Narco-Deforestation Accelerates Loss of Biodiversity

In Central America, drug policies become conservation policies.

The Central American isthmus exploded into prominence as a drug trafficking corridor in 2006, when pressure on Mexican cartels pushed smuggling operations to the south and into the remote forest frontiers of Honduras, Guatemala, and Nicaragua. Since then, vigorous interdiction programs have pushed traffickers into ever more remote zones, back and forth from country to country, bringing money, manpower, and greater opportunities for deforestation.

Kendra McSweeney of the Department of Geography at Ohio State University and co-workers dug into the recent comprehensive report by the Organization of American States (OAS), titled The Drug Problem in the Americas, and wrote up their findings in a recent contribution to Science's Policy Forum. They found that “mounting evidence suggests that the trafficking of drugs (principally cocaine) has become a crucial—and overlooked—accelerant of forest loss in the isthmus.” (See graph above, representing forest clearings in Eastern Honduras.)

In the Caribbean lowlands area known as the Mesoamerican Biological Corridor, and in protected rural regions like Laguna del Tigre National Park in Guatemala and the Rio Platano Biosphere Reserve in Honduras (now listed as “in danger” by UNESCO due to forest loss), there is no shortage of reasons why deforestation in Central American is increasing. Among the causes are weak or corrupt government agencies, climate change, poverty, illegal logging, ill-advised development, and rampant agribusiness expansion. However, what has been called the “compounding pressure” of drug trafficking on biodiverse forestlands and associated rural communities is making things worse. The report in Science documented that an unprecedented flow of cocaine into Central America “coincided with a period of extensive forest loss” as narco-traffickers purchase large ranches in “contested rural landscapes.”

What are the active causal connections between drug trafficking and deforestation? The researchers identified three interrelated mechanisms “by which forest loss follows the establishment of a drug transit hub.”

1. Drug traffickers cut down forests to establish secret roads and aircraft landing strips.

2. Drug money amps up the pressure on weakly governed frontier areas, resulting in “narco-capitalized” land speculators and timber harvesting operations. In the process, local small landowners get priced out, even though the conversion of forests to farmlands is illegal in protected areas.

3. Drug trafficking organizations are themselves drawn into local forest-to-agriculture development plans like pastures and oil-palm plantations. Buying up and developing land is a preferred method of laundering drug money. These vague “narco-estates” monopolize land use in some territories and serve as cover for expanded smuggling operations.

What could mitigate this form of additional pressure on tropical deforestation? The researchers suggest that the heart of the problem is the traditional emphasis on supply-side policies, such as interdiction and crop eradication on foreign soil. “Analysts have long noted that eradication policies often push coca (and opium poppy and marijuana) growers into ever more ecologically sensitive zones, with substantial environmental impacts.”

The authors of the Science article view all of this as something to be added to “the long list of negative unintended consequences borne by poor countries as a result of the overwhelming emphasis on supply-side drug reduction policies…. Recognizing the ecological costs of drug trafficking in transit countries would improve full-cost pricing analyses of the drug policy scenarios explored by the OAS.”

McSweeney K., Nielsen E.A., Taylor M.J., Wrathall D.J., Pearson Z., Wang O. & Plumb S.T. (2014). Drug Policy as Conservation Policy: Narco-Deforestation, Science, 343 (6170) 489-490. DOI: 10.1126/science.1244082

Grab Bag of Addiction Links

Recent reading from around the net.

Can Medical Marijuana and Recreational Marijuana Coexist?

“The Washington State Liquor Control Board released recommendations for what to do with the state's medical marijuana system now that recreational marijuana is legal.” [Atlantic Cities]

Premature claims of a cannabis addiction "cure"

“Have scientists found a ‘cure’ for marijuana addiction? New treatment blocks the kick that users get from the drug,” reports the Mail Online. Based on the evidence presented in the study, which involved animals, the answer to the Mail’s question is 'not yet'. [NHS Choices]

Can Gambling Machines Prevent Addiction?

“Today's digital slot machines and poker screens in casinos and at online gambling sites are capable of amassing a wealth of behavioral data on individual players, and they are on the verge of altering game play on the fly.” [Scientific American Mind]

Food for thought: UF researcher’s book lays out evidence for food addiction

“For some, the famous potato chip slogan “Betcha can't eat just one” isn’t a wager — it’s a promise.” [University of Florida Health]

New Zealand’s bold experiment with regulating recreational drugs

“It’s been nearly a century since the United States began its experiment in prohibiting recreational drugs besides alcohol, caffeine and tobacco — and virtually no one sees the trillion dollar policy as a success.” [Reuters]

More Than 1,000 Meet in Denver to Develop Drug War Exit Strategy

“Which state will be next to legalize marijuana? What do the Obama administration's recent announcements about marijuana legalization and mandatory minimums really mean?” [Huffington Post]

This Is Why Social Media and Drinking Alcohol Don't Mix (Infographic)

“Engaging with peers and customers on social platforms can be dangerous. Doing so while you’re under the influence of alcohol is downright irresponsible. “ [Entrepreneur]

Economists Predict Marijuana Legalization Will Produce "Public-Health Benefits"

“In their 2012 book Marijuana Legalization: What Everyone Needs to Know, Jonathan Caulkins and three other drug policy scholars identify the impact of repealing pot prohibition on alcohol consumption as the most important thing no one knows.” [Forbes]

Photo Credit: http://lifeonthebalcony.com/

The Media and Drug Policy: Where’s the Science?

Groping blindly toward a new framework.

As states and the federal government clash at the legal, social, and political levels over legalizing marijuana, the science of drugs and addiction has taken a back seat. The dismal state of the addiction treatment business has recently been documented by Anne M. Fletcher in Inside Rehab, while over the past few years, drug policy officials in the U.S. have had to cope with three major developments: the medicalization and legalization of marijuana, the emergence of new synthetic drugs, and the abuse of potent prescription painkillers.

Major media outlets have largely failed to highlight the relevant scientific issues in each case. What we see instead is that journalists and others who are covering drugs and addiction issues are not making connections with solid scientific sources in the neurochemical research community. All too often, media reports of adverse drug events are sourced solely by police officers, or spokespersons on behalf of for-profit rehab centers, who are no more ready to make science-based pronouncements on these matters than anyone else.

States are now in the process of relaxing strictures on the possession and use of cannabis—and they are doing it well before they have put in place a set of evidence-based policies for the implementation of this new state of affairs. Who is in charge of directing policy decisions in Washington and Colorado? What will be the regulatory structure at the level of county and municipal government? Whose voices will actually be heard? Should the feds leave it to the states, and the states leave it to the counties, who then leave it to the cities? To what degree are the two states taking the medical and health aspects of this sweeping change into account? Can evidence be substituted for opinion in such cases? If so, how?

Even if the Department of Justice decides to shut down all efforts at relaxing marijuana statutes, it will need to rely upon a sound collection of scientific evidence to make its argument. The media play a compelling role in drug discussions, but coverage traditionally has been limited to articles about the legal, political, and sociocultural ramifications of the changes. These are all critical parts of the story, but science journalists need to step forward and direct more coverage toward emerging medical issues and the findings of science. Ordinary citizens will want to have at least a partial grasp of the medical and science-based decisions that state and federal governments will be making about personal health and habits as they legislate and adjudicate these concerns.

