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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

"The New Jim Crow" Author Michelle Alexander Talks Race and Drug War [FEATURE]

On Thursday, Michelle Alexander, author of the best-selling and galvanizing The New Jim Crow: Mass Incarceration in the Age of Colorblindness sat down with poet/activist Asha Bandele of the Drug Policy Alliance to discuss the book's impact and where we go from here.

Michelle Alexander (wikimedia.org)
The New Jim Crow has been a phenomenon. Spending nearly 80 weeks on The New York Times bestseller list, it brought to the forefront a national conversation about why the United States had become the world's largest incarcerator, with 2.2 million in prison or jail and 7.7 million under control of the criminal justice system, and African American boys and men -- and now women -- making up a disproportionate number of those imprisoned. Alexander identified failed drug war policies as the primary driver of those numbers, and called for a greater challenge to them by key civil rights leaders.

It's now been nearly four years since The New Jim Crow first appeared. Some things have changed -- federal sentencing reforms, marijuana legalization in two states -- but many others haven't. Alexander and Bandele discuss what has changed, what hasn't, and what needs to, raising serious questions about the path we've been down and providing suggestions about new directions.

Audio of the conversation is online here, and a transcript follows here:

Asha Bandele: The US has 5% of the world's population, but has 25% of the world's incarcerated population, and the biggest policy cause is the failed drug war. How has the landscape changed in the last four years since The New Jim Crow came out?

Michelle Alexander: The landscape absolutely has changed in profound ways. When writing this book, I was feeling incredibly frustrated by the failure of many civil rights organizations and leaders to make the war on drugs a critical priority in their organization and also by the failure of many of my progressive friends and allies to awaken to the magnitude of the harm caused by the war on drugs and mass incarceration. At the same time, not so long ago, I didn't understand the horror of the drug war myself, I failed to connect the dots and understand the ways these systems of racial and social control are born and reborn.

But over last few years, I couldn't be more pleased with reception. Many people warned me that civil rights organizations could be defensive or angered by criticisms in the book, but they've done nothing but respond with enthusiasm and some real self-reflection.

There is absolutely an awakening taking place. It's important to understand that this didn't start with my book -- Angela Davis coined the term "prison industrial complex" years ago; Mumia Abu-Jamal was writing from prison about mass incarceration and our racialized prison state. Many, many advocates have been doing this work and connecting the dots for far longer than I have. I wanted to lend more credibility and support for the work that so many have been doing for some, but that has been marginalized.

I am optimistic, but at the same time, I see real reasons for concern. There are important victories in legalizing marijuana in Colorado and Washington, in Holder speaking out against mandatory minimums and felon disenfranchisement, in politicians across the country raising concerns about the size of the prison state for the first time in 40 years, but much of the dialog is still driven by fiscal concerns rather than genuine concern for the people and communities most impacted, the families destroyed. We haven't yet really had the kind of conversation we must have as a nation if we are going to do more than tinker with the machine and break our habit of creating mass incarceration in America.

Asha Bandele: Obama has his My Brother's Keeper initiative directed at black boys falling behind. A lot of this is driven by having families and communities disrupted by the drug war. Obama nodded at the structural racism that dismembers communities, but he said it was a moral failing. He's addressed race the least of any modern American president. Your thoughts?

Michelle Alexander: I'm glad that Obama is shining a spotlight on the real crisis facing black communities today, in particular black boys and young men, and he's right to draw attention to it and elevate it, but I worry that the initiative is based more in rhetoric than in a meaningful commitment to addressing the structures and institutions that have created these conditions in our communities. There is a commitment to studying the problem and identifying programs that work to keep black kids in school and out of jail, and there is an aspect that seeks to engage foundations and corporations, but there is nothing in the initiative that offers any kind of policy change from the government or any government funding of any kind to support these desperately needed programs.

There is an implicit assumption that we just need to find what works to lift people up by their bootstraps, without acknowledging that we're waging a war on these communities we claim to be so concerned about. The initiative itself reflects this common narrative that suggests the reasons why there are so many poor people of color trapped at the bottom -- bad schools, poverty, broken homes. And if we encourage people to stay in school and get and stay married, then the whole problem of mass incarceration will no longer be of any real concern.

But I've come to believe we have it backwards. These communities are poor and have failing schools and broken homes not because of their personal failings, but because we've declared war on them, spent billions building prisons while allowing schools to fail, targeted children in these communities, stopping, searching, frisking them -- and the first arrest is typically for some nonviolent minor drug offense, which occurs with equal frequency in middle class white neighborhoods but typically goes ignored. We saddle them with criminal records, jail them, then release them to a parallel universe where they are discriminated against for the rest of their lives, locked into permanent second-class status.

We've done this in the communities most in need our support and economic investment. Rather than providing meaningful support to these families and communities where the jobs have gone overseas and they are struggling to move from an industrial-based economy to a global one, we have declared war on them. We have stood back and said "What is wrong with them?" The more pressing question is "What is wrong with us?"

Asha Bandele: During the Great Depression, FDR had the New Deal, but now it seem like there is no social commitment at the highest levels of government. And we see things like Eric Holder and Rand Paul standing together to end mandatory minimums. Is this an unholy alliance?

