Position Statement – December 2011

The flawed proposition of drug legalisation

Various well funded pressure groups have mounted campaigns to overturn the United Nations Conventions on drugs. These groups claim that society should accept the fact of drugs as a problem that will remain and, therefore, should be managed in a way that would enable millions of people to take advantage of an alleged ‘legal right’ to use drugs of their choice.

It is important to note that international law makes a distinction between “hard law” and “soft law.” Hard law is legally binding upon the States. Soft law is not binding. UN Conventions, such as the Conventions on Drugs, are considered hard law and must be upheld by the countries that have ratified the UN Drug Conventions.

International narcotics legislation is mainly made up of the three UN Conventions from 1961 (Single Convention on Narcotic Drugs), 1971 (Convention on Psychotropic Substances), and 1988 (Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances):

• The 1961 Convention sets out that “the possession, use, trade in, distribution,import, export, manufacture and the production of drugs is exclusively limited to medical and scientific purposes”. Penal cooperation is to be established so as to ensure that drugs are only used licitly (for prescribed medical purposes).

• The 1971 Convention resembles closely the 1961 Convention, whilst
establishing an international control system for Psychotropic Substances.

• The 1988 Convention reflects the response of the international community to increasing illicit cultivation, production, manufacture, and trafficking activities. International narcotics legislation draws a line between licit (medical) and illicit (non-medical) use, and sets out measures for prevention of illicit use, including penal measures. The preamble to the 1961 Convention states that the parties to the Convention are “Recognizing that addiction to narcotic drugs constitutes a serious evil for the individual and is fraught with social and economic danger to mankind”. The Conventions are reviewed every ten years and have consistently been upheld.

The UN system of drug control includes the Office of Drugs and Crime, the International Narcotics Control Board, and the Commission on Narcotic Drugs. The works of these bodies are positive and essential in international drug demand and supply reduction. They are also attacked by those seeking to legalise drugs.

It is frequently and falsely asserted that the so-called “War on Drugs” is inappropriate and has become a very costly and demonstrable failure. It is declared by some that vast resources have been poured into the prevention of drug use and the suppression of illicit manufacturing, trafficking, and supply. It is further claimed that what is essentially a chronic medical problem has been turned into a criminal justice issue with inappropriate remedies that make “innocent” people criminals. In short, the flawed argument is that “prohibition” monies have been wasted and the immeasurable financial resources applied to this activity would be better spent for the general benefit of the community.

The groups supporting legalisation are: people who use drugs, those who believe that the present system of control does more harm than good, and those who are keen to make significant profits from marketing newly authorised addictive substances. In addition to pernicious distribution of drugs, dealers circulate specious and misleading information. They foster the erroneous belief that drugs are harmless, thus adding to even more confused thinking.

Superficially crafted, yet pseudo-persuasive arguments are put forward that can be accepted by many concerned, well intentioned people who have neither the time nor the knowledge to research the matter thoroughly, but accept them in good faith. Frequently high profile people claim that legalisation is the best way of addressing a major social problem without cogent supporting evidence. This too influences others, especially the ill informed who accept statements as being accurate and well informed. Through this ill-informed propaganda, people are asked to believe that such action would defeat the traffickers, take the profit out of the drug trade and solve the drug problem completely.

The total case for legalisation seems to be based on the assertion that the government assault on alleged civil liberties has been disastrously and expensively ineffective and counter-productive. In short, it is alleged, in contradiction to evidence, that prohibition has produced more costs than benefits and, therefore, the use of drugs on a personal basis should be permitted. Advocates claim that legalisation would eliminate the massive expenditure incurred by prohibition and would take the profit out of crime for suppliers and dealers. They further claim that it would decriminalise what they consider “understandable” human behaviour and thus prevent the overburdening of the criminal justice system that is manifestly failing to cope. It is further argued irrationally that police time would not be wasted on minor drug offences, the courts would be freed from the backlog of trivial cases and the prisons would not be used as warehouses for those who choose to use drugs, and the saved resources could be used more effectively.

Types of drug legalisation

The term “legalisation” can have any one of the following meanings:

1. Total Legalisation – All illicit drugs such as heroin, cocaine, methamphetamine, and marijuana would be legal and treated as commercial products. No government regulation would be required to oversee production, marketing, or distribution.

2. Regulated Legalisation – The production and distribution of drugs would be regulated by the government with limits on amounts that can be purchased and the age of purchasers. There would be no criminal or civil sanctions for possessing, manufacturing, or distributing drugs unless these actions violated the regulatory system. Drug sales could be taxed.

3. Decriminalisation – Decriminalisation eliminates criminal sanctions for drug use and provides civil sanctions for possession of drugs. To achieve the agenda of drug legalisation, advocates argue for:

• legalising drugs by lowering or ending penalties for drug possession and use – particularly marijuana;

• legalising marijuana and other illicit drugs as a so-called medicine;
• harm reduction programmes such as needle exchange programmes, drug injection sites, heroin distribution to addicts, and facilitation of so-called safe use of drugs that normalize drug use, create the illusion that drugs can be used safely if one just knows how, and eliminates a goal of abstinence from drugs;

• legalised growing of industrial hemp;
• an inclusion of drug users as equal partners in establishing and enforcing drug policy; and

• protection for drug users at the expense and to the detriment of non-users under the pretence of “human rights.”

The problem is with the drugs and not the drug policies

Legalisation of current illicit drugs, including marijuana, is not a viable solution to the global drug problem and would actually exacerbate the problem. The UN Drug Conventions were adopted because of the recognition by the international community that drugs are an enormous social problem and that the trade adversely affects the global economy and the viability of some countries that have become transit routes.

The huge sums of illegal money generated by the drug trade encourage money laundering and have become inextricably linked with other international organised criminal activities such as terrorism, human trafficking, prostitution and the arms trade. Drug Lords have subverted the democratic governments of some countries to the great detriment of law abiding citizens.

Drug abuse has had a major adverse effect on global health and the spread of communicable diseases such as AIDS/HIV. Control is vitally important for the protection of communities against these problems. There is international agreement in the UN Conventions that drugs should be produced legally under strict supervision to ensure adequate supplies only for medical and research purposes. The cumulative effects of prohibition and interdiction combined with education and treatment during 100 years of international drug control have had a significant impact in stemming the drug problem. Control is working and one can only imagine how much worse the problem would have become without it. For instance:

• In 2007, drug control had reduced the global opium supply to one-third the level in 1907 and even though current reports indicate recent increased cultivation in Afghanistan and production in Southeast Asia, overall production has not increased.

• During the last decade, world output of cocaine and amphetamines has stabilized; cannabis output has declined since 2004; and opium production has declined since 2008. We, therefore, strongly urge nations to uphold and enhance current efforts to prevent the use, cultivation, production, traffic, and sale of illegal drugs. We further urge our leaders to reject the legalisation of currently illicit drugs as an acceptable solution to the world’s drug problem because of the following reasons:

• Only 6.1% of people globally between the ages of 15 and 64 use drugs (World Drug Report 2011 UNODC) and there is little public support for the legalisation of highly dangerous substances. Prohibition has ensured that the total number of users is low because legal sanctions do influence people’s behaviour.

• There is a specific obligation to protect children from the harms of drugs, as is
evidenced through the ratification by the majority of United Nations Member States of the UN Convention on the Rights of the Child (CRC). Article 33 states that Member States “shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties, and to prevent the use of children in the illicit production and trafficking of such substances”.

• Legalisation sends the dangerous tacit message of approval, that drug use is
acceptable and cannot be very harmful.

• Permissibility, availability and accessibility of dangerous drugs will result in
increased consumption by many who otherwise would not consider using them.

• Enforcement of laws creates risks that discourage drug use. Laws clearly define what is legal and illegal and emphasise the boundaries.

• Legalisation would increase the risks to individuals, families, communities and world regions without any compensating benefits.

• Legalisation would remove the social sanctions normally supported by a legal system and expose people to additional risk, especially the young and vulnerable.

• The legalisation of drugs would lead inevitably to a greater number of dependencies and addictions likely to match the levels of licit addictive substances. In turn, this would lead to increasing related morbidity and mortality, the spread of communicable diseases such as AIDS/HIV and the other blood borne viruses exacerbated by the sharing of needles and drugs paraphernalia, and an increased burden on the health and social services.

• There would be no diminution in criminal justice costs as, contrary to the view held by those who support legalisation, crime would not be eliminated or reduced. Dependency often brings with it dysfunctional families together with increased domestic child abuse.

• There will be increases in drugged driving and industrial accidents.

• Drug Control is a safeguard protecting millions from the effects of drug abuse and addiction particularly, but not exclusively, in developing countries.

• Statements about taxation offsetting any additional costs are demonstrably flawed and this has been shown in the case of alcohol and tobacco taxes. Short of governments distributing free drugs, those who commit crime now to obtain them would continue to do so if they became legal.

• Legalisation would not take the profit out of the drug trade as criminals will always find ways of countering legislation. They would continue their dangerous activities including cutting drugs with harmful substances to maximise sales and profits. Aggressive marketing techniques, designed to promote increased sales and use, would be applied rigorously to devastating effect.

• Other ‘legal’ drugs – alcohol and tobacco, are regularly traded on the black market and are an international smuggling problem; an estimated 600 billion cigarettes are smuggled annually (World Drug report 2009). Taxation monies raised from these products go nowhere near addressing consequential costs.

• Many prisons have become incubators for infection and the spread of drug related diseases at great risk to individual prisoners, prison staff and the general public. Failure to eliminate drug use in these institutions exacerbates the problem.

• The prisons are not full of people who have been convicted for mere possession of drugs for personal use. This sanction is usually reserved for dealers and those who commit crime in the furtherance of their possession.

• The claim that alcohol and tobacco may cause more harm than some drugs is not a pharmacokinetics of psychotropic substances suggest that more, not less, control of their access is warranted.

• Research regularly and increasingly demonstrates the harms associated with drug use and misuse. There is uncertainty, yet growing evidence, about the long-term detrimental effects of drug use on the physical, psychological and emotional health of substance users.

• It is inaccurate to suggest that the personal use of drugs has no consequential and damaging effects. Apart from the harm to the individual users, drugs affect others by addiction, violence, criminal behaviour and road accidents. Some drugs remain in the body for long periods and adversely affect performance and behaviour beyond the time of so-called ‘private’ use. Legalisation would not diminish the adverse effects associated with drug misuse such as criminal, irrational and violent behaviour and the mental and physical harm that occurs in many users.

• All drugs can be dangerous including prescription and over the counter medicines if they are taken without attention to medical guidance. Recent research has confirmed just how harmful drug use can be and there is now overwhelming evidence (certainly in the case of cannabis) to make consideration of legalisation irresponsible.

• The toxicity of drugs is not a matter for debate or a vote. People are entitled to their own opinions but not their own facts. Those who advocate freedom of choice cannot create freedom from adverse consequences.

• Drug production causes huge ecological damage and crop erosion in drug producing areas.

• Nearly every nation has signed the UN Conventions on drug control. Any government of signatory countries contemplating legalisation would be in breach of agreements under the UN Conventions which recognise that unity is the best approach to combating the global drug problem. The administrative burden associated with legalisation would become enormous and probably unaffordable to most governments. Legalisation would require a massive government commitment to production, supply, security and a bureaucracy that would necessarily increase the need for the employment at great and unaffordable cost for all of the staff necessary to facilitate that development.

• Any government policy must be motivated by the consideration that it must first do no harm. There is an obligation to protect citizens and the compassionate and sensible method must be to do everything possible to reduce drug dependency and misuse, not to encourage or facilitate it. Any failures in a common approach to a problem would result in a complete breakdown in effectiveness. Differing and fragmented responses to a common predicament are unacceptable for the wellbeing of the international community. It is incumbent on national governments to cooperate in securing the greatest good for the greatest number.

ISSUED this 21st day of December, 2011 by the following groups:
Drug Prevention Network of the Americas (DPNA)
Institute on Global Drug Policy
International Scientific and Medical Forum on Drug Abuse
International Task Force on Strategic Drug Policy
People Against Drug Dependence & Ignorance (PADDI), Nigeria
Europe Against Drugs (EURAD)
World Federation Against Drugs (WFAD)
Peoples Recovery, Empowerment and Development Assistance (PREDA)
Drug Free Scotland

Theresa May, the Home Secretary, issued a humiliating rebuke to her drug advisers after they called for the possession of drugs to be decriminalised.

The Home Office said there was no intention to give people a “green light” to use drugs because they “destroy lives and cause untold misery”.

The Advisory Council on the Misuse of Drugs (ACMD) risked a fresh row with the Home Office after suggesting those who possess any drug, including cocaine or heroin, for personal use should be taken out of the criminal justice system.

The Government issued a blunt statement insisting drug laws would not be liberalised and “decriminalisation is not the answer”. It is the latest in a series of run-ins between Whitehall’s official drug advisory body and the Home Office.

In 2009, the then Home Secretary Alan Johnson, sacked the ACMD chairman Professor David Nutt after he openly criticised the Government’s stance on cannabis. He had also previously said taking Ecstasy was no more dangerous than riding a horse.

The ACMD called for a review on how those caught in possession of drugs are handled in a submission to the Sentencing Council, which is consulting on guidelines for courts on drug offences.
However, it is not in the remit of the Sentencing Council to consider what would effectively decriminalisation and the ACMD only included its comments in the final section asking for any further comments. It wrote: “There is an opportunity to be more creative in dealing with those who have committed an offence by possession of drugs.

“For people found to be in possession of drugs (any) for personal use (and involved in no other criminal offences), they should not be processed through the criminal justice system but instead be diverted into drug education/awareness courses.”

The courses “would be the equivalent of the apparently successful ‘speed awareness’ courses to which drivers can be referred as a diversion”, the council added. It also suggested that those accused of possessing drugs could also face “more creative civil punishments”, such as the loss of a driving licence or passport.

A spokesman for the Home Office said: “We have no intention of liberalising our drugs laws. Drugs are illegal because they are harmful – they destroy lives and cause untold misery to families and communities. “Those caught in the cycle of dependency must be supported to live drug free lives, but giving people a green light to possess drugs through decriminalisation is clearly not the answer.”

Source: www.telegraph.co.uk 18th Oct 2011

Conference in Moses Room, House of Lords, 28th November 2002-11-28 CONSENSUS OF CONFERENCE

● In the light of the most recent international evidence regarding the adverse effects of cannabis, we urge the Prime Minister and the Home Secretary to reconsider their determination to reclassify Cannabis from a schedule B to schedule C drug.

● We are concerned that reclassification sends the message ‘it is ok to take cannabis’ or ‘cannabis is harmless’ or ‘taking cannabis is legal now’, especially to young people. We therefore strongly oppose reclassification.

● Instead, we urge the Prime Minister and the Home Office not to play down the many adverse and sometimes irreversible health effects of cannabis but to send out the clear message that cannabis is both harmful and, for that reason, illegal.

● We urge the Prime Minister – in the light of recent evidence – to reassess the adverse physical, emotional, mental and spiritual impact cannabis abuse has on individuals, but also to assess the adverse effects of cannabis on society including families with a special reference to ethnic minorities, the education system, the National Health Service, the Police, the criminal justice system.

● We are concerned that drug prevention is not given the emphasis it deserves, that ‘mixed messages’ are sent out and in particular we are very concerned at public funding of organisations whose ‘drug education material’ appears to promote rather than prevent drug abuse.

● We urge the Prime Minister to allocate more resources on prevention of cannabis abuse. Prevention is better than cure. We believe that these resources will be well spent. Our society and especially our young people deserve to be protected from cannabis abuse.

Illegal drugs not only harm a user’s mind and body, they devastate families, communities, and neighborhoods. They jeopardize public safety, prevent too many Americans from reaching their full potential, and place obstacles in the way of raising a healthy generation of young people.

To address these challenges, today we are releasing the 2012 National Drug Control Strategy — the Obama Administration’s primary policy blueprint for reducing drug use and its consequences in America. The President’s inaugural National Drug Control Strategy, published in 2010, charted a new direction in our approach to drug policy. Today’s strategy builds upon that approach, which is based on science, evidence, and research. Most important, it is based on the premise that drug addiction is a chronic disease of the brain that can be prevented and treated. Simply put, we are not powerless against the challenge of substance abuse — people can recover, and millions are in recovery. These individuals are our neighbors, friends and family members. They contribute to our communities, our workforce, our economy, and help make America stronger.

Our emphasis on addressing the drug problem through a public health approach is grounded in decades of research and scientific study. There is overwhelming evidence that drug prevention and treatment programs achieve meaningful results with significant long-term cost savings. In fact, recent research has shown that each dollar invested in an evidence-based prevention program can reduce costs related to substance use disorders by an average of $18.

But reducing the burden of our nation’s drug problem stretches beyond prevention and treatment. We need an all of the above approach. To address this problem in a comprehensive way, the President’s new strategy also applies the principles of public health to reforming the criminal justice system, which continues to play a vital role in drug policy. It outlines ways to break the cycle of drug use, crime, incarceration, and arrest by diverting non-violent drug offenders into treatment, bolstering support for reentry programs that help offenders rejoin their communities, and advancing support for innovative enforcement programs proven to improve public health while protecting public safety.

Together, we have achieved significant reform in the way we address substance abuse. And the Affordable Care Act will — for the first time — require insurers to cover treatment for drug addiction the same way they would other chronic diseases. This is a revolutionary shift in how we address drug policy in America.
Over the past three decades, we have reduced illegal drug use in America. Over the long term, rates of drug use among young people today are far lower than they were 30 years ago. More recently cocaine use has dropped nearly 40 percent and meth use has dropped by half. And we can do more. As President Obama has noted, we have successfully changed attitudes regarding rates of smoking and drunk driving, and with your help we can do the same with our illegal drug problem.

Source: R. Gil Kerlikowske
Director, White House Office of National Drug Control Policy 18th April 2012

The fashionable party drug mephedrone has been linked to up to 98 recent deaths in Britain, the Government’s advisers warned last night, as they called for tougher action to combat the proliferation of legal highs.

The Advisory Council on the Misuse of Drugs (ACMD) said unscrupulous manufacturers made a mockery of the law by falsely advertising addictive substances as “plant food” or “bath salts”. Its chairman, Professor Les Iverson, warned young users of “designer drugs” were playing “Russian roulette” with their lives – and said the effects were already being seen in hospitals. He said: “We are not seeing just a nice party drug but something that can kill.”

Prof Iverson released figures showing that in the past two years mephedrone had been confirmed as a factor in 42 deaths and had not been ruled out as contributing to another 56.
Users of designer drugs – created in labs to mimic the make-up of banned substances such as ecstasy and amphetamines – suffered such extreme side-effects that they had to be sedated. They had also been treated for paranoia, psychosis, high heart rates and raised blood pressure, he said. He added: “Users are playing Russian roulette. They are buying substances marked as research chemicals. The implication is that you should do the research on yourself to find out whether they’re safe or not. This is a totally uncontrolled, unregulated market.”

The first large quantities of legal highs, or psychoactive drugs – many made in China – appeared in Britain two years ago. They can be easily bought online or from shops selling drug paraphernalia and herbal goods. Some undergraduates also sell them to fellow students. The ACMD said: “Many people importing these new substances appear to have had no previous involvement in the illicit drug trade and are just in it to make a quick buck. They have included students who have set up websites to supply nationally and who also supply the local student population.”

Ministers have outlawed several such substances, but the ACMD warned that producers were sidestepping the bans by tweaking the composition of drugs. It backed creating a new system of broader bans in which all substances chemically similar to controlled drugs were automatically made illegal. The ACMD also called for suppliers to have to demonstrate that legal highs were not being produced for human consumption and for a fresh drive to alert the public to their dangers.

Roger Howard, chief executive of the UK Drug Policy Commission, backed the proposals. He said: “We have rapidly growing numbers of psychoactive drugs on the market and it’s increasingly difficult for police to identify the different drugs they are finding.”

The Home Office said it was considering the recommendations and added: “The Government is leading the way in cracking down on legal highs by outlawing not just individual drugs but whole families of related substances.”

By numbers…
2009 The year police made first seizure of mephedrone. It was banned in 2010.
£15 Approximate price of a gram before it was classified.
98 The number of deaths recently linked to mephedrone.

Source: The Independent 26th October

A pill that makes alcoholics want to drink less has been developed by scientists for the first time, a conference has been told.

The drug is thought to work by blocking mechanisms in the brain that give alcoholics enjoyment from drink and so helps them fight the urge to drink too much. It only needed to be taken when people were going out where they might be tempted to drink alcohol. Alcoholics taking the drug and having counselling more than halved the amount of alcohol they drank per day and binged on fewer days. The findings were presented at the European Psychiatric Association (EPA) congress in Prague.

The drug, developed by Lundbeck pharmaceutical company, called nalmefene is not licensed yet and is currently going through clinical trials. There are other drugs on the market that make addicts ill if they drink any alcohol at all but this is thought to be the first aimed at reducing the amount of alcohol consumed. Side effects included dizziness, nausea, fatigue, sleep disorder or insomnia, vomiting, cold-like symptoms or excessive sweating.

Dr David Collier, of Barts and The London School of Medicine, Queen Mary University of London and an investigator in a nalmefene study, said: “The people volunteering for these trials had real problems with alcohol dependence, most had never sought help before, and others had tried and failed with abstinence strategies – stopping drinking for good.”

“Abstinence is the right option for many people, but not everyone wants to do that, and in those that do try, it helps only about half of them. From our experience in these trials, reducing alcohol consumption to safer levels can be a realistic and practical treatment goal for people who are dependent on alcohol, that can bring many short- and longer-term benefits to health.”

“These trial results suggest that the combination of medication and counselling could offer a new option for people in the UK not currently treated for their alcohol dependence.” There are thought to be 1.6m people addicted to alcohol who are not currently being treated.

Andrew Langford, Chief Executive of The British Liver Trust said: “We are genuinely worried about the increasing numbers of people from all walks of life with alcohol problems who are functioning seemingly well with their lives yet have built up a need for alcohol. Many feel that they need to drink just to feel normal, increasing potential negative effects on their physical and emotional health, including liver disease such as cirrhosis and liver cancer.”

In the study, nalmefene was used as needed by the patients, who took one tablet only when they perceived that there was a risk of drinking alcohol. Both the nalmefene and placebo groups of the study received counselling to maximise their motivation to reduce their alcohol intake, and ensure they continued to take the medicine.

Over six months in the trial the average amount of alcohol consumed per day reduced from 84g per day – the equivalent to a bottle of wine – to 30g per day or a large glass of wine. The number of days they drank heavily reduced from 19 to seven in those taking the drug alongside counselling.

The large study was conducted with 604 patients in Austria, Finland, Germany and Sweden.

Source: www. WiredIn.org.uk 6th March 2012

The attraction that the medical profession has for medical marihuana continues to mystify me. Many of the same physicians who will exercise exemplary caution in caring for their patients, will throw caution aside when it comes to pot. I know internists in private practice who refuse to accept new patients if they smoke tobacco. I often wonder if they would have the same reaction if the patients smoke pot! Yesterday, I entered an online discussion by a medical group on this subject and I’ve pasted my comment below
The medical profession needs to apologize for letting the public down on this one – once again. In the early 1900s, although medical organizations like the AMA were against patent medicines and refused to post ads in JAMA that did not list the ingredients of the products being promoted, there were quite a few doctors who nonetheless sold and promoted the use of patent medicines, most of which were worthless elixirs of cocaine or morphine or heroin or cannabis or combinations thereof, laced with copious amounts of alcohol, coloring agents and flavorings. They were promoted as curing everything from the common cold to cancer. Although the docs knew better, they argued that they were giving their patients what they wanted and if they didn’t, the patients would buy them on the street from sidewalk vendors who were not trained healthcare professionals. Ethical?
As best we know, any “positive” effects of these nostrums came in the form of intoxication, a normal reaction to psychotropic substances, including alcohol. Therapeutic they were not. Even during alcohol prohibition (1919-1933), the federal government issued special prescriptions to physicians –only– that allowed them to prescribe “medicinal alcohol” in the form of wine, whiskey, and beer. Overnight, pharmacies became liquor stores. And doctors did, indeed, prescribe alcohol for medicinal purposes and plenty of it during Prohibition. Ethical?
Fast-forward to the 1980s and 1990s and along comes the return of “medical marihuana.” This time, however, it’s not in the form of a tincture but, instead, promoted for use in its crude form as smoked marihuana. Not surprisingly, smoked pot today is touted as a cure-all for anything that ails one, from stress, to headache, to multiple sclerosis, to cancer pain and even cancer itself. How could a drug that’s so great be overlooked for so long by so many? Moreover, as in the case of alcohol prohibition, only doctors in certain states can prescribe (or recommend) it for medicinal purposes only. Ethical?
What these brief histories have in common is the promotion and use of intoxicants for therapeutic purposes. In all three cases, doctors promoted the use of these substances knowing that the anecdotal evidence of efficacy was weak at best, unsupported by unbiased clinical trial data, and not likely to improve the patient’s condition but only mask symptoms temporarily through intoxication. Incidentally, we could add tobacco to this list, too. A favorite ad of mine comes from a 1950s magazine that shows a photo of a physician holding a cigarette with a caption proclaiming that in a national survey of physicians, more preferred Camels over any other brand of cigarette. Ethical?
Wake up, America, and realize that whatever therapeutic molecules we might be able to squeeze out of the pot plant must be synthesized, purified, and manufactured to measured standards and dosing units before being used in medical treatment. Consider morphine and codeine. We don’t recommend that people grow opium poppies, harvest them, extract and chew the gum to get pain relief. Instead, we have synthesized and standardized pharmaceutically pure opiate medicines. Current pot research is underway to isolate and restructure the genetic pathways that provide pot’s psychic effect. This, scientists say, will be accomplished without interfering or reducing in any way the therapeutic properties of the beneficial cannabinoids in the plant. The final product will be safe and effective – far more effective as a medicine than smoking pot because dosing will be concentrated and stronger – and not controlled because there will be no psychotropic response. In effect, if pot truly has medicinal benefits independent of its intoxicating effects, they should be more readily available and useful in a finished pharmaceutical form. Also, users will be spared the toxic effects of inhaling smoke. Smoking anything — paper, tobacco, dry leaves, or pot — is not good for lung tissue of any living organism. Finally, the new pot without its psychic effect can be compared to decaffeinated coffee. It will have many of the same properties of the real thing except the kick. And, let’s face it, a good cup of Starbuck’s decaf can’t be distinguished from the regular stuff.
When all this happens in a few years, pot heads now desperately trying to promote pot for everything and anything will be left with nothing but the fact that their story of pot’s medicinal history will join the other historical artifacts described above. Someday, their kids and grand-kids will look back and say the same thing that we say now when we look at those old cigarette ads from the 1950s: What were you thinking?

