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Commentator: Why Do Pols, Society Ignore Failure Of Drug War? (Opinion)

Location: 
United Kingdom
Last year, Professor Neil McKeganey of the University of Glasgow, one of the most respected academics in Britain, established that the authorities seize just 1% of the heroin that enters Scotland in any one year. But where are the headlines about this utter failure? Documentary filmmaker Angus Macqueen thinks he knows the answer -- our drug policies have been hijacked by the emotive rhetoric of moralists.
Publication/Source: 
The Crime Report (NY)
URL: 
http://thecrimereport.org/2010/08/03/commentator-why-do-pols-society-ignore-failed-drug-war/

HOPHEAD CONFESSIONS!!! A DISEASE OR A CRIME???!!!

"The individual has always had to struggle to keep from being overwhelmed by the tribe. If you try it, you will be lonely often, and sometimes frightened. But no price is too high to pay for the privilege of owning yourself." "All things are subject to interpretation; whichever interpretation prevails at a given time is a function of power and not truth." "The advantage of a bad memory is that one can enjoy the same good things for the first time several times." "A little poison now and then: that makes for agreeable dreams." -F. Nietzsche Recreational narcotic addiction. This subject is as welcome in polite company as recreational pedophilia I suppose. But here I write from the the eye of the hurricane, no longer in the belly of the beast. Perhaps this is a privilege of age and white skin and a little luck. But still I must suffer the financial toll of the gray and black market. And the little HepC bugs gnawing on my liver. I've used narcotics for pleasure since 1971, opium was my preference, or chemical narcotic drugs whenever opium was not available, which is now virtually all the time. The "drug world" has changed over the years that I have used, or "practiced" as the old timers used to call it, and not for the better. The available "street" narcotic, heroin, has declined in quality terribly over the decades. At least the junk that comes from Mexico, which is now the primary heroin source for the U.S. it appears. Despite the government inflicted propaganda that both Cannabis and heroin are both now much "stronger" or of a higher quality than we "baby boomers" had access to when we were young: think Vietnamese black, Cambodian red or the ultimate moonrocket weed, Thai. And Double U-O Globe brand #4 "China white" heroin smuggled from Vietnam and Thailand (90-99% purity). This was 40 years ago. Don't let my generations always narrow minded and often duplicitous career social engineers bullshit you. Street heroin is and has been cut with just about everything under the sink over the last couple decades. When I was young heroin was cut with lactose. Too far down the "junk pyramid" some might be cut with procaine in the west, or quinine in the east. I lived in L.A. during the 80s when crack profits funded the rapid proliferation of criminal gangs. After a period of drug abstinence, in 1994 I went to score near 6th and Union, an old open heroin street market in L.A. Once inhabited by independent dealers, the area had, in my "absence" been claimed, tagged off and monopolized with armed force, as 18th Street gang turf. And the 18th Street gang was cutting their dope with shoe polish. The drugs induced delirium and a near death experience for me. Others were not so lucky, I suppose. I've only dabbled in junk over the last 20 years, the quality and/or cut of the junk has been so bad, even for strong dope of high "purity" that I believe I flushed a good 20% of all the nasty stuff I've purchased over the last 20 years. Todays veinless junkies carry the brown recluse spiderbite like scars of the filthy junk that is contaminated with flesh eating bacteria. And the veins go fast using the shit on the street these days. Thank God and the pharmaceutical companies for all the nasty pills people mix like inept alchemists, or maybe lemmings. But save the pantapon and dilaudid for me. I suppose. You can have the OC. That little hook takes too long to shake off. And the "cures" for narcotic addiction, addiction to the narcotic drugs methadone and buprenorphine. I think I'll pass on that too. Highly educated academic addiction specialists with the insight of virgin sex therapists, armed with reductionist and social pseudoscience, tell me I suffer from a disease of the brain. This disease forces me against even my own will to desire and consume opium. Help I cry. A huge mutliizillion dollar addiction recovery complex is now in place to help the newly painpill addicted avoid, allegedly, the suffering of drug withdrawal. O the Horror! I recently read that some addicts may need to be addicted to buprenorphine or methadone for life in order to medically recover from addiction. Orwellian medspeak? Others say that I am merely a criminal in need of incarceration or worse in order to save society from itself. Personally I think I just have an acquired taste for a forbidden fruit. But truthfully, to ask me to abstain from this passion permanently is no more reasonable than demanding lifelong sexual abstinence. That conformity is part of your moral code, not mine. This acquired taste runs deep. I practice temperance and self restraint in my use of narcotics and it is no more reasonable of you to hold me responsible for the actions of criminal or terminal addicts than it is of me to hold social drinkers responsible for the actions of criminal or terminal alcoholics. I've kicked many times and always on my own. I do not relapse. I freely choose to use narcotics with eyes wide open. Opium is best suited for use by very mature and stoic individuals. Paradise is temporary and fleeting. Agony is the price exacted for lingering in this paradise. And payment is due in full immediately at the exit when the ride is over. I'm personally fine with this price tag, thank you. Those who wish to avoid agony and suffering should steer clear. Don't you suppose? "O mother of pearl, I wouldn't change you for the whole world". -B. Ferry

Feature: Schwarzenegger Trying to Gut California Methadone Funding in Budget Move

With California facing a $19 billion budget deficit, Gov. Arnold Schwarzenegger (R) last month proposed saving the state $53 million by cutting off Medi-Cal funding for methadone maintenance for most heroin addicts. That would cause the loss of more than $60 million in matching federal funds. The move was fiercely resisted by methadone advocates -- including a former drug czar -- and public policy analysts, and the proposal was defeated last week in committee votes in the state Senate and Assembly.

