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Chronicle AM -- March 27, 2014

No marijuana legalization in New Hampshire this year, neurologists recommend cannabis oil for MS, New Mexico pharmacists will start prescribing naloxone, Russian-US drug cooperation is at risk over the Crimea crisis, and more. Let's get to it:

Coat of arms for the Russian Federal Drug Control Service. It's getting the cold shoulder from the US these days. (kremlin.ru)
Marijuana Policy

California PPIC Poll Has Support for Legalization at 53%. A new Public Policy Institute of California poll has support for marijuana legalization at 53% among registered voters, with 60% of independents and 57% of Democrats in favor. On the other hand, 62% of Republicans were opposed.

New Hampshire House Kills Legalization Bill. A bill to legalize marijuana in New Hampshire died in the House yesterday on a 192-140 vote. The House had passed the bill once in January, but support has eroded since then. The measure was House Bill 492.

Medical Marijuana

California Supreme Court Ruling Upholds Local Cultivation Bans. The state Supreme Court Wednesday denied review of an appellate court decision upholding the rights of local governments to completely ban personal cultivation by medical marijuana patients. The ruling came in a lawsuit sponsored by California NORML, which had asked the high court to "depublish" the decision. "We are deeply disappointed by the court's decision," said CANORML Director and Prop 215 coauthor Dale Gieringer, "They have effectively undermined Prop. 215's stated purpose 'to ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes.'"

American Academy of Neurology Recommends Cannabis Oil for Multiple Sclerosis. The American Academy of Neurology is recommending oral cannabis extract to help ease spasticity symptoms and pain in patients with multiple sclerosis, along with other therapies, in new evidence-based complementary and alternative medicine (CAM) recommendations. Click on the link for more details.

Kentucky CBD Medical Marijuana Bill Passes House. The House voted 98-0 Wednesday to approve a bill allowing the use of high CBD cannabis oil to treat seizures in children. Senate Bill 124 has already passed the Senate, but must return there for approval of minor changes made in the House version of the bill.

Heroin

Kentucky Heroin Bill Wins House Committee Vote. A bill that would address heroin use with a combination of increased penalties for trafficking and harm reduction measures for users squeaked through the House Judiciary Committee on a one-vote margin. But Senate Bill 5 faces an uncertain future; civil libertarians oppose some law enforcement provisions, while some elected officials oppose some harm reduction provisions.

Harm Reduction

New Mexico Pharmacists to Start Prescribing Overdose Reversal Drug. New Mexico pharmacists are the first in the nation to be certified to prescribe the overdose reversal drug naloxone (Narcan). The first batch of 60 pharmacists have been trained and certified by the state Health Department. New Mexico law allows pharmacists to prescribe certain drugs.

Law Enforcement

Detroit Drug Sweep Nets Arrests, Not Many Drugs. Yesterday's sweep of poor Detroit neighborhoods, the most recent in a series of mass drug sweeps, yielded 44 felony and 19 misdemeanor arrests, two grams of cocaine, three grams of heroin, 25 pounds of marijuana, 4,000 prescription pills, $14,500 in cash, and about two dozen illegal weapons. Similar raids in November, December, and February have netted similar results.

International

US Drug Official Rejects Invitation from Russian Counterpart. Deputy director of the Office of National Drug Control Policy (ONDCP) Michael Botticelli has rejected an invitation to meet on drug issues in Moscow, citing the ongoing Crimea crisis. "Given the continued violation of the sovereignty and territorial integrity of Ukraine by Russia, we are suspending some bilateral discussions with the Russian Federation, including this one," Rafael Lemaitre, ONDCP communications director, told Itar-Tass news agency. Russian Federal Drug Control Service chief Viktor Ivanov is one of the Russia political figures sanctioned by the US as a result of the Crimea conflict.

International Ibogaine Providers Conference in South Africa in May. The 4th International Ibogaine Provider's Conference will take place between May 7 and 10 in Durban, South Africa. Discussions will cover a broad spectrum of topics, from developments in research, treatment protocol, and legislation. The featured topic of interest for the conference will be the sustainability of tabernanthe iboga, the implications of ibogaine treatment on regional practices in Africa, and ways that international collaborations can help to ease the effects of demand on iboga's availability. Click on the link for more details and registration information.

Crisis Looms for Addicts as Russia Bans Methadone in Crimea

Things are about to get harder for opiate users in Crimea, the former Ukrainian province now annexed by Russia. While Ukraine has embraced a harm reduction approach to hard drug use, Russia rejects such an approach and has some of the most repressive drug laws in the world.

Oberleitungsbusbahnhof in Simferopol (user Cmapm via Wikimedia)
Russia does not support efficient programs for preventing HIV and Hepatitis C among its drug using population, and harm reduction measures like needle exchanges and opiate substitution therapy (OST), of which methadone maintenance is a subset, are illegal.

Now, the concrete consequences of Crimea's reincorporation into the ample bosom of Mother Russia are coming home for drug users there. On Wednesday, Russian "drug czar" Viktor Ivanov -- one of 31 allies of Pres. Vladimir Putin sanctioned by the US government this month -- announced that Russia will ban the use of methadone in Crimea. That comes after vows a week before that he would move away from harm reduction practices in general in Crimea.

"Methadone is not a cure," Ivanov claimed. "Practically all methadone supplies in Ukraine were circulating on the secondary market and distributed as a narcotic drug in the absence of proper control. As a result, it spread to the shadow market and traded there at much higher prices. It became a source of criminal incomes," he said.

Whatever Ivanov says, cutting off methadone for an estimated 800 patients will be a disaster, the International HIV/AIDS Alliance warned. And the threat of a broader rejection of harm reduction measures puts an estimated 14,000 Crimean injection drug users at risk.

"When the supply of these medicines is interrupted or stopped, a medical emergency will ensue as hundreds of OST patients go into withdrawal, which will inevitably lead to a drastic increase in both acute illness as well as increases in injecting as people seek to self-medicate," said the alliance's Ukraine director, Andriy Klepikov.

"Any interruption to harm reduction programming is a disaster for health, human rights and the HIV epidemic in the region and we urge the authorities in Crimea to step in and ensure that critical supply chains are not disrupted and lives not put at risk as a result of territorial politicking," Klepikov added.

Ukraine has practiced methadone maintenance (or OST) therapy in Crimea since 2005. Patients in Simferopol, Sevastopol, Yalta, Eupatoria, Feodosia, Kerch and other cities receive daily treatment at local healthcare facilities.

The AIDS alliance is not the only group raising the alarm. The International Network of People who Use Drugs (INPUD) has issued an urgent appeal to UN rapporteurs on the Crimea "calling upon you all to issue a public statement making clear the imminent risk that this population faces of losing access to essential medicines, we are requesting that you raise the issue with the Russian government urging them not to close down the currently running opiate substitution programs; and we are calling upon you to raise the issue with utmost urgency with the Human Rights Council with a view to ensuring continued access to the programs."

When it comes to drug policy and harm reduction, Crimea would seem to be worse off as part of Russia than as part of Ukraine. As the AIDS alliance's Klepikov put it:

"The Russian Federation has extremely repressive drug laws and its punitive approach to people who use drugs means that it now experiences one of the highest rates of new HIV infections in the world. Injecting drug users represent nearly 80% of all HIV cases in the country."

Russia

Chronicle AM -- March 19, 2014

Fewer people are getting arrested for marijuana possession in Washington state after legalization -- imagine that! -- Kansas legislators want to drug test teachers, a New Jersey heroin and opiates panel has recommendations, Russell Brand goes to Vienna, and more. Let's get to it:

Russell Brand speaks out for drug decriminalization at the CND in Vienna. (wikimedia.org)
Marijuana Policy

Oregon GOP Gubernatorial Candidate Says Legalize It. Republican gubernatorial candidate Tim Carr says he favors legalizing and taxing recreational marijuana use and would spend the proceeds on helping the homeless and others in need. Carr is one of six Republicans running in the primary to determine who takes on incumbent Democrat John Kitzhaber. He's not the front-runner; that distinction goes to state Rep. Dennis Richardson.

