STAGES of HARM REDUCTION- by Douglas Willinger:
STAGE 1 Clean needles and safer crack pipes.
STAGE 2 Pharmaceutic-ally consistent heroin and cocaine powders and sulfates.
STAGE 3 The Plant Drugs Instead of the Concentrates:
- Opium instead of concentrated morphine-heroin.
- Coca instead of concentrated cocaine.
- MJ instead of concentrated cocaine and or heroin or alcohol
STAGE 4 The Plant Drugs Instead of the Pharmaceuticals (Concentrated Patentable Synthetics)
- MJ, Coca and or Opium instead of anti-depressants, Oxycontin, etc.
STAGE 5 The Plant Drugs Instead of the Already Licit Plant Drugs:
- Coca instead of Coffee - caffeine
- Coca instead of Tobacco
Alas, the Drug Policy Alliance - successor organization to the Drug Policy Foundation - seriously short-sells the concept of 'Harm Reduction', limiting it essentially to the first stage: clean needles and safer crack pipes.
Reducing Drug Harms:
Harm reduction is a public health philosophy and intervention that seeks to reduce the harms associated with drug use and ineffective drug policies. A basic tenet of harm reduction is that there has never been, and will never be, a drug-free society. The Drug Policy Alliance advocates reducing the harms of drugs through accurate, fact-based drug education, drug-related illness and injury prevention, and effective treatment for problematic drug use. We believe that every solution with the potential to help people and to mitigate harm should be considered. We continue to seek innovative health approaches to drug use, drug treatment, and drug policy that are based on science and research.
Supervised Injection Facilities
That last one sounds the most promising.
Drug substitution and maintenance approaches have a long history of providing individuals struggling with problematic drug use with legal access to drugs that would otherwise be obtained through illegal means. The Centers for Disease Control and Prevention, the Institute of Medicine, the Substance Abuse and Mental Health Service Administration (SAMHSA), the National Institute on Drug Abuse (NIDA), the World Health Organization and over four decades of government-funded, peer-reviewed medical research have unequivocally and repeatedly proven that substitution therapies like methadone maintenance are the most effective treatments for opioid dependence.
Methadone is the most widely-used maintenance treatment. Used properly, methadone reduces drug use and related crime, death, and disease among heroin users. But methadone has been handicapped by restrictive government regulations, by misinformation - among treatment providers and drug users alike - and by prejudice against methadone treatment. Methadone is the most tightly restricted drug in the U.S. Doctors in general medical practice can't prescribe methadone, and regular pharmacies don't distribute it. Buprenorphine is a newer medication that has also been shown to be effective and it can be prescribed by physicians who have gone through special training. The Drug Policy Alliance advocates for making both methadone and buprenorphine more accessible, through changing attitudes, laws, regulations, and health insurance policies. Funding must be increased for access to methadone and buprenorphine through the public health system for those who cannot afford it otherwise.
For drug users who have not found success with methadone, the most dramatic developments in drug substitution therapies have been in the field of Heroin-Assisted Treatment (HAT). HAT programs, as part of comprehensive treatment strategies, provide substantial benefits to long-term heroin users who have not been responsive to other treatment. Studies have shown that those enrolled in HAT demonstrate a reduction in drug use and an improvement in overall physical and mental health. Additionally, several studies have found that individuals who participated in these programs significantly reduced their involvement in criminal activities, generating large cost savings. Heroin maintenance may be a feasible, effective and cost-effective strategy for reducing drug use and drug-related harm among long-term heroin users for whom other treatment programs have failed.
Anti-prohibitions have forever pointed out that prohibition removes any guaranteed consistency of potency for the white powder drug forms.
Richard Cowan had already by 1986 pointed out that prohibition also shifts the drug markets to the troublesome concentrated forms and their more direct modes of administration, encouraged by the prohibition-inflated price.
Richard B. Karel spoke before the U.S. Congress 'narcotics' committee in 1988 about changing the laws to reflect the pharmacological distinctions between Coca and concentrated cocaine.
I have already been doing this and more since 1987, in pointing out how the shift to the troublesome white powders was a shift away from highly beneficial useful substances as Coca, and how its banning was an act of agricultural mercantilism via the USDA Bureau of Chemistry at protecting the well established domestic U.S. agricultural commodity of Virginia Bright Leaf Tobacco, at a time of the construction of the Panama Canal (which would have significantly reduced the shipping times of Coca leaves to North Atlantic markets), and after the USDA's own experimentation with growing Coca and other drug crops commercially within the U.S.A.- which was a part of my talk as a panelist of the 1992 Foreign Trade panel moderated by Ethan Nadelman, after being published by the Drug Policy Foundation (DPF) in 1990, 1991 and 1992.
The now incarcerated activist Dana Beal, leader of Cures Not Wars, has likewise spent the last two plus decades advocating the use of the West African Iboga plant (root bark) as an addiction interrupter for physically addictive and psychologically addictive drugs- including cigarettes!
Yet the Drug Policy Alliance can only focus upon the lowest level of 'harm reduction' - clean needles and pipes etc, with the logical evolution of substitution (replacement therapy) dumbed down to simply the same labor-intensive wastefulness of methadone programs (imagine such inefficiencies and indignities placed upon cigarette and caffeine addicts- with nicotine patches and picking up say boxes of caffeine chewing gum requiring a visit to a doctor!) Panel proposals as “Coca: Turning Over a New Leaf Towards Reducing Health Care Costs.” (supported by its moderator Dr. Lester Grinspoon) and "Tinctures of Opium, Wines of Coca, etc: Popular, Pre-prohibition Uses of Natural Plants Perverted by Drug Prohibition into today's "Hard" Drug Plague" are somehow too radical.
This keeps such drugs as cocaine available and as now popularly used, in the more abusable concentrated forms, sustaining an empire of drug addiction treatment specialists to treat the victims of overly concentrated drug dosing, while roughly containing this cocaine market to its existing parameters, thereby protecting Coffee-caffeine and especially Tobacco products from the market competition of Coca leaf extract products. Hence, the DPA retreats from the 'Harm Reduction' concept's above defined STAGE 2, to STAGE 1, rather then dare progress to STAGE 3, let alone 4 or 5. Never mind the immense public health benefits of a switchover towards Coca, particularly with that conveniently protected by the 1906 US Food and Drugs Act commodity of Virginia Bright Leaf Tobacco- sucker's cigarette smoke.
And we wonder why heath care costs spiral upwards.
Or why does the DPA follows the DPF's post 1992 malevolent malaise towards the Coca issue, eliminating their cocaine panels (which I was a panelist in 1991 and 1992) after 1992, folding the issue into a virtual all woman's Latin America panel, and neglecting to highlight it even in 2011 the year of Bolivia's historic denunciation of the 1961 U.N. 'narcotics' treaty or 'convention'?
The Ira Glasser I had met at the 1993 DPF conference, with British Medical journalist Anita Bennett seemed sincerely interested in learning about such cost-effective therapeutic uses of Coca such as easing childbirth and hence reducing the incidences of prolonged labor- brain damaged newborns.
Yet apparently not at anytime since- if conference agendas are to suggest anything.