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Feature: Anthrax-Tainted Heroin Takes Toll in Europe, Prompts Calls for Emergency Public Health Response

European heroin users are on high alert as the death toll rises from heroin tainted with anthrax. At least eight people have died -- seven in Scotland and one in Germany -- since early December, and another 14 Scottish heroin users have been hospitalized after being diagnosed with anthrax. Meanwhile, drug reform and drug user activists are reporting a cluster of nine suspicious heroin-related deaths in Coimbra, Portugal, although it is unclear at this point whether they are linked to anthrax-tainted heroin.

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anthrax spores
The Scottish government has responded by urging heroin users to stop using and to seek drug treatment. That advice has not gone over well with drug users and public health and harm reduction advocates, who are demanding an emergency public health response.

The first four Scottish deaths were in Glasgow, but after one person died in Tayside and one in the Forth Valley earlier this month, Health Protection Scotland epidemiologist Dr. Colin Ramsay said: "The death of this patient in NHS Forth Valley indicates further geographical spread of the cases, meaning that heroin users all across Scotland need to be aware of the risks of a potentially contaminated supply. I would urge all users to stop using heroin immediately and contact local drug support services for help in stopping. If any heroin users do notice signs of infection, for example marked redness and swelling around an injection site or other signs of serious infection such as a high fever, they should seek urgent medical advice."

The French government has also reacted, with the General Directorate for Health issuing a statement Tuesday warning that contaminated heroin may be circulating in France and other European countries. Noting the rising death toll, the statement said "the likeliest source is heroin contaminated by anthrax spores."

Heroin users should be alert, the French statement said, because heroin contaminated with anthrax is indistinguishable from other heroin. "There is no outward sign or color enabling the user to tell whether the heroin has been contaminated by anthrax, and contaminated heroin dissolves or is used in the same way as uncontaminated heroin," it said.

Anthrax is a potentially lethal bacterium that exists naturally in the soil and can also occur among cattle. It is also a potential bio-terror weapon.

The vast majority of heroin consumed in Europe comes from Afghanistan, and while so far evidence is lacking, speculation is that anthrax spores may have been present in bone meal, an animal product sometimes used as a cutting agent. Another possibility is that containers used in the heroin production process were contaminated with anthrax spores. And, given fears that Al Qaeda and its Taliban allies could resort to biological warfare against the West and given the Taliban's role in the Afghan opium and heroin trade, a bio-attack cannot be completely ruled out.

"The anthrax-infected heroin hasn't decreased use, whether people are injecting it or chasing [smoking] it," said Tam Miller, chair of Chemical Reaction, an Edinburgh drug user group, and a member of INPUD (the International Network of People who Use Drugs). "People are scared -- you can be sure of that -- but I think they're more afraid of withdrawing. The Scottish government's advice was for people to stop using heroin, but that won't happen."

Instead, Miller said, heroin users are doing what they can to protect themselves. "Users feel there's not much they can do personally and, as usual, they feel isolated," he said. "A lot are looking up the effects on anthrax on the net and passing on information to people with no internet access. We think the powers that be should put out information on how to spot signs if someone has been in contact with access. Basically, mate, the Scottish government wants little to do with it."

The Scottish government's response so far has drawn a harsh rebuke from the United Kingdom's harm reduction and public health community. In a Tuesday letter to the Scottish government, the International Harm Reduction Association, the drug think tank Release, the Transform Drug Policy Foundation, the UK Harm Reduction Alliance, and individual public health experts called on the government to put in place an emergency public health plan to deal with the crisis.

The letter said the government's advice to heroin users to stop using and enter treatment was "reckless in light of the fact that waiting times in Scotland for opiate substitute treatment (OST) are the longest in the UK. Many of those accessing services are informed that it is a condition of their treatment to engage with the service for a minimum period of time, before they will be entitled to a prescription offering an alternative substitute medication, usually methadone. In some areas of Scotland we have been informed that waiting times for OST can be up to 12 months."

[There is another potential issue with methadone, as well. The antibiotic drug Cipro, used to treat anthrax, interacts with methadone, leading to the possibility of methadone overdoses.]

Given the reality of treatment shortages and delays, it is "unacceptable" for the Scottish government to just tell users to stop or to go to treatment that isn't there, the letter said. "It is clear that this kind of approach can only lead to the death of more vulnerable people."

