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Chronicle Book Review: Drugs and Drug Policy

Drugs and Drug Policy: What Everyone Needs to Know, by Mark Kleiman, Jonathan Caulkins, and Angela Hawken (2011, Oxford University Press, 234 pp., $16.95 PB)

http://www.stopthedrugwar.com/files/drugs_and_drug_policy.jpg
Mark Kleiman isn't real popular among the drug reform set. The UCLA professor of public policy is no legalizer, and even though he's too much of an evidence-minded academic to be a wild-eyed drug warrior, he still seems to have an unbecoming fondness for the coercive power of the state. Kleiman, who gets top-billing over coauthors Jonathan Caulkins of Carnegie Mellon and Angela Hawken at Pepperdine, also ruffles reformers' feathers with unnecessary snideness and snark.

But I watched Kleiman address Students for Sensible Drug Policy conventions a couple of times, and I thought it was a good thing, a very useful jolt to the group-think that can grip any gathering of congregants committed to a cause. I thought having the students have to hear the arguments of a leading academic thinker on drug policy who, while not "the enemy," was not especially saying what the average SSDPer wanted to hear, was salubrious for their critical thinking skills. I still think so.

In Drugs and Drug Policy, Kleiman and his coauthors continue with the occasional jibes aimed at the drug reform movement, at times reach conclusions at odds with my own, but also serve up a surprisingly chewy work of drug policy wonkery in delicious bite-size chunks. The innovative format, something like a series of FAQs organized within broader chapters -- "Why Have Drug Laws?" "How Does Drug Law Enforcement Work?" "What Treats Drug Abuse?" "Can Problem Drugs Be Dealt With at the Source?" -- allows us to unpack that all-encompassing monster called "drug policy" one subset at a time, and for that achievement alone, is worthy of praise. That it manages to cover so much ground in a paltry 234 pages is all the more laudable.

Overall, Drugs and Drug Policy is smart, reasonable, and thoughtful. It wants policies based on evidence and it advocates for some intelligent alternatives to current policies. It recognizes the utility of needle exchanges, safe injection sites, and opiate maintenance, even as it complains that "harm reduction" has been hijacked by legalizers. It explains that most people who use drugs -- even those diagnosable as suffering from substance abuse disorders -- will quit using drugs themselves without recourse to treatment. And it even allows that drug use can have beneficial effects, even if it doesn't do so until the seventh chapter.

But Kleiman et. al dismiss decriminalization as unlikely to have a big impact on the social fiscal burden of drug law enforcement because, even though it doesn't appear to have much impact on consumption, drug consumers are not, for the most part, filling our prisons -- drug dealers are. While they do concede that not criminalizing otherwise law-abiding citizens could have "significant benefits," they seem to underplay the negative, life-long impact of a criminal drug record on one's life prospects.

In fact, they seem all too comfortable with maintaining the pernicious role of the criminal justice system in drug policy even as they recognize that enforcing the drug laws is "unavoidably an ugly process," with its reliance on snitches, surveillance, and other "intrusive methods" of enforcement. To give them credit, they want smarter drug law enforcement -- concentrating police repression on violent drug dealers while turning a blind eye to discreet dealing, triaging coerced drug treatment spots so they are reserved for the people who could most benefit from them, giving up on interdiction and source country eradication as ineffective -- that might actually reduce the social and fiscal costs of both drug abuse and enforcement, and since drug prohibition isn't going away anytime soon, at least wasting less money on drug war tactics that don't work well should be on the table.

And they reject drug legalization as too scary to experiment with, but seem to imagine it as possible only within a corporate-controlled, heavily-advertised, low-priced scenario similar to that which has accreted around the alcohol industry. Yes, it's probably true that selling cocaine like Coors, would lead (at least initially) to a significant increase in use and problem use, but why does that have to be the only model? A government monopoly similar to the state liquor store model, with reasonable taxes and no corporate pressure to advertise could conceivably allow legalization without the increases in consumption that the authors predict, even though they concede they don't know how large they might be.

