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In Memoriam: Dave Purchase, Needle Exchange Pioneer

Needle exchange pioneer Dave Purchase died last month in Tacoma, Washington, where he had long resided and where he began handing out sterile syringes to prevent the spread of AIDS among intravenous drug users back in the summer of 1998. Purchase died on January 21 of complications from pneumonia. He was 73.

http://www.stopthedrugwar.org/files/dave-purchase-250px.jpg
Dave Purchase
Purchase is widely cited as having started the first needle exchange in the country, although that is difficult to verify.

A Harley rider, the bearded and burly Purchase was working as a drug counselor when he was hit by a drunk driver in 1983. He returned to work after recovering and used $3,000 from a settlement from the crash to buy his first supplies and begin handing out needles, cotton swabs, bleach, and condoms. Within months, he had handed out 13,000 needles, most of them bought with his own money.

By 1993, Purchase had founded the Point Defiance AIDS Project, working with local authorities, and the North American Syringe Exchange Network (NASEN), which now distributes more than 15 million needles a year to syringe exchange programs.

Purchase started his exchanges without official sanction and said he was prepared to go to jail for possessing drug paraphernalia, but then-Tacoma Police Chief Ray Fjetland wisely suspended enforcement of the paraphernalia law at the exchanges. Over the years, Purchase's Tacoma exchange became a model, especially in winning the cooperation of local authorities.

At last count, there were around 200 needle exchange programs in the country, which distributed some 36 million syringes in 2011. Those needle exchange programs have been repeatedly shown to save lives by reducing the spread of AIDS and other blood-borne infections. Dave Purchase wasn't the only early needle exchange advocate, but he was a tireless one, and countless people owe their lives to his efforts.

And maybe more than lives. In a testimonial posted on the NASEN web site (linked below), Nick Crofts expressed thoughts felt by many in calling Dave "a presence in the world... a taken-for-granted, a defining pole, a constant point of reference when there was trouble or confusion, an ethical touchstone." Crofts wrote, "[a]ll the people Dave inspired share one characteristic with him... he accepted people for what they were, he valued them for their very existence, he made it known to them and everyone else that their lives were equally important as his and everyone else's. This is the hallmark and the revolution of the harm reduction movement... and Dave stamped this all over the north American scene, and through his acolytes all over the world."

Dave may be gone now, but his work lives on. More testimonials and links about him can be found on the NASEN web site and the Tacoma Syringe Program Facebook page.

Tacoma, WA
United States

The Top Ten Drug Policy Stories of 2012 [FEATURE]

In some ways, 2012 has been a year of dramatic, exciting change in drug policy, as the edifice of global drug prohibition appears to crumble before our eyes. In other ways it is still business as usual in the drug war. Marijuana prohibition is now mortally wounded, but there were still three-quarters of a million pot arrests last year. The American incarceration mania appears to be running its course, but drug arrests continue to outnumber any other category of criminal offense. There is a rising international clamor for a new drug paradigm, but up until now, it's just talk.

The drug prohibition paradigm is trembling, but it hasn't collapsed yet -- we are on the cusp of even more interesting times. Below, we look at the biggest drug policy stories of 2012 and peer a bit into the future:

1. Colorado and Washington Legalize Marijuana!

Voters in Colorado and Washington punched an enormous and historic hole in the wall of marijuana prohibition in November. While Alaska has for some years allowed limited legal possession in the privacy of one's home, thanks to the privacy provisions of the state constitution, the November elections marked the first time voters in any state have chosen to legalize marijuana. This is an event that has made headlines around the world, and for good reason -- it marks the repudiation of pot prohibition in the very belly of the beast.

And it isn't going away. The federal government may or may not be able to snarl efforts by the two states to tax and regulate legal marijuana commerce, but few observers think it can force them to recriminalize marijuana possession. It's now legal to possess up to an ounce in both states and to grow up to six plants in Colorado and -- barring a sudden reversal of political will in Washington or another constitutional amendment in Colorado -- it's going to stay that way. The votes in Colorado and Washington mark the beginning of the end for marijuana prohibition.

2. Nationally, Support for Marijuana Legalization Hits the Tipping Point

If Colorado and Washington are the harbingers of change, the country taken as a whole is not far behind, at least when it comes to public opinion. All year, public opinion polls have showed support for marijuana legalization hovering right around 50%, in line with last fall's Gallup poll that showed steadily climbing support for legalization and support at 50% for the first time. A Gallup poll this month showed a 2% drop in support, down to 48%, but that's within the margin of error for the poll, and it's now a downside outlier.

Four other polls released this month
demonstrate a post-election bump for legalization sentiment. Support for legalization came in at 47%, 51%, 54%, and 57%, including solid majority support in the West and Northeast. The polls also consistently find opposition to legalization strongest among older voters, while younger voters are more inclined to free the weed.

As Quinnipiac pollster Peter Brown put it after his survey came up with 51% support for legalization, "This is the first time Quinnipiac University asked this question in its national poll so there is no comparison from earlier years. It seems likely, however, that given the better than 2-1 majority among younger voters, legalization is just a matter of time."

Caravan for Peace vigil, Brownsville, Texas, August 2012
3. Global Rejection of the Drug War

International calls for alternatives to drug prohibition continued to grow ever louder this year. Building on the work of the Latin American Commission on Drugs and Democracy and the Global Commission on Drug Policy, the voices for reform took to the stage at global venues such as the Summit of the Americas in Cartagena, Colombia, in April, the International AIDS Conference in Washington in July, and at the United Nations General Assembly in September.

While calls for a new paradigm came from across the globe, including commissions in Australia and the United Kingdom, this was the year of the Latin American dissidents. With first-hand experience with the high costs of enforcing drug prohibition, regional leaders including Colombian President Santos, Guatemalan President Perez Molina, Costa Rican President Chinchilla, and even then-Mexican President Calderon all called this spring for serious discussion of alternatives to the drug war, if not outright legalization. No longer was the critique limited to former presidents.

That forced US President Obama to address the topic at the Summit of the Americas and at least acknowledge that "it is entirely legitimate to have a conversation about whether the laws in place are doing more harm than good in certain places" before dismissing legalization as a policy option. But the clamor hasn't gone away -- instead, it has only grown louder -- both at the UN in the fall and especially since two US states legalized marijuana in November.

