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Hoffman, Heroin, and What Is To Be Done [FEATURE]

The news last Sunday that acclaimed actor Phillip Seymour Hoffman had died of an apparent heroin overdose has turned a glaring media spotlight on the phenomenon, but heroin overdose deaths had been on the rise for several years before his premature demise. And while there has been much wailing and gnashing of teeth -- and quick arrests of low-level dealers and users -- too little has been said, either before or after his passing, about what could have been done to save him and what could be done to save others.

cooking heroin (wikimedia.org)
There are proven measures that can be taken to reduce overdose deaths -- and to enable heroin addicts to live safe and normal lives, whether they cease using heroin or not. All of the above face social and political obstacles and have only been implemented unevenly, if at all. If there is any good to come of Hoffmann's death it will be to the degree that it inspires broader discussion of what can be done to prevent the same thing happening to others in a similar position.

Hoffman, devoted family man and great actor that he was, died a criminal. And perhaps he died because his use of heroin was criminalized. Criminalized heroin -- heroin under drug prohibition -- is of uncertain provenance, of unknown strength and purity, adulterated with unknown substances. While we don't know what was in the heroin that Hoffman injected, we do know that he maintained his addiction and went to meet his maker with black market dope. That's what was found beside his lifeless body.

In a commentary published by The Guardian, actor Russell Brand, a recovered heroin addict, laid the blame for Hoffman's demise on the drug laws. "Addiction is a mental illness around which there is a great deal of confusion, which is hugely exacerbated by the laws that criminalise drug addicts," Brand wrote, calling prohibitionists' methods "so gallingly ineffective that it is difficult not to deduce that they are deliberately creating the worst imaginable circumstances to maximise the harm caused by substance misuse." As a result, "drug users, their families and society at large are all exposed to the worst conceivable version of this regrettably unavoidable problem."

We didn't always treat our addicts this way. Even after the passage of the Harrison Act in 1914, doctors continued for years to prescribe maintenance doses of opiates to addicts -- and hundreds of them went to jail for it as the medical profession fought, and ultimately lost, a battle with the nascent drug prohibition bureaucracy over whether giving addicts their medicine was part of the legitimate practice of medicine.

The idea of treating heroin addicts as patients instead of criminals was largely vanquished in the United States, but it never went away -- it lingers with methadone substitution, for example. But other countries have for decades been experimenting with providing maintenance doses of opioids to addicts, and to good result. It goes by various names -- opiate substitution therapy, heroin-assisted theatment, heroin maintenance -- and studies from Britain and other European countries, such as Germany, the Netherlands, and Switzerland, as well as the North American Opiate Medications Initiative (NAOMI) and the follow-up Study to Assess Long-Term Opiate Maintenance in Canada have touted its successes.

Those studies have found that providing pharmaceutical grade heroin to addicts in a clinical setting works. It reduces the likelihood of death or disease among clients, as well as allowing them to bring some stability and predictability to sometimes chaotic lives made even more chaotic by the demands of addiction under prohibition. Such treatment has also been found to have beneficial effects for society, with lowered criminality among participants and increased likelihood of their integration as productive members of society.

The dry, scientific language of the studies obscures the human realities around heroin addiction and opioid maintenance therapy. One NAOMI participant helps put a human face on it.

"I want to tell you what being a participant in this study did for me," one participant told researchers. "Initially it meant 'free heroin.' But over time it became more, much more. NAOMI took much of the stress out of my life and allowed me to think more clearly about my life and future. It exposed me to new ideas, people (staff and clients) that in my street life (read: stressful existence) there was no time for."

"After NAOMI, I was offered oral methadone, which I refused. After going quickly downhill, I ended up hopeless and homeless. I went into detox in April 2007, abstained from using for two months, then relapsed. In July 2008 I again went to detox and I am presently in a treatment center... I am definitely not "out of the woods" yet, but I feel I am on the right path. And this path started for me at the corner of Abbott and Hastings in Vancouver... Thank you and all who were involved in making NAOMI happen. Without NAOMI, I wouldn't be where I am today. I am sure I would be in a much worse place."

Arnold Trebach, one of the fathers of the drug reform in late 20th Century America, has been studying heroin since 1972, and is still at it. He examined the British system in the early 1970s, when doctors still prescribed heroin to thousands of addicts, and authored a book, The Heroin Solution, that compared and contrasted the US and UK approaches. Later this month, the octogenarian law professor will be appearing on a panel at the Vermont Law School to address what Gov. Peter Shumlin (D) has described as the heroin crisis there.

Phillip Seymour Hoffman (wikimedia.org)
"The death of Phillip Seymour Hoffman is a tragedy all the way around," Trebach told the Chronicle. "It's a bad idea to use heroin off the street, and he shouldn't have been doing that."

That said, Trebach continued, it didn't have to be that way.

"If we had had a sensible system of dealing with this, he would have been in treatment under medical care," he said. "If he was going to inject heroin, he should have been using pharmaceutically pure heroin in a medical setting where he could also have been exposed to efforts to straighten out his personal life, and he could have access to vitamins, weight control advice, and the whole spectrum of medical care. And if he had had access to opioid antagonists, he could still be alive," he added.

While Hoffman may have made bad personal choices, Trebach said, we as a society have made policy choices seemingly designed to amplify the prospects for disaster.

"This is a sad thing. He is just another one of the many victims of our barbaric drug policy," he said. "This was a totally unnecessary death at every level. He shouldn't have been using, but we should have been taking care of him."

The stuff ought to be legalized, Trebach said.

"I'm an advocate of full legalization, but if we can't go that far, we need to at least provide social and psychological support for these people," he said. "And even if we were to decriminalize or legalize, I would still want to figure out ways to provide support and love and kindness to people using the stuff. I advise you not to do it, but if you're going to use it, I want to keep you alive. I remember talking to people from Liverpool [a famous heroin maintenance clinic covered in the '90s by Sixty Minutes, linked above] about harm reduction around heroin use back in the 1970s. One of the ladies said it is very hard to rehabilitate a dead addict."

"There are plenty of things we can be doing," said Hilary McQuie, Western director for the Harm Reduction Network, reeling off a list of harm reduction interventions that are by now well-known but inadequately implemented.

