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 Organisation’s 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 didn’t. 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 individual 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: â€¢ health, education, housing and social care – confined to England â€¢ policing and the criminal justice system – England and Wales â€¢ the work of the Department for Work and Pensions – England, Wales and Scotland (Home Office, 2012) The Scottish Government and Welsh Government’s 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 Government’s 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” (O’Hara, 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 Kingdom’s 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
International Development homework help. This is a paper that is focusing on identify a common theme in media representations of substance use. The paper also provides additional information to use in writing the assignment paper clearly.,Identify a common theme in media representations of substance use,Media Analysis Option: In this paper, you will analyze in detail a common trope in media representations of substance use. Your paper will identify a common theme in media representations of substance use and will use examples from a few pieces of media that demonstrate how this trope is represented (ideally, 2-3 pieces of media in order to both demonstrate a trend and provide in-depth analysis of your primary sources). Your analysis should also explain how social locations such as gender and race work within or modify the use of this trope. You will use scholarly support to help explain why this trope is damaging, stigmatizing, positive, or inaccurate.,SOURCE REQUIREMENTS: You must incorporate a minimum of 3 peer-reviewed, scholarly sources into this paper, one of which must NOT be assigned materials from this class. Scholarly sources include articles from academic journals and researched nonfiction books. You are to incorporate other kinds of sources as needed, such as popular media or pieces from journalistic publications, but these do not count toward your final source count.,When you incorporate these sources, they must be properly citation within the body of your paper. You must include a Works Cited page at the end of your paper. You may cite these sources in whatever citation style you are comfortable with. (,MLA, APA, Chicago,, etc.), but please be consistent in your formatting.,LENGTH AND FORMATTING: Your paper must be a minimum of 3 pages long and a maximum of 4 pages long. For consistency, please format your paper in size 12 Times New Roman font, double-spaced, with one-inch margins on all sides.,Attachments,Click Here To Download,International Development homework help
You Decide External Auditing.
Smackey Dog Foods Inc. started in the kitchen of Sarah, Kim, and Jillian’s family home in the suburbs of Chicago. The three sisters initially bought the ingredients for their natural dog food recipes from the local grocery store. They used their dogs and the neighborhood dogs as their taste testers. Their dog food products were so good, the local kennels and veterinary offices were glad to distribute the sisters’ products to their customers.Local demand increased significantly. Local pet stores and small grocery stores discovered the products and became distributors. The sisters moved the expanding business into a larger facility and hired a few more workers. Although their competitors’ sales were flat or declining, Smackey Dog Food Inc.’s sales were on a vertical climb!Sales were so good last year that the sisters opened a boutique division named Best Boy Gourmet, specializing in freshly manufactured, one-serving packages meant for consumption no later than 3 days after production. They sell this product at three times the cost of their other products and by special order only through their new website. Demand is high, but waste has been an issue.Sarah is the president and general manager of the operation. Sarah has been very proactive in growing the business. She has met with her banker to discuss expanding the facilities and equipment with another $150,000 loan. Their first loan for $150,000 was secured by the industrial-size food production equipment purchased with the loan. The banker now demands an audit of the corporate financial statements before releasing another loan to the company. Sarah has offered to place the corporate account receivables up as collateral to secure the second loan. Based on revenue projections by her sister Jillian’s sales team, Sarah believes that the company will not have trouble paying down the loan in a short period of time.Kim manages the production operations. She oversees the inventory, production, and shipment of dog food products. The Best Boy Gourmet line has taken almost all of her attention lately. The winter holidays are approaching, and sales demand based on forecasts from the sales force are higher than ever. Attaining fresh, raw ingredients is more difficult in the winter months. If any of the fresh ingredients are delayed, production comes to a standstill. There has been significant inventory waste as a result.Kim’s assistant, Henry, monitors the production and shipment of Smackey Dog Food’s regular line of product. Henry takes pride in his work