Harm Intensification

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New Report Challenges Meth Misinformation

In a new report released this week, neuroscientist Dr. Carl Hart and coauthors Joanne Csete and Don Habibi examines common assumptions about methamphetamine use and users and finds them wanting. Instead of careful, evidence-based analysis, rising concern about meth use has resulted in "a barrage of misinformation and reckless policies," Hart finds.

http://stopthedrugwar.org/files/methamphetamine-dangers-exaggerated-report.jpg
"The scientific literature on methamphetamine is replete with unwarranted conclusions, which has provided fuel for the implementation of draconian drug policies that exacerbate problems faced by poor people," said Hart.

As its title suggests, the report, Methamphetamine: Fact vs. Fiction and Lessons from the Crack Hysteria, finds clear parallels between the tide of distorted facts, faulty assumptions, and misinformation that characterized the crack cocaine scare of the early 1980s and similar claims made about the most recent drug panic over methamphetamine. Both feature the same sorts of claims, made by the same sorts of claims makers -- largely police, health professionals, and academics.

While the report finds real detrimental health effects with sustained meth use, it says those effects are exaggerated and/or the result of factors other than meth use in or by itself, such as poor overall health, poor nutrition, poor dental care, and poverty. It also challenges claims that meth is more powerfully addictive than other drugs.

In the report, Hart calls on lawmakers at home and abroad to revisit laws that harshly punish methamphetamine possession, to invest in treatment instead of punishment, to reconsider restrictions on access to amphetamines for legitimate medical purposes, and to stop supporting "wasteful and ineffective" scare campaigns replete with misinformation about meth use.

"We've been down this road before with other drugs that were poorly studied and misrepresented by media," said Kasia Malinowska-Sempruch, director of the Open Society Global Drug Policy Program. "The results included policies that hurt the users, ineffectively addressed the problem and ultimately failed society. We can't afford to repeat these experiences."

Hoffman, Heroin, and What Is To Be Done [FEATURE]

The news last Sunday that acclaimed actor Phillip Seymour Hoffman had died of an apparent heroin overdose has turned a glaring media spotlight on the phenomenon, but heroin overdose deaths had been on the rise for several years before his premature demise. And while there has been much wailing and gnashing of teeth -- and quick arrests of low-level dealers and users -- too little has been said, either before or after his passing, about what could have been done to save him and what could be done to save others.

cooking heroin (wikimedia.org)
There are proven measures that can be taken to reduce overdose deaths -- and to enable heroin addicts to live safe and normal lives, whether they cease using heroin or not. All of the above face social and political obstacles and have only been implemented unevenly, if at all. If there is any good to come of Hoffmann's death it will be to the degree that it inspires broader discussion of what can be done to prevent the same thing happening to others in a similar position.

Hoffman, devoted family man and great actor that he was, died a criminal. And perhaps he died because his use of heroin was criminalized. Criminalized heroin -- heroin under drug prohibition -- is of uncertain provenance, of unknown strength and purity, adulterated with unknown substances. While we don't know what was in the heroin that Hoffman injected, we do know that he maintained his addiction and went to meet his maker with black market dope. That's what was found beside his lifeless body.

In a commentary published by The Guardian, actor Russell Brand, a recovered heroin addict, laid the blame for Hoffman's demise on the drug laws. "Addiction is a mental illness around which there is a great deal of confusion, which is hugely exacerbated by the laws that criminalise drug addicts," Brand wrote, calling prohibitionists' methods "so gallingly ineffective that it is difficult not to deduce that they are deliberately creating the worst imaginable circumstances to maximise the harm caused by substance misuse." As a result, "drug users, their families and society at large are all exposed to the worst conceivable version of this regrettably unavoidable problem."

We didn't always treat our addicts this way. Even after the passage of the Harrison Act in 1914, doctors continued for years to prescribe maintenance doses of opiates to addicts -- and hundreds of them went to jail for it as the medical profession fought, and ultimately lost, a battle with the nascent drug prohibition bureaucracy over whether giving addicts their medicine was part of the legitimate practice of medicine.

The idea of treating heroin addicts as patients instead of criminals was largely vanquished in the United States, but it never went away -- it lingers with methadone substitution, for example. But other countries have for decades been experimenting with providing maintenance doses of opioids to addicts, and to good result. It goes by various names -- opiate substitution therapy, heroin-assisted theatment, heroin maintenance -- and studies from Britain and other European countries, such as Germany, the Netherlands, and Switzerland, as well as the North American Opiate Medications Initiative (NAOMI) and the follow-up Study to Assess Long-Term Opiate Maintenance in Canada have touted its successes.

Those studies have found that providing pharmaceutical grade heroin to addicts in a clinical setting works. It reduces the likelihood of death or disease among clients, as well as allowing them to bring some stability and predictability to sometimes chaotic lives made even more chaotic by the demands of addiction under prohibition. Such treatment has also been found to have beneficial effects for society, with lowered criminality among participants and increased likelihood of their integration as productive members of society.

The dry, scientific language of the studies obscures the human realities around heroin addiction and opioid maintenance therapy. One NAOMI participant helps put a human face on it.

"I want to tell you what being a participant in this study did for me," one participant told researchers. "Initially it meant 'free heroin.' But over time it became more, much more. NAOMI took much of the stress out of my life and allowed me to think more clearly about my life and future. It exposed me to new ideas, people (staff and clients) that in my street life (read: stressful existence) there was no time for."

"After NAOMI, I was offered oral methadone, which I refused. After going quickly downhill, I ended up hopeless and homeless. I went into detox in April 2007, abstained from using for two months, then relapsed. In July 2008 I again went to detox and I am presently in a treatment center... I am definitely not "out of the woods" yet, but I feel I am on the right path. And this path started for me at the corner of Abbott and Hastings in Vancouver... Thank you and all who were involved in making NAOMI happen. Without NAOMI, I wouldn't be where I am today. I am sure I would be in a much worse place."