"We can make naloxone (Narcan) more available. We need better access to it. It should be offered to people like Hoffman when they are leaving treatment programs, especially if they've been using opiates, just as a safeguard," she said. "Having treatment programs as well as harm reduction programs distribute it is important. We can cut the overdose rate in half with naloxone, but there will still be people using alone and people using multiple substances."

There are other proven interventions that could be ramped up as well, McQuie said.

"Safe injection sites would be very helpful, so would more Good Samaritan overdose emergency laws, and more education, not to mention more access to methadone and buprenorphine and other opioid substitution therapies (OST)," she said, reeling off possible interventions.

Dr. Martin Schechter, director of the School of Population and Public Health at the University of British Columbia in Vancouver, knows a thing or two about OST. The principal study investigator for the NAOMI and the follow-up SALOME study, Schechter has overseen research into the effectiveness of treating intractable addicts with pharmaceutical heroin, as well as methadone. The results have been promising.

"What we're using is medically prescribed pharmaceutical diacetylmorphine, the active ingredient in heroin," he explained. "It's what you have when you strip away all the street additives. This is a stable, sterile medication from a pharmaceutical manufacturer. We know the precise dose tailored for each person. With street heroin, not only is it adulterated and injected in unsterile situations, but people really don't know how strong it is. That's probably what happened to Mr. Hoffman."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)
In NAOMI, 90,000 injections were administered to study participants, and only 11 people suffered overdoses requiring medical attention.

"Never did we have a fatal overdose," Schechter said. "Because it was in a clinic, nurses and doctors are right there. We administer Narcan (naloxone), and they wake up."

Heroin maintenance had even proven more effective than methadone in numerous studies, Schechter said.

"There have been seven randomized control trials across Europe and in Canada that have shown for people who have already tried treatments like methadone, that medically prescribed heroin is more effective and cost effective treatment than simply trying methadone one more time."

Those studies carry a lesson, he said.

"We have to start looking at heroin from a medicinal point of view and treat it like a medicine," he argued. "The more we drive its use underground, the more overdoses we get. We need to expand treatment programs, not only with methadone, but with medically prescribed heroin for people who don't respond to other treatments."

Safe injection sites are also a worthwhile intervention, Schechter said, although he also noted their limitations.

"Injecting under supervision is much safer; if there is an overdose, there is prompt attention, and they provide sterile equipment, reducing the risk of HIV and Hep C," he said. "But they are still injecting street heroin."

He would favor decriminalizing heroin possession, too, he said.

Harm reduction measures, opioid maintenance treatments, and the like are absolutely necessary interventions, said McQuie, but there is a larger issue at hand, as well.

"We still need to look at the overall issue of the stigmatization of drug users," she said. "People aren't open about their use, and that puts them in a more dangerous situation. It's really hard in a criminalized environment."

Stigmatization means to mark or brand someone or something as disgraceful and subject to strong disapproval. Defining an activity, such as heroin possession, as a crime is stigmatization crystallized into the legal structures of society itself.

"The ultimate harm reduction solution," McQuie argued, "is a regulated, decriminalized environment where it is available by prescription, so people know what they're getting, they know how much to use, and it's not cut with fentanyl or other deadly adulterants. People wouldn't have to deal with all the collateral damage that comes from being defined as criminals as well as dealing with the consequences of their drug use. They could deal with their addictions without having to worry about losing their homes, their families, and their freedoms."

While such approaches have a long way to go before winning wide popular acceptance, policymakers should at least be held to account for the consequences of their decision-making, McQuie said, suggesting that the turn to heroin in recent years was a foreseeable result of the crackdown on prescription opioid pain medication beginning in the middle of the last decade.

"They started shutting down all those 'pill mills' and people should have anticipated what would happen and been ready for it," she said. "What we have seen is more and more people turning to injecting heroin, but nobody stopped to do an impact statement on what would be the likely result of restricting access to pain pills."

The impact can be seen in the numbers on heroin use, addiction, and overdoses. While talk of a "heroin epidemic" is overblown rhetoric, the number of heroin users has increased dramatically in the past decade. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of past year users grew by about 50% between 2002 and 2011, from roughly 400,000 to more than 600,000. At the same time, the number of addicted users increased from just under 200,000 to about 370,000, a slightly lesser increase.

If there is any good news, it is that, according to the latest (2012) National Household Survey of Drug Use and Health, the number of new heroin users has remained fairly steady at around 150,000 each year for the past decade. That suggests, however, that more first-time users are graduating to occasional and sometimes, dependent user status.

And some of them are dying of heroin overdoses, although not near the number dying from overdoses from prescription opioids. Between 1999 and 2007, heroin deaths hovered just under 2,000, even as prescription drug deaths skyrocketed, from around 2,500 in 1999 to more than 12,000 just eight years later. But, according to the Centers for Disease Control, by 2010, the latest year for which data are available, heroin overdose deaths had surpassed 3,000, a 50% increase in just three years.

While the number of heroin overdose deaths is still but a fraction of those attributed to prescription opioid overdoses and the numbers since 2010 are spotty, the increase that showed up in 2010 shows no signs of having gone away. Phillip Seymour Hoffman may be the most prominent recent victim, but in the week since his death, another 50 or 60 people have probably followed him to the morgue due to heroin overdoses.

There are ways to reduce the heroin overdose death toll. It's not a making of figuring out what they are. It's a matter of finding the political and social will to implement them, and that requires leaving the drug war paradigm behind.

New York City, NY
United States

Chronicle AM -- February 7, 2014

Marijuana and medical marijuana dominate the drug policy news again today, the Maryland Senate votes to ban Everclear, meth and prescription pills continue to draw legislative attention, and Schapelle Corby will soon be freed from an Indonesian jail, and more. Let's get to it:

Schapelle Corby will soon walk out of an Indonesian jail.
Marijuana Policy

New Mexico Senate Committee Considers Legalization Bill Today. The Senate Rules Committee was expected to consider a marijuana legalization bill today. The bill is Senate Joint Resolution 10, sponsored by Sen. Gerald Ortiz y Pino (D-Albuquerque). It would create a constitutional amendment legalizing marijuana, which, if approved by the legislature, would then have to be approved by voters in a referendum.

Arizona Legalization Bill Introduced.Sen. Ruben Gallego (D-Phoenix) has introduced House Bill 2558, which would allow adults to use, possess, and cultivate small amounts of marijuana, and set up a system to tax and regulate marijuana commerce.

