Showing posts with label drugs. Show all posts
Showing posts with label drugs. Show all posts

Tuesday, March 5, 2024

Oregon is re-criminalizing drugs

 The war on drugs is unforgiving, and neither criminalization nor decriminalization seems to be a winning strategy.  The NYT has the latest from Oregon, where there were high hopes for decriminalization and harm reduction, and where there are now second thoughts. 

Oregon Is Recriminalizing Drugs, Dealing Setback to Reform Movement. Oregon removed criminal penalties for possessing street drugs in 2020. But amid soaring overdose deaths, state lawmakers have voted to bring back some restrictions.  By Mike Baker

"Three years ago, when Oregon voters approved a pioneering plan to decriminalize hard drugs, advocates looking to halt the jailing of drug users believed they were on the edge of a revolution that would soon sweep across the country.

"But even as the state’s landmark law took effect in 2021, the scourge of fentanyl was taking hold. Overdoses soared as the state stumbled in its efforts to fund enhanced treatment programs. And while many other downtowns emerged from the dark days of the pandemic, Portland continued to struggle, with scenes of drugs and despair.

"Lately, even some of the liberal politicians who had embraced a new approach to drugs have supported an end to the experiment. On Friday, a bill that will reimpose criminal penalties for possession of some drugs won final passage in the State Legislature and was headed next to Gov. Tina Kotek, who has expressed alarm about open drug use and helped broker a plan to ban such activity.

“It’s clear that we must do something to try and adjust what’s going on out in our communities,” State Senator Chris Gorsek, a Democrat who had supported decriminalization, said in an interview. Soon after, senators took the floor, with some sharing stories of how addictions and overdoses had impacted their own loved ones. They passed the measure by a 21-8 margin."

Monday, February 26, 2024

Prison gangs, in Latin America and in the U.S.

 It's one thing to be able to capture and confine prisoners. When gangs are involved, it's quite another thing to control the prisons, or the ability of prisoners to continue to control gang activity outside of prison.

The NYT has the story, from Latin America:

In Latin America, Guards Don’t Control Prisons, Gangs Do. Intended to fight crime, Latin American prisons have instead become safe havens and recruitment centers for gangs, fueling a surge in violence. By Maria Abi-Habib, Annie Correal and Jack Nicas

"Inside prisons across Latin America, criminal groups exercise unchallenged authority over prisoners, extracting money from them to buy protection or basic necessities, like food.

"The prisons also act as a safe haven of sorts for incarcerated criminal leaders to remotely run their criminal enterprises on the outside, ordering killings, orchestrating the smuggling of drugs to the United States and Europe and directing kidnappings and extortion of local businesses.

"When officials attempt to curtail the power criminal groups exercise from behind bars, their leaders often deploy members on the outside to push back.

“The principal center of gravity, the nexus of control of organized crime, lies within the prison compounds,” said Mario Pazmiño, a retired colonel and former director of intelligence for Ecuador’s Army, and an analyst on security matters.

“That’s where let’s say the management positions are, the command positions,” he added. “It is where they give the orders and dispensations for gangs to terrorize the country.”

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I wrote a related post in November (see below) about a Brazilian prison gang, and received an illuminating email from Professor David Skarbek of Brown University, saying

"I enjoyed your blog post about the PPC Brazilian prison gang. I thought that you might be interested to know that the same phenomenon exists in the US as well. I'm attaching a piece I published in the American Political Science Review on the Mexican Mafia in Southern California."

Here's the link to that article:

Skarbek, David. "Governance and prison gangs." American Political Science Review 105, no. 4 (2011): 702-716.

Abstract: How can people who lack access to effective government institutions establish property rights and facilitate exchange? The illegal narcotics trade in Los Angeles has flourished despite its inability to rely on state-based formal institutions of governance. An alternative system of governance has emerged from an unexpected source—behind bars. The Mexican Mafia prison gang can extort drug dealers on the street because they wield substantial control over inmates in the county jail system and because drug dealers anticipate future incarceration. The gang's ability to extract resources creates incentives for them to provide governance institutions that mitigate market failures among Hispanic drug-dealing street gangs, including enforcing deals, protecting property rights, and adjudicating disputes. Evidence collected from federal indictments and other legal documents related to the Mexican Mafia prison gang and numerous street gangs supports this claim.

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Earlier

Tuesday, November 21, 2023

Wednesday, January 24, 2024

Guns and drugs on the U.S. Mexico border

 Here are two stories about some of the illegal traffic on the border between the U.S. and Mexico.

First, the war on drugs is fought with American guns on both sides:

The NY Times has the story:

Appeals Court Revives Mexico’s Lawsuit Against Gunmakers. The decision, which is likely to be appealed, is one of the most significant setbacks for the gun industry since passage of a federal law that provided immunity from some lawsuits.  By Glenn Thrush  Jan. 22, 2024

"A federal appeals panel in Boston ruled on Monday that a $10 billion lawsuit filed by Mexico against U.S. gun manufacturers whose weapons are used by drug cartels can proceed, reversing a lower court that had dismissed the case.

