NEW YORK (Reuters Health) - There is no one-size-fits-all explanation for why teenagers take up smoking, hint findings of a Canadian study.
Therefore, focusing on one single risk factor is not likely to help adolescents resist peer pressure to smoke, or help advance the understanding of why young people smoke, Dr. Jennifer O'Loughlin and colleagues report in the American Journal of Epidemiology.
O'Loughlin, at the University of Montreal in Quebec, therefore suggests that efforts to prevent smoking should take into account "individual-level factors such as age, self-esteem, alcohol use, and academic success." Those involved should also bear in mind "contextual factors such as smoking in parents and friends, and school smoking policies," she told Reuters Health in email correspondence.
Her group investigated how numerous factors altered smoking initiation among 877 students (half male), who were pushing 13 years of age at the start of the study and had never smoked.
Every 3 months for the next 5 years, the researchers surveyed students' smoking habits and other factors potentially linked with starting to smoke. During this period, 421 (48 percent) of the students started smoking, and 87 (21% of these) took up daily smoking.
Living in a single-parent family and poor academic performance in school all increased smoking risk. Using alcohol and other tobacco products upped risk nearly 3- and 5-fold.
Having siblings and friends who smoked raised an adolescent's risk for smoking about 2- and 3-fold. Having a parent or teachers and school staff who smoked increased the risk of beginning to smoke by about half or more.
Feeling the need for a cigarette raised smoking risk 6-fold. Adolescents who felt stressed, acted impulsively, and showed susceptibility to tobacco advertising were also more likely to begin smoking.
By contrast, gender, parents' education, feelings of depression, worry about weight or being overweight, seeking novel experiences, physical activity or playing sports, and television watching were some of the factors not linked with increased risk.
Prevention and cessation programs that target social, home, and school smoking, as well as tobacco advertising, may have a positive impact on adolescent smoking, O'Loughlin and colleagues surmise. They call for further investigations into factors linking alcohol use and smoking, and genetic variables tied to smoking risk.
SOURCE: American Journal of Epidemiology, September 1, 2009.
Frequent binge drinking has increased over the last decade at colleges with the biggest drinking problems, demonstrating the lack of progress these schools have made in addressing underage and excessive alcohol use, Science Daily reported Sept. 11.
Researchers focused on 18 colleges identified in 1993 as having especially bad problems with student drinking. A 2005 followup found that frequent binge drinking at the schools rose from 28 percent of students in 1993 to 32 percent in 2005. Overall binge-drinking rates declined over the decade, but only slightly -- from 58 percent to 56 percent.
In both 1993 and 2005, the overwhelming majority of students said they drank alcohol, and rates of consumption, drunk driving, unprotected sex after drinking, and alcohol-related injuries barely budged over the study period.
Opiate-replacement therapy (ORT) such as methadone and buprenorphine are available in only about half of all federal and state prison systems, and just 23 states provide referrals to addiction treatment upon release from prison, according to new research.
Medical News Today reported Sept. 9 that researchers from Miriam Hospital, Brown University and the Center for Prisoner Health and Human Rights said that both the World Health Organization and the U.S. Centers for Disease Control and Prevention recommend that prisoners be offered ORT, which the study authors described as a proven and cost-effective intervention.
"Improving correctional policies for addiction treatment could dramatically improve prisoner and community health as well as reduce both taxpayer burden and reincarceration rates," said lead study author Amy Nunn of Brown University.
Researchers surveyed the medical directors of all 50 state corrections systems as well as the District of Columbia and their counterparts in the federal prison system. They found that 55 percent of systems offer methadone to some degree, although only to certain populations in some cases, and 45 percent offer post-release linkages to community-based methadone programs. Only 14 percent of prison systems provide buprenorphine, while 29 percent link to post-release buprenorphine treatment.
Most health officials at prison systems that didn't offer ORT said they preferred drug-free detoxification, while others cited security concerns. Significant numbers also admitted ignorance about the efficacy of methadone and buprenorphine. "Our interviews with prison medical directors suggest that changing these policies may require an enormous cultural shift within correctional systems," said Nunn.
Announcement from Purple Ribbons for Overdose Prevention
Dear Friends and Colleagues:
Please read and support the following announcement regarding a documentary film being made about the importance of passing the Good Samaritan 9-1-1 laws. These laws provide legal protection for people who call for medical help in the event of a drug overdose. They save lives! The filmmaker is looking for family members in Southern California who have lost a loved one to overdose and would be willing to speak about the experience in the film.
This is just one other way that we can use our experience and relationships to support the paradigm shift taking place toward a more humane, just, compassionate social response to the problems associated with drug use in the country. Please be an active part in moving the paradigm forward.
Thank you for all that you do.
Andrew Tatarsky, PhD
Harm Reduction Psychotherapy and Training Associates
303 Fifth Avenue, Suite 1403
New York, NY 10016
212-633-8157
www.andrewtatarsky.com
I know many of you have lost children and spouses to accidental drug overdose, and I know many of you believe that a call to 911 or a shot of naloxone could have saved your loved one. A documentary filmmaker approached me, asking if I could help him locate a family member in Southern California to interview for his upcoming film about international drug policies.
He would like to interview a family member who believes that the US needs uniform Good Samaritan 9-1-1 laws, to protect & encourage people to call for help if they witness someone overdosing. We know that many people hesitate or fail to call for help because of fear of arrest for drug possession and that Good Samaritan 9-1-1 laws would put an end to that.
If you lost your son, daughter or spouse to overdose and believe that no one should ever be punished or penalized for calling 911 to save a life--and that naloxone should be made readily available to people at risk of opiate overdose--and you are willing to be interviewed for this important new film, please contact me immediately. This is an incredible project, involving some of the most important political voices from around the world!
If you aren't available to be interviewed for the film, but would be interested in telling your story to other members of the press, please let me know.
Email me: mralston@drugpolicy or send a message to me on Facebook. Visit www.drugpolicy.org/overdose to learn more about the issues & get involved. Thank you!
Meghan Ralston
Cause Creator
The Harm Reduction and Mental Health Project: September Presentation
Talk Presented to The Harm Reduction and Mental Health Project
By Andrew Tatarsky, PhD
September 25, 2009
3:00-4:30 PM
New York University
6 Washington Place
Room 551, NYC
Since my last writing I have been doing an increased amount of training around the US and overseas in Poland, Austria, Chile and Ukraine. These experiences
have facilitated the evolution of my thinking about IHRP and well as introduced me to some amazing like-minded colleagues around the world.
In this meeting I will share some of these experiences to give participants an update on the state of harm reduction therapy around the world. I will also
share with you recent developments in my own thinking and work.
This workshop will outline my approach to Integrative Harm Reduction Psychotherapy. IHRD is based on a multifaceted view of problem substance use as
reflecting the interplay of biology, personal and interpersonal dynamics and social context. IHRD integrates a relational psychoanalytic approach with
active skills building to support positive changes in substance use and related issues.
We will explore:
A psychobiosocial process view of addiction
The multiple meanings of substance use as points of engagement
How to use these ideas to create a collaborative, negotiated therapeutic alliance
IHRD’s 7 therapeutic tasks with emphasis on process and technique
I look forward to a spirited sharing of experiences….
Dr. Andrew Tatarsky has specialized in the field of substance use treatment for over 25 years as supervisor, program director, trainer and author. He holds a
doctorate in clinical psychology from the City University of New York and is a candidate in New York University’s Post-doctoral program. Co-Director of Harm
Reduction Psychotherapy and Training Associates; founding board member, Division on Addictions of NYSPA, and founding board member, Association for Harm
Reduction Therapy. His book, Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems, has been published in the United States and Poland.
Dr. Tatarsky is in private practice in New York City and trains nationally and internationally.
When: September 25, 2009; 3:00-4:30 PM
Where: New York University, 6 Washington Place, Room 551, NYC
The members of the Harm Reduction and Mental Health Project organizing committee are: Michele Stocknoff, LMSW (mstocknoff@hotmail.com), Kathryn Grooms, LMSW
(kathryn@kathryngrooms.com), and Scott Kellogg, PhD (scott.kellogg@nyu.edu)
Scott Kellogg, PhD
Department of Psychology
Faculty of Arts and Sciences
New York University
6 Washington Place, Room 403
New York, NY 10003
A new study from the American Heart Association finds that smoking as few as three cigarettes daily raises the risk of cardiovascular disease by 65 percent, WVNS-TV reported Sept. 1.
Secondhand-smoke exposure raises the risk of dying from cardiovascular disease 20-30 percent, the study also found.
Researchers from Brigham Young University also looked at the risk of illness from other forms of air pollution, WebMD reported Sept. 1.
"It doesn't require extreme exposure to have significant cardiovascular effects. Even passive exposures to ambient air pollution and secondhand smoke contribute to significant increases in cardiovascular mortality," said study author C. Arden Pope III, Ph.D. "A critical finding of our study is that smoking is unhealthy even at small amounts. Reducing the amount one smokes does some good, but the biggest benefits come from stopping completely."
Smoking half a pack of cigarettes raised the risk of dying from heart disease by 79 percent, the researchers found, while smoking a pack a day increased the risk 100 percent.
The study appears in the August 2009 issue of the journal Circulation.
A study from Europe finds that the much-lamented "beer belly" isn't necessarily from drinking beer per se, but rather a consequence of binge drinking regardless of alcohol type.
WebMD reported Sept. 2 that a study of more than 28,000 middle-aged men and women found that those who were monthly binge drinkers (defined as consuming 80 grams of alcohol at a sitting, the equivalent of a six pack of beer) had average waistlines a half-inch bigger than those who drank the same amount of alcohol during the course of an entire week.
Beer drinkers weren't any more apt to sport a "beer belly" than consumers of other types of alcohol, according to researcher Martin Bobak of University College London and colleagues. Bingers had more body fat than non-bingers even if their overall weight was the same.
"Abdominal obesity is an important risk factor for diabetes and for cardiovascular disease," Bobak noted. "The finding that binge drinking is related to abdominal obesity is therefore important for our understanding of the link between heavy drinking and these diseases."
A new survey finds that 23 percent of teens say they can get marijuana within an hour and that prescription drugs are easier to obtain than beer -- findings echoed in stories from young drug users themselves.
In an Aug. 26 article, CNN interviewed youths whose experiences mirrored the major findings in the National Center on Addiction and Substance Abuse at Columbia University's 14th annual Teen Survey. While looking for Pop Tarts at a friend's house, Jessi Danner, then only 10, found a bag of cocaine in a drawer. "There's this little baggie and she's like, 'I have seen this in movies. You shove it up your nose' – and so that's what we did," recalled Danner.
Danner, who became addicted, is now in the final stage of treatment at Vanguard Services in Virginia.
Similarly, Daniel Buruca was only 9 when he started using LSD. Devon Kennedy was in the 9th grade when she started using amphetamines and then quickly progressed to using cocaine and heroin.
Kennedy, who grew up in a Washington suburb, said she had no problems finding drugs at a young age.
"Every time I went to someone's house, the first thing I said was I had to go to the bathroom and I went to the bathroom cabinets and there would always be something in there. Everywhere you went, somebody had a parent who had something," said Kennedy.
The CASA survey found that the number of teens who say it is easier to buy marijuana than cigarettes or beer has increased by 37 percent since 2007, and two-thirds of teens surveyed said drugs are used, kept or sold in their high school.
Debbie Taylor, Vanguard's president and CEO, said parents should ask pediatricians to give their kids drug tests during their yearly physicals so any problems can be spotted right away. "Children go so quickly into an adaptive and addictive phase that it's very difficult to reel them back at that point," said Taylor.
About 30 percent of college students have smoked tobacco from a hookah, or water pipe, and some college athletes are more likely than non-athletes to smoke a hookah despite the fact that athletes are typically less likely to smoke cigarettes.
Medical News Today reported Aug. 27 that researchers from the University of Pittsburgh found that while varsity athletes were 22 percent less likely than non-athletes to smoke a water pipe, club and intramural athletes were 15 percent more likely to do so than their non-athlete peers.
"Varsity athletes may be particularly cautious with any type of substance use because of the demands of their sport and the seriousness of their athletic commitment," said study author Brian Primack, M.D., of the Pitt School of Medicine. "But club and intramural athletes clearly perceive this as a safer form of tobacco use. We in public health need to impress upon them that it is not."
Occasional teen smokers whose parents smoke and provide minimal supervision have a 71-percent chance of becoming daily smokers, while children of nonsmokers who are closely supervised face just a 31-percent chance of becoming addicted to cigarettes, according to a new study.
Reuters reported Aug. 26 that researchers who tracked 270 teens who smoked occasionally before high school found that 58 percent of the study subjects became daily smokers by their senior year. The smoking habits of parents and friends had a strong influence on whether the teens kept smoking or not, the authors said.
Lead researcher Min Jung Kim of the University of Washington said that parents can break their teens' progression from occasional to addicted smoker by quitting themselves and engaging in "effective supervision and appropriate punishment or rewards for children's behavior."
The study was published in the September 2009 issue of the journal Pediatrics.
Supervision and Training in Integrative Harm Reduction Psychotherapy, Fall 2009
Monthly Supervision Group on Integrative Harm Reduction Psychotherapy (IHRP) for Professionals Starting October 5, 2009
This group provides training and case supervision in my approach to Integrative Harm Reduction Psychotherapy for people with drug and alcohol concerns. Substance use problems are understood as being intertwined with the unique complexity of the person in context. IHRP is based on an integration of relational psychoanalytic and cognitive-behavioral theory and technique. IHRP blends a skills building focus on cognitive and behavioral change with an exploration of the multiple meanings and functions of substance use and other risk behaviors in the context of a therapeutic relationship that anchors the process and is also an agent of change.
The harm reduction principles that inform this approach are: meeting the patient as a unique individual, the primacy of the therapeutic alliance, abandoning the abstinence requirement and any other preconceived agenda for the patient, special attention to social, personal and induced countertransference, working collaboratively to assess and identify problems, clarify goals and strategies that best suit the patient's needs, recognizing small incremental positive change as success and meeting the patient with empathy, respect, acceptance and flexibility. In this spirit the form, structure and timing of the therapy emerge out of the therapeutic process rather than being predetermined.
The group will combine topical presentations, case presentation with selected readings as appropriate to the members.
Fee: $60.00 The group meets currently on a monthly basis on Mondays, 12-1:30 PM. It may meet more frequently if there is interest.
November 21, 2009
Treating Drug and Alcohol Users in Your Practice: Rationale, Theory and Technique of Integrative Harm Reduction Psychotherapy
A one-day introductory training at:
The Training Institute for Mental Health
115 W. 27th Street
New York, NY
To Register: 212-627-8181
December 11, 2009
Effective Psychotherapy with Drug and Alcohol Users in Your Practice: Rationale, Theory and Technique of Integrative Harm Reduction Psychotherapy
A one-day training at:
The Albert Ellis Institute
45 East 65th Street
New York, NY
To register call: 212-535-0822 and tell them Andrew Tatarsky told you about the training…
Integrative Harm Reduction Psychotherapy Workshops and Trainings
Over the last several years I have been offering workshops and trainings in the U.S. and internationally for groups that wish to get a deeper immersion in harm reduction philosophy, it’s epidemiological and outcome research support, theoretical basis and applications to psychotherapy and counseling. This approach integrates a skills building focus to cognitive and behavioral change with an exploration of the multiple meanings and functions of substance use and other risk behaviors in the context of a therapeutic relationship the anchors the process and is also an agent of change. There is an emphasis on group participation and learning both theory and technique. Trainings are delivered in the collaborative spirit of harm reduction. These trainings can be delivered from half day to five full day formats depending on the needs of the group. Trainings can be tailored to the specific needs of the agency and client population.
Modules include:
History and Evolution of Harm Reduction Philosophy and History
Clinical Challenges and Limitations of Traditional Treatment
Clinical and Epidemiological Rationales for Harm Reduction Psychotherapy
Theoretical Basis of Harm Reduction Psychotherapy
Biopsychosocial Process Model of Addiction
Multiple Meanings of Drug Use
Motivational Stages of Change
Clinical Philosophy of Harm Reduction Psychotherapy: The New Paradigm
Overview of Integrative Harm Reduction Psychotherapy
Building Alliances with Drug Using Patients for Physicians
Therapeutic Tasks
Managing the Therapeutic Alliance
Therapeutic Relationship as Agent of Change
Facilitating Self-management Skills for Change: awareness and affect tolerance
Assessment as Treatment
Embracing Ambivalence
Harm Reduction Goal Setting
Active Strategies for Facilitating Positive Change
All activities will be led by Andrew Tatarsky, PhD. and colleagues at 303 Fifth Avenue, Suite 1403, NE corner at 31st Street. For more information call 212-633-8157. More information can be found at: www.andrewtatarsky.com
Andrew Tatarsky is the author of Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems, Jason Aronson, 2007.
WARSAW – It was two decades ago this summer that communist rule began to implode from Tallinn in the Baltic to Tirana in the Adriatic, ushering in free elections, market reforms, and expanded civil liberties. Since then, the countries of Central and Eastern Europe have come a long way. Many are now members of the European Union. My homeland, Poland, has a steady economy and a thriving media.
Yet Poland, like many of the other new democracies in our region, remains stuck in the past when it comes to the humane treatment of drug users. Indeed, throughout the former Soviet bloc, there is a disturbing trend in using outdated, conservative, and heavy-handed policies to address drug abuse.
For example, Gdansk – the birthplace of the Solidarity movement – does not have a single methadone treatment center. People must travel for three hours to get the medicine that is proven to control cravings and reduce the harms of drug use. And they are the lucky ones. Only 5% of opiate users in Poland have access to methadone at all, compared to 40% in Germany.
Instead of focusing on treatment that works, the Polish government chooses to give priority to long-term rehabilitation centers located in the depths of the countryside that have little, if anything, to do with evidence-based medicine. Poland also chooses to treat possession of even the smallest quantities of drugs as criminal, as evidenced by the fact that 60% of people sentenced for drug possession in Poland are marijuana smokers.
Addressing drug use through criminalization and rehabilitation centers does nothing to curb demand, however, and usage rates have failed to decline. By driving users underground, criminalization contributes to a deepening public-health crisis.
This pattern persists across Central and Eastern Europe, where governments have also opted to imprison drug users. In Hungary, for example, the penal code calls for two years imprisonment for personal possession by a drug-dependent person. In neighboring Slovakia, the penalty for personal possession is, as in Poland, up to three years.
This approach is not only inhumane, but also economically untenable: leaders in these countries should be encouraged to redirect scarce law enforcement, court, and prison resources towards more pressing causes. Simply put, governments can no longer afford to drain precious time and money that could be better spent elsewhere by locking up people for drug-related offenses.
If Poland and its neighbors are to chart a new way forward, at least three things must happen. First, these countries should look West for alternative, and more humane, drug policies. A report released recently by the United Kingdom’s Drug Policy Commission correctly calls for a “smarter” drug policy that focuses on addressing associated violence rather than simply making arrests.
Officials in Central and Eastern Europe should pay heed to recent comments by the UK’s Home Office, which said that “harm reduction underpins every element of our approach to tackling this complex issue.”
Portugal recently went a step further in voting to decriminalize recreational drugs, including heroin and cocaine – a move that has led to a significant decline in drug-related deaths and a fall in new HIV infections.
Second, law-makers should listen to their constituents: a recent public awareness campaign by Gazeta Wyborcza , a leading Polish daily newspaper, collected more than 23,000 signatures in five days for a petition calling for changes to the current drug law. The changes, modeled after Germany’s progressive policies, would stop punishing people for possessing small amounts of drugs for their own use, impose stricter penalties for dealers and provide more effective treatment for drug-dependent people.
In a step forward, a debate in the Polish parliament on the proposed drug law is set to start in September. Young people should not start their working lives with criminal records because of personal possession.
Finally, at the European level, EU policymakers can help by encouraging member states to decriminalize possession of small amounts of drugs. By freeing up resources devoted to enforcing policies against low-level users, countries can better tackle serious drug-supply issues and provide people with the effective treatment that they need and deserve.
Kasia Malinowska-Sempruch is the director of the Global Drug Policy Program at the Open Society Institute.
Anyone who has spent time around a college campus knows that the local bars offer drink specials to entice the party crowd.
Alcohol researchers from the University of Florida and San Diego State University decided to gauge how the drink specials influence the quantity of alcohol consumed. The findings will be published in the November issue of Alcoholism: Clinical and Experimental Research.
Bar owners claim bargain drinks simply attract customers to the establishment, but that the low prices don’t spur patrons to drink more. But alcohol researchers believe many drinkers, particularly young drinkers, are sensitive to price. If they have $10 to spend they will buy two, $5-dollar drinks or five, $2-dollar drinks, depending on what the drink special is.
In the latest study, the researchers examined the relationship between price and drinking level by collecting data on 495 men and 309 women leaving seven bars near a university campus. The bar patrons were given breath alcohol concentration tests and also told researchers what they drank and spent during their time at the bar.
Beer, wine and spirits all have different levels of ethanol, so the researchers calculated the cost per gram of pure alcohol. So a man in the study who spent $5 for five 12-ounce bottles of 4.2 percent beer ended up consuming about 56 grams of ethanol — at a cost of 9 cents per gram.
The researchers found that the higher the cost per gram of ethanol, the less intoxicated bar patrons were upon leaving the establishment. The study showed that the least intoxicated bar patrons paid, on average, $4.44 for 14 grams of ethanol. Patrons with the highest level of intoxication had paid $1.81 for the same amount of pure alcohol.
The association between cost of the drink and amount consumed was strong. For every $1.40 hike in drink price, the bar goer was 30 percent less likely to leave the bar legally drunk.
The data show that drink specials likely do entice college students to drink more than they would consume if prices were higher. Researchers noted that college students are more sensitive to price reductions than older drinkers, who typically have more disposable income.
In the college bar district where the study was conducted, the bars typically offered “all-you-can-drink” deals for $5 to $7.The data suggest that the bar patrons studied were drinking on a limited budget. The vast majority of drinkers (87%) spent less than $20 on alcohol for themselves at bars. The median amount spent was $9 ($10 for males, $7 for females). Over 25% of men and women in the study spent exactly $5 for all of their alcohol that evening.
“These findings do warrant a discussion about the unintended consequences of cheap alcohol, especially among the price-sensitive college student population, which has a well-documented history of alcohol-related problems,” said Ryan J. O’Mara, graduate research fellow at the University of Florida.
Upcoming Training Activities by Dr. Andrew Tatarsky
SEPTEMBER 16TH 2009 Integrative Harm Reduction Process: An Overview of an Exciting New Philosophy and Strategy for Positive Change - A workshop for members and staff of Fountain House,
New York, NY
OCTOBER 1ST 2009 Effective Psychotherapy for Drug and Alcohol Users Across the Spectrum: Theory and Technique of Integrative Harm Reduction Psychotherapy, Grand Rounds -
The Department of Psychiatry and Behavioral Sciences-
Saint Vincent Catholic Medical Centers and New York Medical
- 11:00 AM in the sixth floor Large Conference Room of the O’Toole Building - 203 West 12th Street,
between Greenwich and Seventh Avenues in Manhattan.
Drug users who ingested cocaine cut with a substance called levamisole have contracted a blood disease known as agranulocytosis in Massachusetts and other states, the Boston Globe reported Sept. 1.
Massachusetts doctors recently treated their first patient known to have contracted the disease from cocaine cut with levamisole, a drug that has been used as an antibiotic and to treat roundworm in livestock and fish. Cocaine cut with levamisole also has been blamed for illnesses and deaths in Washington and other states.
Health officials in Massachusetts and Washington have sent out warnings about levamisole and the risk of agranulocytosis, a disease that causes a drop in white blood-cell count and carries symptoms including high fever, chills, weakness, swollen glands, and painful sores. "This can be very serious," said Al DeMaria, the chief epidemiologist in Massachusetts. "Why someone would be using this in cocaine, no one really knows."
Six million people worldwide will die from smoking-related illnesses next year, according to the annual Tobacco Atlas report from the American Cancer Society.
"Tobacco accounts for one out of every 10 deaths worldwide and will claim 5.5 million lives this year alone," the study said, predicting that current trends indicate that tobacco-related deaths could top 8 million annually by 2030.
Reuters reported Aug. 25 that the report also estimated the annual cost of tobacco use to societies globally at $500 million, including healthcare expenses, decreased productivity, and harm to the environment. Researchers estimated that tobacco decreases the world's overall gross domestic product (GDP) by 3.6 percent.
"One hundred million people were killed by tobacco in the 20th century," the report said. "Unless effective measures are implemented to prevent young people from smoking and to help current smokers quit, tobacco will kill 1 billion people in the 21st century."
The Tobacco Atlas said that there are 1 billion male smokers worldwide and 250 million female smokers, and that tobacco kills one-third to one-half of those who smoke.
A new study finds that long-term marijuana users have a lower risk of certain head and neck cancers, Reuters reported Aug. 25.