Oregon Bill Would Allow Gun License Despite Marijuana Conviction. Oregon law currently allow people with marijuana possession convictions to obtain a concealed hand gun permit, but a new bill, House Bill 4068 would expand that protection to include people busted in other states, and perhaps, people busted before 1973. The bill got a hearing Wednesday. It is supported by the Oregon State Sheriff's Association, which called it "an issue of fundamental fairness."

Joe Biden Reiterates Obama Administration Marijuana Policy. While the Obama administration thinks cracking down on marijuana is a waste of resources, it doesn't favor legalizing it, either, Vice President Biden told Time magazine Thursday. "I think the idea of focusing significant resources on interdicting or convicting people for smoking marijuana is a waste of our resources," Biden said. "That's different than [legalization.] Our policy for our administration is still not legalization, and that is and continues to be our policy."

Massachusetts Poll Has Slight Majority for Legalization. A new Suffolk University/Boston Herald poll has support for marijuana legalization in the Bay State at 53%, with 37% opposed and 10% undecided.

Medical Marijuana

Michigan High Court Rules for Medical Marijuana. In a bellwether case, the Michigan Supreme Court ruled Thursday that cities and counties cannot pass ordinances that conflict with the state's five-year-old Medical Marihuana Act. The ruling came in Ter Beek v. the City of Wyoming. A number of cities had attempted to ban medical marijuana activities, but the ruling says they cannot do that, although they can regulate them.

Maine Medical Marijuana Bills Get Hearings. Medical marijuana bills are getting attention in Augusta. Legislative Document 1674, which would expand prohibitions on the use of pesticides in cultivation to include patients growing for themselves, got a hearing Thursday. Legislative Document 1597, which would give government officials access to any medical marijuana grow, is set for a hearing next Thursday. The industry group Medical Marijuana Caregivers of Maine thinks the latter bill is too broad. Legislative Document 1739 would create additional regulations and is set for a hearing next Tuesday. Click on the title link for more hearing information.

Florida CBD Medical Marijuana Bill Filed. Rep. Matt Gaetz (R-Shalimar) has filed a bill to allow for low-THC, high-CBD strains of marijuana to be used for medical purposes. The bill is House Bill 843.

Georgia CBD Medical Marijuana Bill Gets Hearing Monday. A bill that would allow the use of high-CBD cannabis oil for patients suffering from certain types of seizures will get a hearing Monday. House Bill 885, sponsored by Rep. Allen Peake (R-Macon), will get a hearing at the House Health and Human Services Committee.

Hemp

President Obama Signs Farms Bill With Hemp Amendment. President Obama Friday signed into law the omnibus farm bill, which includes a hemp amendment allowing for research pilot projects in states that have approved them.

Hemp Bill Moving in Washington State. A bill that would authorize Washington State University to study the feasibility and value of a hemp industry in the state is on the move. House Bill 1888 passed out of the House Appropriations Subcommittee on General Government & Information Technology Thursday and now heads for the Ways and Means Committee. The just-passed federal farm bill includes a provision allowing for hemp research in states that have approved it.

Alcohol

Maryland Senate Passes Ban on Everclear. The Maryland Senate this approved a bill that would ban the sale of any alcohol product at or above 190 proof, or 95% ethyl alcohol. The bill is Senate Bill 75, and supporters said the ban would cut down on binge drinking and date rape, but opponents called it a "feel good" move. Similar legislation has twice previously passed the Senate, only to die in the House, but this year it has the backing of Del. Charles Barkley (D-Montgomery), chair of the Economic Matters subcommittee on alcohol, which increases its chances of getting a floor vote.

Prescription Drugs

South Carolina Bill Would Increase Penalties for Pill Trafficking, Set Them By Pill Quantity. A bill backed by Lt. Gov Glenn McConnell (R) and aimed at what he called "a criminal cancer that will affect the health of seniors" would increase penalties for prescription drug trafficking and set penalties based on the number of pills seized -- not the weight of the drugs. Possession of 600 or more prescription pills would garner a mandatory minimum 15-year prison sentence. Senate Bill 1012 would also make having multiple prescriptions for the same drug evidence of possession with intent to distribute.

Methamphetamine

Michigan Bill Would Bar Drug Felons From Buying Pseudoephedrine. A bill that would bar people with felony drug convictions from purchasing products containing pseudoephedrine, a precursor chemical for meth, got a hearing Wednesday in the House Criminal Justice Committee. House Bill 5088 was introduced by Rep. John Kivela (D-Marquette). Two related bills, House Bill 5089 and House Bill 5090 were also discussed. They address "smurfing."

Harm Reduction

Needle Exchange Reform Bill Moving in Maryland. The state Senate Thursday approved a bill to undo a restriction in existing state law that prevents injection drug users from picking up more clean needles at the Baltimore needle exchange than they turn in. The Senate approved Senate Bill 263 by an overwhelming 39-5 vote. The measure now heads to the House.

International

Schapelle Corby Wins Parole in Indonesia. Indonesian authorities announced Friday that Schapelle Corby, an Australian woman whose case made international headlines when she was convicted for smuggling nine pounds of marijuana into Bali in 2005, has been paroled. It's not clear yet when she will actually walk out of prison in Bali. She had been sentenced to 20 years in what many Australians considered a set-up.

Smart Needle Exchange Reform Bill Moving in Maryland

The Maryland Senate today moved to undo a restriction in existing state law that prevents injection drug users from picking up more clean needles at the Baltimore needle exchange than they turn in.

The Senate approved Senate Bill 263 by an overwhelming 39-5 vote. The measure now heads to the House.

The bill doesn't include a specific limit on the number of needles can pick up at one time, but one of the bill's supporters, Sen. Verna Jones-Rodwell (D-Baltimore), said 50 might be a good number, and that the bill may be amended to get specific.

The bill is supported by the entire Baltimore Senate delegation as well as the city of Baltimore.  The health department there says the city's needle exchange program serves about 2,500 people a year and exchanges about 200 needles for each one.

Needle exchanges are a proven means of reducing the transmission of HIV, Hep C, and other blood-borne illnesses among injection drug users.

Good on the Maryland Senate for moving to get rid of this mindless restriction.

