The Brief Addiction Science Information Source (BASIS)

Op-Ed/Editorials: List of selected recipients for January giveaway "Change your Gambling, Change your Life"

The Division on Addiction is pleased to announce the following people will receive the book Change your Gambling, Change your Life: Jeanne Blake, Nicola Coalter, Don Feeney, Sally Langland, Jamie Large, Judy McCormick, Gavin Miller, Tom Murphy, Megan Petra, Nanciellen Poulin, Glen Rampton, Fred Smith, Naoko Takiguchi, Bob Thomson, Edith Townsend, Marianne Vick, Marlene Warner, Jessica Williams, Andrea Wöhr, and Trish Wright. http://bit.ly/editorial_DOA20th. We’ve selected people from as far away as Australia, Canada, Germany, and Japan. Thank you for celebrating our 20th anniversary with us!

Op-Ed/Editorials: The Division on Addiction is Celebrating its 20th Anniversary during 2012!

We are pleased to announce that 2012 is the 20th anniversary of the Division on Addiction. To celebrate, each month we will host one anniversary event. During January, this event will consist of giving away 20 copies of our upcoming book, Change your Gambling, Change your Life to BASIS subscribers. To be eligible to receive a copy of this new book, send a note to basis@divisiononaddictions.org by January 24th. On January 25th, we will post on The BASIS a list of book recipients. For more information about upcoming anniversary events, check our website, The BASIS, our Facebook account, or Twitter (howard_shaffer) for updates. Thanks for celebrating with us!

Op-Ed/Editorials - Loving the child, hating the disease.

Last night I saw pictures of Amy Winehouse's parents as they visited the shrine erected by Amy's fans in front of her apartment.  They looked lost, and shocked - bereft.  As the parent of a child who is both an addict and has a (currently untreated) mental illness, my heart aches for them. It is difficult to understand the unique and exquisite pain that accompanies parenting an addict.  This message is meant as an attempt - feeble I'm sure - to elucidate that pain and to remind people that, for every addict lost, there are parents who are left behind with guilt and sorrow and a sense that there was something, something, something they should have done.

The parental instinct is a strong one.  The majority of parents will tell you that the love they experience for their children surpasses in intensity any other emotion in human experience.  When parents claim that they will gladly lay down their lives for their children, it is not simply rhetoric.  Instead, it stems from a primal instinct that runs deep throughout most species in existence.  When children are ill, parents go to extreme measures to seek the very best of care.  No expense is spared.  No sacrifice too great. Such is our drive to protect our children.

Addiction is an illness; make no mistake.  Unlike other illnesses, however, addiction fools the brain and body into acting against its own best interests.  Addiction changes the brain in a very fundamental way, literally rewiring it in such a way that the drug of choice, and ONLY the drug of choice, matters to the brain and its survival.   Addiction tells the brain and body that only the drug of choice can make it well.  Addiction fights against every attempt to cure it, and its weapons are powerful.  Addiction takes a child and turns that child into a relentless machine that exists for one purpose and one purpose only . . . to feed the addiction.

Our parenting instinct tells us to fight the addiction, to free our children from its grips.  We seek treatment, and counsel, and therapy, and prayers.  We cycle through anger, and hope, and despair, and anger again.  We rage against the addiction; we rage against our own children.  We want to shake them until their teeth rattle.  We want to understand -  WHY WHY WHY do you keep going back to the drug?  WHY do you let it control you?

We seek advice from those who claim to know.  We turn our backs on all our instincts and we let our children fall, and then ooze pain from our pores as we watch them suffer - dirty, hungry, helpless, homeless, hopeless - and when finally we can bear their suffering no longer, we reach out a hand to them only to be told that helping them is wrong and serves to escalate the problem.  We let them sit in jail; we bail them out of jail.  We turn them from our doorsteps; we let them in and wipe their tears.  We slip them twenty dollars and we hope, we hope, we hope that they will use it for a decent meal, while knowing in our souls that there is only one hunger that will be fed this night.

Then one day, someday, on a day that comes sooner or later but always comes, we realize that they will die.  It will happen.  We don't know where, we don't know when, but they will die.  It is the only end in sight.  So we prepare.  At night we lie awake and wait to hear the phone/the knock/the doorbell.  We write obituaries in our heads.  We plan a service and we plan what we will say.  Will we admit that it was drugs?  Or will we blame it on something else?  We think about the things they own; the few, the meager things.  Will we give it all away?  Is there something we should keep?  Is there something in there somewhere to remind us of the children we once knew?

