Harm Intensification

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Feature: New York Post's Attack on "Heroin How-to" Harm Reduction Pamphlet Fails to Get It Dropped

Harm reduction in New York City came under attack last weekend when the tabloid New York Post ran an article titled Heroin for Dummies, excoriating the city for spending $32,000 for a 2007 harm reduction pamphlet that, among other things, gave injection drug users advice on how to reduce the harm of injecting. Since then, the story has been picked up by the New York Times and national media, including CNN and Fox News.

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uncomfortable, but the right thing to do
But while the assault on evidence-based harm reduction practices is worrisome, it also sparked a vigorous defense of the pamphlet from Mayor Michael Bloomberg and city health officials and has provided an opportunity to broaden public awareness of harm reduction. By Thursday, despite demands that they be pulled, Health Commissioner Thomas Farley had decided that the pamphlets will continue to be distributed.

The pamphlet, Take Charge, Take Care, was distributed by the city's Department of Health and Mental Hygiene and was aimed at injection drug users in the city. The harm reduction purpose behind it was to save lives and prevent overdoses and the spread of blood-borne disease. It counsels things like quitting, not sharing needles, and seeking treatment.

But also included in its advice were things like "Find the vein before you try to inject," "If you don't register [hit the vein], pull out and try again," and "Warm your body (jump up and down) to show your veins." Such common-sense harm reduction advice was like waving a red flag for Post and the drug warriors it interviewed.

"It's basically step-by- step instruction on how to inject a poison," said John Gilbride, head of the DEA's New York office. "It concerns me that the city would produce a how-to on using drugs," Gilbride said. "Heroin is extremely potent. You may only get the chance to use it once. To suggest there is a method of using that alleviates the dangers, that's very disturbing."

"It's sick," said City Council member Peter Vallone Jr. (D-Queens), chair of the council's public safety committee, who vowed to try to shut down distribution of the pamphlet. "This is a tremendous misuse of city funds, and I'm going to see what I can do to stop it. It sends a message to our youth: give it a try," he fumed.

"What we do not want to do is suggest that there's anything safe about shooting up narcotics," said Bridget Brennan, the city's special narcotics prosecutor. "No matter how many times you wash your hands or how clean the needle is, it's still poison that you're putting in your veins."

Only at the very end of the Post article was any supporter of harm reduction or the pamphlet given a say. "Our goal is to promote health and save lives with this information," explained Daliah Heller, assistant commissioner for the Bureau of Alcohol and Drug Use Prevention, Care and Treatment. "From a health perspective, there is a less harmful way to inject yourself."

The New York Times article the following day was less one-sided than the Post's hit piece, but still gave Vallone and other critics top billing. "You're spending taxpayer money and getting a how-to guide for first-time users," Vallone claimed.

The pamphlet was "absolutely not" a how-to manual, Dr. Adam Karpati, executive deputy commissioner for the health department's division of mental hygiene, told the Times. "Our primary message, as it is in all our initiatives, is to help people stop using drugs and to provide them with information on how to quit," Karpati said, adding that health officials recognized that quitting was not a realistic expectation for all drug users.

While Karpati was playing defense, harm reduction supporters went on the offensive. "The Health Department's booklet is solidly grounded in science and public health," said Ethan Nadelmann, executive director of the Drug Policy Alliance. "But the same cannot be said of the irresponsible comments by John Gilbride, Bridget Brennan, and Peter Vallone, Jr. These sorts of reckless statements by top level city and federal law enforcement agents need to be repudiated by their superiors in city and federal government."

On Monday, Mayor Bloomberg defended the pamphlet. "I would certainly not recommend to anyone that they use hard drugs or soft drugs," Bloomberg said. "But our health department does have an interest in if you're going to do certain things to get you to do it as healthily as you possibly can."

Now that the flap is behind them, two leading harm reductionists are assessing what it all means. "There was a political agenda at work with this," said Allan Clear, head of the Harm Reduction Coalition. "The District Attorney's Office fed this to the Post. This is a deliberate attack, and it follows on the footsteps of Rockefeller drug law reform, where DAs had some of their power stripped away. This was a red rag for foes to wave to provoke people, when the amount spent on the brochure is relatively small."

"This was not a book for people who have never injected," said Robert Heimer, professor at the Yale School of Public Health. "We know that people use opiates for around three years before they start injecting, and they don't do it because of a pamphlet, but because they are following their friends' example. This pamphlet was distributed at needle exchanges, STD clinics, drug treatment centers, and to people leaving Rikers Island. That's who the audience is, not people who have never injected."

Neither Clear nor Heimer thought much of the press coverage, although Clear was more charitable to the Times than Heimer. "The brochure has been deceptively portrayed consistently in all the articles," said Clear. "This is a manual aimed at people who are using injection drugs. The first thing it says is if you want help, call this number. If you compare the articles in the Post and the Times, the anti-drug user invective in the Post was just horrendous and demonstrated a very biased position to begin with," said Clear. "The conversation in the Times was much more pro-public health and sympathetic."

"The Times article was incredibly negative," said Heimer. "The first eight or ten paragraphs were all the opposition, and only after that do you get to the health department and why it's a common sense public health approach. When you have 'liberal media' like the Times and rightwing Murdoch papers like the Post both condemning you, you are under a lot of pressure to change."

