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Fighting Stigmatization of Drug Users in Denver [FEATURE]

In many ways, ours is harsh, moralistic, and punitive society. One need only look at our world-leading incarceration rate to see the evidence. We like to punish wrongdoers, and our conception of wrongdoers often includes those who are doing no direct wrong to others, but who are doing things of which we don't approve.

We label those people of whom we don't approve. When it comes to drugs and drug use, the labels are all too familiar: Heroin users are "fucking junkies;" alcohol abusers are "worthless drunks;" cocaine smokers are "crack heads;" stimulant users are "tweakers;" people with prescription drug habits are "pill poppers." The disdain and the labeling even extends to the use of drugs on the cusp of mainstream acceptance. Marijuana users are "stoners" or "pot heads" or "couch potatoes."

Such labeling -- or stigmatizing -- defines those people as different, not like us, capital-O Other. It dehumanizes the targeted population. And that makes it more socially and politically feasible to define them as threats to the rest of us and take harsh actions against them. It's a pattern that we've seen repeatedly in the drug panics that sweep the nation on a regular basis. Drug users are likened to disease vectors or dangerous vermin that must be repressed, eradicated, wiped out to protect the rest of us.

(It is interesting in this regard to ponder the response to the most recent wave of opiate addiction, where, for the first time, users are being seen as "our sons and daughters," not debauched decadents or scary people of color who live in inner cities. Yes, the impulse to punish still exists, but it is now attenuated, if not superseded, by calls for access to treatment.)

Never mind that such attitudes can be counterproductive. Criminalizing and punishing injection drug use has not, for example, slowed the spread of blood-borne infectious diseases such as HIV and hepatitis C. To the contrary, it has only contributed to the spread of those diseases. Likewise, criminalizing drug possession does not prevent drug overdoses, but it may well prevent an overdose victim's friends or acquaintances from seeking life-saving medical attention for him.

A recent survey from the National Council on Alcoholism and Drug Dependence reinforces the view that we tend to stigmatize drug users as morally decrepit. That survey found that Americans are significantly more likely to have negative attitudes about drug addiction and addicts than about mental illness.

Only one out of five said they would be willing to work closely on the job with a person addicted to drugs (as compared to 62% for mental illness), and nearly two-thirds said employers should be able to deny a job to someone with an addiction issue (as compared to 25% for mental illness). And 43% said drug addicts should be denied health insurance benefits available to the public at large.

"While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition," said study leader Colleen L. Barry, Ph.D. of the Johns Hopkins Bloomberg School of Public Health. "In recent years, it has become more socially acceptable to talk publicly about one's struggles with mental illness. But with addiction, the feeling is that the addict is a bad or weak person, especially because much drug use is illegal."

"The more shame associated with drug addiction, the less likely we as a community will be in a position to change attitudes and get people the help they need," study coauthor Beth McGinty, Ph.D. said in a news release. "If you can educate the public that these are treatable conditions, we will see higher levels of support for policy changes that benefit people with mental illness and drug addiction."

As the survey suggests, the process of stigmatization is an impediment to smart, evidence-based approaches to dealing with problematic drug use. Now, the Denver-based Harm Reduction Action Center is trying to do something about it.

In the last few days, it has rolled out a new anti-stigmatization campaign featuring the faces of injection drug users, the locations where they overdosed or suffered other bad consequences, and their individual stories in brief.

"My name is Alan," says a middle-aged man with a brushy mustache. "I overdosed on heroin. Right there in that parking lot in that picture. I know the risks of doing heroin, but drug dependency is strong."

The second part of Alan's message is repeated with each drug user pictured: "There are 11,500 injection drug users like me in Metro Denver. 73% of us carry Hepatitis C. 14% of us have HIV. The transmission of bloodborne diseases and drug overdoses are nearly 100% preventable. Support the Harm Reduction Action Center. Learn more about how our public health strategies keep you, and the people you know, safe."

"My name is Andrew," says a dreadlocked and pierced young man whose image is coupled with a photo of an empty apartment. "After a decade living as a homeless youth, the most traumatic thing that happened to me didn't happen to me at all. It happened to my best friend Val. She died of a heroin overdose. Right here in this picture. She was my friend. She was someone's daughter. Sobriety has taught me a lot about the thin line that separates us all. Val was someone you knew. She probably served you coffee. She probably even greeted you with a friendly smile."

"My name is Joanna," says a woman whose image is paired with a photo of a car parked beneath a highway overpass. "When I was diagnosed with lymphoma, I was prescribed a heavy dose of pain killers. Cancer hurts, but with treatment, it went away. My dependency on opioids did not. Two years later, this is where I live; in a car, under the interstate. I did not choose to get cancer. I did not choose to get dependent on opioids."

The images and the messages are strong and direct. That's the idea, explained HRAC executive director Lisa Raville.

"This campaign is about bringing awareness of our work in the community, focusing on the common sense approach championed by harm reduction," she said. "Stigma, of course, is one of the biggest stumbling blocks, preventing otherwise reasonable conversation on the matter of communicable diseases and accidental overdoses. This campaign sets the scene that harm reduction is a valid and evidence-based approach to public health. Access to clean syringes, proper syringe disposal, and naloxone are key components to a comprehensive public health strategy that curbs the spread of HIV, HVC, and reduces the rate of otherwise fatal overdoses."

It's a message directed at the general public even more than drug users themselves, Raville said.

"One of the fundamental problems faced by health care advocates working with injection drug users is a generalized, public perception that the issue is isolated to people and places outside of the normal social sphere. Generally speaking, our tendency is to dissociate our ordinary experiences -- the people we know and the places we go -- from things that we consider dangerous, dark, or forbidden," she said.

"In the arena of injection drug use, the consequence of this mode of thinking has been historically devastating," she continued. "Instead of crafting public policy that works to minimize the harm caused by addiction, our trajectory tends towards amplifying consequences for anyone that wanders outside of the wire and into these foreign spaces. Rather than treating addiction as a disease, we treat it as something that is volitional and deserving of its consequences. Accordingly, our policies view the contraction of blood-borne pathogens and the risk of overdose as deterrents to the act of injecting drugs."

That cold-blooded attitude may make some people feel better about themselves and their policy prescriptions, but it hasn't proven useful in reducing deaths, disease, or other harms resulting from injection drug use. Instead, it tends to increase them.

"These 'consequences,' of course, have little impact on rates of addiction," Raville argued. "They do, however, all but ensure the continued spread of HIV and hepatitis C. Moreover, possession and distribution of naloxone, a drug that counters the effects of otherwise fatal opiate overdoses, remains criminal in many areas throughout the world."

At bottom, the campaign is not just about drug users but about better public health.

"As our campaign points out, when we drive things underground, we make them truly dangerous," Raville said. "Harm reduction is predicated on the fact that people use drugs. Those who inject drugs are among the most insular and at-risk for contracting HIV, HCV or dying of an overdose. Like a stone that falls in the water, these acute health-related events have ripples which touch all of us, regardless of whether or not we use drugs. HIV infects those who inject the same as those who do not; the best way to prevent its spread is to prevent its spread across all populations of people, not just those deemed more socially 'worthy.' By facing stigma head-on and by humanizing the people in our community who we serve, the Harm Reduction Action Center hopes to normalize the issue and bring the conversation about drug use and healthcare to a more practical level. As a public health agency that serves people who inject, we could get so much more done in our community without stigma."

