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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.

Thai Government in Massive Campaign to Round Up Drug Users [FEATURE]

In a new wave of repression aimed at drug users, the government of Thailand has begun rounding up suspected "drug addicts" to be forced into "rehabilitation centers." That has health, human rights, and harm reduction groups expressing grave concerns, especially given previous Thai pogroms against drug users, like that in 2003, when tens of thousands were rounded up and more than 2,000 killed by police in summary executions.

Bangkok looks so modern, but some Thai drug policies are downright medieval. (Image via Wikimedia)
The official announcement from the National News Bureau of Thailand of the government's plans came only last week. "The Ministry of Interior has picked next week to get all drug addicts across Thailand clean," it said, with Deputy Permanent Secretary for Interior Surapong Pongtadsirikul as putting the number of untreated addicts at 30,000.

"During 20-27 February, 2011, drug abusers in Bangkok will be brought to the rehabilitation centers to get clean," the notice continued. "There will be those who are encouraged to receive treatment on their freewill and those who will be forced against their will. A rehabilitation camp will be open for addicts elsewhere in Thailand where a rehab center is scarce."

The announcement also said staff training would be carried out and a location for a "makeshift rehab center for drug addicts" will be selected. Chillingly, it added that "their names will be recorded in the database specifically designed for easy tracking and providing updates on their progress in the future."

The roundup has already begun in Bangkok, according to Karyn Kaplan of the Thai AIDS Treatment Action Group (TTAG). "Yes, people are being arrested right now," she said. "The police have quotas, they do this every few months, and this is just another excuse to round people up again. Even in our own small network of people who use drugs, people have been arrested, even workers at our harm reduction center."

While the Thai government officially embraces harm reduction principles -- it adopted harm reduction as a national strategy last fall -- it schizophrenically continues its crackdowns on drug users and sends them to "treatment centers" not worthy of the name.

"We don't call them treatment centers, because they aren't run by people who know how to treat people," said Kaplan. "They were originally set up because of prison overcrowding, but even though they have a policy that says drug users are patients, not criminals, they still use the police to sweep the streets and throw people into the system. But then the system says there is no room in prison, send them to the camps. The camps are in military bases and run by the military, and they aren't trained for that. The military is just housing them, and there are beatings and forced labor for no money. There is no due process," she said.

It is as if the Thai government's left hand doesn't know what its right hand is doing, said Kaplan. "The government at least pays lip service to harm reduction, but the Ministry of the Interior is not talking to the Narcotics Control Board, which sponsors the harm reduction policy," she said. "We have gotten unofficial statements from senior officials inside the Public Health Ministry saying they are going to speak with the board and the Interior Ministry about what Thailand might do more effectively."

In the mean time, the roundups continue.

The threat of the mass roundup of suspected drug users has led a coalition of Thai and international health, harm reduction, and human rights organizations to publicly air their fears that it will trample on human rights and could lead to the widespread abuses of drug users seen in other Thai anti-drug campaigns.

"These plans for mass detention and forced treatment raise considerable human rights concerns, especially given Thailand’s history of nationwide punitive and ineffective anti-drug campaigns," they said in an open letter to the Thai government. "There is no way for the government to implement a campaign to forcibly 'treat' tens of thousands of people who use drugs without widespread human rights abuses taking place."

Groups signing on to the letter include the TTAG, the International Harm Reduction Association (IHRA), the International Drug Policy Consortium (IDPC), the International Harm Reduction Program of the Open Society Institute, the Canadian HIV/AIDS Legal Network, and the International Network of People Who Use Drugs (INPUD).

"The mandatory rounding up and detention of people who use illicit drugs for the purpose of enforced treatment is not only a violation of their human rights, it's a violation of common sense -- enforced detention doesn't work," said INPUD's Jude Byrne. "Never has, never will! Communities need to look to the reason people are using drugs. Stop the systemic violence against the poor, minorities, people of different sexual persuasion and the unemployed. Rounding up the most marginalized people in the community will do nothing except provide jobs for the police and the people who run the detention centers. It will also drive INPUD's community underground so they are not able to access harm reduction information or equipment where it is available. The transmission of HIV and Hep C among the injecting drug using community will soar, and that is the real crime, not the use of drugs."

"This crackdown flies in the face of Thailand’s 2002 policy, which states that people who use drugs should be treated as patients, not criminals. There is nothing therapeutic about rounding up thousands of drug users and forcing them into military boot camps that fail to provide appropriate services and support," said Paisan Suwannawong, TTAG executive director and co-founder of the Thai Drug Users' Network.

