http://www.bmj.com/cgi/content/full/bmj.c3360?ijkey=xIwckDCjknVi9wn&keytype=ref

 

Comment Columnists / Mindelle Jacobs

HIV only winner in useless drug war

By MINDY JACOBS, QMI AGENCY

Last Updated: July 26, 2010 10:00pm

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Over the centuries, scientists who dared to challenge rulers of the day often found themselves in jail. Today, politicians who prefer ideology over truth just stick their fingers in their ears.

The key statement that emerged from last week’s International AIDS Conference was a declaration asking governments to base their drug policies on scientific evidence.

So far, about 14,000 people have signed the so called Vienna declaration, including Nobel Laureates, former heads of state, religious leaders and experts in science, medicine and law.

In Canada, five provincial medical officers of health and the Canadian Public Health Association have endorsed the statement. So have past presidents of Mexico, Brazil and Colombia, as well as the wife of the president of Georgia, the deputy chair of the Georgian parliament and that country’s minister of labour, health and social affairs. Georgia is one of the hardest hit countries in eastern Europe in terms of the spread of HIV.

In Mexico, about 23,000 people have been killed since Mexico launched its anti-drug campaign in 2006. The drug war is getting more violent in North America as well.

But both the U.S. and Canada have shied away from taking a stand on the declaration.

Maxine Davis, head of Vancouver’s Dr. Peter AIDS Foundation, says she asked Health Minister Leona Aglukkaq at the AIDS conference if she agreed clean needles can prevent HIV.

“She repeatedly failed to confirm her support.”

If the Canadian health minister can’t summon up enough courage to acknowledge the importance of clean needles in the fight against HIV, what hope is there for intelligent debate? Reason, it seems, has been strangled by political intransigence.

The declaration calls for a review of the effectiveness of drug policies and a science based public health approach to the harms stemming from illicit drugs. It also urges the decriminalization of drug use.

The drug war has wasted billions of dollars, fuelled rising HIV rates and destabilized countries such as Colombia,

Mexico and Afghanistan, the statement points out.

Countless lives have been lost and drug lords are laughing all the way to the bank.

Meanwhile, your taxes are going up to pay for all that useless drug law enforcement. “This is something that conservatives should identify with — lack of government accountability (and) the wasting of tax dollars,” says Dr. Evan Wood, founder of the Vancouver- based International Centre for Science in Drug Policy.

“You’d think that (the federal government) would change policy if there was something that showed that public health can be improved and tax dollars can be saved.”

Each case of HIV costs Canadian taxpayers about $250,000, notes Wood, who chaired the committee that wrote the Vienna declaration.

“At the end of the day,” he says, “any effort to reduce the supply of drugs has the perverse effect of making it that much more profitable for someone else.”

Wood’s centre recently did a review of studies on the effect of drug enforcement on drug-related violence.

The vast majority of the studies concluded that increased enforcement leads to greater drug-related violence.

“We’re in a fight between science and ideology,” says Wood.

Perhaps it’s our politicians — not our drug addicts — who should be in jail.

mindy.jacobs@sunmedia.ca

The Washington Post
Sunday, July 25, 2010

Colorado official works to regulate, legitimize medical marijuana industry

By Michael W. Savage
Washington Post Staff Writer

DENVER -- When Matt Cook was coaxed out of early retirement to become Colorado's chief revenue enforcer three years ago, he assumed his time would be spent overseeing the casinos, liquor stores and car dealerships he had been keeping an eye on for much of his career.

If he had hoped for a quiet few years before heading for the golf course, his timing could not have been worse.

Cook, senior director of enforcement at Colorado's Department of Revenue, returned just as a new kind of business rolled into town promoting a controversial product. Medical marijuana was legalized a decade ago in the state, but retail-style dispensaries began springing up only in 2007.

The trickle of new outlets has turned into a flood. Officials think more than 1,100 dispensaries are operating statewide. As the numbers grew, dispensaries offered ever more cannabis strains, marijuana-infused products and delivery services.

When alarmed lawmakers decided they wanted to curb the burgeoning industry, all eyes turned to Cook. "It was last Christmas that I saw this was heading our way," he said. "Merry Christmas."

Relatively late in his career, Cook has become a pioneer in the medical marijuana industry, drawing up a stringent regulation scheme that aims to turn the industry into a legitimate -- and respectable -- enterprise.

"We plan to track the entire commodity from seed to sale," the 53-year-old said. "We will use a Web-based, 24-7 video surveillance system, and we will see virtually everything from the time a seed goes into the ground to the time the plants are harvested, cultivated, processed, packaged, stored."

