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The Drug Czar: Harm Reductionists, Treatment and Recovery Advocates Come Down on Different Sides of Rumored Ramstad Nomination

Former Minnesota congressman, self-acknowledged recovered alcoholic, and treatment and recovery advocate Jim Ramstad is widely rumored to be in the running for head of the Office of National Drug Control Policy (ONDCP -- the drug czar's office), and he is garnering both support and opposition from within the drug reform community, broadly defined.

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Jim Ramstad
It may all be for naught. Ramstad himself has asked the Obama transition team to consider him to head SAMHSA, the Substance Abuse and Mental Health Services Administration, a post where his appointment would arguably be less controversial. And President Bush's last-minute appointment Monday of current acting ONDCP deputy director Patrick Ward to replace outgoing drug czar John Walters only muddies the waters further.

While Ramstad has serious credentials on treatment and recovery, his opposition to needle exchange programs spurred drug policy analyst and author Maia Szalavitz to oppose his nomination in an article in the Huffington Post. "Ramstad may be a drug warrior in recovering person's clothing," she wrote, noting that he also opposes medical marijuana.

"While Ramstad has opposed some interdiction efforts and called for more treatment funding, someone who doesn't even believe that addicts have a right to life if they aren't in treatment is not the kind of recovering person that I want representing me as drug czar," Szalavitz, a former injection drug user herself, continued. "That's not change, President Obama -- that's more of the same. Don't make the mistake that Bill Clinton did and install a drug czar who will ignore science and push dogma. While it's great to have a recovering person as an example, just having a disease and talking with others who've recovered the same way you did does not make you an expert. We need someone who knows the science, recognizes that there are many paths to recovery -- and understands that dead addicts can't recover."

Szalavitz wasn't the only alarmed harm reductionist. Psychologist Andrew Tatarsky authored an open letter signed by more than 450 substance use and mental health treatment professionals warning that both SAMHSA and the drug czar's office need leadership that "supports evidence-based policies and that will make decisions based on science, not politics or ideology" and "we have reason to believe that Congressman Ramstad is not that person." In addition to Ramstad's opposition to harm reduction measures, Tatarsky noted that throughout his congressional tenure, Ramstad had failed to take any action on sentencing reform.

A Ramstad nomination also drew concern from the National Organization for the Reform of Marijuana Laws (NORML), which noted in a blog post that Ramstad had voted against medical marijuana at every opportunity, voted against needle exchange, and had been appointed to the board of directors of Joe Califano's anti-drug reform propaganda organization, the National Center for Addiction and Substance Abuse (CASA).

But while drug reformers and advocates of science-based policies raised concerns, parts of the treatment community are supporting Ramstad. In a January 11 letter to the Obama transition team, the treatment advocacy organization Faces and Voices of Recovery, a stalwart in many drug policy reform efforts, supported the Ramstad nomination.

"Clearly, the appointment of a person in long-term recovery from addiction to this important position would inspire the millions of Americans and their families who have battled addictions," wrote the group's executive director, Pat Taylor. "Even if Congressman Ramstad were not in recovery, he would be an excellent candidate for the Director of ONDCP. A Member of Congress for 18 years, he is a highly experienced and respected legislator who led the successful battle to require health insurers to cover addiction treatment at parity with other medical conditions. He founded and co-chaired the bi-partisan Addiction Treatment and Recovery Caucus and the Law Enforcement Caucus on Capitol Hill and has been influential in shaping drug policy in countries around the globe. He was a practicing criminal justice attorney for five years and has served on numerous non-profit boards; all of whom have the reduction of the global demand for drugs as part of their mission."

And Ramstad has picked up support from progressive groups like his home state Wellstone Action, the legacy of progressive Minnesota Sen. Paul Wellstone. In a January 9 letter, the group argued that despite Ramstad's misguided stands on needle exchange and medical marijuana, he still deserved the nomination. "Congressman Ramstad's leadership on policies and programs within the White House Office of National Drug Control Policy will serve President-elect Obama's administration and millions of Americans well," Wellstone Action said.