Denver, CO
United States

Chronicle AM -- July 25, 2014

Wichita looks set to vote on decriminalization this fall, Rand Paul (busy, busy) files a federal asset forfeiture reform bill, drug users finally get a voice at the International AIDS Conference, and more. Let's get to it:

http://www.stopthedrugwar.org/files/KFC_logo2.jpg
Marijuana Policy

Wichita Decriminalization Initiative Campaign Turns in Twice the Necessary Signatures. Organizers of a decriminalization initiative signature-gathering campaign yesterday turned in 5,800 signatures to get the initiative on the November ballot. Kansas for Change needs 2,928 valid voter signatures to qualify. They turned in the signatures at 4:20pm.

Five People Ticketed for Marijuana Possession in First Week of DC Decriminalization Law. DC police have cited five people for marijuana possession in the week since the DC decrim law went into effect. Four of the five citations came in predominantly black areas of the city east of the Anacostia River. Last year, before decrim, police made about 11 marijuana possession arrests a day.

Poll: California Latinos Strongly Oppose Deportation for Marijuana Possession. A new poll from Latino Decisions and Presente.org finds that nearly two-thirds (64%) of California Latinos strongly oppose deporting non-citizens for marijuana possession. Marijuana possession is the fourth most common criminal offense leading to deportation, according to a 2012-2013 study by the Transactional Records Access Clearinghouse (TRAC) at Syracuse University.

Asset Forfeiture

Rand Paul Files Asset Forfeiture Reform Bill. Sen. Rand Paul (R-KY) has filed a bill to reform federal asset forfeiture laws. Yesterday, he introduced the FAIR (Fifth Amendment Integrity Restoration) ACT, Senate Bill 2644, which would require the government to prove with clear and convincing evidence that the property it wishes to forfeit is connected with a crime. The FAIR Act would also require that state law enforcement agencies abide by state law when seizing property. It would also remove the profit incentive for forfeiture by redirecting forfeitures assets from the Attorney General's Asset Forfeiture Fund to the Treasury's General Fund.

International

Drug Users Get a Voice at Global AIDS Conference. For the first time, a group of drug users has been allowed space at the International AIDS Conference, taking place this year in Melbourne, Australia. The International Network of People Who Use Drugs (INPUD) had a booth at the conference and also held a movie premiere event at the conference for the film, "We are Drug Users."

British National Survey Finds Slight Overall Increase in Drug Use. The number of drug users in Britain increased by 0.7% last year, according to the 2013 to 2014 Crime Survey for England and Wales. Some 8.8% of adults used drugs in the past year; 6.6% used marijuana. Cocaine was the second most commonly used drug, at 2.4%.

Guatemalan President Still Mulling Marijuana Legalization. President Otto Pérez Molina said in an interview in Washington yesterday that he hadn't ruled out the possibility of legalizing marijuana. "Right now we have a commission that's following what's been happening in Uruguay, Portugal, Holland, Colorado, and the state of Washington," he said. "I expect to receive the studies, analysis and recommendations at the end of the year and from there we will make the decisions that would best fit our country." Pérez Molina will be hosting an international conference on drug policy in Guatemala in September. [Editor's Note: We are not aware of any conference in Guatemala this fall. It's not clear if Perez Molina misspoke or the Washington Post misheard. There is a V Conferencia latinoamerica sobre la politica de drogas set for Costa Rica in September.]

WOLA Releases Analysis of Ecuador Drug Policy Trends and Contradictions. The Washington Office on Latin America (WOLA) has published "Reforma y contradicciones en la politica de drogas de Ecuador." The report identified advances and blockages in Ecuador's path to a more progressive drug policy. Click on the link to read it in Spanish or use your translate button or wait a few days for WOLA's English version to read it in English.

Chronicle AM -- July 21, 2014

The World Health Organization calls for drug decriminalization (and more), international drug reform and harm reduction groups warn of an AIDS prevention crisis, marijuana policy is popping up in some Republican primaries, and more. Let's get to it:

Times are changing when marijuana legalization becomes an issue in Republican primaries. (wikimedia.org)
Marijuana Policy

MPP Urges Votes for Bob Barr in Georgia Republican Congressional Primary Tomorrow. The Marijuana Policy Project is calling on its Georgia supporters to get out and vote for Republican congressional candidate Bob Barr in the primary tomorrow in the state's 11th congressional district. Barr made a reputation in the 1990s as an arch-drug warrior, but has since become a staunch supporter of drug policy reform and civil liberties.

Kansas GOP Gubernatorial Candidate Challenges Incumbent With Platform That Includes Legalizing Marijuana. Gov. Sam Brownback (R) is facing a long-shot challenge from Jennifer Winn, a small businesswoman whose son is facing a murder charge over a marijuana deal gone bad. She says she entered the race out of anger over that, and her platform includes legalizing marijuana and industrial hemp, as well as a broader call for drug policy reform. Her race is being watched as a sign of how damaged the state GOP is after years of Brownback's ultraconservative social and economic policies.

Washington State Rang Up $1.2 Million in Marijuana Sales in First Week. Only a handful of stores were actually open and supplies were limited, but the first week of legal marijuana sales in Washington still generated more than $1.2 million in sales, according to the state Liquor Control Board. It also generated $318,043 in taxes collected so far.

Despite Philadelphia City Council's Decriminalization Vote, Marijuana Possession Arrests Continue. Last month, the city council voted to decriminalize possession of up to an ounce, but Mayor Michael Nutter opposes the bill, and Police Chief Charles Ramsey vowed to continue marijuana possession arrests. He's lived up to his word. Since the bill was passed, 246 people have been arrested for pot possession, 140 of them charged only with pot possession. Of the 124 people charged with additional crimes, the vast majority were only drug charges. Mayor Nutter has until September to act on the decriminalization bill. He can sign it, veto it, or do nothing, in which case it becomes law without his signature.

Medical Marijuana

Illinois Governor Signs Bill to Expand Access to Medical Marijuana. Gov. Pat Quinn (D) yesterday signed into law a bill that will expand the state's medical marijuana program by allowing people with seizure disorders to use it and by allowing minors to participate in it with parental consent. The measure is Senate Bill 2636.

New Mexico Backs Off on Medical Marijuana Program Changes. The state Department of Health announced last Thursday that it will not move forward with proposed rule changes that included limiting the number of plants patients could grow and requiring criminal background checks for patient growers. The department said there will likely be another hearing for public comments before new rules are finalized this fall.

Psychedelics

Memorial Event for Sasha Shulgin in Berkeley Next Month. The psychonauts at Erowid are hosting a memorial and community gathering in Berkeley next month to honor the memory of Dr. Alexander "Sasha" Shulgin, the legendary scientist of psychedelics who died early last month. Please RSVP if you are planning to attend; click on the link to do so.