Arnold Trebach, one of the fathers of the drug reform in late 20th Century America, has been studying heroin since 1972, and is still at it. He examined the British system in the early 1970s, when doctors still prescribed heroin to thousands of addicts, and authored a book, The Heroin Solution, that compared and contrasted the US and UK approaches. Later this month, the octogenarian law professor will be appearing on a panel at the Vermont Law School to address what Gov. Peter Shumlin (D) has described as the heroin crisis there.

Phillip Seymour Hoffman (wikimedia.org)
"The death of Phillip Seymour Hoffman is a tragedy all the way around," Trebach told the Chronicle. "It's a bad idea to use heroin off the street, and he shouldn't have been doing that."

That said, Trebach continued, it didn't have to be that way.

"If we had had a sensible system of dealing with this, he would have been in treatment under medical care," he said. "If he was going to inject heroin, he should have been using pharmaceutically pure heroin in a medical setting where he could also have been exposed to efforts to straighten out his personal life, and he could have access to vitamins, weight control advice, and the whole spectrum of medical care. And if he had had access to opioid antagonists, he could still be alive," he added.

While Hoffman may have made bad personal choices, Trebach said, we as a society have made policy choices seemingly designed to amplify the prospects for disaster.

"This is a sad thing. He is just another one of the many victims of our barbaric drug policy," he said. "This was a totally unnecessary death at every level. He shouldn't have been using, but we should have been taking care of him."

The stuff ought to be legalized, Trebach said.

"I'm an advocate of full legalization, but if we can't go that far, we need to at least provide social and psychological support for these people," he said. "And even if we were to decriminalize or legalize, I would still want to figure out ways to provide support and love and kindness to people using the stuff. I advise you not to do it, but if you're going to use it, I want to keep you alive. I remember talking to people from Liverpool [a famous heroin maintenance clinic covered in the '90s by Sixty Minutes, linked above] about harm reduction around heroin use back in the 1970s. One of the ladies said it is very hard to rehabilitate a dead addict."

"There are plenty of things we can be doing," said Hilary McQuie, Western director for the Harm Reduction Network, reeling off a list of harm reduction interventions that are by now well-known but inadequately implemented.

"We can make naloxone (Narcan) more available. We need better access to it. It should be offered to people like Hoffman when they are leaving treatment programs, especially if they've been using opiates, just as a safeguard," she said. "Having treatment programs as well as harm reduction programs distribute it is important. We can cut the overdose rate in half with naloxone, but there will still be people using alone and people using multiple substances."

There are other proven interventions that could be ramped up as well, McQuie said.

"Safe injection sites would be very helpful, so would more Good Samaritan overdose emergency laws, and more education, not to mention more access to methadone and buprenorphine and other opioid substitution therapies (OST)," she said, reeling off possible interventions.

Dr. Martin Schechter, director of the School of Population and Public Health at the University of British Columbia in Vancouver, knows a thing or two about OST. The principal study investigator for the NAOMI and the follow-up SALOME study, Schechter has overseen research into the effectiveness of treating intractable addicts with pharmaceutical heroin, as well as methadone. The results have been promising.

"What we're using is medically prescribed pharmaceutical diacetylmorphine, the active ingredient in heroin," he explained. "It's what you have when you strip away all the street additives. This is a stable, sterile medication from a pharmaceutical manufacturer. We know the precise dose tailored for each person. With street heroin, not only is it adulterated and injected in unsterile situations, but people really don't know how strong it is. That's probably what happened to Mr. Hoffman."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)
In NAOMI, 90,000 injections were administered to study participants, and only 11 people suffered overdoses requiring medical attention.

"Never did we have a fatal overdose," Schechter said. "Because it was in a clinic, nurses and doctors are right there. We administer Narcan (naloxone), and they wake up."

Heroin maintenance had even proven more effective than methadone in numerous studies, Schechter said.

"There have been seven randomized control trials across Europe and in Canada that have shown for people who have already tried treatments like methadone, that medically prescribed heroin is more effective and cost effective treatment than simply trying methadone one more time."

Those studies carry a lesson, he said.

"We have to start looking at heroin from a medicinal point of view and treat it like a medicine," he argued. "The more we drive its use underground, the more overdoses we get. We need to expand treatment programs, not only with methadone, but with medically prescribed heroin for people who don't respond to other treatments."

Safe injection sites are also a worthwhile intervention, Schechter said, although he also noted their limitations.

"Injecting under supervision is much safer; if there is an overdose, there is prompt attention, and they provide sterile equipment, reducing the risk of HIV and Hep C," he said. "But they are still injecting street heroin."

He would favor decriminalizing heroin possession, too, he said.

Harm reduction measures, opioid maintenance treatments, and the like are absolutely necessary interventions, said McQuie, but there is a larger issue at hand, as well.

"We still need to look at the overall issue of the stigmatization of drug users," she said. "People aren't open about their use, and that puts them in a more dangerous situation. It's really hard in a criminalized environment."

Stigmatization means to mark or brand someone or something as disgraceful and subject to strong disapproval. Defining an activity, such as heroin possession, as a crime is stigmatization crystallized into the legal structures of society itself.

"The ultimate harm reduction solution," McQuie argued, "is a regulated, decriminalized environment where it is available by prescription, so people know what they're getting, they know how much to use, and it's not cut with fentanyl or other deadly adulterants. People wouldn't have to deal with all the collateral damage that comes from being defined as criminals as well as dealing with the consequences of their drug use. They could deal with their addictions without having to worry about losing their homes, their families, and their freedoms."