The regime may be copied by the 13 other states that already have legalized medical marijuana and the 14 additional states that could soon allow its use. Cook's counterparts in other states, as well as the District, have been seeking advice.

Legislation passed by the D.C. Council in May permits the establishment of up to eight dispensaries. Virginia and Maryland do not permit medical marijuana use.

"I didn't find tough regulatory schemes out in any of the other states,"
Cook said. "The numbers of dispensaries they have are very limited. It is the most intensive period of work I have had at any point in my career."

A drive down Denver's Federal Boulevard, an industrial stretch running through the inner city, illustrates why his expertise was needed. New dispensaries, with their marijuana-leaf signs, are providing the latest source of urban regeneration.

Herbal Wellness, just down the street from a derelict movie theater, has a steady flow of patients. The pungent smell of its produce wafts through the front door. A sign displayed by the roadside tells passing
drivers: "Sale! $250 an ounce." Chronic Wellness, Daddy Fat Sacks, Doctors Orders, Earth's Medicine and Mr. Stinky's are among the other vendors found along the strip.

Denver and Colorado Springs could have as many as 500 dispensaries each, officials estimate. Dozens also have opened in Boulder.

However, the new regulations have stopped the boom and are widely expected to cut the number of outlets significantly. No new dispensaries can be opened until next summer. Existing owners wanting to remain in business have to apply for a license by Aug. 1.

Anyone wanting a license has to fill out a 22-page form detailing immediate family and personal financial history. People with drug-related felonies are disqualified. When all the rules kick in on July 1 next year, practices such as giving away free joints will be outlawed. Delivery services will be allowed only in rare cases.

In the first year, even the smallest dispensaries must hand over at least $7,500 for a license, while bigger operations will have to find as much as $18,000 to stay in business.

Cook's starring role in shaping legal marijuana sales is all the more remarkable given that, 30 years ago, Cook was a narcotics enforcement officer who threw Colorado's cannabis growers behind bars. His Drug Enforcement Administration training certificate, dated 1980, hangs on his office wall. On a table, three volumes of Colorado statute sit next to a copy of Cannabis Connoisseur magazine.

He says his past made his new task a "big pill to swallow" but insists it is all aimed at ensuring genuine patients receive the best treatment.

Some in the industry have decided to get out before the wave of new rules hits.

"We've been jumping hoops since the beginning to get compliance, and it is getting tiring," said Charlie Van Valkenburg, who is selling his 5280 Wellness dispensary.

Cook says the new licensing requirements will shut down some shops. On a visit to the Tender Healing Care dispensary, Cook stood next to a glass counter filled with marijuana strains as he outlined some of the new rules to Geoff Graehling, the dispensary's co-owner. Cook explained that 70 percent of the marijuana sold in the store will have to be grown there and that each jar of cannabis will need to be labeled with the chemicals used during its production.

Despite the paperwork, costs and modifications, Graehling and his fellow owner, Barb Visher, say they are embracing regulation. "I think it was needed to deal with some of the bad apples that are operating,"
Graehling said. They are not alone in welcoming the chance to earn respectability. "Compared to the Wild West we've been in, the regulations are actually going to put some legitimacy on the medical marijuana laws," said Andy Cookston, owner of Cannabis Medical, Denver's first dispensary.
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Golden State eyes pot of gold
Potential for budget relief is at stake as Californians vote this fall on legalization of marijuana
Peter Henderson
Edmonton Journal
July 26, 2010

attached - From the Vancouver Sun, July 19, 2010.

 

 

Fighting Drugs With Drugs: An Obscure Hallucinogen Gains Legitimacy as a Solution for Addictions

By Steven Kotler Posted 07.21.2010 at 11:25 am

 
Trippy Medicine Ibogaine, derived from a plant root, acts on the brain’s nicotine receptors to help alleviate cravings for alcohol and drugs like heroin. Courtesy Christopher Hansen/Clare S. Wilkins/Pangea Biomedics

Giving a heroin addict one of the most powerful psychedelic drugs seems like a bad idea. Yet that’s exactly what a group of scientists will do this month. Ibogaine, they say, might be the best way to break drug addicts of their habit.

Ibogaine, a brown powder derived from the African Tabernathe iboga plant, has intrigued researchers since 1962, when Howard Lotsof, a student at New York University and an opiate addict, found that a single dose erased his drug cravings without causing any withdrawal symptoms. Unfortunately, the hallucinogen can increase the risk of cardiac arrest, and the U.S. Drug Enforcement Agency lists it as a Schedule 1 substance, a classification for drugs like ecstasy and LSD with “no known medical value” and “high potential for abuse,” making it difficult to get federal funding to run clinical trials.