Still, when you get to what it is Kleiman et al. would do if they had their druthers, all but the most purist of legalization advocates will find a lot to like. They create three separate lists of recommendations -- a "consensus list" of reforms they think are politically doable now or in the near future, a "pragmatic list" of reforms that would appeal to dispassionate observers but could raise the hackles of moralists, and a "political bridge too far list" of reforms too radical for mainstream politicians to embrace.

The "consensus list" includes expanding opiate maintenance therapy, encouraging evidence-based treatment, early intervention by the health care system, encouraging people to quit on their own (as opposed to being "powerless"), relying less on interdiction, ending the charade that alternative development is drug control, and concentrating drug enforcement on reducing violence and disorder, as well as smarter, more effective coerced treatment in the legal system. If we saw the drug czar's office produce a National Drug Control Strategy with these recommendations, we would consider that a great victory. It ain't legalization, but its headed in a more intelligent, more humane direction.

The "pragmatic list" includes recommendations to lower the number of drug dealers behind bars, not reject harm reduction even if it's been "hijacked," stop punishing former dealers and addicts, reduce barriers to medical research on illegal substances, and be open-minded about less harmful forms of tobacco use.

The authors don't neglect alcohol and tobacco -- the two most widely-used drugs -- and that is really evident in their "political bridge too far" recommendations. The first three items there are aimed squarely at reducing alcohol consumption and its ill effects. They also argue for the legalization of individual or collective marijuana cultivation, a sort of legalization without the market, increased study of the non-medical benefits of drugs, and increasing cigarette taxes in low tax states.

I think Drugs and Drug Policy needs to be read by anyone seriously interested in drug policy reform. It hits almost all the bases, and it's well-informed, provocative, and challenging of dogmatic positions. You don't like the authors' conclusions? Refute them. It'll be good for you.

Chronicle Book Review: The Power of the Poppy

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

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

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

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

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

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

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

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

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

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

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

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

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

Thai Government in Massive Campaign to Round Up Drug Users [FEATURE]

In a new wave of repression aimed at drug users, the government of Thailand has begun rounding up suspected "drug addicts" to be forced into "rehabilitation centers." That has health, human rights, and harm reduction groups expressing grave concerns, especially given previous Thai pogroms against drug users, like that in 2003, when tens of thousands were rounded up and more than 2,000 killed by police in summary executions.

Bangkok looks so modern, but some Thai drug policies are downright medieval. (Image via Wikimedia)
The official announcement from the National News Bureau of Thailand of the government's plans came only last week. "The Ministry of Interior has picked next week to get all drug addicts across Thailand clean," it said, with Deputy Permanent Secretary for Interior Surapong Pongtadsirikul as putting the number of untreated addicts at 30,000.

"During 20-27 February, 2011, drug abusers in Bangkok will be brought to the rehabilitation centers to get clean," the notice continued. "There will be those who are encouraged to receive treatment on their freewill and those who will be forced against their will. A rehabilitation camp will be open for addicts elsewhere in Thailand where a rehab center is scarce."

The announcement also said staff training would be carried out and a location for a "makeshift rehab center for drug addicts" will be selected. Chillingly, it added that "their names will be recorded in the database specifically designed for easy tracking and providing updates on their progress in the future."

The roundup has already begun in Bangkok, according to Karyn Kaplan of the Thai AIDS Treatment Action Group (TTAG). "Yes, people are being arrested right now," she said. "The police have quotas, they do this every few months, and this is just another excuse to round people up again. Even in our own small network of people who use drugs, people have been arrested, even workers at our harm reduction center."

While the Thai government officially embraces harm reduction principles -- it adopted harm reduction as a national strategy last fall -- it schizophrenically continues its crackdowns on drug users and sends them to "treatment centers" not worthy of the name.

