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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

UN Drug Agencies Fret over Uruguay Marijuana Vote

Wednesday night's vote in the Uruguayan chamber of deputies to approve state-run marijuana commerce would make the South American nation the first to create legal pot markets, and that's making United Nations anti-drug bureaucracies nervous. Both the International Narcotics Control Board (INCB) and the UN Office on Drugs and Crime (UNODC) issued statements Thursday fretting about the vote.

Uruguay hasn't legalized the marijuana market yet -- that will require a vote in the Uruguayan Senate this fall -- but the Vienna-based UN organs aren't waiting. Charged with enforcing the global drug prohibition regime, and its legal backbone, the 1961 Single Convention on Narcotic Drugs and successor treaties, the INCB and UNODC are raising the alarm about the apparent looming breach of the treaty.

"The INCB has noted with concern a draft law under consideration in Uruguay which, if adopted, would permit the sale of cannabis herb for non-medical use," INCB head Dr. Raymond Yans said in a statement. "Such a law would be in complete contravention to the provisions of the international drug control treaties, in particular the 1961 Single Convention on Narcotic Drugs, to which Uruguay is a party."

The INCB said it had always "aimed at maintaining a dialogue with the government of Uruguay" and complained that Montevideo wasn't paying attention to it. "The Board regrets that the government of Uruguay refused to receive an INCB mission before the draft law was submitted to parliament," Yans said.

The statement further urged Uruguayan leaders "to ensure that the country remains fully compliant with international law which limits the use of narcotic drugs, including cannabis, exclusively to medical and scientific purposes" and warned that legalization "might have serious consequences for the health and welfare of the population and for the prevention of cannabis abuse among the youth."

The UNODC, for its part, said in its statement that it supported the INCB statement and was continuing "to follow developments in Uruguay closely."

But, perhaps signaling a belated recognition that the global drug prohibition regime is increasingly tattered, the UNODC acknowledged that the results of enforcing drug prohibition, including "horrorific violence" related to black market drug trafficking have "led to a debate over best to address such problems."

UNODC said it "welcomes this discussion," but that "this dialogue should be conducted on the basis of the agreed conventions, in line with international law. It invited nations to talk about it all at the Commission on Narcotic Drugs meeting next year.

In the meantime, Uruguay isn't waiting, and there is little the UN anti-drug agencies can do about except shout from their bully pulpits.

Vienna
Austria

You Don't Need Prohibition to Help People

CDC headquarters, Atlanta
A new Centers for Disease Control study has found the US rate of tobacco usage dropping again:

ATLANTA (AP) — Fewer U.S. adults are smoking, a new government report says.

Last year, about 18 percent of adults participating in a national health survey described themselves as current smokers.

The nation’s smoking rate generally has been falling for decades, but had seemed to stall at around 20 to 21 percent for about seven years. In 2011, the rate fell to 19 percent, but that might have been a statistical blip.

Health officials are analyzing the 2012 findings and have not yet concluded why the rate dropped, a spokesman for the Centers for Disease Control and Prevention said. The CDC released its study Tuesday.

Of course, this was achieved without prohibition -- some regulation that has not been without controversy, but without prohibition. So what else could be achieved without prohibition?

The Top Ten Drug Policy Stories of 2012 [FEATURE]

In some ways, 2012 has been a year of dramatic, exciting change in drug policy, as the edifice of global drug prohibition appears to crumble before our eyes. In other ways it is still business as usual in the drug war. Marijuana prohibition is now mortally wounded, but there were still three-quarters of a million pot arrests last year. The American incarceration mania appears to be running its course, but drug arrests continue to outnumber any other category of criminal offense. There is a rising international clamor for a new drug paradigm, but up until now, it's just talk.

The drug prohibition paradigm is trembling, but it hasn't collapsed yet -- we are on the cusp of even more interesting times. Below, we look at the biggest drug policy stories of 2012 and peer a bit into the future:

1. Colorado and Washington Legalize Marijuana!

Voters in Colorado and Washington punched an enormous and historic hole in the wall of marijuana prohibition in November. While Alaska has for some years allowed limited legal possession in the privacy of one's home, thanks to the privacy provisions of the state constitution, the November elections marked the first time voters in any state have chosen to legalize marijuana. This is an event that has made headlines around the world, and for good reason -- it marks the repudiation of pot prohibition in the very belly of the beast.

And it isn't going away. The federal government may or may not be able to snarl efforts by the two states to tax and regulate legal marijuana commerce, but few observers think it can force them to recriminalize marijuana possession. It's now legal to possess up to an ounce in both states and to grow up to six plants in Colorado and -- barring a sudden reversal of political will in Washington or another constitutional amendment in Colorado -- it's going to stay that way. The votes in Colorado and Washington mark the beginning of the end for marijuana prohibition.

2. Nationally, Support for Marijuana Legalization Hits the Tipping Point

If Colorado and Washington are the harbingers of change, the country taken as a whole is not far behind, at least when it comes to public opinion. All year, public opinion polls have showed support for marijuana legalization hovering right around 50%, in line with last fall's Gallup poll that showed steadily climbing support for legalization and support at 50% for the first time. A Gallup poll this month showed a 2% drop in support, down to 48%, but that's within the margin of error for the poll, and it's now a downside outlier.

Four other polls released this month
demonstrate a post-election bump for legalization sentiment. Support for legalization came in at 47%, 51%, 54%, and 57%, including solid majority support in the West and Northeast. The polls also consistently find opposition to legalization strongest among older voters, while younger voters are more inclined to free the weed.

As Quinnipiac pollster Peter Brown put it after his survey came up with 51% support for legalization, "This is the first time Quinnipiac University asked this question in its national poll so there is no comparison from earlier years. It seems likely, however, that given the better than 2-1 majority among younger voters, legalization is just a matter of time."

Caravan for Peace vigil, Brownsville, Texas, August 2012
3. Global Rejection of the Drug War

International calls for alternatives to drug prohibition continued to grow ever louder this year. Building on the work of the Latin American Commission on Drugs and Democracy and the Global Commission on Drug Policy, the voices for reform took to the stage at global venues such as the Summit of the Americas in Cartagena, Colombia, in April, the International AIDS Conference in Washington in July, and at the United Nations General Assembly in September.

