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Category: Drug Law Reform

  • Training Drug Users and Bystanders to Treat Overdose Saves Lives

    Training Drug Users and Bystanders to Treat Overdose Saves Lives

    Drug overdose is a growing public health crisis that now kills more adults per year in the United States than motor vehicle accidents. In cars, seatbelts and airbags save lives. When it comes to opioid overdose a safe and non-abusable medicine called naloxone can restore breathing and avert death. Pragmatic doctors and health officials want anyone who uses opioids like heroin—and anyone likely to be around during an overdose—to have access to this life-saving drug, and know how to use it.

    In Massachusetts, researchers led by Dr. Alexander Walley at the Boston University Medical Center set out to discover the results of a state-supported overdose education and naloxone distribution program on deaths from overdose. We sat down with Dr. Walley to discuss the findings.

    What did your research find?

    This study demonstrates that overdose education and naloxone distribution is an effective public health intervention to address the growing overdose epidemic. We found that communities that received overdose education and naloxone reported significantly fewer deaths than communities that received no training. We also observed that the higher the cumulative rate of program implementation, the greater the reduction in death rates. In other words, the more people at risk or in contact with people at risk for overdose who were given naloxone, and trained to prevent, recognize and respond to an overdose, the lower the overdose death rates.

    Why are overdose education and naloxone delivery programs like these so important?

    Since the beginning of the Massachusetts overdose education and naloxone delivery programs, there have been more than 1,700 overdose rescues using naloxone. While we do not know how many of these people may have died if they had not received naloxone, it is likely that many of them would have. These rescues have inspired many us to maintain hope that all overdose deaths can be prevented.

    People who have recently stopped using opioids—whether because of jail time or treatment—are at increased risk of overdose, and we’ve heard inspiring stories of overdose reversals in these cases. While opioid addiction is a treatable disease, it is a chronic disease where relapse is unfortunately part of the natural history. Preventing overdose allows people to continue their progress towards recovery, and may enable them to seek out other lifesaving services.

    What barriers stand in the way of implementing programs like this in other parts of the United States?

    I’ll start first by listing features of the program in Massachusetts that contributed to its success and would support broader implementation: one is the use of a nasal delivery device for naloxone, allowing naloxone to be administered through the nose, instead of by injection. The other is a standing order issued by the health department that permits non-medical personnel to deliver overdose education and distribute naloxone. Without this order, a doctor would need to be present each time naloxone is given out. To date, there are still large parts of the country with no access to a lifesaving naloxone distribution program; though this program locator tool can help you find out if there is one near you.

    The two main barriers to the expansion of these initiatives are that insurance companies do not cover the nasal delivery device that allows naloxone to be administered through the nose, and prescribers (doctors, nurse practitioners and physicians’ assistants) are not yet adequately educated on prescribing naloxone. We’ve created a website, prescribetoprevent.org, to help facilitate naloxone prescribing.

    What message would you send to officials in countries like Russia and China where the death toll from drug overdoses continues to climb?

    Preventing needless deaths from opioid overdose is a bridge issue – it’s a cause that people from different perspectives on treatment and harm reduction can agree and work together on. It can be a starting point from which we can work together in addressing the harms associated with drug use.

    What happens now?

    We keep implementing and evaluating this program and ones like it. In Massachusetts, overdose education and naloxone have been delivered to heroin users, prescription opioid users, patients in emergency departments, and the people who are most likely to respond to an overdose including: people who are incarcerated, family members, social service providers, police officers, and firefighters. It is important to determine how these programs should be tailored to different populations to maximize their reach, effectiveness and sustainability. That’s what we’re working on now.

    This blog post was originally published on the Open Society Foundations website.
  • If The War On Drugs Isn’t Working, Why Are We Still Fighting It?

    If The War On Drugs Isn’t Working, Why Are We Still Fighting It?

    When leaders from the Organization of American States gathered in Cartagena last April, Prime Minister Stephen Harper offered a rare concession on the topic of drug policy.

    In response to the chorus of dissent coming from countries like Guatemala, Mexico and Colombia, Harper stated:

    “I think what everyone believes and agrees with, and to be frank myself, is that the current approach is not working, but it is not clear what we should do.”

    But as the Canadian Press reported yesterday, it would seem that the Harper government is steadfast in its commitment to dysfunctional anti-drug strategies:

    “Spillover from Mexico’s violent drug war is prompting the Harper government and the Canadian military to become more involved in helping defend the tiny, Central American country of Belize.

    A series of internal reports, obtained by The Canadian Press under the access to information law, show the government has quietly increased co-operation with the Commonwealth nation, formerly known as British Honduras.”

