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Responding to Holder on Heroin, Reformers Call for a Health Direction [FEATURE]

US Attorney General Eric Holder had heroin on his mind Monday, using his weekly video message and an accompanying press release to draw attention to rising heroin overdose deaths and vowing to combat the problem with a combination of law enforcement, treatment, prevention, and harm reduction measures. Drug reformers generally responded positively, but called on the Obama administration to seek comprehensive, science- and health-based solutions instead of engaging in more drug war.

Attorney General Holder takes on heroin (usdoj.gov)
"Addiction to heroin and other opiates -- including certain prescription pain-killers -- is impacting the lives of Americans in every state, in every region, and from every background and walk of life -- and all too often, with deadly results. Between 2006 and 2010, heroin overdose deaths increased by 45%," Holder said. "Scientific studies, federal, state and local investigations, addiction treatment providers, and victims reveal that the cycle of heroin abuse commonly begins with prescription opiate abuse. The transition to -- and increase in -- heroin abuse is a sad but not unpredictable symptom of the significant increase in prescription drug abuse we've seen over the past decade."

What Holder didn't mention is that the rise in prescription pain pill misuse is tied to a massive increase in prescribing opioids for pain in the past decade. A study published last fall found that between 2000 and 2010, the amount of opioids prescribed for non-cancer pain had nearly doubled, and that during the same period, the percentage of people complaining of pain who received prescriptions for opioids jumped from 11% to nearly 20%. But reining in prescriptions generally isn't the answer either.

But at the same time, a 2011 Institute of Medicine report found that while "opioid prescriptions for chronic non-cancer pain [in the US] have increased sharply… 29% of primary care physicians and 16% of pain specialists report they prescribe opioids less often than they think appropriate because of concerns about regulatory repercussions."

As the IOM report noted, having more opioid prescriptions doesn't necessarily mean that "patients who really need opioids [are] able to get them." Opioid misuse and under-use of opioids for pain treatment when they are needed are problems that coexist in society. Pain pill crackdowns have also been found to result in increased use of street heroin, as a Washington Post article last week reports -- two additional reasons advocates prefer public health approaches to heroin more than law enforcement -- and why great care should be taken with the law enforcement measures.

"It's clear that opiate addiction is an urgent -- and growing -- public health crisis. And that's why Justice Department officials, including the DEA, and other key federal, state, and local leaders, are fighting back aggressively," Holder continued. "Confronting this crisis will require a combination of enforcement and treatment. The Justice Department is committed to both."

Holder pointed to DEA efforts to prevent diversion of pharmaceutical pain-relievers to non-medical users, mentioning investigations of doctors, pharmacists, and distributors.

"With DEA as our lead agency, we have adopted a strategy to attack all levels of the supply chain to prevent pharmaceutical controlled substances from getting into the hands of non-medical users," Holder said.

Cooking heroin (wikimedia.org)
Holder also pointed out that DEA had opened some 4,500 heroin investigations since 2011 and promising more to come.

But, as Holder noted, "enforcement alone won't solve the problem," so the administration is working with civil society and law enforcement "to increase our support for education, prevention, and treatment."

And although he didn't use the words "harm reduction," Holder is also calling for some harm reduction measures. He urged law enforcement and medical first responders to carry the overdose reversal drug naloxone (Narcan) and signaled support for "911 Good Samaritan" laws, which grant immunity from criminal prosecution to those seeking medical help for someone experiencing an overdose.

Holder got restrained plaudits from drug reformers for his small steps toward harm reduction measures, but they called for a more comprehensive approach.

"Preventing fatal overdose requires a comprehensive solution," said Meghan Ralston, harm reduction manager for the Drug Policy Alliance. "While naloxone is an absolutely critical component, we need a scientific, health-based approach to truly address the roots of the problem. This includes improving access to effective, non-coercive drug treatment for everyone who wants it, as well as improving access to medication-assisted treatments such as methadone and buprenorphine."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)
Ralston also added that just making naloxone available to cops and EMTs wasn't good enough. Friends and family members, not "first responders," are most often the people who encounter others in the throes of life-threatening overdoses.

"While we applaud Attorney General Holder's clear support for expanding access to naloxone, particularly among law enforcement and 'first responders,' we urge him to clarify that he supports naloxone access for anyone who may be the first person to discover an opiate overdose in progress," she said.

But Law Enforcement Against Prohibition (LEAP), a group of law enforcement officials opposed to the war on drugs, applauded the move, which could help soften reflexive law enforcement opposition to carrying the overdose antidote, an attitude reflected in the the International Association of Chiefs of Police's opposition to all harm reduction measures.

"Police may not be the first to embrace change, but we are slowly evolving," said Lieutenant Commander Diane Goldstein (Ret.). "We cannot arrest our way out of a public health problem, and it's clear that the Attorney General is beginning to understand that and to embrace the role of harm reduction in reducing death, disease and addiction in our communities. We still have a long way to go, but this is a good sign."

The idea is "a no-brainer," according to executive director Major Neill Franklin (Ret.). "It is simply immoral not to support something proven to save lives for political reasons," Franklin added. "Yes, police send a message when they choose not to carry naloxone. But that message is not 'don't do drugs,' it's 'if you make the wrong decisions in your life, we don't care about you.' That offends me both as a former cop and as a human being."

The nuanced pushback to Holder's law enforcement/prevention/treatment/hint of harm reduction approach is good as far as it goes, but it doesn't go far enough. Decriminalizing and destigmatizing now illicit drug use, as has been the case in Portugal, is an obvious next step, and removing the question of drugs from the purview of the criminal justice system altogether would be even better. Still, that a sitting attorney general is calling for treatment and harm reduction as well as law enforcement is a good thing, and for reformers to be calling him on not going far enough is a good thing, too.

Chronicle AM -- February 20, 2014

Colorado is rolling in the marijuana tax dollars, Washington state gets closer to licensing legal grows, a New Hampshire patient grow bill is moving, the Europeans are worried about some new drugs, and more. Let's get to it:

The Europeans are worried about "N Bomb"
Marijuana Policy

Colorado Governor Announces Marijuana Tax Revenues Plan. Gov. John Hickenlooper (D) Wednesday announced his plan to start spending tax revenues from legalized marijuana. He said he would spend $99 million next fiscal year, with half of it going to youth use prevention, another 40% going to substance abuse treatment, and more than $12 million for public health. His proposal must be approved by the legislature.

