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New Mexico Legislature to Study Supervised Injection Sites [FEATURE]

In a groundbreaking move, the New Mexico legislature has approved a proposal to study how to enhance and expand the state's already cutting edge harm reduction programs, including a look a medically supervised injection sites (SIJs -- sometimes also known as safe injection sites) for hard drug users. That could clear the way for an eventual SIJ pilot program to operate in the state, although considerable political and legal hurdles remain.

The legislation, Senate Memorial 45, was sponsored by Sen. Richard Martinez, whose constituency includes Rio Arriba County, which has a drug overdose fatality rate five times the state's rate. The state's rate is double the national rate, making New Mexico the nation's leader in drug overdose-related deaths per capita.

"These deaths are preventable," said Martinez. "Overdose spares no one and affects everyone, especially families."

State health officials estimate the state has at least 24,000 injection drug users. Other estimates put that figure as high as 50,000.

The memorial, which was also endorsed by the New Mexico Public Health Association, passed the Senate on a 43-0 vote Monday night and does not need any further action to go into effect. It directs the University of New Mexico's Robert Wood Johnson Foundation Health Policy Center to undertake the study of emerging and evidence-based harm reduction approaches, including SIJs, and report back to the legislature by November 1.

"Sadly, our drug overdose epidemic has outgrown our current harm reduction approaches," said Emily Kaltenbach, director of the Drug Policy Alliance (DPA) New Mexico office. "On Monday, our state senators realized this and did not let politics trump science. They clearly stated their intent to go beyond the status quo and explore innovative strategies to help New Mexico’s families."

"Wow, getting something like that on the state level is huge," said Hilary McQuie, Western director for the Harm Reduction Coalition (HRC). "New Mexico once again takes the lead in state harm reduction efforts; it's one of the few states to take a statewide approach to these things."

"Heroin is still the number one cause of ODs here, but we're also seeing a high number of prescription drug overdose deaths," said Kaltenbach, "so I'm incredibly encouraged that the legislature is willing to look beyond the status quo and start studying proven programs like supervised injection sites. We're hoping to study the feasibility and legal and ethical implications, leading to a pilot site in New Mexico."

If that actually happens, it would be the first SIJ in the nation. Although SIJS are operating in at least 27 cities around the world, including Vancouver and Sydney, and have been proven to reduce the spread of HIV, Hep C, and other blood-borne diseases, as well as prevent overdoses, without increasing criminality or drug use, political and legal obstacles in the US have so far prevented them from spreading here. They face morality-based opposition as well as federal issues including a "crack house law," which bars anyone from knowingly allowing others to use controlled substances.

"These same sorts of issues came up when syringe exchange programs were first discussed," said Kaltenbach. "I think the legal issues can be overcome, but the states have to be willing to look at it as an extension of syringe exchange. This study will address those issues."

While New Mexico is the first state to order a study of SIJs, it isn't the only place in the country where they are on the agenda. In San Francisco, drug user groups, activists, and advocates are working toward winning approval for one there, while in New York City, a similar effort is going on.

"The biggest obstacle is the perception of legal barriers," said DPA's Laura Thomas, who has been working on the San Francisco effort. "We have these crack house statutes, as well as state laws, that say it's illegal to knowingly allow people to use controlled substances. We have to figure out if there's room for a research project, like in Sydney, or create an exemption, like in Vancouver, or get a state law passed, like in New Mexico. We need a ruling that says 'yes,' this is not a violation."

http://stopthedrugwar.org/files/richard-martinez.jpg
Richard Martinez
In the meantime, the achingly slow process of building political support for an SIJ, or at least a feasibility study, goes forward. A year ago this week, a city Hep C task force recommended looking at SIJs. That followed on a similar recommendation from the city's HIV coalition.

"We continue to try to build support for a safe injection site," said Thomas. "During the mayoral campaign last year, at one of the candidate forums, they were all asked if they would support evaluating whether it would work for San Francisco, and most of them said they did, including our current city attorney, Dennis Herrera."

But despite the recommendations and expressions of support, nothing has happened yet. The San Francisco Drug Users' Union is trying to change that.

"We will be pressing the Board of Supervisors to study the possibilities," said the group's Isaac Jackson. "We're also doing a SIJ community design competition, a project in community imagineering. We'll give the winner a nominal prize and we'll present the winning design to the Board," he said.

"We think the city's Human Rights Commission will recommend safe injection sites in April," said HRC's McQuie. "But there have been other bodies and other recommendations. It's a matter of where the political will is and the priorities are."

For HRC, said McQuie, getting a safe injection site up and running in San Francisco is a back burner issue right now, but that could change.

"We have a lot of really great harm reduction projects going on, like the DOPE Project, that aren't getting financial support, and while there was a lot of enthusiasm for awhile about working toward a safe injection site, we kept planning meetings, but nobody would show up. It didn't feel like the energy was there. If the San Francisco Drug Users' Union wants to take some leadership, we would be happy to support it," said McQuie. "I think we will be going back to San Francisco and asking somebody to do something on this issue, but we're not sure who yet."

