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Cambodia Drug Detention Centers Rife With Abuse

Cambodian authorities illegally imprison hundreds of drug users and other "undesirables" in detention centers where they don't get drug treatment but instead face torture, sexual abuse, and forced labor, Human Rights Watch charged in a report released Sunday. The rights group called for the centers to be closed immediately.

Cambodian "intervention" truck rounding up drug users and other "undesirables" in Phnom Penh. (hrw.org)
The report, "They Treat Us Like Animals": Mistreatment of Drug Users and 'Undesirables'in Cambodia's Drug Detention Centers, documents the experiences of people recently confined in the centers, who described being thrashed with rubber water hoses and hit with sticks or branches. Some described being punished with exercises intended to cause intense physical pain and humiliation, such as crawling along stony ground or standing in septic water pits.

Former female detainees described rape and other sexual abuse by male guards. Many detainees said they were forced to work unpaid in the centers -- and in some cases, on construction sites -- and those who refused were beaten.

"The only 'treatment' people in Cambodia's drug detention centers receive is being beaten, bruised, and forced to work," said Joseph Amon, health and human rights director at Human Rights Watch. "The government uses these centers as dumping grounds for beggars, sex workers, street children, and other 'undesirables,' often in advance of high-profile visits by foreign dignitaries."

The report identified eight of the drug detention centers and is based on interviews with 33 people who had been held in them. It wasn't just drug users, either. According to the report, authorities also use the drug detention centers to hold homeless people, beggars, street children, sex workers, and people with disabilities.

People interviewed said they saw unaccompanied children as young as six in the detention centers. The children were held in the same rooms as adults, forced to perform exhausting physical exercises and military-like drills, chained, and beaten.

"The government admits that 10% of those held in the centers are children under 18," Amon said. "Children who use drugs or who live on the streets should be protected from harm, not locked up, beaten, and abused."

Human Rights Watch issued a similar report on drug detention center abuses in 2010, Skin on the Cable, which focused national and international attention to the issue of compulsory drug dependency "treatment" centers in the country. Following that report, the United Nations and donor agencies condemned the lack of due process and abusive treatment in centers in Cambodia and the region, while Cambodian government officials largely sought to dismiss the report as "untrue."

A dozen UN agencies issued a joint statement last year calling on countries with such centers "to close them without delay and release the individuals detained," but Cambodian authorities have not responded to that call, nor have they investigated or prosecuted anyone over the reports of torture and abuse at the centers.

"The Cambodian government should conduct a thorough and impartial investigation of arbitrary detention, torture, ill-treatment, and forced labor in its drug detention centers," Human Rights Watch said. "In line with the 2012 UN agency statement, everyone detained in the centers should immediately be released and all the centers closed. The government should replace the centers with expanded access to voluntary, community-based drug treatment."

Cambodia

Chronicle AM -- November 19, 2013

Hmmm, on the same day the DEA warns that "marijuana availability seems to be on the increase," hundreds of people apply for licenses to sell pot in Washington state. Times are changing, and somebody needs to let the DEA know. And there's more news, too. Let's get to it:

Crackdowns on pain pills are leading the way to comeback for heroin. (wikipedia.org)
Marijuana Policy

Hundreds Apply for Pot Business Licenses in Washington State. Monday was the first day budding ganjapreneurs could apply for licenses to open marijuana cultivation, processing, and retail facilities, and interest was intense. By 2:00pm Monday, 299 applications had been submitted. The state envisions up to 334 marijuana retail shops opening next year; it is unclear how many production and processing facilities will be licensed, although regulators have said they want to limit cultivation to two million square feet statewide. Applications are being accepted through December 17.

Arkansas Attorney General Rejects Another Marijuana Initiative. The Arkansas attorney general's office Monday rejected the proposed language of an initiative that would repeal the state's marijuana laws. The initiative isn't clear about what it seeks to achieve, the office said. The attorney general's office has been busy with initiatives this year; it has already approved two separate medical marijuana initiatives, and the author of this one can come back with new language if she wishes.

Drug Policy

DEA Releases 2013 National Drug Threat Assessment. The DEA Monday released the annual drug threat assessment, which includes looks at drug use and trafficking trends. The report identifies the illicit use of controlled prescription drugs as "the nation's fastest growing drug problem," warns that heroin use and supply is up, as is methamphetamine, but that cocaine use and supply is down. Also, "marijuana availability seems to be increasing," and synthetic drugs "have emerged as a serious problem in the United States."

New Yorkers to Map Out City Drug Policies on Saturday. New York City residents just elected a self-described progressive -- Bill de Blasio -- as mayor. Now, they will have a chance to let him know what direction they want the city to take on drug policy. As part of Talking Transition, "an open conversation about the future of New York City," hundreds of people are expected to attend a Saturday forum on "Ending the New Jim Crow: Mapping the Future of Drug Policy in New York City," then break into small groups to make recommendations on issues ranging from racially-biased marijuana arrests, lack of effective drug treatment, and overdose prevention strategies. Click on the main link for more details.

