US Conference of Mayors Entertains Drug Policy Reformers
Peter Stoker

Prevention or liberalisation? Resistance or collaboration? A constant tug-of-war, fought out on a wide range of fields – usually involving a contest between dedicated adversaries. But an engagement of a different sort took place at the 75th Annual Meeting of the US Conference of Mayors (USCM) held in Los Angeles in June 2007, different in that opponents were not invited – this was the unusual spectacle of a tug-of-war with only one team on the rope.

The Mayors’ Conference currently has 1,139 member cities, representing any US city with a population of 30,000 or more (1). The Conference is defined as ‘nonpartisan’.

It is not easy to establish how many mayors actually attend the conference or attend any given session, but – for example, in 2007 – a resolution on the Iraq War presented ‘to the full body of the Conference’, and which should have been a magnet event, attracted only one hundred voters – rather less than 10% of the Conference membership (2).

Against this background, USCM ‘75 entertained a discussion on drug policy and practice and, in due course, developed a Resolution which was reportedly passed by two committees before coming to the general assembly where it was passed unanimously ‘with minimal debate’. Resolutions such as this are expected to be used by USCM ‘to guide the Washington lobbying’. To that extent, they are binding on the membership – even though one of the Resolution’s architects conceded “While it has no legal effect, it has powerful symbolic effect”.

The disquieting nature of this particular Resolution lies is in its claim that ‘The Drug War has failed’ and in its call for a ‘harm-reduction oriented approach to drug policy that focuses on public health’, as reported in a Join Together News feature of l8th July, 2007 (3).

The Resolution
The Resolution itself runs to around 1200 words with no less than 21 introductory paragraphs preceding the six paragraph Resolution. Here is an abbreviated version, which ran under the title of: ‘A new bottom line in reducing the harms of substance abuse’ (4).
           
Under the introductory headings, the Resolution offers observations on the current position, as the drafters see it, which may be summarised as:

• Addiction is treatable, and drug treatment succeeds more than cancer treatment.
• The US imprisons more than any other country, with many imprisoned for simple possession.
• Treatment yields benefits at a 7:1 ratio.
• The drug war costs hugely, but many still use, and demand has not decreased.
• Only one third of the drugs budget goes toward education, prevention and treatment.
• Aids and Hep-C are caused by the lack of needle exchange programmes (NEPs).
• Government prevention programmes are useless.
• Non-whites get more severe penalties.

The six sections of the Resolution itself are:

• The drug war has failed – we need a public health approach.
• We should focus on harm reduction.
• Rigorous evaluation should be applied; more money should go to evaluating harm reduction.
• Methadone, maintenance therapy and treatment are to be preferred over jail.
• Prevention of HIV/Hep-C should be by NEPs and overdose prevention.
• Local communities suffer consequences, so they should have power (federal role should be confined to providing the money).

Understanding how the mayors came to such a radical position is easier once one appreciates who drafted the Resolution and who sponsored it.

The drafter was none other than the Drug Policy Alliance (DPA) – the Soros-financed evolution of the Lindesmith Institute and the Drug Policy Foundation, an  unmitigated pressure group for liberalisation and preferably legalisation of drugs. To those who know of DPA and its writings, the USCM Resolution reads like a photocopy of the DPA literature.

The sponsor is less well known outside the mayoral scene, but high profile within it (5). Mayor Rocky Anderson presides over Salt Lake City and minces no words in his condemnation of all things Republican. Bush is, he opines, “…the most dangerous President the country’s ever had”.  Described by some as energetic, radical, charismatic, populist, attorney-trained, globally conscious, Anderson has concluded that in the short term he must shelve any notions of higher office, but he can meanwhile gain satisfaction from rattling the Washington cage from the outside.  He is a founding member of the New Cities Project, a group linking ‘progressive’ mayors from around the country, which holds twice-yearly fringe meetings at USCM conferences.

Mayor Rocky, is reportedly a lapsed Mormon, ‘anti-machine’, anti-global warming, pro-gay rights, pro-immigrants rights, and pro-counselling instead of prison for DUIs and prostitutes. In the drug policy context Anderson is against DARE, having thrown it out of Salt Lake City schools. Whilst some antipathy of African Americans towards DARE is understandable – it having been originated by Los Angeles Police Chief Daryl Gates (alleged to have overseen a higher rate of deaths amongst African Americans compared to Caucasians in police custody during his term of office), and of course DARE has always been seen by the liberalisers as a prevention flagship they would dearly love to scupper.  However, the news about Mayor Anderson is not all bleak; he is in favour of Restorative Justice as an alternative to imprisonment, and this is a process which has much to commend it as part of preventing repeat felonies.