While not involved in the regional calls for an alternative paradigm, Uruguayan President Mujica made waves with his announcement of plans to legalize the marijuana commerce there (possession was never criminalized). That effort appears at this writing to have hit a bump in the road, but the proposal and the reaction to it only added to the clamor for change.

4. Mexico's Drug War: The Poster Child for Drug Legalization

Mexico's orgy of prohibition-related violence continues unabated with its monstrous death toll somewhere north of 50,000 and perhaps as high as 100,000 during the Calderon sexenio, which ended this month. Despite all the killings, despite Calderon's strategy of targeting cartel capos, despite the massive deployment of the military, and despite the hundreds of millions of dollars in US aid for the military campaign, the flow of drugs north and guns and money south continues largely unimpeded and Mexico -- and now parts of Central America, as well -- remain in the grip of armed criminals who vie for power with the state itself.

With casualty figures now in the range of the Iraq or Afghanistan wars and public safety and security in tatters, Calderon's misbegotten drug war has become a lightning rod for critics of drug prohibition, both at home and around the world. In the international discussion of alternatives to the status quo -- and why we need them -- Mexico is exhibit #1.

And there's no sign things are going to get better any time soon. While Calderon's drug war may well have cost him and his party the presidency (and stunningly returned it to the old ruling party, the PRI, only two elections after it was driven out of office in disgrace), neither incoming Mexican President Enrique Pena Nieto nor the Obama administration are showing many signs they are willing to take the bold, decisive actions -- like ending drug prohibition -- that many serious observers on all sides of the spectrum say will be necessary to tame the cartels.

The Mexican drug wars have also sparked a vibrant and dynamic civil society movement, the Caravan for Peace and Justice, led by poet and grieving father Javier Sicilia. After crisscrossing Mexico last year, Sicilia and his fellow Mexican activists crossed the border this summer for a three-week trek across the US, where their presence drew even more attention to the terrible goings on south of the border.

5. Medical Marijuana Continues to Spread, Though the Feds Fight Back

Eighteen states and the District of Columbia have now legalized the use of marijuana for medical purposes, and while there was only one new one this year, this has been a year of back-filling. Medical marijuana dispensaries have either opened or are about to open in a number of states where it has been legal for years but delayed by slow or obstinate elected officials (Arizona, New Jersey, Washington, DC) or in states that more recently legalized it (Massachusetts).

None of the newer medical marijuana states are as wide open as California, Colorado, or Montana (until virtual repeal last year), as with each new state, the restrictions seem to grow tighter and the regulation and oversight more onerous and constricting. Perhaps that will protect them from the tender mercies of the Justice Department, which, after two years of benign neglect, changed course last year, undertaking concerted attacks on dispensaries and growers in all three states. That offensive was ongoing throughout 2012, marked by federal prosecutions and medical marijuana providers heading to federal prison in Montana. While federal prosecutions have been less resorted to in California and Colorado, federal raids and asset forfeiture threat campaigns have continued, resulting in the shuttering of dozens of dispensaries in Colorado and hundreds in California. There is no sign of a change of heart at the Justice Department, either.

6. The Number of Drug War Prisoners is Decreasing

The Bureau of Justice Statistics announced recently that the number of people in America's state and federal prisons had declined for the second year in a row at year's end 2011. The number and percentage of drug war prisoners is declining, too. A decade ago, the US had nearly half a million people behind bars on drug charges; now that number has declined to a still horrific 330,000 (not including people doing local jail time). And while a decade ago, the percentage of people imprisoned for drug charges was somewhere between 20% and 25% of all prisoners, that percentage has now dropped to 17%.

That decline is mostly attributable to sentencing reforms in the states, which, unlike the federal government, actually have to balance their budgets. Especially as economic hard times kicked in in 2008, spending scarce taxpayer resources on imprisoning nonviolent drug offenders became fiscally and politically less tenable. The passage of the Proposition 36 "three strikes" sentencing reform in California in November, which will keep people from being sentenced to up to life in prison for trivial third offenses, including drug possession, is but the latest example of the trend away from mass incarceration for drug offenses.

The federal government is the exception. While state prison populations declined last year (again), the federal prison population actually increased by 3.1%. With nearly 95,000 drug offenders doing federal time, the feds alone account for almost one-third of all drug war prisoners.

President Obama could exercise his pardon power by granting clemency to drug war prisoners, but it is so far a power he has been loathe to exercise. An excellent first candidate for presidential clemency would be Clarence Aaron, the now middle-aged black man who has spent the past two decades behind bars for his peripheral role in a cocaine deal, but activists in California and elsewhere are also calling for Obama to free some of the medical marijuana providers now languishing in federal prisons. The next few days would be the time for him to act, if he is going to act this year.

7. But the Drug War Juggernaut Keeps On Rolling, Even if Slightly Out of Breath

NYC "stop and frisk" protest of mass marijuana arrests
According to annual arrest data released this summer by the FBI, more than 1.53 million people were arrested on drug charges last year, nearly nine out of ten of them for simple possession, and nearly half of them on marijuana charges. The good news is that is a decline in drug arrests from 2010. That year, 1.64 million people were arrested on drug charges, meaning the number of overall drug arrests declined by about 110,000 last year. The number of marijuana arrests is also down, from about 850,000 in 2010 to about 750,000 last year.

But that still comes out to a drug arrest every 21 seconds and a marijuana arrest every 42 seconds, and no other single crime category generated as many arrests as drug law violations. The closest challengers were larceny (1.24 million arrests), non-aggravated assaults (1.21 million), and DWIs (1.21 million). All violent crime arrests combined totaled 535,000, or slightly more than one-third the number of drug arrests.

The war on drugs remains big business for law enforcement and prosecutors.

8. And So Does the Call to Drug Test Public Benefits Recipients

Oblivious to constitutional considerations or cost-benefit analyses, legislators (almost always Republican) in as many as 30 states introduced bills that would have mandated drug testing for welfare recipients, people receiving unemployment benefits, or, in a few cases, anyone receiving any public benefit, including Medicaid recipients. Most would have called for suspicionless drug testing, which runs into problems with that pesky Fourth Amendment requirement for a search warrant or probable cause to undertake a search, while some attempted to get around that obstacle by only requiring drug testing upon suspicion. But that suspicion could be as little as a prior drug record or admitting to drug use during intake screening.