Michelle Alexander: We have to be very clear that so much of the progress being made on drug policy reflects the fact that we are at a time when politicians are highly motivated to downsize prisons because we can't afford the massive prison state without raising taxes on the predominantly white middle class. This is the first time in 40 years we've been willing to have a serious conversation about prison downsizing.

But I'm deeply concerned about us doing the right things for the wrong reasons. This movement to end mass incarceration and the war on drugs is about breaking the habit of forming caste-like systems and creating a new ethic of care and concern for each of us, this idea that each of us has basic human rights. That is the ultimate goal of this movement. The real issue that lies at the core of every caste system ever created is the devaluing of human beings.

If we're going to do this just to save some cash, we haven't woken up to the magnitude of the harm. If we are not willing to have a searching conversation about how we got to this place, how we are able to lock up millions of people, we will find ourselves either still having a slightly downsized mass incarceration system or some new system of racial control because we will have not learned the core lesson our racial history is trying to teach us. We have to learn to care for them, the Other, the ghetto dwellers we demonize.

Temporary, fleeting political alliances with politicians who may have no real interest in communities of color is problematic. We need to stay focused on doing the right things for the right reasons, and not count as victories battles won when the real lessons have not been learned.

Asha Bandele: Portugal decriminalized all drugs and drug use has remained flat, overdoses been cut by a third, HIV cut by two-thirds. What can we learn from taking a public health approach and its fundamental rejection of stigma?

Michelle Alexander: Portugal is an excellent example of how it is possible to reduce addiction and abuse and drug related crime in a non-punitive manner without filling prisons and jails. Supposedly, we criminalize drugs because we are so concerned about the harm they cause people, but we wind up inflicting far more pain and suffering than the substances themselves. What are we doing really when we criminalize drugs is not criminalizing substances, but people.

I support a wholesale shift to a public health model for dealing with drug addiction and abuse. How would we treat people abusing if we really cared about them? Would we put them in a cage, saddle them with criminal records that will force them into legal discrimination the rest of their lives? I support the decriminalization of all drugs for personal use. If you possess a substance, we should help you get education and support, not demonize, shame, and punish you for the rest of your life.

I'm thrilled that Colorado and Washington have legalized marijuana and DC has decriminalized it -- these are critically important steps in shifting from a purely punitive approach. But there are warning flags. I flick on the news, and I see images of people using marijuana and trying to run legitimate businesses, and they're almost all white. When we thought of them as black or brown, we had a purely punitive approach. Also, it seems like its exclusively white men being interviewed as wanting to start marijuana businesses and make a lot of money selling marijuana.

I have to say the image doesn't sit right. Here are white men poised to run big marijuana businesses after 40 years of impoverished black kids getting prison time for doing the same thing. As we talk about legalization, we have to also be willing to talk about reparations for the war on drugs, as in how do we repair the harm caused.

With regard to Iraq, Colin Powell said "If you break it, you own it," but we haven't learned that basic lesson from our own racial history. We set the slaves free with nothing, and after Reconstruction, a new caste system arose, Jim Crow. A movement arose and we stopped Jim Crow, but we got no reparations after the waging of a brutal war on poor communities of color that decimated families and fanned the violence it was supposed to address.

Do we simply say "We're done now, let's move on" and white men can make money? This time, we have to get it right; we have to tell the whole truth, we have to repair the harm done. It's not enough to just stop. Enormous harm had been done; we have to repair those communities.

War of Words: The International Narcotics Control Board vs. A Changing World [FEATURE]

The global drug prohibition bureaucracy's watchdog group, the International Drug Control Board (INCB) released its Annual Report 2013 today, voicing its concerns with and wagging its finger at drug reform efforts that deviate from its interpretation of the international drug control treaties that birthed it. The INCB is "concerned" about moves toward marijuana legalization and warns about "the importance of universal implementation of international drug control treaties by all states."

"We deeply regret the developments at the state level in Colorado and Washington, in the United States, regarding the legalization of the recreational use of cannabis," INCB head Raymond Yans said in introducing the report. "INCB reiterates that these developments contravene the provisions of the drug control conventions, which limit the use of cannabis to medical and scientific use only. INCB urges the Government of the United States to ensure that the treaties are fully implemented on the entirety of its territory."

For some years now, some European and Latin American countries have been expressing a desire to see change in the international system, and "soft defections," such as the Dutch cannabis coffee shop system and Spain's cannabis cultivation clubs, have stretched the prohibitionist treaties to their legal limits. But legal marijuana in Uruguay is a clear breach of the treaties, as Colorado and Washington may be. That is bringing matters to an unavoidable head.

After surveying the state of drug affairs around the globe, the 96-page INCB report ends with a number of concerns and recommendations, ranging from non-controversial items such as calling for adequate prevention and treatment efforts to urging greater attention to prescription drug abuse and more attention paid to new synthetic drugs. [Ed: There is some controversy over how to best approach prescription drug abuse and synthetic drugs. e.g. the type of attention to pay to them.]

But the INCB is clearly perturbed by the erosion of the international drug prohibition consensus, and especially by its concrete manifestations in legalization in Uruguay, Colorado, and Washington and the spreading acceptance of medical marijuana.

"The Board is concerned that a number of States that are parties to the 1961 Convention are considering legislative proposals intended to regulate the use of cannabis for purposes other than medical and scientific ones" and "urges all Governments and the international community to carefully consider the negative impact of such developments. In the Board's opinion, the likely increase in the abuse of cannabis will lead to increased public health costs," the report said.

