Under-treatment of Pain

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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

Chronicle AM -- February 21, 2014

Marijuana legalization in the District of Columbia hits a bump, the Epilepsy Foundation comes out for medical marijuana, India passes landmark access to pain medication legislation, and more. Let's get to it:

"Big Plans, Little Brains." Canada's criminally cretinous Trailer Park Boys fight marijuana legalization in their latest flick.
Marijuana Policy

DC's Top Lawyer Says Proposed Legalization Ordinance Can't Go to Voters. District of Columbia Attorney General Irvin Nathan issued a formal opinion yesterday saying the proposed DC marijuana legalization initiative should not go before the voters because it violates federal law. His opinion is not binding, but carries weight with the Board of Elections, which meets on the issue next Tuesday. Initiative backers are scrambling to see if they can't fix the language in question before then.

New Mexico House Approves Study of Legalization Effects. The state House late Wednesday passed a nonbinding memorial (bill) that calls for studying the effects of marijuana legalization in Colorado and Washington. Under the measure, the Legislative Finance Committee would conduct the study and report its findings later this year. The committee will be looking specifically at state revenue and agricultural production levels as well as addiction rates and the availability of law enforcement resources. The bill is House Memorial 38.

Medical Marijuana

Epilepsy Foundation Calls for Access to Medical Marijuana, Tells DEA to Back Off. "The Epilepsy Foundation supports the rights of patients and families living with seizures and epilepsy to access physician directed care, including medical marijuana. Nothing should stand in the way of patients gaining access to potentially life-saving treatment," said Epilepsy Foundation President and CEO Philip M. Gattone and Epilepsy Foundation Board of Directors Chairman Warren Lammert. "If a patient and their healthcare professionals feel that the potential benefits of medical marijuana for uncontrolled epilepsy outweigh the risks, then families need to have that legal option now -- not in five years or ten years. For people living with severe uncontrolled epilepsy, time is not on their side." The foundation said it was moved to act after getting repeated inquiries about the use of medical marijuana, especially high CBD cannabis oils. It also urged the DEA to get out of the way. Click on the link to read the press release.

New Jersey Patients Air Grievances Before Assembly Committee. Medical marijuana patients and advocates got a chance to lay out their problems with the state's medical marijuana program Thursday at a hearing of the Assembly Regulatory Oversight Committee. Click on the link to get all the details.

Maryland Medical Marijuana Program Still 18 Months Away, Official Says. Dr. Paul Davies, head of the commission set up to oversee the implementation of a medical marijuana program told lawmakers Thursday that the initiative is at least 18 months away from offering pain relief to the first patients. And that's the best-case scenario.

Harm Reduction

Naloxone (Opioid Overdose Reversal Drug) Bills Move in Ohio, Wisconsin. Bills that would expand access to the opioid overdose reversal drug naloxone (Narcan) are moving in Ohio and Wisconsin. The Christian Science Monitor mentions these bills in a broader article on states moving to respond opioid overdoses. Click on the link to read the whole thing.

International

India's Rajya Sabha Passes Bill to Increase Access to Opiate Pain Medications. India's parliament has passed a bill that will ease access to opiate pain medications. The Narcotic Drugs and Psychotropic Substances (Amendment) Bill, 2014, was passed by the Rajya Sabha, or upper house Friday. It had passed the Lok Sabha, or lower house, the day before. The law will bring relief to thousands of cancer patients in the country who use opiates for acute and chronic pain relief. It had been pushed by the Indian Association for Palliative Care, among other groups.

Canadian Pro-Legalization Group Seeks Candidates to Support in Next Year's Elections. A new organization, Legalize Canada, has popped-up with the intent of "supporting strong and vocal pro-legalization candidates for public office" in the 2015 federal election. The group said it had identified 95 to 100 ridings (legislative districts) out of 338 in the country where support for legalization could be a critical, election-winning issue. The group says it is aiming for a $7 million budget.

Canada's Trailer Park Boys Say Don't Legalize It. Canada's cult TV and movie phenomenon, Trailer Park Boys, is back with a new sequel, Trailer Park Boys 3: Don't Legalize It. Ricky, Julian, Bubbles, and the rest of the crew have too much invested in their latest criminal pot growing scheme to put up with legal weed.

Seven Killed in Philippines Drug Raid. Philippines anti-drug police killed seven suspected drug dealers and arrested several more in a Friday raid on the outskirts of Davao City. "They put up a fight and were killed in the process," Mayor Rodrigo Duterte said here when asked about the deaths. Duterte has long been suspected of being behind extrajudicial killings in Davao City, an accusation the Aquino administration ally has repeatedly denied.