Researchers from Brown University studied patients with head and neck squamous-cell carcinoma (HNSCC) and a control group and found that subjects who had smoked marijuana for 10 to 20 years had a 62-percent reduced risk of getting HNSCC. Those who smoked marijuana 0.5 to 1.5 times per week had a 48-percent reduction in risk.
The study authors, led by Karl T. Kelsey, said that the findings may be linked to the known antitumor action of cannabinoids. However, they cautioned that larger studies are needed to confirm the findings and that the risks of marijuana use may outweigh any health benefits.
Heroin addicts who are given maintenance doses of the drug were more likely to remain in treatment and less likely to use street drugs or engage in other criminal activity than those receiving methadone, according to a study of a heroin-maintenance program in Canada.
The New York Times reported Aug. 20 that researcher Martin T. Schechter of the School of Population and Public Health at the University of British Columbia said, "The main finding is that, for this group that is generally written off, both methadone and prescription heroin can provide real benefits."
After one year, 88 percent of the heroin-maintenance patients, who received doses of 450 milligrams of the drug, remained in the program and about two-thirds had greatly reduced their illicit activities, compared to 54 percent and 48 percent, respectively, among the methadone group.
However, the heroin group experienced more side-effects, including 10 overdoses. A total of 226 addicts took part in the study.
"Heroin works better than methadone in this population of users, and patients will be more willing to take it," said Joshua Boverman of the Oregon Health and Science University, a study co-author.
A survey of 12- to 17-year-olds in the U.S. has found that about 20 percent said they have given their prescription drugs like Oxycontin and Darvocet to friends or obtained drugs the same way, Reutersreported Aug. 18.
Allergy drugs, narcotic pain relievers, antibiotics, acne medications, antidepressants, and anti-anxiety medications were the most commonly shared. Three-quarters of those who borrowed drugs from friends said they did so in lieu of visiting a doctor.
About one-third of those who borrowed medications said they had experienced an allergic reaction or other negative side-effects as a result.
Past research has shown that 40 percent of adults also share their medications. "However, prior to our study, no one had asked adolescents how often they shared prescription medications, which meds they shared and what some of the outcomes were," said lead researcher Richard Goldsworthy of Academic Edge, Inc.
Once again, as a group of mental health and substance use treatment professionals, we have an opportunity to take a public stance on behalf of the health and safety of drug using citizens. Please read the announcement below about the crisis of opiate overdose in the US and a petition to make naloxone (it blocks the effects of opiates and reverses overdose and saves lives) available over-the-counter as it is in Italy.
Overdose prevention is being implemented in small ways already under research conditions and has been shown to be very effective. This measure could save countless lives.
Please sign the petition by clicking below and forward this on to three colleagues.
Thank you!
Andrew Tatarsky, PhD
Harm Reduction Psychotherapy and Training Associates www.andrewtatarsky.com
This is it! Please get involved in helping to reduce our out-of-control overdose crisis by signing the national petition! Our drug czar Gil Kerlikowske has been talking a lot lately about what a terrible problem accidental overdose has become, but he hasn't done anything yet to try to FIX the problem!
We know that a majority of these deaths are caused by opiates like Vicodin, methadone and heroin, and we know that the safe, effective drug naloxone reverses an overdose immediately. We know that people in Italy have been buying naloxone over-the-counter for years--so why can't we? Why is this incredibly safe, effective, lifesaving drug--so urgently needed right now--still only available with a prescription? People are dying--we need better access NOW!
Sign the petition urging our drug czar to start working with FDA & related agencies to move naloxone from prescription-only status to over-the-counter status. Its 30 year track record of incredible safety & efficacy demand a new plan to make it more available now and to DO something to stop our growing overdose crisis. Sign TODAY! And thank you for everything you do to help prevent overdose deaths!
Acclaimed addiction researcher A. Thomas McLellan has been unanimously confirmed by the U.S. Senate to serve as the deputy director of the White House Office of National Drug Control Policy (ONDCP).
The Philadelphia Inquirer reported Aug. 8 that McLellan's appointment was approved by unanimous consent.
McLellan, formerly the executive director of the Treatment Research Institute (TRI) at the University of Pennsylvania, will be in charge of demand-reduction policy at ONDCP. "The nation has gained a leader who has been at the forefront of science-based efforts to improve treatment systems for people suffering from drug addictions. We know Tom McLellan will bring this expertise to the country’s efforts to reduce demand for illegal substances of abuse," said TRI Board Chair Carolyn Asbury, Ph.D.
Update on the situation in Uzbekistan regarding the suspension of substitution treatment
Dear Colleagues:
I am passing on a thank you to those of you who signed on to the attached letter to the President of Uzbekistan regarding the suspension of substitution treatment in that country. The list of signatories is an impressive group of professionals from around the world. There is also an update about the situation there and what people might do to support the improvement of treatment for opiate dependent people in that nation.
I think it is very important that American professionals participate in international efforts to improve the treatment of substance using patients as well as contribute to such efforts at home. I thank you for your efforts as well.
Andrew Tatarsky, PhD
Harm Reduction Psychotherapy and Training Associates
EHRN is thankful for your support to substitution treatment in Uzbekistan, and for your help to its initiative aiming to inform the President and Government of Uzbekistan about the negative consequences of closing the OST program. EHRN sent the attached letter to its addressees, and we will inform you once we receive feedback.
Meanwhile, we thought we should provide a brief update based on our discussions with local specialists and EHRN Director Raminta Stuikyte's visit to the country:
According to the Ministry of Health of Uzbekistan, the opioid substitution therapy program there was a pilot program which had come to conclusion and which had been evaluated. Following the evaluation, the pilot program was not extended and no new ‘non-pilot’ program is set up. According to information gathered through a series of meetings with local stakeholders, international organizations and local NGOs were not consulted and the decision was made without them. Local NGOs and international organizations recognize that the pilot program had to address quality issues, including illegal drug use by clients, however, general appreciation of the substitution pilot was expressed during the EHRN’s Director visit to Uzbekistan last week. According to anecdotal information, the program's 200 patients are currently undergoing other treatment options or have ceased to have contact with health settings.
Although the Ministry of Health communicated openness to gathering further evidence around substitution therapy, it is unlikely that their decision to fend the pilot and not to start implementing substitution therapy in the health system can be reversed in the near future. One opportunity to return to this discussion is to conduct an assessment of OST implementation in Uzbekistan, demonstrating that the problems were related to the particular program rather than the method itself.
AIDS NGOs and other stakeholders met by the EHRN Director during her visit to Uzbekistan last week are rather pessimistic about the future of OST and also about other harm reduction services in
the country. Current funding for low threshold programs is coming to end and the last three attempts to get support from the Global Fund were not successful. Additionally, a national program around spiritual and moral values which was recently approved by the Uzbek AIDS Commission might have impact on harm reduction developments and operations of more than 200 low threshold sites for drug users operating in the country. Two major harm reduction NGOs: the local branch of World Vision running one service site; and CARHAP providing methodological, technical and other support, are both closing their operations around harm reduction. However, an Uzbek NGO consortium is planned to be a principal recipient in a new RCC application to the Global Fund (to extend the current GF-funded program with similar or larger levels of funding) and take over responsibility for all services and advocacy work around vulnerable groups, including injecting drug users. The draft proposal excludes OST. Some problems of existing low threshold programs exist and, for example, a service site visited in Tashkent did not have needles for the last one or two months and as waiting for procurement from the GF project management. Thus more investment into the Uzbekistan’s harm reduction with a solid capacity building element is needed. The governmental commission is currently doing some review of data on low-threshold programs.
The country is closed and rather isolated. There is a need for more support for harm reduction capacity on the ground, however this should be implemented through a dialogue with governmental institutions, respecting their competence and understanding limited role of international agencies.
Thank you again, and we hope that you will continue to support EHRN initiatives and public health programs in the region of Central and Eastern Europe and Central Asia.
On Friday, July 24th, the House of Representatives is expected to begin debating the FY 2010 Labor, Health and Human Services and Education Appropriations bill, which funds the National Institutes of Health (NIH). While the current legislation
provides a $941.8 million increase to the NIH, it is expected that Rep. Darrell Issa (R-CA) will offer an amendment to the bill that would rescind funding from three currently funded, peer-reviewed grants that focus on HIV/AIDS prevention, as an example of wasteful spending.
Take Action:
Please call your member of Congress today and urge him/her to vote NO on this amendment.
NIH's peer review process is the gold standard for determining the quality and relevance of grant proposals. Scientists from universities across the country with expertise in their fields of research make independent and objective evaluations of each proposal submitted to the NIH. Advisory councils with public representation also approve studies before NIH funds them. Efforts to restrict peer-reviewed research would undermine one of the core principles of the research enterprise.
Given that HIV/AIDS is a global epidemic that has already killed more than 25 million men, women, and children and 33 million are currently living with HIV, it is clear that prevention of HIV infection should be a priority area of research
funding.
The research is easy to ridicule if it is taken out of its public health context. The fact is, scientists need to explore a range of research avenues in vulnerable populations around the world to learn the best ways to control the transmission of HIV.
In response to previous congressional concerns about whether sexual health research should be funded by the agency, NIH reviewed the entire NIH sexuality portfolio in 2004.
That investigation found that all of the NIH grants in areas of sexual health met the rigorous standards of scientific and ethical quality, that they were not funded out of proportion to the public health burden of these diseases, and that the merit review system had been followed.
Targeted Research Projects:
Substance Abuse Use and HIV Risk Among Thai Women Grant Number: 1R21DA026324-01A1
The proposed collaboration study between Ms. Usaneya Perngparn, Chulalongkorn University, Thailand and Dr. Nemoto, Public Health Institute, California, will investigate the sociocultural contexts of HIV risk behaviors and drug use among Thai female and male-to-female transgender (kathoey) sex workers in Bangkok. Research is currently needed to develop and adapt HIV prevention models that take into account sociocultural factors so that the further transmission of HIV and
sexually transmitted infections can be averted. Participation in these types of studies also can provide a way for persons suffering from the health consequences of illicit sexual activity to receive treatment while contributing to our knowledge of prevention and treatment outcomes in these populations.
HIV Prevention for Hospitalized Russian Alcoholics Grant Number: 5R01AA016059-03
Investigators are adapting a prevention approach that has been demonstrated to be effective in decreasing high-risk HIV related behaviors in the U.S. for use in Russia, a country with a rapidly expanding incidence of HIV.C2 The approach, called Health Relationships Intervention, involves the development of a plan of action for each client to increase social support and reduce high-risk behaviors. This includes the disclosure of information to family and friends on the client's health, social needs and condition thereby assisting the client in maintaining low risk behaviors.
Venue-based HIV and Alcohol Use Risk Reduction Among Female Sex Workers in China Grant Number: 1R01AA018090-01
Research has provided evidence linking alcohol-related, high risk sexual behavior with HIV and other sexually-transmitted infections. Research has also provided rich descriptions of social, cultural, and economic contexts in which people engage in alcohol-related sexual risk behaviors. More specifically, alcohol use characteristics (e.g., binge drinking) have been linked with sexual risk-taking that occurs in a range of high risk environments. The investigators have proposed a 5-year study to develop, implement, and evaluate a theory-guided, multiple components, and venue-based HIV and alcohol use risk reduction intervention among commercial sex workers (FSWs) in China.
Internet and face-to-face individuals counseling were most effective in curbing college drinking, whereas mail and group feedback did little to change drinking habits, according to a systematic review of previously published research on college alcohol use.
HealthDay News reported July 20 that researchers from Oxford Brookes University in England reviewed 22 past studies and found that 62 percent of students receiving Internet-based interventions reported reductions in their drinking, as did 65 percent of students who received in-person, one-on-one counseling.
The researchers expressed support for social-norms prevention focused on perception of alcohol consumption, saying that students might drink less if they knew that their friends weren't drinking as much as they did. However, one expert also expressed surprise that group interventions were found to be ineffective.
"By providing normative information to a group, I would have expected that it would provide a level of social support for refusal," said Jeanie Alter, program manager and lead evaluator of the Indiana Prevention Resource Center at Indiana University's School of Health, Physical Education and Recreation. "A similarly minded group usually would back you up in your decision not to use."
The review was published in the June 19, 2009 issue of the Cochrane Library.
Horizons is an annual forum for learning about psychedelics, hosted by Judson Memorial Church in New York City. Its goal is to open a fresh dialogue about psychedelics and rethink their role in medicine, culture, history, spirituality and art.
Psychedelics are a unique class of psychoactive drugs that have been used by humans for thousands of years. In the 1950s and early 1960s, academic research with psychedelics yielded important discoveries in psychology and neuroscience. Just a few years later, they entered popular culture across North America, Europe and the world. Questions about their safety, medical value, history and implications in politics and culture were unfortunately answered with numerous myths spread by both their users and the media. The millennial rave fever brought a similar wave of popularity and hysteria.
Recently, a renaissance in psychedelic research and dialog has taken shape. Horizons objective is to bring together the brightest minds and boldest voices of this movement to share their insights and dreams for the future.
I have attached and copied below the July 2009 Newsletter of the
Addiction Division of the New York State Psychological Association of
which I am a member of the executive board. The Division has been in
existence for about 20 years. Over this time we have been a home for
psychologists working with problematic substance use and other
addictive problems. We have also been committed to creating contexts
for ongoing dialogue and exploration to advance the understanding and
treatment of people with addictive problems. We have done this by
holding regular professional conferences, workshops and other
activites. Past conferences have looked at the the state of the art of
addiction treatment at various points in time, the relationship between
trauma and addiction, the intersection of harm reduction and abstinence
based treatments and addiction treatment being in a period of ongoing
metamorphosis, among others. We are currently considering how to best
create a conference to explore how political issues such as race, class
and the stigmatization of substance users impact on substance using
patients and their treatment.
We welcome the participation of all workers who have an interest in the
issues we address. We invite participation in our conferences, member
listserve and newsletters. The Newletterwill give you a more of a
sense of what we are about. I invite you to join us in our activites
and contribute to the evolution of this important field. Contact
information is at the end of the newsletter. Feel free to be in touch.
I’m very pleased and honored to be serving as the current president of the Addiction Division of NYSPA. And I want to thank our past president, Bryan Fallon, PhD, for the wonderful and steady work he did during the past year. Among other things, his leadership allowed us to put together another well-attended conference this past November, which explored the interplay between trauma and addiction. We already have several exciting ideas for our next conference, and are in the early planning stages. We will keep you informed when a date is established for the next conference.
With the change of the administration at the national level, we have noticed some excitement about what this may bring to the field of working with individuals with addictions. Andrew Tatarsky, PhD, took a characteristically active role and drafted a letter to President Obama urging him to appoint a Drug Czar that has a record of supporting legislation that advocates treatment innovation and sentencing reform. Dr. Tatarsky’s letter received significant circulation and recognition. Gil Kerlikowske , the Police Chief of
Seattle, was confirmed as the new drug czar. Mr. Kerlikowske is known as someone who allows needle exchange programs and supports drug treatment for low-level offenders as an alternative to prison. And more recently, President Obama named Thomas McLellan, PhD, to the post of Deputy Director of the Office of National Drug Control Policy. Dr. McLellan is a prominent researcher who is expected to bring this important voice to the dialogue. (Division members may remember that Dr. McLellan was the invited speaker at our 2006 conference.)
Dr. Tatarsky has also spearheaded the circulation of a letter to President Obama regarding the choice of a director of the Substance Abuse and Mental Health Services Administration (SAMHSA). We have included the letter in this issue of our Newsletter in an effort to spark discussion, debate and action.
There have also been recent changes in our own state of New York. The legislative leaders in Albany recently announced that they had reached an agreement to repeal the mandatory sentencing laws, or the Rockefeller laws, for low-level drug offenders. This would allow judges the discretion to send people to treatment instead of prison when the situation warrants this course of action. The plan still needs to be approved by the Assembly and the Senate, but is expected to allow judges to send first-time nonviolent offenders who plead guilty to drug charges to treatment. If treatment were not successfully completed, the judge would then have the option of imposing a prison sentence.
Dr. Tatarsky will conduct a three-day training in counseling for psychologists and narcologists working in substitution treatment.
International HIV/AIDS Alliance in Ukraine
Kiev, Ukraine
Letter to Uzbek authorities re abrupt cessation of methadone and buprenorphine
Dear Colleagues —
In the early days after the recent election, nearly 500 mental health and substance use professionals in the US and abroad took a public stance with the new administration about the selection of the new Drug Czar. Our collective voice may have had a hand in the selection of Gil Kerlikowske as the director of the Office of National Drug Control Policy and Dr. Tom McLellan as his deputy. These are two professionals who meet many of the criteria that we called for and support many of the policies that we advocate for including a greater emphasis on treatment rather than incarceration for drug users who need it and support for evidence based practices such as substitution treatment, syringe exchange and motivational approaches. Their selection signals a very positive turn at the federal level toward a more rational drug policy that is good for drug users and the country at large.
Lets consider the potential for our collective voice to continue to have an impact on national and international policies that affect our substance using patients and fellow citizens.
I have copied below an appeal from the Eurasian Harm Reduction Network to the government of Uzbekistan, which has announced that it will cease provision of methadone and buprenorphine.
If you are able to sign, please send your name and organizational affiliation to Andrew Tatarsky, info@andrewtatarsky.com and cc me. If you agree with this effort please forward this note to one or more friends or colleagues and encourage them to sign on. The matter is urgent, so your prompt attention appreciated.
We express our deep respect to you and would like to address the following issue:
As we became aware, in the near future, following a decision by Government, Uzbekistan plans to close its Buprenorphine and Methadone Substitution Therapy Programs.
As specialists working in the field of drug addiction and prevention and treatment of HIV, we would like to note that Buprenorphine and Methadone Substitution Therapy is a scientifically proven method. Its effectiveness has been repeatedly noted in WHO, UNODC and UNAIDS documents. The role of Substitution Therapy is unique in reducing the spread of HIV and other blood-borne diseases, and criminality, as well as in creating opportunities to involve patients in treatment of such diseases as AIDS and Tuberculosis. That is why in 2005, WHO included Methadone and Buprenorphine to its List of Essential Medicines. Substitution Therapy is successful in such culturally diverse countries as the EU, USA, and countries of Asia (China, Iran, Malaysia, Kyrgyzstan, Azerbaijan, Kazakhstan, etc. ).
Regardless of the reasons for bringing the Substitution Therapy programs to stop, we know that among its inevitable consequences will be worsening of the HIV situation, growth in criminality and in drug traffickers' profits, as well as other negative repercussions. It has been established that in absence of treatment access, the majority of patients of Substitution Therapy programs return to the use of street drugs, which increases the risk of infection through non-sterile injecting equipment, death from overdoses and increase in criminal activity. All these consequences threaten not only the 200 patients of the programs, but also the rest of the country's citizens.
Dear Mr. President!
Being aware of the degree of responsibility that you bear for safety and well-being of the citizens of Uzbekistan, we appeal to you for suspending the decision on closing Substitution Therapy programs and establishing a qualified commission involving international experts and practitioners with long-term experience in implementation of such programs, that would be able to suggest necessary steps for their strengthening in Republic Uzbekistan.
Yours Truly
Mental Health: A Guide for Latinos and their Families
American Psychiatric Association has released a new DVD and guidebook on mental health for Latinos.
The materials, “Mental Health: A Guide for Latinos and their
Families,” are in English and Spanish and single copies are available
free.
The materials are aimed at helping to inform the general Latino public
about mental health, to dispel common misperceptions, and to reduce the
stigma of mental illness among Latinos. The DVD and booklet acknowledge
the uniqueness of the Latino culture in the U.S., including strengths of
Latino culture, and address some of the challenges to getting help for
mental illness that many Latinos face today.
Topics covered in the 30-minute DVD and booklet:Types of mental illness
(anxiety, depression, schizophrenia, eating disorders, substance-related
disorders, and ADHD) Mental health and Latino culture - including some
conditions that are unique to some Latino cultures (such as nerves or
susto) Treating mental illness Finding help, including a description of
the types of mental health professionals Tips to help maintain mental
health and increase resilience.
The DVD and booklet were developed by the American Psychiatric
Association (APA’s Committee of Hispanic Psychiatrists and APA staff)
in collaboration with the League of United Latin American Citizens
(LULAC) and the National Hispanic Medical Association.
How to order:
Copies of the video and guidebook can also be ordered by emailing apa@psych.org or by calling APA Toll-Free: 1-888-35-PSYCH
(888-357-7924).
Groups Put Pressure on Governments to Reform Harmful Drug Policies
For Immediate Release
Groups Put Pressure on Governments to Reform Harmful Drug Policies
Contacts:
Paul Silva, +1 212.548.0309, +1 917.478.8403, psilva@sorosny.org (United States)
Jon Lidén, +41 58.791.1723, +41 79.244.6006, jon.liden@theglobalfund.org (Europe)
NEW YORK / GENEVA
25 June 2009
As the United Nations launches the 2009 World Drug Report this week, more than 40 international groups and experts worldwide today issued a call to action that presses governments to adopt a humane approach to drug policy.
The call to action, signed by the Open Society Institute, former president of Brazil Fernando Cardoso, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, urges governments to enact policies that are based on scientific and medical research rather than politics.
“In many regions, particularly Asia and Eastern Europe, the AIDS epidemic is largely dependent on HIV transmission through injection drug use,” said Dr. Michel Kazatchkine, Executive Director of the Global Fund. “Criminalizing individual possession of drugs undermines HIV prevention by marginalizing users, forcing them to hide from services and healthcare that could help them and keep others safe.”
Rather than being reached with harm reduction services—care and treatment that can stem the spread of HIV—millions of nonviolent drug users languish in prisons around the globe or live as outcasts from society as a result of current drug policies. As a result, HIV and other infectious diseases spread uncontrolled and threaten whole societies.
Criminalization does not ease the global problem of drugs. The drug trade continues to grow while families are torn apart by the global war on drugs. Instead of continuing with these ineffective and harmful policies, today’s call to action urges governments to focus on reducing the harms of drug trade and use. This involves providing services such as clean needle exchange and substitution treatment to help reduce the health risks associated with drug use. The groups also call on governments to decriminalize the possession of small quantities of drugs for personal use—a step which has been credited with reducing drug use and HIV infections in Portugal.
“In too many countries, the war on drugs has become a war on people,” said Kasia Malinowska-Sempruch, Director of the Open Society Institute’s Global Drug Policy Program. “We need to stop the spiral of drug-related violence by approaching this from a health and human rights perspective.”
In addition to criminalization, anti-drug measures such as crop destruction have had a devastating impact on peoples’ lives, according to the groups. In many regions, aerial eradication of coca and poppy fields have destroyed thousands of farms, while doing nothing to alleviate the poverty that causes many farmers to grow illicit crops. Yet, numerous studies have shown that crop eradication is the least effective method for controlling drug supply, and treatment and prevention programs are better suited to reduce the demand for drugs.
The Open Society Institute’s Global Drug Policy Program aims to broaden, diversify, and consolidate the network of like-minded organizations that are actively challenging the current state of international drug policy. The program strives to engage and support drug policy experts, economists, and other professionals as they analyze and publicize the effects of drug policy on public health, human rights, national20security, and the economy.
The Global Fund to Fight AIDS, Tuberculosis and Malaria is an international financing institution that invests the world’s money to save lives. To date, it has committed US$ 16 billion in 140 countries to support large-scale prevention, treatment and care programs against the three diseases. www.theglobalfund.org
There are so many reasons to join us November 12-14 in Albuquerque. First, as I mentioned in my email last week, this may be the best opportunity to continue the unprecedented momentum toward positive change. If you're working in any area of drug policy reform, or want to be, you have to be part of this conversation.
Second, there is, simply stated, no better crash course in drug policy than this three-day event. Many hundreds of people have described past meetings as transformative experiences in their lives. This one promises to be the best yet.
And finally, your participation in the conference will ensure the amazing diversity that makes this meeting what it is. We've also worked hard to make it affordable for you. We offer members, New Mexico residents, students and all early-bird registrants a significant discount off our regular non-member registration rate:
Attendee Type
Before Oct. 9
After Oct. 9
On Site
Non-members
$325
$425
$450
DPA Members
$275
$375
$400
NM Residents
$200
$300
$325
Students
$100
$150
$175
The energy of this gathering is like no other. You will meet people who challenge you, who inspire you and who could be partners in your reform efforts. Register now to attend the Reform Conference and experience all of this in person.
Thanks for all you do.
Sincerely,
Ethan Nadelmann
Executive Director
Drug Policy Alliance
P.S. Don't forget to tell your friends to come. The Reform Conference is a great introduction to the world of drug policy reform, and your personal invite will help build our movement.
NAPW helps Immigrant Pregnant Woman Win Release from prison
Dear Friends and Allies:
NAPW is pleased to announce that yesterday morning a federal District Court judge, responding to a motion for bail and our emergency amicus brief, released Quinta Tuleh, a 28 year-old pregnant woman, from federal custody.
