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Europe: Anthrax-Tainted Heroin Death Toll Up to Ten

The death toll from anthrax-tainted heroin in Europe has risen to 10 as Health Protection Scotland confirmed that a heroin user who died in the Glasgow area on December 12 was infected with anthrax. Nine of the 10 deaths occurred in Scotland; the other occurred in Germany.

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anthrax spores
The latest announced death is actually the earliest. Prior to the announcement of this death, the earliest known death took place December 16.

At least 19 drug users -- 18 of them Scottish -- have been diagnosed with anthrax since the outbreak began. A pair of heroin deaths in Sweden turned out to be unrelated, and a cluster of deaths in Portugal has not been confirmed as being linked to anthrax.

While Scottish authorities have yet to find any anthrax-tainted heroin, they believe either the heroin itself or cutting agents have been contaminated with anthrax spores. They said there is no evidence of person-to-person infection.

"While public health investigations are continuing to attempt to identify the source of the contamination, no drug samples tested to date have shown anthrax contamination, although a number of other types of potentially harmful bacteria have been found," said Colin Ramsay, an agency epidemiologist. "It must therefore be assumed that all heroin in Scotland carries the risk of anthrax contamination and users are advised to cease taking heroin by any route. While we appreciate that this may be extremely difficult advice for users to follow, it remains the only public health protection advice possible based on current evidence."

As noted in our earlier story linked to above, harm reductionists have called for other measures, ranging from informational campaigns to liberalized prescribing of pharmaceutical heroin.

Infected patients typically developed inflammation or abscesses around the injection site within one or two days and were hospitalized about four days after that. In some severe cases, the lesions developed necrotizing fasciitis, a flesh-eating disease.

Feature: Anthrax-Tainted Heroin Takes Toll in Europe, Prompts Calls for Emergency Public Health Response

European heroin users are on high alert as the death toll rises from heroin tainted with anthrax. At least eight people have died -- seven in Scotland and one in Germany -- since early December, and another 14 Scottish heroin users have been hospitalized after being diagnosed with anthrax. Meanwhile, drug reform and drug user activists are reporting a cluster of nine suspicious heroin-related deaths in Coimbra, Portugal, although it is unclear at this point whether they are linked to anthrax-tainted heroin.

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anthrax spores
The Scottish government has responded by urging heroin users to stop using and to seek drug treatment. That advice has not gone over well with drug users and public health and harm reduction advocates, who are demanding an emergency public health response.

The first four Scottish deaths were in Glasgow, but after one person died in Tayside and one in the Forth Valley earlier this month, Health Protection Scotland epidemiologist Dr. Colin Ramsay said: "The death of this patient in NHS Forth Valley indicates further geographical spread of the cases, meaning that heroin users all across Scotland need to be aware of the risks of a potentially contaminated supply. I would urge all users to stop using heroin immediately and contact local drug support services for help in stopping. If any heroin users do notice signs of infection, for example marked redness and swelling around an injection site or other signs of serious infection such as a high fever, they should seek urgent medical advice."

The French government has also reacted, with the General Directorate for Health issuing a statement Tuesday warning that contaminated heroin may be circulating in France and other European countries. Noting the rising death toll, the statement said "the likeliest source is heroin contaminated by anthrax spores."

Heroin users should be alert, the French statement said, because heroin contaminated with anthrax is indistinguishable from other heroin. "There is no outward sign or color enabling the user to tell whether the heroin has been contaminated by anthrax, and contaminated heroin dissolves or is used in the same way as uncontaminated heroin," it said.

Anthrax is a potentially lethal bacterium that exists naturally in the soil and can also occur among cattle. It is also a potential bio-terror weapon.

The vast majority of heroin consumed in Europe comes from Afghanistan, and while so far evidence is lacking, speculation is that anthrax spores may have been present in bone meal, an animal product sometimes used as a cutting agent. Another possibility is that containers used in the heroin production process were contaminated with anthrax spores. And, given fears that Al Qaeda and its Taliban allies could resort to biological warfare against the West and given the Taliban's role in the Afghan opium and heroin trade, a bio-attack cannot be completely ruled out.

"The anthrax-infected heroin hasn't decreased use, whether people are injecting it or chasing [smoking] it," said Tam Miller, chair of Chemical Reaction, an Edinburgh drug user group, and a member of INPUD (the International Network of People who Use Drugs). "People are scared -- you can be sure of that -- but I think they're more afraid of withdrawing. The Scottish government's advice was for people to stop using heroin, but that won't happen."

Instead, Miller said, heroin users are doing what they can to protect themselves. "Users feel there's not much they can do personally and, as usual, they feel isolated," he said. "A lot are looking up the effects on anthrax on the net and passing on information to people with no internet access. We think the powers that be should put out information on how to spot signs if someone has been in contact with access. Basically, mate, the Scottish government wants little to do with it."