and is involved in every facet of the operation. With only one other warehouse employee to help, Henry personally is involved in preparing and approving all inventory records. Henry ensures that very little finished inventory sits in the warehouse. However, the shipping dock always seems to be full of returned dog food that should be restocked. When Kim asks him about it, Henry laughs and tells her that “first in, first out” applies to dog food returns as well. Kim smiles and just accepts that answer.Jillian is not very good at understanding accounting. The sisters placed Jillian in charge of sales. She manages a sales team of 12 salesmen in Illinois, Indiana, and Wisconsin. Her fear of flying and poor driving skills limit her ability to get around to the areas outside of Chicago. As a result, she has placed a lot of faith in her sales team. The sales team complained last year that they did not like waiting for their commissions until after bookkeeping calculated the actual revenues. In order to keep their spirits fired up, Jillian has her sales people project what their sales will be in the upcoming quarter, and she pays commissions in advance on those projections. The sales team loves her, and Jillian loves their approval. Jillian has noticed that the projections typically are off by 11% on average.The employees of Smackey Dog Food Inc. all own dogs. It was a hiring requirement on the job application. One employee was fired when it was discovered she never owned a dog when she was hired. A lawsuit is pending by the fired employee.At this time, the receivables represent 29% of the corporate assets. The Chicago retail chain Pup Stores Co. is Smackey Dog Food’s largest buyer. It alone represents 31% of overall sales and usually pays within 30 days. However, Pup Stores is facing a major lawsuit from an animal rights group. The legal fees are eating into the company’s cash reserves, and it is facing some store closures.The accounts receivable aging indicates that 38% of the receivables are 30 days or less. Twenty-two percent are 31–60 days. Twenty-one percent of the receivables are 61–90 days old. Ten percent are 90–120 days. The remaining receivables are older than 120 days. Sarah has not written off any of the receivables, nor will she.Sales are projected to steadily grow at 16% next year if the company does not expand its facilities. With the expansion, sales are projected to rise 26%, with the most significant jump in the last quarter after expansion is completed and holiday sales pick up.Your RoleYou and your firm, Keller CPAs, have never audited a dog food manufacturer. Although it is late in the year to be accepting a new calendar-year-end audit, you need the work and have the time to devote to the audit before your 2-week ski vacation in February.You begin the audit process just prior to year-end by sending your audit manager, Pete, and two audit staffers, Ben and Maureen, out to the client. They spend time assessing the client and planning the audit.During the first month of field work after year-end, Ben and Maureen note that the dog food bags piled high on the docks are marked “Returned.” One employee is seen throwing bags of the premium Best Boy Gourmet dog food into the dumpster in the morning and pulling it out and throwing it into Henry’s car during the employee lunch hour.Pete’s new best friend, Alan, was married to Smackey Dog Food Inc.’s owner, Kim, 4 years ago. Alan is also good friends with the banker from whom Sarah is seeking the loan. Pete is unaware of the relationship. Pete has talked about some of the details of the audit to Alan over a few beers.Required : During our course, each of you will prepare one short (five to seven pages, double-spaced) paper based on the Smackey Dog Food Inc. case facts above. The purpose of the project is to move you beyond the black letter into the actual practical application of legal principles in real-life situations. The project case is due at any point before the end of Week 7. It serves to highlight the importance of audit opinions and reports. This project gives you an opportunity to conduct certain audit procedures and determine the course of action regarding the audit.Note : You are being graded on analyzing issues you identify in the project case, in addition to responding to the questions listed in the YD_Activity (see link below)Use the YD_Activity document to answer the questions related to this scenario.documents–yd_activity_smackey_dog_food.docx
You Decide External Auditing
MRKT 001 WLAC Handling an Irate Customer Who Has Been a Good Client Discussion
MRKT 001 WLAC Handling an Irate Customer Who Has Been a Good Client Discussion.
I’m working on a business question and need a sample draft to help me learn.
How would you handle an irate customer who has been a good customer and you want to keep, after your having made a major mistake? Or, give a real-world experience you have had or observed.In most case very few words would not suffice. Respond as if you were presenting to your classmates in the physical classroom or writing a presentation. Please be sure that you have substance in your DI. Demonstrate having studied the current chapter and complete the other assignments and reading before responding to the DIs. For more guidance be sure you have read and understood the announcements regarding the DIs.
