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Feature: Western Hemisphere's Only Heroin Maintenance Program Coming to an End

Every day for 15 months, Vancouver heroin addict Rob Scott Vincent, 36, went into a nondescript building on the city's Downtown Eastside where a nurse would hand him a syringe loaded with pharmaceutical grade heroin. Sitting at a sterile, stainless steel counter, Vincent would inject himself with the drug, then sit in an equally sterile waiting room for awhile as the drug took hold before heading out to do his daily business.

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Hastings Street, on Vancouver's East Side (courtesy VANDU)
Vincent was one of 251 participants -- 192 in Vancouver and the rest in Montreal -- in the only heroin maintenance program in the hemisphere, a pilot program known as the North American Opiate Maintenance Initiative (NAOMI). Originally intended to operate in both Canada and the US, the US component never got off the ground in the drug war atmosphere there. And now, NAOMI is winding down in Vancouver and Montreal. The last handful of participants in the program will get their last fixes at the end of this month.

In the program, which was limited to long-time addicts over 25 who had failed to kick the habit at least twice in previous treatment tries, participants used treatments of oral methadone or injected heroin. A small percentage received a pharmaceutical opiate called Dilaudid. Participants also received counseling and other support services. The Canadian federal government (then under control of the Liberals) funded the project with $1.8 million and agreed to allow the importation of pharmaceutical heroin for the project.

Similar pilot opiate maintenance projects in Switzerland, Germany and the Netherlands produced results showing reductions in criminality, drug use, and economic costs to society, and increases in health, stability, and employability among participants. NAOMI researchers and supporters are hoping it will produce similar results. While the final research report from NAOMI is not expected until the fall, preliminary results suggest the findings will be similar to those in Europe.

In a March briefing paper, NAOMI reported that 85% of participants taking injected heroin had stayed with the program for 12 months, that the treatment had proven to be "extremely safe," and that there had been no security issues or evidence that NAOMI had had a deleterious impact on the neighborhood. The paper also suggested that the program would show a positive economic impact.

Canada estimates that each heroin addict costs the country $45,000 a year. The studies of European opiate maintenance programs report that they save host countries $20,000 a year for each participant.

"What we know now is that we were able to recruit people with long-term dependence on heroin who repeatedly failed other treatments and who had many health and social problems when they entered," said Dr. David Marsh, one of the co-investigators and lead clinical physician for the study. "From a doctor's perspective, whether they were treated with methadone or heroin, many of them improved dramatically. We'll know from the formal research results how much and in what ways they improved."

The provision of methadone or heroin was only part of the treatment, Marsh said. "The medication is a component of a broader package of primary care, mental health care, addiction counseling, and case management to provide participants with access to a range of welfare and other benefits," said Marsh. "We work with people to try to manage the negative consequences of their drug use and help them improve their lives."

Vincent had been addicted to opiates for nearly 15 years when he decided to participate in NAOMI. "I wanted to see if it could better my life, and it did," he said. "It helped me slowly wean down. I'm still using, but not even one-third of what I was using."

Vincent's stint in NAOMI ended in March. Since then, he has had to return to the streets to find his drugs. "It's not too bad," he said. "I mostly use morphine pills, and I pick up a pill for $5 bucks every morning and I'm good for the day." Vincent pays for his fixes by collecting and recycling cans. But sometimes, he can't find what he wants and has to spend time searching for a substitute opiate -- heroin, dilaudid, whatever is around. "It's usually readily available," he said, "but sometimes I have to scrounge around."

Getting participants completely off opiates wasn't the be-all and end-all of the pilot program, said Marsh. "Patients benefit in a lot of ways," he said. "Some were able to stop taking illegal opiates, and in my view, if a patient is prescribed methadone and is using it properly, I consider that a success. Methadone treatment has been available for many years, and there are thousands of studies showing its benefits."

The Vancouver Area Network of Drug Users (VANDU) was one of the key supporters of NAOMI, despite its complaints about the restrictiveness of the standards for qualifying for the study. The program needs to continue, VANDU said.

"Regardless of the parameters they set that made it tough to qualify, this is a badly needed service and it's a shame it's just a pilot project and is not continuing," said VANDU president Richard Utendale. "I've talked to a lot of people who have been helped by it. They were able to improve their day-to-day lives by not having to struggle to feed their drug habits. NAOMI provided a safe place and support, and participants didn't have to worry about being jacked up by the police or ripped off or sold inferior products or dope with adulterants."

The Downtown Eastside, where both VANDU and NAOMI are located is the epicenter of one of the largest hard drug scenes in the hemisphere. The program had an impact on the area, said Utendale. "I think NAOMI also improved the neighborhood, with less street and property crime."

There was a downside to NAOMI, though, said Utendale. "The drawback is that when people are finished with the program, they have to go back on the street and resort to the same old means of getting their drugs. That's why this needs to be permanent."

Vincent said he wished the program could continue. "I would most definitely participate in a permanent program," he said. "It was very, very helpful. It's a lot easier to quit or reduce my intake with pharmaceutical grade heroin. Most of the stuff on the street is cut with other things -- that's why I like to use morphine. I can't see any reason for not keeping this open," he said. "NAOMI is a medical facility, just like Insite [the Vancouver safe injection site]. They should not shut it down."

