Many of us who have worked in the substance abuse field know that US drug policies are a failure. We know that major reforms re needed. It is surprising how many drug abuse professionals will express support, or at least interest, in drug decriminalization approaches when they discuss these things privately, over a bottle of wine. Yet, very few will ever mention the possibility of decriminalization in the sober light of day, when colleagues and potential funders may hear.
Glenn Greenwald [yes, the same Greenwald I'm always quoting on torture and civil liberties] has recently produced a major report on drug decriminalization in Portugal. Evidently Portugal decriminalized all drugs in 2001, making possession an administrative, rather than a criminal matter. Drug dealing is still a crime. Greenwald finds that the effects are overwhelmingly positive, while potential negative effects did not materialize.
Possible drug decriminalization in the US may have different effects than it did in Portugal. It is likely that drug use, in its complex intersection with class and race, may be somewhat different in this country. Certainly our attitudes toward the criminal justice system are far different, mostly for the worse I suspect. But any reasoned discussion of drug policy should carefully study and evaluate the Portuguese experience.
A Scientific American reporter recently heard Greenwald speak on his report and produced this brief article on the issue:
5 Years After: Portugal’s Drug Decriminalization Policy Shows Positive Results
Street drug-related deaths from overdoses drop and the rate of HIV cases crashes
By Brian Vastag
In the face of a growing number of deaths and cases of HIV linked to drug abuse, the Portuguese government in 2001 tried a new tack to get a handle on the problem—it decriminalized the use and possession of heroin, cocaine, marijuana, LSD and other illicit street drugs. The theory: focusing on treatment and prevention instead of jailing users would decrease the number of deaths and infections.
Five years later, the number of deaths from street drug overdoses dropped from around 400 to 290 annually, and the number of new HIV cases caused by using dirty needles to inject heroin, cocaine and other illegal substances plummeted from nearly 1,400 in 2000 to about 400 in 2006, according to a report released recently by the Cato Institute, a Washington, D.C, libertarian think tank.
“Now instead of being put into prison, addicts are going to treatment centers and they’re learning how to control their drug usage or getting off drugs entirely,” report author Glenn Greenwald, a former New York State constitutional litigator, said during a press briefing at Cato last week.
Under the Portuguese plan, penalties for people caught dealing and trafficking drugs are unchanged; dealers are still jailed and subjected to fines depending on the crime. But people caught using or possessing small amounts—defined as the amount needed for 10 days of personal use—are brought before what’s known as a “Dissuasion Commission,” an administrative body created by the 2001 law.
Each three-person commission includes at least one lawyer or judge and one health care or social services worker. The panel has the option of recommending treatment, a small fine, or no sanction.
Peter Reuter, a criminologist at the University of Maryland, College Park, says he’s skeptical decriminalization was the sole reason drug use slid in Portugal, noting that another factor, especially among teens, was a global decline in marijuana use. By the same token, he notes that critics were wrong in their warnings that decriminalizing drugs would make Lisbon a drug mecca.
“Drug decriminalization did reach its primary goal in Portugal,” of reducing the health consequences of drug use, he says, “and did not lead to Lisbon becoming a drug tourist destination.”
Walter Kemp, a spokesperson for the United Nations Office on Drugs and Crime, says decriminalization in Portugal “appears to be working.” He adds that his office is putting more emphasis on improving health outcomes, such as reducing needle-borne infections, but that it does not explicitly support decriminalization, “because it smacks of legalization.”
Drug legalization removes all criminal penalties for producing, selling and using drugs; no country has tried it. In contrast, decriminalization, as practiced in Portugal, eliminates jail time for drug users but maintains criminal penalties for dealers. Spain and Italy have also decriminalized personal use of drugs and Mexico’s president has proposed doing the same. .