While calls for a new paradigm came from across the globe, including commissions in Australia and the United Kingdom, this was the year of the Latin American dissidents. With first-hand experience with the high costs of enforcing drug prohibition, regional leaders including Colombian President Santos, Guatemalan President Perez Molina, Costa Rican President Chinchilla, and even then-Mexican President Calderon all called this spring for serious discussion of alternatives to the drug war, if not outright legalization. No longer was the critique limited to former presidents.

That forced US President Obama to address the topic at the Summit of the Americas and at least acknowledge that "it is entirely legitimate to have a conversation about whether the laws in place are doing more harm than good in certain places" before dismissing legalization as a policy option. But the clamor hasn't gone away -- instead, it has only grown louder -- both at the UN in the fall and especially since two US states legalized marijuana in November.

While not involved in the regional calls for an alternative paradigm, Uruguayan President Mujica made waves with his announcement of plans to legalize the marijuana commerce there (possession was never criminalized). That effort appears at this writing to have hit a bump in the road, but the proposal and the reaction to it only added to the clamor for change.

4. Mexico's Drug War: The Poster Child for Drug Legalization

Mexico's orgy of prohibition-related violence continues unabated with its monstrous death toll somewhere north of 50,000 and perhaps as high as 100,000 during the Calderon sexenio, which ended this month. Despite all the killings, despite Calderon's strategy of targeting cartel capos, despite the massive deployment of the military, and despite the hundreds of millions of dollars in US aid for the military campaign, the flow of drugs north and guns and money south continues largely unimpeded and Mexico -- and now parts of Central America, as well -- remain in the grip of armed criminals who vie for power with the state itself.

With casualty figures now in the range of the Iraq or Afghanistan wars and public safety and security in tatters, Calderon's misbegotten drug war has become a lightning rod for critics of drug prohibition, both at home and around the world. In the international discussion of alternatives to the status quo -- and why we need them -- Mexico is exhibit #1.

And there's no sign things are going to get better any time soon. While Calderon's drug war may well have cost him and his party the presidency (and stunningly returned it to the old ruling party, the PRI, only two elections after it was driven out of office in disgrace), neither incoming Mexican President Enrique Pena Nieto nor the Obama administration are showing many signs they are willing to take the bold, decisive actions -- like ending drug prohibition -- that many serious observers on all sides of the spectrum say will be necessary to tame the cartels.

The Mexican drug wars have also sparked a vibrant and dynamic civil society movement, the Caravan for Peace and Justice, led by poet and grieving father Javier Sicilia. After crisscrossing Mexico last year, Sicilia and his fellow Mexican activists crossed the border this summer for a three-week trek across the US, where their presence drew even more attention to the terrible goings on south of the border.

5. Medical Marijuana Continues to Spread, Though the Feds Fight Back

Eighteen states and the District of Columbia have now legalized the use of marijuana for medical purposes, and while there was only one new one this year, this has been a year of back-filling. Medical marijuana dispensaries have either opened or are about to open in a number of states where it has been legal for years but delayed by slow or obstinate elected officials (Arizona, New Jersey, Washington, DC) or in states that more recently legalized it (Massachusetts).

None of the newer medical marijuana states are as wide open as California, Colorado, or Montana (until virtual repeal last year), as with each new state, the restrictions seem to grow tighter and the regulation and oversight more onerous and constricting. Perhaps that will protect them from the tender mercies of the Justice Department, which, after two years of benign neglect, changed course last year, undertaking concerted attacks on dispensaries and growers in all three states. That offensive was ongoing throughout 2012, marked by federal prosecutions and medical marijuana providers heading to federal prison in Montana. While federal prosecutions have been less resorted to in California and Colorado, federal raids and asset forfeiture threat campaigns have continued, resulting in the shuttering of dozens of dispensaries in Colorado and hundreds in California. There is no sign of a change of heart at the Justice Department, either.

6. The Number of Drug War Prisoners is Decreasing

The Bureau of Justice Statistics announced recently that the number of people in America's state and federal prisons had declined for the second year in a row at year's end 2011. The number and percentage of drug war prisoners is declining, too. A decade ago, the US had nearly half a million people behind bars on drug charges; now that number has declined to a still horrific 330,000 (not including people doing local jail time). And while a decade ago, the percentage of people imprisoned for drug charges was somewhere between 20% and 25% of all prisoners, that percentage has now dropped to 17%.

That decline is mostly attributable to sentencing reforms in the states, which, unlike the federal government, actually have to balance their budgets. Especially as economic hard times kicked in in 2008, spending scarce taxpayer resources on imprisoning nonviolent drug offenders became fiscally and politically less tenable. The passage of the Proposition 36 "three strikes" sentencing reform in California in November, which will keep people from being sentenced to up to life in prison for trivial third offenses, including drug possession, is but the latest example of the trend away from mass incarceration for drug offenses.

The federal government is the exception. While state prison populations declined last year (again), the federal prison population actually increased by 3.1%. With nearly 95,000 drug offenders doing federal time, the feds alone account for almost one-third of all drug war prisoners.

President Obama could exercise his pardon power by granting clemency to drug war prisoners, but it is so far a power he has been loathe to exercise. An excellent first candidate for presidential clemency would be Clarence Aaron, the now middle-aged black man who has spent the past two decades behind bars for his peripheral role in a cocaine deal, but activists in California and elsewhere are also calling for Obama to free some of the medical marijuana providers now languishing in federal prisons. The next few days would be the time for him to act, if he is going to act this year.

7. But the Drug War Juggernaut Keeps On Rolling, Even if Slightly Out of Breath

NYC "stop and frisk" protest of mass marijuana arrests
According to annual arrest data released this summer by the FBI, more than 1.53 million people were arrested on drug charges last year, nearly nine out of ten of them for simple possession, and nearly half of them on marijuana charges. The good news is that is a decline in drug arrests from 2010. That year, 1.64 million people were arrested on drug charges, meaning the number of overall drug arrests declined by about 110,000 last year. The number of marijuana arrests is also down, from about 850,000 in 2010 to about 750,000 last year.