Location: 
Annapolis, MD
United States

Chronicle AM -- January 10, 2014

The marijuana issue continues hot and heavy, one of our favorite authors is nominated for an award, harm reduction bills move in Wisconsin, and the US Sentencing Commission wants to cut drug sentences. And more. Let's get to it:

Dr. Carl Hart, nominated for an NAACP Image Award for "High Price" (columbia.edu)
Marijuana Policy

Colorado Legal Marijuana Sales Hit $5 Million in First Week. Sales of legal marijuana in Colorado since January 1 are estimated to have exceeded $5 million, with some 100,000 people lining up to buy it, according to industry insiders.

Colorado Republicans File Bill to Ban Food Stamps in Marijuana Shops. File under: solutions in search of problems. There is no evidence that anyone has ever used a food stamp EBT card to purchase marijuana products, but that hasn't stopped a handful of GOP state legislators to file a bill to outlaw it. "We need this bill, if for nothing else, as a statement," said Rep. Jared Wright (R-Grand Junction). "We shouldn't be enabling anyone to buy a substance that is banned under federal law. It's not a good use of taxpayer money," he said. The bill is Senate Bill 37.

New Hampshire House Didn't Vote on Marijuana Legalization. The House was set to vote Wednesday on a bill to legalize marijuana, but it didn't happen. The vote has instead been pushed back for a week as legislators dealt first with attempts to override vetoes on bills passed last year. The bill is House Bill 492.

No Marijuana Legalization Bill for Ohio This Year. The only Ohio legislator to push for marijuana legalization last year won't try it again this year. Rep. Bob Hagan (D-Youngstown) said he had no plans to introduce a measure this year after last year's effort to pass a resolution to let residents vote on the issue was sidelined.

Washington Congressman Urges Feds to Act Quickly on Marijuana Banking. Rep. Denny Heck (D-Washington) Friday called on federal regulators to move swiftly to resolve the issue of financial institutions being able to do business with legal marijuana businesses. In a statement, the coauthor of pending federal legislation that would do just that said that "it is urgent federal regulators come to a resolution on this issue as soon as possible."

Powerful Maryland Pol Comes Out for Marijuana Legalization. Delegate Maggie McIntosh (D-Baltimore) has joined the list of powerful state legislators calling for marijuana legalization. She said legalization is one of "the biggest, most important issues" facing the General Assembly this year. She joins Senate President Thomas Miller (D) and Democratic gubernatorial candidate Heather Mizeur in supporting legalization, but Gov. Martin O'Malley (D) and House Speaker Michael Busch (D) both oppose it.

Steny Hoyer Opposes Marijuana Legalization in Maryland. US House Minority Whip Steny Hoyer (D-MD) said Thursday he opposes legalizing pot in the state. "I'm not a proponent of legalizing marijuana," he said. "As I talked to people who deal with drug abuse issues, with rehabilitation issues, I became convinced that marijuana was, in fact, a threshold drug and it would lead to the use of harder, very harmful drugs," he added.

Medical Marijuana

Kentucky House Panel Holds Medical Marijuana Hearing. The House Health and Welfare Committee held a hearing Thursday to discuss medical marijuana. No specific bill was under discussion, but one legislator, Sen. Perry Clark (D-Louisville) filed a bill this week, Senate Bill 43, which would legalize medical marijuana.

Florida House Committee Chair Will Propose Bill to Legalize High CBD Strains for Seizures. Rep. Matt Gaetz (R-Shalimar), chair of the House Criminal Justice Subcommittee, said Thursday he would introduce a bill to allow for the medical use of marijuana strains that are high in CBDs. The vow came after a heart-wrenching hearing from parents of children who suffer seizure disorders, who called on the legislature to legalize strains such as "Charlotte's Web."

Asset Forfeiture

Utah Attorney General Sees Asset Forfeiture as Tool against Drug Legalizing Attorneys. After changes to undo asset forfeiture reforms approved by voters in 2000 snuck through the state legislature last year came under this week, Utah Attorney General Sean Reyes issued a brief defending the new law. But a bullet point justifying a new cap on attorneys' fees for people who successfully defend their property is setting off alarms among First Amendment advocates. "By setting a limit on attorney's fees it will take away the incentive for attorneys who actively promote the legalization of drugs in the state of Utah from soliciting clients who are engaged in criminal activity," the attorney general's brief said. Click on the link for a lengthier critique.

Drug Testing

Welfare Drug Testing Bill Coming Back in Indiana. House Speaker Brian Bosma (R-Indianapolis) said Thursday that while welfare drug testing legislation is not part of the House Republican agenda, a pending bill to do just that is "one we're going to enthusiastically endorse and move forward on." The bill, which passed the House, but not the Senate, last year, would require drug testing of welfare recipients based on some form of reasonable suspicion.

Harm Reduction

Push On to End Needle Exchange Ban in Federal Funding Bill. Harm reduction and public health advocates are urging lawmakers to lift the prohibition on the use of federal funds to pay for needle exchange programs. The battlefield is the conference committee that will reconcile House and Senate budget bills. The Senate version had language that included funding for needle exchanges, but the GOP-led House is expected to oppose it.

Wisconsin Overdose 911, Naloxone Bills Pass Assembly Committee. A bill to provide limited legal immunity to people who notify authorities of an overdose passed the Assembly Criminal Justice Committee Thursday. So did a bill that would allow first responders to carry and use the overdose reversal drug naloxone. Both now goes to the full Assembly, which should vote on them Tuesday. The bills have the backing of Attorney General JB Van Hollen (R) and are expected to sail through the Senate as well.

Honors

Carl Hart Wins NAACP Image Award Nomination for "High Price." Neuroscientist and Drug Policy Alliance board member Carl Hart's "High Price: A Neuroscientist's Journey of Self Discovery That Changes Everything You Know About Drugs and Society" has been nominated for an NAACP Image Award in the category of literary nonfiction. The awards ceremony takes place on February 22.

Sentencing

US Sentencing Commission Suggests Lowering Drug Guideline Sentences. The US Sentencing Commission voted Thursday to publish proposed federal drug sentencing guideline amendments that would include lowering guideline sentences for drug trafficking offenses. The amendments would reduce drug trafficking sentences by about 11 months, leading to a reduction in the federal prison population of more than 6,000 prisoners five years after taking effect. The commission is now seeking public comment on the proposal.

International

Jamaica Marijuana Growers to Organize. Jamaican legalization activists and marijuana growers will form a Cannabis Future Growers and Producers Association as part of a major conference next week. The "Going Forward -- Legalize It" conference is organized by the Ganja Law Reform Coalition, the Cannabis Commercial and Medicinal Research Task Force, and the National Alliance for the Legalization of Ganja, and hopes to help lay the groundwork for a legal marijuana industry on the island.

