------------------------------------------------------------------- Suicide law still draws emotional responses (The Oregonian interviews four doctors who work with dying patients about the Oregon Death With Dignity Act, the state's unique physician-assisted suicide law that took effect in 1997.) The Oregonian letters to editor: firstname.lastname@example.org 1320 SW Broadway Portland, OR 97201 Fax: 503-294-4193 Web: http://www.oregonlive.com/ Suicide law still draws emotional responses * Four doctors, two for and two against, offer their personal feelings on helping the terminally ill take their own lives Monday, December 28 1998 By Erin Hoover Barnett of The Oregonian staff Since the Oregon Death With Dignity Act took effect in 1997, all doctors in Oregon who work with dying patients have had to face a question many may have preferred to avoid: Would they help terminally ill patients take their own lives? The state's physician-assisted suicide law doesn't force doctors to participate. But it does give dying patients the right to ask and to find a doctor who might help them. Now, more than a year since the law took effect, assisted suicide is still not a topic that most doctors want to discuss publicly. One doctor said it isn't even discussed among colleagues. But the following physicians, approached by The Oregonian, were willing to share how this issue is playing out in their practices. Two have assisted patients and two have not. All have grappled with where they draw their own line and why. Dr. Jim Patterson, 56, pulmonologist Almost once a week, one of Dr. Jim Patterson's patients dies. From lung cancer. From emphysema. From chronic obstructive pulmonary disease. But Patterson has never assisted in a patient's suicide -- and doesn't believe he needs to. He says that in more than 20 years as a pulmonologist and critical care doctor, the two patients who even hinted at wanting to die early changed their outlook when he promised attentive care. That does not mean that he has not helped people to die. He often must help with the decision to remove life support, and he will use medication to treat suffering aggressively even if that also hastens death. He draws a clear line between this and assisted suicide, where a patient obtains a lethal dose to swallow. "My experience doesn't lead me to think physician-assisted suicide is a necessary or even important part of taking care of a dying patient," Patterson said. "I am so interested in focusing on the educational process of caring for the terminally ill. I think that's where it's at. Not physician-assisted suicide." Patterson said he would not get in the way of a person's right to have help with assisted suicide and has felt humbled by stories of the suffering that some people experience as they die. But for him, giving a person a lethal prescription to take at will -- particularly with lung disease patients for whom it's hard to predict survival time -- feels like abandonment. Patterson feels that most patients do not want to die prematurely. They also do not want to suffer. He thinks that doctors schooled in pain management and respectful of the choices patients already have can help people die comfortably. Patterson remembers how, soon after he went into practice at Providence Portland Medical Center in 1976, a woman in her 60s helped him understand the distinction that medical ethicists make between ordinary and extraordinary care. Intelligent and aware, the woman had emphysema and could breathe only with the help of a ventilator. She couldn't talk because of the tube down her throat to her lungs. But she told him -- by shaking and nodding her head -- that she did not want to stay on the ventilator, even though she knew she would die. Patterson had grown attached to the woman. It hurt to give up. The woman was Catholic. Patterson is not. But an elderly priest eased Patterson's mind as well as his patient's. The priest told the woman that she had no obligation to stay on the ventilator, and that Patterson had no obligation to keep her on the machine. He told the woman that she would still go to heaven. That didn't make it easy for Patterson when he gave her morphine to relax any anxious drive to breathe and removed the tube from her lungs with her family around her. But it did help him to see how he could help a person die in terms acceptable to them. Dr. Mark Rarick, 44, oncologist Dr. Mark Rarick tells patients in his Portland oncology practice that they are the captain. His job is to guide them. He will discourage bad choices. But he believes patients do better when they can make their own decisions. That's why Rarick was uncomfortable a few years back when he could not help a woman in the way she clearly wanted. The woman was near death from breast cancer. It hurt just to move. She slept upright on the couch. She didn't want more pain medication. She was ready to die. "I felt handicapped," Rarick said. "I was able to treat her through her whole illness, but at the end, I couldn't help her." All Rarick could do was give her more morphine until she died more than 10 days later. With Oregon's physician-assisted suicide law, Rarick feels that he can help patients with a fuller range of choices they may decide to make. "My support is of a person's right to choose," said Rarick. "They have the right to choose chemotherapy, to choose resuscitation, and they have a right to choose their death." Rarick has always openly discussed with his terminally ill patients at Kaiser Permanente how they want to die -- whether they want to be revived if they stop breathing or when to get hospice care. He deters patients whom he feels may be looking to die when treatment or other care may still be desirable options. Even when he's sure they're sure, though, he finds the process tough. He cared for one woman with breast cancer for more than a year, and knew that she was near death. She told him she wanted control. She filled out an advance directive and consulted with a psychiatrist. Rarick, in turn, knew she was clear in her request, and not acting rashly. He took comfort in the guidance he got from Kaiser Permanente's process to help physicians handle patient requests appropriately under the law. Still, he remembers getting a headache from trying so hard to be certain he covered the checklist of things required by the law -- the second opinion, her mental competency, whether she understood her options for pain control. "I remember feeling trembly. Every time I checked things off, I felt it was really happening," Rarick said. He even checked her driver's license with the state to be sure she was a resident. He remembers exactly where he was sitting in his office when