The reform movement is split on Ramstad, with treatment advocates coming down in favor and harm reductionists and drug law reformers opposed. As addiction skeptic Dr. Stanton Peele noted in the Huffington Post Tuesday: "For Wellstone, the Kennedy's, and many other progressives, the idea of treating substance abusers as disease sufferers is tremendously appealing -- indeed, one thrust of the drug policy reform movement is to shift from incarcerating addicts to treating them! But, for reformers, courting treatment advocates has come a cropper as addiction-as-disease proponents back a man who stands against drug policy reform's basic value of finding new, pragmatic approaches to drugs in America."

The drug reform movement is broad and encompasses many diverse actors. Where they come down on the Ramstad issue reflect philosophical differences as well as institutional interests. Just because we're part of a broader movement doesn't mean we're always going to agree.

Feature: Gazing Into the Crystal Ball -- What Can We Expect in 2009?

In the other feature article in this issue, we looked back at last year, examining the drug policy high and lows. Here, we look forward, and not surprisingly, see some of the same issues. With a prohibitionist drug policy firmly entrenched, many issues are perennial -- and will remain issues until they are resolved.

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gazing into the future of drug policy reform '09 (picture from wikimedia.org)
Of course, America's drug war does not end at our borders, so while there is much attention paid to domestic drug policy issues, our drug policies also have an important impact on our foreign policy. In fact, Afghanistan, which is arguably our most serious foreign policy crisis, is inextricably intertwined with our drug wars, while our drug policies in this hemisphere are also engendering crisis on our southern border and alienation and loss of influence in South America.

Medical Marijuana in the States

In November, Michigan voters made it the 13th medical marijuana state and the first in the Midwest. Now, nearly a quarter of the US population resides in medical marijuana states, and it is likely that number will increase this year. Legislative efforts are underway in Kansas, Illinois, Minnesota, New Jersey, and New York, among others, and chances are one or more of them will join the club this year. Interest in medical marijuana is also emerging in some unlikely places, such as Idaho, where one legislator has vowed to introduce a bill this year, and South Dakota, where activists who were defeated at the polls in 2006 are trying to get a bill in the legislature this month.

California's Grand Experiment with Medical Marijuana

As with so many other things, when it comes to medical marijuana, California is a different world. With its broadly written law allowing virtually anyone with $150 for a doctor's visit to seek certification as a a registered medical marijuana patient, and with its thriving system of co-ops, collectives, and dispensaries, the Golden State has created a situation of very low risk for consumers and significant protections even for growers and sellers.

With tax revenue streams from the dispensaries now pouring into the state's cash-starved coffers, medical marijuana is also creating political facts on the ground. The state of California is not going to move against a valuable revenue generator.

And if President-Elect Obama keeps his word, the DEA will soon butt out, too. But even if he doesn't, and the raids against dispensaries continue, it seems extremely unlikely that the feds can put the genie back in the bottle. The Bush administration tried for eight years and managed to shut down only a small fraction of operators, most of whom were replaced by competitors anyway.

The state's dispensary system, while currently a patch-work with some areas well-served with stores and other whole counties without any, is also a real world model of what regulated marijuana sales can look like. Despite the wailing and gnashing of teeth by pot foes, the dispensaries have, for the most part, operated non-problematically and as good commercial and community neighbors.

California's medical marijuana regime continues to evolve as the state comes to grips with the reality the voters created more than a decade ago. We will continue to watch and report as -- perhaps -- California leads the way to taxed and regulated marijuana sales, and not just for patients.

What Will Obama Do?

It will be a new era in Washington, DC, when President-Elect Obama becomes President Obama in less than three weeks. While the president cannot pass laws, he can provide leadership to the Congress and use his executive powers to make some changes, such as calling off the DEA in California, which he has promised to do.

The one thing we know he will not do is try to legalize marijuana. In response to publicly generated questions about marijuana legalization, his team has replied succinctly: No.

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What will President Obama do?
One early indicator of Obama's proclivities will be his selection of a replacement for John Walters, the head of the Office of National Drug Control Policy. While there has been speculation about some possible candidates, none of them very exciting for drug policy reformers, no candidate has yet been named.

President Obama will also submit budgets to Congress. Those documents will provide very clear indications of his priorities on matters of interest to the reform community, from the controversial program of grants to fund anti-drug law enforcement task forces to spending levels for drug prevention and treatment, as well as funding for America's foreign drug war adventures.

