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Feature: Effort to Bring Safe Injection Facility to New York City Getting Underway

Last Friday, more than 150 people gathered at John Jay College of Criminal Justice in New York City for a daylong conference on the science, politics, and law of safe injection facilities (SIFs) as part of a budding movement to bring the effective but controversial harm reduction measure to the Big Apple. Sponsored, among others, by the college, the Harm Reduction Coalition, and an amalgam of 17 different New York City needle exchange and harm reduction programs known as the Injection Drug User Health Alliance (IDUHA), the conference targeted not only harm reductionists but public health advocates and officials, law enforcement, service providers, and the general public.

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John Jay College, NYC (courtesy wikipedia.org)
The Safe Injection Facilities in New York conference aimed to create public awareness of SIFs, provide evidence that they are cost-effective, and start developing a plan for implementing SIFS in New York. As the conference program indicates, organizers relied heavily on experts from Vancouver, where the Downtown Eastside Insite SIF has been in operation -- and under evaluation -- since 2003, to provide the evidence base.

The first SIFs opened in Switzerland in the mid-1980s. Since then, they have spread slowly and there are now 65 SIFS operating in 27 cities in eight countries: Switzerland, Germany, the Netherlands, Spain, Australia, Norway, Luxembourg, and Canada. Although advocates have been working for the past year-and-a-half to bring an SIF to San Francisco, that effort has yet to bear fruit.

SIFS are credited with saving lives through overdose prevention, reducing the spread of blood-borne disease, reducing public drug use and attendant drug litter, and creating entryways to treatment and other services for hard-core drug users not ready to abstain. The results reported by the Vancouver delegation on Insite were typical:

  • No fatal overdoses at the SIF.
  • No increase in local drug trafficking.
  • No substantial increase in the rate of relapse into injection drug use.
  • Reductions in public drug use, publicly discarded syringes and syringe sharing.
  • SIF users 1.7 times more likely to enter detox programs.
  • More than 2,000 referrals to counseling and other support services since opening.
  • Collaboration with police to meet public health and public order objectives.

But despite such research results, the United States remains without an operating SIF. The obstacles range from the legal, such as the federal crack house law and its counterparts in many states, to the political and the moral. But for harm reduction and public health advocates, it is the failure to embrace such proven life-saving measures that has the stench of the immoral.

"The reality is that we have people shooting up in unsafe injection facilities as we speak," said Joyce Rivera, executive director of St. Ann's Corner of Harm Reduction and chair of the conference. "The reality is they are not shooting up in a safe, hygienic environment with the possibility of a transition into a range of care. That's what's not happening. As public health advocates, we are saying let's recognize that reality and create those safe facilities. Let these people enter through the portal of public health into a safe environment and start to pace their own change," she said.

"We have to acknowledge the social fact that people are shooting up in unsafe venues," Rivera said. "It's not some esoteric or academic argument. The question is what do we do about it? Public health is supposed to protect the community, and SIFs are a necessary evolution in our public health policy."

"The big issue here is that we know we have about 200,000 injection drug users in the city, and the needle exchange programs only serve a few thousand of them," said Robert Childs of Positive Health Project, one of the members of the IDUAH. "Most of them are getting needles from unregulated needle exchanges, shooting galleries, from friends. That is a large part of why New York City has the most HIV and Hepatitis C cases in the US and one of the highest rates of infection in North America," he said.

"The other big issue is that we're giving injectors the tools to inject, but not a safe space to do it," Childs pointed out. "Many shoot up in the public domain, in the bathrooms at Starbucks or McDonalds or White Castle, in libraries, parks, alleys, phone booths. They leave their syringes in locations that aren't evident to a non-injector, and that's a public health issue."

They also overdose. Drug overdose is the fourth leading cause of death in the city. While it is a tragedy for the victim, overdoses both lethal and non-lethal are also a burden to the city. "Taxpayers have to pay these costs," said Childs. "For an ambulance to respond to an overdose costs between $400 and $1,200, and that's going on many times a day every day."

It's not just ambulances. Failing to address injection drug use under prohibition conditions costs real dollars in other ways as well. Each new diagnosis of HIV in the city comes with a $648,000 price tag for life-long medications and medical care, and even that may be on a low end estimate. A case of hepatitis C often requires $280,000 to $380,000 for a liver transplant; for those cases that do not warrant a liver transplant, treatment costs anywhere from $60,000 to $100,000.

And it's not just taxpayers paying. According to Childs, local businesses, including service providers, spend thousands of dollars a year on plumbing repairs -- from needles disposed of in toilets for lack of biohazard containers.

Now, said advocates, it is time to move forward. The conference was but the opening shot in what will likely be a long and frustrating campaign.

"The conference went very well and it will be a bit of a lift," said John Jay Professor Richard Curtis, who addressed the topic of moving forward from here at the conference. "The evidence is piling up from Sydney and Vancouver and Europe, and that is helping us, too. But this isn't something the health departments and the politicians aren't quickly going to jump on the bandwagon for. We have to give them a push, and if we don't start working on it now, it'll never happen. We didn't get where we are today by behaving ourselves," he added, relating how his own needle exchange effort first faced official opposition before being accepted.