Canada's SensibleBC Sees 2014 as a Building Year. After an effort to put marijuana reform on the provincial ballot via an initiative faltered last year, Sensible BC leader Dana Larsen said this year would be a year of building momentum, training canvassers, and spreading the message of marijuana legalization. Larsen will also be touring the province this spring and summer to build support.

Chronicle AM -- December 12, 2013

A push is on to end the federal ban on needle exchange funding, a secret federal panel meets to discuss marijuana banking issues, UN anti-drug bureaucrats are still unhappy with Uruguay, more bodies show up in Mexico, and more. Let's get to it:

A move is on to end the federal ban on funding needle exchanges.
Marijuana Policy

Federal Banking Panel Meets on Pot Sales. The Bank Secrecy Act Advisory Group (BSAAG) met in Washington, DC, Thursday to discuss how to deal with banking issues related to medical marijuana and legal marijuana industries. Under current federal laws, marijuana sellers can't set up bank accounts or process credit card transaction because financial institutions fear being implicated in drug trafficking or money laundering cases. The meeting is closed-door, and there is no word yet on what, if anything, was decided.

One Year In, Coloradans Still Like Marijuana Legalization. A Public Policy Polling survey released this week found that Coloradans still support marijuana legalization. The poll found 53% agreed that marijuana use should be legal. It will be interesting to see the poll numbers a year from now, when Coloradans have had time to experience a legal marijuana industry. That begins on January 1.

Washington State Regulators Want to Ban Pot Smoking Wherever Alcohol is Sold. The state Liquor Control Board, which is also in charge of legal marijuana commerce, has proposed banning marijuana consumption in businesses licensed for liquor sales, but a Wednesday meeting saw loud opposition, in particular from Frankie Schnarr, owner of Frankie's Sports Bar and Grill in Olympia. Schnarr years ago emerged victorious in a battle with the board over whether he could open the second floor of his bar to smokers, who joined a "club" for the privilege. Schnarr opened his club to pot smokers after I-502 passed, and now claims 13,500 club members. Schnarr and others said the proposed rule was aimed directly at him. The board will vote on the proposed rule next week.

Philadelphia "Smoke Down Prohibition" Marijuana Prosecutions Continue, So Will Demonstrations. Comedian NA Poe will be sentenced Friday in federal court for smoking pot at Independence Hall as part of Philly NORML's ongoing Smoke Down Prohibition demonstrations. Two more members of the "Liberty Bell 4," Chris Goldstein and Don Dezarn will go on trial next week for puffing pot in demos this past summer, while a fourth, US Marine veteran Mike Whiter will make his first court appearance on similar federal charges. Click on the link for more details and how you can participate.

Gov. Cuomo Dismisses New York Legalization Bill as "Non-Starter." Well, that didn't take long. Yesterday, state Sen. Liz Krueger (D-Manhattan) announced she was introducing a marijuana legalization bill. That same day, a Cuomo spokesman scoffed at the bill, calling it "a non-starter."

Medical Marijuana

New Jersey Medical Marijuana Expansion Wins Assembly Committee Vote. A bill that would allow Garden State medical marijuana patients to buy the drug in other states and bring it back with them passed the Assembly Health Committee on a 7-4 vote Thursday. But Gov. Chris Christie (R) has said he will veto it or any other expansion of the state's program.

Harm Reduction

Maryland Docs, Scientists Call for End to Federal Needle Exchange Funding Ban. In the wake of the budget agreement announced this week by congressional negotiators, more than 70 Maryland-based doctors and scientists sent an open letter to Senate Appropriations Committee Chair Sen. Barbara Mikulski (D-MD) urging her to act to get the longstanding ban on federal needle exchange funding lifted. The ban had been overturned in 2010, but was reinstated without any public debate during budget negotiations the following year.

Pain Pills

State Attorneys General Call on FDA to Reconsider Zohydro Approval. The FDA is running into more flak over its October decision to approve the first hydrocodone-only drug in America, Zohydro, which will be available in a time-release form. Four US senators challenged the decision earlier this week, and now, 28 state attorneys general have asked the agency to reconsider. They cited the roll-out of earlier pain relieving drugs in time-release formulas, which they said resulted in "overzealous pharmaceutical sales" and "doctors overprescribing narcotics," among other ills. But Attorneys General are typically trained as lawyers, not doctors or pharmacists, and they seem oblivious to the continuing problem of undertreatment of pain that their campaigns foster. The FDA said it would reply directly to the law enforcement officials.

International

UNODC Criticizes Uruguay Marijuana Legalization. The UN Office on Drugs and Crime (UNODC) isn't happy with Uruguay. The South American nation's decision to legalize marijuana is a blow against international cooperation in the war on drugs, said UNODC head Yuri Fedotov. "Just as illicit drugs are everyone's shared responsibility, there is a need for each country to work closely together and to jointly agree on the way forward for dealing with this global challenge," he said in a statement. He also called the move "unfortunate."

More Mass Graves in Mexico. Authorities in the central Mexican state of Morelos have uncovered two mass graves containing at least 20 bodies. Authorities believe some of the bodies are victims of the Beltran Leyva cartel, which was largely dismantled two years ago. Others were apparently killed more recently. The discovery comes on the heels of a similar gruesome find in western Michoacan state, where the latest count had 66 bodies removed from mass graves there. More than 100,000 people are estimated to have been killed in Mexico's prohibition-related violence since 2006 and tens of thousands more have disappeared, including more than a thousand in the past two years in Moreleos, according to the state human rights commission.

Chronicle AM -- December 11, 2013

Uruguay legalizes the marijuana trade (and the usual suspects object), Denver provides a helpful guide to legalization there, Human Rights Watch scorches Louisiana for its AIDS-enhancing policies, and more. Let's get to it:

Marijuana Policy

Denver Debuts Marijuana Legalization FAQ Web Site. The city of Denver has created a web site seeking to address questions from residents and visitors, parents and neighbors, business and property owners, and marijuana retailers and home growers about how legalization will work.

New York Marijuana Legalization Bill Announced. State Sen. Liz Kreuger (D-Manhattan) Wednesday unveiled a proposal to legalize and tax marijuana in the Empire State. Pot prohibition is "a policy that just has not worked," she said. Advocates concede that the bill is unlikely to pass this session, but you have to start somewhere.