The Scottish government's response so far has drawn a harsh rebuke from the United Kingdom's harm reduction and public health community. In a Tuesday letter to the Scottish government, the International Harm Reduction Association, the drug think tank Release, the Transform Drug Policy Foundation, the UK Harm Reduction Alliance, and individual public health experts called on the government to put in place an emergency public health plan to deal with the crisis.

The letter said the government's advice to heroin users to stop using and enter treatment was "reckless in light of the fact that waiting times in Scotland for opiate substitute treatment (OST) are the longest in the UK. Many of those accessing services are informed that it is a condition of their treatment to engage with the service for a minimum period of time, before they will be entitled to a prescription offering an alternative substitute medication, usually methadone. In some areas of Scotland we have been informed that waiting times for OST can be up to 12 months."

[There is another potential issue with methadone, as well. The antibiotic drug Cipro, used to treat anthrax, interacts with methadone, leading to the possibility of methadone overdoses.]

Given the reality of treatment shortages and delays, it is "unacceptable" for the Scottish government to just tell users to stop or to go to treatment that isn't there, the letter said. "It is clear that this kind of approach can only lead to the death of more vulnerable people."

Instead, the Scottish government must immediately implement a public health plan that includes rapid access and low-threshold prescribing of alternatives to street heroin, the letter-writers advised. They recommended prescribing dihydrocodeine, a synthetic opiate approximately twice as strong as codeine. It is sold in the US under brand names including Panlor, Paracodin, and Synalgos.

"Such an approach will go some way to prevent any more loss of life and will provide greater protection to the public as a whole," the letter said. "Failure to adopt such a policy would mean that the Scottish state would be failing in its duty to its citizens."

Joep Oomen of the European Coalition for Just and Effective Drug Policies (ENCOD) had another suggestion. "The only decent reaction to this kind of episode is to immediately open facilities where people can test their heroin and where they can use in safe conditions, supervised by people who can help if anything goes wrong," he said.

"Hopefully, in the longer term, because of these incidents, authorities will start to see the need for introducing heroin maintenance programs, not as a trial for a limited group of people, but as a permanent service for all those who cannot abstain from heroin for a longer period of time," he added.

Ultimately, said Oomen, prohibition is the problem. "Adulteration is a practice that belongs to the illegal market," he said. "It happens because the people who control the heroin market have no interest at all in the health of their customers."

Dr. Sharon Stancliff of the US Harm Reduction Coalition agreed with her colleagues' assessment of the Scottish government's response. "Telling people to stop is not useful information," she said. "Maybe some occasional users will have a glass of wine instead, but if people are sick and treatment is limited, telling people that heroin is bad for them isn't going to have much impact," she explained.

"At this point, the European harm reduction people should be getting the word out, and the medical people over there need to be on the alert," she added.

Stancliff said she had seen no sign of heroin contaminated with anthrax on this side of the Atlantic, but she was worried. "I hope the DEA is out there buying heroin to see what's in it," she said. "If there is any hint of it here, physicians should be alerted by the Centers for Disease Control as they were with levamisole-tainted cocaine."

If the anthrax-contaminated heroin is coming from Afghanistan, as most heroin consumed in Europe does, US heroin users may catch a break. Most heroin consumed here is of Mexican or Colombian provenance.

But on the other side of the Atlantic, adulterated heroin is killing drug users.

Heroin Maintenance: SALOME Trials Set to Begin in Vancouver

In the Chronicle's review of the top international drug policy stories of the year last week, the slow spread of heroin maintenance was in the mix. This week, it's back in the news, with word that a new Canadian heroin maintenance study in Vancouver is about to get underway.

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Hastings St., on Vancouver's Downtown Eastside (courtesy vandu.org)
The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) will choose a Downtown Eastside location next month and begin taking applications from potential participants in February, according to a Tuesday press release from the Inner Change Foundation, which, along with the Canadian Institutes of Health Research, is funding the trial. With selection of participants supposed to last only three weeks, that means SALOME could be underway by March.

SALOME will enroll 322 hard-core heroin addicts -- they must have been using at least five years and failed other treatments, including methadone maintenance -- in a year-long, two-phase study. During the first phase, half will be given injectable heroin (diacetylmorphine) and half will be given injectable Dilaudid® (hydromorphone). In the second phase, half of the participants will be switched to oral versions of the drug they are using.

The comparison of heroin and Dilaudid® was inspired by unanticipated results from SALOME's forerunner, NAOMI (the North American Opiate Medication Study), which began in Vancouver in 2005 and produced positive results in research reviews last year. In NAOMI, researchers found that participants could not differentiate between heroin and Dilaudid®. The comparison of success rate among injection and oral administration users was inspired by hopes of reducing rates of injection heroin use.

SALOME was also supposed to take place in Montreal, but Quebec provincial authorities effectively killed it there by refusing to fund it. SALOME researchers have announced that it will now proceed in Vancouver alone.

With an estimated 5,000 heroin addicts in the Downtown Eastside and a municipal government that has officially embraced the progressive four pillars approach to problematic drug use -- prevention, treatment, harm reduction, and law enforcement -- Vancouver is most receptive to such ground-breaking research. It is also the home of Insite, North America's only safe injection site.