Chronicle AM -- February 5, 2014

Alaska will vote on marijuana legalization this summer, the DC council gives preliminary approval to a decriminalization bill, the farm bill with the hemp amendment intact passes Congress, advocates urge India's parliament to act on access to pain medications, and more. Let's get to it:

Marijuana Policy

Patients in India need access to opioid pain medications, too. (cansupport.org)
Alaska Legalization Initiative Qualifies for Ballot. State election officials said Tuesday that a marijuana legalization initiative has enough signatures to qualify for the August ballot. The measure isn't officially certified yet, but it's all but a done deal.

DC Council Gives Preliminary Approval to Decriminalization. The District of Columbia city council Tuesday approved a marijuana decriminalization bill, Council Bill 20-409, but only after first accepting amendments that would criminalize the public use of marijuana and allow police to search vehicles if they encounter the odor of marijuana. A second and final vote will most probably happen next month, and efforts are underway to strip out the bad amendments. Meanwhile, a legalization bill and a legalization initiative are pending.

Deputy Drug Czar Forced to Admit Marijuana Safer Than Alcohol. Deputy ONDCP head Michael Botticelli had a rough hearing Tuesday at the House Government Oversight Committee. Rep. Gerry Connolly (D-VA) got him to admit that marijuana is safer than alcohol, but it was a painful process. Click on the link for the dialog.

Medical Marijuana

Delaware Finalizes Regulations for a Single Medical Marijuana Compassion Center. The Marijuana Policy Project complains that its limit of 150 plants will be too few to meet patients' needs, but says its efforts to get the cap lifted have been blocked. Maybe the regs can be changed later, the group said.

Project CBD Responds to Attacks from Project SAM. Project CBD's Martin Lee has penned a lengthy rebuttal of a recent Project SAM (Smart Approaches to Marijuana) "fact sheet" that seeks to justify continued marijuana prohibition "by misinforming the public about cannabidiol and THC." Check it out at the title link.

Hemp

Farm Bill With Hemp Amendment Passes Congress. The Senate Tuesday passed the omnibus farm bill with the hemp amendment intact. The amendment will allow universities and agriculture departments that have approved hemp production to undertake research. The president is expected to sign the bill any day now.

Drug Testing

Farm Bill Passes Congress Without Drug Testing Amendment. The same Farm Bill package that passed the Senate did not include language passed in a version of the bill last summer that would have encouraged states to drug test recipients of Supplemental Nutritional Assistance, also known as food stamps.

South Dakota Public Benefits Drug Testing Bill Dies. A bill that would have required drug screening and testing for public benefits recipients died Tuesday in the Senate Health and Human Services Committee on a 5-2 vote. The bill had been fiercely opposed by the administration of Republican Gov. Dennis Daugard.

Law Enforcement

Silk Road Mastermind Indicted By Feds. Ross Ulbricht, the suspected mastermind behind the dark web's Silk Road web site, has been indicted by federal prosecutors for allegedly trafficking drugs through the site. The indictment supersedes the original complaint from October 2013. Meanwhile, another version of Silk Road is back online, and so are competitors.

Prescription Drugs

Florida Prescription Drug Database Overhaul With Privacy Protections Passes Senate Committee. A bill that amends the state's Prescription Drug Monitoring Program to require investigators to get court orders to access the database passed the Senate Health Policy Committee Tuesday. The move came over the objection of law enforcement, which said it would hamper its ability to curb the abuse of controlled substances. The bill is Senate Bill 7106.

Students

South Dakota Bill to Reduce Collateral Student Drug Punishments Advances. The Senate Education Committee Tuesday approved a bill that would reduce the collateral penalties for high school students convicted of drug offenses. Under current state law, students convicted of drug offenses are suspended from school activities for a year, but can get that reduced to 60 days if they attend treatment or counseling. The bill approved by the committee would reduce that to 30 days if the student undergoes treatment.

International

British PM Rejects Junior Partner's Call to End "Unwinnable" Drug War. British Prime Minister David Cameron flatly rejected Deputy PM Nick Clegg's call to end the war on drugs and explore alternative approaches. Clegg made his comments in over the weekend on a trip to Colombia, but Cameron was having none of it, according to a spokesman: "No. The PM's views are well-known and unchanged," when asked if Cameron agreed. "He thinks that we have the right approach. The government has a good record in this area, with drug usage at the lowest level since records began." [Ed: Actually, the prime minister's views are changed, or at least the public version of them. Prior to becoming prime minister, Cameron favored legalization.]

Indian Doctors, Advocates Call for Parliament to Quit Dithering, Pass Opioid Medication Law. Indian doctors and pain patient advocates are calling on parliament to pass an amendment to the Narcotic Drugs and Psychotropic Substances Bill that would increase the availability of opioid pain medications. They say millions of Indians are suffering from untreated pain because of lack of access to such substances. Among the groups calling for action on the bill are Pallium India, the Indian Association of Palliative Care, and CanSupport, which provides home care and palliative care for patients with cancer.