Massachusetts Poll Has Near Majority for Legalization.A new WBUR TV poll shows increased support for marijuana legalization, with 48% in favor and 41% opposed. A Boston Herald/Suffolk University poll showed majority support for the first time. These two polls suggest that attitudes toward legalization in the Bay State have moved in a positive direction in the past year.

Washington State ACLU Reports Big Drop in Pot Arrests. Misdemeanor marijuana possession arrests plummeted last year, the ACLU of Washington reported today. There were just 120 such arrests last year after legalization went into effect, compared to 5,531 the year before. But black people are still getting arrested for pot possession more often. They're getting popped at a rate three times that of whites, the ACLU said.

National Cannabis Industry Association to Host Marijuana Business Summit. The NCIA will hold its first national conference, the Cannabis Business Summit, June 24-25 in Denver. Click on the links for more details.

Medical Marijuana

Alabama CBD Medical Marijuana Bill Advances. A bill that would study the impact of using a marijuana derivative to treat seizures is one step closer to becoming state law. Senate Bill 174 passed the House Judiciary Committee after it was amended in the Senate last week.

Drug Testing

Kansas School Teacher Drug Testing Bill Passes Senate. A bill that requires drug testing of school employees and affirms the firing of educators convicted of DUI, drug crimes, and other offenses passed the state Senate Tuesday. Senate Bill 335 was approved after Senate Democrats successfully offered an amendment that would subject members of the House and Senate to treatment requirements and financial sanctions mirroring those in state law for the unemployed or those on cash aid. The welfare drug testing law passed last year also included elected representatives, but contained no provisions for sanctioning them or requiring they seek help. The bill now goes to the House.

Heroin

Kentucky Omnibus Heroin Bill Stuck in House. A bill that would both enact harm reduction measures and crack down on heroin-selling offenses is stuck in the House Judiciary Committee. Senate Bill 5 would let drug dealers be charged with murder if the sale of Schedule I drugs results in death and increases penalties for high-volume heroin dealers. It also seeks increased Medicare funds for drug treatment, access to the overdose reversal drug naloxone, and a 911 Good Samaritan provision. The Senate passed the bill in January.

New Jersey Heroin Task Force Calls for Broad Reforms. A governor's task force on heroin and opiate use called for a wide array of reforms, saying it is "time to confront our demons." According to The Newark Star-Ledger, which obtained an advance copy, the panel's report calls for tighter prescription pill monitoring laws, changes in the state's insurance system to make treatment more available, and expanded use of drug treatment recovery communities.

Sentencing

California Bill Would Equalize Crack and Powder Cocaine Sentences. A bill filed by state Sen. Holly Mitchell (D-Culver City) would cut prison sentences for people convicted of selling crack to bring them in line with sentences for people convicted of selling powder cocaine. Senate Bill 1010 was introduced last month, but amended Monday. It is before the Senate Rules Committee.

International

In Vienna, Russell Brand Joins "Support, Don't Punish" Campaign. British actor and comedian Russell Brand spoke at the UN Commission on Narcotic Drugs in Vienna today and publicly joined forces with the Support, Don't Punish campaign to decriminalize drug possession and end the imprisonment and punishment of people who use drugs.

Senior Mexican Anti-Drug Official Resigns. Manuel Mondragón y Kalb, Mexico's national security commissioner and one of the most senior officials in charge of the country's counternarcotics fight, has resigned "for personal reasons." The National Security Commission (CNS), which falls under the Interior Ministry, was created by President Enrique Peña Nieto in January 2013 to replace the Secretariat of Public Security. The CNS, which is in charge of the Federal Police, is behind schedule in its task to create a National Gendarmerie to bolster the country's counter-narcotics fight, which is one of Peña Nieto's campaign promises.

(This article was published by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also shares the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

Chronicle AM -- March 13, 2014

Attorney General Holder endorses federal drug sentencing reductions, CBD medical marijuana bills move in the South, a New Hampshire decriminalization bill advances, Zohydro may get some competition, and the UN is generating plenty of news, and more. Let's get to it:

Attorney General Eric Holder endorses federal drug sentence reductions. (usdoj.gov)
Marijuana Policy

Marylanders Rally for Legalization. Nearly 100 supporters of sweeping changes in Maryland's marijuana laws rallied in Annapolis Thursday before planned legislative hearings on bills to legalize -- or at least decriminalize -- possession of the drug. The House Judiciary Committee is hearing a series of marijuana reform bills this afternoon, including a legalization bill (House Bill 880) from Rep. Curt Anderson (D-Baltimore).

Maryland Poll Has Slim Majority for Legalization. As the legislature considers marijuana reform bills, a new Goucher Poll has support for legalization at 50.1%, with 39.4% opposed. The poll also had a whopping 89.6% in favor of medical marijuana.

New Hampshire Decriminalization Bill Passes House. The House approved a decriminalization bill by a veto-proof margin Wednesday. House Bill 1625, sponsored by Rep. Adam Schroadter (R-Newmarket) and a bipartisan group of seven cosponsors including Sen. Jeff Woodburn (D-Dalton), would make possession of up to one ounce of marijuana punishable by a civil fine of up to $100. It would also make cultivation of up to six plants a Class A misdemeanor instead of a felony. Currently, possession of any amount of marijuana is a misdemeanor punishable by up to one year in prison and a fine of up to $2,000. Now, it's on to the state Senate.

Medical Marijuana

Kentucky Senate Approves CBD Medical Marijuana Bill. The Senate passed a bill allowing doctors to prescribe and patients to use CBD cannabis oil for medical reasons Wednesday. The bill passed with no opposition. Senate Bill 124 now goes to the House.

Georgia Senate Committee Approves CBD Medical Marijuana Bill. The Senate Health and Human Services Committee unanimously approved House Bill 885, which would allow patients to use CBD-based cannabis oils. It also amended the bill to allow parents to bring the oil into the state without facing penalties. The bill has already passed the House and now awaits a Senate floor vote.

South Carolina Senate Panel Approves CBD Medical Marijuana Bill. A subcommittee of the Senate Committee on Medical Affairs approved a bill allowing people suffering from epilepsy to use CBD cannabis oil Wednesday. Senate Bill 1035 still needs to pass the full committee. Similar legislation is moving in the House.

Hemp

Tennessee Hemp Bill Wins House Committee Vote. A bill that would allow the cultivation of hemp for research purposes passed the House Agriculture and Natural Resources Committee Wednesday. House Bill 2445 now heads for the House Finance Ways and Means Committee.

Drug Testing

Mississippi Food Stamp Drug Testing Bill Heads to Governor. A bill that would require applicants for Temporary Assistance for Needy Families (TANF) to undergo drug testing if there is a suspicion they are using drugs passed the Senate Wednesday and now goes to the desk of Gov. Phil Bryant (R), who has made it a keystone of his legislative agenda. House Bill 49 passed the Senate after debate in which supporters couched the program as an additional benefit that could help somebody struggling with addiction, while opponents said it was unfairly singling out the poor.

ASAM White Paper Calls for Vastly Expanded Drug Testing. The American Society for Addiction Medicine (ASAM) has published a white paper by former NIDA director and present day drug testing consultant Robert Dupont calling drug testing "underutilized" and arguing it should be expanded to be include people of all ages in virtually all aspects of daily life. The totalitarian vision is ably critiqued by NORML drug testing expert Paul Armentano (click the title link), as well as by progressive talk radio host Thom Hartman, who countered Dupont with an op-ed entitled "It's Time to End All Drug Testing." Both Armentano's and Hartman's critiques are worth the read.

