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Chronicle AM -- July 9, 2014

The White House issues its annual drug control strategy, the Brooklyn DA announces an end to most small-time marijuana possession arrests, a suburban Maryland county adopts a marijuana reform resolution, the first medical cannabis oil permits are issued in Utah, Lebanese hash farmers vow to fight to protect their crops, and more. Let's get to it:

Under Maryland's new decrim law, that bud won't get you arrested, but the pipe will. (wikimedia.org/erik fenderson)
Marijuana Policy

Obama Offered a Hit of Weed in Denver; Responds With a Smile. During a visit to a Denver bar last night, President Obama was offered some of the state's legal marijuana. "Do you want to hit this?" came a voice from the crowd. The president did not respond to the offer, except to flash his trademark smile. On route to the event, the president was also confronted by apparently pro-marijuana protestors, including one holding a sign saying "Free Weed for Obama." We won't even mention the guy in a horse head mask who shook the president's hand.

Brooklyn DA Announces No More Prosecutions for First-Time Marijuana Offenders, Except… Brooklyn, New York, District Attorney Kenneth Thompson announced Tuesday that his office will no longer prosecute first-time offenders for small-time marijuana possession charges. "This new policy is a reasonable response to the thousands of low-level marijuana arrests that weigh down the criminal justice system, require significant resources that could be redirected to more serious crimes and take an unnecessary toll on offenders. Pursuant to this policy, we will use our prosecutorial discretion to decline to prosecute, and dismiss upfront, certain low-level marijuana possession cases based on criteria concerning the particular individual and the circumstances of the case. For example, cases will be dismissed prior to arraignment for those with little or no criminal record, but we will continue to prosecute marijuana cases which most clearly raise public health and safety concerns." But Thompson added that he would still pursue charges for public pot smoking, if the defendant is a teen (he will be directed to juvenile court and a diversion program), or if the defendant has a criminal record suggesting he may act violently under the influence of marijuana.

Montgomery County, Maryland, Adopts Marijuana Policy Reform Resolution. The Montgomery County council Tuesday unanimously adopted a resolution calling for making marijuana possession offenses the lowest law enforcement priority and for revising the state's yet-to-go-into-effect decriminalization law to include pot-smoking paraphernalia. Under the law as written, people could not be arrested for possessing small amounts of marijuana, but they can still be arresting for possessing the pipe to smoke it in.

Medical Marijuana

Utah Issues First Permits to Use High CBD, Low THC Cannabis Oil. Utah officials Tuesday issued the first permits to use high CBD cannabis oil for the treatment of epilepsy in children under a law passed earlier this year. That law okays the use of cannabis oils containing at least 15% CBD and less than 0.3% THC. But while initial permits have been issued, families are likely to have to wait until September to acquire the cannabis oil because the Colorado nonprofit that produces it has a long waiting list and a crop that won't be ready until the fall.

California Medical Marijuana Citizens' Lobby Day Will Be August 4. The medical marijuana advocacy group Americans for Safe Access has announced that its annual citizens' lobby day in Sacramento will be held this year on August 4. The group is supporting the statewide regulation bill, Senate Bill 1262, but wants some changes, too. Click on the title link for more details.

Drug Policy

White House Releases 2014 National Drug Control Strategy. The White House's Office of National Drug Control Policy (ONDCP -- the drug czar's office) today released its annual drug control strategy. In the big picture it doesn't appear to be a whole lot different from last year's, or the year before that or the year before that or… But there are some good things to be found. Check back here later today for a feature article on it. In the meantime, click on the link to take a look yourself.

International

Mexico Anti-Cartel Vigilantism Spreads Close to US Border. Vigilante groups targeting criminal drug trafficking organizations first sprung up last year in the west-central Mexican state of Michoacan, where they battled the Knights Templar cartel before eventually being folded into the Mexican police apparatus. Now, they are appearing in Tamaulipas state, just across the Rio Grande River from Texas. A group known as the Pedro Mendez Column is operating in the city of Hidalgo, where it does nightly patrols to defend the city from the Zetas cartel. It also claims to have killed several Zetas. And the Zetas claim to have killed several people it accuses of being linked to the vigilantes. The Zetas also accuse the rival Gulf cartel of arming the vigilantes.

Lebanese Marijuana Farmers Vow to Fight Back Against Eradication Campaign. The Lebanese government has announced it will begin destroying marijuana farms in the Bekaa Valley tomorrow, but farmers there are vowing to defend their crops with their lives. Ali Nasri Shammas, a major grower and spokesman for the illicit industry, said growers would do what it takes to defend their crops, whether by protesting, blocking roads, or more violent means. "We will also use arms to face the security forces, who will damage the crops, even if it leads to bloodshed. Destroying the crops is forbidden no matter the results," Shammas warned. Given the ongoing Syrian civil war next door, it remains to be seen whether the government will be able to actually eradicate much of the marijuana crop.

Russians Say They Lose 100,000 People a Year to Drug Overdoses. Russia's Federal Drug Control Service reports that nearly 100,000 people died of drug overdoses last year and that the rate of drug-related deaths in Russian urban areas was 28.7 per 100,000. That rate is 2.7 times higher than the previous year. By contrast, in the US, some 41,000 people died of drug overdoses in 2012, according to the Centers for Disease Control and Prevention.

