READINGS 180.docx

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Week 1
Clinical trial: the muddled Canadian landscape
- the industry, government and academia will have to collaborate to maintain/increase
Canada‟s share of clinical trials in the global market
- The problem is that it‟s hard to recruit physicians/doctors to run trials
- Pharmaceutical companies are the main sponsors of clinical trials in Canada
- The majority of the companies‟ research and development spending was in Ontario and
Quebec
- With the number of clinical trial sites, Canada ranks fourth in the world
- Pharmaceutical companies are outsourcing clinical trials to contract research
organizations, which organize trials in community and hospitals
- In the future Canada will focus on targeted drugs producing bigger effects in smaller
populations as opposed to having large number of patients and looking at small effects
- Challenges facing the clinical trial industry include
o Lack of basic info about clinical trial landscape in Canada, lack of cooperation
among parties (i.e. hospitals)
o Increased complexity of documentation required for clinical trials, lack of
standardization of contracts and among research ethic boards
o Public‟s lack of confidence in pharmaceutical companies and difficulties
recruiting patients for trials
o Trials that are unnecessarily complex or uninteresting, requires time and huge
money
o Language/cultural challenges, different provinces have different privacy
legislation that organizers have to cope with for Canada-wide trials
- 1%-3% of the eligible Canadian population participates in clinical trials
- For Canada to prosper in clinical trials, there must be cooperation between academics and
pharmaceutical companies
Health Services Minister Kevin Falcon and Big Pharma target research group
- Therapeutic Initiative (TI) is a world renowned drug-research program
- TI saves lives and money; it provides unbiased, evidence based info on wide variety of
drug therapies
- NDP health critic said that the B.C. liberals are getting rid of the TI because their funders
in the pharmaceutical industry don‟t like the independence of the TI
- Meanwhile drug-industry lobby groups are saying that TI was contributing positively and
improving BC‟s health care
Generation Rx: Taking action on teen prescription drug abuse
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- Opioids are prescribed to manage chronic or severe pain
- Linda Gardiner‟s son died of addiction to OxyContin, a pain reliever
- In Toronto, 2007: 21% of students (grade 7 grade 12) admitted to taking opioid for non-
medical purposes in the previous year. Over ¾ of them got the drug from their home
- Canada is the world‟s top per capita consumer of a number of opioids, this easy access
pays a big role
- Canada forbid direct-to-consumer prescription drug advertising ads can only name a
drug or what it treats, not both
- Federal govt‟s new national anti drug strategy
o Too focused on high profile illicit drugs
o Doesn‟t support for harm reduction strategies
- Strategies that aim to identify individuals at high risk for diversion
o Cost more, have a low impact
- Strategies that aim to identify liberal prescribers work better
- Few provinces have prescription monitoring programs, i.e. Nova Scotia
- Community‟s integrated approach to solve problems are effective
o Police, health authorizes, educators, doctors, pharmacists, parents
- Partnership consists of 3 working groups:
o Education and prevention
o Treatment
o Community safety
- Best way to control Prescription Opioids
o Education & Awareness Campaigns
o Strong Anti Diversion Policies
o Drug Monitoring Programs
Week 2
Drug courts: Conceptual foundation, empirical findings, and policy implications
- Drug courts have emerged within the last two decades and they divert greatly from the
traditional judicial practices
- To strengthen drug courts, the theory that they are based on have to be anchored to
policy, policy to practice, and ultimately, practice to evidence-based outcomes
Why drug courts were created:
- The zero-tolerance crackdown of the war on drugs initiated in the early 1970‟s created so
much backlog in the Criminal Justice System (CJS) that an alternative was necessary
- Miami, U.S.A. was the first to have a drug court, then Canada; Australia and Macedonia
also have them
- To try a new method since the prevailing courts have failed
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Criminal Court vs. Drug Courts
- Criminal courts operate on the basis of an adversarial model, prosecutor and defense
serve incompatible interests and the judge rules
- Instead of punishment, drug courts believe in “motivational sanctions” or “incentives for
ensuring compliance”
- Drug courts have an integrated component of the treatment team instead of an
independent legal advocate
- Traditional courts emphasize on free will, individual choice and personal accountability,
all this contradicts the deterministic, pathological and even biological basis from which
drug addiction treatment flows
- The judge‟s role in a Drug Court has been compared to the role of a “guardian angel”
who is constantly watching over, whereas at traditional courts, the judge “plays god”,
holding the defendant‟s destiny; some view the judge‟s role at drug courts as Non-neutral
- These formal adversarial rules generally don‟t apply to Drug courts
- Most drug courts are not technically an adjudicatory process; in most cases the defendant
does not need to plead guilty or innocent, they can avoid prosecution completely and
participate in a treatment regimen instead (almost like a judicial probation)
Problems with the Drug Court:
- Participating clients have to receive counseling and remain substance free, all this is
viewed to be “highly demanding”
- failure to do results in a much longer sentence than what they would have gotten
previously
- personal investment in this treatment is not worth the dispositional trade-off especially
for a defendant facing a short-sentence
- it has been noted that the very presence of drug courts is generating more arrests and
prosecutorial filings in the kinds of low-level drug cases that simply would not have been
bothered with before, and when these people fail to comply, they get sent to jail, so
essentially it is increasing the number of people going to jail
- questions raised about whether it is ethical to force treatment upon someone
- according to labeling theory, it might be stigmatizing more offenders at drug addicts
- another critique is that, drug courts are full of judges who think they are doctors, and
view drug addiction as a disease
Good things about the Drug Courts:
- Their ability to mobilize community support and resources through a team-oriented
approach to building partnerships with the key stakeholders
- Punitive approach of the traditional courts don‟t work for severely addicted criminals,
they have a tendency of relapsing, drug courts try to restore and rehabilitate them
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