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Crisis Looms for Addicts as Russia Bans Methadone in Crimea

Things are about to get harder for opiate users in Crimea, the former Ukrainian province now annexed by Russia. While Ukraine has embraced a harm reduction approach to hard drug use, Russia rejects such an approach and has some of the most repressive drug laws in the world.

Oberleitungsbusbahnhof in Simferopol (user Cmapm via Wikimedia)
Russia does not support efficient programs for preventing HIV and Hepatitis C among its drug using population, and harm reduction measures like needle exchanges and opiate substitution therapy (OST), of which methadone maintenance is a subset, are illegal.

Now, the concrete consequences of Crimea's reincorporation into the ample bosom of Mother Russia are coming home for drug users there. On Wednesday, Russian "drug czar" Viktor Ivanov -- one of 31 allies of Pres. Vladimir Putin sanctioned by the US government this month -- announced that Russia will ban the use of methadone in Crimea. That comes after vows a week before that he would move away from harm reduction practices in general in Crimea.

"Methadone is not a cure," Ivanov claimed. "Practically all methadone supplies in Ukraine were circulating on the secondary market and distributed as a narcotic drug in the absence of proper control. As a result, it spread to the shadow market and traded there at much higher prices. It became a source of criminal incomes," he said.

Whatever Ivanov says, cutting off methadone for an estimated 800 patients will be a disaster, the International HIV/AIDS Alliance warned. And the threat of a broader rejection of harm reduction measures puts an estimated 14,000 Crimean injection drug users at risk.

"When the supply of these medicines is interrupted or stopped, a medical emergency will ensue as hundreds of OST patients go into withdrawal, which will inevitably lead to a drastic increase in both acute illness as well as increases in injecting as people seek to self-medicate," said the alliance's Ukraine director, Andriy Klepikov.

"Any interruption to harm reduction programming is a disaster for health, human rights and the HIV epidemic in the region and we urge the authorities in Crimea to step in and ensure that critical supply chains are not disrupted and lives not put at risk as a result of territorial politicking," Klepikov added.

Ukraine has practiced methadone maintenance (or OST) therapy in Crimea since 2005. Patients in Simferopol, Sevastopol, Yalta, Eupatoria, Feodosia, Kerch and other cities receive daily treatment at local healthcare facilities.

The AIDS alliance is not the only group raising the alarm. The International Network of People who Use Drugs (INPUD) has issued an urgent appeal to UN rapporteurs on the Crimea "calling upon you all to issue a public statement making clear the imminent risk that this population faces of losing access to essential medicines, we are requesting that you raise the issue with the Russian government urging them not to close down the currently running opiate substitution programs; and we are calling upon you to raise the issue with utmost urgency with the Human Rights Council with a view to ensuring continued access to the programs."

When it comes to drug policy and harm reduction, Crimea would seem to be worse off as part of Russia than as part of Ukraine. As the AIDS alliance's Klepikov put it:

"The Russian Federation has extremely repressive drug laws and its punitive approach to people who use drugs means that it now experiences one of the highest rates of new HIV infections in the world. Injecting drug users represent nearly 80% of all HIV cases in the country."

Russia

War of Words: The International Narcotics Control Board vs. A Changing World [FEATURE]

The global drug prohibition bureaucracy's watchdog group, the International Drug Control Board (INCB) released its Annual Report 2013 today, voicing its concerns with and wagging its finger at drug reform efforts that deviate from its interpretation of the international drug control treaties that birthed it. The INCB is "concerned" about moves toward marijuana legalization and warns about "the importance of universal implementation of international drug control treaties by all states."

"We deeply regret the developments at the state level in Colorado and Washington, in the United States, regarding the legalization of the recreational use of cannabis," INCB head Raymond Yans said in introducing the report. "INCB reiterates that these developments contravene the provisions of the drug control conventions, which limit the use of cannabis to medical and scientific use only. INCB urges the Government of the United States to ensure that the treaties are fully implemented on the entirety of its territory."

