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Southeast Asia: DEA Bringing Drug War Tactics to Vietnam

DEA agents are in Vietnam this month to train Vietnamese anti-drug officers how to conduct drug raids American-style, but local UN officials say you can't police your way out of a drug problem. Still, that's not stopping the American drug warriors from teaching door-kicking-in and other skills they consider necessary for their paramilitarized approach to drug law enforcement.

According to a report from Voice of America radio, DEA agents like Joe Boix, the agency's head firearms and tactical instructor in the state of Arizona, are showing the Vietnamese how it's done back home. As Boix watched, a column of masked Vietnamese police practiced raiding a drug den.

"Someone needs to be on that side of the door," said Agent Boix. The agents kicked in the door and enter the room. "Protect your back. Turn around now," continued Boix.

"The drug problem is an international problem, and it's killing children, and it's killing families, and it's all the same no matter where you go," Boix told VOA.

Although Vietnam is not a drug producer, it has seen rising levels of heroin addiction since it opened itself to foreign trade two decades ago. Amphetamines and ecstasy are also popular. But the DEA isn't particularly concerned about drug use in Vietnam; rather, it wants to crack down on the use of the country as a transshipment point in the global drug trade.

"Our main thrust is to go after the international organizations. We'll help them out. That's what this training is for, to help them deal with their internal problem. But we want to go after the bigger organizations, the large ones, international in scope," said Jeff Wanner, the DEA officer at the US Embassy in Hanoi.

While training exercises like the one now on-going may help increase cooperation between US and Vietnamese law enforcement, it is unlikely to reduce drug use rates in Vietnam, and may even exacerbate problems related to drug abuse, said Jason Eligh, a harm reduction specialist at the UN Office on Drugs and Crime Hanoi office.

"If police enforcement is extremely strong, extremely rigid, concerned about stopping all things related to drugs, imprisoning people, imposing strict fines, that's going to cause heroin users to flee from authority, Eligh told VOA. "In Vietnam, drug use is classified as a social evil and as a crime. Where there's strong enforcement, you're seeing drug users not want to engage in services," he said.

When tough law enforcement drives drug users underground, the result can be higher rates of HIV infection, Eligh said. Nor was he particularly enamored of the current Vietnamese approach to drug users, which is to intern them in mandatory rehabilitation camps, generally for two years, but sometimes for as long as five years, but then offers few services once drug users go back home.

"There are a number of better ways of dealing with drug dependence, and this is not one of them. Certainly methadone is by far the best approach to heroin dependence that we have in the world today," said Eligh.

Vietnam recently began implementing its first methadone maintenance programs. That's a more progressive and humane approach than either the rehab camps or American-style drug raids.

Feature: Feds Score Another Conviction Against a California Medical Marijuana Dispensary Operator

In a trial that garnered national attention because of the conflict between state and federal marijuana laws, a federal jury in Los Angeles Tuesday convicted the owner of a Morro Bay medical marijuana dispensary on five counts of violating federal drug laws. As was the case in previous federal prosecutions, the defense was not allowed to mount a medical marijuana defense or even mention the words "medical marijuana" during the course of the trial.

http://www.stopthedrugwar.org/files/charlielynch.gif
Charlie Lynch (from friendsofccl.com)
Charles Lynch, 46, operator of Central Coast Compassionate Caregivers in San Luis Obispo County, faces a minimum of five years in prison and as many as 85 years after being found guilty of distributing more than 100 kilograms of marijuana, some of to people considered minors under federal law.

Federal prosecutors portrayed Lynch as a mercenary drug dealer, toting around backpacks full of cash and selling dope to minors. One minor, Owen Beck, actually took the stand in Lynch's defense. Beck suffers from bone cancer, and accompanied by his parents, he would visit the dispensary to purchase medical marijuana recommended to him by his Stanford University oncologist. But as soon as Beck mentioned that he was ill, Federal District Court Judge George Wu blocked his testimony.

In an interview with the Los Angeles Times after reaching a verdict, jury forewoman Kitty Meese said jurors understood Lynch was no run-of-the-mill drug dealer, but that federal law made no provision for dispensary operators. "We all felt Mr. Lynch intended well," Meese said. "But under the parameters we were given for the federal law, we didn't have a choice." She added, "it was a tough decision for all of us because the state law and the federal law are at odds."

