Brussels, European Parliament
March 1-2, 2005
J. Marc Wheat is the Staff Director and Chief Counsel to the Subcommittee on Criminal Justice, Drug Policy, & Human Resources, chaired by Congressman Mark Souder (R-IN). The Subcommittee brings much of its focus on narcotics (eradication, interdiction, prosecution, and treatment), the President’s Faith Based Initiative, and bioethics.
Before joining the Subcommittee in August 2003, Wheat was a Bush appointee as the Senior Advisor for Senate Affairs at the U.S. Department of State. His responsibilities were focused on enacting the Department's priorities for reconstructing Afghanistan and Iraq through the $16 billion Foreign Operations Appropriations bill.
Prior to joining the State Department in October of 2001, he was Counsel to the House Energy and Commerce Committee since June 1995. As a member of the Committee's health team, Wheat worked in all areas of the Committee's health jurisdiction. His areas of responsibility included public health, Medicare, medical confidentiality, organ transplantation, biotechnology, bioterrorism, National Institutes of Health, and the Centers for Disease Control and Prevention.
Wheat is the former Director of Tax and Budget Policy for Citizens for a Sound Economy, a nationwide non-partisan organization whose 250,000 members and supporters work for greater economic freedom and opportunity.
While at CSE, he founded and chaired the Porkbusters Coalition, a coalition of public interest organizations and 18 members of the House and Senate dedicated to the elimination of wasteful pork-barrel spending. The Porkbusters Coalition introduced President George H. W. Bush's 98 rescissions in March 1992, and succeeded in the elimination of $8.1 billion of wasteful spending in May 1992, the largest such rescission since 1982. Wheat's Porkbusters Coalition was the subject of Adventures in Porkland, a book by Washington Post reporter Brian Kelly and illustrated by political cartoonist Pat Oliphant.
Prior to joining CSE, Wheat worked for Congressman Dennis Hastert (R-IL) for three years. As the congressman's Senior Legislative Assistant, Wheat led Congressman Hastert's drive to repeal the Social Security earnings limit (later the 7th pledge in the Contract With America), and handled Congressman Hastert's tax and budget policy work.
Wheat presently is serving a three-year term as a gubernatorial appointee to the Virginia Board of Medical Assistance Services, which oversees the state Medicaid program; First Vice President of the Memorial Foundation of Germanna Colonies; and Chairman of Oakseed Ministries.
A sixth-generation Hoosier from Fort Wayne, Indiana, Wheat received his Bachelor of Arts degree (majoring in Spanish) from the University of Illinois at Urbana-Champaign in 1987, and his Juris Doctor in the Corporate and Securities Specialty Track at George Mason University. He frequently lectures on parliamentary tactics and strategy at the Leadership Institute.
A member of the Society of the Cincinnati in the State of Virginia, Wheat has been listed in The Almanac of the Unelected, Who's Who in America (57th edition), and Who's Who in the World (20th edition). He is married to Marie G. Wheat, Chief of Staff/Chief Operating Officer and White House Liaison at the Peace Corps. The Wheats raise their son in Arlington, Virginia. (Rev. 1/05).
The Flaws of Harm Reduction in the United States
We should all work for “Healing America’s Drug Users,” as President Bush calls us to do in his National Drug Control Strategy. From the evidence gathered by the Subcommittee on Criminal Justice, Drug Policy, and Human Resources, it remains to be seen if “harm reduction” brings healing or just harm.
The Subcommittee for which I work drives most of the agenda on illegal drug policy in the House of Representatives. I believe this Subcommittee, chaired by Congressman Mark Souder of Indiana, was the first to hold a hearing on measuring the effectiveness of drug treatment programs, and was the first to hold a hearing on the President’s Access To Recovery initiative, which seeks to increase and enhance the availability of drug treatment in the United States. Many members of the Subcommittee are working together to pass the Drug Addiction Treatment Expansion Act, introduced by Chairman Souder.
But there is a broad level of disagreement in Congress on the merits of “harm reduction.”
