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The Year on Drugs 2009: International Drug Policy Developments

(Please read our top ten US domestic drug policy stories review too!)

As 2009 winds to a close, we review the global year in drug policy. There were a number of events of global significance -- the trend toward decriminalization of drug possession in Europe and Latin America, the slow spread of heroin maintenance therapy, the frontal assault on global prohibitionist orthodoxy at the UN -- as well as new developments in ongoing drug-policy related struggles from the poppy fields of Afghanistan to the cannabis cafes of Amsterdam.

This review can't cover everything -- it's a big world, and there's a lot happening in drug policy these days. Among the items worth at least mentioning in passing: Israel's embrace of medical marijuana, Canada's flirtation with mandatory minimum sentences for marijuana growers (still in process, and amended to be less harmful by the Canadian Senate), the continuing resort to the death penalty for drug offenses in the Middle East and Southeast Asia, the bemusing link between cannabis and schizophrenia apparently at work only in some Commonwealth countries, the Andean drug war (unchanged in its essential outlines this year), and the rise of poor West African nations as favored smugglers' destinations.

What about Mexico? There is one glaring omission here, but there is a reason for that: In the third year of Mexican President Felipe Calderon's offensive against the so-called drug cartels, the violence is more intense and destabilizing than ever. What is happening in Mexico is certainly a drug policy-related phenomenon of global significance, but this year, with more than a billion US dollars in the anti-drug aid pipeline, beefed up border security, official acknowledgement that insatiable American appetites play a crucial role, and growing public and political concern about the violence on the border, we will examine the Mexican drug war in the context of US domestic drug policy issues. Look for it to be among the Top 10 domestic drug policy stories in our feature next issue.

With that as a caveat, here are this year's biggest global drug policy developments:

Afghanistan: War on Drugs, Meet War on Terror

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Afghan opium
Eight years after the US and NATO forces invaded and occupied Afghanistan, driving the Taliban from power, the Taliban have returned with a vengeance, fueled by revenues from the country's primary cash crop: opium. Western estimates of Taliban income from the poppy and heroin trade are in the hundreds of millions of dollars annually, which buys a lot of shiny new weapons for the resurgent insurgents.

This year has been the bloodiest yet for Western occupiers, with 495 US and NATO forces killed this year, according to iCasualties.org. Part of the uptick in violence can be attributed to the Taliban's opium wealth, but the decision by US and NATO forces to move aggressively into the Taliban's eastern and southern heartlands, especially Helmand and Kandahar provinces, has also led to increased fighting and higher casualties.

In June, President Obama, adhering to his election campaign vows if not the wishes of his some of his most ardent supporters, moved to directly confront the drug trade, sending 20,000 troops into Helmand to take on the Taliban and allied traffickers. But while that looked like more of the same, just weeks later, the US announced a major shift in its anti-drug policy in Afghanistan when US envoy Richard Holbrooke announced the US would no longer participate in poppy eradication campaigns. That was a startling, reality-driven break from previous US policy in Afghanistan, as well as with current US policies against coca production in Colombia and Peru.

Instead of persecuting poverty-stricken opium-growing peasants, the US and NATO would concentrate on drug manufacturers and traffickers, but only those linked to the Taliban -- not those linked to the corrupt and illegitimate (after this fall's fraudulent election fiasco) regime of Afghan President Hamid Karzai. The US beefed up the in-country DEA contingent and even came up with a "hit list" of some 50 Afghan traffickers linked to the Taliban.

This fall, fighting has been intense in southern and eastern Afghanistan, as well as across the border in Pakistan, and now, the first of President Obama's promised 30,000-troop escalation is headed precisely for Helmand, where one of its first assignments will be to take and hold a major Taliban trafficking center. The war on drugs and the war on terror will continue to collide in Afghanistan, but now, at least, the imperatives of the war on terror have forced a historic shift in US anti-drug policy, at least in Afghanistan.

Latin American Leaders Call for a Drug Policy Paradigm Shift

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Commission panel, former President of Colombia Cesar Gaviria on left (courtesy comunidadsegura.org)
In February, a blue-ribbon panel of Latin American leaders, including former Brazilian President Fernando Henrique Cardoso, former Mexican President Ernesto Zedillo, and former Colombian President Cesar Gaviria issued a report and statement saying the US-led war on drugs has failed and it is time to consider new policies, particularly treating drug use as a public health matter and decriminalizing marijuana possession.

The report, Drugs and Democracy: Toward a Paradigm Shift, is the work of the Latin American Commission on Drugs and Democracy, which also includes prominent writers Paulo Coelho, Mario Vargas Llosa, Sergio Ramírez and Tomás Eloy Martínez as well as leading scholars, media members and politicians.

Latin America is the leading exporter of both cocaine and marijuana. As such, it has faced the ravages of heavy-handed American anti-drug interventions, such as Plan Colombia and earlier efforts to destroy the Bolivian coca crop, as well as the violence of drug trafficking organizations and politico-military formations of the left and right that have grown wealthy off the black market bonanza. And while the region's level of drug consumption has historically been low, it is on the rise.

"The main reason we organized this commission is because the available evidence indicates the war on drugs is a failed war," said Cardoso at a February press conference in Rio de Janeiro to announce the report. "We need a different paradigm to cope with the problem of drugs. The power of organized crime is undermining the very foundations of democracy in some Latin American countries. We must acknowledge that these policies have failed and we must break the taboo that prevents us from discussing different strategies."

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''Global Marijuana Day'' demonstration in Mexico City, May 2008
The report garnered considerable attention, not only in the US and Latin America, but worldwide, and it set the tone for a very reformist year in Latin America.

Mexico Decriminalizes Drug Possession

In May, Mexico decriminalized the possession of small amounts of illicit drugs, including up to five grams of marijuana, a fifth-gram of ecstasy and methamphetamine, a tenth-gram of heroin, and a half-gram of cocaine. The new law closely resembled a 2006 decriminalization bill that had passed the legislature only to die in the face of US protests. There were no US protests this time.

With the Mexican government's action, drug decriminalization has now reached the very borders of the US.

But, according to well-placed observers, the Mexican decriminalization is a case of two steps forward, one step back. In addition to decriminalizing possession of very small amounts of drugs, the new law grants drug enforcement powers to state and local police forces that they never had before. That could mean an increase in the arrests and prosecution of retail-level drug sellers. Still, the long-term political ramifications could be helpful; as one observer noted, "the headline will read that Mexico decriminalized drugs."

Argentina Decriminalizes Marijuana Possession, Laws Against Possessing Other Drugs Tremble

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Supreme Court of Argentina
While Mexico decriminalized through the legislative process, Argentina is doing it through the courts. In a series of cases dating back to 2006, Argentine judges have grown increasingly skeptical of arguments for criminalizing drug use. In the spring, judges in Buenos Aires threw out marijuana cultivation charges against a defendant, saying the plants were for personal use, and the following month, a federal appeals court threw out ecstasy possession charges against a group of defendants, again saying the drugs were for personal use. In both cases, the courts cited a 2006 Argentine Supreme Court ruling that it was the burden of the state "to demonstrate unequivocally that the drugs were not for personal use." In the ecstasy case, the appeals court held that the portion of the country's drug law regarding drug possession must be declared unconstitutional.