On the other side of the country, street-level activists are aiming for an SIJ in New York City. Citiwide Harm Reduction in the South Bronx, which is on the verge of opening the city's first fully staffed primary care clinic at a syringe exchange, is preparing to build a full-scale model of an SIJ at its 144th Street building. It may seem like performance act, but its purpose is educational.

"Our inspiration is the Smithsonian museums, where you can go inside the cockpit of the space shuttle," said Citiwide executive director Robert Cordero. "People have this grisly misconception of what a safe injection site would be like, and we want them to be able to have this Smithsonian experience here in the Bronx."

Such a model could be quite useful in educating elected officials and law enforcement, Cordero said.

"SIJs are a humane public health approach to reducing overdoses, HIV, Hep C, and crime, and can provide compassionate care for addicted people until they are ready to get into treatment," he said. "Do we want that, or do we want them just hanging out in front of the bodegas on 149th all day?"

Citiwide isn't going it alone on agitating for SIJs, and it isn't even taking the lead. Instead it is working with groups like HRC and the Vocals-NY Users' Union in a broader campaign.

"We're not trying to be the HRC or Vocals-NY," said Cordero. "We advocate through demonstrating what it would be like while partnering with others who are advocating every day. Our effort is to build the SIJ model, and when anyone comes to New York who is interested in these issues, there can be an educational moment."

Supervised injection sites are not a reality yet in the US, but pressure for them is mounting. Whether it's New Mexico, New York City, or San Francisco, one of these years someone is going to lead the US into the ranks of nations that understand their utility -- and their humanity. New Mexico has just taken a giant step, but let's hope it has to move fast to beat San Francisco and New York.

Santa Fe, NM
United States

San Francisco Marks 600th Overdose Death Prevented

For the past eight years, the San Francisco Department of Public Health has been handing out the opioid antagonist naloxone (Narcan) in a bid to reduce heroin overdose deaths. This week, the city marked what it said was the 600th life saved by using the overdose-reversal drug.

This drug stops heroin overdoses -- 600 so far in San Francisco (wikimedia.org)
The city distributes naloxone through needle-exchange sites, nonprofit organizations, and community organizations that deal with injection drug users. The department also prescribes the drug to people in residential hotels and the friends and families of heroin users, and conducts training sessions in the county jail.

Not only have hundreds of overdose deaths been averted, but the department also reported that heroin-related visits to the city's emergency rooms had declined by half between 2004 and 2009.

The lifesaving measure is funded by a department expenditure of $73,000 a year, which goes to the Oakland-based Drug Overdose and Prevention Education Project (DOPE Project). DOPE uses the money to buy and distribute the drug and train people on how to use it.

"San Francisco has always been a heroin town," Alice Gleghorn, DPH's head of Community Behavioral Health Services told the SF Weekly. "At one time, San Francisco had an overdose death every day, and that rate has really gone down. I hope our naloxone programs have contributed to that drop. But we don't have the money to do the research."

Eliza Wheeler, director of the DOPE Project, compared naloxone to insulin and said its use posed few problems for injection drug users. "The folks we see are pretty adept with administering drugs, so they'll be okay. People are very capable and willing to save their friends' lives... my experience is that people are really proud of themselves," Wheeler said.

Harm reduction is saving lives in San Francisco. Perhaps other cities and counties should take heed.

San Francisco, CA
United States

Canada Supreme Court Okays Safe Injection Site [FEATURE]

Rebuffing the Conservative government of Prime Minister, the Canadian Supreme Court Friday ruled unanimously that Vancouver's safe injection site for heroin addicts can stay open. Known as Insite, the Downtown Eastside facility is the only safe injection site in North America.

Vancouver's safe injection site wins a reprieve. (Image: Vancouver Coastal Health)
The Downtown Eastside, centered on the intersection of Main and Hasting, streets, has one of the highest concentrations of injection drug users in the world. An overgrown Skid Row flush with prostitution and destitution, most of its residents live in decaying SRO hotels lining Main Street. Out of 12,000 residents in the area, some 5,000 are estimated to be drug addicts.

At Insite, drug users are provided clean needles and sterilized water with which to mix their drug. Insite does not provide the drugs; users must bring their own. The users inject under medical supervision at one of 12 injecting alcoves.

Insite operates under the auspices of the British Columbia Ministry of Health and the local public health authority, Vancouver Coastal Health. Numerous research reports on Insite have found that it has reduced fatal drug overdoses, reduced HIV and Hepatitis C transmission rates, reduced crime rates in the neighborhood, and increased the number of drug users entering treatment.

It has operated since 2003 under an exemption to Canada's drug laws, but since coming to power, the Harper government has attempted to shut it down, claiming it "enables" drug users. Friday's decision by the Canadian Supreme Court is the final chapter in that effort.