Medical Marijuana

American Herbal Pharmacopeia Classifies Marijuana as Botanical Medicine. The world's leading expert organization on herbal medicine, the American Herbal Pharmacopeia, has released the first part of a two-part monograph on marijuana that classifies it as a botanical medicine, alongside many other accepted complementary and alternative medicines. Americans for Safe Access calls it a "historic move" and will host a Google Hangout Thursday at 5:30pm PT to discuss its ramifications.

Oregon Medical Marijuana Regulation Panel Meets for Last Time. The committee charged with creating Oregon's first statewide medical marijuana dispensary regulations is meeting for what is supposed to be the last time today. The panel has been meeting since September to craft rules around security, background checks, and marijuana testing. A 30-page draft version of the rules should be finalized.

Guam Medical Marijuana Bill Gets Another Hearing Today. Guam residents will have another chance to voice their opinions on medical marijuana at a hearing set for today. Sen. Tina Muna Barnes has introduced a measure, Bill 215, that would allow the use of medical marijuana for various illnesses. The hearing starts at 5:30pm Guam time.

Drug Testing

Pennsylvania School Employee Drug Testing Bill Passes House. A bill that would require prospective public school employees to submit to drug testing passed the House Tuesday. The ACLU of Pennsylvania calls House Bill 810 "invasive, impractical, and unconstitutional" and vows to challenge it -- and win -- if it ever becomes law. The bill now heads to the Senate.

Harm Reduction

Human Rights Watch Report Slams Louisiana Laws, Police Practices as Increasing AIDS Toll. Human Rights Watch issued a report Wednesday charging that Louisiana laws and practices that bar access to clean needles and criminalize sex work contribute to a raging HIV epidemic and a very high AIDS death rate. The report is In Harm's Way: State Response to Sex Workers, Drug Users, and HIV in New Orleans.

Push Is On for Naloxone and Good Samaritan Law in Minnesota. Elected officials and members of law enforcement called Tuesday for new state laws that would allow deputies to carry and administer the overdose reversal drug Naloxone and provide legal protections for people who contact authorities to report a drug overdose. The moves are a response to a rising toll of heroin overdose deaths, particularly in the Twin Cities.

International

Uruguay Legalizes Marijuana Commerce. The Uruguayan Senate Tuesday night gave final approval to the government's marijuana legalization bill. Now, once President Jose Mujica signs it into law, Uruguay will be 120 days away from a legal commerce in marijuana.

UN Anti-Drug Bureaucrats Say Uruguay Legalization Breaks Treaty. The International Narcotics Control Board (INCB) reacted unhappily to Uruguay's Tuesday night legalization vote. "Uruguay is breaking international conventions on drug control with the cannabis legislation approved by its congress," the INCB complained in a Wednesday press release. The INCB qualified itself as "surprised" that Uruguay had "knowingly decided to break the universally agreed and internationally endorsed legal provisions of the treaty."

Russian Drug Czar Says Drug Legalization "Impossible." Reacting to Uruguay's move to legalize marijuana, Viktor Ivanov, head of Russia's Federal Service for Drug Control, said the legalization of any drug is "impossible, and I think it will not be possible" in Russia. "Moreover, we have strengthened our political will with an anti-drug strategy," he added, although he also said it was possible that Russia could grow hemp and low opiate content poppies for agricultural purposes.

With Legalization Looming, Lessons from the Netherlands [FEATURE]

The US states of Colorado and Washington voted last year to legalize marijuana and are moving forward toward implementing legalization. Activists in several states are lining up to try to do the same next year, and an even bigger push will happen in 2016. With public opinion polls now consistently showing support for pot legalization at or above 50%, it appears that nearly a century of marijuana prohibition in the US is coming to an end.

A coffee shop in Amsterdam, where clients can sit and smoke. Why no on-premises consumption here? (wikimedia.org)
Exactly how it comes to an end and what will replace it are increasingly important questions as we move from dreaming of legalization to actually making it happen. The Netherlands, which for decades now has allowed open marijuana consumption and sales at its famous coffee shops, provides some salutary lessons -- if reformers, state officials, and politicians are willing to heed them.

To be clear, the Dutch have not legalized marijuana. The marijuana laws remain on the books, but are essentially overridden by the Dutch policy of "pragmatic tolerance," at least as far as possession and regulated sales are concerned. Cultivation is a different matter, and that has proven the Achilles Heel of Dutch pot policy. Holland's failure to allow for a system of legal supply for the coffee shops leaves shop owners to deal with illegal marijuana suppliers -- the "backdoor problem" -- and leaves the system open to charges it is facilitating criminality by buying product from criminal syndicates.

Still, even though the Dutch system is not legalization de jure and does not create a complete legal system of marijuana commerce, reformers and policymakers here can build on the lessons of the Dutch experience as we move toward making legal marijuana work in the US.

"Governments are looking to reform their drug policies in order to maximize resources, promote health and security while protecting people from damaging and unwarranted arrests," said Kasia Malinowska-Sempruch, Director of the Open Society Global Drug Policy Program. "The Netherlands has been a leader in this respect. As other countries and local jurisdictions consider reforming their laws, it's possible that the Netherlands' past offers a guide for the future."

A new report from the Open Society Global Drug Policy Program lays out what Dutch policymakers have done and how they have fared. Authored by social scientists Jean-Paul Grund and Joost Breeksema of the Addiction Research Center in Utrecht, the report, Coffee Shops and Compromise: Separated Illicit Drug Markets in the Netherlands tells the history of the Dutch approach and describes the ongoing success of the country's drug policy.

This includes the separation of the more prevalent marijuana market from hard drug dealers. In the Netherlands, only 14% of cannabis users say they can get other drugs from their sources for cannabis. By contrast in Sweden, for example, 52% of cannabis users report that other drugs are available from cannabis dealers. That separation of hard and soft drug markets has limited Dutch exposure to drugs like heroin and crack cocaine and led to Holland having the lowest number of problem drug users in the European Union, the report found.

Pragmatic Dutch drug policies have not been limited to marijuana. The Netherlands has been a pioneer in harm reduction measures, such as needle exchanges and safe consumption sites, has made drug treatment easy to access, and has decriminalized the possession of small quantities of all drugs. As a result, in addition to having the lowest number of problem drug users, Holland has virtually wiped out new HIV infections among injection drug users. And, because of decriminalization, Dutch citizens have been spared the burden of criminal records for low-level, nonviolent offenses.

