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America, We Can Fix This: 24 Ways to Reduce Opioid Overdoses and Addiction [FEATURE]

Drugs, mainly opioids, are killing Americans at a record rate. The number of drug overdose deaths in the country quadrupled between 1999 and 2010 -- and compared to the numbers we're seeing now, those were the good old days.

Some 30,000 people died of drug overdoses in 2010. According to a new estimate from the New York Times, double that number died last year. And the rate of increase in overdose deaths was growing, up a stunning 19% over 2015.

The Times' estimate of between 59,000 and 65,000 drug overdose deaths last year is greater than the number of American soldiers killed during the entire Vietnam War, greater than that number of people killed in the peak year for car crash deaths, greater than the number of people who died in the year the AIDS epidemic peaked, and higher than the peak year for gun deaths.

In the first decade of the century, overdoses and addiction rose in conjunction with a dramatic increase in prescription opioid prescribing; since then, as government agents and medical professionals alike sought to tamp down prescribing of opioids, the overdose wave has continued, now with most opioid OD fatalities linked to illicit heroin and powerful black market synthetic opioids, such as fentanyl and carfentanil.

The Centers for Disease Control and Prevention says we are in the midst of "the worst drug overdose epidemic in history," and it's hard to argue with that.

So, what do we do about it? Despite decades of failure and unintended consequences, the prohibitionist reflex is still strong. Calls for more punitive laws, tougher prosecutorial stances, and harsher sentences ring out from state houses across the land to the White House. But tough drug war policies haven't worked. The fact that the overdose and addiction epidemic is taking place under a prohibition regime should make that self-evident.

More enlightened -- and effective -- approaches are now being tried, in part, no doubt, because today's opioid epidemic is disproportionately affecting white, middle class people and not the inner city black people identified with heroin epidemics of the past. But they are also being tried because for the past quarter-century an ever-growing drug reform movement has articulated the failures of prohibition and illuminated more effective alternatives.

The drug reform movement's most powerful organization, the Drug Policy Alliance, this spring published A Public Health and Safety Approach to Problematic Opioid Use and Overdose, which lays out more than two dozen specific policy prescriptions in the realms of addiction treatment, harm reduction, prevention, and criminal justice that have been proven to save lives and reduce dependency on opioids. These policy prescriptions are doable now -- and some are being implemented in some fashion in some places -- but require that political decisions be made, or that forces be mobilized to get those decisions made. Some would require a radical divergence from the orthodoxies of drug prohibition, but that's a small price to pay given the mounting death toll.

Here are 24 concrete policy proposals that can save lives and reduce addiction right now. All the facts and figures are fully documented in the heavily-annotated original. Consult it if you want to get down to the nitty-gritty. In the meantime:

Addiction Treatment

1. Create Expert Panel on Treatment Needs: States should establish an expert panel to address effective treatment needs and opportunities. The expert panel should evaluate barriers to existing treatment options and make recommendations to the state legislature on removing unnecessary impediments to accessing effective treatment on demand. Moreover, the panel should determine where gaps in treatment exist and make recommendations to provide additional types of effective treatment and increased access points to treatment (such as hospital-based on demand addiction treatment). The expert panel must also set evidence-based standards of care and identify the essential components of effective treatment and recovery services to be included in licensed facilities, especially with regards to medication-assisted treatment, admission requirements, discharge, continuity of care and/or after-care, pain management, treatment programming, integration of medical and mental health services, and provision of or referrals to harm reduction services. The expert panel should identify how to improve or create referral mechanisms and treatment linkages across various healthcare and other providers. The panel should establish clear outcome measures and a system for evaluating how well providers meet the scientific requirements the panel sets. And, finally, the expert panel should evaluate opportunities under the ACA to expand coverage for treatment.

2. Increase Insurance Coverage for Medication-Assited Treatment (MAT): Seventeen state medical plans under the Patient Protection and Affordable Care Act (ACA) do not provide coverage for methadone or buprenorphine for opioid dependence. Moreover, the Veterans Administration's (VA's) insurance system has explicitly prohibited coverage of methadone and buprenorphine treatment for active duty personnel or for veterans in the process of transitioning from Department of Defense care. As a result, veterans obtaining care through the VA are denied effective treatment for opioid dependence. Insurance coverage for these critical medications should be standard practice.

3. Establish and Implement Office-Based Opioid Treatment for Methadone: Currently, with a few exceptions, methadone for the treatment of opioid dependence is only available through a highly regulated and widely stigmatized system of Opioid Treatment Programs (OTPs). Moreover, several states have imposed moratoriums on establishing new OTPs that facilitate methadone treatment despite large, unmet treatment needs for a growing opioid-dependent population. Patients enrolled in methadone treatment in many communities are often limited to visiting a single OTP and face other inconveniences that make adherence to treatment more difficult. Initial trials have suggested that methadone can be effectively delivered in office-based settings and that, with training, physicians would be willing to prescribe methadone to their patients to treat their opioid dependence. Office-based methadone may help reduce the stigma associated with methadone delivered in OTPs as well as provide a critical window of intervention to address medical and psychiatric conditions. Office-based opioid treatment programs offering methadone have been implemented in California, Connecticut, and Vermont.

4. Provide MAT in Criminal Justice Settings, Including Jails/Prisons and Drug Courts: Individuals recently released from correctional settings are up to 130 times more likely to die of an overdose than the general population, particularly in the immediate two weeks after release. Given that approximately one quarter of people incarcerated in jails and prisons are opioid-dependent, initiating MAT behind bars should be a widespread, standard practice as a part of a comprehensive plan to reduce risk of opioid fatality. Jails should be mandated to continue MAT for those who received it in the community and to assess and initiate new patients in treatment. Prisons should initiate methadone or buprenorphine prior to release, with a referral to a community-based clinic or provider upon release. In addition, drug courts should be mandated to offer participants the option to participate in MAT if they are not already enrolled, make arrangements for their treatment, and should not be permitted to make discontinuation of MAT a criterion for successful completion of drug court programs. The Substance Abuse and Mental Health Services Administration will no longer provide federal funding to drug courts that deny the use of MAT when made available to the client under the care of a physician and pursuant to a valid prescription. The National Association of Drug Court Professionals agrees: "No drug court should prohibit the use of MAT for participants deemed appropriate and in need of an addiction medication."

