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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

War of Words: The International Narcotics Control Board vs. A Changing World [FEATURE]

The global drug prohibition bureaucracy's watchdog group, the International Drug Control Board (INCB) released its Annual Report 2013 today, voicing its concerns with and wagging its finger at drug reform efforts that deviate from its interpretation of the international drug control treaties that birthed it. The INCB is "concerned" about moves toward marijuana legalization and warns about "the importance of universal implementation of international drug control treaties by all states."

"We deeply regret the developments at the state level in Colorado and Washington, in the United States, regarding the legalization of the recreational use of cannabis," INCB head Raymond Yans said in introducing the report. "INCB reiterates that these developments contravene the provisions of the drug control conventions, which limit the use of cannabis to medical and scientific use only. INCB urges the Government of the United States to ensure that the treaties are fully implemented on the entirety of its territory."

For some years now, some European and Latin American countries have been expressing a desire to see change in the international system, and "soft defections," such as the Dutch cannabis coffee shop system and Spain's cannabis cultivation clubs, have stretched the prohibitionist treaties to their legal limits. But legal marijuana in Uruguay is a clear breach of the treaties, as Colorado and Washington may be. That is bringing matters to an unavoidable head.

After surveying the state of drug affairs around the globe, the 96-page INCB report ends with a number of concerns and recommendations, ranging from non-controversial items such as calling for adequate prevention and treatment efforts to urging greater attention to prescription drug abuse and more attention paid to new synthetic drugs. [Ed: There is some controversy over how to best approach prescription drug abuse and synthetic drugs. e.g. the type of attention to pay to them.]

But the INCB is clearly perturbed by the erosion of the international drug prohibition consensus, and especially by its concrete manifestations in legalization in Uruguay, Colorado, and Washington and the spreading acceptance of medical marijuana.

"The Board is concerned that a number of States that are parties to the 1961 Convention are considering legislative proposals intended to regulate the use of cannabis for purposes other than medical and scientific ones" and "urges all Governments and the international community to carefully consider the negative impact of such developments. In the Board's opinion, the likely increase in the abuse of cannabis will lead to increased public health costs," the report said.

Similarly, the INCB "noted with concern" Uruguay's marijuana legalization law, which "would not be in conformity with the international drug control treaties, particularly the 1961 Convention" and urged the government there "to ensure the country remains fully compliant with international law, which limits the use of narcotic drugs, including cannabis, exclusively to medical and scientific purposes."

Ditto for Colorado and Washington, where the board was "concerned" about the marijuana legalization initiatives and underlined that "such legislation is not in conformity with the international drug control treaties." The US government should "continue to ensure the full implementation of the international drug control treaties on its entire territory," INCB chided.

But even as INCB struggles to maintain the legal backbone of global prohibition, it is not only seeing marijuana prohibition crumble in Uruguay and the two American states, it is also itself coming under increasing attack as a symbol of a crumbling ancien regime that creates more harm than good with its adherence to prohibitionist, law enforcement-oriented approaches to the use and commerce in psychoactive substances.

"We are at a tipping point now as increasing numbers of nations realize that cannabis prohibition has failed to reduce its use, filled prisons with young people, increased violence and fueled the rise of organized crime," said Martin Jelsma of the Transnational Institute. "As nations like Uruguay pioneer new approaches, we need the UN to open up an honest dialogue on the strengths and weaknesses of the treaty system rather than close their eyes and indulge in blame games."

"For many years, countries have stretched the UN drug control conventions to their legal limits, particularly around the use of cannabis," agreed Dave Bewley-Taylor of the Global Drug Policy Observatory. "Now that the cracks have reached the point of treaty breach, we need a serious discussion about how to reform international drug conventions to better protect people's health, safety and human rights. Reform won't be easy, but the question facing the international community today is no longer whether there is a need to reassess and modernize the UN drug control system, but rather when and how."

"This is very much the same old stuff," said John Collins, coordinator of the London School of Economics IDEAS International Drug Policy Project and a PhD candidate studying mid-20th Century international drug control policy. "The INCB views its role as advocating a strict prohibitionist oriented set of policies at the international level and interpreting the international treaties as mandating this one-size-fits-all approach. It highlights that INCB, which was created as a technical body to monitor international flows of narcotics and report back to the UN Commission on Narcotic Drugs, has carved out and maintains a highly politicized role, far removed from its original treaty functions. This should be a cause for concern for all states interested in having a functioning, public health oriented and cooperative international framework for coordinating the global response to drug issues," Collins told the Chronicle.

"The INCB and its current president, Raymond Yans, take a very ideological view of this issue," Collins continued. "Yans attributes all the negative and unintended consequences of bad drug policies solely to drugs and suggests the way to lessen these problems is more of the same. Many of the policies the board advocates fly in the face of best-practice public health policy -- for example the board demanding that states close 'drug consumption rooms, facilities where addicts can abuse drugs,'" he noted.

"If the board was really concerned about the 'health and welfare' of global populations it would be advocating for these scientifically proven public health interventions. Instead it chooses the road of unscientific and ideological based policies," Collins argued.

The INCB's reliance on ideology-driven policy sometimes leads to grotesque results. There are more than 30 countries that apply the death penalty for drugs in violation of international law. Virtually every international human rights and drug control body opposes the death penalty for drugs including the United Nations Office on Drugs and Crime, the UN Human Rights Committee, the UN's human rights experts on extrajudicial killings, torture and health, among many others.

