Amidst the continuing furor of anti-drug polemics and hysterics, it's easy to make the casual observer forget one of the basic realities of this issue: Most people who use drugs are okay. For most of the people who use drugs, it's OK that they are using drugs. We may legitimately worry about those who truly have problems with their drug use, and the people they may affect; we legitimately worry about the consequences of the illicit trade in drugs -- which is to say, the consequences of prohibition. And we would like to see the drug trade made less accessible to children.

But when one faces facts straight on, they say a simple thing: Most people who use drugs are okay. If results are what count, in most cases it's okay that people are using drugs. Not in all cases, to be sure. But in most cases.

Certain types of civil disobedience can illustrate the pointlessness of criminalization of drug use in a vivid enough way to be both noticed and understood. Members of the European Parliament Marco Cappato of Italy and Chris Davies of Great Britain accomplished this three years ago when they presented themselves to police in the London suburb of Manchester with minute quantities of marijuana attached to the back of a couple of postage stamps, getting arrested in the process. Cappato and Davies weren't even using the marijuana, it wasn't even enough to be used, they clearly were not menacing society in any way, they are highly respectable citizens. Yet it was enough to get them sent to jail in handcuffs. That is an effective demonstration of the pointlessness of criminalization.

Drug reformers in the formerly Communist nation of Hungary are doing something similar right now. Roughly 30 of them have turned themselves in as drug users to Budapest and other city police headquarters since the beginning of April. Among them was a famous novelist who is also grandmother -- clearly not a threat to society. Police are being forced to arrest these people and make the law look ridiculous in the process. It is fueling discussion, not only about casual use of marijuana but also how society deals with the truly problematic drug users. It is raising the issue of the unlucky ones who get caught and might not get a lenient sentence. It may well help to change the country's drug laws.

The criminalization of responsible drug users is only one of the many pointless aspects of drug prohibition. Criminalization of the trade in drugs itself is also pointless, though for more complex reasons that involve economics, public health and many other factors. But criminalization of users is pointless on its face. People may miss that obvious point a lot of the time. But they are capable of grasping it, without a lot of effort, if it is pointed out in a clear and compelling manner.

I believe they can understand the rest of it too. As New Mexico's former governor, Gary Johnson, has put it, support for the drug war is a mile wide but an inch deep. Our drug policies are so far off-base, with such serious consequences, it isn't that hard to get a lot of people, perhaps most, to understand at a minimum that some things are wrong. Prohibition is pointless, but our efforts to end it need not be.

Last week witnessed the conclusion of a sad chapter in an ongoing saga; the sentencing of Dr. William Hurwitz, a well-known physician specializing in pain management, to 25 years in prison and a $2 million fine for purported drug dealing involvement.

Supporters of Dr. Hurwitz say that his decision to treat pain aggressively with opioids (narcotics), in the way he did, derived from an ethical principle applied to its logical conclusion. Physicians are obligated by their medical oath to properly treat pain, which in general means relieving to the best feasible extent. To deny a patient adequate pain treatment is "tantamount to torture," in Hurwitz' own words. If you treat pain, then some of the people seeking opioid prescriptions from you inevitably will turn out to be drug diverters or abusers. But it is unethical to punish actual pain patients -- to torture them by denying them medicine -- just because such people are out there. So Hurwitz chose to err on the side of prescribing for pain rather than not doing so. Because his ethics, and his interpretation of them, required him to do so, drug warriors notwithstanding.

I agree with those ethics. It may be that reasonable people can believe that some degree of non-treatment of real patients should be risked in order to "balance" that priority with the priority of diversion control. I don't agree with that -- partly because denial of pain treatment really is torture, in my opinion -- and partly because I understand that the economics of the drug trade and prohibition renders diversion control ineffective regardless. If we can get to a point where a debate on the issue is taking place at that level, I'm not going to call anyone unreasonable who is rationally and sincerely trying to sort it out. But I agree with Hurwitz on this point.

I also believe that Dr. Hurwitz is in fact innocent. No actual evidence was ever presented that he knew that any of his patients were diverting or abusing drugs. And as one of the few people in the world holding both a medical degree and a law degree, Hurwitz would have been readily able to earn millions of dollars per year; a financial motive for the crimes of which he was accused simply did not exist. But whether my faith in Dr. Hurwitz is on target or not, even that may ultimately only have secondary importance.

There are two primary issues at stake. One is that it should have been doctors who decided whether Hurwitz had acted properly, but was not. Russell Portenoy, one of the world's top pain specialists, moved the issued forward this week by saying as much to the Los Angeles Times.

The other is the sheer lack of ethics displayed by prosecutors, by their witnesses, and sadly even by the judge himself, Leonard Wexler. I have it on good authority that the prosecutor arguing for a life sentence yesterday lied repeatedly during his performance. The judge invoked a tape he claims he saw, but which was never entered into evidence, to justify harsh treatment of Hurwitz. For a variety of reasons this is not very plausible. But even if it turns out to be true, it would still conflict with the spirit (albeit not the letter, perhaps) of the Supreme Court's recent pronouncements on these issues.

A witness for the prosecution, an addict in recovery, told of how he squandered his whole inheritance on drugs, conjuring the image of hundreds of thousands of dollars if not millions down the drain. He didn't mention, nor did anyone, that it was a mere $20,000, a lot to him perhaps but not a lot. Prosecutors leveraged their power to prosecute that individual and others, in order to get them to testify against Hurwitz in exchange for leniency -- a practice that courts have called bribery, though the Supreme Court ultimately did not uphold that. But the unreliability of testimony made under such duress is clear, and it is unethical to use it or allow it.

Most seriously, the prosecution's medical witness gave testimony that six of the leading experts on pain treatment characterized as "misleading" and even "absurd" in a letter they sent to the judge. But that letter was never shown to the jurors. How dare Judge Wexler withhold exculpatory information of fundamental importance to the case from the jurors? It may be that sharing the letter with the jurors would have been unusual and something that courts don't like to do. But given who that letter came from and the nature of its content, I can conceive of no moral justification for withholding such information from jurors regardless of usual procedures. There must have been some appropriate way for Judge Wexler to get them that information, and that's what he ethically had to do, but did not do.

