Medical Consequences of the Drug War: a focus on violence

1. Medical Consequences of the Drug War: a focus on violence 2007 National Student Physicians for Social Responsibility Conference 2/24/07 Sunil Aggarwal, Washington PSR-Immediate Past President MD/PhD student, University of Washington, Seattle

2. Drug War or “War on Drugs”? • “Drugs” – a term of obfuscation • “alcohol and drugs” as if alcohol is not a drug and as if by drugs we all know what is being talked about (292 listed in CSA) • “War”: a heavily enforced, yet oft-duplicitous, policy of international prohibition. • Basic “weapon”: criminalize possession of selected substances which can have psychoactive properties (unlike US 18th amendment)—ownership by gov’ts • A technical stand-in for criminalizing consumption and particular forms of psychoactivation • Yet psychoactivation has been called an acquired “fourth drive” along with the innate drives of hunger, thirst, and sex. (Siegel) • A War against drug abuse or against human drives?

3. Mission of SPSR • Elimination of nuclear weapons and other weapons of mass destruction • Achievement of a sustainable environment • Reduction of violence and its causes • Promotion of peace and social justice

4. Wielding the Basic Drug War Weapon of Criminal Sanction • Drives production and consumption of select substances into a violent, unregulated industrial underground economy worth ~ $450-$500 billion/yr • Exploits and further marginalizes vulnerable populations and those with problematic psychoactive substance use patterns • Leads to mass punishment: incarceration and execution • Causes lost opportunities: medical, religious, and agroeconomic/chemurgic

5. Structural Violence Structural violence, a term coined by Johan Galtung and by liberation theologians during the 1960s, describes social structures—economic, political, legal, religious, and cultural—that stop individuals, groups, and societies from reaching their full potential [57]. In its general usage, the word violence often conveys a physical image; however, according to Galtung, it is the “avoidable impairment of fundamental human needs or the impairment of human life, which lowers the actual degree to which someone is able to meet their needs below that which would otherwise be possible” [58]. Structural violence is often embedded in longstanding “ubiquitous social structures, normalized by stable institutions and regular experience” [59]. Because they seem so ordinary in our ways of understanding the world, they appear almost invisible. Disparate access to resources, political power, education, health care, and legal standing are just a few examples. The idea of structural violence is linked very closely to social injustice and the social machinery of oppression [16]. Farmer PE, Nizeye B, Stulac S, Keshavjee S (2006) Structural Violence and Clinical Medicine. PLoS Med 3(10): e449

6. Where do “Drugs” Come from? • Some of natural origin • Some synthetic • 10 major banned biota

7. Chacruna (Psychotria viridis) Yage (Basinsteriopsis caapi) AYAHUASCA Erythoxylum coca Catha edulis Cannabis sativa White opium poppy (Papeverium somniferum) Peyote (Lophophora williamsi) Iboga (Tabernanthe iboga) Salvia divinorum Psilocybe azurescens spores

8. NaHCO3 (baking soda) Cocaine (1860) crack

9. opium opium gum Morphine (1805) No. 3 heroin (20-30% purity) No. 4 heroin (80-90% purity) (1898) (CH3CO)2O (anhydrous vinegar)

10. marijuana hash(ish)

11. DEA Briefing Book 2001 $6.00 1970 1.5 % $3.90 3.6% 38 % $0.80

12. The Writing’s on the Wall I “The international drug control regime, which criminalizes narcotics, does not reduce drug use, but it does produce huge profits for criminals and the armed groups and corrupt officials who protect them. Our drug policy grants huge subsidies to our enemies…If it were not illegal, it would be worth hardly anything. It’s only the illegality that makes it so valuable.” Sept. 21, 2006 testimony by Afghanistan expert NYU Professor Barnett Rubin, before the US Senate Foreign Relations Committee.

13. The Writing’s on the Wall II “The international traffic in illicit drugs contributes to terrorist risk through at least five mechanisms: supplying cash, creating chaos and instability, supporting corruption, providing “cover” and sustaining common infrastructures for illicit activity, and competing for law enforcement and intelligence attention. Of these, cash and chaos are likely to be the two most important.” 2004 Congressional Research Service report to Congress, “Illicit Drugs and the Terrorist Threat: Causal Links and Implications for Domestic Drug Control Policy.”