While such approaches have a long way to go before winning wide popular acceptance, policymakers should at least be held to account for the consequences of their decision-making, McQuie said, suggesting that the turn to heroin in recent years was a foreseeable result of the crackdown on prescription opioid pain medication beginning in the middle of the last decade.

"They started shutting down all those 'pill mills' and people should have anticipated what would happen and been ready for it," she said. "What we have seen is more and more people turning to injecting heroin, but nobody stopped to do an impact statement on what would be the likely result of restricting access to pain pills."

The impact can be seen in the numbers on heroin use, addiction, and overdoses. While talk of a "heroin epidemic" is overblown rhetoric, the number of heroin users has increased dramatically in the past decade. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of past year users grew by about 50% between 2002 and 2011, from roughly 400,000 to more than 600,000. At the same time, the number of addicted users increased from just under 200,000 to about 370,000, a slightly lesser increase.

If there is any good news, it is that, according to the latest (2012) National Household Survey of Drug Use and Health, the number of new heroin users has remained fairly steady at around 150,000 each year for the past decade. That suggests, however, that more first-time users are graduating to occasional and sometimes, dependent user status.

And some of them are dying of heroin overdoses, although not near the number dying from overdoses from prescription opioids. Between 1999 and 2007, heroin deaths hovered just under 2,000, even as prescription drug deaths skyrocketed, from around 2,500 in 1999 to more than 12,000 just eight years later. But, according to the Centers for Disease Control, by 2010, the latest year for which data are available, heroin overdose deaths had surpassed 3,000, a 50% increase in just three years.

While the number of heroin overdose deaths is still but a fraction of those attributed to prescription opioid overdoses and the numbers since 2010 are spotty, the increase that showed up in 2010 shows no signs of having gone away. Phillip Seymour Hoffman may be the most prominent recent victim, but in the week since his death, another 50 or 60 people have probably followed him to the morgue due to heroin overdoses.

There are ways to reduce the heroin overdose death toll. It's not a making of figuring out what they are. It's a matter of finding the political and social will to implement them, and that requires leaving the drug war paradigm behind.

New York City, NY
United States

Smart Needle Exchange Reform Bill Moving in Maryland

The Maryland Senate today moved to undo a restriction in existing state law that prevents injection drug users from picking up more clean needles at the Baltimore needle exchange than they turn in.

The Senate approved Senate Bill 263 by an overwhelming 39-5 vote. The measure now heads to the House.

The bill doesn't include a specific limit on the number of needles can pick up at one time, but one of the bill's supporters, Sen. Verna Jones-Rodwell (D-Baltimore), said 50 might be a good number, and that the bill may be amended to get specific.

The bill is supported by the entire Baltimore Senate delegation as well as the city of Baltimore.  The health department there says the city's needle exchange program serves about 2,500 people a year and exchanges about 200 needles for each one.

Needle exchanges are a proven means of reducing the transmission of HIV, Hep C, and other blood-borne illnesses among injection drug users.

Good on the Maryland Senate for moving to get rid of this mindless restriction.

Location: 
Annapolis, MD
United States

Chronicle AM -- January 10, 2014

The marijuana issue continues hot and heavy, one of our favorite authors is nominated for an award, harm reduction bills move in Wisconsin, and the US Sentencing Commission wants to cut drug sentences. And more. Let's get to it:

Dr. Carl Hart, nominated for an NAACP Image Award for "High Price" (columbia.edu)
Marijuana Policy

Colorado Legal Marijuana Sales Hit $5 Million in First Week. Sales of legal marijuana in Colorado since January 1 are estimated to have exceeded $5 million, with some 100,000 people lining up to buy it, according to industry insiders.

Colorado Republicans File Bill to Ban Food Stamps in Marijuana Shops. File under: solutions in search of problems. There is no evidence that anyone has ever used a food stamp EBT card to purchase marijuana products, but that hasn't stopped a handful of GOP state legislators to file a bill to outlaw it. "We need this bill, if for nothing else, as a statement," said Rep. Jared Wright (R-Grand Junction). "We shouldn't be enabling anyone to buy a substance that is banned under federal law. It's not a good use of taxpayer money," he said. The bill is Senate Bill 37.

New Hampshire House Didn't Vote on Marijuana Legalization. The House was set to vote Wednesday on a bill to legalize marijuana, but it didn't happen. The vote has instead been pushed back for a week as legislators dealt first with attempts to override vetoes on bills passed last year. The bill is House Bill 492.

No Marijuana Legalization Bill for Ohio This Year. The only Ohio legislator to push for marijuana legalization last year won't try it again this year. Rep. Bob Hagan (D-Youngstown) said he had no plans to introduce a measure this year after last year's effort to pass a resolution to let residents vote on the issue was sidelined.

Washington Congressman Urges Feds to Act Quickly on Marijuana Banking. Rep. Denny Heck (D-Washington) Friday called on federal regulators to move swiftly to resolve the issue of financial institutions being able to do business with legal marijuana businesses. In a statement, the coauthor of pending federal legislation that would do just that said that "it is urgent federal regulators come to a resolution on this issue as soon as possible."

Powerful Maryland Pol Comes Out for Marijuana Legalization. Delegate Maggie McIntosh (D-Baltimore) has joined the list of powerful state legislators calling for marijuana legalization. She said legalization is one of "the biggest, most important issues" facing the General Assembly this year. She joins Senate President Thomas Miller (D) and Democratic gubernatorial candidate Heather Mizeur in supporting legalization, but Gov. Martin O'Malley (D) and House Speaker Michael Busch (D) both oppose it.

Steny Hoyer Opposes Marijuana Legalization in Maryland. US House Minority Whip Steny Hoyer (D-MD) said Thursday he opposes legalizing pot in the state. "I'm not a proponent of legalizing marijuana," he said. "As I talked to people who deal with drug abuse issues, with rehabilitation issues, I became convinced that marijuana was, in fact, a threshold drug and it would lead to the use of harder, very harmful drugs," he added.

