04/27/14 Eric Holder

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Doug McVay report: US Attorney General Eric Holder on efforts to crack down on opiate misuse: Martin Sheen, Judge Jim Gray of California, Sheriff Grayson Robinson of Colorado, Superintendent Rick Van Wickler of New Hampshire, and Judge Robert Francis of Texas .Mark Kleiman, professor of public policy in the UCLA School of Public Affairs; Kasia Malinowska-Sempruch; director of the Open Society Global Drug Policy Program; and Otto Pérez Molina, the president of Guatemala

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Transcript

Century of Lies April 27, 2014

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DEAN BECKER: The failure of Drug War is glaringly obvious to judges, cops, wardens, prosecutors and millions more. Now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century of Lies.

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DOUG McVAY: Hello and welcome to Century of Lies. I'm your guest host, Doug McVay, editor of Drug War Facts dot org. Century of Lies is a production of the Drug Truth Network, and is brought to you through the Pacifica network's radio station KPFT-fm in Houston, Texas. Find us on the web at drug truth dot net, where you can find past programs and you can subscribe to our podcasts. You can follow me on twitter, where I'm at drug policy facts, and also at doug mcvay. The Drug Truth Network is on Facebook, be sure to give its page a Like, you can find Drug War Facts on Facebook as well, please give it a like and share it with friends.

Before we start, I want to say hello to a few of the stations out there that carry Century Of Lies, including KRFP 90.3 FM in Moscow, Idaho; WERU 89.9 FM in Blue Hill, Maine; and WGOT-LP 94.7 FM in Gainesville, Florida. You can also hear Century Of Lies via 420 Radio dot org on Mondays at 7am, Tuesdays at 10pm, and Saturdays at 2am. If you're listening via any of our affiliates or 420 Radio, thank you!

Let's get to the news.

You've all seen the headlines and heard the panicked warnings: Heroin Epidemic. New wave of heroin use hits American cities. Overdoses skyrocketing. New laws being pushed through to deal with the crisis. Yet the truth, like so much in this war on drugs, is much less sensational.

Survey data do show that in 2012, there were a reported 335,000 so-called current heroin users in the US. Yet we know that survey data on illegal drug use are typically under-estimates. Some experts, such as Professor Ernest Drucker of New York, believe that the number is closer to one million. In addition, in 2012 there were an estimated 4.9 million people who reportedly are current nonmedical – that is, illegal - users of prescription painkillers. Again, the survey data are typically under-estimates, it's probably closer to 8 million people but we just don't know.

Whether it's heroin, codeine, morphine, or oxycodone, they're all opiates. There are some differences, heroin is often injected, snorted, or smoked, while prescription painkillers typically come in pill form, yet as regular listeners know Oxy for example can also be crushed up and snorted or injected.

Let's go back to the numbers. One problem should be immediately apparent. Look at the calendar. It's 2014, this is the second quarter of the year. So federal survey data are two years old at best. Federal data on overdose and drug-related mortality are available for 2010 – four years old. Some more recent state data are available, from 2012 – two years ago. Arrest data are problematic, sure we have raw numbers for 2012, but the Arrestee Drug Abuse Monitoring program has been scrapped so we don't have any data on what drugs that population has been using.

The Community Epidemiology Work Group is a project of the National Institute on Drug Abuse, it meets twice a year, and is intended as an early-warning system. According to the website, quote: “At the meetings, CEWG members present data on drug abuse from a variety of city, State, Federal, and other sources. These data are enhanced with information gathered through ethnographic research, focus groups, interviews, and other qualitative methods. This integration of quantitative with qualitative data provides invaluable insight into emerging drug use trends.” End quote.

The CEWG report for June 2013 is available in full, for January 2014 we have just regional summaries available for now. The June 2013 document is composed of reports from only 21 area representatives from around the US, yet still, 2013 eh? No. Here's what that June 2013 report states, quote: “These summary findings also include selected results of cross-area comparisons of DEA NFLIS data on drug reports from drug items seized and identified in forensic laboratories in CEWG areas for 2011 and 2012; treatment admissions data for selected drugs reported as primary substance abuse problems for 2008–2012; and heroin price (per milligram pure) and percent purity from the DEA HDMP system for 2007 - 2011.” End quote.

Again, what we're looking at is more history than current events. Good laws require good data. Sadly, we're still lacking in both areas.

What is driving the use of these opiates? The federal National Academy of Sciences' Institute of Health published a book in 2011 titled “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research,” that can point us toward some answers.

