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New Mexico Legislature to Study Supervised Injection Sites [FEATURE]

In a groundbreaking move, the New Mexico legislature has approved a proposal to study how to enhance and expand the state's already cutting edge harm reduction programs, including a look a medically supervised injection sites (SIJs -- sometimes also known as safe injection sites) for hard drug users. That could clear the way for an eventual SIJ pilot program to operate in the state, although considerable political and legal hurdles remain.

The legislation, Senate Memorial 45, was sponsored by Sen. Richard Martinez, whose constituency includes Rio Arriba County, which has a drug overdose fatality rate five times the state's rate. The state's rate is double the national rate, making New Mexico the nation's leader in drug overdose-related deaths per capita.

"These deaths are preventable," said Martinez. "Overdose spares no one and affects everyone, especially families."

State health officials estimate the state has at least 24,000 injection drug users. Other estimates put that figure as high as 50,000.

The memorial, which was also endorsed by the New Mexico Public Health Association, passed the Senate on a 43-0 vote Monday night and does not need any further action to go into effect. It directs the University of New Mexico's Robert Wood Johnson Foundation Health Policy Center to undertake the study of emerging and evidence-based harm reduction approaches, including SIJs, and report back to the legislature by November 1.

"Sadly, our drug overdose epidemic has outgrown our current harm reduction approaches," said Emily Kaltenbach, director of the Drug Policy Alliance (DPA) New Mexico office. "On Monday, our state senators realized this and did not let politics trump science. They clearly stated their intent to go beyond the status quo and explore innovative strategies to help New Mexico’s families."

"Wow, getting something like that on the state level is huge," said Hilary McQuie, Western director for the Harm Reduction Coalition (HRC). "New Mexico once again takes the lead in state harm reduction efforts; it's one of the few states to take a statewide approach to these things."

"Heroin is still the number one cause of ODs here, but we're also seeing a high number of prescription drug overdose deaths," said Kaltenbach, "so I'm incredibly encouraged that the legislature is willing to look beyond the status quo and start studying proven programs like supervised injection sites. We're hoping to study the feasibility and legal and ethical implications, leading to a pilot site in New Mexico."

If that actually happens, it would be the first SIJ in the nation. Although SIJS are operating in at least 27 cities around the world, including Vancouver and Sydney, and have been proven to reduce the spread of HIV, Hep C, and other blood-borne diseases, as well as prevent overdoses, without increasing criminality or drug use, political and legal obstacles in the US have so far prevented them from spreading here. They face morality-based opposition as well as federal issues including a "crack house law," which bars anyone from knowingly allowing others to use controlled substances.

"These same sorts of issues came up when syringe exchange programs were first discussed," said Kaltenbach. "I think the legal issues can be overcome, but the states have to be willing to look at it as an extension of syringe exchange. This study will address those issues."

While New Mexico is the first state to order a study of SIJs, it isn't the only place in the country where they are on the agenda. In San Francisco, drug user groups, activists, and advocates are working toward winning approval for one there, while in New York City, a similar effort is going on.

"The biggest obstacle is the perception of legal barriers," said DPA's Laura Thomas, who has been working on the San Francisco effort. "We have these crack house statutes, as well as state laws, that say it's illegal to knowingly allow people to use controlled substances. We have to figure out if there's room for a research project, like in Sydney, or create an exemption, like in Vancouver, or get a state law passed, like in New Mexico. We need a ruling that says 'yes,' this is not a violation."

http://stopthedrugwar.com/files/richard-martinez.jpg
Richard Martinez
In the meantime, the achingly slow process of building political support for an SIJ, or at least a feasibility study, goes forward. A year ago this week, a city Hep C task force recommended looking at SIJs. That followed on a similar recommendation from the city's HIV coalition.

"We continue to try to build support for a safe injection site," said Thomas. "During the mayoral campaign last year, at one of the candidate forums, they were all asked if they would support evaluating whether it would work for San Francisco, and most of them said they did, including our current city attorney, Dennis Herrera."

But despite the recommendations and expressions of support, nothing has happened yet. The San Francisco Drug Users' Union is trying to change that.

"We will be pressing the Board of Supervisors to study the possibilities," said the group's Isaac Jackson. "We're also doing a SIJ community design competition, a project in community imagineering. We'll give the winner a nominal prize and we'll present the winning design to the Board," he said.

"We think the city's Human Rights Commission will recommend safe injection sites in April," said HRC's McQuie. "But there have been other bodies and other recommendations. It's a matter of where the political will is and the priorities are."

For HRC, said McQuie, getting a safe injection site up and running in San Francisco is a back burner issue right now, but that could change.