Medical Marijuana

Kentucky House Panel Holds Medical Marijuana Hearing. The House Health and Welfare Committee held a hearing Thursday to discuss medical marijuana. No specific bill was under discussion, but one legislator, Sen. Perry Clark (D-Louisville) filed a bill this week, Senate Bill 43, which would legalize medical marijuana.

Florida House Committee Chair Will Propose Bill to Legalize High CBD Strains for Seizures. Rep. Matt Gaetz (R-Shalimar), chair of the House Criminal Justice Subcommittee, said Thursday he would introduce a bill to allow for the medical use of marijuana strains that are high in CBDs. The vow came after a heart-wrenching hearing from parents of children who suffer seizure disorders, who called on the legislature to legalize strains such as "Charlotte's Web."

Asset Forfeiture

Utah Attorney General Sees Asset Forfeiture as Tool against Drug Legalizing Attorneys. After changes to undo asset forfeiture reforms approved by voters in 2000 snuck through the state legislature last year came under this week, Utah Attorney General Sean Reyes issued a brief defending the new law. But a bullet point justifying a new cap on attorneys' fees for people who successfully defend their property is setting off alarms among First Amendment advocates. "By setting a limit on attorney's fees it will take away the incentive for attorneys who actively promote the legalization of drugs in the state of Utah from soliciting clients who are engaged in criminal activity," the attorney general's brief said. Click on the link for a lengthier critique.

Drug Testing

Welfare Drug Testing Bill Coming Back in Indiana. House Speaker Brian Bosma (R-Indianapolis) said Thursday that while welfare drug testing legislation is not part of the House Republican agenda, a pending bill to do just that is "one we're going to enthusiastically endorse and move forward on." The bill, which passed the House, but not the Senate, last year, would require drug testing of welfare recipients based on some form of reasonable suspicion.

Harm Reduction

Push On to End Needle Exchange Ban in Federal Funding Bill. Harm reduction and public health advocates are urging lawmakers to lift the prohibition on the use of federal funds to pay for needle exchange programs. The battlefield is the conference committee that will reconcile House and Senate budget bills. The Senate version had language that included funding for needle exchanges, but the GOP-led House is expected to oppose it.

Wisconsin Overdose 911, Naloxone Bills Pass Assembly Committee. A bill to provide limited legal immunity to people who notify authorities of an overdose passed the Assembly Criminal Justice Committee Thursday. So did a bill that would allow first responders to carry and use the overdose reversal drug naloxone. Both now goes to the full Assembly, which should vote on them Tuesday. The bills have the backing of Attorney General JB Van Hollen (R) and are expected to sail through the Senate as well.

Honors

Carl Hart Wins NAACP Image Award Nomination for "High Price." Neuroscientist and Drug Policy Alliance board member Carl Hart's "High Price: A Neuroscientist's Journey of Self Discovery That Changes Everything You Know About Drugs and Society" has been nominated for an NAACP Image Award in the category of literary nonfiction. The awards ceremony takes place on February 22.

Sentencing

US Sentencing Commission Suggests Lowering Drug Guideline Sentences. The US Sentencing Commission voted Thursday to publish proposed federal drug sentencing guideline amendments that would include lowering guideline sentences for drug trafficking offenses. The amendments would reduce drug trafficking sentences by about 11 months, leading to a reduction in the federal prison population of more than 6,000 prisoners five years after taking effect. The commission is now seeking public comment on the proposal.

International

Jamaica Marijuana Growers to Organize. Jamaican legalization activists and marijuana growers will form a Cannabis Future Growers and Producers Association as part of a major conference next week. The "Going Forward -- Legalize It" conference is organized by the Ganja Law Reform Coalition, the Cannabis Commercial and Medicinal Research Task Force, and the National Alliance for the Legalization of Ganja, and hopes to help lay the groundwork for a legal marijuana industry on the island.

Canada's SensibleBC Sees 2014 as a Building Year. After an effort to put marijuana reform on the provincial ballot via an initiative faltered last year, Sensible BC leader Dana Larsen said this year would be a year of building momentum, training canvassers, and spreading the message of marijuana legalization. Larsen will also be touring the province this spring and summer to build support.

Chronicle AM -- December 12, 2013

A push is on to end the federal ban on needle exchange funding, a secret federal panel meets to discuss marijuana banking issues, UN anti-drug bureaucrats are still unhappy with Uruguay, more bodies show up in Mexico, and more. Let's get to it:

A move is on to end the federal ban on funding needle exchanges.
Marijuana Policy

Federal Banking Panel Meets on Pot Sales. The Bank Secrecy Act Advisory Group (BSAAG) met in Washington, DC, Thursday to discuss how to deal with banking issues related to medical marijuana and legal marijuana industries. Under current federal laws, marijuana sellers can't set up bank accounts or process credit card transaction because financial institutions fear being implicated in drug trafficking or money laundering cases. The meeting is closed-door, and there is no word yet on what, if anything, was decided.

One Year In, Coloradans Still Like Marijuana Legalization. A Public Policy Polling survey released this week found that Coloradans still support marijuana legalization. The poll found 53% agreed that marijuana use should be legal. It will be interesting to see the poll numbers a year from now, when Coloradans have had time to experience a legal marijuana industry. That begins on January 1.

