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Chronicle AM -- June 17, 2014

It looks like Oregon is set to join Alaska in voting on marijuana legalization this year, the New York medical marijuana bill is going down to the wire, Florida's governor signs a pair of drug-related bills, Colombia's drug-reforming president wins reelection, and more. Let's get to it:

Colombia's drug reforming and peace negotiating President Juan Manuel Santos has won reelection. (wikiemedia.org)
Marijuana Policy

New Approach Oregon Legalization Initiative Now Has More Than 100,000 Signatures. Only yesterday, we reported that just before the weekend, the New Approach Oregon legalization initiative had handed in some 83,000 raw signatures, but that proponents would need more than 100,000 raw signatures to feel comfortable that they will actually attain the 87,213 valid signatures needed to qualify for the November ballot. Now, the campaign reports that it has more than 100,000 raw signatures and will continue signature-gathering until the July 3 deadline. It looks like Oregon is about to join Alaska as states where residents will vote on marijuana legalization this fall.

Medical Marijuana

Thirty Congressmembers Call on HHS to End Roadblocks to Marijuana Research. Thirty members of Congress led by Rep. Earl Blumenaur (D-OR) have sent a letter to Health and Human Services Secretary Mathews Burkwell calling on her to make the process for obtaining marijuana for research purposes less onerous.

California Assembly Committee is Debating Medical Marijuana Regulation Bill. A bill that would create the first statewide regulation of medical marijuana is being heard in the Assembly Business, Professions and Consumer Protection Committee today. Senate Bill 1262, sponsored by Sen. Lou Correa (D-Santa Ana), has already passed the Senate.

Florida Governor Signs Limited CBD Medical Marijuana Bill. Gov. Rick Scott (R) Monday signed into law the "Charlotte's Web" bill (Senate Bill 1030), which allows a small number of patients to use high-CBD, low-THC cannabis oils for the treatment of epilepsy or cancer.

New York Medical Marijuana Fight Going Down to Last Minute. Medical marijuana proponents continued to do battle with Gov. Andrew Cuomo (D) over the Compassionate Care Act as the state's legislative session draws to a close. Legislators have amended the bill to address Cuomo's concerns, but patients and providers expressed outrage over Cuomo's "attempt to derail the legislation." Cuomo has called for eliminating many medical conditions from eligibility for medical marijuana, as well as imposing onerous restrictions on physicians. Another obstacle is the Senate's GOP leadership, which could block a floor vote. The session ends on Thursday.

Oklahoma Initiative Signature-Gatherers Complain of Harassment by Tulsa Police. Signature-gatherers for the state's medical marijuana initiative say that on at least four occasions, Tulsa Police have shown up to harass them. Police asked signature-gatherers to leave, then, when they asserted their right to petition, began asking for identification and doing background checks on them. Tulsa Police, for their part, said they had records of two calls reporting that signature-gatherers were selling marijuana. But no one was arrested for selling marijuana or anything else, and the campaign group Oklahomans for Health said its people were not selling or advertising marijuana. The group said it has asked the ACLU of Oklahoma for assistance.

Privacy

Methadone Advocates Warn of SAMHSA Patient Confidentiality Threat. A proposed Substance Abuse and Mental Health Services (SAMHSA) regulation that would end the exclusion of methadone treatment records from electronic health records is raising concern among methadone advocates. They say methadone patients suffer from stigma and that the records of their treatment should stay protected. Click on the link for information about how to have some input on the decision-making process.

New Synthetic Drugs

Florida Governor Signs Bill Targeting New Synthetic Drugs. Gov. Rick Scott Monday signed into law House Bill 697, which adds six new synthetic drugs to the list of criminally banned substances. The new synthetics targeted all appear to be phenethylamines.

Law Enforcement

South Dakota Drug Arrests Up More than 40% Last Year. Although overall arrests were only up slightly last year, drug arrests in South Dakota jumped more than 40%. Law enforcement is saying the big jump is due to the increased presence of meth and other drugs in the state's largest cities, Sioux Falls and Rapid City "Certainly more people have been arrested for drug offenses," Attorney General Marty Jackley said. "Part of that is attributable to more people using controlled substances." Drug arrests accounted for one out of six of all arrests in the state last year. More people were arrested for drugs than for DUI, assault, or larceny.

New Orleans Police Department Loosens Past Drug Use Policies. Under a policy change approved Monday, past drug use is no longer an automatic disqualifier for being hired as a New Orleans police officer. Now, applicants can be hired if that have not used marijuana or prescription pills within the last three years and most other drugs within the last 10 years. The brings the NOPD in line with the FBI and other major city police departments.

International

Drug Reformer, Peace Negotiator Juan Manuel Santos Re-Elected President of Colombia. Juan Manuel Santos has won reelection as president of Colombia in a race against a rightist candidate who criticized his peace negotiations with the leftist guerrillas of the FARC. Santos has been a loud voice for drug reform on the national and international stages.

Bermuda Approves Drug Testing of Parliamentarians. After rancorous debate, Bermuda's parliament has approved a proposal to require drug testing of parliamentarians. MPS can test positive for marijuana three times before they are suspended; for other drugs, it's one time.

What Does the Dance of the Peruvian Drug Czars Mean? Peruvian President Ollanta Humala recently fired hard-line DEVIDA head Carmen Macias, replacing her with former Defense Minister Luis Alberto Otarola. Humala also backed away from a controversial coca eradication campaign about to get under way in the Apurimac-Ene-Mantaro River Valley (VRAEM) that faced strong local opposition. Washington Office on Latin America analyst Coletta Youngers has written an analysis of what it all means, both domestically and internationally. Click on the link to read her piece.

Chronicle AM -- May 29, 2014

Minnesota becomes the 22nd medical marijuana state, the California Senate passes a medical marijuana regulation bill and a bill equalizing crack and powder cocaine offenses, a new study reports on who current heroin users are, there are a series of votes set for today to rein in the DEA, a Canadian court allows heroin-assisted treatment trials to move forward, and more. Let's get to it:

Cocaine is cocaine, whether rock or powder, and the California Senate has voted to treat it like that. (wikimedia.org)
Marijuana Policy

Michigan Poll Has Support for Legalization at 42%. A Detroit News/WDIV-TV poll released today has support for marijuana legalization at 42%, with 52% opposed. The poll conducted by the Glengariff Group of Chicago surveyed 600 voters. It has a margin of error of +/ -4%. "There is a sharp difference in attitudes on marijuana legalization among voters under and over the age of 40," said pollster Richard Czuba. "And while Democratic voters support legalization of marijuana, independents and Republican voters strongly oppose legalization." Click the link for more demographic details.

Washington, DC, Initiative is Sweating the Signature-Gathering. Organizers of the DC initiative to legalize the possession and cultivation of small amounts of marijuana -- but not the legalization and regulation of marijuana sales -- are "a little nervous" about the progress of their signature-gathering campaign. They have until July 7 to collect 22,373 valid voter signatures. They had collected some 19,000 raw signatures by Monday, but of the 16,734 that have been processed, only 5,360 have been found to be valid.

Delaware Decriminalization Bill Filed. Rep. Helene Keeley (D-Wilmington) today introduced a decriminalization bill, House Bill 371. It would make possession of up to an ounce a civil offense with a maximum $100 fine for people 21 and over. Currently, possession is a misdemeanor punishable by up to six months in jail.

Medical Marijuana

Minnesota Governor Signs Medical Marijuana Bill. Gov. Mark Dayton (DFL) today signed into law the medical marijuana bill approved earlier this month by the legislature. It allows for eight distribution centers across the state to by supplied by two medical marijuana manufacturers. The bill does not allow for the smoking of medical marijuana; but it can be vaped or eaten. Some medical marijuana groups are calling the law "overly restrictive."

California Senate Approves Medical Marijuana Regulation Bill. The state Senate yesterday approved Senate Bill 1262, sponsored by Sen. Lou Correa (D-Anaheim). It is supported by cities and law enforcement, and would impose tighter controls on dispensaries, cultivation, and recommending. A competing bill, Assembly Bill 1894, sponsored by Assemblyman Tom Ammiano (D-San Francisco) was expected to be voted on today. If both pass their respective houses, look for a compromise.