Washington State Regulators Announce Rules Modifications. The Washington State Liquor Control Board announced Wednesday that it will limit marijuana business applicants to one pot grow each, down from the three-license limit it originally set. The board also reduced by 30% the amount of grow space that licensees can use. The board is trying to address how to equitably distribute the two million square foot of grow space it has set as a statewide cap. The move also opens the way to the actual issuance of grow licenses, which could come as soon as early next month.

Medical Marijuana

New Hampshire Patient Cultivation Bill Wins Committee Vote. A bill that would allow qualifying patients to cultivate a limited amount of medical marijuana in New Hampshire was approved this morning in a 13-3 vote by the House Committee on Health, Human Services, and Elderly Affairs. The bill will be considered by the full House sometime in March. Sponsored by Rep. Donald Wright (R-Tuftonboro), House Bill 1622 would patients or their designated caregivers to possess up to two mature plants and twelve seedlings. The cultivation location would have to be reported to the Department of Health and Human Services, and patients would lose their ability to cultivate when an alternative treatment center opens within 30 miles of their residence.

South Carolina CBD Medical Marijuana Bill Filed. Sen. Tom Davis (R-Beaufort) Wednesday introduced a bill to allow for the use of CBD cannabis oil for the treatment of epilepsy seizures. Senate Bill 1035 has been referred to the Committee on Medical Affairs.

Arizona Bill Would Use Medical Marijuana Fees to Fund Anti-Drug Campaigns. A bill approved Wednesday by the House Health Committee would set up a special fund using fees from medical marijuana user and dispensaries to "discourage marijuana use among the general population." House Bill 2333, sponsored by Rep. Ethan Orr (R-Tucson) is being derided by the Marijuana Policy Project, whose spokesman, Mason Tvert, said "It is remarkable how much money some government officials are willing to flush down the toilet in hopes of scaring adults away from using marijuana."

Heroin

Vermont Law School Symposium Will Address Heroin Addiction and New Solutions. The Vermont Law Criminal Law Society is hosting a symposium on heroin and opiate addiction and responses to it on Monday. "This event is about new ideas from new sources," said Vermont Law JD candidate George Selby ', one of the panel organizers. "We need to fundamentally change the way we treat addicts and the opiates they fall victim to." Panelists will include addiction and pain specialists, a narcotics investigator, and an advocate for revolutionizing drug policy. They will discuss whether drug courts, replacement therapy, and support groups are enough, and tackle a controversial question: Should doctors be allowed to prescribe heroin to treat heroin addiction? One of the featured speakers is Arnold Trebach, JD, PhD, professor emeritus of public affairs at American University and founder of the Drug Policy Foundation, the precursor to the Drug Policy Alliance, who plans to call for action in Vermont. Click on the title link for more details.

International

Europeans Issue Alert on Four New Synthetic Drugs. The European Monitoring Center for Drugs and Drug Addiction has issued an alert and announced a formal risk assessment of four new synthetic drugs. They are the hallucinogenic phenethylamine 251-NBOMe ("N-Bomb," linked to three deaths), the synthetic opioid AH-7921 (15 reported deaths in Europe), the synthetic cathinone derivative MDPV ("legal cocaine," linked to 99 deaths), and the arylcyclohexamine drug Methoxetamine (linked to 20 deaths). Click on the link above for more details.

British Columbia Judge Rules Mandatory Minimum Drug Sentences Unconstitutional. A judge in Canada's British Columbia ruled Wednesday that mandatory minimum sentences for drug offenders under the federal 2012 Safe Streets and Communities Act are unconstitutional. In November, an Ontario judge struck down a similar sentence for a weapons offense, but BC is the first province to have the drug offense sentences quashed. Crown prosecutors are expected to appeal.

India Asset Forfeiture Bill Passes Lok Sabha. A bill that would increase the Indian government's ability to seize assets from drug traffickers was approved Wednesday by the Lok Sabha, the lower house of the country's bicameral parliament. The Narcotic Drugs and Psychotropic Substances (Amendment) Bill, 2011 passed on a voice vote after members took turns worrying aloud about the spread of drug use in the world's most populous democracy.

Hoffman, Heroin, and What Is To Be Done [FEATURE]

The news last Sunday that acclaimed actor Phillip Seymour Hoffman had died of an apparent heroin overdose has turned a glaring media spotlight on the phenomenon, but heroin overdose deaths had been on the rise for several years before his premature demise. And while there has been much wailing and gnashing of teeth -- and quick arrests of low-level dealers and users -- too little has been said, either before or after his passing, about what could have been done to save him and what could be done to save others.

cooking heroin (wikimedia.org)
There are proven measures that can be taken to reduce overdose deaths -- and to enable heroin addicts to live safe and normal lives, whether they cease using heroin or not. All of the above face social and political obstacles and have only been implemented unevenly, if at all. If there is any good to come of Hoffmann's death it will be to the degree that it inspires broader discussion of what can be done to prevent the same thing happening to others in a similar position.

Hoffman, devoted family man and great actor that he was, died a criminal. And perhaps he died because his use of heroin was criminalized. Criminalized heroin -- heroin under drug prohibition -- is of uncertain provenance, of unknown strength and purity, adulterated with unknown substances. While we don't know what was in the heroin that Hoffman injected, we do know that he maintained his addiction and went to meet his maker with black market dope. That's what was found beside his lifeless body.

In a commentary published by The Guardian, actor Russell Brand, a recovered heroin addict, laid the blame for Hoffman's demise on the drug laws. "Addiction is a mental illness around which there is a great deal of confusion, which is hugely exacerbated by the laws that criminalise drug addicts," Brand wrote, calling prohibitionists' methods "so gallingly ineffective that it is difficult not to deduce that they are deliberately creating the worst imaginable circumstances to maximise the harm caused by substance misuse." As a result, "drug users, their families and society at large are all exposed to the worst conceivable version of this regrettably unavoidable problem."

We didn't always treat our addicts this way. Even after the passage of the Harrison Act in 1914, doctors continued for years to prescribe maintenance doses of opiates to addicts -- and hundreds of them went to jail for it as the medical profession fought, and ultimately lost, a battle with the nascent drug prohibition bureaucracy over whether giving addicts their medicine was part of the legitimate practice of medicine.