When all is said and done, did the pamphlet flap turn out to be a boon or a bane for harm reduction? Again, the two men differed.

"When you get this on Fox News or CNN and people are talking about it, even though the initial effort was to discredit the brochure, it actually brought harm reduction to public consciousness in a good way," said Clear. "While we feel attacked, there has been a lot of positive response, and this has raised the profile of harm reduction and the need to educate drug users. The public reaction hasn't been that bad; in fact, it's been quite good."

"Any time there is negative press, it's not good for harm reduction," said Heimer. "It's still fragile here. In places like Holland, Britain, Canada, and Australia, harm reduction is one of the four pillars -- prevention, treatment, law enforcement, harm reduction -- but in this country, very little is done about prevention, there is not enough drug treatment because there is not enough emphasis on demand reduction, and we spend all our money on supply reduction, and we know how that has worked."

Feature: Fired Up in Albuquerque -- The 2009 International Drug Policy Reform Conference

Jazzed by the sense that the tide is finally turning their way, more than a thousand people interested in changing drug policies flooded into Albuquerque, New Mexico, last weekend for the 2009 International Drug Policy Reform Conference, hosted by the Drug Policy Alliance. Police officers in suits mingled with aging hippies, politicians met with harm reductionists, research scientists chatted with attorneys, former prisoners huddled with state legislators, and marijuana legalizers mingled with drug treatment professionals -- all united by the belief that drug prohibition is a failed policy.

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candlelight vigil outside the Albuquerque Convention Center (courtesy Drug Policy Alliance)
As DPA's Ethan Nadelmann said before and repeated at the conference's opening session: "We are the people who love drugs, we are the people who hate drugs, we are the people that don't care about drugs," but who do care about the Constitution and social justice. "The wind is at our backs," Nadelmann chortled, echoing and amplifying the sense of progress and optimism that pervaded the conference like never before.

For three days, conference-goers attended a veritable plethora of panels and breakout sessions, with topics ranging from the drug war in Mexico and South America to research on psychedelics, from implementing harm reduction policies in rural areas to legalizing marijuana, from how to organize for drug reform to what sort of treatment works, and from medical marijuana to prescription heroin.

It was almost too much. At any given moment, several fascinating panels were going on, ensuring that at least some of them would be missed even by the most interested. The Thursday afternoon time bloc, for example, had six panels: "Medical Marijuana Production and Distribution Systems," "After Vienna: Prospects for UN and International Reform," "Innovative Approaches to Sentencing Reform," "Examining Gender in Drug Policy Reform," "Artistic Interventions for Gang Involved Youth," and "The Message is the Medium: Communications and Outreach Without Borders."

The choices weren't any easier at the Friday morning breakout session, with panels including "Marijuana Messaging that Works," "Fundraising in a Tough Economy," "Congress, President Obama, and the Drug Czar," "Zoned Out" (about "drug-free zones"), "Psychedelic Research: Neuroscience and Ethnobotanical Roots," "Opioid Overdose Prevention Workshop," and "Border Perspectives: Alternatives to the 40-Year-Old War on Drugs."

People came from all over the United States -- predominantly from the East Coast -- as well as South Africa, Australia, Canada, Europe (Denmark, England, France, Hungary, the Netherlands, Poland, Portugal, Scotland, and Switzerland), Latin America (Argentina, Brazil, Colombia, and Mexico), and Asia (Cambodia and Thailand).

Medical marijuana was one of the hot topics, and New Mexico, which has just authorized four dispensaries, was held up as a model by some panelists. "If we had a system as clear as New Mexico's, we'd be in great shape," said Alex Kreit, chair of a San Diego task force charged with developing regulations for dispensaries there.

"Our process has been deliberate, which you can also read as 'slow,'" responded Steve Jenison, medical director of the state Department of Health's Infectious Disease Bureau. "But our process will be a very sustainable one. We build a lot of consensus before we do anything."

Jenison added that the New Mexico, which relies on state-regulated dispensaries, was less likely to result in diversion than more open models, such as California's. "A not-for-profit being regulated by the state would be less likely to be a source of diversion to the illicit market," Jenison said.

For ACLU Drug Policy Law Project attorney Allen Hopper, such tight regulation has an added benefit: it is less likely to excite the ire of the feds. "The greater the degree of state involvement, the more the federal government is going to leave the state alone," Hopper said.

At Friday's plenary session, "Global Drug Prohibition: Costs, Consequences and Alternatives," Australia's Dr. Alex Wodak amused the audience by likening the drug war to "political Viagra" in that it "increases potency in elections." But he also made the more serious point that the US has exported its failed drug policy around the world, with deleterious consequences, especially for producer or transit states like Afghanistan, Bolivia, Colombia, Mexico, and Peru.

At that same session, former Mexican foreign minister Jorge Castaneda warned that Latin American countries feel constrained from making drug policy reforms because of the glowering presence of the US. Drug reform is a "radioactive" political issue, he said, in explaining why it is either elder statesmen, such as former Brazilian President Cardoso or people like himself, "with no political future," who raise the issue. At a panel the following day, Castaneda made news by bluntly accusing the Mexican army of executing drug traffickers without trial. (See related story here).