"We have a lot of really great harm reduction projects going on, like the DOPE Project, that aren't getting financial support, and while there was a lot of enthusiasm for awhile about working toward a safe injection site, we kept planning meetings, but nobody would show up. It didn't feel like the energy was there. If the San Francisco Drug Users' Union wants to take some leadership, we would be happy to support it," said McQuie. "I think we will be going back to San Francisco and asking somebody to do something on this issue, but we're not sure who yet."

On the other side of the country, street-level activists are aiming for an SIJ in New York City. Citiwide Harm Reduction in the South Bronx, which is on the verge of opening the city's first fully staffed primary care clinic at a syringe exchange, is preparing to build a full-scale model of an SIJ at its 144th Street building. It may seem like performance act, but its purpose is educational.

"Our inspiration is the Smithsonian museums, where you can go inside the cockpit of the space shuttle," said Citiwide executive director Robert Cordero. "People have this grisly misconception of what a safe injection site would be like, and we want them to be able to have this Smithsonian experience here in the Bronx."

Such a model could be quite useful in educating elected officials and law enforcement, Cordero said.

"SIJs are a humane public health approach to reducing overdoses, HIV, Hep C, and crime, and can provide compassionate care for addicted people until they are ready to get into treatment," he said. "Do we want that, or do we want them just hanging out in front of the bodegas on 149th all day?"

Citiwide isn't going it alone on agitating for SIJs, and it isn't even taking the lead. Instead it is working with groups like HRC and the Vocals-NY Users' Union in a broader campaign.

"We're not trying to be the HRC or Vocals-NY," said Cordero. "We advocate through demonstrating what it would be like while partnering with others who are advocating every day. Our effort is to build the SIJ model, and when anyone comes to New York who is interested in these issues, there can be an educational moment."

Supervised injection sites are not a reality yet in the US, but pressure for them is mounting. Whether it's New Mexico, New York City, or San Francisco, one of these years someone is going to lead the US into the ranks of nations that understand their utility -- and their humanity. New Mexico has just taken a giant step, but let's hope it has to move fast to beat San Francisco and New York.

Santa Fe, NM
United States

This Week's Corrupt Cops Stories

Cops continue to have problems keeping their hands off the drugs they come across. And they're developing problems with prescription pills, too. Let's get to it:

In Seattle, a South Seattle police officer was arrested January 4 in a sting after colleagues and members of the public complained of his handling of drug evidence. Patrolman Richard Nelson went down after failing an "integrity test," in which an undercover officer posing as someone who found a purse containing cocaine turned it in to him as investigators monitored him. He didn't turn in the drugs and was arrested. He was released from jail early the next morning, and hours later, he shot himself to death in the Cascades foothills.

In Rhine, Georgia, the Rhine police chief was arrested last Thursday on charges he was trafficking in prescription pills. Chief Kip Herman Cravey went down after a joint investigation by the Dodge County Sheriff's Office, the Eastman Police Department, and the Oconee Drug Task Force. He is charged with one count of unlawfully distributing Schedule III narcotics (two dozen Soma tablets) and one count of criminal attempt to purchase Schedule II narcotics (Roxicodone). Additional charges may be filed. No word yet on bail arrangements.

In Piscataway, New Jersey, a former Piscataway police officer pleaded guilty last Thursday to stealing cocaine from the department's evidence vault. Albert Annuzzi, 47, a 22-year veteran of the department, was arrested in April 2011. In court, he admitted he took the cocaine for his own personal use. Under a plea deal with prosecutors, he faces up to three years in prison and must serve two before being eligible for parole. He will also be banned from holding any public job in New Jersey and forfeit his pension. He is free on bond pending sentencing.

In Wolfeboro, New Hampshire, a former Wolfeboro police officer was convicted last Thursday of stealing drugs from the department's evidence room. Roger Martel, 40, was caught stealing 120 oxycodone tablets given to police as part of a prescription drug take-back program. He was charged and convicted on one count of theft by unauthorized taking and one count of controlling a vehicle in which a controlled drug was illegally kept. The eight-year veteran will do only three days in jail after he convinced the judge that he stole the pills because he had developed an addiction to them after being injured on the job. He was sentenced to 12 months behind bars, but the judge deferred all but three days provided Martel follows the court's other orders.

In Buffalo, New York, a former TSA "behavior detection officer" was sentenced January 4 to two years in prison for letting a local drug operation smuggle cash through the Buffalo Niagara International Airport. Minnetta Walker got the maximum sentence allowed after pleading down from her original charges of participating in a continuing criminal enterprise and conspiracy to distribute marijuana.