The federal government will have to begin working with states rather than against them, if public opinion continues to change on legalization issues. At the same time, the feds will be called upon to provide guidance for the states that is consistent with international drug treaties. Congressional committees will have to grapple with the realities of setting forth the limits and logistics of the market for marijuana in coherent and consistent ways. Incredibly, very little of this is pinned down, firmly understood, or even grasped as imminent problems by either legalizers or their opponents. Many of the issues that took years to wrestle down with cigarettes, such as warning labels on cigarette packages, will present themselves with equal and immediate force in the case of states with legalization plans.

In addition, marijuana policy makers in Colorado and Washington will have to render decisions concerning sales to minors, cannabis in the workplace, DUI marijuana laws, addiction issues, sales outlets, tax issues, and the results of ongoing medical research on marijuana. Some states allow private dispensaries, some have banned them. Some allow private cultivation of cannabis, and some do not. 

As for the newer synthetic drugs—the cannabis-like products known as Spice, and designer stimulant drugs known collectively as “bath salts”— these chemicals exist in a twilight zone of ignorance, with very little sound medical information passing to the public. Few people understand with any degree of certainty just what is inside those shiny foil packages. This glaring disconnect between clinical research and media reports leads to unsupported tales of face-eating zombies and dead teenagers on bath salts, well in advance of the drug testing that might factually answer questions about drug-related behavior. Meanwhile, scientists fear that the continuing effort to ban every substance illegally marketed in this category will close off certain valuable avenues of research, including new drug discovery.

Finally, the ongoing battle to lower the soaring use and abuse of oxycontin, Vicodin, and other opiate drugs has caused problems for legitimate pain patients across the country. Yet this medical aspect of the painkiller panic is rarely remarked upon. Some addiction researchers believe that as prescription painkillers are removed from the market or made more difficult to abuse, those with opiate addictions will migrate to heroin in greater numbers. Scientific research on addiction suggests that this may well be the case. 

What is missing specifically from most drug policy debates is the recognition of the vast metabolic variation among individuals. Different drugs affect different people differently, and for the first time, neuroscientists are building a solid body of information that could help policy makers better forecast the results of their actions. Lethality, side effects, tolerance, and susceptibility to addiction all vary widely due to metabolic differences among people.

But some shared reactions, and basic withdrawal parameters, do exist. Congress, the FDA, NIDA, as well as state health agencies and other regulatory bodies, need information about drugs and drug use that scientists have been busily compiling. The public needs this information, too. We need to search for ways media can more effectively inject science-based drug information into current policy debates. 

Science journalists are perfectly situated to serve as potential communicators between warring parties. What can the media do to markedly enhance intelligent, science-based coverage of drug issues?

Photo: Telstar Logistics

Status of Medical Marijuana to be Tested in U.S. Appeals Court

Ten-year old petition could change everything.

Medical marijuana advocates will finally have their day in federal court, after the United States Court of Appeals for D.C. ended ten years of rebuffs by agreeing to hear oral arguments on the government’s classification of marijuana as a dangerous drug.

A decision in the case could either finish off medical marijuana for good, or else upend the fed’s rationale for its stepped-up war against the medical marijuana industry. Americans for Safe Access v. Drug Enforcement Administration asks that the federal government review the scientific evidence regarding marijuana’s therapeutic value. The D.C. Circuit Court of Appeals has agreed to do so in October.

The original petition, filed by the Coalition for Rescheduling Cannabis (CRC) in 2002, has languished in obscurity, but recent moves to have marijuana rescheduled from its status as a Schedule 1 drug—a class that includes heroin—have increased in the wake of America’s Civil War over medical marijuana.  “This is a rare opportunity for patients to confront politically motivated decision-making with scientific evidence of marijuana’s med efficacy,” said Joe Elford, chief council for Americans for Safe Access, the group that successfully challenged the denial of the original CRC petition. “What’s at stake in this case is nothing less than our country’s scientific integrity and the imminent needs of millions of patients.”

The Controlled Substance Act reserves Schedule 1 for drugs that “have a high potential for abuse, have no currently accepted medical use in treatment in the United States, and there is lack of accepted safety for use of the drug or other substance under medical supervision.”

Recently, an article by Dr. Igor Grant in the Open Neurology Journal argued that marijuana’s Schedule 1 classification and surrounding political controversy were “obstacles to medical progress in this area.”

Seventeen states have now adopted some form of medical marijuana law, but the nascent field remains in limbo due to federal regulations about the illegality of marijuana use. Over the past year, the U.S. Justice Department has stepped up its pressure on medical marijuana purveyors, culminating in dozens of indictments, seizures, and shutdowns. Most recently, the Los Angeles City Council simply threw up its hands and banned most marijuana dispensaries in the city. But it’s not even clear if the ban on state-legal dispensaries is itself legal. A pot collective in Covina recently won its challenge to a blanket ban on pot sales in unincorporated areas of Los Angeles County in the state’s 2nd District Court of Appeal. As a Los Angeles Times editorial aptly put it, “we’re confused about how to legally restrict a quasi-legal business.”

According to Chris Roberts, writing in the SF Weekly, “the court hearing would be the first time the medical merits of cannabis would be examined in a federal courtroom since 1994.” At the core of the argument is the federal government’s contention that the marijuana plant has no redeeming medical value, as opposed to the mountain of scientific studies suggesting that marijuana may be applicable in the treatment of glaucoma, cancer, chronic pain, and possibly other conditions, such as multiple sclerosis.

Graphics Credit:   http://en.wikipedia.org/

Drug Links, Various

Pharmacology, Politics, and Recovery

* USA Today article on Opana abuse rivalling Oxy abuse.

* US Attorneys Crack Down on California Medical Marijuana Dispensaries.

* Downloadable reports from Alcohol Justice, an industry watchdog group.

* With regard to the approval of Lorcaserin as a diet pill, here's the saga of Phen-Fen--how a blockbuster diet pill died.

* Why the Dutch "weed pass" won't work.

* Cigars won't save you: Cigars cause your body similar problems as cigarettes.

* Playwright Sam Shepard on his stint in rehab: “I finally did AA down on Pico Boulevard. I said, 'Don’t put me in with Elton John or anything, just throw me to the lions.’”

* 4,848 and 390: number of medical marijuana providers in Montana in March 2011 and June 2012, respectively.

* Andrea Mitchell talks to NIDA's Nora Volkow

* Listen to the talking urinal cake: Don’t drive drunk

* Feds say celebrity psychiatrist Dr. Drew was paid by Glaxo to talk up antidepressant on TV.

* Reactions to Marc Ambinder's GQ piece on Obama and the Drug War

* Lengthy interview with Drug Czar Kerlikowske by Mike Guy at The Fix:


Graphics Credit: http://tucsonvelo.com

The Empty Seat at the Holiday Table

Mothers and the War on Drugs.

Guest post by Gretchen Burns Bergman

Gretchen Burns Bergman is Co-Founder and Executive Director of A New PATH (Parents for Addiction Treatment and Healing) and lead organizer of Moms United to End the War on Drugs.

The Holiday season is upon us. At this time, when the weather turns chilly and we move indoors to enjoy the warmth and safety of our homes and the closeness of family and friends, I am acutely aware of those not so fortunate: people who are out in the elements, either because of dire financial situations or mental and addictive illness.