The NAOMI and SALOME projects are the only heroin maintenance programs to take place in North America. Ongoing or pilot heroin maintenance programs are underway in Britain, Denmark, Germany, the Netherlands, Spain, and Switzerland.

Move Over NAOMI, Here Comes SALOME--Vancouver's New Heroin Maintenance Trial About to Get Underway

In the Chronicle's review of the top international drug policy stories of the year last week, the slow spread of heroin maintenance was in the mix. This week, its back in the news, with word that a new Canadian heroin maintenance study in Vancouver is about to get underway. The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) will choose a Downtown Eastside location next month and begin taking applications from potential participants in February, according to a Tuesday press release from the Inner Change Foundation, which, along with the Canadian Institutes of Health Research, is funding the trial. With selection of participants supposed to last only three weeks, that means SALOME could be underway by March. SALOME will enroll 322 hard-core heroin addicts—they must have been using at least five years and failed other treatments, including methadone maintenance—in a year-long, two-phase study. During the first phase, half will be given injectable heroin (diacetylmorphine) and half will be given injectable Dilaudid® (hydromorphone). In the second phase, half of the participants will be switched to oral versions of the drug they are using. The comparison of heroin and Dilaudid® was inspired by unanticipated results from SALOME's forerunner, NAOMI (the North American Opiate Medication Study), which began in Vancouver in 2005 and produced positive results in research reviews last year. In NAOMI, researchers found that participants could not differentiate between heroin and Dilaudid®. The comparison of success rate among injection and oral administration users was inspired by hopes of reducing rates of injection heroin use. SALOME was also supposed to take place in Montreal, but Quebec provincial authorities effectively killed it there by refusing to fund it. SALOME researchers have announced that it will now proceed in Vancouver alone. With an estimated 5,000 heroin addicts in the Downtown Eastside and a municipal government that has officially embraced the progressive four pillars approach--prevention, treatment, harm reduction, and law enforcement—to problematic drug use, Vancouver is most receptive to such ground-breaking research. It is also the home of Insite, North America's only safe injection site. The NAOMI and SALOME projects are the only heroin maintenance programs to take place in North America. Ongoing or pilot heroin maintenance programs are underway in Britain, Denmark, Germany, the Netherlands, Spain, and Switzerland.
Location: 
Vancouver, BC
Canada

The Year on Drugs 2009: International Drug Policy Developments

(Please read our top ten US domestic drug policy stories review too!)

As 2009 winds to a close, we review the global year in drug policy. There were a number of events of global significance -- the trend toward decriminalization of drug possession in Europe and Latin America, the slow spread of heroin maintenance therapy, the frontal assault on global prohibitionist orthodoxy at the UN -- as well as new developments in ongoing drug-policy related struggles from the poppy fields of Afghanistan to the cannabis cafes of Amsterdam.

This review can't cover everything -- it's a big world, and there's a lot happening in drug policy these days. Among the items worth at least mentioning in passing: Israel's embrace of medical marijuana, Canada's flirtation with mandatory minimum sentences for marijuana growers (still in process, and amended to be less harmful by the Canadian Senate), the continuing resort to the death penalty for drug offenses in the Middle East and Southeast Asia, the bemusing link between cannabis and schizophrenia apparently at work only in some Commonwealth countries, the Andean drug war (unchanged in its essential outlines this year), and the rise of poor West African nations as favored smugglers' destinations.

What about Mexico? There is one glaring omission here, but there is a reason for that: In the third year of Mexican President Felipe Calderon's offensive against the so-called drug cartels, the violence is more intense and destabilizing than ever. What is happening in Mexico is certainly a drug policy-related phenomenon of global significance, but this year, with more than a billion US dollars in the anti-drug aid pipeline, beefed up border security, official acknowledgement that insatiable American appetites play a crucial role, and growing public and political concern about the violence on the border, we will examine the Mexican drug war in the context of US domestic drug policy issues. Look for it to be among the Top 10 domestic drug policy stories in our feature next issue.

With that as a caveat, here are this year's biggest global drug policy developments:

Afghanistan: War on Drugs, Meet War on Terror

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Afghan opium
Eight years after the US and NATO forces invaded and occupied Afghanistan, driving the Taliban from power, the Taliban have returned with a vengeance, fueled by revenues from the country's primary cash crop: opium. Western estimates of Taliban income from the poppy and heroin trade are in the hundreds of millions of dollars annually, which buys a lot of shiny new weapons for the resurgent insurgents.

This year has been the bloodiest yet for Western occupiers, with 495 US and NATO forces killed this year, according to iCasualties.org. Part of the uptick in violence can be attributed to the Taliban's opium wealth, but the decision by US and NATO forces to move aggressively into the Taliban's eastern and southern heartlands, especially Helmand and Kandahar provinces, has also led to increased fighting and higher casualties.