Heroin

Ohio Attorney General Declares War on Heroin. Ohio Attorney General Mike DeWine Monday announced he had created a new heroin unit within his office to fight back against what he called "an epidemic" of heroin use. The move comes as heroin overdose deaths have doubled in recent years, from 292 in 2010 to 606 last year. DeWine said his office will spend an additional $1 million a year on increased assistance to law enforcement, community outreach workers, and lab technicians. The rise in heroin use in Ohio comes after Gov. John Kasich cracked down on pain clinics in 2011, leaving illicit heroin as the last resort for people strung out on opioids.

International

China to Turn "Re-Education" Labor Camps into Drug Treatment Centers. At its recent Third Plenary meeting, the Chinese Communist Party announced it was abolishing its controversial "re-education" labor camps. Now, it turns out that the camps won't be closing, but will instead be converted into drug treatment and rehabilitation centers. "The new rehab centers will provide compulsory drug rehabilitation treatment for addicts, and help them find self-confidence again," one official explained. There are 1.8 million "officially registered" addicts in China, but the number of actual addicts could run as high as 12 million.

Canadian Students for Sensible Drug Policy Meets in Vancouver This Weekend. Canadian SSDP is holding its annual national conference this weekend in Vancouver. In addition to panels and speeches, there will be tours of Insite, Vancouver's supervised injection facility, a Downtown Eastside Walking Tour, and rides on the Sensible BC bus. For more details, click the link.

Health Canada Approves Heroin Maintenance [FEATURE]

Last Friday, Health Canada used some creative rule-reading to approve a program that would provide prescription heroin to a small number of hard-core users, and the Conservative health minister isn't happy. But doctors, advocates, and the users themselves are quite pleased -- and once again, Canada stays on the cutting edge when it comes to dealing smartly with heroin use.

Health Canada approved access to prescription heroin for at least 15 people who are completing their participation in Vancouver's Study to Assess Long-term Opioid Dependence (SALOME), which is testing whether prescribing heroin was more effective than prescribing methadone for users who have proven resistant to conventional treatments. The move came after participants and advocates have been calling for an "exit strategy" for the 322 people in the study.

SALOME began at the end of 2011 and has been enrolling participants on a rolling basis for a year at a time. The final group of participants will finish up at the end of next year. It built on the success of the North American Opioid Maintenance Initiative (NAOMI), a study in Vancouver and Montreal from 2005 to 2008. That study found that using heroin is cheaper and more effective than using methadone to treat recalcitrant heroin users.

While the Conservative federal government has been a staunch opponent of heroin maintenance, not to mention also fighting a bitter losing battle to close down the Vancouver safe injection site, Health Canada bureaucrats were able to find a loophole that will allow doctors to prescribe heroin to graduating study participants under the ministry's Special Access Program (SAP).

That program is designed to provide drugs to Canadians with life-threatening illnesses on a "compassionate or emergency" basis. The SAP includes "pharmaceutical, biologic and radiopharmaceutical products that are not approved for sale in Canada." The program covers diseases including intractable depression, epilepsy, transplant rejection and hemophilia, but heroin addiction isn't mentioned.

"Health Canada made a wonderful decision," said Scott Bernstein, Health and Drug Policy Lawyer for the Vancouver-based Pivot Legal Aid Society, which represents 22 SALOME participants and the BC Association of People on Methadone in order to advocate for their continued access to health care and the protection of their human rights. "The decision was one based on the evidence and not ideology. It means that those SALOME participants allowed access can live safer, more stable lives, lives free of crime and remaining under the care of doctors, not drug dealers."

But Health Minister Rona Ambrose appeared to have been caught flat-footed by the Health Canada decision. She issued a statement the same day decrying the move, saying that it contradicted the government's anti-drug stance.

Pharmaceutical diacetylmorphine AKA heroin (wikimedia.org)
"Our government takes seriously the harm caused by dangerous and addictive drugs," Ambrose said. "Earlier today, officials at Health Canada made the decision to approve an application under the Special Access Program's current regulations to give heroin to heroin users -- not to treat an underlying medical condition, but simply to allow them to continue to have access to heroin for their addiction even though other safe treatments for heroin addiction, such as methadone, are available."

The move is "in direct opposition to the government's anti-drug policy and violates the spirit and intent of the Special Access Program," Ambrose said, adding that she would take action to "protect the integrity of the (SAP) and ensure this does not happen again."