    While details are scarce, the Canadian military has been actively participating in a variety of counter-narcotic operations in the region. For example, in December, a Canadian Forces press release indicated that the Canadian Navy was involved in a “large drug bust”.

    From the release:

    “Working alongside our American and multinational allies, HMCS Ottawa’s successful operation demonstrates our Government’s commitment to address the illegal trafficking of drugs in the Caribbean basin”, said the Honourable Peter MacKay.   “I’m proud our sailors act as excellent ambassadors for our nation, for making Canadian streets safer by patrolling the seas to our south and for working with like-minded nations to better protect citizens of our continent.”

    This particular dimension of the war on drugs – military interdiction ­– has been especially damaging to those Central and South American states that have hosted broad counter-narcotic conflicts. And tragically, the mistakes that have been made time and time again seem to be materializing in Belize.

    The rationale for the Canadian military’s involvement in Central America and the Caribbean is built on a series of faulty premises. Firstly – that military might and securitization can defeat drug cartels. One need only look to Mexico, which saw an explosion in violence after President Calderón declared war on the drug cartels, to see how woefully dangerous an idea this is.

    Secondly, regardless of the Canadian military’s interdiction efforts, the supply of illegal drugs to Canadian consumers has remained the same. As with all attempts over the last forty-plus years to control the flow of narcotics into Canada, as long as a demand exists, the supply will continue. No counter-narcotic activity, no matter how costly or logistically sophisticated, has ever managed to halt the flow of drugs across Canadian borders. All it does is shift violence from one theatre to the next, destroying communities and causing unneeded deaths as conflict spills from state to state.

    And so the question is – if war on drugs isn’t working, as PM Harper has stated, then why are we still fighting it?

    Thankfully there is a silver lining to the Belize report – if one scrolls below the fold and scans the comment section, you’ll find an outpouring of common sense from readers.

    As one commenter put it:

    “The single biggest thing we can do is end the drug war at home.”

  • CDPC Heads to Panama to Create Alternative Scenarios for Drug Policy

    CDPC Heads to Panama to Create Alternative Scenarios for Drug Policy

    At the April 2012 Summit of the Americas in Cartagena, the members of the Organization of American States commissioned the OAS to analyze the hemisphere’s drug policies and to present and explore alternatives to address the issue of illegal drugs and drug use. On Saturday, January 20th, the OAS will formally commence this process in Panama City, Panama.

    The CDPC is proud to announce that CDPC Executive Director and SFU Adjunct Professor, Donald MacPherson, will be in attendance as part of the OAS’s scenario-building team and representative of Canada.

    “There is a real shift taking place in the global drug policy regime and the OAS review process is a good indicator of this. Governments from across the hemisphere are beginning to look for smarter alternatives to the war on drugs that are more effective at addressing both public health harms and public safety issues at the same time,” said MacPherson.

    “Who knows what will happen when we start imagining different futures in the area of drug policy. The important thing is to get people talking about alternatives – alternatives that have a hope of achieving success. The OAS process will begin to do that – it will bring people with diverse views together to look forward and see what kind of drug policies make more sense than prohibition. And in the end we all have the same goal – improved public health and safety when it comes to drugs and drug use.”

    The group will meet twice over the next two months and work together for four days each meeting. The meetings are being facilitated by Reos Partners and the Centro de Liderazgo y Gestion and will result in a report that will be used to inform the OAS’s position on drug policy.

  • Breaking the Taboo

    Breaking the Taboo

    The CDPC is proud to join together with the Beckley Foundation, Virgin Unite, Sundog Pictures, Avaaz.org, The Global Commission on Drugs, and civil society NGO’s from around the world in calling for a fundamental review of global strategies in response to drugs.

    Breaking the taboo is a bold new international challenge. At the heart of the initiative is a groundbreaking documentary film that uncovers the UN sanctioned war on drugs, charting its origins and its devastating impact on countries like the USA, Colombia and Russia. Narrated by Morgan Freeman and featuring prominent statesmen including Presidents Clinton and Carter, the film follows The Global Commission on Drug Policy on a mission to break the political taboo and expose the biggest failure of global policy in the last 50 years.

    www.breakingthetaboo.info

    We encourage you to get involved, read the Beckley Foundation letter, sign the AVAAZ Campaign, and join the conversation on twitter using the hashtag #breakingthetaboo.