the pharmacist came by and Rarick signed his name on the prescription. He and the pharmacist paused and looked at each other. Rarick drew a breath and let it out. But Rarick took comfort in his queasiness. He didn't want to feel at ease about writing a lethal prescription. In the end, the woman chose not to use the prescription. But Rarick learned from her friends that she was buoyed by knowing that she had the choice if she wanted it. When Rarick learned she had died, he felt sad. He also felt he had done right by her as her physician. "I felt that she was in control to the end, and I was able to help her do that," Rarick said. "I met my goals of helping her through her illness and her death." Dr. Walter Urba, 46, oncologist Dr. Walter Urba isn't confused about physician-assisted suicide. He won't do it. His feelings, which became clear to him very early in the assisted suicide debate, grew out of his own struggle with facing his patients' deaths and his realizations about the value of excellent care and not cutting short a patient's dying. Urba is concerned that assisted suicide could interrupt that opportunity for healing and closure that can make a death so much gentler for the patient, family and caregivers. He remembers in particular a young woman who came to the Robert W. Franz Cancer Research Center at Providence Portland Medical Center, which Urba directs. In her 20s, the woman was full of vitality and an avid skier. But she had skin cancer and had moved with her husband to Oregon for treatment. Urba and his colleagues tried experimental therapies to eradicate the cancer. When those failed, they tried treatments to slow it down. The cancer kept spreading. Urba had to tell the woman and her husband that she was going to die. She told Urba she wanted to return to her home state. Urba made sure she had hospice care there. Before she left Portland, she turned to Urba and thanked him for trying. Urba remembers realizing that he would never see her again. Urba couldn't help but feel that he had failed. "We all have the sense that we didn't get the job done," Urba said. She died at home with her family around her. Not long after her death, he heard a knock at his office door. In strode the woman's husband, baseball cap on backwards, and her parents. They had come to sprinkle the woman's ashes in Oregon. They wanted to see Urba to say thank you. They planned to start a scholarship fund to allow young people to come to the cancer research center to study. Her husband shook Urba's hand. Urba was overwhelmed. Years later, his throat still tightens when he talks about it. But the experience has helped him to understand how something as dreadful as losing a young woman in the prime of her life can create something larger and stronger that did not exist before. "It's proof to me of the principle that caring and compassionate people can provide good end of life for people," Urba said. He won't abandon a dying patient who wants assistance committing suicide; he will refer the patient to someone who can help. He, however, doesn't want his patients confused about what his job is. "I've never had a doubt how I would behave toward my patients. My role is as a healer and to relieve suffering and not to help my patients commit suicide," Urba said. "Nobody needs to look at me and see anything else." Dr. Pete Reagan, 52, family practice When Dr. Pete Reagan was asked by the right-to-die group Compassion in Dying last spring to evaluate a patient who wanted a lethal prescription, Reagan felt frightened, worried -- and honored. Reagan believes deeply in people's right to control their lives. As a Quaker and a radical pacifist, he was placed on probation in lieu of three years in prison for resisting the draft during the Vietnam War. As a family doctor in private practice in Portland, Reagan tries to advise, not dictate to, his patients. "It's not my job to set their goals," he said. "It's my job to help them figure out how to reach theirs." But when Reagan met the patient he calls Helen, he was in for a profound test of his personal convictions. Reagan saw that Helen qualified for a prescription under the law. In her mid-80s, she had cancer throughout her body. Reagan and a pulmonologist concluded her prognosis was measured in weeks. Reagan saw no indication of depression, nor did the psychiatrist who extensively evaluated her. She had plenty of money for care. Hospice nurses attended to her. But she felt she had had a good life. Now she was done. For Reagan, that was the hard part. In the past, he had a patient die angry when he could not help him die. Another slashed his wrists with scissors in a nursing home. But now that he faced a patient he could legitimately assist, the magnitude of it felt frightening. Reagan worried about the controversy swirling around the law. He worried about the consequences for him professionally. And, most of all, he struggled with Helen's "shocking impatience" to die. Reagan sought out the consulting physician and the psychiatrist. They talked for hours, trying to figure out if they'd missed something, trying to understand Helen's determination. Reagan talked with his wife during supper and before bed. He talked with Helen and her family, trying to get to know them and understand their feelings. Helen realized his struggle. As he left her home one afternoon, Reagan remembers her saying from her wheelchair, "When you do this thing, you'll be able to sleep well at night because you will know what you did was right." Helen chose the evening she wanted to die. Reagan saw other patients throughout the day. But Helen weighed on his mind. He looked out the window of his office at the lovely spring weather. The notion of leaving the earth felt sad to him. But when he saw Helen that night, he knew she did not share that sadness. She was sitting up in bed with her family around her, reminiscing. She repeated her wishes. She took the milkshake-like concoction containing the powdered barbiturates in her hand and drank it immediately. She smiled a small smile and shrugged, like she was proud at getting it all down. Then she fell asleep. Reagan said the mood in the room was sad, yet strangely triumphant. She had reached her goal. Within a half hour, she was dead. For Reagan, the suddenness was unnerving. Reagan still grapples with his experience. He has declined other requests from patients who weren't qualified. But if he meets another patient who is qualified, he will help. To him, it would feel like abandonment if he didn't. "It doesn't feel good to write a prescription for someone to kill themselves," Reagan said. "But sometimes it feels like the right thing to do. It feels worse to not do it."