"The decision, which is likely to be appealed, is one of the most significant setbacks for gunmakers since passage of a federal law nearly two decades ago that has provided immunity from lawsuits brought by the families of people killed and injured by their weapons.

"Mexico, in an attempt to challenge the reach of that law, sued six manufacturers in 2021, including Smith & Wesson, Glock and Ruger. It contended that the companies should be held liable for the trafficking of a half-million guns across the border a year, some of which were used in murders.

...

" lawyers for Mexico, assisted by U.S. gun control groups, claimed that the companies “aided and abetted the knowingly unlawful downstream trafficking” of their guns into Mexico.

"Gun violence is rampant in Mexico despite its near-blanket prohibition of firearms ownership.

"About 70 to 90 percent of guns trafficked in Mexico originated in the United States, according to Everytown Law, the legal arm of the gun control group founded by the former mayor of New York Michael R. Bloomberg.

"Gun control advocates hailed the decision on Monday by a three-judge panel, describing it as a milestone in holding the gun industry accountable."

***********

As for drugs, it turns out that harm reduction drugs are highly controlled in Mexico, so illegal drugs also flow both ways.

Here's that story, from the Guardian:

Carriers sneak life-saving drugs over border as Mexico battles opioid deaths  People forced to bring overdose-reversal drug naloxone from US, as critics accuse Mexican government of creating shortage. by Thomas Graham in Tijuana, Tue 23 Jan 2024 

"Every day, people cross the US-Mexico border with drugs – but not all of them are going north. Some head in the opposite direction with a hidden cargo of naloxone, a life-saving medicine that can reverse an opioid overdose but is so restricted as to be practically inaccessible in Mexico.

"This humanitarian contraband is necessary because Mexico’s border cities have their own problems with opioid use – problems that activists and researchers say are being made more deadly by government policy.

“Mexico has long seen itself as a production and transit country, but not a place of consumption,” said Cecilia Farfán Méndez, a researcher at the University of California at San Diego. “And a lot of the conversation is still around that being a US problem – not a Mexican one.”

...

"The situation has been exacerbated by a government policy that, aside from cutting budgets for harm reduction services like PrevenCasa, has also created shortages of life-saving medicines for opioid users.

"In response to the fentanyl crisis, authorities in the US made naloxone available without a prescription. Naloxone vending machines have proliferated across the country.

"But in Mexico naloxone remains strictly controlled – despite the efforts of some senators from Andrés Manuel López Obrador’s own party, Morena, who proposed a law to declassify it.

"The president, popularly known as Amlo, has criticised naloxone, asking whether it did any more than “prolong the agony” of addicts, and questioning who stood to profit from its sale."

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Earlier:

Sunday, January 22, 2023

Tuesday, January 23, 2024

The war on drugs is a war

The war on drugs doesn't begin at U.S. borders.

Here's a dispatch from Ecuador, in the WSJ:

Ecuador Is at War With Drug Gangs, President Says. Troops patrolled the country’s largest city a day after a series of attacks against the new government  By Kejal Vyas and Ryan Dubé

"Ecuador is at war with drug gangs, President Daniel Noboa said Wednesday, as troops patrolled the country’s largest city, Guayaquil, a day after gunmen took over a TV studio and launched a series of attacks against the Andean nation’s new government.

“We are in a noninternational armed conflict,” Noboa said in a radio interview. “We are in a state of war. We cannot give in to those terrorist groups.”

"The armed forces and national police scrambled to bring order to Guayaquil, and shops and schools were closed after a series of coordinated attacks Tuesday on shopping centers, hospitals and a university left at least 11 people dead.

"Drug-trafficking gangs in recent years have turned Ecuador into one of the world’s most violence-plagued nations as they battled over the cocaine trade.
...
" Once relatively peaceful, Ecuador has seen the homicide rate shoot up from less than six per 100,000 in 2018 to more than 40 in 2023, said police."
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And here's one from Belgium, in the Washington Post:

Belgian customs officers seized three times as much cocaine in the port of Antwerp last year as U.S. customs and border officials seized in all of the United States.  By Gerrit De Vynck

"The head of Belgium’s customs service said in an interview that especially big seizures in the fall appeared to have prompted a violent backlash, along with a new issue: Authorities haven’t always been able to destroy what they’ve confiscated before drug gangs try to steal it back.

“Attacking the police, attacking the customs, this is not something you see in Europe,” said Kristian Vanderwaeren, director general of Belgium’s customs agency. “I was really afraid that my people would be killed if this would continue.”
...
"“The criminal organization was not afraid to come to a facility and capture their cocaine, even if it meant they would kill a customs officer,” Vanderwaeren said.
...
"According to Europol, the European Union’s law enforcement agency, Ecuador and its main port of Guayaquil have been the biggest sources of cocaine destined for Europe, reflecting how Mexican and Albanian gangs have infiltrated the country. This month, the president of Ecuador declared a “state of war” against drug gangs, after a series of assassinations, prison breaks and bombings there."



Saturday, December 30, 2023

Some year-end good news: U.S. homicides are down

To put deaths in their grim perspective, we have a lot more deaths from drug overdoses than from homicides.  But we're headed in the right direction on one of those. 