The Dutch have, for example, virtually eliminated marijuana possession arrests. According to figures cited in the report, in a typical recent year, Dutch police arrested people for pot at a rate of 19 per 100,0000, while rates in the US and other European countries were 10 times that or more.

For veteran drug reform activist Joep Oomen of the European NGO Coalition for Just and Effective Drug Policies (ENCOD), the report is welcome but not exactly "stop the presses" news.

"The conclusions of this report have been known for a long time," he told the Chronicle. "Already by the end of the 1990s, when European governments had to acknowledge that Dutch drug policies had proven more effective in reducing risks and harms than many other countries, the criticism that had been expressed earlier by mainly German and French heads of state was silenced. For instance, in the Netherlands the age of first heroin use is the highest of Europe, which is explained by the relative tolerance concerning cannabis use." [Ed: A high age of first use is considered good, because it means that fewer people are experimenting with a drug when they are young -- which in turn means fewer people ever trying it, and those who do being more likely to be capable of avoiding problematic use.]

While the Dutch can point to solid indications of success with their pragmatic drug policies, it is not all rosy skies. The "back door problem" alluded to above continues unresolved, and the relative laxness of Dutch marijuana policy has led to an influx of "drug tourists," especially from neighboring countries, such as France and Germany. Both of those irritants have provided fodder for conservative parties and administrations that have sought to roll back the reforms.

"There seems to be more admiration for Dutch drug policy outside the Netherlands than inside," Oomen observed. "Right-wing governments that have dominated the Dutch political climate since 2002 have slowly dismantled acceptance-oriented drug policy. Lately the establishment of the Weedpass in the southern part of the country [which excludes non-Dutch from access to the coffee shops] and new measures against grow shops and coffee shops are definitely threatening to undermine the coffee shop model," he said.

"Instead of completing the regulation of this model by solving the coffee shops' back door problem, the government seems to apply a policy of slow elimination by making the conditions worse in which the shops have to operate," Oomen continued. "And the Dutch press follows blindly, often referring to coffee shops as a link in a criminal chain, which is unavoidable since the ban on cultivation forces shop owners to deal with criminals, but without questioning the measures that reinforce the criminal aspect."

While the national government may now be hostile to pragmatic marijuana policies, it is facing considerable resistance from elected officials. The Weedpass program now appears to be largely a dead letter, thanks to opposition from the likes of Amsterdam Mayor Eberhard van der Laan, and other local elected officials are moving to address the back door problem.

"Several Dutch mayors have plans for municipal cannabis farms to supply the coffee shops and take crime out of the industry," said Grund, research director at the Addiction Research Center. "But if Dutch drug policy offers one lesson to foreign policymakers, it is that change should be comprehensive, regulating sale to consumers, wholesale supply and cultivation."

Grund is watching the American experience with legalization in Colorado and Washington and had some observations he shared with the Chronicle.

"As far as I can judge," he said, "these are both pretty solid proposals, although quite different in detail and approach -- e.g., a vertically integrated chain of supply in Colorado and separate licensing for producers, processors, and retailer in Washington. Clearly in both states legislators have done their best. Interesting then, that they end up with rather different plans, which is actually fine, as it provides us with the opportunity to evaluate different models. For more than 25 years, there was just about only the Dutch experience with cannabis decriminalization and coffee shops; now we see different models of cannabis reform and distribution being implemented across continents. Comparing these experiences as they evolve should allow us to develop more effective drug policies."

Policymakers and regulators should try to avoid rigidity and be ready to deal with unintended responses and consequences, the Dutch social scientist said.

"The point is to approach these flexibly and pragmatically; adjust when necessary, while keeping your eyes on the ball: cutting the link between cannabis on the one hand, and criminal records, mafia and more, on the other," Grund advised, noting that the 1976 Dutch law separating hard and soft drugs did not anticipate the arrival of the coffee shop phenomenon. "As Dr. Eddy Engelsman, former chief drug policy maker at the ministry of health -- and known as the architect of Dutch drug policy -- said when we interviewed him, 'coffee shops just emerged.' The policymakers deemed that these fit their overall policy objectives and allowed for them to ply their trade openly," he recalled.

Grund also weighed in on personal cultivation -- Colorado allows it; Washington does not -- and public use, which it appears will remain forbidden in both states.

"I think Washington presents more of a business and revenue raising strategy, while Colorado feels more like grassroots meets civil libertarian meets amenable regulator," he opined. "The more social, homegrown orientation of the Colorado proposal – allowing for home growing, bartering between friends -- could perhaps engender a less market driven distribution structure, where friends compete in growing the most pleasant marijuana, not the most profitable. Something like the Spanish cannabis clubs," he suggested.

Public, convivial pot smoking in designated areas should be allowed, Grund said, because it has benefits.

"Dedicated places of consumption -- such as the coffee shops in the Netherlands or shisha parlors -- offer an opportunity to promote responsible behavior around cannabis consumption," he argued. "Smoking cannabis in a safe, hospitable and stress free environment engenders different use patterns from quickly getting high in a service ally behind a bar or in a car parked in a quiet place. Coffee shops offer a moderating environment where self regulation is supported by social learning and control."

While Grund was looking forward to the future in the US, Oomen was thinking of the unfinished business in the Netherlands, but his musing also provide food for thought for American reformers, especially those contemplating decriminalization measures.

"The lesson here is that decriminalization or depenalization are useful concepts for a transition period, but real progress can only be obtained and assured with legal regulation of the entire chain from producer to consumer," the ENCOD leader noted. "The Dutch case shows that politicians will always use the smallest margin they have to maintain to a repressive model, provoking criminal activities which they can use to justify their policies publically. This is the drug policy perpetual motion machine."

Colorado and Washington are already well down their particular paths to marijuana legalization. But there is still time for the next wave of legalization states to learn and apply those lessons, not just from Denver and Olympia, but from the Dutch pioneers as well.

Netherlands

Malaysia Minister Talks Drug Decriminalization

A Malaysian government minister said Sunday the Southeast Asian nation is moving toward decriminalizing drug possession, but her remarks also suggested that drug users would be exchanging jail cells for treatment beds. Minister in the Prime Minister's Department Nancy Shukri said the government's policy was moving from prosecuting drug users to treating them.