    Global commissioner on drug policy Richard Branson hopes “this film will open people’s eyes on the war on drugs and the failed war on drugs and make it easier for people who want to be brave and do something about it.” Among those featured are Colombian president Juan Manuel Santos and former US president Bill Clinton, who admits bluntly that the US-led war on drugs in Colombia “hasn’t worked”. Clinton also talks about the need for rehabilitation rather than incarceration when dealing with people with addictions. Sir Richard said countries such as Portugal and Spain, where drug users receive treatment rather than being jailed, provide a template. He believes that legalisation of cannabis is “inevitable”. “I have hardly ever come across a politician that won’t say – off the record – what needs to be done … in the end they just need to be brave,” he said.

  • A Seismic Shift in Drug Policy

    A Seismic Shift in Drug Policy

    Watching the vote in last night in the U.S. was quite an amazing experience. We watched history being made yet again and not just with the re-election of America’s first black president.

    Yes, a second term for Obama was a rare feat given the poor economic situation in the U.S. and the vulnerability that brings for an incumbent president. A second term for Obama is without a doubt a historical event. But there was more – there was a seismic shift in the world of drug policy. In the belly of the beast of the war on drugs, in the country that historically has promoted a vigorous global assault on drugs and drug users, citizens of Washington state and Colorado sunk a wedge a mile wide into the monolithic paradigm of drug prohibition. In both states the voters have overwhelmingly supported the regulation of marijuana for adult use.

    Prohibition is upheld by a global consensus enshrined in international drug treaties. Much like the mortar that held the Berlin Wall together, it holds fast as long as no one challenges the logic of the system in a significant way. As long as things stay the same and no one has the courage to confront the absurdity of the status quo, the status quo prevails. But once the wall starts to be dismantled by ordinary citizens and the authorities stand aside, it is over. The mortar crumbles like dust. What was inconceivable only a few years ago seems like common sense today. Just like that wall in Berlin came tumbling down on November 9th, 1989, prohibition is collapsing before our eyes. The citizens of the U.S. have peacefully voted to overthrow the tired and worn out policy of drug prohibition and common sense has prevailed. It’s about time.

    There are many questions about how these two states will move forward and actually implement the regulations they have proposed. As they say, the devil is in the details. But that’s the grinding day-to-day work of finding the best regulatory regime that meets the many competing goals that are important to our communities – public health, public safety, civil liberties, education about the harms and benefits of substance use and the stewardship of our youth within a culture that has so many mixed messages around drug use. This is important work that we believe will improve the quality of life in those states that made this decision to move forward. The fact that resources will be focused on how to best regulate marijuana rather than whether to regulate this ubiquitous product is the most important point for those of us in Canada.

    Now that the U.S. has opened the door and started down that path towards regulation, the old excuse that Canadian politicians always use – that we can’t change anything until the Americans do, is gone. So let’s get on with it.

  • Drug Policy 101: Dangers of an Unregulated Drug Market

    Drug Policy 101: Dangers of an Unregulated Drug Market

    “We need to recognize that it’s not deviant or pathological for humans to desire to alter their consciousness with psychoactive substances. They’ve been doing it since pre-history… and it can be in a religious context, it can be in a social context, or it can be in the context of symptom management.”

    – Dr. Perry Kendall, Provincial Health Officer, British Columbia

    If the past century of prohibition has proved anything, it is that the Controlled Drugs and Substances Act has failed to discourage Canadians from using illegal drugs. Likewise, prohibition has also shown us that the financial incentive to produce and sell illegal drugs is far more powerful than the deterrent effect of the criminal law.

    This ongoing flow of supply and demand has, of course, resulted in a large and highly profitable black market for drugs in Canada. One aspect of this black market that goes unaddressed by the criminal justice system is that prohibition results in a situation where Canadians are consuming a completely unregulated product.

    Because the product is unregulated, its quality is not just questionable, but potentially dangerous. And those individuals who use drugs of questionable quality often have no idea as to the nature of the substance they are consuming.

    Some of the most illuminating examples of the dangers of an unregulated market can be found in relation to the differences between “ecstasy” and MDMA. In its pure form, and taken in controlled doses, MDMA is a relatively safe substance when compared to other drugs, legal and illegal.

    Many scientists and doctors have argued in favour of its regulation, including former UK government drugs advisor David Nutt, who recently conducted a televised study of MDMA’s therapeutic potential, and BC Provincial Health Officer Dr. Perry Kendall, who went on the record stating that MDMA could be “safe” for adults if consumed responsibly, and has called for a public dialogue on a regulatory regime. Such a dialogue could enable a full and honest discussion on the benefits and harms of using substances such as MDMA and similar drugs.