Medication-Assisted Treatment (MAT) can help.
5. Offer Hospital-Based MAT: Emergency departments should be mandated to inform patients about MAT and offer buprenorphine to those patients that visit emergency rooms and have an underlying opioid use disorder, with an appointment for continued treatment with physicians in the community. Hospitals should also offer MAT within the inpatient setting, and start MAT prior to discharge with community referrals for ongoing MAT.

6. Assess Barriers to Accessing MAT to Increase Access to Methadone and Buprenorphine: A number of known barriers prevent MAT from being as widely accessible as it should be. The federal government needs to reevaluate the need for and effectiveness of the OTP model and make necessary modifications to ensure improved and increased access to methadone. And, while federal law allows physicians to become eligible to prescribe buprenorphine for the treatment of opioid dependence, it arbitrarily caps the number of opioid patients a physician can treat with buprenorphine at any one time to 30 through the first year following certification, expandable to up to potentially 200 patients thereafter. Moreover, states need to evaluate additional barriers created by state law, including, among others, training and continuing education requirements, restrictions on nurse practitioners, insurance enrollment and reimbursement, and lack of provider incentives.

7. Establish and Implement a Heroin-Assisted Treatment Pilot Program: Heroin-assisted treatment (HAT) refers to the administering or dispensing of pharmaceutical-grade heroin to a small and previously unresponsive group of chronic heroin users under the supervision of a doctor in a specialized clinic. The heroin is required to be consumed on-site, under the watchful eye of trained professionals. This enables providers to ensure that the drug is not diverted, and allows staff to intervene in the event of overdose or other adverse reaction. Permanent HAT programs have been established in the United Kingdom, Switzerland, the Netherlands, Germany and Denmark, with additional trial programs having been completed or currently taking place in Spain, Belgium and Canada. Findings from randomized controlled studies in these countries have yielded unanimously positive results, including: 1) HAT reduces drug use; 2) retention rates in HAT surpass those of conventional treatment; 3) HAT can be a stepping stone to other treatments and even abstinence; 4) HAT improves health, social functioning, and quality of life; 5) HAT does not pose nuisance or other neighborhood concerns; 6) HAT reduces crime; 7) HAT can reduce the black market for heroin; and, 8) HAT is cost-effective (cost-savings from the benefits attributable to the program far outweigh the cost of program operation over the long-run). States should consider permitting the establishment and implementation of a HAT pilot program. Nevada and Maryland have introduced legislation of this nature and the New Mexico Legislature recently convened a joint committee hearing to query experts about this strategy.

8. Evaluate the Use of Cannabis to Decrease Reliance on Prescription Opioids and Reduce Opioid Overdose Deaths: Medical use of marijuana can be an effective adjunct to or substitute for opioids in the treatment of chronic pain. Research published last year found 80 percent of medical cannabis users reported substituting cannabis for prescribed medications, particularly among patients with pain-related conditions. Another important recent study reported that cannabis treatment "may allow for opioid treatment at lower doses with fewer [patient] side effects." The result of substituting marijuana, a drug with less side effects and potential for abuse, has had profound harm reduction impacts. The Journal of the American Medical Association, for instance, documents a relationship between medical marijuana laws and a significant reduction in opioid overdose fatalities: "[s]tates with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws."Another working paper from the RAND BING Center for Health Economics notes that "states permitting medical cannabis dispensaries experienced a 15 to 35 percent decrease in substance abuse admissions and opiate overdose deaths." There is also some emerging evidence that marijuana has the potential to treat opioid addiction, but additional research is needed.

Harm Reduction

9. Establish and Implement Safe Drug Consumption Services: States and/or municipalities should permit the establishment and implementation of safe drug consumption services through local health departments and/or community-based organizations. California and Maryland have introduced legislation to establish safe drug consumption services, and the City of Ithaca, New York has included a proposal for a supervised injection site in their widely-publicized municipal drug strategy. In Washington State, the King County Heroin an Prescription Opiate Addiction Task Force has recommended the establishment of at least two pilot supervised consumption sites as part of a community health engagement program designed to reduce stigma and "decrease risks associated with substance use disorder and promote improved health outcomes" in the region that includes the cities of Seattle, Renton and Auburn.

10. Maximize Naloxone Access Points, Including Lay Distribution and Pharmacy Access, As Well As Immunities for Prescription, Distribution and Administration:Naloxone should be available directly from a physician to either a patient or to a family member, friend, or other person in a position to assist in an overdose, from community-based organizations through lay distribution or standing order laws, and from pharmacies behind-the-counter without a prescription through standing order, collaborative agreement, or standardized protocol laws or regulations. Though some states, including California, New York, Colorado and Vermont, among others, have access to naloxone at each of these critical intervention points, many others only provide naloxone through a standard prescription. Civil and criminal immunities should be provided to prescribers, dispensers and lay administrators at every access point. In addition, all first responders, firefighters and law enforcement should be trained on how to recognize an overdose and be permitted to carry and use naloxone. Naloxone should also be reclassified as an over-the-counter (OTC) medication. Having naloxone available over-the-counter would greatly increase the ability of parents, caregivers, and other bystanders to intervene and provide first aid to a person experiencing an opioid overdose. FDA approval of OTC naloxone is predicated on research that satisfies efficacy and safety data requirements. Pharmaceutical companies, however, have not sought to develop an over-the-counter product.88 Federal funding may be needed to meet FDA approval requirements.

11. Provide Dedicated Funding for Community-Based Naloxone Distribution and Overdose Prevention and Response Education: Few states provide dedicated budget lines to support the cost of naloxone or staffing for community-based opioid overdose prevention programs. The CDC, however, reports that, between 1996 and 2014, these programs trained and equipped more than 152,280 laypeople with naloxone, who have successfully reversed 26,463 opioid overdoses.89 Without additional and dedicated funding, community-based opioid overdose prevention programs will not be able to continue to provide naloxone to all those who need it, and the likelihood of new programs being implemented is slim. A major barrier to naloxone access is its affordability and chronic shortages in market supply, 90 which overdose prevention programs, operating on shoestring budgets, can have a difficult time navigating.

