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Chronicle AM -- June 19, 2014

We can watch the marijuana policy landscape shift before our eyes, with legalization initiatives and decrim measures popping up around the country and even Oklahoma Republicans arguing over legalization. There is also action on the opiate front, the Senate will vote on defunding the DEA's war on medical marijuana in states where it is legal, and more. Let's get to it:

US Senator Cory Booker (D-NJ) cosponsors an amendment to cut DEA medical marijuana funding. (senate.gov)
Marijuana Policy

House Fails to Add Rider to Block DC Decriminalization Law. The House Financial Services and General Government Appropriations Subcommittee approved a familiar series of social policy riders on the District of Columbia budget, but did not include one that would seek to undo the city's recent adoption of marijuana decriminalization. It's not a done deal yet, however; such a rider could still be added during the legislative process. The subcommittee did approve riders barring the District from funding needle exchanges or medical marijuana programs.

Delaware Decriminalization Bill Heads for House Floor Vote. A bill that would decriminalize the possession of up to an ounce of marijuana and levy a maximum $250 fine passed the House Public Safety Committee today. House Bill 371 now heads for a House floor vote.

Marijuana Policy in the Oklahoma GOP Governor's Race. In next week's GOP primary, sitting Gov. Mary Fallin is up against two longshot opponents who both favor marijuana legalization. Both Chad Moody, also known as "The Drug Lawyer," and Dax Ewbank, a libertarian-leaning Republican, have come out in favor of freeing the weed. But Fallin says that's not on her to-do list: "I just don't see that it provides a substantial benefit to the people of Oklahoma," Fallin said.

Milwaukee Legalization Initiative Signature-Gathering Drive Underway. A coalition of Milwaukee groups have begun a petition drive to place a municipal legalization ordinance on the November ballot. The measure would legalize the possession of up to an ounce. The groups have until July 29 to come up with 30,000 valid voter signatures. People interested in helping out can get more information here.

Philadelphia City Council Votes to Decriminalize Marijuana. The city council today approved a decriminalization measure introduce last month by Councilman Jim Kenney. Up to 30 grams is decriminalized, with a maximum $25 fine. Four years ago this month, the city began treatment small-time possession as a summary offense, with a maximum $200 fine and three-hour class on drug abuse.

Activists Gather Twice the Signatures Needed for York, Maine, Legalization Initiative. Activists supported by the Marijuana Policy Project needed 100 valid voter signatures to present a marijuana legalization petition to the York Board of Selectmen. They handed in 200. Similar petition drives are going on in Lewiston and South Portland, and Portland voters approved a legalization referendum last year. The local efforts are laying the groundwork for a statewide legalization initiative in 2016.

Medical Marijuana

Sens. Rand Paul, Cory Booker Cosponsor DEA Defunding Amendment in Senate; Vote Could Come as Soon as Tonight. Sens. Rand Paul (R-KY) and Cory Booker (D-NJ) have cosponsored an amendment to the Justice Department funding bill that would shield medical marijuana patients and providers from the attention of the DEA in states where it is legal. The vote could come as soon as tonight or tomorrow. The House passed such an amendment at the end of last month.

New York Governor, Legislature in Tentative Deal as Session Draws to End. With the legislative ticking down its final hours, Gov. Andrew Cuomo (D) and legislative leaders today announced a deal that would allow passage of a medical marijuana pilot program, but would not allow patients to smoke their medicine.

North Carolina Limited CBD Medical Marijuana Bill Wins House Committee Votes. A bill that would allow some patients to use a high-CBD cannabis oil was approved by the House Health Committee Wednesday and the House Finance Committee today.

Drug Policy

Drug Policy in the Colorado GOP Senatorial Race. Former Colorado Congressman Tom Tancredo, who is running for the state's GOP senatorial nomination, is being attacked as a drug legalizer in a radio ad created by a committee supporting former Sen. Mike Copp. While Tancredo supports marijuana legalization and has in the past spoken of the need to consider drug legalization, he says he is not ready to legalize hard drugs and is demanding that the ads be pulled.

Opiates

Vermont Governor Signs Package of Bills Aimed at Opiate Use. Gov. Peter Shumlin (D) Tuesday signed into law a package of bills and executive orders that will ramp up treatment for opiate addiction, but also increase penalties for bringing more than one gram of heroin into the state. The centerpiece of the legislative package is Senate Bill 295, which will fund pretrial screening and drug treatment for suspects before they are arraigned.

New York Assembly Set to Approve Package of Heroin Bills. Gov. Andrew Cuomo (D) and key lawmakers announced Tuesday night that they had a deal on a package of heroin bills that would raise awareness of the issue and increase insurance coverage of heroin treatment. What isn't clear is whether they agreement also includes a series of Rockefeller drug law-style measure passed by the Republican-dominated Senate that would increase criminal penalties for some heroin offenses.

Harm Reduction

DC Police Chief Orders No Arrests for Overdose Victims. In a recent memorandum, Metropolitan Police Department Chief Cathy Lanier has instructed her police force to observe protections from arrest and charge granted under a DC law designed to encourage residents to seek immediate medical assistance for a person experiencing an overdose. The Good Samaritan Overdose Prevention Amendment Act of 2012 (#A19-564), which was passed by the D.C. Council in 2012 and took effect on March 19, 2013, provides limited legal protection from arrest, charge and prosecution for those who witness or experience a drug overdose and summon medical assistance.

Sentencing

Federal Fair Sentencing Act Picks Up Another Sponsor. And then there were 39. Rep. William Envart (D-IL) has signed on as a cosponsor to the Federal Fair Sentencing Act. That makes 25 Democrats, along with 14 Republicans. It would reduce the use of mandatory minimum sentences and impose retroactivity for crack cocaine sentences handed down before 2010.

International

Britain's Looming Khat Ban Could Create Black Market. A ban on khat is about to go into effect in England, and this report suggests that it could create political tensions in East Africa, as well as creating a black market for the substance in England itself.

Albanian Siege of Marijuana-Producing Village Continues. A police assault on the village of Lazarat that began Monday is still underway as clashes continued between police and armed villagers. Some 800 police are involved in the operation, and they say they have seized or destroyed more than 10 tons of marijuana so far. But that's only a fraction of the 900 tons the village is estimated to produce annually. The town's $6 billion pot crop is equivalent to about half Albania's GDP.

(This article was published by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also shares 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.)

Tennessee's Scary New Law Criminalizing Drug-Using Pregnant Women [FEATURE]

When -- despite the objections of medical groups, reproductive health advocates, and even the drug czar's office -- Tennessee Gov. Bill Haslam (R) signed into law Senate Bill 1391 late last month, the Volunteer State became the first in the nation to pass a law criminalizing pregnancy outcomes. Other states, such as Alabama and South Carolina, have used fetal harm laws to charge drug-using pregnant women, but Tennessee is the first to explicitly criminalize drug use during pregnancy.