The Holidays are particularly difficult for those who must navigate the mighty and destructive waves of addiction. It is a painful time for families who are separated because of a loved one’s incarceration, whose young person is lost on the streets due to drug problems, whose children are in danger because of the violence of the drug cartels, or those who have lost a loved one to overdose. Often a family member is missing from the festivities because of stigma and shame.

I don’t remember when I started dreading Thanksgiving. It wasn’t after my father or my nephew died, because they were remembered and celebrated at the table, or even after the breakup of my first marriage. It was all of the times that my older son was absent because he was locked behind bars in that cold, concrete jungle, and I couldn’t figure out where I belonged – with him to somehow nurture and sustain him, or in the bosom of the rest of my family. It is the memories of holidays when one of my sons wasn’t included because he was lost in the maze of his addiction, and his name wasn’t even mentioned because of pain, discomfort, and even judgment. Those omissions widened the hole in my heart.

I weep for the countless families who have been torn apart by discriminatory and destructive drug policies that lock up fathers and remove children from their mothers in the name of the war on drugs, which is really a war waged against families and communities.

This season, mothers are banding together and speaking out with human stories of injustice and devastation, to encourage other mothers to join our voices for change. Moms United to End the War on Drugs is a national movement to end the violence, mass incarceration and accidental overdose deaths that are result of these blundering punitive policies. At a time when 2.3 million people are incarcerated in the United States and overdose is a leading cause of accidental death, mothers must lead the way in demanding harm reduction strategies, health-oriented solutions, and restorative justice.

The following are stories written by mothers who have experienced the ravages of the war on drugs, and who honor that empty seat at the holiday table:

The missing seat at the prison visiting table.

It was Thanksgiving and my family and I drove 4 hrs to visit my young son in his California prison for the holiday. He was serving time for drug possession, celled with a murderer, in one of the state’s highest security prisons, so “processing time” including prison official dysfunction, near total disrobing, endless questioning, metal detectors, sally-ports, and guard escorts, took about 4 hours to complete before we got to the highly secure visiting room. Because of this time consuming process, there was only 45 minutes left to visit. On the other side, my inmate son was being strip searched and waiting in a line moving at glacial speed to enter the visiting area. I cried to the guard that, as time ticked by, I was being left with five minutes to see my son for Thanksgiving…but I wanted those five minutes. He waited in his sally-port on the other side, while we all waited at our assigned table for that precious few minutes with my son. That seat remained empty. Alerts sounded that visiting was over.

--Julia Negron, A New PATH Los Angeles, California

Until this war ends, an extra place at my table.

During the holidays, we reflect as we prepare meals, set our tables, and decorate our homes. As I begin planning, with my daughter and husband’s help, I think back to the time when I was addicted to heroin, and missing from my family’s holiday table. Though it was more than 20 years ago, my family experienced extreme grief over my addiction. My father tells me that he is so grateful that I am alive. He didn’t know, in the midst of my homelessness, whether I’d ever be able to attend, let alone host, a Thanksgiving with my own family. I think how lucky I am, because I had the opportunity to get treatment that worked for me. I know someone waited and despaired over me. Now, I wait for those with substance use disorders to be served by our health care system rather than languishing in prison. Until that wait is over, there will always be an extra place setting at my holiday table for those who are locked up, thrown away or left out. The person in prison for a drug crime might not be able to eat with me this year, but perhaps next year, they will.

--Kathie Kane-Willis, Illinois Consortium on Drug Policy, Roosevelt University

Emptiness is everywhere.

Since our son was born, we always picked out the Christmas tree together. It became a tradition and one of the fun parts of the holiday rush. Dad would put the lights on the tree and make clam chowder, while Jeff and I did the ornaments. As years passed, it was sometimes difficult for us all to be together for this tradition, but we were. Our son had addictive illness, and through the many rehabs, the short county incarcerations, the times where he’d isolate because he was using, we somehow were able to keep that tradition. Christmas Eve was spent with our entire family either in our home or my sister’s. The first year without Jeff – just 3 months after he died of an accidental overdose and 2 days after release from 4 months in county jail, was unreal. Jeff had been so much a part of Christmas, sharing Santa duties and passing out gifts to the little ones with the biggest smile on his face. The emptiness was EVERYWHERE. He should have been there. We haven’t had a Christmas tree or decorations in our home since 2007. I don’t think we ever will again. The Holidays bring nothing but pain.

--Denise Cullen, Broken No More, Orange County, California

Photo Credit: http://sisterjohnpaul.blogspot.com/

Feds Go “Passive-Aggressive” in Fight Against Medical Marijuana

Sending in the IRS instead of knocking down doors.

It’s official: The Obama administration has thrown off the gloves, repudiating Attorney General Eric Holder’s vow of two years ago that the federal government was not interested in prosecuting “state-legal” cannabis activity. Instead, a flurry of action is underway, intended to signal that the DOE and DEA are out to put a stake through the heart of the medical marijuana industry as a whole. Marijuana, however it is used, remains wholly illegal under federal statutes, and federal law enforcement officials insist such laws trump any state laws aimed at allowing the sale and use of cannabis.

During the last 30 days:

-- The DEA raided medical marijuana clinics in Tempe, Arizona.

--The Rhode Island governor reneged on an earlier pledge to okay medical marijuana in his state, saying that any such activity would make the state a target for federal prosecution. 

-- Federal prosecutors seized the bank accounts of medical marijuana shops in Sacramento, claiming a series of “irregular deposits.”

--The IRS decreed that the biggest marijuana dispensary in California cannot deduct ordinary business expenses on its taxes.

--A study of marijuana for posttraumatic stress disordered descended into “regulatory limbo,” as Brian Vastag reported for the Washington Post, after the National Institute on Drug Abuse (NIDA), the only legal source of cannabis for researchers, refused to hand over government marijuana to the study authors because of “a number of concerns” about research protocol.

--A California Appellate Court ruled that the statute allowing  marijuana dispensaries in Long Beach is in violation of federal law, which will force a long and arduous rewrite of the permitting laws for that city, and presumably other cities as well.

 The irony is that California’s medical marijuana industry, the first in the nation, may have survived the SWAT team attacks of the Bush years, only to fall victim to renewed regulatory fervor under President Obama’s watch. And, as I reported earlier at The Fix: “Britain’s giant GW Pharmaceuticals received U.S. patent approval for the use of Sativex, its nasal spray for treatment of advanced cancer pain composed of—yes, that’s right—a combination of the two primary chemicals found in cannabis. Since then, Sativex has made it all the way to Phase III clinical testing in a bid for FDA approval. At the moment, the company’s chances of producing a cannabis based pill are looking very good.” Meanwhile, so-called “whole-plant” marijuana research is getting squeezed out.

And now comes word that federal prosecutors are following up with a giant crackdown on all California dispensaries. Associated Press reports that U.S. attorneys sent letters this week to at least 16 pot dispensaries, “warning the stores they must shut down in 45 days or face criminal charges and confiscation of their property even if they are operating legally under the state’s 15-year-old medical-marijuana law.”

Sources say that cease-and-desist letters from U.S. Attorney Melinda Haag in California had been received by some dispensaries, stating the “violations of the federal law referenced…. is a federal crime,” and further stipulating that the penalties could include property forfeitures and 40 years of prison time, reports Chris Roberts at SF Weekly.

And the Associated Press obtained copies of letters sent to San Diego dispensaries, in which federal prosecutors claim that marijuana shops are illegal and subject to criminal prosecution and civil enforcement actions. “Real and personal property involved in such operations are subject to seizure by and forfeiture to the United States… regardless of the purported purpose of the dispensary.”

