Archive for the ‘Social programs’ Category

Portugese drug reform 10 years later: no “illusion” that society will be drug free

July marks the 10-year anniversary of a radical experiment in drug policy in Portugal:  complete decriminalization of all drugs. Earlier this month, I had an opportunity to visit Portugal and interview government officials, public health workers, addicts and non-profit volunteers about the impact of drug decriminalization and a host of related public health reforms.

A psychologist with Associasão Ares do Pinhal, a government-contracted non-profit based in Lisbon, holds syringes and other public health supplies distributed to heroin addicts. Robust harm reduction programs are key elements of Portugal's drug strategy.

To the Portugese, drug abuse is a health issue, first and foremost. That’s how they got to this point: In the 1990s, about one percent of the Portugese population was addicted to heroin. While the country’s overall drug rates were about on par with other European nations, the rate of problematic drug use was alarmingly high. HIV and Hepatitis C were spreading rapidly among intravenous drug users. Public consumption of drugs and drug trafficking had become the number one public concern. Instead of digging in its heels in the war on drugs, the government convened a panel of experts and actually listened to them, bringing the war to its end.

Luis Mendão, a Portugese AIDS activist and drug policy reformer, recalls the rationale: “Some of us were convinced – are convinced – that drugs and psychostimulant drugs have always been used in society. Alcohol. Poppy seeds. Coca leaves. The solution that was found in going deeper and deeper in the war on drugs not only did not achieve the goal of zero consumption in the country, but it also did more harm than good. To transform someone who has a problem into a criminal is the wrong approach.”

In 2001, the Portugese parliament declared that personal possession of drugs – generally regarded as up to 5 grams of hashish, 25 grams of marijuana, one gram of heroin or 10 pills of ecstasy or other drugs – was no longer a crime. Today, if you are caught using drugs in public you are referred to a local “dissuasion board” which determines if you are an addict or a recreational user. Addicts are referred to free government treatment (though not compelled to participate). Recreational users are told that drugs are dangerous and still illegal and often (but not always) given a fine that is the equivalent of a speeding ticket. (Note that I specifically referred to doing drugs in public, like on the street or in a public park. Police will not investigate cases of drug use inside your home, unless you are suspected of drug trafficking – which is still a crime.) The dissuasion commissions are part of the Ministry of Health – not part of the criminal justice system. To the Portugese, addiction is a disease; recreational use is, well… who cares?

“A drug free society is not doable, so we are not aiming for that,” explains Nuno Portugal Capaz, a sociologist and vice president of the Lisbon dissuasion board. “We are trying to change their drug using from addiction. We don’t try to push people from doing drugs. We try to prevent people from misusing or abusing it.”

From most indications, it is working: problematic drug use and use among youth is down and the rate of new HIV infections among drug users has plummeted, officials say. While there was an uptick in overall rates of adults who have tried drugs at some point in their lives (which has been latched onto by anti-drug forces), officials explain this is because the population who never tried drugs (prior to the nation’s 1974 revolution that opened up trade and travel to and from the country) are dying off.  The country has also not become a mecca of drug tourism, as some feared — primarily because it is just as difficult to get drugs in Portugal as it is anywhere else. There is no legal equivalent to Amsterdam’s coffee houses or anything. The only advantage a tourist would have is knowledge that they won’t go to jail if they are caught. (I’ll let the experts weigh in on the outcome: Here’s the much publicized 2009 report from the Cato Institute and the more recent and well-rounded analysis that appeared in The British Journal of Criminology  late last year.)

Dr. João Goulão, president of Portugal’s Institute of Drugs and Drug Addiction (IDT), a branch of the health ministry which oversees the nation’s drug strategy, stresses that it is the public health component – not the change to criminal law – that has made the real impact in the country. The reality is that Portugal never locked away all that many drug users anyway. Still, drug decriminalization freed up activists to give out clean syringes and drug addicts felt more comfortable seeking help. Today, IDT operates a number of treatment clinics that are mostly free, offering a range of treatment services including methadone treatment, detoxification and a day center where addicts learn socialization skills. The agency and local governments also contract with non-governmental organizations to provide harm reduction services to more marginalized populations. (See pictures.)

Goulão says he believes societies need to learn to “live with” drug use, just like we live with disease. “I don’t think this solves the problem in our society, but I feel we are dealing with it in an appropriate way. We don’t have the illusion that we can eradicate drug use,” he says.

Heroin addicts get methadone from a mobile van operated by the non-profit Associasão Ares do Pinhal under a bridge in Lisbon. The group is funded by national and local government contracts.