It wasn't all listening to panels. In the basement of the Albuquerque Convention Center, dozens of vendors showed off their wares, made their sales, and distributed their materials as attendees wandered through between sessions. And for many attendees, it was as much a reunion as a conference, with many informal small group huddles taking place at the center and in local bars and restaurants and nearby hotels so activists could swap experiences and strategies and just say hello again.

The conference also saw at least two premieres. On the first day of the conference, reporters and other interested parties repaired to a Convention Center conference room to see the US unveiling of the British Transform Drug Policy Foundation publication, After the War on Drugs: A Blueprint for Legalization, a how-to manual on how to get to drug reform's promised land. Transform executive director Danny Kushlick was joined by Jack Cole of Law Enforcement Against Prohibition, Sanho Tree of the Institute for Policy Studies, Deborah Small of Break the Chains, and DPA's Nadelmann as he laid out the case for moving beyond "what would it look like."

"There's never been a clear vision of a post-prohibition world," said Kushlick. "With this, we've tried to reclaim drug policy from the drug warriors. We want to make drug policy boring," he said. "We want not only harm reduction, but drama reduction," he added, envisioning debates about restrictions on sales hours, zoning, and other dreary topics instead of bloody drug wars and mass incarceration.

"As a movement, we have failed to articulate the alternative," said Tree. "And that leaves us vulnerable to the fear of the unknown. This report restores order to the anarchy. Prohibition means we have given up on regulating drugs; this report outlines some of the options for regulation."

That wasn't the only unveiling Thursday. Later in the evening, Flex Your Rights held the first public showing of a near-final version of its new video, 10 Rules for Dealing with Police. The screening of the self-explanatory successor to Flex Your Right's 2003 "Busted" -- which enjoyed a larger budget and consequently higher production level -- played to a packed and enthusiastic house. This highly useful examination of how not to get yourself busted is bound to equal if not exceed the break-out success of "Busted." "10 Rules" was one of a range of productions screened during a two-night conference film festival.

The conference ended Saturday evening with a plenary address by former New Mexico Gov. Gary Johnson, who came out as a legalizer back in 2001, and was welcomed with waves of applause before he ever opened his mouth. "It makes no sense to spend the kind of money we spend as a society locking up people for using drugs and using the criminal justice system to solve the problem," he said, throwing red meat to the crowd.

We'll do it all again two years from now in Los Angeles. See you there!

Feature: Veterans Incarcerated and Ignored When They Could Be Getting Help, Report Finds

Roughly 200,000 US veterans are in prison or jail, many of them there because of substance abuse or mental health issues, according to a new report released Wednesday. The report outlines the problem and suggests reforms that could ease the plight of American soldiers returning from the war zone and trying to make the transition back to civilian society.

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VA Medical Center, Columbia, MO
According to the report, 140,000 vets were in prison in 2004, with tens of thousands more serving time in jails. Nearly half (46%) of vets doing time in federal prison were incarcerated for drug offenses, while 15% of those in state prison were, including 5.6% doing time for simple possession. Three out five (61%) of incarcerated vets met the criteria for substance dependence or abuse.

The report, Healing a Broken System: Veterans Battling Addiction and Incarceration, comes at a critical time. With hundreds of thousands of soldiers currently deployed in Iraq and Afghanistan, the US faces a mounting challenge in caring for returning vets.

Many are returning home damaged by their experiences. According to the report, 30% of Iraq and Afghanistan veterans report symptoms of Post-Traumatic Stress Disorder (PTSD), traumatic brain injury, depression, mental illness, or other cognitive disability. These medical conditions, if left untreated, can contribute to problematic drug use, addiction, and fatal overdoses, as well as homelessness, suicide, and criminality, particular violations of the drug laws.

While the study mentions 200,000 vets behind bars, the number is most likely much higher. That's because owing to problems in data collection -- a problem in itself -- the last year for which hard numbers on vets behind bars is available was 2004. Since then, more than a million more vets have returned from their deployments and mustered out.

The report had its genesis about a year and a half ago, when the Drug Policy Alliance (DPA) teamed up with a classroom of law students at Northeastern University in Boston to investigate the obstacles veterans were facing in obtaining adequate access to mental health and substance abuse services. In addition to a series of surprising and dramatic findings, the report also includes a list of specific recommendations about how to improve services for vets suffering mental health and substance abuse issues.

"We learned that far too many returning vets are falling victim to the war on drugs because of barriers to effective treatment," said DPA's Dan Abrahamson at a Wednesday press conference. "There are nearly a quarter million vets behind bars right now for crimes motivated in part by mental health or drug addiction problems. One third of returning vets report symptoms of Post-Traumatic Stress Disorder (PTSD). Also, vets suffer from traumatic brain injury, depression, and mental illness at higher rates than normal. All of those are contributory factors to substance abuse and drug addiction, as well as overdose, homelessness, suicide, and being arrested for a non-violent drug offense."

In the battle theater, soldiers are supposed to function despite high stress, and the military is more than willing to prescribe them whatever it takes to keep them fighting. But it's a different story when the vets come home.