Conclusion
DPA makes frequent use of its substantial finance and staffing resources to gain exposure like this; the expedient partnership with radical politicians is also no surprise. Less understandable is the ‘unanimous’ vote awarded by USCM to the DPA/Anderson pitch. ONDCP spokesman Tom Riley said after the conference results were published that  “…most of the mayors our office talks to consider drugs a huge problem in their communities and are anxious to get more resources for prevention, treatment and law enforcement. I don’t know many mayors who are in favour of drug legalisation”.

Riley was disparaging of the USCM resolution exercise, branding it “… a publicity stunt by proponents of drug legalization”. This is an understandable reaction, if one is in the Washington environment; i.e., listen courteously to the USCM propositions, but remind them where the real power lies.  But mayors are by no means without power in their locales, and they are clearly sensitive to the issue of how much power they have relative to the central government. A more pragmatic response might therefore be to take the Resolution at face value (leaving aside who wrote it) – after all, it received a unanimous vote and is now firmly in the USCM portfolio, but suggest that a balanced appraisal would be at least worth exploring.

Such an appraisal might begin with asking to what extent a ‘unanimous’ vote – by what would seem to be less than 100 mayors – is truly representative of USCM as a whole (knowing that many mayors in contact with ONDCP profess the opposite view).

Turning to the actual content of the Resolution and its introductory paragraphs, the following observations can be made:

The stated core value of the Resolution is a drug policy that

“… concentrates more fully on reducing the negative consequences associated with drug abuse, while ensuring that our policies do not exacerbate these problems or create new social problems of their own; establishes quantifiable, short- and long- term objectives for drug policy; saves taxpayers money; and holds State and Federal agencies responsible”.

Not much there that a prevention advocate would find uncomfortable – except perhaps the proposed focus being

            “…more fully on reducing the negative consequences”

More prevention would, of course, reduce the consequences – but it is well known that this is not what DPA has in mind. Moreover, Mayor Anderson seems to be cast in the DPA mould; indeed, he received DPA’s 2005 ‘Richard J. Dennis Drug Peace Award’ for his ‘reforming’ efforts. If nothing else, this 2005 award shows that Anderson has been ‘in close proximity to’ DPA for several years already.

It is of course legitimate for USCM, and indeed anyone else,  to challenge where ONDCP puts its money, but USCM needs to base its challenge on something more substantial than DPA rhetoric. To champion drug treatment on the argument that fewer people die from it than from cancer treatment is plain silly, comparing apples with oranges. Equally, to cite the 46% of citizens using ‘at least once’ paints a falsely bleak picture of drug abuse prevalence – it is now well understood and widely agreed that many users give up after only one or two tries, and the percentage persisting beyond this is much lower – typically around 15% or less, which means that 85% of the population either sustain or soon achieve lasting abstinence. Moreover, the present administration is not without progress in this context: current drug use by youth has declined 24 percent since 2001. Treatment can claim a several-fold ‘Benefit v Cost’ ratio – but the ratio for prevention is even better, which makes the relatively tiny funding it receives (in comparison with education and treatment) all the more reprehensible.  

Needle exchanges and methadone maintenance programmes are increasingly incurring professional criticism, including but not limited to an in-depth study by Robert L. DuPont, MD and Eric A. Voth, MD as well as others (6). USCM really should try to keep up with the research. (Corresponding research in the UK by Professor Neil McKeganey and others shows that most users do not want needle exchanges or methadone maintenance, etc. - they want help to stop using).

USCM and DPA claims, that ethnic minorities are imprisoned more than whites, are not supported by the evidence. Attorney and drug policy specialist Robert Peterson has conducted analyses of imprisonments related to drug offences (7), and amongst other things he discovered a simple truth; in the Northern states where incarceration occurs less, there are fewer black people – in the Southern states the opposite is the case. This variation of ethnicity, on its own, explains the black/white numerical differences in incarceration rates. Moreover, Peterson confirmed that almost no one is imprisoned for simple possession. Almost all prisoners come into the justice system with other offences known; plea bargaining makes many of these other offences disappear. In the US as elsewhere, arrests for simple possession rarely lead into the justice system.

The strategies built into the USCM Resolution are invalidated by the above distortions. Whilst the Resolution makes some valid observations, which few would find contentious, the overall product is an undistinguished reiteration of DPA rhetoric.

