(Please read our top ten US domestic drug policy stories review too!)

As 2009 winds to a close, we review the global year in drug policy. There were a number of events of global significance -- the trend toward decriminalization of drug possession in Europe and Latin America, the slow spread of heroin maintenance therapy, the frontal assault on global prohibitionist orthodoxy at the UN -- as well as new developments in ongoing drug-policy related struggles from the poppy fields of Afghanistan to the cannabis cafes of Amsterdam.

This review can't cover everything -- it's a big world, and there's a lot happening in drug policy these days. Among the items worth at least mentioning in passing: Israel's embrace of medical marijuana, Canada's flirtation with mandatory minimum sentences for marijuana growers (still in process, and amended to be less harmful by the Canadian Senate), the continuing resort to the death penalty for drug offenses in the Middle East and Southeast Asia, the bemusing link between cannabis and schizophrenia apparently at work only in some Commonwealth countries, the Andean drug war (unchanged in its essential outlines this year), and the rise of poor West African nations as favored smugglers' destinations.

What about Mexico? There is one glaring omission here, but there is a reason for that: In the third year of Mexican President Felipe Calderon's offensive against the so-called drug cartels, the violence is more intense and destabilizing than ever. What is happening in Mexico is certainly a drug policy-related phenomenon of global significance, but this year, with more than a billion US dollars in the anti-drug aid pipeline, beefed up border security, official acknowledgement that insatiable American appetites play a crucial role, and growing public and political concern about the violence on the border, we will examine the Mexican drug war in the context of US domestic drug policy issues. Look for it to be among the Top 10 domestic drug policy stories in our feature next issue.

With that as a caveat, here are this year's biggest global drug policy developments:

Afghanistan: War on Drugs, Meet War on Terror

Afghan opium

This year has been the bloodiest yet for Western occupiers, with 495 US and NATO forces killed this year, according to iCasualties.org. Part of the uptick in violence can be attributed to the Taliban's opium wealth, but the decision by US and NATO forces to move aggressively into the Taliban's eastern and southern heartlands, especially Helmand and Kandahar provinces, has also led to increased fighting and higher casualties.

In June, President Obama, adhering to his election campaign vows if not the wishes of his some of his most ardent supporters, moved to directly confront the drug trade, sending 20,000 troops into Helmand to take on the Taliban and allied traffickers. But while that looked like more of the same, just weeks later, the US announced a major shift in its anti-drug policy in Afghanistan when US envoy Richard Holbrooke announced the US would no longer participate in poppy eradication campaigns. That was a startling, reality-driven break from previous US policy in Afghanistan, as well as with current US policies against coca production in Colombia and Peru.

Instead of persecuting poverty-stricken opium-growing peasants, the US and NATO would concentrate on drug manufacturers and traffickers, but only those linked to the Taliban -- not those linked to the corrupt and illegitimate (after this fall's fraudulent election fiasco) regime of Afghan President Hamid Karzai. The US beefed up the in-country DEA contingent and even came up with a "hit list" of some 50 Afghan traffickers linked to the Taliban.

This fall, fighting has been intense in southern and eastern Afghanistan, as well as across the border in Pakistan, and now, the first of President Obama's promised 30,000-troop escalation is headed precisely for Helmand, where one of its first assignments will be to take and hold a major Taliban trafficking center. The war on drugs and the war on terror will continue to collide in Afghanistan, but now, at least, the imperatives of the war on terror have forced a historic shift in US anti-drug policy, at least in Afghanistan.

Latin American Leaders Call for a Drug Policy Paradigm Shift

Commission panel, former President of Colombia Cesar Gaviria on left (courtesy comunidadsegura.org)

The report, Drugs and Democracy: Toward a Paradigm Shift, is the work of the Latin American Commission on Drugs and Democracy, which also includes prominent writers Paulo Coelho, Mario Vargas Llosa, Sergio Ramírez and Tomás Eloy Martínez as well as leading scholars, media members and politicians.

Latin America is the leading exporter of both cocaine and marijuana. As such, it has faced the ravages of heavy-handed American anti-drug interventions, such as Plan Colombia and earlier efforts to destroy the Bolivian coca crop, as well as the violence of drug trafficking organizations and politico-military formations of the left and right that have grown wealthy off the black market bonanza. And while the region's level of drug consumption has historically been low, it is on the rise.