For example, according to the Institute of Health, quote:

"Approximately 100 million American adults experience pain from common chronic conditions, and additional millions experience short-term acute pain (Chapter 2). Many people could have better outcomes if they received incrementally better care as part of the treatment of the chronic diseases that are causing their pain. A nationwide health system straining to contain costs will be hard pressed to address the problem, however, unless early savings can be clearly demonstrated through reduced health care utilization and disability and fewer dollars wasted on ineffective treatments. The high prevalence of pain suggests that it is not being adequately treated, and under-treatment generates enormous costs to the system and to the nation’s economy (see Chapter 2)."
End quote.

And further, quote:

"A number of barriers to effective pain care involve the attitudes and training of the providers of care. First, health professionals may hold negative attitudes toward people reporting pain and may regard pain as not worth their serious attention. As discussed in detail in Chapter 2, patients can be at a particular disadvantage if they are members of racial or ethnic minorities, female, children, or infirm elderly. They also may have less access to care if they are perceived as drug seeking or if they have, or are perceived to have, mental health problems. A literature review showed that people with pain, especially women, often have attitudes and goals that are different from, and sometimes opposed to, the attitudes and goals of their practitioners; patients seek to have their pain legitimized, while practitioners focus on diagnosis and therapy (Frantsve and Kerns, 2007). Consumers testified before the committee that patients often believe practitioners trivialize pain, which makes them feel even worse. Researchers working with patient focus groups have noted the 'perceived failures of providers to fully respect, trust, and accept the patient, to offer positive feedback and support, and to believe the participants’ reports of the severity and adverse effects of their pain' (Upshur et al., 2010, p. 1793)."

End quote.

A commentary on opiate misuse and various approaches to reduce harms was published last week in the New England Journal of Medicine. It was written by the directors of the National Institute on Drug Abuse (NIDA), the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Medicare and Medicaid Services (CMS). The commentary calls upon health care providers to expand their use of medications to treat opioid addiction and reduce overdose deaths, and describes a number of misperceptions that have limited access to these potentially life-saving medications. The commentary also discusses how medications can be used in combination with behavior therapies to help drug users recover and remain drug-free, and use of data-driven tracking to monitor program progress.

According to the commentary, quote:

“A number of barriers contribute to low access to and utilization of MATs, including a paucity of trained prescribers and negative attitudes and misunderstandings about addiction medications held by the public, providers, and patients. For decades, a common concern has been that MATs merely replace one addiction with another. Many treatment-facility managers and staff favor an abstinence model, and provider skepticism may contribute to low adoption of MATs. Systematic prescription of inadequate doses further reinforces the lack of faith in MATs, since the resulting return to opioid use perpetuates a belief in their ineffectiveness.

Policy and regulatory barriers are another concern. A recent report from the American Society of Addiction Medicine describing public and private insurance coverage for MATs highlights several policy-related obstacles that warrant closer scrutiny. These barriers include utilization-management techniques such as limits on dosages prescribed, annual or lifetime medication limits, initial authorization and reauthorization requirements, minimal counseling coverage, and ‘fail first’ criteria requiring that other therapies be attempted first. Although these policies may be intended to ensure that MAT is the best course of treatment, they may hinder access and appropriate care. For example, maintenance MAT has been shown to prevent relapse and death but is strongly discouraged by lifetime limits.

“In addition, although Medicaid covers buprenorphine and methadone in every state, some Medicaid programs or their managed-care organizations apply the utilization-management policies described above. Most commercial insurance plans also cover some opioid-addiction medications — most commonly buprenorphine — but coverage is generally limited by similar policies, and access to care may be limited to in-network providers. Few private insurance plans provide coverage for the depot injection formulation of naltrexone, and most do not cover methadone provided through opioid treatment programs.”

End quote.

Now, let's hear from US Attorney General Eric Holder on efforts to crack down on opiate misuse:

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ERIC HOLDER: When confronting the problem of substance abuse it makes sense to focus attention on the most dangerous types of drugs and right now fewer substances are more lethal than prescription opiates and heroin. Addiction to heroin and other opiates including certain prescription pain killers is impacting the lives of Americans in every state, in every region and from every background and walk of life and all too often with deadly results.

In 2006 and 2010 heroin overdose deaths increased by 45%. Scientific studies, federal, local and state investigations, addiction treatment providers reveal that the cycle of heroin use commonly begins with prescription opiate abuse. The transition to and increase in heroin abuse is a sad but not unpredictable symptom of the significant increase in prescription drug abuse that we’ve seen over the past decade.