INCB head Raymond Yans (incb.org)
But when an INCB board member was asked in Thailand -- where 14 people have been executed for drugs since 2001 -- what its position on capital punishment was, he said, "the agency says it neither supports nor opposes the death penalty for drug-related offenses," according to the Bangkok Post.

Human rights experts were horrified and immediately wrote asking for clarification, to which the INCB responded, "The determination of sanctions applicable to drug-related offenses remains the exclusive prerogative of each State and therefore lie beyond the mandate and powers which have been conferred upon the Board by the international community," according to Human Rights Watch.

Another area where the board's concern about the health and welfare of global populations is being challenged is access to pain medications. A key part of the INCB's portfolio is regulating opioid pain medications, and this year again it said there is more than enough opium available to satisfy current demand, although it also noted that "consumption of narcotic drugs for pain relief is concentrated within a limited number of countries."

The World Health Organization (WHO) agrees about that latter point. A 2011 study estimated that around 5.5 billion people -- or 83% of the world population -- live in countries with 'low to non-existent' access to opioid pain relief for conditions such as cancer and HIV/AIDS. These substances are listed by the WHO as essential medicines, and the international drug control conventions recognise explicitly that they are 'indispensable' to the 'health and welfare of mankind.'

Adding to the paradox -- the global supply is sufficient, but four-fifths of the world doesn't have access -- the INCB calls on governments to "ensure that internationally controlled substances used for pain relief are accessible to people who need them."

What is going on?

"The INCB uses totals of requirements for opioid medicines compiled by the UN treaty signatory states," said Ann Fordham, executive director of the International Drug Policy Consortium, which keeps an eye on the agency with its INCB Watch. "Unfortunately there is often a huge gap between these administrative estimates and the actual medical needs of their populations."

The prohibitionist slant of global drug control also creates a climate conducive to understating the actual need for access to pain relief in other ways, Fordham told the Chronicle.

"Many governments interpret the international drug control conventions in a more restrictive manner than is necessary, and focus their efforts towards preventing access to the unauthorized use of opioids rather than to ensuring their medical and scientific availability," she said. "This is a grossly unbalanced reading of the conventions, underpinned by fear and prejudice regarding opioids and addiction."

Although the agency has cooperated somewhat with the WHO in attempting to enhance access to the medicines, said Fordham, it bears some blame for rendering the issue so fraught.

"The INCB has continually stressed the repressive aspect of the international drug control regime in its annual reports and other public statements, and in its direct dealings with member states," she said. "The INCB is therefore responsible for at least some of the very anxieties that drive governments toward overly restrictive approaches. This ambivalence considerably weakens the INCB's credibility and contradicts its health-related advocacy."

Fordham joined the call for a fundamental reform of global drug prohibition, and she didn't mince words about the INCB.

"The entire UN drug control system needs to be rebalanced further in the direction of health rather than criminalization, and it is changing; the shift in various parts of the system is apparent already," she said before leveling a blast at Yans and company. "But the INCB is notable as the most hard line, backward-looking element, regularly overstepping its mandate in the strident and hectoring manner its adopts with parties to the treaties, in its interference in functions that properly belong to the WHO and in its quasi-religious approach to a narrow interpretation of the drug control treaties."

The INCB should get out of the way on marijuana and concentrate on its pain relief function, said Collins.

"The INCB should stay out if it," he said bluntly. "It is a technocratic monitoring body. It should not be involving itself in national politics and national regulatory systems. So it doesn't need to be either a help or hindrance on issues regarding cannabis reform. It has no reason to be involved in this debate. It should be focusing on ensuring access to essential pain medicines. These debates are a distraction from that core function and I would argue one of the reasons it is failing to meet this core function."

Sorry, INCB. Welcome to the 21st Century.

Vienna
Austria

Chronicle AM -- February 20, 2014

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

The Europeans are worried about "N Bomb"
Marijuana Policy

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

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

Medical Marijuana

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

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

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

Heroin

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

International

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The stuff ought to be legalized, Trebach said.

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

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

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

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

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

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

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

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

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

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

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

Those studies carry a lesson, he said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New York City, NY
United States

Chronicle AM -- February 4, 2014

Legalization proves profitable for Colorado's coffers, decrim moves closer in DC, more drug test bills get filed, Vermont attempts to do something about its opioid problem, a crime lab scandal brews in Florida, and more. Let's get to it:

meth house (assumptionsheriff.com)
Marijuana Policy

DC City Council Approves Decriminalization Bill. The District of Columbia city council today gave initial approval to the "Marijuana Possession Decriminalization Amendment Act of 2014" (Council Bill 20-409), which would eliminate the threat of arrest for possessing or using marijuana and ensure that people are no longer saddled with life-long convictions that make it difficult to obtain employment and housing. The bill still faces another council vote, needs the approval of the mayor, then needs Congress to let it happen.

Colorado Takes in $1.2 Million in Marijuana Taxes in First Month. According to an NBC News survey of Colorado retail marijuana shops, pot sales in the month since they were legal have contributed at least $1.24 million in tax revenues to state coffers. But wait -- there's more: The survey only counted tax receipts from half of the shops that opened New Year's Day, meaning the month's total is probably in the $2.4 million to $3 million range.