The conventional wisdom is that Obama is not going to expend political capital trying to undo decades of drug war policies, but perhaps the budget axe will do the talking. Goodness knows, we don't have any money to waste in the federal budget these days.

What Will the Congress Do?

Democrats now control not only the White House, but both houses of Congress. One area we will be watching closely is the progress, if any, of federal sentencing reform. There are now more than 100,000 federal drug war prisoners, too many of them low-level crack offenders serving draconian sentences thanks to the efforts of people like Vice President elect Joe Biden, a long-time congressional drug warrior. Several different crack-powder cocaine sentencing disparity bills have been introduced. The best was authored by Biden himself, a sign of changing times, if only slowly changing. It is past time for one of these bills, hopefully a good one, to pass into law.

Rep. Barney Frank (D-MA) introduced a federal marijuana decriminalization bill last year. The best prediction is that it will go nowhere, but we could always stand to be pleasantly surprised.

Rep. John Conyers (D-MI), head of the House Judiciary Committee, has emerged as a strong critic of federal interference in state medical marijuana programs. Conyers could use his position to highlight that issue, and possibly, to introduce legislation designed to address the problem of federal interference.

One area where the Congress, including the Democratic leadership, has proven vulnerable to the politics of tough on crime is the federal funding of those anti-drug task forces. In a rare fit of fiscal sanity, the Bush administration has been trying for years to zero out those grants, but the Congress keeps trying to get them back in the budget -- and then some. We will be watching those funding battles this year to see if anything has changed.

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Coca Museum, La Paz, Bolivia
Mexico

With the death toll from prohibition-related violence topping 5,000 last year, Mexico is in the midst of a multi-sided war that is not going to end in the foreseeable future, especially given America's insatiable appetite for the forbidden substances that are making Mexican drug trafficking organizations obscenely wealthy. With the $1.4 billion anti-drug military and police assistance known as Plan Merida approved last year by the Bush administration and the Congress, the US is now investing heavily in escalating the violence.

The National Drug Information Center has identified Mexican drug trafficking organizations as the nation's number one criminal threat, and chances are the violence south of the border will begin to ooze across the line. That will only add to the pressure among law enforcement and political figures to "do something." But given the current mindset among policymakers, just about anything they may be inclined to do to "help" is unlikely to be helpful.

The cartel wars in Mexico are also having an impact on Mexican domestic politics, with President Felipe Calderón's popularity suffering a significant decline. The angst over the escalating violence has already provided an opening for talk about drug policy reform in Mexico, with the opposition PRD saying that legalization has to be on the table, and Calderón himself announcing he wants to decriminalize drug possession (although how that would have any noticeable impact on the traffic or the violence remains unclear).

Look for the violence to continue, and watch to see if the resulting political pressure results in any actual policy changes. Drug War Chronicle will likely be heading down to Tijuana before too long for some on-scene reporting.

The Andean Drug War

... is not going well. Despite pouring billions of dollars into Plan Colombia, coca production there is at roughly the same level as a decade ago. Cocaine exports continue seemingly immune to all efforts to suppress them, although more appears to be heading for Europe these days. During the Bush administration, the US war on drugs in Colombia has morphed into openly supporting the Colombian government's counterinsurgency war against the leftist FARC rebels, who have been weakened, but, flush with dollars from the trade, are not going away. Neither are the rightist paramilitary organizations, who also benefit from the trade. Will an Obama administration try something new?

Meanwhile, Bolivia and Venezuela, the only countries singled out by the Bush administration as failing to comply with US drug policy objectives, have become allies in an emerging leftist bloc that seeks to challenge US hegemony in the region. Both countries have thrown out the DEA -- Venezuela in 2005, Bolivia last fall -- and are cooperating to expand markets for Bolivia's nascent coca industry. Bolivian President Evo Morales acknowledged this week that some coca production is being diverted to cocaine traffickers, but said that he does not need US help in dealing with it.