But that still comes out to a drug arrest every 21 seconds and a marijuana arrest every 42 seconds, and no other single crime category generated as many arrests as drug law violations. The closest challengers were larceny (1.24 million arrests), non-aggravated assaults (1.21 million), and DWIs (1.21 million). All violent crime arrests combined totaled 535,000, or slightly more than one-third the number of drug arrests.

The war on drugs remains big business for law enforcement and prosecutors.

8. And So Does the Call to Drug Test Public Benefits Recipients

Oblivious to constitutional considerations or cost-benefit analyses, legislators (almost always Republican) in as many as 30 states introduced bills that would have mandated drug testing for welfare recipients, people receiving unemployment benefits, or, in a few cases, anyone receiving any public benefit, including Medicaid recipients. Most would have called for suspicionless drug testing, which runs into problems with that pesky Fourth Amendment requirement for a search warrant or probable cause to undertake a search, while some attempted to get around that obstacle by only requiring drug testing upon suspicion. But that suspicion could be as little as a prior drug record or admitting to drug use during intake screening.

Still, when all the dust had settled, only three states -- Georgia, Oklahoma, and Tennessee -- actually passed drug testing bills, and only Georgia's called for mandatory suspicionless drug testing of welfare recipients. Bill sponsors may have been oblivious, but other legislators and stakeholders were not. And the Georgia bill is on hold, while the state waits to see whether the federal courts will strike down the Florida welfare drug testing bill on which it is modeled. That law is currently blocked by a federal judge's temporary injunction.

It wasn't just Republicans. In West Virginia, Democratic Gov. Roy Tomblin used an executive order to impose drug testing on applicants to the state's worker training program. (This week came reports that only five of more than 500 worker tests came back positive.) And the Democratic leadership in the Congress bowed before Republican pressures and okayed giving states the right to impose drug testing requirements on some unemployment recipients in return for getting an extension of unemployment benefits.

This issue isn't going away. Legislators in several states, including Indiana, Ohio, Texas, and West Virginia have already signaled they will introduce similar bills next year, and that number is likely to increase as solons around the country return to work.

9. The US Bans New Synthetic Drugs

In July, President Obama signed a bill banning the synthetic drugs known popularly as "bath salts" and "fake weed." The bill targeted 31 specific synthetic stimulant, cannabinoid, and hallucinogenic compounds. Marketed under brand names like K2 and Spice for synthetic cannabinoids and under names like Ivory Wave, among others, for synthetic stimulants, the drugs have become increasingly popular in recent years. The drugs had previously been banned under emergency action by the DEA.

The federal ban came after more than half the states moved against the new synthetics, which have been linked to a number of side effects ranging from the inconvenient (panic attacks) to the life-threatening. States and localities continue to move against the new drugs, too.

While the federal ban demonstrates that the prohibitionist reflex is still strong, what is significant is the difficulty sponsors had in getting the bill passed. Sen. Rand Paul (R-KY) put a personal hold on the bill until mandatory minimum sentencing requirements were removed and also argued that such efforts were the proper purview of the states, not Washington. And for the first time, there were a substantial number of Congress members voting "no" on a bill to create a new drug ban.

10. Harm Reduction Advances by Fits and Starts, At Home and Abroad

Harm reduction practices -- needle exchanges, safer injection sites, and the like -- continued to expand, albeit fitfully, in both the US and around the globe. Faced with a rising number of prescription pain pill overdoses in the US -- they now outnumber auto accident fatalities -- lawmakers in a number of states have embraced "911 Good Samaritan" laws granting immunity from prosecution. Since New Mexico passed the first such law in 2007, nine others have followed. Sadly, Republican Gov. Chris Christie vetoed the New Jersey bill this year.

Similarly, the use of the opioid antagonist naloxone, which can reverse overdoses and restore normal breathing in minutes, also expanded this year. A CDC report this year that estimated it had saved 10,000 lives will only help spread the word.

There has been movement internationally as well this year, including in some unlikely places. Kenya announced in June that it was handing out 50,000 syringes to injection drug users in a bid to reduce the spread of AIDS, and Colombia announced in the fall plans to open safe consumption rooms for cocaine users in Bogota. That's still a work in progress.

Meanwhile, the UN Commission on Narcotic Drugs unanimously supported a resolution calling on the World Health Organization and other international bodies to promote measures to reduce overdose deaths, including the expanded use of naloxone; Greece announced it was embracing harm reduction measures, including handing out needles and condoms, to fight AIDS; long-awaited Canadian research called for an expansion of safe injection sites to Toronto and Ottawa; and Denmark first okayed safe injection sites in June, then announced it is proposing that heroin in pill form be made available to addicts. Denmark is one of a handful of European countries that provide maintenance doses of heroin to addicts, but to this point, the drug was only available for injection. France, too, announced it was going ahead with safe injection sites, which could be open by the time you read this.  

This has been another year of slogging through the mire, with some inspiring victories and some oh-so-hard-fought battles, not all of which we won. But after a century of global drug prohibition, the tide appears to be turning, not least here in the US, prohibition's most powerful proponent. There is a long way to go, but activists and advocates can be forgiven if they feel like they've turned a corner. Now, we can put 2012 to bed and turn our eyes to the year ahead.

Canada Health Ministry Bans "Bath Salts" Drug

The Canadian government has banned MDPV (methylenedioxypyrovalerone), a synthetic stimulant commonly found in "bath salts" drugs. The ban went into effect last Wednesday, the same day it was announced by Health Canada.

now banned in Canada (wikimedia.org)
"Our government is committed to protecting hardworking Canadian families and keeping our streets and communities safe," said Health Minister Leona Aglukkaq in a statement. "That's why we have moved quickly to make the illicit drug known as "bath salts" illegal to possess, traffic, import or export, unless authorized by regulation."

The criminalization of MDPV -- it is now a Schedule I controlled substance, like heroin and cocaine -- had been a promise of the Conservative government of Prime Minister Stephen Harper. Aglukkaq said in July that regulation was forthcoming.