------------------------------------------------------------------- Drugs: A Silent Alarm Prompts The Search Of Robert Evans' San Francisco Apartment (An Associated Press version of yesterday's news about the bust of Rich Evans, a medical-marijuana patient and activist.) Date: Wed, 30 Dec 1998 05:27:26 -0800 From: email@example.com (MAPNews) To: firstname.lastname@example.org Subject: MN: US CA: Wire: Drugs: A Silent Alarm Prompts The Search Of Robert Evans' San Francisco Sender: email@example.com Reply-To: firstname.lastname@example.org Organization: Media Awareness Project http://www.mapinc.org/lists/ Newshawk: John W. Black Pubdate: December 28, 1998 Source: Associated Press Copyright: 1998 Associated Press. Note: The following story, which also appeared in the San Francisco newspapers, has caused us concern. It is Richard Evans, not Robert. We have been advised that the allegations of child pornography are baseless. The police found a book that Rich bought at the Ansel Adams gallery which included nudity of children (and others). The book is surely artwork -- even under Cincinnati standards. When Rich was being booked the officer said that with this child pornography charge included Rich's supporters would run from him and his support would evaporate. BUT before we could post the article below, we also received word that all charges have been dropped. Will the newspapers that carried this story bring us the rest of the story? We will be watching. - The editors @ MAP DRUGS: A SILENT ALARM PROMPTS THE SEARCH OF ROBERT EVANS' SAN FRANCISCO APARTMENT. San Francisco-A nationally known advocate of medical marijuana was arrested this weekend when police searched his apartment and found more than $60,000 worth of packaged pot and child pornography, authorities said. A silent emergency alarm alerted officers early Saturday to Robert Evans' apartment, where they also discovered an elaborate marijuana-growing operation. Evans, who has described himself as director of Americans for Compassionate Use, was jailed on charges of cultivation and possession for sale of marijuana, and possession of child pornography. Officers forced their way into the apartment believing the alarm might have been triggered by someone with a medical emergency, Lt. Kitt Crenshaw said. Inside, they smelled burning marijuana and saw an incoherent man moving toward the front of the residence. As officers followed him, they discovered an elaborate hydroponics system for growing marijuana and called the narcotics unit. Narcotics officers obtained a search warrant and found 17 pounds of packaged marijuana and three bedrooms containing a total of 40 plants up to 6 feet tall, along with irrigation, lighting and temperature-control systems, the police spokesman said. They also found child pornography, he said. Evans is a longtime advocate of legalizing marijuana for medicinal use, and police said he recently had applied for a city permit to operate a medical marijuana club. In 1996, police in Covington, Ky., raided an apartment where Evans allegedly operated a medical marijuana buying club across from the county courthouse.
------------------------------------------------------------------- The Last Worst Place (The San Francisco Chronicle visits Florence, Colorado's $60 million ADX prison - governmentese for "administrative maximum." Unparalled in America, it is the only prison specifically designed to keep each of its 400 occupants in near-total solitary confinement.) Date: Mon, 28 Dec 1998 18:11:37 -0800 From: email@example.com (MAPNews) To: firstname.lastname@example.org Subject: MN: US CO: The Last Worst Place Sender: email@example.com Reply-To: firstname.lastname@example.org Organization: Media Awareness Project http://www.mapinc.org/lists/ Newshawk: email@example.com (Frank S. World) Pubdate: Monday, December 28, 1998 Source: San Francisco Chronicle (CA) Page: A3 Copyright: 1998 San Francisco Chronicle Contact: firstname.lastname@example.org Website: http://www.sfgate.com/chronicle/ Forum: http://www.sfgate.com/conferences/ Author: Michael Taylor, Chronicle Staff Writer THE LAST WORST PLACE The isolation at Colorado's ADX prison is brutal beyond compare. So are the inmates This is it. The end of the line. The toughest ``supermax'' prison in the United States. If you make it here, the odds are you'll be an old man when you get out of custody -- if you get out. ADX-Florence -- governmentese for ``administrative maximum'' -- is the place where the federal government puts its ``worst of the worst'' prisoners, mainly felons sent from other federal prisons after they killed their fellow inmates, or on occasion, their guards. Among its current 400 residents, the ADX also houses a handful of high-profile prisoners, among them Unabomber Theodore Kaczynski, serving four life sentences plus 30 years. But the criminally renowned -- less than 5 percent of the ADX population -- are just a sideshow to the real raison d'etre of this place: to try and extract reasonably peaceful behavior from extremely violent career prisoners. Here, rehabilitation is hardly an issue. The goal is to release inmates to a less restrictive prison to serve out the rest of their days. The ominous objective might seem an odd match for the arid surroundings of Florence, population 4,000, in what was once cattle and coal country, south of Colorado Springs. But today, this is prison country. There were already nine state-run lockups in the county when eager Florence residents bought 600 acres and gave the land to the federal government, which used it to build four correctional facilities, including the ADX. Unparalled in America, it is the only prison specifically designed to keep every occupant in near-total solitary confinement, rarely allowing inmates to see other prisoners. The worst behaved men could serve an entire sentence -- decades -- in isolation. And for some, it doesn't matter. They are the men, former Warden John M. Hurley says, who have ``decided that life is inside the walls of a prison. They don't think about what's going on in Colorado Springs or Detroit. . . . They're not motivated in trying to be a better citizen. If you're 42 years old and your release date is in August 2034, you're not thinking about getting out and getting a job.'' Prison psychology experts, like Dr. Craig Haney of the University of California at Santa Cruz, say this long-term solitary confinement can have devastating effects. ``That's what is new about these so-called supermax prisons,'' he said, ``of which Florence is the most extreme example.'' Indeed, Florence is the leader in a nationwide trend toward supermax prisons: in the past few years, 36 states have built strongbox facilities to house their most dangerous inmates. In California, the most notorious are the Security Housing Units at Pelican Bay and Corcoran, already the subjects of numerous lawsuits and investigations into alleged cruel and unusual punishment, as well as the staging, by