The Subcommittee started working in the area of “harm reduction” in February 2004 when it was brought to our attention that two major pharmaceutical companies, Abbott Laboratories and Roche Pharmaceuticals, were financing programs of the New York-based Harm Reduction Coalition and were, for a time, listed as corporate cosponsors of 5th National Harm Reduction Conference entitled, “Working Under Fire: Drug Users Health and Justice 2004.”
The 5th Conference included topics such as “Priorities in Addressing Crystal Meth Use among MSM,” “Tweaking Tips for Party Boys,” The Need for Heroin Maintenance,” “Lifetime of Punishment: Collateral Consequences of the War on Drugs,” “Psychedelic Emergency Services: Reducing Harms and Enhancing Benefits of Psychedelics and MDMA (Ecstasy),” “Improving Upon a Pictorial Guide: Teaching Safer Injection and Better Vein Care,” “Harm Reduction Lobbying 101, and “The Art of War: Institutionalizing Harm Reduction within the Conservative Community.”
The workshops at the previous Conference included, “The War on Drugs-A War on the People,” “Drugs in the Workplace,” “Starting a Drug User Group,” “Developing Political Support Among Legislators for Reform of Drug Sentencing Laws,” “Community Opposition -- Neutralizing the Opposition and Bringing Out the Activists in Your Community,” “Advocacy in Eastern Europe: A Growing User Movement in Eastern Europe,” “Exercising and Protecting Your Rights During a Police Encounter,” “The Future of Medical Marijuana,” “Advocating for Medical Cannabis Patients,” “OxyContin Injection and Overdoses in Connecticut: Overblown?,” “Using Media to Organize Support for Needle Exchange,” “Sex Work Track -Youth,” “SexWork Track-SexWorkers Organize: Labor, Law, Reform and Policy Change,” “Legislative Advocacy,” “Working with Pregnant and Parenting Drug Users: Dealing with Mandatory Child Abuse Reporting and Confidentiality Laws,” “A Sex Radical Approach to HIV Prevention for Street Youth,” “Sentencing Reform in Hawaii: Reducing the Harm from Drug Laws,” “The Place of Safer Injection Facilities in Harm Reduction,” “Safe Injection Spaces,” “Heroin Maintenance,” and “What Impact Will Decriminalization of Heroin have on Urban Policing by 2010?”
From the titles of these presentations and workshops, the agenda of the “harm reduction” movement seems clear. But how well does that agenda serve Americans caught in the snare of drug abuse?
Congressman Souder, who not only chairs the Subcommittee but also Speaker Hastert’s Task Force for a Drug-Free America, attempted to bring that matter into focus at the February 16th hearing. He asked, “when evaluating drug control policies, we must look beyond the intent of a program and look to the results. We should always apply a common-sense test: do the policies in question reduce illegal drug use? That is the ultimate ‘performance measure’ for any drug control policy, whether it is related to enforcement, treatment, or prevention.”
As Chairman Souder pointed out, if we apply that test to federal drug programs on the whole, the Bush Administration is doing very well. Drug use, particularly among young people, is down since President Bush took office in 2001. Under this Administration, we have seen an 11 percent reduction in drug use, and over the past three years there has been an historic 17 percent decrease in teenage drug use. That is in stark contrast to what happened in the mid- to late-1990s under the Clinton Administration, when drug use – particularly among teenagers – rose dramatically after major declines in the 1980s and early 1990s.
Now, what if we were to apply that same test to that of “harm reduction?” It wouldn’t even be close – “harm reduction” does not have the goal of abstention from drugs. Many members of the “harm reduction” movement assume certain individuals are incapable of making healthy decisions. Advocates of this position hold that dangerous behaviors, such as drug abuse, therefore simply must be accepted by society and those who choose such lifestyles -- or become trapped in them -- should be enabled to continue these behaviors in a manner less “harmful” to others. Often, however, these lifestyles are the result of addiction, mental illness, or other conditions that should and can be treated rather than accepted as normal, healthy behaviors.