Lynch had run the dispensary in compliance with state law and with the blessing of local officials in Morro Bay, but after a fruitless, year-long investigation by San Luis Obispo County Sheriff Pat Hedges failed to find any violations of state law, the sheriff invited the DEA to come and raid the dispensary. The DEA did just that last year, and a few months later a federal grand jury indicted him.

Lynch is only the latest of at least six dispensary operators convicted under the federal drug laws, and his dispensary is but one of the dozens raided by the DEA in the last couple of years. With federal juries blocked from hearing about or considering the state's medical marijuana laws by federal judges in those cases, convictions are all but a foregone conclusion.

"This just goes to show the difficulty of getting a fair trial on this in federal court," said Dale Gieringer, head of California NORML. "The feds are batting a thousand when it comes to getting convictions in these cases. You cannot get a fair hearing."

"Charley got steamrolled by the federal government," said San Luis Obispo attorney Lou Koory, who represented Lynch in his dealings with local officials. "It's just not a fair fight when you can't tell the whole story," he said.

"The jury selection process revealed that potential jurors in Los Angeles had major questions about why the feds would be prosecuting someone like Charley when there are several dispensaries operating within walking distance of the courthouse there," Koory pointed out. "Those jurors were dismissed for cause, so we were left with citizens who were apparently not concerned about the federal government's actions in this case and who felt compelled to follow the judge's instructions."

"When you have things like Owen Beck being prevented from testifying, that only escalates the tragedy of this case," said Kris Hermes, spokesman for the medical marijuana defense group Americans for Safe Access. "The jury was not allowed to hear the whole truth in the larger context of the state law," he said.

Hermes was quick to point out that Lynch was not the only victim of the DEA and its local law enforcement collaborators. "When Charles was raided, his was one of the only facilities in the whole region," said Hermes. "Now patients have to go much longer distances, sometimes hundreds of miles, to get their medicine. Not only has this destroyed Charlie's life, it has worsened the lives of hundreds of patients."

With the deck stacked against dispensary operators in these federal prosecutions, activists and advocates are looking for ways to change the status quo. Some involve fighting back against recalcitrant law enforcement officials like Sheriff Hedges, others looks to greater help from state officials, while still others are turning a jaundiced eye on the federal marijuana laws.

At least one of Lynch's patients has filed suit against Hedges, alleging that he violated patients' privacy protections by seizing patient records and violated both her state and federal constitutional rights by doing an end run around state law.

"The sheriff couldn't get a state search warrant, so he calls in the DEA and participates in the raid," said Koory. "In return for serving up Charley on a silver platter, the sheriff got access to all the evidence, including patient records," he explained. "The dispensary was a rock in the sheriff's shoe, so after a year's worth of failed investigation, Sheriff Hedges invited the DEA to come up to Morro Bay and raid the dispensary. That's the real story here."

While the idea of suing sheriffs sounds appealing, it's a long-shot, said Hermes. "They are certainly subject to litigation if someone wants to file a lawsuit against a local official for cooperating with the federal government, but it's a difficult legal challenge," he said. "There is no law that prohibits local law enforcement from cooperating with the feds. What officials like the sheriff are doing is wrongheaded, harmful, and unnecessary, but it will be difficult to win, I think."

In the meantime, said Hermes, there are other avenues to pursue in reining in renegade local officials. "One thing would be to get a pronouncement from Attorney General Jerry Brown directing law enforcement on appropriate conduct around these issues. We're expecting that to happen soon," he said. "Absence of direction from the attorney general has made it easier not only for federal law enforcement to come in and undermine the implementation of state law, but also to make it easier for local law enforcement to help in that effort."

Hermes said that recent state court decisions, including last week's slap-down of San Diego County's challenge to the law (see related story this issue) are also helping define the playing field. "We've had multiple appellate court rulings declaring the state's medical marijuana law is not preempted by federal law, that the two can coexist, and that local law enforcement should be upholding state law and not federal law," he said. "Between these rulings and the pending guidelines from the attorney general, there will be less and less wiggle room for local law enforcement to skirt the law."

There is also the ballot box. Sheriffs are elected officials, and they could be challenged at the voting booth over their medical marijuana misbehavior, but ASA's Hermes couldn't recall a case where someone was either defeated or elected over the issue. "It is certainly an issue to bring up in sheriffs' races," he said. "If there are renegade law enforcement officials trying to skirt state law, we can try to make them feel the political heat."

Still, Hermes predicted that given the state court rulings, the pending guidelines from the attorney general, and new set of faces in Washington next year, the renegade law enforcement problem will probably recede. "If it continues to happen," he said, "there will be a political battle I think public officials will be sorry they got into. I think we will see less and less cooperation between local law enforcement and the feds on this."