Drug Policy

World Health Organization Calls for Drug Decriminalization, Broad Drug Policy Reforms. In a report on HIV treatment and prevention released earlier this month, the World Health Organization quietly called for drug decriminalization, needle exchanges, and opiate substitution therapy. The WHO's positions are based on concerns for public health and human rights.

Drug Testing

Mississippi Public Hearing on Welfare Drug Test Law Tomorrow. The Department of Human Services is holding a hearing tomorrow in Jackson to hear public comment on a new welfare drug testing law that was supposed to have gone into effect July 1. It was delayed to allow for a public hearing. The law is opposed by the ACLU and racial and social justice activists. Click on the link for time and location details.

Harm Reduction

Drug Reform and AIDS Groups Warn of "Global Crisis" in HIV Prevention Funding, Especially for Injection Drug Users. As the 20th International AIDS Conference gets underway in Melbourne, Australia, three drug reform, harm reduction, and AIDS groups have issued a report, The Funding Crisis for Harm Reduction, warning that because of donor fatigue, changing government policies, and an over-reliance on drug law enforcement, the goal of an "AIDS-free generation" risks slipping away. The three groups are Harm Reduction International, the International Drug Policy Consortium, and the International HIV/AIDS Alliance.

Law Enforcement

In Forsythe County, North Carolina, Majority of SWAT Deployments are For Drug Raids. SWAT teams were designed to be used in extreme situations -- hostage-taking events, terrorist attacks, and the like -- but have been subject to mission creep over the years. Forsythe County is one example. In an in-depth report, the Winston-Salem Journal found that the Forsythe County SWAT team had been deployed 12 times in the past year and the Winston-Salem Police SWAT team had been deployed 40 days in the past year "mostly to execute search warrants for drugs."

International

Report on Illicit Drug Corridors Between Bolivia and Peru Published. In a report based on on-the-scene investigation, the Bolivian NGO Puente Investigacion y Enlace (PIE), led by former human rights ombudsman Godo Reinicke, has studied the drug and precursor chemical networks straddling the Peru-Bolivia border. Read the report, Corredores ilicitos entre Boliva-Peru, ¿Rutas escondidas y extrañas? in Spanish, or click on your translate button.

(This article was published by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also shares the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

The 2014 National Drug Control Strategy: Baby Steps in the Right Direction [FEATURE]

The White House Office of National Drug Control Policy (ONDCP -- the drug czar's office) released its 2014 National Drug Control Strategy Wednesday. While in general, it is remarkable for its similarities to drug control strategies going back more than a decade, it does include some signals suggesting that the Obama administration is ready for a shift in emphasis in the drug war -- from a criminal justice approach to a more public health-oriented approach.

But even that rhetorical positioning is somewhat undercut by the strategy's continuing commitment to the criminalization of drug users and the people who supply them, as well as particular policy prescriptions, such as its support for expansion of drug courts -- the use of the criminal justice system to enforce therapeutic health goals like abstinence from drug use, as opposed to measures that don't involve criminal justice intervention.

The 2014 strategy also continues the roughly 3:2 funding ratio between law enforcement and treatment and prevention spending that has marked federal anti-drug spending since at least the Clinton administration in the 1990s. And it does so somewhat deceptively.

"In support of this Strategy," ONDCP wrote in a press release, "the President has requested $25.5 billion in Fiscal Year 2015. Federal funding for public health programs that address substance use has increased every year, and the portion of the Nation's drug budget spent on drug treatment and prevention efforts -- 43% -- has grown to its highest level in over 12 years. The $10.9 billion request for treatment and prevention is now nearly 20% higher than the $9.2 billion requested for Federally-funded domestic drug law enforcement and incarceration."

What the press release doesn't mention when claiming that treatment and prevention spending now exceeds spending on law enforcement is that it did not include figures for drug interdiction and international spending on the law enforcement side of the ledger. The White House's proposed federal drug budget for 2015, however, shows that those drug prohibition-enforcement costs add up to another $5.4 billion, or $14.6 billion for enforcing drug prohibition versus $10.9 billion for treatment and prevention.

The strategy does, however, provide a sharper focus than in the past on reducing the harms associated with drug use, such as overdoses and the spread of HIV/AIDS, hepatitis C, and other blood-borne diseases. It calls for greater access to the opiate overdose reversal drug naloxone and supports needle exchange and state laws that provide limited immunity from prosecution for people suffering overdoses and the people who seek help for them -- the so-called 911 Good Samaritan laws. The strategy also sets a five-year goal for reducing overdose deaths, something drug reform advocates had been seeking.

The strategy also acknowledges the need to reduce mandatory minimum drug sentencing and recognizes that the US has the world's largest prison population, but in absolute terms and per capita. And, implicitly acknowledging that Americans increasingly see the war on drugs as a failed policy, the 2014 strategy has adjusted its rhetoric to emphasize public health over the drug war.

Acting ONDCP head or "drug czar" Michael Botticelli (ONDCP)
But, despite polls now consistently showing majority support for marijuana legalization, and despite the reality of legal marijuana in two states, with two more and the District of Columbia likely to embrace it later this year, the 2014 strategy appears not only wedded to marijuana prohibition, but even disturbed that Americans now think pot is safer than booze.

That puts ONDCP at odds not only with the American public, but with the president. In an interview published in January by the New Yorker, Obama said marijuana is less dangerous than alcohol "in terms of its impact on the individual consumer."

Noting that about three-quarters of a million people are arrested on marijuana charges each year, and nearly nine out of ten of those for simple possession, the Marijuana Policy Project (MPP) pronounced itself unimpressed with the new national drug strategy.

The drug czar's office is still tone deaf when it comes to marijuana policy. It appears to be addicted to marijuana prohibition. Why stay the course when the current policy has utterly failed to accomplish its goals?" asked MPP communications director Mason Tvert.

"The strategy even goes so far as to lament the public's growing recognition that marijuana is not as harmful as we were once led to believe. President Obama finally acknowledged the fact that marijuana is less harmful than alcohol, yet his administration is going to maintain a policy of punishing adults who make the safer choice," Tvert continued. "Most Americans think marijuana should be made legal, and even the Justice Department has acknowledged that regulating marijuana could be a better approach than prohibition. Legalizing and regulating marijuana is not a panacea, but it is sound policy."

The Drug Policy Alliance (DPA), with a wider policy remit than MPP, had a nuanced response to the release of the drug strategy. It was critical of some aspects of the strategy, but had kind words for others.

"The administration says drug use is a health issue but then advocates for policies that put people in the criminal justice system," said Bill Piper, DPA national affairs director. "Until the drug czar says it is time to stop arresting people for drug use, he is not treating drug use as a health issue no matter what he says. I know of no other health issue in which people are thrown in jail if they don't get better."

Still, said Piper, the drug czar's office deserves some credit for addressing serious issues associated with drug use under prohibition.