14. The Writing’s on the Wall III “It has become more and more difficult to distinguish clearly between terrorist groups and organized crime units, since their tactics increasingly overlap. The world is seeing the birth of a new hybrid of ‘organized crime – terrorist organizations’ and it is imperative to sever the connection between crime, drugs, and terrorism now. Organized crime continues to rely on billions of narco-dollars to fund a host of heinous enterprises—from child trafficking to arms smuggling, and wholesale efforts to sabotage legal institutions and democratic governments across the world via invasive, systemic corruption.” Antonio Maria Costa, UN, “UNODC and European Commission Agree Drugs, Crime, Terrorism Inextricably Linked: Bilateral Solutions Needed to Combat New Threats,” Press Release, Jan. 18, 2005 “Without a doubt, the greatest single threat today to global development, democracy, and peace is transnational organized crime and the drug trafficking monopoly that keeps this sinister enterprise rolling.”

15. Prohibited drugs = currency for violence • “One Afghan drug trafficker reportedly provides lieutenants of Osama bin Laden in Pakistan with 2,000 kilograms of heroin valued at $28 million every eight weeks.” Christian Science Monitor, Feb. 2004 • “Most of the plotters were Morroccan and Syrian immigrants, many with criminal records in Spain for drug trafficking and other crimes. They paid for explosives used in the attack with hashish.” March 9, 2006, AP MSNBC • “Drugs have taken over as the chief means of financing terrorism.” (Interpol’s chief drug control officer, Iqbal Hussain Rizvi (1994).) • Surpasses precious metals, materials, gems, contraband, stolen goods, extortions & kidnappings, etc.

16. Three major regions • North Andean -- Columbia • Central Asian -- Afghanistan • Interior Southeast Asian – Myanmar Secondary Zones: • Mexico and Peru • Horn of Africa • The Levant (Israel, Jordan, Lebanon, Syria and the Occupied Palestinian territories.)

17. “We have created an American Gulag.” --Former Federal Drug “czar” Barry McCaffrey. (1996), Keynote Address, Opening Plenary Session, National Conference on Drug Abuse Prevention Research, National Institute on Drug Abuse, Washington, D.C., Sept. 19, 1996. --5% of world’s pop and 25% of world’s prisoners

18. A War in Pictures

19. IDUs and HIV • Shared injection supplies and “war” policies result in increased incidence of HIV, HCV, TB, and other illnesses • NAS: injection drug use is the cause of approx. one-third of new HIV+’s outside of Sub-Saharan Africa. • 2002: CDC estimated 384,906 people living with AIDS in the US; 122,289 were related to injection drug use. • 1/3 of heterosexual transmission results from HIV positive IDU and non drug using partner

20. Medical Marijuana Apartheid

21. Failed Back Surgery Syndrome AIDS and N-H Lymphoma Quadriplegic Rheumatoid Arthritis Paraplegic

22. Elucidation of the Right to Health Taken From: • General Comment No. 14 (2000) on The Right to the Highest Attainable Standard of Health (Article 12 of the International Covenant on Economic, Social, and Cultural Rights); Committee on Economic, Social, and Cultural Rights; UN doc.E/C.12/2000/4, 4 July 2000 • Report of the UN Special Rapporteur for the Right to Health to the Commission on Human Rights CONTOURS OF THE RIGHT TO HEALTH: From: 2003 59th session CHR, E/CN.4/2003/58 • “..the indispensable role of health professionals in the promotion and protection of the right to health…”

23. Freedoms and Entitlements Contained in the Right to Health • “…freedoms include the right to control one’s health and body…and the right to be free from interference, such as the right to be free from torture ” • “…entitlements include the right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health

24. Some Enumerated State Violations of the Right to Health Violations of the Obligation to Respect • “50. Violations of the obligation to respect are those State actions, policies or laws that contravene the standards set out in article 12 of the Covenant and are likely to result in bodily harm, unnecessary morbidity and preventable mortality. Examples include the denial of access to health facilities, goods and services to particular individuals or groups as a result of de jure or de facto discrimination; the deliberate withholding or misrepresentation of information vital to health protection or treatment; the suspension of legislation or the adoption of laws or policies that interfere with the enjoyment of any of thecomponents of the right to health;

27. DEA Staffing and AppropriationsFY 1973-2000 Employees Tripled 2,898 $75 $1,550,000,000 9,132 Budget - 20 times larger

28. Police Militarization due to War on Drugs: Over 90% of cities with populations over 50,000, and 70% of smaller cities, have paramilitary units in their police departments, sometimes equipped with tanks, grenade launchers and helicopters.” • Arrests only include personal possession, not sales, trafficking, or manufacturing.. • † includes homicide, rape, robbery, and assault.

29. Drug Prohibition Causes Crime “Where there is no recourse to the law to settle disputes or to protect the trade from competitors, business is often conducted by force or threat of force. For example, somewhere between 20 and 40 percent of murders in the United States take place because of the black-market drug business.” --King County Bar Association