"The main reason we organized this commission is because the available evidence indicates the war on drugs is a failed war," said Cardoso at a February press conference in Rio de Janeiro to announce the report. "We need a different paradigm to cope with the problem of drugs. The power of organized crime is undermining the very foundations of democracy in some Latin American countries. We must acknowledge that these policies have failed and we must break the taboo that prevents us from discussing different strategies."

''Global Marijuana Day'' demonstration in Mexico City, May 2008

Mexico Decriminalizes Drug Possession

In May, Mexico decriminalized the possession of small amounts of illicit drugs, including up to five grams of marijuana, a fifth-gram of ecstasy and methamphetamine, a tenth-gram of heroin, and a half-gram of cocaine. The new law closely resembled a 2006 decriminalization bill that had passed the legislature only to die in the face of US protests. There were no US protests this time.

With the Mexican government's action, drug decriminalization has now reached the very borders of the US.

But, according to well-placed observers, the Mexican decriminalization is a case of two steps forward, one step back. In addition to decriminalizing possession of very small amounts of drugs, the new law grants drug enforcement powers to state and local police forces that they never had before. That could mean an increase in the arrests and prosecution of retail-level drug sellers. Still, the long-term political ramifications could be helpful; as one observer noted, "the headline will read that Mexico decriminalized drugs."

Argentina Decriminalizes Marijuana Possession, Laws Against Possessing Other Drugs Tremble

Supreme Court of Argentina

In August, the Supreme Court did just that, using another marijuana possession case to rule that the section of the country's drug law that criminalizes drug possession is unconstitutional. While the ruling referred only to marijuana possession, the portion of the law it threw out makes no distinction among drugs.

Imprisoning people absent harm to others violates constitutional protections, a unanimous court held. "Each individual adult is responsible for making decisions freely about their desired lifestyle without state interference," their ruling said. "Private conduct is allowed unless it constitutes a real danger or causes damage to property or the rights of others. The state cannot establish morality."

"It is significant that the ruling was unanimous," said Martin Jelsma, coordinator of the Drugs and Democracy program at the Transnational Institute, which has worked closely with Latin American activists and politicians on drug reform issues. "It confirms the paradigm shift visible throughout the continent, which recognizes that drug use should be treated as a public health matter instead of, as in the past, when all involved, including users, were seen as criminals."

UN's Global Anti-Drug Bureaucracy Meets Organized Resistance

demonstration at the UN drug meeting, Vienna

In the end, the CND issued a political statement and plan of action that largely reaffirmed existing prohibitionist policies and ignored harm reduction, but with some victories for reformers both substantive and symbolic. For one, the US delegation finally removed its objection to needle exchanges.

But if the global anti-drug bureaucracies ignored their critics in their report, they were impossible to ignore in Vienna. Demonstrations took place outside the meeting hall, and Bolivian President Evo Morales brandished then chewed coca leaves as he demanded that his country's sacred plant be removed from the list of proscribed substances.

Even UN Office on Drugs and Crime head Antonio Maria Costa was forced to publicly acknowledge the failures and unintended consequences of prohibition. In his address opening the session, Costa bravely argued that "drugs are not harmful because they are controlled; they are controlled because they are harmful," but was forced to concede that prohibition had created a dire situation in some places. "When mafias can buy elections, candidates, political parties, in a word, power, the consequences can only be highly destabilizing" he said. "While ghettoes burn, West Africa is under attack, drug cartels threaten Central America and drug money penetrates bankrupt financial institutions."

All the more reason to challenge prohibitionism and its consequences. After this year, the global anti-drug bureaucracy knows that not only is its long-held consensus under assault, it is beginning to crack.

Czech Republic Decriminalizes Drug Possession, Finally Sets Quantity Limits

Czech marijuana reform demonstration, 2005 (courtesy Michal Vlk)

This month, Czech authorities formalized "smaller than large amounts." The new guidelines mean Czechs will suffer neither arrest nor prosecution for up to 15 grams or five marijuana plants, five grams of hashish, 40 magic mushroom segments, five peyote plants, five LSD tablets, four ecstasy tablets, two grams of amphetamine or methamphetamine, 1.5 grams of heroin, five coca plants, or one gram of cocaine.

The new quantity rules go into effect on January 1.