The Harper government argued that the federal drug law took precedence over British Columbia's public health policies. British Columbia and other Insite supporters argued that because Insite is providing a form of health care, its operation is a provincial matter. The federal government's concerns did not outweigh the benefits of Insite, the court said.

"The grave consequences that might result from a lapse in the current constitutional exemption for Insite cannot be ignored," the court said. "Insite has been proven to save lives with no discernible negative impact on the public safety and health objectives of Canada."

Hundreds of Insite supporters gathered at the facility at dawn and broke out in cheers after the decision was announced. As the news spread, harm reduction, public health, and drug reform groups in Canada and around the world lined up to applaud it.

"We are absolutely delighted that we finally have a clear decision on the legal framework for Insite," said Dr. Patricia Daly, Vancouver Coastal Health Chief Medical Health Officer. "Since 2003, Insite has made a positive impact on thousands of clients, saved lives by preventing overdoses, and provided vital health services to a vulnerable population. Today's ruling allows us to continue the outstanding work Insite, its doctors, nurses, staff and partners provide."

"This represents a victory for science," said Dr. Julio Montaner, Director of the BC Center for Excellence for HIV/AIDS. "Prior attempts from the federal government to stop the activities of Insite have been ruled unconstitutional. We are thankful for the continued and unwavering support from the provincial government that has allowed us to set an example in Canada and the world for how to deal with addiction which is, indeed, a medical condition."

"We applaud today's landmark decision by the Canadian Supreme Court to uphold the human rights of all Canadians by allowing Insite to remain open," said the Canadian HIV/AIDS Legal Network, CACTUS Montreal, and Harm Reduction International in a joint statement. "We are heartened the Supreme Court of Canada has recognized that criminal laws on drugs must give way to good public health practices and harm reduction."

"This is a victory for science, compassion and public health -- and, given the fiscal benefits of such programs, the Canadian taxpayer. The Supreme Court of Canada recognized that Insite saves lives, and that that should be a guiding principle in deciding drug policy," said Laura Thomas, California deputy director for the Drug Policy Alliance. "Congratulations to the advocates, drug users, researchers, nurses, and elected officials who have campaigned for Vancouver's supervised injection facility for so long. This is a complete validation of their work."

The Supreme Court of Canada's Insite ruling applies only to Insite. Other Canadian localities seeking to establish safe injection sites must win permission from the federal government. Canadian activists urged them to do so.

"In light of today's Supreme Court decision, jurisdictions Canada-wide should act fearlessly on evidence and make harm reduction services modeled on Insite available to those in need in their locales," said the Canadian groups. "The Minister of Health must respect the court's decision and grant similar exemptions to other sites so that people across Canada will be able to access the public health services they desperately need."

There are 67 safe injection sites operating today, with one in Australia, Insite in Vancouver, and the rest in Europe. There are no safe injection sites operating in the United States, although a move is afoot in San Francisco to get one underway there. The Drug Policy Alliance's Thomas said it is time to start pushing harder.

"For communities in the US which have been hard hit by drug use, it is time to look at the evidence from Canada and start opening supervised injection facilities here," she said. "We look forward to implementing the same desire to save lives in the US."

Vancouver, BC
Canada

Massachusetts Marks 1,000th Narcan Overdose Reversal

State officials in Massachusetts announced Tuesday that the state's pilot Narcon (naloxone) pilot program has marked the 1,000th overdose reversal since the program was introduced in 2007. The program is part of a broader effort undertaken by the Department of Public Health, its Bureau of Substance Abuse Services and its Bureau of Infectious Disease Control to reduce fatal and non-fatal opiate overdoses.

Narcan is saving lives in Massachusetts. (image courtesy Cambridge OPEN)
Narcan is an opioid antagonist that blocks the effects of opioids, such as heroin, oxycodone, hydrocodone, fentanyl, codeine and methadone. The pilot programs teach people how to use Narcan, including opioid users and trusted people in their lives, such as family, friends and staff of human services programs. The Narcan pilot sites also provide education on overdose prevention and referrals to treatment. The Department of Public Health reported that more than 10,000 people are now enrolled in the pilot program, including drug users, friends, and family members.

"Too many families have been impacted by the rise in opiate abuse and overdoses in Massachusetts," said Lieutenant Governor Timothy Murray, Chair of the Interagency Council on Substance Abuse and Prevention. "As we continue to combat opiate abuse and provide resources for prevention and treatment services, Narcan has proven to be a powerful tool in saving lives, so that opiate abusers can receive treatment and begin to recover from their addiction."

"Massachusetts is a national leader in opioid overdose prevention," said Secretary of Health and Human Services JudyAnn Bigby, MD. "By using community-based programs to enroll participants and distribute Intra-nasal Narcan, this pilot has allowed us to reach opioid users and bystanders in communities across the state."

Intra-nasal Narcan is available at pilot sites located in 12 Massachusetts cities, including Boston, Brockton, Cambridge, Fall River, Gloucester, Hyannis, Lynn, New Bedford, Northampton, Provincetown, Quincy and Springfield. The pilot sites provide education on overdose prevention, recognition and response to opiate users and family and friends of opiate users, along with referrals to treatment. Click here to learn more.