Passed in the midst of rising concern over prescription drug and heroin abuse and aimed, its proponents said, at protecting babies, the law allows women to be criminally charged with an "assaultive offense for the illegal use of a narcotic drug while pregnant, if her child is born addicted to or harmed by the narcotic drug or for criminal homicide if her child dies as a result of her illegal use of a narcotic drug taken while pregnant."

Felony assault can earn you up to 15 years in prison in Tennessee. And while some prosecutors have said they will only file misdemeanor charges, that's not written into the law.

Proponents cited recent reports that the number of babies being born addicted to drugs is on the rise. Such infants are diagnosed as having Neonatal Abstinence Syndrome, or withdrawal symptoms after being exposed to opiates in the womb.

"Over the past decade, we have seen a nearly ten-fold rise in the incidence of babies born with NAS in Tennessee," the state Department of Health reported. Infants with NAS stay in the hospital longer than other babies and they may have serious medical and social problems."

But the state Health Department notwithstanding, experts in the field say that NAS doesn't actually have long-term effects, it's not accurate to call newborn infants "addicted," and that misrepresenting matters by vilifying pregnant women isn't helpful. In fact, more than 40 of them said so in an open letter last month.

More generally, leading medical groups, including the American Medical Association, the American Nurses Association, the American Academy of Pediatrics, and the American Public Health Association reject the prosecution and punishment of pregnant women who use drugs. The groups mentioned above and many others said so in this 2011 document.

A coalition of medical, public health, women's rights, and social justice groups worked to oppose the bill as it made its way through the legislature, and then to convince Gov. Haslam to kill it. A petition with over 11,000 signatures urging him to veto the bill went to his office late last month. More than two dozen organizations devoted to ensuring families have access to health care likewise urged a veto, as did the American Association of Pediatrics, the National Perinatal Association, and International Doctors for Healthier Drug Policy.

Even acting drug czar Michael Botticelli raised a warning flag.

"Under the Obama administration, we've really tried to reframe drug policy not as a crime but as a public health-related issue, and that our response on the national level is that we not criminalize addiction," he said during a visit to Nashville as the governor pondered. "We want to make sure our response and our national strategy is based on the fact that addiction is a disease. What's important is that we create environments where we're really diminishing the stigma and the barriers, particularly for pregnant women, who often have a lot of shame and guilt about their substance abuse disorders."

But none of that mattered. On April 29, Haslam signed the bill into law.

"In reviewing this bill, I have had extensive conversations with experts including substance abuse, mental health, health and law enforcement officials," Haslam said in a statement. "The intent of this bill is to give law enforcement and district attorneys a tool to address illicit drug use among pregnant women through treatment programs."

"Today, the Tennessee governor has made it a crime to carry a pregnancy to term if you struggle with addiction or substance abuse," Alexa Kolbi-Molinas, staff attorney with the ACLU Reproductive Freedom Project, said in a statement in response to the signing. "This deeply misguided law will force those women who need health care the most into the shadows. Pregnant women with addictions need better access to health care, not jail time."

The statewide coalition Healthy and Free Tennessee also lambasted the new law.

"We are very sorry to see that Governor Haslam let an opportunity to do the right thing slip through his fingers," said Rebecca Terrell, the group's chairwoman."The experts could not have been clearer: this law is bad for babies and bad for Tennessee."

"This law says that women are to be held criminally accountable for the outcomes of their pregnancies," said Farah Diaz-Tello, a staff attorney with National Advocates for Pregnant Women, which was part of the coalition fighting the new law. "It essentially creates a system of separate and unequal rights. Drug ingestion is not a crime in Tennessee, just possession, and now, only pregnant women are criminalized for ingesting. They can be surveilled and punished by the state in ways different from other people. The law also treats fertilized eggs or fetuses as if they were people independent of the pregnant woman," she told the Chronicle.

Gov. Bill Haslam (tn.gov)
"It's the wrong response to the problem of addiction," said Diaz-Tello. "It's a health problem that is not responsive to threats and punishment. What kind of society do we want to be? Do we want to punish the people most in need of help and support? These are women largely living in poverty, women of color, who are already made vulnerable by our social policies, and now we hold them solely responsible without looking at society and what else is going on leading to pregnancy among addicted people and this horrible punitive response."

Even framing the issue as "pregnant women taking drugs" is somewhat misleading, said Diaz-Tello.

"We often make the mistake of thinking of people using drugs during pregnancy as pregnant women who became addicted to drugs when it should be the other way around," she said. "The reasons for addiction are complex and often gender-based. Women who have experienced violence and trauma are often self-medicating, and there is a lot of unresolved pain and trauma out there. And half the pregnancies in our country are unintended, which disproportionately affects women on the margins. It's not like someone wakes up pregnant one day and decides they want to do drugs."

The law will not operate in a vacuum. Tennessee is one of those states that has refused to expand Medicaid and has rejected the Affordable Care Act. It is more difficult for poor women there to get access to health care services, including drug treatment, but now it will be easier to prosecute them.

"This is definitely for the most part going to affect poor, marginalized, predominantly rural women," said Cherisse Scott, founder of SisterReach, a Memphis-based group working for reproductive justice for women and girls in the city and the Mid-South area. "That's because of the many barriers they face. Many rural areas just don't have the facilities to offer help to these women."

Scott also bemoaned the criminalization of pregnant women who use drugs under the law, a process of stigmatization and punishment only made more severe for women lacking resources.

"Low income women, women of color, already have issues navigating the court system, and many don't have any kind of support system," she said. "When their children are taken, they don't have the resources to get them back. And the other piece of this is that jails aren't hospitals or treatment centers. They don't offer women an opportunity to be properly rehabilitated from drug use."

And then there's the aftermath of a criminal conviction.

"If you look at this through the lens of racial and reproductive justice, how does a woman with this on her record bounce back, how does she get a job? With a criminal background, she will be further locked out," said Scott. "These are the kinds of barriers and issues that will ultimately hurt the mothers of Tennessee. We can't support legislation that uses criminalization as a means of rehabilitating people," she told the Chronicle.

"Our lawmakers had good intentions, but they didn't think it through," said Scott. "They seem to be very ready to separate mothers and children as a way of helping, and we don't see it like that, especially when there are rehab programs that keep mother and children together."

The new law is also generating alarm with advocates for people who use opioid maintenance therapy to deal with opiate addictions. Methadone and buprenorphine maintenance are the gold standard for treating pregnant women addicted to narcotics. While state health officials have said they interpret the law to mean that a pregnant woman on methadone maintenance would not be in violation of it, there is no language in it that explicitly says that.