But that is what is going to happen at the end of this month. Last November, doctors appealed on compassionate grounds to extend the program on behalf of five participants. So far there has been no agreement from either Health Canada or the regional health authority.

"Dreams are free," Utendale sighed, "but the way things are looking right now, this isn't going forward without some changes in Ottawa."

Marsh said it was "premature" to try to predict what would happen. "But I'm optimistic we'll find funding and get the regulatory approval at some point to apply the lessons we've learned from this study," he said.

But given the current Conservative federal government's ideological opposition to harm reduction, as evidenced by its losing battle to shut down Vancouver's safe injection site, it is going to take a new national election before there is any chance that Canada will follow the Europeans' lead and make heroin maintenance part of a broader public health policy.

Drug Treatment: Massachusetts Senate Ponders "Secure Treatment Centers"

Faced with rising drug overdose deaths and high rates of opiate addiction, Massachusetts lawmakers this week began discussing a $5 million plan to fund two "secure treatment centers" for arrested drug users. Under the initiative, drug users busted for small-time offenses who currently face jail would be given the option of seeking drug treatment for up to 90 days.

According to the state Department of Public Health, the number of opiate-related deaths in the Bay State increased from 363 in 2000 to 637 in 2006. The number of non-fatal drug overdoses has also increased dramatically, from 8,000 in 1996 to more than 18,000 in 2005.

"This is an epidemic," state Sen. Steven Tolman (D-Boston), who is pushing the plan, told the Associated Press. "We have all these kids and young adults who get hooked on the OxyContin and heroin, but the treatment infrastructure we have is mostly for alcohol."

Under Tolman's plan, which is included in the Senate version of the state budget, the $5 million would create two 60-bed secure treatment centers. The budget also includes language establishing a special commission to investigate and study the impact of OxyContin and heroin and make additional recommendations.

The plan was set to be discussed this week in the state Senate as part of the appropriations process.

Feature: Vancouver's Safe Injection Site Fights for Its Life -- Again

The only officially-sanctioned safe injection site in North America, Vancouver's InSite will have to close its doors June 30 if the Canadian federal government does not extend its exemption from Canada's Controlled Drugs and Substances Act. But while the Conservative government of Prime Minister Stephen Harper has made no secret of its distaste for the program, it has very strong community, local, provincial, and international support, and its supporters are now engaged in a strong campaign to ensure its continued existence.

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InSite (courtesy Vancouver Coastal Health)
Situated on Hastings Street in Vancouver's Downtown Eastside, home to one of the hemisphere's largest concentrations of hard drug users, InSite has operated since 2003, when it was granted a three-year exemption by the then Liberal government. With the advent of Conservative government, with its ideological opposition to programs that "encourage" or "facilitate" drug use, InSite's continued existence has been shaky. Twice, the Conservatives have granted the program temporary 18-month exemptions, saying that more research on its efficacy was needed.

But now, after five years of monitoring and evaluation, the results are in: According to peer-reviewed scientific studies, InSite increased the use of addiction treatment services, increased the use of detox services, reduced needle sharing, led to improvement in neighborhood public order and quality of life, resulted in no increase in drug-related crime, prevented overdose deaths, and helped reduce the spread of HIV/AIDS among drug injectors.

As if the nearly two-dozen studies of InSite were not enough, the Conservative government last year commissioned its own study, "Vancouver's INSITE service and other Supervised injection sites: What has been learned from research?," which was released in early April. According to Simon Fraser University criminologist Neil Boyd, who was hired by the government to advise the committee overseeing the study, the research shows that InSite has no apparent negative impacts, has resulted in "modest decreases" in drug use, and has not disturbed public order.

In fact, said Boyd at a press conference announcing his findings, InSite should not only be continued, but the program should be expanded to other locations. "I think our data suggests... the building of additional facilities of a similar kind in neighborhoods where they are needed would yield benefits much in excess of the costs required for such projects," he said.

That's unlikely under the Harper government, which is ideologically opposed to such harm reduction practices and in fact removed funding for them from its anti-drug budget. As Harper put it last October: "Because if you remain an addict, I don't care how much harm you reduce, you're going to have a short and miserable life."

Harper has also scoffed at empirical evidence when it conflicts with his agenda. In a January speech to party faithful, he mocked opponents who cited falling crime statistics in challenging his emphasis on law and order. "They try to pacify Canadians with statistics," said the prime minister. "Your personal experiences and impressions are wrong, they say; crime is really not a problem."

More recently, Health Minister Tony Clement and his underlings have sounded similar themes. Science would not be the only factor in determining whether to continue InSite's exemption, Clement's undersecretary, Winnipeg MP Steven Fletcher told The Canadian Press earlier this month. While the government would make a "rational and thoughtful decision based on science," it must also take into account "the realities of the situation," Fletcher explained. "There's multiple sides to this and they all have to be taken into consideration," said Fletcher.

