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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: 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: Seattle Safe Injection Site "Die-In," ME MJ Init Vote Recount, More... (12/5/16)

Foes challenging the narrow legalization victory in Maine got their recount going today, patients take to the courts in Arizona and to the streets in Michigan, Seattle health care professionals do a die-in for safe injection sites, Ireland takes another step toward medical marijuana, and more.

Vancouver's safe injection site. Doctors and nurses in Seattle are agitating for something similar there. (vcha.ca)
Marijuana Policy

Maine Legalization Initiative Recount Begins. The Question 1 initiative legalizing marijuana won by less than 1% of the popular vote, garnering 381,692 votes to the opposition's 377,619 votes, a difference of 4,073 votes. Citing the narrow margin of victory, foes called a recount, and it began Monday. The recount could take up to a month, delaying putting legalization into effect until it is completed.

Medical Marijuana

Pair of Arizona Patients Sue Over Fees. Attorneys for patients Yolanda Daniels and Lisa Becker filed suit last Friday to force a reduction in the annual fee for registration cards that patients are legally required to obtain. The state health department is charging $150 a year, even though it has nearly $11.5 million in its medical marijuana account. "In a time when medication is more expensive than ever, the state should be helping to make it cheaper for Arizonans," the patients' attorney argued. "The state is deliberately squatting on the excess fund instead of refunding it to patients or using it in furtherance of the Arizona Medical Marijuana Act, such as to help patients."

Michigan Protestors Denounce Kent County Dispensary Raids. A couple of dozen people gathered outside the Plainfield Township Hall last Friday to protest a series of raids last Monday that shuttered three dispensaries in Plainfield. Demonstrators said they have nowhere to go to get their medicine, but Plainfield officials countered that dispensaries had been banned there since 2011.

Harm Reduction

Seattle Nurses, Doctors Do Die-In at City Hall in Protest Calling for Safe Injection Sites. As Seattle officials ponder whether to move toward allowing a safe injection site, doctors and nurses are turning up the heat. Last Friday, more than 30 members of Health Care Workers for Supervised Consumption Spaces held a die-in at City Hall to imitate the corpses that will be created if safe injection sites aren't allowed. City officials have been generally sympathetic to the idea, and a Seattle/King County opioid task force recommended the move in September.

International

British Town to Allow Drug Testing at Clubs. In a harm reduction first for the United Kingdom, a town in Lancashire will be the first in the country to offer testing of drug samples provided by club-goers at night clubs. The tests will examine samples of cocaine and MDMA to test the strength and purity of the drugs in a bid to reduce deaths related to "adulterated or highly potent" drugs. The National Police Chief's Council reportedly said the scheme could be useful but was still not yet endorsed on a national basis.

Ireland Takes Another Step Toward Medical Marijuana. The Dáil Éireann, the lower house of parliament, last Thursday approved an amendment allowing for the medicinal use of marijuana. But the measure still has to undergo another round of approval before it becomes law.

Poll: More Irish Support Marijuana Legalization Than Not. As the parliament ponders medical marijuana, a new poll finds that more Irish than not support full-blown legalization. A poll asking "Should cannabis be legalized for recreational use?" had 48% saying yes, 41% saying no, and 11% undecided.

Chronicle AM: Chelsea Clinton "Misspoke" on MJ Dangers, NYC Safe Injection Sites?, More... (9/29/16)

No, medical marijuana doesn't kill patients, Chelsea Clinton's spokeswoman admits, New York City is about to embark on a study of supervised injection facilities, and more.

The InSite supervised injection facility in Vancouver. New York City will study whether to have them, too. (vch.ca)
Medical Marijuana

Chelsea Clinton "Misspoke" About Risk of Marijuana Fatalities. Chelsea Clinton "misspoke" when she suggested that using medical marijuana along with other medications could be fatal, a spokeswoman has conceded. "While discussing her and her mother's support for rescheduling marijuana to allow for further study of both its medical benefits and possible interactions with other medications, Chelsea misspoke about marijuana's interaction with other drugs contributing to specific deaths," the spokeswoman said. While campaigning for her mother, the former first daughter told students at Youngstown State University in Ohio over the weekend that "some of the people who were taking marijuana for those [medicinal] purposes, the coroner believes, after they died, there was drug interactions with other things they were taking."

Harm Reduction

New York City to Study Supervised Injection Facilities. The city council has agreed to fund a $100,000 study into the pros and cons of supervised injection facilities. "The Council's new supervised injection impact study will assess the feasibility and impact of New York City having a program that provides a safe, clean haven to high-risk, vulnerable New Yorkers and will help prevent drug overdoses and disease transmissions, "Council Speaker Melissa Mark-Viverito said after passage of the proposal.