The action follows warning letters that were sent to dispensary owners and state officials by federal prosecutors in June, which strongly hinted that state employees might be liable for prosecution as well. A California attorney told SF Weekly that the feds were now embarking on a more effective “passive-aggressive” approach to shutting down the medical marijuana industry. “They’ve systematically changed their approach,” said the attorney. “Probably after talking to a PR professional.”

Graphics Credit:  http://www.shouselaw.com/

Common Field Test for Marijuana is Unreliable, Critics Say

A 75-year old pot assay is due for an update.

We’ve all seen it on cop shows: The little plastic bag, the officer breaking the seal on a small pipette and inserting a bit of marijuana, then a firm shake, and voila, the liquid in the test satchel turns purple: Guilty.

Here’s an interesting twist they don’t tell you about: The so-called Duquenois-Levine test—the dominant method for field-testing marijuana since 1930—is considered by many to be wildly inaccurate, and frequently doesn’t hold up in court. One U.S. Superior Court judge referred to the test as “pseudo-scientific.”

The test itself works fine. The problem is that, in addition to identifying marijuana or hashish, the Duquenois-Levine, or D-L, frequently reads positive for tea, nutmeg, sage, and dozens of other chemicals—including resorcinols, a family of over-the-counter medicines, which, according to John Kelly at AlterNet, includes Sucrets throat lozenges. This does matter, because in New York, Washington, D.C., and elsewhere, inner-city minority kids are getting busted for pot in record numbers. Lacking a reliable test protocol, marijuana is whatever the officer says it is. In a classic case that continues to bedevil the testing industry, a middle-aged woman was busted for marijuana while bird watching. A “leafy substance” turned purple on the Duquenois-Levine (D-L) test, and the woman was arrested. The material turned out to be sage, sweetgrass, and lavender, and the woman was engaging in a Native American purifying ritual using a smudge, a concept with which the arresting officers were unfamiliar.

So, when push comes to shove, a positive D-L rarely establishes the presence of marijuana beyond a reasonable doubt, without further confirmatory testing. For at least 20 years now, a visual inspection and a NarcoPouch, as the D-L field test is called, were enough to bring on the felony charges. State courts have squabbled over the matter, but state legislatures have been reluctant to intervene, in large part because sending samples to a lab for confirmatory testing is prohibitively expensive, particularly when the busts are small. The D-L test saves money.

According to the official drug policy of the United Nations, a positive marijuana ID requires gas chromatography/mass spectrometry analysis. And even this far more sophisticated test has angered courts in Washington and Colorado, the UK Guardian reports, “because the DEA doesn’t have standard lab protocols to govern its use.” In part, the judges are furious because plea-bargaining depends upon valid drug possession evidence. So, the officers themselves, when it comes to testifying in court, become de facto expert witnesses, able to identify illegal drugs on sight. Ah, those were the days. But now, cannabis-based products come in a bewildering variety of sizes, shapes, colors, smells, and chemical compositions.

But c’mon, if it looks like bud and it smells like bud… except that the research shows there are 120 terpenoid-type compounds involved in the odor of marijuana. No two varieties smell exactly alike. There is no characteristic marijuana smell—there are hundreds of characteristic marijuana smells. Nonetheless, in 2009 the National Academy of Sciences called the testing of controlled substances “a mature forensic science discipline,” according to AlterNet.

In a 2008 article for the Texas Tech Law Review, Frederic Whitehurst, Executive Director for the Forensic Justice Project and formerly with the FBI, concluded: “We are arresting vast numbers of citizens for possession of a substance that we cannot identify by utilizing the forensic protocol that is presently in use in most crime labs in the United States.” In another section of the article, Whitehurst asks: “Why is this protocol still being utilized to decide whether human beings should be confined to cages and at times, to death chambers?” And as Stewart J. Lawrence and John Kelly write in the Guardian, “using manifestly flawed drug identification tests to charge defendants, or pressure them to plead guilty, is hard to square with a defendant’s right to due process.”

Photo Credit: http://www.howardcountydui.com/ 

Essay: The Genuine Drug War is in Biomedicine

Knowledge, not firepower, is the key to the future.

In modern American society, heart disease, cancer, HIV\AIDS, diabetes, alcoholism, and cigarette addiction account for millions of deaths. They are all disease entities with strong psychological and behavioral components—complicated, multicellular, multi-organ disorders. But they have all been associated, at one time or another, with negative personality traits and moral flaws. The less we know about the mechanics of a human disorder, the more likely we are to view its external symptoms as signs of laziness, or neuralgia of the spirit, or as a form of damage caused by specific kinds of thoughts and emotions. Without a doubt, all kinds of flaws are sometimes expressed in the behavior of people who have these disorders. Yet none of these flaws can be considered the root cause of the diseases.

Addiction is being added to the roster of physical disorders once thought to be symptoms of insanity, but which are now seen to be disease entities with strong mental components, like most diseases. As Professor Felton J. Earls of the Harvard School of Public Health argued almost twenty years ago: “Until we have an Institute of Addictive Behaviors, we are not going to get very far on the public-policy issues because we will not have our science-policy issues properly aggregated and organized in order to move forward on the issues in any meaningful way.”  Witness the tangle over merging NIDA and the NIAAA, and you’ll have a good idea of how far we still have to go in this respect.

The genuine drug war is being fought in the arena of biomedicine. The New York State Division of Substance Abuse Services in Albany  estimated several years ago that the annual bill for successfully treating a single drug addict is $3,850, compared with $14,000 in estimated annual expenses— health, welfare and law enforcement costs—associated with one untreated addict. The real crisis is the indisputable fact that there exists today an appalling shortage of funds for biomedical research—ironically one of the fields of scientific endeavor in which the U.S. holds a clear lead.

The cause of the dilemma is a fundamental misunderstanding among politicians and the public about how diseases can be understood and conquered. Cross-fertilization among scientific disciplines yields unexpected results. Targeted research, such as the much-ballyhooed war on cancer, or the crash program to find a cure for A.I.D.S., is not necessarily the most desirable way to proceed. Insights come from unexpected places, in serendipitous ways. As the scientific understanding of cells and receptors deepens, diseases and disorders once thought to have unrelated causes are seen to have common and entirely unanticipated origins. Research into the viral mechanisms of the common cold may ultimately yield more insights into AIDS then all of the directed research now underway. In biomedicine, there is no guarantee that goals can be reached through the front door, by a systematic assault akin to an engineering project. We cannot, for example, hope to cure addiction, or even the common cold, by means of the same methods we used to put a man on the moon.

There are, however, certain things we can begin to do immediately, if, as a nation, we are serious about drug abuse. As a society, Americans have not done a very good job of laying the groundwork for an objective look at addiction and recovery. To begin with, we must attend to the staggering number of drug-related deaths, injuries, and hospitalizations caused by the abuse of prescription medications. The government itself has proven the case for this contention in numerous reports issued by the National Institute on Drug Abuse and other official bodies. According to the U.S. Department of Health and Human Services, “Older Americans account for more than half of all deaths from drug reactions,” leading one to suspect that the majority of drug fatalities stem from accidentally fatal overdoses by heavily medicated senior citizens. Our national fixation on illegal drugs has blinded us to certain verifiable facts about prescription drug abuse.