And when it finally happens we are lost and shocked, bereft.  We wonder wonder wonder what we could have done and should have done.  We listen to the whispers and we know that we have failed . . . that we have failed to do the one and only thing that a parent is meant to do.  We have failed to protect our children.  There is nothing we could ever do to make up for this epic failure.  Nothing.  You can be sure that we're aware of just how deep our failure runs.  You don't need to remind us.  We remind ourselves each day.

I hope that you can find it in yourselves to remember all the parents of the addicts in this world.  I hope that you can see that ANY parent can have an addict as a child.  ANY parent can lose a child to this enemy that seems to have an arsenal against which we're nearly defenseless.  Have compassion in your soul tonight for the parents of Amy Winehouse.  They did not want to lose her, and tonight they are in pain.

- Lesa Ellis

Lesa Ellis is an Associate Professor of Psychology and Neuroscience at Westminster College.

Op-Ed/Editorials: March Madness - Gambling Madness

The NEW DOA BBGS e-Screening and Intervention system is coming soon! Check back next week for more information.

Op-Ed/Editorials - Gambling and the Law®: Compulsive Gambler Just Can’t Win

A federal judge in New Jersey has issued the most complete and comprehensive judgment ever about whether a compulsive gambler can sue a casino.
 
The short version of her 10-page-long legal analysis:  “No.”
 
Arelia Margarita Taveras, a disbarred lawyer, sued most of the casinos in Atlantic City, as well as many of their owners and employees. 
 
She alleged that “the Defendants facilitated Plaintiff’s gambling addiction and induced her to gamble away money belonging to her and others . . .”  She pleaded 12 separate causes of action, including negligence, negligent and intentional infliction of emotional distress, breach of contract, unjust enrichment, and violations of the federal racketeering statutes and the Bank Secrecy Act.
 
Some of Taveras’s claims were a stretch.  For example, she alleged that the casinos owe her money because they failed to report her cash transactions of more than $10,000.  The problem is that even if a casino does fail to file its required reports, that does not give a player the right to sue.
 
But raising every possible claim required U.S. District Judge Renee Marie Bumb to examine every possible legal theory a compulsive gambler could have. 
 
Judge Bumb is a federal judge, so she is free to interpret federal statutes, like the Bank Secrecy Act, bound only by the decisions of higher federal courts.  But many of Taveras’s causes of action were based on New Jersey state law.  Judge Bumb’s role was to decide how the New Jersey Supreme Court would answer legal questions, which it often had never considered.

Judge Bumb started with the rule that for there to be negligence, “the Court must find as a matter of law that Defendants owed Plaintiff a duty.”  Taveras argued that casinos have a duty to keep their premises safe, and “that her continued gambling was an unreasonable danger foreseeable to Defendants.”
 
Judge Bumb focused on New Jersey’s “extraordinary, pervasive and intensive regulations over virtually every facet of casino gambling.”  Her conclusion:  If the state had wanted to impose a duty on casinos to rescue compulsive gamblers from themselves, it would have said so.
 
Judge Bumb similarly rejected Taveras’s request to create a duty somewhat like that imposed on bars to not serve drinks to obviously drunk patrons.  “Plaintiff’s theory would, in effect, have no limit . . . [it] would impose a duty on shopping malls and credit-card companies to identify and exclude compulsive shoppers.”
 
One of the more interesting parts of the Opinion was Taveras’s claim that gambling is an “abnormally dangerous activity.”  Looking at cases such as dumping toxic waste, Judge Bumb concluded:  “Needless to say, gambling can indeed be a safe activity, gambling is common, and state-regulated casinos are not inappropriate locations for gambling.”
 
The Opinion contains other statements that can prove useful for the gaming industry both legally and politically.  In rejecting Taveras’s claims for emotional distress, Judge Bumb held, “In allowing, even encouraging, Plaintiff to continue gambling, Defendants acted well within the bounds of the community norms reflected in state law.” 
 
In dismissing the counts based on fraud, for supposedly misleading Taveras “into thinking that gambling would result in high returns and rewards,” Judge Bumb ruled, “Plaintiff fails to identify with particularity (by quoting, for example) even a single falsehood or misleading statement . . .”
 
There is no doubt that compulsive gambling can destroy lives.  But the legal problem for compulsive gamblers is that the decision by a state to legalize gaming means the state has consciously weighed the pros and cons.
 
So long as card clubs and casinos, and their executives, obey the rules, they should not be legally responsible for the harm compulsive gamblers do to themselves.

END

#10-5 © Copyright 2011, Professor I. Nelson Rose, Encino, California.  All rights reserved worldwide.  Gambling and the Law® is a registered trademark of Prof. Rose, www.GAMBLINGANDTHELAW.com.
© Copyright 2011.  Professor I Nelson Rose is recognized as one of the world’s leading experts on gambling law and is a consultant and expert witness for players, governments and industry.  His latest books, INTERNET GAMING LAW (1st & 2nd editions), BLACKJACK AND THE LAW and GAMING LAW: CASES AND MATERIALS, are available through his website, www.GAMBLINGANDTHELAW.com.

