Harm Reduction (STDW)

On this Mother's Day, more than 100,000 women are behind bars in American prisons, according to the Bureau of Justice Statistics, and many of them are doing time for drug offenses. That's too many, said members of a new coalition, Moms United to End the War on Drugs, as they held events last week in the days running up to Mother's Day.

[image:1 align:left caption:true]"The war on drugs is really a war on families," said Mom's United's Gretchen Burns Bergman. "It is time to end the stigmatization and criminalization of people who use drugs and move from arrest and mass incarceration to therapeutic, health-oriented strategies. Moms were the driving force in repealing alcohol prohibition and now moms will play a similar role in ending the war on drugs."

Bergman, from San Diego, is the mother of two sons who have struggled with substance abuse and incarceration and is a founder of A New PATH (Parents for Addiction Treatment & Healing). A New PATH has joined forces with other groups, including Law Enforcement Against Prohibition (LEAP), the NORML Women's Alliance, Families to Amend California's Three Strikes, and Students for Sensible Drug Policy to form Moms United to agitate for an end to the drug war and a turn toward sensible, evidence-based drug policies.

The week leading up to Mother's Day was a week of action under the rubric of Cops and Moms Working Together to End Prohibition. The week saw events and press conferences in Atlanta, Boston, New York City, and Washington, DC, in the East and Los Angeles, San Diego, Oakland on the West Coast. 

"Mother's Day was derived out of an intensely political effort to organize women on both sides of the Mason-Dixon Line against the Civil War," said Sabrina Fendrick, coordinator for the NORML Women's Alliance. "The reason mothers were made the vehicle was because they were the ones whose children were dying in that war. Women were also largely responsible for ending alcohol prohibition.  This is more than just a ‘greeting-card holiday,’ this is the beginning of an institutional change in our society. The government's war on drugs is unacceptable. For our children's sake, the concerned mothers of the world are being called on to demand the implementation of a rational, responsible, reality-based drug and marijuana policy."

Last Wednesday, at a San Diego press conference, the umbrella group unveiled the Moms United to End the War on Drugs Bill of Rights, a 12-point motherhood and drug reform manifesto which calls for "the right to nurture our offspring, and to advocate for their care and safety" and "the parental right to policies and practices that recognize addiction as a disease in need of treatment, rather than a willful behavior to be criminalized," as well as the right to have harm reduction and overdose prevention practices implemented, the right to be free from heavy-handed, constitution-threatening drug war policing, and the right to be free from drug war violence.

[image:2 align:right caption:true]"If we stop arresting and incarcerating drug users, think of the number of children who would have the chance to look upon their parents as positive role models instead of having parents who are absent because they are incarcerated," the group said. "We have a moral and ethical obligation to give these children a better chance in life by allowing parents to take care of their families. These parents should have the opportunity to become the productive members of society and role models to their children that they want to be and that their children need and deserve."

The Bill of Rights has been endorsed by a number of religious, reform, and civil rights groups, and individuals can sign onto it, too. To sign on, go to the online petition.

"We are building a movement to stop the stigmatization and criminalization of people who use drugs or are addicted to drugs," the group said. "We urgently call for health-oriented strategies and widespread drug policy reform in order to stop the irresponsible waste of dollars and resources, and the devastating loss of lives and liberty."

It's not just Moms United who is using Mother's Day to strike a blow for drug reform. In Colorado, where Amendment 64 to legalize and regulate marijuana is on the ballot, the Campaign to Regulate Marijuana Like Alcohol is running a television ad featuring a young woman writing an email to her mother in which she explains that she has found her marijuana use to be safer and healthier than the drinking she did in college.

The ad is aimed at a demographic that is both critical to and difficult for the campaign: women in their 30s and 40s, many of whom are mothers. The ad appeared Friday and again on Mother's Day.

“Our goal with the ad is to start a conversation — and encourage others to start their own conversations — about marijuana,” Betty Aldworth, the advocacy director for the campaign.

And it's not just the United States, either. In mother-honoring Mexico, which marked Mother's Day on Thursday, hundreds of women and other family members traveled to Mexico City on the National March for Dignity to demand that the government locate their loved ones gone missing in the drug wars, according to the Frontera NorteSur news service.