Drug Policy

Congress Set to Vote Today on Four Amendments to Reign in DEA. Congress is set to vote today on at least four amendments aimed at reigning in the Drug Enforcement Administration (DEA). One would prohibit DEA from interfering in states that allow medical marijuana; another would prohibit it from blocking hemp seed imports in states that have approved hemp research; a third would prohibit it from undermining state laws that allow for hemp cultivation; and a fourth would reject a proposed $35 million increase in the DEA's FY 2015 budget.

Heroin

Today's Heroin Users Are Mainly Young, White and Not in the Big City, New Study Finds. A new research article published in the Journal of the American Medical Association finds that, unlike the heroin boom of the 1960s, most heroin users today are young white men whose opiate habits overwhelmingly started with prescription pain pills. "Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas," the authors concluded.

Law Enforcement

Minnesota Prosecutor "Sending a Message" Charges Five Teens With Murder in Teen Girl's Overdose Death. Washington County Attorney Pete Orput has charged five local teenagers with murder in the January death of a 17-year-old girl who died after taking a new synthetic hallucinogen. "We think there's a moral obligation to keep kids free of drugs," said Orput. "We're sending a message that suppliers will be held fully to account." Those charged include a 19-year-old, an 18-year-old, and three 17-year-olds. Orput said the three minors will be charged as adults. The 19-year-old is accused of being the dealer; the others bought some of the drug and shared it among themselves and the dead girl.

Customs to Curtail Searches of General Aviation Aircraft Not Crossing Borders. After loud complaints from private pilots that their domestic flights were being searched for drugs by Customs agents, the Customs and Border Protection agency (CBP) has announced it will curtail the searches. An official told National Public Radio yesterday that "his agency has heard pilots' grievances and the program is being altered so as not to needlessly affront law-abiding pilots." The Airline Operators and Pilots Association has been raising a stink about the issue for the past year, saying it has received more than 50 reports from members who recounted their encounters with law enforcement at airports.

Georgia SWAT Team Throws Flash-Bang Grenade, Burns Toddler in Drug Raid. A 2-year-old child was burned when members of the Habersham County Special Response Team deployed a "distraction device" as they executed a drug search warrant early yesterday morning. The raid came a day after a snitch made a drug buy at the home and reported no children present. The raiders got themselves a no-knock warrant and breached the door of the home. "What had happened was there was a playpen -- a Pack N Play -- that was pushed up against the door, and when they breached the door it wouldn't open up because of the Pack N Play," Sheriff Joey Terrell said. "It was just wide enough to toss the flash bang in, then they had to physically push it [Pack N Play] on out of the way to get in. That's when the team medics saw the child, stopped at the child, took the child out and began first aid. "The door that we entered was the door that we bought dope out of -- that's why entered at that door," Terrell said. "Our team went by the book. Given the same scenario, we'll do the same thing again. I stand behind what our team did," he maintained. He blames the target of the warrant. Read the whole story at the link.

Sentencing

California Senate Approves Bill to Eliminate Crack/Powder Cocaine Sentencing Disparity. The state Senate Wednesday approved a bill that would equalize the penalties for crack and powder cocaine sales and make it easier to get probation for either. The measure is Senate Bill 1010, introduced by Sen. Holly Mitchell (D-Los Angeles). It now goes to the Assembly.

International

Peru Names Former Defense Minister as New Drug Czar. President Ollanta Humala has named former Defense Minister Luis Otorala as the new head of the Peruvian anti-drug agency, DEVIDA. He replaces Carman Masias. Otarola said that while eradication of coca crops will continue, greater emphasis will be placed on economic alternatives for farmers. Hardline critics said the move and the new emphasis "showed a weakening in the resolve of the government" to confront the drug trade. Peru is once again the world's leading coca and cocaine producer.

Medical Marijuana Bill Introduced in Philippines. Rep. Rodolfo Albano III has filed a medical marijuana bill in the Philippine legislature. House Bill 4477, the Compassionate Use of Medical Cannabis Bill, is intended "to provide accessible, affordable, safe medical cannabis to qualifying patients."

British Columbia Supreme Court Grants Injunction for Heroin Treatment Study to Continue. Canada's BC Supreme Court today granted an injunction for an exemption from federal drug laws for participants in the SALOME study (The Study to Assess Long-term Opioid Maintenance Effectiveness). The injunction will allow doctors in the study to continue prescribing heroin to patients for whom other treatment options have been ineffective.

Chronicle AM -- May 12, 2014

Elderly senators grumble about new-fangled rules allowing legal marijuana businesses to use the financial system, there are more legalization polls, an Oklahoma US Senate candidate is talking marijuana reform, there is medical marijuana initiative news, Minnesota passes asset forfeiture reform and the governor signs it, and more. Let's get to it:

Oklahoma state Sen. Constance Johnson (D) is running for the US Senate and talking marijuana reform. (oksenate.gov)
Marijuana Policy

Feinstein, Grassley Try to Thwart Normalized Marijuana Banking. Sens. Dianne Feinstein (D-CA) and Charles Grassley (R-IA) aren't happy with the Obama administration's efforts to find a way to let marijuana businesses in states where it is legal have access to the financial system. They sent a letter to the Financial Crimes Enforcement Network (FinCEN) complaining about the guidance it was offering banks "on providing financial services for drug traffickers," in Grassley's words. FinCen responded here, but that wasn't good enough for the crusty drug warriors. Now, Grassley has responded to the response, maintaining that "unless federal law is changed, selling marijuana, laundering marijuana proceeds, and aiding and abetting those activities all remain illegal" and that "FinCEN's guidance to financial institutions is absolutely contrary to the mission of the agency." Click on the title link to read the rest.

Connecticut Poll Has 52% for Legalization. A Quinnipiac University poll released Monday has support for marijuana legalization at 52% among Connecticut voters, who also said overwhelmingly that alcohol was a bigger health problem than pot. A whopping 80% of voters under 30 supported legalization. Voters also supported having medical marijuana dispensaries in their towns by a margin of more than two-to-one. The state legalized medical marijuana in 2012.

New Mexico Poll Has Only 40% for Legalization, But… an Albuquerque Journal flash poll had support for marijuana legalization at 40%, with 47% opposed. The poll only asked only if marijuana should be legalized, however, without specifying what legalization might look like. A poll done last year for the Drug Policy Alliance got 53% support for legalization when it asked whether marijuana should be legalized for adults so that it could be taxed and regulated, like alcohol, with restrictions on where it could be bought and consumed.

Colorado Marijuana Tax Revenues Top $20 Million So Far This Year. The state Department of Revenue released figures last Thursday showing that revenues from adult and medical marijuana taxes, licenses, and fees were at nearly $22 million for the first three months of the year. The state reported that March adult marijuana sales hit $19 million, up $5 million over February, while medical marijuana sales were about $34 million.

Push Underway to Decriminalize Toledo. A petition drive is underway for a municipal initiative to decriminalize small-time marijuana possession in the Northwest Ohio city. The initiative is sponsored by the Toledo NORML chapter, which says it has already collected 2,800 signatures. It needs 3,800 valid signatures to qualify for the November ballot.

Oklahoma's Leading Democratic US Senate Candidate Pushes Marijuana Law Reform. State Sen. Constance Johnson (D-Oklahoma City), the leading candidate for the state's Democratic Party US Senate nomination, is the author of repeated failed medical marijuana bills in the state legislature and is currently working to get a legalization initiative on the November ballot. A Democrat winning a Senate seat in Oklahoma is a long shot, but Johnson says she hopes marijuana will drive voters to the polls. "This whole issue, to me, is not about smoking marijuana. It's about criminalizing it. That's where these young people stand to be hurt the most. They get that," said Johnson. "Unless we change who's voting, things will stay the same," she said. "It's time to send a message -- not only to the policymakers... but to the people -- that we can change this." You can do that by putting marijuana on the ballot, she said.

Medical Marijuana

Minnesota Governor Says He Will Sign House Bill. Gov. Mark Dayton (DFL) sent a letter Friday to lawmakers saying he could sign the medical marijuana bill passed by the House. Senate File 2470 was filed by Rep. Carly Melin (DFL-Hibbing) after her earlier, full-fledged medical marijuana bill, House File 1818 was blocked by law enforcement and the governor. A stronger bill, Senate File 1641, has passed the Senate, but Dayton didn't say he could sign that one. Now, the Senate must accept the House version or try to reach a compromise in conference committee.