Source: John Coleman Drug-Watch International Feb.2010

Jay’s story has a familiar ring. The pre-teen experimentation with cannabis after his father walked out on the family, followed by flirtation with ecstasy and cocaine. He had smoked his first wrap of heroin before he was old enough to buy a pint of beer. But it was only when he was off the street, safely incarcerated in a young offender institution, that methadone was added to Jay’s palate. As the gaunt teenager with grey skin shuffled from foot to foot in the West London drizzle, uncaringly dressed in a hooded tracksuit, his pin-pricked pupils scanned the streets.
“I was running wild with a raging [heroin] habit when they got me,” he said. “They tried to detox me inside but as soon as I complained they put my dose of methadone up again. I came out needing drugs as much as when I went in.”
His six-month stretch inside passed in a methadone-induced daze with, according to Jay, little attempt by prison staff to offer him a pathway to drug-free recovery. When he was released two years ago, Jay, whose only family contact is an elder brother he occasionally stays with, swiftly returned to the messy chaos of an opiate-obsessed existence. He thinks that he will be back in prison within weeks. “Most junkies I know want to be clean but if you can’t do it when you’re inside, when can you?” he says.
Methadone, a heroin substitute that is more addictive than heroin itself, has assumed a dominant position in the State’s drug-control armoury. It is given to half the country’s estimated 300,000 heroin addicts while parliamentary answers have revealed that 65,000 prisoners were prescribed it in the past year, including nearly 20,000 on a maintenance programme which can last years — an annual rise of 57 per cent. In some patches of “broken Britain” it is responsible for more fatal overdoses than any other substance.
Supporters say it stabilises addicts and protects society by removing the need for drug-financing crime sprees. Opponents argue that the State is happy to “park” people on methadone for years, giving up hope that addicts will ever lead a productive, drug-free life.
One aspect most agree on is that drug addiction is a lucrative business. Professor Neil McKeganey, a leading opponent of mass methadone medicating, said: “There’s considerable financial incentive that drug users remain drug dependent.” Drug companies make millions from producing methadone, GPs in many parts of the country get paid in the region of £220 per methadone patient per year, pharmacists can get £200 administration fees plus about £1.50 per administered dose, while more than 150,000 people are employed in drug-action teams funded largely from the public purse.
Mark Johnson, a former drug user who founded the charity Uservoice, said that although prisons are the ideal location for rehabilitation because they are “the only place that removes some people from dysfunction and gives them a respite”, the authorities are increasingly opting for the methadone route. “All we’re doing is containing the problem, not solving it,” he said.
Several studies have shown that a residential-based abstinence programme lasting at least a month has a roughly one in four success rate, while a recent study on addicts in society showed that after three years on methadone only 3 per cent are drug-free.
Despite this, however, the Government, backed by a cadre of policy experts and health professionals, is increasing its multi-million annual spend on methadone maintenance programmes. At the same time, at least 20 residential rehabilitation centres have closed in the past two years because primary care trusts have stopped referring clients. Last month Middlegate Lodge, the only residential rehab centre specifically for teenagers, closed.
Just 850 prisoners were put on the relatively succesful 12-step abstinence programme last year. No figures are available for how many young offenders are prescribed methadone.
Inspectors’ reports into young offenders’ institutions record that while alcohol and cannabis are the biggest substance problems, the use of methadone is being encouraged and is increasing.
Kathy Gyngell, a drugs policy analyst for the Centre for Policy Studies, said that prescribing methadone to young offenders had become routine. She added: “It might appear the easier option but it leads to longer term problems. Individuals who historically used their short sentences to gain clean time now feel the necessity to carry on using methadone, as it takes no effort other than presenting themselves at the healthcare door to get it.”
David Burrowes, a Tory justice spokesman, said that drug treatment was “characterised by methadone” and that a variety of treatment options needed to be available.
Katherine, a former addict, whose descent into heroin addiction began after she was raped as a teenager, said that after a decade ricocheting between methadone in prison and heroin outside, she had finally kicked her habit after becoming one of the few prisoners to be offered a place on a RAPt (Rehabilitation for Addicted Prisoners Trust) abstinence programme.
“Methadone is not a solution,” said Katherine, who left prison drug-free in 2008. “The message it gives is, ‘You come in with a habit and we’ll keep the habit and let you back out into society with no changes whatsoever.” She said that even in prison, addicts are able to exploit the system by using cotton wool to absorb the sickly-sweet green methadone linctus, before selling it on to other inmates and buying heroin with the proceeds.
Rosie, who started taking heroin at the age of 14, was prescribed methadone after leaving a young offenders’ institution and said that she had never seen a succesful methadone-led withdrawal from drug use. “It’s almost more of a poison than heroin, there doesn’t ever seem to be an end to it,” she said. She became drug-free after attending an abstinence-based treatment centre provided by the Nelson Trust.
To its advocates, though, methadone is a useful tool. At best, it stabilises addicts before they are weaned off; at worst, it can be used to maintain addicts long term, minimising the need for them to commit crime to pay for street heroin. Overall, drug-related crime is estimated to cost the country more than £13 billion a year.
There are also risks associated with forcing prisoners to go cold turkey. Cynics suggest the prison authorities’ increasing enthusiasm for methadone may have something to do with the £750,000 it was forced to pay out in 2006 after almost 200 drug-addicted prisoners sued the Government, claiming that their rights were infringed when they were forced to withdraw suddenly.
Even for those who claim to have benefited from it, methadone is at best a stopgap. James, 30, from Renfrewshire, had been a heroin user for nine years when he was given methadone in Barlinnie Prison, Glasgow. “Everything in prison was all about drugs,” he said. “Sometimes you couldn’t get any heroin and you couldn’t eat your dinner, you were in bed with all your clothes on, teeth rattling. They put me on 30ml of methadone, a low dose, and it settled me. I was a lot calmer; it was like a safety net.”
Roger Howard, the chief executive of the UK Drug Policy Commission, an advocate for methadone, admits that it could not alone cure drug addicts. “What everyone wants is to reduce deaths from dangerous street heroin and to reduce criminality,” he said. “Methadone is not the problem. These people come with a bucketful of problems: abuse, unemployment, homelessness, family.”
Professor McKeganey, who works at the Centre for Drug Misuse at the University of Glasgow, warned that Britain was sleepwalking into a situation similar to that in the Netherlands, where the Government provided places at old people’s homes for those with long-term methadone habits: the so-called “geriaddicts”. Mr Howard agreed: “There is a cohort who are probably so damaged and with such profound health problems that they will never get a job and will for ever rely on the State.”
As he prepared to pad the darkened streets of West London in shoes as punctured as his bony, needle-marked forearm in an all-consuming search for his next hit, Jay pondered a parting question: if you could survive in prison on methadone alone, why not, when outside, give your daily, drug-free urine sample, take the supervised dose of methadone and shun street drugs?
“But where would it get me? All right, the craving for smack’s not there but you soon get the craving for the meth. Nobody I know on a heoin ’script is getting any better. They’re just surviving.”

Source: Times Online 17th March 2010

The cost of a quick fix
2.4m Methadone prescriptions written in 2007, a rise of 60 per cent since 2003
£1.2bn Amount spent annually by government (central and local) tackling drug use in England in 2009-10
£15.3bn The cost per year to society of problem drug use
£13.9bn The estimated cost of drug-related offending in 2003, made up of a £9.9 billion cost to victims of crime and £4 billion costs incurred by the criminal justice system
330,000 Estimated number of problem drug users in England, of whom 166,000 are in some form of treatment programme

Sources: NAO, Drugscope, Home Office

Whichever way you look at it, the Government’s increasing reliance on methadone to treat heroin addicts involves moral issues. Predominant among these is that the State is in effect cast in the role of drug dealer — conceivably for as long as the addicts live.
The uneasy relationship becomes especially problematic when users die of overdoses, having supplemented methadone with other street drugs.
Never forget how dangerous this is. When official figures show that in some areas a third of the people who die from drug-related causes have methadone in their bodies, put there by the taxpayer, and that this proportion doubled from 2006-08, we are on dodgy ethical ground.
Increasingly, it means the substance that is supposed to be a primary solution appears to be an intrinsic part of the problem. What methadone also represents is the transfer of personal responsibility for addiction away from the drug user. In this sense, the heroin substitute symbolises the cultural shift in modern drug policy: the addict is a victim who needs support and maintenance, rather than someone who should change their behaviour.
This official non-judgmentalism is interesting, especially when there is public debate about the resources devoted to the consequences of smoking, alcohol and overeating — which are not illegal. The merits of a humane approach to drug addiction are apparent. No one argues that methadone is not a useful part of the weaponry. It’s relatively cheap; it can stabilise the lives of addicts who shoplift or supply heroin to others; and of course, rather importantly, it allows the Government to say that it is doing something.
But what worries critics of methadone is not only its excessive use, but the lack of an exit strategy. In parts of the country there are addicts who have been taking it for decades. Even advocates concede that people are being kept on the drug for too long without any target to get them off.
All of which makes it troubling to hear that young offenders are being prescribed it, if only because, without any commitment to get them off drugs, they may end up “parked” for many years of dependency.
Professor Neil McKeganey, in his latest book, laments the lack of consensus about the goals of treatment, pointing out that although the majority of addicts want to be free of drugs, this is not facilitated by government policy. He wants to see a target limiting use to two years.
Methadone is a smokescreen for the absence of alternatives when it comes to problem use. There appears to be no new thinking, no initiatives, few open minds; and indeed little political will.
In a sense, the ubiquity of the heroin substitute is an admission that not only have social policies failed, but that we have no solutions for the consequences.

Source: Times Online 17th March 2010

The California Medical Association (CMA) took a major leap lacking science and common sense. With the issuance of a White Paper calling for the legalization of marijuana for medical and non-medial purposes, they have transitioned from a medical group into a lapdog of the drug legalization lobby.
“I am thoroughly appalled by the CMA’s decision to release this policy in an attempt to legalize a drug that we know causes so much harm to individuals and families,” said Eric Voth, M.D., F.A.C.P. and Chair of the Institute on Global Drug Policy. “The CMA has managed to single-handedly make a mockery of modern medicine and the ethical practices of physicians. There is nothing scientific about this White Paper – it is total politics.”

The White Paper just released contains a number of incorrect statements. Contrary to what the paper states:
• According to the National Household Survey on Drug Abuse, the rate of current, past 30-day use of marijuana by Americans aged 12 and older in 1979 was 13.2%. In 2008 that figure stood at 6.1%. This 54% reduction over that 29-year period is a major public health triumph, not a failure! Now, we must not only push back against the drugs but, the advocates who seek to normalize and legalize them.
• The Netherlands reclassified high potency marijuana as a “hard drug” because of the harms that have occurred from the drug and moved to shut down hundreds of “coffee shops” that serve marijuana. Their lenient policy caught up with them and they are moving back to more conservative actions.
• Portugal’s policy that decriminalized consumption and possession of illicit drugs in 2001 was a dismal failure. The 2007 national drug survey showed an increase in life-time prevalence of drug use in the general population, especially regarding cannabis use and use of cocaine has nearly doubled. Cocaine seizures increased seven-fold between 2001and 2006 and murders increased 40%.

“The CMA is dead wrong in asserting that the marijuana legalization movement is driven by the public. Instead it is driven by a group of well-financed legalization advocates. The ballot initiative to legalize pot was defeated in California and no other state has approved such an ill-advised policy, despite millions of dollars poured into this effort by ivory-tower elitists unaffected by the impact of drug use, like the rest of us. Even the issue of marijuana as medicine was rejected by two-thirds of the country,” stated Calvina Fay, Executive Director of Drug Free America Foundation.

“It is laudable that CMA supports more research and more education efforts to reduce marijuana use among children, adolescents, and young adults (although we believe it should include all adults). Ongoing research into potential medicines and cures is an important endeavor but, the solution should be to require marijuana to meet the standards of modern medicine, not by ballot initiatives or legislation and certainly not by legalizing it for recreational use” Fay concluded.
Drug Free America Foundation, Inc. is dedicated to fighting drug use, drug addiction and drug trafficking and to promoting effective sound drug policies, education and prevention.

Source: www.dfaf.org October 17, 2011

CALLS have been made for a rethink on the use of methadone in Scotland after official figures revealed the number of deaths in which it was implicated reached a ten-year high last year.
Amid a general fall in people being killed by drugs, fatalities in which the heroin substitute was cited as a contributory factor rose to 173 in 2009, up from 169 in 2008 and a surge of 51 per cent since 2007 when it was associated with 114 deaths. The controversial drug treatment was found to be at least partly responsible for more than a third (32 per cent) of all of the 545 drug-related fatalities in Scotland last year, and was associated with the second-highest number of drug-addict deaths after heroin or morphine, which contributed to 322 losses of life – 59 per cent of the total.

The 2009 methadone figure also equates to roughly one death every 48 hours.

The rising number of deaths linked to methadone led to calls for the policy of wide prescription of the treatment to addicts to be reviewed, with one drug-misuse expert describing the current situation as being of “enormous concern”.

Professor Neil McKeganey, the director of the Centre for Drug Misuse Research at Glasgow University, said: “The situation in relation to methadone – where it appears we have around a third of addict deaths associated with the drug we are prescribing most widely to treat drug addiction – is of enormous concern. We really ought to be looking again at this policy of widespread methadone prescribing. The statistics are inescapable – we ought to be looking at why we are doing it and whether all of those to whom it is being prescribed are deriving benefit from it.”

Peter McCann, the chairman of the Castle Craig Hospital for alcoholism and drug addiction, lent his weight to the calls, adding: “Today’s drug-death figures would have been described as totally catastrophic just a few years ago. There must now be a total rethink in Scotland along the lines of the National Treatment Agency in England which totally reversed its policy earlier this month. “They will be limiting the use of methadone with strict multi-disciplinary assessments at regular intervals. The policies prescribing methadone in Scotland have obviously failed and must be revised.”

Murdo Fraser, Scottish Conservative health spokesman, said the focus of the Scottish drugs strategy should be on recovery and abstinence. He said: “The attempts of the last decade to merely manage the problem, based on harm reduction and an over-reliance on methadone, just have not worked. The challenge now is to expand the range of rehabilitation services on offer and move to abstinence and recovery.”

But the treatment was defended by Biba Brand of the Scottish Drugs Forum: “We know from research that staying on methadone tends to prolong their life by about 13 per cent. “We also know that of those deaths that are occurring (overall], two-thirds are outwith treatment, so being in treatment – and generally that involves methadone – is helping people stay alive. Methadone can help save lives, but we need to help people progress through treatment.”

A Scottish Government spokesman added: “We do not favour one form of treatment over any other. Decisions on the most appropriate treatment to prescribe an individual are for clinicians, in discussion with their patients and in line with national guidelines.”

Overall, the number of people killed by drugs in Scotland fell by 5 per cent since 2008, but the 545 drug-related deaths during 2009 equated to the second-highest total ever recorded; an increase of 20 per cent since 2007 and a rise of 87 per cent since 1999.

A wider analysis, using figures recorded by the Office for National Statistics, showed the number of deaths related to drugs in Scotland last year was 716, down from 737 in 2008, but a rise from the 2007 total of 630.

This figure included people killed by solvent abuse, legal highs and through overdoses of prescription medication. It also included people dying with mental-health problems linked to drug abuse, as well as those killed by the health complications allied to contaminated drugs. More than a third of all deaths in Scotland, some 200, were in the Greater Glasgow and Clyde NHS board area, and this represented the highest total on record. Deaths in Lothian dropped, by 13 to 81, as did fatalities in Fife (37 to 32) and Forth Valley (23 to 14).

There was also a rise in the number of older people dying from drugs, with deaths among those aged 35 and over rising from 271 in 2008 to 296 in 2009, while at the same time deaths among users under 35 dropped from 303 to 249.

Source: News.Scotsman.com 18th Augutst 2010

The impact medical marijuana has had on our adolescent substance-abuse treatment program in Denver is profound.

The 2009 boom in marijuana distribution coincides with a tripling of teens referred to our program. Currently, 51 percent of our patients report getting their marijuana from someone with a medical marijuana license.

Not surprisingly, patient attitudes about marijuana are changing – and in ways that make it much more difficult for us to help them stop using the drug. Recently, a teenage boy said he couldn’t stop smoking marijuana because “it is my medicine for anger.”

Even worse, a few young adult patients in treatment for marijuana addiction have marijuana licenses. These patients struggle with conflicting messages from one physician who recommends smoking marijuana and another who recommends stopping.

In Denver, marijuana is advertised on billboards and in magazines and newspapers using themes that appeal to young people. Because youth are highly vulnerable to both the effects of advertising and the addictive potential of marijuana, it is not surprising that 60 percent of the state’s medical marijuana users are under 44 years old.

We must act swiftly to prevent situations such as this from getting worse.
Christian Thurstone, M.D. is the Medical Director of Adolescent Substance Treatment, Education and Prevention at Denver Health and Hospital Authority and Assistant Professor, Department of Psychiatry, University of Colorado Denver.

Source: http://ofsubstance.gov/cs/blogs Wednesday, October 13, 2010

The extension of “payment by results” to the treatment of drug addicts will test the method’s limits

AT PHOENIX FUTURES in Birmingham, Karen is six weeks into a programme of group therapy sessions, life-skills training and one-on-one meetings with her keyworker, Dean. Things are looking pretty good. A former heroin user, she was on methadone for years before going into residential rehab last October. Karen now takes a relatively low dose of Subutex, a weaker heroin substitute, which she intends to come off altogether over the next six weeks. She credits her treatment with giving her the stability to have her three-year-old son to stay with her at weekends, and hopes to take a course or get a job—and eventually to work with drug users—once she is fully abstinent.
There are many Karens in Britain, though most are not doing as well as she is. Around 320,000 people are thought to be on heroin or crack cocaine or both in England alone. Many more use cannabis (the most popular drug), powder cocaine or a constantly changing clutch of designer drugs and legal highs: in all, almost 3m in England and Wales used some sort of illegal drug in 2009-10. A big push by the previous Labour government lifted the numbers in treatment (see chart), and drug use seems to be falling a bit now. But it remains high by European standards. Some argue that too many users have been “parked” on methadone rather than encouraged to kick chemical dependence altogether.
Intent on remedying what the Conservatives see as the persistent ills of “broken Britain”, the Tory-led coalition government has big ambitions in drugs policy. It wants to get more people through treatment and functioning again—free of drugs if possible, but also employed, housed and law-abiding. There is a moral dimension to its emphasis on recovery rather than harm reduction, but also an economic one. Use of heroin or crack cocaine is linked to between a third and a half of all acquisitive crimes; an estimated 400,000 benefit claimants who are dependent on drugs or drink cost the Treasury £1.6 billion a year; and demands on the health service and criminal-justice system are great. The coalition’s commitment is real: at a time of screaming budget cuts, central-government funds for drug treatment in communities and prisons have barely been hit.
A key plank of the strategy is “payment by results”. This approach to delivering public services—rewarding charities, community groups or private firms not for what they do but for how well they do it—has been seized on gratefully by a cash-strapped government. Versions are being tried to get welfare recipients into work and discourage criminal reoffending. Now eight drug-treatment pilots are to be launched. This breaks new ground internationally, says Martin Barnes, the head of DrugScope, a drug-information charity.
No magic wand
The theoretical argument for payment by results is that, by rewarding only success, it drives up standards while reducing costs. “It will make organisations focus on delivering quality services because they won’t survive if they don’t,” says David Biddle, deputy chief executive of CRI, a charity whose drug and alcohol services have grown rapidly. Kent is one area chosen for a payment-by results pilot. “Commissioners will now have the opportunity to reward those who innovate, and deliver efficient and effective services,” says Amanda Honey of Kent County Council.
Not everyone is sure that payment by results will work in drug treatment, however. Outcomes are hard to measure. In welfare-to-work schemes, a claimant either gets and holds a job or he doesn’t. A prisoner is convicted of reoffending or he isn’t. With drugs, progress often consists of baby steps on various fronts, which is why the government proposes to pay for a range of positive outcomes including jobs, housing and so forth. Coming up with precise measures is proving hard.
Setting tariffs is difficult, too. Payment by results works only if risk is transferred to the provider. But drug users are prone to relapses, and recovery can take years. Most not-for-profits in drug treatment are small; they need payment along the way to cover their costs. If instead they become subcontractors to larger outfits, a one-size-fits-all approach could replace the tailored solutions seen by many as a key to success. Whoever is contracted, “if the basic tariff isn’t enough, it will wipe out the chances of the provider doing anything good. If it’s too much, then there is no risk transfer. If it’s the wrong mix [of incentives], then it encourages gaming,” says Lord Adebowale, the chief executive of Turning Point, a health and social-care organisation.
Despite the challenges, Turning Point and CRI are both interested in the trials. For its part, smaller Phoenix Futures has started offering a payment-by-results option off its own bat. “I wanted us to be ready,” says Karen Biggs, its chief executive.
But other uncertainties loom, as more administrative power is pushed down from Whitehall. From 2013 the funds earmarked by central government for drug treatment in the community (currently about £500m) will be handed over by Public Health England, a new bit of the NHS, to local authorities; drug and alcohol funding will merge, and perhaps disappear into the overall public-health pot. New elected police and crime commissioners will have a say in this area, as might local GPs newly charged with commissioning health care.
Anne Milton, the minister for public health, is determined that money will not leak away from drug treatment, counting on a national “outcomes framework” to make sure that needs which are not regarded as a priority locally continue to be met. Payment by results in this complicated and difficult area might prove transformative in all the right ways—or it might turn out an unholy mess. If it does work, says one sceptical charity, “they can use payment by results to deliver absolutely anything.”

Source: www.economist.com 14th April 2011

BBC Radio 4’s Any Questions: The drug policy debate in early June mentioned an organisation in which I am involved – the UK National Drug Prevention Alliance – many times, so we must respond. In doing so, I hope to convey proven facts about the dangers of legalising drugs.

Nadine Dorries was correct that much modern cannabis is stronger than years ago but we do not agree with her figures. Typically, modern cannabis is three to four times stronger in THC, the psychoactive ingredient, than even the strongest cannabis of the 1960s and 1970s. This has been achieved by selective breeding and in response to consumer demand.

But the picture is more complex than ‘just’ THC strength. The presence – or rather absence in modern forms – of another chemical, CBD, appears to have aggravated the brain-damaging potential of cannabis. Use has also changed. Age of first use and regular use is earlier than in the 1960s and that is another damaging factor. The evidence caused the UK government, with cross-party agreement, to reclassify cannabis upwards two years ago. At the time (Sky News, 6 April 2008), prime minister David Cameron admitted that a parliamentary committee, of which he had been a member, had been wrong about lowering the classification of cannabis. Lessons have been learned and are unlikely to be overturned. Cannabis contributes substantially to academic under-achievement and very poor mental health, regardless of other effects.