In June, President Obama, adhering to his election campaign vows if not the wishes of his some of his most ardent supporters, moved to directly confront the drug trade, sending 20,000 troops into Helmand to take on the Taliban and allied traffickers. But while that looked like more of the same, just weeks later, the US announced a major shift in its anti-drug policy in Afghanistan when US envoy Richard Holbrooke announced the US would no longer participate in poppy eradication campaigns. That was a startling, reality-driven break from previous US policy in Afghanistan, as well as with current US policies against coca production in Colombia and Peru.

Instead of persecuting poverty-stricken opium-growing peasants, the US and NATO would concentrate on drug manufacturers and traffickers, but only those linked to the Taliban -- not those linked to the corrupt and illegitimate (after this fall's fraudulent election fiasco) regime of Afghan President Hamid Karzai. The US beefed up the in-country DEA contingent and even came up with a "hit list" of some 50 Afghan traffickers linked to the Taliban.

This fall, fighting has been intense in southern and eastern Afghanistan, as well as across the border in Pakistan, and now, the first of President Obama's promised 30,000-troop escalation is headed precisely for Helmand, where one of its first assignments will be to take and hold a major Taliban trafficking center. The war on drugs and the war on terror will continue to collide in Afghanistan, but now, at least, the imperatives of the war on terror have forced a historic shift in US anti-drug policy, at least in Afghanistan.

Latin American Leaders Call for a Drug Policy Paradigm Shift

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Commission panel, former President of Colombia Cesar Gaviria on left (courtesy comunidadsegura.org)
In February, a blue-ribbon panel of Latin American leaders, including former Brazilian President Fernando Henrique Cardoso, former Mexican President Ernesto Zedillo, and former Colombian President Cesar Gaviria issued a report and statement saying the US-led war on drugs has failed and it is time to consider new policies, particularly treating drug use as a public health matter and decriminalizing marijuana possession.

The report, Drugs and Democracy: Toward a Paradigm Shift, is the work of the Latin American Commission on Drugs and Democracy, which also includes prominent writers Paulo Coelho, Mario Vargas Llosa, Sergio Ramírez and Tomás Eloy Martínez as well as leading scholars, media members and politicians.

Latin America is the leading exporter of both cocaine and marijuana. As such, it has faced the ravages of heavy-handed American anti-drug interventions, such as Plan Colombia and earlier efforts to destroy the Bolivian coca crop, as well as the violence of drug trafficking organizations and politico-military formations of the left and right that have grown wealthy off the black market bonanza. And while the region's level of drug consumption has historically been low, it is on the rise.

"The main reason we organized this commission is because the available evidence indicates the war on drugs is a failed war," said Cardoso at a February press conference in Rio de Janeiro to announce the report. "We need a different paradigm to cope with the problem of drugs. The power of organized crime is undermining the very foundations of democracy in some Latin American countries. We must acknowledge that these policies have failed and we must break the taboo that prevents us from discussing different strategies."

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''Global Marijuana Day'' demonstration in Mexico City, May 2008
The report garnered considerable attention, not only in the US and Latin America, but worldwide, and it set the tone for a very reformist year in Latin America.

Mexico Decriminalizes Drug Possession

In May, Mexico decriminalized the possession of small amounts of illicit drugs, including up to five grams of marijuana, a fifth-gram of ecstasy and methamphetamine, a tenth-gram of heroin, and a half-gram of cocaine. The new law closely resembled a 2006 decriminalization bill that had passed the legislature only to die in the face of US protests. There were no US protests this time.

With the Mexican government's action, drug decriminalization has now reached the very borders of the US.

But, according to well-placed observers, the Mexican decriminalization is a case of two steps forward, one step back. In addition to decriminalizing possession of very small amounts of drugs, the new law grants drug enforcement powers to state and local police forces that they never had before. That could mean an increase in the arrests and prosecution of retail-level drug sellers. Still, the long-term political ramifications could be helpful; as one observer noted, "the headline will read that Mexico decriminalized drugs."

Argentina Decriminalizes Marijuana Possession, Laws Against Possessing Other Drugs Tremble

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Supreme Court of Argentina
While Mexico decriminalized through the legislative process, Argentina is doing it through the courts. In a series of cases dating back to 2006, Argentine judges have grown increasingly skeptical of arguments for criminalizing drug use. In the spring, judges in Buenos Aires threw out marijuana cultivation charges against a defendant, saying the plants were for personal use, and the following month, a federal appeals court threw out ecstasy possession charges against a group of defendants, again saying the drugs were for personal use. In both cases, the courts cited a 2006 Argentine Supreme Court ruling that it was the burden of the state "to demonstrate unequivocally that the drugs were not for personal use." In the ecstasy case, the appeals court held that the portion of the country's drug law regarding drug possession must be declared unconstitutional.

In August, the Supreme Court did just that, using another marijuana possession case to rule that the section of the country's drug law that criminalizes drug possession is unconstitutional. While the ruling referred only to marijuana possession, the portion of the law it threw out makes no distinction among drugs.