Boston, MA
United States

Cuomo Signs NY Good Samaritan Drug Overdose Bill

New York Gov. Andrew Cuomo June signed into law July 20 legislation aimed at reducing the number of preventable drug overdose deaths in the Empire State. The new law gives protection from prosecution for drug possession offenses to overdose victims seeking medical help or to people seeking medical help for them.

Gov. Andrew Cuomo (D) has signed a bill designed to reduce drug overdose fatalities. (image via wikimedia.org)
The new law also provides protection from underage drinking and drug paraphernalia prosecutions for overdose sufferers or others seeking to help them. The law does not provide protection from drug distribution charges.

New York now becomes the most populous state to enact what are commonly referred to as 911 Good Samaritan laws. They are designed to reduce overdose deaths by removing the fear of prosecution for victims or their acquaintances seeking help.

New York is one of the states where drug overdose -- from both legal and illegal drugs -- is the leading cause of accidental death. In the absence of protections like those just enacted, people suffering overdoses or their friends have often been reluctant to seek medical attention for fear of being arrested.

"No one should go to jail for trying to save a life," said Hiawatha Collins, a leader and Board member of VOCAL-NY, one of the many groups that supported the reforms. "This law will help make sure that calling 911 is the first thing someone does if they witness an overdose -- not worry about what the cops will do. New York is making clear that saving lives needs to be our priority, not locking people up."

"It is uplifting to see our elected officials come together to pass a law that will save thousands of lives in New York," said Evan Goldstein, policy coordinator of the Drug Policy Alliance. "Our elected officials should be applauded for passing this law that is grounded in science, compassion, health and human rights."

New York is the fourth state to enact a 911 Good Samaritan law, following the lead of New Mexico in 2007, Washington state in 2010, and Connecticut earlier this year. The law will go into effect in 60 days.

Albany, NY
United States

Chronicle Book Review: The Power of the Poppy

The Power of the Poppy: Harnessing Nature's Most Dangerous Plant Ally, by Kenaz Filan (2011, Park Street Press, 312 pp, $18.95 PB)

Kenaz Filan thinks that Poppy (always capitalized in the book) is a sentient being. Before you roll your eyes as you recall the fervent mushroom cultists who say the same sort of thing, recall also that more mainstream authors, such as foodie Michael Pollan, have been known to talk like that, too, posing similar questions about what plants want. I'm not personally convinced about the sentience of plants, but I find that adherents of such a position definitely bring something of value to the table: respect for their subjects.

The opium poppy certainly deserves our respect. It can bring miraculous surcease from suffering through the pain-relieving alkaloids within, but those same alkaloids can also bring addiction, oblivion, and death. Our "most dangerous plant ally" can be both kindness and curse, boon and bane. Only by respecting Poppy, writes Filan, can we learn how best to manage our relationship with her.

The Power of the Poppy is part historical treatment, part cultural essay, part pharmacopeia, part practical guide. As such, positions on plant consciousness notwithstanding, it's a fascinating and illuminating treatment of the poppy and its derivatives. Filan traces the history of man's relationship with poppy from 6,000-year-old archeological digs in Europe, through early uses in the Roman empire and the Islamic world, and on to the current era of the war on drugs.

While Filan addresses the war on drugs and finds it stupid, this is not mainly a book about drug policy, and he dismisses the issue in short order. "Our war on drugs has been a one-sided rout," he writes in the introduction. "We keep saying 'no' to drugs, but they refuse to listen."

In his few pages devoted to the past century of opium prohibition, he reiterates the futility of trying to stamp out poppy even as its cultivation spreads. "Poppy is happy to fulfill our needs as long as we propagate her species," he writes. "To her, our 'war' is like locust invasions and droughts -- an annoyance, but hardly something that will endanger the continued existence of her children."

From there, Filan turns to the chemistry and pharmacology of opium and its derivatives and synthetics. He traces the isolation of morphine, codeine, heroin, thebaine (from which is derived hydromorphone [Dilaudid], oxymorphone [Opana], hydrocodone [Vicodin], and oxycodone [Oxycontin]), kompot (East European homebrew heroin), methadone, and fentanyl. Along the way, Filan touches on such topics as the lack of pain-relieving poppy products in the developing world, the development of Oxycontin and the rapid spread of "hillbilly heroin," and controversies over needle exchanges, safe injection sites, and methadone maintenance therapies.

In nearly every case of the development of a new opiate or opioid drug, researchers were hoping to find a substance that maintains poppy's analgesic qualities while eliminating or at least reducing its addictive ones. No such luck. "Despite the best efforts of our chemical minds," Filan writes, "Poppy still demands her bargain…Even as we go to war with Poppy, we are forced to do business with her."

