The Brief Addiction Science Information Source (BASIS)

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

Bayoumi, A. M., & Zaric, G. S. (2008). The cost-effectiveness of Vancouver's supervised injection facility. Canadian Medical Association Journal, 179(11), 1143-1151.

Beletsky, L., Davis, C. S., Anderson, E., & Burris, S. (2008). The law (and politics) of safe injection facilities in the United States. American Journal of Public Health, 98(2), 231-237.

Bravo, M. J., Royuela, L., De la Fuente, L., Brugal, M. T., Barrio, G., & Domingo-Salvany, A. (2009). Use of supervised injection facilities and injection risk behaviours among young drug injectors. Addiction, 104(4), 614-619.

Crowe, A. H. (1998). Drug identification and testing in the juvenile justice system (No. NCJ167889). Washington, DC: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention.

Deaths: Final Data for 2005. (2008). National Vital Statistics Reports (Vol. 56, pp. 121): Center for Disease Control.

Deaths: Final Data for 2006. (2009). National Vital Statistics Reports (Vol. 57, pp. 80): Center for Disease Control.

Fast, D., Small, W., Wood, E., & Kerr, T. (2008). The perspectives of injection drug users regarding safer injecting education delivered through a supervised injecting facility. Harm Reduction Journal, 5, 32.

Graham, J. (2008). Supervised injection sites - a view from law enforcement. British Columbia Medical Journal, 50(3), 132-134.

Kerr, T., & Palepu, A. (2001). Safe injection facilities in Canada: is it time? Canadian Medical Association Journal, 165(4), 436-437.

Salmon, A. M., Dwyer, R., Jauncey, M., van Beek, I., Topp, L., & Maher, L. (2009). Injecting-related injury and disease among clients of a supervised injecting facility. Drug and Alcohol Dependence, 101(1-2), 132-136.

Schechter, M. T., Strathdee, S. A., Cornelisse, P. G., Currie, S., Patrick, D. M., Rekart, M. L., et al. (1999). Do needle exchange programmes increase the spread of HIV among injection drug users? An investigation of the Vancouver outbreak. AIDS, 13(6), F45-51.

Small, D. (2008). Fighting addiction's death row: British Columbia Supreme Court Justice Ian Pitfield shows a measure of legal courage. Harm Reduction Journal, 5, 31.

Small, W., Wood, E., Lloyd-Smith, E., Tyndall, M., & Kerr, T. (2008). Accessing care for injection-related infections through a medically supervised injecting facility: a qualitative study. Drug and Alcohol Dependence, 98(1-2), 159-162.

Strathdee, S. A., Patrick, D. M., Currie, S. L., Cornelisse, P. G., Rekart, M. L., Montaner, J. S., et al. (1997). Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS, 11(8), F59-65.

Vancouver's supervised injection facility granted constitutional exemption from federal drug law. (2008). HIV/AIDS Policy and Law Review, 13(2-3), 28-29.

Zinberg, N. E., & Shaffer, H. J. (1990). Essential Factors of a Rational Policy on Intoxicant Use. The Journal of Drug Issues, 20(4), 619-627.

Op-Ed/Editorials - Gambling and the Law®: Another “What Is Poker” Case

I. Nelson Rose

Last column I started the discussion of whether the prohibitions on internet gambling should apply to online poker by asking the fundamental question:  “What is poker?”

Twenty years ago I actually had to answer that question under oath in the “7-card down” case I described in my last column.  The fight was about what games were prohibited by an 1885 statute that outlawed “stud-horse poker.”

But in my next case, the definition of poker was the central issue in the case.

It was ten years later, April 1997, and Florida had recently legalized poker to be played commercially at the state’s parimutuel outlets.  Unfortunately, the proponents were willing to make a compromise to get cardrooms authorized that almost proved fatal:  They agreed that the stakes would be the same low stakes permitted for home social games.

Everyone called them “penney-ante.” but in a way they were worse.  At least with antes of a penney many players play seriously, to avoid the embarrassment of having to buy in again.  In internet Texas hold’em games where chips are entirely free, many players go all in on the first two cards.  But go to a micro-stakes table where players are betting 2 cents - 4 cents or 5 cents - 10 cents, and you see most player wait until they have somewhat decent cards.

What Florida did was put a $10 limit on how much any player could win in a single game.  This meant at a card club table with eight players, each player simply bet $1.25 before the deal and then the winner got the $10 pot.  There could be no betting after the first round.  And the house charged a seat rental fee.

The clubs tried desperately to figure out a way around the restriction.  The St. Petersburg Kennel Club requested the Florida Department of Business and Professional Regulation to permit it to spread Big Poker 21, Florida 21 and Sure-2-Win.  These games are obviously not the games you think of when you think of poker.  In fact, you could say they are not poker according to Hoyle.