The audience included people from the city and state health departments, Curtis said. "The health officials are all very supportive... unofficially," he said. "They didn't want to be on the agenda, but they say they're supportive. But this is an election year, and that makes it hard for them."

There will be an organizing meeting in two weeks to map out strategy, Curtis said. "We'll see who is willing and able, whether there is an existing agency bold enough to forge ahead or whether we will have to create some alternative organizations. We want to put this issue on the table now."

"We're forming an action group to bring this into New Yorkers' consciousness," said Childs. "The people who do know about -- drug users -- are one of the most stigmatized populations in the city. We are going to a campaign similar to Vancouver about how these people are not bogeymen, but our sons and daughters. We're also trying to organize some media events around it. A group of lawyers will help by challenging some codes. And we'll be trying to work with our legislators and city councilors," he said.

But Curtis and others are not willing to wait forever. "I'm not hopeful that federal crack house laws will end any time soon," he said. "But we started needle exchanges by just doing it. If it has to come to that, we'll have to make them arrest us again. We need to back them into a corner at the very least."

Harm Reduction Coalition Western Coordinator Hilary McQuie has been involved in the ongoing SIF effort in San Francisco. Just because something isn't happening officially doesn't mean it isn't happening, she noted.

"I don't know much about shooting galleries in New York," she said, "but out here, it's no big secret that the bathrooms of service providers, drop-in centers, homeless shelters, soup kitchens are used for shooting up. What people are doing to try to make these current injection spaces safer is perhaps having safe injection instructions, syringe disposal devices, soap and water, things like that," she said. "Also, it's sort of semi-supervised. If someone's in the bathroom and doesn't come out, you can open the door and save them from an overdose. That happens every day in San Francisco."

Obama Claims to Support Needle Exchange, While Telling Congress to Ban it

Can someone please explain to me what this means?


White House spokesman Ben LaBolt said the administration isn't yet ready to lift the ban - but Obama still supports needle exchange.

"We have not removed the ban in our budget proposal because we want to work with Congress and the American public to build support for this change," he said. "We are committed to doing this as part of a National HIV/AIDS strategy and are confident that we can build support for these scientifically-based programs." [Huffington Post]

So they're going to build support for needle exchange by telling Congress to continue the federal needle exchange ban? How's that supposed to work? And what's up with this:
The White House website no longer features the president's support of the program, however. See the before and after here.

"It's hard to imagine how removing mention of support for a proven lifesaving program from the White House website is part of a grand strategy to 'build support' for syringe exchange," said Tom Angell, a spokesman for the group Law Enforcement Against Prohibition.

Exactly. If Obama wants to promote needle exchange, he should consider not making it illegal for the government to support needle exchange.

The administration is arguing that supporting the ban at this time is necessary to avoid politicizing the budget process, yet opposing needle exchange is just as political as supporting it. You're taking a political stance either way, obviously. The only difference is that Obama is choosing the wrong side and lending legitimacy to crazy idiots who oppose needle exchange.

Obama No Longer Supports Needle Exchange Programs That Reduce AIDS

On the campaign trail, Obama made clear statements in support of needle exchange as a proven means of reducing transmission of AIDS and other diseases among drug users. Once in office, the President reiterated his commitment to ending the federal blockade against these life-saving programs:

The President also supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users.

That language appeared on the President's own website, until it was ominously removed a couple weeks ago. Today, the President's Budget (pg. 795) formally announces Obama's decision to continue the federal needle exchange ban:

"Notwithstanding any other provision of this Act, no funds appropriated in this Act shall be used to carry out any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug."

With that one sentence, Obama blatantly violates an important campaign promise and chooses politics over science with thousands of lives on the line. It's just disgraceful, and if he thought no one would notice, he was wrong.  

This isn't a matter of Obama not understanding the issue. He's already said that needle exchange would "dramatically reduce rates of infection among drug users," so it should be unnecessary to further debate that point or dig any deeper into the towering mountain of evidence surrounding the efficacy of needle exchange programs.

Apparently, the President simply isn't willing to spend political capital saving the lives of drug users. If this is all about politics, and I believe it is, then the question that must be asked is why the hell the President thinks needle exchange is a political liability. When Jim Ramstad's name was circulating as potential nominee for drug czar, his opposition to needle exchange was a big factor in sinking his candidacy. Moreover, the newly appointed drug czar, Gil Kerlikowske, is known for supporting needle exchange during his tenure as Seattle Police Chief. Maybe Obama should talk to his new drug czar before resurrecting the Bush Administration's failed and fatal policy of opposing harm reduction.

There is simply no serious or credible opposition to implementing proven life-saving programs in the fight against AIDS. Obama's previous statements in support of such programs provoked zero backlash on the campaign trail and obviously didn’t prevent him from becoming President. All he had to do was leave this stupid language out of the budget -- like he said he would -- and no one would even have noticed.