Op-Ed/Editorials - Gambling and the Law®: Making Poker Legal as a Public Service

I Nelson Rose

What do insurance, commodities trading and state lotteries all have in common?  They were all originally outlawed as forms of gambling.

The major fight today over whether poker should be legalized usually revolves around the question of whether it is predominantly skill or chance. 
 
But this unnecessarily gives up part of the political as well as legal battleground.  Many activities that are indisputably gambling are now operated under state licenses, or by the state itself.  And other activities, such as insurance and commodities, are today generally not even thought of as gambling.
 
Although they are.
 
Insurance is, after all, betting a small sum to obtain, that is, win, a much larger sum if a certain future event occurs.  Of course, unlike traditional gambling, the buyer usually hopes the future event won't happen.  The industry's greatest invention was changing the name of death insurance to life insurance, so that bettors would not be focusing on the fact that to win this wager they have to die.
 
Insurance eventually overcame its gambling roots because it was seen as creating a benefit for the general public, as an efficient way of spreading and lessening risk.
 
Still, some anti-gambling prohibitions remain.  You cannot take out a life insurance policy on someone you have no connection with.  That would be too much like making a bet that another person would die.  Plus, government is afraid that you might be tempted to do something to try to increase your chances of winning.
 
Trading in stocks and commodities is still gambling.  The Securities Exchange Act of 1934 expressly preempts state anti-gambling statutes:  "No State law which prohibits or regulates the making or promoting of wagering or gaming contracts" can apply to transactions on American exchanges.  Congress had to add that provision, and others similar to it, to federal laws regulating stock and futures markets, because too many states still have laws on their books that had been used against trading.  Prior to these federal laws, speculators had to concoct legal fictions, such as pretending that they actually planned to accept delivery of tons of pork bellies.
 
Congress preempted state anti-gambling laws after becoming convinced that markets were an efficient way to raise money for businesses, and to allow farmers and food processors to shift the risk of changing prices of crops to speculators.
 
Federal preemption does not apply to all trades.  A boiler-room operation selling penny stocks and other risky ventures on unregulated or foreign exchanges is probably still today violating state anti-gambling laws.
 
More conventional forms of gambling have been legalized because the public benefit was seen as outweighing the public harm.  State lotteries raise money for education, casinos provide jobs and tax relief, even horseracing was seen as bettering the breed.
 
Poker, where legal, certainly provides as much public benefit.  For example, in California most of the cities with licensed card clubs make significant percentages of their government revenue from their clubs.
 
We don't have enough evidence, yet, but I predict that studies will find that poker contributes in other ways.  Poker players are -- probably -- smarter, happier and more sociable.  They certainly have to know at least a little about math, money management and how to play by the rules.
 
Maybe we should start thinking up ways to prove that poker should be made legal, not because it is not gambling, but because a society is better with poker without.

END

© Copyright 2010.  Professor I Nelson Rose is recognized as one of the world’s leading authorities on gambling law and is a consultant and expert witness for governments and industry.  His latest books, INTERNET GAMING LAW (1st & 2nd editions), BLACKJACK AND THE LAW and GAMING LAW: CASES AND MATERIALS, are available through his website, www.GAMBLINGANDTHELAW.com.

Op-ed/Editorials: Will Data-Proof Decision Making Prevail in New York City?

Since 2006, the New York City Department of Health and Mental Hygiene has been distributing a science-based guide to safer injection drug use. Take Charge, Take Care: 10 Tips for Safer Use repeatedly urges readers to get
help to stop using injection drugs. However, for people who have not yet stopped using, the guide also includes tips on injecting more safely. As a result, critics claim the guide reflects an implicit endorsement of intravenous drug use by a government-funded health agency. 

   One of the guide’s most vocal critics is New York City council member Peter Vallone Jr. Vallone calls the guide an  “egregious misuse of taxpayer money” (Cho, 2010). His chief argument is that the city should unequivocally promote abstinence from drug use. Providing information about injecting drugs more safely, Vallone suggests, will send the message to teens and first-time users that there is a safe way to inject heroin and other drugs (Buxbaum, 2010; Cho, 2010). 

