On each is a candle and a kidney-shaped dish. Inside the dish are a syringe, some cotton, a spoon, Band-Aids and a rubber tourniquet. Mirrors line the walls to be used by junkies who must shoot up into their necks because their arm veins are gone. A medical practitioner stands ready, if needed, to provide instruction in the proper injection of heroin or to intervene in the case of an overdose. Addicts return several times a day to such “safe-injection rooms” to receive their high-quality fix at little or no cost, sometimes with a cup of coffee. And all thanks to the Swiss government.

The Swiss government has authorized the controlled distribution of prescription heroin since 1994 and it was approved by Swiss voters in a June 1999 referendum after a furious campaign based on Swiss government reports. Never mind that those studies were deeply flawed, say independent analysts, including the World Health Organization, or WHO.

Now, despite the emphatic claims of independent agencies that Swiss drug policy has been a failure, some are advocating that the United States follow the Swiss example.

There is a libertarian-populist streak in the American political temperament to which this sort of thing appeals.

Rep. Tom Campbell, the Republican senatorial candidate seeking to unseat Sen. Dianne Feinstein in California, tells Insight that although he is not endorsing any such proposal, “if a city wants to try what was tried in Zurich, it should have the freedom” to do so.

But even some recovering addicts are dubious about this approach.

Former heroin addict Jerome Hunt of Atlanta tells Insight that safe-injection rooms involve “exploitation of freedom” and “an incentive to remain addicted.” He adds that heroin is “a tool of self-destruction, whether it’s free or whether you have to steal to get it. It’s fueling an allergy that’s going to make you break out, no matter how you get it. It’s going to lead me to the same consequences that it has led me to over and over and over again.

That’s just the nature of addiction.”

Nevertheless, the advocates of legal venues for heroin use have no doubts. Ethan Nadelmann is the executive director of the Lindesmith Center, a New York-based think tank funded by billionaire George Soros and dedicated to liberalizing drug policy.

In an interview with Insight, Nadelmann calls the Swiss heroin-prescription experiments “extremely successful” and proposes that, “at the very least, [we should] try them here to see if they’d work.” Nadelmann invokes the Swiss example as a “harm-reduction” guide for treating hard-to-reach addicts.

The idea is that abuse of narcotics is here to stay and that policies must be developed to deal with the reality by seeking to minimize harm to drug users and to society itself.

The Swiss experiment was a response to the widespread marketing and use of drugs in public spaces such as railroad stations and Zurich’s “Needle Park.” The feasibility of prescribing and supervising self-administered heroin injections to more than 1,000 persons in safe-injection rooms was evaluated in 18 projects from 1994 to 1996, often known as the Swiss drug trials. Although these projects were officially authorized on condition that they be studied scientifically, physician analyst Ernst Aeschbach of Swiss Doctors Against Drugs writes that the principal impetus was “political pressure to devise a plan for easy and unlimited access to heroin” and other drugs.

The Swiss federal Office of Public Health and the experiment’s directors were praising the results even before the end of the test period.

The public was informed that almost every possible measurement showed a plus — that drug use stabilized, crime was down, health and social functioning of addicts improved, the death rate plummeted and society was saving money.

The Swiss were promised that the forthcoming report from WHO would corroborate all of this.

At the request of the International Narcotics Control Board, or INCB, the WHO had convened an independent evaluation by experts to study the integrity of the Swiss projects.

When the long-awaited report was released in April 1999, the WHO experts pronounced the studies deeply flawed.

These flaws have been corroborated by Aeschbach and Yale University’s Sally Satel, both physicians who state flatly in the Journal of Substance Abuse Treatment that “the Swiss heroin trials cannot be considered a valid experiment.” Aeschbach and Satel point out that the scientific method of these trials was faulty; the sample of participants was not representative; the verification of outcomes was inadequate; and finally, the doctors note, even the Swiss report itself cites negative consequences.

Nadelmann responds by attacking the critics.

