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Drug War Chronicle Book Review: "In the Realm of Hungry Ghosts: Close Encounters With Addiction," by Dr. Gabor Maté (2010, North Atlantic Books, 468 pp., $17.95 PB)

Phillip S. Smith, Writer/Editor

In the revised edition of his prize-winning Canadian best-seller, Vancouver's Dr. Gabor Maté has made an important contribution to the literature on drug use and addiction. For more than a dozen years, Maté has been a staff physician for the Portland Hotel Society in Vancouver's infamous Downtown Eastside, home to one of the hemispheric largest, most concentrated populations of drug addicts. The Portland is unique -- once just another shoddy Skid Row SRO, under the management of the Society it is now both a residence for the hardest of the hard-core and a harm reduction facility.

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As a medical resident at the Portland, Maté has seen it all. The first section of "Hungry Ghosts" is filled with descriptions of his patients and their lives. Much of this is quite literally horrendous: Coked-out women turning tricks in alleys for their next rock and contracting syphilis; suicidal, opiate-addicted women refusing HIV treatments; mentally ill and alcoholic men dying young of liver cancer from Hepatitis C infections; people strung out on crack scrabbling at pieces of gravel on the sidewalk in the hallucinatory hope it's another rock; multi-addicted men and women, blood oozing from festering sores as they search yet again for a vein to hit, people overdosing and then going right back at it, people overdosing and dying.

And yet, despite the misery they are in and the wrecks that are their lives, they keep on using. "Hungry Ghosts" is an extended meditation on why. The second chunk of the book is devoted in particular to addressing that question. Maté offers an extended tour of the latest research into the disease model of addiction, with succinct and understandable (to the layperson) explanations of reward circuits in the brain, dopamine and serotonin flows, and all that good neuro-bio-pharmacological stuff so beloved of NIDA grantees. Repeated use of a substance indeed "rewires" the brain, creating pleasure circuits demanding to be fulfilled and pleasure deficits demanding to be fixed... with that next fix.

But unlike the NIDA people, with what I consider to be their neuro-bio-pharmacological determinism and reductionism, Maté goes a step further. He points out, accurately enough, that no matter what substance we're talking about, only a fraction of users, typically between 10% and 20%, become addicts. The "chronic relapsing brain disease" model may have some utility, but it fails to explain why some people are susceptible to addiction in the first place and others are not.

Maté noticed something about his downtrodden, strung-out clientele in Vancouver. They were almost universally abused as children, and at best, neglected. And I mean abused: Not spanked too hard, but raped, beaten, raped again, exploited, sent into foster care, literally spit on by their parents. It's very ugly.

One story especially sticks with me. A First Nations woman whose mother lives on the Downtown Eastside was given up at birth by her addicted mother, and sent to live with relatives, several of whom repeatedly sexually molested her in especially disgusting ways. She grew up an angry, depressed kid who turned to drugs and drink early. Tired of her life, she saved up $500 when she was 14 and ran away to Vancouver to find her mother. She did find her mother -- too bad for her. Mommie dearest promptly shot her up with heroin, spent the $500 on drugs for herself, then turned her out to turn tricks on the street. And you wonder why this woman prefers a narcotized bliss?

Maté doesn't just rely on anthropology and anecdote. He takes the reader instead into an extended look at the research on early childhood development and identifies messed-up childhoods as the key indicator of future substance abuse (as well as many other) problems. It doesn't have to be as extreme as some of these cases, but Maté makes clear that a nurturing early up-bringing is absolutely vital to the development of mentally and emotionally stable human beings.

Maté also has a startling confession to make: He, too, is an addict. The good doctor has been fighting a lifelong battle with his addiction to... wait for it... buying classical music CDs. He has behaved just like a junkie, he admits, spending thousands of dollars on his habit, lying to his wife, neglecting his kids, even leaving in the middle of medical procedures to run and score the latest Vivaldi. He's suffered the same feelings of compulsion, guilt, disgust, and self-denigration as any other addict, even if he doesn't have the scars on his veins to show for it.

