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FDA Panel Wants Tighter Control over Pain Pills

A US Food and Drug Administration advisory panel voted last Friday to recommend that popular pain relievers containing the opioid hydrocodone be moved from Schedule III to Schedule II of the Controlled Substances Act. Popular prescription drugs containing hydrocodone include Vicodin and Lortab.

That would put Lortab and Vicodin in the same schedule as morphine and Oyxcontin, which contains oxycodone.

If the FDA agrees with its advisory panel and reschedules hydrocodone, pain patients using the drug will have to go the doctor's office to get prescriptions written twice as frequently as now. Schedule III drugs can be prescribed for up to six months at a time, while Schedule II drugs can only be prescribed for three months without another visit to the doctor.

The FDA has for years resisted efforts to tighten controls over hydrocodone, saying it could limit patients' access to pain medicine, but as overdose deaths and addiction rates from prescription pain relievers have jumped in recent years, pressure has been mounting on the agency. The agency is acting now after receiving a request from the DEA to consider rescheduling.

The advisory panel's 19-10 vote received mixed reviews from experts consulted by the Milwaukee Journal-Sentinel.

Andrew Kolodny, a psychiatrist and addiction specialist who heads Physicians for Responsible Opiate Prescribing lauded the vote, saying it will lead to fewer people getting addicted to opiates.

"Doctors have had a false sense of security (about prescribing the drugs)," said Kolodny. "This is a clear message that hydrocodone is addictive," he told the Wisconsin newspaper.

"It seemed pretty clear to me that the preponderance of the evidence supported rescheduling," said Peter Kaboli, associate professor at the University of Iowa Carver College of Medicine.

But Jan Chambers, president of the National Fibromyalgia and Chronic Pain Association, said she voted against the proposal because she has heard so much from family members of people who have committed suicide because they are in such pain.

"Millions of people don't have access to the pain specialist or the doctors who can prescribe these Schedule III drugs," she said.

And Lynn Webster, president-elect of the American Academy of Pain Medicine, said putting tighter controls on hydrocodone will reduce prescribing and abuse, but worried about the impact on pain patients.

"I hope chronic pain patients and acute pain patients don't suffer as a result," said Webster, who spoke at the panel hearing but was not a panel member.

The FDA has not said when it will make a final decision on the issue. Now, the FDA and the National Institutes of Health must make a recommendation to the assistant secretary for health, who will make a final recommendation to the DEA.

Washington, DC
United States

Danes Want Heroin Pills for Addicts

In remarks reported by the Copenhagen Post Sunday, Danish Health Minister Astrid Krag announced that she is proposing that heroin in pill form be made available to addicts. Denmark is one of a handful of European countries that provide maintenance doses of heroin to addicts, but to this point, the drug was only available for injection.

Heroin safer in pill form? Danes thinks so. (wikimedia.org)
It is time to offer users a safer choice, Krag said, adding that the pills should be available next year. She said the Danish Board of Health had evidence to believe making heroin available in pill form would reduce the risks of disease and overdose.

"With tablets, we get a tool that lessens the risk of incorrect dosages, injuries and incidences of cancer," she explained. "This will be an improvement of the current system. It clearly needs to be in place by 2013."

The Danish government approved heroin maintenance in 2008, with the first clinic opening in 2010. There are now five of them. A supervised injection site is set to open in the Copenhagen neighborhood of Vesterbro later this year. In the meantime, a mobile injection site is zooming around the neighborhood.

Opposition conservative party spokespersons said they were open to the proposal, but wondered how it would be paid for. But spokespersons for the government Socialistisk Folkeparti said that was just politics.

"It is remarkable that [the conservative opposition] says that financing must be in place before you make a proposal," said Jonas Dahl, health spokesman for the Socialists. "The working procedure has always been that we first get a professional recommendation from the Board of Health and then find the money."

Copenhagen
Denmark

Narc Scandal Front and Center in Florida Sheriff Race [FEATURE]

Scandal has been brewing in the Pinellas County, Florida, Sheriff's Office over the possibly criminal misbehavior of some of its narcotics detectives, and Sheriff Bob Gualtieri, a Republican, has been trying to keep it from spinning out of control. But with his job on the line in November, his challengers, Republicans and Democrats alike, are making the scandal -- and the department's emphasis on busting marijuana grows -- issues with which to wound him in the campaign.

Narcotics deputies went above and beyond in their efforts to bust indoor marijuana grows (wikimedia.org)
Pinellas County sits on Florida's Gulf Coast and includes the city of St. Petersburg. For the last few years, it has been an epicenter of the state's prescription opioid epidemic, but despite the county leading the state in Oxycontin overdose deaths, some Pinellas County narcs were more interested in pot growers than pill mill merchants.[Editor's Note: At least one candidate for sheriff is challenging the conventional law enforcement narrative regarding opioid pain medications; see Scott Swope's comments on the topic at the end of this article.]

It all began when narcotics detectives with the sheriff's office hit on the bright idea of spying on a legal business -- a Largo hydroponics grow shop -- and taking down the license plate numbers of customers, and then snooping around to see what they could find. At least four detectives were involved in surveillance that apparently crossed the line into illegality by trespassing on private property without a warrant, by disguising themselves as utility company workers, and by subsequently falsifying search warrant affidavits (they would claim to have smelled marijuana from the street, when they had actually trespassed to find evidence).

They would have gotten away with it if not for tenacious defense attorneys. But things began to unravel last year, when the attorney for Allen Underwood, who had been arrested in a grow-op bust, filed a complaint saying that Underwood's surveillance cameras had recorded one of the detectives hopping over his fence. The detective ordered the surveillance video deleted, and the sheriff's office found no evidence of wrongdoing by its man.

Next, Largo defense attorney John Trevena charged in a case that one of the detectives had donned a Progress Energy shirt and cap to gain warrantless access to a private property. The detective first denied it under oath, then admitted it. At the time, Gualtieri attributed the deception to "over-exuberance" by a young detective.

Then, in February, Tarpon Springs attorney Newt Hudson questioned one of the detectives under oath about whether he ever saw his dope squad colleagues trespass. Under questioning, the detective admitted that he and one of the other detectives had once broken down a fence to enter a yard of interest.