In his next section, demonstrates the bargain poppy extracts as he profiles 11 famous users, including Confessions of an Opium Eater author Thomas de Quincy, Samuel Taylor Coleridge, William Burroughs, Lou Reed (whose Velvet Underground-era Heroin and Waiting for My Man put the 1960s New York junkie experience to music), and DJ Screw, whom I must confess I never heard of until reading The Power of the Poppy. Mr. Screw, whose real name, it turns out, was Robert Earl Davis, was a Houston DJ who rose to hip-hop fame after smoking Mexican weed and accidentally hitting the pitch button as he mixed tapes. The ensuing distorted vocals and slowed down beats became known as "screwed down" and Davis picked up the moniker DJ Screw.

Among the favorite topics of Screw and his crew was "purple drank," a concoction of soda pop, codeine cough syrup, and Jolly Ranchers candy, that created a warm, relaxed high. Screwed down music was the perfect accompaniment for a drank-fueled evening. While DJ Screw died young, in part because of his fondness for drank, he was also an overweight, fried-food loving smoker. While drank may have helped make DJ Screw, as always, poppy exacted her part of the bargain.

In the final segment of the book, Filan gets practical. He describes how to grow your own (from papaver somniferum seeds widely available at gardening stores) and how to extract the raw opium. He describes poppy tea brewing recipes, as well as how to use poppy in pill, tablet, or capsule form; as well as eating smoking, snorting, and shooting it. And he doesn't stint on explaining the dangerous path one is on when one embraces the poppy. Although I don't recall Filan ever using the words harm reduction, he is all about it as he cautions about overdose, dependency, and addiction.

The Power of the Poppy elucidates the many ways the histories of man and poppy are intertwined, and it's full of interesting tidbits along the way. Who knew that the use of "dope" to mean drugs came from Dutch sailors mixing opium and tobacco off China in the 17th Century? They called the mixture "doep," like a greasy stew they ate. Or that calling seedy establishments "dives" derived from scandalized descriptions of California opium dens, with the patrons reclining on divans? Or that the scientific name for snorting is "insufflation"?

If you have an interest in opium and its role in human affairs, The Power of the Poppy will be both entertaining and enlightening. And -- who knows? -- maybe you'll start treating that plant and its derivatives with the respect they deserve.

NY State Legislature Considers a Medical Amnesty Policy to Curb Escalating Overdose Crises

Location: 
NY
United States
Proposed laws in the New York legislature that would allow New York residents to call for medical assistance during drug or alcohol overdose situations without fear of prosecution have been introduced in both legislative chambers. Both bills will first be under consideration in the Codes Committees.
Publication/Source: 
NewsLI (NY)
URL: 
http://www.newsli.com/2011/05/18/ny-state-legislature-considers-a-medical-amnesty-policy-to-curb-escalating-overdose-crises/

Vancouver Safe Injection Site Saves Lives, Report Finds

Drug overdose deaths in Vancouver's Downtown Eastside fell dramatically after a safe injection site opened there, according to a study published online Monday in the British medical journal The Lancet. Fatal drug overdoses declined 35% in the vicinity of the Insite safe injection site in the two years after it opened, compared to only a 9% decline in the rest of the city.

Vancouver's Insite safe injection site on East Hastings Street (Image courtesy Vancouver Coastal Health)
"No one has ever been able to demonstrate a substantial reduction in overdose deaths due to the presence of a safe injection site, but we have done so," said Thomas Kerr of the Urban Health Research Initiative at St. Paul’s Hospital in Vancouver and one of the authors of the study.

The study examined 290 drug overdose deaths between 2001 and 2005, 89 of which occurred within 500 meters of the Insite location. Insite opened in 2003. After Insite opened, the overdose death rate within 500 meters dropped from 253.8 per 100,000 to 165.1 per 100,000, a 35% decrease. In the two years prior to Insite opening, 56 neighborhood drug users suffered fatal overdoses; in the two years after, only 33 did.

Previous research had shown that Insite reduced behaviors that could lead to blood-borne infections like Hepatitis C and HIV and contributed to public order by getting IV drug use off the streets and into a clinical setting.

It is not that drug overdoses do not occur at Insite; in fact, there have been 2,000 of them at the facility, but no deaths. In addition to providing injection booths and clean syringes, Insite has nurses on staff who can and do revive users who have overdosed.

Despite previously demonstrated benefits of Insite and the strong support of provincial health authorities, Canada's Conservative government has sought repeatedly to shut it down. The Canadian Supreme Court next month will hear the government's appeal of British Columbia courts' rulings that denying injection drug users such a service violates their rights under the Charter of Rights and Freedoms and that the province has jurisdiction in the case because Insite is providing a health care service, a provincial function.

For the study's authors, the conclusion was obvious: "Safe injection facilities should be considered where injection drug use is prevalent, particularly in areas with high density of overdose."

Vancouver
Canada

The Prospects for Drug Reform: California [FEATURE]

[Editor's Note: This is the first in a series of reports on the prospects for drug reform in a handful of states where the chances of legalizing marijuana are the strongest. But these reports will also look at medical marijuana, harm reduction, and sentencing reform prospects. They are a work in progress and will be revised. Look for reports on Colorado, Oregon, and Washington in coming weeks.]