At first glance, Maté's claim almost seems ludicrous, but he's making an important point: Addiction is addiction, whether it's to heroin or gambling, cocaine or shopping, he argues. The process of changes in the brain is the same, the compulsion is the same, the negative self-feelings are the same. We don't blame playing cards for gambling addiction or shopping malls for shopaholism; similarly, drugs are not to blame for drug addiction -- our own messed up psyches are the root of the problem.

And that leads to another important point: Those hollow-eyed addicts are like the rest of us, they are a dark mirror on our own inner problems, and most of us have some. (I'm reminded of a cartoon I once saw of a man sitting by all alone in an empty auditorium under a hanging banner saying, "Welcome to the convention of children of non-dysfunctional families.")

This is important because it stops us from dehumanizing drug addicts. They are not "the other." They are us, different only in degree. They deserve caring and compassion even if it is tough and seemingly fruitless work. Maté chides himself for falling from that saintly pedestal on occasion, and good for him.

Not surprisingly, Maté is a strong advocate of harm reduction and a harsh critic of prohibitionist drug policies and the US war on drugs in particular. By grinding drug users down even further, prohibition serves only to make them more likely to seek solace in chemical nirvana. It's almost as if prohibition were designed to create and perpetuate drug addiction.

In the final chapters of "Hungry Ghosts," Maté offers a glimmer of hope for beating drug addiction (or gambling addiction or sex addiction or whatever your particular compulsion is). It is a tough path of self-awareness and spiritual practice. I don't know if it will work -- I haven't tried it myself -- but it is important to remind ourselves that addiction is not necessarily a hopeless trap with no escape.

This is good, strong, compassionate, highly informed reading. I heartily recommend this book to anyone with an interest in addiction, addiction treatment, early childhood development, or drug policy. Thanks, doc.

Methamphetamine: Cold Sufferers Caught in the Crosshairs

Meth lab busts nationwide were up 27% last year over the previous year, according to the DEA, and state legislatures, prodded by law enforcement, are responding with a new batch of bills to ban pseudoephedrine, a key ingredient in home-cooked meth, but also a key ingredient in widely used cold remedies such as Sudafed and Claritin-B.

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In at least three states -- California, Indiana, Kentucky, and Missouri -- bills to make products containing pseudoephedrine available by prescription only have been or will be filed. Meanwhile, Mississippi this week became the first state this year to pass such a law, and only the second in the nation. Oregon passed such a law in 2006 and saw a dramatic reduction in meth lab busts.

In Mississippi, Gov. Hailey Barbour (R) is poised to sign HB 512, which would make ephedrine and pseudoephedrine Schedule III controlled substances available only by prescription. The measure passed the House 45-4 late last month and passed the Senate 45-4 on Tuesday.

The Tuesday vote came as about 50 uniformed members of Mississippi law enforcement looked on from the gallery. Mississippi law enforcement had been the primary force behind the bill.

As the cops looked on, supporters of the bill fended off amendments to the bill that would allow patients to be charged lower than normal fees when going to a physician to get a prescription. Opponents of the bill had argued that it would place a burden on Mississippi residents who would now be saddled with having to pay for a doctor's visit and a co-pay for their now prescription drug.

"I look forward to signing House Bill 512, which will make it more difficult to obtain the ingredients for this drug that tears families apart and harms many of our communities," Barbour said in a statement.

Barbour and the cops may have been happy, but the Consumer Healthcare Products Association, which represents over-the-counter medicine makers, was not. The bill will be a burden on residents and will raise health care costs in the state, the group said.

"We are disappointed that the Mississippi Senate chose to overlook consumer sentiment and passed a bill today that will significantly impact how cold and allergy sufferers access some of their medicines," said association spokeswoman Linda Suydam. "While well-intentioned, this bill will impose an unnecessary burden on Mississippians, despite there being a better and more effective solution to address the state's meth production problem."

The association said that electronic tracking of over-the-counter medications containing pseudoephedrine was a "more effective, less-costly alternative, and one that eight states have adopted to fight domestic methamphetamine production while maintaining consumer access to these medicines."

Indiana is also moving to restrict pseudoephedrine, but not to make it prescription-only. The state Senate voted 46-4 Tuesday to approve SB 383, which limits customers to 3.6 grams of ephedrine or pseudoephedrine in one day and nine grams of the drugs in one month. That bill now heads to the House.