Ms. Tuleh, a woman from Cameroon, had already served 114 days in jail for allegedly having false immigration documents. Shortly after her arrest, she learned she was both pregnant and HIV positive. On May 14, 2009, instead of releasing her, a US District Court Judge extended Ms. Tuleh's sentence to ensure that she remain incarcerated for the duration of her pregnancy. (Judge Jails Pregnant Woman Until Baby is Born and Behind Bars for Being Pregnant and HIV-Positive.)
At the sentencing hearing, Judge Woodcock stated: "My obligation is to protect the public from further crimes of the defendant, and that public, it seems to me at this point, should include the child she's carrying...I don't think the transfer of HIV to an unborn child is a crime technically under the law, but it is as direct and as likely as an ongoing assault."
As is often the situation in cases involving pregnant women, Courts make decisions without the benefit of full briefing or input from experts. Indeed, uncertain of Ms. Tuleh's due date and how long he would need to extend the sentence to ensure she was imprisoned through her due date, the Judge looked out over the courtroom and said "So maybe we ought to consult with the women here. Any sense of what a safe range would be?"
Yesterday morning, National Advocates for Pregnant Women, the Center for HIV Law and Policy and attorneys Elizabeth Frankel and Valerie Wright of the Maine firm Verrill Dana, LLP filed an emergency amicus (friend-of-the-court) brief on behalf of 28 public health experts, advocates, and organizations, as well as a declaration from prison health expert Dr. Robert L. Cohen. The brief and expert testimony provided legal and public health information challenging the incarceration of a pregnant woman in order to protect an "innocent" "unborn child."
The judge called the brief "articulate and helpful" during yesterday's hearing where he released Ms. Tuleh on bail pending an appeal of her sentence to the First Circuit Court of Appeals. Ms. Tuleh will now be receiving medical, housing, and other support coordinated by the Frannie Peabody Center, a Portland, Maine community-based HIV resource center. Ms. Tuleh has expressed that she is deeply touched by all of the support she has received. The picture of her yesterday, smiling from ear to ear speaks volumes.
Ms. Tuleh is being represented on her appeal by Zachary L. Heiden of the Maine ACLU.
NAPW and Center for HIV Law and Policy are grateful to Laura McTighe, Director of Project UNSHACKLE, Community HIV/AIDS Mobilization Project (CHAMP), for her extraordinary help in this effort.
Your continued support of NAPW makes this kind of effective, cross issue collaboration possible. Please contribute what you can to NAPW so that we can continue our collaborative and successful advocacy on behalf of all pregnant women.
This report examines the nationwide opioid overdose epidemic and calls for immediate action to address this public health crisis. As “Preventing Overdose, Saving Lives,” details, evidence-based strategies already exist that can reduce overdose risk, protect Good Samaritans and medical professionals, streamline government response systems, and save lives. A national overdose prevention effort is urgently needed, and this report provides a clear way forward for policymakers seeking a public health approach to the overdose emergency.
Announcement from the Drug Policy Alliance - Overdose Prevention
June 11 2009
Dear Friends,
Today is such an exciting, important day for all of us who care about overdose prevention! I’m thrilled to announce two significant things:
The Drug Policy Alliance released a landmark report on the national overdose crisis, “Preventing Overdose, Saving Lives.” This report assesses the crisis, examines policy solutions available and how such policies have been successfully implemented across the country. The report recommends a range of solutions, including expanded access to naloxone and “Good Samaritan” immunity laws.
Congresswoman Donna F. Edwards (D-MD) introduced the groundbreaking Drug Overdose Reduction Act of 2009. This bill—the first of its kind—will allocate resources to community groups and public health agencies to implement overdose prevention and education programs, including expanded naloxone distribution.
This is an exciting time to be an overdose prevention supporter. There is fantastic progress on the horizon. I personally invite you to read this terrific report and share the information and ideas with your friends and local legislators.
Drug Policy Alliance remains committed to the fight to save lives from being lost to accidental overdose. Working together, we can all make a difference. The national dialogue about preventing overdose fatalities starts with all of us, right now, today.
- Meghan Ralston
Purple Ribbons for Overdose Prevention, creator
IHRA E-Newsletter May 2009
Harm Reduction 2009 Takes Place in Bangkok
‘Harm Reduction 2009: IHRA’s 20th International Conference’ took place in Bangkok, Thailand from the 20th to 23rd April, and – despite the city being in a ‘state of emergency’ due to recent political uncertainty – brought together an incredible 1,000 delegates from 80 countries, including many from Thailand and other Asian countries. The four days were filled with discussions and debates about the latest research findings, best practice guidelines, policy developments and advances in harm reduction programming worldwide.
The conference theme was ‘Harm Reduction and Human Rights’, and this was a recurring issue throughout the event – including a dedicated Plenary Session, sessions documenting some of the human rights violations committed in the name of drug control, and a dignified protest by Thai drug users and their allies at the Opening Session in which they called for “treatment not torture”. The Opening Session on Monday 20th April also included a formal welcome from the Governor of Bangkok, an opening address from IHRA’s Executive Director, and a keynote address from Professor Michel Kazatchkine, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Professor Kazatchkine emphasised the need for decriminalising drug use as part of a public health approach, and the huge discrepancy which exists between the global resources needed for harm reduction and the current levels of funding – both issues which gained much attention during the rest of the conference. These powerful statements from a senior international policy maker were received with a standing ovation from the delegates and attracted a great deal of media interest from around the world.
The four-day conference programme included over 60 sessions and showcased over 200 presentations and 250 posters on topic as diverse as HIV, hepatitis C, tuberculosis, alcohol, tobacco, methamphetamine, policing, research, opiate substitution treatment, needle exchange programmes, compulsory drug treatment, poverty, prisons, young people, sex work, risk environments, drug user organisations, families, the war on drugs, and the recent UN High Level Segment on Drug Control in Vienna. There were also sessions focusing on harm reduction in the host country, a separate programme of skills-building workshops, a ‘Dialogue Space’ hosted by the Global Fund to allow delegates to meet international leaders, the 6th International Drugs and Harm Reduction Film Festival, and a conference party and awards ceremony featuring a performance from ‘Kormix’ (a hip hop group from Korsang, Cambodia’s only harm reduction programme).
The conference closed on Thursday 23rd April with an impassioned keynote address from Craig McClure, the Executive Director of the International AIDS Society. After five years in his current position, Mr McClure reflected on the politics surrounding harm reduction, the global responses to HIV, and the evolving status of injecting drug use within these responses. He told delegates that, globally, “Blatant and wilful denial of the evidence can only be based on deep-seated fear. Fear drives the global war on drugs. Fear drives abuse by doctors and others in the medical system of people who use drugs and the continuing use of so-called ‘treatments’ that might more accurately be called ‘torture’”.
Overall, the conference highlighted how far harm reduction has progressed and where there are still huge challenges to be overcome. It brought together health workers, law enforcement, human rights activists, people who use drugs, frontline workers, policy makers and researchers at an important time for harm reduction and for the host country (against a backdrop of discussions about a new Thai harm reduction policy and a major national grant from the Global Fund). Around half of the delegates were attending an international harm reduction conference for the first time – further justifying IHRA’s decision to hold the conference in Bangkok – and there was a great sense of energy and enthusiasm throughout the four days.
A full review – including presentations, images, video footage and abstracts – will be available soon as part of the previous conferences archive on www.ihraconferences.net
Youth RISE and IHRA Launch New Briefing
Over the last few months, Youth RISE – the international youth-led harm reduction network – and IHRA asked youth researchers from every region of the world to compile and write country reports on the status of young people, drug use and harm reduction programming in their countries and regions. Although every country and region is different – not to mention every city and town within each country, and each group of young people within every city and town – there were some commonalities in what was being reported.
To coincide with Harm Reduction 2009: IHRA’s 20th International Conference, Youth RISE and IHRA have highlighted some of the common themes through a short briefing. The report overviews the current situation regarding young people who use drugs, and the human rights approach to addressing them based on the UN Convention on the Rights of the Child. A full report is due out later in 2009, which will illustrate the legal, social and political recommendations of the Conventions of the Rights the Child and how they relate to young people, substance use and access to prevention and harm reduction services.
At the Harm Reduction 2009 conference in Bangkok, IHRA has released its 2008 Annual Report. The report – which was launched at the IHRA Annual General Meeting on Monday 20th April – features commentary from Dr Mukta Sharma (the Chair of the Board of Directors) and Professor Gerry Stimson (the Executive Director) which review 2008. It also features a summary of IHRA’s programmes and activities – including the Global State of Harm Reduction publication and the Harm Reduction and Human Rights (HR2) programme. It also includes financial information and accounts for 2008.
DFID Launch New Reports on Access to Medication and International Drug Control
In March 2009, the UK Department for International Development (DFID) – through the ‘Drug Control and Access to Medicines’ (DCAM) Consortium – launched three major new reports entitled ‘A Blueprint for Reforming Access to Opioid Medications’, ‘Closing the Gap: Case Studies of Opioid Access Reform in China, India, Romania & Vietnam’, and ‘Review of Global Policy Architecture and Country Level Practice on HIV/AIDS and Drug Treatment’. These documents describe how countries have reformed regulations which limited access to therapeutic opioid medications, and how donors, international organisations and health advocates can make further progress in the future.
The ‘Drug Control and Access to Medicines’ (DCAM) Consortium is an international collaboration of experts on drug control regulation, drug treatment, HIV, and pain and palliative care. The participating institutions include the Center for Health Law, Policy and Practice at Temple University, the AIDS Projects Management Group, and the Pain and Policy Studies Group at the University of Wisconsin. The Consortium has been funded by DFID – who also provide major funding to IHRA – to support and contribute to efforts by a range of stakeholders to reduce policy-related barriers that prevent patients from receiving controlled medicines for pain and drug dependency.
Malaysia is one of many countries in Asia which have embraced harm reduction approaches and interventions such as needle and syringe programmes, methadone substitution treatment, drop-in centres and outreach work. In response to a HIV epidemic which is mainly driven by injecting drug use (71.2% of reported HIV cases between 1986 and 2008 were injecting drug users), the Malaysian Government began with pilot needle exchange schemes in three states, but this intervention will soon be available in every state across the country through health clinics and in partnership with NGOs and the Malaysian AIDS Council.
In an article in The Star – Malaysia's leading English-language newspaper – the Health Minister Datuk Seri Liow Tiong Lai claimed that Malaysians are “wise and mature enough” to understand the principles and rationale behind needle and syringe exchange as a form of HIV prevention, and stated that these services “will serve as a driving force towards a wide range of harm reduction-related activities such as information, education and communication on risk reduction, HIV testing and counselling, health screening, anti-retroviral treatment and psycho-social care and support”.
In the same article, Professor Adeeba Kamarulzaman – the President of the Malaysian AIDS Council and a former Director of IHRA – noted that Malaysia has come a long way but more still needed to be done in terms of reaching a target of 60% of the country’s drug users through expanding provision and changing existing laws and policies.
Professor Wodak Speaks About Drug Consumption Rooms
Professor Alex Wodak spoke at an event in Sydney, Australia on May 6th which marked the 10 year anniversary of the opening of Australia’s first and only safer injecting facility. In his speech, Professor Wodak stated that the group which established the service had only one intention, “to establish... a place in Kings Cross [an area in Sydney] where people determined to inject illegal drugs could do so safely... [and] without fear of being charged and arrested”.
The Sydney facility was a response to high rates of heroin overdose in Australia, one in ten of which occurred within two kilometres of the site. Faced with numerous legal barriers, “Our last resort was civil disobedience. About 30 people came together from all walks of life to establish the Tolerance Room here in a basement of a church at the Wayside Chapel. There were parents of drug users, some drug users, nurses, doctors, a former politician and a businessman”.
Professor Wodak went on to state that the service in Kings Cross is still supported by more than 70% of local residents for the impact that it has had on public injecting, and quoted some of the recent positive statements being made by international policy makers and organisations such as the United Nations. He then called upon the New South Wales Government to recognise that their safer injecting facility is just as much a part of the health care system as other harm reduction measures (such as needle exchange programmes and substitution treatment – “which were also controversial when they were introduced”) – and as emergency departments, hospitals and doctors. “Yet for political reasons, after eight years, the MSIC still remains a research trial... We call upon all governments to apply the same standards when evaluating all interventions for illicit drugs – whether these are intended to reduce the supply, demand or harms resulting from drugs”.
The full text of Professor Wodak’s speech has been uploaded to the IHRA Blog. According to IHRA’s Global State of Harm Reduction research, there are currently only eight countries around the world which have drug consumption rooms.
Data Request for Global Burden of Disease Project
As part of the Global Burden of Disease 2005 project, the ‘Mental Disorders and Illicit Drug Use Expert Group’ are conducting systematic reviews of the prevalence, incidence and remission of mental health disorders and drug dependence in order to estimate the burden of disease attributable to illicit drug dependence. For the first time, this project will also provide estimates for different drug types. The Expert Group is looking for data from around the world on the prevalence of use and dependence on amphetamines, cannabis, cocaine, and heroin and other opioids.
The project is in the process of updating estimates for every country around the world on the prevalence of use and the prevalence of dependence of each included drug type (amphetamines, cannabis, cocaine, and heroin and other opioids). Producing these estimates is big challenge as many countries do not have prevalence data measuring the prevalence of drug use or dependence, or the data that exists may not be widely available. So far, the Expert Group have conducted a large search of the peer-reviewed literature and have tried to gather as much information as possible. However, it is inevitable that some data and material will have been missed, so the Expert Group is seeking prevalence data from 1990 to the present day.
If you have any information that may assist this important project, your contribution will be individually acknowledged in all related publications (unless requested otherwise). Please send relevant studies, data and reports to gbd@med.unsw.edu.au before Sunday 31 May 2009.
Integrative Harm Reduction Psychotherapy for Problem Substance Use: A Two-day Introductory Training in the History,Rationale, Theory and Clinical Technique
Dr. Tatarsky will present at the North Carolina Harm Reduction Coalition
Winston-Salem, North Carolina
Please see the historic news detailed in the linked article below
regarding ONDCP Director Kerlikowski's statement about ending the "war
on drugs". It took my breath away.This seems to be the tipping point
we've been anticipating! Thank all of you for your contributions to the
efforts over many years that contributed to this event.
We may finally get the support we have been working for for the kind of
research and treatment that will improve the care of our drug mis-using
citizens.
Day Conference “Safe Injection Facilities in New York”
SPONSORS:
DUHA, John Jay College of Criminal Justice, Harm Reduction Coalition, NYSPA - Division on Addictions
DATE & TIME:
Friday May 22, 2009 (9 AM - 5 PM)
LOCATION:
John Jay College of Criminal Justice/CUNY
445 West 59th. Street. Room 1311 (1st floor)
NY, NY
To RSVP send email with name and affiliation to: safeinjectionfacility@gmail.com
BACKGROUND:
The Injection Drug User Health Alliance (IDUHA) is an alliance of sixteen Syringe Exchange/Harm Reduction programs in NYC that promotes the provision of pragmatic harm reduction services to injecting drug users.
One IDUHA initiative is to explore strategies to implement Supervised Injection Facilities (SIFs) for IDUs in NYC. The term ‘supervised injection facilities’, refers to locations that are legally established and organized specifically to allow drug users to use their drugs in a (medically) supervised, normative, and safe environment.
The main objective of creating SIFs is to reduce health-related harm associated with chaotic drug consumption, both for the drug user (private harm, e.g. the reduction of overdose (death) or infectious diseases) and his or her environment (public harm, e.g. prevent scattering of used needles, open drug scenes).
Together with John Jay College of Criminal Justice and the Harm Reduction Coalition, IDUHA will organize a one day conference on the topic of ‘Safe Injection Facilities in New York’ on Friday May 22, 2009, at John Jay College of Criminal Justice/CUNY.
Objectives for the Conference:
Create public awareness of this Harm Reduction intervention and start building a constituency among local and state politicians, officials from the DOH, researchers, police departments, service providers and the general public. Important here is to further de-construct the negative drug user profile.
Provide information on the (cost-)effectiveness of SIFs in the realms of Public Health and Public Order.
Start developing a concrete scenario to implement SIFs in New York.
The SIF would be part of a comprehensive effort to offer needle-exchange, street outreach, HIV & HCV testing and counseling, palliative care, educational workshops, support groups, and referral services including drug treatment. The results of a 2008 survey conducted among 200 NYC IDUs from IDUHA agencies indicated that 84% of the IDUs sampled would utilize a SIF should one be implemented, and that those most likely to use it are IDUs at the highest risk for contracting or spreading blood-borne diseases such as HIV and hepatitis, and for experiencing a drug overdose.
Robert BB Childs, MPH, QMHA
Director of Program Services
Positive Health Project, Inc.
301 West 37th Street
New York, NY 10018 USA
Telephone: 212.465.8304 ext.107
Mobile: 347.307.5357
Fax: 212.465.8306
Email: rchilds@phpnyc.org
Website: http://www.positivehealthproject.org
Appointment of Treatment Research Institute Co-Founder and Noted Drug/Alcohol Expert Signals National Shift in Addiction Policy
Philadelphia, PA - April 10, 2009: The Obama/Biden Administration has named A. Thomas McLellan, Ph.D. to the post of Deputy Director of the White House Office of National Drug Control Policy. McLellan is one of the nation's leading drug and alcohol experts.
McLellan got his start in the 1980s as a scientist with the Veterans Administration and University of Pennsylvania where he led development of the Addiction Severity Index and Treatment Services Review, two measurement instruments premised on the then-novel view that addiction was a multi-dimensional condition, with impairments in other life functions that had to be concurrently addressed for treatment to be effective. Eventually, the premise came to be embraced, with the instruments becoming widely used to measure and improve the effectiveness of many forms of treatment.
In 2000, McLellan and three other experts authored a report in JAMA pointing out the similarities between addiction and commonly recognized, chronically relapsing medical diseases like hypertension, type II diabetes and asthma, arguing that like these other illnesses, serious addictive disorders cannot be cured but can be effectively managed. The implications proved to be significant. Today, most experts refer to addiction as a chronic illness and call for longer-term care strategies patterned after medical models.
A firm believer in the transformative power of science, in 1992 McLellan co-founded the non-profit TRI as a translational center that would adapt and engineer promising scientific findings into useful products and services that could be broadly used throughout the field. Over the next seventeen years, McLellan assembled a team of researchers and entered into intertwining collaborations with universities, major treatment and prevention groups, and legal groups. TRI became known for practical models of continuing care and monitoring; criminal justice strategies as an alternative to jailing drug-involved offenders; revitalizing the nation's public system of addiction treatment; engaging doctors and other primary care providers; and helping parents learn skills to protect children from drugs and alcohol.
Beginning in 2006, McLellan recruited policy experts to TRI to help state and local governments promote quality improvement by revamping their purchasing, regulatory, and other administrative structures.
"We're sorry to lose Tom McLellan to higher office, but we're not surprised an innovation-minded Administration would recruit someone like him for national drug policy," said Constance Pechura, Ph.D., TRI's second-in-command who will assume leadership of TRI. "With his presence, the Administration has created a formidable drug control team predisposed to evidence and policies that 'work,'" she said.
"Tom McLellan has been a leader in advancing the science of addiction treatment and improving access to effective care," said Carolyn Asbury, Senior Consultant to the Dana Foundation and Chair of the TRI Board of Directors. "He has pioneered the translation of research into more effective clinical practices that have helped to achieve better outcomes for individuals and their families. No one is better equipped to help transform the nation's response to its drug problems," she said.
ONDCP was established in 1988 to advise the President and Vice President on a drug control program for the nation, coordinating the activities of multiple federal agencies toward that end. With Gil Kerlikowske, the President's pick for ONDCP Director, McLellan's appointment signals a shift to science-based treatment and prevention strategies - including what McLellan calls "a long-overdue national look at our prison policies; collaborative strategies among the prevention, treatment, criminal justice, healthcare and education fields, and continued modernization of specialty treatment and prevention centers."
************************************************************
The Treatment Research Institute is a non-profit research and development organization specializing in science-driven reform of policy and practice in substance use and abuse.
For more information contact Bonnie Catone, TRI Director of Communications,
at bcatone@tresearch.org or visit the TRI website at www.tresearch.org.
Dear Colleague,
I am copying below a very interesting and timely report on the effectiveness of California's Prop. 36, a ballot measure approved by California voters in 2000 that offers treatment instead of incarceration for nonviolent drug offenders. The report finds that the ballot initiative is being undermined by inadequate funding, participants dropping out of treatment, and increased arrests for drug and property crimes. The good new is that the initiative has saved taxpayers millions of dollars, several promising new programs have the potential to improve Proposition 36's results, and violent crime arrests have decreased more in California than nationally since the proposition's implementation.
Califonia's experience has much to teach us as we plan for the changes in NY State that will result from Rockefeller reform. We don't want to repeat their mistakes s w anticipate a much greater referral to treatment of arrested non-violent drug users. We will need a well-funded system that has the re-training to handle this somewhat new population. Without the knee-jerk reaction to send patients who continue to use substances in treatment back to prison, we will need a system that has a greater appreciation of the complex challenges these patients bring and face and the sophistication and time often required to help many problem users begin to make positive change in their use of substances.
This system must be committed to sophisticated psychological, substance use and medical evaluation and treatment that considers substance use in the context of the whole person in their context. Effective treatment is attractive and relevant to patients (or else why should they stay in treatment?). It is highly individualized and has as essential ingredients motivational enhancement, offering patients goal choice, understanding that continued use, slips and relapses are part of the change process and not evidence of failure and that people must begin the treatment process with treatment that truely starts where they are to maximize therapeutic alliance and retention in treatment. It is too long that the system has held patients accountable for "treatment failure" and not sufficiently looked at how limitations of funding, sophistication and creativity set up patients and clinicians to fail seeming to justify incarceration.
I welcome any feedback and discussion around these critically important issues.
Contact: Mark Wheeler mwheeler@mednet.ucla.edu
310-794-2265
University of California - Los Angeles
UCLA issues new report on Prop. 36
Treatment alternative for drug offenders has had mixed success
The effectiveness of Proposition 36, a ballot measure approved by California voters in 2000 that offers t
reatment instead of incarceration for nonviolent drug offenders is being undermined by inadequate funding, participants dropping out of treatment, and increased arrests for drug and property crimes.
The good news, however, is that the initiative has saved taxpayers millions of dollars, several promising new programs have the potential to improve Proposition 36's results, and violent crime arrests have decreased more in California than nationally since the proposition's implementation.
These are some of the key findings from UCLA's latest report on Proposition 36, also known as the Substance Abuse and Crime Prevention Act (SACPA) of 2000. The measure, which went into effect in July 2001, allows nonviolent adult drug offenders to receive substance-abuse treatment with supervision as an alternative to incarceration or supervision without treatment. The law also calls for an independent evaluation of the program, which is being conducted by UCLA's Integrated Substance Abuse Programs at the Semel Institute for Neuroscience and Human Behavior.
According to the report, under Proposition 36, more than 30,000 drug offenders enter treatment each year and about half of them are being treated for the first time. Most receive outpatient care, which is less expensive than residential treatment but is also less effective for heavy drug users. Although the number of available residential treatment beds has increased since the measure's enactment, the i
ncreases have not been able to meet the rising need. Stakeholders interviewed in focus groups indicated that this was due to limited funding and infrastructure.
The report also found that drug and property crime arrests were higher among Proposition 36 participants than among a comparison group of pre-Proposition 36 drug offenders, the latter having spent more days in custody and fewer days "on the street" during which they could get arrested. However, despite early concerns by critics of SACPA that the law would result in an increase in violent crime, the rate of violent crime dropped more in California (12 percent between 2001 and 2005) than nationally (9 percent over the same period).
While the Proposition 36 group was more likely to be rearrested, the measure has been a much less expensive alternative to jail or prison time. By reducing incarceration, Proposition 36 has helped save taxpayers about $2 for every $1 invested in the program. To improve Proposition 36's implementation, the report calls for greater use of narcotics-treatment programs, employment assistance and residential treatment, as well as graduated sanctions, ranging from more drug-test requirements to short jail stays, for those participants who fail to comply with the program's provisions.
Better integration of substance-abuse and mental health services for the mentally ill homeless population and more restrictive management for offenders with many prior conviction
s are also recommended in the report. While additional funding would likely be needed to implement some of these recommendations — and the use of jail sanctions would require a change in the law, since Proposition 36 forbids it — other recommendations could be implemented now and at low cost.
One such low-cost recommendation was demonstrated in a recent pilot project. Currently, about 15 percent of those convicted in California who agree to Proposition 36's provisions never show up to be assessed. But according to a Los Angeles County study, treatment programs that adopted a set of "process improvement" practices borrowed from the business world showed a dramatic 80 percent reduction in the number of assessment no-shows.
"It is particularly exciting to find a tool like this in the current environment of budget cuts," said Darren Urada, the principal investigator on UCLA's Proposition 36 evaluations. "Funding for Proposition 36 has been insufficient and shrinking over the years, and this has eroded stakeholders' ability to adequately treat and monitor offenders. Furthermore, the unpredictability in funding from year to year has undermined long-term planning efforts."
