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Chronicle AM -- August 15, 2014

The California legislature acts on harm reduction, but kills medical marijuana regulation, Jeb Bush takes a stand on medical marijuana, New Hampshire bans a kind of synthetic cannabinoid, and more. Let's get to it:

Jeb Bush comes out against Florida's medical marijuana initiative. (wikipedia/gage skidmore)
Medical Marijuana

California Medical Marijuana Statewide Regulation Bill Dies. A controversial bill that would have imposed statewide regulations on California's multi-billion dollar medical marijuana industry died yesterday in Sacramento. The bill, Senate Bill 1262, was blocked by the Assembly Appropriations Committee, and the effort to impose some order on the industry is now dead for another year. The bill sponsored by Sen. Lou Correa (D-Santa Ana) was supported by law enforcement and the state's municipalities, as well as by some elements of the state's medical marijuana community. But it was also strongly opposed by other elements of the medical marijuana and drug reform communities.

Jeb Bush Joins Opposition to Florida Medical Marijuana Initiative. Former Republican state governor and potential 2016 presidential candidate Jeb Bush has come out against Amendment 2, the state's medical marijuana initiative. "Florida leaders and citizens have worked for years to make the Sunshine State a world-class location to start or run a business, a family-friendly destination for tourism and a desirable place to raise a family or retire," Bush said. "Allowing large-scale, marijuana operations to take root across Florida, under the guise of using it for medicinal purposes, runs counter to all of these efforts," he added. Bush appears to be out of step with Florida voters, who are supporting the measure in the 85-90% range, according to recent polls.

Harm Reduction

Overdose Prevention, Syringe Access Bills Pass in California. Two harm reduction bills, one allowing pharmacists to dispense unlimited numbers of syringes without a prescription and the other allowing them to dispense the overdose drug naloxone, have passed the California legislature. The bills are Assembly Bill 1535 (syringes) and Assembly Bill 1743 (naloxone). They now go to the desk of Gov. Jerry Brown.

New Synthetic Drugs

New Hampshire Declares State of Emergency Over "Smacked" Synthetic Marijuana. Gov. Maggie Hassan (D) yesterday declared a state of emergency to quarantine a synthetic cannabinoid product marketed under the name "Smacked." Her action comes after 44 people reported overdosing on the stuff after smoking or ingesting it. No deaths have been reported. Officials have revoked the business licenses of three Manchester stores where the stuff has been found.

International

BC Court Rules Ban on Medical Marijuana Edibles Unconstitutional. The BC Court of Appeals ruled yesterday that it is unconstitutional to ban licensed medical marijuana users from possessing medical marijuana edibles or other products, such as creams or salves. The court ordered parliament to redraft the Controlled Drugs and Substances Act to allow for such uses of medical marijuana. The case is Regina v. Owen Smith.

Colombian President Endorses Medical Marijuana Bill. President Juan Manuel Santos said Thursday he was endorsing newly introduced legislation to allow for the medicinal use of marijuana. The bill was introduced last month by a member of the governing coalition.

WOLA Brief on Ecuador Drug Policy. The Washington Office on Latin America (WOLA) has released an issue brief, "Reforms and Contradictions in Ecuador's Drug Policy." The brief comes as a sweeping new penal code reflecting some drug reforms goes into effect and examines the complexities and contradictions of implementing the new law.

Harm Reduction Measures Pass in California

With the Golden State's legislative clock ticking down toward session's end, two harm reduction measures have been approved this week. One would expand access to sterile syringes; the other would expand access to the overdose prevention drug naloxone.

Yesterday, the Assembly gave final approval to Assembly Bill 1743, sponsored by Assemblymember Phil Ting (D-San Francisco), which would allow pharmacies to sell an unlimited amount of syringes without a prescription. The bill has already passed the Senate and came back to the Assembly for a final concurrence vote.

"Syringes can be bought over the counter in nearly every state because the policy saves lives without taxpayer expense," said Ting. "Mountains of research and the medical community stand squarely behind this bill. We are not innovating, we are playing catch up. By signing the bill, the Governor can put California in step with the rest of the nation."

"This bill is an exciting breakthrough," said Laura Thomas, Deputy State Director for the Drug Policy Alliance. "Pharmacy syringe access is a proven and cost-effective way to save lives by reducing the spread of HIV and hepatitis. It has taken years of advocacy to receive such strong support for sterile syringe access inside the State Capitol."

Under a current law that expires at the end of this year, pharmacies can sell up to 30 syringes without a prescription. Without passage of a new syringe access law, only pharmacists in the 15 counties and 4 cities that have declared injection drug-related public health emergencies would be able to continue dispensing syringes without a prescription.

Also yesterday, the Assembly gave final approval to Assembly Bill 1535, sponsored by Assemblymember Richard Bloom (D-Los Angeles). The bill would allow pharmacists to provide naloxone without a prescription. The measure had already passed both houses and came back to the Assembly for a final concurrence vote.

"The bipartisan support of the legislature is gratifying and will directly help many California families," said Assemblymember Bloom (D-Santa Monica). "As the bill heads to the Governor's desk, I am committed to continuing our efforts to stop the epidemic of overdose deaths."

"This bill reaching the Governor is a triumph for all Californians who love someone at risk of an overdose," said Meghan Ralston, Harm Reduction Manager for bill cosponsor the Drug Policy Alliance. "California has thousands of pharmacies, and lives can be lost in the minutes waiting for a police officer or ambulance to arrive with naloxone to reverse an overdose. This would make it easier for caregivers and family members to keep naloxone on hand for use in those critical moments."

Both bills now go to the desk of Gov. Jerry Brown (D).

