Drug-Related AIDS/HIV or Hepatitis C

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Asia: Drug Users Form Regional Drug User Organization

In a meeting in Bangkok last weekend, more than two dozen drug users from nine different countries came together to put the finishing touches on the creation of a new drug user advocacy organization, the Asian Network of People who Use Drugs (ANPUD). The Bangkok meeting was the culmination of a two-year process began at a meeting of the International Congress on AIDS in Asia and the Pacific in Colombo, Sri Lanka, in 2007, and resulted in creating a constitution and selecting a steering committee for the new group. ANPUD adopts the principles of MIPUD (Meaningful Involvement of People who Use Drugs), and in doing so, aligns itself with other drug user advocacy groups, including the International Network of People who Use Drugs (INPUD), of which ANPUD is an independent affiliate, the Australian Injection and Illicit Drug Users League (AIVL),the Vancouver Area Network of Drug Users, and the Nothing About Us Without Us movement. ANPUD currently has more than 150 members and sees its mission to advocate for the rights of drug users and communities before national governments and the international community. There is plenty to do. Asia has the largest number of drug users in the world, but is, for the most part, woefully retrograde on drug policy issues. Not only do drug users face harsh criminal sanctions—up to and including the death penalty—but Asian has the lowest coverage of harm reduction services in the world. Access to harm reduction programs, such as needle exchanges and opioid maintenance therapy, is extremely limited. "People who use drugs are stigmatized, criminalized and abused in every country in Asia," said Jimmy Dorabjee, a key figure in the formation of ANPUD. "Our human rights are violated and we have little in the way of health services to stay alive. If governments do not see people who use drugs, hear us and talk to us, they will continue to ignore us." The Director of the UNAIDS Regional Support Team, Dr. Prasada Rao, spoke of the urgent need to engage with drug user networks and offered his support to ANPUD, saying that "For UNAIDS, HIV prevention among drug users is a key priority at the global level," said Dr. Prasada Rao, director of the UNAIDS Regional Support Team. "I am very pleased today to be here to see ANPUD being shaped into an organization that will play a key role in Asia's HIV response. It is critical that we are able to more effectively involve the voices of Asian people who use drugs in the scaling up of HIV prevention services across Asia." "When I go back home, I am now responsible for sharing the experiences with the 250 or so drug users who are actively advocating for better services at the national level," said Nepalese drug user and newly elected steering committee member Ekta Thapa Mahat. "It will be a great way for us to work together and help build the capacity of people who use drugs in Asia." "The results of the meeting exceeded my expectations," said Ele Morrison, program manager for AVIL's Regional Partnership Project. "The participants set ambitious goals for themselves and they have achieved a lot in just two days to set up this new organization. The building blocks for genuine ownership by people who use drugs is definitely there." While the meetings leading to the formation were organized and managed by drug users, the process received financial support from the World Health Organization, the UNAIDS Regional Task Force, and AIVL.
Location: 
Bangkok
Thailand

Southwest Asia: Afghan Opium Trade Wreaking Global Havoc, UNODC Warns

Southwest Asia: Afghan Opium Trade Wreaking Global Havoc, UNODC Warns The UN Office on Drugs and Crime (UNODC) warned Wednesday that the traffic in Afghan opiates is spreading drug use and addiction along smuggling routes, spreading diseases, and funding insurgencies. The warning came in a new report, Addiction, Crime, and Insurgency: The Threat of Afghan Opium. "The Afghan opiate trade fuels consumption and addiction in countries along drug trafficking routes before reaching the main consumer markets in Europe (estimated at 3.1 million heroin users), contributing to the spread of HIV/AIDS and other blood-borne diseases," the report said. Neighboring countries, especially Iran, Pakistan, and the Central Asian republics, are among the hardest hit, said UNODC. According to the report, Iran now has the highest opiate addiction rates in the world. "Iran faces the world's most serious opiate addiction problem, while injecting drug use in Central Asia is causing an HIV epidemic," UNODC said. But the impact of the multi-billion flow of Afghan opiates could have an especially deleterious impact on Central Asia, UNODC chief Antonio Maria Costa warned in remarks accompanying the report. "The Silk Route, turned into a heroin route, is carving out a path of death and violence through one of the world's most strategic yet volatile regions," Costa said. "The perfect storm of drugs, crime and insurgency that has swirled around the Afghanistan/Pakistan border for years is heading for Central Asia." In Pakistan and Afghanistan, the opium trade is funding violent radicals. "The funds generated from the drugs trade can pay for soldiers, weapons and protection, and are an important source of patronage," the report said. In Afghanistan, the Taliban generated between $90 million and $160 million annually in recent years, the UNODC estimated. In Pakistan, the UNODC estimated the trade at $1 billion annually, with "undetermined amounts going to insurgents." Although Afghan opium production declined slightly last year, the country is producing—and has produced—more opium needed than to meet global supply. As a result, the UNODC estimates that there is an unaccounted for stockpile of 12,000 tons of opium—enough to satisfy every junkie on the planet for the next three to four years. "Thus, even if opiate production in Afghanistan were to cease immediately, there would still be ample supply," the report said. Unsurprisingly, the UNODC report did not address the role that global drug prohibition plays in exacerbating problems related to opiate use and the opiate trade. Prohibitionist attitudes restrict the availability of harm reduction programs, such as needle exchanges, that could reduce the spread of blood-borne diseases. And it is global drug prohibition itself that creates the lucrative black market the UNODC says is financing insurgencies and spreading political instability.