Now it’s clear that opiate addiction is a urgent and growing public health crisis and that’s why Justice Department officials including the DEA and other key federal, state and local leaders are fighting back very aggressively. Confronting this crisis will require a combination of enforcement as well as treatment. The Justice Department is committed to both.

On the enforcement side we are doing more than ever to keep illicit drugs off the streets and to bring violent traffickers to justice. The DEA as our lead agency have adopted a strategy to attack all levels of the supply chain to prevent pharmaceutical controlled substances from getting into the hands of non-medial users. DEA proactively investigates the diversion of controlled substances at all levels of the supply chain. This includes practitioners that illegal dispense prescriptions, pharmacists that fill those prescriptions and distributors that send controlled substances downstream without due diligence efforts.

DEA also uses its regulatory authority to review and to investigate new pharmacy applications in targeted areas to identify and to prevent storefront traffickers from obtaining DEA registrations and they’re also going after “pill mills.” Since 2011 the DEA has opened more than 4,500 investigations related to heroin. They are on track to open many more. As a result of these aggressive enforcement efforts the amount of heroin seized along America’s southwest border has increased by more than 320% between 2008 and 2013.

Of course enforcement alone won’t solve the problem and that’s why we are enlisting a variety of partners including doctors, educators, community leaders and police officials to increase our support for education, prevention and treatment. The DEA engages in widespread education of pharmacists, doctors and other health practitioners in the identification and prevention of controlled substance diversion during the health care delivery process.

In the northern district of Ohio, for example, the US Attorney convened a summit at the Cleveland Clinic bringing together health and law enforcement officials to address that area’s 400% rise in heroin-related deaths. Nationwide the Justice Department is supporting more than 2,600 specialty courses that connect over 120,000 people convicted of drug-related offences with the services that they need to avoid future drug use and to rejoin their communities.

We can and we should be proud of these results but more can be done. Frequently the most effective are those that begin at home. Parents and families can help raise awareness about the devastating consequences of opiate abuse.

Americans like the Gates family of Skowhegan, Maine are showing the way. Their son was a bright, young student at the University of Vermont who overdosed on heroin and lost his life 5 years ago this month. During their grief Will’s parents and his brother have transformed their historic heartbreaking loss into a powerful force for change. Working with the US Attorney’s office in Vermont they created an award-winning documentary called, “The Opiate Affect” to educate people about the realities and the dangers of opiate abuse.

50,000 people have already watched this video for free online. I urge you to do the same because it is only by working together that we can confront this crisis, strengthen our communities and save lives.

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DOUG McVAY: I know I've said it before, yet it's true: We have a lot of work to do. This drug war isn't even close to finished.

Of course having said all that, we have made a lot of progress. The fear over a heroin epidemic is at least helping to drive the effort to make Naloxone more readily available. In fact, the FDA recently approved a home naloxone kit that may save countless lives. Substitution treatment such as methadone, as the commentary indicates, is still not as widely available as we need yet we are making some progress. Office-based treatment is even available now, though on a limited basis and only with buprenorphine. Research has been done to show the feasibility of office-based treatment using methadone, however that's still not a legal option in the US. The point is, we've made a good bit of progress.

When I started working in drug policy reform in the early 1980s, there were only two legal medical cannabis patients in the entire country. Now there are 21 states plus the District of Columbia which have effective medical cannabis laws, and tens, even hundreds of thousands of people now have safe legal access to medical cannabis. Two states have partially legalized adult social use of cannabis.

Sentencing reform is another area in which we've made great strides. Mandatory minimum sentences and the federal sentencing guidelines are still creating a nightmare problem of overcrowding in our federal prison system. The disparity in sentencing for offenses involving powder cocaine versus crack is not the only problem. Fortunately, even the Administration realizes this, as this message from US Attorney General Eric Holder from April 21, 2014, indicates:

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ERIC HOLDER: In 2010 President Obama signed The Fair Sentencing Act reducing unfair disparities on sentences imposed on people for offences involving different forms of cocaine but there are still too many people in federal prison who were sentenced under the old regime and who, as a result, will have to spend far more time in prison than they would if sentenced today for exactly the same crime. This is simply not right.

Legislation pending in congress would help address these types of cases but in the meantime President Obama took a sensible step towards addressing the situation by granting commutations last December to 8 men and women who had each served more than 15 years in prison for crack cocaine offences.