"We don't call them treatment centers, because they aren't run by people who know how to treat people," said Kaplan. "They were originally set up because of prison overcrowding, but even though they have a policy that says drug users are patients, not criminals, they still use the police to sweep the streets and throw people into the system. But then the system says there is no room in prison, send them to the camps. The camps are in military bases and run by the military, and they aren't trained for that. The military is just housing them, and there are beatings and forced labor for no money. There is no due process," she said.

It is as if the Thai government's left hand doesn't know what its right hand is doing, said Kaplan. "The government at least pays lip service to harm reduction, but the Ministry of the Interior is not talking to the Narcotics Control Board, which sponsors the harm reduction policy," she said. "We have gotten unofficial statements from senior officials inside the Public Health Ministry saying they are going to speak with the board and the Interior Ministry about what Thailand might do more effectively."

In the mean time, the roundups continue.

The threat of the mass roundup of suspected drug users has led a coalition of Thai and international health, harm reduction, and human rights organizations to publicly air their fears that it will trample on human rights and could lead to the widespread abuses of drug users seen in other Thai anti-drug campaigns.

"These plans for mass detention and forced treatment raise considerable human rights concerns, especially given Thailand’s history of nationwide punitive and ineffective anti-drug campaigns," they said in an open letter to the Thai government. "There is no way for the government to implement a campaign to forcibly 'treat' tens of thousands of people who use drugs without widespread human rights abuses taking place."

Groups signing on to the letter include the TTAG, the International Harm Reduction Association (IHRA), the International Drug Policy Consortium (IDPC), the International Harm Reduction Program of the Open Society Institute, the Canadian HIV/AIDS Legal Network, and the International Network of People Who Use Drugs (INPUD).

"The mandatory rounding up and detention of people who use illicit drugs for the purpose of enforced treatment is not only a violation of their human rights, it's a violation of common sense -- enforced detention doesn't work," said INPUD's Jude Byrne. "Never has, never will! Communities need to look to the reason people are using drugs. Stop the systemic violence against the poor, minorities, people of different sexual persuasion and the unemployed. Rounding up the most marginalized people in the community will do nothing except provide jobs for the police and the people who run the detention centers. It will also drive INPUD's community underground so they are not able to access harm reduction information or equipment where it is available. The transmission of HIV and Hep C among the injecting drug using community will soar, and that is the real crime, not the use of drugs."

"This crackdown flies in the face of Thailand’s 2002 policy, which states that people who use drugs should be treated as patients, not criminals. There is nothing therapeutic about rounding up thousands of drug users and forcing them into military boot camps that fail to provide appropriate services and support," said Paisan Suwannawong, TTAG executive director and co-founder of the Thai Drug Users' Network.

While the Thai government refers to "drug addicts," its plans appear to include any drug users. Under the current plan, "occasional" users will be detained for one week, "continuous" users for two weeks, and those showing signs of drug dependence for 6 1/2 weeks (45 days).

"There are many reasons to be worried," said IHRA executive director Rick Lines. "Due process guarantees have been thrown out the window. What is the legal basis for mass detention? There are numerous examples of how forced detention in the name of drug dependence 'treatment' can lead to human rights violations and breaches of accepted principles of medical ethics," he continued. "What is more, many who do not need any form of drug dependence treatment will be herded into detention centers. Where is the clinical assessment?" he asked.

The activists also expressed concern about the temporary detention centers that will be set up outside Bangkok. They feared they would be operated not by health workers, but by police or soldiers, they said.

"We are profoundly concerned that these centers may be run by public security forces such as the police or paramilitary civil-defense organizations" said Kaplan. "It is dangerous and extremely disheartening given recent progress made in the country on injecting drug use and HIV. This can only serve to undermine those efforts in the long term. The immediate concern, however, is for the safety and well-being of those targeted."

But the medium term goal is to persuade the Thai government to embrace not merely the rhetoric of harm reduction, but the practice. That is going to take continuing pressure on the government, and the United Nations needs to step up, said Kaplan.

