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Chronicle AM -- November 26, 2013

Medical marijuana gets attention in the statehouse, another drug war atrocity in New Mexico, Greece's first safe injection site is open, and a gram of opium or a few pounds of pot can get you the death penalty if you're in the wrong place. And more. Let's get to it:

This is three times the amount of opium that could get an immigrant worker executed in Dubai. (erowid.org)
Medical Marijuana

Key Michigan Politico Says Medical Marijuana Top Priority in December. House Judiciary Committee Chair Kevin Cotter (R-Mount Pleasant) said Monday his top priority next month is to take up three medical marijuana-related bills. The first,House Bill 4271, would revive medical marijuana dispensaries in Michigan after recent court rulings effectively stopped the facilities from operating in the state. Cotter also plans to take up two other medical marijuana-related bills. House Bill 5104 would allow patients to use edible forms of marijuana. And Senate Bill 660 would clear the way for pharmacies to sell medical marijuana in Michigan, but only if the federal government decides to regulate cannabis as a prescription drug.

New Jersey Lawmaker Files Bill Allowing Patients to Buy Out of State. Assemblywoman Linda Stender (D-Union) Monday introduced a bill that would allow Garden State medical marijuana patients to buy their medicine in other states where it is legal and consume it in New Jersey. The bill attempts to address restrictions in the state's medical marijuana law that prevent easy access to some medical marijuana formulations, especially strains with high levels of CBD.

Alabama Lawmaker Ready to Try Again on Medical Marijuana. State Rep. Patricia Todd (D-Birmingham) will reintroduce medical marijuana legislation again next year, she said Monday. The bill would allow for the use of CBD. Todd's previous medical marijuana bills have gotten nowhere in Montgomery.

Hemp

New Jersey Hemp Bill Wins Committee Vote. A bill that would create an industrial hemp license to regulate the "planting, growing, harvesting, possessing, processing, selling, and buying" of the crop passed the Assembly Agriculture and Natural Resources Committee Monday. The bill, Assembly Bill 2415, sponsored by Assemblyman Reed Gusciora (D-Mercer), would require the end of federal hemp prohibition before licenses could be issued.

Law Enforcement

New Mexico Woman Sues over Vaginal Macing During Drug Arrest. What on earth is going on in New Mexico? Just weeks ago, it was forced enemas and colonoscopies for drug suspects; now, another New Mexican, Marlene Tapia, is suing Bernalillo County after she says jail guards strip searched her and sprayed mace in her vagina, where she was hiding drugs. The ACLU of New Mexico is taking the case.

New Jersey Bill Would Increase Drug Penalties. A bill that would reduce the amount of heroin necessary to be charged with a first-degree crime and allow prosecutors to charge drug offenses by the number of units of the drug involved instead of their weight passed the Assembly Judiciary Committee Monday. The bill, Assembly Bill 4151, is sponsored by Assemblyman Scott Rumana (R-Passaic).

International

Greece Sets Up First Supervised Injection Site. Greece has opened its first "drug consumption" room in a bid to slow the spread of blood-borne diseases among injection drug users there. The site has been open since last month and has been used by more than 200 people so far.

European Drug Experts Urge Austerity-Battered Governments Not to Cut Drug Treatment. Drug experts and policy makers from around Europe gathered in Athens Monday to urge governments to exclude drug-abuse treatment from austerity budget cuts, citing an alarming rise in HIV infections among drug users in Greece. Included in the call are harm reduction programs like the Greek supervised injection site, which is funded with Council of Europe funds.

Colombia's FARC Wants to Lead Alternative Crop Pilot Project. The leftist guerrillas of the FARC, now in peace negotiations with the Colombian government, want an active role in a pilot project to get coca farmers to grow alternative crops. The group is proposing that one of its local military units team with the government in a village in southern Colombia in a five-year project intended to get farmers to quit growing coca.

Malaysia Court Gives Thai Woman Death Sentence for Weed. A judge in Malaysia Monday sentenced a 36-year-old Thai woman to death after she was caught with about 30 pounds of marijuana at a bus depot. Barring a successful appeal, Thitapah Charenchuea will be hanged. DPP Nor Shuhada Mohd Yatim prosecuted the case.

Dubai Prosecutors Seeks Death Penalty for Less Than One Gram of Opium. Prosecutors in Dubai are seeking the death penalty for an Iranian worker accused of possessing 0.8 grams of opium. They charged he possessed it for "promotional purposes," the equivalent of "with the intent to distribute."