Ibogaine Roots:  Laurent Sazy/Fedephoto
Animal tests, however, have shown the drug’s medicinal promise. “Rats addicted to morphine will quit for weeks after receiving ibogaine,” says Stanley Glick, the director of the Center for Neuropharmacology and Neuroscience at Albany Medical College. And addicts have reported positive effects in Mexico and Europe, where ibogaine therapy is legal. “Going cold turkey is horrible. There’s vomiting and diarrhea and pain and a constant drug craving,” says Randy Hencken, a drug user who was treated in Mexico. “After ibogaine, I didn’t feel any symptoms or cravings. I’ve been clean for nine years. Heroin and cocaine no longer have any power over me.”

Despite these successes, ibogaine lacks scientific credibility. “As great as ibogaine seems, no one knows exactly how effective it is as a treatment,” says Valerie Mojieko, the director of clinical research for the Multidisciplinary Association for Psychedelic Research (MAPS), a privately funded Massachusetts-based nonprofit. So starting this month, MAPS will enlist Clare Wilkins, the director of Pangea Biomedics, to run the first long-term study to gauge the drug’s lasting effects at her clinic in Mexico (where patients already pay $5,000 for the treatment). She will treat 20 to 30 heroin addicts and, for the next year, MAPS will subject them to psychological and drug tests to quantify ibogaine’s effectiveness.

The study will also help establish how to prescribe the drug safely. “Most psychedelics are relatively harmless,” says neurologist Deborah Mash of the University of Miami, “but ibogaine has a much narrower margin for error.” Mash runs an ibogaine clinic in St. Kitts and has treated more than 400 addicts without incident in the past decade. But in the early 1990s, overdoses of the drug at a clinic in the Netherlands led to several deaths, which ultimately scared off the National Institute of Drug Addiction (NIDA) from starting its own research program in the U.S.

From the limited research, though, scientists have two theories about how ibogaine works. Some say it’s purely biological­that ibogaine degrades into a compound that binds with opiate receptors in the brain to quiet cravings. Others believe that it is also psychological, with the “whole-life review” part of the hallucination providing perspective on the negative aspects of drug use, and so the subject strives to quit.

Regardless of the mechanism, proving ibogaine works is essential to winning approval and funding for clinical trials in the U.S. The sooner the better: Nearly seven million Americans abuse illicit drugs, costing the nation an estimated $181 billion a year in health care, crime and lost productivity.

The MAPS study should begin to answer questions about ibogaine’s efficacy and safety, but most experts think prescriptions are 10 to 15 years away. Until then, desperate patients will continue to seek out treatment in unregulated places such as Mexico, and that’s ideal for neither the patients nor the researchers. Rick Doblin, the founder of MAPS, hopes this study will force regulators’ hands. “If we can show great results, it could increase support for ibogaine clinics and maybe get NIDA interested again­because that’s who really should be doing this research.”

Drugs and Needles:  Marianne Williams/Getty Images

Please note my NEW email address:

annlive@telus.net

http://www.nationalpost.com/news/Eight+great+things+about+cancer/3315065/story.html

#2 is about the value of marijuana from someone who starts "When you’re not into marijuana, it takes some mind-bending to think of the substance as a medicine..."

 

War on drugs helping spread HIV: criminalisation of illicit drug use

 

Alex Wodak

The Australian

July 24, 2010

THE international system of drug prohibition is under increasing challenge these days.

As illustrated by the Vienna Declaration launched at the recent International AIDS Conference, powerful voices are arguing that prohibition is undermining efforts to slow the spread of HIV among and from injecting drug users.

The declaration articulates the argument that the criminalisation of illicit drug users is fuelling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. A full policy reorientation is needed.

Recent papers and editorials in leading medical journals have picked up these themes, specifically the failure of the war on drugs and the need to consider how states, rather than criminals and corrupt police, could regulate these drugs.

An important new guidance document issued by the US President's Emergency Plan for AIDS Relief finally endorses harm reduction, though still not by name.

The Vienna Declaration (www.viennadeclaration.com) was drafted by very senior international figures including Nobel laureate Francoise Barre-Sinoussi, co-discoverer of HIV, Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, TB and Malaria, and Julio Montaner, president of the International AIDS Society.

Thousands of people from many counties around the world signed the declaration.