MRKT 001 WLAC Handling an Irate Customer Who Has Been a Good Client Discussion
AMU Wk 2 Hacking & Hackers Technological Skills & Complex Programming Discussion
term paper help AMU Wk 2 Hacking & Hackers Technological Skills & Complex Programming Discussion.
Answer Stated question and respond to two classmate’s post. 250 words eachStated Discussion Questions: How are definitions of computer hacking and hackers constructed and often contested? Assess how political, criminal justice and popular representations of hackers embody wider cultural concerns about technological and social change. What are some realities behind the myth of hacking as an expert and elite activity?Classmate 1 Sesan: One of the more highly publicized categories of cybercrime involves hacking, which can be defined as any activities involving an attempt to gain unauthorized access to IT systems’ (Furnell, 2009). Hacking is used as a broad term in the media and could be considered as too simplistic as there are a number of different sub-groups. For example, a white hat or ethical hacker infiltrates a system without causing any damage in the process and such an individual can be hired by companies to find weaknesses in security systems. Alternatively, some hackers unrequested, infiltrate systems in order to highlight frailties and report it to the organization in order for them to improve their security. While there is obviously a benign motivation for such activity, it is still an illegal act (as a form of trespassing) and hackers can be prosecuted even without having done any damage (Aiken et al. 2015). Conversely, black hat hackers penetrate computer systems with the specific purpose of causing damage or accessing unauthorised information. Grey hat hackers may seek opportunities to exploit systems in the hope of obtaining a monetary reward and may cause malicious damage to an individual or organisation they deem to be unethical. Kirwan and Power (2012) discussed the ‘dark figure’ of hacking; that is, the difficulty of knowing just how much hacking occurs due to issues in completing methodical surveys, attackers not wanting to incriminate themselves, victims’ disinclined to report hacking, and victims who may even be unaware and therefore unable to report. In terms of social developments, what has emerged in recent years is an unusually strong political culture in hacking. There now exists the figure of the hacktivist who draws ‘on the creative use of computer technology for the purposes of facilitating online protests, performing civil disobedience in cyberspace (Gunkel, 2005). Hacking began as an ‘intellectual curiosity’ arguably with hints of vandalistic overtones, it now has distinct overtones of political and social protest. However, at the same time, such exploits require reasonably high levels of technical expertise, but such is not necessarily required in order to gain access to a system. Cybercriminals have become adept in hiding their illegal activity online. It is important to remember that what is commonly called ‘the Web’ is really just the surface Internet, beneath that surface content lies a vast, mostly uncharted area known as the ‘DeepWeb’. It is estimated that the surface web accounts for only about 1% of all content online; the remaining 99% is housed in the deep web (Aiken et al. 2015). The Onion Router (is so-called because of its many layers of security) is one of the gateways to purposefully hidden information in the Deep Web (Kotenko, 2014 as cited in Aiken et al. 2015). The Deep Web and The Onion Router are designed to anonymise users; it also has a function for whistleblowers, activists and confidential sources (Kotenko, 2014). Deep web and The Onion Router protocols were arguably originally intended for sensitive communications including political dissent; however, in the last decade they have become hubs for criminal black markets that distribute drugs, counterfeit pharmaceuticals, stolen credit cards, child pornography online, pirated media and more. In a financial and corporate context, the threat of cybercrime has been a substantial fear for quite some time, with references to the Internet being a ‘wild west’ type of environment stretching back at least 20 years (Meyer, 1995). That idea, with its associations with general lawlessness, still recurs in information security literature (Moraski, 2011 as cited in Aiken et al. 2015). The 2014 hack of the multi-billion dollar company Sony offers a prime example of the cost of cybercrime, the attack ended up costing the company over $35 million (Seal, 2015). Consequently, it is no overstatement to say that cybercrime presents a very clear danger to the government and our society at large. ReferencesAiken, M., Mc-Mahon, C., Haughton, C., O’Neill, L., & O’Carroll, E. (2015). A consideration of the social impact of cybercrime: examples from hacking, piracy, and