Under-treatment of Pain

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Chronicle AM: Bratton Blames MJ for Prohibition Violence, Opioid Prescriptions Decline, More... (5/23/16)

Bill Bratton misses the point on prohibition and violence, Nebraskans will have to wait for medical marijuana, Fentanyl is displacing heroin in Vancouver, and more.

NYPD Commissioner Bill Bratton (Creative Commons)
Marijuana Policy

New York City's Top Cop Blames Marijuana Legalization -- Not Prohibition -- for Black Market Violence. NYPD Commissioner Bill Bratton Sunday criticized states that have legalized weed because there is violence around the black market in his city, which hasn't legalized weed. "Here in New York, the violence we see associated with drugs, the vast majority of it, is around the issue of marijuana, which is ironic considering the explosion in use of heroin now in the city," Bratton said. "Interestingly enough, here in New York City most of the violence we see -- violence around drug trafficking -- is involving marijuana and I have to scratch my head as we are seeing many states wanting to legalize marijuana, and more liberalization of policies."

Medical Marijuana

No Medical Marijuana Initiative for Nebraska This Year. Cornhusker medical marijuana advocates have decided to delay a petition drive to get the issue on the ballot until 2018. They cited the late start this year and the expense involved.

Rhode Island Senate Approves Adding PTSD to List of Qualifying Conditions. The Senate last Friday unanimously approved a bill that will add PTSD to the list of debilitating medical conditions that qualify a patient for medical marijuana. The bill now heads to the House.

Heroin and Prescription Opioids

Opioid Prescriptions are Falling for the First Time in 20 Years. Two reports from health information providers show that opioid prescriptions have declined in recent years. IMS Health reported a 12% decline in opioid prescriptions nationally since 2012, while Symphony Health Solutions reported an 18% drop during those years. IMS said prescriptions have fallen in 49 states, with only South Dakota showing an increase. The figures could have implications not only for overdose and addiction rates, but also for pain patients. "The climate has definitely shifted," said Dr. Daniel B. Carr, the director of Tufts Medical School's program on pain research education and policy. "It is now one of reluctance, fear of consequences and encumbrance with administrative hurdles. A lot of patients who are appropriate candidates for opioids have been caught up in that response."

International

In Vancouver, Heroin Has Been Displaced by Fentanyl. The synthetic opioid has been identified in half of all drug overdoses in the city this year, which is on track to exceed last year's drug overdose toll. Advocates for drug users in the city's Downtown East Side say there's no more heroin on the street after it has been pushed out by the cheaper and more potent Fentanyl. "Traditionally, heroin comes in about four different colors,"said the longtime drug advocate Hugh Lampkin of the Vancouver Area Network of Drug Users, describing a bland palette of beiges, browns and blacks. "Well now you're seeing multiple colors, like colors of the rainbow: green and pink and orange and white... Right away, when you see these colors that's a pretty good indicator that it's fentanyl that you're doing. The people who are controlling the supply, they're passing off what should be heroin as fentanyl because of the close proximity of the high."

Afghans Celebrate Bumper Opium Harvest. Hundreds of laborers from across the Pashtun heartland gathered in Naqil, Uruzgan province, to harvest a bumper crop of opium poppies and celebrate with after-work games in a festival-like atmosphere. "This is the only time of the year to make money," said Afzal Mohammad, who came all the way from Kandahar, standing amid chest-high poppy stalks nearby. "People work here for about 15 days and then are jobless for the rest of the year."

Chronicle AM: CDC Urges Docs to Severely Limit Pain Pill Prescribing, NY Rep Wants Safe Injection Sites, More... (3/16/16

Another poll has a national majority for pot legalization, the Vermont legalization bill is now before the House, the CDC urges doctors to really cut back on pain pill prescriptions, a New York assemblywoman wants supervised injection sites, a Mexican governor wants a pilot program of opium cultivation, and more. 

Prepare for physicians to begin tightening up on writing pain pill 'scrips. (Creative Commons)
Marijuana Policy

Another Poll Has a Narrow National Majority for Legalization. A new national tracking poll conducted by Morning Consult has support for legalization at 52%, with 43% opposed and 5% undecided. That's in line with other major national polls in recent years that generally show support for legalization in the 50s. The most recent Gallup poll had it at 60%.

Massachusetts Sheriffs Oppose Legalization Initiative. More of the usual suspects weigh in against legalization, with the state's sheriffs saying it would destigmatize drug use and make it easier for teens to get their hands on the weed. Last week, the state Hospital Association and leading elected officials, including Gov. Charlie Baker (R), Attorney General Maura Healey (D), and Boston Mayor Marty Walsh (D) came out against the initiative from the Campaign to Regulate Marijuana Like Alcohol in Massachusetts.  

Vermont Legalization Bill Now Before House. Senate Bill 241, the pot legalization bill, is now before the House Judiciary Committee. On Tuesday, Sen. Dick Sears (D-Bennington) and Sen. Joe Benning (R-Caledonia) introduced the bill to the committee.

Medical Marijuana

Georgia CBD Cannabis Oil Bill Revived. Supporters of House Bill 722, which would expand access to CBD cannabis oil, have resurrected the measure by attaching its language to an old Senate bill. It could go to a House vote as early as today. The bill would expand conditions that qualify for CBD cannabis oil and allow companies outside the state to ship it in. Language that would have allowed in-state marijuana cultivation to produce the oil was stripped out earlier in the House.

More Michigan Medical Marijuana Dispensary Raids. The West Michigan Enforcement Team (WEMET) has raided four dispensaries for allegedly selling medical marijuana to cardholders who were not their registered patients. Two were in Saugatuck, one in Allegan City, and one in Pullman. Twelve other Northern Michigan dispensaries were raided last week.

Ohio Medical Marijuana Campaign Resubmits Initiative. That didn't take long. Last Friday, Attorney General Mike DeWine (R) rejected the Ohioans for Medical Marijuana initiative because of deficiencies in its summary. On Tuesday, the campaign submitted revised language. After 20 days of review by state officials, the campaign will then have until July to gather 306,000 valid voter signatures to qualify for the November ballot.

Criminal Justice

Massachusetts Conference Committee Agrees on Ending Driver's License Suspensions for Drug Offenders. House and Senate negotiators announced Tuesday that they had reached agreement on a bill to end the state's long-running policy of automatically suspending for five years the driver's licenses of people convicted of drug crimes. The relic of the 1980s drug war will be officially repealed after the full House and Senate vote on the amended bill. Both houses passed bills, and the conference committee has been ironing out the differences. More than 30 other states have taken similar steps.