12. Improve Insurance Coverage for Naloxone: Individuals who use heroin and other opioids are often both uninsured and marginalized by the healthcare system.91 States should insure optimal reimbursement rates for naloxone to increase access to those who need it most – users themselves.

Overdose reversal drugs need to be made much more widely available -- and affordable. (health.pa.gov)
13. Provide Naloxone to Additional At-Risk Communities: People exiting detox and other treatment programs as well as periods of incarceration are at particularly high risk for overdose because their tolerance has been substantially decreased. After their period of abstinence, if they relapse and use the same amount, the result is often a deadly overdose. States should require overdose education and offer naloxone to people upon discharge from detox and other drug treatment programs and jails/prisons. The Substance Abuse and Mental Health Services Administration has declared that prescribing or dispensing naloxone is an essential complement to both detoxification services as well as medically supervised withdrawal. Vermont passed legislation making naloxone available to eligible pilot project participants who are transitioning from incarceration back to the community. In addition, there are other programs/studies that provide naloxone to recently released individuals on a limited basis, including in San Francisco, California, King County, Washington and Rhode Island.

14. Encourage Distribution of Naloxone to Patients Receiving Opioids: Physicians should be encouraged to prescribe naloxone to their patients and opioid treatment programs should inform their clients about naloxone, if prescribing or dispensing an opioid to them. Pharmacists should similarly be encouraged to offer naloxone along with all Schedule II opioid prescriptions being filled, for syringe purchases (without concurrent injectable medication), and for all co-prescriptions (within 30 days) of a benzodiazepine (such as Valium™, Xanax™ or Klonopin™) and any opioid medication. The Rhode Island Governor's Overdose Prevention and Intervention Task Force found that offering naloxone to those prescribed a Schedule II opioid or when co-prescribed a benzodiazepine and any opioid would have reached 86% of overdose victims who received a prescription from a pharmacy prior to their death, and could have prevented 58% of all overdose deaths from 2014 to 2015.

15. Expand Good Samaritan Protections: "Good Samaritan" laws provide limited immunity from prosecution for specified drug law violations for people who summon help at the scene of an overdose. But, protection from prosecution is not enough to ensure that people are not too frightened to seek medical help. Other consequences, like arrest, parole or probation violations, and immigration consequences, can be equal barriers to calling 911. States with Good Samaritan laws already on the books should evaluate the protections provided and determine whether expansion of those protections would increase the likelihood that people seek medical assistance.

16. End the Criminalization of Syringe Possession: Syringes should be exempt from state paraphernalia laws in order to provide optimal access to people who inject drugs. Twenty-two states criminalize syringe possession. Thus, even if there is a legal access point, such as pharmacy sales, paraphernalia laws still permit law enforcement to arrest and prosecute individuals in possession of a syringe. Public health and law enforcement authorities should not be working at cross-purposes.

17. Reduce Barriers to Over-The-Counter Syringe Sales and Permit Direct Prescriptions of Syringes: While the non-prescription, over-the-counter sale of syringes is now permitted in all but one U.S. state, access is still unduly restricted.States should evaluate the potential barriers to accessing syringes over-thecounter and implement measures to improve access. Moreover, doctors should be permitted to prescribe syringes directly to their patients, a practice few states currently permit.

18. Authorize and Fund Sterile Syringe Access and Exchange Programs; Increase Programs: States should explicitly authorize and fund sterile syringe access and exchange programs, and states that have already authorized them should evaluate how to increase the number or capacity of programs to ensure all state residents – whether in urban centers or rural communities -- have access to clean syringes, as well as evaluate any possible barriers to access such as unnecessary age restrictions.

19. Provide Free Public, Community-Level Access to Drug Checking Services: Technology exists to test heroin and opioid products for adulterants via GC/MS analysis, but it has so far been unavailable at a public level in the US (aside from a mail-in service run by Ecstasydata.org). Making these services available in the context of a community outreach service or academic study would lower the number of deaths and hospitalizations and also allow for real-time tracking of local drug trends.

Prevention

20. Establish Expert Panel on Opioid Prescribing: Though the CDC has issued guidelines for prescribing opioids for chronic pain, the guidelines are voluntary and are likely to exacerbate disparities in treatment that already exist. Research has shown, for example, that African Americans are less likely than whites to receive opioids for pain even when being treated for the same conditions. Moreover, the CDC guidelines only address prescribing practices for chronic pain, not prescribing practices more broadly. States should accordingly establish an expert panel to undertake an assessment as to whether prescribing practices, such as co-prescriptions for benzodiazepines and opioids or overprescribing of opioids, have contributed to increased rates of opioid dependence, and, if so, the expert panel should develop a plan to address any such linkages as well as any treatment disparities. The plan must account for the potential negative effects of curtailing prescribing practices or swiftly reducing prescription opioid prescribing volume. A task force in Rhode Island found that while changes in opioid supply can have the intended effect of reducing availability of abuse-able medications, they have also been linked to an increase in transition to illicit drug use and in more risky drug use behaviors (e.g., snorting and injecting pain medications). The plan must also account for chronic pain patients, particularly those already underserviced, and not unduly limit their access to necessary medications. Finally, to the extent prescribing guidelines are issued as part of the plan, they should be mandatory and applied across the board.

21. Mandate Medical Provider Education: States should mandate that all health professional degree-granting institutions include curricula on opioid dependence, overdose prevention, medication-assisted treatment, and harm reduction interventions, and that continuing education on these topics be readily available.

22. Develop Comprehensive, Evidence-Based Health, Wellness, and Harm Reduction Curriculum for Youth: State education departments, in conjunction with an expert panel consisting of various stakeholders that ascribe to scientific principles of treatment for youth, should develop a comprehensive, evidence-based health, wellness, and harm reduction curriculum for use in schools that incorporates scientific education on drugs, continuum of use, and contributors to problematic drug use (e.g., coping and resiliency, mental health issues, adverse childhood experiences, traumatic events and crisis), as well as how reduce harm (e.g., not mixing opioids with benzodiazepines). Education departments should also establish protocols and resources for early intervention, counseling, linkage to care, harm reduction resources, and other supports for students.

