Overdoses

Chronicle Film Review: Prohibition

by Phillip Smith, October 05, 2011, 06:17pm, (Issue #703)

Prohibition: A Film by Ken Burns and Lynn Novick (2011, Florentine Films/WETA, 3 discs, 5 ½ hrs., $41.99)

One of America's leading documentarians has done it again. Ken Burns, producer of the widely watched and hailed documentaries, Baseball and The Civil War, has now teamed up with Lynn Novick to examine the rise, fall, and repeal of the 18th Amendment banning alcohol sales and production. It is a worthy effort, and well-executed.

Prohibition "postcards" online at pbs.org/kenburns/prohibition/send-postcards/

The multi-hour must-see premiered over three nights this week on PBS, pulling in nearly four million viewers on its opening night -- very big numbers for public TV. It's also available online at the PBS Ken Burns Prohibition web site.

For most us of Prohibition is ancient history, skimmed over bloodlessly in dusty tomes in high school and undergraduate history courses. My 83-year-old mother, for instance, was still a toddler when revelers across the land tippled with delirious joy to mark repeal. For anyone younger than her -- and that's most of us -- Prohibition is no more than a school lesson, not a thing of living memory, except, perhaps, for an old story or two told by grandpa or grandma.

One of the successes of Prohibition is the way it brings that dry history to life. Through the skillful use of contemporary film, photographic stills, oral history, written remembrances narrated by actors, and a lively narration by Peter Coyote, Burns and Novick are able to recreate the living, breathing reality of second half 19th and early 20th Century America. Staring face to face at the glowering glare of a doughty battle-axe like Carrie Nation or the lizard-lidded, full-lipped gaze of Chicago gangster Al Capone, listening to Al Smith rail against the dries or Mabel Willibrand rally preachers against repeal, helps us put a human face on the passions and frailties behind the march of the social revolution that was Prohibition and the mass rejection of it that was repeal.

Similarly, vivid scenes of saloon debauchery, with passed out drunks and giddy tipplers, of speakeasies filled with good-time guys and giddy flappers, of mass marches for and against, of political conventions and campaigns in which Prohibition was a burning issue of the day, help put living flesh on the dry bones of history.

The early 20th Century experiment in social control and legislating morality contains many lessons for contemporary activists seeking to undo the damage done by drug prohibition. Burns and Novick deserve our thanks for teasing out the varied strands that turned the 19th Century's temperance movement among mostly rural, Protestant, church-going women into a political powerhouse capable of blunting the power of big booze, shuttering the breweries and distilleries, and eliminating the saloons men saw as their last refuge from the demands of wife and children.

For me, the most important achievement of Prohibition is the way in situates the temperance movement within the broader social and political context of a tension-filled, rapidly evolving America. As Burns and Novick make abundantly clear, Prohibition did not happen in a vacuum. Among the forces propelling it were many of the same forces active today propelling reactionary social movements: racism (directed against newly arrived Irish, German, and Jewish immigrants), nativism (ditto), religious bigotry (aimed at those Catholic immigrants), nationalism (against mainly German-American beer brewers, especially during World War I), and rural vs. urban tensions.

But while it may be easy to ridicule the reactionaries of the last century, the roots of Prohibition also come uncomfortably close for present-day progressives. The temperance movement -- in all its intemperance -- was closely tied to "what about the children!" sentiment and women's suffrage, a cry for healthy living, as well as the sort of "do-gooderism" conducted by "busybodies" that still informs much of the discourse when it comes to drug policy reform today.

As Prohibition shows most excellently, the politics of morality and social control are deep and twisted, and unraveling them reveals some unflattering facets of progressivism, as well as the more easily derided absolutists of what could fairly be called the Christian Right.

Where Prohibition is perhaps most useful to modern day drug reformers is in its depiction of the social ills it generated. Much as the Drug Policy Alliance likes to say "drug abuse is bad, drug prohibition is worse," viewers of Prohibition could fairly draw the conclusion that "mass drunkenness is bad, mass drunkenness under Prohibition is worse." Burns and Novick sketch the rapid expansion of organized crime under Prohibition, the gang wars of Chicago and New York, the corruption of cops and public officials -- all the side-effects of prohibition so familiar to present day reformers.

Prohibition "postcards" online at pbs.org/kenburns/prohibition/send-postcards/

But they also look at its public health consequences, which -- like current drug prohibition -- were also in many ways disastrous. There were mass deaths from bad bathtub gin, deaths from drinking wood alcohol, outbreaks of "Jake Leg," a neurological disorder caused by contaminated whiskey that crippled hundreds, if not thousands, and while alcohol consumption initially declined, that decline was soon reversed, and with even more unhealthy drinking patterns.

