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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: NV Syringe Vending Machines, Good and Bad CO MJ Bills, More... (4/17/17)

Nevada will soon see the first syringe vending machines in the country, the Colorado legislature responds to a threatened federal crackdown -- for better and worse -- Wisconsin Gov. Scott Walker is moving forward with plans to drug test Medicaid recipients, and more.

Syringe vending machines -- coming first to Nevada. (wikimedia.org)
Marijuana Policy

A Majority of American Adults Have Tried Marijuana, Poll Finds. A new Marist/Yahoo poll finds that 52% of American adults have tried marijuana at least once, and that 56% find the drug "socially acceptable. The same poll has support for legalization at 49%, with 47% opposed.

DC Marijuana Activists to Hand Out Free Joints on Capitol Hill for 4/20. The same folks who brought legal marijuana to the nation's capital are planning to hand out more than a thousand free marijuana joints on Capitol Hill Thursday, 4/20, the unofficial marijuana holiday. Anyone over 21 who has a congressional ID is eligible for the free weed, said DCMJ. The activists said the action was meant to life the "special interest smokescreen" blocking marijuana reform in Congress.

Homeland Security Chief Says Marijuana "Not a Factor" in Drug War. DHS Secretary John Kelly said Sunday that marijuana is "not a factor" in the country's drug war and that "arresting a lot of users" will not solve the country's drug problems. Kelly responded to a question about whether legalizing marijuana in the US would help or hinder his work attempting to interdict drug shipments to the US. "Yeah, marijuana is not a factor in the drug war," Kelly responded, adding later: "It's three things. Methamphetamine. Almost all produced in Mexico. Heroin. Virtually all produced in Mexico. And cocaine that comes up from further south." And rather than arresting users: "The solution is a comprehensive drug demand reduction program in the United States that involves every man and woman of goodwill. And then rehabilitation. And then law enforcement. And then getting at the poppy fields and the coca fields in the south."

Colorado Social Consumption Bill Dies. A bill that would have set up the country's first statewide law allowing for on-premises marijuana consumption at licensed businesses is dead, with legislators citing fear of a federal crackdown for its demise. The House voted last Thursday to amend Senate Bill 17-184 to remove the provision that would have allowed adults to bring their own weed to businesses and consume it on-premises.

Colorado Senate Approves Bill to Shift Legal Marijuana Inventories Over to Medical Marijuana in Event of Federal Crackdown. The state Senate has approved Senate Bill 17-192, which would allow adult-use marijuana businesses to transfer their inventory to medical marijuana status if a federal crackdown on adult-legal weed happens. The bill now goes to the House.

Nevada Legislature Still Faces Heavy Load of Marijuana Bills. The legislative session marked its first key deadline last Friday when all proposed bills had to have passed out of their committee of introduction or be declared dead. And fourteen marijuana-related bills remain alive, including one, Senate Bill 302, that would allow dispensaries to begin selling marijuana to any adult beginning in July. Click the link for the rest of the bills and their status.

Tennessee Governor Signs Bill Killing Decrim in Memphis and Nashville. Gov. Bill Haslam (R) last Friday signed into law House Bill 173, which bars cities in the state from crafting marijuana penalties lesser than state law. The bill was a response to moves by the state's two largest cities, Memphis and Nashville, which had passed municipal decriminalization ordinances.

Medical Marijuana

Arkansas Regulators Finalize Medical Marijuana Rules. The state Medical Marijuana Commission last Tuesday gave final approval to rules governing dispensaries and cultivation facilities. The rules must still be approved by the legislature, which has passed some legislation that appears to conflict with them. The legislature only has until May 8 to modify the rules or the state will be out of compliance with the Medical Marijuana Act, which is now part of the state constitution.

Heroin and Prescription Opioids

Alabama House Approves Tougher Penalties for Heroin, Fentanyl. The House voted last week to approve harsh new penalties for the possession and sale of heroin and fentanyl. In a unanimous vote, the chamber approved a one-year mandatory minimum sentence for simple possession and increased penalties for trafficking, including a mandatory life sentence without parole for trafficking 10 or more kilos of either drugs. The bill is House Bill 203, which is now before the Senate.