For some years now, some European and Latin American countries have been expressing a desire to see change in the international system, and "soft defections," such as the Dutch cannabis coffee shop system and Spain's cannabis cultivation clubs, have stretched the prohibitionist treaties to their legal limits. But legal marijuana in Uruguay is a clear breach of the treaties, as Colorado and Washington may be. That is bringing matters to an unavoidable head.

After surveying the state of drug affairs around the globe, the 96-page INCB report ends with a number of concerns and recommendations, ranging from non-controversial items such as calling for adequate prevention and treatment efforts to urging greater attention to prescription drug abuse and more attention paid to new synthetic drugs. [Ed: There is some controversy over how to best approach prescription drug abuse and synthetic drugs. e.g. the type of attention to pay to them.]

But the INCB is clearly perturbed by the erosion of the international drug prohibition consensus, and especially by its concrete manifestations in legalization in Uruguay, Colorado, and Washington and the spreading acceptance of medical marijuana.

"The Board is concerned that a number of States that are parties to the 1961 Convention are considering legislative proposals intended to regulate the use of cannabis for purposes other than medical and scientific ones" and "urges all Governments and the international community to carefully consider the negative impact of such developments. In the Board's opinion, the likely increase in the abuse of cannabis will lead to increased public health costs," the report said.

Similarly, the INCB "noted with concern" Uruguay's marijuana legalization law, which "would not be in conformity with the international drug control treaties, particularly the 1961 Convention" and urged the government there "to ensure the country remains fully compliant with international law, which limits the use of narcotic drugs, including cannabis, exclusively to medical and scientific purposes."

Ditto for Colorado and Washington, where the board was "concerned" about the marijuana legalization initiatives and underlined that "such legislation is not in conformity with the international drug control treaties." The US government should "continue to ensure the full implementation of the international drug control treaties on its entire territory," INCB chided.

But even as INCB struggles to maintain the legal backbone of global prohibition, it is not only seeing marijuana prohibition crumble in Uruguay and the two American states, it is also itself coming under increasing attack as a symbol of a crumbling ancien regime that creates more harm than good with its adherence to prohibitionist, law enforcement-oriented approaches to the use and commerce in psychoactive substances.

"We are at a tipping point now as increasing numbers of nations realize that cannabis prohibition has failed to reduce its use, filled prisons with young people, increased violence and fueled the rise of organized crime," said Martin Jelsma of the Transnational Institute. "As nations like Uruguay pioneer new approaches, we need the UN to open up an honest dialogue on the strengths and weaknesses of the treaty system rather than close their eyes and indulge in blame games."

"For many years, countries have stretched the UN drug control conventions to their legal limits, particularly around the use of cannabis," agreed Dave Bewley-Taylor of the Global Drug Policy Observatory. "Now that the cracks have reached the point of treaty breach, we need a serious discussion about how to reform international drug conventions to better protect people's health, safety and human rights. Reform won't be easy, but the question facing the international community today is no longer whether there is a need to reassess and modernize the UN drug control system, but rather when and how."

"This is very much the same old stuff," said John Collins, coordinator of the London School of Economics IDEAS International Drug Policy Project and a PhD candidate studying mid-20th Century international drug control policy. "The INCB views its role as advocating a strict prohibitionist oriented set of policies at the international level and interpreting the international treaties as mandating this one-size-fits-all approach. It highlights that INCB, which was created as a technical body to monitor international flows of narcotics and report back to the UN Commission on Narcotic Drugs, has carved out and maintains a highly politicized role, far removed from its original treaty functions. This should be a cause for concern for all states interested in having a functioning, public health oriented and cooperative international framework for coordinating the global response to drug issues," Collins told the Chronicle.

"The INCB and its current president, Raymond Yans, take a very ideological view of this issue," Collins continued. "Yans attributes all the negative and unintended consequences of bad drug policies solely to drugs and suggests the way to lessen these problems is more of the same. Many of the policies the board advocates fly in the face of best-practice public health policy -- for example the board demanding that states close 'drug consumption rooms, facilities where addicts can abuse drugs,'" he noted.