"They took them alive, and alive we want them," the marchers chanted.

While the drug wars in Mexico have claimed at least 50,000 lives, including 49 people whose dismembered bodies were found on a highway outside Monterrey Sunday morning, thousands more have gone missing, either simply vanished or last seen in the hands of armed, uniformed men.

The Mexican government doesn't report on how many have gone missing in its campaign against the cartels, but the Inter-American Human Rights Commission counts more than 5,000 missing persons complaints filed with police—and this in a country where many people so mistrust the police they don't bother to file official reports.

"For some it has been years, for others months or days, of walking alone, of clamoring in the desert of the hallways of indolent and irresponsible authorities, many of them directly responsible for disappearances or complicit with those who took our loved ones away," the mothers’ group said.

On Mother's Day, many mothers in Mexico have "nothing to celebrate," said Norma Ledezma, co-founder of Justice for Our Daughters in Chihuahua City. "As families, we want to take this occasion to tell society not to forget that in Mexico there is home with a plate and a seat empty."

"We have walked alone in the middle of stares and stigmatizing commentaries, and we have been treated like lepers,  marginalized and condemned to the worst pain a human being could live: not knowing the whereabouts of our sons and daughters," the new mother’s movement declared. "But now we are not alone. We have found hundreds of mothers and we unite our clamor and our love to recover our loved ones and bring them home."

On Mother's Day, the agony of the drug war transcends borders. And the call from mothers for a more sane and human alternative continues to grow, from Chihuahua to Chicago and from Oaxaca to Washington.

A long-awaited report from Canadian researchers is recommending that Toronto could use three supervised drug injection sites and Ottawa could use two. The report said the sites would be a good health care investment, would reduce drug use, and would reduce the rate of new HIV and hepatitis C infections.

[image:1 align:right caption:true]The study, the Toronto and Ottawa Supervised Consumption Assessment (TOSCA), did not make specific location recommendations for the sites, saying that should be left up to the cities themselves, should they decided to follow the recommendations.

"Supervised injection facilities in Toronto have the potential to offer meaningful improvements for the health of people who use drugs," said the study's co-principal investigator, Dr. Ahmed Bayoumi from the Center for Research on Inner City Health at St. Michael's Hospital. "The facilities could also make neighborhoods where drug use is common more livable."

But within hours after the study was released, some Toronto elected officials were expressing hesitation.

Deputy Mayor Doug Holyday told the Toronto Star local official need to see all the "facts and figures" behind the study before they decide to approve a safe-injection site. "I have some doubts as to whether or not there is real benefit and whether or not you don't just attract more problems so I would like to really get the thorough results of other places that have done this and I'd like to hear from other experts on the matter," he said.

"There has not been enough research done on the topic in Toronto -- whether that is the way to go with Toronto," echoed Councillor John Filion, chair of the city's board of health, which will consider TOSCA's recommendations.

Toronto Police Chief Bill Blair told reporters late Wednesday that he opposes supervised injection sites, a stance that TOSCA noted in its report. "My concern is there need to be sufficient assurances within the community that the quality of life will not be put in jeopardy," Blair said.

But not everyone at City Hall was so hesitant. There is already ample evidence of the benefits of supervised injection sites, Councillor Gord Perks, chair of the Toronto Drug Strategy Implementation Task Force, told the Star.

"We have today in front of us research that shows there are lives to be saved, money to be saved and neighborhoods to be improved," said Perks. "When you have differing views you go to the evidence, and the evidence is clear -- supervised injection sites save money, save lives and improve the quality of our neighborhoods."

The province of Ontario said it was open to evidence, but had no immediate plans to move forward.

"We are always prepared to listen to good advice, and we make our decisions based on evidence," Health Minister Deb Mathews said in a written statement Wednesday. "Experts continue to be divided on the value of the sites. We have no plans to pursue supervised sites at this time."

Canada's only operating supervised injection site is InSite in Vancouver. It is operating under an exemption from Canada's drug laws, much to the chagrin of the Conservative national government. Any future supervised injections sites would have to win similar exemptions. But at this point, worrying about that seems premature.