Maryland General Assembly Passes Package of Heroin/Opioid Bills. The Assembly last week approved a package of bills aimed at tackling the state's heroin and prescription opioid crisis. One bill would create 24/7 drug treatment centers for addicts, increase reimbursements for drug treatment, and ease access to the opioid overdose reversal drug naloxone. A second bill would create drug awareness programs in schools and allow school nurses to stock and dispense naloxone. A third bill would require doctors to follow best practices when prescribing opioids, while a fourth bill increases prison sentences for people convicted of fentanyl offenses. The bills now await the governor's signature.

Asset Forfeiture

Arizona Governor Signs Civil Asset Forfeiture Reform Bill. Gov. Doug Ducey (R) last week signed into law House Bill 2477, which requires a higher evidentiary standard before police and prosecutors can seize assets from suspects. Instead of a "preponderance" of the evidence, cops must now provide "clear and convincing evidence" that the assets are linked to a crime.

Drug Policy

New York City Council Passes Bill to Coordinate Drug Policy Among City Departments. The city council recently passed legislation to create a coordinated municipal drug strategy. The bill empowers the Mayor to designate a lead agency or office to convene stakeholders including city agencies, outside experts, and communities impacted by drug use to develop a city-wide, health-focused plan for a coordinated approach in addressing issues related to drug use.

West Virginia Legislature Passes Bill Creating Drug Policy Office. A bill that would create an Office of Drug Control Policy within the Department of Health and Human Services has passed both houses of the legislature and awaits the governor's signature. The measure, House Bill 2620, passed last Friday, the final day of the session. Gov. Jim Justice (D) has fifteen days to sign the bill.

Drug Testing

Wisconsin Governor Moving Forward With Plan to Drug Test Medicaid Recipients. Gov. Scott Walker (R) on Monday posted his proposal for moving people off state Badgercare Medicaid, which includes a provision requiring drug screenings for Medicaid recipients. People suspected of illegal drug use after screening would be ineligible for coverage until they are tested. People who test positive would be offered drug treatment, while people who refuse the test would lose benefits for six months.

Harm Reduction

Nevada Becomes First State to Install Needle Vending Machines. In a bid to combat the spread of HIV/AIDS and Hep C, a needle exchange program in Las Vegas is now providing clean needles in vending machines. The Las Vegas Harm Reduction Center worked together with the Southern Nevada Health District and the Nevada AIDS Research and Education Society to install the new machines. Each client will be limited to two kits per week, with the kits including syringes, alcohol wipes, condoms, and a needle disposal box.

International

Canada Unveils Plan for Legal Marijuana Sales by June 2018. The Liberal government of Prime Minister Justin Trudeau last Thursday filed legislation designed to implement marijuana legalization by June of next year. The bill would allow adults 18 and over to possess up to 30 grams of dried marijuana and would allow the federal government to regulate producers, while the provinces would regulate sales to consumers. Other issues, such as pricing, taxation, and packaging are still to be worked out.

Chronicle AM: Legal MJ Industry Reacts to Spicer Threat, VA Needle Exchange, More... (2/24/17)

The uproar is deafening in the wake of White House press secretary Sean Spicer's hint Thursday that Trump could crack down on legal weed, Virginia's governor signs a needle exchange bill into law, the Arizona House unanimously passes asset forfeiture reform, and more.

Needle exchange programs are coming to Virginia under a new law just signed by the governor. (Creative Commons/Wikimedia)
Marijuana Policy

Marijuana Industry, Advocates React to Spicer Threat. White House press secretary Sean Spicer's statement Thursday that he expects the Justice Department to crack down on recreational marijuana in states where it is legal has excited a firestorm in the industry and among advocates. "To have Mr. Spicer say in one sentence that they're a states' rights administration and in the very next sentence say they're going to crack down... it just defies logic," said Robert Capecchi, director of federal policies for the Marijuana Policy Project, an organization that lobbies for pot-friendly changes to drug-related legislation. Click on the link for more reaction.