Instead, the Scottish government must immediately implement a public health plan that includes rapid access and low-threshold prescribing of alternatives to street heroin, the letter-writers advised. They recommended prescribing dihydrocodeine, a synthetic opiate approximately twice as strong as codeine. It is sold in the US under brand names including Panlor, Paracodin, and Synalgos.

"Such an approach will go some way to prevent any more loss of life and will provide greater protection to the public as a whole," the letter said. "Failure to adopt such a policy would mean that the Scottish state would be failing in its duty to its citizens."

Joep Oomen of the European Coalition for Just and Effective Drug Policies (ENCOD) had another suggestion. "The only decent reaction to this kind of episode is to immediately open facilities where people can test their heroin and where they can use in safe conditions, supervised by people who can help if anything goes wrong," he said.

"Hopefully, in the longer term, because of these incidents, authorities will start to see the need for introducing heroin maintenance programs, not as a trial for a limited group of people, but as a permanent service for all those who cannot abstain from heroin for a longer period of time," he added.

Ultimately, said Oomen, prohibition is the problem. "Adulteration is a practice that belongs to the illegal market," he said. "It happens because the people who control the heroin market have no interest at all in the health of their customers."

Dr. Sharon Stancliff of the US Harm Reduction Coalition agreed with her colleagues' assessment of the Scottish government's response. "Telling people to stop is not useful information," she said. "Maybe some occasional users will have a glass of wine instead, but if people are sick and treatment is limited, telling people that heroin is bad for them isn't going to have much impact," she explained.

"At this point, the European harm reduction people should be getting the word out, and the medical people over there need to be on the alert," she added.

Stancliff said she had seen no sign of heroin contaminated with anthrax on this side of the Atlantic, but she was worried. "I hope the DEA is out there buying heroin to see what's in it," she said. "If there is any hint of it here, physicians should be alerted by the Centers for Disease Control as they were with levamisole-tainted cocaine."

If the anthrax-contaminated heroin is coming from Afghanistan, as most heroin consumed in Europe does, US heroin users may catch a break. Most heroin consumed here is of Mexican or Colombian provenance.

But on the other side of the Atlantic, adulterated heroin is killing drug users.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Feature: 2009 International Drug Policy Reform Conferences Opens Amid Optimism in Albuquerque

Hundreds, possibly more than a thousand, people poured into the Convention Center in downtown Albuquerque, New Mexico, as the Drug Policy Alliance's 2009 International Drug Policy Reform Conference got underway yesterday. Set to go on through Saturday, the conference is drawing attendees from around the country and the world to discuss dozens of different drug reform topics. (See the link above for a look at the program.)

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screening of near-final version of the next Flex Your Rights film, 10 Rules for Dealing with Police
This is the second time DPA has brought the conference to the distant deserts of the Southwest. In 2001, DPA rewarded libertarian-leaning New Mexico Gov. Gary Johnson (R) for becoming the highest ranking elected official in the US to call for ending drug prohibition by bringing the conference to his home state. Since then, the ties between DPA and New Mexico have only deepened.

As DPA New Mexico office head Reena Szczepanski explained at the opening plenary session, the Land of Enchantment is fertile ground for drug reform. "Back in 1997, when drug policy reform was little more than a twinkle in the eye, New Mexico passed a harm reduction act mandating the Department of Health to give out clean syringes for people with HIV/AIDS," she noted. "Then, when Gov. Johnson said it was time to end the war on drugs, DPA very wisely immediately opened an office here. In 2001, we passed the overdose prevention act, allowing for the distribution of naloxone. Then we passed opting out on the federal welfare ban, we passed asset forfeiture reform, we passed the 911 Good Samaritan Act -- saving somebody's life is more important than busting them for small amounts of drugs."

But wait, there's more. "Thanks to Gov. Bill Richardson, we became the 12th state to have legal access to medical marijuana for seriously ill people," Szczepanski continued. "We're working on treatment instead of incarceration, we're working to end the war on drugs in New Mexico and this country. This is a very special place for drug policy reform."

New Mexico is also right next store to one of the drug war's bloodiest battlegrounds: the mean streets of Ciudad Juarez, just across the Rio Grande River from El Paso, Texas, which in turn in borders New Mexico. More than 2,200 people have died in prohibition-related violence in Juarez this year alone.

That violence just across the river inspired El Paso City Councilman Beto O'Rourke to turn a motion expressing sympathy for El Paso's sister city into one that also asked for an open and honest debate on ending drug prohibition. The resolution passed the city council by a unanimous vote, only to be vetoed by the mayor. Then, as the council scheduled an override vote, the pressure came down.

