Harm Intensification

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Feature: Tainted Cocaine Sickening, Killing People, But Feds Slow to Act

On the last day of August, media outlets around the country ran an Associated Press story reporting that nearly one-third of the cocaine in the country is tainted with a veterinary medicine, a de-worming agent called levamisole. According to the AP, the tainted cocaine is responsible for at least three deaths in the US and Canada, as well as sickening more than a hundred other people.

According to health authorities, the cocaine tainted with levamisole is linked to an unusual incidence of agranulocytosis, a condition of a suppressed immune system, whose symptoms include persistent sore throat, persistent or recurrent fever, swollen glands, painful sores, skin infections with painful swelling, thrush, and other unusual infections.

The DEA suspects that levamisole is being added as a cutting agent by Colombian drug traffickers. Researchers speculate that it may boost the cocaine high by acting as a dopamine reuptake inhibitor, but there is of yet little research to support that.

While the cumulative death toll and illness count was news, the fact that cocaine is being laced with levamisole shouldn't have been. Delaware public health officials issued a health advisory on levamisole-tainted cocaine in 2005, and British researchers reported in 2006 on 14 deaths in a one-year period from the tainted cocaine.

Last fall, the DEA quietly reported in its obscure Microgram Journal that levamisole-contaminated cocaine had been encountered beginning in April 2005 and that the percentage of contaminated cocaine had generally increased since then to reach 30% of all samples by October 2008 (page 83). But it didn't publicize those findings.

Soon after, local public health alerts about levasimole-tainted cocaine deaths or illnesses began trickling in, including Alberta, Canada, in November 2008, Los Angeles County in December 2008, New Mexico in January, Erie County, Pennsylvania, in March, and King County, Washington, in June.

Also early this year, researchers reported on cases of agranulocytosis after consumption of levamisole-laced cocaine in January in the Annals of Internal Medicine, and Criminal Justice Policy Foundation head Eric Sterling blogged about it in March.

Given the large number of cocaine users in the US, tainted product poses a significant public health risk. According to the most recent National Survey on Drug Use and Health released yesterday, there are 1.9 million "current cocaine users."

"If it really 30% of the cocaine, that would be a huge public health problem," said Dr. Sharon Stancliff, medical director for the Harm Reduction Network. "Medical people need to be aware of this."

They aren't, said Dr. Eric Lavonas, assistant director of the Rocky Mountain Poison and Drug Center in Denver, where nearly half of the cocaine is thought to be cut with levasimole. "I would think it would be fair to say the vast majority of doctors in the United States have no idea this is going on," he said. "You can't diagnose a disease you've never heard of."

But despite the mounting pile of reports and alerts and the potential public health risks, federal officials have remained silent. That may be about to change.

"The Center for Substance Abuse Treatment (CSAT) is going to put out a 'dear colleague' alert," said Stancliff. "It should happen relatively soon."

The Centers for Disease Control is also expected to issue an alert, sources told the Chronicle, though a media specialist at CDC denied that. "We don't do drugs," she said -- unaware of the CDC's involvement in a national alert about fentanyl-tainted heroin in 2006 and 2007 and pointing the Chronicle toward CSAT. CSAT had not responded to Chronicle inquiries by press time.

The 2006-2007 wave of fentanyl-tainted heroin overdoses -- hundreds of people died from them -- provides a model for how CSAT and the CDC might respond to the ongoing levasimole-tainted cocaine problem. As the Chronicle reported at the time, people began overdosing on the tainted heroin in the fall of 2006.

While the initial response by federal agencies was slow, by the summer of 2007, CSAT had issued a nationwide alert to outreach workers, treatment providers, and hospitals warning of the deadly problem. The CDC also got involved, although to a lesser degree. That summer, a team of CDC epidemiologists went to Detroit in response to a request from the Michigan Department of Community Health. The team assisted state and local officials with autopsy reports and analysis to help understand the overdose wave and formulate prevention guidelines for clinicians and educators.

The current wave of deaths and illnesses related to levasimole-tainted cocaine is not as severe as the fentanyl overdoses -- so far at least -- but as indicated above CSAT is set to act soon. Whether the CDC will actually get involved this time around remains to be seen.

While waiting for the feds to act, harm reductionists and public health workers are struggling with how to best act on the tainted cocaine. "Medical people need to be aware of this," said Stancliff, "but can we make warnings about smoking versus shooting versus snorting? I have no idea. There may be differences in terms of biomedical availability, but we don't know that yet," she said.