Medical Marijuana

North Carolina Medical Marijuana Bill Filed. House Democrats Wednesday introduced House Bill 185, a full-fledged medical marijuana bill that contains generous provisions on the amount of marijuana patients may possess (up to 24 ounces or "an adequate supply" as determined by a physician) and grow (up to 250 square feet of canopy), as well as providing for caregivers and establishing a system of dispensaries and commercial medical grows. Similar bills died in the 2015-2016 session, with one issued an "unfavorable report," meaning its subject matter could not be considered by the House for two years.

Asset Forfeiture

Arizona House Unanimously Passes Asset Forfeiture Reform Bill. The House voted unanimously Thursday to approve House Bill 2477, which sets a higher evidentiary standard for prosecutors to overcome before they can seize cash or property under civil asset forfeiture. Currently, prosecutors need prove only "a preponderance of the evidence," but under this bill, they would have to provide "clear and convincing evidence" the property or cash was linked to a crime. The bill doesn't abolish civil asset forfeiture, but does tighten it. It would also bar prosecutors from doing an end-run around state laws by passing cases off to the feds. The bill now heads to the Senate.

Harm Reduction

Virginia Governor Signs Needle Exchange Bill. Gov. Terry McAuliffe (D) has signed into law House Bill 2317, which authorizes the state health commissioner to establish and operate needle exchange programs after declaring a public health emergency. Health Commissioner Dr. Marissa Levine and Gov. McAuliffe declared that emergency last year.

International

Bolivian Congress Approves Near Doubling of Legal Coca Cultivation.The lower house approved a bill Thursday that would nearly double the amount of land allowed for legal coca cultivation, and the Senate approved it Friday. The bill would allow farmers to plant up to about 50,000 acres with coca, up dramatically from the 30,000 acres currently allowed. Even that new, higher limit was too much for some coca farmers, who want no limits, and clashed violently with police earlier this week.

Chronicle AM: Guam Gov Files Legalization Bill, More Iran Drug Executions, More... (1/11/17)

Marijuana legalization bills get filed in Guam and the District of Columbia, the Global Drug Policy Commission asks Obama to commute more sentences, Chris Christie vows to fight drug addiction during his last year in office, and more.

Iran has already executed ten drug offenders this year, with another dozen set to face the gallows. (iranhr.org)
Marijuana Policy

Guam Governor Files Legalization Bill. Gov. Eddie Calvo Tuesday introduced a bill to legalize marijuana on the US island territory. "I am introducing this bill, not because I personally support the recreational use of marijuana, but as a solution to the regulatory labyrinth that sprouted from the voter-mandated medical marijuana program," Calvo said in a press release. The measure would legalize marijuana for people over 21 and impose a 15% tax on sales. Medical marijuana patients would be exempt from the tax.

DC Councilmember Files Bill for Legal Marijuana Commerce and Regulation. Councilmember David Grosso Tuesday filed a bill to establish a full tax and regulatory framework for legal marijuana commerce. If passed, the bill would put the District in conflict with Congress, which must approve city spending. But Grosso said that Congress had forced the District's hand with its meddling in city affairs.

Drug Policy

New Jersey Governor Vows to Heighten Fight Against Drug Addiction. In his final state of the state address, Gov. Chris Christie (R) said he will spend his last year as governor fighting drug addiction. "Our state faces a crisis which is more urgent to New Jersey's families than any other issue we could confront," Christie told the legislature in Trenton. "Beyond the human cost, which is incalculable, there is a real cost to every part of life in New Jersey." Christie is pushing for treatment instead of jail for nonviolent drug offenders, expanded drug courts, and expanded needle exchange programs, among other initiatives.

Law Enforcement

Federal Bill to Clear Way for more Surplus Military Gear for Police Filed. Rep. John Ratcliffe (R-TX) has filed House Resolution 426, which would bar the federal government from limiting the sale or donation of excess federal property to state and local agencies for law enforcement purposes. The bill is a response to the Obama administration's short-lived decision last year to block the transfer of military-style equipment to domestic police forces.

Sentencing

Global Drug Policy Commission Asks Obama to Free More Prisoners. In an open letter to the outgoing president, the commission, which includes a number of former heads of state, thanked Obama for his efforts to shift from a punitive approach to drugs, noted that he had freed more than a thousand drug war prisoners through his clemency program, and asked for more: "We hope that in these final days of your presidency, you will use the power of your office to commute even more prison sentences of low-level drug offenders, and restore dignity and hope to their lives," the commission wrote. "May your example inspire not only your successor, but also governors across the country."