Imprisoning people absent harm to others violates constitutional protections, a unanimous court held. "Each individual adult is responsible for making decisions freely about their desired lifestyle without state interference," their ruling said. "Private conduct is allowed unless it constitutes a real danger or causes damage to property or the rights of others. The state cannot establish morality."

"It is significant that the ruling was unanimous," said Martin Jelsma, coordinator of the Drugs and Democracy program at the Transnational Institute, which has worked closely with Latin American activists and politicians on drug reform issues. "It confirms the paradigm shift visible throughout the continent, which recognizes that drug use should be treated as a public health matter instead of, as in the past, when all involved, including users, were seen as criminals."

UN's Global Anti-Drug Bureaucracy Meets Organized Resistance

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demonstration at the UN drug meeting, Vienna
It wasn't like this a decade ago, the last time the UN General Assembly Special Session on drugs took place. This year, for the first time, the UN's global anti-drug bureaucracy ran into organized resistance when its Committee on Narcotic Drugs (CND) met in March in Vienna. Not only did a large contingent of drug reform, human rights, and public health NGOs show up to challenge global prohibitionist orthodoxy, they were joined by a number of European and Latin American countries showing serious signs of defecting from the half-century old prohibitionist consensus.

In the end, the CND issued a political statement and plan of action that largely reaffirmed existing prohibitionist policies and ignored harm reduction, but with some victories for reformers both substantive and symbolic. For one, the US delegation finally removed its objection to needle exchanges.

But if the global anti-drug bureaucracies ignored their critics in their report, they were impossible to ignore in Vienna. Demonstrations took place outside the meeting hall, and Bolivian President Evo Morales brandished then chewed coca leaves as he demanded that his country's sacred plant be removed from the list of proscribed substances.

Even UN Office on Drugs and Crime head Antonio Maria Costa was forced to publicly acknowledge the failures and unintended consequences of prohibition. In his address opening the session, Costa bravely argued that "drugs are not harmful because they are controlled; they are controlled because they are harmful," but was forced to concede that prohibition had created a dire situation in some places. "When mafias can buy elections, candidates, political parties, in a word, power, the consequences can only be highly destabilizing" he said. "While ghettoes burn, West Africa is under attack, drug cartels threaten Central America and drug money penetrates bankrupt financial institutions."

All the more reason to challenge prohibitionism and its consequences. After this year, the global anti-drug bureaucracy knows that not only is its long-held consensus under assault, it is beginning to crack.

Czech Republic Decriminalizes Drug Possession, Finally Sets Quantity Limits

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Czech marijuana reform demonstration, 2005 (courtesy Michal Vlk)
Following in Portugal's footsteps, authorities in the Czech Republic voted late last year to decriminalize the possession of "smaller than large amounts" of drugs. But that term was vague, leaving its interpretation up to police and prosecutors and resulting in situations where people like personal marijuana growers were being charged as traffickers.

This month, Czech authorities formalized "smaller than large amounts." The new guidelines mean Czechs will suffer neither arrest nor prosecution for up to 15 grams or five marijuana plants, five grams of hashish, 40 magic mushroom segments, five peyote plants, five LSD tablets, four ecstasy tablets, two grams of amphetamine or methamphetamine, 1.5 grams of heroin, five coca plants, or one gram of cocaine.

The new quantity rules go into effect on January 1.

Science vs. Politics in Great Britain

The British Advisory Council on the Misuse of Drugs (ACMD) is an official body charged with providing evidence-based analysis of drug policy issues for the British Home Office. Tensions between the ACMD and the Labor government of Prime Minister Gordon Brown had been on the rise since it rejected the ACMD's recommendation that marijuana, which had been down-scheduled from a Class B to a Class C (least harmful) drug under Brown's predecessor, Tony Blair, remain at Class C. The government instead up-scheduled it back to Class B.

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David Nutt
The ACMD was slighted again in February, when it recommended that ecstasy be down-scheduled from Class A (most harmful) to Class B, only to have the Home Office reject that recommendation the same day. ACMD head Professor David Nutt also drew heated criticism from the Home Office -- as well as Britain's horsey set -- for heretically suggesting that ecstasy was safer than horse-riding. Nutt was forced to apologize for his remarks.

After a relatively quiet summer, the clash between drug science and drug politics exploded anew when Home Secretary Alan Johnson fired Nutt in late October for again criticizing the government's refusal to follow the science-based recommendations of the panel. That firing caused a huge fire storm of protest, including the resignations of at least six ACMD members, and was splashed across newspaper front pages for weeks.

Now, the credibility of the Labor government and its adherence to evidence-based policy-making have been called into serious doubt, as it becomes clear that Home Office drug scheduling decisions are driven by a political calculus, not a scientific one. And if the Home Office thought firing Nutt was going to make him go away, it was sadly mistaken. Nutt is maintaining a high public profile and is vowing to set up his own independent drug panel.