Chronicle AM -- December 9, 2013

A West Virginia man gets a first degree murder charge in his wife's accidental drug death, a Utah "Good Samaritan" overdose bill is moving, some US senators grumble about Zohydro ER, and we have a pair of stories about opiates in India. And more. Let's get to it:

Zohydro ER
Marijuana Policy

Massachusetts High Court Rules against Prosecutors in Small-Time Marijuana Cases. Possession of up to an ounce of pot is decriminalized in Massachusetts, even if that less-than-an-ounce amount is divided up in separate baggies. The state Supreme Judicial Court ruled last month that possessing small amounts of marijuana in separate baggies is not sufficient evidence to charge someone with possession with intent to distribute. Prosecutors are grumbling.

Harm Reduction

Utah "Good Samaritan" Drug Overdose Bill Moving. A bill that would provide limited criminal immunity for people who report a drug overdose has passed the Criminal Justice Committee and will be taken up by the full legislature when it reconvenes next month. The bill is sponsored by Rep. Carol Spackman Moss (D-Holladay) and has the backing of harm reductionists and the Utah Statewide Association of Prosecutors alike. There were more than 500 drug overdose deaths in Utah last year.

Law Enforcement

COPS Program Worried About Police Militarization. Cop-watcher Radley Balko notes that the monthly newsletter of the Justice Department's Community Oriented Police Services (COPS) program is raising the alarm about the militarization of policing in the US. Balko cites a warning from COPS program senior policy analyst Karl Bickel: "Police chiefs and sheriffs may want to ask themselves -- if after hiring officers in the spirit of adventure, who have been exposed to action oriented police dramas since their youth, and sending them to an academy patterned after a military boot camp, then dressing them in black battle dress uniforms and turning them loose in a subculture steeped in an 'us versus them' outlook toward those they serve and protect, while prosecuting the war on crime, war on drugs, and now a war on terrorism -- is there any realistic hope of institutionalizing community policing as an operational philosophy?"

West Virginia Man Faces First Degree Murder Charge in Wife's Drug Overdose Death. Prosecutors have charged a Roane County man with first degree murder in the accidental drug overdose of his wife. Todd Honaker thought he was buying LSD, but instead gave his wife the synthetic drug 25b-NBOMe ("N-bomb"). The man who supplied the drug has been charged with delivery of a controlled substance. It's not clear why Honaker is facing such severe charges.

Pain Pills

Four Senators Scold FDA on Zohydro Approval. Four US senators have sent a letter to the FDA saying they disagree with its decision to approve Zohydro ER, a long-acting version of the pain reliever hydrocodone. Sens. Kirsten Gillibrand (D-NY), Dianne Feinstein (D-CA), Amy Klobuchar (D-MN), and Joe Manchin (D-WV) said the decision "will only contribute to the rising toll of addiction and death" caused by the misuse of prescription drugs. Zohydro can be crushed and snorted by people seeking a strong, quick high, which the senators called "irresponsible." [Ed: As the item immediately below about pain control in India demonstrates, poorly conceived control measures can and do have a devastating impact on the lives of pain patients who end up under-medicated or un-medicated. We have this problem in the US too. Other measures than bans are needed to address prescription drug misuse -- the FDA was right to approve Zohydro.]

International

Less Than 4% of Indians Suffering From Chronic Cancer Pain Have Access to Morphine. Legal restrictions on access to opioid pain medications leave millions of Indians suffering from severe and chronic pain without access to relief, leading to an "epidemic of pain in India." Ironically, India produces 99% of the global supply of licit opium, most of which it exports.

Indian Authorities Warn of Rising Opium Cultivation in Northeast. Illicit opium production is on the rise in states such as Manipur and Nagaland, Indian drug experts said at a Saturday conference in Guwahati. Cultivation was increasing both as a cash crop and for personal consumption, the experts said. In some villages, between 60% and 90% of families were growing opium, they said.

Chronicle AM -- November 29, 2013

Uruguay's marijuana legalization bill passes another hurdle, a Berlin borough wants cannabis cafes, Chicago proposes tough medical marijuana regulations, Kentucky officials hound the DEA about hemp, and more. Let's get to it:

Is this the face of marijuana legalization? Uruguayan President Jose Mujica (wikimedia.org)
Medical Marijuana

Chicago Proposes Strict Medical Marijuana Regulations. Chicago officials have proposed regulations that would allow medical marijuana dispensaries and grows only in manufacturing districts, would limit the number of grows to 22, and would require that dispensaries and grows be at least 2,500 feet from a school, day care center, or residential area. Medical marijuana becomes legal in Illinois on January 1.

