awareness of the rising levels of hepatitis (B and C), thus increasing the recognition of the need for better distribution of clean injecting equipment (Matheson et al., 2007). The model of delivery for needle exchange (specialist centre based, detached, outreach or pharmacy-based) will vary according to locally defined need (NHS, 2009/10). Community pharmacists play an important role in the UK in the provision of harm reduction services and in the treatment of drug misusers. They distribute clean needles through exchange or sale and dispense substitute drugs (primarily methadone) for maintenance and detoxification, often supervising the self-administration in the pharmacy to ensure it is taken by the intended person (Matheson et al., 2007). Participation in needle exchange at pharmacy level in Scotland has increased overall but more so in some NHS areas than others. It is still relatively low having only increased from 9.7 to 12.5% compared with England where 19% of pharmacies provide this service (Matheson et al., 2007, Sheridan J, 1996) As discussed above, needle exchange and open access services offer an opportunity not only to provide access to safer injecting materials but also to engage with service users who are not in contact with more structured services. They provide health promotion advice, information and materials, brief interventions, healthcare checks, and referral on to other specialist services (NHS, 2009/10). Increasing the number of pharmacy schemes is likely to offer the best opportunity for the rapid expansion of distribution sites, especially for out of hours cover, supported by robust local co-ordination and monitoring of needle and syringe exchange programmes (NHS, 2009/10). Closely connected to such needle exchange programmes are community-based outreach programmes, with which they are sometimes linked. Without necessarily distributing needles and syringes, these aim to obtain face-to-face contact with IDUs, provide literature about HIV risk reduction, distribute condoms and bleach for disinfection of needles and syringes (especially where needle exchange programmes are not operating), promote teaching and modelling of HIV risk reduction by network leaders, referral to services, improve access to risk assessment and HIV testing, provide counselling and support community organising (Hunt, 2010). It has been shown that such community-based responses can be an effective component of the overall drug response (Hunt, 2010). 2.6 Methadone and other replacement therapies Methadone maintenance treatment is the most researched treatment currently available for people who are dependent on opioids. Its use is supported by an evidence-base developed over almost 40 years and from across many different countries. It retains patients in treatment for longer than any alternative, non-replacement therapy, and has a superior effect on the reduction of heroin use and crime associated with opioid dependence (Power, 1994). 2.7 Historical perspective and the policy development The first controls of drug possession were introduced in the First World War, and in the Dangerous Drugs Act of 1920 (Stimson, 2010). At this time, prescribing heroin and morphine was considered legitimate medical treatment for people who would otherwise be unable to withdraw- a very similar concept to the harm reduction strategy known today- and thus helping the patient lead a useful and fairly normal life. The harm reduction approach to drug use first developed among Dutch heroin users in the 1970s. The original Junkiebond (users union) of Rotterdam spread fast into a national federation which successfully negotiated substantial decriminalization, the prescription of methadone, and the provision of clean needles and syringes. The new approach rapidly spread through Germany, Austria, Switzerland, the UK, France, and other northern European countries (Des Jarlais, 1993, Van Solinge, 1999, Gowan et al., 2012). CHAPTER 4 POLICY ANALYSIS 4.1 Drug Policy Despite the long-standing political prominence of the problem, relatively coherent strategies and substantial investments, the United Kingdom has the highest level of dependent drug use and among the highest levels of recreational drug use in Europe (Reuter, 2007). There are vast arrays of different policies and programmes working towards solving problems related to drug use and drug related harm at all levels, and they vary considerably in their effectiveness. In this chapter, policies in the United Kingdom in general and England in particular will be considered. The United Kingdom consists of England, Wales, Scotland and Northern Ireland, within which England accounts for 85% of the UK population (Office for National Statistics, 2012). A number of powers have been devolved from the UK Parliament to Wales, Scotland, and Northern Ireland, but each has different levels of devolved responsibilities. The United Kingdom Government is responsible for setting the overall strategy and for its delivery in the devolved administrations only in matters where it has reserved power (Department of Health, 2011). In the United Kingdom, illicit drug policy and attitude towards harm reduction strategies has shifted with government changes. Between 1987 and 