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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

China, Southeast Asia Vow More Better Drug War

At a meeting in Myanmar Thursday, China and five Southeast Asian nations vowed to redouble their efforts and boost cooperation in an effort to get a grip on illegal drug use and trafficking, which they called "a significant threat" to the region.

opium poppy (UNODC)
China was joined by Cambodia, Laos, Myanmar, Thailand, and Vietnam), along with the UN Office on Drugs and Crime (UNODC), for the Ministerial Meeting of the Signatory Countries to the 1993 Memorandum of Understanding on Drug Control in the Greater Mekong Sub-Region.

"Consumption and production of narcotic drugs continues to grow rapidly within the region and worldwide, constituting a significant threat to the East Asian region," according to a joint statement adopted at the meeting.

The countries and the UNODC pledged to heighten cross-border cooperation, examine alternative development programs, and share experiences in drug treatment, prevention, and public awareness.

"This agreement marks the continued commitment of the six MOU countries in supporting drug control in the region, and the celebration of 20 years of partnership and collaboration," said Myanmar representative Home Affairs Minister Lt. Gen. Ko Ko at the signing ceremony. "The MOU Member States re-affirm our commitment and assure the international community of our efforts to eliminate the drug problem in our region."

Southeast Asia has been a hotbed of methamphetamine production in recent years, and Myanmar is now the world's second largest producer of opium -- although its production is only about one-tenth that of world leader Afghanistan.

"Major challenges persist," said John Sandage, UNODC director of treaty affairs. "The resurgence of opium poppy cultivation, the dramatic spread of amphetamine-type stimulants (ATS), the influx of drugs new to the region and increased levels of addiction. UNODC looks forward to working with the MOU states to implement plans that help us better understand the threat and challenges, build technical capacity and lead to greater cooperation across borders and among agencies."

Nay Pyi Taw
Myanmar

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

Modest Changes in Obama's FY 2014 Drug Budget

The Obama administration released its Fiscal Year 2014 budget proposal Wednesday, including its 2014 federal drug budget. Pundits and politicians on both sides of the aisle quickly pronounced the Obama budget dead on arrival, but it does provide both a window into administration thinking on drug policy and a starting point for negotiations.

Obama's 2014 drug budget came out Wednesday. (whitehouse.gov)
There's not much new. The historic 2:1 ratio between law enforcement and interdiction spending and treatment and prevention spending, representing what critics have long called an over-reliance on enforcement, is slightly attenuated. The Obama 2014 drug budget allocates 58% of spending to enforcement vs. 42% to treatment and prevention. It is a slight improvement over the FY 2013 drug budget, where the figures were 62% and 38% -- starting to climb away from 2:1, if it continues, but not dramatically.

In a post on its web site, the Office of National Drug Control Policy's Rafael Lemaitre writes that treatment and prevention spending now tops domestic law enforcement spending, and "that's what a 21st Century approach to drug policy looks like," but that post does not include interdiction and international drug enforcement spending. When those are included, the Obama drug budget is clearly weighted on the side of law enforcement -- very much what a late 20th Century drug policy looked like.

Still, the budget calls for an 18% increase in treatment funding, and cuts in interdiction and international enforcement funding, as welling as reducing funding for the High Intensity Drug Trafficking Area (HIDTA) program, which generates ever more drug arrests working with state and local drug task forces. But spending for both the DEA and Bureau of Prisons is going up, and that raised the hackles of one drug reform activist.

"The administration deserves some credit for moving this ratio slightly in the right direction over the years, but a drug control budget that increases funding for the DEA and the Bureau of Prisons is simply not the kind of strategy we need in the 21st Century," said Tom Angell, spokesman for the Marijuana Majority. "At a time when a majority of Americans support legalizing marijuana, and states are moving to end prohibition, this president should be spending less of our money paying narcs to send people to prison, not more. If, as administration officials say, 'we can't arrest our way out of the drug problem,' then why are they continuing to devote so many resources to arresting people for drug problems?"

The administration also deserves "some credit" for reducing HIDTA funding, said Angell, but "still $193 million for the program is $193 million more than should be used to arrest people for drugs in the 21st Century."