Nor was Stancliff certain about whether it was time to alert needle exchange clients about the problem. "When New York state sent out an advisory, we made sure the Injection Drug Users Health Alliance was aware of it, but I'm never sure when we should be alerting the people going to the needle exchanges. We want to save our alerts for times when people are thinking about changing their behavior."

For Doctor of Public Health David Duncan, a Kentucky-based expert on substance abuse and epidemiology, contaminated drugs are an expected consequence of prohibitionist regimes. "This is one of the things you inevitably have with black market drugs," he said. "You don’t know what you’re dealing with and the makers don’t necessarily know what they’re making. It seems to be an iron law of prohibition--outlaw something and whatever it is, it gets stronger and more dangerous."

"The appropriate public health response is to tell people there is a contaminant, and we’re not sure how dangerous it is," said Duncan. "But all black market cocaine contains contaminants. As long as it is illegal, there is risk of contamination. The only way to make it safe is to make it legal."

Stancliff added that testing for levasimole in cocaine is relatively simple. That leads to the obvious question of whether a drug testing program like those that evolved around Ecstasy and the rave scene may be appropriate. At least one specialist thinks so.

"I thought to myself, why isn't there a test kit? It is easy to test for," said Dr. Michael Clark, assistant professor in the Department of Psychiatry and Behavioral Science at the University of Washington's Harborview Medical Center. "It would be like testing your hot tub for its chemistry. Take a sample, mix some chemicals together, add a reagant, and see what turns what color."

Clark is working on developing just such a test kit. "It could be used at street level, and it could be used by a lot of public health and harm reduction groups. You want to identify levasimole before people ingest, very much like the Ecstasy testing. You could do the same thing with cocaine and levasimole," he said.

But that's addressing the problem on the back end. The solution is an untainted cocaine supply. "Someone needs to talk to those folks in Colombia," Stancliff said. And, as Duncan suggested, someone needs to talk to those folks in Washington--the ones who continue to assist on a prohibitionist regime despite all its negative collateral consequences, of which a tainted drug supply is only one.

Drug War Chronicle Book Review: "Marijuana is Safer -- So Why Are Driving People to Drink?" by Paul Armentano, Steve Fox, and Mason Tvert (2009, Chelsea Green Publishers, 209 pp., $14.95 PB)

In the past few years, Colorado-based activist Mason Tvert has taken the notion of comparing marijuana to alcohol and used it to great success, first in organizing college students around equalizing campus penalties for marijuana and underage drinking infractions (marijuana offenses are typically punished more severely), then in running a successful legalization initiative in Denver in 2005. Tvert and his organization, SAFER (Safer Alternatives for Enjoyable Recreation), continue to hammer away at marijuana prohibition, and now, in collaboration with NORML analyst Paul Armentano and MPP director for state campaigns Steve Fox, he has taken his "marijuana is safer" campaign to a new level -- and, hopefully, to a new and broader audience.

Having known (and repeatedly interviewed) all three coauthors in the course of my duties for the Drug War Chronicle, I assumed "Marijuana Is Safer" would be a good book. I was mistaken. It's a great book, and an extremely useful one. "Marijuana Is Safer" starts out hitting on all eight cylinders with a foreword from former Seattle police chief Norm Stamper and never lets up. It hits its points concisely and engagingly, it is thoroughly researched, and its political arguments are carefully thought out.

Regular readers of the Chronicle may not expect to learn a lot that they didn't know already, but they will likely be surprised, especially when it comes to the deleterious effects of alcohol. Did you know about the nasty effects of acetaldehyde? I didn't. It's what you get when you metabolize ethanol (alcohol), and it's carcinogenic and damages internal organs. Because it is so damaging, the body breaks it down into acetate, but if you're drinking at the rate of more than a drink an hour, you're body starts lagging behind. Something to keep in mind the next time someone invites you to join a drinking contest.

Similarly, you may share the general conviction that alcohol use can lead to violence, disease, crime, and accidents, but "Marijuana Is Safer" offers up the hard numbers -- complete with footnotes. Here's just one hard number: 35,000. That's the number of deaths each year attributed to chronic alcohol consumption. We all know what the number of deaths attributed to chronic use of the chronic is, don't we? That's right, zero.

Armentano, Fox and Tvert offer a mix of history, science, medicine, media critique, and just plain straight talk as they survey the history of alcohol and marijuana use in America, discuss the differing attitudes toward the two drugs, explain the rise of marijuana prohibition, and, most centrally, compare and contrast the effects of the two drugs on individual consumers and society as a whole.