In the end, Prohibition died of neglect, ridicule, and changing social attitudes, forged at least in part by the experience of Prohibition itself. And at the end, it revealed itself to be hollow, crumpling with amazing rapidity after the Great Depression hit and the big city, immigrant-friendly Democrats under FDR took power. Before the end of FDR's first year in office, Prohibition was history.

There are many lessons and parallels for contemporary drug reformers in Prohibition, but they are not exact and may not apply across the board. Alcohol prohibition lasted barely a decade, but drug prohibition is now in its second century. Why one was a flash in the pan and the other remains a painful, enduring legacy are questions that need to be answered if we are ever to leave drug prohibition in the dustbin of history along with Prohibition. Prohibition can help us start to ask the questions that will give us the right answers.

Disappointingly, Ken Burns doesn't appear interested in pursuing the parallels, nor even the dissimilarities, between Prohibition then and prohibition now. He does not reference the prohibition of other drugs in Prohibition (although heroin and cocaine were already criminalized federally and marijuana was being banned in a number of states), nor, as he has made clear in interviews, does he see a useful comparison between the two.

But that disagreement or lack of boldness notwithstanding, Prohibition is still a great viewing experience that brings alive a critical episode in US social and political history, an episode who reverberations still linger and whose contours are still echoed in drug prohibition. This is your history, America -- watch, enjoy, learn, and ponder.

Canada Supreme Court Okays Safe Injection Site [FEATURE]

by Phillip Smith, September 30, 2011, 04:52pm, (Issue #703)

Rebuffing the Conservative government of Prime Minister, the Canadian Supreme Court Friday ruled unanimously that Vancouver's safe injection site for heroin addicts can stay open. Known as Insite, the Downtown Eastside facility is the only safe injection site in North America.

Vancouver's safe injection site wins a reprieve. (Image: Vancouver Coastal Health)

The Downtown Eastside, centered on the intersection of Main and Hasting, streets, has one of the highest concentrations of injection drug users in the world. An overgrown Skid Row flush with prostitution and destitution, most of its residents live in decaying SRO hotels lining Main Street. Out of 12,000 residents in the area, some 5,000 are estimated to be drug addicts.

At Insite, drug users are provided clean needles and sterilized water with which to mix their drug. Insite does not provide the drugs; users must bring their own. The users inject under medical supervision at one of 12 injecting alcoves.

Insite operates under the auspices of the British Columbia Ministry of Health and the local public health authority, Vancouver Coastal Health. Numerous research reports on Insite have found that it has reduced fatal drug overdoses, reduced HIV and Hepatitis C transmission rates, reduced crime rates in the neighborhood, and increased the number of drug users entering treatment.

It has operated since 2003 under an exemption to Canada's drug laws, but since coming to power, the Harper government has attempted to shut it down, claiming it "enables" drug users. Friday's decision by the Canadian Supreme Court is the final chapter in that effort.

The Harper government argued that the federal drug law took precedence over British Columbia's public health policies. British Columbia and other Insite supporters argued that because Insite is providing a form of health care, its operation is a provincial matter. The federal government's concerns did not outweigh the benefits of Insite, the court said.

"The grave consequences that might result from a lapse in the current constitutional exemption for Insite cannot be ignored," the court said. "Insite has been proven to save lives with no discernible negative impact on the public safety and health objectives of Canada."

Hundreds of Insite supporters gathered at the facility at dawn and broke out in cheers after the decision was announced. As the news spread, harm reduction, public health, and drug reform groups in Canada and around the world lined up to applaud it.

"We are absolutely delighted that we finally have a clear decision on the legal framework for Insite," said Dr. Patricia Daly, Vancouver Coastal Health Chief Medical Health Officer. "Since 2003, Insite has made a positive impact on thousands of clients, saved lives by preventing overdoses, and provided vital health services to a vulnerable population. Today's ruling allows us to continue the outstanding work Insite, its doctors, nurses, staff and partners provide."

"This represents a victory for science," said Dr. Julio Montaner, Director of the BC Center for Excellence for HIV/AIDS. "Prior attempts from the federal government to stop the activities of Insite have been ruled unconstitutional. We are thankful for the continued and unwavering support from the provincial government that has allowed us to set an example in Canada and the world for how to deal with addiction which is, indeed, a medical condition."

"We applaud today's landmark decision by the Canadian Supreme Court to uphold the human rights of all Canadians by allowing Insite to remain open," said the Canadian HIV/AIDS Legal Network, CACTUS Montreal, and Harm Reduction International in a joint statement. "We are heartened the Supreme Court of Canada has recognized that criminal laws on drugs must give way to good public health practices and harm reduction."