All activities involving MDPV are now illegal, except for research and scientific activities, which must be authorized by regulation. That means that people seeking to use and distribute it will have to resort to underground markets, something that police spokesmen who lauded the move don't seem to understand.

"Today's announcement by the Government of Canada to add MDPV in Schedule I of the Controlled Drug and Substances Act is an important step in stopping organized criminal groups from acquiring and profiting from this illegal substance," said Staff Inspector Randy Franks of the Canadian Association of Chiefs of Police and Acting Chair of the Canadian Association of Chiefs of Police Drug Abuse Committee.

But as Marni Soupcoff noted in a National Post op-ed critical of the ban, Franks was both taking credit where it was not due and making unwarranted assumptions about how drug markets work.

"The substance, which is a key ingredient in the drug known as 'bath salts,' was obviously not illegal before the ban," Soupcoff wrote. "So it's circular to credit the ban for stopping the acquisition of something illegal. My bigger problem with the quote is the notion that making a substance illegal stops organized criminals from profiting from it. This is precisely the opposite of how things have gone with alcohol, cocaine, heroin, methamphetamine, marijuana and pretty much every other illicit drug or beverage in history."

Instead of prohibiting a relatively new and uncommon drug, Canada could have gone a more rational, public health-oriented way, Soupcoff suggested.

"What else could Canada have done to try to mitigate harm from MDPV?" she asked. "How about public health and education initiatives? Maybe monitoring MDPV sellers to ensure compliance with existing laws (investigating instances of fraud, false advertising, etc.) and creating open forums for MDPV buyers to report complaints, adverse reactions, etc. Heck, Health Canada could even have formally declared the stuff dangerous, no good, terrible, very bad and to be avoided by those who know what’s good for them."

But instead Canada gets a new addition to its list of banned substances -- and a new, underground criminal market to supply it.

Ottawa, ON
Canada

Latin Americans Seek Drug Policy Debate at the UN

Wednesday's United Nations General Assembly session saw not one, not two, but three Latin American heads of state call on it to promote debate on alternatives to the war on drugs. The presidents of Colombia, Guatemala, and Mexico all used their 15-minute addresses at the Assembly to call for exploring new paths.

Otto Pérez Molina
Outgoing Mexican President Felipe Calderon, who has presided over a drug war that has left more than 55,000 people dead during his six-year term, told the General Assembly the UN should lead "a profound international debate" about ways to reduce drug trafficking and its consequences. The UN itself should do more to intervene if wealthy Western countries that consume "tons and tons of drugs" cannot bring their demand down.

The US and other drug consuming countries need to "evaluate with all sincerity, and honesty, if they have the will to reduce the consumption of drugs in a substantive manner," Calderon said. "If this consumption cannot be reduced, it is urgent that decisive actions be taken." 

Colombian President Juan Manuel Santos also called for a "frank, and without a doubt, global" discussion on alternatives to the status quo. "It is our duty to determine -- on objective scientific bases -- if we are doing the best we can or if there are better options to combat the scourge," he said.

According to the UN News Network, Calderon hinted without quite suggesting an examination of legalization alternatives, stating, "The enormous profits from the black market due to prohibition have exacerbated the ambition of criminals, increasing the massive flow of resources to their organizations and allowing them to create powerful networks," adding "thousands and thousands of young people in Latin America have died because of drug trafficking-related violence, and, in particular, the nations that are suffering the most are the ones located between the drug-producing zone in the Andes and the main drug market: the United States."

There was speculation that Guatemalan President Otto Perez Molina would actually call for the legalization of the drug trade, as he has in the past, but he didn't go that far in New York.

"We must seek new avenues with responsibility and perseverance, with the cooperation of all: producing, consuming and transit countries," he said, adding that his government "would like to establish an international group of countries that are well disposed to reforming global policies on drugs" and would consider "new creative and innovative alternatives."

A concerted call for discussing alternatives to the drug war, yes. A clarion call for drug legalization, not yet.

New York, NY
United States

Mexico's "Caravan for Peace" Heads to Washington [FEATURE]

The Mexico-based Caravan for Peace and Justice and its American allies are now more than halfway through their 6,000-mile, 27-city journey to focus attention on the drug war's terrible toll in both countries. After beginning two weeks ago in San Diego, the caravan has now traversed California, Arizona, New Mexico, and miles and miles of Texas, and on Wednesday, was set to join with African-American and other activists to march over the historic Edmund Pettus Bridge into Selma, Alabama.

rally in El Paso
The Edmund Pettus Bridge is an enduring symbol of the civil right struggles of the 1960s and was the scene of the Bloody Sunday of March 7, 1965, when armed police officers attacked peaceful civil rights demonstrators attempting to march to the state capitol in Montgomery.

While on Wednesday, the theme of the day's events was to be "the new Jim Crow" and the mass criminalization and incarceration of large numbers of African-Americans through the war on drugs, that is only one of the themes the caravan is emphasizing in its bid to put the harms of the drug war on full view for the American public and its politicians.

Led by Mexican poet Javier Sicilia, the caravan said it wants put faces on Mexico's drug war dead -- who are too often assumed to have been "bad" by virtue of having been killed.

"Our purpose is to honor our victims, to make their names and faces visible," Sicilia said. "We will travel across the United States to raise awareness of the unbearable pain and loss caused by the drug war -- and of the enormous shared responsibility for protecting families and communities in both our countries."

vigil in Brownsville
But it's not just about honoring the victims of the drug war; the Caravan also explicitly seeks policy changes on both sides of the border, not only to drug policy. These policy areas and the Caravan's recommendations include:

"Drug War policies: We propose the need to find a solution, with a multidisciplinary and intergenerational approach that places individuals, and their welfare and dignity, at the center of drug policy. We call on both the Mexican and the U.S. community to open and maintain a dialogue about alternatives to Prohibition based on evidence, and which is inclusive in its considerations of the diverse options for drug regulation.

"Arms trafficking: We propose that the President of the United States immediately prohibit the importation of assault weapons to the United States. Assault weapons are often smuggled into Mexico, and have also been used too many times against innocent civilians in the US. We propose giving authorities effective regulatory tools and adequate resources to halt arms smuggling in the border regions, especially in border states like Arizona and Texas.