The Hurwitz case is high profile. But such violations of decency occur all the time, in the countless more ordinary cases being thrust through the system every day. The courts have hence become institutions not to be respected, but rather feared and condemned. It is not good enough for the courts to do the right thing, to protect us from dangerous criminals and enact legitimate justice, but to do so only some of the time. The courts must make all reasonable efforts to maintain and enforce the highest moral and ethical standards at all times. But they lack the will, and perhaps the desire, to do so.

The courts are in a moral fog, unable to discern right and wrong in their own actions, while sitting in judgment on others. It is time not only to oppose and criticize injustice, but to stand against it. Ethics requires that of us too.

The Honorable Judge Leonard D. Wexler
United States District Court
Eastern District of Virginia, Alexandria Division
401 Courthouse Square
Alexandria, VA 22314

Re: United States v. William Eliot Hurwitz, 03-CR-467-ALL (LDW)

Dear Judge Wexler:

I am writing to express concern about comments made by Ralph Craft, foreman of the Hurwitz case jury, which appeared in the Dec. 21, 2004 edition of the The Washington Post. Mr. Craft's remarks indicate the jurors fundamentally misconstrued both the legal and medical issues involved in the case. I have observed the pain issue and worked with pain patients, physicians and their advocates for 10 years and am well versed in the issue.

Mr. Craft told the Post that, "legitimate doctors out there don't prescribe anywhere close to what Hurwitz did."

However, the dosage which, according to the Post, "astounded" Craft, 1,600 5mg oxycodone pills, adds up to 8 grams daily, of a medication equivalent in its potency to morphine. According to Dr. Russell Portenoy, Chairman of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center, "[i]n clinical practice, the range of opioid doses required by patients is enormous" and "[d]oses equivalent to more than 35g morphine per day have been reported in highly tolerant patients. ..."

The 35 grams Dr. Portenoy, one of the world's leading pain specialists, finds appropriate in some cases, is more than four times the dosage Mr. Craft and presumably other jurors believed was impossibly large -- a serious misconception that appears to have played a major role in the convictions.

Mr. Craft also told the Post that Dr. Hurwitz "wasn't running a criminal enterprise." However, the charges of which he and other jurors voted to convict Dr. Hurwitz are clearly intended to apply to persons involved in major criminal enterprises. That Mr. Craft and perhaps other jurors could understand that Dr. Hurwitz did not run a criminal enterprise and yet convict him for running a criminal enterprise, suggests they were either unable, unwilling, or inadequately prepared to properly interpret the charges on which they were deciding.

Given the multiple, fundamental errors made by jurors, I believe your legal and moral obligation is to reverse the convictions and release Dr. Hurwitz immediately. Short of that, I urge you at least to use the discretion afforded by the recent Booker/Fanfan Supreme Court ruling to sentence reasonably, and sentence Dr. Hurwitz to time served when he appears before you this week. Since the jurors themselves did not believe Dr. Hurwitz ran a criminal enterprise, it would be unreasonable to hand down a sentence Congress intended for leaders of criminal enterprises.

Thank you for taking my points into consideration. I will be attending the April 14 sentencing hearing in support of Dr. Hurwitz, pain patients, and all enlightened physicians who wish to treat them. I believe this is a matter of the utmost moral gravity and that history will watch and remember the actions you take that day.

It was the talk of the airwaves today: Congress held hearings on steroid use in professional baseball, with sports stars like Mark McGwire and Sammy Sosa subpoenaed to be there. Is steroid use wrong? Can baseball police itself? Are congressmen seeking the public good or just grandstanding? Should the issue lie within Congress' purview at all? Numerous participants in the public debate have opined on the issue, and it will no doubt continue to be talked about for months or more likely years to come.

The most emotion-laden argument heard is that of the superstar athlete as role model for the nation's youth. One of the witnesses at the hearing was a grieving father whose son committed suicide, it is believed, as a result of withdrawal from anabolic steroid use. If kids get the idea that steroids can make them excel at sports, maybe even make the major leagues, more kids will use them and more such tragedies will be the result, is the idea. There may or may not be a lot of truth to the notion – it is notably difficult to sort fact from fiction on matters involving drugs and especially drugs and kids. But let's assume for the sake of argument that there is at least some truth to it. There probably is at least a little.

All the more reason Congress was wrong to do what it did this week. If there were any young people in America who didn't know that steroids can enhance one's athleticism, they almost certainly know it now. Along with thinking about the policy and social issues, some young people are now thinking, more than they were before, about whether or not to take steroids. It is an inevitable chain of events whenever politicians or the media draw attention to a drug. Though I do not know whether steroid use will increase as a result of the hearings, I would not be surprised by that. Whereas I would be surprised if the hearings directly or indirectly caused steroid use to drop. That's just not the way these things tend to work out.

Anyone interested in this issue should read "How To Launch a Nationwide Drug Menace", chapter 44 of the 1972 classic, The Consumers Union Report on Licit and Illicit Drugs. The chapter traces the evolution of glue sniffing from an obscure habit in 1959 to a major national phenomenon by the early 1960s. Anyone hurt or concerned by the harms wrought by drugs on some of their users ought to be disheartened by that story's similarities to today's steroid brouhaha. Will publicity from Congress' unintended advertising of steroid use serve to drive use up?

Time will tell, but if history is any guide, the answer is probably yes. And I for one was not interested in yet another demonstration of what not to do. Unfortunately, history likes to repeat itself. One more nationwide drug menace in the making.

Years after candidate George Bush's non-answers to questions about his possible drug past fueled controversy and a sense that he indeed had such a past, proof for some of it at least has at last emerged. Taped excerpts from a conversation, released by the author of a new book, reveal the future president essentially admitting to past marijuana use and explaining why he would never acknowledge it in public.

On one level, the educated reaction to this news is something along the lines of, "So what?" Tens of millions of Americans have used marijuana during their lives. It wasn't a big deal for most of them. Even the more dangerous drugs aren't a problem for most of their users – that's not the strongest argument for legalization of them, but it's true. All the more so for marijuana. Bill Clinton used marijuana. Al Gore used marijuana. It did not and should not have disqualified them from the nation's top job. Nor does it disqualify George Bush.