"I asked the governor to veto the bill because that exclusion wasn't made," said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. "The real question is whether some representative for the attorney general's office or a DA or child protection services interprets it that way. This is a potential problem. When you're talking about child protection, it's not unusual for a judge or child protection worker to say to a pregnant mom 'You can't be on methadone.' I hope this law will not be used as a method of forcing maintained patients out of care."

While babies born to opiate-addicted women can suffer from Neonatal Abstinence Syndrome, or withdrawals, they can be treated for that, mainly by slowly tapering the dose of opiates. But, Parrino said, not all pregnant mothers on methadone maintenance have babies with the syndrome, and consequences for fetuses can be serious if mothers are forced off opiates during their pregnancies.

"What happens to a fetus if you force mom to end her medication?" he asked. "In the first trimester, a sudden decrease can be harmful to the fetus. There could be spontaneous abortion. It's in the literature. That's why laws like this raise concerns in people who have some knowledge about how pregnant women are treated."

Parrino, too, saw race a playing a role, but in an unexpected way.

"What I am seeing for the first time in 30 years is a real interest by elected officials, many US senators and governors and legislators, who can't wrap their heads around why white teens and 20-somethings from middle class families in the suburbs and rural areas are shooting heroin," Parrino observed. "Those elected officials are right to be worried. This legislation in Tennessee is a result of those dynamics."

While the law may have been passed with the best motives, "the problem is the criminalization aspect," said Parrino. "Even if it can be explained as having a reasonably good intention of getting pregnant women not to use drugs and go to treatment, you are unwittingly subverting that goal by saying that being in methadone maintenance might be seen as not complete treatment. That uncertainty is creating anxiety."

The new law is set to go into effect on July 1, but efforts are already underway to block it and, barring that, to mitigate its effects.

"We're still trying to figure out the best plan of action," Scott said. "We want to figure out the best way to support women who are going to be victims of this policy. At the grass roots level, that means education, awareness, getting the word out through rehab centers to let the women know this is coming. Then we have to figure out what is the legal strategy to try to change this law. We're working on it."

"We're thinking about a legal challenge, especially on constitutional grounds," said Diaz-Tello. "We have worked with public defenders in Tennessee and other states on challenging similar laws on constitutional grounds. There's also the possibility of an affirmative suit to get the law enjoined. It would be ideal to stop this law before anyone gets arrested under it."

Barring the successful blocking of the law, drug-addicted pregnant women in Tennessee will face the tender mercies of the criminal justice system. But not all of them, of course.

"Race and class plays a role as always," said Scott. "Poor mothers go to jail; mothers with access to more resources may not be penalized at all. Women who have access to health care and can afford private prenatal care and treatment will get treatment; women who have no alternative but public aid or a public health clinic will be disproportionately impacted as always. Nothing's changed as far as race and class."

TN
United States

London School of Economics Report Calls for New Approaches to Drug Policy

A report from the London School of Economics released Monday night outlines the enormous negative outcomes and collateral damage from the war on drugs and calls for new, evidence-based approaches to drug use and the drug trade.

The report, Ending the Drug Wars: Report of the LSE Expert Group on the Economics of Drug Policy, has chapters authored by leading drug policy experts from around the world and has been signed onto by five Nobel Prize-winning economists, as well as political figures including British Deputy Prime Minister Nick Clegg, Guatemalan Foreign Minister Luis Fernando Carrera Castro, former Polish President Aleksander Kwasniewski, former US Secretary of State George Schultz, and former European Union High Representative for Common Foreign and Security Policy Dr. Javier Solana, among other luminaries.

"It is time to end the 'war on drugs' and massively redirect resources towards effective evidence-based policies underpinned by rigorous economic analysis," the report says forthrightly. "The pursuit of a militarized and enforcement-led global 'war on drugs' strategy has produced enormous negative outcomes and collateral damage. These include mass incarceration in the US, highly repressive policies in Asia, vast corruption and political destabilization in Afghanistan and West Africa, immense violence in Latin America, an HIV epidemic in Russia, an acute global shortage of pain medication and the propagation of systematic human rights abuses around the world."

The stark prohibitionist approach to drug control has been a flop even by its own measures, the report found.

"The strategy has failed based on its own terms," it noted. "Evidence shows that drug prices have been declining while purity has been increasing. This has been despite drastic increases in global enforcement spending. Continuing to spend vast resources on punitive enforcement-led policies, generally at the expense of proven public health policies, can no longer be justified."

The report chided the United Nations for its continued adherence to such failed policies and urged it to accept experimentation while emphasizing public health and human rights.

"The United Nations has for too long tried to enforce a repressive, 'one-size-fits-all' approach," the report concluded. "It must now take the lead in advocating a new cooperative international framework based on the fundamental acceptance that different policies will work for different countries and regions. This new global drug strategy should be based on principles of public health, harm reduction, illicit market impact reduction, expanded access to essential medicines, minimization of problematic consumption, rigorously monitored regulatory experimentation and an unwavering commitment to principles of human rights."

"The drug war's failure has been recognized by public health professionals, security experts, human rights authorities and now some of the world's most respected economists," said John Collins, coordinator of LSE IDEAS International Drug Policy Project. "Leaders need to recognize that toeing the line on current drug control strategies comes with extraordinary human and financial costs to their citizens and economies."

"Repressive drug laws cost governments billions of dollars and result in horrible epidemics of infectious diseases and serious human rights abuses," said Dr. Kasia Malinowska-Sempruch, the director of the Open Society Global Drug Policy Program, which hosted a launch event for the report at the LSE Monday night. "We know the terrible costs of failed strategies and what can be gained from smarter approaches."

More fuel for the fire as an increasingly broad-based global movement for drug reform takes aim at the UN and its 2016 General Assembly Special Session (UNGASS) on Drugs.

London
United Kingdom

Uruguay's Mujica is the Grumpy Old Man of Global Marijuana Legalization

Uruguay will formally unveil the regulations for its legal marijuana commerce next week, although the broad outlines are already known. The stuff will be genetically tracked from seed to sale and beyond, it'll see for less than a buck a gram, and registered consumers will only be able to buy 40 grams a month.

Jose "Pepe" Mujica. Not exactly Captain Cannabis. (wikimedia.org)
It's not exactly a free-for-all. Instead, it's a tightly regulated effort to break the black market in marijuana in the country, where it's never been a crime to smoke pot. And it's most definitely not about creating a pothead utopia, as Uruguayan President Mujica showed in an interview yesterday with the Associated Press.

