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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Copenhagen Safe Injection Site Set to Open

A private safe injection site for heroin users is set to open in Copenhagen this week despite warnings from police and over the objections of neighbors. The harm reduction operation will be located in the city's Vesterbro district near Central Station. It will be the first in Denmark.

Copenhagen's Vesterbro district (Image via Wikimedia)
Police said they did not oppose the site's opening, but would shut it down if they find people using drugs there. "The room is not illegal per se, but possession of narcotics is illegal," Copenhagen Police spokesman Arne Wissing told the Copenhagen Post.  "We have no intention to sit passively and witness criminal acts, so if we see people in possession of illegal drugs, we will certainly act."

But safe injection site organizer Michael Lodberg Olsen said there was nothing illegal about it. "If that's the case, then they could just as well have shut down all of Vesterbro 30 years ago," he said, referring to needle exchange programs that have operated there for decades. "A report from the UN states that handing out clean needles to drug abusers is the same as establishing an injection room," he said.

Safe injection sites are already operating in Australia, Canada, Germany, Luxembourg, the Netherlands, Norway, and Spain. There are no safe injection sites in the US, although there has been talk about establishing one in San Francisco.

Copenhagen
Denmark

California Governor Vetoes Needle Access Bill

Gov. Arnold Schwarzenegger (R) last Thursday vetoed a bill that would have allowed pharmacies all over California sell syringes to adults without a prescription. The bill was touted by health experts as a key step in reducing the transmission of HIV/AIDS, hepatitis, and other blood-borne diseases.

mobile needle exchange/clinic site, Fresno
The state Department of Public Health estimates that approximately 3,000 California residents contract hepatitis C through syringe sharing every year and another 750 cases of HIV are caused by syringe sharing. Sharing dirty needles is the leading cause of new hepatitis C infections in the state and the second leading cause of new HIV infections.

"When I signed legislation my first year in office allowing for a pilot program to allow the sale of syringes through participating counties and registered pharmacies, I was seeking to balance the competing public health, law enforcement and local control issues that this issue requires," the governor wrote in his veto message. "I believe this balance was achieved and SB 1029 would remove the ability of local officials to best determine policies in their jurisdiction. Some counties have not sought to implement this pilot program, citing competing priorities, lack of pharmacy interest and law enforcement opposition. I respect these local decisions and while I appreciate the author’s hard work and dedication to this issue, I cannot sign this bill," Schwarzenegger wrote.

Instead, Schwarzenegger signed AB 1701, which extends the existing Disease Prevention Demonstration Project for another eight years. That gives cities and counties the option of opting out of the program and not allowing syringe sales without a prescription.

The veto angered SB 1029 author Sen. Leland Yee (D-San Francisco), who in a statement last Friday said Schwarzenegger apparently "was not interested in an effective public health measure that would reduce health care costs to taxpayers. Not only did he ignore the recommendation of doctors and other health experts, but he ignored the fact that HIV-AIDS and hepatitis do not recognize county borders. Such epidemics are certain to continue without implementing these comprehensive strategies."

SB 1029's approach "has been evaluated extensively throughout the world and has been found to significantly reduce rates of HIV and hepatitis without contributing to any increase in drug use, drug injection, crime or unsafe discard of syringes," Yee continued. "In fact, there is not one credible study that refutes these findings. The governor’s veto is a moral and fiscal dilemma."

The veto was "tragic and infuriating," said Laura Thomas of the Drug Policy Alliance, which supported Yee's bill. "It is an irrational attachment to drug war hysteria, at the expense of human life and fiscal responsibility to the California taxpayer," she said. "Nothing would have worked better and cost less in reducing the spread of HIV and hepatitis C than SB 1029."

Sacramento, CA
United States

Canadian Medical Association Journal Article Sides with Drug Injection Site

Location: 
Vancouver, BC
Canada
An article in the Canadian Medical Association Journal slams the federal government for its efforts to shut down Insite in downtown Vancouver, Canada's only safe injection site for drug addicts.
Publication/Source: 
CBC Radio-Canda (Canada)
URL: 
http://www.cbc.ca/consumer/story/2010/08/30/con-insite-cmaj.html

On the street, you can see the harm caused by drug laws (Opinion)

Location: 
Canada
Former British Columbia police officer David Bratzer discusses drug prohibition's role in increasing the rate of HIV infections, and how the Vienna Declaration is trying to bring positive change.
Publication/Source: 
The Ottawa Citizen (Canada)
URL: 
http://www.ottawacitizen.com/opinion/street+harm+caused+drug+laws/3334743/story.html

UNODC: The Russians Are Coming

[Update, 6:20pm EST: Peter Sarosi at HCLU just told me Ban Ki-moon has indeed picked Fedotov. Hence I have removed the question mark from the end of the title of this article. :( - DB]

Current head of the UN Office on Drugs and Crime (UNODC) Antonio Maria Costa is set to end his 10-year term at the end of this month, and according to at least one published report, a Russian diplomat has emerged as the frontrunner in the race to replace him. That is causing shivers in some sectors of the drug reform community because the Russians are viewed as quite retrograde in their drug policy positions.