New Group Seeks to Stop Marijuana Legalization [FEATURE]

The passage of marijuana legalization measures by voters in Colorado and Washington in November has sparked interest in marijuana policy like never before, and now it has sparked the formation of a new group dedicated to fighting a rearguard action to stop legalization from spreading further.

http://stopthedrugwar.org/files/patrick-kennedy.jpg
Patrick Kennedy (bioguide.congress.gov)
The group, Smart Approaches to Marijuana (SAM or Project SAM) has among its "leadership team" liberal former Rhode Island Democratic congressman and self-admitted oxycodone and alcohol addict Patrick Kennedy and conservative commentator David Frum. It also includes professional neo-prohibitionist Dr. Kevin Sabet and a handful of medical researchers. It describes itself as a project of the Policy Solutions Lab, a Cambridge, Massachusetts, a drug policy consulting firm headed by Sabet.

SAM emphasizes a public health approach to marijuana, but when it comes to marijuana and the law, its prescriptions are a mix of the near-reasonable and the around-the-bend. Rational marijuana policy, SAM says, precludes relying "only on the criminal justice system to address people whose only crime is smoking or possessing a small amount of marijuana" and the group calls for small-time possession to be decriminalized, but "subject to a mandatory health screening an marijuana-education program." The SAM version of decrim also includes referrals to treatment "if needed" and probation for up to a year "to prevent further drug use."

But it also calls for an end to NYPD-style "stop and frisk" busts and the expungement of arrest records for marijuana possession. SAM calls for an end to mandatory minimum sentences for marijuana cultivation or distribution, but wants those offenses to remain "misdemeanors or felonies based on the amount possessed."

For now, SAM advocates a zero-tolerance approach to marijuana and driving, saying "driving with any amount of marijuana in one's system should be at least a misdemeanor" and should result in a "mandatory health assessment, marijuana education program, and referral to treatment or social services." If a scientifically-based impairment level is established, SAM calls for driving at or above that level to be at least a misdemeanor.

Less controversially, SAM advocates for increased emphasis on education and prevention. It also calls for early screening for marijuana use and limited intervention "for those who not progressed to full marijuana addiction."

For a taste of SAM's kinder, gentler, neo-prohibitionist rhetoric, David Frum's Monday CNN column is instructive. "We don't want to lock people up for casual marijuana use -- or even stigmatize them with an arrest record," he writes. "But what we do want to do is send a clear message: Marijuana use is a bad choice."

Marijuana use may be okay for some "less vulnerable" people, Frum writes, but we're not all as good at handling modern life as he is.

"But we need to recognize that modern life is becoming steadily more dangerous for people prone to make bad choices," he argues. "At a time when they need more help than ever to climb the ladder, marijuana legalization kicks them back down the ladder. The goal of public policy should not be to punish vulnerable kids for making life-wrecking mistakes. The goal of public policy should be to protect (to the extent we can) the vulnerable from making life-wrecking mistakes in the first place."

Marijuana legalization advocates are having none of it. And they level the charge of hypocrisy in particular at Kennedy, whose family made its fortune selling alcohol. The Marijuana Policy Project (MPP) has called on Kennedy to explain why he wants to keep "an objectively less harmful alternative to alcohol illegal" and has created an online petition calling on him to offer an explanation or resign as chairman of SAM.

"Former Congressman Kennedy's proposal is the definition of hypocrisy," said MPP communications director Mason Tvert. "He is living in part off of the fortune his family made by selling alcohol while leading a campaign that makes it seem like marijuana -- an objectively less harmful product -- is the greatest threat to public health. He personally should know better."

Nor did Tvert think much of SAM's insistence that marijuana users need treatment.

"The proposal is on par with forcing every alcohol user into treatment at their own cost or at a cost to the state. In fact, it would be less logical because the science is clear that marijuana is far less toxic, less addictive, and less likely to be associated with acts of violence," Tvert said.

"If this group truly cares about public health, it should be providing the public with facts regarding the relative harms of marijuana and discouraging the use of the more harmful product," Tvert said. "Why on earth would they want keep a less harmful alternative to alcohol illegal? Former Congressman Kennedy and his organization should answer this question before calling on our government to start forcing people into treatment programs and throwing them into marijuana re-education camps."

Project SAM is out of step with current public opinion, said NORML executive director Allen St. Pierre.

