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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.

Feature: Vancouver's Safe Injection Site Fights for Its Life -- Again

The only officially-sanctioned safe injection site in North America, Vancouver's InSite will have to close its doors June 30 if the Canadian federal government does not extend its exemption from Canada's Controlled Drugs and Substances Act. But while the Conservative government of Prime Minister Stephen Harper has made no secret of its distaste for the program, it has very strong community, local, provincial, and international support, and its supporters are now engaged in a strong campaign to ensure its continued existence.

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InSite (courtesy Vancouver Coastal Health)
Situated on Hastings Street in Vancouver's Downtown Eastside, home to one of the hemisphere's largest concentrations of hard drug users, InSite has operated since 2003, when it was granted a three-year exemption by the then Liberal government. With the advent of Conservative government, with its ideological opposition to programs that "encourage" or "facilitate" drug use, InSite's continued existence has been shaky. Twice, the Conservatives have granted the program temporary 18-month exemptions, saying that more research on its efficacy was needed.

But now, after five years of monitoring and evaluation, the results are in: According to peer-reviewed scientific studies, InSite increased the use of addiction treatment services, increased the use of detox services, reduced needle sharing, led to improvement in neighborhood public order and quality of life, resulted in no increase in drug-related crime, prevented overdose deaths, and helped reduce the spread of HIV/AIDS among drug injectors.

As if the nearly two-dozen studies of InSite were not enough, the Conservative government last year commissioned its own study, "Vancouver's INSITE service and other Supervised injection sites: What has been learned from research?," which was released in early April. According to Simon Fraser University criminologist Neil Boyd, who was hired by the government to advise the committee overseeing the study, the research shows that InSite has no apparent negative impacts, has resulted in "modest decreases" in drug use, and has not disturbed public order.

In fact, said Boyd at a press conference announcing his findings, InSite should not only be continued, but the program should be expanded to other locations. "I think our data suggests... the building of additional facilities of a similar kind in neighborhoods where they are needed would yield benefits much in excess of the costs required for such projects," he said.

That's unlikely under the Harper government, which is ideologically opposed to such harm reduction practices and in fact removed funding for them from its anti-drug budget. As Harper put it last October: "Because if you remain an addict, I don't care how much harm you reduce, you're going to have a short and miserable life."

Harper has also scoffed at empirical evidence when it conflicts with his agenda. In a January speech to party faithful, he mocked opponents who cited falling crime statistics in challenging his emphasis on law and order. "They try to pacify Canadians with statistics," said the prime minister. "Your personal experiences and impressions are wrong, they say; crime is really not a problem."

More recently, Health Minister Tony Clement and his underlings have sounded similar themes. Science would not be the only factor in determining whether to continue InSite's exemption, Clement's undersecretary, Winnipeg MP Steven Fletcher told The Canadian Press earlier this month. While the government would make a "rational and thoughtful decision based on science," it must also take into account "the realities of the situation," Fletcher explained. "There's multiple sides to this and they all have to be taken into consideration," said Fletcher.

When pressed in parliament by Vancouver East MP Libby Davies, a staunch InSite supporter, Clement vowed to make a decision before June 30 and responded to her criticism about rejecting the science supporting the program: "We are the government that actually wants more research, that actually commissioned more research because we want to make sure this decision is the right decision for Canada, for addicts and for the community in Vancouver," he said. "That is the decision we have made, more research and more consideration. That is because we are open-minded and we want to make the best decision for Canada and Canadians."

Now, as the June 30 deadline looms, InSite's supporters have mobilized. Already this month, the International Journal of Drug Policy published articles by scientists from around the world condemning the federal government for interfering politically with the site's research, Boyd held his Ottawa press conference, advocates held a rally in a Downtown Eastside park featuring 1,000 white crosses to symbolize the people who didn't die from drug overdoses while injecting at InSite, Vancouver street nurses picketed the office of the Vancouver Police Union, whose president is a leading critic of the site, BC Nurses Association president Debra MacPherson held a press conference to tout the health benefits of InSite, and all three BC civic parties have signaled their joint support of the program.