In just a couple of days, President Obama will fly to Cartagena, Colombia, to attend this weekend's Organization of American States (OAS) Sixth Summit of the Americas. He and the US delegation are going to get an earful of criticism of US drug policies from Latin American leaders, and that makes it an historic occasion. For the first time, alternatives to drug prohibition are going to be on the agenda at a gathering of hemispheric heads of state.

[image:1 align:left caption:true]It's been building for some time now. More than a decade ago, Uruguayan President Jorge Batlle became the first Latin American sitting head of state to call for a discussion of drug legalization. Former Mexican President Vicente Fox joined the call, albeit only briefly while still in office through some media quotes, much more frequently after leaving office in 2006. Honduran President Manuel Zelaya issued a similar call in 2008, but didn't move on it before being overthrown in a coup the following year.

Meanwhile, drug prohibition-related violence in Mexico exploded in the years since President Felipe Calderon called out the army after taking office in December 2006. As the savagery of the multi-sided Mexican drug wars intensified and the death toll accelerated, surpassing 50,000 by the end of last year, the call for another path grew ever louder and more insistent.

In 2009, a group of very prominent Latin American political leaders and public intellectuals led by former Brazilian President Henrique Cardoso, former Colombian President Cesar Gaviria, and former Mexican President Ernesto Zedillo formed the Latin American Commission on Drugs and Democracy, calling for a fundamental reexamination of drug policy in the hemisphere and a discussion of alternatives, including decriminalization and regulation of black markets. That was followed last year by the Global Commission on Drug Policy, which includes the Latin American ex-presidents, as well as former Switzerland President Ruth Dreiffus and other prominent citizens such as Richard Branson and former UN Secretary General Kofi Annan, echoing the Latin American Commission's call for reform.

As the commissions issued their reports, the violence in Mexico not only worsened, it spread south into Central America, where governments were weaker, poverty more endemic, and violent street gangs already well-entrenched. Guatemala, Honduras, and El Salvador, in particular, saw homicide rates soar in recent years, well beyond Mexico's, as the Mexican cartels moved into the region, a key transit point on the cocaine trail from South America to the insatiable consumers of the north.

Colombian President Juan Manuel Santos, the secretary of defense under his predecessor, Alvaro Uribe, and a man who knows well just what a sustained war on drugs can and cannot achieve, has been among the latest to pick up the torch of drug reform. Santos has made repeated statements in favor of putting alternatives to prohibition on the table, although he has been careful to say Colombia doesn't want to go it alone, and now he has been joined by another unlikely reformer, Guatemalan President Otto Perez Molina, a rightist former general who campaigned on a tough on crime agenda.

It is Perez Molina who has been most active in recent weeks, calling for a Central American summit last month to discuss alternatives to drug prohibition ranging from decriminalization to regulated drug transit corridors to charging the US a "tax" on seized drugs. That summit saw two of his regional colleagues attend, Costa Rican President Laura Chinchilla and Panamian President Ricardo Martinelli, but no consensus was achieved, no declaration was issued, and three other regional leaders declined to show up. But that summit, too, was a first -- the first time Latin American leaders met specifically to discuss regional drug law reform.

All of this has not gone unnoticed by policymakers in Washington. Vice-President Biden, Homeland Security Secretary Napolitano, State Department functionaries and US military brass have all been flying south this year, reluctantly conceding that drug legalization may be a legitimate topic of debate, but that the US is having none of it.

"It's worth discussing," Biden told reporters in Mexico City last month. "But there's no possibility the Obama-Biden administration will change its policy on legalization. There are more problems with legalization than non-legalization."

But along with discussing an end to prohibition, the Latin Americans have also offered up proposals between the polar opposites of prohibition and legalization. Options discussed have included decriminalization of drug possession and marijuana legalization to different approaches to combating the drug trade to maintaining addicts with a regulated drug supply. In Colombia, Santos has sponsored legislation to decriminalize possession of "personal dose" quantities of drugs, restoring a policy mandated by the country's Constitutional Court but undone by a constitutional amendment under President Uribe.

