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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.

https://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.

https://stopthedrugwar.org/files/opium-fiend.jpg
"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."

https://stopthedrugwar.org/files/social-poison.jpg
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.

Ohio Cop Kills One in Undercover Bust Gone Bad

Cincinnati Police undercover officers shot and killed one man and wounded another during a drug buy gone bad Wednesday night. Montez Oneal, 19, becomes the 59th person to die in US domestic drug law enforcement operations so far this year.

According to WKRC TV 12 News, acting Police Chief James Whalen said Friday Oneal was driving a car that drove away from two undercover officers who attempted to pull it over after buying heroin from the three men inside. Oneal's vehicle eventually drove into a dead end, when he allegedly put the car in reverse and slammed into the unmarked car carrying the undercover officers. Another Cincinnati police officer in a patrol car then pulled his cruiser beside Oneal's car to try to box him in.

At that point, according to Whalen, one of the men then jumped out of the vehicle, pointed a weapon at the uniformed officer, then fled as the officer fired on him. Whalen said police did not think that suspect had been hit. He remains at large.

Then, Oneal stepped halfway out of his car and fired at the uniformed officer with a .45 caliber handgun. The officer returned fire, striking Oneal multiple times. He died at the scene. A third man in the vehicle, Robert Matthews, 23, who was the target of the investigation, was in the back seat. He was wounded when the officer fired on Oneal, then treated at a local hospital and jailed.

The police shooter, Officer Orlando Smith, has been reassigned to administrative duties pending the outcome of an investigation into the shooting.

Cincinnati, OH
United States

Drug War Chronicle Book Review: The Lebanese Connection

The Lebanese Connection: Corruption, Civil War, and the International Drug Traffic, by Jonathan Marshall (2012, Stanford University Press, 261 pp., $24.95 HB)

It's harvest time in Lebanon right now, and Shiite farmers in the Bekaa Valley are out working their fields, preparing to turn thousands of acres of cannabis plants into hashish, the Red Lebanese and Blond Lebanese for which the tiny Middle Eastern country is famous. And with the harvest comes conflict, as the country's anti-drug agency and the Lebanese Army head out into the fields to try to eradicate them.

The Chronicle reported at the beginning of August about hash farmers firing machine guns and RPGs at eradicators, vandalizing tractors and bulldozers used to plow under the fields, and organizing street blockades in cities in the valley. Protests broke out in Yammouneh, Baalbek, and Boudai, and authorities backed off, announcing a week later that they would form a committee to study development issues in the Bekaa. And the harvest goes on.

Of course, it wasn't just farmers' resistance that hampered the eradication effort this year. The Bekaa Valley, with its Shiite tribes, sits right next door to Syria, currently embroiled in a brutal civil war now based largely on sectarian and confessional divisions, many of which echo profoundly in Lebanon. In fact, Lebanon was part of Greater Syria until the French carved it out under a League of Nations mandate in 1943. Now, it has seen outbreaks of street fighting between rival pro- and anti-Assad militias in Tripoli, the largest city of the Lebanese north, as well as kidnapping by Shiite tribal militias after some of their number were kidnapped by Sunni militias on the other side of the border.

"Our policy is very clear. We want to demolish all of the hashish cultivation in the Bekaa," Col. Adel Mashmoushi, head of the office of drug control, tells the Lebanon Daily Star a couple of weeks ago, before quickly adding that eradication had been enfeebled this year because "the situation in the Bekaa is very delicate right now" due to "the political and security situation caused by Syria."

Mashmoushi said his men had managed to destroy only about 1,500 acres of cannabis fields out of what he estimated to be somewhere between 7,000 and 10,000 acres planted in the northern valley.

But, as global drug trade scholar Jonathan Marshall makes clear in his masterful and highly informative The Lebanese Connection, despite the terrifying sectarian war next door, the violent echoing clashes in Tripoli, and the Bekaa farmers' and traders' violent defense of their industry, this is a relatively quiet time in Lebanon's history in the international drug trade. According to his elaborately sourced estimates, Lebanese hash production was at level five to seven times higher during the period on which he focuses, the Lebanese civil war of 1975 to 1990.

In fact, relying heavily on archival State Department, Federal Bureau of Narcotics, and DEA documents, among other sources, Marshall shows that the tiny sliver of the Levant that is Lebanon was a giant in the drug trade going as far back as the 1950s and a significant hash producer as early as the end of World War I.