Heroin and Prescription Opioids

CDC Urges Docs to Reduce Prescribing Pain Relievers. In a move bitterly decried by chronic pain advocates, the Centers for Disease Control and Prevention (CDC) said Tuesday doctors should only prescribe opioid pain relievers as a last resort. Instead, doctors should urge their patients to try physical therapy, exercise, and over-the-counter medications before using opioids to treat chronic pain. The CDC is recommending not using opioids except to treat cancer and for palliative end-of-life care, using the lowest effective dose of opioids, and limiting prescriptions to three days for short-term pain.

Harm Reduction

New York Assemblywoman Wants Supervised Injection Facilities Statewide. Assemblywoman Linda Rosenthal (D-Manhattan) said Tuesday she will soon introduce a bill to establish the harm reduction facilities. Rosenthal's move comes after Ithaca Mayor Svante Myrick hoisted a proposal for such a facility there. "New York, and nearly every other state across the country, is grappling with a heroin and opioid addiction crisis that has grown to epidemic proportions," said Rosenthal, who heads the Assembly's Committee on Alcoholism and Drug Abuse, in a statement. "Addiction is a public health crisis, and we must address it as such, with aggressive, community-based solutions that reduce harm and provide access to life-saving treatment services."

International

Mexican Governor Proposes Legalizing Opium Cultivation.  Hector Astudillo, governor of violence-plagued Guerrero, said Monday that legalizing opium cultivation for medical purposes might help reduce the violence in his state and the idea should be considered. "Let's do some sort of pilot scheme," Astudillo, a member of President Enrique Pena Nieto's Institutional Revolutionary Party, said. "Provided it's used for medical issues ... It's a way out that could get us away from the violence there has been in Guerrero," he added.

Will UNGASS 2016 Be the Beginning of the End for the War on Drugs?

This article is by Ann Fordham and Martin Jelsma, and is republished from openDemocracy. It is part a series of articles about this April's UNGASS. Further information appears below.

In April 2016, the UN will dedicate, for the third time in its history, a United Nations General Assembly Special Session (UNGASS) to discuss global drug policy. The UNGASS has the potential to be a ground-breaking moment that could change the course of the international drug control system. However, political divisions and entrenched institutional dynamics have dampened hopes that it will go down in history as the beginning of the end of the war on drugs.

At the joint request of Mexico, Colombia and Guatemala, the General Assembly decided to bring forward the convention of a special session to assess "the achievements and challenges in countering the world drug problem", originally foreseen for 2019 or 2020. The three countries stated at the time that "revising the approach on drugs maintained so far by the international community can no longer be postponed", and the UN needed to exercise leadership to "conduct an in-depth review analyzing all available options, including regulatory or market measures, in order to establish a new paradigm that would impede the flow of resources to organized crime groups". An international meeting had to be convened, "capable of taking the decisions necessary to increase the effectiveness of the strategies and instruments with which the global community addresses the challenges of drugs and their consequences".

Conventional drug control wisdom has put forward the view that stopping the supply of drugs at the source would solve the 'world drug problem', but Latin American countries bear witness to the failure of this approach. Stirred into action by the futility of spending billions of dollars to fight an unwinnable and increasingly violent war on drugs, it is no surprise that political leaders from Latin America have been at the forefront of the drug policy debate. From their perspective, the high human cost in terms of violence, insecurity, mass incarceration and the exacerbation of the social and economic vulnerability of some of society’s most marginalised groups – can no longer be justified as necessary collateral damage in pursuit of eradicating drug markets.

A growing group of Latin American and Caribbean countries are calling for a real discussion on alternative policies. In the meantime, Uruguay has moved to create the world's first national legally regulated cannabis market for recreational use, and similar initiatives have happened in the US at the state level. This opening up of the long entrenched and seemingly immovable discussion on prohibitionist drug control principles is unprecedented and has implications for global policy.

In this context, the UNGASS in April represents a critical juncture, an opportunity for an honest evaluation of global drug policy and how to address the most pressing challenges going forward. Secretary General Ban Ki-moon, in recognition of this rare and important opportunity, has urged member states to use the 2016 UNGASS "to conduct a wide-ranging and open debate that considers all options."

The UNGASS preparations

The initial discussions to prepare for the UNGASS were fraught with disagreements over many procedural aspects. These included difficult negotiations over the extent to which the UN Commission on Narcotic Drugs (CND) in Vienna would lead the process; how to strike the right balance between the UN capitals of Vienna, Geneva and New York in the preparations; how to ensure meaningful involvement of all relevant UN agencies, academia and civil society; and – last but not least – how open the debate should be: should it be restricted to a discussion of how to improve the implementation of the 2009 Political Declaration and the achievement of its targets for 2019, or should the UNGASS be an opportunity to challenge the current global drug control strategy, possibly even questioning its foundation of the three UN drug conventions?

 

These difficult negotiations, which on the surface often appeared to be arguments over procedure, reflected the deep political divisions within the international drug policy debate. The much-revered 'Vienna Consensus' continues to weaken as the divide between some governments becomes increasingly irreconcilable. A growing number of countries now believe that the traditional repressive drug control approach, based on zero-tolerance, has not worked and has led to disastrous consequences for human rights, public health, citizen security and sustainable development, and as a result it has to be modernised.

 

Some countries calling for an open and inclusive debate at the UNGASS questioned whether this could be truly achieved with a process led by the Vienna-based drug control apparatus, given that the CND, the UN Office on Drugs and Crime (UNODC) and the International Narcotics Control Board (INCB) have all gained quite a conservative reputation over the decades. Conducting all the preparations in Vienna led to a further problem for inclusivity, given that at least 70 member states do not have permanent representation there and would therefore struggle to fully participate in the process. The point of convening an UNGASS, is that by definition all UN member states and the whole UN system should be included on a equal basis, but limiting the political negotiations on the outcomes exclusively to Vienna, means that in practice the countries and UN agencies not represented in Vienna have much less influence on the process.

In the end, the hard fought-over resolution on the procedures decided that the UNGASS "will have an inclusive preparatory process that includes extensive substantive consultations, allowing organs, entities and specialized agencies of the United Nations system, relevant international and regional organizations, civil society and other relevant stakeholders to fully contribute to the process", while the CND "as the central policymaking body within the United Nations system dealing with drug-related matters, shall lead this process", inviting the president of the General Assembly to "support, guide and stay involved in the process".