Michigan Appeals Court to Hear Cases on Unemployment Benefits. The Michigan Appeals Court has agreed to hear two cases to determine whether someone fired for using medical marijuana can collect unemployment benefits. Lower court judges have overturned state agency rulings denying the benefits, but medical marijuana foe Attorney General Bill Schuette argues that the law only protects people from criminal prosecutions, not civil penalties.

Hemp

Kentucky Officials Send Letter to DEA Requesting Clarification on Hemp. Kentucky officials have sent a letter to the DEA asking for clarification of its position on industrial hemp. Agriculture Commissioner James Comer, US Sen. Rand Paul (R), and US Reps. John Yarmouth and Thomas Massie want the agency to tell them whether growing hemp in states that have enacted a regulatory framework remains illegal. They point to the federal government's response to marijuana legalization and argue that hemp should be treated the same way.

Drug Testing

Idaho Supreme Court Upholds Drug Possession Conviction Based Solely on Drug Test. Idaho's high court Tuesday upheld the conviction of a woman charged with drug possession after blood from her newborn child's umbilical cord tested positive for methadone. The court held unanimously that the drug test result was probable cause to support a possession conviction.

International

Uruguay Marijuana Legalization Bill Wins Senate Committee Vote. Uruguay is one step closer to becoming the first country to legalize the marijuana trade after the Senate Health Commission voted Thursday to approve the bill. The government-supported legislation has already passed the lower house and is expected to win final approval in the Senate next month.

Cannabis Cafes Coming to Berlin? Legislators in the hip Berlin borough of Friedrichschain-Kruezberg voted Thursday to approve cannabis coffee shops there. The move is the brainchild of Green Party Mayor Monika Hermann, who proposed it in September. Now, the borough must get the German federal government to agree. Under Article 3 of the German Narcotics Act, sufficient public interest could lead to law changes, provided there is public support and backing scientific evidence.

European Cancer Docs Say Restrictive Laws Aimed at Drug Abuse Block Millions from Pain Relief. The European Society for Medical Oncology warned that half the world's population lacks effective access to pain relievers because of restrictive laws aimed at reducing drug abuse. The group's Global Opioid Policy Initiative survey estimated that millions of cancer patients don't have access to seven cheap medicines essential for pain relief, including morphine and codeine. Access to such drugs "is catastrophically difficult" in many countries, the report's lead author said.

British Tories, Lib Dems At Odds Over Drug Policy. Britain's governing coalition is at odds with itself over drug policy after the new Liberal Democrat drugs minister, Norman Baker, said earlier this week that marijuana legalization "should be considered." That caused Conservative front-bencher and Justice Minister Chris Grayling to clarify that he and the Home Office "won't be considering it."

Northern Nigeria Alcohol Crackdown Sees 240,000 Bottles of Beer Destroyed. In attempt to deepen a sharia law ban on alcohol imposed in 2001, but largely ignored in hotels and the city's Christian quarter, Islamic police in the northern city of Kano destroyed 240,000 bottles of beer. They chanted "God is great" as they did so, and the head of the religious police warned that they will put an end to alcohol consumption. Multiple bombings of bars in the Christian quarter in late July carried out by suspected Islamic militants who complained the government wasn't enforcing sharia law adequately left 29 dead.

Peru Eradicates Record Amount of Coca. Peru, once again the world's largest coca and cocaine producer, announced Thursday that it had eradicated a record 55,000 acres of coca, about one-fifth of the total estimated 250,000-acre crop. That's a 60% increase in eradication over last year. The government said the increase was due to tougher anti-drug efforts and a weakening of the Shining Path in coca growing areas.

Israel Medical Marijuana Use up 30% This Year. Medical marijuana use is up sharply this year in Israel, according to the Health Ministry, which released figures showing 13,000 patients were approved to us it this year, up from 10,000 last year. The increase comes as the government is working on a new proposal to regulate medical marijuana. The Health, Agriculture, and Public Security ministries are expected to present it within the next couple of weeks.

UN Report Slams Cruel Drug Treatment as "Torture"

Compulsory "treatment" for drug addiction in some parts of the world is "tantamount to torture or cruel, inhuman or degrading treatment," according to report last month from the UN's special rapporteur on torture and other degrading treatments and punishments. The report was delivered to the Office of the UN High Commissioner for Human Rights in Vienna.

drug "rehabilitation center," Vietnam (ohchr.org)
Authored by Special Rapporteur Juan Mendez, the report takes special aim at forced "rehabilitation centers" for drug users. Such centers are typically found in Southeast Asian states, such as Vietnam and Thailand, as well as in some countries in the former Soviet Union. But the report also decries the lack of opiate substitution therapies in confinement setting and bemoans the lack of access to effective opioid pain treatment in large swathes of the world.