On other levels, however, the information is troubling, for two reasons. One is that candidate Bush criticized his opponent, Al Gore, not for having used marijuana but for having admitted to it. "I want to lead," he explained on the tapes, and "I don't want some little kid doing what I tried." He couldn't criticize Gore for having used drugs because he had also used drugs. So instead he criticized him for being open and truthful.

There is a level on which one could legitimately hold that it is counterproductive for kids to be keenly focused on the drug use of famous role models; this is an area on which reasonable people can hold varying points of view. But the way to accomplish that would be through legalization and treating private drug use as not a big deal. And that is not what George Bush has advocated.

Which leads us to the second reason, one of hard policy. As governor, Mr. Bush escalated sentences for some drug offenses, putting other people in prison for longer time periods for things that he himself had done or supported. As president, under his authority the federal government has targeted medical marijuana cooperatives, escalated the war on pain doctors, campaigned against drug policy reform initiatives or legislation, promoted drug testing and vastly overreaching drugged-driving laws, gone to court against any reform to drug policy that it could no matter how modest.

So if marijuana use in the distant past is not relevant to judging the president, hypocrisy on the drug issue is very relevant. And if not being open or candid about one's own youth is not exactly the same as lying to children, it verges on that. Not to suggest that his predecessor and failed opponents have stellar records on the issue by any means; they most certainly don't. But they're not president right now.

So if it is unimportant that George Bush used marijuana, it is kind of sad that he opposes honesty about it. And it is very sad that he continues to support cruel and repressive drug policies – policies which could have ruined his life if they had been in place back then, but realistically only in theory.

I am glad, therefore, that now there is proof of George Bush's drug use. If only by providing one more bit of rhetorical ammunition, it will make it slightly harder for the drug warriors to continue to escalate their pogrom against the American people.

Not a day goes by in the drug war without something happening that shouldn't. This week an innocent and heroic doctor was convicted in a court, by a jury that wasn't afforded information they should have had, of charges that should never have been brought, under laws that shouldn't exist. Soon he will be given a prison sentence that any right-thinking person should regard as obscene.

He is William Hurwitz, the most prominent advocate, and at one time practitioner of, aggressive treatment for severe chronic pain for patients who suffer from it. I have written about Dr. Hurwitz since 1996, the year the Board of Medicine of Virginia yanked his license, to his patients' detriment, and I have met him on multiple occasions, including the day he received an award from the American Society for Action on Pain for the risks he took.

One of those patients was David Covillion, a former police officer who became disabled from a fight with a suspect. Covillion, like most of Hurwitz's patients, was not able to find another doctor willing to treat him. His pain was so great that he saw no way out but to end his life. He recorded a dramatic videotape the day before, explaining his decision, a tape that was played on 60 Minutes when it reported on the case.

The media, unfortunately, has not been clear in its more recent reporting on this history. Hurwitz, in fact, was essentially exonerated by the medical board, which restored his license, though not before much damage was done. He was able to return to practicing medicine and treating pain – until two years ago, when, knowing that the federal investigation was coming, he closed his practice. He wanted to give his patients a chance – whatever little they had of one – to find other doctors willing to treat them. Two and a half months after Hurwitz announced his decision, the feds raided his office and home.

It is a simple concept – one would think – that patients should get what they need for pain. But the drugs patients need for pain are also among the drugs that drug police make a living hunting down. The enforcement bureaus devoted to that nexus – anti-diversion bureaus – must draw blood to justify their existence and expand. The convictions they have now obtained against Dr. Hurwitz – which will put him in prison for life if the situation goes un-remedied – are bad news for pain patients. As one advocate told the media on getting the news, doctors are going to "run for the hills" whenever they meet a pain patient from now on. Who can blame them? Life in prison is a steep cost to risk for any cause, even the cause of obeying one's physician's oath.

It is that oath that Hurwitz was following. Frank Fisher, another pain doctor who had (relatively) better luck, has described Dr. Hurwitz as the most ethical of the pain doctors – the most ethical because he would always treat a pain patient for the pain, absent proof of the patient's misconduct. This included the patients other doctors most feared to treat – the patients with addictions, the poor, those with an unsavory look – those for whom the risk to the doctor of being fooled and ending up facing a prosecution is the greatest.

But as Dr. Hurwitz told the jury when he took the stand, to deny a patient pain treatment is tantamount to torture. If he had proof that patients were diverting the drugs, he would cut them off. But without proof, he was obligated to treat the pain they seemed to have, because to do otherwise would violate medical ethics. Dr. Hurwitz was unwilling to torture his patients by denying them medicine, even though that was what was needed to protect himself from the drug police.

This is the basic issue of the case, the issue that Hurwitz and his lawyers tried to convey to the jury, but there is more to it. Other issues are the misuse of the law by federal prosecutors, the lack of clarity in the law, the sheer length of the federal mandatory minimum sentences, and the willingness of the judge to aid and abet the prosecutors in their successful endeavor to obscure the issue for the jurors. Judge Wexler made a series of bad decisions that will probably constitute the basis for the appeal.

Wexler would not instruct the jury clearly, in response to their query, that it is legal to prescribe opiates to people with addictions to them, so long as the prescriptions are for pain control. Wexler did not communicate the "good faith" standard, that doctors who prescribe in good faith are innocent, even if the faith they showed some of their patients turns out to be misplaced. Both of these are errors of law which biased the jury's deliberations toward conviction.

Wexler also disallowed the defense from presenting a document published recently by DEA and pain treatment experts to the jury, because the DEA had withdrawn the document by that time. Would it not have been more in the spirit of truth – the "whole truth," as the witness oath goes – to show the jury the document, as well as the DEA's letter explaining their withdrawal of it, as well as the response by DEA's former physician partners which outlined how distorted and dishonest DEA's reasons really were, as well as the evidence that is suggestive that DEA withdrew the document to improve their chances of convicting Hurwitz himself? And there were other errors on Wexler's part.