UN special sessions are rare and crucial moments in UN-level policy making and are designed to ensure a coherent UN system-wide response to global problems of major concern to the international community. This has so far been less than optimal in discussions on global drug policy. After initial slow engagement from other key UN agencies, significant contributions have now been made from UNDP, UNAIDS and the WHO. The Office of the High Commissioner for Human Rights has also submitted a comprehensive reportthat outlines the most pertinent human rights violations in relation to drug control policies, while the Human Rights Council held a high level panel in September 2015 on the topic of "the impact of the world drug problem on the enjoyment of human rights".

A Civil Society Task Force (CSTF) was convened to ensure the participation of civil society in the process. The CSTF has representatives from every region of the world, as well as representatives of the key affected populations such as people who use drugs and subsistence farmers growing drug-linked crops among others. Initially, formal recognition of the CSTF was challenging – civil society has always had to fight for visibility and access at the CND but over the last year there has been increasing support for this initiative from governments.  A major victory for the CSTF was explicit support from the president of the General Assembly, who presided over an Informal Interactive Stakeholder Dialogue in New York on the 10 February 2016 organised with the CSTF in support of the preparatory process. The calls for progressive policiesbased in principles of harm reduction, of public health and of human rights from global civil society were deafening at the event.

Shifting regional priorities

 

In terms of regional perspectives, as noted above, the impetus for pushing for another UNGASS on drugs followed growing calls for reform from across Latin America at the highest political level. In fact, the previous UNGASS meetings in 1990 and 1998 had been convened in response to similar calls from Colombia and Mexico. Around them, a group of like-minded countries is gradually shaping up around certain positions, including Ecuador, Uruguay and Costa Rica and supported by Brazil and Bolivia on some issues. Caribbean countries have long been largely absent from the debate, not least because discussions have been limited to the CND in Vienna, where few Caribbean countries are represented – although Jamaica has recently joined the chorus of dissent and the discussion on several other islands has intensified.

In terms of European, particularly European Union (EU), engagement, this has been markedly different from Latin America and reflects the fact that Europe has managed to avoid the sharpest edges of a repressive approach to drug control. European countries have not experienced to the same extent, the high human cost in terms of violence, insecurity, and mass incarceration experienced in Latin America.  Of course the context is different, but in addition, many European governments have been pragmatic, have prioritised health care, harm reduction and human rights protection. While in Europe there are some serious issues regarding the criminalisation of people who use drugs and disproportionate sentences for minor drug offences, most European countries have managed to keep a certain distance from the escalation of the war on drugs in the 1980s and 1990s in the US, Latin America and Asia. At the international level, the leadership that EU governments have shown in this regard has been critical in shifting the drug policy narrative towards public health, harm reduction and human rights principles.

On issues where common positions can be found, the EU can have a strong impact on the global debate. For example, a united EU promoted the principle of proper sequencing with respect to ensuring that subsistence farmers have sufficient access to alternative livelihoods before being forced to abandon their drug-linked crops. The EU has also demonstrated unity and commitment on harm reduction and the removal of death penalty for drug offences, although a global consensus on these issues is not yet in sight.

Unfortunately, there are also crucial areas where a strong European voice has been absent, and the EU has failed to understand or acknowledge the sense of urgency and relevance of this UNGASS. This is clearly the case with regard to the shift in priority that Latin American countries are seeking, to move away from arresting small-time dealers and chasing drug shipments towards reducing drug-related violence, organised crime and corruption instead. In a sense, this is a plea for a harm reduction policy on the supply side: the drugs market will not be “eliminated or significantly reduced” by 2019, and it is time to forget the hollow illusion of a drug-free world.

Instead, government policy could be more sophisticated and focus on mitigating the most harmful aspects of the drug trade through reducing the levels of illicit drug market-related violence, crime, insecurity and corruption. This thinking mirrors similar priority shifts that have previously taken place in Europe under the harm reduction banner, with governments taking a pragmatic approach to reduce the harms associated with drug consumption without necessarily seeking to stop the use of drugs. These harm reduction policies and programmes have significantly reduced drug-related harm such as overdose deaths, and HIV and hepatitis C prevalence among people who inject drugs.

Cannabis policy and UN treaties

 

Another example is the lack of EU engagement in the debate about global cannabis policy developments, the result of the absence of a common EU position on cannabis and huge national policy variations. Demonstrating an ostrich-like denial regarding cannabis policy developments in the Americas but also at local levels within the EU, the EU common position for the UNGASS underscores the need to “maintain a strong and unequivocal commitment to the UN conventions” and that there is “sufficient scope and flexibility within the provisions of the UN Conventions to accommodate a wide range of approaches to drug policy”. In addition, the issue of drug control is a low political priority as the EU currently has it hands full with the refugee crisis and existential threats around the euro and the future of European integration.

A game-changing difference between this UNGASS and the preceding ones is the fact that the position of the US has fundamentally changed. No longer among the hardliners, the US has acknowledged, both at the UN but also more recently domestically, that the over-reliance on incarceration has failed. In August 2013, US Attorney General Eric Holder admitted that mandatory minimum sentences for drug offences were ‘draconian’ and that too many Americans had been imprisoned for too long for no good law enforcement justification. He made it clear that the status quo was unsustainable and damaging. In 2015, President Obama began a process to commute the sentences of around 6,000 federal drug offenders. In early 2016 the congressional task force created to examine overcrowding in the federal prison system, recommended the repeal of federal mandatory minimum sentences for drug offences. Different legislative initiatives have been tabled, including the Smarter Sentencing Act, which would cut many mandatory minimums for drug offences in half.

The domino effect of cannabis regulation at state level makes the US less sure-footed of condemning other countries for not stringently adhering to a zero-tolerance approach. Cannabis regulation for recreational use is outside of the scope of the current UN treaty framework for drugs, creating a significant problem for the US since it undermines its credibility to continue defending the conventions as they stand. The big question is whether this will lead to the US accepting more flexibility in policy areas that have been explored elsewhere. These include initiatives such as decriminalisation, drug consumption rooms or the regulation of coca in Bolivia, all policy options that the US currently opposes.