"Money laundering: We call for governments on both sides of the border to take concrete steps to combat money laundering. We propose that financial institutions be held accountable for preventing money laundering through increased government surveillance, investigations, fines and criminal charges. We also call for the Treasury Department to immediately implement Congress’ 2009 call to close the "prepaid/stored value cards" loophole.


visit to the Sacred Heart Convent, Houston
"US foreign aid policy: We call for a change from the United States' "war" focus to one of human security and development that contemplates promoting the healing of Mexico's torn social fabric. We propose the immediate suspension of US assistance to Mexico's armed forces. The "shared responsibility" for peace that both governments share must begin with each country complying with its own respective national laws.

"Immigration: We call for a change in the policies that have militarized the border and criminalized immigrants. These policies have generated a humanitarian crisis driven by unprecedented levels of deportations and incarceration of migrants. In addition, these policies have also inflicted immeasurable environmental damage. We call for protecting the dignity of every human being, including immigrant populations that have been displaced by violence who are fleeing to the US seeking safe haven and a better life."

 

The Caravan is a natural outgrowth of Sicilia's Mexican Movement for Peace and Justice with Dignity (MMPJD), which he formed after his son and several comrades were kidnapped and murdered by drug cartel gunmen in Cuernavaca in March 2011. It is designed to put names and faces on the estimated 60,000 dead, 10,000 disappeared, and 150,000 displaced by the prohibition-related violence pitting the so-called cartels against each other and the Mexican state.

memorial representing victims of the Monterrey Casino Royale attack
In Mexico, the MMPJD struck a deep chord with a population increasingly angered and frightened by the often horrific violence raging across the country. Caravans organized by the MMJPD crisscrossed the country last year before bringing 100,000 people to mass in Mexico City's huge national plaza, the Zocalo in June. The mass outpouring of grief and anger convinced President Felipe Calderon to meet with Sicilia, who brought along photos of some of the dead depicting them as happy, smiling human beings.

"The powers that be were trying to tell us that all those who were dying were just criminals, just cockroaches," Sicilia explained. "We had to change the mindset, and put names to the victims for a change."

In Texas last week, the caravan traveled the breadth of the state, stopping in El Paso, Laredo, McAllen, San Antonio, Austin, and Houston before heading into the final half of the tour. In Austin, groups such as Law Enforcement Against Prohibition (LEAP) and local NORML affiliates joined the travelers.

El Paso
"I think what is important is the binational nature of this caravan," said Roberto Lovato, the founder of Presente.org, an online Latino advocacy organization. "The drug war has been a fantastic failure here in the United States, if you look at more than 2 million people being incarcerated, families destroyed by that incarceration, a trillion of our tax dollars utterly wasted. So we have law enforcement officers who lost their brothers and their sisters in the law enforcement world, and people who have lost family members in Mexico."

"The drug problem isn’t just an American problem, and the harm that prohibition of drugs causes in the world is phenomenal," said LEAP member and Texas resident Terry Nelson, who spent more than three decades in federal law enforcement. "Hundreds of thousands are dying in the Western Hemisphere alone, it’s got to stop," he said. "The drug war is a war on people, it's not a war on drugs."

In Houston, state Rep. Sylvester Turner (D-Houston) presented Sicilia with a non-binding resolution praising his efforts and criticizing the drug war.

Javier Sicilia with the LEAP van
"Although our nation spends in excess of $40 billion a year combating the drug trade, the United States remains the principal destination for drugs produced in and transported through Mexico," the resolution said. "Moreover, many of the firearms found at crime scenes in Mexico have been traced to sources in the United States; interdiction initiatives have not resulted in the decline of drug abuse."

Along the way, the caravan has touched on a number of intersecting issues. Javier Sicilia himself told Maricopa County Sheriff Joe Arpaio to treat his prisoners better, and the caravan has visited immigrant detention centers to criticize US policies toward undocumented immigrants. Similarly, in Houston, group members purchased a pistol and an AK-47 at gunshow, then dismantled the rifle, transforming into a peace symbol in line with its calls on the US government to crack down on the flow of firearms south of the border. And above all, the call for the respect for human rights has been a constant on the caravan.

The caravan is set to arrive in Washington, DC, on September 10 for events scheduled the following day. So far, it is succeeding in its aim of bringing attention to the harms of the drug war on both sides of the border -- a Google news search for "caravan for peace" now shows 2,660 results. That number was at 145 when last we wrote about the caravan two weeks ago.

Many more photos are available on the Caravan's Flickr page.

Book Review: Drugs, Insecurity, and Failed States: The Problems of Prohibition

Chronicle Book Review: Drugs, Insecurity, and Failed States: The Problems of Prohibition by Nigel Inkster and Virginia Comolli (2012, Adelphi, 163 pp. PB, $12.50) 

Longtime readers of Drug War Chronicle likely are already familiar with many -- but not all -- of the topics in Drugs, Insecurity, and Failed States. The Chronicle has been on the ground and reported back from Afghanistan, Colombia, and Mexico -- all of which get individual chapters in this new book -- on the problems generated by drug prohibition in those producer and/or transit nations.

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We've also reported to a lesser extent on the drug war's impact on Central America, but almost not at all on its impact in the countries of West Africa, which has become an important staging ground for drug flows from Latin America to Europe and the Middle East. Drugs, Insecurity, and Failed States has individual chapters on these two regions as well.

Even though some of the information is new, the book's thesis should also be familiar to Chronicle readers: The present drug prohibition regime is not only failing to win the war on drugs, it is also setting off and prolonging violent conflict -- both political and criminal -- in producer and transit countries.

We have certainly seen that in spades in the past few decades. In Mexico, which is both a producer and a transit state, the multi-sided drug wars pitting the so-called cartels against each other and the state have left more than 50,000 dead in six years and shaken public confidence in state institutions. In Colombia, profits from the illicit coca and cocaine trade fund leftist guerrilla armies -- one of which, the FARC, has been at war with the state since 1964 -- and rightist paramilitaries alike. In Afghanistan, which supplies almost 90% of the world's opium and the heroin derived from it, both the Taliban and elements of the Afghan state are profiting handsomely from the illicit trade.