Sacramento, CA
United States

Chronicle AM -- July 21, 2014

The World Health Organization calls for drug decriminalization (and more), international drug reform and harm reduction groups warn of an AIDS prevention crisis, marijuana policy is popping up in some Republican primaries, and more. Let's get to it:

Times are changing when marijuana legalization becomes an issue in Republican primaries. (wikimedia.org)
Marijuana Policy

MPP Urges Votes for Bob Barr in Georgia Republican Congressional Primary Tomorrow. The Marijuana Policy Project is calling on its Georgia supporters to get out and vote for Republican congressional candidate Bob Barr in the primary tomorrow in the state's 11th congressional district. Barr made a reputation in the 1990s as an arch-drug warrior, but has since become a staunch supporter of drug policy reform and civil liberties.

Kansas GOP Gubernatorial Candidate Challenges Incumbent With Platform That Includes Legalizing Marijuana. Gov. Sam Brownback (R) is facing a long-shot challenge from Jennifer Winn, a small businesswoman whose son is facing a murder charge over a marijuana deal gone bad. She says she entered the race out of anger over that, and her platform includes legalizing marijuana and industrial hemp, as well as a broader call for drug policy reform. Her race is being watched as a sign of how damaged the state GOP is after years of Brownback's ultraconservative social and economic policies.

Washington State Rang Up $1.2 Million in Marijuana Sales in First Week. Only a handful of stores were actually open and supplies were limited, but the first week of legal marijuana sales in Washington still generated more than $1.2 million in sales, according to the state Liquor Control Board. It also generated $318,043 in taxes collected so far.

Despite Philadelphia City Council's Decriminalization Vote, Marijuana Possession Arrests Continue. Last month, the city council voted to decriminalize possession of up to an ounce, but Mayor Michael Nutter opposes the bill, and Police Chief Charles Ramsey vowed to continue marijuana possession arrests. He's lived up to his word. Since the bill was passed, 246 people have been arrested for pot possession, 140 of them charged only with pot possession. Of the 124 people charged with additional crimes, the vast majority were only drug charges. Mayor Nutter has until September to act on the decriminalization bill. He can sign it, veto it, or do nothing, in which case it becomes law without his signature.

Medical Marijuana

Illinois Governor Signs Bill to Expand Access to Medical Marijuana. Gov. Pat Quinn (D) yesterday signed into law a bill that will expand the state's medical marijuana program by allowing people with seizure disorders to use it and by allowing minors to participate in it with parental consent. The measure is Senate Bill 2636.

New Mexico Backs Off on Medical Marijuana Program Changes. The state Department of Health announced last Thursday that it will not move forward with proposed rule changes that included limiting the number of plants patients could grow and requiring criminal background checks for patient growers. The department said there will likely be another hearing for public comments before new rules are finalized this fall.

Psychedelics

Memorial Event for Sasha Shulgin in Berkeley Next Month. The psychonauts at Erowid are hosting a memorial and community gathering in Berkeley next month to honor the memory of Dr. Alexander "Sasha" Shulgin, the legendary scientist of psychedelics who died early last month. Please RSVP if you are planning to attend; click on the link to do so.

Drug Policy

World Health Organization Calls for Drug Decriminalization, Broad Drug Policy Reforms. In a report on HIV treatment and prevention released earlier this month, the World Health Organization quietly called for drug decriminalization, needle exchanges, and opiate substitution therapy. The WHO's positions are based on concerns for public health and human rights.

Drug Testing

Mississippi Public Hearing on Welfare Drug Test Law Tomorrow. The Department of Human Services is holding a hearing tomorrow in Jackson to hear public comment on a new welfare drug testing law that was supposed to have gone into effect July 1. It was delayed to allow for a public hearing. The law is opposed by the ACLU and racial and social justice activists. Click on the link for time and location details.

Harm Reduction

Drug Reform and AIDS Groups Warn of "Global Crisis" in HIV Prevention Funding, Especially for Injection Drug Users. As the 20th International AIDS Conference gets underway in Melbourne, Australia, three drug reform, harm reduction, and AIDS groups have issued a report, The Funding Crisis for Harm Reduction, warning that because of donor fatigue, changing government policies, and an over-reliance on drug law enforcement, the goal of an "AIDS-free generation" risks slipping away. The three groups are Harm Reduction International, the International Drug Policy Consortium, and the International HIV/AIDS Alliance.

Law Enforcement

In Forsythe County, North Carolina, Majority of SWAT Deployments are For Drug Raids. SWAT teams were designed to be used in extreme situations -- hostage-taking events, terrorist attacks, and the like -- but have been subject to mission creep over the years. Forsythe County is one example. In an in-depth report, the Winston-Salem Journal found that the Forsythe County SWAT team had been deployed 12 times in the past year and the Winston-Salem Police SWAT team had been deployed 40 days in the past year "mostly to execute search warrants for drugs."

International

Report on Illicit Drug Corridors Between Bolivia and Peru Published. In a report based on on-the-scene investigation, the Bolivian NGO Puente Investigacion y Enlace (PIE), led by former human rights ombudsman Godo Reinicke, has studied the drug and precursor chemical networks straddling the Peru-Bolivia border. Read the report, Corredores ilicitos entre Boliva-Peru, ¿Rutas escondidas y extrañas? in Spanish, or click on your translate button.

(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.)

The 2014 National Drug Control Strategy: Baby Steps in the Right Direction [FEATURE]

The White House Office of National Drug Control Policy (ONDCP -- the drug czar's office) released its 2014 National Drug Control Strategy Wednesday. While in general, it is remarkable for its similarities to drug control strategies going back more than a decade, it does include some signals suggesting that the Obama administration is ready for a shift in emphasis in the drug war -- from a criminal justice approach to a more public health-oriented approach.