"Compulsory detention for drug users is common in so-called rehabilitation centers," Mendez wrote. "Sometimes referred to as drug treatment centers or 'reeducation through labor' centers or camps, these are institutions commonly run by military or paramilitary, police or security forces, or private companies. Persons who use, or are suspected of using, drugs and who do not voluntarily opt for drug treatment and rehabilitation are confined in such centers and compelled to undergo diverse interventions."

The victims of such interventions face not only drug withdrawal without medical assistance, but also "state-sanctioned beatings, caning or whipping, forced labor, sexual abuse, and intentional humiliation," as well as "flogging therapy," "bread and water therapy," and forced electroshock treatments, all in the name of rehabilitation.

As Mendez notes, both the World Health Organization (WHO) and the UN Office on Drug Control (UNODC) have determined that "neither detention nor forced labor have been recognized by science as treatment for drug use disorders." Such forced detentions, often with no legal or medical evaluation or recourse, thus "violate international human rights law and are illegitimate substitutes for evidence-based measures, such as substitution therapy, psychological interventions and other forms of treatment given with full, informed consent."

Such centers continue to operate despite calls to close them from organizations including the WHO, the UNODC, and the UN Commission on Narcotic Drugs. And they are often operating with "direct or indirect support and assistance from international donors without adequate human rights oversight."

Drug users are "a highly stigmatized and criminalized population" who suffer numerous abuses, including denial of treatment for HIV, deprivation of child custody, and inclusion in drug registries where their civil rights are curtailed. One form of ill-treatment and "possibly torture of drug users" is the denial of opiate substitute therapy, "including as a way of eliciting criminal confessions through inducing painful withdrawal symptoms."

The denial of such treatments in jails and prisons is "a violation of the right to be free from torture and ill-treatment," Mendez noted, and should be considered a violation in non-custodial settings as well. "By denying effective drug treatment, state drug policies intentionally subject a large group of people to severe physical pain, suffering and humiliation, effectively punishing them for using drugs and trying to coerce them into abstinence, in complete disregard of the chronic nature of dependency and of the scientific evidence pointing to the ineffectiveness of punitive measures."

The rapporteur also noted with chagrin that 5.5 billion people, or 83% of the planet's population, live in areas "with low or no access to controlled medicines and have no access to treatment for moderate to severe pain." While most of Mendez' concern is directed at the developing world, he also notes that "in the United States, over a third of patients are not adequately treated for pain."

Mendez identified obstacles to the availability of opioid pain medications as "overly restrictive drug control regulations," as well as misinterpretation of those regulations, deficiencies in supply management, lack of concern about palliative care, and "ingrained prejudices" about using such medications.

New York City, NY
United States

Dr. Shaygan's Saga: Prosecutorial Misconduct in the War on Pain Docs [FEATURE]

special to Drug War Chronicle by investigative journalist Clarence Walker, cwalkerinvestigate@gmail.com

Part 4 in a series, "Prosecutorial Misconduct and Police Corruption in Drug Cases Across America."

In what could become an historic case, a Florida doctor acquitted of drug dealing charges over his prescribing practices is asking the US Supreme Court to reinstate a $600,000 award made to him by a lower court after federal prosecutors were found to have engaged in misconduct that was "vexatious, frivolous, or in bad faith." That language comes from the Hyde Amendment, enacted in 1997, which gives federal judges the power to force the government to pay attorney's fees to acquitted defendants if the actions of those prosecutors met that standard of misconduct.

http://stopthedrugwar.org/files/dr-shaygan.jpg
Dr. Ali Shaygan
The case of Florida physician Dr. Ali Shaygan has been closely watched by pain-management doctors -- an area in which the federal government has waged a fierce "war on prescription doctors" -- a war fueled by a rising death toll in recent years from prescription drug overdoses in America, but also preceding that rise. Since 2003, according to DEA, hundreds of physicians across the nation have been charged in federal or state court for illegally dispensing narcotic pain medicine to patients.

This past August, the 11th US Circuit Court of Appeals overturned the trial court decision awarding the money to Shaygan, who had operated a Miami pain clinic. He was acquitted in March 2009 of 141 counts of illegally distributing narcotics to patients, including one case where a patient died of an overdose.

Shaygan's attorneys charged that two Assistant US Attorneys, Sean Cronin and Andrea Hoffman, as well as a DEA agent, had acted "vexatiously" and withheld materially important evidence after Shaygan was originally charged in a 23-count indictment. US Circuit Court Judge Alan Gold, who presided over the high-profile trial, agreed that prosecutors violated disclosure requirements by withholding information from the defense and the court and ordered the cash award.