In St. Ignace, Michigan, a former state prison guard was sentenced last Friday to 10 months in jail for trying to smuggle drugs into the prison. Matthew Bell was busted in September 2011 and later pleaded guilty to possession with intent to deliver less than 50 grams of heroin, possession of less than 25 grams of heroin, and maintaining a drug house. He must also do two years probation.

North Carolina Opium Law Snares Small Prescription Pain Pill Holders

North Carolina's drug laws, which severely punish people who traffic in opiates, are yielding harsh prison sentences for people possessing or trafficking small quantities of prescription pain pills. That is leading to renewed debate in the Tar Heel State about whether the laws are too harsh.

This pill bottle fulls of opiate pain pills could get you 20 years or more in North Carolina. (wikimedia.org)
Under North Carolina's opium law, which was designed to attack heroin trafficking, anyone caught with more than four grams of opium, heroin, or an opium derivative faces a mandatory minimum prison sentence of between six and seven years. But as the Wilmington Star News reported, the four-gram limit means people caught with as few as four Lorcet tablets, five Percocets, or six Vicodin are subject to those draconian punishments.

The sentences increase with the quantities of drugs in question. Having between a half ounce and an ounce of prescription pain pills can earn a seven-to-10-year sentence, while having more than an ounce garners between 19 and 23 years. A single pill bottle full of pain pills could be enough for that latter sentence.

The penalties for opiates are much more severe than for other drugs under the North Carolina law. Trafficking an ounce to 199 grams of amphetamines has a two-year mandatory minimum, while the same quantity of cocaine has a three-year mandatory minimum. When it comes to marijuana, to get the same mandatory minimum as five or six pain pills, one would have to be caught with a ton or more of pot.

While some relatives of pain pill overdose victims have lobbied for harsher penalties, even some North Carolina prosecutors say the punishments are already too extreme.

"You can literally end your life in prison on a handful of pills," said Chris Thomas, an assistant district attorney in Brunswick County. "When the legislature enacted the trafficking law back when they did, I don't think they ever intended it to apply to prescription drugs. That was when heroin was a big problem," he told the Star News. "But it's one of those things that's on the books, and it's a tool that we're going to utilize."

New Hanover County Assistant District Attorney Janet Coleman, who handles drug cases, said many people she has prosecuted for pain pills had no prior criminal record. "None, zero, not even a speeding ticket," she said. "They are otherwise law-abiding citizens who end up in this nightmare."

[Editor's Note: Why prosecute people with those laws then? Prosecutors have the discretion to not do so.]

The issue has gained the attention of state lawmakers, but has so far gone nowhere. A bill in the 2008 legislature would have allowed some some convicted traffickers to get out after serving half their sentence if they lacked a violent criminal history and did not have a firearm when the offense was committed, in addition to meeting other criteria, but it died in committee.

NC
United States

The 2011 National Drug Control Strategy: Drug Policy on Autopilot [FEATURE]

The Office of National Drug Control Policy (ONDCP -- the drug czar's office) Monday released this year's version of the annual guiding federal document on drug policy, the 2011 National Drug Control Strategy, and there's not much new or surprising there. There is a lot of talk about public health, but federal spending priorities remain weighted toward law enforcement despite all the pretty words.

http://stopthedrugwar.com/files/kerlikowske-200px.jpg
Drug Czar Gil Kerlikowske -- captured by the drug war establishment
The strategy identifies three "policy priorities": reducing prescription drug abuse, addressing drugged driving, and increased prevention efforts. It also identifies populations of special interest, including veterans, college students, and women with children.

The strategy promises continued strong law enforcement and interdiction efforts, including going after the opium and heroin trade in Afghanistan and cooperating with Mexican and Central American authorities in the $1.4 billion Plan Merida attack on Mexican drug gangs.

"Drug use affects every sector of society, straining our economy, our healthcare and criminal justice systems, and endangering the futures of our young people," said ONDCP head Gil Kerlikowske in introducing the strategy. "The United States cannot afford to continue paying the devastating toll of illicit drug use and its consequences."

This is all standard stuff. One thing that is new is ONDCP's felt need to fight back against rising momentum to end the drug war, or at least legalize marijuana, and rising acceptance of medical marijuana. The strategy devoted nearly five full pages to argumentation against legalization and medical marijuana.

"Marijuana and other illicit drugs are addictive and unsafe," ONDCP argued in a section titled Facts About Marijuana. "Making matters worse, confusing messages being conveyed by the entertainment industry, media, proponents of 'medical' marijuana, and political campaigns to legalize all marijuana use perpetuate the false notion that marijuana use is harmless and aim to establish commercial access to the drug. This significantly diminishes efforts to keep our young people drug free and hampers the struggle of those recovering from addiction."