But even that rhetorical positioning is somewhat undercut by the strategy's continuing commitment to the criminalization of drug users and the people who supply them, as well as particular policy prescriptions, such as its support for expansion of drug courts -- the use of the criminal justice system to enforce therapeutic health goals like abstinence from drug use, as opposed to measures that don't involve criminal justice intervention.

The 2014 strategy also continues the roughly 3:2 funding ratio between law enforcement and treatment and prevention spending that has marked federal anti-drug spending since at least the Clinton administration in the 1990s. And it does so somewhat deceptively.

"In support of this Strategy," ONDCP wrote in a press release, "the President has requested $25.5 billion in Fiscal Year 2015. Federal funding for public health programs that address substance use has increased every year, and the portion of the Nation's drug budget spent on drug treatment and prevention efforts -- 43% -- has grown to its highest level in over 12 years. The $10.9 billion request for treatment and prevention is now nearly 20% higher than the $9.2 billion requested for Federally-funded domestic drug law enforcement and incarceration."

What the press release doesn't mention when claiming that treatment and prevention spending now exceeds spending on law enforcement is that it did not include figures for drug interdiction and international spending on the law enforcement side of the ledger. The White House's proposed federal drug budget for 2015, however, shows that those drug prohibition-enforcement costs add up to another $5.4 billion, or $14.6 billion for enforcing drug prohibition versus $10.9 billion for treatment and prevention.

The strategy does, however, provide a sharper focus than in the past on reducing the harms associated with drug use, such as overdoses and the spread of HIV/AIDS, hepatitis C, and other blood-borne diseases. It calls for greater access to the opiate overdose reversal drug naloxone and supports needle exchange and state laws that provide limited immunity from prosecution for people suffering overdoses and the people who seek help for them -- the so-called 911 Good Samaritan laws. The strategy also sets a five-year goal for reducing overdose deaths, something drug reform advocates had been seeking.

The strategy also acknowledges the need to reduce mandatory minimum drug sentencing and recognizes that the US has the world's largest prison population, but in absolute terms and per capita. And, implicitly acknowledging that Americans increasingly see the war on drugs as a failed policy, the 2014 strategy has adjusted its rhetoric to emphasize public health over the drug war.

Acting ONDCP head or "drug czar" Michael Botticelli (ONDCP)
But, despite polls now consistently showing majority support for marijuana legalization, and despite the reality of legal marijuana in two states, with two more and the District of Columbia likely to embrace it later this year, the 2014 strategy appears not only wedded to marijuana prohibition, but even disturbed that Americans now think pot is safer than booze.

That puts ONDCP at odds not only with the American public, but with the president. In an interview published in January by the New Yorker, Obama said marijuana is less dangerous than alcohol "in terms of its impact on the individual consumer."

Noting that about three-quarters of a million people are arrested on marijuana charges each year, and nearly nine out of ten of those for simple possession, the Marijuana Policy Project (MPP) pronounced itself unimpressed with the new national drug strategy.

The drug czar's office is still tone deaf when it comes to marijuana policy. It appears to be addicted to marijuana prohibition. Why stay the course when the current policy has utterly failed to accomplish its goals?" asked MPP communications director Mason Tvert.

"The strategy even goes so far as to lament the public's growing recognition that marijuana is not as harmful as we were once led to believe. President Obama finally acknowledged the fact that marijuana is less harmful than alcohol, yet his administration is going to maintain a policy of punishing adults who make the safer choice," Tvert continued. "Most Americans think marijuana should be made legal, and even the Justice Department has acknowledged that regulating marijuana could be a better approach than prohibition. Legalizing and regulating marijuana is not a panacea, but it is sound policy."

The Drug Policy Alliance (DPA), with a wider policy remit than MPP, had a nuanced response to the release of the drug strategy. It was critical of some aspects of the strategy, but had kind words for others.

"The administration says drug use is a health issue but then advocates for policies that put people in the criminal justice system," said Bill Piper, DPA national affairs director. "Until the drug czar says it is time to stop arresting people for drug use, he is not treating drug use as a health issue no matter what he says. I know of no other health issue in which people are thrown in jail if they don't get better."

Still, said Piper, the drug czar's office deserves some credit for addressing serious issues associated with drug use under prohibition.

"Director Botticelli should be applauded for taking strong steps to reduce drug overdose fatalities and the spread of HIV/AIDS, hepatitis C and other infectious diseases," he said. "His leadership on these issues, and his work overall to reduce the stigma associated with substance misuse, are encouraging."

But when it comes to marijuana policy, DPA found itself pretty much on the same page as MPP.

"The Administration continues to keep its head in the sand when it comes to marijuana law reform," said Piper. "Hundreds of thousands of Americans are being arrested each year for nothing more than possessing small amounts of marijuana for personal use. Once arrested they can be discriminated against in employment and housing for life. The administration can't ignore the destructive impact of mass arrests forever."

Washington, DC
United States

There's More to Colorado Than Marijuana [FEATURE]

Colorado has certainly garnered a lot of attention since voters there decided to legalize marijuana in the 2012 election, but when it comes to drug reform, there's a lot more going on in the Rocky Mountain State than just buds, blunts, and bongs. In the past few years, Colorado has taken significant steps toward more enlightened drug policies, and with the powerful coalitions that have emerged to push the agenda, more is likely to come.

Passed last year while all the attention was on the legislature's race to get marijuana commerce regulations passed, the single most significant piece of broader drug reform legislation was Senate Bill 250, which aims to rein in and redirect corrections spending by reducing the number of drug offenders in prison.