"That was the game changer," Sheriff Gualtieri told the Tampa Bay Times last month as he announced he was launching a criminal investigation of the four detectives. "Misconduct will not be tolerated and we will hold accountable any member of the Pinellas County Sheriff's Office who acts contrary to the law," Gualtieri said. "The ends never justify the means."

Embattled Sheriff Bob Gualtieri (bobforsheriff.com)
Three of the detectives have resigned, and Gualtieri fired the fourth, but it might be too late to undo the damage to local law enforcement and to Gualtieri's own political prospects. At least 18 pending marijuana grow prosecutions have been halted, and Gualtieri and Chief Assistant State Attorney Bruce Bartlett said they also will review charges against about two dozen other defendants who previously pleaded guilty, were convicted or accepted plea bargains.

And Gualtieri has been repeatedly pummeled by challengers over the scandal. Not only the sole Democrat in the race, Palm Harbor attorney Scott Swope, but Gualtieri's Republican challengers, most notably former Sheriff Everett Rice, have criticized his handling of the affair. The Republican primary, which Gualtieri hopes to survive, is set for August 14.

"They shouldn't have been investigating the store to begin with," Swope told the Chronicle. "As far as criminal activity is concerned, we have bigger fish to fry than trying to catch people who are purchasing grow lamps. It was absolutely ridiculous."

Especially given that the sheriff's office had had to cut $100 million from its budget and eliminate 600 positions, including the cold case unit and sexual predator tracking, Swope said, alluding to the severe financial straits in which the department and the county found themselves.

"When I'm at a campaign presentation and tell people that they had detectives for surveilling this business selling legal equipment, but not for human trafficking or cold cases, everyone hears that and goes 'wow,'" Swope said. "It's an argument that has some traction."

Swope also criticized the leisurely pace of Gualtieri's internal investigation.

"The internal investigation took way too long," said Swope. "When you have an assertion that one of your detectives is trespassing to obtain evidence, falsifying ID to obtain evidence, falsifying affidavits, then destroying evidence, that needs to take precedence over every other internal investigation, and it didn't. When Gualtieri first went on the record, he said he didn't believe it; he just dismissed it, at least initially."

For Rice, who served as sheriff for 16 years until 2004, the pot grow scandal was an indication of misplaced priorities in Gualtieri's department.

"How is it that Pinellas and Pasco County became the pill-mill capital of the world in the last three or four years," Rice asked at a candidates' forum this spring, "and meanwhile we're spying on people who have hydroponic materials?"

Rice was still on the attack last month, telling the Tampa Bay Times that problems in the department are not limited to the pot grow scandal, but also include reports of slipshod internal investigations, narcotics sergeants claiming pay while monitoring detectives from home, and possible thefts.

"The question is,'' said Rice, "how did that culture come about in the first place? I think people realize that a Sheriff Rice wouldn't put up with such things,'' Rice said.

Except that he did. During his time in office, one of Rice's narcotics detectives gathered evidence of a pot grow illegally and lied about it under oath. He also fabricated evidence for a search warrant by calling in his own "anonymous tip." In another case, deputies used an informant to get a search warrant without revealing that the informant's wife was having an affair with the suspect. Pinellas judges tossed a number of pot grow cases over police misconduct during Rice's reign, and one detective was prosecuted for perjury.

One of the cases tossed was against Randy Heine, a Pinellas Park smoke shop owner. In that 1997 bust, deputies raided Heine's home and seized two pounds of pot, but a judge threw out the case, finding that deputies had resorted to "gross, material misrepresentation of the facts'' in their search warrant application.

Heine, a perennial gadfly on the local scene, has also become a harsh critic of Pinellas-style drug law enforcement. He was briefly a candidate in the sheriff's face before dropping out after failing to pay a filing fee. That leaves Swope, Gualtieri, and Rice.

Democratic challenger Scott Swope (swopeforsheriff.com)
For Swope, Gualtieri and Rice are birds of a feather -- traditional lawmen who don't think twice about the futility and expense of continuing to fight the war on marijuana. He offers a different vision, one that includes marijuana decriminalization and, eventually, legalization and regulation.

"Florida should go the way of more than a dozen other states and decriminalize," he said. "Then the sheriff's office wouldn’t have to expend limited resources trying to catch people in possession of small amounts. That would make it so those young people don't have a criminal record, they're still eligible for student loans, they can get jobs. It's a bit of a shocker for some of my audiences, but when you think about it, it makes perfect sense to save tax dollars by not investigating and prosecuting possession of small amounts."

A marijuana bust of 20 grams or less is a misdemeanor in Florida, but it means a trip to jail, booking, and waiting to get bonded out. It also uses up law enforcement man-hours during arrest, booking, detention, and prosecution. Florida should and will decriminalize eventually, Swope said, but he wouldn't wait for the legislature to act if elected.

"As sheriff, I can't tell the legislature what to do, but I would have some influence over the county commission. I could lobby them to enact an ordinance making possession of less than 20 grams an ordinance violation," he explained. "That way, instead of deputies having to arrest people and put them in the criminal justice system, they could just issue an ordinance violation ticket, and the fines would go to Pinellas County.

Swope was philosophically open to legal, regulated marijuana sales, but wasn't pushing it as a campaign position. First things first, he said.

"From the perspective of this campaign, the majority of the population believes medical marijuana should be legal, and I do, too," he explained. "Decriminalization and regulation similar to alcohol and cigarettes, well, that's a bit more of a progressive position. I think it's going to be a two-step process: Make medical marijuana legal, and after enough time, and people realize these folks aren't committing crimes, then it's time for step two."

Swope also had an interesting perspective on the pain pill and pill mill issue.

"Pinellas County had a very serious problem with pain pills, we led the state four straight years in Oxycontin deaths, and it's still a serious problem, but unfortunately, when they really ramp up the pain pill mill enforcement, the pendulum can swing too far the other way," he noted. "There is a potentially serious negative impact on doctors and pharmacies trying to help people who need the help. If Florida were a little more progressive and had a medical marijuana law, perhaps many could treat themselves with that instead of narcotics."

The one-time deputy's drug war positions are winning him support outside of traditional Democratic constituencies, including Libertarian Party figures ranging from county stalwarts to presidential nominee Gary Johnson.

"I have the endorsement of the Libertarian Party here, and that has some of the Democrats scratching their heads. I just explain that I'm a lawyer familiar with the Constitution, I'm progressive-thinking and understand and appreciate the value of personal liberty and what the Constitution means and I will make damned sure the sheriff's office abides by the Constitution."

