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Category Archives: War On Drugs

Architect of Mexico’s war on drugs held in Texas for taking cartel bribes – The Guardian

Posted: December 13, 2019 at 1:44 pm

A former minister who was considered an architect of Mexicos war on drugs has been arrested on charges that he allowed the Sinaloa cartel to operate with impunity in exchange for briefcases stuffed with cash.

Genaro Garca Luna, who oversaw the creation of Mexicos federal police, was arrested in Texas on Monday.

He helped oversee the militarized crackdown on organized crime which was launched in 2006 by the then president, Felipe Caldern, and has continued with slight modifications ever since.

But according to the indictment against him unsealed on Tuesday, Garca Luna received millions of dollars in bribes from the Sinaloa cartel in exchange for providing protection for its drug trafficking activities.

Caldern sends in the army

Mexicos war on drugs began in late 2006 when the president at the time, Felipe Caldern, ordered thousands of troops onto the streets in response to an explosion of horrific violence in his native state of Michoacn.

Caldern hoped to smash the drug cartels with his heavily militarized onslaught but the approach was counter-productive and exacted a catastrophic human toll. As Mexicos military went on the offensive, the body count sky-rocketed to new heights and tens of thousands were forced from their homes, disappeared or killed.

Kingpin strategy

Simultaneously Caldern also began pursuing the so-calledkingpin strategyby which authorities sought to decapitate the cartels by targeting their leaders.

That policy resulted in some high-profile scalps notably Arturo Beltrn Leyva who wasgunned down by Mexican marines in 2009 but also did little to bring peace. In fact, many believe such tactics served only to pulverize the world of organized crime, creating even more violence as new, less predictable factions squabbled for their piece of the pie.

Under Calderns successor, Enrique Pea Nieto, the governments rhetoric on crime softened as Mexico sought to shed its reputation as the headquarters of some the worlds most murderous mafia groups.

But Calderns policies largely survived, with authorities targeting prominent cartel leaders such as Sinaloas Joaqun El Chapo Guzmn.

When El Chapo was arrested in early 2016, Mexicos president bragged: Mission accomplished. But the violence went on. By the time Pea Nieto left office in 2018, Mexico had suffered another record year of murders, with nearly 36,000 people slain.

"Hugs not bullets"

The leftwing populist Andrs Manuel Lpez Obrador took power in December, promising a dramatic change in tactics. Lpez Obrador, or Amlo as most call him, vowed to attack the social roots of crime,offering vocational trainingto more than 2.3 million disadvantaged young people at risk of being ensnared by the cartels.

It will be virtually impossible to achieve peace without justice and [social] welfare, Amlo said, promising to slash the murder rate from an average of 89 killings per day with his hugs not bullets doctrine.

Amlo also pledged to chair daily 6am security meetings and create a 60,000 strong "National Guard". But those measures have yet to pay off, with the new security force used mostly to hunt Central American migrants.

Mexico now suffers an average of about 96 murders per day, with nearly 29,000 people killed since Amlo took office.

Garca Luna stands accused of taking millions of dollars in bribes from El Chapo Guzmns Sinaloa cartel while he controlled Mexicos federal police force and was responsible for ensuring public safety in Mexico, said US attorney Richard P Donoghue.

Todays arrest demonstrates our resolve to bring to justice those who help cartels inflict devastating harm on the United States and Mexico, regardless of the positions they held while committing their crimes.

Garca Luna led Mexicos federal investigation agency from 2001 to 2005, and from 2006 to 2012, he served under Caldern as secretary of public security.

Caldern deployed troops against the cartels in December 2006, but the crackdown unleashed a wave of violence which has claimed more than 200,000 lives, left more than 35,000 missing and continues today.

The arrest of Calderns right-hand man delivers a serious blow to the former leader, a prominent critic of the current president, Andrs Manuel Lpez Obrador, who has promised a hugs not bullets strategy of tackling the social roots of crime.

This is a bombshell, said Carlos Bravo Regidor, a commentator in Mexico City. Theres never been a detention of such a high-ranking Mexican official.

Caldern stood steadfastly by Garca Luna despite growing allegations of impropriety and accusations that security forces concentrated their efforts against the Sinaloa cartels rivals.

A 2010 analysis of crime figures by NPR found that only 12% of people arrested, prosecuted or sentenced for drug, organised crime and weapons offences had ties to the Sinaloa cartel.

This guy probably knows where all the bodies are buried and all other kinds of secrets involving political figures the most important aspect of drug trafficking together with the money trail, said Jorge Kawas, a security analyst in the northern city of Monterrey.

On Tuesday Caldern tweeted that he only learned of the arrest through social media. My position will always be in favour of justice and the law, he said.

According to the indictment, cartel bagmen twice delivered briefcases containing millions of dollars to Garca Luna. In 2018, former cartel member Jess Zambada testified at the trial of the Sinaloa kingpin Joaqun El Chapo Guzmn that he personally made at least $6m in hidden payments to Garca Luna, on behalf of his older brother, cartel boss Ismael El Mayo Zambada.

In exchange for the bribes, the Sinaloa cartel obtained safe passage for its drug shipments, inside details of police investigations, and information about rival drug cartels, the indictment said.

Garca Luna departed Mexico after Caldern left office in December 2012. Prosecutors allege Garca Luna lied to US authorities about his activities for the cartel when he applied for naturalisation in 2018.

According to financial records obtained by the government, by the time Garca Luna relocated to the United States in 2012, he had amassed a personal fortune of millions of dollars, the indictment said.

Mike Vigil, a former DEA chief of international operations, said he and other US anti-narcotics agents had worked closely with Garca Luna. I never saw any issue of corruption, any issue which compromised any of our operations, he said. Whatever we needed, he provided without question. We probably worked better with him than any other Mexican official.

Garca Luna is charged with drug-trafficking conspiracy and making false statements. If convicted on the drug-trafficking charges, he faces a mandatory minimum sentence of 10 years in prison and could receive a life sentence.

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In Honduras, the US War on Drugs Is Empowering Corrupt Elites – Foreign Policy

Posted: at 1:44 pm

Honduras is a key transit country for drugs being trafficked to the United States from South America, especially for cocaine-laden aircraft departing from South America, the U.S. State Department noted in its 2018 International Narcotics Control Strategy report.

As a result, Honduras is one of the most violent countries in the world. Huge numbers of Hondurans and other Central American citizens are fleeing due to drug- and gang-related activities. Many have headed for the United States, desperate to escape instability often caused by Washingtons support for the so-called war on drugs. Roughly 425,000 unauthorized migrants of Honduran origin were recorded in the United States in 2016.

Honduran President Juan Orlando Hernndez is mired in controversy, accused of fraudulently rigging the 2017 election in his favor. And yet the Trump administration remains a strong supporter of his government due to its backing for Washingtons immigration and drug policies.

Traveling through the Honduran interior reveals the extent of the countrys descent into chaos. It isnt a war zone in the traditional sense; insurgents arent targeting foreigners or engaging in attacks that kill indiscriminately. But the countryside is home to rampaging soldiers and gangs, along with police who routinely harass locals.

Virtually everybody I met on a visit in 2016 was scared or cautious when talking about the government and security forces. Relative calm was deceptive even in a pretty city such as La Esperanza, located in the southwest of the country. At its center were bustling fruit and vegetable markets, and children played soccer on a green field. The name Berta was spray-painted everywhere a reference to the environmental activist Berta Cceres, who was murdered in the city in 2016. Even on the outside walls of the local prison, there were two massive color murals of her face. Next to one was a message about police death squads that read, Police dickface. Elsewhere it read, Police hit man. The authorities hadnt removed them.

The Council of Popular and Indigenous Organizations of Honduras (Copinh), the local organization founded by Cceres, operates a network of community services in the area, including the House of Healing for domestic violence victims. Its manager, Lilian Esperanza Lpez, explained that its purpose was to fight machismo, support assaulted women in a society that rarely did so, and back families who had been displaced by deforestation.

Berta taught us to resist, she said. After the 2009 coupwhich overthrew democratically elected President Manuel Zelaya, replaced him with Roberto Micheletti, and was supported by U.S. President Barack Obamas administrationemergency contraception for women was outlawed, and abortion is now banned in all circumstances, despite the country having one of the highest rates of sexual violence in the world outside an official war zone.

The Copinh headquarters, which was called Utopia, was in a luscious green field. It had the feel of a community center with training facilities, dorm rooms, and large meeting spaces. One Copinh leader was Jos Asuncin Martnez, a kind-looking man wearing a cap, colorful scarf, denim jacket, and jeans. He lived in Santa Elena, a community near the border with El Salvador. We sat around a sheltered wooden table as the rain began to pour. A dog started chasing a nearby bull, causing the chickens to revolt and squawk. Like so many Copinh members, Asuncin Martnez offered political analysis that wasnt theoretical but gained from living with the daily threat of state assassination.

The role of Washington is to work with the Honduran government to repress indigenous communities in the country, he said. Thirty-five percent of Honduras has concessions for oil, gas, and hydro-electric projects on indigenous lands. Its illegal. He called the concessions, often given without consulting local communities, projects of death, mainly mining and hydropower projects.

Martnez opposes the presence of the United States and European Union in his country, because their agenda has never been publicly admitted. They say theyre here to back the Honduran government and strengthen the military, but its really just a way to grow U.S. bases, he said. The Honduran government allows more U.S. bases even though it claims its fighting the war on drugs. Its militarizing indigenous land.

Although Asuncin Martnez believed that the murder of Cceres had strengthened the Copinh struggle, he recognized that Honduras was infected with drug money. Our country is a narco-state with narco-mayors and narco-MPs, he said. They get funded by drug traffickers, and when they get into power they have to pay traffickers back.

In the north of the country, citizens face similar threats. In the city of La Ceiba, gangs increasingly control the streets. Public buses have been attacked, with drivers threatened and killed. I was shown a shocking video on a cell phone, in black and white with no audio, of a female gang member pulling a gun on a bus driver while he was driving. She shot him dead. The passengers were terrified, and the bus crashed. The woman was eventually caught after being identified on Facebook.