When pressed in parliament by Vancouver East MP Libby Davies, a staunch InSite supporter, Clement vowed to make a decision before June 30 and responded to her criticism about rejecting the science supporting the program: "We are the government that actually wants more research, that actually commissioned more research because we want to make sure this decision is the right decision for Canada, for addicts and for the community in Vancouver," he said. "That is the decision we have made, more research and more consideration. That is because we are open-minded and we want to make the best decision for Canada and Canadians."

Now, as the June 30 deadline looms, InSite's supporters have mobilized. Already this month, the International Journal of Drug Policy published articles by scientists from around the world condemning the federal government for interfering politically with the site's research, Boyd held his Ottawa press conference, advocates held a rally in a Downtown Eastside park featuring 1,000 white crosses to symbolize the people who didn't die from drug overdoses while injecting at InSite, Vancouver street nurses picketed the office of the Vancouver Police Union, whose president is a leading critic of the site, BC Nurses Association president Debra MacPherson held a press conference to tout the health benefits of InSite, and all three BC civic parties have signaled their joint support of the program.

"We're fully behind the effort to keep InSite open," said David Hurford, director of communications for Vancouver Mayor Sam Sullivan. "It is part of the solution, not part of the problem, and it is a bottom-up solution from the grassroots. The federal government has said it supports grassroots decision-making, so why should bureaucrats from 3,000 miles away be making decisions for us here?" he asked.

The mayor's office is "working with local stakeholders to help communicate the benefits of InSite," said Hurford. "We wrote to the health minister last week asking him to keep the site open, and at a minimum, to extend the permits until all pending legal issues are heard."

Hurford is referring to a lawsuit pending in the BC courts that challenges Health Canada's jurisdiction over InSite. That suit argues that since under Canadian law, health care is the domain of the provinces, the federal government should not have control over InSite. But that lawsuit will not be settled by the end of next month.

Opposition politicians have also joined the fight. "This government chooses to view harm reduction as nothing more than dirty words, at the expense of protecting the safety and health of Canadians," said Liberal Party public health spokesperson Dr. Carolyn Bennett.

"The results from the InSite project show measurable evidence that it saves lives," said Liberal MP Dr. Hedy Fry, who played a key role in bringing the agreement that allowed InSite to open. "This has won it widespread support not only from experts in Canada but from the international scientific community, from the Vancouver police and from residents of the Downtown Eastside," said Dr. Fry. "It is simply irresponsible to ignore scientifically-based proof of the efficacy of harm reduction programs like this, and base public policy on ideology alone because real people suffer the consequences."

"The Conservative government must stop its unconscionable interference in scientific research on Vancouver's safe injection site," added New Democratic Party MP Libby Davies, who represents the Downtown Eastside. "Medical researchers from the University of British Columbia have revealed that Harper and his team have been suppressing evidence and denying funding to scientists who are looking objectively at the merits of Insite," she said.

"More than 20 medical and academic studies have been published showing the health and social benefits of InSite. We now have both scientific fact and evidence from users in our community that this facility is helping, not hurting the people of our city. The research record shows that Insite saves lives and increases public safety," Davies continued. "Harper doesn't understand that you can't just hide the facts whenever they don't suit your political agenda. We need a change in direction. It's time for this government to make decisions based on evidence instead of ideology -- InSite needs to be kept open."

"What we want is a 3 ½ year renewal of the exemption from the Controlled Substances Act," said Nathan Allen of InSite for Community Safety. "The fact that the Harper government has not granted this renewal shows they are very reluctant to support the community."

While the Harper government has previously said it needed more research to evaluate InSite's efficacy, that dog won't hunt anymore, said Allen. "They've already spent more than $1.5 million studying InSite, they've produced two dozen academic papers, and they've concluded that it has all kinds of positive impacts. We're wondering what questions the government has left to ask," he scoffed. "InSite has undergone the most thorough and well-funded scrutiny of any health clinic in the country."

In the event the government refuses to grant another exemption, Allen said he hoped it would respect provincial authority and local autonomy. "This has been a regional response to a local crisis here in Vancouver. We need to let the people here on the ground do what they need to do. If not, people will die," he predicted bluntly.

The clock is ticking for InSite, but the pressure is mounting on the Harper government. The next few weeks will determine if that pressure is sufficient to overcome the government's ideological opposition to the safe injection site.

Southeast Asia: Vietnam Ponders Drug Decriminalization

The Vietnamese National Assembly is considering legislation that would make drug use an administrative violation -- not a crime. Under current Vietnamese law, drug use is a criminal offense, a violation of Article 199 of the country's criminal code, and is punishable by up two years in prison.

But Truong Thi Mai, chair of the Assembly's Committee on Social Affairs, told a press conference last Friday the committee had recommended scrapping Article 199. "Being addicted to or using drugs should be considered a disease, and should only be subject to administrative fines," Mai said. "We cannot jail hundreds of thousands of drug users, can we?"

In actuality, Vietnam does not typically jail drug users; instead, it confines them in mandatory drug detoxification centers for up to two years, or in some centers, up to five years. Local governments maintain lists of drug addicts in their areas and send them to detox centers at their discretion. Few drug users are actually prosecuted under Article 199, so the impact of a decriminalization move would be mostly symbolic.