The bill creates a separate sentencing system for drug offenders and allows people convicted of some felony drug charges to be sentenced to probation and community-based sentencing and see that felony charge changed to a misdemeanor conviction upon completion of probation. It allow provides that savings from the sentencing changes be plowed back into drug treatment.

The bill didn't come out of nowhere. It was the outgrowth of a 2008 law that created the Colorado Commission on Criminal and Juvenile Justice. That panel brought together in one effort the heads of all the relevant state agencies as they grappled with how to reduce recidivism and put a brake on prison spending. It also provided an opportunity for groups like the Colorado Criminal Justice Reform Coalition (CCJRC) to start confronting the commission with research-based evidence about what does and doesn't work.

"There is a lot of good evidence-based practice that shows what we did in the past didn't work, and a lot of it had to do with national attention," said Pam Clifton, communications coordinator for the CCJRC. "People were asking 'How come half your people are going back to prison?' Well, we didn't have funding for treatment in Colorado. If you didn't have any money, there wasn't any place for you to go. Another problem was helping people on the front end. How can we be more proactive with people on probation? The recession gave us a little bit of leverage."

But to get sentencing and drug reforms passed required not just a commission to come up with best policies and practices, but a political leadership that was willing to act. That came in 2008, when Colorado turned from red to blue, with a new Democratic governor, Bill Ritter, and Democrats in control of the legislature.

"When Bill Owens (R) was governor, he wasn't going to let anything happen," said Clifton. "But with the commission, a lot of conversations got started and we were able to educate about why change was needed, so when we had a change in leadership, there was a mandate from the commission to get good legislation passed. A lot of the recommendations the commission made went directly to the legislature, and when a bill showed up from the commission, it had a better opportunity to survive the process."

And while, as noted above, the legislature has passed other reforms, Senate Bill 250 was the biggie.

"That was the landmark legislation that really changes things," said Clifton. "This was the whole state -- prosecutors, defense counsel, the commission, us -- coming together and agreeing it was the right approach."

The bill only went into effect last October, so its results remain to be seen. But advocates are confident it has not only changed the conversation about drugs and sentencing, but that it will pay off in terms of fewer prisoners doing less time at less cost to the state -- and with less harm to the futures of drug offenders in the state.

Even the prisons are scenic in Colorado, although it is hoped that fewer prisoners will be forced to enjoy the view soon. (CDOC)
"It's too early to tell what impact Senate Bill 250 will have," said Art Way, Colorado manager for the Drug Policy Alliance. "It was definitely a step in the right direction, though. It shrank the number of felony degrees for drug charges from six to four, and now, many low-level drug felonies can wobble down to misdemeanors thanks to that bill. It's not true defelonization of use and possession, but it still gives defendants some opportunities to avoid the label of felons."

And the CCJRC deserves some major credit, he said.

"The CCJRC has been doing great work in the past decade revealing that we are on an unsustainable path," said Way. "The Department of Corrections budget was only increasing year after year, and they were able to make this a fiscal argument as well as a human argument. They've been at the forefront here."

Another front where Colorado is forging ahead is harm reduction. Needle exchange programs were legalized in 2010 and there are now six across the state, the state passed a 911 Good Samaritan law in 2012, and a law allowing friends and family members of injection drug users to carry and administer the overdose reversal drug naloxone (Narcan) passed last year.

Activists have also managed to push through laws exempting needle exchange participants from the state's drug paraphernalia laws, and in Denver, an ordinance last year allowed the first mobile needle exchange in the state.

"We've been really excited, not only about all these programs, but also about getting these policy wins," said Lisa Raville of the Denver-based Harm Reduction Action Center. "Every time we go to the capitol, we've been winning. The legislature is very excited about harm reduction."

After passing Senate Bill 250, this year was relatively quiet on the sentencing and drug reform front. There are a number of reasons for that, some of them having to do with gauging public (and legislative) attitudes in the wake of a well-publicized violent crime, the killing of state prison chief Tom Clements by a parolee.

"Our corrections director was murdered last spring, and that caused a lot of ripples and made people at the capitol freak out a bit, so we wanted to tread lightly," said Clifton. "And things are really tricky in Colorado now," she added. "Elections are coming up, and everyone's concerned about what color we're going to be come November. Our elected officials are all being very cautious right now."

Like the CCJC, the harm reductionists were quiet in the legislature this year. It was a time for solidifying gains and getting previous victories implemented, Raville said.

Harm reduction measures in place in Colorado include needle exchanges and overdose reversal drug access. (wikimedia.org)
"This is an election year, and we knew they would be playing defense at the capitol," she said. "We decided this year would be all about promoting harm reduction policies and procedures. When we got those laws passed, we assumed that the legislature and the courts would implement them, but they didn't, so we spent the first six months promoting implementation, working with the legislature, as well as working with doctors and pharmacies so they know about these new laws."

But that doesn't mean the Harm Reduction Action Center is giving up on the legislature.

"Depending on how the election goes, our goal next year is total syringe decriminalization," said Raville. "We have the exemption for needle exchange participants, but there are still folks who won't ever access a needle exchange program, and we want them exempt as well. Now, you can get eight to 15 days in jail for every syringe, clean or used."

Raville pointed to the success of the North Carolina Harm Reduction Coalition in getting a similar measure passed last year in the last year in getting a similar measure passed in the Tar Heel State. That partial decriminalization bill allows people carrying needles to avoid arrest if they inform officers they are carrying them.

"Robert Childs and the NCHRC got that passed with the support of law enforcement, who didn't want to get pricked," she said. "That's inspired us to work closely with the Denver Police Department. We have two officers on our advisory board."

