11/3/14

Strange Bedfellows: Terrorists and Drugs

© Hurricanehank | Dreamstime.com - Terrorist In Mask With A Gun Photo

© Hurricanehank | Dreamstime.com – Terrorist In Mask With A Gun Photo

This past May, the DEA raided a Birmingham Alabama warehouse as a part of Project Synergy. Inside, agents found hundreds of thousands of “Scooby Snax” baggies containing spice (synthetic marijuana). Sales of the product were also linked to $40 million in wire transfers to Yemen. Yemen is the home base for Al-Qa‘ida in the Arabian Peninsula (AQAP). While not able to directly link the money to a particular group or organization, DEA spokesperson Rusty Payne said: “It doesn’t take a rocket scientist to figure out that people aren’t sending $40 million to their struggling relatives overseas.”

Derek Maltz, the director of the Special Operations Division of the DEA said: “There’s a significant, long history between drug trafficking and terror organizations.” More than 50 percent of the State Department’s designated foreign terrorist organizations (FTOs) are involved with the drug trade. While the Obama administration has been successful in cutting off state-sponsored funding for terrorist organizations, they have looked for other sources of revenue. The $400 billion annual international drug trade is the most lucrative illicit business in the world and a tempting “investment opportunity” for terrorists.

Maltz went on to say that the synthetic drug market is a “two-for-one deal” for terrorists—they undermine Western countries with the drugs and make millions in the process. We’ve put a bull’s-eye on our back, he said. “When you see a designer synthetic drug industry as lucrative as this in the U.S., it would only be natural that it would be a huge target for those trying to finance their terrorists.”

The world of narcoterrorism has some diversity in its investers. The Taliban in Afghanistan distribute heroin; FARC in Columbia deals in cocaine; and al Shabab in West Africa is alleged to sell khat. While the association of al Shabab and khat may be questionable (here and here), the links between the Taliban and heroin as well as FARC and cocaine are well documented.

While Afghanistan and growing opium have been linked for thousands of years, it has only been in the last three decades that it has become the center for worldwide opium cultivation. Since 2001, opium production in Afghanistan has increased from 70 percent of the overall global opium production to 92 percent. To give you a sense of the size of this, the 2013 World Drug Report indicated that in 2011, Afghanistan produced 5,800 tons of opium, down from 7,400 tons in 2007. The next largest opium producer in 2011 was Myanmar with 610 tons of opium.

The World Bank estimated that the opium GDP of Afghanistan is between $2.6 and $2.7 billion. This amounts to 27 percent of the country’s total GDP, both licit and illicit. And yet, only 3 percent of the natural agricultural land in Afghanistan is used for its production. Poverty is widespread in Afghanistan and many of farmers are compelled by economics and force to grow opium. “Opium is valued at over $4,500 per hectare, as opposed to only $266 for wheat.” Because of this potential profit, many farmers are pressured to cultivate opium by various organizations, warlords and landowners.

The provinces of Helmand and Kandahar, which were regularly in the news during the war in Afghanistan, are also the primary opium producing provinces in the country. As former Afghan president Hamid Karzia said: “The question of drugs . . . is one that will determine Afghanistan’s future. . . . [I]f we fail, we will fail as a state eventually, and we will fall back in the hands of terrorism.”

According to sources in Spanish intelligence, the Islamic State and other jihadist groups are using their connections in the illegal drug market to finance their operations in Iraq and Syria. Jihadists use their knowledge of drug smuggling routes to export arms, contraband and new recruits from Europe to Iraq and Syria. Ironically, the pressure to dry up legal fundraising for terrorist organizations has contributed to their increased trade with illegal arms and drugs.

According to reports from Spain’s recently established government intelligence and counter-terrorism unit CITCO, 20% percent of those detained in Spain under suspicion of working with Islamic State and other jihadist groups have previously served prison sentences for offences such as drug trafficking or document counterfeiting.

FARC rebels control over 60 percent of Columbia’s drug trade, including overseas trafficking. The Revolutionary Armed Forces of Columbia (FARC) earns about $1 billion annually from the production and sale of cocaine in Columbia. According to General Jose Roberto Leon, the head of the Columbian national police force, “We have information found on computers after operations that have captured or killed FARC leaders, and it’s involvement in drug trafficking is evident.” The Columbian anti-narcotics police chief, General Ricardo Restrepo, said that officials fear that if a peace deal with FARC is successfully negotiated, thus cutting into cocaine production, that new gangs producing synthetic drugs will emerge. “It will be our next battle.”

The connection between terrorism and drug trafficking does not currently get much attention in the news media, in part, because the connections are difficult to make. But it does exist and seems to be a growing trend. Spanish intelligence sources have reported that European jihadist groups are using drug smuggling routes to export drug contraband and new recruits from Europe to Iraq and Syria. And most of the cocaine entering Europe is reportedly going through territories controlled by the Islamic State.