"Each of us on the council got a call from Rep. Silvestre Reyes, our congressman and a very powerful figure," O'Rourke told the crowd Thursday. "He told us if we went forward with this, it will be very hard to get your district the federal funding you need. That's a powerful threat, since we rely on federal funding to deliver basic services. It was enough to get four members to change their votes."

While the resolution was defeated, the debacle opened the door for serious debate on drug policy in El Paso and generated support for ending prohibition as well, O'Rourke said. "Our local Students for Sensible Drug Policy chapter came out very strongly and helped organize a global policy forum in El Paso. I received hundreds of calls, letters, and emails of support from around the country and the world," O'Rourke related to sustained applause.

If Councilman O'Rourke was a new face, Ira Glasser is a familiar one. Former executive director of the ACLU and president of the DPA board of directors, Glasser told the crowd he was more optimistic about the prospects for change than ever before.

"Today we stand on the brink of transformative progress," he said. "I have never said that before. We can almost touch the goals we have sought, the unraveling of the so-called war on drugs, which is really a war on fundamental freedoms and constitutional rights, on personal autonomy, on our sovereignty over our minds and bodies, a war against people of darker skin color."

Just as Jim Crow laws were the successor to the system of slavery, said Glasser, so the drug war has been the successor to Jim Crow. "It's no accident that after the civil rights revolution ended with the passage of the last federal civil right law in 1968, Richard Nixon was elected on the southern strategy against progress on civil rights," he noted. "Within months of taking office, Nixon declared the modern war on drugs."

Glasser wasn't the only one feeling uplifted. "I am feeling good, better than ever before," said DPA executive director and plenary keynote speaker Ethan Nadelmann. "The wind is at our back. We are making progress like never before. We have to move hard and fast. Historically speaking, there are moments when everything comes together," drawing a pointed comparison with the successful temperance movement that managed to get alcohol banned during Prohibition. But Prohibition generated its own counter-movement, he said, again drawing a pointed parallel.

"Now, we're in another moment," Nadelmann said. "We're hurting with the recession, state budgets are hemorrhaging. More and more people are realizing we can't afford to pay for our prejudices, we can't continue to be the world's largest incarcerator."

But it's not just the economy that is opening the window, he continued. "What's happening in Mexico and Afghanistan, where illicit drugs are ready sources of revenues for criminals and political terrorists, that has people thinking. We have two major national security problems causing people to think afresh."

Nadelmann had a suggestion: "Ending marijuana prohibition is a highly effective way of undermining that violence," he said. "Until we end it, buy American."

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

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

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

That wasn't the only unveiling Thursday. Later in the evening, Flex Your Rights held the first public showing of its new video, 10 Rules for Dealing with Police. The screening of the self-explanatory successor to Flex Your Right's 2003 "Busted" played to a packed and enthusiastic house. This highly useful examination of how not to get yourself busted is bound to equal if not exceed the break-out success of "Busted."

The conference, of course, continued Thursday afternoon and will go through Saturday, but your reporter was busy getting this week's Drug War Chronicle ready to go. Come back next week for fuller reports on the 2009 International Drug Policy Reform Conference.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Feature: Historic Hearing on Marijuana Legalization in the California Legislature

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Drug War Chronicle Book Review: "Drug War Zone: Frontline Dispatches from the Streets of El Paso and Juarez," by Howard Campbell (2009, University of Texas Press, 310 pp., $24.95 PB)

Phillip S. Smith, Writer Editor

Howard Campbell's "Drug War Zone" couldn't be more timely. Ciudad Juárez, just across the Rio Grande from El Paso, is awash in blood as the competing Juárez and Sinaloa cartels wage a deadly war over who will control the city's lucrative drug trafficking franchise. More than 2,000 people have been killed in Juárez this year in the drug wars, making the early days of Juárez Cartel dominance, when the annual narco-death toll was around 200 a year, seem downright bucolic by comparison.

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The violence in Mexico, of which Juárez is the current epicenter, has been setting off alarm bells in Washington, and the US has responded with thousands more law enforcement agents on the border and more than a billion dollars in aid to the Mexican government. In other words, what we've been doing hasn't worked, so let's do even more of it, even more intensely.