Ambrose's remarks prompted a Monday response from SNAP (the SALOME/NAOMI Patients Association), comprised of "the only patients in North America to be part of two heroin-assisted treatment (HAT) clinical trials" -- NAOMI and SALOME. SNAP noted that European heroin-assisted treatment trials had allowed participants to continue to be prescribed heroin on compassionate grounds after the trials ended and that "heroin-assisted therapy is an effective and safe treatment that improves physical and psychological health when the participants are receiving treatment."

"The Canadian NAOMI trial is the only heroin-assisted treatment study that failed to continue offering HAT to its participants when the trial ended in Vancouver," SNAP said. "We do not want to see the same outcome for the SALOME trial. Currently, SALOME patients are being offered oral hydromorphone when they exit the trial. However, there is currently no scientific evidence to support this treatment option for opiate addiction in the doses required; thus we urge you to reconsider your comments and to support Health Canada's decision to grant special access to heroin for patients exiting the SALOME trial. We also urge Canadians to support the immediate establishment of a permanent HAT program in Vancouver, BC."

Patients and their supporters weren't the only ones supporting the Health Canada move and criticizing Minister Ambrose for her opposition. New Democratic Party health critic Libby Davies also had some choice words for her.

Davies was "outraged" that Ambrose would "overrule her own experts," she said. "Medicalized heroin maintenance has been used very successfully in places like Europe. It's another example of the Conservative government ignoring sound public policy, instead making decisions based on political dogma."

Indeed, while Canada has been on the cutting edge of opiate maintenance in North America, being the scene of the hemisphere's only safe injection site and heroin-maintenance studies, similar moves have been afoot in Europe for some time. Prescription heroin programs have been established in several European countries, such as Switzerland, Germany, Denmark, The Netherlands, and the United Kingdom.

Now, it seems that Canada will join them, despite the health minister's dismay.

Vancouver
Canada

Chronicle Book Review: High Price

High Price: A Neuroscientist's Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society, by Dr. Carl Hart (2013, Harper/Harper Collins Publishers, 340 pp., $26.99 HB)

Dr. Carl Hart grew up black and poor in Miami in the 1970s and 1980s, learned discipline from his desire to be a professional athlete, joined the armed forces, and wandered almost by happenstance into a career in the neurosciences. Now, Hart is at the pinnacle of his field -- a respected researcher in drug effects, the first African-American to become a tenured professor in the sciences at Columbia University, and a member of the National Advisory Council on Drug Abuse and Dependency. And he has some things to say.

Some of those things contradict the conventional wisdom, but Hart has the cred -- both street and academic -- to state them. Although it is the addict or problematic drug user who is too often the media's face of drug use or the subject of scientific research, he notes, the vast majority of drug users are not addicts or problematic. And yes, that even extends to the most demonized drugs, like crack. While we were told one hit could get you strung out, it turns out only a small fraction of crack consumers are addicts, he points out.

Hart also has good, practical advice -- naive drug users shouldn't take drugs the same way experienced users do, for example, or get enough sleep! -- based not only on scientific research, but also personal observation and experience. Now at the pinnacle of his profession, he also wants to restore some sanity to our drug policies.

Dr. Hart has come a long way from the mean, if sun-splashed, streets of Miami, and with High Price, he takes you along for the ride. The journey is well worth it. Part memoir, part social history, part drug science, part plea for sanity on the issues of drugs, race, and class, High Price is revelatory as well as readable, illuminating as well as incisive, as impassioned as it is important.

While Hart grew up the wrong color and in a family scrabbling to hang on to its lower middle class status, his is, above all, an American story -- a story of coming of age, overcoming adversity, and striving for success and understanding in a world seemingly stacked against him. It's also the story of the American working class, buffeted by the de-industrialization that began in the 1970s, targeted by Reagan Republicans with cuts in social programs in the 1980s, and mostly dealt with by "tough on crime" and "tough on drugs" policies that have been in place ever since. That the malignant swelling of the nation's prison population is tied to Reagan era policies ( though many of them enacted by Democratic legislators) too often goes unnoted.

But of course, Hart isn't an unhyphenated American, he's African-American, and that means he carries an additional burden, the assumption too many make of criminality based on little more than his skin color. He wasn't expected to succeed, but to become a number, like so many of his peers. And, as he notes, but for the grace of god he could have gone down that path. He recounts the teenage criminality of he and his peers, making the stark point that a single arrest could make the difference between a career as a scientist and a career as an ex-con car washer. Some of his friends, no better or worse than he, had that unfortunate first encounter with law enforcement and the criminal justice system and never recovered: Educational opportunities blocked, job opportunities lost, they were essentially assigned to the scrap heap.