In nearby Tocoa, it was indigenous leaders and peasants who felt the wrath of the state. Vitalino lvarez, 53 years old with seven children, was a high-profile member of the United Peasant Movement and a campesino leader. His name appeared on a military hit list, alongside that of Berta Cceres and dozens of other environmental and social activists, used by United States-trained special forces to eliminate enemies. Having survived at least four assassination attempts since 2010, lvarez was named by the Inter-American Commission on Human Rights in 2014 as needing urgent protection. He never received it.

When Berta was killed, I became top of the list, lvarez said. Seventeen days after Bertas murder, they tried to kill me. I had participated in protests and supported her. Men on motorcycles came to my landlord and wanted to know where I was, but I wasnt home. They were angry. I left the area with my two kids immediately by taxi. I gave them money in case I was killed or injured.

Additionally, much of Honduran media reinforced the religious nature of the country and rarely reported honestly about the endemic political corruption. As we spoke, a poll appeared on Honduran state TV: How believable for you is the fact that the Virgin Mary is seen crying today? Seventy-seven per cent said it was very believable. Such polls were a convenient distraction for a general public that knew the dysfunctional reality all too well.

Another campesino leader was Johnny Rivas, a member of the United Peasant Movement in the Bajo Agun region. He was also placed on the military hit list. During a meeting of farmers in Tocoa, he told me that much of his peoples farmland in this agricultural heartland had been turned into palm oil plantations owned by the multimillionaire Miguel Facuss Barjums company, Dinant. Ten oligarch families dominate the industry and most the country, with some estimates asserting they own 90 percent of the countrys wealth. The Wests obsession with reducing its carbon footprint is directly connected to the dirty war in Honduras and the mass expansion of palm oil production.

The World Bank backed these programs two decades ago, which forcibly took land from local farmers and gave them to agribusinesses to develop African palms. These plants were then sent around the world for biofuel and often exchanged in a lucrative carbon credit market.

Despite the huge profits that biofuel brought, the same farming land has also been used by traffickers to smuggle drugs. Honduras is a convenient midpoint on a flight path from Colombia to the United States, and a huge amount of cocaine is now flowing from Colombia, through Honduras, and into the U.S. market.

Drug traffickers buy land and have cattle here, but this is cover for building landing strips, to facilitate the transportation of drugs from South America to the United States, Rivas said. Drugs are not produced here, just delivered, although theres evidence that cartels are increasingly farming coca in Honduras.

Drug trafficking has affected the Bajo Agun region. It has reduced the campesinos land holdings, but their conflict isnt with the traffickers. We have no friction with drug traffickers, but private security companies, protecting the landowners, work with police, military, and traffickers. The traffickers keep to themselves and dont bother us, Rivas said.

WikiLeaks state department cables confirmed what I had heard in the Bajo Agun region. Since the 2009 coup, the government had worked with landowners in the area to secure territory for biofuel production through intimidation, coercion, and bribery. One of the leading businessmen was Facuss Barjum, who died in 2015, and his private security guards stood accused of killing dozens of peasant activists who resisted their moves. His guards worked with the Honduran police and military, both of whom received huge amounts of funding from the U.S. government to fight its drug war.

The cables showed that the United States government had been aware of Facusss role as a cocaine importer since 2004 but had done nothing to stop its money going to fund, train, and maintain Honduran forces working alongside his team. One cable from 2004, titled, Drug Plane Burned on Prominent Hondurans Property, stated that, a known drug trafficking flight with a 1,000 kilo cocaine shipment from Colombia successfully landed March 14 on the private property of Miguel Facusse. Facuss controlled at least one-fifth of the land in the Bajo Agun region22,000 acres with African palms covering the territory for his burgeoning biofuel business.

Heading further into the area controlled by traffickers revealed even greater desperation among civilians. The drive from Tocoa to Vallecito village was mostly on dirt tracks; there were 30 families in brick and concrete homes, with many new structures being built with tin and wood.

Upon my arrival, my guide, fixer, and I were fed a basic meal of fresh fish, rice, and beans by a local family. White-tipped fences stretching for miles indicated that, years ago, like in other parts of the country where such fences signified drug smuggling activity, the property behind them had belonged to the Los Cachiros drug cartel family. They used to control the land, but heads of the family were extradited to the United States on drug charges, and their property was transferred to the Honduran government.

What happened to the two brothers behind the Los Cachiros gang revealed a familiar tactic employed by the U.S. Drug Enforcement Administration in Honduras and globally: Offer leniency to the Los Cachiros group, or other major cartels, in exchange for evidence of collaboration between traffickers and the elites (not the favored, drug-connected elites of the U.S. government but drug cartels that both Washington and the Los Cachiros wanted to take down). It was impossible to know what the victims families in Honduras thought of the arrangement, as they were never asked about it.

Devis Leonel Rivera Maradiaga and Javier Eriberto Rivera Maradiaga ran a brutal enterprise while living lavishly, killing at least 78 people since 2003 and building an empire as middlemen by moving huge amounts of drugs from hidden airstrips in Honduras to Mexican cartels (who then sent it onto the United States). They bought off politicians, allegedly including former President Porfirio Lobo and his son Fabio (who was found guilty in a United States court in 2017 for importing cocaine) and allegedly president Juan Orlando Hernndezwhose brother, Tony Hernndez, was recently found guilty of cocaine trafficking.

The Rivera brothers approached the DEA and made an offer as early as 2013; they knew that the agency was investigating them, so this gave the DEA a unique opportunity to catch some senior figures in the drug trade. Although both men had to confess to the crimes that they had committed, they avoided long jail sentences and were believed to have been offered admission into the witness protection program, while some members of their family were granted permission to move to the United States. The DEA accepted the deal and implied that it would decrease the use of Honduras as a drug-transit country. There is no evidence to support this claim, as the country remains a key smuggling nation for cocaine.

As we continued to drive, surrounded by green, rolling hills with cows and sheep grazing the fields, we were constantly stopped at military checkpoints along the road. Armed men and police asked for our IDs and wanted to know where we were headed. Some of the roads had once been used by drug traffickers as landing strips.

Our driver said that years before hed seen planes landing here at night, and roadblocks established to stop all traffic and allow the cartel time to unload the drugs. I saw alternative paths off the main road where landing strips still exist today. I was told by my local guide that during President Zelayas government before the 2009 coup, there was a happy hour in the area when radar was switched off by officials for an hour a day to allow drug traffickers to fly in and deliver drugs.

A small plane would land after 6 p.m. when it was getting dark. Traffickers used a generator to power lights along the landing strip. The drugs were removedthey usually came from Colombiaand the plane was burned and ditched in the Atlantic Ocean. The drugs would then be taken to the United States by plane and boat. The municipal government regularly smoothed the road, which, my guide Guillermo said, was just one way that the state supported the drug trade.

This was the home of the indigenous Garifuna people, numbering in the tens of thousands, who lived in many communities along the Caribbean coast. Nearly all of the neighboring areas face rising sea levels due to climate change.

Miriam Miranda, the head of Ofraneh, the Black Fraternal Organization of Honduras, is one of the countrys most prominent advocates. She told me in the capital, Tegucigalpa, that the drug war directly impacted her people, and that she faced constant threats to her life. The Garifuna people have had to organize not only because their land is where the drugs are being transported from and to, but also because authorities are involved in drug trafficking, she said.

This was the heart of drug-trafficking territory in Honduras. At a point along the red dirt road from Cusuna to Ciriboya, Guillermo said that the long, relatively straight path was used by drug traffickers as a landing strip as recently as five months ago. The Garifuna used to protest, but the traffickers were too powerful to be stopped. They have come to accept that their lands are now prime targets for a lucrative trade over which they had no say.

The Garifuna fight against traffickers, Guillermo told me, but its hard when youre fighting a state that colludes with the traffickers.

This article is adapted from the new book Pills, Powder, and Smoke: Inside the Bloody War on Drugs by Antony Loewenstein.


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Afghanistan: Another Failure of the Drug War – The National Interest Online

Posted: at 1:44 pm

The Washington Post has just published a deep dive into the war in Afghanistan, including the war on opium. These newly released documents expose in stark terms the dramatic failures of our century-long war on drugs. Of all the aspects of the Afghan quagmire, the war on opium has been among the most indefensibly foolish. Metaphorical wars against inanimate objects (drugs, alcohol, etc.) or vague ideas (crime, poverty, etc.) have an extensive history of failure. Continuing to pursue them is nonsensical at best, and deadly at worst.

U.S. opium poppy eradication efforts have cost nearly $9 billion since 2001. In 2001 US airstrikes targeted a network of clandestine opium production labs that U.S. officials said was helping to generate $200 million a year in drug money for the Taliban, but aerial efforts were abandoned after many of the suspected labs turned out to be empty, mud-walled compounds[and] the U.S. military concluded it was a waste of resources to keep blowing up primitive targets with advanced aircraft and laser-guided munitions.

American officials struggled with the question of how to address Afghanistans status as the worlds leading opium supplier. According to the Washington Post article, military leaders under the Bush administration saw [fighting opium production] as a distraction or hindrance to their primary mission of fighting terrorists. Under the Obama administration officials began recognizing the role of opium profits in funding insurgents but were also concerned that acting could alienate poppy farmersor U.S.-friendly warlords who profited from opium trafficking, which would alienate US allies on the ground.

The tipping point in the war on poppies came when US military and intelligence officials began to perceive drug trafficking as a financial boon for terrorists. The drugs themselves were not a cause of terrorism, but prohibition made them a highly profitable and lucrative source of income for the US enemies. Therefore, in the eyes of US officials, fighting opium and fighting terrorism were intrinsically linked.

One striking illustration of the folly of strategies developed by the US and its allies was paying farmers large sums to destroy opium crops. The Post reports:

In the spring of 2002, British officialsagreed to pay Afghan poppy farmers $700 an acre a fortune in the impoverished, war-ravaged country to destroy their crops.