The idea of treating heroin addicts as patients instead of criminals was largely vanquished in the United States, but it never went away -- it lingers with methadone substitution, for example. But other countries have for decades been experimenting with providing maintenance doses of opioids to addicts, and to good result. It goes by various names -- opiate substitution therapy, heroin-assisted theatment, heroin maintenance -- and studies from Britain and other European countries, such as Germany, the Netherlands, and Switzerland, as well as the North American Opiate Medications Initiative (NAOMI) and the follow-up Study to Assess Long-Term Opiate Maintenance in Canada have touted its successes.

Those studies have found that providing pharmaceutical grade heroin to addicts in a clinical setting works. It reduces the likelihood of death or disease among clients, as well as allowing them to bring some stability and predictability to sometimes chaotic lives made even more chaotic by the demands of addiction under prohibition. Such treatment has also been found to have beneficial effects for society, with lowered criminality among participants and increased likelihood of their integration as productive members of society.

The dry, scientific language of the studies obscures the human realities around heroin addiction and opioid maintenance therapy. One NAOMI participant helps put a human face on it.

"I want to tell you what being a participant in this study did for me," one participant told researchers. "Initially it meant 'free heroin.' But over time it became more, much more. NAOMI took much of the stress out of my life and allowed me to think more clearly about my life and future. It exposed me to new ideas, people (staff and clients) that in my street life (read: stressful existence) there was no time for."

"After NAOMI, I was offered oral methadone, which I refused. After going quickly downhill, I ended up hopeless and homeless. I went into detox in April 2007, abstained from using for two months, then relapsed. In July 2008 I again went to detox and I am presently in a treatment center... I am definitely not "out of the woods" yet, but I feel I am on the right path. And this path started for me at the corner of Abbott and Hastings in Vancouver... Thank you and all who were involved in making NAOMI happen. Without NAOMI, I wouldn't be where I am today. I am sure I would be in a much worse place."

Arnold Trebach, one of the fathers of the drug reform in late 20th Century America, has been studying heroin since 1972, and is still at it. He examined the British system in the early 1970s, when doctors still prescribed heroin to thousands of addicts, and authored a book, The Heroin Solution, that compared and contrasted the US and UK approaches. Later this month, the octogenarian law professor will be appearing on a panel at the Vermont Law School to address what Gov. Peter Shumlin (D) has described as the heroin crisis there.

Phillip Seymour Hoffman (wikimedia.org)
"The death of Phillip Seymour Hoffman is a tragedy all the way around," Trebach told the Chronicle. "It's a bad idea to use heroin off the street, and he shouldn't have been doing that."

That said, Trebach continued, it didn't have to be that way.

"If we had had a sensible system of dealing with this, he would have been in treatment under medical care," he said. "If he was going to inject heroin, he should have been using pharmaceutically pure heroin in a medical setting where he could also have been exposed to efforts to straighten out his personal life, and he could have access to vitamins, weight control advice, and the whole spectrum of medical care. And if he had had access to opioid antagonists, he could still be alive," he added.

While Hoffman may have made bad personal choices, Trebach said, we as a society have made policy choices seemingly designed to amplify the prospects for disaster.

"This is a sad thing. He is just another one of the many victims of our barbaric drug policy," he said. "This was a totally unnecessary death at every level. He shouldn't have been using, but we should have been taking care of him."

The stuff ought to be legalized, Trebach said.

"I'm an advocate of full legalization, but if we can't go that far, we need to at least provide social and psychological support for these people," he said. "And even if we were to decriminalize or legalize, I would still want to figure out ways to provide support and love and kindness to people using the stuff. I advise you not to do it, but if you're going to use it, I want to keep you alive. I remember talking to people from Liverpool [a famous heroin maintenance clinic covered in the '90s by Sixty Minutes, linked above] about harm reduction around heroin use back in the 1970s. One of the ladies said it is very hard to rehabilitate a dead addict."

"There are plenty of things we can be doing," said Hilary McQuie, Western director for the Harm Reduction Network, reeling off a list of harm reduction interventions that are by now well-known but inadequately implemented.

"We can make naloxone (Narcan) more available. We need better access to it. It should be offered to people like Hoffman when they are leaving treatment programs, especially if they've been using opiates, just as a safeguard," she said. "Having treatment programs as well as harm reduction programs distribute it is important. We can cut the overdose rate in half with naloxone, but there will still be people using alone and people using multiple substances."

There are other proven interventions that could be ramped up as well, McQuie said.

"Safe injection sites would be very helpful, so would more Good Samaritan overdose emergency laws, and more education, not to mention more access to methadone and buprenorphine and other opioid substitution therapies (OST)," she said, reeling off possible interventions.

Dr. Martin Schechter, director of the School of Population and Public Health at the University of British Columbia in Vancouver, knows a thing or two about OST. The principal study investigator for the NAOMI and the follow-up SALOME study, Schechter has overseen research into the effectiveness of treating intractable addicts with pharmaceutical heroin, as well as methadone. The results have been promising.

"What we're using is medically prescribed pharmaceutical diacetylmorphine, the active ingredient in heroin," he explained. "It's what you have when you strip away all the street additives. This is a stable, sterile medication from a pharmaceutical manufacturer. We know the precise dose tailored for each person. With street heroin, not only is it adulterated and injected in unsterile situations, but people really don't know how strong it is. That's probably what happened to Mr. Hoffman."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)
In NAOMI, 90,000 injections were administered to study participants, and only 11 people suffered overdoses requiring medical attention.

"Never did we have a fatal overdose," Schechter said. "Because it was in a clinic, nurses and doctors are right there. We administer Narcan (naloxone), and they wake up."

Heroin maintenance had even proven more effective than methadone in numerous studies, Schechter said.

"There have been seven randomized control trials across Europe and in Canada that have shown for people who have already tried treatments like methadone, that medically prescribed heroin is more effective and cost effective treatment than simply trying methadone one more time."

Those studies carry a lesson, he said.

"We have to start looking at heroin from a medicinal point of view and treat it like a medicine," he argued. "The more we drive its use underground, the more overdoses we get. We need to expand treatment programs, not only with methadone, but with medically prescribed heroin for people who don't respond to other treatments."