The NYT has the story:

After Rise in Murders During the Pandemic, a Sharp Decline in 2023. The country is on track for a record drop in homicides, and many other categories of crime are also in decline, according to the F.B.I. By Tim Arango and Campbell Robertson  Dec. 29, 2023

"In 2020, as the pandemic took hold and protests convulsed the nation after the murder of George Floyd by a police officer in Minneapolis, the United States saw the largest increase in murders ever recorded. Now, as 2023 comes to a close, the country is likely to see one of the largest — if not the largest — yearly declines in homicides, according to recent F.B.I. data and statistics collected by independent criminologists and researchers.

"The rapid decline in homicides isn’t the only story. Among nine violent and property crime categories tracked by the F.B.I., the only figure that is up over the first three quarters of this year is motor vehicle theft. The data, which covers about 80 percent of the U.S. population, is the first quarterly report in three years from the F.B.I., which typically takes many months to release crime data.

Thursday, December 28, 2023

Limitations of harm reduction: will Oregon recriminalize drug use?

 The NYT has the story:

To Revive Portland, Officials Seek to Recriminalize Public Drug Use. State and local leaders are proposing to roll back part of the nation’s pioneering drug decriminalization law and step up police enforcement.  by Mike Baker

"After years of rising overdoses and an exodus of business from central Portland, Oregon Gov. Tina Kotek said on Monday that state and city officials are proposing to roll back a portion of the nation’s most wide-ranging drug decriminalization law in a bid to revive the troubled city.

"Under the plan brokered by Gov. Kotek, a Democrat, state lawmakers would be asked to consider a ban on public drug use and police would be given greater resources to deter the distribution of drugs. Ms. Kotek said officials hoped to restore a sense of safety for both visitors and workers in the city’s beleaguered urban core, which has seen an exodus of key retail outlets, including REI, an institution in the Pacific Northwest.

“When it comes to open-air drug use, nobody wants to see that,” Ms. Kotek said in an interview. “We need different tools to send the message that that is not acceptable behavior.”

...

"Oregon voters in 2020 approved the nation’s first law decriminalizing possession of small amounts of hard drugs, including fentanyl, heroin and methamphetamines. The ballot measure sought to end the use of jail as a punishment for drug users and instead treat addiction as a health issue. The effort was to be joined with major new investments in drug treatment, but those new systems have been slow to develop.

...

"Last month, Seattle implemented a new law that prohibits possession of drugs and public use.

...

"Ms. Kotek’s task force does not have the power to immediately ban public drug use, but the panel called for the Legislature to take up the issue in the coming session along with changes that could reduce barriers to prosecuting those who deliver drugs. Lawmakers have already been discussing potential changes to the decriminalization law."

Thursday, December 7, 2023

Drug addiction: not just opioids

 Consumption of addictive drugs seems to come in deadly cocktails these days, which is making interdiction of drugs, and treatment of addiction more complicated.

The NYT has the story:

‘A Monster’: Super Meth and Other Drugs Push Crisis Beyond Opioids. Millions of U.S. drug users now are addicted to several substances, not just opioids like fentanyl and heroin. The shift is making treatment far more difficult.  By Jan Hoffman

"The United States is in a new and perilous period in its battle against illicit drugs. The scourge is not only opioids, such as fentanyl, but a rapidly growing practice that the Centers for Disease Control and Prevention labels “polysubstance use.”

Over the last three years, studies of people addicted to opioids (a population estimated to be in the millions) have consistently shown that between 70 and 80 percent also take other illicit substances, a shift that is stymieing treatment efforts and confounding state, local and federal policies.

“It’s no longer an opioid epidemic,” said Dr. Cara Poland, an associate professor at the Michigan State University College of Human Medicine. “This is an addiction crisis.”

...

"The incursion of meth has been particularly problematic. Not only is there no approved medical treatment for meth addiction, but meth can also undercut the effectiveness of opioid addiction therapies. Meth explodes the pleasure receptors, but also induces paranoia and hallucinations, works like a slow acid on teeth and heart valves and can inflict long-lasting brain changes.


"The Biden administration has been pouring billions into opioid interventions and policing traffickers, but has otherwise lagged in keeping pace with the evolution of drug use. There has been comparatively little discussion about meth and cocaine, despite the fact that during the 12-month period ending in May 2023, over 34,000 deaths were attributed to methamphetamine and 28,000 to cocaine, according to provisional federal data.

...

"Like opioids, which originally came from the poppy, meth started out as a plant-based product, derived from the herb ephedra. Now, both drugs can be produced in bulk synthetically and cheaply. They each pack a potentially lethal, addictive wallop far stronger than their precursors."

Tuesday, November 21, 2023

Balance of violence: prison-based criminal cartels, the case of Brazil's PCC.

The vexed relationship between banned markets and black markets is perhaps nowhere clearer than when prison based gangs of convicted drug dealers are able to extend their empires outside of prisons. While national authorities are able to capture, convict and imprison gang leaders, those gangs retain the ability to organize violence not only inside prisons but outside of them, and hence operate national and international black markets as well.