Arizona Democrat Files Marijuana Legalization Bill. State Rep. Ruben Gallegos (D) and 12 other Democrats have filed a bill to "regulate and tax marijuana in a manner similar to alcohol." The measure, House Bill 2558, allows for the possession of up to an ounce and a small number of plants as well. Another bill, House Bill 2474, would decriminalize the possession of up to an ounce.

Medical Marijuana

CBD Oil Medical Marijuana Bill for Epileptic Kids Filed in Utah. A bill that would allow for the importation into the state of marijuana extracts containing cannabidiol for use by epileptic children has been filed in Salt Lake City. Rep. Gage Froerer (R-Huntsville) introduced House Bill 100 yesterday.

Hemp

Indiana Senate Passes Hemp Bill. A bill that would allow the production of industrial hemp in the Hoosier State was approved unanimously by the Indiana Senate Monday. Senate Bill 357 would require a waiver from federal law before hemp could be grown there. The bill now heads to the House.

Drug Testing

Georgia Food Stamp Drug Test Bill Filed. State Rep. Greg Morris (R-Vidalia) has filed a bill to require mandatory, suspicionless drug testing for food stamp recipients. The bill is House Bill 772. Similar legislation ordering mandatory, suspicionless drug testing for welfare recipients was signed into law in 2012, but never implemented after a federal judge struck down a similar Florida law.

Northern Marianas Bills Would Require Drug Tests for Candidates, Elected Officials. Bills that would require that candidates for political office and elected officials submit to mandatory drug testing have passed the House Committee on Judiciary and Government Operations. House Bill 18-21 requires testing for candidates, and House Bill 18-152 requires testing for elected officials. The US Supreme Court has found a similar Georgia law unconstitutional.

Drug Treatment

Vermont Rolls Out Early Intervention Program for Criminal Drug Users. Gov. Peter Shumlin (D) and other state officials Monday announced a new program to divert crime-committing drug users into a pre-court, 90-day drug treatment program. If they successfully complete the program, they will not be prosecuted. Only those with nonviolent offenses will be eligible. "Instead of treating this as a crime, let's treat it as the disease that it is and offer addicts the opportunity to get into treatment, get the support they need and if they succeed, never to have to go through the criminal process," Shumlin said Monday at the Rutland County Courthouse.

Law Enforcement

Crime Lab Scandal Has Florida Police Reviewing Thousands of Drug Cases. Hundreds of drug convictions may be jeopardized and thousands of drug cases are under review in Florida after a single chemist at a state-run crime lab was accused of tampering with evidence. The chemist, who works at the Pensacola Regional Crime Lab, is suspected of removing "large" quantities of prescription pills from evidence packages and replacing them with over-the-counter medications, the Florida Department of Law Enforcement announced Saturday. That chemist handled at least 2,600 drug cases.

Methamphetamine

Indiana House Passes Meth Property Disclosure Bill. A bill that would require Indiana property owners to disclose to potential new buyers whether the property had previously been used to manufacture methamphetamine passed the House Monday. The bill, House Bill 1141, would require that such properties be listed on a state web site until at least 90 days after it has been certified as decontaminated. The measure now goes to the Senate.

International

Scholar Francisco Thoumi Offers Comprehensive Analysis of FARC Illicit Drug Cultivation Proposals. Colombian scholar Francisco Thoumi, a long-renowned expert on drug production and trafficking there, has authored a lengthy analysis of the FARC's proposals in peace negotiations with the Colombian government in the area of illicit crop cultivation. The article is Las FARC y el campesinado cultivador de plantas ilícitas: dilemas, ideología y decisiones (The FARC and the Drug-Growing Peasantry: Dilemmas, Ideology, and Decisions). It is in Spanish, but can be translated.

In Colombia, British Liberal Democrat Leader Says UK Should Abandon Current Drug Policies. During a visit to Colombia, British Lib Dem leader Nick Clegg said Britain should abandon its current drug policies because they're not working. He said new approaches were needed, but declined to back full legalization. He said the Lib Dems would offer their own alternative proposals shortly.

Chronicle AM -- February 3, 2014

Short-sighted Tories slam a Welsh harm reduction drug testing program, DC could decriminalize marijuana possession tomorrow, Oregon's governor thinks the legislature should legalize it, South Dakota legislators get busy with bad bills, and a South Dakota Indian reservation is thinking about legalization, and more. Let's get to it:

Marijuana Policy

DC City Council Votes on Decriminalization Tomorrow. The DC city council is expected to vote Tuesday to approve the "Marijuana Possession Decriminalization Amendment Act of 2014 (Council Bill 20-409)" would eliminate the threat of arrest for possessing or using marijuana and ensure that people are no longer saddled with life-long convictions that make it difficult to obtain employment and housing. Instead of arresting people the bill would impose a $25 civil fine for possession and a $100 civil fine for smoking marijuana in public places, as well as forfeiture of the marijuana and any paraphernalia used to consume or carry it.

Oregon Governor Wants Legislature to Act on Legalization. Faced with the seeming inevitability of marijuana legalization in his state, Oregon Gov. John Kitzhaber (D) said last Friday the legislature should take it up. "I hear the drumbeats from Washington and Colorado," he said. "I want to make sure we have a thoughtful regulatory system," Kitzhaber said. "The Legislature would be the right place to craft that." A bill to do that, Senate Bill 1556, is currently before the legislature. If the legislature doesn't act, a ballot initiative that could legalize marijuana in the state is waiting in the wings.