If these arguments sound familiar, it is because critics have used the same line of reasoning over the past two decades to fight against needle exchange programs, methadone maintenance therapy, and, more recently, safe-injection facilities. The history of needle exchange programs in this country, in particular, has much to teach us about the tendency for U.S. politicians to use (or, more appropriately, fail to use) evidence-based judgment when it comes to drug control policies. In the mid-1980s, critics mounted a vigorous campaign to prohibit needle-exchange programs. As with Take Charge, Take Care, their central argument was that needle exchange programs would encourage substance abuse by sending a message that the government condones drug use (Drucker & Clear, 1999). In 1988, zero-tolerance policies triumphed when Congress established a ban on federal funding for needle exchange programs. And yet, about one hundred programs continued to operate in the next decade thanks to private, state, and local funding.

In 1997, after an extensive review of the available data, the National Institutes of Health concluded that not only did needle exchange programs fail to promote drug use or encourage non-users to use; they also dramatically reduced rates of HIV transmission (National Institutes of Health, 1997), all in a cost-effective manner. The NIH report summed up the state of the science in this way: “Can the opposition to needle exchange programs in the United States be justified on scientific grounds? Our answer is simple and emphatic: no” (National Institutes of Health, 1997). In response, the Secretary of Health and Human Services, the Surgeon General, the National Academy of Sciences, the American Medical Association, the U.S. Conference of Mayors and others all expressed their support for needle exchange programs. And yet, the ban on federal funding remained, as politicians continued to assert there was no evidence in favor of the programs’ effectiveness. As late as 2005, Rep. Mark Souter had this to say about the state of the science (2005):

“And when we find a strategy that reduces death in our community, and the best scientific minds in the United States—not in some developing country, in the United States—tell us this works, you betcha that's exactly what we ought to do. And when everybody from the CDC and NIH to the AMA and the Pharmaceutical Association of America tell me that, according to their studies, approaches like needle exchange reduce death in our country, that is who I am going to listen to.”

Souter and others were apparently unaware that the jury had already returned its verdict on needle exchange.

The ban on federal funding was finally repealed in December of 2009, with the restriction that programs cannot operate within 1,000 feet of any area where children are likely to congregate. This restriction will effectively put many programs out of business (e.g., Ellis, 2009) .

We can situate the history of needle-exchange policies within a typology of public-health decisions advanced by Des Jarlais (2008). During the years of the ban, particularly after the first decade of data collection, the U.S. government made a “data-proof” decision to prohibit federal funds despite evidence of their effectiveness, not on the basis of scientific data, but on the potentially symbolic value of these programs. When the ban was lifted but with strict restrictions on where programs could operate, the government made a “data-compromise” decision, which recognizes the available scientific evidence but retains a symbolic disapproval.

Of course, there is no comparable database on the effects of Take Charge, Take Care. So far, the science suggests that the benefits outweigh the potential costs. From 2006-2008, when Take Charge, Take Care was most widely available, rates of unintentional drug overdose and HIV infection among injection drug users declined in New York City (New York City Department of Health and Mental Hygiene, 2008, 2009, 2010a, 2010b).  And contrary to the critics’ warnings, providing tips on safer injection does not appear to encourage non-users to take up the habit. The rate of lifetime heroin use among New York City high school students slightly decreased from 2005 to 2007, from 1.8% to 1.3% (Centers for Disease Control and Prevention, 2006, 2008). This is consistent with other research indicating that when medical authorities provide a means of safer injection drug use, it is high-risk, long-time users—and not the uninitiated—who respond (Kerr et al., 2007; Wood et al., 2005).

Unfortunately, we might never get to find out whether Take Charge, Take Care helps to make injection drug use safer or encourages users to seek support to quit. In response to recent criticism, the Department of Health as removed the guide from its website, and City Council Member Peter Vallone is currently attempting to cutoff funding for the pamphlet’s distribution. If Vallone succeeds, so to will “data-proof” decision-making.

--Heather Gray

References

Buxbaum, E. (2010). NYC heroin pamphlet -- is it a help or a how-to guide? .   Retrieved March 4, 2010, from http://www.cnn.com/2010/CRIME/01/04/ny.heroin.pamphlet/index.html

Centers for Disease Control and Prevention. (2006). Youth Risk Behavior Surveillance — United States, 2005.   Retrieved March 8, 2010, from http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf

Centers for Disease Control and Prevention. (2008). Youth Risk Behavior Surveillance — United States, 2007.   Retrieved March 8, 2010, from http://www.cdc.gov/mmwr/PDF/ss/ss5704.pdf

Cho, A. (2010). A heroin how-to?   Retrieved March 4, 2010, from http://www.cnn.com/video/#/video/us/2010/01/06/cho.heroin.how.to.cnn

Des Jarlais, D. C. (2008). Data and public health decision making on HIV prevention in injection drug users. Journal of Urban Health, 85(3), 303-305.

Drucker, E., & Clear, A. (1999). Harm reduction in the home of the war on drugs: Methadone and needle exchange in the USA. Drug and Alcohol Review, 18(1), 103-112.