Safe injection sites are also a worthwhile intervention, Schechter said, although he also noted their limitations.

"Injecting under supervision is much safer; if there is an overdose, there is prompt attention, and they provide sterile equipment, reducing the risk of HIV and Hep C," he said. "But they are still injecting street heroin."

He would favor decriminalizing heroin possession, too, he said.

Harm reduction measures, opioid maintenance treatments, and the like are absolutely necessary interventions, said McQuie, but there is a larger issue at hand, as well.

"We still need to look at the overall issue of the stigmatization of drug users," she said. "People aren't open about their use, and that puts them in a more dangerous situation. It's really hard in a criminalized environment."

Stigmatization means to mark or brand someone or something as disgraceful and subject to strong disapproval. Defining an activity, such as heroin possession, as a crime is stigmatization crystallized into the legal structures of society itself.

"The ultimate harm reduction solution," McQuie argued, "is a regulated, decriminalized environment where it is available by prescription, so people know what they're getting, they know how much to use, and it's not cut with fentanyl or other deadly adulterants. People wouldn't have to deal with all the collateral damage that comes from being defined as criminals as well as dealing with the consequences of their drug use. They could deal with their addictions without having to worry about losing their homes, their families, and their freedoms."

While such approaches have a long way to go before winning wide popular acceptance, policymakers should at least be held to account for the consequences of their decision-making, McQuie said, suggesting that the turn to heroin in recent years was a foreseeable result of the crackdown on prescription opioid pain medication beginning in the middle of the last decade.

"They started shutting down all those 'pill mills' and people should have anticipated what would happen and been ready for it," she said. "What we have seen is more and more people turning to injecting heroin, but nobody stopped to do an impact statement on what would be the likely result of restricting access to pain pills."

The impact can be seen in the numbers on heroin use, addiction, and overdoses. While talk of a "heroin epidemic" is overblown rhetoric, the number of heroin users has increased dramatically in the past decade. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of past year users grew by about 50% between 2002 and 2011, from roughly 400,000 to more than 600,000. At the same time, the number of addicted users increased from just under 200,000 to about 370,000, a slightly lesser increase.

If there is any good news, it is that, according to the latest (2012) National Household Survey of Drug Use and Health, the number of new heroin users has remained fairly steady at around 150,000 each year for the past decade. That suggests, however, that more first-time users are graduating to occasional and sometimes, dependent user status.

And some of them are dying of heroin overdoses, although not near the number dying from overdoses from prescription opioids. Between 1999 and 2007, heroin deaths hovered just under 2,000, even as prescription drug deaths skyrocketed, from around 2,500 in 1999 to more than 12,000 just eight years later. But, according to the Centers for Disease Control, by 2010, the latest year for which data are available, heroin overdose deaths had surpassed 3,000, a 50% increase in just three years.

While the number of heroin overdose deaths is still but a fraction of those attributed to prescription opioid overdoses and the numbers since 2010 are spotty, the increase that showed up in 2010 shows no signs of having gone away. Phillip Seymour Hoffman may be the most prominent recent victim, but in the week since his death, another 50 or 60 people have probably followed him to the morgue due to heroin overdoses.

There are ways to reduce the heroin overdose death toll. It's not a making of figuring out what they are. It's a matter of finding the political and social will to implement them, and that requires leaving the drug war paradigm behind.

New York City, NY
United States

Could Different Drug Policies Have Saved Philip Seymour Hoffman?

The tragic death of actor Philip Seymour Hoffman yesterday has prompted expressions of grief and of praise for his talent. It also, naturally, has prompted discussions of addiction, the impact of pain pill prescriptions on the addicted, even of pain pill restrictions causing more people to turn to heroin.

Philip Seymour Hoffman at the 81st Academy Awards (courtesy Chrisa Hickey, flickr.com/photos/chrisahickey/, via wikimedia.org)
While the latter raises the question about whether different drug policies could make things safer or less damaging or risky for heroin addicts, I haven't heard that question directly raised in the media. Although we don't know how Hoffman would have fared under a different system -- a system that had more options available, we do have information from places that do offer more options, and they are worth examining.

One of those options is heroin maintenance programs (also known now as heroin assisted treatment, or HAT). The most famous such program operated in Liverpool, England, before the conservative Thatcher government, encouraged by the Reagan administration (so we heard), shut it down. But HAT programs current operate in Switzerland, The Netherlands, Germany, Denmark, and the Canadian cities of Vancouver and Montreal. Patients in such programs receive a supply of pharmaceutically-produced heroin from a clinic (for free, though one can infer similar benefits if the heroin were merely cheap). They regularly access health services as a part of their participation. Those who need to inject the drug to relieve their cravings receive instruction on how to do so without damaging their veins, and heroin is made available in other forms as well.

A 2009 paper by leading drug policy researcher Peter Reuter, written for The Abell Foundation in Baltimore, reviewed research done in three of those countries. According to Reuter, Switzerland found a decrease in criminal involvement from 70% of the patients down to 10% after 18 months; and an increase in employment, from 14% to 32%. The health safety results were particularly impressive, including decreased contact with the street drug scene, and with very few adverse events or safety issues.

Many of those findings relate more to indigent addicts than they would to a famous actor. But the final point seems key, very few "adverse events" (e.g. overdoses and so forth) or safety issues, in any of the programs. Again, we don't know how Hoffman would have fared if he had entered a heroin maintenance program instead of buying it on the street. For that matter, we don't know if under legalization, broad or just for the addicted, whether Hoffman would have accessed such services in time, or chose to access them at all. But we know that many people do access these services in the countries that offer them, and that very few of the patients enrolled suffer overdose.

More generally, by prohibiting heroin, even for people who are already addicted to it, we prevent a whole class of possible approaches from every being taken to try to help people -- a whole set of options that people with substance abuse problems might be able to use to manage their problems -- to literally save their lives.

In the meanwhile, there are things to do that are legal even now, at least in a few states that have moved forward with them, with no federal laws standing in the way. These are Good Samaritan policies, that protect people from criminal liability when they seek help in an overdose situation; and use of the antidote medication for heroin overdoses, Naloxone. Meghan Ralston wrote about these in an oped yesterday.

