Needle Exchange

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Breaking: Congress Votes to Kill People

Earlier this week we alerted our email subscribers and web site readers that Republicans in Congress were pushing to reinstate the only recently repealed syringe exchange funding ban. Lifted two years ago as part of the FY 2010 budget bill, the ban had prevented states from making their own decisions as to whether to use federal AIDS grant funding to support needle exchange programs. As most if not all aspects of the drug issue demonstrate, when Republicans talk about state and local control, they don't sincerely mean it, at least not as a group. (The libertarian-minded Ron Paul initially supported the ban, but changed his view and helped repeal it years later.)

Not that the ban's reinstatement can be blamed solely on Republicans, certainly not in the Democratically-controlled Senate. It happened in part because Democrats did not make it a priority to keep it from happening.

Congress's action this week means misery and death for large numbers of people. As the eight federal reviews of the research on this issue demonstrate, needle exchange programs reduce the spread of HIV without increasing the use of drugs. According to the Harm Reduction Coalition, needle sharing by injection drug users accounts for 8,000 new cases of HIV and 15,000 new cases of Hepatitis C each year. Of course the diseases spread from them to other people on occasion, including people who have no involvement in illegal drug use. As HRC points out, New York City has seen a 75% reduction in new HIV cases as a result of instituting such programs, according to a 2005 study.

So let's be clear; the evidence is overwhelming. In fact, even the studies cited by opponents of needle exchange actually support needle exchange, if you take the time to read them. Reinstituting the federal ban will have the effect of defunding many programs, and the science is clear that this means more infections and more needless of life. It won't save the federal government any money, because it doesn't affect the total amount of funding in the Ryan White program. All it does is make the program less effective at accomplishing its goals. And of course, health care costs will only grow because expensive AIDS and Hepatitis treatments will be needed for more people. Sadly, expressing the drug war ideology through deadly legislating seems to be more important for certain members of Congress than any of that. On the bright side, at least they didn't reinstate the old ban on the District of Columbia spending its own funds on needle exchange programs.

Don't give up and don't think that it's over. The ban got repealed once, and it will get repealed again. In the meanwhile, here are a few of the statements about the event that have come to my attention since yesterday. (Feel free to link more in the comments section.)

Congress to Restore Federal Syringe Exchange Funding Ban as Part of 2012 Spending Package

Drug Policy Alliance

www.drugpolicy.org

For Immediate Release: December 16, 2011
Contact: Tony Newman or Bill Piper

Congress to Restore Federal Syringe Exchange Funding Ban as Part of 2012 Spending Package

Ban on Allowing States to Use HIV Prevention Money on Life-Saving Syringe Programs was Overturned in 2009 After 20-Year Struggle

Reinstatement of Ban will Lead to Thousands of New HIV/AIDS, Hepatitis C Cases Annually

As part of the 2012 spending package being voted on today, Congress is restoring a ban on using federal funding for syringe exchange programs that reduce the spread of HIV/AIDS, hepatitis C, and other infectious diseases. The ban, enacted in the 1980s and repealed in 2009, was largely responsible for hundreds of thousands of Americans contracting HIV/AIDS directly or indirectly from the sharing of used syringes. Advocates warn that restoring the ban will result in thousands of Americans contracting HIV/AIDS, hepatitis C or other infectious diseases next year alone.

“The federal syringe funding ban was costly in both human and fiscal terms – it is outrageous that Congress is restoring 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.”

House Republicans passed restrictive language in three separate appropriations bills, and succeeded in getting two of three bans in the current House-Senate compromise omnibus for Fiscal Year 2012 being voted on today. In addition to the overarching ban on domestic use of federal funds contained in the Labor-HHS spending bill, House republicans also succeeded in imposing a ban on use of State Department funds for syringe access in international programs. In large parts of the world the HIV/AIDS epidemic is being driven by injection drug use. The international syringe funding ban will mean the global HIV/AIDS epidemic will continue to grow.