We also need to recognize the problem of underprescribing opiates and other addictive painkillers for children and adults in hospital settings. If we continue to stringently prohibit the use and sale of synthetic and designer drugs like methadone, morphine, amphetamines, and barbiturates, we will have to make one important exception: pain abatement in medical applications. One of the great scandals to come out of the drug war is the growing understanding that potent painkillers are not being offered in sufficient amounts to patients suffering intractable and agonizing pain.

“There’s a certain amount of hysteria about narcotics among doctors,” maintains one researcher. At least half of all cancer patients seen in routine practice report inadequate pain relief, according to the American College of Physicians. For cancer patients in pain, adequate relief is quite literally a flip of the coin.

At least 6 million cancer and AIDS patients currently receive no appropriate pain treatment of any kind. In addition, WHO estimates that four out of five patients dying of cancer are also suffering severe pain. The numbers of untreated patients suffering intractable, unrelieved pain from nerve damage, burns, gunshots, sickle cell anemia, and a host of other medical conditions can only be guessed at.

Figures gathered by a different U.N. agency, the International Narcotics Control Board, make clear that “citizens of rich nations suffer less.” To put it starkly, the use of morphine per person in the United States is 17,000 times higher than per person usage in Sierra Leone. Doctors in Africa paint a grim picture of patients hanging themselves or throwing themselves in front of trucks as an alternative to life without pain relief. The U.S., Canada, Britain, France, Germany, and Australia together account for roughly 80 per cent of the world’s medicinal morphine use. Other countries, particularly the poor and undeveloped nations, scramble for what’s left.

In many cases, pain relief is the one thing doctors can offer their patients, and the one thing they withhold.

--Adapted from The Chemical Carousel, by Dirk Hanson

Photo Credit: http://www.eurac.edu 

The Undiagnosed Epidemic of Incarceration

Prison once again a place for addicts and the mentally ill.

Readers may remember the dark day of January 1, 2008, when the U.S. set an all-time record: One out of every 100 adults was behind bars. That’s more than 2.3 million people. That’s 25% of all the prisoners in the world—and the world includes some very nasty nations. What gives?

You know the answer: drug crimes. Can it really be a coincidence that over the past 40 years, ever since President Richard Nixon first declared war on drugs, the number of people housed in U.S. prisons has gone up by more than 600%? Are we really just that much more vicious and larcenous than we used to be? 600% more unlawful than we were as a people in 1971? Last month, a group of medical professionals from the Division of Infectious Diseases at Brown Medical School, and the Center for Prisoner Health and Human Rights, both in Providence, Rhode Island, co-authored an article for the New England Journal of Medicine entitled “Medicine and the Epidemic of Incarceration in the United States.” The investigators conclude that the explosion in the prison population is a direct result of “our country’s failure to treat addiction and mental illness as medical conditions. The natural history of these diseases often leads to behaviors that result in incarceration.” Packed prisons are also the result of a broader movement over the past 40 years to shift the burden of care for addiction and mental illness over to the prison system. “Deinstitutionalization of the mentally ill over the past 50 years and severe punishment for drug users starting in the 1970s have shifted the burden of care for addiction and mental illness to jails and prisons,” the authors argue.

Do the social costs of this massive transfer of addicts and the mentally ill to the U.S. prison system outweigh the benefits? According to the NEJM article by Josiah D. Rich and co-workers, “more than 50% of inmates meet the DSM-IV criteria for drug dependence or abuse, and 20% of state prisoners have a history of injection-drug use.” Rich estimates that up to a third of all heroin users pass through the criminal justice system each year. These figures are shockingly high, compared to the general population, even allowing for a higher level of drug use among the criminal population.

“The largest facilities housing psychiatric patients in the United States are not hospitals but jails,” they write. “More than half of inmates have symptoms of a psychiatric disorder… yet correctional facilities are fundamentally designed to confine and punish, not to treat disease.” Furthermore, as most people are aware, the punishment is not meted out equally: “By middle age, black men in the United State are more likely to have spent time in prison than to have graduated from college or joined the military and they are far more likely than whites to be sent to prison for drug offenses despite being no more likely that whites to use drugs.”

And there is one aspect of the sorry situation that receives almost no attention at all: Most prisoners are eventually released. This post-release period, says the NEJM article, “presents extraordinary risks to individuals and costs to society.” In the first two weeks after release, former inmates are 129 times more likely to die from a drug overdose than the average man or woman on the street. They are 12 times more likely to die, period. And here’s a nice touch: Most of them don’t have Medicaid or other medical insurance, and there is usually no primary care follow-up to assure that they have access to affordable medications, if they need them. Inevitably, these are among the people who make the local emergency room their primary care facility, at great cost to everyone involved.  As the article states: "Addressing the health needs of this vulnerable population is thus not only an ethical imperative, but also of crucial importance from both a fiscal and a public health perspective."

State spending on correctional institutes is now the second fastest growing sector of government spending, after Medicaid. According to the authors, five states now spend more on prisons than they spend on higher education. “Locking up millions of people for drug-related crimes has failed as a public-safety strategy and has harmed public health in the communities to which these men and women return.”

The authors make it clear that, for addicts, drug and mental health treatment programs are humane and sensible alternatives to incarceration. They are also cost-effective: In Rhode Island, for example, the price for putting someone behind bars for a year is $41,000—or $110,000, if we are talking about the new super maximum-security facilities. Why haven’t politicians seized on all of this as a budgeting issue; as a cost-effective way to address drug and alcohol addiction without clogging up the criminal justice system, and creating embarrassing rates of incarceration? The authors have an answer: the fear of being tagged as “soft on crime.” If addiction is a craven failure of will power leading to the violation of social norms, as so many citizens seem to think, than prison is where addicts belong. The result: political pandering on the drug issue, by politicians suffering from a craven failure of will.


Here is where President Obama’s Affordable Care Act could really end up making a difference. Former prisoners will have a good shot at health coverage, and a policy that links together community health centers and academic medical centers could radically improve care during the critical post-release period. As Rich and colleagues argue: “Such access could redirect many people with serious illnesses away from the revolving door of the criminal justice system, thereby improving overall public health in the communities to which prisoners return and decreasing the costs associated with reincarceration due to untreated addiction and mental illness.”

Rich JD, Wakeman SE, & Dickman SL (2011). Medicine and the epidemic of incarceration in the United States. The New England journal of medicine, 364 (22), 2081-3 PMID: 21631319

Pic http://scrapetv.com 

How the Drug War Ended

Thoughts on the 40th anniversary of the War on Drugs.

Last week marked the end of four decades of drug wars first unleashed under President Richard Nixon. The event was well publicized, with parades and pronouncements on all sides. But nothing struck me quite like a recent essay by Daniel Lende at his blog site, Neuroanthropology.

For anthropologist Daniel Lende, the tipping point was a clutch of superb—and superbly horrifying—photographs of drug war victims in Mexico. The old, the young, the innocent. Nothing but blood and death and dying. “Despite years of living in Colombia,” Lende writes, “I’d never really come face-to-face with the costs of the drug war there.” And, up until a few weeks ago, he had been “the good scientist, waiting for more evidence, and the good anthropologist, waiting for something that makes better sense.”

If anything is in short supply in the never-ending, no endpoint, no endgame war, it’s better sense, not bullets. These were the pictures, and there was no way of making the pictures theoretical.  And one photo in particular—a dead grandmother, huddled in a protective embrace meant to shield her two dead grandchildren—finished it off for Lende. “We can’t squirm away, we can’t simply forget or say it’s not so bad. It is that bad. These photos show it.”

