21 April 2014

"Is the War on Drugs Over?" New York panel discussion.

April 4, Vanderbilt Hall, Law School, NYU. "Is the War on Drugs Over?" A Panel Discussion on the Drug War's Effects on Human Rights and US Policies.
 
Three panel members (the fourth cancelled in unfortunate but almost humorous circumstances) were very actively chaired by Mattathias Schwartz. 
 
Kathleen Frydl is an award-winning historian of US policies.  Her most recent book, Drug Wars in America 1940-1973, was hailed by SUNY Professor Paul Gootenberg as "the most compelling scholarly book to date written on America's post-war transition to punitive domestic drug policy". 
 
Hamilton Morris is a research chemist and an expert on synthetic and psychedelic drug and contributes to Harper's and is science editor at Vice, where he hosts "Hamilton's Pharmacopeia", a video series. 
 
Cesar Gaviraia served as President of Colombia from 1990 to 1994 and Secretary General of the Organisation of American States from 1994 to 2004.  He is a member of the Global Commission on Drug Policy, which has advocated a shift towards de-criminalization, harm reduction, and demandside anti-drug programs. 
 
Michael Botticelli is Acting Director of the White House Office of National Drug Control Policy, also know as the office of the drug czar.  He previously served as Director of the Bureau of Substance Abuse Services for the State of Massachusetts. [cancelled and no substitute available]
 
Vice drug czar Mr Michael Botticelli was missing in action having apparently had an underling call the moderator earlier to cancel.  We were told an amusing description of the chain of events.  Moderator Mr Swartz asked if another drug office person might fill in and when that was declined, even the staffer, who seemed to be very knowledgeable about the subject himself, was asked if he would like to attend and represent the Government.  No go.  
 
This chain of events is hardly surprising in the current climate where popular opinion and science are diametrically opposed to long-time official Washington policy.  One of the pertinent comments of the evening was a question as to how one might get members of a prohibitionist orientated administration into the same room as the activists, doctors and public health experts.  My answer from Australian experience would be to wait until a member of one of the high profile families is affected by drugs or, even more likely, affected adversely by current drugs policy in America. 
 
The moderator was highly effective young journalist Mattathias Schwartz who writes on national security and state power for The New Yorker, the London Review of Books, and other publications.  "A Mission Gone Wrong," his most recent New Yorker story, gives a history of the drug war as waged abroad.  [A rather long-winded but fascinating article available on http://www.newyorker.com/reporting/2014/01/06/140106fa_fact_schwartz?currentPage=all  ]
 
This meeting was one of the most enlightening I have been to in some time.  It was held in the beautiful and high-tech Vanderbilt lecture hall at NYU Law School near Washington Square.  Three eminent speakers and an on-side (the side of reason) moderator were unanimous in agreeing that the drug war was not yet over, although signs were present that an end might be in sight, at least for some aspects of that long, expensive and unproductive conflict/noble experiment. 
 
Mr Schwartz asked ex-President Gavaria if he would still condone his governments pursuit and assassination of Pablo Escobar in 1993.  Schwartz repeated his proposition that Escobar might have just been replaced by another king-pin anyway and asked if it was therefore right to go ahead with his killing.  Gavaria had no hesitation is saying that as a fugitive and acting against the countrys rule of law that of course action had to be taken against him.  However, the ex-President followed up by saying that the breaking of the Escobar cartel made little if any difference to the flow of drugs northwards which continues to this day unabated.  Mr Gavaria emphasised that only measures which affect demand in the consumer countries can have any meaningful effect on this. 
 
El ex-Presidente then spoke at length about numerous issues, belabouring and berating journalists and politicians especially for their lack of attention to drug related matters.  He described modern journalism as the art of the unusual, (making quite a lot of sense to my mind).  He said that nobody wanted to hear about public health statistics but anecdotes, even those contrary to trends, are more likely to be published prominently than small changes elsewhere which might save hundreds of lives.  He gave an example of legalisation of cannabis in which a teenager has a car accident and kills a family while intoxicated even though the main game of crime, corruption and medical consequences are far more significant to the country. 
 