A Clean, Well-Lit Place to Shoot Dope -- In Your City, Soon? [FEATURE]

The only existing supervised injection site for hard drug users in North America is Vancouver's Insite, but panelists at a session of the International Drug Reform Conference in Denver last month said activists in a number of US cities are working to be next. (Plans are also afoot in a couple of Canadian cities.)

client at Vancouver's Insite supervised injection site (vch.ca)
Supervised injection sites (SIS) are a proven public health and harm reduction intervention that can save lives by preventing overdoses, bring a measure of stability to the sometimes chaotic lives of addicts, reduce the spread of bloodborne infectious diseases such as HIV/AIDS and Hepatitis C, and reduce crime and disorder in the community.

SISs also exist in a number of European countries and Australia, but face both legal and political hurdles in the US. Still, advocates are ready to push the envelope here in a bid to bring the life-, health-, and money-saving innovation here.

Donald Macpherson, executive \director of the Canadian Drug Policy Coalition and former head of Vancouver's Four Pillars drug policy program explained the prehistory of Insite, offering hints of possible courses of action in the US.

"We had a public health disaster," he said, referring to the city's escalating heroin problem in the 1990s. "Drug users themselves opened an SIS in 1995, and the police watched it, but didn't shut it down. A second opened in 2002. A year later, another non-sanctioned injection site opened up. It was really messy and it took years."

But in the end, Vancouver ended up with Insite and has managed to keep it open despite the best efforts of the Conservative federal government in Ottawa.

"Insite survives because it has an exemption from Canadian drug laws," Macpherson explained. "We won in the British Columbia courts, we won in the Canadian Supreme Court, which instructed the health minister to issue a permit. But we still barely have Insite, and though other cities are working on it, there is a big chill in Canada right now and we're just trying to hang on to what we've got."

Plans for SISs in the US face similar obstacles, but that isn't stopping advocates in a number of cities -- notably Austin, New York City, San Francisco, and Seattle, as well as somewhere in New Mexico -- from pressing forward with plans to open them there.

"I don't know if we'll be first, but we'll be one of many," said Robert Cordero, president and chief program officer of Boom! Health in the Bronx.

Boom! Health, which resulted from the merger of Bronx AIDS Services and Citiwide Harm Reduction, is a multi-service organization with a three-story building that includes a pharmacy, pharmacists with a harm reduction orientation, and a seven-day-a-week drop in center.

"Safe injection would be embedded with all these other services," he said.

"I don't know if we want to be first, but we want to be one of many," said Olivia Sloan, outreach and education associate for the Drug Policy Alliance (DPA) in New Mexico, which has been working patiently to bring cutting edge programs like SISs to the state. "We passed harm reduction, including needle exchange, through the state legislature, but it's not working," Sloan said. "We have overdose deaths at four or five times the national average."

Advocates in New Mexico have been and continue to lay the groundwork for SISs, Sloan said.

"We took a political and academic approach, and our conversation about injection facilities started a few years ago," she explained. "We have mobile syringe exchanges. We drafted legislation last year and the Senate passed a memorial to require we study the feasibility of SISs in New Mexico. We have partnered with the University of New Mexico and are looking for a principal investigator."

In San Francisco, preliminary discussions with local officials about SISs have been going on for some time, but the San Francisco Drug Users Union may follow the path taken by organized Vancouver drug users, as well as many of the needle exchange pioneers in the US, and just do it.

"We have a committee very committed to an SIS that meets every Monday for two hours," said Holly Bradford, the union's coordinator. "We're really on the verge. We have a very active bathroom here; you just open the door," she smiled. We're bringing it to San Francisco," she said. "It might not be sanctioned or aboveground, but it's going to happen."

Whether underground or not, SISs face a hazard-strewn trek. State, local, or federal officials can throw up any number of obstacles, said Lindsay LaSalle, a Berkeley-based law fellow for DPA.

"Drug possession remains illegal and could impact any SIS user, although probably not the staff or operator because they're not handling the drugs," she explained.

"Then there are the crack house laws, which both the federal government and some states have. They make it illegal for anyone to maintain, own, lease, or rent a property where drugs are used, consumed, or manufactured. These laws could cover SISs, and this could impact both clients and staff and operators alike," she elaborated.

"Then there are civil forfeiture statutes. They've used them to go after medical marijuana dispensaries," she enumerated.

Winning local official support reduces some risks, but not all, LaSalle said.

"If SISs were sanctioned at the local level, many of the legal risks dissipate, but state actors could still choose to prosecute," she warned. "In most states, local officers are deputized to enforce state law, so they could still go after an SIS. If authorized at the state level, that would be an incredible victory, but we would still have to deal with the federal government."

While acknowledging that lawyers can be "a buzzkill," LaSalle also hastened to add that things can change faster than we think.

"These legal barriers are not so different from the challenges we've faced with other drug policy issues, like syringe exchanges," she noted. "They were seen as completely radical, but now we have an almost universally accepted public health intervention with the exchanges."

Part of the process of initiating a supervised injection site is selling it to other stakeholders. Panelists had a number of ideas about messages that worked.

