In a blistering op-ed last Wednesday in Spain's most important newspaper, El País, the country's former drug czar, Araceli Manjón-Cabeza, called for an end to drug prohibition. Manjòn-Cabeza's call for legalization comes just a week after former Spanish Prime Minister Felipe González also called for drug legalization.
Manjón-Cabeza is the former director general of Spain's National Drug Plan, a former judge in the criminal chamber of the Audiencia Nacional, Spain's equivalent of the Supreme Court, and is currently professor of criminal law at Complutense University in Madrid.
"Prohibitionism, installed in the United States at the beginning of the 20th Century, and imposed by that country on the rest of the planet, has failed," Manjòn-Cabeza wrote. "There are multiple law enforcement and public health reasons that recommend legalization."
Citing a list of pro-legalization luminaries ranging from economist Milton Friedman to novelist Mario Vargas Llosa, author Paulo Coehlo, and Latin American ex-presidents Henrique Cardoso, Ernesto Zedillo, and Cesar Gaviria, and the 17,000 people who have signed the Vienna Declaration calling for science- and evidence-based drug policies, Manjón-Cabeza argues that the bloodshed in Mexico as "the clearest proof" of the futility of drug prohibition.
"Mexico provides the clearest, but not the only, proof of the failure and unbearable costs of continuing [drug prohibition]," she wrote. "Since 2006, President Calderon's war on drugs has provoked two wars -- one unleashed among the drug traffickers and one by the state against organized crime -- and 30,000 dead (900 were minors under age 17)."
While drug use might go up temporarily under legalization, that must be weighed against other "beneficial effects," she wrote: "Quality control for the substances, which would prevent the ills associated with consumption of illegal poisons that exist today; reductions in price, which would drastically reduce the indices of drug-induced delinquency; delivering consumers from especially unhealthy and dangerous markets, in order to lead them to a legal and controlled market."
But there is more, Manjón-Cabeza wrote: "It would deprive organized crime of its favorite and most profitable activity, deprive it of part of its ability to corrupt public and private wills and infiltrate the licit economy, it would dispense with the legal exceptionality demanded by the persecution and repression of the drug trade, which, at times, brings us to the limit of what the state of law is able to support; it would make vanish the pretext of the United States that an effective struggle against the drug trade justifies its intervention in the affairs of other countries punished by that whip."
Many so-called "drug problems" are really the "children of prohibition," Manjón-Cabeza wrote. The US's prohibitionist crusade beginning a century ago was not inspired by public health concerns, but by "racist motives... economic motives... political motives," including "finding one of the pretexts -- others have been communism and Islamic terrorism -- to legitimize the intervention of a great power in the evolution of other countries."
She ends her op-ed thusly: "Launching whatever legalizing option inspires vertigo, overthrowing prohibition won't be easy, but maintaining global drug prohibition is madness."
One more voice in the growing anti-prohibitionist chorus. And a highly respected one at that.
Frustrated that people continued to consume so much alcohol even after it was banned, federal officials had decided to try a different kind of enforcement. They ordered the poisoning of industrial alcohols manufactured in the United States, products regularly stolen by bootleggers and resold as drinkable spirits. The idea was to scare people into giving up illicit drinking. Instead, by the time Prohibition ended in 1933, the federal poisoning program, by some estimates, had killed at least 10,000 people.
It's a nightmarish tale of prohibitionist lunacy that's worth reading in its entirety. Government officials were viciously calculating in their actions and callously blamed naïve drinkers for the consequences.
Today, prohibition kills people in different, yet equally abhorrent and unnecessary ways. Its advocates continue to deny responsibility for the predictable and inevitable consequences of the policies they defend and the death toll has grown to incalculable proportions, spanning the globe. The drug war leaves sickness and murder in its wake at every turn, yet many among us remain blind to the lessons learned nearly a century ago.
Prohibition: Contaminated Drug Supply Threatening Cocaine Users in North America, Heroin Users in Europe
Problems with contaminated drug supplies reemerged on two fronts this week, with health authorities in Scotland announcing another case of anthrax among heroin users and health authorities in Quebec warning that cocaine continues to be contaminated with levamisole, a veterinary de-worming agent.