We can also improve the debate. It's not enough to talk about the challenges of addiction and the risk of relapse people can face their entire lives, important as that is. It's a good start that people are starting to recognize the unintended consequences of the pain pill crackdown. But that isn't enough either. It's also important to take the next logical step in the argument, and rethink prohibition.

Editorial: Did Trey Radel Really Vote for Drug Testing?

One of the top political stories this week was the recent arrest of Rep. Trey Radel, a freshman Republican congressman from Florida. Radel pleaded guilty to cocaine possession yesterday and was sentenced to a year of supervised probation. Last night he gave a press conference to apologize to the country and his constituents and family, and announced he would be taking a leave of absence to pursue counseling and drug treatment.

http://stopthedrugwar.com/files/borden12.jpg
David Borden
Since the bust came to light, numerous headlines have circulated to the effect of Radel having voted for legislation to drug test food stamp recipients. But this is only true in a technical sense. As the text of these articles notes, unlike their headlines, the legislation Radel voted for was an ultimately failed version of the Farm Bill, one of the recurring major federal budget packages authorized every five years. Drug testing was a noxious but small part of the legislation, which also was a mechanism for continuing agricultural subsidies, for continuing the SNAP program itself, and many other things. There were Democrats who voted for the bill too, the roll call shows, some of them liberals who undoubtedly opposed the drug testing provision. Also, the amendment that got drug testing added to the Farm Bill was passed through a voice vote, and there is therefore no record of who voted for or against it. That means that Radel's vote for the Farm Bill could have been consistent with supporting drug testing of SNAP recipients, opposing drug testing, or having no position on it. There is no way to know without delving further. Politicians often have to vote for bills despite there being provisions they don't like, because they want an overall bill to pass.

Radel is also one of just three Republican sponsors of the Justice Safety Valve Act, a bill to undo mandatory minimum sentencing by allowing judges to impose sentences below any specified minimums. Although mandatory minimums extend to more issues than drugs, it is drug offenders who are the principle targets of them. So Radel has actually done more than most members of Congress to try to at least reduce the use of incarceration in America, and for drug offenders in particular. A piece published on ThinkProgress.org Tuesday in fact noted a number of statements Radel has made that express skepticism about drug war policies. It also noted that he has expressed opposition to marijuana legalization, so there are facts on both sides. On the other hand, most members of Congress are still likely to say they're not for legalization, despite our movement's recent victories and where opinion polls have gone, so I'm not inclined to attach much significance to that.

Radel news conference, 11/20/13 (TodayNews via YouTube)
That doesn't mean there isn't a valid lesson to be learned from the Radel arrest. A Politico article fairly described the incident as "bring[ing] up drug testing for food stamps." Nancy Pelosi legitimately made this point. Radel's Republican colleagues who are the main supporters of the drug testing amendment may deserve the hypocrisy charge. But it's less than clear that Radel does.

More important than piling on a member of Congress who probably doesn't deserve it, but more important in any case, is to make the points that the incident helps to illustrate about the discrimination and injustices inherent in drug war policies -- like drug testing poor people who don't use drugs more than anyone else, and throwing them out the window when they make the same mistakes in their stressful lives that many others who have easier lives make too.

FDA Panel Wants Tighter Control over Pain Pills

A US Food and Drug Administration advisory panel voted last Friday to recommend that popular pain relievers containing the opioid hydrocodone be moved from Schedule III to Schedule II of the Controlled Substances Act. Popular prescription drugs containing hydrocodone include Vicodin and Lortab.

That would put Lortab and Vicodin in the same schedule as morphine and Oyxcontin, which contains oxycodone.

If the FDA agrees with its advisory panel and reschedules hydrocodone, pain patients using the drug will have to go the doctor's office to get prescriptions written twice as frequently as now. Schedule III drugs can be prescribed for up to six months at a time, while Schedule II drugs can only be prescribed for three months without another visit to the doctor.

The FDA has for years resisted efforts to tighten controls over hydrocodone, saying it could limit patients' access to pain medicine, but as overdose deaths and addiction rates from prescription pain relievers have jumped in recent years, pressure has been mounting on the agency. The agency is acting now after receiving a request from the DEA to consider rescheduling.

The advisory panel's 19-10 vote received mixed reviews from experts consulted by the Milwaukee Journal-Sentinel.

Andrew Kolodny, a psychiatrist and addiction specialist who heads Physicians for Responsible Opiate Prescribing lauded the vote, saying it will lead to fewer people getting addicted to opiates.

"Doctors have had a false sense of security (about prescribing the drugs)," said Kolodny. "This is a clear message that hydrocodone is addictive," he told the Wisconsin newspaper.

"It seemed pretty clear to me that the preponderance of the evidence supported rescheduling," said Peter Kaboli, associate professor at the University of Iowa Carver College of Medicine.

But Jan Chambers, president of the National Fibromyalgia and Chronic Pain Association, said she voted against the proposal because she has heard so much from family members of people who have committed suicide because they are in such pain.

"Millions of people don't have access to the pain specialist or the doctors who can prescribe these Schedule III drugs," she said.

And Lynn Webster, president-elect of the American Academy of Pain Medicine, said putting tighter controls on hydrocodone will reduce prescribing and abuse, but worried about the impact on pain patients.

"I hope chronic pain patients and acute pain patients don't suffer as a result," said Webster, who spoke at the panel hearing but was not a panel member.

The FDA has not said when it will make a final decision on the issue. Now, the FDA and the National Institutes of Health must make a recommendation to the assistant secretary for health, who will make a final recommendation to the DEA.

Washington, DC
United States

Danes Want Heroin Pills for Addicts

In remarks reported by the Copenhagen Post Sunday, Danish Health Minister Astrid Krag announced that she is proposing that heroin in pill form be made available to addicts. Denmark is one of a handful of European countries that provide maintenance doses of heroin to addicts, but to this point, the drug was only available for injection.

Heroin safer in pill form? Danes thinks so. (wikimedia.org)
It is time to offer users a safer choice, Krag said, adding that the pills should be available next year. She said the Danish Board of Health had evidence to believe making heroin available in pill form would reduce the risks of disease and overdose.

"With tablets, we get a tool that lessens the risk of incorrect dosages, injuries and incidences of cancer," she explained. "This will be an improvement of the current system. It clearly needs to be in place by 2013."

