Harm Intensification

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Asia: Drug Users Form Regional Drug User Organization

In a meeting in Bangkok last weekend, more than two dozen drug users from nine different countries came together to put the finishing touches on the creation of a new drug user advocacy organization, the Asian Network of People who Use Drugs (ANPUD). The Bangkok meeting was the culmination of a two-year process began at a meeting of the International Congress on AIDS in Asia and the Pacific in Colombo, Sri Lanka, in 2007, and resulted in creating a constitution and selecting a steering committee for the new group. ANPUD adopts the principles of MIPUD (Meaningful Involvement of People who Use Drugs), and in doing so, aligns itself with other drug user advocacy groups, including the International Network of People who Use Drugs (INPUD), of which ANPUD is an independent affiliate, the Australian Injection and Illicit Drug Users League (AIVL),the Vancouver Area Network of Drug Users, and the Nothing About Us Without Us movement. ANPUD currently has more than 150 members and sees its mission to advocate for the rights of drug users and communities before national governments and the international community. There is plenty to do. Asia has the largest number of drug users in the world, but is, for the most part, woefully retrograde on drug policy issues. Not only do drug users face harsh criminal sanctions—up to and including the death penalty—but Asian has the lowest coverage of harm reduction services in the world. Access to harm reduction programs, such as needle exchanges and opioid maintenance therapy, is extremely limited. "People who use drugs are stigmatized, criminalized and abused in every country in Asia," said Jimmy Dorabjee, a key figure in the formation of ANPUD. "Our human rights are violated and we have little in the way of health services to stay alive. If governments do not see people who use drugs, hear us and talk to us, they will continue to ignore us." The Director of the UNAIDS Regional Support Team, Dr. Prasada Rao, spoke of the urgent need to engage with drug user networks and offered his support to ANPUD, saying that "For UNAIDS, HIV prevention among drug users is a key priority at the global level," said Dr. Prasada Rao, director of the UNAIDS Regional Support Team. "I am very pleased today to be here to see ANPUD being shaped into an organization that will play a key role in Asia's HIV response. It is critical that we are able to more effectively involve the voices of Asian people who use drugs in the scaling up of HIV prevention services across Asia." "When I go back home, I am now responsible for sharing the experiences with the 250 or so drug users who are actively advocating for better services at the national level," said Nepalese drug user and newly elected steering committee member Ekta Thapa Mahat. "It will be a great way for us to work together and help build the capacity of people who use drugs in Asia." "The results of the meeting exceeded my expectations," said Ele Morrison, program manager for AVIL's Regional Partnership Project. "The participants set ambitious goals for themselves and they have achieved a lot in just two days to set up this new organization. The building blocks for genuine ownership by people who use drugs is definitely there." While the meetings leading to the formation were organized and managed by drug users, the process received financial support from the World Health Organization, the UNAIDS Regional Task Force, and AIVL.
Location: 
Bangkok
Thailand

Feature: Federal Needle Exchange Funding Ban Battle Continues

Years of effort by harm reductionists, public health authorities, HIV/AIDS researchers and activists, and drug law reformers to undo the more than 20-year-old ban on federal funding for needle exchange programs (NEPs) may come to fruition this year, but there are significant obstacles to overcome. Still, advocates of the reform are cautiously optimistic.

Since 1988, the US government has prevented local and state public health authorities from using federal funds for NEPs, which studies have shown to be effective in reducing HIV infection rates among injection drug users (IDUs) and their sexual partners, promoting public health and safety by taking syringes off the streets, and protecting law enforcement personnel from injuries. NEPS have been endorsed by the World Health Organization, the American Medical Association, Centers for Disease Control and Prevention Director Thomas Frieden, and former Surgeons General Everett Koop and David Satcher, among many others.


Chicago map demonstrating the impact of the
1000-foot rule -- click for larger copies and more
maps of Chicago and San Francisco (courtesy
Dr.Russell Barbour, Center for Interdisciplinary
Research on AIDS, Yale School of Medicine)

Injection drug use accounts for up to 16% of the 56,000 new HIV infections in the US every year -- or nearly 9,000 people. IDUs represent 20% of the more than 1 million people living with HIV/AIDS in the US and the majority of the 3.2 million Americans living with hepatitis C infection.

