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Danes Want Heroin Pills for Addicts

In remarks reported by the Copenhagen Post Sunday, Danish Health Minister Astrid Krag announced that she is proposing that heroin in pill form be made available to addicts. Denmark is one of a handful of European countries that provide maintenance doses of heroin to addicts, but to this point, the drug was only available for injection.

Heroin safer in pill form? Danes thinks so. (wikimedia.org)
It is time to offer users a safer choice, Krag said, adding that the pills should be available next year. She said the Danish Board of Health had evidence to believe making heroin available in pill form would reduce the risks of disease and overdose.

"With tablets, we get a tool that lessens the risk of incorrect dosages, injuries and incidences of cancer," she explained. "This will be an improvement of the current system. It clearly needs to be in place by 2013."

The Danish government approved heroin maintenance in 2008, with the first clinic opening in 2010. There are now five of them. A supervised injection site is set to open in the Copenhagen neighborhood of Vesterbro later this year. In the meantime, a mobile injection site is zooming around the neighborhood.

Opposition conservative party spokespersons said they were open to the proposal, but wondered how it would be paid for. But spokespersons for the government Socialistisk Folkeparti said that was just politics.

"It is remarkable that [the conservative opposition] says that financing must be in place before you make a proposal," said Jonas Dahl, health spokesman for the Socialists. "The working procedure has always been that we first get a professional recommendation from the Board of Health and then find the money."

Copenhagen
Denmark

Danish Parliament Okays Drug Consumption Rooms

As of next week, supervised injection (and other drug consumption) sites will be legal in Denmark. Earlier this month, the Danish Parliament voted 63-43 to allow the facilities to open, including language that instructs police and prosecutors to not search, seize, and prosecute users in possession of "small quantities" of drugs.

the supervised injection site in Vancouver (vch.ca)
Just what "small quantities" are is up in the air at the moment. Guidelines from the attorney general say the amount should be 0.2 grams of heroin or cocaine or less, but a Supreme District Court ruling held that a man caught in possession of 1.37 grams of heroin had it for personal use.

The new law not only allows for supervised injection sites, but also allows Danish municipalities to establish facilities for smoking or snorting heroin or crack cocaine.

The law was impelled by the activism of the Danish Street Lawyers, who describe themselves as "hard core harm reducers," and who published a legal paper and press release during last year's election campaign calling for drug consumption rooms and arguing that the only obstacles to them were political -- not legal. Then, just days before last September's election, the nonprofit group Social Entrepreneur opened a mobile drug consumption room in Copenhagen, drawing more attention to the issue.

After a left-wing minority government won the election, the Liberal Alliance, one of the governing coalition's members, pushed for movement on drug consumption rooms, and after six months of inaction, the government finally introduced a bill in April. But the Street Lawyers objected to provisions of that bill, including one that required drug consumption room staff to report to police on their clients' whereabouts, and the bill was amended to remove the language.

Denmark will now join a small but growing number of countries that allow supervised injection sites as a harm reduction measure. Those countries include Australia, Canada, Germany, the Netherlands, Spain, and Switzerland.

Copenhagen
Denmark

Kenya to Distribute Needles to Injection Drug Users

The Kenyan government will begin distributing needles to the country's estimated 50,000 injection drug users next month in a bid to slow the spread of HIV and other blood-borne diseases. The plan was announced last week in Mombasa, where the first pilot program will begin.

Mombasa, a port city, is reportedly a transit route for international drug trafficking. It also has the country's highest number of injecting heroin users.

"We are trying our best to address the entire problem of drug abuse amongst the youths. We had to identify an alternative of stopping the youths from sharing needles, our attention having been drawn by the rate at which these young people were contracting HIV and other diseases, such as hepatitis," said Dr. Anisa Omar, the Coast Provincial Director of Public Health and Sanitation. "In Mombasa alone, we have over 26,000 youths who use injection drugs, with at least one out of every four being found to be HIV-positive. In Nairobi, we have 20,000 youths who are IDUs."