Word of the $30 million program ignited a poppy-growing frenzy. Farmers planted as many poppies as they could, offering part of their yield to the British while selling the rest on the open market. Others harvested the opium sap right before destroying their plants and got paid anyway.

In a Lessons Learned interview, Anthony Fitzherbert, a British agricultural expert, called the cash-for-poppies program an appalling piece of complete raw naivete, saying that the people in charge had no knowledge of nuances and [I] dont know they really cared.

U.S. officials said the British wanted to be seen as doing something, even though they had little confidence the program would work. Michael Metrinko, a former U.S. diplomat who served in the embassy in Kabul at the time, said the results were predictable.

Years of failed policy have proven that victory in the war on drugs, as with the war on terror, will not come easily. But one approach will unlink drugs and terror: legalize the production, sale, and use of drugs. Competition in legal markets will drive prices down, thus eliminating drug trafficking as a means to fuel terrorism. The U.S. has no reason to continue a costly, ineffective prohibition when history has shown, time and again, that it does not work.

This article by Jeffrey Miron and Erin Partin


Afghanistan: Another Failure of the Drug War - The National Interest Online

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In East Jerusalem’s war on drugs, residents say police are on the wrong side – Haaretz

Posted: at 1:44 pm

An unprecedented conference took place Friday in the Shoafat refugee camp in East Jerusalem. After prayers, hundreds of men headed into a large hall. Representatives of all the families living in the camp sat up front; on stage stood teens in gold vests bearing a logo of a fist smashing a hypodermic needle.

As dramatic music played in the background, one of the teens read a declaration signed by all the family representatives: I resolve to put family security above the drug dealers. I resolve to boycott them, to not give them respect, to not invite them to weddings and not to attend their funerals.

It was the first community gathering of its kind in Shoafat's war on drugs. The speakers included notable camp residents, former addicts, a physician who explained the dangers of the newest generation of drugs and a preacher from Al-Aqsa Mosque. The conference was the climax of a rolling campaign by social activists and local East Jerusalem leaders against drug purveyors. Ahead of the conference, young people organized confrontations with drug dealers, helped commit addicts to rehab centers, and hung anti-drug posters throughout the camp's streets.

Residents of East Jerusalem say that there was always a serious drug problem, but now it has become an absolute plague. In almost every neighborhood, residents know where to find the local dealer, where the addicted lay helpless and recount stories of the drug-related violence that erupts periodically.

Many blame the Israel Police and Shin Bet security service. Residents say that the Israeli authorities prefer that the youth of East Jerusalem be busy with drugs rather than firebombs that drugs are part of the security services' toolbox to maintain quiet in the eastern part of the city.

This isn't a new claim, but it seems that over the past few months the situation has further deteriorated. The East Jerusalem drug market has been flooded with cheap drugs like Nice Guy and Mabsuton, and dealers have started to market the stuff to teens and children. According to a number of East Jerusalem sources, a child can get a dose of Nice Guy for 10 shekels ($2.88) or less. Some dealers give out the first dose for free to hook clients.

Sources in the camp say traffickers will simply drop small baggies of drugs into schoolyards, and tell of a package containing 72 such packets that was found in one of the camp's schools. "Once the traffickers had some shame, they had principles; today, nothing. They sell at school entrances and no one says anything to them," says Nasser Hashan of Shoafat, a leading anti-trafficking activist.

Its around 200 meters from my house to school, he continues. In that distance my daughter sees an addict strewn on the ground, a drunk, a dealer selling to someone, maybe ten incidents like that.

We felt that people were deliberately throwing [drugs] into the schools, they don't care about anything, just sell their quantity and bring more," Mohammed Malham. The question is who has their back? Who can deal like that in the middle of the street without the police coming?

Almost all those interviewed say the police ignore, if not encourage, the problem. For example, in the refugee camp, it is widely claimed that drug dealers enjoy unofficial shelter at the checkpoint separating Shoafat from the city. They sell at the checkpoint and if they see anyone [of the anti-drug activists] approaching, they run to stand next to the border policemen because then they know no one will touch them, says one of the activists at the camp.

In the Silwan neighborhood, residents claim that dealers photograph kids who buy drugs and give the pictures to police. Police later use the photos to coerce the drug users, who are often minors, into becoming informers for security related matters.

Around a month ago the A-Tur neighborhood held a similar conference of youths and family heads against drugs and drug dealers, but it was forcibly dispersed by the police, who even fired tear gas at attendees. The police reported that theyd broken up the event because of disorderly conduct.

It seemed to the public that the police had shown up to help the dealers, like here, where the dealers feel safest near the checkpoint," says Issam Johan, a former addict who has worked many years in rehab and in anti-drug programs in the Palestinian Authority and in East Jerusalem.

If we catch a drug dealer who is from the West Bank we send him back and the Palestinian police deal with him, but if he is Israeli [meaning an Israeli citizen or a resident of Jerusalem] we can't touch him. He would immediately complain [to security services]," says Omar Elkam, who lives in the refugee camp.

Elkam says that the day before the Shoafat conference there were policemen and municipal inspectors issuing tickets to illegally parked cars. I went over to them and told them there were drug dealers here, they should deal with them. Ticketing cars is important, but this is more important but they told me to stay out of it, he says.

On Sunday three of the organizers of the conference in the refugee camp were summoned for questioning to Room 4, the room of the minorities division and the Shin Bet in Jerusalem Police headquarters. Every resident of East Jerusalem knows that the detectives in Room 4 arent interested in drugs, but in terror-related crimes.

The detective said he wants to help me. I told him that youre the Shin Bet, your whole head is in security and you are bringing me to Room 4. What does Room 4 have to do with drugs? says Hashan. I said if you want to help me, bring me to the unit that deals with drugs.

On Saturday afternoon, the day after the conference in the refugee camp, activists and young people from Silwan and Abu Tor gathered for a protest event that included a joint lunch in front of the home of the man they claim is the biggest drug dealer in the area. The home is surrounded by no less than 10 security cameras. Drugs have been sold from this house for 25 years, the neighbors say.

Show me where in West Jerusalem or in Tel Aviv a man would put cameras on his drug den? asks Khaled Zeir, a Silwan resident. He knows they wont do anything to him. If anyone touches him he would come with his weapon and shoot. The police know, everyone knows and no one does anything. Nobody dares touch him.

According to Silwan residents, minors reported in two cases that during their questioning by police or the Shin Bet, they were shown pictures of themselves buying drugs. The security forces threatened to expose them unless they cooperated.

Bilal Elkam, a refugee camp resident, was addicted to hard drugs for 28 years. Hes been clean for the past four years and works as a counselor at the camp's rehab center. Heroin withdrawal takes three or four days; with Nice Guy you can have withdrawal symptoms for 25 days. Its a drug you use once, after that it uses you, he says.

The recovering addicts in the center, among them Arabs from Israel's north, are blocked from the outside world by two sets of locked doors. But when the doors are opened after long weeks in rehab, re-entering the world is not easy. The rehab center sits on the camp's main street, a 30-second walk from the junction identified as the center of the drug trade. "A man walks out the door and there's immediately there's someone there to give him drugs," says Elkam.

The police said in response: As part of the ongoing fight against drugs, the police are constantly using overt and covert enforcement, particular against drug manufacturing and trafficking, by exposing, arresting and prosecuting the perpetrators. The police operate regularly throughout Jerusalem and especially in the eastern part of the city. As a result, in the past year alone, a number of agents were planted and dozens of drug dealers were arrested, some of whom were detained until the end of the proceedings."

With regard to the dispersal of the assembly in Abu Tur," the police said, apparently referring to the anti-drug event broken up by police in A-Tur, "there was a protest there during which a number of rioters started to disrupt public order. In response police had to disperse the rioters in order to allow the protest to take place in a legal, orderly fashion. The Israel Police will continue to allow legal free expression and protest, but will not allow violations of order, disregard for police instructions and disproportionate harm to residents daily routine.

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The Appeal Podcast: The Regressive Pseudoscience of Our ‘War on Opioid Addiction’ – The Appeal

Posted: at 1:44 pm

On our last episode of the year were doing something a little different. Joining us today is Appeal contributor Zachary Siegel, a journalism fellow at Northeastern University Law Schools Health in Justice Action Lab, to discuss false narratives around drug addiction and how prisons are increasingly choosing puritanical pseudoscience in the so-called War on Opioid Addiction. We will also be joined by Lev Facher of STAT News.

Adam Johnson: Hi welcome to The Appeal. Im your host Adam Johnson. This is a podcast on criminal justice reform, abolition and everything in between. Thisll be the final episode of the season. We will be back in the new year on January 16th with all new episodes. I just want to take time out now to say thank you for all the support and everyone for listening. We really appreciate it.

Were doing something a little different for this segment. Joining me today is Appeal contributor, Zach Siegel, who is also a journalist fellow at Northeastern University Law Schools Health and Justice Action Lab. There Zach helps run a project called Changing the Narrative, which aims to de-stigmatize the media and politics surrounding addiction. Zach thank you so much for joining us.

Zachary Siegel: Yeah glad to be here.

Adam: So given your background covering addiction, we wanted this episode to cover the topic in the context of the criminal illegal carceral system. This is a subject more than anything where misinformation, disinformation and ignorance surrounding the way addiction works, works in a feedback loop with lawmakers and the media to create a carceral system that has improved slightly, but its still stuck somewhere between the years 1890 and 1922 vis-a-vis the rest of the world, which has a far different, more empirical approach to this, but were specifically talking about the so-called opioid crisis where some call an overdose crisis or an opioid related overdose crisis. We wanted to talk about the ways in which drug courts quote unquote treat addiction as a sort of medical and health issue and how one pharmaceutical company in particulars drug became the go to treatment inside jails and prisons effectively sidelining more effective treatments. And to establish the stakes here, cause I think its important, were talking about millions of people. Were talking about a lot of people. This is a crisis. How you frame the crisis is subjective, but it is objectively, a crisis and so the main go to drug to help prisons and jails, quote unquote treat addiction is of tremendous import. And were going to focus today on one pharmaceutical company called Alkermes, which has used an aggressive sales force and marketing effort to push a medication called Vivitrol to people who are incarcerated. So lets start out by talking about Vivitrol. What is it and how does it compare to the other popular quote unquote addiction treatment drugs?