Europe: Czech Government Announces Decriminalization Quantities; Law Goes Into Effect on New Year’s Day

The Czech cabinet Monday approved a Justice Ministry proposal that sets personal use quantity limits for illicit drugs under a penal code revision that decriminalizes drug possession in the Czech Republic. The law and its quantity limits will take effect on January 1. The Czech government had approved the decriminalization law late last year, but failed to set precise quantities covered by it, instead leaving it to police and prosecutors to determine what constituted a “larger than small” amount of drugs. The resulting confusion--and the prosecution of some small-scale marijuana growers as drug traffickers--led the government to adopt more precise criteria. Under the new law, possession of less than the following amounts of illicit drugs will not be a criminal offense: Marijuana 15 grams (or five plants) Hashish 5 grams Magic mushrooms 40 pieces Peyote 5 plants LSD 5 tablets Ecstasy 4 tablets Amphetamine 2 grams Methamphetamine 2 grams Heroin 1.5 grams Coca 5 plants Cocaine 1 gram Possession of “larger than a small amount” of marijuana can result in a jail sentence of up to one year. For other illicit drugs, the sentence is two years. Trafficking offenses carry stiffer sentences. Justice Minister Daniela Kovarova said that the ministry had originally proposed decriminalizing the possession of up to two grams of hard drugs, but decided that limits being imposed by courts this year were appropriate. "The government finally decided that it would stick to the current court practice and drafted a table based on these limits," Kovarova said. The Czech Republic now joins Portugal as a European country that has decriminalized drug possession.
Location: 
Prague
Czech Republic

Europe: Czech Government Decriminalizes Up To Five Marijuana Plants, 15 Grams

Beginning January 1, possession of up to 15 grams of marijuana or up to five marijuana plants will not be a punishable offense in the Czech Republic. Likewise, people will be able to possess up to 40 hallucinogenic mushrooms. The limits were announced Tuesday after they were decided on by the cabinet.

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Old Town Square, Prague, Czech Republic
Late last year, the Czech parliament approved a new penal code that specified no punishment for the possession of "small amounts" of drugs. But the code did not specify just what constituted a "small amount," with the result that police sometimes charged people, especially home pot growers, with more serious offenses. The task of formalizing those limits has been taken up by the Justice Ministry, which submits its proposals to the cabinet.

The ministry has also proposed setting the "small amount" limits for ecstasy at four tablets and for hashish at five grams. Similarly, people could possess up to two grams of methamphetamine without fear of punishment. The cabinet will consider those proposals in two weeks.

Possession of amounts greater than "small amounts," but less than those assumed to indicate drug trafficking, will result of prison sentences of up to one year for marijuana and up to two years for other drugs.

According to the European Monitoring Center for Drugs and Drug Addiction's latest annual report, Czechs are among Europe's leading pot smokers. Among young Czechs (age 16 to 34), 22% toke up at least once a year. The European average was 16%.

Europe: Czech Government Decriminalizes Up To Five Pot Plants, 15 Grams

Beginning January 1, possession of up to 15 grams of marijuana or up to five marijuana plants will not be a punishable offense in the Czech Republic. Likewise, people will be able to possess up to 40 hallucinogenic mushrooms. The limits were announced Tuesday after they were decided on by the cabinet. Late last year, the Czech parliament approved a new penal code that specified no punishment for the possession of “small amounts” of drugs. But the code did not specify just what constituted a “small amount,” with the result that police sometimes charged people, especially home pot growers with more serious offenses. The task of formalizing those limits has been taken up by the Justice Ministry, which submits its proposals to the cabinet. The ministry has also proposed setting the “small amount” limits for ecstasy at four tablets and for hashish at five grams. Similarly, people could possess up to two grams of methamphetamine without fear of punishment. The cabinet will consider those proposals in two weeks. Possession of amounts greater than “small amounts,” but less than those assumed to indicate drug trafficking, will result of prison sentences of up to one year for marijuana and up to two years for other drugs. According to the European Monitoring Center for Drugs and Drug Addiction‘s latest annual report, Czechs are among Europe’s leading pot smokers. Among young Czechs (age 16 to 34), 22% toke up at least once a year. The European average was 16%.
Location: 
Prague
Czech Republic

Law Enforcement: Utah "Meth Cops" Lose Out on Health Claims

More than 50 Utah law enforcement officers have filed workers compensation claims over ailments they believe were caused by exposure to methamphetamine labs, but none have been approved, and most have been dismissed for lack of evidence or because officers sought dismissal in a bid to come up with evidence. Only five cases are still pending.