guards, of deadly fights among inmates. In state facilities, though, isolation cells are just one segment of a large, general population prison. At Florence, isolation is all there is. The ADX has a three-year program that keeps inmates in their cells 23 hours a day for the first year, then gradually ``socializes'' them with other inmates and staff. In their last year, prisoners can be out of their cells from 6 a.m. to 10 p.m. and eat meals in a shared dining room, rather than having food shoved through a slot in their steel cell door. ``We have the agency's most violent and dangerous offenders,'' said Hurley, shortly before he retired after nearly 30 years in the world of corrections. ``It is something we emphasize to our staff day in and day out.'' More than half the inmates have murdered somebody in or out of prison, said Blake Davis, Hurley's assistant. A third of the men are in prison gangs, including the well-known Aryan Brotherhood, Black Guerrilla Family and Mexican Mafia, as well as lesser known but just as deadly outfits such as the Dirty White Boys. The average sentence is 36 years. It is spent, typically, in a 12-by-7- foot cell. Beds, desks and stools are made of poured concrete. Toilets have a valve that shuts off the water if an inmate tries to flood his cell by stopping it up. Sinks have no taps, just buttons -- inmates used to unscrew the taps and use the plumbing parts as shanks. A 42-inch window, 4 inches wide, looks out on a one-man concrete recreation yard, which prisoners with good behavior can eventually use. When prison guards unlock a cell door they quickly cover their key with an aluminum shield. Some inmates, said prison research analyst Tom Werlich, can glance at the key, memorize the configuration and size of its teeth and later duplicate it from materials picked up around the prison. ``They have a lot of time to figure these things out,'' said a guard who preferred to remain anonymous, lest he begin to get threats from inmates' friends or relatives. Out of reflex, the guard on a recent tour walked to a cell shower and thumped the drain with his baton. ``They tie a weapon to a piece of string,'' he said, ``then drop it down the drain to hide it.'' The ADX goes to great lengths to bring everything into the cells -- books, food, television -- so that inmates never need to leave. A 12- inch black-and-white TV in each cell shows closed-circuit classes in psychology, education, anger management, parenting and literacy. Religious services of numerous denominations are piped in from a small chapel, where prison officials display for the videocamera the religious objects appropriate for a given faith. The harsh quarantine is rooted in equally harsh reality: a single, deadly day 15 years ago gave birth to the ADX. On Oct. 22, 1983, two handcuffed inmates at the federal prison in Marion, Ill. killed two guards in separate incidents. In the first, ``The inmate was walking down the hall, with his hands cuffed in front of him,'' Werlich said. So fast and practiced was the prisoner, he ``was able to suddenly turn and shove his cuffed hands into the cell of a friend, who quickly unlocked the cuffs with a stolen key, handed his friend a knife and the inmate turned around and killed the guard.'' Later that day, another inmate used the same lethal tactic. Up until then, Marion -- the place where the Bureau of Prisons formerly sent its worst offenders -- was an old-style, open population prison. When trouble broke out, the prison was locked down and all inmates kept in their cells until a few days later, when it would open back up. And then the killings and assaults would resume. For Norman Carlson, then director of the Federal Bureau of Prisons, the deaths of the two guards was the turning point. ``I decided I had no alternative but to bite the bullet and do it'' -- institute a permanent lockdown at Marion -- ``and hope the courts would understand,'' Carlson said. ``There is no way to control a very small subset of the inmate population who show absolutely no concern for human life,'' he said. ``These two characters (who killed the two guards) had multiple life sentences. Another life sentence is no deterrent.'' Carlson, now retired, persuaded the government to build a new and different prison that would effectively isolate prisoners from each other and, for the most part, from prison staff. The result was Florence, which opened four years ago. Since then, to the government's credit, the $60 million ADX has not drawn the same kind of withering criticism as its state cousins, such as Pelican Bay. ``The Bureau of Prisons has taken a harsh punitive model and done it as well as anybody I know,'' said Jamie Fellner, an attorney with Human Rights Watch, the largest U.S.- based human rights organization. Fellner was recently given a tour of the prison. ``What I'd like to see is more debate within the BOP to see how we can minimize the need for supermaxes,'' she said. Haney, the Santa Cruz psychologist who has testified as an expert witness in cases involving supermax confinement, said the effect of isolation in places like Florence is dramatic. Prisoners ``become extremely depressed and lethargic -- sleeping, lying on their bunks, staring at the ceiling, declining to go out and exercise,'' he said. They begin to lose memory, can't concentrate and suffer severe panic attacks, he said, or become uncontrollably enraged over insignificant things. Haney and others suggest that prison officials pay more attention to the individual needs of supermax inmates rather than spending so much time and money on high-tech prison gadgetry and oppressive controls. But Davis, the warden's assistant, says extreme control, for some prisoners, is the only way to save bloodshed. ``Behavior puts them here,'' Davis said, repeating what has become the prison motto. ``And behavior gets them out.'' IMFAMOUS INMATES Among the prisoners at Colorado's ADX-Florence: -- THEODORE KACZYNSKI, 56, the Unabomber, serving four consecutive life sentences. -- TIMOTHY McVEIGH, 30, sentenced to death for the 1995 bombing of the Oklahoma City federal building which killed 168 people. -- TERRY NICHOLS, 43, McVeigh's accomplice, is now serving life in prison. -- CHARLES HARRELSON, 59, the father of actor Woody Harrelson, is serving two life sentences for the murder of a federal judge. -- RAYMOND LUC LEVASSEUR, 51, member of a U.S. radical group, serving 40 years for bombing buildings and attempted bombings in the 1970s. -- EYAD ISMOIL, 27, serving 240 years for driving the rental van holding the bomb in the World Trade Center attack. -- YU KIKUMURA, 46, Japanese Red Army terrorist, serving 30 years for transporting bombs in preparation for an attack on a Navy recruiting center. -- LUIS FELIPE, 35, leader of New York's Latin Kings gang, who ordered the murders of six gang members from his jail cell and is serving a life sentence. -- RODNEY HAMBRICK, 33, serving a 68-year sentence on bomb charges.