Similarly, the INCB "noted with concern" Uruguay's marijuana legalization law, which "would not be in conformity with the international drug control treaties, particularly the 1961 Convention" and urged the government there "to ensure the country remains fully compliant with international law, which limits the use of narcotic drugs, including cannabis, exclusively to medical and scientific purposes."

Ditto for Colorado and Washington, where the board was "concerned" about the marijuana legalization initiatives and underlined that "such legislation is not in conformity with the international drug control treaties." The US government should "continue to ensure the full implementation of the international drug control treaties on its entire territory," INCB chided.

But even as INCB struggles to maintain the legal backbone of global prohibition, it is not only seeing marijuana prohibition crumble in Uruguay and the two American states, it is also itself coming under increasing attack as a symbol of a crumbling ancien regime that creates more harm than good with its adherence to prohibitionist, law enforcement-oriented approaches to the use and commerce in psychoactive substances.

"We are at a tipping point now as increasing numbers of nations realize that cannabis prohibition has failed to reduce its use, filled prisons with young people, increased violence and fueled the rise of organized crime," said Martin Jelsma of the Transnational Institute. "As nations like Uruguay pioneer new approaches, we need the UN to open up an honest dialogue on the strengths and weaknesses of the treaty system rather than close their eyes and indulge in blame games."

"For many years, countries have stretched the UN drug control conventions to their legal limits, particularly around the use of cannabis," agreed Dave Bewley-Taylor of the Global Drug Policy Observatory. "Now that the cracks have reached the point of treaty breach, we need a serious discussion about how to reform international drug conventions to better protect people's health, safety and human rights. Reform won't be easy, but the question facing the international community today is no longer whether there is a need to reassess and modernize the UN drug control system, but rather when and how."

"This is very much the same old stuff," said John Collins, coordinator of the London School of Economics IDEAS International Drug Policy Project and a PhD candidate studying mid-20th Century international drug control policy. "The INCB views its role as advocating a strict prohibitionist oriented set of policies at the international level and interpreting the international treaties as mandating this one-size-fits-all approach. It highlights that INCB, which was created as a technical body to monitor international flows of narcotics and report back to the UN Commission on Narcotic Drugs, has carved out and maintains a highly politicized role, far removed from its original treaty functions. This should be a cause for concern for all states interested in having a functioning, public health oriented and cooperative international framework for coordinating the global response to drug issues," Collins told the Chronicle.

"The INCB and its current president, Raymond Yans, take a very ideological view of this issue," Collins continued. "Yans attributes all the negative and unintended consequences of bad drug policies solely to drugs and suggests the way to lessen these problems is more of the same. Many of the policies the board advocates fly in the face of best-practice public health policy -- for example the board demanding that states close 'drug consumption rooms, facilities where addicts can abuse drugs,'" he noted.

"If the board was really concerned about the 'health and welfare' of global populations it would be advocating for these scientifically proven public health interventions. Instead it chooses the road of unscientific and ideological based policies," Collins argued.

The INCB's reliance on ideology-driven policy sometimes leads to grotesque results. There are more than 30 countries that apply the death penalty for drugs in violation of international law. Virtually every international human rights and drug control body opposes the death penalty for drugs including the United Nations Office on Drugs and Crime, the UN Human Rights Committee, the UN's human rights experts on extrajudicial killings, torture and health, among many others.

INCB head Raymond Yans (incb.org)
But when an INCB board member was asked in Thailand -- where 14 people have been executed for drugs since 2001 -- what its position on capital punishment was, he said, "the agency says it neither supports nor opposes the death penalty for drug-related offenses," according to the Bangkok Post.

Human rights experts were horrified and immediately wrote asking for clarification, to which the INCB responded, "The determination of sanctions applicable to drug-related offenses remains the exclusive prerogative of each State and therefore lie beyond the mandate and powers which have been conferred upon the Board by the international community," according to Human Rights Watch.

Another area where the board's concern about the health and welfare of global populations is being challenged is access to pain medications. A key part of the INCB's portfolio is regulating opioid pain medications, and this year again it said there is more than enough opium available to satisfy current demand, although it also noted that "consumption of narcotic drugs for pain relief is concentrated within a limited number of countries."

The World Health Organization (WHO) agrees about that latter point. A 2011 study estimated that around 5.5 billion people -- or 83% of the world population -- live in countries with 'low to non-existent' access to opioid pain relief for conditions such as cancer and HIV/AIDS. These substances are listed by the WHO as essential medicines, and the international drug control conventions recognise explicitly that they are 'indispensable' to the 'health and welfare of mankind.'

Adding to the paradox -- the global supply is sufficient, but four-fifths of the world doesn't have access -- the INCB calls on governments to "ensure that internationally controlled substances used for pain relief are accessible to people who need them."

What is going on?

"The INCB uses totals of requirements for opioid medicines compiled by the UN treaty signatory states," said Ann Fordham, executive director of the International Drug Policy Consortium, which keeps an eye on the agency with its INCB Watch. "Unfortunately there is often a huge gap between these administrative estimates and the actual medical needs of their populations."

The prohibitionist slant of global drug control also creates a climate conducive to understating the actual need for access to pain relief in other ways, Fordham told the Chronicle.