A new administration in Washington could make a huge difference, Hermes said. "If we elect Obama, and he follows through on his promise to end federal raids on dispensaries, then we will hopefully see less federal activity here in California."

But the ultimate solution is changing the federal law around marijuana. Legalization, decriminalization, rescheduling marijuana out of Schedule 1, or even passage of the Hinchey-Rohrabacher amendment, which would cut off funds for federal raids in medical marijuana states, are some of the steps that could be taken.

"We need to see either marijuana rescheduled as something other than Schedule 1, or the US Supreme Court's Raich decision needs to be revisited and overruled. The logic behind that decision -- that medical marijuana grown, distributed, and consumed within California affects interstate commerce -- is a stretch at best," said Koory.

"What we need is a comprehensive federal policy in the US," said Hermes. "Rescheduling or passing Hinchey would be easier than passing either decriminalization or legalization, but we would welcome any of those. We'll be working for a sweeping federal policy that includes rescheduling, further research, and allows for safe access to medical marijuana for patients all across the country."

Until the federal marijuana laws are reformed or eliminated, medical marijuana patients are not safe. Instead, they will be subject to the whims and political proclivities of whoever has hold of the levers of power in Washington.

Click here to watch Drew Carey's video about Charlie Lynch, on Reason TV.

Don't let Congress get away with it

 

Tell Congress to Stand Up for Students


Tell your representative and senators that you are tired of the same old "Drug War" politics.
http://www.ssdp.org/speakup/

 

Dear friends,

Congress failed us.

Despite a decade-long campaign by Students for Sensible Drug Policy, supporters like you, and a large and powerful coalition of more than 500 prominent organizations, Congress finally reauthorized the Higher Education Act (HEA) last week but chose to ignore our demands that they overturn the provision that strips financial aid from college students with drug convictions.

How come?

Outrageously, staffers on Capitol Hill are telling us that some members of Congress were terrified of facing negative attack ads calling them "pro-drug" if they voted for a bill reinstating aid to students with drug convictions.

Even as Congress was debating the HEA bill last week, Rep. Mark Souder (R-IN), the author and chief proponent of the aid penalty claimed on the House floor that his precious provision "has been much aligned [sic] by ***pro-drug groups*** around the country."

So you can see that one of the major roadblocks to reform is the false conventional wisdom that voters will punish politicians who do the right thing by repealing harmful and ineffective drug laws. 

It's up to reformers like you and me to smash this false conventional wisdom by standing up and showing politicians that they will actually win votes for doing the right thing (and that, conversely, we may punish them at the polls for letting their unfounded fears stand in the way of progress).  After all, it is this anti-education penalty itself that causes more drug abuse, right?

So no matter how many times you have taken action on this issue in the past, please take just one minute to edit and send a pre-written letter to your representative and two senators demanding that Congress stop letting senseless political fears keep deserving and hardworking students out of school.

Click here right now to take action. http://www.ssdp.org/speakup/

And please make sure you forward us any responses you get from your legislators so we can track who is standing in the way of change.  Send those important responses to letters@ssdp.org when you get them.

Despite this setback, SSDP and our coalition allies are as determined as ever to see this senseless penalty repealed.  We are already planning our strategy for the next Congress and presidential administration, and remain optimistic that despite the barriers we have yet to overcome, we will ultimately restore financial aid to the more than 200,000 students impacted by this penalty.  In the meantime, members of Congress need to continue to hear an unwavering message from constituents that the public will not stand idly by as our elected officials continue to deny access to education in the name of the so-called "War on Drugs."

If we don't speak up and demand change when legislators need to hear it most, who will?  Please take action today. http://www.ssdp.org/speakup/

Thanks for all that you do,
Tom Angell
SSDP Government Relations Director

P.S. If you'd like to see SSDP continue to work on this and other issues, let us know by making a donation today. http://www.ssdp.org/donate

P.P.S. If you are a student wishing to get involved in fighting back against Drug War attacks on youth, contact us about starting an SSDP chapter: http://www.ssdp.org/chapters/start

Congress to skip vote on medical marijuana this year

[Courtesy of Marijuana Policy Project] 

Dear friends:

Congress has recessed for the summer without voting on the medical marijuana amendment that Congressmen Maurice Hinchey (D-N.Y.) and Dana Rohrabacher (R-Calif.) offer every summer. Unfortunately, this means the amendment will not come up for a vote this year — the first year since 2002.