And in Peru, where President Alan García has sent out the army to eradicate coca crops in line with US policy, unrest is mounting in coca growing regions, coca farmers are pushing into indigenous territories, causing more problems, and the Shining Path insurgency, once thought decisively defeated, has reemerged, although apparently minus its Maoist ideology, as a criminal trafficking organization and protector of coca farmers. The Peruvian government blames the Shining Path for killing 25 soldiers, police, and anti-drug workers in ambushes last year. Look for that toll to increase this year.

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Afghan opium
Afghanistan

More than seven years after the US invaded to overthrow the Taliban and destroy Al Qaeda, Afghanistan is the world's largest opium producer, and has been each year since the Taliban were driven from power. While US drug war imperatives remain strong, they are in conflict with the broader objectives of the counterinsurgency there, and any efforts to suppress poppy planting or the opium trade will not only have a huge impact on the national economy, but are likely to drive Afghan farmers into the waiting arms of the resurgent Taliban, which is estimated to make hundreds of millions of dollars a year off taxing and protecting the trade. That buys a lot of guns to point at Afghan, American and NATO troops.

President elect Obama has vowed to reinvigorate the US war in Afghanistan by sending 20,000 additional troops, and NATO has reluctantly agreed to attack the drug trade by going after traffickers linked to the Taliban or various warlords -- but not those linked to the government in Kabul. Last year was the bloodiest year yet for coalition forces in Afghanistan; look for this year to top it.

Bush Endorses Harm Reduction Group…Sort Of

President Bush did a photo-op today in which he delivered used coats at the headquarters of Pathways to Housing and praised the organization’s efforts to help the homeless. Of course, there’s nothing surprising about the President doing charitable appearances during the Christmas season. What’s interesting is that Pathways to Housing offers a quite unique and forward-thinking approach to the problem of homelessness:

Founded in 1992, Pathways to Housing, a not-for-profit organization, works with individuals who have been turned away from other programs because of active substance use/abuse, refusal to participate in psychiatric treatment, histories of violence or incarceration, or other behavioral problems.

Pathways to Housing separates housing from treatment. It treats homelessness by providing people with individual apartments, and then treats mental illness by intensive and individualized programs that seek out and actively work with clients as long as they need, in order to address their emotional, psychiatric, medical, and human needs, on a twenty-four-hour, seven-day-a-week basis.

This is basically a harm reduction approach to homelessness, in that active drug users receive services (including an apartment) in order to stabilize their situation and connect them to opportunities for treatment and health care. It’s a fantastic program that is achieving remarkable success, which is exactly why I’m surprised to see the President associate himself with it.

Bush’s White House has vehemently pushed an abstinence-first approach to drug treatment, even going so far as to oppose overdose prevention kits on the theory that overdosing would teach users a lesson. Pathways to Housing’s approach to drug addiction is just the complete opposite of everything Bush’s drug policy has stood for. Thus today’s appearance illustrates once again the gaping disparity between what actually works and what his priorities have been for the last 8 years.

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.

Europe: Government Must Support Employers in Hiring Drug Users, British Drug Watchdog Group Warns

With drug strategies and welfare reform plans in the British Isles moving toward pushing drug users into treatment and from treatment into the workplace, the British government is going to have to do a lot more to help drug users find jobs, a leading British drug policy think tank said in a report released this week. The report, Working Toward Recovery: Getting Problem Drug Users Into Jobs was published by the UK Drug Policy Commission and contains more than three-dozen recommendations aimed at easing the transition.

The report noted that while holding a job is a key component of drug user rehabilitation and integration into society, about 80% of problem drug users were unemployed. (The report defined "problem drug user" as someone dependent on heroin or crack cocaine.) And while government strategies in England, Scotland, and Wales are to get users off drugs and into jobs, the strategies are undeveloped and, and employer practices sometimes counterproductive.

In particular, the report criticized the informal "two years drug free" rule used by many employers. With the two years of abstinence including abstinence from opiate substitute medications, such as methadone, the practice is unduly harsh and unnecessary, given that many people on the controlled drug regimen have already achieved the stability employers say they want.

Employers are unlikely to want to hire problem drug users, with only 26% saying they would be prepared to hire a former drug user. Employers cited several types of risk associated with drug users -- from continuing drug use, to the firm's reputation, and to the firm's customers and employees -- and about three-quarters of them they needed more government help in developing risk assessments, support for drug using employees, and information about indemnity insurance.