Still, that would be a good thing, said Le Minh Loan, a police chief and former director of counter-drug efforts in a province with one of the country's highest heroin addiction rates. "I think it makes sense to drop the article," Loan said. "Few countries in the world sentence drug addicts to prison terms."

Vietnamese drug rehabilitation efforts are not particularly effective, Loan said. "The rate of relapse into drug use is very high."

While Vietnam has harsh laws for drug dealing -- 85 people were sentenced to death last year for drug offenses and nine more so far this year -- those laws have had little impact on drug use in the Southeast Asian nation. Harsh enforcement is not working, said Mai. "Many people have been sentenced to death for trafficking heroin, but heroin trafficking is still rampant," Mai said. "The traffickers know that the laws are strict but they are still trafficking narcotics."

Drug Treatment: Idaho Senate Overrides Governor's Funding Increase Veto, Battle Continues

The Idaho Senate voted overwhelmingly Tuesday to override a gubernatorial veto of a bill that would have increased funding for drug treatment and prevention programs. Now, the House must vote to override by a similar "supermajority" to complete the restoration of funding against the wishes of Republican Gov. Butch Otter.

Last week, Otter vetoed line items in two bills that would have provided $16.8 million for Idaho substance abuse programs. The Senate override vote on SB 1458 restores $2.4 million in supplemental funding. But Otter also vetoed $14.4 million in treatment funding for the coming year in HB 608.

The twin vetoes would cut in half the funding for drug courts and treatment for probationers and parolees, as well as some community-based treatment programs. The tussle at the statehouse is the latest round in fighting over how best to continue a three-year, $21 million dollar anti-drug effort originally funded by a federal grant. The federal money ran out last year, and lawmakers replaced it with state funds. Otter complained that the programs were unproven and had been expanded beyond their original scope.

But the state Senate seemed determined to do something other than just pay for more prison cells, and for several senators, Idaho's drug war has hit close to home. "I don't believe there is a family represented in this body who has not been affected by drugs or alcohol or mental health problems at some point," said Sen. Chuck Coiner (R-Twin Falls) in remarks reported by The New West magazine.

Sen. Brent Hill (R-Rexburg), also speaking in support of the override, told of a family member "almost ruined" by methamphetamine. "Her teeth rotted right out of her head," he told his colleagues.

Sen. Lee Heinrich (R-Cascade) said his son had spent two and a half years in prison on drug-related charges. "He could have benefited from this program... I know what these drug-related things can do to families," he added, but then said he would vote against the override because he wasn't sure "we've looked at all the alternatives."

But it was Sen. Dean Cameron (R-Rupert) who was perhaps most perceptive, speaking of a "paradigm shift" among his conservative colleagues. "Doesn't it seem smart to get on the front end of these decisions? Doesn't it seem smart to try to affect them before they become incarcerated, so they don't offend in the first place?" he asked. "Cells alone are not the answer."

At mid-week, the governor was signaling he still sought compromise. "The governor has consistently indicated that he was willing to discuss this issue and reach a compromise as he has on other important issues," he said in a Wednesday statement. But the size of the increase in treatment spending "could not be justified in a year when we are asking so many others agencies, not to mention state workers, to do with less."

Now, the ball is in the House's court.

1/3 of People Admitted to Marijuana Treatment Hadn't Been Smoking Marijuana!

Advocates for harsh marijuana laws can be counted on to infuse their rhetoric with incessant declarations that marijuana is highly addictive. Rarely, if ever, could one expose oneself to such discussion without being told something like this:
Decriminalizing marijuana – the drug which sends the most of America's youth into substance abuse treatment and recovery – is a dangerous first step towards complete drug legalization. In fact, marijuana sends the highest percentage of New Hampshire residents into drug treatment than any other illicit drug.


I strongly urge responsible leaders in New Hampshire to stop any effort to decriminalize or legalize the highly addictive drug marijuana."
These words belong to the Deputy Drug Czar and they are less than a week old, thus they represent what his office currently believes to be the strongest and most important argument for marijuana prohibition: that the drug is highly addictive.

As Paul Armentano at NORML points out, however, the government's own data on marijuana dependency shows that a plurality of people entering treatment for marijuana hadn't smoked it in a month or more. Isn't that just amazing? I mean, wow. 36% of people entering treatment for pot addiction had already kicked the habit on their own. Highly-addictive my ash.

But how could this be? The answer can be found on this page, which shows that 58% of people entering marijuana treatment were referred by the criminal justice system. They didn't ask for help, rather they were found in possession of marijuana, which led a judge to issue a diagnosis of "marijuana addiction" and order them to get help for that.

When more than half the sample consists of people who were forced into treatment, it should come as no surprise that so many of them haven't actually been smoking marijuana. Some may never have been marijuana users to begin with and just happened to be in the wrong place at the wrong time. More commonly, I suspect, a large number of marijuana arrestees simply quit after getting busted, either voluntarily or because their lawyers recommended it, pretrial drug screenings, etc. Since marijuana isn't actually very addictive to begin with, this is easy to do.

