California's Democrats endorse marijuana legalization, Caricom gets ready to talk marijuana, Attorney General Holder calls for expanded access to naloxone to prevent overdose deaths, legislatures in the Pacific Northwest make moves on medical marijuana, and more. Let's get to it:
[image:1 align:right caption:true]Marijuana Policy
Rep. Jared Polis Introduces Federal Marijuana Impaired Driving Bill. Rep. Jared Polis (D-CO) has introduced the Limiting Unsafe Cannabis-Impaired Driving (LUCID) Act, which would expand the federal definition of an impaired driver to include those impaired by marijuana use. The bill is not yet available online, and the devil is in the details. Stay tuned.
California Democratic Party Endorses Legalization. The California Democratic Party voted Sunday to include in its platform a plank "to support the legalization, regulation and taxation of pot in a manner similar to that of tobacco or alcohol."
Support for Legalization at CPAC. Attendees at the Conservative Political Action Conference in Washington included many supporters of marijuana legalization, according to both a Huffington Post informal survey and a CPAC straw poll, which had 62% saying legalize it.
New Jersey Program Won't Consider Adding New Conditions Until 2015. A Health Department spokesperson said late last week that the state's medical marijuana program will not consider expanding the list of conditions covered under state law until next year. That would appear to contradict the law, which required the health department to consider adding new diseases requested by the public after it submitted two annual reports, beginning in 2011, charting the program’s progress. It also required the health department to produce a biennial report in 2012 and every two years after assessing whether there were enough growers to meet demand. But the Chris Christie administration didn't issue any reports at all until late last month, and now says it is too soon to add more illnesses.
Washington Senate Votes to Regulate Medical Marijuana. Legislation that would essentially fold the state's existing medical marijuana program into the I-502 legalization framework passed the Senate Saturday. Senate Bill 5887 would require dispensaries to be licensed under the legalization format. Patients could get their medicine there or grow their own, and they could voluntarily register with the state to get a partial tax break and buy greater quantities than allowed under general legalization. The measure now goes to the House, which has already passed a bill that requires mandatory patient registration. The session ends this week.
New York Assembly Democrats Roll Medical Marijuana Bill into Budget Proposal. In a bid to finally get medical marijuana through the legislature, Assembly Democrats have folded a bill to do that into this week's budget proposal. The bill resembles the Compassionate Care Act introduced by Assemblyman Dick Gottfried (D-Manhattan), but is not identical to it.
Holder Calls Heroin ODs "Urgent Public Health Crisis," Calls for Expanded Naloxone Access. US Attorney General Eric Holder Monday said the Justice Department was stepping up efforts to slow the increase in heroin overdose deaths. As part of that effort, he reiterated the administration's call for more law enforcement agencies to be equipped with the opiate overdose reversal drug naloxone (Narcan).
Pseudoephedrine Restriction Bill Introduced in Missouri House. Reps. Stanley Cox (R-118) and Kenneth Wilson (R-12) have filed a bill that lowers limits on the amount of pseudoephedrine-based medicines that people can purchase each month, sets an annual limit on purchase amounts, lowers the amount people can legally possess, and requires a prescription for anyone with a felony drug offense. House Bill 1787 is similar to legislation filed earlier this year in the Senate. That bill, Senate Bill 625, is currently before the Senate Judiciary Committee.
LEAP Proposes Amendment to UN Drug Treaties. Law Enforcement Against Prohibition (LEAP) has proposed an amendment to the UN drug treaties, the legal backbone of global drug prohibition. The amendment seeks to "eliminate the criminalization-oriented drug policy paradigm and replace it with a health, harm reduction, and human rights-oriented policy." The proposed amendment is accompanied by a letter to world leaders from LEAP executive director Neill Franklin. Read the amendment by clicking on the title link and sign onto it at the MoveOn.org link here.
Caricom Leaders to Debate Marijuana Legalization This Week. Leaders of the Caribbean Community (Caricom) trade bloc will discuss a preliminary report on decriminalizing marijuana and exploring its medicinal uses at a two-day summit beginning today on the Caribbean island of St. Vincent. The summit comes on the heels of a research report released last week by Caricom researchers that found such moves could help the region's sluggish economy.
Mexico Kills La Familia Cartel Leader—Again. Mexican authorities are reporting that that they killed Nazario "El Mas Loco" (The Craziest One) Moreno in a shoot-out in Michoacan Sunday. The funny thing is that Moreno, one time leader of the La Familia Cartel, was also reported killed by authorities in December 2010. But his body was never found, and now government spokesmen say he was still alive and was acting as head of La Familia's replacement, the Knights Templar Cartel.
Oregon's medical marijuana dispensary regulation bill has gone back to the Senate with compromise language allowing only temporary local bans, a GOP US Senate candidate there says legalize it, Chuck Schumer fights heroin, Canada's Tories look to be going soft on pot law enforcement, and more. Let's get to it:
[image:1 align:right caption:true]Marijuana Policy
Alaska Legalization Debate Draws Hundreds. A week after the Alaska marijuana legalization initiative was officially certified for the ballot, hundreds of people streamed into the Wendy Williamson Auditorium at the University of Alaska in Anchorage for a debate on marijuana policy. In an opening speech, Ethan Nadelmann of the Drug Policy Alliance called the war on drugs "a rat hole of waste" and that marijuana prohibition was "grounded in bigotry, prejudice, and ignorance." Then a panel of five people, including Nadelmann, as well as an anti-legalization Project Sam representative, went at it. Click on the title link for more.