Judge Gold also accused the government of launching a separate "tactical" effort to disqualify the doctor's attorney, David Markus, shortly before the trial began. In that effort, which Gold characterized as part of a scheme to undermine the defendant's rights to a fair trial, the prosecutors failed to notify the defense that the DEA had attempted to manipulate two witnesses in the case into trying to entrap Markus into paying off witnesses to give favorable testimony at the trial to help the doctor beat the rap.

Following a sanction hearing after the doctor's acquittal in 2009, Judge Gold issued a scathing ruling against the prosecutors. The government conduct was so "profoundly disturbing that it raises troubling issues about the integrity of those who wield enormous power over the people they prosecute," Gold concluded.

After Gold requested that the Justice Department investigate the government's misconduct, prosecutor Cronin conceded to the Miami Herald, "We should have done a better job," but insisted that "at no time was I acting in bad faith."

He said he authorized secret recordings of attorney Markus because a witness, Courtney Tucker, had told a DEA agent the defense might be trying to tamper with her testimony. Yet Tucker contradicted Cronin's claim when she testified that a DEA agent had tried to pressure her to tailor her testimony to bolster the prosecution's case against Dr. Shaygan.

http://stopthedrugwar.org/files/david-markus.jpg
Atty. David Markus after the acquittal
When federal prosecutors appealed the cash award to the 11th Circuit, a sharply divided panel overturned it, holding that Gold had overreached and wrongly interpreted the Hyde Amendment by applying the incorrect legal standard for awarding the fees under the statue. The appeals court majority also held that "as long as a prosecutor had an objectively reasonable basis in law (not frivolous and not vexatious), an award of attorney fees under the Hyde Amendment is improper." One judge concluded that the overall prosecution and allegations on the original indictment were "objectively valid."

But in a harsh dissent, Judge Beverly Martin wrote that the majority opinion "will render trial judges mere spectators of extreme government misconduct."

Markus told the Chronicle the appeals court reversal was not what he expected. "The decision was surprising given how the oral argument went and how thorough Judge Gold's order was," Markus said, adding that he was appealing to the Supreme Court.

Now a coalition of former federal judges and prosecutors, organized by the bipartisan group the Constitution Project has signed onto an amicus brief supporting Markus's writ of certiorari asking the Supreme Court to overturn the appeals court decision and reinstate the cash award in US v. Shaygan.

"When a court bends the law to excuse a prosecutor's bad faith, public confidence in the criminal justice system suffers," the Constitution Project brief said.

Just Another Pain Doctor Prosecution

The wheels of justice in Dr. Shaygan's case began turning on June 9, 2007, when one of the long-term patients at his pain clinic, James Brendan Downey, died of a drug overdose from a fatal combination of prescribed methadone and illegal cocaine. Shaygun had prescribed the methadone to Downey two days before he died, and an autopsy found that the levels of methadone in his blood alone were enough to kill him.

In a subsequent undercover sting operation, two Florida police officers posed as potential patients at Shaygan's office to determine how easily they could obtain prescribed narcotics. Federal prosecutors said both officers obtained a prescription for controlled substances on their first visit without presenting medical records, and that Shaygan only administered minimal physical examination.

http://stopthedrugwar.org/files/judge-gold.jpg
Judge Gold
On February 8, 2008, the Southern Florida US Attorneys Office filed a 23-count indictment against Shaygan alleging that "the doctor distributed and dispensed controlled substances outside the scope of professional practice unintended for legitimate medical purposes in violation of 21 U.S.C. 841."

Three days later, DEA agents arrested Shaygan at his office. Agents seized Shaygan's active patient files and even confiscated his leather-bound daily planner. Prosecutors said that DEA agents reported that Shaygan allegedly made a statement to the effect, "I want to cooperate." On May 14, Markus filed a motion to suppress his client's statement during his arrest.

At a post-hearing on the suppression motion held on August 2008, Markus clashed with lead prosecutor Cronin over Markus's attempt to keep his client's alleged statement from being heard by the jury. Cronin threatened Markus with an enhanced prosecution of his client if he persisted in that strategy.

"Cronin told me that if we litigated the suppression issues, there would be no more plea discussions, and that if I went after his witnesses (DEA agents), there would be a 'seismic shift' in the way he would prosecute the case against Mr. Shaygan," Markus said.

Markus dismissed Cronin's threat and forged ahead with the suppression hearing, offering up damaging testimony by Shaygan, who testified that DEA agents, while flashing their weapons, continued to interrogate him, despite his request to speak with a lawyer. Agents denied this happened. After hearing from a defense witness that he overheard Shaygan say, "May I please have my lawyer," Judge Gold granted the motion to suppress, which barred prosecutors from using Shaygan's statements during the trial.