We've all seen the horrific headlines; we've all seen the grim and garish displays of exemplary violence; we've read the statistics about the immense size of the illegal drug business in Mexico and the insatiable appetites of drug consumers in El Norte ("the north," e.g. the US). What we haven't had -- up until now -- is a portrayal of the El Paso-Juárez drug trade and drug culture that gets beneath the headlines, the politicians' platitudes, and law enforcement's self-justifying pronouncements. With "Drug War Zone," Campbell provides just that.

He's the right guy in the right place at the right time. A professor of sociology and anthropology at the University of Texas-El Paso who has two decades in the area, Campbell is able to do his fieldwork when he walks out his front door and has been able to develop relationships with all sorts of people involved in the drug trade and its repression, from low-level street dealers in Juárez to middle class dabblers in dealing in El Paso, from El Paso barrio boys to Mexican smugglers, from journalists to Juárez cops, from relatives of cartel victims to highly-placed US drug fight bureaucrats.

Using an extended interview format, Campbell lets his informants paint a detailed picture of the social realities of the El Paso-Juárez "drug war zone." The overall portrait that emerges is of a desert metropolis (about a half million people on the US side, a million and a half across the river), distant both geographically and culturally from either Washington or Mexico City, with a long tradition of smuggling and a dense binational social network where families and relationships span two nations. This intricately imbricated web of social relations and historical factors -- the rise of a US drug culture, NAFTA and globalization -- have given rise to a border narco-culture deeply embedded in the social fabric of both cities.

(One thing that strikes me as I ponder Campbell's work, with its description of binational barrio gangs working for the Juárez Cartel, and narcos working both sides of the border, is how surprising it is that the violence plaguing Mexico has not crossed the border in any measurable degree. It's almost as if the warring factions have an unwritten agreement that the killings stay south of the Rio Grande. I'd wager they don't want to incite even more attention from the gringos.)

Campbell compares the so-called cartels to terrorists like Al Qaeda. With their terroristic violence, their use of both high tech (YouTube postings) and low tech (bodies hanging from bridges, warning banners adorning buildings) communications strategies, their existence as non-state actors acting both in conflict and complicity with various state elements, the comparison holds some water. Ultimately, going to battle against the tens of thousands of people employed by the cartels in the name of an abstraction called "the war on drugs" is likely to be as fruitless and self-defeating as going to battle against Pashtun tribesmen in the name of an abstraction called "the war on terror."

But that doesn't mean US drug war efforts are going to stop, or that the true believers in law enforcement are going to stop believing -- at least most of them. One of the virtues of "Drug War Zone" is that it studies not only the border narco-culture, but also the border policing culture. Again, Campbell lets his informants speak for him, and those interviews are fascinating and informative.

Having seen its result close-up and firsthand, Campbell has been a critic of drug prohibition. He still is, although he doesn't devote a lot of space to it in the book. Perhaps, like (and through) his informants, he lets prohibition speak for itself. The last interview in the book may echo Campbell's sentiments. It's with former Customs and Border Patrol agent Terry Nelson. In the view of his former colleagues, Nelson has gone over to the dark side. He's a member of Law Enforcement Against Prohibition.

If you're interested in the border or drug culture or the drug economy or drug prohibition, you need to read "Drug War Zone." This is a major contribution to the literature.

Southwest Asia: Afghan Opium Trade Wreaking Global Havoc, UNODC Warns

The UN Office on Drugs and Crime (UNODC) warned Wednesday that the traffic in Afghan opiates is spreading drug use and addiction along smuggling routes, spreading diseases, and funding insurgencies. The warning came in a new report, Addiction, Crime, and Insurgency: The Threat of Afghan Opium. "The Afghan opiate trade fuels consumption and addiction in countries along drug trafficking routes before reaching the main consumer markets in Europe (estimated at 3.1 million heroin users), contributing to the spread of HIV/AIDS and other blood-borne diseases," the report said.

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Afghan opium
Neighboring countries, especially Iran, Pakistan, and the Central Asian republics, are among the hardest hit, said UNODC. According to the report, Iran now has the highest opiate addiction rates in the world. "Iran faces the world's most serious opiate addiction problem, while injecting drug use in Central Asia is causing an HIV epidemic," UNODC said.

But the impact of the multi-billion flow of Afghan opiates could have an especially deleterious impact on Central Asia, UNODC chief Antonio Maria Costa warned in remarks accompanying the report. "The Silk Route, turned into a heroin route, is carving out a path of death and violence through one of the world's most strategic yet volatile regions," Costa said. "The perfect storm of drugs, crime and insurgency that has swirled around the Afghanistan/Pakistan border for years is heading for Central Asia."