Just to be clear, ONDCP went on to say flatly "marijuana use is harmful," although it didn't bother to say how harmful or compared to what, nor did it explain why the best public policy approach to a substance that causes limited harm is to criminalize it and its users.

ONDCP also argued that despite medical marijuana being legal in 16 states and the District of Columbia, "the cannabis (marijuana) plant is not a medicine." Somewhat surprisingly, given that the DEA just days ago held that marijuana has no accepted medical use, the national drug strategy conceded that "there may be medical value for some of the individual components of the cannabis plant," but then fell back on the old "smoking marijuana is an inefficient and harmful method" of taking one's medicine.

"This administration steadfastly opposes drug legalization," the strategy emphasized.  "Legalization runs counter to a public health approach to drug control because it would increase the availability of drugs, reduce their price, undermine prevention activities, hinder recovery support efforts, and pose a significant health and safety risk to all Americans, especially our youth."

It was this section of the strategy that excited the most attention from drug policy reformers. They lined up to lambast its logic.

"It is encouraging that ONDCP felt a need to address both medical marijuana and general legalization of the plant in its 2011 strategy booklet, which was released today," noted Jacob Sullum at the Reason blog. "It is also encouraging that the ONDCP's arguments are so lame… The ONDCP never entertains the possibility that a product could be legal even though it is not harmless. Do the legality of alcohol and tobacco send the message that they are harmless? If you oppose a return to alcohol prohibition, should you be blamed for encouraging kids to drink and making life harder for recovering alcoholics? ONDCP director Gil Kerlikowske may have renounced the use of martial rhetoric to describe the government's anti-drug crusade, but he still manages to imply that reformers are traitors whose 'confusing messages' are undermining morale in the nation's struggle against the existential threat of pot smoking."

"It's sad that the drug czar decided to insert a multi-page rant against legalizing and regulating drugs into the National Drug Control Strategy instead of actually doing his job and shifting limited resources to combat the public health problem of drug abuse," said Neill Franklin, director of Law Enforcement Against Prohibition. "Obama administration officials continually talk about the fact that addiction is a medical problem, but when our budgets are so strained I cannot understand why they're dumping more money into arrests, punishment and prisons than the Bush administration ever did. The fact is, once we legalize and regulate drugs, we will not only allow police to focus on stopping violent crime instead of being distracted by arresting drug users, but we will also be able to put the resources that are saved into funding treatment and prevention programs that actually work. Who ever heard of curing a health problem with handcuffs?"

Some reformers offered a broader critique of the strategy.

"Other than an escalating war of words on marijuana, it's all pretty much the same thing as last year," said Bill Piper, director of national affairs for the Drug Policy Alliance. "There's nothing really new here, except they are a bit more punitive this year," he added, citing the pushback on marijuana, the call for a drugged driving offensive, and a call to encourage workplace drug testing. "Last year, it was more about reform, but this year ONDCP is up to its old tricks again. Whatever window they had to turn over a new leaf is closed; Kerlikowske has been fully captured by the drug war establishment."

The Obama administration could pay a price for its intransigence on drug policy, said Piper.

"They badly underestimate the American people and the drug reform movement, especially on medical marijuana," he said. "It's not just the strategy, but the DEA refusal to reschedule and the Department of Justice memo, too. They are talking about coming out big against medical marijuana, but I think they know there is little they can do. In a sense, this is an act of desperation, a sign that we are winning. First they ignore you…"

The veteran drug reform lobbyist also professed concern about the drugged driving campaign. The strategy sets as a goal a 10% reduction in drugged driving (although it doesn’t even know how prevalent it is) and encourages states to pass zero tolerance per se DUID laws that are bound to ensnare drivers who are not impaired but may have used marijuana in preceding days or weeks.

"We are concerned about getting states to pass those laws," he said. "They are problematic because people can go to jail for what they did a week ago. We're also concerned about the push for employee drug testing."

Piper's overall assessment?

"There's not a lot of new policies there, and that's disappointing," he said. "This is a drug policy on autopilot; it's just a little more aggressive on the marijuana issue."

Washington, DC
United States

Virginia Police Kill Old Man in Pill Raid

[Editor's Note: This year, Drug War Chronicle is trying to track every death directly attributable to drug law enforcement during the year. We can use your help. If you come across a news account of a killing related to drug law enforcement, please send us an email at psmith@drcnet.org.]

Police in Hampton, Virginia, executing a search warrant for prescription pain pills shot and killed a 69-year-old homeowner after he fired on them inside the house. William Cooper becomes the 30th person killed in US domestic law enforcement operations so far this year.

http://www.stopthedrugwar.org/files/hampton-police-badge.jpg
According to the Daily Press Hampton News, police sought a search warrant after a confidential informant told them Cooper had sold methadone, Percocet, and "several other unknown prescription pills" from his home. Police executed the warrant just after 10:00am Saturday, forcing his front door open and entering the residence.

