Drug Prevention

Harm reduction in New York City came under attack last weekend when the tabloid New York Post ran an article titled Heroin for Dummies, excoriating the city for spending $32,000 for a 2007 harm reduction pamphlet that, among other things, gave injection drug users advice on how to reduce the harm of injecting. Since then, the story has been picked up by the New York Times and national media, including CNN and Fox News.

uncomfortable, but the right thing to do

The pamphlet, Take Charge, Take Care, was distributed by the city's Department of Health and Mental Hygiene and was aimed at injection drug users in the city. The harm reduction purpose behind it was to save lives and prevent overdoses and the spread of blood-borne disease. It counsels things like quitting, not sharing needles, and seeking treatment.

But also included in its advice were things like "Find the vein before you try to inject," "If you don't register [hit the vein], pull out and try again," and "Warm your body (jump up and down) to show your veins." Such common-sense harm reduction advice was like waving a red flag for Post and the drug warriors it interviewed.

"It's basically step-by- step instruction on how to inject a poison," said John Gilbride, head of the DEA's New York office. "It concerns me that the city would produce a how-to on using drugs," Gilbride said. "Heroin is extremely potent. You may only get the chance to use it once. To suggest there is a method of using that alleviates the dangers, that's very disturbing."

"It's sick," said City Council member Peter Vallone Jr. (D-Queens), chair of the council's public safety committee, who vowed to try to shut down distribution of the pamphlet. "This is a tremendous misuse of city funds, and I'm going to see what I can do to stop it. It sends a message to our youth: give it a try," he fumed.

"What we do not want to do is suggest that there's anything safe about shooting up narcotics," said Bridget Brennan, the city's special narcotics prosecutor. "No matter how many times you wash your hands or how clean the needle is, it's still poison that you're putting in your veins."

Only at the very end of the Post article was any supporter of harm reduction or the pamphlet given a say. "Our goal is to promote health and save lives with this information," explained Daliah Heller, assistant commissioner for the Bureau of Alcohol and Drug Use Prevention, Care and Treatment. "From a health perspective, there is a less harmful way to inject yourself."

The New York Times article the following day was less one-sided than the Post's hit piece, but still gave Vallone and other critics top billing. "You're spending taxpayer money and getting a how-to guide for first-time users," Vallone claimed.

The pamphlet was "absolutely not" a how-to manual, Dr. Adam Karpati, executive deputy commissioner for the health department's division of mental hygiene, told the Times. "Our primary message, as it is in all our initiatives, is to help people stop using drugs and to provide them with information on how to quit," Karpati said, adding that health officials recognized that quitting was not a realistic expectation for all drug users.

While Karpati was playing defense, harm reduction supporters went on the offensive. "The Health Department's booklet is solidly grounded in science and public health," said Ethan Nadelmann, executive director of the Drug Policy Alliance. "But the same cannot be said of the irresponsible comments by John Gilbride, Bridget Brennan, and Peter Vallone, Jr. These sorts of reckless statements by top level city and federal law enforcement agents need to be repudiated by their superiors in city and federal government."

On Monday, Mayor Bloomberg defended the pamphlet. "I would certainly not recommend to anyone that they use hard drugs or soft drugs," Bloomberg said. "But our health department does have an interest in if you're going to do certain things to get you to do it as healthily as you possibly can."

Now that the flap is behind them, two leading harm reductionists are assessing what it all means. "There was a political agenda at work with this," said Allan Clear, head of the Harm Reduction Coalition. "The District Attorney's Office fed this to the Post. This is a deliberate attack, and it follows on the footsteps of Rockefeller drug law reform, where DAs had some of their power stripped away. This was a red rag for foes to wave to provoke people, when the amount spent on the brochure is relatively small."

"This was not a book for people who have never injected," said Robert Heimer, professor at the Yale School of Public Health. "We know that people use opiates for around three years before they start injecting, and they don't do it because of a pamphlet, but because they are following their friends' example. This pamphlet was distributed at needle exchanges, STD clinics, drug treatment centers, and to people leaving Rikers Island. That's who the audience is, not people who have never injected."

Neither Clear nor Heimer thought much of the press coverage, although Clear was more charitable to the Times than Heimer. "The brochure has been deceptively portrayed consistently in all the articles," said Clear. "This is a manual aimed at people who are using injection drugs. The first thing it says is if you want help, call this number. If you compare the articles in the Post and the Times, the anti-drug user invective in the Post was just horrendous and demonstrated a very biased position to begin with," said Clear. "The conversation in the Times was much more pro-public health and sympathetic."

"The Times article was incredibly negative," said Heimer. "The first eight or ten paragraphs were all the opposition, and only after that do you get to the health department and why it's a common sense public health approach. When you have 'liberal media' like the Times and rightwing Murdoch papers like the Post both condemning you, you are under a lot of pressure to change."

When all is said and done, did the pamphlet flap turn out to be a boon or a bane for harm reduction? Again, the two men differed.