California, viewed from space
The West Coast is a different world when it comes to progress on drug policy reform. Three of the four states most likely to see strong pushes for marijuana legalization in the next couple of years are on the West Coast (the other being Colorado). And medical marijuana is a fact of life from San Diego to Seattle, even if many bruising battles remain, and is certain to be an area of contention in coming years.

But it's not just pot politics that makes the West Coast different. The region has also been a pioneer in sentencing reform and harm reduction practices, even if countervailing forces remain strong and both policy areas remain contested terrain.

And the fact that all three states are initiative and referendum states adds another dimension to the politics of drug reform. In all three states, the initiative process has been an important vehicle for drug reform, although it has also been used for anti-reform efforts, most notably with Oregon sentencing initiatives.

Will the West Coast continue to be the drug reform vanguard? Here, we look at the prospects for reform in four broad areas -- medical marijuana, marijuana legalization or decriminalization, drug sentencing reform, and the enactment of harm reduction practices -- and assess where the reform movement can most productively apply its energies. We also attempt to identify areas and issues around which larger coalitions can be formed to advance drug policy and criminal justice reform objectives.

We begin with California, the first state to legalize medical marijuana and that state where advocates last year came within a handful of percentage points of winning voter approval for pot legalization. California is the nation's most populous state and has long been at the cutting edge of social change, but now it is also faced with a monstrous $25 billion budget deficit. How social change and fiscal crisis interact in the realm of drug reform policy-making will be a key issue for advocates as they attempt to deepen existing drug reforms and introduce new ones.

Marijuana Legalization

Last year saw efforts to legalize pot both in Sacramento and at the ballot box in November. Rep. Tom Ammiano (D-San Francisco) made history when his legalization bill was approved by the Assembly Public Safety Committee, but that bill later died. Ammiano is back at it again this year, but getting a legalization bill through the legislature will be a tough fight.

The tax and regulate marijuana legalization initiative led by Oaksterdam's Richard Lee managed to put together an impressive coalition of labor, civil rights, and other groups in the run-up to the November election, but that wasn't enough to get the measure over the top. Proposition 19 scored 46.5% of the vote. Legalization advocates are already laying the groundwork for another initiative; several hundred people gathered at a sold-out California NORML (CANORML) conference in Berkeley late last month in a bid to take the first steps toward consensus among the state's complex, variegated, and often fractious marijuana community.

While Prop 19 failed to win a majority, reformers see the coalition-building that took place around it as a basic building block toward eventual victory. For the first time, pot legalization enjoyed organized support from outside the marijuana community.

"Prop 19 has opened up everything and moved marijuana legalization into the mainstream of American politics, particularly in the Western states," said Steve Gutwillig, California state director for the Drug Policy Alliance. "Its defeat was at most a speed bump, and the Prop 19 campaign process itself accelerated the marijuana reform movement. It created unprecedented mainstream media coverage, educated millions of voters, and forged a new coalition that is poised to be recreated and expanded on in California and other states in 2012," he said.

Winning a legalization vote in California means continuing to mobilize labor and civil rights groups, he said. And the stars are aligning.

"Organized labor has to be at the table of what is clearly a burgeoning industry with thousands of viable jobs from agriculture to retail. For mainstream civil rights organizations, the racial profiling that is at the center of marijuana enforcement is an issue that intersects with groups with whom they are naturally allied on other issues. We're seeing a confluence of economic and racial justice issues at a time when mainstream voters are expressing a fatigue with the drug war in general and a contempt for marijuana prohibition in particular," Gutwillig argued.

"The SEIU's endorsement of Prop 19 in California opened the door to a serious conversation with the service employee unions all across the country, said Gutwillig. "The SEIU also took a long look at the Washington initiative, but didn't think the numbers were there. But even that examination was significant. The SEIU thought the timing wasn't right last year, but all of this will be in play again and all of this represents real progress in coalition building. This conversation is taking place in a way that was unimaginable five years ago."

Gutwillig identified one more constituency reformers will be working to draw closer: the Democratic Party and its voters.

"The California Democratic Party took a neutral position, but a majority of county Democratic committees endorsed Prop 19," he noted. "That signals that there will be real conversations about what role marijuana legalization will play in terms of turnout among traditional Democratic voters."

Long-time CANORML head and veteran scene-watcher Dale Gieringer doesn't think winning outright marijuana legalization is going to be easy despite the coalition-building. Instead, he is talking about getting to the Promised Land through small steps and by broadening the existing medical marijuana system with its population of legally sanctioned adult users and providers.

Gieringer wants to down-grade minor marijuana distribution and cultivation offenses from felonies to misdemeanors, legalize private adult use, and establish a legally-regulated production system that includes manufacturing, processing, delivery, and legal sales to legally authorized users, namely anyone who has a medical marijuana recommendation.