Whither Holland's Cannabis Coffee Shops?

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downstairs of a Maastricht coffee shop (courtesy Wikimedia)
This year has seen the long-running battle over the Netherland's famous cannabis coffee shops continue to escalate. Under the Dutch policy of "gedogen," or pragmatic tolerance, marijuana remains technically illegal in Holland, but the sale and possession of small amounts is tolerated and even regulated.

But that tolerant policy is not a favorite of the conservative coalition national government, and it has created a number of problems. "Drug tourism," as the influx of border town marijuana buyers from more repressive neighboring countries is known, has led to everything from traffic jams to public urination to lurking hard-drug peddlers.

And Holland's halfway approach to marijuana policy -- it does not allow for the regulated provision of marijuana to the coffee houses -- has led to the "backdoor problem," in which coffee shop proprietors must rely on criminal-by-definition suppliers to provide them with their product. That provides additional ammunition for the anti-coffee shop crowd.

The conservative coalition government, however, is split on how best to rein in the coffee shops and has promised not to take action at the national level until after the 2010 elections. That has left the field to local authorities, and they have responded.

In March, the "drug tourism" problem resulted in the announcement by the mayors of Roosendaal and Bergen op Zoom that they would close all the coffee shops in their towns by September. In May, the mayors of the eight towns in the border province of Limburg announced coffee shops would be "members only." In August, the Dutch government announced it was providing more than $200,000 for a pilot "members only" program in the border town of Maastricht. Court challenges from coffee shop owners have so far failed to stop any of this.

Meanwhile, in Amsterdam, an urban renewal plan unveiled in May called for a reduction in coffee shops there from 226 to 192, with a 50% reduction in the number of coffee shops in the central Red Light District. But just last week, Amsterdam Mayor Job Cohen fought back, saying that national coffee house policy should not be based solely on border "drug tourism" concerns, that he opposed the "members only" option, and that he rejected a ban on coffee houses within 250 yards of schools.

Holland's marijuana coffee shops have been around for more than 30 years now, but as was made clear this year, they will continue to be a battle front between the forces of Dutch conservatism and Dutch liberal pragmatism.

Heroin Maintenance Continues to Spread

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maintenance programs can make heroin addiction cleaner and safer
This year saw a continuation of the slow spread of heroin maintenance programs for severely addicted users unamenable to other forms of drug treatment. At the beginning of the year, permanent or pilot heroin prescription programs were in place in Britain, the Netherlands, Spain, and Switzerland.

Denmark joined the club in February and Germany came aboard in June. These moves come after Switzerland voted in a popular referendum last year to move from a pilot to a permanent heroin maintenance program, based on favorable results from the pilot program.

Canada is about to join the club, too. After the success of the three-year North American Opiate Maintenance Initiative (NAOMI) in Vancouver, Canadian researchers are moving forward with SALOME (the Study to Assess Long-term Opiate Maintenance), a pilot heroin maintenance program set for Vancouver and Montreal. But as of late last month, Montreal's participation was a question mark after Quebec authorities said they would not pay their share of program costs.

Despite lingering political distaste for heroin by prescription, the body of evidence demonstrating its efficacy -- in terms of users' quality of life, public health, and public safety -- continues to grow. There has even been some discussion of bringing a heroin maintenance pilot program to the US. Dr. Peter Reuter, the renowned University of Maryland drug policy expert, authored a study this summer about the possibility of a pilot program in Baltimore.

There is an old saw about not being able to turn an ocean liner on a dime. That's certainly true when it comes to changing drug policies for the better at the national or international level. But each year, it seems that more progress is being made. Let's see what 2010 brings.

Open Forum on Heroin-Assisted Treatment

A town hall-style seminar will explore a variety of perspectives on the future of heroin assisted treatment (HAT) as a cutting edge intervention in the United States. Renowned international speakers will give presentations on what components an evidenced-based drug policy should include, what HAT programs have looked like when implemented elsewhere, and how we can consider all options in order to best meet the needs of those individuals struggling with drug addiction. For more information, contact 202.994.2160 or email dhutchins@drugpolicy.org. The event is sponsored by the Drug Policy Alliance and the GWU School of Public Health and Health Services.
Date: 
Wed, 01/20/2010 - 6:00pm - 8:30pm
Location: 
2300 I Street, NW
Washington, DC 20037
United States

Canada: Montreal Heroin Maintenance Study in Doubt after Quebec Refuses to Pay

Fresh on the success of NAOMI, the North American Opiate Maintenance Initiative, in which hardcore heroin addicts in Vancouver were given either methadone, heroin, or Dilaudid in maintenance doses, Canadian researchers announced earlier this year plans to broaden and deeper their research with SALOME, the Study to Assess Long-term Opiate Maintenance Effectiveness. SALOME was supposed to begin this fall in Vancouver and Montreal, but Quebec provincial authorities have thrown a wrench in the works.