Hampton Police spokesman Jason Price said police identified themselves when they arrived at the house. "We did knock and announce our presence," he said. "It was not a no-knock search warrant."

A common police practice in executing warrants is to announce their presence with loud knocks on the doors and shouts of "Police!" or similar phrases, then wait a matter of seconds before breaking down the door, effectively making them knock and announce raids in technical legal terms only. Neighbors reported the police had forced their way in, and the door was visibly broken.

Price said there was an exchange of gunfire, with Cooper shooting first and the officers firing back. Cooper was pronounced dead at a local hospital an hour later.

Police announced Tuesday
they had seized four prescription pain pill bottles -- three of them empty -- and a number of weapons in the retiree's home. They consisted of one empty bottle of Oxycontin and three bottles of Oxycodone-acetaminophen (Percocet), with one containing pills. They also seized 16 other pill bottles, including ones containing drugs used for treating the symptoms of arthritis, diabetes, and heart disease. Police also seized Cooper's wallet, $903 in cash, and his 2000 Lexus, as well as a vehicle title and "financial documents." They alleged the 11-year-old car was connected to the drug sales.

"We did locate evidence that supports the charge of distribution of illegal narcotics," police spokesman Jason Price said Tuesday. Police did not say whether Cooper had prescriptions for the pain pills.

But friends of Cooper said he used a cane, suffered from knee and back pain, and took lots of pain medications. Cooper complained that the drugs he was taking "weren't enough" for the pain, said Richard Zacharias, 58, a retired NASA employee who was renting a trailer home from Cooper. He also said that Cooper had poor eyesight because of cataracts and often slept late. Those factors might have caused him not to realize it was police in his home at 10:00am, Zacharias said.

But Price said police would continue to identify themselves as they moved through the home. "It's very obvious that we're the police," he said.

"It doesn’t smell right," Zacharias protested. "He wasn't real big, he wasn't real threatening." The police killed Cooper "in his own house, and that doesn't sit right with me," he said. "People around here sleep with a gun beside their bed because of all the home invasions we've had. The guy was a nice guy. The guy was a good guy."

The two so far unnamed police shooters are now on administrative leave with pay pending an investigation. But Hampton Police Chief Charles Jordan Jr. didn't see any need to wait for that. "The investigation thus far supports the actions of the officers," Jordan said Saturday. "They were met with deadly force and had no alternative other than to return fire."

Hampton, VA
United States

Chronicle Book Review: The Power of the Poppy

The Power of the Poppy: Harnessing Nature's Most Dangerous Plant Ally, by Kenaz Filan (2011, Park Street Press, 312 pp, $18.95 PB)

Kenaz Filan thinks that Poppy (always capitalized in the book) is a sentient being. Before you roll your eyes as you recall the fervent mushroom cultists who say the same sort of thing, recall also that more mainstream authors, such as foodie Michael Pollan, have been known to talk like that, too, posing similar questions about what plants want. I'm not personally convinced about the sentience of plants, but I find that adherents of such a position definitely bring something of value to the table: respect for their subjects.

The opium poppy certainly deserves our respect. It can bring miraculous surcease from suffering through the pain-relieving alkaloids within, but those same alkaloids can also bring addiction, oblivion, and death. Our "most dangerous plant ally" can be both kindness and curse, boon and bane. Only by respecting Poppy, writes Filan, can we learn how best to manage our relationship with her.

The Power of the Poppy is part historical treatment, part cultural essay, part pharmacopeia, part practical guide. As such, positions on plant consciousness notwithstanding, it's a fascinating and illuminating treatment of the poppy and its derivatives. Filan traces the history of man's relationship with poppy from 6,000-year-old archeological digs in Europe, through early uses in the Roman empire and the Islamic world, and on to the current era of the war on drugs.

While Filan addresses the war on drugs and finds it stupid, this is not mainly a book about drug policy, and he dismisses the issue in short order. "Our war on drugs has been a one-sided rout," he writes in the introduction. "We keep saying 'no' to drugs, but they refuse to listen."

In his few pages devoted to the past century of opium prohibition, he reiterates the futility of trying to stamp out poppy even as its cultivation spreads. "Poppy is happy to fulfill our needs as long as we propagate her species," he writes. "To her, our 'war' is like locust invasions and droughts -- an annoyance, but hardly something that will endanger the continued existence of her children."