"Director Botticelli should be applauded for taking strong steps to reduce drug overdose fatalities and the spread of HIV/AIDS, hepatitis C and other infectious diseases," he said. "His leadership on these issues, and his work overall to reduce the stigma associated with substance misuse, are encouraging."

But when it comes to marijuana policy, DPA found itself pretty much on the same page as MPP.

"The Administration continues to keep its head in the sand when it comes to marijuana law reform," said Piper. "Hundreds of thousands of Americans are being arrested each year for nothing more than possessing small amounts of marijuana for personal use. Once arrested they can be discriminated against in employment and housing for life. The administration can't ignore the destructive impact of mass arrests forever."

Washington, DC
United States

What To Do About the Drug Trade in West Africa? [FEATURE]

Over the past decade, West Africa has emerged as an increasingly important player in the global illicit drug trade. Although the region has historically not been a drug producing one -- with the important exception of marijuana -- it has become a platform for predominantly Latin American drug traffickers moving their illicit commodities toward lucrative European and Middle Eastern markets. The cocaine traffic alone is worth more than a billion dollars a year, according to a 2013 report from the UN Office on Drugs and Crime (UNODC).

children walking from home to school in Bamako, Mali (JoeyTranchinaPhotography©2014 Sète, France)
And the trade is becoming more complex. Now, it's not only cocaine flowing through the region, but heroin destined mainly for Western Europe and methamphetamines being manufactured there and exported to Asia and South Africa, that same UNODC report found.

The region -- stretching along the African coast from Nigeria to the east to Senegal on the west, and extending deep into the Sahara Desert in countries such as Mali and Niger -- is plagued by weak states and corrupt governments, making it attractive to criminals of all sorts, who thrive in lawless lands. And it's not just criminals. The region is also home to various bands of Islamist militants, some of whom are involved in the drug trade.

Now, a commission of prominent West Africans is calling for fundamental changes in drug policies in the region. Last week, the West Africa Commission on Drugs, issued a report, Not Just in Transit: Drugs, the State and Society in West Africa, calling for the decriminalization of drug use, treating drug use primarily as a public health issue, and for the region to avoid becoming the next front line in the failed war on drugs.

The commission is impressive. It was initiated by former UN Secretary-General Kofi Annan of Nigeria and headed by former Nigerian President Olusegun Obasanjo, and includes other former heads of state as well as a distinguished group of West Africans from the worlds of politics, civil society, health, security and the judiciary.

And so is its very existence. It marks the entrance of West African civil society into the international debate on drug policy in which calls for fundamental drug reform have gained increasing momentum in recent years. In 2008, former Latin American heads of state and other luminaries formed the Latin American Commission on Drugs and Democracy, and in 2011, Annan and other world luminaries and former heads of state came together to form the Global Commission on Drug Policy. Now, West Africa adds its voice to the chorus calling for change.

"We call on West African governments to reform drug laws and policies and decriminalize low-level and non-violent drug offenses," said Obasanjo upon the report's release last week. "West Africa is no longer just a transit zone for drugs arriving from South America and ending up in Europe but has become a significant zone of consumption and production. The glaring absence of treatment facilities for drug users fuels the spread of disease and exposes an entire generation, users and non-users alike, to growing public health risks."

"Most governments' reaction to simply criminalize drug use without thinking about prevention or access to treatment has not just led to overcrowded jails, but also worsened health and social problems," added Kofi Annan.

West Africa
"We need the active support and involvement of civil society and of the international community," said commission member Edem Kodjo. "South America, where most of the drugs smuggled to West Africa come from, and Europe, which is the main consumer market, must take the lead to deal with both production and consumption at home. We cannot solve this problem alone; governments and civil society have to come together in West Africa to help prevent the drug problem from getting completely out of hand."

The report won kudos from American drug reformer Ethan Nadelmann, head of the Drug Policy Alliance.

"First Europe, then the Americas, now Africa," he said. "Drug policy reform is truly becoming a global movement, with Kofi Annan and Olusegun Obasango providing the sort of bold leadership that we've also seen in Latin America. Maybe, just maybe, West Africa will be spared the fate of other parts of the world where prohibition-related crime, violence and corruption spiraled out of control."

But some analysts, while welcoming the report, suggested that it did not get at the heart of the problem in West Africa.

"The report focuses on public health, and that's great, but I'm not sure that's the issue," said Vanda Felbab-Brown, a senior fellow with the Center for 21st Century Security and Intelligence in the Foreign Policy program at the Brookings Institution who has published extensively on West Africa. "Nor are there generally large prison populations due to the arrests of low-level drug offenders. There is increasing drug use, and many addicts don't have access to public health. That, however is not because they were arrested, but because Africa in general doesn't have access to public health," she pointed out.

"In some senses, the commission report is preventative -- it warns of policies that would be counterproductive -- but it is not going to solve West Africa's problems," Felbab-Brown continued. "And the harm reduction approaches that dominate the discourse in Europe and the US are not really apropos for West African public health issues. The increasing focus of the international community is interdiction, but that accounts for only a small fraction of the total traffic, and the report doesn't deal with what kind of alternate law enforcement there should be, or who should be targeted."

But others thought the criminal justice and public health emphasis in the report were a step down the right path.

"The report's message about alternatives to criminalization for use and minor offenses is important in criminal justice terms -- to discourage the horrible over-representation of minor drug offenders in prisons in the region -- but also as a reminder that there are no such alternatives unless the health and social sectors develop those alternatives," said Joan Csete, deputy director of the Open Society Foundation's Global Drug Policy Program.

"Health ministries need to be as important around the drug policymaking table as the police, which is far from the case in most of Africa today," she added. "Services for treatment of drug dependence in the region are absent or of appalling quality. Improving health and social support for people with drug dependence is a key to drug policy reform in West Africa."

And Felbab-Brown agreed that while measures like drug prevention and treatment wouldn't solve the region's problems, they would still be helpful.

"We're already seeing quite a bit of heroin in the region, and we are seeing increasing use," she said. "These are cheap and prevalent commodities, the traffickers partake in kind, and user communities are being established. In a sense, developing strategies to prevent use, get treatment, and prevent the spread of HIV and Hepatitis C is useful because there are more and more users."

drug, security, and insurgency analyst Vanda Felbab-Brown (brookings.edu)
But for Felbab-Brown, the key problem for West Africa is its weak and corrupt states.

"The big trafficking issues are around the intersection of very poor, very weak, very corrupt, and often very fragile states with state participation in various forms of criminality," she said. "Drugs are just another commodity to be exploited by elites for personal enrichment. Elites are already stealing money from oil, timber, and diamonds, and now there is another resource to exploit for personal enrichment and advancement," she argued.

"One narrative has it that drug trafficking has caused fragility and instability, but I think trafficking compounded the problems; it didn't create them," Felbab-Brown continued. "There is a systematic deficiency of good governance. Many of these states have functioned for decades like mafia bazaars, and the trafficking just augments other rents. There are rotten governments, miserable institutions, and poor leadership around all commodities, not just drugs."