The Kenyan government estimates that injection drug use accounts for 4% of HIV infections and 17% of new HIV infections in Coast Province, where Mombasa is located. The government moved in 2010 to shift from addressing drug use as a criminal issue to addressing it as a public health issue.

The government plans to distribute some eight million needles to injection drug users as the plan is rolled out. It will also encourage people to be tested for HIV and will provide antiretroviral drugs, condoms, and medicines for tuberculosis, which commonly co-infects with HIV.

While the government has shifted to a public health and harm reduction approach, not everybody is on board. Anti-drug activists and some religious leaders have criticized the move.

"We will file a petition in court… these children of ours don't even have any veins remaining in their bodies," said Amina Abdalla, secretary of the Coast Community Anti-Drugs Coalition. "Where do they expect them to inject themselves? Their bodies are ruptured and rotten as a result of constant use of the needles. Besides, drug peddlers and barons will have a field day, for they'll know their products will be on demand, and that's not acceptable."

Coast religious leaders also objected, saying the government should instead spend its resources on drug treatment.

But Dr. Omar said that needle sharing significantly reduced the risk of coming down with HIV and hepatitis, and that justified the program.

"The program, which will see every addict given three needles and syringes per day, will be supplied to specified private rehabilitation centers and hospitals by NGOs and qualified medical practitioners, in collaboration with anti-drug campaigners, whom we soon plan to train on how they'll best handle the addicts."

Mombasa
Kenya

Most of North Carolina Grand Jury's Cases Are Drugs

A Pitt County (Greenville), North Carolina, grand jury offered up a batch of indictments on April 9 that suggest that the war on drugs is generating most of the criminal justice system activity in the county. This snapshot offers a revealing glance at just what law enforcement and prosecutors are spending their resources on, at least with this grand jury.

City Hall, Greenville (wikimedia.org)
Grand juries are empanelled by local prosecutors to bring charges when prosecutors believe they have evidence a person can be charged with a crime. Grand jury indictments are a strong indicator of law enforcement and prosecutorial priorities.

Overall, the April grand jury indicted 37 people felony charges. Only two were for violent offenses, both of which were assaults with a deadly weapon. Another two people were indicted for child sex offenses.

One person was indicted for possession of a stolen firearm and carrying a concealed weapon, one for obstruction of justice, one for breaking and entering, and four more for various theft offenses (obtaining property under false pretenses, larceny by an employee, larceny of a merchant, financial card theft).

Overall, 15 people were indicted on non-drug offenses. But 22 were indicted in cases where drugs were the leading charge, and eight of them were indicted for possession of marijuana with the intent to sell and deliver. That's 22% of all the indictments, or nearly one-quarter of the grand jury's business.

Another four people were charged with possession of cocaine with intent to sell and deliver, three people were charged with trafficking heroin/opium, three with trafficking a Schedule II controlled substance (pain pills), two with conspiracy to traffic cocaine, one with possession of cocaine, and one with attempting to obtain a controlled substance by fraud.

Drug possession or sales cases thus accounted for a whopping 60% of all indictments by the April 9 grand jury. If drug possession and sales were not criminal offenses, police and prosecutors could use those resources elsewhere, or elected officials could decide that police and prosecutors don't need as many resources and reallocate those taxpayer dollars to more fruitful ventures. Or they could lower taxes.

Greenville, NC
United States

Louisiana Heroin Penalties Not Harsh Enough, Solon Claims

In Louisiana, merely possessing an ounce of heroin earns a mandatory minimum five-year prison sentence and up to 45 years, and possessing 400 grams (less than a pound) earns a 15-year mandatory minimum. Possession of any amount with the intent to distribute earns a five-year mandatory minimum sentence, and up to 50 years. That's not enough for one Louisiana legislator.

