Heroin

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Could Different Drug Policies Have Saved Philip Seymour Hoffman?

The tragic death of actor Philip Seymour Hoffman yesterday has prompted expressions of grief and of praise for his talent. It also, naturally, has prompted discussions of addiction, the impact of pain pill prescriptions on the addicted, even of pain pill restrictions causing more people to turn to heroin.

Philip Seymour Hoffman at the 81st Academy Awards (courtesy Chrisa Hickey, flickr.com/photos/chrisahickey/, via wikimedia.org)
While the latter raises the question about whether different drug policies could make things safer or less damaging or risky for heroin addicts, I haven't heard that question directly raised in the media. Although we don't know how Hoffman would have fared under a different system -- a system that had more options available, we do have information from places that do offer more options, and they are worth examining.

One of those options is heroin maintenance programs (also known now as heroin assisted treatment, or HAT). The most famous such program operated in Liverpool, England, before the conservative Thatcher government, encouraged by the Reagan administration (so we heard), shut it down. But HAT programs current operate in Switzerland, The Netherlands, Germany, Denmark, and the Canadian cities of Vancouver and Montreal. Patients in such programs receive a supply of pharmaceutically-produced heroin from a clinic (for free, though one can infer similar benefits if the heroin were merely cheap). They regularly access health services as a part of their participation. Those who need to inject the drug to relieve their cravings receive instruction on how to do so without damaging their veins, and heroin is made available in other forms as well.

A 2009 paper by leading drug policy researcher Peter Reuter, written for The Abell Foundation in Baltimore, reviewed research done in three of those countries. According to Reuter, Switzerland found a decrease in criminal involvement from 70% of the patients down to 10% after 18 months; and an increase in employment, from 14% to 32%. The health safety results were particularly impressive, including decreased contact with the street drug scene, and with very few adverse events or safety issues.

Many of those findings relate more to indigent addicts than they would to a famous actor. But the final point seems key, very few "adverse events" (e.g. overdoses and so forth) or safety issues, in any of the programs. Again, we don't know how Hoffman would have fared if he had entered a heroin maintenance program instead of buying it on the street. For that matter, we don't know if under legalization, broad or just for the addicted, whether Hoffman would have accessed such services in time, or chose to access them at all. But we know that many people do access these services in the countries that offer them, and that very few of the patients enrolled suffer overdose.

More generally, by prohibiting heroin, even for people who are already addicted to it, we prevent a whole class of possible approaches from every being taken to try to help people -- a whole set of options that people with substance abuse problems might be able to use to manage their problems -- to literally save their lives.

In the meanwhile, there are things to do that are legal even now, at least in a few states that have moved forward with them, with no federal laws standing in the way. These are Good Samaritan policies, that protect people from criminal liability when they seek help in an overdose situation; and use of the antidote medication for heroin overdoses, Naloxone. Meghan Ralston wrote about these in an oped yesterday.

We can also improve the debate. It's not enough to talk about the challenges of addiction and the risk of relapse people can face their entire lives, important as that is. It's a good start that people are starting to recognize the unintended consequences of the pain pill crackdown. But that isn't enough either. It's also important to take the next logical step in the argument, and rethink prohibition.

Chronicle AM -- January 17, 2014

Washington's attorney general has dealt a body blow to the statewide legalization of marijuana commerce there, medical marijuana continues to keep state legislatures busy, a New Mexico town and county pay out big time for a horrid anal search, heroin legislation is moving in Kentucky, and more. Let's get to it:

Marijuana Policy

Washington Attorney General Rules Localities Can Ban Marijuana Businesses. In a formal opinion released Thursday, the Washington attorney general's office held that "Initiative 502 as drafted and presented to the voters does not prevent local governments from regulating or banning marijuana businesses in their jurisdictions." The ACLU of Washington said the attorney general's opinion is mistaken and it "will go to court if necessary" to see it overturned, while the state Liquor Control Board, which is charged with implementing I-502 said that the "opinion would be a disappointment to the majority of voters who approved the law."

Marijuana Reforms Will Be on the Legislative Agenda in Louisiana Again This Year. State Rep. Austin Badon (D-New Orleans) has already introduced House Bill 14, which would dramatically lessen the state's draconian marijuana penalties, and further-reaching bills could be forthcoming. The Badon bill passed the House last year before dying in the Senate.

Medical Marijuana

Pennsylvania Medical Marijuana Bill to Get Hearing This Month. State Senate Law and Justice Committee Chairman Chuck McIlhinney (R) said Thursday he had scheduled a public hearing for January 28 on a medical marijuana bill introduced this week. The bill, Senate Bill 1182, is cosponsored by Sens. Daylin Leach (D) and Mike Folmer (R).

Hawaii House Speaker Says State Needs Dispensaries. House Speaker Joe Souki said Wednesday that the lack of places for medical marijuana patients to obtain their medicine was "a gap in the law" that needs to be addressed. That patients can use medical marijuana but have no place to obtain it is "an anomaly," he said. Addressing dispensaries is a "humanitarian" issue, he added.