It’s all too easy to blame it on drug thugs, so Lende doesn’t bother. Besides, “for too many years, the Mexican government treated drug trafficking like just another corruption, manageable and profitable for those in power. And now the violence has hit as a storm of torture, death, and gruesome display.”

Do we really believe it can’t happen here? U.S. government officials are, as Lende writes, supposedly built from sterner stuff. “Their corruption is not easy money and institutional decay. It’s the sheer rigidity of their approach—an approach of annihilation and denial eerily reminiscent of drug users themselves. It is tyrannical more than puritanical. A war can never be lost, no matter the cost, even if the enemy (demand) comes from our own people.”

Lende is not in favor of legalization—far from it.  “Releasing drugs to the unfettered powers of the capitalist market is not a good option. If they can’t even handle mortgages, what would happen with drugs?” Besides, it’s obvious enough that alcohol, tobacco, and prescription drugs cause enough mayhem as legal drugs.

So, what to do? We can’t go forward, and we can’t go back. Or so it sometimes seems. Lende offers up four suggestions; small ways of making improvements at the margin, where such improvements often start.

--Fairness in drug regulation. Similar drugs should be treated in similar ways. Witness the entanglement the criminal justice system got itself into with huge sentencing disparities between crack cocaine and powdered cocaine; disparities that amounted to racial profiling.

--A focus on consequences rather than simple possession. For example, alcohol is legal, but not drunk driving. “Similar policies that target harmful behaviors users commit are an utter necessity.”

--Mandated restitution and treatment, rather than jail. Lende argues that drug courts can help provide “the long-term protection of the community and the rehabilitation of individuals found to commit acts in counter to commonly established laws.”

--An emphasis on small, immediate costs to drug abusers: “fines for possession, obliging users to show up in court and face social judgment… and one or two day jail sentences are all ways to generate change using a criminal justice approach.”

But is there really any evidence that social interventions of the kind Lende champions can really make a difference? As it happens, yes. Consider smoking. Taxes, warning labels, and social changes in tolerance for smoking have all had a direct effect.

Full Disclosure: Daniel Lende used "The Chemical Carousel," my book about addiction, in one of his anthropology classes at the University of Notre Dame, although we both made zero money out of the deal. He's now an Associate Professor in Anthropology at the University of South Florida. I also fully disclose that he’s a great guy and has proven to me that this is not your mother’s anthropology anymore. It’s a terrific essay. Read it in full here.

Photo Credit:  www.presstv.ir

Drug Czar Kerlikowske Interviewed in Foreign Policy Magazine

Drug War goes international in a big way.

Gil Kerlikowske, Director of the Office of National Drug Control Policy--a.k.a. the Drug Czar--finds himself in a curious position. Kerlikowske can be forgiven for feeling a little like J. Edgar Hoover, when the FBI director found that domestic security at home seemed to require some rather active investigations into Cubans and other Communists abroad. Kerlikowske is now riding a horse he never had much say in buying. The U.S. is in the midst of launching a new international drug strategy consisting of “interlocking plans” in Central and South America aimed at “transnational criminal groups.”

AFP reporter Jordi Zamora wrote that “the strategy will merge a handful of existing programs, including Plan Colombia, which has received more than $6 billion in U.S. aid since it was launched in 2000, and the Merida Initiative for Mexico, for which Congress has appropriated $1.5 billion since 2008.” Kerlikowske said that the global nature of the drug threat “requires a strategic response that is also global in scope.” With various crackdowns and battles over smuggling routes, the drug trade in the region has led to thousands of deaths, and has created “complex and evolving threats” from crime syndicates,” according to Assistant Secretary of State William Brownfield.  However, “progress in Central America will only push drug traffickers elsewhere if we do not support strong institutions throughout the hemisphere,” he said.  It seems like the Office of National Drug Control Policy continues to be internationalist in scope.

With all that as background, Foreign Policy magazine spoke with Kerlikowske in search of more detail, and got some--including a strange paean to America’s ability to produce and distribute its own illegal drugs, with no help from Mexico, thank you very much. Kerlikowske seems almost to be bragging. And if he’s right, what are all those border killings about, anyway?

FP: What's your big-picture sense of the drug situation in Latin America?

GK: It used to be fairly easy to categorize countries as production countries, transit countries, or consumer countries. I think those lines have been--if not completely obliterated--generally blurred. The amount of drug use in Mexico is significant. It's also clear from my most recent trip to visit drug treatment centers in Colombia that they're concerned as well. 

FP: U.S. Ambassador Carlos Pascual was forced to leave his position in Mexico two weeks ago because of comments he made in WikiLeaks cables about the perception that the drug war in Mexico is failing and about pervasive corruption in Mexican law enforcement. Are those concerns you share?

GK: As a police officer, I can say that cynicism just comes with the territory, and it's pretty easy to adapt that kind of attitude to Mexico. I'm not overly optimistic, but I think there has been some progress and we have an administration that's courageously taking on these criminal organizations, who are now involved in so many other kinds of crimes.

FP: It does seem that there have been a number of recent scandals involving U.S.-Mexico drug partnership: the Pascual resignation, the reports of the ATF allowing cross-border gunrunning, the controversial use of drones over Mexican territory. Has that relationship become more difficult lately?

GK: In my two years of dealing with this on a closer level, I'd say these last two months are more strained than during the rest of the time I've been here, but I don't see it as a significant bump in the road or a glitch that's going to stop things.

FP: What do you say to those in Latin America who say that it’s useless to crack down on the drug trade as long as the demand persists from the United States?

GK: For one thing, we've become much better at producing drugs in the United States: hydroponic marijuana with a very high THC content -- public lands produce a lot of marijuana. And we don't get any prescription drugs smuggled in to any great extent--which, right now, are our No. 1 growing drug problem in the United States, and also methamphetamine. We're getting much better at making our own, albeit in small amounts.

FP: How do you respond to the growing number of former Latin American leaders--former Mexican President Vicente Fox, most recently--who have come out in favor of legalization or at least a radical overhaul of the current policy?

GK: Isn't it funny how people who no longer have responsibility for anyone's safety or security suddenly see the light? I think it's not a lot different from what we've heard in recent years in the United States, which is: We've had a war on drugs for 40 years and we don't see success. If we have a kid in high school, they can still get drugs or there's drugs on the street corner. So legalization must be an answer…. Heaven knows, we're not very successful with alcohol. We don't collect much in tax money to cover the costs. We certainly can't keep it out of the hands of teenagers or people who get behind the wheel. Why in heaven’s name do we think that if we legalize marijuana, we'd have a system where we could collect enough tax revenue to cover the increased health-care costs? I haven't seen that grand plan. “

Photo Credit: www.fs.fed.us

Drug Wars Increase Drug Violence

 Homicides rise with anti-drug expenditures.

In a large review of studies evaluating the association between drug law enforcement and violence, the Vancouver-based International Centre for Science in Drug Policy (ICSDP) concluded that “the existing scientific evidence strongly suggests that drug prohibition likely contributes to drug market violence and higher homicide rates. On the basis of these findings, it is reasonable to infer that increasingly sophisticated methods of disrupting drug distribution networks may increase levels of drug-related violence.”