The Guardian has the story:

How a Brazilian prison gang became an international criminal leviathan  by Tom Phillips

"The PCC – First Capital Command – arose in the country’s notoriously brutal penitentiaries 30 years ago but now controls a billion-dollar drug trade supplying much of Europe’s cocaine,

...

"For much of its 30-year existence the PCC has been considered a jailhouse fraternity, which recruited incarcerated “brothers” such as the Venezuelan by offering them protection within Brazil’s violent, overcrowded prisons. Created in August 1993, it grew into Brazil’s most feared criminal faction, conquering drug markets, smuggling routes, shantytowns and prisons across Brazil, including in far-flung corners of the Amazon. It also became a major player in other South American countries such as neighbouring Paraguay where the group has been blamed for multimillion-dollar armed robberies and bombings and targeted assassinations.

But over the past five years, investigators say the PCC – which the US now calls one of the world’s most powerful organized crime groups – has morphed into an even more formidable force after forging lucrative alliances with partners ranging from Bolivian cocaine producers to Italian mafiosi. Today, the group boasts tens of thousands of members and has a growing portfolio of interests, including illegal goldmines in the Amazon. It controls one of South America’s most important trafficking routes – linking Bolivia and Brazil to Europe and Africa – and is partly responsible for a tsunami of cocaine that has brought car bombings, assassinations and gunfights to parts of Europe.

...

"During the 1990s, the PCC tightened its grip on São Paulo’s prison system but largely flew under the radar until thousands of guards and visitors were captured during a massive 2001 uprising. Five years later the group again made headlines, bringing São Paulo to a virtual standstill with a wave of coordinated attacks on police that caused hundreds of deaths.

...

"Having dominated much of Brazil’s domestic drug market – and established a monopoly over São Paulo’s crime scene – Gakiya said the PCC began looking overseas in late 2016. Deals were struck with Italy’s most powerful mafia group, the ’Ndrangheta, as well as Serbian and Albanian mafias, and the PCC began shipping tonnes of cocaine from Brazilian ports to Europe.

...

"Marcola, 55, who is serving a 342-year prison sentence for murder, robbery and drug trafficking, is also not a man to be crossed. In late 2018, Gakiya decided to transfer him to a high-security federal prison after the discovery of an audacious multimillion-dollar plot to free him with the help of foreign mercenaries, helicopters and anti-aircraft guns. “I knew it might change my life but I also realized it needed doing,” the prosecutor said, admitting he did not consult his family first.


Gakiya was no stranger to death threats, but moving Marcola turned his life upside down. PCC leaders issued a “decree” calling for the prosecutor’s assassination, condemning Gakiya to a reclusive existence he compared to the life of Giovanni Falcone, the anti-mafia crusader assassinated in 1992. “I hope, of course, not to share the same fate as Falcone,” added Gakiya..."

Wednesday, November 1, 2023

The broken market for antibiotics, continued

 Not only is the market for new antibiotics broken, companies that explore them are going broke.

Here's a story from the WSJ:

The World Needs New Antibiotics. The Problem Is, No One Can Make Them Profitably.  New drugs to defeat ‘superbug’ bacteria aren’t reaching patients   By Dominique Mosbergen

"The push for antibiotics to fight fast-evolving superbugs is snagging on a broken business model. 

"Six startups have won Food and Drug Administration approval for new antibiotics since 2017. All have filed for bankruptcy, been acquired or are shutting down. About 80% of the 300 scientists who worked at the companies have abandoned antibiotic development, according to Kevin Outterson, executive director of CARB-X, a government-funded group promoting research in the field.  

...

"The reason, the companies say: They couldn’t sell their lifesaving products because the system that produces drugs for cancer and Alzheimer’s disease—which counts on companies selling enough of a new treatment or charging a high enough price to reward investors and make a profit—isn’t working for antibiotics. 

New antibiotics are meant to be used rarely and briefly to defeat the most pernicious infections so bacteria don’t develop resistance to them too quickly. Companies have priced them at 100 times as much as the generic antibiotics doctors have prescribed for decades that cost a few dollars per dose. Most have sold poorly. 

...

"Most large pharmaceutical companies aren’t developing antibiotics. Several have closed or divested antibiotic development programs. “There’s no profitability,” Hyun said. "


Saturday, October 28, 2023

Magic mushrooms as therapy

 The legal use of psychedelics in therapy is growing.

The NYT has the story:

A New Era of Psychedelics in Oregon. The state has pioneered a therapeutic market for psychedelic mushrooms. Researchers are watching with a mix of excitement and unease.  By Mike Baker

"Stigmatized in law and medicine for the past half-century, psychedelics are in the midst of a sudden revival, with a growing body of research suggesting that the mind-altering compounds could upend psychiatric care. Governments in several places have cautiously started to open access, and as Oregon voters approved a broad drug decriminalization plan in 2020, they also backed an initiative to allow the use of mushrooms as therapy.

...

"For those who have long worked on psychedelics research, the sudden expansion in access in Oregon and Colorado, along with cities like Denver, Detroit, Minneapolis and Washington, D.C., have prompted a mix of elation and trepidation. Oregon has settled on a middle-of-the-road approach, requiring neither a doctor’s supervision nor a specific medical diagnosis, but providing for strict oversight of supply and use.