The report names Russia's current ambassador to the United Kingdom, Yuri Fedotov, as the top candidate to oversee UNODC and its $250 million annual budget. Other short-listed candidates include Spanish lawyer Carlos Castresana, who headed a UN anti-crime commission in Guatemala, Colombian Ambassador to the European Union Carlos Holmes Trujillo, and Brazilian attorney Pedro Abramovay. The final decision is up to UN Secretary General Ban Ki-moon.

If Fedotov wins the position, Russia would be in a far more influential position to influence international drug policy, and that is raising concerns because of Russia's increasingly shrill demands that the US and NATO return to opium eradication in Afghanistan, its refusal to allow methadone maintenance and its refusal to fund needle exchange programs even as it confronts fast-growing heroin addiction and HIV infection rates.

The concerns have crystallized in a campaign to block his appointment, including a Facebook group called We Don't Want A Russian UN Drug Czar!, which is urging people to send an email message to that effect to Secretary General Ki-moon. Group organizers the Hungarian Civil Liberties Union have also produced a video on the subject:

Harm Reduction: Colorado Bill Would Legalize Needle Exchanges

Colorado is one of just 17 US states that do not allow needle exchanges, but that could change under a bill before the Colorado Senate. The bill, SB 189, would allow local health departments to exchange dirty needles for clean ones in a bid to slow the spread of blood-borne diseases, such as HIV/AIDS and Hepatitis C among injection drug users.

https://stopthedrugwar.org/files/needle-exchange-logo.gif
widely-used needle exchange graphic
The bill passed its first legislative hurdle Wednesday, passing out of the Senate Health and Human Services Committee with only two no votes. It now goes before the Senate for a floor vote.

"This is intended to be a public health measure to stop the spread of infectious diseases," lead sponsor Sen. Pat Steadman (D-Denver) told ABC 7 News.

But the bill is generating opposition from solons who fear it will enable drug use. "It does give kind of a wink and a nod towards the use of illegal drugs," said Sen. Kevin Lundberg (R-Berthoud), who opposes the measure. "My common sense says a needle exchange program is a de facto drug legalization and I'm not going to go there. We've got a problem with illegal drugs," he said. "Let's not make it worse by saying maybe, sort of, kind of, you can do it."

"No one's condoning illegal drug use," Steadman retorted. "No one's saying, 'Go have a good time.' What we're saying is, 'Please be safe.'"

Under current Colorado law, groups are allowed to collect used syringes, but not exchange them for clean ones. The only city in the state that allows for needle exchanges is Boulder, which passed a 1989 law exempting some groups from prosecution for doing exchanges.

That doesn't mean there is no needle exchange in Denver, the state's largest city. The Underground Syringe Exchange of Denver (USED) has been doing exchanges since 2008 and has handed out more than 11,000 needles to drug users.

"We remove syringes off the streets of Denver," said USED member Chris Conner. "They wind up in our dumpsters. They wind up thrown away in public bathrooms or discarded in parks," he said. "So this is a public health issue for all of us."

Drug War Chronicle Book Review: "In the Realm of Hungry Ghosts: Close Encounters With Addiction," by Dr. Gabor Maté (2010, North Atlantic Books, 468 pp., $17.95 PB)

Phillip S. Smith, Writer/Editor

In the revised edition of his prize-winning Canadian best-seller, Vancouver's Dr. Gabor Maté has made an important contribution to the literature on drug use and addiction. For more than a dozen years, Maté has been a staff physician for the Portland Hotel Society in Vancouver's infamous Downtown Eastside, home to one of the hemispheric largest, most concentrated populations of drug addicts. The Portland is unique -- once just another shoddy Skid Row SRO, under the management of the Society it is now both a residence for the hardest of the hard-core and a harm reduction facility.

http://www.stopthedrugwar.org/files/hungryghosts.jpg
As a medical resident at the Portland, Maté has seen it all. The first section of "Hungry Ghosts" is filled with descriptions of his patients and their lives. Much of this is quite literally horrendous: Coked-out women turning tricks in alleys for their next rock and contracting syphilis; suicidal, opiate-addicted women refusing HIV treatments; mentally ill and alcoholic men dying young of liver cancer from Hepatitis C infections; people strung out on crack scrabbling at pieces of gravel on the sidewalk in the hallucinatory hope it's another rock; multi-addicted men and women, blood oozing from festering sores as they search yet again for a vein to hit, people overdosing and then going right back at it, people overdosing and dying.