"There is no way to tell if your heroin is contaminated and there is no way to take heroin which we can advise is safer or less likely to result in illness or death if it has anthrax contamination," warned Dr. Colin Ramsey, consultant epidemiologist for Health Protection Scotland. "Drug users are advised that the only way to avoid the risk of anthrax in this outbreak is not to take heroin. While we appreciate that this may be extremely difficult advice to follow, it remains the only public health protection advice possible due to the nature of anthrax infection."
Such advice dismays harm reductionists, who have called for more informational campaigns and the prescribing of pharmaceutical heroin to addicts.
Users should seek urgent medical attention in the event of symptoms such as redness or swelling at or near an injection site, or other symptoms of general illness such a fever, chills or a severe headache, as early antibiotic treatment can be lifesaving, Health Protection Scotland said. Marked swelling of a limb which has been used as an injection site is a particularly important sign of possible anthrax infection.
Meanwhile, in Montreal, the National Public Health Institute of Quebec has issued a report on levamisole contamination in cocaine (sorry, French only) in the province. According to that report, eight out of 10 blood samples taken from known cocaine users in Quebec contained the cutting agent.
When ingested by humans, levamisole can cause nausea, dizziness, and diarrhea. Chronic use can lead to neutropenia, a potentially lethal blood disorder, or a related condition, agranulocytosis.
The US DEA first reported the presence of levamisole in cocaine in 2002 and its use is on the rise. In November 2009, Center for Substance Abuse and Mental Health Services published a survey indicating that 70% of cocaine seized in the US contained levamisole.
Back in September, we reported on the appearance of cocaine cut with levamisole, a veterinary de-worming agent, and its links to at least three deaths in the US and Canada from a disease caused by levamisole, agranulocytosis. At that time, the DEA reported that levamisole was turning up in about 30% of the cocaine it sampled.
Levamisole suppresses immune function and the body's ability to fight off even minor infections, and people who ingest levamisole-tainted cocaine can be faced with quickly-developing, life-threatening infections. Agranulocytosis is a condition of suppressed immune systems. Its symptoms include chills or high fever, weakness, swollen glands, painful sores, sudden or lingering infections, skin infections, abscesses, thrush, and pneumonia.
Cocaine contaminated with levamisole, although not users with agranulocytosis, has also popped up in the last few days in Maine and Ohio. Samples of crack cocaine in Mansfield, Ohio, tested positive late last month. And public health officials reported Tuesday that 30% to 50% of Maine cocaine samples tested positive.
The Substance Abuse and Mental Health Services Administration (SAMHSA) put out an alert late in September warning of the tainted cocaine, but federal authorities have done little publicly since then.
Given the geographically widespread reports of cocaine contaminated with the veterinary drug, it is assumed that levamisole is being added as a cutting agent either in source countries or in transit countries, not by local dealers.
English authorities announced Wednesday that a Blackpool heroin user died of anthrax, making him the first fatality in England from what is apparently a batch of heroin contaminated with anthrax. The bad dope has been blamed for nine deaths in Scotland and one in Germany since the outbreak began in December.
The spate of anthrax cases among heroin users is baffling police and health experts, who have yet to actually come up with any heroin samples containing anthrax spores. There is speculation that the heroin could have been contaminated at its likely source in Afghanistan, perhaps from contaminated soils or animal skins, or that it was present in a cutting agent added there or at some other point on its transcontinental trek to northern Europe.
The cases in Germany and England have no known link to those in Scotland, leading to fears that tainted dope could be widespread. On the other hand, the numbers so far reported as being infected remain relatively small.
Although harm reductionists and drug user advocates have called for measures including public information campaigns among users, swift access to drug treatment, and making prescription heroin more widely available, British health officials continue to do little more than tell users to quit. Dr. Arif Rajpura, director of public health at NHS Blackpool, was singing from the same official hymnal this week.