"This is a victory for science, compassion and public health -- and, given the fiscal benefits of such programs, the Canadian taxpayer. The Supreme Court of Canada recognized that Insite saves lives, and that that should be a guiding principle in deciding drug policy," said Laura Thomas, California deputy director for the Drug Policy Alliance. "Congratulations to the advocates, drug users, researchers, nurses, and elected officials who have campaigned for Vancouver's supervised injection facility for so long. This is a complete validation of their work."

The Supreme Court of Canada's Insite ruling applies only to Insite. Other Canadian localities seeking to establish safe injection sites must win permission from the federal government. Canadian activists urged them to do so.

"In light of today's Supreme Court decision, jurisdictions Canada-wide should act fearlessly on evidence and make harm reduction services modeled on Insite available to those in need in their locales," said the Canadian groups. "The Minister of Health must respect the court's decision and grant similar exemptions to other sites so that people across Canada will be able to access the public health services they desperately need."

There are 67 safe injection sites operating today, with one in Australia, Insite in Vancouver, and the rest in Europe. There are no safe injection sites operating in the United States, although a move is afoot in San Francisco to get one underway there. The Drug Policy Alliance's Thomas said it is time to start pushing harder.

"For communities in the US which have been hard hit by drug use, it is time to look at the evidence from Canada and start opening supervised injection facilities here," she said. "We look forward to implementing the same desire to save lives in the US."

Vancouver, BC

Canada

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Massachusetts Marks 1,000th Narcan Overdose Reversal

by Phillip Smith, September 21, 2011, 04:58pm, (Issue #701)

State officials in Massachusetts announced Tuesda y that the state's pilot Narcon (naloxone) pilot program has marked the 1,000th overdose reversal since the program was introduced in 2007. The program is part of a broader effort undertaken by the Department of Public Health, its Bureau of Substance Abuse Services and its Bureau of Infectious Disease Control to reduce fatal and non-fatal opiate overdoses.

Narcan is saving lives in Massachusetts. (image courtesy Cambridge OPEN)

Narcan is an opioid antagonist that blocks the effects of opioids, such as heroin, oxycodone, hydrocodone, fentanyl, codeine and methadone. The pilot programs teach people how to use Narcan, including opioid users and trusted people in their lives, such as family, friends and staff of human services programs. The Narcan pilot sites also provide education on overdose prevention and referrals to treatment. The Department of Public Health reported that more than 10,000 people are now enrolled in the pilot program, including drug users, friends, and family members.

"Too many families have been impacted by the rise in opiate abuse and overdoses in Massachusetts," said Lieutenant Governor Timothy Murray, Chair of the Interagency Council on Substance Abuse and Prevention. "As we continue to combat opiate abuse and provide resources for prevention and treatment services, Narcan has proven to be a powerful tool in saving lives, so that opiate abusers can receive treatment and begin to recover from their addiction."

"Massachusetts is a national leader in opioid overdose prevention," said Secretary of Health and Human Services JudyAnn Bigby, MD. "By using community-based programs to enroll participants and distribute Intra-nasal Narcan, this pilot has allowed us to reach opioid users and bystanders in communities across the state."

Intra-nasal Narcan is available at pilot sites located in 12 Massachusetts cities, including Boston, Brockton, Cambridge, Fall River, Gloucester, Hyannis, Lynn, New Bedford, Northampton, Provincetown, Quincy and Springfield. The pilot sites provide education on overdose prevention, recognition and response to opiate users and family and friends of opiate users, along with referrals to treatment. Click here to learn more.

Boston, MA

United States

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Big Name Panel Calls Global Drug War a "Failure" [FEATURE]

by Phillip Smith, June 02, 2011, 06:53pm, (Issue #687)

The global war on drugs is a failure and governments worldwide should shift from repressive, law-enforcement centered policies to new ways of legalizing and regulating drugs, especially marijuana, as a means of reducing harm to individuals and society, a high-profile group of world leaders said in a report issued last Thursday.

Richard Branson blogs about being invited onto the global commission, on virgin.com.

The Global Commission on Drug Policy, whose members include former UN Secretary-General Kofi Annan and former presidents of Brazil, Colombia, and Mexico, said the global prohibitionist approach to drug policy, in place since the UN adopted the Single Convention on Narcotic Drugs a half-century ago, has failed to reduce either the drug supply or consumption.

Citing UN figures, the report said global marijuana consumption rose more than 8% and cocaine use 27% in the decade between 1998 and 2008. Again citing UN figures, the group estimated that there are some 250 million illegal drug consumers worldwide. "We simply cannot treat them all as criminals," the report concluded.