Washington State Regulators Want to Ban Pot Smoking Wherever Alcohol is Sold. The state Liquor Control Board, which is also in charge of legal marijuana commerce, has proposed banning marijuana consumption in businesses licensed for liquor sales, but a Wednesday meeting saw loud opposition, in particular from Frankie Schnarr, owner of Frankie's Sports Bar and Grill in Olympia. Schnarr years ago emerged victorious in a battle with the board over whether he could open the second floor of his bar to smokers, who joined a "club" for the privilege. Schnarr opened his club to pot smokers after I-502 passed, and now claims 13,500 club members. Schnarr and others said the proposed rule was aimed directly at him. The board will vote on the proposed rule next week.

Philadelphia "Smoke Down Prohibition" Marijuana Prosecutions Continue, So Will Demonstrations. Comedian NA Poe will be sentenced Friday in federal court for smoking pot at Independence Hall as part of Philly NORML's ongoing Smoke Down Prohibition demonstrations. Two more members of the "Liberty Bell 4," Chris Goldstein and Don Dezarn will go on trial next week for puffing pot in demos this past summer, while a fourth, US Marine veteran Mike Whiter will make his first court appearance on similar federal charges. Click on the link for more details and how you can participate.

Gov. Cuomo Dismisses New York Legalization Bill as "Non-Starter." Well, that didn't take long. Yesterday, state Sen. Liz Krueger (D-Manhattan) announced she was introducing a marijuana legalization bill. That same day, a Cuomo spokesman scoffed at the bill, calling it "a non-starter."

Medical Marijuana

New Jersey Medical Marijuana Expansion Wins Assembly Committee Vote. A bill that would allow Garden State medical marijuana patients to buy the drug in other states and bring it back with them passed the Assembly Health Committee on a 7-4 vote Thursday. But Gov. Chris Christie (R) has said he will veto it or any other expansion of the state's program.

Harm Reduction

Maryland Docs, Scientists Call for End to Federal Needle Exchange Funding Ban. In the wake of the budget agreement announced this week by congressional negotiators, more than 70 Maryland-based doctors and scientists sent an open letter to Senate Appropriations Committee Chair Sen. Barbara Mikulski (D-MD) urging her to act to get the longstanding ban on federal needle exchange funding lifted. The ban had been overturned in 2010, but was reinstated without any public debate during budget negotiations the following year.

Pain Pills

State Attorneys General Call on FDA to Reconsider Zohydro Approval. The FDA is running into more flak over its October decision to approve the first hydrocodone-only drug in America, Zohydro, which will be available in a time-release form. Four US senators challenged the decision earlier this week, and now, 28 state attorneys general have asked the agency to reconsider. They cited the roll-out of earlier pain relieving drugs in time-release formulas, which they said resulted in "overzealous pharmaceutical sales" and "doctors overprescribing narcotics," among other ills. But Attorneys General are typically trained as lawyers, not doctors or pharmacists, and they seem oblivious to the continuing problem of undertreatment of pain that their campaigns foster. The FDA said it would reply directly to the law enforcement officials.

International

UNODC Criticizes Uruguay Marijuana Legalization. The UN Office on Drugs and Crime (UNODC) isn't happy with Uruguay. The South American nation's decision to legalize marijuana is a blow against international cooperation in the war on drugs, said UNODC head Yuri Fedotov. "Just as illicit drugs are everyone's shared responsibility, there is a need for each country to work closely together and to jointly agree on the way forward for dealing with this global challenge," he said in a statement. He also called the move "unfortunate."

More Mass Graves in Mexico. Authorities in the central Mexican state of Morelos have uncovered two mass graves containing at least 20 bodies. Authorities believe some of the bodies are victims of the Beltran Leyva cartel, which was largely dismantled two years ago. Others were apparently killed more recently. The discovery comes on the heels of a similar gruesome find in western Michoacan state, where the latest count had 66 bodies removed from mass graves there. More than 100,000 people are estimated to have been killed in Mexico's prohibition-related violence since 2006 and tens of thousands more have disappeared, including more than a thousand in the past two years in Moreleos, according to the state human rights commission.

Chronicle AM -- December 11, 2013

Uruguay legalizes the marijuana trade (and the usual suspects object), Denver provides a helpful guide to legalization there, Human Rights Watch scorches Louisiana for its AIDS-enhancing policies, and more. Let's get to it:

Marijuana Policy

Denver Debuts Marijuana Legalization FAQ Web Site. The city of Denver has created a web site seeking to address questions from residents and visitors, parents and neighbors, business and property owners, and marijuana retailers and home growers about how legalization will work.

New York Marijuana Legalization Bill Announced. State Sen. Liz Kreuger (D-Manhattan) Wednesday unveiled a proposal to legalize and tax marijuana in the Empire State. Pot prohibition is "a policy that just has not worked," she said. Advocates concede that the bill is unlikely to pass this session, but you have to start somewhere.

Medical Marijuana

American Herbal Pharmacopeia Classifies Marijuana as Botanical Medicine. The world's leading expert organization on herbal medicine, the American Herbal Pharmacopeia, has released the first part of a two-part monograph on marijuana that classifies it as a botanical medicine, alongside many other accepted complementary and alternative medicines. Americans for Safe Access calls it a "historic move" and will host a Google Hangout Thursday at 5:30pm PT to discuss its ramifications.

Oregon Medical Marijuana Regulation Panel Meets for Last Time. The committee charged with creating Oregon's first statewide medical marijuana dispensary regulations is meeting for what is supposed to be the last time today. The panel has been meeting since September to craft rules around security, background checks, and marijuana testing. A 30-page draft version of the rules should be finalized.

Guam Medical Marijuana Bill Gets Another Hearing Today. Guam residents will have another chance to voice their opinions on medical marijuana at a hearing set for today. Sen. Tina Muna Barnes has introduced a measure, Bill 215, that would allow the use of medical marijuana for various illnesses. The hearing starts at 5:30pm Guam time.