In August, the Supreme Court did just that, using another marijuana possession case to rule that the section of the country's drug law that criminalizes drug possession is unconstitutional. While the ruling referred only to marijuana possession, the portion of the law it threw out makes no distinction among drugs.

Imprisoning people absent harm to others violates constitutional protections, a unanimous court held. "Each individual adult is responsible for making decisions freely about their desired lifestyle without state interference," their ruling said. "Private conduct is allowed unless it constitutes a real danger or causes damage to property or the rights of others. The state cannot establish morality."

"It is significant that the ruling was unanimous," said Martin Jelsma, coordinator of the Drugs and Democracy program at the Transnational Institute, which has worked closely with Latin American activists and politicians on drug reform issues. "It confirms the paradigm shift visible throughout the continent, which recognizes that drug use should be treated as a public health matter instead of, as in the past, when all involved, including users, were seen as criminals."

UN's Global Anti-Drug Bureaucracy Meets Organized Resistance

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demonstration at the UN drug meeting, Vienna
It wasn't like this a decade ago, the last time the UN General Assembly Special Session on drugs took place. This year, for the first time, the UN's global anti-drug bureaucracy ran into organized resistance when its Committee on Narcotic Drugs (CND) met in March in Vienna. Not only did a large contingent of drug reform, human rights, and public health NGOs show up to challenge global prohibitionist orthodoxy, they were joined by a number of European and Latin American countries showing serious signs of defecting from the half-century old prohibitionist consensus.

In the end, the CND issued a political statement and plan of action that largely reaffirmed existing prohibitionist policies and ignored harm reduction, but with some victories for reformers both substantive and symbolic. For one, the US delegation finally removed its objection to needle exchanges.

But if the global anti-drug bureaucracies ignored their critics in their report, they were impossible to ignore in Vienna. Demonstrations took place outside the meeting hall, and Bolivian President Evo Morales brandished then chewed coca leaves as he demanded that his country's sacred plant be removed from the list of proscribed substances.

Even UN Office on Drugs and Crime head Antonio Maria Costa was forced to publicly acknowledge the failures and unintended consequences of prohibition. In his address opening the session, Costa bravely argued that "drugs are not harmful because they are controlled; they are controlled because they are harmful," but was forced to concede that prohibition had created a dire situation in some places. "When mafias can buy elections, candidates, political parties, in a word, power, the consequences can only be highly destabilizing" he said. "While ghettoes burn, West Africa is under attack, drug cartels threaten Central America and drug money penetrates bankrupt financial institutions."

All the more reason to challenge prohibitionism and its consequences. After this year, the global anti-drug bureaucracy knows that not only is its long-held consensus under assault, it is beginning to crack.

Czech Republic Decriminalizes Drug Possession, Finally Sets Quantity Limits

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Czech marijuana reform demonstration, 2005 (courtesy Michal Vlk)
Following in Portugal's footsteps, authorities in the Czech Republic voted late last year to decriminalize the possession of "smaller than large amounts" of drugs. But that term was vague, leaving its interpretation up to police and prosecutors and resulting in situations where people like personal marijuana growers were being charged as traffickers.

This month, Czech authorities formalized "smaller than large amounts." The new guidelines mean Czechs will suffer neither arrest nor prosecution for up to 15 grams or five marijuana plants, five grams of hashish, 40 magic mushroom segments, five peyote plants, five LSD tablets, four ecstasy tablets, two grams of amphetamine or methamphetamine, 1.5 grams of heroin, five coca plants, or one gram of cocaine.

The new quantity rules go into effect on January 1.

Science vs. Politics in Great Britain

The British Advisory Council on the Misuse of Drugs (ACMD) is an official body charged with providing evidence-based analysis of drug policy issues for the British Home Office. Tensions between the ACMD and the Labor government of Prime Minister Gordon Brown had been on the rise since it rejected the ACMD's recommendation that marijuana, which had been down-scheduled from a Class B to a Class C (least harmful) drug under Brown's predecessor, Tony Blair, remain at Class C. The government instead up-scheduled it back to Class B.

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David Nutt
The ACMD was slighted again in February, when it recommended that ecstasy be down-scheduled from Class A (most harmful) to Class B, only to have the Home Office reject that recommendation the same day. ACMD head Professor David Nutt also drew heated criticism from the Home Office -- as well as Britain's horsey set -- for heretically suggesting that ecstasy was safer than horse-riding. Nutt was forced to apologize for his remarks.

After a relatively quiet summer, the clash between drug science and drug politics exploded anew when Home Secretary Alan Johnson fired Nutt in late October for again criticizing the government's refusal to follow the science-based recommendations of the panel. That firing caused a huge fire storm of protest, including the resignations of at least six ACMD members, and was splashed across newspaper front pages for weeks.

Now, the credibility of the Labor government and its adherence to evidence-based policy-making have been called into serious doubt, as it becomes clear that Home Office drug scheduling decisions are driven by a political calculus, not a scientific one. And if the Home Office thought firing Nutt was going to make him go away, it was sadly mistaken. Nutt is maintaining a high public profile and is vowing to set up his own independent drug panel.

Whither Holland's Cannabis Coffee Shops?

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downstairs of a Maastricht coffee shop (courtesy Wikimedia)
This year has seen the long-running battle over the Netherland's famous cannabis coffee shops continue to escalate. Under the Dutch policy of "gedogen," or pragmatic tolerance, marijuana remains technically illegal in Holland, but the sale and possession of small amounts is tolerated and even regulated.

But that tolerant policy is not a favorite of the conservative coalition national government, and it has created a number of problems. "Drug tourism," as the influx of border town marijuana buyers from more repressive neighboring countries is known, has led to everything from traffic jams to public urination to lurking hard-drug peddlers.

And Holland's halfway approach to marijuana policy -- it does not allow for the regulated provision of marijuana to the coffee houses -- has led to the "backdoor problem," in which coffee shop proprietors must rely on criminal-by-definition suppliers to provide them with their product. That provides additional ammunition for the anti-coffee shop crowd.

The conservative coalition government, however, is split on how best to rein in the coffee shops and has promised not to take action at the national level until after the 2010 elections. That has left the field to local authorities, and they have responded.

In March, the "drug tourism" problem resulted in the announcement by the mayors of Roosendaal and Bergen op Zoom that they would close all the coffee shops in their towns by September. In May, the mayors of the eight towns in the border province of Limburg announced coffee shops would be "members only." In August, the Dutch government announced it was providing more than $200,000 for a pilot "members only" program in the border town of Maastricht. Court challenges from coffee shop owners have so far failed to stop any of this.