For some of them, it was a drug bust. Slinging dope was and is a way of life for the marginalized poor, an income, although not a great one, and a way to achieve status and respect. But of course, it's also a ticket to the slammer, particularly if you're poor and of color, without the resources available to middle class white folks. One thing Hart makes crystal clear is just how stacked the deck is against the urban poor, and that alone makes his book worth noting.

Hart grew into young adulthood imbibing the conventional wisdom about how drugs had had such a devastating impact on his community, but he also began to start thinking critically about the mismatch between rhetoric and reality. At some point along the way, he had a Chris Rock moment.

"You know what they say, crack is destroying the ghetto," Rock once famously observed. "Yeah, like the ghetto was so nice before crack. They say that shit like everyone in the 'hood had a yacht, a mansion, and a swimming pool, and crack came by and dried it all up."

As Hart began studying psychology and eventually neuroscience, he began noticing that the effects of crack cocaine widely touted in media and political discourses didn't match the science. In fact, he observed, most of the devastating effects attributed to crack could more fairly and accurately be attributed to poverty. Crack didn't bring guns to the ghetto; they were already there. Crack didn't bring broken families to the ghetto; they were already there. It may not have helped, but it was not the root cause of the problem.

"The effect of crack, when it had one, was mainly to exacerbate the problems that I'd seen in my home and in the hood since the 1970s," he wrote. "The drug's pharmacology didn't produce excess violence."

The studies on which he embarked, moving on from observing the effects of drugs on rats to observing their effects on people, led him to a startling -- and eye-opening -- conclusion: "Much of what we are doing in terms of drug education, treatment and public policy is inconsistent with scientific data."

Hart's critique extends to the science itself. He describes famous experiments where rats or monkeys alone in a cage will repeatedly press a lever to get more drugs, up to the point of death itself. But he then explains how those doses are many times higher than those any human would use, and he makes the crucial point that obsessive drug-taking behavior is reduced when the lab animals are part of a community and when they have other options.

Based on his scientific research, as well as his own observations and historical research (and musical and lyrical inspiration from the likes of Bob Marley and Public Enemy), Hart decided he needed to speak out against the injustices of the war on drugs. He became a board member of the Drug Policy Alliance, he began speaking to groups large and small, and High Price is part of that same education project.

This is not your typical drug policy tome. It's not a paean to pot, nor is it a dry academic treatise. But it is important, not only because it provides a voice for the voiceless peers he left behind, but also because it is a science- and evidence-based clarion call for a smarter and more human approach to drugs, one that situates drugs and problematic drug use within the broader social context. And it's a damned good read, too.

Malaysia Minister Talks Drug Decriminalization

A Malaysian government minister said Sunday the Southeast Asian nation is moving toward decriminalizing drug possession, but her remarks also suggested that drug users would be exchanging jail cells for treatment beds. Minister in the Prime Minister's Department Nancy Shukri said the government's policy was moving from prosecuting drug users to treating them.

Nancy Shukri (frim.gov.my)
Her remarks came at the end of a High Level Meeting on Drug Policy and Public Health sponsored by the Global Commission on Drug Policy. The meeting was held in conjunction with the 2013 International Aids Conference held over the weekend in Kuala Lumpur, the Malaysian capital.

Shukri also said that the Association of Southeast Asian Nations' (ASEAN) goal of a drug-free region by 2015 was not realistic, but that smarter approaches by authorities could reduce drug dependence.

"There is no such thing as drug-free but we can control it by changing or shifting our policy," Shukri said. "Instead of looking at drug dependents as criminals, we should actually look at them as patients. Instead of bringing them to jail, we bring them to the clinic," she told a press gaggle after the AIDS conference ended.

Shukri said that Malaysia had been taking steps toward a more effective and humane drug policy, but that those initiatives were not widely known. She cited ongoing needle exchange programs for injection drug users. The sharing of needles is a known vector for the transmission of the AIDS virus, and the program had resulted in a reduction in new HIV/AIDS infections, she said.

"Others include the harm reduction program and upgrading of the rehabilitation centers into Cure & Care Clinics," Shukri said. "We are already there (decriminalizing drugs) but we are not making it loud enough for the people to understand that we have this policy. Our policy has not been established in a formal way."

That could be coming, though. Shukri said the government is currently reviewing the country's drug laws, including the Drug Dependents (Treatment and Rehabilitation) Act of 1983.

"The Law Reform Committee is now in the process of discussing to amend that particular provision [Section 4(1)(b) of the Act which allows the detention of a suspected drug dependent for up to 14 days for a test to be conducted]," she said.

Kuala Lumpur
Malaysia

Drug Prohibitions Hurt Science, Researchers Charge

In a paper published Wednesday in the journal Nature Reviews Neuroscience, a group of leading scientists argue that global drug prohibition has not only compounded the harms of drug use, but also produced the worst censorship of research in centuries. They likened the banning of psychoactive drugs and the subsequent hampering of research on them to the Catholic Church banning the works of Copernicus and Galileo.