"The states are not monolithic," Csete noted. "Some have high-level corruption, some are aggressive in trying to fight money-laundering and other elements of organized criminal networks, some rely heavily on traditional interdiction methods. Some of these countries have relatively strong democratic systems and relatively strong economic growth; some have governance institutions that are less strong."

The state of the states in West Africa influenced the commission and its recommendations, Csete said.

"Legalization of drugs -- production, sale, consumption -- was not judged to be politically feasible or necessarily desirable by the commission," she explained. "I think the commissioners generally perceive that generally these countries do not yet have a political climate favorable to debate on progressive changes in drug policy. The whole idea of the commission and its report is to open those debates -- high-profile people from the region saying things that sitting officials do not find it politically easy to say."

"These are newer post-colonial states," Felbab-Brown noted. "Are we having unreasonable expectations? Is this like Europe in the 13th Century, or is that some of these countries are doomed to exist in perpetual misgovernance?"

While there may be concern in Western capitals about the specter of West African drug trafficking, many West Africans have other, more pressing, drug policy concerns.

In its 2013 report, the UNODC noted that the importation of fake pharmaceutical drugs from South and Southeast Asia into the region was a problem. Joey Tranchina, a longtime drug policy observer who has recently spent time in Mali, agrees.

"Having traversed Mali from Bamako to Mopti, except for the usual oblique indigenous references to smoking weed, the only personal experience I have with drug crime is counterfeit pharmaceuticals from India, China, and Russia," he said. "They're sold cheap in the streets to people who can't afford regular meds and they take the place of real pharmaceuticals, especially malaria and HIV drugs. These drug scams are killing people in Mali," he said.

"Most people in West Africa don't see drug trafficking as that much of a problem," said Felbab-Brown. "If it's mostly going to Westerners, they say so what? For them it is a mechanism to make money, and those drug traffickers frequently become politicians. They are able to create and reconstitute patronage networks around drug trafficking, just as they were once able to get elected with money from blood diamonds."

It seems that, to the degree that drug use and drug trafficking are West African problems, they are problems inextricably interwoven with the broader issues of weak, fragile, and corrupt states that are unable or unwilling to deliver the goods for their citizens. The West Africa Commission on Drugs has pointed a way toward some solutions and avoiding some failed policies already discredited elsewhere, but it seems clear that that is just the beginning.

Crisis Looms for Addicts as Russia Bans Methadone in Crimea

Things are about to get harder for opiate users in Crimea, the former Ukrainian province now annexed by Russia. While Ukraine has embraced a harm reduction approach to hard drug use, Russia rejects such an approach and has some of the most repressive drug laws in the world.

Oberleitungsbusbahnhof in Simferopol (user Cmapm via Wikimedia)
Russia does not support efficient programs for preventing HIV and Hepatitis C among its drug using population, and harm reduction measures like needle exchanges and opiate substitution therapy (OST), of which methadone maintenance is a subset, are illegal.

Now, the concrete consequences of Crimea's reincorporation into the ample bosom of Mother Russia are coming home for drug users there. On Wednesday, Russian "drug czar" Viktor Ivanov -- one of 31 allies of Pres. Vladimir Putin sanctioned by the US government this month -- announced that Russia will ban the use of methadone in Crimea. That comes after vows a week before that he would move away from harm reduction practices in general in Crimea.

"Methadone is not a cure," Ivanov claimed. "Practically all methadone supplies in Ukraine were circulating on the secondary market and distributed as a narcotic drug in the absence of proper control. As a result, it spread to the shadow market and traded there at much higher prices. It became a source of criminal incomes," he said.

Whatever Ivanov says, cutting off methadone for an estimated 800 patients will be a disaster, the International HIV/AIDS Alliance warned. And the threat of a broader rejection of harm reduction measures puts an estimated 14,000 Crimean injection drug users at risk.

"When the supply of these medicines is interrupted or stopped, a medical emergency will ensue as hundreds of OST patients go into withdrawal, which will inevitably lead to a drastic increase in both acute illness as well as increases in injecting as people seek to self-medicate," said the alliance's Ukraine director, Andriy Klepikov.

"Any interruption to harm reduction programming is a disaster for health, human rights and the HIV epidemic in the region and we urge the authorities in Crimea to step in and ensure that critical supply chains are not disrupted and lives not put at risk as a result of territorial politicking," Klepikov added.

Ukraine has practiced methadone maintenance (or OST) therapy in Crimea since 2005. Patients in Simferopol, Sevastopol, Yalta, Eupatoria, Feodosia, Kerch and other cities receive daily treatment at local healthcare facilities.

The AIDS alliance is not the only group raising the alarm. The International Network of People who Use Drugs (INPUD) has issued an urgent appeal to UN rapporteurs on the Crimea "calling upon you all to issue a public statement making clear the imminent risk that this population faces of losing access to essential medicines, we are requesting that you raise the issue with the Russian government urging them not to close down the currently running opiate substitution programs; and we are calling upon you to raise the issue with utmost urgency with the Human Rights Council with a view to ensuring continued access to the programs."

When it comes to drug policy and harm reduction, Crimea would seem to be worse off as part of Russia than as part of Ukraine. As the AIDS alliance's Klepikov put it:

"The Russian Federation has extremely repressive drug laws and its punitive approach to people who use drugs means that it now experiences one of the highest rates of new HIV infections in the world. Injecting drug users represent nearly 80% of all HIV cases in the country."

Russia

"The New Jim Crow" Author Michelle Alexander Talks Race and Drug War [FEATURE]

On Thursday, Michelle Alexander, author of the best-selling and galvanizing The New Jim Crow: Mass Incarceration in the Age of Colorblindness sat down with poet/activist Asha Bandele of the Drug Policy Alliance to discuss the book's impact and where we go from here.

Michelle Alexander (wikimedia.org)
The New Jim Crow has been a phenomenon. Spending nearly 80 weeks on The New York Times bestseller list, it brought to the forefront a national conversation about why the United States had become the world's largest incarcerator, with 2.2 million in prison or jail and 7.7 million under control of the criminal justice system, and African American boys and men -- and now women -- making up a disproportionate number of those imprisoned. Alexander identified failed drug war policies as the primary driver of those numbers, and called for a greater challenge to them by key civil rights leaders.

It's now been nearly four years since The New Jim Crow first appeared. Some things have changed -- federal sentencing reforms, marijuana legalization in two states -- but many others haven't. Alexander and Bandele discuss what has changed, what hasn't, and what needs to, raising serious questions about the path we've been down and providing suggestions about new directions.

Audio of the conversation is online here, and a transcript follows here:

Asha Bandele: The US has 5% of the world's population, but has 25% of the world's incarcerated population, and the biggest policy cause is the failed drug war. How has the landscape changed in the last four years since The New Jim Crow came out?

Michelle Alexander: The landscape absolutely has changed in profound ways. When writing this book, I was feeling incredibly frustrated by the failure of many civil rights organizations and leaders to make the war on drugs a critical priority in their organization and also by the failure of many of my progressive friends and allies to awaken to the magnitude of the harm caused by the war on drugs and mass incarceration. At the same time, not so long ago, I didn't understand the horror of the drug war myself, I failed to connect the dots and understand the ways these systems of racial and social control are born and reborn.