Harm Reduction: Pennsylvania Allows Syringe Sales Without Prescription, Effective Immediately

Responding to years of agitation by harm reductionists and public health advocates, the Pennsylvania Board of Pharmacy Saturday published new regulations that will allow pharmacies to sell syringes without a prescription. The change goes into effect immediately. The move was lauded by activists as a significant public health victory in the battle against the spread of HIV/AIDS and Hepatitis C via injection drug use.

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popular syringe exchange logo
Under previous regulations, pharmacies could sell syringes only to people who obtained a doctor's prescription. The new regulations carry no limit on the number of syringes that can be purchased at a time, nor do they have age limits.

"This change is particularly important in Pennsylvania because we have only two locations -- Pittsburgh and Philadelphia -- in which legally authorized syringe exchange programs operate," said David Webber, an attorney for the AIDS Law Project of Pennsylvania. "These two programs alone are simply not adequate to address this problem across the entire state, but syringe exchange programs continue to be crucial in providing sterile syringes as well as access to drug treatment and health care for injection drug users."

"This is a chance for every pharmacy to become part of HIV prevention in Pennsylvania," said Scott Burris, professor at Temple University's School of Law and a national authority on syringe regulation and HIV prevention. "The pharmacy board has taken an important step forward for evidence-based policy."

It didn't come swiftly or easily. Activist organizations including the Pennsylvania Aids Law Project, Prevention Point Pittsburgh, Prevention Point Philadelphia, as well as legislators, HIV workers, and others had lobbied for the change for a decade. An article in the Lancaster Intelligencer Journal cited several efforts:

  • In 2002, a group called the Pennsylvania Coalition for Responsible Syringe Policy asked the Pharmacy Board to consider deregulation.
  • In 2005, another group called Pennsylvanians for the Deregulation of Syringe Sales filed a formal petition to the Board, and met with legislators and officials in the Rendell Administration.
  • In 2007, the the Pennsylvania Pharmacists Association endorsed syringe deregulation and asked the Pharmacy Board to move swiftly on it.

Robert Field, organizer of Pennsylvanians for the Deregulation of Syringe Sales and co-chair of the Lancaster-based Common Sense for Drug Policy, told the Intelligencer Journal he looked at syringe deregulation after efforts to start a syringe exchange program in Reading met with opposition. The board responded in August 2007, proposing new regulations allowing for over-the-counter syringe sales and opening them up for public comment. Thanks to concerns expressed by harm reduction and public health groups during the comment period, the board removed age and quantity restrictions.

The board heard a number of concerns from the Pennsylvania Medical Society that the rule change would increase drug use. But research won the day. "Studies indicate that making syringes available will reduce the spread of HIV and will not lead to an increase of illicit drug use," said Field.

The board also rejected record-keeping requirements requested by the House Professional Licensure Committee, saying it "does not believe that maintaining a record and requiring individuals to provide a name or other identifying information would advance the public health and safety."

Now the number of states that do not allow syringe sales without a prescription is down to two: Delaware and New Jersey.

Harm Reduction: Pennsylvania Allows Syringe Sales Without Prescription, Effective Immediately