In that interview, Mujica, a former leftist guerrilla who spent years in prison during the time of military dictatorship in the 1970s, made clear that he's no hipster.

"We don't go along with the idea that marijuana is benign, poetic and surrounded by virtues. No addiction is good," he said. "We aren't going to promote smoke fests, bohemianism, all this stuff they try to pass off as innocuous when it isn't. They'll label us elderly reactionaries. But this isn't a policy that seeks to expand marijuana consumption. What it aims to do is keep it all within reason, and not allow it to become an illness."

Well, with all due respect, Mr. Mujica, you sound like an elderly reactionary. This is a guy who has never smoked pot, and it shows. Referring to marijuana use as an addiction puts him in the company of mad scientists like NIDA head Dr. Nora Volkow and the professional prohibitionists of Project SAM, and spouting platitudes like "no addiction is good" manages to conflate being physically addicted to things like heroin and prescription opiates to habitually puffing a pot pipe or having a cup of coffee first thing every morning.

Mujica also took some gratuitous pot shots at Colorado's legalization regime and at medical marijuana in the US. Uruguay's system will be superior to Colorado's, he said, because Colorado doesn't track pot after it is purchased.

The AP quoted Mujica as saying "it's a complete fiction what they do in Colorado," which seems to be his way of claiming that legalization there is out of control because it doesn't track individual purchasers. Well, I find it kind of creepy to think the government is keeping track of my consumption habits (like with, say, a prescription monitoring database—oops, never mind), and I have to wonder why Mujica isn't pushing for something similar for alcohol purchases in his country.

And, Mujica said, the medical marijuana laws in US states are based on "hypocrisy" because they allow people with "fake illnesses" to obtain marijuana. Well, he has something of a point there, but only to a degree. California is by far the most wide open medical marijuana state, and people do take advantage of the loosely-written law to obtain and use medical marijuana without fear of arrest.

California can remedy that by recognizing reality and just getting on with legalization, as it will almost certainly do in 2016. But the other medical marijuana states are much more restrictive, and, perversely, the more public support grows for medical marijuana, the tighter the restrictions seem to be.

So, why is Mujica being such a grumpy old man about marijuana legalization? After all, he's the guy who pushed it through in Uruguay. I think there are a couple of things going on.

First, he's a square. He's a straight, old leftist, a former revolutionary, with no experience with marijuana and no connections to the cannabis culture. He really sees this as a public health and public security problem, not as a step toward human liberation. In that sense, he's your grandpa.

But he's also moving forward with legalization in the face of strong public opposition to it in Uruguay.  In a poll last week, nearly two-thirds remained opposed to the new law, although 51% said it was better to give it a chance than to kill it at birth. I suspect many of Mujica's comments were made with that domestic audience in mind. In that sense, he's a smart politician.

And grumpy old man he may be; he's still the guy who is leading the first country to break with global pot prohibition. Adelante, companero.

Location: 
Montevideo
Uruguay

Responding to Holder on Heroin, Reformers Call for a Health Direction [FEATURE]

US Attorney General Eric Holder had heroin on his mind Monday, using his weekly video message and an accompanying press release to draw attention to rising heroin overdose deaths and vowing to combat the problem with a combination of law enforcement, treatment, prevention, and harm reduction measures. Drug reformers generally responded positively, but called on the Obama administration to seek comprehensive, science- and health-based solutions instead of engaging in more drug war.

Attorney General Holder takes on heroin (usdoj.gov)
"Addiction to heroin and other opiates -- including certain prescription pain-killers -- is impacting the lives of Americans in every state, in every region, and from every background and walk of life -- and all too often, with deadly results. Between 2006 and 2010, heroin overdose deaths increased by 45%," Holder said. "Scientific studies, federal, state and local investigations, addiction treatment providers, and victims reveal that the cycle of heroin abuse commonly begins with prescription opiate abuse. The transition to -- and increase in -- heroin abuse is a sad but not unpredictable symptom of the significant increase in prescription drug abuse we've seen over the past decade."

What Holder didn't mention is that the rise in prescription pain pill misuse is tied to a massive increase in prescribing opioids for pain in the past decade. A study published last fall found that between 2000 and 2010, the amount of opioids prescribed for non-cancer pain had nearly doubled, and that during the same period, the percentage of people complaining of pain who received prescriptions for opioids jumped from 11% to nearly 20%. But reining in prescriptions generally isn't the answer either.

But at the same time, a 2011 Institute of Medicine report found that while "opioid prescriptions for chronic non-cancer pain [in the US] have increased sharply… 29% of primary care physicians and 16% of pain specialists report they prescribe opioids less often than they think appropriate because of concerns about regulatory repercussions."

As the IOM report noted, having more opioid prescriptions doesn't necessarily mean that "patients who really need opioids [are] able to get them." Opioid misuse and under-use of opioids for pain treatment when they are needed are problems that coexist in society. Pain pill crackdowns have also been found to result in increased use of street heroin, as a Washington Post article last week reports -- two additional reasons advocates prefer public health approaches to heroin more than law enforcement -- and why great care should be taken with the law enforcement measures.

"It's clear that opiate addiction is an urgent -- and growing -- public health crisis. And that's why Justice Department officials, including the DEA, and other key federal, state, and local leaders, are fighting back aggressively," Holder continued. "Confronting this crisis will require a combination of enforcement and treatment. The Justice Department is committed to both."

Holder pointed to DEA efforts to prevent diversion of pharmaceutical pain-relievers to non-medical users, mentioning investigations of doctors, pharmacists, and distributors.

"With DEA as our lead agency, we have adopted a strategy to attack all levels of the supply chain to prevent pharmaceutical controlled substances from getting into the hands of non-medical users," Holder said.

Cooking heroin (wikimedia.org)
Holder also pointed out that DEA had opened some 4,500 heroin investigations since 2011 and promising more to come.

But, as Holder noted, "enforcement alone won't solve the problem," so the administration is working with civil society and law enforcement "to increase our support for education, prevention, and treatment."

And although he didn't use the words "harm reduction," Holder is also calling for some harm reduction measures. He urged law enforcement and medical first responders to carry the overdose reversal drug naloxone (Narcan) and signaled support for "911 Good Samaritan" laws, which grant immunity from criminal prosecution to those seeking medical help for someone experiencing an overdose.

Holder got restrained plaudits from drug reformers for his small steps toward harm reduction measures, but they called for a more comprehensive approach.

"Preventing fatal overdose requires a comprehensive solution," said Meghan Ralston, harm reduction manager for the Drug Policy Alliance. "While naloxone is an absolutely critical component, we need a scientific, health-based approach to truly address the roots of the problem. This includes improving access to effective, non-coercive drug treatment for everyone who wants it, as well as improving access to medication-assisted treatments such as methadone and buprenorphine."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)
Ralston also added that just making naloxone available to cops and EMTs wasn't good enough. Friends and family members, not "first responders," are most often the people who encounter others in the throes of life-threatening overdoses.