The Danish government approved heroin maintenance in 2008, with the first clinic opening in 2010. There are now five of them. A supervised injection site is set to open in the Copenhagen neighborhood of Vesterbro later this year. In the meantime, a mobile injection site is zooming around the neighborhood.

Opposition conservative party spokespersons said they were open to the proposal, but wondered how it would be paid for. But spokespersons for the government Socialistisk Folkeparti said that was just politics.

"It is remarkable that [the conservative opposition] says that financing must be in place before you make a proposal," said Jonas Dahl, health spokesman for the Socialists. "The working procedure has always been that we first get a professional recommendation from the Board of Health and then find the money."

Copenhagen
Denmark

Narc Scandal Front and Center in Florida Sheriff Race [FEATURE]

Scandal has been brewing in the Pinellas County, Florida, Sheriff's Office over the possibly criminal misbehavior of some of its narcotics detectives, and Sheriff Bob Gualtieri, a Republican, has been trying to keep it from spinning out of control. But with his job on the line in November, his challengers, Republicans and Democrats alike, are making the scandal -- and the department's emphasis on busting marijuana grows -- issues with which to wound him in the campaign.

Narcotics deputies went above and beyond in their efforts to bust indoor marijuana grows (wikimedia.org)
Pinellas County sits on Florida's Gulf Coast and includes the city of St. Petersburg. For the last few years, it has been an epicenter of the state's prescription opioid epidemic, but despite the county leading the state in Oxycontin overdose deaths, some Pinellas County narcs were more interested in pot growers than pill mill merchants.[Editor's Note: At least one candidate for sheriff is challenging the conventional law enforcement narrative regarding opioid pain medications; see Scott Swope's comments on the topic at the end of this article.]

It all began when narcotics detectives with the sheriff's office hit on the bright idea of spying on a legal business -- a Largo hydroponics grow shop -- and taking down the license plate numbers of customers, and then snooping around to see what they could find. At least four detectives were involved in surveillance that apparently crossed the line into illegality by trespassing on private property without a warrant, by disguising themselves as utility company workers, and by subsequently falsifying search warrant affidavits (they would claim to have smelled marijuana from the street, when they had actually trespassed to find evidence).

They would have gotten away with it if not for tenacious defense attorneys. But things began to unravel last year, when the attorney for Allen Underwood, who had been arrested in a grow-op bust, filed a complaint saying that Underwood's surveillance cameras had recorded one of the detectives hopping over his fence. The detective ordered the surveillance video deleted, and the sheriff's office found no evidence of wrongdoing by its man.

Next, Largo defense attorney John Trevena charged in a case that one of the detectives had donned a Progress Energy shirt and cap to gain warrantless access to a private property. The detective first denied it under oath, then admitted it. At the time, Gualtieri attributed the deception to "over-exuberance" by a young detective.

Then, in February, Tarpon Springs attorney Newt Hudson questioned one of the detectives under oath about whether he ever saw his dope squad colleagues trespass. Under questioning, the detective admitted that he and one of the other detectives had once broken down a fence to enter a yard of interest.

"That was the game changer," Sheriff Gualtieri told the Tampa Bay Times last month as he announced he was launching a criminal investigation of the four detectives. "Misconduct will not be tolerated and we will hold accountable any member of the Pinellas County Sheriff's Office who acts contrary to the law," Gualtieri said. "The ends never justify the means."

Embattled Sheriff Bob Gualtieri (bobforsheriff.com)
Three of the detectives have resigned, and Gualtieri fired the fourth, but it might be too late to undo the damage to local law enforcement and to Gualtieri's own political prospects. At least 18 pending marijuana grow prosecutions have been halted, and Gualtieri and Chief Assistant State Attorney Bruce Bartlett said they also will review charges against about two dozen other defendants who previously pleaded guilty, were convicted or accepted plea bargains.

And Gualtieri has been repeatedly pummeled by challengers over the scandal. Not only the sole Democrat in the race, Palm Harbor attorney Scott Swope, but Gualtieri's Republican challengers, most notably former Sheriff Everett Rice, have criticized his handling of the affair. The Republican primary, which Gualtieri hopes to survive, is set for August 14.

"They shouldn't have been investigating the store to begin with," Swope told the Chronicle. "As far as criminal activity is concerned, we have bigger fish to fry than trying to catch people who are purchasing grow lamps. It was absolutely ridiculous."

Especially given that the sheriff's office had had to cut $100 million from its budget and eliminate 600 positions, including the cold case unit and sexual predator tracking, Swope said, alluding to the severe financial straits in which the department and the county found themselves.

"When I'm at a campaign presentation and tell people that they had detectives for surveilling this business selling legal equipment, but not for human trafficking or cold cases, everyone hears that and goes 'wow,'" Swope said. "It's an argument that has some traction."

Swope also criticized the leisurely pace of Gualtieri's internal investigation.

"The internal investigation took way too long," said Swope. "When you have an assertion that one of your detectives is trespassing to obtain evidence, falsifying ID to obtain evidence, falsifying affidavits, then destroying evidence, that needs to take precedence over every other internal investigation, and it didn't. When Gualtieri first went on the record, he said he didn't believe it; he just dismissed it, at least initially."

For Rice, who served as sheriff for 16 years until 2004, the pot grow scandal was an indication of misplaced priorities in Gualtieri's department.

"How is it that Pinellas and Pasco County became the pill-mill capital of the world in the last three or four years," Rice asked at a candidates' forum this spring, "and meanwhile we're spying on people who have hydroponic materials?"

Rice was still on the attack last month, telling the Tampa Bay Times that problems in the department are not limited to the pot grow scandal, but also include reports of slipshod internal investigations, narcotics sergeants claiming pay while monitoring detectives from home, and possible thefts.

"The question is,'' said Rice, "how did that culture come about in the first place? I think people realize that a Sheriff Rice wouldn't put up with such things,'' Rice said.

Except that he did. During his time in office, one of Rice's narcotics detectives gathered evidence of a pot grow illegally and lied about it under oath. He also fabricated evidence for a search warrant by calling in his own "anonymous tip." In another case, deputies used an informant to get a search warrant without revealing that the informant's wife was having an affair with the suspect. Pinellas judges tossed a number of pot grow cases over police misconduct during Rice's reign, and one detective was prosecuted for perjury.