"We need more high-level action to push the government over to harm reduction," she said. "The World Health Organization and the UN Office on Drugs and Crime don't listen to civil society, so we need governments to step up. It is very important and progressive that Thailand is talking harm reduction, but to actually do it, they need a lot of help."

Thailand

Hemispheric Think Tank Says Time for Drug Policy Rethink

A prestigious Washington, DC-based center for hemispheric policy analysis and discussion, the Inter-American Dialogue, is calling for a refashioning of US drug policy. It demands an end to "the silent tolerance of ineffective, socially harmful laws, institutions, and policies" and has some suggestions as to where to go next.

In a report authored by the Dialogue's Peter Hakim, Rethinking US Drug Policy, the Dialogue said: "The available evidence suggests that in the past two decades, US anti-drug policies have done little to diminish the problems they were designed to address." The report proposed a number of initiatives the US government could undertake to set the stage for a thorough rethinking of US drug policy:

  • Support recent Congressional initiatives to establish House and Senate commissions to review US anti-drug strategies and develop alternative approaches;
  • Join with other nations to organize an inter-governmental task force on narcotics strategy that would review and appraise global drug policies;
  • Revise outdated UN treaties that underpin the international narcotics regime;
  • Expand data collection, analysis, and research on multiple aspects of drug problems and the policies and programs designed to address them; and
  • Identify and scale up successful drug programs that promise to reduce drug addiction and the health risks to addicts, increase the prospects of rehabilitation, and decrease drug related crimes.

The Inter-American Dialogue is holding a public discussion of the report and its recommendations Thursday, 2/10/11 on Capitol Hill.

Washington, DC
United States

Heroin Drought Causing Problems in England

A scarcity of heroin in England is leading to a growing number of drug overdoses and poisonings as users ingest dope cut with other substances by dealers trying to stretch supplies, The Guardian reported this week. Scene watchers there are calling it the worst drought in years.

Are you sure that's heroin? Be careful out there, especially in England
The drought is being blamed not on seizures by law enforcement agencies, but on a fungus that has blighted the Afghan opium poppy crop, reducing the size of this year's poppy crop by half. Afghanistan accounts for more than 90% of the world's opium production and likely 100% of the British heroin supply.

"There is a very significant heroin shortage across the UK at the moment," said Gary Cross, head of drug policy for the non-profit group Release.  "It has been going on for some time now, but the last two months have seen stockpiles exhausted."

"I've never known anything like it in 30 years," wrote one long-time heroin user on an on-line forum discussing the shortage.

As dealers and users scramble to grapple with the shortage, users are turning up at hospitals after ingesting adulterated heroin or, in some cases, fake heroin consisting of a powerful sedative, caffeine, and paracetamol, a bulking agent. Some have passed out after smoking or ingesting, while others have reported vomiting, amnesia, and flu-like symptoms.

"This 'heroin drought' appears to be serious and geographically widespread," said Neil Hunt, director of research at KCA, a nationwide community drug treatment service. "Street heroin is in a complete and utter muddle at the moment, and users are collapsing unexpectedly. We need to standardize information about what's out there.

"If people use this intravenously, perhaps on top of alcohol and methadone [the prescribed substitute drug for heroin], it is extremely risky," said Dr. John Ramsey, who runs a drug database at St. George's Medical School in London. "We have had many reports of people overdosing. It's really important that accident and emergency departments understand that they may not be dealing with a 'normal' heroin overdose when people are brought in," he said.

Harm reduction drug agencies are aware of the problem and working to address it. Several of them held an urgent meeting last week to discuss setting up an online warning system to give users notice about contaminated or adulterated drugs.

London
United Kingdom

FDA Approves Once-A-Month Injectable Drug to Fight Opiate Addiction

The US Food and Drug Administration (FDA) announced Tuesday that it had approved a once-a-month injectable drug for use in treating opiate addiction. The drug, marketed as Vivitrol, is a form of naloxone, an opioid atagonist that blocks the action of opioids on brain cells and is currently used in responding to overdoses.