Pinellas County has 3,000 more registered Democrats than Republicans, but most county offices, including the sheriff's, have been in Republican hands for decades. A victory for Democratic challenger Scott Swope in November would not only break the GOP's stranglehold on elected office in Pinellas, it could also bring a fresh new perspective to Florida law enforcement.

Meanwhile, Sheriff Gualtieri has just unleashed an offensive against "fake pot."

(This article was published by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also shares the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

St. Petersburg, FL
United States

Harsh Cameron Douglas Sentence Sparks Appeal, Support

Cameron Douglas, the son of noted Hollywood actor Mike Douglas, had a well-known history of drug addiction when he was sentenced to five years in federal prison for heroin possession and drug distribution. Not offered drug treatment, Douglas relapsed while in prison and was caught in possession of a small amount of heroin and Suboxone.

Cameron Douglas
Most federal prisoners caught with small amounts of drugs are dealt with administratively, and that happened to Douglas. He spent 11 months in solitary confinement and was denied visits during that period for his transgression.

But, unusually, Douglas was also prosecuted for drug possession by a prisoner, and even more unusually, he was hammered hard at sentencing. Federal District Court Judge Richard Berman nearly doubled his original drug trafficking time, sentencing him to an additional 4 ½ years in prison. Prosecutors had asked for at most an additional two years.

In imposing the harsh sentence, Judge Berman said that Douglas was "continuously reckless, disruptive, and noncompliant" and had repeatedly refused to obey the law.

The draconian sentence for Douglas has sparked a reaction. Unlike most federal prisoners, thanks to his father, Douglas had the resources to appeal his sentence, which is possibly the longest in federal prison history for simple drug possession behind bars. And now that appeal has been joined by about two dozen addiction and drug treatment doctors and organizations who have signed an amicus curiae brief on his behalf.

The brief does not just argue that Douglas should be sentenced more leniently; it argues that Douglas is a classic example "of someone suffering from untreated opioid dependence" and that more prison time will do nothing to address his addiction. The brief shows that many federal prisoners suffer from drug addictions, that many fail to get any meaningful treatment for it in prison, and argues that imposing additional incarceration for drug-addicted prisoners serves no penological purpose.

"A central theme of the [brief] is the need to provide effective, evidence-based treatment to opioid-dependent persons, particularly to those under criminal justice supervision. Time and again, over the past four decades, the provision of appropriate substance abuse treatment to opioid-dependent persons has been shown to profoundly improve not only their health and well-being across a broad range of metrics, but also the health and safety of the larger public. This is especially true of methadone and other opioid substitution treatments," the brief argued.

"Conversely, [we] are acutely aware of the ramifications when such treatment is withheld -- the suffering, disease, death, and criminal behavior that result when punitive sanctions replace proven medical interventions and opioid dependence is left to fester," the addiction specialists argued.

The brief was written by Dan Abrahamson, director of legal affairs for the Drug Policy Alliance, which organized the effort to intervene in the Douglas case. Its signatories include the New York and California Societies of Addiction Medicine, as well as other medical, public health and human rights organizations, along with prominent individual physicians and substance abuse researchers.

"Tacking on more prison time for a person who is addicted to drugs because they relapse behind bars goes against fundamental principles of medicine, inflicts unnecessary suffering and undermines both safety and health," said Abrahamson.  "Such a response only fuels the vicious cycle we see daily across the country of drug-dependent persons being imprisoned while sick, coming out sicker, and then returning to jail even quicker -- at huge expense to everyone."

Most federal prisoners don't have the resources or the celebrity of Cameron Douglas, but many share his struggles with addiction. Justice for Cameron Douglas could help lead to more just treatment for them, as well.

New York, NY
United States

Marking Mother's Day With Calls for Reform [FEATURE]

On this Mother's Day, more than 100,000 women are behind bars in American prisons, according to the Bureau of Justice Statistics, and many of them are doing time for drug offenses. That's too many, said members of a new coalition, Moms United to End the War on Drugs, as they held events last week in the days running up to Mother's Day.

Gretchen Burns Bergman at the National Press Club (Moms United)
"The war on drugs is really a war on families," said Mom's United's Gretchen Burns Bergman. "It is time to end the stigmatization and criminalization of people who use drugs and move from arrest and mass incarceration to therapeutic, health-oriented strategies. Moms were the driving force in repealing alcohol prohibition and now moms will play a similar role in ending the war on drugs."

Bergman, from San Diego, is the mother of two sons who have struggled with substance abuse and incarceration and is a founder of A New PATH (Parents for Addiction Treatment & Healing). A New PATH has joined forces with other groups, including Law Enforcement Against Prohibition (LEAP), the NORML Women's Alliance, Families to Amend California's Three Strikes, and Students for Sensible Drug Policy to form Moms United to agitate for an end to the drug war and a turn toward sensible, evidence-based drug policies.

The week leading up to Mother's Day was a week of action under the rubric of Cops and Moms Working Together to End Prohibition. The week saw events and press conferences in Atlanta, Boston, New York City, and Washington, DC, in the East and Los Angeles, San Diego, Oakland on the West Coast.

"Mother's Day was derived out of an intensely political effort to organize women on both sides of the Mason-Dixon Line against the Civil War," said Sabrina Fendrick, coordinator for the NORML Women's Alliance. "The reason mothers were made the vehicle was because they were the ones whose children were dying in that war. Women were also largely responsible for ending alcohol prohibition. This is more than just a ‘greeting-card holiday,’ this is the beginning of an institutional change in our society. The government's war on drugs is unacceptable. For our children's sake, the concerned mothers of the world are being called on to demand the implementation of a rational, responsible, reality-based drug and marijuana policy."

Last Wednesday, at a San Diego press conference, the umbrella group unveiled the Moms United to End the War on Drugs Bill of Rights, a 12-point motherhood and drug reform manifesto which calls for "the right to nurture our offspring, and to advocate for their care and safety" and "the parental right to policies and practices that recognize addiction as a disease in need of treatment, rather than a willful behavior to be criminalized," as well as the right to have harm reduction and overdose prevention practices implemented, the right to be free from heavy-handed, constitution-threatening drug war policing, and the right to be free from drug war violence.