But California gives the governor the power to veto individual budget items, so advocates are not resting yet. Instead they are reaching out to the administration in hopes they can enlighten it and persuade the budget axe-wielding Schwarzenegger to aim elsewhere.

Schwarzenegger isn't the first top-tier elected official to go after methadone maintenance. Back in 1999, then New York City Mayor Rudy Giuliani vowed to wean all of the city's methadone patients off it in three months. While Giuliani acted for ideological rather than budgetary reasons -- he said he wanted "drug freedom," not drug dependence -- the pugnacious mayor later changed his tune, admitting the idea was "maybe somewhat unrealistic."

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superheroes for harm reduction: ''Methadone Man'' public awareness campaign during last February's Olympics in Vancouver. You're needed everywhere, Methadone Man.
Currently, nearly 150 methadone clinics provide the heroin substitute to some 35,000 addicts, 55% of whom are on Medi-Cal. Advocates and treatment providers said that clinics would be forced to close if the proposal passed, affecting not only the Medi-Cal patients, but also patients who paid out of their own pockets or through private insurance to be able to get maintenance methadone.

"Methadone isn't a cure," said Roxanne Baker, president of the National Alliance of Methadone Advocates (NAMA), "but much like thyroid medication, as long as you keep taking it, it keeps your disease in check, and opiate addiction is a disease. When you mess with your brain with painkillers, it then doesn't produce the endorphins it should. It's not a matter of will power, it's a disease. You need something to replace those endorphins, whether its methadone, suboxone, or even prescription heroin, although I doubt we'll ever see that here."

Enacting the proposed cuts would be "a disaster," said Baker. "There would be no methadone programs left. More than half the patients statewide are on drug MediCal, and they wouldn't even have a place to go. A lot of these people have their lives in order. This is somebody's brother, somebody's aunt, somebody's mom. Please don't take this from us."

Last week, Clinton-era drug czar Gen. Barry McCaffrey flew into the state to hold a press conference denouncing the cut. "Dumping tens of thousands of opiate addicts back on the street would be an immediate disaster to law enforcement, and to the families of people who have become stable, functioning adults" thanks to methadone, said McCaffrey, who has a consulting firm and serves on the board of directors of an organization that treats chemical dependency.

Legislators were listening, not only to McCaffrey, but to the methadone treatment community. A Senate Budget Committee hearing last week proved tough going for Schwarzenegger's representatives.

"This measure would eliminate the drug MediCal program with the exception of the perinatal and youth funding," said John Wardlaw from the state Department of Finance. "This is not an easy reduction in any way. We are at the point where we are making very difficult reductions."

Committee Chair Denise Moreno Ducheny (D-San Diego) wasn't buying it. "How much federal funding are you giving up?" she asked.

"Sixty-six million dollars," Wardlaw said.

"We save $53 million and lose $66 million?" asked Ducheny.

"That is correct, ma'am."

Ducheny just stared at him for a few uncomfortable moments before moving on to the next witness.

"There would be cost shifts in the area of corrections and child welfare services," Greg Tallivant of the legislative analysts' office told the solons. "The day the clinic closes, those people have to do something. If they can't make it to the next methadone clinic, heroin would be the next choice. You would see people arrested. You would see prison costs and child welfare costs go up."

Assemblyman Mark Leno (D-San Francisco) was visibly irritated by the proposal. "There is a complete lack of interest in any cost-benefit analysis here," he said. "This is reckless and cavalier. It doesn't really make much sense. We have 171,000 people addicted to drugs. This will increase our crime rate; it's a recipe for disaster on our streets. Does the governor have no interest in this or does he not believe that this will impact the safety of our children and communities? We've already zero-funded the base Proposition 36 program. The outcome of this is to have drug offenders with no jail and no treatment."

"This is really a short-sighted proposal that shifts costs from funding treatment to funding law enforcement, jails, and prisons," said Jason Kletter, a member of the Bay Area Addiction Research Team (BAART), which is in turn a member of California Opioid Maintenance Providers (COMP), a nonprofit organization representing opioid maintenance treatment centers. "It is a public safety issue, to say nothing of the humanitarian crisis it would provoke," he said.

"We think if this happened many clinics would close, and the folks who lose access to care would likely relapse and cost the system much, much more in a short time," said Kletter. "We see relapse rates of 80% within a year when clinics close, so it wouldn't even be like we'd be kicking the can three or four years down the road."

"This would have the biggest impact on programs that have a high percentage of Medi-Cal beneficiaries in treatment and would be unable to stay open because more than half their patients, and thus, their revenues, are gone," said Kletter. "You would have a fundamental dismantling of the system."

The cost incurred would be staggering, Kletter said."If 80% relapse in same year, we know that the state will incur $700 million to $1 billion in new costs in the criminal justice system," he said, citing a study from the 1990s that found each dollar invested in treatment produced a seven-dollar return. "The state wants to save $53 million by eliminating drug Medi-Cal and will also turn away more than $60 million in matching funds. That's $115 total program cost. A seven-to-one return on that is close to a billion dollars. "With 80% relapse, we could end up seeing $700 million in new criminal justice and prison costs."