Prescription Opioids

Oxycontin Maker Offers Alternative to Zohydro. Purdue Pharma, the manufacturer of Oxycontin, says it has completed testing of an abuse-resistant version of the painkiller hydrocodone, a surprise development that could derail sales of the recently launched Zohydro, a similar medication that has been criticized for lacking such safeguards. Purdue Pharma says it plans to submit its extended-release hydrocodone drug to the Food and Drug Administration later this year. Shares of rival Zogenix Inc. plunged more than 20% after the announcement, which appears to jeopardize sales of the company's just-launched drug Zohydro. Zogenix began shipping Zohydro to pharmacies last week.

Sentencing

Attorney General Holder Endorses Proposal to Cut Federal Sentences. US Attorney General Eric Holder today endorsed a proposal from the US Sentencing Commission to reduce the sentences of people convicted of federal drug trafficking offenses by about a year, from an average of 62 to months to an average of 51 months. "This overreliance on incarceration is not just financially unsustainable," Holder said. "It comes with human and moral costs that are impossible to calculate."

International

Listen to the UN Commission on Narcotic Drugs Sessions. You can do it by clicking on the UNODC's webcast page at the link above. Also, Oregon activist Doug McVay has uploaded audio of the second part of today's plenary session here. There will be more updates on McVay's weekly Drug War Facts podcast.

UNODC Panel Says Criminalizing Drug Use "Not Beneficial". Today, a key working group of the United Nations Office on Drugs and Crime (UNODC) announced the release of groundbreaking recommendations discouraging criminal sanctions for drug use. The Scientific Consultation Working Group on Drug Policy, Health and Human Rights of the UNODC -- which includes Nora Volkow, head of the US National Institute on Drug Abuse (NIDA) -- is releasing the recommendations at the High-Level Segment of the 57th UN Commission on Narcotic Drugs. The working group recommendations say "criminal sanctions are not beneficial" in addressing the spectrum of drug use and misuse.

UNODC Sees "Serious Setbacks" in Fight Against Drugs. Addressing the opening session of the Commission on Narcotic Drugs (CND), UN Office on Drugs and Crime (UNOC) head Yury Fedotov said the global fight against drugs had suffered "serious setbacks," including record opium crops in Afghanistan, violence linked to drug trafficking in Central America, and weak West African states succumbing to the blandishments of traffickers. While he said legalization was no solution, he did add that: "A public health response to the drug use problem should consider alternatives to penalization and incarceration of people with use disorders."

Caricom Creates Commission to Study Marijuana Legalization. The leaders of the Caricom Caribbean trade bloc announced today that they are creating a commission to study the impact of legalizing marijuana. The move came at the end of a two-day summit where members discussed a preliminary report on decriminalization. The commission is charged with presenting its report in early July for a Caricom summit in Antigua.

Iran Executed More Than 300 People for Drugs Last Year, Report Says. A report from the nonprofit group International Campaign for Human Rights in Iran released Wednesday says Iran executed 331 people on drug-related charges last year. The drug executions accounted for almost half of all executions in the Islamic Republic, the report found. The UN Office on Drugs and Crime sponsors anti-drug programs in Iran, and is under increasing pressure from European donor countries to put in place measures to stop its support from contributing to the death penalty.

Dire Prospects for Afghanistan Drug War, Analysis Finds. A new analysis from Alex Pollard-Lipkis of Foreign Policy in Focus finds that "if costly drug war strategies in Afghanistan have been unsuccessful even with a strong US military presence, they won't stand a chance after the US withdraws." The analysis critiques contemporary US approaches and peeks into the post-US future. Click on the title link to read the whole thing.

Chronicle AM -- March 12, 2014

Medical marijuana is keeping state legislators busy, Maine's governor has a 20th Century approach to drug problems, New Mexico's governor cuts funds to a diversion program, Indonesia shifts its stance on drug users, and more. Let's get to it:

Responding to new synthetic drugs by banning them is still a favored response in state legislatures. (wikimedia.org)
Medical Marijuana

DEA, LAPD Raid Dispensaries. DEA agents assisted by LAPD officers raided and closed several Los Angeles dispensaries Tuesday. They hit the Black Rose dispensary in Fairfax, Downtown Medical Caregivers off Main Street, Washington and Western Medical Group in Harvard Heights, Herbman in Exposition Park and two homes in Beverly Hills. The same person allegedly owns all four dispensaries.

Vermont Senate Passes Medical Marijuana Expansion Bill. A bill that lifts the 1,000-patient cap on the state's dispensaries and authorizes two more dispensaries passed the Senate with little debate Tuesday. Senate Bill 247 now heads to the House.

Revised Alabama CBD Medical Marijuana Bill Passes Senate. A CBD medical marijuana bill revised by its sponsors so that the University of Alabama-Birmingham would conduct a research study passed the Senate on a unanimous vote Tuesday night. Senate Bill 174 now moves to the House.

Utah CBD Medical Marijuana Bill Passes Senate. A bill that would allow compassionate use of non-intoxicating cannabis oil by Utahns with untreatable epilepsy passed the Senate Tuesday by a wide margin, despite reservations some senators have about the oil's safety and long term benefits. House Bill 105 now goes back to the House, which had already passed it, but now must sign off on changes in the Senate version.

Michigan Medical Marijuana Bills Get Hearing. Two bills that would legalize the manufacture and sale of medical marijuana-infused products such as brownies and oils and permit communities to allow and regulate marijuana dispensaries got a hearing in the Senate Government Operations Committee hearing Tuesday, but no vote. Committee chair and Senate Majority Leader Randy Richardville (R-Monroe) is not expected to schedule another hearing for at least a couple of weeks. The bills are House Bill 5104 and House Bill 4271.

California Bill to Tighten Location Restrictions on Dispensaries Killed in Committee. A bill that would have widened "dispensary free" zone around schools from 600 feet to 1,000 feet has been blocked in the Assembly Public Safety Committee, Assembly Minority Leader Connie Conway (R-Tulare) said Tuesday. Conway is the author of the bill in question, Assembly Bill 1588.

American Herbal Pharmacopoeia Releases Study on Marijuana and Epilepsy. The medical research group American Herbal Pharmacopoeia (AHP) issued a new scientific review Tuesday, Cannabis in the Treatment of Epilepsy, which compiles much of the leading and historical research on epilepsy and cannabis (medical marijuana) for use by scientists, physicians, patients, and parents, as well as those producing and manufacturing it for treatment. Patient advocacy group Americans for Safe Access (ASA) will host a Google Hangout today, March 12th at 8:00pm EDT, featuring AHP director Roy Upton, ASA scientific advisory board member Dr. Sunil Aggarwal and others.

Law Enforcement

Maine Governor Wants More Drug War. Confronted by increasing levels of opiate drug use, Maine Gov. Paul LePage (R) responded Tuesday by proposing to beef up drug war spending. The conservative governor wants to add 22 new state positions including 14 new Maine Drug Enforcement agents, four new prosecutors for the Office of the Maine Attorney General as well as four new district court judges to bolster the state's four drug courts in Lewiston, Presque Isle, Bangor and Portland. He also criticized methadone, saying the drug should be provided in a clinical setting only. He said he intended to focus equally on the addiction side of the drug equation but did not offer any details.

New Mexico Governor Vetoes Funding for Drug Diversion Pilot Program. Gov. Susana Martinez (R) vetoed spending $140,000 for a Santa Fe program to divert some drug offenders to treatment Tuesday. The city's pre-booking diversion program, otherwise known as Law Enforcement Assisted Diversion (LEAD), will begin late this month. If successful, this model could become a model for other New Mexico communities, saving both the criminal justice and health systems tens of millions of dollars each year.

Salvia Divinorum

Rhode Island Bill to Ban Salvia, Jimson Weed Has Hearing Today. A bill that would ban the use of salvia divinorum and Jimson weed was scheduled for committee action today. House Bill 7191, sponsored by Rep. Arthur Corvese (D-North Providence), gets a vote before the House Judiciary Committee. It's not clear what prompted the bill.

