Search This Blog

Wednesday, July 4, 2018

Drug liberalization

From Wikipedia, the free encyclopedia
 
A coffeeshop in the Netherlands where cannabis is sold.

Drug liberalization is the process of eliminating or reducing drug prohibition laws. Variations of drug liberalization include: drug legalization, drug relegalization and drug decriminalization.[1] Whilst many people would argue that decriminalistion will only cause an increase in usage, studies from California and Colorado, two states who implemented the policy, found that '"decriminalization" of marijuana possession had little or no impact on rates of use.' (Winter, 1989). Drug liberalization may go hand in hand with or include measures to ensure responsible drug use and some state that its challenge is not in criticizing prohibition, but in designing something better.[2]

Arguments for liberalizing drugs

Some reasons given for liberalizing drugs include claims that:
  • war on drugs policies have resulted in a failure
  • the quality of the drugs can not be screened, resulting in fatalities due to added compounds
  • there is a huge loss of income from not taxing the drug trade.
  • adults have the right to live their lives without interference from the government
  • a reduction in crime will be the result of this drug liberalization.[3] Portugal implemented drug decriminalization and saw a reduction in problematic drug usage.
  • the prohibition in effect creates and funds drug cartels around the world.[4]

Policies

The 1988 United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances made it mandatory for the signatory countries to "adopt such measures as may be necessary to establish as criminal offences under its domestic law" (art. 3, § 1) all the activities related to the production, sale, transport, distribution, etc. of the substances included in the most restricted lists of the 1961 Single Convention on Narcotic Drugs and 1971 Convention on Psychotropic Substances. Criminalization also applies to the "cultivation of opium poppy, coca bush or cannabis plants for the purpose of the production of narcotic drugs". The Convention distinguishes between the intent to traffic and personal consumption, stating that the latter should also be considered a criminal offence, but "subject to the constitutional principles and the basic concepts of [the state’s] legal system" (art. 3, § 2).[5]

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defines decriminalization as the removal of a conduct or activity from the sphere of criminal law; depenalisation signifying merely a relaxation of the penal sanction exacted by law. Decriminalization usually applies to offences related to drug consumption and may include either the imposition of sanctions of a different kind (administrative) or the abolition of all sanctions; other (noncriminal) laws then regulate the conduct or activity that has been decriminalized. Depenalisation usually consists of personal consumption as well as small-scale trading and generally signifies the elimination or reduction of custodial penalties, while the conduct or activity still remains a criminal offence. The term legalization refers to the removal of all drug-related offences from criminal law: use, possession, cultivation, production, trading, etc.[5][6]

Drug liberalization proponents hold differing reasons to support liberalization, and have differing policy proposals. The two most common positions are drug legalization (or re-legalization), and drug decriminalization.

Drug legalization

Drug legalization calls for a return to the pre-20th century situation in which almost all drugs were legal. This would require ending government-enforced prohibition on the distribution or sale and personal use of specified (or all) currently banned drugs. Proposed ideas range from full legalization which would completely remove all forms of government control, to various forms of regulated legalization, where drugs would be legally available, but under a system of government control which might mean for instance:[7]
  • Mandated labels with dosage and medical warnings,
  • Restrictions on advertising,
  • Age limitations,
  • Restrictions on amount purchased at one time,
  • Requirements on the form in which certain drugs would be supplied,
  • Ban on sale to intoxicated persons,
  • Special user licenses to purchase particular drugs.
  • A possible clinical setting for the consumption of some intravenous drugs and/or supervised consumption.
The regulated legalization system would probably have a range of restrictions for different drugs, depending on their perceived risk, so while some drugs would be sold over the counter in pharmacies or other licensed establishments, drugs with greater risks of harm might only be available for sale on licensed premises where use could be monitored and emergency medical care made available. Examples of drugs with different levels of regulated distribution in most countries include: caffeine (coffee, tea), nicotine (tobacco),[8] and ethyl alcohol (beer, wine, spirits).

Full legalization is often proposed by groups such as libertarians who object to drug laws on moral grounds, while regulated legalization is suggested by groups such as Law Enforcement Against Prohibition who object to the drug laws on the grounds that they fail to achieve their stated aims and instead greatly worsen the problems associated with use of prohibited drugs, but who acknowledge that there are harms associated with currently prohibited drugs which need to be minimized. Not all proponents of drug re-legalization necessarily share a common ethical framework, and people may adopt this viewpoint for a variety of reasons. In particular, favoring drug legalization does not imply approval of drug use.[9][10][11]

Drug decriminalization

Drug decriminalization calls for reduced control and penalties compared to existing laws. Proponents of drug decriminalization generally support the use of fines or other punishments to replace prison terms, and often propose systems whereby illegal drug users who are caught would be fined, but would not receive a permanent criminal record as a result. A central feature of drug decriminalization is the concept of harm reduction.

Drug decriminalization is in some ways an intermediate between prohibition and legalization, and has been criticized as being "the worst of both worlds", in that drug sales would still be illegal, thus perpetuating the problems associated with leaving production and distribution of drugs to the criminal underworld, while also failing to discourage illegal drug use by removing the criminal penalties that might otherwise cause some people to choose not to use drugs. However, there are many that argue that the decriminalization of possession of drugs would redirect focus of the law enforcement system of any country to put more effort into arresting dealers and big time criminals, instead of arresting minor criminals for mere possession, and thus be more effective.

In 2001 Portugal began treating use and possession of small quantities of drugs as a public health issue (Ingraham, 2015). This means rather than incarcerating those in possession they are referred to a treatment program. The drugs are still illegal, the police just handle the situation differently. This also decreases the amount of money the government spends fighting a war on drugs and money spent keeping drug users incarcerated. “As noted by the EMCDDA, across Europe in the last decades, there has been a movement toward “an approach that distinguishes between the drug trafficker, who is viewed as a criminal, and the drug user, who is seen more as a sick person who is in need of treatment” (EMCDDA 2008, 22).6 A number of Latin American countries have similarly moved to reduce the penalties associated with drug use and personal possession” (Laqueur, 2015, p. 748).

Ingraham, C. (2015, June 05). Why hardly anyone dies from a drug overdose in Portugal. Retrieved from https://www.washingtonpost.com/news/wonk/wp/2015/06/05/why-hardly-anyone-dies-from-a-drug-overdose-in-portugal/?utm_term=.244920e59c91 Laqueur, H. (2015). Uses and Abuses of Drug Decriminalization in Portugal. Law & Social Inquiry, 40(3), 746-781.

Portugal is the first country that has decriminalized the possession of small amounts of drugs, to positive results.[12] Anyone caught with any type of drug in Portugal, if it is for personal consumption, will not be imprisoned.

Economics

There are numerous economic and social impacts of the criminalization of drugs. Prohibition increases crime (theft, violence, corruption) and drug price and increases potency.[13] In many developing countries the production of drugs offers a way to escape poverty. Milton Friedman estimated that over 10,000 deaths a year in the US are caused by the criminalization of drugs, and if drugs were to be made legal innocent victims such as those shot down in drive by shootings, would cease or decrease. The economic inefficiency and ineffectiveness of such government intervention in preventing drug trade has been fiercely criticised by drug-liberty advocates. The War on Drugs of the United States, that provoked legislation within several other Western governments, has also garnered criticism for these reasons.

Prices and consumption

Much of the debate surrounding the economics of drug legalization centers on the shape of the demand curve for illegal drugs and the sensitivity of consumers to changes in the prices of illegal drugs.[14] Proponents of drug legalization often assume that the quantity of addictive drugs consumed is unresponsive to changes in price; however, studies into addictive, but legal, substances like alcohol and cigarettes, have shown that consumption can be quite responsive to changes in prices.[15] In the same study, economists Michael Grossman and Frank J. Chaloupka estimated that a 10% reduction in the price of cocaine would lead to a 14% increase in the frequency of cocaine use.[15]:459 This increase indicates that consumers are responsive to price changes in the cocaine market. There is also evidence that in the long run, consumers are much more responsive to price changes than in the short run,[15]:454 but other studies have led to a wide range of conclusions.[16]:2043

Considering that legalization would likely lead to an increase in the supply of drugs, the standard economic model predicts that the quantity of drugs consumed would rise and the prices would fall.[15]:428 However, Andrew E. Clark, an economist who has studied the effects of drug legalization, suggests that a specific tax, or sin tax, would counteract the increase in consumption.[14]:3

Associated costs

Proponents of drug prohibition argue that many negative externalities, or third party costs, are associated with the consumption of illegal drugs.,[16]:2043[17]:183 Externalities like violence, environmental effects on neighborhoods, increased health risks and, increased healthcare costs are often associated with the illegal drug market.[14]:3 Opponents of prohibition argue that many of those externalities are created by current drug policies. They believe that much of the violence associated with drug trade is due to the illegal nature of drug trade, where there is no mediating authority to solve disputes peacefully and legally.[14]:3[17]:177 The illegal nature of the market also affects the health of consumers by making it difficult to acquire syringes, which often leads to needle sharing.[17]:180–181 Prominent economist Milton Friedman argues that prohibition of drugs creates many negative externalities like increased incarceration rates, the undertreatment of chronic pain, corruption, disproportional imprisonment of African Americans, compounding harm to users, the destruction of inner cities and harm to foreign countries.[18] Proponents of legalization also argue that prohibition decrease the quality of the drugs made, which often leads to more physical harm, like accidental overdoses and poisoning, to the drug users.[17]:179 Steven D. Levitt and Ilyana Kuziemko point to the over crowding of prisons as another negative side effect of the war on drugs. They believe that by sending such a large number of drug offenders to prison, the war on drugs has reduced the prison space available for other offenders. This increased incarceration rate not only costs tax payers more to maintain, it could possibly increase crime by crowding violent offenders out of prison cells and replacing them with drug offenders.[16]:2043

Direct costs

A Harvard economist, Jeffrey Miron, estimated that ending the war on drugs would inject 76.8 billion dollars into the US economy in 2010 alone.[19] He estimates that the government would save $41.3 billion for law enforcement and the government would gain up to $46.7 billion in tax revenue.[20]

Since the war on drugs began under the administration of President Richard Nixon, the federal drug-fighting budget has increased from $100 million in 1970 to $15.1 billion in 2010, with a total cost estimated near 1 trillion dollars over 40 years. In the same time period an estimated 37 million nonviolent drug offenders have been incarcerated. $121 billion was spent to arrest these offenders and $450 billion to incarcerate them.[21]

Size of the illegal drug market

According to 2013 data from the United Nations Office on Drugs and Crime (UNODC) and European crime-fighting agency Europol, the annual global drugs trade is worth around $435 billion a year, with the annual cocaine trade worth $84 billion of that amount.[22][23]

History

Prior to prohibition, cannabis was available freely in a variety of forms

The cultivation, use and trade of psychoactive and other drugs has occurred since the dawn of civilization. In the 20th century, the United States government led a major renewed surge in drug prohibition called the "War on Drugs." It was only in the 20th Century that Britain and the United States outlawed cannabis. The British had gone to war with China in the 19th Century in what became known as the First and Second Opium Wars to protect their valuable trade in narcotics.