In Pakistan and Afghanistan, the opium trade is funding violent radicals. "The funds generated from the drugs trade can pay for soldiers, weapons and protection, and are an important source of patronage," the report said. In Afghanistan, the Taliban generated between $90 million and $160 million annually in recent years, the UNODC estimated. In Pakistan, the UNODC estimated the trade at $1 billion annually, with "undetermined amounts going to insurgents."

Although Afghan opium production declined slightly last year, the country is producing -- and has produced -- more opium than is needed to meet global demand. As a result, the UNODC estimates that there is an unaccounted for stockpile of 12,000 tons of opium -- enough to satisfy every junkie on the planet for the next three to four years. "Thus, even if opiate production in Afghanistan were to cease immediately, there would still be ample supply," the report said.

Unsurprisingly, the UNODC report did not address the role that global drug prohibition plays in exacerbating problems related to opiate use and the opiate trade. Prohibitionist attitudes restrict the availability of harm reduction programs, such as needle exchanges, that could reduce the spread of blood-borne diseases. And it is global drug prohibition itself that creates the lucrative black market the UNODC says is financing insurgencies and spreading political instability.

Asia: Drug Users Form Regional Organization

In a meeting in Bangkok last weekend, more than two dozen drug users from nine different countries came together to put the finishing touches on the creation of a new drug user advocacy organization, the Asian Network of People who Use Drugs (ANPUD). The Bangkok meeting was the culmination of a two-year process began at a meeting of the International Congress on AIDS in Asia and the Pacific in Colombo, Sri Lanka, in 2007, and resulted in the creation of a constitution and the selection of a steering committee for the new group.

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ANPUD group photo
ANPUD adopts the principles of MIPUD (Meaningful Involvement of People who Use Drugs), and in doing so, aligns itself with other drug user advocacy groups, including the International Network of People who Use Drugs (INPUD), of which ANPUD is an independent affiliate, the Australian Injection and Illicit Drug Users League (AIVL),the Vancouver Area Network of Drug Users, and the Nothing About Us Without Us movement.

ANPUD currently has more than 150 members and sees its mission to advocate for the rights of drug users and communities before national governments and the international community. There is plenty to do. Asia has the largest number of drug users in the world, but is, for the most part, woefully retrograde on drug policy issues. Not only do drug users face harsh criminal sanctions -- up to and including the death penalty -- but Asian countries have the lowest coverage of harm reduction services in the world. Access to harm reduction programs, such as needle exchanges and opioid maintenance therapy, is extremely limited.

"People who use drugs are stigmatized, criminalized and abused in every country in Asia," said Jimmy Dorabjee, a key figure in the formation of ANPUD. "Our human rights are violated and we have little in the way of health services to stay alive. If governments do not see people who use drugs, hear us and talk to us, they will continue to ignore us."

The Director of the UNAIDS Regional Support Team, Dr. Prasada Rao, spoke of the urgent need to engage with drug user networks and offered his support to ANPUD, saying that "For UNAIDS, HIV prevention among drug users is a key priority at the global level." Rao continued, "I am very pleased today to be here to see ANPUD being shaped into an organization that will play a key role in Asia's HIV response. It is critical that we are able to more effectively involve the voices of Asian people who use drugs in the scaling up of HIV prevention services across Asia."

"When I go back home, I am now responsible for sharing the experiences with the 250 or so drug users who are actively advocating for better services at the national level," said Nepalese drug user and newly elected steering committee member Ekta Thapa Mahat. "It will be a great way for us to work together and help build the capacity of people who use drugs in Asia."

"The results of the meeting exceeded my expectations," said Ele Morrison, program manager for AVIL's Regional Partnership Project. "The participants set ambitious goals for themselves and they have achieved a lot in just two days to set up this new organization. The building blocks for genuine ownership by people who use drugs is definitely there."

While the meetings leading to the formation were organized and managed by drug users, the process received financial support from the World Health Organization, the UNAIDS Regional Task Force, and AIVL.