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meth lab
"They have to have enough evidence to justify the claims," said Carla Rush, adjudication manager for the Utah Labor Commission, which handles the claims. "Preferably a doctor saying they have been injured in a work-related exposure to meth. That would be the best evidence."

Scores of Utah police officers participated in breaking down clandestine meth labs in the 1980s and 1990s, wearing only standard police-issue uniforms. That was before they understood the caustic nature of some of the chemicals involved in cooking meth. Now, officers on meth lab duty wear air tanks and hazmat suits.

Those officers from the old days began filing claims asserting that a variety of physical ailments they were suffering were the result of meth lab exposure. By 2006, the Utah legislature commissioned a half-million dollar study to explore the issue. But that study, which was meant to establish a causal link between meth exposure and everything from cancer to nerve damage, was inconclusive.

The state has also paid out tens of thousands of dollars to the Utah Meth Cops Project for a scientifically unsupported detox regime backed by the Church of Scientology. But toxicologists say that toxins would have left the officers' bodies long ago, and the detox program is little more than quackery.

How about a study of legalization, to eliminate the meth lab problem once and for all -- followed by a detox from the consequences of prohibition?

Feature: Busted for Handing Out Clean Needles -- The Mono Park 2 Fight Back in California's Central Valley

Hit hard by a double whammy of drought and economic slowdown, California's Central Valley has become a hotbed of methamphetamine and other injection drug use. Now, the dusty town of Modesto, in Stanislaus County, has become a focal point in the statewide and nationwide battle over how to help injection drug users. Last week, two volunteers at an unsanctioned needle exchange were in court in Modesto hoping to reach a plea bargain after they were arrested in April for handing out syringes. Now known as the Mono Park 2, they're looking at serious jail time for trying to save lives.

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mobile needle exchange/clinic site in nearby Fresno
The deal was supposed to be that Stanislaus County District Attorney Birgit Fladager would drop drug paraphernalia possession charges against exchange volunteers Kristy Tribuzio and Brian Robinson if they agreed to quit handing out needles until there was a legal program in place. But that didn't happen. Instead, at the last minute, the DA rejected the plea deal. Another hearing is set for November 9. If the DA and defense attorneys cannot reach agreement then, the case will go to trial.

The case has its genesis in longstanding efforts to win official approval for a needle exchange in Modesto. California law allows for needle exchanges, but only as a local option. The county board of supervisors must declare a health emergency in order for needle exchanges to operate legally.

In a 2008 report, Containing the Emerging Threat of Hepatitis through a Syringe Exchange Program (begins on page 22), the Stanislaus County Civil Grand Jury recommended the county authorize syringe exchanges and implement them either directly or through a community based contractor. The effort also had the support of county public health officials, including Public Health Department, the Advisory Board for Substance Abuse Programs, the Local AIDS Advisory Implementation Group, and the Hepatitis C Task Force, who cited a high incidence of Hepatitis C. They cited research indicating that needle exchanges reduced the spread of blood-borne diseases, brought injection drug users into contact with public health workers, and did not result in increases in drug use.

But despite the input from the public health community and the grand jury report, the Stanislaus County Board of Supervisors a year ago voted unanimously against allowing needle exchanges. In so doing, they heeded their own prejudices and those of law enforcement over science-based policies and the advice of the public health community.

County Sheriff Adam Christianson and DA Fladager both spoke out against needle exchanges, saying they would enable drug users to continue their addiction. Fladager said needle exchanges sent the wrong message to young people and encouraged them to think the county would take care of them if they become addicted.

"All of the challenges we are faced with in Stanislaus County, the gangs, methamphetamine, crimes, all have elements of drug addiction," Christianson said. "A syringe exchange program enables people to continue with their drug addiction."