The Labor government's welfare reform proposals will tie money to pay for drug treatment to drug users agreeing to a rehabilitation plan, the study noted. But with employment a big part of rehabilitation, the government is going to have to provide incentives and programmatic support if it is going to force those drug users into the job market.

Southeast Asia: Thai Government in New Drug Crackdown

The government of Thai Prime Minister Somchai Wongsawat announced a new anti-drug offensive last week aimed at a resurgent methamphetamine market and an enduring market in opium and heroin. Somchai said the new 90-day offensive could be seen as a continuation of the 2003 anti-drug campaign led by then Prime Minister Thaksin Shinawatra.

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2003 protest at Thai embassy, DRCNet's David Guard in foreground
A Thai government commission investigating Thaksin's war "to make Thailand drug-free" found that nearly 3,000 people were killed, many of them not involved in the drug trade. While no criminal convictions have been handed down, it is widely assumed that most of those killed were executed by police anti-drug death squads.

Somchai said his government would take measures to prevent more killings, but like his predecessor, tried to pin the killings on "slayings among suspected drug dealers," not the extrajudicial execution of drug dealers. That isn't exactly building confidence among Thai drug users and sellers or among the human rights community, which strongly criticized Thailand over the 2003 murder spree.

"The prime minister says that this time around killings will not be tolerated, but the government said the same thing last time," said Brad Adams, Asia director for Human Rights Watch, in a Wednesday news release warning that more abuses could lie ahead. "Somchai's credibility is at stake here."

After Thaksin was deposed last year, the government of General Surayud Chulanont appointed a special committee chaired by former Attorney General Khanit na Nakhon to investigate the extrajudicial killings that took place in 2003 as part of the "war on drugs." After five months of inquiries, the committee provided findings that 2,819 people had been killed between February-April 2003.

Many of those killed had been blacklisted by police or local authorities as suspected drug dealers. Police officers were suspected to have been involved in many of the attacks, particularly as many were killed soon after being summoned to police stations for questioning. For example, a 42-year-old grocery shop owner, Somjit Khayandee, was shot dead execution style in her house in Petchburi province on February 20, 2003, three days after she had been summoned to the police station. Local police told Somjit's relatives that her name was on their blacklist.

Police and other anti-drugs units in Thailand have sweeping powers and rarely face punishment for abuses and misconduct. The sense that officials will not be held accountable for their actions is so strong that abusive officials have sought promotion, fame, and financial rewards from the suffering of their victims.

"Many of the same people suspected of killings and other abuses in the last 'war on drugs' remain in positions of authority," Adams said. "The government should prosecute and discipline those involved in previous abuses and institute reforms before asking the police to mount another campaign. Otherwise, more people are likely to be killed."

While Thai authorities said they were going to concentrate on drug dealers, they also said drug users caught up in the net would participate in rehabilitation programs at military bases or be sent to prison. But given Thailand's poor record with respect to coerced drug treatment, that is not good news. Since 2003, thousands of people have been coerced into rehabilitation centers run by security forces without a clinical assessment that they are indeed drug dependent. Many have been held for extended periods of time -- usually 45 days -- in prison-based facilities, even if they are later referred to outpatient treatment. "Rehabilitation" is often provided by security personnel, with military drills a mainstay of the "treatment" provided.

Such coerced treatment has the effect of driving drug users away from seeking treatment or even government-sponsored health care services, Human Rights Watch said. With an estimated 40-50 percent of drug users in Thailand HIV-positive, this may keep drug users from accessing lifesaving HIV-prevention services and treatment.

"Forcing drug users into badly designed rehabilitation programs is incompatible with international standards requiring fully informed consent to treatment," Adams said. "Furthermore, fear of prosecution and harsh treatment will drive them away from seeking health care services that are theirs by right and that could actually help them."

Thailand's latest war on drugs is looking a lot like a war on drug users. That's a shocker.