In approving Vivitrol, the FDA cited a Russian study with 250 heroin addicts that found it reduces relapse rates and blocks cravings for narcotics. In that study, after six months, 86% of subjects taking Vivitrol had stayed off opiates and were functioning in work or school, compared to only 57% who were given a placebo.

Unlike methadone and buprenorphine, which are commonly used in opiate substitution treatments, Vivitrol is not addictive and does not maintain opiate dependency. Additionally, unlike those two substitutes, Vivitrol does not need to be taken daily, but is instead administered monthly via intramuscular injection.

The approval of Vivitrol for opiate addiction is "an important turning point in our approach to treatment," said Dr. Nora Volkow, head of the National Institute on Drug Abuse, in a statement greeting the FDA announcement.

Nearly 810,000 Americans are addicted to heroin, with more than twice that number using prescription opioids, such as Oxycontin and Vicodin, for non-prescription purposes, Volkow noted.

Washington, DC
United States

Russian Diplomat Takes Over at UN Drug Agency

As of Monday, the United Nations Office on Drugs and Crime (UNODC) is under new management. Russian diplomat Yury Fedotov , who was nominated for the post earlier this year by UN Secretary General Ban Ki-moon, has now taken over the organization that makes up a key part of the global drug prohibition regime. He replaces outgoing UNODC head Antonio Maria Costa.

Yuri Fedotov (courtesy Voice of Russia, ruvr.ru)
The Vienna-based agency, established in 1997, is charged with fighting the illegal drug trade, as well as other international crime, such as corruption and human trafficking. It also publishes annual reports on the global drug scene, as well as regional reports, including annual surveys of Afghan opium poppy production.

"Public health and human rights must be central" to his agency's work, Fedotov said in a statement Monday. "Whether we talk of the victims of human trafficking, communities oppressed by corrupt leaders, unfair criminal justice systems or drug users marginalized by society, we are committed to making a positive difference," he said.

"Drug dependence is a health disorder, and drug users need humane and effective treatment -- not punishment," he added. "Drug treatment should also promote the prevention of HIV."

Harm reductionists and AIDS activists had earlier urged Ki-moon not to appoint Fedotov, pointing to Russia's abysmal record on human rights, the treatment of drug users, and HIV/AIDS prevention. But on Monday, the International Harm Reduction Association told the Associated Press it was willing to give Fedotov a chance based on his early remarks.

"We certainly hope this sets the benchmark for the path he'll be taking," said the association's executive director Rick Lines. "For any public official, they're going to be judged by what they do with the responsibility they're given."

Vienna
Austria

UNODC: The Russians Are Coming

[Update, 6:20pm EST: Peter Sarosi at HCLU just told me Ban Ki-moon has indeed picked Fedotov. Hence I have removed the question mark from the end of the title of this article. :( - DB]

Current head of the UN Office on Drugs and Crime (UNODC) Antonio Maria Costa is set to end his 10-year term at the end of this month, and according to at least one published report, a Russian diplomat has emerged as the frontrunner in the race to replace him. That is causing shivers in some sectors of the drug reform community because the Russians are viewed as quite retrograde in their drug policy positions.

The report names Russia's current ambassador to the United Kingdom, Yuri Fedotov, as the top candidate to oversee UNODC and its $250 million annual budget. Other short-listed candidates include Spanish lawyer Carlos Castresana, who headed a UN anti-crime commission in Guatemala, Colombian Ambassador to the European Union Carlos Holmes Trujillo, and Brazilian attorney Pedro Abramovay. The final decision is up to UN Secretary General Ban Ki-moon.

If Fedotov wins the position, Russia would be in a far more influential position to influence international drug policy, and that is raising concerns because of Russia's increasingly shrill demands that the US and NATO return to opium eradication in Afghanistan, its refusal to allow methadone maintenance and its refusal to fund needle exchange programs even as it confronts fast-growing heroin addiction and HIV infection rates.