And yet, despite the misery they are in and the wrecks that are their lives, they keep on using. "Hungry Ghosts" is an extended meditation on why. The second chunk of the book is devoted in particular to addressing that question. Maté offers an extended tour of the latest research into the disease model of addiction, with succinct and understandable (to the layperson) explanations of reward circuits in the brain, dopamine and serotonin flows, and all that good neuro-bio-pharmacological stuff so beloved of NIDA grantees. Repeated use of a substance indeed "rewires" the brain, creating pleasure circuits demanding to be fulfilled and pleasure deficits demanding to be fixed... with that next fix.

But unlike the NIDA people, with what I consider to be their neuro-bio-pharmacological determinism and reductionism, Maté goes a step further. He points out, accurately enough, that no matter what substance we're talking about, only a fraction of users, typically between 10% and 20%, become addicts. The "chronic relapsing brain disease" model may have some utility, but it fails to explain why some people are susceptible to addiction in the first place and others are not.

Maté noticed something about his downtrodden, strung-out clientele in Vancouver. They were almost universally abused as children, and at best, neglected. And I mean abused: Not spanked too hard, but raped, beaten, raped again, exploited, sent into foster care, literally spit on by their parents. It's very ugly.

One story especially sticks with me. A First Nations woman whose mother lives on the Downtown Eastside was given up at birth by her addicted mother, and sent to live with relatives, several of whom repeatedly sexually molested her in especially disgusting ways. She grew up an angry, depressed kid who turned to drugs and drink early. Tired of her life, she saved up $500 when she was 14 and ran away to Vancouver to find her mother. She did find her mother -- too bad for her. Mommie dearest promptly shot her up with heroin, spent the $500 on drugs for herself, then turned her out to turn tricks on the street. And you wonder why this woman prefers a narcotized bliss?

Maté doesn't just rely on anthropology and anecdote. He takes the reader instead into an extended look at the research on early childhood development and identifies messed-up childhoods as the key indicator of future substance abuse (as well as many other) problems. It doesn't have to be as extreme as some of these cases, but Maté makes clear that a nurturing early up-bringing is absolutely vital to the development of mentally and emotionally stable human beings.

Maté also has a startling confession to make: He, too, is an addict. The good doctor has been fighting a lifelong battle with his addiction to... wait for it... buying classical music CDs. He has behaved just like a junkie, he admits, spending thousands of dollars on his habit, lying to his wife, neglecting his kids, even leaving in the middle of medical procedures to run and score the latest Vivaldi. He's suffered the same feelings of compulsion, guilt, disgust, and self-denigration as any other addict, even if he doesn't have the scars on his veins to show for it.

At first glance, Maté's claim almost seems ludicrous, but he's making an important point: Addiction is addiction, whether it's to heroin or gambling, cocaine or shopping, he argues. The process of changes in the brain is the same, the compulsion is the same, the negative self-feelings are the same. We don't blame playing cards for gambling addiction or shopping malls for shopaholism; similarly, drugs are not to blame for drug addiction -- our own messed up psyches are the root of the problem.

And that leads to another important point: Those hollow-eyed addicts are like the rest of us, they are a dark mirror on our own inner problems, and most of us have some. (I'm reminded of a cartoon I once saw of a man sitting by all alone in an empty auditorium under a hanging banner saying, "Welcome to the convention of children of non-dysfunctional families.")

This is important because it stops us from dehumanizing drug addicts. They are not "the other." They are us, different only in degree. They deserve caring and compassion even if it is tough and seemingly fruitless work. Maté chides himself for falling from that saintly pedestal on occasion, and good for him.

Not surprisingly, Maté is a strong advocate of harm reduction and a harsh critic of prohibitionist drug policies and the US war on drugs in particular. By grinding drug users down even further, prohibition serves only to make them more likely to seek solace in chemical nirvana. It's almost as if prohibition were designed to create and perpetuate drug addiction.