"Many governments interpret the international drug control conventions in a more restrictive manner than is necessary, and focus their efforts towards preventing access to the unauthorized use of opioids rather than to ensuring their medical and scientific availability," she said. "This is a grossly unbalanced reading of the conventions, underpinned by fear and prejudice regarding opioids and addiction."

Although the agency has cooperated somewhat with the WHO in attempting to enhance access to the medicines, said Fordham, it bears some blame for rendering the issue so fraught.

"The INCB has continually stressed the repressive aspect of the international drug control regime in its annual reports and other public statements, and in its direct dealings with member states," she said. "The INCB is therefore responsible for at least some of the very anxieties that drive governments toward overly restrictive approaches. This ambivalence considerably weakens the INCB's credibility and contradicts its health-related advocacy."

Fordham joined the call for a fundamental reform of global drug prohibition, and she didn't mince words about the INCB.

"The entire UN drug control system needs to be rebalanced further in the direction of health rather than criminalization, and it is changing; the shift in various parts of the system is apparent already," she said before leveling a blast at Yans and company. "But the INCB is notable as the most hard line, backward-looking element, regularly overstepping its mandate in the strident and hectoring manner its adopts with parties to the treaties, in its interference in functions that properly belong to the WHO and in its quasi-religious approach to a narrow interpretation of the drug control treaties."

The INCB should get out of the way on marijuana and concentrate on its pain relief function, said Collins.

"The INCB should stay out if it," he said bluntly. "It is a technocratic monitoring body. It should not be involving itself in national politics and national regulatory systems. So it doesn't need to be either a help or hindrance on issues regarding cannabis reform. It has no reason to be involved in this debate. It should be focusing on ensuring access to essential pain medicines. These debates are a distraction from that core function and I would argue one of the reasons it is failing to meet this core function."

Sorry, INCB. Welcome to the 21st Century.

Vienna
Austria

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

Chronicle AM -- December 6, 2013

A new marijuana legalization has been filed in California, the Florida medical marijuana initiative faces a pair of challenges, the British Columbia decriminalization initiative is struggling, and more. Let's get to it:

Marijuana Policy

A New California Marijuana Legalization Initiative is Filed. The Control, Regulate, and Tax Marijuana Act was filed with the California attorney general's office Wednesday. It would legalize up to an ounce and four plants for people 21 and over and create a statewide system of regulated marijuana commerce. It's not clear, however, whether its backers will seek to gather signatures for 2014 or will use it as a place marker for 2016. Another legalization initiative, the California Cannabis Hemp Initiative of 2014 is in the signature-gathering phase, but lacks deep-pocketed financial backing.

Thinking About a Post-Pot Prohibition World. Martin Lee, the author of Acid Dreams and Smoke Signals, about the cultural histories of LSD and marijuana, respectively, writes about marijuana legalization as a beginning, not an end, and has some interesting and provocative thoughts about what should come next.

Medical Marijuana

Florida Supreme Court Hears Challenge to Medical Marijuana Initiative. The Florida Supreme Court Thursday heard arguments on whether the proposed constitutional amendment to allow medical marijuana should go on the November 2014 ballot. Attorney General Pam Bondi (R) had challenged it as misleading and in violation of federal law. The justices did not decide the issue, but a decision will be coming shortly.

Florida Medical Marijuana Initiative Needs a Lot of Signatures in a Hurry. The state Division of Elections reported Thursday that People United for Medical Marijuana, the group behind the initiative, has just under 137,000 signatures that have been validated. They need 683,149 by February. There is some lag between signatures gathered and signatures validated, and organizers say they have collected 400,000 signatures so far. But that means they need probably another 400,000 in just a few weeks just to have a cushion that would allow for the inevitable invalid signatures.

International

British Columbia Marijuana Decriminalization Initiative Campaign Struggling. Sensible BC's signature-gathering campaign to put a decriminalization initiative on the ballot in British Columbia looks like it is going to fall short. The group needs 310,000 valid signatures by Monday, but only has 150,000 gathered. But if they don't make it this time, that won't be the end of it. "Sensible BC is here to stay," said the group's Dana Larsen. "You can be quite sure we're going to try this campaign again sometime in the next year to year-and-a-half, if we don't succeed this time. We're not going away."

Report Says SE Asia Amphetamine Use is Fueling Rise in HIV Risk. An increase in injection use of amphetamines in Southeast Asia is raising the risk of the spread of HIV and requires "urgent" action, according to a new report from the Australian National Council on Drugs (ANCD) and the Asia-Pacific Drugs and Development Issues Committee. Not only injection drug use, but risky sexual behavior as well among amphetamine users, is part of the problem, the report says.

Chronicle AM -- November 26, 2013

Medical marijuana gets attention in the statehouse, another drug war atrocity in New Mexico, Greece's first safe injection site is open, and a gram of opium or a few pounds of pot can get you the death penalty if you're in the wrong place. And more. Let's get to it:

This is three times the amount of opium that could get an immigrant worker executed in Dubai. (erowid.org)
Medical Marijuana

Key Michigan Politico Says Medical Marijuana Top Priority in December. House Judiciary Committee Chair Kevin Cotter (R-Mount Pleasant) said Monday his top priority next month is to take up three medical marijuana-related bills. The first,House Bill 4271, would revive medical marijuana dispensaries in Michigan after recent court rulings effectively stopped the facilities from operating in the state. Cotter also plans to take up two other medical marijuana-related bills. House Bill 5104 would allow patients to use edible forms of marijuana. And Senate Bill 660 would clear the way for pharmacies to sell medical marijuana in Michigan, but only if the federal government decides to regulate cannabis as a prescription drug.

