Some are very nuts and bolts, saying the war on drugs has cost trillions of dollars while only making the problem worse. Others like Kane, while agreeing on that point, are more philosophical. “Our national drug policy is inconsistent with the nature of justice, abusive of the nature of authority, and ignorant of the compelling force of forgiveness,” he says on the web site of Law Enforcement Against Prohibition.

Retired Denver police officer Tony Ryan

 

Colorado attorney Leonard Frieling

From a press release sent along by the Office of National Drug Control Policy:

National Drug Control Policy Director Gil Kerlikowske said today “a new direction in drug policy” is required to reduce the strain on the Nation’s economy caused by drug abuse and to improve the public health and safety of our citizens.

Testifying before the Subcommittee on Domestic Policy of the House Oversight and Government Reform Committee, Director Kerlikowske outlined national drug control priorities and the Fiscal Year 2011 National Drug Control Budget, noting that the Obama Administration approach to drug policy is “grounded in common sense, sound science, and practical experience.”

With drug use accounting for tens of billions of dollars per year in healthcare costs, and drug overdoses ranking second only to motor vehicle crashes as the leading cause of accidental death, the Nation “needs to discard the idea that enforcement alone can eliminate our Nation’s drug problem,” Director Kerlikowske said. “Only through a comprehensive and balanced approach – combining tough, but fair, enforcement with robust prevention and treatment efforts – will we be successful in stemming both the demand for and supply of illegal drugs in our country.

“The forthcoming National Drug Control Strategy calls for addressing our Nation’s enormous demand for drugs by scaling up our public health policy response, integrating treatment programs into mainstream medicine, and recognizing that effective drug policy requires engagement at the community level,” Director Kerlikowske said.

He also noted that ONDCP would continue to work to “break down the silos between the prevention, treatment, and law enforcement communities– and the greatest use must be made of the finite resources at our disposal.”

The President’s $15.5 billion Fiscal Year 2011 National Drug Control Budget lays the foundation for these efforts and provides resources for five major drug control functions: substance abuse prevention; substance abuse treatment, domestic law enforcement, interdiction, and international support. The budget request specifically calls for an increase of $521.1 million over the FY 2010 enacted level, and includes a 6.5 percent increase for prevention and treatment; an increase of $73.8 million for Federal interdiction efforts; and an increase of $20.1 million for international support.

Critics claim that needle-exchange programs create a moral hazard by legitimizing drug abuse. But it does not legitimate drug abuse to help people with the clinical disease of addiction avoid other deadly diseases until they are ready for help. Sacrificing the lives of addicts to send an “unmixed” moral message actually sends a troubling moral message: that the unwanted have no worth.

The topic is timely, because House lawmakers have passed legislation repealing a 21-year-old ban on federal funding for needle exchange programs, which have been endorsed by a long list of public health groups and federal health officials. Conservative critics, however, say the programs simply condone drug use and contribute to crime. Bowing to such sentiments, House Democrats were forced to dilute their proposal by prohibiting needle exchanges within 1,000 feet of schools, daycare centers, pools, parks, and basically anywhere else that children gather. In a city setting, that means just about everywhere.

In the eyes of Gerson, the restrictions make no sense.

This restriction might make sense if needle-exchange programs increased the number of addicts. But they don’t. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, has comprehensively reviewed the scientific studies on needle exchange. “It does not,” he says, “result in an increase in drug abuse, and it does decrease the incidence of HIV. . . . The idea that kids are going to walk out of school and start using drugs because clean needles are available is ridiculous.”

Later in the year, House and Senate lawmakers will meet to decide whether the repeal of the federal ban on needle-exchange funding will remain in the larger bill, which will provide funds for the Department of Health and Human Services. A number of Democrats hope that, not only will that language remain, but the 1,000-foot restriction will be eliminated as well.

[T]his Administration believes that the current federal cocaine sentencing structure fails to appropriately reflect the differences and similarities between crack and powder cocaine, the offenses involving each form of the drug, and the goal of sentencing serious and major traffickers to significant prison sentences.  We believe the structure is especially problematic because a growing number of citizens view it as fundamentally unfair.  The Administration believes Congress’s goal should be to completely eliminate the sentencing disparity between crack cocaine and powder cocaine.

Under current federal law, possession of five grams of crack cocaine with an intent to distribute carries a mandatory five year sentence. But for powder cocaine, it requires possession of at least 500 grams with an intent to distribute to get the same five year sentence. At the time the laws were passed in the mid 1980s, the thinking was that crack cocaine was more closely linked to violent crime. But it also happens to be used disproportionately by blacks and Hispanics.