He tells Insight that the INCB is “a corrupt and dishonest body [which has] lost sight of its basic mission — which is that drug control should be about public health.” With scant mention of the WHO findings, he and the Lindesmith Center continue to tout the alleged successes of heroin-maintenance projects, using experts from Switzerland now in other countries attempting to transplant the Swiss model.

Nadelmann cites the work of Ambros Uchtenhagen, the head of the Swiss program, whose summary of the drug trials was published by Lindesmith in 1997. The summary does not mention that the scientific protocols set up to use double-blind and randomized studies to compare the effectiveness of heroin with other narcotics such as morphine and methadone were discarded after 42 days. This raises grave suspicion since, in a double-blind study, neither researchers nor participants know which substance is received by the subject. The WHO report reveals that both parties in the Swiss trials were aware of which substances were injected.

According to Aeschbach, participants thus may be “choosing” their own drugs, eliminating the possibility of being randomly assigned to a group.

Even Nadelmann’s publication confirms that “the trial quickly determined that virtually all participants preferred heroin, and doctors subsequently prescribed it for them.” In the end, the ratio of heroin users to those of morphine and/or methadone became 8-to-1, respectively.

Initially the target group or sample was to include only the “severely addicted” who were more than 20 years of age — addicts of at least two years duration who had failed in at least two other treatment programs.

As the study progressed, these criteria were not met. For instance, 49 percent of participants had not had any inpatient therapy for their addiction, while another 26 percent had only had one therapeutic experience. Their state of health at the time of recruitment was classified as “good” or “very good” in 79 percent, with 80 percent deemed to be in a good nutritional state.

Only 2 percent were in “very bad” psychological condition.

According to Aeschbach, the volunteers’ overall good health casts doubt on the categorization of these persons as “severely addicted.” Moreover, 18 percent of the sample did not qualify as heroin addicts according to a prescribed criteria of usage, and some 61 percent of participants should not have been included since they were in active treatment programs which had not yet proved unsuccessful.

The alleged positive outcomes attributed to the Swiss drug trials become less conclusive the more they are scrutinized. Many of the reports of reduced crime were in fact “self-reports” from the addicts themselves. Such measurement, without verification, is not scientifically valid.

Also HIV/AIDS testing was not done consistently; thus, the rate of infection could not be determined accurately. And urine testing to check for drug usage was performed only at expected times, making it an unreliable modality for assessment.

While addicts reported improvements in their health and social functioning, there was no control group that received social services but did not take narcotics. As Aeschbach and Satel record, the heroin trials spent almost five times more per patient for social services than is spent on those receiving standard methadone treatment.

And the WHO report concludes that it was not possible to determine whether any positive effects were the result of the heroin maintenance itself or of the psycho-social care.

A summary booklet of the WHO findings graphs drug-related deaths from 1986 through 1998 and explains that these data “very clearly show that the reduction in the number of drug-related deaths is chronologically correlated with the closing of the drug scenes and not with the distribution of heroin to addicts.”

Generally speaking, the studies failed to provide “convincing evidence that, even for persistent methadone failures, the medical prescription of heroin generally leads to better outcomes than further methadone-based treatment.” In the Geneva project, two-thirds of those assigned to a waiting list for the heroin-prescription trials chose not to enroll six months later since they had been stabilized on methadone.

In the words of the WHO panel, “[T]his indicates the need for extreme caution in the prescription of heroin” and suggests that the need for such prescriptions may be lessened if more efforts are made to engage patients in methadone-type programs.

One of the consequences of the Swiss heroin projects has been the marked reduction in the number of people enrolling in residential treatment facilities. In some instances, the caseload decreased by 50 percent. Abstinence-oriented clinics also reported a drop in registration, which forced some to close.

Given the finding that heroin maintenance could not be found to produce better outcomes than more conventional abstinence-oriented treatments, the closing of such treatment facilities is viewed by many as a negative by-product of the experiments.

In response to the Swiss trial data, Dan Schecter, a spokesman for the White House Office of National Drug Control Policy, tells Insight, “Sure. [Take] people who are hard-core addicts and put them in a medicalized environment where they’re getting more-frequent access to medical care [and], of course, you’re going to see some positive outcomes from that. But compare anything they’ve achieved through these heroin-stabilization programs with what drug treatment achieves, and there’s no comparison whatsoever! There are ways to go that achieve much better outcomes by many orders of magnitude compared with simply enabling an addict to be a heroin user.”