For 2 of these individuals it was the first conviction they had ever received yet due to mandatory-minimum guidelines that were considered severe at the time and are profoundly out of date today they and 4 others received life sentences. Now these stories illustrate the vital role that the clemency process can play in America’s justice system.

The Whitehouse has indicated it wants to consider additional clemency applications to restore a degree of justice, fairness and proportionality for deserving individuals who do not pose a threat to public safety. The Justice Department is committed to recommending as many qualified applicants as possible for reduced sentences.

Later this week the Deputy Attorney General will announce new criteria that the department will consider when recommending applications for the President’s review. This new and improved approach will make the criteria for clemency recommendation more expansive. This will allow the Department of Justice and the President to consider requests from a larger field of eligible individuals.

Once these reforms go into effect we expect to receive thousands of additional applications for clemency. We, at the Department of Justice, will meet this need by assigning potentially dozens of lawyers with backgrounds in both prosecution and defense to review applications and provide the rigorous scrutiny that all clemency applications require.

As a society we pay much too high a price whenever our system fails to deliver the just outcomes necessary to deter and punish crime – to keep us safe and to ensure that those who have paid their debts have a chance to become productive citizens. Our expanded clemency application process will aid in this effort and it will advance the aims of our innovative new Smart on Crime Initiative to strengthen criminal justice system, promote public safety and deliver on the promise of equal justice under law.

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DOUG McVAY: Organizations like the American Civil Liberties Union, Families Against Mandatory Minimums, and others are pushing hard to get Congress to line up with the Administration. They've even put together a PSA about it, here's the audio. You'll hear from Martin Sheen, Judge Jim Gray of California, Sheriff Grayson Robinson of Colorado, Superintendent Rick Van Wickler of New Hampshire, and Judge Robert Francis of Texas.

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MARTIN SHEEN: A basic principle of justice is that the punishment should fit the crime. Mandatory Minimums undermine that principle by forcing judges to ignore individual circumstances.

JIM GRAY: I’ve known of judges (federal, state) who are literally in tears because they know that this sentence is inappropriate but they have to follow the law and so they would apologize to people as they are sending them to prison for 10 years and know full well it really shouldn’t even be a prison sentence but that’s what the law requires.

No one, no one can in advance decide a reasonable sentence without knowing what the circumstances were. You can’t do that reasonably so you need to have judges with discretion to be able to make those decisions.

MARTIN SHEEN: The United States now has a higher percentage of its people behind bars than any country on earth.

GRAYSON ROBINSON: Just the number of that are incarcerated in the United States is appalling. It’s embarrassing that we would put that many people into an incarceration environment.

RICK VAN WICKLER: Some studies suggest that up to 40% of the people that are incarcerated in America are not a threat to public safety, they are not a threat of flight – why are they in jail?

ROBERT FRANCIS: In Texas we went from about an 8,400-bed prison system and built to 150,000. All we did was fill the 150,000 beds and the crime rate stayed the same. We weren’t making the society that we live in any better we were just simply jacking the taxpayers out of a whole lot more money.

MARTIN SHEEN: There have been successful reforms on the state level that we could implement nationwide.

ROBERT FRANCIS: The crime rate in Texas dropped 8.45%. The incarceration rate dropped 1.45%. The legislature was set to build 2 new prisons so they were expecting to add 17,000 people. We didn’t have those 17,000 people and then we lowered it enough that we closed the prison.

We spent 2 billion dollars – that’s ‘b’ as in big – 2 billion, not million, billion dollars which is huge in a state budget.

MARTIN SHEEN: It’s time for elected officials to focus on solutions like flexible sentencing guidelines. Our goal must be a justice system that avoids unnecessary incarceration and irresponsible spending.

Tell congress to pass the Smarter Sentencing Act.

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DOUG McVAY: So there’s hope.

There are some events coming up next month that will be of great interest to drug policy reformers. The report of the Expert Group on the Economics of Drug Policy, the most thorough independent economic analysis of the current international drug control strategy ever conducted, will be presented on May 7th at the London School of Economics. Speakers include: Mark Kleiman, professor of public policy in the UCLA School of Public Affairs; Kasia Malinowska-Sempruch; director of the Open Society Global Drug Policy Program; and Otto Perez Molina, the president of Guatemala. The event will be webcast live via YouTube, with luck I'll be able to record all or most of the audio, meanwhile here are some words from Mark Kleiman on drugs, violence, and criminal cartels:

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MARK KLEIMAN: Will Rogers once said that “It is not what you don’t know that hurts you. It what you know that ain’t so.”