Proposition 36 funding was cut further last month when Gov. Arnold Schwarzenegger vetoed 10 percent of the program's funding in response to the state's fiscal problems. Funding for the voter-mandated evaluation of the measure, which includes research on ways to
improve the program, has also been suspended.
UCLA's evaluation reports may be of particular interest to voters this year, given that a closely related measure, Proposition 5 (the Nonviolent Offender Rehabilitation Act), will be on November's ballot. If passed, this proposition would integrate Proposition 36 into a tiered system of treatment and supervision for nonviolent drug offenders. According to the official summary provided by California's attorney general, the new initiative would allocate $460 million annually to improve and expand treatment programs for those convicted of drug and other offenses; limit court authority to incarcerate offenders who commit certain drug crimes, break drug-treatment rules or violate parole; substantially shorten parole for certain drug offenses; divide California Department of Corrections and Rehabilitation authority between two state secretaries; and create a 19-member board to direct parole and rehabilitation policy.
The UCLA Integrated Substance Abuse Program, part of the Semel Institute for Neuroscience and Human Behavior, is an interdisciplinary research and education institute that serves to advance the knowledge base on drug problems and to improve the delivery of drug-abuse treatment services through an array of projects. The Semel Institute is devoted to the understanding of complex human behavior, in
cluding the genetic, biological, behavioral and sociocultural underpinnings of normal behavior, and the causes and consequences of neuropsychiatric disorders.
Dear Colleagues:
The letter regarding the importance of professional leadership of SAMHSA is now off to Presdent Obama. You can still sign on if you haven't and view the list of signatories at www.andrewtatarsky.com/samhsaletter/.
Please disseminate the press release that is copied below and attached to any press you think may be interested in covering this story.
Thank you for your continuing support of this very important issue.
Andrew Tatarsky, PhD www.andrewtatarsky.com 212-633-8157
Dozens of prominent substance use and mental health treatment and research professionals urge President Obama to break with recent administrations and appoint a professional with expertise in the science of substance use, mental health and public health to direct the Substance Abuse and Mental Health Services Administration (SAMHSA). They urge the President to appoint a leader to SAMSHA who supports evidence-based and theoretically sound treatments and will make decisions based on science rather than ideology and politics.
To fix SAMHSA’s chronic dysfunction, strong scientific and professional credentials are seen as key to insure that the agency’s $3.3 billion budget is best spent to effectively address the treatment and prevention of mental illness and addiction. The past two decades have seen dramatic scientific advances in understanding mental illness and addiction which have led to the development of effective treatments and prevention programs. Unfortunately, these treatments are not reaching the vast majority of the public who need them. It is noted that the United States spends about $120 billion on behavioral health care but a government review of SAMHSA, the agency responsible for overseeing this area of healthcare, rated the agency’s programs as largely ineffective and that much more could be accomplished with this money. Only 1 out of every 4 of these dollars is spent on evidence-based care with the rest going toward treatments and programs of questionable value. Many politicians including Congressman and Senators who sit on relevant oversight committees have never heard of SAMSHA, despite the fact that SAMSHA is on the same organizational level in the Public Health Service as CDC and FDA.
One major reason for SAMSHA’s obscurity and dysfunction has been the failure to appoint a person with significant scientific and professional expertise to lead the agency. Past administrators have been drawn from the ranks of state government with experience in community action, but without recognized high level scientific mental health, addiction, and public health expertise. These professionals say that it is essential to have the highest caliber professional leading the agency in the fight to improve the lives of all those who struggle with mental health problems and the consequences of substance abuse and to assure that government money works for the benefit of all Americans. They call on the Obama transition team to appoint a professional with a national reputation of excellence as a scientist and innovator in implementing science-based and theoretically sound mental health, addiction and public health programs in communities.
For further information or to arrange interviews with Andrew Tatarsky, the organizer of this campaign, or any of the other signatories call 212-633-8157 or email atatarsky@aol.com.
As many of you know, on March 11-12 a High Level Segment of the Commission on
Narcotic Drugs will review the implementation of targets adopted by the UNGASS
in 1998. HCLU launched a new campaign to raise awareness on the unintended
consequences of the international drug control system and mobilize people to ask
for change.
Please have a look at our brand new campaign site and make sure you send this
link to as many people as possible: http://daretoact.net/
We also launched a new YouTube group profile where people can upload their own
messages to the governmental delegates - this intro video explains why and how:
This campaign will work only if you help us to circulate these links and post
them to your websites or blogs - so we count on you!
Best wishes,
Peter Sarosi
Drug Policy Program Director
Hungarian Civil Liberties Union
Tel.: +36 1 279 2236
www.drugreporter.net
Upcoming Trainings on Integrative Harm Reduction Psychotherapy for Problem Substance Use
Dear Colleague:
I copy below information about two training opportunites coming up in the near future on Integrative Harm Reduction Psychotherapy. Next Thursday, March 26th, I will be giving a free introductory talk on my work at the Washington Square Institute down in the Village. The following Friday afternoon, April 3rd, I will be offering a three hour workshop at the et Ellis Institute on 65th Street in which we will have more time to explore the theory and techniqe of my approach with an emphasis on how you can integrate it into your therapy practice. I would welcome case material and clinical challenges that you have come up against to bring to the discussion.
Free introductory talk on Integrative Harm Reduction Psychotherapy (IRP)
Thursday March 26, 2009 @8:30-10pm
Scientific Meeting
Washington Square Institute
41-51 East 11th Street
New York, NY 10003
212-477-2600
Free to Public
RSVP: registrar@wsi.org , 212-477-2600
Effective Psychotherapy for Drug and Alcohol Users: Theory and Technique of Integrative Harm Reduction Psychotherapy
The treatment of patients with drug and alcohol problems has been dominated by an anti-psychological disease model which promotes the view that such patients cannot benefit from psychodynamic psychotherapy and instead require authoritarian treatment. Experienced and well-intentioned psychotherapists have been influenced by this view and avoid treating this population of 35 million in the USA.
I will introduce Integrative Harm Reduction Psychotherapy (IHRP) as an alternative approach to effective treatment of substance using patients. IHRD is based on a multifaceted view of problem substance use as reflecting the interplay of biology, personal and interpersonal dynamics and social context. IHRD integrates a relational psychoanalytic approach with active skills building to support positive changes in substance use and related issues.
I will discuss clinical challenges and limitations of traditional treatment and the clinical rationale for harm reduction as an alternative paradigm for helping substance users. I will define the harm reduction model, give a little history and discuss its application to psychotherapy. I will discuss the theoretical basis for IHRP including a biopsychosocial process view of addiction, the multiple meanings of substance use as points of engagement and the stages of motivational change model and will explore how to use these ideas to create a collaborative, negotiated therapeutic alliance. Fina lly, I will present an overview of IHRD’s 7 therapeutic tasks with emphasis on therapeutic process and technique.
Integrating Harm Reduction Psychotherap y Into Your Practice
HALF-DAY WORKSHOP emphasizing theory and technique at The Albert Ellis Institute
Friday, April 3, 2009, 1:30-4:30pm
The Albert Ellis Institute
45 East 65th Street
New York, NY
(212) 535-0822
The Workshop will:
Explore the main tenets of the clinical philosophy of Integrative Harm Reduction Psychotherapy
Identify the three main theoretical bases of this approach: a biopsychosocial process model of problem substance use, the multiple meanings model and the stages of motivational change
Discuss the three domains of IHRP: the therapeutic alliance sets the stage for the therapeutic process, active skills building for assessment, goal-setting and working toward positive change and exploration of the multiple personal and social meanings of substance use
Describe the seven key therapeutic tasks, including managing the therapeutic alliance, therapeutic relationship as healing agent, facilitating capacities for change, assessment as treatment, embracing ambivalence, goal setting, and working toward positive change
TUITION
Regular Registration: $50.00
F/T grad students (with proof of status) $40.00
Call to register: (212) 535-0822
Bio:
Dr. Andrew Tatarsky has specialized in the field of substance use treatment for almost 30 years as psychotherapist, supervisor, program director, trainer and author. He holds a doctorate in clinical psychology from the City University of New York and is a candidate in20New York University’s Post-doctoral program. He is Co-Director of Harm Reduction Psychotherapy and Training Associates; founding board member, Division on Addictions of NYSPA, Chairman of the board of Moderation Management and founding board member, Association for Harm Reduction Therapy. His book, Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems, now in paperback, has been published in the United States and Poland. Dr. Tatarsky is in private practice in New York City and trains nationally and internationally.
This website and booklet from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides evidence-based information and interactive tools about risky drinking patterns, signs of an alcohol problem, and ways to help people cut back or quit drinking.
Publisher
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
5635 Fishers Lane, MSC 9304
Bethesda, md 20892
Phone: 301-443-3885
Website: http://www.niaaa.nih.gov/
Dear Colleague:
I am copying below a letter from leading substance use and mental health professionals to President Obama calling on him to appoint a director of SAMHSA who is a respected professional with a scientific background in mental health, substance use disorders and public health. The letter discussed the agency's dysfunction in previous years under leadership lacking in this expertise.
If you support our point of view, please distribute the letter to your colleagues, listserves, blogs,contacts in the media and government and others with an interest in this critically important appointment. I am getting the letter to President Obama through several channels. Let's get the message to President Obama in as many ways as we can.
It is time for real change in how our government ensures high quality, evidence-based and theoretically sound treatment for all Americans struggling with substance use and mental health issues. Please support this effort!
Best,
Andrew Tatarsky, PhD
Letter to President Obama regarding the Importance of Appointing a Nationally Recognized Professional with a Strong Science Background to be the Administrator of Substance Abuse and Mental Health Services Administration (SAMHSA)
March 9, 2009
Dear President Obama
Virtually every family in America is affected by mental illness or addiction. The cost in personal suffering and economic loss is staggering. Part of the tragedy of mental illness and addiction is that these disorders typically strike in late adolescence and early adulthood, between 18-25 years of age. By contrast, most major medical illnesses occur much later in life. The World Health Organization found that mental illness and addiction were the leading causes of disability among Americans ages 18-45, confirming that these diseases rob young Americans of their most productive years.
The last two decades have witnessed dramatic scientific advances in understanding mental illness and addiction which have led to the development of effective treatments and prevention programs. Unfortunately, unlike standard protocols for advances in other areas of medicine, these treatments are not reaching the vast majority of the public who need them. For example, the United States spends about $120 billion annually on behavioral health care [1]. Yet, less than 25% of this care is evidence-based, with 75% of questionable value. The result of the mediocre quality of behavioral health care is that many Americans are suffering needlessly and some are dying because they are not receiving treatment has been shown to work.
What can be done to solve this problem? Most advocacy groups call for increased spending. While lack of resources is part of the problem, increasing funding alone will not solve the problem. Currently, Americans are not receiving adequate value for the $120 billion that are spent annually and much more could be accomplished using existing resources. This is the main conclusion of a landmark report on the state of behavioral healthcare issued by the Institute of Medicine of the National Academy of Science in 2006.
The federal government’s response to this situation has been woefully inadequate. The federal agency responsible for overseeing the quality of behavioral health care and prevention is the Substance Abuse and Mental Health Services Administration (SAMSHA). SAMSHA has a $3.3 billion budget. An OMB review of this agency rated the agency’s programs as largely ineffective; an assessment shared by most mental health and addiction experts. Many politicians including Congressman and Senators who sit on relevant oversight committees have never heard of SAMSHA, despite the fact that SAMSHA is on the same organizational level in the Public Health Service as CDC and FDA.
One major reason for SAMSHA’s obscurity and dysfunction has been the failure to appoint a person with significant scientific and professional expertise to the lead the agency. Past administrators have been drawn from the ranks of state government with experience in community action, but without recognized high level scientific mental health, addiction, and public health expertise. By contrast, the recent heads of FDA and CDC have been nationally prominent scientists with accompanying expertise and stature to effectively lead their agencies.
President Obama, you have a unique opportunity to improve the treatment and prevention of mental illness and addiction by breaking with the past tradition of placing a political appointee with regulatory and administrative experience as the Administrator of SAMSHA. Instead, your transition team should seek a professional with a national reputation of excellence as a scientist and innovator in implementing science-based mental health and addiction programs and public health models in communities. This move would be consistent with your approach to attracting the highest caliber professionals into government, has the potential to improve the lives of many Americans, and would elicit uniform praise from advocates, the scientific community, and the press.
[1] Behavioral health care means addiction and mental health services combined.
Respectfully,
Andrew Tatarsky, PhD, Founding board member and past president, Division on Addiction, New York State Psychological Association, New York, NY; Co-director, H
arm Reduction Psychotherapy and Training Associates
John H. Halpern, M.D., Assistant Professor of Psychiatry, Harvard Medical School, Director of the Laboratory for Integrative Psychiatry, Division of Alcohol and Drug Abuse, Associate Director of Substance Abuse Research, Biological Psychiatry Laboratory, Alcohol and Drug Abuse Research Center, McLean Hospital, Belmont, MA
Mark B. Sobell, Ph.D., ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida
Jon Morgenstern, Ph.D., Professor & Director, Substance Abuse Services, Department of Psychiatry, Columbia University Medical Center, New York , NY
Reid K. Hester, Ph.D., Director, Research Division, Behavior Therapy Associates, LLP
Albuquerque, NM
Linda C. Sobell, Ph.D., ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida
William R. Miller, Ph.D., Emeritus Distinguished Professor of Psychology and Psychiatry, The University of New Mexico, Albuquerque, NM
Richard Juman, PsyD, Representative to Council, Division on Addictions , New York State Psychological Association, New York, NY
Ernest Drucker PhD, Professor, Montefiore Medical Center, Albert Einstein College of Medicine and Columbia University Mailman School of Public Health, New York , NY
Debra Rothschild, PhD, CASAC, Past President, Division on Addictions, New York State Psychological Association, New York, NY
Tom Horvath, Ph.D., ABPP, Practical
Recovery, La Jolla, CA
Joe Ruggiero, Ph.D., Assistant Clinical Director, Addiction Institute of New York, Director,Crystal Clear Project, New York, NY
G. Alan Marlatt, Ph.D. , Professor and Director, Addictive Behaviors Research Center University of Washington, Dept. of Psychology, Seattle, WA
George H Northrup, PhD, President, New York State Psychological Association, New York, NY
Scott Kellogg, PhD, Department of Psychology, Faculty of Arts and Sciences, New York University, New York, NY
John Rotrosen, MD, Professor, Department of Psychiatry, NYU School of Medicine, New York, NY
Nicholas Lessa, Chief Executive Officer, Inter-Care, LTD, New York, NY
Randy Seewald, MD, Beth Israel Medical Center MMTP, Medical Director, Beth Israel Medical Center, New York, NY
Alexandra Woods, PhD, Psychologist/psychoanalyst in private practice, Board of Directors, Division on Addictions, New York State Psychological Association
Karen Frieder, PhD, Executive board member, Addiction Division, New York State Psychological Association, Private Practice, New York, NY
Ana Kosok, Ed. D., Executive Director, Moderation Management Network, New York
Julie Barnes, PhD, CASAC, private practice, Executive board member, Addiction Division, New York State Psychological Association
Genata Carol, PhD, Director of Mental Health Services, AIDS Service Center of Lower Manhattan New York, NY
Patt Denning, PhD, Director of Clinical Services and Training, Harm
Reduction Therapy Center, San Francisco, CA
Jeannie Little, CSW, Executive Director, Harm Reduction Therapy Center, San Francisco, CA
Laura Kogel, LCSW, The Women's Therapy Centre Institute, New York, NY.
Bryan Fallon, PhD, Clinical supervisor in mental health for Prison Health Services. New York, NY
Produced by an Oscar-winning studio for the Global Drug Policy Program of the Open Society Institute, International Drug Policy: Animated Report 2009 highlights some of the disastrous effects of drug policy in recent years and proposes solutions for a way forward.
In the run-up to the March 2009 UN Commission on Narcotic Drugs meeting—where the future path of international drug policy will be determined—this film seeks to show that pursuing a "drug-free world" can lead to more harm than good.
Two new studies suggest that red wine and marijuana may help to prevent or slow Alzheimer’s disease and other age-related memory loss.
An article first published at miller-mccune.com on November 21, 2008, points out that at the November, 2008 meeting of the Society of Neuroscience in Washington, D.C., Ohio State University researchers reported that THC, the main psychoactive substance in the cannabis plant, may lower inflammation in the brain, and even stimulate formation of new brain cells.
And in the Nov. 21, 2008, issue of the Journal of Biological Chemistry, neurologist David Teplow of the University of California, Los Angeles reported that naturally occurring components of red wine called polyphenols can block the formation of proteins that build the toxic plaques thought to destroy brain cells. In addition, these substances can reduce the toxicity of existing plaques. Both actions can slow memory loss.
Neither of these findings surprises me. That marijuana has medical efficacy against a variety of conditions is firmly established scientifically, and the health benefits of moderate red wine consumption are also becoming clearer with each passing year. As of November, 2008, 15 states had laws with provisions for medical marijuana on the books, and I hope more states enact enlightened policies in this regard. In the meantime, if you enjoy an occasional glass of red wine, continue to do so as part of an overall healthy diet.
Study Finds No Link Between Medical Heroin and Crime
A researcher studying the effect of supervised injection sites on Montreal and Vancouver communities found no relation between providing heroin to drug addicts at medically supervised clinics and neighborhood crime, the Montreal Gazette reported Feb. 18.
Serge Brochu from the University of Montreal's School of Criminology studied neighborhoods in Montreal and Vancouver that hosted the North American Opiate Medication Initiative (NAOMI) -- a Canadian study in which participants received heroin under the supervision of nurses, doctors, psychiatrists and social workers.
"There's always this 'not in my back yard' attitude," said Brochu, the study's author. "It's good for the patient, but if it's not good for the community, (then) we have a problem."
Brochu and his team conducted repeat site visits, studied crime data, and interviewed residents, merchants, social workers and security guards to ascertain the effect of the NAOMI study on the neighboring community. They reported neither an increase in crime in the neighborhood nor deterioration in the neighboring community.
"This program should live and the government should continue to fund it," Brochu said, citing the beneficial effect on the health of the drug user and the lack of negative neighborhood impact.
Researchers have been advocating for continued funding for the clinic for nearly two years, but the office of Quebec's minister for social services said the final NAOMI report has yet to be analyzed.
In a press release issued February 24th 2009, GW pharmaceuticals reported that there is no evidence of withdrawal from long term use of Sativex, an oral cannabis spray. The study looked at 36 MS (Multiple Sclerosis) patients who used the medicine for over 3 years. The patients were divided into two groups for this 4 week investigation. One group kept using Sativex and the other switched to placebo (no drug). Of course, without their medicine, patient’s muscle spasms became worse. The link between cannabis for the treatment of spasms has been established for a long time, over 150 years ago. Yet, this is study may provide some unique evidence that cannabis, if allowed to be researched for medical use, can grow into a safe and effective medicine.
Before we can understand the meaning of these findings, we should take a minute to review how Sativex is made. Sativex is an extract of two cannabis varieties. This isn’t a crude extract, but precise and scientific removal of all the essential plant components. Cannabinoids and terpenes are extracted from soil grown plants which produce a specific ratio of the active ingredients. GW has different types of stable cannabis plants available for their work, such as varieties that have been cultivated to produce a certain cannabinoid or ingredient. Of the more than 70 cannabinoids that can be found on the plant, generally the two most common molecules are THC and CBD. Thus, GW basically combines a THC-rich and CBD-rich plant to maximize specific therapeutic actions (decrease muscle spasms) and minimize negative effects (withdrawal symptoms).
Combining different strains or varieties of cannabis to create a medicine with virtually no withdrawal or side effects may seem counter intuitive to some people or it may even sound like a plot for a Pineapple Express sequel. However, the individual compounds found in cannabis varieties, produce different beneficial effects and sometimes even opposite effects. With the help of science these compounds can be measured, plant materials can be mixed, extracted, and delivered with precision.Furthermore, not only were there no withdrawal symptoms reported but there were little or no negative effects reported that are usually associated with a long term THC treatment. Pure THC and cannabis (or cannabis extracts) have unique properties which separate them from each other.
This surprising detail may be partially due to misconceptions resulting from restrictions on cannabis research in the U.S; most of the public knowledge on the negative effects of cannabis comes from studies looking at the effects of pure THC. For lack of a better analogy, this is like studying the effects of beer by giving research subjects pure alcohol.
When given the opportunity and access to openly investigate cannabis, researchers can readily provide a cannabis medicine with symptom specificity. GW’s ongoing work demonstrates that with proper knowledge and scientific methods, a safe and effective medicine can be made from mixtures of soil grown cannabis plants.
Study Finds No Link Between Medical Heroin and Crime
A researcher studying the effect of supervised injection sites on Montreal and Vancouver communities found no relation between providing heroin to drug addicts at medically supervised clinics and neighborhood crime, the Montreal Gazette reported Feb. 18.
Serge Brochu from the University of Montreal's School of Criminology studied neighborhoods in Montreal and Vancouver that hosted the North American Opiate Medication Initiative (NAOMI) -- a Canadian study in which participants received heroin under the supervision of nurses, doctors, psychiatrists and social workers.
"There's always this 'not in my back yard' attitude," said Brochu, the study's author. "It's good for the patient, but if it's not good for the community, (then) we have a problem."
Brochu and his team conducted repeat site visits, studied crime data, and interviewed residents, merchants, social workers and security guards to ascertain the effect of the NAOMI study on the neighboring community. They reported neither an increase in crime in the neighborhood nor deterioration in the neighboring community.
"This program should live and the government should continue to fund it," Brochu said, citing the beneficial effect on the health of the drug user and the lack of negative neighborhood impact.
Researchers have been advocating for continued funding for the clinic for nearly two years, but the office of Quebec's minister for social services said the final NAOMI report has yet to be analyzed.
It features an update on the Mental Health and Substance Use Professionals Sign-on Letter to President Obama that many of you signed. I have heard through the grapevine that politicians and drug policy people on all sides of the debate and at the highest levels were very aware of our efforts and the letter may have played a role in Rep. Ramstad not being selected for the Drug Czar position. You may have heard that Gil Kerlikowske, former police chief of Seattle was just selected for the Drug Czar position. While not a public health or substance use treatment specialist, there seem to be many good things to say about him including that while he was Seattle's police chief, he policed a city with some of the most progressive drug policy in the country turning from a criminal justice to a public health approach to substance use.
For those of you who haven't yet, there is still time to sign on to the letter to put in a vote for science and rationality rather than ideology at the helm of SAMHSA. The director of SAMHSA has not yet been selected. Visit my blog accessed on my website on the lower left of the homepage to read letters and journalists' opinions about this issue.
Sign the letter if you agree with our position! And, please forward this to others whom you think may be interested in the issue. This is an ongoing work in progress. As Russell Simons said at a recent conference at the New York Academy of Medicine, We elected them on their promises and now we need to keep the heat up to make them follow through!
Best,
Andrew Tatarsky, PhD
Harm Reduction Psychotherapy and Training Associates
New York City
212-633-8157
Special
Federal Edition
A new administration
and a new Congress
promise new opportunities
for harm reduction
advocates. This inaugural
edition of the Harm Reduction
Coalition Policy
Update will map out
some of the possibilities.
Sign of the times: “The President
also supports lifting the
federal ban on needle exchange,
which could dramatically
reduce rates of infection
among drug users.”-- posted
on the White House website as soon
as President Obama was
sworn in to office.
Officials and key staff in federal
agencies charged with
tackling drug user health issues
have for years kept harm
reduction at arms length, with
issues such as syringe exchange
treated as politically
radioactive. The Obama administration
offers hope that
harm reduction will finally have
a place in the policies and
priorities of federal government,
after years of dismissal,
silence, distortion, and suppression.
At this time, permanent appointments
to key posts – the
directors for the CDC (Centers
for Disease Control and Prevention),
SAMHSA (Substance
Abuse and Mental Health Services
Administration), and the
ONDCP (Office of National Drug Control Policy), and the
U.S. Global AIDS Coordinator –
have not been announced.
An early rumor that the Obama
transition team was considering
former Congressman
James Ramstad (R, MN) for
ONDCP Director (commonly
known as the “Drug Czar”)
sparked a petition drafted by
Dr. Andrew Tatarsky of Harm
Reduction Psychotherapy and
Training Associates challenging
Ramstad’s qualifications
based on factors including his
voting record against syringe
exchange. The petition has been signed by over 450
substance abuse and mental
health treatment professionals
to date.
For now, ONDCP counsel Edward
Jurith has been named interim director. Of particular
concern to harm reduction
advocates is a letter
that he wrote to the
New York Times, published
October 9, 2001, when he was
last acting ONDCP director
under the Bush administration,
in response to an article
on DanceSafe ‘’Harm reduction’ is a political
movement, not sound policy
based on science. Far from
reducing harm, its advocates
promote policies that lead to
increased usage rates and a
false sense of security for Ecstasy
users.