The existing federal syringe exchange policy, signed into law by President Obama in December of 2009, allows states and local public health officials to use federal funds for syringe access, in consultation and with the consent of  local law enforcement. The policy change is widely credited with having prevented thousands of new cases of HIV and Hepatitis C, thereby saving many lives and improving public health and safety.  

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. Increasing the availability of sterile syringes through exchange programs, pharmacies and other outlets also helps injection drug users obtain drug education and treatment. Eight federal reports have found that increasing access to sterile syringes saves lives without increasing drug use.

“We may have lost this battle, but we have just begun to fight,” said Piper. “The Republicans who insisted on restoring the ban, and the Democrats who didn’t fight hard enough to oppose it, will be responsible for thousands of Americans contracting HIV/AIDS or hepatitis C. We will make sure Americans know which members of Congress care about their health and well-being and which do not.”

###

ALERT: Don't Let Congress Backslide on Needle Exchange

Dear drug policy reformer:

One of the most important actions taken by Congress in recent years was the lifting of a ban on the use of federal AIDS grants to support needle exchange programs. We have just learned that as part of the end-of-year Congressional spending package, Republicans are pushing hard to reinstate the ban. If they succeed, it won't reduce federal spending -- this is entirely about the choices state and local officials get to make with the funds that they have -- but it will kill people by promoting syringe sharing by injection drug users and the resulting spread of deadly diseases like Hepatitis and HIV, in turn driving up health care costs related to those diseases.

Please call the White House to urge President Obama to stand firm on this issue and not allow the needle exchange funding ban to be reinstated. The White House comment line number is (202) 456-1414. Here is a sample script for your phone call: "My name is _______. I live in <CITY, STATE>. Thank you for your past support of syringe exchange. I support maintaining current language that allows local officials to make their own decisions to use federal and local Washington DC funds for Syringe Exchange. Please do not allow the Senate or House to change the current law in the Fiscal Year 2012 Appropriations negotiations. Thank you."

Please also make the following calls to Congress:

  1. Senate Majority Leader Harry Reid (D-NV): (202) 224-3542
  2. Senate Assistant Majority Leader Richard Durbin (D-IL): (202) 224-2152
  3. Charles Schumer, chair of Senate Democratic Policy Committee (D-NY): (202) 224-6542
  4. Your Own Two Senators: (202) 224-3121 for the Congressional Switchboard or look up your Senator's numbers at senate.gov

    Sample script for phone calls to the Senate: "My name is _______. I live in <CITY, STATE>. I support maintaining current language that allows local officials to make their own decisions to use federal and local Washington DC funds for Syringe Exchange. Please do not change the current law in the Fiscal Year 2012 Appropriations negotiations. Thank you."
  5. House Democratic leader Nancy Pelosi (D-CA): (202) 225-4965

    "Thank you for your past support of syringe exchange. "My name is _______. I live in <CITY, STATE>. I support maintaining current language that allows local officials to make their own decisions to use federal and local Washington DC funds for Syringe Exchange. Please do not change the current law in the Fiscal Year 2012 Appropriations negotiations. Thank you."

Please email us to let us know what phone calls you've made -- especially if the staffers who take your phone calls offer any indication as to what their bosses' intentions are. Thank you for your taking action.

California Gov. Brown Signs Needle Access Bills

California Gov. Jerry Brown (D) has signed into law a pair of bills that will expand access to clean needles and help prevent the spread of HIV and Hepatitis C infections in the state. The move is winning him kudos from drug reformers and public health advocates.

Badly needed needle exchanges could be coming to more CA counties under a bill just signed by Gov Brown. (wikimedia.org)
The first bill, Senate Bill 41, sponsored by Sen. Leland Yee (D-San Francisco), makes legal the sale of syringes at pharmacies without a prescription. An earlier pilot program allowing such sales had been in effect in some counties and has proven effective at reducing needle-sharing, but most counties did not participate. Now, once the bill goes into effect on January 1, people will be able to buy syringes without a prescription at pharmacies statewide.