"There really aren’t that many people publicly opposing marijuana law reform these days," St. Pierre noted. "The fact that a liberal like Patrick Kennedy is joining with a conservative like David Frum speaks to a mainstream disconnect. Both these guys are seen as mainstream, but three-quarters of the population support medical marijuana and decriminalization, half the country supports legalization, and we know that in two states, 55% voted for legalization. I can't speak to why they're so politically tone deaf."

"Kevin Sabet recognizes the old approach is just done for -- just saying marijuana turns you into an addict is no longer working," MPP's Tvert told the Chronicle. "This is a thinly veiled attempt to maintain marijuana prohibition by appealing to the sensibilities of people who recognize it’s a failure. They are clutching at straws. If they truly think people shouldn’t have their lives ruined for marijuana, they shouldn’t be proposing it be kept illegal."

"We are well past the epoch of the A.M. Rosenthals and the Joe Califanos," said St. Pierre, referring to ardent drug warriors of yore. "The mainstream media has moved away from the type of Reefer Madness that Frum and Kennedy are trying to engage in," he said. "Their advocacy is based on Kevin Sabet's rhetoric, and it's an extension of a failed policy. They're trying to buy time and delay marijuana law reform."

The political terrain has undergone a seismic shift with the November election results, and the rhetorical terrain has been shifting (reality not so much) away from drug war talk under the Obama administration. Now, Project SAM can join drug czar Kerlikowske is hoping talking more gently can thwart the progress of marijuana legalization.

Decriminalize Drug Possession, UK Experts Say

In a report six years in the making, the United Kingdom Drug Policy Commission, a non-governmental advisory body chaired by Dame Edith Runciman, has called for a reboot of British drug policy and for decriminalizing the possession of small amounts of drugs for personal use.

The report, A Fresh Approach to Drugs, found that the UK is wasting much of the $4.8 billion a year it spends fighting illegal drugs, and that the annual cost to the country of hard drug use was about $20 billion. A smarter set of drug policies emphasizing prevention, diversion, and treatment would be a more effective use of public resources, the report found.

Some 42,000 people in the UK are convicted each year of drug possession offenses and another 160,000 given citations for marijuana possession. Arresting, citing, and jailing all those people "amounts to a lot of time and money for police, prosecution, and courts," the report said.

"To address these costs, there is evidence to suggest that the law on the possession of small amounts of controlled drugs, for personal use only, could be changed so that it is no longer a criminal offence. Criminal sanctions could be replaced with simple civil penalties, such as a fine, perhaps a referral to a drug awareness session run by a public health body, or if  there was a demonstrable need, to a drug treatment program. The evidence from other countries that have done this is that it would not necessarily lead to any significant increase in use, while providing opportunities to address some of the harms associated with existing drug laws," the report recommended.

"Given its relatively low level of harm, its wide usage, and international developments, the obvious drug to focus on as a first step is cannabis, which is already subject to lesser sanctions than previously with the use of cannabis warnings. If evaluations indicated that there were no substantial negative consequences, similar incremental measures could be considered, with caution and careful further evaluation, for other drugs," the report said.

But while the commission was ready to embrace decriminalization, it was not ready to go as far as legalizing drug sales.

"We do not believe that there is sufficient evidence at the moment to support the case for removing criminal penalties for the major production or supply offenses of most drugs," it said.

Still, policymakers might want to consider lowering the penalties for growing small numbers of marijuana plants to "undermine the commercialization of production, with the associated involvement of organized crime."

The report also called for a review of harsh sentences for drug offenses, a consistent framework for regulating all psychoactive substances -- from nicotine to heroin -- and for moving the policy prism through which drug policy is enacted from the criminal justice system to the public health system.

But the Home Office, which currently administers drug policy in Britain, wasn't having any of it. Things are going swimmingly already, a Home Office spokesperson said.

"While the government welcomes the UKDPC's contribution to the drugs debate, we remain confident that our ambitious approach to tackling drugs -- outlined in our drugs strategy -- is the right one," the spokesperson said. "Drug usage is at its lowest level since records began. Drug treatment completions are increasing and individuals are now significantly better placed to achieve recovery and live their lives free from drugs. "I want to take this opportunity to thank the UKDPC for its work in this area over the past six years."