Motivations claimed by supporters of drug prohibition laws across various societies and eras have included religious observance, allegations of violence by racial minorities, and public health concerns. Those who are not proponents of anti-drug legislation characterize these motivations as religious intolerance, racism, and public healthism.

Various proponents of drug liberalization wish to repeal these laws for reasons ranging from individual rights-based defenses of liberty, to consequentialist arguments against the economic and social outcomes of drug prohibition. Starting in the 20th century, large organized movements to overturn existing drug laws formed around the world. The most vocal of these groups exist in liberal democracies, and typically attract liberal and libertarian supporters, although drug liberalization itself is a non-partisan issue and may be supported by adherents of any ideology.

The campaign against alcohol prohibition culminated in the Twenty-first Amendment to the United States Constitution repealing prohibition on 5 December 1933, as well as liberalization in Canada, and some but not all of the other countries that enforced prohibition. However, many laws controlling the use of alcohol continue to exist even in these countries.

Current proponents of drug liberalization seek the repeal or softening of drug prohibition laws, most commonly cannabis but also including other controlled substances such as alcohol, tobacco, opiates, stimulants, psychedelics, dissociatives, prescription drugs, and others.

Around the world

Europe

Czech Republic

In the Czech Republic, until 31 December 1998 only drug possession "for other person" (i.e. intent to sell) was criminal (apart from production, importation, exportation, offering or mediation, which was and remains criminal) while possession for personal use remained legal.[24]

On 1 January 1999, an amendment of the Criminal Code, which was necessitated in order to align the Czech drug rules with the Single Convention on Narcotic Drugs, became effective, criminalizing possession of "amount larger than small" also for personal use (Art. 187a of the Criminal Code) while possession of small amounts for personal use became a misdemeanor.[24]

The judicial practice came to the conclusion that the "amount larger than small" must be five to ten times larger (depending on drug) than a usual single dose of an average consumer.[25]

On 14 December 2009, the Government of the Czech Republic adopted Regulation No. 467/2009 Coll., that took effect on 1 January 2010, and specified what "amount larger than small" under the Criminal Code meant, effectively taking over the amounts that were already established by the previous judicial practice. According to the regulation, a person could possess up to 15 grams of marijuana or 1.5 grams of heroin without facing criminal charges. These amounts were higher (often many times) than in any other European country, possibly making the Czech Republic the most liberal country in the European Union when it comes to drug liberalization, apart from Portugal.[26] Czech Republic has also the highest prevalence of last years cannabis use among young adults (15-34) (18.5% in 2012) among the 30 counties reporting to the EMCDDA.[27]

Under the Regulation No. 467/2009 Coll, possession of the following amounts or less of illicit drugs was to be considered smaller than large for the purposes of the Criminal Code and was to be treated as a misdemeanor subject to a fine equal to a parking ticket:[28]
In 2013, a District Court in Liberec was deciding a case of a person that was accused of criminal possession for having 3.25 grams of methamphetamine (1.9 grams of straight methamphetamine base), well over the Regulation's limit of 2 grams. The court considered that basing a decision on mere Regulation would be unconstitutional and in breach of Article 39 of the Czech Charter of Fundamental Rights and Freedoms which states that "only a law may designate which acts constitute a crime and what penalties, or other detriments to rights or property, may be imposed for committing them" and proposed to the Constitutional Court to abolish the Regulation. In line with the District Courts' argument, the Constitutional Court abolished the Regulation effective from 23 August 2013, noting that the "amount larger than small" within the meaning of the Criminal Code may be designated only by the means of an Act of Parliament, and not a Governmental Regulation. Moreover, the Constitutional Court further noted that the Regulation merely took over already existing judicial practice of interpretation of what constitutes "amount larger than small" and thus its abolishment will not really change the criminality of drug possession in the country.[29] Thus, the above-mentioned amounts from the now-not-effective Regulation remain as the base for consideration of police and prosecutors, while courts are not bound by the precise grammage.

Sale of any amount (not purchase) remains a criminal act. Possession of "amount larger than a small" of marijuana can result in a jail sentence of up to one year. For other illicit drugs, the sentence is up to two years. Trafficking as well as production (apart from growing up to five plants of marijuana) offenses carry stiffer sentences.[30]

Medical use of cannabis on prescription has been legal and regulated since 1 April 2013.[31][32]

France

Following a contentious debate France opened its first supervised injection centre on 11 October 2016. Marisol Touraine, the Minister of Health, declared that the centre was "a strong political response, for a pragmatic and responsible policy that brings high-risk people back towards the health system rather than stigmatizing them."[33] The centre is located near the Gare du Nord.

Germany

In 1994 the Federal Constitutional Court ruled that drug addiction was not a crime, nor was the possession of small amounts of drugs for personal use. In 2000 the German narcotic law ("BtmG") was changed to allow for supervised drug injection rooms. In 2002, a pilot study was started in seven German cities to evaluate the effects of heroin-assisted treatment on addicts, compared to methadone-assisted treatment. The positive results of the study led to the inclusion of heroin-assisted treatment into the services of the mandatory health insurance in 2009. On 4 May 2016 the Cabinet of Germany decided to approve the measure for legal cannabis for seriously ill patients who have consulted with a doctor and "have no therapeutic alternative". German Health Minister, Hermann Gröhe, presented the legal draft on the legalization of medical cannabis to the cabinet which is expected to take effect early 2017.

Ireland

On 2 November 2015, Aodhán Ó Ríordáin, the minister in charge of the National Drugs Strategy, announced that Ireland planned to introduce supervised injection rooms.The minister also referenced that possession of controlled substances will be decriminalized although supply and production will remain criminalized.[39] On July 12, 2017, the Health Committee of the Irish government rejected a bill that would have legalized medical cannabis.[40]

Netherlands

A Dutch coffeeshop

The drug policy of the Netherlands is based on 2 principles:
  1. Drug use is a public health issue, not a criminal matter
  2. A distinction between hard drugs and soft drugs exists
Cannabis remains a controlled substance in the Netherlands and both possession and production for personal use are still misdemeanors, punishable by fine. Cannabis coffee shops are also illegal according to the statutes.[41]

However, a policy of non-enforcement has led to a situation where reliance upon non-enforcement has become common, and because of this the courts have ruled against the government when individual cases were prosecuted.

Norway

On 14 June 2010, the Stoltenberg commission recommended implementing heroin assisted treatment and expanding harm reduction measures.[42] On 18 June 2010, Knut Storberget, Minister of Justice and the Police announced that the ministry was working on new drug policy involving decriminalization by the Portugal model, which was to be introduced to parliament before the next general election.[43] Later, however, Storberget changed his statements, saying the decriminalization debate is "for academics", instead calling for coerced treatment.[44] In early March 2013, minister of health and care services Jonas Gahr Støre proposed to decriminalize the inhalation of heroin by 2014 as a measure to decrease drug overdoses.[45] In 2011 there were 294 fatal overdoses, in comparison only 170 traffic related deaths.[45]

Portugal

In 2001, Portugal became the first European country to abolish all criminal penalties for personal drug possession, under Law 30/2000.[46] In addition, drug users were to be provided with therapy rather than prison sentences. Research commissioned by the Cato Institute and led by Glenn Greenwald found that in the five years after the start of decriminalisation, illegal drug use by teenagers had declined, the rate of HIV infections among drug users had dropped, deaths related to heroin and similar drugs had been cut by more than half, and the number of people seeking treatment for drug addiction had doubled.[47] However, Peter Reuter, a professor of criminology and public policy at the University of Maryland, College Park, suggests that the heroin usage rates and related deaths may have been due to the cyclical nature of drug epidemics, but conceded that "decriminalization in Portugal has met its central goal. Drug use did not rise."[48]

Latin America

In the late 2000s and early 2010s, advocacy for drug legalization has increased in Latin America. Spearheading the movement Uruguayan government announced in 2012 plans to legalize state-controlled sales of marijuana in order to fight drug-related crimes. Some countries in this region have already advanced towards depenalization of personal consumption.

Argentina

In August 2009, the Argentine supreme court declared in a landmark ruling that it was unconstitutional to prosecute citizens for having drugs for their personal use - "adults should be free to make lifestyle decisions without the intervention of the state".[49] The decision affected the second paragraph of Article 14 of the country’s drug control legislation (Law Number 23,737) that punishes the possession of drugs for personal consumption with prison sentences ranging from one month to two years (although education or treatment measures can be substitute penalties). The unconstitutionality of the article concerns cases of drug possession for personal consumption that does not affect others.[50][51]

Brazil

In 2002 and 2006, Brazil went through legislative changes, resulting in a partial decriminalization of possession for personal use. Prison sentences no longer applied and were replaced by educational measures and community services.[52] However, the 2006 law does not provide objective means to distinguish between users or traffickers. A disparity exists between the decriminalization of drug use and the increased penalization of selling drugs, punishable with a maximum prison sentences of 5 years for the sale of very minor quantities of drugs. Most of those incarcerated for drug trafficking are offenders caught selling small quantities of drugs, among them drug users who sell drugs to finance their drug habits. Since 2006, there's been a long debate whether the anti-drug law goes against the Constitution and principle of personal freedom. In 2009,[53] the Supreme Federal Court re-opened to vote if the law is Constitutional, or if it goes against the Constitution specifically against personal Freedom of choice. Since each Minister inside the tribunal can take a personal time to evaluate the law, the voting can take years. In fact, the voting was re-opened in 2015, 3 ministers voted in favor, and then the law was again paused by another minister.[54]

Colombia

Guatemalan President Otto Pérez Molina and Colombian President Juan Manuel Santos proposed the legalisation of drugs in an effort to counter the failure of the War on Drugs, which was said to have yielded poor results at a huge cost.[55] On 25 May 2016, the congress approved the legalization of marijuana for medical usage.[56]

Costa Rica

Costa Rica has decriminalized drugs for personal consumption. Manufacturing or selling drugs is still a jailable offense.