The second bill, AB 604, sponsored by Assemblywoman Nancy Skinner (D-Berkeley), allows the California Department of Public Health to authorize new needle exchange programs after consultation with local public health and law enforcement. Currently, needle exchange programs are only authorized after county officials declare a public health emergency, and the political will to do that has been lacking in some counties. This bill allows public health officials to take the initiative instead of waiting for elected officials. It, too, will go into effect on January 1.

"I am directing the department to administer AB 604 in a constrained way, working closely not only with local health officers and police chiefs, but with neighborhood associations as well," said Gov. Brown in his signing statement. "I believe that AB 604 can reduce the spread of communicable diseases and the suffering they cause and, at the same time, respect public safety and local preference."

"This is a huge victory for public health and common sense," said Laura Thomas, Deputy Director of California for the Drug Policy Alliance. "Now all Californians will have the same access to proven, effective HIV and hepatitis C prevention. This gives drug users the tools that they need to protect their health and that of their partners, children, and communities, as well as protecting the California taxpayer from the cost of HIV and hepatitis C infections."

Sacramento, CA
United States

Scottish Needle Exchange Conference

Scottish Needle Exchange Conference

'Working Together'

Stirling Highland Hotel, Stirling, Scotland 

WEDNESDAY 9TH NOVEMBER

 

The conference is the inaugural Scottish Needle Exchange Conference held to support the implementation of the first national needle exchange contract.

The primary aim of the conference is to communicate on a Scottish wide basis, trends within the needle exchange arena, and to support best practice, working together.

Visit http://www.snxc.org for further information.

Date: 
Wed, 11/09/2011 - 8:30am - 5:00pm
Location: 
Stirling, STG
United Kingdom

Chronicle Book Review: Drugs and Drug Policy

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

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

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

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

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

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

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

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

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

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

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

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

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

US Surgeon General Gives Okay for Needle Exchange Funding

Needle exchanges save lives -- ask the Surgeon General (Image via Wikimedia)
In a notice dated last Friday, but posted in the Federal Register Wednesday, US Surgeon General Regina Benjamin has determined that needle exchange programs constitute a form of drug treatment, which means that NEPS can qualify for funding under the Substance Abuse Prevention and Treatment block grant programs.

"[NEPs] are widely considered to be an effective way of reducing HIV transmission among individuals who inject illicit drugs and there is ample evidence that [NEPs] also promote entry and retention into treatment," Benjamin said in making the determination. "The Surgeon General of the United States Public Health Service has therefore determined that a demonstration syringe services program would be effective in reducing drug abuse and the risk that the public will become infected with the etiologic agent for AIDS."

The use of federal dollars to fund NEPS had been banned for 21 years until 2009, when a Democrat-controlled Congress undid it and President Obama signed the lifting of the ban into law. But moves are afoot in the Republican-controlled House of Representatives to put it back in place. The Surgeon General's notice will weaken that effort.

Washington, DC
United States

White House Moves to Fund Needle Exchanges As Drug Treatment

The Obama administration has designated needle exchanges as a drug treatment program, allowing federal money set aside to treat addictions to be used to distribute syringes to intravenous drug users. Two years ago President Obama lifted the 21-year ban on federally funded needle exchange programs as a necessary evil to reduce the spread of HIV among illicit drug users. The new position, determined by the surgeon general, is that the states can receive federal funding for programs that hand out the syringes as a treatment. A 11-year-old study in the Journal of Substance Abuse Treatment that found that addicts who participated in needle exchanges were five times more likely to enter drug treatment.
Publication/Source: 
Washington Examiner (DC)
URL: 
http://washingtonexaminer.com/local/crime-punishment/2011/02/white-house-moves-fund-needle-exchanges-drug-treatment

The Prospects for Drug Reform: California [FEATURE]

[Editor's Note: This is the first in a series of reports on the prospects for drug reform in a handful of states where the chances of legalizing marijuana are the strongest. But these reports will also look at medical marijuana, harm reduction, and sentencing reform prospects. They are a work in progress and will be revised. Look for reports on Colorado, Oregon, and Washington in coming weeks.]