He repeated warnings for users to stop using and advised them to be on the lookout for symptoms of anthrax, including rashes, swelling, severe headaches, and high fevers. "Heroin users are strongly advised to cease taking heroin by any route, if at all possible, and to seek help from their local drug treatment services. This is a very serious infection for drug users and prompt treatment is crucial," he said.
The death toll from anthrax-tainted heroin in Europe has risen to 10 as Health Protection Scotland confirmed that a heroin user who died in the Glasgow area on December 12 was infected with anthrax. Nine of the 10 deaths occurred in Scotland; the other occurred in Germany.
At least 19 drug users -- 18 of them Scottish -- have been diagnosed with anthrax since the outbreak began. A pair of heroin deaths in Sweden turned out to be unrelated, and a cluster of deaths in Portugal has not been confirmed as being linked to anthrax.
While Scottish authorities have yet to find any anthrax-tainted heroin, they believe either the heroin itself or cutting agents have been contaminated with anthrax spores. They said there is no evidence of person-to-person infection.
"While public health investigations are continuing to attempt to identify the source of the contamination, no drug samples tested to date have shown anthrax contamination, although a number of other types of potentially harmful bacteria have been found," said Colin Ramsay, an agency epidemiologist. "It must therefore be assumed that all heroin in Scotland carries the risk of anthrax contamination and users are advised to cease taking heroin by any route. While we appreciate that this may be extremely difficult advice for users to follow, it remains the only public health protection advice possible based on current evidence."
As noted in our earlier story linked to above, harm reductionists have called for other measures, ranging from informational campaigns to liberalized prescribing of pharmaceutical heroin.
Infected patients typically developed inflammation or abscesses around the injection site within one or two days and were hospitalized about four days after that. In some severe cases, the lesions developed necrotizing fasciitis, a flesh-eating disease.
Feature: Anthrax-Tainted Heroin Takes Toll in Europe, Prompts Calls for Emergency Public Health Response
European heroin users are on high alert as the death toll rises from heroin tainted with anthrax. At least eight people have died -- seven in Scotland and one in Germany -- since early December, and another 14 Scottish heroin users have been hospitalized after being diagnosed with anthrax. Meanwhile, drug reform and drug user activists are reporting a cluster of nine suspicious heroin-related deaths in Coimbra, Portugal, although it is unclear at this point whether they are linked to anthrax-tainted heroin.
The first four Scottish deaths were in Glasgow, but after one person died in Tayside and one in the Forth Valley earlier this month, Health Protection Scotland epidemiologist Dr. Colin Ramsay said: "The death of this patient in NHS Forth Valley indicates further geographical spread of the cases, meaning that heroin users all across Scotland need to be aware of the risks of a potentially contaminated supply. I would urge all users to stop using heroin immediately and contact local drug support services for help in stopping. If any heroin users do notice signs of infection, for example marked redness and swelling around an injection site or other signs of serious infection such as a high fever, they should seek urgent medical advice."
The French government has also reacted, with the General Directorate for Health issuing a statement Tuesday warning that contaminated heroin may be circulating in France and other European countries. Noting the rising death toll, the statement said "the likeliest source is heroin contaminated by anthrax spores."
Heroin users should be alert, the French statement said, because heroin contaminated with anthrax is indistinguishable from other heroin. "There is no outward sign or color enabling the user to tell whether the heroin has been contaminated by anthrax, and contaminated heroin dissolves or is used in the same way as uncontaminated heroin," it said.
Anthrax is a potentially lethal bacterium that exists naturally in the soil and can also occur among cattle. It is also a potential bio-terror weapon.
The vast majority of heroin consumed in Europe comes from Afghanistan, and while so far evidence is lacking, speculation is that anthrax spores may have been present in bone meal, an animal product sometimes used as a cutting agent. Another possibility is that containers used in the heroin production process were contaminated with anthrax spores. And, given fears that Al Qaeda and its Taliban allies could resort to biological warfare against the West and given the Taliban's role in the Afghan opium and heroin trade, a bio-attack cannot be completely ruled out.
