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Portuguese Drug Reformers Look Beyond Decriminalization [FEATURE]

The Portuguese government has garnered well-earned plaudits for its nine-year-old policy of the decriminalization of drug possession, first last year from Glenn Greenwald in a White Paper commissioned by the Cato Institute, and just last month in a new academic study in the British Journal of Criminology. But while they applaud the Portuguese government for embracing decriminalization, some drug user advocates there are saying there is more to be done.

Lisbon, capital of Portugal
Portugal broke new ground back in July 2001 when it decriminalized the possession of up to a 10-day supply of all illicit drugs. Under the new policy, drug users caught with drugs are not arrested, but are instead referred to regional "committees for the dissuasion of addiction." Those committees are empowered to impose warnings or administrative penalties, including fines, restrictions on driving, and referral to treatment.

But in most cases, the committees simply suspend the proceedings, meaning that, in effect, no punishment is meted out. The decriminalization policy has been accompanied by increased investment in treatment and harm reduction services, including methadone maintenance for people addicted to heroin.

As Greenwald found last year, and researchers Dr. Caitlin Hughes and Professor Alex Stevens last month, decriminalization is working. Hughes and Stevens found that while there had been a modest increase in drug use by adults, it was in line with increases reported by other southern European countries.

While drug use increased modestly, Hughes and Stevens were able to report that the harms associated with drug use had decreased under decriminalization. They found a reduction in the rate of spread of HIV/AIDS, a reduction in drug-related deaths, and a reduction in drug use by adolescents. They also found that drug seizures had increased under decriminalization.

"Contrary to predictions, the Portuguese decriminalization did not lead to major increases in drug use," the researchers concluded. "Indeed, evidence indicates reductions in problematic use, drug-related harms and criminal justice overcrowding.”

For Hughes and Stevens, the Portuguese experiment was also significant because it showed that decriminalization reduces harm for all drugs, not just marijuana. "Such effects can be observed when decriminalizing all drugs," they wrote. "This is important, as decriminalization is commonly restricted to cannabis alone."

Speaking in New York last week, Stevens elaborated: "The evidence from Portugal suggests that we could end the criminalization of users of all types of drugs -- and not just marijuana -- without increasing drug use and harms. It also shows the importance of continued investment in treatment services and harm reduction to reduce drug-related deaths and HIV."

But while Portugal's decriminalization is gathering praise from abroad, the view from the ground is a bit more nuanced. Decriminalization has improved the lives of drug users, but much remains to be done, said Jorge Roque, a Portuguese attorney who works with the European Coalition for Just and Effective Drug Policies (ENCOD), the International Network of People Who Use Drugs (INPUD), and the Portuguese group Diferenca Real, which attempts to improve conditions for drug users there.

"Decriminalization allowed drug users to stop being persecuted by the police and helped many of them realize they are not criminals simply because they chose to use drugs," said Roque. "And many people are now receiving help from the drug attendance centers," where addicted drug users may be sent after being caught. "Many drug users are trying hard to stay within the law, because if one isn't a criminal just for using drugs and one can pay for his drugs through his job, he doesn't want to be identified as a criminal, which was impossible before decriminalization."

Decriminalization has also led to changes in policing, said Roque. "After some time, the police shifted from arresting drug users to going after small-time dealers," he noted. "The police realized that arresting the small-timers is the best way to catch the big sharks," he said, alluding to the continuing black market drug trade. "The black market remains. Decriminalization didn't stop that," Roque said.

"The majority of drug-related crime wasn't caused by using a drug," the attorney continued, "but by committing an offense to buy drugs. Decriminalization is an important step, but it is only a step. Drug distribution is still forbidden in Portugal, and that means traffickers have a monopoly on the drug supply, and as a result, the prices are very high. So many people commit small thefts to buy their drugs, and the police try to control them and the drug neighborhoods with all the usual abuses."

The Portuguese government should not be sitting on its laurels, Roque said. While it deserves praise for what it has done, it has not done enough, he said.