Still, those numbers could have been higher. In a 2008 study, the CDC concluded that the incidence of HIV among injection drug users had decreased by 80% in the past 20 years, in part due to needle exchange programs. There are today an estimated 185 NEPs operating in 36 states, the District of Columbia, and Puerto Rico. But they rely on local or private funds, and many of them are failing to meet demand because of lack of funding. While the CDC says that its public health policy goal is 100% needle exchange, current estimates are that only 3.2% of needles used by drug users in urban areas are exchanged for clean ones.

The federal funding ban was first removed in a July 10 vote of the House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. A week later, the full Appropriations Committee approved the bill after voting down an amendment proposed by US Rep. Chet Edwards (D-TX) that would have reinstated the funding ban.

But the Appropriations Committee did approve an amendment dictating that federally funded NEPs could not operate "within 1,000 feet of a public or private day care center, elementary school, vocational school, secondary school, college, junior college, or university, or any public swimming pool, park, playground, video arcade, or youth center, or an event sponsored by any such entity."

A floor amendment by Rep. Mark Souder (R-IN) to reinstate the funding ban also was defeated, clearing the way for repeal of the ban to pass the House. But the thousand-foot language remains in the appropriations bill approved by the House, and it's extremely objectionable to reform advocates. The Senate committee working on the issue did not include ending the funding ban, but reform advocates are pinning their hopes on both ending the ban and killing the thousand-foot restriction on the end-game House-Senate appropriations conference committee.

"The Senate has taken up their version of the bill in committee, but hasn't had a full vote," explained Daniel Raymond, policy director for the Harm Reduction Coalition. "At the committee level, the Senate chose not to take any action on the ban. At this point, there is a conflict between the House and the Senate." HRC is lobbying the Senate to repeal the ban, without the restrictions.

"We commend the full House for recognizing that NEPs are essential, effective tools that work in our fight against HIV and hepatitis transmission," said Kevin Robert Frost, chief executive of the Foundation for AIDS Research. "And while the compromise in the bill isn't perfect, we are hopeful that a final bill will reach President Obama's desk without limitations."

"We urge Congress to recognize both the benefit and cost-savings of syringe exchange programs, and the research that NEPs do not have detrimental impact on communities," said Marjorie Hill of Gay Men's Health Crisis, which has just released yet another study demonstrating NEPs' effectiveness in decreasing the transmission of blood-borne diseases. "For too long, we have allowed ideology to drive public health policy. It is time to remove the federal funds ban for syringe exchange and remove the harmful 1,000 feet restriction," added Hill.

"The House bill, as it stands, still puts ideology before science by limiting how federal funds can be used for NEPs," Frost said. "But we have time to fix the legislation, and I'm hopeful that the full US Congress will realize the importance of allowing local elected and public health officials to make their own decisions about how to address their HIV and hepatitis epidemics."

"I believe that the president, the Senate, and the House all want to do the right thing and they're trying to figure out how to do it," said Bill McColl of AIDS Action. "If they follow their own rhetoric about science- and evidence-based HIV/AIDS prevention policy, then they will remove the thousand-foot restriction," he said.

"The thousand-foot provision is a backdoor means of reinstating the funding ban," McColl continued. "There is almost no urban environment in which it would allow needle exchanges to operate. There are no currently existing needle exchanges that would be able to get federal funding, so it just doesn't make sense to change the policy that way. Drug policy groups have gone and literally shown Congress maps of what would be excluded. They've got letters from mayors and police saying this is not a workable provision. Again, Congress and the president know what the science is."

In addition to eliminating federally-funded needle exchanges in vast swathes of the urban landscape, the thousand-foot rule would have other insidious effects, said McColl. "Having that rule would have undesirable side effects, in that it would separate needle exchange from other public health services. Our AIDS program does testing in areas with lots of drug use -- that's where we need to be testing, and that's where we want the population to have clean syringes. With federal funding available and with the thousand-foot rule, prevention services will be driven away from needle exchanges."

Alice Bell, prevention project coordinator for Prevention Point Pittsburgh, already lives with geographical restrictions. "We have a local regulation that specifies 1,500 feet from schools only, not all the other restrictions in the current language of the federal bill. We have to move our main needle exchange site because the building we're in is being sold, and we're having trouble finding a good place. Any federal restrictions would make it even tougher," she said.