Chronicle AM -- May 14, 2014

The NFL is about to adopt a more sensible marijuana policy, the DEA will unblock imported hemp seeds so Kentucky can do some research, Minnesota legislators try to reach a compromise on medical marijuana, the rate of prescription overdose deaths is up, and more. Let's get to it:

People are dying of prescription drug overdoses at a rate three times that of a decade ago, says the CDC. (wikimedia.org
Marijuana Policy

NORML PAC Endorses a Florida Congressional Candidate. NORML PAC, the campaign and lobbying arm of NORML, has endorsed Democrat Wes Neuman for Congress in Florida's 7th District. NORML says it believes "Wes will be a great champion for marijuana law reform in Washington, DC." Neumann says he will advocate for marijuana legalization.

NFL Reportedly Will Cut Marijuana Punishments. ESPN.com is reporting that when the NFL's new player drug policy is announced, punishments handed out for marijuana use will be reduced. ESPN also reported that the new drug policy will have a higher threshold for the amount of marijuana needed to trigger a positive test result. At least one current NFL player, Cleveland Browns receiver Josh Gordon, is facing a season-long suspension for running afoul of the league's marijuana policy. The NFL Players Association had suggested the league review its policy on marijuana and drug testing in general.

Medical Marijuana

Competing Minnesota Medical Marijuana Bills Head for Conference Committee. The state Senate voted Tuesday not to concur with the medical marijuana bill passed by the House, Senate File 2470, which is more narrowly tailored than the bill that has passed the Senate, Senate File 1641. That means a conference committee will have to try to hammer out an acceptable compromise.

Hemp

DEA Will Allow Hemp Seeds to Enter US for Kentucky Research Project. Kentucky Agriculture Commissioner James Comer said Tuesday that the DEA will quit trying to block the import of Italian hemp seeds to Kentucky for research purposes now permitted under the hemp amendment to the recently passed omnibus farm bill. The seeds are being held by US Customs at a warehouse in Louisville. Cromer was ready to go to federal court today, if the DEA had not yielded. The state Agriculture Department and several universities are planning hemp research projects this year, but they need to get the seeds in the ground. The clock is ticking.

Drug Treatment

Massachusetts Drug Treatment Bill Being Debated Today. A bill that would ease access to drug treatment, by forcing insurance companies to cover treatment that's provided without prior authorization from them, is being heard in the state Senate today. The measure is Senate Bill 2133, which was developed by a special legislative committee on drug addiction. There are 37 amendments to get through, too.

Prescription Drugs

Rate of Prescription Drug Overdoses Increased More Than Threefold in a Decade, CDC Report Says. A new report from the Centers for Disease Control (CDC), Health, United States, 2013, finds that the rate of prescription drug overdose deaths in the US increased from 1.9 per 100,000 residents 15 and over in 1999-2000 to 6.6 per 100,000 in 2009-2010.

International

No Safe Injection Rooms for Brighton after UK Government Warns Health Workers of Risk of Arrest. Last year, the Independent Drugs Commission for Brighton and Hove suggested that Brighton and Hove establish drug consumption rooms, saying they could take drug use off the streets and reduce overdose deaths. But those plans have now been shelved after the Home Office warned that health workers working in such facilities might be subject to arrest. The idea also got a mixed reception from the public.

In Face of New Zealand's Renewed Ban on Synthetic Weed, Auckland Deputy Mayor Says Decriminalize the Real Thing. Auckland Deputy Mayor Penny Hulse, who had previously opposed decriminalizing marijuana, has had a change of heart. She told an Auckland Council meeting Tuesday that it didn't make sense to regulate synthetic marijuana without considering safer alternatives -- like real marijuana.

Jamaica Marijuana Conference Coming Later This Month. The inaugural Jamaica Cannabis Conference is set for May 22-24 at the University of the West Indies campus in Mona. The theme is "Wake Up, Jamaica; Our Opportunities Are Slipping Away." Click on the link for more details.

Jamaican Musician and Poet Mutabaruka Tells Gambia to Legalize It. On a visit to Gambia to perform at the 11th annual International Roots Homecoming Festival, famed Jamaican poet and reggae singer Mutabaruka said Tuesday that Gambia should legalize marijuana and that "no youth should be in trouble over marijuana," citing the international movement toward marijuana legalization.

(This article was published by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also shares the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

Chronicle AM -- May 13, 2014

The DC marijuana legalization initiative picks up some welcomed support, there's a legal challenge to Washington state's ability to collect marijuana taxes, a Republican US senator talks drug reform and takes some jabs at Obama, fentanyl-laced heroin is killing people in Philadelphia, and more. Let's get to it:

Marijuana Policy

Two Drug Reform Groups Get Behind DC Legalization Initiative. The Drug Policy Alliance has hired Dr. Malik Burnett as a full-time organizer in Washington, DC, to build support for Initiative 71, the DC marijuana legalization initiative. But his work in DC will also go beyond marijuana policy to include broader drug and social justice reform issues. Meanwhile, StoptheDrugWar.org (that's us) has endorsed the initiative and is seeking to deliver 5,000 of the 25,000 signatures needed. You can sign up to donate to our initiative effort here or sign up to volunteer here. Or click on the endorsement link for more information. Click the title link for more info about the DPA move.