"While we applaud Attorney General Holder's clear support for expanding access to naloxone, particularly among law enforcement and 'first responders,' we urge him to clarify that he supports naloxone access for anyone who may be the first person to discover an opiate overdose in progress," she said.

But Law Enforcement Against Prohibition (LEAP), a group of law enforcement officials opposed to the war on drugs, applauded the move, which could help soften reflexive law enforcement opposition to carrying the overdose antidote, an attitude reflected in the the International Association of Chiefs of Police's opposition to all harm reduction measures.

"Police may not be the first to embrace change, but we are slowly evolving," said Lieutenant Commander Diane Goldstein (Ret.). "We cannot arrest our way out of a public health problem, and it's clear that the Attorney General is beginning to understand that and to embrace the role of harm reduction in reducing death, disease and addiction in our communities. We still have a long way to go, but this is a good sign."

The idea is "a no-brainer," according to executive director Major Neill Franklin (Ret.). "It is simply immoral not to support something proven to save lives for political reasons," Franklin added. "Yes, police send a message when they choose not to carry naloxone. But that message is not 'don't do drugs,' it's 'if you make the wrong decisions in your life, we don't care about you.' That offends me both as a former cop and as a human being."

The nuanced pushback to Holder's law enforcement/prevention/treatment/hint of harm reduction approach is good as far as it goes, but it doesn't go far enough. Decriminalizing and destigmatizing now illicit drug use, as has been the case in Portugal, is an obvious next step, and removing the question of drugs from the purview of the criminal justice system altogether would be even better. Still, that a sitting attorney general is calling for treatment and harm reduction as well as law enforcement is a good thing, and for reformers to be calling him on not going far enough is a good thing, too.

Chronicle AM -- February 20, 2014

Colorado is rolling in the marijuana tax dollars, Washington state gets closer to licensing legal grows, a New Hampshire patient grow bill is moving, the Europeans are worried about some new drugs, and more. Let's get to it:

The Europeans are worried about "N Bomb"
Marijuana Policy

Colorado Governor Announces Marijuana Tax Revenues Plan. Gov. John Hickenlooper (D) Wednesday announced his plan to start spending tax revenues from legalized marijuana. He said he would spend $99 million next fiscal year, with half of it going to youth use prevention, another 40% going to substance abuse treatment, and more than $12 million for public health. His proposal must be approved by the legislature.

Washington State Regulators Announce Rules Modifications. The Washington State Liquor Control Board announced Wednesday that it will limit marijuana business applicants to one pot grow each, down from the three-license limit it originally set. The board also reduced by 30% the amount of grow space that licensees can use. The board is trying to address how to equitably distribute the two million square foot of grow space it has set as a statewide cap. The move also opens the way to the actual issuance of grow licenses, which could come as soon as early next month.

Medical Marijuana

New Hampshire Patient Cultivation Bill Wins Committee Vote. A bill that would allow qualifying patients to cultivate a limited amount of medical marijuana in New Hampshire was approved this morning in a 13-3 vote by the House Committee on Health, Human Services, and Elderly Affairs. The bill will be considered by the full House sometime in March. Sponsored by Rep. Donald Wright (R-Tuftonboro), House Bill 1622 would patients or their designated caregivers to possess up to two mature plants and twelve seedlings. The cultivation location would have to be reported to the Department of Health and Human Services, and patients would lose their ability to cultivate when an alternative treatment center opens within 30 miles of their residence.

South Carolina CBD Medical Marijuana Bill Filed. Sen. Tom Davis (R-Beaufort) Wednesday introduced a bill to allow for the use of CBD cannabis oil for the treatment of epilepsy seizures. Senate Bill 1035 has been referred to the Committee on Medical Affairs.

Arizona Bill Would Use Medical Marijuana Fees to Fund Anti-Drug Campaigns. A bill approved Wednesday by the House Health Committee would set up a special fund using fees from medical marijuana user and dispensaries to "discourage marijuana use among the general population." House Bill 2333, sponsored by Rep. Ethan Orr (R-Tucson) is being derided by the Marijuana Policy Project, whose spokesman, Mason Tvert, said "It is remarkable how much money some government officials are willing to flush down the toilet in hopes of scaring adults away from using marijuana."

Heroin

Vermont Law School Symposium Will Address Heroin Addiction and New Solutions. The Vermont Law Criminal Law Society is hosting a symposium on heroin and opiate addiction and responses to it on Monday. "This event is about new ideas from new sources," said Vermont Law JD candidate George Selby ', one of the panel organizers. "We need to fundamentally change the way we treat addicts and the opiates they fall victim to." Panelists will include addiction and pain specialists, a narcotics investigator, and an advocate for revolutionizing drug policy. They will discuss whether drug courts, replacement therapy, and support groups are enough, and tackle a controversial question: Should doctors be allowed to prescribe heroin to treat heroin addiction? One of the featured speakers is Arnold Trebach, JD, PhD, professor emeritus of public affairs at American University and founder of the Drug Policy Foundation, the precursor to the Drug Policy Alliance, who plans to call for action in Vermont. Click on the title link for more details.

International

Europeans Issue Alert on Four New Synthetic Drugs. The European Monitoring Center for Drugs and Drug Addiction has issued an alert and announced a formal risk assessment of four new synthetic drugs. They are the hallucinogenic phenethylamine 251-NBOMe ("N-Bomb," linked to three deaths), the synthetic opioid AH-7921 (15 reported deaths in Europe), the synthetic cathinone derivative MDPV ("legal cocaine," linked to 99 deaths), and the arylcyclohexamine drug Methoxetamine (linked to 20 deaths). Click on the link above for more details.

British Columbia Judge Rules Mandatory Minimum Drug Sentences Unconstitutional. A judge in Canada's British Columbia ruled Wednesday that mandatory minimum sentences for drug offenders under the federal 2012 Safe Streets and Communities Act are unconstitutional. In November, an Ontario judge struck down a similar sentence for a weapons offense, but BC is the first province to have the drug offense sentences quashed. Crown prosecutors are expected to appeal.

India Asset Forfeiture Bill Passes Lok Sabha. A bill that would increase the Indian government's ability to seize assets from drug traffickers was approved Wednesday by the Lok Sabha, the lower house of the country's bicameral parliament. The Narcotic Drugs and Psychotropic Substances (Amendment) Bill, 2011 passed on a voice vote after members took turns worrying aloud about the spread of drug use in the world's most populous democracy.