While the Thai government refers to "drug addicts," its plans appear to include any drug users. Under the current plan, "occasional" users will be detained for one week, "continuous" users for two weeks, and those showing signs of drug dependence for 6 1/2 weeks (45 days).

"There are many reasons to be worried," said IHRA executive director Rick Lines. "Due process guarantees have been thrown out the window. What is the legal basis for mass detention? There are numerous examples of how forced detention in the name of drug dependence 'treatment' can lead to human rights violations and breaches of accepted principles of medical ethics," he continued. "What is more, many who do not need any form of drug dependence treatment will be herded into detention centers. Where is the clinical assessment?" he asked.

The activists also expressed concern about the temporary detention centers that will be set up outside Bangkok. They feared they would be operated not by health workers, but by police or soldiers, they said.

"We are profoundly concerned that these centers may be run by public security forces such as the police or paramilitary civil-defense organizations" said Kaplan. "It is dangerous and extremely disheartening given recent progress made in the country on injecting drug use and HIV. This can only serve to undermine those efforts in the long term. The immediate concern, however, is for the safety and well-being of those targeted."

But the medium term goal is to persuade the Thai government to embrace not merely the rhetoric of harm reduction, but the practice. That is going to take continuing pressure on the government, and the United Nations needs to step up, said Kaplan.

"We need more high-level action to push the government over to harm reduction," she said. "The World Health Organization and the UN Office on Drugs and Crime don't listen to civil society, so we need governments to step up. It is very important and progressive that Thailand is talking harm reduction, but to actually do it, they need a lot of help."

Thailand

Hemispheric Think Tank Says Time for Drug Policy Rethink

A prestigious Washington, DC-based center for hemispheric policy analysis and discussion, the Inter-American Dialogue, is calling for a refashioning of US drug policy. It demands an end to "the silent tolerance of ineffective, socially harmful laws, institutions, and policies" and has some suggestions as to where to go next.

In a report authored by the Dialogue's Peter Hakim, Rethinking US Drug Policy, the Dialogue said: "The available evidence suggests that in the past two decades, US anti-drug policies have done little to diminish the problems they were designed to address." The report proposed a number of initiatives the US government could undertake to set the stage for a thorough rethinking of US drug policy:

  • Support recent Congressional initiatives to establish House and Senate commissions to review US anti-drug strategies and develop alternative approaches;
  • Join with other nations to organize an inter-governmental task force on narcotics strategy that would review and appraise global drug policies;
  • Revise outdated UN treaties that underpin the international narcotics regime;
  • Expand data collection, analysis, and research on multiple aspects of drug problems and the policies and programs designed to address them; and
  • Identify and scale up successful drug programs that promise to reduce drug addiction and the health risks to addicts, increase the prospects of rehabilitation, and decrease drug related crimes.

The Inter-American Dialogue is holding a public discussion of the report and its recommendations Thursday, 2/10/11 on Capitol Hill.

Washington, DC
United States

Heroin Drought Causing Problems in England

A scarcity of heroin in England is leading to a growing number of drug overdoses and poisonings as users ingest dope cut with other substances by dealers trying to stretch supplies, The Guardian reported this week. Scene watchers there are calling it the worst drought in years.

Are you sure that's heroin? Be careful out there, especially in England
The drought is being blamed not on seizures by law enforcement agencies, but on a fungus that has blighted the Afghan opium poppy crop, reducing the size of this year's poppy crop by half. Afghanistan accounts for more than 90% of the world's opium production and likely 100% of the British heroin supply.

"There is a very significant heroin shortage across the UK at the moment," said Gary Cross, head of drug policy for the non-profit group Release.  "It has been going on for some time now, but the last two months have seen stockpiles exhausted."

"I've never known anything like it in 30 years," wrote one long-time heroin user on an on-line forum discussing the shortage.

As dealers and users scramble to grapple with the shortage, users are turning up at hospitals after ingesting adulterated heroin or, in some cases, fake heroin consisting of a powerful sedative, caffeine, and paracetamol, a bulking agent. Some have passed out after smoking or ingesting, while others have reported vomiting, amnesia, and flu-like symptoms.

"This 'heroin drought' appears to be serious and geographically widespread," said Neil Hunt, director of research at KCA, a nationwide community drug treatment service. "Street heroin is in a complete and utter muddle at the moment, and users are collapsing unexpectedly. We need to standardize information about what's out there.