California, viewed from space
The West Coast is a different world when it comes to progress on drug policy reform. Three of the four states most likely to see strong pushes for marijuana legalization in the next couple of years are on the West Coast (the other being Colorado). And medical marijuana is a fact of life from San Diego to Seattle, even if many bruising battles remain, and is certain to be an area of contention in coming years.

But it's not just pot politics that makes the West Coast different. The region has also been a pioneer in sentencing reform and harm reduction practices, even if countervailing forces remain strong and both policy areas remain contested terrain.

And the fact that all three states are initiative and referendum states adds another dimension to the politics of drug reform. In all three states, the initiative process has been an important vehicle for drug reform, although it has also been used for anti-reform efforts, most notably with Oregon sentencing initiatives.

Will the West Coast continue to be the drug reform vanguard? Here, we look at the prospects for reform in four broad areas -- medical marijuana, marijuana legalization or decriminalization, drug sentencing reform, and the enactment of harm reduction practices -- and assess where the reform movement can most productively apply its energies. We also attempt to identify areas and issues around which larger coalitions can be formed to advance drug policy and criminal justice reform objectives.

We begin with California, the first state to legalize medical marijuana and that state where advocates last year came within a handful of percentage points of winning voter approval for pot legalization. California is the nation's most populous state and has long been at the cutting edge of social change, but now it is also faced with a monstrous $25 billion budget deficit. How social change and fiscal crisis interact in the realm of drug reform policy-making will be a key issue for advocates as they attempt to deepen existing drug reforms and introduce new ones.

Marijuana Legalization

Last year saw efforts to legalize pot both in Sacramento and at the ballot box in November. Rep. Tom Ammiano (D-San Francisco) made history when his legalization bill was approved by the Assembly Public Safety Committee, but that bill later died. Ammiano is back at it again this year, but getting a legalization bill through the legislature will be a tough fight.

The tax and regulate marijuana legalization initiative led by Oaksterdam's Richard Lee managed to put together an impressive coalition of labor, civil rights, and other groups in the run-up to the November election, but that wasn't enough to get the measure over the top. Proposition 19 scored 46.5% of the vote. Legalization advocates are already laying the groundwork for another initiative; several hundred people gathered at a sold-out California NORML (CANORML) conference in Berkeley late last month in a bid to take the first steps toward consensus among the state's complex, variegated, and often fractious marijuana community.

While Prop 19 failed to win a majority, reformers see the coalition-building that took place around it as a basic building block toward eventual victory. For the first time, pot legalization enjoyed organized support from outside the marijuana community.

"Prop 19 has opened up everything and moved marijuana legalization into the mainstream of American politics, particularly in the Western states," said Steve Gutwillig, California state director for the Drug Policy Alliance. "Its defeat was at most a speed bump, and the Prop 19 campaign process itself accelerated the marijuana reform movement. It created unprecedented mainstream media coverage, educated millions of voters, and forged a new coalition that is poised to be recreated and expanded on in California and other states in 2012," he said.

Winning a legalization vote in California means continuing to mobilize labor and civil rights groups, he said. And the stars are aligning.

"Organized labor has to be at the table of what is clearly a burgeoning industry with thousands of viable jobs from agriculture to retail. For mainstream civil rights organizations, the racial profiling that is at the center of marijuana enforcement is an issue that intersects with groups with whom they are naturally allied on other issues. We're seeing a confluence of economic and racial justice issues at a time when mainstream voters are expressing a fatigue with the drug war in general and a contempt for marijuana prohibition in particular," Gutwillig argued.