Moms United in Los Angeles (Moms United)
"If we stop arresting and incarcerating drug users, think of the number of children who would have the chance to look upon their parents as positive role models instead of having parents who are absent because they are incarcerated," the group said. "We have a moral and ethical obligation to give these children a better chance in life by allowing parents to take care of their families. These parents should have the opportunity to become the productive members of society and role models to their children that they want to be and that their children need and deserve."

The Bill of Rights has been endorsed by a number of religious, reform, and civil rights groups, and individuals can sign onto it, too. To sign on, go to the online petition.

"We are building a movement to stop the stigmatization and criminalization of people who use drugs or are addicted to drugs," the group said. "We urgently call for health-oriented strategies and widespread drug policy reform in order to stop the irresponsible waste of dollars and resources, and the devastating loss of lives and liberty."

It's not just Moms United who is using Mother's Day to strike a blow for drug reform. In Colorado, where Amendment 64 to legalize and regulate marijuana is on the ballot, the Campaign to Regulate Marijuana Like Alcohol is running a television ad featuring a young woman writing an email to her mother in which she explains that she has found her marijuana use to be safer and healthier than the drinking she did in college.

The ad is aimed at a demographic that is both critical to and difficult for the campaign: women in their 30s and 40s, many of whom are mothers. The ad appeared Friday and again on Mother's Day.

"Our goal with the ad is to start a conversation -- and encourage others to start their own conversations -- about marijuana," Betty Aldworth, the advocacy director for the campaign.

And it's not just the United States, either. In mother-honoring Mexico, which marked Mother's Day on Thursday, hundreds of women and other family members traveled to Mexico City on the National March for Dignity to demand that the government locate their loved ones gone missing in the drug wars, according to the Frontera NorteSur news service.

"They took them alive, and alive we want them," the marchers chanted.

While the drug wars in Mexico have claimed at least 50,000 lives, including 49 people whose dismembered bodies were found on a highway outside Monterrey Sunday morning, thousands more have gone missing, either simply vanished or last seen in the hands of armed, uniformed men.

The Mexican government doesn't report on how many have gone missing in its campaign against the cartels, but the Inter-American Human Rights Commission counts more than 5,000 missing persons complaints filed with police -- and this in a country where many people so mistrust the police they don't bother to file official reports.

"For some it has been years, for others months or days, of walking alone, of clamoring in the desert of the hallways of indolent and irresponsible authorities, many of them directly responsible for disappearances or complicit with those who took our loved ones away," the mothers' group said.

On Mother's Day, many mothers in Mexico have "nothing to celebrate," said Norma Ledezma, cofounder of Justice for Our Daughters in Chihuahua City. "As families, we want to take this occasion to tell society not to forget that in Mexico there is home with a plate and a seat empty."

"We have walked alone in the middle of stares and stigmatizing commentaries, and we have been treated like lepers, marginalized and condemned to the worst pain a human being could live: not knowing the whereabouts of our sons and daughters," the new mother's movement declared. "But now we are not alone. We have found hundreds of mothers and we unite our clamor and our love to recover our loved ones and bring them home."

On Mother's Day, the agony of the drug war transcends borders. And the call from mothers for a more sane and human alternative continues to grow, from Chihuahua to Chicago and from Oaxaca to Washington.

Russell Brand Talks Drug Policy in Parliament

Actor, comedian, and ex-heroin addict Russell Brand appeared before a parliamentary committee in London Tuesday and told MPs that drug taking should not be approached as a "criminal or judicial matter" and that decriminalizing drug use could be "useful" in some regards.

Russell Brand at the premiere of Arthur (wikimedia.org)
Brand, 36, who recently divorced singer Katy Perry, wore a black hat, gold chains and crosses and a torn black vest top for his appearance before the committee. He called MPs "mate" and addressed them by their first names during a lively half-hour long hearing.

Brand was asked about drug legalization, but demurred, saying he didn't think he was "particularly qualified" to make that judgment. He added, however, that,  "I'm not saying we should have a wacky free-for-all where everyone takes drugs, it didn't do me any good."

The flamboyant entertainer appeared before the Home Affairs Committee, which is reviewing British drug policy. The Tuesday hearing was the fourth in what the committee is calling "a comprehensive review" of the drug laws. The committee also heard from opponents of relaxing the drug laws, including columnist Peter Hitchens and campaigner Mary Brett of Cannabis Skunk Sense, an all-volunteer group whose mission is to "raise awareness of the continuing and growing threat to children, teenagers and their families, posed by cannabis use."

Brand, who has had a more than decade-long career as a comic in Britain, exploded on the US scene with his portrayal of heedless rock star Aldous Snow in 2008's Forgetting Sarah Marshall, a role he reprised and expanded on as the falling-off-the wagon rocker in Get Him to the Greek in 2010. Brand also played the role of the alcohol-besotted title character in last year's Arthur, a remake of the Dudley Moore classic.

But Brand has also been a thoughtful and incisive author, commentator, and radio and television host whose views have been informed by his own struggles with substances. His 2007 autobiography My Booky Wook dealt extensively with his drug-using career and subsequent abstinence, and he won wide acclaim for his open letter For Amy after the alcohol overdose death of Grammy award-winning chanteuse Amy Winehouse last year.

The legal status of drugs didn't matter much to addicts, Brand said. "I'm not a legal expert. I'm saying that, to a drug addict, the legal aspect is irrelevant," he said. "If you need to get drugs, you will. The criminal and legal status, I think, sends the wrong message. Being arrested isn't a lesson, it's just an administrative blip," he added.

"For me what is more significant is the way we socially regard the condition of addiction," Brand said. "It is something I consider to be an illness, and therefore more of health matter than a criminal or judicial matter. It is more important that we regard people suffering from addiction with compassion and there is a pragmatic rather than a symbolic approach to treating it."

Brand pointed to the experience of Portugal, which decriminalized drug possession in 2001, saying decriminalization could be "useful and efficient." Instead of using the "carrot and stick," Brand said, drug addiction should be approached with "love and compassion."

The committee will conduct further hearings before issuing a report.