"The anthrax-infected heroin hasn't decreased use, whether people are injecting it or chasing [smoking] it," said Tam Miller, chair of Chemical Reaction, an Edinburgh drug user group, and a member of INPUD (the International Network of People who Use Drugs). "People are scared -- you can be sure of that -- but I think they're more afraid of withdrawing. The Scottish government's advice was for people to stop using heroin, but that won't happen."
Instead, Miller said, heroin users are doing what they can to protect themselves. "Users feel there's not much they can do personally and, as usual, they feel isolated," he said. "A lot are looking up the effects on anthrax on the net and passing on information to people with no internet access. We think the powers that be should put out information on how to spot signs if someone has been in contact with access. Basically, mate, the Scottish government wants little to do with it."
The Scottish government's response so far has drawn a harsh rebuke from the United Kingdom's harm reduction and public health community. In a Tuesday letter to the Scottish government, the International Harm Reduction Association, the drug think tank Release, the Transform Drug Policy Foundation, the UK Harm Reduction Alliance, and individual public health experts called on the government to put in place an emergency public health plan to deal with the crisis.
The letter said the government's advice to heroin users to stop using and enter treatment was "reckless in light of the fact that waiting times in Scotland for opiate substitute treatment (OST) are the longest in the UK. Many of those accessing services are informed that it is a condition of their treatment to engage with the service for a minimum period of time, before they will be entitled to a prescription offering an alternative substitute medication, usually methadone. In some areas of Scotland we have been informed that waiting times for OST can be up to 12 months."
[There is another potential issue with methadone, as well. The antibiotic drug Cipro, used to treat anthrax, interacts with methadone, leading to the possibility of methadone overdoses.]
Given the reality of treatment shortages and delays, it is "unacceptable" for the Scottish government to just tell users to stop or to go to treatment that isn't there, the letter said. "It is clear that this kind of approach can only lead to the death of more vulnerable people."
Instead, the Scottish government must immediately implement a public health plan that includes rapid access and low-threshold prescribing of alternatives to street heroin, the letter-writers advised. They recommended prescribing dihydrocodeine, a synthetic opiate approximately twice as strong as codeine. It is sold in the US under brand names including Panlor, Paracodin, and Synalgos.
"Such an approach will go some way to prevent any more loss of life and will provide greater protection to the public as a whole," the letter said. "Failure to adopt such a policy would mean that the Scottish state would be failing in its duty to its citizens."
Joep Oomen of the European Coalition for Just and Effective Drug Policies (ENCOD) had another suggestion. "The only decent reaction to this kind of episode is to immediately open facilities where people can test their heroin and where they can use in safe conditions, supervised by people who can help if anything goes wrong," he said.
"Hopefully, in the longer term, because of these incidents, authorities will start to see the need for introducing heroin maintenance programs, not as a trial for a limited group of people, but as a permanent service for all those who cannot abstain from heroin for a longer period of time," he added.
Ultimately, said Oomen, prohibition is the problem. "Adulteration is a practice that belongs to the illegal market," he said. "It happens because the people who control the heroin market have no interest at all in the health of their customers."
Dr. Sharon Stancliff of the US Harm Reduction Coalition agreed with her colleagues' assessment of the Scottish government's response. "Telling people to stop is not useful information," she said. "Maybe some occasional users will have a glass of wine instead, but if people are sick and treatment is limited, telling people that heroin is bad for them isn't going to have much impact," she explained.
"At this point, the European harm reduction people should be getting the word out, and the medical people over there need to be on the alert," she added.
Stancliff said she had seen no sign of heroin contaminated with anthrax on this side of the Atlantic, but she was worried. "I hope the DEA is out there buying heroin to see what's in it," she said. "If there is any hint of it here, physicians should be alerted by the Centers for Disease Control as they were with levamisole-tainted cocaine."
If the anthrax-contaminated heroin is coming from Afghanistan, as most heroin consumed in Europe does, US heroin users may catch a break. Most heroin consumed here is of Mexican or Colombian provenance.
But on the other side of the Atlantic, adulterated heroin is killing drug users.
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.
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.
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.