South Dakota's Pine Ridge Indian Reservation Considers Legalization. The Oglala Sioux Tribal Council on southwestern South Dakota's Pine Ridge Reservation has taken preliminary steps toward a public vote on marijuana legalization. Last week, the tribe's business development community approved the measure, and Tribal Chairman James Cross supports it. The full tribal council could approve a vote within the next month.

California Legalization Initiative Cleared for Signature-Gathering. The Marijuana Control, Legalization and Revenue Act (MCLR) initiative was approved last Friday for signature gathering to begin. Organizers now have until May to qualify for the November 2014 ballot. They need 504,000 valid voter signatures to do so. Three other legalization initiatives have also been submitted, but at this point, it appears unlikely that any of the initiatives will qualify for the ballot.

Two-Thirds of Hawaiians Ready to Legalize It, Poll Finds. Support for marijuana legalization in the Aloha State has jumped nine points since 2012 and now stands at 66%, according to a new QMark Research Poll. The survey also found 77% opposed jail time for pot possession and 85% supported allowing medical marijuana dispensaries.

New Jersey Poll: Only 41% Support Legalization. A new Fairleigh Dickinson University PublicMind Poll has support for legalizing small quantities of marijuana or personal use at 41%, although it is trending upward. "These numbers point to the possibility that fertile ground exists in the state for those looking to expand legalization beyond medicinal use," poll director Krista Jenkins said. "Policymakers will likely be watching for changes in public opinion as the percentage difference between those in favor and opposed gets closer to the 50/50 mark. Right now, however, a majority of the public remains opposed."

Medical Marijuana

Portland, Oregon, Medical Marijuana Business Symposium Draws Hundreds. Hundreds of people showed up in Portland Saturday at a marijuana business symposium to give and get advice on how to operate dispensaries and related businesses in the state. Beginning in March, the state of Oregon will start accepting applications for the businesses, making it a taxed and regulated industry.

Guam Senate Passes Bill to Put Medical Marijuana on the Ballot. The Guam Senate Saturday approved Bill 215, which would put the question of legalizing medical marijuana directly to the voters. The governor could still veto it, but unless he takes affirmative action to do so it will go into effect. Sponsor Sen. Tina Muna Barnes (D-Mangilao) amended the bill to allow for a popular referendum after running into opposition in the legislature.

New Mexico Medical Marijuana Grower Sues over Stalled Permit. A Santa Fe man has sued the state Department of Health over what he describes as a severe medical marijuana shortage. Mark Springer of Medical Marijuana, Inc. accuses the department of failing to act on his application and asks that it reopen the application period for growers and ease limits on how much they can grow.

Michigan Medical Marijuana Bills Stalled. Two bills that would make it easier for patients to acquire medical marijuana, including allowing dispensaries and the use of edibles, passed the House late last year, but now appear stalled by a hostile Senate committee chair. They are stuck in the Senate Government Operations Committee, chaired by Senate Majority Leader Randy Richardville (R-Monroe), who is not a big fan. "I'm going to sit on them for awhile," he said. The two bills are House Bill 5104 (edibles) and House Bill 4271 (dispensaries).

Methamphetamine

South Dakota Meth Precursor Registry Bill Passes Senate. A bill that would make South Dakota the 30th state to join the National Precursor Log Exchange (NPLEx) to track pseudoephedrine sales passed the Senate last week. Senate Bill 24 now heads to the House for consideration.

Drug Testing

South Dakota Public Benefits Drug Testing Bill Filed. A bill that would direct the state Department of Social Services to screen and drug test public benefits applicants for drug use has been filed in the South Dakota Senate. State Sen. Mark Kirkeby (R-Rapid City) tried and failed with similar bills in 2011 and 2012, but he's back this year with Senate Bill 123.

International

French Legislator Has Bill to Legalize Marijuana. A Green Party legislator said Saturday she had written a bill to legalize marijuana in France. Sen. Esther Benbassa, who represents a district on the outskirts of Paris, said France suffered from "a paradox," with some of the toughest marijuana laws in Europe, but also rising use levels.

Welsh Tories Attack Government for Funding Harm Reduction Drug Testing. Public Health Wales is operating a web site, Wedinos, where individuals can have drug samples tested for content and purity, and that has Welsh Tories crying foul. "This website suggests that Labour in Wales has given up the fight against drugs," complained Shadow Health Minister Jim Millar. "This free service is not just testing recreational highs, but illegal and dangerous drugs including heroin, cocaine and crack and gives advice on snorting and injecting substances." A government spokesman responded that it totally rejects those charges. "We are taking action to help individuals and society deal with the problems of substance misuse," he said. "Wedinos can provide essential intelligence and can help save lives. "It contributes to the wider UK and European Early Warning Systems in place to identify and monitor changing trends in drug use."

United Arab Emirates Toughens Drug Trafficking Laws. The United Arab Emirates (UAE) is vowing to seize assets from drug dealers and traffickers, but at the same time, it is working to enhance drug treatment services as part of "a containment policy for drug addicts, guiding them towards annihilating their addiction through innovative services."

Chronicle AM -- January 24, 2014

Bills are popping at state houses across the land, pot politics continues hot and heavy, world leaders have harsh words for prohibition at Davos, and much, much more. Let's get to it:

Marijuana Policy

Texas Gov. Rick Perry Touts Decriminalization, States' Rights. Texas Gov. Rick Perry (R), speaking at the World Economic Forum in Davos, Switzerland, Thursday, said he believes states should have the right to legalize marijuana and that he would move Texas toward decriminalization.

