Needle Exchange

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Cleveland Has Ohio's Only Legal Syringe Exchange Program

Location: 
Cleveland, OH
United States
The Free Medical Clinic of Greater Cleveland runs Ohio's only legal syringe exchange program. Cleveland first allowed syringe exchanges in 1995, when more than 17 percent of new HIV infections were associated with intravenous drug use. Last year, that number had fallen to 3.4 percent, according to the Cleveland Department of Public Health.
Publication/Source: 
The Plain Dealer (OH)
URL: 
http://www.cleveland.com/healthfit/index.ssf/2010/09/cleveland_has_ohios_only_legal.html

A Failed "War on Drugs" Prompts Rethinking on HIV Infections Among Injection Drug Users

Drug policy has focused on a policing approach of prohibition and incarceration, which has contributed to spreading HIV within the injection-drug community. Comprehensive drug reform policies are showing better results. Despite massive investments in drug law enforcement in the past three decades, with much of the international interdiction effort paid for by the U.S. government through assistance to national military and police forces, there is "a general pattern of falling drug prices and increasing drug purity" throughout the world, according to the Vienna Declaration.
Publication/Source: 
Scientific American (NY)
URL: 
http://www.scientificamerican.com/article.cfm?id=a-failed-war-on-drugs

New York Governor Signs Needle Exchange Bill

http://stopthedrugwar.org/files/used-syringes.jpg
used syringes collected by syringe exchange program -- they might have gotten discarded in public without the program
New York Gov. David Paterson (D) Saturday signed into law a bill, A08396A, that will protect needle exchange participants. Although needle exchanges are permitted in New York, some participants in such programs have been arrested for possession of needles and syringes, while others have been charged with drug possession for residues left in syringes. The new law is designed to address that conflict between public health law and penal law.

The law, also known as the Governor's Program Bill No. 23, will:
 

  • Clarify in the Penal Law that a person does not act unlawfully by possessing a hypodermic needle or syringe if he or she participates in a needle exchange or syringe access program authorized under the Public Health Law;
  • Provide that possession of a residual amount of a controlled substance on a needle or syringe does not constitute a criminal act if the individual is permitted to possess such needle or syringe under the Public Health Law; and
  • Require the Division of Criminal Justice Services to periodically notify law enforcement agencies and prosecutors about the right of individuals to possess syringes under a qualifying public health program and how to verify that a person is participating in such a program.

"The success of needle exchange and syringe access programs has been repeatedly verified to be instrumental in reducing the transmission of blood-borne diseases," Gov. Paterson said. "I proposed this legislation to prevent people from being arrested unnecessarily, thus ensuring that syringe users are not deterred from participating in these important programs."

"I want to commend Governor Paterson for signing this landmark legislation," said Sen. Thomas Duane. "By signing the syringe access legislation, Governor Paterson has once again put New York at the vanguard of a good public health policy that has proven to reduce transmission of HIV and other blood-borne diseases. Furthermore, New York's Penal law now finally conforms with its rational and compassionate health policy."

"Throwing an infected syringe into the gutter, out of fear of prosecution for possession of a trace of substance, is bad for public health and safety," said Assemblyman Richard Gottfried. "Stopping the arrest of drug users for possessing a used needle is a common sense way to protect public health and safety."

"It's important that we encourage drug injectors to utilize our public health programs without fear of arrest," said State Health Commissioner Dr. Richard Daines. "Syringe exchange programs help reduce transmission of HIV and offer access to drug treatment and other services to those most in need. We encourage injectors to return all used syringes so they are not disposed of in a way that would put others at risk."

It is a good day when, in some small way, the imperatives of public health are not sacrificed on the altar of the drug war. Saturday was a good day for New York.

Albany, NY
United States

UNODC: The Russians Are Coming

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

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

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

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

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

Feature: Drug War a Devastating Failure, Scientists and Researchers Say in Vienna Declaration

A decade ago, scientists, researchers, and AIDS activists confronted a sitting president in South Africa who denied that AIDS was caused by HIV. They responded by declaring at the 2000 Durbin AIDS conference that the evidence was in and the matter was settled. Now, with the Vienna AIDS conference coming up later this month, they are at it again -- only this time the target is the war on drugs.

http://www.stopthedrugwar.org/files/vienna2009demo1.jpg
HCLU-organized demonstration outside UN anti-drug agency, former SSDP executive director Kris Krane inside cage (drogriporter.hu/en/demonstration)
Their weapon is the Vienna Declaration, an official conference statement authored by experts from the International AIDS Society, the International Center for Science in Drug Policy, and the British Columbia Center for Excellence in HIV/AIDS. The document is a harsh indictment of the global drug war that calls for evidence-based policymaking. It demands that laws which criminalize drug users and help fuel the spread of AIDS be reformed.