They also dissect the arguments that legalizers have used -- so far, unsuccessfully -- to try to end marijuana prohibition. While those arguments are perfectly valid, the coauthors argue that they cannot counter the objection of people who might otherwise be persuaded: Why should we legalize another vice?

Naturally enough, Armentano, Fox and Tvert have the answer: "We would not be adding a vice; we would be allowing adults the option to choose a less harmful alternative for relaxation and recreation," they write.

They also provide the "money quotes" for several other skeptical responses to a legalization pitch, all designed to highlight the comparison of alcohol and marijuana. And these three are extremely well-positioned to know what to say; all three have been engaging in this conversation for years.

The coauthors also make a compelling argument that the "marijuana is safer" approach is a winner precisely because it forces listeners to think about alcohol and what it does -- something that all Americans know quite a bit about even if they don't drink. The comparison of marijuana and alcohol brings the discussion down from lofty abstractions about freedom and liberty to real world experiences with America's most popular drugs.

The "marijuana is safer" approach works just fine for marijuana, but potentially subverts broader anti-prohibitionist politics. It is difficult to imagine an argument for drug legalization based on "methamphetamine is safer" or "heroin is safer." It also effectively throws up a wall between "soft" marijuana and "hard" other drugs, abandoning broader drug legalization for freeing the weed alone. But perhaps "abandoning" is the wrong word. After all, Armentano and Fox work for marijuana reform organizations -- not drug reform organizations -- and Tvert's work all along has been about marijuana.

But possible unhelpful side-effects for broader anti-prohibitionism aside, "Marijuana Is Safer" is extremely worthwhile. This is a book you can hand to your mother or your teacher or your preacher and provide him or her with a nice framework for looking at marijuana -- one that by its inexorable comparative logic leads to the inescapable conclusion that marijuana should be legalized.

And for those readers with an interest in activism, this book needs to be on your bookshelf. It's full of handy, well-documented facts, it's got the answers to the questions you're likely to hear, and it's even got a how-to activism section at the back. I guarantee that if you own this book, it's going to be very well-thumbed before very long.

SAFER Book Launch

SAFER is hosting a party to celebrate the launch of Marijuana Is Safer. The event will include appetizers and an auction, and all proceeds from book sales will benefit SAFER. Copies of the book will be available for just $20 -- or for $30, get a copy and have one sent to a Colorado legislator! -- and SAFER's Mason Tvert will be on hand to discuss the book and sign copies.
Sun, 08/23/2009 - 2:00pm - 5:00pm
1550 Blake Street
Denver, CO
United States

The Great Marijuana Book Bomb

The highly acclaimed book co-authored by SAFER's Mason Tvert, Marijuana Is Safer: So Why Are We Driving People to Drink?, is now available. A book about marijuana has never hit #1 on Amazon.com, but with your help that could change. Please join hundreds of other marijuana reform supporters in purchasing the book via Amazon on Thursday, August 20. Amazon re-ranks book sales on an hourly basis, so Marijuana is Safer doesn't need to be the bestselling book for the past month; it just needs to generate a lot of sales on the day of the Book Bomb. If everyone acts, it will reach the top. For more information visit http://www.MarijuanaBookBomb.com.
Thu, 08/20/2009 - 12:01am - 11:59pm

Lecture: Marijuana is Safer: So why are we driving people to drink?

Mason Tvert is the cofounder and executive director of Safer Alternative for Enjoyable Recreation (SAFER) and the SAFER Voter Education Fund. He appears frequently in the news and travels the country promoting the "Marijuana Is Safer Than Alcohol" message. He resides in Denver, where he serves on the city’s Marijuana Policy Review Panel appointed by Mayor John W. Hickenlooper. "Marijuana is Safer" compares and contrasts the relative harms and legal status of the two most popular recreational substances in the world—marijuana and alcohol. Through an objective examination of the two drugs and the laws and social practices that steer people toward alcohol, the authors pose a simple yet rarely considered question: Why do we punish adults who make the rational, safer choice to use marijuana instead of alcohol? VIDEO: Part 1 of 2. SAFER's Mason Tvert debates a DEA Agent about why adults in Denver should be allowed to possess small amounts of marijuana: http://www.youtube.com/watch?v=yZMzQ_8Px80 Part 2 of 2. SAFER's Mason Tvert debates a DEA Agent about why adults in Denver should be allowed to possess small amounts of marijuana: http://www.youtube.com/watch?v=EYFxLNVm7cI For more information, contact 417-434-8279 or mssussdp@yahoo.com.
Thu, 09/10/2009 - 7:00pm - 8:30pm
3950 Newman Rd
Joplin, MO
United States

Book Premier: "Marijuana Is Safer: So Why Are We Driving People to Drink?"