New Jersey Lawmaker Files Bill Allowing Patients to Buy Out of State. Assemblywoman Linda Stender (D-Union) Monday introduced a bill that would allow Garden State medical marijuana patients to buy their medicine in other states where it is legal and consume it in New Jersey. The bill attempts to address restrictions in the state's medical marijuana law that prevent easy access to some medical marijuana formulations, especially strains with high levels of CBD.

Alabama Lawmaker Ready to Try Again on Medical Marijuana. State Rep. Patricia Todd (D-Birmingham) will reintroduce medical marijuana legislation again next year, she said Monday. The bill would allow for the use of CBD. Todd's previous medical marijuana bills have gotten nowhere in Montgomery.

Hemp

New Jersey Hemp Bill Wins Committee Vote. A bill that would create an industrial hemp license to regulate the "planting, growing, harvesting, possessing, processing, selling, and buying" of the crop passed the Assembly Agriculture and Natural Resources Committee Monday. The bill, Assembly Bill 2415, sponsored by Assemblyman Reed Gusciora (D-Mercer), would require the end of federal hemp prohibition before licenses could be issued.

Law Enforcement

New Mexico Woman Sues over Vaginal Macing During Drug Arrest. What on earth is going on in New Mexico? Just weeks ago, it was forced enemas and colonoscopies for drug suspects; now, another New Mexican, Marlene Tapia, is suing Bernalillo County after she says jail guards strip searched her and sprayed mace in her vagina, where she was hiding drugs. The ACLU of New Mexico is taking the case.

New Jersey Bill Would Increase Drug Penalties. A bill that would reduce the amount of heroin necessary to be charged with a first-degree crime and allow prosecutors to charge drug offenses by the number of units of the drug involved instead of their weight passed the Assembly Judiciary Committee Monday. The bill, Assembly Bill 4151, is sponsored by Assemblyman Scott Rumana (R-Passaic).

International

Greece Sets Up First Supervised Injection Site. Greece has opened its first "drug consumption" room in a bid to slow the spread of blood-borne diseases among injection drug users there. The site has been open since last month and has been used by more than 200 people so far.

European Drug Experts Urge Austerity-Battered Governments Not to Cut Drug Treatment. Drug experts and policy makers from around Europe gathered in Athens Monday to urge governments to exclude drug-abuse treatment from austerity budget cuts, citing an alarming rise in HIV infections among drug users in Greece. Included in the call are harm reduction programs like the Greek supervised injection site, which is funded with Council of Europe funds.

Colombia's FARC Wants to Lead Alternative Crop Pilot Project. The leftist guerrillas of the FARC, now in peace negotiations with the Colombian government, want an active role in a pilot project to get coca farmers to grow alternative crops. The group is proposing that one of its local military units team with the government in a village in southern Colombia in a five-year project intended to get farmers to quit growing coca.

Malaysia Court Gives Thai Woman Death Sentence for Weed. A judge in Malaysia Monday sentenced a 36-year-old Thai woman to death after she was caught with about 30 pounds of marijuana at a bus depot. Barring a successful appeal, Thitapah Charenchuea will be hanged. DPP Nor Shuhada Mohd Yatim prosecuted the case.

Dubai Prosecutors Seeks Death Penalty for Less Than One Gram of Opium. Prosecutors in Dubai are seeking the death penalty for an Iranian worker accused of possessing 0.8 grams of opium. They charged he possessed it for "promotional purposes," the equivalent of "with the intent to distribute."

Chronicle AM -- November 21, 2013

Movement toward legal marijuana commerce continues in Washington, movement toward dispensaries continues in Massachusetts, medical marijuana polls very well in Florida, and more. Let's get to it:

Coming soon to a Washington state retail store near you.
Marijuana Policy

Washington State Marijuana Business License Applications Pile Up. As of Wednesday morning, the state Department of Revenue had received 585 completed applications for marijuana business licenses in the two days since the process opened up Monday. They include 27 applications for processors, 134 for growers, 144 for retailers, and 280 for operations doing both growing and processing. The state foresees 334 marijuana retail outlets. The number of growers and processors remains to be seen, but regulators want to limit legal production to two million square feet statewide.

Medical Marijuana

Florida Poll: Crist 47%, Scott 40%, Medical Marijuana 82%. A new Quinnipiac poll has support for medical marijuana in Florida at 82%, the greatest support for medical marijuana ever polled there, and nearly as much as the support for the leading gubernatorial contenders combined. The poll comes as People United for Medical Marijuana is in the midst of a signature-gathering campaign to put an initiative on the 2014 ballot. The poll strongly suggests that if the initiative can make the ballot, it will win.

Last Day for Dispensary Proposals in Massachusetts. Today is the deadline for the 158 qualified applicants seeking to open medical marijuana dispensaries in the Bay State. They are vying to be one of the 35 dispensaries envisioned by state law. In the second phase of the selection process, applicants will now go before a committee that will score their applications on a number of factors, including ability to meet the health needs of patients, appropriateness of the location, geographic distribution, local support, and plans to ensure public safety.