Ohio Medical Marijuana Initiative Campaign in Midst of Signature-Gathering. The Ohio Rights Group is leading a signature-gathering campaign to put a medical marijuana (and hemp) initiative on the November ballot. They need to collect 385,000 valid voter signatures by July 5. They had 50,000 signatures on March 1 and haven't reported any more recent figures, but the campaign has been ramping up this month.

Arkansas Attorney General Again Rejects Medical Marijuana Initiative Language. Attorney General Dustin McDaniel has once again rejected the proposed wording for a medical marijuana initiative from Arkansans for Medical Cannabis. This is about the sixth time he has rejected proposals from the group. Meanwhile, another initiative, this one from Arkansans for Compassionate Care, is in the signature-gathering phase. The Arkansas Medical Cannabis Act needs some 65,000 valid signatures to qualify for the November ballot.

Asset Forfeiture

Minnesota Governor Signs Asset Forfeiture Reform Bill. Last week, Gov. Mark Dayton (DFL) signed into law Senate File 874, which forces authorities to actually convict someone of a criminal offense or get a guilty plea before seizing his property. The bill also forces the government to prove the property was the instrument or proceeds of crime. Previously, it had been up to the victim of the seizure to prove it was not connected to crimes.

Drug Testing

Federal Judge Rejects City of Key West Prospective Employee Drug Testing. A US district court judge has ruled that Key West's policy of drug-testing prospective employees is illegal. The ACLU of Florida had brought suit on behalf of a woman who was offered a job as the city's recycling coordinator, but had the job offer rescinded after she refused a drug test. The city failed to demonstrate "a special need or important government interest which justifies the policy's Fourth Amendment intrusion," Judge James Lawrence King held. And while the city argued that the tests should be allowed because job applicants were forewarned, King wasn't buying it. The law doesn't allow a government entity "to violate a person's rights under the Fourth Amendment so long as prior notice of the impending violation is given," he ruled.

International

Heroin Maintenance Coming to Norway? The Norwegian city of Bergen has proposed undertaking a program of heroin maintenance, or heroin-assisted treatment (HAT). Norway has long been skeptical of opioid maintenance therapies, allowing the use of methadone only in 1998. Dr. Ola Josendal, director of addiction medicine at Haukeland University Hospital proposed HAT clinical trials in December, but the national health minister rejected them. Now, however, the Labor Party, the largest bloc in parliament, is in favor, so it could happen. Stay tuned.

Bermuda Cannabis Reform Collaborative Says Decriminalize It. A panel tasked with examining Bermuda's marijuana laws issued its report last Friday, and it calling for the decriminalization of small-time pot possession, allowing people to grow a small number of plants, and allowing the medical use of the plant on the island. Marijuana prohibition is not working, the report said.

Mexico's Plan to Demobilize Anti-Cartel Vigilantes Hits Snags. Anti-cartel vigilantes in the state of Michoacan were supposed to begin laying down their arms and integrating into a new rural police force Saturday, but The Washington Post reports that the process isn't exactly going smoothly. The vigilante groups formed more than a year ago with an apparent wink and nod from the government and managed to drive the Knights Templar cartel out of parts of the state, but now, the government fears they may get out of control. Click the link for a full report.

(This article was published by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also shares the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

Tennessee's Scary New Law Criminalizing Drug-Using Pregnant Women [FEATURE]

When -- despite the objections of medical groups, reproductive health advocates, and even the drug czar's office -- Tennessee Gov. Bill Haslam (R) signed into law Senate Bill 1391 late last month, the Volunteer State became the first in the nation to pass a law criminalizing pregnancy outcomes. Other states, such as Alabama and South Carolina, have used fetal harm laws to charge drug-using pregnant women, but Tennessee is the first to explicitly criminalize drug use during pregnancy.

Passed in the midst of rising concern over prescription drug and heroin abuse and aimed, its proponents said, at protecting babies, the law allows women to be criminally charged with an "assaultive offense for the illegal use of a narcotic drug while pregnant, if her child is born addicted to or harmed by the narcotic drug or for criminal homicide if her child dies as a result of her illegal use of a narcotic drug taken while pregnant."

Felony assault can earn you up to 15 years in prison in Tennessee. And while some prosecutors have said they will only file misdemeanor charges, that's not written into the law.

Proponents cited recent reports that the number of babies being born addicted to drugs is on the rise. Such infants are diagnosed as having Neonatal Abstinence Syndrome, or withdrawal symptoms after being exposed to opiates in the womb.

"Over the past decade, we have seen a nearly ten-fold rise in the incidence of babies born with NAS in Tennessee," the state Department of Health reported. Infants with NAS stay in the hospital longer than other babies and they may have serious medical and social problems."

But the state Health Department notwithstanding, experts in the field say that NAS doesn't actually have long-term effects, it's not accurate to call newborn infants "addicted," and that misrepresenting matters by vilifying pregnant women isn't helpful. In fact, more than 40 of them said so in an open letter last month.

More generally, leading medical groups, including the American Medical Association, the American Nurses Association, the American Academy of Pediatrics, and the American Public Health Association reject the prosecution and punishment of pregnant women who use drugs. The groups mentioned above and many others said so in this 2011 document.

A coalition of medical, public health, women's rights, and social justice groups worked to oppose the bill as it made its way through the legislature, and then to convince Gov. Haslam to kill it. A petition with over 11,000 signatures urging him to veto the bill went to his office late last month. More than two dozen organizations devoted to ensuring families have access to health care likewise urged a veto, as did the American Association of Pediatrics, the National Perinatal Association, and International Doctors for Healthier Drug Policy.

Even acting drug czar Michael Botticelli raised a warning flag.

"Under the Obama administration, we've really tried to reframe drug policy not as a crime but as a public health-related issue, and that our response on the national level is that we not criminalize addiction," he said during a visit to Nashville as the governor pondered. "We want to make sure our response and our national strategy is based on the fact that addiction is a disease. What's important is that we create environments where we're really diminishing the stigma and the barriers, particularly for pregnant women, who often have a lot of shame and guilt about their substance abuse disorders."

But none of that mattered. On April 29, Haslam signed the bill into law.

"In reviewing this bill, I have had extensive conversations with experts including substance abuse, mental health, health and law enforcement officials," Haslam said in a statement. "The intent of this bill is to give law enforcement and district attorneys a tool to address illicit drug use among pregnant women through treatment programs."

"Today, the Tennessee governor has made it a crime to carry a pregnancy to term if you struggle with addiction or substance abuse," Alexa Kolbi-Molinas, staff attorney with the ACLU Reproductive Freedom Project, said in a statement in response to the signing. "This deeply misguided law will force those women who need health care the most into the shadows. Pregnant women with addictions need better access to health care, not jail time."

The statewide coalition Healthy and Free Tennessee also lambasted the new law.

"We are very sorry to see that Governor Haslam let an opportunity to do the right thing slip through his fingers," said Rebecca Terrell, the group's chairwoman."The experts could not have been clearer: this law is bad for babies and bad for Tennessee."

"This law says that women are to be held criminally accountable for the outcomes of their pregnancies," said Farah Diaz-Tello, a staff attorney with National Advocates for Pregnant Women, which was part of the coalition fighting the new law. "It essentially creates a system of separate and unequal rights. Drug ingestion is not a crime in Tennessee, just possession, and now, only pregnant women are criminalized for ingesting. They can be surveilled and punished by the state in ways different from other people. The law also treats fertilized eggs or fetuses as if they were people independent of the pregnant woman," she told the Chronicle.

Gov. Bill Haslam (tn.gov)
"It's the wrong response to the problem of addiction," said Diaz-Tello. "It's a health problem that is not responsive to threats and punishment. What kind of society do we want to be? Do we want to punish the people most in need of help and support? These are women largely living in poverty, women of color, who are already made vulnerable by our social policies, and now we hold them solely responsible without looking at society and what else is going on leading to pregnancy among addicted people and this horrible punitive response."

Even framing the issue as "pregnant women taking drugs" is somewhat misleading, said Diaz-Tello.

"We often make the mistake of thinking of people using drugs during pregnancy as pregnant women who became addicted to drugs when it should be the other way around," she said. "The reasons for addiction are complex and often gender-based. Women who have experienced violence and trauma are often self-medicating, and there is a lot of unresolved pain and trauma out there. And half the pregnancies in our country are unintended, which disproportionately affects women on the margins. It's not like someone wakes up pregnant one day and decides they want to do drugs."