"We have an overdose issue here in Colorado," Raville noted. "ODs have tripled in the past 10 years, and we have a fatal overdose every day and a half in the state. Not many doctors are prescribing naloxone, but we've had 92 overdose reversals so far. And a couple of hospitals in Denver are discharging overdose patients with a prescription for naloxone. We're trying to make that the standard for hospitals across the state."

While it was relatively quiet this year in the legislature, activists had to play defense on one set of bills and managed to kill them. That was a pair of bills to amend the civil code for child neglect to explicitly include marijuana use as an indicator, even though the state has legalized both medical and recreational marijuana use and possession.

"Stopping that bill was our top concern this year," said Way. "We worried that amending the civil code the way those bills tried to do would simply help law enforcement during drug investigations by leveraging parental rights. This wasn't a public health approach; it was a law enforcement bill couched as a public health and child protection bill," he said.

"The bill's fiscal notes only involving increasing bed space for what they expected to an influx of people put in jail," he noted. "There was nothing about access to treatment or reunification with kids. It was a standard, punitive drug war approach to a public health issue, and we were able to kill it for the second year in a row."

The CCJRC, for its part, is continuing to push for reform. While it wasn't ready to share its strategic planning for the near future, Clifton did say that the group is working around implementation of the Affordable Care Act's provisions requiring insurance companies to cover drug treatment.

"We've convened a stakeholder group from around the state -- health care and criminal justice people -- to make sure they knew each other as a step toward successfully implementing the ACA, getting more people in treatment, and reducing the prison population. We're teaching people how to navigate the system and teaching the system how to help people navigate it," she said.

And while sentencing reform and harm reduction efforts in Colorado haven't, for the most part, been about marijuana, the whole opening on marijuana has given political and social space to drug reform efforts that go beyond pot.

"The conversation about marijuana has absolutely helped," said Raville. "We legalized it and the sky didn't fall. This has helped normalize pot and normalize drug use more broadly. And it's been a good opportunity to talk to people about how voting matters."

"Marijuana reform has helped legislators understand what we mean by a public health approach," said Way. "We hope to now be able to address drug policy on a broader level with the legislature."

But much of that will depend on what the makeup of the legislature looks like after November. Still, Colorado has shown what some persistence, some coalition-building, and some science, evidence, and compassion can accomplish.

CO
United States

Chronicle AM -- May 8, 2014

Another poll has marijuana legalization at the tipping point, a Colorado bill to form credit co-ops for pot businesses passes, an Illinois bill to let kids with epilepsy use medical marijuana is moving, a New York naloxone bill passes, Pittsburgh needle exchanges get some breathing room, and more. Let's get to it:

Pittsburgh needle exchanges get some breathing room. (wikimedia.org)
Marijuana Policy

Fairleigh Dickinson Poll Has 50% Support for Legalization. A new poll from Fairleigh Dickinson University has support for marijuana legalization at 50% nationwide. By a ratio of 2-to-1, Democrats (63%) favor legalization more than Republicans (32%), with independents (58%) more closely aligned with Democrats. Young people also are far more supportive of legalization, with 65% of the millennial generation and over half of Gen Xers (56%) in favor, compared with fewer than half (48%) of baby boomers and around a third (36%) of the World War II generation. "Democrats see getting high as a lifestyle choice, whereas Republicans are more likely to understand it through the prism of morality and social deviance," political science professor and poll director Krista Jenkins told the Associated Press. "However, the age differences we're seeing suggest that legal [marijuana] smoking in the future is more a question of 'when' rather than 'if.'"

Colorado Legislature Passes Marijuana Credit Co-op Bill. Legislation to create a state-backed credit co-op to provide banking services to Colorado's all-cash marijuana industry is on its way to the governor's desk. House Bill 1398, after a battle over whether or not to allow hemp businesses to take part, passed the full House on a 33-31 final vote after lawmakers there ended a standoff between various factions and the Capitol's two chambers by signing off on Senate changes to the bill, including allowing the inclusion of hemp businesses.

Medical Marijuana

Illinois Bill to Allow Children With Epilepsy to Use Medical Marijuana Wins Committee Vote. A measure that would allow children with epilepsy to use medical marijuana is moving. The House Rules Committee approved Senate Bill 2636 Wednesday on a 15-0 vote. The legislation would add epilepsy to the list of treatable diseases in the state's medical cannabis pilot program. It would also allow children with epilepsy to use medical cannabis. The bill has already passed the Senate and now heads for a House floor vote.

Drugged Driving

Michigan Drugged Driving Bills to Drop Roadside Saliva Tests. A provision pending in a pair of bills in the Michigan legislature that would let police give roadside saliva tests to drivers suspected of being under the influence of drugs will be removed from the legislation today, according to a cosponsor of the bill. Critics including researchers said the tests are inaccurate and could lead to inappropriate arrests of medical marijuana patients. Republican state Rep. Mike Callton said he plans to introduce an amendment removing the saliva testing provision at a House Judiciary Committee hearing Thursday. The bills are House Bill 5384 and House Bill 5385.

Drug Testing

Florida Governor Tries Again to Drug Test All Welfare Recipients. Gov. Rick Scott (R) is at it again. Weeks after the Supreme Court refused to hear his argument for why all state employees should have to pee in cups, Scott has filed a new brief in appellate court asking to re-argue his right to drug-test all welfare recipients in Florida. The plan was originally halted by court order in October 2011 while the ACLU challenged it, and the US District Court threw out the rule in December 2013 based on the arguments of a Navy veteran who said it violated his right against unreasonable search and seizure. But now Scott is back in appeals court, arguing in the new brief that there is a "demonstrated problem with drug use" among welfare recipients. Except there isn't: More than 4,000 people were tested while the program was in place, and a grand total of 108 failed. That's less than 3%.