Responding to years of agitation by harm reductionists and public health advocates, the Pennsylvania Board of Pharmacy Saturday published new regulations that will allow pharmacies to sell syringes without a prescription. The change goes into effect immediately. The move was lauded by activists as a significant public health victory in the battle against the spread of HIV/AIDS and Hepatitis C via injection drug use. Under previous regulations, pharmacies could sell syringes only to people who obtained a doctor’s prescription. The new regulations carry no limit on the number of syringes that can be purchased at a time, nor do they have age limits. “This change is particularly important in Pennsylvania because we have only two locations--Pittsburgh and Philadelphia--in which legally authorized syringe exchange programs operate,” said David Webber, an attorney for the AIDS Law Project of Pennsylvania. “These two programs alone are simply not adequate to address this problem across the entire state, but syringe exchange programs continue to be crucial in providing sterile syringes as well as access to drug treatment and health care for injection drug users.” “This is a chance for every pharmacy to become part of HIV prevention in Pennsylvania,” said Scott Burris, professor at Temple University’s School of Law and a national authority on syringe regulation and HIV prevention. “The pharmacy board has taken an important step forward for evidence-based policy.” It didn’t come swiftly or easily. Activist organizations including the Pennsylvania Aids Law Project, Prevention Point Pittsburgh, Prevention Point Philadelphia, as well as legislators, HIV workers, and others had lobbied for the change for a decade. In August 2007, the pharmacy board proposed new regulations allowing for over-the-counter syringe sales and opened them up for public comment. Thanks to concerns expressed by harm reduction and public health groups during the comment period, the board removed age and quantity restrictions. The board rejected record-keeping requirements requested by the House Professional Licensure Committee, saying it “does not believe that maintaining a record and requiring individuals to provide a name or other identifying information would advance the public health and safety.” Similarly, it rejected a number of concerns from the Pennsylvania Medical Society that the rule change would increase drug use. The board’s action reflected well-established scientific evidence that access to clean syringes is a critical component of stemming the spread of blood-borne diseases such as HIV and Hep C among injection drug users. Now the number of states that do not allow syringe sales without a prescription is down to two: Delaware and New Jersey.
Location: 
PA
United States

Tough Times: California Protests Over HIV/AIDS Budget Cuts -- Needle Exchange Funding at Risk, Prop. 36 Funding to Vanish

California's $24 billion budget deficit and the steep cuts proposed by Gov. Arnold Schwarzenegger (R) to reduce it provoked demonstrations by HIV/AIDS activists and harm reductionists last Friday in Los Angeles, Monday in Fresno, and Wednesday in Sacramento calling for the restoration of funding. Late last month, Schwarzenegger announced plans to slice $80.1 million in funding for critical HIV/AIDS services, including totally eliminating general fund support for all State Office of AIDS programs except the AIDS Drug Assistance Program, which will lose $12.3 million in general fund support.

The cuts would zero out state funding for harm reduction services through the AIDS office, as well as most of the HIV/AIDS prevention funds that California cities use to provide grants for needle exchange programs. For most of the 40 needle exchanges in the state, those grants provided between 60% and 90% of their total funding.

HIV/AIDS and harm reduction groups have organized a coalition known as Stop the HIV Cuts in a bid to reverse the proposed cuts. In addition to the demonstration in Sacramento, protests were also held Wednesday in San Diego and Palm Springs.

Funding for Proposition 36, the voter-approved 2001 law that requires that low-level drug offenders be sent to treatment instead of jail or prison, is also on the line. Gov. Schwarzenegger wants the legislature to eliminate the $108 million line-item for the program, which enrolls some 36,000 drug offenders in the state.

But that would leave California in a strange bind. Prop. 36 is not a program, but a state law, approved by the voters, who mandated that the legislature fund the program through 2006. It prevents judges from sending Prop. 36-eligible offenders to prison, instead of requiring that they receive treatment. If the state does not provide funding, the burden will shift to counties and municipalities, which will not be able to make up the difference. That means that Prop. 36-eligible offenders may, in the near future, receive neither jail sentences nor treatment.

Feature: Meeting in Vienna, UN Commission on Narcotics Drugs Prepares to Head Further Down Same Prohibitionist Path, But Dissenting Voices Grow Louder

The United Nations Commission on Narcotic Drugs (CND) met this week in Vienna to draft a political statement and plan of action to guide international drug policy for the next decade. The statement largely affirms existing prohibitionist policies and ignores harm reduction, as the CND has done it the past. [Editor's note: The draft statement had not been formally approved as of press time, but is likely to be approved as is.]

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Vienna International Center, home of the UN Office on Drugs and Crime
The political statement is supposed to evaluate the implementation of the previous political declaration and action plan approved by the UN General Assembly Special Session (UNGASS) in 1998. At the 1998 session, UNGASS adopted the slogan "A Drug-Free World -- We Can Do It" and launched a "campaign" to wipe out all drug crops -- from marijuana to opium to coca -- by 2008.

But while the international community continues to slide down its century-old prohibitionist path regarding non-medicinal drug use and sales, it is encountering an increasing amount of friction. The United States, as leader of the hard-liners, continues to dominate the debates and set the agenda, but an emerging bloc of mainly Latin American and European countries is expressing deep reservations about continuing the same policies for another decade.

The atmosphere in Vienna this week was circus like, complete with street protests, as national delegations, non-governmental organizations (NGOs), and other interested parties heatedly debated what an increasingly vociferous minority called a "failed" approach to the issue. Debate was particularly intense about the inclusion of harm reduction in the political statement -- a position rejected by the US delegation, led by outgoing acting drug czar Edward Jurith.