Utah Poll Finds Narrow Majority for Medical Marijuana. A new Salt Lake Tribune poll has 51% of Utahns supporting medical marijuana, but 67% opposing decriminalization or legalization.

Georgia Poll Finds Narrow Majority for Medical Marijuana. A new InsiderAdvantage poll has 51% of Georgians supporting medical marijuana "in very specific instances, such as in a liquid form to reduce seizures from young children." Some 27% were opposed, and 22% undecided. "The key here is that any legislation must be on a limited basis. That said, Republicans and Democrats both support this legislation by well over 50 percent, while independent voters are close to a majority as well," said Matt Towery, president of InsiderAdvantage and a former legislator.

Heroin

Kentucky Senate Approves Bill to Reduce Overdose Deaths, Increase Trafficking Penalties. The state Senate Thursday approved Senate Bill 5, which would create more treatment beds for heroin users and lengthen prison sentences for heroin and methamphetamine traffickers. A similar version of the bill passed the Republican-led Senate last year, but stalled in the Democratic-led House. The bill would require the state Medicaid program to cover several inpatient and outpatient treatment options for people addicted to opiates, including heroin and prescription painkillers. It also would divert some of the state's hoped-for savings from a 2011 prison sentencing reform package to expand treatment programs. But the bill would also stiffen penalties for people convicted of trafficking in larger quantities of heroin, methamphetamines or both, requiring them to serve at least half of their prison sentences before they are eligible for shock probation or parole.

Search and Seizure

New Mexico Town, County Pay Out Big Time for Forced Anal Searches of Drug Suspect. A Deming, New Mexico, man who was subjected to a hospital anal exam involving three enemas, a colonoscopy, and being forced to defecate in front of police and medical personnel in a fruitless search for drugs will get $1.6 million in damages in a settlement from Deming and Hidalgo County. David Eckert will most likely win additional damages from a local hospital where doctors agreed to perform the exam.

Sentencing

Charles Colson Task Force on Federal Corrections Funded in Federal Spending Bill. The omnibus federal spending bill filed this week and expected to pass quickly includes $1 million to establish the Charles Colson Task Force on Federal Corrections, an independent, bipartisan grouping that will examine a number of challenges facing the federal correctional system, including overcrowding and ways to minimize growth, violence behind bars, rehabilitation, and reentry. Colson was a Nixon administration official jailed in the Watergate scandal who became a prison reformer in the wake of that experience.

International

Spurred by Attorney, Bermuda's Medical Marijuana Debate Heats Up. Attorney Alan Gordon's online petition to have the Bermudan government allow emergency access to medical marijuana for cancer patients has spurred considerable notice on the island, with National Security Minister Michael Dunkley and Gordon publicly clashing over the law and whether Dunkley can act. Click on the link to see Dunkley's comments and Gordon's well-publicized written response.

Vietnam Sentences Three Drug Offenders to Death; Iran Executes Six. And the resort to the death penalty against drug offenders continues. According to the anti-death penalty group Hands Off Cain, three Vietnamese men charged with heroin trafficking got death sentences, while Iran, the world's leading drug offender execution, hung another six.

Chronicle AM -- January 16, 2014

Florida's medical marijuana initiative appears poised to qualify for the ballot (if it survives a challenge in the state Supreme Court), a new poll finds the country evenly split on marijuana legalization, Afghanistan was on the agenda in the Senate yesterday, and more. Let's get to it:

harvesting opium poppies in Afghanistan (unodc.org)
Marijuana Policy

ABC News/Washington Post Poll Has Americans Split on Marijuana. A new ABC News/Washington Post poll has support for marijuana legalization nationwide at 49%, with 48% opposed. The poll is in the same ballpark as other polls since the November 2012 elections, where support for legalization has ranged between 45% and 58%. Click on the link to see full poll results.

DEA Operations Chief Bemoans Marijuana Legalization Trend. DEA operations chief James Capra told a Senate committee Wednesday that marijuana legalization at the state level was "reckless and irresponsible" and could lead to dire consequences. "It scares us," Capra said, responding to a question. "Every part of the world where this has been tried, it has failed time and time again." [Editor's Note: No country had legalized marijuana until Uruguay did late last year, and that hasn't gone into effect yet. If Capra is referring to Amsterdam, where sales are tolerated, if not technically legal, cannabis coffee shops are now in their fourth decade of existence, and the problems associated with them are relatively trivial.] "There are more dispensaries in Denver than there are Starbucks," he continued. "The idea somehow people in our country have that this is somehow good for us as a nation is wrong. It's a bad thing. This is a bad experiment. It's going to cost us in terms of social costs."