For instance, Schecter points to a 1997 study by the National Institute on Drug Abuse in which methadone treatment reduced heroin use by 70 percent during one year, while illegal activity decreased 57 percent among outpatient participants. In addition, a 1998 long-term study of treatment effectiveness by the Substance Abuse and Mental Health Services Administration evaluated outcomes for a national sample of 1.1 million individuals. Five years after discharge from treatment, it found 21 percent fewer users of any illicit drugs.

Longer stays in treatment predicted greater decreases in alcohol abuse, drug use and criminality.

Even if the science of heroin maintenance should someday yield valid findings, the practice of harm reduction which underpins heroin by prescription would remain problematic to many. Satel, for example, has written of “the raw truth about harm reduction [as] the public-policy manifestation of the addict’s dearest wish: to use free drugs without consequence.” And, according to Schecter, “The source of harm is the nature of heroin and what it does to the human brain.

It’s not due to a moral failing on the part of someone, or necessarily to weakness.”

Indeed. A heroin addict of 30 years, now with almost 10 years in recovery, shares his experience with Insight. “I loved being on drugs, I loved it,” he says. “My [dream] was that I was going to be in a rocking chair and have me a home-care nurse who gave me my injections twice a day. But I was ‘dead,’ dead. I didn’t [have an] interest in anything, only heroin.

All I wanted to do was use it.” Now drug-free and working, this former addict claims to have everything he really needs. “I have those things because I stopped using and got back with you guys in this real world.

I used to stand on the street corner saying, ‘Look at that sucker having to go to work in the morning.’ No! We were the suckers, the ones that was using.”

According to Patrick Holzmann, a Swiss surgeon and activist against liberalizing his country’s drug policy, rehabilitating the addict requires abstinence. To him, it stands to reason that a tolerant atmosphere toward drug use, emblemized by the safe-injection room, only will increase the number of persons who try drugs.

In turn, the more people who experiment with drugs, the more who will become addicted.

Holzmann, who also volunteers his time to help prevent the spread of AIDS, denies the claims that new AIDS cases went down with the drug trials and cites the WHO report that, at any rate, inadequate testing made this impossible to prove.

In the end, Holzmann characterizes shooting rooms as “paint over rusty iron.”

The Swiss organization Courage to Take a Moral Stance, known in Europe by the acronym VPM, was at the forefront of the attempt to dissuade the Swiss public from adopting the so-called harm-reduction program.

Its president, Florian Ricklin, is a psychiatrist who is discouraged by the failure of efforts to persuade the Swiss to vote against the program in last year’s referendum. Ricklin tells Insight: “The whole world thinks the Swiss model works, but it doesn’t really.

It’s crazy what we are doing here in Switzerland.”

MAP posted-by: Don Beck

NEW YORK, Aug. 25 – Peruvian officials this week confirmed details of a vast drugs-for-weapons ring involving Russian arms merchants, corrupt diplomats, Jordanian officials and Colombia’s largest rebel movement, a story that was first reported exclusively by MSNBC.com last April.

ON APRIL 9, MSNBC.com reported that Russian crime syndicates and military officers are supplying sophisticated weapons to the Revolutionary Armed Forces of Colombia, known as FARC, in return for huge shipments of cocaine.

The enterprise, described by a senior U.S. intelligence official as “literally an industry” involves giant Russian-built IL-76 cargo planes taking off from various airstrips in Russian and the Ukraine, refueling in Amman with the cooperation of corrupt diplomats and bribed local officials, and then using remote airstrips or parachute air-drops to provide tons of weapons to FARC, a violent insurgent army linked to drug cartels that is battling the Colombian government’s control of large areas of the country.

In exchange, the planes return laden with up to 40,000 kilograms of cocaine, most of which eventually makes its way into the former Soviet Union, Europe and the Persian Gulf.