Press Release -- Advocates Denounce Gov. Paterson's Cuts to Drug Treatment: Jail is More Expensive and Less Effective

For Immediate Release: November 7, 2008 For more info: Gabriel Sayegh at (646) 335-2264 or Tony Newman at (646) 335-5384 Gov. Paterson Announces $8.6 Million in Cuts to Drug Treatment in Response to Budget Crisis Advocates: Gov. Paterson Should be Doing the Opposite and Expanding Cost-Effective Treatment With Democrats in Control of Senate and Assembly, Gov. Paterson Should Keep His Pledge and Reform Draconian Rockefeller Drug Laws with Treatment to Save Lives and Money Health advocates and treatment providers were shocked to learn that New York Governor Paterson is cutting $8.6 million from its substance abuse programs in response to the state's current budget crisis. "This is penny wise and pound foolish and exactly the opposite of what the governor should be doing," said Howard Josepher, President of the Exponents treatment programs. "Treatment is less expensive and more effective than the lock-them-up strategy that costs taxpayers $29,000 per person to incarcerate someone with an addiction. Treatment also offers a better opportunity to prevent recidivism" The Rockefeller Drug Laws have been a miserable failure. These draconian laws have not delivered on their promise to rid our streets of drugs or keep people from using them, but they have drained New York of hundreds of millions of dollars and destroyed tens of thousands of lives. Treatment providers, family members, policy experts and newspaper editorials have been calling for change for years but have been stifled due to Republican control of the State Senate and the lack of leadership from Governors Pataki and Spitzer. When Gov. Paterson took over there was an expectation that there might be reform of these laws as the governor has been a long-time voice for change of the laws. "The time is right to move from away from inhumane, costly and ineffective mass incarceration to a health approach to our drug problems," said Gabriel Sayegh of the Drug Policy Alliance. "The Democrats have a majority of the Senate, Assembly and the Governorship. Helping people with drug problems get community based treatment instead of jail does not cost money, it saves money. The governor is in the difficult position of needing to cut programs and costs. Reforming the drug laws is a rare win-win: you can save hundreds of millions of dollars and help keep families together."
Localização: 
NY
United States

Feature: Sentencing Reform Initiative Defeated in California, "Tough on Crime" Initiatives Win in Oregon

Tough on crime can still trump smart on crime, if Tuesday's elections results on sentencing initiatives in two of the nation's most progressive states are any indication. In Oregon, voters approved two competing initiatives that will increase sentences and prison populations, while in California, a multi-million dollar campaign to dramatically reform sentencing went down in the face of opposition from prison guards and politicians, and another initiative that will see longer sentences and more prisoners was approved by voters.

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overcrowding at Mule Creek State Prison (from cdcr.ca.gov)
In California, the Drug Policy Alliance and the Campaign for New Drug Policies pumped nearly $8 million into the effort to pass Proposition 5, the Nonviolent Offenders Rehabilitation Act (NORA). NORA would have deepened and vastly expanded the "treatment not jail" sentencing reforms passed in 2001 as Prop. 36. While the Legislative Analyst's Office estimated it would cost $1 billion a year to implement, it also estimated that it would save $1 billion a year in prison costs, as well as $2.5 billion in savings from prisons that would not have to be built.

NORA had the near unanimous support of the drug treatment community, as well as the League of Women Voters of California, the Children's Defense Fund-California, the California Nurses Association, the California Federation of Teachers, the California Society of Addiction Medicine, the California State Conference of the NAACP and the National Council of La Raza, among others.

But a deep-pocketed opposition led by five current and former governors whose policies helped to create California's seemingly never-ending prison crisis and financed largely by the people who most directly benefit from increased prison populations, the California prison guards' union, undermined public support for NORA. The measure was also opposed by another group whose ox would have been gored, the drug court professionals -- arguably a part of the treatment community, but just as arguably a part of the law enforcement community. Several prominent state newspapers and actor Martin Sheen joined the opposition as well.

"It is a great threat to our neighborhoods," Gov. Arnold Schwarzenegger said at a news conference featuring the assembled governors outside the Criminal Courts Building in downtown Los Angeles last Thursday. "It was written by those who care more about the rights of criminals."

The measure "will cost dollars and it will cost lives," chimed in former Gov. Gray Davis, a Democrat, neglecting to mention that it would have saved many more dollars than it would have cost.