An ounce of heroin would get you eight years in prison under a bill proposed in Louisiana. (wikimedia.org)
Sen. J.P. Morrell (D-New Orleans) has introduced a pair of bills that would make those draconian sentences even harsher. Senate Bill 66 would double the mandatory minimum for possession with intent from five to 10 years, while Senate Bill 67 increases the penalty for possessing an ounce from five to eight years and the penalty for possessing 400 grams from 15 to 24 years.

Those bills are currently before the Senate Judiciary Committee, as is another Morell-sponsored bill, Senate Bill 3, which would alter the state's second-degree murder statute.

Under that law, deaths that occur during the commission of any of 15 specified felonies are considered second-degree murder, even if the perpetrator had no intent to kill. Morrell's bill would add "the unlawful sale, distribution, or dispensation of heroin, methamphetamine or 'crack' cocaine" to the list. Under Morrell's bill, people who sold those drugs to others who then overdosed and died could be charged with second-degree murder.

Yet another Morrell bill, Senate Bill 59, would make it a felony offense to use a minor in a drug trafficking offense or even to commit such an offense if a minor is present. Morrell seeks a 10-year mandatory minimum for that one, and up to 30 years. SB 59 has already passed out of committee and awaits a Senate floor vote.

Baton Rouge, LA
United States

Greece to Hand out Needles, Condoms in AIDS Fight

The Greek government announced Tuesday that it will begin harm reduction measures, including handing out condoms and needles to heroin addicts, in an effort to slow an alarming rise in new HIV cases, Agence-France Presse reported. The government anti-drug organization Okana and volunteer organizations will hand out 30,000 condoms and 10,000 needles as part of the effort, which will be initially launched in Athens.

view of the Acropolis at sunset (wikimedia.org)
"There is an imperative need for immediate action to limit the spread of infection," deputy health minister Michalis Timosidis said in a parliamentary document.

Greek health officials had reported in November that new HIV cases were up by 52.7% last year over 2010. The government center for disease control and prevention said over 800 new cases had been recorded through October 2011.

A third of the new cases were reported among gay men, but officials said most new cases were linked to prostitution and intravenous drug use. The number of new HIV infections among heroin users increased a whopping 1,250% in a year, the disease control center said.

Because of the economic crisis, Greece has been forced to radically cut social spending to eliminate budget deficits in order to receive loans from the International Monetary Fund and the European Union. Those spending cuts have seen staff layoffs and mergers in the health sector, which doctors said are weakening the effectiveness of the Greek health care system.

Athens
Greece

UN Anti-Drug Body Supports Overdose Prevention Measures

Delegates to the 55th session of the UN Commission on Narcotics Drugs (CND) in Vienna unanimously approved a resolution to promote measures to prevent drug overdose deaths last Friday. The resolution calls on the UN Office on Drugs and Crime (UNODC), the World Health Organization (WHO), and other international organizations to work with individual countries to address and reduce drug overdoses. Crucially, the resolution included mention of naloxone, an opioid antagonist that can effectively reverse opiate overdoses and which does not carry any danger of abuse.

Naloxone can save lives, the CND recognized Friday (wikimedia.org)
The resolution was introduced by the Czech Republic and cosponsored by Israel and Denmark (the latter on behalf of the European Union). Earlier in the week, Gil Kerlikowske, head of the US Office on National Drug Control Policy (ONDCP -- the drug czar's office) affirmed US support for overdose prevention. In his opening statement at the week-long session, Kerlikowske endorsed training public health and medical personnel in overdose recognition and response, as well as the use of naloxone and other overdose reversal medications.

"Every life is worth saving," said Dasha Ocheret, policy and advocacy program manager for the Eurasian Harm Reduction Network. "Everyone knows someone who has died from an overdose. It's thrilling that the United Nations recognizes this is a problem to be taken seriously and something can be done."