And it's not just Latin American political leaders. The calls for change at the top are reflected in a civil society movement for drug reform that has been quietly percolating for years. In fact, an international, but mainly Latin American, group of non-governmental organizations this week issued an Open Letter to the Presidents of the Americas calling for decriminalizing drug use and possession, alternatives to incarceration for non-serious drug offenses, a regulated market for marijuana, a public health approach to problematic drug use, alternative development, respect for traditional uses, and a more focused war on organized crime that is less broadly repressive than current models. In Mexico, a social movement led by poet Javier Sicilia, whose son fell victim to cartel violence, has called for an end to the violence and pressed Preident Calderon on drug reform.

After decades of US-imposed drug war, from US military operations in Bolivia in the 1980s to the multi-billion dollar Plan Colombia, with its counterinsurgency and aerial herbicide spraying, to the blood-stained Mexican border towns and the drug gang-ridden slums of Rio de Janeiro, Latin America is growing increasingly ready to strike out on a different path.

That's what awaits President Obama and the US delegation in Cartagena. The most vibrant discussions may well take place in hallways or behind closed doors, but the US is now faced with yawning cracks in its decades-long drug war consensus.

[image:2 align:right caption:true]"It's very clear that we may be reaching a point of critical mass where a sufficient number of people are raising the questions of why not dialog on this issue, why not discuss it, why peremptorily dismiss it, why does the president laugh when the subject of drugs is brought up, is he so archly political that it becomes a sort of diabolical act to seriously discuss it, why isn't some new direction being ventured forth?" said Larry Birns, executive director of the Council on Hemispheric Affairs.

"It seems the public is approaching the point where it has become credible to say quite frankly that the drug war hasn't worked. The real menace to society is not so much legalization but the failure to confront the hard fact that after decades of effort and hundreds of billions of dollars, a successful prohibition strategy has not been created, nor is there any likelihood of it being created," he said.

"This is the first major gathering of heads of state at which alternatives to prohibitionist drug control policies, including decriminalization and legal regulation of currently illegal drugs, will be on the agenda," said Ethan Nadelmann, head of the Drug Policy Alliance. "Arguments that were articulated just five years ago primarily by intellectuals and activists, and three years ago by former presidents, are now being advanced, with growing sophistication and nuance, by current presidents. There is now, for the first time, a critical mass of support in the Americas that ensures that this burgeoning debate will no longer be suppressed."

"A lot of countries don't want to do the US's dirty work anymore -- enforcing the prohibitionist policies that are unenforceable and hypocritical," said Laura Carlson, director for Latin America rights and security in the Americas program at the Center for International Policy. "Everybody knows that it's impossible to wipe out the illicit drug business without making it legal, and most people know that the efforts aimed at ostensibly doing that are not 100% honest and certainly not effective. Many Latin American countries don't want the degree of US intervention in their national security that the drug war entails either," she noted.

"Having said that, the US government is determined to put down any talk of alternatives and particularly alternatives that begin with regulation rather than prohibition. The recent visits of Napolitano, Biden, [US State Department Assistant Secretary for the Bureau of International Narcotics and Law Enforcement Affairs William] Brownfield and the military leaders all carried that message," the Mexico City-based analyst continued. "Small and dependent countries -- El Salvador is the example here, after reversing its position on legalization -- are afraid to stand up to the US on this, and progressive countries don't seem to want to get involved, both because they find the issue a political hot potato and because they are focusing efforts on strengthening alternative organizations to the OAS."

"I think the US strategy of Brownfield and the State Department will be to say that legalization was brought up and rejected by the Latin American leaders," offered Sanho Tree, director of the Drug Policy Project at the Institute for Policy Studies. "They will use dichotomous rhetoric, they will try to maneuver the discussion into either prohibition or heroin in vending machines, but this is about the whole spectrum of regulatory possibilities. That's what we need to be talking about instead of that false dichotomy."

Still, to even deign to discuss policy alternatives to prohibition is a notable step forward for the US, even if it is only to dismiss them, Nadelmann argued.