The report also argued that arresting "tens of millions" of low-level dealers, drug couriers, and drug-producing farmers not only failed to reduce production and consumption, but also failed to address the economic needs that pushed people into the trade in the first place.

Prohibitionist approaches also foster violence, most notably in the case of Mexico, the group argued, and impede efforts to stop the spread of diseases like HIV/AIDS and Hepatitis. Governments should instead turn to science- and evidence-based public health and harm reduction approaches, the group said. It cited studies of nations like Portugal and Australia, where the decriminalization of at least some drugs has not led to significantly greater use.

"Overwhelming evidence from Europe, Canada and Australia now demonstrates the human and social benefits both of treating drug addiction as a health rather than criminal justice problem and of reducing reliance on prohibitionist policies," said former Swiss president Ruth Dreifuss. "These policies need to be adopted worldwide, with requisite changes to the international drug control conventions."

The report offered a number of recommendations for global drug policy reform, including:

End the criminalization, marginalization and stigmatization of people who use drugs but who do no harm to others.
Encourage experimentation by governments with models of legal regulation of drugs (especially cannabis) to undermine the power of organized crime and safeguard the health and security of their citizens.
Ensure that a variety of treatment modalities are available -- including not just methadone and buprenorphine treatment but also the heroin-assisted treatment programs that have proven successful in many European countries and Canada.
Apply human rights and harm reduction principles and policies both to people who use drugs as well as those involved in the lower ends of illegal drug markets such as farmers, couriers and petty sellers.

"Fifty years after the initiation of the UN Single Convention on Narcotic Drugs, and 40 years after President Nixon launched the US government's global war on drugs, fundamental reforms in national and global drug control policies are urgently needed," said former president of Brazil Fernando Henrique Cardoso. "Let's start by treating drug addiction as a health issue, reducing drug demand through proven educational initiatives, and legally regulating rather than criminalizing cannabis."

"The war on drugs has failed to cut drug usage, but has filled our jails, cost millions in tax payer dollars, fuelled organized crime and caused thousands of deaths. We need a new approach, one that takes the power out of the hands of organized crime and treats people with addiction problems like patients, not criminals," said Richard Branson, founder of the Virgin Group and cofounder of The Elders, United Kingdom. "The good news is new approaches focused on regulation and decriminalization have worked. We need our leaders, including business people, looking at alternative, fact based approaches. We need more humane and effective ways to reduce the harm caused by drugs. The one thing we cannot afford to do is to go on pretending the war on drugs is working."

The Obama administration is having none of it. "Making drugs more available -- as this report suggests -- will make it harder to keep our communities healthy and safe," Rafael Lemaitre, spokesman for the Office of National Drug Control Policy told the Wall Street Journal the same day the report was released.

That sentiment is in line with earlier pronouncements from the administration that while it will emphasize a public health approach to drug policy, it stands firm against legalization. "Legalizing dangerous drugs would be a profound mistake, leading to more use, and more harmful consequences," drug czar Gil Kerlikowske said earlier this year.

But if the White House isn't listening, US drug reformers are -- and they're liking what they're hearing.

"It's no longer a question of whether legalizing drugs is a serious topic of debate for serious people," said Neill Franklin, executive director of Law Enforcement Against Prohibition (LEAP) and a 34-year veteran police officer from Baltimore, Maryland. "These former presidents and other international leaders have placed drug legalization squarely on the table as an important solution that policymakers need to consider. As a narcotics cop on the streets, I saw how the prohibition approach not only doesn't reduce drug abuse but how it causes violence and crime that affect all citizens and taxpayers, whether they use drugs or not."

"These prominent world leaders recognize an undeniable reality. The use of marijuana, which is objectively less harmful than alcohol, is widespread and will never be eliminated," said Rob Kampia, executive director of the Marijuana Policy Project. "They acknowledge that there are only two choices moving forward. We can maintain marijuana's status as a wholly illegal substance and steer billions of dollars toward drug cartels and other criminal actors. Or, we can encourage nations to make the adult use of marijuana legal and have it sold in regulated stores by legitimate, taxpaying business people. At long last, we have world leaders embracing the more rational choice and advocating for legal, regulated markets for marijuana. We praise these world leaders for their willingness to advocate for this sensible approach to marijuana policy."

"The long-term impact of the Global Commission's efforts will be defining," predicted David Borden, executive director of StoptheDrugWar.org (publisher of this newsletter). "Most people don't realize that there are leaders of this stature who believe prohibition causes much of the harm commonly seen as due to drugs. As more and more people hear these arguments, coming from some of the most credible people on the planet, legalization will come to be viewed as a credible and realistic option."