Still, when all the dust had settled, only three states -- Georgia, Oklahoma, and Tennessee -- actually passed drug testing bills, and only Georgia's called for mandatory suspicionless drug testing of welfare recipients. Bill sponsors may have been oblivious, but other legislators and stakeholders were not. And the Georgia bill is on hold, while the state waits to see whether the federal courts will strike down the Florida welfare drug testing bill on which it is modeled. That law is currently blocked by a federal judge's temporary injunction.

It wasn't just Republicans. In West Virginia, Democratic Gov. Roy Tomblin used an executive order to impose drug testing on applicants to the state's worker training program. (This week came reports that only five of more than 500 worker tests came back positive.) And the Democratic leadership in the Congress bowed before Republican pressures and okayed giving states the right to impose drug testing requirements on some unemployment recipients in return for getting an extension of unemployment benefits.

This issue isn't going away. Legislators in several states, including Indiana, Ohio, Texas, and West Virginia have already signaled they will introduce similar bills next year, and that number is likely to increase as solons around the country return to work.

9. The US Bans New Synthetic Drugs

In July, President Obama signed a bill banning the synthetic drugs known popularly as "bath salts" and "fake weed." The bill targeted 31 specific synthetic stimulant, cannabinoid, and hallucinogenic compounds. Marketed under brand names like K2 and Spice for synthetic cannabinoids and under names like Ivory Wave, among others, for synthetic stimulants, the drugs have become increasingly popular in recent years. The drugs had previously been banned under emergency action by the DEA.

The federal ban came after more than half the states moved against the new synthetics, which have been linked to a number of side effects ranging from the inconvenient (panic attacks) to the life-threatening. States and localities continue to move against the new drugs, too.

While the federal ban demonstrates that the prohibitionist reflex is still strong, what is significant is the difficulty sponsors had in getting the bill passed. Sen. Rand Paul (R-KY) put a personal hold on the bill until mandatory minimum sentencing requirements were removed and also argued that such efforts were the proper purview of the states, not Washington. And for the first time, there were a substantial number of Congress members voting "no" on a bill to create a new drug ban.

10. Harm Reduction Advances by Fits and Starts, At Home and Abroad

Harm reduction practices -- needle exchanges, safer injection sites, and the like -- continued to expand, albeit fitfully, in both the US and around the globe. Faced with a rising number of prescription pain pill overdoses in the US -- they now outnumber auto accident fatalities -- lawmakers in a number of states have embraced "911 Good Samaritan" laws granting immunity from prosecution. Since New Mexico passed the first such law in 2007, nine others have followed. Sadly, Republican Gov. Chris Christie vetoed the New Jersey bill this year.

Similarly, the use of the opioid antagonist naloxone, which can reverse overdoses and restore normal breathing in minutes, also expanded this year. A CDC report this year that estimated it had saved 10,000 lives will only help spread the word.

There has been movement internationally as well this year, including in some unlikely places. Kenya announced in June that it was handing out 50,000 syringes to injection drug users in a bid to reduce the spread of AIDS, and Colombia announced in the fall plans to open safe consumption rooms for cocaine users in Bogota. That's still a work in progress.

Meanwhile, the UN Commission on Narcotic Drugs unanimously supported a resolution calling on the World Health Organization and other international bodies to promote measures to reduce overdose deaths, including the expanded use of naloxone; Greece announced it was embracing harm reduction measures, including handing out needles and condoms, to fight AIDS; long-awaited Canadian research called for an expansion of safe injection sites to Toronto and Ottawa; and Denmark first okayed safe injection sites in June, then announced it is proposing that heroin in pill form be made available to addicts. Denmark is one of a handful of European countries that provide maintenance doses of heroin to addicts, but to this point, the drug was only available for injection. France, too, announced it was going ahead with safe injection sites, which could be open by the time you read this.  

This has been another year of slogging through the mire, with some inspiring victories and some oh-so-hard-fought battles, not all of which we won. But after a century of global drug prohibition, the tide appears to be turning, not least here in the US, prohibition's most powerful proponent. There is a long way to go, but activists and advocates can be forgiven if they feel like they've turned a corner. Now, we can put 2012 to bed and turn our eyes to the year ahead.

New Jersey Finds Syringe Exchange Works

In a report released Tuesday, the New Jersey Department of Health and Senior Services has found that the state's needle exchange program has provided clean needles to nearly 10,000 drug users and gotten more than 2,000 of them into drug treatment. In the report, Health Commissioner Mary O'Dowd concluded that the program is a success and should be continued.

The goal of needle exchange programs is to reduce harm to injection drug users and the community at large by reducing the spread of blood-borne diseases, such as HIV/AIDS and Hepatitis C. According to the report, injection drug users accounted for nearly 40% of new HIV/AIDS cases in the state through 2010.

"Sterile syringe access programs (SAPs) which include drug treatment and behavioral interventions are one model proven to significantly prevent/reduce the transmission of these diseases," the report noted. "These programs have also been shown to facilitate enrollment of IDUs into drug rehabilitation programs."

New Jersey passed a pilot needle exchange law in 2006, and Atlantic City became the first in the state to implement a needle exchange the following year. Camden, Newark, and Paterson came on board in 2008, and Jersey City in 2009.

Those programs saw 9,912 people enrolled between November 2007 and November 2011. Nearly 300,000 clean needles were distributed, with more than 160,000 dirty ones collected. In 2010, the state began providing each program with a nurse, and since then 59 pregnant injection drug users have received prenatal care and drug treatment.

"We are totally thrilled and certainly very grateful to the commissioner for her support," said Roseanne Scotti, head of the Drug Policy Alliance New Jersey office, who faced off against lawmakers, law enforcement, and social conservatives to help push the bill through. "This is a culmination of a 20-year battle, when Senator Wynona Lipman introduced the bill back in 1992."

Trenton, NJ
United States

"You Can't Stop AIDS Without Ending the Drug War" [FEATURE]

The XIX International AIDS Conference took place in Washington, DC, last week, bringing more than 20,000 scientists, activists, government officials, and journalists to assess the science and determine best practices for reducing the spread of the HIV virus. The US was able to host the conference for the first time in 22 years after it finally repealed a law denying people with HIV admission to the country.