If passed, the amendment would have prevented the Justice Department — which includes the DEA — from interfering with the medical marijuana laws on the books in 12 states.

Congress decided that rather than considering the Justice Department's annual spending bill, which contains thousands of funding requests and issue-oriented amendments, Congress will instead simply vote to allow this year's funding levels to carry over until next year.   

However, there are two other pieces of legislation in Congress that your U.S. House member needs to hear from you about:

1. The Medical Marijuana Patient Protection Act of 2008 (H.R. 5842) would give states greater authority to determine their own medical marijuana policies.

2. The Personal Use of Marijuana By Responsible Adults Act of 2008 (H.R. 5843) would remove federal penalties for possessing up to 3.5 ounces of marijuana.

Would you please take one minute to visit MPP's online action center and ask your U.S. House member to co-sponsor these two bills?

Meanwhile, we're also gearing up for the changed — and more favorable — political climate that we can expect from a new presidential administration and Congress next year. You'll be hearing more from us about our plans for 2009 in the coming months.

As always, thank you for your support.

Sincerely,
Kampia signature (e-mail sized)

Rob Kampia
Executive Director
Marijuana Policy Project
Washington, D.C.

P.S. As I've mentioned in previous alerts, a major philanthropist has committed to match the first $3.0 million that MPP can raise from the rest of the planet in 2008. This means that your donation today will be doubled.

Location: 
Washington, DC
United States

A Life and Death Issue

You Can Make a Difference

Dear friends,

Several months ago my colleague Naomi Long and I had an op-ed in The Washington Post calling for a repeal of the federal prohibition that blocks states from using their share of HIV/AIDS prevention money on syringe exchange programs. We had a hard-hitting conclusion: “As many as 300,000 Americans could contract HIV/AIDS or hepatitis C over the next decade because of a lack of access to sterile syringes. This essentially makes the national syringe ban a death sentence for drug users, their partners and children.”

Take action now to support a bill in Congress that would repeal the ban.

Last year my colleague Jasmine Tyler lost her father to HIV/AIDS that he contracted from injection drug use and it really hit our D.C. office hard. She had this to share: “From the time he found out he was HIV-positive until the day he died in April of 2007, he suffered greatly and so did our family.  Every day I know that the hell he lived through could have been avoided if only he had had access to sterile needles all the time.  It’s too late to bring him back, but every other life that can be saved should be.”

While our country spends billions of dollars on efforts to prevent the spread of HIV/AIDS, hepatitis C and other infectious diseases, the U.S. prohibits the use of prevention funds to support syringe exchange programs. This robs cities, states and private organizations of the right to do what’s best for the people, and costs taxpayers a lot of money. It’s far cheaper to distribute syringes and prevent the spread of HIV/AIDS and hepatitis than it is to treat people who contract those infectious diseases after it's too late.

Last year, District of Columbia Congressional Delegate Eleanor Holmes Norton and New York Congressman Jose Serrano successfully repealed a federal ban that prohibited D.C. from spending its own budget money on syringe exchange programs. This week Rep. Serrano introduced a bill that would repeal the national syringe funding ban. If enacted, it could save hundreds of thousands of lives and millions in taxpayer dollars. Please urge your representative to support this urgent, life-saving bill.

Take action now.

Want to do more? Set up a meeting with your representative when he or she is in your district during Congress's August recess. Learn how.

Sincerely,

Bill Piper
Director of National Affairs
Drug Policy Alliance

More Information

--According to the Centers for Disease Control and Prevention (CDC), of the 415,193 people reported to be living with AIDS in the United States at the end of 2004, about 30 percent of cases are related to injection drug use, either directly (sharing contaminated syringes) or indirectly (having sex with someone who used a contaminated syringe or being born to a mother who used a contaminated syringe).

--Each year, approximately 12,000 Americans contract HIV/AIDS directly or indirectly from the sharing of dirty syringes. About 17,000 people contract hepatitis C.
 
--The Centers for Disease Control and Prevention (CDC), American Medical Association, National Academy of Sciences, American Public Health Association, and numerous other scientific bodies have found that syringe exchange programs are highly effective at preventing the spread of HIV/AIDS and other infectious diseases. Moreover, seven federal reports have found that increasing access to sterile syringes saves lives without increasing drug use.

--Increasing the availability of sterile syringes through exchange programs, pharmacies and other outlets reduces unsafe injection practices such as syringe sharing, curtails transmission of HIV/AIDS and hepatitis, increases safe disposal of used syringes, and helps injection drug users obtain drug education and treatment.