Then, playing legal hardball, prosecutor Cronin made good on his threat, filing an additional 108 drug charges against Shaygan totaling hundreds of years in prison and bringing the total number of charges filed against him to 131. Cronin filed the extra charges after DEA agent Chris Wells located and interviewed Shaygan's former patients Carlos Vento, Trinity Clendening, Courtney Tucker and Andrew McQuarrie. These former patients would play a pivotal role in the misconduct allegations against federal prosecutors Cronin and Hoffman.

Before trial, prosecutors Cronin and Hoffman received a tip from DEA agent Wells that Shaygan's defense team might be tampering with the witnesses. Wells said one witness, Courtney Tucker, "was about to go south and not testify." Prosecutors relayed this new information to Karen Gilbert, the Assistant US Attorney in charge of the narcotics unit. Gilbert authorized DEA agent Wells to ask witnesses Tucker and Carlos Vento to record phone calls with the defense team and for the witnesses to ask attorney Markus for funds to testify that Dr. Shaygan had not overprescribed medication that killed James Downey. Vento later signed a confidential informant agreement with the DEA.

Trial Shenanigans

During a three-week trial in beginning in 2009, prosecutors characterized Dr. Shaygan as a drug dealer who recklessly sold prescriptions for dangerous narcotic painkillers, such as oxycodone and methadone, to increase his wealth. Prosecutor Cronin told the jury the government would prove that Shaygan's illegal distribution of methadone contributed to Mr. Downey's death. Jurors viewed evidence showing prescription bottles from Shaygan found in Downey's bedroom, where he died in his sleep. Downey's girlfriend, testifying for the government, said her boyfriend had obtained methadone from Shaygan hours before he died.

But the girlfriend also undercut the prosecution's case by testifying that Shaygan had questioned and cautioned Downey about the large amount of methadone he had requested. Defense attorney Markus further undercut the prosecution case by presenting evidence of additional medicine bottles at the scene prescribed by other doctors.

For the defense, renowned expert forensic pathologist Dr. Michael Baden testified that when Downey used multiple prescribed drugs there was no verifiable way to conclude the drugs given to him by Dr. Shaygan actually caused his death.

Then, in a dramatic twist right out of Perry Mason, former Shaygan patient and government witness Trinity Clendening let slip that he had recorded for the DEA a telephone call he made to to Markus's office to solicit payment for testifying on Shaygan's behalf. A recording later heard in court showed that that Markus had directly refused to offer bribes. "I am not paying money for anything," he said on the tape.

Markus was furious. During a hearing outside the presence of the jury, he hammered the witness. Clendening, now unraveling the government's deceit, revealed the whole scheme to set up Markus for a witness tampering charge. Markus attacked the prosecutors relentlessly over their withholding evidence of the scheme. In closing arguments, Markus rhetorically compared the prosecutorial misconduct in Shaygan's case with the infamous Salem Witch trials, and told the jury it had been misled by the government's flagrant violation of the law through withholding evidence that the defense had asked for under the law and not received.

Judge Gold instructed jurors that they were legally bound to consider the prosecutor's violations of the law during their deliberations over Shaygan's guilt or innocence. After deliberating four hours, the jury acquitted Dr. Shaygan on March 12, 2009.

Shaygan's relatives, friends and colleagues erupted with cheers after hearing the verdict, and jurors hugged Shaygan as he left the courtroom.

"I feel vindicated," Shaygan told the Miami Herald. "I feel that my life can move forward again."

"This verdict sends a message that justice prevails," Markus added.

But justice hasn't prevailed just yet. The federal prosecutors who engaged in the misconduct have not been punished for their actions, either criminally, professionally, or financially. The 11th Circuit Court of Appeals decision reversing the $600,000 award for misconduct that is "vexatious, frivolous, or in bad faith" remains the last word on the affair -- unless the Supreme Court agrees to take the case.

At least, Dr. Ali Shaygan is out from under his legal woes and, having had his license to prescribe medicine reinstated, he is once again helping patients.

Pain Relief Network's Siobhan Reynolds Killed in Plane Crash

Prominent pain patient advocate and Pain Relief Network founder Siobhan Reynolds, 50, was killed in a plane crash on Christmas Eve day. She was one of three people aboard a small private plane attempting to land at an Ohio airport that afternoon. The plane missed the runway and instead crashed on a parallel road, killing all aboard.

For the last decade, Reynolds had been a fierce advocate for patients suffering chronic pain and the doctors who attempted to treat them with high-dose opioid pain medication protocols. She came to be an advocate through personal tragedy -- her husband, a chronic pain patient, died as the family moved cross-country seeking effective relief for him.