The law will not operate in a vacuum. Tennessee is one of those states that has refused to expand Medicaid and has rejected the Affordable Care Act. It is more difficult for poor women there to get access to health care services, including drug treatment, but now it will be easier to prosecute them.

"This is definitely for the most part going to affect poor, marginalized, predominantly rural women," said Cherisse Scott, founder of SisterReach, a Memphis-based group working for reproductive justice for women and girls in the city and the Mid-South area. "That's because of the many barriers they face. Many rural areas just don't have the facilities to offer help to these women."

Scott also bemoaned the criminalization of pregnant women who use drugs under the law, a process of stigmatization and punishment only made more severe for women lacking resources.

"Low income women, women of color, already have issues navigating the court system, and many don't have any kind of support system," she said. "When their children are taken, they don't have the resources to get them back. And the other piece of this is that jails aren't hospitals or treatment centers. They don't offer women an opportunity to be properly rehabilitated from drug use."

And then there's the aftermath of a criminal conviction.

"If you look at this through the lens of racial and reproductive justice, how does a woman with this on her record bounce back, how does she get a job? With a criminal background, she will be further locked out," said Scott. "These are the kinds of barriers and issues that will ultimately hurt the mothers of Tennessee. We can't support legislation that uses criminalization as a means of rehabilitating people," she told the Chronicle.

"Our lawmakers had good intentions, but they didn't think it through," said Scott. "They seem to be very ready to separate mothers and children as a way of helping, and we don't see it like that, especially when there are rehab programs that keep mother and children together."

The new law is also generating alarm with advocates for people who use opioid maintenance therapy to deal with opiate addictions. Methadone and buprenorphine maintenance are the gold standard for treating pregnant women addicted to narcotics. While state health officials have said they interpret the law to mean that a pregnant woman on methadone maintenance would not be in violation of it, there is no language in it that explicitly says that.

"I asked the governor to veto the bill because that exclusion wasn't made," said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. "The real question is whether some representative for the attorney general's office or a DA or child protection services interprets it that way. This is a potential problem. When you're talking about child protection, it's not unusual for a judge or child protection worker to say to a pregnant mom 'You can't be on methadone.' I hope this law will not be used as a method of forcing maintained patients out of care."

While babies born to opiate-addicted women can suffer from Neonatal Abstinence Syndrome, or withdrawals, they can be treated for that, mainly by slowly tapering the dose of opiates. But, Parrino said, not all pregnant mothers on methadone maintenance have babies with the syndrome, and consequences for fetuses can be serious if mothers are forced off opiates during their pregnancies.

"What happens to a fetus if you force mom to end her medication?" he asked. "In the first trimester, a sudden decrease can be harmful to the fetus. There could be spontaneous abortion. It's in the literature. That's why laws like this raise concerns in people who have some knowledge about how pregnant women are treated."

Parrino, too, saw race a playing a role, but in an unexpected way.

"What I am seeing for the first time in 30 years is a real interest by elected officials, many US senators and governors and legislators, who can't wrap their heads around why white teens and 20-somethings from middle class families in the suburbs and rural areas are shooting heroin," Parrino observed. "Those elected officials are right to be worried. This legislation in Tennessee is a result of those dynamics."

While the law may have been passed with the best motives, "the problem is the criminalization aspect," said Parrino. "Even if it can be explained as having a reasonably good intention of getting pregnant women not to use drugs and go to treatment, you are unwittingly subverting that goal by saying that being in methadone maintenance might be seen as not complete treatment. That uncertainty is creating anxiety."

The new law is set to go into effect on July 1, but efforts are already underway to block it and, barring that, to mitigate its effects.

"We're still trying to figure out the best plan of action," Scott said. "We want to figure out the best way to support women who are going to be victims of this policy. At the grass roots level, that means education, awareness, getting the word out through rehab centers to let the women know this is coming. Then we have to figure out what is the legal strategy to try to change this law. We're working on it."

"We're thinking about a legal challenge, especially on constitutional grounds," said Diaz-Tello. "We have worked with public defenders in Tennessee and other states on challenging similar laws on constitutional grounds. There's also the possibility of an affirmative suit to get the law enjoined. It would be ideal to stop this law before anyone gets arrested under it."

Barring the successful blocking of the law, drug-addicted pregnant women in Tennessee will face the tender mercies of the criminal justice system. But not all of them, of course.

"Race and class plays a role as always," said Scott. "Poor mothers go to jail; mothers with access to more resources may not be penalized at all. Women who have access to health care and can afford private prenatal care and treatment will get treatment; women who have no alternative but public aid or a public health clinic will be disproportionately impacted as always. Nothing's changed as far as race and class."

TN
United States

Crisis Looms for Addicts as Russia Bans Methadone in Crimea

Things are about to get harder for opiate users in Crimea, the former Ukrainian province now annexed by Russia. While Ukraine has embraced a harm reduction approach to hard drug use, Russia rejects such an approach and has some of the most repressive drug laws in the world.

Oberleitungsbusbahnhof in Simferopol (user Cmapm via Wikimedia)
Russia does not support efficient programs for preventing HIV and Hepatitis C among its drug using population, and harm reduction measures like needle exchanges and opiate substitution therapy (OST), of which methadone maintenance is a subset, are illegal.

Now, the concrete consequences of Crimea's reincorporation into the ample bosom of Mother Russia are coming home for drug users there. On Wednesday, Russian "drug czar" Viktor Ivanov -- one of 31 allies of Pres. Vladimir Putin sanctioned by the US government this month -- announced that Russia will ban the use of methadone in Crimea. That comes after vows a week before that he would move away from harm reduction practices in general in Crimea.

"Methadone is not a cure," Ivanov claimed. "Practically all methadone supplies in Ukraine were circulating on the secondary market and distributed as a narcotic drug in the absence of proper control. As a result, it spread to the shadow market and traded there at much higher prices. It became a source of criminal incomes," he said.

Whatever Ivanov says, cutting off methadone for an estimated 800 patients will be a disaster, the International HIV/AIDS Alliance warned. And the threat of a broader rejection of harm reduction measures puts an estimated 14,000 Crimean injection drug users at risk.

"When the supply of these medicines is interrupted or stopped, a medical emergency will ensue as hundreds of OST patients go into withdrawal, which will inevitably lead to a drastic increase in both acute illness as well as increases in injecting as people seek to self-medicate," said the alliance's Ukraine director, Andriy Klepikov.

"Any interruption to harm reduction programming is a disaster for health, human rights and the HIV epidemic in the region and we urge the authorities in Crimea to step in and ensure that critical supply chains are not disrupted and lives not put at risk as a result of territorial politicking," Klepikov added.

Ukraine has practiced methadone maintenance (or OST) therapy in Crimea since 2005. Patients in Simferopol, Sevastopol, Yalta, Eupatoria, Feodosia, Kerch and other cities receive daily treatment at local healthcare facilities.

The AIDS alliance is not the only group raising the alarm. The International Network of People who Use Drugs (INPUD) has issued an urgent appeal to UN rapporteurs on the Crimea "calling upon you all to issue a public statement making clear the imminent risk that this population faces of losing access to essential medicines, we are requesting that you raise the issue with the Russian government urging them not to close down the currently running opiate substitution programs; and we are calling upon you to raise the issue with utmost urgency with the Human Rights Council with a view to ensuring continued access to the programs."

When it comes to drug policy and harm reduction, Crimea would seem to be worse off as part of Russia than as part of Ukraine. As the AIDS alliance's Klepikov put it:

"The Russian Federation has extremely repressive drug laws and its punitive approach to people who use drugs means that it now experiences one of the highest rates of new HIV infections in the world. Injecting drug users represent nearly 80% of all HIV cases in the country."

Russia

Chronicle AM -- March 25, 2014

Richard Branson speaks out on California drug policy reforms, a leading anti-drug group gives up the ghost on fighting marijuana legalization, the Canadian government is under attack from a couple of directions, and more. Let's get to it:

Richard Branson speaks out again on drug policy reform (David Shankbone/wikimedia)
Marijuana Policy

Drugfree.org Gives Up on Anti-Marijuana Ad Campaign. The people who brought you "this is your brain on drugs" and similar anti-drug advertising campaigns have given up on fighting marijuana legalization. Formerly known as the Partnership for a Drug-Free America, the group and its CEO, Steve Pasierb, say they have rejected a request to launch a campaign against marijuana legalization because legalization "is happening in America." Here is the interview in Advertising Age where Pasierb speaks out.