Prof. David Nutt (gov.uk)
The paper, Effects of Schedule I Drug Laws on Neuroscience Research and Treatment Innovation (abstract only), was written by Professor David Nutt of Imperial College London and Leslie King, both former government advisors, and Professor David Nichols of the University of North Carolina-Chapel Hill.

The possession of marijuana, MDMA (ecstasy) and psychedelics are stringently regulated under national laws and international conventions dating back to the 1960s, but those laws are not based on science, and the global prohibition regime is rigid and resistant to change, they argued.

"The decision to outlaw these drugs was based on their perceived dangers, but in many cases the harms have been overstated and are actually less than many legal drugs such as alcohol," said Nutt, professor of neuropsychopharmacology at Imperial College London. "The laws have never been updated despite scientific advances and growing evidence that many of these drugs are relatively safe. And there appears to be no way for the international community to make such changes."

In the paper, Nutt and his colleagues argue that the scheduling of psychoactive drugs impedes research into their methods of action and therapeutic potentials and sometimes makes it impossible.

"This hindering of research and therapy is motivated by politics, not science," said Nutt. "It's one of the most scandalous examples of scientific censorship in modern times. The ban on embryonic stem cell research by the Bush administration is the only possible contender, but that only affected the USA, not the whole world."

Research in psychoactive drugs should be free of severe restrictions, the scientists argued.

"If we adopted a more rational approach to drug regulation, it would empower researchers to make advances in the study of consciousness and brain mechanisms of psychosis, and could lead to major treatment innovations in areas such as depression and PTSD," Nutt said.

Nutt headed Britain's Advisory Committee on the Misuse of Drugs until 2009, when he was forced out by the Labor government of Prime Minister Gordon Brown. Nutt was sacked after publicly criticizing the government for ignoring the committee's scientific advice on marijuana on ecstasy. He then became chair of the Independent Scientific Committee on Drugs, which aims to review and investigate the harms and benefits of drugs free from political interference.

London
United Kingdom

Colorado Legislature Passes Sentencing Reform

In the final week of Colorado's legislative sessions, while all the attention was focused on passing marijuana commerce regulations, the state legislature quietly passed a measure designed to reduce the number of drug offenders sent to prison and save the state money. Senate Bill 250 had passed the Senate in April, the House passed it with amendments last Friday, and the Senate concurred with the House version Monday.

The bill creates a separate sentencing system for drug offenders and allows people convicted of some felony drug charges to be sentenced to probation and community-based sentencing and see that felony charge changed to a misdemeanor conviction upon completion of probation.

It also creates an "exhaustion of remedies" requirement for some drug offenders. That means they must have already participated in several other forms of treatment and sentencing before being sentenced to prison.

Those and other reform provisions in the bill will save the state of Colorado $5 million a year, according to the Colorado Commission on Criminal and Juvenile Justice. Some 550 offenders a year will be able to avoid prison sentences for their drug offenses under the new law, according to a legislative analysis.

"It's been a long time coming," said Sen. Steve King (R), sponsor of the bill. "It starts to deal with addiction issues and getting them off drugs."

The governor is expected to sign the bill shortly.

Denver, CO
United States

GAO Says ONCDP Not Achieving Drug Goals So Far

Just a day after the Office of National Drug Control Policy (ONDCP -- the drug czar's office) released its latest annual national drug control strategy, the Government Accountability Office (GAO) has issued a report finding that ONDCP has fallen well short of goals enunciated in its 2010 national drug strategy.

In the report, Office of National Drug Control Policy: Office Could Better Identify Opportunities to Increase Program Coordination, GAO noted that ONDCP and the federal government "have not made progress toward achieving most of the goals articulated in the 2010 National Drug Control Strategy." In some areas, including reducing teen drug use, reducing drug overdose deaths, and reducing HIV infections from injection drug use, GAO found, ONDCP was not only not making progress, but sometimes the numbers were moving in the opposite direction.

For instance, under the broader goal of "curtailing illicit drug consumption in America," ONDCP had set use reduction goals to be achieved by 2015. It sought to reduce last month drug use by teens by 15%, but has achieved no movement. Similarly, it sought a 15% reduction in past month use by young adults, but has achieved no movement. It also sought to reduce lifetime use of drugs, alcohol, and tobacco by 8th graders by 15%, and was making progress toward its goal with alcohol and tobacco, but not with illegal drugs.

Likewise, under ONDCP's broad goal of "improving the public health and public safety of the American people by reducing the consequences of drug use," ONDCP identified goals of reducing overdose deaths, drug-related hospital emergency room visits, and drug-related HIV infections by 15% by 2015, but showed "movement away from goal" between 2010 and 2012.