Fujimori Offers Details

On Monday, Peru’s President Alberto Fujimori announced that his shadowy security adviser Vladimiro Montesinos had broken a smuggling ring supplying Jordanian arms to Colombian rebels. The ring, which officials said was headed by a retired Peruvian army lieutenant, used parachutes to drop at least 10,000 Russian-made automatic rifles obtained in the Middle East into rebel-held Colombian territory between March and July of 1999. Montesinos said that the Jordanian arms were shipped from the Canary Islands to Guyana and finally to Peru’s northern Amazon city of Iquitos, passing over southern Colombia.

The announcement drew an angry reply from Jordan, which denied any illegal activity. It was also denounced in Peru by opposition figures, who view it as a distraction from Fujimori’s current political troubles.

A senior Jordanian government official said in an interview with the Associated Press on Thursday that the arms were sold in 1998 through legal channels and that Jordan was willing to show Peruvian government officials all the documents pertaining to the deal.

The Ukrainian Connection

The Peruvian announcement did not touch on the Russian connection to the arms shipments, although U.S. intelligence officials, all of whom spoke to MSNBC.com on condition of anonymity, said the Russian involvement is substantial, the scope of which remains unknown to all but a few high-ranking figures in the American government.

“The source of the weapons is both organized crime and military. There is a tremendous gray area between the two in Russia and the Ukraine.”

After the fall of the Berlin Wall, many KGB and other Soviet security agents appropriated bank accounts, companies and contacts used for covert operations, and turned them instead into conduits for their own organized crime activities, including arms and drug trafficking.

Refueling In Jordan

Officials close to the investigation cited intelligence intercepts that show the IL-76 cargo planes use Royal Jordanian Airlines cargo facilities in Amman, where airline officials are bribed to ignore false cargo manifests. While in Amman, the planes are cleared for transit under diplomatic cover originating from a Spanish-speaking embassy in Amman, according to U.S. intelligence officials.

“They’re using diplomatic authority to get that stuff in,” said a senior U.S. intelligence official close to the investigation. “If they’re not using a [diplomatic] pouch, they’re using diplomatic authority to clear the shipment. This is a big operation. There are a lot of people involved – it’s literally an industry.”

Once the planes have refueled in Amman, they fly to various landing strips throughout South America, where shipments are coordinated by a renegade Peruvian military officer, whose role was confirmed by Fujimori on Monday.

The FARC rebels, who control the distribution of the arms, pay the smugglers with cocaine, which is loaded onto the planes for the return journey through Amman. Hundreds of thousands of kilos of cocaine have been smuggled over the last two years. And at up to $50,000 per kilo, the payoff can be huge for the Russian crime groups, which smuggle most of the Colombian cocaine into the European heartland, usually via Spain.

U.S. Aid To Battle Colombia’s Cartels

The latest details about the arms-for-drugs smuggling ring put the spotlight again on Colombia’s losing battle against the well-armed cocaine cartels that operate with impunity in large sections of the country.

This week, overriding opposition from human rights groups, U.S. President Bill Clinton released $1.3 billion in aid to Colombia to fight its drug trade and he travels to Cartagena next Wednesday to meet President Andres Pastrana. According to U.S. officials, the aid package includes a few hundred U.S. military advisers who will go to Colombia to train special battalions in fighting the drug trade. But their presence is also likely to draw the attention of the guerrillas, whose weaponry, according to intelligence officials, include rocket-propelled grenade launchers (RPGs) and Russian SA-model shoulder-mounted anti-aircraft weapons similar to the U.S. Stinger missiles.

“[The guerrillas] get the RPG to explode in the vicinity of the tail rotor, which gives the helicopter its horizontal stability,” said a U.S. Army official. “All that has to happen is for the tail rotor to become a bit unbalanced or for a hydraulic line to be cut, and that helicopter is coming down. It takes good aim and cases full of RPGs, but it’s been done many times.”

However, National Security Advisor Sandy Berger on Thursday denied that the aid allocation would lead to the “Vietnamization” of Colombia. American involvement in Vietnam began with the dispatch of military advisers and ended with the deaths of around 50,000 U.S. troops.