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Hastings Street, on Vancouver's East Side (vandu.org)
The Toronto Star reported this week that Quebec has balked on paying its share of the project, stopping the Montreal portion of SALOME in its tracks. The Vancouver portion, supported by the British Columbia provincial government, is set to move forth.

Quebec's refusal to pay its share -- the Canadian Institutes of Health Research are kicking in $1 million for the three-year project -- led Montreal's SALOME head researcher to charge the government with discrimination. The decision will have "disastrous consequences for people addicted to heroin and (who) don't respond to standard treatment," said Dr. Suzanne Brissette, chief of addiction medicine at Saint-Luc hospital. "There is no other treatment for these people."

NAOMI showed that heroin maintenance worked for people for whom methadone and other forms of treatment had not, she said. Had researchers found a treatment for cancer or diabetes, Quebec would not hesitate to help fund it, she added. "It's a clear case of discrimination," she said. "We have a treatment that works and they're saying, 'Sorry folks, you won't get it.'"

NAOMI researchers estimate that Canada has between 60,000 and 90,000 heroin addicts. The NAOMI trials found that addicts on maintenance heroin used less illicit heroin, committed fewer crimes, and adapted healthier lifestyles.

Canada: Montreal Heroin Maintenance Study in Doubt after Quebec Refuses to Pay

Fresh on the success of NAOMI, the North American Opiate Maintenance Initiative, in which hard-core heroin addicts in Vancouver were given either methadone, heroin, or Dilaudid in maintenance doses, Canadian researchers announced earlier this year plans to broaden and deeper their research with SALOME, the Study to Assess Long-term Opiate Maintenance Effectiveness. SALOME was supposed to begin this fall in Vancouver and Montreal, but Quebec provincial authorities have thrown a wrench in the works. The Toronto Star reported this week that Quebec has balked on paying its share of the project, stopping the Montreal portion of SALOME in its tracks. The Vancouver portion, supported by the British Columbia provincial government, is set to move forth. Quebec's refusal to pay its share—the Canadian Institutes of Health Research are kicking in $1 million for the three-year project—led Montreal's SALOME head researcher to charge the government with discrimination. The decision will have "disastrous consequences for people addicted to heroin and (who) don't respond to standard treatment," said Dr. Suzanne Brissette, chief of addiction medicine at Saint-Luc hospital. "There is no other treatment for these people." NAOMI showed that heroin maintenance worked for people for whom methadone and other forms of treatment had not, she said. Had researchers found a treatment for cancer or diabetes, Quebec would not hesitate to help fund it, she added. "It's a clear case of discrimination," she said. "We have a treatment that works and they're saying, `Sorry folks, you won't get it.'" NAOMI researchers estimate that Canada has between 60,000 and 90,000 heroin addicts. The NAOMI trials found that addicts on maintenance heroin used less illicit heroin, committed fewer crimes, and adapted healthier life-styles.
Location: 
Montreal, QC
Canada

Feature: Fired Up in Albuquerque -- The 2009 International Drug Policy Reform Conference

Jazzed by the sense that the tide is finally turning their way, more than a thousand people interested in changing drug policies flooded into Albuquerque, New Mexico, last weekend for the 2009 International Drug Policy Reform Conference, hosted by the Drug Policy Alliance. Police officers in suits mingled with aging hippies, politicians met with harm reductionists, research scientists chatted with attorneys, former prisoners huddled with state legislators, and marijuana legalizers mingled with drug treatment professionals -- all united by the belief that drug prohibition is a failed policy.

http://stopthedrugwar.com/files/vigildpa09.jpg
candlelight vigil outside the Albuquerque Convention Center (courtesy Drug Policy Alliance)
As DPA's Ethan Nadelmann said before and repeated at the conference's opening session: "We are the people who love drugs, we are the people who hate drugs, we are the people that don't care about drugs," but who do care about the Constitution and social justice. "The wind is at our backs," Nadelmann chortled, echoing and amplifying the sense of progress and optimism that pervaded the conference like never before.

For three days, conference-goers attended a veritable plethora of panels and breakout sessions, with topics ranging from the drug war in Mexico and South America to research on psychedelics, from implementing harm reduction policies in rural areas to legalizing marijuana, from how to organize for drug reform to what sort of treatment works, and from medical marijuana to prescription heroin.

It was almost too much. At any given moment, several fascinating panels were going on, ensuring that at least some of them would be missed even by the most interested. The Thursday afternoon time bloc, for example, had six panels: "Medical Marijuana Production and Distribution Systems," "After Vienna: Prospects for UN and International Reform," "Innovative Approaches to Sentencing Reform," "Examining Gender in Drug Policy Reform," "Artistic Interventions for Gang Involved Youth," and "The Message is the Medium: Communications and Outreach Without Borders."

The choices weren't any easier at the Friday morning breakout session, with panels including "Marijuana Messaging that Works," "Fundraising in a Tough Economy," "Congress, President Obama, and the Drug Czar," "Zoned Out" (about "drug-free zones"), "Psychedelic Research: Neuroscience and Ethnobotanical Roots," "Opioid Overdose Prevention Workshop," and "Border Perspectives: Alternatives to the 40-Year-Old War on Drugs."