Drugs, Insecurity, and Failed States provides succinct, yet fact-filled overviews of the deleterious effects of prohibition in all three countries, as well as West Africa and Central America. In all of them, the lure of the profits of prohibition exceed the threat of law enforcement or the ability of the state to suppress the black market economy. That's not news.

What is newsworthy about Drugs, Insecurity, and Failed States is who has produced it. The authors, Nigel Inkster and Virginia Comolli, are, respectively the director of Transnational Threats and Political Risk at the London-based International Institute of Strategic Studies (IISS) and a research analyst at that august institution. Not only that, Inkster is a veteran of the British Secret Intelligence Service who spent his last two years as the Assistant Chief and Director for Operations and Intelligence. 

The IISS, which was founded to manage the Cold War for the West more than half a century ago, describes itself as "the world's leading authority on political-military conflict." With many former US and British government officials among its members, IISS very much is the establishment, an organ of the global security elite.

When the IISS says a policy has not only failed but has produced counterproductive results, governments tend to listen. Now, we have the IISS quite clearly and vehemently saying that drug prohibition has done both. And that's what makes Drugs, Insecurity, and Failed States so remarkable -- not that we want to give short shrift to the cogent analysis in the book.

It is noteworthy that the authors also take on the international drug control bureaucracy based in UN agencies such as the International Narcotics Control Board (INCB) and the Office on Drugs and Crime. They chide the INCB for not only failing to control the illicit drug traffic, but also with failing to uphold the other part of its mandate: ensuring an adequate supply of opiate-based pain medications. Noting that a handful of Western countries account for a staggering 80% or more of all opioid pain medication usage, Inskter and Comolli clearly think vast portions of the planet are not getting sufficient pain medications, and they blame the INCB. To be fair, though, they also acknowledge other obstacles to the effective treatment of pain in developing nations.

Drugs, Insecurity, and Failed Statesis also useful for its discussion of the alternatives to prohibition and what decriminalization or legalization would and would not achieve. Decriminalization would be a benefit to drug users, they argue, citing the Portuguese experience, but would not address black market profits. And legalization would certainly weaken, but is unlikely to eliminate, the violent criminal organizations running amok in places like Mexico and Central America.

For politically motivated actors, such as the FARC in Colombia and the Taliban in Afghanistan, for which the profits of the drug trade are not an end in themselves, but a means to achieving political goals, legalization would have little impact, except on their revenue streams. Such groups would find other means to continue, Inkster and Comolli suggest.

The book also discusses the prospects for trying to change the global prohibition regime, which is based on the 1961 Single Convention and its two successor treaties. The outlook is not sunny, the authors suggest, given a distinct lack of interest in reforms by such major players as the United States, China, and Russian, not to mention the lack of a hue and cry for change from regions including Africa, the Middle East, and Southeast and East Asia.

But even within the ambit of the global prohibition regime, there is a bit of room for experimentation. The INCB could try to find less restrictive interpretations of the treaties, and the Office on Drugs and Crime could shift its emphases. That could result in some small openings, perhaps for supervised injection sites or heroin maintenance and the like, but not in major changes and not in an end to global drug prohibition.

Drugs, Insecurity, and Failed States concisely restates some old arguments and adds a few new ones, and it provides handy overviews of the problems of prohibition in producer and transit countries. One can only hope that members of the policymaking circles at which it is aimed actually pick it up and read it because the global security establishment is telling them in no uncertain terms that not only is prohibition not working, it's making matters worse.

Now They're Trying to Ban... Kratom? [FEATURE]

The prohibitionist impulse is strong. When confronted with a newly encountered psychoactive substance, there are always special pleaders to sound the alarm and politicians willing to reflexively resort to the power of the ban. Whether it is something with serious potential dangers, like the "bath salts" drugs, or something much more innocuous, like khat, the mild stimulant from the Horn of Africa, doesn't seem to matter; the prohibitionist impulse is strong.

mitragyna speciosa (kratom) tree (photo by Gringobonk, courtesy Erowid.org)
Kratom is a substance that falls on the more innocuous side of the psychoactive spectrum. It is the leaves of the kratom tree, mitragyna speciosa, which is native to Thailand and Indonesia, where the leaves have been chewed or brewed into a tea and used for therapeutic and social purposes for years. According to the online repository of psychoactive knowledge, the Vaults of Erowid, kratom acts as both a mild stimulant and a mild sedative, creates feelings of empathy and euphoria, is useful for labor, and is relatively short-acting.

Of course, any psychoactive substance has its good and its bad sides, but kratom's downside doesn't seem very severe. Erowid lists its negatives as including a bitter taste, dizziness and nausea at higher doses, mild depression coming down, feeling hot and sweaty, and hangovers similar to alcohol. There is no mention of potential for addiction, and while fatal overdoses are theoretically possible, especially with its methanol and alkaloid extracts, in the real world, ODing on kratom doesn't appear to be an issue. No fatal overdoses are known to have actually occurred.

On the other hand, some of kratom's alkaloids bind to opioid receptors in the brain, making it an opioid agonist, and it is now being sold in the West and used to treat pain, depression, anxiety, and opiate withdrawal. Sold in smoke shops, herbal supplement emporia, and on the Internet, it is now apparently being lumped in with synthetic cannabinoids and the "bath salts" drugs by treatment professionals, law enforcement, and others who make a habit of searching for scary new drugs.

Kratom is not listed as a banned substance in the 1961 Single Convention on Narcotic Drugs or its successor treaty, and has been banned in only a handful of countries, most ironically in Thailand itself. It was banned there in 1943, when then Thai government was taxing the opium trade and opium users were switching to kratom to aid in withdrawals and as a substitute.

Arrests for kratom possession have jumped in recent years, from more than 1,200 in 2005 to more than 7,000 in 2009, even though the Thai Office of the Narcotics Control Board recommended to the Justice Department in 2010 that it be decriminalized because of the lack of any perceivable social harms.