The authors of the Vienna Declaration want you to sign on, too. You can do so at the web site linked to above.

"The criminalization of illicit drug users is fueling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. A full policy reorientation is needed," they said in the declaration.

Arguing there is "overwhelming evidence that drug law enforcement has failed to meet its stated objectives," the declaration lays out the consequences of the drug war:

  • HIV epidemics fueled by the criminalization of people who use illicit drugs and by prohibitions on the provision of sterile needles and opioid substitution treatment.
  • HIV outbreaks among incarcerated and institutionalized drug users as a result of punitive laws and policies and a lack of HIV prevention services in these settings.
  • The undermining of public health systems when law enforcement drives drug users away from prevention and care services and into environments where the risk of infectious disease transmission (e.g., HIV, hepatitis C & B, and tuberculosis) and other harms is increased.
  • A crisis in criminal justice systems as a result of record incarceration rates in a number of nations. This has negatively affected the social functioning of entire communities. While racial disparities in incarceration rates for drug offenses are evident in countries all over the world, the impact has been particularly severe in the US, where approximately one in nine African-American males in the age group 20 to 34 is incarcerated on any given day, primarily as a result of drug law enforcement.
  • Stigma towards people who use illicit drugs, which reinforces the political popularity of criminalizing drug users and undermines HIV prevention and other health promotion efforts.
  • Severe human rights violations, including torture, forced labor, inhuman and degrading treatment, and execution of drug offenders in a number of countries.
  • A massive illicit market worth an estimated annual value of US $320 billion. These profits remain entirely outside the control of government. They fuel crime, violence and corruption in countless urban communities and have destabilized entire countries, such as Colombia, Mexico and Afghanistan.
  • Billions of tax dollars wasted on a "War on Drugs" approach to drug control that does not achieve its stated objectives and, instead, directly or indirectly contributes to the above harms.

"Many of us in AIDS research and care confront the devastating impacts of misguided drug policies every day," said Julio Montaner, president of the International AIDS Society and director of the BC Center for Excellence in HIV/AIDS. "As scientists, we are committed to raising our collective voice to promote evidence-based approaches to illicit drug policy that start by recognizing that addiction is a medical condition, not a crime," added Montaner, who will serve as chairman of the Vienna conference.

"There is no positive spin you can put on the war on drugs," said Dr. Evan Wood, founder of the International Center for Science in Drug Policy. "You have a $320 billion illegal market, the enrichment of organized crime, violence, the spread of infectious disease. This declaration coming from the scientific community is long overdue. The community has not been meeting its ethical obligations in terms of speaking up about the harms of the war on drugs."

Stating that governments and international organizations have "ethical and legal obligations to respond to this crisis," the declaration calls on governments and international organizations, including the UN to:

  • Undertake a transparent review of the effectiveness of current drug policies.
  • Implement and evaluate a science-based public health approach to address the individual and community harms stemming from illicit drug use.
  • Decriminalize drug users, scale up evidence-based drug dependence treatment options and abolish ineffective compulsory drug treatment centers that violate the Universal Declaration of Human Rights.
  • Unequivocally endorse and scale up funding for the implementation of the comprehensive package of HIV interventions spelled out in the WHO, UNODC and UNAIDS Target Setting Guide.
  • Meaningfully involve members of the affected community in developing, monitoring and implementing services and policies that affect their lives.
  • We further call upon the UN Secretary-General, Ban Ki-moon, to urgently implement measures to ensure that the United Nations system -- including the International Narcotics Control Board -- speaks with one voice to support the decriminalization of drug users and the implementation of evidence-based approaches to drug control.

"This is a great initiative," enthused Ethan Nadelmann, executive director of the Drug Policy Alliance. "It is the most significant effort to date by the sponsors of the global AIDS conference to highlight the destructive impact of the global drug war. It is nicely coordinated with The Lancet to demonstrate legitimacy in the medical community. And it is relatively far reaching given that the declaration was drafted as a consensus statement."

"This is aimed at politicians, leaders of governments, the UN system, and it's aimed at housewives. We are trying to do basic education around the facts on this. There are still politicians who get elected vowing to crack down on drugs," said Wood. "While the declaration has a global aim and scope, at the end of the day, the person who is going to end the drug war is your average voter, who may or may not have been affected by it," he said.

"This was needed a long time ago," said Wood. "The war on drugs does not achieve its stated objectives of reducing the availability and use of drugs and is incredibly wasteful of resources in locking people up, which does little more than turn people into hardened criminals," he said.

The authors are hoping that an official declaration broadly endorsed will help begin to sway policy makers. "It will be interesting to see what kind of support it receives," said Wood. "Former Seattle Police Chief Norm Stamper has endorsed it, and we have a 2008 Nobel prize winner for medicine on the web site. There are high level endorsements, and more are coming. Whether we touch a nerve with the news media remains to be seen. I am hoping it will have a big impact since this is the official conference declaration of one of the largest public health conferences on the planet."