"It's a terrible proposal," said Glenn Backes, a Sacramento-based public policy analyst who works with the Drug Policy Alliance at the Capitol. "California Democrats in both houses have said so. The Senate Republicans didn't do a cost-benefit analysis; they just said we can't afford to give out subsidized health care."

But in reality, the situation is even worse, said Backes. "They've killed Proposition 36 funding, drug courts are being slashed. According to the governor's finance director, that's 171,000 patients. The cost-benefit for this is worse than nil. If only one out of a thousand relapses and goes to prison, you've already lost money because prison is so much more expensive than treatment. If only one out of a thousand gets Hep C, the taxpayer loses. If only one out of a thousand gets HIV, the taxpayer loses."

It's easy to lose the human side in all the numbers, Backes said. "If only one out of a thousand ODs and dies, that's 170 California families who have lost a loved one."

And the battle continues. "While both the Senate and the Assembly budget committees have rejected the governor's proposal, in California, the governor has a line item veto," said Kletter. "We are continuing to try to work with the administration to explain the impact of this kind of proposal and get them to understand it is a public safety and cost-shifting issue. We haven't had any direct meeting with them yet, but that's next on our agenda. We want to educate them about them dire consequences of this sort of action."

Even if advocates many to salvage the drug Medi-Cal program, they would be well-advised to be searching for alternative funding sources, and how better than to take money from the drug war? Tough times call for creative solutions, and Backes has one: Use federal Byrne Justice Assistance Grants to fund treatment instead of drug task forces. Every dollar funding more drug war arrests costs $10 additional in spending for courts and prisons, he said.

"Historically, Byrne grant funds have been given to task forces to increase arrests," Backes noted. "The Drug Policy Alliance position is that Byrne funds would be better spent on almost anything other than doing low-level drug sweeps. We would rather see that money go into treatment for people in the system."

Opiate Maintenance: Prescribing Heroin to Hard-Core Addicts Keeps Them Off Street Smack, British Study Finds

In research findings reported in The Lancet, scientists monitoring the Randomized Injectable Opiate Treatment Trial (RIOTT) reported that allowing addicts who have failed to get off heroin to use injectable "medical grade" heroin resulted in lower levels of street heroin use than in addicts given either oral or injectable methadone. The research was done by Professor John Strang and colleagues from the National Addiction Center's Institute of Psychiatry at King's College in London.

Up to 10% of heroin addicts fail to respond to conventional treatments, for reasons that are unclear. In recent years, scientific evidence suggesting that providing medicinal heroin, known as diamorphine in the United Kingdom, under supervision is an effective treatment for chronic heroin addiction, has only increased. This study adds to the mounting evidence.

The RIOTT study chose as subjects chronic addicts who were receiving oral maintenance doses, typically of methadone, but were continuing to regularly inject street heroin. Subjects were provided with oral methadone, injectable methadone, or injectable heroin over a half-year period. At the end of the study, 80% of the subjects remained in treatment, with the highest figure for those using heroin (88%), followed by injectable methadone (81%) and oral methadone (69%). Among subjects who had 50% or more negative samples for street heroin -- the authors' measure of measurable improvement -- 66% of medicinal heroin users avoided street smack, while only 30% of injectable methadone users did and only 19% of oral methadone users did.

"We have shown that treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone," the authors said in a press release announcing the findings. "Furthermore, this difference was evident within the first six weeks of treatment."

Noting that the UK government's 2008 Drug Strategy had called for rolling out prescription heroin and methadone to clients who don't respond to other forms of treatment, contingent on the results of the RIOTT study, the authors said the results were in and it was time to act. "In the past 15 years, six randomized trials have all reported benefits from treatment with injectable heroin compared with oral methadone. Supervised injectable heroin should now be provided, with close monitoring, for carefully selected chronic heroin addicts in the UK," they concluded.

"Our scientific understanding about how to treat people with severe heroin addiction has taken an important step forward," said Professor Strang. "The RIOTT study shows that previously unresponsive patients can achieve major reductions in their use of street heroin and, impressively, these outcomes were seen within six weeks. Our work offers government robust evidence to support the expansion of this treatment, so that more patients can benefit."

You can watch Professor Strang discuss the findings here.

Feature: Reed College in the Crosshairs of Prosecutorial Drug Crackdown

While Oregon sees hundreds of drug overdose deaths a year -- from both illegal and prescription drugs -- a pair of publicity-seeking state and federal prosecutors have made a small Portland liberal arts college where two students have died of heroin overdoses in the past two years the public focus of their attack on the drug trade. Last week, Reed College President Colin Diver was summoned to the federal courthouse in downtown Portland, where he was warned that the school could face a cutoff of federal funds, including student loans, if it is not found to be taking "adequate steps to combat illegal drug activity," starting with this weekend's annual school year-end bash, Renn Fayre, which the prosecutors vowed will be filled with undercover police determined to quash drug use and sales.

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Renn Fayre (sarako on flickr.com)
According to the Oregon State Medical Examiner, 119 people died from heroin overdoses in 2008 and 127 in 2009. Including prescription drug overdoses, 492 Oregonians died of ODs in 2008, 270 from prescription opiates. For some reason, the State Medical Examiner did not include prescription drug deaths in the 2009 figures.