New Synthetic Drugs

Minnesota Synthetic Drug Ban Bill Wins House Committee Vote. A bill that would give the state pharmacy board the authority to use its emergency powers to classify new synthetic drugs as banned substances is advancing in the House. House File 2446, introduced by Rep. Erik Simonson (D-Duluth) passed the House Health and Human Services Policy Committee Tuesday with few questions and a unanimous vote.

International

LEAHN Releases Frankfurt Principles on Drug Law Enforcement. The Law Enforcement and HIV Network (LEAHN) has released the Frankfurt Principles on Drug Law Enforcement, developed at the International Conference on Drug Policy and Policing last November in Frankfurt. The principles are designed to make law enforcement an effective partner in a harm reduction approach to drug use and related illness.

TDPF Releases Report on Dutch Coffee Shop Policy. Prompted by "misreports and misunderstandings that have led many to believe the Netherlands is retreating from its pragmatic policy of allowing cannabis to be sold via 'coffee shop,'" the British Transform Drug Policy Foundation has released a new report to set things straight. The report is Cannabis policy in the Netherlands: Moving forward, not backwards.

Ghana Anti-Drug Head Calls for Marijuana Legalization Debate. The executive secretary of the Narcotics Control Board (NACOB), Akrasi Sarpong, has called for a national debate on legalization of marijuana in the country. "Ordinary people can say don't legalize it but that will be vocalizing the ostrich hiding its head in the sand, because there is a virtual legalization on the ground," Sarpong said. Many people believe "what you are fighting is not crime," he added. "Reports say cannabis is the number one problem in Africa so what are we therefore saying. People laugh at these things, because, they are growing them in their homes," he said.

Peru Ponders Restarting Drug Plane Shootdown Program.Peru suspended its law allowing its Air Force to shoot down suspected drug planes in April 2001, when the Peruvian Air Force, accompanied by a CIA support plane, mistakenly shot down an aircraft carrying American missionaries, killing Veronica Bowers and her infant daughter. Now, Congressman Carlos Turbino, a retired general, has filed a bill to reinstate the program. It is currently before the congressional defense committee, even though it is opposed as unnecessary by the government of President Ollanta Humala.

New Indonesian Drug Law Emphasizes Rehabilitation Instead of Punishment of Drug Users. Indonesian ministers this week signed a memorandum of understanding that they say will declare drug users "victims" instead of criminals, to be treated at rehabilitation centers instead of sentencing to prison. President Susilo Bambang Yudhoyono has gone on the record supporting a softer touch for addicts, but early efforts to push for more rehabilitation centers have met with resistance from judges who are loathe to appear weak on drugs and lawmakers who often use the early release of traffickers as opportunities to grandstand against the president. Drug user make up 42% of all Indonesian prisoners.

Marijuana Reform Rally Set for Glasgow Next Month. A mass marijuana rally called by the Glasgow Cannabis Social Club is set for the city center next month, and it's already causing grumbling. "People will be extremely annoyed at the high-profile celebration of something that's illegal," grumped Conservative MSP John Lamont. "It is disappointing that such a carnival in homage to an illegal substance is being facilitated in this way," he added. The old fogies want the police to shut it down, but the police have said they will stop it only if lawbreaking takes place. The celebration is due to take place at Glasgow Green on Sunday April 20. So far, more than 200 people have signed up via Facebook to attend.

Responding to Holder on Heroin, Reformers Call for a Health Direction [FEATURE]

US Attorney General Eric Holder had heroin on his mind Monday, using his weekly video message and an accompanying press release to draw attention to rising heroin overdose deaths and vowing to combat the problem with a combination of law enforcement, treatment, prevention, and harm reduction measures. Drug reformers generally responded positively, but called on the Obama administration to seek comprehensive, science- and health-based solutions instead of engaging in more drug war.

Attorney General Holder takes on heroin (usdoj.gov)
"Addiction to heroin and other opiates -- including certain prescription pain-killers -- is impacting the lives of Americans in every state, in every region, and from every background and walk of life -- and all too often, with deadly results. Between 2006 and 2010, heroin overdose deaths increased by 45%," Holder said. "Scientific studies, federal, state and local investigations, addiction treatment providers, and victims reveal that the cycle of heroin abuse commonly begins with prescription opiate abuse. The transition to -- and increase in -- heroin abuse is a sad but not unpredictable symptom of the significant increase in prescription drug abuse we've seen over the past decade."

What Holder didn't mention is that the rise in prescription pain pill misuse is tied to a massive increase in prescribing opioids for pain in the past decade. A study published last fall found that between 2000 and 2010, the amount of opioids prescribed for non-cancer pain had nearly doubled, and that during the same period, the percentage of people complaining of pain who received prescriptions for opioids jumped from 11% to nearly 20%. But reining in prescriptions generally isn't the answer either.

But at the same time, a 2011 Institute of Medicine report found that while "opioid prescriptions for chronic non-cancer pain [in the US] have increased sharply… 29% of primary care physicians and 16% of pain specialists report they prescribe opioids less often than they think appropriate because of concerns about regulatory repercussions."

As the IOM report noted, having more opioid prescriptions doesn't necessarily mean that "patients who really need opioids [are] able to get them." Opioid misuse and under-use of opioids for pain treatment when they are needed are problems that coexist in society. Pain pill crackdowns have also been found to result in increased use of street heroin, as a Washington Post article last week reports -- two additional reasons advocates prefer public health approaches to heroin more than law enforcement -- and why great care should be taken with the law enforcement measures.

"It's clear that opiate addiction is an urgent -- and growing -- public health crisis. And that's why Justice Department officials, including the DEA, and other key federal, state, and local leaders, are fighting back aggressively," Holder continued. "Confronting this crisis will require a combination of enforcement and treatment. The Justice Department is committed to both."

Holder pointed to DEA efforts to prevent diversion of pharmaceutical pain-relievers to non-medical users, mentioning investigations of doctors, pharmacists, and distributors.

"With DEA as our lead agency, we have adopted a strategy to attack all levels of the supply chain to prevent pharmaceutical controlled substances from getting into the hands of non-medical users," Holder said.

Cooking heroin (wikimedia.org)
Holder also pointed out that DEA had opened some 4,500 heroin investigations since 2011 and promising more to come.

But, as Holder noted, "enforcement alone won't solve the problem," so the administration is working with civil society and law enforcement "to increase our support for education, prevention, and treatment."

And although he didn't use the words "harm reduction," Holder is also calling for some harm reduction measures. He urged law enforcement and medical first responders to carry the overdose reversal drug naloxone (Narcan) and signaled support for "911 Good Samaritan" laws, which grant immunity from criminal prosecution to those seeking medical help for someone experiencing an overdose.

Holder got restrained plaudits from drug reformers for his small steps toward harm reduction measures, but they called for a more comprehensive approach.

"Preventing fatal overdose requires a comprehensive solution," said Meghan Ralston, harm reduction manager for the Drug Policy Alliance. "While naloxone is an absolutely critical component, we need a scientific, health-based approach to truly address the roots of the problem. This includes improving access to effective, non-coercive drug treatment for everyone who wants it, as well as improving access to medication-assisted treatments such as methadone and buprenorphine."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)
Ralston also added that just making naloxone available to cops and EMTs wasn't good enough. Friends and family members, not "first responders," are most often the people who encounter others in the throes of life-threatening overdoses.

"While we applaud Attorney General Holder's clear support for expanding access to naloxone, particularly among law enforcement and 'first responders,' we urge him to clarify that he supports naloxone access for anyone who may be the first person to discover an opiate overdose in progress," she said.

But Law Enforcement Against Prohibition (LEAP), a group of law enforcement officials opposed to the war on drugs, applauded the move, which could help soften reflexive law enforcement opposition to carrying the overdose antidote, an attitude reflected in the the International Association of Chiefs of Police's opposition to all harm reduction measures.