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activists interrupt the conference opening session to protest the exclusion of drug users and sex workers (video at droginreporter.hu/en)
But other critical groups remained excluded -- drug users and sex workers. Although they make up a majority of people living with HIV in many countries, people who admit to ever using drugs or engaging in prostitution within the past 10 years are inadmissible under US immigration laws. The State Department could have issued a blanker waiver of inadmissibility for people attending the conference, but declined to do so.

Drug users and sex workers who wanted to attend the conference were thus faced with a dilemma: Tell the truth and be barred or lie on the visa application, which in itself is a violation of US immigration law. As a result, representatives of some of the groups most affected -- and most likely to be affected in the future -- were unable to attend.

"People do not want to run the risk of attending the conference in a country where they are told they are not wanted or desired," said Allan Clear, the executive director of the Harm Reduction Coalition. "It sends the message that people who have a history of drug use or sex work are not actually included in the dialog at all, and is a serious setback in the fight against AIDS. I don't think the US government has any particular interest in actually involving sex workers or drug users in policy or programming."

The exclusion of drug users and sex workers hasn't gone down well with activists. As far back as two years ago at the Vienna AIDS conference, Indian activist Meena Seshu called for a boycott of AIDS 2012, pointing out that it was unethical three decades into the AIDS epidemic to discuss AIDS policy without including those most affected. Some have boycotted the conference, opting instead to attend a Kiev conference that began July 9 for drug users and people living with HIV from Eastern Europe. Sex workers and their allies followed with a side meeting in Kolkata this week. While those two events are officially considered "hubs" of the International AIDS Conference, many attended them as a means of protesting the exclusion of drug users and sex workers in Washington.

Unhappiness broke into the open in Washington Monday when dozens of drug user and sex workers activists disrupted the conference's opening press event. They leapt from their seats unexpectedly and marched through the room, waving banners and shouting slogans such as "No drug users? No sex workers? No International AIDS conference!"

Discontent with AIDS policies that marginalize drug users and sex workers escaped from the conference rooms and onto the streets again on Tuesday, as hundreds marched to the White House chanting "No More Drug War" in a rally timed to coincide with the conference. The march broadened the scope of protest, linking the battle against AIDS with the war on drugs and corporate domination of US political life.

On the way to the White House, protestors stopped at UPS and Wells Fargo facilities to chide those corporations for unhelpful practices. UPS took heat for donating to politicians who voted to restore the federal ban on needle exchange funding, and Wells Fargo for investing in private prisons.

"Wells Fargo is literally invested in locking more people up," said Laura Thomas of Drug Policy Alliance (DPA).

Activism around drug users and AIDS also took place in the conference's Global Village, including the installation of a model of Vancouver's Insite supervised injection site and tours of a local needle exchange outreach van courtesy of DC's Family and Medical Counseling Services. The Harm Reduction and Global Drug Policy Zone in the village also featured special events and presentations put on by groups including the Harm Reduction Coalition, Harm Reduction International, the Hungarian Civil Liberties Union, the Eurasian Harm Reduction Network, and the International Network of People Who Use Drugs.

Advocates also took advantage of the AIDS conference to unleash a campaign on the theme of "You Can't End AIDS Unless You End the Drug War." Articles to that effect appeared on Alternet and the Huffington Post (and were picked up elsewhere), while Global Commission on Drug Policy member Richard Branson penned a USA Today op-ed piece on how drug prohibition contributes to the spread of HIV. As part of the same campaign, Politico ran a full-page ad signed by Global Commission members and other notables, repeating the message and directly challenging both President Obama and Gov. Romney to "do the right thing." Giants in AIDS advocacy like Michael Kazatchkine and Stephen Lewis joined the calls in speeches given during the conference.

In an unexpected cap to things, former President Bill Clinton called for drug use to be treated as a public health issue, not a criminal justice one, in remarks at the closing plenary. Clinton cited The Huffington Post and Alternet op-eds, coauthored by the Drug Policy Alliance's Ethan Nadelmann and American Foundation for AIDS Research founder Matthilde Krim.

Activists demanding a larger role for drug users and sex workers in setting the policies that are supposed to help them fight AIDS came armed with powerful ammunition. Two recent reports clearly lay out how criminalizing drug use helps spread the disease and how many countries are failing to adequately deal with the spread of HIV among injection drug users.

The first report, from the Global Commission on Drug Policy, makes its findings clear in its title: "The War on Drugs and HIV/AIDS: How Criminalization of Drug Use Fuels the Global Pandemic." In the report, the commission noted that injection drug use now accounts for one-third of new HIV infections outside of sub-Saharan Africa, including some 354,000 people in the US.

"Throughout the world, research has consistently shown that repressive drug law enforcement practices force drug users away from public health services and into hidden environments where HIV risk becomes markedly elevated," the commission said. "Mass incarceration of nonviolent drug offenders also plays a major role in spreading the pandemic."

The commission also remarked on "the remarkable failure" of drug prohibition in reducing the global drug supply. The worldwide supply of illicit opiates, such as heroin, has increased almost four-fold in recent decades, the commissioners noted. They also noted the drug war's contribution to the growth of organized crime and violence.

The commission identified proven addiction treatment and evidence-based public health measures that countries should put in place to reduce the spread of HIV and protect community health and safety. They include needle exchange programs, safer injecting facilities, and prescription heroin programs.

"Failure to take these steps is criminal," the commission said.

In the second report, "The Global State of Harm Reduction 2012: Towards an Integrated Response," from the London-based Harm Reduction International (formerly the International Harm Reduction Association), researchers found that while injection drug use has been identified in 158 countries, only half of them have any programs aimed at preventing the spread of HIV among injectors, and the situation internationally is not improving. Even in countries that are addressing the problem, programs suffer from lack of funding and donor support is decreasing. That is undermining the global response to AIDS, the report concluded.

"In the last two years, we have seen a significant scale-down of services in countries with some of the highest HIV burdens among people who inject drugs," said Rick Lines, the group's executive director. "As tens of thousands gather in Washington this week to call for an end to AIDS, it is becoming increasingly clear that governments have neither the will nor the intention of ending the spread of HIV among people who use drugs."

"We have seen the number of needle exchange programs in Russia drop for 70 in 2010 to only six in 2012. This is made worse by a retreat of many bilateral and multilateral donors to funding effective harm reduction interventions in many countries," said Claudia Stoicescu, public health analyst at Harm Reduction International and author of the report. "Such developments significantly limit progress toward global commitments to halve HIV transmission related to unsafe injecting by 2015, let alone any hope of achieving universal access to HIV prevention, treatment, care and support for people who inject drugs."