Missouri Marijuana Legalization Petitions Approved for Circulation. Secretary of State Jason Kander announced Wednesday that 13 marijuana legalization initiatives had been approved for signature-gathering. The bakers' dozen initiatives are all variations on a theme: legalize and regulate marijuana in Missouri. They were submitted by Columbia defense attorney Dan Viets, the chairman of the activist group Show-Me Cannabis. To make the November 2014 ballot, organizers must gather 157,778 valid voter signatures for at least one of them by May 4.

Maryland Coalition to Legalize Marijuana Launched. Maryland legislators Thursday launched an effort to get a marijuana legalization bill, the Marijuana Control Act of 2014, passed this year. They were joined at a press conference by members of the newly formed Marijuana Policy Coalition of Maryland, which includes the ACLU of Maryland, Law Enforcement Against Prohibition, the Maryland League of Women Voters, the Marijuana Policy Project, and the Maryland NAACP.

Medical Marijuana

Florida Initiative Campaign Has Gathered 1.1 Million Signatures. The folks behind the Florida medical marijuana initiative, United For Care/Patients United for Freedom, announced Wednesday night that they had gathered 1.1 million signatures, nearly half a million more than needed to qualify for the ballot. While all the signatures haven't been validated yet, organizers are now confident they will pass that hurdle. Now, they have to wait and see if the state Supreme Court is going to allow the effort to move ahead.

Washington Patients, Advocates Speak Out Against Bill That Would Gut Medical Marijuana System. The House Health Committee got an earful from medical marijuana advocates at a hearing Wednesday on House Bill 2149, which would eliminate cultivation cooperatives (and thus, dispensaries) by 2020 and reduce the amount of marijuana patients could possess and the number of plants they could grow. The bill mirrors many of the recommendations of the state Liquor Control Board, which is charged with implementing I-502 marijuana legalization.

Hemp

Indiana Hemp Bill Introduced. State Sen. Richard Young (D-Milltown) has introduced Senate Bill 357, which would allow the Department of Agriculture to license industrial hemp growing and production. The bill requires the department to get necessary approvals from the federal government, which has yet to approve any such production anywhere in the US.

Illinois Hemp Bill Seeks New Life in 2014. State Rep. Kenneth Dunkin (D-Chicago) introduced a hemp bill, House Bill 2668, last year, but it has languished in committee despite picking up some bipartisan support. He said Wednesday that he was cautiously optimistic that opposition may be softening, and the bill could move this year.

Heroin

Maine Heroin Deaths Up Fourfold from 2011 to 2012. The number of heroin overdose deaths in Maine quadrupled between 2011 and 2012, according to numbers released by state officials Wednesday. Officials said the increase was due to tightening restrictions on the use of prescription opiates, a cheap heroin supply, and, possibly, cuts in MaineCare. But while the increase was dramatic, the 28 heroin overdose deaths reported in 2012 is well below the 2005 peak of 43. In the years between 2005 and 2011, heroin deaths declined steadily.

Heroin Prevention Bill Package Passes Wisconsin Assembly. The State Assembly Wednesday passed the HOPE (Heroin Opiate Prevention and Education) package of four bills designed to reduce the number of overdose deaths in the state. Sponsored by Rep. John Nygren (R-Marinette), one bill would allow anyone to use naloxone to reverse overdoses, another would grant legal immunity to drug users who call for help in an overdose emergency, a third would allow communities to establish prescription drug drop-off points, and the fourth would require people to show ID when picking up prescription drugs. The naloxone and legal immunity bills are Assembly Bill 446 and Assembly Bill 447. The package now moves to the Senate.

Kratom

Oklahoma Wants to Ban Kratom, But Meets Resistance. The Oklahoma Bureau of Narcotics wants to ban the Southeast Asian herb kratom, which it calls "the legal form of heroin," but kratom fans are responding with dismay and disputing the narcs' assessment. Kratom is not a controlled substance under federal law, but narc Mark Woodward said he planned to ban it until it is federally proven to have medical benefits. Kratom users have started a petition to challenge efforts to ban Kratom.

Drug Courts

Study Finds Drug Courts Ignore Science When it Comes to Opiate Substitution Therapies. A small study of drug courts in New York state finds that their skeptical approach to opiate substitution therapies (OST), such as methadone and buprenorphine, can be a barrier to successful treatment. "Many courts do not respect medical consensus on scientifically sound treatment standards. Some courts included OST as part of court-mandated treatment options, while others allowed OST for a court-defined period of time as a bridge to abstinence. Still others showed intolerance and even disdain for anything having to do with methadone and buprenorphine, or -- as with the drug court in Albany County -- refused outright to admit people on methadone or buprenorphine treatment," the authors wrote. "Ordering people who are dependent on opioids to get off their prescribed methadone or buprenorphine medicines can force patients to seek out and become dependent on other opioids like prescription analgesics. Addiction to prescription opioids has been recognized as a priority problem by U.S. policy-makers, but drug courts may be exacerbating it."