"The SEIU's endorsement of Prop 19 in California opened the door to a serious conversation with the service employee unions all across the country, said Gutwillig. "The SEIU also took a long look at the Washington initiative, but didn't think the numbers were there. But even that examination was significant. The SEIU thought the timing wasn't right last year, but all of this will be in play again and all of this represents real progress in coalition building. This conversation is taking place in a way that was unimaginable five years ago."

Gutwillig identified one more constituency reformers will be working to draw closer: the Democratic Party and its voters.

"The California Democratic Party took a neutral position, but a majority of county Democratic committees endorsed Prop 19," he noted. "That signals that there will be real conversations about what role marijuana legalization will play in terms of turnout among traditional Democratic voters."

Long-time CANORML head and veteran scene-watcher Dale Gieringer doesn't think winning outright marijuana legalization is going to be easy despite the coalition-building. Instead, he is talking about getting to the Promised Land through small steps and by broadening the existing medical marijuana system with its population of legally sanctioned adult users and providers.

Gieringer wants to down-grade minor marijuana distribution and cultivation offenses from felonies to misdemeanors, legalize private adult use, and establish a legally-regulated production system that includes manufacturing, processing, delivery, and legal sales to legally authorized users, namely anyone who has a medical marijuana recommendation.

"That would leave room for local governments to expand the universe of authorized users" without explicitly legalizing non-medicinal sale to adults, Gieringer said. "Taking on adult sales at this moment is premature, but we can write a law that opens the door to adult sales without explicitly doing it immediately."

Medical Marijuana

Using California's existing medical marijuana program as a segue to adult legalization, however, requires something the state still lacks: clarity about what is and is not allowed by Proposition 215 and the legislature's attempt to clarify it, SB 420. Some state prosecutors insist that no medical marijuana sales are legal, and the courts have yet to provide rigorous guidance. Cases have been and are being prosecuted in those counties, meaning that access to medical marijuana depends to a great extent on where one lives within California.

"Fixing the medical marijuana system has to be integral and a number one priority," said Gieringer. "We have to make changes to the medical marijuana system. The public is not happy with the current situation and would like something that is better regulated. A lot of operators feel the same way, but have differing opinions about what would be nice."

While a fix could come through the legislature, Gieringer was leery. "I can't see the legislature passing anything we would like," he said. "Given the level of support we have in Sacramento, we could probably get a bill to clearly allow medical marijuana sales, but it would also likely be loaded down with things we would find unacceptable, like 1000-foot provisions, no on-site smoking, no sale of edibles and the like," he predicted.

"They dickered around with it last year, but it was mainly about extracting money from everybody," Gieringer continued. "What's really needed is to clarify what's legal and what isn't."

Gieringer suggested that the people working on marijuana legalization initiatives include clarifying medical marijuana sales. "I think we could get something better through a vote of the people," he said. "I am hoping that medical marijuana reform will be part of the next legalization effort if there is one."

Such a strategy also has the potential of blunting opposition to a legalization initiative within the medical marijuana community. Some dispensary operators and medical marijuana patients were among the harshest critics of Prop 19.

Job protection for medical marijuana users is another area with the potential for coalition-building. State Sen. Mark Leno (D-San Francisco) has introduced a bill to prevent most employers from firing medical marijuana users who test positive for the drug. Perhaps unions, who, after all, represent workers, would be amenable to working on the issue.

Sentencing Reform

California's bloated prison system, with its insatiable, dollar-gobbling budgetary demands has seen some sentencing reform, most notably the passage by initiative of the "treatment not jail" Proposition 36. But the prisons remain full, and with no state money for the treatment end of Prop 36, it's only the law enforcement side of the equation that is fully functioning.

In announcing his budget proposal last month, Gov. Jerry Brown (D) including diverting people convicted "nonviolent, non-serious, non-sex offenses, and without any previous convictions for such offenses" to county jails instead of the state prison system. That includes first-time drug offenders. 