Instead, we're forced to come to terms with the reality that our President is willing to sacrifice human lives based on an ill-conceived perception of political convenience and nothing more.

Please contact the White House to demand that Obama keep his promise to support needle exchange and save lives.

Feature: Meeting in Vienna, UN Commission on Narcotics Drugs Prepares to Head Further Down Same Prohibitionist Path, But Dissenting Voices Grow Louder

The United Nations Commission on Narcotic Drugs (CND) met this week in Vienna to draft a political statement and plan of action to guide international drug policy for the next decade. The statement largely affirms existing prohibitionist policies and ignores harm reduction, as the CND has done it the past. [Editor's note: The draft statement had not been formally approved as of press time, but is likely to be approved as is.]

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Vienna International Center, home of the UN Office on Drugs and Crime
The political statement is supposed to evaluate the implementation of the previous political declaration and action plan approved by the UN General Assembly Special Session (UNGASS) in 1998. At the 1998 session, UNGASS adopted the slogan "A Drug-Free World -- We Can Do It" and launched a "campaign" to wipe out all drug crops -- from marijuana to opium to coca -- by 2008.

But while the international community continues to slide down its century-old prohibitionist path regarding non-medicinal drug use and sales, it is encountering an increasing amount of friction. The United States, as leader of the hard-liners, continues to dominate the debates and set the agenda, but an emerging bloc of mainly Latin American and European countries is expressing deep reservations about continuing the same policies for another decade.

The atmosphere in Vienna this week was circus like, complete with street protests, as national delegations, non-governmental organizations (NGOs), and other interested parties heatedly debated what an increasingly vociferous minority called a "failed" approach to the issue. Debate was particularly intense about the inclusion of harm reduction in the political statement -- a position rejected by the US delegation, led by outgoing acting drug czar Edward Jurith.

The drug summit came as the UN, the CND, and the countries pushing the prohibitionist hard-line have come under repeated attack for essentially maintaining the status quo. On Tuesday, the European Commission issued a report that found while in the past decade policies to help drug users and go after drug traffickers have matured, there was little evidence to suggest that the global drug situation had improved.

"Broadly speaking the situation has improved a little in some of the richer countries, while for others it worsened, and for some of those it worsened sharply and substantially, among which are a few large developing or transitional countries," an EC media statement on the report said. "In other words, the world drugs problem seems to be more or less in the same state as in 1998: if anything, the situation has become more complex: prices for drugs in most Western countries have fallen since 1998 by as much as 10% to 30%, despite tougher sentencing of the sellers of e.g. cocaine and heroin in some of these markets."

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SSDP's Kris Krane, caged as part of HCLU demonstration at UN (drogriporter.hu/en/demonstration)
Current anti-drug policies also came under attack from a growing coalition of NGOs, including Human Rights Watch, the International Harm Reduction Association, the European NGO Coalition for Just and Effective Drug Policies (ENCOD), and the International Drug Policy Consortium, as well as various NGOs from the US, Brazil, Canada, and England, among others, all of whom were in Vienna for the meeting. Human Rights Watch urged the CND to undo a decade of neglect, while the English group Transform Drug Policy Foundation called for a moratorium on global strategic drug policy setting, a review of the consequences of prohibitionist policies, and a commission to explore alternatives to the failed war on drugs.

"Every state that signs up to the political declaration at this commission recommits the UN to complicity in fighting a catastrophic war on drugs," said Danny Kushlick, policy director for Transform. "It is a tragic irony that the UN, so often renowned for peacekeeping, is being used to fight a war that brings untold misery to some of the most marginalized people on earth. 8,000 deaths in Mexico in recent years, the destabilization of Colombia and Afghanistan, continued corruption and instability in the Caribbean and West Africa are testament to the catastrophic impact of a drug control system based upon global prohibition. It is no surprise that the declaration is unlikely even to mention harm reduction, as it runs counter to the primary impact of the prevailing drug control system which, as the past ten years demonstrate, increases harm."

Not all the action took place in the conference hall. Wednesday saw a lively demonstration by NGO groups including Students for Sensible Drug Policy, the drug user group INPUD, ENCOD, and the Hungarian Civil Liberties Union, among others. Protestors spoke to reporters from jail-like cages, waved signs and passed out pamphlets to delegates forced to run their gauntlet, and decried the harms of drug prohibition. One particularly effective protestor was dressed as a sun-glass wearing, cigar-puffing Mafioso, celebrating that business was good thanks to prohibition.

Even UN Office on Drugs and Crime (UNODC) head Antonio Maria Costa, while whistling past the graveyard to insist that progress had been made in the past decade, acknowledged that current global policies have backfired in some ways. Giving the opening address Wednesday, Costa said "the world drug problem has been contained, but not solved" thanks to international anti-drug efforts.