And yet we continue to waste limited government resources investigating, arresting, adjudicating, and treating these people for an addiction they never actually had. In sum, the Drug Czar's best evidence of marijuana addiction comes from the fact that the government categorizes people as marijuana addicts if they're found sitting near a bag of marijuana. The instant we stop calculating it that way, the evidence ceases to exist and the drug warriors' favorite and best argument against marijuana reform is, well…cashed.
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Drug War Chronicle Book Review: "Over the Influence: The Harm Reduction Guide to Managing Drugs and Alcohol," by Patt Denning, Jeanne Little, and Adina Glickman (2004, Guilford Press, 328 pp., $16.95 PB)

Phillip S. Smith, Writer/Editor

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We usually reserve this space for books hot off the press, but in the case of "Over the Influence," we make an exception. This book is special enough for us to make it a premium for our contributors, and given that we are publishing a story this week about the rapidly rising toll from drug overdoses, we think its importance is self-evident.

Like most people interested in drug law reform, I believe that substance use is a constant in human affairs, and that -- as US history over the past few decades demonstrates -- nothing short of totalitarianism can stomp it out, and then, most likely, only temporarily. I also believe that substance use does not automatically equate to substance abuse or addiction.

Nor am I especially comfortable with the "disease model" of addiction championed by the mad scientists of NIDA, as well as too many well-meaning drug reformers and, perhaps, self-interested drug treatment providers. The concomitant to the disease model, which seeks to replace human agency with biopsychopharmacological determinism, is the Alcoholics Anonymous-based drug treatment dogma that people with problematic drug habits are addicts, the victims of a progressive, incurable disease whose only cure is lifelong abstinence.

As the authors of "Over the Influence" note, philosophical objections aside, a major, major problem with abstinence-based drug treatment is that it just doesn't work. Although abstinence-based programs account for more than nine out of ten programs in the US, that appears to be more because of inertia than results: Such programs, which define "success" as abstinence from all drugs, work only between 5% and 39% of the time, and that's for the small minority of users who actually complete them.

Instead of relying on programs and models that rely on the disease model and the insistence that the only success is staying completely straight, the authors of "Over the Influence" suggest that we apply the principles of harm reduction to drug use in our personal lives. While the notion of harm reduction in this context is controversial, it shouldn't be -- because it's only common sense.

Harm reduction accepts that people may do things that pose potential risks or harms to them and -- duh -- seeks to reduce those harms. Some people like to race automobiles. Abstinence says they should never race; harm reduction says they should wear helmets and protective clothing. Some people (like those darned teenagers) like to have sex without waiting for marriage. Abstinence says they should remain virgins until the holy day arrives; harm reduction says provide them with birth control and protection from disease if they're going to be sexually active.

When it comes to substance use, the advocates of abstinence are even more insistent: The only way to cure the disease is to never use any psychoactive substance (except for cigarettes and coffee, as any AA veteran knows). But Denning, Little, and Glickman, all three of whom have long experience in harm reduction and therapy under their belts, dare to suggest what has heretofore been anathema in the treatment community: There are other choices besides quitting. In fact, they take as their mantra a slogan popularized by the Chicago Recovery Alliance: Any Positive Change.

What does that mean? Say you think your cocaine use is getting out of hand. You had been snorting only on weekends, but now you find yourself doing it every day. Can you at least skip Tuesday and Thursdays? If you manage to do that, you have not only reduced the potential harm of chronic cocaine use, you have also proven to yourself that you can control your relationship with your drug of choice, that you are not a helpless victim doomed to a downward spiral of addiction and misery.

Or maybe you like to drink, but you find that your nightly bottle of wine is making you so sluggish the next day that you are not getting your work done and your job could be in jeopardy. Can you make it a half-bottle? If so, once again, you have reduced the harm of your substance use and you have demonstrated your control over your own life. And you have not given up the fruit of the vine, only moderated your use of it.

Of course, not everyone is just going to wake up one day, decide to change their substance use habits, and be successful at it. But even if one does not succeed on the first try, the very act of trying to assess and regulate one's drug use is a step in the direction of harm reduction. One of the elements that makes "Over the Influence" so useful for drug users (and those concerned about them) is that it shows readers how to think critically about their drug use, its benefits, and its potential harms. A little introspection never hurt anybody, and when it comes to potentially lethal substances like alcohol or hard drugs, a little introspection can save lives.

"Over the Influence" is absolutely essential for anyone seeking to come to grips with his or her substance use, and even more so for those friends or family members of people who are having problems with their drug use. Unlike AA-based abstinence programs, which seem to work for only a small percentage of people, applying the principles of harm reduction to substance use is likely to make a difference in the larger world of still-drug-using people.

It seems so sensible. How can this be controversial?

Pregnancy: Arizona Bill to Force Meth-Using Mothers-To-Be Into Treatment Passes Committee

The Arizona Senate Judiciary Committee Monday approved a bill that would allow the state to detain pregnant women who use methamphetamine and hold them involuntarily in drug treatment programs. The bill also creates the crime of child abuse against a fetus. With a 4-3 "do pass" vote in the committee, the measure now heads for the Senate floor.