"If the board was really concerned about the 'health and welfare' of global populations it would be advocating for these scientifically proven public health interventions. Instead it chooses the road of unscientific and ideological based policies," Collins argued.

The INCB's reliance on ideology-driven policy sometimes leads to grotesque results. There are more than 30 countries that apply the death penalty for drugs in violation of international law. Virtually every international human rights and drug control body opposes the death penalty for drugs including the United Nations Office on Drugs and Crime, the UN Human Rights Committee, the UN's human rights experts on extrajudicial killings, torture and health, among many others.

INCB head Raymond Yans (incb.org)
But when an INCB board member was asked in Thailand -- where 14 people have been executed for drugs since 2001 -- what its position on capital punishment was, he said, "the agency says it neither supports nor opposes the death penalty for drug-related offenses," according to the Bangkok Post.

Human rights experts were horrified and immediately wrote asking for clarification, to which the INCB responded, "The determination of sanctions applicable to drug-related offenses remains the exclusive prerogative of each State and therefore lie beyond the mandate and powers which have been conferred upon the Board by the international community," according to Human Rights Watch.

Another area where the board's concern about the health and welfare of global populations is being challenged is access to pain medications. A key part of the INCB's portfolio is regulating opioid pain medications, and this year again it said there is more than enough opium available to satisfy current demand, although it also noted that "consumption of narcotic drugs for pain relief is concentrated within a limited number of countries."

The World Health Organization (WHO) agrees about that latter point. A 2011 study estimated that around 5.5 billion people -- or 83% of the world population -- live in countries with 'low to non-existent' access to opioid pain relief for conditions such as cancer and HIV/AIDS. These substances are listed by the WHO as essential medicines, and the international drug control conventions recognise explicitly that they are 'indispensable' to the 'health and welfare of mankind.'

Adding to the paradox -- the global supply is sufficient, but four-fifths of the world doesn't have access -- the INCB calls on governments to "ensure that internationally controlled substances used for pain relief are accessible to people who need them."

What is going on?

"The INCB uses totals of requirements for opioid medicines compiled by the UN treaty signatory states," said Ann Fordham, executive director of the International Drug Policy Consortium, which keeps an eye on the agency with its INCB Watch. "Unfortunately there is often a huge gap between these administrative estimates and the actual medical needs of their populations."

The prohibitionist slant of global drug control also creates a climate conducive to understating the actual need for access to pain relief in other ways, Fordham told the Chronicle.

"Many governments interpret the international drug control conventions in a more restrictive manner than is necessary, and focus their efforts towards preventing access to the unauthorized use of opioids rather than to ensuring their medical and scientific availability," she said. "This is a grossly unbalanced reading of the conventions, underpinned by fear and prejudice regarding opioids and addiction."

Although the agency has cooperated somewhat with the WHO in attempting to enhance access to the medicines, said Fordham, it bears some blame for rendering the issue so fraught.

"The INCB has continually stressed the repressive aspect of the international drug control regime in its annual reports and other public statements, and in its direct dealings with member states," she said. "The INCB is therefore responsible for at least some of the very anxieties that drive governments toward overly restrictive approaches. This ambivalence considerably weakens the INCB's credibility and contradicts its health-related advocacy."

Fordham joined the call for a fundamental reform of global drug prohibition, and she didn't mince words about the INCB.

"The entire UN drug control system needs to be rebalanced further in the direction of health rather than criminalization, and it is changing; the shift in various parts of the system is apparent already," she said before leveling a blast at Yans and company. "But the INCB is notable as the most hard line, backward-looking element, regularly overstepping its mandate in the strident and hectoring manner its adopts with parties to the treaties, in its interference in functions that properly belong to the WHO and in its quasi-religious approach to a narrow interpretation of the drug control treaties."

The INCB should get out of the way on marijuana and concentrate on its pain relief function, said Collins.