But global drug control efforts have had "a dramatic unintended consequence," he added, "a criminal black market of staggering proportions." The international drug trade is "undermining security and development and causing some to make a dangerous wager in favor of legalization. Drugs are not harmful because they are controlled; they are controlled because they are harmful." Drug legalization would be "a historic mistake," he said.

Even so, Costa painted a dire picture of what prohibition had wrought: "When mafias can buy elections, candidates, political parties, in a word, power, the consequences can only be highly destabilizing" he said. "While ghettoes burn, West Africa is under attack, drug cartels threaten Central America and drug money penetrates bankrupt financial institutions".

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activists from International Network of People Who Use Drugs (INPUD) at demo (drogriporter.hu/en/demonstration)
Not everybody was buying into the UNODC-CND-US position of more of the same. Bolivian President Evo Morales brandished a coca leaf, then chewed it during his address to the delegates to underline his demand that coca be removed from the list of proscribed substances.

"This is coca leaf, this is not cocaine; this is part and parcel of a culture," Morales said. The ban on coca was a "major historical mistake," he added. "It has no harmful impact, no harmful impact at all in its natural state. It causes no mental disturbances, it does not make people run mad, as some would have us believe, and it does not cause addiction."

Neighboring Brazil was also critical. "We ought to recognize the important progress achieved over the last decade," said Brazilian delegate Jorge Armando Felix. "But the achievements have not been accomplished. The aim of a world free of drugs has proven to be unobtainable and in fact has led to unintended consequences such as the increase of the prison population, increase in violence related to an illegal drug market, increase in homicide and violence among the young population with a dramatic impact on mortality and life expectancy -- social exclusion due to drug use and the emergence of synthetic drugs."

Felix also had some prescriptions for UNGASS and the CND. "At this historic moment with the opportunity to reassess the past 10 years and more importantly to think about the challenges to come, Brazil enforces the need for recognition of and moving towards: harm reduction strategies; assessing drug dependence, and HIV AIDS populations; securing the human rights of drug users; correcting the imbalance between investments in supply and demand reduction areas; increasing actions and programs of prevention based on scientific evidence with an emphasis towards vulnerable populations and towards increase of access to and care for problematic or vulnerable drug users; and to the acknowledgment of different models of treatment for the need for increased funding of these efforts."

Brazilian Luiz Paulo Guanabara, head of the NGO Psicotropicus, observed it all with mixed feelings. "Early on, I thought the NGO strategy for harm reduction would not result in anything and that we should aim for drug regulation instead," he said. "And in the end, the term harm reduction is not in the political declaration, but the Beyond 2008 document is very strong and has not gone unnoticed."

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Mafioso-looking activist distributing ''United Nations of Prohibition'' 1,000 note bills with UNODC chief Costa's face on one side, and a thank you from the In Memoriam Al Capone Trust on the other (drogriporter.hu/en/demonstration)
Guanabara had harsh words for both the Americans and the UN. "It seems like the American delegates believe harm reduction is a sin -- or they favor harm increase, so they can lock up more people and have more HIV patients, increase crime, sell more weapons and make money out of the disgrace of others and families' destruction. Their prohibitionist stance is obscene," he declared. "And these guys at the CND understand nothing of drugs and drug use, they are just bureaucrats. To put drugs in the hands of bureaucrats is as dangerous as putting them in the hands of criminals."

But despite the lack of results this time around, Guanabara was thrilled by the participation of civil society. "The civil society mobilization is enormous and intense," he said. "The NGO events around the meeting were the real high-level meetings, not the low-level ones with the bureaucrats at the CND."

While the sentiments from Brazil and Bolivia were echoed by various national delegations, mainly European, and while even the UNODC and the US are willing to give nods to an increased emphasis on treatment and prevention, with the US delegation even going so far as to approve of needle exchanges, at the end of the day, the CND political declaration and action plan represents a stubborn adherence to the prohibitionist status quo.

"Government delegations could have used this process to take stock of what has failed in the last decade in drug-control efforts, and to craft a new international drug policy that reflects current realities and challenges," said Prof. Gerry Stimson, executive director of the International Harm Reduction Association. "Instead, they produced a declaration that is not only weak -- it actually undermines fundamental health and human rights obligations."

American attendee and long-time drug reform activist Michael Krawitz also had mixed feelings. "The slow train wreck that Harry Anslinger started with the 1961 Single Convention is finally grinding to a halt," he said. "The argument here has been a semantic one over harm reduction, but the subtext is much more important, and the subtext is that the treaties were set up to protect public health and are currently being interpreted in such a way as to do the opposite. The declaration wound up being watered down and piled high with reservations. The next five years should prove interesting."

The IHRA and other NGOs called on governments with reservations about the political declaration to refuse to endorse it. That probably will not happen, but some governments have indicated they will add reservations to their approval of the declaration. After a century of prohibition, the first formal cracks are beginning to appear at the center of the legal backbone of global drug prohibition. Given that the dissent has largely appeared only since the last UNGASS in 1998, perhaps this isn't such a bad start.