“I think you can get paralyzed by the foreign policy of analogy,” Berger said. “You should learn from what happened before. But the fact is this is nothing similar whatsoever. We’re talking about a few hundred American people going to train some Colombian army battalions.”

Berger said the training would allow the battalions to provide security for the national police to go into the areas where the drug problem is most pervasive and destroy crops and laboratories.

MAP posted-by: Richard Lake

Clostridium novyi Type A is the name of the bacteria which health experts believe caused the deaths of the 36 injecting heroin users.

Experts at the Public Health Laboratory Service in Cardiff, Wales, and at the Centre for Disease Control in Atlanta, Georgia, are now satisfied that the bacteria clostridium novyi Type A is the source of the illness which baffled health chiefs since it first emerged in Glasgow on April 19.

Professor Brian Duerden, medical director of the Public Health Laboratory Service said: ”Clostridium novyi Type A is well known as a cause of severe infection in domestic animals but rarely does so in humans.

”As far as we know, this is the first time this bacteria strain has ever caused an outbreak of infection in drug injectors.”

The bacterium was first identified at the beginning of the last century and was responsible for thousands of deaths during the First World War.

A spokesman for the Greater Glasgow Health Board said: “Our suspicion is that these clostridium have been in the heroin that the patients have been injecting. We might be talking about bacteria, but basically this is a human tragedy.”

He said the new cases which emerged in recent days show the bad batch of heroin is still in use.

The bacteria, which is not always fatal, has killed more than 50% of those who have contracted it since April.

Eight of the 15 heroin addicts who were infected in Dublin died, along with 20 of the 43 addicts infected in Glasgow, and nine of the 16 victims in England and Wales.

The bacteria’s spores can lie dormant in soil for months or years, and only become active in very particular circumstances, as the bacteria can only live in an oxygen free environment.

The illness has only affected drug users who inject heroin directly into muscle as opposed to a blood vein and women seem to be more susceptible than men to the illness.

Experts believe that the injection site may have dead tissue close by, which has no oxygen supply and allows the spores to activate and grow.

The scientists also speculate that the citric acid often added to the drug before injecting may help activate the dormant spores.

The bacteria does not cause problems but powerful toxins they release travel throughout the body wreaking havoc with vital organs including the heart.

Medical experts urge addicts with symptoms to get to hospital quickly. The infection is difficult to treat, even with modern antibiotics, but surgeons may be able to cut away the dead tissue containing the bacteria to save patients.

MAP posted-by: Keith Brilhart

records of suspected gunmen and drug traffickers on the Internet in a bid to get public help to arrest them, police said on Monday.

Police webmaster Nathathorn Prousunthorn said the police hoped the public would tip them off if they saw the faces of wanted criminals.

“Information on criminals was previously known only to a small group of people,” said Nathathorn.

“Now the data is on the Internet, not only the public, but also police officers from different units know who to arrest.”

Mugshots and the records of about 20 suspects have been put on the website (http://www.specialcrime.police.go.th).

He said the United Nations’ Drug Control Programme would support the project financially after Thai police officers spent thousands of dollars of their own money setting up the website.

MAP posted-by: Allan Wilkinson

WASHINGTON – The White House Office of National Drug Control Policy has taken its anti-drug message to the Internet, and it is secretly tracking those who find it in the process.

Search for drug terms like “grow pot” on some Internet sites, and an ad banner that pops up from the drug office may drop a “cookie” program in your computer that tracks your online activities.

“It’s sort of spooky,” said Internet consultant Richard Smith, a privacy advocate and former software engineer.

But despite what one critic called “Big Brother” tactics, the White House drug office says there’s nothing surreptitious going on. The computer cookies are simply tracking its anti-drug media campaign.

“Cookies” are personal identifiers used to track the Web sites that computer users visit and what they buy. They identify Internet surfers by the service they are using to get access to the Internet, and can be matched with other information online to provide personal identification. Cookies are secretly inserted in personal computers when surfers visit certain Web sites.

Smith said he inadvertently discovered the U.S. government cookies being dropped into his computer while doing Internet research for pharmaceutical companies.