"We are completely happy that the government decriminalized drug use, but the drug situation is very complex and touches on many different aspects -- legal, political, health, social, economic, morality -- and we have some demands that we think the government is not addressing because it is satisfied with what it has done with decriminalization," said Roque.

That point was echoed by Joep Oomen, head of ENCOD. If the Portuguese government stops with just decriminalization, it will be just as hypocritical as any other government, he said.

"By decriminalizing the use and possession of small quantities of illegal drugs, Portugal has reduced the immediate damage of drug prohibition," Oomen said. "The police don't persecute users and petty dealers as much, and problematic users find their way to health services. But decriminalization has not solved the main problem of prohibition: Drugs continue to be distributed by traffickers who inflate the price, impose criminal marketing methods, and have minimal concern for product quality or the safety of consumers. If Portuguese authorities do not take the next step toward legal regulation of the market, their policies will remain as hypocritical as those of any other country," he said.

But that's unlikely any time in the near future, said Roque. Even other drug reforms this side of ending prohibition are now stalled, he said.

"After all the international news reporting on the success of decriminalization in Portugal, the politicians' egos are so big they think they don't need to do anything else," said Roque. "But many drug users want to see safe injection sites, heroin maintenance programs, and the like, instead of just decriminalizing use. Similarly, the cannabis reform bill is still stuck in parliament waiting for approval. The government says it is busy with the international financial crisis and now our own public deficit, and can't do anything, even though this could mean revenues for the government."

With its drug decriminalization policy, Portugal has indeed become a beacon to the world, a model of progressive drug reform that could and should be emulated elsewhere. But as Roque and Oomen make clear, decriminalization is only half the battle.

Portugal

Fraser Health Authority Urged to Push Needle Exchanges Into Hostile Cities

Location: 
Canada
Injection drug addicts are at much greater risk of catching and spreading disease in the Fraser Health region because health authority officials have failed to deliver on the promise of their harm reduction policy, reform advocates charge. They say access to needle exchanges, safe injection sites and methadone clinics is much poorer than in the Vancouver area – largely due to opposition from hostile city councils and police forces who think an abstinence policy is best.
Publication/Source: 
Hope Standard (Canada)
URL: 
http://www.bclocalnews.com/fraser_valley/hopestandard/news/106728428.html

The World Can Learn from Switzerland's Drug Policy

In the late 1980s, Switzerland saw a significant increase in injection drug use, and the crime and public health harms that are associated with it under our prohibition system. A new video from the Hungarian Civil Liberties Union features a range of Swiss experts discussing the science-based policies that the country has adopted to deal with those issues, including Professor Ambros Uchtenhagen, head of the first heroin maintenance program in Switzerland; Felix Lengweiler, the chief of security police and policing of narcotics crime at the Zurich City Police; and Uwe Serduelt, deputy director, Centre of Research on Direct Democracy at the Zurich University.

The video's release coincides with a new report on the subject by the Open Society Institute, Read From the Mountaintops: What the World Can Learn from Drug Policy Change in Switzerland.

Swiss Drug Policy Should Serve As Model: Experts

Location: 
Switzerland
Switzerland's innovative policy of providing drug addicts with free methadone and clean needles has greatly reduced deaths while cutting crime rates and should serve as a global model, health experts said. Countries whose drug policy remains focused on punishing offenders, including Russia and much of Eastern Europe and Central Asia, should learn from a Swiss strategy based on "harm reduction" that protects both users and communities, they said.
Publication/Source: 
Reuters
URL: 
http://www.reuters.com/article/idUSTRE69O3VI20101025

Doctor Calls Ontario's Methadone Program Oppressive and Discriminatory

Location: 
ON
Canada
A Toronto doctor says Ontario's methadone program for addicts is "oppressive" in the way it discriminates against patients and forces them to give up their privacy. Patients who are prescribed methadone for addiction to drugs such as heroin or morphine are shackled to the health-care system and must sign away their privacy rights in exchange for treatment, Dr. Philip Berger told a legislative committee.
Publication/Source: 
Winnipeg Free Press (Canada)
URL: 
http://www.winnipegfreepress.com/life/health/doctor-calls-ontarios-methadone-program-oppressive-and-discriminatory-105215519.html

FDA Approves Once-A-Month Injectable Drug to Fight Opiate Addiction

The US Food and Drug Administration (FDA) announced Tuesday that it had approved a once-a-month injectable drug for use in treating opiate addiction. The drug, marketed as Vivitrol, is a form of naloxone, an opioid atagonist that blocks the action of opioids on brain cells and is currently used in responding to overdoses.