"Service-related drug dependency is being talked about quite a bit in the veterans community, but is not well understood outside the military," said Tom Tarantino, an Iraq war veteran and now legislative associate for Iraq and Afghanistan Veterans of America. "The ease of obtaining prescriptions in theater is staggering," he explained. "I know crack dealers who are more discriminating about issuing drugs than some of the medics I saw in Iraq. It's alarming how many people were just given anti-depressants instead of asking whether they were really fit for duty," said the veterans' lobbyist.

"Sometimes, it's just a matter of expediency and life in a combat zone, but then you have vets coming back from an environment where meds are very loosely prescribed and they are confronted with a medical system much more stringent about issuing drugs," Tarantino explained. "And that can cause problems."

"Let's be smarter than the problem," said veterans' advocate Guy Gambill. "We can't afford not to be. We arrest too many people and incarcerate them for too long. Then the mark of a criminal record keeps them from getting jobs, housing, and other services, and then the recidivism rate goes up."

There are things that can be done, Gambill said. States can change their incarceration policies. Localities can be more proactive.

"Chicago police and the LAPD are doing front-end interventions," Gambill noted. "In LA, trained peer specialists are doing ride-alongs with the LAPD so the officers will recognize Iraq and Afghanistan war vets. In Chicago, police are doing crisis intervention training, and the first hundred of them are all Iraq and Afghanistan vets. They'll try to grab these guys at first contact and get them into treatment instead of jail. These sorts of peer-led interventions work very well. We need to catch this on the front end, so we don't have 200,000 homeless vets on the streets like we do now."

Another stumbling block is the Department of Veterans Affairs current policy on drug treatment for vets. The VA is willing to offer treatment, but not for vets behind bars.

"We need the Department of Veterans Affairs to lift their ban on drug treatment of incarcerated vets," said Tarantino. "We're pleased that the department now has a justice coordinator at every VA hospital, but they're waiting outside the prison door, not inside, when the vets need it most. This is a regulation they can change with the stroke of a pen," he said.

Yet another problem for vets, especially those with substance abuse issues, is the lack of access to proven treatments. And because the insurance provided to soldiers by the armed forces also covers their families, lack of access to treatment affects them as well.

"Vets don't qualify for substance abuse treatment unless they are diagnosed with PTSD," said Abel Moreno, a former Army sergeant who saw service in both theaters and who now works with veterans through his organization Vets 4 Vets. "We are fighting two wars at once. It's obvious PTSD exists, and it's clear there are going to be substance abuse issues. We've created a subgenre among today's vets where there is a pain pill-popping mitigation ideal. We need quantified data so we can attack this situation head on," he said.

It's not only in failing to provide drug treatment absent a PTSD diagnosis where the DOD falls down, said Dr. Bob Newman, MD, director of the Rothschild Chemical Dependency Institute at Beth Israel Medical Center in New York City. "Tricare, the Department of Defense insurance plan refuses to pay for maintenance treatment of addiction with methadone or buprenorphine," he noted. "Maintenance therapy is not a new idea. It's endorsed by agencies such as NIDA, SAMHSA, the Institute of Medicine, and the World Health Organization. The US government supports this, yet DOD has an insurance plan that excludes maintenance treatment without explanation. That's outrageous," he said.

Tricare insures not only military personnel, but also their families. Tricare's refusal to pay for maintenance therapy nearly cost Teresa Bridges her daughter. Teresa's daughter, Amanda, married a soldier, Sgt. Shawn Dressler. Dressler was killed in combat shortly after the couple were wed, and Amanda retreated into a haze of Lortab and Tramitol. Tricare paid for her treatment, but after a year, her doctor noted on her records that she was being subscribed maintenance doses of Suboxone.

"Suddenly, Tricare dropped her like a hot potato," Bridges said. "Tricare believes taking Suboxone is just substituting one addictive drug for another -- at least that's what they told me. Amanda has done well on Suboxone, and if she stops taking it, she will eventually relapse. Fortunately, she is now in a temporary assistance program, but that will end after a year."

There are potential reforms that could ease the plight of returning vets, the report said. Among them are:

  • Changes in state and federal statutes to focus on treatment instead of incarceration for veterans who commit nonviolent drug-related offenses.
  • Adoption by government agencies of overdose prevention programs and policies targeting veterans who misuse substances or take prescription medications.
  • Significantly expanded access for veterans to medication-assisted therapies such as methadone and buprenorphine to treat opioid dependence.

"The care and feeding and support of vets is a national concern and responsibility," said Gen. Stephen Xenakis, MD, Special Adviser to the Chairman of the Joint Chiefs for Staff, Warrior & Family Support . "We are looking to knit together all the various services and institutions so that the soldier who has served and come home and ends up having problems or maybe ended up incarcerated gets treatment from all the sources available."

One of the big problems, said Tarantino, is lack of hard information. He noted that the Justice Department numbers in the report are from 2004. "In 2004, there were over one million fewer vets than there are today," he said. "We don't know how many vets are behind bars right now. We have no method for tracking vets unless they interact with some social services. We need to have DOD and DOJ compare lists. We need data," he said.

Lack of coordination among agencies dealing with vets is part of the problem, said Xenakis. "We need to better configure what we're doing," he said. "Records are not shared. The Department of Justice doesn't have access to Department of Defense records. We need to get organized so we can track people over time."