From there, Filan turns to the chemistry and pharmacology of opium and its derivatives and synthetics. He traces the isolation of morphine, codeine, heroin, thebaine (from which is derived hydromorphone [Dilaudid], oxymorphone [Opana], hydrocodone [Vicodin], and oxycodone [Oxycontin]), kompot (East European homebrew heroin), methadone, and fentanyl. Along the way, Filan touches on such topics as the lack of pain-relieving poppy products in the developing world, the development of Oxycontin and the rapid spread of "hillbilly heroin," and controversies over needle exchanges, safe injection sites, and methadone maintenance therapies.

In nearly every case of the development of a new opiate or opioid drug, researchers were hoping to find a substance that maintains poppy's analgesic qualities while eliminating or at least reducing its addictive ones. No such luck. "Despite the best efforts of our chemical minds," Filan writes, "Poppy still demands her bargain…Even as we go to war with Poppy, we are forced to do business with her."

In his next section, demonstrates the bargain poppy extracts as he profiles 11 famous users, including Confessions of an Opium Eater author Thomas de Quincy, Samuel Taylor Coleridge, William Burroughs, Lou Reed (whose Velvet Underground-era Heroin and Waiting for My Man put the 1960s New York junkie experience to music), and DJ Screw, whom I must confess I never heard of until reading The Power of the Poppy. Mr. Screw, whose real name, it turns out, was Robert Earl Davis, was a Houston DJ who rose to hip-hop fame after smoking Mexican weed and accidentally hitting the pitch button as he mixed tapes. The ensuing distorted vocals and slowed down beats became known as "screwed down" and Davis picked up the moniker DJ Screw.

Among the favorite topics of Screw and his crew was "purple drank," a concoction of soda pop, codeine cough syrup, and Jolly Ranchers candy, that created a warm, relaxed high. Screwed down music was the perfect accompaniment for a drank-fueled evening. While DJ Screw died young, in part because of his fondness for drank, he was also an overweight, fried-food loving smoker. While drank may have helped make DJ Screw, as always, poppy exacted her part of the bargain.

In the final segment of the book, Filan gets practical. He describes how to grow your own (from papaver somniferum seeds widely available at gardening stores) and how to extract the raw opium. He describes poppy tea brewing recipes, as well as how to use poppy in pill, tablet, or capsule form; as well as eating smoking, snorting, and shooting it. And he doesn't stint on explaining the dangerous path one is on when one embraces the poppy. Although I don't recall Filan ever using the words harm reduction, he is all about it as he cautions about overdose, dependency, and addiction.

The Power of the Poppy elucidates the many ways the histories of man and poppy are intertwined, and it's full of interesting tidbits along the way. Who knew that the use of "dope" to mean drugs came from Dutch sailors mixing opium and tobacco off China in the 17th Century? They called the mixture "doep," like a greasy stew they ate. Or that calling seedy establishments "dives" derived from scandalized descriptions of California opium dens, with the patrons reclining on divans? Or that the scientific name for snorting is "insufflation"?

If you have an interest in opium and its role in human affairs, The Power of the Poppy will be both entertaining and enlightening. And -- who knows? -- maybe you'll start treating that plant and its derivatives with the respect they deserve.

Most of World Lacks Access to Pain Drugs, UN Agency Says [FEATURE]

More than eight out of 10 of the world's inhabitants have little or no access to opioid pain medications, the International Narcotics Control Board (INCB) said Wednesday. The finding came as the INCB released both its Annual Report 2010 and a special report on the global availability of pain medications.

INCB head Hamid Ghodse (l) briefing reporters in Vienna (incb.org)
People in many countries in Africa, Asia, and parts of the Americas had little or no access to opioid pain medications and psychotropic substances for medical purposes, the INCB found. Opioids include both narcotics, such as morphine and oxycodone, and synthetic opiates, such as fentanyl. Psychotropic medicines include depressants, antidepressants, and antipsychotics.

"Ninety percent of the licit drugs are consumed by 10% of the world's population in the United States, Australia, Canada, New Zealand and some European countries," Hamid Ghodse, the INCB's president, said in a briefing on the release of the reports. "It has to be recognized that the availability of narcotics and psychotropic medicines is indispensable to medical practice," Ghodse told reporters.

The US is by far the world's leading consumer of opioid pain medications. According to INCB figures, for every pain pill consumed per capita in Asia, Africa, or Latin America, 50 are consumed in Europe, and 300 in North America. The US alone, with 5% of the world population, consumed 56% of the world's pain pills. [Editor's Note: This does not mean that US patients who need opioids can always get prescriptions for them.]

The special report on the availability of pain medicines found that while the global supply of raw opium for licit needs is adequate, there are a number of obstacles blocking their availability in large parts of the world. The INCB identified the obstacles in descending order as concerns about addiction, reluctance to stock or prescribe, lack of training of professionals, restrictive laws, administrative problems, cost, distribution problems, lack of supply, and absence of policies around the prescribing of the drugs for pain treatment.