Another Missouri Legalization Initiative Approved for Signature-Gathering. Missouri Secretary of State Jason Kander approved a marijuana legalization initiative for signature gathering Wednesday. This is not one of the initiatives filed by Show-Me Cannabis, which had a bakers' dozen of similarly-worded initiatives approved earlier this year, but has decided to wait until 2016 for its effort. The initiative has a May 4 deadline for handing in petitions, and must obtain signatures from registered voters equal to 8% of the total votes cast in the 2012 governor's election from six of the state's eight congressional districts.
Maryland Sheriffs Rally Against Legalization. Local sheriffs attended a rally in Annapolis to voice opposition to proposed legislation to decriminalize marijuana in Maryland Wednesday. Sheriffs from the Eastern Shore and local police chiefs attended a rally sponsored by the Maryland Sheriff's Association and its supporters. The sheriffs are taking a stand against legalizing marijuana in Maryland, as lawmakers ponder a legalization bill.
Oregon GOP US Senate Candidate Endorses Legalization. Portland attorney Tim Crawley, who is seeking the Republican US Senate nomination, favors marijuana legalization. In a press release this week, he said he had "long been concerned with the tremendous waste of money and human potential the criminalization of marijuana has involved." In a subsequent interview, Crawley said he would support a legalization initiative in Oregon and if elected to the Senate, he would support removing marijuana from the controlled substances list.
Oregon House Passes Dispensary Regulation Bill With Only Temporary Local Bans. The statewide dispensary legalization and regulation bill, Senate Bill 1531, passed out of the House on Wednesday with a provision allowing localities to ban dispensaries, but only for a year while they develop regulations for them. The Senate has already passed a version without the temporary ban language, but is expected to accept this compromise language.
Florida CBD Medical Marijuana Bill Advances with House Committee Vote. A bill that would allow the use of high-CBD cannabis oil to treat seizure disorders passed the House Criminal Justice Subcommittee Wednesday. House Bill 843 now heads for the House Judiciary Committee.
South Carolina Medical Marijuana Bill Introduced. A bill to allow patients with specified diseases and conditions to use medical marijuana with a doctor's recommendation to use and grow their own medicine or purchase it at dispensaries has been introduced. House Bill 4879, filed by Minority Leader Rep. J. Todd Rutherford (D-Columbia, has been referred to the House Judiciary Committee.
Schumer Wants New York Heroin Database. US Sen. Charles Schumer (D-NY) called Wednesday for a standardized heroin database to fight crime and addiction related to the drug's use. "Data and information sharing drives solutions, and we're seriously lacking in that department," said Schumer. "All we know for sure is heroin is ravaging families across New York state." He called on the Office of National Drug Control Policy (ONDCP) to help set up a statewide "Drugstat" database to track heroin use patterns, hospitalizations, and overdoses, which he said could help police combat the drug.
California Informants Sue San Luis Obispo Over Rogue Narc. A civil lawsuit recently filed in federal court against the city and county of San Luis Obispo by two former confidential informants of disgraced narcotics detective Cory Pierce charges that Pierce allegedly forced the female informant to have sex with him. Pierce is currently serving a prison term for corruption. According to prosecutors in his federal trial, both informants aided Pierce in acquiring cash, oxycodone and heroin, and now allege that they were forced into indentured servitude, including being kept addicted to drugs and engaging in dangerous and illegal activities. According to prosecutors, Pierce used the informants to set up drug buys with local dealers, then later robbed them. He is currently in prison. The federal lawsuit alleges that Pierce used his position as a detective to force the woman into engaging in sex with him, including an act of oral copulation, and on another occasion, forced sexual intercourse, the suit alleges. In an additional incident, Pierce allegedly pushed and rubbed his body up against her. Click on the link for more sleazy details.
Canada's Tories Hint at Move Toward Ticketing Marijuana Possession Offenders. Conservative Justice Minister Peter Mackay said Wednesday that the government is seriously considering looser marijuana laws that would allow police to ticket anyone caught with small amounts of pot instead of laying charges, Justice Minister Peter MacKay said Wednesday. "We're not talking about decriminalization or legalization," MacKay said prior to the weekly Conservative caucus meeting on Parliament Hill. "The Criminal Code would still be available to police, but we would look at options that would... allow police to ticket those types of offenses." Liberal Party leader Justin Trudeau has called for legalization.
Vancouver Police Say They Won't Bother with Busting Dispensaries. All but a handful of medical marijuana dispensaries are supposed to be illegal after Canada's new medical marijuana law comes into effect April 1, but Vancouver police said Wednesday they are not going to bother them unless there are signs they are selling to people without a medical marijuana permit. "I don't think for now there is any plan to change the current drug policy that is in place to fit specifically with these changes," said Constable Brian Montague. "We don't have plans for massive raids on April 2nd."
(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 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.
[image:1 align:left caption:true]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.
[image:2 align:right caption:true]"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."
[image:3 align:left caption:true]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.
The tragic death of actor Philip Seymour Hoffman yesterday has prompted expressions of grief and of praise for his talent.