Bell wants the federal funding ban ended, but worries that the thousand-foot rule would put a crimp in her efforts. "We still want it. We need the federal funding. Our program is expanding, but we can't really expand our exchange service because we don't have money for needles. The toughest thing is always getting money for needles. Ending the federal funding ban would make a huge difference to us."

Federal funding becomes even more significant when coupled with economic hard times and budget problems at the state and local level, Bell noted. "We're mostly funded through foundations and private donations, and we've begun getting some state and county money for overdose prevention and HIV prevention, but the needle exchange -- the core of what we do -- is the toughest to get funded."

"The Senate will most likely go along with the House in conference committee," said Drug Policy Alliance director of national affairs Bill Piper. "They will probably take a bunch of appropriations bills and put them in a massive omnibus spending bill. It is far from clear that there will be a ban in what comes out of the Congress."

But the thousand-foot rule has to go, he said. "A lot of groups have been lobbying really hard on the thousand-foot issue," Piper noted. "It would be an effective ban is many cities. Here in DC, for example, the only place you could do a needle exchange program would be down at the docks on the Potomac. The strategy is to convince the conference committee to either take that out or come up with something better."

Advocates are lobbying hard right now, said the Harm Reduction Coalition's Raymond. "Right now, we're doing a push to make sure the Senate is educated about the issue and ask the leadership to get on board with House's action to address the ban," he said. "The House version has the thousand-foot restriction, so we're also making the arguments about why that's not workable and needs to be redone. We've been circulating maps showing its impact to House members who are focused on the issue. This restriction goes far beyond any reasonable desire to balance public health with other interests. When that provision was thrown in at the last minute, its effects hadn't really been thought out," he argued.

"We keep up the work in reaching out to Congress on both House and Senate side," said Raymond, "and we're also asking the White House to show some leadership and urge the Senate to address the federal ban. We don't want this issue to get lost in the shuffle, we're calling on everyone in the community to make our voices heard and reaching out to our elected officials."

It may take awhile to get settled, said Piper. "The entire appropriations process is messed up, and a lot of will depend on if, when, and how the Senate deals with health care," he explained. "Supposedly, they will get the appropriations bills done by the end of October, but I think that's a fantasy. Last year, they didn't even do this year's appropriations bills until March."

Still, AIDS Action's McColl maintains a positive outlook. "I think the members who will be called on to vote on this understand the issues," he said. "I have a pretty good feeling about this. I'm hopeful this is the year."

Harm Reduction: Drug-Related Deaths Rose Dramatically in Recent Years, CDC Says

In a report released Wednesday, the Centers for Disease Control (CDC) has found that drug-related deaths -- the vast majority of them overdoses -- increased dramatically between 1999 and 2006, and that drug-related deaths now outpace deaths from motor vehicle accidents in 16 states. That's up from 12 states the previous year and double the eight states in 2003.

More people died from drug-related causes than traffic accidents in the following states: Massachusetts, New Hampshire, Rhode Island, Connecticut, New York, New Jersey, Maryland, Pennsylvania, Ohio, Michigan, Illinois, Colorado, Utah, Nevada, Oregon and Washington.

The news comes even as harm reductionists and public health advocates seek to gain support on Capitol Hill for passage of H.R. 2855, the Drug Overdose Reduction Act, sponsored by Rep. Donna Edwards (D-MD). The bill would create a federal grant program to support both existing and new overdose prevention programs across the country.

"Patients and their families could receive written instructions on how to recognize and respond to an overdose. In addition, college campuses could utilize overdose prevention money to educate students on how to recognize and respond to an alcohol overdose," advocates for H.R. 2855 wrote in a letter to Reps. Henry Waxman (D-CA) and Frank Pallone (D-NJ), chairmen of the House Energy and Commerce Committee and the committee's Health subcommittee, respectively.

Something like H.R. 2855 is desperately needed. According to CDC researchers, who examined death certificate data from around the country, some 45,000 died in traffic accidents in 2006, while 39,000 people suffered drug-related deaths. About 90% of the drug deaths were classified as overdoses, but researchers also included in that figure people who died of organ damage from long-term drug use.

Researchers reported a sharp increase in deaths tied to cocaine and to the opioid analgesics, a class of powerful drugs, used medically for pain treatment (as well as for non-prescription drug-taking via the black market), that includes fentanyl, methadone, morphine, and popular pain relievers like Vicodin and Oxycontin. Cocaine-related deaths jumped from about 4,000 in 1999 to more than 7,000 in 2006, but methadone-related deaths increased seven-fold to about 5,000, and other opioid deaths more than doubled from less than 3,000 to more than 6,000. Interestingly, heroin-related deaths actually declined slightly, hovering just below 2,000 a year throughout the period in question.