Ecuador

According to the 2008 Constitution of Ecuador, in its Article 364, the Ecuadorian state does not see drug consumption as a crime but only as a health concern.[57] Since June 2013 the State drugs regulatory office CONSEP has published a table which establishes maximum quantities carried by persons so as to be considered in legal possession and that person as not a seller of drugs. The "CONSEP established, at their latest general meeting, that the following quantities be considered the maximum consumer amounts: 10 grams of marijuana or hash, 4 grams of opiates, 100 milligrams of heroin, 5 grams of cocaine, 0.020 milligrams of LSD, and 80 milligrams of methamphetamine or MDMA".[60]

Honduras

On 22 February 2008, Honduras President Manuel Zelaya, called on the United States to legalize drugs, in order, he said, to prevent the majority of violent murders occurring in Honduras. Honduras is used by cocaine smugglers as a transiting point between Colombia and the US. Honduras, with a population of 7 million suffers an average of 8–10 murders a day, with an estimated 70% being as a result of this international drug trade. The same problem is occurring in Guatemala, El Salvador, Costa Rica and Mexico, according to Zelaya.[61]

Mexico

In April 2009, the Mexican Congress approved changes in the General Health Law that decriminalized the possession of illegal drugs for immediate consumption and personal use allowing a person to possess up to 5 g of marijuana or 500 mg of cocaine. The only restriction is that people in possession of drugs should not be within a 300 meter radius of schools, police departments, or correctional facilities. Opium, heroin, LSD, and other synthetic drugs were also decriminalized, it will not be considered as a crime as long as the dose does not exceed the limit established in the General Health Law.[62] Many question this, as cocaine is as much synthesised as heroin, both are produced as extracts from plants. The law establishes very low amount thresholds and strictly defines personal dosage. For those arrested with more than the threshold allowed by the law this can result in heavy prison sentences, as they will be assumed to be small traffickers even if there are no other indications that the amount was meant for selling.[63]

Uruguay

Uruguay is one of few countries that never criminalized the possession of drugs for personal use. Since 1974, the law establishes no quantity limits, leaving it to the judge’s discretion to determine whether the intent was personal use. Once it is determined by the judge that the amount in possession was meant for personal use, there are no sanctions.[64]
In June 2012, the Uruguayan government announced plans to legalize state-controlled sales of marijuana in order to fight drug-related crimes. The government also stated that they will ask global leaders to do the same.[65]

On 31 July 2013, the Uruguayan House of Representatives approved a bill to legalize the production, distribution, sale, and consumption of marijuana by a vote of 50 to 46. The bill then passed the Senate, where the left-leaning majority coalition, the Broad Front, holds a comfortable majority, the bill was approved by the Senate by 16 to 13 on 10-December-2013.[66] The bill was presented to the President José Mujica, also of the Broad Front coalition, who has supported legalization since June 2012. Relating this vote to the 2012 legalization of marijuana by the U.S. states Colorado and Washington, John Walsh, drug policy expert of the Washington Office on Latin America, stated that "Uruguay's timing is right. Because of last year’s Colorado and Washington State votes to legalize, the U.S. government is in no position to browbeat Uruguay or others who may follow."[67]

In July 2014, government officials announced that part of the implementation of the law (the sale of cannabis through pharmacies) is postponed to 2015, as "there are practical difficulties". Authorities will grow all the cannabis that can be sold legal. Concentration of THC shall be 15% or lower.[68] In August 2014 an opposition presidential candidate, who was not elected in the November 2014 presidential elections, claimed that the new law was never going to be applied, as it was not workable.[69] By the end of 2016 the government announced that the sale through pharmacies will be fully implemented during 2017.[70]

North America

Canada

A cannabis shop in Montreal

The cultivation of cannabis is currently illegal in Canada, with exceptions only for medical usage or when the THC concentration is low enough to be considered industrial hemp. However, the use of cannabis by the general public is tolerated to a certain degree and varies depending on location and jurisdiction,[71] and a vigorous campaign to legalize cannabis is underway nationwide. The sale of marijuana seeds remains legal.

In 2001, the Globe and Mail reported that a poll found 47% of Canadians agreed with the statement, "The use of marijuana should be legalized" in 2000, compared to 26% in 1975.[72] A more recent poll found that more than half of Canadians supported legalization. However, in 2007 Prime Minister Stephen Harper's government tabled Bill C-26 to amend the Controlled Drugs and Substances Act, 1996 to bring forth a more restrictive law with higher minimum penalties for drug crimes.[73][74] Bill-26 died in committee after the dissolution of the 39th Canadian Parliament in September 2008, but the Bill had subsequently been resurrected by the government twice. In 2016, the Liberal Party of Canada campaigned on a promise to legalize marijuana and has since passed legislation to make marijuana legal across Canada on 17 October 2018.[75][76][77]

United States

Throughout the United States, various people and groups have been pushing for the legalization of marijuana for medical reasons. Organizations such as NORML and the Marijuana Policy Project work to decriminalize possession, use, cultivation, and sale of marijuana by adults, even beyond medical uses.[78] In 1996, 56% of California voters voted for California Proposition 215, legalizing the growing and use of marijuana for medical purposes. This created significant legal and policy tensions between federal and state governments. Since then, 20 more states and the District of Columbia have legalized and regulated medical marijuana. State laws in conflict with federal law about cannabis remain valid, and prevent state level prosecution, despite cannabis being illegal under federal law (see Gonzales v. Raich).
On 6 November 2012, Colorado and Washington state legalized possession of small amounts of marijuana for private recreational use, and created a process for writing rules for legal growing and commercial distribution of marijuana within each state.[79]

The 2014 Midterms saw voters in Oregon, Alaska, and Washington, D.C. vote to legalize marijuana for recreational use.

In 2016, California Proposition 64 was passed, legalizing private, recreational use of marijuana for those age 21 or older in the state of California.[80]

Oceania

Australia

Australia has one of the highest percentages of marijuana smokers in the world.[81] In 1993, HEMP (Help End Marijuana Prohibition) was established and continued the fight for law reform. In 2010, HEMP qualified as a political party and will be fielding candidates in elections where possible.

In 2011, the Cannabis Campaign seemed to experience a renaissance in Australia, no doubt due to developments worldwide, with many new groups appearing in different states, using social media as a conduit and forum. Since 1985, the Federal Government has run a declared "War on Drugs" and while initially Australia led the world in 'harm-minimisation' approach, they have since lagged. In 2012, the think tank Australia 21, released a report on the decriminalization of drugs in Australia.[82]

'Harm-minimisation' approaches towards MDMA and ecstasy have also met opposition. A trial of drug checking at the popular Spilt Milk festival was cancelled in October 2017. While organisers have blamed this on a lack of documentation sources allege that political pressure caused the cancellation.[83] Proponents argue that pill testing is an important service considering Australia having the highest per capita use of ecstasy globally as well as some of the most adulterated pills.[84]

In October 2016, Australia legislated for some medicinal use cannabis.[85]

Political parties

Many political parties support, to various degrees, and for various reasons, liberalising drug control laws, from liberal parties to far-left movements, as well as some pragmatic right-wing intellectuals. Drug liberalization is fundamental in the platforms of most libertarian parties.
In the UK in March 2016, the Liberal Democrats became the first major political party in the country to support the legalisation of cannabis.

There are also numerous single issue marijuana parties devoted to campaign for the legalisation of cannabis exclusively.
at

Allegations of CIA drug trafficking

From Wikipedia, the free encyclopedia

Central Intelligence Agency

The United States Central Intelligence Agency (CIA) has been accused of involvement in drug trafficking. Books and investigations on the subject that have received general notice include works by historian Alfred McCoy; professor and diplomat Peter Dale Scott; and journalists Gary Webb, and Alexander Cockburn, as well as by writer Larry Collins. These claims have led to investigations by the United States government, including hearings and reports by the United States House of Representatives, Senate, Department of Justice, and the CIA's Office of the Inspector General. The subject remains controversial.

Following is a summary of some of the main claims made by geographical area.

Golden Triangle

During the Korean War, the first allegations of CIA drug trafficking surfaced after 1949, stemming from a deal whereby arms were supplied to Chiang Kai-shek's defeated generals in exchange for intelligence.[1] Later in the same region, while the CIA was sponsoring a "Secret War" in Laos from 1961 to 1975, it was openly accused of trafficking heroin in the area then known as the Golden Triangle.