"Police may not be the first to embrace change, but we are slowly evolving," said Lieutenant Commander Diane Goldstein (Ret.). "We cannot arrest our way out of a public health problem, and it's clear that the Attorney General is beginning to understand that and to embrace the role of harm reduction in reducing death, disease and addiction in our communities. We still have a long way to go, but this is a good sign."

The idea is "a no-brainer," according to executive director Major Neill Franklin (Ret.). "It is simply immoral not to support something proven to save lives for political reasons," Franklin added. "Yes, police send a message when they choose not to carry naloxone. But that message is not 'don't do drugs,' it's 'if you make the wrong decisions in your life, we don't care about you.' That offends me both as a former cop and as a human being."

The nuanced pushback to Holder's law enforcement/prevention/treatment/hint of harm reduction approach is good as far as it goes, but it doesn't go far enough. Decriminalizing and destigmatizing now illicit drug use, as has been the case in Portugal, is an obvious next step, and removing the question of drugs from the purview of the criminal justice system altogether would be even better. Still, that a sitting attorney general is calling for treatment and harm reduction as well as law enforcement is a good thing, and for reformers to be calling him on not going far enough is a good thing, too.

War of Words: The International Narcotics Control Board vs. A Changing World [FEATURE]

The global drug prohibition bureaucracy's watchdog group, the International Drug Control Board (INCB) released its Annual Report 2013 today, voicing its concerns with and wagging its finger at drug reform efforts that deviate from its interpretation of the international drug control treaties that birthed it. The INCB is "concerned" about moves toward marijuana legalization and warns about "the importance of universal implementation of international drug control treaties by all states."

"We deeply regret the developments at the state level in Colorado and Washington, in the United States, regarding the legalization of the recreational use of cannabis," INCB head Raymond Yans said in introducing the report. "INCB reiterates that these developments contravene the provisions of the drug control conventions, which limit the use of cannabis to medical and scientific use only. INCB urges the Government of the United States to ensure that the treaties are fully implemented on the entirety of its territory."

For some years now, some European and Latin American countries have been expressing a desire to see change in the international system, and "soft defections," such as the Dutch cannabis coffee shop system and Spain's cannabis cultivation clubs, have stretched the prohibitionist treaties to their legal limits. But legal marijuana in Uruguay is a clear breach of the treaties, as Colorado and Washington may be. That is bringing matters to an unavoidable head.

After surveying the state of drug affairs around the globe, the 96-page INCB report ends with a number of concerns and recommendations, ranging from non-controversial items such as calling for adequate prevention and treatment efforts to urging greater attention to prescription drug abuse and more attention paid to new synthetic drugs. [Ed: There is some controversy over how to best approach prescription drug abuse and synthetic drugs. e.g. the type of attention to pay to them.]

But the INCB is clearly perturbed by the erosion of the international drug prohibition consensus, and especially by its concrete manifestations in legalization in Uruguay, Colorado, and Washington and the spreading acceptance of medical marijuana.

"The Board is concerned that a number of States that are parties to the 1961 Convention are considering legislative proposals intended to regulate the use of cannabis for purposes other than medical and scientific ones" and "urges all Governments and the international community to carefully consider the negative impact of such developments. In the Board's opinion, the likely increase in the abuse of cannabis will lead to increased public health costs," the report said.

Similarly, the INCB "noted with concern" Uruguay's marijuana legalization law, which "would not be in conformity with the international drug control treaties, particularly the 1961 Convention" and urged the government there "to ensure the country remains fully compliant with international law, which limits the use of narcotic drugs, including cannabis, exclusively to medical and scientific purposes."

Ditto for Colorado and Washington, where the board was "concerned" about the marijuana legalization initiatives and underlined that "such legislation is not in conformity with the international drug control treaties." The US government should "continue to ensure the full implementation of the international drug control treaties on its entire territory," INCB chided.

But even as INCB struggles to maintain the legal backbone of global prohibition, it is not only seeing marijuana prohibition crumble in Uruguay and the two American states, it is also itself coming under increasing attack as a symbol of a crumbling ancien regime that creates more harm than good with its adherence to prohibitionist, law enforcement-oriented approaches to the use and commerce in psychoactive substances.

"We are at a tipping point now as increasing numbers of nations realize that cannabis prohibition has failed to reduce its use, filled prisons with young people, increased violence and fueled the rise of organized crime," said Martin Jelsma of the Transnational Institute. "As nations like Uruguay pioneer new approaches, we need the UN to open up an honest dialogue on the strengths and weaknesses of the treaty system rather than close their eyes and indulge in blame games."

"For many years, countries have stretched the UN drug control conventions to their legal limits, particularly around the use of cannabis," agreed Dave Bewley-Taylor of the Global Drug Policy Observatory. "Now that the cracks have reached the point of treaty breach, we need a serious discussion about how to reform international drug conventions to better protect people's health, safety and human rights. Reform won't be easy, but the question facing the international community today is no longer whether there is a need to reassess and modernize the UN drug control system, but rather when and how."

"This is very much the same old stuff," said John Collins, coordinator of the London School of Economics IDEAS International Drug Policy Project and a PhD candidate studying mid-20th Century international drug control policy. "The INCB views its role as advocating a strict prohibitionist oriented set of policies at the international level and interpreting the international treaties as mandating this one-size-fits-all approach. It highlights that INCB, which was created as a technical body to monitor international flows of narcotics and report back to the UN Commission on Narcotic Drugs, has carved out and maintains a highly politicized role, far removed from its original treaty functions. This should be a cause for concern for all states interested in having a functioning, public health oriented and cooperative international framework for coordinating the global response to drug issues," Collins told the Chronicle.

"The INCB and its current president, Raymond Yans, take a very ideological view of this issue," Collins continued. "Yans attributes all the negative and unintended consequences of bad drug policies solely to drugs and suggests the way to lessen these problems is more of the same. Many of the policies the board advocates fly in the face of best-practice public health policy -- for example the board demanding that states close 'drug consumption rooms, facilities where addicts can abuse drugs,'" he noted.

"If the board was really concerned about the 'health and welfare' of global populations it would be advocating for these scientifically proven public health interventions. Instead it chooses the road of unscientific and ideological based policies," Collins argued.

The INCB's reliance on ideology-driven policy sometimes leads to grotesque results. There are more than 30 countries that apply the death penalty for drugs in violation of international law. Virtually every international human rights and drug control body opposes the death penalty for drugs including the United Nations Office on Drugs and Crime, the UN Human Rights Committee, the UN's human rights experts on extrajudicial killings, torture and health, among many others.

INCB head Raymond Yans (incb.org)
But when an INCB board member was asked in Thailand -- where 14 people have been executed for drugs since 2001 -- what its position on capital punishment was, he said, "the agency says it neither supports nor opposes the death penalty for drug-related offenses," according to the Bangkok Post.

Human rights experts were horrified and immediately wrote asking for clarification, to which the INCB responded, "The determination of sanctions applicable to drug-related offenses remains the exclusive prerogative of each State and therefore lie beyond the mandate and powers which have been conferred upon the Board by the international community," according to Human Rights Watch.

Another area where the board's concern about the health and welfare of global populations is being challenged is access to pain medications. A key part of the INCB's portfolio is regulating opioid pain medications, and this year again it said there is more than enough opium available to satisfy current demand, although it also noted that "consumption of narcotic drugs for pain relief is concentrated within a limited number of countries."

The World Health Organization (WHO) agrees about that latter point. A 2011 study estimated that around 5.5 billion people -- or 83% of the world population -- live in countries with 'low to non-existent' access to opioid pain relief for conditions such as cancer and HIV/AIDS. These substances are listed by the WHO as essential medicines, and the international drug control conventions recognise explicitly that they are 'indispensable' to the 'health and welfare of mankind.'

Adding to the paradox -- the global supply is sufficient, but four-fifths of the world doesn't have access -- the INCB calls on governments to "ensure that internationally controlled substances used for pain relief are accessible to people who need them."

What is going on?