In fact, it was the fact that the games had few of the elements of poker games found in Hoyle, specifically HOYLE’S MODERN ENCYCLOPEDIA OF CARD GAMES by Walter B. Gibson, 1974, 1st edition, that they were not considered poker.  The regulator had adopted that book as a guideline in evaluating whether a game would be approved to be played in the new card rooms.

Edmund Hoyle would probably have approved.  Although he died 200 years earlier and never saw a poker hand, since the game had not yet been invented, he did believe in categorizing games according to their rules.  And these games did not look much like poker.

I was called to testify that they did not have the basic elements of poker.  In particular, there was no way a player could bluff.

But before I started testifying, the games first had to be described to the administrative judge hearing the case.  Big Poker 21, for example requires players to make their bets before they see their cards.  They then are dealt two cards.  All face cards have the same value, they are worth ten points.  Aces are one or eleven.  If a player gets 21 on his first two cards, he automatically wins.  Otherwise he can keep drawing cards until he decides to stand, with the player getting closer to 21 being the winner.

Before I could be asked a single question, the judge said, “That’s not poker, that’s blackjack.”

© Copyright 2009. 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 (2nd edition just published) and GAMING LAW: CASES AND MATERIALS, are available through his website, www.GAMBLINGANDTHELAW.com.
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Op-Ed/Editorials - Gambling and the Law®: What Is Poker?

I. Nelson Rose

Should the prohibitions on internet gambling have a carve-out for online poker?

The question is much more complicated than it seems.     If the argument is that poker is not gambling but rather a contest of skill, should the exemption be limited to poker tournaments?  What is “online” – what about people playing against each others at terminals in a club, or linked clubs?  Which laws are getting changed, federal or state?  And who is doing the changing, legislature, courts or regulators?

Let’s start with what should be the easiest question:  “What is poker?”   

I have been asked that question twice while on the witness stand and under oath.  Fortunately, in both cases I was prepared.

The first came in the 1980s when California card clubs were trying to expand beyond 5-card high, 5-card low and panguini, the only games they were spreading at the time.  Even Texas hold ‘em was thought to be illegal.  The problem was a statute from 1885 which outlawed “stud-horse poker.”

The Attorney General and local law enforcement thought this outlawed any poker game where a card was dealt face up.  They also thought that all forms of poker were illegal except for draw.

So, the now defunct Huntington Park Club invented a game to test the law: “7-card down.”  Here are the rules: players are dealt two cards face down, there is a round of betting; then each remaining player receives three cards face down and there’s another round of betting; then the fourth and then the fifth cards are dealt face down with betting rounds.  The best five card hand wins.

It was purposely designed to look like hold ‘em, but clearly to be something else.

The L.A. County Counsel tried to shut it down, claiming it violated the prohibition on stud-horse poker.

I testified about the years of research I had conducted trying to find out what the stud-horse poker was that was outlawed in 1885.  The best I can tell from court cases, 123 year-old newspapers and interviews with an old-timer in Arkansas, which had a case within living memory, stud-horse poker was either a house banked game, 5-card stud, or code for “Let’s cheat the newcomer.”  Whatever it was, it was played with players getting at least one card face up.

The judge interrupted my testimony as an expert witness to ask his own question: “What is poker?”  My answer was that players got equal number of cards, there was a ranking of hands based on how rare the hand was, but players could win with lower ranked hands if they made a bet that was not called.

He then asked, “What is stud poker?”  The County’s expert testified that multiple betting rounds distinguished stud from draw.  I said there are additional forms of poker, including straight poker, the original game, where all the cards are face down but without a draw, and community card games like spit in the ocean and hold ‘em. 

I said that stud poker means at least one of the players’ own cards is face up, so that the strength of their hands is shown to all.

Journalists speak of a “stud horse headline.”  These are the ones in gigantic, bold print, like “WAR.”

My theory is that we know a real live “stud-horse” is a stud horse because he is (don’t blush) obviously male.

Later, the Legislature removed stud-horse poker from the list of prohibited games, leaving us with the simple question of what is poker?  No problem there, right?

More next column.
END

© Copyright 2009. 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 (2nd edition just published) and GAMING LAW: CASES AND MATERIALS, are available through his website, www.GAMBLINGANDTHELAW.com.
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The Addictiveness of Specific Gambling Games

John W. Welte, Ph. D.
Principal Investigator, Research Institute on Addictions, State University of New York at Buffalo

With the growth of legalized gambling in the United States in recent decades, concern about addiction to gambling has intensified. In virtually every U.S. state, and in many other countries, there have been acrimonious debates and political controversies over proposed extensions of legal gambling. Video gambling machines have sometimes been at the center of these controversies, as they were placed in racetracks, and also in such venues as bars, restaurants and veteran’s organizations. Proponents argued that the machines provide much-needed revenue for government and business; opponents argued that they promote problem gambling. 
     