An addict takes the methadone, distributed in the van by a nurse. Addicts also get regular screenings for AIDS, tuberculosis and other diseases.

READ MORE: A more detailed essay on Portugal’s drug policy will appear soon in a U.S. political magazine. This post will be updated with the details. 

-AJC

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New AZ medical pot industry could be targeted by feds

Large-scale marijuana growers and dispensaries in Arizona could be prosecuted under federal law – even if they comply with new regulations governing the state’s fledgling medical marijuana industry. In a letter to state health officials, the U.S. Attorney for Arizona Dennis K. Burke said his office would not devote resources to prosecuting medical marijuana patients but left the door open to “vigorously prosecute individuals and organizations that participate in unlawful manufacture, distribution and marketing activity involving marijuana, even if such activities are permitted under state law.” It is important to note, however, that Burke did not mention state employees in the letter. In a similar letter last month, Burke’s counterparts in Washington State specifically warned state officials there that government employees could be prosecuted if they licensed marijuana dispensaries in that state. Burke’s letter has led to calls by opponents for the state to halt implementation of the voter-approved medical marijuana law.  However, most involved say they think it will just change the size and scope of the new marijuana businesses, curbing large operations.

Read Burke’s letter here.

Read The Arizona Republic story here.

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Zoraya’s Story: Drug court offers treatment & hope

 A row of plastic coins in silver, red, orange and green are affixed along the side of a mirror in Zoraya Arias’ bathroom at the Center for Hope treatment center in Mesa. There are nine of them – one for every month she has stayed clean.

 “I keep things to remind myself: I have a life worth living,” she tells me.

Zoraya, 25, is a former meth addict with the kind of life story that makes you think that maybe if it were you, you might have turned to meth to numb your frontal lobe, too. When Zoraya was six years old she saw her mother gunned down in a drive-by shooting during a family picnic in their front yard in Central Phoenix. A few years later, her dad went to prison. She has a middle school education. She started using alcohol, marijuana, cocaine and other drugs in her teens. She had her first child at 19. She stuck around for a few months, then she took off, leaving her son with his father’s family. She started using meth.

In the beginning “a twenty” of meth ($20 worth) would last her for a week. By the end, she and her friends would put away an “eight ball” that costs $200 in a few hours. To make money for meth, Zoraya became a “party girl.” When men asked if she was a prostitute she would say “no, but I’m not free.” At first, she lived in denial. Then she started walking the streets in stilettos and turning tricks at the La Quinta where she lived for a while. The drugs and prostitution came together in a vicious cycle: she had to get high to do what she was doing; she had to do what she was doing to get high. “I did things I never thought I would do,” she says. She got pregnant again and lost the baby.

Eventually the cops showed up at the La Quinta. She was arrested and put on probation. She didn’t get any treatment. She kept using meth. She was arrested again and went to jail. This time, she was placed in Maricopa County Drug Court.

I met Zoraya last month while researching drug court for a feature article that will appear in the April medical issue of Phoenix Magazine. Drug court is an alternative to incarceration, a program that combines drug treatment and probation to help addicts get clean and stay out of crime. In Arizona, the program is post-conviction: Participants are assigned to drug court as part of probation, with the threat of a prison term hanging over their head if they mess up. It is the only place in the criminal justice system here where an addict is guaranteed to get intensive drug treatment regardless of ability to pay. Research shows that treatment is much more effective than incarceration in helping to break the cycle of addiction and crime, and yet even though most Arizona prisoners have underlying substance abuse issues few get treatment. (And the treatment that is available is often not sufficient to meet their needs.)

Drug courts have been touted as one of the most successful criminal justice innovations of the last two decades. Research commissioned for the federal government’s National Institute of Justice found they save money, reduce crime and fight addiction. (Read more from the National Association of Drug Court Professionals here.)

For Zoraya, drug court combined with residential treatment has helped her get on the path to turn her life around. “I gained so much because I wanted to change my life,” she says. “Drug court gave me so many chances and opportunities.”

At first, she continued using even while participating in drug court. She was ordered into residential treatment. When she tried to slit her wrist, they kicked her out. She draws her finger up the inside of her left forearm along a ridge of scars. She’s been “a cutter” since age 10 – it is a coping mechanism, she tells me. The facility was not equipped to deal with her mental health issues, too. She went to another facility and got kicked out again. She was thrown in jail for 45 days last year. It was there that her attitude turned around. In May, she was admitted to the Center for Hope, a long-term residential facility specifically designed for women with children and mental health challenges.