Its largest market back then was Egypt, which had been supplied by Greek growers. But when the Greeks banned cannabis planting in 1918, poor Shiite farmers in the Bekaa took up the slack, and they haven't stopped growing ever since. Production boomed during the civil war and was banned in 1992 after the return of a central government, but it has never stopped. Eradication programs have been half-hearted, ill-conceived, and met with hostility, and promised alternative development schemes somehow never seem to materialize.

But it wasn't just hash, either. With Beirut a rising financial center for the Middle East and the center of global networks of Lebanese traders, Marshall shows definitively how it also became a center of the global drug trade. Opium skimmed from legal production in Turkey was smuggled into Syria by Kurds, transmuted to morphine base by Syrian chemists in Aleppo, smuggled into Lebanon by various means and various actors, transported through seaports controlled by Christian politicians to be delivered to French (later, Italian) organized crime groups, whose chemists refined it into heroin, and whose international networks, including American mobsters, sent it on the veins of consumers in the West.

In a history replete with ton-plus hash busts and multi-kilo heroin seizures, Marshall works his way through the underworld of Lebanon-based drug trafficking, its connections abroad, its crime bosses and political allies, both foreign and domestic. Along the way, he exposes the hypocrisy and cynicism of numerous nations, who with one hand raged against drugs, while with the other were complicit in--or at least looked away from--the billion-dollar a year business.

Marshall excels at seeing through the smoke of the murky milieu where all this took place. And what a milieu! Beirut in the mid-20th Century was a decadent, cosmopolitan oasis in the desert of Middle East culture, home to Westernized Arab princes, anything-goes nightclubs, lavish casinos, and European prostitutes. It was also awash in spies, arms dealers, and adventurers -- the Cold War Russian and American intelligence services, the French, the Israelis, the Syrians, the Turks, and, after the Iranian Revolution of 1979, a flashpoint of the brewing proxy war between the Shia Islam of Iran and the Sunni Islam of Saudi Arabia and the Gulf States.

And Lebanon was a weak, communally divided state operating under a political agreement that divvied up key political positions by sect -- the Christian Maronites got the presidency and the leadership of the armed forces, the Sunnis got the prime minister's office -- but froze those divisions even as the demographic makeup of the country shifted toward its Muslim communities, not to mention an influx of hundreds of thousands of Palestinian refugees from Israel, and later, Jordan after the Hashemite kingdom drove out the PLO in 1970.

A weak central state, rising sectarian tensions, highly profitable drug smuggling operations, external manipulation by any number of foreign interests, and a tradition of corruption in government came together in a perfect storm as Lebanon imploded into civil war in 1975, not to emerge from it for 15 years. When it came to the role of drugs in the conflict or to arming the various factions, Marshall shows definitively that nobody had clean hands.

As the Lebanese economy crumbled amidst the violence, the importance of the illicit drug economy became all the more critical for the militias: they relied on drug profits to pay their soldiers and buy their weapons. The global drug trade may not have been the cause of the conflict (although it was a cause -- Marshall cites incidents of precursor violence between Christian and Palestinian militias over drug deals that helped ratchet up the tension), but he shows that it was profits from the trade in prohibited drugs that allowed the contending factions to make the war deadlier and longer than it otherwise would have been.

He also shows that some of the most deadly fighting was not for sectarian reasons, but over control over lucrative drug smuggling routes and, especially, ports. And, paradoxically, he shows how complicity in the drug trade overcame sectarian and even regional divisions: Syrian soldiers patrolling the Bekaa turned a blind eye to Shiite hash farmers, who trafficked their product with the connivance of Christian Maronite warlords. Meanwhile, Israeli military intelligence turned a blind eye to hash smuggled into and through Israel by its allies in the South Lebanon Army or by other traffickers from whom it thought it could glean intelligence.

The Lebanese Connection is too dense with chewy information to do more than touch on its contents in a review, but it is a sterling contribution to the academic literature on the global drug trade, having made a truly original contribution.  It also opens a revealing view not only on the contemporary Middle East, but contemporary terrorism, covert operations by state and non-state actors, and the making of narco-states and failed states.

It's also a very timely book, appearing as Syria bursts into flames. Syria is Lebanon writ large: many of the same ethnic and sectarian divisions are at play, as is the international meddling at several levels of proxy war, with familiar faces like the US, Britain, France, Iran, Israel, and Saudi Arabia all seeking to influence the outcome and doing goodness knows what behind the scenes. Syria, however, is not a major global drug trade hub, but careful followers of the  situation there will have noted the occasional accusations -- from both sides -- of  "criminals" being involved. Maybe in 20 years, we will have a better idea of what went on behind the scenes and the role of drug trafficking and smuggling networks there. In the meantime, The Lebanese Connection provides some insight into the forces at play.

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

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