In the final chapters of "Hungry Ghosts," Maté offers a glimmer of hope for beating drug addiction (or gambling addiction or sex addiction or whatever your particular compulsion is). It is a tough path of self-awareness and spiritual practice. I don't know if it will work -- I haven't tried it myself -- but it is important to remind ourselves that addiction is not necessarily a hopeless trap with no escape.

This is good, strong, compassionate, highly informed reading. I heartily recommend this book to anyone with an interest in addiction, addiction treatment, early childhood development, or drug policy. Thanks, doc.

Tainted Supply: Cocaine Laced With Levamisole Keeps Turning Up

Back in September, we reported on the appearance of cocaine cut with levamisole, a veterinary de-worming agent, and its links to at least three deaths in the US and Canada from a disease caused by levamisole, agranulocytosis. At that time, the DEA reported that levamisole was turning up in about 30% of the cocaine it sampled.

http://www.stopthedrugwar.org/files/taintedcocainegraph.jpg
DEA levamisole findings
Now, the DEA says that figure is up to 70%. While the number of fatalities has remained unchanged since last fall, new cases of agranulocystosis continue to appear in North American drug users. Earlier this month, authorities in Winnipeg, Manitoba, reported that two cocaine users contracted the disease there and that additional cases had been reported in neighboring Alberta.

Levamisole suppresses immune function and the body's ability to fight off even minor infections, and people who ingest levamisole-tainted cocaine can be faced with quickly-developing, life-threatening infections. Agranulocytosis is a condition of suppressed immune systems. Its symptoms include chills or high fever, weakness, swollen glands, painful sores, sudden or lingering infections, skin infections, abscesses, thrush, and pneumonia.

Cocaine contaminated with levamisole, although not users with agranulocytosis, has also popped up in the last few days in Maine and Ohio. Samples of crack cocaine in Mansfield, Ohio, tested positive late last month. And public health officials reported Tuesday that 30% to 50% of Maine cocaine samples tested positive.

The Substance Abuse and Mental Health Services Administration (SAMHSA) put out an alert late in September warning of the tainted cocaine, but federal authorities have done little publicly since then.

Given the geographically widespread reports of cocaine contaminated with the veterinary drug, it is assumed that levamisole is being added as a cutting agent either in source countries or in transit countries, not by local dealers.

Feature: Anthrax-Tainted Heroin Takes Toll in Europe, Prompts Calls for Emergency Public Health Response

European heroin users are on high alert as the death toll rises from heroin tainted with anthrax. At least eight people have died -- seven in Scotland and one in Germany -- since early December, and another 14 Scottish heroin users have been hospitalized after being diagnosed with anthrax. Meanwhile, drug reform and drug user activists are reporting a cluster of nine suspicious heroin-related deaths in Coimbra, Portugal, although it is unclear at this point whether they are linked to anthrax-tainted heroin.

http://stopthedrugwar.org/files/anthraxspores.jpg
anthrax spores
The Scottish government has responded by urging heroin users to stop using and to seek drug treatment. That advice has not gone over well with drug users and public health and harm reduction advocates, who are demanding an emergency public health response.

The first four Scottish deaths were in Glasgow, but after one person died in Tayside and one in the Forth Valley earlier this month, Health Protection Scotland epidemiologist Dr. Colin Ramsay said: "The death of this patient in NHS Forth Valley indicates further geographical spread of the cases, meaning that heroin users all across Scotland need to be aware of the risks of a potentially contaminated supply. I would urge all users to stop using heroin immediately and contact local drug support services for help in stopping. If any heroin users do notice signs of infection, for example marked redness and swelling around an injection site or other signs of serious infection such as a high fever, they should seek urgent medical advice."

The French government has also reacted, with the General Directorate for Health issuing a statement Tuesday warning that contaminated heroin may be circulating in France and other European countries. Noting the rising death toll, the statement said "the likeliest source is heroin contaminated by anthrax spores."

Heroin users should be alert, the French statement said, because heroin contaminated with anthrax is indistinguishable from other heroin. "There is no outward sign or color enabling the user to tell whether the heroin has been contaminated by anthrax, and contaminated heroin dissolves or is used in the same way as uncontaminated heroin," it said.

Anthrax is a potentially lethal bacterium that exists naturally in the soil and can also occur among cattle. It is also a potential bio-terror weapon.