I don't know whether Judge Wexler was biased or whether he meant well and was merely manipulated into his bad decisions by smart prosecutors. I also don't know whether prosecutors McNulty or Lytle or Rossi meant well but are merely misguided – truthfully I consider their motives deeply suspect, but that is only a speculation. Regardless, they are all participants in, and perpetrators of, a profoundly destructive attack on the rights and lives of pain patients everywhere. Some of the people reading this editorial are patients who may regard their hopes for relief from pain as having been dealt a blow yesterday in the courthouse. All of us could be in that situation one day and become the victims of McNulty and Lytle and Rossi and Wexler.

But they are also perpetrators of a travesty of justice against an individual – a lynching, in effect – of an innocent doctor whose only crime is that he would not torture his patients by denying them the medicine they needed. And that is not what the law is meant to achieve.

In 2004 we do not need or want martyrs, but we seem to have them. I am sure Dr. Hurwitz does not want to spend years in prison awaiting his appeal, nor spend the remainder of his life there if the appeal fails and no other relief is obtained. But if that is what happens, the reason may at least be some small source of comfort and large source of pride: He would not torture.

The District of Columbia saw a tragedy last week. Jonathan Magbie, a 27-year-old quadriplegic medical marijuana patient, died while under the care of the D.C. court and jail. Magbie had been arrested for marijuana possession, and Judge Judith Retchin sentenced him to 10 days in jail, despite recommendations from officials against it. Her reason? There was a loaded gun in the car with him.

But Magbie didn't use the gun on anyone. And now I've learned it wasn't even his.

Things went haywire immediately after Magbie entered custody. He wound up getting sent back and forth between the jail and the hospital. His mother was not allowed to bring him his ventilator in jail, for two days. By the time the jail finally agreed to it, it was too late.

I don't believe that any of the officials involved in this debacle wanted what happened to happen. Some combination of incompetence and/or overloading of the system and/or poorly crafted regulations or procedures all combined to end Jonathan Magbie's life. But that doesn't mean there's no one to blame.

Surely Judge Retchin shares the blame. According to the Washington Post article, she is known for harsh sentences. In a nation with two million prisoners, whose incarceration rate has been criticized by prominent human rights organizations, such an impulse is part of the problem. The attitude that drove her to send a helpless, wheelchair-bound young man, who had hurt no one, to jail, is a barbaric one that our society desperately needs to leave behind. And knowing how dangerous the jails can be, even for the healthy and strong, it was especially reckless. If she didn't understand that, it is to her discredit.

Others are to blame too. Why did the hospital send Magbie back to the jail and refuse to take him back? Where did the miscommunications take place in the court and jail? The more basic truth, though, is that gulags breed carelessness and error.

It is too late to save Jonathan Magbie – the decision-makers who needed to do that didn't try hard enough. But this sad episode must not be allowed to go gently into the night. Magbie and his family deserve a full accounting, and a reflection on the sad state of criminal justice in this country is long overdue. Let it start here.

A government-convened panel of scientists in the UK is considering what the Independent properly termed "a radical scheme" – a proposal to use vaccines, currently under development by pharmaceutical corporations, to immunize children against "euphoria" from drugs such as heroin, cocaine and nicotine. Panel members say the plan would target children who are at risk of becoming drug users in the future. They have not said how it would be determined who is at risk.

It's only a matter of time until some of our own drug war zealots or anti-drug mad scientists take this idea up here in the US.

An anti-drug vaccine differs fundamentally from vaccines designed to protect individuals from diseases like measles, the example a committee member raised to the Independent's reporter. Measles is a disease that no one, or virtually no one, wants to catch. It is communicable and could therefore spread to large numbers of people if unchecked. Perhaps measles vaccinations should not be compulsory, if we believe in freedom of choice. But the wisdom of such vaccinations is clear, and it's legitimate for society to encourage and make them widely available.

An anti-drug vaccine, on the other hand, is designed to produce a permanent chemical alteration to an individual's brain chemistry to disable one's ability to experience certain mind states that humans are designed to be able to experience – and which despite their downsides many people desire to experience. Though heroin and cocaine are illegal, that may not always be the case, and nicotine is legal. Legal or not, it is the individual's human right to seek such experiences. But even if one disagrees with that last statement, to alter a human being's brain and body to make the experience impossible, forever, is an extremist approach.

The "side effects" of such an alteration are hard to predict. Heroin is an opiate that was developed for pain control, for which it is still used in some countries. It is derived from morphine and hence fundamentally similar to many other pain medicines. Would a heroin vaccine interfere with the ability of a pain patient to gain relief through other opiate medications?

Cocaine is also used as a medicine, not for such a large number of patients as the opiates, but important for the ones for whom it is used. Would a cocaine vaccine interfere with a patient's ability to gain those medical benefits? Would it interfere with the potency of similar drugs like novocaine? Does nicotine have current or potential medical uses that would be stymied by a vaccine?

Not necessarily – the physiological processes occurring in pain relief are not identical to those involved in opiate use to produce, euphoria, for example, or for relieving the cravings of an addiction. Nor, however, are they entirely dissimilar – it's the same substance, after all. How can we determine in advance, with surety, that no such problems will arise?

The anti-drug vaccine is a fundamentally different proposition in this respect as well, for at least two reasons. One is that it is not necessary, as effective alternatives for reducing or avoiding the harms that sometimes from drug addiction are already available – moderation, harm reduction, and abstinence.

The other reason is the sheer scale, in time and in numbers of people, that would be needed to thoroughly assess an anti-drug vaccine's risks and effects. It's not something that can be accomplished in one or even 10 years, with any reasonable number of people.

Take the number of people needed for a proper drug trial. Then divide that by the fraction of them who statistically are likely to suffer from serious medical conditions in the future that require with opiates (a larger number) or cocaine (a smaller number). That much larger number of test subjects is the minimum number needed to ensure that the subset of the test subjects who will develop severe chronic pain and other serious conditions in the future will be available and still part of the study. There would need to be an ample number of them requiring heavy use of opiates. And the time scale is a lifetime, as the subjects would receive the vaccinations as children while the drugs are most often needed as medicines late in life.

We're not talking thousands of test subjects, nor tens of thousands. We are talking about at least hundreds of thousands and probably millions or more – a substantial chunk of a generation – with statistically significant results not possible for the better part of a century, to determine with any degree of confidence that such vaccines will not interfere with important medical treatments later in life.

