The Obama administration released its Fiscal Year 2011 budget proposal this week, including the federal drug control budget. On the drug budget, the Obama administration is generally following the same course as the Bush administration and appears to be flying on autopilot.

According to the Office of National Drug Control Policy (ONDCP -- the drug czar's office), the administration is requesting $15.5 billion for drug control, an increase of 3.5% over the current budget. Drug law enforcement funding would grow from $9.7 billion this year to $9.9 billion in 2011, an increase of 5.2%. Demand side measures, such as prevention and treatment, also increased from $5.2 billion this year to $5.6 billion next year.

The Obama drug budget largely maintains the roughly two-to-one imbalance between spending on treatment and prevention and spending on law enforcement. Drug Czar Gil Kerlikowske called the imbalanced budget "balanced."

Highlights and lowlights:

• Funding for the Substance Abuse and Mental Health Services Administration prevention programs (SAMHSA) is set at $254.2 million, up $29.6 million from this year, while funding for SAMHSA treatment programs is set at $635.4 million, up $101.2 million from this year.
• Funding for ONDCP's Drug Free Communities program is set at $85.5 million, down $9.5 million from this year.
• Funding for the widely challenged National Youth Anti-Drug Media Campaign is set at $66.5 million, an increase of more than 50% over this year.
• The Arrestee Drug Abuse Monitoring II program (ADAM) is funded at $10 million. It got no money this year.
• Funding for the Department of Health and Human Services Substance Abuse Prevention and Treatment program is set at $1.799 billion, the same as this year.
• Funding for the Second Chance Act for reintegrating people completing prison sentences is set at $50 million, a whopping 66% increase over this year.
• Funding for the Justice Department's Organized Crime Drug Enforcement Task Force is set at $579.3 million, up $50.8 million over this year.
• Funding for the High Intensity Drug Trafficking Areas (HIDTA) program is set at $210 million, down $29 million from this year.
• Funding for the Defense Department's counternarcotics efforts in Afghanistan is set at $501.5 billion, up about one-third over this year.
• Funding for State Department counternarcotics activities in West Africa is set at $13.2 million, up $10 million from this year.
• Funding for State Department counternarcotics activities in Colombia is set at $178.6 million, down $26.6 million from this year.
• Funding for the DEA is set at $2.131 billion, up 5.5% over this year. That pays for 8,399 employees, 4,146 of whom are DEA agents.
• Funding for the Office of Justice Programs' Byrne grant program, Southwest Border Prosecutor Initiative, Northern Border Prosecutor Initiative, and Prescription Drug Monitoring program has been eliminated.

"The new budget proposal demonstrates the Obama administrations' commitment to a balanced and comprehensive drug strategy," said Kerlikowske. "In a time of tight budgets and fiscal restraint, these new investments are targeted at reducing Americans' drug use and the substantial costs associated with the health and social consequences of drug abuse."

Drug reformers tended to disagree with Kerlikowske's take on the budget. "This is certainly not change we can believe in," said Bill Piper, national affairs director for the Drug Policy Alliance. "It's extremely similar to the Bush administration drug budgets, especially in terms of supply side versus demand side. In that respect, it's extremely disappointing. There's nothing innovative there."

"This budget reflects the same Bush-era priorities that led to the total failure of American drug policy during the last decade," said Aaron Houston, director of government relations for the Marijuana Policy Project. "One of the worst examples is $66 million requested for the National Youth Anti-Drug Media Campaign when every independent study has called it a failure. The president is throwing good money after bad when what we really need is a new direction."

Houston also took umbrage with the accounting legerdemain that continues to allow ONDCP to understate the real cost of federal drug policies. "It's disconcerting to see the Obama administration employ the same tactics in counting the drug budget that the Bush administration did," said Houston. "Congress told ONDCP in 2006 to stop excluding certain items from the budget, and we had a Democratic committee chairman excoriate John Walters over his cooking of the books, but it doesn't appear they've done anything to stop that. Maybe they have to cook the books to make this look like a successful program."

But reformers also noted that some good drug policy news had already come out of the Obama administration. They also suggested that the real test of Obama's direction in drug policy would come in March, when Kerlikowske releases the annual national drug control strategy.

"I'm a little disappointed," said Keith Stroup, founder of the National Organization for the Reform of Marijuana Laws, "but I think there is a significant difference in the environment from the Bush years. Maybe not in this budget, but things like issuing those Department of Justice regulations on medical marijuana have made a major difference."

"They are unwilling or unable to change the drug war budget, but the true measure of their commitment to a shift in drug policy will be the national drug control strategy that comes out in a few weeks," said Piper. "The question is will their drug strategy look like Bush's and like their drug budget does, or will they articulate a new approach to drug policy more in line with the president's comments on the campaign trail that drug use should be treated as a public health issue, not a criminal justice one."