The drug summit came as the UN, the CND, and the countries pushing the prohibitionist hard-line have come under repeated attack for essentially maintaining the status quo. On Tuesday, the European Commission issued a report that found while in the past decade policies to help drug users and go after drug traffickers have matured, there was little evidence to suggest that the global drug situation had improved.

"Broadly speaking the situation has improved a little in some of the richer countries, while for others it worsened, and for some of those it worsened sharply and substantially, among which are a few large developing or transitional countries," an EC media statement on the report said. "In other words, the world drugs problem seems to be more or less in the same state as in 1998: if anything, the situation has become more complex: prices for drugs in most Western countries have fallen since 1998 by as much as 10% to 30%, despite tougher sentencing of the sellers of e.g. cocaine and heroin in some of these markets."

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SSDP's Kris Krane, caged as part of HCLU demonstration at UN (drogriporter.hu/en/demonstration)
Current anti-drug policies also came under attack from a growing coalition of NGOs, including Human Rights Watch, the International Harm Reduction Association, the European NGO Coalition for Just and Effective Drug Policies (ENCOD), and the International Drug Policy Consortium, as well as various NGOs from the US, Brazil, Canada, and England, among others, all of whom were in Vienna for the meeting. Human Rights Watch urged the CND to undo a decade of neglect, while the English group Transform Drug Policy Foundation called for a moratorium on global strategic drug policy setting, a review of the consequences of prohibitionist policies, and a commission to explore alternatives to the failed war on drugs.

"Every state that signs up to the political declaration at this commission recommits the UN to complicity in fighting a catastrophic war on drugs," said Danny Kushlick, policy director for Transform. "It is a tragic irony that the UN, so often renowned for peacekeeping, is being used to fight a war that brings untold misery to some of the most marginalized people on earth. 8,000 deaths in Mexico in recent years, the destabilization of Colombia and Afghanistan, continued corruption and instability in the Caribbean and West Africa are testament to the catastrophic impact of a drug control system based upon global prohibition. It is no surprise that the declaration is unlikely even to mention harm reduction, as it runs counter to the primary impact of the prevailing drug control system which, as the past ten years demonstrate, increases harm."

Not all the action took place in the conference hall. Wednesday saw a lively demonstration by NGO groups including Students for Sensible Drug Policy, the drug user group INPUD, ENCOD, and the Hungarian Civil Liberties Union, among others. Protestors spoke to reporters from jail-like cages, waved signs and passed out pamphlets to delegates forced to run their gauntlet, and decried the harms of drug prohibition. One particularly effective protestor was dressed as a sun-glass wearing, cigar-puffing Mafioso, celebrating that business was good thanks to prohibition.

Even UN Office on Drugs and Crime (UNODC) head Antonio Maria Costa, while whistling past the graveyard to insist that progress had been made in the past decade, acknowledged that current global policies have backfired in some ways. Giving the opening address Wednesday, Costa said "the world drug problem has been contained, but not solved" thanks to international anti-drug efforts.

But global drug control efforts have had "a dramatic unintended consequence," he added, "a criminal black market of staggering proportions." The international drug trade is "undermining security and development and causing some to make a dangerous wager in favor of legalization. Drugs are not harmful because they are controlled; they are controlled because they are harmful." Drug legalization would be "a historic mistake," he said.

Even so, Costa painted a dire picture of what prohibition had wrought: "When mafias can buy elections, candidates, political parties, in a word, power, the consequences can only be highly destabilizing" he said. "While ghettoes burn, West Africa is under attack, drug cartels threaten Central America and drug money penetrates bankrupt financial institutions".

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activists from International Network of People Who Use Drugs (INPUD) at demo (drogriporter.hu/en/demonstration)
Not everybody was buying into the UNODC-CND-US position of more of the same. Bolivian President Evo Morales brandished a coca leaf, then chewed it during his address to the delegates to underline his demand that coca be removed from the list of proscribed substances.

"This is coca leaf, this is not cocaine; this is part and parcel of a culture," Morales said. The ban on coca was a "major historical mistake," he added. "It has no harmful impact, no harmful impact at all in its natural state. It causes no mental disturbances, it does not make people run mad, as some would have us believe, and it does not cause addiction."

Neighboring Brazil was also critical. "We ought to recognize the important progress achieved over the last decade," said Brazilian delegate Jorge Armando Felix. "But the achievements have not been accomplished. The aim of a world free of drugs has proven to be unobtainable and in fact has led to unintended consequences such as the increase of the prison population, increase in violence related to an illegal drug market, increase in homicide and violence among the young population with a dramatic impact on mortality and life expectancy -- social exclusion due to drug use and the emergence of synthetic drugs."