That effort has the support of the Pentagon, Xenakis said. "Our leadership heartily endorses this," he said. "It is really important that this information that this information is out there now, and that we follow it with the best action plans we can create. As a country, we have a responsibility to support our vets."

MPP of Nevada Asks Law Enforcement: How Does Steering Adults Toward Alcohol Make Us Safer?

MEDIA ADVISORY                                                                                                            
NOVEMBER 3, 2009

 

MPP of Nevada Asks Law Enforcement to Explain How Steering Adults Toward Alcohol Over Marijuana is Making Us Safer
Demand comes as major new report shows marijuana arrest rates in Nevada increasing faster than the national average, while binge drinking in Nevada is also growing steadily

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

LAS VEGAS — At a news conference on Thursday in front of the new Las Vegas Metropolitan Police Department Headquarters construction site, the Marijuana Policy Project of Nevada will ask law enforcement officials to explain how steering adults toward the use of alcohol instead of marijuana is making our communities safer. Specifically, MPP-NV will display a sign asking members of law enforcement to complete this sentence: “Steering adults away from marijuana use and toward alcohol makes us safer by ___________.”

     This event coincides with the release of the most exhaustive collection of data ever on U.S. marijuana arrests, penalties and related information. Assembled by Professor Jon Gettman at Shenandoah University in Virginia, the new report finds that marijuana arrests in Nevada increased from 4,504 in 2003 to 7,950 in 2007. The arrest rate for possession per 100,000 residents in Nevada increased 57.9% over that time period, compared to just 12.7% in the U.S. While Nevada law enforcement was using its power to punish and intimidate marijuana users, binge drinking rates in the state rose 16% in those four years, but just 1.8% nationally.

     Who: Dave Schwartz, manager, Marijuana Policy Project of Nevada

     What: Press conference to challenge Nevada law enforcement’s marijuana arrest rates

     When: Thursday, November 5, at 11:00 a.m.

     Where: Southeast corner of Alta Blvd and Martin Luther King Blvd, Las Vegas, NV

      MPP of Nevada is a non-profit 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: 
Las Vegas, NV
United States

Tell the Drug Czar...

One week ago today, Office of National Drug Control Policy Director Gil Kerlikowske (aka the Drug Czar) issued a statement declaring the issue of marijuana legalization a "non-starter" not even worthy of discussion in the Obama Administration.

The Drug Czar's statement also highlighted the extraordinary social and health care costs associated with widespread alcohol use, suggesting that similar problems would occur if marijuana were to be regulated and treated like alcohol.  Yet every objective study on marijuana has concluded that it is far less harmful than alcohol both for the user and for society.

In response to the Drug Czar's statement, SAFER has launched an on-line petition, calling on the drug czar to either start basing our nation's drug policies on reason and evidence instead of mythology and ideology, or start explaining why he'd prefer adults use alcohol instead of a far safer substance -- marijuana. 

Please visit http://tinyurl.com/yj32wxb or click on the button to the right to sign the petition today. Then forward word of it to anyone who might be interested in siging on before we present it to the drug czar.

Along with launching the petition, SAFER has issued...

An Open Letter to the Drug Czar About Marijuana Legalization

On the afternoon of Friday, October 23, at a time when government bureaucrats make announcements they hope will not be picked up by the media, you issued a statement boldly declaring:

Marijuana legalization, for any purpose, remains a non-starter in the Obama Administration. It is not something that the President and I discuss; it isn't even on the agenda.

As the individual most directly responsible for marijuana policy in this country, this seems utterly irresponsible.  Worse, your decision does not appear to be based on reason or evidence.

Let's begin with one glaringly obvious omission in your statement. You failed to cite a single societal or health-related harm caused by the use of marijuana. Not one! Instead, you offered up some weak guilt-by-association scare tactics.

To test the idea of legalizing and taxing marijuana, we only need to look at already legal drugs -- alcohol and tobacco. We know that the taxes collected on these substances pale in comparison to the social and health care costs related to their widespread use.

Apparently, you believe that marijuana users should be punished and perhaps even jailed because alcohol, tobacco and pharmaceutical drugs are so harmful to users and society.

Sorry, Mr. Kerlikowske, but that just doesn't cut it. If you are going to remain closed-minded in your approach to marijuana, you are going to need to step it up. Unfortunately, you know as well as we do that you don't have a whole lot going for you, which explains your flaccid, evidence-free statement.

Sadly, we have come to expect this kind of nonsensical garbage from our nation's drug czars. (After all, you have Kevin Sabet, a Bush Administration holdover and former speechwriter for his drug czar,

John Walters, feeding you the same old lines.) But what makes your position on marijuana legalization even more shameful is your background as a law enforcement officer on the streets.

You know -- and maybe at some point during your tenure you will have the guts to admit -- that alcohol is really the drug in our society that causes the greatest amount of harm. This isn't an attempt to demonize alcohol, mind you; it's simply based on alcohol's close association with serious health problems and violent crime, as documented by scientific research and government statistics. The use of marijuana, on the other hand, does not have serious health consequences and is not associated with violent behavior.