Law Enforcement

GOP Congressman's Bill Would Subject Heroin Spiked with Fentanyl Dealers to the Death Penalty. Rep. Tom Reed (R-NY) has filed a bill that would allow federal prosecutors to seek the death penalty for dealers linked to an overdose death caused by heroin laced with fentanyl. The measure is HR 6158, the Help Ensure Lives are Protected (HELP) Act. The move was quickly criticized by drug reform advocates. "This bill is a doubling down on the very ineffective, harsh and punitive policies that characterized the early war on drugs and which have widely been proven ineffective at reducing drug use," said Lindsay LaSalle, senior staff attorney for the Drug Policy Alliance.

(This article was prepared by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also pays the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

Making Sure Drugs Kill: Commission Blames Drug War for Spreading AIDS [FEATURE]

On Tuesday, as the UN's global drug prohibition bureaucracy marked its annual International Day Against Drug Abuse and Illicit Trafficking and UN Office on Drugs and Crime head Yuri Fedotov blamed hard drug use for "bringing misery to thousands of people, insecurity, and the spread of HIV," a group of leading international voices offered a starkly contrasting perspective, arguing instead that is the failures and consequences of global drug prohibition that are driving the spread of HIV/AIDS and other blood-borne diseases among drug users.

Commission members Michel Kazatchkine, Ruth Dreifuss, and Ilana Szabo at London press conference
Those voices, gathered together as the Global Commission on Drug Policy, include six former presidents from around the world, public health experts, and socially conscious entrepreneurs such as Sir Richard Branson. They took the opportunity of global anti-drug day to issue a report, The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic that directly condemns the drug war as a failure and calls for immediate, fundamental reforms of the global drug prohibition regime to slow the spread of HIV and reduce other drug war harms.

There are an estimated 33 million people worldwide infected with HIV, and outside sub-Saharan Africa, injection drug use accounts for one-third of new infections. The situation is particularly bad in Russia and other countries in the former Soviet Union and East Bloc that continue to take harsh drug war approaches to drug use despite the evidence before their own eyes. In Russia, nearly one in a hundred adults is now infected with HIV.

But it's not just the Russian sphere where policymakers ignore the evidence. The report also cites China, Thailand, and the US, where Congress recently reinstated a longstanding ban on the use of federal funds for syringe exchange programs. In countries that have adopted evidence-based HIV prevention programs, such as Switzerland and Portugal, injection drug use-related HIV infections have nearly been eliminated.

According to the report, drug prohibition and the criminalization of drug users spurs the spread of HIV through the following means:

  • Fear of arrest drives persons who use drugs underground, away from HIV testing and HIV prevention services and into high-risk environments.
  • Restrictions on provision of sterile syringes to drug users result in increased syringe sharing.
  • Prohibitions or restrictions on opioid substitution therapy and other evidence-based treatment result in untreated addiction and avoidable HIV risk behavior.
  • Deficient conditions and lack of HIV prevention measures in prison lead to HIV outbreaks among incarcerated drug users.
  • Disruptions of HIV antiretroviral therapy result in elevated HIV viral load and subsequent HIV transmission and increased antiretroviral resistance.
  • Limited public funds are wasted on harmful and ineffective drug law enforcement efforts instead of being invested in proven HIV prevention strategies.

"The Global Commission is calling on all entities to acknowledge and address the causal links between the war on drugs' criminalization of drug use and drug users and the spread of HIV/AIDS," commission member Michel Kazatchkine, the former executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria told a London press conference. "For people who inject drugs and their sex partners, the AIDS epidemic continues to be a public health emergency."

"It is so clear now that there is a relation between repressive drug policies and the spread of HIV/AIDS," said former Colombian President Cesar Gaviria. "If we don't get people into the health system without fear, it will be very difficult to do treatment and prevention."

Commission member Sir Richard Branson at "Atlantic Exchange" drug policy discussion, Washington, DC, March 2012
"I have long thought the war on drugs did more harm than good, and the commission's report put the data behind those beliefs," said Branson. "The war on drugs is not stopping drug use, and it also contributes significantly to the AIDS epidemic by driving users into the shadows. As an entrepreneur, if my business was failing for 40 years, I would close it down. Refusing to implement public health measures to reduce HIV and protect people with a drug problem is nothing short of criminal."