International

Colombia Coca Cultivation Set to Increase. Colombia's post-conflict minister, Rafael Pardo, said Tuesday that coca cultivation will increase this year, the third year in a row that has seen increases in the country's coca crop. Pardo said part of the reason was the government's turn away from using aerial eradication, but that a bigger part was the government's devaluation of the peso, which dramatically increased profit margins for drug traffickers.

Iran Starts New Year With Spate of Drug Executions. The world's leading drug executioner is at again. In the first week of the new year, Iran executed 16 people, 10 of them for drug offenses. Iran executes hundreds of people each year, with drug offenders accounting for an increasing number of them. In 2015, the last year with full statistics, 66% of all executions in Iran were for drug offenses. Another 12 prisoners were set to be executed for drug offenses this week.

Chronicle AM: CT Legalization Bills Filed, WI CBD Bill Set to Move This Year, More... (1/6/17)

Connecticut legislators prepare to take up marijuana legalization, Wisconsin legislators look set to pass a CBD bill this year, Indiana's new governor will ease up on needle exchange restrictions, and more.

Legal weed could be coming to Connecticut. (Wikimedia)
Marijuana Policy

Legalization Bills Filed in Connecticut. At least three pot legalization bills have been filed for the looming session of the state legislature, including one from state Rep. Melissa Ziobron (R-East Hampton) and one from Senate President Pro Tem Martin Looney (D-New Haven). Only Looney's bill yet shows up on the state legislative website. It is Senate Bill 11.

Medical Marijuana

After Key Legislator Waives Objection, Wisconsin Could See CBD Bill Passed. Legislation to allow the use of CBD cannabis oil could pass this year after key opponents last year said they would get out of the way this year. The Assembly passed a CBD bill last year, only to see it derailed in the Senate by opposition from three Senate Republicans, Leah Vukmir, Duey Stroebel, and Mary Lazich. Vukmir now says she will support a CBD bill, Stroebel is staying silent, and Lazich is gone. The bill is expected to be introduced later this month.

Heroin and Prescription Opioids

Wisconsin Governor Calls for Legislative Special Session on Heroin. Gov. Scott Walker (R) said Thursday he will order a special session of the legislature to "fight heroin addiction." He is also calling on state agencies to ramp up their responses to opioid use in the state. "This is a public health crisis, and that's why I'm calling a special session of the Legislature and directing state agencies to ramp up the state's response," Walker said. Opioid overdose deaths have been on the rise in the state for nine straight years. Walker is eyeing a package of bills that include expanding access to naloxone, Good Samaritan 911 protections for reporting overdoses, a civil commitment procedure for addicts, and requiring codeine-containing cough syrups to be prescription-only.

Harm Reduction

Indiana's Incoming Governor to Ease Pence's Needle Exchange Restrictions. Governor-to-be Eric Holcomb (R) vowed Thursday to roll back restrictions on needle exchanges signed into law by his predecessor, Vice President-elect Mike Pence. Holcomb said local -- not state -- officials should be able to authorize needle exchanges. Holcomb has also created a "drug czar" position within his incoming administration, which will, among other duties, seek increased funding for needle exchanges.

The Top Ten Domestic Drug Policy Stories of 2016 [FEATURE]

As 2016 comes to a tumultuous end, we look back on the year in drugs and drug policy. It's definitely a mixed bag, with some major victories for drug reform, especially marijuana legalization, but also some major challenges, especially around heroin and prescription opioids, and the threat of things taking a turn for the worse next year. Here are the ten biggest domestic drug policy stories of the year. (Check back for a top ten international drug policy stories soon.)

1. Marijuana Legalization Wins Big

Legalization initiatives won in California, Maine, Massachusetts, and Nevada, losing only in Arizona. These weren't the first states to do so -- Colorado and Washington led the way in 2012, with Alaska, Oregon, and Washington, DC, following in 2014 -- but in one fell swoop, states with a combined population of nearly 50 million people just freed the weed. Add in the earlier states, and we're now talking about around 67 million people, or more than one-fifth of the national population.