White House ads offering information on marijuana pop up when Internet users search for certain words connected to drugs on Internet search engines like AltaVista or Lycos. The banner ads steer users to the anti-drug site Freevibe.com, which is operated by the White House drug office. A tracking cookie is inserted in the user’s personal computer as the site is activated.

A Doubleclick Connection

Although Freevibe’s privacy notice states that “no information, including your e-mail address, will be sold or distributed to any other organization,” the site is connected to Doubleclick.com. Officials of Doubleclick, a New York advertising firm that is one of the largest companies gathering data on Internet user use, told the Senate Commerce Committee last week it is developing new products that will profile more than 40 million Internet users.

Freevibe’s site says the White House drug office will collect the e-mail address “only so we can identify your submission.” It does not disclose that it will drop a cookie program in the personal computers of visitors to the site.

Donald Maple, senior policy analyst with the White House drug office, said the cookie programs are part of the banner advertising campaign run through the New York advertising firm Ogilvie and Mather. He said the government is not getting personal information on visitors to the site.

‘Didn’t Know It Was There’

“We have a specific agreement with Ogilvie and Mather that they will not provide personal identification,” Maple said. He said the advertising company uses the data to determine which banner ads are effective, and to tailor the ads to attract more visitors.

Maple admitted one of the anti-drug sites operated by the White House drug office and visited by 240,000 parents a month seeking information on drug abuse is itself inserting cookies into the computers of visitors. He said the drug office did not know this until a reporter pointed it out, and Tuesday ordered the contractor to disable the program.

“We didn’t know it was there,” Maple said. “It won’t be shortly.”

‘Not Tracking Individuals’

Gary Towning, director of the Office of National Drug Control Policy account at Ogilvie and Mather, said the use of cookies started only this month “to help us better understand if the (ad) banners are driving people to our site.” He said the advertising firm has also bought the rights to link the drug office’s ads with several words typed in on search engines, including the word “pot.”

“We’re not tracking individuals. There’s nothing identifying here,” he said. “We’re trying to understand our media campaign.”

Civil liberties lawyers said government tracking of Internet users could raise constitutional questions involving issues of searches without a warrant, and questioned why the government is monitoring citizen’s Internet activities.

‘A Case Of Big Brother’

“This is nothing like what was envisioned by members of Congress,” said Eric Sterling, former counsel to the House Judiciary Committee. Sterling worked with the panel in 1988 when it drafted the law creating the White House Office of National Drug Control Policy to coordinate the government’s anti-drug-use policies.

“This is what is fairly called a case of Big Brother, you know as in ’1984′ where the government is clandestinely tracking you,” said Sterling, now president of the Criminal Justice Policy Foundation lobbying group.

Maple rejected concerns of civil liberties lawyers.

“I can’t see anything wrong with it at all,” he said, adding that the Internet is an ideal technology to reach young people with anti-drug messages.

MAP posted-by: Eric Ernst

Drug addicts are not criminals per se, they are victims, and their criminality flows from being a victim. Illegality keeps the price of illegal drugs high and, therefore, forces addicts into crime to feed their habit. Illegality keeps the trade highly profitable. Illegality also encourages addicts to delay seeking help.

Prevention, harm minimisation and treatment are complementary approaches to the problem. Injecting rooms are merely the lifeboats into which addicts can be pulled so that their lives can be saved. Offers of effective help should be the next step.

By definition, addicts need their drug. Supply an addict with their drug of choice, legally and under strict control, and you immediately break the nexus between addiction and criminality. Once an addict has his/her need for a drug met, then he/she is available to consider a range of options for recovery including the decision to stay on a drug of addiction if he/she cannot succeed in becoming drug free.

The most successful drug maintenance program I have come across was a small, rural heroin maintenance program run by a very sane and humane British GP. He was supporting 18 addicts, all of whom were stable and crime-free. The Home Office finally closed the program.

The GP’s epitaph for it was that all of his patients would be dead in 12 months. All but two of them were.

Paul Edwards, Balgowlah Heights.

MAP posted-by: Allan Wilkinson