Felix also had some prescriptions for UNGASS and the CND. "At this historic moment with the opportunity to reassess the past 10 years and more importantly to think about the challenges to come, Brazil enforces the need for recognition of and moving towards: harm reduction strategies; assessing drug dependence, and HIV AIDS populations; securing the human rights of drug users; correcting the imbalance between investments in supply and demand reduction areas; increasing actions and programs of prevention based on scientific evidence with an emphasis towards vulnerable populations and towards increase of access to and care for problematic or vulnerable drug users; and to the acknowledgment of different models of treatment for the need for increased funding of these efforts."

Brazilian Luiz Paulo Guanabara, head of the NGO Psicotropicus, observed it all with mixed feelings. "Early on, I thought the NGO strategy for harm reduction would not result in anything and that we should aim for drug regulation instead," he said. "And in the end, the term harm reduction is not in the political declaration, but the Beyond 2008 document is very strong and has not gone unnoticed."

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Mafioso-looking activist distributing ''United Nations of Prohibition'' 1,000 note bills with UNODC chief Costa's face on one side, and a thank you from the In Memoriam Al Capone Trust on the other (drogriporter.hu/en/demonstration)
Guanabara had harsh words for both the Americans and the UN. "It seems like the American delegates believe harm reduction is a sin -- or they favor harm increase, so they can lock up more people and have more HIV patients, increase crime, sell more weapons and make money out of the disgrace of others and families' destruction. Their prohibitionist stance is obscene," he declared. "And these guys at the CND understand nothing of drugs and drug use, they are just bureaucrats. To put drugs in the hands of bureaucrats is as dangerous as putting them in the hands of criminals."

But despite the lack of results this time around, Guanabara was thrilled by the participation of civil society. "The civil society mobilization is enormous and intense," he said. "The NGO events around the meeting were the real high-level meetings, not the low-level ones with the bureaucrats at the CND."

While the sentiments from Brazil and Bolivia were echoed by various national delegations, mainly European, and while even the UNODC and the US are willing to give nods to an increased emphasis on treatment and prevention, with the US delegation even going so far as to approve of needle exchanges, at the end of the day, the CND political declaration and action plan represents a stubborn adherence to the prohibitionist status quo.

"Government delegations could have used this process to take stock of what has failed in the last decade in drug-control efforts, and to craft a new international drug policy that reflects current realities and challenges," said Prof. Gerry Stimson, executive director of the International Harm Reduction Association. "Instead, they produced a declaration that is not only weak -- it actually undermines fundamental health and human rights obligations."

American attendee and long-time drug reform activist Michael Krawitz also had mixed feelings. "The slow train wreck that Harry Anslinger started with the 1961 Single Convention is finally grinding to a halt," he said. "The argument here has been a semantic one over harm reduction, but the subtext is much more important, and the subtext is that the treaties were set up to protect public health and are currently being interpreted in such a way as to do the opposite. The declaration wound up being watered down and piled high with reservations. The next five years should prove interesting."

The IHRA and other NGOs called on governments with reservations about the political declaration to refuse to endorse it. That probably will not happen, but some governments have indicated they will add reservations to their approval of the declaration. After a century of prohibition, the first formal cracks are beginning to appear at the center of the legal backbone of global drug prohibition. Given that the dissent has largely appeared only since the last UNGASS in 1998, perhaps this isn't such a bad start.

Feature: The Boston Ibogaine Forum -- from Shamanism to Cutting Edge Science

special to Drug War Chronicle by Doug Greene, assisted by Kevin Franciotti

On a cold and clear Presidents Day weekend, dozens of treatment professionals, underground providers, patients, researchers and entheogenic enthusiasts gathered at Boston's Northeastern University for the Boston Ibogaine Forum, the 2009 installment of the annual ibogaine conference, sponsored the Northeastern Students for Sensible Drug Policy (which is also hosting the Northeast SSDP Regional conference on April 3-5), the National AIDS Brigade, and Cures Not Wars.

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conference panel, Dana Beal at podium
Ibogaine is considered the 'active' compound in the Tabernanthe iboga plant, used for centuries as a healer, teacher, and catalyst for ceremonies by the Bwiti people indigenous to what is now the Central-west African republic of Gabon. But the versatile plant has remained virtually unknown in the West, where it has a very different history.

Researcher Howard Lotsof, PhD, addicted to heroin and methadone, discovered the anti-addictive action of ibogaine in 1962. Given a capsule of pure ibogaine HCL by a trusted friend who was familiar with chemistry, Lotsof was simply seeking a new high. He was astonished when coming out of this difficult experience 36-opiate-abstinent hours later to realize he had no physical craving for opiates, and even more remarkably, had experienced very little of the agonizing physical symptoms normally associated with opiate withdrawal.