On the wider question of decriminalisation and even legalisation of all drugs, the NDPA believes that a monstrous, well financed and very slick fraud is being perpetrated internationally and that this fraud has fooled some of the “great and good” who signed up as supporters. There is no evidence at all that either measure could reduce the total harm from drugs. The reverse is very much the case, with academic opinion saying that either measure would inevitably normalise and increase, use. The manifest harm from the legal drugs and the legislation on alcohol and tobacco, as variously applied around the world, confirms that. Comments on wishful good effects from decriminalisation were profoundly incorrect and reflect manipulative messages. For years, we have been bombarded with the Netherlands as the example of sound drug policy – despite the fact that the country, through its policies, created the largest base for drugs-related criminality in Europe with supply, warehousing, distribution and manufacture at astonishing levels. At one stage, the Netherlands had more drug related murder than anywhere else in Europe. The Netherlands is changing. It spends proportionally more than the UK on enforcement and is currently more effective and better organised than the UK.

Portugal and decriminalisation appears now to be “the new orthodoxy” for those with a certain direction of travel and for those “user advocates” who want more freedom to use, regardless of the wider social effects. But Portugal is being misrepresented, as demonstrated below.

1. The number of new cases of HIV and Hepatitis C in Portugal is eight times the average in other EU countries.
2. Portugal has the most cases of injected drug related Aids, with 85 new cases per million citizens. Other EU countries average 5 per million.
3. Since decriminalisation, drug-related homicides have increased 40%.
4. Drug overdoses have increased substantially, by over 30% in 2005.
5. There has been an increase of 45% in post mortems testing positive for illegal drugs.
6. Amphetamine and cocaine consumption has doubled in Portugal, with cocaine seizures increasing sevenfold between 2001 and 2006.

Finally, the suggestion that legalisation would somehow remove criminality from drug supply is ridiculous. Criminality loves use-reinforcing substances and behaviours. Over 20% of the UK tobacco market is smuggled, counterfeit or both. In some other countries, the figures are worse. Legalisation or decriminalisation of substances unfit for human consumption should occur only if a demonstrable “public good” can be evidenced. The problem for the legalisation lobby is that it
cannot.
DAVID RAYNES is executive councillor of the
UK National Drug Prevention Alliance (http:// drugprevent.org.uk/ppp/about-us).

Source: Addiction Today July/August 2011

Should drugs be legalized? Some people think so, like a recent article written by Ethan Nadelmann in Foreign Policy magazine. The Executive Director of UNODC, Antonio Maria Costa, put forward his views on the topic to a meeting in New Orleans hosted by the Drug Policy Alliance. Here is a full text of the speech:

Ladies and Gentlemen,

From both sides of the aisle, there have been noises about my presence here. Is it right to invite this fellow, the so-called drug czar of the United Nations, to our annual conference?  Indeed, in some of the pro-legalization literature I am depicted as a die-hard prohibitionist, a drug control Taleban, a naive proponent of a drug free world, even a general in the war on drugs.

I have heard similar complaints from the opposite front: what is the point of the UNODC Executive Director joining the caucus of those who ask for the end of drug control, mixing with drug legalizers, the radical fringe of the pro-drug lobby, pressing for a world of free drugs that will never come?

I am glad that eventually we all decided that this exchange of views could be constructive, and help public opinion understand better a century-old drama: drug abuse, and the damage that it causes.

Is there some common ground between those who insist on a world free of drugs, and those who propose a world of free drugs? By the time this session is over, I hope we will all be able to answer in the affirmative. Here are a few pointers:

• First, health and security have to be protected when we talk about society, including when we talk about how society deals with drugs.
• Second, as a corollary, we can all agree on the need to reduce the harm caused by drugs — by preventing their use, by treating those who abuse them, and by limiting the damage they cause to the individual and society.
• Third, I hope we also agree on the need to ensure that drug policy is evidence-based, not the result of political considerations or ideological preferences.
• Fourth, I submit that the dichotomy prohibition vs legalization is a misnomer. Such a confrontation is too simplistic for scientific deliberations, nor does it help those whom we all wish to assist: our brothers and sisters, the drug addicts.
• Fifth, and finally, I hope you also agree that it is more accurate to refer to our divergence as a difference about the degree to which addictive substances (drugs, alcohol and tobacco) should be regulated. 

If these points are accepted, the discussion is to be centred on  where the bar is set , how to define the degrees of regulation. In other words, instead of accentuating our differences, I hope we build on the ground we share.

Let me begin with the world drug situation: where do we stand?

The world drug situation

In a recent article Ethan Nadelmann wrote: “it is dangerous when rhetoric drives policy”. I agree.  Res, not verba, [actions, not words] my ancestors the Romans, would have said. So let’s begin with the facts.

A growing body of evidence, including recent UNODC World Drug Reports, shows that the drug market has stabilized over time and space. [Opium in Afghanistan is mostly an insurgency issue (4/5 of the cultivation takes place in the areas controlled by the Taliban).]

On the basis of this evidence, I can state that, since a few years, for all drugs there are signs of world market stability (for opiates, cocaine, cannabis, and ATS). What I mean is that in every component of the drug business (cultivation, production, consumption), aggregate totals have lost the upward momentum they had in the 1980s and ’90s. Of course, world aggregates hide improvements in some countries and for some drugs, offset by deterioration elsewhere. Yet, the global totals are stable. This is what I like to call containment.

This finding refers to the past few years. Hopefully, in the period ahead evidence to support this claim – over the long term – will become statistically and logically incontrovertible.

Next question: how did this market change come about? Is this the result of the UNGASS process? I see correlations over time and space, but evidence of causality is hard to come by (social sciences are generally poor in proving cause/effect relations). Drug trends respond to a wide range of factors, especially changes in society’s revealed preferences. Yet for me, the result is what counts. If you have evidence to refute our data, I would like to see it.

Despite evidence of containment the world still has an enormous drug problem. There are some 25 million problem drug users. But let’s keep this in perspective – that’s less than 0.6% of the world’s population. Even if you take into account the number of people who take drugs at least once a year (approximately 200 million people), this is still below 5% of everyone on the planet.

By comparison, 50% of the world’s population uses alcohol, and 30% smoke. Alcohol, we know, kills 2.5 million people a year. More than half of all homicides and road-accidents, and most domestic violence, is alcohol-related. Tobacco kills 5 million people a year, because of cardio-vascular diseases and cancer — two of the greatest killers of our time.

What is my conclusion? There is growing public and medical pressure to tighten controls on the consumption of alcohol and cigarettes. That’s right. So why increase the public health damage caused by drugs by making them more freely available: drugs whose damage — thanks to the controls – is limited to 1/10th the casualties caused by tobacco? Why ignore the knowledge that we have gained from our experience with other addictive substances? 

If dreams come true…..

In order to show where I like to set the drug control bar, let me begin with the slogan so many of you have ridiculed:  a drug free world. Wait, wait: hold on to the tomatoes – I am not the author of this slogan. While in my life time I would certainly like to see a world without drugs, I have never used this slogan. Actually, you will not find it in any of my speeches, nor in any of the official United Nations documents, starting from the most relevant of them: the conventions (of 1961, 1971, and 1988) that created the UN drug control regime, and the General Assembly resolution about drugs (most notably from the UNGASS, 1998).

Yes, of course, several years ago (ie BC, before Costa) my Office put out posters with that slogan screaming across the page. While I never used this concept, personally I see nothing wrong with it. Is a drugs free world attainable? Probably not. Is it desirable? Most certainly, yes. Therefore I see this slogan as an aspirational goal, and not as an operational target – in the same way that we all aspire to eliminate poverty, hunger, illiteracy, diseases, even wars.

So let’s move on. I start with a series of (hypothetical) situations that I deem useful to set priorities in drug policy. I present them to you as dreams.

First, I invite you all to imagine that this year, all drugs produced and trafficked around the world, were seized: the dream of law enforcement agencies. Well, when we wake up having had this dream, we would realize that the same amount of drugs – hundreds of tons of heroin, cocaine and cannabis – would be produced again next year. In other words, this first dream shows that, while law enforcement is necessary for drug control, it is not sufficient. New supply would keep coming on stream, year after year.

So let’s dream a second time. Let’s dream that, by some miracle, we can convince farmers around the world to eradicate the thousands of hectares of drug crops, replaced by the fruits of development assistance (in Afghanistan, Colombia, Morocco, and Myanmar). A great dream of course, but yet again one that would not on its own solve the world drug problem. Why? Because when we wake up after this second dream we would realize that other sources of supply would inevitably open up somewhere else on the planet, to satisfy the craving of millions of drug users around the world.

So we come to a third dream which is the real challenge of drug policy: to reduce the demand for drugs. Prevention, treatment and reintegration, combined in a single health based programme, must be our priority. Of course the world’s supply of drugs needs to be reduced, but lower demand for drugs is the required condition to make drug policy realistic and pragmatic.

I hope you agree on this sequence, to separate the three elements of the drug chain, and their primary agents:  supply, by farmers in need of assistance;  trafficking, by criminals deserving retribution; and demand, by addicts in need of health care. At the UN, governments have captured this concept nicely in the expression shared responsibility.

Our Office focuses on the first and third part of this trilogy, namely the farmers and the drug users. Going after the traffickers is the role of law enforcement agencies. We help indirectly in this endeavour by promoting criminal justice and counter-narcotics cooperation. I take this opportunity to salute the work of counter-narcotics officials around the world whose important work is often carried out at the cost of their lives: please recognize that they deal with loathsome predators who exploit human vulnerability for the purposes of profit.

Health and Security  

With two building blocks of my argumentation in place (namely, stability of the world drug market and the priority of reducing drug demand), let me now turn to the issues of health and security.

Some people say that drug use is a personal and private choice – and nobody else’s business.

I have a few problems with this argument. First, there is a health issue. A growing body of scientific evidence shows that drug abuse is a disease affecting the brain, as much as any other neurological or psychiatric disorder. It is both triggered by vulnerability, and, in turn, deepens vulnerability. This has consequences both for the drug user and society as a whole. 

Second, if people don’t care about the dangers to themselves, what about the dangers that drugs cause to others: like road accidents or crimes committed by people under the influence of psycho-active substances, or the spread of blood borne diseases to others? The pharmacological effects of drugs are independent of their legal status. Drugs are not dangerous because they are illegal. They are illegal because they are dangerous. No wonder that public outcry against the collateral damage of drug use is building, just like successful campaigns against passive smoking or drunk driving. 

Third, drugs threaten security – not only public safety in inner-cities, but the security of states — think of Central America, the Caribbean and West Africa, caught in the cross-fire of drug trafficking.

I know your argument on this last point. Prohibition causes violence and crime by creating a lucrative black market for drugs: so, legalize drugs to defeat organized crime. Thus far, as an economist, I agree with you. But this is not only an economic argument. Legalization may reduce the profits to organized crime, but it will also increase the damage done to the health of individuals and society. Evidence shows a strong correlation between drug availability and drug abuse. Let us therefore reduce the availability of drugs – through tackling supply and demand – and thereby reduce the risks to health and security.  

In short, drug policy does not have to choose between either (i) protecting health, through drug control, or (ii) ensuring law-and-order, by liberalizing drugs. Democratic governments can and must protect both health and safety.

Besides, just because something is hard to control doesn’t mean that its legalization will solve the problem. For example, it is hard to stop human trafficking – a modern form of slavery. This is a multi-billion dollar business. Because the problem is out of control, would you equally propose that we accept it?

Let’s Not Condemn People to a Life of Addiction  

In order not to condemn people to a life of addiction, my Office is putting a strong emphasis on drug prevention and treatment. This goes back to the roots of drug control. The 1961 Convention on Narcotic Drugs is based on the premise that health is the first principle of drug control. This becomes more relevant every day as a growing body of medical and scientific evidence shows that drug addiction is an illness. So let’s treat it that way. There are no ideological debates about curing cancer or diabetes. So why have them about drug addiction? People to the left or right of the political spectrum are not divided on the need for preventing or treating tuberculosis and HIV/AIDS. So why with drugs?

Scientific evidence has proven that drug dependence is a health and social issue, the result of nature and nurture. People are vulnerable to addiction because of a mix of genetic, personal and social factors: gene variants , namely genetic predisposition to addiction, childhood, pre-natal stress and inadequate parental care, neglect, abuse, low school engagement, lack of bonding, and social conditions , marginalization, exclusion, poverty, latent or overt psychiatric disorders as well as popular culture and peer pressure.

There is a double jeopardy at play here: not only are such people more vulnerable to addiction, but addiction deepens their vulnerability. As a result, the disadvantaged are pushed even further away from society.

If drugs were legalized, these people would be condemned to a life of dependence. The privileged can afford expensive treatment for their drug habits, or those of their kids. But what about the less fortunate who lack the same means and opportunities?

Now extrapolate the problem onto a global scale. Imagine the impact of unregulated drug use in developing countries where no prevention or treatment are available. This would unleash an epidemic of drug addiction and all the social and health consequences that go with it.

Instead of reducing harm, there would be increased damage to individuals and communities because of drugs. Will you share the responsibility for the overdoses, HIV, and broken lives?

Beyond 2008 

Ladies and gentlemen, if you really want to rethink drug policy, then help rebalance global drug control in favour of prevention and treatment. You are an outspoken Alliance. Be more radical. Go beyond handing out condoms, clean needles or a bowl of soup. Offer all drug addicts a comprehensive package that includes prevention, treatment and reintegration, not only harm reduction gadgets. Join me as an “extremist of the centre”. We have been hearing about a balanced approach for a quarter century. It’s time to turn it into reality.

If you want to shake things up, if you want to break the vicious circle of dependence and disadvantage, then:

Do not only:

- prevent the spread of diseases that precede and accompany drug use, like HIV and hepatitis.

This is a noble aim that we all share. But let us go further and:   

- devote more attention to prevention and early detection of drug vulnerability;

- reach out to people who need treatment, on a non-discriminatory basis;

- support the mainstreaming of drug therapy into high-quality and accessible public health and social services.

Let us also:

- promote alternative measures to prison for drug addicts, offering them rehabilitation programmes;

- treat all forms of addiction. There is no consolation for stabilizing drug trends if people turn instead to other substances; 

- finally, and most importantly, make drug control a society-wide issue.

Drug policies are too important to be left to drug experts like you and me, and to governments alone. It is a society-wide responsibility that requires society-wide engagement. This means working with children, starting from parents and teachers, to ensure that they develop self-esteem. Support family-based programmes, because prevention begins at home.

Schools teach life-skills. They should also teach the dangers of drugs. Help young people engage in healthy activities, like sports and culture, to prevent social isolation that leads to drugs and crime. Invest in better understanding, preventing and treating the illness of addiction.   People can be steered away from drugs. And those that do suffer the misery of addiction can be brought back into society. This is the true meaning of harm reduction which goes far beyond its usual narrow definition. My Office promotes this approach, together with the World Health Organization.

Ladies and Gentlemen,

The strength of the international drug control system is its universality, with all governments solidly behind the United Nations drug conventions and strongly supportive of my Office. I hope I have won you over as well. If not, any change you would like to make to the existing drug control regime must be done by governments. You can influence the process. The review of UNGASS is a golden opportunity. We all want to help the poor farmers – to switch from crops to sustainable livelihoods. We all want to help the drug addicts – to save them from a life of misery. We all want to reduce the violence and crime associated with the drug economy.

So let’s build on this common ground to make a safer and healthier world.  Thank you for your attention.

Source:  Antonio Maria Costa. United Nations Office Drug Control. Dec. 7^th, 2007

It is a cocktail of heroin and cold medicine that can kill your child – and it goes by the name ‘Cheese’. Police in New York are on alert for a wave of deaths as young children get hooked on the latest fad drug to sweep the city.
Coined ‘Cheese’ by the schoolchildren who are addicted to it, the brown powder gives a high for just $2 that can easily be sniffed between lessons.
Victims: Oscar Gutierrez, 15, and Nick Cannata, 16, both died after becoming addicted to ‘Cheese’. Dealers are increasingly the drug, known as ‘starter heroin’, at children to get them addicted young
Dealers have been stamping packets with child-friendly brands like Lady Gaga, Mickey Mouse, the Looney Tunes logo and characters from the Lion King in order to lure in ever younger customers. But once children are hooked they find it incredibly hard to quit – withdrawal symptoms start within six hours meaning addicts have to dose themselves up to 15 times per day.
The dark twist is that ‘Cheese’ also contains a potentially fatal amount of acetaminophen, a common ingredient in cold medicines like Tylenol, giving rise to its other name – ‘Tylenol With Smack’.
The drug has been linked to a string of fatalities in Texas and now police in New York fear it is heading their way too ‘It can ruin lives,’ said an NYPD commander who recently taught patrol officers how to spot it.
Lethal: Cheese is a combination of heroin and cold medicine which is highly addictive and is said to be behind at least 20 deaths in the U.S.
‘Cheese’ has been on the radar of drugs officials since 2005 since when it has been blamed for more than 20 deaths in Dallas alone. Although just 2.6 per cent of high school students have tried heroin, dealers are using ‘Cheese’ to get them hooked at a lower cost. The drug is made by mixing the heroin powder with cough medicine, possibly with the addition of water or other ingredients, and then usually snorted.It has a heroin purity of up to 8 per cent, well below the level of intravenously injected drugs, but enough to make it addictive.
Police have found that children as young as 12 have become hopelessly addicted to the drug and only escaped its clutches with the constant help of their families.
Among those who lost their child to ‘Cheese’ is Dave Cannata from Dallas, who now travels the U.S. warning other parents about the drugs. Mr Cannata found son Nick dead in his bedroom five years ago after he overdosed on the cocktail. The 16-year-old had only been out of rehab for six months when he came home and apparently went straight to bed. He was found dead the next morning.
‘Parents need to be scared of this stuff,’ Mr Cannata said. ‘Every day I look at his picture and I wish that I spent the 40 grand a month to send him away to get some help. ‘You have to jump on the problem right away. This drug is so highly addictive.’
The Drug Enforcement Agency refers to ‘Cheese’ as ‘starter heroin’ because of the low amount of the drug in it. Over time users build up their tolerance level so they need increasingly large amounts to get high – before moving on to the real thing.

Source: – http://www.dailymail.co.uk 14th Oct 2010

Dr. Dewey, a Physiatrist and Scientist has studied for over 20 years the brains of people using all kinds of drugs.

At a forum in Ronkonkoma,he presented information about a recent study with teenagers who smoke marijuana. He asked for subjects only using marijuana. He needed 400 teenagers just using pot. He received 7000 responses.

He selected 400 teenagers and tested them. In 72% of the marijuana use Methamphetamine was found. Every subject indicated that they were not using Methamphetamine.

Dr. Dewey stated that the pot is laced with Methamphetamine. This is very alarming said
Ginger Katz CEO of The Courage to Speak Foundation.

Source: Ginger Katz Founder & CEO of The Courage to Speak Foundation Oct 2010

Methadone for drug addicts costs the taxpayer £105m in four years
METHADONE for drug addicts has cost the Scottish government more than £105million in just over four years, it was revealed yesterday.
An average of £67,838 was spent every day buying and dispensing the heroin substitute since March 2006 – despite experts claiming it does not work.
More than 100 people have died of methadone overdoses in that time.
And there are fears that addicts are being “parked” on the substance as Scotland’s drug problems spiral out of control. Rehabilitation workers have joined politicians in calling for a radical overhaul of treatments.
Professor Neil McKeganey, of the Centre for Drug Misuse Research in Glasgow, described the bill as “staggering”. He said: “Scotland needs to address its reliance on methadone, which has become our main drug treatment – but it is costly and delivering dubious results. It is becoming difficult to persuade the Scottish government to look at alternatives. The solution is to get people off drugs and into drug treatment services. But that can’t be done by putting people on methadone indefinitely.”
Mark Hepburn, clinical director of the Alexander Rehabilitation Clinic at Oldmeldrum in Aberdeenshire, said: “My criteria for recovery is not for a drug-maintained life, but a drug-free one. But we are just parking people on it.”
Former Aberdeen heroin addict Barry Glaze, 29, was on methadone for five years and now believes it made coming off drugs harder. He said: “I started taking heroin when I was 16 and was first prescribed methadone when I was 19. It wasn’t until I was 25 that I came off it and that was after I asked my GP. If I hadn’t, I would probably still be on it.”
Labour justice spokesman Richard Baker said: “There have been too many cuts in services that work with addicts, and unless we see support for these services then these figures will not go down”.
The government spent £20.5million prescribing the drug in 2006-07, £24.7million in 2007-08, £27.5million in 2008-09 and £27.9million in 2009-10.
A government spokesman said: “We know that the annual cost of drug misuse in the wider context of total economic and social costs is estimated at £3.5billion.
“That’s over £60,000 per problem drug user – a cost for the whole community. However, these costs typically decrease by tens of thousands of pounds once an individual engages in treatment to support their recovery.
“That’s why we are providing a record £28.6million investment in frontline drug treatment services in 2010-11 and our view is that the overarching aim of all drug treatment services should be recovery and this is at the core of our drugs strategy.”

Source: http://www.dailyrecord.co.uk/news 30.09.10

The Government’s official drug advisers will recommend later this month that the “legal high” mephedrone should be banned because of the potential serious risks to public health.  But the drug – a legal stimulant sold as plant food and known as miaow-miaow – will not be formally banned until at least the summer as further consultation is needed on whether it should be a Class A, B or C drug.

Pressure on the Government to outlaw mephedrone intensified yesterday when a post-mortem examination on John Sterling Smith, 46, of Hove, East Sussex, showed he died from mephedrone poisoning. His family said they were stunned and called for a ban. Results of toxicology tests released last night blamed mephedrone for his fatal cardiac arrest.  A Sussex Police spokeswoman said that Mr Smith collapsed at a party in Hove in the early hours of February 7. “Two men, aged 35 and 40, both from Brighton, were arrested on suspicion of supplying Class A drugs and released on police bail until May 5 pending further inquiries,” she said.

Headteachers called yesterday for action on the drug, which has been linked with at least five deaths.  Louis Wainwright, 18, and Nicholas Smith, 19, from Scunthorpe, died after taking mephedrone, which can be bought for £4 and is also known as “M-cat”. Both teenagers had been drinking alcohol and police said last night that they may have taken the heroin substitute methadone too.  There have been two other deaths in Britain linked to mephedrone, which is illegal in countries including Norway, Germany and Finland.

The Advisory Council on the Misuse of Drugs at present lacks sufficient members to make a formal recommendation, but the appointments process is being brought forward to next week to get over the legal problem. A spokesman said: “The council has been looking at the dangers of mephedrone and related cathinone compounds, as a priority. The ACMD held an evidence-gathering meeting on February 22 and continues to carefully work on considerations with a view to providing advice to ministers on March 29.”

Alan Campbell, a junior Home Office minister, said: “We are determined to act swiftly but it is important we consider independent expert advice to stop organised criminals exploiting loopholes by simply switching to a different but similar compound.”  The Home Office denied that the sacking of Professor David Nutt, former chairman of the council, and subsequent resignations of key members of the organisation had led to “inordinate” delays in considering a ban.

Professor Nutt warned yesterday against a hasty reaction, saying a ban had to be based on “sound science”.

Tim Hollis, the Association of Police Chief Constables’ spokesman on drugs, said a ban would enable police to act against those possessing and supplying the drug. He spoke as Mike Stewart, head of Westlands School in Torquay, Devon, said teachers were in the absurd position of having to hand back packages of the drug seized in lessons.  Side-effects of mephadrone include high blood pressure, a burning throat, nose bleeds and purple joints.

