Harm Intensification

Feature: Drug War a Devastating Failure, Scientists and Researchers Say in Vienna Declaration

by Phillip Smith, July 08, 2010, 11:00pm, (Issue #639)

A decade ago, scientists, researchers, and AIDS activists confronted a sitting president in South Africa who denied that AIDS was caused by HIV. They responded by declaring at the 2000 Durbin AIDS conference that the evidence was in and the matter was settled. Now, with the Vienna AIDS conference coming up later this month, they are at it again -- only this time the target is the war on drugs.

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HCLU-organized demonstration outside UN anti-drug agency, former SSDP executive director Kris Krane inside cage (drogriporter.hu/en/demonstration)

Their weapon is the Vienna Declaration, an official conference statement authored by experts from the International AIDS Society, the International Center for Science in Drug Policy, and the British Columbia Center for Excellence in HIV/AIDS. The document is a harsh indictment of the global drug war that calls for evidence-based policymaking. It demands that laws which criminalize drug users and help fuel the spread of AIDS be reformed.

The authors of the Vienna Declaration want you to sign on, too. You can do so at the web site linked to above.

"The criminalization of illicit drug users is fueling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. A full policy reorientation is needed," they said in the declaration.

Arguing there is "overwhelming evidence that drug law enforcement has failed to meet its stated objectives," the declaration lays out the consequences of the drug war:

HIV epidemics fueled by the criminalization of people who use illicit drugs and by prohibitions on the provision of sterile needles and opioid substitution treatment.

HIV outbreaks among incarcerated and institutionalized drug users as a result of punitive laws and policies and a lack of HIV prevention services in these settings.
The undermining of public health systems when law enforcement drives drug users away from prevention and care services and into environments where the risk of infectious disease transmission (e.g., HIV, hepatitis C & B, and tuberculosis) and other harms is increased.
A crisis in criminal justice systems as a result of record incarceration rates in a number of nations. This has negatively affected the social functioning of entire communities. While racial disparities in incarceration rates for drug offenses are evident in countries all over the world, the impact has been particularly severe in the US, where approximately one in nine African-American males in the age group 20 to 34 is incarcerated on any given day, primarily as a result of drug law enforcement.
Stigma towards people who use illicit drugs, which reinforces the political popularity of criminalizing drug users and undermines HIV prevention and other health promotion efforts.
Severe human rights violations, including torture, forced labor, inhuman and degrading treatment, and execution of drug offenders in a number of countries.
A massive illicit market worth an estimated annual value of US $320 billion. These profits remain entirely outside the control of government. They fuel crime, violence and corruption in countless urban communities and have destabilized entire countries, such as Colombia, Mexico and Afghanistan.
Billions of tax dollars wasted on a "War on Drugs" approach to drug control that does not achieve its stated objectives and, instead, directly or indirectly contributes to the above harms.

"Many of us in AIDS research and care confront the devastating impacts of misguided drug policies every day," said Julio Montaner, president of the International AIDS Society and director of the BC Center for Excellence in HIV/AIDS. "As scientists, we are committed to raising our collective voice to promote evidence-based approaches to illicit drug policy that start by recognizing that addiction is a medical condition, not a crime," added Montaner, who will serve as chairman of the Vienna conference.

"There is no positive spin you can put on the war on drugs," said Dr. Evan Wood, founder of the International Center for Science in Drug Policy. "You have a $320 billion illegal market, the enrichment of organized crime, violence, the spread of infectious disease. This declaration coming from the scientific community is long overdue. The community has not been meeting its ethical obligations in terms of speaking up about the harms of the war on drugs."

Stating that governments and international organizations have "ethical and legal obligations to respond to this crisis," the declaration calls on governments and international organizations, including the UN to:

Undertake a transparent review of the effectiveness of current drug policies.
Implement and evaluate a science-based public health approach to address the individual and community harms stemming from illicit drug use.
Decriminalize drug users, scale up evidence-based drug dependence treatment options and abolish ineffective compulsory drug treatment centers that violate the Universal Declaration of Human Rights.
Unequivocally endorse and scale up funding for the implementation of the comprehensive package of HIV interventions spelled out in the WHO, UNODC and UNAIDS Target Setting Guide.
Meaningfully involve members of the affected community in developing, monitoring and implementing services and policies that affect their lives.
We further call upon the UN Secretary-General, Ban Ki-moon, to urgently implement measures to ensure that the United Nations system -- including the International Narcotics Control Board -- speaks with one voice to support the decriminalization of drug users and the implementation of evidence-based approaches to drug control.