The White House: Obama on Drug Policy

The incoming Obama administration has posted its agenda online at the White House web site Whitehouse.gov. While neither drug policy nor criminal justice merited its own category in the Obama agenda, several of the broad categories listed do contain references to drug and crime policy and provide a strong indication of the administration's proclivities.

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But before getting into what the agenda mentions, it's worth noting what the agenda does not mention: marijuana. There is not a word about the nation's most widely used illicit drug or the nearly 900,000 arrests a year generated by marijuana prohibition. Nor, despite Obama campaign pledges, is there a word about medical marijuana or ending the DEA raids on providers in California -- which doesn't necessarily mean he will go back on his word. It could well be that the issue is seen as too marginal to be included in the broad agenda for national change. With the first raid on a medical marijuana clinic during the Obama administration hitting this very week, reformers are anxiously hoping it is only the work of Bush holdovers and not a signal about the future.

Reformers may find themselves pleased with some Obama positions, but they will be less happy with others. The Obama administration wants to reduce inequities in the criminal justice system, but it also taking thoroughly conventional positions on other drug policy issues.

But let's let them speak for themselves. Here are the relevant sections of the Obama agenda:

Under Civil Rights:

  • End Racial Profiling: President Obama and Vice President Biden will ban racial profiling by federal law enforcement agencies and provide federal incentives to state and local police departments to prohibit the practice.
  • Reduce Crime Recidivism by Providing Ex-Offender Support: President Obama and Vice President Biden will provide job training, substance abuse and mental health counseling to ex-offenders, so that they are successfully re-integrated into society. Obama and Biden will also create a prison-to-work incentive program to improve ex-offender employment and job retention rates.
  • Eliminate Sentencing Disparities: President Obama and Vice President Biden believe the disparity between sentencing crack and powder-based cocaine is wrong and should be completely eliminated.
  • Expand Use of Drug Courts: President Obama and Vice President Biden will give first-time, non-violent offenders a chance to serve their sentence, where appropriate, in the type of drug rehabilitation programs that have proven to work better than a prison term in changing bad behavior.
  • Promote AIDS Prevention: In the first year of his presidency, President Obama will develop and begin to implement a comprehensive national HIV/AIDS strategy that includes all federal agencies. The strategy will be designed to reduce HIV infections, increase access to care and reduce HIV-related health disparities. The President will support common sense approaches including age-appropriate sex education that includes information about contraception, combating infection within our prison population through education and contraception, and distributing contraceptives through our public health system. The President also supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users. President Obama has also been willing to confront the stigma -- too often tied to homophobia -- that continues to surround HIV/AIDS.

Under Foreign Policy:

  • Afghanistan: Obama and Biden will refocus American resources on the greatest threat to our security -- the resurgence of al Qaeda and the Taliban in Afghanistan and Pakistan. They will increase our troop levels in Afghanistan, press our allies in NATO to do the same, and dedicate more resources to revitalize Afghanistan's economic development. Obama and Biden will demand the Afghan government do more, including cracking down on corruption and the illicit opium trade.

Under Rural Issues:

  • Combat Methamphetamine: Continue the fight to rid our communities of meth and offer support to help addicts heal.

Under Urban Issues:

  • Support Local Law Enforcement: President Obama and Vice President Biden are committed to fully funding the COPS program to put 50,000 police officers on the street and help address police brutality and accountability issues in local communities. Obama and Biden also support efforts to encourage young people to enter the law enforcement profession, so that our local police departments are not understaffed because of a dearth of qualified applicants.
  • Reduce Crime Recidivism by Providing Ex-Offender Supports: America is facing an incarceration and post-incarceration crisis in urban communities. Obama and Biden will create a prison-to-work incentive program, modeled on the successful Welfare-to-Work Partnership, and work to reform correctional systems to break down barriers for ex-offenders to find employment.

Harm Reduction and Allan's Diplomatic Faux Pas, on the Final Day of the U.N. Drug Treatment Conference, Vienna