"The INCB should stay out if it," he said bluntly. "It is a technocratic monitoring body. It should not be involving itself in national politics and national regulatory systems. So it doesn't need to be either a help or hindrance on issues regarding cannabis reform. It has no reason to be involved in this debate. It should be focusing on ensuring access to essential pain medicines. These debates are a distraction from that core function and I would argue one of the reasons it is failing to meet this core function."

Sorry, INCB. Welcome to the 21st Century.

Vienna
Austria

Smart Needle Exchange Reform Bill Moving in Maryland

The Maryland Senate today moved to undo a restriction in existing state law that prevents injection drug users from picking up more clean needles at the Baltimore needle exchange than they turn in.

The Senate approved Senate Bill 263 by an overwhelming 39-5 vote. The measure now heads to the House.

The bill doesn't include a specific limit on the number of needles can pick up at one time, but one of the bill's supporters, Sen. Verna Jones-Rodwell (D-Baltimore), said 50 might be a good number, and that the bill may be amended to get specific.

The bill is supported by the entire Baltimore Senate delegation as well as the city of Baltimore.  The health department there says the city's needle exchange program serves about 2,500 people a year and exchanges about 200 needles for each one.

Needle exchanges are a proven means of reducing the transmission of HIV, Hep C, and other blood-borne illnesses among injection drug users.

Good on the Maryland Senate for moving to get rid of this mindless restriction.

Location: 
Annapolis, MD
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 12, 2013

A push is on to end the federal ban on needle exchange funding, a secret federal panel meets to discuss marijuana banking issues, UN anti-drug bureaucrats are still unhappy with Uruguay, more bodies show up in Mexico, and more. Let's get to it:

A move is on to end the federal ban on funding needle exchanges.
Marijuana Policy

Federal Banking Panel Meets on Pot Sales. The Bank Secrecy Act Advisory Group (BSAAG) met in Washington, DC, Thursday to discuss how to deal with banking issues related to medical marijuana and legal marijuana industries. Under current federal laws, marijuana sellers can't set up bank accounts or process credit card transaction because financial institutions fear being implicated in drug trafficking or money laundering cases. The meeting is closed-door, and there is no word yet on what, if anything, was decided.

One Year In, Coloradans Still Like Marijuana Legalization. A Public Policy Polling survey released this week found that Coloradans still support marijuana legalization. The poll found 53% agreed that marijuana use should be legal. It will be interesting to see the poll numbers a year from now, when Coloradans have had time to experience a legal marijuana industry. That begins on January 1.

Washington State Regulators Want to Ban Pot Smoking Wherever Alcohol is Sold. The state Liquor Control Board, which is also in charge of legal marijuana commerce, has proposed banning marijuana consumption in businesses licensed for liquor sales, but a Wednesday meeting saw loud opposition, in particular from Frankie Schnarr, owner of Frankie's Sports Bar and Grill in Olympia. Schnarr years ago emerged victorious in a battle with the board over whether he could open the second floor of his bar to smokers, who joined a "club" for the privilege. Schnarr opened his club to pot smokers after I-502 passed, and now claims 13,500 club members. Schnarr and others said the proposed rule was aimed directly at him. The board will vote on the proposed rule next week.

Philadelphia "Smoke Down Prohibition" Marijuana Prosecutions Continue, So Will Demonstrations. Comedian NA Poe will be sentenced Friday in federal court for smoking pot at Independence Hall as part of Philly NORML's ongoing Smoke Down Prohibition demonstrations. Two more members of the "Liberty Bell 4," Chris Goldstein and Don Dezarn will go on trial next week for puffing pot in demos this past summer, while a fourth, US Marine veteran Mike Whiter will make his first court appearance on similar federal charges. Click on the link for more details and how you can participate.

Gov. Cuomo Dismisses New York Legalization Bill as "Non-Starter." Well, that didn't take long. Yesterday, state Sen. Liz Krueger (D-Manhattan) announced she was introducing a marijuana legalization bill. That same day, a Cuomo spokesman scoffed at the bill, calling it "a non-starter."