Meanwhile, in Amsterdam, an urban renewal plan unveiled in May called for a reduction in coffee shops there from 226 to 192, with a 50% reduction in the number of coffee shops in the central Red Light District. But just last week, Amsterdam Mayor Job Cohen fought back, saying that national coffee house policy should not be based solely on border "drug tourism" concerns, that he opposed the "members only" option, and that he rejected a ban on coffee houses within 250 yards of schools.

Holland's marijuana coffee shops have been around for more than 30 years now, but as was made clear this year, they will continue to be a battle front between the forces of Dutch conservatism and Dutch liberal pragmatism.

Heroin Maintenance Continues to Spread

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maintenance programs can make heroin addiction cleaner and safer
This year saw a continuation of the slow spread of heroin maintenance programs for severely addicted users unamenable to other forms of drug treatment. At the beginning of the year, permanent or pilot heroin prescription programs were in place in Britain, the Netherlands, Spain, and Switzerland.

Denmark joined the club in February and Germany came aboard in June. These moves come after Switzerland voted in a popular referendum last year to move from a pilot to a permanent heroin maintenance program, based on favorable results from the pilot program.

Canada is about to join the club, too. After the success of the three-year North American Opiate Maintenance Initiative (NAOMI) in Vancouver, Canadian researchers are moving forward with SALOME (the Study to Assess Long-term Opiate Maintenance), a pilot heroin maintenance program set for Vancouver and Montreal. But as of late last month, Montreal's participation was a question mark after Quebec authorities said they would not pay their share of program costs.

Despite lingering political distaste for heroin by prescription, the body of evidence demonstrating its efficacy -- in terms of users' quality of life, public health, and public safety -- continues to grow. There has even been some discussion of bringing a heroin maintenance pilot program to the US. Dr. Peter Reuter, the renowned University of Maryland drug policy expert, authored a study this summer about the possibility of a pilot program in Baltimore.

There is an old saw about not being able to turn an ocean liner on a dime. That's certainly true when it comes to changing drug policies for the better at the national or international level. But each year, it seems that more progress is being made. Let's see what 2010 brings.

Press Release: Jay Leno mocks Miss New Jersey’s use of medical marijuana

FOR IMMEDIATE RELEASE: October 23, 2009 CONTACT: Ken @ (609) 394-2137 Tonight Show host Jay Leno mocks Miss New Jersey’s use of medical marijuana WHO: Tonight Show host Jay Leno WHAT: Mocked Miss New Jersey’s Medical Marijuana Use WHEN: October 22, 2009 WHERE: Opening monologue WHY: Leno’s ignorance of marijuana’s therapeutic value During his opening monologue last night, Tonight Show host Jay Leno mocked a former Miss New Jersey’s use of medical marijuana to relieve her asthma symptoms. Leno said that “smoking marijuana to cure asthma is like eating (fast food) to cure diarrhea…If she really wants to cure her asthma she should leave New Jersey.” Georgine DiMaria, 24, the 2006 Miss New Jersey said that as a child her asthma was so severe that it left her bedridden, forcing her to be homeschooled. "When you can't breathe, nothing else matters," DiMaria said in the Press of Atlantic City in April 2009. At the National Constitution Center in Philadelphia in April 2009, Miss DiMaria eloquently described how marijuana has consistently relieved her asthma symptoms. Miss DiMaria does not smoke the marijuana—she uses a vaporizer and inhales the therapeutic vapors, which are both bronchodilating and anxiety-relieving. Many asthmatics report finding relief from the use of marijuana—even smoked marijuana—and scientific studies support the first-hand experiences of these patients. “Medical marijuana is not a joke,” said Ken Wolski, RN, from the Coalition for Medical Marijuana--New Jersey. “Marijuana is a safe, effective and inexpensive therapeutic agent for a wide variety of diseases, symptoms, and medical conditions. It is an outrage that patients in New Jersey continue to go to jail for trying to relieve their suffering and it is a further outrage that all Mr. Leno can do is make fun of this.” The "New Jersey Compassionate Use Medical Marijuana Act,” which was approved by the New Jersey Senate, awaits a vote in the Assembly. This bill would allow New Jersey patients to use a small amount of marijuana when a licensed physician recommends it, in a program run by the Department of Health and Senior Services. Governor Jon Corzine has said that he would sign the bill into law when it gets to his desk. ###

The Need for Prescription Drug Harm-Reduction

Today I had the second appointment with my psychiatrist. In ten minutes, I was prescribed a 5 month supply of the stimulant medication Adderall. I'm concerned at how casually I was just prescribed a schedule II drug with a “high potential for abuse” that “may lead to severe psychological or physical dependence". As our movement looks beyond the the Marijuana legalization debate, I think it is important to discuss the future of regulating all types of drugs. Considering the current hysteria about prescription drug abuse, there is clearly something wrong with today's prescription drug regulations. Here I would like to share my own experience and concerns about legally obtaining a drug which is not so different from Cocaine. Let me begin one year ago when I first set out to get an Adderall prescription. At college, I had bought Adderall from friends to use as a study-aid. I don't believe ADD is a disease, but I do believe certain people have more difficulty concentrating than others, and I think I am one of those people. Having an immense respect for drugs, I researched the potential harms of Adderall before I used it. I knew there was abuse potential, so I used it once or twice per week at the most. Last year, I decided to get my own prescription to save money. I found a psychiatrist though my insurance. Before I met with him, he sent me a 20 page questionnaire asking me various questions about my mental health. I honestly answered questions concerning my concentration, anxiety, and overall mental health. I brought the questionnaire to the first appointment. He spent about ten minutes reviewing my answers, and diagnosed me with general anxiety and ADD. Five minutes later, I left with a prescriptions for four months worth of Adderall and Paxil, the latter one I never filled because I don't believe I have an anxiety disorder. I didn't talk to him again until today, one year later, when we met for 10 minutes and he refilled my prescriptions. He asked me two questions: if school was stressful, and if I experienced any bad side effects. Yes, school is stressful, no, no debilitating side effects. I see several concerning issues with my experience. This might sound hypocritical, considering I set out to legally obtain a drug, and I did. Why should I be complaining about how easy it was? Because I'm worried about society treating powerful substances so casually. I believe the increase in prescription drug abuse, especially among youth, has to do with precisely this lack of oversight and nonchalant attitude among some psychiatrists at passing out drugs. Here are my concerns: 1) The diagnosis process. It's not okay for a doctor to spend 15 minutes with a person and determine they have a psychiatric disorder in need of medication. This is a process which should take several visits and discussions between patient and doctor on the unique needs of the patient, not a generic questionnaire. 2) The prescription. Right off the bat, I was prescribed 30 mg a day of Adderall. This is way too much Adderall for anyone to be taking, in my opinion, never mind someone just beginning. 3) No follow-up. My situation was complicated because I was going to college, but still, to give me a 4 month supply of powerful drugs and make no effort to contact me on how I am tolerating the treatment is ridiculous and dangerous. 4) No education. He should have given me warning signs to expect if I am having problems with the drug. Not everyone would have done the extra research I did, he should have told me how the drug effects my brain and body. It is easy to build up tolerance to Adderall, which is why it is important to start with low doses and never take more than you need. He never told me that unlike drugs for depression or anxiety which you must take everyday because the effects are gradual, Adderall works instantly and it is okay not to take it everyday. In fact, in my experience it is best not to take Adderall everyday, but instead only when you need it. I'm not sure how common my psychiatric experience is. I'm guessing my psychiatrist is more irresponsible than most, and I hope that the average psychiatrist spends more time with patients. Still, my experience points to a general lack of proper procedure among psychiatrists at doling out drugs, and the lack of any sort of oversight on the actions of psychiatrists. If a psychiatrist has their heart set on making money, they will squeeze as many patients as in as possible, meaning no patient will receive adequate care. I'm struggling to figure out exactly how I feel about my experience. I am a firm believer in my right over my own body. I want to be able to obtain any substances which I please, I want it to be my choice. At the same time, like everything else in society, we need drug specialists to facilitate the decisions we make regarding drug usage. There is a necessary place in a legalized drug market for "psychiatrist" type people, we can't expect everyone to research which drugs they need and how to use them safely on their own. If we truly want to reduce the harms of drugs, we need to start being proactive by making sure psychiatrists educate patients about drugs from the moment they can obtain them. There is a common conception that certain people have "addictive personalities" or are simply prone to abusing drugs, as if a certain group of genes are programed to abuse drugs. I believe this philosophy severely underestimates humans. We have much more will-power than we give ourselves credit for, the problem is that we don't have the necessary resources to make smart decisions concerning drugs. It is the psychiatrist's job to educate patients on their bodies and substances. As much as I hate the government exaggerating the harms of drugs, I wish psychiatrists would make people more scared of truly dangerous drugs. I'm worried about the people who visit my psychiatrist who are oblivious to the nature of drugs and addiction and blindly follow the word of an incompetent doctor. As drug policy reformers, it is in our interest to assess current legal drug regulations if we hope to eventually move all substances into a regulated market. This is important for transforming public opinion on legalization. The public is being bombarded with stories about how harmful prescription drugs are, take Michael Jackson's case. We can't expect people to support moving Cocaine, MDMA, or Heroin into a regulated market, when the current market looks pretty scary and problematic.