1997, there was a public health approach. The aim was to help problem drug users to lead healthier lives, and to limit the damage they might cause to themselves or others (Stimson, 2000). Harm reduction developed in a context of a healthy policy although there were hitches in getting it accepted, for the most part it was well integrated into an amenable existing framework (Stimson, 2000). In 2002 the Liberal Democrats launched new drug policy in which it was proposed that imprisonment should no longer be a punishment option and cannabis should be legalised. The Lib Dem policies were evidence-based, rejecting artificial distinctions between the harm caused by legal and illegal drugs, and rejecting enforcement and prison as primary policy tools based on evidence of ineffectiveness. Unsuccessful in promoting their policies in 2002, in 2011, experts backed calls to be made at the Liberal Democrats conference for the decriminalisation of all drugs, saying it would not lead to a surge in drug use (Travis, 2011). This call came not long after the launch of a new drug strategy, launched in December 2010, replacing that of the previous Government. The 2010 strategy sets out a fundamentally different approach to preventing drug use in communities, and in supporting recovery from drug and alcohol dependence. Some of the main aspects include the responsibility it puts on the indi vidual to seek help and overcome dependency as well as providing a more holistic approach, by addressing other issues in addition to treatment to support people dependent on drugs or alcohol, such as offending, employment and housing. The 2010 strategy aims to reduce demand and takes an uncompromising approach to crack down on those involved in the drug supply both at home and abroad. With the devolution of power, it puts accountability in the hands of local communities to tackle drugs and the harms they cause. The coverage of the new strategy is as follows: à ¢Ã¢â€š ¬Ã‚ ¢ health, education, housing and social care confined to England à ¢Ã¢â€š ¬Ã‚ ¢ policing and the criminal justice system England and Wales à ¢Ã¢â€š ¬Ã‚ ¢ the work of the Department for Work and Pensions England, Wales and Scotland (Home Office, 2012) The Scottish Government and Welsh Governments national drug strategies were published in 2008 and all three strategies aim to make further progress on reducing harm and each focuses on recovery (Department of Health, 2011). The changes in the Governments drug policies have not gone without remark. In response to the change in Government strategy, the recently published document Charting New Waters from the UK Drug Policy Commission examined potential threats to drug services. The radical shift from centralised oversight toward local control of commissioning services, raised concerns and questions about whether the changes will deliver the outcomes that people need or help control public expenditure. The report concludes that the new policy is a major social experiment, the outcomes of which are uncertain (OHara, 2012). Research by the UK Drug Policy commission has shown that in addition to the reforms to police, justice, health and local council services in England, these systemic changes together with the budget cuts risk reducing the ability of local areas to respond effectively to problems caused by illicit drug use (Beck 2012). 4.2 UK policy approach As is the case in most European countries, drug-related deaths, infectious diseases, co-morbidity and other health consequences are key policy issues within the United Kingdoms drug strategies (EMCDDA, 2012). Interventions include information campaigns on the risks associated with drug use for different target groups, as well as information on safer injecting and safer sex practices, needle exchange schemes, infection counselling, support and testing, and vaccinations against hepatitis B. In most parts of the United Kingdom, particularly in England, there is a four-tier system of treatment for drug abuse. Tier 1 refers to generic interventions such as information and advice, screening and referral to more specialist services. Tier 2 refers to open-access interventions, such as drop-in services providing advice, information and some harm reduction services such as syringe exchange. Tier 3 services are specialist community services and include prescribing services, structured day programmes and structured psychosocial interventions, such as counselling and therapy and community-based detoxification. Tier 4 services are inpatient services, including detoxification and residential rehabilitation. The majority of structured treatment is delivered at Tier 3, predominantly through community-based specialist drug treatment services (EMCDDA, 2012). 4.3 Drugs and the law The Misuse of Drugs Act 1971, with amendments, is the main law regulating drug control in the UK. Drug use per se is not an offence under the Misuse of Drugs Act 1971: it is the possession of the drug which constitutes an offence (EMCDDA, 2012). The Misuse of Drugs Act 1971 divides controlled substances into 3 Classes (A, B, C) based on harm, with Class A being the most harmful. The classification of a drug has several consequences, specifically in determining the legal penalties for importation, supply, and possession, as well as the degree of police effort targeted at restricting its use (Nutt et al., 2007). The actual classifi