Other commission members include Louise Arbour, former UN High Commissioner for Human Rights, Canada; Fernando Henrique Cardoso, former President of Brazil (chair); Marion Caspers-Merk, former State Secretary at the German Federal Ministry of Health; Maria Cattaui former Secretary-General of the International Chamber of Commerce, Switzerland; Carlos Fuentes, writer and public intellectual, Mexico; Asma Jahangir, human rights activist, former UN Special Rapporteur on Arbitrary, Extrajudicial and Summary Executions, Pakistan; Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria , France; Mario Vargas Llosa, writer and public intellectual, Peru; George Papandreou, Prime Minister of Greece; George P. Shultz, former Secretary of State, United States (honorary chair); Javier Solana, former European Union High Representative for the Common Foreign and Security Policy , Spain; Thorvald Stoltenberg, former Minister of Foreign Affairs and UN High Commissioner for Refugees, Norway; Paul Volcker, former Chairman of the United States Federal Reserve and of the Economic Recovery Board; John Whitehead, banker and civil servant, chair of the World Trade Center Memorial Foundation, United States; and Ernesto Zedillo, former President of Mexico.

While the Obama administration may be loathe to listen, the weight of world opinion, as reflected in the composition of the global commission that issued this report, is starting to create stress fractures in the wall of prohibition. A half-century of global drug prohibition has showed us what it can deliver, and the world is increasingly finding it wanting.

Scottish Liberal Democrats Back Prescription Heroin

by Phillip Smith, March 05, 2011, 11:20pm, (Issue #674)

Scottish Liberal Democrats at their party conference in Perth voted Saturday to make campaigning for heroin maintenance treatment part of their party platform. Heroin users should not be fined or imprisoned, but should be given the drug through the National Health Service, party members agreed.

Tavish Scott's Lib Dems want "heroin on the NHS." (Image via Wikimedia)

The Liberal Democrats are an opposition party in Scotland, holding 16 of 129 Scottish Parliament seats, 11 of 59 Scottish seats in the British Parliament, and one of six Scottish seats in the European Parliament. They are fourth of five major political parties, behind the National Party, Labor, and the Conservatives, but ahead of the Scottish Greens. They are led by Tavish Scott.

The Lib Dems argued that both society and heroin users would benefit from prescribing the drug. Overdose and tainted drug deaths would decline, and addicts would not have to turn to crime or prostitution to feed their habits, they said.

"For drug offenders, fines and jail time simply don't work. In fact a fine will make it much more likely for a drug user to turn to a life of crime to fuel their habit," said Callum Leslie, a candidate for Mid Fife and Glenrothes. "Instead, the Liberal Democrats want to see a much greater use of Drug Treatment and Testing Orders (DTTOs) and Community Service Orders (CSOs). The evidence shows that these methods work. Offenders are forced to pay back the community they harmed and have a chance to get drug free for good. Controlled diamorphine [heroin] treatment is a method that works where other methods have failed. It stops offenders getting street heroin, which can be fatal and turns offenders to further crime to fund their habit."

"There is a great cost to society, and the public purse, if offenders are just abandoned to a cycle of crime and prison," said Alex Cole-Hamilton, Liberal Democrat candidate for Edinburgh Central. "DTTOs and CSOs are measures that would save public money by keeping drug abusers out of jail. Drug offenders should not be treated the same as murderers. We should work to treat the problem of drug abuse, not lock addicts away and condemn them to a life of crime."

United Kingdom

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Heroin Drought Causing Problems in England

by Phillip Smith, November 23, 2010, 03:32pm, (Issue #660)

A scarcity of heroin in England is leading to a growing number of drug overdoses and poisonings as users ingest dope cut with other substances by dealers trying to stretch supplies, The Guardian reported this week. Scene watchers there are calling it the worst drought in years.

Are you sure that's heroin? Be careful out there, especially in England

The drought is being blamed not on seizures by law enforcement agencies, but on a fungus that has blighted the Afghan opium poppy crop, reducing the size of this year's poppy crop by half. Afghanistan accounts for more than 90% of the world's opium production and likely 100% of the British heroin supply.

"There is a very significant heroin shortage across the UK at the moment," said Gary Cross, head of drug policy for the non-profit group Release. "It has been going on for some time now, but the last two months have seen stockpiles exhausted."

"I've never known anything like it in 30 years," wrote one long-time heroin user on an on-line forum discussing the shortage.

As dealers and users scramble to grapple with the shortage, users are turning up at hospitals after ingesting adulterated heroin or, in some cases, fake heroin consisting of a powerful sedative, caffeine, and paracetamol, a bulking agent. Some have passed out after smoking or ingesting, while others have reported vomiting, amnesia, and flu-like symptoms.