"The reluctance of governments to fund an adequate response to HIV and injecting drug use stands in stark contrast to the seemingly limitless budgets for ineffective and punitive law enforcement responses," said Lines. "Governments care more about fighting a losing war on drugs than they do about winning the fight against HIV."

As the world enters its fourth decade of living -- and dying -- with HIV/AIDS, this week's conference and its barriers to participation by and concern for some of those most directly affected by the crisis -- drug users and sex workers -- demonstrate how far we still have to go. They also make achingly clear the destructive role that drug prohibition and the criminalization of marginalized populations play in perpetuating the epidemic.

Maybe next time the International AIDS Society will hold its conference someplace where drug users and other marginalized groups can attend and be heard. Or maybe the United States will alter its harsh visa requirements aimed at drug users and sex workers. Either one would be good. Ending drug prohibition, the stigma it generates, and the obstacles to fighting disease it engenders would be better.

Washington, DC
United States

Making Sure Drugs Kill: Commission Blames Drug War for Spreading AIDS [FEATURE]

On Tuesday, as the UN's global drug prohibition bureaucracy marked its annual International Day Against Drug Abuse and Illicit Trafficking and UN Office on Drugs and Crime head Yuri Fedotov blamed hard drug use for "bringing misery to thousands of people, insecurity, and the spread of HIV," a group of leading international voices offered a starkly contrasting perspective, arguing instead that is the failures and consequences of global drug prohibition that are driving the spread of HIV/AIDS and other blood-borne diseases among drug users.

Commission members Michel Kazatchkine, Ruth Dreifuss, and Ilana Szabo at London press conference
Those voices, gathered together as the Global Commission on Drug Policy, include six former presidents from around the world, public health experts, and socially conscious entrepreneurs such as Sir Richard Branson. They took the opportunity of global anti-drug day to issue a report, The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic that directly condemns the drug war as a failure and calls for immediate, fundamental reforms of the global drug prohibition regime to slow the spread of HIV and reduce other drug war harms.

There are an estimated 33 million people worldwide infected with HIV, and outside sub-Saharan Africa, injection drug use accounts for one-third of new infections. The situation is particularly bad in Russia and other countries in the former Soviet Union and East Bloc that continue to take harsh drug war approaches to drug use despite the evidence before their own eyes. In Russia, nearly one in a hundred adults is now infected with HIV.

But it's not just the Russian sphere where policymakers ignore the evidence. The report also cites China, Thailand, and the US, where Congress recently reinstated a longstanding ban on the use of federal funds for syringe exchange programs. In countries that have adopted evidence-based HIV prevention programs, such as Switzerland and Portugal, injection drug use-related HIV infections have nearly been eliminated.

According to the report, drug prohibition and the criminalization of drug users spurs the spread of HIV through the following means:

  • Fear of arrest drives persons who use drugs underground, away from HIV testing and HIV prevention services and into high-risk environments.
  • Restrictions on provision of sterile syringes to drug users result in increased syringe sharing.
  • Prohibitions or restrictions on opioid substitution therapy and other evidence-based treatment result in untreated addiction and avoidable HIV risk behavior.
  • Deficient conditions and lack of HIV prevention measures in prison lead to HIV outbreaks among incarcerated drug users.
  • Disruptions of HIV antiretroviral therapy result in elevated HIV viral load and subsequent HIV transmission and increased antiretroviral resistance.
  • Limited public funds are wasted on harmful and ineffective drug law enforcement efforts instead of being invested in proven HIV prevention strategies.

"The Global Commission is calling on all entities to acknowledge and address the causal links between the war on drugs' criminalization of drug use and drug users and the spread of HIV/AIDS," commission member Michel Kazatchkine, the former executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria told a London press conference. "For people who inject drugs and their sex partners, the AIDS epidemic continues to be a public health emergency."

"It is so clear now that there is a relation between repressive drug policies and the spread of HIV/AIDS," said former Colombian President Cesar Gaviria. "If we don't get people into the health system without fear, it will be very difficult to do treatment and prevention."

Commission member Sir Richard Branson at "Atlantic Exchange" drug policy discussion, Washington, DC, March 2012
"I have long thought the war on drugs did more harm than good, and the commission's report put the data behind those beliefs," said Branson. "The war on drugs is not stopping drug use, and it also contributes significantly to the AIDS epidemic by driving users into the shadows. As an entrepreneur, if my business was failing for 40 years, I would close it down. Refusing to implement public health measures to reduce HIV and protect people with a drug problem is nothing short of criminal."

Branson and the other commissioners made some concrete recommendations for action in the report. Those include:

  • Push national governments to halt the practice of arresting and imprisoning people who use drugs but do no harm to others.
  • Measure drug policy success by indicators that have real meaning in communities, such as reduced rates of transmission of HIV and other infectious diseases, fewer overdose deaths, reduced drug market violence, fewer individuals incarcerated and lowered rates of problematic substance use.
  • Respond to the fact that HIV risk behavior resulting from repressive drug control policies and under-funding of evidence-based approaches is the main issue driving the HIV epidemic in many regions of the world.
  • Act urgently: The war on drugs has failed, and millions of new HIV infections and AIDS deaths can be averted if action is taken now.

"The AIDS epidemic is a harsh and brutal teacher that obliges us to take a scientific approach to deal with sex workers and drug addicts," said former Swiss President and commission member Ruth Dreifuss. "Politicians have to inform citizens of the benefits, risks, and failures of drug policy, and politics has to take responsibility for policy change. Public health has to be at least as important as criminalizing the drug traffic," she told the press conference.

"Addicted injecting drug users is one of the main sources of the spread, and not all of them will achieve abstinence," said Dreifuss. "Substitution therapies can take people away from street drug dealers and violence. For some, the provision of medical heroin is necessary to allow them to abandon criminal activities and overcome marginalization. It's possible to implement these large scale programs at low costs with high benefits," she argued.

"For others, harm reduction measures are necessary in order to avoid the spread of HIV/AIDS and other bloodborne disease. Needle exchange programs, free condoms, safe consumption rooms all not only save the lives of drug users but protect the whole population," Dreifuss explained. "We need the full spectrum of these measures for those in prison, too, who are at more risk for HIV infections."