The Obama administration's decision to not interfere with medical marijuana in the states was one example of a paradigm shift, said Piper. So was its support for repealing the federal needle exchange funding ban and ending the sentencing disparity between crack and powder cocaine offenses.

"In a lot of ways, the budget trimming that comes out of the White House is a fraud because they know Congress won't make those cuts," said Piper. "I wonder if that's the game Obama is playing with the Byrne grants. That's the kind of thing they can articulate in the drug strategy if they wanted to. They should at least talk about the need to shift from the supply side to the demand side approach. They could even admit that this year's budget does not reflect that, but still call for it."

This is only the administration's budget request, of course. What it will look like by the time Congress gets through with it is anybody's guess. But it strongly suggests that, so far, there's not that much new under the sun in the Obama White House when it comes to the drug budget.

In a scathing 93-page report released today, the international human rights group Human Rights Watch (HRW) accused Cambodian drug detention centers of torturing and raping detainees, imprisoning children and the mentally ill, and illegally detaining and imprisoning drug users. The centers are beyond reform and should be closed, the group said.

"Individuals in these centers are not being treated or rehabilitated, they are being illegally detained and often tortured," said Joseph Amon, director of the Health and Human Rights division at HRW. "These centers do not need to be revamped or modified; they need to be shut down."

The report cited detailed testimonies from detainees who were raped by center staff, beaten with electric cables, shocked with cattle prods, and forced to give blood. It also found that drug users were "cured" of their conditions by being forced to undergo rigorous military-style drills to sweat the drugs out of their systems.

"[After arrest] the police search my body, they take my money, they also keep my drugs... They say, 'If you don't have money, why don't you go for a walk with me?... [The police] drove me to a guest house.... How can you refuse to give him sex? You must do it. There were two officers. [I had sex with] each one time. After that they let me go home," said Minea, a woman in her mid-20's who uses drugs, explaining how she was raped by two police officers.

"[A staff member] would use the cable to beat people... On each whip the person's skin would come off and stick on the cable," said M'noh, age 16, describing whippings he witnessed in the Social Affairs "Youth Rehabilitation Center" in Choam Chao. The title of the HRW report is "Skin on the Cable."

More than 2,300 people were detained in Cambodia's 11 drug detention centers in 2008. That is 40% more than in 2007.

"The government of Cambodia must stop the torture occurring in these centers," said Amon. "Drug dependency can be addressed through expanded voluntary, community-based, outpatient treatment that respects human rights and is consistent with international standards."

Cambodian officials from the National Authority for Combating Drugs, the Interior Ministry, the National Police, and the Social Welfare Ministry all declined to comment when queried by the Associated Press. But Cambodian Brig. Gen. Roth Srieng, commander of the military police in Banteay Meanchy province, denied torture at his center, while adding that some detainees were forced to stand in the sun or "walk like monkeys" as punishment for trying to escape.

Children as young as 10, prostitutes, beggars, the homeless, and the mentally ill are frequently detained and taken to the drug detention centers, the report found. About one-quarter of those detained were minors. Most were not told why they were being detained. The report also said police sometimes demanded sexual favors or money for release and told some detainees they would not be beaten or could leave early if they donated blood.

The report relied on testimony from 74 people, most of them drug users, who had been detained between February and July 2009.

European heroin users are on high alert as the death toll rises from heroin tainted with anthrax. At least eight people have died -- seven in Scotland and one in Germany -- since early December, and another 14 Scottish heroin users have been hospitalized after being diagnosed with anthrax. Meanwhile, drug reform and drug user activists are reporting a cluster of nine suspicious heroin-related deaths in Coimbra, Portugal, although it is unclear at this point whether they are linked to anthrax-tainted heroin.

anthrax spores

The first four Scottish deaths were in Glasgow, but after one person died in Tayside and one in the Forth Valley earlier this month, Health Protection Scotland epidemiologist Dr. Colin Ramsay said: "The death of this patient in NHS Forth Valley indicates further geographical spread of the cases, meaning that heroin users all across Scotland need to be aware of the risks of a potentially contaminated supply. I would urge all users to stop using heroin immediately and contact local drug support services for help in stopping. If any heroin users do notice signs of infection, for example marked redness and swelling around an injection site or other signs of serious infection such as a high fever, they should seek urgent medical advice."

The French government has also reacted, with the General Directorate for Health issuing a statement Tuesday warning that contaminated heroin may be circulating in France and other European countries. Noting the rising death toll, the statement said "the likeliest source is heroin contaminated by anthrax spores."

Heroin users should be alert, the French statement said, because heroin contaminated with anthrax is indistinguishable from other heroin. "There is no outward sign or color enabling the user to tell whether the heroin has been contaminated by anthrax, and contaminated heroin dissolves or is used in the same way as uncontaminated heroin," it said.