MPP Petitions Obama to Deschedule Marijuana. The Marijuana Policy Project Wednesday unveiled a Change.org petition asking the Obama administration to deschedule -- not reschedule -- marijuana The petition had nearly 36,000 signatures by Friday afternoon; it needs 50,000 to be addressed by the White House.

Hawaii House Majority Floor Leader Introduces Marijuana Export Bill. House Majority Floor Leader Rep. Rida Cabanilla Thursday introduced House Bill 2124, which would put the state's Department of Business, Economic Development and Tourism and Department of Agriculture in charge of a working group that would outline a plan to legalize the cultivation of marijuana in Hawaii for sale and export to foreign jurisdictions where marijuana is legal.

Rep. Jared Polis Invites Obama, Harry Reid to Check Out Legal Marijuana in Colorado. Colorado US Rep. Jared Polis (D-Boulder) Thursday sent a letter to President Obama and Senate Majority Leader Harry Reid (D-NV) inviting them to come see how Colorado is implementing marijuana legalization. In the letter, Polis wrote that he was"confident that when you see Colorado's work to implement the law while protecting children and raising revenue for our schools firsthand, we can begin to make similar efforts on a federal level."

Pennsylvania Democratic Governor Candidate Says Legalize Marijuana. Former state Department of Environmental Protection head John Hanger, who is seeking the Democratic gubernatorial nomination, called for marijuana legalization at a campaign forum Wednesday night at Lehigh University. "This issue is moving and Democrats better get on board or we'll lose this election to Tom Corbett because people will not come out and vote," Hanger said. "We must expand the voting population." None of the other five Democratic candidates took a stand on the issue.

DC Council to Vote on Decriminalization Bill February 4. The District of Columbia city council will vote on a bill to decriminalize marijuana during its February 4 meeting. It is expected to pass, but may see some amendments during consideration. A legalization bill is also pending before the council, and activists are also leading an effort to legalize through the initiative process.

Medical Marijuana

Florida Medical Marijuana Initiative Has Enough Valid Signatures to Qualify for Ballot. The Florida Department of Elections reported today that the Use of Marijuana for Certain Medical Conditions initiative has more than enough valid signatures to qualify for the November ballot.The department reported more than 710,000 valid signatures; 683,000 were needed. The initiative campaign earlier said it had gathered more than 1.1 million raw signatures. It still must win approval by the state Supreme Court, which is expected to rule by April 1.

Florida Medical Marijuana Initiative Polling at 65%. A new Public Policy Polling survey has support for the Florida medical marijuana initiative at 65%, with only 23% opposed. The initiative will require the votes of 60% of voters to pass because it is a constitutional amendment, as opposed to a statutory initiative.

West Virginia Medical Marijuana Bill Filed. Delegate Mike Manypenny (D-Taylor) and nine cosponsors Thursday filed a medical marijuana bill, House Bill 4264. This is the fourth consecutive year Manypenny has filed such a bill.

Oregon Bill Would Let Localities Regulate, Ban Medical Marijuana Facilities. A bill that would allow local governments to regulate or ban dispensaries or grow ops will be heard by the legislature next month. Senate Bill 1531, sponsored by state Sens. Bill Hansell (R-Athena) and Rod Monroe (D-Portland), was filed at the request of the Association of Oregon Counties and the League of Oregon Cities. The bill is a response to legislation last year that created statewide dispensary regulation and left regulation in the hands of the state, not localities.

Pennsylvania Nurses Endorse Medical Marijuana Bill. The Pennsylvania State Nurses Association Thursday became the first medical professional group in the state to publicly support a pending medical marijuana bill, Senate Bill 1182. The bill gets a hearing before the Senate Law and Justice Committee Tuesday.

Vermont Bill Would Ease Limits on Dispensaries. A bill introduced earlier this month would ease the rules for dispensaries. Senate Bill 247 would remove the 1,000-patient cap on the number of patients dispensaries can see, remove the cap limiting dispensaries to four, allow patients to grow their own, and allow for delivery services. The bill is now before the Senate Committee on Government Operations.

Louisiana Gov. Jindal Says Medical Marijuana Okay if Tightly Regulated. Louisiana's Republican governor, Bobby Jindal, said Wednesday night that he supports making medical marijuana available if it is tightly controlled. "I continue to be opposed to legalization of marijuana," Jindal said as he fielded questions Wednesday during an event at the Pennington Biomedical Research Center. "When it comes to medical marijuana… if there is a legitimate medical need, I'd certainly be open to making it available under very strict supervision for patients that would benefit from that."

Hemp

Virginia Hemp Advocates Meet, Look Ahead. The Virginia Industrial Hemp Coalition met Thursday in Harrisonburg to watch a film and plan how to advance the cause in the Old Dominion. They said they are considering proposing a bill for the next general assembly session.

Heroin

Ohio Attorney General Creates Special Heroin Unit. Ohio Attorney General Mike DeWine (R) announced Wednesday the creation of an investigative unit in his office to combat heroin trafficking and use. The Heroin Unit will include investigators, lawyers, and drug abuse awareness specialists, and will work with local leaders and law enforcement. DeWine is allocating $1 million for the unit. The move comes as the state's heroin overdose toll more than doubled between 2010 and 2012. [But will it accomplish its goal, better than other such programs have in the past? California's naloxone bill would be a better idea for Ohio, too.]