But Reynolds turned her personal tragedy into activism of the highest sort, founding the Pain Relief Network to advocate for an effective response to the under-treatment of pain in this county. She was present for the trial of Northern Virginia pain management pioneer Dr. William Hurwitz, a trial I attended and where we first met. Hurwitz was convicted of being a drug dealer and imprisoned, an injustice that only deepened Reynolds' fire for justice.

She and the Pain Relief Network played a central role in winning freedom for Richard Paey, the wheelchair-bound pain patient sentenced to 25 years in state prison, and that was just one of her many interventions in the DEA's war pain doctors. Where the DEA saw only "pill mills" and Dr. Feelgoods, Reynolds saw the effectiveness with which high-dose opioid theory brought relief to suffering people.

Her feisty and tireless advocacy brought her into direct conflict with the DEA and federal prosecutors, most notably in the case of Kansas pain clinic owner Dr. Steven Scheider, who was charged with over-prescribing pain pills, and his wife, Linda, a nurse who was charged along with him. When Reynolds set up shop in Kansas to publicize the case and the issues and lend support to the Schneiders, Assistant US Attorney Tanya Treadway opened a criminal investigation into Reynolds and the Pain Relief Network, seeking, among other things, all of Reynolds' email, phone records, and other communications with doctors, patients, and attorneys.

As always, Reynolds fought back against the feds, and, in a shameful episode in American jurisprudence, she lost -- and worse. Not only was she forced to comply with Treadway's subpoena, but Treadway and the federal courts conspired to hide the whole sordid episode from public view. The ruling in the case has never been published, nor are the briefs available for scrutiny. Reynolds was even barred from sharing the briefs she submitted with the press.

That ruling was the last straw for the Pain Relief Network, which Reynolds announced was being dissolved a year ago. But not for Reynolds. I spoke with her earlier this year, and she was planning to form another pain advocacy organization. It is our loss that she never got the chance.

Siobhan Reynolds wasn't always easy to work with because she was a true believer in her issue. She was impatient with potential allies who were not willing to go as far as she was, whether they were physicians groups or academics or drug reformers. She wanted the Controlled Substances Act abolished as an abomination, and if you weren't ready to go there, she didn't really want to waste her time with you. But sometimes a movement needs a determined, fiery-eyed idealist. Siobhan Reynolds was that person for the movement against the under-treatment of chronic pain.

McArthur, OH
United States

Pain Patients Lose a Leading Advocate, Siobhan Reynolds, 1961-2011

Siobhan Reynolds (left) at 2004 Congressional briefing, with Dr. Frank Fisher, Ron Libby and Maia Szalavitz (photo courtesy PRN)
My friend and colleague Siobhan Reynolds, founder of the Pain Relief Network (PRN), died in a plane crash this weekend outside Columbus, Ohio. The pilot of the plane, her partner Kp Byers, was also a pain activist, an attorney whose practice had focused since 1992 on defending medical professionals caught in the crosshairs of the drug war. Radley Balko has written an extensive tribute to Siobhan, online here. So does Jacob Sullum at Reason.

As Radley has noted and as many others will doubtless note, Siobhan's work organizing media and legal support for patients, doctors, pharmacists and nurses was a courageous one. An article in the New York Times last year by Adam Liptak shows the degree to which prosecutors and even some judges felt threatened by the scrutiny Siobhan and PRN had drawn to their handling of certain cases, and the lengths to which they were willing to abuse legal process to shut her down. Perhaps the daring of riding in a small plane is a mirror of the daring she showed in her career taking on the government.

PRN did shut down last year, the organization's financial resources and Siobhan's own resources depleted by the struggle. But Siobhan was working on forming a new patient advocacy organization, Radley noted. I hope that others will take up that torch in her name. The under-prescribing of opiates to many patients who need them, and the injustice of lengthy mandatory minimum drug sentences being leveled at doctors and others over prescribing practices that at worst are debatable, is one of the most challenging problems in the drug war to take on. There is far too little help -- medical, advocacy, or otherwise -- for the people most deeply affected. Among those people were her husband, the late Sean Greenwood.

The Pain Relief Network still has an online presence, and its home page provides Siobhan's reasons for the organization's closure and her hopes of what could happen in the future. Our own web site has an archive devoted to the pain under-treatment issue, much of the material in it about Siobhan's work.  Also, Siobhan wrote several articles this year on prohibition and the drug war's impact on the doctor-patient relationship, the articles linked to from her web site.

Last but not least, in the YouTube video posted below, "Being Unable to Help," Siobhan talks about what was impossible to do for her husband in the current medical and legal environment. Share it widely.

 

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