Medical Marijuana

New Jersey Medical Marijuana Expansion Wins Assembly Committee Vote. A bill that would allow Garden State medical marijuana patients to buy the drug in other states and bring it back with them passed the Assembly Health Committee on a 7-4 vote Thursday. But Gov. Chris Christie (R) has said he will veto it or any other expansion of the state's program.

Harm Reduction

Maryland Docs, Scientists Call for End to Federal Needle Exchange Funding Ban. In the wake of the budget agreement announced this week by congressional negotiators, more than 70 Maryland-based doctors and scientists sent an open letter to Senate Appropriations Committee Chair Sen. Barbara Mikulski (D-MD) urging her to act to get the longstanding ban on federal needle exchange funding lifted. The ban had been overturned in 2010, but was reinstated without any public debate during budget negotiations the following year.

Pain Pills

State Attorneys General Call on FDA to Reconsider Zohydro Approval. The FDA is running into more flak over its October decision to approve the first hydrocodone-only drug in America, Zohydro, which will be available in a time-release form. Four US senators challenged the decision earlier this week, and now, 28 state attorneys general have asked the agency to reconsider. They cited the roll-out of earlier pain relieving drugs in time-release formulas, which they said resulted in "overzealous pharmaceutical sales" and "doctors overprescribing narcotics," among other ills. But Attorneys General are typically trained as lawyers, not doctors or pharmacists, and they seem oblivious to the continuing problem of undertreatment of pain that their campaigns foster. The FDA said it would reply directly to the law enforcement officials.

International

UNODC Criticizes Uruguay Marijuana Legalization. The UN Office on Drugs and Crime (UNODC) isn't happy with Uruguay. The South American nation's decision to legalize marijuana is a blow against international cooperation in the war on drugs, said UNODC head Yuri Fedotov. "Just as illicit drugs are everyone's shared responsibility, there is a need for each country to work closely together and to jointly agree on the way forward for dealing with this global challenge," he said in a statement. He also called the move "unfortunate."

More Mass Graves in Mexico. Authorities in the central Mexican state of Morelos have uncovered two mass graves containing at least 20 bodies. Authorities believe some of the bodies are victims of the Beltran Leyva cartel, which was largely dismantled two years ago. Others were apparently killed more recently. The discovery comes on the heels of a similar gruesome find in western Michoacan state, where the latest count had 66 bodies removed from mass graves there. More than 100,000 people are estimated to have been killed in Mexico's prohibition-related violence since 2006 and tens of thousands more have disappeared, including more than a thousand in the past two years in Moreleos, according to the state human rights commission.

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.

Chronicle AM -- December 6, 2013

A new marijuana legalization has been filed in California, the Florida medical marijuana initiative faces a pair of challenges, the British Columbia decriminalization initiative is struggling, and more. Let's get to it:

Marijuana Policy

A New California Marijuana Legalization Initiative is Filed. The Control, Regulate, and Tax Marijuana Act was filed with the California attorney general's office Wednesday. It would legalize up to an ounce and four plants for people 21 and over and create a statewide system of regulated marijuana commerce. It's not clear, however, whether its backers will seek to gather signatures for 2014 or will use it as a place marker for 2016. Another legalization initiative, the California Cannabis Hemp Initiative of 2014 is in the signature-gathering phase, but lacks deep-pocketed financial backing.

Thinking About a Post-Pot Prohibition World. Martin Lee, the author of Acid Dreams and Smoke Signals, about the cultural histories of LSD and marijuana, respectively, writes about marijuana legalization as a beginning, not an end, and has some interesting and provocative thoughts about what should come next.

Medical Marijuana

Florida Supreme Court Hears Challenge to Medical Marijuana Initiative. The Florida Supreme Court Thursday heard arguments on whether the proposed constitutional amendment to allow medical marijuana should go on the November 2014 ballot. Attorney General Pam Bondi (R) had challenged it as misleading and in violation of federal law. The justices did not decide the issue, but a decision will be coming shortly.