Drug Testing

Indiana Welfare Drug Testing Bill Wins Committee Vote. A bill that would require welfare recipients to be screened for drug use and subjected to drug testing if they are likely drug users passed a House committee on an 8-4 vote Wednesday.

Harm Reduction

California Bill Would Expand Pharmacy Access to Overdose Reversal Drug. Assemblyman Richard Bloom (D-Santa Monica) has introduced Assembly Bill 1535, which would allow pharmacists to provide the overdose reversal drug naloxone to drug users, friends, and family members. "California's overdose crisis remains one of the state's most serious health problems," Bloom said. "Pharmacists are highly trained, highly trusted healthcare professionals. This bill makes it easier for them to help prevent a fatal drug overdose."

International

World Leaders Offer Harsh Assessment of Drug War at Davos. Global leaders gathered for the World Economic Forum in Davos, Switzerland, called drug prohibition a failure and said world leaders need to consider alternatives. "It's been a disaster and has inflicted enormous harm," said former UN Secretary General Kofi Annan. "My country has suffered probably the most from the war on drugs. We need to find more efficient ways to combat it," added Juan Manuel Santos, president of Colombia. "People are being given enormous prison terms just for use. There has got to be a better way than ruining so many people's lives," Kenneth Roth, executive director of Human Rights Watch, said.

Human Rights Watch Makes Case for Drug Reform in 2014 Annual Report. Human Rights Watch released its World Report 2014 and included in it a special essay (click on the title link) on a human rights approach to drug control. The group is calling for the decriminalization of drug possession, finding alternatives to the criminalization of drug markets, and the primacy of human rights considerations in drug treatment.

Dark Web Drug Buyers and Sellers Can Now Use DarkList. A dark web web site that reappeared Wednesday is designed to serve as a directory of underground drug dealers operating dark web drug marketplaces, such as Silk Road 2.0, Agora, The Marketplace, Blue Sky, and others. DarkList says it will help customers connect with preferred dealers. "Let's face it -- buying and selling anonymously on the Dark Web is currently in a volatile state," reads the tagline on the site's homepage. "We built this directory so that you can always have a way to stay in contact with those you love."

Bulgaria Moving Backward on Drug Policy, NGOs Warn. Bulgaria's draft penal code, which has already won initial cabinet approval, includes mandatory prison sentences for any drug possession offense, and that is drawing sharp criticism from drug policy and human rights groups. "With these new proposals, Bulgaria is traveling in the opposite direction to what most other countries are doing," said Ann Fordham, Executive Director of the International Drug Policy Consortium (IDPC). "They are going backwards, while the rest of Europe is modernizing their drug laws and implementing health-based approaches to drugs -- policies that support, rather than punish, people who use drugs."

Bermuda Marijuana Policy Debate Continues to Roil. Activist and attorney Alan Gordon continues to successfully stir the pot in the island nation's marijuana policy debate. On Wednesday, he sent an open letter to Governor George Fergusson asking him to clarify whether Government House would seek to block marijuana legalization legislation. Click on the link to read the letter.

Chronicle AM -- January 22, 2014

Marijuana, marijuana, marijuana. It sure is generating lots of activity, plus Chris Christie speaks out on the drug war, a major farm organization endorses hemp, and Honduras wants to shoot down drug planes. Let's get to it:

New Jersey Gov. Chris Christie (R) wants to end the "failed war on drugs." (state.nj.us)
Marijuana Policy

Philadelphia City Councilman Will Introduce Decriminalization Bill. City Councilman James Kenney said Tuesday he would introduce a bill that would end mandatory arrests for simple marijuana possession. The bill would allow police to issue a summons requiring a $200 fine and a three-hour drug abuse class instead of arresting violators. Philadelphia DA Seth Williams already doesn't prosecute such cases, instead sending offenders straight to class and giving them the fine. "If the DA is not going to prosecute, there's no reason to arrest," Kenney said.

Wisconsin Legislature Passes Bill to Let Localities Prosecute Marijuana Offenses Even if DAs Don't Want To. A bill, Assembly Bill 164, that would expand municipalities' ability to enforce local marijuana ordinances even if district attorneys decline to prosecute passed the state Assembly Tuesday. It already passed the state Senate last September.

Louisiana Legislators Hear Marijuana Legalization Pitch. Supporters of marijuana legalization told lawmakers Tuesday it could generate tax dollars, provide a cash crop for farmers, shrink jail populations, and bring relief to the sick. The testimony was part of a House Criminal Justice Committee study requested by Rep. Dalton Honore (D-Baton Rouge). No legalization bill has been proposed in Louisiana this year.

Legalization Efforts Coming to Three More Maine Cities. After successfully getting a local legalization initiative passed in Portland, the Marijuana Policy Project said Tuesday it will try to do the same thing in Lewiston, South Portland, and York. The group will attempt to put a marijuana legalization question on ballots in all three municipalities through local citizen petitions. The move is part of a larger effort to legalize marijuana statewide in Maine.

Montana Legalization Advocates Turn Eyes to 2016. Big Sky Country marijuana legalization advocates are halting efforts to put an initiative on the ballot this year, and are instead looking to do so in 2016. An initiative had already been filed and cleared for signature gathering, but "the timing wasn't right," said the Marijuana Policy Project.