"This represents a critical step towards improving global public health," said Donald McPherson, director of the Canadian Drug Policy Coalition and former drug policy coordinator for the city of Vancouver. "The global overdose epidemic can be addressed with meaningful, evidence-based interventions to reduce the immediate potential harms associated with opioid use, and prevent unnecessary death. It is heartening to witness CND member countries take this step together to save lives."

The biggest risk of fatal overdose is around opiates and opioid pain medications. According to the UNODC, "the ingestion of opioids accounts for nearly half of the global drug-related deaths, and the majority of deaths could have been prevented." The UNODC puts the number of user of opium derivatives, both medical and non-medical, at around 21 million worldwide.

Opioid overdose deaths are generally preventable for three reasons: The deaths occur gradually after drug use, there are typically other people present, and the effects of overdose can be reversed with naloxone, also known under its brand name, Narcan.

In some countries, including some states in the US, there are ongoing programs to offer naloxone to drug users, their friends, and family members. Last fall, Massachusetts announced its 1,000th overdose reversal using naloxone. New Mexico has also been a pioneer in expanding the use of naloxone.

"Naloxone is a safe and effective medication that has been available for more than forty years," said Sharon Stancliff of the New York City-based Harm Reduction Coalition. "It's exciting that the UN has officially recognized the importance of making this life-saving medication more widely available. It is vital that it is made accessible to people who need it, both inside the hospital setting and outside, through emergency services and to family members of opioid users."

Vienna
Austria

Iran Executed Nearly 500 Drug Offenders Last Year

The Norwegian-based human rights group Iran Human Rights (IHR) has presented its annual report on the death penalty in the Islamic Republic and announce that at least 676 people were executed there last year. Of those, 480, or 71%, were executed for drug offenses, IHR said.

public mass execution in Iran, 2008 (ncr-iran.org)
The count of 676 executions was based on information reported by official Iranian news, other independent sources, or high-ranking officials in the Iranian judiciary. IHR said that the actual number of executions is "probably much higher" than that figure.

Of the 676 executions tallied by IHR, only 416, or 62%, were reported by official media or high-ranking officials. The group said some executions are not announced by state media, but lawyers and family members were notified prior to the execution. In other cases of "secret" executions, not even family and lawyers are notified. IHR left more than 70 additional reported executions off its tally because of difficulty in confirming details.

Drug offenses were far and away the most common death penalty charges. More than five times as many people were hung for drug crimes as for rape (13%) and more than 10 times as many as for murder (7%). Some 4% were executed for being "enemies of God," 1% for acts against chastity, and in 3% of the cases, no charge was made public.

Situated next door to Afghanistan, supplier of nearly 90% of the world's illicit opium and heroin, Iran has been waging a fierce "war on drugs" against smugglers and traffickers transiting the country on the way to European markets. But much of that opium and heroin is destined for Iran itself, which suffers one of the world's highest opiate addiction rates.

While China, the world's leading executioner state, may execute more drug offenders -- the numbers are hard to come by because China doesn't report them -- Iran leads the world in executions per capita, both for drug offenses and all offenses combined.

Last year, IHR helped launch the International Campaign Against the Death Penalty in Iran. More broadly, Harm Reduction International has an ongoing Death Penalty Project aimed at the 32 countries that have laws on the books allowing the death penalty for drug offenses. Opponents of the death penalty for drug offenses argue that such statutes violate UN human rights laws, which say the death penalty can be applied only for "the most serious crimes."

Iran

New Mexico Legislature to Study Supervised Injection Sites [FEATURE]

In a groundbreaking move, the New Mexico legislature has approved a proposal to study how to enhance and expand the state's already cutting edge harm reduction programs, including a look a medically supervised injection sites (SIJs -- sometimes also known as safe injection sites) for hard drug users. That could clear the way for an eventual SIJ pilot program to operate in the state, although considerable political and legal hurdles remain.

The legislation, Senate Memorial 45, was sponsored by Sen. Richard Martinez, whose constituency includes Rio Arriba County, which has a drug overdose fatality rate five times the state's rate. The state's rate is double the national rate, making New Mexico the nation's leader in drug overdose-related deaths per capita.