--The lifetime cost of treating just one person who contracts HIV/AIDS can be as high as $600,000. This cost is often borne by taxpayers. In contrast, syringe exchange programs can prevent thousands of new HIV/AIDS cases at very little cost. Funding syringe exchange programs saves both lives and taxpayer money.

--A federal appropriations rider in the annual Labor, Health and Human Services, Education, and Related Agencies spending bill prohibits states from spending their share of federal prevention money on syringe exchange programs. H.R. 6680 would repeal that provision.

Location: 
Washington, DC
United States

Marijuana decriminalization bill gaining support in Congress

[Courtesy of Marijuana Policy Project] 

Dear friends:

Here's a photo of MPP's Rob Kampia and Congressman Barney Frank (D-Mass.) at a news conference yesterday, where we announced the growing support for his bill to decriminalize marijuana possession on the federal level.

Barney Frank and Rob Kampia 7/30/2008

The event was covered by CNN, The Politico, The San Francisco Chronicle, Roll Call, Reason, Denver Daily News, and many other news outlets. You can see some of the coverage here, and you can see our video of the event here.

We haven't even made a push for co-sponsors yet, but members of Congress keep coming forward to attach their names to the bill:

Tammy Baldwin (D-Wisc.)
Earl Blumenauer (D-Ore.)
William Lacy Clay (D-Mo.)
Barbara Lee (D-Calif.)
Zoe Lofgren (D-Calif.)
Jim McDermott (D-Wash.)
Ron Paul (R-Texas)

Imagine what would happen if everyone reading this e-mail alert were to send a letter to his or her U.S. House member asking him or her to co-sponsor the bill too. You can send that letter in about 60 seconds right here.

The “Personal Use of Marijuana By Responsible Adults Act” would eliminate all federal penalties for possession of less than 100 grams of marijuana and the not-for-profit transfer of 1 ounce or less.

Please visit MPP's online action center today and ask your U.S. House member to co-sponsor this legislation.  

Thank you,
Aaron signature
Aaron Houston
Director of Government Relations
Marijuana Policy Project
Washington, D.C.

P.S. If you'd like to read Rob Kampia's written remarks presented at the press conference, you can read them here.

Location: 
Washington, DC
United States

Feature: Federal Marijuana Decriminalization Bill Has Its Coming Out Party

For the first time in decades, a marijuana decriminalization bill is before the Congress. Actually introduced by Rep. Barney Frank (D-MA) in April, the Act to Remove Federal Penalties for the Personal Use of Marijuana by Responsible Adults (H.R. 5843) got its coming out party Wednesday as Frank, a handful of other representatives, and leaders of prominent drug reform organizations held a Capitol Hill press conference to push for the bill.

In the eyes of many, the bill couldn't come soon enough. Since 1965, more than 20 million Americans have been arrested on marijuana charges, 830,000 in 2006. Of those, nearly 90% were for simple possession. In addition to the jail time and other costs imposed on offenders, marijuana law enforcement costs society more than $7 billion a year.

While passage of a federal decriminalization bill would have little direct impact -- only 160 people were charged with federal marijuana possession offenses last year -- its symbolic impact could help break the marijuana law reform log-jam that has endured since the days of the hippies.

Here is the text of the bill in its entirety:

"Notwithstanding any other provision of law, no penalty may be imposed under an Act of Congress for the possession of marijuana for personal use, or for the not-for-profit transfer between adults of marijuana for personal use. For the purposes of this section, possession of 100 grams or less of marijuana shall be presumed to be for personal use, as shall the not-for-profit transfer of one ounce or less of marijuana, except that the civil penalty provided in section 405 of the Controlled Substances Act (21 U.S.C. 844a) may be imposed for the public use of marijuana if the amount of the penalty does not exceed $100."

http://www.stopthedrugwar.org/files/frankpressconf.jpg
Reps. Lee, Frank and Clay at press conference (courtesy Drug Policy Alliance)
Frank and other advocates conceded the bill has no chance of passage this year, but lauded it as a long overdue beginning. Hearings could come next year, they said.

The federal government should stop arresting marijuana users, Frank said as he stood before the microphones flanked by Congressional Black Caucus members Reps. Lacy Clay (D-MO) and Barbara Lee (D-CA), and advocates Allen St. Pierre, executive director of NORML; Rob Kampia, executive director of the Marijuana Policy Project, and Bill Piper, national affairs director of the Drug Policy Alliance.