"For business people, you tell them this is how we clean up the neighborhood," said a Seattle activist.

"It is a very incremental change from syringe exchange to supervised injection sites," said LaSalle. "Position it as a very small change in an organization that provides all these other services to drug users."

"There's always 'what we're doing is not working,'" said Sloan.

"We're not going to arrest our way out of this problem," suggested Cordero. "But don't go straight to the SIS conversation. Let people see what we're doing, and then they say 'you're doing God's work' and second, 'Holy shit! Where would all those people be if you weren't open?'"

The obstacles to implementing supervised injection sites in the US are formidable, but the need to do so is urgent and increasingly understood, as are the benefits. With activists and advocates in a number of American locales pursuing SISs through a variety of means, the question is not whether it will happen here, but when and where.

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

With Legalization Looming, Lessons from the Netherlands [FEATURE]

The US states of Colorado and Washington voted last year to legalize marijuana and are moving forward toward implementing legalization. Activists in several states are lining up to try to do the same next year, and an even bigger push will happen in 2016. With public opinion polls now consistently showing support for pot legalization at or above 50%, it appears that nearly a century of marijuana prohibition in the US is coming to an end.

A coffee shop in Amsterdam, where clients can sit and smoke. Why no on-premises consumption here? (wikimedia.org)
Exactly how it comes to an end and what will replace it are increasingly important questions as we move from dreaming of legalization to actually making it happen. The Netherlands, which for decades now has allowed open marijuana consumption and sales at its famous coffee shops, provides some salutary lessons -- if reformers, state officials, and politicians are willing to heed them.

To be clear, the Dutch have not legalized marijuana. The marijuana laws remain on the books, but are essentially overridden by the Dutch policy of "pragmatic tolerance," at least as far as possession and regulated sales are concerned. Cultivation is a different matter, and that has proven the Achilles Heel of Dutch pot policy. Holland's failure to allow for a system of legal supply for the coffee shops leaves shop owners to deal with illegal marijuana suppliers -- the "backdoor problem" -- and leaves the system open to charges it is facilitating criminality by buying product from criminal syndicates.

Still, even though the Dutch system is not legalization de jure and does not create a complete legal system of marijuana commerce, reformers and policymakers here can build on the lessons of the Dutch experience as we move toward making legal marijuana work in the US.

"Governments are looking to reform their drug policies in order to maximize resources, promote health and security while protecting people from damaging and unwarranted arrests," said Kasia Malinowska-Sempruch, Director of the Open Society Global Drug Policy Program. "The Netherlands has been a leader in this respect. As other countries and local jurisdictions consider reforming their laws, it's possible that the Netherlands' past offers a guide for the future."

A new report from the Open Society Global Drug Policy Program lays out what Dutch policymakers have done and how they have fared. Authored by social scientists Jean-Paul Grund and Joost Breeksema of the Addiction Research Center in Utrecht, the report, Coffee Shops and Compromise: Separated Illicit Drug Markets in the Netherlands tells the history of the Dutch approach and describes the ongoing success of the country's drug policy.

This includes the separation of the more prevalent marijuana market from hard drug dealers. In the Netherlands, only 14% of cannabis users say they can get other drugs from their sources for cannabis. By contrast in Sweden, for example, 52% of cannabis users report that other drugs are available from cannabis dealers. That separation of hard and soft drug markets has limited Dutch exposure to drugs like heroin and crack cocaine and led to Holland having the lowest number of problem drug users in the European Union, the report found.

Pragmatic Dutch drug policies have not been limited to marijuana. The Netherlands has been a pioneer in harm reduction measures, such as needle exchanges and safe consumption sites, has made drug treatment easy to access, and has decriminalized the possession of small quantities of all drugs. As a result, in addition to having the lowest number of problem drug users, Holland has virtually wiped out new HIV infections among injection drug users. And, because of decriminalization, Dutch citizens have been spared the burden of criminal records for low-level, nonviolent offenses.

The Dutch have, for example, virtually eliminated marijuana possession arrests. According to figures cited in the report, in a typical recent year, Dutch police arrested people for pot at a rate of 19 per 100,0000, while rates in the US and other European countries were 10 times that or more.

For veteran drug reform activist Joep Oomen of the European NGO Coalition for Just and Effective Drug Policies (ENCOD), the report is welcome but not exactly "stop the presses" news.

"The conclusions of this report have been known for a long time," he told the Chronicle. "Already by the end of the 1990s, when European governments had to acknowledge that Dutch drug policies had proven more effective in reducing risks and harms than many other countries, the criticism that had been expressed earlier by mainly German and French heads of state was silenced. For instance, in the Netherlands the age of first heroin use is the highest of Europe, which is explained by the relative tolerance concerning cannabis use." [Ed: A high age of first use is considered good, because it means that fewer people are experimenting with a drug when they are young -- which in turn means fewer people ever trying it, and those who do being more likely to be capable of avoiding problematic use.]