Video gambling machines have been criticized as one of the most addictive forms of gambling, with critics in some cases referring to them as the “crack cocaine of gambling”.  These devices provide rapid turnaround of gambling opportunities, and also provide a variable reinforcement schedule, so an argument can be made from learning theory that they are particularly addictive. Some research studies have shown that gambling machine players may develop gambling problems more quickly than gamblers who do not play gambling machines. Furthermore, video gambling machines are designed deceptively, so that (for example) the expected return to the player is lower than would be estimated from the external characteristics of the display.
     
However, caution is necessary when associating problem gambling with a particular type of gambling. It is not sufficient to show that a high proportion of problem gamblers play a particular game, or that a relatively high proportion of those who play a particular game are problem gamblers, because those gamblers will often engage in other forms of gambling as well. My colleagues and I attempted to take the respondents’ total gambling into account when we analyzed data from a national U.S. adult survey and a national youth survey (see The WAGER, Vol. 14(5)). In both studies we examined the following question: Which forms of gambling predicted problem gambling, when taking all forms of gambling engaged in by an individual into account? In our adult survey, the types of gambling most predictive of problem gambling were casino gambling, bingo, and cards, in that order. In the youth survey, it was cards, casinos, and “other gambling” (which included betting on elections, shooting the biggest deer, and betting on fights in school). In both studies we found that playing gambling machines, other than in a casino, was not predictive of problem gambling. There were other examples of the same phenomenon. It has also been suggested that internet gambling is an especially addictive form of gambling. In our youth survey, internet gamblers had more gambling symptoms than those who engaged in any other form of gambling. However, internet gamblers also engaged in the most forms of gambling in total, and internet gambling was also not predictive of problem gambling when the respondent’s entire gambling was taken into account. In addition to these analyses of specific forms of gambling, my colleagues and I also found that the number of different types of gambling in which an individual engaged was highly related to problem gambling, even after taking the frequency of all gambling, and average wins or losses, into account.
     
These findings contain some relevant messages for those interested in gambling policy and prevention. Problem gambling is probably more related to the gambler’s total repertoire than to any particular game. Gambling on cards, usually a non-commercial gambling activity, may play an important role in the development of problem gambling. And the introduction of a casino into a particular region, with its ability to cater to many gambling tastes, is something that should be considered carefully.

Division on Addictions Creates First Ever Public Data Repository and Exchange

The following was a featured article for the World Online Gambling Law Report Vol. 8 (3).

In a move to make addiction research more open and accessible, the Division on Addictions at the Cambridge Health Alliance, a teaching affiliate of Harvard Medical School, has created a data repository called “The Transparency Project”. This data repository allows scientists from around the world to engage in a free exchange of data from privately-funded research. Open access to information from research supported by private interests will promote evidence from this resource to take its place alongside that from government sponsored research. Ultimately, to the benefit of health providers as well as to political and legal decision-makers deciding on complex addiction-related issues, the Transparency Project will enhance confidence in scientific findings. 

Politicians, judges, and regulators face difficult decisions when confronted with issues involving human behaviors, such as concerns about gambling addiction. The scientific community can offer guidance to the often heated discussion that usually surrounds matters of addiction. However, limited access to important addiction-related data could impede the amount of guidance science can provide. The newly launched ‘Transparency Project’ is the first ever publicly available data repository for privately-funded research datasets that are addiction-related (e.g., relating to gambling, alcohol, shopping, illicit drugs, etc.). It promotes transparency for privately-funded science, the exchange of quality-reviewed data, and lists publications based on the different datasets. Consequently, The Transparency Project constitutes an important dynamic source of information for scientists and stakeholders who rely on up-to-date scientific research.

There is increasing agreement that scientific information should be available broadly to both the scientific community and the general public. In the United States, for example, researchers must make publicly-funded scientific datasets freely available to others. Policy makers believe that greater access to scientific information will provide other scientists the opportunity to extend existing research and speed the process of improving the public’s health. Convinced of this belief, the Division on Addictions has created ‘The Transparency Project’, making privately-funded datasets (e.g., foundation-funded and industry-funded) openly accessible for the first time. The availability will help foster global rapid growth in knowledge related to addictive behavior and advance the process of finding answers to public health concerns.

To ensure privacy and high scientific standards, the datasets, created by addiction researchers working throughout the world, are de-identified to the level required by the US Health Insurance Portability and Accountability Act. To protect human subjects, an institutional board of review must have approved the study methods. To ensure quality, the datasets must have an associated peer-reviewed publication.