The bill, SB1500, is sponsored by Sen. Pamela Gorman (R-Anthem). In committee, Gorman said she is not normally a proponent of government interference in the private lives of citizens. "But I do think that the state has some very specific roles," she said. "And one of them is to protect people from harm from other people."

Under the bill, if state Child Protective Service workers know or have reasonable grounds to believe a pregnant woman is using meth and is not voluntarily seeking treatment, they must seek a court order requiring her to cooperate in a treatment program. If the woman refuses to cooperate, the bill would allow CPS to ask a judge to have sheriff's deputies pick up the woman and take her to a treatment facility. As the bill itself puts it:

"Allows a CPS worker to petition the court for an emergency custody order directing a sheriff or law enforcement officer to take the expectant mother into custody and transport the expectant mother to an institution or facility specified in the order, if either of the following applies:

a) the expectant mother refuses to comply with an issued order to cooperate.

b) the CPS worker reasonably believes that the expectant mother has previously failed or refused to comply with an appropriate prescribed course of treatment or monitoring and believes that emergency custody is necessary to protect the unborn child."

Such an unprecedented intervention is necessary given the "highly addictive" nature of meth, Gorman said. Even women highly motivated to stay clean could backslide, she warned. "I would propose that a child can't wait for a year for backsliding off good intentions to be released from being forced-fed methamphetamines by the mother," Gorman said.

Meth-using pregnant women had no advocates at the committee hearing. The three committee members who voted against the measure did so not out of concern for the well-being of those women, but out of fear that Gorman's measure could be a stalking horse for cracking down on abortion in the state. The portion of the bill that creates the crime of child abuse against a fetus could be used to halt abortions, they warned.

Bush Drug Treatment, Prevention, and Recovery Budget Cuts Raise Chorus of Criticism

The Bush administration's proposed Fiscal Year 2009 spending for drug treatment, prevention, and recovery includes significant funding cuts for some programs, and that has critics ranging from former federal drug warriors to the treatment and recovery community crying foul. While economic pressures may necessitate a lean budget, say the critics, cutting drug treatment, prevention, and recovery is not the way to do it.

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Bush administration drug strategy report and budget
Overall, substance abuse treatment and prevention funding within the Substance Abuse and Mental Health Services Administration (SAMHSA), the main conduit for such funds, will decrease from $2.35 billion this year to $2.27 billion next year. (See details of the SAMHSA budget here.) Other highlights and lowlights of the treatment, prevention, and recovery budgets include:

  • Funding for the Substance Abuse Prevention and Treatment Block Grant program would see a small increase to $1.779 billion, but that increase would be earmarked for the most effective existing grant recipients.
  • The Center for Substance Abuse Treatment (CSAT) would receive $336.7 million, a decrease of $63 million from FY 2008, and a number of programs would be zeroed out, including the Recovery Community Support Program. Other losers include the Treatment Systems for the Homeless program (cut from $42.5 million to $32.6 million) and the Opioid Treatment Program/Regulatory Activities (cut from $8.9 million to $6 million). But funding for the Access to Recovery grant program would remain unchanged at $99.7 million, and drug court funding would increase from $15 million to $37 million.
  • The Center for Substance Abuse Prevention (CSAP) would receive $158 million, a decrease of $36 million from FY 2008.
  • Funding for the Center for Mental Health Services would be cut by $126 million.
  • The Safe and Drug-Free Schools and Communities (SDFSC) State Grants program, which supports community-based prevention programming through the Department of Education, would receive $100 million, a decrease of $194.8 million.
  • The National Institute on Drug Abuse (NIDA) would receive $1.002 billion, a nearly $1 million increase over FY 2008.
  • The National Institute on Alcohol Abuse and Alcoholism (NIAAA) would receive $436.68 million, a $0.4 million increase over last year's funding.

"We're very concerned about these cuts and looking forward to working with Congress to restore the funding," said Pat Taylor, executive director of Faces and Voices of Recovery, a national organization advocating for those affected by substance abuse problems. "We're especially concerned about the elimination of the Recovery Community Services Program -- it's the only program that funds community recovery services," she said.

Even though the Office of Management and Budget (OMB) report that accompanied the Bush budget claimed such programs are ineffective, thus justifying their being cut, Taylor said that report was wrong. "We know from the government's own data that these programs are highly effective at a relatively low cost," she said. "Funding has gone to organizations that have leveraged tens of thousands of volunteer hours in communities around the country."

"There's not a lot of money for treatment and prevention as it is," said Bill Piper, director of national affairs for the Drug Policy Alliance. "Bush is also cutting law enforcement," Piper said, referring to proposed cuts in the Byrne Justice Action Grants program, "but we know which one Congress is more likely to restore."