United Kingdom

Making Sure Drugs Kill: Commission Blames Drug War for Spreading AIDS [FEATURE]

On Tuesday, as the UN's global drug prohibition bureaucracy marked its annual International Day Against Drug Abuse and Illicit Trafficking and UN Office on Drugs and Crime head Yuri Fedotov blamed hard drug use for "bringing misery to thousands of people, insecurity, and the spread of HIV," a group of leading international voices offered a starkly contrasting perspective, arguing instead that is the failures and consequences of global drug prohibition that are driving the spread of HIV/AIDS and other blood-borne diseases among drug users.

Commission members Michel Kazatchkine, Ruth Dreifuss, and Ilana Szabo at London press conference
Those voices, gathered together as the Global Commission on Drug Policy, include six former presidents from around the world, public health experts, and socially conscious entrepreneurs such as Sir Richard Branson. They took the opportunity of global anti-drug day to issue a report, The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic that directly condemns the drug war as a failure and calls for immediate, fundamental reforms of the global drug prohibition regime to slow the spread of HIV and reduce other drug war harms.

There are an estimated 33 million people worldwide infected with HIV, and outside sub-Saharan Africa, injection drug use accounts for one-third of new infections. The situation is particularly bad in Russia and other countries in the former Soviet Union and East Bloc that continue to take harsh drug war approaches to drug use despite the evidence before their own eyes. In Russia, nearly one in a hundred adults is now infected with HIV.

But it's not just the Russian sphere where policymakers ignore the evidence. The report also cites China, Thailand, and the US, where Congress recently reinstated a longstanding ban on the use of federal funds for syringe exchange programs. In countries that have adopted evidence-based HIV prevention programs, such as Switzerland and Portugal, injection drug use-related HIV infections have nearly been eliminated.

According to the report, drug prohibition and the criminalization of drug users spurs the spread of HIV through the following means:

  • Fear of arrest drives persons who use drugs underground, away from HIV testing and HIV prevention services and into high-risk environments.
  • Restrictions on provision of sterile syringes to drug users result in increased syringe sharing.
  • Prohibitions or restrictions on opioid substitution therapy and other evidence-based treatment result in untreated addiction and avoidable HIV risk behavior.
  • Deficient conditions and lack of HIV prevention measures in prison lead to HIV outbreaks among incarcerated drug users.
  • Disruptions of HIV antiretroviral therapy result in elevated HIV viral load and subsequent HIV transmission and increased antiretroviral resistance.
  • Limited public funds are wasted on harmful and ineffective drug law enforcement efforts instead of being invested in proven HIV prevention strategies.

"The Global Commission is calling on all entities to acknowledge and address the causal links between the war on drugs' criminalization of drug use and drug users and the spread of HIV/AIDS," commission member Michel Kazatchkine, the former executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria told a London press conference. "For people who inject drugs and their sex partners, the AIDS epidemic continues to be a public health emergency."

"It is so clear now that there is a relation between repressive drug policies and the spread of HIV/AIDS," said former Colombian President Cesar Gaviria. "If we don't get people into the health system without fear, it will be very difficult to do treatment and prevention."

Commission member Sir Richard Branson at "Atlantic Exchange" drug policy discussion, Washington, DC, March 2012
"I have long thought the war on drugs did more harm than good, and the commission's report put the data behind those beliefs," said Branson. "The war on drugs is not stopping drug use, and it also contributes significantly to the AIDS epidemic by driving users into the shadows. As an entrepreneur, if my business was failing for 40 years, I would close it down. Refusing to implement public health measures to reduce HIV and protect people with a drug problem is nothing short of criminal."

Branson and the other commissioners made some concrete recommendations for action in the report. Those include:

  • Push national governments to halt the practice of arresting and imprisoning people who use drugs but do no harm to others.
  • Measure drug policy success by indicators that have real meaning in communities, such as reduced rates of transmission of HIV and other infectious diseases, fewer overdose deaths, reduced drug market violence, fewer individuals incarcerated and lowered rates of problematic substance use.
  • Respond to the fact that HIV risk behavior resulting from repressive drug control policies and under-funding of evidence-based approaches is the main issue driving the HIV epidemic in many regions of the world.
  • Act urgently: The war on drugs has failed, and millions of new HIV infections and AIDS deaths can be averted if action is taken now.