Vienna was chosen as the site for this international AIDS conference largely because of its proximity to Russia and other countries in eastern Europe and Central Asia that responded poorly to the epidemic of HIV spreading among injecting drug users.

Many of these countries recently intensified their massive investment in drug law enforcement at the very time that it's become clear that law enforcement has failed to cut global drug supplies, merely shifting problems from one place to another.

In recent decades, the price of street drugs has slumped and their purity has increased. But drug law enforcement is supposed to increase the price of street drugs and decrease their purity.

Illicit drug use is also spreading to more countries.

The international trade in illicit drugs is estimated to have an annual turnover of $US322 billion ($364bn).

The lucrative profits are fuelling crime, violence, instability and corruption in countries including Colombia, Mexico, Pakistan and Afghanistan.

The sharing of needles and syringes among injecting drug users accounts for one in three new HIV infections outside sub-Saharan Africa.

This means injecting drug use now accounts for one in 10 new HIV infections in the world.

The declaration notes that in some countries 70 per cent of injecting drug users are infected with HIV and 80 per cent of new HIV infections are attributed to injecting drug users.

Recognition that zealous drug prohibition and HIV control among injecting drug users are mutually exclusive options is not confined to AIDS activists.

UN Secretary-General Ban Ki-Moon said in May 2009 that in addition to criminalising HIV transmission, many countries impose criminal sanctions for same-sex sex, commercial sex and drug injection. Such laws constitute barriers to reaching key populations with HIV services.

Those behaviours should be decriminalised, and people addicted to drugs should receive health services for the treatment of their addiction.

Last month the UN Development Program, together with UNAIDS, announced the formation of a new global commission to examine how legal environments affect HIV efforts. Their joint press release notes that laws can compromise the ability of high-risk populations to access HIV prevention and treatment.

Global drug prohibition also makes it more difficult to raise the funding needed for effective HIV prevention services. Each year the world spends only $US180 million on harm reduction while it's estimated that $US2.13bn is required.

Consequently, the world provides an average of only two sterile needles and syringes per drug user each month. Only 8 per cent of international heroin injectors are in methadone treatment.

After a long struggle, some countries are now beginning harm reduction programs while others are rapidly expanding old programs with low coverage.

In recent weeks, methadone treatment has begun in Tajikistan, Morocco, Cambodia and Bangladesh; it began in Afghanistan in February.

But while there've been recent moves towards more enlightened and effective approaches to illicit drugs, there've also been a few painful backwards steps.

This month, for instance, the UN's Ban appointed Yuri Fedotov, a Russian diplomat, as executive director of the UN Office on Drugs and Crime.

Yet in Russia, 37 per cent of people who inject drugs have HIV and injecting drug users account for about 80 per cent of new HIV infections.

Further, Russia refuses to provide opioid substitution therapy such as methadone, opposes the most effective means of controlling HIV among injecting drug users and has an appalling record of breaching the human rights of injecting drug users.

Clearly, Fedotov's appointment will severely damage the credibility of UNODC as the UN's leading agency on HIV related to injecting drug use and prisons.

Still, the Vienna Declaration is another sign that the system of global drug prohibition, which began 101 years ago, is slowly dying.

Although it's not yet known what will replace the old system, it's clear a new system will one day abandon the one-size-fits-all approach for nations and be based solidly on science and human rights.

Alex Wodak is director of the Alcohol and Drug Service at St Vincent's Hospital in Sydney

http://www.theaustralian.com.au/news/health-science/war-on-drugs-helping-spread-hiv-criminalisation-of-illicit-drug-use/story-e6frg8y6-1225895832406

 

Dr. Alex Wodak,
Director, Alcohol and Drug Service,
St. Vincent's Hospital,
Darlinghurst, NSW, 2010,
AUSTRALIA

Telephone: (61+02) 9361 8012
If no prompt answer, try 9361 8014
Facsimile: (61+02) 8382 4738
awodak@stvincents.com.au

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Why our drug policy is 'inconsistent' with all available evidence

The Ottawa Citizen

Fri Jul 23 2010

Page: A13

Section: Arguments

Byline: Dan Gardner

Column: Dan Gardner

Source: The Ottawa Citizen

It's safe to assume most people have never heard of the "Vienna Declaration." And that simple fact helps explain why public policies that fail -- policies that do vastly more harm than good -- can live on despite overwhelming evidence of their failure.