"When you get this on Fox News or CNN and people are talking about it, even though the initial effort was to discredit the brochure, it actually brought harm reduction to public consciousness in a good way," said Clear. "While we feel attacked, there has been a lot of positive response, and this has raised the profile of harm reduction and the need to educate drug users. The public reaction hasn't been that bad; in fact, it's been quite good."

"Any time there is negative press, it's not good for harm reduction," said Heimer. "It's still fragile here. In places like Holland, Britain, Canada, and Australia, harm reduction is one of the four pillars -- prevention, treatment, law enforcement, harm reduction -- but in this country, very little is done about prevention, there is not enough drug treatment because there is not enough emphasis on demand reduction, and we spend all our money on supply reduction, and we know how that has worked."

US House and Senate negotiators in conference committee approved the finishing touches on the Fiscal Year 2010 budget Tuesday night, and they included a number of early Christmas presents for different drug reform constituencies. It isn't quite a done deal yet -- this negotiated version of the FY 2010 Consolidated Appropriations Act must now win final approval on both the House and Senate floors. But they are up-or-down, no-amendments-allowed votes -- if the bill passes, it will include the drug reforms.

US Capitol, Senate side

• Ending the ban on federal funding for needle exchange programs -- without previous language that would have banned them from operating within 1,000 feet of schools, parks, and similar facilities. (Instead it seems to give local authorities the ability to overrule state or other officials on location choices.)
• Ending the ban on the use of federal funds for needle exchanges in the District of Columbia.
• Allowing the District of Columbia to implement the medical marijuana initiative passed by voters in 1998 but blocked by congressional diktat ever since.
• Cutting funding for the Office of National Drug Control Policy's National Youth Anti-Drug Media Campaign from $70 million this year to $45 million next year.

In a news release after agreement was reached, this is how the committee described the language on needle exchange:

Modifies a prohibition on the use of funds in the Act for needle exchange programs; the revised provision prohibits the use of funds in this Act for needle exchange programs in any location that local public health or law enforcement agencies determine to be inappropriate.

Its description of the DC appropriations language:

Removing Special Restrictions on the District of Columbia: ...Also allows the District to implement a referendum on use of marijuana for medical purposes as has been done in other states, allows use of Federal funds for needle exchange programs except in locations considered inappropriate by District authorities.

And its language on the youth media campaign:

National Youth Anti-Drug Media Campaign: $45 million, $25 million below 2009 and the budget request, for a national ad campaign providing anti-drug messages directed at youth. Reductions were made in this program because of evaluations questioning its effectiveness. Part of the savings was redirected to other ONDCP drug-abuse-reduction programs.

Citing both reforms in the states -- from medical marijuana to sentencing reform -- as well as the conference committee's actions, Drug Policy Alliance executive director Ethan Nadelmann stopped just short of declaring victory Wednesday. "It's too soon to say that America's long national nightmare -- the war on drugs --is really over," Nadelmann. "But yesterday's action on Capitol Hill provides unprecedented evidence that Congress is at last coming to its senses when it comes to national drug control policy."

As noted above, there are still two votes to go, and reformers are applying the pressure until it is a done deal. "Hundreds of thousands of Americans will get HIV/AIDS or hepatitis C if Congress does not repeal the federal syringe funding ban," said Bill Piper, DPA national affairs director. "The science is overwhelming that syringe exchange programs reduce the spread of infectious diseases without increasing drug use. We will make sure the American people know which members of Congress stand in the way of repealing the ban and saving lives."

Washington, DC, residents got a two-fer from the committee when it approved ending the ban on the District funding needle exchanges and undoing the Barr Amendment, the work of erstwhile drug warrior turned reformer former Rep. Bob Barr (R-GA). Barr's amendment forbade the District from implementing the 1998 medical marijuana initiative, which won with 69% of the vote.

"Congress is close to making good on President Obama's promise to stop the federal government from undermining local efforts to provide relief to cancer, HIV/AIDS and other patients who need medical marijuana," said Naomi Long, the DC Metro director of the Drug Policy Alliance. "DC voters overwhelmingly voted to legalize marijuana for medical use and Congress should have never stood in the way of implementing the will of the people."

"The end of the Barr amendment is now in sight," said Aaron Houston, director of government relations for the Marijuana Policy Project. "This represents a huge victory not just for medical marijuana patients, but for all city residents who have every right to set their own policies in their own District without congressional meddling. DC residents overwhelmingly made the sensible, compassionate decision to pass a medical marijuana law, and now, more than 10 years later, suffering Washingtonians may finally be allowed to focus on treating their pain without fearing arrest."

Medical marijuana in the shadow of the Capitol? Federal dollars being spent on proven harm reduction techniques? Congress not micromanaging DC affairs? What is the world, or at least Washington, coming to?

The Obama administration last Friday unveiled its Southwest Border Counternarcotics Strategy to deal with the unremitting prohibition-related violence plaguing Mexico, and especially its border cities. Since Mexican President Felipe Calderon enlisted the military in his offensive against the so-called cartels in December 2006, some 11,000 people have died in the violence, and the streets of Mexican border towns have at times resembled battlefields.