Again, you know this from your time on the streets. If you've forgotten, just recall the alcohol-fueled Seattle Mardi Gras riot that occurred on your watch. Or ask you're predecessor, Gen. Barry McCaffrey, who called alcohol "the most dangerous drug in America today," during a 1999 ONDCP press conference.

So just why is it that you want to punish people who use marijuana, when you know the likely result is that many of these people will simply turn to using alcohol instead? Ya know, because it's "legal."

We don't want to hear that alcohol does not fall under the mission of ONDCP. You, sir, raised the subject by asserting -- contrary to everything known about the two substances -- that we should look at our experience with alcohol if we want to get a sense of the potential social and health care costs associated with more widespread marijuana use. Moreover, given that the two substances are so popular in our society, you simply cannot discuss the prohibition of marijuana without considering its impact on alcohol usage rates.

You hold a great deal of power in your hands. You can help determine whether we continue to steer adults toward using alcohol -- which you know produces serious societal harms -- or whether we instead allow them to make the rational choice to use a safer substance: marijuana.

Come on. Show us that it is possible to be the drug czar and be thoughtful, open-minded, and accepting of scientific evidence at the same time. Or, at the very least, why don't you find some actual statistics to back up your bluster?


Feature: Historic Hearing on Marijuana Legalization in the California Legislature

In an historic hearing Wednesday, the California legislature examined the pros and cons of marijuana legalization. The hearing marked the first time legalization has been discussed in the legislature since California banned marijuana in 1913.

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Ammiano press conference for hearing
Onlookers and media packed the hearing room for the three-hour session. Capitol employees had to hook up remote monitors in the hallway for the overflowing crowd of supporters and opponents of marijuana legalization.

The hearing before the legislature's Public Safety Committee was called for and chaired by Assemblyman Tom Ammiano (D-SF), who earlier this year introduced AB 390, a bill that would legalize, regulate, and tax marijuana in the state. While Ammiano has made clear that he supports legalization, the witness list for the hearing was well-balanced, with legislative analysts and representatives of law enforcement as well as reform advocates in the mix.

The hearing began with testimony from legislative analysts, who estimated that the state could realize tax revenues ranging from hundreds of millions to nearly $1.4 billion a year from legalization. The latter figure was from the state Board of Equalization, while the lower estimates came from the Legislative Analyst's Office.

But tax revenues wouldn't be the only fiscal impact of legalization. "If California were to legalize, we would no longer have offenders in state prison or on parole for marijuana offenses," noted Golaszewski. "We estimate the savings there at several tens of millions of dollars a year. There would also be a substantial reduction in the number of arrests and criminal cases law enforcement makes. To the extent they no longer have to arrest people for marijuana, they could shift resources elsewhere."

Golaszewski said there are roughly 1,500 people imprisoned on marijuana charges in California, 850 of them for possession offenses.

The analysts were followed by a panel of attorneys who debated the legality of state legalization. "If California decides to legalize, nothing in the Constitution stands in its way," said Tamar Todd, a staff attorney for the Drug Policy Alliance Network.

But while Marty Mayer, attorney for the California Peace Officers Association (CPOA), generally agreed with that assessment, he also argued that the state could not unilaterally legalize. "The state of California cannot unequivocally legalize marijuana," he said, noting that marijuana is prohibited under federal law.

Next up were the cops, and there were no surprises there. "Marijuana radically diminishes our society," said CPOA president John Standish. "Marijuana is a mind-altering addictive drug that robs you of memory, motivation, and concentration," he said before Ammiano cut him short, noting that the purpose of the hearing was to discuss public safety and economic impacts of legalization, not to debate marijuana's effects on health.

"Alcohol and cigarettes are taxed to the hilt, but the taxes don't cover the cost of medical treatment, let alone DUIs," Standish continued. "This would lead to an increase in crime rates, social costs, medical costs, and environmental concerns. There is also a very real concern that Mexican drug cartels are behind most of the imported marijuana coming into the US," he added, without explaining what that had to do with legalizing marijuana production in California.

And, pulling out yet another woolly chestnut, Standish resorted to the old and discredited "gateway theory" that marijuana use is a stepping stone to hard drug use. "Marijuana is a gateway drug," he said. "Every incident in 30 years of law enforcement I have been in where marijuana has been involved has not been good. Both marijuana and methamphetamine are equally critical problems," he said.

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overflow room
After reciting a short list of violent incidents around large-scale illegal grows allegedly operated by Mexican drug cartels, Sara Simpson, acting assisting chief of the Attorney General's Bureau of Narcotics Enforcement, warned that the cartels were likely to try to maintain their market share. "That could lead to more violence," she warned.

"Legalizing marijuana is bad public policy," said Simpson. "A significant number of marijuana users are incapacitated," she claimed. "When a recreational drug user backs over your four-year-old, you consider yourself a victim of violent crime. Legalization would increase death and injury totals."

"Why would we want to legalize a substance known to cause cancer?" asked Scott Kirkland, chief of police in El Cerrito and chairman of the California Police Chiefs' Medical Marijuana Task Force. "Legalization will only result in increased use of marijuana with a corresponding increase in drugged driving," he warned.