If informed, consenting adults want to take an anti-drug vaccine, and if it could work on adults, maybe they should have that right. But the government should play no role in sponsoring, nor even encouraging, such a practice. An anti-drug vaccine for children is such a bad idea that it isn't even worth considering.

One of the stranger aspects of the drug debate in America is the disconnect between the people at large and those involved in legislating or executing the war on drugs. An annual survey of police chiefs and sheriffs, for example, recently found that only 40 percent of them favor legalization of marijuana for medicinal purposes, as opposed to the 70-80 percent of public support shown by recent polls. Advocates are disappointed that a solid majority of America's law enforcement leaders favor the criminalization, and resulting arrests and prosecutions, of patients for medical marijuana use.

Another disappointing attitude is that of New Jersey's top law enforcement office. After Atlantic City officials announced plans to open a city-run needle exchange program, citing state law allowing them to do so, NJ attorney general Peter Harvey came out with a statement that law does not allow it -- but not explaining why the law cited in support of the proposal did not apply. This week a spokesman for Harvey revealed an ideological preference rather than the previous legal interpretation, saying "Our office has serious concerns about any policy or practice which facilitates or encourages drug use." This despite overwhelming evidence that needle exchange does not have that effect and that laws prohibiting syringe distribution and possession, and enforcement of those laws, have cost the lives of massive numbers of New Jerseyans and others.

The contrast with police of some nations in Europe is very striking. Preparing for an influx of soccer fans from around the continent, and knowing the reputation of some (mainly British) fans to be rowdy, police in Lisbon, Portugal, have promised to turn a blind eye to open marijuana use. The nation has already decriminalized drug use and possession, but smoking in public is still illegal. For purely pragmatic reasons, they have decided to use their discretion to allow it. As a police spokeswoman told the British newspaper The Guardian (perhaps hoping to get the message to the infamous soccer hooligans in advance), "If you are quietly smoking and a police officer is 10 meters away, what's the big risk in your behavior? I'm not going to tap you on the shoulder and ask 'What are you smoking?' if you are posing no menace to others. Our priority is alcohol."

In Switzerland, the police aren't satisfied with discretion and decriminalization. Following a narrow vote by the Swiss Parliament to pass a bill, already approved by the Senate, to legalize marijuana outright, police officials were among the voices publicly expressing their disappointment.

Which police would you rather have for your state and community? Though we are frequently critical of police practices, I'm not someone who claims that cops as a rule are bad; and I recognize the risks to life and limb to which police officers subject themselves on a regular basis to protect members of the public, and which sometimes cost them their lives. We need to remember that. Still, I have no reason to believe that police in Portugal or Switzerland are any less willing to step into harm's way when situations call for them to do so. No disrespect is intended here for America's men and women in blue. But given the more enlightened attitudes toward drug policy of police in parts of Western Europe -- which in my opinion make their countries not only more just but also more safe -- I guess that overall I would pick their cops over our cops if I had the choice.

The news is not all bad. Though it is disappointing that 60 percent of chiefs and sheriffs oppose medical marijuana, 40 percent is a large number and an encouraging sign among a notably enforcement-oriented group of people. And the same survey also found that nearly 70 percent of them recognize that decriminalization of possession would free up resources to fight serious crime. So I haven't given up on them yet, either. Perhaps our friends at Law Enforcement Against Prohibition will help America's cops catch up with their counterparts across the ocean.

One of the reasons I became interested in drug policy was the wide range of issues it impacts. There are few areas of policy, or of life, that aren't touched by the drug war. I haven't found a connection between the drug war and social security reform -- yet -- but that's an exception. I have learned to presume that there is always another angle I haven't thought of, some harm flowing from the drug laws that has heretofore escaped my notice.

Still, ten years into this, it's seldom that any really new angles come to my attention. This week National Public Radio uncovered a new one. It's a minor angle, at least on the surface, compared with the extremities that have become so common in today's drug war. But sometimes the understated injustices, or even the mere annoyances, can illustrate a point in a different way than the worse ones.

According to a report by Alex Cohen of NPR affiliate station KQED in Los Angeles, aired Thursday night on All Things Considered, the California legislature is wrestling with the issue of teen posture, including the impact of heavy school textbooks that kids have to carry around with them. A student named David from North Hollywood was interviewed who takes Tylenol regularly to manage chronic pain; the culprit, possibly, is the 30 pounds of books in his backpack, 19 percent of his body weight. The American Chiropractic Association recommends that young people limit their backpack loads to 10 percent of their weight.

Contributing to the phenomenon, a state politico explained, is the decision by some school systems to stop providing students with locker space. Schools are trying to cope with the twin problems of guns and drugs, which some administrators see the lockers as facilitating. Get rid of the lockers, and maybe that will help to protect students from drugs and guns, I suppose is the line of reasoning.

You can't blame school officials from wanting to keep the guns, or drugs, out of their schools. I don't know enough about guns and schools to say whether eliminating lockers could make students safer. I'm skeptical, but I don't really know.

I do know enough about drugs and schools to say that eliminating lockers is unlikely to do more than shift drug selling from inside the buildings to outside in the parking lots. And I know enough about drugs and guns to say that drug prohibition is one of the reasons so many young people possess guns, in schools and elsewhere. Prohibition creates a criminal underground that is governed by violence or the threat thereof, and which is subject to no government regulation. Hence an incentive is created for kids to sell drugs to other kids, in the schools, and to carry guns to protect themselves and their goods. And the guns thereby become normal and customary, spreading out to non-sellers.

It is possible to overestimate the contribution prohibition-spurred locker closures make to teen back pain, of course. One expert commented that lack of exercise or stretching is a more important factor than heavy textbooks, in his opinion. Still, the war on drugs has been potentially implicated in a public health problem facing our nation's youth. Who would have guessed it? Maybe no one, but that only demonstrates even more strongly how pervasive the unintended consequences of the drug laws are in our society -- you just can't get away from them, wherever you look. And if the example seems trivial, tell that to young David -- who deals with pain daily, whose liver is at risk of damage from frequent Tylenol use; who may suffer such pain all his life, perhaps worsening with age -- in part because his school won't let him keep his books in a locker, because they're afraid that some of the lockers might be used to store drugs or to hide guns carried by students who sell drugs.