UNGASS outcomes: change of course

 

The past several years have seen significant changes in the global drug policy landscape representing a trend towards more humane and proportional responses based on health, human rights and development principles. To some extent, the UNGASS will acknowledge those advances and thereby consolidate the significant change of course that is happening in various regions of the world. Perhaps the most significant advance will be on the issue of access to controlled medicines – an area that has long been de-prioritised in favour of a focus on repressive, law enforcement-led approaches to reduce the illicit drug trade. Most drugs included in the schedules of the UN conventions also have important medical purposes, and several appear on the WHO “List of Essential Medicines”.  However, the availability of opiate painkillers like morphine for example, has been dramatically low in most developing countries due to overly strict regulations reflecting over-riding concerns about diversion and addiction rather than a need to ensure access to pain relief.

Unfortunately, other areas of progress remain stilted. Russia, alongside several Asian and Middle Eastern countries, has played hardball in the negotiations, effectively putting the brakes on the shifting discourse. The negotiations are driven by consensus, making it unlikely that contested policies in the field of harm reduction, or reforms like decriminalisation, despite being widely accepted and propounded by all relevant UN agencies, will be explicitly recommended in the UNGASS outcome document. Likewise, a clear condemnation of the death penalty for drug offences is probably going to be blocked by a small group of countries. The prophecy that allowing the CND to take full control over the UNGASS preparations would undermine progress towards a more system-wide coherent UN drugs policy seems to be being borne out. Negotiations about the UNGASS outcomes have taken place mostly in ‘informal’ sessions in Vienna, dominated by a minority of member states and from which civil society is excluded from participating or even observing.

For the General Assembly, an obvious priority for this UNGASS would be how to align UN drug policy with the recently adopted new global framework of the Sustainable Development Goals (SDGs), but negotiations in Vienna carry on as if they are negotiating another CND resolution. Submissions from other member states, UN agencies and civil society calling for a recognition of the failure of repressive responses and highlighting the need to connect the drugs issue with the agreed UN priorities for the future of the planet have so far not been reflected in successive drafts of the UNGASS outcome document.  The general tone of these drafts is very much ‘business-as-usual’.

At present, few countries are willing to openly acknowledge the existence of structural deficiencies with regard to UN system-wide coherence, the institutional architecture and the legal treaty framework. No easy solutions are available for reforming the foundations of the global control system and consensus will be hard to find, but a continued denial of the reality of the on-going policy trends and the resulting tensions with the treaty system will not make them disappear. In fact, to do so will hinder the much-needed evolution of the UN drug control system and its ability to adapt to the realities of today. Towards this end, it could be helpful if the UNGASS outcome leads to the convening of an advisory group or an expert panel to think through different scenarios for the future evolution of the system, especially in the lead up to the next important moment in 2019 when member states will have to agree a new global action plan on drugs, hopefully more in line with the broader set of UN priority goals for the next decade.

Although it is clear that the so-called ‘Vienna consensus’ has been breaking apart for some time and there is a growing desire to find viable policy alternatives to repression and punishment, there are still powerful countries and entrenched bureaucracies that are staunchly opposed to any kind of reform. The divisions between member states but also between UN agencies on this issue have become too visible to ignore and the UNGASS is a perfect opportunity for an honest assessment of the performance of the international drug control system and the options for a change of course.

Given the high human cost of the damaging approaches pursued to date, many people around the world have high hopes that governments will not squander this opportunity. And yet, to what extent the UNGASS can really live up to these hopes remains to be seen. The latest dynamics in Vienna do not bode well, as bureaucratic machinations, political complacency and exclusion seem to rule the process. The lack of vision, inclusivity and commitment to finding new solutions to many of the challenges that remain must be strongly condemned, especially given the urgency expressed by those countries that called for this moment in the first place.

This article was written by Ann Fordham of the International Drug Policy Consortium and Martin Jelsma of the Transnational Institute. It is published as part of an editorial partnership between openDemocracy and CELS, an Argentine human rights organisation with a broad agenda that includes advocating for drug policies respectful of human rights. The partnership coincides with the United Nations General Assembly Special Session (UNGASS) on drugs.

Chronicle AM: DC Council See-Saws on Pot Clubs, Fed Judge Throws Out Pot Credit Union Lawsuit, More (1/6/16)

Marijuana business access to banking services takes a hit from a federal judge, DC marijuana social clubs take a hit from the city council, Vermont legalization prospects get downplayed, pain patients are in the cross-hairs, and more.

Mexico City Mayor Miguel Angel Mancera says legalize it. (wikipedia.org)
Marijuana Policy

Federal Judge Throws Out Marijuana Credit Union Lawsuit. US District Court Judge R. Brooke Johnson today dismissed a lawsuit seeking approval from the Federal Reserve branch in Kansas City for the first credit union for pot businesses in the state. Jackson said he was compelled to dismiss the suit because marijuana remains illegal under federal law.

DC City Council Approves, Then Bans Marijuana Social Clubs. In a topsy-turvy day, the council first voted 7-6 to let an emergency ban on pot social clubs expire, but moments later, two council members switched positions, and the ban was extended a a 9-4 vote. The ban remains in effect for 90 days, and activists will continue to agitate for it to be allowed to expire.

Vermont Legislative Leaders Pour Cold Water on Legalization Prospects This Year. As the legislative session opens, House Speaker Shap Smith (D) said that there are still too many unanswered questions about how legalization would work and that he doesn't think it is ready for a full debate at this time. Minority Leader Sen. Joe Benning (R) said he, too, had similar questions and that the effort was "not quite ready for prime time." Both Smith and Benning said they generally support legalization.

Medical Marijuana

Georgia Medical Marijuana Cultivation Bill Filed. State Rep. Allen Peake (R-Macon) has filed House Bill 722 (not yet available on the legislative website), which would allow the state to issue up to six licenses for medical marijuana growers. The legislature last year passed a bill allowing for the use of high-CBD marijuana, but included no provisions for growing it in the state.

New Psychoactive Substances

Florida Grand Jury Calls for Statewide Bans on Broad Classes of NPSs. Empaneled to confront the use of "flakka," a synthetic cathinone called alpha-PDP, a Broward County grand jury has issued a report calling for a state law that would ban entire classes of new psychoactive substances, such as synthetic cathinones, rather than limited bans on specified chemical compounds. The report calls for passage of the 2016 Florida Designer Drugs Enforcement Act proposed Monday by Attorney General Pam Bondi (R). Flakka has been linked to some 60 deaths in the state over the past four years.