“Research, not rhetoric, should
be used to educate potential
drug users. So-called harm
reduction programs only obfuscate
the truth: Ecstasy has
been proven to cause longterm
brain damage resulting in
memory loss, depression,
paranoia and confusion.
“At best, harm reduction is an approach that concedes drug
abuse prevention is impossible.
Pretending harmful activity will
be reduced if it is passively condoned
is irresponsible."
“Increasing help for those dependent
on drugs is better than
decreasing harm”
HRC will continue to monitor
these appointments and demand
that officials in key
roles at federal agencies and
offices demonstrate an understanding
of the role and value
of harm reduction, a respect
for science and evidence in
guiding policy, and a commitment
to rejecting the previous
administration’s politicization
of harm reduction.
FEDERAL BAN ON SYRINGE EXCHANGE
Momentum continues to
increase towards lifting the
ban prohibiting the use of
federal funds for syringe
exchange. Rep. Jose Serrano
(D, NY) has reintroduced The
Community AIDS and Hepatitis
Prevention Act (H.R. 179),
which would eliminate all
restrictions on use of federal
funding for syringe exchange.
The bill currently has 39 cosponsors, listed
here
(http://thomas.loc.gov/cgibin/bdquery/z?d111:HR00179:@@@P).
HRC is asking everyone to
contact your member of Congress
and urge them to cosponsor
the bill. Take action
here.
HRC is also leading a grassroots
campaign to lift the
ban, and seeking coordinators
in every state. If you’re
interested in spending a few
hours a week volunteering,
contact Hilary McQuie at
(510) 444-6969 or
mcquie@harmreduction.org later in February, and work to
make sure that language
extending the ban is removed
from the annual
spending bills (known as
Appropriations). Background
materials and advocacy
documents are available on HRC’s website here.
Harm Reduction in the News
HRC’s Executive Director Allan
Clear has been blogging about
harm reduction policy and the
Obama administration at Alter-
Net and the Huffington Post
(Online Course)
As part of the Certificate in Harm Reduction**
Course 1 - Theory and History of Harm Reduction
This course offers an introduction to the concept of Harm Reduction, its history and how it fits into a broader framework of working with people who use substances. It provides a foundation for understanding key issues regarding Harm Reduction, policy and practice.
Course 1: Theory and History of Harm Reduction
Location:
Online
Semester:
Winter 2009
Start Date:
April 27
End Date:
July 24
No. of
Sessions
13
No. of Hours:
39
Tuition:
$665 (GST exempt)
Learning Outcomes for Course 1:
Participants will be able to:
understand the use of psychoactive substances (history, cultural context, history of treatment);
understand neuro-pharmacological perspective on drugs;
understand the history of drug policy in domestic and international contexts;
undertake a historical analysis of stigma and the marginalization of drugs and the people who use them (and how this intersects with other types of marginalization);
understand the theoretical foundation of Harm Reduction;
understand the emergence of Harm Reduction domestically and internationally and analyze the evidence of its efficacy; and
understand the historical role of peer involvement.
Program Instructors
Courses 1, 2 and 3: Dale Kuehl, MSW, RSW, is Discipline-in-Chief of Addiction Therapy at the Centre for Addiction and Mental Health (CAMH) in Toronto. He teaches in the School of Social Work programs at York and Ryerson Universities, is an instructor with the School of Health and Community Services at Durham College, and a harm reduction psychotherapist/consultant in private practice in Toronto.
Course 1: Barb Panter, BSW, is the IDU Outreach Educator at Queen West 0D
Community Health Centres in Toronto, where she works primarily with homeless drug users. She has worked in harm reduction for over 10 years in Toronto and in the Downtown Eastside of Vancouver. She obtained her BSW at the University of British Columbia.
Course 2: Susan Shepherd, MSW, is the Manager of the Toronto Drug Strategy Secretariat, the staff team that supports implementation of the drug strategy. Previously she worked ten years as a social policy analyst with the City, in the areas of substance use, poverty and homelessness. She has a BA in Psychology and an MSW. Prior to joining the City of Toronto, Susan was a front-line worker in the community-based service sector.
Course 3: Peggy Milson is a medical doctor and Associate Professor in the Department of Public Health Sciences, Faculty of Medicine, University of Toronto. Her current academic interests are in: injection drug use & HIV prevention; harm reduction; social, behavioural and epidemiological aspects of HIV infection, especially among women; care, treatment and support for HIV positive persons; tuberculosis and HIV co-infection; and epidemiology and prevention of sexually transmitted diseases.
Overall Program Summary
** The Certificate in Harm Reduction consists of 117 hours of instruction (3 courses in total) and is designed to introduce service providers, administrators and policy makers to the principles, concepts and practices of harm reduction; to provide an opportunity to critically examine examples of harm reduction work; and to become familiar with strategies for mobilizing support for and developing harm reduction programs in communities and institutions. Course #2 will be offered in-class at the York campus in the Fall semester 2009, and Course #3 will be offered in-class at the York campus in the Winter semester 2010, prior to being offered online.
Participants who complete all three courses and all evaluative components will receive a Certificate in Harm Reduction from York University.
The National Program Advisory Committee assisting in the development of the curriculum for this Program includes personnel from:
The Toronto Harm Reduction Task Force
The Canadian Harm Reduction Network
Toronto Public Health
CounterFIT Harm Reduction Program, Toronto
HIV Social, Behavioural and Epidemiological Studies Unit, Faculty of Medicine, University of Toronto
Vancouver Coastal Health Authority
Drug Sense
Canadian AIDS Society / Société canadienne du sida
Ontario Aboriginal HIV/AIDS Strategy
Streetworks, Edmonton, Alberta
Superior Points Harm Reduction Program, Thunder Bay, Ontario
South Riverdale Community Health Centre, Toronto
Community Services, City of Vancouver
Blood Ties Four Directions Centre, Whitehorse, Yukon Territory
Co-Sponsor
This course was developed in collaboration with the Faculty of Education, Field Development, York University.
Admission Requirements
a degree or diploma in a human or social service, allied health discipline; or
a minimum of two years’ full-time relevant practice experience related to Harm Reduction; or
current employment in a related position; or
Permission of Program Manager.
For those who meet admission requirements 2 and 3, but not requirement 1, permission of the Program and Logistics Manager will be required.
To register or request information please contact:
The Division of Continuing Education (DCE)
York University
Nneka Roberts, Information Assistant
Atkinson Building
Room 107
4700 Keele Street
Toronto, ON M3J 1P3
America's current foreign policy has very little impact on reducing supply, consumption or cultivation. Obama has a big chance to turn it around.
Everyone knows that Barack Obama became the 44th president of the United States last Tuesday, Jan. 20. As an advocate for sound, sane drug policy and HIV prevention, I hope that his inauguration will mark a change to an administration that chooses science over dogma.
By contrast, practically no one knows about the Commission on Narcotic Drugs meeting that will take place in Vienna, Austria, six weeks from now, March 12-13. This meeting of United Nations member states will review the results of the1998 U.N. General Assembly Special Session on drugs that set the framework for the last decade's international drug policy. They will then release a political declaration that will set the framework for the next decade -- and, by implication, the course for the global response to the HIV epidemic as it affects drug users.
It is imperative that the new Obama administration act quickly to ensure that the U.S. delegation to this upcoming UNGASS review reflect Obama's publicly stated position that he, per the official White House site, "supports lifting the federal ban on needle exchange, which could dramatically reduce rates of [HIV] infection among drug users."
Otherwise, our new president will miss a vital early opportunity to lead us back into an era of evidence-based policy.
Our current U.S. delegation is primarily made up of State Department bureaucrats soldiering in the war on drugs. 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.
By making drug use as dangerous as possible, the United States has facilitated the spread of HIV and viral hepatitis, has allowed death from overdose to remain unchecked and has created a prison system unlike anything since the Soviet gulags. At the same time, U.S. commitment to providing effective drug treatment on demand is virtually nonexistent. Moreover, in critical negotiations in international settings, Team USA is rabidly hostile toward harm reduction and syringe exchange at a time when Australia, Canada, Iran and most European Union countries embrace them as important drug policy tools.
The UNGASS review presents an opportunity for the Obama administration not only to lose these Bush-era ideologues, but also to join with other nations to create a genuinely balanced and useful blueprint for international drug policy.
We should follow the example of other U.N. member states, including some countries in the Caribbean as well as the U.K., and the Netherlands, and expand the U.S. contingent to include members of civil society -- people with a distinct viewpoint who can engage in the proceedings and represent the views of drug users.
After all, countries around the world, including the United States, have long understood the importance of including people living with HIV/AIDS at U.N. meetings. Yet, when it comes to making U.N. drug policy, the current U.S. framework renders the most affected community, individuals who use drugs, silent. It will be easier to design effective solutions with input from all affected parties.
In July 2008, over 300 representatives from civil society came together under the auspices of the United Nations Office on Drugs and Crime to provide input into the UNGASS review at a meeting called Beyond 2008. The resulting declaration was designed to partially mirror that being produced by the formal government review process. This consensus-based document, while imperfect, directs governments to address global drug problems in a proportional fashion and redress the imbalance caused by focusing on the supply side of drug policy.
(Try getting consensus in a group that includes the Drug Free America Foundation, National Narcotics Officers' Associations' Coalition, Students for Sensible Drug Policy, and the American Civil Liberties Union! And that's just part of the U.S. contingent.)
The only government that was arrogant enough to meddle in the formative process was (surprise) the United States. But despite all that preparation -- and three days of meetings -- the Beyond 2008 Declaration is destined to be sidelined at the UNGASS review meeting, as there is no clear indication from the Commission on Narcotic Drugs that the views of civil society will be included in the March meeting.
Who benefits from keeping the voice of civil society out of the UNGASS review process? The United States and Russia, primarily, as they both maintain positions that civil society opposes. The United States wants to keep syringe exchange and harm reduction off of the agenda; the Russians want to continue to demonize methadone.
In a letter co-sponsored with our allies at Physicians for Human Rights and co-signed by more than 60 public health and human rights organizations, the Harm Reduction Coalition has asked the Obama administration to immediately appoint a more progressive U.S. delegation to the UNGASS review process -- one that reflects the president's stance on syringe exchange and puts civil society at the table where it belongs.
The time has come to return to drug policy based on best medical practices, to recognize the human rights of drug users and to produce a political declaration that will shift the focus of international drug policy toward a public-health-based approach that will aid rather than hurt drug users.
Public Health and Human Rights Advocates Ask Obama to Ensure That US Delegation to UN Drug Meeting Reflects His Support for Syringe Exchange
FOR IMMEDIATE RELEASE BY THE HARM REDUCTION COALITION: January 27, 2009
NEW YORK CITY - The Harm Reduction Coalition published an op-ed today urging the Obama administration to send delegates to an upcoming meeting of United Nations Member States that will reflect the President’s public health and drug policies. Per the official White House site, President Obama supports “lifting the federal ban on needle exchange, which could dramatically reduce rates of [HIV] infection among drug users.”
“Our current US delegation is primarily made up of State Department bureaucrats that have been hostile towards syringe exchange and harm reduction at a time when Australia, Canada, Iran, and most European Union countries embrace them as important drug policy tools,” said Allan Clear, Executive Director of the Harm Reduction Coalition and the writer of the op-ed. “We don’t want President Obama to miss this vital early opportunity to lead us back into an era of evidence-based policy.”
The upcoming Commission on Narcotic Drugs meeting, which will take place in Vienna on March 12-13, 2009, will review the results of the1998 UN General Assembly Special Session (UNGASS) on drugs that set the framework for the last decade’s international drug policy. Delegates from UN Member States will then release a political declaration that will set the framework for the next decade — and, by implication, the course for the global response to the HIV epidemic as if affects drug users.
In addition, the op-ed urges the Obama administration to expand the US delegation to include members of civil society. Notes Rebecca Schleifer, an advocate for Human Rights Watch's HIV/AIDS program, “The UNGASS meeting must be opened up to include civil society. This is the standard for UN conferences about women, HIV/AIDS, and disability. However, when it comes to drug policy, we see again that the voices of those who are most affected are missing.” Sanho Tree, a Fellow and Director of the Drug Policy Project at the Institute for Policy Studies in Washington, DC, concurs: “It will be easier to design effective solutions with input from all affected parties.”
In a letter co-sponsored with Physicians for Human Rights and co-signed by 60+ public health and human rights organizations, the Harm Reduction Coalition has asked the Obama administration to immediately appoint a more progressive US delegation to the UNGASS review process. As of today’s date, January 27th, a mere six weeks from the 2009 UNGASS, there has been no response from the Obama administration.
To speak with Allan Clear or other media spokespeople, including Rebecca Schleifer and Sanho Tree, contact Nancy Goldstein at 347 563 1647 or nancygoldstein@yahoo.com
Harm Reduction Coalition’s UNGASS Sign-On Letter to Obama
January 1, 2009
Dear President-elect Obama,
Congratulations on your historic election. As advocates working to address US government policy on drug use and HIV, we hope that your administration will shift US policy in this critical area away from ideology and to positions based firmly on evidence, public health principles, and human rights.
We are fast approaching a very important meeting of the United Nations Commission on Narcotic Drugs. In March 2009, UN Member States will gather in Vienna for a high level meeting to assess progress since the 1998 General Assembly Special Session addressing world drug problems. The political declaration coming out of this two-day meeting will set the framework for the next phase of international drug control and will set the course for the global response to the HIV epidemic.
This political declaration is being drafted right now and will be largely completed by the end of January, shortly after you take office. Bush Administration State Department negotiators are currently taking advantage of the US government's status as a world power to undermine and block accepted World Health Organization (WHO) and UNAIDS approaches to HIV prevention among drug users – strategies that are now strongly supported by the vast majority of UN Member States. The negotiators for the outgoing US administration 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.
We are concerned that because this key international meeting comes at a time shortly after you assume office and will be facing extraordinary demands, the default response may be a continuation by the US negotiators of the harmful status quo. We believe that those currently representing the US government in Vienna do not reflect the values you espoused in your successful election campaign, and that your own administration will wish to chart a quite different course. The March 2009 meeting represents an immediate and important opportunity for the US government to adjust course, and to work with other UN Member States in supporting a new, evidence-based drug and HIV policy.
Our requests are that:
* The US delegation to these negotiations should be more qualified. Delegates should be familiar with evidence, best practices of HIV prevention, and human rights. The Office of Global AIDS Coordinator should guide the process as it relates to harm reduction and HIV prevention. Members of civil society whose views are distinct from those of the State Department negotiators should be added to the delegation to provide advice and monitor the process.
* The US government should support the global consensus on the need to provide services to help drug users avoid HIV. You have already expressed your support of federal funding for needle and syringe exchange.
* The US should affirm the importance of expanding access to these services worldwide.
* The US government uphold the principles of the Beyond 2008 consensus document at the upcoming Ministerial portion of the Commission on Narcotic Drugs meeting.
* The US government should support calls for scale-up of evidence-based treatment for drug addiction, including access to methadone and buprenorphine.
* The US government should support efforts to remove the restrictions on access to controlled drugs for medical use for pain relief and treatment of drug dependence.
Because time is short, we would appreciate the opportunity for a face-to-face meeting as soon as possible with the appropriate member of your transition team to help ensure that past US mistakes are not repeated, and to make the most of this opportunity to demonstrate positive US leadership on this crucial aspect of HIV prevention policy on the international stage.
Further, we hope you will consider us as a resource as you move through the transition and during your administration. We will be in touch to schedule a meeting. If you have any questions, please contact either Paola Barahona, Senior Global Health Policy Advocate, Physicians for Human Rights (202.728.5335, x300; pbarahona@phrusa.org) or Allan Clear, Executive Director, Harm Reduction Coalition (212-213-6376, x11; clear@harmreduction.org).
Letter to Ambassador Rice from Reps. Serrano, Waxman and Lee Congress of the United States
Washington, DC 20515
January 28, 2009
The Honorable Susan E. Rice
Ambassador
United States Mission to the United Nations
140 E. 45th Street
New York, NY 10017
Dear Ambassador Rice:
We wish to congratulate you on your new post. We look forward to working closely with you to address the enormous challenges before us.
Among those challenges, as you well know, is the spread of HIV/AIDS. Within the United States and globally, intravenous drug use has been a significant factor in the spread of HIV and other infections, such as Hepatitis B, that are major threats to public health.
Within the Congress, we three have worked to try to allow federal funding to support domestic needle exchange programs, which have been shown to reduce rates of infection among drug users without increasing illegal drug use. In the United States and around the world, needle exchange is recognized as a practical and proven way to help minimize the terrible harms associated with illegal drug use.
We are pleased that President Obama supports lifting the ban on federal funding for needle exchange, and we look forward to working with the Administration to bolster this critical HIV prevention strategy.
The following is a policy statement prepared by a colleague that discusses the rationale for having leadership at SAMHSA (Substance Abuse and Mental Health Services Administration) that is guided by science rather than ideology and politics as the agency has been for some time. It discusses the problems that have resulted from political leadership over the past and why we need a scientist who knows addiction and is committed to supporting evidence-based treatment for substance use and mental health problems and ongoing research to inform improved treatment efficacy of these very common human problems that effect us all.
I welcome comments, support and dialogue on this policy statement.
Andrew Tatarsky, PhD
The Importance of Appointing a Nationally Recognized Professional with a Strong Science Background to be the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA)
Virtually every family in America is affected by mental illness or addiction. The cost in personal suffering and economic loss is staggering. Part of the tragedy of mental illness and addiction is that these diseases typically strike in late adolescence and early adulthood, between 18-25 years of age. By contrast, most major medical illnesses occur much later in life. The World Health Organization found that mental illness and addiction were the leading causes of disability among Americans ages 18-45, confirming that these diseases rob young Americans of their most productive years.
The last two decades have witnessed dramatic scientific advances in understanding mental illness and addiction which have led to the development of effective treatments and prevention programs. Unfortunately, unlike standard protocols for advances in other areas of medicine, these treatments are not reaching the vast majority of the public who need them. For example, the United States spends about $120 billion annually on behavioral health care [1]. Yet, less than 25% of this care is evidence-based, with 75% of questionable value. The result of the mediocre quality of behavioral health care is that many Americans are suffering needlessly and some are dying because they are not receiving treatment has been shown to work.
What can be done to solve this problem? Most advocacy groups call for increased spending. While lack of resources is part of the problem, increasing funding alone will not solve the problem. Currently, Americans are not receiving adequate value for the $120 billion that are spent annually and much more could be accomplished using existing resources. This is the main conclusion of a landmark report on the state of behavioral healthcare issued by the Institute of Medicine of the National Academy of Science in 2006.
The federal government’s response to this situation has been woefully inadequate. The federal agency responsible for overseeing the quality of behavioral health care and prevention is the Substance Abuse and Mental Health Services Administration (SAMSHA). SAMSHA has a $3.3 billion budget. An OMB review of this agency rated the agency’s programs as largely ineffective; an assessment shared by most mental health and addiction experts. Many politicians including Congressman and Senators who sit on relevant oversight committees have never heard of SAMSHA, despite the fact that SAMSHA is on the same organizational level in the Public Health Service as CDC and FDA.
One major reason for SAMSHA’s obscurity and dysfunction has been the failure to appoint a person with significant scientific and professional expertise to the lead the agency. Past administrators have been drawn from the ranks of state government with experience in community action, but without recognized high level scientific mental health, addiction, and public health expertise. By contrast, the recent heads of FDA and CDC have been nationally prominent scientists with accompanying expertise and stature to effectively lead their agencies.
President elect Obama has a unique opportunity to improve the treatment and prevention of mental illness and addiction by breaking with the past tradition of placing a political appointee with regulatory and administrative experience as the Administrator of SAMSHA. Instead, the Obama transition team should seek a professional with a national reputation of excellence as a scientist and innovator in implementing science-based mental health and addiction programs and public health models in communities. This move would be consistent with President elect Obama’s approach to attract the highest caliber professionals into government, has the potential to improve the lives of many Americans, and would elicit uniform praise from advocates, the scientific community, and the press.
[1] Behavioral health care means addiction and mental health services combined.
Update on January 8, 2009 of the progress of:
Substance Use and Mental Health Treatment Professionals Letter to President Elect Obama
Regarding the Selection of Directors of the Office of National Drug Control (the Drug Czar) and the Substance Abuse and Mental Health Services Agency (SAMHSA)…
As of today over 260 mental health and substance use treatment professionals and over 160 researchers, academics and other concerned citizens have signed on to our letter expressing concern about the possible choice by President-elect Obama of Rep. Jim Ramstad to direct either the White House Office of National Drug Control Policy or the Substance Abuse and Mental Health Services Administration. The concern is based on Rep. Ramstad’s voting record over 28 years in congress that suggests his views on substance use treatment reflect ideology and politics rather than science. The letter goes on to urge President-elect Obama to choose leaders for these agencies who will put science first in formulating drug and drug treatment policy and goes on to make six specific recommendations regarding support for treatment and criminal justice issues.
The letter is historically significant in two important ways. First, it reflects the recognition by a large cross section of substance use treatment and other professionals of the need to take political action to address social policies that negatively affect substance users in this country in addition to the work we do in our offices. It is also significant that these professionals, many of whom are national leaders in their fields, are speaking up on behalf of progressive, innovative, non-abstinence only treatments that are well supported by science that shows they effectively treat addiction and save lives. Many of these treatments have not been supported by Rep. Ramstad and previous administrations.
To date the letter has been hand delivered to President-elect Obama’s transition team by a sitting congressperson. It has been posted on President-elect Obama’s transition team website, www.change.gov. It has been mentioned in numerous blogs, most notably John Tierney’s Tiernylab at NYTimes.com and the Huffington Post and I have been interviewed about the letter on WBAI and Air America. There are several other avenues being pursued to ensure that our views are considered in the selection of these leadership positions.
You can provide more support for this important movement by forwarding this note, the press release and the letter to any journalists and others who may be interested in knowing about what we are doing. You may also have your own creative ideas for further publicizing the letter. You can also urge colleagues who have not yet signed on to consider doing so.
I welcome any feedback, suggestions or other opinions on these very important issues.
Thank you for your support!
Sincerely, Andrew Tatarsky, PhD
For Immediate Release: Contact: Andrew Tatarsky, PhD (212) 633-8157
Monday, December 22, 2008
Possible Obama Pick for "Drug Czar" or head of SAMHSA Criticized by Hundreds of Substance Abuse and Mental Health Treatment Professionals, Researchers and Academics
Ramstad's Positions on Syringe Exchange, Sentencing Reform, Medical Marijuana and other Issues Unscientific and Harmful Say Experts
Leading Substance Abuse and Mental Health Experts Suggest Six Positions that Leaders of ONDCP and SAMHSA Should Support
A growing number of professionals have expressed concern about reports in the media that President-elect Obama may be considering appointing Republican Congressman Jim Ramstad (R-MN) either as the next "Drug Czar", director of the Office of National Drug Control, or as director of SAMHSA, the Substance Abuse and Mental Health Services Administration. In a letter to President-elect Obama released today, over 250 clinicians working with patients with substance use problems and nearly 150 researchers, academics and other concerned citizens warn that Ramstad is not the man for either of these jobs because his record suggests that his perspective is ideologically based and at odds with science.
The letter applauds Rep. Ramstad's support for expanding access to drug treatment and improving addiction awareness and it honors his own personal triumph over addiction. However, in spite of these contributions, Ramstad has supported unscientific faith-based treatment while opposing evidence-based practices such as methadone maintenance and syringe exchange, two of the most effective interventions for addiction and transmission of infectious disease that save lives. He has also consistently opposed congressional efforts to stop the arrest of patients with HIV/AIDS, cancer and other illnesses who use prescribed medical marijuana in states where it is legal and he has failed to co-sponsor legislation that would eliminate sentencing disparity between crack cocaine and powder cocaine, despite the fact that there were three different crack/powder reform bills in the 110th Congress. These positions clearly conflict with President-elect Obama's stated positions on these issues.
These professionals call for President-elect Obama to select leaders for these critically important positions who are committed to reducing the harms associated with both drugs and punitive drug laws and who will base their decisions on science rather than politics or ideology.
They call for leaders who will support evidence-based treatment across the spectrum including:
Non-abstinence based interventions like Motivational Interviewing, opiate substitution treatment and abstinence oriented treatment for appropriately matched patients;
Integrated treatment for patients with co-occurring disorders;
Syringe exchange programs to halt the spread of HIV and hepatitis-C.
They also call for leaders who will treat substance abuse and dependence as health issues rather than as criminal issues and be committed to:
Sentencing reform
Better educating criminal justice professionals associated with drug courts in the complexities of substance use problems and their treatment and
More fully involving clinical staff in decisions about individuals mandated by drug courts to treatment
The letter concludes, "There ar e many roads to recovery and recovery can take different paths…these views are in the best interests of individuals struggling with substance use disorders and all Americans".