In the US, the DEA added kratom to its list of drugs of concern in 2010, although that doesn't mean that a federal ban is necessarily imminent. Salvia divinorum, for example, has been a drug of concern for more than a decade now, with no action taken. But while the feds haven't acted, there were efforts to ban kratom in several states in the US this year, although only Indiana actually succeeding in outlawing it. In Louisiana, age restrictions were placed on its purchase.

The experience of Iowa, where legislation to ban kratom is still pending, is illustrative of how bans are created. The Iowa effort happened after state Rep. Clel Baudler (R) heard about kratom on a radio program. Within two hours, he was moving to ban it.

"Kratom is a hallucinogen, addictive, and can be life threatening," he said at the time, in complete contradiction of all that is actually known about kratom.

It's not just states that are considering bans on kratom. Pinellas County, Florida, was about to enact one this week, but the prohibitionist bandwagon hit a bump in the road in the form of perennial drug war gadfly Randy Heine, owner of Rockin' Cards and Gifts in Pinellas Park, who told the Chronicle he had been selling kratom in his store since 1981.

Seeing what was coming down the pike, Heine alerted the Kratom Association, a group of users, producers, and vendors dedicated to keeping kratom legal, who flooded county commissioners with emails. He also addressed the commission itself.

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Randy Heine
"I have been selling kratom for over 30 years out of my store on Park Blvd. I challenge anyone to find any problem originating from my store selling kratom," he wrote in a letter made available to the Chronicle. "Do not lump in synthetic chemicals with an organic plant material. This is like comparing apples to oranges. I would like to see kratom be sold only to persons over the age of 18, similar to the proposal being made in our sister state of Louisiana."

In the conservative county, Heine also appealed to the ghost of Ronald Reagan in his letter to commissioners. What riles up the Reagan in him, Heine wrote, is "growing the bureaucracy by creating another board to regulate what I and others do in privacy of our own homes."

"I got letters back from two of the commissioners," said Heine. "They read my Ronald Reagan letter out loud, and one of the GOP commissioners thanked me for sharing my thoughts. The commission has now deferred this item so we can take a closer look at the issues involved."

Many of his kratom customers are using it as an opiate substitute, he said.

"We have a drug rehab place here, and my feeling is that a lot of their clients are purchasing kratom instead of methadone. It's competition; I'm taking away money," he said. "Some of my customers say methadone is worse than heroin and keeps you addicted. Kratom weans them off heroin. A lot of them say they just do less and less kratom until the craving stops. I have a couple of senior women who say they're tired of taking prescription pills, that they make them nutty, and kratom works for them."

Chronicle readers may recall that Pinellas County is where a drug reform-minded upstart Democratic candidate for sheriff is taking on either the scandal-plagued Republican incumbent sheriff or his challenger and predecessor, former Sheriff Everett Rice (the GOP primary is next week), whose supporters on the council were pushing the kratom ban. That Democrat, Scott Swope, is so good on drug policy that his candidacy persuaded Heine to drop his own bid for the sheriff's office.

"This looks like another unconstitutional intrusion into the lives of Pinellas citizens who aren't harming anyone," Swope said. "I've researched kratom and although there doesn't seem to be as much research available as cannabis, it appears to me to be a plant product that should not be banned. I think the purchase or possession of any of these things (cannabis, kratom, bath salts) by minors should not be allowed. Adults, however, should be free to do what they want as long as they aren't harming anyone else."

While Heine is currently bedeviled by the effort to ban kratom, as well as an associated effort to force smoke shops to put large signs on their doors saying they sell drug paraphernalia, the Swope candidacy has him hoping for better times ahead. 

"Swope can win," he exulted. "We finally have a candidate who is talking about marijuana. Even the Republican candidates are now saying they wouldn't bust people for marijuana. When I was still a candidate, I went to many forums to talk about pot, and the media started asking these guys about it. Scott won't arrest people for personal use."

Whether it's relatively unknown substances like kratom or now familiar substances like marijuana, the battle lines are drawn in what is ultimately a culture war. On one hand, the forces of fear and authoritarianism; on the other, the forces of free inquiry and personal liberty. It's been a long war, and it isn't going to end anytime soon, but perhaps now there are hints that the correlation of forces is changing.

Stopping unnecessary prohibitions before they get started is part of the struggle; undoing entrenched prohibitions with powerful interests behind them is another part of the struggle, but even though the substances are different, it's the same struggle.

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

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United States

"You Can't Stop AIDS Without Ending the Drug War" [FEATURE]

The XIX International AIDS Conference took place in Washington, DC, last week, bringing more than 20,000 scientists, activists, government officials, and journalists to assess the science and determine best practices for reducing the spread of the HIV virus. The US was able to host the conference for the first time in 22 years after it finally repealed a law denying people with HIV admission to the country.

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activists interrupt the conference opening session to protest the exclusion of drug users and sex workers (video at droginreporter.hu/en)
But other critical groups remained excluded -- drug users and sex workers. Although they make up a majority of people living with HIV in many countries, people who admit to ever using drugs or engaging in prostitution within the past 10 years are inadmissible under US immigration laws. The State Department could have issued a blanker waiver of inadmissibility for people attending the conference, but declined to do so.

Drug users and sex workers who wanted to attend the conference were thus faced with a dilemma: Tell the truth and be barred or lie on the visa application, which in itself is a violation of US immigration law. As a result, representatives of some of the groups most affected -- and most likely to be affected in the future -- were unable to attend.

"People do not want to run the risk of attending the conference in a country where they are told they are not wanted or desired," said Allan Clear, the executive director of the Harm Reduction Coalition. "It sends the message that people who have a history of drug use or sex work are not actually included in the dialog at all, and is a serious setback in the fight against AIDS. I don't think the US government has any particular interest in actually involving sex workers or drug users in policy or programming."

The exclusion of drug users and sex workers hasn't gone down well with activists. As far back as two years ago at the Vienna AIDS conference, Indian activist Meena Seshu called for a boycott of AIDS 2012, pointing out that it was unethical three decades into the AIDS epidemic to discuss AIDS policy without including those most affected. Some have boycotted the conference, opting instead to attend a Kiev conference that began July 9 for drug users and people living with HIV from Eastern Europe. Sex workers and their allies followed with a side meeting in Kolkata this week. While those two events are officially considered "hubs" of the International AIDS Conference, many attended them as a means of protesting the exclusion of drug users and sex workers in Washington.