Good People in Cannery Row Essay

John Steinbeck’s Cannery Row, on its surface, is a very simplistic book in which its plot does not have any significant impact on its universe, let alone its characters. However, if one might delve deeper into Steinbeck’s clever subtext and rich overtones, a world of bliss and beauty can be found. Cannery Row, is a book where its characters are self-described as â€Å"Whores, Pimps, gamblers, and sons of bitches† and yet called â€Å"Saints and angels and martyrs and holy men† on the very same page (405). The point of these contradictions is to comment on society’s view of Morality. This is specifically noted when one of the main Characters, Doc, says â€Å"It has always seemed strange to me†¦The things we admire in men, kindness and generosity, openness, honesty, understanding and feeling, are the concomitants of failure in our system. And those traits we detest, sharpness, greed, acquisitiveness, meanness, egotism and self-interest, are the traits of success.† When referring a group of Former homeless men called Mack and the boys (505). Mack and the boys are a group of bums that live in the row, and often do nothing but drink alcohol. These men never do anything necessarily heroic, or daring, or even Courageous, but these men are the most moral individuals in the entirety of Cannery Row. Through the Scenes following Mack and the Boys, John Steinbeck develops Idea that despite their lack of ambition, they are viewed as morally upstanding individuals, who have a positive impact on society. With their happy go lucky nature, and simple needs, these men can achieve the impossible. One might think that they are very unintelligent individuals due to their standard of living, but that couldn’t be farther than the truth. Time and time again they prove themselves to be people that are not only capable, but show extraordinary prowess in certain fields. One of these men, for instance was gay. When referring to his mechanical ability, Steinbeck narrates â€Å"Indeed there are men near   Whom a car runs better. And such a one was gay. His fingers on a timer or a carburetor adjustment screw were gentle and wise and sure.† The way he listens to the ills of automatons, it is of no impossibility he could have become a wealthy mechanic, fixing cars in a garage of his owning. Gay Instead enjoys his time at the flop house, drinking and talking the day away. All Gay really wants, is to have a good time, and for the others around him to do the same. This is a key component of why gay is a moral citizen of society. Gay is often able to do wrong, but never is willing. Gay lives with an abusive Wife, which constantly beats him. He never wants to, but occasionally he has to return the favor. He used to get thrown into jail because of this, but that he liked the conditions in jail, so his wife beats him while he sleeps instead/ Gay, specifically, is an interesting case, because he has a life in which is deeper than one might believe. he is the only one to have a life of suburbia waiting for him. Gay lived a world in which he had a house and a loving wife. Through another lens, Gay was trapped in a cage with a woman that beats him so much that being put in jail is sweet relief. Despite this, Gay eventually always choses to go back to his wife. He believes that he is wrong in the situation and returns to his wife trying to be a better man. That truly is the reason why he is an upstanding person. He’s a very humble and simple creature, who just wishes to enjoy life. Another Example of such ambition would the leader of the group, Mack. Mack is by far, is the flop house’s driving force. When leading the group, he is a moral center, and the speaker of wisdom; when alone, he is a very tragic man. Throughout the book, Mack and the boys only ambition was to throw a party for Doc, a local good Samaritan. When this ambition ends in failure, he proclaims: It don’t do good to say I’m sorry. I’ve been sorry all my life†¦I had a wife†¦same thing. Ever’thing I done turn sour. She couldn’t stand it no more. If I done a good thing it got poisoned up some way†¦I don’t do nothin’ but clown no more. Try to make the boys laugh. (496) Mack seemingly is the only one who doesn’t lack ambition by choice. Whilst in with the other, Mack often is the one to set goals, albeit small ones. This is where the true tragedy of his character comes in. No matter what he does, or hard he works, all of his plans inevitably turn to failure. Mack is a man of good intentions, and made of good morals, but he is seemingly cursed with bad luck, and the world reacts as such. One of Mack’s greatest qualities is his way with words. A lesser person might use his power of speech craft to control the populace, and shape the world in his image, but Mack just wants to have fun. Whenever he uses this sort of power, he is always talking about doing something for someone else. The adventures of Mack and the boys is filled with irony: Gay having a wife that beats him, Hazel likes conversation, but hates talking, or having a party for someone who doesn’t attend. Perhaps