The Center for Hope is a non-descript commercial building, set back from a residential street. While most residential facilities keep patients 30-90 days, the Center for Hope is a yearlong program that also helps with transitional housing afterward.  Children under four years old can stay there with their mothers.

Zoraya says the program has taught her how to cope with her past and prepare for the future. “I learned to understand and forgive my past. I have made a lot of mistakes and I am willing to make amends with everyone and myself,” she says. She is working on her GED and looking for a job in retail. She wants to be a peer counselor to help others get off drugs. One day, she would like to open a restaurant with her party girl name, “Ra Ra’s Bar & Grill.” She specializes in cooking soul food. “I learned I am a strong woman. I am determined to do more in life,” she says. “Although, there are a lot of things that happened, I don’t let it get to me. I don’t want to sound conceited…” She throws her dark hair back and laughs: “I love the way I am now!”

In her room at the treatment facility, she points to a picture of a too-thin woman with poorly bleached hair and hollow eyes. It is hard to recognize the curvy, happy, bubbly woman she is now in that image. She pulls out an old ID card to prove it.

Her room is a shrine for the son she left behind and for her own budding hope. She shows a visitor a picture of the boy, C.J., in a frame that says “My Angel.” She says she is getting better for him. More pictures of him are all around the room, along with photos of friends and family members. Inspirational messages are everywhere: on picture frames, clipped and pasted to the walls, on a poster behind the door: “Seize the moment.” “Be yourself.” “It’s time to feel good again.” “Survivor.”

In a criminal justice system far better at punishing drug addicts than rehabilitating them, Zoraya’s turnaround through drug court is a an example of one of the things we may be doing right.

–AJC

Read Amanda J. Crawford’s feature on Maricopa County Drug Court, “All Rise, Some Fall” in Phoenix Magazine’s April medical issue.

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This Week in Drugs (Feb. 5, 2011)

Mexican authorities in Guadalajara were scrambling Tuesday night to regain control of the country’s second-largest city after violent clashes between criminal gangs and police, the Associated Press reports. The suspected drug cartel gunmen used grenades and forced civilians out of their cars, using them as roadblocks on major streets. Fernando Guzman Perez, interior secretary of the state of Jalisco, said the seven coordinated attacks were likely in retaliation for  recent arrests of drug cartel members.

This prompted American officials to warn U.S. citizens not to drive at night in certain areas of Guadalajara, the AP reports. A message on the website of the U.S. consulate in Guadalajara posted  Thursday said the consulate had prohibited U.S. diplomatic personnel from traveling the highway to the airport at night, and that it “recommends that U.S. citizens consider similar precautions.”

The Ladies Professional Golf Association canceled the Tres Marias Championship in Morelia, Mexico, over safety concerns regarding the violence from the drug war. LPGA spokesman David Higdon told the AP that its security firm “determined the safety issues were too severe” but the association hopes to return next year if conditions have improved.

Emilio Gutierrez Soto, the Mexican journalist who fled across the border after saying he received death threats due to his critical coverage of the Mexican military, spent seven hours pleading his case to Immigration Judge Robert Hough in El Paso before it was rescheduled for May 9, 2012. The AP reports that Gutierrez and his son were placed in immigration jail for seven months but that Gutierrez has obtained a work permit and is supporting his son and himself with odd jobs in Las Cruces, New Mexico.

Border Patrol Agent Bryan Gonzalez was allegedly fired for talking to a fellow agent about Law Enforcement Against Prohibition and stating his opinion on the matter of legalization of marijuana. Gonzalez has filed a federal lawsuit alleging his termination violated the First Amendment.

Former South Carolina Treasurer Thomas Ravenel has recently spoke out on America’s drug war by calling the government’s response a failure and advocating the end of drug prohibition, The Post & Courier of Charleston, S.C., reports. Ravenel, who is still serving a term of three years of probation for a 2007 cocaine conspiracy charge, called drug abuse a “medical, healthcare and spiritual problem, not a problem to be solved with a criminal justice model.”

The largest medical cannabis dispensary in Berkeley, Calif., the Berkeley Patients Group, owes the state $6 million in taxes and interest from three years when it did not pay, reports The 420 Times. The group disputed the tax in 2007 saying medical marijuana should be left untaxed like other medicines, but lost its case. Now, California wants the money.

Washington Rep. Mary Lou Dickerson of Seattle has once again called for the state legislature to legalize marijuana for adults 21 and over, My Ballard reported. Dickerson says legalization could generate $400 million every two years and ease the budget shortfall.