Calling it Medical Marijuana sends the RIGHT message to kids.

Talking to kids about marijuana can be a daunting task for a parent. With 13 states allowing cannabis for medical use, and five others with pending legislation, the issue is no longer as simple as "Just Say No."

  medi-kids

   

Children are not stupid. Indeed, they tend to be more aware than most adults, who, by the age of 30 have generally devolved into repetitive patterns of mind and behavior. We either engage in futile endeavors to preserve the status quo, or launch doomed attempts at improvement by endlessly rearranging “things" around us. Adults, as a rule, have lost true openness and presence of mind. Indeed, the actual present hardly registers on our consciousness, as we live mired in memory, suffer interminable rounds of discursive thought, and forge futile projections.

I admit, I don't give long shrift to adults (and here I include myself). We are as a lot, self-involved, suffer from petty motivations and believe, despite all evidence to the contrary, that we actually know something. The messages we routinely give to children are wrought with hidden agendas and confused communication. As a general rule, we believe that children must be shielded from life, which, to the adult, invariably means telling half-truths, downright lies or simply avoiding an issue altogether. Thus, adults propagate a vicious cycle of disinformation which ends in the sad and sorry shutdown of the self.

Telling children the truth, on the other hand, frees both the adult and the child. Initially, it frees the adult because we must actually confront the truth of a situation; and that truth is accessible only by a mind that has become still. Truth is arrived at, revealed not – sorry to say – by thought, but through detatched witnessing. We even have a phrase for it: scientific method.

What is this method? In the most simple terms, it is proposing a hypothesis, and then verifying or disproving said hypothesis through observation. This takes time and attention and therefore is not very popular. It is much easier to repeat hearsay.

Secondly, when a verified construction is, in turn, presented to a child, couched in the caveat that this has been my observation, the child is given the opportunity to a.) learn the scientific method, and b.) possibly apply this valuable resource to her or his own life experiences.

The trouble is, most adults are afraid of the truth. Oh, we believe we can handle it, but that children (or spouses, cousins, parents, bosses, friends, bankers, employees) certainly can't. Worse, we believe there is some personal advantage to lying. But lies are lies, no matter how we rationalize them.

Which brings me to the recent veto of the New Hampshire Medical Marijuana bill by Democratic Governor John Lynch. This legislation would have protected severely ill patients from arrest and prosecution for simply using cannabis as medicine. The bill which passed the Rhode Island Senate by a solid 14 – 10 vote, and the House by an overwhelming 232 –108, would allow terminally ill and acute care patients to use and acquire medical cannabis through government regulated “compassion centers.”

There's a good chance that the veto will be overridden. The tide toward medicinal use of marijuana has definitely turned, with 1/4 of the US population  living in the 13 states where it is already legal. At present, there are at least 4 more states vying to become the 14th, either by legislation or referrendum. Sadly, Lynch is apparently a member of the old guard of politicians who value political safety over common sense and the needs and desires of their constituents.

Lynch's stated reason for denying such safe access to the estimated 150 New Hampshire medical cannabis patients who would avail themselves of these services each year is (and I paraphrase) “I caved to the demands of law enforcement.” Strangely, on this particular topic, law enforcement seems to believe it has a mandate to influence legislation, rather than simply enforcing it. Why this should be so may have a lot to do with the fact that drug enforcement is the big cash cow... but that is a topic for another blog.

And so we come, at long last, to the statement that was the impetus for this particular rant. I quote Portsmouth Police Chief, Michael Magnant, identified in a secoastonline.com article by Michael Mccord, as having encouraged the governor to veto the bill:

“Calling it medicine doesn't make it so. It's not FDA-approved, and there's no quality control. It leads to higher drug use, and it impairs driving. I think it sends the wrong message to our kids,”
said Magnant.

There is so much wrong with this statement, in addition to that last sentence, that I hardly know where to begin. Leaving the ultimate truth of his position aside for a moment, I would like to point out the following:

a.) Calling cannabis a drug, doesn't make it so (it is in fact, verifiably, an herb).
b.) Suggesting that FDA approval actually sets a safety standard indicates that Chief Magnant hasn't read recent reports about acetaminophen.
c.) Saying that “it” leads to higher drug use is typical of the empty phrases in popular usage by drug warriors whenever this issue is discussed. The statement neither specifies what exactly is meant by higher drug use, nor what hard evidence, if any, supports this hypothesis.
d.) Driving, of course, is impaired by any number of factors including health, weather, tiredness, cell phones, hunger, eating, worn tires, radio, alcohol, looking at maps, talking, stupidity, and “FDA approved” drugs. None of these substances or situational occurances are banned outright, and only use of cell phones and alcohol constitute vehicular prohibitions in certain states and circumstances.

And finally
e.) It...sends...the...wrong....message.... to....our....kids.