"That would leave room for local governments to expand the universe of authorized users" without explicitly legalizing non-medicinal sale to adults, Gieringer said. "Taking on adult sales at this moment is premature, but we can write a law that opens the door to adult sales without explicitly doing it immediately."

Medical Marijuana

Using California's existing medical marijuana program as a segue to adult legalization, however, requires something the state still lacks: clarity about what is and is not allowed by Proposition 215 and the legislature's attempt to clarify it, SB 420. Some state prosecutors insist that no medical marijuana sales are legal, and the courts have yet to provide rigorous guidance. Cases have been and are being prosecuted in those counties, meaning that access to medical marijuana depends to a great extent on where one lives within California.

"Fixing the medical marijuana system has to be integral and a number one priority," said Gieringer. "We have to make changes to the medical marijuana system. The public is not happy with the current situation and would like something that is better regulated. A lot of operators feel the same way, but have differing opinions about what would be nice."

While a fix could come through the legislature, Gieringer was leery. "I can't see the legislature passing anything we would like," he said. "Given the level of support we have in Sacramento, we could probably get a bill to clearly allow medical marijuana sales, but it would also likely be loaded down with things we would find unacceptable, like 1000-foot provisions, no on-site smoking, no sale of edibles and the like," he predicted.

"They dickered around with it last year, but it was mainly about extracting money from everybody," Gieringer continued. "What's really needed is to clarify what's legal and what isn't."

Gieringer suggested that the people working on marijuana legalization initiatives include clarifying medical marijuana sales. "I think we could get something better through a vote of the people," he said. "I am hoping that medical marijuana reform will be part of the next legalization effort if there is one."

Such a strategy also has the potential of blunting opposition to a legalization initiative within the medical marijuana community. Some dispensary operators and medical marijuana patients were among the harshest critics of Prop 19.

Job protection for medical marijuana users is another area with the potential for coalition-building. State Sen. Mark Leno (D-San Francisco) has introduced a bill to prevent most employers from firing medical marijuana users who test positive for the drug. Perhaps unions, who, after all, represent workers, would be amenable to working on the issue.

Sentencing Reform

California's bloated prison system, with its insatiable, dollar-gobbling budgetary demands has seen some sentencing reform, most notably the passage by initiative of the "treatment not jail" Proposition 36. But the prisons remain full, and with no state money for the treatment end of Prop 36, it's only the law enforcement side of the equation that is fully functioning.

In announcing his budget proposal last month, Gov. Jerry Brown (D) including diverting people convicted "nonviolent, non-serious, non-sex offenses, and without any previous convictions for such offenses" to county jails instead of the state prison system. That includes first-time drug offenders. 

"Governor Brown set an important tone and made it clear that our expensive state prisons should be reserved for people convicted of serious offenses, not for everyone who's ever made a mistake,"  said Margaret Dooley-Sammuli, DPA deputy state director for Southern California. "California is expected to save $500 million a year by handling more petty offenses, including low-level drug possession, at the county level. We think the savings would be even greater if drug treatment were made more available in the community. Under the plan, counties would have that option."

An opportunity to save big bucks and reduce the yawning budget gap could appeal to fiscal conservatives, but in California, conservatives have a long tradition of using tough on crime politics to fill the prisons. Whether they could swallow a measure that to some degree empties them remains to be seen.

"The challenge is finding fiscally conservative Republicans who are willing to publicly challenge the drug war orthodoxy that has long been a mainstay of the Republican Party," said Gutwillig. "There are plenty of Republicans who are willing to say privately they know the mass arrests and incarceration of low-level drug offenders is not a good use of scarce resources, but they have a hard time breaking ranks with a GOP leadership that still needs inflexible tough on crime rhetoric to beat up on the substantial Democratic majorities in both houses of the legislature. It's one of their main tools to undermine the Democratic reform instinct.

Still, the continuing budget crisis may allow reformers to peel off a conservative or two, Gutwillig said. "The economics of the state are in such open-ended crisis that no one can deny the reality that we can no longer afford the blank check we perpetually give to law enforcement and the corrections system."

A 2008 sentencing reform initiative, the Nonviolent Offender Rehabilitation Act (NORA) would have deepened and vastly broadened the Prop 36 reforms, but was defeated thanks to last minute attacks by prison guards and politicians. The time could be approaching for another effort on that front, either in the legislature or via the initiative process. 

Harm Reduction

Access to clean needles, preventing not only heroin, but, increasingly, prescription opioid overdose deaths, and opening a safe injection site in San Francisco are some of the issues facing California's harm reduction community. As in other reform areas, the perpetual budget crisis means if anything is going to happen, it better be inexpensive.

"We can't do anything this year that costs money, so we have to be about erasing some of the rules and barriers that exist," said Hilary McQuie, Western director of the Harm Reduction Coalition. "Jerry Brown is pretty good on these issues, and we have a solidly Democratic government, so we should be able to get some of these things through as long as there is no fiscal impact."