"If people use this intravenously, perhaps on top of alcohol and methadone [the prescribed substitute drug for heroin], it is extremely risky," said Dr. John Ramsey, who runs a drug database at St. George's Medical School in London. "We have had many reports of people overdosing. It's really important that accident and emergency departments understand that they may not be dealing with a 'normal' heroin overdose when people are brought in," he said.

Harm reduction drug agencies are aware of the problem and working to address it. Several of them held an urgent meeting last week to discuss setting up an online warning system to give users notice about contaminated or adulterated drugs.

London
United Kingdom

FDA Approves Once-A-Month Injectable Drug to Fight Opiate Addiction

The US Food and Drug Administration (FDA) announced Tuesday that it had approved a once-a-month injectable drug for use in treating opiate addiction. The drug, marketed as Vivitrol, is a form of naloxone, an opioid atagonist that blocks the action of opioids on brain cells and is currently used in responding to overdoses.

In approving Vivitrol, the FDA cited a Russian study with 250 heroin addicts that found it reduces relapse rates and blocks cravings for narcotics. In that study, after six months, 86% of subjects taking Vivitrol had stayed off opiates and were functioning in work or school, compared to only 57% who were given a placebo.

Unlike methadone and buprenorphine, which are commonly used in opiate substitution treatments, Vivitrol is not addictive and does not maintain opiate dependency. Additionally, unlike those two substitutes, Vivitrol does not need to be taken daily, but is instead administered monthly via intramuscular injection.

The approval of Vivitrol for opiate addiction is "an important turning point in our approach to treatment," said Dr. Nora Volkow, head of the National Institute on Drug Abuse, in a statement greeting the FDA announcement.

Nearly 810,000 Americans are addicted to heroin, with more than twice that number using prescription opioids, such as Oxycontin and Vicodin, for non-prescription purposes, Volkow noted.

Washington, DC
United States

Russian Diplomat Takes Over at UN Drug Agency

As of Monday, the United Nations Office on Drugs and Crime (UNODC) is under new management. Russian diplomat Yury Fedotov , who was nominated for the post earlier this year by UN Secretary General Ban Ki-moon, has now taken over the organization that makes up a key part of the global drug prohibition regime. He replaces outgoing UNODC head Antonio Maria Costa.

Yuri Fedotov (courtesy Voice of Russia, ruvr.ru)
The Vienna-based agency, established in 1997, is charged with fighting the illegal drug trade, as well as other international crime, such as corruption and human trafficking. It also publishes annual reports on the global drug scene, as well as regional reports, including annual surveys of Afghan opium poppy production.

"Public health and human rights must be central" to his agency's work, Fedotov said in a statement Monday. "Whether we talk of the victims of human trafficking, communities oppressed by corrupt leaders, unfair criminal justice systems or drug users marginalized by society, we are committed to making a positive difference," he said.

"Drug dependence is a health disorder, and drug users need humane and effective treatment -- not punishment," he added. "Drug treatment should also promote the prevention of HIV."

Harm reductionists and AIDS activists had earlier urged Ki-moon not to appoint Fedotov, pointing to Russia's abysmal record on human rights, the treatment of drug users, and HIV/AIDS prevention. But on Monday, the International Harm Reduction Association told the Associated Press it was willing to give Fedotov a chance based on his early remarks.

"We certainly hope this sets the benchmark for the path he'll be taking," said the association's executive director Rick Lines. "For any public official, they're going to be judged by what they do with the responsibility they're given."

Vienna
Austria

Europe: Norwegian Committee Calls for Heroin Prescription Trials, Harm Reduction Measures

A blue-ribbon committee in Norway has called for heroin prescription trials and expanded harm reduction measures, such as expanding safe injection sites. The Stoltenberg Committee presented its findings in a 49-page report (sorry, Norwegian only) issued last month.

https://stopthedrugwar.org/files/norwegianfjord.jpg
Norwegian fjord (courtesy Erik A. Drabløs via wikimedia.org)
The committee was created last year by then Health Minister Bjarne Hakon Hanssen to review the situation of hard drug users in Norway. It was tasked in particular with evaluating whether the government should allow a trial heroin prescription program because the notion was so controversial in Norway. The committee did not address soft drug use.