"Governor Brown set an important tone and made it clear that our expensive state prisons should be reserved for people convicted of serious offenses, not for everyone who's ever made a mistake,"  said Margaret Dooley-Sammuli, DPA deputy state director for Southern California. "California is expected to save $500 million a year by handling more petty offenses, including low-level drug possession, at the county level. We think the savings would be even greater if drug treatment were made more available in the community. Under the plan, counties would have that option."

An opportunity to save big bucks and reduce the yawning budget gap could appeal to fiscal conservatives, but in California, conservatives have a long tradition of using tough on crime politics to fill the prisons. Whether they could swallow a measure that to some degree empties them remains to be seen.

"The challenge is finding fiscally conservative Republicans who are willing to publicly challenge the drug war orthodoxy that has long been a mainstay of the Republican Party," said Gutwillig. "There are plenty of Republicans who are willing to say privately they know the mass arrests and incarceration of low-level drug offenders is not a good use of scarce resources, but they have a hard time breaking ranks with a GOP leadership that still needs inflexible tough on crime rhetoric to beat up on the substantial Democratic majorities in both houses of the legislature. It's one of their main tools to undermine the Democratic reform instinct.

Still, the continuing budget crisis may allow reformers to peel off a conservative or two, Gutwillig said. "The economics of the state are in such open-ended crisis that no one can deny the reality that we can no longer afford the blank check we perpetually give to law enforcement and the corrections system."

A 2008 sentencing reform initiative, the Nonviolent Offender Rehabilitation Act (NORA) would have deepened and vastly broadened the Prop 36 reforms, but was defeated thanks to last minute attacks by prison guards and politicians. The time could be approaching for another effort on that front, either in the legislature or via the initiative process. 

Harm Reduction

Access to clean needles, preventing not only heroin, but, increasingly, prescription opioid overdose deaths, and opening a safe injection site in San Francisco are some of the issues facing California's harm reduction community. As in other reform areas, the perpetual budget crisis means if anything is going to happen, it better be inexpensive.

"We can't do anything this year that costs money, so we have to be about erasing some of the rules and barriers that exist," said Hilary McQuie, Western director of the Harm Reduction Coalition. "Jerry Brown is pretty good on these issues, and we have a solidly Democratic government, so we should be able to get some of these things through as long as there is no fiscal impact."

Brown's predecessor, Gov. Arnold Schwarzenegger (R), wasn't so good on harm reduction issues. Last year, he failed to sign two bills that would have eased access to syringes. One expanded a pilot pharmacy syringe sales program statewide; the other expanded access to needle exchanges statewide.

"It looks like those bills will be reintroduced this year," said McQuie.

Overdose prevention continues to be a key harm reduction issue. Last year, a bill extending liability protection for the opioid antagonist naloxone to peer providers passed, but it only applies in a limited number of counties.

"We would like to see Naloxone made more easily available to people," said McQuie. "Maybe pharmacists could prescribe it along with opiates."

McQuie mentioned prescription opiates because that's where the action is now. And that means harm reductionists have to adapt their tactics to new clienteles. With prescription drug overdoses rising dramatically, programs aimed mainly at injection heroin users must now broaden their focus.

"Most of our overdose education happens through needle exchanges and other sites that reach injection drug users, but the trend in overdoses is toward prescription drugs," said McQuie. "We hope we can build coalitions with pharmacists, drug treatment people, and medical associations around peer intervention for overdose prevention among prescription drug users."

But coalition-building with drug and alcohol treatment providers means harm reductionists come up against abstinence-based advocates. "It is a long-term project for us to get them to recognize that they are serving people who are currently using rather than just addressing needs of people in treatment," McQuie sighed. "That will be really important for us. We need a bigger coalition in place."

And then there's the San Francisco safe injection site. At this point, it's little more than a gleam in the eye of harm reductionists, although the creation of such a site has been recommended first by the San Francisco HIV planning council and just last month by the mayor's Hepatitis C Task Force.

But given budgetary constraints, as well as morality-based opposition certain to emerge, if a safe injection site is going to happen, it's most likely to happen from the ground up. Vancouver, where drug users organized themselves and started their own safe injection site, could be a possible model, said McQuie.