child abuse material online, Contemporary Social Science, DOI: 10.1080/21582041.2015.1117648 Furnell, S. (2009). Hackers, viruses and malicious software. In Y. Jewkes & M. Yar (Eds.), Handbook of internet crime (pp. 173-193). New York, NY: Willan.Gunkel, D. (2005). Editorial: Introduction to hacking and hacktivism. New Media & Society, 7, 595-597.DOI: 10.1177/1461444805056007Kirwan, G., & Power, A. (2012). The psychology of cybercrime: Concepts and principles. Cambridge: Cambridge University Press.Kotenko, J. (2014). What is Tor? A beginner’s guide to the underground internet. Retrieved from http://www.digitaltrends.com/computing/a-beginners-guide-to-tor-how-to-navigatethrough-the-underground-internet/Meyer, M. (1995). Stop! Cyberthief! Newsweek, 36-38. Retrieved from: http://www.d.umn.edu/~pcannan/mikemeyer.pdfMoraski, L. (2011). Cybercrime knows no borders. Infosecurity, 8(2), 20-23. DOI: 10.1016/S1754-4548(11)70021-3Seal, M. (2015). An exclusive look at Sony’s hacking Saga. Vanity Fair. Retrieved from: http://www.vanityfair.com/hollywood/2015/02/sony-hacking-seth-rogen-evan-goldberg Classmate 2 Brent: The definition of hacking has changed throughout the years. As mentioned in the content, early hackers were held up as some sort of noble rebel who was just getting into places with no real criminal intent and there was a sort of ‘no harm, no foul’ attitude towards it. This is similar to phreakers that operated right about the time computers were taking more control over phone systems people began to break into the systems. There was, at one point, a rather lively black market trade for a Cap’n Crunch Bo’Sun whistle that could mimic the proper tones to enter into the back-end of a phone system (The Telephone Museum, N.d.). While all of this sounds romantic and Robin Hood like, in reality this is like me who can pick locks strolling into your house and sitting in your favorite chair just to show I can. While I might intend to just walk in and leave, I am still committing a crime. It was somewhat interesting to see that the ‘original hacker’ Lloyd Blankenship said that these things would be ‘dirt cheap if not run by profiteering gluttons’ in respect to his own activities. In reality, there is a lot of research and development involved with programs and all of that costs money. From getting your education in computer science to working on the program and fixing the bugs that pop up, there is a financial tail that tags along with the program and that must be recovered by the programming company. As for the realities behind hacking, there are no real suave hackers out there. The most common hacker is the script kiddie. This is the person who purchases programs created by other, more skilled hackers, to hack other systems or specific targets in order to steal information of money. There are not many true ‘black hat’ hackers in the world and most of the cyber crime is conducted by others who have a more rudimentary understanding of the technology involved.The Telephone Museum. N.d. 2600 Cycles Per Second and the Secrets of the Little Blue Box: Secrets of the Little Blue Box and Why Because of the Captain Crunch Whistle, We Have Apple Corporation and the iPhone. Retrieved from: elephone-museum.org/telephone-collections/capn-crunch-bosun-whistle/
AMU Wk 2 Hacking & Hackers Technological Skills & Complex Programming Discussion
Week 4/5 Group Projects
Week 4/5 Group Projects. I’m studying for my English class and need an explanation.
Engage with your group members in a mini-research project on the working and living conditions for current migrant farm workers.
Each member of the group will focus on a different aspect of migrant life such as working conditions, housing, schooling, medical care, or other topics of interest that you choose together.
Group members will share their findings and together create a slideshow or wiki-page that is a “profile of a migrant worker” to share with the whole class.
You can use the library to find your own research, which must be included on a Works Cited Page with your project. Additionally, each individual member of the group must write a 1-page “Letter to the Editor” of the Pasadena City College Newspaper sharing what you’ve learned about migrant farm workers.
Research Resources might include the following:
• The United Farm Workers: https://ufw.org/ (Links to an external site.)
• “Migrant Farm Workers: Our Nation’s Invisible Population”: https://tinyurl.com/y9mqks9t (Links to an external site.)
• “Immigrant Workers in the U.S. Labor Force,” Brookings Institute: https://tinyurl.com/ycjc3qb8 (Links to an external site.)
• “In the Strawberry Fields”: https://tinyurl.com/ y78wst6d
• “Fingers to the Bone: United States Failure to Protect Child Farmworkers”: https://www.hrw.org/ reports/2000/frmwrkr/
• The National Farmworker Ministry: http://nfwm.org/ (Links to an external site.)