There are innumerable ways the drug laws serve to adversely affect our nation's youth, not to mention the rest of us. The scariest thing is that we have no good way to know or predict all of them. Rather than tearing out school lockers and forcing the nation's children to bear the resulting toil and inconvenience -- knowing full well that this too will fail to solve the problem -- shouldn't we try to address the root causes instead? Legalization would be a much sounder, more fundamental way of reducing the dangers to young people posed by drugs under prohibition and the drug war. I say, keep the lockers, change the drug laws.

David Borden is executive director of Drug Reform Coordination Network

One of the greatest but least-discussed problems in modern medicine is the under-treatment of patients living with severe, chronic pain. More than 30 million patients suffer from chronic pain, and seven million of them cannot relieve their pain without opiates (narcotics), but only 4,000 doctors in the country are willing to prescribe them, according to the National Chronic Pain Outreach Association. A New England Journal of Medicine editorial stated that 56 percent of cancer outpatients and 82 percent of AIDS outpatients were under-treated for pain, as were 50 percent of hospitalized patients with a range of conditions.

Today's massive denial of pain medication is a consequence of the social, regulatory and law enforcement climate created by the war on drugs. Doctors can suffer loss of license or even incarceration for the inevitable mistake of providing medicine to a real or pretend patient who may be misusing or diverting medication, or using it for non-sanctioned purposes. The climate has led to a situation in which most physicians are incorrectly trained in pain management and under- or non-treatment of pain is the norm. Doctors who treat pain correctly typically must exceed the usual prescribed dosages, and in so doing draw the scrutiny of state medical boards, the DEA and other agencies. Any overdose, any death of an ill or elderly patient, any billing of public health insurers (e.g. Medicare, Medicaid) to pay for opiates therapy, is a potential red flag, no matter how reasonable the prescription or how innocent the circumstances. And for the typical physician, the possible legal and financial ramifications, even if imposed only infrequently, tend to represent a greater legal and financial risk than they are willing or able to afford.

One of the most recent possible "witch-hunts" in this arena is that of Dr. Daniel Maynard, whose Dallas home, office and bank were raided by dozens of state and federal cops three weeks ago. The massive force of heavily armed anti-drug agents handcuffed 30-40 of Maynard's patients while running warrant checks on them and seized Maynard's records, and the state of Texas has frozen his ability to be reimbursed by Medicare. Maynard is of course being tried in the media for his supposed crimes, and his former patients are scrambling to find new doctors who will take their pain treatment needs seriously. I'd bet money at least one of them gets treated for handcuff bruises.

The reason for the raid? Eleven of Dr. Maynard's patients had died subsequent to receiving opiate prescriptions from him. But it is unclear what relation some of the reported causes of death would have to opiate use -- hypertensive cardiovascular disease and chronic alcoholism, for example -- and in those cases where drug overdose was a possible cause, it is unclear whether the fault or responsibility would lie with Dr. Maynard rather than the patients themselves. And this is only based on the limited information that came out in the press. The real facts, once they are presented, may tell a different story yet.

I don't know enough about Dr. Maynard's case to say with certainty whether he is being persecuted for nothing or whether his prescribing practices did have problems. My guess is the former, but only the medical evidence, interpreted correctly, with the benefit of medical experience and knowledge and free from the mind-numbing grip of opiophobia, can tell for sure. At least one of Dr. Maynard's patients has spoken out publicly in his defense.

What I don't need the evidence to be able to say, with substantial confidence, is what will happen -- or rather what is already happening -- to those of Dr. Maynard's patients who live with painful, long-term conditions, and who need narcotics in relatively strong doses to be able to manage.

Those patients will go to their new doctors, and those doctors, regardless of their professional opinions, will decide -- or rather, have already decided -- that they would be crazy to write the same kinds of prescriptions, that doing so would be equivalent to asking a District Attorney to investigate them and the medical board to suspend their right to practice, or for comparable assaults on their practices, reputations and freedom.

Those doctors will assume that some of the very seriously ill patients formerly treated by Dr. Maynard will die during the period of time for which they are those doctors' patients -- due to age or illness, in all likelihood, because they intend to be careful -- but they will assume that any such death will draw scrutiny with a greatly increased likelihood of prosecution, administrative sanctions or lawsuits, and that their colleagues as a group won't take a stand on their behalf.

I also don't need Dr. Maynard's records to determine what will happen -- or rather, has happened -- to doctors and patients in Dr. Maynard's county or state, indeed throughout all the United States. Cowboy drug enforcement isn't limited to Texas. Doctors will conclude -- long have concluded -- that prescribing narcotics beyond a certain dosage level, or to more than a certain number of patients, right as that may be, is far too risky an endeavor under the prevailing police state of medicine. Most won't write those prescriptions, and countless needless tragedies are taking place every day for the suffering people whose palliative is known and available, yet not truly available enough.

So be Dr. Maynard without fault, or have he fault, the state's approach to him is wrong and works great destructive effect against the welfare of patients everywhere. The police state of medicine is the enemy of health, not the friend. Dr. Maynard has the benefit of my doubt, at least, but the state does not.

More to This Vote Than Meets the Eye David Borden, Executive Director, borden@drcnet.org,

Activists have barely begun the debate on this year's round of drug reform votes.Some of the losses, however, may have more to them than meets the eye. Nevada's marijuana initiative, Question 9, sponsored by Nevadans for Responsible Law Enforcement, a campaign of the Marijuana Policy Project, is a good example. With 61% against and 39% for, a CNN report the next day described the initiative, which would have established a legal framework for adults possessing up to three ounces of marijuana, as having been "soundly defeated." In electoral terms, it was.

But a glass can be half empty or half full -- in this case, 39% full. Nearly four out of ten voters in Nevada chose to effectively make marijuana legal -- a clear demonstration that legalization of marijuana at least is a mainstream viewpoint, not the "fringe" or "radical" notion as charged by prohibitionists. And not only did those 39% choose legalization. They chose to have Nevada go that route alone, in advance of every other state in the country.