Existing laws aimed at marijuana users punish otherwise law-abiding citizens and sick people whose doctors have recommended the drug, disproportionately impact African-Americans, and waste law enforcement resources, Frank said. They also amount to an unwarranted intrusion into the private lives of Americans, he said.

"There is absolutely nothing wrong with the responsible use of marijuana by adults and this should be of no interest or concern to the government," said NORML's St. Pierre. "In fact, the vast majority of marijuana smokers are adults who cause no harm to themselves or to anyone else, so there is no reason for the state to be involved."

Marijuana use should be treated like alcohol use, St. Pierre continued. "With alcohol we acknowledge the distinction between use and abuse, and we focus our law enforcement involvement on efforts to stop irresponsible use. We do not arrest or jail responsible alcohol drinkers. That should be our policy with marijuana as well," he said, noting that there were more than 11 million marijuana arrests since 1990.

Reps. Clay and Lee both emphasized the inordinate number of arrests of minority pot smokers. The application of the marijuana laws unfairly targets blacks, said Clay.

Clay called marijuana prohibition part of "a phony war on drugs that is filling up our prisons, especially with people of color." It is time for a "practical, common sense approach" instead, he said.

Lee also noted the disproportionate impact of marijuana law enforcement on the minority community, but as a representative of a state where medical marijuana is legal also singled out another group that suffers under the law. "This bill is about compassion," she said. "The federal government has better things to do than send sick people to jail."

MPP's Kampia noted that marijuana arrests outnumber arrests for "all violent crimes combined," and suggested that law enforcement concentrate less on pursuing nonviolent marijuana offenders. "Ending arrests is the key to marijuana policy reform," he said. "It is important to eliminate the threat of arrest. For the many marijuana users who aren't arrested, they still live in fear of arrest."

Marijuana prohibition is "one of the most destructive criminal justice policies in America today," said DPA's Piper, noting that in addition to arrest and possible imprisonment, marijuana users face the loss of jobs, financial aid for college, federal benefits, and access to low-cost public housing.

Even while conceding the bill has virtually zero chance of passing this year, earlier in the week Piper said you have to start somewhere. "The goal is to raise the issue and have something that advocates can organize around," he said. "But just having this bill introduced is groundbreaking in itself."

It could also rub off at state houses across the land, Piper said. "This will encourage state lawmakers to introduce similar bills. This is also something we can now turn around and use to lobby with at state houses," he said.

"There's a growing sentiment in Congress that the prisons are overcrowded," said MPP spokesman Dan Bernath. "I think we are at or near a tipping point, and this bill is a good way to start chipping away at our marijuana laws," he said. "This will set the stage for sensible marijuana reforms at the state and local level, as well as more meaningful federal reforms in the future."

If reformers see little likelihood of anything happening this year, the federal government's anti-drug bureaucrats were taking no chances. Crashing the gate at the press conference were Office of National Drug Control Policy (ONDCP) chief scientist Dr. David Murray and two aides. They came carrying glossy ONDCP propaganda and hoping to immediately rebut any claims by reformers, but both press corps and event participants seemed more bemused by their appearance than interested in what they had to say.

Feature: Prescription Drug "Fatal Medical Errors" Rising Dramatically -- What Does It Mean?

A study released this week charted a startling increase in deaths from "fatal medical errors," particularly those associated with people mixing street drugs and alcohol with prescription medications at home. In this context, "fatal medical error" refers to people dying from taking prescribed medications, usually opioids, but also including other drugs, such as benzodiazepines (Valium, for example).

http://www.stopthedrugwar.org/files/oxycontin.jpg
the pain reliever Oxycontin
But while the numbers have some in the medical community calling for tighter restrictions on prescribing, they have some in the pain relief community worrying about just that possibility. And they're leaving other interested observers wondering just how accurate they are, what they mean, and just who is dying.

According to the study by University of California at San Diego sociologist David Phillips, which examined all US death certificates from the beginning of 1983 to the end of 2004, the overall death rate from fatal medical errors increased more than three-fold over that period, but the death rate from fatal medical errors when the drugs are taken at home and combined with alcohol and/or street drugs has increased a whopping 30-fold.

That means that accidental overdoses at home with alcohol or street drugs involved accounted for 17% of fatal medical error deaths in 2004. That's a seven-fold increase over the 2.3% reported in 1983.