Drug czar Gil Kerlikowske is talking up a "21st Century Approach" to drug use with a heavy emphasis on treatment and prevention, but the latest national drug budget still allocates 58% of funding to law enforcement and interdiction. And those remaining funds for treatment and prevention are "fragmented" across 15 federal agencies, with much overlapping. GAO reviewed 76 federal drug treatment and prevention programs and found 59 of them overlapped.

GAO did note that while ONDCP was not showing progress in most of its goals, it had implemented 107 of the 112 "action items" contemplated to meet those goals. The auditors noted that "ONDCP officials stated that implementing these action items is necessary, but may not be sufficient to achieve Strategy goals."

Washington, DC
United States

White House 2013 National Drug Strategy Released

The White House Office of National Drug Control Policy (ONDCP -- the drug czar's office) released its 2013 National Drug Control Strategy Wednesday. The strategy is being billed as a "21st Century Approach" to drug use and trafficking, but despite some rhetorical softening maintains the US hard-line approach to the issue.

"The president has outlined his vision of an America built to last -- where an educated, skilled workforce has the knowledge, energy and expertise to compete in the global marketplace. Yet -- for far too many Americans -- that vision is limited by drug use, which not only diminishes the potential of the individual, but jeopardizes families, communities and neighborhoods," ONDCP wrote on a blog post announcing the strategy's release and touting reductions in cocaine and prescription drug abuse as progress made.

"Today we are releasing a science-driven plan for drug policy reform in America to build upon this progress," ONDCP continued. "This 21st century drug policy outlines a series of evidence-based reforms that treat our nation's drug problem as a public health issue, not just a criminal justice issue. This policy underscores what we all know to be true: we cannot arrest or incarcerate our way out of the drug problem."

The strategy emphasizes treatment and prevention, but despite the rhetoric, the Fiscal Year 2014 federal drug budget it accompanies continues to be imbalanced, with 58% of federal anti-drug spending directed at law enforcement and interdiction efforts. That figure does mark a decline from previous years, but only a marginal one.

And even its emphasis on treatment also includes punitive criminal justice elements, such as its embrace of the drug court system, where drug-addicted people are subjected to legal sanctions for such addiction-related behaviors as failing a drug test or missing an appointment. That has some drug reformers calling foul.

"The administration says drug use is a health issue but then advocates for policies that put people in the criminal justice system," said Bill Piper, director of national affairs for the Drug Policy Alliance. "Until the drug czar says it is time to stop arresting people for drug use, he is not treating drug use as a health issue no matter what he says. I know of no other health issue in which people are thrown in jail if they don't get better."

While much of the strategy is little more than the same old same old, the strategy does call for expanded access to naloxone, a low-cost antidote that can reverse the effects of opioid overdoses. That is in response to the rapid growth in prescription drug overdose deaths in recent years.

"Director Kerlikowske should be applauded for taking steps to reduce drug overdose fatalities, but he's not doing much to reduce drug arrests or the many other problems associated with treating drug use through the criminal justice system," said Piper.

But while the drug strategy shows flexibility in its efforts to deal with fatal drug overdoses, it maintains a staunch opposition to marijuana reform and includes attacking outdoor and indoor marijuana cultivation as one of its key goals.

"The administration's continued opposition to marijuana law reform shows they're not serious about reforming US drug policy," said Piper. "At the very least they should stop getting in the way of states that are trying to improve public health and safety by regulating marijuana like alcohol."

Washington, DC
United States

The Push is On for PTSD and Medical Marijuana [FEATURE]

Access to medical marijuana continues to expand as more and more states embrace the healing power of the herb. At the same time, hundreds of thousands of veterans of America's decade of wars are returning home burdened with Post Traumatic Stress Disorder (PTSD), a condition as old as war itself, but that in years past went either unrecognized or was seen as a soldier's personal failure, his "shell shock" or "battle fatigue." Could medical marijuana help?

http://stopthedrugwar.org/files/scott-murphy-iraq-deployment-200px.jpg
Scott Murphy Iraq deployment photo
Scott Murphy of Newton, Massachusetts, is an Iraq combat veteran who uses medical marijuana for chronic pain. "I use medical cannabis for chronic pain from a motorcycle accident that was aggravated by my military service," Murphy said. "I had a severe accident when I was 18, I have a rod in my femur and four plates in my hip. The pain is to the point where it is affecting my walk."

But Murphy also wants to ensure that his state's new medical marijuana law provides for access to the plant for PTSD. A man Murphy described as his "best friend," a fellow veteran, committed suicide at age 22 after being kicked out of the Army for misconduct related to his mental issues rather than being given a medical discharge as promised.

"He had been showing signs of PTSD," Murphy recalled. "He was a good soldier, but when he got back from his second deployment he was having problems. When they kicked him out of the Army, he went home and killed himself."