CRIMINAL JUSTICE

23. Establish Diversion Programs, Including Law Enforcement Assisted Diversion (LEAD): LEAD is a pre-booking diversion program that establishes protocols by which police divert people away from the typical criminal justice route of arrest, charge and conviction into a health-based, harm-reduction focused intensive case management process wherein the individual receives support services ranging from housing and healthcare to drug treatment and mental health services. Municipalities should create and implement LEAD programs and states and the federal government should provide dedicated funding for such programs. Various other forms of diversion programs exist and can be implemented should LEAD prove unsuitable to a particular population or municipality.

24. Decriminalize Drug Possession: Decriminalization is commonly defined as the elimination of criminal penalties for drug possession for personal use. In other words, it means that people who merely use or possess small amounts of drugs are no longer arrested, jailed, prosecuted, imprisoned, put on probation or parole, or saddled with a criminal record. Nearly two dozen countries have taken steps toward decriminalization. Empirical evidence from the international experiences demonstrate that decriminalization does not result in increased use or crime, reduces incidences of HIV/AIDs and overdose, increases the number of people in treatment, and reduces social costs of drug misuse. All criminal penalties for possession of small amounts of controlled substances for personal use should be removed.

Chronicle AM: FL Solons Reach MedMJ Accord, CO Gov Signs Asset Forfeiture Bill, More... (6/12/17)

Florida lawmakers finally reach agreement on implementing the medical marijuana constitutional amendment, Colorado's governor signs an asset forfeiture reform bill, and more.

Faced with large protests, Georgia's prime minister says he will hurry up with drug reform. (IPN screengrab)
Marijuana Policy

House Effort to Help Marijuana Businesses With Banking Thwarted. Two Florida representatives, Matt Gaetz (R-Fort Walton Beach) and Darren Soto (D-Orlando), filed an amendment to the Financial CHOICE Act of 2017 that would have eased federal restrictions on banking services for marijuana businesses. The bill was approved by the House last Thursday, but not before the House Rules Committee stripped the amendment from the bill.

Colorado Governor Signs Bills Limiting Plant Counts, Caregivers. Gov. John Hickenlooper (D) last Thursday signed into law House Bill 17-1220, which limits personal cultivation to 12 plants per residence unless a local government allows more, and House Bill 17-1221, which says that only caregivers can grow plants for other people and sets up a grant program to fund police efforts to prosecute crimes related to black market weed.

Medical Marijuana

Connecticut Takes Another Step Toward Adding More Qualifying Conditions. Consumer Protection Commissioner Michelle Seagull announced last Friday that she would follow a recommendation from the Medical Marijuana Program Board of Physicians to include three new conditions among the list of qualifying conditions for medical marijuana use. They are hydrocephalus with intractable headaches, intractable migraines, and trigeminal neuralgia. Seagull will now draft a new regulation by the end of the month, and after that, there will be a 30-day public comment period, then a review by the office of the attorney general, and then the approval of the Regulation Review Committee of the General Assembly. The whole process could take another year.

Florida Legislature Passes Medical Marijuana Implementation Bill. Lawmakers used a special session to come to an agreement on how to handle medical marijuana last Friday. Under the proposal approved by the legislature, which Gov. Rick Scott (R) says he will sign, the state will gain an additional ten medical marijuana operators within four month. Each operator can operate up to 25 dispensaries across the state. But the bill also bans the smoking of medical marijuana even though the constitutional amendment approved by voters last November expressly included a provision that allows smoking. That has led Orlando lawyer John Morgan, who largely bankrolled the amendment, to vow to sue the state over the no-smoking provision.

Vermont Governor Signs Medical Marijuana Expansion Bill. Gov. Phil Scott (R) last Thursday signed into law Senate Bill 16, which expands the list of qualifying conditions for medical marijuana. The new conditions added are Parkinson's disease, Crohn's disease, and PTSD. The new law also increases the number of dispensaries in the state from four to five.

Asset Forfeiture

Colorado Governor Signs Asset Forfeiture Reform Bill. Gov. John Hickenlooper (D) last Friday signed into law a civil asset forfeiture reform bill, House Bill 17-1313, which blocks state and local law enforcement from handing forfeiture cases off to the feds if the total value of the seized property is less than $50,000. In cases prosecuted by the federal government, the local law enforcement agency receives 80% of the proceeds, while under state law, the proceeds go to a general fund. Under the new law, police must also report all asset forfeitures and how they were used to the state.

International

Facing Mass Protests, Georgian Prime Minister Vows to Soften Harsh Drug Policies. After large crowds gathered in the capital Tbilisi to protest the arrest of two rappers who claim police planted drugs on them, Prime Minister Giorgi Kvirikashvili unexpectedly weighed in a vowed to soften the country's drug laws. "I call on the parliament to accelerate the work [on the issue of softening drug legislation] in order at last to adopt a modified and humane law for the fall session in line with European standards," said in a statement published on the government website.

Chronicle AM: Mexico Drug War Violence Roils Reynosa, RI MJ Commission Expanded, More... (6/8/17)

A Rhode Island legislative commission studying marijuana legalization gets an expanded membership, including more seats favorable to legalization, cartel infighting leaves a bloody toll in Reynosa, British public health experts call for festival pill testing, and more.

No let up in prohibition-related violence along the Rio Grande. (Borderlands Beat/Creative Commons)
Marijuana Policy

Rhode Island Legalization Commission Gets Expanded. The House Judiciary Committee has voted to expand the membership of a commission studying legalization by adding five more people. The five new members will add heft to the commission's pro-legalization contingent. They include the head of the local NAACP branch, a representative of Doctors for Cannabis Regulation, a criminal defense attorney, and the director of the local chapter of Direct Action for Rights and Equality. This brings the size of the commission to 22. The panel would report recommendations on legalizing marijuana to the General Assembly by March 2018.

