Overdose Prevention

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Bipartisan Bill to Fight Overdoses Filed in Congress

A bipartisan group of legislators led by Reps. Donna Edwards (D-MD) and Mary Bono Mack (R-CA) last Thursday introduced a bill designed to reduce the number of overdose deaths related to the use of opioid pain medications. Among other measures, the bill seeks to ramp us the use of naloxone, an opioid antagonist that quickly reverses overdoses among heroin and opioid pain reliever users.

naloxone package (wikimedia.org)
The bill, known as the Stop Overdoses Stat Act, did not have a bill number and was not yet available online as of last Thursday afternoon. [Update: It is now online as H.R. 6311.] It would create federal support for overdose prevention, education, and training programs run by cities, states, tribal governments, and community groups.

It is aimed primarily at the rapid increase in fatal prescription opioid overdose deaths that have accompanied the massive increase in opioid pain pill prescriptions over the past decade. Since the late 1990s, roughly the time Oxycontin appeared on the scene, the number of fatal overdose deaths have jumped more than 140%, claiming more than 28,500 lives in 2009 (the latest year data is available). While overdoses from illegal drugs persist as a major public health problem, fatal overdoses from prescribed opioid pain relievers such as oxycodone account for more than 40% of all overdose deaths.

Fatal drug overdoses now exceed the number of deaths from firearms and are second only to car crashes as the leading cause of accidental death. Currently, somebody dies of a drug overdose every 14 minutes in the US.

Despite growing recognition among federal health authorities and lawmakers that overdose prevention programs employ techniques and resources that are highly effective at saving lives at low-cost to taxpayers, few federal dollars are dedicated to supporting these critical programs. A February report from the Centers for Disease Control credits overdose prevention programs with saving more than 10,000 lives since 1996.

"Local health officials and frontline workers engaged in overdose prevention are saving lives every day using straightforward, low-cost interventions. With federal support, we could be saving many more lives and spare countless families from enduring the heart wrenching, yet completely preventable, loss of a loved one," said Grant Smith, federal policy coordinator for the Drug Policy Alliance. "The Drug Policy Alliance applauds Congresswoman Edwards and Congresswoman Bono Mack for introducing this live-saving legislation and showing leadership on this issue in Congress."

"The SOS Act will fight a growing health crisis that is going largely unnoticed in our country," said Edwards. "Approximately 30,000 Americans die each year from drug overdoses, yet the national response to combat this ongoing crisis remains woefully inadequate. It is time that the federal government took on an active role in promoting proven treatments recommended by medical associations. I want to thank Congresswoman Mary Bono Mack for joining me in introducing the SOS Act, and I look forward to working with all my colleagues to pass this bill into law."

Local overdose prevention programs have been successfully implemented in more than 180 locations nationwide, including pioneering statewide programs in Massachusetts, New Mexico, and New York, and in major cities including Baltimore, Boston, Los Angeles, Pittsburg, and San Francisco. Passage of the SOS Act would make federal funds available to support these and similar programs and add new ones.

"As Americans, we rally around efforts to fight breast cancer, childhood diseases and other serious health threats. But for far too long, there have only been hushed whispers about prescription drug abuse -- now the fastest growing drug problem in America. So as the death toll from prescription drug overdoses continues to rise sharply, it's time to move this story from the obituary page to the front page where it belongs," said Bono Mack. "It's time to realize that we can't simply wish this horrific problem away. Not with more than 20,000 people a year dying from it. Not when the number of newborn babies who must be withdrawn from opiate dependence at birth has tripled in the past decade. Not when nearly one out of 4 high school seniors has used prescription painkillers. This is nothing less than a national tragedy. If 20,000 people died each year from food poisoning, Americans would demand immediate action."

The bill currently has two dozen cosponsors.

Washington, DC
United States

Needle Exchange Funding Returns in Senate Appropriations Bill

The Harm Reduction Coalition has reported that language authorizing the use of federal funds for needle exchange programs has been included in the Senate's Fiscal Year 2013 Labor, Health & Human Services appropriations bill. Funding had been approved for FY 2010 and 2011, but the formerly longstanding ban on federal funding was reinstated in December for FY 2012.

The Republican-controlled House of Representatives is expected to once again vote for the ban on needle exchange funding in its version of the appropriations bill. Having funding language in the Senate version will give Senate negotiators something to negotiate on needle exchange when the bills are reconciled, which probably won't happen until after the November elections.