With Republicans in the House looking to limit spending in the next fiscal year, supporters of drug policy reform are suggesting cutting the DEA’s budget. Marijuana Policy Project’s Steve Fox told Talking Points Memo, “The entire federal budget dedicated to keeping marijuana illegal and carrying out all the enforcement measures to do so is really something that is long past its prime.”

-DR

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Arizona’s Medical Marijuana Industry Moves Forward

In the weeks since the passage of Arizona’s Proposition 203, which made the state the 15th state in the nation with legalized medicinal marijuana, there has been a flurry of interest in the new industry and lots of media coverage.

The Marijuana Policy Project, which helped to push and fund the initiative, reports a flood of phone calls from people interested in setting up a business catering to the medical marijuana community, according to the StopTheDrugWar.org.

This Phoenix New Times story explains the billion dollar industry budding in the state.

The East Valley Tribune and The Arizona Republic examined the challenges employers face and questions they have about drug testing in the workplace in the wake of the new law.

AZCapitolTimes.com reports that visiting medical marijuana patients from other states could face problems with law enforcement when bringing pot into Arizona.

And in Flagstaff, City Council members sent staff back to the drawing board to come up with less restrictive zoning for medical marijuana businesses noting that strip clubs faced less restrictive zoning in the initial plan.

-DR

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World AIDS Day 2010: Fight AIDS, Stop the drug war

Today, is World AIDS Day — a day to advocate for policies that stop the spread of HIV/AIDS.

In honor of it, I would like to note that when the world’s top AIDS researchers and advocates met in Vienna this summer, number one on their agenda was stopping the international war on drugs.

Why? Because the AIDS epidemic is fueled by dirty needle use in the drug underground. A drug war that advocates harsh incarceration policies drives addicts underground, where they have limited access to clean needles. A science-based, harm reduction approach to fighting addiction would allow addicts to come out of the underground and help halt the spread of AIDS, they said.

Read more about the “Vienna Declaration” here.

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At International AIDS Conference in Vienna: A call to reform drug policy and end global War on Drugs

The International AIDS Conference kicked off today in Vienna, Austria, bringing together more than 25,000 medical professionals, activists and policymakers to discuss ways to fight the global HIV/AIDS epidemic — and halt the War on Drugs.

The conference is the largest gathering of AIDS workers and policymakers in the world, according to UNAIDS, the Joint United Nations Programme on HIV/AIDS, which is a co-sponsor. Yet U.S. news coverage has barely touched on the single most significant policy recommendation coming out of the convention, the so-called “Vienna Declaration,” which calls for reforming international drug policy in the wake of the undeniable “failure” of prohibition that “has resulted in overwhelmingly negative health and social consequences.”

One of the main regions of focus of the conference is Eastern Europe and Central Asia, where HIV infection rose 66 percent from 2001 to 2008, according to UNAIDS. In that region, an estimated 3.7 million people inject illicit drugs, and the UN estimates 1 in 4 are HIV positive. Drug laws criminalize illicit drug users, driving them underground and hindering efforts to provide treatment and access to clean needles and syringes, the writers note. The declaration calls for the international community to abandon ideological-driven policies in favor of a science-based public health approach to address the harms of drug abuse.

But the declaration extends far beyond the impact the drug war has had on spreading HIV. It also attacks the War on Drugs generally — and U.S. policies in particular — for leading to mass incarceration, racial disparities in enforcement, human rights violations, and violence and instability in Mexico, Colombia and Afghanistan. “Billions of tax dollars [have been] wasted on a ‘War on Drugs’ approach to drug control that does not achieve its stated objectives and, instead, directly or indirectly contributes to the above harms,” the declaration states.

The authors call on the international community to “acknowledge the limits and harms of prohibition” as part of an overall revamping of drug policy that also removes barriers for treatment and prevention of HIV.

Dr. Julio Montaner, AIDS 2010 chair and president of the International AIDS Society, writes:

There is also a critical mass of scientific evidence regarding the unintended negative consequences of policies based exclusively on drug law enforcement.  We have to recognize that the war on drugs has not only failed to reduce illicit drug supply and use, but it has also resulted in a range of human rights violations, drug market violence and HIV and HCV epidemics among users.

That being said, this wealth of evidence we have generated over the last couple of decades are being systematically neglected and ignored in favor of a highly prevalent ideologically driven war on drugs.

It’s high time for policy and decision-makers to admit that law enforcement based attempts to address illicit drug use are causing more harm than good.

Three former presidents of Latin American countries have signed onto the declaration, Fernando Henrique Cardoso (Brazil), Ernesto Zedillo (México) and César Gaviria (Colombia), as well as a host of other health, law enforcement and thought leaders. Read more about the declaration here and the full text here.