Washington State Lawsuit Challenges State's Ability to Collect Marijuana Taxes. A Washington dispensary operator has filed a lawsuit attempting to stop the state from collecting taxes on marijuana sales. The operator, Martin Nickerson, is being prosecuted for the sale of medical marijuana he produced and argues that forcing him to pay taxes on his marijuana sales would violate his 5th Amendment right against self incrimination. He is represented by Douglas Hiatt, a Seattle marijuana and medical marijuana defense attorney and ardent foe of the I-502 legalization scheme. I-502's main proponent, Alison Holcomb, said she thinks the lawsuit has little chance of succeeding.

Ohio Supreme Court Forum to Discuss "Unintended Consequences" of Legalization Today. A discussion on "Marijuana Legalization and the Law of Unintended Consequences" moderated by state Supreme Court Justice Maureen O'Connor will take place today at 5:30pm at the Ohio Supreme Court in Columbus. Panelists are Colorado Deputy Atttorney General David Blake, Ohio State law professor and Sentencing Law and Policy blog author Douglas Berman, and Marijuana Policy Project director of federal policies Dan Riffle. Questions can be submitted via Twitter using hashtag #OhioFOTL.

Illinois Drug Policy Consortium to Discuss New Marijuana Policy Report Monday. The IDPC will have a panel discussing its new report on marijuana policy, Patchwork Policy: An evaluation of arrests and tickets in Illinois, next Monday, the day it is released. Click on the link for more info, including time and location details.

Medical Marijuana

Iowa Governor Likely to Sign Limited CBD Medical Marijuana Bill. Gov. Terry Brandstad (R) told a news conference Monday he has consulted with the governors of other states that have passed limited CBD medical marijuana bills and he thinks Iowa can move forward without "unintended consequences." He gave the legislature credit for crafting a very tight bill. "I think it's important that we respond to legitimate concerns from the public but we also have to protect against unforeseen consequences. I think the legislature in this case has tried to do that. My inclination at this point is to say that I'm inclined to think that it's likely that I will sign it," he said. The bill is Senate File 2360.

Drug Policy

Republican Senator Rob Portman Talks Drug Reform. Sen. Rob Portman (R-OH) is set to give a speech today at the American Enterprise Institute in Washington, DC, in which he will reportedly call for a reassessment of the decades long war on drugs. He will also reportedly criticize President Obama's plan to grant clemency to hundreds or thousands of convicted drug offenders, calling it a "band aid solution" that doesn't address deeper problems driving recidivism. He will also advocate for reauthorization of the Second Chance Act, which is aimed at reducing recidivism. Portman could have national ambitions in 2016.

Heroin

Fentanyl-Laced Heroin Killing People in Philly. At least 28 people in Philadelphia died from overdosing on fentany-laced heroin between March 3 and April 20, the Department of Behavioral Health and Intellectual Disability said Monday. The department is awaiting test results on seven more people. Fentanyl is a powerful narcotic many times more potent than heroin and is used to treat severe pain. An earlier wave of fentanyl-laced heroin killed 269 people in the city in 2006 and more than 2,000 people nationwide. The city health department has issued an alert.

International

Zetas Co-Founder Among Six Killed in Mexican Border Town Shootout. Gallando Mellado Cruz, one of the military deserters who helped found the gang of drug enforcers for the Gulf Cartel that morphed into the Zetas, was among six people killed in a gun battle between Mexican soldiers and cartel gunmen in the border town of Reynosa, Tamaulipas, just across the Rio Grande River from McAllen, Texas. Four other cartel gunmen and one soldier also died. Tamaulipas was the scene of bloody infighting between the Zetas and the Gulf cartel before calming down somewhat in 2012, but fighting has broken out again in recent weeks.

Canada's Sensible BC Announces Future Plans. The Canadian marijuana law reform group Sensible BC, which managed to gather more than 200,000 signatures for a provincial referendum to stop arrests for pot possession in BC, but still failed to make the ballot, has announced it will hold off on another referendum campaign until after the federal election in October 2015. Then, if Conservative Prime Minister Steven Harper wins reelection or if his replacement refuses to move forward on legalization, the group says it will launch a new referendum campaign in 2016. Until then, Sensible BC says it will focus on building its network and organization, keeping the issue alive in the media, and working on municipal elections coming in November.

London School of Economics Report Calls for New Approaches to Drug Policy

A report from the London School of Economics released Monday night outlines the enormous negative outcomes and collateral damage from the war on drugs and calls for new, evidence-based approaches to drug use and the drug trade.

The report, Ending the Drug Wars: Report of the LSE Expert Group on the Economics of Drug Policy, has chapters authored by leading drug policy experts from around the world and has been signed onto by five Nobel Prize-winning economists, as well as political figures including British Deputy Prime Minister Nick Clegg, Guatemalan Foreign Minister Luis Fernando Carrera Castro, former Polish President Aleksander Kwasniewski, former US Secretary of State George Schultz, and former European Union High Representative for Common Foreign and Security Policy Dr. Javier Solana, among other luminaries.

"It is time to end the 'war on drugs' and massively redirect resources towards effective evidence-based policies underpinned by rigorous economic analysis," the report says forthrightly. "The pursuit of a militarized and enforcement-led global 'war on drugs' strategy has produced enormous negative outcomes and collateral damage. These include mass incarceration in the US, highly repressive policies in Asia, vast corruption and political destabilization in Afghanistan and West Africa, immense violence in Latin America, an HIV epidemic in Russia, an acute global shortage of pain medication and the propagation of systematic human rights abuses around the world."

The stark prohibitionist approach to drug control has been a flop even by its own measures, the report found.