Drug Testing

Pennsylvania School Employee Drug Testing Bill Passes House. A bill that would require prospective public school employees to submit to drug testing passed the House Tuesday. The ACLU of Pennsylvania calls House Bill 810 "invasive, impractical, and unconstitutional" and vows to challenge it -- and win -- if it ever becomes law. The bill now heads to the Senate.

Harm Reduction

Human Rights Watch Report Slams Louisiana Laws, Police Practices as Increasing AIDS Toll. Human Rights Watch issued a report Wednesday charging that Louisiana laws and practices that bar access to clean needles and criminalize sex work contribute to a raging HIV epidemic and a very high AIDS death rate. The report is In Harm's Way: State Response to Sex Workers, Drug Users, and HIV in New Orleans.

Push Is On for Naloxone and Good Samaritan Law in Minnesota. Elected officials and members of law enforcement called Tuesday for new state laws that would allow deputies to carry and administer the overdose reversal drug Naloxone and provide legal protections for people who contact authorities to report a drug overdose. The moves are a response to a rising toll of heroin overdose deaths, particularly in the Twin Cities.

International

Uruguay Legalizes Marijuana Commerce. The Uruguayan Senate Tuesday night gave final approval to the government's marijuana legalization bill. Now, once President Jose Mujica signs it into law, Uruguay will be 120 days away from a legal commerce in marijuana.

UN Anti-Drug Bureaucrats Say Uruguay Legalization Breaks Treaty. The International Narcotics Control Board (INCB) reacted unhappily to Uruguay's Tuesday night legalization vote. "Uruguay is breaking international conventions on drug control with the cannabis legislation approved by its congress," the INCB complained in a Wednesday press release. The INCB qualified itself as "surprised" that Uruguay had "knowingly decided to break the universally agreed and internationally endorsed legal provisions of the treaty."

Russian Drug Czar Says Drug Legalization "Impossible." Reacting to Uruguay's move to legalize marijuana, Viktor Ivanov, head of Russia's Federal Service for Drug Control, said the legalization of any drug is "impossible, and I think it will not be possible" in Russia. "Moreover, we have strengthened our political will with an anti-drug strategy," he added, although he also said it was possible that Russia could grow hemp and low opiate content poppies for agricultural purposes.

Chronicle AM -- December 6, 2013

A new marijuana legalization has been filed in California, the Florida medical marijuana initiative faces a pair of challenges, the British Columbia decriminalization initiative is struggling, and more. Let's get to it:

Marijuana Policy

A New California Marijuana Legalization Initiative is Filed. The Control, Regulate, and Tax Marijuana Act was filed with the California attorney general's office Wednesday. It would legalize up to an ounce and four plants for people 21 and over and create a statewide system of regulated marijuana commerce. It's not clear, however, whether its backers will seek to gather signatures for 2014 or will use it as a place marker for 2016. Another legalization initiative, the California Cannabis Hemp Initiative of 2014 is in the signature-gathering phase, but lacks deep-pocketed financial backing.

Thinking About a Post-Pot Prohibition World. Martin Lee, the author of Acid Dreams and Smoke Signals, about the cultural histories of LSD and marijuana, respectively, writes about marijuana legalization as a beginning, not an end, and has some interesting and provocative thoughts about what should come next.

Medical Marijuana

Florida Supreme Court Hears Challenge to Medical Marijuana Initiative. The Florida Supreme Court Thursday heard arguments on whether the proposed constitutional amendment to allow medical marijuana should go on the November 2014 ballot. Attorney General Pam Bondi (R) had challenged it as misleading and in violation of federal law. The justices did not decide the issue, but a decision will be coming shortly.

Florida Medical Marijuana Initiative Needs a Lot of Signatures in a Hurry. The state Division of Elections reported Thursday that People United for Medical Marijuana, the group behind the initiative, has just under 137,000 signatures that have been validated. They need 683,149 by February. There is some lag between signatures gathered and signatures validated, and organizers say they have collected 400,000 signatures so far. But that means they need probably another 400,000 in just a few weeks just to have a cushion that would allow for the inevitable invalid signatures.

International

British Columbia Marijuana Decriminalization Initiative Campaign Struggling. Sensible BC's signature-gathering campaign to put a decriminalization initiative on the ballot in British Columbia looks like it is going to fall short. The group needs 310,000 valid signatures by Monday, but only has 150,000 gathered. But if they don't make it this time, that won't be the end of it. "Sensible BC is here to stay," said the group's Dana Larsen. "You can be quite sure we're going to try this campaign again sometime in the next year to year-and-a-half, if we don't succeed this time. We're not going away."

Report Says SE Asia Amphetamine Use is Fueling Rise in HIV Risk. An increase in injection use of amphetamines in Southeast Asia is raising the risk of the spread of HIV and requires "urgent" action, according to a new report from the Australian National Council on Drugs (ANCD) and the Asia-Pacific Drugs and Development Issues Committee. Not only injection drug use, but risky sexual behavior as well among amphetamine users, is part of the problem, the report says.

Chronicle AM -- November 29, 2013

Uruguay's marijuana legalization bill passes another hurdle, a Berlin borough wants cannabis cafes, Chicago proposes tough medical marijuana regulations, Kentucky officials hound the DEA about hemp, and more. Let's get to it:

Is this the face of marijuana legalization? Uruguayan President Jose Mujica (wikimedia.org)
Medical Marijuana

Chicago Proposes Strict Medical Marijuana Regulations. Chicago officials have proposed regulations that would allow medical marijuana dispensaries and grows only in manufacturing districts, would limit the number of grows to 22, and would require that dispensaries and grows be at least 2,500 feet from a school, day care center, or residential area. Medical marijuana becomes legal in Illinois on January 1.