Amid increasing evidence that medical marijuana can have a beneficial impact in helping people cope with PTSD, the push is on to expand access to the healing herb. Murphy spent Monday morning testifying at a public hearing on draft regulations for the Massachusetts medical marijuana program. Although voters voted for the initiative that listed specific qualifying conditions -- not including PTSD -- as well as "and other" conditions, state regulators are considering changing that to "and other debilitating" conditions, a change that Murphy and others fear could limit access to medical marijuana for PTSD patients.

In some medical marijuana states, adding PTSD requires going through a medical marijuana regulatory commission; in others, it is being pushed through the legislature. In Oregon, for example, Senate Bill 281, which would add PTSD to the list of treatable conditions, was approved by the state Senate last Thursday, and now moves to the House. In Michigan, by contrast, hearings on PTSD and medical marijuana were held recently by Michigan's Advisory Committee on Medical Marijuana (ACMM).

State legislatures are proving to be an easier path than unelected medical marijuana overseers, said activists. "There have been a number of states that have tried to petition to get it added to the list that have so far failed," said Kris Hermes, media liaison for Americans for Safe Access.

Air Force veteran Michael Krawitz of Veterans for Medical Cannabis Access (VCMA) and a plaintiff in Americans for Safe Access v. Drug Enforcement Agency, a case which seeks to see marijuana moved out of the Controlled Substance Act's Schedule I, agreed. "That Oregon effort is moving in the legislature because the state oversight panel was so intractable," said Krawitz, who was deeply involved in the effort there. "Any time we've had to go through the process provided by the state to address expanding access to medical marijuana, we've had trouble. Michigan is another example. There, there was a petition to add PTSD, but there was no actual process to do so. They were essentially keeping the process from moving forward until [vaunted Michigan marijuana attorney] Matt Abel sued them. Now, we have hearings before the advisory committee."

The need to do something for veterans is a major impetus behind the push, but PTSD effects lots of people who aren't veterans as well. "It isn't just veterans who suffer from PTSD," Krawitz said. "At that hearing, there were many veterans, but also other people who had suffered trauma -- child abuse survivors, rape survivors, emergency response workers."

Michael Krawitz testifying in support of Oregon bill
Still, veterans mustering out after more than a decade of US wars in Iraq and Afghanistan are coming home with PTSD in record numbers. A 2004 study in the New England Journal of Medicine estimated that 18% of returning Iraq combat veterans had PTSD. And a 2008 RAND Corporation report estimated that up to 225,000 veterans will return from the wars with PTSD.

The trauma of war is reflected not only in the number of vets suffering from PTSD, but even more ominously, in sky-high suicide rates. US military veterans are committing suicide at a rate of 22 per day, up 20% from just five years ago. And according to a Veterans Administration study released in February, that number almost certainly undercounts the number of veteran suicides because of data limitations.

The military and public health workers are keenly aware of the problem, and are attempting to address it through means both conventional and unconventional. The military and the Veterans Administration have been open to therapeutic interventions including yoga, meditation, and the use of companion dogs; they have also armed themselves with the arsenal of psychotherapeutic drugs -- anti-depressants, anti-psychotics, tranquilizers -- available in the standard pharmacopeia. But those drugs can have some nasty side effects, and their utility in treating PTSD is questionable; noting reports of negative consequences, the Army has warned against over reliance on them.

In the search for succor, more and more vets and other victims of PTSD are turning to medical marijuana. But there is a problem. Not only do a majority of states not recognize medical marijuana, even in those states that do, many of them do not allow its use for PTSD. Despite mounting evidence that medical marijuana can help with PTSD, only a handful of medical marijuana states have approved its used. According to Americans for Safe Access, only California, Connecticut, Delaware, New Mexico and Massachusetts would allow for its use for PTSD, and as we have seen above, it's still up in the air in the Bay State.

"As we find more and more people, especially veterans, benefiting from its use, we see the unfortunate absence of availability for patients across the country," said ASA's Hermes, "It's only approved in five states; that means well below half the medical marijuana states recognize the need for patients to use it for PTSD."

Americans for Safe Access supports expanded access to medical marijuana for PTSD, according to Hermes. "We wholeheartedly support the efforts to petition where patients can do so to get PTSD added to the list of conditions, and we're also pushing for recognition inside the Veterans Administration, but that's an uphill slog," he said.

And it isn't only PTSD treatment that's at stake for veterans. "I'm not only pushing for chronic pain and PTSD, but other stress-related combat issues, and that language is one of the things I asked [the Massachusetts Department of Public Health] to clarify today," Murphy said in an interview following the hearing. "Does their definition of 'debilitating' include PTSD? If they're going to use a broad definition of 'debilitating' so that it covers the full spectrum of vets' injuries, that would be one thing. But it's unclear if PTSD or other mental conditions will be covered. I think we should leave the wording with "and other" -- that's what the voters voted on. I don't think we should have to wait until someone's PTSD is so bad it's life-limiting to be able to get access."