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used syringes collected by exchange -- they might otherwise have been discarded in public places
Noting that Hep C was not a big issue for the county because most patients are covered by insurance, Supervisor Bill O'Brien also objected on bizarre moral grounds. "Then there's the human issue. Giving a drug user a clean needle is not the best thing for him. Illegal drug use has a risk, and making it safer promotes it," he said.

Supervisor Jim DeMartini thanked the grand jury for the report, but then dismissively added, "Like many well-intentioned programs that don't work out, this will never work out and deliver the benefits promised."

Too bad the sheriff, the DA, and the county board don't agree with the nation's drug czar. "Needle exchange programs have been proven to reduce the transmission of blood-borne diseases," Gil Kerlikowske told Congress during confirmation hearings earlier this year. "A number of studies conducted in the US have shown needle exchange programs do not increase drug use. I understand that research has shown these programs, when implemented in the context of a comprehensive program that offers other services such as referral to counseling, healthcare, drug treatment, HIV/AIDS prevention, counseling and testing, are effective at connecting addicted users to drug treatment."

Given the knowledge base about the effectiveness of exchanges and the evident human need for them in Modesto, needle exchange advocates were not content to simply roll over and die. Instead, they created an unauthorized needle exchange in the city's Mono Park, also known as needle park by residents because of the used needles littering the ground there. The program was publicized and went along on a low-level basis without a hitch until April, when, after an elaborate undercover sting, police swooped down and arrested the exchange volunteers.

Kristi Tribuzio just happened to be volunteering with the needle exchange the day the bust went down. Now, she's one of the defendants. "There was a direct need for this, and when I found out there was an existing exchange -- I saw a flyer on a telephone pole -- I asked how is this happening?" she said. "I got involved; I was just going out there for the people. An undercover cop came up and did an exchange, and then, a little later eight to 10 undercover officers drove up with a drug dog and arrested us. It was pretty harsh and crazy," she recalled.

"Looking back, Brian and I think it was maybe naive of us to just go out there and do something that was helping people in line with other syringe exchange programs," said Tribuzio. "We didn't understand what the consequences could be."

Now, she and Robinson face up to a year in jail for violating the paraphernalia law. For Tribuzio, there were other consequences, including the loss of her contract position with the Stanislaus County drug and alcohol education and prevention program. "I was laid off two days after I was arrested. Because I was a contract worker, they didn't need a reason to fire me, and no official reason was given. Ironically, my employer supports needle exchange," she said. "Maybe that's why they laid me off instead of firing me for cause. Now, at least, I can get unemployment."

Tribuzio had previously worked as a substitute teacher, but she can't do that now, either. "I'm getting an MA in education, and I have a teaching credential, but my credential is now suspended," she said. "Imagine, a teacher in San Francisco could be doing just what I did, and there would be no problem."

That's because needle exchanges have been authorized by the San Francisco County Board of Supervisors, just as they have in most large California cities. But in more conservative locales, like the Central Valley, the fight is more difficult, and therein lies the problem -- and the solution -- said one prominent harm reductionist.

"What we need is to get legislation authorizing syringe exchanges on a statewide level rather than our current system, which requires that they be authorized by local authorities," said Hilary McQuie, Oakland-based Western director of the Harm Reduction Coalition. "Requiring local authorization means we have to deal with 54 jurisdictions instead of just one, and the politics makes it really difficult in conservative places like Fresno or Modesto. It will be really difficult to get syringe exchange approved in Modesto without a statewide mandate," she said.

Short of that, needle exchange advocates need to carefully lay the groundwork beforehand, she said. In that respect, the Modesto needle exchange perhaps suffered from political naivete. "The effort with the grand jury in Modesto was done in good faith, but the grand jury finding required a response from the Board of Supervisors within three months," she noted. "They hadn't really lined up their support with the Board, and the Board ended up voting against it. That was problematic."

While personally difficult for Tribuzio and Robinson, the battle over needle exchanges in Modesto has moved the issue forward locally and stirred support from around the country and the world. A Mono Park 2 Defense Committee has formed to back them. At last week's hearing, more than a dozen supporters were present in court, and the pair had letters of support from some 35 public health and harm reduction organizations here and abroad.