"The INCB uses totals of requirements for opioid medicines compiled by the UN treaty signatory states," said Ann Fordham, executive director of the International Drug Policy Consortium, which keeps an eye on the agency with its INCB Watch. "Unfortunately there is often a huge gap between these administrative estimates and the actual medical needs of their populations."

The prohibitionist slant of global drug control also creates a climate conducive to understating the actual need for access to pain relief in other ways, Fordham told the Chronicle.

"Many governments interpret the international drug control conventions in a more restrictive manner than is necessary, and focus their efforts towards preventing access to the unauthorized use of opioids rather than to ensuring their medical and scientific availability," she said. "This is a grossly unbalanced reading of the conventions, underpinned by fear and prejudice regarding opioids and addiction."

Although the agency has cooperated somewhat with the WHO in attempting to enhance access to the medicines, said Fordham, it bears some blame for rendering the issue so fraught.

"The INCB has continually stressed the repressive aspect of the international drug control regime in its annual reports and other public statements, and in its direct dealings with member states," she said. "The INCB is therefore responsible for at least some of the very anxieties that drive governments toward overly restrictive approaches. This ambivalence considerably weakens the INCB's credibility and contradicts its health-related advocacy."

Fordham joined the call for a fundamental reform of global drug prohibition, and she didn't mince words about the INCB.

"The entire UN drug control system needs to be rebalanced further in the direction of health rather than criminalization, and it is changing; the shift in various parts of the system is apparent already," she said before leveling a blast at Yans and company. "But the INCB is notable as the most hard line, backward-looking element, regularly overstepping its mandate in the strident and hectoring manner its adopts with parties to the treaties, in its interference in functions that properly belong to the WHO and in its quasi-religious approach to a narrow interpretation of the drug control treaties."

The INCB should get out of the way on marijuana and concentrate on its pain relief function, said Collins.

"The INCB should stay out if it," he said bluntly. "It is a technocratic monitoring body. It should not be involving itself in national politics and national regulatory systems. So it doesn't need to be either a help or hindrance on issues regarding cannabis reform. It has no reason to be involved in this debate. It should be focusing on ensuring access to essential pain medicines. These debates are a distraction from that core function and I would argue one of the reasons it is failing to meet this core function."

Sorry, INCB. Welcome to the 21st Century.

Vienna
Austria

Chronicle AM -- February 20, 2014

Colorado is rolling in the marijuana tax dollars, Washington state gets closer to licensing legal grows, a New Hampshire patient grow bill is moving, the Europeans are worried about some new drugs, and more. Let's get to it:

The Europeans are worried about "N Bomb"
Marijuana Policy

Colorado Governor Announces Marijuana Tax Revenues Plan. Gov. John Hickenlooper (D) Wednesday announced his plan to start spending tax revenues from legalized marijuana. He said he would spend $99 million next fiscal year, with half of it going to youth use prevention, another 40% going to substance abuse treatment, and more than $12 million for public health. His proposal must be approved by the legislature.

Washington State Regulators Announce Rules Modifications. The Washington State Liquor Control Board announced Wednesday that it will limit marijuana business applicants to one pot grow each, down from the three-license limit it originally set. The board also reduced by 30% the amount of grow space that licensees can use. The board is trying to address how to equitably distribute the two million square foot of grow space it has set as a statewide cap. The move also opens the way to the actual issuance of grow licenses, which could come as soon as early next month.

Medical Marijuana

New Hampshire Patient Cultivation Bill Wins Committee Vote. A bill that would allow qualifying patients to cultivate a limited amount of medical marijuana in New Hampshire was approved this morning in a 13-3 vote by the House Committee on Health, Human Services, and Elderly Affairs. The bill will be considered by the full House sometime in March. Sponsored by Rep. Donald Wright (R-Tuftonboro), House Bill 1622 would patients or their designated caregivers to possess up to two mature plants and twelve seedlings. The cultivation location would have to be reported to the Department of Health and Human Services, and patients would lose their ability to cultivate when an alternative treatment center opens within 30 miles of their residence.

South Carolina CBD Medical Marijuana Bill Filed. Sen. Tom Davis (R-Beaufort) Wednesday introduced a bill to allow for the use of CBD cannabis oil for the treatment of epilepsy seizures. Senate Bill 1035 has been referred to the Committee on Medical Affairs.

Arizona Bill Would Use Medical Marijuana Fees to Fund Anti-Drug Campaigns. A bill approved Wednesday by the House Health Committee would set up a special fund using fees from medical marijuana user and dispensaries to "discourage marijuana use among the general population." House Bill 2333, sponsored by Rep. Ethan Orr (R-Tucson) is being derided by the Marijuana Policy Project, whose spokesman, Mason Tvert, said "It is remarkable how much money some government officials are willing to flush down the toilet in hopes of scaring adults away from using marijuana."

Heroin

Vermont Law School Symposium Will Address Heroin Addiction and New Solutions. The Vermont Law Criminal Law Society is hosting a symposium on heroin and opiate addiction and responses to it on Monday. "This event is about new ideas from new sources," said Vermont Law JD candidate George Selby ', one of the panel organizers. "We need to fundamentally change the way we treat addicts and the opiates they fall victim to." Panelists will include addiction and pain specialists, a narcotics investigator, and an advocate for revolutionizing drug policy. They will discuss whether drug courts, replacement therapy, and support groups are enough, and tackle a controversial question: Should doctors be allowed to prescribe heroin to treat heroin addiction? One of the featured speakers is Arnold Trebach, JD, PhD, professor emeritus of public affairs at American University and founder of the Drug Policy Foundation, the precursor to the Drug Policy Alliance, who plans to call for action in Vermont. Click on the title link for more details.

International

Europeans Issue Alert on Four New Synthetic Drugs. The European Monitoring Center for Drugs and Drug Addiction has issued an alert and announced a formal risk assessment of four new synthetic drugs. They are the hallucinogenic phenethylamine 251-NBOMe ("N-Bomb," linked to three deaths), the synthetic opioid AH-7921 (15 reported deaths in Europe), the synthetic cathinone derivative MDPV ("legal cocaine," linked to 99 deaths), and the arylcyclohexamine drug Methoxetamine (linked to 20 deaths). Click on the link above for more details.

British Columbia Judge Rules Mandatory Minimum Drug Sentences Unconstitutional. A judge in Canada's British Columbia ruled Wednesday that mandatory minimum sentences for drug offenders under the federal 2012 Safe Streets and Communities Act are unconstitutional. In November, an Ontario judge struck down a similar sentence for a weapons offense, but BC is the first province to have the drug offense sentences quashed. Crown prosecutors are expected to appeal.

India Asset Forfeiture Bill Passes Lok Sabha. A bill that would increase the Indian government's ability to seize assets from drug traffickers was approved Wednesday by the Lok Sabha, the lower house of the country's bicameral parliament. The Narcotic Drugs and Psychotropic Substances (Amendment) Bill, 2011 passed on a voice vote after members took turns worrying aloud about the spread of drug use in the world's most populous democracy.

Hoffman, Heroin, and What Is To Be Done [FEATURE]

The news last Sunday that acclaimed actor Phillip Seymour Hoffman had died of an apparent heroin overdose has turned a glaring media spotlight on the phenomenon, but heroin overdose deaths had been on the rise for several years before his premature demise. And while there has been much wailing and gnashing of teeth -- and quick arrests of low-level dealers and users -- too little has been said, either before or after his passing, about what could have been done to save him and what could be done to save others.

cooking heroin (wikimedia.org)
There are proven measures that can be taken to reduce overdose deaths -- and to enable heroin addicts to live safe and normal lives, whether they cease using heroin or not. All of the above face social and political obstacles and have only been implemented unevenly, if at all. If there is any good to come of Hoffmann's death it will be to the degree that it inspires broader discussion of what can be done to prevent the same thing happening to others in a similar position.