London
United Kingdom

Review Essay: The Border and Mexico's Drug Wars

Border Junkies: Addiction and Survival on the Streets of Juarez and El Paso, by Scott Comar (2011, University of Texas Press, 214 pp., $24.95 PB)

Border Wars, by Tom Barry (2011, MIT Press, 171 pp., $14.95 HB)

Dealing Death and Drugs: The Big Business of Dope in the US and Mexico, by Beto O'Rourke and Susie Byrd (2011, Cinco Puntos Press, 119 pp., $12.95 PB)

El Sicario: The Autobiography of a Mexican Assassin, edited by Molly Molloy and Charles Bowden (2011, Nation Books, 209 pp., $15.99 PB)

In addition to an ever-increasing death toll, now more than 50,000 since President Calderon sent in the army in December 2006, Mexico's drug wars are generating an increasing level of concern and interest in the US, including a burgeoning literature. Next week, we'll review a trio of new works that seek to describe the emergence and significance of the so-called cartels, but this week, we look at a quartet of books that focus on the drug wars (and the drug scene) along the border.

If there's anywhere in America more attuned to the Mexican drug wars -- by which I mean the prohibition-related violence among competing drug trafficking organizations, between them and Mexican law enforcement and the military, and, sometimes, even between different factions of the Mexican security apparatus -- it's El Paso, just across the Rio Grande from one of the epicenters of the drug trade and the violence, Ciudad Juarez.

That's reflected in these titles. One is written by a pair of El Paso politicians, two more are largely set in the El Paso-Ciudad Juarez bi-national metroplex, and the last covers the US border region of which El Paso is front and center. The view from El Paso, staring across the river at the killing and mayhem, can be frightening, but also enlightening.

In Dealing Death and Drugs, El Paso city council members Susie Byrd and Beto O'Rourke (he of the famous city council resolution calling for a discussion of legalization and now running for Congress) bring a home-town perspective on the drug wars, provide some lessons on the economics of the illicit marijuana business and present a concise, yet cogent, argument for legalizing weed as a means of weakening the cartels and reducing the violence.

Marijuana is critical for the cartels, Byrd and O'Rourke argue, because unlike cocaine, which must be purchased from producers elsewhere or methamphetamine, which requires imported precursor chemicals, the cartels control it from farm to market, generating profits each step of the way. They take you from the pot fields of the Sierra Madre Occidental, where a pound costs $23 to Juarez, where it goes for $73 a pound. Getting it past the border and into El Paso drives the price up to $240, and getting it past the Border Protection Service checkpoints a few miles into Texas gets it to its final US wholesale price of about $550 a pound.

US and Mexican law enforcement seized or eradicated 22 metric tons of Mexican weed in 2008, Byrd and O'Rourke note. That's as much as 90% of high end estimates of all the pot smoked in the US, which means either those estimates are way low or that the business is way profitable. And throwing billions of dollars at the problem through law enforcement hasn't helped.

Legalizing, regulating, and taxing the marijuana market is "the least bad" solution, Boyd and O'Rourke write. Their argument, like the book itself, is pithy, yet compelling, and, as Boyd notes in an afterword, even Calderon is starting to come around. But not yet most policymakers in the US.

With El Sicario, we take a deep, dark turn toward the underbelly of the Mexican drug wars. Border sage and drug war critic Charles Bowden and translator and Juarez body count keeper Molly Molloy bring the terrifying realities of the business into chilling focus through their interviews with a former cartel hitman now in hiding with a contract on his head. This may be the single scariest book I've read about the Mexican drug wars, not for its calm and collected accounts of horrifying acts of brutality, which can be truly stomach-turning, but for the picture it paints of absolutely corrupted and complicit law enforcement, including the military.

Can you imagine if you don't know whether that cop who just stopped you is going to write you a ticket or shoot you dead without warning, or kidnap and torture you because he's actually working for the cartels? That's the case in Mexico now. Our interlocutor in El Sicario attended the Chihuahua state police academy, rose to the rank of comandante, and underwent training by the FBI, all while carrying out killings, kidnappings, and tortures for the Juarez and Sinaloa cartels. Even more perversely, while he was running the anti-kidnapping squad for the state police, he was using police vehicles to kidnap people and transport drugs.

And he is by no means alone. According to the hit man, about a quarter of his graduating class at the police academy were on the cartel payroll -- from the very beginning of their law enforcement careers! The Mexican police are heavily salted with cartel men; it's a long-term business strategy that has paid handsomely for the cartels, but has absolutely shredded any trust the public has in state and local law enforcement there.

But it's not just rotten on the Mexican side of the border. The hit man details how he and his colleagues transported tens of millions of dollars worth of drugs across the border and how he personally paid a US Customs officer $50,000 to let cars full of drugs get through. El Sicario shows that dirty knows no borders, even if the cartels are smart enough to keep the blood-letting almost entirely south of the border.

But there are other ways US law enforcement is benefiting from the Mexican drug wars. In Border Wars, journalist and Center for International Policy analyst Tom Barry uses a series of interlocking essays to argue that since the September 2001 Al Qaeda attacks, the US has spent billions of dollars "securing the border" against a triple threat of illegal immigration, drugs, and terror, and has accomplished little good, quite a bit of bad, and plenty of stupid.

Barry opens with the death of Jesus Manuel Galindo, who died for lack of proper medical treatment in 2008 in a privately operated, publicly owned federal immigration prison in remote Pecos, Texas. He recalls that until 2006, we typically handled illegal immigration administratively, often simply deporting Mexicans back across the Rio Grande. But since then, the Bush administration began treating illegal immigration as a criminal matter, and now some 20,000 people languish in those distant prisons. Barry paints chilling, Kafkasque scenes of assembly-line "justice" where judges, prosecutors, and defense attorneys, all in the pay of the Us government, process dozens of shackled would-be immigrant laborers into the ever-expanding federal immigration detention system.

There is money to be made there, sucking off the federal teat, although more of it appears to go to lawyers, consultants, dealmakers and lobbyists than to the desperate rural towns hoping a private prison will provide them with a semblance of an economy. There's even more money to be made by border sheriffs and border state law enforcement entities in the seemingly endless billions of Department of Homeland Security dollars to fight drugs and terror.

Barry takes us to Texas and Arizona border counties where the numbers show little violent crime, but the sheriffs and politicians cry to high heaven about "spill over violence," Korans found on the border, and the threat of narco-Hezbollah conspiracies, for which there is no evidence. Some of these counties are among the poorest in the nation, lacking social and public services, yet in one of them, the sheriff's department is so awash in federal grant money that each deputy has two official vehicles, one patrol car and one SUV.