Aaaaaaahhhhhhehhehehehehheheheeeeeeeeeeeeee!!!!!!

What is particularly noxious about the last statement, besides its vapidity, is that is is so patently wrong. How can any sane, rational person believe that categorizing, as medicine, a substance which relieves or eliminates nausea, treats glaucoma, alleviates pain, lifts the spirits, and reduces seizures and muscle spasms, is sending a “wrong message” to anyone. It is a true message, a factual message, a verifiable message, and most importantly, by classifying marijuana, or as I prefer to call it, cannabis, as a medicine, we are telling children that healthy people don't need it.

Now, I could end this article right here, but in case I have not driven the point home sufficiently, I will just add that it is my observation (and I invite you to verify my hypothesis) that children do not like to think of themselves as sick, nor do they like to take “stuff” to make them “better.”

So, if you want kids to view pot as sexy, adult, cool, gangsta, whatever, fine, but as for me, I would much prefer them to see it as plain old yukky medicine.                     

###

For further study: Report on teen usage in medical marijuana states.

First published on OpenSalon

 

Medical Marijuana: UCSF School of Medicine's Continuing Medical Education

Patients Out of Time's 2008 conference is now on the UCSF School of Medicine's Continuing Medical Education for physicians and other health care professionals to view and earn their continuing education units. Link: http://www.medicalcannabis.com/OnlineEducation/ PDF: http://medicalcannabis.com/Online%20Education%20UCSF%20PRINT.pdf Image: http://medicalcannabis.com/medical-education.html Direct Link: http://www.cecity.com/ce-bin/owa/bel?cc=CECA&aid=14422
Location: 
San Francisco, CA
United States

Canada: New Heroin Maintenance Pilot Program to Get Underway Later This Year

Despite fighting in the courts to shut down Insite, Canada's only safe injection site, Canada's conservative federal government is providing funding for a heroin prescription pilot program in Vancouver and Montreal. The program will begin providing heroin to some 200 hard-core users later this year.

Known as SALOME (the Study to Assess Longer-term Opioid Medication Effectiveness), the program builds on a similar multi-year program in Vancouver that ended last summer. That program, NAOMI (the North American Opiate Medication Initiative), was funded with $8 million from the Canadian Institutes of Health Research with the approval of Health Canada, but the government of Prime Minister Steven Harper has refused to publicly acknowledge research findings that participants' physical and mental health improved and that they committed fewer crimes.

Still, the Institutes of Health Research are quietly throwing in $1 million for SALOME. Josee Bellemare, press secretary to Health Minister Leona Aglukkaq, told the Toronto Globe & Mail: "Our government recognizes that injection drug users need assistance. That's why we are investing in prevention and treatment, to help people recover from their drug addictions."

The three-year trial will offer heroin in both pill and injectable forms, and will also offer hydromorphone to see if it could be used as a substitute. The trial will seek to assess whether prescription heroin is a safe and effective treatment and whether users will accept the drug in pill form. Researchers are currently recruiting hard-core users who have not responded to conventional treatments and say they expect to have clinics operating in the two cities by this fall.

Canada joins Britain, Denmark, the Netherlands, Spain, and Switzerland as countries where heroin prescription programs are in place either permanently or on a trial basis. The German parliament voted last week to join the club, too.

Feature: Effort to Bring Safe Injection Facility to New York City Getting Underway

Last Friday, more than 150 people gathered at John Jay College of Criminal Justice in New York City for a daylong conference on the science, politics, and law of safe injection facilities (SIFs) as part of a budding movement to bring the effective but controversial harm reduction measure to the Big Apple. Sponsored, among others, by the college, the Harm Reduction Coalition, and an amalgam of 17 different New York City needle exchange and harm reduction programs known as the Injection Drug User Health Alliance (IDUHA), the conference targeted not only harm reductionists but public health advocates and officials, law enforcement, service providers, and the general public.

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John Jay College, NYC (courtesy wikipedia.org)
The Safe Injection Facilities in New York conference aimed to create public awareness of SIFs, provide evidence that they are cost-effective, and start developing a plan for implementing SIFS in New York. As the conference program indicates, organizers relied heavily on experts from Vancouver, where the Downtown Eastside Insite SIF has been in operation -- and under evaluation -- since 2003, to provide the evidence base.

The first SIFs opened in Switzerland in the mid-1980s. Since then, they have spread slowly and there are now 65 SIFS operating in 27 cities in eight countries: Switzerland, Germany, the Netherlands, Spain, Australia, Norway, Luxembourg, and Canada. Although advocates have been working for the past year-and-a-half to bring an SIF to San Francisco, that effort has yet to bear fruit.

SIFS are credited with saving lives through overdose prevention, reducing the spread of blood-borne disease, reducing public drug use and attendant drug litter, and creating entryways to treatment and other services for hard-core drug users not ready to abstain. The results reported by the Vancouver delegation on Insite were typical:

  • No fatal overdoses at the SIF.
  • No increase in local drug trafficking.
  • No substantial increase in the rate of relapse into injection drug use.
  • Reductions in public drug use, publicly discarded syringes and syringe sharing.
  • SIF users 1.7 times more likely to enter detox programs.
  • More than 2,000 referrals to counseling and other support services since opening.
  • Collaboration with police to meet public health and public order objectives.

But despite such research results, the United States remains without an operating SIF. The obstacles range from the legal, such as the federal crack house law and its counterparts in many states, to the political and the moral. But for harm reduction and public health advocates, it is the failure to embrace such proven life-saving measures that has the stench of the immoral.

"The reality is that we have people shooting up in unsafe injection facilities as we speak," said Joyce Rivera, executive director of St. Ann's Corner of Harm Reduction and chair of the conference. "The reality is they are not shooting up in a safe, hygienic environment with the possibility of a transition into a range of care. That's what's not happening. As public health advocates, we are saying let's recognize that reality and create those safe facilities. Let these people enter through the portal of public health into a safe environment and start to pace their own change," she said.

"We have to acknowledge the social fact that people are shooting up in unsafe venues," Rivera said. "It's not some esoteric or academic argument. The question is what do we do about it? Public health is supposed to protect the community, and SIFs are a necessary evolution in our public health policy."

"The big issue here is that we know we have about 200,000 injection drug users in the city, and the needle exchange programs only serve a few thousand of them," said Robert Childs of Positive Health Project, one of the members of the IDUAH. "Most of them are getting needles from unregulated needle exchanges, shooting galleries, from friends. That is a large part of why New York City has the most HIV and Hepatitis C cases in the US and one of the highest rates of infection in North America," he said.

"The other big issue is that we're giving injectors the tools to inject, but not a safe space to do it," Childs pointed out. "Many shoot up in the public domain, in the bathrooms at Starbucks or McDonalds or White Castle, in libraries, parks, alleys, phone booths. They leave their syringes in locations that aren't evident to a non-injector, and that's a public health issue."