the most ironic of all is that despite their lack of ambition and lazy attitude, their actions Influence everyone around them. All throughout cannery row, people would look on to these men, and get inspired in some way. One of the greatest examples of such inspiration is the aforementioned Doc. Even though Mack and the Boys destroyed his home by throwing a party for him, without him, he still holds them in high regard. â€Å"The sale of souls to gain the whole world is completely voluntary and almost unanimous—but not quite†¦You know how they tried to give me a party and it went wrong. But they wanted to give me a party. That was their impulse. â€Å"(505). What Doc is saying here, is that he respects the lifestyle that Mack and the Boys have chosen, and thinks of them as moral even though things don’t go their way. This is  Implied in a number of ways. Initially, he denotes the idea of throwing the party was on a whim of theirs. This is a Reference to the continuing notion of their lack of aspiration. Mack and the Boys don’t do things for certain reasons, they just decide to act whence they get the inspiration. Furthermore, he begins with a metaphor comparing the Consumerist system, a place where you have to work for a place you often hate, to selling your soul, giving away your humanly essence and personality. This metaphor works well contrasting with the boys, to those who seemingly suffer from working into monotony. Doc is implicating that their way of spontaneity is a way wherein they have the capability to do good. Steinbeck often uses these sections with Doc to illustrate the importance of the boy’s actions. Whenever Doc speaks of them, he outlines how â€Å"[business] men are sick men†, and how the boys are â€Å"healthy and strangely clean† (504). Mack and the boys don’t have that thirst that humans often have. That hunger for Silver stitching and velvet bed sheets. Steinbeck uses a group of happy homeless men as a symbol for the importance of caring for one another, while living in the moment. Mack and the boys outline how to do well in life, without selling one’s soul for wealth and power. Morality is often a tricky subject to tackle – and often when it is tackled, it’s not done well—But Steinbeck has it pegged. One might think that things such as be considerate of one another and be humble would be simple Ideologies for a book to go behind, Steinbeck does it justice. Cannery Row Shows just how people react to good deeds, as misguided as they are. John Steinbeck’s Cannery Row, on its surface, is a very simplistic book, but it is so much more.

Careers in law are open to all and the legal profession is sufficiently diverse. Discuss.

Introduction As a minority group, women have traditionally remained underrepresented within the legal profession. Whilst careers in law may, theoretically, be open to all, the reality is that due to the physiological make-up, maternalistic nature and historical suppression of women in society they have struggled to break entry into the traditionally male-dominated and elitist profession. This essay will argue that although efforts have and are continuing to be made to make a career in the law accessible for women, one could argue that the profession cannot yet be deemed sufficiently diverse as challenges continue to face women who elect to work with this profession. This essay will begin by summarising the history of the position of women in society, move to look to the challenges that face women and employers and finally, summarise steps that can be taken in an effort to eliminate such restraints. Women have fought a long battle against subordination. As late as the twentieth century, in England and Wales, women remained legally subordinate to men. In other cultures, this position remains in practice today. In England and Wales, coverture referred to the rights of women being subsumed by those of her husband through common law marriage. This legal doctrine left women without an identity and gave her husband control of her, her property and the custody of her children. Marital rape was not outlawed until R v R came before the House of Lords in 1992. Society saw women merely as objects of their husbands. It was not acceptable for women to study medicine or law or to engage in politics. Liberal ideals were quashed by the belief that women were irrational, temperamentally unfit to deal with such subjects and their place was in the home being a subservient wife and maternal parent. During the war effort, in particular, women proved that they were capable of holding down important r oles within the workforce and society more generally, and were seen as rational and intelligent in their thinking as their male counterparts. Women were granted suffrage in 1928 through the Equal Franchise Act and have since broken down the barriers into almost all professions. Despite, in theory, women having the ability to do everything a man can do, challenges remain that make it difficult to suggest that men and women are truly equal. Both society and the legal profession now support women embarking on careers within the industry. By 2008-9, 60% of all new admissions to the Roll were women and 52% of those called to the Bar in the same year were