US Border Patrol

• Building visual shields near border-crossing points so drug cartel spotters can't alert approaching motorists about inspections.
• Improving non-lethal weapons technology to help officers incapacitate suspects and disable motor vehicles and boats used by traffickers.
• Reviving an interagency working group to coordinate intelligence.
• Using more intelligence analysts to uncover drug-dealing networks.
• Helping Mexico bolster its judicial system through training in the United States.
• Focusing on combating corruption among US law enforcement and elected officials.
• Delivering an additional $60 million to border law enforcement agencies.

"This new plan, combined with the dedicated efforts of the government of Mexico, creates a unique opportunity to make real headway on the drug threat," said Gil Kerlikowske, head of the Office of National Drug Control Policy (ONDCP), at an Albuquerque press conference unveiling the new strategy.

"International cooperation is very, very key," said Homeland Security Secretary Janet Napolitano, taking time to praise Calderon for his efforts. "We have an unprecedented opportunity to work on drug trafficking on both sides of the border," she said. "We should not let this opportunity go by."

According to the Justice Department, Mexican and other South American drug trafficking organizations are laundering between $18 billion and $39 billion a year in drug profits in the US. Some of that money then goes to purchase weapons in the lightly-controlled US gun market. Traffickers use those weapons against each other, as well as Mexican police and soldiers, as evidenced dramatically last weekend in the Acapulco shootout that left 18 people dead, including two soldiers, and the killings of 13 people in Ciudad Juarez last Friday despite the presence of more than 5,000 soldiers patrolling the city.

Reducing demand in the US is a key part of the struggle, said Napolitano. "We can't just fight drugs at the border. We can't just fight drugs by fighting traffickers. We must fight drugs in the United States," Napolitano said.

"This strategy is tough, it's strong, and it's balanced," said Attorney General Eric Holder, adding that it will be "an effective way forward that will crack down on cartels and make our country safer."

cross-border smuggling tunnel

"Rather than trying to make America's 15 million monthly marijuana consumers go away, we need to gain control of this market by regulating marijuana like we do beer, wine and liquor," Houston continued. "Any anti-drug effort that leaves the marijuana trade in the hands of the cartels is nothing but a full-employment plan for professional drug warriors and cartel bosses alike, not a serious proposal to address the problem," he said.

The Drug Policy Alliance (DPA) was a bit more diplomatic. "The violence on the US and Mexico border is spiraling out of control because of the Mexican drug war. We are hopeful that Obama's new strategy will bring real change, and not more of the same policies that are failing our nation and communities," said Julie Roberts, acting director of Drug Policy Alliance New Mexico. "It is disappointing that our federal officials today remained focused on targeting the supply side of the Mexican drug war. Of course we need solutions that improve public safety and keep our country safe, but we also need to develop a public health plan for safely reducing drug demand in this country."

"The time has surely come to give serious consideration to taxing and regulating marijuana like alcohol," added DPA executive director Ethan Nadelmann. "That wouldn't solve all of Mexico's and America's prohibition-related problems, but it would prove invaluable in breaking the taboo on open debate and honest policy analysis, without which there can be no long term solutions to today's challenges."

While the criticism from drug reformers was blunt, some Latin Americanists had a more nuanced response. "This is the Obama administration's response to Mexico's criticism about the US not doing enough on arms trafficking, money laundering, and drug consumption," said Maureen Meyer of the Washington Office on Latin America. "The idea of enhanced cooperation among the different US agencies involved is an important step forward, and enhanced cooperation with Mexico is also important."

But while the administration is talking a good game, said Meyer, a look at the federal drug budget reveals a drug policy on cruise control. "The ONDCP drug control budget is a continuation of the same focus in US drug policy, with its objectives focusing a lot on interdiction and law enforcement, and not so much on arms trafficking. There is a slight increase in funding for treatment programs, but a reduction in funding for prevention. I don't see any shift in the balance," she said.

"When it comes to Mexico, what we need to see is a larger focus on some of the structural issues, such as reforming the police and the judicial system," Meyer said. "That is going to have more of a long-term impact than just providing more equipment for the police and the military."

For Larry Birns, executive director of the Council on Hemispheric Affairs, the new strategy appeared mostly symbolic. "I think the announcement of this strategy is way to put drug issues on the back burner for awhile while the administration deals with more pressing issues, like health care," he said. "The administration is trying to inoculate itself from criticism rather than undertaking an effort to effectively deal with drugs, which would involve the thornier border issues of immigration reform and the NAFTA traffic."

The border is a complicated place, affected not only by the drug trade but by licit trade, human migration, and weapons, among other issues. The drug trade in turn is driven by demand. Unfortunately, the Obama administration's Southwest Border Counternarcotics Strategy is largely more of the same old drug war, the critics suggest. Perhaps all the other issues would be better dealt without that drug war.