It wasn't just the governors. Sen. Dianne Feinstein and Attorney General Jerry Brown, also Democrats, opposed the measure too, and taped TV commercials against it. "Say no to drug dealers," Feinstein said in her ad, while Brown -- whose spot was paid for by the prison guards union -- called it "a complicated measure" that would "limit court authority over drug dealers and addicts who refuse treatment."

All told, the organized opposition pumped nearly $3.6 million into defeating NORA, more than half of it coming from the prison guards' union. And it worked -- on election day, NORA went down to defeat by a margin of 61% to 39%.

In a statement Tuesday evening when the outcome became apparent, Yes on 5 campaign spokeswoman Margaret Dooley-Sammuli laid the defeat at the door of the opposition. "Today we saw special interests overpower the public interest," she said. "California's prison guards poured millions of dollars into stopping Prop. 5 and securing this victory for the poison politics of crime."

Stopping NORA would be a pyrrhic victory, Dooley-Sammuli predicted, citing a looming federal court hearing on whether to take control of the overcrowded, under-budgeted prison system.

"The prosecutors and prison guards who led the campaign against Prop. 5 got their way tonight -- but they've really lost. The next step for our prisons will probably be a federal takeover. Prop. 5 was Californians' last, best chance to avoid a takeover and make our own choices about how to address prison overcrowding. Now federal judges are likely to impose solutions that no one will be happy about."

The effort to pass NORA was "not in vain," Dooley-Sammuli added. "Prop. 5 presented a vision for a future in which we do more for young people with drug problems, and improve the way we provide court-supervised treatment in California. There is plenty to build on going forward," she said.

But Golden State voters were still seduced by the "tough on crime" message that has played so well in California since the days of Ronald Reagan. While defeating NORA, they passed Proposition 9, also known as the Crime Victims Bill of Rights Act, by a margin of 53% to 47%. Naturally enough, the measure is concerned primarily with victims' rights, but also includes provisions that block local authorities from granting early release to prisoners to alleviate overcrowding and mandates that the state fund corrections costs as much as necessary to accomplish that end. It also lengthens the amount of time a prisoner serving a life sentence who has been denied parole must wait before re-applying. Currently, he must wait one to five years; under Prop. 9, he must wait three to 15 years. Prop. 9 would also allow parolees who have been jailed for alleged parole violations to be held 15 days instead of the current 10 before they are entitled to a hearing to determine if they can be held pending a revocation hearing, and stretches from 35 to 45 the number of days they could be held before such a hearing. These last two provisions, as well as one limiting legal counsel for parolees, all conflict with an existing federal court order governing California's procedures.

But if "tough on crime" still sells, another measure, Proposition 6, the Safe Neighborhoods Act, was too hard-sell even for California's crime-weary electorate. That measure, which was aimed primarily at gang members, violent criminals, and criminal aliens, also included provisions increasing penalties for methamphetamine possession, possession with intent, and distribution to be equal to those for cocaine, and provided for the expulsion from public housing of anyone convicted of a drug offense. The measure also mandates increased spending for law enforcement. It lost 69% to 31%.

"Tough on crime" worked this year in Oregon, too, with two competing measures that would ratchet up sentences and prison populations both passing. Measure 57, a legislative measure placed before the voters, and Measure 61, the brainchild of inveterate Oregon crime-fighter and initiative-generator Kevin Mannix, won with 61% and 51% of the vote, respectively.

The Mannix measure, the tougher of the two, would have set mandatory minimum sentences for a number of offenses, including drug sales, and is projected to add between 4,000 and 6,000 new inmates to the prison system over the next five years at a cost of between $500 million and $800 million. But because it garnered fewer votes than Measure 57, the latter is the one that will actually become law.

Measure 57 increases some sentences for repeat offenders and includes funding for behind-bars drug treatment. It is estimated to generate 1,670 additional prisoners over the next five years at a cost of $411 million, as well as requiring the state to borrow another $314 million for new prison construction.

Even with the national economy in a free-fall and state budgets increasingly feeling the squeeze, it looks like it's still easier to win with the politics of fear than with the politics of justice and compassion.