Hoffman, devoted family man and great actor that he was, died a criminal. And perhaps he died because his use of heroin was criminalized. Criminalized heroin -- heroin under drug prohibition -- is of uncertain provenance, of unknown strength and purity, adulterated with unknown substances. While we don't know what was in the heroin that Hoffman injected, we do know that he maintained his addiction and went to meet his maker with black market dope. That's what was found beside his lifeless body.

In a commentary published by The Guardian, actor Russell Brand, a recovered heroin addict, laid the blame for Hoffman's demise on the drug laws. "Addiction is a mental illness around which there is a great deal of confusion, which is hugely exacerbated by the laws that criminalise drug addicts," Brand wrote, calling prohibitionists' methods "so gallingly ineffective that it is difficult not to deduce that they are deliberately creating the worst imaginable circumstances to maximise the harm caused by substance misuse." As a result, "drug users, their families and society at large are all exposed to the worst conceivable version of this regrettably unavoidable problem."

We didn't always treat our addicts this way. Even after the passage of the Harrison Act in 1914, doctors continued for years to prescribe maintenance doses of opiates to addicts -- and hundreds of them went to jail for it as the medical profession fought, and ultimately lost, a battle with the nascent drug prohibition bureaucracy over whether giving addicts their medicine was part of the legitimate practice of medicine.

The idea of treating heroin addicts as patients instead of criminals was largely vanquished in the United States, but it never went away -- it lingers with methadone substitution, for example. But other countries have for decades been experimenting with providing maintenance doses of opioids to addicts, and to good result. It goes by various names -- opiate substitution therapy, heroin-assisted theatment, heroin maintenance -- and studies from Britain and other European countries, such as Germany, the Netherlands, and Switzerland, as well as the North American Opiate Medications Initiative (NAOMI) and the follow-up Study to Assess Long-Term Opiate Maintenance in Canada have touted its successes.

Those studies have found that providing pharmaceutical grade heroin to addicts in a clinical setting works. It reduces the likelihood of death or disease among clients, as well as allowing them to bring some stability and predictability to sometimes chaotic lives made even more chaotic by the demands of addiction under prohibition. Such treatment has also been found to have beneficial effects for society, with lowered criminality among participants and increased likelihood of their integration as productive members of society.

The dry, scientific language of the studies obscures the human realities around heroin addiction and opioid maintenance therapy. One NAOMI participant helps put a human face on it.

"I want to tell you what being a participant in this study did for me," one participant told researchers. "Initially it meant 'free heroin.' But over time it became more, much more. NAOMI took much of the stress out of my life and allowed me to think more clearly about my life and future. It exposed me to new ideas, people (staff and clients) that in my street life (read: stressful existence) there was no time for."

"After NAOMI, I was offered oral methadone, which I refused. After going quickly downhill, I ended up hopeless and homeless. I went into detox in April 2007, abstained from using for two months, then relapsed. In July 2008 I again went to detox and I am presently in a treatment center... I am definitely not "out of the woods" yet, but I feel I am on the right path. And this path started for me at the corner of Abbott and Hastings in Vancouver... Thank you and all who were involved in making NAOMI happen. Without NAOMI, I wouldn't be where I am today. I am sure I would be in a much worse place."

Arnold Trebach, one of the fathers of the drug reform in late 20th Century America, has been studying heroin since 1972, and is still at it. He examined the British system in the early 1970s, when doctors still prescribed heroin to thousands of addicts, and authored a book, The Heroin Solution, that compared and contrasted the US and UK approaches. Later this month, the octogenarian law professor will be appearing on a panel at the Vermont Law School to address what Gov. Peter Shumlin (D) has described as the heroin crisis there.

Phillip Seymour Hoffman (wikimedia.org)
"The death of Phillip Seymour Hoffman is a tragedy all the way around," Trebach told the Chronicle. "It's a bad idea to use heroin off the street, and he shouldn't have been doing that."

That said, Trebach continued, it didn't have to be that way.

"If we had had a sensible system of dealing with this, he would have been in treatment under medical care," he said. "If he was going to inject heroin, he should have been using pharmaceutically pure heroin in a medical setting where he could also have been exposed to efforts to straighten out his personal life, and he could have access to vitamins, weight control advice, and the whole spectrum of medical care. And if he had had access to opioid antagonists, he could still be alive," he added.

While Hoffman may have made bad personal choices, Trebach said, we as a society have made policy choices seemingly designed to amplify the prospects for disaster.

"This is a sad thing. He is just another one of the many victims of our barbaric drug policy," he said. "This was a totally unnecessary death at every level. He shouldn't have been using, but we should have been taking care of him."

The stuff ought to be legalized, Trebach said.

"I'm an advocate of full legalization, but if we can't go that far, we need to at least provide social and psychological support for these people," he said. "And even if we were to decriminalize or legalize, I would still want to figure out ways to provide support and love and kindness to people using the stuff. I advise you not to do it, but if you're going to use it, I want to keep you alive. I remember talking to people from Liverpool [a famous heroin maintenance clinic covered in the '90s by Sixty Minutes, linked above] about harm reduction around heroin use back in the 1970s. One of the ladies said it is very hard to rehabilitate a dead addict."

"There are plenty of things we can be doing," said Hilary McQuie, Western director for the Harm Reduction Network, reeling off a list of harm reduction interventions that are by now well-known but inadequately implemented.

"We can make naloxone (Narcan) more available. We need better access to it. It should be offered to people like Hoffman when they are leaving treatment programs, especially if they've been using opiates, just as a safeguard," she said. "Having treatment programs as well as harm reduction programs distribute it is important. We can cut the overdose rate in half with naloxone, but there will still be people using alone and people using multiple substances."

There are other proven interventions that could be ramped up as well, McQuie said.

"Safe injection sites would be very helpful, so would more Good Samaritan overdose emergency laws, and more education, not to mention more access to methadone and buprenorphine and other opioid substitution therapies (OST)," she said, reeling off possible interventions.

Dr. Martin Schechter, director of the School of Population and Public Health at the University of British Columbia in Vancouver, knows a thing or two about OST. The principal study investigator for the NAOMI and the follow-up SALOME study, Schechter has overseen research into the effectiveness of treating intractable addicts with pharmaceutical heroin, as well as methadone. The results have been promising.

"What we're using is medically prescribed pharmaceutical diacetylmorphine, the active ingredient in heroin," he explained. "It's what you have when you strip away all the street additives. This is a stable, sterile medication from a pharmaceutical manufacturer. We know the precise dose tailored for each person. With street heroin, not only is it adulterated and injected in unsterile situations, but people really don't know how strong it is. That's probably what happened to Mr. Hoffman."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)
In NAOMI, 90,000 injections were administered to study participants, and only 11 people suffered overdoses requiring medical attention.

"Never did we have a fatal overdose," Schechter said. "Because it was in a clinic, nurses and doctors are right there. We administer Narcan (naloxone), and they wake up."

Heroin maintenance had even proven more effective than methadone in numerous studies, Schechter said.

"There have been seven randomized control trials across Europe and in Canada that have shown for people who have already tried treatments like methadone, that medically prescribed heroin is more effective and cost effective treatment than simply trying methadone one more time."

Those studies carry a lesson, he said.

"We have to start looking at heroin from a medicinal point of view and treat it like a medicine," he argued. "The more we drive its use underground, the more overdoses we get. We need to expand treatment programs, not only with methadone, but with medically prescribed heroin for people who don't respond to other treatments."

Safe injection sites are also a worthwhile intervention, Schechter said, although he also noted their limitations.

"Injecting under supervision is much safer; if there is an overdose, there is prompt attention, and they provide sterile equipment, reducing the risk of HIV and Hep C," he said. "But they are still injecting street heroin."

He would favor decriminalizing heroin possession, too, he said.

Harm reduction measures, opioid maintenance treatments, and the like are absolutely necessary interventions, said McQuie, but there is a larger issue at hand, as well.

