Transcript Medical Consequences of the Drug War

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
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?
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
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
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
Where do “Drugs” Come from?
• Some of natural origin
• Some synthetic
• 10 major banned biota
Chacruna (Psychotria viridis) Yage (Basinsteriopsis caapi)
AYAHUASCA
Erythoxylum coca
Catha edulis
Cannabis sativa
White opium poppy (Papeverium somniferum)
Iboga (Tabernanthe iboga)
Salvia divinorum
Peyote (Lophophora williamsi)
Psilocybe azurescens spores
NaHCO3 (baking soda)
Cocaine (1860)
crack
opium
opium gum
Morphine (1805)
No. 3 heroin (20-30% purity)
(CH3CO)2O (anhydrous vinegar)
No. 4 heroin (80-90% purity) (1898)
marijuana
hash(ish)
DEA Briefing Book 2001
$6.00
1970
$3.90
1.5 %
3.6%
$0.80
38 %
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.
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.”
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.”
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.
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.)
“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
A War in Pictures
80000
70000
60000
50000
40000
30000
20000
10000
0
All Incarcerated Drug Offenders
600000
67000
500000
500000
Number
Number
Federal Drug Offenders in Prison
400000
300000
200000
100000
3400
42000
0
1970
2001
1980
Year
Year
2003 Drug Arrests
2004
2001 Federal Drug Abuse Budget
Prevention &
Treatment
25%
All Other 19%
Possession
81%
Arrest &
Sanction
75%
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 SubSaharan 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
Medical Marijuana Apartheid
Failed Back Surgery Syndrome
AIDS and N-H Lymphoma
Rheumatoid Arthritis
Quadriplegic
Paraplegic
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…”
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
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 the components of the right to
health;
DEA Staffing and Appropriations
FY 1973-2000
Employees Tripled
Total
Special Suppor
Year Employee Agents t Staff
s
197
2,898
2,898
3
9,132
1,470
1,428
Budget
($ in
Millions)
$75
74.9
$1,550,000,000
200
9,132 - 20
4,561times
4,571 larger
1,550
Budget
Annual US Arrests
Yr
Cannabis Possess.*
Violent Crime†
'05
696,074
603,503
'04
684,319
590,258
'03
662,886
597,026
'02
613,986
620,510
'01
641,109
627,132
'00
646,042
625,132
Police Militarization due to War on
•Arrests only include personal possession,
Drugs:
not sales, trafficking, or manufacturing..
Over 90% of cities with populations
•† includes homicide, rape, robbery, and
over 50,000, and 70% of smaller
assault.
cities, have paramilitary units in their
police departments, sometimes
equipped with tanks, grenade
launchers and helicopters.”
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