In Multnomah County alone, where Reed is located, 63 people died of heroin overdoses in 2008 and 71 in 2009. That's more than one a week for both years. But no other single overdose or pair of overdose deaths has excited the reaction displayed by state and federal prosecutors who went after Reed last week.

Reed makes an excellent target for drug warriors. For decades, the academically rigorous school has had a reputation as a counterculture haven where drug use is accepted. While that reputation is overblown and outdated, students say, it makes the college a handy lightning rod for those engaged in the culture wars.

Enter US Attorney for Oregon Dwight Holton and Multnomah County (Portland) District Attorney Michael Schrunk. In an email to Divers that they asked be forwarded to the Reed community, the prosecutorial pair used the deaths of the two students as a battle cry for a crackdown.

After lamenting the loss of the students, they wrote: "But while now may be a time for reflection and grief, it is also a time for action. It is now time for the Reed community to abandon the myth that drug use is a safe and acceptable form of exploration. It is time for Renn Fayre and Reed to adopt a zero tolerance policy prohibiting illegal drugs flat-out."

It isn't beatnik days anymore, prosecutors wrote, in a bid to appeal to Reed's countercultural heritage: "The illegal drug trade has changed radically since the days when giants like Alan (sic) Ginsberg and Gary Snyder '51 roamed campus here. The fact is that the drug trade is now fueled by one of the most potent forces in the West: greed."

The pair then explained at length how "drug cartels" are "targeting middle class and wealthier kids," then went on to say they made no distinction between non-lethal drug like marijuana and drugs like heroin. "Don't get sucked in by this bogus Siren call. The fact is that if the Reed community insists that this is 'not our problem' and tries to draw distinctions between 'hard' and other drugs, you will send the message that drug use can be safe... It is time for the Reed community to embrace the notion that drug use is not safe and it will not be tolerated -- without fine print, without provisos, and without conditions."

They then issued a blunt warning: "As the top federal prosecutor in Oregon and the Multnomah County District attorney, we have a responsibility to this community -- including you and your families. We cannot, and we will not stand by if drug use is tolerated on your campus. We cannot, and we will not stand by if Renn Fayre is a repeat of years past -- where even in the wake of Alejandro Lluch's death drug use and distribution were allegedly rampant."

Finally, the prosecutorial pair gallantly offered their assistance: "We stand ready to help in any way we can. If need be, we will use all the tools available to us in federal and state law enforcement. We owe that to the people of our community, including you."

A suitably cowed President Diver responded with his own email to the Reed community: "My message regarding drug use at Renn Fayre 2010 is very simple: Do not use illegal drugs. That means no marijuana, hallucinogens, designer drugs, cocaine, amphetamines, opiates, or other illegal substances."

Diver said he got a forceful and direct message from the prosecutors: "Shut down illegal drug use and distribution at Reed College, starting with Renn Fayre. Based on ongoing criminal investigations, including conversations with current and former students and other sources, these officials have heard numerous allegations about drug use at Reed, and particularly at Renn Fayre."

Diver also mentioned the threats he received: "In the course of the conversation, the US Attorney pointedly referred to a federal statute that makes it a criminal and civil offense for anyone knowingly to operate any facility for the purpose of using illegal drugs. We were also reminded of federal legislation that allows all federal funding -- including student loans -- to be withdrawn from any college or university that fails to take adequate steps to combat illegal drug activity."

On Wednesday, Diver was forced to clarify. According to Inside Higher Education News, the US Attorney only cited the federal crack house statute, under which Reed could face large fines, not the Drug-Free Schools Act, which is the statute that could impact student loans, Diver said. While the US Attorney "referred to federal legislation that could be applied to the college if it failed to crack down more forcefully," he never cited the Drug-Free Schools Act, Diver conceded.

In his email to the Reed community, Diver also delivered a more immediate warning: "We have been told that, during next weekend's Renn Fayre celebration, undercover Portland police officers will be circulating on campus, uniformed Portland police officers will be on alert to respond immediately to calls, and prosecutors stand ready to process criminal charges."

The prosecutorial shakedown has stirred controversy both on campus and in the broader Portland community, with many defending Reed's students, while others say the "druggies" need to be brought under control. In any case, Reed's reputation has complicated its relations with law enforcement.

"There's always a market here for a 'Reed is strange and weird' story," Bear Wilner-Nugent, a Reed alumnus, one-time director of Renn Fayre, and Portland criminal lawyer told USA Today this week. "I think it's going to scare students using drugs to be more underground. I think it's going to discourage students from seeking help for drug problems. It's a waste of resources on what is a tiny fingernail clipping in the drug problem," he said. "It's showboating."

Wilner-Nugent will be attending Renn Fayre again this year, and he said it compares favorably with end-of-semester parties at other schools. "There's a less macho attitude to it, there is less drinking and so you don't see the sexual harassment compared to other institutions," he said. "They are busting one of the saner and healthier college parties in the nation."

"This is the first time any college president has been threatened with the loss of federal funding because of campus drug use, so that's pretty interesting," said Jon Perri, West Coast coordinator for Students for Sensible Drug Policy (SSDP). "We need to be criticizing those prosecutors, as well as law enforcement, for sending in undercover agents and spreading misinformation about drug dealers coming in to target rich white kids. And we need to keep after Reed President Divers, who after his sit-down with prosecutors, basically said don't do illegal drugs, then mentioned a long list of drugs that doesn't include alcohol, which does more harm," Perri pointed out.