Background

To fight its "Secret War" against the Pathet Lao communist movement of Laos, the CIA used the Miao/Meo (Hmong) population. Because of the war, the Hmong depended upon opium poppy cultivation for hard currency. The Hmong were very important to CIA operations and the CIA was very concerned with their well-being. The Plain of Jars had been captured by Pathet Lao fighters in 1964, which resulted in the Royal Lao Air Force being unable to land its C-47 transport aircraft on the Plain of Jars for opium transport. The Royal Laotian Air Force had almost no light planes that could land on the dirt runways near the mountaintop poppy fields. Having no way to transport their opium, the Hmong were faced with economic ruin. The CIA front Air America was, therefore, the only airline available in northern Laos. "According to several unproven sources, Air America began flying opium from mountain villages north and east of the Plain of Jars to CIA asset Hmong General Vang Pao's headquarters at Long Tieng."[2]

Detailed documentations

Larry Collins´ sources alleged that, "During the Vietnam War, US operations in Laos were largely a CIA responsibility. The CIA's surrogate there was a Laotian general, Vang Pao, who commanded Military Region 2 in northern Laos. He enlisted 30,000 Hmong tribesmen in the service of the CIA. These tribesmen continued to grow, as they had for generations, the opium poppy. Before long, someone--there were unproven allegations that it was a Mafia family from Florida--had established a heroin drug refinery lab in Region Two. The lab's production was soon being ferried out on the planes of the CIA's front airline, Air America. A pair of BNDD [the predecessor of the US Drug Enforcement Agency] agents tried to seize an Air America."[1]

Further documentation of CIA-connected Laotian opium trade was provided by Rolling Stone magazine in 1968, and by Alfred W. McCoy in 1972.[3] [4]

The CIA's front company, Air America was alleged to have profited from transporting opium and heroin on behalf of Hmong leader Vang Pao,[5] [6] [7] or of "turning a blind eye" to the Laotian military doing it.[8] [9] This allegation has been supported also by former Laos CIA paramilitary Anthony Poshepny (aka Tony Poe), former Air America pilots, and other people involved in the war. It is portrayed in the movie Air America. However, historian William M. Leary, writing on behalf of Air America, claimed that the opium transportation was done without the airline employees' direct knowledge and that the airline did not trade in drugs.[10] Curtis Peebles denies the allegation of Air America's direct knowledge of the opium transportation, citing Leary's study as evidence.[11]

Historian Alfred W. McCoy stated that:
In most cases, the CIA's role involved various forms of complicity, tolerance or studied ignorance about the trade, not any direct culpability in the actual trafficking ... [t]he CIA did not handle heroin, but it did provide its drug lord allies with transport, arms, and political protection. In sum, the CIA's role in the Southeast Asian heroin trade involved indirect complicity rather than direct culpability.[12]

CIA response

The CIA made its own internal inquiries of its staff and clients in Laos concerning the drug trade, but never denied the essential allegation. Rather, the CIA took the position that trading in opium was legal in Laos until 1971. The CIA explained that opium served the isolated Lao hill tribes as their sole cash crop and that opium was one of the few medicines available in the primitive living circumstances.[13]

The CIA had its own internal security agents investigating possible commercial opium exports mid-1968 onward. Air America, the CIA´s airline was barred from CIA airfields on suspicion of drug smuggling. One Hmong guerrilla commanding officer was pressured into giving up dealing in opium. The CIA concluded that small amounts of opium might have been smuggled via Air America, given wartime conditions. The Agency's case officers even staged a couple of impromptu raids on drug refineries, but were reined in by the CIA Office of General Counsel.[13]

United States

Mena, Arkansas

A number of allegations have been written about and several local, state, and federal investigations have taken place related to the alleged use of the Mena Intermountain Municipal Airport as a CIA drop point in large scale cocaine trafficking beginning in the early 1980s.[14] Some conspiracy theories regarding the airport extend to alleging the involvement of figures such as Oliver North and former presidents George H. W. Bush and Bill Clinton.[15]

The CIA's self-investigation, overseen by the CIA's inspector general, concluded that the CIA had no involvement in or knowledge of any illegal activities that may have occurred in Mena. The report said that the agency had conducted a training exercise at the airport in partnership with another Federal agency and that companies located at the airport had performed "routine aviation-related services on equipment owned by the CIA".[16]

A film about these events called American Made focusing on the notorious pilot and Medellin cartel drug smuggler Barry Seal, portrayed by Tom Cruise, was released on September 29, 2017.[17]

Mexico

In October 2013, two former federal agents and an ex-CIA contractor told an American television network that CIA operatives were involved in the kidnapping and murder of DEA covert agent Enrique Camarena, because he was a threat to the agency's drug operations in Mexico. According to the three men, the CIA was collaborating with drug traffickers moving cocaine and marijuana to the United States, and using its share of the profits to finance Nicaraguan Contra rebels attempting to overthrow Nicaragua's Sandinista government. A CIA spokesman responded, calling it "ridiculous" to suggest that the Agency had anything to do with the murder of a US federal agent or the escape of his alleged killer.[18]

Honduras

The Honduran drug lord Juan Matta-Ballesteros was the owner of SETCO, an airline which the Nicaraguan Contras used to covertly transport military supplies and personnel in the early 1980s.[19] Writers such as Peter Dale Scott and Jonathan Marshall have suggested that the U.S. government's desire to conceal or protect these clandestine shipments led it to close the DEA office in Honduras when an investigation began into SETCO, allowing Matta-Ballesteros to continue and expand his trafficking.[20]

Nicaragua

In 1986, the United States Senate Committee on Foreign Relations began investigating drug trafficking from Central and South America and the Caribbean to the United States. The investigation was conducted by the Sub-Committee on Terrorism, Narcotics, and International Operations, chaired by Senator John Kerry, so its final 1989 report was known as the Kerry Committee report. The Report concluded that "it is clear that individuals who provided support for the Contras were involved in drug trafficking, the supply network of the Contras was used by drug trafficking organizations, and elements of the Contras themselves knowingly received financial and material assistance from drug traffickers."[21]

In 1996 Gary Webb wrote a series of articles published in the San Jose Mercury News, which investigated Nicaraguans linked to the CIA-backed Contras who had smuggled cocaine into the U.S. which was then distributed as crack cocaine into Los Angeles and funneled profits to the Contras. His articles asserted that the CIA was aware of the cocaine transactions and the large shipments of drugs into the U.S. by the Contra personnel and directly aided drug dealers to raise money for the Contras. The Los Angeles Times, The New York Times, and The Washington Post launched their own investigations and rejected Webb's allegations.[22] In May 1997, The Mercury News executive editor Jerry Ceppos, who had approved the series, published a column that acknowledged shortcomings in the series reporting, editing, and production, while maintaining the story was correct "on many important points."[22] Webb later published a book based on the series, Dark Alliance: The CIA, the Contras, and the Crack Cocaine Explosion.[23]

A 2014 movie depicted actor Jeremy Renner as Gary Webb. The movie about these events was called Kill the Messenger.[24]

Panama


The U.S. military invasion of Panama after which dictator Manuel Noriega was captured.

In 1989, the United States invaded Panama as part of Operation Just Cause, which involved 25,000 American troops. General Manuel Noriega, head of government of Panama, had been giving military assistance to Contra groups in Nicaragua at the request of the U.S.—which, in exchange, allowed him to continue his drug-trafficking activities—which they had known about since the 1960s.[25][26] When the DEA tried to indict Noriega in 1971, the CIA prevented them from doing so.[25] The CIA, which was then directed by future president George H. W. Bush, provided Noriega with hundreds of thousands of dollars per year as payment for his work in Latin America.[25] However, when CIA pilot Eugene Hasenfus was shot down over Nicaragua by the Sandinistas, documents aboard the plane revealed many of the CIA's activities in Latin America, and the CIA's connections with Noriega became a public relations "liability" for the U.S. government, which finally allowed the DEA to indict him for drug trafficking, after decades of allowing his drug operations to proceed unchecked.[25] Operation Just Cause, whose ostensible purpose was to capture Noriega, pushed the former Panamanian leader into the Papal Nuncio where he surrendered to U.S. authorities. His trial took place in Miami, where he was sentenced to 45 years in prison.[25]

Noriega's prison sentence was reduced from 30 years to 17 years for good behavior.[27] After serving 17 years in detention and imprisonment, his prison sentence ended on September 9, 2007.[28] He was held in U.S. custody before being extradited to France where he was sentenced to 7 years for laundering money from Colombian drug cartels.[29]

Venezuela

A failed CIA anti-drug operation in Venezuela resulted in at least a ton of cocaine being smuggled into the United States and sold on the streets. The incident, which was first made public in 1993, was part of a plan to assist an undercover agent to gain the confidence of a Colombian drug cartel. The plan involved the unsupervised shipment of hundreds of pounds of cocaine from Venezuela. The drug in the shipments was provided by the Venezuelan anti-drug unit which was working with the CIA, using cocaine seized in Venezuela. The shipments took place despite the objections of the U.S. DEA. When the failed plan came to light, the CIA officer in charge of the operation resigned, and his supervisor was transferred.[30]

In addition, the former Venezuelan anti-narcotics chief General Ramon Guillen Davila and his chief civilian aide were both indicted in connection with the shipments.[31] Because Venezuela does not extradite its citizens, Guillen was not tried in the U.S., but his civilian aide was arrested while in the United States and sentenced to 20 years.[32]
at

Heroin

From Wikipedia, the free encyclopedia

Heroin
INN: Diamorphine[1]
Heroin - Heroine.svg
Heroin-from-xtal-horizontal-3D-balls.png
Clinical data
Pronunciation Heroin: /ˈhɛroʊɪn/
Synonyms Diacetylmorphine, acetomorphine, (dual) acetylated morphine, morphine diacetate
AHFS/Drugs.com heroin
Dependence
liability		 Physical: Very high
Psychological: Very high
Addiction
liability		 High[2]
Routes of
administration		 Intravenous, inhalation, transmucosal, by mouth, intranasal, rectal, intramuscular, subcutaneous, intrathecal
Drug class Opioid
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability <35 44="" by="" class="reference" id="cite_ref-pmid16433897_3-0" inhaled="" mouth="" sup="">[3]
Protein binding 0% (morphine metabolite 35%) Metabolism liver Onset of action Within minutes[4] Elimination half-life 2–3 minutes[5] Duration of action 4 to 5 hours[6] Excretion 90% kidney as glucuronides, rest biliary Identifiers CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
ChEBI
ChEMBL
ECHA InfoCard 100.008.380 Edit this at Wikidata Chemical and physical data Formula C21H23NO5 Molar mass 369.41 g/mol
Heroin, also known as diamorphine among other names,[1] is an opioid most commonly used as a recreational drug for its euphoric effects.[2] Medically it is used in several countries to relieve pain or in opioid replacement therapy.[7][8][9] Heroin is typically injected, usually into a vein; however, it can also be smoked, snorted or inhaled.[2][10][11] The onset of effects is usually rapid and lasts for a few hours.