But over last few years, I couldn't be more pleased with reception. Many people warned me that civil rights organizations could be defensive or angered by criticisms in the book, but they've done nothing but respond with enthusiasm and some real self-reflection.

There is absolutely an awakening taking place. It's important to understand that this didn't start with my book -- Angela Davis coined the term "prison industrial complex" years ago; Mumia Abu-Jamal was writing from prison about mass incarceration and our racialized prison state. Many, many advocates have been doing this work and connecting the dots for far longer than I have. I wanted to lend more credibility and support for the work that so many have been doing for some, but that has been marginalized.

I am optimistic, but at the same time, I see real reasons for concern. There are important victories in legalizing marijuana in Colorado and Washington, in Holder speaking out against mandatory minimums and felon disenfranchisement, in politicians across the country raising concerns about the size of the prison state for the first time in 40 years, but much of the dialog is still driven by fiscal concerns rather than genuine concern for the people and communities most impacted, the families destroyed. We haven't yet really had the kind of conversation we must have as a nation if we are going to do more than tinker with the machine and break our habit of creating mass incarceration in America.

Asha Bandele: Obama has his My Brother's Keeper initiative directed at black boys falling behind. A lot of this is driven by having families and communities disrupted by the drug war. Obama nodded at the structural racism that dismembers communities, but he said it was a moral failing. He's addressed race the least of any modern American president. Your thoughts?

Michelle Alexander: I'm glad that Obama is shining a spotlight on the real crisis facing black communities today, in particular black boys and young men, and he's right to draw attention to it and elevate it, but I worry that the initiative is based more in rhetoric than in a meaningful commitment to addressing the structures and institutions that have created these conditions in our communities. There is a commitment to studying the problem and identifying programs that work to keep black kids in school and out of jail, and there is an aspect that seeks to engage foundations and corporations, but there is nothing in the initiative that offers any kind of policy change from the government or any government funding of any kind to support these desperately needed programs.

There is an implicit assumption that we just need to find what works to lift people up by their bootstraps, without acknowledging that we're waging a war on these communities we claim to be so concerned about. The initiative itself reflects this common narrative that suggests the reasons why there are so many poor people of color trapped at the bottom -- bad schools, poverty, broken homes. And if we encourage people to stay in school and get and stay married, then the whole problem of mass incarceration will no longer be of any real concern.

But I've come to believe we have it backwards. These communities are poor and have failing schools and broken homes not because of their personal failings, but because we've declared war on them, spent billions building prisons while allowing schools to fail, targeted children in these communities, stopping, searching, frisking them -- and the first arrest is typically for some nonviolent minor drug offense, which occurs with equal frequency in middle class white neighborhoods but typically goes ignored. We saddle them with criminal records, jail them, then release them to a parallel universe where they are discriminated against for the rest of their lives, locked into permanent second-class status.

We've done this in the communities most in need our support and economic investment. Rather than providing meaningful support to these families and communities where the jobs have gone overseas and they are struggling to move from an industrial-based economy to a global one, we have declared war on them. We have stood back and said "What is wrong with them?" The more pressing question is "What is wrong with us?"

Asha Bandele: During the Great Depression, FDR had the New Deal, but now it seem like there is no social commitment at the highest levels of government. And we see things like Eric Holder and Rand Paul standing together to end mandatory minimums. Is this an unholy alliance?

Michelle Alexander: We have to be very clear that so much of the progress being made on drug policy reflects the fact that we are at a time when politicians are highly motivated to downsize prisons because we can't afford the massive prison state without raising taxes on the predominantly white middle class. This is the first time in 40 years we've been willing to have a serious conversation about prison downsizing.

But I'm deeply concerned about us doing the right things for the wrong reasons. This movement to end mass incarceration and the war on drugs is about breaking the habit of forming caste-like systems and creating a new ethic of care and concern for each of us, this idea that each of us has basic human rights. That is the ultimate goal of this movement. The real issue that lies at the core of every caste system ever created is the devaluing of human beings.

If we're going to do this just to save some cash, we haven't woken up to the magnitude of the harm. If we are not willing to have a searching conversation about how we got to this place, how we are able to lock up millions of people, we will find ourselves either still having a slightly downsized mass incarceration system or some new system of racial control because we will have not learned the core lesson our racial history is trying to teach us. We have to learn to care for them, the Other, the ghetto dwellers we demonize.

Temporary, fleeting political alliances with politicians who may have no real interest in communities of color is problematic. We need to stay focused on doing the right things for the right reasons, and not count as victories battles won when the real lessons have not been learned.

Asha Bandele: Portugal decriminalized all drugs and drug use has remained flat, overdoses been cut by a third, HIV cut by two-thirds. What can we learn from taking a public health approach and its fundamental rejection of stigma?

Michelle Alexander: Portugal is an excellent example of how it is possible to reduce addiction and abuse and drug related crime in a non-punitive manner without filling prisons and jails. Supposedly, we criminalize drugs because we are so concerned about the harm they cause people, but we wind up inflicting far more pain and suffering than the substances themselves. What are we doing really when we criminalize drugs is not criminalizing substances, but people.

I support a wholesale shift to a public health model for dealing with drug addiction and abuse. How would we treat people abusing if we really cared about them? Would we put them in a cage, saddle them with criminal records that will force them into legal discrimination the rest of their lives? I support the decriminalization of all drugs for personal use. If you possess a substance, we should help you get education and support, not demonize, shame, and punish you for the rest of your life.

I'm thrilled that Colorado and Washington have legalized marijuana and DC has decriminalized it -- these are critically important steps in shifting from a purely punitive approach. But there are warning flags. I flick on the news, and I see images of people using marijuana and trying to run legitimate businesses, and they're almost all white. When we thought of them as black or brown, we had a purely punitive approach. Also, it seems like its exclusively white men being interviewed as wanting to start marijuana businesses and make a lot of money selling marijuana.

I have to say the image doesn't sit right. Here are white men poised to run big marijuana businesses after 40 years of impoverished black kids getting prison time for doing the same thing. As we talk about legalization, we have to also be willing to talk about reparations for the war on drugs, as in how do we repair the harm caused.

With regard to Iraq, Colin Powell said "If you break it, you own it," but we haven't learned that basic lesson from our own racial history. We set the slaves free with nothing, and after Reconstruction, a new caste system arose, Jim Crow. A movement arose and we stopped Jim Crow, but we got no reparations after the waging of a brutal war on poor communities of color that decimated families and fanned the violence it was supposed to address.

Do we simply say "We're done now, let's move on" and white men can make money? This time, we have to get it right; we have to tell the whole truth, we have to repair the harm done. It's not enough to just stop. Enormous harm had been done; we have to repair those communities.