Colorado Supreme Court Says Lawyers Can Work With Marijuana Businesses. The Colorado Supreme Court approved a rule change Monday that will eliminate the threat of ethics sanctions against attorneys who work with marijuana businesses. Lawyers "may assist a client in conduct that the lawyer reasonably believes is permitted by these constitutional provisions and the statutes, regulations, orders, and other state and local provisions implementing them," Chief Justice Nancy Rice wrote in the updated rule.

Delaware Poll Has Majority for Legalization, Two-Thirds for Decriminalization. A Public Policy Polling survey commissioned by the Marijuana Policy Project finds that a narrow majority (51%) support legalizing marijuana, while an overwhelming majority (68%) support decriminalization of the possession of small amounts.

Illinois Decriminalization Bill Has Hearing Today. A bill to decriminalize the possession of up to an ounce of marijuana gets a hearing today in the House Restorative Justice Committee. The measure, House Bill 5708, was introduced by Rep. Kelley Cassidy (D-Chicago).

Medical Marijuana

Florida CBD Medical Marijuana Bill Wins Senate Committee Vote. A bill to legalize a special strain of low-dose medical marijuana passed through the Senate Criminal Justice Subcommittee on Monday. Senate Bill 1030, sponsored by Sen. Rob Bradley (R-Fleming Island), Sen. Aaron Bean (R-Fernandina Beach), and Sen. Jeff Brandes (R-St. Petersburg) would only allow patients to use extracts containing at least 15% CBD and less than 0.5% THC. The House companion bill, House Bill 843, differs in several ways. The two measures would have to be reconciled if both pass their respective chambers.

Illinois Bill to Add Seizure Disorders Gets Hearing Today. A bill that would add seizure disorders to the list of diseases and conditions for which medical marijuana is approved gets a hearing today in the Senate Public Health Committee. Filed by Sen. Iris Martinez (D-Chicago), Senate Bill 2636 will be supported in committee by testimony from Kurt Florian, president of the Epilepsy Foundation of Chicago, as well as a family practitioner and parents of two children suffering from seizure disorders.

Drug Policy

Richard Branson Op-Ed Urges Support for California Drug Reforms. Virgin Airlines head and Global Drug Policy Commission member Richard Branson has penned an op-ed calling for support of an initiative campaign to decriminalize drug possession in California. Click on the title link to read the op-ed. Branson is also appearing this afternoon at an event in San Francisco, where Sundog Pictures will hold a special screening of its drug war documentary "Breaking the Taboo." That's at 5:30 pm at the New People Cinema on Post Street.

Law Enforcement

Pennsylvania Man Sues Philly Narcs for 13 Years of False Imprisonment. Philadelphia resident Kareem Torain has filed a lawsuit against a trio of current and former Philadephia narcotics officers, in which he claims they falsified evidence that led to him being convicted on drug charges and spending 13 years in prison. In addition to the individual narc, the lawsuit also targets the city of Philadelphia for "systemic deficiencies and deliberate indifference" that "have caused police officers, including defendant police Officers Monaghan and Reynolds, and former police Officer Walker in this case, to believe that they can violate the rights of citizens, with impunity, including the use of fraud and falsehood, without fear that their actions will be investigated." In recent years scores of drug cases have been dismissed by Philadelphia courts, and several lawsuits have been filed, claiming that narcotics officers routinely planted evidence and lied in court to secure convictions.

International

Russian Drug Czar Calls for New Plan to Combat Afghan Drug Threat. Viktor Ivanov, head of the Russian anti-drug agency, has called for the UN Security Council to address "planet scale" drug production in Afghanistan and for interested countries to create a global alliance for alternative development in Afghanistan through "forced industrialization." Ivanov is one of the Russian political leaders sanctioned as a result of the Crimea crisis, and last week, he suggested that the US was using the crisis to deliberately destroy the international anti-drug cooperation in order to hide its responsibility for the drug crisis in Afghanistan.

Canada Blocked Support for Harm Reduction at UN CND Meeting, Observers Say. Canadian diplomats in Vienna for the UN Commission on Narcotic Drugs (CND) meeting blocked harm reduction health approaches abroad that are widely practiced at home, said Canadian Drug Policy Coalition director Donald MacPherson, who attended the conference. "Historically, Canada had been a leader in this area," MacPherson noted. "A substantial amount of the scientific research validating harm reduction measures was done right here in Vancouver, and we've implemented quite robust harm reduction policies at the provincial level across Canada. It's hypocritical for us to oppose adoption of these strategies internationally, especially since this is a matter of life and death in many countries with high levels of injection drug use and HIV." Similarly, Richard Elliot, executive director of the Toronto-based Canadian HIV/AIDS Legal Network, described the position adopted by Canada in Vienna as "profoundly stupid."

Canada Court Hearing Request for Injunction to Allow Prescription Heroin This Week. The Vancouver-based Pivot Legal Society and Providence Health Care will be in court this week to argue that participants in the SALOME study (The Study to Assess Long-term Opioid Maintenance Effectiveness) should receive an exemption from recent amendments to federal drug laws that prohibit doctors from prescribing heroin to patients for whom other treatment options have been ineffective. Pivot is representing five patients whose condition improved while in the SALOME study, operated by Providence Health, and who can no longer access the treatment now that their time in the study is over. Click on the link for more details.

Mexican Lawmakers Hit DC, NYC to Discuss Their Marijuana Reform Proposals. Legislators from the Mexican Congress and the Mexico City Assembly will be in Washington, DC, and New York City to discuss the bills they introduced to decriminalize the consumption and purchase of marijuana for personal use in Mexico City and to legalize medical marijuana countrywide. Mexico City Senator Mario Delgado and Mexico City Assembly member Vidal Llerenas, both from the Democratic Revolution Party (PRD), will be in DC on March 24 and 25 and in NY on March 26 to discuss the aims of the marijuana reform proposals in Mexico. Click on the link for more details.

Chronicle AM -- March 12, 2014

Medical marijuana is keeping state legislators busy, Maine's governor has a 20th Century approach to drug problems, New Mexico's governor cuts funds to a diversion program, Indonesia shifts its stance on drug users, and more. Let's get to it:

Responding to new synthetic drugs by banning them is still a favored response in state legislatures. (wikimedia.org)
Medical Marijuana

DEA, LAPD Raid Dispensaries. DEA agents assisted by LAPD officers raided and closed several Los Angeles dispensaries Tuesday. They hit the Black Rose dispensary in Fairfax, Downtown Medical Caregivers off Main Street, Washington and Western Medical Group in Harvard Heights, Herbman in Exposition Park and two homes in Beverly Hills. The same person allegedly owns all four dispensaries.

Vermont Senate Passes Medical Marijuana Expansion Bill. A bill that lifts the 1,000-patient cap on the state's dispensaries and authorizes two more dispensaries passed the Senate with little debate Tuesday. Senate Bill 247 now heads to the House.

Revised Alabama CBD Medical Marijuana Bill Passes Senate. A CBD medical marijuana bill revised by its sponsors so that the University of Alabama-Birmingham would conduct a research study passed the Senate on a unanimous vote Tuesday night. Senate Bill 174 now moves to the House.

Utah CBD Medical Marijuana Bill Passes Senate. A bill that would allow compassionate use of non-intoxicating cannabis oil by Utahns with untreatable epilepsy passed the Senate Tuesday by a wide margin, despite reservations some senators have about the oil's safety and long term benefits. House Bill 105 now goes back to the House, which had already passed it, but now must sign off on changes in the Senate version.

Michigan Medical Marijuana Bills Get Hearing. Two bills that would legalize the manufacture and sale of medical marijuana-infused products such as brownies and oils and permit communities to allow and regulate marijuana dispensaries got a hearing in the Senate Government Operations Committee hearing Tuesday, but no vote. Committee chair and Senate Majority Leader Randy Richardville (R-Monroe) is not expected to schedule another hearing for at least a couple of weeks. The bills are House Bill 5104 and House Bill 4271.

California Bill to Tighten Location Restrictions on Dispensaries Killed in Committee. A bill that would have widened "dispensary free" zone around schools from 600 feet to 1,000 feet has been blocked in the Assembly Public Safety Committee, Assembly Minority Leader Connie Conway (R-Tulare) said Tuesday. Conway is the author of the bill in question, Assembly Bill 1588.