Hoffman, Heroin, and What Is To Be Done [FEATURE]

The news last Sunday that acclaimed actor Phillip Seymour Hoffman had died of an apparent heroin overdose has turned a glaring media spotlight on the phenomenon, but heroin overdose deaths had been on the rise for several years before his premature demise. And while there has been much wailing and gnashing of teeth -- and quick arrests of low-level dealers and users -- too little has been said, either before or after his passing, about what could have been done to save him and what could be done to save others.

cooking heroin (wikimedia.org)
There are proven measures that can be taken to reduce overdose deaths -- and to enable heroin addicts to live safe and normal lives, whether they cease using heroin or not. All of the above face social and political obstacles and have only been implemented unevenly, if at all. If there is any good to come of Hoffmann's death it will be to the degree that it inspires broader discussion of what can be done to prevent the same thing happening to others in a similar position.

Hoffman, devoted family man and great actor that he was, died a criminal. And perhaps he died because his use of heroin was criminalized. Criminalized heroin -- heroin under drug prohibition -- is of uncertain provenance, of unknown strength and purity, adulterated with unknown substances. While we don't know what was in the heroin that Hoffman injected, we do know that he maintained his addiction and went to meet his maker with black market dope. That's what was found beside his lifeless body.

In a commentary published by The Guardian, actor Russell Brand, a recovered heroin addict, laid the blame for Hoffman's demise on the drug laws. "Addiction is a mental illness around which there is a great deal of confusion, which is hugely exacerbated by the laws that criminalise drug addicts," Brand wrote, calling prohibitionists' methods "so gallingly ineffective that it is difficult not to deduce that they are deliberately creating the worst imaginable circumstances to maximise the harm caused by substance misuse." As a result, "drug users, their families and society at large are all exposed to the worst conceivable version of this regrettably unavoidable problem."

We didn't always treat our addicts this way. Even after the passage of the Harrison Act in 1914, doctors continued for years to prescribe maintenance doses of opiates to addicts -- and hundreds of them went to jail for it as the medical profession fought, and ultimately lost, a battle with the nascent drug prohibition bureaucracy over whether giving addicts their medicine was part of the legitimate practice of medicine.

The idea of treating heroin addicts as patients instead of criminals was largely vanquished in the United States, but it never went away -- it lingers with methadone substitution, for example. But other countries have for decades been experimenting with providing maintenance doses of opioids to addicts, and to good result. It goes by various names -- opiate substitution therapy, heroin-assisted theatment, heroin maintenance -- and studies from Britain and other European countries, such as Germany, the Netherlands, and Switzerland, as well as the North American Opiate Medications Initiative (NAOMI) and the follow-up Study to Assess Long-Term Opiate Maintenance in Canada have touted its successes.

Those studies have found that providing pharmaceutical grade heroin to addicts in a clinical setting works. It reduces the likelihood of death or disease among clients, as well as allowing them to bring some stability and predictability to sometimes chaotic lives made even more chaotic by the demands of addiction under prohibition. Such treatment has also been found to have beneficial effects for society, with lowered criminality among participants and increased likelihood of their integration as productive members of society.

The dry, scientific language of the studies obscures the human realities around heroin addiction and opioid maintenance therapy. One NAOMI participant helps put a human face on it.

"I want to tell you what being a participant in this study did for me," one participant told researchers. "Initially it meant 'free heroin.' But over time it became more, much more. NAOMI took much of the stress out of my life and allowed me to think more clearly about my life and future. It exposed me to new ideas, people (staff and clients) that in my street life (read: stressful existence) there was no time for."

"After NAOMI, I was offered oral methadone, which I refused. After going quickly downhill, I ended up hopeless and homeless. I went into detox in April 2007, abstained from using for two months, then relapsed. In July 2008 I again went to detox and I am presently in a treatment center... I am definitely not "out of the woods" yet, but I feel I am on the right path. And this path started for me at the corner of Abbott and Hastings in Vancouver... Thank you and all who were involved in making NAOMI happen. Without NAOMI, I wouldn't be where I am today. I am sure I would be in a much worse place."

Arnold Trebach, one of the fathers of the drug reform in late 20th Century America, has been studying heroin since 1972, and is still at it. He examined the British system in the early 1970s, when doctors still prescribed heroin to thousands of addicts, and authored a book, The Heroin Solution, that compared and contrasted the US and UK approaches. Later this month, the octogenarian law professor will be appearing on a panel at the Vermont Law School to address what Gov. Peter Shumlin (D) has described as the heroin crisis there.

Phillip Seymour Hoffman (wikimedia.org)
"The death of Phillip Seymour Hoffman is a tragedy all the way around," Trebach told the Chronicle. "It's a bad idea to use heroin off the street, and he shouldn't have been doing that."

That said, Trebach continued, it didn't have to be that way.

"If we had had a sensible system of dealing with this, he would have been in treatment under medical care," he said. "If he was going to inject heroin, he should have been using pharmaceutically pure heroin in a medical setting where he could also have been exposed to efforts to straighten out his personal life, and he could have access to vitamins, weight control advice, and the whole spectrum of medical care. And if he had had access to opioid antagonists, he could still be alive," he added.

While Hoffman may have made bad personal choices, Trebach said, we as a society have made policy choices seemingly designed to amplify the prospects for disaster.

"This is a sad thing. He is just another one of the many victims of our barbaric drug policy," he said. "This was a totally unnecessary death at every level. He shouldn't have been using, but we should have been taking care of him."

The stuff ought to be legalized, Trebach said.

"I'm an advocate of full legalization, but if we can't go that far, we need to at least provide social and psychological support for these people," he said. "And even if we were to decriminalize or legalize, I would still want to figure out ways to provide support and love and kindness to people using the stuff. I advise you not to do it, but if you're going to use it, I want to keep you alive. I remember talking to people from Liverpool [a famous heroin maintenance clinic covered in the '90s by Sixty Minutes, linked above] about harm reduction around heroin use back in the 1970s. One of the ladies said it is very hard to rehabilitate a dead addict."

"There are plenty of things we can be doing," said Hilary McQuie, Western director for the Harm Reduction Network, reeling off a list of harm reduction interventions that are by now well-known but inadequately implemented.

"We can make naloxone (Narcan) more available. We need better access to it. It should be offered to people like Hoffman when they are leaving treatment programs, especially if they've been using opiates, just as a safeguard," she said. "Having treatment programs as well as harm reduction programs distribute it is important. We can cut the overdose rate in half with naloxone, but there will still be people using alone and people using multiple substances."

There are other proven interventions that could be ramped up as well, McQuie said.

"Safe injection sites would be very helpful, so would more Good Samaritan overdose emergency laws, and more education, not to mention more access to methadone and buprenorphine and other opioid substitution therapies (OST)," she said, reeling off possible interventions.