Search and Seizure

ACLU Sues Border Patrol Over Interior Border Check Point Searches. The American Civil Liberties Union (ACLU) has filed suit against the Border Patrol, claiming its agent routinely violate the constitutional rights of local residents by stopping and searching them at interior checkpoints on highways near the border. In a 1976 ruling, the US Supreme Court ruled that immigration checkpoints were permissible if the stops were brief, involved "a limited enquiry into residence status," and a visual inspection of the exterior of the vehicle. "But that's not what's happening here," said ACLU attorney James Duff Lyall in Tucson. He said the cases mentioned in the lawsuit provide strong indications that the Border Patrol is using the checkpoints for general crime control, "which the courts have said is not acceptable for a checkpoint. The same thing is happening over and over again to many border residents," Lyall said. "They're going on fishing expeditions where there's no reasonable suspicion."

International

Afghan Drug Situation "Dire," Federal Auditor Tells Senators."The situation in Afghanistan is dire with little prospect for improvement in 2014 or beyond," Special Inspector General for Afghanistan Reconstruction John Sopko told the Senate Caucus on International Narcotics Control Wednesday. Poppy cultivation is at record levels and the drug trade now accounts for 15% of Afghan GDP, Sopko said.

US to Help Afghanistan With Drug Problem, State Department Official Tells Senators. At the same hearing mentioned in the story above, Assistant Secretary of State for the Bureau of International Narcotics and Law Enforcement Affairs ("drugs and thugs") William Brownfield vowed the US would remain committed to helping Afghanistan fight drug production and trafficking even after US and NATO troops pull out at the end of this year. "We will continue to ensure our counternarcotics programs are well integrated with broader US efforts, including assistance programs aimed at supporting a vibrant legal economy," he testified Wednesday. "The expanding cultivation and trafficking of drugs is one of the most significant factors putting the entire US and international donor investment in the reconstruction of Afghanistan at risk," he said.

"Obamacare" Heroin Hits the Market

Like any other businessmen seeking to differentiate their product from similar competitors, heroin dealers come up with brand names, too. Among the latest is this entry from Massachusetts: "Obamacare"

This photo comes courtesy of the Massachusetts State Patrol, whose troopers seized 1,250 packets of heroin stamped "Obamacare" or "Kurt Cobain" during a Friday morning traffic stop.

Branding heroin is nothing new; legendary New York City heroin dealer Frank Lucas had his "Blue Magic" back in the 1970s. In recent years, the trend has continued, with names such as "Bugs Bunny," "Buddha," "Bin Laden," and "LeBron James" all making appearances, some for more obvious reasons than others.

"Kurt Cobain" I can understand, from a heroin marketer's viewpoint. This shit will blow your brains out.

But I'm not sure what message dealers are trying to convey with the "Obamacare" brand. Is this stuff gonna kill you as dead as socialized medicine? Or is it gonna bliss you out like knowing you have access to reasonably priced health insurance despite preexisting conditions?

Location: 
MA
United States

Chronicle AM -- November 19, 2013

Hmmm, on the same day the DEA warns that "marijuana availability seems to be on the increase," hundreds of people apply for licenses to sell pot in Washington state. Times are changing, and somebody needs to let the DEA know. And there's more news, too. Let's get to it:

Crackdowns on pain pills are leading the way to comeback for heroin. (wikipedia.org)
Marijuana Policy

Hundreds Apply for Pot Business Licenses in Washington State. Monday was the first day budding ganjapreneurs could apply for licenses to open marijuana cultivation, processing, and retail facilities, and interest was intense. By 2:00pm Monday, 299 applications had been submitted. The state envisions up to 334 marijuana retail shops opening next year; it is unclear how many production and processing facilities will be licensed, although regulators have said they want to limit cultivation to two million square feet statewide. Applications are being accepted through December 17.

Arkansas Attorney General Rejects Another Marijuana Initiative. The Arkansas attorney general's office Monday rejected the proposed language of an initiative that would repeal the state's marijuana laws. The initiative isn't clear about what it seeks to achieve, the office said. The attorney general's office has been busy with initiatives this year; it has already approved two separate medical marijuana initiatives, and the author of this one can come back with new language if she wishes.

Drug Policy

DEA Releases 2013 National Drug Threat Assessment. The DEA Monday released the annual drug threat assessment, which includes looks at drug use and trafficking trends. The report identifies the illicit use of controlled prescription drugs as "the nation's fastest growing drug problem," warns that heroin use and supply is up, as is methamphetamine, but that cocaine use and supply is down. Also, "marijuana availability seems to be increasing," and synthetic drugs "have emerged as a serious problem in the United States."