Medical Marijuana

Illinois Issues Medical Marijuana Draft Rules, Gets Criticism. The Illinois Department of Public Health Tuesday issued draft rules for the state's medical marijuana program, which set a $150 fee to apply for a patient card, require fingerprinting at the patient's expense for a background check, and bar anyone with a drug felony from getting a card, among other things. Patient advocates criticized the lethargic timeline -- it could take up to a year for some patients to get cards -- the costs imposed on patients, and the background checks. The department is soliciting comment on the draft rules until February 14.

Chicago Ordinance Would Limit Dispensaries to Manufacturing Zones. A proposed ordinance (click on the link) supported by Mayor Rahm Emanuel and Councilmember Edward Burke would restrict the locations of dispensaries in Chicago to manufacturing zones. The Marijuana Policy Project is calling on patients and supporters to attend a Committee on Zoning, Landmarks and Building Standards tomorrow to speak out against the restrictive measure. The meeting starts at 10:00am at city council chambers.

North Carolina Poll Has Solid Majority for Medical Marijuana. A new Public Policy Polling survey sponsored by NORML has support for medical marijuana at 63%, up five points from last year. The poll also found support for legalization growing, but still a minority position. Some 42% of North Carolinians now support legalization, up from 39% last year.

New Mexico Doctor Sues Medical Marijuana Board Over Documentation Requirements, Conflict of Interest. A Santa Fe physician has filed a complaint against the Medical Cannabis Advisory Board, claiming the agency exceeded its authority in requiring patient documentation beyond that required by state law and that the director of the board, Dr. Steven Rosenberg, has a conflict of interest because he reviews patient applications for his own practice.

Hemp

Farm Bureau Calls for Removal of Hemp from Controlled Substances List. At its annual convention in San Antonio last week, the American Farm Bureau Federation passed a policy resolution calling for the repeal of hemp's classification as a controlled substance. The Farm Bureau now joins a majority of leading farming organizations that support hemp farming, including the National Grange, the National Farmers Union, and the National Association of State Departments of Agriculture.

Drug Policy

New Jersey Gov. Christie Calls for End to "Failed" Drug War. In his inaugural address Tuesday marking the beginning of his second term in office, New Jersey's embattled Gov. Chris Christie (R) said the war on drugs needs to end. "We will end the failed war on drugs that believes that incarceration is the cure of every ill caused by drug abuse," he said. "We will make drug treatment available to as many of our nonviolent offenders as we can and we will partner with our citizens to create a society that understands this simple truth: every life has value and no life is disposable."

International

Honduras Passes Law to Shoot Down Drug Planes. Honduran legislators late last week approved a bill that would allow the government to shoot down planes suspected of trafficking drugs. Under the bill, authorities would take progressively more forceful steps to make unidentified aircraft land, although with only the defense minister authorized to order a plane be shot down. The Honduran military shot two small planes in 2012 suspected of carrying drugs, and that led the US to suspend anti-drug radar support for about three months.

Chronicle AM -- January 17, 2014

Washington's attorney general has dealt a body blow to the statewide legalization of marijuana commerce there, medical marijuana continues to keep state legislatures busy, a New Mexico town and county pay out big time for a horrid anal search, heroin legislation is moving in Kentucky, and more. Let's get to it:

Marijuana Policy

Washington Attorney General Rules Localities Can Ban Marijuana Businesses. In a formal opinion released Thursday, the Washington attorney general's office held that "Initiative 502 as drafted and presented to the voters does not prevent local governments from regulating or banning marijuana businesses in their jurisdictions." The ACLU of Washington said the attorney general's opinion is mistaken and it "will go to court if necessary" to see it overturned, while the state Liquor Control Board, which is charged with implementing I-502 said that the "opinion would be a disappointment to the majority of voters who approved the law."

Marijuana Reforms Will Be on the Legislative Agenda in Louisiana Again This Year. State Rep. Austin Badon (D-New Orleans) has already introduced House Bill 14, which would dramatically lessen the state's draconian marijuana penalties, and further-reaching bills could be forthcoming. The Badon bill passed the House last year before dying in the Senate.

Medical Marijuana

Pennsylvania Medical Marijuana Bill to Get Hearing This Month. State Senate Law and Justice Committee Chairman Chuck McIlhinney (R) said Thursday he had scheduled a public hearing for January 28 on a medical marijuana bill introduced this week. The bill, Senate Bill 1182, is cosponsored by Sens. Daylin Leach (D) and Mike Folmer (R).

Hawaii House Speaker Says State Needs Dispensaries. House Speaker Joe Souki said Wednesday that the lack of places for medical marijuana patients to obtain their medicine was "a gap in the law" that needs to be addressed. That patients can use medical marijuana but have no place to obtain it is "an anomaly," he said. Addressing dispensaries is a "humanitarian" issue, he added.

Utah Poll Finds Narrow Majority for Medical Marijuana. A new Salt Lake Tribune poll has 51% of Utahns supporting medical marijuana, but 67% opposing decriminalization or legalization.

Georgia Poll Finds Narrow Majority for Medical Marijuana. A new InsiderAdvantage poll has 51% of Georgians supporting medical marijuana "in very specific instances, such as in a liquid form to reduce seizures from young children." Some 27% were opposed, and 22% undecided. "The key here is that any legislation must be on a limited basis. That said, Republicans and Democrats both support this legislation by well over 50 percent, while independent voters are close to a majority as well," said Matt Towery, president of InsiderAdvantage and a former legislator.