"It's out on the horizon, and we're going to try," she said. "But nobody has the staff, resources, and willingness to risk their program sites and funding for this project. The way this could happen is if one of the agencies or drug user groups just starts doing it. It seems unlikely they would get prior permission."

Given the strain that existing harm reduction programs are under, maybe a new, expensive safe injection site program isn't the highest priority right now, McQuie. "But what this proposal does is open up a bigger conversation about harm reduction. Still, we need to set the stage for when the economy rebounds, and also to be prepared to step up and support whoever starts doing it."

California is fertile terrain for drug policy reform. It is also fiercely contested terrain. The coming years will tell whether the forces of reform can forge the alliances they need to emerge victorious on any number of fronts.

CA
United States

San Francisco 30-Member Task Force Unanimously Backs Legal Intravenous Drug Center

Location: 
San Francisco, CA
United States
A San Francisco task force charged with devising strategies for reducing Hepatitis C infections has recommended making the city the first in the U.S. with a drop-in center where intravenous drug users can obtain needles and shoot up.
Publication/Source: 
San Francisco Chronicle (CA)
URL: 
http://www.sfgate.com/cgi-bin/article.cgi?f=%2Fn%2Fa%2F2011%2F02%2F06%2Fstate%2Fn121708S00.DTL

Drug War Issues

Criminal JusticeAsset Forfeiture, Collateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Court Rulings, Drug Courts, Due Process, Felony Disenfranchisement, Incarceration, Policing (2011 Drug War Killings, 2012 Drug War Killings, 2013 Drug War Killings, 2014 Drug War Killings, Arrests, Eradication, Informants, Interdiction, Lowest Priority Policies, Police Corruption, Police Raids, Profiling, Search and Seizure, SWAT/Paramilitarization, Task Forces, Undercover Work), Probation or Parole, Prosecution, Reentry/Rehabilitation, Sentencing (Alternatives to Incarceration, Clemency and Pardon, Crack/Powder Cocaine Disparity, Death Penalty, Decriminalization, Defelonization, Drug Free Zones, Mandatory Minimums, Rockefeller Drug Laws, Sentencing Guidelines)CultureArt, Celebrities, Counter-Culture, Music, Poetry/Literature, Television, TheaterDrug UseParaphernalia, ViolenceIntersecting IssuesCollateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Violence, Border, Budgets/Taxes/Economics, Business, Civil Rights, Driving, Economics, Education (College Aid), Employment, Environment, Families, Free Speech, Gun Policy, Human Rights, Immigration, Militarization, Money Laundering, Pregnancy, Privacy (Search and Seizure, Drug Testing), Race, Religion, Science, Sports, Women's IssuesMarijuana PolicyGateway Theory, Hemp, Marijuana -- Personal Use, Marijuana Industry, Medical MarijuanaMedicineMedical Marijuana, Science of Drugs, Under-treatment of PainPublic HealthAddiction, Addiction Treatment (Science of Drugs), Drug Education, Drug Prevention, Drug-Related AIDS/HIV or Hepatitis C, Harm Reduction (Methadone & Other Opiate Maintenance, Needle Exchange, Overdose Prevention, Safe Injection Sites)Source and Transit CountriesAndean Drug War, Coca, Hashish, Mexican Drug War, Opium ProductionSpecific DrugsAlcohol, Ayahuasca, Cocaine (Crack Cocaine), Ecstasy, Heroin, Ibogaine, ketamine, Khat, Marijuana (Gateway Theory, Marijuana -- Personal Use, Medical Marijuana, Hashish), Methamphetamine, New Synthetic Drugs (Synthetic Cannabinoids, Synthetic Stimulants), Nicotine, Prescription Opiates (Fentanyl, Oxycontin), Psychedelics (LSD, Mescaline, Peyote, Salvia Divinorum)YouthGrade School, Post-Secondary School, Raves, Secondary School