Lack of supply was near the bottom of the list. The INCB said opiate raw materials, including opium, poppy straw, and poppy straw concentrate were sufficient to outstrip consumption. "There is no problem whatsoever with the availability of raw materials," Ghodse said.

Ghodse called on governments to analyze the problem, identify barriers to adequate availability, and take action to reduce or remove them. The report called on governments to collect data on licit drug requirements, legislation, education and training, national drug control systems, and steps to combat misuse.

For the INCB, the flip side of barriers to adequate pain pill access in large swathes of the world is excess availability, which it said can lead to abuse and drug dependence. While the number of single doses of opioid pain medications consumed has increased four-fold in the last 20 years, driven largely by increases in synthetic opioid production, consumption in the US, for example, has increased six-fold. The US now sees more people dying of prescription drug overdoses than from illegal drugs.

morphine consumption by region (incb.org)
"In countries with excessive availability, the non-medical use of pain relievers, tranquillizers, stimulants or sedatives has become the fastest growing drug problem," the report said.

That is a theme repeated from last year's INCB report, when the monitoring body reported that the abuse of prescription drugs was increasingly markedly worldwide. More people were taking prescription drugs for non-medical reasons than were using heroin, cocaine, and ecstasy combined, that report said.

Another major theme for the INCB in this year's report was increasing concern over the emergence of new synthetic drugs, or what it called designer drugs. The INCB said the development of such drugs is escalating so rapidly that governments need to adopt generic bans on new substances.

The report cited 4-methyl-methcathinone, or mephedrone, which has effects similar to cocaine or amphetamines and is being marketed as bath salts under names like Ivory Wave. The drug is currently the cause of ongoing concern in the US, where it has been banned in at least four states, and in Europe, where it has been banned by the European Union.

"Mephedrone has now become a problem drug of abuse in Europe, North America, Southeast Asia and in Australia and New Zealand," the INCB report said. But mephedrone is just "one example of a large number of designer drugs that are being abused."

The European Union, for example, is monitoring 15 other methcathinone analogues alone, while Japan recently placed 51 designer drugs under control. The INCB is recommending generic bans on such substances.

"Given the health risks posed by the abuse of designer drugs, we urge governments to adopt national control measures to prevent the manufacture, trafficking in and abuse of these substances," said Ghodse.

The INCB's schizophrenic report -- increase access to licit opioid pain medications, continue to ban new drugs -- reflects its bifurcated mission. At the same time it is charged with ensuring an adequate supply of medicines to the world, it is also charged with preventing non-medical use and diversion.

Vienna
Austria

Pain Management: FDA to Tighten Regulation of Extended-Release and Patch Opioid Meds

The Food & Drug Administration (FDA) is beginning a "massive new program" to reduce overdoses, diversion, and inappropriate use of powerful opioid pain relievers, especially targeting extended-release and patch formulations of fentanyl, methadone, morphine, oxycodone, and oxymorphone. On Monday, the FDA announced it had sent letters to 16 drug companies who produce the 24 listed products informing them they would now have to create a Risk Evaluation and Management Strategy (REMS) "to ensure that the benefits of the drugs continue to outweigh the risks."

That means physicians are likely to face new procedures in prescribing the drugs, and patients are likely to face more hurdles in obtaining them, an FDA official said at a Monday press conference. But pain patients already face serious obstacles in obtaining relief. The FDA action comes in the context of a campaign by the DEA to crack down on doctors it deems to have improperly prescribed large amounts of opioid pain medication -- even though prescribing what at first glance appear to be extremely large amounts is well with standard pain relief practice. Physician's fears of being prosecuted have contributed to what pain patient advocates describe as a crisis in chronic pain relief.

"Pain patients aren't drug abusers looking for a prescription fix," said Gregory Conko, senior fellow at the Competitive Enterprise Institute, which teamed up with the Pain Relief Network last May to create the Politics of Pain campaign to fight for patients' access to sufficient pain medications. "It's a genuine tragedy that the DEA often treats them and their doctors as if they were. It's as though the agency just doesn't care whether its single-minded waging of the war on drugs imposes collateral damage."

The Politics of Pain campaign has collected personal stories from physicians and patients who have explained firsthand how difficult it can be to either offer or find sufficient treatment for pain conditions. In one video interview, Gulf War veteran James Fernandez and his wife tell their story of how he, once a robustly healthy US Marine, is now virtually confined to his home because of severe, ongoing pain that has been under-treated for years.