Source:   Times online 18th March 2010

Mephedrone — a stimulant that is currently legal in both the U.K. and the U.S. — has gained recent and surprising popularity among club-goers in the U.K., according to Britain’s National Addiction Center.
The BBC reported Jan. 14 that the drug, also known as meph, 4-MMC, MCAT, Drone, Meow or Bubbles, was the fourth-most popular drug cited by readers of Mixmag, a popular British dance magazine.
“It’s come from nowhere to become very popular,” said researcher Adam Winstock. “For a drug that’s been around for a relatively short amount of time, mephedrone has certainly made a big impact on the dance drug scene.”
Users describe the drug’s high as falling somewhere between that of ecstasy and cocaine. The drug is sold legally in the U.K. as a plant food; it is a powder that can be taken in pill form, snorted, mixed with liquid or even injected.
Side effects include headaches, heart palpitations, and nausea.
Source: BBC 14th Jan 2010

 Jul 10, 2008

A Review of What Works

Introduction
Alcoholism affects millions of people in the United States alone. According to the National Institute of Alcohol Abuse (NIAA), a division of the National Institutes of Health in Bethesda, Maryland USA, at least 700,000 Americans receive treatment for this disease every day. Some kinds of treatment, such as Alcoholics Anonymous (AA) have been around for many years while others are relatively new. Clinical research to determine the effectiveness of these various treatments has resulted in some important findings.
In October 2000 the NIAA released a summary of its conclusions based on fifteen years of research on alcohol treatments. According to the NIAA, self-help programs such as AA, psychotherapy and pharmacotherapy, either alone or in combination, are in fact effective and do reduce the use of alcohol.
Alcoholics Anonymous
Of all the treatments for alcohol misuse, Alcoholics Anonymous (AA) is probably the most well known. In AA, a form of “self-help” treatment, participants take part in a series of mental, written and verbal activities that can lead to recovery and abstinence. In one study, alcoholic patients who received inpatient and outpatient psychotherapy, as well as AA, had better outcomes than those patients who attended only one kind of treatment.
It is thought that AA helps people because it provides a new social network that replaces the alcohol abuser’s usual group of friends who drink with him or her, and provides a fellowship that inspires motivation and lends support toward the goal of reaching and maintaining abstinence. AA also teaches a set of coping skills so that, when stressed, the alcohol abuser has more constructive ways of coping, and does not need to turn to alcohol to escape his or her problems.
Another study, conducted at a Department of Veteran Affairs hospital, indicated that those alcoholic patients who underwent either cognitive-behavioral therapy (CBT) or a 12-step program in combination with CBT did better, over the long run, than those who participated in the 12-step program alone. (CBT entails learning coping skills, new ways of interpreting and reacting to stressful situations, and changing one’s destructive or maladaptive behavior patterns.) The patients who received the combination treatment stayed sober longer and were able to hold down a job for longer periods than those patients who received only CBT.
Both of these studies seem to show that a combination of some kind of psychotherapy and a 12-step program such as AA produces the most beneficial results for patients who use alcohol in excess.
Other beneficial treatments
Other promising treatments of alcohol abuse that are being studied include Motivational Enhancement Therapy (MET); couples therapy; Brief Intervention Therapy; dual-addiction treatment; and pharmacotherapy.
Motivational Enhancement Therapy: The key component of MET is an interviewing technique conducted by a trained psycho-therapist. The goal of this method is to increase an individual’s degree of motivation to stop drinking and to maintain abstinence. This is accomplished by the therapist gauging the individual’s readiness to change and then adjusting feedback accordingly. An intensive, individualized interviewing strategy, MET was demonstrated to overcome many patients’ disinclination to address their alcohol problem in treatment and increase their willingness to change.
Couples Therapy: Patients who include their non-alcohol abusing partners in their psychotherapy are more apt to attend therapy, and more likely to alter their unhealthy drinking habits. In one model of couples therapy known as Behavioral-Marital Therapy (BMT), communication and conflict-resolution skills are taught. When a relapse-prevention plan was added to this model, alcohol abstinence rates were even higher.
Brief Intervention Therapy: This treatment method usually takes place when alcohol users visit their primary care physicians. It typically entails the imparting of information about the negative consequences of drinking to excess, as well as supportive programs in the community. Two studies, carried out in the United States and Canada, showed that patients did reduce their alcohol consumption as a result of these interventions. This treatment seems to work best with those individuals who are at-risk for alcohol abuse. Those who are already dependent are better off being referred to specialized treatment programs.
Dual-addiction treatment: This method attempts to target both cigarette (nicotine) and alcohol dependencies at once. The use of one of these substances seems to make an individual more susceptible to dependence on the other. The rationale behind dual-addiction treatment is that reducing dependence on one may help a person reduce his or her reliance on the other. Although this is a newer approach to treatment, a recent study seems to suggest that this is indeed the case.
Pharmacotherapy: Finally, if taken on a regular basis, the drug naltrexone, approved by the U.S. Food and Drug Administration in 1995, can be a valuable aid in preventing relapse among recovering alcoholics receiving psychotherapy. Another medication, acamprosate, proved helpful in several European trials. (Editor’s note: It is now undergoing clinical trials in the United States.) Zofran, a medication usually used to prevent nausea during chemotherapy for cancer, was beneficial in the treatment of early-onset (i.e. those who started drinking heavily before age 25) alcoholism. Sertraline (Zoloft), an anti-depressant, was found to be helpful in reducing drinking in those with late-onset alcoholism.
Summary
Using proven methods of evaluating medical therapies, recent research reveals that many effective treatments exist to help people to stop drinking and maintain abstinence. These treatments include self-help groups such as AA, psychosocial approaches and medications.
Continued research in the field of alcoholism is likely to produce highly specific medications that will reduce the craving for alcohol. It will also yield an even broader range of therapies, including those mentioned here, that will improve the alcohol abusing person’s chance for recovery.
Over time, those who suffer from alcohol abuse and/or dependence will have even more and possibly better options for successful treatment. In the meantime, effective treatments already being offered by mental health professionals and community groups have been demonstrated to reduce alcohol use and promise a better life for people who make use of them.

In May 2008 the current Home Secretary Jacqui Smith announced that she would reverse the 2004 decision and put cannabis back into category B.
The move went against the ACMD’s latest recommendations, but was, she said, necessary because of research linking heavy use of the drug with schizophrenia and other mental illnesses.

Ms Smith said she was particularly concerned over the rise in consumption of super-strength strains of cannabis, such as “skunk”.
The Home Office say such strains account for 80% of all cannabis seizures in the UK.

Read the article

http://news.bbc.co.uk/go/pr/fr/-/2/hi/uk_news/7845023.stm

*** THE NEW APPROACH

Class A: Ecstasy, LSD, heroin, cocaine, crack, magic mushrooms,
amphetamines (if prepared for injection).
Possession: Up to seven years in prison or an unlimited fine or both.
Dealing: Up to life in prison or an unlimited fine or both.

Class B: Cannabis, amphetamines, Methylphenidate (Ritalin), Pholcodine.
Possession: Up to five years in prison or an unlimited fine or both.
Dealing: Up to 14 years in prison or an unlimited fine or both.

Class C: Tranquilisers, some painkillers, Gamma hydroxybutyrate (GHB),
Ketamine.
Possession: Up to two years in prison or an unlimited fine or both.
Dealing: Up to 14 years in prison or an unlimited fine or both

Source: ECAD Newsletter 25th Jan. 2009

UK Advocates threatens legal action against health authorities providing drug-based treatments over rehabilitation. Alcohol dependency affects 1.1 million people
NHS authorities that offer alcoholics controlled drinking treatments relying on medication rather than total abstinence could face legal action from a patients’ organisation. UK Advocates, a pressure group campaigning for the wider availability of rehabilitation courses for addicts, is preparing to file claims against the Department of Health and local health services.
The charity maintains it has found evidence of thousands of patients with severe alcohol problems being given “psycho-active drugs” while they are still drinking. The combination, it is alleged, can be “potentially lethal” and is at odds with the manufacturer’s prescription advice and guidelines. “In many cases,” UK Advocates claims, “drugs and controlled drinking programmes are administered to sufferers without the doctor or clinicians involved having performed effective liver function tests to establish the extent of liver damage from excessive drinking.
“Treating alcoholics with drugs and on a basis of ‘moderation’ is similar to advising someone with lung cancer to cut down their smoking,” says Bob Beckett, founder of UK Advocates. “Controlled drinking programmes … hark back to the 1960s and 70s when we believed pharmaceuticals would cure everything, including addiction to alcohol. They simply have not worked.
“There are nearly one million people with alcohol problems taking up NHS beds. If we are serious about dealing with alcohol addiction then we have to look at cessation programmes, not drug-based detox, not hypnotherapy, but properly defined, intensive abstinence treatment.”
UK Advocates says its insistence on abstinence programmes follows guidelines adopted by the World Health Organisation (WHO). The organisation is now assessing whether programmes offered by primary care trusts (PCTs) meet “these statutory requirements as adopted by the European Union in accordance with WHO recommendations”. It says it will take “legal action against those it believes have been negligent by failing to offer day and residential abstinence treatments where clearly required”.
In May, the all-party parliamentary group on alcohol criticised “a general lack of capacity and variety in alcohol treatment services, due to poor levels of funding and, in some cases, a harm reduction agenda driven largely by crime and disorder rather than health considerations”. The committee found that although as many as 1.1 million people are classified as alcohol dependent nationally, only 1 in 18 enter any sort of specialist treatment each year. Spending on drug addiction outweighs that on alcohol dependency. UK Advocates says that it will issue proceedings in the administrative division of the high court “against PCTs and clinicians who may be proven to have acted negligently”.
Tom Gard, a spokesman for the group, said: “We have heard of someone who has been drinking two bottles of wine a day and has [only] been told to cut down to one and a half.” The charity claims that an audit of PCTs across the East Midlands and Yorkshire has revealed a picture, reflected nationwide, of many trusts offering no residential or intensive day abstinence treatment at all.
“In many areas those suffering from alcohol dependence are instead offered only ‘controlled drinking’ programmes, often without appropriate prior tests to establish whether or not the person needs to stop drinking completely to avoid developing serious physical and mental health problems.”
A Department of Health spokesperson said: “We have a comprehensive strategy to tackle health-related alcohol harm. The number of structured alcohol treatment places is increasing. Around 104,000 people were recorded as receiving treatment in 2007-08, against an estimated number of 63,000 in 2004.
“We have launched the alcohol improvement programme which assists PCTs in understanding local need and planning commissioning decisions. Most specialist alcohol services aim to help people reduce the harm associated with drinking. For those with moderate and severe dependence, this will usually involve advice and support to become abstinent, whether in the community or in-patient settings.
“Where a clinician considers medication would be the most appropriate treatment it is normal practice to discuss the effects and potential side-effects of the medication with the patient.”
Source: guardian.co.uk, Monday 3 August 2009

Professor Susan GreenfieldIt is folly to legalise a drug that is known to leave users with permanent damage to their ability to reason, argues Susan Greenfield, the distinguished expert on brain processes (Sunday August 18 2002, The Observer) now that those anxious to look cool can puff cannabis freely in without fear of arrest, perhaps those of us who have argued that
relaxing the laws on cannabis is irresponsible and dangerous should
retreat gracefully behind our chintz curtains. Yet the downgrading of
the classification of cannabis perpetuates the same tired old myths
and the same serious problems.

Take the myth that cannabis is ‘just the same as’ alcohol. A glib yet logical riposte might be that if the drugs are truly identical why not just stick with the booze? What is the distinct appeal of cannabis that can be ignored in equating the two drugs? Such sophistry is inappropriate because alcohol and cannabis work on the brain and body in very different ways. Alcohol has a range of non-specific actions that affect the tiny electrical signals between one brain cell and another; cannabis has its own specialised chemical targets, so far less has a more potent effect.
Moreover, although drinking in excess can lead to terrible
consequences, there are guidelines for the amount of alcohol that
constitutes a ‘safe’ intake. Such a calculation is possible because we
know alcohol is eliminated relatively quickly from the body.

With cannabis, it is a different story. The drug will accumulate in
your body for days, if not weeks, so, as you roll your next spliff,
you never know how much is already working away inside you. I
challenge any advocate of cannabis to state what a ‘safe’ dose is.
Until they do, surely it is irresponsible to send out positive
signals, however muted? Another notion is that cannabis is less
harmful than cigarettes. I’m not sure how this idea came about,
certainly not as the results of any scientific papers. We do know
cannabis smoke contains the same constituents as that of tobacco:
however, it is now thought that three to four cannabis cigarettes a
day are equivalent to 20 or more tobacco cigarettes, regarding damage
to the lining of the bronchus, while the concentration of carcinogens
in cannabis smoke is actually higher than in cigarettes. And if
cannabis were ‘just the same’ as alcohol and cigarettes, why are
people not taking those already legal drugs for the much-lauded
pain-relief effects? After all, another case for the relaxation of the
laws on cannabis is the ‘medical’ one that it is an effective
analgesic. But there is a world of difference between medication
prescribed in a hospital, where the cost-benefit balance tips in
favour of pain relief, compared to a healthy person endangering their
brain and body needlessly. Even the most loony of liberals has not
suggested tolerance for morphine or heroin abuse, because they
are prescribed clinically as potent painkillers. And think about it:
if cannabis brings effective relief from pain, then how does it do so?
Clearly by a large-scale action on the central nervous system.
Further wishful thinking is that, because cannabis doesn’t
actually kill you, it is OK to send out less negative legal signals,
even though the Home Secretary admits that the drug is dangerous.
Leaving aside the issue that cannabis could indeed be lethal, in that
the impaired driving it can trigger could well kill, there is more to
life than death. It is widely accepted that there is a link between
cannabis and schizophrenia: as many as 50 per cent of young people
attending psychiatric clinics may be regular or occasional cannabis
users. The drug can also precipitate psychotic attacks, even in those
with no previous psychiatric history. Moreover, there appears to be a
severe impairment in attention span and cognitive performance in
regular cannabis users, even after the habit has been relinquished.
All these observations testify to a strong, long-lasting action on the
brain. Some attempts have been made in laboratories to work out
what cannabis could actually be doing to brain cells. So far,
some data have suggested that there can be damage to neurons, and at doses comparable to those taken on the street.

None the less, others argue that the experimental scenario of isolated neurons growing in a lab dish are hardly a natural situation, and that such data have to be interpreted with caution. But absence of evidence is not evidence of absence. The effects on the brain in real life are most probably
subtle and therefore hard to monitor: it’s not so much that cannabis
will create great holes in your brain, or deplete you wholesale of all
your best neurons. Instead, by acting on its own special little
chemical targets (and because it will therefore work as an impostor to
a naturally occurring transmitter), the drug is likely to modify the
configuration of the networks of brain cell connections. These
configurations of connections make you the unique person you are, since they usually reflect your particular experiences. So a change
will be hard to register from one person to another, and certainly
from one slice of rat brain to another: but still, it will make you
see the world in a different way – characteristically one depleted of
motivation.

It is hard for me, as a neuroscientist, to accept that a
drug that has the biochemical actions that it does, that hangs
around in the brain and body, and that has dramatic effects on brain
function and dysfunction, could not be leaving its mark, literally, on
how our neurons are wired up and work together. It is argued that
we will never stamp out cannabis use, and therefore we should
give up trying. But we will not stamp out murder or house break-ins or mugging, yet I’ve never heard an argument for freeing up police time
by liberalising the law on these acts. Laws, it is said, are
only enforceable when the majority wants them enforced, yet the
arguments used for easing up on cannabis apply equally to promoting
ecstasy or other mind-bending substances.
Do we really want a drug-culture lifestyle in the UK? Cynically, one could argue that it is politically expedient to court the youth vote, to open up the
inevitable prospect of revenue from a new source of taxes and to help
the ailing tobacco industry prosper from a great new product of
readymade packets of spliffs. The condoning of chemical consolation
also distracts from other problems. We have failed our young
people in providing homes and jobs and, by giving them an easy route into a chilled-out oblivion, have turned our backs on the far more challenging prospect of initiating policies to help them realise their
potential and live better and more fulfilling lives. They are paying a
high price for cool.

Source: www.guardian.co.uk/science Aug.2002

White House drug czar John Walters said high-potency marijuana coming from Canada is causing an increase in marijuana-related emergency-room cases in the U.S., “Canada is exporting to us the crack of marijuana and it is a dangerous problem,” Walters said. “We need to have political leadership in Canada that recognizes the problem. Addiction is going to spread in Canada dramatically. It has in many places.”

Walters blamed Canada’s more relaxed attitude towards marijuana and an increase in hydroponically-grown marijuana, which is grown in nutrient-rich solutions rather than soil, for the growing number of ER cases. Walters said such marijuana contains 20 to 30 percent of psychoactive Delta-9-Tetrahydrocannabinol (THC), compared with 1 percent THC of marijuana from the 1960s and 1970s.

“It is extremely dangerous. It is one of the reasons why we believe we have seen a doubling of emergency-room cases involving marijuana in the last several years from 60,000 to 120,000,” Walters said.

Despite U.S. criticism, Canadian Prime Minister Paul Martin said he plans to proceed with his strategy to decriminalize possession of small amounts of marijuana.

The Ministry of Health is warning users of illegal drugs about the added danger they may be exposing themselves to after Dutch authorities found strychnine in a sample of MDMA (Ecstasy} in Holland. The New Zealand Customs Service advise that most of the Ecstasy smuggled into New Zealand comes from Western Europe, particularly Holland. Strychnine, which is now only used as a rat poison, is deadly in quite small doses. Two tablets, each containing the amount reported from the Dutch sample, could be fatal. Substances including and ketamine, anaesthetic medicine also used as an animal tranquilliser, have been found. “This issue highlights the danger with illegal drugs. The consumer has no idea what he/she is buying and they should realise that they could be putting themselves at serious risk of injury or death”, said Dr Bob Boyd, Chief Advisor.

An increasing number of American youths who use the club drug Ecstasy are mixing it with the anti-impotence drug Viagra, leading drug-abuse specialists to warn about the health risks of a combination that users say fuels all-night dancing and marathon sex.
The combined drugs known in the club scene as ‘sextasy’ began as a fad among youths in England and Australia. About a year ago, officials of the U.S. Drug  Enforcement Administration began hearing reports that the mixture had become popular in the country’s gay party culture.

Calling medical marijuana the “Trojan horse of the new millennium,” Andrea Grubb Barthwell, deputy director for demand reduction for the White House Office of National Drug Control Policy, criticized the use of medical pot and said the drug is a public-health threat. Barthwell made her comments in San Francisco, California during a 25-city nationwide tour to discuss drug-fighting efforts with local officials. Barthwell criticized medical-marijuana advocates, saying they are using the drug as a pawn in their agenda to legalize all dangerous drugs.  “Marijuana is a wedge issue to create a change in drug policy, with the intent to legalize drugs without limits,” Barthwell said. “Today, marijuana is strong enough to change the trajectory of a kid’s life.”

In response, marijuana advocates said the Bush administration is ignoring research showing the positive medical applications for marijuana. Advocates also cited studies that showed that since voters approved Proposition 36 three years ago, 35,000 Californians arrested for possessing marijuana and other drugs have opted for treatment instead of criminal penalties. “The bottom line is, her administration is still spending 70 percent to 80 percent of its money on interdiction instead of treatment,” said Daniel .Abrahamson, director of legal affairs for the Drug Policy Alliance. “She can play politics and stand on the bandwagon, but things are passing her by.” Barthwell acknowledged that Proposition 36 is valuable in getting drug users into treatment. But she said the federal government needs to strongly re establish “a culture of disapproval” while increases access to treatment. Barthwell also argued that no significant studies have found marijuana use beneficial.

A new health education campaign launching in the Phoenix area seeks to respond to data from the Partnership for a Drug-Free America (PDFA) that finds usage rates of methamphetamine and Ecstasy among Phoenix-area teens are above national averages. The campaign unveiled today by the Partnership – with support from the Partnership for a Drug-Free Arizona, the Arizona Chapter of the American Academy of Pediatrics (AzAAP) and Consumer Healthcare Products Association (CHPA) – is dedicated to reducing methamphetamine and Ecstasy use among teens in the Phoenix area. The campaign consists of a pediatrician-driven media outreach effort designed to educate parents and teens about the dangerous health consequences of these drugs, and includes an intensive public service advertising campaign in the Phoenix market. Phoenix is one of two U.S. cities where the campaign is being introduced.

“The disturbing number of teens in the Phoenix area who already are experimenting with these drugs makes this a health problem that must be addressed,’ said Dr. Peggy Stemmler, president of the AzAAP, a key partner in the new health education campaign. “Paediatricians are in a unique position to help close the gap between perception and reality about the real consequences of these drugs.”

In the Phoenix area, 14 paediatricians will serve as primary spokespeople for the media communications effort. Campaign coordinators believe the voice of the medical community will resonate with parents in particular in order to motivate them to take an active role in persuading their teens not to use these drugs. HMA Public Relations, a local public relations agency, will coordinate media efforts for paediatricians participating locally.

“More than one of every three teens in the Phoenix area has been offered Ecstasy or ‘meth,’ and teen use of both drugs is above national averages,” said Steve Pasierb, president and CEO of the Partnership, the national non profit organization best known for its media-based drug education campaigns. “Phoenix needs the facts about the real risks of using these drugs if we’re going to turn those numbers around.” The Partnership is providing the local effort with hard-hitting public service ads for television, radio, print and Internet, as well as with research to measure the impact of the effort.

Top-line findings of the Partnership for a Drug-Free America’s study include:

* 13 percent of Phoenix-area teenagers report having used methamphetamine (meth), compared to nine percent of all teens nationwide; 13 percent report having used Ecstasy, compared to 11 percent of all teens nationwide;
* 33 percent of teens report having been offered methamphetamine, and 35 percent report being offered Ecstasy;
* 61 percent of teens report knowing someone who uses Ecstasy, and half (50 percent) report knowing someone who uses methamphetamine; and
* Just one to two percent of Phoenix-area parents surveyed (one percent for Ecstasy, two percent for meth) agree that it’s possible their kids may have tried these drugs.

“Survey data also show parents and teens underestimate the specific health risks of these drugs,’ said Pasierb. “Risk-related attitudes correlate strongly with trends in drug use; for example, when teenagers see greater risks associated with a particular drug, use of that drug declines, Unfortunately, the opposite holds true as well, so the time is right for a concerted intervention to reverse the trends were seeing in Phoenix.”

Methamphetamine is an addictive stimulant. Often called ‘speed’ or ‘crystal’, meth is a crystal-like, powdered substance that sometimes comes in large rock-like chunks. Meth is usually white or slightly yellow, depending on the purity. The drug can be taken orally, injected, snorted or smoked. Once a threat largely in the American southwest, production and use of the drug, which is cheaper and longer lasting than cocaine, has moved steadily eastward in recent years, finding willing users in a generation unlikely to remember the phrase, ‘speed kills’. Long-term use and/or high doses of methamphetamine can bring on full-blown toxic psychosis, often exhibited as violent, aggressive behaviour. Ecstasy–chemically known as 3-4 methylenedioxymethamphetamine, or MDMA – is a psychoactive drug with amphetamine-like and hallucinogenic properties. It can be extremely dangerous, especially in high doses. Usually taken orally in pill form, the drug accelerates the release of serotonin in the brain and provides users with an intense high, characterized by feelings of love and acceptance, as well as a general sense of well being, decreased anxiety and enhanced sensitivity to touch. Ecstasy can cause dramatic increases in body temperature, muscle breakdown, and kidney and cardiovascular system failure, as reported in some fatalities.
Source: Press release, Partnership For Drug Free America June 200

A smoking ban was today introduced on long-distance commuter services between Waterloo, Hampshire and borset following a “serious safety
incident’ involving a discarded cigarette.The ban, however, while popular with the majority of commuters will infuriate others, many of whom have pledged defiance and say they will continue to light up.
Stagecoach-owned SWT, one of the busiest commuter operators, is among the few remaining which permit smoking on trains. It is only allowed on
certain long-distance routes.

Source: Evening Standard, 1 December 2003

Recently, the British Prime Minister Mr. Tony Blair gave an interview to the News of the World newspaper. In a paper more noted for salacious stories it was a sober affair. Reflecting on 6 years in power , he said “I’ve had lumps kicked out of me ….but I’m tougher than ever”. In the wide ranging interview, Mr. Blair introduced his newest plan -random drug testing in schools.

Mr. Blair’s government does not seem to know what to do about the drugs problem. They ignore evidence from other countries on what works to lower the incidence of drug use and rely instead upon advice from so-called experts – many of whom have been advocating the relaxation of drug laws for years.

Re-classifying Cannabis has sent out totally the wrong message to our youth who mostly now believe that cannabis is (a) legal and (b) harmless. The government rushes in to Spend £1 million on a campaign to tell people that cannabis is (a) not legal and (b) harmful.

More money is being spent on treatment – and with this we have no argument. People who have problems from drug use need all the help and treatment they can get to become drug free and contributory members of society again. Treatment is always expensive – and there is the ‘revolving door’ syndrome where users enter treatment for a few weeks or months, return to society and often begin using again – once the use results in a more chaotic lifestyle again the user returns to treatment. Relapse is common and costs money.

Mr. Blair’s new idea – random drug testing – has resulted in the inevitable dichotomy between those who approve of the plan and those who regard it as a great infringement of personal liberty. Some organizations who want drug laws relaxed are scaremongering by suggesting that pupils know that cannabis stays in the body for longer than many other drugs and so would stop using cannabis and instead turn to Ecstasy or Heroin. This is very unlikely since the majority of young people who do use cannabis whilst at school do so because they believe it is harmless – they do not use so-called ‘hard’ drugs because they know they are harmful. Understandably the teaching profession have expressed great concern about the time, costs and legal ramifications of testing. A large majority of parents think it is an excellent idea – and, surprisingly to some, most young people agree with it.

The NDPA have seen evidence of the success of drug testing in America and Australia and work closely with a Belgian colleage who has made a study of drug testing. One of our colleagues has also worked in Restorative Justice and this could be tied in with drug testing. Many companies in the USA and the UK have introduced random drug tests amongst their work force and this has cut down accident and absence rates and staff turnover . Therefore, our belief is that there is mileage in using random drug tests in schools – provided they are handled sensitively. It would need all schools and colleges to ‘opt in’ to be a total success – and schools would need financial help to cover the inevitable costs. And schools need to consider that random drug testing should not belinked to punishing or excluding pupils who test positive.

Today, the Florida Department of Law Enforcement (FDLE) released the Florida Medical Examiners Commission’s Report on Drugs Identified in Deceased Persons. The report contains information compiled from autopsies performed by medical examiners across the state in 2003. During that period there were approximately 170,000 deaths. According to the report, 6,767 individuals examined had drugs in the system.