Private sources are very important for research. Private sources finance about twice the research sponsored by public sources. However, some privately-funded research has come under criticism. For example, misconduct by the tobacco industry has created an atmosphere of skepticism and mistrust related to private funding sources in general. As documented, these concerns are not unwarranted. However, the misdeeds of some should not preclude the many private sources from contributing to the advancement of science. On the contrary, because some private sources provide both opportunity and exposure to potential objects of addiction, the public expects these private sources to provide funding for high quality programs of scientific investigation. The Transparency Project expressly recognizes the need to meet these concerns and increases accessibility and scrutiny to privately-funded data.

US President Obama has called for the development of more public-private partnerships in the conduct of research activities. Under the condition that scientific independence is ensured, these partnerships hold a strong potential to advance science and public health. They also take into account scarce public resources that are under increasing pressure for allocation. As public-private partnerships emerge and further evolve, the research community must assure full transparency to protect the credibility of scientific findings. With this benchmark in mind, the Division on Additions invites the community of stakeholders to utilize The Transparency Project, participate in the development of public-private research partnerships, and advance our collective knowledge about addiction. The Transparency Project provides the opportunity to work together to alleviate the burdens caused by addictive behaviors.

Howard J. Shaffer, PhD

Debi A. LaPlante, PhD

Y. Evelyn Chao, PhD

Simon Planzer, Attorney at Law, MLaw, M.A

Richard A. LaBrie, PhD

Sarah E. Nelson, PhD

The Transparency Project: http://www.thetransparencyproject.org
For questions and to get involved: info@thetransparencyproject.org

Op-Ed/Editorials - Gambling and the Law®: Don't Finish This Book

I. Nelson Rose

There ought to be a law prohibiting anyone from writing a book about gambling who does not know how to make a bet.  (There also ought to be a law against writing books if you can't write, but that is a different subject.)

Gambling has been at the heart of many stories.  The best, inevitably, are by writers who know gamblers, because they are gamblers themselves.

Among the first, and most famous, is Fyodor Dostoevsky’s The Gambler.   The story centers on a game, roulette, and is written in a style that are out-molded today.  But reading it we know that Dostoevsky was a gambler, and probably a compulsive one.

The best recent book involving gambling is James McManus’ Positively Fifth Street.  McManus is not only a brilliant poker player and writer, he is a gambler.  He took his entire advance for a magazine article he was to write on the 2000 World Series of Poker and the Ted Binion murder trial, and used it to enter the WSOP himself.  He won $247,760, finishing fifth.  A real-world ending that an editor would say is as unbelievable as naming a winning poker player Moneymaker.

Which brings us to the most recent book revolving around gambling, Lottery by Patricia Wood.  If you haven’t heard about this yet, you will.  And later, if you’re male, you’ll be dragged into seeing the movie. 

Wood is good when she writes about what she knows: the mentally disabled, sailboats and winning a state lottery (her father won one).  She writes like the beginning author (she thanks the Maui Writers Retreat) she is about everything else.

Wood does a good job of giving voice to Perry L. Crandall, I.Q. of 76. Most of the rest of her characters cannot even be described as two-dimensional.  Perry’s relatives are all evil, greedy lawyers and MBAs.  His best friend is an alcoholic Vietnam vet, who, despite farting and swearing and having to be over 60, becomes the love interest of Cherry, a 17-year-old tattooed cashier.  Woods even has a character named Mike Dinelli, who says things like, “If this doesn’t work out you are going to have much more to worry about than each other.  Capisce?”

Perry wins the state lottery, so his evil family tries to get his money. 

But clearly Wood never bought a lottery ticket herself.

If someone has just won $12 million, what would you want to know?  How’s he going to spend it, of course.  But lottery players want to know how many tickets did he buy?  How did he choose the numbers?  How often did he play?  What was the game?

Wood isn’t interested in any of that.  She is writing a chick-flick. 

I like romantic comedies.  But they have to be internally consistent. 

We can forgive Wood solving a romantic triangle with the deux ex machina of a convenient fatal auto accident.  And it’s O.K., barely, that Perry is a marketing genius. 

But, having resolved the fight over the money, Wood, for no reason, reintroduces it.  Then, she has Perry give it all to his family, after he describes them as jackals.  His reason?  “People should get what they want,” and it will stop his family from pestering him.  But after one brother embezzles it all, Perry’s mother pesters him for more, and Perry has no trouble telling her no.

The ending is so ridiculous, it ruins the book.  So, my recommendation is stop about half way and make up your own ending.  Whatever you think up would be more realistic than giving away $12 million to a bunch of jackals.

© Copyright 2009. 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 and GAMING LAW: CASES AND MATERIALS, are available through his website,  www.GAMBLINGANDTHELAW.com.