Branson and the other commissioners made some concrete recommendations for action in the report. Those include:

  • Push national governments to halt the practice of arresting and imprisoning people who use drugs but do no harm to others.
  • Measure drug policy success by indicators that have real meaning in communities, such as reduced rates of transmission of HIV and other infectious diseases, fewer overdose deaths, reduced drug market violence, fewer individuals incarcerated and lowered rates of problematic substance use.
  • Respond to the fact that HIV risk behavior resulting from repressive drug control policies and under-funding of evidence-based approaches is the main issue driving the HIV epidemic in many regions of the world.
  • Act urgently: The war on drugs has failed, and millions of new HIV infections and AIDS deaths can be averted if action is taken now.

"The AIDS epidemic is a harsh and brutal teacher that obliges us to take a scientific approach to deal with sex workers and drug addicts," said former Swiss President and commission member Ruth Dreifuss. "Politicians have to inform citizens of the benefits, risks, and failures of drug policy, and politics has to take responsibility for policy change. Public health has to be at least as important as criminalizing the drug traffic," she told the press conference.

"Addicted injecting drug users is one of the main sources of the spread, and not all of them will achieve abstinence," said Dreifuss. "Substitution therapies can take people away from street drug dealers and violence. For some, the provision of medical heroin is necessary to allow them to abandon criminal activities and overcome marginalization. It's possible to implement these large scale programs at low costs with high benefits," she argued.

"For others, harm reduction measures are necessary in order to avoid the spread of HIV/AIDS and other bloodborne disease. Needle exchange programs, free condoms, safe consumption rooms all not only save the lives of drug users but protect the whole population," Dreifuss explained. "We need the full spectrum of these measures for those in prison, too, who are at more risk for HIV infections."

Dreifuss touted her own country's experience as a model. Faced with mounting injection drug use, Switzerland eventually went the route of supervised injection sites and opioid maintenance, including heroin maintenance.

"Our experience is that it works," she said. "The police protect the injection rooms from dealers. The four pillar policy [prevention, treatment, harm reduction, enforcement] has been broadly accepted by our citizens and the spread of HIV/AIDS is under control."

Even within the constraints imposed by the global drug prohibition regime, countries can still take action to mitigate the drug war's role in the spread of infectious disease, she said.

"It is possible for countries to adopt effective harm reduction measures within existing drug laws," Dreifuss argued. "The decriminalization of drug use is the first step, and the second step is to determine what type of market can drive out dealers. The war on drugs has failed to reduce supply or demand; let us replace prohibition with regulation and avoid jeopardizing public health and harm reduction policies with inefficient measures."

"Our message is that prohibitionist law enforcement has failed in its goals of eradicating drugs and protecting people's health," said Kazatchkine. "Illegal drugs have become cheaper and more available and HIV and other health risks have increased. Prohibitionist policies have been shifting the market to stronger drugs and led to a war on users with numerous human rights abuses, police harassment, violence, extortion. The fear of police and stigma is driving users underground and away from access to information, care, and medical services," he warned.

"One cannot improve health through war," he concluded. "This is an epidemic among people who inject that we can actually control. If we are to have a chance at reducing the transmission of AIDS, we need to open up and change our ways."

The Global Commission on Drugs has laid out the problem and showed us the path to fix it. Now, it is up to our political leadership to act accordingly, and it is up to us to ensure that it does.

London
United Kingdom

Drug Prohibition's Cocaine Traffickers Have Proven Both Vicious and Resilient

Location: 
Since the beginning of the drug prohibition war, the drug trade has ballooned, spreading violence and corruption across large parts of the globe. Despite billions spent on combating them drug traffickers have for decades outwitted the authorities, keeping consumers in North America and Europe supplied at a price and purity that remains remarkably consistent despite law enforcement officials around the world frequently heralding the dismantling of trafficking networks.
Publication/Source: 
The Irish Times (Ireland)
URL: 
http://www.irishtimes.com/newspaper/world/2011/0127/1224288397713.html

Random Drug Testing Won’t Save the Children From Heroin

Here’s drug czar John Walters shamelessly using a young woman’s death as an opportunity to plug student drug testing:

Heroin killed 19-year-old Alicia Lannes, and her parents say she got the drug from a boyfriend.  Experts say that's how most young kids get introduced to drugs: by friends or relatives.

While teen drug use is declining, Walters says a Fairfax County heroin ring busted in connection with Lannes' death proves it's still a problem.  He supports a federal program used in more than 4,000 schools to randomly drug test students.

"There's no question in my mind had this young woman been in a school, middle school or high school with random testing," said Walters, "She would not be dead today." [FOX DC]

Walters sounds supremely confident, as usual, yet the reality is that random drug testing is often impotent when it comes to discovering heroin use. Student drug testing programs typically rely on urine tests, which can only detect heroin for 3-4 days after use. Only marijuana -- which stays in your system for up to a month – can be effectively detected this way. Thus, random testing actually incentivizes students to experiment with more dangerous drugs like heroin that increase your chances of passing a drug test.