Not all members of the “harm reduction” movement support the legalization of drugs, but the Subcommittee received testimony that legalization advocates had a great deal to do with launching the movement. According to the February 16th testimony before the Subcommittee of Robert Peterson, Vice President of PRIDE Youth Programs, the term “harm reduction” was “first selected and promoted in 1987 by a group of drug lawyers meeting in Great Britain sponsored by the drug legalization group – the Drug Policy Foundation. This group was later merged into the George Soros-backed Drug Policy Alliance. The term ‘Harm reduction’ ran a close second with the term ‘harm minimization’ to avoid the “L” word: ‘legalization.’” Mr. Peterson’s testimony also quoted Peter McDermott, who wrote “as a member of the Liverpool cabal who hijacked the term Harm Reduction and used it aggressively to advocate change during the 1980’s, I am able to say what we meant when we used the term… Harm reduction implied a break with the old unworkable dogmas – the philosophy that placed a premium on seeking to obtain abstinence.”
Dr. Eric Voth, in his testimony before the Subcommittee on February 16th, identified some of the outcome measurements we should look for in reviewing scientific literature on the efficacy of “harm reduction” measures like needle distribution programs. As Dr. Voth explained to the Subcommittee, there should be at least three measures of success for needle distribution programs: First, is there a consistent reduction in Hepatitis B, C and HIV in terms of net incidence and conversion rate among the participants, not just on the needles tested? Second, are there significant reductions in actual use of IV drug use and a consistent increase in the number of users enrolled in needle distribution programs that seek and participate in treatment? Third, is there an elimination of dirty needles on the street? Dr. Voth concluded, “You will find that most, if not all, needle handouts fail in every one of these measures.”
Similarly, in written testimony submitted for the record, Dr. Fred J. Payne wrote that the rationale for needle exchange is simple; if the injection drug users had access to clean needles and syringes and would use them consistently without sharing them, the chain of HIV transmission from person to person through needle sharing would be broken. Although this is a seemingly plausible idea, the effectiveness of these programs has been difficult to evaluate… Those studies selected should have been able to show differences in viral seroprevalence between users of needle/syringe exchange and non-users, reduction in viral incidence, or show differences in an endpoint such as mortality. At the time of most of these studies it was thought that risky injection behavior such as needle sharing was the principle route of HIV transmission among IDUs. Now, however, high-risk sexual behavior is recognized to be equally, if not more, important.”
Dr. Voth testified on some specific studies that “detailed evaluations in Montreal and Seattle as well as several others clearly demonstrate that HIV and Hepatitis B and C among the participants in needle handouts increases over non-participants. In Montreal, a study of HIV seroconversion rate found a rate of 7.9 per 100 person-years among NEP [needle exchange program] participants, and a rate of 3.1 per 100 person-years among non-participants. A cumulative probability of 33% HIV seroconversion existed among NEP participants as compared to 13% for non-users.” Dr. Voth also highlighted the experience of Seattle, where “in 1996 prevalence of HIV, Hepatitis B, and Hepatitis C were respectively 1%, 8%, and 17%. In February 2002, prevalence was 2%, 18%, and 66%. The conclusion was that the needle exchange program alone was not able to control the spread of Hepatitis C.” Dr. Payne commented that in Seattle, “the highest incidence of infection with [HBV and HCV] occurred among current users of the exchange. The authors stated that the goal of elimination or substantial reduction in risk behavior that may transmit HIV among IDUs had not been achieved. Risk behavior for HBV and HCV transmission were still practiced by a substantial proportion of Seattle area drug injectors.”
Dr. Beilenson testified that there are studies demonstrating that the needle distribution and outreach programs are working in Baltimore, and that the health of drug users is improving. Chairman Souder was unconvinced, and asked if the improving health measurements were due to the aggressive outreach of health prevention and treatment efforts that happened to also include needle distribution. In his written testimony, Dr. Payne observed that “It is fair to say that NEP have not been measurably effective in limiting the spread of HIV, or of HBV and HCV in any of these studies. Some of them like Vancouver, Seattle, and Baltimore had been operating in areas that lacked basic public health programs such as HIV name reporting and partner notification, programs usually used for control of sexually transmitted infections. The needle exchange and counseling apparently were the primary means of harm reduction.”