The concerns have crystallized in a campaign to block his appointment, including a Facebook group called We Don't Want A Russian UN Drug Czar!, which is urging people to send an email message to that effect to Secretary General Ki-moon. Group organizers the Hungarian Civil Liberties Union have also produced a video on the subject:

Europe: Norwegian Committee Calls for Heroin Prescription Trials, Harm Reduction Measures

A blue-ribbon committee in Norway has called for heroin prescription trials and expanded harm reduction measures, such as expanding safe injection sites. The Stoltenberg Committee presented its findings in a 49-page report (sorry, Norwegian only) issued last month.

http://stopthedrugwar.org/files/norwegianfjord.jpg
Norwegian fjord (courtesy Erik A. Drabløs via wikimedia.org)
The committee was created last year by then Health Minister Bjarne Hakon Hanssen to review the situation of hard drug users in Norway. It was tasked in particular with evaluating whether the government should allow a trial heroin prescription program because the notion was so controversial in Norway. The committee did not address soft drug use.

Committee head Thorvald Stoltenberg is a well-known and well-respected political figure in Norway, having served in the past as foreign minister. He is the father of the current prime minister. He is also the father of an adult daughter who is a former heroin addict.

Current Health Minister Anna-Greta Strom-Erichsen agreed with the committee's call for more harm reduction and expanded treatment services, but wasn't ready to sign off on prescribed heroin just yet.

"I agree with the committee that services for the most vulnerable drug addicts must be better," she said in a press release. "The committee wants greater degree of coordination of services. This is a task that is central to the work of collaborative reform, which is especially important for people with drug problems," she added.

But heroin prescribing is "a difficult question" on which the government must move carefully, Strom-Erichsen said. "The government has not reached a conclusion on the question of heroin assisted treatment. Regardless of the conclusion to this question, there is a need for an intensified effort for people with drug problems, including medical treatment, "she said.

The committee report will now form the basis for a broad dialog on its recommendations among government officials, local officials, drug users, relatives, and other interested parties. After that, the Health Ministry will send a proposal to parliament.

While the committee report is quite moderate by international standards, it represents a major break from traditional Norwegian responses to hard drug use and an embrace of the harm reduction philosophy.

Prosecution: Kentucky Supreme Court Rules Pregnant Women Cannot Be Criminalized for Drug Use

Women who take illegal drugs while pregnant cannot be charged with child endangerment crimes for doing so, the Kentucky Supreme Court ruled last Friday. The court held that such prosecutions are unlawful under the state's Maternal Health Act of 1992, which expressly forbids charging women with a crime if they drink or do drugs during pregnancy.

The case is Cochran v. Kentucky, in which Casey County prosecutors charged Ina Cochran with first-degree wanton endangerment after she gave birth to a child who tested positive for cocaine in 2005. Cochran's attorney moved to have the charges dismissed, and a Casey Circuit Court judge agreed, but prosecutors appealed to the state Court of Appeals, which held that the charges could be allowed.

The state Supreme Court overturned the Court of Appeals ruling, arguing that the appeals court had erred both because its decision was intolerably vague and because the Kentucky legislature had expressly held that pregnant women were not to be prosecuted for drug use. "It is the legislature, not the judiciary, that has the power to designate what is a crime," the opinion said.

In passing the Maternal Health Act of 1992, the legislature explicitly stated that "punitive actions taken against pregnant alcohol or substance abusers would create additional problems, including discouraging these individuals from seeking the essential prenatal care."

The high court cited a similar earlier case it had decided, and that quotation is worth repeating:

"The mother was a drug addict. But, for that matter, she could have been a pregnant alcoholic, causing fetal alcohol syndrome; or she could have been addicted to self abuse by smoking, or by abusing prescription painkillers, or over-the-counter medicine; or for that matter she could have been addicted to downhill skiing or some other sport creating serious risk of prenatal injury, risk which the mother wantonly disregarded as a matter of self-indulgence. What if a pregnant woman drives over the speed limit, or as a matter of vanity doesn't wear the prescription lenses she knows she needs to see the dangers of the road?