They also overdose. Drug overdose is the fourth leading cause of death in the city. While it is a tragedy for the victim, overdoses both lethal and non-lethal are also a burden to the city. "Taxpayers have to pay these costs," said Childs. "For an ambulance to respond to an overdose costs between $400 and $1,200, and that's going on many times a day every day."

It's not just ambulances. Failing to address injection drug use under prohibition conditions costs real dollars in other ways as well. Each new diagnosis of HIV in the city comes with a $648,000 price tag for life-long medications and medical care, and even that may be on a low end estimate. A case of hepatitis C often requires $280,000 to $380,000 for a liver transplant; for those cases that do not warrant a liver transplant, treatment costs anywhere from $60,000 to $100,000.

And it's not just taxpayers paying. According to Childs, local businesses, including service providers, spend thousands of dollars a year on plumbing repairs -- from needles disposed of in toilets for lack of biohazard containers.

Now, said advocates, it is time to move forward. The conference was but the opening shot in what will likely be a long and frustrating campaign.

"The conference went very well and it will be a bit of a lift," said John Jay Professor Richard Curtis, who addressed the topic of moving forward from here at the conference. "The evidence is piling up from Sydney and Vancouver and Europe, and that is helping us, too. But this isn't something the health departments and the politicians aren't quickly going to jump on the bandwagon for. We have to give them a push, and if we don't start working on it now, it'll never happen. We didn't get where we are today by behaving ourselves," he added, relating how his own needle exchange effort first faced official opposition before being accepted.

The audience included people from the city and state health departments, Curtis said. "The health officials are all very supportive... unofficially," he said. "They didn't want to be on the agenda, but they say they're supportive. But this is an election year, and that makes it hard for them."

There will be an organizing meeting in two weeks to map out strategy, Curtis said. "We'll see who is willing and able, whether there is an existing agency bold enough to forge ahead or whether we will have to create some alternative organizations. We want to put this issue on the table now."

"We're forming an action group to bring this into New Yorkers' consciousness," said Childs. "The people who do know about -- drug users -- are one of the most stigmatized populations in the city. We are going to a campaign similar to Vancouver about how these people are not bogeymen, but our sons and daughters. We're also trying to organize some media events around it. A group of lawyers will help by challenging some codes. And we'll be trying to work with our legislators and city councilors," he said.

But Curtis and others are not willing to wait forever. "I'm not hopeful that federal crack house laws will end any time soon," he said. "But we started needle exchanges by just doing it. If it has to come to that, we'll have to make them arrest us again. We need to back them into a corner at the very least."

Harm Reduction Coalition Western Coordinator Hilary McQuie has been involved in the ongoing SIF effort in San Francisco. Just because something isn't happening officially doesn't mean it isn't happening, she noted.

"I don't know much about shooting galleries in New York," she said, "but out here, it's no big secret that the bathrooms of service providers, drop-in centers, homeless shelters, soup kitchens are used for shooting up. What people are doing to try to make these current injection spaces safer is perhaps having safe injection instructions, syringe disposal devices, soap and water, things like that," she said. "Also, it's sort of semi-supervised. If someone's in the bathroom and doesn't come out, you can open the door and save them from an overdose. That happens every day in San Francisco."

Feature: Twenty Years of Drug Courts -- Results and Misgivings

The drug court phenomenon celebrates its 20th birthday this year. The first drug court, designed to find a more effective way for the criminal justice system to deal with drug offenders, was born in Miami in 1989 under the guidance of then local prosecutor Janet Reno. Since then, drug courts have expanded dramatically, with their number exceeding 2000 today, including at least one in every state.

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drug court scene
According to Urban Institute estimates, some 55,000 people are currently in drug court programs. The group found that another 1.5 million arrestees would probably meet the criteria for drug dependence and would thus be good candidates for drug courts.

The notion behind drug courts is that providing drug treatment to some defendants would lead to better outcomes for them and their communities. Unlike typical criminal proceedings, drug courts are intended to be collaborative, with judges, prosecutors, social workers, and defense attorneys working together to decide what would be best for the defendant and the community.

Drug courts can operate either by diverting offenders into treatment before sentencing or by sentencing offenders to prison terms and suspending the sentences providing they comply with treatment demands. They also vary in their criteria for eligibility: Some may accept only nonviolent, first-time offenders considered to be addicted, while others may have broader criteria.

Such courts rely on sanctions and rewards for their clients, with continuing adherence to treatment demands met with a loosening of restrictions and relapsing into drug use subjected to ever harsher punishments, typically beginning with a weekend in jail and graduating from there. People who fail drug court completely are then either diverted back into the criminal justice system for prosecution or, if they have already been convicted, sent to prison.

Drug courts operate in a strange and contradictory realm that embraces the model of addiction as a disease needing treatment, yet punishes failure to respond as if it were a moral failing. No other disease is confronted in such a manner. There are no diabetes courts, for example, where one is placed under the control of the criminal justice system for being sick and subject to "flash incarceration" for eating forbidden foods.

Conceptual dilemmas notwithstanding, drug courts have been extensively studied, and the general conclusion is that, within the parameters of the therapeutic/criminal justice model, they are successful. A recently released report from the Sentencing Project is the latest addition to the literature, or, more accurately, review of the literature.

In the report, Drug Courts: A Review of the Evidence, the group concluded that:

  • Drug courts have generally been demonstrated to have positive benefits in reducing recidivism.
  • Evaluations of the cost-effectiveness of drug courts have generally found benefits through reduced costs of crime or incarceration.
  • Concern remains regarding potential "net-widening" effects of drug courts by drawing in defendants who might not otherwise have been subject to arrest and prosecution.

"What you have with drug courts is a program that the research has shown time and time again works," said Chris Deutsch, associate director of communications for the National Association of Drug Court Professionals in suburban Washington, DC. "We all know the problems facing the criminal justice system with drug offenders and imprisonment. We have established incentives and sanctions as an important part of the drug court model because they work," he said. "One of the reasons drug courts are expanding so rapidly," said Deutsch, "is that we don't move away from what the research shows works. This is a scientifically validated model."

"There is evidence that in certain models there is success in reducing recidivism, but there is not a single model that works," said Ryan King, coauthor of the Sentencing Project report. "We wanted to highlight common factors in success, such as having judges with multiple turns in drug court and who understand addiction, and building on graduated sanctions, but also to get people to understand the weaknesses."

"Drug courts are definitely better than going to prison," said Theshia Naidoo, a staff attorney for the Drug Policy Alliance, which has championed a less coercive treatment-not-jail program in California's Proposition 36, "but they are not the be-all and end-all of addressing drug abuse. They may be a step forward in our current prohibitionist system, but when you look at their everyday operations, it's pretty much criminal justice as usual."

That was one of the nicest things said about drug courts by harm reductionists and drug policy reformers contacted this week by the Chronicle. While drug courts can claim success as measured by the metrics embraced by the therapeutic-criminal justice complex, they appear deeply perverse and wrongheaded to people who do not embrace that model.