Massachusetts regulators were supposed to have their draft regulations ready by May 5, but in the wake of the Boston bombings, that is now up in the air.

Part of the problem with winning acceptance of using medical marijuana for treatment of PTSD is the relative paucity of clinical studies on its safety and efficacy. When the state of Arizona considered adding PTSD to its list of qualifying conditions, researchers hired by the Department of Human Services found very little of use in their review of the literature.

But studies do exist. Krawitz and Veterans for Medical Cannabis Access compiled an impressive set of studies suggesting marijuana is safe and effective in treating PTSD and anxiety for Michigan regulators. (They are downloadable as submitted at the following links: Packet 1, part 1 of 3, Packet 1, part 2 of 3, Packet 1, part 3 of 3, Packet 2, Packet 3). That same packet also went out to New Mexico, where an effort to remove PTSD from the list of treatable ailments was foiled, and to Oregon, where the PTSD bill moved forward this week.

"While we don't have a lot of studies titled 'PTSD Response to Cannabis Therapy,' we do have a preponderance of evidence that shows cannabis works in various ways, including for symptoms of PTSD," said Krawitz.

Scott Murphy at 2013 press conference (courtesy ASA via YouTube)
One important reason the hard science officials would like to see on the efficacy and safety of marijuana for PTSD is federal government obstructionism. The Multidisciplinary Association for Psychedelic Studies (MAPS), for instance, has been attempting for years to win approval for its study of PTSD and medical marijuana. But it's still waiting and still patiently trying to satisfy the endless niggling of the National Institute on Drug Abuse and the Department of Health and Human Services. The DEA and the courts haven't helped either -- the agency in 2011 denied a request by UMass scientist Dr. Lyle Craker to grow marijuana for research purposes, disregarding its own administrative law judge's recommendation to approve it, and a court last week sided with DEA.

Nevertheless, anecdotal evidence on marijuana treatment for PTSD is helping to move the issue forward. The site ProCon.org, which features a major section devoted to medical marijuana, has posted several readers' comments on the subject:

"I had severe reservations about 'smoking pot.' It is illegal and I am a health care professional," one anonymous commenter wrote. "Still, I wanted to feel better, to be myself again, and to be the person I was before the PTSD. I smoked the pot. Immediately I felt relaxed and calm. I smiled and laughed. I finally felt at peace for the first time in two years. I slept my first night in three years without the sleep medication. The next day I felt refreshed and renewed. I had hope again. My son told me that he was so happy to see the old me again."
 

"I was shot thru the right sub and supra orbital sections of the right side of my head exiting over my right ear. They rebuilt 1/4 of my skull," wrote another commenter. "Epilepsy, PTSD, and other issues such as severe anxiety, constant pain and depression... I am still alive because I smoke [marijuana] every day. Empirical evidence has proven to me that failure to utilize generally causes a seizure and at minimum I get really aggressive... I will not live on narcotics. Ibuprofen or aspirin all have side effects worse than any temporary pain. Replacement liver from the damage of man-made drugs? No thanks."

In the meanwhile, veterans and others continue to suffer from PTSD and continue to use marijuana for relief. In states that do not have medical marijuana laws, that makes them criminals. In states that do have medical marijuana laws, but don't allow it to be used for PTSD, they are criminals, too -- unless they hide what they're actually using it for.

"These state medical marijuana control boards are willing to allow vets to have it for pain, but not PTSD, so in states like Arizona, vets suffering from PTSD are using a pain diagnosis to be legal under state law, and that's problematic. We're trying to get people suffering from PTSD to actually come in and get help, and it's difficult because there's a lot of stigma around it. What are we telling our soldiers when we tell them 'tell the doc you have pain, don't say you have PTSD'"? Krawitz asked. "What are we saying about the validity of their condition?"

That leads to other problems, too Krawitz said.

"When we can't recommend medical marijuana for PTSD, we're pushing people to use chronic pain as a qualifying condition, and that leads to police and prosecutors seeing all those pain recommendations and saying there must be fraud in the system," he said. "There are a lot of patients who would otherwise have had recommendations for PTSD."

PTSD sufferers are not waiting for peer-reviewed, clinically-controlled studies to tell them what works. PTSD is a real and growing problem, and medical marijuana appears to do some good. The scientific studies that would satisfy legislators and state review boards need to be done, and that is happening, albeit too slowly, but in the meanwhile, people are suffering because the government they served at risk to life and limb is now obstructing the research that would legitimize their treatment.

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