"The strategy has failed based on its own terms," it noted. "Evidence shows that drug prices have been declining while purity has been increasing. This has been despite drastic increases in global enforcement spending. Continuing to spend vast resources on punitive enforcement-led policies, generally at the expense of proven public health policies, can no longer be justified."

The report chided the United Nations for its continued adherence to such failed policies and urged it to accept experimentation while emphasizing public health and human rights.

"The United Nations has for too long tried to enforce a repressive, 'one-size-fits-all' approach," the report concluded. "It must now take the lead in advocating a new cooperative international framework based on the fundamental acceptance that different policies will work for different countries and regions. This new global drug strategy should be based on principles of public health, harm reduction, illicit market impact reduction, expanded access to essential medicines, minimization of problematic consumption, rigorously monitored regulatory experimentation and an unwavering commitment to principles of human rights."

"The drug war's failure has been recognized by public health professionals, security experts, human rights authorities and now some of the world's most respected economists," said John Collins, coordinator of LSE IDEAS International Drug Policy Project. "Leaders need to recognize that toeing the line on current drug control strategies comes with extraordinary human and financial costs to their citizens and economies."

"Repressive drug laws cost governments billions of dollars and result in horrible epidemics of infectious diseases and serious human rights abuses," said Dr. Kasia Malinowska-Sempruch, the director of the Open Society Global Drug Policy Program, which hosted a launch event for the report at the LSE Monday night. "We know the terrible costs of failed strategies and what can be gained from smarter approaches."

More fuel for the fire as an increasingly broad-based global movement for drug reform takes aim at the UN and its 2016 General Assembly Special Session (UNGASS) on Drugs.

London
United Kingdom

Hoffman, Heroin, and What Is To Be Done [FEATURE]

The news last Sunday that acclaimed actor Phillip Seymour Hoffman had died of an apparent heroin overdose has turned a glaring media spotlight on the phenomenon, but heroin overdose deaths had been on the rise for several years before his premature demise. And while there has been much wailing and gnashing of teeth -- and quick arrests of low-level dealers and users -- too little has been said, either before or after his passing, about what could have been done to save him and what could be done to save others.

cooking heroin (wikimedia.org)
There are proven measures that can be taken to reduce overdose deaths -- and to enable heroin addicts to live safe and normal lives, whether they cease using heroin or not. All of the above face social and political obstacles and have only been implemented unevenly, if at all. If there is any good to come of Hoffmann's death it will be to the degree that it inspires broader discussion of what can be done to prevent the same thing happening to others in a similar position.

Hoffman, devoted family man and great actor that he was, died a criminal. And perhaps he died because his use of heroin was criminalized. Criminalized heroin -- heroin under drug prohibition -- is of uncertain provenance, of unknown strength and purity, adulterated with unknown substances. While we don't know what was in the heroin that Hoffman injected, we do know that he maintained his addiction and went to meet his maker with black market dope. That's what was found beside his lifeless body.

In a commentary published by The Guardian, actor Russell Brand, a recovered heroin addict, laid the blame for Hoffman's demise on the drug laws. "Addiction is a mental illness around which there is a great deal of confusion, which is hugely exacerbated by the laws that criminalise drug addicts," Brand wrote, calling prohibitionists' methods "so gallingly ineffective that it is difficult not to deduce that they are deliberately creating the worst imaginable circumstances to maximise the harm caused by substance misuse." As a result, "drug users, their families and society at large are all exposed to the worst conceivable version of this regrettably unavoidable problem."

We didn't always treat our addicts this way. Even after the passage of the Harrison Act in 1914, doctors continued for years to prescribe maintenance doses of opiates to addicts -- and hundreds of them went to jail for it as the medical profession fought, and ultimately lost, a battle with the nascent drug prohibition bureaucracy over whether giving addicts their medicine was part of the legitimate practice of medicine.

The idea of treating heroin addicts as patients instead of criminals was largely vanquished in the United States, but it never went away -- it lingers with methadone substitution, for example. But other countries have for decades been experimenting with providing maintenance doses of opioids to addicts, and to good result. It goes by various names -- opiate substitution therapy, heroin-assisted theatment, heroin maintenance -- and studies from Britain and other European countries, such as Germany, the Netherlands, and Switzerland, as well as the North American Opiate Medications Initiative (NAOMI) and the follow-up Study to Assess Long-Term Opiate Maintenance in Canada have touted its successes.

Those studies have found that providing pharmaceutical grade heroin to addicts in a clinical setting works. It reduces the likelihood of death or disease among clients, as well as allowing them to bring some stability and predictability to sometimes chaotic lives made even more chaotic by the demands of addiction under prohibition. Such treatment has also been found to have beneficial effects for society, with lowered criminality among participants and increased likelihood of their integration as productive members of society.

The dry, scientific language of the studies obscures the human realities around heroin addiction and opioid maintenance therapy. One NAOMI participant helps put a human face on it.

"I want to tell you what being a participant in this study did for me," one participant told researchers. "Initially it meant 'free heroin.' But over time it became more, much more. NAOMI took much of the stress out of my life and allowed me to think more clearly about my life and future. It exposed me to new ideas, people (staff and clients) that in my street life (read: stressful existence) there was no time for."