President Obama campaigned on a platform of ending the sentencing disparity. This is the first step; now Congress stands at bat.

Hemp advocates (yes, there are hemp advocates out there) argue that the change would benefit the economy at a time when it could certainly use the boost.

“Hemp is a versatile, environmentally-friendly crop that has not been grown here for over 50 years because of a politicized interpretation of the nation’s drug laws by the Drug Enforcement Administration (DEA),” Eric Steenstra, president of Vermont-based Vote Hemp, said in a statement. “Jobs would be created overnight, as there are numerous U.S. companies that now have no choice but to import hemp materials valued at $360 million in annual retail sales and growing.”

Any number of domestic businesses — from soap makers to auto suppliers — use industrial hemp in their products, but the hemp must be farmed overseas and imported. (Nearly every other industrialized country in the world already produces the crop.) The Frank-Paul bill, Steenstra said, “will return us to more rational times when the government regulated marijuana, but allowed farmers to continue raising industrial hemp just as they always had.”

The Obama administration has already shown some signs that it plans to move the country’s drug policy away from the “war on drugs” mentality that’s marked the last few decades. Support for the Frank/Paul bill would be another signal that it’s serious.

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The move hasn’t pleased drug reform advocates. Here’s a statement released this afternoon by the London-based International Drug Policy Consortium:

We have witnessed an almost total unwillingness to confront the real policy dilemmas and a series of increasingly surreal political and diplomatic battles over wording that are entirely disconnected from the reality of drug use and problems as experienced in the outside world.

The facts show that the political declaration is institutional self-deception on a grand scale and calls into question the competence of the CND [U.N. Commission on Narcotic Drugs] as the custodian of the international drug control system.

The declaration fails to address, in any meaningful way, the spread of HIV from injecting drug use. The evidence has clearly shown that harm reduction measures have reduced the spread of HIV infections and this approach has been tested and accepted by all the responsible multilateral health bodies. However, the CND has agreed on a declaration that simply ignores the facts.

Maybe a decade from now, Washington will have evolved.

President Barack Obama (WDCpix)

The Obama administration’s opposition to controversial drug treatment programs has helped kill a prominent global effort to prevent the spread of HIV/AIDS and other diseases among drug users.

Gathered in Vienna, members of the United Nations are drafting a nonbinding framework to guide the next decade’s international drug policy. The United States has rejected initial language promoting “harm reduction” measures, which include needle exchanges, safe injection facilities, drug substitution therapies and other programs designed to mitigate the damaging effects associated with illegal drug use. In doing so, the biggest U.N. contributor has, in effect, condemned certain drug abuse programs supported by some of its closest allies.

Illustration by: Matt Mahurin

Many countries — most in Europe, but also including Canada and Australia — have adopted some of these programs on their own, arguing that monitoring drug use not only offers a safer alternative to criminalizing it, but also provides a clearer path to treatment and recovery.

While the Obama White House has come out squarely in support of clean-syringe programs, it opposes the broader reference to harm reduction on the grounds of the term’s ambiguity. Largely due to U.S. opposition, no mention of either harm reduction or needle exchange will appear in the U.N. declaration, which is set to be finalized next week during a special meeting of the U.N. General Assembly. The document, to which no funds are attached, will next be updated in 2019.

The White House position is some indication that, despite early signals that the Obama administration intends to refocus the nation’s drug policies on public health, the decades-old law enforcement mentality — encapsulated by the Reagan-era “war on drugs” slogan — still rules the day in Washington.

Many health care advocates and human rights groups are blasting the administration’s stand against harm reduction, arguing that it represents a missed opportunity to approach drug abuse from the pragmatic angle that its eradication is a practical impossibility. Some blame an old-school thinking they say is embedded among senior State Department and other agency officials — holdovers from other administrations who view drug policy strictly through the lenses of law enforcement.

“Inertia took over,” said John Walsh, senior associate for drug policy at the Washington Office on Latin America, a human rights group. “The people in place have been adamantly opposed to harm reduction, and they’re the ones advising the White House what to do.”

In a statement explaining the White House opposition to harm reduction, Geoffrey R. Pyatt, deputy chief of the U.S. mission to the U.N. in Vienna, emphasized the administration’s support for needle exchange programs and “other evidence-based approaches to reduce the negative health and social consequences of drug abuse, including access to medication-assisted treatment for narcotic addiction.”

“However,” Pyatt continued, “the United States continues to believe that the term ‘harm reduction’ is ambiguous. It is interpreted by some to include practices that the United States does not wish to endorse.”