A spokesperson for the White House’s Office of National Drug Control Policy declined to comment, citing the pending Senate confirmation of the office’s new director, former Seattle Police Chief Gil Kerlikowske. The U.S. Drug Enforcement Administration (DEA) and the U.S. Department of State’s Bureau of International Narcotics and Law Enforcement Affairs also declined to comment on the report.
April 10th, 2009
Eugene Robinson in this Washington Post column, has decided that a Truth Commission is not enough. We need punishment, he says:
Crimes That Deserve Punishment
By Eugene Robinson
It’s no longer possible to mince words, or pretend we didn’t know. The International Committee of the Red Cross concluded in a secret report that the Bush administration’s so-called “enhanced” interrogation methods, used on “high-value” terrorism suspects, plainly constituted torture. The time for euphemisms is over, and the time for accountability has arrived.
The Red Cross report — published this week in its entirety for the first time by the New York Review of Books — is a stunning account of how the Bush administration spat on our laws, traditions and ideals. I realize that many Americans, given the scope of the economic crisis and the ambitions of the new administration, would rather look forward than revisit the past. The business of torture, however, is too unspeakable to be left unresolved.
After years of stonewalling, the Bush administration in October 2006 allowed the Red Cross to interview 14 Guantanamo detainees who had previously been held and interrogated in the CIA’s secret prisons. Among them were several men who almost certainly played major roles in planning and executing the Sept. 11, 2001, terrorist attacks, including Khalid Sheik Mohammed and Ramzi Binalshib. Others, such as Abu Zubaydah, now seem to have had less involvement in the attacks than once believed.
The 14 men told remarkably similar stories. After being arrested — whether in Pakistan, Dubai, Thailand or Djibouti — they were blindfolded, shackled and flown to an interrogation center that all of them identified as being in Afghanistan. This was probably the prison facility at the U.S.-run Bagram air base north of Kabul. Twelve of the 14 said they were tortured.
Three of the detainees reported being subjected to suffocation by water — the torture known as waterboarding. Abu Zubaydah’s account of the experience is quoted at length in the report: “I was put on what looked like a hospital bed, and strapped down very tightly with belts. A black cloth was then placed over my face and the interrogators used a mineral water bottle to pour water on the cloth so that I could not breathe. After a few minutes the cloth was removed and the bed was rotated into an upright position. The pressure of the straps on my wounds caused severe pain. I vomited. The bed was then again lowered to a horizontal position and the same torture carried out.”
Ten of the detainees said they were forced to stand in an excruciatingly painful position for days at a time, with their hands chained to a bar above their heads. If you don’t believe that’s torture, try it — and see if you last five minutes. One detainee, Walid Bin Attash, had an artificial leg, which he said his CIA jailers sometimes removed to make the “stress standing position” more agonizing.
Nine of the men said they were subjected to daily beatings in the first weeks of their detention. Abu Zubaydah said he was sometimes confined for long periods in boxes designed to constrict his movement — one of them tall and narrow, the other so short that he could only squat in an awkward and painful position.
According to the report, some of the tortures were aided and abetted by “health personnel” whom the detainees believed were doctors or psychologists.
This is barbarity with an ugly sheen of bureaucracy. Mohammed told the Red Cross that before he was waterboarded, one of his CIA interrogators bragged of having received “the green light from Washington” to give the prisoner “a hard time.” Who, precisely, was in the chain of command that gave the order for torture?
Who are the “health personnel” who monitored the suffocation sessions and the “stress position” tortures, at times suggesting a pause or a resumption of the agony? Who are the CIA torturers? Who are the Air Force officers at Bagram who might have disapproved of what the CIA was doing but took no steps to stop it?
I have believed all along that we urgently need to conduct a thorough investigation into the Bush administration’s moral and legal transgressions. Now I am convinced that some kind of “truth commission” process isn’t enough. Torture — even the torture of evil men — is a crime. It deserves not just to be known, but to be punished.