The Birmingham bust discussed above is particularly disturbing to me as it connects the making and distribution of the newest addictive danger, new psychoactive substances (NPS), with terrorism. This combination truly is a two-for-one threat. But we can have a two-for-one response to that threat. Both the war on drugs and the war on terrorism can be fought by social policies as well as drug treatment and education that aim for the reduction of drug use.  Who would have thought that the slogan in the war on drugs would someday be: Fight Terrorism by Becoming Drug Free.

08/25/14

Chained to a Dragon

By the time Stephanie (not her real name) had been seen for her first “counseling” appointment, she had already been activated as a client at the methadone clinic. She met the required criteria: 18 or over (she was 18); previous failed drug treatment (as an adolescent who smoked pot she had failed to complete an outpatient drug treatment program); she reported using heroin for a year (with her older boyfriend); she was eligible for Medicaid. Heroin addiction is considered a “life threatening medical condition” for which a doctor had already signed and completed the necessary paperwork for the clinic to get paid; and Stephanie to receive additional medical care. She didn’t realize she has just chained herself to a dragon.

Methadone maintenance is considered by many to be the “gold standard” for opiate/opioid use disorders. And leaving methadone treatment is seen as ill advised in the literature. “Methadone Maintenance Treatment: (MMT)” by Herman, Stancliffe and Langrod, said that: “Methadone maintenance reduces and/or eliminates the use of heroin, reduces the death rates and criminality associated with heroin use, and allows patients to improve their health and social productivity.” Leaving Methadone Treatment” by Magura and Rosenblum, cautioned that: “The detrimental consequences of leaving methadone treatment are dramatically indicated by greatly increased death following discharge.”

But let’s flip this gold standard over and look at the other side. A 2005 review of the MMT literature, “Eyes Wide Shut?” suggested that rigorous evaluation of MMT programs is rare. The evidence for the effectiveness of MMT is mixed; and largely partial and only over the short term. “The quality of existing MMT research, and evidence for its general effectiveness are limited.”

An HBO documentary, “Methadonia,” painted a bleak picture of the life of several MMT patients in NYC. Steve, one of the persons followed in the film, who was trying to get off of methadone, said: “Once they get you hooked, you’re nothing but a junkie. Come get your fix in the morning.” You can view “Methadonia” online for free here and here. It is also available through Netflix. At one point in the film, Steve nods out repeatedly in the middle of speaking to the camera.

A recovering heroin addict I know told me about a classroom discussion he participated in about the pros and cons of methadone maintenance. My friend was for abstinence-based recovery; a classmate who was in a MMT program was pro medication-assisted recovery. In the middle of a statement on the benefits of MMT, the classmate nodded out for several seconds, picked right back up where he’d stopped speaking and finished his statement. My friend’s comment was: “I rest my case.”

According to Magura and Rosenblum, a large percentage of those who attempt to taper off of methadone will either resume active heroin use or resume MMT. They pointed to the considerable evidence that individuals who left methadone treatment had a high rate of relapse to opiate use. “Until we learn more through research, it is unwise to structure methadone programs … to discourage or impede long-term maintenance, and at the same time to pressure patients overtly to accept abstinence.” Herman et al. said: “It may be necessary for patients to remain in treatment for indefinite periods of time, possibly for the duration of their lives.”

A recent article in the New England Medical Journal strongly advocated for expanded access to medication-assisted therapies (MAT) like methadone maintenance, saying: “Expanding access to MATs is a crucial component of the effort to help patients recover.” But the authors fail to clearly distinguish between opioid MATs like methadone and buprenorphine and non-opioid naltrexone.

Further, while the “abuse liability” of buprenorphine is acknowledged by the authors as a disadvantage, the “abuse potential” of methadone is not! The opioid addicts I’ve known with experience using or abusing methadone and buprenorphine have always testified of the exponentially greater difficulty they have withdrawing or tapering off of methadone and “bupe” than they have with heroin.

Steely Dan, in their classic song “Time Out of Mind”, sung about “chasing the dragon.” This was a reference to the technique of using a straw or tube to inhale the vapor from heroin that had been placed on a piece of tinfoil and heated. The metaphor is an allusion to the hope that the next dose of heroin will return the user to the nirvana of their first high. But continued use never quite lives up to the promise. Each use leads to diminishing positive effects, leading to a fruitless chasing of the dragon to recapture the initial high. That is what the promise of methadone maintenance is like—chasing a chained dragon. To learn more, see my paper “Chasing a Chained Dragon: Methadone Abuse and Misuse.”

Also read, “The Consequences of Ignoring the Past.”