Brown's predecessor, Gov. Arnold Schwarzenegger (R), wasn't so good on harm reduction issues. Last year, he failed to sign two bills that would have eased access to syringes. One expanded a pilot pharmacy syringe sales program statewide; the other expanded access to needle exchanges statewide.

"It looks like those bills will be reintroduced this year," said McQuie.

Overdose prevention continues to be a key harm reduction issue. Last year, a bill extending liability protection for the opioid antagonist naloxone to peer providers passed, but it only applies in a limited number of counties.

"We would like to see Naloxone made more easily available to people," said McQuie. "Maybe pharmacists could prescribe it along with opiates."

McQuie mentioned prescription opiates because that's where the action is now. And that means harm reductionists have to adapt their tactics to new clienteles. With prescription drug overdoses rising dramatically, programs aimed mainly at injection heroin users must now broaden their focus.

"Most of our overdose education happens through needle exchanges and other sites that reach injection drug users, but the trend in overdoses is toward prescription drugs," said McQuie. "We hope we can build coalitions with pharmacists, drug treatment people, and medical associations around peer intervention for overdose prevention among prescription drug users."

But coalition-building with drug and alcohol treatment providers means harm reductionists come up against abstinence-based advocates. "It is a long-term project for us to get them to recognize that they are serving people who are currently using rather than just addressing needs of people in treatment," McQuie sighed. "That will be really important for us. We need a bigger coalition in place."

And then there's the San Francisco safe injection site. At this point, it's little more than a gleam in the eye of harm reductionists, although the creation of such a site has been recommended first by the San Francisco HIV planning council and just last month by the mayor's Hepatitis C Task Force.

But given budgetary constraints, as well as morality-based opposition certain to emerge, if a safe injection site is going to happen, it's most likely to happen from the ground up. Vancouver, where drug users organized themselves and started their own safe injection site, could be a possible model, said McQuie.

"It's out on the horizon, and we're going to try," she said. "But nobody has the staff, resources, and willingness to risk their program sites and funding for this project. The way this could happen is if one of the agencies or drug user groups just starts doing it. It seems unlikely they would get prior permission."

Given the strain that existing harm reduction programs are under, maybe a new, expensive safe injection site program isn't the highest priority right now, McQuie. "But what this proposal does is open up a bigger conversation about harm reduction. Still, we need to set the stage for when the economy rebounds, and also to be prepared to step up and support whoever starts doing it."

California is fertile terrain for drug policy reform. It is also fiercely contested terrain. The coming years will tell whether the forces of reform can forge the alliances they need to emerge victorious on any number of fronts.

CA
United States

SF Mayor's Hep C Task Force Recommends Supervised Injection Facilities (Press Release)

For Immediate Release: February 9, 2011                                   

Contact: Laura Thomas at (415) 283-6366 or Tommy McDonald (510) 229-5215

SF Mayor’s Hepatitis C Task Force Issues Recommendations for Fighting Epidemic, Including Supervised Injection Facilities (SIF)

SIF Allow People to Consume Their Drugs with Sterile Equipment in Presence of Medically-Trained Staff; Reduce HIV, Overdose Deaths and Public Drug Use, While Not Increasing Drug Use

SF Elected Officials Need to Embrace Science and Public Health Approach


The San Francisco Mayor’s Hepatitis C Task Force issued its report a few weeks ago, with strong recommendations for how San Francisco can better address the hepatitis C epidemic here. There are an estimated 12,000 people living with hepatitis C in San Francisco, most of whom do not know that they are infected. San Francisco has the opportunity to ensure that everyone knows their risk, knows their status, has access to hepatitis C treatment and support if they need it, and has the tools and information that they need to protect themselves from hepatitis C. One of those tools, as recommended by the Task Force, is a supervised injection site, where people could consume their drugs with sterile equipment in the presence of medicallytrained staff.

“Supervised injection facilities reduce HIV and overdose deaths without increasing drug use,” says Laura Thomas, deputy state director, San Francisco for the Drug Policy Alliance. “This has been done around the world and it has been proven to work effectively.”

Supervised injection facilities (SIFs) are operating in many countries around the world. They are not a new idea and the science has shown that they work. Insite, in Vancouver, British Columbia, has been extensively evaluated and has shown that a SIF can reduce public drug use, hepatitis C and HIV risk behaviors, overdoses, and other health problems, while not increasing crime or drug use.

In fact, Insite increased the number of people entering treatment for their problematic drug use. SIFs are a serious and well-researched approach to a significant problem. Politicians who are committed to reducing the harms that drugs create for our communities would be well served by paying attention to the evidence.

“San Francisco has led the way in dealing with HIV. The City needs to take these recommendations seriously and begin to address hepatitis C with the same courage and leadership it has shown for HIV,” Thomas added. “Politics can’t trump science in this case. There are too many lives on the line and here will be a serious price for slow learning curve.

“We need elected officials who are not afraid to do the right thing, and who are willing to put all of the options on the table as we fight the spread of hepatitis C and HIV.”

Location: 
San Francisco, CA
United States

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