Such practices, according to State Department spokeswoman Laura Tischler, include drug legalization, drug consumption rooms, heroin prescription initiatives and programs to provide drug paraphernalia that has no tangible health benefit to the user.

Other opponents of harm reduction measures argue that they represent a slippery slope toward acceptance and greater drug use. The website for the Drug Free America Foundation, for example, urges policymakers to “reject ineffective harm reduction tactics that ask society to accept drug use or allege that drugs can be used safely or responsibly, creating the misunderstanding that drug use itself is not harmful and increasing addiction.”

Drug reform advocates are cheering the White House acceptance of needle exchanges, which marks a sharp break from two decades of federal policy. But they quickly add that, in opposing harm reduction, the administration didn’t go nearly far enough to fulfill its leadership role on the global stage.

“This is not the Bush administration,” said Rebecca Schleifer, advocate for the health and human rights division at Human Rights Watch. “But they have a long way to go before they really endorse evidence-based measures.”

Daniel Wolfe, director of the Open Society Institute’s harm reduction development program, was even more blunt. “They took a half step,” he said, “when a bold step was needed.”

The episode has also angered much of Europe, where many countries have already adopted some of the same harm reduction programs that the United States has come out against. The European Union, in near unanimity, had fought fervently to include harm reduction in the U.N. declaration.

To no avail.

An informal vote taken this week in Vienna by members of a U.N. narcotics panel found the United States siding with Russia, Japan, Iran and nine other countries in opposition to mentioning harm reduction in a footnote of the U.N. declaration. Following that straw poll vote, according to sources in the room, the panel chairwoman, representing Namibia, snipped the language from the document, and the debate was over.

One European delegate present during the vote called the episode “the best example of a morally bankrupt and systemically corrupt outcome that I have yet encountered in any political negotiation I have ever been in.”

At least five countries — Germany, the Netherlands, the United Kingdom, Portugal and Spain — have announced plans to submit a reservation to the declaration to protest the exclusion of the harm reduction clause. (Reservations, in this process, are symbolic gestures of discontent, published as an addendum to the official declaration but not appearing in the document itself.)

A number of studies indicate the protesters have some reason to be agitated. Three years after a safe injection facility opened in Vancouver in 2003, for example, researchers found that the experiment had reduced public drug use, publicly discarded syringes and needle sharing among local drug users. A similar study conducted around a heroin prescription facility in Montreal reached similar conclusions. Both studies found that there was no increase in drug trafficking or other drug-related crimes in the vicinity of the facilities.

Given the evidence, some advocates have questioned Pyatt’s reference to the United States “evidence-based approaches.”

“It’s almost as if they’re denying that any research outside of the U.S. is legitimate,” said Allan Clear, executive director of the Harm Reduction Coalition, an advocacy group.

There are other reasons that drug policy reformers are puzzled by the Obama administration’s sharp opposition to harm reduction. First, the United States is already on record endorsing the strategy. A 2006 U.N. declaration on HIV/AIDS urges countries to adopt a “wide range of prevention programmes” including “harm reduction efforts related to drug use.” The measure passed by a consensus of the General Assembly.

And second, the language in the declaration is nonbinding, meaning that it would neither force countries to adopt harm reduction programs, nor prevent them from doing so. Still, advocates are quick to point out that the absence of the harm reduction language means that no country will be encouraged to consider programs that have been proven to alleviate the ill side-effects of drug abuse. The importance of the language, Walsh said, is to “make it clearer that these programs and strategies are accepted.”

Figures tallied by the World Health Organization reveal the issue is much more than symbolic. WHO estimates that, worldwide, dirty drug needles cause 10 percent of all new HIV cases. In Eastern Europe and Central Asia, WHO says, the number rises to 80 percent. “WHO strongly supports harm reduction as an evidence based approach to HIV prevention, treatment and care for drug users,” the group’s Website reads.

The controversy has not eluded the watchful eyes of Congress. In January, several powerful Democrats wrote to Susan Rice, U.S. ambassador to the U.N., asking the administration to explain its resistance to harm reduction language in the UN declaration.

“We risk crafting a U.N. declaration that is at odds with our own national policies and interests, even as we needlessly alienate our nation’s allies in Europe,” wrote Reps. Henry Waxman (D-Calif.), Barbara Lee (D-Calif.) and Jose Serrano (D-N.Y.).

It’s unclear if Rice’s office responded to the lawmakers’ concerns. Calls this week to the offices of Waxman, Lee and Serrano were not returned.