• “Farm Worker Conditions Likened to Modern Slavery” (video): https://tinyurl.com/y92etoxd (Links to an external site.)
my topic is American immigrants’ schooling and housing also I want each of them have 3 sources to annotate the sources
also 1-page of “Letter to the Editor”
Week 4/5 Group Projects
UW Environmental Ethics Martin Schonfeld Climatic & Environmental Critique Essay
UW Environmental Ethics Martin Schonfeld Climatic & Environmental Critique Essay.
Choose one of the following1a) With reference to Leopold’s piece, (i) reconstruct Leopold’s position into clear premises and a conclusion; (ii) articulate two objections to Leopold’s piece (provide examples, provide at least one counter-objection to each objection advanced and attempt to respond to it/them, in turn); and (iii) articulate how one may come to cultivate the kind of attitude Leopold believes is necessary for his Land Ethic (provide detailed examples).1b) With reference to Naess’s piece, (i) reconstruct Naess’s position into premises and a conclusion; (ii) articulate two objections to Naess’s piece (provide examples, provide at least one counter-objection to each objection advanced and attempt to respond to it/them, in turn); and (iii) articulate how one may come to cultivate the kind of attitude Naess believes is necessary for his deep ecosophy-T to thrive (provide detailed examples).1c) With reference to the spirit of Hill, Jr.’s and Williston’s pieces, (i) elaborate upon either one individual practice (your eating practices, exercise practices, work ethic in a non-academic context, etc.) in which you partake or a collective practice in which you partake (your role in some club, your relationship to some person/people, etc.); (ii) attempt to delimit the extremes of the practice (to mimic the extremes of deficiency and excess) and provide an argument to justify your delimitation of these extremes (example: excess of eating=binge eating, deficiency of eating=self-induced starvation); (iii) articulate, given what you argue in (ii), to be the Golden Mean of the given practice; (iv) given the extremes of deficiency and excess defined by you in (ii) and the Golden Mean you establish in (iii), examine and elucidate which virtues attach to this practice and justify why you believe those virtues most closely associate with the practice; (iv) elucidate where you believe you fall in relation to the Golden Mean of the practice and its associated virtues; and (v) elaborate how you might implement a plan (develop phronesis) to more closely meet the Golden Mean of the practice in question.1d) With reference to Schönfeld’s “American Disenlightenment, or Climate Change Made in the USA,” (i) reconstruct Schönfeld’s position into premises and a conclusion; (ii) articulate two objections to Schönfeld (provide examples, provide at least one counter-objection to each objection advanced and attempt to respond to it/them, in turn); and (iii) defend Schönfeld’s position using examples not utilized in the article itself and explain why the examples you propound defend Schönfeld’s position.Choose one of the following2a) With reference to the video on Dr. Shiva, (i) reconstruct Shiva’s position into premises and a conclusion; (ii) articulate two objections to Shiva (provide examples, provide at least one counter-objection to each objection advanced and attempt to respond to it/them, in turn); and (iii) defend Shiva’s position using examples not utilized in the video itself and explain why the examples you propound defend Shiva’s position.2b) With direct reference from both Sioui’s and Morito’s articles, reconstruct (i) Sioui’s depiction of the “environmentally-friendly/concerned ‘Amerindian’s'” relation to Turtle Island (the land and other people (other indigenous peoples and “colonizers”, past and present)), (ii) Morito’s characterizations of the “noble savage”/”ignoble savage”/”the ecological Indian” and each of their relations to Turtle Island (the land and other people (other indigenous peoples and “colonizers”, past and present)), and (iii) elaborate upon three examples (of events, practices, etc. related to indigenous relations to the environment – past or present – to be researched, cited) not found in the textbook that lend credence to Sioui’s description and explain why the lend credence, and (iv) elaborate upon three examples (of events, practices, etc. of indigenous relations to the environment to be researched, cited) not found in the textbook that lend credence to Morito’s descriptions of the “noble savage”/”ignoble savage”/”ecological Indian” and explain why they lend credence.
UW Environmental Ethics Martin Schonfeld Climatic & Environmental Critique Essay