Also see how the conference is practicing what it preaches, with medical facilities that provide clean needles and syringes and free Opioid Substitution Therapy (OST) prescriptions (methadone and buprenorphine) for drug users. The harm reduction paradigm it presents is rather jolting to most in the U.S.

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What do you do with addicts who commit crimes? What about drug treatment?

What to do about drug addicts? Lock them up, let them out and watch them commit more crimes?

Newsweek has a great article this week arguing that the costs of treating drug addiction in prison saves money and cuts crime in the long-run. The article notes that nationally only one-fifth of inmates get drug treatment, even though nearly half of the 2.3 million people in prison nationwide have a history of drug addiction. While not all of those people are incarcerated for drug offenses, many crimes — like burglary — are fueled by addiction.

Drug treatment programs — just like other safety net programs – help prevent crime and continued drug abuse. But these programs are often the first things on the chopping block as state legislators struggle with budget deficits:

The irony here is that by lowering recidivism, the programs themselves save money in the long run. The NIDA report released last year cited a remarkable statistic: heroin addicts who received no treatment in jail were seven times as likely as treated inmates to become re-addicted, and three times as likely to end up in prison again. For every dollar spent, the programs save $2 to $6 by reducing the costs of re-incarceration, according to Human Rights Watch. Looked at another way, the programs can save the justice system about $47,000 per inmate.

Here’s the problem: Politicians can’t run for office and win on a “Treat them all” mantra. But “lock ‘em up” pays dividends. The best example I can think of is my own hometown sheriff, Maricopa County Sheriff Joe Arpaio. Arpaio has cost the county millions of dollars, has failed to investigate rapes and other serious crimes and abused the power of his office time and time again. But since he puts his low-level jail inmates in pink underwear and feeds them spoiled meat and pledges to round-up illegal landscapers, he gets elected again and again.

We have more people in prison per capita in the U.S. than anywhere else in the world.  We must demand that our politicians get smart — rather than continue to be tough and stupid — on crime. Maybe instead of a War on Drugs — which is, really, a War on Drug Users — we should try to truly battle drug addiction.

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Border security & budget cuts: two “drug” stories today show what we do right, wrong in Drug War

A delegation of Obama administration officials met with Arizona state leaders today to discuss border security, pledging hundreds of millions of dollars more in financial resources and increased manpower to fight crime at the Arizona-Mexico border (including 524 National Guard troops). The lengthy report from the White House on the tactics discussed in the meetings (link to PDF below) includes some smart efforts to fight cartel crime, such as a focus on southbound guns and money. But as I read the report, I found myself thinking about another unrelated “drug” story in Arizona, about thousands of mentally ill people who will lose access to treatment and medications because of state budget cuts.

At first blush, these two stories don’t seem connected at all. But for years, we have waged a war on drugs that has all but ignored the root causes of the problem. Year after year, politicians have increased minimum sentences for drug crimes and built more prisons while slashing drug treatment services and social programs that address poverty, mental illness and other societal problems linked to drug abuse. As I read this morning’s Arizona Republic story about the mental health program cuts, I thought about Paula, a woman with bipolar disorder I wrote about for  Phoenix Magazine this spring, who would lapse back into self-medicating by smoking crack whenever she didn’t have access to treatment or the right prescription meds. Arizona leaders who are so concerned about Mexicans bringing us drug cartel violence should consider what role they play in fighting drug use — not just punishing drug users — here at home. Treating and caring for those with mental illness is an important part of the social safety net that helps prevent crime, homelessness and drug abuse.

The Obama administration’s Southwest Border Strategy includes a tacit acknowledgment of the role the U.S. plays in the Mexican drug violence. The bloody battle with and between drug cartels that has left 23,000 Mexicans dead since 2006 is funded by money from U.S. drug sales and waged with U.S.-purchased guns. As I wrote yesterday, we can’t expect to get at the problem by targeting immigrants. But targeting southbound weapons and money is smart.

More information:

-Read the full White House report on today’s meetings here. Highlights: The White House has pledged $600 million to secure the Southwest border and enhance law enforcement efforts; additional ATF “Gunrunner Teams” and prosecutors; and 1,200 additional National Guard troops on the border (524 in Arizona).

-Read about efforts by the office of Arizona’s U.S. Attorney Dennis Burke to target firearms trafficking in a new border security fact sheet posted last week here.

-Watch the press conference by Arizona Attorney General Terry Goddard and U.S. Rep. Gabrielle Giffords today on the increase in National Guard troops here.

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