...

"While some form of legalized marijuana is authorized in all but 12 states, creating a huge, multi-billion-dollar industry, the psilocybin market remains small, with an uncertain financial outlook for those entering it. Only five businesses are approved to manufacture the therapeutic-use fungi in Oregon, with 13 sites approved to host dosing sessions.

...

"Officials in other states are watching what happens in Oregon. Voters in Colorado approved a measure last year to decriminalize psilocybin and to set the state on the path to a legal therapeutic market. In other states, including Texas, lawmakers have authorized studies of psilocybin for treating ailments such as PTSD. The F.D.A. has granted the drug “breakthrough therapy” status, which allows for expedited review of substances that have demonstrated substantial promise.

"But there is uncertainty about the best path forward. California lawmakers approved a bill this year to decriminalize several hallucinogens, but Gov. Gavin Newsom vetoed the measure, saying the state needs to first set up regulated treatment guidelines. The American Psychiatric Association has urged caution, saying treatments should be limited to research studies for now."

Friday, October 13, 2023

Fentanyl

 The NY Times has the story:

Some Key Facts About Fentanyl. It’s lowering American life expectancy and influencing the nation’s politics. By Josh Katz, Margot Sanger-Katz and Eileen Sullivan

"Overdose deaths have been increasing in the United States for decades, but the introduction of fentanyls has led to a staggering rise, accounting for the vast majority of overdose deaths in recent years.


"Around 77,000 Americans died from overdoses involving synthetic opioids like fentanyl in the 12-month period ending in April of this year, according to provisional estimates from the Centers for Disease Control and Prevention. In 2022, the most recent year with complete data, this number was around 74,000. Those three wars  [Vietnam, Iraq and Afghanistan] killed a little over 65,000 Americans combined.

"For comparison, around 55,000 Americans died in 1972 from car crashes, the year with the most such deaths. Around 49,000 died from guns in 2021 (including suicide), the year with the most such deaths.

"Fentanyl alone has become a leading cause of U.S. deaths. It was responsible for a third of deaths among Americans 25 to 34 in 2022, according to a New York Times analysis of C.D.C. mortality data.

...

"Most of the fentanyl sold in the United States is coming from Mexico, where drug cartels synthesize the drugs from precursor chemicals believed to come from factories in China. Some fentanyls are also shipped directly from China into the United States."

Thursday, September 21, 2023

Drugs, drug economics, and violence in Colombia and Ecuador, as Colombia withdraws from the war on drugs

 Fighting a war on drugs hasn't yielded clear successes (at any point in the supply chain), but surrendering is no picnic either. The WSJ has the story from Colombia, and the Guardian reports on the situation in Ecuador.

Here's the WSJ story:

Colombian Cocaine Production Sees Record Surge. The country’s output of the drug, which reaches far corners of the world, rises 24%, U.N. says. By Juan Forero

"Colombia has set a record in the estimated production of cocaine, the United Nations said Monday, as President Gustavo Petro’s government tries a less punitive approach to fighting drugs.

"The amount of cocaine manufactured in Colombia, the world’s largest producer, rose to 1,738 tons in 2022, compared with 1,400 tons the year before, a 24% increase, with the cocaine shipped not only to the U.S. but increasingly to Europe and other continents, said officials presenting the U.N. Office on Drugs and Crime’s annual report on Colombia’s cocaine trade. Some 22 million people worldwide consume the drug.

...

"The size of Colombia’s coca fields and the production of cocaine has been rising fast since 2013, when the government of then-President Juan Manuel Santos began a process that by 2015 phased out a U.S.-sponsored program to spray coca fields from crop dusters with the herbicide glyphosate. 

...

"The leftist government of Petro, who took office 13 months ago, has characterized the war on drugs as a failure and veered away from a hard-line approach to dealing with coca farmers. For Colombia to reduce cocaine production to 900 tons by 2026, Justice Minister Néstor Iván Osuna, said Bogotá would hold negotiations with armed groups, build roads and provide social services. The state also offered assistance for the so-called cocaleros, or farmers, to produce legal crops.

...

"There is additional cause for concern, he said, because of the increasing importance to traffickers of 15 so-called “productive enclaves,” which make up only 14% of all the land dedicated to coca but produce 44% of all the coca in Colombia. In those regions, powerful gangs are intensely focused on the production of high-quality cocaine and the entire economy is linked with the cocaine trade. Those regions are particularly lawless as well as close to transnational drug routes.

...

"About 65% of all the coca in Colombia is now in the provinces of Nariño and Putumayo, which border Ecuador, and Norte de Santander in the northeast bordering Venezuela. All three provinces are hard-hit by violence and lack schools, paved roads, hospitals and other state institutions—as is Ecuador, where the homicide rate has skyrocketed as Colombian cocaine has flowed in."

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Here's the Guardian report on Ecuador:

‘We should treat it as a war’: Ecuador’s descent into drug gang violence. Successive governments have been unable to rein in violence as South American country became cocaine superhighway.  by Dan Collyns 

"In recent years, the South American nation has experienced a nightmarish descent into violence, with successive governments proving unable to rein in organized crime factions. Last month, the cartels showed their power with a mass hostage-taking in six prisons, in an apparent response to the prison transfer of a senior gang leader.