New Mexico's Bernalillo County Bans County Employees from Using Medical Marijuana. Bernalillo County (Albuquerque), the state's most populous county, has banned the use of medical marijuana by county workers under a new policy issued November 12 by County Manager Tom Zdunek. Zdunek cited federal prohibition and county policy as reasons for the ban. "This is a backwards policy that will prevent people who are suffering from accessing the medicine that works for them," said Jessica Gelay, policy coordinator for Drug Policy Alliance in New Mexico. "It is unconscionable that the County Manager would unilaterally attempt to deny Bernalillo County employees the right to use a medicine recommended by their physician. Patients deserve above all else, the freedom to choose the safest and most effective treatment for their disabling conditions -- whatever that treatment might be. It is time to stop demonizing marijuana and creating a double standard for prescription medications."

Cannabis Oil for Kids Greeted Warmly at Utah Capitol. Parents seeking access to cannabis oils for their epileptic children got a warm reception at a pair of committee hearings at the statehouse Wednesday. This is only a first step; there is no bill pending, but the response from lawmakers was largely positive, especially if such "hemp supplements" contained only small amounts of THC. There are about 10,000 Utah kids suffering from "refractory seizures" from epilepsy, and 35 of them are on a Colorado waiting list for a cannabis extract called Alepsia.

Drug Testing

Minnesota Now Drug Testing Public Benefits Recipients with Drug Felonies. People with a previous drug felony who are receiving or seeking public benefits are now subject to random drug testing under a law passed by the legislature in 2012. Those programs are the Minnesota Family Investment Program, General Assistance Program, Minnesota Supplemental Aid and the Supplemental Nutrition Assistance Program, or food stamps. About 1% of state public benefits have felony drug records, similar to the proportion in the general population.

International

Myanmar Opium Eradication Campaign Falls Short. Opium eradicators in Myanmar's southern Shan State have fallen well short of wiping out the poppy crop. Police had planned to eradicate 30,000 acres of poppy in the past 30 days, but only actually destroyed about 4,600 acres, or 13% of the target. They blamed manpower shortages, poor road links, and a flawed crop substitution program for their failure to meet their targets. Myanmar is the world's second largest opium producer, but lags far behind Afghanistan, which produces about 90% of the illicit global supply.

Tanzania Scolded on Need for Drug Reform, Harm Reduction. The Tanzanian government needs to come up with a harm reduction strategy for drug users and reform its drug laws, Doctors of the World harm reduction specialist Damali Lucas told a Dar es Salaam press conference Monday. The country's 1995 drug law does not differentiate between someone holding a small amount of drugs and someone holding large amounts, she noted. She also called for a harm reduction policy to be implemented to address the spread of HIV and related illnesses.

With Legalization Looming, Lessons from the Netherlands [FEATURE]

The US states of Colorado and Washington voted last year to legalize marijuana and are moving forward toward implementing legalization. Activists in several states are lining up to try to do the same next year, and an even bigger push will happen in 2016. With public opinion polls now consistently showing support for pot legalization at or above 50%, it appears that nearly a century of marijuana prohibition in the US is coming to an end.

A coffee shop in Amsterdam, where clients can sit and smoke. Why no on-premises consumption here? (wikimedia.org)
Exactly how it comes to an end and what will replace it are increasingly important questions as we move from dreaming of legalization to actually making it happen. The Netherlands, which for decades now has allowed open marijuana consumption and sales at its famous coffee shops, provides some salutary lessons -- if reformers, state officials, and politicians are willing to heed them.

To be clear, the Dutch have not legalized marijuana. The marijuana laws remain on the books, but are essentially overridden by the Dutch policy of "pragmatic tolerance," at least as far as possession and regulated sales are concerned. Cultivation is a different matter, and that has proven the Achilles Heel of Dutch pot policy. Holland's failure to allow for a system of legal supply for the coffee shops leaves shop owners to deal with illegal marijuana suppliers -- the "backdoor problem" -- and leaves the system open to charges it is facilitating criminality by buying product from criminal syndicates.

Still, even though the Dutch system is not legalization de jure and does not create a complete legal system of marijuana commerce, reformers and policymakers here can build on the lessons of the Dutch experience as we move toward making legal marijuana work in the US.

"Governments are looking to reform their drug policies in order to maximize resources, promote health and security while protecting people from damaging and unwarranted arrests," said Kasia Malinowska-Sempruch, Director of the Open Society Global Drug Policy Program. "The Netherlands has been a leader in this respect. As other countries and local jurisdictions consider reforming their laws, it's possible that the Netherlands' past offers a guide for the future."

A new report from the Open Society Global Drug Policy Program lays out what Dutch policymakers have done and how they have fared. Authored by social scientists Jean-Paul Grund and Joost Breeksema of the Addiction Research Center in Utrecht, the report, Coffee Shops and Compromise: Separated Illicit Drug Markets in the Netherlands tells the history of the Dutch approach and describes the ongoing success of the country's drug policy.

This includes the separation of the more prevalent marijuana market from hard drug dealers. In the Netherlands, only 14% of cannabis users say they can get other drugs from their sources for cannabis. By contrast in Sweden, for example, 52% of cannabis users report that other drugs are available from cannabis dealers. That separation of hard and soft drug markets has limited Dutch exposure to drugs like heroin and crack cocaine and led to Holland having the lowest number of problem drug users in the European Union, the report found.