"This is a great initiative," enthused Ethan Nadelmann, executive director of the Drug Policy Alliance. "It is the most significant effort to date by the sponsors of the global AIDS conference to highlight the destructive impact of the global drug war. It is nicely coordinated with The Lancet to demonstrate legitimacy in the medical community. And it is relatively far reaching given that the declaration was drafted as a consensus statement."

"This is aimed at politicians, leaders of governments, the UN system, and it's aimed at housewives. We are trying to do basic education around the facts on this. There are still politicians who get elected vowing to crack down on drugs," said Wood. "While the declaration has a global aim and scope, at the end of the day, the person who is going to end the drug war is your average voter, who may or may not have been affected by it," he said.

"This was needed a long time ago," said Wood. "The war on drugs does not achieve its stated objectives of reducing the availability and use of drugs and is incredibly wasteful of resources in locking people up, which does little more than turn people into hardened criminals," he said.

The authors are hoping that an official declaration broadly endorsed will help begin to sway policy makers. "It will be interesting to see what kind of support it receives," said Wood. "Former Seattle Police Chief Norm Stamper has endorsed it, and we have a 2008 Nobel prize winner for medicine on the web site. There are high level endorsements, and more are coming. Whether we touch a nerve with the news media remains to be seen. I am hoping it will have a big impact since this is the official conference declaration of one of the largest public health conferences on the planet."

"We have reached a tipping point in the conversation about drugs, drug policy, drug law enforcement, and the drug war," said Stamper, now a member of Law Enforcement Against Prohibition. "More and more, science has found its way into the conversation, and this is one step to advance that in some more dramatic fashion. I've heard much from the other side that is emotional and irrational. This is one effort to create even more impetus for infusing this dialogue on drug policy with evidence-driven, research-based findings."

That the AIDS conference is being held in Vienna adds a special fillip to the declaration, Wood said. "Vienna is symbolically important because it is where the infrastructure for maintaining the global war on drugs is located," said Woods, "and also because of the problems in Eastern Europe. In Russia, it's estimated that one out of every 100 adults is infected with the AIDS virus because Russia has not embraced evidence-based approaches. Methadone maintenance therapy is illegal there, needle exchanges are severely limited, the treatment programs are not evidence-based, and there are all sorts of human rights abuses around the drug war."

With the AIDS conference set to open July 18, Wood and the other authors are hoping the momentum will keep building up to and beyond. "It is my hope that now that the Vienna Declaration is online, large numbers of people will come forward and lend their names to this effort," he said.

The Vienna Declaration is one more indication of just how badly drug war orthodoxy has wilted under the harsh gaze of science. It's hard to win an argument when the facts are against you, but as the declaration notes, there are "those with vested interests in maintaining the status quo." The declaration should make their jobs that much more difficult and bring progressive approaches to drug policy that much closer.

Feature: Fired Up in Albuquerque -- The 2009 International Drug Policy Reform Conference

by Phillip Smith, November 19, 2009, 11:00pm, (Issue #609)

Jazzed by the sense that the tide is finally turning their way, more than a thousand people interested in changing drug policies flooded into Albuquerque, New Mexico, last weekend for the 2009 International Drug Policy Reform Conference, hosted by the Drug Policy Alliance. Police officers in suits mingled with aging hippies, politicians met with harm reductionists, research scientists chatted with attorneys, former prisoners huddled with state legislators, and marijuana legalizers mingled with drug treatment professionals -- all united by the belief that drug prohibition is a failed policy.

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candlelight vigil outside the Albuquerque Convention Center (courtesy Drug Policy Alliance)

As DPA's Ethan Nadelmann said before and repeated at the conference's opening session: "We are the people who love drugs, we are the people who hate drugs, we are the people that don't care about drugs," but who do care about the Constitution and social justice. "The wind is at our backs," Nadelmann chortled, echoing and amplifying the sense of progress and optimism that pervaded the conference like never before.

For three days, conference-goers attended a veritable plethora of panels and breakout sessions, with topics ranging from the drug war in Mexico and South America to research on psychedelics, from implementing harm reduction policies in rural areas to legalizing marijuana, from how to organize for drug reform to what sort of treatment works, and from medical marijuana to prescription heroin.