Heroin

Kentucky Senate Approves Bill to Reduce Overdose Deaths, Increase Trafficking Penalties. The state Senate Thursday approved Senate Bill 5, which would create more treatment beds for heroin users and lengthen prison sentences for heroin and methamphetamine traffickers. A similar version of the bill passed the Republican-led Senate last year, but stalled in the Democratic-led House. The bill would require the state Medicaid program to cover several inpatient and outpatient treatment options for people addicted to opiates, including heroin and prescription painkillers. It also would divert some of the state's hoped-for savings from a 2011 prison sentencing reform package to expand treatment programs. But the bill would also stiffen penalties for people convicted of trafficking in larger quantities of heroin, methamphetamines or both, requiring them to serve at least half of their prison sentences before they are eligible for shock probation or parole.

Search and Seizure

New Mexico Town, County Pay Out Big Time for Forced Anal Searches of Drug Suspect. A Deming, New Mexico, man who was subjected to a hospital anal exam involving three enemas, a colonoscopy, and being forced to defecate in front of police and medical personnel in a fruitless search for drugs will get $1.6 million in damages in a settlement from Deming and Hidalgo County. David Eckert will most likely win additional damages from a local hospital where doctors agreed to perform the exam.

Sentencing

Charles Colson Task Force on Federal Corrections Funded in Federal Spending Bill. The omnibus federal spending bill filed this week and expected to pass quickly includes $1 million to establish the Charles Colson Task Force on Federal Corrections, an independent, bipartisan grouping that will examine a number of challenges facing the federal correctional system, including overcrowding and ways to minimize growth, violence behind bars, rehabilitation, and reentry. Colson was a Nixon administration official jailed in the Watergate scandal who became a prison reformer in the wake of that experience.

International

Spurred by Attorney, Bermuda's Medical Marijuana Debate Heats Up. Attorney Alan Gordon's online petition to have the Bermudan government allow emergency access to medical marijuana for cancer patients has spurred considerable notice on the island, with National Security Minister Michael Dunkley and Gordon publicly clashing over the law and whether Dunkley can act. Click on the link to see Dunkley's comments and Gordon's well-publicized written response.

Vietnam Sentences Three Drug Offenders to Death; Iran Executes Six. And the resort to the death penalty against drug offenders continues. According to the anti-death penalty group Hands Off Cain, three Vietnamese men charged with heroin trafficking got death sentences, while Iran, the world's leading drug offender execution, hung another six.

Cambodia Drug Detention Centers Rife With Abuse

Cambodian authorities illegally imprison hundreds of drug users and other "undesirables" in detention centers where they don't get drug treatment but instead face torture, sexual abuse, and forced labor, Human Rights Watch charged in a report released Sunday. The rights group called for the centers to be closed immediately.

Cambodian "intervention" truck rounding up drug users and other "undesirables" in Phnom Penh. (hrw.org)
The report, "They Treat Us Like Animals": Mistreatment of Drug Users and 'Undesirables'in Cambodia's Drug Detention Centers, documents the experiences of people recently confined in the centers, who described being thrashed with rubber water hoses and hit with sticks or branches. Some described being punished with exercises intended to cause intense physical pain and humiliation, such as crawling along stony ground or standing in septic water pits.

Former female detainees described rape and other sexual abuse by male guards. Many detainees said they were forced to work unpaid in the centers -- and in some cases, on construction sites -- and those who refused were beaten.

"The only 'treatment' people in Cambodia's drug detention centers receive is being beaten, bruised, and forced to work," said Joseph Amon, health and human rights director at Human Rights Watch. "The government uses these centers as dumping grounds for beggars, sex workers, street children, and other 'undesirables,' often in advance of high-profile visits by foreign dignitaries."

The report identified eight of the drug detention centers and is based on interviews with 33 people who had been held in them. It wasn't just drug users, either. According to the report, authorities also use the drug detention centers to hold homeless people, beggars, street children, sex workers, and people with disabilities.

People interviewed said they saw unaccompanied children as young as six in the detention centers. The children were held in the same rooms as adults, forced to perform exhausting physical exercises and military-like drills, chained, and beaten.

"The government admits that 10% of those held in the centers are children under 18," Amon said. "Children who use drugs or who live on the streets should be protected from harm, not locked up, beaten, and abused."

Human Rights Watch issued a similar report on drug detention center abuses in 2010, Skin on the Cable, which focused national and international attention to the issue of compulsory drug dependency "treatment" centers in the country. Following that report, the United Nations and donor agencies condemned the lack of due process and abusive treatment in centers in Cambodia and the region, while Cambodian government officials largely sought to dismiss the report as "untrue."

A dozen UN agencies issued a joint statement last year calling on countries with such centers "to close them without delay and release the individuals detained," but Cambodian authorities have not responded to that call, nor have they investigated or prosecuted anyone over the reports of torture and abuse at the centers.

"The Cambodian government should conduct a thorough and impartial investigation of arbitrary detention, torture, ill-treatment, and forced labor in its drug detention centers," Human Rights Watch said. "In line with the 2012 UN agency statement, everyone detained in the centers should immediately be released and all the centers closed. The government should replace the centers with expanded access to voluntary, community-based drug treatment."

Cambodia

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