"This 'heroin drought' appears to be serious and geographically widespread," said Neil Hunt, director of research at KCA, a nationwide community drug treatment service. "Street heroin is in a complete and utter muddle at the moment, and users are collapsing unexpectedly. We need to standardize information about what's out there.

"If people use this intravenously, perhaps on top of alcohol and methadone [the prescribed substitute drug for heroin], it is extremely risky," said Dr. John Ramsey, who runs a drug database at St. George's Medical School in London. "We have had many reports of people overdosing. It's really important that accident and emergency departments understand that they may not be dealing with a 'normal' heroin overdose when people are brought in," he said.

Harm reduction drug agencies are aware of the problem and working to address it. Several of them held an urgent meeting last week to discuss setting up an online warning system to give users notice about contaminated or adulterated drugs.

London

United Kingdom

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Washington State 911 Good Samaritan Law to Prevent ODs Now in Effect

by Phillip Smith, June 11, 2010, 04:08pm

A law that provides some legal immunity for people who report a drug overdose in Washington state is now in effect. That makes Washington the second state to enact a "911 Good Samaritan Law." New Mexico was the first in 2007. Under the measure, if someone overdoses and someone else seeks assistance, that person cannot be prosecuted for drug possession, nor can the person overdosing. Good Samaritans could, however, be charged with manufacturing or selling drugs. The measure is aimed at reducing drug overdoses by removing the fear of arrest as an impediment to seeking medical help. According to the state Department of Health, there were 820 fatal drug overdoses in the state in 2006, more than double the 403 in 1999. The bill also allows people to use the opioid agonist naloxone, which counteracts the effects of opiate overdoses, if it is used to help prevent an overdose. Washington is the first state this year to pass a 911 Good Samaritan bill, but it may not be the last. According to the National Conference of State Legislatures, Hawaii, Massachusetts, Minnesota, and Rhode Island are considering similar measures. Supporters of the new law held a press conference Monday to tout its benefits. “In 2008, there were 794 drug overdose deaths in Washington state,” said Dr. Caleb Banta-Green, a drug overdose researcher from the University of Washington. “These overdoses do not need to be fatal. Death often takes several hours to occur,” and people are often present. He said more information on the law is available at www.stopoverdose.org. “We’re here today to encourage people who don’t work in hospitals to help saves lives,” Attorney General Rob McKenna said. “More people are dying now from prescription drug overdoses (than traffic accidents) and yet fewer people are aware of it,” McKenna said. He said drug overdoses are a hidden problem because they aren’t as visible as, for example, traffic accidents.. Sen. Rosa Franklin, who worked to pass the bill, said she worked as a nurse before becoming a legislator and wanted to address a problem she saw and read about. She said this bill will save lives. “We can no longer … put our heads in the sand and say that drug overdose is not happening.” Alison Holcomb of the ACLU of Washington said drug overdoses wouldn’t happen in an ideal world, and this law wouldn’t be necessary. She said people do drugs to cope, find acceptance or escape. “We can continue to condemn such people as morally deviant and treat them as criminals,” but, she said, that doesn’t work. She said this law is an important step and a compromise agreement. “My son, a bright, creative, compassionate and funny kid, began using prescription opiates … during his senior year of high school,” John Gahagan said. Just weeks after graduation, his son died of a drug overdose. “The 911 Good Samaritan Law will save lives,” he said, adding that his son was alone at the time of his overdose, but he knows parents of other teens who could have been saved. “This law will only be effective if there is awareness of it … Call 911 to save a life,” he said.

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United States

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Feature: Pennsylvania Lawmakers' Aim at Reducing Methadone Deaths, But Shoot Wide

by Phillip Smith, June 11, 2010, 12:00am, (Issue #636)

Late last month, Pennsylvania state Senate Republicans -- and one Senate Democrat -- held a press conference at the statehouse in Harrisburg to roll out their "Methadone Accountability Package." The package, they said, aims at increasing safety and fiscal accountability and reducing the illicit use of methadone and methadone overdose deaths. A related Senate resolution is also calling for a moratorium on new methadone treatment centers. But methadone treatment advocates and researchers are cautioning that the package may be unnecessary, and are calling for any legislation on methadone to be based on facts and scientific evidence -- rather than overheated rhetoric and anecdotes.