"After NAOMI, I was offered oral methadone, which I refused. After going quickly downhill, I ended up hopeless and homeless. I went into detox in April 2007, abstained from using for two months, then relapsed. In July 2008 I again went to detox and I am presently in a treatment center... I am definitely not "out of the woods" yet, but I feel I am on the right path. And this path started for me at the corner of Abbott and Hastings in Vancouver... Thank you and all who were involved in making NAOMI happen. Without NAOMI, I wouldn't be where I am today. I am sure I would be in a much worse place."

Arnold Trebach, one of the fathers of the drug reform in late 20th Century America, has been studying heroin since 1972, and is still at it. He examined the British system in the early 1970s, when doctors still prescribed heroin to thousands of addicts, and authored a book, The Heroin Solution, that compared and contrasted the US and UK approaches. Later this month, the octogenarian law professor will be appearing on a panel at the Vermont Law School to address what Gov. Peter Shumlin (D) has described as the heroin crisis there.

Phillip Seymour Hoffman (wikimedia.org)
"The death of Phillip Seymour Hoffman is a tragedy all the way around," Trebach told the Chronicle. "It's a bad idea to use heroin off the street, and he shouldn't have been doing that."

That said, Trebach continued, it didn't have to be that way.

"If we had had a sensible system of dealing with this, he would have been in treatment under medical care," he said. "If he was going to inject heroin, he should have been using pharmaceutically pure heroin in a medical setting where he could also have been exposed to efforts to straighten out his personal life, and he could have access to vitamins, weight control advice, and the whole spectrum of medical care. And if he had had access to opioid antagonists, he could still be alive," he added.

While Hoffman may have made bad personal choices, Trebach said, we as a society have made policy choices seemingly designed to amplify the prospects for disaster.

"This is a sad thing. He is just another one of the many victims of our barbaric drug policy," he said. "This was a totally unnecessary death at every level. He shouldn't have been using, but we should have been taking care of him."

The stuff ought to be legalized, Trebach said.

"I'm an advocate of full legalization, but if we can't go that far, we need to at least provide social and psychological support for these people," he said. "And even if we were to decriminalize or legalize, I would still want to figure out ways to provide support and love and kindness to people using the stuff. I advise you not to do it, but if you're going to use it, I want to keep you alive. I remember talking to people from Liverpool [a famous heroin maintenance clinic covered in the '90s by Sixty Minutes, linked above] about harm reduction around heroin use back in the 1970s. One of the ladies said it is very hard to rehabilitate a dead addict."

"There are plenty of things we can be doing," said Hilary McQuie, Western director for the Harm Reduction Network, reeling off a list of harm reduction interventions that are by now well-known but inadequately implemented.

"We can make naloxone (Narcan) more available. We need better access to it. It should be offered to people like Hoffman when they are leaving treatment programs, especially if they've been using opiates, just as a safeguard," she said. "Having treatment programs as well as harm reduction programs distribute it is important. We can cut the overdose rate in half with naloxone, but there will still be people using alone and people using multiple substances."

There are other proven interventions that could be ramped up as well, McQuie said.

"Safe injection sites would be very helpful, so would more Good Samaritan overdose emergency laws, and more education, not to mention more access to methadone and buprenorphine and other opioid substitution therapies (OST)," she said, reeling off possible interventions.

Dr. Martin Schechter, director of the School of Population and Public Health at the University of British Columbia in Vancouver, knows a thing or two about OST. The principal study investigator for the NAOMI and the follow-up SALOME study, Schechter has overseen research into the effectiveness of treating intractable addicts with pharmaceutical heroin, as well as methadone. The results have been promising.

"What we're using is medically prescribed pharmaceutical diacetylmorphine, the active ingredient in heroin," he explained. "It's what you have when you strip away all the street additives. This is a stable, sterile medication from a pharmaceutical manufacturer. We know the precise dose tailored for each person. With street heroin, not only is it adulterated and injected in unsterile situations, but people really don't know how strong it is. That's probably what happened to Mr. Hoffman."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)
In NAOMI, 90,000 injections were administered to study participants, and only 11 people suffered overdoses requiring medical attention.

"Never did we have a fatal overdose," Schechter said. "Because it was in a clinic, nurses and doctors are right there. We administer Narcan (naloxone), and they wake up."

Heroin maintenance had even proven more effective than methadone in numerous studies, Schechter said.

"There have been seven randomized control trials across Europe and in Canada that have shown for people who have already tried treatments like methadone, that medically prescribed heroin is more effective and cost effective treatment than simply trying methadone one more time."

Those studies carry a lesson, he said.

"We have to start looking at heroin from a medicinal point of view and treat it like a medicine," he argued. "The more we drive its use underground, the more overdoses we get. We need to expand treatment programs, not only with methadone, but with medically prescribed heroin for people who don't respond to other treatments."

Safe injection sites are also a worthwhile intervention, Schechter said, although he also noted their limitations.

"Injecting under supervision is much safer; if there is an overdose, there is prompt attention, and they provide sterile equipment, reducing the risk of HIV and Hep C," he said. "But they are still injecting street heroin."

He would favor decriminalizing heroin possession, too, he said.

Harm reduction measures, opioid maintenance treatments, and the like are absolutely necessary interventions, said McQuie, but there is a larger issue at hand, as well.

"We still need to look at the overall issue of the stigmatization of drug users," she said. "People aren't open about their use, and that puts them in a more dangerous situation. It's really hard in a criminalized environment."

Stigmatization means to mark or brand someone or something as disgraceful and subject to strong disapproval. Defining an activity, such as heroin possession, as a crime is stigmatization crystallized into the legal structures of society itself.