Pragmatic Dutch drug policies have not been limited to marijuana. The Netherlands has been a pioneer in harm reduction measures, such as needle exchanges and safe consumption sites, has made drug treatment easy to access, and has decriminalized the possession of small quantities of all drugs. As a result, in addition to having the lowest number of problem drug users, Holland has virtually wiped out new HIV infections among injection drug users. And, because of decriminalization, Dutch citizens have been spared the burden of criminal records for low-level, nonviolent offenses.

The Dutch have, for example, virtually eliminated marijuana possession arrests. According to figures cited in the report, in a typical recent year, Dutch police arrested people for pot at a rate of 19 per 100,0000, while rates in the US and other European countries were 10 times that or more.

For veteran drug reform activist Joep Oomen of the European NGO Coalition for Just and Effective Drug Policies (ENCOD), the report is welcome but not exactly "stop the presses" news.

"The conclusions of this report have been known for a long time," he told the Chronicle. "Already by the end of the 1990s, when European governments had to acknowledge that Dutch drug policies had proven more effective in reducing risks and harms than many other countries, the criticism that had been expressed earlier by mainly German and French heads of state was silenced. For instance, in the Netherlands the age of first heroin use is the highest of Europe, which is explained by the relative tolerance concerning cannabis use." [Ed: A high age of first use is considered good, because it means that fewer people are experimenting with a drug when they are young -- which in turn means fewer people ever trying it, and those who do being more likely to be capable of avoiding problematic use.]

While the Dutch can point to solid indications of success with their pragmatic drug policies, it is not all rosy skies. The "back door problem" alluded to above continues unresolved, and the relative laxness of Dutch marijuana policy has led to an influx of "drug tourists," especially from neighboring countries, such as France and Germany. Both of those irritants have provided fodder for conservative parties and administrations that have sought to roll back the reforms.

"There seems to be more admiration for Dutch drug policy outside the Netherlands than inside," Oomen observed. "Right-wing governments that have dominated the Dutch political climate since 2002 have slowly dismantled acceptance-oriented drug policy. Lately the establishment of the Weedpass in the southern part of the country [which excludes non-Dutch from access to the coffee shops] and new measures against grow shops and coffee shops are definitely threatening to undermine the coffee shop model," he said.

"Instead of completing the regulation of this model by solving the coffee shops' back door problem, the government seems to apply a policy of slow elimination by making the conditions worse in which the shops have to operate," Oomen continued. "And the Dutch press follows blindly, often referring to coffee shops as a link in a criminal chain, which is unavoidable since the ban on cultivation forces shop owners to deal with criminals, but without questioning the measures that reinforce the criminal aspect."

While the national government may now be hostile to pragmatic marijuana policies, it is facing considerable resistance from elected officials. The Weedpass program now appears to be largely a dead letter, thanks to opposition from the likes of Amsterdam Mayor Eberhard van der Laan, and other local elected officials are moving to address the back door problem.

"Several Dutch mayors have plans for municipal cannabis farms to supply the coffee shops and take crime out of the industry," said Grund, research director at the Addiction Research Center. "But if Dutch drug policy offers one lesson to foreign policymakers, it is that change should be comprehensive, regulating sale to consumers, wholesale supply and cultivation."

Grund is watching the American experience with legalization in Colorado and Washington and had some observations he shared with the Chronicle.

"As far as I can judge," he said, "these are both pretty solid proposals, although quite different in detail and approach -- e.g., a vertically integrated chain of supply in Colorado and separate licensing for producers, processors, and retailer in Washington. Clearly in both states legislators have done their best. Interesting then, that they end up with rather different plans, which is actually fine, as it provides us with the opportunity to evaluate different models. For more than 25 years, there was just about only the Dutch experience with cannabis decriminalization and coffee shops; now we see different models of cannabis reform and distribution being implemented across continents. Comparing these experiences as they evolve should allow us to develop more effective drug policies."

Policymakers and regulators should try to avoid rigidity and be ready to deal with unintended responses and consequences, the Dutch social scientist said.

"The point is to approach these flexibly and pragmatically; adjust when necessary, while keeping your eyes on the ball: cutting the link between cannabis on the one hand, and criminal records, mafia and more, on the other," Grund advised, noting that the 1976 Dutch law separating hard and soft drugs did not anticipate the arrival of the coffee shop phenomenon. "As Dr. Eddy Engelsman, former chief drug policy maker at the ministry of health -- and known as the architect of Dutch drug policy -- said when we interviewed him, 'coffee shops just emerged.' The policymakers deemed that these fit their overall policy objectives and allowed for them to ply their trade openly," he recalled.

Grund also weighed in on personal cultivation -- Colorado allows it; Washington does not -- and public use, which it appears will remain forbidden in both states.

"I think Washington presents more of a business and revenue raising strategy, while Colorado feels more like grassroots meets civil libertarian meets amenable regulator," he opined. "The more social, homegrown orientation of the Colorado proposal – allowing for home growing, bartering between friends -- could perhaps engender a less market driven distribution structure, where friends compete in growing the most pleasant marijuana, not the most profitable. Something like the Spanish cannabis clubs," he suggested.

Public, convivial pot smoking in designated areas should be allowed, Grund said, because it has benefits.