------------------------------------------------------------------- VA To Take A Look At How To Treat Pain (The Grand Rapids Press, in Michigan, says beginning in January, the U.S. Department of Veterans Affairs will do what few health-care providers have done. It will assess a patient's level of pain along with other vital signs such as temperature, blood pressure and pulse. Veterans facilities ranging from hospitals to nursing homes to clinics will use the assessments to develop long term strategies for treating both chronic and acute pain. The VA serves more than 25 million veterans, and one third of American medical residents and about half of American medical students are trained in VA facilities.) Date: Thu, 31 Dec 1998 21:53:29 -0800 From: email@example.com (MAPNews) To: firstname.lastname@example.org Subject: MN: US: VA To Take A Look At How To Treat Pain Sender: email@example.com Reply-To: firstname.lastname@example.org Organization: Media Awareness Project http://www.mapinc.org/lists/ Newshawk: Lee T. Neidow Pubdate: Monday, 28 Dec 1998 Source: Grand Rapids (Michigan) Press Copyright: 1998, Grand Rapids Press Contact: email@example.com Fax: 616-222-5212 Website: http://www.gr.mlive.com Author: Sarah Kellogg - Grand Rapids Press Bureau VA TO TAKE A LOOK AT HOW TO TREAT PAIN - The Assessments Could Be Used To Develop A National Treatment Policy. WASHINGTON - How to you ease a patient's persistent, severe pain? Soon, the federal government hopes to find an answer. Beginning in January, the U.S. Department of Veterans Affairs will do what few health-care providers have done. It will assess a patient's pain as it gauges other vital signs, such as temperature, blood pressure and pulse. Veterans facilities, ranging from hospitals to nursing homes to clinics, will use the assessments to develop long term strategies for treating both chronic and acute pain. "One of the goals of this national strategy is that no dying veteran shall suffer from preventable pain while being cared for by the VA health-care system", said Bonnie Ryan, the VA's chief of home and community based care. "We want to get pain assessment performed in a consistent manner. We also want to assure (patients) that pain treatment is prompt and appropriate," Ryan added. The medical overseer of the Grand Rapids Outpatient Clinic believes the new strategy could help some veterans avoid a trip to Ann Arbor for pain management. "We would be addressing these issues on a comprehensive basis" said Dr. Sita Kondapaneni, chief of physical medicine and rehabilitation for the Battle Creek based Veterans Affairs Medical Center. Kondapaneni said officials will asses veterans who use the Grand Rapids clinic to see who might benefit from such an approach, which would convene specialists in rehabilitation, anesthesiology, psychology, psychiatry to determine the best course of pain treatment. "We will be able to do more than we have in the past" Kondapaneni said. Michigan medical officials believe the new VA policy will do more than help veterans. It will also set an example for health care providers. A change in VA policy can have that kind of impact because the system is so large. It serves more than 25 million veterans nationally. One-third of the nation's medical residents and about half of the medical students are trained each year in VA facilities, VA officials say. "The need is out there", said Robert Werner, who directs the Ann Arbor VA Medical Center's physical medicine and rehabilitation program. "Not enough people ... know how to manage (pain). A national strategy will not only focus on pain clinics like ours, but will focus on educating our primary care doctors in all our facilities." Plus, the new VA policy may show physicians that the federal government cares as much about easing pain as it does about stopping doctors who are trafficking in drugs. "The government's war on drugs has had a chilling effect on liberal prescribing for patients who have legitimate needs," said Dr. John Finn, medical director for the Hospice of Michigan, a non-profit group that operates 25 hospices throughout the state. "It's stunted physicians attitudes as well as skills in regards to pain management. Finally the government is saying we have a problem here." In Michigan, the VA main management strategy will be implemented in it's five medical centers in Ann Arbor, Battle Creek, Detroit, Iron Mountain and Saginaw. Veterans, about 949,000 in Michigan, also will be able to receive assistance with pain at outpatient clinics in Gaylord and Grand Rapids. Physicians expect the assessment procedure to be difficult to implement if only because it's so individual. It probably will be done verbally with the patient rating his or her pain on a scale from 1 to 10. Once assessed, doctors will need to match the treatment with a patient's specific needs. Is it a pain related to cancer treatments? Or is it a pain as a result of back or muscle injuries? Treatments could range from exercise regimens to narcotics, such as morphine, to using electrical devices to interrupt nerve impulses. "It's not so much that this is new knowledge," Ryan said. "It's bringing all kinds of information together in a new way to make it easy for people to do the right thing (for patients)." Michigan hospitals and doctors are watching. Many hope the strategy will spur efforts in private facilities. "We are in the infancy of pain assessment and management," said Dr. Cathy Blight, president of the Michigan State Medical Society, a group representing about 11,000 Michigan doctors. "Pain is very subjective. What one person can handle ... another person can't, so that requires a very specialized response to each individual patient." Up to now, the medical responses have been guided, in part, by wary physicians who feared losing their drug prescribing licenses to anti-drug government regulators. That wasn't helped much by Congress' attempts this year to establish a tracking system for addictive drugs and the physicians who prescribe them. The bill, spurred by fears that physicians might abuse Oregon's assisted- suicide law, eventually died in committee. Meanwhile, the state Legislature took a less aggressive step, passing bills requiring physicians to be educated about severe pain and how to treat it. The legislation is awaiting Gov. John Engler's signature. "I'd like to see a statement from state lawmakers or the federal government outlining what is good care and adequate care," said Finn. "The public's attitudes are changing, so should the government's." The VA's pain management strategy may be just that. It surely is the best example of the medical community's recognition of the role it plays in end- of-life care. Death has always been viewed as a failure of the health care system," said Patrick Foley, spokesman for the Michigan Health and Hospital Association, which represents hospitals and health maintenance organizations. "There's a realization now that death is an integral part of life. Hospitals are taking more seriously their roles in providing dignified, end-of-life care for all their patients."