Common side effects include respiratory depression (decreased breathing), dry mouth, and addiction.[10] Other side effects can include abscesses, infected heart valves, blood borne infections, constipation, and pneumonia.[10] After a history of long-term use, withdrawal symptoms can begin within hours of last use.[10] When given by injection into a vein, heroin has two to three times the effect as a similar dose of morphine.[2] It typically comes as a white or brown powder.[10]

Treatment of heroin addiction often includes behavioral therapy and medications.[10] Medications can include buprenorphine, methadone, or naltrexone.[10] A heroin overdose may be treated with naloxone.[10] An estimated 17 million people as of 2015 use opiates such as heroin,[12] which together with opioids resulted in 122,000 deaths.[13] The total number of opiate users has increased from 1998 to 2007 after which it has remained more or less stable.[12] In the United States about 1.6 percent of people have used heroin at some point in time.[10] When people die from overdosing on a drug, the drug is usually an opioid.[12]

Heroin was first made by C. R. Alder Wright in 1874 from morphine, a natural product of the opium poppy.[14] Internationally, heroin is controlled under Schedules I and IV of the Single Convention on Narcotic Drugs.[15] It is generally illegal to make, possess, or sell heroin without a license.[16] In 2015 Afghanistan produced about 66% of the world's opium.[12] Heroin, which is illegally sold, is sometimes mixed with other substances such as sugar, starch, quinine, or strychnine.[2]

Uses

Long-term effects of intravenous usage, including – and indeed primarily because of – the effects of the contaminants common in illegal heroin and contaminated needles.[17]
Short-term effects of usage[17]

Recreational

The original trade name of heroin is typically used in non-medical settings. It is used as a recreational drug for the euphoria it induces. Anthropologist Michael Agar once described heroin as "the perfect whatever drug."[18] Tolerance develops quickly, and increased doses are needed in order to achieve the same effects. Its popularity with recreational drug users, compared to morphine, reportedly stems from its perceived different effects.[19] In particular, users report an intense rush, an acute transcendent state of euphoria, which occurs while diamorphine is being metabolized into 6-monoacetylmorphine (6-MAM) and morphine in the brain. Some believe that heroin produces more euphoria than other opioids; one possible explanation is the presence of 6-monoacetylmorphine, a metabolite unique to heroin – although a more likely explanation is the rapidity of onset. While other opioids of recreational use produce only morphine, heroin also leaves 6-MAM, also a psycho-active metabolite. However, this perception is not supported by the results of clinical studies comparing the physiological and subjective effects of injected heroin and morphine in individuals formerly addicted to opioids; these subjects showed no preference for one drug over the other. Equipotent injected doses had comparable action courses, with no difference in subjects' self-rated feelings of euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness.[20]

Short-term addiction studies by the same researchers demonstrated that tolerance developed at a similar rate to both heroin and morphine. When compared to the opioids hydromorphone, fentanyl, oxycodone, and pethidine (meperidine), former addicts showed a strong preference for heroin and morphine, suggesting that heroin and morphine are particularly susceptible to abuse and addiction. Morphine and heroin were also much more likely to produce euphoria and other positive subjective effects when compared to these other opioids.

Some researchers have attempted to explain heroin use and the culture that surrounds it through the use of sociological theories. In Righteous Dopefiend, Philippe Bourgois and Jeff Schonberg use anomie theory to explain why people begin using heroin. By analyzing a community in San Francisco, they demonstrated that heroin use was caused in part by internal and external factors such as violent homes and parental neglect. This lack of emotional, social, and financial support causes strain and influences individuals to engage in deviant acts, including heroin usage.[21] They further found that heroin users practised "retreatism", a behavior first described by Howard Abadinsky, in which those suffering from such strain reject society's goals and institutionalized means of achieving them.[22]

Medical uses

In the United States heroin is not accepted as medically useful.[2]

Under the generic name diamorphine, heroin is prescribed as a strong pain medication in the United Kingdom, where it is given via subcutaneous, intramuscular, intrathecal or intravenously. Its use includes treatment for acute pain, such as in severe physical trauma, myocardial infarction, post-surgical pain, and chronic pain, including end-stage cancer and other terminal illnesses. In other countries it is more common to use morphine or other strong opioids in these situations. In 2004 the National Institute for Health and Clinical Excellence produced guidance on the management of caesarean section, which recommended the use of intrathecal or epidural diamorphine for post-operative pain relief.[23]

Diamorphine continues to be widely used in palliative care in the UK, where it is commonly given by the subcutaneous route, often via a syringe driver, if patients cannot easily swallow morphine solution. The advantage of diamorphine over morphine is that diamorphine is more fat soluble and therefore more potent by injection, so smaller doses of it are needed for the same effect on pain. Both of these factors are advantageous if giving high doses of opioids via the subcutaneous route, which is often necessary in palliative care.

Maintenance therapy

A number of European countries including the United Kingdom allow the prescribing of heroin for heroin addiction.[24]
Diamorphine is also used as a maintenance drug to assist the treatment of opiate addiction, normally in long-term chronic intravenous (IV) heroin users. It is only prescribed following exhaustive efforts at treatment via other means. It is sometimes thought that heroin users can walk into a clinic and walk out with a prescription, but the process takes many weeks before a prescription for diamorphine is issued. Though this is somewhat controversial among proponents of a zero-tolerance drug policy, it has proven superior to methadone in improving the social and health situations of addicts.[25]

The UK Department of Health's Rolleston Committee Report[26] in 1926 established the British approach to diamorphine prescription to users, which was maintained for the next 40 years: dealers were prosecuted, but doctors could prescribe diamorphine to users when withdrawing from it would cause harm or severe distress to the patient. This "policing and prescribing" policy effectively controlled the perceived diamorphine problem in the UK until 1959 when the number of diamorphine addicts doubled every 16 months during the ten years from 1959 to 1968.[27] In 1964 the Brain Committee recommended that only selected approved doctors working at approved specialised centres be allowed to prescribe diamorphine and benzoylmethylecgonine (cocaine) to users. The law was made more restrictive in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and the use of methadone; currently only a small number of users in the UK are prescribed diamorphine.[28]

In 1994, Switzerland began a trial diamorphine maintenance program for users that had failed multiple withdrawal programs. The aim of this program was to maintain the health of the user by avoiding medical problems stemming from the illicit use of diamorphine. The first trial in 1994 involved 340 users, although enrollment was later expanded to 1000, based on the apparent success of the program.

The trials proved diamorphine maintenance to be superior to other forms of treatment in improving the social and health situation for this group of patients.[29] It has also been shown to save money, despite high treatment expenses, as it significantly reduces costs incurred by trials, incarceration, health interventions and delinquency.[30] Patients appear twice daily at a treatment center, where they inject their dose of diamorphine under the supervision of medical staff. They are required to contribute about 450 Swiss francs per month to the treatment costs.[31] A national referendum in November 2008 showed 68% of voters supported the plan,[32] introducing diamorphine prescription into federal law. The previous trials were based on time-limited executive ordinances. The success of the Swiss trials led German, Dutch,[33] and Canadian[34] cities to try out their own diamorphine prescription programs.[35] Some Australian cities (such as Sydney) have instituted legal diamorphine supervised injecting centers, in line with other wider harm minimization programs.

Since January 2009, Denmark has prescribed diamorphine to a few addicts that have tried methadone and subutex without success.[36] Beginning in February 2010, addicts in Copenhagen and Odense became eligible to receive free diamorphine. Later in 2010 other cities including Århus and Esbjerg joined the scheme. It was supposed that around 230 addicts would be able to receive free diamorphine.[37] However, Danish addicts would only be able to inject heroin according to the policy set by Danish National Board of Health.[38] Of the estimated 1500 drug users who did not benefit from the then-current oral substitution treatment, approximately 900 would not be in the target group for treatment with injectable diamorphine, either because of "massive multiple drug abuse of non-opioids" or "not wanting treatment with injectable diamorphine".

In July 2009, the German Bundestag passed a law allowing diamorphine prescription as a standard treatment for addicts; a large-scale trial of diamorphine prescription had been authorized in that country in 2002.[40]

On August 26, 2016 Health Canada issued regulations amending prior regulations it had issued under the Controlled Drugs and Substances Act; the "New Classes of Practitioners Regulations", the "Narcotic Control Regulations", and the "Food and Drug Regulations", to allow doctors to prescribe diamorphine to people who have a severe opioid addiction who have not responded to other treatments.[41][42] The prescription heroin can be accessed by doctors through Health Canada's Special Access Programme (SAP) for "emergency access to drugs for patients with serious or life-threatening conditions when conventional treatments have failed, are unsuitable, or are unavailable."[41]

Routes of administration

The onset of heroin's effects depends upon the route of administration. Studies have shown that the subjective pleasure of drug use (the reinforcing component of addiction) is proportional to the rate at which the blood level of the drug increases.[43] Intravenous injection is the fastest route of drug administration, causing blood concentrations to rise the most quickly, followed by smoking, suppository (anal or vaginal insertion), insufflation (snorting), and ingestion (swallowing).

Ingestion does not produce a rush as forerunner to the high experienced with the use of heroin, which is most pronounced with intravenous use. While the onset of the rush induced by injection can occur in as little as a few seconds, the oral route of administration requires approximately half an hour before the high sets in. Thus, with both higher the dosage of heroin used and faster the route of administration used, the higher potential risk for psychological addiction.

Large doses of heroin can cause fatal respiratory depression, and the drug has been used for suicide or as a murder weapon. The serial killer Harold Shipman used diamorphine on his victims, and the subsequent Shipman Inquiry led to a tightening of the regulations surrounding the storage, prescribing and destruction of controlled drugs in the UK. John Bodkin Adams is also known to have used heroin as a murder weapon.

Because significant tolerance to respiratory depression develops quickly with continued use and is lost just as quickly during withdrawal, it is often difficult to determine whether a heroin lethal overdose was accidental, suicide or homicide. Examples include the overdose deaths of Sid Vicious, Janis Joplin, Tim Buckley, Hillel Slovak, Layne Staley, Bradley Nowell, Ted Binion, and River Phoenix.[44]

Chronic use of heroin and other opioids has been shown to be a potential cause of hyponatremia, resultant because of excess vasopressin secretion.