New Yorkers to Map Out City Drug Policies on Saturday. New York City residents just elected a self-described progressive -- Bill de Blasio -- as mayor. Now, they will have a chance to let him know what direction they want the city to take on drug policy. As part of Talking Transition, "an open conversation about the future of New York City," hundreds of people are expected to attend a Saturday forum on "Ending the New Jim Crow: Mapping the Future of Drug Policy in New York City," then break into small groups to make recommendations on issues ranging from racially-biased marijuana arrests, lack of effective drug treatment, and overdose prevention strategies. Click on the main link for more details.

Heroin

Ohio Attorney General Declares War on Heroin. Ohio Attorney General Mike DeWine Monday announced he had created a new heroin unit within his office to fight back against what he called "an epidemic" of heroin use. The move comes as heroin overdose deaths have doubled in recent years, from 292 in 2010 to 606 last year. DeWine said his office will spend an additional $1 million a year on increased assistance to law enforcement, community outreach workers, and lab technicians. The rise in heroin use in Ohio comes after Gov. John Kasich cracked down on pain clinics in 2011, leaving illicit heroin as the last resort for people strung out on opioids.

International

China to Turn "Re-Education" Labor Camps into Drug Treatment Centers. At its recent Third Plenary meeting, the Chinese Communist Party announced it was abolishing its controversial "re-education" labor camps. Now, it turns out that the camps won't be closing, but will instead be converted into drug treatment and rehabilitation centers. "The new rehab centers will provide compulsory drug rehabilitation treatment for addicts, and help them find self-confidence again," one official explained. There are 1.8 million "officially registered" addicts in China, but the number of actual addicts could run as high as 12 million.

Canadian Students for Sensible Drug Policy Meets in Vancouver This Weekend. Canadian SSDP is holding its annual national conference this weekend in Vancouver. In addition to panels and speeches, there will be tours of Insite, Vancouver's supervised injection facility, a Downtown Eastside Walking Tour, and rides on the Sensible BC bus. For more details, click the link.

UN Drug Chief Warns of Afghanistan "Narco-State"

Afghanistan could collapse into a "full-fledged narco-state" as the looming withdrawal of US and NATO combat forces creates a gaping hole in the center of the country's economy, Yuri Fedotov, the head of the UN Office on Drugs and Crime (UNODC) warned Wednesday.

In an interview with Reuters, Fedotov noted that the Western forces generate about a third of all jobs and investment in Afghanistan. They are due to leave the country by the end of next year, and even the presence of a residual force of up to 10,000 fighters is increasingly in doubt as the US and Afghan haggle over a status of forces agreement that would allow them to stay.

The other major economic activity in the country is opium production, processing, and distribution, including the manufacture of heroin from raw opium, which accounts for roughly another third of the national economy. Since the US invaded Afghanistan in October 2001, it has consistently been the world's leading source of illicit opium production, accounting for nearly 90% of all poppies produced worldwide.

Multi-hundred million dollar annual cash flows associated with the opium economy have benefited the Taliban insurgency, which taxes farmers in areas it controls as well as engaging in or protecting drug trafficking. They have also benefited corrupt Afghan government officials and associated warlords.

Fedotov, whose native Russia has been flooded with Afghan heroin, said Wednesday that an upcoming UNODC survey due later this month will show increases in both opium cultivation and production.

"The situation is worsening, that is clear and very disappointing," he said. "It is a very serious setback, but we need to take that as a warning shot," he added, calling for increased international assistance.

"That is also fertile ground for corruption and other forms of transnational organized crime. It is a multi-faceted challenge and we need to take that as a serious problem," Fedotov warned. "Otherwise we have a serious risk that without international support, without more meaningful assistance, this country may continue to evolve into a full-fledged narco-state," he said. "We have not been able to develop an alternative economy in Afghanistan," Fedotov said. "With all our efforts, it was very hard to move from illicit to licit."

Oh, and those Afghan farmers? When they're not producing opium, they're producing cannabis. Afghanistan is also one of the world's preeminent producers of it, according to UNODC, and production was up again last year, the group reported last month.

Afghanistan

Health Canada Approves Heroin Maintenance [FEATURE]

Last Friday, Health Canada used some creative rule-reading to approve a program that would provide prescription heroin to a small number of hard-core users, and the Conservative health minister isn't happy. But doctors, advocates, and the users themselves are quite pleased -- and once again, Canada stays on the cutting edge when it comes to dealing smartly with heroin use.

Health Canada approved access to prescription heroin for at least 15 people who are completing their participation in Vancouver's Study to Assess Long-term Opioid Dependence (SALOME), which is testing whether prescribing heroin was more effective than prescribing methadone for users who have proven resistant to conventional treatments. The move came after participants and advocates have been calling for an "exit strategy" for the 322 people in the study.

SALOME began at the end of 2011 and has been enrolling participants on a rolling basis for a year at a time. The final group of participants will finish up at the end of next year. It built on the success of the North American Opioid Maintenance Initiative (NAOMI), a study in Vancouver and Montreal from 2005 to 2008. That study found that using heroin is cheaper and more effective than using methadone to treat recalcitrant heroin users.