Pain Treatment

CDC Proposed Opiate Prescribing Guidelines for Chronic Pain Include Provisions for Drug Testing All Pain Patients -- Still Time to Comment. The Centers for Disease Control (CDC) Guideline for Prescribing Opioids for Chronic Pain includes provisions for requiring drug testing of all pain patients -- including those with cancer or terminal illnesses. Comment on the proposed guidelines here. Comments are open until January 13.

International

Mexico City Mayor Supports Marijuana Legalization, Says Would Hurt Cartels. Mayor Miguel Angel Mancera said last week that marijuana legalization is an issue of personal freedom and that it would hurt illegal drug trafficking organizations. "My position is always in defense of freedom," he told El Universal. "I do support legalization." Legalizing marijuana would not be attractive for drug cartels, he added, saying "it would be a blow to them." Mancera's comments come as the country prepares for a national debate on legalization later this month.

Chronicle AM: UN Decriminalization Drama, Global Undertreatment of Pain Report, More (10/19/15)

A thousand march for marijuana in Dallas, a few dozen in Montgomery; a UNODC document calling for drug decriminalization gets leaked, then yanked; the Global Commission on Drug Policy issues a report on pain, and more.

A Halloween/Reefer Madness-themed billboard rolled out today by Arizona legalization activists.
Marijuana Policy

Dallas March for Marijuana Brings Nearly a Thousand to the Streets. Around a thousand people joined a march calling for marijuana law reform in Texas Saturday. The march was organized by Dallas-Fort Worth NORML. Click on the link for more.

Dozens Turn Out for Alabama Rally for Marijuana Law Reforms. Several dozen people took to the foot of the state capitol last Friday to call for marijuana decriminalization and access to medical marijuana. Efforts to pass a medical marijuana bill have stalled in the legislature.

Medical Marijuana

Seneca Nation Moving Toward Medical Marijuana. The Seneca Nation of Indians is preparing to vote early next month on whether to authorize the National Council to start drafting laws and regulations to govern medical marijuana. The vote would be only a first step toward the tribe getting in the medical marijuana business. The Justice Department opened the door for tribes to get involved in pot operations with a memo last fall.

Kansas Silver Haired Legislature to Renew Push for Medical Marijuana. The Silver Haired Legislature, which advocates for senior citizens, is again calling on the legislature to pass medical marijuana. At a meeting earlier this month in Topeka, the group adopted three proposed bills it will push to see passed in the next term. Click on the link for more details.

International

UN Bid to Urge Drug Decriminalization Foiled. The UN Office on Drugs and Crime (UNODC) has withdrawn a document calling on governments to consider "decriminalizing drug use and possession for personal consumption" after at least one country objected. The document was leaked by Sir Richard Branson over the weekend, and when a journalist violated the UNODC's embargo on release of the document, UNODC walked back the report.

Global Commission on Drug Policy Releases Report on Undertreatment of Pain. The Global Commission on Drug Policy (GCDP) today released its third thematic report, The Global Crisis of Avoidable Pain: The Negative Impact of Drug Control on Public Health. The report was launched by Commissioners, former Swiss President Ruth Dreifuss, UN Secretary General Special Envoy on HIV/AIDS in Eastern Europe and Central Asia, Michel Kazatchkine and former United Nations Special Rapporteur on the right to health, Anand Grover. The report finds that three-quarters of the world's population has no access to pain-relieving drugs and that "the reasons for this have little to do with issues of cost or scarcity of supplies- and everything to do with the prohibition and repressive stand the world has taken on drugs. States are obsessed by the fear that people will use controlled medicines, such as morphine as drugs, thereby neglecting the important medical uses." Click on the title link to read the report.

WOLA Discussion on Impact of Drug Policy on Human Rights in the Americas Wednesday. The Washington Office on Latin America (WOLA) is hosting the discussion in Washington, DC, at lunch time Wednesday. Click on the link for speakers, more information, and to RSVP.

State Department Cuts Some Mexico Drug War Funding Over Human Rights Concerns. The State Department has concluded that Mexico failed to reach some human rights goals in its drug war, triggering the cutoff of millions of dollars of drug war assistance. The move only affects a small portion of overall US drug war aid to Mexico, but does signal growing frustration with alleged abuses by Mexican security forces. Some 15% of aid provided to Mexican security forces is subject to human rights provisions, meaning that Mexico lost $5 million of a total of $148 million in US drug war funding this year. That $5 million was instead diverted to Peru to help finance coca eradication.

Mexico Supreme Court to Take Up Marijuana Legalization Next Week. The high court is set to discuss a legal challenge that could effectively legalize the use and production of marijuana. The challenge comes from a non-profit that filed an injunction against the Mexican health regulatory body COFEPRIS over a 2013 ruling by that body. The hearing is set for October 28.

Norway's Two Largest Cities to Move Toward Giving Free Heroin to Addicts. The cities of Oslo and Bergen are set to begin heroin-assisted treatment pilot programs after the Labor Party won local elections there, but they will have to win approval from the national parliament first. Parliament rejected a 2012 effort to start the programs. Norway has the world's second highest drug overdose rate, after Estonia.

Chronicle AM: MI Forfeiture Reforms Head to Governor, OH Sues Over Toledo Decrim, More (10/7/15)

Toledo's decriminalization is challenged, Florida officials face heat for delays in implementing the state's CBD medical marijuana law, an Illinois panel approves medical marijuana for pain conditions (but will the governor go for it?), and more.

Ohio's attorney general worries that decriminalization could make Toledo a cartel hot-spot.
Marijuana Policy

Ohio Sues Toledo Over Municipal Decriminalization Ordinance. State Attorney General Mike DeWine, joined by the Lucas County prosecutor and sheriff, have sued the city of Toledo in a bid to overturn its decriminalization ordinance. Toledo voters approved the ordinance last month, becoming the first in the state to enact municipal decriminalization. The lawsuit objects to provisions in the ordinance barring police from reporting marijuana crimes to other agencies, making pot trafficking a "negligible" offense, and decriminalizing the possession of small amounts of other drugs. Toledo could become a cartel capital because of the ordinance, DeWine warned: "Absent legal action, it's not hard to imagine international drug rings making Toledo their regional base for operations," he said.