Unhappiness broke into the open in Washington Monday when dozens of drug user and sex workers activists disrupted the conference's opening press event. They leapt from their seats unexpectedly and marched through the room, waving banners and shouting slogans such as "No drug users? No sex workers? No International AIDS conference!"

Discontent with AIDS policies that marginalize drug users and sex workers escaped from the conference rooms and onto the streets again on Tuesday, as hundreds marched to the White House chanting "No More Drug War" in a rally timed to coincide with the conference. The march broadened the scope of protest, linking the battle against AIDS with the war on drugs and corporate domination of US political life.

On the way to the White House, protestors stopped at UPS and Wells Fargo facilities to chide those corporations for unhelpful practices. UPS took heat for donating to politicians who voted to restore the federal ban on needle exchange funding, and Wells Fargo for investing in private prisons.

"Wells Fargo is literally invested in locking more people up," said Laura Thomas of Drug Policy Alliance (DPA).

Activism around drug users and AIDS also took place in the conference's Global Village, including the installation of a model of Vancouver's Insite supervised injection site and tours of a local needle exchange outreach van courtesy of DC's Family and Medical Counseling Services. The Harm Reduction and Global Drug Policy Zone in the village also featured special events and presentations put on by groups including the Harm Reduction Coalition, Harm Reduction International, the Hungarian Civil Liberties Union, the Eurasian Harm Reduction Network, and the International Network of People Who Use Drugs.

Advocates also took advantage of the AIDS conference to unleash a campaign on the theme of "You Can't End AIDS Unless You End the Drug War." Articles to that effect appeared on Alternet and the Huffington Post (and were picked up elsewhere), while Global Commission on Drug Policy member Richard Branson penned a USA Today op-ed piece on how drug prohibition contributes to the spread of HIV. As part of the same campaign, Politico ran a full-page ad signed by Global Commission members and other notables, repeating the message and directly challenging both President Obama and Gov. Romney to "do the right thing." Giants in AIDS advocacy like Michael Kazatchkine and Stephen Lewis joined the calls in speeches given during the conference.

In an unexpected cap to things, former President Bill Clinton called for drug use to be treated as a public health issue, not a criminal justice one, in remarks at the closing plenary. Clinton cited The Huffington Post and Alternet op-eds, coauthored by the Drug Policy Alliance's Ethan Nadelmann and American Foundation for AIDS Research founder Matthilde Krim.

Activists demanding a larger role for drug users and sex workers in setting the policies that are supposed to help them fight AIDS came armed with powerful ammunition. Two recent reports clearly lay out how criminalizing drug use helps spread the disease and how many countries are failing to adequately deal with the spread of HIV among injection drug users.

The first report, from the Global Commission on Drug Policy, makes its findings clear in its title: "The War on Drugs and HIV/AIDS: How Criminalization of Drug Use Fuels the Global Pandemic." In the report, the commission noted that injection drug use now accounts for one-third of new HIV infections outside of sub-Saharan Africa, including some 354,000 people in the US.

"Throughout the world, research has consistently shown that repressive drug law enforcement practices force drug users away from public health services and into hidden environments where HIV risk becomes markedly elevated," the commission said. "Mass incarceration of nonviolent drug offenders also plays a major role in spreading the pandemic."

The commission also remarked on "the remarkable failure" of drug prohibition in reducing the global drug supply. The worldwide supply of illicit opiates, such as heroin, has increased almost four-fold in recent decades, the commissioners noted. They also noted the drug war's contribution to the growth of organized crime and violence.

The commission identified proven addiction treatment and evidence-based public health measures that countries should put in place to reduce the spread of HIV and protect community health and safety. They include needle exchange programs, safer injecting facilities, and prescription heroin programs.

"Failure to take these steps is criminal," the commission said.

In the second report, "The Global State of Harm Reduction 2012: Towards an Integrated Response," from the London-based Harm Reduction International (formerly the International Harm Reduction Association), researchers found that while injection drug use has been identified in 158 countries, only half of them have any programs aimed at preventing the spread of HIV among injectors, and the situation internationally is not improving. Even in countries that are addressing the problem, programs suffer from lack of funding and donor support is decreasing. That is undermining the global response to AIDS, the report concluded.

"In the last two years, we have seen a significant scale-down of services in countries with some of the highest HIV burdens among people who inject drugs," said Rick Lines, the group's executive director. "As tens of thousands gather in Washington this week to call for an end to AIDS, it is becoming increasingly clear that governments have neither the will nor the intention of ending the spread of HIV among people who use drugs."

"We have seen the number of needle exchange programs in Russia drop for 70 in 2010 to only six in 2012. This is made worse by a retreat of many bilateral and multilateral donors to funding effective harm reduction interventions in many countries," said Claudia Stoicescu, public health analyst at Harm Reduction International and author of the report. "Such developments significantly limit progress toward global commitments to halve HIV transmission related to unsafe injecting by 2015, let alone any hope of achieving universal access to HIV prevention, treatment, care and support for people who inject drugs."

"The reluctance of governments to fund an adequate response to HIV and injecting drug use stands in stark contrast to the seemingly limitless budgets for ineffective and punitive law enforcement responses," said Lines. "Governments care more about fighting a losing war on drugs than they do about winning the fight against HIV."

As the world enters its fourth decade of living -- and dying -- with HIV/AIDS, this week's conference and its barriers to participation by and concern for some of those most directly affected by the crisis -- drug users and sex workers -- demonstrate how far we still have to go. They also make achingly clear the destructive role that drug prohibition and the criminalization of marginalized populations play in perpetuating the epidemic.

Maybe next time the International AIDS Society will hold its conference someplace where drug users and other marginalized groups can attend and be heard. Or maybe the United States will alter its harsh visa requirements aimed at drug users and sex workers. Either one would be good. Ending drug prohibition, the stigma it generates, and the obstacles to fighting disease it engenders would be better.

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