Drug Policy

Wisconsin Seeks to Keep Locking Up Pregnant Women Suspected of Drug Use Despite Court Ruling. The state Department of Justice has asked the 10th US Circuit of Appeals to let it continue to apply a law allowing it to detain pregnant women it suspects of drug use even though a US district court judge struck it down in April. State officials first sought an emergency stay to block the ruling while they appeal, but when that was denied Monday, on Tuesday they asked to continue to apply the law to pending cases while it appeals the denial to the US Supreme Court.

International

British Public Health Group Calls for Pill Testing at Festivals. Citing the danger of "serious health harm" from stronger ecstasy in the UK, the Royal Society for Public Health is calling for a program to allow festival goers to test their drugs on site. The society reported than a one-off pill testing pilot program last year resulted in 18% of people bringing their drugs in deciding to through them in the garbage after they turned out to be counterfeit or adulterated.

Mexico Drug War Violence Continues to Roil Reynosa. At least 50 people have been killed in the past month in the Mexican border town of Reynosa, just across the Rio Grande River from McAllen, Texas, according to unofficial counts in local media. Most of the dead are reportedly gunmen from rival factions of the Gulf Cartel, who are fighting for control of local drug trafficking routes, but at least one civilizan -- a taco cart vendor -- is among the dead.

Medical Marijuana Update

The Veterans Administration secretary hints at openness to medical marijuana for PTSD, Arkansas regulators are ready to accept applications, Florida lawmakers are ready to move forward on implementing the will of the voters, and more.

National

Last Wednesday, the VA secretary said he's open to medical marijuana for PTSD. Department of Veterans Affairs Secretary David Shulkin said he is open to expanding the use of medical marijuana to treat soldiers with post-traumatic stress disorder in states where it is legal. There may be some evidence that this is beginning to be helpful and we're interested in looking at that and learning from that," Shulkin said during a press conference. "Right now, federal law does not prevent us at VA to look at that as an option for veterans... I believe that everything that could help veterans should be debated by Congress and by medical experts and we will implement that law."

Arkansas

On Tuesday, tstate regulators finalized the process for medical marijuana applications. The state Medical Marijuana Commission finalized the process for accepting applications for medical marijuana growers and sellers. The move comes after the commission developed a more detailed scoring system for ranking applicants. The application period will open June 30 and go on for 90 days. The commission will distribute 32 dispensary licenses and five cultivation facility licenses.

Florida

Last Friday, the governor vetoed medical marijuana research projects. Gov. Rick Scott (R) used his line-item veto power to kill three line items that would have provided more than $3 million dollars to the Moffitt Cancer Center and the University of Florida for medical marijuana research. In his veto message, Scott wrote that the institutions had plenty of money to fund the research on their own.

On Wednesday, lawmakers reached agreement on implementing medical marijuana. Lawmakers came to agreement on how to implement the state's voter-approved medical law. Under the agreement, 10 new growers will be licensed this year, with five licenses going to previous applicants, five going to new applicants, and at least one reserved for a black farmer. The state current licenses only seven commercial grows. The agreement also caps the number of dispensaries each grower can operate at 25.

Oregon

Last Friday, a bill to let medical growers sell limited amounts on the recreational market advanced. A bill that seeks to reshape the state's medical marijuana program so it can coexist with legal recreational marijuana is advancing. House Bill 2198, which would let medical growers sell up to 20 pounds in the recreational market in a bid to stay viable, passed the Joint Committee on Marijuana Regulation last Friday and is now before Joint Committee on Ways and Means.

[For extensive information about the medical marijuana debate, presented in a neutral format, visit MedicalMarijuana.ProCon.org.]

Chronicle AM: NYT Says ODs at Record High, WI Gov Advances Medicaid Drug Testing, More... (6/7/17)

Drug overdoses are at an all time high, drug war dinosaur senators want to return to harsh sentencing, Wisconsin's GOP governor moves forward with first in the nation plan to drug test Medicaid applicants, and more.

Fatal drug overdoses totaled nearly 60,000 last year, the New York Times reports. (Wikimedia)
Marijuana Policy

Connecticut House Debates Legalization, But There is No Vote. The House debated the pros and cons of marijuana legalization Tuesday night, but Democratic leaders then ended debate without any vote. They said a legalization bill would have failed in the House, but the debate could increase the chances of legalization being included as part of a budget bill, although observers describe that prospect as "a long shot."

Wichita Reduces Pot Penalties. The city council voted Tuesday to adopt an ordinance that would reduce the penalty for possession of up to 32 grams (slightly more than an ounce) of marijuana to $50 plus court costs.

ACLU, Drug Policy Alliance Sue Southern California City Over Pot Cultivation Ordinance. The ACLU of California and the Drug Policy Alliance are suing Fontana, claiming that the city's marijuana ordinance conflicts with rights granted to all Californians under Proposition 64. Under Prop. 64, every Californian 21 or older has a right to cultivate up to six marijuana plants for personal use. But the law also says cities or counties can ban outdoor gardens and "reasonably regulate" indoor grows.Fontana -- a city of 200,000 people that sits 50 miles east of Los Angeles -- passed an ordinance in January that requires residents who want to cultivate up to six plants inside their home to first get a $411 permit from the city and not have any drug convictions within the past five years, a policy the groups describe as both illegal and "egregious."

Medical Marijuana

Arkansas Finalizes Process for Medical Marijuana Applications. In a meeting Tuesday, the state Medical Marijuana Commission finalized the process for accepting applications for medical marijuana growers and sellers. The move comes after the commission developed a more detailed scoring system for ranking applicants. The application period will open June 30 and go on for 90 days. The commission will distribute 32 dispensary licenses and five cultivation facility licenses.

Florida Lawmakers Reach Agreement on Implementing Medical Marijuana. Lawmakers on Wednesday came to agreement on how to implement the state's voter-approved medical law. Under the agreement, ten new growers will be licensed this year, with five licenses going to previous applicants, five going to new applicants, and at least one reserved for a black farmer. The state current licenses only seven commercial grows. The agreement also caps the number of dispensaries each grower can operate at 25.