Although other early research was undertaken in the 1960s, ibogaine's eventual acceptance as anti-addiction agent in the West was tied to Lotsof's remarkable personal story. Off opiates, Lotsof turned with enthusiasm toward ibogaine and other psychedelics, running trials in the mid-1960s before going to prison under new federal drug laws banning the psychedelics at the end of the decade. For another two decades, Lotsof and ibogaine as addiction treatment wandered in the wilderness, his research supported by groups such as Cures Not Wars.

It was only in 1989 that Lotsof made significant contacts with mainstream researchers, who undertook their own pioneering researches. In the years between then and now, thanks to the missionary efforts of Lotsof and his supporters, ibogaine has ever so slowly become of greater and greater interest to addiction researchers and others.

Valentine's Day morning found ibogaine aficionados at the movies for Facing the Habit, a 2007 film featuring heroin users who succeed -- or fail -- to kick their habit through ibogaine treatments. Next up was ibogaine's most prominent advocate, the mustachioed Cures not Wars co-founder and Yippie! Dana Beal, who brought conference attendees up to speed on the latest research on ibogaine's anti-addictive properties, including its ability to regenerate dopamine pathways in the brain through its activation of glial cell line-derived neurotrophic factor GDNF. This exciting research had a panel of its own later in the day featuring Roman Paskulin, founder and director of Slovenia's Open Mind Institute and Dr. Tracy Blevins.

Beal was followed by a panel of ibogaine treatment providers discussing the special safety challenges involved in treating multiple addictions to different drugs, including Drs. Anwar Jeewa and A.R. Gani, of the groundbreaking residential treatment center Minds Alive in Durban, South Africa, Dr. Bruno Rasmussin of Brazil, and long-time provider Rocky Caravelli.

Next up was one of the most interesting presentations of the conference, by Justin Kirkland, Vice President of Sales and Marketing for Obiter Research on the company's efforts to develop more cost-effective methods of synthesizing 18 Methoxycorinaridine 18-MC, an ibogaine analog with fewer side effects and greater potential for treating methamphetamine and nicotine dependence. The day's events closed with McLean Hospital's Dr. Carl Anderson discussing ibogaine, dream states and fetal R.E.M.

Sunday started with another ibogaine documentary, the Dutch Rites of Passage, followed by SSDP Northeastern's Arielle Torra presenting on the subjective experiences of patients treated at Dr. Deborah Mash's Healing Transitions Institute for Addiction clinic on St. Kitts.

The first scheduled panel of the day addressed the controversial use of ibogaine for other indications, including hepatitis C (HCV). Former New Mexico Department of Health Harm Reduction Coordinator Phillip Fiuty and Rocky Caravelli confirmed the existence of HCV patients whose conditions have improved and even cleared the virus without interferon treatment. Caravelli also described positive effects on herpes, MS and asthma. Jason Farrell, founder and former executive director of Positive Health Project and currently CEO of Harm Reduction Consulting Services, Inc., suggested a collaborative study by clinics in South Africa, Mexico and Brazil tracking the viral loads of HIV/HCV patients for six months to a year.

Next, former High Times and drugwar.com writer and editor Preston Peet gave dramatic personal testimony on ibogaine's efficacy in managing chronic pain by drastically cutting opioid tolerance.

The liveliest panel of the conference came up next, featuring Patrick Kroupa -- a pioneer hacker and long-time activist whose multiple roles include High Priest of the Sacrament of Transition, an Eastern European based iboga religion -- Dr. Deborah Mash, Peet, and Lenny of the New York City ibogaine support group comparing ibogaine to more conventional treatments, such as 12-step cold turkey, methadone taper, buprenorphine and ultra-rapid opiate detox (UROD). UROD -- the direct injection of the opiate blocker naltrexone under benzodiazepine sedation -- was denounced by all panelists as ineffective and inhumane.

The next panel, comparing the anti-addictive effects of ibogaine to other entheogens, featured Harvard Assistant Professor of Psychiatry John H. Halpern and Jon Harrison, the principal investigator for the Multidisciplinary Association for Psychedelic Studies ibogaine outcome study at Pangea Biomedics in Playas de Tijuana, Mexico. Halpern compared ibogaine's effectiveness to other entheogens sometimes given as treatment modalities for drug addiction, most notably peyote use in the possible treatment of alcoholism among the Native American population, and the sacramental use of ayahuasca among American members of the Santo Daime and UDV churches.

This observational case study is examining changes in substance use in 30 individuals seeking ibogaine-based addiction treatment, and is intended to gather information to evaluate whether ibogaine-assisted therapy helps opiate-dependent people stop using opiates or practice moderated use after the therapy. Twelve-month follow-up data is being collected from participants in the study to examine whether ibogaine-assisted therapy facilitates improvements in quality of life that result in decreased harms associated with chronic or mismanaged opiate use. The study has received Institutional Review Board approval from the California Institute of Integral Studies and has enrolled 11 of the 30 subjects. For many months, MAPS had no success in raising funds for the study, but received its first significant donation at the conference, and by March 2nd, had raised all the funds for the study.