In approving Vivitrol, the FDA cited a Russian study with 250 heroin addicts that found it reduces relapse rates and blocks cravings for narcotics. In that study, after six months, 86% of subjects taking Vivitrol had stayed off opiates and were functioning in work or school, compared to only 57% who were given a placebo.

Unlike methadone and buprenorphine, which are commonly used in opiate substitution treatments, Vivitrol is not addictive and does not maintain opiate dependency. Additionally, unlike those two substitutes, Vivitrol does not need to be taken daily, but is instead administered monthly via intramuscular injection.

The approval of Vivitrol for opiate addiction is "an important turning point in our approach to treatment," said Dr. Nora Volkow, head of the National Institute on Drug Abuse, in a statement greeting the FDA announcement.

Nearly 810,000 Americans are addicted to heroin, with more than twice that number using prescription opioids, such as Oxycontin and Vicodin, for non-prescription purposes, Volkow noted.

Washington, DC
United States

FDA Appoves Drug to Treat Heroin, Morphine Addiction

The Food and Drug Administration has approved an injectable drug designed to treat people addicted to opiates who have undergone detoxification treatment. Vivitrol, made by Massachusetts drug maker Alkermes, is a so-called extended-release formulation of the drug naltrexone that is injected once a month into the muscle, according to an FDA statement. The drug works to block opioid receptors in the brain.
Publication/Source: 
All Headline News (FL)
URL: 
http://www.allheadlinenews.com/articles/7020200536?FDA%20Appoves%20Drug%20To%20Treat%20Heroin,%20Morphine%20Addiction

Revolutionary New Device Could Help Drug Addicts

Location: 
Researchers at the University of California Los Angeles say they’ve come up with an implanted device that administers the medication buprenorphine, which helps end dependence on heroin and opioids that are found in many prescription painkillers.
Publication/Source: 
WTMA (SC)
URL: 
http://www.wtma.com/rssItem.asp?feedid=116&itemid=29587707

UK: Liberal Democrats Told Drug Policy 'Wrong'

Location: 
United Kingdom
The Liberal Democrats were told that their drug policy is wrong and the party should support the legalization of cannabis and moves to provide pharmaceutical heroin to addicts instead of methadone. Ewan Hoyle, founder of Liberal Democrats for Drug Policy Reform, accused candidates and MPs of being "silent" on drugs since the issue was last discussed at conference in 2002.
Publication/Source: 
The Press Association (UK)
URL: 
http://www.google.com/hostednews/ukpress/article/ALeqM5jxlgY74TbfECJl5ClfDYmCD9zfkw

Cambodia Opens First Methadone Clinic

The Cambodian Ministry of Health has opened a clinic where people addicted to opiates, primarily heroin, can be administered methadone. The move is a significant departure in a country in which "drug treatment" has typically meant imprisonment, forced labor, and unproven herbal treatments.

Royal Palace, Cambodia (wikimedia.org)
The opening of the clinic is the culmination of years of quiet effort by harm reduction organizations, the BBC reported. Two of those groups, which run outreach programs for drug users, will identify candidates for treatment.

The program is strictly voluntary. Participants will be taken to the clinic for a needs assessment in line with international standards. The clinic is inside a public hospital and run by the Ministry of Health with support from the UN's World Health Organization.

While harm reductionists and public health workers are pleased with the government's new approach, they said more steps need to be taken to shut down the existing, punitive drug treatment centers. But the government says it has no plans to do so.

Read an expose of existing Cambodian drug treatment centers here.

Cambodia

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