And despite all the alarms about young people dying of drug overdoses, the 15-24 age group had the lowest drug-related death rate of any group except those over 65. Only about three per 100,000 young people died of drug-related causes in 2006, compared to six per 100,000 among the 25-34 age group, eight per 100,000 in the 35-44 age group, and 10 per 100,000 in the 45-54 age group.

CDC researchers did not discuss causes for the increase in overall drug-related deaths or the rate of drug-related deaths.

Public Health: Feds Finally Issue Warning on Tainted Cocaine

Three weeks ago, Drug War Chronicle reported on cocaine cut with the veterinary agent levamisole and asked what the federal government was doing about it. Ten days later, the feds responded to the situation, with the Substance Abuse and Mental Health Services Administration (SAMSHA) issuing a public health alert on September 21.

http://stopthedrugwar.org/files/taintedcocainegraph.jpg
The alert, sent out to medical professionals, substance abuse treatment centers, and other public health authorities, warned of the "life-threatening risk" that much of the US cocaine supply may be adulterated with the veterinary anti-parasitic drug. It has been linked to a serious, sometimes fatal, blood disorder called agranulocytosis, with SAMHSA saying there are at least 20 confirmed or suspected cases and two deaths in the US associated with the tainted cocaine.

Despite being first noticed by forensic scientists at least three years ago and by the DEA late last year, there has been little public awareness of the public health threat. SAMHSA expects the number of cases to rise as public and professional awareness spreads.

"SAMHSA and other public health authorities are working together to inform everyone of this serious potential public health risk and what measures are being taken to address it," said SAMHSA Acting Administrator Eric Broderick, DDS, MPH.

The addition of levamisole to cocaine is believed to be done by Colombian drug traffickers. Ingesting the tainted drug can seriously reduce a person's white blood cells, suppressing immune function and the body's ability to fight off even minor infections. People who snort, smoke, or inject crack or powder cocaine contaminated by levamisole can experience overwhelming, rapidly-developing, life threatening infections, SAMHSA warned. Other serious side effects can also occur.

The DEA is reporting that levamisole is showed up in over 70% of cocaine analyzed in July, and authorities in Seattle are reporting that 80% of persons testing positive for cocaine are also testing positive for levamisole.

In its alert, SAMHSA warned that:

THIS IS A VERY SERIOUS ILLNESS THAT NEEDS TO BE TREATED AT A HOSPITAL. If you use cocaine, watch out for:

  • high fever, chills, or weakness
  • swollen glands
  • painful sores (mouth, anal)
  • any infection that won't go away or gets worse very fast, including sore throat or mouth sores; skin infections, abscesses; thrush (white coating of the mouth, tongue, or throat); pneumonia (fever, cough, shortness of breath).

The Centers for Disease Control and Prevention (CDC) is also getting in on the act. CDC will shortly publish a case report analysis in its Morbidity and Mortality Weekly Report and will be working with state public health authorities to collect information on the phenomenon. That information will be "used to guide treatment and prevention initiatives to address this public health concern."

One thing the feds are not doing is coming up with a test kit that would allow users to detect the presence of levamisole in cocaine. That's too bad, said Dr. Michael Clark, assistant professor in the Department of Psychiatry and Behavioral Science at the University of Washington Harborview Medical Center. "I thought to myself, why isn't there a test kit? It is easy to test for," he said. "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.

MPP of Nevada to Offer $10,000 Challenge: Marijuana is Safer Than Alcohol

MEDIA ADVISORY   
SEPTEMBER 21, 2009

 

MPP of Nevada to Offer $10,000 Challenge:
Marijuana is Safer Than Alcohol -- Prove Us Wrong and We'll Pay $10,000

Press Conference Sept. 23 to Reveal Details


PHOTO-OP: Large Mock Check For $10,000


CONTACT: Dave Schwartz,  MPP-NV Manager...................................................702-727-1081


LAS VEGAS -- At a Las Vegas news conference Sept. 23, the Marijuana Policy Project of Nevada will announce details of a $10,000 challenge to the people of Nevada. MPP-NV will pay $10,000 to anyone who can disprove three statements of fact that demonstrate that marijuana is objectively and unquestionably safer than alcohol.