Ellis, M. (2009). Congress looks to lift two-decade ban on federal needle exchange funds [Electronic Version]. The Washington Independent, 7/31/2009. Retrieved March 5, 2010 from http://washingtonindependent.com/53339/congress-looks-to-lift-two-decade-ban-on-federal-needle-exchange-funds.

Foydel, E. (2010). Dept. of Health under fire for controversial heroin leaflet.   Retrieved March 5, 2010, from http://www.columbiaspectator.com/2010/01/28/dept-health-under-fire-controversial-heroin-leaflet

Kerr, T., Tyndall, M. W., Zhang, R., Lai, C., Montaner, J. S. G., & Wood, E. (2007). Circumstances of first injection among illicit drug users accessing a medically supervised safer injection facility. American Journal of Public Health, 97(7), 1228-1230.

National Institutes of Health. (1997). Consensus Development Statement on Interventions To Prevent HIV Risk Behaviors.   Retrieved March 8, 2010, from http://consensus.nih.gov/1997/1997PreventHIVRisk104html.htm

New York City Department of Health and Mental Hygiene. (2008). HIV Epidemiology & Field Services Semiannual Report (October, 2007). New York: Author.

New York City Department of Health and Mental Hygiene. (2009). HIV Epidemiology & Field Services Semiannual Report (October, 2008). New York: Author.

New York City Department of Health and Mental Hygiene. (2010a). HIV Epidemiology & Field Services Semiannual Report (October, 2009). New York: Author.

New York City Department of Health and Mental Hygiene. (2010b). NYC Vital Signs: Illicit Drug Use in New York City. New York: Author.

Souter, M. (2005). Harm reduction or harm maintenance: Is there such a thing as safe drug abuse? Hearing before the Subcommittee on Criminal Justice, Drug Policy, and Human Resources Committee on Government Reform  1st Session. Retrieved March 5, 2010, from http://ftp.resource.org/gpo.gov/hearings/109h/22200.txt

Wood, E., Tyndall, M. W., Li, K., Lloyd-Smith, E., Small, W., Montaner, J. S. G., et al. (2005). Do Supervised Injecting Facilities Attract Higher-Risk Injection Drug Users? American Journal of Preventive Medicine, 29(2), 126-130.

Op-Ed/Editorials: An Inconvenient Leak: ClimateGate and The Transparency Project

This year, the Division on Addictions launched The Transparency Project, an initiative that provides, to our knowledge, the first-ever open access database repository for privately-funded data related to addiction.

Recent events surrounding research on global warming have reinforced the importance of transparency in research practices. A set of emails involving prominent climatology researchers at the University of East Anglia was leaked to the public a couple of weeks ago. These emails contain statements that suggest data were being manipulated to support pre-existing conclusions. Whether we consider the emails to be taken out of context or unmistakable evidence reflecting unethical research practices, one thing is clear: this team’s research has been called into question, and without access to the data, it is impossible to evaluate the accuracy of that research. A search of these emails (available in a searchable database at: http://www.eastangliaemails.com) reveals a reluctance to release both raw data and, more crucially for the arguments being made, algorithms used to convert the data to the “hockey stick” type graphs often presented as evidence of anomalous global warming during the late 20th century (see http://www.eastangliaemails.com/emails.php?eid=1037&filename=1254751382.txt). 

Let’s assume for argument’s sake that no willful misconduct took place. What can we assume to be the researchers’ motivation for not disclosing their data? First, examination of the emails reveals that several global warming skeptics (e.g., Steve McIntyre) have been constant thorns in this research group’s side for a decade or more. The emails reveal that the research group viewed these critics as pestering them incessantly for data access and nitpicking their results. Most researchers involved in any area of research that crosses into the realm of public policy and politics are familiar with persistent critics and, perhaps, can sympathize with the desire to ignore them and hope they go away quietly. But this strategy does more to harm the science than protect it, no matter how political the arena. Let the data and methods speak for themselves. If the critics are crackpots, their criticisms will fall away when countered with actual data and facts. If they are genuine scientists, science can be advanced by having more eyes and brains engaged with the data. Skepticism and critical investigation are often the engines that drive scientific advance.