The question is where does marijuana win next? We won't see state legalization initiatives until 2018, (and conventional wisdom may suggest waiting for the higher-turnout 2020 presidential election year), and most of the low-hanging fruit in terms of initiative states has been harvested, but activists in Michigan came this close to qualifying for the ballot this year and are raring to go again. In the meantime, there are the state legislatures. When AlterNet looked into the crystal ball a few weeks ago, the best bets looked like Connecticut, Maryland, New Mexico, Rhode Island, and Vermont.

2. Medical Marijuana Wins Big

Medical marijuana is even more popular than legal marijuana, and it went four-for-four at the ballot box in November, adding Arkansas, Florida, Montana, North Dakota to the list of full-blown medical marijuana states. That makes 28 states -- more than half the country -- that allow for medical marijuana, along with another dozen or so red states that have passed limited CBD-only medical marijuana laws as a sop to public opinion.

It's worth noting that Montana is a special case. Voters there approved medical marijuana in 2004, only to see a Republican-dominated state legislature gut the program in 2011. The initiative approved by voters this year reinstates that program, and shuttered dispensaries are now set to reopen.

The increasing acceptance of medical marijuana is going to make it that much harder for the DEA or the Trump administration to balk at reclassifying marijuana away from Schedule I, which is supposedly reserved for dangerous substances with no medical uses. It may also, along with the growing number of legal pot states, provide the necessary impetus to changing federal banking laws to allow pot businesses to behave like normal businesses.

Drug reformers are nervous about the future. (Gage Skidmore/Creative Commons)
3. The Republicans Take Control in Washington

The Trump victory and Republican control of both houses of Congress has profound drug policy implications, for everything from legal marijuana to funding for needle exchange programs to sentencing policy to the border and foreign policy and beyond. Early Trump cabinet picks, such as Alabama Sen. Jeff Sessions (R) to lead the Justice Department, are ominous for progressive drug reform, but as with many other policy spheres, what Trump will actually do is a big unknown. It's probably safe to say that any harm reduction programs requiring federal funding or approval are in danger, that any further sentencing reforms are going to be in for a tough slog, and that any federal spending for mental health and substance abuse treatment will face an uphill battle. But the cops will probably get more money.

The really big question mark is around marijuana policy. Trump has signaled he's okay with letting the states experiment, but Sen. Sessions is one of the most retrograde of drug warriors in Washington. Time will tell, but in the meantime, the marijuana industry is on tenterhooks and respect for the will of voters in pot legal states and even medical marijuana states is an open question.

4. The Opioid Epidemic Continues

Just as this year comes to an end, the CDC announced that opioid overdose deaths last year had topped 33,000, and with 12,000 heroin overdoses, junk had overtaken gunplay as a cause of death. There's little sign that things have gotten any better this year.

The crisis has provoked numerous responses, at both the state and the federal levels, some good, but some not. Just this month, Congress approved a billion dollars in opioid treatment and prevention programs, and the overdose epidemic has prompted the loosening of access to the opioid overdose reversal drug naloxone and prodded ongoing efforts to embrace more harm reduction approaches, such as supervised injection sites.

On the other hand, prosecutors in states across the country have taken to charging the people who sell opioids (prescription or otherwise) to people who overdose and die with murder, more intrusive and privacy-invading prescription monitoring programs have been established, and the tightening of the screws on opioid prescriptions is leaving some chronic pain sufferers in the lurch and leading others to seek out opioids on the black market.

5. Obama Commutes More Than a Thousand Drug War Sentences

In a bid to undo some of the most egregious excesses of the drug war, President Obama has now cut the sentences of and freed more than a thousand people sentenced under the harsh laws of the 1980s, particularly the racially-biased crack cocaine laws, who have already served more time than they would have if sentenced under current laws passed during the Obama administration. He has commuted more sentences in a single year than any president in history, and he has commuted more sentences than the last 11 presidents combined.

The commutations come under a program announced by then-Attorney General Eric Holder, who encouraged drug war prisoners to apply for them. The bad news is that the clock is likely to run out before Obama has a chance to deal with thousands of pending applications backlogged in the Office of the Pardons Attorney. The good news is that he still has six weeks to issue more commutations and free more drug war prisoners.