Medical Examiners collected information on the following drugs: Ethyl Alcohol, Amphetamines, Methamphetamines, MDMA (Ecstasy), MDA, MDEA, Alprazolam, Diazepam, Flunitrazepam (Rohypnol), other Benzodiazepines, Cannabinoids, Carisoprodol/Meprobamate, Cocaine, GHB, Inhalants, Ketamine, Fentanyl, Heroin, Hydrocodone, Hydromorphone, Meperidine, Methadone, Morphine, Oxycodone, Propoxyphene, Tramadol, and Phencyclidine (PCP).

The report reveals a decrease in the incidences of Heroin in 2003 when compared with 2002. This decrease includes cases in which the drug levels found during the exams were both lethal and non-lethal. In addition, the report indicates the three most frequently occurring drugs found in decedents were Ethyl Alcohol (3,467), all Benzodiazepines (1,794), and Cocaine (1,614). The drugs that caused the most deaths were Cocaine, all Benzodiazepines, Methadone, Oxycodone, Ethyl Alcohol, Heroin, Alprazolam, and Morphine.

The three drugs that were the most lethal, meaning more than 50 percent of the deaths were caused by the drug when the drug was found, were Heroin (88 percent), Fentanyl (63 percent), and Methadone (60 percent). The report also reveals that excluding newly tracked prescription drugs, prescription drugs of Benzodiazepines, Hydrocodone, Methadone, and Oxycodone continued to be found more often than illicit drugs in both lethal (60 percent) and non-lethal (55 percent) levels during 2003.

“This report shows that with few exceptions, both illicit and prescription drugs persist in being a continuing and increasing danger to the citizens of the State of Florida,” said FDLE Commissioner Guy Tunnell. “While heroin deaths have decreased over the past year, most of the other illicit and prescription drug deaths remain at an alarming level for the year, although decreases are noted during the second half of the year.”

“The results from this report are evidence of the immense danger associated with drug abuse and more specifically prescription drug abuse,” said Jim McDonough, Director of the Florida Office of Drug Control. “Far too many Floridians are dying from prescription drugs. To address this problem Florida will continue to strengthen its efforts in the areas of prevention, treatment, and law enforcement in order to reduce the unacceptable amount of deaths that result from the abuse of prescription drugs.”

The use of Ecstasy in combination with other drugs is an increasing diagnostic and treatment problem for A&E staff, a study has revealed. The records of all patients tending A&E at St Thomas’ Hospital London were studied over a 15 month period. The notes of those who were suspected of having used Ecstasy, or methylenedioxymethamphetarnine, were systematically reviewed. They found 48 cases all in the 15-30 age group. Most presented in the early hours at weekends, The average number of tablets taken was two, and 40% of the patients had taken drugs before. However, half of them had taken another substance at the same time, usually amphetamines or cocaine. A wide range of clinical features were noted. The most common are detailed below. The most serious complications were in patients who had taken more than one drug. The authors say the problems caused in A&E by dance drugs are increased by multiple drug ingestion.

Symptoms of Ecstasy use alone or in combination. Most common symptoms with Ecstasy use alone:

Strange/unwell/dizzy/weak 44 %
Palpitations 37 %
Nausea or vomiting 31 %
Panic/anxiety/restlessness 31 %
Hot/cold 25 %
Abdominal pain 15 %
Most common symptoms with Ecstasy and other drugs/alcohol:
Collapsed/Loss of consciousness 31 %
Strange/unwell/dizzy/weak 25 %
Nausea or vomiting 19 %
Palpitations 19 %
Panic/anxiety/restlessness 12 %
Headache 12 %
Shaking 12 %
Source: Williams H., Drareau L, Taylor L., et al. (1998)
“Saturday night fever” Ecstasy related problems in a London accident and emergency department journal of Accident and Emergency Medicine 15: 5. 322-325

Recreational use of 3,4 methylenedioxyethylamphetamine (MDMA), more commonly known as “ecstasy” (and a variety of other names including “XTC”, “Adam” or “E”), is now well established. In Britain upwards of 500,000 people are said to use the drug each week (Harris Poll (1992) for “Reportage”, BBC2, 22 Jan 1993).

MDMA is a ring-substituted amphetamine with psychoactive properties. First synthesised in 1914 from methylenedioxyamphetamine (MDA), itself a drug of misuse (known as the “love drug”), it has been used in psychotherapy and was originally used as an appetite suppressant. The drug has ceased to be used medicinally and is now an established part of the illegal drug scene. It is banned in most countries. In the UK it is a class A drug as defined in Schedule 2 of the Misuse of Drugs Act 1971. It has no medicinal use in the UK and cannot be prescribed.

As well as MDA and MDMA, another variant, methylenedioxyethylamphetamine (MDEA, known as “eve”), which is similarly proscribed, is commonly encountered. All have similar pharmacological effects.
In the UK, MDMA is often taken by young people at discos and rave parties. Both involve dancing, but especially at the latter there is vigorous repetitive dancing in crowded rooms with a hot and humid atmosphere. The dangers of this activity are recognised to a certain extent as rooms to “chill out” are often available for people to rest in after periods of exertion. Toxic effects and the occasional death following ring substituted amphetamine misuse have been reported but postmortem data are lacking. In this paper we report on deaths associated with ring substituted amphetamine misuse and detail the postmortem findings.

Seven deaths have been investigated by the University of Sheffield Department of Forensic Pathology in the past three years, which were associated with ring substituted amphetamine misuse. All of the subjects were white men, between 20 and 25 years of age. Three of the victims collapsed at a rave or disco, two were found in bed, one in a collapsed state and one dead, one collapsed in the street, and one was admitted to hospital with progressive jaundice.

Abstract
Aims – To study the postmortem pathology associated with ring substituted amphetamine (amphetamine derivatives) misuse.

Methods
The postmortem findings in deaths associated with the ring substituted amphetamines 3,4-methylenedioxymethyl-amphetamine (MDMA, ecstasy) and 3,4-methylenedioxyethylamphetamine (MDEA, eve) were studied in seven young white men aged between 20 and 25 years.

Results
Striking changes were identified in the liver, which varied from foci of individual cell necrosis to centrilobular necrosis. In one case there was massive hepatic necrosis. Changes consistent with catecholamine induced myocardial damage were seen in five cases. In the brain perivascular haemorrhagic and hypoxic changes were identified in four cases. Overall, the changes in four cases were the same as those reported in heat stroke, although only two cases had a documented history of hyperthermia. Of these four cases, all had changes in their liver, three had changes in their brains, and three in their heart. Of the other three cases, one man died of fulminant liver failure, one of water intoxication and one probably from a cardiac arrhythmia associated with myocardial fibrosis.

Conclusions
These data suggest that there is more than one mechanism of damage in ring substituted amphetamine misuse, injury being caused by hyperthermia in some cases, but with ring substituted amphetamines also possibly having a toxic effect on the liver and other organs in the absence of hyperthermia.

C M Milroy J C Clark A R W Forrest Department of Clinical Chemistry, Royal Hallamshire Hospital, Sheffield – Department of Forensic Pathology, University of Sheffield
Source: (J Clin Pathol 1996;49:149-.153)

This study examines the extent to which alcohol and drug use is related to violent and nonviolent criminal activity among adolescent males. Based on data collected from 312 youthful offenders at a public juvenile facility, the findings reveal that in comparison to marijuana and heroin, alcohol use is more strongly and consistently associated with both violent and nonviolent offenses. When other factors are introduced into the analysis, the results show that while an adolescent’s criminal history and racial identity are relatively more important in predicting criminal activity overall, the effect of substance use (especially alcohol and marijuana) continues to be present.

Source: Dawkins, M. Adolescence 32(126):395-405, 1997
Availability: Marvin P Dawkins, Department of Sociology Coral Gables FL 33124

Imaging studies in humans suggest that the amygdala plays an important role in craving elicited by cocaine and cocaine-conditioned environmental stimuli. The research examined the relationship between neurochemical changes in the amygdala and cocaine-seeking behavior following exposure to a cocaine-paired environment or a cocaine priming injection. It measured cocaine-seeking behavior by assessing the persistence of lever-pressing in the absence of cocaine reinforcement in animals previously trained to press a lever for cocaine infusions. Lever-pressing under these conditions is thought to reflect the incentive motivational properties of cocaine and cocaine-associated stimuli. It first investigated whether the pattern of changes in cocaine-seeking behavior corresponded with changes in concentrations of dopamine in dialysates obtained from the amygdala during the course of cocaine withdrawal.

There were concomitant changes in cocaine-seeking behavior and dialysate dopamine following the cocaine priming injection, but not following exposure alone to the cocaine self-administration environment. It next investigated changes in Fos protein expression as a general marker for neuronal activation. Exposure to the cocaine self-administration environment, but not the cocaine priming injection, elicited Fos expression in the basolateral nucleus of the amygdala, nucleus accumbens shell, and cingulate cortex. In contrast, the cocaine priming injection, but not the environmental stimuli, elicited Fos expression in the central nucleus of the amygdala and dorsolateral caudate-putamen.

The findings suggest that different neural mechanisms mediate cocaine-seeking behavior elicited by cocaine conditioned environmental stimuli and those elicited by a priming injection of cocaine. Increases in extracellular dopamine may be critical for the induction of cocaine-seeking behavior elicited by cocaine but may not be elicited by cocaine-conditioned environmental stimuli.

Source: Janet Neisewander, Ph.D., Arizona State University

This edition of Prevention Works lists some studies, which look at the gateway/addiction theory of progressive drug misuse. The implications for prevention are clear – Early use of nicotine, alcohol and marijuana is a predictor of later use of cocaine (etc. …)

Predicting continued use of marijuana among adolescents: the relative influence of drug-specific and social context factors.

Bailey SL. Flewelling RL. Rachal JV Journal of Health and Social Behavior1992:33:51-66

Compared with people who used only one gateway drug (tobacco, alcohol and marijuana), children who used all three are 77 times more likely to use cocaine.
Children who smoke daily are 13 times more likely to use heroin than children who smoke less often.

Compton DR. Dewey WL. Martin BR. Advances in Alcohol and Substance Abuse. 199O:9:129-147. [Cannabis dependence and tolerance production]

Children who use marijuana are 85 times more likely to use cocaine than non-marijuana users. 90% of children who used marijuana, smoked or drank first. Children who drink are 50 times more likely to use cocaine than non drinkers.

Children who use gateway drugs – tobacco, alcohol and marijuana are up to 266 times more likely to use cocaine than those who don’t use any gateway drugs.
Study concludes nearly 90% of cocaine users smoked, drank and used marijuana

Center on Addiction and Substance Abuse at Columbia University (CASA), Oct. 27, 1994.

A 12- year-old who smokes is 30 times more likely to have used illicit drugs than a child of the same age who doesn’t smoke. This analysis proves that, for too many children cigarettes are a drug of entry into the world of illicit drugs

Center on Addiction and Substance Abuse at Columbia University (CASA), March 10, 1994.

Marijuana’s role as a gateway drug to serious drug use appears to have increased.

Golub A. Johnson BD. The Shifting Importance of Alcohol and Marijuana as Gateway Substances among Serious Drug Abusers. J. Stud Alcohol 1994:55:607-614.

Very few try illicit drugs other than marijuana without prior use of marijuana.

Kandel DB. Yamaguchi K. Chen K. Stages of Progression in Drug Involvement from Adolescence to Adulthood: Further Evidence for the Gateway Theory, J Stud. Alcohol; 1992:447-457.

Study describes cannabis dependence. Impaired cognitive skills and functioning were documented in chronic cannabis users.

Lundqvist. Life Science, Vol. 56 pp 2145 -2155.

Brain event-related measures normalize during acute marijuana intoxication. suggesting a basis for the physical dependence component of marijuana use.

Solowij et at. Life Sciences, Vol. 56 pp 2127-2134. 1995.

The chronic use of cocaine. particularly when used with marijuana, sets up craving behavior by depleting brain dopamine and norepinephrine.

Mirochnik, et at. Pediatrics 99:555-559,1997.

A 12-step treatment approach for marijuana (cannabis) dependence.

Miller NS, Gold MS. Pottash AC. Journal of Substance Abuse Treatment. 1989; 6:24 1-250.

Results of tests for drug use in 21 big cities in the US are found in the ADAM Report. The conclusion says that: By any measure, the level of recent drug use among 1997 ADAM arrestees is significant. Every site reported that a majority of its male adult arrestees tested positive for at least one drug. The same is true for female adult arrestees in 19 out of 21 sites where data was collected. There are differences in trends for specific drugs and segments of persons arrested.
The 1996 national Survey of Inmates in Local Jails in the U.S. showed that
A. 82% of all jail inmates in 1996 said they had ever used an illegal drug, up from 78% in 1989.
B. The percentage ever using drugs regularly went from 58% in 1989 to 64% in 1996.
C. 55% used drugs in the month before the offense, vs. only 44% in 1989.
D. 36% were using drugs at the time of the offense, up from 27%.
E. 16% said they committed the crime for drug money, up a little from the 13% in 1989.

Arrestee Drug Abuse Monitoring Program

Much of the push toward drug testing has come from the federal government. In 1982, the Navy began the first broad-scale random drug testing after an aircraft accident aboard the USS Nimitz uncovered widespread drug use about the ship. The practice soon spread to other branches of the military. Then drug testing was introduced in safety-sensitive government agencies such as the Nuclear Regulatory Commission, and mandated for government contractors with contracts worth more than $25,OOO.

Several horrific accidents spurred drug testing in the transportation industry. In 1987, two trains collided in Chase, Md., causing 16 deaths, and it was later revealed that one of the trains engineers had been smoking marijuana before the collision. And in 1991, eight people were killed in a New York subway train crash; the train’s driver later tested positive for alcohol.

These incidents led to the passage of the Omnibus Transportation Employee Testing Act of 1991 which required the Department of Transportation to mandate drug and alcohol  testing of employees in safety-sensitive transportation positions in private companies.

A snapshot of how drug testing works comes from Tom Warner, president of three D.C-based plumbing, heating and air conditioning companies that together employ 92 workers.  He wasn’t pushed to his drug-testing policy because of any big disaster. Instead, it was little things such as recurring minor accidents and foolish mistakes.  He remembers one experienced technician, for example, who had used his bare hands on a sewer-contaminated piece of machinery, rather than use his gloves. “It wasn’t something a rational person would do” he recalled thinking at the time.

Warner decided to introduce drug testing, and the first results startled him.  About half of a group of new trainees failed. as did the worker who had failed to use his safety gloves. Some drug users quit rather than be tested. Warner decided to clean out the problem workers by simply firing people who tested positive for drug use.  They are invited to reapply after one year and will be rehired if they pledge to remain drug-free.  Few drug users either apply or reapply now, Warner said. “It’s known we’re a drug-free company,”  he said. “People who do drugs want to do drugs — and want to be in a place where they can.” The percentage of major firms requiring employee drug tests has escalated in the past decade, … and the percentage of employees who test positive has declined significantly.

Construction workers are among the category of employees reporting the highest usage rate of Illegal drugs. Percentage of employees, 18-49, reporting use of illicit drugs in the past month :-
 

The Swedish epidemic of intravenous amphetamine injection, which started in 1945, was surveyed annually in Stockholm from 1965 to 1987. During that period, approximately 250.000 arrestees were examined for needle marks from intravenous drug injections that they presented in their cubital regions. The progression or regression of the epidemic was gauged by calculating the percentage of addicts (marked with needle scars) among the population arrested for any kind of criminal or civil offense. This epidemiological study using an objective marker demonstrated that a permissive drug policy leads to a rapid spread of drug use. A restrictive policy not only checks the spread of addiction but brings about a considerable reduction in the rate of current consumption. The restrictive policy is based on a general consensus of social refusal of illicit drug use, and strict law enforcement. All countries which have adopted this model such as China, Japan, Korea, Singapore and Taiwan have succeeded in controlling epidemics of amphetamine or heroin addiction. By contrast, Western industrialized nations which have accepted permissive policies have seen their epidemics of drug addiction grow steadily since World II War and erode their democratic institutions. The author concludes that such a trend may only be reversed by adopting a restrictive model validated by epidemiological and historical facts.

United States of America
At the turn of the century cocaine, heroin and marijuana were in use legally and widely promoted. Between 1907 and 1917 thc murder rate rose by 300% Cocaine and opium addiction rates in these early years rivaled those of today and the effects led to pub1ic outcry.
In 1914 these drugs were made illegal and by 1940 the number of addicts had dropped from 250,000 to 50,000. Between 1923 and 1939 the rate of opium addiction fell 90%, apparently simply as a result of a strict drug policy which dramatically reduced exposure factors.

The US experimented briefly with decriminalisation of marijuana in the period 1975 to 1978. This resulted in a statistically significant increase in the reported number of marijuana-related visits to hospital emergency departments compared to metropolitan areas where decriminalisation had not been implemented.

By 1979 use of all drugs in the US was very high but between then and 1991, largely due to the efforts of parents, the number of users dropped from 23 million to 14 million, a 60% reduction sustained over a 12-year period. Use of cannabis halved, daily use fell by 75% and the use of cocaine fell by 50%. A wide-ranging and successful collaboration between Customs & Excise. Police. educationists, social workers and parents and the young people themselves reinforced the idea that the use of drugs is not normal and is socially unacceptable However, since 1991 a relaxation of this strategy has seen an increase in the problem.

In the state of Arizona Proposition 200 authorised doctors to issue prescriptions for drugs such as marijuana, heroin, LSD and PCP. It encouraged the immediate release of 1032 prison inmates sentenced for drugs offences and prohibited prison sentences for drug offences until the third conviction. A poll carried out between January 27th and 31st  1997 by Dr. Bruce Merrill (Prof. Of Mass Communications and Director of the Walter Cronkite School. Arizona State University) overwhelmingly supports the conclusion that Arizona residents believe the enactment of Proposition 200 has led to dangerous unintended consequences 85% of registered voters in Arizona believe that Proposition 200 needs to be changed.  60% of registered voters believe it should be repealed.

References
1. Musto, David F. “The American Disease – Origins of Narcotic Contr6l’. OUP New York 1987 especially pp 70-73
2. US Bureau of the Census. Historical Statistics of the United States Colonial Times to 1970. Part One. Washington DC. 1975
3. See ref 1: especially pp 91. 115. Also Wall St Journal June 11th  1986. p30: Parade July 31st  1988
4. See ref 1. Also Wilson. James Q. “Against the Legalisation of Drugs”, Commentary February 1990, pp 21-28
5. Bejerot. N. ‘Drogue et Societe. Masson Paris 1990 ‘Cannabis: Physiopathology. Epidemiology, Detection.’ Nahas G & Latour C (eds). CRC Press. 1993.
6. Model. KE. The Effect of Marijuana Decriminalisation on Hospital Emergency Room Episodes 1975-1978. Journal of the American &Statistical Association. 88: 737-747. 1993
7. Rosenthal. MS. Report from North America. In “Cannabis: Physiopathology, Epidemiology. Detection.’ Nahas G & Latour C (eds). CRC Press~ 1993
8. News Release from the Office of Maricopa County Attorney, 301 West Jefferson, Phoenix, Arizona 85003

By JAMES SLACK

Drug addicts have been given £2.5million of heroin and nursing care in NHS “shooting galleries” while law-abiding patients are denied life-prolonging treatment.

The addicts are allowed to inject themselves with a pure form of the class A drug in private rooms, under the supervision of round-the-clock nursing staff.

Despite free access to the drug – which costs £15,000 a year, including nursing care – many are still committing crimes.

But leaders of the joint Home Office and Department of Health project, which began quietly two years ago, say initial results are encouraging.

The pilot, limited to London, Brighton and Darlington, could eventually be rolled out nationwide.

Trial leader Professor John Strang, of the National Addiction Centre, based at London’s Institute of Psychiatry, said about 40 per cent of users in London had “quit their involvement with the street scene completely”. “Of those who have continued, which obviously is a disappointment, it goes down from every day to about four days per month,” he added.

“Their crimes, for example, have gone from 40 a month to perhaps four crimes per month. The reduction in crime is not perfect but is a great deal better for them and crucially a great deal better for society.”

The cost of the treatment, including providing heroin, is between £9,000 and £15,000 per patient – three times as much as a year’s course of methadone. It is restricted to hardcore addicts, who experts say cannot be helped in other ways. But critics questioned the decision to plough so much money into treating drug addicts when law-abiding citizens were being denied much-needed drugs.

Despite a huge public backlash, Alzheimer’s patients newly diagnosed with mild symptoms no longer qualify for medication – despite a cost of only £2.50 each day.

Drugs for some types of cancer, arthritis, bone disease and the prevention of blindness in older people are also being restricted, leading to claims of postcode prescribing and bitter court challenges.

Matthew Elliott, chief executive of the Taxpayers’ Alliance, said: “It shows a pretty warped sense of priorities to give criminals free drugs on the NHS whilst denying life-saving treatments to law-abiding citizens.

“Free healthcare shouldn’t be about getting high at the taxpayer’s expense. Drug users should be given help to give up their habits and to lead an honest life. We shouldn’t be aiding and abetting their personal failings.”

Shadow home secretary David Davis said: “This is a white flag approach. The Government are effectively conceding that the war on drugs is not winnable and instead spending millions of pounds trying to ‘manage’ addiction.

“We believe the Government should not focus spending on trying to manage drug addiction but should spend the drugs budget on ending addiction.

“We would do this by expanding the use of abstinence-based drug rehabilitation programs which have proved far more successful at getting people off drugs than the Government’s approach.

“By simply giving addicts drugs, the Government is betraying the people in our society who so desperately need our help, to a life of addiction.”

A spokesman for the Victims of Crime Trust said: “We should not be giving free Class-A drugs to addicts – many of whom will be prolific criminals – at a time when law-abiding members of the public are being forced to go to the High Court to get life-saving treatment.

“We need to get criminals off drugs and stop them re-offending, but it should not be at the expense of people whose only crime is to be gravely ill. We are allowing Class-A drug addicts to hold us to ransom.”

Dr Nicola Metrebian, who manages the clinical trials, acknowledged that supplying the addicts with the specially imported heroin is a heavy financial investment but she added: “It is more expensive than standard treatment, but what we do know is that standard treatment – although it is cheaper – is not effective for this group of people.”

Source: Daily Mail 19th Nov. 2007

The government was at loggerheads with its own advisers last night over its new drugs policy.

An influential Home Office-backed committee raised serious doubts about the consultation process behind the 10-year strategy which will be unveiled in April. The Advisory Council on the Misuse of Drugs (ACMD) described the process as ‘self-congratulatory and generally disappointing’ and questioned the credibility of much of the evidence presented to government.  

A spokesman for the Home Office said last month that the consultation process, which is being conducted by the polling agency Mori, had been ‘open’ and had included a wide range of views.

But the council said: ‘We consider that an opportunity has been missed to address the public health problem relating to drug misuse and the balance with law enforcement and the Criminal Justice System…The consultation would benefit from extending further to the wider social harm of drug misuse.’ 

It also said: ‘It is of concern that the evidence presented, and the interpretation given, are not based on rigorous scrutiny. It is not acknowledged that in many cases the information is uncertain and sometimes of poor quality.’ 

Last night politicians said the council’s response raised questions about whether the government was more interested in spinning its record than tackling the war on drugs. ‘The failures of the government’s drugs policy are laid bare for all to see when their own advisory committee condemns the Home Office as being misleading and self-congratulatory,’ said Liberal Democrat leadership contender Nick Clegg. ‘When will the government wake up and acknowledge something many members of the public know: we are losing the war on drugs?’ Clegg said  

Steve Rolles of think tank Transform, which advises the UN on drugs policy, said: ‘The consultation process behind the new strategy has been woeful.’ Last month Transform branded the consultation process a ‘sham’, saying the government had already made up its mind to continue with its current strategy. 

Concerns about the direction of the government’s next drugs strategy come as senior police officers warn that cannabis now presents a greater ‘long-term’ threat to Britain than cocaine. The increasing strength of high-grade ‘skunk’ combined with growing evidence of major criminal involvement in its production was fast becoming an issue of mounting concern. Hospitals recently revealed that the number of mental health admissions as a result of cannabis use had risen by 73 per cent.

 Source: The Observer December 2, 2007

Overdoses have claimed more than 30 lives in Glasgow this year

Councillors and drug groups in Glasgow and Lanarkshire are to pilot use of the anti-opiate revival drug Naloxone.

They believe heroin overdose deaths could be halved if addicts’ families are issued with the treatment to inject into overdose victims.

The Conservatives have criticised the £20,000 project as sending out a message that drug misuse is acceptable.

It is estimated that most drug overdoses are witnessed by members of family or friends of addicts.

Police have warned that purer heroin on the streets is contributing to a rise in overdose deaths.

Chaotic lives

In Glasgow alone there were 35 fatalities in the first four months of this year.