The prevalence of injection drug use in urban areas poses a major public health challenge due to high levels of drug-related mortality and the transmission of blood-borne viruses including HIV and Hepatitis B and C. Local communities with large populations of injection drug users complain of extensive public drug use, improperly discarded syringes in parks and playgrounds, and high rates of drug-related crime. In response, many European governments as well as local governments in Sydney, Australia and Vancouver, Canada have opened medically-supervised “safe-injection facilities” (SIFs), also called drug consumption rooms, which allow drug users to inject “safely” and legally under medical supervision. From time to time, we learn of self-appointed public health advocates who seek to set up SIFs in their own cities in the United States.
Despite the fact that SIFs have been open in Europe for over 10 years, public health experts have noted that quantitative data on the effectiveness of these facilities is limited. Nonetheless, proponents of SIFs and other “harm-reduction” strategies claim that these facilities have resulted in “a number of public health and community benefits,” causing some, including public health officials in Hawaii and New York City, to call for their implementation in the U.S. Although touted as an “evidence-based” public health strategy, a thorough examination of the scientific literature reveals that SIFs fail to significantly reduce harm among injection drug users, particularly with respect to the reduction of HIV and Hepatitis transmission (HBV and HCV).
In 2004, more than ten years after SIFs became operational in several Swiss cities, researchers reported, “It has not yet been demonstrated that the frequentation of Drug Consumption facilities has reduced the number of cases of HIV or HCV infection.” Similarly, researchers in Sydney concluded that there was no evidence that the SIF impacted the incidence of HIV, HBV, or HCV infection among SIF users. Significantly, the European Report on Drug Consumption rooms, a survey of published studies detailing the impact of SIFs across Europe, failed to cite any European study describing the effect of SIFs on HIV transmission. Among published studies describing SIFs in Switzerland, Germany, and the Netherlands, researchers have never demonstrated that SIFs curb the rate of HIV transmission among drug users.
But what about public nuisance? A study involving five SIFs in Germany found that 64% of SIF clients “stated that the amount of time they spent in the [public] drug scene remained unchanged after they began attending the drug consumption room.” In Sydney, the SIF had no statistically significant effect on the number of improperly discarded syringes in the local community, and in Biel, Switzerland an increase in the number of discarded syringes was reported after the opening of the SIF. Significantly, a study in Hamburg, Germany reported an increase in the number of drug-related resident complaint calls asking for local police intervention and “the departure of families from the residential quarter was noted as an indication of declining quality of life.” Studies in Switzerland and Australia found no change in drug-related crime after the introduction of SIFs. Together, these studies demonstrate that the public nuisance associated with intravenous drug use appears to be largely unaffected by the presence of SIFs, a surprising result given that the reduction of public nuisance was a primary goal of many SIFs across Europe and in Australia.
As noted by researchers in Europe, several studies have observed that “small-scale” drug trafficking occurs in the immediate vicinity of SIFs, a result consistent with the fact that 62% of frequent SIF clients in Hamburg indicate that they use the SIF to meet people. I think we would all agree with Dr. Fred Payne, who concluded, “Far from reducing harm, simply bringing needle/syringe exchange into this maelstrom only adds more fuel to the fire.”
We see two defined positions in the United States: “harm reduction” and what we might call “harm elimination” with members of both camps largely congregating around these two standards, with some people somewhat in the middle between the two poles.
The position of the Bush Administration and the House and Senate Republican majority are largely in the anti-drug “harm elimination” camp, although there are some Federal agencies that have funded programs in the “harm reduction” camp.
Two examples demonstrate that even the Bush Administration has difficulty in funding programs that fit a coherent theory on the public health implications of drug abuse. On the afternoon of February 10th, White House Office of National Drug Control Policy Director John Walters testified before the Subcommittee on Criminal Justice, Drug Policy, and Human Resources. Chairman Souder asked him about the involvement of the U.S. Agency for International Development (our primary foreign assistance agency) in two questionable projects. The first project was the 14th International Conference on Reduction of Drug Related Harm held in Chiang Mai, Thailand from April 6-10, 2003. In an e-mail invitation to the conference, it was promoted as having a “special emphasis on harm reduction advocacy… Harm reduction has to fight hard to get a hearing in the midst of all this and to challenge the new social order campaigns.” The conference was sponsored by the International Harm Reduction Association, the Asian Harm Reduction Network, and cosponsored by the Centre for Harm Reduction and USAID.