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

Hoffman, Heroin, and What Is To Be Done [FEATURE]

The news last Sunday that acclaimed actor Phillip Seymour Hoffman had died of an apparent heroin overdose has turned a glaring media spotlight on the phenomenon, but heroin overdose deaths had been on the rise for several years before his premature demise. And while there has been much wailing and gnashing of teeth -- and quick arrests of low-level dealers and users -- too little has been said, either before or after his passing, about what could have been done to save him and what could be done to save others.

cooking heroin (wikimedia.org)
There are proven measures that can be taken to reduce overdose deaths -- and to enable heroin addicts to live safe and normal lives, whether they cease using heroin or not. All of the above face social and political obstacles and have only been implemented unevenly, if at all. If there is any good to come of Hoffmann's death it will be to the degree that it inspires broader discussion of what can be done to prevent the same thing happening to others in a similar position.

Hoffman, devoted family man and great actor that he was, died a criminal. And perhaps he died because his use of heroin was criminalized. Criminalized heroin -- heroin under drug prohibition -- is of uncertain provenance, of unknown strength and purity, adulterated with unknown substances. While we don't know what was in the heroin that Hoffman injected, we do know that he maintained his addiction and went to meet his maker with black market dope. That's what was found beside his lifeless body.

In a commentary published by The Guardian, actor Russell Brand, a recovered heroin addict, laid the blame for Hoffman's demise on the drug laws. "Addiction is a mental illness around which there is a great deal of confusion, which is hugely exacerbated by the laws that criminalise drug addicts," Brand wrote, calling prohibitionists' methods "so gallingly ineffective that it is difficult not to deduce that they are deliberately creating the worst imaginable circumstances to maximise the harm caused by substance misuse." As a result, "drug users, their families and society at large are all exposed to the worst conceivable version of this regrettably unavoidable problem."

We didn't always treat our addicts this way. Even after the passage of the Harrison Act in 1914, doctors continued for years to prescribe maintenance doses of opiates to addicts -- and hundreds of them went to jail for it as the medical profession fought, and ultimately lost, a battle with the nascent drug prohibition bureaucracy over whether giving addicts their medicine was part of the legitimate practice of medicine.

The idea of treating heroin addicts as patients instead of criminals was largely vanquished in the United States, but it never went away -- it lingers with methadone substitution, for example. But other countries have for decades been experimenting with providing maintenance doses of opioids to addicts, and to good result. It goes by various names -- opiate substitution therapy, heroin-assisted theatment, heroin maintenance -- and studies from Britain and other European countries, such as Germany, the Netherlands, and Switzerland, as well as the North American Opiate Medications Initiative (NAOMI) and the follow-up Study to Assess Long-Term Opiate Maintenance in Canada have touted its successes.

Those studies have found that providing pharmaceutical grade heroin to addicts in a clinical setting works. It reduces the likelihood of death or disease among clients, as well as allowing them to bring some stability and predictability to sometimes chaotic lives made even more chaotic by the demands of addiction under prohibition. Such treatment has also been found to have beneficial effects for society, with lowered criminality among participants and increased likelihood of their integration as productive members of society.

The dry, scientific language of the studies obscures the human realities around heroin addiction and opioid maintenance therapy. One NAOMI participant helps put a human face on it.

"I want to tell you what being a participant in this study did for me," one participant told researchers. "Initially it meant 'free heroin.' But over time it became more, much more. NAOMI took much of the stress out of my life and allowed me to think more clearly about my life and future. It exposed me to new ideas, people (staff and clients) that in my street life (read: stressful existence) there was no time for."

"After NAOMI, I was offered oral methadone, which I refused. After going quickly downhill, I ended up hopeless and homeless. I went into detox in April 2007, abstained from using for two months, then relapsed. In July 2008 I again went to detox and I am presently in a treatment center... I am definitely not "out of the woods" yet, but I feel I am on the right path. And this path started for me at the corner of Abbott and Hastings in Vancouver... Thank you and all who were involved in making NAOMI happen. Without NAOMI, I wouldn't be where I am today. I am sure I would be in a much worse place."

Arnold Trebach, one of the fathers of the drug reform in late 20th Century America, has been studying heroin since 1972, and is still at it. He examined the British system in the early 1970s, when doctors still prescribed heroin to thousands of addicts, and authored a book, The Heroin Solution, that compared and contrasted the US and UK approaches. Later this month, the octogenarian law professor will be appearing on a panel at the Vermont Law School to address what Gov. Peter Shumlin (D) has described as the heroin crisis there.

Phillip Seymour Hoffman (wikimedia.org)
"The death of Phillip Seymour Hoffman is a tragedy all the way around," Trebach told the Chronicle. "It's a bad idea to use heroin off the street, and he shouldn't have been doing that."

That said, Trebach continued, it didn't have to be that way.

"If we had had a sensible system of dealing with this, he would have been in treatment under medical care," he said. "If he was going to inject heroin, he should have been using pharmaceutically pure heroin in a medical setting where he could also have been exposed to efforts to straighten out his personal life, and he could have access to vitamins, weight control advice, and the whole spectrum of medical care. And if he had had access to opioid antagonists, he could still be alive," he added.

While Hoffman may have made bad personal choices, Trebach said, we as a society have made policy choices seemingly designed to amplify the prospects for disaster.

"This is a sad thing. He is just another one of the many victims of our barbaric drug policy," he said. "This was a totally unnecessary death at every level. He shouldn't have been using, but we should have been taking care of him."

The stuff ought to be legalized, Trebach said.

"I'm an advocate of full legalization, but if we can't go that far, we need to at least provide social and psychological support for these people," he said. "And even if we were to decriminalize or legalize, I would still want to figure out ways to provide support and love and kindness to people using the stuff. I advise you not to do it, but if you're going to use it, I want to keep you alive. I remember talking to people from Liverpool [a famous heroin maintenance clinic covered in the '90s by Sixty Minutes, linked above] about harm reduction around heroin use back in the 1970s. One of the ladies said it is very hard to rehabilitate a dead addict."

"There are plenty of things we can be doing," said Hilary McQuie, Western director for the Harm Reduction Network, reeling off a list of harm reduction interventions that are by now well-known but inadequately implemented.

"We can make naloxone (Narcan) more available. We need better access to it. It should be offered to people like Hoffman when they are leaving treatment programs, especially if they've been using opiates, just as a safeguard," she said. "Having treatment programs as well as harm reduction programs distribute it is important. We can cut the overdose rate in half with naloxone, but there will still be people using alone and people using multiple substances."

There are other proven interventions that could be ramped up as well, McQuie said.

"Safe injection sites would be very helpful, so would more Good Samaritan overdose emergency laws, and more education, not to mention more access to methadone and buprenorphine and other opioid substitution therapies (OST)," she said, reeling off possible interventions.

Dr. Martin Schechter, director of the School of Population and Public Health at the University of British Columbia in Vancouver, knows a thing or two about OST. The principal study investigator for the NAOMI and the follow-up SALOME study, Schechter has overseen research into the effectiveness of treating intractable addicts with pharmaceutical heroin, as well as methadone. The results have been promising.