     MPP-NV manager Dave Schwartz will unveil a large mock check for $10,000 as he announces specifics of the challenge, which kicks off a long-term public education campaign regarding the relative harms of marijuana and alcohol, and the harm caused by marijuana prohibition.


     WHAT: News conference to announce the Marijuana Policy Project of Nevada's $10,000 challenge


     WHO: MPP-NV manager Dave Schwartz


     WHEN: Wednesday, Sept. 23, 11:00 a.m.


     WHERE:  Near the emergency room entrance of University Medical Center Hospital (behind the hospital), corner of Goldring Avenue and Rose Street, Las Vegas.

     MPP of Nevada is a nonprofit organization dedicated to educating Nevadans about the true nature of marijuana and about the harms caused by marijuana prohibition in the state. For more information about MPP of Nevada, please visit http://www.mppnv.org.

####

Location: 
NV
United States

Overdose and Other Drug-Related Deaths Now Closing In on Car Wrecks as Leading Accidental Killer in US

In a report released Wednesday, the Centers for Disease Control (CDC) has found that drug-related deaths—the vast majority of them overdoses—increased dramatically between 1999 and 2006, and that drug-related deaths now outpace deaths from motor vehicle accidents in 16 states. That's up from 12 states the previous year and double the eight states in 2003. More people died from drug-related causes than traffic accidents in the following states: Massachusetts, New Hampshire, Rhode Island, Connecticut, New York, New Jersey, Maryland, Pennsylvania, Ohio, Michigan, Illinois, Colorado, Utah, Nevada, Oregon and Washington. According to CDC researchers, who examined death certificate data from around the country, some 45,000 died in traffic accidents in 2006, while 39,000 people suffered drug-related deaths. About 90% of the drug deaths were from overdoses, but researchers also included in that figure people who died of organ damage from long-term drug use. Researchers reported a sharp increase in deaths tied to cocaine and to the opioid analgesics, a class of powerful drug that includes fentanyl, methadone, morphine, and popular pain relievers like Vicodin and Oxycontin. Cocaine-related deaths jumped from about 4,000 in 1999 to more than 7,000 in 2006, but methadone-related deaths increased seven-fold to about 5,000, and other opioid deaths more than doubled from less than 3,000 to more than 6,000. Oddly enough, heroin-related deaths actually declined slightly, hovering just below 2,000 a year throughout the period in question. And despite all the alarums about young people dying of drug overdoses, the 15-24 age group had the lowest drug-related death rate of any group except those over 65. Only about three per 100,000 young people died of drug-related causes in 2006, compared to six per 100,000 among the 25-34 age group, eight per 100,000 in the 35-44 age group, and 10 per 100,000 in the 45-54 age group. CDC researchers did not discuss causes for the increase in overall drug-related deaths or the rate of drug-related deaths, but several plausible (and complementary) explanations come to mind: the introduction and widespread use of Oxycontin, the fentanyl-tainted heroin epidemic that appeared in 2006, the increasing non-medical use of prescription pain relievers, and the increasing use of methadone as a pain reliever.
Location: 
Atlanta, GA
United States

Harm Reduction: Pennsylvania Allows Syringe Sales Without Prescription, Effective Immediately

Responding to years of agitation by harm reductionists and public health advocates, the Pennsylvania Board of Pharmacy Saturday published new regulations that will allow pharmacies to sell syringes without a prescription. The change goes into effect immediately. The move was lauded by activists as a significant public health victory in the battle against the spread of HIV/AIDS and Hepatitis C via injection drug use.

http://stopthedrugwar.org/files/nline.gif
popular syringe exchange logo
Under previous regulations, pharmacies could sell syringes only to people who obtained a doctor's prescription. The new regulations carry no limit on the number of syringes that can be purchased at a time, nor do they have age limits.

"This change is particularly important in Pennsylvania because we have only two locations -- Pittsburgh and Philadelphia -- in which legally authorized syringe exchange programs operate," said David Webber, an attorney for the AIDS Law Project of Pennsylvania. "These two programs alone are simply not adequate to address this problem across the entire state, but syringe exchange programs continue to be crucial in providing sterile syringes as well as access to drug treatment and health care for injection drug users."