And thanks to the complete failure of the drug war, heroin is stronger today than ever before:

The drug enforcement agency says the purity of heroin found in Virginia is typically higher than usual—making it more deadly.

"They tend not to know how to gauge the strength and they usually take more than they need to," said Patrick McConnel, who oversees Treatment for Youth Services Administration Alcohol and Drug Services.

There are no easy answers here, to be sure, and I don’t claim any monopoly on the solutions to youth drug abuse. But I guarantee you that the problem isn’t our failure to collect more urine from young people. As long as the most dangerous substances continue to be manufactured, distributed, and controlled by criminals, the face of our drug problem will remain the same.

Marijuana Evolves Faster Than Human Beings

Explaining the failure of marijuana prohibition is easy. Sociology, economics, history, and psychology can all help to explain why a safe and popular drug cannot be removed from the market by force. Still, there is another important reason why marijuana is here to stay: it evolves at an incredibly rapid pace, becoming stronger and more profitable every day.

The vigorous growth and adaptability of the marijuana plant has long frustrated efforts by law-enforcement to thwart its production. Specific strains are easily cross-bred, producing offspring that emphasize certain qualities, thus growers in Oregon can develop a strain that grows well in Oregon's climate with minimal effort. Hybridization not only improves potency, but can also shorten flowering time and increase yield, thereby enabling growers to produce more in less time.

We're witnessing a situation in which the biological vigor of the plant itself has far outpaced law-enforcement efforts that were never effective to begin with. Indoor-grown strains can advance through 3-4 generations in a year's time, with the best specimens from each batch selected for cloning or crossbreeding. Each successive generation carries on the best traits of the former, which explains why growers can now accomplish in a basement what used to require an acre or more in the woods.

The great irony of all this is that drug warriors still think increased marijuana potency is an argument for their side. In reality, nothing could better illustrate the failure of their efforts to reduce the drug's production. Harsh marijuana laws have incentivized growers to produce a stronger product, which carries the same penalties by weight, while commanding higher prices on the street.

As the bitter debate over marijuana legalization rages on, the plants will grow ever faster, bigger, and stronger. Marijuana is one of nature's most remarkable creations, and it is unbelievable that so many people still haven't figured out that this plant is here to help us. From healthy foods to a promising cancer cure, we should be grateful that cannabis sativa grows and evolves as vigorously as it does.

With every forward step in marijuana's evolution, the war against this resilient plant becomes less and less effective.

Note: Thanks to court-qualified cannabis expert Chris Conrad for answering growing questions, and to pot-paparazzi Steve Bloom for turning me on to the government's awesome 2008 cultivation assessment, which got me thinking about this.
Location: 
United States

This is Not Your Parents' Cocaine

From The Baltimore Sun:
The United States and its Latin American allies are losing a major battle in the war on drugs, according to indicators showing that cocaine prices dipped for most of 2006 and American users were getting more bang for their buck.
We've already covered this story, but it's beginning to generate broader coverage. Of course, no amount of negative publicity will silence our brave drug warriors even momentarily. Here's Karen Tandy just yesterday:
"Plan Colombia is working. The amount of land used for the cultivation of coca is at an historic low in Colombia," the head of the US Drug Enforcement Administration, Karen Tandy, told a drug law enforcement conference in Madrid. [AFP]

So why does Washington cover up increased cocaine potency, while aggressively trumpeting increased marijuana potency? The answer is simple, although if you asked the drug czar, he'd turn purple and pretend not to understand what you mean.

In the case of cocaine, the federal government has long identified reducing purity and increasing price as the primary goals of our ridiculously expensive and ongoing South American drug war investments. Increased cocaine potency in 2007 raises serious doubts about the efficacy of the brutal jungle wars we've been bankrolling for 10 years.

In the case of marijuana, however, the government's primary interest is in convincing an experienced public that this isn’t the same drug that has so consistently failed to hurt anyone. Jacob Sullum puts it best:

These warnings have to be understood mainly as a rationalization for the hypocrisy of parents (and politicians) who smoked pot in their youth and thought it was no big deal then but feel a need to explain why it is a big deal now.
Of course, while drug war demagogues are fond of comparing today's more potent marijuana to cocaine, there's really nothing to which they can compare today's stronger cocaine. I dunno, anthrax maybe? When I start hearing reports about weaponized nose-candy, I'm totally moving to Jupiter.

Location: 
United States

U.S. will limit use of fentanyl ingredient

Location: 
Washington, DC
United States
Publication/Source: 
Detroit Free Press
URL: 
http://www.freep.com/apps/pbcs.dll/article?AID=/20070508/NEWS05/705080338/1007

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