"The defense asks where do we draw the line on self-abuse by a pregnant woman that wantonly exposes to risk her unborn baby? The Commonwealth replies that the General Assembly probably intended to draw the line at conduct that qualifies as criminal, and then leave it to the prosecutor to decide when such conduct should be prosecuted as child abuse in addition to the crime actually committed.

"However, it is inflicting intentional or wanton injury upon the child that makes the conduct criminal under the child abuse statutes, not the criminality of the conduct per se. The Commonwealth's approach would exclude alcohol abuse, however devastating to the baby in the womb, unless the Commonwealth could prove an act of drunk driving; but it is the mother's alcoholism, not the act of driving that causes the fetal alcohol syndrome. The 'case-by-case' approach suggested by the Commonwealth is so arbitrary that, if the criminal child abuse statutes are construed to support it, the statutes transgress reasonably identifiable limits; they lack fair notice and violate constitutional due process limits against statutory vagueness."

Somebody ought to tell them in South Carolina, where the courts have upheld the prosecution and imprisonment of pregnant women who used drugs.

Drug War Issues

Criminal JusticeAsset Forfeiture, Collateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Court Rulings, Drug Courts, Due Process, Felony Disenfranchisement, Incarceration, Policing (2011 Drug War Killings, 2012 Drug War Killings, 2013 Drug War Killings, 2014 Drug War Killings, 2015 Drug War Killings, 2016 Drug War Killings, Arrests, Eradication, Informants, Interdiction, Lowest Priority Policies, Police Corruption, Police Raids, Profiling, Search and Seizure, SWAT/Paramilitarization, Task Forces, Undercover Work), Probation or Parole, Prosecution, Reentry/Rehabilitation, Sentencing (Alternatives to Incarceration, Clemency and Pardon, Crack/Powder Cocaine Disparity, Death Penalty, Decriminalization, Defelonization, Drug Free Zones, Mandatory Minimums, Rockefeller Drug Laws, Sentencing Guidelines)CultureArt, Celebrities, Counter-Culture, Music, Poetry/Literature, Television, TheaterDrug UseParaphernalia, ViolenceIntersecting IssuesCollateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Violence, Border, Budgets/Taxes/Economics, Business, Civil Rights, Driving, Economics, Education (College Aid), Employment, Environment, Families, Free Speech, Gun Policy, Human Rights, Immigration, Militarization, Money Laundering, Pregnancy, Privacy (Search and Seizure, Drug Testing), Race, Religion, Science, Sports, Women's IssuesMarijuana PolicyGateway Theory, Hemp, Marijuana -- Personal Use, Marijuana Industry, Medical MarijuanaMedicineMedical Marijuana, Science of Drugs, Under-treatment of PainPublic HealthAddiction, Addiction Treatment (Science of Drugs), Drug Education, Drug Prevention, Drug-Related AIDS/HIV or Hepatitis C, Harm Reduction (Methadone & Other Opiate Maintenance, Needle Exchange, Overdose Prevention, Safe Injection Sites)Source and Transit CountriesAndean Drug War, Coca, Hashish, Mexican Drug War, Opium ProductionSpecific DrugsAlcohol, Ayahuasca, Cocaine (Crack Cocaine), Ecstasy, Heroin, Ibogaine, ketamine, Khat, Kratom, Marijuana (Gateway Theory, Marijuana -- Personal Use, Medical Marijuana, Hashish), Methamphetamine, New Synthetic Drugs (Synthetic Cannabinoids, Synthetic Stimulants), Nicotine, Prescription Opiates (Fentanyl, Oxycontin), Psychedelics (LSD, Mescaline, Peyote, Salvia Divinorum)YouthGrade School, Post-Secondary School, Raves, Secondary School