But later witnesses said that California was simply wasting resources by arresting marijuana offenders. Dan Macallair, executive director of the Center on Juvenile and Criminal Justice, said that arrest statistics from the past 20 years show that California law enforcement is more focused on prosecuting simple possession cases than cultivation and sales.

"California's drug war, particularly on marijuana, is focused on drug users," he said. "Virtually every category of crime has declined since 1990, except for a dramatic increase in arrests for marijuana possession. In 1990, there were 20,834 arrests for possession. Last year, there were 61,388 arrests. "

This was going on while arrests for all other drug offenses declined, Macallair said. For all other drugs, arrests were down 29%. Even marijuana manufacture and sales arrests had declined by 21%. More people went to prison in California in 2008 for marijuana possession than for manufacture or sales, he added.

"Our courtrooms are full every day with marijuana cases," said Terence Hallinan, the former San Francisco City and County District Attorney. "It's still against the law to sell even a gram. There are a lot of people in court and jail for marijuana offenses."

The Rev. Canon Mary Moreno Richardson of St. Paul's Episcopal Cathedral in San Diego told the committee marijuana law enforcement has especially pernicious effects on the young. "When they find a group of kids with a joint, they take them all in to juvie. When they're incarcerated, they join gangs for safety. Jails have become the boot camps for the gangs," she said. "We need to think about and protect our youth."

"I speak on behalf of California's millions of marijuana users who are tired of being criminals and would like to be taxpaying, law-abiding citizens," said Dale Gieringer, executive director of California NORML. "We think it makes no sense for taxpayers to pay for criminalizing marijuana users and their suppliers when we could be raising revenues in a legal market."

"Today, our marijuana laws are putting our children in harm's way," said retired Orange County Superior Court Judge James P. Gray. "We want to reduce the exposure of a lifestyle of marijuana use and selling to our children, but prohibition's illegal dealers don't ask for ID," he said.

At the end of the hearing, Ammiano opened the floor to public comment. While most speakers supported legalization, a contingent of conservative African-American religious leaders vigorously denounced it. "I know from personal experience the devastation that occurs in one's life and community as a result of drug abuse that began with marijuana," said Bishop Ron Allen, founder and president of the International Faith Based Coalition.

Also in opposition was Californians for Drug Free Youth. John Redman, the group's director, said legalizing marijuana to raise revenues was reprehensible. "This is blood money, pure and simple," Redman said.

The battle lines are shaping up. On one side are law enforcement, conservative clerics, and anti-drug zealots. On the other are researchers, activists, and, evidently, the majority of Californians. Ammiano gave as a handout at the hearing a sheet listing at least six recent polls showing majority support for marijuana legalization in the state.

The bill isn't going anywhere for awhile. Ammiano said he will hold more hearings later and may revise it based on the hearings. But marijuana legalization is now before the legislature in California.

Feature: Busted for Handing Out Clean Needles -- The Mono Park 2 Fight Back in California's Central Valley

Hit hard by a double whammy of drought and economic slowdown, California's Central Valley has become a hotbed of methamphetamine and other injection drug use. Now, the dusty town of Modesto, in Stanislaus County, has become a focal point in the statewide and nationwide battle over how to help injection drug users. Last week, two volunteers at an unsanctioned needle exchange were in court in Modesto hoping to reach a plea bargain after they were arrested in April for handing out syringes. Now known as the Mono Park 2, they're looking at serious jail time for trying to save lives.

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mobile needle exchange/clinic site in nearby Fresno
The deal was supposed to be that Stanislaus County District Attorney Birgit Fladager would drop drug paraphernalia possession charges against exchange volunteers Kristy Tribuzio and Brian Robinson if they agreed to quit handing out needles until there was a legal program in place. But that didn't happen. Instead, at the last minute, the DA rejected the plea deal. Another hearing is set for November 9. If the DA and defense attorneys cannot reach agreement then, the case will go to trial.

The case has its genesis in longstanding efforts to win official approval for a needle exchange in Modesto. California law allows for needle exchanges, but only as a local option. The county board of supervisors must declare a health emergency in order for needle exchanges to operate legally.

In a 2008 report, Containing the Emerging Threat of Hepatitis through a Syringe Exchange Program (begins on page 22), the Stanislaus County Civil Grand Jury recommended the county authorize syringe exchanges and implement them either directly or through a community based contractor. The effort also had the support of county public health officials, including Public Health Department, the Advisory Board for Substance Abuse Programs, the Local AIDS Advisory Implementation Group, and the Hepatitis C Task Force, who cited a high incidence of Hepatitis C. They cited research indicating that needle exchanges reduced the spread of blood-borne diseases, brought injection drug users into contact with public health workers, and did not result in increases in drug use.

But despite the input from the public health community and the grand jury report, the Stanislaus County Board of Supervisors a year ago voted unanimously against allowing needle exchanges. In so doing, they heeded their own prejudices and those of law enforcement over science-based policies and the advice of the public health community.

County Sheriff Adam Christianson and DA Fladager both spoke out against needle exchanges, saying they would enable drug users to continue their addiction. Fladager said needle exchanges sent the wrong message to young people and encouraged them to think the county would take care of them if they become addicted.