From George W. Bush on down, individuals decided to sanction, commit and tolerate the practice of torture. They took pains to paper this vile enterprise with rationalizations and justifications, but they knew it was wrong. So do we.
eugenerobinson@washpost.com
April 10th, 2009
Mark Benjamin and Michael de Yoanna at Salon complete their story on the army’s misdiagnosis of PTSD as other conditions, such as anxiety disorders. [See my earlier take on this story.] Yesterday they described the farce of an Army “Internal Investigation,” a.k.a. coverup of these diagnostic abuse, conducted by officers previously accused of involvement in such abuse!
What also escaped the black pen was the name of the man who presided over the review: Brig. Gen. James Gilman, who commands Great Plains Regional Medical Command, which oversees several Army hospitals, including the one under scrutiny at Fort Carson. Gilman assigned Col. Bruce Crow, the clinical psychology consultant to the Army surgeon general, to supervise the actual investigation….
Crow, meanwhile, was also implicated in the “personality disorder” scandal. As Knorr was writing up his review back in 2007, the Army dispatched Crow to Congress to “set the record straight,” as he told the House Committee on Veterans’ Affairs on July 25, 2007. Crow said the Army would study soldiers dismissed with personality disorders but suggested the Army was doing nothing wrong. He said soldiers with a diagnosis of personality disorder only “feel” they have been wrongly separated from the Army. “I want to assure the Congress that the Army Medical Department’s highest priority is caring for our warriors and their families,” he told the panel.
The investigators did not even talk to the officer accused of applying pressure to misdiagnose:
It appears, however, that investigators did not question the Army officer who Douglas McNinch said had pressured him not to diagnose PTSD. In an interview with Salon, McNinch said the pressure to misdiagnose soldiers came from the psychiatrist who used to head the Department of Behavioral Health at Fort Carson. “His name was Steve Knorr,” McNinch said.
Another officer involved in the investigation was junior to this same Knorr:
Salon has learned that one of the officers conducting the investigation of the tape is a junior officer to Knorr at their shared Army post. Lt. Col. Kris Peterson, chief psychiatrist at Madigan Army Medical Center at Fort Lewis, Wash., assisted Col. Bruce Crow in the investigation of the tape. Knorr is now a health consultant at Madigan.
In typical military behavior, a general announced what the investigation would conclude before it was even conducted.
Cody told Stichman and his associates that an internal investigation of the tape would be conducted. To Stichman’s surprise, Cody then suggested what the not-yet-completed investigation would reveal.
Cody denied that the Army was pressuring doctors not to diagnose PTSD in soldiers. “There is no one in leadership telling doctors to do this,” stated Cody. “This is not Army policy.” Cody called the evidence on the tape “anecdotal.”
In today’s concluding installment, Benjamin explains what is at stake for the military in this alleged behavior, money, a lot of it:
[I]f soldiers are identified as suffering from PTSD and thus disabled, the Army may have to separate those soldiers from the military and pay benefits — benefits that are extensive and can last a lifetime. The direct costs to the Army for treating soldiers with PTSD are potentially astronomical.
If you are a soldier who is officially disabled, you are entitled to collect a percentage of your base pay each month. The percentage depends upon your level of disability. Though this doesn’t happen in every case, the proper disability rating for PTSD is 50 percent, according to an Army memo that is now part of a class-action lawsuit by the National Veterans Legal Services Program. So let’s say, for example, that a 25-year-old private first class was discharged from the Army because of combat-induced PTSD and lived to be 75 years old while collecting benefits at the proper rate of 50 percent. The PFC would receive $784 a month, or half of $1,568 base pay (based on 2009 pay levels) for 50 years. That’s $470,400.
Now take that half-million dollar figure and multiply it by the number of returned troops who may be suffering from PTSD. Almost 2 million men and women from all service branches have served in Iraq and Afghanistan. The academic studies of PTSD cited in the Rand report include estimates of the true incidence of PTSD among Iraq veterans that range up toward 20 percent. A 2004 study in the New England Journal of Medicine said that 19.9 percent of Marines deployed to Iraq and 18 percent of Army troops deployed to Iraq may suffer from “broad definition” PTSD.