Medical Marijuana

Florida Lawmakers Grumble Over Slow Pace of CBD Medical Marijuana Implementation. At a hearing in Tallahassee Tuesday, lawmakers grilled Health Department representatives over delays in the program. "I mean, it's been almost two years since this bill was passed," said Rep. Greg Stube (R-Sarasota). "And we still don't have any restitution for these children that are trying to get this drug that the legislature recognizes is something needed for the state of Florida," he complained. The department said it was "mindful" of the need to make progress, but still couldn't say when five initial cultivation licenses would actually be issued.

Illinois Panel Approves Medical Marijuana for Chronic and Other Pain. The state's Medical Cannabis Advisory Board voted Wednesday to approve chronic pain, intractable pain, and chronic post-operative pain. The additions must also be approved by Gov. Bruce Rauner (R), who earlier rejected 11 other suggestions for expanding the list of qualifying conditions. The board is also pondering whether to add autism, irritable bowel syndrome, osteoarthritis, and PTSD.

Asset Forfeiture

Michigan Legislature Passes Asset Forfeiture Reform Package. The state Senate Wednesday gave final approval to a seven-bill package that will increase civil asset forfeiture reporting requirements and increase the burden of proof for seizures from "a preponderance" of the evidence to "clear and convincing" evidence the seized items were connected to a crime. The package has already passed the House. Some groups, including the Mackinac Center for Public Policy and the Michigan ACLU, want to see even deeper reforms, including eliminating civil asset forfeiture entirely and requiring a conviction before property can be seized in a criminal proceeding. But this is a start.

Sentencing

Massachusetts Bill Would Block Sending Women to Prison for Drug Treatment. An amendment to a supplemental spending bill would prohibit women from being civilly committed to the Framingham state prison for drug treatment. The bill and its amendments are to be debated tomorrow. It's a move that was recommended by Gov. Charlie Baker's (R) task force on opioid abuse. Baker is looking for $5.8 million in the supplemental budget to pay for women in the prison for drug treatment to be moved to a hospital, most likely Taunton State Hospital.

Chronicle AM: MA Inits Filed, Pill Crackdown Hurts Patients, Yemen War Snarls Drug Trade, More (8/05/15)

Competing legalization initiatives get filed in Massachusetts, pain patients face obstacles amidst the pill mill crackdown, the Yemen war is messing up the peninsular drug trade, and more.

Bags of the popular Middle Eastern amphetamine Captagon seized by Saudi officials. (moj.gov.sa)
Marijuana Policy

Two Competing Groups Filed Massachusetts Legalization Initiatives. Both the Marijuana Policy Project-backed Campaign to Regulate Marijuana Like Alcohol in Massachusetts and the local group Bay State Repeal today filed initiatives to legalize marijuana in the state. Bay State Repeal actually filed three versions of its initiative. Click on the organization link to get details on the various proposals.

Medical Marijuana

Leaked Document Shows DOJ Misled Congress on Impact of Medical Marijuana Amendment. In the days before Congress voted to approve an amendment limiting the Justice Department's ability to interfere in medical marijuana states, an internal memo obtained by Tom Angell at Marijuana.com shows that the department tried to mislead Congress by falsely claiming that the amendment could "in effect, limit or possibly eliminate the Department's ability to enforce federal law in recreational marijuana cases as well," according to the document. [Emphasis added.] The memo admits that the DOJ talking points were "intended to discourage passage of the rider," but "do not reflect our current thinking." Click on the link for more.

Under-treatment of Pain

Pill Mill Crackdown Hurting Pain Patients. New Hampshire Public Radio has done a lengthy report on the impact of the pain pill crackdown on pain patients. One patient who moved to Florida reports that his pharmacy runs out of pain medications, and the pharmacy owner reported that pharmaceutical wholesalers will no longer distribute the amount of drugs he needs to serve his clients. There's much more there, too; click the link to read the whole thing.

International

Yemen War Messing Up Arabian Peninsula Drug Traffic. Saudi Arabia's four-month bombing campaign against Houthi rebels is not only killing hundreds, perhaps thousands, of Yemenis, it's also choking off the supply of Middle Eastern amphetamines and hashish that have been being trafficked across the Yemen-Saudi border. Saudi border guards say the war has shut down trafficking, while Riyadh residents complain that supplies are drying up. The article also provides an overview of drug use in the region; click on the link to get it all.

Release: Major Groups Call for UN to Respect Countries That Legalize Marijuana or Other Drugs (5/5/15)

FOR IMMEDIATE RELEASE: May 5, 2015

CONTACT: David Borden, borden@drcnet.org

Major Groups Call for UN to Respect Countries That Legalize Marijuana or Other Drugs

Human Rights Should Take Priority Over Drug Enforcement, New Letter Says

NEW YORK, NY – As the United Nations prepares for the first comprehensive review of global responses to drug problems in nearly two decades, a broad coalition of more than 100 organizations is pushing for the international body to respect countries that move away from prohibition.

"Existing US and global drug control policies that heavily emphasize criminalization of drug use, possession, production and distribution are inconsistent with international human rights standards and have contributed to serious human rights violations," the groups write in a new letter being released today.

Groups including the American Civil Liberties Union, Human Rights Watch, Global Exchange, Drug Policy Alliance and the Ella Baker Center for Human Rights are among the signatories. Also notable are a number of organizations devoted to health policy and AIDS services.

The letter's release is timed to a United Nations "High-Level Thematic Debate on the World Drug Problem" taking place in New York on Thursday, May 7, in preparation for a UN General Assembly Special Session on Drugs (UNGASS) scheduled for April 2016. Advocates believe that countries should take the UNGASS as an opportunity to pursue a range of reforms to global drug policy, including revising provisions of the UN Drug Conventions that threaten to stand in the way of reform. The Obama administration has taken the stance that countries should be free to pursue different kinds of systems under the treaties – including legalization – but has also opposed treaty reform, a stance which advocates have questioned.

"The administration's call to respect countries' right to try regulation rather than prohibition is a positive step for drug policy, as are other reforms the US has sought internationally," said David Borden, executive director of StoptheDrugWar.org, who coordinated the sign-on letter. "But it doesn't make sense to oppose having a discussion within the UN about modernizing the treaties to reflect that."

The coalition has called for the UN to appoint a "Committee of Experts" to study treaty reform, a common UN procedure for addressing issues of interest.