"Before that, presidential candidate Fernando Villavicencio was shot dead in broad daylight less than two weeks before the election’s first round.

...

"But the country’s armed forces and police appear to be losing the battle against the narcos who have turned the country into a cocaine superhighway as gangs – both inside and outside the weak and overcrowded prison system – vie for drug trafficking routes, with backing from powerful Mexican cartels.

"Drug trafficking is not new in Ecuador, thanks to its location – sandwiched between the world’s main cocaine producers Colombia and Peru – its porous borders and major Pacific Ocean ports. The amount of cocaine seized at the country’s ports has tripled since 2020 to 77.4 tonnes last year.

"But in recent years, the scale of the accompanying violence has rocketed. Ecuador saw 4,600 violent deaths in 2022, double the previous year, and the country is set to break the record again with 3,568 violent deaths in the first half of 2023. Of those, nearly half were in Guayas, the province that includes Guayaquil, where nearly 1,700 people have been murdered so far this year.

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Earlier posts on further down the supply chain:

Tuesday, August 8, 2023

Saturday, September 2, 2023

Innovations in medicine: psychedelic drugs to treat depression

 Here's an editorial in JAMA that accompanies a report on treating some depressive patients using psilocybin therapy.

Psychedelic Therapy—A New Paradigm of Care for Mental Health, by Rachel Yehuda, PhD Amy Lehrner, PhD JAMA. Published online August 31, 2023. doi:10.1001/jama.2023.12900

"An increasing number of clinicians and researchers have become interested in the potential of psychedelic drugs for the treatment of mental health disorders, including depression, anxiety, posttraumatic stress disorder, eating disorders, and addictions.1,2

"Currently, most psychedelic compounds are illegal under federal law. They were placed on the most restrictive class of drugs, Schedule I, in the 1970s as part of the “war on drugs,” meaning that they were considered to have high potential for abuse with no accepted medical use.2 However, the ever-growing global mental health crisis, coupled with the shortage of effective therapeutic strategies, has given rise to a reconsideration of the therapeutic potential of these compounds in recent years.

...

"The study by Raison et al provides an excellent example of the promise of this new approach using psilocybin therapy for patients with major depressive disorder.3 Although the trial was relatively small, it demonstrated that a single dose of psilocybin in the context of a 6-week period that included active psychotherapy resulted in a rapid, robust, and sustained reduction in depressive symptoms.

"Psilocybin is a naturally occurring compound belonging to a class of compounds known as tryptamines, similar to lysergic acid diethylamide (LSD), dimethyltryptamine (DMT), and mescaline. Understanding its therapeutic efficacy requires an appreciation of the context in which it is used, and not just its pharmacological profile or biological mechanism of action. The psychotherapy that occurs with the psychedelic medication is a critical component of this approach.4

...

"The social, economic, and public health impacts of untreated mental disorders demand solutions. If psychedelic therapies do prove to have enduring effects after just a single or a few administrations in the context of a few sessions for preparation and integration, they have the potential to offer not just a new approach to mental health care, but an entirely new paradigm of care."

Tuesday, August 8, 2023

Homelessness and fentanyl, in Oregon and California

 Both the criminal justice system and the harm reduction movement seem to be facing an intractable problem with fentanyl and homelessness.  (We lost the war on drugs, but surrender isn't working either.)

Here are two NYT stories, from Oregon and California.

The Struggle to Save Portland, Oregon. The city has long grappled with street homelessness and a shortage of housing. Now fentanyl has turned a perennial problem into a deadly crisis and a challenge to the city’s progressive identity.  By Michael Corkery

"This city of 635,000 ...  has long grappled with homelessness. But during the pandemic this perennial problem turned into an especially desperate and sometimes deadly crisis that is dividing Portland over how to fix it.

...

"In 2022, Portland experienced a spate of homicides and other violence involving homeless victims that rattled many in the community.

...

"The search for answers points in many directions — to city and county officials who allowed tents on the streets because the government had little to offer in the way of housing, to Oregon voters who backed decriminalizing hard drugs and to the unrest that rocked Portland in 2020 and left raw scars.

"But what has turbocharged the city’s troubles in recent years is fentanyl, the deadly synthetic drug, which has transformed long standing problems into a profound test of the Portland ethos.

"Outreach workers in Portland say rampant fentanyl use has coincided with the increasing turmoil among many homeless residents.

"Doctors who care for people living on the streets say fentanyl addiction is proving harder to treat than many other dependencies."

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Homeless Camps Are Being Cleared in California. What Happens Next? One of the state’s largest homeless encampments was recently shut down in Oakland, but that didn’t stop the problem of homelessness.  By Livia Albeck-Ripka

"The evictions have brought into sharp relief one of the most intractable challenges for American cities, particularly those in California. As homelessness has surged, more people have congregated in large encampments for some semblance of security and stability. But such sites are often unsanitary and dangerous, exhausting neighbors and the owners of nearby businesses.