"What we're using is medically prescribed pharmaceutical diacetylmorphine, the active ingredient in heroin," he explained. "It's what you have when you strip away all the street additives. This is a stable, sterile medication from a pharmaceutical manufacturer. We know the precise dose tailored for each person. With street heroin, not only is it adulterated and injected in unsterile situations, but people really don't know how strong it is. That's probably what happened to Mr. Hoffman."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)
In NAOMI, 90,000 injections were administered to study participants, and only 11 people suffered overdoses requiring medical attention.

"Never did we have a fatal overdose," Schechter said. "Because it was in a clinic, nurses and doctors are right there. We administer Narcan (naloxone), and they wake up."

Heroin maintenance had even proven more effective than methadone in numerous studies, Schechter said.

"There have been seven randomized control trials across Europe and in Canada that have shown for people who have already tried treatments like methadone, that medically prescribed heroin is more effective and cost effective treatment than simply trying methadone one more time."

Those studies carry a lesson, he said.

"We have to start looking at heroin from a medicinal point of view and treat it like a medicine," he argued. "The more we drive its use underground, the more overdoses we get. We need to expand treatment programs, not only with methadone, but with medically prescribed heroin for people who don't respond to other treatments."

Safe injection sites are also a worthwhile intervention, Schechter said, although he also noted their limitations.

"Injecting under supervision is much safer; if there is an overdose, there is prompt attention, and they provide sterile equipment, reducing the risk of HIV and Hep C," he said. "But they are still injecting street heroin."

He would favor decriminalizing heroin possession, too, he said.

Harm reduction measures, opioid maintenance treatments, and the like are absolutely necessary interventions, said McQuie, but there is a larger issue at hand, as well.

"We still need to look at the overall issue of the stigmatization of drug users," she said. "People aren't open about their use, and that puts them in a more dangerous situation. It's really hard in a criminalized environment."

Stigmatization means to mark or brand someone or something as disgraceful and subject to strong disapproval. Defining an activity, such as heroin possession, as a crime is stigmatization crystallized into the legal structures of society itself.

"The ultimate harm reduction solution," McQuie argued, "is a regulated, decriminalized environment where it is available by prescription, so people know what they're getting, they know how much to use, and it's not cut with fentanyl or other deadly adulterants. People wouldn't have to deal with all the collateral damage that comes from being defined as criminals as well as dealing with the consequences of their drug use. They could deal with their addictions without having to worry about losing their homes, their families, and their freedoms."

While such approaches have a long way to go before winning wide popular acceptance, policymakers should at least be held to account for the consequences of their decision-making, McQuie said, suggesting that the turn to heroin in recent years was a foreseeable result of the crackdown on prescription opioid pain medication beginning in the middle of the last decade.

"They started shutting down all those 'pill mills' and people should have anticipated what would happen and been ready for it," she said. "What we have seen is more and more people turning to injecting heroin, but nobody stopped to do an impact statement on what would be the likely result of restricting access to pain pills."

The impact can be seen in the numbers on heroin use, addiction, and overdoses. While talk of a "heroin epidemic" is overblown rhetoric, the number of heroin users has increased dramatically in the past decade. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of past year users grew by about 50% between 2002 and 2011, from roughly 400,000 to more than 600,000. At the same time, the number of addicted users increased from just under 200,000 to about 370,000, a slightly lesser increase.

If there is any good news, it is that, according to the latest (2012) National Household Survey of Drug Use and Health, the number of new heroin users has remained fairly steady at around 150,000 each year for the past decade. That suggests, however, that more first-time users are graduating to occasional and sometimes, dependent user status.

And some of them are dying of heroin overdoses, although not near the number dying from overdoses from prescription opioids. Between 1999 and 2007, heroin deaths hovered just under 2,000, even as prescription drug deaths skyrocketed, from around 2,500 in 1999 to more than 12,000 just eight years later. But, according to the Centers for Disease Control, by 2010, the latest year for which data are available, heroin overdose deaths had surpassed 3,000, a 50% increase in just three years.

While the number of heroin overdose deaths is still but a fraction of those attributed to prescription opioid overdoses and the numbers since 2010 are spotty, the increase that showed up in 2010 shows no signs of having gone away. Phillip Seymour Hoffman may be the most prominent recent victim, but in the week since his death, another 50 or 60 people have probably followed him to the morgue due to heroin overdoses.

There are ways to reduce the heroin overdose death toll. It's not a making of figuring out what they are. It's a matter of finding the political and social will to implement them, and that requires leaving the drug war paradigm behind.

New York City, NY
United States

Chronicle AM -- December 6, 2013

A new marijuana legalization has been filed in California, the Florida medical marijuana initiative faces a pair of challenges, the British Columbia decriminalization initiative is struggling, and more. Let's get to it:

Marijuana Policy

A New California Marijuana Legalization Initiative is Filed. The Control, Regulate, and Tax Marijuana Act was filed with the California attorney general's office Wednesday. It would legalize up to an ounce and four plants for people 21 and over and create a statewide system of regulated marijuana commerce. It's not clear, however, whether its backers will seek to gather signatures for 2014 or will use it as a place marker for 2016. Another legalization initiative, the California Cannabis Hemp Initiative of 2014 is in the signature-gathering phase, but lacks deep-pocketed financial backing.

Thinking About a Post-Pot Prohibition World. Martin Lee, the author of Acid Dreams and Smoke Signals, about the cultural histories of LSD and marijuana, respectively, writes about marijuana legalization as a beginning, not an end, and has some interesting and provocative thoughts about what should come next.

Medical Marijuana

Florida Supreme Court Hears Challenge to Medical Marijuana Initiative. The Florida Supreme Court Thursday heard arguments on whether the proposed constitutional amendment to allow medical marijuana should go on the November 2014 ballot. Attorney General Pam Bondi (R) had challenged it as misleading and in violation of federal law. The justices did not decide the issue, but a decision will be coming shortly.

Florida Medical Marijuana Initiative Needs a Lot of Signatures in a Hurry. The state Division of Elections reported Thursday that People United for Medical Marijuana, the group behind the initiative, has just under 137,000 signatures that have been validated. They need 683,149 by February. There is some lag between signatures gathered and signatures validated, and organizers say they have collected 400,000 signatures so far. But that means they need probably another 400,000 in just a few weeks just to have a cushion that would allow for the inevitable invalid signatures.

International

British Columbia Marijuana Decriminalization Initiative Campaign Struggling. Sensible BC's signature-gathering campaign to put a decriminalization initiative on the ballot in British Columbia looks like it is going to fall short. The group needs 310,000 valid signatures by Monday, but only has 150,000 gathered. But if they don't make it this time, that won't be the end of it. "Sensible BC is here to stay," said the group's Dana Larsen. "You can be quite sure we're going to try this campaign again sometime in the next year to year-and-a-half, if we don't succeed this time. We're not going away."

Report Says SE Asia Amphetamine Use is Fueling Rise in HIV Risk. An increase in injection use of amphetamines in Southeast Asia is raising the risk of the spread of HIV and requires "urgent" action, according to a new report from the Australian National Council on Drugs (ANCD) and the Asia-Pacific Drugs and Development Issues Committee. Not only injection drug use, but risky sexual behavior as well among amphetamine users, is part of the problem, the report says.

Drug War Issues

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