American Herbal Pharmacopoeia Releases Study on Marijuana and Epilepsy. The medical research group American Herbal Pharmacopoeia (AHP) issued a new scientific review Tuesday, Cannabis in the Treatment of Epilepsy, which compiles much of the leading and historical research on epilepsy and cannabis (medical marijuana) for use by scientists, physicians, patients, and parents, as well as those producing and manufacturing it for treatment. Patient advocacy group Americans for Safe Access (ASA) will host a Google Hangout today, March 12th at 8:00pm EDT, featuring AHP director Roy Upton, ASA scientific advisory board member Dr. Sunil Aggarwal and others.

Law Enforcement

Maine Governor Wants More Drug War. Confronted by increasing levels of opiate drug use, Maine Gov. Paul LePage (R) responded Tuesday by proposing to beef up drug war spending. The conservative governor wants to add 22 new state positions including 14 new Maine Drug Enforcement agents, four new prosecutors for the Office of the Maine Attorney General as well as four new district court judges to bolster the state's four drug courts in Lewiston, Presque Isle, Bangor and Portland. He also criticized methadone, saying the drug should be provided in a clinical setting only. He said he intended to focus equally on the addiction side of the drug equation but did not offer any details.

New Mexico Governor Vetoes Funding for Drug Diversion Pilot Program. Gov. Susana Martinez (R) vetoed spending $140,000 for a Santa Fe program to divert some drug offenders to treatment Tuesday. The city's pre-booking diversion program, otherwise known as Law Enforcement Assisted Diversion (LEAD), will begin late this month. If successful, this model could become a model for other New Mexico communities, saving both the criminal justice and health systems tens of millions of dollars each year.

Salvia Divinorum

Rhode Island Bill to Ban Salvia, Jimson Weed Has Hearing Today. A bill that would ban the use of salvia divinorum and Jimson weed was scheduled for committee action today. House Bill 7191, sponsored by Rep. Arthur Corvese (D-North Providence), gets a vote before the House Judiciary Committee. It's not clear what prompted the bill.

New Synthetic Drugs

Minnesota Synthetic Drug Ban Bill Wins House Committee Vote. A bill that would give the state pharmacy board the authority to use its emergency powers to classify new synthetic drugs as banned substances is advancing in the House. House File 2446, introduced by Rep. Erik Simonson (D-Duluth) passed the House Health and Human Services Policy Committee Tuesday with few questions and a unanimous vote.

International

LEAHN Releases Frankfurt Principles on Drug Law Enforcement. The Law Enforcement and HIV Network (LEAHN) has released the Frankfurt Principles on Drug Law Enforcement, developed at the International Conference on Drug Policy and Policing last November in Frankfurt. The principles are designed to make law enforcement an effective partner in a harm reduction approach to drug use and related illness.

TDPF Releases Report on Dutch Coffee Shop Policy. Prompted by "misreports and misunderstandings that have led many to believe the Netherlands is retreating from its pragmatic policy of allowing cannabis to be sold via 'coffee shop,'" the British Transform Drug Policy Foundation has released a new report to set things straight. The report is Cannabis policy in the Netherlands: Moving forward, not backwards.

Ghana Anti-Drug Head Calls for Marijuana Legalization Debate. The executive secretary of the Narcotics Control Board (NACOB), Akrasi Sarpong, has called for a national debate on legalization of marijuana in the country. "Ordinary people can say don't legalize it but that will be vocalizing the ostrich hiding its head in the sand, because there is a virtual legalization on the ground," Sarpong said. Many people believe "what you are fighting is not crime," he added. "Reports say cannabis is the number one problem in Africa so what are we therefore saying. People laugh at these things, because, they are growing them in their homes," he said.

Peru Ponders Restarting Drug Plane Shootdown Program.Peru suspended its law allowing its Air Force to shoot down suspected drug planes in April 2001, when the Peruvian Air Force, accompanied by a CIA support plane, mistakenly shot down an aircraft carrying American missionaries, killing Veronica Bowers and her infant daughter. Now, Congressman Carlos Turbino, a retired general, has filed a bill to reinstate the program. It is currently before the congressional defense committee, even though it is opposed as unnecessary by the government of President Ollanta Humala.

New Indonesian Drug Law Emphasizes Rehabilitation Instead of Punishment of Drug Users. Indonesian ministers this week signed a memorandum of understanding that they say will declare drug users "victims" instead of criminals, to be treated at rehabilitation centers instead of sentencing to prison. President Susilo Bambang Yudhoyono has gone on the record supporting a softer touch for addicts, but early efforts to push for more rehabilitation centers have met with resistance from judges who are loathe to appear weak on drugs and lawmakers who often use the early release of traffickers as opportunities to grandstand against the president. Drug user make up 42% of all Indonesian prisoners.

Marijuana Reform Rally Set for Glasgow Next Month. A mass marijuana rally called by the Glasgow Cannabis Social Club is set for the city center next month, and it's already causing grumbling. "People will be extremely annoyed at the high-profile celebration of something that's illegal," grumped Conservative MSP John Lamont. "It is disappointing that such a carnival in homage to an illegal substance is being facilitated in this way," he added. The old fogies want the police to shut it down, but the police have said they will stop it only if lawbreaking takes place. The celebration is due to take place at Glasgow Green on Sunday April 20. So far, more than 200 people have signed up via Facebook to attend.

Chronicle AM -- February 26, 2014

A Maryland police chief embarrasses himself with bogus marijuana death claims, welfare drug testing bills face challenges in the Deep South, a hemp bill advances in Indiana, Russia's drug czar says "nyet" to legalization, and more. Let's get to it:

Marijuana Policy

Maryland Decriminalization, Legalization Bills Get Hearing; Police Chief Cites Hoax Story About Pot Overdose Deaths. Sen. Robert Zirkin's (D-Baltimore) Senate Bill 364, which would decriminalize marijuana possession, and Sen. Jamie Raskin's (D-Montgomery County) Senate Bill 658, which would legalize marijuana, got hearings in the Senate Judiciary Committee Tuesday. Law enforcement opposed the bills, while leaders of the ACLU and NORML members supported it. The lowlight of the hearing was Annapolis Police Chief Michael Pristoop's testimony mentioning an article about 37 overdose deaths the day marijuana became legal in Colorado. After being called out for repeating the hoax story by Sen. Raskin, Pristoop quickly backtracked.

Iowa Semi-Decriminalization Bill Introduced. A bill that would remove the possibility of jail time for possession of less than an ounce and a half of marijuana has been introduced by Rep. Bruce Hunter (D-Des Moines). It's not a true decriminalization bill because it would keep simple possession as a misdemeanor offense. House File 2313 has been referred to the House Judiciary Committee. Click on the link to read the bill.

Texas Poll Finds Near Majority for Legalization. Almost half -- 49% -- of Texans surveyed in a University of Texas/Texas Tribune poll support legalizing weed in either small quantities (32%) or any quantity (17%). Another 28% supported legalization only for medical purposes, while only 23% opposed any form of legalization.

New York Poll Finds Majority Oppose Legalization. A new Siena poll has support for legalization at only 43%, with 53% opposed. That contrasts with a recent Q Poll that had New Yorkers supporting legalization 57% to 39%. Differences in the questions asked and the margin of error in the polls may account for the difference. Or New Yorkers are conflicted.

Medical Marijuana

Kentucky CBD Medical Marijuana Bill Advances. A bill that would allow for the trial use of high CBD cannabis oil to treat childhood epileptic seizures was approved by the Senate Health and Welfare Committee Wednesday. Senate Bill 124 now heads for the Senate floor.

Hemp

Hemp Bill Advances in Indiana. A bill to legalize the production of industrial hemp passed the House Agriculture Committee Tuesday and now heads for the House floor. The bill is Senate Bill 357. It has already passed the Senate.

Drug Testing

Welfare Drug Testing Bill Advances in Georgia. A bill that would require food stamp and welfare recipients to undergo drug testing upon "reasonable suspicion" passed the House Judiciary Committee Monday. House Bill 772 now moves to the House floor.

Welfare Drug Testing Bill Stalls in Alabama Senate. A bill requiring drug testing of some welfare applicants hit a roadblock in the Senate Tuesday when Senate President Pro Tem Del Marsh (R-Anniston) adjourned the body after Democrats began fighting the bill. Senate Bill 63 would require drug testing of any applicant with a drug conviction in the last five years. It is just one of five bills in the Republican agenda to tighten regulations for public assistance.