"We have reached a tipping point in the conversation about drugs, drug policy, drug law enforcement, and the drug war," said Stamper, now a member of Law Enforcement Against Prohibition. "More and more, science has found its way into the conversation, and this is one step to advance that in some more dramatic fashion. I've heard much from the other side that is emotional and irrational. This is one effort to create even more impetus for infusing this dialogue on drug policy with evidence-driven, research-based findings."

That the AIDS conference is being held in Vienna adds a special fillip to the declaration, Wood said. "Vienna is symbolically important because it is where the infrastructure for maintaining the global war on drugs is located," said Woods, "and also because of the problems in Eastern Europe. In Russia, it's estimated that one out of every 100 adults is infected with the AIDS virus because Russia has not embraced evidence-based approaches. Methadone maintenance therapy is illegal there, needle exchanges are severely limited, the treatment programs are not evidence-based, and there are all sorts of human rights abuses around the drug war."

With the AIDS conference set to open July 18, Wood and the other authors are hoping the momentum will keep building up to and beyond. "It is my hope that now that the Vienna Declaration is online, large numbers of people will come forward and lend their names to this effort," he said.

The Vienna Declaration is one more indication of just how badly drug war orthodoxy has wilted under the harsh gaze of science. It's hard to win an argument when the facts are against you, but as the declaration notes, there are "those with vested interests in maintaining the status quo." The declaration should make their jobs that much more difficult and bring progressive approaches to drug policy that much closer.

Press Release: Legislation Clarifying Law on Syringe Possession Heads to Gov. Paterson

Voices of Community Advocates and Leaders (VOCAL) | Drug Policy Alliance For Immediate Release: June 29, 2010 Contact: Sean Barry at (646) 373-3344 or Gabriel Sayegh at (646) 335-2264 Life-saving Legislation to Increase Access to Effective Public Health Programs Passes Legislature with Bi-partisan Support Bill Clarifies Confusion, States Clearly that People can Possess Syringes; New Law Should End Harassment by Police, Save Lives by Ensuring Clean Syringe Access and Safe Disposal Advocates Applaud Legislature, Await Governor Paterson’s Signature ALBANY -- Today, the New York State Legislature passed legislation clarifying conflict between the Penal Law and the Public Health Law. Senate Bill 5620-A (Duane) and it’s companion, Assembly Bill 8396-A (Gottfried) builds on 20 years of New York’s commitment to innovative and effective programs that have dramatically reduced the rates of HIV/AIDS and Viral Hepatitis transmission rates among people who inject drugs and their families. New York’s Public Health Law allows people that participate in Syringe Exchange Programs (SEP) and the Expanded Syringe Access Program (ESAP) – a law passed in 2000 that allowed for syringe sales for those over 18 at pharmacies without a prescription -- to possess clean syringes. However, the provision that allows for participants to possess syringes was never put into the Penal Code, which resulted in police harassment of participants, leading to a chilling effect that decreased access to clean syringes and prevented proper disposal of used ones. Since the police carry the Penal Law, and not the Public Health law, they often did not know that possession of syringes in New York was entirely legal. Thus cops would often arrest program participants, leading to a chilling effect around a syringe exchange and reducing participation. The evidence on syringe exchange programs is clear: In New York City, syringe exchange programs (SEPs) have expanded access to clean syringes, leading to a dramatic health benefits: HIV/AIDS transmissions amongst intravenous drug users dropped by 75% between 1990 and 2001. Along with access to clean syringes and safe disposal of used ones, exchanges offer HIV/AIDS and Hepatitis C testing, condoms, counseling, and referrals to drug treatment. The clarification of the law—bringing the Penal Law into accordance with the Public Health law – will lead to increased access of these life-saving programs. Hiawatha Collins, a Leader of VOCAL NY-Users Union, a membership-led union of current and former drug users who create and advocate for policies that directly impact them, knows first hand how the police harassment has decreased access to clean syringes and proper disposal of used ones. “I want to thank Assemblymember Gottfried, Senator Duane and Governor Paterson for their leadership in passing this legislation,” Collins said. “They proved their commitment to under-served and diverse communities throughout New York City and State, and relied on the clear evidence that these programs save lives and enhance the health and safety of all New Yorkers. They looked into their hearts and chose to make a commitment to saving lives.” Governor Paterson submitted the same program bill last year that would place the Public Health Law language that allowed for syringe possession into the Penal Code, permit program participants to possess syringes for proper disposal, and create oversight by the Department of Criminal Justice Services to ensure that participants stop getting harassed. The bill passed the Assembly last year and was scheduled for a Senate vote before it was stalled by Senate coup last June. Last week, the Senate passed the legislation with strong bi-partisan support. The Governor’s signature is expected shortly. “This legislation is good for communities, good for cops, and good for New York,” said Evan Goldstein, policy associate at the Drug Policy Alliance. “By clarifying the law on syringe possession, there will be less confusion by cops and communities alike about accessing syringe exchanges, which save New Yorkers tens millions of dollars in health care costs each year while increasing the health of communities. We thank Assemblyman Gottfried, Senator Duane, and Governor Paterson for their leadership on this issue, and we thank the Legislature for their continued effort to address drugs as an issue of public health and safety.”
Location: 
NY
United States