Zachary Siegel: Right. So right now there are three FDA approved medications to treat whats called Opioid Use Disorder. This is the clinical term for opioid addiction. And unlike drugs like alcohol or cocaine or other drugs people get addicted to opioid addiction actually has three medications available that do a pretty good job of treating it. And of course the issue is these drugs are not widely available, especially to people who are incarcerated. And setting the stakes here people exiting correctional settings, if they have an Opioid Use Disorder, their risk of fatally overdosing is 40 to 130 times greater than the general public. So when people leave correctional settings, they lose their tolerance to opioids, they get out, they havent been treated, and they go use again and this is when people are most vulnerable to overdosing and dying. And so the stakes here are literally life and death. And what we do know is when you make these medications available to people, their likelihood of overdosing and dying is greatly reduced. But really its two of these medications, one called methadone, the other called buprenorphine, largely known as Suboxone. These two drugs have been around for a while and all around the world they show that they slash the likelihood of a fatal overdose by 50 percent or more. When France made this drug widely available, their overdose rate plunged by 79 percent. And so in comes Vivitrol where it functions much differently than methadone and buprenorphine. So those are both opioids. Vivitrol is an opioid receptor antagonist, so it attaches to the receptor and effectively blocks other opioids from activating that receptor. So the chemistry here, the way it functions inside your brain is very different than methadone and buprenorphine. And this is where a lot of the misinformation and stigma and and politics about how we treat addiction, you know, come into play.

Adam: So, before we, methadone has an interesting history, but I do think its important to know that history, like you said, this episode is going to be in the weeds here. So lets talk about methadones relationship with the criminal legal system and how that informs the current debate within the United States. And I want to be clear, we are talking specifically about the United States. In most of the quote unquote developed world this isnt really even a debate. They wouldnt have to do this episode. So lets talk about methadone and its history with relation to the carceral system in this country.

Zachary Siegel: Yeah, it is really interesting. So a guy by the name of Robert DuPont, hes got some hawkish views about drugs. Like he once said that marijuana is the quote most dangerous drug which is false. Need to say that.

Adam: Yeah. In the interest of clarity, not the most dangerous drug, black tar heroin is worse than that, but go ahead.

Zachary Siegel: Yet theyre in the same category. So. So anyhow, DuPont was the first director of the National Institute on Drug Abuse in the seventies and he was the second ever White House Drug Czar under Presidents Richard Nixon and Gerald Ford. And so Nixon ran on law and order and this was a time when heroin from Southeast Asia thank you Vietnam war was flooding American cities and DuPont convinced Nixon that prescribing methadone to people with heroin addictions would reduce crime. And since Nixon campaigned on reducing crime, he listened to DuPont. And in this era, the number of methadone clinics expanded greatly. And its important to talk about this because there isnt really any other medication out there whose success is measured by a reduction in crime rates. Theyre not asking are these people healthy? Are their lives better? Theyre wondering, are they still robbing cars and mugging strangers and loitering and being unsightly.

Adam: This perverse kind of criteria has stayed with us. We of course always frame drugs as a crime issue, not a public health issue. Its now become somewhat cliched, people say we need to treat it like a public health issue and a crime issue. Although the actual policy has not really changed much, the rhetoric shifted because he needed to sound woke. But the actual policies havent really changed much. So this is obviously the wrong approach. Methadone has been shown to get people off heroin, help stabilize their lives, build networks, sort of rebuild family connections. Now its not, of course sort of panacea. And obviously the drug war is steeped in racism here. And we could do ten episodes on why people like Trump suddenly care about drugs, white nationalists like Trump suddenly care about drugs but didnt before. But we wont. But can we talk about the kind of moral dimensions to not wanting to go use methadone versus this other which doesnt have opioid properties and how that, why thats popular because of this puritan streak in our country, one of its primary sales pitches for legislators. Is that, is that a fair statement?

Zachary Siegel: Yeah. So all of these false assumptions and outdated ideas about drug use and treating addiction are still with us today. And they really infect the health policy and the politics here. So as our guest will explain later the idea that prescribing an opioid to people who are addicted to opioids, and Im talking here, opioids like methadone and buprenorphine, to do that sort of doesnt compute with our standard narrative that if someones addicted to drugs, you need to get them off of drugs. And that comes from a misunderstanding of the physiology and the chemistry here. So when someone is on methadone or buprenorphine, yes they are taking an opioid but they no longer meet the criteria for addiction. They are now dependent on an opioid. The hallmarks of addiction, the literal definition of addiction is continued drug use despite negative consequences. So if youre using an opioid like methadone and youre going to work and you have friends and youre just living your life, you dont meet any criteria of addiction anymore, but youre dependent on this drug. And to be dependent in this country on anything is an indictment of your character. Its a weakness.

Adam: Unless it is a prescribed drug by a pharma company or five fingers of whiskey a night while you watch the game. Those are all normal.

Zachary Siegel: Right. Right. Those dependencies, you know, people feel okay with I guess, but right. So the Vivitrol comes into play here because its not an opioid. It blocks other opioids from activating the receptors. And so its a much more palatable course of treatment. And what well unpack here throughout this episode is how this more palatable option has really been pitched heavily to drug courts, to drug court judges, to parole boards, to jails and prisons. Alkermes saw a huge market in prisons and jails and went after it and quite successfully dominate this area of treatment.

Adam: Right. Theyve kind of appealed to the puritan streak in this country as part of their marketing strategy. So lets talk about the other treatment options that are not methadone, but do have opioid properties. How are those different than methadone and what is the sort of good quick primer about those so we have a sense of what the hell it is were talking about?

Zachary Siegel: Yeah. So methadone is heavily bureaucratized and tightly controlled and you can only get it through these special clinics and there arent enough of those and so its really hard to access. You also need to go to that clinic every single day to get your dose until you can get special privileges like take home doses. So its really just bureaucratized like out of utility for so many people.

Adam: Cause the idea is you dont want people just to like take like fifty hits of, cause thats what the, you know, opioid crisis is largely also been driven by, which is-

Zachary Siegel: Over prescribing and drugs being everywhere. Right?

Adam: Yeah. Willy nilly. Passing out at parties, you know what the fuck? I had a rough day at the office, so why dont I pop one? Right?

Zachary Siegel: Right.

Adam: Presumably theres some logic to it other than-

Zachary Siegel: Yeah, like it mostly it goes back to the days of Nixon where the people taking these drugs are criminals. You cant trust them. So you need to heavily watch the administration of the drug. And so thats methadone. In comes a drug called buprenorphine. So the formulation of buprenorphine naloxone is called by its brand name, Suboxone. And in 2002 it gets approved by the FDA to treat opioid addiction. And unlike methadone, a doctor with a special DEA waiver called an X Waiver can prescribe a month supply to a patient that they can then take home. And then once a month they, you know, have a, a checkup and get their refill and go on their day. So its not like methadone where you need to go every morning to a clinic and get it. You can just see your doctor once a month and get your prescription. And Suboxone operates similarly to methadone. Its also an opioid, its whats called a partial agonist. So it does like activate the same receptor sites as drugs like heroin, but to a far lesser degree, it also has a ceiling effect. So say you take, a standard dose is like eight milligrams, say you take 32 milligrams, it sorta just stops working. Like it has a ceiling effect whereby you cant take more and more and get more of the euphoria. So its good in that its more difficult to misuse and overdose on. So the preferred drug for a lot of people is buprenorphine because it has a ceiling effect and because you can take home a scrip and you dont have to go through the clinic. So thats the landscape. Those are the drugs that were talking about here.

Adam: Okay. And so theres these kind of three primary categories of drugs, two of which have opioid properties, one of which doesnt. Vivitrol is the one thats becoming increasingly popular. I was shocked to learn, although I probably shouldnt be after doing this for over two years, I was shocked to learn that the one that has no opioid properties is extremely popular with lawmakers, the sort of proverbial crusty white men who mostly drive these policy decisions. Very few prisons, if Im not mistaken, very few states, offer an all the above approach. Can we talk about what the standard is in most states and what medical professionals and addiction activists such that they are, have said about this?

Zachary Siegel: Yeah. So first, federally, the Federal Bureau of Prisons has a blanket ban on prescribing methadone and buprenorphine and other treatments like there is literally like zero addiction treatment happening in federal prisons, which is wild. But then lets move out to local criminal justice systems, which impact far more people. Most prisons for that matter also do not have all three of these medications available. And so Rikers Island, you know, it has a bad rap and its getting closed and everything, but it has one of the longest running methadone programs of any correctional facility in this country. And so Rikers Island, theyre a model opioid treatment program. They provide all of these medications.

Adam: Despite their horrific torturous conditions.

Zachary Siegel: Yeah, despite the brutal conditions at Rikers, theres actually this like group of doctors there who have been treating opioid addiction with immense success for decades since the eighties and this model has not been expanded. The only other state that has recently got on board after a pilot program was evaluated was Rhode Island. Rhode Island started offering all three medications to every single person going inside the system who screened for opioid addiction. And when they did that, the overdose rate among people leaving the prison system dropped by 65 percent and the rate throughout the whole state dropped by 12 percent so thats, thats a huge success. And still, its not like with this evidence that its been rapidly expanded yet. The ACLU and other players are actually now suing prison systems, jail systems all over the country to just get people the medication that theyre prescribed to because the jails and prisons just dont want to do it.

Adam: And all this is happening within a political context, which is a good place I think to pivot to our guest Lev Facher, who covers politics specifically as it regards to the pharmaceutical industry for Stat, which is a vertical run by the Boston Globe. So we will talk to him in just a minute.