Drug overdoses have risen nationally in recent years, with the increase generally being attributed to increased use of prescription medications such as methadone and buprenorphine. Advocates have suggested overdose prevention approaches such as "Good Samaritan" policies protecting people who call for help -- Washington state's legislature enacted one this week -- or distribution of the overdose antidote naloxone, as ways of stemming the tide. But the PA package announced this week goes a different direction.

http://stopthedrugwar.org/files/pamethadonebills.jpg

the dark side: legislators seeking dramatic methadone restrictions

While the bundle of bills addresses keeping track of methadone-related deaths (SB 1293), diversion control (SB 1376), driving while using methadone (SB 1377, SB 1378), and micromanaging methadone maintenance treatment (SB 1382, SB 1383), the bill that strikes most directly at methadone maintenance treatment for opiate-dependent individuals, is SB 1294, the Methadone Addiction Prevention and Treatment Act, introduced by Sen. Mike Stack (D-District 5). Stack's bill would mandate that:

Potential patients be addicted to opiates for at least one year before methadone treatment is considered;
Potential patients must have twice failed other forms of treatment;
Patients have a written plan with goals and dates to be free from drug dependence, including methadone, within two to three years;
Patients must have a designated driver come with them to the clinic for the first two weeks of treatment; and
Driving under the influence of more than the prescribed dose of methadone be a violation of state driving under the influence laws.

"Pennsylvania needs better laws to prevent methadone abuse and provide patients with the proper protections and treatment plans they need to achieve a lifetime of sobriety," Sen. Stack said. "This package of bills is a solid step toward achieving those goals."

"Pennsylvania's law has not kept pace with the changes in the prescription of methadone -- and too frequently with deadly consequences," said Sen. John Eichelberger (R-District 30). "Methadone is a drug with its own unique properties. One pill or one dose can kill a non- or low-opiate-tolerant person. Even a day or two after the drug is taken, it has led to fatalities for those who mix alcohol or other drugs."

The senators cited reports from the National Drug Intelligence Center that unlawful diversion of methadone had more than doubled between 2003 and 2007 and from the National Center for Health Statistics that the number of methadone overdose deaths had increased nearly five-fold, with OD deaths among young people (15-24) increasing eleven-fold.

Not so fast, say experts. "Let's be careful about this; there are a lot of lives at stake here," said Eric Hulsey, director of performance, evaluation, and program development at the Institute for Research, Education, and Training in Addictions in Pittsburgh. "If the intention behind this stuff is better clinical care, that's a great thing, but we have to caution that it needs to be grounded on evidence-based practice."

Hulsey and National Association for Medication Assisted Recovery president Roxanne Baker also questioned some of the specifics in SB 1294. For Baker, the objections are a bill-killer.

"I would have to oppose this bill because it's too restrictive," she said. "There are already state and federal regulations on methadone treatment centers. Medicine is best left to doctors, not legislators."

Baker objected to the bill's provision for pushing methadone maintenance patients to get off the drug. "They really push the methadone abstinence schedule, don't they," she said. "Here in California, they just say it would be 'harmful to the patient' to taper off. I don't know why that needs to be in there; they don't make you taper off thyroid medication or insulin."

Hulsey didn't see a lot of evidence that methadone maintenance clinics are behind the problems being cited by the politicians. "Methadone prescribing has gone up seven-fold around the country, and we've seen all these methadone overdoses. Most of the federal reports and researchers have concluded that this is coming from the pain management clinics, yet everyone wants to crack down on the methadone treatment clinics."

Methadone treatment clinics are operated under different and stricter sets of regulations than pain clinics, Hulsey said. "It's unclear what the pain clinics are doing to prevent adverse incidents at their facilities, but it is clear that most diverted meds are coming from pain management, therefore, let's legislate against methadone maintenance clinics?"

Not that cracking down on pain clinics is the answer either, according to NAMA's Baker. Pointing out that methadone maintenance clinics are not the problem is fine, she said, but let's not be too quick to go after pain doctors. Citing the massive under-treatment of chronic pain in this country and her own decades-long experience with methadone in both the treatment and the pain clinic milieus, she said methadone patients already face enough barriers.

"I've been taking methadone since 1974," she said. "I stood in those methadone treatment lines, but now I get my medication from a pain specialist. A lot of people want to do that because they treat you better -- if you can find one who will treat you at all."

And that is a problem, Baker said. "A lot of doctors don't want to treat pain patients because they have the DEA breathing down their necks. We don't need more obstacles."

"This is misdirected legislation," said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. "Methadone treatment programs have been functioning for more than 40 years with a considerable degree of safety. There have been at least four federal studies showing that increasing methadone mortality is based on that fact that it is increasingly being used in pain management. If the legislation doesn't address the cause of the problem, it has no basis for existing."

"The science doesn't support a hard and fast rule to get off licit opiates," said Hulsey. "It can be very dangerous to put arbitrary deadlines on that. Treatment has to be individualized to promote recovery."