women. The Bar society indicated that in 2009, 34% of barristers were women. These figures demonstrate that women now make up over a third of all barristers, however, barristers are usually well educated and often from high socioeconomic standing, so this figure does not fully represent whether the legal profession is diverse for the average woman. Statistical evidence also proves that women still struggle to be appointed to the highest positions within the legal profession. Few women are promoted to Queen’s Counsel and the first woman to sit within the House of Lords was only appointed to this position in 2003. Women are traditionally paid lower than men. The Equal Pay Act 1970 has attempted to solve the disparity between the male and female pay gap, however, it is not uncommon for a case of this nature to arise. Recently, an employee sued her employer, Lewis Silkin, on the grounds that she was being paid lower than a male counterpart. Arguments suggest that due to the more emotional, sensitive and maternalistic nature of women in comparison to men, often women opt to specialise in different areas of law, such as family or personal injury law rather than male dominated specialisms, such as corporate or banking law. Family and personal injury law are also often less high-profile and do not hinge on lucrative deals so the specialisms are often not as well paid. To dismiss a woman for falling pregnant and wanting maternity leave is unfair dismissal. Pregnancy does, however, play an important role in this debate. Most employers would assume that a young woman will take a break to have a baby in the future and the fact that having a child is traditionally less disruptive to the work life of a man, it makes the male counterpart a cheaper and safer option in the long-term. A break in work is seen as disruptive and employers need to fill that position during the maternity leave, effectively causing the employer to pay twice for the same job to be completed. In a time when employers are facing tough economic times, having reliable staff that do not have to be replaced for extended durations appears, on face value, to be commercially viable option. Furthermore, there is a concern for the employer that childcare issues may cause disruption and lost working hours when the employee does return. Legal professionals who are self-employed, such as barris ters, can find the transition far more difficult in terms of covering their living costs and retaining clients during maternity leave and the stress of a new baby when they later return to work. In 2004, the Bar Council published policies that cover the issues of maternity, paternity and flexible working hours in an attempt to balance family life and legal practice. To actively reflect this aim, the policy has increased the time a barrister’s seat may be open rent free with Chamber’s expenses from three months to one year. In Heard and another v Sinclair Roche and Temperley (a firm) and others, it was ruled that the firm had unlawfully discriminated on the grounds of family status and combined with unlawful sex discrimination, constituted unfair treatment. This claim arose when the firm failed to promote or progress the individual. The firm had a total of 36 partners and only 6 were women. This case suggested that women are also less likely to be appointed to managerial positions, particularly if the dominating power is male. Other arguments suggest that women are more emotional than men and office politics are more present. Webley suggests that women struggle to progress in the profession for a variety of reasons including masculine office culture, the pressure of working long hours and high billing targets and dissatisfaction with commodification’s effect on work quality. In terms of the legal profession, lawyers represent the legal position of their client and to do so, must relate well and truly understand the situation of their client. If all lawyers were men, one could question whether women in society could ever be adequately represented by the legal profession. There is an argument to say that there is as much a place for women in the profession as men, as women solve problems in a different way, can be more compassionate and can balance an all-male work environment. Parliament has made attempts to allow greater access to the legal profession to minority groups by enacting legislation such as the Courts and Legal Services Act 1990. The main purpose of this enactment was to reform the legal profession after the findings of the Benson Commission in the 1970s. To the judiciary, in particular, important changes were made to appointments and pensions and significant changes were implemented towards the organisation and regulation of the legal profession. The Constitutional Reform Act 2005 later recommended that an independent body should be created to deal with the appointment of judges, which came after criticism from the Law Society regarding the old system. Such legislative and societal support towards the accessibility and diversity of the legal profession should instil a hopefulness into affected women that the profession is moving in the right direction. There have been several attempts by the profession itself to promote