------------------------------------------------------------------- First conviction lands man 25 years to life under Rockefeller laws (The Associated Press says Albert Brunner was convicted about 10 years ago of selling nearly two pounds of cocaine. Under New York state's mandatory minimum sentencing guidelines for drug-law violators, the first-time, non-violent offender was sentenced to 25 years to life in prison. His younger sister, Margaret Liberatore, a school teacher on maternity leave, is circulating petitions calling for reform, and hopes to gather 3,000 signatures by mid-January to send to Gov. George Pataki.) From: "Bob Owen@W.H.E.N." (firstname.lastname@example.org) To: "_Drug Policy --" (email@example.com) Subject: Rockefeller laws 1st conviction lands man 25 yr to life Date: Tue, 29 Dec 1998 18:25:46 -0800 Sender: firstname.lastname@example.org Newshawk: email@example.com Online: http://www.boston.com/dailynews/wirehtml/362/First_conviction_lands_man_25_y ears.shtml First conviction lands man 25 years to life under Rockefeller laws Associated Press, 12/28/98 01:07 AUBURN, N.Y. (AP) - About 10 years ago, Albert Brunner was convicted under the old Rockefeller drug laws for selling nearly two pounds of cocaine. It was his first conviction for a non-violent drug crime, yet Brunner was sentenced to 25 years to life in prison - a jail term comparable to one meted out for murder. ``Ten years ago, people thought go ahead, lock them up and throw away the key,创 said Brunner磗 younger sister, Margaret Liberatore. ``But it hasn磘 changed the availability of drugs out there. ... There磗 more drugs out there than ever.创 The sentence doesn't make sense to Liberatore, a school teacher on maternity leave who lives in Auburn. She's circulating petitions calling for reform of the state's drug sentencing laws. She told the Syracuse Newspapers that she's hoping to gather 3,000 signatures by mid-January to send to Gov. George Pataki. Twenty-five years ago, the Rockefeller drug laws established mandatory sentences for the sale and possession of narcotics that are among the harshest in the nation. A conviction for the sale of two ounces of cocaine or heroin, an A-1 felony, carries a minimum sentence of 15 years to life. First-degree murder, also an A-1 felony, has a minimum sentence of 20 years; first-degree rape, a B-felony, requires a minimum of six years behind bars. In 1974, the year after the laws were enacted, 713 inmates were sent to prison on drug felonies. As of December 1997, there were 8,800 drug offenders locked up in state prisons under the Rockefeller drug laws, according to the state Department of Correctional Services. Cayuga County Court Judge Peter E. Corning, who sentenced Brunner, said he now opposes such mandatory sentences. ``I was district attorney when Rockefeller put those laws in place,创 said Corning. ``He believed they would be a deterrent. It has not worked out.创 James Flateau, speaking for the state department of corrections, said that some inmates sentenced under Rockefeller laws who don't have a violent past have been released under work release and good behavior programs. But not everyone qualifies for those programs. Because he was convicted of an A-1 felony, Brunner is not eligible for the new work release or merit programs. By the time Brunner's eligible for release - Oct. 22, 2014 - taxpayers will have spent roughly $750,000 to keep him locked up, his sister estimates. Since he has been in jail at the Green Haven Correctional Facility in Stormville, 40-year-old Brunner has earned an associate's degree in business and works as a liaison in disputes between inmates and the prison administration. He even married five years ago, a woman from Rochester he met as a pen pal. But none of this, or anything else he does, will help spring him from prison any sooner under current law. ``No matter what good things he does, no matter what positive actions he takes, there磗 no early release,创 Liberatore said. ``It磗 so frustrating, so unjust, so illogical. It makes no sense.创
------------------------------------------------------------------- Sharp Drop in Violent Crime Traced to Decline in Crack Market (The New York Times discusses the many theories about why new statistics released Sunday by the Justice Department show violent crime has dropped seven straight years after an upsurge in the 1980s. The annual survey, carried out for the Justice Department by the Census Bureau, asks 80,000 people ages 12 and older whether they have been victims of a crime in the past year. The newspaper favors the theories that the decline is due primarily to a withering away of the crack market and police efforts to seize handguns from criminals and juveniles.) Date: Wed, 30 Dec 1998 09:25:46 -0800 From: firstname.lastname@example.org (MAPNews) To: email@example.com Subject: MN: US: NYT: Sharp Drop in Violent Crime Traced to Decline in Crack Market Sender: firstname.lastname@example.org Reply-To: email@example.com Organization: Media Awareness Project http://www.mapinc.org/lists/ Newshawk: Richard Lake (firstname.lastname@example.org) Pubdate: Mon, 28 Dec 1998 Source: New York Times (NY) Contact: email@example.com Website: http://www.nytimes.com/ Forum: http://forums.nytimes.com/comment/ Copyright: 1998 The New York Times Company Author: Fox Butterfield SHARP DROP IN VIOLENT CRIME TRACED TO DECLINE IN CRACK MARKET New statistics released Sunday by the Justice Department are helping criminologists resolve a contentious mystery -- why violent crime has dropped seven straight years after an upsurge in the 1980s. The statistics, showing that robbery fell a stunning 17 percent in 1997, suggest that while there are many factors behind the decline in crime in the 1990s, the crucial ones may be the withering away of the crack market and police efforts to seize handguns from criminals and juveniles. The two crimes that have fallen the most sharply since 1991 are homicide and now robbery, the two most often committed with handguns and most associated with the crack cocaine epidemic in the late 1980s, criminologists say. "Homicide and robbery were the two crimes most impacted by crack markets, with the biggest increases, and now as crack markets have declined, homicide and robbery have led the way down," said James Alan Fox, dean of the college of criminal justice at Northeastern University. The figures on robbery were released Sunday by the Bureau of Justice Statistics, a branch of the Justice Department, as part of its National Crime Victimization Survey. The annual survey, carried out for the Justice Department by the Census Bureau, asks 80,000 people ages 12 and older whether they have been victims of a crime in the past year. It complements the other major national set of crime statistics, the FBI's Uniform Crime Report, which measures crimes reported to police. Overall, the Justice Department said, both violent and property crimes have fallen to their lowest levels since 1973, when the victimization survey was started. In fact, the rate of property crime -- which includes burglary, theft and motor vehicle theft -- has fallen by more than half, to 248 per 1,000 households in 1997, down from 555 per 1,000 households in 1973. Property crime, unlike violent crime, has been dropping steadily since 1975. Among the reasons, experts say, are the aging of the baby boom population beyond its prime years for