"This is a chance for every pharmacy to become part of HIV prevention in Pennsylvania," said Scott Burris, professor at Temple University's School of Law and a national authority on syringe regulation and HIV prevention. "The pharmacy board has taken an important step forward for evidence-based policy."

It didn't come swiftly or easily. Activist organizations including the Pennsylvania Aids Law Project, Prevention Point Pittsburgh, Prevention Point Philadelphia, as well as legislators, HIV workers, and others had lobbied for the change for a decade. An article in the Lancaster Intelligencer Journal cited several efforts:

  • In 2002, a group called the Pennsylvania Coalition for Responsible Syringe Policy asked the Pharmacy Board to consider deregulation.
  • In 2005, another group called Pennsylvanians for the Deregulation of Syringe Sales filed a formal petition to the Board, and met with legislators and officials in the Rendell Administration.
  • In 2007, the the Pennsylvania Pharmacists Association endorsed syringe deregulation and asked the Pharmacy Board to move swiftly on it.

Robert Field, organizer of Pennsylvanians for the Deregulation of Syringe Sales and co-chair of the Lancaster-based Common Sense for Drug Policy, told the Intelligencer Journal he looked at syringe deregulation after efforts to start a syringe exchange program in Reading met with opposition. The board responded in August 2007, proposing new regulations allowing for over-the-counter syringe sales and opening them up for public comment. Thanks to concerns expressed by harm reduction and public health groups during the comment period, the board removed age and quantity restrictions.

The board heard a number of concerns from the Pennsylvania Medical Society that the rule change would increase drug use. But research won the day. "Studies indicate that making syringes available will reduce the spread of HIV and will not lead to an increase of illicit drug use," said Field.

The board also rejected record-keeping requirements requested by the House Professional Licensure Committee, saying it "does not believe that maintaining a record and requiring individuals to provide a name or other identifying information would advance the public health and safety."

Now the number of states that do not allow syringe sales without a prescription is down to two: Delaware and New Jersey.

Harm Reduction: Pennsylvania Allows Syringe Sales Without Prescription, Effective Immediately

Responding to years of agitation by harm reductionists and public health advocates, the Pennsylvania Board of Pharmacy Saturday published new regulations that will allow pharmacies to sell syringes without a prescription. The change goes into effect immediately. The move was lauded by activists as a significant public health victory in the battle against the spread of HIV/AIDS and Hepatitis C via injection drug use. Under previous regulations, pharmacies could sell syringes only to people who obtained a doctor’s prescription. The new regulations carry no limit on the number of syringes that can be purchased at a time, nor do they have age limits. “This change is particularly important in Pennsylvania because we have only two locations--Pittsburgh and Philadelphia--in which legally authorized syringe exchange programs operate,” said David Webber, an attorney for the AIDS Law Project of Pennsylvania. “These two programs alone are simply not adequate to address this problem across the entire state, but syringe exchange programs continue to be crucial in providing sterile syringes as well as access to drug treatment and health care for injection drug users.” “This is a chance for every pharmacy to become part of HIV prevention in Pennsylvania,” said Scott Burris, professor at Temple University’s School of Law and a national authority on syringe regulation and HIV prevention. “The pharmacy board has taken an important step forward for evidence-based policy.” It didn’t come swiftly or easily. Activist organizations including the Pennsylvania Aids Law Project, Prevention Point Pittsburgh, Prevention Point Philadelphia, as well as legislators, HIV workers, and others had lobbied for the change for a decade. In August 2007, the pharmacy board proposed new regulations allowing for over-the-counter syringe sales and opened them up for public comment. Thanks to concerns expressed by harm reduction and public health groups during the comment period, the board removed age and quantity restrictions. The board rejected record-keeping requirements requested by the House Professional Licensure Committee, saying it “does not believe that maintaining a record and requiring individuals to provide a name or other identifying information would advance the public health and safety.” Similarly, it rejected a number of concerns from the Pennsylvania Medical Society that the rule change would increase drug use. The board’s action reflected well-established scientific evidence that access to clean syringes is a critical component of stemming the spread of blood-borne diseases such as HIV and Hep C among injection drug users. Now the number of states that do not allow syringe sales without a prescription is down to two: Delaware and New Jersey.
Location: 
PA
United States

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.

http://stopthedrugwar.org/files/taintedcocainegraph.jpg
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.

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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.

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