The language approved by the Senate is compromise language that only bans federal funding "in any location that has been determined by the local public health or local law enforcement authorities to be inappropriate for such distribution." The Harm Reduction Coalition calls that language "consistent with what we advocated for" and notes that the same language allowed needle exchanges in 10 jurisdictions and multiple SAMSHA-funded programs to use federal funds.

The Senate appropriations bill also includes some other good harm reduction news. In its non-binding report, it calls for an overdose prevention public awareness campaign. That report does not specifically mention the anti-overdose drug naloxone, which the Coalition had sought, and the Coalition said it would continue to lobby on that issue.

And, like last year, the bill includes $10 million for viral hepatitis screening. The funding announcement for those dollars from last year's bill has now been released and includes $1.6 million for hepatitis C testing and referrals to programs reaching out to injection drug users, including needle exchanges.

The report accompanying the FY 2013 bill also "notes the high incidence of hepatitis among injection drug users and urges SAMHSA to implement viral hepatitis testing as a standard of care in drug-treatment programs, consistent with the HHS Action Plan for the Prevention, Care and Treatment of Viral Hepatitis."

Washington, DC
United States

Marking Mother's Day With Calls for Reform [FEATURE]

On this Mother's Day, more than 100,000 women are behind bars in American prisons, according to the Bureau of Justice Statistics, and many of them are doing time for drug offenses. That's too many, said members of a new coalition, Moms United to End the War on Drugs, as they held events last week in the days running up to Mother's Day.

Gretchen Burns Bergman at the National Press Club (Moms United)
"The war on drugs is really a war on families," said Mom's United's Gretchen Burns Bergman. "It is time to end the stigmatization and criminalization of people who use drugs and move from arrest and mass incarceration to therapeutic, health-oriented strategies. Moms were the driving force in repealing alcohol prohibition and now moms will play a similar role in ending the war on drugs."

Bergman, from San Diego, is the mother of two sons who have struggled with substance abuse and incarceration and is a founder of A New PATH (Parents for Addiction Treatment & Healing). A New PATH has joined forces with other groups, including Law Enforcement Against Prohibition (LEAP), the NORML Women's Alliance, Families to Amend California's Three Strikes, and Students for Sensible Drug Policy to form Moms United to agitate for an end to the drug war and a turn toward sensible, evidence-based drug policies.

The week leading up to Mother's Day was a week of action under the rubric of Cops and Moms Working Together to End Prohibition. The week saw events and press conferences in Atlanta, Boston, New York City, and Washington, DC, in the East and Los Angeles, San Diego, Oakland on the West Coast.

"Mother's Day was derived out of an intensely political effort to organize women on both sides of the Mason-Dixon Line against the Civil War," said Sabrina Fendrick, coordinator for the NORML Women's Alliance. "The reason mothers were made the vehicle was because they were the ones whose children were dying in that war. Women were also largely responsible for ending alcohol prohibition. This is more than just a ‘greeting-card holiday,’ this is the beginning of an institutional change in our society. The government's war on drugs is unacceptable. For our children's sake, the concerned mothers of the world are being called on to demand the implementation of a rational, responsible, reality-based drug and marijuana policy."

Last Wednesday, at a San Diego press conference, the umbrella group unveiled the Moms United to End the War on Drugs Bill of Rights, a 12-point motherhood and drug reform manifesto which calls for "the right to nurture our offspring, and to advocate for their care and safety" and "the parental right to policies and practices that recognize addiction as a disease in need of treatment, rather than a willful behavior to be criminalized," as well as the right to have harm reduction and overdose prevention practices implemented, the right to be free from heavy-handed, constitution-threatening drug war policing, and the right to be free from drug war violence.

Moms United in Los Angeles (Moms United)
"If we stop arresting and incarcerating drug users, think of the number of children who would have the chance to look upon their parents as positive role models instead of having parents who are absent because they are incarcerated," the group said. "We have a moral and ethical obligation to give these children a better chance in life by allowing parents to take care of their families. These parents should have the opportunity to become the productive members of society and role models to their children that they want to be and that their children need and deserve."

The Bill of Rights has been endorsed by a number of religious, reform, and civil rights groups, and individuals can sign onto it, too. To sign on, go to the online petition.

"We are building a movement to stop the stigmatization and criminalization of people who use drugs or are addicted to drugs," the group said. "We urgently call for health-oriented strategies and widespread drug policy reform in order to stop the irresponsible waste of dollars and resources, and the devastating loss of lives and liberty."

It's not just Moms United who is using Mother's Day to strike a blow for drug reform. In Colorado, where Amendment 64 to legalize and regulate marijuana is on the ballot, the Campaign to Regulate Marijuana Like Alcohol is running a television ad featuring a young woman writing an email to her mother in which she explains that she has found her marijuana use to be safer and healthier than the drinking she did in college.