"The shift in the public posture of the US government -- from rejecting any discussion of legalization to acknowledging that 'it is a legitimate subject of debate' -- is significant, notwithstanding the clear caveat by the Obama administration that it remains firmly opposed to the notion," he noted. "That said, it is safe to assume that the US government will do all it can to suppress, ignore, distort and otherwise derail the emerging dialog.  US officials are handicapped, however, by the remarkable failure of government agencies over the past thirty years to contemplate, much less evaluate, alternative drug control strategies. They also must contend with the fact that the United States has rapidly emerged -- at the level of civil society, public opinion and state government -- as a global leader in reform of marijuana policies."

The discussion on drug policy at Cartagena isn't taking place in a vacuum, and there is at least one other issue where the US finds itself at odds with its host and most of the region: Cuba. The US has once again insisted that Cuba not be allowed to attend the summit, and President Santos reluctantly acceded, but the whole affair leaves a sour taste in the mouth of Latin Americans. Ecuadorian President Correa is not coming because of the snub, and the issue only plays into hemispheric discontent with Washington's war on drugs.

"The US won the day in persuading Santos not to invite Cuba," said Birns, "but the political cost of that action is high, and the whole drug issue is twinned to it, not because Castro has an enlightened position on drugs, but because of anti-Americanism in the region. This means Cartagena is the city where a lethal blow against the status quo will be achieved."

"The United States is not going to listen," said Birns, "but this era of non-discussion of drug legalization and refusal to countenance the possibility of dialog on the issue may be coming to an end. More and more people who aren't known as drug reform crusaders are coming forth and saying it's not working, that we need another approach, and that's probably decriminalization and legalization. We're very much closer to liberation on this issue than we've ever been before."

"Liberation" may now be within sight, but diplomatic dissent is not yet close to being translated into paradigmatic policy shifts. Whatever discussion does take place in Cartagena this weekend, don't expect any official breakthroughs or even declarations, said Carlson.

"I am not optimistic about there being any formal commitment, or perhaps even mention, of legalization per se," she said. "The implementation group for the Sixth Summit is already working on the final declaration and it contains a section on 'Citizen Security and Transnational Organized Crime.' I think that as far as it will go is to state that transnational organized crime is a growing problem and that the nations of the Americas agree to work together, blah, blah, blah," she predicted.

"The United States will reiterate its 'shared responsibility' and commitment, but will not mention the need to change a failed model," Carlson said. "There will be more rhetorical emphasis on social programs for 'resilient communities' and especially on police and judicial reform, although the former will not be reflected in what are largely military and police budgets. I think the best we can hope would be a mandate for a policy review and a commitment to continue to discuss alternatives. The specific proposals to legalize transit, to create a regional court for organized crime cases and US payment for interdictions will not likely be resolved."

"This is a long process, not an immediate objective," said Tree. "In Central America, it's going to take a year or two of thoughtful -- not sensational -- media coverage. When people see anarchy, they want order. With a more thoughtful dialog, we can begin to get traction."

"It is too soon to predict that this Summit of the Americas represents any sort of tipping point in global or even regional drug control policy," Nadelmann summed up. "But the odds are good that this gathering will one day be viewed as a pivotal moment in the transformation from the failed global drug prohibition regime of the twentieth century to a new 21st century global drug control regime better grounded in science, health, fiscal prudence and human rights."

We'll see what happens this weekend, but at the very least, the taboo on serious discussion of reforming the drug prohibition regime at the highest levels has been shattered. Look for a report on the summit itself next week.

After 20 years of walking in the political wilderness, public health and harm reduction advocates for federal funding for needle exchange programs made it to the Promised Land in December 2009, when the Democratic-controlled Congress overturned the longstanding funding ban. But just two years later, led by the Republican-controlled House and with the acquiescence of the Democratic-controlled Senate, Congress reinstated the ban in its 2012 federal omnibus spending bill.

[image:1 align:left caption:true]Advocates were outraged and dismayed by the congressional action, but are determined to fight back to restore funding for a harm reduction practice repeatedly proven to save lives and reduce the spread of infectious blood-borne diseases, such as HIV/AIDS and hepatitis C. This week, they came out swinging with a national day of action Wednesday that saw organized call-ins to members of Congress and civil disobedience actions leading to dozens of arrests at the offices of four of them, as well as actions in a dozen others cities across the county.