While the Dutch can point to solid indications of success with their pragmatic drug policies, it is not all rosy skies. The "back door problem" alluded to above continues unresolved, and the relative laxness of Dutch marijuana policy has led to an influx of "drug tourists," especially from neighboring countries, such as France and Germany. Both of those irritants have provided fodder for conservative parties and administrations that have sought to roll back the reforms.

"There seems to be more admiration for Dutch drug policy outside the Netherlands than inside," Oomen observed. "Right-wing governments that have dominated the Dutch political climate since 2002 have slowly dismantled acceptance-oriented drug policy. Lately the establishment of the Weedpass in the southern part of the country [which excludes non-Dutch from access to the coffee shops] and new measures against grow shops and coffee shops are definitely threatening to undermine the coffee shop model," he said.

"Instead of completing the regulation of this model by solving the coffee shops' back door problem, the government seems to apply a policy of slow elimination by making the conditions worse in which the shops have to operate," Oomen continued. "And the Dutch press follows blindly, often referring to coffee shops as a link in a criminal chain, which is unavoidable since the ban on cultivation forces shop owners to deal with criminals, but without questioning the measures that reinforce the criminal aspect."

While the national government may now be hostile to pragmatic marijuana policies, it is facing considerable resistance from elected officials. The Weedpass program now appears to be largely a dead letter, thanks to opposition from the likes of Amsterdam Mayor Eberhard van der Laan, and other local elected officials are moving to address the back door problem.

"Several Dutch mayors have plans for municipal cannabis farms to supply the coffee shops and take crime out of the industry," said Grund, research director at the Addiction Research Center. "But if Dutch drug policy offers one lesson to foreign policymakers, it is that change should be comprehensive, regulating sale to consumers, wholesale supply and cultivation."

Grund is watching the American experience with legalization in Colorado and Washington and had some observations he shared with the Chronicle.

"As far as I can judge," he said, "these are both pretty solid proposals, although quite different in detail and approach -- e.g., a vertically integrated chain of supply in Colorado and separate licensing for producers, processors, and retailer in Washington. Clearly in both states legislators have done their best. Interesting then, that they end up with rather different plans, which is actually fine, as it provides us with the opportunity to evaluate different models. For more than 25 years, there was just about only the Dutch experience with cannabis decriminalization and coffee shops; now we see different models of cannabis reform and distribution being implemented across continents. Comparing these experiences as they evolve should allow us to develop more effective drug policies."

Policymakers and regulators should try to avoid rigidity and be ready to deal with unintended responses and consequences, the Dutch social scientist said.

"The point is to approach these flexibly and pragmatically; adjust when necessary, while keeping your eyes on the ball: cutting the link between cannabis on the one hand, and criminal records, mafia and more, on the other," Grund advised, noting that the 1976 Dutch law separating hard and soft drugs did not anticipate the arrival of the coffee shop phenomenon. "As Dr. Eddy Engelsman, former chief drug policy maker at the ministry of health -- and known as the architect of Dutch drug policy -- said when we interviewed him, 'coffee shops just emerged.' The policymakers deemed that these fit their overall policy objectives and allowed for them to ply their trade openly," he recalled.

Grund also weighed in on personal cultivation -- Colorado allows it; Washington does not -- and public use, which it appears will remain forbidden in both states.

"I think Washington presents more of a business and revenue raising strategy, while Colorado feels more like grassroots meets civil libertarian meets amenable regulator," he opined. "The more social, homegrown orientation of the Colorado proposal – allowing for home growing, bartering between friends -- could perhaps engender a less market driven distribution structure, where friends compete in growing the most pleasant marijuana, not the most profitable. Something like the Spanish cannabis clubs," he suggested.

Public, convivial pot smoking in designated areas should be allowed, Grund said, because it has benefits.

"Dedicated places of consumption -- such as the coffee shops in the Netherlands or shisha parlors -- offer an opportunity to promote responsible behavior around cannabis consumption," he argued. "Smoking cannabis in a safe, hospitable and stress free environment engenders different use patterns from quickly getting high in a service ally behind a bar or in a car parked in a quiet place. Coffee shops offer a moderating environment where self regulation is supported by social learning and control."

While Grund was looking forward to the future in the US, Oomen was thinking of the unfinished business in the Netherlands, but his musing also provide food for thought for American reformers, especially those contemplating decriminalization measures.

"The lesson here is that decriminalization or depenalization are useful concepts for a transition period, but real progress can only be obtained and assured with legal regulation of the entire chain from producer to consumer," the ENCOD leader noted. "The Dutch case shows that politicians will always use the smallest margin they have to maintain to a repressive model, provoking criminal activities which they can use to justify their policies publically. This is the drug policy perpetual motion machine."