Committee head Thorvald Stoltenberg is a well-known and well-respected political figure in Norway, having served in the past as foreign minister. He is the father of the current prime minister. He is also the father of an adult daughter who is a former heroin addict.

Current Health Minister Anna-Greta Strom-Erichsen agreed with the committee's call for more harm reduction and expanded treatment services, but wasn't ready to sign off on prescribed heroin just yet.

"I agree with the committee that services for the most vulnerable drug addicts must be better," she said in a press release. "The committee wants greater degree of coordination of services. This is a task that is central to the work of collaborative reform, which is especially important for people with drug problems," she added.

But heroin prescribing is "a difficult question" on which the government must move carefully, Strom-Erichsen said. "The government has not reached a conclusion on the question of heroin assisted treatment. Regardless of the conclusion to this question, there is a need for an intensified effort for people with drug problems, including medical treatment, "she said.

The committee report will now form the basis for a broad dialog on its recommendations among government officials, local officials, drug users, relatives, and other interested parties. After that, the Health Ministry will send a proposal to parliament.

While the committee report is quite moderate by international standards, it represents a major break from traditional Norwegian responses to hard drug use and an embrace of the harm reduction philosophy.

UNODC: The Russians Are Coming

[Update, 6:20pm EST: Peter Sarosi at HCLU just told me Ban Ki-moon has indeed picked Fedotov. Hence I have removed the question mark from the end of the title of this article. :( - DB]

Current head of the UN Office on Drugs and Crime (UNODC) Antonio Maria Costa is set to end his 10-year term at the end of this month, and according to at least one published report, a Russian diplomat has emerged as the frontrunner in the race to replace him. That is causing shivers in some sectors of the drug reform community because the Russians are viewed as quite retrograde in their drug policy positions.

The report names Russia's current ambassador to the United Kingdom, Yuri Fedotov, as the top candidate to oversee UNODC and its $250 million annual budget. Other short-listed candidates include Spanish lawyer Carlos Castresana, who headed a UN anti-crime commission in Guatemala, Colombian Ambassador to the European Union Carlos Holmes Trujillo, and Brazilian attorney Pedro Abramovay. The final decision is up to UN Secretary General Ban Ki-moon.

If Fedotov wins the position, Russia would be in a far more influential position to influence international drug policy, and that is raising concerns because of Russia's increasingly shrill demands that the US and NATO return to opium eradication in Afghanistan, its refusal to allow methadone maintenance and its refusal to fund needle exchange programs even as it confronts fast-growing heroin addiction and HIV infection rates.

The concerns have crystallized in a campaign to block his appointment, including a Facebook group called We Don't Want A Russian UN Drug Czar!, which is urging people to send an email message to that effect to Secretary General Ki-moon. Group organizers the Hungarian Civil Liberties Union have also produced a video on the subject:

Prosecution: Kentucky Supreme Court Rules Pregnant Women Cannot Be Criminalized for Drug Use

Women who take illegal drugs while pregnant cannot be charged with child endangerment crimes for doing so, the Kentucky Supreme Court ruled last Friday. The court held that such prosecutions are unlawful under the state's Maternal Health Act of 1992, which expressly forbids charging women with a crime if they drink or do drugs during pregnancy.

The case is Cochran v. Kentucky, in which Casey County prosecutors charged Ina Cochran with first-degree wanton endangerment after she gave birth to a child who tested positive for cocaine in 2005. Cochran's attorney moved to have the charges dismissed, and a Casey Circuit Court judge agreed, but prosecutors appealed to the state Court of Appeals, which held that the charges could be allowed.

The state Supreme Court overturned the Court of Appeals ruling, arguing that the appeals court had erred both because its decision was intolerably vague and because the Kentucky legislature had expressly held that pregnant women were not to be prosecuted for drug use. "It is the legislature, not the judiciary, that has the power to designate what is a crime," the opinion said.

In passing the Maternal Health Act of 1992, the legislature explicitly stated that "punitive actions taken against pregnant alcohol or substance abusers would create additional problems, including discouraging these individuals from seeking the essential prenatal care."

The high court cited a similar earlier case it had decided, and that quotation is worth repeating:

"The mother was a drug addict. But, for that matter, she could have been a pregnant alcoholic, causing fetal alcohol syndrome; or she could have been addicted to self abuse by smoking, or by abusing prescription painkillers, or over-the-counter medicine; or for that matter she could have been addicted to downhill skiing or some other sport creating serious risk of prenatal injury, risk which the mother wantonly disregarded as a matter of self-indulgence. What if a pregnant woman drives over the speed limit, or as a matter of vanity doesn't wear the prescription lenses she knows she needs to see the dangers of the road?