Southwest Asia: Afghan Opium Trade Wreaking Global Havoc, UNODC Warns

Southwest Asia: Afghan Opium Trade Wreaking Global Havoc, UNODC Warns The UN Office on Drugs and Crime (UNODC) warned Wednesday that the traffic in Afghan opiates is spreading drug use and addiction along smuggling routes, spreading diseases, and funding insurgencies. The warning came in a new report, Addiction, Crime, and Insurgency: The Threat of Afghan Opium. "The Afghan opiate trade fuels consumption and addiction in countries along drug trafficking routes before reaching the main consumer markets in Europe (estimated at 3.1 million heroin users), contributing to the spread of HIV/AIDS and other blood-borne diseases," the report said. Neighboring countries, especially Iran, Pakistan, and the Central Asian republics, are among the hardest hit, said UNODC. According to the report, Iran now has the highest opiate addiction rates in the world. "Iran faces the world's most serious opiate addiction problem, while injecting drug use in Central Asia is causing an HIV epidemic," UNODC said. But the impact of the multi-billion flow of Afghan opiates could have an especially deleterious impact on Central Asia, UNODC chief Antonio Maria Costa warned in remarks accompanying the report. "The Silk Route, turned into a heroin route, is carving out a path of death and violence through one of the world's most strategic yet volatile regions," Costa said. "The perfect storm of drugs, crime and insurgency that has swirled around the Afghanistan/Pakistan border for years is heading for Central Asia." In Pakistan and Afghanistan, the opium trade is funding violent radicals. "The funds generated from the drugs trade can pay for soldiers, weapons and protection, and are an important source of patronage," the report said. In Afghanistan, the Taliban generated between $90 million and $160 million annually in recent years, the UNODC estimated. In Pakistan, the UNODC estimated the trade at $1 billion annually, with "undetermined amounts going to insurgents." Although Afghan opium production declined slightly last year, the country is producing—and has produced—more opium needed than to meet global supply. As a result, the UNODC estimates that there is an unaccounted for stockpile of 12,000 tons of opium—enough to satisfy every junkie on the planet for the next three to four years. "Thus, even if opiate production in Afghanistan were to cease immediately, there would still be ample supply," the report said. Unsurprisingly, the UNODC report did not address the role that global drug prohibition plays in exacerbating problems related to opiate use and the opiate trade. Prohibitionist attitudes restrict the availability of harm reduction programs, such as needle exchanges, that could reduce the spread of blood-borne diseases. And it is global drug prohibition itself that creates the lucrative black market the UNODC says is financing insurgencies and spreading political instability.

Southwest Asia: Russia Says US, NATO Anti-Drug Efforts in Afghanistan "Inadequate," Urges Aerial Eradication of Poppy Crops

In a Wednesday interview with the Associated Press, Russia's anti-drug chief said US and NATO anti-drug efforts in Afghanistan were "inadequate" and called for joint action to stem the flow of Afghan heroin flooding into Russia and the former Soviet republics.

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anti-drug artwork, Nejat Center, Kabul (photo by Phil Smith, fall 2005)
Viktor Ivanov told the AP that he had recently urged the Obama administration to begin a program to eradicate opium poppies by spraying them with herbicides from the air. Such a program was argued for by former drug czar John Walters and others during the Bush administration, but was rejected. Earlier this year, the US announced it was shifting away from any eradication and would focus instead on interdiction, destroying drug-making facilities, and disrupting the drug trade.

Russia is burdened with rising heroin addiction rates fueled by cheap Afghan heroin, and injection drug use has been a key factor in spreading the HIV virus there. There are an estimated 2 to 2.5 million heroin addicts in Russia, with about 30,000 dying from overdoses each year.

Ivanov, a former KGB captain who served in Afghanistan during the Soviet occupation in the 1980s, complained that by abandoning eradication efforts in Afghanistan, the West was dooming Russia to a wave of heroin addiction. He also said that growing wheat and other legal crops isn't practical in the middle of a war.

"As long as the situation remains tense and the confrontation continues, no one will engage in agriculture," he said. "They won't be able to cultivate grain even if they want to."

Ivanov noted that the US continues to fund a similar program to eradicate Colombian coca plants. Manual eradication in Afghanistan has failed and will continue to fail because the West has left it to the Afghan government and local authorities lack the clout (or sometimes the will) to effectively implement it, he said.

Ivanov said he had discussed the matter with Obama drug czar Gil Kerlikowske and State Department officials during a September meeting and that both sides agreed to continue discussions on aerial eradication. "I hope that our open-minded dialogue will encourage the US to take more adequate measures," Ivanov said. "We are interested in cooperation."

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