Europe: Scottish Attitudes toward Drugs, Drug Users Harsh and Getting Harsher, Annual Poll Finds

Scottish public opinion is taking a harder line toward drug use and drug users, according to the Scottish Social Attitudes Survey 2009. Support for marijuana legalization has declined by half since 2001, while attitudes toward heroin users are harsh, and support for harsh punishments is stronger than support for harm reduction measures.

The poll comes after several years of a full-blown Reefer Madness epidemic in the United Kingdom press, where sensational assertions that "cannabis causes psychosis" have gained considerably more traction than they have in the US. It also comes as Scotland confronts an intractable, seemingly permanent, population of problem heroin users and increasing calls from Conservatives to treat them more harshly.

Throughout the 1980s and 1990s, support for marijuana legalization rose in Scotland, as if did throughout the UK, reaching 37% by 2001. Last year, it was down to 24%. The decline was especially dramatic among young people, with 62% of 18-to-24-year-olds supporting legalization in 2001 and only 24% last year.

Support was down even among people who have used marijuana. In 2001, 70% supported legalization; now only 47% do. Similarly, attitudes toward pot possession also hardened among the Scots public. In 2001, 51% agreed that people should not be prosecuted for possessing small amounts for personal use. In 2009, this figure fell to just 34%.

Scots don't have much use for heroin users, either. Nearly half (45%) agreed that addicts "have only themselves to blame," while just 27% disagreed. On the obverse, only 29% agreed that most heroin users "come from difficult backgrounds," while 53% disagreed. People who are generally more liberal in their values, people who have friends or family members who have used drugs, and graduates were all more likely to have sympathetic views toward heroin users.

Fewer than half (47%) would be comfortable working around someone who had used heroin in the past, while one in five would be uncomfortable doing so. Similarly, just 26% said they would be comfortable with someone in treatment for heroin living near them, while 49% said they would not be. Only 16% think heroin use should be decriminalized.

When it comes to policy toward heroin use, Scots were split: 32% wanted tougher penalties, 32% wanted "more help for people who want to stop using heroin," and 28% wanted more drug education. And four out of five (80%) agreed that "the only real way of helping drug addicts is to get them to stop using drugs altogether."

Those tough attitudes are reflected in declining support for needle exchanges, the survey's sole measure of support for harm reduction approaches. In 2001, 62% supported needle exchanges; now only 50% do.

It looks like Scottish harm reductionists and drug reformers have their work cut out for them.

Syringe Exchange Victory Celebration

After 21 years, Congress finally removed language prohibiting the use of federal dollars to fund syringe exchange services. The Coalition is hosting this bipartisan celebration to recognize leaders in Congress, to honor community advocates, and to remind everyone that there is still work to be done to ensure these lifesaving services are fully implemented. Confirmed honorees and members of congress attending: • Representative José Serrano (NY) • Representative Barbara Lee (CA) • Representative Ileana Ros-Lehtinen (FL) • Dave Purchase, The North American Syringe Exchange Network • The Harm Reduction Coalition The celebration will be held following a noon rally for World Hepatitis Day. Hors D’oeuvres will be served Please RSVP to gsmith@drugpolicy.org.
Date: 
Wed, 05/19/2010 - 4:00pm - 7:00pm
Location: 
E Capitol St NE & 1st St NE, Room HC-5
Washington, DC 20001
United States

Feature: Obama's First National Drug Strategy -- The Good, the Bad, and the Ugly

A leaked draft of the overdue 2010 National Drug Strategy was published by Newsweek over the weekend, and it reveals some positive shifts away from Bush-era drug policy paradigms and toward more progressive and pragmatic approaches. But there is a lot of continuity as well, and despite the Obama administration's rhetorical shift away from the "war on drugs," the drug war juggernaut is still rolling along.

http://stopthedrugwar.org/files/wasitwalters.jpg
sign of the leaker?
That doesn't quite jibe with Office of National Drug Control Policy (ONDCP -- the drug czar's office) director Gil Kerlikowske's words when he announced in April 2009 that the phrase "war on drugs" was no longer in favor. "Regardless of how you try to explain to people it's a 'war on drugs' or a 'war on a product,' people see a war as a war on them. We're not at war with people in this country."