When a soldier with PTSD is diagnosed with a less serious illness, his benefits may very well be reduced dramatically. PTSD is often the result of witnessing bloodshed or nearly dying and is often linked to combat. But if a soldier’s injury is more vague, like anxiety disorder — the condition the Fort Carson psychologist on Sgt. X’s tape said he was being pressured to diagnose in soldiers instead of PTSD — a soldier may struggle to prove that an injury occurred as a result of the war and lose out on tens of thousands of dollars in benefits. A soldier suffering from anxiety disorder may receive some disability benefits, but almost certainly will not receive benefits that total 50 percent of base pay.
Thus, the amounts at stake could be over $100 Billion, depending on what level of benefits are avoided.
Also involved is the insatiable need for manpower to fight this country’s never-ending wars:
A recent Rand Corp. study estimates that nearly 20 percent of those Army troops who have served in Iraq and Afghanistan might suffer from PTSD or major depression. If they were all barred from the battlefield, the Army could lose as many as one out of every five combat troops while trying to fight two wars.
Given what is at stake, it will take tremendous effort to change the system apparently producing these abuses.
April 10th, 2009
Recently the New York Times editorialized on the role of health professionals in US torture. Unfortunately they ignore the several reports that these techniques were designed by psychologists:
Medically Assisted Torture
There was a great deal to be troubled by in a report by the International Committee of the Red Cross documenting the kinds of torture and abuse inflicted on terrorism suspects by the Central Intelligence Agency. One disturbing footnote is that medical personnel were deeply involved in facilitating the abuses, which were intended to coerce suspects into providing intelligence.
The report, prepared in 2007 but kept secret until it was published by The New York Review of Books, was based on Red Cross interviews in late 2006 with 14 “high-value detainees,” who include some of the most dangerous terrorists in custody. The prisoners’ complaints gain credibility because they described similar abuses and had been kept in isolation at different locations, with no chance to concoct a common story.
Various prisoners said they had been subjected to waterboarding, forced to stand for days with their arms shackled overhead, confined in small boxes, beaten and kicked, slammed repeatedly into walls, prevented from sleeping, deprived of solid food, forced to remain naked for weeks or months at a stretch, often in frigid cells and immersed in cold water. All were kept in continuous solitary confinement for their C.I.A. detention, ranging from 16 months to more than four years.
Medical personnel seem to have been involved mostly as facilitators rather than torturers or interrogators. In one case, they monitored a detainee’s oxygen saturation with a device attached to his finger so waterboarding could be stopped before the prisoner suffocated. In another case, an amputee forced to stand with his arms shackled overhead had his intact leg checked daily for signs of dangerous swelling. Several detainees said health workers sometimes instructed interrogators to continue, adjust or stop particular methods of abuse.
Such activities violate the ethical codes of major health organizations, both national and international. The Red Cross called it “a gross breach of medical ethics” that in some cases “amounted to participation in torture and/or cruel, inhuman or degrading treatment.”
None of the health personnel wore identification, but the prisoners inferred that they were physicians or psychologists. They also could have been paramedics, physician’s assistants or other less-trained personnel.
The report underscores the need to have a full-scale investigation into these abusive practices and into who precisely participated in them. Only then will we know whether indictments or, in the case of physicians, the loss of medical licenses, are warranted.
Remember, as you read this editorial and the ICRC report that stimulated it that the American Psychological Association insists that “psychologists are in a unique position to assist in ensuring that these processes are safe and ethical for all participants.” Thanks to the ICRC, we now have a better understanding of how they, and other health providers, kept these interrogations “safe and ethical for all participants.”
Unfortunately, despite a number of complaints be filed with the APA and state licensing boards, not a single health professional has lost his or her license for their efforts to keep torture “safe and ethical.”
April 10th, 2009