Along the way, he exposes the ugliness of border security politics and some of it practitioners, such as Govs. Rick Perry of Texas and Jan Brewer of Arizona, who use a politics of fear and hate to firm up support among their most reactionary supporters, who hype nonexistent violence on this side of the border, and who constantly tout their border security efforts "without help from Washington" even as they take in billions from Washington to pay for their loudly-touted initiatives. It's rank cynicism, opportunism, and hypocrisy at its worst, and Barry nails it.

For Barry, the central problem is our inability to enact comprehensive immigration reform, a goal always pushed further into the future as we "secure the border" first. And, he says, we have to separate national security from public safety. The gargantuan Department of Homeland Security should worry about terrorists; a separate Customs and Border Protection Service should deal with illegal immigration and drugs.

"The standard of success for our border policy shouldn’t be how completely sealed and secured our border is," he writes, "but rather how well it is regulated. New regulatory frameworks for immigration and drug consumption are fundamental prerequisites for a more cost-effective border policy." And a more sane and human one. 

Finally, with Border Junkies, University of Texas-El Paso borderlands historian Scott Comar takes us back to "the good old days" in Juarez, a decade ago, before the city earned its blood-drenched reputation. In an eye-opening work of auto-ethnography, Comar tells mainly his own story of his descent into abject addiction, in which he moved with appalling speed from owning his own moving truck to panhandling on the streets to feed his habit.

In telling his own story, though, Comar unveils a never-before-written-about world, that of the street junkies of Juarez. His account, based largely on his journal entries, details the day-to-day struggle of the border junkies, the strategies they adopt to survive and score -- and not necessarily in that order -- the kinship and friendship networks that envelop them, the heroin distribution systems that feed their insatiable appetites. For those with a taste for anthropological examinations of the junkie life, this is fascinating stuff, right up there with the work of Philippe Bourgois.

Border Junkies is notable in one other respect: I don't think there is one mention of the cartels in it. Comar recounts constant harassment by the Juarez police (and the El Paso police, too) and petty corruption, he mentions that some of his fellows belonged to gangs, though only passingly, but the existence of the cartels, the source of their dope, is so distant from their daily lives that it is as if they don't exist.

Of course, that was before the death toll in Juarez started climbing to thousands every year. Now those street gangs that in Comar's time seemed to be engaged mainly in minor thuggery, a little smuggling, and posing with pistols have, in the pressure cooker of the Mexican drug wars, morphed into true killing machines like Barrio Azteca, the Artist Assasins, and La Linea. Those guys who quietly peddled smack on the corners or out of their houses in Comar's day died by the hundreds when the violence swept through just a few years later.

Wretched as the border junkie's existence is, it is doable. Comar did it for three years, commuting over the river to panhandle in El Paso, then back across to cop and nod. It was a gritty, miserable existence, but Comar makes it seem almost routine, banal. And, along the way, he has some interesting things to say about addiction and recovery, too.

Perhaps it's fitting to end with the image of the junkie straddling the border, because the root causes of Mexico's drug wars certainly do. Whether it's America's never-ending appetite for Mexican weed, the cartels' addiction to money and power, their alcohol and cocaine-numbed killers, or border state and federal law enforcement's addiction to immigration/drugs/terror funding booty, it's all entangled there on the line.

Mexico may be another country and, thankfully, the violence, at least, remains on that side so far, but we are all in this together. Legalizing marijuana or even ending drug prohibition in the US won't make the cartels magically disappear, but failing to do so will only ensure that they grow ever more entrenched, while continuing to provide sustenance to malign political forces and authoritarian, if not downright Orwellian, policing tendencies here.

Seattle Pilot Program Offers Treatment Not Arrest [FEATURE]

The Belltown neighborhood near downtown Seattle is a charming, vibrant urban locale, located just south of the city's landmark Space Needle. Filled with bars and cafes and desirable condos, it is a nighttime hot spot, but it is also a neighborhood where a relatively small number of problematic drug users have reduced the quality of life for residents and businesses alike. According to a recent study by the Seattle Police Department, some 50 people in Belltown were responsible for a whopping 2700 arrests.

4th Ave. & Wall St., Belltown neighborhood (Chas Redmond via wikimedia.org)
Now, instead of cycling those people through more endless -- and expensive -- rounds of arrest, prosecution, incarceration, and supervision, local officials and the Seattle Defender Association have embarked on an innovative pilot program in which beat officers will offer to take low-level, nonviolent drug offenders to drug treatment instead of arresting them, booking them into jail, and prosecuting them.

The pioneering program will allow officers the discretion to offer treatment to people charged with crimes such as public intoxication or drug possession, but not people with records of violence or those accused of dealing drugs. Offenders can decline the offer of treatment and instead be arrested and go through the criminal justice system.

Known as LEAD (Law Enforcement Assisted Diversion), the pilot program is designed to improve public safety and order and reduce the criminal behavior of program participants. It is based on successful "arrest referral" programs that have been operating in the United Kingdom for the past several years. The program has strong support from local elected and law enforcement officials.

"We are looking for effective public safety solutions,” said Mayor Mike McGinn. "If drug dealing and crime could be solved by arrests alone, we would have solved this problem a couple thousand arrests ago. LEAD offers a promising alternative to traditional responses to street-level drug dealing, and we look forward to tracking its results in Belltown."

"We know that the issue of chemical dependency in our society cannot be solved by law enforcement alone. It is a complex social problem that requires a comprehensive social solution,” said Seattle Chief of Police John Diaz. "LEAD provides our front line police officers with the discretion necessary to ensure that treatment diversion is utilized as a viable alternative to incarceration."

"Sheriff Sue Rahr and her staff support the concepts that act as the basis for the LEAD program, and we look forward to our participation," said King County Sheriff Major James Graddon. "Respect, open communication and common goals among some historically adversarial groups have created a positive environment to move this program forward. Using the formal criminal justice system for all offenses is costly and has proven to not necessarily be the most effective way to impact future offender behavior."

Graddon was referring to strained relations dating back to the last decade between the Seattle Police and the Defender Association, a nonprofit agency that provides legal representation to indigent defendants. In a bid to reduce tensions and work together on the common goal of reducing the number of repeat offenders cycling through the system, the Defender Association and law enforcement began discussing possible responses to the continuing problem of drug-user generated low-level crime with back in 2008. The LEAD program, which rolled out in Belltown a month ago now and which will also be tried in the Skyway neighborhood of unincorporated King County, is the fruit of those discussions.