Three of the nation's most successful marijuana policy reform organizations will come together at the Oaksterdam University Student Union in Oakland to premier the highly acclaimed new book, Marijuana Is Safer: So Why Are We Driving People to Drink? Co-authors Mason Tvert (of SAFER) and Paul Armentano (of NORML) will be on hand to discuss Marijuana Is Safer, beginning at 6 p.m., followed by a session of Q & A and time for book-signing. More information on Marijuana Is Safer is available at http://www.MarijuanaIsSafer.com. About the Book Nationally recognized marijuana-policy experts Steve Fox, Paul Armentano, and Mason Tvert compare and contrast the relative harms and legal status of the two most popular recreational substances in the world-marijuana and alcohol. Through an objective examination of the two drugs and the laws and social practices that steer people toward alcohol, the authors pose a simple yet rarely considered question: Why do we punish adults who make the rational, safer choice to use marijuana instead of alcohol? Marijuana Is Safer reaches for a broad audience. For those unfamiliar with marijuana, it provides an introduction to the cannabis plant and its effects on the user, and debunks some of the government's most frequently cited marijuana myths. For current and aspiring advocates of marijuana-law reform, as well as anyone else who is interested in what is becoming a major political battle, the authors spell out why the message that marijuana is safer than alcohol must be a prominent part of the public debate over legalization. Most importantly, for the millions of Americans who want to advance the cause of marijuana-policy reform-or simply want to defend their own personal, safer choice-this book provides the talking points and detailed information needed to make persuasive arguments to friends, family, coworkers, and elected officials. About the Authors Steve Fox is the Director of State Campaigns for the Marijuana Policy Project (MPP), the nation's largest organization dedicated to reforming marijuana laws. From 2002-2005, he lobbied Congress as MPP's Director of Government Relations. He cofounded Safer Alternative for Enjoyable Recreation (SAFER) in 2005 and has helped guide its operations since its inception. He is a graduate of Tufts University and Boston College Law School and currently lives in Maryland with his wife and two daughters. Paul Armentano is the deputy director of NORML (The National Organization for the Reform of Marijuana Laws) and the NORML Foundation. A recognized national expert in marijuana policy, health, and pharmacology, he has spoken at dozens of national conferences and legal seminars and has testified before state legislatures and federal agencies. He appears regularly on Drew Pinsky's nationally syndicated radio show, Dr. Drew Live, and his work has appeared in over 500 publications. Armentano is the 2008 recipient of the Project Censored Real News Award for Outstanding Investigative Journalism. He currently lives in California with his wife and son. Mason Tvert is the cofounder and executive director of SAFER (Safer Alternative for Enjoyable Recreation) and the SAFER Voter Education Fund. He appears frequently in the news and travels the country promoting the "Marijuana Is Safer Than Alcohol" message. He resides in Denver, where he serves on the city's Marijuana Policy Review Panel appointed by Mayor John W. Hickenlooper. Advance Praise for Marijuana Is Safer "The follies of marijuana prohibition have never been laid bare with more erudition and plain common sense. Marijuana Is Safer: So Why Are We Driving People to Drink? is a book every citizen needs to read, and a question we all have to raise our voices to ask." -Barbara Ehrenreich, bestselling author of Nickel and Dimed: On (Not) Getting By in America and This Land Is Their Land: Reports from a Divided Nation "Finally, a book that confronts the half-baked hallucinations of a drug policy gone mad. If you are one of the millions of Americans who support keeping marijuana illegal but enjoy a good beer, glass of wine or cocktail now and then, I suggest you read Marijuana is Safer, rehab your mind, and get high on the facts. If, on the other hand, you already believe our marijuana laws are illogical, this book will give you hope that change is in the air--and show you how you can do your part to push it along." -David Sirota, nationally syndicated columnist and bestselling author of The Uprising and Hostile Takeover "I have always maintained that the legalization of marijuana would lead to an overall drop in substance abuse in this country. In particular, the option of legal marijuana use, as an alternative to the death and violence associated with alcohol use, would be a welcome societal change. Surprisingly, though, there has never been a book dedicated to conveying this basic idea to the public. But with Marijuana is Safer, now there is. Kudos to Fox, Armentano, and Tvert for their remarkably insightful and important book." -Gary Johnson, former Governor of New Mexico "Our current draconian laws prohibiting the use of marijuana by responsible adults are doubly flawed. Not only does such prohibition violate fundamental freedoms but also, as this book documents, it undermines personal health and public safety. Regardless of your views on the civil liberties issues, this book should convince you of another compelling justification for marijuana law reform: that it will promote health and safety for all of us, including our nation's children." -Nadine Strossen, former President, American Civil Liberties Union, and Professor of Law, New York Law School "From my own work and the experiences of other members of the law enforcement community, it is abundantly clear that marijuana is rarely, if ever, the cause of disruptive or violent behavior. That marijuana causes very little social harm is reason enough in a free society to legalize it for adults. But as Steve, Paul, and Mason so brilliantly demonstrate in this book, an even more persuasive reason is that by prohibiting marijuana we are steering people toward a substance that far too many people already abuse, namely alcohol." -Norm Stamper, former Chief of the Seattle Police Department "I took great pride in my performance on and off the field, and often questioned why our culture embraces alcohol while simultaneously stigmatizing those who choose to consume a less harmful alternative, marijuana. Marijuana Is Safer makes an irrefutable case for liberating current cannabis policy by comparing and contrasting its use with that of alcohol. This outstanding book makes it clear that it is inconsistent, both legally and socially, for our laws to punish adults who make the 'safer' choice." -Mark Stepnoski, five-time NFL Pro Bowler and two-time Superbowl champion with the Dallas Cowboys "In a society too often paralyzed by fear when it comes to finding smart solutions to our failed drug war, Marijuana Is Safer offers a pragmatic way forward. The authors offer a new and common sense approach to marijuana policy--one that is motivated not by incarceration or punishment, but by reducing the overall harm to our society." -Rick Steves, travel guidebook writer and TV and radio host
Tue, 08/04/2009 - 5:00pm - 8:00pm
1915 Broadway
Oakland, CA
United States