Dr. Martin Schechter, director of the School of Population and Public Health at the University of British Columbia in Vancouver, knows a thing or two about OST. The principal study investigator for the NAOMI and the follow-up SALOME study, Schechter has overseen research into the effectiveness of treating intractable addicts with pharmaceutical heroin, as well as methadone. The results have been promising.

"What we're using is medically prescribed pharmaceutical diacetylmorphine, the active ingredient in heroin," he explained. "It's what you have when you strip away all the street additives. This is a stable, sterile medication from a pharmaceutical manufacturer. We know the precise dose tailored for each person. With street heroin, not only is it adulterated and injected in unsterile situations, but people really don't know how strong it is. That's probably what happened to Mr. Hoffman."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)
In NAOMI, 90,000 injections were administered to study participants, and only 11 people suffered overdoses requiring medical attention.

"Never did we have a fatal overdose," Schechter said. "Because it was in a clinic, nurses and doctors are right there. We administer Narcan (naloxone), and they wake up."

Heroin maintenance had even proven more effective than methadone in numerous studies, Schechter said.

"There have been seven randomized control trials across Europe and in Canada that have shown for people who have already tried treatments like methadone, that medically prescribed heroin is more effective and cost effective treatment than simply trying methadone one more time."

Those studies carry a lesson, he said.

"We have to start looking at heroin from a medicinal point of view and treat it like a medicine," he argued. "The more we drive its use underground, the more overdoses we get. We need to expand treatment programs, not only with methadone, but with medically prescribed heroin for people who don't respond to other treatments."

Safe injection sites are also a worthwhile intervention, Schechter said, although he also noted their limitations.

"Injecting under supervision is much safer; if there is an overdose, there is prompt attention, and they provide sterile equipment, reducing the risk of HIV and Hep C," he said. "But they are still injecting street heroin."

He would favor decriminalizing heroin possession, too, he said.

Harm reduction measures, opioid maintenance treatments, and the like are absolutely necessary interventions, said McQuie, but there is a larger issue at hand, as well.

"We still need to look at the overall issue of the stigmatization of drug users," she said. "People aren't open about their use, and that puts them in a more dangerous situation. It's really hard in a criminalized environment."

Stigmatization means to mark or brand someone or something as disgraceful and subject to strong disapproval. Defining an activity, such as heroin possession, as a crime is stigmatization crystallized into the legal structures of society itself.

"The ultimate harm reduction solution," McQuie argued, "is a regulated, decriminalized environment where it is available by prescription, so people know what they're getting, they know how much to use, and it's not cut with fentanyl or other deadly adulterants. People wouldn't have to deal with all the collateral damage that comes from being defined as criminals as well as dealing with the consequences of their drug use. They could deal with their addictions without having to worry about losing their homes, their families, and their freedoms."

While such approaches have a long way to go before winning wide popular acceptance, policymakers should at least be held to account for the consequences of their decision-making, McQuie said, suggesting that the turn to heroin in recent years was a foreseeable result of the crackdown on prescription opioid pain medication beginning in the middle of the last decade.

"They started shutting down all those 'pill mills' and people should have anticipated what would happen and been ready for it," she said. "What we have seen is more and more people turning to injecting heroin, but nobody stopped to do an impact statement on what would be the likely result of restricting access to pain pills."

The impact can be seen in the numbers on heroin use, addiction, and overdoses. While talk of a "heroin epidemic" is overblown rhetoric, the number of heroin users has increased dramatically in the past decade. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of past year users grew by about 50% between 2002 and 2011, from roughly 400,000 to more than 600,000. At the same time, the number of addicted users increased from just under 200,000 to about 370,000, a slightly lesser increase.

If there is any good news, it is that, according to the latest (2012) National Household Survey of Drug Use and Health, the number of new heroin users has remained fairly steady at around 150,000 each year for the past decade. That suggests, however, that more first-time users are graduating to occasional and sometimes, dependent user status.

And some of them are dying of heroin overdoses, although not near the number dying from overdoses from prescription opioids. Between 1999 and 2007, heroin deaths hovered just under 2,000, even as prescription drug deaths skyrocketed, from around 2,500 in 1999 to more than 12,000 just eight years later. But, according to the Centers for Disease Control, by 2010, the latest year for which data are available, heroin overdose deaths had surpassed 3,000, a 50% increase in just three years.

While the number of heroin overdose deaths is still but a fraction of those attributed to prescription opioid overdoses and the numbers since 2010 are spotty, the increase that showed up in 2010 shows no signs of having gone away. Phillip Seymour Hoffman may be the most prominent recent victim, but in the week since his death, another 50 or 60 people have probably followed him to the morgue due to heroin overdoses.

There are ways to reduce the heroin overdose death toll. It's not a making of figuring out what they are. It's a matter of finding the political and social will to implement them, and that requires leaving the drug war paradigm behind.

New York City, NY
United States

Could Different Drug Policies Have Saved Philip Seymour Hoffman?

The tragic death of actor Philip Seymour Hoffman yesterday has prompted expressions of grief and of praise for his talent. It also, naturally, has prompted discussions of addiction, the impact of pain pill prescriptions on the addicted, even of pain pill restrictions causing more people to turn to heroin.

Philip Seymour Hoffman at the 81st Academy Awards (courtesy Chrisa Hickey, flickr.com/photos/chrisahickey/, via wikimedia.org)
While the latter raises the question about whether different drug policies could make things safer or less damaging or risky for heroin addicts, I haven't heard that question directly raised in the media. Although we don't know how Hoffman would have fared under a different system -- a system that had more options available, we do have information from places that do offer more options, and they are worth examining.

One of those options is heroin maintenance programs (also known now as heroin assisted treatment, or HAT). The most famous such program operated in Liverpool, England, before the conservative Thatcher government, encouraged by the Reagan administration (so we heard), shut it down. But HAT programs current operate in Switzerland, The Netherlands, Germany, Denmark, and the Canadian cities of Vancouver and Montreal. Patients in such programs receive a supply of pharmaceutically-produced heroin from a clinic (for free, though one can infer similar benefits if the heroin were merely cheap). They regularly access health services as a part of their participation. Those who need to inject the drug to relieve their cravings receive instruction on how to do so without damaging their veins, and heroin is made available in other forms as well.

A 2009 paper by leading drug policy researcher Peter Reuter, written for The Abell Foundation in Baltimore, reviewed research done in three of those countries. According to Reuter, Switzerland found a decrease in criminal involvement from 70% of the patients down to 10% after 18 months; and an increase in employment, from 14% to 32%. The health safety results were particularly impressive, including decreased contact with the street drug scene, and with very few adverse events or safety issues.