Sentencing

West Virginia Senate Approves Draconian Drug Sentencing Bill. A bill that would increase the penalty for bringing drugs into West Virginia from one year to up to 15 years passed the Senate Monday. It now goes to the House.

International

Russian Drug Czar Rules Out Marijuana Legalization, Methadone Maintenance. The head of Russia's Federal Drug Control Service has called marijuana a dangerous gateway drug and said the authorities did not plan to legalize it, or to allow methadone treatment for heroin addicts. "Marijuana users have a 50 or 60 times higher risk of switching to heroin. There is one step from dope to heroin," Viktor Ivanov said in an interview with the Interfax news agency. He completely ruled out legalization, saying it was too risky in an advanced society. "Today we live in the age of high technology, a lot of things are managed with the help of computer systems. Someone who works at a nuclear power plant can wreak real havoc after smoking marijuana," he said. Ivanov also scoffed at needle exchange and methadone maintenance, saying there was little reliable evidence methadone maintenance worked. [Ed: Ivanov must have missed the entirety large body of research done on both needle exchange and methadone maintenance, which has found them to be effective and of paramount importance.]

Colombia's FARC Calls for Dismantling Drug-Paramilitary Nexus. Colombia's FARC guerrilla army called Tuesday for the dismantling of drug and paramilitary organizations it said were embedded within the Colombian state. The call was part of the FARC's six-point program to deal with the drug issue in the country, which is the fourth item on the agenda of peace talks between the FARC and the Colombian government.

British Chief Constable Says Give Heroin to Addicts. Mike Barton, Chief Constable for Dunham Constabulary, is calling for heroin maintenance for addicts. Such a move would "take money out of drug dealers' pockets," he said, adding that it "isn't practical" to simply arrest addicts. His comments come in a BBC documentary in which he went to Copenhagen to visit drug consumption rooms there.

Hoffman, Heroin, and What Is To Be Done [FEATURE]

The news last Sunday that acclaimed actor Phillip Seymour Hoffman had died of an apparent heroin overdose has turned a glaring media spotlight on the phenomenon, but heroin overdose deaths had been on the rise for several years before his premature demise. And while there has been much wailing and gnashing of teeth -- and quick arrests of low-level dealers and users -- too little has been said, either before or after his passing, about what could have been done to save him and what could be done to save others.

cooking heroin (wikimedia.org)
There are proven measures that can be taken to reduce overdose deaths -- and to enable heroin addicts to live safe and normal lives, whether they cease using heroin or not. All of the above face social and political obstacles and have only been implemented unevenly, if at all. If there is any good to come of Hoffmann's death it will be to the degree that it inspires broader discussion of what can be done to prevent the same thing happening to others in a similar position.

Hoffman, devoted family man and great actor that he was, died a criminal. And perhaps he died because his use of heroin was criminalized. Criminalized heroin -- heroin under drug prohibition -- is of uncertain provenance, of unknown strength and purity, adulterated with unknown substances. While we don't know what was in the heroin that Hoffman injected, we do know that he maintained his addiction and went to meet his maker with black market dope. That's what was found beside his lifeless body.

In a commentary published by The Guardian, actor Russell Brand, a recovered heroin addict, laid the blame for Hoffman's demise on the drug laws. "Addiction is a mental illness around which there is a great deal of confusion, which is hugely exacerbated by the laws that criminalise drug addicts," Brand wrote, calling prohibitionists' methods "so gallingly ineffective that it is difficult not to deduce that they are deliberately creating the worst imaginable circumstances to maximise the harm caused by substance misuse." As a result, "drug users, their families and society at large are all exposed to the worst conceivable version of this regrettably unavoidable problem."

We didn't always treat our addicts this way. Even after the passage of the Harrison Act in 1914, doctors continued for years to prescribe maintenance doses of opiates to addicts -- and hundreds of them went to jail for it as the medical profession fought, and ultimately lost, a battle with the nascent drug prohibition bureaucracy over whether giving addicts their medicine was part of the legitimate practice of medicine.

The idea of treating heroin addicts as patients instead of criminals was largely vanquished in the United States, but it never went away -- it lingers with methadone substitution, for example. But other countries have for decades been experimenting with providing maintenance doses of opioids to addicts, and to good result. It goes by various names -- opiate substitution therapy, heroin-assisted theatment, heroin maintenance -- and studies from Britain and other European countries, such as Germany, the Netherlands, and Switzerland, as well as the North American Opiate Medications Initiative (NAOMI) and the follow-up Study to Assess Long-Term Opiate Maintenance in Canada have touted its successes.

Those studies have found that providing pharmaceutical grade heroin to addicts in a clinical setting works. It reduces the likelihood of death or disease among clients, as well as allowing them to bring some stability and predictability to sometimes chaotic lives made even more chaotic by the demands of addiction under prohibition. Such treatment has also been found to have beneficial effects for society, with lowered criminality among participants and increased likelihood of their integration as productive members of society.

The dry, scientific language of the studies obscures the human realities around heroin addiction and opioid maintenance therapy. One NAOMI participant helps put a human face on it.

"I want to tell you what being a participant in this study did for me," one participant told researchers. "Initially it meant 'free heroin.' But over time it became more, much more. NAOMI took much of the stress out of my life and allowed me to think more clearly about my life and future. It exposed me to new ideas, people (staff and clients) that in my street life (read: stressful existence) there was no time for."

"After NAOMI, I was offered oral methadone, which I refused. After going quickly downhill, I ended up hopeless and homeless. I went into detox in April 2007, abstained from using for two months, then relapsed. In July 2008 I again went to detox and I am presently in a treatment center... I am definitely not "out of the woods" yet, but I feel I am on the right path. And this path started for me at the corner of Abbott and Hastings in Vancouver... Thank you and all who were involved in making NAOMI happen. Without NAOMI, I wouldn't be where I am today. I am sure I would be in a much worse place."

Arnold Trebach, one of the fathers of the drug reform in late 20th Century America, has been studying heroin since 1972, and is still at it. He examined the British system in the early 1970s, when doctors still prescribed heroin to thousands of addicts, and authored a book, The Heroin Solution, that compared and contrasted the US and UK approaches. Later this month, the octogenarian law professor will be appearing on a panel at the Vermont Law School to address what Gov. Peter Shumlin (D) has described as the heroin crisis there.

Phillip Seymour Hoffman (wikimedia.org)
"The death of Phillip Seymour Hoffman is a tragedy all the way around," Trebach told the Chronicle. "It's a bad idea to use heroin off the street, and he shouldn't have been doing that."

That said, Trebach continued, it didn't have to be that way.

"If we had had a sensible system of dealing with this, he would have been in treatment under medical care," he said. "If he was going to inject heroin, he should have been using pharmaceutically pure heroin in a medical setting where he could also have been exposed to efforts to straighten out his personal life, and he could have access to vitamins, weight control advice, and the whole spectrum of medical care. And if he had had access to opioid antagonists, he could still be alive," he added.

While Hoffman may have made bad personal choices, Trebach said, we as a society have made policy choices seemingly designed to amplify the prospects for disaster.

"This is a sad thing. He is just another one of the many victims of our barbaric drug policy," he said. "This was a totally unnecessary death at every level. He shouldn't have been using, but we should have been taking care of him."

The stuff ought to be legalized, Trebach said.

"I'm an advocate of full legalization, but if we can't go that far, we need to at least provide social and psychological support for these people," he said. "And even if we were to decriminalize or legalize, I would still want to figure out ways to provide support and love and kindness to people using the stuff. I advise you not to do it, but if you're going to use it, I want to keep you alive. I remember talking to people from Liverpool [a famous heroin maintenance clinic covered in the '90s by Sixty Minutes, linked above] about harm reduction around heroin use back in the 1970s. One of the ladies said it is very hard to rehabilitate a dead addict."

"There are plenty of things we can be doing," said Hilary McQuie, Western director for the Harm Reduction Network, reeling off a list of harm reduction interventions that are by now well-known but inadequately implemented.

"We can make naloxone (Narcan) more available. We need better access to it. It should be offered to people like Hoffman when they are leaving treatment programs, especially if they've been using opiates, just as a safeguard," she said. "Having treatment programs as well as harm reduction programs distribute it is important. We can cut the overdose rate in half with naloxone, but there will still be people using alone and people using multiple substances."