"These deaths are preventable," said Martinez. "Overdose spares no one and affects everyone, especially families."

State health officials estimate the state has at least 24,000 injection drug users. Other estimates put that figure as high as 50,000.

The memorial, which was also endorsed by the New Mexico Public Health Association, passed the Senate on a 43-0 vote Monday night and does not need any further action to go into effect. It directs the University of New Mexico's Robert Wood Johnson Foundation Health Policy Center to undertake the study of emerging and evidence-based harm reduction approaches, including SIJs, and report back to the legislature by November 1.

"Sadly, our drug overdose epidemic has outgrown our current harm reduction approaches," said Emily Kaltenbach, director of the Drug Policy Alliance (DPA) New Mexico office. "On Monday, our state senators realized this and did not let politics trump science. They clearly stated their intent to go beyond the status quo and explore innovative strategies to help New Mexico’s families."

"Wow, getting something like that on the state level is huge," said Hilary McQuie, Western director for the Harm Reduction Coalition (HRC). "New Mexico once again takes the lead in state harm reduction efforts; it's one of the few states to take a statewide approach to these things."

"Heroin is still the number one cause of ODs here, but we're also seeing a high number of prescription drug overdose deaths," said Kaltenbach, "so I'm incredibly encouraged that the legislature is willing to look beyond the status quo and start studying proven programs like supervised injection sites. We're hoping to study the feasibility and legal and ethical implications, leading to a pilot site in New Mexico."

If that actually happens, it would be the first SIJ in the nation. Although SIJS are operating in at least 27 cities around the world, including Vancouver and Sydney, and have been proven to reduce the spread of HIV, Hep C, and other blood-borne diseases, as well as prevent overdoses, without increasing criminality or drug use, political and legal obstacles in the US have so far prevented them from spreading here. They face morality-based opposition as well as federal issues including a "crack house law," which bars anyone from knowingly allowing others to use controlled substances.

"These same sorts of issues came up when syringe exchange programs were first discussed," said Kaltenbach. "I think the legal issues can be overcome, but the states have to be willing to look at it as an extension of syringe exchange. This study will address those issues."

While New Mexico is the first state to order a study of SIJs, it isn't the only place in the country where they are on the agenda. In San Francisco, drug user groups, activists, and advocates are working toward winning approval for one there, while in New York City, a similar effort is going on.

"The biggest obstacle is the perception of legal barriers," said DPA's Laura Thomas, who has been working on the San Francisco effort. "We have these crack house statutes, as well as state laws, that say it's illegal to knowingly allow people to use controlled substances. We have to figure out if there's room for a research project, like in Sydney, or create an exemption, like in Vancouver, or get a state law passed, like in New Mexico. We need a ruling that says 'yes,' this is not a violation."

http://stopthedrugwar.org/files/richard-martinez.jpg
Richard Martinez
In the meantime, the achingly slow process of building political support for an SIJ, or at least a feasibility study, goes forward. A year ago this week, a city Hep C task force recommended looking at SIJs. That followed on a similar recommendation from the city's HIV coalition.

"We continue to try to build support for a safe injection site," said Thomas. "During the mayoral campaign last year, at one of the candidate forums, they were all asked if they would support evaluating whether it would work for San Francisco, and most of them said they did, including our current city attorney, Dennis Herrera."

But despite the recommendations and expressions of support, nothing has happened yet. The San Francisco Drug Users' Union is trying to change that.

"We will be pressing the Board of Supervisors to study the possibilities," said the group's Isaac Jackson. "We're also doing a SIJ community design competition, a project in community imagineering. We'll give the winner a nominal prize and we'll present the winning design to the Board," he said.

"We think the city's Human Rights Commission will recommend safe injection sites in April," said HRC's McQuie. "But there have been other bodies and other recommendations. It's a matter of where the political will is and the priorities are."