"The ultimate harm reduction solution," McQuie argued, "is a regulated, decriminalized environment where it is available by prescription, so people know what they're getting, they know how much to use, and it's not cut with fentanyl or other deadly adulterants. People wouldn't have to deal with all the collateral damage that comes from being defined as criminals as well as dealing with the consequences of their drug use. They could deal with their addictions without having to worry about losing their homes, their families, and their freedoms."

While such approaches have a long way to go before winning wide popular acceptance, policymakers should at least be held to account for the consequences of their decision-making, McQuie said, suggesting that the turn to heroin in recent years was a foreseeable result of the crackdown on prescription opioid pain medication beginning in the middle of the last decade.

"They started shutting down all those 'pill mills' and people should have anticipated what would happen and been ready for it," she said. "What we have seen is more and more people turning to injecting heroin, but nobody stopped to do an impact statement on what would be the likely result of restricting access to pain pills."

The impact can be seen in the numbers on heroin use, addiction, and overdoses. While talk of a "heroin epidemic" is overblown rhetoric, the number of heroin users has increased dramatically in the past decade. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of past year users grew by about 50% between 2002 and 2011, from roughly 400,000 to more than 600,000. At the same time, the number of addicted users increased from just under 200,000 to about 370,000, a slightly lesser increase.

If there is any good news, it is that, according to the latest (2012) National Household Survey of Drug Use and Health, the number of new heroin users has remained fairly steady at around 150,000 each year for the past decade. That suggests, however, that more first-time users are graduating to occasional and sometimes, dependent user status.

And some of them are dying of heroin overdoses, although not near the number dying from overdoses from prescription opioids. Between 1999 and 2007, heroin deaths hovered just under 2,000, even as prescription drug deaths skyrocketed, from around 2,500 in 1999 to more than 12,000 just eight years later. But, according to the Centers for Disease Control, by 2010, the latest year for which data are available, heroin overdose deaths had surpassed 3,000, a 50% increase in just three years.

While the number of heroin overdose deaths is still but a fraction of those attributed to prescription opioid overdoses and the numbers since 2010 are spotty, the increase that showed up in 2010 shows no signs of having gone away. Phillip Seymour Hoffman may be the most prominent recent victim, but in the week since his death, another 50 or 60 people have probably followed him to the morgue due to heroin overdoses.

There are ways to reduce the heroin overdose death toll. It's not a making of figuring out what they are. It's a matter of finding the political and social will to implement them, and that requires leaving the drug war paradigm behind.

New York City, NY
United States

Chronicle AM -- January 10, 2014

The marijuana issue continues hot and heavy, one of our favorite authors is nominated for an award, harm reduction bills move in Wisconsin, and the US Sentencing Commission wants to cut drug sentences. And more. Let's get to it:

Dr. Carl Hart, nominated for an NAACP Image Award for "High Price" (columbia.edu)
Marijuana Policy

Colorado Legal Marijuana Sales Hit $5 Million in First Week. Sales of legal marijuana in Colorado since January 1 are estimated to have exceeded $5 million, with some 100,000 people lining up to buy it, according to industry insiders.

Colorado Republicans File Bill to Ban Food Stamps in Marijuana Shops. File under: solutions in search of problems. There is no evidence that anyone has ever used a food stamp EBT card to purchase marijuana products, but that hasn't stopped a handful of GOP state legislators to file a bill to outlaw it. "We need this bill, if for nothing else, as a statement," said Rep. Jared Wright (R-Grand Junction). "We shouldn't be enabling anyone to buy a substance that is banned under federal law. It's not a good use of taxpayer money," he said. The bill is Senate Bill 37.

New Hampshire House Didn't Vote on Marijuana Legalization. The House was set to vote Wednesday on a bill to legalize marijuana, but it didn't happen. The vote has instead been pushed back for a week as legislators dealt first with attempts to override vetoes on bills passed last year. The bill is House Bill 492.

No Marijuana Legalization Bill for Ohio This Year. The only Ohio legislator to push for marijuana legalization last year won't try it again this year. Rep. Bob Hagan (D-Youngstown) said he had no plans to introduce a measure this year after last year's effort to pass a resolution to let residents vote on the issue was sidelined.

Washington Congressman Urges Feds to Act Quickly on Marijuana Banking. Rep. Denny Heck (D-Washington) Friday called on federal regulators to move swiftly to resolve the issue of financial institutions being able to do business with legal marijuana businesses. In a statement, the coauthor of pending federal legislation that would do just that said that "it is urgent federal regulators come to a resolution on this issue as soon as possible."

Powerful Maryland Pol Comes Out for Marijuana Legalization. Delegate Maggie McIntosh (D-Baltimore) has joined the list of powerful state legislators calling for marijuana legalization. She said legalization is one of "the biggest, most important issues" facing the General Assembly this year. She joins Senate President Thomas Miller (D) and Democratic gubernatorial candidate Heather Mizeur in supporting legalization, but Gov. Martin O'Malley (D) and House Speaker Michael Busch (D) both oppose it.

Steny Hoyer Opposes Marijuana Legalization in Maryland. US House Minority Whip Steny Hoyer (D-MD) said Thursday he opposes legalizing pot in the state. "I'm not a proponent of legalizing marijuana," he said. "As I talked to people who deal with drug abuse issues, with rehabilitation issues, I became convinced that marijuana was, in fact, a threshold drug and it would lead to the use of harder, very harmful drugs," he added.