This finding is either self-evident or counterintuitive, depending upon your point of view. But it is entirely consistent with several historical examples, most notably the breakup of the Cali and Medellin cartels in Columbia during the 1990s. “The destruction of the cartels’ cocaine duopoly,” says the report, “was followed by the emergence of a fractured network of smaller cocaine-trafficking cartels that increasingly used violence to protect and increase their market share.”

In its review of available English language studies focusing on the association between drug enforcement and violence, the ICSDP looked at “longitudinal analyses involving up to six years of prospective follow-up, multilevel regression analyses, qualitative analyses, and mathematical predictive models.” The result? “Contrary to our primary hypothesis, among studies that employed statistical analyses of real world data, 82% found a significant positive association between drug law enforcement and violence.” 

According to Harvard economist Jeffrey Miron, who is quoted in the report: “Prohibition creates violence because it drives the drug market underground. This means buyers and sellers cannot resolve their disputes with lawsuits, arbitration or advertising, so they resort to violence instead.”

The drug policy group estimates that the worldwide illicit drug trade adds up to as much as $320 billion annually. Latin America is still the world’s leading supplier of marijuana and cocaine, but it has also become a major player in the opium and heroin trade. Afghanistan and West Africa are also plagued with serious political and social instability and violence due to drug traffic.

In light of the continuing economic downturn, it seems pertinent to note that the study estimates total U.S. drug law enforcement expenditures at about $15 billion a year for roughly the past 15 years. During that period, illegal drugs “have become cheaper and drug purity has increased, while rates of use have not markedly changed.” As an example, the report points to the “startling increase in heroin purity” from 1980 to 1999, when the Drug War was in full swing, and contrasts that trend with the “equally startling drop in price over the same period.”

The ICSDP is a recently-formed multinational network of scientists, health practitioners, and academics who seek to move the focus on drugs from law enforcement to harm reduction through “evidence-based drug policy guidelines and research collaborations with scientists and institutions across continents and disciplines.” Among its members are Michel D. Kazatchkine, executive director of The Global Fund to Fight Aids, TB and Malaria; Dr. David Nutt, a professor of neuropsychopharmacology at Imperial College, London, who was recently dismissed as a drug adviser by the British government for his anti-drug war views; and Dr. Julio Montaner, president of the International AIDS Society.

The report, like all such summary studies, is open to dispute by scholars and scientists on the grounds of statistical methodology, but to date it serves as additional evidence for the proposition that federal drug control officials must seek alternative regulatory models--or risk being responsible for helping to lower price, increase supply, and foment a truly appalling level of homicidal violence in their efforts to interdict drug traffic and incarcerate users. 

Drug wars never work. The report from the International Centre for Science in Drug Policy is another reminder that drug wars intrinsically raise the level of violence in the countries and the communities where they are quixotically waged.

Graphics Credit: http://www.icsdp.org/

White House Releases New National Drug Strategy

The official press statement.


The White House
Office of the Press Secretary
For Immediate Release
May 11, 2010

WASHINGTON, DC – Today, President Obama released the Administration’s inaugural National Drug Control Strategy, which establishes five-year goals for reducing drug use and its consequences through a balanced policy of prevention, treatment, enforcement, and international cooperation.   The Strategy was developed by the Office of National Drug Control Policy (ONDCP) with input from a variety of Federal, State, and local partners.

“This Strategy calls for a balanced approach to confronting the complex challenge of drug use and its consequences,” said President Obama. “By boosting community-based prevention, expanding treatment, strengthening law enforcement, and working collaboratively with our global partners, we will reduce drug use and the great damage it causes in our communities.  I am confident that when we take the steps outlined in this Strategy, we will make our country stronger and our people healthier and safer.”

The 2010 Strategy highlights a collaborative and balanced approach that emphasizes community-based prevention, integration of evidence-based treatment into the mainstream health care system, innovations in the criminal justice system to break the cycle of drug use and crime, and international partnerships to disrupt transnational drug trafficking organizations.  

During a nationwide listening tour soliciting input for the development of the Strategy, National Drug Policy Director Gil Kerlikowske met with police and medical professionals, drug treatment providers and people in recovery, elected officials, corrections officials, academics, parents groups, faith leaders, and others.  Throughout the consultation process, significant themes emerged which connect the drug issue to major Administration policy priorities, including the economy, health care reform, youth development, public safety, military and veterans’ issues, and foreign relations.

“In following President Obama’s charge to seek a broad range of input in the Strategy, I gained a renewed appreciation of how deeply concerned Americans are about drug use,” said Director Kerlikowske. “It touches virtually all of us, whether we know a family member, a friend, or a colleague who suffers from addiction or is in recovery, a police officer working to protect the community, or a parent striving to keep a child drug free,” said Director Kerlikowske.

The 2010 Strategy establishes five-year goals to reduce drug use and its consequences, including:

• Reduce the rate of youth drug use by 15 percent;
• Decrease drug use among young adults by 10 percent;
• Reduce the number of chronic drug users by 15 percent;
• Reduce the incidence of drug-induced deaths by 15 percent; and
• Reduce the prevalence of drugged driving by 10 percent.

In addition, the Strategy outlines three significant drug challenges on which the Administration will specifically focus this year: prescription drug abuse, drugged driving, and preventing drug use.  Prescription drug abuse is the Nation’s fastest growing drug problem, driving significant increases of drug overdoses in recent years.   Drugged driving poses threats to public safety, as evidenced by a recent roadside survey which found that one in six drivers on weekend nights tested positive for the presence of drugs.  Preventing drug use before it starts is the best way to keep America’s youth drug-free.  In addressing each of these issues, the Strategy outlines a research-driven, evidence-based, and collaborative approach.

New Strategy elements also include a focus on making recovery possible for every American addicted to drugs through an expansion of community addiction centers and the development of new medications and evidence-based treatments for addiction.  Continued support for law enforcement, the criminal justice system, disrupting domestic drug traffic and production, working with partners to reduce global drug trade, and innovative community-based programs, such as drug courts, play a critical role in reducing American drug use and its effects.

For more information about the 2010 National Drug Control Strategy visit www.whitehousedrugpolicy.gov.

Photo Credit: http://www.whitehouse.gov

What Would a Genuine Drug War Look Like?

An essay on biomedicine and the body politic.

Millions of addicts in America want effective treatment, and cannot get it. Funds for research and treatment are still scarce, compared to money for interdiction and law enforcement. What would happen if we took the billions spent on interdiction and let it flow into addiction research and treatment? What would happen if we gave people truthful, accurate information about drugs, and trusted them to make intelligent decisions more often than stupid ones? Can it end up any worse that the present state of affairs?

Susan Sontag’s warnings about the danger of disease as metaphor still ring true. In modern American society, heart disease, cancer, AIDS, alcoholism, and cigarette addiction account for millions of deaths. They are all disease entities with strong psychological and behavioral components—complicated, multicellular, multi-organ disorders. But they have all been associated, at one time or another, with negative personality traits and moral flaws. The less we know about the mechanics of a human disorder, the more likely we are to view its external symptoms as signs of laziness, or neuralgia of the spirit, or as a form of damage caused by specific kinds of thoughts and emotions. Without a doubt, all kinds of flaws are sometimes expressed in the behavior of people who have these disorders. Yet none of these flaws can be considered the root cause of the diseases.