Ironically, if the real goal of harm reduction (and of this Resolution) is to reduce all the harms to all of society rather than a narrowly-focused set of interventions concentrating on making life less harmful and more viable for those who wish to continue use, the logical policy outcome would be a concentration on primary prevention. 

One can agree with USCM that the effectiveness of prevention so far is mixed – the potential of effective prevention has yet to be fully realised (and is likely to remain so until resourcing is stepped up by an order or two of magnitude). But the feasibility and viability of prevention are givens – it follows that what is needed is more focus on making prevention effective and less indulgence in suing for surrender to the drug problem.

References
1. USCM – About the USCM. http://usmayors.org/uscm/about/what_is/what_is_uscm.html

2. USCM - Press Release, June 25, 2007 (URL: usmayors.org )

3. Join Together - News Feature by Bob Curley, July 18, 2007 – US Mayors declare drug war a failure.

4. USCM – 2007 Adopted Resolutions – Children, Health and Human Services: ‘A New Bottom Line in Reducing the harms of Substance Abuse’.

5. The Nation – ‘The Other Rocky’ by Sasha Abramsky, January 1, 2007 –
http://www.thenation.com/doc/20070101/abramsky

6. DuPont FL, Voth EA. Ann Intern Med. 1995 Sep 15;123(6): 461-5 Drug legalization, harm reduction and drug policy.
See also www.globaldrugpolicy.org/1/4/4.php

7. Peterson RE  -  ‘Drug Enforcement Works’ - Archived at http://www.wsnia.org/articles/Spring1998/drugworks.htm

Harm Reduction or Harm Denial?
Dr. Juan Alberto Yaría, Drug Dependence Institute Director – Salvador University (Argentina)
GRADIVA Rehabilitation Center Director (Argentina)

Editor’s Note: The complete version in Spanish is available here without benefit of peer review.

The harm reduction movement has turned into a denial that drugs cause harm precisely when, since the 90s, there have been neuroimage means to measure the atrophies and problems of metabolism and brain perfusion caused by drugs in an exact way. This harm reduction movement is turning into an  ideological submission plan for the public, especially young people, creating a massive tyrannical control and then a subclass of “mutants” and “brainless” young people in the short term with the consequence of the growth of crime, AIDS, consumption and drug selling, accidents and mental and neurological diseases.

This harm denial movement, as I dare to call it, denies the concept of  mental illness associated with the use of drugs; considering drug taking as a mere life choice, it works as an evil tool since any preventive education on damages from  drug taking is attacked, and using drugs without consequences is taught.

What choice may there be if there is no damage preventive education? In Argentina, leaflets are handed out at the door of nightclubs, concerts or public shows in which the following concepts are mentioned: “Marijuana by itself does not produce a mental illness,” or “It is extremely important for those people who are going to take the drug for the first time to take the necessary precautions of graduating the first consumption very slowly, especially if it is a good quality and powerful substance; a few puffs (no more than four or five) have to be smoked and at least ten or twenty minutes should be waited to see the effect produced in order to avoid the possibility of a bad experience or an acute sickness.” (ARDA Argentinian Damage Decrease Association)  The same concepts are followed with synthetic and other drugs.

In addition, this movement – and I call it a movement because it is more than a structure based on medical principles, it is almost an element of political pressure on public opinion trying to foster tolerance and social acceptance of drug consumption – has a very particular view of the user´s rights and does not take into account the non-user´s rights. If the individual’s well-being (supposing drug-taking is something good) is the only one that prevails, setting aside the social well-being and public health, our society will become a primitive one. In this peculiar political concept, the Law, more than a factor that allows social integration as Plato said: “It is a road to grow” (Plato – Complete Works), has turned into a discrimination and marginalization tool.

Furthermore, evilly, the marginalization effect, deterioration of behaviour and psychotic isolation develop increasingly since drug use buries the person in a magical, hallucinatory world and eliminates the psychological centers of ethical behaviour and impulse control as shown in pre-frontal syndrome (clearly detected today by neuroimage).

It is necessary to work on the “popular mental complex” of the beliefs, attitudes and cultural values that are seminal to drug taking. If we create social acceptance, demand will rise and the increase of the number of implied consumers will increase social acceptance. This way, from this conception of ideas – paradoxically – will people be freer or more dominated by the market?