"We still need to look at the overall issue of the stigmatization of drug users," she said. "People aren't open about their use, and that puts them in a more dangerous situation. It's really hard in a criminalized environment."

Stigmatization means to mark or brand someone or something as disgraceful and subject to strong disapproval. Defining an activity, such as heroin possession, as a crime is stigmatization crystallized into the legal structures of society itself.

"The ultimate harm reduction solution," McQuie argued, "is a regulated, decriminalized environment where it is available by prescription, so people know what they're getting, they know how much to use, and it's not cut with fentanyl or other deadly adulterants. People wouldn't have to deal with all the collateral damage that comes from being defined as criminals as well as dealing with the consequences of their drug use. They could deal with their addictions without having to worry about losing their homes, their families, and their freedoms."

While such approaches have a long way to go before winning wide popular acceptance, policymakers should at least be held to account for the consequences of their decision-making, McQuie said, suggesting that the turn to heroin in recent years was a foreseeable result of the crackdown on prescription opioid pain medication beginning in the middle of the last decade.

"They started shutting down all those 'pill mills' and people should have anticipated what would happen and been ready for it," she said. "What we have seen is more and more people turning to injecting heroin, but nobody stopped to do an impact statement on what would be the likely result of restricting access to pain pills."

The impact can be seen in the numbers on heroin use, addiction, and overdoses. While talk of a "heroin epidemic" is overblown rhetoric, the number of heroin users has increased dramatically in the past decade. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of past year users grew by about 50% between 2002 and 2011, from roughly 400,000 to more than 600,000. At the same time, the number of addicted users increased from just under 200,000 to about 370,000, a slightly lesser increase.

If there is any good news, it is that, according to the latest (2012) National Household Survey of Drug Use and Health, the number of new heroin users has remained fairly steady at around 150,000 each year for the past decade. That suggests, however, that more first-time users are graduating to occasional and sometimes, dependent user status.

And some of them are dying of heroin overdoses, although not near the number dying from overdoses from prescription opioids. Between 1999 and 2007, heroin deaths hovered just under 2,000, even as prescription drug deaths skyrocketed, from around 2,500 in 1999 to more than 12,000 just eight years later. But, according to the Centers for Disease Control, by 2010, the latest year for which data are available, heroin overdose deaths had surpassed 3,000, a 50% increase in just three years.

While the number of heroin overdose deaths is still but a fraction of those attributed to prescription opioid overdoses and the numbers since 2010 are spotty, the increase that showed up in 2010 shows no signs of having gone away. Phillip Seymour Hoffman may be the most prominent recent victim, but in the week since his death, another 50 or 60 people have probably followed him to the morgue due to heroin overdoses.

There are ways to reduce the heroin overdose death toll. It's not a making of figuring out what they are. It's a matter of finding the political and social will to implement them, and that requires leaving the drug war paradigm behind.

New York City, NY
United States

Chronicle AM -- February 4, 2014

Legalization proves profitable for Colorado's coffers, decrim moves closer in DC, more drug test bills get filed, Vermont attempts to do something about its opioid problem, a crime lab scandal brews in Florida, and more. Let's get to it:

meth house (assumptionsheriff.com)
Marijuana Policy

DC City Council Approves Decriminalization Bill. The District of Columbia city council today gave initial approval to the "Marijuana Possession Decriminalization Amendment Act of 2014" (Council Bill 20-409), which would eliminate the threat of arrest for possessing or using marijuana and ensure that people are no longer saddled with life-long convictions that make it difficult to obtain employment and housing. The bill still faces another council vote, needs the approval of the mayor, then needs Congress to let it happen.

Colorado Takes in $1.2 Million in Marijuana Taxes in First Month. According to an NBC News survey of Colorado retail marijuana shops, pot sales in the month since they were legal have contributed at least $1.24 million in tax revenues to state coffers. But wait -- there's more: The survey only counted tax receipts from half of the shops that opened New Year's Day, meaning the month's total is probably in the $2.4 million to $3 million range.

Arizona Democrat Files Marijuana Legalization Bill. State Rep. Ruben Gallegos (D) and 12 other Democrats have filed a bill to "regulate and tax marijuana in a manner similar to alcohol." The measure, House Bill 2558, allows for the possession of up to an ounce and a small number of plants as well. Another bill, House Bill 2474, would decriminalize the possession of up to an ounce.

Medical Marijuana

CBD Oil Medical Marijuana Bill for Epileptic Kids Filed in Utah. A bill that would allow for the importation into the state of marijuana extracts containing cannabidiol for use by epileptic children has been filed in Salt Lake City. Rep. Gage Froerer (R-Huntsville) introduced House Bill 100 yesterday.

Hemp

Indiana Senate Passes Hemp Bill. A bill that would allow the production of industrial hemp in the Hoosier State was approved unanimously by the Indiana Senate Monday. Senate Bill 357 would require a waiver from federal law before hemp could be grown there. The bill now heads to the House.

Drug Testing

Georgia Food Stamp Drug Test Bill Filed. State Rep. Greg Morris (R-Vidalia) has filed a bill to require mandatory, suspicionless drug testing for food stamp recipients. The bill is House Bill 772. Similar legislation ordering mandatory, suspicionless drug testing for welfare recipients was signed into law in 2012, but never implemented after a federal judge struck down a similar Florida law.

Northern Marianas Bills Would Require Drug Tests for Candidates, Elected Officials. Bills that would require that candidates for political office and elected officials submit to mandatory drug testing have passed the House Committee on Judiciary and Government Operations. House Bill 18-21 requires testing for candidates, and House Bill 18-152 requires testing for elected officials. The US Supreme Court has found a similar Georgia law unconstitutional.

Drug Treatment

Vermont Rolls Out Early Intervention Program for Criminal Drug Users. Gov. Peter Shumlin (D) and other state officials Monday announced a new program to divert crime-committing drug users into a pre-court, 90-day drug treatment program. If they successfully complete the program, they will not be prosecuted. Only those with nonviolent offenses will be eligible. "Instead of treating this as a crime, let's treat it as the disease that it is and offer addicts the opportunity to get into treatment, get the support they need and if they succeed, never to have to go through the criminal process," Shumlin said Monday at the Rutland County Courthouse.

Law Enforcement

Crime Lab Scandal Has Florida Police Reviewing Thousands of Drug Cases. Hundreds of drug convictions may be jeopardized and thousands of drug cases are under review in Florida after a single chemist at a state-run crime lab was accused of tampering with evidence. The chemist, who works at the Pensacola Regional Crime Lab, is suspected of removing "large" quantities of prescription pills from evidence packages and replacing them with over-the-counter medications, the Florida Department of Law Enforcement announced Saturday. That chemist handled at least 2,600 drug cases.

Methamphetamine

Indiana House Passes Meth Property Disclosure Bill. A bill that would require Indiana property owners to disclose to potential new buyers whether the property had previously been used to manufacture methamphetamine passed the House Monday. The bill, House Bill 1141, would require that such properties be listed on a state web site until at least 90 days after it has been certified as decontaminated. The measure now goes to the Senate.

International

Scholar Francisco Thoumi Offers Comprehensive Analysis of FARC Illicit Drug Cultivation Proposals. Colombian scholar Francisco Thoumi, a long-renowned expert on drug production and trafficking there, has authored a lengthy analysis of the FARC's proposals in peace negotiations with the Colombian government in the area of illicit crop cultivation. The article is Las FARC y el campesinado cultivador de plantas ilícitas: dilemas, ideología y decisiones (The FARC and the Drug-Growing Peasantry: Dilemmas, Ideology, and Decisions). It is in Spanish, but can be translated.

In Colombia, British Liberal Democrat Leader Says UK Should Abandon Current Drug Policies. During a visit to Colombia, British Lib Dem leader Nick Clegg said Britain should abandon its current drug policies because they're not working. He said new approaches were needed, but declined to back full legalization. He said the Lib Dems would offer their own alternative proposals shortly.

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