Science vs. Politics in Great Britain

The British Advisory Council on the Misuse of Drugs (ACMD) is an official body charged with providing evidence-based analysis of drug policy issues for the British Home Office. Tensions between the ACMD and the Labor government of Prime Minister Gordon Brown had been on the rise since it rejected the ACMD's recommendation that marijuana, which had been down-scheduled from a Class B to a Class C (least harmful) drug under Brown's predecessor, Tony Blair, remain at Class C. The government instead up-scheduled it back to Class B.

David Nutt

After a relatively quiet summer, the clash between drug science and drug politics exploded anew when Home Secretary Alan Johnson fired Nutt in late October for again criticizing the government's refusal to follow the science-based recommendations of the panel. That firing caused a huge fire storm of protest, including the resignations of at least six ACMD members, and was splashed across newspaper front pages for weeks.

Now, the credibility of the Labor government and its adherence to evidence-based policy-making have been called into serious doubt, as it becomes clear that Home Office drug scheduling decisions are driven by a political calculus, not a scientific one. And if the Home Office thought firing Nutt was going to make him go away, it was sadly mistaken. Nutt is maintaining a high public profile and is vowing to set up his own independent drug panel.

Whither Holland's Cannabis Coffee Shops?

downstairs of a Maastricht coffee shop (courtesy Wikimedia)

But that tolerant policy is not a favorite of the conservative coalition national government, and it has created a number of problems. "Drug tourism," as the influx of border town marijuana buyers from more repressive neighboring countries is known, has led to everything from traffic jams to public urination to lurking hard-drug peddlers.

And Holland's halfway approach to marijuana policy -- it does not allow for the regulated provision of marijuana to the coffee houses -- has led to the "backdoor problem," in which coffee shop proprietors must rely on criminal-by-definition suppliers to provide them with their product. That provides additional ammunition for the anti-coffee shop crowd.

The conservative coalition government, however, is split on how best to rein in the coffee shops and has promised not to take action at the national level until after the 2010 elections. That has left the field to local authorities, and they have responded.

In March, the "drug tourism" problem resulted in the announcement by the mayors of Roosendaal and Bergen op Zoom that they would close all the coffee shops in their towns by September. In May, the mayors of the eight towns in the border province of Limburg announced coffee shops would be "members only." In August, the Dutch government announced it was providing more than $200,000 for a pilot "members only" program in the border town of Maastricht. Court challenges from coffee shop owners have so far failed to stop any of this.

Meanwhile, in Amsterdam, an urban renewal plan unveiled in May called for a reduction in coffee shops there from 226 to 192, with a 50% reduction in the number of coffee shops in the central Red Light District. But just last week, Amsterdam Mayor Job Cohen fought back, saying that national coffee house policy should not be based solely on border "drug tourism" concerns, that he opposed the "members only" option, and that he rejected a ban on coffee houses within 250 yards of schools.

Holland's marijuana coffee shops have been around for more than 30 years now, but as was made clear this year, they will continue to be a battle front between the forces of Dutch conservatism and Dutch liberal pragmatism.

Heroin Maintenance Continues to Spread

maintenance programs can make heroin addiction cleaner and safer

Denmark joined the club in February and Germany came aboard in June. These moves come after Switzerland voted in a popular referendum last year to move from a pilot to a permanent heroin maintenance program, based on favorable results from the pilot program.

Canada is about to join the club, too. After the success of the three-year North American Opiate Maintenance Initiative (NAOMI) in Vancouver, Canadian researchers are moving forward with SALOME (the Study to Assess Long-term Opiate Maintenance), a pilot heroin maintenance program set for Vancouver and Montreal. But as of late last month, Montreal's participation was a question mark after Quebec authorities said they would not pay their share of program costs.

Despite lingering political distaste for heroin by prescription, the body of evidence demonstrating its efficacy -- in terms of users' quality of life, public health, and public safety -- continues to grow. There has even been some discussion of bringing a heroin maintenance pilot program to the US. Dr. Peter Reuter, the renowned University of Maryland drug policy expert, authored a study this summer about the possibility of a pilot program in Baltimore.

There is an old saw about not being able to turn an ocean liner on a dime. That's certainly true when it comes to changing drug policies for the better at the national or international level. But each year, it seems that more progress is being made. Let's see what 2010 brings.

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."