Dreifuss touted her own country's experience as a model. Faced with mounting injection drug use, Switzerland eventually went the route of supervised injection sites and opioid maintenance, including heroin maintenance.

"Our experience is that it works," she said. "The police protect the injection rooms from dealers. The four pillar policy [prevention, treatment, harm reduction, enforcement] has been broadly accepted by our citizens and the spread of HIV/AIDS is under control."

Even within the constraints imposed by the global drug prohibition regime, countries can still take action to mitigate the drug war's role in the spread of infectious disease, she said.

"It is possible for countries to adopt effective harm reduction measures within existing drug laws," Dreifuss argued. "The decriminalization of drug use is the first step, and the second step is to determine what type of market can drive out dealers. The war on drugs has failed to reduce supply or demand; let us replace prohibition with regulation and avoid jeopardizing public health and harm reduction policies with inefficient measures."

"Our message is that prohibitionist law enforcement has failed in its goals of eradicating drugs and protecting people's health," said Kazatchkine. "Illegal drugs have become cheaper and more available and HIV and other health risks have increased. Prohibitionist policies have been shifting the market to stronger drugs and led to a war on users with numerous human rights abuses, police harassment, violence, extortion. The fear of police and stigma is driving users underground and away from access to information, care, and medical services," he warned.

"One cannot improve health through war," he concluded. "This is an epidemic among people who inject that we can actually control. If we are to have a chance at reducing the transmission of AIDS, we need to open up and change our ways."

The Global Commission on Drugs has laid out the problem and showed us the path to fix it. Now, it is up to our political leadership to act accordingly, and it is up to us to ensure that it does.

London
United Kingdom

Needle Exchange Funding Returns in Senate Appropriations Bill

The Harm Reduction Coalition has reported that language authorizing the use of federal funds for needle exchange programs has been included in the Senate's Fiscal Year 2013 Labor, Health & Human Services appropriations bill. Funding had been approved for FY 2010 and 2011, but the formerly longstanding ban on federal funding was reinstated in December for FY 2012.

The Republican-controlled House of Representatives is expected to once again vote for the ban on needle exchange funding in its version of the appropriations bill. Having funding language in the Senate version will give Senate negotiators something to negotiate on needle exchange when the bills are reconciled, which probably won't happen until after the November elections.

The language approved by the Senate is compromise language that only bans federal funding "in any location that has been determined by the local public health or local law enforcement authorities to be inappropriate for such distribution." The Harm Reduction Coalition calls that language "consistent with what we advocated for" and notes that the same language allowed needle exchanges in 10 jurisdictions and multiple SAMSHA-funded programs to use federal funds.

The Senate appropriations bill also includes some other good harm reduction news. In its non-binding report, it calls for an overdose prevention public awareness campaign. That report does not specifically mention the anti-overdose drug naloxone, which the Coalition had sought, and the Coalition said it would continue to lobby on that issue.

And, like last year, the bill includes $10 million for viral hepatitis screening. The funding announcement for those dollars from last year's bill has now been released and includes $1.6 million for hepatitis C testing and referrals to programs reaching out to injection drug users, including needle exchanges.

The report accompanying the FY 2013 bill also "notes the high incidence of hepatitis among injection drug users and urges SAMHSA to implement viral hepatitis testing as a standard of care in drug-treatment programs, consistent with the HHS Action Plan for the Prevention, Care and Treatment of Viral Hepatitis."

Washington, DC
United States

Kenya to Distribute Needles to Injection Drug Users

The Kenyan government will begin distributing needles to the country's estimated 50,000 injection drug users next month in a bid to slow the spread of HIV and other blood-borne diseases. The plan was announced last week in Mombasa, where the first pilot program will begin.

Mombasa, a port city, is reportedly a transit route for international drug trafficking. It also has the country's highest number of injecting heroin users.

"We are trying our best to address the entire problem of drug abuse amongst the youths. We had to identify an alternative of stopping the youths from sharing needles, our attention having been drawn by the rate at which these young people were contracting HIV and other diseases, such as hepatitis," said Dr. Anisa Omar, the Coast Provincial Director of Public Health and Sanitation. "In Mombasa alone, we have over 26,000 youths who use injection drugs, with at least one out of every four being found to be HIV-positive. In Nairobi, we have 20,000 youths who are IDUs."

The Kenyan government estimates that injection drug use accounts for 4% of HIV infections and 17% of new HIV infections in Coast Province, where Mombasa is located. The government moved in 2010 to shift from addressing drug use as a criminal issue to addressing it as a public health issue.

The government plans to distribute some eight million needles to injection drug users as the plan is rolled out. It will also encourage people to be tested for HIV and will provide antiretroviral drugs, condoms, and medicines for tuberculosis, which commonly co-infects with HIV.

While the government has shifted to a public health and harm reduction approach, not everybody is on board. Anti-drug activists and some religious leaders have criticized the move.

"We will file a petition in court… these children of ours don't even have any veins remaining in their bodies," said Amina Abdalla, secretary of the Coast Community Anti-Drugs Coalition. "Where do they expect them to inject themselves? Their bodies are ruptured and rotten as a result of constant use of the needles. Besides, drug peddlers and barons will have a field day, for they'll know their products will be on demand, and that's not acceptable."

Coast religious leaders also objected, saying the government should instead spend its resources on drug treatment.

But Dr. Omar said that needle sharing significantly reduced the risk of coming down with HIV and hepatitis, and that justified the program.

"The program, which will see every addict given three needles and syringes per day, will be supplied to specified private rehabilitation centers and hospitals by NGOs and qualified medical practitioners, in collaboration with anti-drug campaigners, whom we soon plan to train on how they'll best handle the addicts."

Mombasa
Kenya

Battle for Restored Needle Exchange Funding Heats Up [FEATURE]

After 20 years of walking in the political wilderness, public health and harm reduction advocates for federal funding for needle exchange programs made it to the Promised Land in December 2009, when the Democratic-controlled Congress overturned the longstanding funding ban. But just two years later, led by the Republican-controlled House and with the acquiescence of the Democratic-controlled Senate, Congress reinstated the ban in its 2012 federal omnibus spending bill.