"Our chapter there is actively participating in the planning for Renn Fayre, and they will be waging a Good Samaritan policy campaign, while the feds are coming in and trying to do the same old stuff," Perri. "Reed SSDP is trying to pitch it as instead of trying to increase penalties, try something that will save lives."

Perri said he worked with students at Reed to reactivate the Good Samaritan campaign after the second student death. Good Samaritan policies allow drug overdose victims or their friends to seek help without fear of arrest, or, in the case of colleges, academic discipline. "I encouraged them to get it back up and running," he said. "They were wary of starting a campaign because they didn't want to be seen as politicizing those kids' deaths, but that's what the prosecutors have now done."

While by all accounts there has been drug use at Renn Fayre in past years, it is a much milder, less raucous event than many end-of-year campus parties, with a penchant for hallucinogens -- not heroin -- and an abundance of weed. Renn Fayre also features full-body human chess, softball tournaments, a great feast, and lots of music. And alcohol for those over 21.

"Everyone here fears that come Saturday there could be mass arrests for marijuana possession and underage drinking," said Reed SSDP chapter head McKenzie Warren. "It some senses, it's not totally surprising because there has been a lot of local press aimed at Reed, but there is a lot of worry," she reported. "ODs happen all the time, but the homeless population isn't going to get the same focus as a well-known private liberal arts college," said Warren. "Over the years, Reed earned a reputation as a crazy drug-taking school. Maybe it once was, way back in the 1970s, but these days the reputation outstrips the reality."

Reed SSDP is working with other campus groups to protect students from the tender ministrations of law enforcement, Warren said. "We have a number of groups working on harm reduction this weekend, we've had a Reed alumni who is a lawyer come and give talks on how to deal with the police, especially with respect to dorm rooms, and we printed up 1,500 ACLU know your rights cards. We've also been putting up flyers and posters."

And it will push for a full-fledged Good Samaritan policy. "We have only half a Good Samaritan policy," said Warren. "The school just adopted a new implementation plan for our drug policy, and it differentiates pot and alcohol from harder drugs. There is a Good Samaritan policy for alcohol and marijuana, but not for harder drugs. The administration is trying to crack down."

A Good Samaritan policy for alcohol makes sense; for marijuana, the need for it is much less. But a Good Samaritan policy that excludes the drugs that are most likely to kill people doesn't make much sense. There is work to be done at Reed, and the Good Samaritan battle looks like a good way to counter the weight of the prosecutorial offensive.

England: Royal College of Nursing Leader Calls for Prescription Heroin by the NHS

The head of Britain's largest nurses' union has called for the routine prescribing of heroin to addicts by the National Health Service (NHS) as a means of weaning them from their addiction. The remarks by Peter Carter, general secretary of the Royal College of Nursing (RCN), came after the RCN debated the idea at its convention in Bournemouth this week. No vote was taken.

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Peter Carter
Expressing his personal views after the debate, Carter, the former head of Central and North West London Mental Health NHS Trust, advocated for harm reduction measures as well as heroin prescription. He said he supported also supported needle exchanges and safe injection sites for intravenous drug users.

"The fact is heroin is very addictive," he said. "People who are addicted so often resort to crime, to steal to buy the heroin. It obviates the need for them to steal. It might take a few years but I think people will understand that if you are going to get people off heroin then in the initial stages we have to have proper heroin prescribing services. Critics say you are encouraging drug addiction but the reality is that these people are addicts and they are going to do it anyway," he added.

The most recent incarnation of heroin prescription calls began in 2002, when then Home Secretary David Blunkett first advocated for them. That call gave rise to pilot programs in London, Brighton, and Darlington in which users were provided with pharmaceutical heroin and allowed to inject under medical supervision. Those programs cut local crime rates by two-thirds over a six month period.

They also led to drug use and spending reductions. Of the 127 users involved in the pilot projects, three-quarters "substantially reduced" their use of street drugs, while their drug spending declined six-fold.

Carter's comments and the nurses' debate comes amid controversy and contention over how to deal with Britain's estimated 200,000 heroin addicts and just 10 days before British national elections. While all three parties have stressed alternative treatments for hard-core addicts, Conservatives have been attacking opiate maintenance programs, especially methadone maintenance, as morally bankrupt and are instead advocating for more abstinence-based programs.

At the RCN convention, Claire Topham-Brown, a nurse from Cambridgeshire, proposed the motion to support prescription heroin. It could be a means of harm reduction, she said, which despite some resistance from health professionals "has now become an accepted model of practice."

But not all delegates agreed. "Where would this stop, cannabis, cocaine, crack cocaine and other illicit substances? If we do this for heroin, do we have to do this for other substances, and can the NHS afford this?" asked Gayle Brooks, a member of the RCN's safety representatives committee.

Feature: First Drug User Union Forms in San Francisco

Thanks to the on-the-ground efforts of local harm reductionists and the funding largesse of the Drug Policy Alliance, San Francisco is now the home of only the second drug user union in the United States. The nascent effort is just getting off the ground, but plans to follow in the footsteps of Canada's Vancouver Area Network of Drug Users (VANDU) and the New York City VOCAL drug user union affiliated with the NYC Aids Housing Network.

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While self-identified drug user unions are rare in the US, they have a history dating back to the Dutch "junkiebund" of the 1970s. The movement is currently spreading internationally, with affiliates of the International Network of People Who Use Drugs (INPUD) operating in Europe, North America, South America, and Asia. And while medical marijuana patients did not refer to themselves as drug users, they have done similar organizing based on their use of the weed.