Colorado and Washington are already well down their particular paths to marijuana legalization. But there is still time for the next wave of legalization states to learn and apply those lessons, not just from Denver and Olympia, but from the Dutch pioneers as well.

Netherlands

Paris to Get Supervised Drug Injection Site

France's first supervised injection site (SIJ) for hard drug users will open in Paris by this fall, local officials announced Thursday. It will be located near the Gare du Nord train station, an area of open hard drug use and sales and petty crime.

injecting at a supervised injection site in Vancouver (vch.ca)
The SIJ will be ready "by the autumn," Remi Feraud, mayor of the 10th arrondissement, where it will be located, told reporters. The site is "sufficiently far from residential areas, schools and shops to not pose a serious risk of public disorder," he said.

The project is "aimed at reducing the number of people taking drugs in the street, in common areas of apartment buildings and other areas such as car parks," added deputy mayor Myriam El Khomri. The area would be given a boosted police presence, she added, to prevent dealers from selling their wares in the proximity.

While supervised injection sites are a proven harm reduction measure, local officials were downplaying that aspect and instead highlighting the public order and safety effects. That could be a bid to blunt opposition and hostility from local residents' associations, who have said they fear the SIJ would further degrade the area, described as "an open air drug market."

While this will be the first SIJ in the City of Light, Paris already has a needle exchange program. It handed out more than 300,000 syringes last year, half of them in the Gare du Nord.

SIJs already operate in a number of European countries, include Germany and Switzerland, as well as Australia and Canada.

Paris
France

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

The Top Ten Drug Policy Stories of 2012 [FEATURE]

In some ways, 2012 has been a year of dramatic, exciting change in drug policy, as the edifice of global drug prohibition appears to crumble before our eyes. In other ways it is still business as usual in the drug war. Marijuana prohibition is now mortally wounded, but there were still three-quarters of a million pot arrests last year. The American incarceration mania appears to be running its course, but drug arrests continue to outnumber any other category of criminal offense. There is a rising international clamor for a new drug paradigm, but up until now, it's just talk.

The drug prohibition paradigm is trembling, but it hasn't collapsed yet -- we are on the cusp of even more interesting times. Below, we look at the biggest drug policy stories of 2012 and peer a bit into the future:

1. Colorado and Washington Legalize Marijuana!

Voters in Colorado and Washington punched an enormous and historic hole in the wall of marijuana prohibition in November. While Alaska has for some years allowed limited legal possession in the privacy of one's home, thanks to the privacy provisions of the state constitution, the November elections marked the first time voters in any state have chosen to legalize marijuana. This is an event that has made headlines around the world, and for good reason -- it marks the repudiation of pot prohibition in the very belly of the beast.

And it isn't going away. The federal government may or may not be able to snarl efforts by the two states to tax and regulate legal marijuana commerce, but few observers think it can force them to recriminalize marijuana possession. It's now legal to possess up to an ounce in both states and to grow up to six plants in Colorado and -- barring a sudden reversal of political will in Washington or another constitutional amendment in Colorado -- it's going to stay that way. The votes in Colorado and Washington mark the beginning of the end for marijuana prohibition.

2. Nationally, Support for Marijuana Legalization Hits the Tipping Point

If Colorado and Washington are the harbingers of change, the country taken as a whole is not far behind, at least when it comes to public opinion. All year, public opinion polls have showed support for marijuana legalization hovering right around 50%, in line with last fall's Gallup poll that showed steadily climbing support for legalization and support at 50% for the first time. A Gallup poll this month showed a 2% drop in support, down to 48%, but that's within the margin of error for the poll, and it's now a downside outlier.

Four other polls released this month
demonstrate a post-election bump for legalization sentiment. Support for legalization came in at 47%, 51%, 54%, and 57%, including solid majority support in the West and Northeast. The polls also consistently find opposition to legalization strongest among older voters, while younger voters are more inclined to free the weed.

As Quinnipiac pollster Peter Brown put it after his survey came up with 51% support for legalization, "This is the first time Quinnipiac University asked this question in its national poll so there is no comparison from earlier years. It seems likely, however, that given the better than 2-1 majority among younger voters, legalization is just a matter of time."

Caravan for Peace vigil, Brownsville, Texas, August 2012
3. Global Rejection of the Drug War

International calls for alternatives to drug prohibition continued to grow ever louder this year. Building on the work of the Latin American Commission on Drugs and Democracy and the Global Commission on Drug Policy, the voices for reform took to the stage at global venues such as the Summit of the Americas in Cartagena, Colombia, in April, the International AIDS Conference in Washington in July, and at the United Nations General Assembly in September.