Needle exchange advocates arrested on Capitol Hill Wednesday (Stephanie Simpson, Housing Works)
Advocates were outraged and dismayed by the congressional action, but are determined to fight back to restore funding for a harm reduction practice repeatedly proven to save lives and reduce the spread of infectious blood-borne diseases, such as HIV/AIDS and hepatitis C. This week, they came out swinging with a national day of action Wednesday that saw organized call-ins to members of Congress and civil disobedience actions leading to dozens of arrests at the offices of four of them, as well as actions in a dozen others cities across the county.

Although the funding ban's main proponents are Republicans, repealing the ban is actually the states' rights, deregulation position. Each year the federal government authorizes funding for grants to states to be used for AIDS prevention and treatment. When the ban was temporarily lifted, it neither increased nor decreased the amount of AIDS funding, but it meant that states could choose for themselves whether or not to use some of those funds to support needle exchange programs.

The activists have science and the evidence on their side. The Centers for Disease Control and Prevention (CDC), American Medical Association, National Academy of Sciences, American Public Health Association, and numerous other scientific bodies have found that syringe exchange programs are highly effective at preventing the spread of HIV/AIDS and other infectious diseases. Eight federal reports have found that increasing access to sterile syringes saves lives without increasing drug use.

More than 200 needle exchange programs operate across the country in cooperation with local law enforcement officials and health departments, but many are in danger of closing their doors or cutting back services without access to federal funds. That puts lives and the public health at risk.

Needle exchange supporters said the restored the ban will result in thousands of Americans contracting HIV/AIDS, hepatitis C or other infectious diseases next year alone. According to the Harm Reduction Coalition (HRC), needle sharing by injection drug users accounts for 8,000 new cases of HIV and 15,000 new cases of hepatitis C each year. In New York City, there has been a 75% reduction in new HIV cases as a result of instituting such programs, according to a 2005 study cited by HRC.

"We need Congress to stand behind public health and science, and declare a cease-fire on syringe exchange," said HRC executive director Allan Clear. "All of the research tells the same story: Syringe exchange prevents infections, promotes drug treatment, and reduces drug use. Congress must stop treating syringe exchange as an ideological pawn in partisan politics."

"The federal syringe funding ban was costly in both human and fiscal terms -- it is outrageous that Congress has restored it given how overwhelming and clear the science is in support of making sterile syringes widely available," said Bill Piper, director of national affairs for the Drug Policy Alliance. "Make no mistake about it -- members of Congress who supported this ban have put the lives of their constituents in jeopardy."

Cherry blossoms bloom in DC as arrestee is detained (Stephanie Simpson, Housing Works)
The renewed ban on federal funding for needle exchanges couldn't come at a more inopportune time. With a wave of drug users who began their careers with opioid pain pills finding succor in the needle, making access to clean needles more difficult is likely to make matters worse.

"We need to support syringe exchange programs now more than ever," said HRC policy director Daniel Raymond. "Health officials in many states report a disturbing new trend of hepatitis C outbreaks in young people, driven by a new wave of injection drug use linked to the prescription painkiller epidemic. We're in danger of starving programs of federal funds, just when the demand for syringe exchange is increasing."

In Washington, while a coordinated campaign of phone calling kept the congressional switchboard humming, dozens of AIDS and harm reduction activists went to Capitol Hill and held sit-ins at the offices of four House Republicans, including Speaker John Boehner (R-OH), Rep. Denny Rehberg (R-MT), Mike Rogers (R-MI) and Eric Cantor (R-VA) for their role in reinstating the ban on federal funding for syringe exchange programs last December.

Carrying signs reading "Syringe Exchange: A Fix for AIDS," the activists chanted and blocked doorways before being arrested by Capitol Police. They were expected to be booked and released later Wednesday.

At least 32 people were arrested at Congress, according to Housing Works, a New York City-based group that provides services for AIDS sufferers. Housing Works participated in the action as part of the We Can End AIDS Coalition, an umbrella group coordinating a July 24 mass protest in Washington around economic justice and human rights for AIDS patients.

"Our government should be embarrassed as this year's host of the International AIDS Conference to have sneaked this into an unrelated bill under the cloak of night last December," said Housing Works CEO Charles King. "The US cannot be any shining example to the rest of the world on how to end the AIDS epidemic when we’re still fighting foolish policies that reject what we know works."

Wednesday's action was only an opening skirmish in what will be a determined battle to restore the federal funds. The AIDS, public health, and harm reduction communities are not going to just roll over and play dead while Congress makes decisions that will result in real people becoming really dead.

"We refuse to let the close-mindedness of anti-science conservatives dictate public health policy," said Clear. "We can't afford these political games, and we can't afford any more new infections. Our communities are struggling; Congress needs to listen and show leadership by rescinding the funding ban."

Greece to Hand out Needles, Condoms in AIDS Fight

The Greek government announced Tuesday that it will begin harm reduction measures, including handing out condoms and needles to heroin addicts, in an effort to slow an alarming rise in new HIV cases, Agence-France Presse reported. The government anti-drug organization Okana and volunteer organizations will hand out 30,000 condoms and 10,000 needles as part of the effort, which will be initially launched in Athens.

view of the Acropolis at sunset (wikimedia.org)
"There is an imperative need for immediate action to limit the spread of infection," deputy health minister Michalis Timosidis said in a parliamentary document.

Greek health officials had reported in November that new HIV cases were up by 52.7% last year over 2010. The government center for disease control and prevention said over 800 new cases had been recorded through October 2011.

A third of the new cases were reported among gay men, but officials said most new cases were linked to prostitution and intravenous drug use. The number of new HIV infections among heroin users increased a whopping 1,250% in a year, the disease control center said.

Because of the economic crisis, Greece has been forced to radically cut social spending to eliminate budget deficits in order to receive loans from the International Monetary Fund and the European Union. Those spending cuts have seen staff layoffs and mergers in the health sector, which doctors said are weakening the effectiveness of the Greek health care system.

Athens
Greece

New Mexico Legislature to Study Supervised Injection Sites [FEATURE]

In a groundbreaking move, the New Mexico legislature has approved a proposal to study how to enhance and expand the state's already cutting edge harm reduction programs, including a look a medically supervised injection sites (SIJs -- sometimes also known as safe injection sites) for hard drug users. That could clear the way for an eventual SIJ pilot program to operate in the state, although considerable political and legal hurdles remain.