It was almost too much. At any given moment, several fascinating panels were going on, ensuring that at least some of them would be missed even by the most interested. The Thursday afternoon time bloc, for example, had six panels: "Medical Marijuana Production and Distribution Systems," "After Vienna: Prospects for UN and International Reform," "Innovative Approaches to Sentencing Reform," "Examining Gender in Drug Policy Reform," "Artistic Interventions for Gang Involved Youth," and "The Message is the Medium: Communications and Outreach Without Borders."

The choices weren't any easier at the Friday morning breakout session, with panels including "Marijuana Messaging that Works," "Fundraising in a Tough Economy," "Congress, President Obama, and the Drug Czar," "Zoned Out" (about "drug-free zones"), "Psychedelic Research: Neuroscience and Ethnobotanical Roots," "Opioid Overdose Prevention Workshop," and "Border Perspectives: Alternatives to the 40-Year-Old War on Drugs."

People came from all over the United States -- predominantly from the East Coast -- as well as South Africa, Australia, Canada, Europe (Denmark, England, France, Hungary, the Netherlands, Poland, Portugal, Scotland, and Switzerland), Latin America (Argentina, Brazil, Colombia, and Mexico), and Asia (Cambodia and Thailand).

Medical marijuana was one of the hot topics, and New Mexico, which has just authorized four dispensaries, was held up as a model by some panelists. "If we had a system as clear as New Mexico's, we'd be in great shape," said Alex Kreit, chair of a San Diego task force charged with developing regulations for dispensaries there.

"Our process has been deliberate, which you can also read as 'slow,'" responded Steve Jenison, medical director of the state Department of Health's Infectious Disease Bureau. "But our process will be a very sustainable one. We build a lot of consensus before we do anything."

Jenison added that the New Mexico, which relies on state-regulated dispensaries, was less likely to result in diversion than more open models, such as California's. "A not-for-profit being regulated by the state would be less likely to be a source of diversion to the illicit market," Jenison said.

For ACLU Drug Policy Law Project attorney Allen Hopper, such tight regulation has an added benefit: it is less likely to excite the ire of the feds. "The greater the degree of state involvement, the more the federal government is going to leave the state alone," Hopper said.

At Friday's plenary session, "Global Drug Prohibition: Costs, Consequences and Alternatives," Australia's Dr. Alex Wodak amused the audience by likening the drug war to "political Viagra" in that it "increases potency in elections." But he also made the more serious point that the US has exported its failed drug policy around the world, with deleterious consequences, especially for producer or transit states like Afghanistan, Bolivia, Colombia, Mexico, and Peru.

At that same session, former Mexican foreign minister Jorge Castaneda warned that Latin American countries feel constrained from making drug policy reforms because of the glowering presence of the US. Drug reform is a "radioactive" political issue, he said, in explaining why it is either elder statesmen, such as former Brazilian President Cardoso or people like himself, "with no political future," who raise the issue. At a panel the following day, Castaneda made news by bluntly accusing the Mexican army of executing drug traffickers without trial. (See related story here).

It wasn't all listening to panels. In the basement of the Albuquerque Convention Center, dozens of vendors showed off their wares, made their sales, and distributed their materials as attendees wandered through between sessions. And for many attendees, it was as much a reunion as a conference, with many informal small group huddles taking place at the center and in local bars and restaurants and nearby hotels so activists could swap experiences and strategies and just say hello again.

The conference also saw at least two premieres. On the first day of the conference, reporters and other interested parties repaired to a Convention Center conference room to see the US unveiling of the British Transform Drug Policy Foundation publication, After the War on Drugs: A Blueprint for Legalization, a how-to manual on how to get to drug reform's promised land. Transform executive director Danny Kushlick was joined by Jack Cole of Law Enforcement Against Prohibition, Sanho Tree of the Institute for Policy Studies, Deborah Small of Break the Chains, and DPA's Nadelmann as he laid out the case for moving beyond "what would it look like."

"There's never been a clear vision of a post-prohibition world," said Kushlick. "With this, we've tried to reclaim drug policy from the drug warriors. We want to make drug policy boring," he said. "We want not only harm reduction, but drama reduction," he added, envisioning debates about restrictions on sales hours, zoning, and other dreary topics instead of bloody drug wars and mass incarceration.