Adam: Lev Facher thank you so much for joining us.

Lev Facher: Thanks for having me.

Zachary Siegel: Hey. So one reason we wanted to talk to you Lev in particular is because you cover the governments response to the overdose crisis and sort of the nexus of politics that determines that response, like which solutions and treatments get prioritized. And so there have been numerous investigations and long stories detailing how Alkermes, the manufacturer of Vivitrol, has pitched itself to the criminal legal system like drug courts, jails and prisons. So ProPublica covered this, NPR has been on this and so have you. To start us off, can you walk us through some of the marketing strategies? Like what would a Alkermes salesperson be saying to a sheriff or a politician or an official in the system?

Lev Facher: Sure, so obviously the pitch is going to change from person to person, but the overarching theme and one that some addiction physicians have taken issue with is the idea that there are three FDA approved medications to treat Opioid Use Disorder and only one, which is Vivitrol, the drug Alkermes manufacturers, is not an opioid, which is to say its not a partial agonist or a full agonist. Its an antagonist and that means that its not a controlled substance. Its not something that in their words could be diverted. Its not really something that would be sold for illegal use. So this is something for people often who view opioid use and risky drug use as much at least a criminal justice issue as a health issue. Its a very appealing pitch. Our drug they would say is non-addictive, its not an opioid. You could use it in your correctional facility. Theres no risk of it really being sold on the black market. You cant overdose on Vivitrol. So thats the kind of language and thats the kind of appeal that Alkermes has broadly made and theyve done it not just to physicians, as is standard in the pharmaceutical industry, but in a lot of criminal justice settings. So thereve been pitches to parole boards for instance, that when people are released from a correctional setting, they are prescribed Vivitrol because it makes one essentially immune as theyd say to the effects of a drug like heroin or in a drug court setting there would be requirements Sure were not going to put you in jail as a result of your drug possession conviction, but if were going to give you community service or some non incarceration alternative, one thing that would go along with that is being prescribed Vivitrol. So theres been this very aggressive and very broad push at the federal level, at the state, at the local level to make sure that Vivitrol is seen as this non-addictive, non-opioid drug regardless of the efficacy measurements compared to the other two drugs that have also become part of the standard of care for opioid addiction, methadone and buprenorphine.

Adam: So lets talk about this efficacy issue. Cause that obviously seemed central here, this all seems rather puritan to me as a layman, that theres obviously these things are very measurable. You can sort of quantify and qualify the extent to which, which ones better than the other. It seems like the marketing appeal is a fundamentally conservative appeal. It sort of seems more wholesome, which does not necessarily make good health policy. So can we talk about the efficacy concerns, what some of the downsides are to this kind of cold turkey method and what are health experts finding frustrating with the ways in which the Trump administration and the media is sort of playing into this kind of puritanical dichotomy?

Lev Facher: Sure. So youre right that efficacy is going to be the central question here. We can go back to November 2017, thats when the National Institute on Drug Abuse put out a study comparing two drugs head to head, they were Vivitrol and Suboxone, which is a very common formulation of buprenorphine combined with naloxone and found essentially that the two drugs had roughly equivalent efficacy when it came to reducing overdose and reducing mortality related to drug use. Theres a huge caveat though, which is that people notoriously have difficulty continuing courses of treatment on Vivitrol. So essentially what this NIDA study said was that for people who continue to take Vivitrol, treatment is as effective as with people who continue to take buprenorphine. So essentially two people both in recovery and they both continue to take these different options, these different pharmacological treatment options, each of them, their mortality likelihood is reduced. Their risk of drug use is going to be reduced by about an equivalent level. So it is an apples to apples comparison that shapes up very well for Vivitrol with the caveat that people just have much more trouble continuing Vivitrol treatment, which is to say overall there is an emerging body of data that suggests people on buprenorphine are just more likely to not experience an overdose and to not experience an overdose death . But as I said, theres not a ton of data here. And of course, as I said, the marketing is really central just in terms of Alkermes and not just Alkermes, but a lot of people who have, you know, kind of more old fashioned attitudes about addiction and behavioral health disorders and treating addiction. Theres really a very fundamental appeal in prescribing and taking a drug thats not an opioid, thats not a controlled substance. And thats really central to the whole debate.

Adam: Right.

Zachary Siegel: And theres another big caveat with that study. So theres this like induction problem. So with Vivitrol people need to be off of all opioids for about a week before they can start it. So that means they need to go through a quite grueling withdrawal process before they can be administered their first Vivitrol shot. Whereas with methadone or buprenorphine, you can start methadone the same day. So people really dont need to experience that nasty withdrawal phase. And with buprenorphine you have to wait, you know, depending on which opioid you were addicted to, like 24 to 36 hours, which is really before the withdrawal becomes very intense. And so in the literature its just like called the induction problem whereby its harder to get people started on Vivitrol in the first place and then like youre saying, its also more difficult to keep them on it month to month.

Lev Facher: Right. And Ive actually written, with the huge caveat that I am not a physician, but theres a growing movement around the country to induce people on buprenorphine treatment almost immediately after a nonfatal overdose. So in an emergency room setting, its becoming more common for an emergency room physician to offer someone buprenorphine. I wrote a few months ago that the state of New Jersey actually, the health commissioner there authorized paramedics to induce people whove just been revived or treated for a non fatal overdose in the state of New Jersey, I wrote recently the health commissioner there has authorized paramedics to offer people whove undergone a non fatal overdose buprenorphine essentially on the spot. So paramedics in ambulances can carry buprenorphine and can begin the treatment process very soon after someone is stabilized post nonfatal overdose. As you say, yeah, its very difficult to immediately begin Vivitrol treatment. It does require what people would call a detox period. One thing that has helped with that is that in 2018 the FDA approved a drug called Lofexidine, which is specifically targeted to treat opioid withdrawal symptoms. So people see that if you want to use Vivitrol, if thats the desired treatment drug, people do see that drug Lofexidine as a bit of a bridge through that week or ten day period to treatment. But absolutely the thing about methadone and buprenorphine that a lot of physicians view as a huge advantage is the rapid nature in which you can begin treatment because when people seek treatment, addiction physicians like to be able to provide it.

Adam: I want to establish the kind of stakes here in terms of suffering. I imagine that if I am someone with an addiction problem and you offer me the thing thats similar to the thing that I had an addiction to and this other thing that just told me cold turkey, Im probably going to prefer the former and I imagined that week or ten day period is pretty goddamn miserable. Is there any sense of how thats quantified into this equation? Is there any data about like the sort of suffering involved in that, cause I know that efficacy looks at like curing or sort of getting over addiction, but obviously theres a sort of mental health component and is there any sense of suicide rates or anything that would indicate that a cold turkey method is basically kind of a hellish experience and how does that sort of quantify? How do we put that into the calculus here?

Lev Facher: You know, I dont have data to cite for you, nor have I experienced this myself, but I can tell you that people view unsupervised detox, untreated detox as dangerous and agonizing. Theres no question, and I think there are instances in which people have died during this detox period. Im not saying that has anything to do with use of Vivitrol or intention to use that drug, but its absolutely a very, very vulnerable period for people, especially sometimes people who are incarcerated, dont have access to the drugs that they had previously been using and also dont have access to the treatment drugs like methadone and buprenorphine that would mitigate those withdrawal symptoms.

Zachary Siegel: Right. And I think, changing topics slightly, theres the sort of stigma and misinformation about drugs like methadone and buprenorphine that are part of the marketing pitch and the political landscape. And you wrote about Trumps Opioid Commission back in 2018, so he convened a group of experts to sort of come out with a plank to mobilize a federal response to the overdose crisis. And you wrote a piece about how that commission wrote in favoritism for Vivitrol specifically. Can you sort of talk about why, again, the notions of addiction and how to treat it are sort of all pointing in Vivitrols favor?

Lev Facher: Sure, so Ill put it in the political context first. As you said, when President Trump was inaugurated, he very quickly commissioned a panel to address the opioid crisis. It was chaired by Chris Christie who then was the governor of New Jersey. It had a lot of really credible voices in addiction policy. Patrick Kennedy was on that commission, a few other governors, and they put out this sweeping set of recommendations later in 2017 that the addiction policy experts I spoke with largely thought were very holistic and really a good direction in which to move federal addiction policy. And President Trump knew that the opioid crisis wasnt just a huge issue in terms of the health and wellbeing of Americans, but it was a huge political issue. It was something that candidates heard about all over the 2016 campaign trail and here we are in 2017 all of a sudden, Republicans control the Senate, they control the House, they control the White House. So there is a desire for action on the opioid crisis, but the action is really being orchestrated on the part of people who are largely conservative and largely and historically have taken the view that drug use is a criminal justice issue. So to their credit, there are a lot of Republicans who in a very short span of time really evolved on the concept of medication assisted treatment and use of drugs like buprenorphine and methadone to treat opioid addiction. But there were some early mishaps, so Tom Price, he was the Health Secretary until late 2017 when he resigned in scandal, but he at one point infamously said essentially that he viewed use of a drug like buprenorphine as essentially substituting one opioid for another. Obviously, when you compare outcomes with, for example, heroin use and buprenorphine use, its really not a good comparison. Its not medically sound and he was pretty widely condemned by addiction physicians. But I say all this only to illustrate there really was a desire to distinguish between continuing strong enforcement efforts and not doing what people in conservative advocacy circles would characterize as facilitating opioid use. And in that frame, the White House put out a white paper in 2018 that essentially guided treatment. It recommended a course of treatment for the roughly 185,000 people incarcerated in the federal prison system and it essentially said for those people with substance use disorders, specifically with Opioid Use Disorder, upon their release, we are going to administer injectable naltrexone. And as I wrote back at the beginning of 2018 there is only one manufacturer of injectable naltrexone and it is Alkermes and their drug Vivitrol. So essentially the White House was recommending for the thousands and thousands of federal inmates who had an opioid addiction, we are going to give them this one drug of three potential options, which by the way is far and away the most expensive. This is a monthly shot that can exceed $1,000 per dose. And that was essentially the, the crux of that story.