Add to those 39% the Nevadans who would go for legalization or regulation as part of a nationwide or worldwide reform. Add the people who had problems only with specific details of the provision in this yes or no vote, such as the fairly substantial three ounce limit, but would have opted for some similar initiative. And add to all of them the Nevadan voters who tended to favor it, but weren't sure and were hesitant in these uncertain times to approve a significant policy change whose ramifications they hadn't had a chance to fully analyze and think through, the usual drop in support suffered by most controversial ballot measures in their final days.

Then consider the overall conservative tide, and Nevada's anti-gay marriage initiative, which likely mobilized significant numbers of religious cultural conservatives to get to the polls, passing it by a wide margin. The same voters who saw fit to interfere through the force of government with the private relationship decisions of consenting individuals, are also likely to have opposed the marijuana initiative as well. This probably worked to the detriment of Question 9, but without necessarily reflecting on overall public sentiment.

Put it all together, and public support in Nevada for ending marijuana prohibition is probably pretty close to the 50% mark -- as polling showed more than once. Prohibitionist opponents of Question 9 will doubtless hold it up as an example of the public rejecting drug legalization. But that is only one side of the story.

The real message of Question 9 is that anti-prohibitionism is a cause that is not yet at the point of victory, but is gaining ground and is well inside the mainstream of political thought. Question 9 didn't change Nevada law this year, but it did take the discussion to the cover of Time magazine and TV screens and households around the country. Whether mounting Question 9 was the right decision is an issue that will be debated in reform circles for years to come, and there may never be consensus on that point. Nevertheless, NRLE and MPP deserve credit for taking the issue to a new level. This fight has only just begun.

One of the most cited arguments for liberalization of drug laws is the example of European nations that have moved down that path, the Netherlands being a striking example, Switzerland as well. The reality is complex and typically not very clearly presented, particularly by prohibitionists who wish to discredit any alternative to the drug war status quo. But it is true that much of Europe is in a very different place vis à vis drug policy than the United States. Last week I had the chance to visit a number of European cities and take a look at the scene myself for the first time.

Contrary to prohibitionist distortion and popular misconception, the Netherlands hasn't legalized drugs, technically not even marijuana. Marijuana policy is pretty close to constituting a de facto legalization, though, at least in some respects. Residents and visitors alike can freely walk into any number of downtown Amsterdam's "coffee shops."

No reasonable observer can stroll Amsterdam's streets and conclude that Dutch marijuana use is a major problem. The tolerance policy, actualized to a degree approaching regulated legalization, very clearly works for as far as it goes. Those hysterical voices labeling the country's drug scene a disaster are being profoundly dishonest. Liberalization of policies toward other drugs has not progressed as far -- they are still prohibited -- but users are not criminalized.

Some dealers of hard drugs don't seem to be too worried either. More than once I was followed up a block or more by sellers who didn't want to take "not interested" for an answer. When I finally convinced them I really wasn't planning to buy any drugs, they proceeded to beg for cash. They probably don't expect to wind up in prison, at least not for very long.

Annoying as they were, though, they didn't seem very dangerous; the minor annoyance of some over-aggressive street peddlers doesn't seem a good reason to abandon an enlightened policy that has lowered the human toll of punitive, ineffective drug prohibition laws. On the other hand, the phenomenon serves to illustrate the limitations of tolerance whilst drugs remain illegal -- ultimately only legalization can spare us the disorders of the illicit street market. It is ironic that the most striking aspect of the Dutch drug scene for me was one of the consequences of continued prohibition from which the country still suffers.

The drug policy debate in much of Western Europe has also advanced much further than the typical political dialogue here in the states. At a high-level seminar convened earlier this week by the Institute for Public Policy Research, a leading British think tank, participants examined the international drug treaties and the obstacles they present to states or nations that wish to enact drug policies that aren't based on prohibition. The consensus was that the treaties do not prevent signatory nations from moving quite far in the direction of liberalization, but do forbid them from stepping over the line to actual drug legalization.

The consensus was also that the end of prohibition won't truly be achieved without repealing or at least amending the treaties. Europe is a diverse continent made up of many neighboring nationalities and cultures, many of which warred for centuries. Europeans hence tend to view the system of international agreements as an important factor enabling their various societies to coexist in prosperity and peace. It is inconceivable to them that any European nation would simply pull out of the international drug conventions, regardless of how much of a liability its populace or politicians may come to view them.

Ireland was one exception discussed there -- they never ratified the drug conventions and hence aren't bound by them -- but Ireland has also never had the drug policy debate that some of its neighbors have, and there is little interest there even in harm reduction or decriminalization. Repeal of reform of the conventions, then, is not enough, as prohibition is certainly capable of existing without them. But as much as we American drug reformers may dream of it, Europe is not going to legalize drugs in the absence of a coordinated global shift in the ground rules governing drug policies.

The seminar also concluded that amending the treaties is not going to be easy. In March of next year, for example, the United Nations will hold another General Assembly Special Session on Drugs. (Readers may remember the 1998 UNGASS and its silly slogan -- "Drug Free in Ten, We Can Do It!") A scholar formerly employed by the UN pointed out that a decisive majority of nations would be needed to initiate the process of even considering modifying the treaties, and that the US and the set of poor, international aid recipient nations under its thumb are more than enough to block it. The US even has enough power to prevent such a vote from taking place, even though it hasn't paid up its UN dues and hence couldn't actually vote. It is somewhat reminiscent of the Republic's Senate of the Star Wars movies, corrupted under the influence of the Dark Lord of the Sith, hardly a model for enlightened international policymaking.

But if the loosening of drug prohibition's international stranglehold seems years away, it will be forever if we don't start to try. So start we have. At a meeting in Antwerp last weekend, representatives of a wide range of European organizations decided to join forces with sympathetic political leaders and organizations from other continents to preempt the UN's drug barons and call for an end to prohibition, with reform of the drug conventions as an initial step toward that goal. DRCNet is a proud sponsor and co-organizer of this event, which has affiliated with our upcoming international conference series, "Out from the Shadows: Ending Drug Prohibition in the 21st Century." We will in the near future present a special report on the organizations leading drug policy reform in Europe and their plans for this and related efforts.