"As a movement, we have failed to articulate the alternative," said Tree. "And that leaves us vulnerable to the fear of the unknown. This report restores order to the anarchy. Prohibition means we have given up on regulating drugs; this report outlines some of the options for regulation."

That wasn't the only unveiling Thursday. Later in the evening, Flex Your Rights held the first public showing of a near-final version of its new video, 10 Rules for Dealing with Police. The screening of the self-explanatory successor to Flex Your Right's 2003 "Busted" -- which enjoyed a larger budget and consequently higher production level -- played to a packed and enthusiastic house. This highly useful examination of how not to get yourself busted is bound to equal if not exceed the break-out success of "Busted." "10 Rules" was one of a range of productions screened during a two-night conference film festival.

The conference ended Saturday evening with a plenary address by former New Mexico Gov. Gary Johnson, who came out as a legalizer back in 2001, and was welcomed with waves of applause before he ever opened his mouth. "It makes no sense to spend the kind of money we spend as a society locking up people for using drugs and using the criminal justice system to solve the problem," he said, throwing red meat to the crowd.

We'll do it all again two years from now in Los Angeles. See you there!

The Need for Prescription Drug Harm-Reduction

by , July 31, 2009, 02:05pm

Today I had the second appointment with my psychiatrist. In ten minutes, I was prescribed a 5 month supply of the stimulant medication Adderall. I'm concerned at how casually I was just prescribed a schedule II drug with a “high potential for abuse” that “may lead to severe psychological or physical dependence". As our movement looks beyond the the Marijuana legalization debate, I think it is important to discuss the future of regulating all types of drugs. Considering the current hysteria about prescription drug abuse, there is clearly something wrong with today's prescription drug regulations. Here I would like to share my own experience and concerns about legally obtaining a drug which is not so different from Cocaine. Let me begin one year ago when I first set out to get an Adderall prescription. At college, I had bought Adderall from friends to use as a study-aid. I don't believe ADD is a disease, but I do believe certain people have more difficulty concentrating than others, and I think I am one of those people. Having an immense respect for drugs, I researched the potential harms of Adderall before I used it. I knew there was abuse potential, so I used it once or twice per week at the most. Last year, I decided to get my own prescription to save money. I found a psychiatrist though my insurance. Before I met with him, he sent me a 20 page questionnaire asking me various questions about my mental health. I honestly answered questions concerning my concentration, anxiety, and overall mental health. I brought the questionnaire to the first appointment. He spent about ten minutes reviewing my answers, and diagnosed me with general anxiety and ADD. Five minutes later, I left with a prescriptions for four months worth of Adderall and Paxil, the latter one I never filled because I don't believe I have an anxiety disorder. I didn't talk to him again until today, one year later, when we met for 10 minutes and he refilled my prescriptions. He asked me two questions: if school was stressful, and if I experienced any bad side effects. Yes, school is stressful, no, no debilitating side effects. I see several concerning issues with my experience. This might sound hypocritical, considering I set out to legally obtain a drug, and I did. Why should I be complaining about how easy it was? Because I'm worried about society treating powerful substances so casually. I believe the increase in prescription drug abuse, especially among youth, has to do with precisely this lack of oversight and nonchalant attitude among some psychiatrists at passing out drugs. Here are my concerns: 1) The diagnosis process. It's not okay for a doctor to spend 15 minutes with a person and determine they have a psychiatric disorder in need of medication. This is a process which should take several visits and discussions between patient and doctor on the unique needs of the patient, not a generic questionnaire. 2) The prescription. Right off the bat, I was prescribed 30 mg a day of Adderall. This is way too much Adderall for anyone to be taking, in my opinion, never mind someone just beginning. 3) No follow-up. My situation was complicated because I was going to college, but still, to give me a 4 month supply of powerful drugs and make no effort to contact me on how I am tolerating the treatment is ridiculous and dangerous. 4) No education. He should have given me warning signs to expect if I am having problems with the drug. Not everyone would have done the extra research I did, he should have told me how the drug effects my brain and body. It is easy to build up tolerance to Adderall, which is why it is important to start with low doses and never take more than you need. He never told me that unlike drugs for depression or anxiety which you must take everyday because the effects are gradual, Adderall works instantly and it is okay not to take it everyday. In fact, in my experience it is best not to take Adderall everyday, but instead only when you need it. I'm not sure how common my psychiatric experience is. I'm guessing my psychiatrist is more irresponsible than most, and I hope that the average psychiatrist spends more time with patients. Still, my experience points to a general lack of proper procedure among psychiatrists at doling out drugs, and the lack of any sort of oversight on the actions of psychiatrists. If a psychiatrist has their heart set on making money, they will squeeze as many patients as in as possible, meaning no patient will receive adequate care. I'm struggling to figure out exactly how I feel about my experience. I am a firm believer in my right over my own body. I want to be able to obtain any substances which I please, I want it to be my choice. At the same time, like everything else in society, we need drug specialists to facilitate the decisions we make regarding drug usage. There is a necessary place in a legalized drug market for "psychiatrist" type people, we can't expect everyone to research which drugs they need and how to use them safely on their own. If we truly want to reduce the harms of drugs, we need to start being proactive by making sure psychiatrists educate patients about drugs from the moment they can obtain them. There is a common conception that certain people have "addictive personalities" or are simply prone to abusing drugs, as if a certain group of genes are programed to abuse drugs. I believe this philosophy severely underestimates humans. We have much more will-power than we give ourselves credit for, the problem is that we don't have the necessary resources to make smart decisions concerning drugs. It is the psychiatrist's job to educate patients on their bodies and substances. As much as I hate the government exaggerating the harms of drugs, I wish psychiatrists would make people more scared of truly dangerous drugs. I'm worried about the people who visit my psychiatrist who are oblivious to the nature of drugs and addiction and blindly follow the word of an incompetent doctor. As drug policy reformers, it is in our interest to assess current legal drug regulations if we hope to eventually move all substances into a regulated market. This is important for transforming public opinion on legalization. The public is being bombarded with stories about how harmful prescription drugs are, take Michael Jackson's case. We can't expect people to support moving Cocaine, MDMA, or Heroin into a regulated market, when the current market looks pretty scary and problematic.