In real numbers, the study found 22,770 fatalities from medication errors in 2004, with 3,792 of them attributed to mixing meds with alcohol or other drugs. In 1983, by contrast, only 92 people died from mixing drugs.

The increase in fatal medical errors involving prescription drugs is larger than the increase in the use of prescription drugs themselves, which has increased about 70% in the last decade.

Fatal medical errors involving prescription drugs dispensed in a hospital or doctor's office setting increased only 5%, while such errors involving home use but no street drug or alcohol use and such errors involving medical settings and alcohol and/or street drug use both increased five-fold.

Phillips and his coauthors pointed their finger at the ongoing migration of prescription drug dispensing from medical professionals at hospitals and doctors' office to patients at home. The decades-long shift in the location of medication consumption from clinical to domestic settings, they said, "is linked to a dramatic increase in fatal medication errors."

It is not just people swallowing prescription pills at home, but the involvement of other drugs in the overdoses that is disturbing, they said. "Domestic fatal medication errors, combined with alcohol and/or street drugs, have become an increasingly important health problem."

The study recommended increased screening for patient abuse of prescription drugs, alcohol, or street drugs, as well as increased vigilance toward prescribing medicines with known dangerous interactions with alcohol or street drugs.

But others in the medical profession are taking the study's findings and running with them. One medical blogger looking to restrict access to pain meds put it like this: "What is going on here is a direct result of politicizing medicine by the pain rights movement and the organizations that have mandated liberal pain management into guidelines and enforcement standards. More recently the push to promote patient satisfaction in healthcare organizations has resulted in liberalizing of prescribing opioid medications to make patients happy. Whatever happened to do no harm? Medicine has lost its way. These numbers should serve as a wake up call and re-examination of pain management practices."

And that is, unsurprisingly, raising hackles in the embattled pain relief movement. Pain relief advocates have long argued that access to effective opioid pain medications is too restricted, pointing to numerous cases of doctors prosecuted and imprisoned for their prescribing practices -- and the patients being left in the lurch.

"The pain relief movement had made only modest gains when it was faced with a government-wide crackdown, led by the Justice Department," said Siobhan Reynolds of the Pain Relief Network. "Now, those who know that they could find help in the form of opioids, find themselves shut out of care and stigmatized by the entire system. I don't think I have ever seen a more destructive phenomenon sweep this country... all in the name of a drug free America, an America which could never exist."

It's not pain patients who are dying of opioid overdoses, said California pain management physician Dr. Frank Fisher. "I've analyzed dozens of these deaths now, and the field of forensic pathology is in such disarray that any time they find an opioid post-mortem, they label the death an overdose," he said. "But pain patients almost never overdose because of the phenomenon of tolerance -- unless it's a massive deliberate overdose, and then they have to take the benzos, barbiturates, or alcohol."

"It's true that it's very hard for an opioid tolerant person to overdose -- if they know what they're doing," said Dr. Matt Das Gupta, an epidemiologist working with North Carolina's Project Lazarus, a program that distributes the opioid antagonist naloxone (Narcan) to drug users to prevent overdoses. But mixing opioids with other drugs or alcohol can fell even the hardiest opioid tolerant patient, he warned.

Most pain patients are dying of cardiac disease, said Fisher. "Heart disease kills pain patients because they're sedentary because of their conditions and they're under stress from chronic pain. What I'm seeing is an epidemic of cardiac disease brought on or exacerbated by chronic pain. Medical examiners are calling them overdoses because they have opioids in their systems, but the medical examiners are wrong when it comes to chronic pain patients."

Suicides among pain patients are no surprise, said Fisher, but they tend to be undercounted. "Unless they leave a note, the medical examiner never calls it suicide, they will call it undetermined or accidental overdose. The medical examiners are giving us terrible data," he complained.

"Medical examiners not coding properly is a perennial problem," said Das Gupta. But that could go both ways. "There are people who died who probably should be included, but were not coded as ODs. For example, one code is chronic use of opioids. If you include that, the numbers go up by 10% or 15%."

(For more on the controversies surrounding drug-related deaths, cause of death coding issues, and associated topics, check out this page at Brian C. Bennett's web site, Truth: The Anti-Drug War.)

While pain relief advocates such as Reynolds and Fisher are concerned primarily with protecting patients' access to effective opioid pain relievers, harm reductionists such as Das Gupta are concerned primarily with preventing overdoses and other deaths related to drug use. While the harm reduction movement has traditionally focused on the use of street drugs, like cocaine and heroin, the rapid increase in prescription drug deaths may be a sign that it needs to broaden its focus.