Prescription Opioids

Massachusetts Medical Society Warns Don't Forget Pain Patients in Battle Against Prescription Drug Abuse. Policymakers "need to balance the needs of legitimate patients with pain, against the dangers to the public of opiates being in circulation," the Massachusetts Medical Society said in a statement delivered to the state's Senate Special Committee on Drug Abuse and Treatment Options Tuesday. "It is critical that we not forget the needs of our patients in pain to comprehensive medical care that effectively helps them to have the best quality of life that their disease or diagnosis will allow," the doctors' group emphasized.

Law Enforcement

Detroit Mass Drug Sweeps Continue. Authorities are conducting a narcotics blitz and warrant sweep Thursday afternoon on the city's west side as part of the eighth and latest high-profile police raid. They're part of an ongoing police offensive called Operation Restore Order. In March, two crime-ridden neighborhoods were flooded as part of Operation Restore Order March Madness, which targeted problematic areas in the Ninth and Sixth precincts, on the city's east and west sides, respectively. The first Operation Restore Order raid came in November, when officers flooded the high-crime Colony Arms Apartments on Jefferson. Since then, there have been raids of the Martin Luther King Apartments, a 1.2 square-mile area of the west side known for heavy drug dealing, and warrant sweeps in the Fifth, Sixth, Eighth and Ninth Precincts. It's not clear yet whether order has actually been restored.

Harm Reduction

New York Bill to Expand Overdose Reversal Drug Access to Friends, Family Members Passes Legislature. State lawmakers have passed a bill expanding access to the drug naloxone (Narcan), which can reverse an overdose of opioids such as heroin and morphine. Assembly Bill 8637 would allow health care professionals and pharmacies to distribute Narcan, without a prescription, to at-risk people and those who know them. It was unclear late Wednesday whether Gov. Andrew Cuomo intends to sign the bill into law.

Pittsburgh Needle Exchanges Get Some Breathing Room. The Allegheny County Board of Health unanimously passed a motion that will lift location restrictions for needle exchange programs within the city of Pittsburgh. The previous regulation banned needle exchanges within 1,500 feet of schools, daycare centers and drug treatment centers. But that proved far too restrictive for the densely populated city of Pittsburgh, where needle exchanges would have few places to operate. The motion passed today would lift that restriction, though city council would still have to approve new needle exchange locations. The location restriction remains the same in the rest of the county.

International

US Will Cut Off Anti-Drug Assistance to Ecuador. The United States will end decades of anti-drug trafficking assistance to Ecuador this month, pulling its staff from the INL office in the South American nation, a top official said Wednesday. "I am quite prepared to acknowledge right now the INL section, which has been in Ecuador now for more than 30 years, is also going to close up shop," Ambassador William Brownfield, Assistant Secretary of State for International Narcotics and Law Enforcement Affairs (INL), told a congressional hearing. Brownfield said the move was a reflection of the level of cooperation the United States has right now from Ecuador.

South Australian Politicians Compete to See Who Can Be Toughest on Drugs. It seems so last century, but "tough on drugs" is the stance of the day in South Australia. Opposition politicians are seeking a three-strikes policy under which repeat drug offenders would not be offered diversion to counseling, while state Attorney General John Rau is renewing his own push to crack down on serious drug offenders, including measures to strip them of their assets regardless of whether they were proceeds of crime. Legislation is pending.

Chief Minister Says Isle of Man Should Consider Marijuana Decriminalization. The Chief Minister of the Isle of Man has said the island should consider decriminalizing cannabis. Allan Bell's comments followed a presentation on the island given by former Westminster drug policy advisor David Nutt, whom the Labor government fired after he criticized its move to increase penalties. Bell praised Nutt's "fresh perspective," saying "there is a consensus developing internationally now that the old-style war on drugs has failed miserably and there needs to be a new approach." Bell cited marijuana legalization in the US and Uruguay as examples of nations taking a positive approach to drug policy.

Crisis Looms for Addicts as Russia Bans Methadone in Crimea

Things are about to get harder for opiate users in Crimea, the former Ukrainian province now annexed by Russia. While Ukraine has embraced a harm reduction approach to hard drug use, Russia rejects such an approach and has some of the most repressive drug laws in the world.

Oberleitungsbusbahnhof in Simferopol (user Cmapm via Wikimedia)
Russia does not support efficient programs for preventing HIV and Hepatitis C among its drug using population, and harm reduction measures like needle exchanges and opiate substitution therapy (OST), of which methadone maintenance is a subset, are illegal.

Now, the concrete consequences of Crimea's reincorporation into the ample bosom of Mother Russia are coming home for drug users there. On Wednesday, Russian "drug czar" Viktor Ivanov -- one of 31 allies of Pres. Vladimir Putin sanctioned by the US government this month -- announced that Russia will ban the use of methadone in Crimea. That comes after vows a week before that he would move away from harm reduction practices in general in Crimea.

"Methadone is not a cure," Ivanov claimed. "Practically all methadone supplies in Ukraine were circulating on the secondary market and distributed as a narcotic drug in the absence of proper control. As a result, it spread to the shadow market and traded there at much higher prices. It became a source of criminal incomes," he said.

Whatever Ivanov says, cutting off methadone for an estimated 800 patients will be a disaster, the International HIV/AIDS Alliance warned. And the threat of a broader rejection of harm reduction measures puts an estimated 14,000 Crimean injection drug users at risk.