Oral

Oral use of heroin is less common than other methods of administration, mainly because there is little to no "rush", and the effects are less potent.[45] Heroin is entirely converted to morphine by means of first-pass metabolism, resulting in deacetylation when ingested. Heroin's oral bioavailability is both dose-dependent (as is morphine's) and significantly higher than oral use of morphine itself, reaching up to 64.2% for high doses and 45.6% for low doses; opiate-naive users showed far less absorption of the drug at low doses, having bioavailabilities of only up to 22.9%. The maximum plasma concentration of morphine following oral administration of heroin was around twice as much as that of oral morphine.[46]

Injection

Injection, also known as "slamming", "banging", "shooting up", "digging" or "mainlining", is a popular method which carries relatively greater risks than other methods of administration. Heroin base (commonly found in Europe), when prepared for injection, will only dissolve in water when mixed with an acid (most commonly citric acid powder or lemon juice) and heated. Heroin in the east-coast United States is most commonly found in the hydrochloride salt form, requiring just water (and no heat) to dissolve. Users tend to initially inject in the easily accessible arm veins, but as these veins collapse over time, users resort to more dangerous areas of the body, such as the femoral vein in the groin. Users who have used this route of administration often develop a deep vein thrombosis. Intravenous users can use a various single dose range using a hypodermic needle. The dose of heroin used for recreational purposes is dependent on the frequency and level of use: thus a first-time user may use between 5 and 20 mg, while an established addict may require several hundred mg per day. As with the injection of any drug, if a group of users share a common needle without sterilization procedures, blood-borne diseases, such as HIV/AIDS or hepatitis, can be transmitted. The use of a common dispenser for water for the use in the preparation of the injection, as well as the sharing of spoons and/or filters can also cause the spread of blood-borne diseases. Many countries now supply small sterile spoons and filters for single use in order to prevent the spread of disease.[47]

Smoking

Smoking heroin refers to vaporizing it to inhale the resulting fumes, not burning it to inhale the resulting smoke. It is commonly smoked in glass pipes made from glassblown Pyrex tubes and light bulbs. It can also be smoked off aluminium foil, which is heated underneath by a flame and the resulting smoke is inhaled through a tube of rolled up foil. This method is also known as "chasing the dragon".[48]

Insufflation

Another popular route to intake heroin is insufflation (snorting), where a user crushes the heroin into a fine powder and then gently inhales it (sometimes with a straw or a rolled-up banknote, as with cocaine) into the nose, where heroin is absorbed through the soft tissue in the mucous membrane of the sinus cavity and straight into the bloodstream. This method of administration redirects first-pass metabolism, with a quicker onset and higher bioavailability than oral administration, though the duration of action is shortened. This method is sometimes preferred by users who do not want to prepare and administer heroin for injection or smoking, but still experience a fast onset. Snorting heroin becomes an often unwanted route, once a user begins to inject the drug. The user may still get high on the drug from snorting, and experience a nod, but will not get a rush. A "rush" is caused by a large amount of heroin entering the body at once. When the drug is taken in through the nose, the user does not get the rush because the drug is absorbed slowly rather than instantly.

Suppository

Little research has been focused on the suppository (anal insertion) or pessary (vaginal insertion) methods of administration, also known as "plugging". These methods of administration are commonly carried out using an oral syringe. Heroin can be dissolved and withdrawn into an oral syringe which may then be lubricated and inserted into the anus or vagina before the plunger is pushed. The rectum or the vaginal canal is where the majority of the drug would likely be taken up, through the membranes lining their walls.

Adverse effects

Two types of heroin

Like most opioids, unadulterated heroin does not cause many long-term complications other than dependence and constipation.[49] The purity of street heroin varies greatly. This variation has led to individuals inadvertently experiencing overdoses when the purity of the drug was higher than they expected.[50][51] Intravenous use of heroin (and any other substance) with needles and syringes or other related equipment may lead to:
Many countries and local governments have begun funding programs that supply sterile needles to people who inject illegal drugs in an attempt to reduce these contingent risks, and especially the spread of blood-borne diseases. The Drug Policy Alliance reports that up to 75% of new AIDS cases among women and children are directly or indirectly a consequence of drug use by injection.[53] The United States federal government does not operate needle exchanges, although some state and local governments do support such programs.

Anthropologists Philippe Bourgois and Jeff Schonberg performed a decade of fieldwork among homeless heroin and cocaine addicts in San Francisco, published in 2009. They reported that the African-American addicts they observed were more inclined to "direct deposit" heroin into a vein, while "skin-popping" was a far more widespread practice: "By the midpoint of our fieldwork, most of the whites had given up searching for operable veins and skin-popped. They sank their needles perfunctorily, often through their clothing, into their fatty tissue." Bourgois and Schonberg describes how the cultural difference between the African-Americans and the whites leads to this contrasting behavior, and also points out that the two different ways to inject heroin comes with different health risks. Skin-popping more often results in abscesses, and direct injection more often leads to fatal overdose and also to hepatitis C and HIV infection.[21]

A small percentage of heroin smokers, and occasionally IV users, may develop symptoms of toxic leukoencephalopathy. The cause has yet to be identified, but one speculation is that the disorder is caused by an uncommon adulterant that is only active when heated. Symptoms include slurred speech and difficulty walking.

Cocaine is sometimes used in combination with heroin, and is referred to as a speedball when injected or moonrocks when smoked together. Cocaine acts as a stimulant, whereas heroin acts as a depressant. Coadministration provides an intense rush of euphoria with a high that combines both effects of the drugs, while excluding the negative effects, such as anxiety and sedation. The effects of cocaine wear off far more quickly than heroin, so if an overdose of heroin was used to compensate for cocaine, the end result is fatal respiratory depression.
  • Preparing heroin for injection
  • Modified syringe for suppository administration
  • One stamp of heroin
  • Chunky "No.3" heroin

Withdrawal

The withdrawal syndrome from heroin (the so-called "cold turkey") may begin within 6–24 hours of discontinuation of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose. Symptoms may include:[57] sweating, malaise, anxiety, depression, akathisia, priapism, extra sensitivity of the genitals in females, general feeling of heaviness, excessive yawning or sneezing, tears, rhinorrhea, sleep difficulties (insomnia), cold sweats, chills, severe muscle and bone aches, nausea, vomiting, diarrhea, cramps, watery eyes,[58] fever and cramp-like pains and involuntary spasms in the limbs (thought to be an origin of the term "kicking the habit"[59]).

Overdose

Heroin overdose is usually treated with an opioid antagonist, such as naloxone (Narcan). This reverses the effects of heroin and other opioids and causes an immediate return of consciousness but may result in withdrawal symptoms. The half-life of naloxone is shorter than most opioids, so that it has to be administered multiple times until the opioid has been metabolized by the body.

Depending on drug interactions and numerous other factors, death from overdose can take anywhere from several minutes to several hours. Death usually occurs due to lack of oxygen resulting from the lack of breathing caused by the opioid. Heroin overdoses can occur because of an unexpected increase in the dose or purity or because of diminished opioid tolerance. However, many fatalities reported as overdoses are probably caused by interactions with other depressant drugs such as alcohol or benzodiazepines.[60] It should also be noted that since heroin can cause nausea and vomiting, a significant number of deaths attributed to heroin overdose are caused by aspiration of vomit by an unconscious person. Some sources quote the median lethal dose (for an average 75 kg opiate-naive individual) as being between 75 and 600  mg.[61][62] Illicit heroin is of widely varying and unpredictable purity. This means that the user may prepare what they consider to be a moderate dose while actually taking far more than intended. Also, tolerance typically decreases after a period of abstinence. If this occurs and the user takes a dose comparable to their previous use, the user may experience drug effects that are much greater than expected, potentially resulting in an overdose. It has been speculated that an unknown portion of heroin-related deaths are the result of an overdose or allergic reaction to quinine, which may sometimes be used as a cutting agent.[63]

Pharmacology

Black tar heroin

When taken orally, heroin undergoes extensive first-pass metabolism via deacetylation, making it a prodrug for the systemic delivery of morphine.[64] When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the blood–brain barrier because of the presence of the acetyl groups, which render it much more fat soluble than morphine itself.[65] Once in the brain, it then is deacetylated variously into the inactive 3-monoacetylmorphine and the active 6-monoacetylmorphine (6-MAM), and then to morphine, which bind to μ-opioid receptors, resulting in the drug's euphoric, analgesic (pain relief), and anxiolytic (anti-anxiety) effects; heroin itself exhibits relatively low affinity for the μ receptor.[66] Unlike hydromorphone and oxymorphone, however, administered intravenously, heroin creates a larger histamine release, similar to morphine, resulting in the feeling of a greater subjective "body high" to some, but also instances of pruritus (itching) when they first start using.[67][68]

Both morphine and 6-MAM are μ-opioid agonists that bind to receptors present throughout the brain, spinal cord, and gut of all mammals. The μ-opioid receptor also binds endogenous opioid peptides such as β-endorphin, Leu-enkephalin, and Met-enkephalin. Repeated use of heroin results in a number of physiological changes, including an increase in the production of μ-opioid receptors (upregulation).[citation needed] These physiological alterations lead to tolerance and dependence, so that stopping heroin use results in uncomfortable symptoms including pain, anxiety, muscle spasms, and insomnia called the opioid withdrawal syndrome. Depending on usage it has an onset 4–24 hours after the last dose of heroin. Morphine also binds to δ- and κ-opioid receptors.

There is also evidence that 6-MAM binds to a subtype of μ-opioid receptors that are also activated by the morphine metabolite morphine-6β-glucuronide but not morphine itself.[69] The third subtype of third opioid type is the mu-3 receptor, which may be a commonality to other six-position monoesters of morphine. The contribution of these receptors to the overall pharmacology of heroin remains unknown.