The United States is not the sole reason that harm reduction was plucked from the UN’s drug policy manifesto. In the middle of February, the Vatican issued a statement arguing that, “So-called harm reduction leads to liberalisation of the use of drugs, to an increase in the number of addicted people and to blurring of consciences, leading also to the loss of one’s free will.”

The move caused Italy to announce its opposition as well, in effect breaking the E.U. block of support for harm reduction.

Still, the United States — which is far and away the most generous supplier of U.N. funding — holds considerable sway over U.N. deliberations. Observers contend that the White House could have pressured other members to accept the harm reduction strategy — if it chose to do so.

“The U.S. does tend to use its super-donor status to run the debate,” said Wolfe of the Open Society Institute. “This is not a unique story.”

Some health care and drug reform advocates have maintained a glimmer of hope that next week’s U.N. gathering will somehow find the harm reduction clause returned to the drug policy document. Many others, however, are resigned to accept the draft as it stands. And they’re not pleased with the content — nor the process that brought it about.

“It’s fair to say,” said Walsh of the Washington Office on Latin America, “that the document that comes out of the convention will not be a reflection of the actual debate.”

Flickr: Nick Atkins Photography

Bush-era envoys to the United Nations are trying to block global efforts to promote HIV/AIDS-prevention programs such as needle exchanges, according to health and human rights advocates who supplied documents of the negotiations. The envoys’ opposition runs directly counter to the stated position of President Obama, who supports lifting a ban on clean-syringe programs that’s existed in the United States for 20 years.

The saga unfolds as the members of the United Nations are busy drafting a non-binding declaration of global drug-policy goals for the next decade. Although a number of countries — many in the European Union — are pushing hard to include language promoting “harm reduction measures,” including syringe-exchange programs shown to prevent needle-born illness, the U.S. representatives have already lobbied that provision out, according to health and human rights groups familiar with the negotiations.

Illustration by: Matt Mahurin

The U.S. opposition is consistent with current federal policy, which prevents federal funding for needle exchange programs. But it remains curious because Obama supports a repeal of that ban.

The White House Website outlines Obama’s position directly, proclaiming that the president “supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users.”

The episode has attracted the attention of some congressional Democrats. In a Jan. 28 letter to U.S. Ambassador to the United Nations Susan Rice, Reps. Henry Waxman (D-Calif.), Barbara Lee (D-Calif.) and Jose Serrano (D-N.Y.) cite “an apparent disconnect in U.S. policy” as it pertains to efforts to promote needle exchange to fight HIV/AIDS.

“We understand that the U.S. delegation in Vienna has been actively blocking the efforts of some of our closest allies — including the European Union — to incorporate in the declaration reference to harm reduction measures, such as needle exchange,” the Democrats wrote. They’re urging that the delegation “should immediately be given new instructions from the highest levels of the new Administration.”

In an op-ed published this week, Allan Clear, executive director of the Harm Reduction Coalition, an advocacy group, provided one explanation why the U.S. ban has extended to the UN declaration despite Obama’s opposition to it.

“Our current U.S. delegation is primarily made up of State Department bureaucrats soldiering in the war on drugs,” Clear wrote. “They promote policies that have had dramatic negative consequences (intended and unintended) on the lives of drug users, their families and their communities but very little impact on reducing drug supply, consumption or cultivation.”

In a Jan. 1 letter to Obama, a group of 65 health groups and human rights advocates echoed that description. “The negotiators for the outgoing US administration,” the groups wrote, “are defending positions that will inhibit essential public health interventions in the many parts of the world where HIV epidemics are driven by drug injection.”

There’s not much time for the Obama team to act. The official U.N. meeting to finalize the draft — dubbed the U.N. General Assembly Special Session on drugs — will take place on March 12 and 13.

The State Department did not return calls for comment.

The U.S. ban on federal funding for needle exchange programs went into effect in 1988 and has been renewed each year since then as part of the appropriations process. Supporters of the ban argue that needle exchanges encourage drug use, and therefore Washington has no business funding them. Many opponents also reject the thought that taxpayers should subsidize the habits of drug users. After all, they argue, criminals should be imprisoned, not treated with government gifts.

But health and human rights groups reject those claims, arguing that if the government can’t prevent the use of drugs, it should at least take steps to ensure that the process is safe.

Many members of the medical community support needle-exchange programs. In 1998, Donna Shalala, health secretary under the Clinton administration, commissioned a report finding that such programs help prevent needle-born diseases while doing little to encourage drug use.