While the Conservative federal government has been a staunch opponent of heroin maintenance, not to mention also fighting a bitter losing battle to close down the Vancouver safe injection site, Health Canada bureaucrats were able to find a loophole that will allow doctors to prescribe heroin to graduating study participants under the ministry's Special Access Program (SAP).

That program is designed to provide drugs to Canadians with life-threatening illnesses on a "compassionate or emergency" basis. The SAP includes "pharmaceutical, biologic and radiopharmaceutical products that are not approved for sale in Canada." The program covers diseases including intractable depression, epilepsy, transplant rejection and hemophilia, but heroin addiction isn't mentioned.

"Health Canada made a wonderful decision," said Scott Bernstein, Health and Drug Policy Lawyer for the Vancouver-based Pivot Legal Aid Society, which represents 22 SALOME participants and the BC Association of People on Methadone in order to advocate for their continued access to health care and the protection of their human rights. "The decision was one based on the evidence and not ideology. It means that those SALOME participants allowed access can live safer, more stable lives, lives free of crime and remaining under the care of doctors, not drug dealers."

But Health Minister Rona Ambrose appeared to have been caught flat-footed by the Health Canada decision. She issued a statement the same day decrying the move, saying that it contradicted the government's anti-drug stance.

Pharmaceutical diacetylmorphine AKA heroin (wikimedia.org)
"Our government takes seriously the harm caused by dangerous and addictive drugs," Ambrose said. "Earlier today, officials at Health Canada made the decision to approve an application under the Special Access Program's current regulations to give heroin to heroin users -- not to treat an underlying medical condition, but simply to allow them to continue to have access to heroin for their addiction even though other safe treatments for heroin addiction, such as methadone, are available."

The move is "in direct opposition to the government's anti-drug policy and violates the spirit and intent of the Special Access Program," Ambrose said, adding that she would take action to "protect the integrity of the (SAP) and ensure this does not happen again."

Ambrose's remarks prompted a Monday response from SNAP (the SALOME/NAOMI Patients Association), comprised of "the only patients in North America to be part of two heroin-assisted treatment (HAT) clinical trials" -- NAOMI and SALOME. SNAP noted that European heroin-assisted treatment trials had allowed participants to continue to be prescribed heroin on compassionate grounds after the trials ended and that "heroin-assisted therapy is an effective and safe treatment that improves physical and psychological health when the participants are receiving treatment."

"The Canadian NAOMI trial is the only heroin-assisted treatment study that failed to continue offering HAT to its participants when the trial ended in Vancouver," SNAP said. "We do not want to see the same outcome for the SALOME trial. Currently, SALOME patients are being offered oral hydromorphone when they exit the trial. However, there is currently no scientific evidence to support this treatment option for opiate addiction in the doses required; thus we urge you to reconsider your comments and to support Health Canada's decision to grant special access to heroin for patients exiting the SALOME trial. We also urge Canadians to support the immediate establishment of a permanent HAT program in Vancouver, BC."

Patients and their supporters weren't the only ones supporting the Health Canada move and criticizing Minister Ambrose for her opposition. New Democratic Party health critic Libby Davies also had some choice words for her.

Davies was "outraged" that Ambrose would "overrule her own experts," she said. "Medicalized heroin maintenance has been used very successfully in places like Europe. It's another example of the Conservative government ignoring sound public policy, instead making decisions based on political dogma."

Indeed, while Canada has been on the cutting edge of opiate maintenance in North America, being the scene of the hemisphere's only safe injection site and heroin-maintenance studies, similar moves have been afoot in Europe for some time. Prescription heroin programs have been established in several European countries, such as Switzerland, Germany, Denmark, The Netherlands, and the United Kingdom.

Now, it seems that Canada will join them, despite the health minister's dismay.

Vancouver
Canada

Norway Government Wants to Decriminalize Heroin Smoking

The Norwegian government said Friday it wants to decriminalize the smoking of heroin as a harm reduction measure, Agence-France Presse reported. Smoking heroin is less dangerous than injecting it, and the move could reduce the number of overdoses, officials said.

heroin smoking image from 1965 UNODC newsletter
"The number of fatal overdoses is too high and I would say it's shameful for Norway," said Health Minister Jonas Gahr Stoere. "The way addicts consume their drugs is central to the question of overdoses. My view is that we should allow people to smoke heroin since injecting it is more dangerous," he said.

According to the Norwegian Institute for Alcohol and Drug Research (SIRUS), heroin overdoses accounted for 30% of 262 fatal overdoses in 2011. By comparison, only 168 people died in traffic accidents that year.

The city of Oslo has opened a supervised injection site in a bid to reduce overdoses, but decriminalizing heroin smoking would also help, said Stoere. Users currently can't smoke at the supervised injection site.

"This isn't about some kind of legalization of heroin but about being realistic," he said. "Those who are in the unfortunate situation of injecting themselves in a drug room should be able to inhale. It is less dangerous, you consume less and the risk of contracting a disease is lower," he added.