"We're fully behind the effort to keep InSite open," said David Hurford, director of communications for Vancouver Mayor Sam Sullivan. "It is part of the solution, not part of the problem, and it is a bottom-up solution from the grassroots. The federal government has said it supports grassroots decision-making, so why should bureaucrats from 3,000 miles away be making decisions for us here?" he asked.

The mayor's office is "working with local stakeholders to help communicate the benefits of InSite," said Hurford. "We wrote to the health minister last week asking him to keep the site open, and at a minimum, to extend the permits until all pending legal issues are heard."

Hurford is referring to a lawsuit pending in the BC courts that challenges Health Canada's jurisdiction over InSite. That suit argues that since under Canadian law, health care is the domain of the provinces, the federal government should not have control over InSite. But that lawsuit will not be settled by the end of next month.

Opposition politicians have also joined the fight. "This government chooses to view harm reduction as nothing more than dirty words, at the expense of protecting the safety and health of Canadians," said Liberal Party public health spokesperson Dr. Carolyn Bennett.

"The results from the InSite project show measurable evidence that it saves lives," said Liberal MP Dr. Hedy Fry, who played a key role in bringing the agreement that allowed InSite to open. "This has won it widespread support not only from experts in Canada but from the international scientific community, from the Vancouver police and from residents of the Downtown Eastside," said Dr. Fry. "It is simply irresponsible to ignore scientifically-based proof of the efficacy of harm reduction programs like this, and base public policy on ideology alone because real people suffer the consequences."

"The Conservative government must stop its unconscionable interference in scientific research on Vancouver's safe injection site," added New Democratic Party MP Libby Davies, who represents the Downtown Eastside. "Medical researchers from the University of British Columbia have revealed that Harper and his team have been suppressing evidence and denying funding to scientists who are looking objectively at the merits of Insite," she said.

"More than 20 medical and academic studies have been published showing the health and social benefits of InSite. We now have both scientific fact and evidence from users in our community that this facility is helping, not hurting the people of our city. The research record shows that Insite saves lives and increases public safety," Davies continued. "Harper doesn't understand that you can't just hide the facts whenever they don't suit your political agenda. We need a change in direction. It's time for this government to make decisions based on evidence instead of ideology -- InSite needs to be kept open."

"What we want is a 3 ½ year renewal of the exemption from the Controlled Substances Act," said Nathan Allen of InSite for Community Safety. "The fact that the Harper government has not granted this renewal shows they are very reluctant to support the community."

While the Harper government has previously said it needed more research to evaluate InSite's efficacy, that dog won't hunt anymore, said Allen. "They've already spent more than $1.5 million studying InSite, they've produced two dozen academic papers, and they've concluded that it has all kinds of positive impacts. We're wondering what questions the government has left to ask," he scoffed. "InSite has undergone the most thorough and well-funded scrutiny of any health clinic in the country."

In the event the government refuses to grant another exemption, Allen said he hoped it would respect provincial authority and local autonomy. "This has been a regional response to a local crisis here in Vancouver. We need to let the people here on the ground do what they need to do. If not, people will die," he predicted bluntly.

The clock is ticking for InSite, but the pressure is mounting on the Harper government. The next few weeks will determine if that pressure is sufficient to overcome the government's ideological opposition to the safe injection site.

Harm Reduction: More Than 300,000 HIV/AIDS Cases Linked to Injection Drug Use

According to the Centers for Disease Control and Prevention, more than 300,000 people have been infected with the HIV/AIDS virus through injection drug use. That is roughly 30% of all the slightly more than one million cases reported in the US since the disease first appeared on the radar in the early 1980s. The figures are contained in Table 3 of the CDC's latest HIV/AIDS Surveillance Report, covering cases through 2006.

According to the report, more than 170,000 men and nearly 75,000 women contracted the virus through sharing dirty needles. Another 68,000 men contracted the virus through a combination of injection drug use and male-to-male sexual contact.

If there is any good news on the HIV/AIDS drug injection front, it is that the percentage of new cases linked to injection drug use appears to be dropping. While over the history of the epidemic, roughly 30% of all cases are linked to needle-sharing, in 2006 that number was only 17%.