"When you look at deaths at the state level and start to pull actual medical examiner case files, you find that the people dying are really a mix of pain patients, non-medical opioid users, and heroin users," said Das Gupta. "Here in North Carolina, we found that 80% of prescription overdose deaths were people with prescriptions. That doesn't mean they were chronic pain patients, though; they could have been people scamming docs. What we have is a really heterogenous mix, and the way things are coded doesn't offer enough nuance."

Project Lazarus is trying to adjust, he said. "We've been tweaking traditional programs to a different setting. Instead of using needle exchange programs, we're doing it through doctors' offices," explained Das Gupta. "Anyone who prescribes opioids for pain in North Carolina should be considering naloxone for specific populations," he said. "There is an ethical responsibility for physicians not to endanger their patients' lives."

"We're working on overdose prevention here in New York, but the people we have had access to are the heroin users," said Dr. Sharon Stancliff, medical director for the Harm Reduction Coalition, for whom she oversees drug overdose prevention projects in New York and San Francisco. "But the bigger problem is people misusing or abusing opioids. We need to be getting information out to the general practitioners who are prescribing these drugs. They need to be prescribing Narcan with all those meds," she suggested.

"We need to change the national agenda about overdose prevention," said Stancliff. "Naloxone is an answer, but it's not the only answer. We need naloxone, we need education, we need more research."

And, Stancliff added, the federal government needs to quit being an obstacle and start helping to solve the problem. "We don't have an early alert system, we have really bad surveillance, we're not getting the research done," Stancliff complained. "We don't know who is dying -- is it the people being prescribed the drugs? Is it people they're giving them to? Is it illicit drug users? We don't know enough. The Centers for Disease Control don't quite cover this, and it should be a Substance Abuse and Mental Health Services Administration (SAMHSA) issue, too. Maybe in the next administration, when harm reduction isn't a dirty word."

Harm Reduction: Bill to End Federal Needle Exchange Ban Filed

Rep. Jose Serrano (D-NY) and 25 cosponsors filed a bill Wednesday that would remove all restrictions on the use of federal funds for needle exchange programs (NEPs). The bill, the Community AIDS and Hepatitis Prevention (CAHP) Act of 2008 (H.R. 6680) is aimed at reducing the spread of blood-borne diseases that may be transmitted through infected syringes, such as HIV/AIDS and hepatitis C.

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widely-used syringe exchange graphic
NEPs have been proven to reduce the spread of blood-borne diseases, and there are now about 185 legal NEPs operating in the US. But since 1988, when the first legal NEP was approved, Congress has barred the use of any federal funds for such programs. While about half of NEPs receive some state or local funding, the federal ban means the cash-starved programs are blocked from accessing a major potential funding source.

The CAHP Act is endorsed by a more than a hundred HIV/AIDS, hep C, and other public policy groups. They have been pushing for more than a year to get the ban lifted. The Harm Reduction Coalition was one of the groups welcoming Serrano's bill.

"The Harm Reduction Coalition applauds Rep. Serrano's leadership in taking on the outdated and harmful federal funding ban", said Allan Clear, the group's executive director. "The federal funding ban has resulted in tens of thousands of needless HIV and hepatitis C infections. We know that syringe exchange works -- it's time for Congress to pave the way, and give communities the flexibility to use their federal HIV prevention dollars according to their own needs and priorities."

Medical Marijuana: DEA Seizes Medical Marijuana Seized By Seattle Police

Washington state has a medical marijuana law, and the city of Seattle has an ordinance making marijuana offenses the lowest law enforcement priority, but that didn't stop Seattle police from raiding the Lifevine medical marijuana co-op two weeks ago, seizing hundreds of patient files, as well as 12 ounces of dried buds and several pounds of leaf.

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California medical marijuana bags (courtesy Daniel Argo via Wikimedia)
In the wake of pointed criticism, King County Prosecutor Dan Satterberg declined to press charges against co-op operator Martin Martinez and ordered the return of the patient files. But police did not return the co-op's stolen property -- the medical marijuana.

Now, it has become clear the medical marijuana will never be returned. The Seattle Police announced Wednesday that the DEA, acting at the request of US Attorney Jeff Sullivan, took the medicine last Friday.

The DEA tersely confirmed it had seized the medicine. "Accordingly, the DEA has seized and processed the marijuana for destruction; that concludes this matter," agency spokesperson Jodie Underwood said in a statement reported by the Associated Press.

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