One of the cases tossed was against Randy Heine, a Pinellas Park smoke shop owner. In that 1997 bust, deputies raided Heine's home and seized two pounds of pot, but a judge threw out the case, finding that deputies had resorted to "gross, material misrepresentation of the facts'' in their search warrant application.

Heine, a perennial gadfly on the local scene, has also become a harsh critic of Pinellas-style drug law enforcement. He was briefly a candidate in the sheriff's face before dropping out after failing to pay a filing fee. That leaves Swope, Gualtieri, and Rice.

Democratic challenger Scott Swope (swopeforsheriff.com)
For Swope, Gualtieri and Rice are birds of a feather -- traditional lawmen who don't think twice about the futility and expense of continuing to fight the war on marijuana. He offers a different vision, one that includes marijuana decriminalization and, eventually, legalization and regulation.

"Florida should go the way of more than a dozen other states and decriminalize," he said. "Then the sheriff's office wouldn’t have to expend limited resources trying to catch people in possession of small amounts. That would make it so those young people don't have a criminal record, they're still eligible for student loans, they can get jobs. It's a bit of a shocker for some of my audiences, but when you think about it, it makes perfect sense to save tax dollars by not investigating and prosecuting possession of small amounts."

A marijuana bust of 20 grams or less is a misdemeanor in Florida, but it means a trip to jail, booking, and waiting to get bonded out. It also uses up law enforcement man-hours during arrest, booking, detention, and prosecution. Florida should and will decriminalize eventually, Swope said, but he wouldn't wait for the legislature to act if elected.

"As sheriff, I can't tell the legislature what to do, but I would have some influence over the county commission. I could lobby them to enact an ordinance making possession of less than 20 grams an ordinance violation," he explained. "That way, instead of deputies having to arrest people and put them in the criminal justice system, they could just issue an ordinance violation ticket, and the fines would go to Pinellas County.

Swope was philosophically open to legal, regulated marijuana sales, but wasn't pushing it as a campaign position. First things first, he said.

"From the perspective of this campaign, the majority of the population believes medical marijuana should be legal, and I do, too," he explained. "Decriminalization and regulation similar to alcohol and cigarettes, well, that's a bit more of a progressive position. I think it's going to be a two-step process: Make medical marijuana legal, and after enough time, and people realize these folks aren't committing crimes, then it's time for step two."

Swope also had an interesting perspective on the pain pill and pill mill issue.

"Pinellas County had a very serious problem with pain pills, we led the state four straight years in Oxycontin deaths, and it's still a serious problem, but unfortunately, when they really ramp up the pain pill mill enforcement, the pendulum can swing too far the other way," he noted. "There is a potentially serious negative impact on doctors and pharmacies trying to help people who need the help. If Florida were a little more progressive and had a medical marijuana law, perhaps many could treat themselves with that instead of narcotics."

The one-time deputy's drug war positions are winning him support outside of traditional Democratic constituencies, including Libertarian Party figures ranging from county stalwarts to presidential nominee Gary Johnson.

"I have the endorsement of the Libertarian Party here, and that has some of the Democrats scratching their heads. I just explain that I'm a lawyer familiar with the Constitution, I'm progressive-thinking and understand and appreciate the value of personal liberty and what the Constitution means and I will make damned sure the sheriff's office abides by the Constitution."

Pinellas County has 3,000 more registered Democrats than Republicans, but most county offices, including the sheriff's, have been in Republican hands for decades. A victory for Democratic challenger Scott Swope in November would not only break the GOP's stranglehold on elected office in Pinellas, it could also bring a fresh new perspective to Florida law enforcement.

Meanwhile, Sheriff Gualtieri has just unleashed an offensive against "fake pot."

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

St. Petersburg, FL
United States

Harsh Cameron Douglas Sentence Sparks Appeal, Support

Cameron Douglas, the son of noted Hollywood actor Mike Douglas, had a well-known history of drug addiction when he was sentenced to five years in federal prison for heroin possession and drug distribution. Not offered drug treatment, Douglas relapsed while in prison and was caught in possession of a small amount of heroin and Suboxone.

Cameron Douglas
Most federal prisoners caught with small amounts of drugs are dealt with administratively, and that happened to Douglas. He spent 11 months in solitary confinement and was denied visits during that period for his transgression.

But, unusually, Douglas was also prosecuted for drug possession by a prisoner, and even more unusually, he was hammered hard at sentencing. Federal District Court Judge Richard Berman nearly doubled his original drug trafficking time, sentencing him to an additional 4 ½ years in prison. Prosecutors had asked for at most an additional two years.

In imposing the harsh sentence, Judge Berman said that Douglas was "continuously reckless, disruptive, and noncompliant" and had repeatedly refused to obey the law.

The draconian sentence for Douglas has sparked a reaction. Unlike most federal prisoners, thanks to his father, Douglas had the resources to appeal his sentence, which is possibly the longest in federal prison history for simple drug possession behind bars. And now that appeal has been joined by about two dozen addiction and drug treatment doctors and organizations who have signed an amicus curiae brief on his behalf.

The brief does not just argue that Douglas should be sentenced more leniently; it argues that Douglas is a classic example "of someone suffering from untreated opioid dependence" and that more prison time will do nothing to address his addiction. The brief shows that many federal prisoners suffer from drug addictions, that many fail to get any meaningful treatment for it in prison, and argues that imposing additional incarceration for drug-addicted prisoners serves no penological purpose.

"A central theme of the [brief] is the need to provide effective, evidence-based treatment to opioid-dependent persons, particularly to those under criminal justice supervision. Time and again, over the past four decades, the provision of appropriate substance abuse treatment to opioid-dependent persons has been shown to profoundly improve not only their health and well-being across a broad range of metrics, but also the health and safety of the larger public. This is especially true of methadone and other opioid substitution treatments," the brief argued.

"Conversely, [we] are acutely aware of the ramifications when such treatment is withheld -- the suffering, disease, death, and criminal behavior that result when punitive sanctions replace proven medical interventions and opioid dependence is left to fester," the addiction specialists argued.

The brief was written by Dan Abrahamson, director of legal affairs for the Drug Policy Alliance, which organized the effort to intervene in the Douglas case. Its signatories include the New York and California Societies of Addiction Medicine, as well as other medical, public health and human rights organizations, along with prominent individual physicians and substance abuse researchers.