The second project was the Asian Harm Reduction Network’s 350-page, second-edition Manual for Reducing Drug Related Harm in Asia (which bears a USAID logo). USAID’s role in the production of the manual is acknowledged inside the cover: “This publication was made possible through support provided by the Office of Strategic Planning, Operations, and Technical Support, Bureau for Asia and the Near East, U.S. Agency for International Development…” Included in the second chapter of the manual, “Rationale for Harm Reduction,” are sections on “needle and syringe programs,” “sales and purchasing of injecting equipment,” and “removing barriers.” In the fifth chapter, “Injecting Safely,” are sections devoted to “sharing of injecting equipment,” and “safe injecting.”
ONDCP Director Walters responded that he was not aware of the "harm reduction” publication financed by USAID nor did he attend the USAID-cosponsored 14th International Conference on Reduction of Drug Related Harm. He added, however, that he has been aggressive in rebuking international organizations which promote “harm reduction.” He pledged to look into this regrettable matter and report back to the Subcommittee.
In its annual report released March 2, 2004, the International Narcotics Control Board -- the United Nations’ drug agency -- sharply criticized “harm reduction” measures such as needle exchange programs and so-called “safe injecting rooms,” because such policies encourage drug use and violate “article 4 of the 1961 Convention [which] obliges State parties to ensure that the production, manufacture, import, export, distribution of, trade in, use and possession of drugs is to be limited exclusively to medical and scientific purposes. Therefore, from a legal point of view, such facilities violate the international drug control conventions.”
What troubles many members of Congress is that at the same time that the International Narcotics Control Board was warning parties to the Single Convention on Narcotic Drugs (1961), the Convention on Psychotropic Substances (1971), and the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988) that government financing of “harm reduction” schemes may be in violation of those accords, it appears that USAID, an arm of the U.S. government, was financing a “harm reduction” agenda of its own.
It is also not clear how much support Congressional Democrats are willing to lend the “harm reduction” movement, but their choice of witnesses is troubling and may give us a hint.
One of the Democrat witnesses at the February 16th hearing, Dr Peter Beilenson, worked several years ago on a project to bring heroin distribution to Baltimore, Maryland. In June 1998, the Baltimore Sun reported that Johns Hopkins University drug abuse experts and Baltimore's health commissioner were “discussing the possibility of a research study in which heroin would be distributed to hard-core addicts in an effort to reduce crime, AIDS and other fallout from drug addiction.” At that time, “public health specialists from a half-dozen cities in the United States and Canada… met at the Lindesmith Center, a drug policy institute supported by financier George Soros, to discuss the logistics and politics of a multi-city heroin maintenance study.” “Such an endeavor would be ‘politically difficult, but I think it's going to happen,’ said Baltimore Health Commissioner Dr. Peter Beilenson.”
Another witness requested by the Democrats, Dr. Robert Newman, served on the Board of Directors for the Drug Policy Foundation as early as 1997, and presently serves on the board of directors with another witness requested by the Democrats, Rev. Edwin Sanders, of the Drug Policy Alliance (the new name of the Drug Policy Foundation since its merger with the aforementioned Lindesmith Center). The Drug Policy Alliance describes itself as “the nation’s leading organization working to end the war on drugs.” Along with its major donor George Soros, it helped produce It’s Just a Plant, a pro-marijuana legalization children’s book.
What are the prospects for the “harm reduction” movement in the United States? If the political winds were to change just slightly and if we do not educate our left-of-center friends about the dangers of “harm reduction,” it seems likely to me that programs meeting the approval of groups like Drug Policy Alliance and the Marijuana Policy Project (also a source for witnesses requested by the Democrats) would increase.
But my chairman is standing against such a change in policy. As Chairman Souder stated at the February 16th hearing on “harm reduction,” “Instead of addressing the symptoms of addiction – such as giving them clean needles, telling them how to shoot up without blowing a vein, recommending that addicts abuse with someone else in case one of them stops breathing - we should break the bonds of their addiction and make them free from needles and pushers and pimps once and for all.”