Glasgow City Council and the Lanarkshire Drug Action Team have now agreed on pilot projects to provide addicts’ families with Naloxone, which reverses opiate harm.

Neil Hunter, general manager of Glasgow Addiction Services, said: “We have to accept that there are some individuals in the city who are unable, at the moment, to benefit from rehabilitation or treatment.

“They are still leading fairly chaotic and high-risk lives and we have to do something to intervene to try to avoid any harmful consequences.”

However, Scottish Conservative health spokesman David Davidson said: “It’s as if the agencies have given up all hope of getting people away from drugs and getting people back into society.”

Source: BBC News 11th June 2006

DRUG USERS IGNORE NEEDLE BINS AS HUNDEREDS THROWN AWAY IN STREETS SURROUNDING CITY CBD;
By Sonia Campbell

CITY Place has been revealed as Cairns’s biggest drug shooting gallery with 1000 syringes discarded since January in toilets and streets surrounding the inner city mall. Addicts are also dumping hundreds of used syringes at many of the city’s other popular public places, including the Esplanade near Muddy’s playground and the city library.

The figures were released this week by Cairns City Council after an audit of its sharps disposal bin program. From January to October the highest number of needles placed in sharps containers in public toilets in Cairns and south of the city were – City Place (700), McKenzie St (188), Lennon Park in West Cairns (129), and Greenpatch at Gordonvale (100).

While the council says the figures confirm the sharps disposal program is working, alarmingly hundreds more used syringes are being discarded carelessly on the ground and in gardens in various public places.

Most of them were found at City Place (300), the Esplanade from Muddy’s to the pirate ship (100), City library (100), and old library site on Lake St (100). “These figures that we’ve got are basically for the southern and city areas and we’re waiting on the northern areas,” Cr Margaret Cochrane said yesterday.

Cr Cochrane said while the City Place figure of 300 syringes found improperly discarded was of particular concern, it wasn’t “disturbing”. “It’s only one improperly discarded needle a day. Which shows that the (sharps) receptacles are being utilised to their intent and the current program is working where the receptacles are,” she said. However, she said in light of the figures, the council would monitor the area more closely. “There would be an opportunity to view the footage on the (security) cameras … and our staff just need to be a little bit more aware of what’s going on.”

Dianne Forsyth from the Cairns Addiction Help Agency said while any used syringe found in a public place was a concern, the numbers being found were quite low, given that about 500,000 needles were issued to the city’s IV drug users in the needle exchange program each year.

“If you look at the number of (discarded) needles that we’re actually collecting, I’m assuming that most are disposing of them safely somewhere else,” Ms Forsyth said. She said more education material supplied to those accessing the city’s needle program, could be one solution.

Cairns Mayor Kevin Byrne said the results of the audit would be used to determine other areas where sharps disposal bins were needed.

Source: The Cairns Post/The Cairns Sun (Australia) December 3, 2005 Saturday

Editorial Comment on British government’s New Media strategy for drugs. May 2003

NEW BRITISH MEDIA DRUG CAMPAIGN HAS SCHIZOID TENDENCIES

Late May saw the public launch, on satellite and terrestrial channels, of the British Government’s latest strategy concerning drug misuse. The strategy includes an array of TV and radio announcements, a new web page (www.talktofrank.com), a new telephone help line (to replace the National Drugs Helpline), an email help line, and a collection of CD Rom or print based materials, which local agencies are encouraged to use to promote the campaign and to generate activities with the public. The budget for this campaign is set at £3 million a year for the next three years. The strategy has been given the brand name of ‘Frank’ – this was chosen after much internal contemplation and focus group dialogue. The organizers perceive this brand name to convey an image which is non-judgmental, honest, down-to-earth, entertaining and always there for you – maybe something like an older uncle … that kind of relative whom young people would feel more comfortable speaking with than they would with their own parents. 

The most usual dictionary definition of the word ‘FRANK’ is “open, honest and direct, especially when dealing with unpalatable matters ” … but another definition – intriguingly – is the “stamping of an official mark on a communication”. Moreover, the original Franks were a people that controlled much of Western Europe for several centuries … the choice of name for this campaign might therefore achieve a certain resonance in Downing Street (as an ‘aspirational target’, anyway).

It would be quite wrong to be unremittingly carping about Frank; there are aspects which deserve commendation and encouragement. Paul Betts, father of the late Leah Betts, whose death from ecstasy sparked off a major media campaign, expressed himself encouraged by some of the content, and by the principle of ‘talking with’ rather than ‘talking at’ the young (not a new practice, but certainly a good one). At the same time any campaign which sets itself up as being ‘open, honest and direct’ must expect commentary upon it to be likewise. An overview, therefore, would conclude that there is a mix of the good and the bad; a mix of the sophisticated and the naive – and, above all, Frank seems to be suffering from schizophrenia when he contemplates his goals.

This last point is most evident when Frank addresses drugs other than his ‘betes noire’ (heroin and cocaine) – the strategy is said to dovetail with the overall drug strategy, which has, as one of its main aims, “… helping young people resist drug misuse in order to achieve their full potential in society”. The official press release for Frank backs this up by saying that “A key priority of the drugs strategy is to educate young people and prevent them becoming involved in drugs”. These are aims which would find favour with all but the most libertarian zealots. Sadly, the actual detail of what Frank will get up to is all but invisible in respect of prevention, and seems, more often than not, to be written in terms of fatalism about drug use and thereafter acceptance of drug-using behaviour. Much is made – especially in the adverts – of the assertion that “… as many as one in three people have taken drugs …” without clarifying that this figure is for any use at all throughout one’s lifetime, and the majority of these ‘users’ never do more than ‘dabble’ once or twice before giving up. Even for the higher use group which is young people, the number who use more than twice is as low as one in six, with the figures for regular or for problematic use being very much lower than this.

If Frank intends to be “honest and direct” about “preventing them becoming involved in drugs” then why does the campaign say it will “… focus on the most vulnerable young people … (and) … will focus on cocaine and heroin”? The answer seems to rest in some of the remarks from the rostrum, to professionals and to the Press, at their respective launches. Once again the assertion was made that cocaine and heroin do more harm to society than other drugs, an assertion based on a narrow, user-centric definition of ‘harm’ which ignores significant categories of damage such as intellectual, social and emotional impacts, and which scarcely touches on the damage to people other than the user. Yet again there came the mantra: “The Just Say No approach does not work” – leaving aside the factually contentious (and sometimes tendentious) nature of this claim, there was a noticeable absence of reference to the many other varieties of primary prevention, where the reduction in use that comes from such initiatives is well documented (a more cynical observer might conclude that the underlying agenda is to neuter all primary prevention). So, Just Say No is a no-no … and yet, referring to the fact sheet for the drug ecstasy, the unequivocal statement is made that “When you buy ecstasy you have no way of knowing what is in it, so the safest thing to take is nothing” – in other words, just say no.

The adverts, both TV and radio, will be found humorous by all but the most determinedly morose, and they have a fast-moving style which should appeal to young people – and to many of their parents. There is a debate to be had about underlying messages in the depictions, particularly of adults and of drug users, but this is for the future. Similarly, the language chosen for the fact sheets on specific drugs is simplified and boiled down in order to be more accessible to the lay reader, even though this risks people misconstruing what they perceive – and gives the more pedantic professionals something to get their teeth into. The risk of people picking up the wrong message is a key aspect – reservations have been expressed by several field workers. Picking up the wrong message is almost an Olympic sport amongst young people, and as one seasoned youth worker once observed “There’s nothing wrong with an adolescent, that reasoning with him won’t aggravate”.

Several professionals had things to say on this front. Alistair Lang, the (then) chief executive of D.A.R.E. UK (Drug Abuse Resistance Education) said “There is no harm in having information about drugs in the right places, but this sounds a bit like a ‘Which? Guide to mobile phones’. From the government you want to hear a categorical health warning, of the sort you get on cigarette packets, that drugs can harm – or even kill you”. Oliver Letwin, the Shadow Home Secretary, said it was “… highly questionable for taxpayers’ money to be spent on telling young people that Ecstasy gave them a buzz”.

Mail on Sunday senior columnist Peter Hitchens was trenchant in his criticisms of Frank; in his column on 1st June he urged parents to visit the website (www.talktofrank.com ) and see for themselves the sort of advice being given out Hitchens quoted this disturbing item: “If only illegal drugs came in packets with instructions … we’d all know what the drug would do, how much is too much and what other drugs are to be avoided at the same time”. Hitchens hammers the implications of this kind of presentation, which are that the law is bound to be ignored, and – even more dangerously, that there are safe ways to do drugs. Hitchens took up the website’s invitation to ask questions, and asked two simple ones: “Is it wrong to take drugs?” and “Is it ever safe to take drugs?”. The website was unable to offer a reply to Peter Hitchens, who concluded his article by wondering whether the Home Secretary David Blunkett could answer those simple questions, and added another question – ‘ Will the Home Secretary shut this site down?’ … an answer is unlikely.

Home Office ‘drugs minister’ Bob Ainsworth claimed that “this is the first time the government has tried to reach out to parents and carers as well as children…” which will be viewed with surprise by those drug professionals whose shelves are sagging under the weight of previous government-sponsored material doing just that. Hazel Blears, Public Health minister, came in for some heavy media criticism when she said, “in many cases people do take drugs because it’s a pleasurable thing to do”. The outcry says more about the critics than about the issue; anyone who does not know that one of the primary motivations for drug abuse is pleasure needs to revisit their textbooks. Where the minister misfired was in not making it clear that pleasure from drugs up is artificial, short-lived, and ultimately empty experience, and therefore that the (legitimate) human pursuit of pleasure should be fulfilled via other routes – which a Public Health minister might be expected to not only be aware of, but to advocate. She compounded the felony by paraphrasing the attack on ‘Just Say No’ approaches, which makes one speculate whether her own ‘aspirational target’ is to render her post redundant! (Just say Go?).

Not all the critics of the Frank Campaign came from the prevention side of the field. Danny Kushlik, director of the ‘legalise everything’ Transform Drugs Policy Institute branded Frank a “wasted opportunity” because it offered no advice on ‘Harm Reduction’. He went on to emote “The campaign is crap. It focuses entirely on illegality. It looks like it’s been designed by some official at the Home Office” (hardly a breathtaking deduction). Even Release, the longtime cannabis legalisation campaigners, were unhappy; “Talk to Frank conjures up an image of a white older man”  (Release has, for several years, itself been managed by a white older man…). Of all the liberalist groups, only DrugScope seemed content – less than surprising to those who can see DrugScope’s fingerprints all over this product.

The fact sheets are certainly written in easy-to-read language, including slang, but some of the statements are a cause for serious concern. Amphetamines receive the admonition: “too much, too often can make people depressed and paranoid” – the implication being that lesser consumption is of no concern. Regular users of cocaine or crack can, it is said, develop “a regular habit” (is there such a thing as a ‘irregular habit’?) – but there is no mention of cocaine or crack addiction. With Ecstasy, “some of those who died did so from heat stroke” – but what of the others? Although, with Ecstasy, the uncertainty of what you are being sold leads Frank to recommend that you avoid it, a similar concern about uncertainty as to what you’re sold when it comes to heroin is not accompanied by any similar recommendation to just say no.

As might be expected, the fact sheet on cannabis is the biggest disappointment; and it receives fire from both sides. The UKCIA (UK Cannabis Information Agency) is incensed by what it sees as avoidance of its version of the truth; understandably enough, given their faith in the weed. Prevention professionals have also expressed serious reservations, but on the basis of research rather than faith. The extraordinary increase in strength in recent years, with the consequent major increased risks of psychoses, is brushed aside by the statement: “Some types are very mild. Some are very strong.” There is a blunt and erroneous statement that “It is very unlikely that any one will become physically dependent on cannabis…” and this is reiterated later in the same fact sheet, albeit with psychological dependency acknowledged – yet in a phrasing that suggests this is somehow less of an issue – which any drug worker worth their salt will know is far from the case. Another misleading statement is that “some people use it for medical reasons – MS, glaucoma, (etc) …” – the more correct statement would have been “some people use it in the belief that it has medical benefit”; some people will see this statement as governmental acceptance of a position which – in respect of ‘raw’ (as-grown) cannabis – remains more likely to be scientifically rejected than accepted. Frank goes on to say “medicinal types of cannabis are being researched” – this is unforgiveably sloppy writing; it is extracts of cannabis which are being researched, and then only for ingestion by means excluding smoking; there is no suggestion in the research that smoking cannabis joints is on the research or government agenda. Once again this sloppiness gives credence where none is justified, and unjustified succour to lobbies who are quite capable of making up their own fantasies without the help of the government writers.

At the launch for drugs professionals, first up to introduce Frank was Cathy Hamlyn – Head of Sexual Health and Substance Abuse at the Department of Health. Referring to an increased spend by her department, up from £236 million to £296 million per year (which makes for interesting comparison with just £3 million per year for Frank. One wonders where all the rest is going). She gave the overall aim of Frank as “helping young people understand the risks and the sources of help” (no mention of prevention there) and to “give parents more confidence”. The target age range for Frank was stated as “young people from 11-21 years and for parents of 11 to 18 year-olds”; this is probably a rational age bracket for those receiving or reading the Frank materials, even though there is some incidence of drug abuse below this age.

Next to speak was Katie Aston of the Home Office, who gave an interesting slant on one goal, which she verbalized as “… to reduce use of class A drugs and to reduce the frequent use of illicit drugs” – presumably infrequent use of illicit drugs is OK by Frank. She went on to say that one expectation was that there would be “… a shift in attitudes on specific drugs”, and she gave the example of “modifying the perception of heroin use as being linked with failure”. Quite what the advantage would be, and for whom, in this kind of ‘rehabilitation’ in the characterization of heroin use, is unclear. Equally unsettling was the stated intention, of “… starting the process of destigmatisation of drug abuse”. One can see the advantage, within a  therapeutic process (of counselling or treatment) of the client’s attitude not being clouded by such characterisations; but this is a world away from some general kind of normalisation across society, and with it the risk of suggesting an active acceptance of drug misuse. Home Office urgently needs to get its act together on these issues – assuming, charitably, that they have not already done so.

Also on the rostrum was Sarah Maclean, representing the Department for Education and Skills; she told the professionals that Frank will support schools (and young workers) through drug education advisers, and that this will involve the Drug Education Forum – not the best news for those drug educators who pursue a preventive approach; the DEF has long been dominated by a ‘harm reduction and personal choice’ model … it remains to be seen whether it changes its direction under its new chairman, Eric Carlin, who is UK chief executive of Mentor, the prevention body which has such diverse board members as HM the Queen of Sweden, and George Soros, as well as Lord Mancroft, a Tory peer with a penchant for relaxing drug laws.

A question about the absence of reference to gun crimes and turf wars, and there being only fleeting reference to crack cocaine, brought the response that Frank did not want to generate worry across the nation about specific drug problems which were more regionally concentrated. Questions about the absence of black people in the adverts threw the panel into a confusion of hand-wringing, with protestations that this was only the beginning, and that all ideas from the public and professions, for modifying the campaign will be entertained with enthusiasm. This remains to be seen.

Overall, then, there are things about Frank that are worthy of encouragement, but he has some worrying traits, and he seems to be facing in several directions when it comes to what he is trying to achieve; almost schizophrenic. Being all things to all men may seem a good strategy for a politician, but for a communicator with young people, parents and carers, Frank needs to be more than ‘open and non-judgemental’ – valuable though these values are. Young people can smell hypocrisy a mile off, and can tell when someone is pandering to them in an attempt to be ‘cool’ or to buy ‘cred’. Frank could usefully mature a little, pluck up his courage, and move beyond mere distribution of information – as a caring ‘older uncle’ might well do. Frank speaking about society’s goals does not have to be off-putting, nor does it have to stray into authoritarian mandates. If Frank can help the young and their parents understand – not only what drugs do, but also why it makes sense to avoid them – in the interest of other people, not just the user – then this would be a real leap forward … far beyond just saying ‘No’, and into a truly honest dialogue worth having, in the interests of all of us.

Website: http://www.talktofrank.com     
email: FRANK@homeoffice.gsi.gov.uk    FRANK Hotline:   0800 77 66 00

ROBBIE DINWOODIE, Chief Scottish Political Correspondent

A LEADING addiction expert last night said the Scottish Executive was relying too heavily on methadone to combat heroin use. Professor Neil McKeganey, of Glasgow University, was speaking after the Tories highlighted official statistics showing that prescription of the heroin substitute rose by 17% in two years.

Bill Aitken, the Glasgow MSP, accused ministers of “consigning more and more addicts to swim in a sea of methadone dependency”, with 19,000 now dependent on it.

Professor McKeganey said there was no doubt that methadone could be a useful tool in tackling heroin addiction over fixed periods, but its indefinite use was causing experts widespread concern. An executive spokesman said: “The most effective treatment will always depend on the circumstances of the individual addict – there is no ‘one size fits all’ solution.”

But the professor said: “The executive is right to say no one treatment is the answer, but this sits oddly with the fact that methadone appears to have become the first choice and its use is lasting many years. That is a genuine concern.”

Professor McKeganey said research last year, involving 1000 users, showed that overwhelmingly they wanted to get off drugs, and this posed the legitimate question of whether methadone was a route to abstention or merely a tool in stabilising their habit. Figures released by the Conservatives show that in 2002, an estimated 16,401 addicts were being prescribed metha-done. By 2004, that figure had risen to 19,227, with the cost to the taxpayer, from April 2003 to April 2004, over £11.6m.

Greater Glasgow NHS board area has the highest number of individuals being prescribed methadone, with an estimated 6623 addicts receiving the treatment in 2004.

Mr Aitken said: “Methadone is an addictive substance that is a substitute for heroin, not a cure. As a country, we are consigning more and more addicts to swim in a sea of methadone dependency – a publicly-funded drug action programme.”

Source: BBC Report August 2005

CHILDREN as young as ten are drinking and sniffing petrol, a growing and potentially lethal form of solvent abuse, experts warned yesterday.

More children have gained access to the fuel after being bought quad bikes or off-road motorbikes. But many have become addicted to the chemicals in petrol and their parents have phoned the solvent abuse charity LOST, begging for help.

John O’Brien, who set up LOST after his son Lee, 16, died in 2002 from inhaling lighter fuel, said children were playing “Russian roulette” and added: “Parents are asleep to this danger, which could kill their children the first time they try it.”

Mr O’Brien, from Methil, Fife, said: “We first heard about kids drinking petrol about two years ago and since then we have had dozens of calls from parents whose children don’t know how to break the addiction. Kids phone us too. Some say they are being bullied into it by peer group pressure.

“Petrol abuse has always been a big problem in the US, South America and Australia. But in this country, although it has always been around to some extent, it has been exacerbated by parents buying their kids these quad bikes and off-road motorbikes. Youngsters tell each other they can get the petrol out the tank and gulp it down. They are mostly unsupervised on these bikes and out of sight of their parents.

“The chemicals in the petrol, such as butane, give them a buzz which lasts ten to 20 minutes and then they try again when it wears off. They don’t realise that the first time can kill them.”

Richard, 12, who lives in Fife, contacted LOST’s 24-hour helpline earlier this year. He said: “My dad bought me a quad bike for Christmas. He said, ‘Away you go son and have fun’. It was brilliant and everyone wanted a shot. My dad always bought the petrol but we fell out.

“Someone told me just to siphon it off his car, so I did. Then this guy says, ‘You take it from your dad and we’ll sell it to other quaddies and we’ll keep some for socialising.’ I didn’t know what he meant but didn’t want to look stupid. He said, Your mum and dad can booze so why can’t we do the same?’ “We drank the petrol in a park where we went on our bikes. It was a total buzz. I didn’t want to stop. Things were getting mad. I was feeling paranoid, so I phoned John [at LOST].”

Professor Anthony Busuttil, of Edinburgh University’s forensic pathology unit, said: “The butane in the petrol is one of the main substances giving the buzz. It is an extremely dangerous thing. Petrol evaporates quickly and stimulates the vagus nerve, which runs down from the brain stem to the back of the nose, tongue, gullet and neck, causing you to drop dead.”

In Britain, death rates from volatile substance abuse (VSA) are highest in Scotland and north-east England. Since 1971, there have been 2,103 VSA deaths, 282 in Scotland.

Campaigners said the true figures were higher as they did not include fatal accidents and suicides as a result of VSA.

The Scottish Executive said: “We are clear that there is a real need to get a clear message out to young people. We do not see volatile substance abuse as separate from drug abuse, but part of it.”

Source: The ScotsMan Tuesday 6 Sep 2005

ALTERNATIVES TO THE HARM REDUCTION POLICY

RESOLUTION

20 May, 2005, Vilnius

 Conference,

  -Having heard the reports of foreign and Lithuanian professionals, and representatives of the Lithuanian organizations, which work in the drug prevention field,

- taking into account the experience of international organizations, which work in the drug prevention field, and their negative assessment they presented of the so called “harm reduction” programs, such as syringes/needles exchange for drug addicts and the substitution or maintenance treatment when drugs (e.g. methadone or subutex) are used, as well as other programs by whatever name, which make the possibility to root drug culture in Lithuania and to legalize drugs,

- having discussed the alternatives suggested by foreign experts – methods and programs,

- taking into consideration the Seimas of the Republic of Lithuania Resolution of March 18, 2003, which stands strictly against attempts to legalize drugs and against the policies, which increase spreading of drugs,

- having assessed the danger for national security of Lithuania and the neighboring countries, which arises from the spreading of drugs,

- having in mind the suggestion of the 1961 conference of the United Nations to the countries, in which drug addiction is a serious problem, and if they have sufficient economies, to ensure drug-free treatment of drug addicts in hospitals,

- paying attention to the fact that in the 48th session of the United Nations Commission on Narcotic Drugs, held on April 7-14, 2005 even the mentioning of the “harm reduction” programs was refused to be included into resolutions, because the commission considered such programs are not relevant to the fight against drugs,

suggests:

For the Action Group of experts organized by the Drug Prevention Commission of the Seimas of the Republic of Lithuania to examine various harm reduction and the alternative programs, which were discussed at the conference, as well as other options and to define the ways how to implement the alternative programs in Lithuania seeking to gradually replace the programs, associated with further legalization of various forms of drug use, with other programs, which are not associated with drug use,

For the Seimas of the Republic of Lithuania to approve the State strategy and policies in the field of drug control and prevention of drug addiction, by which the alternative methods to “harm reduction” programs were legitimated, not raising danger of spreading of drugs, and reducing the drug demand, and by which the following principles would be stipulated:

The Republic of Lithuania invoking the 1961 United Nations Single Convention on Narcotic Drugs, the 1971 United Nations Convention on Psychotropic Substances, the 1988 United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, ratified by the Republic of Lithuania, and the 2002 Seimas of the Republic of Lithuania Resolution on the Prevention of Drug Addiction in Lithuania, as well the 2003 Seimas of the Republic of Lithuania Resolution on the Drugs Control Policy, Decides that:

1) the State priorities of the drug policy are drug supply and demand reduction, which include primary prevention, early diagnostics and intervention in schools and families, also interdiction of illegal distribution of narcotic drugs and psychotropic substances, and the drug-free treatment of drug addicts;

2) The State upholds the strategy against any legalization of drugs, against any theories, strategies or activities, which would stimulate, make easier, and facilitate or promote in any way the use and spreading of narcotic drugs or psychotropic substances;

3) Taking into account the aggravating factors of the criminal responsibility foreseen in the 1988 United Nations Convention, the State tightens up the administrative and criminal responsibility for activities associated with production, distribution, and usage or inducement of someone to use narcotic drugs and psychotropic substances. For persons, who had committed these crimes, with the exception of those who were using narcotic and psychotropic substances, confiscation of property is applied, while release from criminal responsibility, suspension and release from enforcement of punishment for such persons is not used;

4) Special courts (judges) are being established for the lawsuits associated with production, distribution and usage of narcotic drugs and psychotropic substances;

5) The State of Lithuania acknowledges the drug addiction as a disease, and the State undertakes a responsibility to present the adequate conditions for those who want to be treated;

6) Mandatory medical and social control programs are applied for children, who use narcotic drugs and psychotropic substances without prescription, while for those who are dependant on narcotic drugs and psychotropic substances treatment and mandatory social rehabilitation measures financed from the State budget are applied;

7) Regular analysis of normative documents associated with the control of narcotic drugs and psychotropic substances, and activities of the State officials responsible for the drug control on various state power levels, also public organizations, which work in this field is performed with the aim to prevent possible corruption activities and to stop possible attempts of liberalization of the drug policy in Lithuania;

The State supports non-governmental organizations carrying out the programs of drug prevention and the programs of public awareness of the drugs made harm.

The Resolution of the Conference has been adopted by consensus.