The Need for Prescription Drug Harm-Reduction

Today I had the second appointment with my psychiatrist. In ten minutes, I was prescribed a 5 month supply of the stimulant medication Adderall. I'm concerned at how casually I was just prescribed a schedule II drug with a “high potential for abuse” that “may lead to severe psychological or physical dependence". As our movement looks beyond the the Marijuana legalization debate, I think it is important to discuss the future of regulating all types of drugs. Considering the current hysteria about prescription drug abuse, there is clearly something wrong with today's prescription drug regulations. Here I would like to share my own experience and concerns about legally obtaining a drug which is not so different from Cocaine. Let me begin one year ago when I first set out to get an Adderall prescription. At college, I had bought Adderall from friends to use as a study-aid. I don't believe ADD is a disease, but I do believe certain people have more difficulty concentrating than others, and I think I am one of those people. Having an immense respect for drugs, I researched the potential harms of Adderall before I used it. I knew there was abuse potential, so I used it once or twice per week at the most. Last year, I decided to get my own prescription to save money. I found a psychiatrist though my insurance. Before I met with him, he sent me a 20 page questionnaire asking me various questions about my mental health. I honestly answered questions concerning my concentration, anxiety, and overall mental health. I brought the questionnaire to the first appointment. He spent about ten minutes reviewing my answers, and diagnosed me with general anxiety and ADD. Five minutes later, I left with a prescriptions for four months worth of Adderall and Paxil, the latter one I never filled because I don't believe I have an anxiety disorder. I didn't talk to him again until today, one year later, when we met for 10 minutes and he refilled my prescriptions. He asked me two questions: if school was stressful, and if I experienced any bad side effects. Yes, school is stressful, no, no debilitating side effects. I see several concerning issues with my experience. This might sound hypocritical, considering I set out to legally obtain a drug, and I did. Why should I be complaining about how easy it was? Because I'm worried about society treating powerful substances so casually. I believe the increase in prescription drug abuse, especially among youth, has to do with precisely this lack of oversight and nonchalant attitude among some psychiatrists at passing out drugs. Here are my concerns: 1) The diagnosis process. It's not okay for a doctor to spend 15 minutes with a person and determine they have a psychiatric disorder in need of medication. This is a process which should take several visits and discussions between patient and doctor on the unique needs of the patient, not a generic questionnaire. 2) The prescription. Right off the bat, I was prescribed 30 mg a day of Adderall. This is way too much Adderall for anyone to be taking, in my opinion, never mind someone just beginning. 3) No follow-up. My situation was complicated because I was going to college, but still, to give me a 4 month supply of powerful drugs and make no effort to contact me on how I am tolerating the treatment is ridiculous and dangerous. 4) No education. He should have given me warning signs to expect if I am having problems with the drug. Not everyone would have done the extra research I did, he should have told me how the drug effects my brain and body. It is easy to build up tolerance to Adderall, which is why it is important to start with low doses and never take more than you need. He never told me that unlike drugs for depression or anxiety which you must take everyday because the effects are gradual, Adderall works instantly and it is okay not to take it everyday. In fact, in my experience it is best not to take Adderall everyday, but instead only when you need it. I'm not sure how common my psychiatric experience is. I'm guessing my psychiatrist is more irresponsible than most, and I hope that the average psychiatrist spends more time with patients. Still, my experience points to a general lack of proper procedure among psychiatrists at doling out drugs, and the lack of any sort of oversight on the actions of psychiatrists. If a psychiatrist has their heart set on making money, they will squeeze as many patients as in as possible, meaning no patient will receive adequate care. I'm struggling to figure out exactly how I feel about my experience. I am a firm believer in my right over my own body. I want to be able to obtain any substances which I please, I want it to be my choice. At the same time, like everything else in society, we need drug specialists to facilitate the decisions we make regarding drug usage. There is a necessary place in a legalized drug market for "psychiatrist" type people, we can't expect everyone to research which drugs they need and how to use them safely on their own. If we truly want to reduce the harms of drugs, we need to start being proactive by making sure psychiatrists educate patients about drugs from the moment they can obtain them. There is a common conception that certain people have "addictive personalities" or are simply prone to abusing drugs, as if a certain group of genes are programed to abuse drugs. I believe this philosophy severely underestimates humans. We have much more will-power than we give ourselves credit for, the problem is that we don't have the necessary resources to make smart decisions concerning drugs. It is the psychiatrist's job to educate patients on their bodies and substances. As much as I hate the government exaggerating the harms of drugs, I wish psychiatrists would make people more scared of truly dangerous drugs. I'm worried about the people who visit my psychiatrist who are oblivious to the nature of drugs and addiction and blindly follow the word of an incompetent doctor. As drug policy reformers, it is in our interest to assess current legal drug regulations if we hope to eventually move all substances into a regulated market. This is important for transforming public opinion on legalization. The public is being bombarded with stories about how harmful prescription drugs are, take Michael Jackson's case. We can't expect people to support moving Cocaine, MDMA, or Heroin into a regulated market, when the current market looks pretty scary and problematic.