Drug War Allies: Russia, Cuba, Pakistan… USA?

by David Guard, March 18, 2009, 04:18pm

Tell our United Nations delegation to stop opposing harm reduction.

http://ssdp.org/unitednations/act

Friend,

President Obama recently announced that his administration would no longer allow ideology to trump science in policy-making decision. Yet, the very same week, the Obama administration publicly supported worn out Drug War ideology over harm reduction practices that have been proven to save and improve the lives of drug users.

I was back in Vienna, Austria last week to witness the United Nations' final deliberation over a new political declaration and action plan that will guide global drug policy for the next ten years.

Unfortunately, despite recommendations made by 300 Non-Governmental Organizations form around the world, including SSDP, the declaration included no mention of harm reduction.

(Harm reduction is like contraceptives, but for drugs. It's a scientifically proven set of policies and practices that keep drug users alive and healthy, without relying on abstinence-only messaging.)

After final approval of the declaration, 26 nations including Great Britain, Germany, and Australia, courageously spoke up to register their support for harm reduction in the official UN record, setting off a firestorm of debate on the floor of the United Nations.

While most countries chose to remain silent on the issue, a handful chose to speak up and denounce support for harm reduction. These included Russia, Cuba, Pakistan… and the United States!

We must send a message to President Obama and Secretary of State Clinton that the American people will no longer stand idly by as they allow 20th century Drug War ideology to trump science and evidence!

Please visit this action page to send a message to President Obama and Secretary of State Clinton, read the final approved U.N. declaration, and watch video of SSDP participating in a protest and press conference outside the United Nations.

Thank you for your support of SSDP's efforts to bring science and reason to national and global drug policies.

Sincerely,

Kris Krane
Executive Director
Students for Sensible Drug Policy

P.S. Like the work SSDP is doing to influence President Obama and the United Nations to change drug policy? If so, please let us know by making a donation today. http://www.ssdp.org/donate

Location:

Vienna

Austria

Free "American Drug War" Screening

by David Guard, November 09, 2007, 11:48am

Please join us for a screening of AMERICAN DRUG WAR. This will be a very special event! We will be dedicating the screening to Claudia Jensen - activist, pediatrician, and warrior against the powerful elite that fight so hard to keep marijuana illegal. ADW participant, friend and associate, Dr. Claudia Jensen lost her life to breast cancer on September 15, 2007, may she rest in peace. Special guest speakers include Judge Gray, T. Rodgers, Kevin Booth, and Joe Peitri. Tickets are FREE -- please RSVP to Amy Florom at amy.florom@gmail.com or Kevin Booth at Kevin@sacredcow.com. Sacred Cow Productions is proud to announce that "AMERICAN DRUG WAR," will be honored at the 2007 ARTIVIST awards ceremony as the Best Feature Film in the International Human Rights category! The film has already received much recognition, winning the award for "Best Documentary" at three other festivals thus far. Kevin has also been touring with the film. The hype around the film is building - it has been picked up by SHOWTIME to be aired in March of 2008! Filmmaker Kevin Booth has lost several family members to the so-called "legal" drugs of Alcohol, Tobacco, and Pharmaceuticals, and this film has been a labor of love for him that has taken over four years to complete. It is not a film about "drugs", but rather a film that exposes the dark side of the Drug War and the profit motives that continue to fuel this massive system of human misery. For more information, see http://sacredcow.com and http://AmericanDrugWar.com.

Date:

Fri, 11/09/2007 - 9:00pm

Location:

6712 Hollywood Blvd.

Hollywood, CA

United States

See map: Google Maps

Silly Scott

by David Borden, July 02, 2007, 10:06pm

Scott was being silly last Friday night when he published his "D.C. Needle Exchange Ban Lifted: Let's Do Heroin!" blog post. In fact, Scott was being silly in multiple ways. First, the DC needle exchange ban is only a ban on the District using its own tax dollars to fund the program. The PreventionWorks needle exchange program has been operating now for almost nine years, legally, and before that its predecessor program at the Whitman-Walker AIDS Clinic operated the exchange. It has been making do with private funding. Lifting of this ban means that PreventionWorks will be able to expand its operations, and that more needle exchange programs will be able to open, all of them together reaching more of the people who need the help. But it's not a matter of whether Scott personally could have gotten clean needles. Second, the PreventionWorks office is only a 15 minute walk from our office, so if Scott had really wanted to use heroin all this time, he wouldn't even have had to travel far to get clean needles. (It's a pretty walk, too, and there's a nice coffee shop in the neighborhood.) Third, as I pointed out in my editorial this week, the risk created by infected used syringes, while a major one, is by no means the only risk. So long as heroin itself continues to be illegal, the user will continue to be "at risk of overdose from fluctuating purity or poisoning from adulteration," and the addict will continue to suffer "severe financial debilitation from the high street prices created by prohibition," some of them "driven to extreme measures to afford drugs that would cost pennies to produce in a legal market." I know for a fact that Scott understands this as well as I do, and I published that editorial less than 24 hours before Scott wrote his blog post, so it must have been fresh in his mind. (Fourth, Scott was simply being sarcastic, in case anyone didn't realize it. He and I both scoff at the idea that more needle exchange will lead to increased drug use -- and we have the evidence to back us up.) So, I'm afraid that Scott and I will be holding out for legalization before we start shooting smack. I recommend that you wait too. (I'm being sarcastic too -- we also reject the idea that legalization will lead to large numbers of people using intense drugs like heroin who don't already use them now -- I certainly have no interest in it.)

Location:

United States

See map: Google Maps

chicagovigil.com responds to chicagovigil.org

by David Borden, June 18, 2007, 08:54pm

The DEA is at it again, as Drug WarRant blogger Peter Guither puts it, and is holding another "vigil for lost promise" for people who have died from drugs, this one in Chicago (chicagovigil.org). The problem isn't so much what the DEA says -- some people do die from drugs -- but what they don't say. Hence Guither's vigil for lost promise for people who have died from the drug war (chicagovigil.com redirecting to it). It's too simplistic to blame it all on drugs. Even when it looks like drugs (e.g. it's not someone who was imprisoned under a law or shot by a SWAT team, someone actually died from some kind of drug use), it's often the combination of drugs with the drug laws that created the most deadly mix. Guess who has the top link in Google when searching on "vigil for lost promise," at least right now when I'm posting this?

Location:

United States

See map: Google Maps

Drug War Chronicle Book Review: "The Heroin Solution" by Arnold Trebach (2nd ed., 2006, Unlimited Publishing, 330 pp., $19.99 pb.)

by Phillip Smith, May 17, 2007, 07:55pm, (Issue #486)

Phillip S. Smith, Writer/Editor

(Click here to order "The Heroin Solution or other books by Arnold Trebach through DRCNet's latest book offer.)