Some researchers in substance-abuse treatment and advocates for the medical use of marijuana are alarmed at reports that R epresentative Jim Ramstad, a Republican from Minnesota, is a candidate to become the next drug czar — the director of the office of National Drug Control Policy. In a joint letter to President-elect Barack Obama, coordinated by Andrew Tatarsky, the past president of the division of addictions of the New York State Psychological Association, dozens of academics and other professionals in substance-abuse treatment write:
This country needs a drug czar who supports evidence-based policies and one who will make decisions based on science, not politics or ideology. We strongly believe that Congressman Ramstad is not that person.
Rep. Ramstad voted in 1998 in favor of making permanent the federal funding ban on syringe exchange. In 2000, he voted to prohibit the District of Columbia from spending its own locally-raised funds on syringe exchange programs, and in 2007, he voted against lifting the same DC ban, despite decades of research showing that syringe exchange programs reduce the spread of HIV/AIDS, save lives, save money, and do not increase drug use. Representative Ramstad has also c onsistently opposed congressional efforts to stop the arrest of patients with HIV/AIDS, cancer, and other illnesses who use medical marijuana to ease their pain and suffering in states where it is legal.
Similar concerns have been raised in another joint letter, coordinated by the Drug Policy Alliance endorsed by more than three dozen other public-health, criminal-justice and drug-treatment organizations. They write to Mr. Obama:
You showed strong leadership on the campaign trail by pledging to lift the federal funding ban on syringe exchange programs, end the excessive federal law enforcement raids aimed at medical marijuana patients, and eliminate the crack/powder cocaine sentencing disparity. . .
We urge you to nominate for drug czar someone with a public health background, who is committed to reducing the spread of HIV/AIDS, hepatitis C and other infectious diseases, open to systematic drug policy reform, and able to show strong leadership on the issues you believe in.
The costs of the war on drugs are summed up by Ethan Nadelmann, the executive director of the Drug Policy Alliance, in a Wall Street Journal op-ed article celebrating the 75th anniversary of the repeal of Prohibition. After noting that that the repeal was popular not just among drinkers but also non-drinkers worried about the rise in organized crime and other consequences of Prohibition, Mr. Nadelmann writes:
They saw what most Americans still fail to see today: That a failed drug prohibition can cause greater harm than the drug it was intended to banish.
Consider the consequences of drug prohibition today: 500,000 people incarcerated in U.S. prisons and jails for nonviolent drug-law violations; 1.8 million drug arrests last year; tens of billions of taxpayer dollars expended annually to fund a drug war that 76% of Americans say has failed; millions now marked for life as former drug felons; many thousands dying each year from drug overdoses that have more to do with prohibitionist policies than the drugs themselv es, and tens of thousands more needlessly infected with AIDS and Hepatitis C because those same policies undermine and block responsible public-health policies.
And look abroad. At Afghanistan, where a third or more of the national economy is both beneficiary and victim of the failed global drug prohibition regime. At Mexico, which makes Chicago under Al Capone look like a day in the park. And elsewhere in Latin America, where prohibition-related crime, violence and corruption undermine civil authority and public safety, and mindless drug eradication campaigns wreak environmental havoc.
The joint letter to Mr. Obama organized by Dr. Tatarsky suggests a different approach: "We need a new bottom line for U.S. drug policy so that treatment is more available and addiction is treated like a health issue, not a criminal issue. To paraphrase former Baltimore Mayor Kurt Schmoke, we need a surgeon general, not a military general or police officer."
What do you think of Mr. Ramstad as drug czar? Do you have any other nominees for the job? Or other advice for Mr. Obama on drug policy?
IHRA NEWSLETTER JANUARY 2009
Early Bird Registration Discounts: One Week Left! The deadline for discounted ‘Early Bird’ registrations is fast approaching. In order to qualify for a saving of up to £100, delegates are asked to register online and make their payment before Wednesday 21st January 2009. This represents an ideal opportunity for delegates to obtain the best value registration fee – especially given that the fees are currently even better value due to the recent fall in value of the GB£. Click here to find out more
Conference Website Now Available in Thai The conference website has now been launched in Thai as well as English. The majority of pages have now been translated – including the latest news and information – in order to make the event as accessible as possible to those from the host country. In addition, Thai translation will be provided at the event itself for all of the Plenary and Major Sessions as well as half of the Concurrent Sessions. The Thai pages can be accessed by clicking the Thai flag at the top of the website. Click here to find out more
Accommodation Booking Service Now Open
The conference organisers are pleased to announce a partnership with Oriental Events – the official travel partner for Harm Reduction 2009 – to assist delegates in planning their stay in Thailand in April. Hotels, accommodation, trips, excursions and transfers can now be booked (often at special rates) directly through the conference website – including rooms at the conference venue itself, the four-star Imperial Queen’s Park Hotel. Click here to find out more
Reminder: Nominate Someone for an IHRA Award
Nominations are still being invited for the 2009 International Rolleston Award, the 2009 Carol and Travis Jenkins Award, and the 2009 Paolo Pertica Fellowship – all of which will be presented during Harm Reduction 2009. These awards are an excellent opportunity to recognise the outstanding and innovative work of your colleagues, friends and peers. The deadline for nominations is 28th January 2009. Click here to find out more
Stop Press: Medical and Harm Reduction Services in Bangkok
After on-going consultations with the relevant authorities in Thailand, special arrangements have been made to accommodate the needs of delegates for Harm Reduction 2009 who are already on medically supervised opiate substitution treatments in their own country.
Imports: The Thai Government has agreed that conference participants who are already receiving opioid substitution treatment will be able to import their personal medication into Thailand. It is not normally possible to import opiate medications, and we are grateful to the Thai Government for this dispensation. Further details on the importation procedure – including which drugs are covered and the documentation that will be needed – will be available on the conference website soon.
Prescribing and Dispensing in Thailand: Arrangements are also near finalisation regarding a methadone prescribing and dispensing service in Bangkok for people who are already on medically supervised substitution programmes in their own countries but who are unable to import their medication. Confirmation and further details of this service – including eligibility and documentation – will be available on the conference website soon.
Harm Reduction Supplies: We are also currently finalising details of harm reduction services at the conference – including the availability of needles and syringes and Naloxone (or ‘Narcan’). These items can also be purchased from pharmacies and drug stores in Bangkok without a physician's prescription. Click here to find out more
NEW HARM REDUCTION GROUPS FORMING Supervision & Training Activities Offered
Spanish Translation of Dr. Tatarsky's publication Harm reduction psychotherapy: Extending the reach of traditional substance use treatment (Journal of Substance Abuse Treatment) is now available
WNYC devoted a portion of the Leonard Lopate show on 9/11/08 to the issue of psychologists in interrogations. Here is the program description:
Psychologists and Torture
Some professionals are trying to force the American Psychological Association to bar its members from participating in coercive interrogations and torture. Dr. Steven Reisner is running for president of the APA on an anti-terror platform; Dr. Allan Keller is Director of the Bellevue/NYU Program for Survivors of Torture. Journalist Katherine Eban has written about psychologists and torture for Vanity Fair magazine.
A randomized clinical trial of methadone maintenance for prisoners: findings at 6 months post-release. Gordon MS, Kinlock TW, Schw artz RP, O'Grady KE. Addiction 2008 103;8:1333-1342
Dear Colleagues,
These researchers found, predictably, that offering methadone treatment to prisoners with a history of opiate addiction was feasible, safe and effective, just like it is in the community generally when done according to established guidelines. They compared counselling with/without MMT, finding less heroin use and less criminal activity at 6 months after release in those offered MMT. Treatment retention was also higher.
This is yet another example of American research which is decades behind other countries. And this is despite heroin addiction has been accepted as a brain disease’ by the White House and methadone and similar registered treatments are proven effective approaches. However, for those in the US prison system these maxims do not apply for some reason. Note that this study was not published in an American journal.
Almost uniquely, in New South Wales, prisoners have had access to methadone treatment for over 20 years. It was initially introduced as a pre-release measure to address the high rate of overdoses in those recently released. There is now a copious literature on the subject, largely very positive. Methadone has now been introduced in many other jurisdictions, although rarely ‘across the board’ as occurs in New South Wales.
Thus a trial which gave some subjects no access to such treatment would be unethical, unnecessary and cruel in a normal country. Yet in America, despite a large drug budget and constitutional protection s, denying prisoners appropriate treatment seems to be ‘business as usual’, like Guantanamo Bay and capital punishment. These researchers say that there is an “urgent treatment need” yet it is unlikely anything will be done in a hurry in the USA, despite persuasive research like this.
To raise awareness about the worldwide lack of access to methadone and buprenorphine – the best studied and most effective medications for opiate dependence – The International Harm Reduction Development Program of the Open Society Institute launched the Where’s th e Methadone? Campaign at the AIDS Conference in Mexico City. Methadone and buprenorphine are lifesaving medications that help prevent HIV and help those on AIDS treatments stay on them, yet they are currently available to less than 10% of people who need them.
In the tradition of Mexican wrestlers, two superheroes – “Methadone Man” and “Buprenorphine Babe” – took the International AIDS Conferen ce by storm, as they provided posters, postcards and information about the need for these essential medicines. But the campaign did not end with the conference. We need your help to spread the word!
We encourage you to visit www.wheresthemethadone.org to join the campaign. The site, which is available in English, Russian and Spanish, provides more information about methadone and buprenorphine, and their benefits to opiate users and society in general.
The New York City Department of Health Mental Hygiene is now offering information important for the health of all New Yorkers.
To sign up for these new and valuable updates, log-on to our website at http://www.nyc.gov/health/email and select the NYC DOHMH updates you'd like to receive.
Once again, as a group of mental health and substance use treatment professionals, we have an opportunity to take a public stance on behalf of the health and safety of drug using citizens. Please read the announcement below about the crisis of opiate overdose in the US and a petition to make naloxone (it blocks the effects of opiates and reverses overdose and saves lives) available over-the-counter as it is in Italy.
Overdose prevention is being implemented in small ways already under research conditions and has been shown to be very effective. This measure could save countless lives.
Please sign the petition by clicking below and forward this on to three colleagues.
Thank you!
Andrew Tatarsky, PhD
Harm Reduction Psychotherapy and Training Associates www.andrewtatarsky.com
This is it! Please get involved in helping to reduce our out-of-control overdose crisis by signing the national petition! Our drug czar Gil Kerlikowske has been talking a lot lately about what a terrible problem accidental overdose has become, but he hasn't done anything yet to try to FIX the problem!
We know that a majority of these deaths are caused by opiates like Vicodin, methadone and heroin, and we know that the safe, effective drug naloxone reverses an overdose immediately. We know that people in Italy have been buying naloxone over-the-counter for years--so why can't we? Why is this incredibly safe, effective, lifesaving drug--so urgently needed right now--still only available with a prescription? People are dying--we need better access NOW!
Sign the petition urging our drug czar to start working with FDA & related agencies to move naloxone from prescription-only status to over-the-counter status. Its 30 year track record of incredible safety & efficacy demand a new plan to make it more available now and to DO something to stop our growing overdose crisis. Sign TODAY! And thank you for everything you do to help prevent overdose deaths!
Acclaimed addiction researcher A. Thomas McLellan has been unanimously confirmed by the U.S. Senate to serve as the deputy director of the White House Office of National Drug Control Policy (ONDCP).
The Philadelphia Inquirer reported Aug. 8 that McLellan's appointment was approved by unanimous consent.
McLellan, formerly the executive director of the Treatment Research Institute (TRI) at the University of Pennsylvania, will be in charge of demand-reduction policy at ONDCP. "The nation has gained a leader who has been at the forefront of science-based efforts to improve treatment systems for people suffering from drug addictions. We know Tom McLellan will bring this expertise to the country’s efforts to reduce demand for illegal substances of abuse," said TRI Board Chair Carolyn Asbury, Ph.D.
Update on the situation in Uzbekistan regarding the suspension of substitution treatment
Dear Colleagues:
I am passing on a thank you to those of you who signed on to the attached letter to the President of Uzbekistan regarding the suspension of substitution treatment in that country. The list of signatories is an impressive group of professionals from around the world. There is also an update about the situation there and what people might do to support the improvement of treatment for opiate dependent people in that nation.
I think it is very important that American professionals participate in international efforts to improve the treatment of substance using patients as well as contribute to such efforts at home. I thank you for your efforts as well.
Andrew Tatarsky, PhD
Harm Reduction Psychotherapy and Training Associates
EHRN is thankful for your support to substitution treatment in Uzbekistan, and for your help to its initiative aiming to inform the President and Government of Uzbekistan about the negative consequences of closing the OST program. EHRN sent the attached letter to its addressees, and we will inform you once we receive feedback.
Meanwhile, we thought we should provide a brief update based on our discussions with local specialists and EHRN Director Raminta Stuikyte's visit to the country:
According to the Ministry of Health of Uzbekistan, the opioid substitution therapy program there was a pilot program which had come to conclusion and which had been evaluated. Following the evaluation, the pilot program was not extended and no new ‘non-pilot’ program is set up. According to information gathered through a series of meetings with local stakeholders, international organizations and local NGOs were not consulted and the decision was made without them. Local NGOs and international organizations recognize that the pilot program had to address quality issues, including illegal drug use by clients, however, general appreciation of the substitution pilot was expressed during the EHRN’s Director visit to Uzbekistan last week. According to anecdotal information, the program's 200 patients are currently undergoing other treatment options or have ceased to have contact with health settings.
Although the Ministry of Health communicated openness to gathering further evidence around substitution therapy, it is unlikely that their decision to fend the pilot and not to start implementing substitution therapy in the health system can be reversed in the near future. One opportunity to return to this discussion is to conduct an assessment of OST implementation in Uzbekistan, demonstrating that the problems were related to the particular program rather than the method itself.
AIDS NGOs and other stakeholders met by the EHRN Director during her visit to Uzbekistan last week are rather pessimistic about the future of OST and also about other harm reduction services in
the country. Current funding for low threshold programs is coming to end and the last three attempts to get support from the Global Fund were not successful. Additionally, a national program around spiritual and moral values which was recently approved by the Uzbek AIDS Commission might have impact on harm reduction developments and operations of more than 200 low threshold sites for drug users operating in the country. Two major harm reduction NGOs: the local branch of World Vision running one service site; and CARHAP providing methodological, technical and other support, are both closing their operations around harm reduction. However, an Uzbek NGO consortium is planned to be a principal recipient in a new RCC application to the Global Fund (to extend the current GF-funded program with similar or larger levels of funding) and take over responsibility for all services and advocacy work around vulnerable groups, including injecting drug users. The draft proposal excludes OST. Some problems of existing low threshold programs exist and, for example, a service site visited in Tashkent did not have needles for the last one or two months and as waiting for procurement from the GF project management. Thus more investment into the Uzbekistan’s harm reduction with a solid capacity building element is needed. The governmental commission is currently doing some review of data on low-threshold programs.
The country is closed and rather isolated. There is a need for more support for harm reduction capacity on the ground, however this should be implemented through a dialogue with governmental institutions, respecting their competence and understanding limited role of international agencies.
Thank you again, and we hope that you will continue to support EHRN initiatives and public health programs in the region of Central and Eastern Europe and Central Asia.
On Friday, July 24th, the House of Representatives is expected to begin debating the FY 2010 Labor, Health and Human Services and Education Appropriations bill, which funds the National Institutes of Health (NIH). While the current legislation
provides a $941.8 million increase to the NIH, it is expected that Rep. Darrell Issa (R-CA) will offer an amendment to the bill that would rescind funding from three currently funded, peer-reviewed grants that focus on HIV/AIDS prevention, as an example of wasteful spending.
Take Action:
Please call your member of Congress today and urge him/her to vote NO on this amendment.
NIH's peer review process is the gold standard for determining the quality and relevance of grant proposals. Scientists from universities across the country with expertise in their fields of research make independent and objective evaluations of each proposal submitted to the NIH. Advisory councils with public representation also approve studies before NIH funds them. Efforts to restrict peer-reviewed research would undermine one of the core principles of the research enterprise.
Given that HIV/AIDS is a global epidemic that has already killed more than 25 million men, women, and children and 33 million are currently living with HIV, it is clear that prevention of HIV infection should be a priority area of research
funding.
The research is easy to ridicule if it is taken out of its public health context. The fact is, scientists need to explore a range of research avenues in vulnerable populations around the world to learn the best ways to control the transmission of HIV.
In response to previous congressional concerns about whether sexual health research should be funded by the agency, NIH reviewed the entire NIH sexuality portfolio in 2004.
That investigation found that all of the NIH grants in areas of sexual health met the rigorous standards of scientific and ethical quality, that they were not funded out of proportion to the public health burden of these diseases, and that the merit review system had been followed.
Targeted Research Projects:
Substance Abuse Use and HIV Risk Among Thai Women Grant Number: 1R21DA026324-01A1
The proposed collaboration study between Ms. Usaneya Perngparn, Chulalongkorn University, Thailand and Dr. Nemoto, Public Health Institute, California, will investigate the sociocultural contexts of HIV risk behaviors and drug use among Thai female and male-to-female transgender (kathoey) sex workers in Bangkok. Research is currently needed to develop and adapt HIV prevention models that take into account sociocultural factors so that the further transmission of HIV and
sexually transmitted infections can be averted. Participation in these types of studies also can provide a way for persons suffering from the health consequences of illicit sexual activity to receive treatment while contributing to our knowledge of prevention and treatment outcomes in these populations.
HIV Prevention for Hospitalized Russian Alcoholics Grant Number: 5R01AA016059-03
Investigators are adapting a prevention approach that has been demonstrated to be effective in decreasing high-risk HIV related behaviors in the U.S. for use in Russia, a country with a rapidly expanding incidence of HIV.C2 The approach, called Health Relationships Intervention, involves the development of a plan of action for each client to increase social support and reduce high-risk behaviors. This includes the disclosure of information to family and friends on the client's health, social needs and condition thereby assisting the client in maintaining low risk behaviors.
Venue-based HIV and Alcohol Use Risk Reduction Among Female Sex Workers in China Grant Number: 1R01AA018090-01
Research has provided evidence linking alcohol-related, high risk sexual behavior with HIV and other sexually-transmitted infections. Research has also provided rich descriptions of social, cultural, and economic contexts in which people engage in alcohol-related sexual risk behaviors. More specifically, alcohol use characteristics (e.g., binge drinking) have been linked with sexual risk-taking that occurs in a range of high risk environments. The investigators have proposed a 5-year study to develop, implement, and evaluate a theory-guided, multiple components, and venue-based HIV and alcohol use risk reduction intervention among commercial sex workers (FSWs) in China.
Internet and face-to-face individuals counseling were most effective in curbing college drinking, whereas mail and group feedback did little to change drinking habits, according to a systematic review of previously published research on college alcohol use.
HealthDay News reported July 20 that researchers from Oxford Brookes University in England reviewed 22 past studies and found that 62 percent of students receiving Internet-based interventions reported reductions in their drinking, as did 65 percent of students who received in-person, one-on-one counseling.
The researchers expressed support for social-norms prevention focused on perception of alcohol consumption, saying that students might drink less if they knew that their friends weren't drinking as much as they did. However, one expert also expressed surprise that group interventions were found to be ineffective.
"By providing normative information to a group, I would have expected that it would provide a level of social support for refusal," said Jeanie Alter, program manager and lead evaluator of the Indiana Prevention Resource Center at Indiana University's School of Health, Physical Education and Recreation. "A similarly minded group usually would back you up in your decision not to use."
The review was published in the June 19, 2009 issue of the Cochrane Library.
Horizons is an annual forum for learning about psychedelics, hosted by Judson Memorial Church in New York City. Its goal is to open a fresh dialogue about psychedelics and rethink their role in medicine, culture, history, spirituality and art.
Psychedelics are a unique class of psychoactive drugs that have been used by humans for thousands of years. In the 1950s and early 1960s, academic research with psychedelics yielded important discoveries in psychology and neuroscience. Just a few years later, they entered popular culture across North America, Europe and the world. Questions about their safety, medical value, history and implications in politics and culture were unfortunately answered with numerous myths spread by both their users and the media. The millennial rave fever brought a similar wave of popularity and hysteria.
Recently, a renaissance in psychedelic research and dialog has taken shape. Horizons objective is to bring together the brightest minds and boldest voices of this movement to share their insights and dreams for the future.
I have attached and copied below the July 2009 Newsletter of the
Addiction Division of the New York State Psychological Association of
which I am a member of the executive board. The Division has been in
existence for about 20 years. Over this time we have been a home for
psychologists working with problematic substance use and other
addictive problems. We have also been committed to creating contexts
for ongoing dialogue and exploration to advance the understanding and
treatment of people with addictive problems. We have done this by
holding regular professional conferences, workshops and other
activites. Past conferences have looked at the the state of the art of
addiction treatment at various points in time, the relationship between
trauma and addiction, the intersection of harm reduction and abstinence
based treatments and addiction treatment being in a period of ongoing
metamorphosis, among others. We are currently considering how to best
create a conference to explore how political issues such as race, class
and the stigmatization of substance users impact on substance using
patients and their treatment.
We welcome the participation of all workers who have an interest in the
issues we address. We invite participation in our conferences, member
listserve and newsletters. The Newletterwill give you a more of a
sense of what we are about. I invite you to join us in our activites
and contribute to the evolution of this important field. Contact
information is at the end of the newsletter. Feel free to be in touch.
I’m very pleased and honored to be serving as the current president of the Addiction Division of NYSPA. And I want to thank our past president, Bryan Fallon, PhD, for the wonderful and steady work he did during the past year. Among other things, his leadership allowed us to put together another well-attended conference this past November, which explored the interplay between trauma and addiction. We already have several exciting ideas for our next conference, and are in the early planning stages. We will keep you informed when a date is established for the next conference.
With the change of the administration at the national level, we have noticed some excitement about what this may bring to the field of working with individuals with addictions. Andrew Tatarsky, PhD, took a characteristically active role and drafted a letter to President Obama urging him to appoint a Drug Czar that has a record of supporting legislation that advocates treatment innovation and sentencing reform. Dr. Tatarsky’s letter received significant circulation and recognition. Gil Kerlikowske , the Police Chief of
Seattle, was confirmed as the new drug czar. Mr. Kerlikowske is known as someone who allows needle exchange programs and supports drug treatment for low-level offenders as an alternative to prison. And more recently, President Obama named Thomas McLellan, PhD, to the post of Deputy Director of the Office of National Drug Control Policy. Dr. McLellan is a prominent researcher who is expected to bring this important voice to the dialogue. (Division members may remember that Dr. McLellan was the invited speaker at our 2006 conference.)
Dr. Tatarsky has also spearheaded the circulation of a letter to President Obama regarding the choice of a director of the Substance Abuse and Mental Health Services Administration (SAMHSA). We have included the letter in this issue of our Newsletter in an effort to spark discussion, debate and action.
There have also been recent changes in our own state of New York. The legislative leaders in Albany recently announced that they had reached an agreement to repeal the mandatory sentencing laws, or the Rockefeller laws, for low-level drug offenders. This would allow judges the discretion to send people to treatment instead of prison when the situation warrants this course of action. The plan still needs to be approved by the Assembly and the Senate, but is expected to allow judges to send first-time nonviolent offenders who plead guilty to drug charges to treatment. If treatment were not successfully completed, the judge would then have the option of imposing a prison sentence.
Dr. Tatarsky will conduct a three-day training in counseling for psychologists and narcologists working in substitution treatment.
International HIV/AIDS Alliance in Ukraine
Kiev, Ukraine
Letter to Uzbek authorities re abrupt cessation of methadone and buprenorphine
Dear Colleagues —
In the early days after the recent election, nearly 500 mental health and substance use professionals in the US and abroad took a public stance with the new administration about the selection of the new Drug Czar. Our collective voice may have had a hand in the selection of Gil Kerlikowske as the director of the Office of National Drug Control Policy and Dr. Tom McLellan as his deputy. These are two professionals who meet many of the criteria that we called for and support many of the policies that we advocate for including a greater emphasis on treatment rather than incarceration for drug users who need it and support for evidence based practices such as substitution treatment, syringe exchange and motivational approaches. Their selection signals a very positive turn at the federal level toward a more rational drug policy that is good for drug users and the country at large.
Lets consider the potential for our collective voice to continue to have an impact on national and international policies that affect our substance using patients and fellow citizens.
I have copied below an appeal from the Eurasian Harm Reduction Network to the government of Uzbekistan, which has announced that it will cease provision of methadone and buprenorphine.
If you are able to sign, please send your name and organizational affiliation to Andrew Tatarsky, info@andrewtatarsky.com and cc me. If you agree with this effort please forward this note to one or more friends or colleagues and encourage them to sign on. The matter is urgent, so your prompt attention appreciated.
We express our deep respect to you and would like to address the following issue:
As we became aware, in the near future, following a decision by Government, Uzbekistan plans to close its Buprenorphine and Methadone Substitution Therapy Programs.