India: Moonshine Deaths Stir Alcohol Prohibition Debate in Gujarat

Last week, 136 people died in the Indian state of Gujarat after drinking tainted alcohol, and the incident has stirred debate over the state's alcohol prohibition policy, in existence since 1960. One of India's "liquor barons" has invited the state government to do away with prohibition, and the state government has invited him to shut up about it.

moonshine still (courtesy Hagley Library)
The deaths occurred in Ahmedabad, about 35 miles from the state capital, Gandhinagar. Most of the dead were common laborers who had allegedly purchased illicit liquor produced or distributed by one Vinod Dagri, currently a fugitive, and described in local media as "the key mastermind in the hooch tragedy case."

It's not the first time contaminated black market alcohol has killed people in Gujarat. And as Gujarat officials were quick to point out, moonshine deaths also occur in Indian states without alcohol prohibition. In a Monday statement, Gujarat government spokesperson Jaynarayan Vyas noted that tainted alcohol had killed 31 people in Kerala in October 2000, 10 were killed and four blinded by bad hooch in Bhubaneswar in February of this year, 13 people died in of bad booze in Kolkata in May 2008, and 142 people in Karnataka had died from illicit liquor over the course of last year.

[Ed: Deaths from tainted alcohol in states that don't have prohibition are comparable to those in Gujarat, only because people in those states have access to alcoholic beverages that were legally produced, then smuggled into their states. If alcohol prohibition were to become more widespread, or nationwide, legally produced alcohol would become a scarcer commodity, and tainted alcohol would likely cause proportionally many more deaths in places like Kerala or Kolkata or Karnataka than it does today.]

Still, Vijay Mallya, chairman of the UB Group, India's largest liquor conglomerate, couldn't resist taking the opportunity to jab at the state's political leadership for its adherence to prohibitionist policies. Mallya offered to help the state craft a "responsible alcoholic beverages policy" in a statement cited in the Hindustan Times. "The deaths are not only tragic but should serve as a wake-up call to our political hypocrites. [Gujarat Chief Minister] Narendra Modi knows full well that every brand of alcohol is available in Gujarat," Mallya said. "The farce of prohibition, which cannot be enforced, leads to illegal, unhygienic and unsupervised production of deadly cocktails which claim innocent lives. It is time that political masters face reality in the interests of people's health," he added.