While calls for a new paradigm came from across the globe, including commissions in Australia and the United Kingdom, this was the year of the Latin American dissidents. With first-hand experience with the high costs of enforcing drug prohibition, regional leaders including Colombian President Santos, Guatemalan President Perez Molina, Costa Rican President Chinchilla, and even then-Mexican President Calderon all called this spring for serious discussion of alternatives to the drug war, if not outright legalization. No longer was the critique limited to former presidents.

That forced US President Obama to address the topic at the Summit of the Americas and at least acknowledge that "it is entirely legitimate to have a conversation about whether the laws in place are doing more harm than good in certain places" before dismissing legalization as a policy option. But the clamor hasn't gone away -- instead, it has only grown louder -- both at the UN in the fall and especially since two US states legalized marijuana in November.

While not involved in the regional calls for an alternative paradigm, Uruguayan President Mujica made waves with his announcement of plans to legalize the marijuana commerce there (possession was never criminalized). That effort appears at this writing to have hit a bump in the road, but the proposal and the reaction to it only added to the clamor for change.

4. Mexico's Drug War: The Poster Child for Drug Legalization

Mexico's orgy of prohibition-related violence continues unabated with its monstrous death toll somewhere north of 50,000 and perhaps as high as 100,000 during the Calderon sexenio, which ended this month. Despite all the killings, despite Calderon's strategy of targeting cartel capos, despite the massive deployment of the military, and despite the hundreds of millions of dollars in US aid for the military campaign, the flow of drugs north and guns and money south continues largely unimpeded and Mexico -- and now parts of Central America, as well -- remain in the grip of armed criminals who vie for power with the state itself.

With casualty figures now in the range of the Iraq or Afghanistan wars and public safety and security in tatters, Calderon's misbegotten drug war has become a lightning rod for critics of drug prohibition, both at home and around the world. In the international discussion of alternatives to the status quo -- and why we need them -- Mexico is exhibit #1.

And there's no sign things are going to get better any time soon. While Calderon's drug war may well have cost him and his party the presidency (and stunningly returned it to the old ruling party, the PRI, only two elections after it was driven out of office in disgrace), neither incoming Mexican President Enrique Pena Nieto nor the Obama administration are showing many signs they are willing to take the bold, decisive actions -- like ending drug prohibition -- that many serious observers on all sides of the spectrum say will be necessary to tame the cartels.

The Mexican drug wars have also sparked a vibrant and dynamic civil society movement, the Caravan for Peace and Justice, led by poet and grieving father Javier Sicilia. After crisscrossing Mexico last year, Sicilia and his fellow Mexican activists crossed the border this summer for a three-week trek across the US, where their presence drew even more attention to the terrible goings on south of the border.

5. Medical Marijuana Continues to Spread, Though the Feds Fight Back

Eighteen states and the District of Columbia have now legalized the use of marijuana for medical purposes, and while there was only one new one this year, this has been a year of back-filling. Medical marijuana dispensaries have either opened or are about to open in a number of states where it has been legal for years but delayed by slow or obstinate elected officials (Arizona, New Jersey, Washington, DC) or in states that more recently legalized it (Massachusetts).

None of the newer medical marijuana states are as wide open as California, Colorado, or Montana (until virtual repeal last year), as with each new state, the restrictions seem to grow tighter and the regulation and oversight more onerous and constricting. Perhaps that will protect them from the tender mercies of the Justice Department, which, after two years of benign neglect, changed course last year, undertaking concerted attacks on dispensaries and growers in all three states. That offensive was ongoing throughout 2012, marked by federal prosecutions and medical marijuana providers heading to federal prison in Montana. While federal prosecutions have been less resorted to in California and Colorado, federal raids and asset forfeiture threat campaigns have continued, resulting in the shuttering of dozens of dispensaries in Colorado and hundreds in California. There is no sign of a change of heart at the Justice Department, either.

6. The Number of Drug War Prisoners is Decreasing

The Bureau of Justice Statistics announced recently that the number of people in America's state and federal prisons had declined for the second year in a row at year's end 2011. The number and percentage of drug war prisoners is declining, too. A decade ago, the US had nearly half a million people behind bars on drug charges; now that number has declined to a still horrific 330,000 (not including people doing local jail time). And while a decade ago, the percentage of people imprisoned for drug charges was somewhere between 20% and 25% of all prisoners, that percentage has now dropped to 17%.

That decline is mostly attributable to sentencing reforms in the states, which, unlike the federal government, actually have to balance their budgets. Especially as economic hard times kicked in in 2008, spending scarce taxpayer resources on imprisoning nonviolent drug offenders became fiscally and politically less tenable. The passage of the Proposition 36 "three strikes" sentencing reform in California in November, which will keep people from being sentenced to up to life in prison for trivial third offenses, including drug possession, is but the latest example of the trend away from mass incarceration for drug offenses.

The federal government is the exception. While state prison populations declined last year (again), the federal prison population actually increased by 3.1%. With nearly 95,000 drug offenders doing federal time, the feds alone account for almost one-third of all drug war prisoners.