Remarks by Kevin Zeese of Common Sense for Drug Policy hit many of the common themes. "If drug courts result in more people being caught up in the criminal justice system, I do not see them as a good thing," he said. "The US has one out of 31 people in prison on probation or on parole, and that's a national embarrassment more appropriate for a police state than the land of the free. If drug courts are adding to that problem, they are part of the national embarrassment, not the solution."

But Zeese was equally disturbed by the therapeutic-criminal justice model itself. "Forcing drug treatment on people who happen to get caught is a very strange way to offer health care," he observed. "We would see a greater impact if treatment on request were the national policy and sufficient funds were provided to treatment services so that people who wanted treatment could get it quickly. And, the treatment industry would be a stronger industry if they were not dependent on police and courts to be sending them 'clients' -- by force -- and if instead they had to offer services that people wanted."

For Zeese, the bottom line was: "The disease model has no place in the courts. Courts don't treat disease, doctors and health professionals do."

In addition to such conceptual and public policy concerns, others cited more specific problems with drug court operations. "In Connecticut, the success of drug courts depends on educated judges," said Robert Heimer of the Yale University School of Public Health. "For example, in some parts of the state, judges refused to send defendants with opioid addiction to methadone programs. This dramatically reduced the success of the drug courts in these parts of the state compared to parts of the state where judges referred people to the one proven medically effective form of treatment for their addiction."

Heimer's complaint about the rejection of methadone maintenance therapy was echoed on the other side of the Hudson River by upstate New York drug reformer Nicolas Eyle of Reconsider: Forum on Drug Policy. "Most, if not all, drug courts in New York abhor methadone and maintenance treatment in general," he noted. "This is troubling because the state's recent Rockefeller law reforms have a major focus on treatment in lieu of prison, suggesting that more and more hapless people will be forced to enter treatment they may not need or want. Then the judge decides what type of treatment they must have, and when they don't achieve the therapeutic goals set for them they'll be hauled off to serve their time."

Still, said Heimer, "Such courts can work if appropriate treatment options are available, but if the treatment programs are bad, then it is unlikely that courts will work. In such cases, if the only alternative is then incarceration, there is little reason for drug courts. If drug court personnel think their program is valuable, they should be consistently lobbying for better drug treatment in their community. If they are not doing this, then they are contributing to the circumstances of their own failure, and again, the drug user becomes the victim if the drug court personnel are not doing this."

Even within the coerced treatment model, there are more effective approaches than drug courts, said Naidoo. "Drug courts basically have a zero tolerance policy, and many judges just don't understand addiction as a chronic relapsing condition, so if there is a failed drug test, the court comes in with a hammer imposing a whole series of sanctions. A more effective model would be to look at the overall context," she argued. "If the guy has a dirty urine, but has found a job, has gotten housing, and is reunited with his family, maybe he shouldn't be punished for the relapse. The drug court would punish him."

Other harm reductionists were just plain cynical about drug courts. "I guess they work in reducing the drug-related harm of going to prison by keeping people out of prison -- except when they're sending people to prison," said Delaney Ellison, a veteran Michigan harm reductionist and activist. "And that's exactly what drug courts do if you're resistant to treatment or broke. Poor, minority people can't afford to complete a time-consuming drug court regime. If a participant finds he can't pay the fines, go to four hours a day of outpatient treatment, and pay rent and buy food while trapped in the system, he finds a way to prioritize and abandons the drug court."

An adequate health care system that provided treatment on demand is what is needed, Ellison said. "And most importantly, when are we going to stop letting cops and lawyers -- and this includes judges -- regulate drugs?" he asked. "These people don't know anything about pharmacology. When do we lobby to let doctors and pharmacists regulate drugs?"

Drug courts are also under attack on the grounds they deny due process rights to defendants. In Maryland, the state's public defender last week argued that drug courts were unconstitutional, complaining that judges should not be allowed to send someone to jail repeatedly without a full judicial hearing.

"There is no due process in drug treatment court," Public Defender Nancy Foster told the Maryland Court of Appeals in a case that is yet to be decided.

Foster's argument aroused some interest from the appeals court judges. One of them, Judge Joseph Murphy, noted that a judge talking to one party in a case without the other party being present, which sometimes happens in drug courts, has raised due process concerns in other criminal proceedings. "Can you do that without violating the defendant's rights?" he asked.

A leading advocate of the position that drug courts interfere with due process rights is Williams College sociologist James Nolan. In an interview last year, Nolan summarized his problem with drug courts. "My concern is that if we make the law so concerned with being therapeutic, you forget about notions of justice such as proportionality of punishment, due process and the protection of individual rights," Nolan said. "Even though problem-solving advocates wouldn't want to do away with these things, they tend to fade into the background in terms of importance."

In that interview, Nolan cited a Miami-Dade County drug court participant forced to remain in the program for seven years. "So here, the goal is not about justice," he said. "The goal is to make someone well, and the consequences can be unjust because they are getting more of a punishment than they deserve."

Deutsch said he was "hesitant" to comment on criticisms of the drug court model, "but the fact of the matter is that when it comes to keeping drug addicted offenders out of the criminal justice system and in treatment, drug courts are the best option available."

For the Sentencing Project's King, drug courts are a step up from the depths of the punitive prohibitionist approach, but not much of one. "With the drug courts, we're in a better place now than we were 20 years ago, but it's not the place we want to be 20 years from now," he said. "The idea that somebody needs to enter the criminal justice system to access public drug treatment is a real tragedy."

Heroin Maintenance: Study Suggests Baltimore Could Be Ripe for a Pilot Program

Baltimore is home to one of the nation's most intractable heroin-using populations, and now a study done for the city's Abell Foundation is suggesting it could be time to try something new, at least in this country: heroin maintenance. The idea is not so much to push for such a program now, but to open the door for discussion -- a worthy idea given that decades of repression and, more recently, conventional drug treatment have done little to stem the tide of addicts.

Authored by University of Maryland drug policy expert Peter Reuter, the study, Can Heroin Maintenance Help Baltimore?, examined existing heroin maintenance programs in Switzerland and Germany as well as the now-ended North American Opiate Maintenance Initiative (NAOMI) program in Vancouver, and examined the Baltimore heroin scene. His review of results so far found decreases in criminality, increases in employment, and health improvements for participants.

But Reuter also noted that those existing programs are expensive (more expensive than methadone treatment), serve relatively small numbers, and would be politically controversial in the US setting. In fact, the US National Institute on Drug Abuse, offered a chance to participate in the NAOMI program, declined. In addition, Reuter wrote that significant differences between hard core heroin users in Baltimore and in European cities made predictions of success difficult.

Can heroin maintenance help Baltimore? Here's how Reuter answered his own question:

At best there is a case only for an experiment. There are too many potential differences between Baltimore City and the other sites in which HAT [heroin-assisted therapy] has been tried to allow confident predictions of the outcomes. Visits to facilities in other countries hardly provide an inspiring model. The client population in Baltimore City is highly troubled so even if HAT leads to better outcomes for the group as a whole, many of the clients will remain unemployed, marginalized, and in poor health conditions. There will be some poster children but not many.

