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The federal government asserted a role in fighting narcotics abuse since the early 20^th century, but it was not until the Richard Nixon administration starting in 1969 that a federal “war on drugs” became high profile. Nixon stressed drives against smuggling heroin from counties like Turkey and Mexico. His administration's efforts were marred by raids on erroneous locations by a new federal Office of Drug Law Enforcement. A successor agency called the ‘Drug Enforcement Administration’ jockeyed with the FBI for supremacy in the drug enforcement field. Drug treatment generally had lower priority when it came to funding. A scourge of “crack” cocaine spread in the mid‐1980s, causing Congress to increase penalties for drug abuse in such a way that black people who primarily used crack were punished much more severely than whites who tended to use cocaine's powder form. An effort to coordinate federal antidrug resources better resulted in the establishment of a White House director of drug control policy (“drug czar”) in 1989; the first to hold the position was former education secretary William Bennett. Drug abuse declined in the 1990s, but there was disagreement over the primary cause. Advocates credited a combination of more‐intense law enforcement, better treatment, and establishment of more than 500 “drug courts” that could ride herd on offenders. The numbers of drug abusers were creeping back up by 1999.

By 2001, the federal government was spending more than $5.3 billion each year to help states and cities combat crime, on top of the many billions allocated locally. In many instances, the money was going to programs that had not been shown to have much effect on crime. Many ideas have been proved worthwhile, however, and deserve more support. They include cohesive community anticrime campaigns, targeted drug treatment, prevention aimed at young people who show crime tendencies, plugging leaks in the criminal justice system, better news media reporting of crime issues, wiser use of the private sector, and dampening the political rhetoric on crime. As crime has become such a political football, relatively little attention has been paid to serious research on the issue compared with the amount devoted to medicine, for example. The danger in the early 21^st century was that as crime rates went down, government would downgrade even further its efforts to determine what worked and did not work in the past four decades. That could be a big mistake if crime rates started again to increase, a distinct possibility in view of downturns in the economy and more young people in the population.

This chapter considers a variety of tuberculosis control measures that can change the rates of transition between states of health. Without a better understanding of who is most at risk of infection and disease, the opportunities for targeted prevention and treatment are limited. This is why dominant TB control efforts today do not focus on hotspots but rather confront the disease in whole populations. The principal approach to TB control, drug treatment of active disease, has saved millions of lives but has been much less effective in stopping TB transmission. The chapter examines the effects of different approaches to TB control, current and future technologies, and the outcomes for infection, disease, and mortality. It shows that while the mitigation of risk factors such as diabetes, undernutrition, or tobacco smoking is helpful as an accessory to TB control, the greater opportunity for immediate impact lies with the early diagnosis and curative treatment of TB disease.

This chapter analyzes the issue of addiction. It argues that after the Revolution the treatment of substance abuse began to be seen by the government outside the previously held medical paradigm. In accordance with the government's new standards of morality, which were drawn along the Islamic religious precepts, and in accordance with new ideological rhetoric, stringent antidrug campaigns were launched; elements of these campaigns included the fining of addicts, imprisonment, physical punishment, and even the death penalty for serious offenses. Substance-abuse specialists from the medical community—no longer benefiting from government support—were marginalized and treatment centers were closed. Despite these measures (and in tandem with the Iran–Iraq War, political repression, and a deteriorating economy), the drug problem continued to grow, with the number of addicts increasing rapidly. In the early 1990s, as the more pragmatic Rafsanjani came to power, the government began to take a less doctrinaire approach to substance abuse. The chapter explores the history of this shift in policy, beginning with the early days of treatment policy in the Qajar and Pahlavi periods through the early postrevolutionary governments in Iran, and finally to the current crystallization of the harm-reduction treatment model exemplified by community-sponsored methadone and bupenorphine-addition drug-treatment programs.

This chapter draws together the epidemiological insights that come from population biology and considers the context in which tuberculosis remains a “social disease” in the early twenty-first century. The distinctive contribution of population biology is to range quantitatively across demography, ecology, epidemiology, environmental science, and evolution. Widening the horizon will bring into view a greater range of options for tackling TB in the post-2015 era of health and sustainable development. The chapter argues that the striking gap between the actual and potential impact of drug treatment underscores the need to find ways to boost the demand for—and supply of—health services. Much emphasis has been placed on developing new technology for TB control; too little attention has been paid to the design of health and social systems that can make best use of technology.

This chapter traces the history of drug courts and discusses the sociology of knowledge literature. Drug courts, created partly in response to the overcrowding of jails and prisons resulting from punitive drug policies, are intended to address drug addiction that is believed to be the impetus for crime while retaining the coercion traditionally associated with the criminal justice system. Drug courts come in two main models: pre-plea and post-plea. In pre-plea drug courts, also called “deferred prosecution,” the defendant enters mandated drug treatment before pleading guilty to a charge. In the post-plea model, the defendant pleads guilty to the offense before accessing drug treatment. This chapter considers the National Association of Drug Court Professionals' campaign called All Rise to advocate for increased funding for drug courts. It also cites evidence that challenges drug courts' claims as an alternative to incarceration and goes on to chronicle the emergence of coerced treatment with the threat of incarceration as an approach to drug use.

This chapter provides a formulary for children's palliative care (CPC) in Africa. It discusses notes on drug treatment in children; principles of effective morphine prescribing; equivalent dose of opioids; children's palliative care (CPC) formulary; and formula for making oral morphine from powder.