    But because MDMA isn’t currently regulated by a governing body, we have “ecstasy” which is regulated by the criminal element that currently controls its distribution. “Ecstasy” as opposed to pure MDMA, can contain a combination of various drugs, such as PCP, ketamine, methamphetamines and others. This leads to unknown purity, unknown dosage and the possibility that a pill could be contaminated. And the results of consuming pills of unknown origin can be tragic. Examples of the dangers of the current ecstasy market include a string of deaths throughout western Canada, where individuals using ecstasy died because the pills they took were cut with PMMA; a stimulant that has been linked to a number of deaths around the world during the same timeframe.

    These and similar deaths have lead many communities around the country to call for a different approach to how we deal with drugs like ecstasy, as “Just Say No” programs and wishing abstinence upon young people is clearly not working.

    Next Steps:

    As the current approach, which relies upon fear and ignorance to dissuade Canadians from using MDMA has failed, Canada should adopt a knowledge-based approach to best ensure that those who use MDMA and other drugs stay safe and informed.

    One of such existing approaches is the Dutch Drugs and Information Monitoring System (DIMS); a country-wide system of labs that will analyze substances without any threat of legal recourse. Since the 1990s, the Netherlands government has used this system as a measure to prevent the harms associated with unexpected and dangerous substances found in “party pills” and other drugs. The three main substances that DIMS tests are ecstasy/MDMA, amphetamine/Speed, and cocaine, and has tested some 100,000 drug samples since being established. Implementing such a system in Canada would have numerous public health benefits, including allowing drug users to have a full understanding of what they are actually taking, while also enabling public health authorities to respond more effectively when hazardous substances appear on the drug market.

    Long term solution: A regulated drug market

    MDMA is subject to the UN convention on psychotropic substances, rendering it illegal around the world, and any country that attempted to regulate it would be in violation of this treaty. However, there is currently legislation in front of the New Zealand government that would see the creation of the world’s first regulated recreational drug market.

    Under the new regulations, synthetic drugs, also known as “legal highs” or “party pills” would have to undergo an approval process before being brought to market. This process would place the burden on the synthetic drug industry, which would have to prove its products are safe before being made available to the consumer. Taking up to two years, the approval process will determine the effects and side-effects of a proposed drug, measuring it against an established health criteria.

    While it will only cover new drugs, i.e. those not covered by existing UN treaties, New Zealand’s proposed system could function as a blueprint for other nations to pursue the regulation of recreational drugs in the future.

  • Reporting on Canadian Drug Policy

    Reporting on Canadian Drug Policy

    The CDPC is in the process of preparing a report on Canadian drug policy. Due out this winter in advance of the next meeting of the International Narcotics Control Board, this report will assess the state of Canada’s drug policy frameworks using a public health, social inclusion and human rights lens.

    In Canada, as in most other places in the world, the best-funded response to problems associated with drug use has been to increase law enforcement efforts, resulting in the incarceration of increasing numbers of people who use drugs.

    Our critical assessment of policy frameworks will reveal the extent to which our governments are committed to effective policies that prevent and reduce harms associated with alcohol, tobacco and other drugs and seek alternatives to criminalization.

    This report will provide the baseline data for future reports on drug policy in Canada and it will be a cornerstone in the Coalition’s advocacy work. The CDPC is seeking your help with this project. If you have any information you would like to share about your organization or your experience with drug policy in Canada, or if you want more information about this project, please contact Connie Carter, Senior Policy Analyst, by email at [email protected].

  • Our MDPV (Bath Salts) Submission to Health Canada

    Our MDPV (Bath Salts) Submission to Health Canada

    Remember that media-fueled tempest in a teapot in June of this year? That brief but startling drug scare raised the profile of “legal highs” like MDPV, though it likely did little to protect the health of potential and current users, albeit a small group of people. Media coverage did prompt the Canadian federal government to propose that MDPV or Methylenedioxypyrovalerone (Yes! If you can spell it, you can schedule it), be included in Schedule I of the Controlled Drugs and Substances Act where the harshest penalties for possession and trafficking would apply.

    As is usually the case, Health Canada sought feedback on this proposal and in early July the CDPC submitted a response. Our submission was an opportunity to sharpen our analysis of the ease in which governments respond to some drugs with new and harsher forms of criminalization. We suggested that prohibition of this substance would have unintended negative effects, and recommended that alternative models for regulating MDPV be sought that would balance the need to protect the health of Canadians against the potentially negative effects of prohibition. We also drew attention to the important distinctions between prohibition and regulation of drugs and pointed out how the federal proposal to prohibit MDPV forgoes the possibility of regulating and thereby reducing harms from this substance in any meaningful way.