"When the supply of these medicines is interrupted or stopped, a medical emergency will ensue as hundreds of OST patients go into withdrawal, which will inevitably lead to a drastic increase in both acute illness as well as increases in injecting as people seek to self-medicate," said the alliance's Ukraine director, Andriy Klepikov.

"Any interruption to harm reduction programming is a disaster for health, human rights and the HIV epidemic in the region and we urge the authorities in Crimea to step in and ensure that critical supply chains are not disrupted and lives not put at risk as a result of territorial politicking," Klepikov added.

Ukraine has practiced methadone maintenance (or OST) therapy in Crimea since 2005. Patients in Simferopol, Sevastopol, Yalta, Eupatoria, Feodosia, Kerch and other cities receive daily treatment at local healthcare facilities.

The AIDS alliance is not the only group raising the alarm. The International Network of People who Use Drugs (INPUD) has issued an urgent appeal to UN rapporteurs on the Crimea "calling upon you all to issue a public statement making clear the imminent risk that this population faces of losing access to essential medicines, we are requesting that you raise the issue with the Russian government urging them not to close down the currently running opiate substitution programs; and we are calling upon you to raise the issue with utmost urgency with the Human Rights Council with a view to ensuring continued access to the programs."

When it comes to drug policy and harm reduction, Crimea would seem to be worse off as part of Russia than as part of Ukraine. As the AIDS alliance's Klepikov put it:

"The Russian Federation has extremely repressive drug laws and its punitive approach to people who use drugs means that it now experiences one of the highest rates of new HIV infections in the world. Injecting drug users represent nearly 80% of all HIV cases in the country."

Russia

Chronicle AM -- February 26, 2014

A Maryland police chief embarrasses himself with bogus marijuana death claims, welfare drug testing bills face challenges in the Deep South, a hemp bill advances in Indiana, Russia's drug czar says "nyet" to legalization, and more. Let's get to it:

Marijuana Policy

Maryland Decriminalization, Legalization Bills Get Hearing; Police Chief Cites Hoax Story About Pot Overdose Deaths. Sen. Robert Zirkin's (D-Baltimore) Senate Bill 364, which would decriminalize marijuana possession, and Sen. Jamie Raskin's (D-Montgomery County) Senate Bill 658, which would legalize marijuana, got hearings in the Senate Judiciary Committee Tuesday. Law enforcement opposed the bills, while leaders of the ACLU and NORML members supported it. The lowlight of the hearing was Annapolis Police Chief Michael Pristoop's testimony mentioning an article about 37 overdose deaths the day marijuana became legal in Colorado. After being called out for repeating the hoax story by Sen. Raskin, Pristoop quickly backtracked.

Iowa Semi-Decriminalization Bill Introduced. A bill that would remove the possibility of jail time for possession of less than an ounce and a half of marijuana has been introduced by Rep. Bruce Hunter (D-Des Moines). It's not a true decriminalization bill because it would keep simple possession as a misdemeanor offense. House File 2313 has been referred to the House Judiciary Committee. Click on the link to read the bill.

Texas Poll Finds Near Majority for Legalization. Almost half -- 49% -- of Texans surveyed in a University of Texas/Texas Tribune poll support legalizing weed in either small quantities (32%) or any quantity (17%). Another 28% supported legalization only for medical purposes, while only 23% opposed any form of legalization.

New York Poll Finds Majority Oppose Legalization. A new Siena poll has support for legalization at only 43%, with 53% opposed. That contrasts with a recent Q Poll that had New Yorkers supporting legalization 57% to 39%. Differences in the questions asked and the margin of error in the polls may account for the difference. Or New Yorkers are conflicted.

Medical Marijuana

Kentucky CBD Medical Marijuana Bill Advances. A bill that would allow for the trial use of high CBD cannabis oil to treat childhood epileptic seizures was approved by the Senate Health and Welfare Committee Wednesday. Senate Bill 124 now heads for the Senate floor.

Hemp

Hemp Bill Advances in Indiana. A bill to legalize the production of industrial hemp passed the House Agriculture Committee Tuesday and now heads for the House floor. The bill is Senate Bill 357. It has already passed the Senate.

Drug Testing

Welfare Drug Testing Bill Advances in Georgia. A bill that would require food stamp and welfare recipients to undergo drug testing upon "reasonable suspicion" passed the House Judiciary Committee Monday. House Bill 772 now moves to the House floor.

Welfare Drug Testing Bill Stalls in Alabama Senate. A bill requiring drug testing of some welfare applicants hit a roadblock in the Senate Tuesday when Senate President Pro Tem Del Marsh (R-Anniston) adjourned the body after Democrats began fighting the bill. Senate Bill 63 would require drug testing of any applicant with a drug conviction in the last five years. It is just one of five bills in the Republican agenda to tighten regulations for public assistance.

Sentencing

West Virginia Senate Approves Draconian Drug Sentencing Bill. A bill that would increase the penalty for bringing drugs into West Virginia from one year to up to 15 years passed the Senate Monday. It now goes to the House.

International

Russian Drug Czar Rules Out Marijuana Legalization, Methadone Maintenance. The head of Russia's Federal Drug Control Service has called marijuana a dangerous gateway drug and said the authorities did not plan to legalize it, or to allow methadone treatment for heroin addicts. "Marijuana users have a 50 or 60 times higher risk of switching to heroin. There is one step from dope to heroin," Viktor Ivanov said in an interview with the Interfax news agency. He completely ruled out legalization, saying it was too risky in an advanced society. "Today we live in the age of high technology, a lot of things are managed with the help of computer systems. Someone who works at a nuclear power plant can wreak real havoc after smoking marijuana," he said. Ivanov also scoffed at needle exchange and methadone maintenance, saying there was little reliable evidence methadone maintenance worked. [Ed: Ivanov must have missed the entirety large body of research done on both needle exchange and methadone maintenance, which has found them to be effective and of paramount importance.]