"Tacking on more prison time for a person who is addicted to drugs because they relapse behind bars goes against fundamental principles of medicine, inflicts unnecessary suffering and undermines both safety and health," said Abrahamson.  "Such a response only fuels the vicious cycle we see daily across the country of drug-dependent persons being imprisoned while sick, coming out sicker, and then returning to jail even quicker -- at huge expense to everyone."

Most federal prisoners don't have the resources or the celebrity of Cameron Douglas, but many share his struggles with addiction. Justice for Cameron Douglas could help lead to more just treatment for them, as well.

New York, NY
United States

Marking Mother's Day With Calls for Reform [FEATURE]

On this Mother's Day, more than 100,000 women are behind bars in American prisons, according to the Bureau of Justice Statistics, and many of them are doing time for drug offenses. That's too many, said members of a new coalition, Moms United to End the War on Drugs, as they held events last week in the days running up to Mother's Day.

Gretchen Burns Bergman at the National Press Club (Moms United)
"The war on drugs is really a war on families," said Mom's United's Gretchen Burns Bergman. "It is time to end the stigmatization and criminalization of people who use drugs and move from arrest and mass incarceration to therapeutic, health-oriented strategies. Moms were the driving force in repealing alcohol prohibition and now moms will play a similar role in ending the war on drugs."

Bergman, from San Diego, is the mother of two sons who have struggled with substance abuse and incarceration and is a founder of A New PATH (Parents for Addiction Treatment & Healing). A New PATH has joined forces with other groups, including Law Enforcement Against Prohibition (LEAP), the NORML Women's Alliance, Families to Amend California's Three Strikes, and Students for Sensible Drug Policy to form Moms United to agitate for an end to the drug war and a turn toward sensible, evidence-based drug policies.

The week leading up to Mother's Day was a week of action under the rubric of Cops and Moms Working Together to End Prohibition. The week saw events and press conferences in Atlanta, Boston, New York City, and Washington, DC, in the East and Los Angeles, San Diego, Oakland on the West Coast.

"Mother's Day was derived out of an intensely political effort to organize women on both sides of the Mason-Dixon Line against the Civil War," said Sabrina Fendrick, coordinator for the NORML Women's Alliance. "The reason mothers were made the vehicle was because they were the ones whose children were dying in that war. Women were also largely responsible for ending alcohol prohibition. This is more than just a ‘greeting-card holiday,’ this is the beginning of an institutional change in our society. The government's war on drugs is unacceptable. For our children's sake, the concerned mothers of the world are being called on to demand the implementation of a rational, responsible, reality-based drug and marijuana policy."

Last Wednesday, at a San Diego press conference, the umbrella group unveiled the Moms United to End the War on Drugs Bill of Rights, a 12-point motherhood and drug reform manifesto which calls for "the right to nurture our offspring, and to advocate for their care and safety" and "the parental right to policies and practices that recognize addiction as a disease in need of treatment, rather than a willful behavior to be criminalized," as well as the right to have harm reduction and overdose prevention practices implemented, the right to be free from heavy-handed, constitution-threatening drug war policing, and the right to be free from drug war violence.

Moms United in Los Angeles (Moms United)
"If we stop arresting and incarcerating drug users, think of the number of children who would have the chance to look upon their parents as positive role models instead of having parents who are absent because they are incarcerated," the group said. "We have a moral and ethical obligation to give these children a better chance in life by allowing parents to take care of their families. These parents should have the opportunity to become the productive members of society and role models to their children that they want to be and that their children need and deserve."

The Bill of Rights has been endorsed by a number of religious, reform, and civil rights groups, and individuals can sign onto it, too. To sign on, go to the online petition.

"We are building a movement to stop the stigmatization and criminalization of people who use drugs or are addicted to drugs," the group said. "We urgently call for health-oriented strategies and widespread drug policy reform in order to stop the irresponsible waste of dollars and resources, and the devastating loss of lives and liberty."

It's not just Moms United who is using Mother's Day to strike a blow for drug reform. In Colorado, where Amendment 64 to legalize and regulate marijuana is on the ballot, the Campaign to Regulate Marijuana Like Alcohol is running a television ad featuring a young woman writing an email to her mother in which she explains that she has found her marijuana use to be safer and healthier than the drinking she did in college.

The ad is aimed at a demographic that is both critical to and difficult for the campaign: women in their 30s and 40s, many of whom are mothers. The ad appeared Friday and again on Mother's Day.

"Our goal with the ad is to start a conversation -- and encourage others to start their own conversations -- about marijuana," Betty Aldworth, the advocacy director for the campaign.

And it's not just the United States, either. In mother-honoring Mexico, which marked Mother's Day on Thursday, hundreds of women and other family members traveled to Mexico City on the National March for Dignity to demand that the government locate their loved ones gone missing in the drug wars, according to the Frontera NorteSur news service.

"They took them alive, and alive we want them," the marchers chanted.

While the drug wars in Mexico have claimed at least 50,000 lives, including 49 people whose dismembered bodies were found on a highway outside Monterrey Sunday morning, thousands more have gone missing, either simply vanished or last seen in the hands of armed, uniformed men.

The Mexican government doesn't report on how many have gone missing in its campaign against the cartels, but the Inter-American Human Rights Commission counts more than 5,000 missing persons complaints filed with police -- and this in a country where many people so mistrust the police they don't bother to file official reports.

"For some it has been years, for others months or days, of walking alone, of clamoring in the desert of the hallways of indolent and irresponsible authorities, many of them directly responsible for disappearances or complicit with those who took our loved ones away," the mothers' group said.

On Mother's Day, many mothers in Mexico have "nothing to celebrate," said Norma Ledezma, cofounder of Justice for Our Daughters in Chihuahua City. "As families, we want to take this occasion to tell society not to forget that in Mexico there is home with a plate and a seat empty."

"We have walked alone in the middle of stares and stigmatizing commentaries, and we have been treated like lepers, marginalized and condemned to the worst pain a human being could live: not knowing the whereabouts of our sons and daughters," the new mother's movement declared. "But now we are not alone. We have found hundreds of mothers and we unite our clamor and our love to recover our loved ones and bring them home."

On Mother's Day, the agony of the drug war transcends borders. And the call from mothers for a more sane and human alternative continues to grow, from Chihuahua to Chicago and from Oaxaca to Washington.

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