To date, four US states and the District of Columbia have legalized cannabis, as has the nation of Uruguay. Many other countries have decriminalized possession of certain drugs or have implemented harm reduction measures like syringe exchange programs. While the UN's drug enforcement body has warned that some of these policies may violate the treaties, the push for reform doesn't appear to be slowing anytime soon.

The new letter calls for revising the treaties, and says that in the meanwhile "in case of irreconcilable conflict, human rights principles, which lie at the core of the United Nations charter, should take priority over provisions of the drug conventions."  Human rights concerns may require shifting to drug control systems that aren't based on prohibition, the statement suggests. "Accommodating… experiments… with legalization and regulation of internationally controlled substances may require that the UN drug conventions are interpreted in light of countries' international human rights and other obligations."

Although marijuana legalization is a major factor driving the international drug debate, another is the impact the illicit drug trade has in Latin America, where violence and related criminal problems associated with the trade exceed that suffered in other regions.

John Walsh, senior associate at the Washington Office on Latin America (WOLA), said, "Some Latin American leaders are now openly questioning the global drug prohibition regime, because of the destruction caused by criminal organizations fueled by enormous drug trade profits. Meanwhile, the US is undergoing important shifts in its own domestic policy, with the Obama administration wisely accommodating states that are legalizing and regulating cannabis. This expands the political space for other countries as well." Walsh is the coauthor of "Marijuana Legalization is an Opportunity to Modernize International Drug Treaties," co-published by WOLA and The Brookings Institution.

Advocates also warn that flexibility, as called for by the State Department, shouldn't be used to justify human rights violations in any country, such as the death penalty for nonviolent offenses or the banning of life-saving public health interventions like syringe exchange or opioid substitution therapy. "Prohibition has been a public health and human rights disaster," said Charles King, CEO of the US's largest community-based AIDS service organization, Housing Works. "That's why citizens around the world are calling for – and in some cases enacting – forward-thinking reforms that move away from criminalization and toward regulation and control. US and UN agencies should stop trying to cut off the treaty reform discussion and encourage a truly open debate instead."

The full text of the letter and list of signatories are online at http://stopthedrugwar.org/un.

StoptheDrugWar.org works for an end to drug prohibition worldwide, and an end to the "drug war" in its current form. We believe that much of the harm commonly attributed to "drugs" is really the result of placing drugs in a criminal environment. We believe the global drug war has fueled violence, civil instability and public health crises; and that the currently prevalent arrest- and punishment-based policies toward drugs are unjust.

# # #

Chronicle AM: NV Pot Init Will Go to Voters Next Year, Dark Web Drug Bust, Saudis Behead Three, More (3/13/15)

Nevada is the first state in line to legalize it in 2016 after the legislature failed to act this week, a controversial Ohio legalization initiative wins a preliminary approval to move forward, there was a major dark web drug bust in Germany this week, and more.

thousands of ecstasy pills seized by German police in bust of one vendor on one dark web drug sales site
Marijuana

DC Cannabis Campaign to Host Pot Seed Exchange. The folks behind the Measure 71 marijuana possession and cultivation legalization initiative will be hosting two seed exchanges this month. "This will be DC residents' opportunity to share seeds with other adults and start down the path of legally growing your own cannabis in the safety and privacy of your home," the campaign announced Thursday.

Nevada Will Vote on Marijuana Legalization Next Year. After the state legislature failed to act by a deadline today, marijuana legalization is headed to the ballot next year. Initiative organizers have already taken all the necessary steps for the vote to take place. The legislature could have approved the initiative itself, but instead punted. Read the initiative here.

Ohio Attorney General Approves Petition Summary for Responsible Ohio Legalization Initiative. The attorney general's approval means ResponsibleOhio now goes to the Ohio Ballot Board for its approval. Their meeting will take place in about 10 days. Read the ResponsibleOhio initiative here. If the Ballot Board approves, ResponsibleOhio must then gather 305,591 valid signatures of registered Ohio voters from at least 44 of 88 counties to get the measure on the fall ballot.

Medical Marijuana

Federal Medical Marijuana Bill Gets New GOP Cosponsor. A second Republican senator has signed on to the Compassionate Access, Research Expansion and Respect States (CARERS) Act (Senate Bill 683). Sen. Dean Heller (R-NV) joins fellow Republican Sen. Rand Paul (KY) and Democrats Cory Booker (NJ) and Kirsten Gillibrand (NY).

Georgia Senate Passes Restrictive CBD Cannabis Oil Bill. The Senate passed Senate Bill 185, which would allow parents bringing CBD cannabis oil into the state to treat their children with epilepsy to be exempted from criminal prosecution, but would not allow medical marijuana in any other form and would not let adults or children with other diseases use it. The House has passed a broader CBD bill; the Senate Health Committee chair has promised it will try to reconcile the two bills.

International

China Withdraws UN Motion to Make Ketamine a Controlled Substance. After lobbying from Canadian researchers and others who said ketamine is a crucial anesthetic for poorer countries, China today withdrew its motion before the UN Committee on Narcotic Drugs to schedule the drug. The Chinese said they would defer their resolution for another year so ketamine can be studied more.

Germans in Major Dark Web Drug Bust. Police in Leipzig announced yesterday that they had raided 38 locations and arrested seven people, as well as seizing more than 700 pounds of cocaine, ecstasy, LSD, amphetamines, marijuana, and hash. The bust was of only one seller on the dark website Evolution, but the Deep Dot Web blog, which closely tracks the online narcotics trade, calls the law enforcement operation the biggest Dark Web drug bust ever. Still, the vendor busted represented only a fraction of the 20,000 drug listings on Evolution, and that's just one dark web drug sales site.

Saudi Arabia Beheads Three For Drug Smuggling. A Yemeni, a Syrian, and a Saudi national were executed in the kingdom this week for smuggling amphetamines and hashish into the country. That makes about 20 drug executions so far this year in the county, about half of the 43 executions reported so far.

Chronicle AM: CO Pot Law Challenged Again, RI Legalization Bill Filed, Global Pain Med Crisis, More (2/5/15)

Sheriffs from three states are suing Colorado over its pot law, legalization bills get filed in Rhode Island, new research scoffs at links between psychedelics and psychosis, heroin OD deaths are up, there's a big problem with global access to opioid pain medications, and more. 