Oregon Bill to Let Medical Growers Sell Up to 20 Pounds in Recreational Market Advances. A bill that seeks to reshape the state's medical marijuana program so it can coexist with legal recreational marijuana is advancing. House Bill 2198, which would let medical growers sell up to 20 pounds in the recreational market in a bid to stay viable, passed the Joint Committee on Marijuana Regulation last week and is now before Joint Committee on Ways and Means.

Heroin and Prescription Opioids

New York Times Investigation Finds Drug Overdose Deaths Reached All-Time High in 2016. The New York Times published on Monday an investigative report that found that drug overdose deaths last year reached an all-time high, suggesting that the country's long-term opioid crisis continues to worsen and that younger age groups in the U.S. are experiencing record numbers of opioid overdoses than in the past. The Times looked at preliminary overdose data for 2016 provided by hundreds of state and local health authorities, concluding: "Drug overdoses are now the leading cause of death among Americans under 50, and all evidence suggests the problem has continued to worsen in 2017." The report estimates that more than 59,000 people died from a drug overdose in 2016 -- an increase of 19% from 2015. The report does not elaborate on which drugs are behind the estimated jump in overdose deaths last year, nor does the report indicate which age groups under 50 saw the largest increase in overdose deaths over prior years.

Senate Drug Warriors Feinstein and Grassley Prepare Bill With Tough New Penalties for Synthetic Opioids. The senior members of the Senate Judiciary Committee are preparing a bill that would create tough new penalties for people caught with synthetic opioids. A draft of the bill would give the attorney general the power to ban all kinds of synthetic drugs and it would impose a 10-year maximum sentence on people caught selling them for a first offense. A second offense would see the sentence double. The bill would penalize people selling drugs at a low level in the US, critics said.

Drug Testing

Wisconsin Submits Request to Drug Test Medicaid Applicants. Gov. Scott Walker (R) on Wednesday officially submitted a request for a federal waiver to become the first state in the country to drug test applicants for Medicaid benefits. Walker said the plan would provide drug addicts with treatment and make them employable. "Healthy workers help Wisconsin employers fill jobs that require passing a drug test," Walker's administration said in a press release Wednesday announcing the waiver. But critics called the notion a waste of money and an insult to people who need Medicaid.

Chronicle AM: Supreme Court Restricts Forfeiture, Rejects College Drug Test Bid, More... (6/6/17)

The Supreme Court makes two good drug policy-related rulings in one day, the California Assembly approves both a marijuana "sanctuary" bill and a supervised injection site bill, last-ditch efforts to free the weed in Connecticut hit a bump, and more.

The Supreme Court rules favorably on two drug policy-related issues. (Wikimedia)
Marijuana Policy

California Assembly Passes Marijuana "Sanctuary" Bill. The Assembly has approved Assembly Bill 1578, which would prohibit state resources from being used to help enforce federal marijuana laws that conflict with state law. The bill from Assemblyman Reggie Jones-Sawyer (D-Los Angeles) now goes to the state Senate.

Connecticut Legalization Measure Still Stalled. The last-ditch effort to get legalization passed through the budget process broke down early Monday just minutes before a press conference announcing a compromise was to be announced. Rep. Melissa Ziobron (R-East Haddam) complained that she didn't see a copy of the legalization amendment until just minutes earlier, when she learned that Rep. Josh Elliot (D-Hamden) and other Democrats had been crafting the measure since last Friday. "This isn't about headlines. This isn't about a news conference," Ziobron said. "This is about what's good for the state of Connecticut, and doing it last-minute, doing it in a way that is not bipartisan, is very worrisome and should be for every single person in this state."

Nevada Republicans Kill Governor's Pot Tax Bill. A bill supported by Gov. Brian Sandoval (R) that would have imposed a 10% tax on recreational marijuana sales has been defeated in the Senate after Republicans refused to support it because of unrelated budget issues. The vote was 12-9 in favor, but because it was a budget bill, it needed a two-thirds majority, or 14 votes, to pass.

Medical Marijuana

Florida Governor Uses Line-Item Veto to Kill Medical Marijuana Research Projects. Gov. Rick Scott (R) used his line-item veto power to kill three line items that would have provided more than $3 million dollars to the Moffitt Cancer Center and the University of Florida for medical marijuana research. In his veto message, Scott wrote that the institutions had plenty of money to fund the research on their own.

Asset Forfeiture

Supreme Court Restricts Asset Forfeiture in Drug Cases. In a decision handed down Monday, the US Supreme Court has moved to restrict prosecutorial efforts to seize money or goods from drug defendants. In Honeycutt v. US, brothers Terry and Tony Honeycutt were convicted of selling methamphetamine precursor chemicals, and the feds then swooped in to seize $200,000 of the estimated $270,000 profits from the sales. But they then sought to seize the remaining $70,000 from Terry Honeycutt, who was only an employee at his brother's hardware store, and that crossed a line, the court said. "Congress did not authorize the government to confiscate substitute property from other defendants or coconspirators," Sotomayor said. "It authorized the government to confiscate assets only from the defendant who initially acquired the property and who bears responsibility for its dissipation."

Drug Testing

Supreme Court Refuses to Hear Appeal from Missouri Tech College That Wanted to Drug Test All Students. The US Supreme Court on Monday declined to hear an appeal from the State Technical College of Missouri of an appeals court ruling that its mandatory drug testing policy is unconstitutional when applied to all students. Lower courts had upheld mandatory suspicionless drug testing of only a handful of the school's disciplines where safety was a key element. "This case establishes -- once and for all -- that under the Fourth Amendment, every person has the right to be free from an unreasonable search and seizure, including college students," the ACLU, which filed the class-action lawsuit in 2011, said in a statement Monday.

Harm Reduction

California Assembly Passes Supervised Injection Sites Bill. The Assembly last Thursday approved Assembly Bill 186, which would allow for the provision of supervised drug consumption sites. The pioneering harm reduction measure sponsored by Assemblywoman Susan Talamantes Eggman (D-Stockton) now moves to the state Senate. "California is blazing a new trail toward a policy on drug addiction and abuse that treats it as the medical issue and public health challenge that it is, and not as a moral failing," said Talamantes Eggman. "We are in the midst of an epidemic, and this bill will grant us another tool to fight it -- to provide better access to services like treatment and counseling, to better protect public health and safety, and to save lives."