The public health crisis of opiate use disorder (OUD) and HIV infection in the United States demands solutions incorporating structural-level factors to accessing and engaging in drug abuse treatment and HIV care. After providing a review of evidence-based programs that have been used in integrated approaches to treating opioid addiction for persons living with HIV, the chapter provides models of integrating treatments for OUD with services for the prevention and management of HIV infection in primary care. The chapter concludes by reviewing multiple structural barriers to integration of substance use treatment into primary care and offering structural strategies to overcoming and implementing integrated OUD-HIV services in primary care settings.

In this chapter, the author narrates her encounter with a former prisoner named Leche, who at the time of writing is enrolled in an Alternative to Incarceration program. On her last bid in prison, the conclusion of which would have marked seven years served, she was accepted into an ATI program at the Women's Prison Association (WPA). Before the ATI, she had gone straight back to selling drugs after her release from prison. In her depiction, prison had offered little change from the social ills that women encountered on the outside. Leche had entered prison a hustler and continued to hustle on the outside, returning to prison four more times. Like Leche, more than 70 percent of New York's women prisoners are of Latina or African descent, and more than 80 percent of women who are incarcerated for drug offenses are women of color. Despite studies showing that drug treatment and ATI programs are healthier and more cost-effective alternatives to imprisonment, women continue to be imprisoned at staggering rates.

This chapter discusses anaesthesia, which is a highly invasive medical intervention, and perioperative pain management. The first half of the chapter is dedicated to a thorough discussion on anaesthesia, beginning with the many risks associated with anaesthesia and surgery. It then looks at pre-anaesthetic assessment and the proper management of co-existing medical disease that may affect anaesthesia, including cardiovascular disease and renal disease. Certain anaesthesia techniques and do not resuscitate (DNR) orders are then discussed. Pain management comprises the last half of the chapter, covering topics such as the causes and incidence of pain in cancer and some issues in cancer pain management. Assessing pain, pre-emptive analgesia, drug treatments, neurosurgery, and acupuncture are some of the other topics that are discussed.

This chapter explores alternative medicine treatment. When there is no effective and simple drug treatment for a disease, assuming drug treatment can ever be simple, and when the surgical options are dangerous or uncertain in outcome, the field is more than usually open for alternative medicine. It is any healing that does not fall within the realm of conventional medicine, or that which has not been shown consistently to be effective. Lawrence tried to practice the alternative treatment for his tuberculosis and maintain his respect for it.

This chapter describes a clinical trial to be used to compare two anti-congestant drugs, Formoterol and Salbutamol. It considers the ways in which the trial might have been designed (parallel group design and paired design), and in each case how the data would have been analysed.

This chapter highlights the reach of neoliberalism in remaking the welfare state. Welfare-to-work and drug treatment programs are contrasted to highlight how profoundly different forms of social welfare policy as enacted in different states have undergone parallel neoliberalizing changes. The chapter looks at the implications for the welfare state overall as it moves toward a more disciplinary approach to incentivize both its providers and their clients to become more reliant on the market for solving their problems. The chapter discusses the implications of these changes for the helping professions, social work in particular.

This chapter is concerned predominantly with the respiratory and non-respiratory complications of chronic obstructive pulmonary disease (COPD). It reviews the effectiveness of interventions such as oxygen therapy, drug treatment of breathlessness, and ‘pulmonary rehabilitation’. It suggests that the un-met needs of people with COPD are becoming more apparent and that emphasis needs to shift from management of acute exacerbations towards a more palliative approach to care, focusing on the health and social care interface.

Tinnitus research is making tremendous progress in both the understanding of mechanisms and in developing tinnitus management. Yet, we still do not know why only 2/3rd of people with hearing loss develop tinnitus, or why tinnitus occurs in people without hearing loss. We also do not know the reason why both loudness and annoyance of tinnitus are enhanced by stress, whereas the two are typically only weakly correlated. Most importantly we do not know how findings in animal models and those in humans can be integrated. An attractive common ground could be to study cortical neural networks in animals as well as humans using either drug treatment, or local electrical or magnetic stimulation. The ultimate cure for tinnitus might be to restore the hearing loss by regeneration of cochlear hair cells, but this is still far away and even if successful may create its own problems.

While structural causes of head, face, and dental pain must always be considered, the vast majority of patients seeking medical advice with such pains (and, indeed, with back pain too) have no demonstrable physical cause, if not for pain at all, then for the pain of the severity expressed in the consultation. Many of these are depressed, though responsiveness of this depression to drug treatment does not correlate consistently with depression rating-scale scores. In the study by Garvey et al. of 116 depressed out-patients, twenty-six complained of headaches before becoming depressed, and an additional thirty-seven developed headaches only when they became depressed. Other generalized somatic symptoms were commoner among this latter group than among those who experienced headache before their depression.

This chapter examines the pathology and management of hyperventilation and disproportionate breathlessness. It explains that these conditions are complex states and that patients with these complaints are frequently misdiagnosed. The chapter suggests that physiological confirmation should include measurement of carbon dioxide partial pressure (PCO2) and that the management of hyperventilation should include explanation and reassurance; a consideration of rebreathing, breathing, and retraining; and in some cases drug treatment.

Over the past few years a biochemical approach has been used to study the pathogenesis of migraine by looking at transduction mechanisms which would be common to many agents that are putative trigger factors in migraine and would also be common targets for a wide range of drug treatments. Hormones, dietary factors, neurogenic agents such as neurotransmitters, neuropeptides, and other neuromodulators and vasoactive agents are all implicated, most of which would mediate their actions through receptors in the cell membrane. Receptor activation is associated with the generation of second messengers — cyclic AMP (cAMP) from adenylate cyclase, and inositol trisphosphate and diacylglycerol from the polyphosphoinositide system. The second messengers in turn produce their effects by activation of protein kinases or by mobilization of calcium. A number of prophylactic treatments would affect these pathways.