As specialists working in the field of drug addiction and prevention and treatment of HIV, we would like to note that Buprenorphine and Methadone Substitution Therapy is a scientifically proven method. Its effectiveness has been repeatedly noted in WHO, UNODC and UNAIDS documents. The role of Substitution Therapy is unique in reducing the spread of HIV and other blood-borne diseases, and criminality, as well as in creating opportunities to involve patients in treatment of such diseases as AIDS and Tuberculosis. That is why in 2005, WHO included Methadone and Buprenorphine to its List of Essential Medicines. Substitution Therapy is successful in such culturally diverse countries as the EU, USA, and countries of Asia (China, Iran, Malaysia, Kyrgyzstan, Azerbaijan, Kazakhstan, etc. ).
Regardless of the reasons for bringing the Substitution Therapy programs to stop, we know that among its inevitable consequences will be worsening of the HIV situation, growth in criminality and in drug traffickers' profits, as well as other negative repercussions. It has been established that in absence of treatment access, the majority of patients of Substitution Therapy programs return to the use of street drugs, which increases the risk of infection through non-sterile injecting equipment, death from overdoses and increase in criminal activity. All these consequences threaten not only the 200 patients of the programs, but also the rest of the country's citizens.
Dear Mr. President!
Being aware of the degree of responsibility that you bear for safety and well-being of the citizens of Uzbekistan, we appeal to you for suspending the decision on closing Substitution Therapy programs and establishing a qualified commission involving international experts and practitioners with long-term experience in implementation of such programs, that would be able to suggest necessary steps for their strengthening in Republic Uzbekistan.
Yours Truly
Mental Health: A Guide for Latinos and their Families
American Psychiatric Association has released a new DVD and guidebook on mental health for Latinos.
The materials, “Mental Health: A Guide for Latinos and their
Families,” are in English and Spanish and single copies are available
free.
The materials are aimed at helping to inform the general Latino public
about mental health, to dispel common misperceptions, and to reduce the
stigma of mental illness among Latinos. The DVD and booklet acknowledge
the uniqueness of the Latino culture in the U.S., including strengths of
Latino culture, and address some of the challenges to getting help for
mental illness that many Latinos face today.
Topics covered in the 30-minute DVD and booklet:Types of mental illness
(anxiety, depression, schizophrenia, eating disorders, substance-related
disorders, and ADHD) Mental health and Latino culture - including some
conditions that are unique to some Latino cultures (such as nerves or
susto) Treating mental illness Finding help, including a description of
the types of mental health professionals Tips to help maintain mental
health and increase resilience.
The DVD and booklet were developed by the American Psychiatric
Association (APA’s Committee of Hispanic Psychiatrists and APA staff)
in collaboration with the League of United Latin American Citizens
(LULAC) and the National Hispanic Medical Association.
How to order:
Copies of the video and guidebook can also be ordered by emailing
apa@psych.org or by calling APA Toll-Free: 1-888-35-PSYCH
(888-357-7924).
Groups Put Pressure on Governments to Reform Harmful Drug Policies
For Immediate Release
Groups Put Pressure on Governments to Reform Harmful Drug Policies
Contacts:
Paul Silva, +1 212.548.0309, +1 917.478.8403, psilva@sorosny.org (United States)
Jon Lidén, +41 58.791.1723, +41 79.244.6006, jon.liden@theglobalfund.org (Europe)
NEW YORK / GENEVA
25 June 2009
As the United Nations launches the 2009 World Drug Report this week, more than 40 international groups and experts worldwide today issued a call to action that presses governments to adopt a humane approach to drug policy.
The call to action, signed by the Open Society Institute, former president of Brazil Fernando Cardoso, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, urges governments to enact policies that are based on scientific and medical research rather than politics.
“In many regions, particularly Asia and Eastern Europe, the AIDS epidemic is largely dependent on HIV transmission through injection drug use,” said Dr. Michel Kazatchkine, Executive Director of the Global Fund. “Criminalizing individual possession of drugs undermines HIV prevention by marginalizing users, forcing them to hide from services and healthcare that could help them and keep others safe.”
Rather than being reached with harm reduction services—care and treatment that can stem the spread of HIV—millions of nonviolent drug users languish in prisons around the globe or live as outcasts from society as a result of current drug policies. As a result, HIV and other infectious diseases spread uncontrolled and threaten whole societies.
Criminalization does not ease the global problem of drugs. The drug trade continues to grow while families are torn apart by the global war on drugs. Instead of continuing with these ineffective and harmful policies, today’s call to action urges governments to focus on reducing the harms of drug trade and use. This involves providing services such as clean needle exchange and substitution treatment to help reduce the health risks associated with drug use. The groups also call on governments to decriminalize the possession of small quantities of drugs for personal use—a step which has been credited with reducing drug use and HIV infections in Portugal.
“In too many countries, the war on drugs has become a war on people,” said Kasia Malinowska-Sempruch, Director of the Open Society Institute’s Global Drug Policy Program. “We need to stop the spiral of drug-related violence by approaching this from a health and human rights perspective.”
In addition to criminalization, anti-drug measures such as crop destruction have had a devastating impact on peoples’ lives, according to the groups. In many regions, aerial eradication of coca and poppy fields have destroyed thousands of farms, while doing nothing to alleviate the poverty that causes many farmers to grow illicit crops. Yet, numerous studies have shown that crop eradication is the least effective method for controlling drug supply, and treatment and prevention programs are better suited to reduce the demand for drugs.
The Open Society Institute’s Global Drug Policy Program aims to broaden, diversify, and consolidate the network of like-minded organizations that are actively challenging the current state of international drug policy. The program strives to engage and support drug policy experts, economists, and other professionals as they analyze and publicize the effects of drug policy on public health, human rights, national20security, and the economy.
The Global Fund to Fight AIDS, Tuberculosis and Malaria is an international financing institution that invests the world’s money to save lives. To date, it has committed US$ 16 billion in 140 countries to support large-scale prevention, treatment and care programs against the three diseases. www.theglobalfund.org
There are so many reasons to join us November 12-14 in Albuquerque. First, as I mentioned in my email last week, this may be the best opportunity to continue the unprecedented momentum toward positive change. If you're working in any area of drug policy reform, or want to be, you have to be part of this conversation.
Second, there is, simply stated, no better crash course in drug policy than this three-day event. Many hundreds of people have described past meetings as transformative experiences in their lives. This one promises to be the best yet.
And finally, your participation in the conference will ensure the amazing diversity that makes this meeting what it is. We've also worked hard to make it affordable for you. We offer members, New Mexico residents, students and all early-bird registrants a significant discount off our regular non-member registration rate:
Attendee Type
Before Oct. 9
After Oct. 9
On Site
Non-members
$325
$425
$450
DPA Members
$275
$375
$400
NM Residents
$200
$300
$325
Students
$100
$150
$175
The energy of this gathering is like no other. You will meet people who challenge you, who inspire you and who could be partners in your reform efforts. Register now to attend the Reform Conference and experience all of this in person.
Thanks for all you do.
Sincerely,
Ethan Nadelmann
Executive Director
Drug Policy Alliance
P.S. Don't forget to tell your friends to come. The Reform Conference is a great introduction to the world of drug policy reform, and your personal invite will help build our movement.
NAPW helps Immigrant Pregnant Woman Win Release from prison
Dear Friends and Allies:
NAPW is pleased to announce that yesterday morning a federal District Court judge, responding to a motion for bail and our emergency amicus brief, released Quinta Tuleh, a 28 year-old pregnant woman, from federal custody.
Ms. Tuleh, a woman from Cameroon, had already served 114 days in jail for allegedly having false immigration documents. Shortly after her arrest, she learned she was both pregnant and HIV positive. On May 14, 2009, instead of releasing her, a US District Court Judge extended Ms. Tuleh's sentence to ensure that she remain incarcerated for the duration of her pregnancy. (Judge Jails Pregnant Woman Until Baby is Born and Behind Bars for Being Pregnant and HIV-Positive.)
At the sentencing hearing, Judge Woodcock stated: "My obligation is to protect the public from further crimes of the defendant, and that public, it seems to me at this point, should include the child she's carrying...I don't think the transfer of HIV to an unborn child is a crime technically under the law, but it is as direct and as likely as an ongoing assault."
As is often the situation in cases involving pregnant women, Courts make decisions without the benefit of full briefing or input from experts. Indeed, uncertain of Ms. Tuleh's due date and how long he would need to extend the sentence to ensure she was imprisoned through her due date, the Judge looked out over the courtroom and said "So maybe we ought to consult with the women here. Any sense of what a safe range would be?"
Yesterday morning, National Advocates for Pregnant Women, the Center for HIV Law and Policy and attorneys Elizabeth Frankel and Valerie Wright of the Maine firm Verrill Dana, LLP filed an emergency amicus (friend-of-the-court) brief on behalf of 28 public health experts, advocates, and organizations, as well as a declaration from prison health expert Dr. Robert L. Cohen. The brief and expert testimony provided legal and public health information challenging the incarceration of a pregnant woman in order to protect an "innocent" "unborn child."
The judge called the brief "articulate and helpful" during yesterday's hearing where he released Ms. Tuleh on bail pending an appeal of her sentence to the First Circuit Court of Appeals. Ms. Tuleh will now be receiving medical, housing, and other support coordinated by the Frannie Peabody Center, a Portland, Maine community-based HIV resource center. Ms. Tuleh has expressed that she is deeply touched by all of the support she has received. The picture of her yesterday, smiling from ear to ear speaks volumes.
Ms. Tuleh is being represented on her appeal by Zachary L. Heiden of the Maine ACLU.
NAPW and Center for HIV Law and Policy are grateful to Laura McTighe, Director of Project UNSHACKLE, Community HIV/AIDS Mobilization Project (CHAMP), for her extraordinary help in this effort.
Your continued support of NAPW makes this kind of effective, cross issue collaboration possible. Please contribute what you can to NAPW so that we can continue our collaborative and successful advocacy on behalf of all pregnant women.
This report examines the nationwide opioid overdose epidemic and calls for immediate action to address this public health crisis. As “Preventing Overdose, Saving Lives,” details, evidence-based strategies already exist that can reduce overdose risk, protect Good Samaritans and medical professionals, streamline government response systems, and save lives. A national overdose prevention effort is urgently needed, and this report provides a clear way forward for policymakers seeking a public health approach to the overdose emergency.
Announcement from the Drug Policy Alliance - Overdose Prevention
June 11 2009
Dear Friends,
Today is such an exciting, important day for all of us who care about overdose prevention! I’m thrilled to announce two significant things:
The Drug Policy Alliance released a landmark report on the national overdose crisis, “Preventing Overdose, Saving Lives.” This report assesses the crisis, examines policy solutions available and how such policies have been successfully implemented across the country. The report recommends a range of solutions, including expanded access to naloxone and “Good Samaritan” immunity laws.
Congresswoman Donna F. Edwards (D-MD) introduced the groundbreaking Drug Overdose Reduction Act of 2009. This bill—the first of its kind—will allocate resources to community groups and public health agencies to implement overdose prevention and education programs, including expanded naloxone distribution.
This is an exciting time to be an overdose prevention supporter. There is fantastic progress on the horizon. I personally invite you to read this terrific report and share the information and ideas with your friends and local legislators.
Drug Policy Alliance remains committed to the fight to save lives from being lost to accidental overdose. Working together, we can all make a difference. The national dialogue about preventing overdose fatalities starts with all of us, right now, today.
- Meghan Ralston
Purple Ribbons for Overdose Prevention, creator
IHRA E-Newsletter May 2009
Harm Reduction 2009 Takes Place in Bangkok
‘Harm Reduction 2009: IHRA’s 20th International Conference’ took place in Bangkok, Thailand from the 20th to 23rd April, and – despite the city being in a ‘state of emergency’ due to recent political uncertainty – brought together an incredible 1,000 delegates from 80 countries, including many from Thailand and other Asian countries. The four days were filled with discussions and debates about the latest research findings, best practice guidelines, policy developments and advances in harm reduction programming worldwide.
The conference theme was ‘Harm Reduction and Human Rights’, and this was a recurring issue throughout the event – including a dedicated Plenary Session, sessions documenting some of the human rights violations committed in the name of drug control, and a dignified protest by Thai drug users and their allies at the Opening Session in which they called for “treatment not torture”. The Opening Session on Monday 20th April also included a formal welcome from the Governor of Bangkok, an opening address from IHRA’s Executive Director, and a keynote address from Professor Michel Kazatchkine, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Professor Kazatchkine emphasised the need for decriminalising drug use as part of a public health approach, and the huge discrepancy which exists between the global resources needed for harm reduction and the current levels of funding – both issues which gained much attention during the rest of the conference. These powerful statements from a senior international policy maker were received with a standing ovation from the delegates and attracted a great deal of media interest from around the world.
The four-day conference programme included over 60 sessions and showcased over 200 presentations and 250 posters on topic as diverse as HIV, hepatitis C, tuberculosis, alcohol, tobacco, methamphetamine, policing, research, opiate substitution treatment, needle exchange programmes, compulsory drug treatment, poverty, prisons, young people, sex work, risk environments, drug user organisations, families, the war on drugs, and the recent UN High Level Segment on Drug Control in Vienna. There were also sessions focusing on harm reduction in the host country, a separate programme of skills-building workshops, a ‘Dialogue Space’ hosted by the Global Fund to allow delegates to meet international leaders, the 6th International Drugs and Harm Reduction Film Festival, and a conference party and awards ceremony featuring a performance from ‘Kormix’ (a hip hop group from Korsang, Cambodia’s only harm reduction programme).
The conference closed on Thursday 23rd April with an impassioned keynote address from Craig McClure, the Executive Director of the International AIDS Society. After five years in his current position, Mr McClure reflected on the politics surrounding harm reduction, the global responses to HIV, and the evolving status of injecting drug use within these responses. He told delegates that, globally, “Blatant and wilful denial of the evidence can only be based on deep-seated fear. Fear drives the global war on drugs. Fear drives abuse by doctors and others in the medical system of people who use drugs and the continuing use of so-called ‘treatments’ that might more accurately be called ‘torture’”.
Overall, the conference highlighted how far harm reduction has progressed and where there are still huge challenges to be overcome. It brought together health workers, law enforcement, human rights activists, people who use drugs, frontline workers, policy makers and researchers at an important time for harm reduction and for the host country (against a backdrop of discussions about a new Thai harm reduction policy and a major national grant from the Global Fund). Around half of the delegates were attending an international harm reduction conference for the first time – further justifying IHRA’s decision to hold the conference in Bangkok – and there was a great sense of energy and enthusiasm throughout the four days.
A full review – including presentations, images, video footage and abstracts – will be available soon as part of the previous conferences archive on www.ihraconferences.net
Youth RISE and IHRA Launch New Briefing
Over the last few months, Youth RISE – the international youth-led harm reduction network – and IHRA asked youth researchers from every region of the world to compile and write country reports on the status of young people, drug use and harm reduction programming in their countries and regions. Although every country and region is different – not to mention every city and town within each country, and each group of young people within every city and town – there were some commonalities in what was being reported.
To coincide with Harm Reduction 2009: IHRA’s 20th International Conference, Youth RISE and IHRA have highlighted some of the common themes through a short briefing. The report overviews the current situation regarding young people who use drugs, and the human rights approach to addressing them based on the UN Convention on the Rights of the Child. A full report is due out later in 2009, which will illustrate the legal, social and political recommendations of the Conventions of the Rights the Child and how they relate to young people, substance use and access to prevention and harm reduction services.
At the Harm Reduction 2009 conference in Bangkok, IHRA has released its 2008 Annual Report. The report – which was launched at the IHRA Annual General Meeting on Monday 20th April – features commentary from Dr Mukta Sharma (the Chair of the Board of Directors) and Professor Gerry Stimson (the Executive Director) which review 2008. It also features a summary of IHRA’s programmes and activities – including the Global State of Harm Reduction publication and the Harm Reduction and Human Rights (HR2) programme. It also includes financial information and accounts for 2008.
DFID Launch New Reports on Access to Medication and International Drug Control
In March 2009, the UK Department for International Development (DFID) – through the ‘Drug Control and Access to Medicines’ (DCAM) Consortium – launched three major new reports entitled ‘A Blueprint for Reforming Access to Opioid Medications’, ‘Closing the Gap: Case Studies of Opioid Access Reform in China, India, Romania & Vietnam’, and ‘Review of Global Policy Architecture and Country Level Practice on HIV/AIDS and Drug Treatment’. These documents describe how countries have reformed regulations which limited access to therapeutic opioid medications, and how donors, international organisations and health advocates can make further progress in the future.
The ‘Drug Control and Access to Medicines’ (DCAM) Consortium is an international collaboration of experts on drug control regulation, drug treatment, HIV, and pain and palliative care. The participating institutions include the Center for Health Law, Policy and Practice at Temple University, the AIDS Projects Management Group, and the Pain and Policy Studies Group at the University of Wisconsin. The Consortium has been funded by DFID – who also provide major funding to IHRA – to support and contribute to efforts by a range of stakeholders to reduce policy-related barriers that prevent patients from receiving controlled medicines for pain and drug dependency.
Malaysia is one of many countries in Asia which have embraced harm reduction approaches and interventions such as needle and syringe programmes, methadone substitution treatment, drop-in centres and outreach work. In response to a HIV epidemic which is mainly driven by injecting drug use (71.2% of reported HIV cases between 1986 and 2008 were injecting drug users), the Malaysian Government began with pilot needle exchange schemes in three states, but this intervention will soon be available in every state across the country through health clinics and in partnership with NGOs and the Malaysian AIDS Council.
In an article in The Star – Malaysia's leading English-language newspaper – the Health Minister Datuk Seri Liow Tiong Lai claimed that Malaysians are “wise and mature enough” to understand the principles and rationale behind needle and syringe exchange as a form of HIV prevention, and stated that these services “will serve as a driving force towards a wide range of harm reduction-related activities such as information, education and communication on risk reduction, HIV testing and counselling, health screening, anti-retroviral treatment and psycho-social care and support”.
In the same article, Professor Adeeba Kamarulzaman – the President of the Malaysian AIDS Council and a former Director of IHRA – noted that Malaysia has come a long way but more still needed to be done in terms of reaching a target of 60% of the country’s drug users through expanding provision and changing existing laws and policies.
Professor Wodak Speaks About Drug Consumption Rooms
Professor Alex Wodak spoke at an event in Sydney, Australia on May 6th which marked the 10 year anniversary of the opening of Australia’s first and only safer injecting facility. In his speech, Professor Wodak stated that the group which established the service had only one intention, “to establish... a place in Kings Cross [an area in Sydney] where people determined to inject illegal drugs could do so safely... [and] without fear of being charged and arrested”.
The Sydney facility was a response to high rates of heroin overdose in Australia, one in ten of which occurred within two kilometres of the site. Faced with numerous legal barriers, “Our last resort was civil disobedience. About 30 people came together from all walks of life to establish the Tolerance Room here in a basement of a church at the Wayside Chapel. There were parents of drug users, some drug users, nurses, doctors, a former politician and a businessman”.
Professor Wodak went on to state that the service in Kings Cross is still supported by more than 70% of local residents for the impact that it has had on public injecting, and quoted some of the recent positive statements being made by international policy makers and organisations such as the United Nations. He then called upon the New South Wales Government to recognise that their safer injecting facility is just as much a part of the health care system as other harm reduction measures (such as needle exchange programmes and substitution treatment – “which were also controversial when they were introduced”) – and as emergency departments, hospitals and doctors. “Yet for political reasons, after eight years, the MSIC still remains a research trial... We call upon all governments to apply the same standards when evaluating all interventions for illicit drugs – whether these are intended to reduce the supply, demand or harms resulting from drugs”.
The full text of Professor Wodak’s speech has been uploaded to the IHRA Blog. According to IHRA’s Global State of Harm Reduction research, there are currently only eight countries around the world which have drug consumption rooms.
Data Request for Global Burden of Disease Project
As part of the Global Burden of Disease 2005 project, the ‘Mental Disorders and Illicit Drug Use Expert Group’ are conducting systematic reviews of the prevalence, incidence and remission of mental health disorders and drug dependence in order to estimate the burden of disease attributable to illicit drug dependence. For the first time, this project will also provide estimates for different drug types. The Expert Group is looking for data from around the world on the prevalence of use and dependence on amphetamines, cannabis, cocaine, and heroin and other opioids.
The project is in the process of updating estimates for every country around the world on the prevalence of use and the prevalence of dependence of each included drug type (amphetamines, cannabis, cocaine, and heroin and other opioids). Producing these estimates is big challenge as many countries do not have prevalence data measuring the prevalence of drug use or dependence, or the data that exists may not be widely available. So far, the Expert Group have conducted a large search of the peer-reviewed literature and have tried to gather as much information as possible. However, it is inevitable that some data and material will have been missed, so the Expert Group is seeking prevalence data from 1990 to the present day.
If you have any information that may assist this important project, your contribution will be individually acknowledged in all related publications (unless requested otherwise). Please send relevant studies, data and reports to gbd@med.unsw.edu.au before Sunday 31 May 2009.
Integrative Harm Reduction Psychotherapy for Problem Substance Use: A Two-day Introductory Training in the History,Rationale, Theory and Clinical Technique
Dr. Tatarsky will present at the North Carolina Harm Reduction Coalition
Winston-Salem, North Carolina
Please see the historic news detailed in the linked article below
regarding ONDCP Director Kerlikowski's statement about ending the "war
on drugs". It took my breath away.This seems to be the tipping point
we've been anticipating! Thank all of you for your contributions to the
efforts over many years that contributed to this event.
We may finally get the support we have been working for for the kind of
research and treatment that will improve the care of our drug mis-using
citizens.
Day Conference “Safe Injection Facilities in New York”
SPONSORS:
DUHA, John Jay College of Criminal Justice, Harm Reduction Coalition, NYSPA - Division on Addictions
DATE & TIME:
Friday May 22, 2009 (9 AM - 5 PM)
LOCATION:
John Jay College of Criminal Justice/CUNY
445 West 59th. Street. Room 1311 (1st floor)
NY, NY
To RSVP send email with name and affiliation to: safeinjectionfacility@gmail.com
BACKGROUND:
The Injection Drug User Health Alliance (IDUHA) is an alliance of sixteen Syringe Exchange/Harm Reduction programs in NYC that promotes the provision of pragmatic harm reduction services to injecting drug users.
One IDUHA initiative is to explore strategies to implement Supervised Injection Facilities (SIFs) for IDUs in NYC. The term ‘supervised injection facilities’, refers to locations that are legally established and organized specifically to allow drug users to use their drugs in a (medically) supervised, normative, and safe environment.
The main objective of creating SIFs is to reduce health-related harm associated with chaotic drug consumption, both for the drug user (private harm, e.g. the reduction of overdose (death) or infectious diseases) and his or her environment (public harm, e.g. prevent scattering of used needles, open drug scenes).
Together with John Jay College of Criminal Justice and the Harm Reduction Coalition, IDUHA will organize a one day conference on the topic of ‘Safe Injection Facilities in New York’ on Friday May 22, 2009, at John Jay College of Criminal Justice/CUNY.
Objectives for the Conference:
Create public awareness of this Harm Reduction intervention and start building a constituency among local and state politicians, officials from the DOH, researchers, police departments, service providers and the general public. Important here is to further de-construct the negative drug user profile.
Provide information on the (cost-)effectiveness of SIFs in the realms of Public Health and Public Order.
Start developing a concrete scenario to implement SIFs in New York.
The SIF would be part of a comprehensive effort to offer needle-exchange, street outreach, HIV & HCV testing and counseling, palliative care, educational workshops, support groups, and referral services including drug treatment. The results of a 2008 survey conducted among 200 NYC IDUs from IDUHA agencies indicated that 84% of the IDUs sampled would utilize a SIF should one be implemented, and that those most likely to use it are IDUs at the highest risk for contracting or spreading blood-borne diseases such as HIV and hepatitis, and for experiencing a drug overdose.
Robert BB Childs, MPH, QMHA
Director of Program Services
Positive Health Project, Inc.
301 West 37th Street
New York, NY 10018 USA
Telephone: 212.465.8304 ext.107
Mobile: 347.307.5357
Fax: 212.465.8306
Email: rchilds@phpnyc.org
Website: http://www.positivehealthproject.org
Appointment of Treatment Research Institute Co-Founder and Noted Drug/Alcohol Expert Signals National Shift in Addiction Policy
Philadelphia, PA - April 10, 2009: The Obama/Biden Administration has named A. Thomas McLellan, Ph.D. to the post of Deputy Director of the White House Office of National Drug Control Policy. McLellan is one of the nation's leading drug and alcohol experts.
McLellan got his start in the 1980s as a scientist with the Veterans Administration and University of Pennsylvania where he led development of the Addiction Severity Index and Treatment Services Review, two measurement instruments premised on the then-novel view that addiction was a multi-dimensional condition, with impairments in other life functions that had to be concurrently addressed for treatment to be effective. Eventually, the premise came to be embraced, with the instruments becoming widely used to measure and improve the effectiveness of many forms of treatment.