Minister Modi was not amused. "Many elements are giving the tragic incident political color and are trying to ruin the peaceful atmosphere in Gujarat," he said. "My government is sincere about eliminating the vice of illicit liquor."

State Health Minister Jay Narayan Vyas also suggested that Mallya butt out. "This is an internal matter of the Gujarat government and Mr. Mallya should avoid making suggestions on what should be done in Gujarat," Vyas told reporters in Gandhinagar.

Early this week, the Gujarat government was standing firm. "There is no question of any rethink on easing or lifting the prohibition laws," Vyas said on Monday. "The government is committed to implementing the prohibition laws for the peace, prosperity and security of the people of Gujarat."

Harm Reduction: Overdose Prevention Bill Introduced, Study Released

In response to a rapid increase in the number of drug overdose fatalities -- doubling from 11,000 in 1999 to 22,000 in 2005 -- US Rep. Donna Edwards (D-MD) Wednesday introduced the Drug Overdose Reduction Act, which would allocate $27 million a year to cities, states, tribal governments, and nonprofits to implement overdose reduction strategies. Accidental drug overdoses are now the second leading cause of accidental deaths, second only to auto accidents.

Edwards introduced the bill in conjunction with a new report from the Drug Policy Alliance, Preventing Overdose, Saving Lives: Strategies for Combating a National Crisis, which lays out a number of ways in which the overdose toll can be reduced:

  1. Enhance overdose prevention education.
  2. Improve monitoring, research, outreach and coordination to build awareness of the overdose crisis, its ramifications and public health approaches to reducing it.
  3. Remove barriers to naloxone (Narcan) access.
  4. Promote 911 Good Samaritan immunity law reform.
  5. Establish trial supervised injection facilities.

"We've got the science, we've got the technology and the medicine to do this," said Dr. Donald Kurth, head of the American Society of Addiction Medicine during a Wednesday conference call. Yet despite a national overdose death toll "like a jumbo jetliner crashing every three days," the US "as a nation hasn't had the political will to let physicians use what's already available."

Feature: Effort to Bring Safe Injection Facility to New York City Getting Underway

Last Friday, more than 150 people gathered at John Jay College of Criminal Justice in New York City for a daylong conference on the science, politics, and law of safe injection facilities (SIFs) as part of a budding movement to bring the effective but controversial harm reduction measure to the Big Apple. Sponsored, among others, by the college, the Harm Reduction Coalition, and an amalgam of 17 different New York City needle exchange and harm reduction programs known as the Injection Drug User Health Alliance (IDUHA), the conference targeted not only harm reductionists but public health advocates and officials, law enforcement, service providers, and the general public.

John Jay College, NYC (courtesy wikipedia.org)
The Safe Injection Facilities in New York conference aimed to create public awareness of SIFs, provide evidence that they are cost-effective, and start developing a plan for implementing SIFS in New York. As the conference program indicates, organizers relied heavily on experts from Vancouver, where the Downtown Eastside Insite SIF has been in operation -- and under evaluation -- since 2003, to provide the evidence base.

The first SIFs opened in Switzerland in the mid-1980s. Since then, they have spread slowly and there are now 65 SIFS operating in 27 cities in eight countries: Switzerland, Germany, the Netherlands, Spain, Australia, Norway, Luxembourg, and Canada. Although advocates have been working for the past year-and-a-half to bring an SIF to San Francisco, that effort has yet to bear fruit.

SIFS are credited with saving lives through overdose prevention, reducing the spread of blood-borne disease, reducing public drug use and attendant drug litter, and creating entryways to treatment and other services for hard-core drug users not ready to abstain. The results reported by the Vancouver delegation on Insite were typical:

  • No fatal overdoses at the SIF.
  • No increase in local drug trafficking.
  • No substantial increase in the rate of relapse into injection drug use.
  • Reductions in public drug use, publicly discarded syringes and syringe sharing.
  • SIF users 1.7 times more likely to enter detox programs.
  • More than 2,000 referrals to counseling and other support services since opening.
  • Collaboration with police to meet public health and public order objectives.

But despite such research results, the United States remains without an operating SIF. The obstacles range from the legal, such as the federal crack house law and its counterparts in many states, to the political and the moral. But for harm reduction and public health advocates, it is the failure to embrace such proven life-saving measures that has the stench of the immoral.