At last, my final day in Vienna attending the United Nations' "Technical Seminar on Drug Addiction Prevention and Treatment: From Research to Practice" conference. (To read my scene-setting preamble from earlier this week, click here. Day 1 is here and day 2 is here.) It's a wind-down day for a conference that never wound up — the day when harm reduction was finally allowed to rear its head — so often unwelcome at any conference dominated, as this one is, by the United States, whose official governmental representatives are highly and categorically opposed to harm reduction. Harm Reduction appeared in that very earnest fashion whereby presenters say, "Here is the science. We need no more evidence. However, I can tell that you're not listening, so I'm going to tell you again that this all works, folks." It was also the day that I made a diplomatic faux pas (as we say in the language of diplomacy). More about that later. I missed the first couple of presenters as I was grappling with the sudden disappearance of Internet connectivity and was hoping that the coffee would kick in. The Viennese make good coffee although it's more of a utility tool than anything pleasurable, kind of like putting socks on in the morning. As I arrived, Dr. Shanti Ranganathan from TTK Ranganathan Treatment Centre in India had just finished her talk. I gather that she covered home detoxification and a camp for drug injectors (it could be fun to speculate how that camp would work). Speaking to a colleague later in the day, I learned that due to the rural nature of India, the approach to drug treatment there is very different from the way it's done in the northern hemisphere. It's very community oriented, and villages have a say-so in the process. I wish I'd caught more of Ranganathan's presentation, which was more along the lines of what I'd been hoping to get information about. How do you deliver drug services in resource poor countries? A gentleman behind me asked, "Haven't we overspecialized drug addiction treatment and shouldn't it be mainstreamed to take advantage of existing resources?" At last, a cri de coeur from the audience! Drug services including treatment, harm reduction, and diversion programs have all sprouted like varieties of weeds. They're somehow related, but the root system and the genetic coding are different. So how could countries and governments differentiate and choose among them? Or figure out how to construct the best array of services based upon what was on show? They couldn't, to my mind. After all, how could anyone possibly make sense of the patchwork quilt of treatment systems and social services in the north given that they don't necessarily make sense — or work — for drug users in their country of origin to begin with? It's as if we're displaying the leaning tower of Pisa or parading the Venus de Milo as models that they should aspire to, and then wondering why the resource poor world makes buildings that lean and statues that have no arms. One place I would not want to live is Sweden, where a random study of the kids at the youth program being trumpeted revealed that each youth suffered from an average of four mental disorders; the majority of parents had one. It must be good to have sane parents. Nothing like pathologizing the young, is there? The Dutch rolled into town with their admirably well-developed harm reduction knowledge and advocacy models. Dr. Wim van den Brink from the Academic Medical Centre at the University of Amsterdam in the Netherlands ran through the continuum of the stages of a drug user's drug taking career and discussed where, when, and which type of a wide range of interventions can and should occur. He included heroin maintenance in this list. (It is widely accepted that heroin maintenance is the fallback option for users who seek treatment but for whom methadone or buprenorphine has not worked. It's not usually a first line option. Outcomes are comparable to all other maintenance programs.) In van den Brink's view, drug-using patients should be able to talk over what their expectations are with their doctors and then negotiate their options. Fancy that. He was pretty much the first speaker who identified drug users as having a role in their own treatment. And he identified abstinence, maintenance, a safe high, and chaotic use as markers on a scale. That may be the first time in 20 years I've heard a clinician identify pleasure as part of the range of options. The legendary Dr. Franz Trautmann from the Netherlands Institute on Mental Health and Addiction ran through the evidence supporting harm reduction interventions including outreach, drop-in centers, and "drug consumption rooms" — the Dutch term for what we in the United States call safer injection facilities or medically supervised injection centers. (The panel facilitator, Gilberto Gerra, Chief of Health and Human Development Section of UNODC, chimed in to reassure everyone that drug consumption rooms do not violate international conventions). It was kind of a relief to hear Dr. Evgeny Krupitsky, head of a laboratory that conducts research on drug addiction at St. Petersburg State Pavlov Medical University, give a convoluted and amusingly wrong-headed talk about the desperate need for the Russians to make naltrexone the first-line response to drug addiction in Russia. (US rejection of harm reduction has its parallel in Russia's refusal to allow methadone.) Naltrexone is an opioid antagonist, which means you can't get high after you've taken it. The opioid receptors in the brain get too blocked up to let any more opioid in. However, as a form of treatment, it's just not very effective. So the Russians keep adding medications to the basic naltrexone dose, unwittingly creating an out of control medication pharmacopoeia for their patients. Monica Beg of UNODC had the task of informing everyone again that syringe exchange is effective in stopping the spread of HIV. Her PowerPoint showed the global distribution of exchange programs (probably limited to the UN-influenced world, to be fair) and did not cover the United States. "The science is clear. Syringe exchange works. The debate is over." Within UNODC there is no debate on the science but as mentioned in my original preamble, UNODC acts as the secretariat for the Commission on Narcotic Drugs (CND) and so when the member States of CND produce Political Declaration, those member states can completely ignore the science as is the case with the US and Russia. In fact, the HIV Prevention Unit deserve a medal for its work in pushing for support from within UNODC. And that's when I just had to speak. I pointed out that despite all of the evidence that needle exchange has been effective in the US (there are 200+ programs, with some of the larger ones federally funded; needle exchange has reversed the HIV epidemic in NYC, once the global epicenter of injection drug use and HIV; scientists at NIDA, NIH, CDC, NIAID are all on record as saying syringe exchange works), an article still appeared on CNN.com just this last July with David Murray, a supposed scientist for the Office of National Drug Control Policy, saying needle-exchange programs "do not succeed in its effort to control the contagion of disease." My point being that while the scientific debate may be over, the political debate continues in the US — not least in the way the US government has been disrupting the process leading up to this March's United Nations General Assembly Special Session on drugs. (While representatives to the UNGASS, plus numerous non-governmental agencies around the world have been calling for harm reduction to be recognized as an important part of demand reduction, US representatives have continued their war against it.) The chair responded to me by saying that there couldn't be a response to my point as it was a political question and inappropriate for this forum. And that science would win out. Stymied at not having a planned end point, I emotionally said that I was glad that this administration was now out. (Apparently it's taken as bad form to name names.) The interaction was filmed by an Iranian television crew that's covering the Iranian involvement in this meeting, which included Azarahksh Mokri of the Iranian National Center for Addiction Studies, who gave a wonderful presentation on how to introduce a methadone program into a country like Iran. He is a brilliant, charismatic speaker who was succint and on point throughout his talk. Christian Kroll of the UNODC HIV Unit, the last speaker before the closing, had that second returned from a UNAIDS Prgramme Coordinating Board meeting and was fired up from saying farewell to Peter Piot, the UNAIDS Executive Director and Under Secretary-General of the United Nations. Kroll ran through the history of the AIDS movement (accidently conflating Gay Men's Health Crisis and ACT-UP) and the importance of civil society input into the UN process. I kept waiting and waiting for the punch line. "Are you asking for more civil society input into UNODC?", I asked. Kroll's response: "Yes I am." Being practically the only representative from "civil society" at the meeting and definitely the only person that spoke, I can see his point. We then sang the Internationale and Mr. Kroll and I caught the subway home together. Allan Clear is executive director of the Harm Reduction Coalition.