"All of the challenges we are faced with in Stanislaus County, the gangs, methamphetamine, crimes, all have elements of drug addiction," Christianson said. "A syringe exchange program enables people to continue with their drug addiction."

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used syringes collected by exchange -- they might otherwise have been discarded in public places
Noting that Hep C was not a big issue for the county because most patients are covered by insurance, Supervisor Bill O'Brien also objected on bizarre moral grounds. "Then there's the human issue. Giving a drug user a clean needle is not the best thing for him. Illegal drug use has a risk, and making it safer promotes it," he said.

Supervisor Jim DeMartini thanked the grand jury for the report, but then dismissively added, "Like many well-intentioned programs that don't work out, this will never work out and deliver the benefits promised."

Too bad the sheriff, the DA, and the county board don't agree with the nation's drug czar. "Needle exchange programs have been proven to reduce the transmission of blood-borne diseases," Gil Kerlikowske told Congress during confirmation hearings earlier this year. "A number of studies conducted in the US have shown needle exchange programs do not increase drug use. I understand that research has shown these programs, when implemented in the context of a comprehensive program that offers other services such as referral to counseling, healthcare, drug treatment, HIV/AIDS prevention, counseling and testing, are effective at connecting addicted users to drug treatment."

Given the knowledge base about the effectiveness of exchanges and the evident human need for them in Modesto, needle exchange advocates were not content to simply roll over and die. Instead, they created an unauthorized needle exchange in the city's Mono Park, also known as needle park by residents because of the used needles littering the ground there. The program was publicized and went along on a low-level basis without a hitch until April, when, after an elaborate undercover sting, police swooped down and arrested the exchange volunteers.

Kristi Tribuzio just happened to be volunteering with the needle exchange the day the bust went down. Now, she's one of the defendants. "There was a direct need for this, and when I found out there was an existing exchange -- I saw a flyer on a telephone pole -- I asked how is this happening?" she said. "I got involved; I was just going out there for the people. An undercover cop came up and did an exchange, and then, a little later eight to 10 undercover officers drove up with a drug dog and arrested us. It was pretty harsh and crazy," she recalled.

"Looking back, Brian and I think it was maybe naive of us to just go out there and do something that was helping people in line with other syringe exchange programs," said Tribuzio. "We didn't understand what the consequences could be."

Now, she and Robinson face up to a year in jail for violating the paraphernalia law. For Tribuzio, there were other consequences, including the loss of her contract position with the Stanislaus County drug and alcohol education and prevention program. "I was laid off two days after I was arrested. Because I was a contract worker, they didn't need a reason to fire me, and no official reason was given. Ironically, my employer supports needle exchange," she said. "Maybe that's why they laid me off instead of firing me for cause. Now, at least, I can get unemployment."

Tribuzio had previously worked as a substitute teacher, but she can't do that now, either. "I'm getting an MA in education, and I have a teaching credential, but my credential is now suspended," she said. "Imagine, a teacher in San Francisco could be doing just what I did, and there would be no problem."

That's because needle exchanges have been authorized by the San Francisco County Board of Supervisors, just as they have in most large California cities. But in more conservative locales, like the Central Valley, the fight is more difficult, and therein lies the problem -- and the solution -- said one prominent harm reductionist.

"What we need is to get legislation authorizing syringe exchanges on a statewide level rather than our current system, which requires that they be authorized by local authorities," said Hilary McQuie, Oakland-based Western director of the Harm Reduction Coalition. "Requiring local authorization means we have to deal with 54 jurisdictions instead of just one, and the politics makes it really difficult in conservative places like Fresno or Modesto. It will be really difficult to get syringe exchange approved in Modesto without a statewide mandate," she said.

Short of that, needle exchange advocates need to carefully lay the groundwork beforehand, she said. In that respect, the Modesto needle exchange perhaps suffered from political naivete. "The effort with the grand jury in Modesto was done in good faith, but the grand jury finding required a response from the Board of Supervisors within three months," she noted. "They hadn't really lined up their support with the Board, and the Board ended up voting against it. That was problematic."

While personally difficult for Tribuzio and Robinson, the battle over needle exchanges in Modesto has moved the issue forward locally and stirred support from around the country and the world. A Mono Park 2 Defense Committee has formed to back them. At last week's hearing, more than a dozen supporters were present in court, and the pair had letters of support from some 35 public health and harm reduction organizations here and abroad.

"We've gotten a ton of support from the harm reduction community," said Tribuzio. "This whole thing has been stressful and overwhelming for us, but they've given us a wealth of training, knowledge, and support, more than we ever expected. We've gotten support from people in other exchanges, and letters of support from around the world. We've also been building alliances with people in the community. Things in the Central Valley are crazy, and we can't turn our heads away in the face of disease. Now, at least, people are paying attention."

While Robinson and Tribuzio wait for their legal problems to be resolved, they continue to work with at-risk communities. "After the bust, we started Off The Streets, and that does everything except for needle exchange," said Tribuzio. "We're doing needs assessments, trying to get our fingers on the pulse of the community, trying to help where we can."

For McQuie, the trials and tribulations of the Mono Park 2 are, sadly, par for the course. "This is how most of the programs got started, doing them illegally, so they're in good company," she said.

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."

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.

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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.

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