Many of those findings relate more to indigent addicts than they would to a famous actor. But the final point seems key, very few "adverse events" (e.g. overdoses and so forth) or safety issues, in any of the programs. Again, we don't know how Hoffman would have fared if he had entered a heroin maintenance program instead of buying it on the street. For that matter, we don't know if under legalization, broad or just for the addicted, whether Hoffman would have accessed such services in time, or chose to access them at all. But we know that many people do access these services in the countries that offer them, and that very few of the patients enrolled suffer overdose.

More generally, by prohibiting heroin, even for people who are already addicted to it, we prevent a whole class of possible approaches from every being taken to try to help people -- a whole set of options that people with substance abuse problems might be able to use to manage their problems -- to literally save their lives.

In the meanwhile, there are things to do that are legal even now, at least in a few states that have moved forward with them, with no federal laws standing in the way. These are Good Samaritan policies, that protect people from criminal liability when they seek help in an overdose situation; and use of the antidote medication for heroin overdoses, Naloxone. Meghan Ralston wrote about these in an oped yesterday.

We can also improve the debate. It's not enough to talk about the challenges of addiction and the risk of relapse people can face their entire lives, important as that is. It's a good start that people are starting to recognize the unintended consequences of the pain pill crackdown. But that isn't enough either. It's also important to take the next logical step in the argument, and rethink prohibition.

Editorial: Did Trey Radel Really Vote for Drug Testing?

One of the top political stories this week was the recent arrest of Rep. Trey Radel, a freshman Republican congressman from Florida. Radel pleaded guilty to cocaine possession yesterday and was sentenced to a year of supervised probation. Last night he gave a press conference to apologize to the country and his constituents and family, and announced he would be taking a leave of absence to pursue counseling and drug treatment.

http://www.stopthedrugwar.org/files/borden12.jpg
David Borden
Since the bust came to light, numerous headlines have circulated to the effect of Radel having voted for legislation to drug test food stamp recipients. But this is only true in a technical sense. As the text of these articles notes, unlike their headlines, the legislation Radel voted for was an ultimately failed version of the Farm Bill, one of the recurring major federal budget packages authorized every five years. Drug testing was a noxious but small part of the legislation, which also was a mechanism for continuing agricultural subsidies, for continuing the SNAP program itself, and many other things. There were Democrats who voted for the bill too, the roll call shows, some of them liberals who undoubtedly opposed the drug testing provision. Also, the amendment that got drug testing added to the Farm Bill was passed through a voice vote, and there is therefore no record of who voted for or against it. That means that Radel's vote for the Farm Bill could have been consistent with supporting drug testing of SNAP recipients, opposing drug testing, or having no position on it. There is no way to know without delving further. Politicians often have to vote for bills despite there being provisions they don't like, because they want an overall bill to pass.

Radel is also one of just three Republican sponsors of the Justice Safety Valve Act, a bill to undo mandatory minimum sentencing by allowing judges to impose sentences below any specified minimums. Although mandatory minimums extend to more issues than drugs, it is drug offenders who are the principle targets of them. So Radel has actually done more than most members of Congress to try to at least reduce the use of incarceration in America, and for drug offenders in particular. A piece published on ThinkProgress.org Tuesday in fact noted a number of statements Radel has made that express skepticism about drug war policies. It also noted that he has expressed opposition to marijuana legalization, so there are facts on both sides. On the other hand, most members of Congress are still likely to say they're not for legalization, despite our movement's recent victories and where opinion polls have gone, so I'm not inclined to attach much significance to that.

Radel news conference, 11/20/13 (TodayNews via YouTube)
That doesn't mean there isn't a valid lesson to be learned from the Radel arrest. A Politico article fairly described the incident as "bring[ing] up drug testing for food stamps." Nancy Pelosi legitimately made this point. Radel's Republican colleagues who are the main supporters of the drug testing amendment may deserve the hypocrisy charge. But it's less than clear that Radel does.

More important than piling on a member of Congress who probably doesn't deserve it, but more important in any case, is to make the points that the incident helps to illustrate about the discrimination and injustices inherent in drug war policies -- like drug testing poor people who don't use drugs more than anyone else, and throwing them out the window when they make the same mistakes in their stressful lives that many others who have easier lives make too.

FDA Panel Wants Tighter Control over Pain Pills

A US Food and Drug Administration advisory panel voted last Friday to recommend that popular pain relievers containing the opioid hydrocodone be moved from Schedule III to Schedule II of the Controlled Substances Act. Popular prescription drugs containing hydrocodone include Vicodin and Lortab.

That would put Lortab and Vicodin in the same schedule as morphine and Oyxcontin, which contains oxycodone.

If the FDA agrees with its advisory panel and reschedules hydrocodone, pain patients using the drug will have to go the doctor's office to get prescriptions written twice as frequently as now. Schedule III drugs can be prescribed for up to six months at a time, while Schedule II drugs can only be prescribed for three months without another visit to the doctor.

The FDA has for years resisted efforts to tighten controls over hydrocodone, saying it could limit patients' access to pain medicine, but as overdose deaths and addiction rates from prescription pain relievers have jumped in recent years, pressure has been mounting on the agency. The agency is acting now after receiving a request from the DEA to consider rescheduling.

The advisory panel's 19-10 vote received mixed reviews from experts consulted by the Milwaukee Journal-Sentinel.

Andrew Kolodny, a psychiatrist and addiction specialist who heads Physicians for Responsible Opiate Prescribing lauded the vote, saying it will lead to fewer people getting addicted to opiates.

"Doctors have had a false sense of security (about prescribing the drugs)," said Kolodny. "This is a clear message that hydrocodone is addictive," he told the Wisconsin newspaper.

"It seemed pretty clear to me that the preponderance of the evidence supported rescheduling," said Peter Kaboli, associate professor at the University of Iowa Carver College of Medicine.

But Jan Chambers, president of the National Fibromyalgia and Chronic Pain Association, said she voted against the proposal because she has heard so much from family members of people who have committed suicide because they are in such pain.

"Millions of people don't have access to the pain specialist or the doctors who can prescribe these Schedule III drugs," she said.

And Lynn Webster, president-elect of the American Academy of Pain Medicine, said putting tighter controls on hydrocodone will reduce prescribing and abuse, but worried about the impact on pain patients.

"I hope chronic pain patients and acute pain patients don't suffer as a result," said Webster, who spoke at the panel hearing but was not a panel member.

The FDA has not said when it will make a final decision on the issue. Now, the FDA and the National Institutes of Health must make a recommendation to the assistant secretary for health, who will make a final recommendation to the DEA.

Washington, DC
United States

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