Florida Medical Marijuana Initiative Needs a Lot of Signatures in a Hurry. The state Division of Elections reported Thursday that People United for Medical Marijuana, the group behind the initiative, has just under 137,000 signatures that have been validated. They need 683,149 by February. There is some lag between signatures gathered and signatures validated, and organizers say they have collected 400,000 signatures so far. But that means they need probably another 400,000 in just a few weeks just to have a cushion that would allow for the inevitable invalid signatures.

International

British Columbia Marijuana Decriminalization Initiative Campaign Struggling. Sensible BC's signature-gathering campaign to put a decriminalization initiative on the ballot in British Columbia looks like it is going to fall short. The group needs 310,000 valid signatures by Monday, but only has 150,000 gathered. But if they don't make it this time, that won't be the end of it. "Sensible BC is here to stay," said the group's Dana Larsen. "You can be quite sure we're going to try this campaign again sometime in the next year to year-and-a-half, if we don't succeed this time. We're not going away."

Report Says SE Asia Amphetamine Use is Fueling Rise in HIV Risk. An increase in injection use of amphetamines in Southeast Asia is raising the risk of the spread of HIV and requires "urgent" action, according to a new report from the Australian National Council on Drugs (ANCD) and the Asia-Pacific Drugs and Development Issues Committee. Not only injection drug use, but risky sexual behavior as well among amphetamine users, is part of the problem, the report says.

Chronicle AM -- November 29, 2013

Uruguay's marijuana legalization bill passes another hurdle, a Berlin borough wants cannabis cafes, Chicago proposes tough medical marijuana regulations, Kentucky officials hound the DEA about hemp, and more. Let's get to it:

Is this the face of marijuana legalization? Uruguayan President Jose Mujica (wikimedia.org)
Medical Marijuana

Chicago Proposes Strict Medical Marijuana Regulations. Chicago officials have proposed regulations that would allow medical marijuana dispensaries and grows only in manufacturing districts, would limit the number of grows to 22, and would require that dispensaries and grows be at least 2,500 feet from a school, day care center, or residential area. Medical marijuana becomes legal in Illinois on January 1.

Michigan Appeals Court to Hear Cases on Unemployment Benefits. The Michigan Appeals Court has agreed to hear two cases to determine whether someone fired for using medical marijuana can collect unemployment benefits. Lower court judges have overturned state agency rulings denying the benefits, but medical marijuana foe Attorney General Bill Schuette argues that the law only protects people from criminal prosecutions, not civil penalties.

Hemp

Kentucky Officials Send Letter to DEA Requesting Clarification on Hemp. Kentucky officials have sent a letter to the DEA asking for clarification of its position on industrial hemp. Agriculture Commissioner James Comer, US Sen. Rand Paul (R), and US Reps. John Yarmouth and Thomas Massie want the agency to tell them whether growing hemp in states that have enacted a regulatory framework remains illegal. They point to the federal government's response to marijuana legalization and argue that hemp should be treated the same way.

Drug Testing

Idaho Supreme Court Upholds Drug Possession Conviction Based Solely on Drug Test. Idaho's high court Tuesday upheld the conviction of a woman charged with drug possession after blood from her newborn child's umbilical cord tested positive for methadone. The court held unanimously that the drug test result was probable cause to support a possession conviction.

International

Uruguay Marijuana Legalization Bill Wins Senate Committee Vote. Uruguay is one step closer to becoming the first country to legalize the marijuana trade after the Senate Health Commission voted Thursday to approve the bill. The government-supported legislation has already passed the lower house and is expected to win final approval in the Senate next month.

Cannabis Cafes Coming to Berlin? Legislators in the hip Berlin borough of Friedrichschain-Kruezberg voted Thursday to approve cannabis coffee shops there. The move is the brainchild of Green Party Mayor Monika Hermann, who proposed it in September. Now, the borough must get the German federal government to agree. Under Article 3 of the German Narcotics Act, sufficient public interest could lead to law changes, provided there is public support and backing scientific evidence.