President Obama could exercise his pardon power by granting clemency to drug war prisoners, but it is so far a power he has been loathe to exercise. An excellent first candidate for presidential clemency would be Clarence Aaron, the now middle-aged black man who has spent the past two decades behind bars for his peripheral role in a cocaine deal, but activists in California and elsewhere are also calling for Obama to free some of the medical marijuana providers now languishing in federal prisons. The next few days would be the time for him to act, if he is going to act this year.

7. But the Drug War Juggernaut Keeps On Rolling, Even if Slightly Out of Breath

NYC "stop and frisk" protest of mass marijuana arrests
According to annual arrest data released this summer by the FBI, more than 1.53 million people were arrested on drug charges last year, nearly nine out of ten of them for simple possession, and nearly half of them on marijuana charges. The good news is that is a decline in drug arrests from 2010. That year, 1.64 million people were arrested on drug charges, meaning the number of overall drug arrests declined by about 110,000 last year. The number of marijuana arrests is also down, from about 850,000 in 2010 to about 750,000 last year.

But that still comes out to a drug arrest every 21 seconds and a marijuana arrest every 42 seconds, and no other single crime category generated as many arrests as drug law violations. The closest challengers were larceny (1.24 million arrests), non-aggravated assaults (1.21 million), and DWIs (1.21 million). All violent crime arrests combined totaled 535,000, or slightly more than one-third the number of drug arrests.

The war on drugs remains big business for law enforcement and prosecutors.

8. And So Does the Call to Drug Test Public Benefits Recipients

Oblivious to constitutional considerations or cost-benefit analyses, legislators (almost always Republican) in as many as 30 states introduced bills that would have mandated drug testing for welfare recipients, people receiving unemployment benefits, or, in a few cases, anyone receiving any public benefit, including Medicaid recipients. Most would have called for suspicionless drug testing, which runs into problems with that pesky Fourth Amendment requirement for a search warrant or probable cause to undertake a search, while some attempted to get around that obstacle by only requiring drug testing upon suspicion. But that suspicion could be as little as a prior drug record or admitting to drug use during intake screening.

Still, when all the dust had settled, only three states -- Georgia, Oklahoma, and Tennessee -- actually passed drug testing bills, and only Georgia's called for mandatory suspicionless drug testing of welfare recipients. Bill sponsors may have been oblivious, but other legislators and stakeholders were not. And the Georgia bill is on hold, while the state waits to see whether the federal courts will strike down the Florida welfare drug testing bill on which it is modeled. That law is currently blocked by a federal judge's temporary injunction.

It wasn't just Republicans. In West Virginia, Democratic Gov. Roy Tomblin used an executive order to impose drug testing on applicants to the state's worker training program. (This week came reports that only five of more than 500 worker tests came back positive.) And the Democratic leadership in the Congress bowed before Republican pressures and okayed giving states the right to impose drug testing requirements on some unemployment recipients in return for getting an extension of unemployment benefits.

This issue isn't going away. Legislators in several states, including Indiana, Ohio, Texas, and West Virginia have already signaled they will introduce similar bills next year, and that number is likely to increase as solons around the country return to work.

9. The US Bans New Synthetic Drugs

In July, President Obama signed a bill banning the synthetic drugs known popularly as "bath salts" and "fake weed." The bill targeted 31 specific synthetic stimulant, cannabinoid, and hallucinogenic compounds. Marketed under brand names like K2 and Spice for synthetic cannabinoids and under names like Ivory Wave, among others, for synthetic stimulants, the drugs have become increasingly popular in recent years. The drugs had previously been banned under emergency action by the DEA.

The federal ban came after more than half the states moved against the new synthetics, which have been linked to a number of side effects ranging from the inconvenient (panic attacks) to the life-threatening. States and localities continue to move against the new drugs, too.

While the federal ban demonstrates that the prohibitionist reflex is still strong, what is significant is the difficulty sponsors had in getting the bill passed. Sen. Rand Paul (R-KY) put a personal hold on the bill until mandatory minimum sentencing requirements were removed and also argued that such efforts were the proper purview of the states, not Washington. And for the first time, there were a substantial number of Congress members voting "no" on a bill to create a new drug ban.

10. Harm Reduction Advances by Fits and Starts, At Home and Abroad

Harm reduction practices -- needle exchanges, safer injection sites, and the like -- continued to expand, albeit fitfully, in both the US and around the globe. Faced with a rising number of prescription pain pill overdoses in the US -- they now outnumber auto accident fatalities -- lawmakers in a number of states have embraced "911 Good Samaritan" laws granting immunity from prosecution. Since New Mexico passed the first such law in 2007, nine others have followed. Sadly, Republican Gov. Chris Christie vetoed the New Jersey bill this year.