"It's a paradox that you can't smoke heroin when you can inject it, since the first method is less dangerous than the second," SIRUS researcher Astrid Skretting told AFP. "But the culture of injecting which provides a more immediate effect than smoking seems deeply rooted in Norway and it's not certain that a decriminalization will lead to a radical change in behavior," she suggested.

The Norwegian government is set to unveil its latest plan for fighting drug addiction next week. Stoere said the heroin smoking decrim plan has the backing of the center-left government.

Oslo
Norway

Chronicle Review Essay: Opium Dreams

Opium: Reality's Dark Dream, by Thomas Dormandy (2012, Yale University Press, 366 pp., $40.00 HB)

Opium Fiend: A 21st Century Slave to a 19th Century Addiction, by Steven Martin (2012, Villard Books, 400 pp., $26.00 HB)

Social Poison: The Culture and Politics of Opiate Control in Britain and France, 1821-1926, by Howard Padwa (2012, Johns Hopkins University Press, 232 pp., $55.00 HB)

Ah, blessed opium, the beloved bringer of sweet relief from pain, of the body or the soul, the deliverer of bliss and sweet surcease from suffering. From it and its derivatives come the most effective pain relievers known to man. Morphine, codeine, Percocets, Lortabs, Vicodin, Oxycontin, hydrocodone, Fentanyl and rest of the opiates and opioids (synthetic opiates) fill the medicine cabinets of those dying of cancers and other horrifyingly painful conditions and they work wonders with acute pain, from a broken limb to dental surgery, turning agony into pleasantly numb nirvana.

But, oh, cursed opium, death with a needle in its arm, and a trail of wasted junkies left like whispering wraiths in its lee. Thief not only of lives, but also of souls as those in her thrall bend before the sultry temptress enslaved before her insatiable demands.

Opium -- inspiration of writers and artists, tool of physicians, cash crop for peasant farmers, boon of the pained, bane of the moralist. Prototypical commodity of global trade, subject of wars, and funder of armies.

http://stopthedrugwar.org/files/opium-reality.jpg
It's safe to say we have a love-hate relationship with papaver somniferum, the opium poppy. And, as Thomas Dormandy points out in his magisterial history Opium: Reality's Dark Dream, it goes back a long way. Poppy seeds were found in the excavation of a lakeside Swiss village dated to 6000 BC, and the use of the poppy as medicine was part of Egyptian practice as early as 4500 BC. (Interestingly, concern about its deadly and addictive properties came only much later, although, in a gripe that could have come from the online comment section of any newspaper today, grumpy old man Cato the Elder complained about doped-up youth hanging around the Forum in imperial Rome.)

Dormandy takes the reader from that prehistoric Swiss village to the poppy fields of Afghanistan, carrying us along with a graceful narrative and subtle wit as he surveys colonial machinations and imperial intrigue, evolving medical knowledge, literary and artistic output associated with the poppy, and opium's own transformation from consumed resin to alcohol-based tincture (laudanum) to smoked opium (curiously thanks to Dutch and British sailors who brought their new-found tobacco smoking habits, perhaps with a pinch of poppy thrown in, and paraphernalia to the Far East, which didn't have tobacco, but did have plenty of opium to smoke), on to injectable morphine, "heroic" heroin, and now, the newer synthetic opioids.

Along the way, we check in with doctors and scientists, junkies and kings, de Quincey and Coleridge and the the tubercular Romantics. Dormand surveys some well-trodden territory, but brings to the subject refreshing insights and entrancing prose. And he is a model of moderation.

He is loathe to cheerlead for legalization, given the downsides of death and addiction, but is equally skeptical of claims that prohibition -- short of the Maoist model, which even China couldn't get away with now -- can somehow make the poppy and its derivatives go away.

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"Criminalization is justified if it deters potential delinquents and protects the innocent," he writes. "Little if any evidence suggests that current legislation does either."

Dormandy's main prescription -- education, and presumably, prevention -- is unlikely to satisfy partisans on either side of the policy debate, but may, after decriminalization and adoption of a public health approach, be the best we can hope for in the foreseeable future.

Steven Martin's Opium Fiend is not a history of opium, although it contains plenty, but a fascinating memoir of his journey from nerdy teenage compulsive collector to full-blown chaser of the dragon in the back alleys and hidden byways of Southeast Asia. Martin made a career for himself writing for off-the-beaten-path travel series, such as the Rough Guides and Lonely Planet, but his obsession was collecting, and he eventually turned to collecting the paraphernalia of opium smoking.

From collecting opium pipes to seeing how they actually work is a very short leap, one that Martin was quick to take, once he managed to find some of the last real-life opium dens left in the region (and some of the characters who inhabited them). And before he realized it, he had become enslaved to the pipe.