A man walks into your office, and over the course of  an office visit convinces you to prescribe for him a potent narcotic. He tells you that he has been using heroin steadily for the last two years but has been trying to quit. “It all started Doc, when I hurt my back 3 years ago, and I’ve tried to quit but can’t. I’ve applied for a methadone program but there’s a waiting list so can you just prescribe me something until I can get on methadone? I don’t want to have to commit any more crimes.” The two of you decide on MS Contin pills — the 100 mg. size– and before you know it you are prescribing 3 a day for him on a weekly basis, with each week’s excuse as to why he isn’t yet on methadone containing  just enough truth to keep you engaged, though reluctantly. “Well, it’s harm reduction,” you say to yourself, starting to echo the thoughts of your new and very loyal patient. “At least he isn’t out on the streets and using needles.”What you don’t know is that your new patient has been selling most of the pills that you have been providing him with, and injecting the rest. On the streets the grey “peelers” go for $40 each,  (aptly nicknamed because the outer colored coating easily peels off to make them ready for dissolving and injecting.) He’s been using the $120 a day to finance his cocaine addiction, and now he is suddenly able to afford a 2- gram-12 -fixes-a-day habit. Harm reduction? Actually the opposite– this patient was using much less before he started seeing his well intentioned doctor; he didn’t have the money, and was staying away from crime because he was on parole. This type of physician-patient interaction occurs far too frequently, especially when one substitutes Valium or Tylenol 3’s into this scenario. (Financing an alcohol dependence with Valium prescriptions for example)

So what is Harm Reduction and how might it be applied in a medical practice?

Simply put harm reduction attempts to focus on reducing the harm of using drugs rather than on reducing drug use itself. Examples of harm reduction interventions might include needle exchange, drug substitution, safe fixing sites, outreach counseling,  However, as we have seen in the above example, it’s not always that simple. There is a fine line between “enabling”, or facilitating a continued addiction and “harm reduction,”  and it can be difficult to determine when one has crossed that line, especially for those who do not have experience with addiction treatment. Such confusion is also evident on a macro, or policy scale, as any recent news article on harm reduction will illustrate.  Compounding the confusion is a lack of a consistent definition and a measurable outcome for harm reduction.

Harm reduction implemented poorly is not harm reduction. It is now clear that harm reduction needs to take place in a treatment context in order for it to be effective. Perhaps the most obvious example of this is the Swiss experience of the late 80’s, early 90’s. It was the Swiss idea at the time to set aside an area which became “Platzspitz” or Needle Park, where addicts were allowed to buy and use drugs freely. This experiment in harm reduction included free needle exchange, condoms, medical care, and food distribution. By the time this well intentioned idea was deemed a failure and the park was closed, the numbers of addicts in the park had swelled from a few hundred in 1987 to 20,000 in 1992.  Drug related violence and crime rose rapidly in the area. Doctors were resuscitating an average of 12 overdoses a day, and up to 40 on some days. In 1992 the Swiss responded with a period of increased enforcement coupled with a dramatic rise in proven addiction treatments, especially methadone treatment. By the time they were ready to embark on more controversial harm reduction trials the Swiss had a solid foundation of addiction treatment with over 15,000 patients in methadone treatment.

The parallels between the “open drug scene” of Zurich in the early 90’s and the current chaos of the “open drug scene” of downtown Vancouver in the late 90’s are striking. Unfortunately  for BC, it would appear that public policy regarding drug addiction is still being guided by  vocal “service provider” agencies rather than by “treatment providers.” But there is some cause for optimism as “the pendulum has swung back and a reappraisal of the adequacy of harm reduction is occurring…The limitations of a harm reduction framework implemented in isolation from other models has become increasingly evident.” “While promoting tolerance is admirable, the harm reductionists take it too far: if you should not stigmatize addicts, neither should you condone addiction. And with its learn-to-live-with-drugs approach, harm reduction offers no guidance on how to bring down the appallingly high levels of drug addiction in this country.” The challenge now facing those in the field of addiction medicine is how to integrate the strengths of the harm-reduction perspective with the strengths of the conventional use-reduction perspective in a unifying model.To bring it back to the micro level let me offer some suggestions for integrating a harm reduction perspective into your own practice: Expect something in return.
If you find yourself in a situation where you are prescribing abusable drugs with weak medical indications, start by expecting something in return. Consider treatment contracts. Link your prescriptions to measurable outcomes.

Case example: Mr. y has been seeing you for the last two years. He is HIV positive but hasn’t really been taking care of himself. He can’t make it to the lab to get his blood drawn so you have no idea what his T cell count or viral load is. Your relationship has degenerated to the point where you are engaged in intermittent crisis care, except of course for his regular visits to obtain prescriptions for Tylenol 3’s, which you reluctantly provide. “Doc, you can’t cut me off my T3’s, I ‘ve been on them for years, its the only thing that works…it keeps me off heroin….I haven’t used since I started seeing you.”

Sound familiar? (consider adding stats on BC’s Tylenol 3 consumption) In the back of you mind you remember that it is against College regulations to treat heroin dependence with anything other than methadone, but you note that you’re treating low back pain anyway, or headaches. And besides, isn’t it Harm Reduction to keep the patient engaged with you until the time he is ready to get better? Well, you don’t need to wait for this patient’s spontaneous epiphany.  I have seen too many die, or become HIV positive, or lose a limb, while waiting for their epiphany.  There are things you can do to help move your patient further along towards health. What you can do is tell the patient that you want to reevaluate your doctor-patient relationship, that you’re not feeling like the relationship is really benefiting him. Ask him what he wants to do, what are his goals?  What would he like to get out of the relationship?  Quite likely he will be able to offer some suggestions  — things like “I’d like to take better care of my HIV, maybe start taking medications.” or  “Stop using drugs.” The two of you could negotiate a treatment plan/contract that might contain some of the necessary steps. 1) Get bloodwork drawn. 2) Hook up with PWA 3) Start seeing a counselor etc. Down the line you might find yourself saying, ”Well I’ve given you that blood requisition 3 times now and you haven’t been able to get it done– I’m going to expect that before your next prescription is due you’ll have it done.”  The goals can continue to develop as the therapeutic relationship develops.

If your treatment contract doesn’t work out, remember that sometimes terminating a relationship can be the best medicine.
Case example: Ms.L. had been seeing me for methadone treatment for 4 months. At treatment intake she told me that she was using heroin and cocaine, although her intake of cocaine was low enough that she would be able to stop it altogether, which we included in  our contract agreement. By 4 months it was clear that all of our attempts to eradicate the cocaine from her urine samples had proved futile. Every urine came back positive, and her arms continued to show heavy track marks. The only intervention she hadn’t tried was a recovery house which would take patients on methadone, however Ms. L. refused to entertain that possibility. Since Ms. L. was also HIV positive (although she wasn’t interested in any HIV care), I was faced with a dilemma. Was I actually reducing harm with my relationship with her or was I simply facilitating a continuing and destructive addiction? I opted to discontinue the relationship, pointing out to her that the intent of the methadone treatment was to help her to get off  the street, to stop using needles and illicit drugs, and to eliminate the need for engaging in crime. (Issues covered in our pretreatment explicit contract.)

Her next prescription began a weaning process of 1 mg. per day. After 5 days she came into the office announcing that she was ready to try a recovery house where she could stay on methadone. She was admitted that same day to Renaissance House where she stayed for the next 30 days, stabilizing on her usual dose of methadone. I debriefed her on her return from recovery, when she told me that she prior to Renaissance House she had been using 2-300 dollars of cocaine per day, not the once or twice a week she had previously been trying to convince me of. She was also grateful for having been “pushed” into treatment. “I don’t think I would have gone otherwise– I would still have been messed up, I really needed that time away from coke to clear my brain.”

This case also illustrates that the helping person’s role is not limited to continuing to supply drugs until someone “hits bottom;” or waiting for someone to “want to change,”  or spontaneously recover from his/her addiction, as many of those advocating a harm reduction perspective would suggest.  In this case I “raised bottom” by increasing the costs of continuing her cocaine use – she was free to continue using the cocaine, but at the cost of our relationship and methadone treatment. She chose instead to stop the cocaine.

Harm Reduction has brought the welcome concept of “meeting and accepting people where they are at” to the fore, supplanting the rigid dogma and ideology of the past “abstinence-only” perspective. However, that does not mean being relegated to a watching-and-waiting role. Even in those patients I see that “don’t want to  quit,” one usually finds a split, with part of them wanting to quit while another part tries to stay addicted. I tell my patients that I want to align myself with that part of them that is trying to get better.

 There are many tools in the field of addiction medicine that can make the job of treating addiction easier- learning to do a proper assessment, treatment plan, or when to refer, as well as specific tools such as Miller’s  adaptation of Prochaska’s and Diclemente’s “Stages of Change.” This is a very useful framework for assessing readiness to change and how to motivate people for change. Miller offers stage specific interventions and techniques which the helping professional can use to move his patient along, one stage at a time. For instance someone who is still actively using might be in the pre-contemplative stage. Miller suggests the therapist’s role is to offer sound feedback and information in a non-judgmental fashion, and to stay away from suggesting concrete action directives which would be countertherapeutic at this person’s stage. An added strength of this framework is the conceptualization of the stages of change as a circle, or a wheel which one may have to travel around a number of times before establishing permanent behaviour change. (An average of 4.5 times for smokers, for example) This means that relapse is viewed simply as one of the stages which leads on to the next stage, and offers both the patient and therapist a productive focus. Note that this framework dovetails quite neatly with a harm reduction perspective.

Michael Massing, in a recent essay in New York Times Magazine also believes that harm reduction requires a treatment context, and carefully details the considerable potential benefits of diverting money away from enforcement and interdiction, to treatment: ”The best way to get drugs off the streets is also the cheapest: comprehensive treatment.”

Of course they won’t all progress, but almost 100% of heroin users started on it.
There is a frequent pattern of drug use: —
Beer/wine—>cigarettes/spirits—>marjjuana—> other illegal drugs.
Professor Denise Kandel and others of the Dept. of Psychiatry and School of Public
Health, Columbia University, New York, have found this progression in most of their
investigations, published in various journals from the seventies till the present, including,
Science, The American Journal of Public Heal/h, Journal of Drug Issues.

We must try to stop our children from smoking in the first place. Smokers have already mastered the required technique.
A MORI poll in 1991 found that 50% of smokers had tried an illegal drug compared to only 2% of non-smokers.

The more they use, the greater the risk of pro gression.
Of those who had used cannabis more than 1000 times, 90% went onto use other drugs.
Between 100 and 1000 times, it was 79%, dropping to 51% between 10 and 100 times.
Even 1 to 9 times saw 16% go down the slippery slope whereas only 6% of non-users
succumbed (Denise Kandel, 1986)

Use of cannabis and cocaine have been linked in several studies.
“The linkage between marijuana use and later heroin or cocaine use is 10 times greater than the evidence of linkage between cigarette smoking and lung cancer”, Clayton & Voss, US Journal of Drug & Alcohol Dependence, 1982. And from Science, 1997. ’22% of Dutch youths over 12 who have ever used cannabis, have also used cocaine’. ‘The main predictor of crack cocaine use is previous daily use of pot’ (PRIDE, USA)

Recent research from Australia and New Zealand confirms all this.
Youngsters smoking one joint a week are 60 times more likely to progress, the strongest association is among 14-15 year olds (Fergusson and Horwood, Addiction 2000). Genetics was ruled out when a study of 300 pairs of same-sex twins discovered those using cannabis before the age of 17, were 2-5 times more likely to have drug problems and dependency later in life, than their non-using siblings (Linskey etal, JAMA 2003)

Some users say they are looking for a bigger and better ‘high’,
 rather like small children jumping from a higher step or swinging ever higher.
When people become tolerant of a ‘high’, they seek a more potent drug, or the withdrawal symptoms from one can be alleviated by use of another (H. Ashton, Current Opinion in Psychiatry, 2002)

Drug dealers are often blamed for pushing other drugs.
The Dutch ‘experiment’ was supposed to separate the markets of ‘soft’ and ‘hard’ drugs. This has not stopped the progression. Holland has twice as many heroin addicts per capita than Britain (Trimbos Institute 1997; Schwartz R, Hospital Practice May 1991)

A Post investigation suggests tens of thousands of needles given to Nottingham drug addicts through exchange programmes are not returned. Councillor Jon Collins, below, accuses health workers of handing the needles out “like confetti”. But health workers say it is unrealistic to expect every needle to be returned, Health Correspondent CHARLES WALKER reports. The moment a discarded dirty needle pierced six-year-old Rebecca Unwin’s palm is etched into her mother’s memory.” Because they want to put that rubbish in their veins they do not think about others”. Olga Unwin

“Seeing my daughter standing there with a needle and syringe sticking in her I was scared for her life,” said mum, Olga Unwin, who was terrified Rebecca might have caught hepatitis. And six weeks on, that fear has not gone away for Ms Unwin. While her young daughter has almost forgotten the day she picked up the needle and syringe, Ms Unwin is still anxiously awaiting the results of the blood tests, due next month. “I don’t think she remembers it now,” said Ms Unwin, of Coleby Avenue, Lenton. “We do not mention it. She is just a child and should not have to worry about these adult things. But it is a worry knowing the results could be positive. “It is in the back of your mind constantly.”

Rebecca and her eight-year-old friend found the needle and syringe, which contained blood and a brown substance that could have been heroin, when they were playing on the grass in a public place a few yards from Rebecca’s home in March. Despite exchange programmes, which enable drug addicts to bring back used equipment in return for new, Nottingham City Council has been called out to 317 reports of discarded needles in the last year, compared with 146 reports in the previous 12 months. Council officers believe the increase may be due to the introduction of a hotline telephone number through which to report discarded needles. The exchange system provides one needle for each used one returned, but a report from Nottingham City Primary Care Trust acknowledges that does not happen. A Post investigation suggests at least 20,000 given out last year did not come back.

Councillor Brian Grocock, the city council’s cabinet member for street services, said: “It is important people are extra vigilant and they keep their eyes open and contact the local authority about any discarded needles. Parents in particular have to keep an eye on their children and where they play. “We know these needles are out there. People are reporting more now than they were before and they have to be careful. These are extremely dangerous pieces of equipment.” The fear is they could turn up where children play and that makes Olga furious. “It makes me mad,” she said. “Some drug users just do not care who they inflict their needles on when they just drop them. “Just because they want to put that rubbish in their veins they do not think about others.” Her anger is shared by leader of the city council, Councillor Jon Collins, but he points the finger at health workers, who he says should be stricter with drug addicts. “The difficulty is in a number of cases, drug users are not handing over dirty needles,” said Councillor Collins.

“Some services appear to be handing out syringes and needles like confetti. If that was not the case, why are they lying around the city? “People are finding them on a regular basis. It is dangerous and unpleasant. This is a serious, serious issue. “Health workers need to be more responsible and if they are not getting all the needles back they should not hand them out, but we are a mile away from that. They should be one in, one out with no exceptions. “There needs to be a much higher level of accountability of what is happening through needle exchanges.”

The Nottingham PCT report estimates:

More than 300,000 needles were distributed by the various exchange schemes in Greater Nottingham from April 2003 to April 2004. The Health Shop, based in Hockley and run by Nottingham City PCT, supplied almost 200,000 needles and staff estimate only six per cent – or 11,000 – were not returned. Compass supplies more than 20,000 needles each year. The organisation does not collect figures on return rates but staff estimate up to ten per cent (2,000 needles) is not returned. The 16 pharmacies that operate a needle exchange scheme across Greater Nottingham giving out 80,000 needles each year have no figures at all on return rates. Those handing out needles claim it is unrealistic to expect every single one to be returned and they say they are doing a lot to ensure as many as possible are accounted for and return rates have improved.  They say it is vital to provide clean needles to prevent the spread of potentially lethal infections, such as HIV and Hepatitis B and C, in the drug-using population and the wider community. Tests on drug users visiting The Health Shop in the first six months of 2003 – the latest available figures – show the number of infections increased almost three-fold from 2002 and seven-fold from 2001.

A spokesman for Nottingham City Primary Care Trust, which runs the facility, where staff claim a return rate of 94%, said the needles unaccounted for would not necessarily turn up on the streets.”The percentage figure of 94% for returned needles will be higher when confiscations of needles off drug users by the police are taken into account, as well as the figures for needles exchanged by Nottingham community pharmacies,” he said. “Ideally the percentage figure would be 100% but we have to accept the realities of life for some drug users, who may be leading highly chaotic lives.” He said some needles would be left in flats and squats. He added: “There are mechanisms in place whereby at the Health Shop every client’s return rate of used equipment is assessed at every visit. If a client fails to return what has been recorded as given then supply is reduced.”

All the needle exchange programmes in Nottingham now use new tubes for the return of needles and syringes, called “visibins”, which have a clear plastic strip to allow the healthworker to see what is being handed in. Prior to this there had been reports of addicts placing twigs inside tubes to make it sound as though they were returning equipment in a bid to trick health workers. The visibins enable health workers to reduce the supply of needles if too few are returned. Jacqui Molnar, group manager in the East Midlands for Compass, said: “We are taking clear steps. We have changed all the bins so we can monitor what clients are bringing back.” Pharmacies are thought to face the biggest challenge in maintaining high return rates, and they appear to be most vulnerable to Coun. Collins’ criticism. Gordon Ross, community pharmacy project manager at Gedling Primary Care Trust, which manages the exchange scheme in pharmacies throughout Greater Nottingham, accepts some needles go astray but said: “We are doing our utmost to provide a public health service. We have been strict with our return rates and we have lost pharmacy participants in our scheme because of our strict policy of one-for-one.” However, he accepts they are probably not achieving a return rate as high as the other organisations claim. He said staff at The Health Shop and Compass can sit down with clients and interview them when they bring their needles back so they have access information about the individual they are dealing with.  But he added: “In a network of 16 pharmacies that are not linked by computer to share information, it is harder to achieve the same level of returns.” He said there are occasions when staff at all needle exchanges will give out equipment, even though the addict is not returning any.

If a drug user has recently come out of prison or custody, needles and syringes will have been confiscated. In these instances, pharmacists are more susceptible to being tricked into giving out new equipment than drug workers because they tend to have less time to spend with clients and do not have access to such detailed records, which help to check the truth of an addict’s claims. The Notts Drug and Alcohol Action Team is currently developing a programme to offer more support and training to pharmacists and it is hoped this will lead to collecting information on the rate of returns in a consistent way so it can be effectively monitored. However, Mr Ross and other health workers vigorously defend the need to hand give out equipment if it is believed an addict will otherwise use a dirty needle and syringe. Mr Ross said this may occur because of some users’ “chaotic lifestyles” where a desperate person buys drugs but has no equipment. They visit the nearest pharmacy involved in the exchange programme in order to inject as soon as possible. He added: “If a person is desperate to use we have to provide a service to minimise the risk they use old, contaminated equipment.” And he insists the whole community benefits because it helps to limit the level of infectious diseases in Nottingham. He said: “Needle exchanges are fulfilling an important public health role in trying to stop the spread of infectious diseases. Infections do not just affect the drug-using population, they are also a threat to the population at large because the two groups mix with each other and have relationships.” And Mr Ross shares Olga Unwin’s belief that ultimately most drug users are responsible. “The vast majority of the drug-using population fulfil their duty of care to the rest of the population. “Their habit does not impact on other people. But there is a minority who do not take their responsibilities fully and this leads to discarded needles. “It is down to the drug users. They are told and educated.”

‘Vital’

Drug users insist needle exchange services are vital to safeguard their health. A former heroin addict who used needle exchanges in Notts for up to five years told the Post: “They are really, really important. A lot of society thinks when you are using you are not bothered about your health, but you are. “People are very conscious of the risks of using dirty needles. And the last thing you want as an addict is to be admitted to hospital because then you cannot use.” The 32-year woman, who now works with the Notts Drug and Alcohol Action Team, to help other people overcome their addiction, attended a drop-in centre to drop off and pick up about ten needles at a time. She said: “How many you exchange depends on how much money you have and how much gear you can afford. “I would say on average I would use at least three each day. I would go and get two or three days’ worth and take the same number back.” The woman, who did not want to be identified, is adamant the majority of drug users are responsible. “Everybody I used with always took their needles back because we knew if we did not we would not get new ones in their place,” she said. “It was very strict.” However, she warned that if controls became too strict, people might feel forced to use dirty needles.

Source:  www.thisisnottingham.co.uk/displayNode

By Manuel Gamiz Jr. Of The Morning Call
Sixteen-year-old Christina Martucci was driving with a ”significant amount” of marijuana in her blood when she failed to yield at a stop sign, leading to a collision with a school bus that killed a Liberty High School classmate on the first day of school, Bethlehem police say.

Police ended their six-week investigation this week, concluding that marijuana use and the stop-sign violation were the key factors that led to the Aug. 31 crash at Lincoln Street and Easton Avenue.

Bill Blake, a Northampton County assistant district attorney, said blood tests showed Martucci had more than two times the minimum level of marijuana metabolite in her blood needed to prosecute for driving under the influence. The minimum level is 5 nanograms of marijuana metabolite per milliliter of blood.

The police officer heading the investigation, Kenneth Jones, said Martucci had a ”significant amount” of marijuana in her system.

Police said they also found 1.2 grams of marijuana in a ”blunt” cigarette — marijuana rolled in cigar paper — in Martucci’s purse and 2.7 grams of marijuana and a smoking pipe in Smith’s backpack.
Source: www.educatingvoices.org/EVINews.asp Oct.2004

Real estate agents aren’t the only ones alarmed by the increasing number of quiet, suburban homes being used to grow lucrative crops of high-quality marijuana. No longer solely the concern of law enforcement, the rapid spread of such grow-ops is changing the way agencies from insurers to municipalities do business.

“What originally started as a B.C. problem has spread Canada-wide,” said Dave Way, standards and practices co-ordinator for the Insurance Bureau of Canada. It’s becoming a familiar sequence from coast to coast, says Const. Richard Baylin, RCMP national co-ordinator for marijuana grow-ops: the empty house on the nice suburban street, the quiet new neighbours, the cop cars, the TV crews. Then it’s back to the empty home – this time full of toxic mould from high humidity, its foundation chipped away to get at power lines, its drywall damp and crumbling. As far as grow-ops are concerned, British Columbia, Quebec and Ontario are “the Big Three,” Baylin said.

A March RCMP report estimates the number of Ontario grow-ops grew 250 per cent between 2000 and 2002, a year in which there may have been up to 15,000 of them active in the province. Now they’re showing up in Halifax. Winnipeg has called Baylin’s office for advice. A little over a year ago, seven homes on the same upscale Calgary suburban street were busted. Edmonton has increased the number of police officers working on grow-ops to six from four. Experts offer a variety of reasons for the increase from organized crime exploiting a high-profit enterprise to low prison terms for those caught. But for Canadian business, the bottom line is that it’s starting to affect the bottom line.

Real estate agents, who may unwittingly sell a former grow-op or sell to someone wanting to build one, may have the most at stake. “A realtor is the one stuck in the middle,” says Bob Linney of the Real Estate Association of Canada. Agents are obliged to disclose anything that may affect the integrity of the house, he says. But sellers may not tell their agent everything. As well, a house’s grow-op history may be several buyers in the past. And telling a buyer his or her prospective home used to be a grow-op may be slanderous unless a criminal conviction was actually obtained.

“The realtor walks a very fine line,” Linney says. The B.C. Real Estate Association now includes a clause on its listing form that specifically asks the seller if he knows if the building has been used as a grow-op. The national association now publishes a 24-page book on how to recognize a grow-op house, or spot a possible customer who plans to build one. “If someone’s more interested in the basement than the kitchen, that could be the first sign,” says Linney, who has distributed 50,000 copies of the book. Most Canadian insurers now put specific riders in their homeowner policies that absolve them of any liability if a property has been used as a grow-op, says May. Power companies are also stinging from the growing grow-ops. Ontario police estimate Ontario Hydro lost anywhere between $3 million and $36 million per month in 2002 from stolen power – losses that get passed on to other consumers. As well, grow-op homes are typically bought with little cash down. A few crop cycles are usually enough to create serious damage, and mortgage-holders lose big when the property re-enters the market. The Insurance Bureau estimates the average repair bill for a former grow-op house is between $60,000 and $80,000. A profitable sideline has appeared for environmental consulting companies in certifying the rehabilitation of former grow-op houses.

Municipalities are also starting to feel the strain. “The workload is becoming an issue,” says Glenn Jenkins, an environmental health inspector with the City of Edmonton. His job is supposed to centre on inner-city housing, but since January he’s been inspecting former grow-ops on an almost weekly basis. “The first thing you notice is the smell,” says Jenkins, who’s seen one home so mouldy that brown stalactites hung from it. “It has a kind of skunk cabbage smell.” Jenkins says he’s training a second inspector to deal with the problem.

After years of cleaning up hundreds of grow-ops at a cost of about $2,500 each, the city of Surrey, B.C., passed a bylaw making owners of such homes liable for the costs. The bylaw, passed in 2001, also gives city health inspectors the right to enter a house where a grow-op is suspected. The spread of grow-ops comes at the same time as Canadians are becoming increasingly liberal in their attitude to marijuana use. But police officers such as Cpl. Lorne Adamitz, a member of Edmonton’s so-called Green Team of municipal and RCMP officers, strive to separate the two issues. “It’s not a victimless crime,” he says. “It’s not just somebody wanting to smoke a joint. “I do believe attitudes toward simple possession of marijuana, those attitudes have changed,” Adamitz says. “But I don’t believe that commercial production of marijuana has been accepted by the general populace.”