The leak was reported by long-time Washington insider and Newsweek columnist Michael Isikoff, who mentioned it almost off-handedly in a piece asserting "The White House Drug Czar's Diminished Status." Isikoff asserted in the piece that the unveiling of the strategy had been delayed because Kerlikowske didn't have the clout to get President Obama to schedule a joint appearance to release it. His office had been downgraded from cabinet level, Isikoff noted.

That sparked an angry retort from UCLA professor Mark Kleiman, a burr under the saddle to prohibitionists and anti-prohibitionists alike for his heterodox views on drug policy. In a blog post, Kleiman seemed personally offended at the leak, twice referring to the leaker as "a jerk," defending the new drug strategy as innovative if bound by interagency politics, and deriding Isikoff's article as "gossipy."

Kleiman also suggested strongly that the leaker was none other than former John Walters on the basis of an editing mark on the document that had his name on it. But Walters has not confirmed that, and others have point out it could have been a current staffer who is using the same computer Walters used while in office.

On the plus side, the draft strategy embraces some harm reduction programs, such as needle exchanges and the use of naloxone to prevent overdoses, although without ever uttering the words "harm reduction." There is also a renewed emphasis on prevention and treatment, with slight spending increases. But again reality fails to live up to rhetoric, with overall federal drug control spending maintaining the long-lived 2:1 ration in spending for law enforcement, eradication, and interdiction versus that for treatment and prevention.

The strategy also promotes alternatives to incarceration, such drug courts, community courts and the like and for the first time hints that it recognizes the harms that can be caused by the punitive approach to drug policy. And it explicitly calls for reform of the sentencing disparity for crack and powder cocaine offenses.

It sets a number of measurable goals related to reducing drug use. By 2015, ONDCP vows to cut last month drug use by young adults by 10% and cut last month use by teens, lifetime use by 8th graders, and the number of chronic drug users by 15%.

The 2010 goals of a 15% reduction reflect diminishing expectations after years of more ambitious drug use reduction goals followed by the drug policy establishment's inability to achieve them. That could inoculate the Obama administration from the kind of criticism faced by the Clinton administration back in the 1990s when it did set much more ambitious goals.

The Clinton administration's 1998 National Drug Control Strategy called for a "ten-year conceptual framework to reduce drug use and drug availability by 50%." That didn't happen. That strategy put the number of drug users at 13.5 million, but instead of decreasing, according to the 2008 National Household Survey on Drug Abuse and Health, by 2007 the number of drug users was at 20.1 million.

While Clinton took criticism from Republicans that his goals were not ambitious enough -- Newt Gingrich said we should just wipe out drugs -- the Bush administration set similar goals, and achieved similarly modest results. The Bush administration's 2002 National Drug Control Strategy sought a 25% reduction in drug use by both teenagers and adults within five years. While teen drug use declined from 11.6% in 2002 to 9.3% in 2007, then drug czar Walters missed his goal. He did less well with adult use almost unchanged, at 6.3% in 2000 and 5.9% in 2007.

The draft strategy, however, remains wedded to law enforcement, eradication, and interdiction, calls for strong federal support for local drug task forces, and explicitly rejects marijuana legalization. It also seeks to make drugged driving a top priority, which would be especially problematic if the administration adopts per se zero tolerance measures (meaning the presence of any metabolites of a controlled substance could result in a driver's arrest whether he was actually impaired or not).

Still, while the draft strategy is definitely a mixed bag, a pair of keen observers of ONDCP and federal drug policy pronounced themselves fairly pleased overall. While still heavy on the law enforcement side, the first Obama national drug strategy is a far cry from the propaganda-driven documents of Bush era drug czar John Walters.

The Good

"This is somewhat of a surprise, because for the first time they have included reducing the funds associated with the drug war in their strategy, although not in a big way, they're calling for reform of the crack/powder cocaine sentencing disparity, and they are calling for the reform of laws that penalize people," said Bill Piper, national affairs director for the Drug Policy Alliance. "This is the first time they've included anything recognizing that some of our policies are creating harm," he added.

"The stuff about syringe exchange and naloxone for overdose prevention is pretty good. It's the first time they've embraced any part of harm reduction, even though they don't use that name," Piper noted.

"I'm also impressed with the section on alternatives to incarceration," said Piper. "They basically said most drug users don't belong in jail, and a lot of dealers don't, either. It's still wedded to the criminal justice system, but it's good that they looked at so many different things -- drug courts, community courts, Operation Highpoint (warning dealers to desist instead of just arresting them as a means of breaking up open-air drug markets), programs for veterans. They seem interested in finding out what works, which is an evidence-based approach that had been lacking in previous strategies."