In another interview, Dr. Alexander DeLuca, a board-certified specialist in addiction medicine, describes the obstacles faced by a physician trying to deliver the "standard of care" called for by his own medical training. According to DeLuca, virtually no patients in the country today receive proper treatment for chronic pain.

Still, there are a lot of pain pills out there. Last year, US pharmacies dispensed 21 million prescriptions for the 24 medications listed to 3.7 million patients. "This is a very extensively used group of medications," said Dr. John Jenkins, director of the FDA's Office of New Drugs at its Center for Drug Evaluation and Research. "This will be a massive new program."

Jenkins said that abuse, misuse, and accidental overdoses involving those products had been on the rise over the last decade, and the agency is concerned about doctors inappropriately prescribing them for patients who are not suffering moderate or severe chronic pain.

"We continue to see case reports where someone with a sprained ankle receives a fetanyl patch or extended-release opioid," Jenkins said.

Dr. Bob Rappaport, director of FDA's division of anesthesia, analgesia, and rheumatology products, told the press conference the agency was also deeply concerned with the rising non-medical use of the opioids. He cited a Substance Abuse and Mental Health Services Administration (SAMHSA) report released Monday that showed some 5.2 million people said they had used prescription opioids for non-medical purposes in the past month, and that the figure among 18-to-24-year-olds had increased from 4.1% in 2002 to 4.6% in 2007.

"This is an ongoing problem, and it's getting worse," Rappaport said.

Forcing the drug manufacturers to submit REMS plans is "our attempt to ensure the benefits outweigh the risks," Jenkins said. The agency will seek to find an "appropriate balance between legitimate patient need for such drugs and the threats caused by the abuse and misuse," he added.

But tighter regulation isn't going to happen right away; a series of meetings with various stakeholders over the coming months are being set up to arrive at final regulations, said Jenkins. They will include patient advocates, health care professionals, the pharmaceutical companies, and law enforcement. The first meeting with manufacturers is set for March 3. Hopefully the concerns of patient advocates get heeded and successfully addressed, but it's not clear whether that is even possible with a venture of this nature given the current enforcement climate.

Fentanyl timeline: 1950 through today

Location: 
United States
Publication/Source: 
Detroit Free Press (MI)
URL: 
http://www.freep.com/apps/pbcs.dll/article?AID=/20070624/NEWS05/706240567/1007/NEWS

Public Health: DEA Puts Fentanyl OD Death Toll at More Than a Thousand

Last year's wave of overdose deaths from heroin cut with fentanyl, a powerful synthetic opioid pain reliever, killed more than a thousand people, according to the US Drug Enforcement Administration (DEA). The deaths began early in the year in the Mid-Atlantic states before spreading to the Midwest, with significant clusters in Chicago and Detroit.

http://stopthedrugwar.com/files/fentanyl-packet.jpg
fentanyl packet
Early official responses to the wave of deaths was slow and spotty, but concern spread as the death toll mounted. By December, more than 120 public health experts signed an open letter to Health and Human Services Secretary Mike Leavitt calling for a more aggressive response. The deaths have continued, but not at the torrid pace of last fall and summer.

The DEA estimate of the death toll came in an interim rule regulating a fentanyl precursor chemical, N-phenethyl-4-piperidone (NPP), published in
Monday's federal register. "The recent distribution of illicitly manufactured fentanyl has caused an unprecedented outbreak of hundreds of suspected fentanyl-related overdoses, at least 972 confirmed fentanyl-related deaths, and 162 suspected fentanyl-related deaths occurring mostly in Delaware, Illinois, Maryland, Michigan, Missouri, New Jersey, and Pennsylvania," the agency reported.

Noting that fentanyl is 30 to 50 times more powerful than heroin, the DEA went on to warn of its dangers. "The legitimate medical use of fentanyl is for anesthesia and analgesia, but fentanyl's euphoric effects are highly sought after by narcotic addicts," the agency explained. "Fentanyl can serve as a direct pharmacological substitute for heroin in opioid dependent individuals. However, fentanyl is a very dangerous substitute for heroin because the amount that produces a euphoric effect also induces respiratory depression. Furthermore, due to fentanyl's increased potency over heroin, illicit drug dealers have trouble adjusting ("cutting") pure fentanyl into proper dosage concentrations. As a result, unsuspecting heroin users or heroin users who know the substance contains fentanyl have difficulty determining how much to take to get their "high" and mistakenly take a lethal quantity of the fentanyl. Unfortunately, only a slight excess in the amount of fentanyl taken can be, and is often, lethal because the resulting level of respiratory depression is sufficient to cause the user to stop breathing."

The death toll suggests the DEA is not exaggerating in this instance. Let's be careful out there, kids.

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