When "The Heroin Solution" was first published by Yale University Press a quarter-century ago, it got rave reviews from the likes of the New York Times and Publishers Weekly. It was a mindblower. For the vast majority of readers, Arnold Trebach opened a window into an astonishing world they had never before imagined, one where -- gasp! -- doctors, not policemen, dealt with heroin and heroin users.

http://stopthedrugwar.org/files/heroinsolution.jpg

Trebach, who from his base at American University began influencing a generation of disciples and who founded the Drug Policy Foundation (the progenitor of the Drug Policy Alliance) in 1986, is now known as the grand old man of the American drug reform movement, and the success of "The Heroin Solution," along with his 1987 "The Great Drug War," played a big role in cementing that reputation.

What Trebach did in the "Heroin Solution" was tell three interwoven stories: the story of heroin, the story of the American approach to heroin, and the story of the British approach to heroin. For many, that book was an awakening, a realization that there was an alternative to what by 1982 was already being reviled as an atrocious and failing policy of prohibition and repression. Where the American system denied that heroin had any medical utility whatsoever and jailed physicians, junkies, and hapless pain patients alike, the British system was kinder and gentler, with doctors given considerable latitude to prescribe heroin even -- and especially -- in cases where they knew they were only allowing their patients to maintain their addiction.

Now, "The Heroin Solution" is out in a second edition, the last volume of the "Trebach Trilogy," which also includes the reprinted "The Great Drug War" and last year's "Fatal Distraction." But this edition of "The Heroin Solution" is not a substantive reworking of the material; the only addition to the original volume is a new preface.

It still makes timely and compelling reading, but the reason why is hardly good news. "The Heroin Solution" is still relevant because we have progressed so little since it was written. The issues Trebach addressed in 1982 are, in many cases, the same issues we face today. Much has happened, but little has changed, and much of what has changed has changed for the worse.

In Britain, which Trebach described as a model of an enlightened (if not perfect) approach to heroin, the heavy hand of the state and governing medical bodies has slowly shrunk the space in which doctors may prescribe heroin. When Trebach wrote, probably a few thousand British addicts were being prescribed heroin; in his new preface, he estimates that perhaps 500 are. For all the talk of opiate maintenance in Britain, it seems like for the past quarter-century it seems like it's been one step forward, one step back.

http://stopthedrugwar.org/files/trebach-shadows.jpg

Arnold Trebach at 2003 press conference on which DRCNet collaborated

Trebach decried the cruel and inhumane treatment of physicians and pain patients alike in "The Heroin Solution." If anything, the problem has gotten worse in the intervening quarter-century. One thing the book offers, though, is some perspective. The latest round of pain doctor persecutions smell remarkably similar to those of doctors Trebach mentioned operating back in the 1930s. It's a similarity Trebach notes himself in his preface to the new edition, where he cites the case of Dr. William Hurwitz, who just weeks ago was convicted again on federal drug charges for loose prescribing practices and faces possible decades in prison. (He's already been in for two years.)

Trebach asked in 1982 where America found itself nearly seven decades after passage of the Harrison Narcotics Act, and was not happy with the answer. It's much worse now. Back then, Trebach complained that the federal government spent $6 billion fighting the drug war in the 1970s; now $6 billion would fund the federal drug war for about three months. Since then, the prison population of the United States and the number of drug prisoners has gone through the roof. You know the drug war litany.

Trebach does, too, and that is part of the reason his thinking about drug prohibition has evolved over time. When he wrote "The Heroin Solution" in 1982, he called only for doctors to be allowed to prescribe heroin. Now, he is a full-blown anti-prohibitionist. Lack of progress on reforming US drug policy breeds more radical responses.

A revised and updated "The Heroin Solution" would be nice. There could be new chapters on the cutting-edge work on heroin maintenance going on in Switzerland and Germany, Spain and the Netherlands; the rise of safe injection sites; the trials in Vancouver; the spread of heroin addiction in Iran, Pakistan, and the Central Asian republics; and contemporary use patterns in the West, among others.

But 25 years after it was first published, "The Heroin Solution" is still relevant, still revelatory, and still a good read. Or, as Publishers Weekly said the first time around, "A blockbuster!"

(Click here to order "The Heroin Solution or other books by Arnold Trebach through DRCNet's latest book offer.)