"We've gotten a ton of support from the harm reduction community," said Tribuzio. "This whole thing has been stressful and overwhelming for us, but they've given us a wealth of training, knowledge, and support, more than we ever expected. We've gotten support from people in other exchanges, and letters of support from around the world. We've also been building alliances with people in the community. Things in the Central Valley are crazy, and we can't turn our heads away in the face of disease. Now, at least, people are paying attention."

While Robinson and Tribuzio wait for their legal problems to be resolved, they continue to work with at-risk communities. "After the bust, we started Off The Streets, and that does everything except for needle exchange," said Tribuzio. "We're doing needs assessments, trying to get our fingers on the pulse of the community, trying to help where we can."

For McQuie, the trials and tribulations of the Mono Park 2 are, sadly, par for the course. "This is how most of the programs got started, doing them illegally, so they're in good company," she said.

New Zealand: New Anti-Meth Measures Set to Go Into Effect -- Tough Luck, Flu Sufferers

Under an anti-methamphetamine package announced last week by the government of New Zealand, popular cold and flu remedies containing pseudoephedrine will soon be available only by prescription after a visit to the doctor's office. The popular sinus treatment is also considered a precursor chemical for manufacturing meth.

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"We're asking New Zealanders to band together and to accept using alternatives to treat their colds and flus to ensure New Zealand no longer becomes one of the countries most heavily affected by P [as the Kiwis refer to meth]," said Prime Minister John Key as he announced the a series of moves to combat meth use and production.

In addition to restricting access to precursor chemicals, the government will spend more money on drug treatment programs, create a 40-man police anti-meth task force, and charge police with drafting a new anti-meth law enforcement strategy by next month. The government said it would pay for the programs with asset forfeiture funds.

The pseudoephedrine announcement in particular brought a mixed reaction from the public. Some, especially those who had friends or family members who had had problems with meth, were supportive. But others were "annoyed," asking why law-abiding people had to suffer for the actions of drug users and some "voiced concern that it was a bit over the top."

Unsurprisingly, New Zealand police were happy with the new meth package. In a statement greeting the package's announcement, Assistant Commissioner Viv Rickard praised the "whole of government approach" as "more effective" in the battle against meth, but, as always, the police wanted more.

"Police support the control of pseudoephedrine as it would allow us to concentrate resources and work with Customs on preventing the importation of precursors from overseas," Rickard said. "Precursor control is a vital part of disrupting the supply of methamphetamine, but no one action on its own will solve the methamphetamine problem. Stronger legislation around gangs, the ability to seize assets and profits of organized criminals and enhanced treatment programs will all contribute reducing the supply of methamphetamine and making our communities safer."

New Zealand: New Anti-Meth Measures Set to Go Into Effect; Tough Luck, Flu Sufferers

Under an anti-methamphetamine package announced last week by the government of New Zealand, popular cold and flu remedies containing pseudoephedrine will soon be available only by prescription after a visit to the doctor's office. The drug is a precursor chemical for manufacturing meth. "We're asking New Zealanders to band together and to accept using alternatives to treat their colds and flus to ensure New Zealand no longer becomes one of the countries most heavily affected by P [as the Kiwis refer to meth]," said Prime Minister John Key as he announced the a series of moves to combat meth use and production. In addition to restricting access to precursor chemicals, the government will spend more money on drug treatment programs, create a 40-man police anti-meth task force, and charge police with drafting a new anti-meth law enforcement strategy by next month. The government said it would pay for the programs with asset forfeiture funds. The pseudoephedrine announcement in particular brought a mixed reaction from the public. Some, especially those who had friends or family members who had had problems with meth, were supportive. Both others were "annoyed," asking why law-abiding people had to suffer for the actions of drug users and some "voiced concern that it was a bit over the top." Unsurprisingly, New Zealand police were happy with the new meth package. In a statement greeting the package's announcement, Assistant Commissioner Viv Rickard praised the "whole of government approach" as "more effective" in the battle against meth, but, as always, the police wanted more. "Police support the control of pseudoephedrine as it would allow us to concentrate resources and work with Customs on preventing the importation of precursors from overseas," Rickard said. "Precursor control is a vital part of disrupting the supply of methamphetamine, but no one action on its own will solve the methamphetamine problem. Stronger legislation around gangs, the ability to seize assets and profits of organized criminals and enhanced treatment programs will all contribute reducing the supply of methamphetamine and making our communities safer."