Michigan Appeals Court to Hear Cases on Unemployment Benefits. The Michigan Appeals Court has agreed to hear two cases to determine whether someone fired for using medical marijuana can collect unemployment benefits. Lower court judges have overturned state agency rulings denying the benefits, but medical marijuana foe Attorney General Bill Schuette argues that the law only protects people from criminal prosecutions, not civil penalties.

Hemp

Kentucky Officials Send Letter to DEA Requesting Clarification on Hemp. Kentucky officials have sent a letter to the DEA asking for clarification of its position on industrial hemp. Agriculture Commissioner James Comer, US Sen. Rand Paul (R), and US Reps. John Yarmouth and Thomas Massie want the agency to tell them whether growing hemp in states that have enacted a regulatory framework remains illegal. They point to the federal government's response to marijuana legalization and argue that hemp should be treated the same way.

Drug Testing

Idaho Supreme Court Upholds Drug Possession Conviction Based Solely on Drug Test. Idaho's high court Tuesday upheld the conviction of a woman charged with drug possession after blood from her newborn child's umbilical cord tested positive for methadone. The court held unanimously that the drug test result was probable cause to support a possession conviction.

International

Uruguay Marijuana Legalization Bill Wins Senate Committee Vote. Uruguay is one step closer to becoming the first country to legalize the marijuana trade after the Senate Health Commission voted Thursday to approve the bill. The government-supported legislation has already passed the lower house and is expected to win final approval in the Senate next month.

Cannabis Cafes Coming to Berlin? Legislators in the hip Berlin borough of Friedrichschain-Kruezberg voted Thursday to approve cannabis coffee shops there. The move is the brainchild of Green Party Mayor Monika Hermann, who proposed it in September. Now, the borough must get the German federal government to agree. Under Article 3 of the German Narcotics Act, sufficient public interest could lead to law changes, provided there is public support and backing scientific evidence.

European Cancer Docs Say Restrictive Laws Aimed at Drug Abuse Block Millions from Pain Relief. The European Society for Medical Oncology warned that half the world's population lacks effective access to pain relievers because of restrictive laws aimed at reducing drug abuse. The group's Global Opioid Policy Initiative survey estimated that millions of cancer patients don't have access to seven cheap medicines essential for pain relief, including morphine and codeine. Access to such drugs "is catastrophically difficult" in many countries, the report's lead author said.

British Tories, Lib Dems At Odds Over Drug Policy. Britain's governing coalition is at odds with itself over drug policy after the new Liberal Democrat drugs minister, Norman Baker, said earlier this week that marijuana legalization "should be considered." That caused Conservative front-bencher and Justice Minister Chris Grayling to clarify that he and the Home Office "won't be considering it."

Northern Nigeria Alcohol Crackdown Sees 240,000 Bottles of Beer Destroyed. In attempt to deepen a sharia law ban on alcohol imposed in 2001, but largely ignored in hotels and the city's Christian quarter, Islamic police in the northern city of Kano destroyed 240,000 bottles of beer. They chanted "God is great" as they did so, and the head of the religious police warned that they will put an end to alcohol consumption. Multiple bombings of bars in the Christian quarter in late July carried out by suspected Islamic militants who complained the government wasn't enforcing sharia law adequately left 29 dead.

Peru Eradicates Record Amount of Coca. Peru, once again the world's largest coca and cocaine producer, announced Thursday that it had eradicated a record 55,000 acres of coca, about one-fifth of the total estimated 250,000-acre crop. That's a 60% increase in eradication over last year. The government said the increase was due to tougher anti-drug efforts and a weakening of the Shining Path in coca growing areas.

Israel Medical Marijuana Use up 30% This Year. Medical marijuana use is up sharply this year in Israel, according to the Health Ministry, which released figures showing 13,000 patients were approved to us it this year, up from 10,000 last year. The increase comes as the government is working on a new proposal to regulate medical marijuana. The Health, Agriculture, and Public Security ministries are expected to present it within the next couple of weeks.

A Clean, Well-Lit Place to Shoot Dope -- In Your City, Soon? [FEATURE]

The only existing supervised injection site for hard drug users in North America is Vancouver's Insite, but panelists at a session of the International Drug Reform Conference in Denver last month said activists in a number of US cities are working to be next. (Plans are also afoot in a couple of Canadian cities.)

client at Vancouver's Insite supervised injection site (vch.ca)
Supervised injection sites (SIS) are a proven public health and harm reduction intervention that can save lives by preventing overdoses, bring a measure of stability to the sometimes chaotic lives of addicts, reduce the spread of bloodborne infectious diseases such as HIV/AIDS and Hepatitis C, and reduce crime and disorder in the community.

SISs also exist in a number of European countries and Australia, but face both legal and political hurdles in the US. Still, advocates are ready to push the envelope here in a bid to bring the life-, health-, and money-saving innovation here.

Donald Macpherson, executive \director of the Canadian Drug Policy Coalition and former head of Vancouver's Four Pillars drug policy program explained the prehistory of Insite, offering hints of possible courses of action in the US.

"We had a public health disaster," he said, referring to the city's escalating heroin problem in the 1990s. "Drug users themselves opened an SIS in 1995, and the police watched it, but didn't shut it down. A second opened in 2002. A year later, another non-sanctioned injection site opened up. It was really messy and it took years."

But in the end, Vancouver ended up with Insite and has managed to keep it open despite the best efforts of the Conservative federal government in Ottawa.

"Insite survives because it has an exemption from Canadian drug laws," Macpherson explained. "We won in the British Columbia courts, we won in the Canadian Supreme Court, which instructed the health minister to issue a permit. But we still barely have Insite, and though other cities are working on it, there is a big chill in Canada right now and we're just trying to hang on to what we've got."

Plans for SISs in the US face similar obstacles, but that isn't stopping advocates in a number of cities -- notably Austin, New York City, San Francisco, and Seattle, as well as somewhere in New Mexico -- from pressing forward with plans to open them there.