People came from all over the United States -- predominantly from the East Coast -- as well as South Africa, Australia, Canada, Europe (Denmark, England, France, Hungary, the Netherlands, Poland, Portugal, Scotland, and Switzerland), Latin America (Argentina, Brazil, Colombia, and Mexico), and Asia (Cambodia and Thailand).

Medical marijuana was one of the hot topics, and New Mexico, which has just authorized four dispensaries, was held up as a model by some panelists. "If we had a system as clear as New Mexico's, we'd be in great shape," said Alex Kreit, chair of a San Diego task force charged with developing regulations for dispensaries there.

"Our process has been deliberate, which you can also read as 'slow,'" responded Steve Jenison, medical director of the state Department of Health's Infectious Disease Bureau. "But our process will be a very sustainable one. We build a lot of consensus before we do anything."

Jenison added that the New Mexico, which relies on state-regulated dispensaries, was less likely to result in diversion than more open models, such as California's. "A not-for-profit being regulated by the state would be less likely to be a source of diversion to the illicit market," Jenison said.

For ACLU Drug Policy Law Project attorney Allen Hopper, such tight regulation has an added benefit: it is less likely to excite the ire of the feds. "The greater the degree of state involvement, the more the federal government is going to leave the state alone," Hopper said.

At Friday's plenary session, "Global Drug Prohibition: Costs, Consequences and Alternatives," Australia's Dr. Alex Wodak amused the audience by likening the drug war to "political Viagra" in that it "increases potency in elections." But he also made the more serious point that the US has exported its failed drug policy around the world, with deleterious consequences, especially for producer or transit states like Afghanistan, Bolivia, Colombia, Mexico, and Peru.

At that same session, former Mexican foreign minister Jorge Castaneda warned that Latin American countries feel constrained from making drug policy reforms because of the glowering presence of the US. Drug reform is a "radioactive" political issue, he said, in explaining why it is either elder statesmen, such as former Brazilian President Cardoso or people like himself, "with no political future," who raise the issue. At a panel the following day, Castaneda made news by bluntly accusing the Mexican army of executing drug traffickers without trial. (See related story here).

It wasn't all listening to panels. In the basement of the Albuquerque Convention Center, dozens of vendors showed off their wares, made their sales, and distributed their materials as attendees wandered through between sessions. And for many attendees, it was as much a reunion as a conference, with many informal small group huddles taking place at the center and in local bars and restaurants and nearby hotels so activists could swap experiences and strategies and just say hello again.

The conference also saw at least two premieres. On the first day of the conference, reporters and other interested parties repaired to a Convention Center conference room to see the US unveiling of the British Transform Drug Policy Foundation publication, After the War on Drugs: A Blueprint for Legalization, a how-to manual on how to get to drug reform's promised land. Transform executive director Danny Kushlick was joined by Jack Cole of Law Enforcement Against Prohibition, Sanho Tree of the Institute for Policy Studies, Deborah Small of Break the Chains, and DPA's Nadelmann as he laid out the case for moving beyond "what would it look like."

"There's never been a clear vision of a post-prohibition world," said Kushlick. "With this, we've tried to reclaim drug policy from the drug warriors. We want to make drug policy boring," he said. "We want not only harm reduction, but drama reduction," he added, envisioning debates about restrictions on sales hours, zoning, and other dreary topics instead of bloody drug wars and mass incarceration.

"As a movement, we have failed to articulate the alternative," said Tree. "And that leaves us vulnerable to the fear of the unknown. This report restores order to the anarchy. Prohibition means we have given up on regulating drugs; this report outlines some of the options for regulation."

That wasn't the only unveiling Thursday. Later in the evening, Flex Your Rights held the first public showing of a near-final version of its new video, 10 Rules for Dealing with Police. The screening of the self-explanatory successor to Flex Your Right's 2003 "Busted" -- which enjoyed a larger budget and consequently higher production level -- played to a packed and enthusiastic house. This highly useful examination of how not to get yourself busted is bound to equal if not exceed the break-out success of "Busted." "10 Rules" was one of a range of productions screened during a two-night conference film festival.

The conference ended Saturday evening with a plenary address by former New Mexico Gov. Gary Johnson, who came out as a legalizer back in 2001, and was welcomed with waves of applause before he ever opened his mouth. "It makes no sense to spend the kind of money we spend as a society locking up people for using drugs and using the criminal justice system to solve the problem," he said, throwing red meat to the crowd.

We'll do it all again two years from now in Los Angeles. See you there!

Heroin Maintenance Comes to Denmark

Heroin maintenance is coming to Denmark. And it's about time -- how about here too? The evidence is in, and it's only ideology that stands in the way of saving lives that now are being needlessly lost. In the meanwhile, watch the video from the Hungarian Civil Liberties Union and the Danish Street Lawyers about the new program:

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