"We gave a $35,000 grant to the Harm Reduction Therapy Center to organize drug users in San Francisco, said Laura Thomas, DPA California state deputy director. "It is an annual grant, and future funding depends on HRTC re-applying for the funds. We have funded VOCAL in New York for several years."

DPA sees drug user groups as a key component in efforts to reduce the harms of both drug use and prohibitionist drug policies, said Thomas. "We hope that drug users in San Francisco will have a voice in policy decisions that affect them," she said. "We hope that they will become an active and organized part of efforts to reduce the harm related to both drugs and the war on drugs in San Francisco. The group is still in the process of forming and determining what their priority issues are, so I can't speak for what they are going to be working on."

"While we haven't quite chosen our main campaign, we've been talking about what we would ideally like San Francisco to look like, about having a safe place to inject, and about having a safe place to consume other drugs, too," said Alexandra Goldman, the organizer for the group. "Within a couple of months, we will choose our first official campaign," she vowed.

"We are also interested in working to decrease the stigma, both within and outside the drug using community," Goldman added. "We're trying to work with health care providers to make it a more positive experience. Our people tend to wait until they are very seriously ill because they are not treated very well. In our meetings, I'm hearing about how people don't get the prescribed pain medications they need because the doctors don't like them."

The group has already been active, joining in protests against the city's proposed ordinance barring people from sitting or lying on public sidewalks. Homeless people in neighborhoods like Haight-Asbury have roused the ire of business owners with their presence, but activists say they have no place to go and should not be criminalized.

The SF Drug User Union participation in the sit/lie protests makes sense given that many of its members are homeless and that its meetings are generally being held in homeless drop-in centers in the Tenderloin and the Mission. The group boasts about 25 members, with an emerging core group of 10 or 12, but is looking to expand by working with lower income communities and people involved in local harm reduction networks.

"We plan to be active consumers, giving our opinions and our voice on issues and policies that affect us," said Isaac Jackson, the other paid staffer for the union. "People are already asking us for our expertise."

So who can join the union? Anyone who identifies as a drug user, past or present, organizers said. Defining members in that manner allows people to get active without necessarily outing themselves as current users.

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"There is no piss test to get into this group," said Jackson. "We have heroin users, speed users, people who drink, pot smokers. Some people think pot's not a big issue, but anyone who wants to work with us, we say 'right on.' We support the legalization campaign and we support medical marijuana. That's a success story, and so is needle exchange, and we'll be trying to learn from those."

The only rule at meetings is no drug dealing, said Jackson. "We don't want people to deal drugs at the meeting or endanger other people in the group by that kind of activity, but if people are carrying, so what? Some people have showed up tweaking. We don't want to say they can't come because they're too high. We want people to feel welcome whatever their level of sobriety."

Forming a drug user union in San Francisco has been an idea that's been batted around for at least a couple of years, but it took some cold, hard cash to make it happen. "There were some attempts to organize drug users in the past, and I was involved in those, but they didn't stick because people had other jobs," said Goldman. "But once that Drug Policy Alliance grant came in, I got hired in November and we had our first meetings in February."

"I worked at a small health agency working with homeless people with substance use here in the Tenderloin, and was also working with some people with the Youth Homeless Alliance in the Haight," said Jackson. "A lot of people said we ought to do something like VANDU. We had a conference here a couple of years ago to try to jump-start a safe injection site, but that was mostly health care providers, not drug users."

San Francisco has one of the highest rates of drug use per capita in the country, Jackson noted. "Since there is so much civil disobedience going on already -- the laws are wrong, when you have thousands of people doing something for a long period of time, it's like passive civil disobedience -- there was an opportunity there to give drug users a voice in a more organized way. We're consumers of all these services -- treatment, law enforcement, the whole drug industrial complex -- we're consumers and have no voice. The time was right for it to start here."

San Francisco organizers took advantage of last fall's DPA conference to learn from existing drug user groups on the continent. "I met with Ann Livingston from VANDU and I got in touch with some of the folks from VOCAL," Goldman said. "They work on stuff around syringe exchange, trying to pass statewide ordinances to keep police from hassling people with needles, things like that. And, of course, they're subject to the same ridiculous drug laws we are."

"Drug user groups such as VOCAL in New York, VANDU in Vancouver, and hopefully this group in San Francisco play an important role in drug policy change and ending the war on drugs," Thomas said. "Drug users are usually the people most directly affected by bad drug policies, and the least likely to have a voice in debates. Drug users as active participants in the political process also helps reduce the stigma that is attached to drug use and makes people reconsider their prejudices about what they think 'drug users' are like. The drug policy reform conversation can only benefit from the active participation of drug user groups."

Separate drug user union meetings are taking place every three weeks in the Tenderloin and Mission districts. For more information about joining the union, send an email to sf.users.union@gmail.com.

Prohibition: Contaminated Drug Supply Threatening Cocaine Users in North America, Heroin Users in Europe

Problems with contaminated drug supplies reemerged on two fronts this week, with health authorities in Scotland announcing another case of anthrax among heroin users and health authorities in Quebec warning that cocaine continues to be contaminated with levamisole, a veterinary de-worming agent.