"I've argued for years that it's a gross distortion of resources to deny as much funding as necessary for drug treatment, prevention, and education. That is how we stop the link between drugs and crime," said Robert Weiner, who as public affairs director under drug czar Gen. Barry McCaffrey frequently earned reformers' ire (on other issues). Weiner added that two-thirds of arrestees test positive for illegal drugs. "If we prevent it on the front side before forcing them into prison, we save literally billions of dollars and make productive citizens out of these people. The federal drug budget needs to be refigured to change its priorities," he said.

Weiner also had harsh words for the current drug czar, John Walters, for failing to protect his bureaucratic fiefdom. Under Walters, the drug budget under the control of ONDCP has declined from $19 billion to $13 billion.

"That's outrageous," Weiner complained. "Walters has his head in the sand and has been ceding authority. The point of his office was to create an overseer to ride herd on drug policy, but instead, Walters has just been a lackey to this politics of fear and terror and homeland security and has given away the store. It's not just individual programs, but an overall ceding of authority, and that's a shame."

Weiner isn't the only former federal drug warrior taking pot-shots at the Bush administration's drug policy spending priorities. John Carnevale, who served under four different drug czars and helped set federal drug budgets and strategies, ripped into the Bush administration earlier this month with a policy brief charging that it had consistently emphasized the least effective aspects of drug control policy.

According to Carnevale, supply reduction (law enforcement, interdiction, eradication) spending has grown 57% during the Bush years, while demand reduction (treatment, prevention, recovery) spending has increased by only 3%. The ratio between supply reduction and demand reduction spending is about 2:1, near where it has been historically despite repeated claims by federal drug fighters that they are shifting to a more balanced approach.

As Carnevale notes, "Research suggests that treatment and prevention programs are very effective in reducing drug demand, saving lives, and lessening health and crime consequences. It has demonstrated that attacking drugs at their source by focusing on eradication is expensive and not very effective. It has demonstrated that interdiction has little effect on drug traffickers' ability to bring drugs into the United States and on to our street corners where they are sold."

Perversely, however, interdiction funding increased the most during the Bush years, doubling from $1.9 billion in 2002 to $3.8 billion in 2009, while source country funding increased by 50%, law enforcement by 31%, and treatment by only 22%. Spending for drug prevention, on the other hand, actually declined by 25%.

"If research were our guide," wrote Carnevale, "then one would expect the opposite ordering of increases in budgetary resources for drug control. The failure to incorporate research into the budgetary process is a lost opportunity to produce results. The only positive news in this decade is the reduction in youth drug use, a trend which started in the previous decade. Today's discussion of drug policy performance overlooks the fact that adult drug use and rates of addiction remain unchanged in this decade."

The chorus of critics is not just complaining. Led by the treatment and recovery community, moves are afoot in Congress to seek a better mix when it comes to drug policy funding. Look for battles to come in committee hearing rooms and floor votes as advocates seek to restore funding to useful and effective programs.

"These cuts are very shortsighted and I don't think they will stand," said Taylor. "We are working with many allied organizations to support a different budget proposal that we will be distributing on Capitol Hill next week. There is a lot of interest there in moving forward instead of back."

Stop Filling Prisons, California -- Advocates to Take Sentencing Reform Case to Voters

California's prison system is in crisis. With some 172,000 inmates, the state's prison system is second only to the federal system in size, and its budget has ballooned by 79% in the last five years to nearly $8 billion annually. Still, the system is vastly overcrowded and faces two federal class-action suits seeking to cap inmate populations because overcrowding is resulting in the state not delivering constitutionally adequate medical and mental health care.

https://stopthedrugwar.org/files/prison-overcrowding.jpg
overcrowding at Mule Creek State Prison (from cdcr.ca.gov)
In December, Gov. Arnold Schwarzenegger announced he was considering a plan to release some 22,000 nonviolent inmates early in response to the festering crisis. But that one-shot approach would not deal with the systemic problems and policies that created the prison crisis in the first place.

Now, after years of inaction in Sacramento in the face of the crisis, a well-funded initiative campaign that would result in a seismic shift in California sentencing and prison policies, especially when it comes to drug offenders and those whose offenses are related to their problematic drug use, has gotten underway. Dubbed the Non-Violent Offender Rehabilitation Act (NORA), the initiative would dramatically expand the treatment and diversion options made available under a previous reform initiative, Proposition 36, as well as reform parole and probation programs, and make simple marijuana possession an infraction instead of a misdemeanor.

About 35,000 California inmates, or about 20% of the prison population, are doing time for drug offenses. An unknown number, certainly in the thousands and possibly in the tens of thousands, are doing time for offenses related to their drug use. It is these offenders and their future brethren at whom the NORA initiative is aimed.