Adam: Lets talk turkey here, lets talk what are the kind of forces at work behind the lobbying effort. Now, you had mentioned earlier that they sort of throw a lot of weight around. You live in DC. Thats kind of your beat. To a large extent, which is the influence aspect of this. Aside from the sort of anodyne sales pitch about not replacing one drug with another, which again sounds really warm and fuzzy for a certain crowd of people, how much money are we talking in terms of lobbying, in terms of pushing their weight around and what are the, what are the other solutions doing? Im not sure exactly who the players are here. What are they doing this sort of counterbalance that and is it, is it just a thing where everyones throwing money around and the reason why Vivitrol is popular is because it fits into a kind of Jeff Sessions worldview more easily?

Lev Facher: So Alkermes is absolutely a major lobbying presence here in Washington as is Pharma, the trade group for pharmaceutical companies that includes Alkermes as one of its members. Alkermes has a lot of lobbying firms registered to advocate on its behalf here in Washington. In 2018 they, in terms of my napkin math, spent just shy of $4 million on lobbying here. Theyve also funded a group called the Addiction Policy Forum, which has done some really valuable work in terms of creating a tool for people all over the country to find local addiction treatment resources and it doesnt point people in a particular direction on what treatment drug they should use, but at the same time, that group was run initially by a woman who had been registered to lobby for Alkermes at the time she founded the nonprofit, which was in turn funded by Pharma and Alkermes. So accounts really vary in terms of how hard Alkermes has pushed and lately its not so much simply because Washington isnt really working on addiction treatment legislation lately. They did that in 2018 they signed a big bipartisan bill. There was a bill signing in the East Room of the White House, President Trump really basked in the applause there. But at the time of that bill in 2018 and in 2016 when Congress passed the Comprehensive Addiction and Recovery Act, there was certainly a lot of pushing and shoving between various manufacturers of addiction medications, but Alkermes really was insistent that when federal money was being distributed to treatment providers, those providers would be required to offer drugs in the three different categories, the opioid antagonist, the partial agonist and the full agonist and its just that when you write that into law, the effect it has is that providers have to carry Vivitrol because its the only drug that fits into that opioid antagonist category. And to be clear, there are physicians who think Vivitrol is a fantastic drug. Its a huge medical advance. I dont really know anyone who thinks it shouldnt be an option for patients with Opioid Use Disorder. I think its just people want to make sure it is one of many options and not the only one because as weve talked about, there are obstacles with withdrawal. There are obstacles with costs, there are obstacles just in terms of patients having the flexibility to choose what drug works for them. But as with really anything to do with the pharmaceutical industry here in DC, Alkermes and Pharma have a major lobbying presence and those addiction bills were not immune to the advocacy pushes that really occur with every major piece of legislation that moves through the city.

Zachary Siegel: And we dont have to really even be hypothetical about what it would look like to offer all three options inside a correctional facility. We have the Rhode Island study which offered methadone, buprenorphine and naltrexone, all three to all incoming prisoners or inmates who got screened and if they screened positive for Opioid Use Disorder, they were offered all three. And Ive talked to the researchers of that study like Tracy Green and she said, you know, overwhelmingly people choose buprenorphine. Some people choose methadone, some choose Vivitrol, and it just, its like when you practice medicine, everyones body is different. Everybody responds to medications differently. And if theres three drugs on the table for one condition, thats just how medicine works. You offer all three. So all of the issues to, you know, barring that from happening, again, just go right in the direction of Vivitrol as the only drug, which is, like were saying, you know, bad medicine. Bad policy.

Adam: Yeah. Which I mean, so my question would be, right now were talking at or about a party, Im curious what the party, the effect of the party were talking to both incarcerated and people with drug issues, the groups that are fighting on their behalf or the organizations on their behalf what is their general feeling about this in terms of the actual stakeholders and people who are being harmed here? Do you have a sense of what the consensus is on that? Is it a kind of all the above approach?

Lev Facher: I have not talked to any treatment and recovery advocate here in Washington or elsewhere who wants anything other than all three of those drugs to be made available for people seeking treatment.

Adam: Right. So its not even really a debate at this point. Its sort of just a, I mean cause this, to be clear to our listeners, and we, we talked about this at the top of the show, like that is not at all what the standard is now. Thats the standard only in a handful of places.

Lev Facher: Absolutely. And at this point I should say even Alkermes would tell you that they want their drug to be offered in the context of a broader array of treatment options. Its just that specifically when were talking about criminal justice settings, when were talking about drug courts, when were talking about federal prisons, when were talking about the incarcerated population, there are concerns there. If you can imagine a prison warden who is not a physician, is not an expert in addiction treatment and doesnt want any degree of people effectively trying to smuggle buprenorphine into the prison or methadone. And those are different conversations and we can talk about it for a while, but essentially the thinking is I dont want people using unprescribed opioids under my supervision regardless of whether theyre using them in what they would say is a recreational sense or whether theyre using them as a defacto mechanism for addiction treatment even though they havent been prescribed the drug, which is something we often see with buprenorphine. Theres a lot of unprescribed use, but thats not really what people would characterize as drug misuse. Its just unprescribed addiction treatment and weve seen varying approaches and municipalities to policing what they would refer to as buprenorphine diversion, but I digress. Yeah, there are criminal justice settings in which Alkermes has pushed Vivitrol as, practically speaking, the only option just because a prison, a drug court isnt going to be in a position isnt going to want to facilitate buprenorphine or methadone use and Vivitrol is pitched as such a low risk drug, again, not a controlled substance, not an opioid that there are settings in which its been pitched as not one of several options but the only one and thats where experts in policy and in medicine really have a problem.

Adam: This has been really informative. You want to talk about the work you do at Stat and maybe push them wares here in terms of what youre working on and where people can check out your work and what they have to look forward to.

Lev Facher: I appreciate that. So people should check out were a health and science website run by the Boston Globe Company. Weve really taken the lead in covering Purdue Pharmas role in the opioid crisis. We actually spent about three years battling Purdue in court in Kentucky. Recently the Kentucky Supreme Court ruled that Purdue has to release all records of some depositions conducted with members of leadership in that company and the Sackler family that owns it. And those documents are still being released and Stat is still reporting on them. So if thats something that interests you, by all means follow us on Twitter and check our website. A lot of really good comprehensive coverage of addiction, both from a policy and political standpoint and from a medicine standpoint and just what its done to communities across the country.

Adam: Alright, Lev Facher, Stat News. Thank you so much for joining us. We really appreciate it.

Zachary Siegel: Thank you.

Lev Facher: Thanks so much for having me.

Adam: Thanks to our guest Lev Facher from StatNews and I also want to thank our special guest who joined us in the studio today, Zach Siegel, thank you so much for coming on.

Zachary Siegel: Hey, thanks for having me. Im just really glad that this topic is getting out there.

Adam: Thank you so much. I really appreciate it. I am too. This episode was a collaboration between The Appeal and Northeastern University Law Schools Health and Action Lab Changing the Narrative. The episode was co-produced and co-written by Zachary Siegel. The show is produced by Florence Barrau-Adams. The production assistant is Trendel Lightburn. Executive producer is Craig Hunter. Im your host Adam Johnson. Thank you so much. Well see you in January.

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The Appeal Podcast: The Regressive Pseudoscience of Our 'War on Opioid Addiction' - The Appeal

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Crack vs. Heroin: Drug wars’ racial double standard arrested millions of blacks, saw compassion for whites – Asbury Park Press

Posted: at 1:44 pm

Asbury Park Press Published 4:56 a.m. ET Dec. 8, 2019 | Updated 9:02 a.m. ET Dec. 8, 2019

The struggles of two New Jersey men -- one addicted to crack, the other to opioids -- show the differences and similarities of the two epidemics. Brian Johnston, Doug Hood, Peter Ackerman and Thomas P. Costello, Asbury Park Press

In the late 1980s, thecrackepidemic launched a War on Drugs that disproportionately arrested and punished black Americans.

But a generation later, when a new drug scourge struck white communities across the country, the response was dramatically different. The focus shifted to saving lives, treatment, and second chances.

A year-long investigation by the Asbury Park Press and the USA TODAY Network reveals a glaring double standard that hinges on race.

The project examineshow the responses to crack and opioidscreated anunfair justice system;what needs to be done to fix the inequity;the role that cultureand comedy play; andour top 5 takeaways from the project.

Here's a recap of our special report.

A young Richie Lapinski (left) with his brother and sister in a family photo. All three siblings would battle opioid addiction in the years to come, and are now in recovery.(Photo: Doug Hood )

The '80s crack era and the heroin crisis today are separated along racial lines when it comes to arrests andjail time.

America's views on addiction may have softened because of the terrible toll of the opioid epidemic, but the country is still plagued by stark racial disparities in drug enforcement and the collateral damage of ruined lives and hollowed-out neighborhoods caused by the "lock 'emup" policies of the past.

Follow the drastically different paths of those who were involved in the drug trade in both eras consumers, dealers and others through emotional and intimate interviews. See the crises through the decades in vintage photos and video footage (and an exclusive documentary).

Michelle Goodwyn, whose life was destroyed by crack, speaks candidly about the role of race in America's response to drug abuse. Tanya Breen, @tanyabreenphoto

Hear from those who fought the "war on drugs,"and learn what itll take to put an end to the injustice that persists even today.

The project also includes an interactive town-by-town database of cocaine and opioid arrests andcommentary from CNN's Van Jones,former President Barack Obamas first drug czar Gil Kerlikowske, Darryl Strawberryand more.

Here's what you need to know.

Search our interactive town-by-town FBI database of drug arrestsfor cocaine (which includes crack), or our opioids arrest database (which includes heroin) to dig deeper into the data.

In the 80s and 90s, jokes about crack were a staple on the comedy circuit; but jokes about opioid addiction are rare. Why is that? We explore the role society plays in how we view these crises.