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anthrax spores
In a press release issued last Friday, Health Protection Scotland announced the first anthrax case among heroin users in the Edinburgh area had been confirmed. That brings to 33 the number of confirmed cases among heroin users, all but two of them in Scotland. One was reported in Germany and one in London. Eleven people have died of anthrax from tainted heroin, 10 of them in Scotland.

"There is no way to tell if your heroin is contaminated and there is no way to take heroin which we can advise is safer or less likely to result in illness or death if it has anthrax contamination," warned Dr. Colin Ramsey, consultant epidemiologist for Health Protection Scotland. "Drug users are advised that the only way to avoid the risk of anthrax in this outbreak is not to take heroin. While we appreciate that this may be extremely difficult advice to follow, it remains the only public health protection advice possible due to the nature of anthrax infection."

Such advice dismays harm reductionists, who have called for more informational campaigns and the prescribing of pharmaceutical heroin to addicts.

Users should seek urgent medical attention in the event of symptoms such as redness or swelling at or near an injection site, or other symptoms of general illness such a fever, chills or a severe headache, as early antibiotic treatment can be lifesaving, Health Protection Scotland said. Marked swelling of a limb which has been used as an injection site is a particularly important sign of possible anthrax infection.

Meanwhile, in Montreal, the National Public Health Institute of Quebec has issued a report on levamisole contamination in cocaine (sorry, French only) in the province. According to that report, eight out of 10 blood samples taken from known cocaine users in Quebec contained the cutting agent.

When ingested by humans, levamisole can cause nausea, dizziness, and diarrhea. Chronic use can lead to neutropenia, a potentially lethal blood disorder, or a related condition, agranulocytosis.

The US DEA first reported the presence of levamisole in cocaine in 2002 and its use is on the rise. In November 2009, Center for Substance Abuse and Mental Health Services published a survey indicating that 70% of cocaine seized in the US contained levamisole.

Feds: National Drug Intelligence Center Predicts Continued Failure in Drug War

In a report released Thursday, the Justice Department's National Drug Intelligence Center (NDIC) said that overall, the availability of illegal drugs is increasing and that "the overall threat posed by illicit drugs will not diminish in the near term." The announcement comes after more than four decades of harsh state and federal policies designed to curb the supply of illicit drugs.

The report, the National Drug Threat Assessment 2010, also once again identified Mexico's so-called drug cartels as the "single greatest drug trafficking threat to the United States." It blamed the cartels, or DTOs (drug trafficking organizations), as it more accurately but less catchily refers to them, for much of the increase in illegal drug availability.

The NDIC noted that the prevalence of four out of five of the major drugs of concern -- heroin, marijuana, MDMA (ecstasy), and methamphetamine -- was "widespread and increasing in some areas." Only cocaine availability was down, with NDIC reporting persistent shortages.

Heroin availability was up, and NDIC said that was "partly attributable to increased production in Mexico," where opium production more than doubled between 2007 and 2008. Meth availability was up "as the result of higher production in Mexico," and "sustained" US domestic production. Also, "marijuana production increased in Mexico." Only with MDMA did NDIC point the finger at anyone else -- in this case, Asian DTOs who produce it in Canada.

"Mexican DTOs, already the predominant wholesale suppliers of illicit drugs in the United States, are gaining even greater strength in eastern drug markets where Colombian DTO strength is diminishing," NDIC said as it pronounced them the greatest drug trafficking threat. It included the following bullet points making the case:

  • Mexican DTOs were the only DTOs operating in every region of the country.
  • Mexican DTOs increased their cooperation with US-based street and prison gangs to distribute drugs. In many areas, these gangs were using their alliances with Mexican DTOs to facilitate an expansion of their midlevel and retail drug distribution operations into more rural and suburban areas.
  • In 2009, midlevel and retail drug distribution in the United States was dominated by more than 900,000 criminally active gang members representing approximately 20,000 street gangs in more than 2,500 cities.
  • Mexican DTOs increased the flow of severaldrugs (heroin, methamphetamine, and marijuana) into the United States, primarily because they increased production of those drugs in Mexico.
  • Drugs smuggled into the United States by Mexican DTOs usually are transported in private or commercial vehicles; however, Mexican DTOs also use cross-border tunnels, subterranean passageways, and low-flying small or ultra-light aircraft to move drugs from Mexico into the United States.
  • Mexican DTOs smuggled bulk cash drug proceeds totaling tens of billions of dollars from the United States through the Southwest Border and into Mexico. Much of the bulk cash (millions each week) was consolidated by the DTOs in several key areas, including Atlanta, Chicago, Los Angeles, New York City, and North Carolina, where it was prepared for transport to the US-Mexico border and then smuggled into Mexico.
  • According to the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), Mexican DTO members or associates acquire thousands of weapons each year in Arizona, California, and Texas and smuggle them across the border to Mexico.

The report came as a senior US delegation led by Secretary of State Hillary Clinton returns from Mexico City, where it spent two days in talks with Mexican officials about increasing cooperation in their joint struggle against the drug traffic.

Drug War Chronicle Book Review: "In the Realm of Hungry Ghosts: Close Encounters With Addiction," by Dr. Gabor Maté (2010, North Atlantic Books, 468 pp., $17.95 PB)

Phillip S. Smith, Writer/Editor

In the revised edition of his prize-winning Canadian best-seller, Vancouver's Dr. Gabor Maté has made an important contribution to the literature on drug use and addiction. For more than a dozen years, Maté has been a staff physician for the Portland Hotel Society in Vancouver's infamous Downtown Eastside, home to one of the hemispheric largest, most concentrated populations of drug addicts. The Portland is unique -- once just another shoddy Skid Row SRO, under the management of the Society it is now both a residence for the hardest of the hard-core and a harm reduction facility.