Chronicle AM: NH Decrim Goes to Governor, VA Secretary Open to MedMJ for PTSD, More... (6/1/2017)

A decriminalization bill is heading to the New Hampshire governor's desk, Vermont's governor holds out hope for a legalization bill, Trump's opioid addiction commission will meet in a couple of weeks, and more.

Marijuana Policy

Nevada Pot Shop Rollout Could Be Delayed By Lawsuit. A state district court judge on Tuesday issued a temporary restraining order prohibiting the state Department of Taxation from enforcing a Wednesday deadline for license applications for the state's program to get legal marijuana sales off to an early start. The order came in response to a lawsuit from the Independent Alcohol Distributors of Nevada, who complain that the ballot measure that legalized weed in the state gave liquor wholesalers exclusive rights to distribution licenses for the first 18 months of sales. Distributors are those responsible for transporting marijuana from grows and production facilities to dispensaries.

New Hampshire Legislature Gives Final Approval to Decriminalization Bill. The House on Thursday voted to accept Senate changes to House Bill 640, which will decriminalize the possession of up to three-quarters of an ounce of marijuana. The bill now goes to the desk of Gov. Chris Sununu (R) is expected to sign the bill into law within the next couple of weeks.

North Dakota Legalization Signature Drive Will Begin in Fall. Proponents of a 2018 legalization initiative campaign say they will begin a signature gathering campaign in the fall, once students return to classes. A core group of individuals is working on a draft to be submitted to the secretary of state's office later this summer.

Vermont Governor Says Talks Continue on Marijuana Legalization Bill. Gov. Phil Scott (R) said Wednesday he thought it was still possible to pass a marijuana legalization bill during a two-day veto session set for later this month. Republican legislative leaders have said they wouldn't allow a parliamentary maneuver necessary to pass a revised legalization bill, but Scott said that if his public safety concerns are addressed, he could reach out to GOP leaders.

Medical Marijuana

VA Secretary Says He's Open to Medical Marijuana for PTSD. Department of Veterans Affairs Secretary David Shulkin on Wednesday said he is open to expanding the use of medical marijuana to treat soldiers with post-traumatic stress disorder in states where it is legal. "There may be some evidence that this is beginning to be helpful and we're interested in looking at that and learning from that," Shulkin said during a press conference. "Right now, federal law does not prevent us at VA to look at that as an option for veterans... I believe that everything that could help veterans should be debated by Congress and by medical experts and we will implement that law."

Drug Policy

Trump Addiction Commission Set to Meet June 16. The Office of National Drug Control Policy (ONDCP -- the drug czar's office) has announced that the President's Commission on Combating Drug Addiction and the Opioid Crisis will hold an inaugural meeting on June 16. The commission, which is loaded with drug policy conservatives, is charging with providing "advice and recommendations for the President regarding drug issues." The meeting will be at 12:30pm ET and will be available for public viewing via live stream.

International

Peru Takes First Casualties in Offensive in Key Coca Growing Region. A week after Peru announced that security forces were entering the region known as the Valleys of the Apurimac, Ene, and Mantaro Rivers (VRAEM) in a bid to suppress the coca crop in the country's largest coca growing region, two policemen were killed in an ambush by presumed drug traffickers Wednesday. Police said they were killed in the Luricocha district, where traffickers have allegedly allied themselves with remnants of the Shining Path guerrillas.

Canada Tories Want to Remove Home Grow Provisions From Legalization Bill. Conservatives in parliament are criticizing a provision in the legalization bill that would allow adults to grow up to four marijuana plants per household. "Is there any easier way to get marijuana than if your parents and everybody have got plants in the kitchen?" Tory justice critic Rob Nicholson, a former attorney general, asked in a speech to the House. Another Tory MP, Marilyn Gladu, warned that children could eat the plants. "Kids eat plants all the time because their parents do not put them up in the cupboard,” she said, ignorant of the fact that THC in marijuana plants must be heated in order to convert non-psychoactive THCA to THC, the stuff that gets people high.

Medical Marijuana Update

Dianne Feinstein and Chuck Grassley file a CBD research bill, Detroit has been moving against unpermitted dispensaries, and more.

National

Last Thursday, a pair of prohibitoinist senators filed a CBD research bill. Two of the Senate's most ardent prohibitionists, International Narcotics Control caucus leaders Sens. Dianne Feinstein (D-CA) and Chuck Grassley (R-IA) filed a bill to expand research into the medical benefits of cannabidiol and marijuana. The bill has not yet been assigned a number, nor is the text available on the congressional website, but the text can be viewed here. Feinstein authored a similar bill last session that went nowhere.

Arkansas

On Tuesday, state regulators delayed voting on final rules for another week. The state Medical Marijuana Commission needs another week to finalize some rules, commission Chairwoman Dr. Ronda Henry-Tillman said. If it indeed finalizes rules next week, applications for medical marijuana businesses will open up on June 30.

Michigan

As of Monday, Detroit has closed 167 unpermitted dispensaries, with more to come. The city's crackdown on illegally operating dispensaries has seen 167 of them shuttered since the campaign began last year, and another 51 are in line to be closed in coming weeks, according to Detroit corporation counsel Melvin Butch Hollowell. The city had identified 283 illegally operating dispensaries and has a goal of reducing the number of dispensaries in the city to 50.

[For extensive information about the medical marijuana debate, presented in a neutral format, 'visit MedicalMarijuana.ProCon.org.]

Chronicle AM: Senators' Sessions Forfeiture Letter, Canada Legalization Debate, More... (5/31/17)

A bipartisan group of US senators has sent Attorney General Sessions a letter asking him to rein in federal civil asset forfeiture, the Rhode Island House is voting on a pot legalization study commission, the Canadian parliament begins debating the government's legalization bill, and more.