Mayor McGinn at LEAD program press conference (mayormcginn.seattle.gov)
Defender Association Deputy Director Lisa Daugaard has been a prime mover in getting the program going. Given that the state of Washington faces a $2 billion budget deficit and looming social service cuts, Daugaard managed to obtain $4 million in grants from private foundations, including the Open Society Institute and the Ford Foundation, to pay for four years worth of LEAD services, including not only drug treatment, but also job training, housing assistance, and educational opportunities.

"Now, because of the dismantling of the social safety net, these LEAD resources may be the only way that some people will be able to get treatment, housing, and other services," said Daugaard.

LEAD supporters hope that the by the end of the four-year pilot period, the program will be able to demonstrate that it can generate cost savings worthy of being picked up by state and local government. They aren't the only ones watching with interest. Stateline, a media outlet covering state government issues across the land, reported last week that Baltimore, New Orleans, Oakland, and the state of New Mexico have already expressed interest in the program.

As a pilot program, LEAD will undergo a rigorous evaluation to determine whether it has been a success. It that proves to be the case, it could be expanded in other Seattle and King County locales, officials said.

"The LEAD pilot has the potential to help people struggling with addiction and save public dollars at the same time," said King County Executive Dow Constantine. "We can work in partnership to replace a downward spiral toward jail with support and resources. Our families and neighborhoods are better off when those headed for the criminal justice system are instead given the opportunity to lead a fulfilling and productive life."

It won't take four years to see what kind of impact LEAD has on Belltown and Skyway. Within a matter of weeks or months, we should be able to see whether this experiment in smart policing is working and produces a model that can be adopted elsewhere.

Seattle, WA
United States

Chronicle Book Review: Drugs and Drug Policy

Drugs and Drug Policy: What Everyone Needs to Know, by Mark Kleiman, Jonathan Caulkins, and Angela Hawken (2011, Oxford University Press, 234 pp., $16.95 PB)

http://stopthedrugwar.org/files/drugs_and_drug_policy.jpg
Mark Kleiman isn't real popular among the drug reform set. The UCLA professor of public policy is no legalizer, and even though he's too much of an evidence-minded academic to be a wild-eyed drug warrior, he still seems to have an unbecoming fondness for the coercive power of the state. Kleiman, who gets top-billing over coauthors Jonathan Caulkins of Carnegie Mellon and Angela Hawken at Pepperdine, also ruffles reformers' feathers with unnecessary snideness and snark.

But I watched Kleiman address Students for Sensible Drug Policy conventions a couple of times, and I thought it was a good thing, a very useful jolt to the group-think that can grip any gathering of congregants committed to a cause. I thought having the students have to hear the arguments of a leading academic thinker on drug policy who, while not "the enemy," was not especially saying what the average SSDPer wanted to hear, was salubrious for their critical thinking skills. I still think so.

In Drugs and Drug Policy, Kleiman and his coauthors continue with the occasional jibes aimed at the drug reform movement, at times reach conclusions at odds with my own, but also serve up a surprisingly chewy work of drug policy wonkery in delicious bite-size chunks. The innovative format, something like a series of FAQs organized within broader chapters -- "Why Have Drug Laws?" "How Does Drug Law Enforcement Work?" "What Treats Drug Abuse?" "Can Problem Drugs Be Dealt With at the Source?" -- allows us to unpack that all-encompassing monster called "drug policy" one subset at a time, and for that achievement alone, is worthy of praise. That it manages to cover so much ground in a paltry 234 pages is all the more laudable.

Overall, Drugs and Drug Policy is smart, reasonable, and thoughtful. It wants policies based on evidence and it advocates for some intelligent alternatives to current policies. It recognizes the utility of needle exchanges, safe injection sites, and opiate maintenance, even as it complains that "harm reduction" has been hijacked by legalizers. It explains that most people who use drugs -- even those diagnosable as suffering from substance abuse disorders -- will quit using drugs themselves without recourse to treatment. And it even allows that drug use can have beneficial effects, even if it doesn't do so until the seventh chapter.

But Kleiman et. al dismiss decriminalization as unlikely to have a big impact on the social fiscal burden of drug law enforcement because, even though it doesn't appear to have much impact on consumption, drug consumers are not, for the most part, filling our prisons -- drug dealers are. While they do concede that not criminalizing otherwise law-abiding citizens could have "significant benefits," they seem to underplay the negative, life-long impact of a criminal drug record on one's life prospects.

In fact, they seem all too comfortable with maintaining the pernicious role of the criminal justice system in drug policy even as they recognize that enforcing the drug laws is "unavoidably an ugly process," with its reliance on snitches, surveillance, and other "intrusive methods" of enforcement. To give them credit, they want smarter drug law enforcement -- concentrating police repression on violent drug dealers while turning a blind eye to discreet dealing, triaging coerced drug treatment spots so they are reserved for the people who could most benefit from them, giving up on interdiction and source country eradication as ineffective -- that might actually reduce the social and fiscal costs of both drug abuse and enforcement, and since drug prohibition isn't going away anytime soon, at least wasting less money on drug war tactics that don't work well should be on the table.

And they reject drug legalization as too scary to experiment with, but seem to imagine it as possible only within a corporate-controlled, heavily-advertised, low-priced scenario similar to that which has accreted around the alcohol industry. Yes, it's probably true that selling cocaine like Coors, would lead (at least initially) to a significant increase in use and problem use, but why does that have to be the only model? A government monopoly similar to the state liquor store model, with reasonable taxes and no corporate pressure to advertise could conceivably allow legalization without the increases in consumption that the authors predict, even though they concede they don't know how large they might be.

Still, when you get to what it is Kleiman et al. would do if they had their druthers, all but the most purist of legalization advocates will find a lot to like. They create three separate lists of recommendations -- a "consensus list" of reforms they think are politically doable now or in the near future, a "pragmatic list" of reforms that would appeal to dispassionate observers but could raise the hackles of moralists, and a "political bridge too far list" of reforms too radical for mainstream politicians to embrace.