 Perhaps the motivation for withholding data is the worry about what might be found if other groups examine the evidence. The research group might be embarrassed if a data or algorithm error is found. Perhaps data actually have been lost or the methods are not properly documented. But, under these circumstances, there is even more reason to make transparent data sharing a convention among scientists. If data sharing becomes an expected practice, researchers likely will make even better efforts to archive their data and document their methods than they do now. And if there are errors in the original analyses, is it more important to protect our reputations or advance an accurate evidence base? Both the climate change fields and addiction science research communities share the experience of having research put into practice and policy – it is crucial that research findings be as accurate as possible because it is likely that these findings will be acted upon. All scientists can make errors during the crunching of data – if we share our data transparently, observers can evaluate these errors for what they are and correct them. If we do not disclose our data and methods, errors can either harm science by going undiscovered or harm both science and research teams by spawning the claims of cover-up and bias as evidenced by Climategate.

This recent global warming controversy supports our call for more transparency in science. It also illustrates the inherent risks associated with insufficient public visibility and access to the process of scientific inquiry. This unfortunate circumstance diminishes the role of science in contemporary society and allows pseudoscience to hold as much sway as rigorous science. In contrast, an open and transparent system of science is self-correcting and credible. Transparency ensures scientific advancement. We believe that, as the Internet matures, transparency should and will become the norm. Consequently, we invite you to participate in our Transparency Project by making use of the datasets available on our website (http://www.thetransparencyproject.org) and by contributing your own privately-funded addiction-related datasets to this repository.

By Sarah Nelson

(Note: Travis Norsen, Debi LaPlante, and Howard Shaffer contributed to the ideas in this article.)

Op-Ed/Editorials - Gambling and the Law®: Read Those T&Cs

I Nelson Rose

    Party Poker won a nice victory in federal court in Ohio, because its Terms and Conditions say that all disputes will be heard in the courts of Gibraltar.

    The suit had the potential to be a major headache for Party Poker.  The plaintiffs, Rose Wong and Patrick Gibson, had filed a class action, claiming they “and others similarly situated” had lost money because other players with multiple accounts had colluded against them.  So why would Party Poker be liable?  Wong and Gibson claimed Party Poker knew about the collusion and did nothing to prevent it.

    The plaintiffs’ claim was weak from the start.  They quoted from Party Poker’s “Collusion Prevention Statement” on its website, to prove that Party Poker did nothing to prevent collusion.  Of course, the Statement actually warned about collusion and described the ways Party Poker was trying to identify and eliminate players who collude.

    But we will never know if plaintiffs would have been able to convince an American jury to give them big bucks, because the Court dismissed the lawsuit and told them to refile in Gibraltar.

    Party Poker’s Terms and Conditions clearly state that the law of Gibraltar applies to the players’ Agreement, and that players “irrevocably agree to submit, for the benefit of the Company, to the exclusive jurisdiction of the courts of Gibraltar for settlement of any disputes...” 

    Courts are split on whether forum selection clauses like this are enforceable.  Ten years ago, a Texas player sued a California online gaming company operating Funscape’s Casino Royale in his local court.  The federal court in Texas refused to enforce a clause that said all disputes would “be resolved exclusively by final and binding arbitration in the City of San Jose, County of Santa Clara, State of California.”  The Judge, probably incorrectly, decided that this was not really a forum selection clause, because it did not expressly say that all lawsuits must be filed in California. 

    More importantly, the Judge noted that the clause was “buried” in the site’s online Agreement, which nobody reads.  And he went on to hold that the state of Texas’s interest in protecting its citizens outweighed the Agreement.

    Courts will not enforce terms of contracts, like forum selection clauses, if a party has been induced to sign through fraud or misrepresentation.  But this is difficult to prove.

    The Ohio Judge, Ann Aldrich, also held that the plaintiffs did not claim Party Poker’s forum selection clause was unknown to them.  She quoted the boilerplate clause found in all online Agreements that patrons are required to read and agree to the Terms and Conditions.

    The proper procedure for enforcing a forum selection clause is a motion to dismiss under forum non conveniens, which requires the court to weigh all the interests at stake.  Courts often seem to feel that corporations can fight lawsuits anywhere, while individuals cannot face the time and expense of going to another state, let alone another country.

    But Judge Aldrich held the factors weighed in Party Poker’s favor.  Besides the forum selection clause, she held that the plaintiffs would get a fair trial in Gibraltar, which has a court system similar to England’s.  Most importantly, the Judge dismissed the U.S. suit, “because of the clear difficulties” Party Poker would have “in trying a case in a different country from where the business, its documents, and witnesses are likely located.”

    Judge Aldrich’s decision can be persuasive for other online operators.  And the most interesting factor that was conspicuous by its absence was the question of legality.  Would the result have been the same if the plaintiffs had claimed that Party Poker, but not they, were violating Ohio’s anti-gambling laws?

END

© Copyright 2009.  Professor I Nelson Rose is recognized as one of the world’s leading experts on gambling law.  His latest books, INTERNET GAMING LAW (2nd edition just published), BLACKJACK AND THE LAW and GAMING LAW: CASES AND MATERIALS, are available through his website, www.GAMBLINGANDTHELAW.com.