The genuine drug war is being fought in the arena of biomedicine. Addiction is being added to the roster of physical disorders once thought to be symptoms of insanity, but which are now seen to be physiological disease entities with mental components. The real crisis is the indisputable fact that there exists today an appalling shortage of funds for biomedical research. The cause of the dilemma is a fundamental misunderstanding among politicians and the public about how diseases can be understood and conquered. Research into the viral mechanisms of the common cold may ultimately yield more insights into AIDS then all of the directed research now underway. In biomedicine, there is no guarantee that goals can be reached through the front door, by a systematic assault akin to an engineering project. We cannot, for example, hope to cure addiction, or even the common cold, by means of the same methods we used to put a man on the moon.

There are, however, certain things we can do immediately, if we are serious about drug abuse. To begin with, we can attend to the staggering number of drug-related deaths, injuries, and hospitalizations caused by the abuse of prescription medications. The government itself has proven the case for this contention in numerous reports issued by the National Institute on Drug Abuse and other official bodies. According to the U.S. Department of Health and Human Services, older Americans account for more than half of all deaths from drug reactions, leading one to suspect that the majority of drug fatalities in this country stem from accidentally fatal overdoses by heavily medicated senior citizens. Our national fixation on illegal drugs has blinded us to the verifiable facts about prescription drug abuse.

We also need to recognize the problem of underprescribing morphine and other addictive painkillers for children and adults in hospital settings. One of the great scandals to come out of the drug war is the growing understanding that potent painkillers are not being offered in sufficient amounts to patients suffering intractable and agonizing pain.

“There’s a certain amount of hysteria about narcotics among doctors,” maintains one researcher.

At least half of all cancer patients seen in routine practice report inadequate pain relief, according to the American College of Physicians. For cancer patients in pain, adequate relief is quite literally a flip of the coin.

A September 10 New York Times report highlights studies by the World Health Organization which amply document the ongoing scandal in pain management. At least 6 million cancer and AIDS patients currently receive no appropriate pain treatment of any kind. In addition, WHO estimates that four out of five patients dying of cancer are also suffering severe pain. The numbers of untreated patients suffering intractable, unrelieved pain from nerve damage, burns, gunshots, sickle cell anemia, and a host of other medical conditions can only be guessed at. Typically, non-addicted patients take morphine therapeutically for pain at doses in the 5 to 10 mg. range. But experienced morphine addicts regularly take several hundred milligrams a day—a huge difference. In many cases, pain relief is the one thing doctors can offer their patients, and the one thing they withhold

These outcomes, rather than flashy cocaine seizures at the border, represent the lasting fruits of the drug war.

Photo Credit: www.foreignpolicyjournal.com

No Urine Test for Addiction

Drug wars never work.

The recognition that drug wars create crime is long overdue. More than fifteen years ago, a study of the economics of street drug dealing by the Rand Corporation confirmed that most drug dealers make more money illegally than they could possibly make through any form of legitimate employment. That equation has not changed.  For minors, drug dealing is without a doubt the best-paying job available to them. 

The effort to combat drugs has poisoned our relationships with other countries. Farmers in Latin America, Southeast Asia, and Afghanistan are not the source of the drug problem. The danger of concentrating on the interdiction of foreign shipments is that it breeds the fantasy solution—a belief that the nation’s drug problem can be solved offshore, if the barriers and borders of the United States are vigorously defended.

Drug wars weaken the force of law at home. Minor drug laws are flouted with impunity, while basic civil rights are under attack in the name of national security. Drug wars ask a lot from citizens:  weakened rules of evidence, the erosion of the doctrine of probable cause, and an end to the presumption of innocence, for starters.

A different strategy would obviate the need for these enhanced powers of repression and control. Drug wars foster a form of social hypocrisy. Many of the country’s finest doctors, scientists, judges, and legislators have routinely used illegal drugs in their past. Yet their lives were not irreparably damaged, their futures thrown on the trash heap. Millions of productive citizens now in their 40s and 50s know that youthful drug use need not be permanently deleterious. They dare not speak up, of course. The people who have the most experience with these drugs have been systematically excluded from the public debate. The emerging models of addictive disease call into question almost every aspect of drug wars as they have been historically waged.

For many Americans, the use of alcohol, cocaine, or any other addictive drug is a matter of personal recreational choice. None of the strategies employed in the drug wars of the past four decades has been able to override the fact that prohibition can only be effective with the cooperation of the citizenry. Without voluntary compliance, the only recourse is federal coercion; some Orwellian nightmare of detection, control, forced detoxification, and detention.

Only a fraction of the nation’s corporations had drug-testing programs in place in 1990, but the number has climbed dramatically ever since. Inaccuracies and false positives have bedeviled drug-testing programs from the outset. Ibuprofen, available over the counter as Advil or Motrin, registers on some tests as positive for marijuana. Cold remedies such as Nyquil, Allerest, Contac, Dimetapp, and Triaminicin all contain a substance, phenylpropanolamine, which sometimes shows up as positive for amphetamine. The list of potential false positives is a long one.

Many drug testing programs do not test for alcohol, and even if such constitutionally dubious testing programs were unerringly accurate in what they do test for, there would still be valid reasons not to adopt them. Few people would insist that the presence of alcohol metabolites in the bloodstream is incontrovertible proof of incompetence on the job. But we frequently make this assumption in the case of illegal drugs, in part because the drug tests themselves are not refined enough to reliably distinguish between casual use and consistent abuse. There is no urine test for addiction. 

Adapted from The Chemical Carousel: What Science Tells Us About Beating Addiction by Dirk Hanson © 2008.

If You’ve Seen One Drug Czar....

The language of drug politics.

In a May 29 post on his Salon blog, Drug WarRant, Peter Guither deftly deconstructs the language of drug czarism, and its corrosive effect on rational dialog over drug policy:

--So far, there has been little or no discussion of marijuana from the newest drug czar, Obama’s man Gil Kerlikowske, now director of the White House Office of National Drug Control Policy. “I've got to admit that it's a nice change from the reefer madness reign of Walters,” Guither writes. “Maybe Kerlikowske is following my mother's age-old advice... If you can't say something nice (and he can't by law), then don't say anything at all.”

--Prescription drugs are “the new crack.” To his credit, Guither worries about this new emphasis, and where it is likely to lead: “The prescription drug "epidemic" will be an excuse to further crack down on diversion, which will end up continuing the focus on pain doctors who prescribe large amounts of pain medication, with DEA agents deciding they know more than doctors. The result will be even more people suffering, unable to get the pain medication that actually makes life possible for thousands of people.”

--Drugs cause crime. As proof, Kerlikowske cites the statistic that half the men arrested in ten major U.S. cities tested positive for some sort of illegal drug, as reported by USA Today. From this data, Kerlikowske concludes that there is “a clear link between drugs and crime.” Guither notes that “There's a lot of reasons that people who have been arrested would tend to test positive for illicit drug use than the general population..... A very large percentage of arrests are for drug crimes, which naturally skews the population. Then there are socio-economic factors and a lot more.”

However, what the new drug czar is implying, writes Guither, is that drugs cause crime. “But implying that drugs cause crime is a lie. And that's what drug czars do.”

Kerlikowske has also come out in favor of greater use of drug courts as an alternative to prison sentences. Bill Piper, director of national affairs for the Drug Policy Alliance Network, told USA Today he agreed that drug use should be seen as a public health issue, but that “people shouldn't have to get arrested to get treatment."

Photo Credit: Lifehype Magazine

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