"The AIDS epidemic is a harsh and brutal teacher that obliges us to take a scientific approach to deal with sex workers and drug addicts," said former Swiss President and commission member Ruth Dreifuss. "Politicians have to inform citizens of the benefits, risks, and failures of drug policy, and politics has to take responsibility for policy change. Public health has to be at least as important as criminalizing the drug traffic," she told the press conference.

"Addicted injecting drug users is one of the main sources of the spread, and not all of them will achieve abstinence," said Dreifuss. "Substitution therapies can take people away from street drug dealers and violence. For some, the provision of medical heroin is necessary to allow them to abandon criminal activities and overcome marginalization. It's possible to implement these large scale programs at low costs with high benefits," she argued.

"For others, harm reduction measures are necessary in order to avoid the spread of HIV/AIDS and other bloodborne disease. Needle exchange programs, free condoms, safe consumption rooms all not only save the lives of drug users but protect the whole population," Dreifuss explained. "We need the full spectrum of these measures for those in prison, too, who are at more risk for HIV infections."

Dreifuss touted her own country's experience as a model. Faced with mounting injection drug use, Switzerland eventually went the route of supervised injection sites and opioid maintenance, including heroin maintenance.

"Our experience is that it works," she said. "The police protect the injection rooms from dealers. The four pillar policy [prevention, treatment, harm reduction, enforcement] has been broadly accepted by our citizens and the spread of HIV/AIDS is under control."

Even within the constraints imposed by the global drug prohibition regime, countries can still take action to mitigate the drug war's role in the spread of infectious disease, she said.

"It is possible for countries to adopt effective harm reduction measures within existing drug laws," Dreifuss argued. "The decriminalization of drug use is the first step, and the second step is to determine what type of market can drive out dealers. The war on drugs has failed to reduce supply or demand; let us replace prohibition with regulation and avoid jeopardizing public health and harm reduction policies with inefficient measures."

"Our message is that prohibitionist law enforcement has failed in its goals of eradicating drugs and protecting people's health," said Kazatchkine. "Illegal drugs have become cheaper and more available and HIV and other health risks have increased. Prohibitionist policies have been shifting the market to stronger drugs and led to a war on users with numerous human rights abuses, police harassment, violence, extortion. The fear of police and stigma is driving users underground and away from access to information, care, and medical services," he warned.

"One cannot improve health through war," he concluded. "This is an epidemic among people who inject that we can actually control. If we are to have a chance at reducing the transmission of AIDS, we need to open up and change our ways."

The Global Commission on Drugs has laid out the problem and showed us the path to fix it. Now, it is up to our political leadership to act accordingly, and it is up to us to ensure that it does.

London
United Kingdom

Random Idiot Solves the Drug Problem

As calls for legalizing marijuana and ending the drug war become increasingly commonplace in the press, so too do the inevitable shocked responses from frightened individuals who aren't always up to speed on the subject.

At their best, these people sound like they just found out about drugs yesterday.

Perhaps we should consider educating our children about the harms of all drugs to discourage their use.

Maybe the answer lies in discouraging consumption as a means of putting the narco-trafficking organizations out of business thereby reducing the mayhem in Mexico, Central and South America, the U.S. and Canada. 

Maybe instead of whining like babies for candy, drug users, and those sympathetic to them, should consider healthier forms of recreation. [Canada.com]

Okaaay…and if that doesn't work, maybe we should ask police officers to look in people's bags and take their drugs away from them. People who refuse to cooperate could perhaps be sent to special buildings and put on "timeout" to think about what they've done.

Seriously though, what kind of numbskull just walks up and starts suggesting the same stupid crap we've been doing for decades? A few too many I'm afraid, and this idiotic obsession with silver-bullet prevention strategies never quite dies despite the incalculable sums we've pissed away on counterproductive anti-drug propaganda.

It may sound supremely stupid to someone like me, but there remain many among us who still can't bring themselves to envision a post-prohibition world because they insist it's easier to just ask everyone to stop getting stoned. If anyone would like to demonstrate this to me, for example by standing outside a head-shop and convincing customers not to go inside, I'd be willing to tag along and make sure nobody punches you in the face.

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