Halpern, who's published some of the only research on peyote use by Native Americans, surprised the crowd by revealing that the National Institute on Drug Abuse had so constrained his research that he wasn't allowed to directly study peyote's manifest anti-addictive effects. He also had no data on receptor-mediated anti-addictive effects, ascribing it all to "psychedelic glow."

Sunday's program closed with Makky, Boston University Professor of Classical Studies Carl Ruck and Beal discussing shamanic scenes in South America vs. Africa, a possible iboga role in the ancient world, and the dangers of "The Mushroom and the Cross" approach offending fundamentalists, respectively.

Presidents Day opened with a roundup of the international ibogaine scene. Venezuelan Drs. Rosaria Dávalos and Zulema Medrano described great progress in promoting ibogaine treatments, but also obstacles due to continued deference to the US. Drs. Jeewa and Gani gave details on their residential treatment center. Australian treatment provider Jason Chamon described a smaller, informal treatment scene -- clandestine in Australia, legal in New Zealand. De Loenen finished up, appearing live via Skype to contrast the more relaxed attitudes in Spain and Portugal with a forum in Holland on arrhythmia in ibogaine patients.

The international ibogainesters were followed by a panel on ibogaine's role in harm reduction, featuring Jason Farrell, Phil Fiuty and Cures not Wars cofounder and veteran drug policy activist Doug Greene. Farrell stressed the need for ibogaine treatment providers to be careful about whom they treat to minimize risks, citing a recent case in Netherlands where a patient refused to stop alcohol use before a treatment and had a seizure and then two days of arrythmia. At the same time, he urged greater availability of ibogaine treatment, advising potential providers to get a space and cots and "just do it." Greene praised ibogaine as the most libertarian option for drug treatment, and called on the drug policy reform movement to center its efforts on marijuana and ibogaine.

The conference closed with a panel that included the National AIDS Brigade's Jon Stuen-Parker discussing his lawsuit against the federal government for inattention to crack and heroin. MAPS founder and President Rick Doblin then gave the attendees a road map to promote ibogaine to state and federal policymakers, while Dana Beal suggested a letter from members of Congress to President Obama's forthcoming DEA Administrator.

This was the first ibogaine conference to be streamed live on the Internet, with twice as many people often logged-on as were in the room. Although speakers and attendees alike were frustrated by the conference's uneven pacing and complete disregard of the announced, reaction to the content of the conference was generally positive. Jason Farrell said: "It was a very impressive conference that opened my eyes to the serious, international work that's being done on ibogaine. It's unfortunate that it didn't get the news coverage it deserved."

Long-time drug policy reform activist Valerie Vande Panne said: "It's good to see ibogaine getting the research and recognition it deserves. Clearly, it has been beneficial in a holistic, dignified, and humane way to the lives of many who considered themselves addicts ready for a life change."

Rick Doblin said: "Many of the speakers were fascinating and had lots of experience and important information to share, and the future of ibogaine is bright. The clinics are moving toward more of an above-ground, responsible medical model and are realizing the importance of aftercare programs. I'm not sure where resources would come from for clinical studies to make ibogaine legal in the US -- that may be a stretch too far for NIDA, even under Obama. While I don't see commercial drug development happening in the near term in the US, or anywhere else, there will be more prospective research at the clinics which will, over time, build support for more clinical studies."

Streaming video of the conference can be found here.

The White House: Obama on Drug Policy

The incoming Obama administration has posted its agenda online at the White House web site Whitehouse.gov. While neither drug policy nor criminal justice merited its own category in the Obama agenda, several of the broad categories listed do contain references to drug and crime policy and provide a strong indication of the administration's proclivities.

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But before getting into what the agenda mentions, it's worth noting what the agenda does not mention: marijuana. There is not a word about the nation's most widely used illicit drug or the nearly 900,000 arrests a year generated by marijuana prohibition. Nor, despite Obama campaign pledges, is there a word about medical marijuana or ending the DEA raids on providers in California -- which doesn't necessarily mean he will go back on his word. It could well be that the issue is seen as too marginal to be included in the broad agenda for national change. With the first raid on a medical marijuana clinic during the Obama administration hitting this very week, reformers are anxiously hoping it is only the work of Bush holdovers and not a signal about the future.

Reformers may find themselves pleased with some Obama positions, but they will be less happy with others. The Obama administration wants to reduce inequities in the criminal justice system, but it also taking thoroughly conventional positions on other drug policy issues.