Medical Marijuana

Kentucky House Panel Holds Medical Marijuana Hearing. The House Health and Welfare Committee held a hearing Thursday to discuss medical marijuana. No specific bill was under discussion, but one legislator, Sen. Perry Clark (D-Louisville) filed a bill this week, Senate Bill 43, which would legalize medical marijuana.

Florida House Committee Chair Will Propose Bill to Legalize High CBD Strains for Seizures. Rep. Matt Gaetz (R-Shalimar), chair of the House Criminal Justice Subcommittee, said Thursday he would introduce a bill to allow for the medical use of marijuana strains that are high in CBDs. The vow came after a heart-wrenching hearing from parents of children who suffer seizure disorders, who called on the legislature to legalize strains such as "Charlotte's Web."

Asset Forfeiture

Utah Attorney General Sees Asset Forfeiture as Tool against Drug Legalizing Attorneys. After changes to undo asset forfeiture reforms approved by voters in 2000 snuck through the state legislature last year came under this week, Utah Attorney General Sean Reyes issued a brief defending the new law. But a bullet point justifying a new cap on attorneys' fees for people who successfully defend their property is setting off alarms among First Amendment advocates. "By setting a limit on attorney's fees it will take away the incentive for attorneys who actively promote the legalization of drugs in the state of Utah from soliciting clients who are engaged in criminal activity," the attorney general's brief said. Click on the link for a lengthier critique.

Drug Testing

Welfare Drug Testing Bill Coming Back in Indiana. House Speaker Brian Bosma (R-Indianapolis) said Thursday that while welfare drug testing legislation is not part of the House Republican agenda, a pending bill to do just that is "one we're going to enthusiastically endorse and move forward on." The bill, which passed the House, but not the Senate, last year, would require drug testing of welfare recipients based on some form of reasonable suspicion.

Harm Reduction

Push On to End Needle Exchange Ban in Federal Funding Bill. Harm reduction and public health advocates are urging lawmakers to lift the prohibition on the use of federal funds to pay for needle exchange programs. The battlefield is the conference committee that will reconcile House and Senate budget bills. The Senate version had language that included funding for needle exchanges, but the GOP-led House is expected to oppose it.

Wisconsin Overdose 911, Naloxone Bills Pass Assembly Committee. A bill to provide limited legal immunity to people who notify authorities of an overdose passed the Assembly Criminal Justice Committee Thursday. So did a bill that would allow first responders to carry and use the overdose reversal drug naloxone. Both now goes to the full Assembly, which should vote on them Tuesday. The bills have the backing of Attorney General JB Van Hollen (R) and are expected to sail through the Senate as well.

Honors

Carl Hart Wins NAACP Image Award Nomination for "High Price." Neuroscientist and Drug Policy Alliance board member Carl Hart's "High Price: A Neuroscientist's Journey of Self Discovery That Changes Everything You Know About Drugs and Society" has been nominated for an NAACP Image Award in the category of literary nonfiction. The awards ceremony takes place on February 22.

Sentencing

US Sentencing Commission Suggests Lowering Drug Guideline Sentences. The US Sentencing Commission voted Thursday to publish proposed federal drug sentencing guideline amendments that would include lowering guideline sentences for drug trafficking offenses. The amendments would reduce drug trafficking sentences by about 11 months, leading to a reduction in the federal prison population of more than 6,000 prisoners five years after taking effect. The commission is now seeking public comment on the proposal.

International

Jamaica Marijuana Growers to Organize. Jamaican legalization activists and marijuana growers will form a Cannabis Future Growers and Producers Association as part of a major conference next week. The "Going Forward -- Legalize It" conference is organized by the Ganja Law Reform Coalition, the Cannabis Commercial and Medicinal Research Task Force, and the National Alliance for the Legalization of Ganja, and hopes to help lay the groundwork for a legal marijuana industry on the island.

Canada's SensibleBC Sees 2014 as a Building Year. After an effort to put marijuana reform on the provincial ballot via an initiative faltered last year, Sensible BC leader Dana Larsen said this year would be a year of building momentum, training canvassers, and spreading the message of marijuana legalization. Larsen will also be touring the province this spring and summer to build support.

Chronicle AM -- December 11, 2013

Uruguay legalizes the marijuana trade (and the usual suspects object), Denver provides a helpful guide to legalization there, Human Rights Watch scorches Louisiana for its AIDS-enhancing policies, and more. Let's get to it:

Marijuana Policy

Denver Debuts Marijuana Legalization FAQ Web Site. The city of Denver has created a web site seeking to address questions from residents and visitors, parents and neighbors, business and property owners, and marijuana retailers and home growers about how legalization will work.

New York Marijuana Legalization Bill Announced. State Sen. Liz Kreuger (D-Manhattan) Wednesday unveiled a proposal to legalize and tax marijuana in the Empire State. Pot prohibition is "a policy that just has not worked," she said. Advocates concede that the bill is unlikely to pass this session, but you have to start somewhere.

Medical Marijuana

American Herbal Pharmacopeia Classifies Marijuana as Botanical Medicine. The world's leading expert organization on herbal medicine, the American Herbal Pharmacopeia, has released the first part of a two-part monograph on marijuana that classifies it as a botanical medicine, alongside many other accepted complementary and alternative medicines. Americans for Safe Access calls it a "historic move" and will host a Google Hangout Thursday at 5:30pm PT to discuss its ramifications.