Feature: Mexico and Argentina Enact Drug Decriminalization

In the last eight days, the decriminalization of drug possession has gone into effect for 150 million Latin Americans. Last Thursday, as part of a broader bill, Mexico (pop. 110 million) decriminalized the possession of small amounts of all drugs through the legislative process. Four days later, the Argentine Supreme Court declared unconstitutional that country's law criminalizing drug possession. While the Argentine case involved marijuana possession, the ruling clears the way for the government to draft a new law decriminalizing all drug possession.

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Latin America map (usaid.gov)
The shift in policies toward drug users in the two countries is a dramatic indication of the seismic shift in drug policy already well underway in Latin America. Colombia's high court declared the law against drug possession unconstitutional in 1994. Brazil has had a version of decriminalization since 2006 -- users cannot be imprisoned, but can be forced into treatment, educational programs, or community service -- and Uruguay now allows judges to determine if someone in possession of drugs intended to use them or sell and to act accordingly. Movement toward decriminalization is also underway in Ecuador.

That reformist zeitgeist is perhaps best encapsulated in the Latin American Commission on Drugs and Democracy, led by former presidents Cesar Gaviria of Colombia, Ernesto Zedillo of Mexico, and Enrique Cardoso of Brazil. In its report earlier this year, Drugs and Democracy: Toward a Paradigm Shift, the commission called for decriminalization of drug use, especially marijuana, and treating drug use as a public health -- not a law enforcement -- issue. A similar commission got underway in Brazil last week.

"Decriminalization permits a distinction between users and drug traffickers," said John Walsh of the Washington Office on Latin America. "This allows governments to focus their efforts in reducing the terrible harms caused by the big criminal networks and the violence related to the illicit traffic, instead of repressing users and small-scale dealers."

"What's happened in Mexico and now Argentina is very consistent with the broader trend in Europe and Latin America in terms of decriminalizing small amounts of drugs and promoting alternatives to incarceration and a public health approach for people struggling with drug addiction," said Ethan Nadelmann, executive director of the Drug Policy Alliance. "The decision in Argentina reminds me of similar rulings in Colombia more than a decade ago and in Germany before that, and, more generally, what's been going on in the Netherlands, Portugal, and Switzerland. In some cases, there is a legal or constitutional notion about personal sovereignty or autonomy, but there is also a recognition of the failures of the drug war approach vis a vis low-level offenders. There is a kind of human rights element that you see popping up in both contexts," Nadelmann said.

But the devil is in the details. Mexico's decriminalization, for example, comes as part of a broader law aimed at "narcomenudeo," or small-scale drug dealing. In addition to decriminalizing drug possession, the law for the first time allows state and local authorities to arrest and prosecute drug offenders. Previously, such powers had been the sole province of federal authorities. The new law also allows police to make undercover drug buys, a power they did not previously possess. (To read the full text of the law in Spanish, go to page 83 of the Official Daily.)

Under the Mexican law, the amounts of various drugs decriminalized are as follows:

  • opium -- 2 grams
  • cocaine -- 1/2 gram
  • heroin -- 1/10 gram
  • marijuana -- 5 grams
  • LSD -- 150 micrograms
  • methamphetamine -- 1/5 gram
  • ecstasy -- 1/5 gram

For Mexican drug reformers, the law is definitely a mixed bag. The Collective for an Integral Drug Policy, a Mexico City-based reform think-tank, felt compelled to note that while "the law represents certain advances... it could have very negative consequences for the country" because the public health and human rights perspectives are not implicated strongly enough in it.

While the collective applauded the law's distinctions between consumer, addict, and criminal; its rejection of forced drug treatment, its lip service to harm reduction, and its recognition of the traditional, ritual use of some substances, it challenged other aspects of the law. "It focuses on intensifying a military and police strategy that has proven to be a failure," the collective said, alluding to the more than 12,000 people killed in prohibition-related violence since President Felipe Calderon unleashed the military against the cartels in December 2006.