Still, that means that more than 3,000 men and more than 1,700 women contracted the virus in 2006 through injection drug use. Nearly 1,200 more men contracted the virus through a combination of needle-sharing and male-to-male sex.

Needle exchange and other programs designed to reduce the spread of HIV/AIDS currently operate in around 200 US localities, but despite their proven record in reducing the spread of HIV/AIDS, they continue to face hostility in some communities and from some state and local officials. Under an amendment offered by then Sen. Phil Gramm (R-TX), the federal government is prohibited from spending federal funds on needle exchange programs. Both remaining Democratic Party presidential candidates, Sens. Hillary Clinton (NY) and Barack Obama (IL), have called for an end to that ban.

Southeast Asia: Drug Crackdowns Spread HIV/AIDS, Experts Say

Repressive law enforcement responses to injection drug users in Southeast Asia are undermining the effort to slow the spread of HIV/AIDS in the region, analysts meeting in Bangkok said last week. Needle sharing among injection drug users could account for up to 50% of all new infections, they said.

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Thai embassy protest in Washington (DRCNet's David Guard in foreground)
Harassment and arrests of clients at needle exchange programs means many avoid them, while heavy-handed police crackdowns in places like Thailand have driven users deep underground, away from needle exchange programs and treatment services.

In Thailand, where a government "war on drugs" killed a reported 2,500 people over three months in 2003, police often blur the line between dealers and users, hindering efforts to treat addicts, said Precha Knokwan of the Thai Drug Users' Network. "The drug users themselves are afraid that they might be a victim of the police," he said.

It's a similar situation in Indonesia, where prisons are full of HIV-positive drug users who have no access to services, said Aditya Anugrah of the Indonesian Drug Users' Association. "Drug policies in Indonesia do not separate users from dealers," he said. That leads to needle-sharing and the spread of HIV, he said. "Our policies are focusing on sending people to jail and treating them as criminals rather than as health problems."

What is needed is harm reduction, but that requires the cooperation of governments and law enforcement, said Daniel Wolfe of the Open Society Institute. "Harm reduction measures can only work if law enforcement understands them and helps to enforce them," he said.

Feature: San Francisco Ponders a Safe Injection Site, Would Be the Nation's First

San Francisco city officials last Thursday took a tentative first step toward opening the nation's first safe injection site for drug users. In an effort to reduce the city's high number of fatal drug overdoses, as well as slow the spread of blood-borne infectious diseases, such as HIV and Hepatitis C, the city's public health department teamed up with a coalition of health and social service nonprofit groups to present a daylong forum on safe injection sites, how they work, and how they can be established.

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O'Farrell St., Tenderloin district, SF (courtesy Wikimedia)
San Francisco's needle-using population is estimated at between 11,000 and 15,000, with many of them being homeless men. While injection-related HIV rates are relatively low, Hepatitis C is spreading quickly among drug users. About 40 San Franciscans die from drug overdoses each year.

Injection drug use is also a quality of life issue for businesses and residents in areas of the city like the Tenderloin, where public injecting is not rare and dirty needles can be found on the streets. The neighborhood, a center of services for down and out residents, is often mentioned as a potential location for a safe injection site.

Safe injection sites are up and running in some 27 cities in eight European countries, as well as Australia and Canada. They have been shown to reduce overdoses, needle-sharing, and the spread of disease, as well as entice some users into drug treatment -- all without causing increased drug use, crime or other social disorder.

The symposium was cosponsored by the Harm Reduction Coalition, the Drug Policy Alliance, and the San Francisco AIDS Foundation, and was organized by a local consortium of community-based groups known as the Alliance for Saving Lives. That broad-based umbrella group includes public health officials, service providers, legal experts, injection drug users, and researchers.

"Having the conversation today will help us figure out whether this is a way to reduce the harms and improve the health of our community," said Grant Colfax, director of HIV prevention for the San Francisco Department of Public Health.

Vancouver's Insite safe injection site, the only one in North America, was held up as a model for a potential similar program in San Francisco. Both Dr. Thomas Kerr of the British Columbia Center on Excellence in AIDS, who has evaluated InSite, and the facility's program manager, Sarah Evans, addressed the forum about their experiences.