For Hulsey, the bill's requirement that potential patients first twice fail at treatment is just not good policy. "I am not aware of science that supports 'you fail first' policies," he said. "If you go to the expert consensus guidelines for management of methadone facilities, and more importantly, accepted patient placement criteria, you must demonstrate a year's dependency, as well as other thresholds, and that is what should determine appropriate placement. 'Fail first' doesn't capture the full range of factors that experts have agreed upon as the best approach for opiate-dependent individuals."

The consensus guidelines Hulsey cited were SAMSHA/CSAT's Treatment Improvement Protocol 43 and the American Society of Addiction Medicine's Patient Placement Criteria.

"Those are the gold standard for treatment," he said. "They provide a six-dimensional approach to dependence, and you would need to meet those criteria to be appropriately placed in methadone maintenance. It's not appropriate for everybody. Some people may require a detox approach rather than long-term maintenance."

For Hulsey, having the designated driver requirement for new patients was "good risk management," but creating methadone-impaired driving offenses seemed unnecessary. "There are already laws on the books regarding impairment," he said.

Nobody thought the moratorium on new methadone maintenance clinics was a smart move. "They shouldn't do that," said NAMA's Baker. "They don't put moratoriums on doctors who prescribe treatments for diabetics. But there is a lot of NIMBYism in Pennsylvania."

"Addiction is a chronic disease that is treatable when appropriate evidence-based treatment approaches are applied," said Hulsey. "We want to promote recovery and support people rather than limiting access. If we limit the treatment opportunities, we make these people criminals."

Parrino didn't think much of the moratorium idea, either. "You can have a moratorium, but that doesn't reduce the demand for treatment, so what's the rationale for restricting access to care? Do we think the number of people who need this has capped out? That state has to be careful saying that a moratorium seems smart, especially when the problem is not related to the treatment programs you're dealing with," he said.

But methadone maintenance clinics make convenient targets for a number of reasons, said Parrino. "There is NIMBYism, and there is a general stigma about treating addiction, which increases markedly when you talk about the use of medications to treat opiate addiction," he pointed out.

"And elected officials always feel like 'we must do something,'" he continued. "But unless the legislature is able to be more precise in identifying the problem and how to deal with it, I would suggest that they are not addressing the real source of the problem, but doing what seems manageable and convenient. It's easy to say let's put more restrictions on top of a system that is already highly regulated, but pain doctors aren't regulated at all."

So faced with mounting methadone mortality and increasing diversion not linked to methadone maintenance clinics, Pennsylvania legislators are aiming squarely at those clinics. The legislature and the people of Pennsylvania would be better served if this package of bills went back to the drawing board.

Feature: Reed College in the Crosshairs of Prosecutorial Drug Crackdown

by Phillip Smith, April 30, 2010, 12:00am, (Issue #630)

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

http://www.stopthedrugwar.org/files/rennfayre.jpg

Renn Fayre (sarako on flickr.com)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Harm Reduction: Washington State "911 Good Samaritan Law" to Go Into Effect in June

by Phillip Smith, March 12, 2010, 12:00am, (Issue #623)

Washington Gov. Christine Gregoire (D) Wednesday signed into law a measure that provides some legal immunity for people who report a drug overdose. That makes Washington the second state to enact a "911 Good Samaritan Law." New Mexico was the first in 2007.

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Washington State House, Olympia

Under the measure, if someone overdoses and someone else seeks assistance, that person cannot be prosecuted for drug possession, nor can the person overdosing. Good Samaritans could, however, be charged with manufacturing or selling drugs.

The measure is aimed at reducing drug overdoses by removing the fear of arrest as an impediment to seeking medical help. According to the state Department of Health, there were 820 fatal drug overdoses in the state in 2006, more than double the 403 in 1999.

The bill also allows people to use the opioid agonist naloxone, which counteracts the effects of opiate overdoses, if it is used to help prevent an overdose.

"We're going to save lives," Rep. Roger Goodman (D-Kirkland) told Senate sponsor Sen. Rosa Franklin (D-Tacoma) after the bill signing.

"It might take the fear out of calling for help," Franklin said.

Washington is the first state this year to pass a 911 Good Samaritan bill, but it may not be the last. According to the National Conference of State Legislatures, Hawaii, Massachusetts, Minnesota, and Rhode Island are considering similar measures.

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Washington State 911 Good Samaritan Law to Prevent ODs Now in Effect

Feature: Pennsylvania Lawmakers' Aim at Reducing Methadone Deaths, But Shoot Wide

Feature: Reed College in the Crosshairs of Prosecutorial Drug Crackdown

Harm Reduction: Washington State "911 Good Samaritan Law" to Go Into Effect in June

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