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As a medical resident at the Portland, Maté has seen it all. The first section of "Hungry Ghosts" is filled with descriptions of his patients and their lives. Much of this is quite literally horrendous: Coked-out women turning tricks in alleys for their next rock and contracting syphilis; suicidal, opiate-addicted women refusing HIV treatments; mentally ill and alcoholic men dying young of liver cancer from Hepatitis C infections; people strung out on crack scrabbling at pieces of gravel on the sidewalk in the hallucinatory hope it's another rock; multi-addicted men and women, blood oozing from festering sores as they search yet again for a vein to hit, people overdosing and then going right back at it, people overdosing and dying.

And yet, despite the misery they are in and the wrecks that are their lives, they keep on using. "Hungry Ghosts" is an extended meditation on why. The second chunk of the book is devoted in particular to addressing that question. Maté offers an extended tour of the latest research into the disease model of addiction, with succinct and understandable (to the layperson) explanations of reward circuits in the brain, dopamine and serotonin flows, and all that good neuro-bio-pharmacological stuff so beloved of NIDA grantees. Repeated use of a substance indeed "rewires" the brain, creating pleasure circuits demanding to be fulfilled and pleasure deficits demanding to be fixed... with that next fix.

But unlike the NIDA people, with what I consider to be their neuro-bio-pharmacological determinism and reductionism, Maté goes a step further. He points out, accurately enough, that no matter what substance we're talking about, only a fraction of users, typically between 10% and 20%, become addicts. The "chronic relapsing brain disease" model may have some utility, but it fails to explain why some people are susceptible to addiction in the first place and others are not.

Maté noticed something about his downtrodden, strung-out clientele in Vancouver. They were almost universally abused as children, and at best, neglected. And I mean abused: Not spanked too hard, but raped, beaten, raped again, exploited, sent into foster care, literally spit on by their parents. It's very ugly.

One story especially sticks with me. A First Nations woman whose mother lives on the Downtown Eastside was given up at birth by her addicted mother, and sent to live with relatives, several of whom repeatedly sexually molested her in especially disgusting ways. She grew up an angry, depressed kid who turned to drugs and drink early. Tired of her life, she saved up $500 when she was 14 and ran away to Vancouver to find her mother. She did find her mother -- too bad for her. Mommie dearest promptly shot her up with heroin, spent the $500 on drugs for herself, then turned her out to turn tricks on the street. And you wonder why this woman prefers a narcotized bliss?

Maté doesn't just rely on anthropology and anecdote. He takes the reader instead into an extended look at the research on early childhood development and identifies messed-up childhoods as the key indicator of future substance abuse (as well as many other) problems. It doesn't have to be as extreme as some of these cases, but Maté makes clear that a nurturing early up-bringing is absolutely vital to the development of mentally and emotionally stable human beings.

Maté also has a startling confession to make: He, too, is an addict. The good doctor has been fighting a lifelong battle with his addiction to... wait for it... buying classical music CDs. He has behaved just like a junkie, he admits, spending thousands of dollars on his habit, lying to his wife, neglecting his kids, even leaving in the middle of medical procedures to run and score the latest Vivaldi. He's suffered the same feelings of compulsion, guilt, disgust, and self-denigration as any other addict, even if he doesn't have the scars on his veins to show for it.

At first glance, Maté's claim almost seems ludicrous, but he's making an important point: Addiction is addiction, whether it's to heroin or gambling, cocaine or shopping, he argues. The process of changes in the brain is the same, the compulsion is the same, the negative self-feelings are the same. We don't blame playing cards for gambling addiction or shopping malls for shopaholism; similarly, drugs are not to blame for drug addiction -- our own messed up psyches are the root of the problem.

And that leads to another important point: Those hollow-eyed addicts are like the rest of us, they are a dark mirror on our own inner problems, and most of us have some. (I'm reminded of a cartoon I once saw of a man sitting by all alone in an empty auditorium under a hanging banner saying, "Welcome to the convention of children of non-dysfunctional families.")

This is important because it stops us from dehumanizing drug addicts. They are not "the other." They are us, different only in degree. They deserve caring and compassion even if it is tough and seemingly fruitless work. Maté chides himself for falling from that saintly pedestal on occasion, and good for him.

Not surprisingly, Maté is a strong advocate of harm reduction and a harsh critic of prohibitionist drug policies and the US war on drugs in particular. By grinding drug users down even further, prohibition serves only to make them more likely to seek solace in chemical nirvana. It's almost as if prohibition were designed to create and perpetuate drug addiction.

In the final chapters of "Hungry Ghosts," Maté offers a glimmer of hope for beating drug addiction (or gambling addiction or sex addiction or whatever your particular compulsion is). It is a tough path of self-awareness and spiritual practice. I don't know if it will work -- I haven't tried it myself -- but it is important to remind ourselves that addiction is not necessarily a hopeless trap with no escape.

This is good, strong, compassionate, highly informed reading. I heartily recommend this book to anyone with an interest in addiction, addiction treatment, early childhood development, or drug policy. Thanks, doc.

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