The ad is aimed at a demographic that is both critical to and difficult for the campaign: women in their 30s and 40s, many of whom are mothers. The ad appeared Friday and again on Mother's Day.

"Our goal with the ad is to start a conversation -- and encourage others to start their own conversations -- about marijuana," Betty Aldworth, the advocacy director for the campaign.

And it's not just the United States, either. In mother-honoring Mexico, which marked Mother's Day on Thursday, hundreds of women and other family members traveled to Mexico City on the National March for Dignity to demand that the government locate their loved ones gone missing in the drug wars, according to the Frontera NorteSur news service.

"They took them alive, and alive we want them," the marchers chanted.

While the drug wars in Mexico have claimed at least 50,000 lives, including 49 people whose dismembered bodies were found on a highway outside Monterrey Sunday morning, thousands more have gone missing, either simply vanished or last seen in the hands of armed, uniformed men.

The Mexican government doesn't report on how many have gone missing in its campaign against the cartels, but the Inter-American Human Rights Commission counts more than 5,000 missing persons complaints filed with police -- and this in a country where many people so mistrust the police they don't bother to file official reports.

"For some it has been years, for others months or days, of walking alone, of clamoring in the desert of the hallways of indolent and irresponsible authorities, many of them directly responsible for disappearances or complicit with those who took our loved ones away," the mothers' group said.

On Mother's Day, many mothers in Mexico have "nothing to celebrate," said Norma Ledezma, cofounder of Justice for Our Daughters in Chihuahua City. "As families, we want to take this occasion to tell society not to forget that in Mexico there is home with a plate and a seat empty."

"We have walked alone in the middle of stares and stigmatizing commentaries, and we have been treated like lepers, marginalized and condemned to the worst pain a human being could live: not knowing the whereabouts of our sons and daughters," the new mother's movement declared. "But now we are not alone. We have found hundreds of mothers and we unite our clamor and our love to recover our loved ones and bring them home."

On Mother's Day, the agony of the drug war transcends borders. And the call from mothers for a more sane and human alternative continues to grow, from Chihuahua to Chicago and from Oaxaca to Washington.

UN Anti-Drug Body Supports Overdose Prevention Measures

Delegates to the 55th session of the UN Commission on Narcotics Drugs (CND) in Vienna unanimously approved a resolution to promote measures to prevent drug overdose deaths last Friday. The resolution calls on the UN Office on Drugs and Crime (UNODC), the World Health Organization (WHO), and other international organizations to work with individual countries to address and reduce drug overdoses. Crucially, the resolution included mention of naloxone, an opioid antagonist that can effectively reverse opiate overdoses and which does not carry any danger of abuse.

Naloxone can save lives, the CND recognized Friday (wikimedia.org)
The resolution was introduced by the Czech Republic and cosponsored by Israel and Denmark (the latter on behalf of the European Union). Earlier in the week, Gil Kerlikowske, head of the US Office on National Drug Control Policy (ONDCP -- the drug czar's office) affirmed US support for overdose prevention. In his opening statement at the week-long session, Kerlikowske endorsed training public health and medical personnel in overdose recognition and response, as well as the use of naloxone and other overdose reversal medications.

"Every life is worth saving," said Dasha Ocheret, policy and advocacy program manager for the Eurasian Harm Reduction Network. "Everyone knows someone who has died from an overdose. It's thrilling that the United Nations recognizes this is a problem to be taken seriously and something can be done."

"This represents a critical step towards improving global public health," said Donald McPherson, director of the Canadian Drug Policy Coalition and former drug policy coordinator for the city of Vancouver. "The global overdose epidemic can be addressed with meaningful, evidence-based interventions to reduce the immediate potential harms associated with opioid use, and prevent unnecessary death. It is heartening to witness CND member countries take this step together to save lives."

The biggest risk of fatal overdose is around opiates and opioid pain medications. According to the UNODC, "the ingestion of opioids accounts for nearly half of the global drug-related deaths, and the majority of deaths could have been prevented." The UNODC puts the number of user of opium derivatives, both medical and non-medical, at around 21 million worldwide.

Opioid overdose deaths are generally preventable for three reasons: The deaths occur gradually after drug use, there are typically other people present, and the effects of overdose can be reversed with naloxone, also known under its brand name, Narcan.

In some countries, including some states in the US, there are ongoing programs to offer naloxone to drug users, their friends, and family members. Last fall, Massachusetts announced its 1,000th overdose reversal using naloxone. New Mexico has also been a pioneer in expanding the use of naloxone.