In 2000, McLellan and three other experts authored a report in JAMA pointing out the similarities between addiction and commonly recognized, chronically relapsing medical diseases like hypertension, type II diabetes and asthma, arguing that like these other illnesses, serious addictive disorders cannot be cured but can be effectively managed. The implications proved to be significant. Today, most experts refer to addiction as a chronic illness and call for longer-term care strategies patterned after medical models.
A firm believer in the transformative power of science, in 1992 McLellan co-founded the non-profit TRI as a translational center that would adapt and engineer promising scientific findings into useful products and services that could be broadly used throughout the field. Over the next seventeen years, McLellan assembled a team of researchers and entered into intertwining collaborations with universities, major treatment and prevention groups, and legal groups. TRI became known for practical models of continuing care and monitoring; criminal justice strategies as an alternative to jailing drug-involved offenders; revitalizing the nation's public system of addiction treatment; engaging doctors and other primary care providers; and helping parents learn skills to protect children from drugs and alcohol.
Beginning in 2006, McLellan recruited policy experts to TRI to help state and local governments promote quality improvement by revamping their purchasing, regulatory, and other administrative structures.
"We're sorry to lose Tom McLellan to higher office, but we're not surprised an innovation-minded Administration would recruit someone like him for national drug policy," said Constance Pechura, Ph.D., TRI's second-in-command who will assume leadership of TRI. "With his presence, the Administration has created a formidable drug control team predisposed to evidence and policies that 'work,'" she said.
"Tom McLellan has been a leader in advancing the science of addiction treatment and improving access to effective care," said Carolyn Asbury, Senior Consultant to the Dana Foundation and Chair of the TRI Board of Directors. "He has pioneered the translation of research into more effective clinical practices that have helped to achieve better outcomes for individuals and their families. No one is better equipped to help transform the nation's response to its drug problems," she said.
ONDCP was established in 1988 to advise the President and Vice President on a drug control program for the nation, coordinating the activities of multiple federal agencies toward that end. With Gil Kerlikowske, the President's pick for ONDCP Director, McLellan's appointment signals a shift to science-based treatment and prevention strategies - including what McLellan calls "a long-overdue national look at our prison policies; collaborative strategies among the prevention, treatment, criminal justice, healthcare and education fields, and continued modernization of specialty treatment and prevention centers."
************************************************************
The Treatment Research Institute is a non-profit research and development organization specializing in science-driven reform of policy and practice in substance use and abuse.
For more information contact Bonnie Catone, TRI Director of Communications,
at bcatone@tresearch.org or visit the TRI website at www.tresearch.org.
Dear Colleague,
I am copying below a very interesting and timely report on the effectiveness of California's Prop. 36, a ballot measure approved by California voters in 2000 that offers treatment instead of incarceration for nonviolent drug offenders. The report finds that the ballot initiative is being undermined by inadequate funding, participants dropping out of treatment, and increased arrests for drug and property crimes. The good new is that the initiative has saved taxpayers millions of dollars, several promising new programs have the potential to improve Proposition 36's results, and violent crime arrests have decreased more in California than nationally since the proposition's implementation.
Califonia's experience has much to teach us as we plan for the changes in NY State that will result from Rockefeller reform. We don't want to repeat their mistakes s w anticipate a much greater referral to treatment of arrested non-violent drug users. We will need a well-funded system that has the re-training to handle this somewhat new population. Without the knee-jerk reaction to send patients who continue to use substances in treatment back to prison, we will need a system that has a greater appreciation of the complex challenges these patients bring and face and the sophistication and time often required to help many problem users begin to make positive change in their use of substances.
This system must be committed to sophisticated psychological, substance use and medical evaluation and treatment that considers substance use in the context of the whole person in their context. Effective treatment is attractive and relevant to patients (or else why should they stay in treatment?). It is highly individualized and has as essential ingredients motivational enhancement, offering patients goal choice, understanding that continued use, slips and relapses are part of the change process and not evidence of failure and that people must begin the treatment process with treatment that truely starts where they are to maximize therapeutic alliance and retention in treatment. It is too long that the system has held patients accountable for "treatment failure" and not sufficiently looked at how limitations of funding, sophistication and creativity set up patients and clinicians to fail seeming to justify incarceration.
I welcome any feedback and discussion around these critically important issues.
Contact: Mark Wheeler mwheeler@mednet.ucla.edu
310-794-2265
University of California - Los Angeles
UCLA issues new report on Prop. 36
Treatment alternative for drug offenders has had mixed success
The effectiveness of Proposition 36, a ballot measure approved by California voters in 2000 that offers t
reatment instead of incarceration for nonviolent drug offenders is being undermined by inadequate funding, participants dropping out of treatment, and increased arrests for drug and property crimes.
The good news, however, is that the initiative has saved taxpayers millions of dollars, several promising new programs have the potential to improve Proposition 36's results, and violent crime arrests have decreased more in California than nationally since the proposition's implementation.
These are some of the key findings from UCLA's latest report on Proposition 36, also known as the Substance Abuse and Crime Prevention Act (SACPA) of 2000. The measure, which went into effect in July 2001, allows nonviolent adult drug offenders to receive substance-abuse treatment with supervision as an alternative to incarceration or supervision without treatment. The law also calls for an independent evaluation of the program, which is being conducted by UCLA's Integrated Substance Abuse Programs at the Semel Institute for Neuroscience and Human Behavior.
According to the report, under Proposition 36, more than 30,000 drug offenders enter treatment each year and about half of them are being treated for the first time. Most receive outpatient care, which is less expensive than residential treatment but is also less effective for heavy drug users. Although the number of available residential treatment beds has increased since the measure's enactment, the i
ncreases have not been able to meet the rising need. Stakeholders interviewed in focus groups indicated that this was due to limited funding and infrastructure.
The report also found that drug and property crime arrests were higher among Proposition 36 participants than among a comparison group of pre-Proposition 36 drug offenders, the latter having spent more days in custody and fewer days "on the street" during which they could get arrested. However, despite early concerns by critics of SACPA that the law would result in an increase in violent crime, the rate of violent crime dropped more in California (12 percent between 2001 and 2005) than nationally (9 percent over the same period).
While the Proposition 36 group was more likely to be rearrested, the measure has been a much less expensive alternative to jail or prison time. By reducing incarceration, Proposition 36 has helped save taxpayers about $2 for every $1 invested in the program. To improve Proposition 36's implementation, the report calls for greater use of narcotics-treatment programs, employment assistance and residential treatment, as well as graduated sanctions, ranging from more drug-test requirements to short jail stays, for those participants who fail to comply with the program's provisions.
Better integration of substance-abuse and mental health services for the mentally ill homeless population and more restrictive management for offenders with many prior conviction
s are also recommended in the report. While additional funding would likely be needed to implement some of these recommendations — and the use of jail sanctions would require a change in the law, since Proposition 36 forbids it — other recommendations could be implemented now and at low cost.
One such low-cost recommendation was demonstrated in a recent pilot project. Currently, about 15 percent of those convicted in California who agree to Proposition 36's provisions never show up to be assessed. But according to a Los Angeles County study, treatment programs that adopted a set of "process improvement" practices borrowed from the business world showed a dramatic 80 percent reduction in the number of assessment no-shows.
"It is particularly exciting to find a tool like this in the current environment of budget cuts," said Darren Urada, the principal investigator on UCLA's Proposition 36 evaluations. "Funding for Proposition 36 has been insufficient and shrinking over the years, and this has eroded stakeholders' ability to adequately treat and monitor offenders. Furthermore, the unpredictability in funding from year to year has undermined long-term planning efforts."
Proposition 36 funding was cut further last month when Gov. Arnold Schwarzenegger vetoed 10 percent of the program's funding in response to the state's fiscal problems. Funding for the voter-mandated evaluation of the measure, which includes research on ways to
improve the program, has also been suspended.
UCLA's evaluation reports may be of particular interest to voters this year, given that a closely related measure, Proposition 5 (the Nonviolent Offender Rehabilitation Act), will be on November's ballot. If passed, this proposition would integrate Proposition 36 into a tiered system of treatment and supervision for nonviolent drug offenders. According to the official summary provided by California's attorney general, the new initiative would allocate $460 million annually to improve and expand treatment programs for those convicted of drug and other offenses; limit court authority to incarcerate offenders who commit certain drug crimes, break drug-treatment rules or violate parole; substantially shorten parole for certain drug offenses; divide California Department of Corrections and Rehabilitation authority between two state secretaries; and create a 19-member board to direct parole and rehabilitation policy.
The UCLA Integrated Substance Abuse Program, part of the Semel Institute for Neuroscience and Human Behavior, is an interdisciplinary research and education institute that serves to advance the knowledge base on drug problems and to improve the delivery of drug-abuse treatment services through an array of projects. The Semel Institute is devoted to the understanding of complex human behavior, in
cluding the genetic, biological, behavioral and sociocultural underpinnings of normal behavior, and the causes and consequences of neuropsychiatric disorders.
Dear Colleagues:
The letter regarding the importance of professional leadership of SAMHSA is now off to Presdent Obama. You can still sign on if you haven't and view the list of signatories at www.andrewtatarsky.com/samhsaletter/.
Please disseminate the press release that is copied below and attached to any press you think may be interested in covering this story.
Thank you for your continuing support of this very important issue.
Andrew Tatarsky, PhD www.andrewtatarsky.com 212-633-8157
Dozens of prominent substance use and mental health treatment and research professionals urge President Obama to break with recent administrations and appoint a professional with expertise in the science of substance use, mental health and public health to direct the Substance Abuse and Mental Health Services Administration (SAMHSA). They urge the President to appoint a leader to SAMSHA who supports evidence-based and theoretically sound treatments and will make decisions based on science rather than ideology and politics.
To fix SAMHSA’s chronic dysfunction, strong scientific and professional credentials are seen as key to insure that the agency’s $3.3 billion budget is best spent to effectively address the treatment and prevention of mental illness and addiction. The past two decades have seen dramatic scientific advances in understanding mental illness and addiction which have led to the development of effective treatments and prevention programs. Unfortunately, these treatments are not reaching the vast majority of the public who need them. It is noted that the United States spends about $120 billion on behavioral health care but a government review of SAMHSA, the agency responsible for overseeing this area of healthcare, rated the agency’s programs as largely ineffective and that much more could be accomplished with this money. Only 1 out of every 4 of these dollars is spent on evidence-based care with the rest going toward treatments and programs of questionable value. Many politicians including Congressman and Senators who sit on relevant oversight committees have never heard of SAMSHA, despite the fact that SAMSHA is on the same organizational level in the Public Health Service as CDC and FDA.
One major reason for SAMSHA’s obscurity and dysfunction has been the failure to appoint a person with significant scientific and professional expertise to lead the agency. Past administrators have been drawn from the ranks of state government with experience in community action, but without recognized high level scientific mental health, addiction, and public health expertise. These professionals say that it is essential to have the highest caliber professional leading the agency in the fight to improve the lives of all those who struggle with mental health problems and the consequences of substance abuse and to assure that government money works for the benefit of all Americans. They call on the Obama transition team to appoint a professional with a national reputation of excellence as a scientist and innovator in implementing science-based and theoretically sound mental health, addiction and public health programs in communities.
For further information or to arrange interviews with Andrew Tatarsky, the organizer of this campaign, or any of the other signatories call 212-633-8157 or email atatarsky@aol.com.
As many of you know, on March 11-12 a High Level Segment of the Commission on
Narcotic Drugs will review the implementation of targets adopted by the UNGASS
in 1998. HCLU launched a new campaign to raise awareness on the unintended
consequences of the international drug control system and mobilize people to ask
for change.
Please have a look at our brand new campaign site and make sure you send this
link to as many people as possible: http://daretoact.net/
We also launched a new YouTube group profile where people can upload their own
messages to the governmental delegates - this intro video explains why and how:
This campaign will work only if you help us to circulate these links and post
them to your websites or blogs - so we count on you!
Best wishes,
Peter Sarosi
Drug Policy Program Director
Hungarian Civil Liberties Union
Tel.: +36 1 279 2236
www.drugreporter.net
Upcoming Trainings on Integrative Harm Reduction Psychotherapy for Problem Substance Use
Dear Colleague:
I copy below information about two training opportunites coming up in the near future on Integrative Harm Reduction Psychotherapy. Next Thursday, March 26th, I will be giving a free introductory talk on my work at the Washington Square Institute down in the Village. The following Friday afternoon, April 3rd, I will be offering a three hour workshop at the et Ellis Institute on 65th Street in which we will have more time to explore the theory and techniqe of my approach with an emphasis on how you can integrate it into your therapy practice. I would welcome case material and clinical challenges that you have come up against to bring to the discussion.
Free introductory talk on Integrative Harm Reduction Psychotherapy (IRP)
Thursday March 26, 2009 @8:30-10pm
Scientific Meeting
Washington Square Institute
41-51 East 11th Street
New York, NY 10003
212-477-2600
Free to Public
RSVP: registrar@wsi.org , 212-477-2600
Effective Psychotherapy for Drug and Alcohol Users: Theory and Technique of Integrative Harm Reduction Psychotherapy
The treatment of patients with drug and alcohol problems has been dominated by an anti-psychological disease model which promotes the view that such patients cannot benefit from psychodynamic psychotherapy and instead require authoritarian treatment. Experienced and well-intentioned psychotherapists have been influenced by this view and avoid treating this population of 35 million in the USA.
I will introduce Integrative Harm Reduction Psychotherapy (IHRP) as an alternative approach to effective treatment of substance using patients. IHRD is based on a multifaceted view of problem substance use as reflecting the interplay of biology, personal and interpersonal dynamics and social context. IHRD integrates a relational psychoanalytic approach with active skills building to support positive changes in substance use and related issues.
I will discuss clinical challenges and limitations of traditional treatment and the clinical rationale for harm reduction as an alternative paradigm for helping substance users. I will define the harm reduction model, give a little history and discuss its application to psychotherapy. I will discuss the theoretical basis for IHRP including a biopsychosocial process view of addiction, the multiple meanings of substance use as points of engagement and the stages of motivational change model and will explore how to use these ideas to create a collaborative, negotiated therapeutic alliance. Fina lly, I will present an overview of IHRD’s 7 therapeutic tasks with emphasis on therapeutic process and technique.
Integrating Harm Reduction Psychotherap y Into Your Practice
HALF-DAY WORKSHOP emphasizing theory and technique at The Albert Ellis Institute
Friday, April 3, 2009, 1:30-4:30pm
The Albert Ellis Institute
45 East 65th Street
New York, NY
(212) 535-0822
The Workshop will:
Explore the main tenets of the clinical philosophy of Integrative Harm Reduction Psychotherapy
Identify the three main theoretical bases of this approach: a biopsychosocial process model of problem substance use, the multiple meanings model and the stages of motivational change
Discuss the three domains of IHRP: the therapeutic alliance sets the stage for the therapeutic process, active skills building for assessment, goal-setting and working toward positive change and exploration of the multiple personal and social meanings of substance use
Describe the seven key therapeutic tasks, including managing the therapeutic alliance, therapeutic relationship as healing agent, facilitating capacities for change, assessment as treatment, embracing ambivalence, goal setting, and working toward positive change
TUITION
Regular Registration: $50.00
F/T grad students (with proof of status) $40.00
Call to register: (212) 535-0822
Bio:
Dr. Andrew Tatarsky has specialized in the field of substance use treatment for almost 30 years as psychotherapist, supervisor, program director, trainer and author. He holds a doctorate in clinical psychology from the City University of New York and is a candidate in20New York University’s Post-doctoral program. He is Co-Director of Harm Reduction Psychotherapy and Training Associates; founding board member, Division on Addictions of NYSPA, Chairman of the board of Moderation Management and founding board member, Association for Harm Reduction Therapy. His book, Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems, now in paperback, has been published in the United States and Poland. Dr. Tatarsky is in private practice in New York City and trains nationally and internationally.
This website and booklet from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides evidence-based information and interactive tools about risky drinking patterns, signs of an alcohol problem, and ways to help people cut back or quit drinking.
Publisher
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
5635 Fishers Lane, MSC 9304
Bethesda, md 20892
Phone: 301-443-3885
Website: http://www.niaaa.nih.gov/
Dear Colleague:
I am copying below a letter from leading substance use and mental health professionals to President Obama calling on him to appoint a director of SAMHSA who is a respected professional with a scientific background in mental health, substance use disorders and public health. The letter discussed the agency's dysfunction in previous years under leadership lacking in this expertise.
If you support our point of view, please distribute the letter to your colleagues, listserves, blogs,contacts in the media and government and others with an interest in this critically important appointment. I am getting the letter to President Obama through several channels. Let's get the message to President Obama in as many ways as we can.
It is time for real change in how our government ensures high quality, evidence-based and theoretically sound treatment for all Americans struggling with substance use and mental health issues. Please support this effort!
Best,
Andrew Tatarsky, PhD
Letter to President Obama regarding the Importance of Appointing a Nationally Recognized Professional with a Strong Science Background to be the Administrator of Substance Abuse and Mental Health Services Administration (SAMHSA)
March 9, 2009
Dear President Obama
Virtually every family in America is affected by mental illness or addiction. The cost in personal suffering and economic loss is staggering. Part of the tragedy of mental illness and addiction is that these disorders typically strike in late adolescence and early adulthood, between 18-25 years of age. By contrast, most major medical illnesses occur much later in life. The World Health Organization found that mental illness and addiction were the leading causes of disability among Americans ages 18-45, confirming that these diseases rob young Americans of their most productive years.
The last two decades have witnessed dramatic scientific advances in understanding mental illness and addiction which have led to the development of effective treatments and prevention programs. Unfortunately, unlike standard protocols for advances in other areas of medicine, these treatments are not reaching the vast majority of the public who need them. For example, the United States spends about $120 billion annually on behavioral health care [1]. Yet, less than 25% of this care is evidence-based, with 75% of questionable value. The result of the mediocre quality of behavioral health care is that many Americans are suffering needlessly and some are dying because they are not receiving treatment has been shown to work.
What can be done to solve this problem? Most advocacy groups call for increased spending. While lack of resources is part of the problem, increasing funding alone will not solve the problem. Currently, Americans are not receiving adequate value for the $120 billion that are spent annually and much more could be accomplished using existing resources. This is the main conclusion of a landmark report on the state of behavioral healthcare issued by the Institute of Medicine of the National Academy of Science in 2006.
The federal government’s response to this situation has been woefully inadequate. The federal agency responsible for overseeing the quality of behavioral health care and prevention is the Substance Abuse and Mental Health Services Administration (SAMSHA). SAMSHA has a $3.3 billion budget. An OMB review of this agency rated the agency’s programs as largely ineffective; an assessment shared by most mental health and addiction experts. Many politicians including Congressman and Senators who sit on relevant oversight committees have never heard of SAMSHA, despite the fact that SAMSHA is on the same organizational level in the Public Health Service as CDC and FDA.
One major reason for SAMSHA’s obscurity and dysfunction has been the failure to appoint a person with significant scientific and professional expertise to the lead the agency. Past administrators have been drawn from the ranks of state government with experience in community action, but without recognized high level scientific mental health, addiction, and public health expertise. By contrast, the recent heads of FDA and CDC have been nationally prominent scientists with accompanying expertise and stature to effectively lead their agencies.
President Obama, you have a unique opportunity to improve the treatment and prevention of mental illness and addiction by breaking with the past tradition of placing a political appointee with regulatory and administrative experience as the Administrator of SAMSHA. Instead, your transition team should seek a professional with a national reputation of excellence as a scientist and innovator in implementing science-based mental health and addiction programs and public health models in communities. This move would be consistent with your approach to attracting the highest caliber professionals into government, has the potential to improve the lives of many Americans, and would elicit uniform praise from advocates, the scientific community, and the press.
[1] Behavioral health care means addiction and mental health services combined.
Respectfully,
Andrew Tatarsky, PhD, Founding board member and past president, Division on Addiction, New York State Psychological Association, New York, NY; Co-director, H
arm Reduction Psychotherapy and Training Associates
John H. Halpern, M.D., Assistant Professor of Psychiatry, Harvard Medical School, Director of the Laboratory for Integrative Psychiatry, Division of Alcohol and Drug Abuse, Associate Director of Substance Abuse Research, Biological Psychiatry Laboratory, Alcohol and Drug Abuse Research Center, McLean Hospital, Belmont, MA
Mark B. Sobell, Ph.D., ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida
Jon Morgenstern, Ph.D., Professor & Director, Substance Abuse Services, Department of Psychiatry, Columbia University Medical Center, New York , NY
Reid K. Hester, Ph.D., Director, Research Division, Behavior Therapy Associates, LLP
Albuquerque, NM
Linda C. Sobell, Ph.D., ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida
William R. Miller, Ph.D., Emeritus Distinguished Professor of Psychology and Psychiatry, The University of New Mexico, Albuquerque, NM
Richard Juman, PsyD, Representative to Council, Division on Addictions , New York State Psychological Association, New York, NY
Ernest Drucker PhD, Professor, Montefiore Medical Center, Albert Einstein College of Medicine and Columbia University Mailman School of Public Health, New York , NY
Debra Rothschild, PhD, CASAC, Past President, Division on Addictions, New York State Psychological Association, New York, NY
Tom Horvath, Ph.D., ABPP, Practical
Recovery, La Jolla, CA
Joe Ruggiero, Ph.D., Assistant Clinical Director, Addiction Institute of New York, Director,Crystal Clear Project, New York, NY
G. Alan Marlatt, Ph.D. , Professor and Director, Addictive Behaviors Research Center University of Washington, Dept. of Psychology, Seattle, WA
George H Northrup, PhD, President, New York State Psychological Association, New York, NY
Scott Kellogg, PhD, Department of Psychology, Faculty of Arts and Sciences, New York University, New York, NY
John Rotrosen, MD, Professor, Department of Psychiatry, NYU School of Medicine, New York, NY
Nicholas Lessa, Chief Executive Officer, Inter-Care, LTD, New York, NY
Randy Seewald, MD, Beth Israel Medical Center MMTP, Medical Director, Beth Israel Medical Center, New York, NY
Alexandra Woods, PhD, Psychologist/psychoanalyst in private practice, Board of Directors, Division on Addictions, New York State Psychological Association
Karen Frieder, PhD, Executive board member, Addiction Division, New York State Psychological Association, Private Practice, New York, NY
Ana Kosok, Ed. D., Executive Director, Moderation Management Network, New York
Julie Barnes, PhD, CASAC, private practice, Executive board member, Addiction Division, New York State Psychological Association
Genata Carol, PhD, Director of Mental Health Services, AIDS Service Center of Lower Manhattan New York, NY
Patt Denning, PhD, Director of Clinical Services and Training, Harm
Reduction Therapy Center, San Francisco, CA
Jeannie Little, CSW, Executive Director, Harm Reduction Therapy Center, San Francisco, CA
Laura Kogel, LCSW, The Women's Therapy Centre Institute, New York, NY.
Bryan Fallon, PhD, Clinical supervisor in mental health for Prison Health Services. New York, NY
Produced by an Oscar-winning studio for the Global Drug Policy Program of the Open Society Institute, International Drug Policy: Animated Report 2009 highlights some of the disastrous effects of drug policy in recent years and proposes solutions for a way forward.
In the run-up to the March 2009 UN Commission on Narcotic Drugs meeting—where the future path of international drug policy will be determined—this film seeks to show that pursuing a "drug-free world" can lead to more harm than good.
Two new studies suggest that red wine and marijuana may help to prevent or slow Alzheimer’s disease and other age-related memory loss.
An article first published at miller-mccune.com on November 21, 2008, points out that at the November, 2008 meeting of the Society of Neuroscience in Washington, D.C., Ohio State University researchers reported that THC, the main psychoactive substance in the cannabis plant, may lower inflammation in the brain, and even stimulate formation of new brain cells.
And in the Nov. 21, 2008, issue of the Journal of Biological Chemistry, neurologist David Teplow of the University of California, Los Angeles reported that naturally occurring components of red wine called polyphenols can block the formation of proteins that build the toxic plaques thought to destroy brain cells. In addition, these substances can reduce the toxicity of existing plaques. Both actions can slow memory loss.
Neither of these findings surprises me. That marijuana has medical efficacy against a variety of conditions is firmly established scientifically, and the health benefits of moderate red wine consumption are also becoming clearer with each passing year. As of November, 2008, 15 states had laws with provisions for medical marijuana on the books, and I hope more states enact enlightened policies in this regard. In the meantime, if you enjoy an occasional glass of red wine, continue to do so as part of an overall healthy diet.
Study Finds No Link Between Medical Heroin and Crime
‘Harm Reduction 2009: IHRA’s 20th International Conference’ took place in Bangkok, Thailand from the 20th to 23rd April, and – despite the city being in a ‘state of emergency’ due to recent political uncertainty – brought together an incredible 1,000 delegates from 80 countries, including many from Thailand and other Asian countries. The four days were filled with discussions and debates about the latest research findings, best practice guidelines, policy developments and advances in harm reduction programming worldwide. 