Similarly, the use of the opioid antagonist naloxone, which can reverse overdoses and restore normal breathing in minutes, also expanded this year. A CDC report this year that estimated it had saved 10,000 lives will only help spread the word.

There has been movement internationally as well this year, including in some unlikely places. Kenya announced in June that it was handing out 50,000 syringes to injection drug users in a bid to reduce the spread of AIDS, and Colombia announced in the fall plans to open safe consumption rooms for cocaine users in Bogota. That's still a work in progress.

Meanwhile, the UN Commission on Narcotic Drugs unanimously supported a resolution calling on the World Health Organization and other international bodies to promote measures to reduce overdose deaths, including the expanded use of naloxone; Greece announced it was embracing harm reduction measures, including handing out needles and condoms, to fight AIDS; long-awaited Canadian research called for an expansion of safe injection sites to Toronto and Ottawa; and Denmark first okayed safe injection sites in June, then announced it 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. France, too, announced it was going ahead with safe injection sites, which could be open by the time you read this.  

This has been another year of slogging through the mire, with some inspiring victories and some oh-so-hard-fought battles, not all of which we won. But after a century of global drug prohibition, the tide appears to be turning, not least here in the US, prohibition's most powerful proponent. There is a long way to go, but activists and advocates can be forgiven if they feel like they've turned a corner. Now, we can put 2012 to bed and turn our eyes to the year ahead.

France to Introduce Supervised Injection Sites

France looks to be the latest European country to embrace the harm reduction practice of providing supervised injection sites for hard drug users, according to France 24 TV. Facilities could be open by year's end, said Health Minister Marisol Touraine.

c client at the supervised injection site in Vancouver (vch.ca)
Since the first supervised injection site opened in the Netherlands in the 1970s, they have since spread to Germany, Luxembourg, Norway, and Spain, and the Danish parliament approved them earlier this year. Supervised injection sites also exist in Vancouver, Canada, and Sydney, Australia.

Supervised injection sites are credited with lowering overdoses, reducing the spread of blood-borne diseases, improving client health and public health, providing entrée to drug treatment and other medical and social services, and reducing public disorder. They have also been linked to reductions in neighborhood crime.

President Francois Hollande campaigned on a promise to establish the first supervised injection sites in the country, and Paris Deputy Mayor Jean-Marie Le Guen endorsed the idea in August. Several French cities are ready to test the practice, Touraine said.

The conservative opposition party UMP criticized the plan, saying in a statement that allowing such facilities "trivializes drug use and legalizes the use of the hardest drugs at the taxpayer's expense."

In moving forward with supervised injection sites, the French government is going against public opinion, but with science. While an August 2010 Ifop poll found 53% supported the sites and 47% opposed them, a similar poll by Ifop last month found only 45% in favor and 55% opposed.

France

Colombia Okays Prescriptions for Addicts in Bogota

President Juan Manuel Santos has given the go-ahead to Bogota Mayor Gustavo Petro's plan to prescribe otherwise illicit drugs to addicts in the Colombian capital, according to Colombian press reports (and Colombia Reports, the first English-language source with the story). The announcement came after the pair met to discuss the matter last Friday.

Santos and Petro at press conference announcing the initiative (screen shot from Caracol TV)
"We will create physical spaces in the most violent zones of the city where the drug addicts, mostly youth, can get away from being illegal and dependent on the criminal gangs," Petro said after the meeting.

The primary problematic drug on the streets of Bogota is, unsurprisingly, cocaine.

The colorful, left-leaning mayor, who suffered death threats after exposing broad links between the right-wing paramilitaries and Colombian politicians as a senator and who came in fourth in the 2010 presidential elections, first proposed the idea of drug consumption sites last month, but Santos was initially cool to the idea.

"A large part of the violence and crime that still persists in the city derives from the small-scale consumption and trafficking of drugs... We should allow some centers for addicts that provide treatment... where the addict can consume under relative control, without doing damage to society," Petro said when he initially broached the idea.

Santos seemed dubious when he responded days later. "This leap into the dark seems irresponsible to me because one could cause a lot of damage to society, youth and the country," he said.

But Petro appears to have swayed him, confirming after the meeting that the national government had approved his proposal. He needed the government's approval for constitutional reasons, he said.

"The only way to authorize the use of illicit drugs is if it is part of a medical treatment and prescribed by a doctor. We dared to present this proposal publicly, but we could not implement it without permission from the national government."

It's unclear at this point when the plan will be implemented. It's also unclear how the idea of providing addicts prescriptions for their drugs is going to play with the International Narcotics Control Board, the UN Office on Drugs and Crime, and the US government, but it looks like the Colombian government of President Santos is willing to test the limits. Switzerland, Germany, Denmark, The Netherlands and Canada (in two cities) all have such programs for heroin.

Bogota
Colombia

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

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