Evans described the Downtown Eastside Vancouver facility as a bland place where drug users can come in and inject in a safe, sterile environment under medical supervision, then relax in a "chill out" room where they are observed. "It looks kind of like a hair salon," Evans said of the bustling space. "If we were a restaurant, we would be making a profit."

While InSite has seen some 800 drug overdoses, said Kerr, none of them had been fatal because of the medical supervision available at the site. His research has found increases in addicts seeking treatment and decreases in abandoned syringes, needle-sharing, drug-related crime and other problems since the clinic opened three years ago, he said. Those findings suggest it is worth doing elsewhere, despite the criticism it will attract, Kerr said.

But while the science appears to be on the side of such facilities, political reality is a different matter. San Francisco Mayor Gavin Newsome's office has said that he does not support safe injection sites, and by this week, even public health department spokesmen were keeping mum. "We're not talking to the media at all any more," Colfax said on Tuesday in response to inquiries about what comes next.

While there has been community concern, the only vocal reaction has been coming from Washington, DC, where one senator, Republican James DeMint (SC), has introduced an amendment that would cut off federal health funds for any locality that starts a safe injection site, and where the Office of National Drug Control Policy (ONDCP) has attacked the idea via the press and its Pushing Back blog.

Bertha Madras, ONDCP deputy director of demand reduction, told the Associated Press the fact that the idea was even being discussed was "disconcerting" and "poor public policy." According to Madras, "The underlying philosophy is 'We accept drug addiction, we accept the state of affairs as acceptable.' This is a form of giving up."

But Hilary McQuie, Western Director for the Harm Reduction Coalition, and one of the guiding forces behind the push for a safe injection site in San Francisco, pronounced herself unworried about either DC opponent. "DeMint's measure is a rash overreaction that won't go anywhere," she predicted, "and as for ONDCP, well, I won't even debate them. It's none of their business; this is a local issue, not a national one."

It's a local issue that McQuie and others have been working patiently on for some time now. "We initiated the Alliance for Saving Lives about a year ago," she explained. "It's mostly agencies that work with drug users, and we've been meeting monthly. We've had some quiet conversations with the health department, and we decided it was time to take the next step."

Now it's time for advocates to build more community support for a safe injection site, including bringing the mayor and the Board of Supervisors on board. Even with science on their side, they have some work ahead of them.

"We know the issues and the science," said Randy Shaw, a long-time community activist working on homeless issues in the Tenderloin, "but no one here wants more of these kinds of facilities." "Why should the poor people of the Tenderloin have to live with all these problems? There are junkies in Golden Gate Park, there are junkies in SOMA, there's more drug traffic at the 16th Street BART station than anywhere in the Tenderloin," he said. "If some neighborhood wants to accept it, that's fine, we just don't want it in the Tenderloin."

City officials have made the neighborhood "a containment zone," Shaw complained. "We already have methadone clinics, needle exchanges, food programs, shelters, drug treatment programs. Now they don't even think about putting things in other neighborhoods." Some activists want to turn the Tenderloin into Hamsterdam, the industrial neighborhood turned into a drug trafficking free zone in the HBO show The Wire, Shaw said. "But we're a residential neighborhood."

"It's controversial," conceded Tenderloin Economic Development Project executive director Julian Davis, a supporter of the idea. "Some folks think the Tenderloin already has too high a concentration of these kinds of services, while others think like this sort of facility would enable drug users as opposed to ending drug addiction in the Tenderloin."

But Davis has a different perspective. "I look at the Tenderloin and I see that our city, our society is already enabling open drug use and drug dealing," he argued. "The idea behind the site is to get some of these users off the street and inside, where they can get access to services, and also to stop the needle-sharing and the spreading of HIV and Hep C. I see quite a few potential benefits from this."

And so the public discussion begins in San Francisco. It will be a long and twisting path between here and an actually existing safe injection site, with much work to be done at the neighborhood, municipal, state, and federal levels. It could take years, but advocates are confident its day will come.

"I think we will have a safe injection site eventually," McQuie predicted, "but how long that will take depends on how well we organize, who's in power, and how much pressure those in power locally feel from the feds."

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