"The law will criminalize a vast group of people who make a living off the small-time dealing of drugs, but who in reality do not consciously form part of organized crime," but who are instead merely trying to make a living, the collective argued. "Imprisoning them will not diminish the supply of drugs on the street, nor will it improve public security, yet it will justify the war on drugs, since the government will be able to boast of the number of people incarcerated with this policy."

"Mexican decriminalization will have no impact whatsoever on the broader issues of drug trafficking and violence," agreed Nadelmann. "From the legal and institutional perspective, this is very, very significant, but in terms of actual impact on the ground in Mexico, that remains to be seen."

The collective also criticized the law's provision allowing police to make drug buys to nab small-time dealers and warned that the small quantities of drugs decriminalized "are not realistic" and will as a consequence lead to "a significant increase in corruption and extortion of consumers by police forces."

University of Texas-El Paso anthropologist Howard Campbell, who has studied the street drug scene across the river in Ciudad Juarez, was more cynical. "It was a good move by the government to make that distinction between users and traffickers, but I'm not sure what the effects of the law will be," he said. "All over Mexico, cops prey on junkies, and one effect of this might be to give low-down junkies a bit of a break from the cops. On the other hand, street-level drug dealing is often controlled by the cops... but if the cops are corrupt and in control, it doesn't really matter what the law says."

Campbell also doubted the new law would have much effect in reducing the prohibition-related violence. "I don't think it will have much initial impact, but still, the overarching importance of this law is symbolic. It shows that governments can revamp their policies, not just keep on working with failed ones," he said.

In Argentina, the situation is less dire and the reform is less ambiguous. On Tuesday, the Argentine Supreme Court, ratifying a series of lower court decisions in recent years, declared that the section of the country's drug law that criminalizes drug possession is unconstitutional. While the ruling referred only to marijuana possession, the portion of the law it threw out makes no distinction among drugs.

The decision came in the Arriola case, in which a group of young men from the provincial city of Rosario were each caught with small amounts of marijuana, arrested, and convicted. Under Argentina's 1989 drug law, they faced up to two years in prison.

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

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

That paradigm shift has also occurred within the current Argentine government of President Cristina Kirchner, which favors a public health approach to drug use. The government has been waiting on this decision before moving forward with a bill that would decriminalize possession of small quantities of all drugs.

"The declaration of the unconstitutionality of the application of the drug law for marijuana possession is a great advance since it eliminates the repressive arm from a problem that should be confronted with public health policies," said Intercambios, an Argentine harm reduction organization. "Whatever retreat in the application of the criminal law in relation to drug users is positive; not only to stop criminalizing and stigmatizing users, but to permit the advance of educational, social, and health responses that are appropriate for this phenomenon."

Some Argentine harm reductionists warned that while the ruling was of transcendent importance, its real impact would be measured by its effect on the policies of the state. "In the vertical sense, it should oblige all the judges in the country to take heed of this declaration of the unconstitutionality of punishing drug possession for personal use," said Silvia Inchaurraga of the Argentine Harm Reduction Association (ARDA). "In the horizontal sense, it should force all the agencies of the state involved in drug policy to redefine their involvement to guarantee that they do not fail to comply with international human rights treaties subscribed to by the country," she added.

For the Argentine section of the global cannabis nation, it was a happy day. "Wow! This feels like honest good vibrations from the Supreme Court and the government," said Argentine marijuana activist Mike Bifari. "They really do have this new policy of generally being more tolerant and talking about human rights in the drug issue nationally and internationally, instead of that tired old war on drugs."

The Supreme Court decision will pave the way to full decriminalization, he said. "Although this was a marijuana case, the current law is about all types of drugs," said Bifari. "Now we have to wait for the government's scientific committee to come up with a draft of a new drug law, and that will be the government's bill in the congress. We think there are going to be lot of media debates and lots of discussion, and what we will try to do is to occupy all the different cultural spaces and try to advance on issues such as access and medical marijuana."

And so the wheel turns, and the United States and its hard-line drug policies are increasingly isolated in the hemisphere. As anthropologist Campbell noted, "This is happening all over Latin America. You'd think we might be able to do it here, too."

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