The potential for gain, however, is substantial. Even in the aging heroin-addict population, there are many who are heavily involved in crime and return frequently to the criminal justice system. Their continued involvement in street markets imposes a large burden on the community in the form of civil disorder that helps keep investment and jobs out. If heroin maintenance could remove 10 percent of Baltimore's most troubled heroin addicts from the streets, the result could be substantial reductions in crime and various other problems that greatly trouble the city. That is enough to make a debate on the matter worthwhile.

"It is a sensible innovation to consider," Reuter told the Baltimore Sun. "I am not a passionate advocate for it, but I do think someone should try it in the US. It has enough plausibility that it's worth trying."

But Baltimore officials are not convinced. "I think it would be a mistake to pursue an expensive and unproven idea when we need more resources for effective drug treatment," said Dr. Joshua Sharfstein, the city health commissioner, who apparently did not actually read the report. "There's nothing that persuades me to invest in something that is so expensive and without evidence."

Former Baltimore health commissioner Dr. Peter Beilenson worried that the notion was too radical to fly in the US and could undercut more plausible reforms. "It's not like everything has been tried and everything has failed and you just throw up your hands," said Beilenson, who is now Howard County's top health official. "The problem is if you are going to do any reasonable drug policy reform, this heroin thing is such a red flag that it takes all the attention away. It makes it look like anyone who is interested in drug policy reform is crazy." [Ed: Beilenson should know -- he tried it in 1998.]

But some addiction specialists said there should at least be a clinical trial. "Do I think it would be interesting? In a controlled clinical trial setting, yes," said Susan Sherman, an epidemiologist with the Johns Hopkins Bloomberg School of Public Health "To me, it's also important to have a public dialogue, regardless of the outcome. It forces people to deal with really hard issues about drug use and drug users."

"Most studies clearly show they help," said Dr. Christopher Welsh, assistant professor of psychiatry at the University of Maryland medical school. "But using public funds to fund something like this would be a whole other level of politics, especially in this economy."

Feature: It's Time for a New Drug Policy Paradigm, Say Latin American Leaders

A blue-ribbon commission of Latin American leaders has issued a report saying that the US-led war on drugs has failed and it is time to consider new policies, particularly treating drug use as a public health problem and decriminalizing marijuana. The report is an attempt to intervene not only in Latin American, US, and European drug policy debates, but also in the United Nations' ongoing 10-year review of global drug policies, which will culminate next month in a ministerial meeting in Vienna.

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The report, Drugs and Democracy: Toward a Paradigm Shift, is the work of the Latin American Commission on Drugs and Democracy, a 17-member panel that includes former Brazilian President Fernando Henrique Cardoso, former Mexican President Ernesto Zedillo, and former Colombian President Cesar Gaviria. Other commission members include the writers Paulo Coelho, Mario Vargas Llosa, Sergio Ramírez and Tomás Eloy Martínez as well as leading scholars, media members and politicians.

Latin America is the leading exporter of both cocaine and marijuana. As such, it has faced the ravages of heavy-handed American anti-drug interventions, such as Plan Colombia and earlier efforts to destroy the Bolivian coca crop, as well as the violence of drug trafficking organizations and politico-military formations of the left and right that have grown wealthy off the black market bonanza. And while the region's level of drug consumption has historically been low, it is on the rise.

"The main reason we organized this commission is because the available evidence indicates the war on drugs is a failed war," said Cardoso at a Wednesday press conference in Rio de Janeiro to announce the report. "We need a different paradigm to cope with the problem of drugs. The power of organized crime is undermining the very foundations of democracy in some Latin American countries. We must acknowledge that these policies have failed and we must break the taboo that prevents us from discussing different strategies."

In the report, the commission calls for more humane and effective drug strategies. It emphasizes the following broad themes:

  • Treat drug use as a public health issue;
  • Reduce consumption through information and prevention actions;
  • Focus on enforcement against organized crime.

The commission also called on governments and civil society around the globe to "assess in the light of public health and advanced medical science the possibility of decriminalizing possession of marijuana for personal consumption."

"We need to break the taboo that's blocking an honest debate," Cardoso said, repeating one of the phrases of the day. "Numerous scientific studies show that the damage caused by marijuana is similar to that of alcohol or tobacco," said the well-respected former Brazilian leader.

"Decriminalization is only part of the solution," warned former Colombian President Gaviria. "You need to do what the Europeans are doing, which is helping addicts. That's what the US doesn't do; it just puts them in jail," he scolded. "You tripled the jail population in the US in the last 20 years because of prohibitionism. The half million people in jail because of drug consumption, is that reducing consumption?" he asked. "The excuse is that people commit crimes to get money, but you deal with that putting addicts under a doctor and helping them with their problem."

The commission has three objectives, said Gaviria. "We want to create a Latin American policy around the consumption of drugs, we want to promote a debate in the US -- we are very concerned that there is no real public debate on the politics of drug trafficking in US politics -- and we want the European Union countries to take more responsibility for drug consumption," he said. "They are not doing enough to reduce the consumption of drugs."

"This report represents a major leap forward in the global drug policy debate," said Ethan Nadelmann, executive director of the Drug Policy Alliance, who addressed a commission session in Bogotá last September. "It's not the first high-level commission to call the drug war a failure, nor is it the first time any Latin American leader has criticized the prohibitionist approach to global drug control. But it is the first time that such a distinguished group of Latin Americans, including three highly regarded ex-presidents, have gone so far in their critique of US and global drug policy and recommendations for what needs to be done."

The commission report is on "the cutting edge" of the global drug policy debate, said Nadelmann. "This is evident in its call for a 'paradigm shift,' in its recognition of the important role of harm reduction precepts and policies, in its push for decriminalization of cannabis, and in its critique of 'the criminalization of consumption.'"

Now it is on to Vienna -- and beyond -- said commission members. It is past time for a new approach, not only in the US, but internationally, they said.

"We hope the meeting in Vienna will not produce a result like previous meetings, where they just kept pushing back the date on which drugs will disappear," said Rubem Cesar Fernandes of the civil society organization Viva Rio. "The main discussion in Vienna should be whether the world should adopt European harm reduction policies. Most Latin American countries are supporting the approach of dealing with this as a health problem, not a criminal one."

Fernandes looked with guarded optimism at the new Obama administration. "We hope the Obama administration will at least be able to open that possibility because now the US totally opposes harm reduction as good policy," he said. "The world is not moving to follow the US jail policy. The US needs to think about whether putting people in jail is really solving the problem."

"Discussions in Vienna are not enough," said Cardoso. "We need national debates in all our countries, as well as inside the US. A clear dialog with the US is very important. We will try to get in contact with the Obama administration."

And so the pressure builds, on both the UN and the US. Will it be enough to force dramatic changes in Vienna or Washington? Probably not yet. But the global prohibitionist consensus is crumbling, clearly if slowly.

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