A subclass of morphine derivatives, namely the 3,6 esters of morphine, with similar effects and uses, includes the clinically used strong analgesics nicomorphine (Vilan), and dipropanoylmorphine; there is also the latter's dihydromorphine analogue, diacetyldihydromorphine (Paralaudin). Two other 3,6 diesters of morphine invented in 1874–75 along with diamorphine, dibenzoylmorphine and acetylpropionylmorphine, were made as substitutes after it was outlawed in 1925 and, therefore, sold as the first "designer drugs" until they were outlawed by the League of Nations in 1930.

Chemistry

Heroin is derived from opium through a process involving various chemicals such as acetone and acetic anhydride.[70]

Detection in body fluids

The major metabolites of diamorphine, 6-MAM, morphine, morphine-3-glucuronide and morphine-6-glucuronide, may be quantitated in blood, plasma or urine to monitor for abuse, confirm a diagnosis of poisoning or assist in a medicolegal death investigation. Most commercial opiate screening tests cross-react appreciably with these metabolites, as well as with other biotransformation products likely to be present following usage of street-grade diamorphine such as 6-acetylcodeine and codeine. However, chromatographic techniques can easily distinguish and measure each of these substances. When interpreting the results of a test, it is important to consider the diamorphine usage history of the individual, since a chronic user can develop tolerance to doses that would incapacitate an opiate-naive individual, and the chronic user often has high baseline values of these metabolites in his system. Furthermore, some testing procedures employ a hydrolysis step before quantitation that converts many of the metabolic products to morphine, yielding a result that may be 2 times larger than with a method that examines each product individually.[71]

History

Advertisement for Bayer Heroin

The opium poppy was cultivated in lower Mesopotamia as long ago as 3400 BCE.[72] The chemical analysis of opium in the 19th century revealed that most of its activity could be ascribed to two alkaloids, codeine and morphine.

Diamorphine was first synthesized in 1874 by C. R. Alder Wright, an English chemist working at St. Mary's Hospital Medical School in London. He had been experimenting with combining morphine with various acids. He boiled anhydrous morphine alkaloid with acetic anhydride for several hours and produced a more potent, acetylated form of morphine, now called diacetylmorphine or morphine diacetate. The compound was sent to F. M. Pierce of Owens College in Manchester for analysis. Pierce told Wright:
Doses ... were subcutaneously injected into young dogs and rabbits ... with the following general results ... great prostration, fear, and sleepiness speedily following the administration, the eyes being sensitive, and pupils constrict, considerable salivation being produced in dogs, and slight tendency to vomiting in some cases, but no actual emesis. Respiration was at first quickened, but subsequently reduced, and the heart's action was diminished, and rendered irregular. Marked want of coordinating power over the muscular movements, and loss of power in the pelvis and hind limbs, together with a diminution of temperature in the rectum of about 4°.[73]
Bayer Heroin bottle

Wright's invention did not lead to any further developments, and diamorphine became popular only after it was independently re-synthesized 23 years later by another chemist, Felix Hoffmann.[74] Hoffmann, working at Bayer pharmaceutical company in Elberfeld, Germany, was instructed by his supervisor Heinrich Dreser to acetylate morphine with the objective of producing codeine, a constituent of the opium poppy, pharmacologically similar to morphine but less potent and less addictive. Instead, the experiment produced an acetylated form of morphine one and a half to two times more potent than morphine itself. The head of Bayer's research department reputedly coined the drug's new name, "heroin," based on the German heroisch, which means "heroic, strong" (from the ancient Greek word "heros, ήρως"). Bayer scientists were not the first to make heroin, but their scientists discovered ways to make it, and Bayer led commercialization of heroin.[75]

In 1895, the German drug company Bayer marketed diacetylmorphine as an over-the-counter drug under the trademark name Heroin.[76] It was developed chiefly as a morphine substitute for cough suppressants that did not have morphine's addictive side-effects. Morphine at the time was a popular recreational drug, and Bayer wished to find a similar but non-addictive substitute to market. However, contrary to Bayer's advertising as a "non-addictive morphine substitute," heroin would soon have one of the highest rates of addiction among its users.[77]

From 1898 through to 1910, diamorphine was marketed under the trademark name Heroin as a non-addictive morphine substitute and cough suppressant.[78] In the 11th edition of Encyclopædia Britannica (1910), the article on morphine states: "In the cough of phthisis minute doses [of morphine] are of service, but in this particular disease morphine is frequently better replaced by codeine or by heroin, which checks irritable coughs without the narcotism following upon the administration of morphine."

In the U.S., the Harrison Narcotics Tax Act was passed in 1914 to control the sale and distribution of diacetylmorphine and other opioids, which allowed the drug to be prescribed and sold for medical purposes. In 1924, the United States Congress banned its sale, importation, or manufacture. It is now a Schedule I substance, which makes it illegal for non-medical use in signatory nations of the Single Convention on Narcotic Drugs treaty, including the United States.

The Health Committee of the League of Nations banned diacetylmorphine in 1925, although it took more than three years for this to be implemented. In the meantime, the first designer drugs, viz. 3,6 diesters and 6 monoesters of morphine and acetylated analogues of closely related drugs like hydromorphone and dihydromorphine, were produced in massive quantities to fill the worldwide demand for diacetylmorphine—this continued until 1930 when the Committee banned diacetylmorphine analogues with no therapeutic advantage over drugs already in use, the first major legislation of this type.

Bayer lost some of its trademark rights to heroin under the 1919 Treaty of Versailles following the German defeat in World War I.[citation needed]

Use of heroin by jazz musicians in particular was prevalent in the mid-twentieth century, including Billie Holiday, sax legends Charlie Parker and Art Pepper, guitarist Joe Pass and piano player/singer Ray Charles; a "staggering number of jazz musicians were addicts".[79] It was also a problem with many rock musicians, particularly from the late 1960s through the 1990s. Pete Doherty is also a self-confessed user of heroin.[80] Nirvana lead singer Kurt Cobain's heroin addiction was well documented.[81] Pantera frontman, Phil Anselmo, turned to heroin while touring during the 1990s to cope with his back pain.[82] Many musicians have made songs referencing their heroin usage.[83][84][85][86][87]

Society and culture

Names

"Diamorphine" is the Recommended International Nonproprietary Name and British Approved Name.[1][88] Other synonyms for heroin include: diacetylmorphine, and morphine diacetate. Heroin is also known by many street names including dope, H, smack, junk, horse, and brown, among others.[89]

Legal status

Asia

In Hong Kong, diamorphine is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. It is available by prescription. Anyone supplying diamorphine without a valid prescription can be fined $10,000 (HKD). The penalty for trafficking or manufacturing diamorphine is a $50,000 (HKD) fine and life imprisonment. Possession of diamorphine without a license from the Department of Health is illegal with a $10,000 (HKD) fine and/or 7 years of jail time.[90]

Europe

In the Netherlands, diamorphine is a List I drug of the Opium Law. It is available for prescription under tight regulation exclusively to long-term addicts for whom methadone maintenance treatment has failed. It cannot be used to treat severe pain or other illnesses.

In the United Kingdom, diamorphine is available by prescription, though it is a restricted Class A drug. According to the 50th edition of the British National Formulary (BNF), diamorphine hydrochloride may be used in the treatment of acute pain, myocardial infarction, acute pulmonary oedema, and chronic pain. The treatment of chronic non-malignant pain must be supervised by a specialist. The BNF notes that all opioid analgesics cause dependence and tolerance but that this is "no deterrent in the control of pain in terminal illness". When used in the palliative care of cancer patients, diamorphine is often injected using a syringe driver.[92]

It is controlled in the UK by the Misuse of Drugs Act 1971. In the UK it is a class A controlled drug and as such is subject to guidelines surrounding its storage, administration and destruction. Possession of diamorphine without a prescription is an arrestable offence. When diamorphine is prescribed in a hospital or similar environment, its administration must be supervised by two people who must then complete and sign a controlled drugs register (CD register) detailing the patient's name, amount, time, date and route of administration. In the case of a physician administering diamorphine, then he/she may administer the drug alone, however the rule requiring two registered practitioners, such as a nurse, midwife or another physician to sign the CD register still applies. The use of a witness when administering diamorphine is to avoid the possibility of the drug being diverted onto the black market.

For safety reasons, many UK National Health Service hospitals only permit the administration of intravenous diamorphine in designated areas. In practice this usually means a critical care unit, an accident and emergency department, operating theatres by an anaesthetist or nurse anaesthetist or other such areas where close monitoring and support from senior staff is immediately available. However, administration by other routes is permitted in other areas of the hospital. This includes subcutaneous, intramuscular, intravenously as part of a patient controlled analgesia setup, and as an already established epidural infusion pump. Subcutaneous infusion, along with subcutaneous and intramuscular injection (bolus administration), is often used in the patient's own home, in order to treat severe pain in terminal illness.

Australia

In Australia diamorphine is listed as a schedule 9 prohibited substance under the Poisons Standard (October 2015).[93] A schedule 9 drug is outlined in the Poisons Act 1964 as "Substances which may be abused or misused, the manufacture, possession, sale or use of which should be prohibited by law except when required for medical or scientific research, or for analytical, teaching or training purposes with approval of the CEO."[94]

North America

In Canada, diamorphine is a controlled substance[95] under Schedule I of the Controlled Drugs and Substances Act (CDSA).[96] Any person seeking or obtaining diamorphine without disclosing authorization 30 days before obtaining another prescription from a practitioner is guilty of an indictable offense and subject to imprisonment for a term not exceeding seven years. Possession of diamorphine for the purpose of trafficking is an indictable offense and subject to imprisonment for life.

In the United States, diamorphine is a Schedule I drug according to the Controlled Substances Act of 1970, making it illegal to possess without a DEA license.[97] Possession of more than 100 grams of diamorphine or a mixture containing diamorphine is punishable with a minimum mandatory sentence of 5 years of imprisonment in a federal prison.