There are other proven interventions that could be ramped up as well, McQuie said.

"Safe injection sites would be very helpful, so would more Good Samaritan overdose emergency laws, and more education, not to mention more access to methadone and buprenorphine and other opioid substitution therapies (OST)," she said, reeling off possible interventions.

Dr. Martin Schechter, director of the School of Population and Public Health at the University of British Columbia in Vancouver, knows a thing or two about OST. The principal study investigator for the NAOMI and the follow-up SALOME study, Schechter has overseen research into the effectiveness of treating intractable addicts with pharmaceutical heroin, as well as methadone. The results have been promising.

"What we're using is medically prescribed pharmaceutical diacetylmorphine, the active ingredient in heroin," he explained. "It's what you have when you strip away all the street additives. This is a stable, sterile medication from a pharmaceutical manufacturer. We know the precise dose tailored for each person. With street heroin, not only is it adulterated and injected in unsterile situations, but people really don't know how strong it is. That's probably what happened to Mr. Hoffman."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)
In NAOMI, 90,000 injections were administered to study participants, and only 11 people suffered overdoses requiring medical attention.

"Never did we have a fatal overdose," Schechter said. "Because it was in a clinic, nurses and doctors are right there. We administer Narcan (naloxone), and they wake up."

Heroin maintenance had even proven more effective than methadone in numerous studies, Schechter said.

"There have been seven randomized control trials across Europe and in Canada that have shown for people who have already tried treatments like methadone, that medically prescribed heroin is more effective and cost effective treatment than simply trying methadone one more time."

Those studies carry a lesson, he said.

"We have to start looking at heroin from a medicinal point of view and treat it like a medicine," he argued. "The more we drive its use underground, the more overdoses we get. We need to expand treatment programs, not only with methadone, but with medically prescribed heroin for people who don't respond to other treatments."

Safe injection sites are also a worthwhile intervention, Schechter said, although he also noted their limitations.

"Injecting under supervision is much safer; if there is an overdose, there is prompt attention, and they provide sterile equipment, reducing the risk of HIV and Hep C," he said. "But they are still injecting street heroin."

He would favor decriminalizing heroin possession, too, he said.

Harm reduction measures, opioid maintenance treatments, and the like are absolutely necessary interventions, said McQuie, but there is a larger issue at hand, as well.

"We still need to look at the overall issue of the stigmatization of drug users," she said. "People aren't open about their use, and that puts them in a more dangerous situation. It's really hard in a criminalized environment."

Stigmatization means to mark or brand someone or something as disgraceful and subject to strong disapproval. Defining an activity, such as heroin possession, as a crime is stigmatization crystallized into the legal structures of society itself.

"The ultimate harm reduction solution," McQuie argued, "is a regulated, decriminalized environment where it is available by prescription, so people know what they're getting, they know how much to use, and it's not cut with fentanyl or other deadly adulterants. People wouldn't have to deal with all the collateral damage that comes from being defined as criminals as well as dealing with the consequences of their drug use. They could deal with their addictions without having to worry about losing their homes, their families, and their freedoms."

While such approaches have a long way to go before winning wide popular acceptance, policymakers should at least be held to account for the consequences of their decision-making, McQuie said, suggesting that the turn to heroin in recent years was a foreseeable result of the crackdown on prescription opioid pain medication beginning in the middle of the last decade.

"They started shutting down all those 'pill mills' and people should have anticipated what would happen and been ready for it," she said. "What we have seen is more and more people turning to injecting heroin, but nobody stopped to do an impact statement on what would be the likely result of restricting access to pain pills."

The impact can be seen in the numbers on heroin use, addiction, and overdoses. While talk of a "heroin epidemic" is overblown rhetoric, the number of heroin users has increased dramatically in the past decade. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of past year users grew by about 50% between 2002 and 2011, from roughly 400,000 to more than 600,000. At the same time, the number of addicted users increased from just under 200,000 to about 370,000, a slightly lesser increase.

If there is any good news, it is that, according to the latest (2012) National Household Survey of Drug Use and Health, the number of new heroin users has remained fairly steady at around 150,000 each year for the past decade. That suggests, however, that more first-time users are graduating to occasional and sometimes, dependent user status.

And some of them are dying of heroin overdoses, although not near the number dying from overdoses from prescription opioids. Between 1999 and 2007, heroin deaths hovered just under 2,000, even as prescription drug deaths skyrocketed, from around 2,500 in 1999 to more than 12,000 just eight years later. But, according to the Centers for Disease Control, by 2010, the latest year for which data are available, heroin overdose deaths had surpassed 3,000, a 50% increase in just three years.

While the number of heroin overdose deaths is still but a fraction of those attributed to prescription opioid overdoses and the numbers since 2010 are spotty, the increase that showed up in 2010 shows no signs of having gone away. Phillip Seymour Hoffman may be the most prominent recent victim, but in the week since his death, another 50 or 60 people have probably followed him to the morgue due to heroin overdoses.

There are ways to reduce the heroin overdose death toll. It's not a making of figuring out what they are. It's a matter of finding the political and social will to implement them, and that requires leaving the drug war paradigm behind.

New York City, NY
United States

Could Different Drug Policies Have Saved Philip Seymour Hoffman?

The tragic death of actor Philip Seymour Hoffman yesterday has prompted expressions of grief and of praise for his talent. It also, naturally, has prompted discussions of addiction, the impact of pain pill prescriptions on the addicted, even of pain pill restrictions causing more people to turn to heroin.

Philip Seymour Hoffman at the 81st Academy Awards (courtesy Chrisa Hickey, flickr.com/photos/chrisahickey/, via wikimedia.org)
While the latter raises the question about whether different drug policies could make things safer or less damaging or risky for heroin addicts, I haven't heard that question directly raised in the media. Although we don't know how Hoffman would have fared under a different system -- a system that had more options available, we do have information from places that do offer more options, and they are worth examining.

One of those options is heroin maintenance programs (also known now as heroin assisted treatment, or HAT). The most famous such program operated in Liverpool, England, before the conservative Thatcher government, encouraged by the Reagan administration (so we heard), shut it down. But HAT programs current operate in Switzerland, The Netherlands, Germany, Denmark, and the Canadian cities of Vancouver and Montreal. Patients in such programs receive a supply of pharmaceutically-produced heroin from a clinic (for free, though one can infer similar benefits if the heroin were merely cheap). They regularly access health services as a part of their participation. Those who need to inject the drug to relieve their cravings receive instruction on how to do so without damaging their veins, and heroin is made available in other forms as well.

A 2009 paper by leading drug policy researcher Peter Reuter, written for The Abell Foundation in Baltimore, reviewed research done in three of those countries. According to Reuter, Switzerland found a decrease in criminal involvement from 70% of the patients down to 10% after 18 months; and an increase in employment, from 14% to 32%. The health safety results were particularly impressive, including decreased contact with the street drug scene, and with very few adverse events or safety issues.

Many of those findings relate more to indigent addicts than they would to a famous actor. But the final point seems key, very few "adverse events" (e.g. overdoses and so forth) or safety issues, in any of the programs. Again, we don't know how Hoffman would have fared if he had entered a heroin maintenance program instead of buying it on the street. For that matter, we don't know if under legalization, broad or just for the addicted, whether Hoffman would have accessed such services in time, or chose to access them at all. But we know that many people do access these services in the countries that offer them, and that very few of the patients enrolled suffer overdose.

More generally, by prohibiting heroin, even for people who are already addicted to it, we prevent a whole class of possible approaches from every being taken to try to help people -- a whole set of options that people with substance abuse problems might be able to use to manage their problems -- to literally save their lives.

In the meanwhile, there are things to do that are legal even now, at least in a few states that have moved forward with them, with no federal laws standing in the way. These are Good Samaritan policies, that protect people from criminal liability when they seek help in an overdose situation; and use of the antidote medication for heroin overdoses, Naloxone. Meghan Ralston wrote about these in an oped yesterday.

We can also improve the debate. It's not enough to talk about the challenges of addiction and the risk of relapse people can face their entire lives, important as that is. It's a good start that people are starting to recognize the unintended consequences of the pain pill crackdown. But that isn't enough either. It's also important to take the next logical step in the argument, and rethink prohibition.

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