Oregon Medical Marijuana Regulation Panel Meets for Last Time. The committee charged with creating Oregon's first statewide medical marijuana dispensary regulations is meeting for what is supposed to be the last time today. The panel has been meeting since September to craft rules around security, background checks, and marijuana testing. A 30-page draft version of the rules should be finalized.

Guam Medical Marijuana Bill Gets Another Hearing Today. Guam residents will have another chance to voice their opinions on medical marijuana at a hearing set for today. Sen. Tina Muna Barnes has introduced a measure, Bill 215, that would allow the use of medical marijuana for various illnesses. The hearing starts at 5:30pm Guam time.

Drug Testing

Pennsylvania School Employee Drug Testing Bill Passes House. A bill that would require prospective public school employees to submit to drug testing passed the House Tuesday. The ACLU of Pennsylvania calls House Bill 810 "invasive, impractical, and unconstitutional" and vows to challenge it -- and win -- if it ever becomes law. The bill now heads to the Senate.

Harm Reduction

Human Rights Watch Report Slams Louisiana Laws, Police Practices as Increasing AIDS Toll. Human Rights Watch issued a report Wednesday charging that Louisiana laws and practices that bar access to clean needles and criminalize sex work contribute to a raging HIV epidemic and a very high AIDS death rate. The report is In Harm's Way: State Response to Sex Workers, Drug Users, and HIV in New Orleans.

Push Is On for Naloxone and Good Samaritan Law in Minnesota. Elected officials and members of law enforcement called Tuesday for new state laws that would allow deputies to carry and administer the overdose reversal drug Naloxone and provide legal protections for people who contact authorities to report a drug overdose. The moves are a response to a rising toll of heroin overdose deaths, particularly in the Twin Cities.

International

Uruguay Legalizes Marijuana Commerce. The Uruguayan Senate Tuesday night gave final approval to the government's marijuana legalization bill. Now, once President Jose Mujica signs it into law, Uruguay will be 120 days away from a legal commerce in marijuana.

UN Anti-Drug Bureaucrats Say Uruguay Legalization Breaks Treaty. The International Narcotics Control Board (INCB) reacted unhappily to Uruguay's Tuesday night legalization vote. "Uruguay is breaking international conventions on drug control with the cannabis legislation approved by its congress," the INCB complained in a Wednesday press release. The INCB qualified itself as "surprised" that Uruguay had "knowingly decided to break the universally agreed and internationally endorsed legal provisions of the treaty."

Russian Drug Czar Says Drug Legalization "Impossible." Reacting to Uruguay's move to legalize marijuana, Viktor Ivanov, head of Russia's Federal Service for Drug Control, said the legalization of any drug is "impossible, and I think it will not be possible" in Russia. "Moreover, we have strengthened our political will with an anti-drug strategy," he added, although he also said it was possible that Russia could grow hemp and low opiate content poppies for agricultural purposes.

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.

DC 911 Good Samaritan Drug Overdose Bill Takes Effect

As of Tuesday, there will be limited legal protections for people who witness or experience a drug overdose in the District of Columbia and summon medical assistance. That's because the District's Good Samaritan Overdose Prevention Amendment Act goes into effect then.

Passed last fall by the DC city council, the new is aimed at reducing overdose deaths by removing the threat of arrest from overdose victims and those who might assist or seek help for them. Many overdose deaths do not occur immediately, and medical interventions can save lives, but some drug users and their peers are reluctant to seek help because of fear of arrest and prosecution.

"Criminalization should not be a barrier to calling 911," said Grant Smith, policy manager with the Drug Policy Alliance. "This new law will help encourage District residents who witness an overdose to pick up the phone and help save a life." 

Under the new law:

  • Law enforcement officers who observe small amounts of illegal drugs or paraphernalia at the scene of an overdose should not consider these drug law violations to be crimes for the individual experiencing the overdose and the witness who sought emergency medical services.
  • A minor is provided limited protection from criminal charges for underage possession of alcohol if they experience an overdose or seek emergency medical services for a peer.
  • An adult who is 25 years of age or younger is given limited protection from criminal charges for providing alcohol or other drugs to a minor who is 16 years of age or older if they seek emergency medical services for the minor in need.
  • The possession of naloxone – a medication that rapidly reverses opiate overdoses – and its use by lay persons on individuals experiencing an opiate overdose is decriminalized.

Ten states (California, Connecticut, Colorado, Florida, Illinois, Massachusetts, New Mexico, New York, Rhode Island and Washington State) have already enacted Good Samaritan laws for preventing fatal drug overdoses. Good Samaritan legislation is currently pending in New Hampshire, North Carolina, Missouri and other states. A coalition comprised of the Drug Policy Alliance, Students for Sensible Drug Policy, American Civil Liberties Union of the Nation's Capital, Bread for the City, HIPS, students from the George Washington University School of Public Health and Health Services and GW Law Students for Sensible Drug Policy, parents and advocates supported passage of the Good Samaritan law.

"Implementation of this new law by public health and law enforcement officials is critical to improving public willingness to immediately seek medical assistance for overdoses involving illegal drug and alcohol use," said Smith.

Spurred by the rapid rise in opioid pain medication prescribing and the diversion of pain pills, drug overdose rates nationwide have increased five-fold since 1990 and more than doubled between 2000 and 2010. Heroin and other opiates are the second leading cause of overdose deaths in the District in recent years, following cocaine.

Washington, DC
United States

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

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