Canada: BC Local Elections Bring Another Drug Reform Mayor to Vancouver, A Drug Reform Mayor Back to Grand Forks, and a Drug Reformer to Victoria's City Council

Municipal elections in British Columbia Saturday saw Vancouver get another in a string of pro-drug reform mayors, while a marijuana reformer was returned to the mayor's office in Grand Forks in the interior, and another prominent reform advocate was elected to the city council in Victoria.

In Vancouver, the civic electoral coalition Vision Vancouver succeeded in placing its candidate, Gregor Robertson in the mayor's seat as well as sweeping eight of 11 council seats. Robertson and Vision Vancouver are strong supporters of the city's pioneering Four Pillars drug policy.

http://stopthedrugwar.org/files/philippelucas.jpg
Philippe Lucas (from vicgreens.com)
As Vision Vancouver notes in its platform, it will: "Focus on the Four Pillars to deal with drugs in our communities. Prevention, treatment, harm reduction, and enforcement are the most effective tools to make our communities safer. This includes support for InSite, a focus on access to treatment, and expanding prevention education programs."

Meanwhile, in the small interior border town of Grand Forks (pop. 5,000), former mayor and leader in Marc Emery's BC Marijuana Party Bryan Taylor was reelected. Taylor came to drug reform initially around industrial hemp but soon emerged as a leading BC Marijuana Party campaigner in the 2001 elections. He is barred from entering the US, which he can see from his hillside home outside Grand Forks, originally because he was arrested for hemp cultivation ("drug trafficking," in official US-speak). But even after the Canadian government dropped charges against him, US border control authorities continue to deny him entry, accusing him of "fraud and misrepresentation" if he fails to admit he smokes marijuana and deeming him ineligible to enter the country if he does admit it.

And on Vancouver Island, one of the Canadian drug reformers most familiar to his American counterparts, Philippe Lucas, won a seat on the Victoria city council running as a Green Party candidate. Lucas will be joined by Mayor-elect Dean Fortin, who also supports harm reduction and has vowed to find a permanent location for the city's needle exchange program.

In a Victoria radio interview after the election, Fortin said Lucas "is going to challenge the council a lot" and "will be pushing the harm reduction model."

That's no surprise. In addition to running the Vancouver Island Compassion Society, Lucas also authored the BC Green Party drug policy and substance abuse platform planks, which include calls for a legal, regulated market in marijuana. The soft-spoken but keenly focused Lucas will no doubt be a strong force for reform in Victoria.

All in all, a good day for drug reform and its advocates in British Columbia. It looks like BC will retain its position in the vanguard of drug reform in the Western hemisphere.

Australia: Strong Support for Medical Marijuana, Needle Exchange Programs, National Survey Finds

Australia's 2007 National Drug Strategy Household Survey, in which more than 23,000 people over the age of 12 were quizzed by the Australian Institute of Health and Welfare about their drug use and attitudes toward various drug policy positions, has demonstrated broad support for medical marijuana and harm reduction measures aimed at hard drug users.

Regarding heroin use, the survey found that 67% supported needle exchange programs, 68% supported methadone maintenance, 75% supported the use of naltrexone for overdose avoidance, and 79% supported the use of rapid detox therapy. On the other hand, only 50% supported heroin injection sites, and only 33% supported heroin maintenance therapy.

Medical marijuana also won strong support. Some 69% supported legal medical marijuana, while an even larger number, 75%, supported clinical trials for medical marijuana. In all the policy choices cited here, support was at higher levels than the most recent national survey in 2004.

Marijuana legalization for personal use did not fare so well. Only 21% supported legalization, down from 27% in 2004. The intervening period has been one of Reefer Madness Down Under, with Australian authorities and a complicit media waxing hysterical about the alleged dangers of the weed.