#08-20 © Copyright 2009, all rights reserved worldwide.  GAMBLING AND THE LAW® is a registered trademark of Professor I Nelson Rose, www.GAMBLINGANDTHELAW.com.

Op-Ed/Editorials: Using Innovation to Engage Intravenous Drug Users in Harm Reduction

Ingrid Maurice
Research Coordinator
Division On Addictions, Cambridge Health Alliance

Contributors

Heather Gray
Research Associate
Division On Addictions, Cambridge Health Alliance

Debi LaPlante
Associate Director
Division On Addictions, Cambridge Health Alliance

Howard Shaffer
Director
Division On Addictions, Cambridge Health Alliance

According to the Centers for Disease Control, during 2005, drug-induced HIV and viral hepatitis combined to kill more than 51,000 people in the United States;  during 2006, there was an increased number of deaths from viral hepatitis ("Deaths: Final Data for 2005"; "Deaths: Final Data for 2006”. Because of unsafe needle practices (e.g., needle sharing, the use of broken or dirty needles) and isolation from conventional medical treatment, intravenous and injection drug use puts individuals at risk for all three of these diseases (Fast, Small, Wood, & Kerr, 2008; W. Small, Wood, Lloyd-Smith, Tyndall, & Kerr, 2008). Furthermore, as all communities are inextricably connected, the threat of disease in the IDU community also places the general population at risk for various infections. Some clinicians and researchers are addressing the healthcare needs of intravenous drug users with Supervised Injection Facilities (or Safe Injection Facilities, SIFs), a new and controversial form of low-threshold treatment; this treatment is open to all individuals and does not require abstinence or use of medication (Kerr & Palepu, 2001). In this editorial, we will examine the innovative SIF approach and discuss the general population’s responsibility to the public health and well-being by engaging in harm reduction.

Before SIFs, intravenous drug users’ main sources of low-threshold treatment were needle-exchange programs. These programs allowed users to exchange dirty needles for new, sterile needles. Unfortunately, as demonstrated by the HIV outbreak around Vancouver’s only needle-exchange facility (Schechter et al., 1999), the presence of a needle exchange program alone might not always be enough to change the culture of IDU and reach all intravenous drug users. Needle-exchange programs usually include some counseling and function with a “no questions asked” system. Many researchers suggest that intravenous drug users also need thorough counseling, education services, and support in the form of medical personnel; these services are combined and centrally located in SIFs (Fast et al., 2008; Schechter et al., 1999; Strathdee et al., 1997).

Intravenous drug users are at risk for physical injuries and IDU is a significant public health threat. SIF supporters maintain that counseling, education, medical support and other SIF characteristics could make these facilities a useful tool against addiction and public health related threats stemming from IDU. Kerr and Palepu (2001), in their discussion of Canada’s potential need for SIFs, describe SIF objectives:

“Unlike illegal “shooting galleries” run by drug dealers, safe injection facilities are controlled health care settings where people can inject preobtained drugs under staff supervision and receive sterile injecting equipment, primary health care, counseling, and referral to health and social services” (p. 436).

SIFs allow for direct contact with health professionals before, during, and after injections. This might increase users’ knowledge of safe injection practices, decrease the instances of skin and tissue infections and other injuries, and the likelihood of accidental overdose (Bravo et al., 2009; Fast et al., 2008; Salmon et al., 2009; W. Small et al., 2008). As a result, SIFs might reduce the public health threat posed by intravenous drug use. Direct access to medical care provides users with the opportunity to build a relationship with healthcare providers, thus potentially increasing their confidence in the mainstream health care system and providing access to other healthcare services (e.g., primary health care, addiction counseling, and methadone clinic referrals). Intravenous drug users might not find SIFs particularly attractive since they present a completely different setting for drug use (i.e. a sterile environment, the presence of medical personnel). However, as a low-threshold treatment method, also a characteristic of needle exchange programs, SIFs can connect with users at any stage in the process of addiction—from first injection drug use to recognition of an addiction problem—and provide as many or as few services as users are comfortable with to move toward better health, (i.e. fewer injuries and ER visits) an enticing incentive. It is not surprising, then, that evidence-based research suggests that SIFs, a form of immediate short-term intervention, help users face their problems and begin to change (Bayoumi & Zaric, 2008; Bravo et al., 2009; Kerr & Palepu, 2001).

