Voters in Oakland, California, will decide this month whether to create a new business tax aimed at the city's four medical marijuana dispensaries. Mailed ballots went out this week and must be returned to the city registrar's office by July 21 to be counted.

But that's okay with Oakland dispensary operators. In fact, it was the dispensaries that approached Oakland City Councilmembers Rebecca Kaplan and Nancy Nadel about instituting a new tax.

Operators say they are willing to pay their fair share to help the city deal with pressing financial problems. The proposed tax should bring in $315,000 in tax revenues for the city in 2010, up substantially from the $21,000 generated under the retail tax rate last year.

It is also an effort to further legitimize medical marijuana in a city that is already pretty pot-friendly. "Criminals don't pay taxes," said James Anthony, an attorney for Harborside Health Center, one of the dispensaries. "Law-abiding citizens do. We are nothing if not law-abiding citizens," he told the Oakland Tribune.

Councilmember Kaplan, a prominent medical marijuana supporter, also argued in favor of the measure. "It is important that there be regulation and that there be a permit process and that there be taxation," Kaplan said. "Both because the city needs the revenue and to be sure that we weed out the bad actors."

The ballot measure needs a simple majority to pass. It is also supported by the broad-based Yes 4 Oakland coalition.

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

John Jay College, NYC (courtesy wikipedia.org)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prosecutors in Northern California's Contra Costa County, adjacent to Oakland and Alameda County, announced Tuesday they will no longer prosecute a number of misdemeanor offenses, nor will they prosecute felony drug possession cases involving only small amounts of drugs. The new policy goes into effect May 4, District Attorney Robert Kochly told the San Francisco Chronicle.

Under the new policy, anyone caught with less than a gram of methamphetamine or cocaine or less than a half gram of heroin will not be charged. Ditto for people caught carrying fewer than five ecstasy or prescription opioid tablets.

"We had to make very, very difficult choices, and we had to try to prioritize things. There are no good choices to be made here," said Kochly, a 35-year veteran prosecutor. "It's trying to choose the lesser of certain evils in deciding what we can and cannot do."

Kochly sent a memo Monday to the Contra Costa County Police Chiefs Association, which represents local police chiefs, asking them not to even bother submitting such cases. "If they are submitted, they will be screened out by category by support staff and returned to your department without review by a deputy district attorney," he wrote.

The charging changes are necessary to eliminate a $1.9 million budget gap in the district attorney's office this fiscal year. Six deputy district attorneys will be laid off at month's end, and another 11 will be let go by the end of the year, Kochly said.

Kochly had long taken pride in saying his office could "do more with less," he wrote in the memo. "Unfortunately, we have now reached a point where we cannot maintain the status quo," he said. "We will definitely be doing 'less with less' as a prosecution agency."

The cops aren't happy. Several Contra Costa county law enforcement officials told the San Jose Mercury News Wednesday that they would continue to make arrests regardless of prosecutors' charging decisions.

A regime where currently illicit drugs are regulated and legalized would provide numerous benefits to Britain, not the least of which would be up to $20 billion a year in savings to government, crime victims, and drug users, according to a comprehensive comparison of the costs of drug prohibition and drug legalization.

The figure comes from A Comparison of the Cost-effectiveness of Prohibition and Regulation, a report released Wednesday by the British drug reform group the Transform Drug Policy Foundation. The group says it is the first time anyone in Britain has attempted an across-the-board comparison of the differing approaches to drug use and sales.

According to official British policy, policies or programs should be assessed by a cost-benefit analysis or impact assessment, but that has never been done with drug prohibition. Instead of evidence-based policies, the British government has relied on mere assertion to justify maintaining prohibition and to argue that the harms of legalization would outweigh its benefits.

Now, Transform is calling the government's bluff. According to its analysis, which examined criminal justice, drug treatment, crime, and other social costs, a regime of regulated legalization would accrue large savings over the current prohibitionist policy.

Transform postulated four different legalization scenarios based on drug use levels declining by half, staying the same, increasing by half, and doubling. Even under the worst case scenario, with drug use doubling under legalization, Britain would still see annual savings of $6.7 billion. Under the best case scenario, the savings would approach $20 billion annually.

"The conclusion is that regulating the drugs market is a dramatically more cost-effective policy than prohibition and that moving from prohibition to regulated drugs markets in England and Wales would provide a net saving to taxpayers, victims of crime, communities, the criminal justice system and drug users," Transform found.