Marijuana Policy

California Senate Votes to Make Marijuana Use in Cars an Infraction. The state Senate on Tuesday approved Senate Bill 65, which would prohibit the use of marijuana in automobiles because of concerns over drugged driving. The bill would make the offense a violation, punishable by no more than a fine. The bill now goes to the Assembly.

Rhode Island House to Vote Today on Legalization Study Commission. The House is set to vote today on a bill creating a 17-member panel to "conduct a comprehensive review and make recommendations regarding marijuana and the effects of its use." The commission would have until March 1, 2018 to report its findings to the General Assembly. Adopting the bill effectively blocks legalization in the state until next year at the earliest. This measure is supported by anti-reform state Attorney General Peter Kilmartin and Smart Approaches to Marijuana. If the measure passes the House, it then goes to the Senate.

Wisconsin Decriminalization Bill Gets Lone Republican Supporter. Legislative proponents of marijuana decriminalization held a press conference on Tuesday to rally support for a bill that would remove criminal penalties for possession of 10 grams or less. Three Democratic cosponsors were joined by Republican Rep. Adam Jarchow (District 28) at the presser, where they conceded their bill was unlikely to pass this year, but was intended to get the ball rolling.

Medical Marijuana

Arkansas Regulators Delay Voting on Final Rules for Another Week. The state Medical Marijuana Commission needs another week to finalize some rules, commission Chairwoman Dr. Ronda Henry-Tillman said Tuesday. If it indeed finalizes rules next week, applications for medical marijuana businesses will open up on June 30.

Asset Forfeiture

Bipartisan Group of Senators Ask Session to Rein In Asset Forfeiture. Six US senators have sent a letter to Attorney General Jeff Sessions asking him to change Justice Department policy on civil asset forfeiture. "We encourage the Department of Justice to revise its civil asset forfeiture practices to reflect our nation's commitment to the rule of law and due process," Sens. Mike Lee (R-UT), Rand Paul (R-KY), Mike Crapo (R-ID), Martin Heinrich (D-NM), Tom Udall (D-NM) and Angus King (I-ME) wrote to Sessions. "We encourage the Department of Justice to revise its civil asset forfeiture practices to reflect our nation's commitment to the rule of law and due process." Noting that Supreme Court Justice Clarence Thomas had recently expressed skepticism about the practice, they added: "You need not wait for Supreme Court censure before reforming these practices, and, in any event, the Department of Justice should err on the side of protecting constitutional rights."

International

Canada Begins Debating Government's Marijuana Legalization Bill. Parliamentary debate on the C-45 legalization bill got underway Tuesday. Supported by Prime Minister Justin Trudeau, the bill is expected to pass, making Canada the second country after Uruguay to legalize marijuana.

South African Opioid Substitution Program Underway. The city of Tshwane and the University of Pretoria are collaborating on a pilot opioid substitution therapy (OST) program in seven clinics in central Pretoria and Tshwane townships. Doctors are prescribing drugs such as methadone and buprenorphine to be consumed under direct supervision of health workers. The program also links patients to counseling and job skills, as well as testing for HIV and Hep C.

Chronicle AM: France Marijuana Decrim, PA High Court Reins in Forfeiture, More... (5/26/17)

France is moving toward marijuana decriminalization, perhaps as early as September, Vermont legalization supporters still hold out hope, and more.

Vive la France!
Marijuana Policy

New Hampshire Senate Committee Votes to Establish Commission to Study Marijuana Legalization. The Senate Judiciary Committee voted Thursday to approve House Bill 215, which would create a 22-member commission to study"the possible impacts of changing state policy to treat marijuana in a manner similar to the way the state deals with alcohol and shall study the legalization, regulation, and taxation of marijuana including the specific issues related to growing, selling, taxing, limiting use, advertising, promoting, and otherwise regulating marijuana and marijuana-infused edible products." The bill has already passed the House and now heads for the Senate floor.

Vermont Legalization Supporters Seek Compromise. In the wake of Gov. Phil Scott's (R) veto of the Senate Bill 22 legalization measure, supporters are seeking to find a compromise that will make the governor comfortable signing off on legalization. Scott said he wanted more aggressive penalties for driving under the influence or smoking in front of children and clearer and harsher penalties for selling and providing marijuana to minors. But Senate Judiciary Committee Chair Sen. Richard Sears (D-Bennington), a legalization supporter, said while compromise was possible, it might not happen if Republicans don't agree to suspend legislative rules to allow the legislation to move more quickly during a two-day summer session.

Medical Marijuana

Prohibitionist Senators File CBD Research Bill. Two of the Senate's most ardent prohibitionists, International Narcotics Control caucus leaders Sens. Dianne Feinstein (D-CA) and Chuck Grassley (R-IA) filed a bill to expand research into the medical benefits of cannabidiol and marijuana Thursday. The bill has not yet been assigned a number, nor is the text available on the congressional website, but the text can be viewed here. Feinstein authored a similar bill last session that went nowhere.

Asset Forfeiture

Pennsylvania Supreme Court Reins in Prosecutors on Civil Asset Forfeiture. In a unanimous decision Thursday, the state's highest court ruled that before seizing a property, prosecutors must prove it played a significant role in committing a crime, and it's value must be proportionate to the offense. The ruling came in the case of a 72-year-old Philadelphia woman whose $54,000 home and used minivan were seized in 2012 after her son was investigated for selling small amounts of marijuana. Her case has now been sent back to the lower courts to be decided in compliance with this ruling.

Sentencing

Hakeem Jeffries Files Federal Drug Charge Expungement Bill. US Rep. Hakeem Jeffries (D-NY) has filed House Resolution 2617, which would allow first-time, low-level, nonviolent drug possession offenders a change to expunge their convictions and clean up their records upon completion of court imposed probation. The bill has been referred to the House Judiciary Committee.

International

France Could Decriminalize Marijuana Possession as Soon as September. Interior Minister Gerard Collomb said Wednesday that the ministry is set to issue new rules under which someone caught with small amounts of pot would be cited and fined -- not arrested. The new rules could be in place "within three or four months," he said. Collomb's boss, newly-inaugurated President Emmanuel Macron had campaigned in favor of decriminalization and described marijuana prohibition as "posing a security problem."

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