"Dedicated places of consumption -- such as the coffee shops in the Netherlands or shisha parlors -- offer an opportunity to promote responsible behavior around cannabis consumption," he argued. "Smoking cannabis in a safe, hospitable and stress free environment engenders different use patterns from quickly getting high in a service ally behind a bar or in a car parked in a quiet place. Coffee shops offer a moderating environment where self regulation is supported by social learning and control."

While Grund was looking forward to the future in the US, Oomen was thinking of the unfinished business in the Netherlands, but his musing also provide food for thought for American reformers, especially those contemplating decriminalization measures.

"The lesson here is that decriminalization or depenalization are useful concepts for a transition period, but real progress can only be obtained and assured with legal regulation of the entire chain from producer to consumer," the ENCOD leader noted. "The Dutch case shows that politicians will always use the smallest margin they have to maintain to a repressive model, provoking criminal activities which they can use to justify their policies publically. This is the drug policy perpetual motion machine."

Colorado and Washington are already well down their particular paths to marijuana legalization. But there is still time for the next wave of legalization states to learn and apply those lessons, not just from Denver and Olympia, but from the Dutch pioneers as well.

Netherlands

Malaysia Minister Talks Drug Decriminalization

A Malaysian government minister said Sunday the Southeast Asian nation is moving toward decriminalizing drug possession, but her remarks also suggested that drug users would be exchanging jail cells for treatment beds. Minister in the Prime Minister's Department Nancy Shukri said the government's policy was moving from prosecuting drug users to treating them.

Nancy Shukri (frim.gov.my)
Her remarks came at the end of a High Level Meeting on Drug Policy and Public Health sponsored by the Global Commission on Drug Policy. The meeting was held in conjunction with the 2013 International Aids Conference held over the weekend in Kuala Lumpur, the Malaysian capital.

Shukri also said that the Association of Southeast Asian Nations' (ASEAN) goal of a drug-free region by 2015 was not realistic, but that smarter approaches by authorities could reduce drug dependence.

"There is no such thing as drug-free but we can control it by changing or shifting our policy," Shukri said. "Instead of looking at drug dependents as criminals, we should actually look at them as patients. Instead of bringing them to jail, we bring them to the clinic," she told a press gaggle after the AIDS conference ended.

Shukri said that Malaysia had been taking steps toward a more effective and humane drug policy, but that those initiatives were not widely known. She cited ongoing needle exchange programs for injection drug users. The sharing of needles is a known vector for the transmission of the AIDS virus, and the program had resulted in a reduction in new HIV/AIDS infections, she said.

"Others include the harm reduction program and upgrading of the rehabilitation centers into Cure & Care Clinics," Shukri said. "We are already there (decriminalizing drugs) but we are not making it loud enough for the people to understand that we have this policy. Our policy has not been established in a formal way."

That could be coming, though. Shukri said the government is currently reviewing the country's drug laws, including the Drug Dependents (Treatment and Rehabilitation) Act of 1983.

"The Law Reform Committee is now in the process of discussing to amend that particular provision [Section 4(1)(b) of the Act which allows the detention of a suspected drug dependent for up to 14 days for a test to be conducted]," she said.

Kuala Lumpur
Malaysia

GAO Says ONCDP Not Achieving Drug Goals So Far

Just a day after the Office of National Drug Control Policy (ONDCP -- the drug czar's office) released its latest annual national drug control strategy, the Government Accountability Office (GAO) has issued a report finding that ONDCP has fallen well short of goals enunciated in its 2010 national drug strategy.

In the report, Office of National Drug Control Policy: Office Could Better Identify Opportunities to Increase Program Coordination, GAO noted that ONDCP and the federal government "have not made progress toward achieving most of the goals articulated in the 2010 National Drug Control Strategy." In some areas, including reducing teen drug use, reducing drug overdose deaths, and reducing HIV infections from injection drug use, GAO found, ONDCP was not only not making progress, but sometimes the numbers were moving in the opposite direction.

For instance, under the broader goal of "curtailing illicit drug consumption in America," ONDCP had set use reduction goals to be achieved by 2015. It sought to reduce last month drug use by teens by 15%, but has achieved no movement. Similarly, it sought a 15% reduction in past month use by young adults, but has achieved no movement. It also sought to reduce lifetime use of drugs, alcohol, and tobacco by 8th graders by 15%, and was making progress toward its goal with alcohol and tobacco, but not with illegal drugs.

Likewise, under ONDCP's broad goal of "improving the public health and public safety of the American people by reducing the consequences of drug use," ONDCP identified goals of reducing overdose deaths, drug-related hospital emergency room visits, and drug-related HIV infections by 15% by 2015, but showed "movement away from goal" between 2010 and 2012.

Drug czar Gil Kerlikowske is talking up a "21st Century Approach" to drug use with a heavy emphasis on treatment and prevention, but the latest national drug budget still allocates 58% of funding to law enforcement and interdiction. And those remaining funds for treatment and prevention are "fragmented" across 15 federal agencies, with much overlapping. GAO reviewed 76 federal drug treatment and prevention programs and found 59 of them overlapped.

GAO did note that while ONDCP was not showing progress in most of its goals, it had implemented 107 of the 112 "action items" contemplated to meet those goals. The auditors noted that "ONDCP officials stated that implementing these action items is necessary, but may not be sufficient to achieve Strategy goals."

Washington, DC
United States

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