"The defense asks where do we draw the line on self-abuse by a pregnant woman that wantonly exposes to risk her unborn baby? The Commonwealth replies that the General Assembly probably intended to draw the line at conduct that qualifies as criminal, and then leave it to the prosecutor to decide when such conduct should be prosecuted as child abuse in addition to the crime actually committed.

"However, it is inflicting intentional or wanton injury upon the child that makes the conduct criminal under the child abuse statutes, not the criminality of the conduct per se. The Commonwealth's approach would exclude alcohol abuse, however devastating to the baby in the womb, unless the Commonwealth could prove an act of drunk driving; but it is the mother's alcoholism, not the act of driving that causes the fetal alcohol syndrome. The 'case-by-case' approach suggested by the Commonwealth is so arbitrary that, if the criminal child abuse statutes are construed to support it, the statutes transgress reasonably identifiable limits; they lack fair notice and violate constitutional due process limits against statutory vagueness."

Somebody ought to tell them in South Carolina, where the courts have upheld the prosecution and imprisonment of pregnant women who used drugs.

Feature: Schwarzenegger Trying to Gut California Methadone Funding in Budget Move

With California facing a $19 billion budget deficit, Gov. Arnold Schwarzenegger (R) last month proposed saving the state $53 million by cutting off Medi-Cal funding for methadone maintenance for most heroin addicts. That would cause the loss of more than $60 million in matching federal funds. The move was fiercely resisted by methadone advocates -- including a former drug czar -- and public policy analysts, and the proposal was defeated last week in committee votes in the state Senate and Assembly.

But California gives the governor the power to veto individual budget items, so advocates are not resting yet. Instead they are reaching out to the administration in hopes they can enlighten it and persuade the budget axe-wielding Schwarzenegger to aim elsewhere.

Schwarzenegger isn't the first top-tier elected official to go after methadone maintenance. Back in 1999, then New York City Mayor Rudy Giuliani vowed to wean all of the city's methadone patients off it in three months. While Giuliani acted for ideological rather than budgetary reasons -- he said he wanted "drug freedom," not drug dependence -- the pugnacious mayor later changed his tune, admitting the idea was "maybe somewhat unrealistic."

https://stopthedrugwar.org/files/harm-reduction-superheroes-vancouver.jpg
superheroes for harm reduction: ''Methadone Man'' public awareness campaign during last February's Olympics in Vancouver. You're needed everywhere, Methadone Man.
Currently, nearly 150 methadone clinics provide the heroin substitute to some 35,000 addicts, 55% of whom are on Medi-Cal. Advocates and treatment providers said that clinics would be forced to close if the proposal passed, affecting not only the Medi-Cal patients, but also patients who paid out of their own pockets or through private insurance to be able to get maintenance methadone.

"Methadone isn't a cure," said Roxanne Baker, president of the National Alliance of Methadone Advocates (NAMA), "but much like thyroid medication, as long as you keep taking it, it keeps your disease in check, and opiate addiction is a disease. When you mess with your brain with painkillers, it then doesn't produce the endorphins it should. It's not a matter of will power, it's a disease. You need something to replace those endorphins, whether its methadone, suboxone, or even prescription heroin, although I doubt we'll ever see that here."

Enacting the proposed cuts would be "a disaster," said Baker. "There would be no methadone programs left. More than half the patients statewide are on drug MediCal, and they wouldn't even have a place to go. A lot of these people have their lives in order. This is somebody's brother, somebody's aunt, somebody's mom. Please don't take this from us."

Last week, Clinton-era drug czar Gen. Barry McCaffrey flew into the state to hold a press conference denouncing the cut. "Dumping tens of thousands of opiate addicts back on the street would be an immediate disaster to law enforcement, and to the families of people who have become stable, functioning adults" thanks to methadone, said McCaffrey, who has a consulting firm and serves on the board of directors of an organization that treats chemical dependency.

Legislators were listening, not only to McCaffrey, but to the methadone treatment community. A Senate Budget Committee hearing last week proved tough going for Schwarzenegger's representatives.

"This measure would eliminate the drug MediCal program with the exception of the perinatal and youth funding," said John Wardlaw from the state Department of Finance. "This is not an easy reduction in any way. We are at the point where we are making very difficult reductions."