The appearance of synthetic drugs and the polydrug abuse phenomenon
Another consequence of the social acceptance of drug use and harm minimization strategies is the emergence of polydrug abuse in an attempt by users to manage their moods with different substances. In the 80s, there was still a one or two drug dependence at the most. Today, the patient chooses drugs from a “menu” as if he were at a restaurant. Polydrug abuse has also risen, especially among young people, because of recipes downloaded or bought from the Internet. This is a new phenomenon that has added a bigger problem to a serious problem in itself: drug consumption.  The illegal drug trade, especially in synthetic drugs made in local laboratories, has increased dramatically in nightclubs. Polydrug abuse and the availability of synthetic drugs have given a new dimension to drug phenomena. They are having a massive impact and, in addition, are causing an increase in the drug epidemic because of social acceptance and promotion of drug consumption.

Syringe interchange programs are being evaluated
Both in Buenos Aires Province (7-year-research conducted by me) and in other countries, specifically in Chicago (USA), with educational extension programs and community leaders, it was proven that an uncontrolled distribution of syringes without a prevention and education plan caused the adverse effect of increasing drug consumption. In Montreal (Canada) it was proven that the participants of a needle exchange program were three times more liable to get HIV than the ones who did not participate; the blood of 1600 drug addicts was tested every 6 months. In Vancouver (Canada) it was proved that a large number of addicts shared needles, even HIV positive participants; the index of drug addicts with HIV in the city increased from 2% in 1988 to 23% in 1997.

We have forgotten basic elements of prevention and treatment
Prevention of first consumption of drugs and early intervention in experimental and non-addicted consumers should be paramount. We must remember the basic elements of treatment - that daytime, outpatient, and residential active treatments should include programs connected to prevention of a relapse (these concepts have been very well expressed in Buenos Aires in University of Salvador Congress by the Professors Calvina Fay and Mina Seinfeld de Carkushansky – November 2007). These kinds of treatment programs should complement the legal system that implies the observance of the law and prohibition of drug use. Programs must cover all drugs -  illegal as well as legally prescribed drugs and alcohol.

There are four main principles of prevention:

• Discouraging first use
• Massive and early decrease of tobacco and alcohol use
• Continuous work on cultural norms and media strategies conducive to non-social acceptance of drugs
• Taking care of the human genome and the genetic capital; drug dopaminergic activation empowers genetic changes, genetic vulnerability and genetic polymorphism

To prevent drug use is to activate treatment systems and improve them permanently since it is proven that 20% of critical users consume 70% of the drugs in circulation. The strategy that promotes early intervention is only possible through a social leader network, neighborhood by neighborhood and municipality by municipality.

To prevent drug use is to prevent crimes, thefts, street fights and the illegal drug trade. It is proven that an adolescent drug user has more conflicts with the law than an adolescent with an identity crisis who does not take drugs. He will have conflicts or symptoms, but he will be unlikely to have a behavior disorder that causes legal problems.

To prevent drug use is to limit the growth of psychiatric illnesses since 50% of drug abusers have serious mental disorders  (Axis 1 in DSM-IV). The use of marijuana increases by five times the possibility of schizophrenia, eight times the possibility of acquiring anxiety disorders and four times the possibility of triggering mood disorders.

To prevent drug use is to promote early community interventions in the underage with behavior disorders, in children and adolescents with ADHD (Attention-Deficit Hyperactivity Disorder), in child abuse and in violent situations.

Prevention must be connected to intense, persistent communication and media campaigns at all times.

Conclusion
The harm reduction movement is the crystallization of the individualistic tenet of postmodernism itself. It justifies the drug business and denies the illnesses and consequences that are at stake in the individual’s and community’s lives.
As an Argentinian professional and as the University of Salvador Drug Dependence Institute Director, I consider that we are helping pandemic situations connected to wrong conceptions based on harm denial and the social acceptance of drug consumption. We propose – based on our experience - a triple job that goes from the local to the regional levels:

• Developing leadership and encouraging leader formation in its different arenas: family, education, community, religion, healthcare, social communication
• Organizing on this base a Community Preventive Campaign in each locality integrated with a treatment system
• Increasing the coordination of networks and associations by creating Preventive Cities

Our 7-year-job experience in Buenos Aires Province (Argentina) has given excellent results following this model:

• A decrease of intravenous drug consumption from 8% to 2%
• A decrease of syringe interchange from 10% to .5% (without handing out a single syringe)
• A decrease in the first consumption of cocaine from 5% in 1993 to 2.5% in 1999
• A decrease in alcohol on our highways from 8% in 1995 to 2% in 2000

We believe that we can get good results if all of us redouble our efforts for a more humanistic view of man based on scientific principles and for a new urban social order based on Preventive City concepts.