European Cancer Docs Say Restrictive Laws Aimed at Drug Abuse Block Millions from Pain Relief. The European Society for Medical Oncology warned that half the world's population lacks effective access to pain relievers because of restrictive laws aimed at reducing drug abuse. The group's Global Opioid Policy Initiative survey estimated that millions of cancer patients don't have access to seven cheap medicines essential for pain relief, including morphine and codeine. Access to such drugs "is catastrophically difficult" in many countries, the report's lead author said.

British Tories, Lib Dems At Odds Over Drug Policy. Britain's governing coalition is at odds with itself over drug policy after the new Liberal Democrat drugs minister, Norman Baker, said earlier this week that marijuana legalization "should be considered." That caused Conservative front-bencher and Justice Minister Chris Grayling to clarify that he and the Home Office "won't be considering it."

Northern Nigeria Alcohol Crackdown Sees 240,000 Bottles of Beer Destroyed. In attempt to deepen a sharia law ban on alcohol imposed in 2001, but largely ignored in hotels and the city's Christian quarter, Islamic police in the northern city of Kano destroyed 240,000 bottles of beer. They chanted "God is great" as they did so, and the head of the religious police warned that they will put an end to alcohol consumption. Multiple bombings of bars in the Christian quarter in late July carried out by suspected Islamic militants who complained the government wasn't enforcing sharia law adequately left 29 dead.

Peru Eradicates Record Amount of Coca. Peru, once again the world's largest coca and cocaine producer, announced Thursday that it had eradicated a record 55,000 acres of coca, about one-fifth of the total estimated 250,000-acre crop. That's a 60% increase in eradication over last year. The government said the increase was due to tougher anti-drug efforts and a weakening of the Shining Path in coca growing areas.

Israel Medical Marijuana Use up 30% This Year. Medical marijuana use is up sharply this year in Israel, according to the Health Ministry, which released figures showing 13,000 patients were approved to us it this year, up from 10,000 last year. The increase comes as the government is working on a new proposal to regulate medical marijuana. The Health, Agriculture, and Public Security ministries are expected to present it within the next couple of weeks.

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.

Malaysia Minister Talks Drug Decriminalization

A Malaysian government minister said Sunday the Southeast Asian nation is moving toward decriminalizing drug possession, but her remarks also suggested that drug users would be exchanging jail cells for treatment beds. Minister in the Prime Minister's Department Nancy Shukri said the government's policy was moving from prosecuting drug users to treating them.

Nancy Shukri (frim.gov.my)
Her remarks came at the end of a High Level Meeting on Drug Policy and Public Health sponsored by the Global Commission on Drug Policy. The meeting was held in conjunction with the 2013 International Aids Conference held over the weekend in Kuala Lumpur, the Malaysian capital.

Shukri also said that the Association of Southeast Asian Nations' (ASEAN) goal of a drug-free region by 2015 was not realistic, but that smarter approaches by authorities could reduce drug dependence.

"There is no such thing as drug-free but we can control it by changing or shifting our policy," Shukri said. "Instead of looking at drug dependents as criminals, we should actually look at them as patients. Instead of bringing them to jail, we bring them to the clinic," she told a press gaggle after the AIDS conference ended.

Shukri said that Malaysia had been taking steps toward a more effective and humane drug policy, but that those initiatives were not widely known. She cited ongoing needle exchange programs for injection drug users. The sharing of needles is a known vector for the transmission of the AIDS virus, and the program had resulted in a reduction in new HIV/AIDS infections, she said.

"Others include the harm reduction program and upgrading of the rehabilitation centers into Cure & Care Clinics," Shukri said. "We are already there (decriminalizing drugs) but we are not making it loud enough for the people to understand that we have this policy. Our policy has not been established in a formal way."

That could be coming, though. Shukri said the government is currently reviewing the country's drug laws, including the Drug Dependents (Treatment and Rehabilitation) Act of 1983.

"The Law Reform Committee is now in the process of discussing to amend that particular provision [Section 4(1)(b) of the Act which allows the detention of a suspected drug dependent for up to 14 days for a test to be conducted]," she said.

Kuala Lumpur
Malaysia

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