Anthrax is a potentially lethal bacterium that exists naturally in the soil and can also occur among cattle. It is also a potential bio-terror weapon.

The vast majority of heroin consumed in Europe comes from Afghanistan, and while so far evidence is lacking, speculation is that anthrax spores may have been present in bone meal, an animal product sometimes used as a cutting agent. Another possibility is that containers used in the heroin production process were contaminated with anthrax spores. And, given fears that Al Qaeda and its Taliban allies could resort to biological warfare against the West and given the Taliban's role in the Afghan opium and heroin trade, a bio-attack cannot be completely ruled out.

"The anthrax-infected heroin hasn't decreased use, whether people are injecting it or chasing [smoking] it," said Tam Miller, chair of Chemical Reaction, an Edinburgh drug user group, and a member of INPUD (the International Network of People who Use Drugs). "People are scared -- you can be sure of that -- but I think they're more afraid of withdrawing. The Scottish government's advice was for people to stop using heroin, but that won't happen."

Instead, Miller said, heroin users are doing what they can to protect themselves. "Users feel there's not much they can do personally and, as usual, they feel isolated," he said. "A lot are looking up the effects on anthrax on the net and passing on information to people with no internet access. We think the powers that be should put out information on how to spot signs if someone has been in contact with access. Basically, mate, the Scottish government wants little to do with it."

The Scottish government's response so far has drawn a harsh rebuke from the United Kingdom's harm reduction and public health community. In a Tuesday letter to the Scottish government, the International Harm Reduction Association, the drug think tank Release, the Transform Drug Policy Foundation, the UK Harm Reduction Alliance, and individual public health experts called on the government to put in place an emergency public health plan to deal with the crisis.

The letter said the government's advice to heroin users to stop using and enter treatment was "reckless in light of the fact that waiting times in Scotland for opiate substitute treatment (OST) are the longest in the UK. Many of those accessing services are informed that it is a condition of their treatment to engage with the service for a minimum period of time, before they will be entitled to a prescription offering an alternative substitute medication, usually methadone. In some areas of Scotland we have been informed that waiting times for OST can be up to 12 months."

[There is another potential issue with methadone, as well. The antibiotic drug Cipro, used to treat anthrax, interacts with methadone, leading to the possibility of methadone overdoses.]

Given the reality of treatment shortages and delays, it is "unacceptable" for the Scottish government to just tell users to stop or to go to treatment that isn't there, the letter said. "It is clear that this kind of approach can only lead to the death of more vulnerable people."

Instead, the Scottish government must immediately implement a public health plan that includes rapid access and low-threshold prescribing of alternatives to street heroin, the letter-writers advised. They recommended prescribing dihydrocodeine, a synthetic opiate approximately twice as strong as codeine. It is sold in the US under brand names including Panlor, Paracodin, and Synalgos.

"Such an approach will go some way to prevent any more loss of life and will provide greater protection to the public as a whole," the letter said. "Failure to adopt such a policy would mean that the Scottish state would be failing in its duty to its citizens."

Joep Oomen of the European Coalition for Just and Effective Drug Policies (ENCOD) had another suggestion. "The only decent reaction to this kind of episode is to immediately open facilities where people can test their heroin and where they can use in safe conditions, supervised by people who can help if anything goes wrong," he said.

"Hopefully, in the longer term, because of these incidents, authorities will start to see the need for introducing heroin maintenance programs, not as a trial for a limited group of people, but as a permanent service for all those who cannot abstain from heroin for a longer period of time," he added.

Ultimately, said Oomen, prohibition is the problem. "Adulteration is a practice that belongs to the illegal market," he said. "It happens because the people who control the heroin market have no interest at all in the health of their customers."

Dr. Sharon Stancliff of the US Harm Reduction Coalition agreed with her colleagues' assessment of the Scottish government's response. "Telling people to stop is not useful information," she said. "Maybe some occasional users will have a glass of wine instead, but if people are sick and treatment is limited, telling people that heroin is bad for them isn't going to have much impact," she explained.

"At this point, the European harm reduction people should be getting the word out, and the medical people over there need to be on the alert," she added.

Stancliff said she had seen no sign of heroin contaminated with anthrax on this side of the Atlantic, but she was worried. "I hope the DEA is out there buying heroin to see what's in it," she said. "If there is any hint of it here, physicians should be alerted by the Centers for Disease Control as they were with levamisole-tainted cocaine."

If the anthrax-contaminated heroin is coming from Afghanistan, as most heroin consumed in Europe does, US heroin users may catch a break. Most heroin consumed here is of Mexican or Colombian provenance.

But on the other side of the Atlantic, adulterated heroin is killing drug users.