Abuse of prescription medication

Abused prescription medicine such as opioid can lead to heroin addiction.[98] The number of death from illegal opioid overdose follows the increasing number of death caused by prescription opioid overdoses.[99] Prescription opioids are relatively easy to obtain.[100] This may ultimately lead to heroin injection because heroin is cheaper than prescribed pills.[98]

Economics

Production

Diamorphine is produced from acetylation of morphine derived from natural opium sources. Numerous mechanical and chemical means are used to purify the final product. The final products have a different appearance depending on purity and have different names.[101]

Heroin grades

Heroin purity has been classified into four grades. No.4 is the purest form – white powder (salt) to be easily dissolved and injected. No.3 is "brown sugar" for smoking (base). No.1 and No.2 are unprocessed raw heroin (salt or base).[102]

Trafficking and production

International drug routes

Traffic is heavy worldwide, with the biggest producer being Afghanistan. According to a U.N. sponsored survey,[103] in 2004, Afghanistan accounted for production of 87 percent of the world's diamorphine.[104] Afghan opium kills around 100,000 people annually.[105]

In 2003 The Independent reported:[106][107]
... The cultivation of opium [in Afghanistan] reached its peak in 1999, when 350 square miles (910 km2) of poppies were sown ... The following year the Taliban banned poppy cultivation, ... a move which cut production by 94 percent ... By 2001 only 30 square miles (78 km2) of land were in use for growing opium poppies. A year later, after American and British troops had removed the Taliban and installed the interim government, the land under cultivation leapt back to 285 square miles (740 km2), with Afghanistan supplanting Burma to become the world's largest opium producer once more.
Opium production in that country has increased rapidly since, reaching an all-time high in 2006. War in Afghanistan once again appeared as a facilitator of the trade.[108] Some 3.3 million Afghans are involved in producing opium.[109]

At present, opium poppies are mostly grown in Afghanistan (224,000 hectares (550,000 acres)), and in Southeast Asia, especially in the region known as the Golden Triangle straddling Burma (57,600 hectares (142,000 acres)), Thailand, Vietnam, Laos (6,200 hectares (15,000 acres)) and Yunnan province in China. There is also cultivation of opium poppies in Pakistan (493 hectares (1,220 acres)), Mexico (12,000 hectares (30,000 acres)) and in Colombia (378 hectares (930 acres)).[110] According to the DEA, the majority of the heroin consumed in the United States comes from Mexico (50%) and Colombia (43-45%) via Mexican criminal cartels such as Sinaloa Cartel.[111] However, these statistics may be significantly unreliable, the DEA's 50/50 split between Colombia and Mexico is contradicted by the amount of hectares cultivated in each country and in 2014, the DEA claimed most of the heroin in the US came from Colombia.[112] As of 2015, the Sinaloa Cartel is the most active drug cartel involved in smuggling illicit drugs such as heroin into the United States and trafficking them throughout the United States.[113] According to the Royal Canadian Mounted Police, 90% of the heroin seized in Canada (where the origin was known) came from Afghanistan.[114] Pakistan is the destination and transit point for 40 percent of the opiates produced in Afghanistan, other destinations of Afghan opiates are Russia, Europe and Iran.[115][116]

Conviction for trafficking heroin carries the death penalty in most Southeast Asian, some East Asian and Middle Eastern countries (see Use of death penalty worldwide for details), among which Malaysia, Singapore and Thailand are the most strict. The penalty applies even to citizens of countries where the penalty is not in place, sometimes causing controversy when foreign visitors are arrested for trafficking, for example the arrest of nine Australians in Bali, the death sentence given to Nola Blake in Thailand in 1987, or the hanging of an Australian citizen Van Tuong Nguyen in Singapore.

Trafficking history

Primary worldwide producers of heroin

The origins of the present international illegal heroin trade can be traced back to laws passed in many countries in the early 1900s that closely regulated the production and sale of opium and its derivatives including heroin. At first, heroin flowed from countries where it was still legal into countries where it was no longer legal. By the mid-1920s, heroin production had been made illegal in many parts of the world. An illegal trade developed at that time between heroin labs in China (mostly in Shanghai and Tianjin) and other nations. The weakness of government in China and conditions of civil war enabled heroin production to take root there. Chinese triad gangs eventually came to play a major role in the illicit heroin trade. The French Connection route started in the 1930s.

Heroin trafficking was virtually eliminated in the U.S. during World War II because of temporary trade disruptions caused by the war. Japan's war with China had cut the normal distribution routes for heroin and the war had generally disrupted the movement of opium. After World War II, the Mafia took advantage of the weakness of the postwar Italian government and set up heroin labs in Sicily. The Mafia took advantage of Sicily's location along the historic route opium took westward into Europe and the United States.[117] Large-scale international heroin production effectively ended in China with the victory of the communists in the civil war in the late 1940s. The elimination of Chinese production happened at the same time that Sicily's role in the trade developed.

Although it remained legal in some countries until after World War II, health risks, addiction, and widespread recreational use led most western countries to declare heroin a controlled substance by the latter half of the 20th century. In the late 1960s and early 1970s, the CIA supported anti-Communist Chinese Nationalists settled near the Sino-Burmese border and Hmong tribesmen in Laos. This helped the development of the Golden Triangle opium production region, which supplied about one-third of heroin consumed in US after the 1973 American withdrawal from Vietnam. In 1999, Burma, the heartland of the Golden Triangle, was the second largest producer of heroin, after Afghanistan.[118]

The Soviet-Afghan war led to increased production in the Pakistani-Afghan border regions, as U.S.-backed mujaheddin militants raised money for arms from selling opium, contributing heavily to the modern Golden Crescent creation. By 1980, 60 percent of heroin sold in the U.S. originated in Afghanistan.[118] It increased international production of heroin at lower prices in the 1980s. The trade shifted away from Sicily in the late 1970s as various criminal organizations violently fought with each other over the trade. The fighting also led to a stepped-up government law enforcement presence in Sicily.

Following the discovery at a Jordanian airport of a toner cartridge that had been modified into an improvised explosive device, the resultant increased level of airfreight scrutiny led to a major shortage (drought) of heroin from October 2010 until April 2011. This was reported in most of mainland Europe and the UK which led to a price increase of approximately 30 percent in the cost of street heroin and an increased demand for diverted methadone. The number of addicts seeking treatment also increased significantly during this period. Other heroin droughts (shortages) have been attributed to cartels restricting supply in order to force a price increase and also to a fungus that attacked the opium crop of 2009. Many people[weasel words] thought that the American government had introduced pathogens into the Afghanistan atmosphere in order to destroy the opium crop and thus starve insurgents of income.[citation needed]

On 13 March 2012, Haji Bagcho, with ties to the Taliban, was convicted by a U.S. District Court of conspiracy, distribution of heroin for importation into the United States and narco-terrorism. Based on heroin production statistics[124] compiled by the United Nations Office on Drugs and Crime, in 2006, Bagcho's activities accounted for approximately 20 percent of the world's total production for that year.

Street price

The European Monitoring Centre for Drugs and Drug Addiction reports that the retail price of brown heroin varies from €14.5 per gram in Turkey to €110 per gram in Sweden, with most European countries reporting typical prices of €35–40 per gram. The price of white heroin is reported only by a few European countries and ranged between €27 and €110 per gram.[125]

The United Nations Office on Drugs and Crime claims in its 2008 World Drug Report that typical US retail prices are US$172 per gram.[126]

Harm reduction

Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Heroin was ranked 1st in dependence, physical harm, and social harm.[127]

Harm reduction is a public health philosophy that seeks to reduce the harms associated with the use of diamorphine. One aspect of harm reduction initiatives focuses on the behaviour of individual users. This includes promoting safer means of taking the drug, such as smoking, nasal use, oral or rectal insertion. This attempts to avoid the higher risks of overdose, infections and blood-borne viruses associated with injecting the drug. Other measures include using a small amount of the drug first to gauge the strength, and minimize the risks of overdose. For the same reason, poly drug use (the use of two or more drugs at the same time) is discouraged. Injecting diamorphine users are encouraged to use new needles, syringes, spoons/steri-cups and filters every time they inject and not share these with other users. Users are also encouraged to not use it on their own, as others can assist in the event of an overdose.

Governments that support a harm reduction approach usually fund needle and syringe exchange programs, which supply new needles and syringes on a confidential basis, as well as education on proper filtering before injection, safer injection techniques, safe disposal of used injecting gear and other equipment used when preparing diamorphine for injection may also be supplied including citric acid sachets/vitamin C sachets, steri-cups, filters, alcohol pre-injection swabs, sterile water ampules and tourniquets (to stop use of shoe laces or belts).

Another harm reduction measure employed for example in Europe, Canada and Australia are safe injection sites where users can inject diamorphine and cocaine under the supervision of medically trained staff. Safe injection sites are low threshold and allow social services to approach problem users that would otherwise be hard to reach.[128] In the UK the Criminal Justice System has a protocol in place that requires that any individual that is arrested and is suspected of having a substance misuse problem be offered the chance to enter a treatment program. This has had the effect of drastically reducing an area's crime rate as individuals arrested for theft in order to supply the funds for their drugs are no longer in the position of having to steal to purchase heroin because they have been placed onto a methadone program, quite often more quickly than would have been possible had they not been arrested. This aspect of harm reduction is seen as being beneficial to both the individual and the community at large, who are then protected from the possible theft of their goods.

During the late 1980s and early 1990s, Swiss authorities ran the ZIPP-AIDS (Zurich Intervention Pilot Project), handing out free syringes in the officially tolerated drug scene in Platzspitz park.[131] In 1994, Zurich started a pilot project using prescription heroin in heroin-assisted treatment (HAT) which allowed users to obtain heroin and inject it under medical supervision.[132] The HAT program proved to be cost-beneficial to society and improve patients overall health and social stability[132] and has since been introduced in multiple European countries.[133]

Research

Researchers are attempting to reproduce the biosynthetic pathway that produces morphine in genetically engineered yeast.[134] In June 2015 the S-reticuline could be produced from sugar and R-reticuline could be converted to morphine, but the intermediate reaction could not be performed.
at
Subscribe to: Posts (Atom)

Operator (computer programming)

From Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Operator_(computer_programmin...

  • Islamic State and the Levant
    From Wikipedia, the free encyclopedia Islamic State of Iraq and the Levant الدولة الإسلامية في العراق والشام   ( ...
  • Heart Sutra
    From Wikipedia, the free encyclopedia A reproduction of the palm -leaf manuscript in Siddham script ...
  • Slum
    From Wikipedia, the free encyclopedia ...