This piece on solutions shares five thoughts from experts on how to fix the racial inequity that appears built into the system.

Here are the top things we learned duringour investigationinto the crack and heroin crises and what needs to be done going forward.


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Crack vs. Heroin: Drug wars' racial double standard arrested millions of blacks, saw compassion for whites - Asbury Park Press

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States prepare to purge tens of thousands of pot convictions – Los Angeles Times

Posted: at 1:44 pm

With the tap of a computer key, prosecutors in Los Angeles and Chicago plan over the coming weeks to erase tens of thousands of marijuana convictions from peoples criminal records, a key part of a progressive crime-fighting strategy that is seeking to rectify the wrongs of a decades-long drug war.

Prosecutors and legal aid advocates say purging arrest and conviction records removes barriers to jobs and housing, helping to stabilize and improve troubled communities. Jettisoning marijuana convictions has taken on added urgency as more states legalize the possession and sale of marijuana, a lucrative trade, and confront the vexing question of how to handle convictions for crimes that are no longer crimes.

We are undoing the harm prosecutors have caused, said Cook County States Atty. Kim Foxx, whose office handles prosecutions in Chicago, a city of 2.7 million residents, and who has been one of the leading national advocates of expunging peoples records.

Prosecuting these cases was not in the public interest, or in the interest of public safety. These convictions kept people out of the housing market, job market, Foxx said. Folks are going to be making billions of dollars on this, selling it by the metric ton, on the backs of communities that were devastated by the war on drugs. Is that fair? No.

Foxx plans on Wednesday to begin clearing nearly 18,000 misdemeanor convictions for possessing less than an ounce of marijuana. The convictions are the first of potentially hundreds of thousands of marijuana cases, including felonies, that could be wiped from the countys court system.

Los Angeles County prosecutors say they plan to expunge or reduce to lower-level offenses some 50,000 marijuana convictions. The convictions could involve any of four different charges: possessing marijuana, cultivating marijuana, possessing marijuana for sale, and selling or transporting marijuana.

So many people, particularly in communities of color, have been disproportionately affected by cannabis convictions, Dist. Atty. Jackie Lacey said in a statement. My prosecutors are working diligently to ensure that we are on track to expunge or reduce 50,000 felony convictions in coming weeks.

Lacey is seeking reelection next year and facing a challenge from former San Francisco Dist. Atty. George Gascon, who led an effort to purge marijuana convictions in his previous post.

Prosecutors are clearing convictions in response to state legislation that requires the automatic clearing of such criminal records. California, Illinois and New York have passed laws that put the onus on officials to clear the records, and other states are likely to follow suit.

Critics argue that automatically erasing such records is a mistake for a variety of reasons. The process could lead to errors, and convictions should be cleared on a case-by-case basis, not under a blanket policy, they say. Marijuana also has serious collateral consequences, they argue, pointing out that the illicit marijuana trade often was tied to violent drug gangs.

These are people who were convicted of making a decision to break the law, said Bob Bushman, president of the National Narcotic Officers Assns. Coalition. It was illegal when they did it and their convictions were the consequences for their illegal actions. They shouldnt get a free pass like it never happened.

Frankly, we see this as another attempt to normalize and make drug use acceptable, Bushman added. Were going down a very slippery slope when we allow people to choose what laws they want to respect and obey, and which ones they dont.

Advocates counter that clearing minor marijuana convictions is a small step in addressing decades of drug enforcement that disproportionately targeted minorities. Studies have shown that people of color are more likely to be arrested and punished in connection with marijuana offenses, even though white, black and Latino people use and sell marijuana at similar rates.

The result of that unequal enforcement, progressive prosecutors and advocates say, is a cycle of poverty and incarceration that has kept many minorities from getting jobs, going to school or finding housing.

Its truly the gateway conviction, Foxx said in an interview in her Chicago office.

That is true for many of Regina Hernandezs clients. A lawyer for Legal Aid Chicago, a nonprofit group that provides lawyers to the poor, Hernandez said her clients are eagerly awaiting the clearing of their marijuana records. After the county erases those cases, Hernandez will help clients seal other, often more serious, convictions.

Automatic expungement is a very good first step, Hernandez said. Our clients often have very complicated records. And marijuana is often the first conviction and then they cant get jobs or housing, and then there are more convictions.

To speed their work, prosecutors are getting help from Code for America, a nonprofit that aims to improve government efficiency by writing software to improve government services. The group has played a key role in automating the expungement process by creating programs that comb digital records and generate the required court motions to vacate convictions.

As district attorney in San Francisco, Gascon joined forces last year with Code for America, and the group aided in clearing more than 8,000 convictions -- before the state even passed the law requiring prosecutors to take such action.

It took just 10 minutes to do it, once they flipped the switch, Gascon said. It was crazy fast.

Gascon said he automated the process because manually clearing convictions devoured manpower. Erasing such convictions was too important, he said, to allow the process to drag on for months, or years.

Outside experts and advocates say the push to automatically clear pot convictions will gain more traction as more states legalize marijuana, the public becomes more comfortable with the drugs use and progressive prosecutors become more influential in the criminal justice system.

In addition to the three states that have passed laws for automatic expungement of conviction records, 12 others have enacted laws that allow residents to seek the erasure of low-level cannabis convictions. The legal process is time-consuming, complicated and often requires a lawyer, however, so many people arent taking advantage of the opportunity, advocates say.

States are saying, Because we are now regulating this, and it is a big industry, we need to undo past injustices, said Sam Kamin, a professor of law at the University of Denver who focuses on marijuana policy. They want to make this as easy as possible. Its the fair thing to do.

Eleven states and the District of Columbia have legalized marijuana for recreational use, with additional states legalizing medical pot. California voters in 2016 approved Proposition 64, which legalized, among other things, having and buying up to an ounce of marijuana, and allowed people to grow up to six plants for personal use.

The Proposition 64 changes were retroactive, which meant people convicted of marijuana offenses could petition to clear or reduce their records. But the process was time-consuming and hard to navigate, so few people sought relief.

Last year, the state passed a law requiring the California Department of Justice to create a list of everyone potentially eligible to get their records cleared and provide it to local prosecution offices.

Prosecutors are required to review all the cases by July 2020 and decide whether to challenge any dismissals or reductions. They must then inform the courts whether they agree with an expungement or will seek to block it.

Assemblyman Rob Bonta (D-Alameda) said he introduced the bill to make the process automatic because after Prop. 64 passed, he was frequently asked to help fund workshops to explain to people how to clear their records.

I would ask myself, why are we doing this at all? Why are they going through all these hoops, all these hurdles? Bonta said. Good government takes that wall away and brings you closer to your rights. It doesnt put barriers in the way.

Illinois state legislature in June became the first to pass a law legalizing the possession and sale of up to an ounce of marijuana (laws in other states were approved in referendums). The law also included a sweeping provision for the automatic expungement of low-level marijuana convictions by state officials and local prosecutors.

Foxx pushed hard for the measure, speaking about it in personal terms. She grew up in a public housing project, she said, and her mother smoked marijuana nearly every day to deal with bipolar disorder.

She told me it leveled her out, Foxx recalled. She never was arrested for it, but if she had been we could have lost our housing. The idea she could have been considered a criminal is absurd. She wasnt out there hurting people.

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Why Are So Many Black Men in Prison? – Mother Jones

Posted: at 1:44 pm

One of our new writing fellows, Camille Squires, published a piece on Monday telling us that the Kamala was a cop meme didnt originate with Bernie-bro-ish white guys. Rather, it originated on Black Twitter among African Americans who were keenly familiar with Kamala Harriss mixed record as Californias attorney general. Harris billed herself as Californias top cop, and in this era of mass incarceration that just didnt sit well. Its a good piece, and I only wish it had been longer since I would have been interested in a deeper dive into exactly what Black Twitter thought of Harris.

Squiress piece also reminded me that, after years of not getting around to it, I finally read Michelle Alexanders groundbreaking book, The New Jim Crow, a few weeks ago. For those of you who havent read it, heres a nickel summary:

Alexander argues that America has a long history of controlling the black population by whatever means it can get away with. First it was slavery. Later, when that was outlawed, we turned to Jim Crow because it was the best we could do. Then, following the civil rights era, we turned to mass incarceration. It wasnt as effective as either slavery or Jim Crow, but again, it was the best we could do.

The core of Alexanders case is the obvious one: we imprison a lot of people, and among those people we imprison a far bigger share of African Americans than we do of white people. The excuse for this is the war on drugs, which led to the arrest and incarceration of vast numbers of black men. Crucially, Alexander says, we arrest black men for drug offenses that we barely touch white men for. We make up lots of reasons for this, but they mostly turn out to be spurious. Basically, even though black and white men are involved in the drug trade about equally, we mostly imprison only black men for violating our drug laws.

One of the things that struck me as I was reading The New Jim Crow was that it sounded familiar. Not just in its themes, but almost literally. And then it hit me: it sounded very much like some of the things that Angela Davis and her colleagues wrote about incarceration in the early 70s. After rummaging around a bit, I finally found what I was thinking of: an essay by Bettina Aptheker called The Social Functions of the Prisons in the United States, part of Daviss 1971 essay collection If They Come In the Morning. I reread it, and it was eerily similar to Alexanders book.

But it was written 50 years ago. How could it be so similar if Alexander was focused on two recent phenomena: the era of massive prison construction and the war on drugs? And that in turn prompted me to think about timing: Alexanders argument could only be persuasive if the data on black imprisonment fits the timing of the war on drugs. So I started to root around. This chart is the result:

This data is surprisingly hard to come by, and I had to cobble it together from a wide variety of sources. Luckily, in 1991 the Bureau of Justice Statistics published a short study called Race of Prisoners Admitted to State and Federal Institutions, 1926-86. I say luckily because this is not a statistic that can simply be pulled from a database somewhere. A researcher has to dig into the data, clean it up, and finally come up with a reliable and consistent table of data that covers a long time period. I also say luckily because this appears to be the only study ever done on this exact subject and it forms the backbone of my chart.