The Vienna Declaration, published in the medical journal The Lancet, is an official statement of the 18th International AIDS Conference, which wraps up today in Vienna. Drafted by an international team of public health experts, including Evan Wood of the University of British Columbia, the Vienna Declaration seeks to "improve community health and safety" by, in the words of the committee, "calling for the incorporation of scientific evidence into illicit drug policies."

Please don't stop reading. I promise this will not turn into another of my rants about the catastrophic failure of drug prohibition. I've been writing variations on that theme for more than a decade now and everyone knows I am a crazed extremist whose views are not to be trusted by decent folk. I'll spare you.

Instead, I will merely present a few sentences from the Vienna Declaration:

- "The criminalization of illicit drug users is fuelling the HIV epidemic and has resulted in overwhelming health and social consequences."

- "There is no evidence that increasing the ferocity of law enforcement meaningfully reduces the prevalence of drug use."

- "The evidence that law enforcement has failed to prevent the availability of illegal drugs, in communities where there is demand, is now unambiguous. Over the last several decades, (there has been) a general pattern of falling drug prices and increasing drug purity -- despite massive investments in drug law enforcement."

- (Existing policies have produced) "a massive illicit market. ... These profits remain entirely outside the control of government. They fuel crime, violence and corruption in countless urban communities and have destabilized entire countries, such as Colombia, Mexico, and Afghanistan."

- "Billions of tax dollars (have been) wasted on a 'war on drugs' approach ...."

- Governments should "undertake a transparent review of the effectiveness of current drug policies."

- "A full policy reorientation is needed."

Remarkable, isn't it? It's exactly what this crazed extremist has been saying for more than a decade and yet the people who wrote and signed it are anything but crazed extremists. Among them is a long list of esteemed public health experts, including the president of the International AIDS Society, the executive director of the Global Fund to Fight AIDS, TB, and Malaria, and Canada's own Dr. James Orbinski. There are former presidents of Brazil, Mexico, and Colombia. And there are several Nobel laureates, including the economist Vernon Smith. (See the full list of signatories, along with the statement, at viennadeclaration.com).

This should be big news. Drug policies affect everything from the local street corner to the war in Afghan-istan -- and here is a long list of informed and eminent people who agree what we are currently doing is a horrifying mistake that wastes money and takes lives. The public should be alarmed.

But this is not big news. And the public is not alarmed. In fact, most of the public has never heard of the Vienna Declaration. Why not?

To answer that, let me take you way back to Sept. 5, 1989. That evening, U.S. president George H.W. Bush made a televised national address. Holding up a bag labelled "evidence," Bush explained that this was crack seized at the park across the street from the White House. Crack is everywhere, he said. It's an epidemic. Bush vowed "victory over drugs."

The whole thing was a fraud. Federal agents had tried to find someone selling drugs in the park but couldn't. Posing as customers, they called a drug dealer and asked him to come to the park. "Where the (expletive) is the White House?" the dealer said. So the police gave him directions.

This chicanery was exposed not long after but it didn't matter. Bush's address was a smash. The media bombarded the public with hysterical stories about the "crack epidemic." Popular concern soared. And "all this occurred while nearly every index of drug use was dropping," noted sociologists Craig Reinarman and Harry G. Levine.

The power to throw the switch on media coverage isn't exclusive to the White House, of course. In 1998, the United Nations convened a General Assembly Special Session which brought leaders from all over the world to discuss illicit drugs. The media deluged the public with stories about drugs -- and the UN's official goal, signed at the end of the assembly by all member states, of "eliminating or significantly reducing the illicit cultivation of the coca bush, the cannabis plant and the opium poppy by the year 2008."

Time passed. The Special Assembly was forgotten. When 2008 rolled around, cocaine output had increased 20 per cent and opium production had doubled. But this spectacular failure was almost completely ignored in the media. Why? The UN stayed mum. So did national governments. With no major institutions putting the subject on the agenda, the media ignored it.

This is the essential problem: If governments talk about drugs, journalists talk about drugs; if they don't, we don't. And since governments are full of people whose budgets, salaries, and careers depend on the status quo, they talk about drugs when doing so is good for the status quo, but they are silent as mimes when it's not. Thus the media become the unwitting propaganda arm of the status quo.

I'm not sure what it will take to change this. It would certainly help if the media would stop letting governments decide what is news and what is not. Even better would be leaders with the courage to put evidence ahead of cheap politics, entrenched thinking, and vested interests.

But that's not happening. And so, on Monday, the government of Canada felt free to categorically reject the Vienna Declaration because it is "inconsistent" with its policies -- policies which have never been subjected to evidence-based evaluation and would surely be condemned if they were.

This is how failure lives on.