Nancy Shukri (frim.gov.my)
Her remarks came at the end of a High Level Meeting on Drug Policy and Public Health sponsored by the Global Commission on Drug Policy. The meeting was held in conjunction with the 2013 International Aids Conference held over the weekend in Kuala Lumpur, the Malaysian capital.

Shukri also said that the Association of Southeast Asian Nations' (ASEAN) goal of a drug-free region by 2015 was not realistic, but that smarter approaches by authorities could reduce drug dependence.

"There is no such thing as drug-free but we can control it by changing or shifting our policy," Shukri said. "Instead of looking at drug dependents as criminals, we should actually look at them as patients. Instead of bringing them to jail, we bring them to the clinic," she told a press gaggle after the AIDS conference ended.

Shukri said that Malaysia had been taking steps toward a more effective and humane drug policy, but that those initiatives were not widely known. She cited ongoing needle exchange programs for injection drug users. The sharing of needles is a known vector for the transmission of the AIDS virus, and the program had resulted in a reduction in new HIV/AIDS infections, she said.

"Others include the harm reduction program and upgrading of the rehabilitation centers into Cure & Care Clinics," Shukri said. "We are already there (decriminalizing drugs) but we are not making it loud enough for the people to understand that we have this policy. Our policy has not been established in a formal way."

That could be coming, though. Shukri said the government is currently reviewing the country's drug laws, including the Drug Dependents (Treatment and Rehabilitation) Act of 1983.

"The Law Reform Committee is now in the process of discussing to amend that particular provision [Section 4(1)(b) of the Act which allows the detention of a suspected drug dependent for up to 14 days for a test to be conducted]," she said.

Kuala Lumpur
Malaysia

Nevada Governor Signs Medical Marijuana Dispensary, Needle Bills

Nevada's Republican governor, Brian Sandoval, Wednesday signed into law two drug reform measures, one allowing for medical marijuana dispensaries and one removing syringes from the state's drug paraphernalia law.

On the medical marijuana front, Sandoval signed into law Senate Bill 374, which will establish a state-regulated system of dispensaries. The law envisions up to 66 dispensaries across the state, with up to 40 in Las Vegas, 10 in Reno, and at least one in each county.

"We applaud Gov. Sandoval and the legislature for their leadership and commend those law enforcement organizations that expressed support for this much-needed legislation," said Karen O'Keefe, director of state policies for the Marijuana Policy Project, who testified in support of the bill. "It will make Nevada a safer and healthier place not only for medical marijuana patients, but for the entire community. This new law will provide patients with the safe and reliable access to medical marijuana that they deserve," O'Keefe said. "Regulating medical marijuana sales will also generate revenue and take a bite out of the state's underground marijuana market."

Introduced by Sens.Tick Segerblom (D-Las Vegas) and Mark Hutchison (R-Las Vegas), the bill creates rules and regulations not only for dispensaries, but also infused product manufacturers and cultivation and testing facilities. It also imposes 2% excise taxes on both wholesale and retail sales, with 75% of those revenues going to the education fund and 25% going to cover the cost of regulating the medical marijuana industry.

The state's voter-approved medical marijuana law, passed twice in 1998 and 2000, required the legislature to create a medical marijuana program that included appropriate methods of supplying medical marijuana to patients. Now, the legislature has finally done so. Nevada will now join Arizona, Colorado, Maine, New Jersey, New Mexico, and Rhode Island on the list of states that have state-regulated dispensaries. Two more jurisdictions, Washington, DC, and Vermont should come on board this summer, and the rule-making process for dispensaries is underway in Connecticut and Massachusetts.

On the harm reduction front, Sandoval signed into law Senate Bill 410, which decriminalizes the possession of syringes by removing them from the state's drug paraphernalia list. That opens the way for the over-the-counter sale of syringes and needle exchange programs.

"Back in 1996 when first elected, I was asked what bills I'd be pursuing for my first legislative session," said Sen. David Parks (D-Las Vegas).  "My response was employment non-discrimination, HIV/AIDS state funding and decriminalization of hypodermic devices. Little did I know it would be my 9th session before decriminalization of hypodermic devices would come to fruition."

Nevada becomes the 37th state to decriminalize syringe possession and allow for the over-the-counter sale of needles, as well as needle exchange programs, both proven means of reducing the transmission of HIV, viral hepatitis, and other blood-borne infections.

Nevada harm reduction workers said they were ready to get a needle exchange up and running as soon as the law takes effect.

"In addition to getting sterile syringe out to those who need them, our program will increase safe syringe disposal by individuals in the community," said Sharon Chamberlain, director of Northern Nevada HOPES in Reno. "We will educate these users about the new and needed community disposal options, and strongly encourage them to take advantage of this resource. Previously, no community initiatives provided safe disposal options. "

Carson City, NV
United States

Colorado Harm Reduction Bills Pass

Colorado legislators approved not one, but two measures aimed at reducing the harms of drug use this week. Both a syringe exchange bill and a naloxone provision bill passed the legislature and now head for the governor's desk.

syringe exchange supplies (wikimedia.org)
The first measure, Senate Bill 208, expands on the Clean Syringe Exchange bill passed in 2010, which exempted staff and volunteers -- but not exchange participants -- from drug paraphernalia possession charges. That left actual injection drug users making use of the exchange at risk for being arrested for carrying clean or used syringes.

This year's bill adds participants to the categories of the protected. Now, participants in the state's six syringe exchange programs -- in Denver, Boulder, Grand Junction, and Fort Collins -- will be able to carry clean syringes and return used ones for proper disposal without fear of arrest.

The second bill, Senate Bill 14, authorizes anyone who might witness an opiate overdose to be prescribed and administer the opioid overdose reversal drug Naloxone. Naloxone has been shown repeatedly to safe lives by reducing the number of opioid drug overdose deaths.

Both bills were supported by the Denver-based Harm Reduction Action Center, the state Department of Public Health and Environment, and the Drug Policy Alliance. The syringe exchange bill was also supported by the, Denver Colorado AIDS Project, Boulder County Public Health, and the Colorado Criminal Justice Reform Coalition, while the Naloxone bill was also supported by the Colorado Medical Society, the Colorado Psychiatric Society, the Colorado Provider's Association, the Colorado Behavioral Health Council, and Mental Health America of Colorado.

Denver, CO
United States

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