Thats the dark blue line. The orange line is simple prison population by race, and this is a little easier. Early data comes from census reports and later data from annual Justice Department bulletins. As you can see, it follows the blue line pretty closely and provides a good check that the 1991 study is fairly reliable.

So what does this show us? Surprisingly (to me, anyway), what it shows is that there wasnt a huge surge in the rate of black imprisonment during the drug wars of the 70s and 80s. Rather, the share of black men being arrested and imprisoned has gone up slowly but steadily since at least 1926. Between 1970 and 1990, the total number of people in prison skyrockets, but the share of prison admissions thats black continues the same slow ascent its displayed all along.

Im not sure what to make of this. Alexanders argument about the war on drugs might still be correct. Contrary to what most people think, our nations prisons arent mostly filled up with drug offenders. Its mostly filled up with robbers and murderers and carjackers and other folks who have committed violent crimes. So even if the drug offenders who are arrested and imprisoned are very heavily black, it might not affect the overall black imprisonment rate a lot.

Im not sure, and Im not going to draw any conclusions here. Maybe Im missing something in the data. Or maybe it doesnt matter. Maybe the black share of prisoners didnt change much during the prison-building boom of the 70s and 80s, but the simple act of imprisoning more people was all we needed to make sure we got lots of black men off the streets and under the control of the criminal justice system. If a few white men were collateral damage, so be it.

Either way, though, it seems like the story changes. The war on drugs, in particular, doesnt seem like it had a noticeable effect on black imprisonment rates, and Alexander tosses around numbers so blithely in her book that its impossible to construct a consistent statistical argument from them.

The New Jim Crow was published in 2012, and its entirely likely that its been discussed to death since then. Maybe my objections here are nothing new and have been addressed before. But if they have, I havent noticed it. Im curious if anyone has anything to say about this.

POSTSCRIPT: Its worth noting that the imprisonment rate of black men began to fall a couple of decades ago and has continued to fall ever since. Its still far higher than the white imprisonment rate, but theres at least some progress being made.

Id also like to point out, as usual, that even if you think the prison-building spree of the 70s and 80s was misguided, it wasnt completely irrational. Violent crime really did start to skyrocket in the mid-60s, and it really did scare peopleincluding black people in urban cores who were the most numerous victims. As we now know, the crime increase was largely caused by lead poisoning, but nobody knew it at the time. They just knew that their streets were unsafe and they wanted something done about it.

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Drug deaths inquest: Gladys Berejiklian says she is ‘closing the door’ on pill testing – The Guardian

Posted: at 1:44 pm

The New South Wales government will ignore the bulk of the recommendations from a landmark inquest into drug deaths at music festivals, with the premier, Gladys Berejiklian, saying she is closing the door on pill testing.

On Wednesday, the government announced its response to the findings of deputy state coroner Harriet Grahames inquest into six drug-related deaths of young people at music festivals in the state.

Handed down last month, the long-awaited report recommended the government introduce a pill-testing trial, limit the use of strip-searches at music festivals to cases of suspected drug supply and stop the use of sniffer dogs.

But the government has ignored the majority of the recommendations from the inquest, instead saying it would introduce drug amnesty bins at music festivals to allow festival-goers in the state to discard illegal substances without fear of prosecution or penalty.

What we want to do is send a strong message out to young people which is the most important one: do not panic if you see police officers, if you see anything that worries you because youve got pills on your person or your friends do, just throw the pill away, no questions asked, she said.

Just dont take them because that can kill you or kill one of your friends.

While the government has maintained a steadfast opposition pill testing, the premiers refusal to adopt the coroners recommendation was immediately criticised by advocates and both Labour and the Greens.

The emergency doctor David Caldicott, a long-time pill testing advocate who has overseen the only Australian trial of the method in ACT, wrote on Twitter that he found it hard to recall a time when a politician has announced that they are closing the door on any health intervention that has as much expertise behind it.

Greens MP Cate Faehrmann said amnesty bins on their own will not save lives.

My fear is that police will use amnesty bins as an excuse to increase their intimidation tactics in the hopes that they can scare kids into throwing away their drugs, she said.

The war on drugs has proven that a focus on getting people to not take drugs doesnt work. If we cant keep drugs out of prisons were not going to keep them out of festivals.

The reality is that thousands of people will still take drugs at festivals. Amnesty bins will do nothing to reduce the harms of drug use for those inside.

While she said some recommendations might still be considered in the future, Berejiklian said that she was closing the door on pill testing as an option as well as incorrectly claiming the method was unable to check drug purity.

Certainly I read the findings of the deputy coroners report and it was harrowing reading and if you look at the causes of deaths of those young people, it was pure MDMA in five out of the six cases and in the sixth case was the combination of cocaine and MDMA, she said.

None of those lives would have been saved [by pill testing] because it was pure MDMA that killed those young people.

In fact the inquest heard that purity testing had been available at music festivals in Europe for several years and in her findings Grahame wrote that though it was more expensive, claims pill testing couldnt check for purity were clearly incorrect.

In her findings, Grahame wrote that she was satisfied there was significant evidence that intensive and punitive drug policing operations were increasing drug-related risks and harm and called for a complete overhaul of government policy including the decriminalisation of possession.

I am of the firm view there is sound evidence that high-visibility policing and the use of drug dogs is a harmful intervention, Grahame said at the time.

The wholesale practice of strip-searching young people was of grave concern, and its use to target people suspected of drug possession was out of line with the purposes of the legislation.

Standing beside both the commissioner of police Mick Fuller and police minister David Elliott both vocal supporters of strip search tactics Berejiklian said the force was reviewing the operations of how strip-searches are conducted and to make sure that police follow the letter of the law.

Berejiklian has long resisted calls to introduce pill testing in the state despite a long list of medical bodies calling for it to be used. On Wednesday she said people should take personal responsibility for drug use.

I will say today dont take those pills, she said.

That is the strongest message we can send to everybody. Please dont take these pills. These pills can kill you. At the end of the day there is also, and I know, I have to be careful how I use my words, but there is also a level of personal responsibility here.

People have to step up and acknowledge that if you take a pill, if you take multiple pills, it can kill you, it can kill your friends.


Drug deaths inquest: Gladys Berejiklian says she is 'closing the door' on pill testing - The Guardian

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We’re at risk of losing all our progress in the fight against the opioid crisis – Washington Examiner

Posted: at 1:44 pm

Progress has been made in the fight against the opioid epidemic, but it could all be lost unless we make a critical pivot in our approach.

The numbers are striking: In 2018, drug overdoses claimed more than 68,500 lives, and 47,600 were the result of opioid overdoses. The upside is that these same figures show that overdose deaths overall dropped about 5% year-over-year, the first decrease since 1990. Yet a deeper dive into these figures reveals where the problem grows more acute.

To this point, most of our efforts to combat this crisis have centered on opioid addiction treatment and over-use in the medical industry, and the numbers do indicate some positive impacts. Between legislation and self-regulation by pharmaceutical companies and doctors, important steps have been taken to reduce over-prescription and the risk of getting people unwittingly addicted in the first place. However, the larger opioid threat comes not from prescription abuse, but from illicit sources such as heroin and fentanyl.

In 2016, for example, around 75% of opioid-related deaths were caused by illicit drugs. When opioid-related deaths increased almost 13% the following year, fatalities from prescription painkillers leveled off but fatalities from fentanyl and related synthetic opiates rose by nearly 50%.

These statistics demonstrate that while there was indeed initially a need to introduce measures to prevent misuse of opioid-based painkillers, a narrow approach confining our focus to pharmaceutical companies and medical professionals threatens not only to slow down the gains that have been made but actually make the situation worse.

The problem is political as much as anything else.

It is politically easy but intellectually lazy to just go after big businesses or the pharmaceutical industry and focus on the softer side of the equation, such as treatment, education, and so on. Its also become far less popular to advocate the tougher, law enforcement side of things. This political reality is an over-correction from the much-maligned War on Drugs, which aggressively targeted supply but failed to control demand.

The current state of play is simply untenable. The much-needed awareness effort calling attention to over-prescription of opioids has now morphed into a series of politically-expedient measures and frivolous lawsuits aimed at the convenient boogieman of the pharmaceutical industry. Meanwhile, the criminal problem continues to grow. The reality remains that Fentanyl, a synthetic opioid, is the chief culprit.

It is up to 50 times more potent than heroin, so toxic that only a few milligrams of the stuff can kill. Carfentanil, a closely-related fabrication, is even deadlier, requiring only a single grain to result in a lethal overdose. Paradoxically, its potency is what makes it so attractive to addicts, who are continuously chasing an increasingly powerful high up until the one that kills them.

The dilemma gets even more complicated when tracing the origin of these drugs.

China is one of the largest sources of fentanyl and related substances. The country provides it to criminal enterprises, which then handle the distribution. Enormous quantities of fentanyl and its chemical components are sent from China to Mexico, where they are turned into the final product, sometimes mixed with heroin and other drugs, or pressed into counterfeit pills and then smuggled across the border.

Efforts by Chinese authorities to shut down the thousands of labs capable of producing synthetic opioid compounds have proven frustrating, and one wonders how motivated the Chinese government is to stem the tide of drugs into the U.S. in the first place. American law enforcement agencies, meanwhile, such as Customs and Border Protection, have found themselves woefully under-equipped to stop these substances at the border.

Meanwhile, the increasing restrictions placed on doctors who treat chronic pain have prevented patients from receiving relief in the form of properly prescribed pain medication another over-correction that may create a whole new class of potential victims for predatory drug dealers.

If we are serious about combating the opioid crisis, we need to acknowledge the limits of our current approach and recognize the problem as one of criminal interdiction. Law enforcement must be provided the resources necessary to fight illegal opioids where they exist, on the streets, and at the borders.

Kelly Sloan is a former employee of the Calgary Police Service and Royal Canadian Mounted Police and graduated from Mount Royal University with a degree in Criminology. He now resides in Denver, CO.


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