But let's let them speak for themselves. Here are the relevant sections of the Obama agenda:

Under Civil Rights:

  • End Racial Profiling: President Obama and Vice President Biden will ban racial profiling by federal law enforcement agencies and provide federal incentives to state and local police departments to prohibit the practice.
  • Reduce Crime Recidivism by Providing Ex-Offender Support: President Obama and Vice President Biden will provide job training, substance abuse and mental health counseling to ex-offenders, so that they are successfully re-integrated into society. Obama and Biden will also create a prison-to-work incentive program to improve ex-offender employment and job retention rates.
  • Eliminate Sentencing Disparities: President Obama and Vice President Biden believe the disparity between sentencing crack and powder-based cocaine is wrong and should be completely eliminated.
  • Expand Use of Drug Courts: President Obama and Vice President Biden will give first-time, non-violent offenders a chance to serve their sentence, where appropriate, in the type of drug rehabilitation programs that have proven to work better than a prison term in changing bad behavior.
  • Promote AIDS Prevention: In the first year of his presidency, President Obama will develop and begin to implement a comprehensive national HIV/AIDS strategy that includes all federal agencies. The strategy will be designed to reduce HIV infections, increase access to care and reduce HIV-related health disparities. The President will support common sense approaches including age-appropriate sex education that includes information about contraception, combating infection within our prison population through education and contraception, and distributing contraceptives through our public health system. The President also supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users. President Obama has also been willing to confront the stigma -- too often tied to homophobia -- that continues to surround HIV/AIDS.

Under Foreign Policy:

  • Afghanistan: Obama and Biden will refocus American resources on the greatest threat to our security -- the resurgence of al Qaeda and the Taliban in Afghanistan and Pakistan. They will increase our troop levels in Afghanistan, press our allies in NATO to do the same, and dedicate more resources to revitalize Afghanistan's economic development. Obama and Biden will demand the Afghan government do more, including cracking down on corruption and the illicit opium trade.

Under Rural Issues:

  • Combat Methamphetamine: Continue the fight to rid our communities of meth and offer support to help addicts heal.

Under Urban Issues:

  • Support Local Law Enforcement: President Obama and Vice President Biden are committed to fully funding the COPS program to put 50,000 police officers on the street and help address police brutality and accountability issues in local communities. Obama and Biden also support efforts to encourage young people to enter the law enforcement profession, so that our local police departments are not understaffed because of a dearth of qualified applicants.
  • Reduce Crime Recidivism by Providing Ex-Offender Supports: America is facing an incarceration and post-incarceration crisis in urban communities. Obama and Biden will create a prison-to-work incentive program, modeled on the successful Welfare-to-Work Partnership, and work to reform correctional systems to break down barriers for ex-offenders to find employment.

Why has Russia said no to Methadone?

Despite having nearly a million heroin addicts, with HIV spreading rapidly through that population, Russia's government has very tragically said no to methadone maintenance. According to a short video posted by the Hungarian Civil Liberties Union (HCLU), 80% of all new HIV cases in Russia are due to needle sharing by injection drug users. Check out the video here: Check out HCLU here.

Southwest Asia: Iranian Harm Reduction Doctors Arrested, Held Without Explanation

Faced with an intractable and growing opiate addiction problem, in recent years Iran has increasingly embraced the principles of harm reduction. But now, according to an international doctors' human rights organization, two leading Iranian harm reductionists, the brothers Dr. Arash Alaei and Dr. Kamiar Alaei, have been detained without explanation by Iranian authorities.

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International Anti-Drugs Day drug burning, Tehran
The doctors are internationally known experts on HIV/AIDS and have been leaders in HIV/AIDS prevention and treatment efforts in Iran and across the region. For the past decade, the pair have focused on harm reduction for injecting drug users in the conflict-ridden province of Kermanshah, on Iran's west coast.

Physicians for Human Rights earlier this month initiated an international campaign and petition urging Iranian authorities to end the incommunicado detention of the pair and "to disclose their whereabouts, provide them access to lawyers and family, and either to charge them with an internationally recognized crime or release them immediately."

Dr. Kamiar Alaei is a doctoral candidate at the SUNY Albany School of Public Health and is expected to resume his studies there this fall. In 2007, he received Master of Science in Population and International Health from the Harvard School of Public Health. His brother Arash is the former Director of the International Education and Research Cooperation of the Iranian National Research Institute of Tuberculosis and Lung Disease.

The Alaei brothers have held training courses for Afghan and Tajik medical workers and have worked to encourage regional cooperation among 12 Middle Eastern and Central Asian countries. They were key organizers of a tri-national meeting in 2004 in Tehran to discuss harm reduction and substitution treatment in Iran, Tajikistan and Afghanistan. At that meeting, Iran's programs proved to be inspiring role models for the region, according to medical experts who participated in the meeting.

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