The vast majority of heroin consumed in Europe comes from Afghanistan, and while so far evidence is lacking, speculation is that anthrax spores may have been present in bone meal, an animal product sometimes used as a cutting agent. Another possibility is that containers used in the heroin production process were contaminated with anthrax spores. And, given fears that Al Qaeda and its Taliban allies could resort to biological warfare against the West and given the Taliban's role in the Afghan opium and heroin trade, a bio-attack cannot be completely ruled out.

"The anthrax-infected heroin hasn't decreased use, whether people are injecting it or chasing [smoking] it," said Tam Miller, chair of Chemical Reaction, an Edinburgh drug user group, and a member of INPUD (the International Network of People who Use Drugs). "People are scared -- you can be sure of that -- but I think they're more afraid of withdrawing. The Scottish government's advice was for people to stop using heroin, but that won't happen."

Instead, Miller said, heroin users are doing what they can to protect themselves. "Users feel there's not much they can do personally and, as usual, they feel isolated," he said. "A lot are looking up the effects on anthrax on the net and passing on information to people with no internet access. We think the powers that be should put out information on how to spot signs if someone has been in contact with access. Basically, mate, the Scottish government wants little to do with it."

The Scottish government's response so far has drawn a harsh rebuke from the United Kingdom's harm reduction and public health community. In a Tuesday letter to the Scottish government, the International Harm Reduction Association, the drug think tank Release, the Transform Drug Policy Foundation, the UK Harm Reduction Alliance, and individual public health experts called on the government to put in place an emergency public health plan to deal with the crisis.

The letter said the government's advice to heroin users to stop using and enter treatment was "reckless in light of the fact that waiting times in Scotland for opiate substitute treatment (OST) are the longest in the UK. Many of those accessing services are informed that it is a condition of their treatment to engage with the service for a minimum period of time, before they will be entitled to a prescription offering an alternative substitute medication, usually methadone. In some areas of Scotland we have been informed that waiting times for OST can be up to 12 months."

[There is another potential issue with methadone, as well. The antibiotic drug Cipro, used to treat anthrax, interacts with methadone, leading to the possibility of methadone overdoses.]

Given the reality of treatment shortages and delays, it is "unacceptable" for the Scottish government to just tell users to stop or to go to treatment that isn't there, the letter said. "It is clear that this kind of approach can only lead to the death of more vulnerable people."

Instead, the Scottish government must immediately implement a public health plan that includes rapid access and low-threshold prescribing of alternatives to street heroin, the letter-writers advised. They recommended prescribing dihydrocodeine, a synthetic opiate approximately twice as strong as codeine. It is sold in the US under brand names including Panlor, Paracodin, and Synalgos.

"Such an approach will go some way to prevent any more loss of life and will provide greater protection to the public as a whole," the letter said. "Failure to adopt such a policy would mean that the Scottish state would be failing in its duty to its citizens."

Joep Oomen of the European Coalition for Just and Effective Drug Policies (ENCOD) had another suggestion. "The only decent reaction to this kind of episode is to immediately open facilities where people can test their heroin and where they can use in safe conditions, supervised by people who can help if anything goes wrong," he said.

"Hopefully, in the longer term, because of these incidents, authorities will start to see the need for introducing heroin maintenance programs, not as a trial for a limited group of people, but as a permanent service for all those who cannot abstain from heroin for a longer period of time," he added.

Ultimately, said Oomen, prohibition is the problem. "Adulteration is a practice that belongs to the illegal market," he said. "It happens because the people who control the heroin market have no interest at all in the health of their customers."

Dr. Sharon Stancliff of the US Harm Reduction Coalition agreed with her colleagues' assessment of the Scottish government's response. "Telling people to stop is not useful information," she said. "Maybe some occasional users will have a glass of wine instead, but if people are sick and treatment is limited, telling people that heroin is bad for them isn't going to have much impact," she explained.

"At this point, the European harm reduction people should be getting the word out, and the medical people over there need to be on the alert," she added.

Stancliff said she had seen no sign of heroin contaminated with anthrax on this side of the Atlantic, but she was worried. "I hope the DEA is out there buying heroin to see what's in it," she said. "If there is any hint of it here, physicians should be alerted by the Centers for Disease Control as they were with levamisole-tainted cocaine."

If the anthrax-contaminated heroin is coming from Afghanistan, as most heroin consumed in Europe does, US heroin users may catch a break. Most heroin consumed here is of Mexican or Colombian provenance.

But on the other side of the Atlantic, adulterated heroin is killing drug users.

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