The Status Quo

"Drug war reformers have eagerly been waiting the release of President Obama's first National Drug Control Strategy," noted Matthew Robinson, professor of Government and Justice Studies at Appalachian State University and coauthor (with Renee Scherlen) of "Lies, Damned Lies, and Drug War Statistics: A Critical Analysis of Claims Made by the ONDCP." "Would it put Obama's and Kerlikowske's words into action, or would it be more of the same in terms of federal drug control policy? The answer is yes. And no. There is real, meaningful, exciting change proposed in the 2010 Strategy. But there's a lot of the status quo, too," he said.

"The first sentence of the Strategy hints at status quo approaches to federal drug control policy; it announces 'a blueprint for reducing illicit drug use and its harmful consequences in America,'" Robinson said. "That ONDCP will still focus on drug use (as opposed to abuse) is unfortunate, for the fact remains that most drug use is normal, recreational, pro-social, and even beneficial to users; it does not usually lead to bad outcomes for users, including abuse or addiction," he said.

"Just like under the leadership of Director John Walters, Kerlikowske's ONDCP characterizes its drug control approaches as 'balanced,' yet FY 2011 federal drug control spending is still imbalanced in favor of supply side measures (64%), while the demand side measures of treatment and prevention will only receive 36% of the budget," Robinson pointed out. "In FY 2010, the percentages were 65% and 35%, respectively. Perhaps when Barack Obama said 'Change we can believe in,' what he really meant was 'Change you can believe in, one percentage point at a time.'"

There is also much of the status quo in funding levels, Robinson said. "There will also be plenty of drug war funding left in this 'non-war on drugs.' For example, FY 2011 federal drug control spending includes $3.8 billion for the Department of Homeland Security (which includes Customs and Border Protection spending), more than $3.4 billion for the Department of Justice (which includes Drug Enforcement Agency spending), and nearly $1.6 billion for the Department of Defense (which includes military spending). Thus, the drug war will continue on under President Obama even if White House officials do not refer to federal drug control policy as a 'war on drugs,'" he noted.

The Bad

"ONDCP repeatedly stresses the importance of reducing supply of drugs into the United States through crop eradication and interdiction efforts, international collaboration, disruption of drug smuggling organizations, and so forth," Robinson noted. "It still promotes efforts like Plan Colombia, the Southwest Border Counternarcotics Strategy, and many other similar programs aimed at eradicating drugs in foreign countries and preventing them from entering the United States. The bottom line here is that the 'non war on drugs' will still look and feel like a war on drugs under President Obama, especially to citizens of the foreign nations where the United States does the bulk of its drug war fighting."

"They are still wedded to interdiction and eradication," said Piper. "There is no recognition that they aren't very effective and do more harm than good. Coming only a couple of weeks after the drug czar testified under oath that eradication in Colombia and Afghanistan and elsewhere had no impact on the availability of drugs in the US, to then put out a strategy embracing what he said was least effective is quite disturbing."

"The ringing endorsement of per se standards for drugged driving is potentially troubling," said Piper. "It looks a lot like zero tolerance. We have to look at this also in the context of new performance measures, which are missing from the draft. In the introduction, they talk about setting goals for reducing drug use and that they went to set other performance measures, such as for reducing drug overdoses and drugged driving. If they actually say they're going to reduce drugged driving by such and such an amount with a certain number of years, that will be more important. We'll have to see what makes it into the final draft."

"They took a gratuitous shot at marijuana reform," Piper noted. "It was unfortunate they felt the need to bash something that half of Americans support and to do it in the way they did, listing a litany of Reefer Madness allegations and connecting marijuana to virtually every problem in America. That was really unfortunate."

More Good

There are some changes in spending priorities. "Spending on prevention will grow 13.4% from FY 2010 to FY 2011, while spending on treatment will grow 3.7%," Robinson noted. "The growth in treatment is surprisingly small given that ONDCP notes that 90% of people who need treatment do not receive it. Increases are much smaller for spending on interdiction (an increase of 2.4%), domestic law enforcement (an increase of 1.9%), and international spending (an increase of 0.9%). This is evidence of a shift in federal drug control strategy under President Obama; there will be a greater effort to prevent drug use in the first place as well as treat those that become addicted to drugs than there ever was under President Bush."

Robinson also lauded the Obama administration for more clarity in the strategy than was evident under either Clinton or Bush. "Obama's first Strategy clearly states its guiding principles, each of which is followed by a specific set of actions to be initiated and implemented over time to achieve goals and objectives related to its principles. Of course, this is Obama's first Strategy, so in subsequent years, there will be more data presented for evaluation purposes, and it should become easier to decipher the ideology that will drive the 'non war on drugs' under President Obama," he said.