Colombia's FARC Calls for Dismantling Drug-Paramilitary Nexus. Colombia's FARC guerrilla army called Tuesday for the dismantling of drug and paramilitary organizations it said were embedded within the Colombian state. The call was part of the FARC's six-point program to deal with the drug issue in the country, which is the fourth item on the agenda of peace talks between the FARC and the Colombian government.

British Chief Constable Says Give Heroin to Addicts. Mike Barton, Chief Constable for Dunham Constabulary, is calling for heroin maintenance for addicts. Such a move would "take money out of drug dealers' pockets," he said, adding that it "isn't practical" to simply arrest addicts. His comments come in a BBC documentary in which he went to Copenhagen to visit drug consumption rooms there.

Chronicle AM -- February 13, 2014

A bill has been filed to stop forcing the drug czar to oppose drug legalization, CBD medical marijuana bills continue to get attention, and there are big doings south of the border, and more. Let's get to it:

Russell Brand helped push British petition over the top. (flickr.com/photos/evarinaldiphotography/)
Drug Legalization

Congressman Steven Cohen Files Bill to Let Drug Czar Deal Honestly with Drug Legalization. The Office of National Drug Control Policy (ONDCP, the drug czar's office) is required by law to oppose legalization of any Schedule I substance and prohibited from studying it. Now, Rep. Steven Cohen (D-TN) has filed a bill, the Unmuzzle the Drug Czar Act (H.R. 4046), that would strip that language from the drug czar's enabling legislation, the ONDCP Reauthorization Act of 1998.

Marijuana Policy

High Times, Westword Sue Colorado Over Marijuana Advertising Restrictions. Marijuana magazine High Times and Denver alternative weekly Westword filed a lawsuit in federal court Monday challenging Colorado's restrictions on advertising for legal marijuana. The state's rules allow pot businesses to advertise only in adult-oriented publications for which "no more than 30% of the publication's readership is reasonably expected to be under 21." The lawsuit argues that the restrictions are an unconstitutional contravention of free speech.

Rhode Island Legalization Bill Coming. House Judiciary Committee Chair Edith Ajello and Senate Health and Human Services Committee Chair Josh Miller announced Wednesday they will file a bill to legalize marijuana for adults and set up a system of taxation and regulation for marijuana commerce. The effort is backed by Regulate Rhode Island and the Marijuana Policy Project.

Hawaii Decriminalization, Medical Marijuana Bills Get Hearing Today. Three Senate committees are holding a joint hearing today on two decriminalization bills, Senate Bill 2358 and Senate Bill 2733, and one bill, Senate Bill 2402, a bill that would take away protections for patients who possess and use marijuana concentrates.

Medical Marijuana

Medical Marijuana Rally Set for Friday in Topeka. Supporters of a long-stalled medical marijuana bill, Senate Bill 9, will rally at the Kansas State Capitol Rotunda Friday morning and lobby legislators after that. The effort is organized by Kansas for Change. Click on the title link for more details.

Hundreds Pack Oklahoma Capitol for CBD Medical Marijuana Hearing. Demonstrators called for marijuana legalization outside as hundreds of people jammed into the state capitol for a hearing on CBD medical marijuana. Dramatic and moving testimony was heard from family members of children suffering seizure disorders who might be helped by access to CBD cannabis oils.

Wisconsin Lawmakers Hold Hearing on CBD Medical Marijuana. Wisconsin legislators Wednesday heard from families of children with seizure disorders, who pleaded with them to pass a pending CBD medical marijuana bill.

Harm Reduction

Cincinnati Gets Its First Needle Exchange Program. The first needle exchange program in the Southwest Ohio/Northern Kentucky region is open for business. The Cincinnati Exchange Program becomes the third in Ohio, with others already operating in Cleveland and Portsmouth. The needle exchanges have been proven to reduce the spread of HIV, Hep C, and other blood-borne infectious diseases.

Prescription Drugs

Prescription Drug Database Bill Wins Missouri House Vote. A bill that would establish a prescription drug database has won a vote in the House, but senators, citing privacy concerns, said there is little chance of it moving forward in their chamber. The bill would create an electronic database managed by the state health department that would share information about prescriptions, patients, and doctors. The bill is House Bill 1133.

International

Mexico City Decriminalization, Regulation Bill and Mexican National Drug Reform Bill Introduced Today. In Mexico City, legislators for the federal district introduced a bill to decriminalize the possession of up to five grams of marijuana and remove the option of incarceration for possession of small amounts of other drugs. The bill would also allow for limited regulated marijuana sales. The second, national, bill would reschedule marijuana and allow for its medical use. Look for a Chronicle feature article on this soon.

Dark Web Drug Sales Site Busted. German and Dutch authorities have arrested five men in a sting directed at an internet drug sales portal. The men were connected to Black Market Reloaded and its successor web site, Utopia. Undercover police purchased drugs and weapons through the web sites, they said, and seized computers, hard drives, USB sticks, and a Bitcoin wallet containing $680,000 worth of the electronic currency.

More Than 100,000 Sign British Petition for Review of Drug Laws. Green Party MP Caroline Lucas set up an online petition urging the British government to order a cost-benefit analysis and impact assessment of British drug laws within the next year. It has now achieved the benchmark of 100,000 signatures, which means it must be addressed by the Backbench Business Committee. Sign-ons accelerated after actor and comedian Russell Brand joined with the online campaign group Avaaz to encourage its 1.1 million members to sign up.

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

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