The legislation, Senate Memorial 45, was sponsored by Sen. Richard Martinez, whose constituency includes Rio Arriba County, which has a drug overdose fatality rate five times the state's rate. The state's rate is double the national rate, making New Mexico the nation's leader in drug overdose-related deaths per capita.

"These deaths are preventable," said Martinez. "Overdose spares no one and affects everyone, especially families."

State health officials estimate the state has at least 24,000 injection drug users. Other estimates put that figure as high as 50,000.

The memorial, which was also endorsed by the New Mexico Public Health Association, passed the Senate on a 43-0 vote Monday night and does not need any further action to go into effect. It directs the University of New Mexico's Robert Wood Johnson Foundation Health Policy Center to undertake the study of emerging and evidence-based harm reduction approaches, including SIJs, and report back to the legislature by November 1.

"Sadly, our drug overdose epidemic has outgrown our current harm reduction approaches," said Emily Kaltenbach, director of the Drug Policy Alliance (DPA) New Mexico office. "On Monday, our state senators realized this and did not let politics trump science. They clearly stated their intent to go beyond the status quo and explore innovative strategies to help New Mexico’s families."

"Wow, getting something like that on the state level is huge," said Hilary McQuie, Western director for the Harm Reduction Coalition (HRC). "New Mexico once again takes the lead in state harm reduction efforts; it's one of the few states to take a statewide approach to these things."

"Heroin is still the number one cause of ODs here, but we're also seeing a high number of prescription drug overdose deaths," said Kaltenbach, "so I'm incredibly encouraged that the legislature is willing to look beyond the status quo and start studying proven programs like supervised injection sites. We're hoping to study the feasibility and legal and ethical implications, leading to a pilot site in New Mexico."

If that actually happens, it would be the first SIJ in the nation. Although SIJS are operating in at least 27 cities around the world, including Vancouver and Sydney, and have been proven to reduce the spread of HIV, Hep C, and other blood-borne diseases, as well as prevent overdoses, without increasing criminality or drug use, political and legal obstacles in the US have so far prevented them from spreading here. They face morality-based opposition as well as federal issues including a "crack house law," which bars anyone from knowingly allowing others to use controlled substances.

"These same sorts of issues came up when syringe exchange programs were first discussed," said Kaltenbach. "I think the legal issues can be overcome, but the states have to be willing to look at it as an extension of syringe exchange. This study will address those issues."

While New Mexico is the first state to order a study of SIJs, it isn't the only place in the country where they are on the agenda. In San Francisco, drug user groups, activists, and advocates are working toward winning approval for one there, while in New York City, a similar effort is going on.

"The biggest obstacle is the perception of legal barriers," said DPA's Laura Thomas, who has been working on the San Francisco effort. "We have these crack house statutes, as well as state laws, that say it's illegal to knowingly allow people to use controlled substances. We have to figure out if there's room for a research project, like in Sydney, or create an exemption, like in Vancouver, or get a state law passed, like in New Mexico. We need a ruling that says 'yes,' this is not a violation."

http://www.stopthedrugwar.org/files/richard-martinez.jpg
Richard Martinez
In the meantime, the achingly slow process of building political support for an SIJ, or at least a feasibility study, goes forward. A year ago this week, a city Hep C task force recommended looking at SIJs. That followed on a similar recommendation from the city's HIV coalition.

"We continue to try to build support for a safe injection site," said Thomas. "During the mayoral campaign last year, at one of the candidate forums, they were all asked if they would support evaluating whether it would work for San Francisco, and most of them said they did, including our current city attorney, Dennis Herrera."

But despite the recommendations and expressions of support, nothing has happened yet. The San Francisco Drug Users' Union is trying to change that.

"We will be pressing the Board of Supervisors to study the possibilities," said the group's Isaac Jackson. "We're also doing a SIJ community design competition, a project in community imagineering. We'll give the winner a nominal prize and we'll present the winning design to the Board," he said.

"We think the city's Human Rights Commission will recommend safe injection sites in April," said HRC's McQuie. "But there have been other bodies and other recommendations. It's a matter of where the political will is and the priorities are."

For HRC, said McQuie, getting a safe injection site up and running in San Francisco is a back burner issue right now, but that could change.

"We have a lot of really great harm reduction projects going on, like the DOPE Project, that aren't getting financial support, and while there was a lot of enthusiasm for awhile about working toward a safe injection site, we kept planning meetings, but nobody would show up. It didn't feel like the energy was there. If the San Francisco Drug Users' Union wants to take some leadership, we would be happy to support it," said McQuie. "I think we will be going back to San Francisco and asking somebody to do something on this issue, but we're not sure who yet."

On the other side of the country, street-level activists are aiming for an SIJ in New York City. Citiwide Harm Reduction in the South Bronx, which is on the verge of opening the city's first fully staffed primary care clinic at a syringe exchange, is preparing to build a full-scale model of an SIJ at its 144th Street building. It may seem like performance act, but its purpose is educational.

"Our inspiration is the Smithsonian museums, where you can go inside the cockpit of the space shuttle," said Citiwide executive director Robert Cordero. "People have this grisly misconception of what a safe injection site would be like, and we want them to be able to have this Smithsonian experience here in the Bronx."

Such a model could be quite useful in educating elected officials and law enforcement, Cordero said.

"SIJs are a humane public health approach to reducing overdoses, HIV, Hep C, and crime, and can provide compassionate care for addicted people until they are ready to get into treatment," he said. "Do we want that, or do we want them just hanging out in front of the bodegas on 149th all day?"

Citiwide isn't going it alone on agitating for SIJs, and it isn't even taking the lead. Instead it is working with groups like HRC and the Vocals-NY Users' Union in a broader campaign.

"We're not trying to be the HRC or Vocals-NY," said Cordero. "We advocate through demonstrating what it would be like while partnering with others who are advocating every day. Our effort is to build the SIJ model, and when anyone comes to New York who is interested in these issues, there can be an educational moment."

Supervised injection sites are not a reality yet in the US, but pressure for them is mounting. Whether it's New Mexico, New York City, or San Francisco, one of these years someone is going to lead the US into the ranks of nations that understand their utility -- and their humanity. New Mexico has just taken a giant step, but let's hope it has to move fast to beat San Francisco and New York.

Santa Fe, NM
United States

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