"The reality is that we have people shooting up in unsafe injection facilities as we speak," said Joyce Rivera, executive director of St. Ann's Corner of Harm Reduction and chair of the conference. "The reality is they are not shooting up in a safe, hygienic environment with the possibility of a transition into a range of care. That's what's not happening. As public health advocates, we are saying let's recognize that reality and create those safe facilities. Let these people enter through the portal of public health into a safe environment and start to pace their own change," she said.

"We have to acknowledge the social fact that people are shooting up in unsafe venues," Rivera said. "It's not some esoteric or academic argument. The question is what do we do about it? Public health is supposed to protect the community, and SIFs are a necessary evolution in our public health policy."

"The big issue here is that we know we have about 200,000 injection drug users in the city, and the needle exchange programs only serve a few thousand of them," said Robert Childs of Positive Health Project, one of the members of the IDUAH. "Most of them are getting needles from unregulated needle exchanges, shooting galleries, from friends. That is a large part of why New York City has the most HIV and Hepatitis C cases in the US and one of the highest rates of infection in North America," he said.

"The other big issue is that we're giving injectors the tools to inject, but not a safe space to do it," Childs pointed out. "Many shoot up in the public domain, in the bathrooms at Starbucks or McDonalds or White Castle, in libraries, parks, alleys, phone booths. They leave their syringes in locations that aren't evident to a non-injector, and that's a public health issue."

They also overdose. Drug overdose is the fourth leading cause of death in the city. While it is a tragedy for the victim, overdoses both lethal and non-lethal are also a burden to the city. "Taxpayers have to pay these costs," said Childs. "For an ambulance to respond to an overdose costs between $400 and $1,200, and that's going on many times a day every day."

It's not just ambulances. Failing to address injection drug use under prohibition conditions costs real dollars in other ways as well. Each new diagnosis of HIV in the city comes with a $648,000 price tag for life-long medications and medical care, and even that may be on a low end estimate. A case of hepatitis C often requires $280,000 to $380,000 for a liver transplant; for those cases that do not warrant a liver transplant, treatment costs anywhere from $60,000 to $100,000.

And it's not just taxpayers paying. According to Childs, local businesses, including service providers, spend thousands of dollars a year on plumbing repairs -- from needles disposed of in toilets for lack of biohazard containers.

Now, said advocates, it is time to move forward. The conference was but the opening shot in what will likely be a long and frustrating campaign.

"The conference went very well and it will be a bit of a lift," said John Jay Professor Richard Curtis, who addressed the topic of moving forward from here at the conference. "The evidence is piling up from Sydney and Vancouver and Europe, and that is helping us, too. But this isn't something the health departments and the politicians aren't quickly going to jump on the bandwagon for. We have to give them a push, and if we don't start working on it now, it'll never happen. We didn't get where we are today by behaving ourselves," he added, relating how his own needle exchange effort first faced official opposition before being accepted.

The audience included people from the city and state health departments, Curtis said. "The health officials are all very supportive... unofficially," he said. "They didn't want to be on the agenda, but they say they're supportive. But this is an election year, and that makes it hard for them."

There will be an organizing meeting in two weeks to map out strategy, Curtis said. "We'll see who is willing and able, whether there is an existing agency bold enough to forge ahead or whether we will have to create some alternative organizations. We want to put this issue on the table now."

"We're forming an action group to bring this into New Yorkers' consciousness," said Childs. "The people who do know about -- drug users -- are one of the most stigmatized populations in the city. We are going to a campaign similar to Vancouver about how these people are not bogeymen, but our sons and daughters. We're also trying to organize some media events around it. A group of lawyers will help by challenging some codes. And we'll be trying to work with our legislators and city councilors," he said.

But Curtis and others are not willing to wait forever. "I'm not hopeful that federal crack house laws will end any time soon," he said. "But we started needle exchanges by just doing it. If it has to come to that, we'll have to make them arrest us again. We need to back them into a corner at the very least."

Harm Reduction Coalition Western Coordinator Hilary McQuie has been involved in the ongoing SIF effort in San Francisco. Just because something isn't happening officially doesn't mean it isn't happening, she noted.

"I don't know much about shooting galleries in New York," she said, "but out here, it's no big secret that the bathrooms of service providers, drop-in centers, homeless shelters, soup kitchens are used for shooting up. What people are doing to try to make these current injection spaces safer is perhaps having safe injection instructions, syringe disposal devices, soap and water, things like that," she said. "Also, it's sort of semi-supervised. If someone's in the bathroom and doesn't come out, you can open the door and save them from an overdose. That happens every day in San Francisco."

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