committing crime, the increased use of security alarms and the switch of many criminals from burglary to robbery in the 1980s as a quicker way to make money and buy the crack they needed. Violent crime surged unexpectedly with the crack epidemic starting about 1985, and then began to fall, equally unexpectedly, in 1991. Only in retrospect have law-enforcement authorities and criminologists been able to theorize about the causes of the rise and decline in violent crime. At a conference of leading experts in New Orleans this month sponsored by the Harry Frank Guggenheim Foundation, Alfred Blumstein, a criminologist at Carnegie Mellon University, outlined research on what has come to be the most widely accepted view -- that all of the huge increase in homicide in the late 1980s and early 1990s was attributable to a rise in killing by juveniles and young people ages 24 and under, since homicide by adults ages 25 and older has fallen since 1980. This increase in killing was driven by the sudden spread of crack markets and the growing use of high-powered semiautomatic handguns. In fact, Blumstein said, "The growth in homicides by young people, which accounted for all the growth in homicides in the post-1985 period, was accounted for totally by the growth in homicides committed with handguns." Since 1991, homicides have dropped 31 percent, from 9.8 per 100,000 to 6.8 per 100,000 in 1997, while robberies have fallen 32 percent, from 272 per 100,000 to 185 per 100,000 in 1997, according to the FBI. These are the largest declines for any of the major violent or property crimes. Bruce Johnson and Andrew Golub, scholars at the National Development and Research Institutes in New York City, showed the critical role of crack in leading violent crime up and then down. When crack arrived in New York in 1985, it created a huge new market for users and dealers. Unlike heroin, it was sold in small amounts that provided an intense but short-lasting high that required users to go on constant "missions" to find more. Thousands of unskilled, unemployed young men from New York's poor inner city neighborhoods jumped into the crack business as sellers, and to protect themselves in an unstable business environment, they acquired handguns. An explosion in homicides and robberies resulted from the combination of impulsive youth, the confused market situation, the paranoia induced by crack and the increased firepower of the new handguns. The sharp drop in violent crime starting in 1991 can be accounted for by the reversal of these same forces, in what Johnson and Golub described as "an indigenous shift," as youths who came of age in the 1990s turned against smoking or selling crack. "The primary reason" these young people give for avoiding crack, Johnson and Golub reported, "is the negative role models in their lives. They clearly do not want to emulate their parents, older siblings, close relatives or other associates in their neighborhoods who were enmeshed with crack." Crack produced "devastation" in their lives, and they now shun or deride anyone who smokes crack. Among other factors that have played a role in the decline in violence, the experts at the New Orleans conference pointed in particular to aggressive new actions by the police in many cities to stop gun violence, either by frequent searches, as has happened in New York, or by improved efforts to trace guns used in crimes and arrest gun traffickers, a Boston tactic. The booming economy of the 1990s has also helped, the experts agreed, providing legitimate jobs to some urban young people who had worked in the drug trade. Evidence on the role of imprisonment in curbing crime is less clear, the experts said. There is no question that the almost quadrupling of the number of people incarcerated since 1970, to 1.8 million, has incapacitated many criminals and prevented many crimes. But since the prison population has expanded steadily over the past 25 years, it does not explain why crime increased sharply in the late 1980s or decreased in 1991. Here, said Fox, it may be necessary to look separately at the incarceration of adults and juveniles, a study which has not yet been done.
------------------------------------------------------------------- Drug Traffickers Terrorize Upscale Zone In Rio (Reuters says shops and restaurants near the governor's palace in Rio de Janeiro, Brazil, reopened on Monday after drug traffickers forced them to close over the weekend to honour a drug lord killed by police. Residents and business owners in the middle-class neighbourhoods of Laranjeiras and Cosme Velho said shootouts between rival gangs in the nearby shantytowns were common, but the forced closings showed a new level of brashness.) Newshawk: General Pulaski Pubdate: Mon, 28 Dec 1998 Source: Reuters Copyright: 1998 Reuters Limited. Author: Tracey Ober DRUG TRAFFICKERS TERRORIZE UPSCALE ZONE IN RIO RIO DE JANEIRO, Dec 28 (Reuters) - Shops and restaurants near the governor's palace in Rio reopened on Monday after drug traffickers forced them to close over the weekend to honour a drug lord killed by police, community leaders said. Residents and business owners in the middle-class neighbourhoods of Laranjeiras and Cosme Velho said shootouts between rival gangs in the nearby shantytowns were common, but the forced closings showed a new level of brashness. "I've lived in the neighbourhood for more than 20 years and I've never seen businesses shut down like this," said Thereza Amayo, a former president of the residents' association. She said it felt like they were living in a war zone. The most recent spate of violence began early Saturday with a fierce gun battle between rival gangs in a shantytown. Police said they got involved when four armed men leaving the fight on motorcycles engaged them in gunfire in Laranjeiras. One officer was wounded and convicted drug lord Claudio Passos da Rocha, known as "Portuguesinho" or "the little Portuguese boy," was shot and killed. At the same time, police gunned down two alleged drug traffickers in another shantytown near Cosme Velho. Later on Saturday and Sunday business owners in the two neighbourhoods apparently received phone calls warning them to close their restaurants and shops or risk them being targeted in drive-by shootings. "They said that people were showing disrespect toward the dead," said a worker at a grill called Gaucha, which normally serves some 1,500 people for Sunday lunch. "The grill has existed since 1939 and I've never seen anything like this." Residents took to the streets to protest the violence earlier this year after four men armed with assault rifles blocked a car driven by an 18-year-old student in Laranjeiras and killed her with a spray of bullets. Also in Laranjeiras in April, a thief brazenly walked through security at a Rio state government building and robbed a bank branch inside. "The question of security is national. It's unacceptable that armed bands control areas of the city as if they were safe-havens," said former presidential candidate Alfredo Sirkis, a local resident. Police say Brazil is battling a growing drug trade as pressure on traffickers has increased in the neighbouring cocaine-producing nations of Colombia, Bolivia and Peru. In the state of Rio alone, police confiscated more than 1,000 pounds (450 kg) of cocaine and four tonnes (3,600 kg) of marijuana in the first nine months of this year.