"I don't know if we'll be first, but we'll be one of many," said Robert Cordero, president and chief program officer of Boom! Health in the Bronx.

Boom! Health, which resulted from the merger of Bronx AIDS Services and Citiwide Harm Reduction, is a multi-service organization with a three-story building that includes a pharmacy, pharmacists with a harm reduction orientation, and a seven-day-a-week drop in center.

"Safe injection would be embedded with all these other services," he said.

"I don't know if we want to be first, but we want to be one of many," said Olivia Sloan, outreach and education associate for the Drug Policy Alliance (DPA) in New Mexico, which has been working patiently to bring cutting edge programs like SISs to the state. "We passed harm reduction, including needle exchange, through the state legislature, but it's not working," Sloan said. "We have overdose deaths at four or five times the national average."

Advocates in New Mexico have been and continue to lay the groundwork for SISs, Sloan said.

"We took a political and academic approach, and our conversation about injection facilities started a few years ago," she explained. "We have mobile syringe exchanges. We drafted legislation last year and the Senate passed a memorial to require we study the feasibility of SISs in New Mexico. We have partnered with the University of New Mexico and are looking for a principal investigator."

In San Francisco, preliminary discussions with local officials about SISs have been going on for some time, but the San Francisco Drug Users Union may follow the path taken by organized Vancouver drug users, as well as many of the needle exchange pioneers in the US, and just do it.

"We have a committee very committed to an SIS that meets every Monday for two hours," said Holly Bradford, the union's coordinator. "We're really on the verge. We have a very active bathroom here; you just open the door," she smiled. We're bringing it to San Francisco," she said. "It might not be sanctioned or aboveground, but it's going to happen."

Whether underground or not, SISs face a hazard-strewn trek. State, local, or federal officials can throw up any number of obstacles, said Lindsay LaSalle, a Berkeley-based law fellow for DPA.

"Drug possession remains illegal and could impact any SIS user, although probably not the staff or operator because they're not handling the drugs," she explained.

"Then there are the crack house laws, which both the federal government and some states have. They make it illegal for anyone to maintain, own, lease, or rent a property where drugs are used, consumed, or manufactured. These laws could cover SISs, and this could impact both clients and staff and operators alike," she elaborated.

"Then there are civil forfeiture statutes. They've used them to go after medical marijuana dispensaries," she enumerated.

Winning local official support reduces some risks, but not all, LaSalle said.

"If SISs were sanctioned at the local level, many of the legal risks dissipate, but state actors could still choose to prosecute," she warned. "In most states, local officers are deputized to enforce state law, so they could still go after an SIS. If authorized at the state level, that would be an incredible victory, but we would still have to deal with the federal government."

While acknowledging that lawyers can be "a buzzkill," LaSalle also hastened to add that things can change faster than we think.

"These legal barriers are not so different from the challenges we've faced with other drug policy issues, like syringe exchanges," she noted. "They were seen as completely radical, but now we have an almost universally accepted public health intervention with the exchanges."

Part of the process of initiating a supervised injection site is selling it to other stakeholders. Panelists had a number of ideas about messages that worked.

"For business people, you tell them this is how we clean up the neighborhood," said a Seattle activist.

"It is a very incremental change from syringe exchange to supervised injection sites," said LaSalle. "Position it as a very small change in an organization that provides all these other services to drug users."

"There's always 'what we're doing is not working,'" said Sloan.

"We're not going to arrest our way out of this problem," suggested Cordero. "But don't go straight to the SIS conversation. Let people see what we're doing, and then they say 'you're doing God's work' and second, 'Holy shit! Where would all those people be if you weren't open?'"

The obstacles to implementing supervised injection sites in the US are formidable, but the need to do so is urgent and increasingly understood, as are the benefits. With activists and advocates in a number of American locales pursuing SISs through a variety of means, the question is not whether it will happen here, but when and where.

Florida Attorney General Bans "Crazy Clown" Drug

Florida Attorney General Pam Bondi Wednesday filed an emergency rule criminalizing four related synthetic cannabinoid drugs, including one being marketed under the name "Crazy Clown," her office announced in a press release. The emergency move makes the new synthetics Schedule I controlled substances under Florida law.

The four substances are B-PINACA, AB-FUBINACA, ADB-PINACA, and Fluoro ABDICA. They have been tentatively identified as cannabinoid receptor agonists, similar to an earlier round of synthetic cannabinoids that have been marketed under names such as "Spice" and "K2." Those drugs are banned under federal law and are illegal in a number of states as well.

Georgia banned the drugs last month under a synthetic drugs analog law, and now neighboring Florida has moved to do so, too.

The move came after a spate of media reports and law enforcement warnings in August and September about users suffering ill effects from "Crazy Clown," including nausea, vomiting, and violent behavior. But there has been no reported follow-up on those initial accounts.

"I will remain vigilant in my efforts to keep these drugs off store shelves and will continue to outlaw emergent synthetic drug compounds. These drugs pose a serious threat to Floridians, particularly our youth," said Attorney General Bondi.

"While synthetic drugs are marketed as safe alternatives to illegal drugs, make no mistake; these synthetics are dangerous," said Florida Department of Law Enforcement Commissioner Gerald Bailey. "Adding these four new concoctions to Florida's schedule 1 drug list strengthens our fight. We will continue our efforts with Attorney General Bondi to identify illegal chemicals and react swiftly."

Bondi said she will work with the state legislature to permanently ban them next year.

While Bondi's action is of a piece with the reflexive prohibitionist response to the earlier new synthetics apparent both in Washington and in state houses around the country, banning new synthetic drugs is not the only possible response to them. New Zealand made headlines worldwide when instead of banning them, it moved to regulate new synthetics.

Tallahassee, FL
United States

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