Europe has further to go in drug policy than it sometimes seems to those of us watching from afar. Nevertheless, it seems true that the spirit of freedom burns there more strongly, while our own nation suffers under the burden of drug war ideology and terrorism-spawned police state policies. Opponents of drug prohibition and advocates of reform must work together across oceans and borders to usher in a new age of tolerance and enlightenment for the people of all nations.

California-based medical marijuana activists have called for a national day of nonviolent "direct action to push back the DEA" at DEA offices nationwide on Thursday, June 6. According to Americans for Safe Access, or ASA (www.safeaccessnow.org), the group organizing the day of action, the DEA is set to swoop down on California medical marijuana dispensaries on or soon after June 6, the day before US Circuit Judge Charles Breyer is expected to issue a permanent injunction barring medical marijuana distribution dispensaries under federal law.

"This is a proactive measure to put the federal government on notice," said ASA's Stephanie Scherer, one of the campaign's lead organizers. "We will be doing direct actions and civil disobedience, which is a tactical escalation," she told DRCNet. "We have played by the rules, we got laws passed in various states, we worked with state governments, we worked with local law enforcement, we've done everything by the book and still this campaign of terror against medical marijuana patients and providers continues," said Scherer. "The Bush administration is pushing us to the next level. Bush cannot attack the democratic process like this. We are taking a zero-tolerance stand on federal interference with medical marijuana in the states."

The primary target will be local DEA offices across the country, which will be served with "cease and desist" orders demanding that the agency keep hands off medical marijuana patients and providers. Other creative actions, including civil disobedience, are being planned, said Scherer.

"We will also on June 6 send President Bush a letter listing our demands," she added. "Those demands are that they cease this campaign of terror on patients, dispensaries, and caregivers, that Bush endorse the Barney Frank Bill (H.R. 2592, providing for states' rights to enact medical marijuana protections), and that all prosecutions against medical marijuana growers, dispensaries and patients stop now."

ASA is a special campaign of the Cannabis Action Network (www.cannabisaction.net), but is also part of a coalition of allied organizations, including NORML, the Marijuana Policy Project, the Campaign for Sensible Drug Policies, the Drug Policy Alliance, DrugSense and Students for Sensible Drug Policy, said Scherer.

Although the call only went out on Tuesday, actions are already confirmed in 20 cities, primarily on the West Coast, said Scherer. "But every couple of hours, we get a call telling us about another one," she added. More than 150 people have already signed up on the emergency listserv, she said. (By way of comparison, hemp activists were able to target 73 DEA offices in their December action against DEA attempts to ban hemp-based foods with even negligible THC content.)

Organizers are making it easy for interested parties to participate. ASA provides an organizers' manual and sample "cease and desist" order at its web site and is coordinating with the Washington, DC-based Mintwood Media Collective to whip up press attention. "We can help people with legal support, how to do media, how to do grassroots organizing and civil disobedience, all of that," said Scherer.

While the June 6 actions are proactive -- "putting the government on notice," as Scherer put it -- organizers are also preparing emergency response actions to confront any future raids (www.drcnet.org/wol/234.html#calmedmj). "We're doing direct action tours on the weekend of June 1-2 and will hit eight West Coast cities" to lay the groundwork for both reactive and proactive responses, said Scherer.

"We have to protect patients and their access to medical marijuana," said Scherer, "so we have to escalate our tactics." It could be a long hot summer for the DEA in California this year.

What is it about opium? To listen to drug warriors these days, it is the lifeblood of terrorist organizations around the globe. Ohio Rep. Rob Portman lamented that Americans who spend money on heroin (made from Afghani opium) are financing the Taliban, who in turn protect terrorists like Osama bin Laden. Therefore, say Portman and his ilk, reducing drug demand and disrupting drug trafficking organizations is part of the war against terrorism.

Translation: Anti-drug agencies and their supporters are afraid of seeing their budgets cut in favor of other law enforcement priorities. And, they're anxious to get themselves back in the headlines. So it's business as usual for the drug warriors -- stretch the facts as much as necessary, ignore the key issues, and hope no one notices -- or if some people do notice, hope that no one else notices them.

In reality, the resources being poured into the drug war can only come at the expense, not the benefit, of all other budget priorities, law enforcement or otherwise. Certainly, some drug traffickers will turn out to have ties to terrorist groups; but that doesn't mean that indiscriminately targeting all users and sellers of all drugs, is even a remotely efficient way of tracking down or dismantling or disempowering perpetrators of terrorism.

Not to mention that most heroin reaching the US now comes from Latin America, not Asia or the Middle East -- another fatal flaw in Portman's logic. And would an attack on opium cultivation and distribution do anything other than move the supply and supply lines from place to place? That's all such operations have ever done before. Such displacement might take some cash out of the hands of one set of enemies, but could just as easily put it in the hands of another. And eradicating the opium trade from the war-shattered land of Afghanistan, where it is one of the primary sources of income, is an even less realistic than usual drug war strategy.

But there's a larger issue at stake, which drug warriors hate to talk about, at least in a context like this. Why is that opium destined to be processed into heroin is a funding source for crime and terrorism, but opium intended for pain medicines or anesthesia isn't?

Are they two different types of opium? No. Are the drugs highly different? No, heroin and morphine, for example, are essentially similar. Not that any of that would make any difference anyway.

The only difference between opium for heroin and opium for pain meds is that pain meds are manufactured, distributed and taken legally. Heroin, on the other hand, is illegal.

In other words, the reason that opium grown to ultimately be processed into heroin provides easy money for terrorists, is heroin is illegal. And the converse is also obvious: Legalization of drugs would eliminate hundreds of billions of dollars a year of illicit profits, some of which accrues to perpetrators of terror and other violence. While the connection between drug prohibition and terrorism can be overstated; it is clear that ending prohibition is one of the steps that must be taken to make the world a safer place. It is equally clear why drug warriors don't like to talk about this.

Ignoring these undeniable facts is hard to excuse under ordinary circumstances. To still do so now, when Americans are filled with pain and fear and are seeking real answers, and to do so for political and budgetary gain, is a profound failure to lead. What is it about opium, and other such drugs, that our leaders refuse to think or speak rationally about them, at the most important times?