Although there are numerous advantages, many people criticize SIFs. First, critics claim that SIFs encourage and legitimize drug use because employed nurses are present when users inject themselves. Although this criticism is reasonable, many would argue that the benefits of pre-emptive medical treatment outweigh the risks of legitimizing drug use (Fast et al., 2008; Salmon et al., 2009). Second, critics fear that the presence of SIFs in neighborhoods is a cause for concern. The fear that SIFs will change the atmosphere of a neighborhood and make it unsafe is understandable but unwarranted. SIFs, and other IDU services, are often deliberately located in areas with a high concentration of injection drug users (Schechter et al., 1999) and bring with them new law enforcement to maintain control (Graham, 2008). This setting exposes areas that already have a high concentration of underground intravenous drug users and makes services for users more accessible – potentially improving the safety of neighborhoods. The presence of SIFs could help to reduce the negative consequences of intravenous drug use in neighborhoods (i.e. public drug use, safety concerns, etc). There is a known correlation between high rates of drug use, higher crime rates, and lower quality of life (Crowe, 1998); although the presence of SIFs likely would not completely reverse the effect, it could significantly lessen the negative consequences caused by increased neighborhood drug use. Lastly, there are also questions about funding and legal jurisdiction for SIFs. This matter depends on both the government and society’s opinions: who is responsible for the addiction problem? Currently, in Vancouver, funding for Insite, the only SIF in North America, comes from the government and by the public Vancouver Coastal Health authority (D. Small, 2008). Similar funding, a combination of public and private funds, could prove effective in the US as well. With the responsibility of funding divided between multiple entities, people would be aware of about the need for SIFs.

SIFs have undeniable potential to provide new and effective safety and possible treatment methods for those affected by intravenous drug use (i.e. users, communities, etc.) As with all advances, SIFs will need reform, further research, and more testing. However, in a short amount of time, Insite, Canada’s SIF has already started to have an impact and has shown great economic potential, demonstrated by cost-effectiveness and health savings research. Intravenous drug users frequently use emergency and ambulance services for overdoses, infections, and sometimes as a primary source of health care; this use of emergency services represents a large portion of healthcare costs (Beletsky, Davis, Anderson, & Burris, 2008; Salmon et al., 2009). In theory, SIFs should minimize hospital ER and ambulance use and decrease the number of intravenous drug use-related deaths, infections (HIV, AIDS, Hepatitis A), and crimes (Beletsky et al., 2008). The end result would be a potential reduction in millions of wasted dollars and add an increase in years to individual lives. In a 2008 simulation study, researchers considered possible outcomes from SIF use (decreased needle sharing, increased use of safer injection practices, increased referrals to methadone treatment) and their effects, and determined that negative outcomes (e.g.,  infections, overdose, deaths) could be avoided and SIFs could potentially save around $18 million dollars and gain around 1175 life-years (Bayoumi & Zaric, 2008). Figure 1 illustrates the hypothetical ratio of potential cost-effectiveness. As previously stated, SIFs are a pre-emptive mechanism; if injection drug users utilize their services they are less likely to place a financial burden on emergency services.

Figure 1: Cost-effectiveness ratio vs. % of facility users.
“The solid line indicates the cost-effectiveness when decreases in needle sharing are considered the only effect of the facility. The dashed line indicates the cost-effectiveness when all effects are considered (decreased needle sharing, safer injection practices [e.g., use of bleach to sterilize shared needles] and increased referral to methadone maintenance treatment). The base assumption was 21% (not shown)” (Bayoumi & Zaric, 2008).

As with all new interventions, first and early implementations of SIFs might not work up to its potential. The majority of current research about SIFs has been qualitative; this is a significant limitation. However, the results suggest that SIFs have the potential to decrease the spread of HIV/AIDS and Hepatitis in the IDU population (Kerr & Palepu, 2001; D. Small, 2008). Canada’s SIF has shown promise but none has been implemented here in the United States. Combining the positive characteristics of SIFs (i.e., counseling, emergency services, central location, education) with those of NEPs (i.e., low-threshold, “no question asked”, quick needle exchange) and also supplementing these with active outreach (Zinberg & Shaffer, 1990) could potentially result in a more effective form of low-threshold treatment for intravenous drug users.

Concerns about SIFs ignore the significant potential advantages of these programs, especially if combined with aspects of NEPs that already have proven moderately successful. Reaching a large concentration of injection drug users, introducing them to safer injection practices, and putting them in direct contact with health professionals may reduce the public health impact of injection drug use and bring necessary health services to the intravenous drug user population. the longer intravenous drug use remains unchecked the more likely serious infections will continue to plague both the IDU and majority population. The British Columbia Supreme Court took a step in the right direction when it extended Insite’s exemption from a federal drug law ("Vancouver's supervised injection facility granted constitutional exemption from federal drug law," 2008). However, there are many other individuals, worldwide, who we must help to recover and become fully functioning members of society again.

References Cited

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