Sponsored by the Drug Policy Alliance Network, the lobbying arm of the Drug Policy Alliance and the Santa Monica-based Campaign for New Drug Policies, the people who engineered the successful Prop. 36 campaign, the NORA initiative would:

  • Create a multi-track diversion program for adult offenders. Track I provides for treatment for nonviolent drug possession offenders with a plea held in abeyance during treatment. For those who wash out of Track I, Track II provides Prop 36-style treatment after conviction, with graduated sanctions for probation violations, including eventual jail time. Track III is an expansion of existing drug court programs, with stronger sanctions than the other tracks. Judges would have the discretion to use Track III not only for drug offenders, but for any non-violent offenders whose crimes are linked to their drug use. Track III would be mandatory for those identified as "high-cost offenders" (five arrests in the past 30 months). The initiative would fund the diversion and treatment program at $385 million per year.
  • Create drug treatment programs for youth. NORA would invest about $65 million a year to build a prevention and treatment program for young people where none currently exists.
  • Require California prisons to provide rehabilitation programs to all exiting inmates at least 90 days before release and for up to a year after release at state expense.
  • Allow nonviolent prisoners to earn sentence reductions with good behavior and by participating in rehabilitation programs.
  • Cut parole periods for qualifying nonviolent offenders to between six and 12 months, instead of the current up to three years. Early discharge from parole could be gained with completion of a rehabilitation program.
  • Make simple marijuana possession an infraction (ticketing offense) instead of a misdemeanor.

Not only would NORA mean freedom for thousands of nonviolent drug and drug-related offenders, it would also save California billions of dollars. Prop. 36 is estimated to have saved at least $1.3 billion in five years by diverting offenders to treatment, and the California Legislative Analyst's Office projects that NORA could generate a billion dollars a year in savings for the prison system, as well as obviating the need for a one-time prison-building outlay of $2.5 billion.

Paid canvassers for NORA are already hitting the streets in California. They have until April 21 to gather some 435,000 valid signatures to put the measure on the November ballot. NORA will make that goal, organizers vowed.

"We've just announced this to our members and started gathering signatures," said Margaret Dooley-Sammuli of the Southern California office of the Drug Policy Alliance Network. "We're very excited. It looks like the largest sentencing and prison reform in American history will be on the November ballot."

"This is Prop 36 on steroids," said Dale Gieringer, executive director of California NORML. "If it passes, this will lead to a comprehensive rewrite of all of California's laws regarding sentencing, probation, and parole for nonviolent, drug-related offenses. And this is a professional campaign. The measure will be on the ballot in November," he flatly predicted.

"Prop. 36 has been such a success, it has been extensively studied and proven, but the biggest problem is that it isn't big enough," said Dooley-Sammuli. "Combined with the difficulty of getting any prison reform through and of even obtaining adequate funding for existing reforms because of the impasse in Sacramento -- we've seen so many prison reforms die there -- we thought we really needed to put this on the ballot for stable funding, more treatment, and more diversion," she said.

"But NORA is not just about expanding Prop. 36," Dooley-Sammuli was quick to point out. "This is primarily a prison and sentencing reform effort. It brings common sense solutions to the problem of over-incarceration in California, especially the over-incarceration of nonviolent offenders in this state."

"The state has been incredibly reluctant and negligent in addressing the whole problem of nonviolent prisoners," said Gieringer. "Every effort to extricate drug offenders from the prison system has been seen as a political hot potato and has gone nowhere. Sentencing reform is political poison in Sacramento, yet we have this simmering prison crisis here in California."

If the politicians refuse to act, said Gieringer, it is time to take the issue directly to the voters. "This initiative is very justified because of the negligence of California's political class in not dealing with these issues," he said. "In fact, it is overdue, and now we the people have to try to come to grips with the failure of our political leaders to act. And I think we have the public on our side. The polling on this has been very favorable. Most people think nonviolent drug offenses should be handled with treatment, not prison."

"We have federal judges considering whether to take over the entire state prison system," said Dooley-Sammuli. "We don't have solutions coming out of Sacramento. We have very real budget problems that mean we can't afford to keep spending what we are on incarceration. NORA reallocates state spending from incarceration to treatment and rehabilitation, so we will end up with substantial savings over time," she predicted.

Gov. Schwarzenegger's move to release some prisoners early is necessary, but not sufficient, said Dooley-Sammuli. What is needed is not one-shot fixes, but systemic reforms, she said. "NORA is not a one-time opening of the jailhouse gates," said Dooley-Sammuli, "This is about systemic change in our sentencing and parole practices. This is not radical; it's common sense. This is not soft on crime; this is smart on crime. NORA will allow us to get past the politicking and get some solutions."

At this point early in the campaign season, there is no organized opposition, but that is almost certain to change. Too many powerful groups, from prosecutors to prison guards, benefit from the status quo, and fear-mongering on crime issues is a perennial favorite among politicians.

"The question is whether there will be any well-funded political opposition," said Gieringer. "Then there might be a real fight. But we haven't seen an opposition committee form yet. That's the real question mark."

NORA organizers have done their best to blunt opposition at the early stages by bringing potential opponents into the process, said Dooley-Sammuli. "We made many, many efforts to make this a collaborative process by reaching out to a wide variety of stakeholders. This has been a broad effort to bring in as many perspectives and sets of expertise as possible, and we've tried to make friends instead of foes," she said.

Coerced drug treatment is not the best of all possible worlds. But it's difficult to argue that drug law violators are better off in prison than in treatment. The NORA initiative will give California voters a chance to take a giant step in sentencing and prison reform and a small step toward true justice for drug users.

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