For HRC, said McQuie, getting a safe injection site up and running in San Francisco is a back burner issue right now, but that could change.

"We have a lot of really great harm reduction projects going on, like the DOPE Project, that aren't getting financial support, and while there was a lot of enthusiasm for awhile about working toward a safe injection site, we kept planning meetings, but nobody would show up. It didn't feel like the energy was there. If the San Francisco Drug Users' Union wants to take some leadership, we would be happy to support it," said McQuie. "I think we will be going back to San Francisco and asking somebody to do something on this issue, but we're not sure who yet."

On the other side of the country, street-level activists are aiming for an SIJ in New York City. Citiwide Harm Reduction in the South Bronx, which is on the verge of opening the city's first fully staffed primary care clinic at a syringe exchange, is preparing to build a full-scale model of an SIJ at its 144th Street building. It may seem like performance act, but its purpose is educational.

"Our inspiration is the Smithsonian museums, where you can go inside the cockpit of the space shuttle," said Citiwide executive director Robert Cordero. "People have this grisly misconception of what a safe injection site would be like, and we want them to be able to have this Smithsonian experience here in the Bronx."

Such a model could be quite useful in educating elected officials and law enforcement, Cordero said.

"SIJs are a humane public health approach to reducing overdoses, HIV, Hep C, and crime, and can provide compassionate care for addicted people until they are ready to get into treatment," he said. "Do we want that, or do we want them just hanging out in front of the bodegas on 149th all day?"

Citiwide isn't going it alone on agitating for SIJs, and it isn't even taking the lead. Instead it is working with groups like HRC and the Vocals-NY Users' Union in a broader campaign.

"We're not trying to be the HRC or Vocals-NY," said Cordero. "We advocate through demonstrating what it would be like while partnering with others who are advocating every day. Our effort is to build the SIJ model, and when anyone comes to New York who is interested in these issues, there can be an educational moment."

Supervised injection sites are not a reality yet in the US, but pressure for them is mounting. Whether it's New Mexico, New York City, or San Francisco, one of these years someone is going to lead the US into the ranks of nations that understand their utility -- and their humanity. New Mexico has just taken a giant step, but let's hope it has to move fast to beat San Francisco and New York.

Santa Fe, NM
United States

San Francisco Marks 600th Overdose Death Prevented

For the past eight years, the San Francisco Department of Public Health has been handing out the opioid antagonist naloxone (Narcan) in a bid to reduce heroin overdose deaths. This week, the city marked what it said was the 600th life saved by using the overdose-reversal drug.

This drug stops heroin overdoses -- 600 so far in San Francisco (wikimedia.org)
The city distributes naloxone through needle-exchange sites, nonprofit organizations, and community organizations that deal with injection drug users. The department also prescribes the drug to people in residential hotels and the friends and families of heroin users, and conducts training sessions in the county jail.

Not only have hundreds of overdose deaths been averted, but the department also reported that heroin-related visits to the city's emergency rooms had declined by half between 2004 and 2009.

The lifesaving measure is funded by a department expenditure of $73,000 a year, which goes to the Oakland-based Drug Overdose and Prevention Education Project (DOPE Project). DOPE uses the money to buy and distribute the drug and train people on how to use it.

"San Francisco has always been a heroin town," Alice Gleghorn, DPH's head of Community Behavioral Health Services told the SF Weekly. "At one time, San Francisco had an overdose death every day, and that rate has really gone down. I hope our naloxone programs have contributed to that drop. But we don't have the money to do the research."

Eliza Wheeler, director of the DOPE Project, compared naloxone to insulin and said its use posed few problems for injection drug users. "The folks we see are pretty adept with administering drugs, so they'll be okay. People are very capable and willing to save their friends' lives... my experience is that people are really proud of themselves," Wheeler said.

Harm reduction is saving lives in San Francisco. Perhaps other cities and counties should take heed.

San Francisco, CA
United States

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