Although the funding ban's main proponents are Republicans, repealing the ban is actually the states' rights, deregulation position. Each year the federal government authorizes funding for grants to states to be used for AIDS prevention and treatment. When the ban was temporarily lifted, it neither increased nor decreased the amount of AIDS funding, but it meant that states could choose for themselves whether or not to use some of those funds to support needle exchange programs.

The activists have science and the evidence on their side. The Centers for Disease Control and Prevention (CDC), American Medical Association, National Academy of Sciences, American Public Health Association, and numerous other scientific bodies have found that syringe exchange programs are highly effective at preventing the spread of HIV/AIDS and other infectious diseases. Eight federal reports have found that increasing access to sterile syringes saves lives without increasing drug use.

More than 200 needle exchange programs operate across the country in cooperation with local law enforcement officials and health departments, but many are in danger of closing their doors or cutting back services without access to federal funds. That puts lives and the public health at risk.

Needle exchange supporters said the restored the ban will result in thousands of Americans contracting HIV/AIDS, hepatitis C or other infectious diseases next year alone. According to the Harm Reduction Coalition (HRC), needle sharing by injection drug users accounts for 8,000 new cases of HIV and 15,000 new cases of hepatitis C each year. In New York City, there has been a 75% reduction in new HIV cases as a result of instituting such programs, according to a 2005 study cited by HRC.

"We need Congress to stand behind public health and science, and declare a cease-fire on syringe exchange," said HRC executive director Allan Clear. "All of the research tells the same story: Syringe exchange prevents infections, promotes drug treatment, and reduces drug use. Congress must stop treating syringe exchange as an ideological pawn in partisan politics."

"The federal syringe funding ban was costly in both human and fiscal terms -- it is outrageous that Congress has restored it given how overwhelming and clear the science is in support of making sterile syringes widely available," said Bill Piper, director of national affairs for the Drug Policy Alliance. "Make no mistake about it -- members of Congress who supported this ban have put the lives of their constituents in jeopardy."

[image:2 align:right caption:true]The renewed ban on federal funding for needle exchanges couldn't come at a more inopportune time. With a wave of drug users who began their careers with opioid pain pills finding succor in the needle, making access to clean needles more difficult is likely to make matters worse.

"We need to support syringe exchange programs now more than ever," said HRC policy director Daniel Raymond. "Health officials in many states report a disturbing new trend of hepatitis C outbreaks in young people, driven by a new wave of injection drug use linked to the prescription painkiller epidemic. We're in danger of starving programs of federal funds, just when the demand for syringe exchange is increasing."

In Washington, while a coordinated campaign of phone calling kept the congressional switchboard humming, dozens of AIDS and harm reduction activists went to Capitol Hill and held sit-ins at the offices of four House Republicans, including Speaker John Boehner (R-OH), Rep. Denny Rehberg (R-MT), Mike Rogers (R-MI) and Eric Cantor (R-VA) for their role in reinstating the ban on federal funding for syringe exchange programs last December.

Carrying signs reading "Syringe Exchange: A Fix for AIDS," the activists chanted and blocked doorways before being arrested by Capitol Police. They were expected to be booked and released later Wednesday.

At least 32 people were arrested at Congress, according to Housing Works, a New York City-based group that provides services for AIDS sufferers. Housing Works participated in the action as part of the We Can End AIDS Coalition, an umbrella group coordinating a July 24 mass protest in Washington around economic justice and human rights for AIDS patients.

"Our government should be embarrassed as this year's host of the International AIDS Conference to have sneaked this into an unrelated bill under the cloak of night last December," said Housing Works CEO Charles King. "The US cannot be any shining example to the rest of the world on how to end the AIDS epidemic when we’re still fighting foolish policies that reject what we know works."

Wednesday's action was only an opening skirmish in what will be a determined battle to restore the federal funds. The AIDS, public health, and harm reduction communities are not going to just roll over and play dead while Congress makes decisions that will result in real people becoming really dead.

"We refuse to let the close-mindedness of anti-science conservatives dictate public health policy," said Clear. "We can't afford these political games, and we can't afford any more new infections. Our communities are struggling; Congress needs to listen and show leadership by rescinding the funding ban."