------------------------------------------------------------------- Medical trials of cannabis to start in Britain (The Age, in Melbourne, Australia, notes yesterday's news about the British government planning a series of trials into the medical efficacy of cannabis.) From: "Rick Bayer" (firstname.lastname@example.org) To: "Rick Bayer" (email@example.com) Subject: FW: Medical trials of cannabis to start Date: Mon, 28 Dec 1998 09:51:17 -0800 The following article appears in THE AGE (Melbourne) (Monday December 28/98 - but may be drawn from The Sunday Telegraph according to the end credit.) *** Medical trials of cannabis to start in Britain By VICTORIA MacDONALD LONDON, SUNDAY The British Government is officially to sanction a series of trials, involving more than 1000 patients, on the therapeutic uses of cannabis. The Medical Research Council and the Royal Pharmaceutical Society will set out the guidelines for the trials on 11 January at a closed scientific meeting to be attended by Department of Health officials. The Medicines Control Agency, the Government's licensing authority for prescription and over-the-counter drugs, has agreed to advise the scientists on the regulatory aspects of the proposed trials. The Prince of Wales last week appeared to lend his support to the campaign to legalise cannabis for therapeutic uses when he asked a multiple sclerosis sufferer if she had ever tried the drug for pain relief. The patient was later quoted as saying: ``He asked me if I had tried taking cannabis, saying he understood that, under strict medical supervision, it was one of the best things for it.'' But Mr Peter Cardy, the chief executive of the Multiple Sclerosis Society, said that he was inclined to think it was for a doctor - rather than Prince Charles - to make recommendations about trying cannabis. The drug trials will mark the first time that the Government and its agencies have given official sanction to investigating the therapeutic value of cannabis and its derivatives, cannabinoids. The move follows a report from a House of Lords scientific committee that said doctors should be allowed to prescribe cannabis for multiple sclerosis sufferers and other patients who find it helps to relieve pain. Each of the initial three trials will cost about 500,000, (A$1,372,750) with funding from the Medical Research Council if it gives final approval. The first trial will be for spasticity in multiple sclerosis patients. One group of about 100 patients will be given the ordinary treatment for controlling muscle spasms. A second, similar-sized group will receive tetrahydrocannabinol (THC), a cannabis derivative known to have an anti-sickness effect, as well as producing euphoria. A third group will be given standardised cannabis plant material to see if THC is the most important compound or if there are other elements of the drug that help patients. The following two trials will be into the treatment of chronic pain for dying cancer patients or those with phantom limb problems, and for acute pain following operations. Professor Tony Moffatt, scientific adviser to the Royal Pharmaceutical Society, said that the trials were ``all about getting cannabis into patients who need it''. He added: ``Despite all the huffing and puffing over whether it should be legalised, nobody has done anything about it. There is no good scientific evidence that these materials are effective at all.'' The tests are expected to start inthe middle of the year and to run for 18 months. TELEGRAPH
------------------------------------------------------------------- Top-secret Cannabis Ready For Medicinal Harvest (The Times, in London, says Britain's first crop of government-licensed cannabis is to be harvested secretly this week, in preparation for trials on up to 2,000 people that will begin once medicine has been distilled from the plants.) Date: Mon, 28 Dec 1998 16:42:02 -0800 From: firstname.lastname@example.org (MAPNews) To: email@example.com Subject: MN: UK: Top-secret Cannabis Ready For Medicinal Harvest Sender: firstname.lastname@example.org Reply-To: email@example.com Organization: Media Awareness Project http://www.mapinc.org/lists/ Newshawk: Pelle Moulante Source: Times, The (UK) Contact: firstname.lastname@example.org Website: http://www.the-times.co.uk/ Copyright: 1998 Times Newspapers Ltd Pubdate: Monday 28 December 1998 Author: Helen Rumbelow TOP-SECRET CANNABIS READY FOR MEDICINAL HARVEST BRITAIN'S first crop of government-licensed cannabis is to be harvested secretly for medical research this week by a specially vetted team of mature botanists. No younger staff were employed to grow the crop because of fears that they might be tempted to mix business with pleasure. Trials on up to 2,000 people will begin once medicine has been distilled from the plants in the spring, in the hope of developing treatments for illnesses such as multiple sclerosis and epilepsy. The crop has been guarded round the clock as hundreds of fully potent plants have reached 8ft in the past four months. No one but the Home Office and the staff of GW Pharmaceuticals know the location of the greenhouse in southern England. Geoffrey Guy, chairman of the company, holds the only licence for growing the controlled drug for medical research, and the trials will take several years. Next week the Government is set to approve guidelines for a separate series of trials by the Royal Pharmaceutical Society. Dr Guy said that Britain was alone in its pragmatic and open-minded approach to research of the drug. "We enjoy a very liberal research environment," he said. "Our first objective is to get research done, not to find a thousand reasons to block it." Botanists chose ten varieties for the first crop, aimed at getting a high yield of tetrahydrocannabinol (THC) and cannabidiol (CBD). The estimated 1,000 MS sufferers who use cannabis illegally buy a product high in THC, the pyschoactive ingredient liked by recreational users for its euphoric and drowsy effects. Scientists are also interested in CBD as it is believed to reduce the side-effects of THC and be useful in treating strokes and epilepsy. Dr Guy said: "Eventually we aim to breed a special MS variety or epilepsy variety." After the harvest, the plants will be hung up to dry, then processed to produce a treacly liquid. This is cleaned up and can be modified into a thinner liquid for use in inhalers. -------------------------------------------------------------------
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