When it comes to legalizing other drugs, support was in the single digits, and relatively unchanged from 2004.

Frighteningly, large majorities of Australians favored increased criminal penalties for drug sales offenses. More than 80% favored harsher sentences for hard drug sales, while even for marijuana, nearly two-thirds (63%) wanted stiffer penalties.

Harm Reduction: Funds Begin to Flow to DC Needle Exchange Programs

Eight months after Congress voted to end a decade-long ban on the use of federal funds for needle exchange programs (NEPs) in the District of Columbia, money is starting to flow to the programs in the city with the nation's highest rate of HIV. District officials had announced almost immediately after the congressional vote that they would fund NEPs in an effort to control the spread of the disease among injection drug users.

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PreventionWorks! at work (screen shot from nytimes.com '''slide show,'' June '07)
Now, according to the Washington Times, funding is finally reaching the city's NEPs. The city will spend $700,000 a year on NEPs, with the city's largest program, PreventionWorks!, getting $300,000 a year.

According to a DC HIV/AIDS Administration 2007 report, injection drug use is the second most common mode of acquiring the HIV virus after unprotected sex, and the District has some 10,000 injection drug users.

DC NEP advocates have long argued that the federal funding ban left them starved for funds and unable to adequately address the injection drug using population. PreventionWorks!, for example, has had to scrape by on private contributions, limiting the work it has been able to do.

The need is obvious and so is the response, Ken Vail, the group's executive director, told the Times. "If you want to reduce the spread of HIV... you put more syringes out there," he said.

A Life and Death Issue

You Can Make a Difference

Dear friends,

Several months ago my colleague Naomi Long and I had an op-ed in The Washington Post calling for a repeal of the federal prohibition that blocks states from using their share of HIV/AIDS prevention money on syringe exchange programs. We had a hard-hitting conclusion: “As many as 300,000 Americans could contract HIV/AIDS or hepatitis C over the next decade because of a lack of access to sterile syringes. This essentially makes the national syringe ban a death sentence for drug users, their partners and children.”

Take action now to support a bill in Congress that would repeal the ban.

Last year my colleague Jasmine Tyler lost her father to HIV/AIDS that he contracted from injection drug use and it really hit our D.C. office hard. She had this to share: “From the time he found out he was HIV-positive until the day he died in April of 2007, he suffered greatly and so did our family.  Every day I know that the hell he lived through could have been avoided if only he had had access to sterile needles all the time.  It’s too late to bring him back, but every other life that can be saved should be.”

While our country spends billions of dollars on efforts to prevent the spread of HIV/AIDS, hepatitis C and other infectious diseases, the U.S. prohibits the use of prevention funds to support syringe exchange programs. This robs cities, states and private organizations of the right to do what’s best for the people, and costs taxpayers a lot of money. It’s far cheaper to distribute syringes and prevent the spread of HIV/AIDS and hepatitis than it is to treat people who contract those infectious diseases after it's too late.

Last year, District of Columbia Congressional Delegate Eleanor Holmes Norton and New York Congressman Jose Serrano successfully repealed a federal ban that prohibited D.C. from spending its own budget money on syringe exchange programs. This week Rep. Serrano introduced a bill that would repeal the national syringe funding ban. If enacted, it could save hundreds of thousands of lives and millions in taxpayer dollars. Please urge your representative to support this urgent, life-saving bill.

Take action now.

Want to do more? Set up a meeting with your representative when he or she is in your district during Congress's August recess. Learn how.

Sincerely,

Bill Piper
Director of National Affairs
Drug Policy Alliance

More Information

--According to the Centers for Disease Control and Prevention (CDC), of the 415,193 people reported to be living with AIDS in the United States at the end of 2004, about 30 percent of cases are related to injection drug use, either directly (sharing contaminated syringes) or indirectly (having sex with someone who used a contaminated syringe or being born to a mother who used a contaminated syringe).

--Each year, approximately 12,000 Americans contract HIV/AIDS directly or indirectly from the sharing of dirty syringes. About 17,000 people contract hepatitis C.
 
--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. Moreover, seven federal reports have found that increasing access to sterile syringes saves lives without increasing drug use.

--Increasing the availability of sterile syringes through exchange programs, pharmacies and other outlets reduces unsafe injection practices such as syringe sharing, curtails transmission of HIV/AIDS and hepatitis, increases safe disposal of used syringes, and helps injection drug users obtain drug education and treatment.

--The lifetime cost of treating just one person who contracts HIV/AIDS can be as high as $600,000. This cost is often borne by taxpayers. In contrast, syringe exchange programs can prevent thousands of new HIV/AIDS cases at very little cost. Funding syringe exchange programs saves both lives and taxpayer money.

--A federal appropriations rider in the annual Labor, Health and Human Services, Education, and Related Agencies spending bill prohibits states from spending their share of federal prevention money on syringe exchange programs. H.R. 6680 would repeal that provision.

Location: 
Washington, DC
United States

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