Committee Chair Denise Moreno Ducheny (D-San Diego) wasn't buying it. "How much federal funding are you giving up?" she asked.

"Sixty-six million dollars," Wardlaw said.

"We save $53 million and lose $66 million?" asked Ducheny.

"That is correct, ma'am."

Ducheny just stared at him for a few uncomfortable moments before moving on to the next witness.

"There would be cost shifts in the area of corrections and child welfare services," Greg Tallivant of the legislative analysts' office told the solons. "The day the clinic closes, those people have to do something. If they can't make it to the next methadone clinic, heroin would be the next choice. You would see people arrested. You would see prison costs and child welfare costs go up."

Assemblyman Mark Leno (D-San Francisco) was visibly irritated by the proposal. "There is a complete lack of interest in any cost-benefit analysis here," he said. "This is reckless and cavalier. It doesn't really make much sense. We have 171,000 people addicted to drugs. This will increase our crime rate; it's a recipe for disaster on our streets. Does the governor have no interest in this or does he not believe that this will impact the safety of our children and communities? We've already zero-funded the base Proposition 36 program. The outcome of this is to have drug offenders with no jail and no treatment."

"This is really a short-sighted proposal that shifts costs from funding treatment to funding law enforcement, jails, and prisons," said Jason Kletter, a member of the Bay Area Addiction Research Team (BAART), which is in turn a member of California Opioid Maintenance Providers (COMP), a nonprofit organization representing opioid maintenance treatment centers. "It is a public safety issue, to say nothing of the humanitarian crisis it would provoke," he said.

"We think if this happened many clinics would close, and the folks who lose access to care would likely relapse and cost the system much, much more in a short time," said Kletter. "We see relapse rates of 80% within a year when clinics close, so it wouldn't even be like we'd be kicking the can three or four years down the road."

"This would have the biggest impact on programs that have a high percentage of Medi-Cal beneficiaries in treatment and would be unable to stay open because more than half their patients, and thus, their revenues, are gone," said Kletter. "You would have a fundamental dismantling of the system."

The cost incurred would be staggering, Kletter said."If 80% relapse in same year, we know that the state will incur $700 million to $1 billion in new costs in the criminal justice system," he said, citing a study from the 1990s that found each dollar invested in treatment produced a seven-dollar return. "The state wants to save $53 million by eliminating drug Medi-Cal and will also turn away more than $60 million in matching funds. That's $115 total program cost. A seven-to-one return on that is close to a billion dollars. "With 80% relapse, we could end up seeing $700 million in new criminal justice and prison costs."

"It's a terrible proposal," said Glenn Backes, a Sacramento-based public policy analyst who works with the Drug Policy Alliance at the Capitol. "California Democrats in both houses have said so. The Senate Republicans didn't do a cost-benefit analysis; they just said we can't afford to give out subsidized health care."

But in reality, the situation is even worse, said Backes. "They've killed Proposition 36 funding, drug courts are being slashed. According to the governor's finance director, that's 171,000 patients. The cost-benefit for this is worse than nil. If only one out of a thousand relapses and goes to prison, you've already lost money because prison is so much more expensive than treatment. If only one out of a thousand gets Hep C, the taxpayer loses. If only one out of a thousand gets HIV, the taxpayer loses."

It's easy to lose the human side in all the numbers, Backes said. "If only one out of a thousand ODs and dies, that's 170 California families who have lost a loved one."

And the battle continues. "While both the Senate and the Assembly budget committees have rejected the governor's proposal, in California, the governor has a line item veto," said Kletter. "We are continuing to try to work with the administration to explain the impact of this kind of proposal and get them to understand it is a public safety and cost-shifting issue. We haven't had any direct meeting with them yet, but that's next on our agenda. We want to educate them about them dire consequences of this sort of action."

Even if advocates many to salvage the drug Medi-Cal program, they would be well-advised to be searching for alternative funding sources, and how better than to take money from the drug war? Tough times call for creative solutions, and Backes has one: Use federal Byrne Justice Assistance Grants to fund treatment instead of drug task forces. Every dollar funding more drug war arrests costs $10 additional in spending for courts and prisons, he said.

"Historically, Byrne grant funds have been given to task forces to increase arrests," Backes noted. "The Drug Policy Alliance position is that Byrne funds would be better spent on almost anything other than doing low-level drug sweeps. We would rather see that money go into treatment for people in the system."

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