But he suggested that ideology still plays too big a role. "ONDCP hints at its ideology when it claims that programs such as 'interdiction, anti-trafficking initiatives, drug crop reduction, intelligence sharing and partner nation capacity building... have proven effective in the past.' It offers almost no evidence that this is the case other than some very limited, short-term data on potential cocaine production in Colombia. ONDCP claims it is declining, yet only offers data from 2007 to 2008. Kerlikowske's ONDCP seems ready to accept the dominant drug war ideology of Walters that supply side measures work -- even when long-term data show they do not."

Robinson also lauded ONDCP's apparent revelation that drug addiction is a disease. "Obama's first strategy embraces a new approach to achieving federal drug control goals of 'reducing illicit drug consumption' and 'reducing the consequences of illicit drug use in the United States,' one that is evidence-based and public health oriented," Robinson said. "ONDCP recognizes that drug addiction is a disease and it specifies that federal drug control policy should be assisted by parties in all of the systems that relate to drug use and abuse, including families, schools, communities, faith-based organizations, the medical profession, and so forth. This is certainly a change from the Bush Administration, which repeatedly characterized drug use as a moral or personal failing."

While the Obama drug strategy may have its faults, said Robinson, it is a qualitative improvement over Bush era drug strategies. "Under the Bush Administration, ONDCP came across as downright dismissive of data, evidence, and science, unless it was used to generate fear and increased punitive responses to drug-related behaviors. Honestly, there is very little of this in Obama's first strategy, aside from the usual drugs produce crime, disorder, family disruption, illness, addiction, death, and terrorism argument that has for so long been employed by ONDCP," he said. "Instead, the Strategy is hopeful in tone and lays out dozens of concrete programs and policies that aim to prevent drug use among young people (through public education programs, mentoring initiatives, increasing collaboration between public health and safety organizations); treat adults who have developed drug abuse and addiction problems (though screening and intervention by medical personnel, increased investments in addiction treatment, new treatment medications); and, for the first time, invest heavily in recovery efforts that are restorative in nature and aimed at giving addicts a new lease on life," he noted.

"ONDCP also seems to suddenly have a better grasp on why the vast majority of people who need treatment do not get it," said Robinson. "Under Walters, ONDCP claimed that drug users were in denial and needed to be compassionately coerced to seek treatment. In the 2010 Strategy, ONDCP outlines numerous problems with delivery of treatment services including problems with the nation's health care systems generally. The 2010 Strategy seems so much better informed about the realities of drug treatment than previous Strategy reports," he added.

"The strategy also repeatedly calls for meaningful change in areas such as alternatives to incarceration for nonviolent, low-level drug offenders; drug testing in courts (and schools, unfortunately, in spite of data showing it is ineffective); and reentry programs for inmates who need help finding jobs and places to live upon release from prison or jail. ONDCP also implicitly acknowledges that that federal drug control policy imposes costs on families (including the break-up of families), and shows with real data that costs are greater economically for imprisonment of mothers and foster care for their children than family-based treatment," Robinson noted.

"ONDCP makes the case that we are wasting a lot of money dealing with the consequences of drug use and abuse when this money would be better spent preventing use and abuse in the first place. Drug policy reformers will embrace this claim," Robinson predicted.

"The strategy also calls for a renewed emphasis on prescription drug abuse, which it calls 'the fastest growing drug problem in the United States,'" Robinson pointed out. "Here, as in the past, ONDCP suggests regulation is the answer because prescription drugs have legitimate uses that should not be restricted merely because some people use them illegally. And, as in the past, ONDCP does not consider this approach for marijuana, which also has legitimate medicinal users in spite of the fact that some people use it illegally," he said.

The Verdict

"President Obama's first National Drug Control Strategy offers real, meaningful, exciting change," Robinson summed up. "Whether this change amounts to 'change we can believe in' will be debated by drug policy reformers. For those who support demand side measures, many will embrace the 2010 Strategy and call for even greater funding for prevention and treatment. For those who support harm reduction measures such as needled exchange, methadone maintenance and so forth, there will be celebration. Yet, for those who support real alternatives to federal drug control policy such as legalization or decriminalization, all will be disappointed. And even if Obama officials will not refer to its drug control policies as a 'war on drugs,' they still amount to just that."

Feature: First Drug User Union Forms in San Francisco

Thanks to the on-the-ground efforts of local harm reductionists and the funding largesse of the Drug Policy Alliance, San Francisco is now the home of only the second drug user union in the United States. The nascent effort is just getting off the ground, but plans to follow in the footsteps of Canada's Vancouver Area Network of Drug Users (VANDU) and the New York City VOCAL drug user union affiliated with the NYC Aids Housing Network.

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While self-identified drug user unions are rare in the US, they have a history dating back to the Dutch "junkiebund" of the 1970s. The movement is currently spreading internationally, with affiliates of the International Network of People Who Use Drugs (INPUD) operating in Europe, North America, South America, and Asia. And while medical marijuana patients did not refer to themselves as drug users, they have done similar organizing based on their use of the weed.