The "consensus list" includes expanding opiate maintenance therapy, encouraging evidence-based treatment, early intervention by the health care system, encouraging people to quit on their own (as opposed to being "powerless"), relying less on interdiction, ending the charade that alternative development is drug control, and concentrating drug enforcement on reducing violence and disorder, as well as smarter, more effective coerced treatment in the legal system. If we saw the drug czar's office produce a National Drug Control Strategy with these recommendations, we would consider that a great victory. It ain't legalization, but its headed in a more intelligent, more humane direction.

The "pragmatic list" includes recommendations to lower the number of drug dealers behind bars, not reject harm reduction even if it's been "hijacked," stop punishing former dealers and addicts, reduce barriers to medical research on illegal substances, and be open-minded about less harmful forms of tobacco use.

The authors don't neglect alcohol and tobacco -- the two most widely-used drugs -- and that is really evident in their "political bridge too far" recommendations. The first three items there are aimed squarely at reducing alcohol consumption and its ill effects. They also argue for the legalization of individual or collective marijuana cultivation, a sort of legalization without the market, increased study of the non-medical benefits of drugs, and increasing cigarette taxes in low tax states.

I think Drugs and Drug Policy needs to be read by anyone seriously interested in drug policy reform. It hits almost all the bases, and it's well-informed, provocative, and challenging of dogmatic positions. You don't like the authors' conclusions? Refute them. It'll be good for you.

Chronicle Book Review: The Power of the Poppy

The Power of the Poppy: Harnessing Nature's Most Dangerous Plant Ally, by Kenaz Filan (2011, Park Street Press, 312 pp, $18.95 PB)

Kenaz Filan thinks that Poppy (always capitalized in the book) is a sentient being. Before you roll your eyes as you recall the fervent mushroom cultists who say the same sort of thing, recall also that more mainstream authors, such as foodie Michael Pollan, have been known to talk like that, too, posing similar questions about what plants want. I'm not personally convinced about the sentience of plants, but I find that adherents of such a position definitely bring something of value to the table: respect for their subjects.

The opium poppy certainly deserves our respect. It can bring miraculous surcease from suffering through the pain-relieving alkaloids within, but those same alkaloids can also bring addiction, oblivion, and death. Our "most dangerous plant ally" can be both kindness and curse, boon and bane. Only by respecting Poppy, writes Filan, can we learn how best to manage our relationship with her.

The Power of the Poppy is part historical treatment, part cultural essay, part pharmacopeia, part practical guide. As such, positions on plant consciousness notwithstanding, it's a fascinating and illuminating treatment of the poppy and its derivatives. Filan traces the history of man's relationship with poppy from 6,000-year-old archeological digs in Europe, through early uses in the Roman empire and the Islamic world, and on to the current era of the war on drugs.

While Filan addresses the war on drugs and finds it stupid, this is not mainly a book about drug policy, and he dismisses the issue in short order. "Our war on drugs has been a one-sided rout," he writes in the introduction. "We keep saying 'no' to drugs, but they refuse to listen."

In his few pages devoted to the past century of opium prohibition, he reiterates the futility of trying to stamp out poppy even as its cultivation spreads. "Poppy is happy to fulfill our needs as long as we propagate her species," he writes. "To her, our 'war' is like locust invasions and droughts -- an annoyance, but hardly something that will endanger the continued existence of her children."

From there, Filan turns to the chemistry and pharmacology of opium and its derivatives and synthetics. He traces the isolation of morphine, codeine, heroin, thebaine (from which is derived hydromorphone [Dilaudid], oxymorphone [Opana], hydrocodone [Vicodin], and oxycodone [Oxycontin]), kompot (East European homebrew heroin), methadone, and fentanyl. Along the way, Filan touches on such topics as the lack of pain-relieving poppy products in the developing world, the development of Oxycontin and the rapid spread of "hillbilly heroin," and controversies over needle exchanges, safe injection sites, and methadone maintenance therapies.

In nearly every case of the development of a new opiate or opioid drug, researchers were hoping to find a substance that maintains poppy's analgesic qualities while eliminating or at least reducing its addictive ones. No such luck. "Despite the best efforts of our chemical minds," Filan writes, "Poppy still demands her bargain…Even as we go to war with Poppy, we are forced to do business with her."

In his next section, demonstrates the bargain poppy extracts as he profiles 11 famous users, including Confessions of an Opium Eater author Thomas de Quincy, Samuel Taylor Coleridge, William Burroughs, Lou Reed (whose Velvet Underground-era Heroin and Waiting for My Man put the 1960s New York junkie experience to music), and DJ Screw, whom I must confess I never heard of until reading The Power of the Poppy. Mr. Screw, whose real name, it turns out, was Robert Earl Davis, was a Houston DJ who rose to hip-hop fame after smoking Mexican weed and accidentally hitting the pitch button as he mixed tapes. The ensuing distorted vocals and slowed down beats became known as "screwed down" and Davis picked up the moniker DJ Screw.

Among the favorite topics of Screw and his crew was "purple drank," a concoction of soda pop, codeine cough syrup, and Jolly Ranchers candy, that created a warm, relaxed high. Screwed down music was the perfect accompaniment for a drank-fueled evening. While DJ Screw died young, in part because of his fondness for drank, he was also an overweight, fried-food loving smoker. While drank may have helped make DJ Screw, as always, poppy exacted her part of the bargain.

In the final segment of the book, Filan gets practical. He describes how to grow your own (from papaver somniferum seeds widely available at gardening stores) and how to extract the raw opium. He describes poppy tea brewing recipes, as well as how to use poppy in pill, tablet, or capsule form; as well as eating smoking, snorting, and shooting it. And he doesn't stint on explaining the dangerous path one is on when one embraces the poppy. Although I don't recall Filan ever using the words harm reduction, he is all about it as he cautions about overdose, dependency, and addiction.

The Power of the Poppy elucidates the many ways the histories of man and poppy are intertwined, and it's full of interesting tidbits along the way. Who knew that the use of "dope" to mean drugs came from Dutch sailors mixing opium and tobacco off China in the 17th Century? They called the mixture "doep," like a greasy stew they ate. Or that calling seedy establishments "dives" derived from scandalized descriptions of California opium dens, with the patrons reclining on divans? Or that the scientific name for snorting is "insufflation"?

If you have an interest in opium and its role in human affairs, The Power of the Poppy will be both entertaining and enlightening. And -- who knows? -- maybe you'll start treating that plant and its derivatives with the respect they deserve.

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