"What happens after the closure of Wood Street and other camps in California will serve as the latest test of how effectively the state is addressing homelessness. Nearly half of the nation’s unsheltered population — those who sleep on the streets, in tents, in cars or in other places not intended for human habitation — resides in California, according to last year’s federal tally of homelessness. The state makes up about 12 percent of the country’s overall population.

"In California, Democratic leaders who previously tolerated homeless camps have lost their patience for the tent villages and blocks of trailers that proliferated during the pandemic.

"Governor Newsom has helped clear homeless camps himself and has told mayors he was trying to set an example. San Diego recently banned encampments on public property. And Karen Bass, the mayor of Los Angeles, has moved more than 14,000 homeless people into temporary housing since taking office in December, her office said last month.

...

"Community cabins and safe camping sites usually provide only temporary shelter, falling short of the permanent housing that is considered ideal. But they seem to be the best that California can do, with a severe housing shortage and high costs. Despite the state’s spending of more than $30 billion since 2019 on housing-related programs, the homeless population there has continued to grow.

“This is a very difficult population to serve, with very complex needs. And if we can bring someone inside even for a little bit, that’s a victory for that person,” said Jason Elliott, the deputy chief of staff for Governor Newsom. “We may not have permanent housing stick the first time, or the fourth time or the fifth time, but we’re going to keep trying.”

"According to a September audit of Oakland’s homelessness services, close to half of the people housed in community cabins ended up back on the street in the 2020-21 fiscal year."

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Earlier:

Friday, July 14, 2023

Saturday, July 29, 2023

Drug markets: the replacement of agriculture by chemistry

Labs are replacing fields as the source of addictive drugs. Here are two stories, from National Affairs, and the Financial Times.

The current issue of National Affairs has this essay on drugs, drug use, and overdose deaths:

How to Think about the Drug Crisis by Charles Fain Lehman

"A reported 111,219 Americans died from a drug overdose in 2021. That figure has risen more or less unabated, and at an increasing pace, since the early 1990s. Back in 2011, 43,544 Americans died from a drug overdose — less than half the 2021 figure. Ten years earlier, in 2001, it was 21,705 — less than half as many again. And the problem keeps getting worse: The 2021 figure is nearly 50% higher than it was in 2019.

...

"The National Center for Health Statistics estimates that there were roughly 110,000 overdose deaths in the year ending December 2022 — essentially unchanged from a year earlier.

...

"Historically, illicit drugs — heroin, cocaine, marijuana, etc. — were derived from plants grown in fields or greenhouses. But licit pharmacology has long been able to use simple, widely available precursor chemicals to synthesize the active ingredients in these substances. This sidesteps the complex processes of farming altogether. At some point in the past several decades, drug-trafficking organizations learned to use the same techniques at scale. Using precursors sourced primarily from China, they now synthesize a variety of opioids — the class of drugs that includes heroin.

"The most widely known of these is fentanyl, a synthetic opioid conventionally used in anesthesia that is 50 times stronger than heroin. Some are stronger still — carfentanil, the most potent opioid known thus far, is roughly 100 times stronger than fentanyl. In 2021, synthetic opioids were involved in roughly two out of every three overdose deaths.

...

"Complicating the story further is the increasing purity and declining cost of methamphetamine, another synthetic drug with an exploding death rate. After synthetic opioids, methamphetamine is now the second most common cause of drug overdose death. It's also the only tracked drug where deaths not involving synthetic opioids are increasing. That these two lab-produced substances are replacing "organic" drugs at the same time is not a coincidence.

"Why have these drugs taken over the market? Because they're a much better value proposition for sellers. Synthetic drugs significantly reduce production costs, both because chemistry is less labor- and input-intensive per unit produced than farming and because lab production is much easier to obscure from interdiction efforts that drive up costs. Furthermore, because the potency per dose is higher, drug-smuggling operations can move a smaller amount of fentanyl than heroin for the same profit.

"Of course, the stronger the drug, the higher the risk of overdose. Drug-overdose death rates used to be low in part because for the first century or so of modern American drug use, the potency of illicit drugs was constrained by what traffickers could grow in a field. Synthetic drugs remove this limit."

********

And this from the FT:

How fentanyl changed the game for Mexico’s drug cartels.  by Christine Murray

"In the last decade, fentanyl has become the leading cause of death for young adults in the US. Mexico’s illegal drug trade has also adapted to the shift from plant-based drugs towards synthetics, creating a new, streamlined and highly profitable arm of the illicit business with fewer workers and lower costs — but just as much violence.

"The change has caused friction in two of Washington’s most important relationships, with China and Mexico.

...

"Instead of employing tens of thousands of agricultural labourers, the entire fentanyl industry in Mexico could function with “cooks” estimated to number in the hundreds, who were mostly not qualified chemists, Reuter said. Fentanyl’s growth appears to have hit heroin production in particular, with poppy growing in Mexico still well below its peaks, according to the UN Office for Drugs and Crime."





Friday, July 14, 2023

Harm reduction is not a panacea: drug use and drug policy in Portugal, and San Francisco

 The Washington Post has a story about Portugal, and the SF Chronicle has one as well. Both stories touch on the tensions between treating drug addicts with respect, and assuring that cities remain safe and livable.  