No link between psychedelics and psychosis, researchers say. (Jelly Fish Times/Tumblr.com)
Marijuana Policy

Sheriffs From Three States Sue Colorado Over Legalization. Sheriffs from Colorado, Kansas, and Nebraska are the latest bunch to try to overturn the will of Colorado voters via a federal lawsuit. A lawsuit filed in federal court in Denver today asks the court to strike down Amendment 64, which legalized marijuana, and to order the closure of the state's more than 330 pot shops. The sheriffs claim Colorado's legalization creates "a crisis of conscience" for them and forces them to violate their oath to uphold the US Constitution.

Rhode Island Legalization Bills Filed. Senate Health and Human Services Committee Chairman Joshua Miller (D-Cranston) and House Finance Committee member Scott A. Slater (D-Providence) have introduced legislation to make marijuana legal for adults 21 and older and to establish a system in which marijuana is regulated and taxed similarly to alcohol. The bills are House Bill 5777 and Senate Bill 510. The state has been tagged as one of the more likely ones to legalize it through the legislature. 

Medical Marijuana

Idaho CBD Cannabis Oil Bill on Hold. A bill that would allow access to CBD cannabis oil to treat epilepsy seizure disorders is alive, but on hold after the Senate State Affairs Committee decided it needed to be amended to address law enforcement concerns. The bill is Senate Bill 1106. Supporters are supposed to come up with amendments to address those concerns by next week.

North Carolina Medical Marijuana Bill Moves. A bill that would allow for medical marijuana in the Tarheel State has passed its first reading in the House. The bill is House Bill 78

Psychedelics

Researchers find No Link Between Psychedelics and Psychosis. Users of LSD and other psychedelics are no more likely to have mental health conditions than those who don’t, according to data from population surveys. The researchers said anecdotes about "acid casualties" dating back to the 1960s were precisely that—anecdotes. "We are not claiming that no individuals have ever been harmed by psychedelics," says the author of one of the two studies cited, Matthew Johnson, an associate professor in the Behavioral Pharmacology Research Unit at Johns Hopkins University in Baltimore, Maryland. "Anecdotes about acid casualties can be very powerful — but these instances are rare," he says. At the population level, he says, the data suggest that the harms of psychedelics "have been overstated."

Heroin

Rate of Heroin Overdose Tripled Between 2010 and 2013, CDC Says. More than 8,200 Americans died of heroin overdoses in 2013, according to a new report from the Centers for Disease Control (CDC). That's an average of 23 people a day. The rate of heroin overdose deaths nearly tripled, from just under one per hundred thousand to just under three per hundred thousand. Who is dying has also changed. In 2000, the highest overdose rates were among middle-aged black, but by 2013, whites between 18 and 44 had the highest rates.

Drug Testing

Florida Governor Gives Up the Ghost on Welfare Drug Testing. This week was the deadline for Gov. Rick Scott (R) to ask the Supreme Court to overturn lower court rulings that found his suspicionless welfare drug testing law unconstitutional. He didn't act. "We chose not to appeal this case," a spokesman said.

International

INCB Report Says 75% of World Population Still Doesn't Have Access to Pain Relief Meds. In its annual report released this week, the International Narcotics Control Board (INCB) said about 5.5 billion people on the planet are in danger of suffering pain if they become chronically or terminally ill because they don't have access to opioid pain relief medications. Click on the link for more and to read the INCB report.

New Uruguay President Postpones Allowing Pharmacy Pot Sales. New President Tabare Vasquez, who took office Sunday, has decided to postpone implementing public sales of marijuana. His chief drug regulator, Milton Romani, said yesterday he was in "no rush" to start pharmacy sales. "I want this project to be successful," he said. "If we make a mistake by rushing, we fail." For those really interested in getting their weed right now, there are now 15 cannabis clubs in operation and more than 2,000 grows.

Hispanic American Historical Review Has Special Issue on Drugs in Latin America. Lots of good stuff in there for those with an interest in the topic. Here's the table of contents for the issue. 

Drug War Issues

Criminal JusticeAsset Forfeiture, Collateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Court Rulings, Drug Courts, Due Process, Felony Disenfranchisement, Incarceration, Policing (2011 Drug War Killings, 2012 Drug War Killings, 2013 Drug War Killings, 2014 Drug War Killings, 2015 Drug War Killings, 2016 Drug War Killings, Arrests, Eradication, Informants, Interdiction, Lowest Priority Policies, Police Corruption, Police Raids, Profiling, Search and Seizure, SWAT/Paramilitarization, Task Forces, Undercover Work), Probation or Parole, Prosecution, Reentry/Rehabilitation, Sentencing (Alternatives to Incarceration, Clemency and Pardon, Crack/Powder Cocaine Disparity, Death Penalty, Decriminalization, Defelonization, Drug Free Zones, Mandatory Minimums, Rockefeller Drug Laws, Sentencing Guidelines)CultureArt, Celebrities, Counter-Culture, Music, Poetry/Literature, Television, TheaterDrug UseParaphernalia, ViolenceIntersecting IssuesCollateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Violence, Border, Budgets/Taxes/Economics, Business, Civil Rights, Driving, Economics, Education (College Aid), Employment, Environment, Families, Free Speech, Gun Policy, Human Rights, Immigration, Militarization, Money Laundering, Pregnancy, Privacy (Search and Seizure, Drug Testing), Race, Religion, Science, Sports, Women's IssuesMarijuana PolicyGateway Theory, Hemp, Marijuana -- Personal Use, Marijuana Industry, Medical MarijuanaMedicineMedical Marijuana, Science of Drugs, Under-treatment of PainPublic HealthAddiction, Addiction Treatment (Science of Drugs), Drug Education, Drug Prevention, Drug-Related AIDS/HIV or Hepatitis C, Harm Reduction (Methadone & Other Opiate Maintenance, Needle Exchange, Overdose Prevention, Safe Injection Sites)Source and Transit CountriesAndean Drug War, Coca, Hashish, Mexican Drug War, Opium ProductionSpecific DrugsAlcohol, Ayahuasca, Cocaine (Crack Cocaine), Ecstasy, Heroin, Ibogaine, ketamine, Khat, Kratom, Marijuana (Gateway Theory, Marijuana -- Personal Use, Medical Marijuana, Hashish), Methamphetamine, New Synthetic Drugs (Synthetic Cannabinoids, Synthetic Stimulants), Nicotine, Prescription Opiates (Fentanyl, Oxycontin), Psychedelics (LSD, Mescaline, Peyote, Salvia Divinorum)YouthGrade School, Post-Secondary School, Raves, Secondary School