"Naloxone is a safe and effective medication that has been available for more than forty years," said Sharon Stancliff of the New York City-based Harm Reduction Coalition. "It's exciting that the UN has officially recognized the importance of making this life-saving medication more widely available. It is vital that it is made accessible to people who need it, both inside the hospital setting and outside, through emergency services and to family members of opioid users."

Vienna
Austria

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.org/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

San Francisco Marks 600th Overdose Death Prevented

For the past eight years, the San Francisco Department of Public Health has been handing out the opioid antagonist naloxone (Narcan) in a bid to reduce heroin overdose deaths. This week, the city marked what it said was the 600th life saved by using the overdose-reversal drug.

This drug stops heroin overdoses -- 600 so far in San Francisco (wikimedia.org)
The city distributes naloxone through needle-exchange sites, nonprofit organizations, and community organizations that deal with injection drug users. The department also prescribes the drug to people in residential hotels and the friends and families of heroin users, and conducts training sessions in the county jail.

Not only have hundreds of overdose deaths been averted, but the department also reported that heroin-related visits to the city's emergency rooms had declined by half between 2004 and 2009.

The lifesaving measure is funded by a department expenditure of $73,000 a year, which goes to the Oakland-based Drug Overdose and Prevention Education Project (DOPE Project). DOPE uses the money to buy and distribute the drug and train people on how to use it.

"San Francisco has always been a heroin town," Alice Gleghorn, DPH's head of Community Behavioral Health Services told the SF Weekly. "At one time, San Francisco had an overdose death every day, and that rate has really gone down. I hope our naloxone programs have contributed to that drop. But we don't have the money to do the research."

Eliza Wheeler, director of the DOPE Project, compared naloxone to insulin and said its use posed few problems for injection drug users. "The folks we see are pretty adept with administering drugs, so they'll be okay. People are very capable and willing to save their friends' lives... my experience is that people are really proud of themselves," Wheeler said.

Harm reduction is saving lives in San Francisco. Perhaps other cities and counties should take heed.

San Francisco, CA
United States

Canada Supreme Court Okays Safe Injection Site [FEATURE]

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

Vancouver's safe injection site wins a reprieve. (Image: Vancouver Coastal Health)
The Downtown Eastside, centered on the intersection of Main and Hasting, streets, has one of the highest concentrations of injection drug users in the world. An overgrown Skid Row flush with prostitution and destitution, most of its residents live in decaying SRO hotels lining Main Street. Out of 12,000 residents in the area, some 5,000 are estimated to be drug addicts.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Vancouver, BC
Canada

Massachusetts Marks 1,000th Narcan Overdose Reversal

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

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

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

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

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

Boston, MA
United States

Cuomo Signs NY Good Samaritan Drug Overdose Bill

New York Gov. Andrew Cuomo June signed into law July 20 legislation aimed at reducing the number of preventable drug overdose deaths in the Empire State. The new law gives protection from prosecution for drug possession offenses to overdose victims seeking medical help or to people seeking medical help for them.

Gov. Andrew Cuomo (D) has signed a bill designed to reduce drug overdose fatalities. (image via wikimedia.org)
The new law also provides protection from underage drinking and drug paraphernalia prosecutions for overdose sufferers or others seeking to help them. The law does not provide protection from drug distribution charges.

New York now becomes the most populous state to enact what are commonly referred to as 911 Good Samaritan laws. They are designed to reduce overdose deaths by removing the fear of prosecution for victims or their acquaintances seeking help.

New York is one of the states where drug overdose -- from both legal and illegal drugs -- is the leading cause of accidental death. In the absence of protections like those just enacted, people suffering overdoses or their friends have often been reluctant to seek medical attention for fear of being arrested.

"No one should go to jail for trying to save a life," said Hiawatha Collins, a leader and Board member of VOCAL-NY, one of the many groups that supported the reforms. "This law will help make sure that calling 911 is the first thing someone does if they witness an overdose -- not worry about what the cops will do. New York is making clear that saving lives needs to be our priority, not locking people up."

"It is uplifting to see our elected officials come together to pass a law that will save thousands of lives in New York," said Evan Goldstein, policy coordinator of the Drug Policy Alliance. "Our elected officials should be applauded for passing this law that is grounded in science, compassion, health and human rights."

New York is the fourth state to enact a 911 Good Samaritan law, following the lead of New Mexico in 2007, Washington state in 2010, and Connecticut earlier this year. The law will go into effect in 60 days.

Albany, NY
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.

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