Here's the Washington Post:

Once hailed for decriminalizing drugs, Portugal is now having doubts  By Anthony Faiola and Catarina Fernandes Martins

"Portugal decriminalized all drug use, including marijuana, cocaine and heroin, in an experiment that inspired similar efforts elsewhere, but now police are blaming a spike in the number of people who use drugs for a rise in crime. In one neighborhood, state-issued paraphernalia — powder-blue syringe caps, packets of citric acid for diluting heroin — litters sidewalks outside an elementary school.

"Porto’s police have increased patrols to drug-plagued neighborhoods. But given existing laws, there’s only so much they can do. 

...

"Portugal became a model for progressive jurisdictions around the world embracing drug decriminalization, such as the state of Oregon, but now there is talk of fatigue. Police are less motivated to register people who misuse drugs and there are year-long waits for state-funded rehabilitation treatment even as the number of people seeking help has fallen dramatically. The return in force of visible urban drug use, meanwhile, is leading the mayor and others here to ask an explosive question: Is it time to reconsider this country’s globally hailed drug model?

“These days in Portugal, it is forbidden to smoke tobacco outside a school or a hospital. It is forbidden to advertise ice cream and sugar candies. And yet, it is allowed for [people] to be there, injecting drugs,” said Rui Moreira, Porto’s mayor. “We’ve normalized it.”

...

" In the United States alone, overdose deaths, fueled by opioids and deadly synthetic fentanyl, topped 100,000 in both 2021 and 2022 — or double what it was in 2015. According to the National Institutes of Health, 85 percent of the U.S. prison population has an active substance use disorder or was jailed for a crime involving drugs or drug use.

"Across the Atlantic in Europe, tiny Portugal appeared to harbor an answer. In 2001, it threw out years of punishment-driven policies in favor of harm reduction by decriminalizing consumption of all drugs for personal use, including the purchase and possession of 10-day supplies. Consumption remains technically against the law, but instead of jail, people who misuse drugs are registered by police and referred to “dissuasion commissions.” 

...Other countries have moved to channel drug offenses out of the penal system too. But none in Europe institutionalized that route more than Portugal. Within a few years, HIV transmission rates via syringes — one the biggest arguments for decriminalization — had plummeted. From 2000 to 2008, prison populations fell by 16.5 percent. Overdose rates dropped as public funds flowed from jails to rehabilitation. There was no evidence of a feared surge in use.

...

"But in the first substantial way since decriminalization passed, some Portuguese voices are now calling for a rethink of a policy that was long a proud point of national consensus. Urban visibility of the drug problem, police say, is at its worst point in decades

...

"A newly released national survey suggests the percent of adults who have used illicit drugs increased to 12.8 percent in 2022, up from 7.8 in 2001, though still below European averages.

...

"Porto’s mayor and other critics, including neighborhood activist groups, are not calling for a wholesale repeal of decriminalization — but rather, a limited re-criminalization in urban areas and near schools and hospitals to address rising numbers of people misusing drugs."

...

"After years of economic crisis, Portugal decentralized its drug oversight operation in 2012. A funding drop from 76 million euros ($82.7 million) to 16 million euros ($17.4 million) forced Portugal’s main institution to outsource work previously done by the state to nonprofit groups,

...

"Twenty years ago, “we were quite successful in dealing with the big problem, the epidemic of heroin use and all the related effects,” Goulão said in an interview with The Washington Post. “But we have had a kind of disinvestment, a freezing in our response … and we lost some efficacy.”

*******

And here are some related paragraphs about San Francisco, in a story in the San Francisco Chronicle about a concentration of drug dealers from Honduras:

THIS IS THE HOMETOWN OF SAN FRANCISCO’S DRUG DEALERS By Megan Cassidy and Gabrielle Lurie |  July 10, 2023

"Like many other U.S. cities, San Francisco shifted years ago to treating drug use more like a disease than a crime. The heavy policing approach of the War on Drugs era failed to slow dealers or decrease demand while overcrowding jails and disproportionately punishing people of color, studies show.

"Now one of the most progressive cities in the nation is fracturing over concerns that it has become too permissive. What to do about the Honduran dealers is a key political issue as a major citywide election approaches in 2024.

"On a weekday afternoon in June, a man in his early 30s lay motionless on a SoMa sidewalk outside the Federal Building. On his right, a dozen users smoked fentanyl and crack cocaine or hung bent at the waist, heads suspended at their knees. To his left, a handful of dealers, cloaked in black but for the space around their eyes, continued selling while a passerby revived the man with Narcan, the nasal-spray antidote to opioid overdoses, and as paramedics arrived to treat him a few minutes later.

“I’m so mad at them for ruining my neighborhood,” said Kevin DeMattia, who owns Emperor Norton’s bar and has lived in the Tenderloin for the past 25 years. “Businesses are dying because people don’t want to come to the Tenderloin.  They’re ruining the neighborhood in so many ways. They’re poisoning people. … They’re this cancer, this aggressive, metastasizing cancer on the Tenderloin — the dealers and the addicts.”