In a pilot scheme to test offenders as young as 14 for class A drugs, in a bid to give them swift treatment for their habit, youths in 10 pilot areas across England will be obliged to take part in the testing if charged with offences such as burglary, car theft and begging. They will be tested for heroin, crack and cocaine and anyone who tests positive will receive specialist help. The Home Office hopes the scheme will help break the crime-drugs link. Courts will be able to take test results into account when sentencing. Drug support groups said in order to succeed the idea needed to be accompanied by appropriate treatment.

The pilot expands an existing scheme introduced three years ago to drug-test adults. Fourteen to seventeen year-olds who are charged for a “trigger offence” such as burglary, car crime and theft, will be tested. The Home Office pilot is being run by the Metropolitan Police in three London boroughs – Camden, Newham and Southwark. Commander Alf Hitchcock, in charge of Criminal Justice for the Met, said: “Drug testing young offenders in these circumstances is an excellent first step in stopping many young people from slipping into what is essentially career criminality.

“We believe that if you can remove the root cause for crime you can stop the crime from being committed.”

‘Intervene’
He said the young people from the three London boroughs who test positive for class A drugs will go onto specialist drug treatment programmes. In announcing the scheme earlier this week, Home Office Minister Caroline Flint said: “We know that young offenders are more likely to use drugs than other young people. “We need to intervene and stop class A drug abuse as early as possible.” UK drugs information charity DrugScope warned that any testing had to be backed up with investment in prevention and treatment. Martin Barnes, chief executive, said drug testing could be effective to pinpoint those at risk of future drug misuse, but he warned that the “limits” of using the criminal justice system had to be considered.

Source: http://news.bbc.co.uk/1/hi/uk/3943259.stm August 2004

Message from Secretary-General Kofi Annan on the Occasion of the International Day
against Drug Abuse and Illicit Trafficking
26 June 2004

One of the most damaging misconceptions about drug use is that it is a permanent problem. The truth is that treatment for drug abuse can work, and can restore value and dignity to a person’s life. The theme for this year’s International Day against Drug Abuse and Illicit Trafficking, ‘Drugs: Treatment Works’, aims to correct this misconception, and convey the facts about drug abuse treatment, based on the latest and most reliable evidence and research. Millions of people worldwide have been directly affected by drug problems – those who are dependent, as well as their families. Their lives have been disrupted, their health undermined, their education interrupted, their jobs lost, their families broken. People with drug-related problems, and their families and friends, need to know that there is a way out, and that effective help is available in different forms, depending on the needs and situation of each individual.

Today we have a better understanding of the mechanism of dependence. We know that dependence is a chronic and, in many cases, relapsing disorder. We know that, like many other chronic disorders, there are effective interventions that can help those affected to adopt productive lifestyles, avoid and reduce physical and mental health problems, improve family relationships, regain and retain child custody, and find better housing and employment opportunities. We also know that drug-abuse treatment helps communities, by reducing criminality and the risks of transmission of blood-borne infectious diseases, particularly HIV/AIDS, and by allowing them to benefit from the contributions of healthier, more productive and better-integrated individuals and families.

Policy makers need to bear in mind that treatment is a cost-effective way to tackle not only the health and social consequences of drug abuse, but also to reduce the associated costs of medical care, social welfare and criminal justice interventions. The United Nations Office on Drugs and Crime has a variety of tools available at www.unodc.org to help clarify the facts about drug-abuse treatment. On this International Day against Drug Abuse, I call on everyone to examine and take into account the strong evidence about drug-abuse treatment and its effectiveness. When treatment works, it benefits us all.

The National Drug Prevention Alliance would concur with the sentiments above – but would add that as well as supporting drug treatment, drug prevention should have a much higher priority. Prevention Works! has been the strap line for our organisation for eleven years. Proof that prevention works can be found in an article from The Weekly – between 1979 and 1992 drug prevention programmes in the USA cut use by 50% – from 25 million to 11 million users – as a result crime, drug related hospital admissions and road deaths also declined.

A personal view by David Raynes

The background to and an account of the hearing, in London on 5th February 2008, of evidence to the UK Advisory Council on the Misuse of Drugs. It met to take this evidence on re-classifying cannabis to Class B from C under the UK system.

There is surely hardly an observer of drug politics in the world who does not know that the UK, four years ago, surprisingly downgraded cannabis from B to C, under our A to C classification system of potential harm, (also used to establish social sanctions against use & trafficking). With only a short debate in parliament, the issue was driven through by Home Secretary David Blunkett (now out of government) who had only weeks before, entered the UK Home Office as the responsible Minister.  The issue was noticed and claimed around the world as a victory for the drug legalisation lobby who clearly thought this was a step on the way to their nirvana of legal dope for all. Such an action would have been unthinkable for Blunkett’s predecessor Jack Straw (still in Government). Perhaps Prime Minister Blair took his eye off the domestic ball; bogged down over Iraq, he gave Blunkett his way while apparently we are now told, “having real doubts” himself. Thus are we governed.

The downgrading reverberated around and beyond the English speaking world; such is the power of the internet.  Some lobbyists lied about it, saying the UK had made cannabis legal. It had not, it had messed up, confusing the anti-use message and, strangely, had to put up the penalties for trafficking all Class C drugs because Blunkett had apparently not appreciated his proposed action held the danger of making Cannabis trafficking a minor crime compared to tobacco trafficking. Politically unsustainable. He swears now to this writer he had no external influences on him. Foreign readers may not know he is blind. Does his denial of external influence during his arrival briefing and subsequently before his announcement, sound credible?

Cannabis downgrading (and ultimately legalisation) had been heavily pushed in the UK, since the mid 90s, by a small but noisy, largely London based, media lobby. The downgrading and even legalisation issue was taken to the heart of an educated elite, perhaps fearful their kids might get arrested for pot smoking and not overly concerned about the wider social consequences of cannabis use, especially on the socially disadvantaged.

The statutory body that advises government on drugs, the Advisory Council on the Misuse of Drugs (ACMD) had also advanced the downgrading issue. A report from the “Police Foundation” (not much to do with the Police) led by Baroness Runciman also contributed to this new golden age of pro-pot haze and muddled thinking. A current Liberal Democrat candidate for Mayor of London, then a senior Policeman, made his own timely contribution by announcing the relaxing of the policing of cannabis the day before a pro-pot march. The scene was set. South London lapsed into a drugs no-mans land of dealers in all illegal substances. Great work! Really helpful to anxious parents. A real mess of confusing signals.

A couple of oddball Chief Constables added their pro-drugs bit and in all the UK parliamentary parties there were similar odd (but minority) contributors to the general nonsense. None of these people thinking through exactly how this idea would further damage Britain’s already bad drug using culture. Rank and file Police Officers, the key top scientists and many experienced drug workers, of course opposed the changes but were ignored. David Blunkett astonishingly refused to see six top scientists & doctors who strongly opposed his downgrading.

The UK continued to develop one of the biggest drug problems in Europe. We have difficulties with all drugs, legal or illegal. In a separate earlier action in 1999, focussing on “the drugs that cause most harm” (I always wonder who thought up that phrase), UK Customs had stopped targeting cannabis imports and the UK was flooded with the stuff, much of it Moroccan Cannabis Resin and according to users, of poor quality. The price after 2000 dropped as supplies increased, “Blunkett’s Blunder” in downgrading took effect three years later.  “Age of first use” dropped alarmingly as did “age of first regular use”. Reportedly, kids–often pre teen were/are using cannabis on the way to school, at school and on their way home. The effect of this is that these kids become un-teachable, discipline breaks down, they fail academically, some drop out of education, they are forever damaged. Many, too many, become mentally ill, some diagnosed psychotic, others below formal diagnosis as mentally ill, are nevertheless unable to really contribute to society and cause huge distress to their families. The unemployment or mentally disabled register looms for many, their jobs taken by educated hard-working Poles and others from Eastern Europe. The government becomes seriously worried. Alarm bells ring in the Department of Social Security and in the Department of Health, both now picking up the pieces of the very wrong Home Office policy. The downgrading policy is looking expensive and socially damaging.

Out on the streets, the imported poor quality cannabis resin was gradually replaced by home grown and Dutch “sinsemilla” or “skunk” cannabis, this getting progressively stronger but strength alone being only one of several contributing factors to damage. Frequency of use and age of first use is also important, and, in the view of this writer, so is the different ratio of THC to CBD in this new fresh, home grown “super-weed”. The belief is that CBD moderates the effect of THC on the brain.

A new Home Secretary, (Blunkett having left government), took over and anxiously asked the ACMD for advice – yet again, on cannabis classification. The ACMD resorted to “return-to-sender” for this enquiry after a half-hearted review where, according to inside information, there was no vote merely a decision by the Chairman, Sir Michael Rawlins and a round the table “chat”. Dissent in the ACMD, is not encouraged our spies tell us; the ACMD members, all of them, have only negligible knowledge of the drugs market. The self-selection of new members keeps out those who oppose liberalisation so plainly, the internal debate is and can only be, very one-sided.  Perhaps the Home Office should ensure more balance?

No change then, the cannabis problem for teenagers and pre-teens gets worse. In 2007 the spin doctors and even Ministers take comfort in figures from the British Crime Survey which shows a slight reduction in cannabis use at ages 16 to 24. No one other than this writer mentions this is simply because cannabis for older young people is becoming unfashionable and gets replaced by cocaine, crack-cocaine and (particularly) gross & physically damaging alcohol consumption. Government has allowed 24 hour alcohol licensing despite widespread public concern.  Cocaine use in the UK has also zoomed up. The infection spreads to Ireland, that society develops a similar drug habit.

The regular discovery of organised Cannabis Farms, a new phenomenon in the UK (although known elsewhere, for example in Canada) and an entire new industry in the UK since “Blunkett’s Blunder”, goes unexplained, Cannabis use is down we are emphatically told. When this writer challenges this and points to the farms, one joker (A Professor and a pro-pot lobbyist) suggests the UK is a substantial exporter of cannabis. A statement that defies belief, there is no evidence of such a thing, not substantial anyway. Things are spiralling out of control. Britain is a nation of sick young people; drugs of all sorts are cheaper than ever, youth is more affluent than ever. Prime Minister Tony Blair, architect of “Blair’s Britain” and now being blamed for “Blair’s Feral Youth” is forced from office in the autumn of 2007, largely over Iraq and his handling of the Middle East but his party and most other people are basically just sick of him. This writer tells the media that the cannabis market has widened and deepened, the totality of use is higher. If it is not, where is the output of the cannabis farms going?

A new broom and a largely new group of Government Ministers take over in autumn 2007. Gordon Brown as new Prime Minister is a dour Scot, son of a church Minister he sets a different social tone to Blair and just maybe, has more integrity and social conscience. Consideration is suddenly being given to abandoning plans for giant casinos; 24 hour drinking is being reviewed, so is cannabis policy. Brown appoints a new Home Secretary, Jacquie Smith, first woman in that position. She is a self confessed experimenter with pot at University but all credit to her, she and Brown, together, take a different tone on drugs issues. She is after all a mum and mums (good for them) are driving a new national wave of sustained protest about kids being mentally damaged by pot. Brown signals he is minded to re grade cannabis to where it was, back to Class B, ending the confusion and sending clear messages about the harms. Smith refers the issue once again, back to the ACMD. The implication, clear beyond any doubt, is that Brown and Smith want, and will have, cannabis re-graded even if the ACMD do not support it. On the fringes of the ACMD there are dark mutterings about resignations if their views are ignored. Some observers may think that would be a good thing.

So we arrive at 5th February 2008. The ACMD is forced; reluctantly it seems, to hold some of its hearings in public (why not all in public you might ask-Parliament is after all in public). It arranges a one day hearing in the City of London. Public access is limited because numbers are limited and prior application and approval are needed.  Questions to witnesses by members of the public are strictly forbidden though there is a short public comment/question session at the end.

Chairman Sir Michael Rawlins runs a tight ship, ACMD members call him “Sir”, he calls them by their first names. Very few ACMD members ask questions. Of those that do the most active seem to do it to show how clever they are, not, particularly, to illuminate the real issues. We get no indication or feel for what most members think at all. There is a pre-occupation with the penalties for drugs use & possession, not the science and social science of harm-potential and the actuality in the country. Arguably the very things that should most concern this committee. Astonishing.

Early witnesses from the Forensic Science Service and GW Pharmaceuticals confirm that herbal cannabis seizures (home grown) in the UK, are gradually getting much stronger in THC and that this new form of the drug contains hardly any CBD, leaving the effects of strong THC unconstrained. Resin we are told, long the staple of the UK market, is declining in market share and historically had almost equal amounts of THC & CBD. More work is needed on the issue of CBD but it is plain that by selection, a much higher THC-containing product is gradually taking over the market. It will continue to do so. Other academic witnesses on the potential mental health effects tell us that CBD may be “anti-psychotic”. The absence of CBD may therefore be aggravating the mental damage from the stronger THC. The new selected cannabis may be two or three times stronger, certainly not the 10 or 20 times of the tabloid press and even some over zealous commentators on my side of the debate. Cannabis is not homogeneous and techniques are available in the market to sieve it and extract a higher THC product. The mental health ill effects are more marked in young men; by 2010 cannabis use will be implicated in 25% of schizophrenia cases. Professor Robin Murray has spoken of 1500 cases a year, very expensive to treat and of course this is only the clinically diagnosed.

The most telling early witnesses are from “SANE” & “Rethink”, both mental health charities. Marjorie Wallace from SANE talks of the “confusion about legality & safety” and that cannabis is implicated in 80% of 1st episode psychosis. She says, “Only re-classification can counter the mixed messages”. There is then, an immediate and astonishing outburst from Chairman Sir Michael, angry, venomous, red-faced. (This is a really serious scientific approach, observe and learn I think to myself?) He barks out, “Are you really wanting people to go to prison for five years for possession”?

Any minor confidence one might have had in a dispassionate scientific appraisal, led by Sir Michael at least, surely evaporated. His remarks are nonsense of course and misleading of the ignorant. Sentencing guidelines and historical fact show that imprisonment for just personal use possession, of any illegal drug, hardly occurs in the UK. Why bother with the facts when you are Chairman of such an important meeting, advising government, confident, despite the evidence, that you know best? Does the Home Office know he is behaving like this?

The position of “Rethink” is truly hard to fathom. They accept all the harms of cannabis, indeed they tell us about them, yes they are getting worse but to them, re-classifying so that the public can understand this better, is astonishingly not important. To this observer they seem to have been “got at” by someone, so perverse is their position. Is their funding being threatened if they take a more robust view?  Their position is surely odd especially seen in the light of the remarks by Wallace. This observer smells something very wrong indeed. They are in the same business as SANE, or ought to be. Just what is going on?

Professor Louis Appleby, National Director of Mental Health for the Department of Health gives an impressive presentation, he is clear about the mental harm, we hear of patient suicides and homicides, figures trip out, “68% had taken cannabis”, we (as a society) are “guilty of complacency” (about cannabis), “causal factor”, “benefits from re-classification”, “health perspectives” and much more. Professor Appleby is hugely convincing. He is in no doubt at all that re-classification is needed. One is encouraged that here, at last, we have a public servant being so clear about what is needed and why.

Another presentation about the physical harms is convincing that in cannabis there are all the harms of tobacco and more. Talk of head & throat cancers, early emphysema etc. A second presentation about cannabis & driving illuminates the fact that cannabis is now by far the most common drug found in those arrested under the Road Traffic Act. Cannabis influenced drivers exhibit “poor road tracking” & “divided attention”.

Debra Bell of the “Talking about Cannabis” mum’s pressure group then speaks, together with another mum, an anonymous Barrister, whose own family life, like Debra’s has been severely and permanently damaged by teenage cannabis use. Promising young people damaged mentally and permanently, we are told. Educational under-achievement, wasted years. We are told of the thousands of hits on Debra’s website, the families feeling “let down” by government and the ACMD, the widespread feeling that cannabis use has become acceptable and that parents and teachers were undermined by Blunkett’s downgrading.  Debra tells of the phone calls, parents at their wits-end, desperate and helpless in the face of kids who say cannabis is not so bad, “the government downgraded, it must be OK”. Some kids who even think it is legal. These mums must really worry Prime Minister Brown. These are articulate and educated people, they are not going to give up. They are also voters. These are the people we need to take the campaign against cannabis use forward. They bring a new focus to the battle.

Ms Cindy Burnett. Representing the Magistrates Association & Youth Courts. She is very convincing, she and colleagues are “worried about the message”, “downgrading sent the wrong message”, “caused confusion”, “unnecessary”, “poor effect on health”, “increased addiction”, (youthful) “addiction to cannabis”, “downgrading had a bad effect”, “shoplifting driven by drug addiction” (cannabis), “wrong in principle”, “badly handled”, “downward spiral”, need for Youth courts to be supportive. All strong stuff. The ACMD listen in silence, are they taking it in? Who knows?

A few government apparatchiks from the Home Office talk about their wonderful publicity campaign, they show some clips, fancy indeed but have they worked? How could these adverts turn back the bad effect of downgrading? Like swimming against a strong current. Such stuff keeps people in work but will probably have little effect.

The next speaker is Professor Simon Lenton from the National Drug Research Institute of Australia, his presence confuses, just why is he, particularly him here? I notice he pops up later in the programme again on behalf of The Beckley Foundation, (run by our disgraced ex Deputy Drugs Czar Mike Trace who resigned from the UN when exposed as linked with the George Soros inspired legalisation campaign and “Open Society”). I wonder who has paid Lenton’s fare, was it George? He can afford it. I certainly hope it was not UK public money.

Again, I ponder just why his presence is allowed by Sir Michael.

Lenton is badly briefed about the UK debate and absolutely confused; he addresses us on “The impact of the legislative options for Cannabis”. He seems to think that the lobby against cannabis and for re-classification in the UK is from people who want to “lock users up”; he is more concerned about the social sanctions than about the adverse effects. He does not appear to understand that those who want cannabis upgraded, re-graded to where it historically was, are quite prepared to examine different social sanctions, we know, everyone knows, the UK cannot arrest its way out of our drug problem.  Does he not know the pressure is about putting cannabis back where it belongs? To send a signal about the real harms. To start to change the damaging culture created around use, by the downgrading.

Is Lenton a closet legaliser cloaked in fine words, hiding his real intentions? I “Google” Lenton when I get home and check my files. Yes I thought I had heard of him from Australian friends. As I suspected, keywords, legalisation, Lindesmith, International Harm reduction, support for changes to the UN Drug Conventions etc, need I go on? That and the link with Trace tell me enough.

Does Sir Michael Rawlins understand this chap is a covert pro pot lobbyist? Does the Home Office know the witnesses have been rigged like this?

Steve Rolles from Transform, the UK’s main drug legalisation lobby group (for legalising of all drugs) speaks to us. I know him well and away from this subject can enjoy his company. He is a bright guy. His thunder has been stolen by Lenton he complains! Yes Steve, we are having views like yours laid on pretty thick are we not? Is this deliberate? Is Sir Michael rigging all this stuff, does he understand it? If not him just who is rigging it? Legalisation is not up for discussion any more so just why does Transform get a slot (Debra Bell nearly did not!). Steve though admits “Cannabis is more harmful than we thought”. Well more harmful than you thought Steve, my view has been consistent since I met my first pot-heads in the 60s. My allies have always said Blunkett got it wrong, indeed the World Health Organisation indicated the mental harms of pot in its 1997 report.  Rolles advises the ACMD to concentrate on a “Scientific Harm Assessment”. Yes, I can live with that; as long as they take in all harm not just harm to the individual. Yes and they should remember that defining the social penalties for use or trafficking are not what they (the ACMD) are about, leave that to others. Rawlins passion about that penalty issue nags at me.

Do the ACMD silent members (maybe most of them) know they are being manipulated? Again, does the Home Secretary know about this? This loading the witnesses with legalisers when that is not on any agenda is surely verging on the corrupt. No wonder they want to keep out those of a different view. I reflect that it is apparent there are at least two other days of private hearings, just who are this group listening to then?  Would a “Freedom of Information” request flush it out? Can Jacquie Smith just ask? Will she? Perhaps, I muse, she will if she gets a copy of my note.

The penultimate speaker is Simon Byrne Assistant Chief Constable Merseyside Police. He is the Association of Chief Police Officers lead on cannabis. He is a reassuring and sensible figure, ACPO have changed their view, they are seeing the problems with youngsters on the ground, and, picking up the pieces. He is also not interested in locking youngsters up; he wants early intervention, guidance to youngsters and strong signals sent out that use is potentially very damaging. Byrne tells us there have been 2000 cannabis farms found in England & Wales in the last few years since downgrading, that this is a huge new criminal industry since “Blunketts Blunder” (though he does not call it that). Illegal immigrants, often Vietnamese are involved; it is taking up lots of police time. UK based readers may remember downgrading was partly sold as saving police time.  Byrne speaks of confused public views on cannabis; he and his colleagues are now strongly for re-classification to B. Re-classification would reinforce the perceptions of harm. Is anyone listening?

Next witness is Lenton again, this time on behalf of Beckley Foundation.  “Is cannabis use a contributory cause of psychosis”? He is reading a presentation prepared by Wayne Hall & Robin Room.  Yes it is a cause, and more, 1 in 10 users become dependent. Really? Age of first use is important. Well we agree. We just do not agree on a part of the solution, telling the public the truth by classifying the cannabis in the right place.

There is a brief open forum, I manage to chide Lenton for his ignorance about the reasons behind the desire for re classification, I speak about parents and supporting them, telling the truth about cannabis, there is applause from some of the public.  An ACMD member says they are not forgetting the individual sad cases they have heard about (from the mums), he looks at me, he is, I think, defensive, a man with a conscience. I remind the ACMD that Robin Murray’s 1500 schizophrenia cases a year are the tip of an iceberg, there are a quarter of a million people under 35 unable to work and claiming sickness benefits through mental illness, often associated with drug use.  There are thousands of others not in the statistics because their illness is not clinically diagnosed; the prisons are full of those who are said to be mentally ill.

A few other speakers, first a mum, then a legalise cannabis advocate, and more, it comes to an end. It is over. Lenton follows me and speaks to me outside. He is uneasy and edgy.  We debate changing the UN conventions, he wants it, I do not. The best kept international conventions of all I say. Their strength is in the fact that everyone keeps to them. I know but he appears not to, that the UK Government has explicitly said it wishes no change in the conventions. He wants “more freedom for States to do their own thing”. What are those things I say, what can states not do that you want them to do? We in the UK have prescribed heroin for years to a minority of users, the British system. He struggles to answer. He wants the Dutch to be able to deal with and control, (legitimise he means), their cannabis growers. Why I ask? Do neighbours want that? Does he not understand that one European country can not do that independently of the rest? Do the Dutch, most of them, even want that? (We know from an opinion poll that 70% do not want it). I remind him that Dutch drug policy has made the Netherlands, which is a first world country and economy, have a third-world drugs manufacturing, warehousing and distribution problem. Astonishing levels of drugs based criminality feeding ATS (amphetamine type substances) to the whole world, including Australia. He has no other ideas when challenged. He is plainly not used to being properly challenged. Why is someone with his views here, in this meeting, priming people who are going to advise our government? Who invited him?

As I travel home, I reflect, we have heard very strong messages about the harms of cannabis, is the ACMD about to change its position? I very much doubt it. They seem to be set in their ways, closed off to the harms, controlled tightly by Rawlins, most of them not taking part in the debate. I remember the question “do users mix cannabis with tobacco”. Quite extraordinary, he is in another world.

We have though, I think, seen the cannabis legalisation argument holed below the waterline; they will keep trying but that legalisation debate is surely over in the UK. If it is really over here perhaps it will be over everywhere else. What happens in the UK is of enormous influence because of the English language and the Internet.

Will UK Prime Minister Gordon Brown and Home Secretary Jacquie Smith re classify cannabis even if the ACMD is not with them? Yes probably. They will have the support of most MPs; the Conservative parliamentary opposition is supporting it. Even some important Liberal Democrats including the then leader (our third party) who have historically been weak and wrong on drug policy have been seen at Debra Bell’s meetings, that is really good. They are also getting the cannabis harm message.  Drug Policy is best when all parties are in broad agreement. Britain’s drug policy failure can I think, be tracked back to the breaking of that unanimity in the mid 90s.

Prime Minister Brown has “made his views clear” on cannabis, he said that this week at “Prime Ministers Questions” in the House of Commons. Brown has widely been accused by his opponents of dither and “government by review”, of putting off decisions. On this I think, based on the evidence, he means business.

David Raynes. February 2008
Executive Councillor, National Drug Prevention Alliance UK
Member, International Task force on Strategic Drug Policy