and encourage accessibi lity and diversity. The PRIME initiative saw 23 UK and Irish law firms come together to form a ground-breaking initiative to increase social mobility through a wide ranging work experience scheme. Whilst this initiative focused more on socioeconomic status rather than gender, the results suggest that real opportunities within the legal profession have been offered to those who are otherwise unlikely to have been given the opportunity. In conclusion, the legal profession is not yet sufficiently diverse. Both historical and contemporary statistics prove a bias towards men due to the maternalistic nature of women. Statistics demonstrate a trend that the profession is moving in the right direction in terms of equality, diversity and accessibility for women, however, the battle for truly equal treatment, rights and pay for both genders is an ongoing issue within the legal profession, as it is in society generally. Historically, women were refrained from having an identity and practicing within the legal profession because they were considered irrational and incapable. Whilst that perception has clearly disappeared, which is a positive shift, women still face challenges due to the physiological differences between men and women. These differences will never change and unless there is a shift in the mentality of employers’, these are likely to be challenges that remain for the duration. One could argue that the ba ttle between equality and diversity within the legal profession and commercial viability for business owners will never truly resolve. Bibliography Deborah, L. ‘Title of the article’ [2001] Women and the Legal Profession 156 Fredman, S. ‘Discrimination Law’ (New York, United States: Oxford University Press Inc, 2001) Leighton, P. ‘Discrimination and the Law’ (Camp Road, London: Short Run Press, 2004) Macdonald, L. ‘Equality, Diversity and Discrimination’ (Camp Road, London: Chartered Institute of Personnel and Development, 2004) McColgan, A. ‘Discrimination Law’ (North, America: Hart Publishing Co, 2nd edn., 2005). Roach Anleu, S. ‘Law and Social Change’ (City Road, London: Sage Publication Limited, 2000) Sargeant, M. ‘Discrimination Law’ (Essex, England: Pearson Education Limited, 2004) Sommerland, H., Webley, D., Duff, L., Muzio, D., Tomlinson, J. ‘Diversity in the Legal Profession in England and Wales: A Qualitative Study of Barriers and Individual Choices’ Suddards, H. ‘Sex and Race Discrimination’ (Camp Road, London: Chartered Institute of Personnel and Development, 2nd edn., 2002) Webley, L., Duff, L. ‘Women Solicitors as a Barometer for Problems within the Legal Profession: Time to Put Values before Profits?’ (2007) 34 Journal of Law and Society 374 Wilkins, D. ‘Rollin’ on the River: Race, Elite Schools, and the Equality Paradox’ (2000) 25 Law and Social Inquiry 527 Cases Heard and another v Sinclair Roche and Temperley (a firm) and others [2004] All ER (D) 432 (Jul) R v R [1992] 1 A.C. 599 Legislation Constitutional Reform Act 2005 Courts and Legal Services Act 1990 Equal Franchise Act 1928 Equal Pay Act 1970

Eating Disorders And Body Image Issues - 1655 Words

Eating disorders: noun. A group of psychological ailments characterized by intense fear of becoming obese, distorted body image, and prolonged food refusal (anorexia nervosa) and/or binge eating followed by purging through induced vomiting, heavy exercise, or use of laxatives (bulimia nervosa).These ailments are not pretty. In this society, where only the fit and thin bodies are accepted and appreciated, eating disorders are more common than they should be. Children, starting at a young age, see skinny people on television and in magazines. They hear comments on how their bodies look, then hear the same people turn around and make nasty comments on someone else’s figure. This is not okay, because it is teaching young people that anything†¦show more content†¦In sports, there is a heavy praise on athletes who can stay fit and thin, causing more young people to constantly focus on being thin. (source 4) Even athletes without an eating disorder might have a constant focu s on being as thin as possible! This is very unfortunate, because development of an eating disorder may cause an athlete’s performance rate to decrease, even though what was wanted was a higher performance rate. Vegetarians are at a very high risk for eating disorders; they’re at a higher risk than any other group. (source 5) â€Å"While vegetarianism can be a healthy lifestyle choice, it can also be abused.† (source 5) There are even people who believe that eating disorders are not a disease and are actually a lifestyle choice! Some of these people run websites, called ‘pro-ana’ and ‘pro-mia’ websites. These websites overlook or romanticize details of these eating disorders, such as how, â€Å"eating disorders can lead to anxiety, depression, alcoholism, substance abuse, self mutilation, and suicide.† (source 3) Pro-ana and -mia websites are open to the public and support eating disorders, calling them a â€Å"lifestyle† not a disease. (source 3) These websites were brought to the public’s eye through media. â€Å"[Pro-ana and pro-mia websites] emerged as an online subculture in 2001 when several websites glorifying