"We gave a $35,000 grant to the Harm Reduction Therapy Center to organize drug users in San Francisco, said Laura Thomas, DPA California state deputy director. "It is an annual grant, and future funding depends on HRTC re-applying for the funds. We have funded VOCAL in New York for several years."

DPA sees drug user groups as a key component in efforts to reduce the harms of both drug use and prohibitionist drug policies, said Thomas. "We hope that drug users in San Francisco will have a voice in policy decisions that affect them," she said. "We hope that they will become an active and organized part of efforts to reduce the harm related to both drugs and the war on drugs in San Francisco. The group is still in the process of forming and determining what their priority issues are, so I can't speak for what they are going to be working on."

"While we haven't quite chosen our main campaign, we've been talking about what we would ideally like San Francisco to look like, about having a safe place to inject, and about having a safe place to consume other drugs, too," said Alexandra Goldman, the organizer for the group. "Within a couple of months, we will choose our first official campaign," she vowed.

"We are also interested in working to decrease the stigma, both within and outside the drug using community," Goldman added. "We're trying to work with health care providers to make it a more positive experience. Our people tend to wait until they are very seriously ill because they are not treated very well. In our meetings, I'm hearing about how people don't get the prescribed pain medications they need because the doctors don't like them."

The group has already been active, joining in protests against the city's proposed ordinance barring people from sitting or lying on public sidewalks. Homeless people in neighborhoods like Haight-Asbury have roused the ire of business owners with their presence, but activists say they have no place to go and should not be criminalized.

The SF Drug User Union participation in the sit/lie protests makes sense given that many of its members are homeless and that its meetings are generally being held in homeless drop-in centers in the Tenderloin and the Mission. The group boasts about 25 members, with an emerging core group of 10 or 12, but is looking to expand by working with lower income communities and people involved in local harm reduction networks.

"We plan to be active consumers, giving our opinions and our voice on issues and policies that affect us," said Isaac Jackson, the other paid staffer for the union. "People are already asking us for our expertise."

So who can join the union? Anyone who identifies as a drug user, past or present, organizers said. Defining members in that manner allows people to get active without necessarily outing themselves as current users.

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"There is no piss test to get into this group," said Jackson. "We have heroin users, speed users, people who drink, pot smokers. Some people think pot's not a big issue, but anyone who wants to work with us, we say 'right on.' We support the legalization campaign and we support medical marijuana. That's a success story, and so is needle exchange, and we'll be trying to learn from those."

The only rule at meetings is no drug dealing, said Jackson. "We don't want people to deal drugs at the meeting or endanger other people in the group by that kind of activity, but if people are carrying, so what? Some people have showed up tweaking. We don't want to say they can't come because they're too high. We want people to feel welcome whatever their level of sobriety."

Forming a drug user union in San Francisco has been an idea that's been batted around for at least a couple of years, but it took some cold, hard cash to make it happen. "There were some attempts to organize drug users in the past, and I was involved in those, but they didn't stick because people had other jobs," said Goldman. "But once that Drug Policy Alliance grant came in, I got hired in November and we had our first meetings in February."

"I worked at a small health agency working with homeless people with substance use here in the Tenderloin, and was also working with some people with the Youth Homeless Alliance in the Haight," said Jackson. "A lot of people said we ought to do something like VANDU. We had a conference here a couple of years ago to try to jump-start a safe injection site, but that was mostly health care providers, not drug users."

San Francisco has one of the highest rates of drug use per capita in the country, Jackson noted. "Since there is so much civil disobedience going on already -- the laws are wrong, when you have thousands of people doing something for a long period of time, it's like passive civil disobedience -- there was an opportunity there to give drug users a voice in a more organized way. We're consumers of all these services -- treatment, law enforcement, the whole drug industrial complex -- we're consumers and have no voice. The time was right for it to start here."

San Francisco organizers took advantage of last fall's DPA conference to learn from existing drug user groups on the continent. "I met with Ann Livingston from VANDU and I got in touch with some of the folks from VOCAL," Goldman said. "They work on stuff around syringe exchange, trying to pass statewide ordinances to keep police from hassling people with needles, things like that. And, of course, they're subject to the same ridiculous drug laws we are."

"Drug user groups such as VOCAL in New York, VANDU in Vancouver, and hopefully this group in San Francisco play an important role in drug policy change and ending the war on drugs," Thomas said. "Drug users are usually the people most directly affected by bad drug policies, and the least likely to have a voice in debates. Drug users as active participants in the political process also helps reduce the stigma that is attached to drug use and makes people reconsider their prejudices about what they think 'drug users' are like. The drug policy reform conversation can only benefit from the active participation of drug user groups."

Separate drug user union meetings are taking place every three weeks in the Tenderloin and Mission districts. For more information about joining the union, send an email to sf.users.union@gmail.com.

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