    We underscored our concerns about the health and societal risks posed by MDPV, but suggested that the proposal to place this drug in Schedule 1 of the CDSA would not achieve the intended outcome of reducing the dangers of MDPV, and would have unintended negative consequences for people who use this substance. We encouraged a more fulsome discussion of the models and options available to regulate all psychoactive substances, drawing on lessons learned from other public health policy issues. We also emphasized that Health Canada’s proposal to schedule this drug was premature given the limited amount of available information about the science of this drug, the limited scale of its use, and the media hyperbole surrounding its emergence.

    If you would like more information about this issue, a full copy of our submission is available here.

  • New Directions for Drug Policy in Bogota, Colombia

    New Directions for Drug Policy in Bogota, Colombia

    On September 5th and 6th I had the opportunity to participate in a public dialogue on drug policy in Bogota, Colombia initiated by Mayor Gustavo Petro Urrego: Conversatorio 2012 sobre  ”New alternatives of intervention in the consumption of drugs and psychoactive substances”.

    It was an amazing event and reminded me very much of my days at the City of Vancouver where I had the opportunity to work with then-Mayor Philip Owen in 2001 as he launched the City of Vancouver’s Four Pillars Drug Strategy with a series of public dialogues that brought people together to share views on his proposals for addressing drug problems in Vancouver.

    Held in the beautiful auditorium at Bogota City Hall, throughout the day we heard from international experts, academics, public health officials and the Mayor himself, all of whom were focused on potential solutions to Bogota’s serious drug problem.

    One big difference between Vancouver’s process and the one unfolding in Bogota is the speed at which change is taking place in Colombia. Mayor Gustavo Petro Urrego has decided that his beautiful mountain city needs some new ideas and is moving quickly to implement new approaches to Bogota’s drug problems. Mayor Petro speaks of a creating a new democracy where people with addiction problems are included in society and brought in from the cold, so to speak.

    In late July of this year, Colombia passed national legislation decreeing that addiction is a public health issue and “Any person suffering mental disorders or any other pathology derived from the consumption, abuse, and addiction to legal or illegal psychoactive substances has the right to receive comprehensive care from the entities that comprise the General System of Social Security in Health and the public or private institutions specialized in the treatment of said disorders.”

    This new legislation is a significant development and shifts the focus of government responses to drug problems in Colombia towards a health approach and away from the traditional response through the criminal justice system. Of course, mustering the finances to create a comprehensive system is a major challenge for Colombia just as it is here in Canada.

    One of the innovations that Mayor Petro is moving quickly to implement is the establishment of a series of drug consumption rooms in three areas of the city.  Consumption rooms are widely available in Europe as part of a comprehensive approach to marginalized people who use drugs. There is a growing body of evidence that supports these kinds of programs as important components of a comprehensive approach. For Mayor Petro this would begin to demonstrate that Bogota was changing its policy and reaching out to provide assistance to drug users in a new way.

    For thirty years authorities in Bogota have tried to address inner city drug problems without much success. In 2000 they even tried draconian measures such as leveling the main neighbourhood where the urban drug scene was located, “El Cartucho”, to create a new park with the hope that the problem would disappear. Unfortunately and somewhat predictably the drug scene reappeared, only this time in four different areas of the city. Instead of one “problem” neighbourhood they now had four! These new areas of town, El Bronx, a section of Maria Paz en Kennedy, San Bernardo and Las Cruces, are the main problem areas in Bogota and mostly remain out of the control of municipal authorities.

    El Bronx is the most notorious and has been abandoned by the authorities. It is controlled by organized crime and houses thousands of severely addicted people. El Bronx is an extremely dangerous place to venture into if you are not involved in the drug scene in some way, either as a user or a dealer.  While I was there a police officer was killed in El Bronx while investigating an incident. City staff were very clear that they did not want to simply displace the problem again but wanted to begin to stabilize the situation in these neighbourhoods.

    The establishment of consumption rooms is part of the Mayor’s strategy to change the culture in these areas rather than abandoning them and giving in to the local “drug mafia”. He is advocating a health and social approach be taken –  one that would begin to establish harm reduction and treatment services and provide options to people to leave the drug scene. The primary drug that is used at the street level in Bogota is a substance called basuco or coca paste or paco. It is very cheap and is a product that is derived from the intermediate stages of cocaine production.

    Last week Mayor Petro met with President Manuel Santos to discuss his ideas to implement consumption rooms. Early reports suggest that the door is open for the Mayor’s proposal to prescribe illegal drugs to users within a regime of treatment as a way of intervening in the drug market and coming between people with addictions and the drug mafia. This is a bold approach and we will follow how things develop in Bogota over the coming months.