Or had he been liberated? As his world shrank to the confines of his Bangkok apartment and the home of his fellow pipe-head and opium supplier (another American expatriate and antiquities expert whose death in US detention casts a somber shadow over the tale), he congratulated himself on his withdrawal from -- and rejection of -- what he increasingly saw as a brutal and thuggish world. "There was euphoria in what felt like the ultimate act of rebellion against modern society," he wrote. "Opium was setting me free."

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Except it wasn't, as his ghastly recounting of his efforts to kick the habit demonstrated. What was once liberation was now addiction. But how much of Martin's addiction was tied up with his own obsessive-compulsive personality?

Martin's memoir combines the typical obsessive descriptions of drug effects with a survey of the broader historical and cultural traditions surrounding opium, as well as the (surprisingly brief; it was largely extinguished a century ago) history of opium smoking, as well as taking the reader into the strange world of collecting Asian antiques. Opium Fiend is a worthwhile, engaging, and enlightening read, and stands not only as a valuable contribution to the literature of opiate use, but on its own literary merits.

Howard Padwa's Social Poison will attract a much more limited audience, and that's too bad. While it concentrates on the rather esoteric topic of 19th Century approaches to opiate control in Britain and France, it, too, provides interesting insights on the politics of drug control. But this has the appearance of a PhD dissertation turned into a book, and its likely readership is probably a very small number of graduate students in related subjects--who will probably only check it out from university libraries, given its $55.00 price tag.

Still, Padwa is able to disentangle various threads and offer an explanation for the divergent courses of the two countries. While Britain demonstrated an amenability to opiate maintenance and its practitioners, France has historically come down firmly on the side of criminalizing opiate users and the doctors who prescribed to them. Padwa traces the divergence to national conceptions of citizenship and the shifting nature of the drug-using populations in the two countries. His comparative study is well-constructed, and its a shame few are likely to ever even pick up the book.

Opium and its derivatives remain both bane and boon. Prescription pain pills (opiates) are driving the current drug overdose epidemic in the US. At the same time, they are bringing blessed relief to pain sufferers. Opium production is putting foods in the mouths of families in Afghanistan and Myanmar. At the same time, it is corrupting governments and buying guns to fight remote wars. Cheap heroin is creating new generations of addicts. At the same time, it is in some ways making bearable the misery in the lives of the miserable.

Now, if we can only figure out how to end opium (and opiate) prohibition without being engulfed by the downside of opiate use. As Dormandy noted, in 18th and 19th Century England, laudanum was viewed as mother's little helper; it sent baby to sleep. But sometime baby never woke up.

Naloxone Cheap Way to Prevent Drug OD Deaths, Study Finds

Drug overdose deaths are now the leading cause of accidental death in the US, surpassing automobile accidents, but a new study suggests that distributing naloxone to opioid drug users could reduce the death toll in a cost-effective manner. The study was published this week in the Annals of Internal Medicine.

Naloxone package (wikimedia.org)
Opioids, including not just illicit heroin but also widely used prescription pain pills, are responsible for about 80% of drug overdose deaths. Naloxone, an opioid antagonist, works by blocking opioid receptors in the brain, making it possible to reverse the effects of overdoses.

At least 183 public health programs around the country have trained some 53,000 people in how to use naloxone. These programs had documented more than 10,000 cases of successful overdose reversals.

In the study published in the Annals, researchers developed a mathematical model to estimate the impact of more broadly distributing naloxone among opioid drug users and their acquaintances. Led by Dr. Phillip Coffin, director of Substance Use Research at the San Francisco Department of Public Health, and Dr. Sean Sullivan, director of the Pharmaceutical Outcomes Research and Policy Program at the University of Washington, the researchers found that if naloxone were available to 20% of a million heroin users, some 9,000 overdose deaths would be prevented over the users' lifetimes.

In the basic research model, one life would be saved for every 164 naloxone kits handed out. But using more optimistic assumptions, naloxone could prevent as many as 43,000 overdose deaths, saving one life for every 36 kits distributed.

Providing widespread naloxone distribution would cost about $400 for every year of life saved, a figure significantly below the customary $50,000 cut-off for medical interventions. That's also cheaper than most accepted prevention programs in medicine, such as checking blood pressure or smoking cessation.

"Naloxone is a highly cost-effective way to prevent overdose deaths," said Dr. Coffin. "And, as a researcher at the Department of Public Health, my priority is maximizing our resources to help improve the health of the community."

Naloxone has proven very effective in San Francisco, with heroin overdose deaths declining from 155 in 1995 to 10 in 2010. The opioid antagonist has been distributed there since the mid-1990s, and with the support of the public health department since 2004. But overdose deaths for opioid pain medications (oxycodone, hydrocone, methadone) remain high, with 121 reported in the city in 2010. Efforts are underway in the city to expand access to naloxone for patients receiving prescription opioids as well. This study is the latest to suggest that doing so will save lives, and do so cost-effectively.

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