He then told us that one of the worst consequences of being placed on schedule one meant effectively that scientific research on that drug was effectively prevented as the drugs could only be obtained in exceptional circumstances with enormous paperwork and safeguards.  Hamilton mentioned that this was a disaster, especially for LSD and numerous other drugs which had shown promise in certain diverse medical and clinical fields, migraine being just one he mentioned.
 
Morris Hamilton then mentioned that just one day before the seminar, naloxone had been approved by the FDA for public dispensing.  An off-label nasal formulation of the opioid reversal agent has been widely circulated already in some states.  ‘Evzio’ will be marketed by Kaleo but it is not clear who will pay  the estimated $200 for each unit - which will include audible instructions once the unit is opened, rather like a defibrillator.  http://www.bostonglobe.com/lifestyle/health-wellness/2014/04/03/fda-approves-user-friendly-device-reverse-opioid-drug-overdoses/aPUzTAmmY0uMGQn3PwMR7H/story.html
 
In addition, we were given some intriguing information about the leglisation of all synthetic cannabinoids in New Zealand, contrary to trends elsewhere to continue banning anything which appeared to be popular (see http://www.huffingtonpost.com/2013/08/02/new-zealand-drug-law_n_3696809.html  )
 
Other panellists pointed out the fallacy of banning a relatively safe drug like cannabis when legal alternatives may turn out to be far more dangerous and are only or largely used because of prohibition of the progenitor.  Spice, bath salts and other designer drugs were mentioned. 
 
More than once the Presidente made a statement which was highly controversial with the other panellists and some audience members: All drugs are bad.  He defended this, but after much goading, finally admitted that it was just necessary politically to make such statements.  Yet others pointed out that all drugs could be bad and all drugs could be good and it was the set and setting which made the difference.  It was Paracelsus who wrote (in Latin) that the difference between a poison and a drug was just the dose.  That might apply to homeopathy as well. 
 
Ms Frydl made the point that she was agnostic about good and bad with drugs.  When it comes to what should be more strongly regulated she said that such decisions should be based on evidence of actual harms, and the consequences of regulation.  So often it was said that the bans were more harmful than the drug itself.  She mentioned work of the DPA and the legalization issues and an audience member pointed out that DPA supremo Ethan Nadelmann was present in the room.  He had in fact just been in New Zealand giving a keynote address to a conference partly devoted to the new synthetic drug laws. 
 
It was pointed out that prohibition did sometimes work as with methaqualone and some analgesics.  Yet the flat balloon analogy was used by El Presidente that if you restrict one popular drug then another will take its place very quickly, sometimes with disastrous consequences.  One panel member said that recent changes in availability of prescribed opioids in places like Vermont had cause them to be largely replaced with street heroin which in turn had been associated with very high numbers of overdoses … every one preventable.  Vermont has one single methadone program which is totally inadequate for a state which has a rural population and long distances for most residents to reach such a facility.  Fortunately buprenorphine is available for some who can afford it. 
 
In question time I made a comment about the lamentable reluctance of Americans to allow their doctors to prescribe methadone and of their pharmacists to supervise its administration.  Ms Frydl interjected that methadone is always available in clinics in this country (a rather pusillanimous sentiment considering waiting lists and high costs to consumers).  I was surprised but touched that the Colombian ex-President said that some of the most sensible comments and arguments he had heard had come from Australian physicians (probably including Dr Alex Wodak who often speaks common sense at international forums on the subject). 
 
We were told that one major factor in the repeal of alcohol prohibition in America was the fear of the general population that they would be subjected to income tax, something which only affected the very rich in that era.  Legalising alcohol again would ensure a flow of excise funds to government to use for schools, hospitals, etc.  I had never heard of this before, always assuming that it was the mothers of America’ who were campaigning against the occurrence of truancy and drunken school children who were the main force against the prohibition of the 1920s.  Maybe it was both. 
 
Very brief and incomplete summary of this informative talkfest - written by Andrew Byrne ..