Obstacles to the Development and Use of Pharmacotherapies for Addiction

The Law & Health Care Program at the University of Maryland School of Law invites you to attend Obstacles to the Development and Use of Pharmacotherapies for Addiction. The event is co-sponsored by Physicians and Lawyers for National Drug Policy and the Open Society Institute-Baltimore. In recent years, there has been a growing understanding that alcohol and other drug addictions are chronic diseases that require long-term relapse prevention therapy. At the same time that our understanding of addiction as a chronic disease has developed, so has the ability to treat patients with pharmacotherapies. While there is an increasing body of evidence that the use of pharmacotherapies to treat alcohol and other addictions is both clinically and cost effective, there are still a number of obstacles that exist to their development and use in the therapeutic setting. This conference will explore the various impediments that stand in the way of a more robust acceptance of such treatment by health care providers, patients, regulators, and the courts. Panelists at the conference will discuss the obstacles that exist at each stage of medication development and uptake, including challenges for pharmaceutical companies; obstacles relating to clinical trials and the FDA approval process; patient reluctance to use and provider reluctance to screen for, and prescribe, medications to treat addiction; and gaps in insurance coverage for these medications. Because a significant number of individuals receive treatment for their addictions through the justice system, a conference panel will be devoted to discussing the experience of drug court judges and the work of scholars who have studied the use of such treatment in the courts and prisons. The intended audience for this conference includes lawyers, health care providers and health policy makers who work on issues related to alcohol and other addictions. The conference fee is $25. For additional information and to register on-line, please visit the conference website: www.law.umaryland.edu/healthlaw2008. Public parking is available in the Baltimore Grand Garage across from the School of Law. The entrance is on Paca Street. Parking fees are the responsibility of the participant. If you require special accommodations to attend or participate, please provide information about your requirements to Lu Ann Marshall, 410-706-4128 (1-800-735-2258 TTY/VOICE), [email protected], at least five business days in advance.
Data: 
Fri, 11/07/2008 - 8:30am - 4:45pm
Localização: 
500 West Baltimore Street
Baltimore, MD 21201
United States

Press Release: Bay Area Legislators Call Prop. 5 Much Needed, Just-in Time Reform

For Immediate Release: November 3, 2008 Contact: Margaret Dooley-Sammuli at (213) 291-4190 or Tommy McDonald at (510) 229-5215 Bay Area Legislators Call Prop. 5 Much-Needed, Just-in-Time Reform Echo State Democratic Party Endorsement SAN JOSE – Bay Area legislators today announced support for Proposition 5, echoing the endorsement of the State Democratic Party. Highlighting the cost savings of treatment not incarceration programs, Assemblymembers Beall, Lieber and Leno called on voters to approve the much-needed treatment expansion and prison reform. Assemblyman Jim Beall, of San Jose, said, “By failing to directly address the problem of addiction, California has taken a one-sided, punitive and costly approach – incarceration. Little funding goes to the most cost-effective approach that stops the cycle of addiction: prevention and early intervention for our youth. In this time of economic crisis, we need an effective approach to combat the disease of addiction rather than continuing to fund an ineffective incarceration-first policy.” Assembly Member Sally Lieber, of Silicon Valley, said, “The state’s worsening prison overcrowding and ballooning budget deficits are not separate crises. They are intimately related. Until we address our failed prison policies, we will only see our budget problems increase. That’s why Prop. 5 is the right thing for California. It will usher in more effective and affordable responses to nonviolent drug offenses – and stop pouring taxpayer money down the drain of the bloated prison system.” Assembly Member Mark Leno, of San Francisco, said, “California can’t afford to kick the can down the road any longer. If we don’t address our broken prison system, it will drain our state coffers at a time when we most need to spend cautiously. For better public safety and better use of taxpayer dollars, we need real prison and sentencing reform. Prop. 5 brings that reform to California just in time – when we really can’t wait any longer.” The nonpartisan Legislative Analyst’s Office found that Prop. 5 will lower incarceration costs by $1 billion each year and save taxpayers $2.5 billion in reduced prison-construction costs. This doesn’t include savings related to reduced crime, fewer social services costs (e.g. emergency room visits, child protective services, welfare), and increased individual productivity. For more information, visit www.Prop5Yes.org. ###
Localização: 
CA
United States

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