At the time, The San Francisco Chronicle quoted Harold Varmus, then-director of the National Institutes of Health and an author of the study, saying that, “An exhaustive review of the science indicates that needle exchange programs can be an effective component of the global effort to end the AIDS epidemic. Recent findings have strengthened the scientific evidence that needle exchange programs do not encourage the use of illegal drugs.”

No matter. Despite the report, the Clinton White House continued to deny federal funding for the syringe program, in effect extending the ban.

It seems poised to be extended overseas. A Jan. 15 draft version of the U.N. declaration includes language to “develop, review and strengthen” drug-treatment programs to include “harm reduction measures aiming at preventing and reducing the adverse health, social and economic consequences of drug use and dependence.” The U.S. representatives — along with those from Russia, Japan and Colombia — insisted the language be removed, according to John Walsh, senior associate for drug policy at the Washington Office on Latin America, a human-rights group.

Countries in support of harm reduction then moved the clause into a footnote. That, too, was rejected by the United States, Walsh said.

Supporters of the provision are wondering why the language — which is non-binding — remains so controversial. “We find it hard to understand how the U.S. delegation could object to language which would not obligate any country to adopt particular policies with which it disagrees,” the House Democrats wrote in their letter to Rice.

Even if the language is nonbinding, Walsh said, including it is an important way to signal that there’s no stigma attached to those programs.

“By excluding [the language],” Walsh said, “it says that the conventions don’t permit it. It castigates it. It makes it seem that there’s something wrong with doing it.”

Waxman, Lee and Serrano have already reintroduced legislation this year to eliminate the U.S. ban on needle exchange programs. With Obama in the White House and the Democrats controlling larger majorities in both congressional chambers, advocates are hopeful for success in 2009.

“This year, we have reason to think it might get somewhere,” Walsh said.

Whether the same will be true on the global stage is yet to be seen.

The coalition cites Ramstad’s past opposition to federal funding of needle exchange programs for intravenous drug users, as well as his opposition to legalized medical marijuana, and his failure to support eliminating sentencing disparities for crimes concerning crack and powder cocaine — which critics say disproportionately target African-Americans.

From the letter:

While we applaud Representative Ramstad for his courageous and steady support for expanding drug treatment access and improving addiction awareness, and honor his own personal and very public triumph over addiction, we have strong reservations about his candidacy for the drug czar position. In his twenty-eight years in the U.S. House, Representative Ramstad has consistently opposed policies that seek to reduce drug-related harm and create common ground on polarizing issues.

Representative Ramstad voted in 1998 in favor of making permanent the federal funding ban on syringe exchange, voted in 2000 to prohibit the District of Columbia from spending its own locally raised funds on syringe exchange programs and voted in 2007 against lifting the same DC ban, despite decades of research showing that syringe exchange programs reduce the spread of HIV/AIDS without increase drug use. Rep. Ramstad has also consistently opposed congressional efforts to stop the arrest of HIV/AIDS, cancer and other patients who use medical marijuana to ease their pain and suffering in states where it is legal.

Unlike you and Vice President-elect Biden, Rep. Ramstad has also failed to cosponsor any legislation eliminating the sentencing disparity between crack cocaine and powder cocaine, despite the fact that there were four different crack/powder reform bills before the U.S. House in the 110th Congress. A number of recent studies have found that long prison sentences are one factor driving disproportionate rates of HIV/AIDS infections in communities of color. A primary task of the next drug czar should be to deal with this and other issues related to overincarceration.

The coalition includes numerous AIDS-prevention and drug policy reform organizations.

Admittedly, I know almost nothing about Ramstad. If the letter accurately states his positions, he’s probably a poor choice to direct the new administration’s drug control policy.

However, if Obama is determined to put a bipartisan face on his anti-drug efforts, reformers may have several reasons to remain optimistic.

First, Obama and pending Senate confirmation, his nominee for attorney general, Eric Holder, are African-Americans who are very probably tuned in to the concerns of the black community regarding injustices within the legal system. Of course, this doesn’t necessarily mean they will be radical reformers, but they are certainly aware that the nation’s drug laws are a major reason black men are three times more likely to go to prison than college.

Second, Obama has publicly expressed his support for federal funding for needle exchange programs; legalized medical marijuana, albeit with conditions; and opposition to federal mandatory minimum sentences, like those that apply to crack cocaine — but no other illegal drug.

Finally, and most important, there is this comment Obama made Monday at a press conference in which he named his foreign policy team:

I will be setting policy as president. I will be responsible for the vision that this team carries out, and I expect them to implement that vision once decisions are made. As Harry Truman said, “The buck will stop with me.”

Presumably, this will apply to all aspects of the new administration’s domestic and foreign policy, including drug control.