Everybody knows that drug abuse and crime are sort of the same thing and, therefore, fighting the War on Drugs is a good way to reduce crime. Unfortunately that ain’t so and we need to distinguish sharply between policies to reduce drug abuse and the damage that it does to individuals and people around them and policies to reduce predatory crime which is roughly hurting people and taking their stuff.

And, yes, drug abuse has a connection with predatory crime but it’s not the same thing and a lot of the stuff that we do that is supposed to control drug abuse actually turns out to increase predatory crime. We could think about not doing that..

In particular, drug law enforcement has a natural tendency to increase the stakes in drug dealing – put more money on the table to put more time behind bars in prison and, therefore, to increase the value of violence to people engaged in the illicit drug trade so we should expect - other things equal – that ramping up drug law enforcement is going to increase revenue and increase violence. That’s what we see in Mexico.

Now that doesn’t have to be true. You can focus drug law enforcement in a way that reduces violence by in effect saying to market participants, “Your chances of being nailed for your drug activity goes up if you hurt people in the process.”

The main thing that we do to reduce drug abuse is make the drugs illegal. That makes them expensive and hard to get compared to any legal drug. We need to enforce those laws to keep them from being dead letters but enforcement probably can’t change drug abuse very much.

The job of enforcement is to limit the side effects that are created by prohibition. If you prohibit a drug that a lot of people want then we are going to have a big illicit market and we’re going to have crime, corruption and violence around that illicit market. I think of the job of drug law enforcement primarily as reducing those side effects so we shouldn’t measure drug enforcement in terms of whether we can make the drugs more expensive or harder to get or reduce the number of users. That’s not the law enforcement job. The law enforcement job is protecting people from aggression.

My work on crime control draws from two social scientific traditions. One is behavioral economics – how do you do appropriate nudge strategies that push people in the direction you want to push them, adjusting for the fact that they are not perfectly rational.

The other is gang theory. Even if people were perfectly rational in a situation where there are many people breaking the law then the risk faced by each one of them of being punished depends on how many other people are breaking the same law, how much enforcement we have and that’s what leads me to say concentrate.

A level of enforcement that is completely inadequate to control everybody can be more than adequate to control somebody and once somebody’s behavior comes under control then you can slowly expand the range of control never violating your sanctions capacity for strength. You have to make sure never to utter more threats than you can deliver on considering how many times that the threats will be ignored.

Once your threats are credible you can issue a lot of checks against the small amount of checks because the checks aren’t going to be cashed. Until your threats are credible you had better have a sanction for every threat that you issue.

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DOUG McVAY: Finally, our friends with the group patients out of time are holding their major conference May 8-10, when they bring their prestigious clinical cannabis conference series to Portland, Oregon.

The theme for The Eighth National Clinical Conference on Cannabis Therapeutics is: The Endocannabinoid System and Age-Related Illnesses. Presentations will focus on the emerging science of the endogenous cannabinoid system (ECS) and its effects on health as we age. This conference will promote understanding cannabis as beneficial not only as a medicine for the ill, but also as helpful in preventing many health problems, keeping systems in balance and protecting us from stressors.

The conference brings this information to Oregon at the perfect moment, with new dispensary laws, the average age of a patient being 58, and The Oregon Medical Marijuana Program (OMMP) being one of the most successful in the nation, with 15 years regulating cannabis for patients.

Preconference workshops take place on May 8th at Portland University Place Hotel, with separate tracks providing continuing education credits for doctors, for nurses, and, new this year, for lawyers. The main conference begins May 9th at the Hotel and continues May 10th at the National College of Natural Medicine (NCNM). Information and registration details are available through the Patients Out of Time website at medicalcannabis dot com. For those who can't make it to Portland yet are still interested in the conference, a simulcast is available. Contact Patients Out of Time through their website for more details.

That's it for this week. This has been Century of Lies. Thank you for listening. You can find a recording of this show and past shows at the website drug truth dot net, where you can also check out our other programs and subscribe to our podcasts. Follow me on Twitter, where I'm @ Drug Policy Facts. The Drug Truth Network is on Facebook, be sure to give its page a Like, you can find Drug War Facts on Facebook as well, please give it a like and share it with friends. Spread the word. Remember: Knowledge is power.

For the drug truth network, this is Doug McVay saying so long. So long!

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For the Drug Truth Network, this is Dean Becker asking you to examine our policy of Drug Prohibition.

The Century of Lies.

This show produced at Pacifica Studios at KPFT, Houston.

Transcript provided by: Jo-D Harrison of www.DrugSense.org