6. The DEA Gets a Wake-Up Call When It Tries to Ban Kratom

Derived from a Southeast Asian tree, kratom has become popular as an unregulated alternative to opioids for relaxation and pain relief, not to mention withdrawing from opioids. It has very low overdose potential compared to other opioids and has become a go-to drug for hundreds of thousands or perhaps millions of people.

Perturbed by its rising popularity, the DEA moved in late summer to use its emergency scheduling powers to ban kratom, but was hit with an unprecedented buzz saw of opposition from kratom users, scientists, researchers, and even Republican senators like Orrin Hatch (R-UT), who authored and encouraged his colleagues to sign a letter to the DEA asking the agency to postpone its planned scheduling.

The DEA backed off -- but didn't back down -- in October, announcing that it was shelving its ban plan for now and instead opening a period of public comment. That period ended on December 1, but before it did, the agency was inundated with submissions from people opposing the ban. Now, the DEA will factor in that input, as well as formal input from the Food and Drug Administration before making its decision.

The battle around kratom isn't over, and the DEA could still ban it in the end, but the whole episode demonstrates how much the ground has shifted under the agency. DEA doesn't just get its way anymore.

7. Federal Funds for Needle Exchanges Flow Again

It actually happened late in 2015, but the impact was felt this year. In December 2015, Congress approved an omnibus budget bill that removed the ban on federal funding of needle exchanges. The ban had been in place for 20 years, except for a two-year stretch between 2009 and 2011, when Democrats controlled the House.

Federal funding for needle exchanges is another drug policy response that could be endangered by Republican control of both the Congress and the presidency.

Vancouver's safe injection site. Is one coming to a city near you? (vch.ca)
8. The Slow Turn Towards Safe Injection Sites Accelerates

When will the US join the ranks of nations that embrace the harm reduction tactic of supervised drug consumption sites? Maybe sooner than you think. Moves are underway in at least three major US cities to get such facilities open, a need made all the more urgent by the nation's ongoing opioid crisis, as the Drug Policy Alliance noted in a December report calling for a number of interventions, including safe injection sites, to address it.

In New York City, the city council has approved a $100,000 study into the feasibility of safe injection sites, while in San Francisco, city public health officials have endorsed a call for them there and have even suggested they need as many as a half dozen. But San Francisco Mayor Ed Lee opposes them, so battle lines are being drawn.

The best bet may be Seattle, where city and surrounding King County officials are on board with a plan to open safe injection sites to fight heroin and prescription opioid abuse. That plan, conceived by the Heroin and Prescription Opiate Addiction Task Force, was released in September.

9. Asset Forfeiture Reform Advances

Nearly 20 years after Congress passed limited federal civil asset forfeiture reform, the practice is now under sustained assault in the states. More than a half-dozen states had passed civil asset forfeiture reforms before the year began, and this year the following states came on board (although some of the new laws did not end, but only modified or restricted civil asset forfeiture): California, Florida, Mississippi, Nebraska, Ohio, Oklahoma, Tennessee, and Wyoming.

And next year looks to be more of the same. Bills have already been filed in Missouri and Texas, and renewed efforts are likely in New Hampshire and Wisconsin, where they were thwarted this year.

10. The DEA is Busting Fewer People

The Transactional Records Access Clearinghouse (TRAC) reported in December that convictions for drug cases referred by the DEA continued a 10-year decline. During Fiscal Year 2016, federal prosecutors won 9,553 criminal convictions on cases referred by the DEA. That's down 7.1% from the previous year, down 25% from five years ago, and down 35% from 10 years ago. TRAC notes that the decline in convictions is the result of fewer referrals by the DEA, not a lowered conviction rate, which has held steady.

Chronicle AM: World AIDS Day, Psilocybin Could Help Terminal Patients, More... (12/1/16)

New studies suggest psychedelics could help terminal patients deal with their fears, the Ohio legislature prepares to pass asset forfeiture reform, and more.

Psilocybin, the psychedelic ingredient in magic mushrooms, can help terminal patients cope, a pair of new studies suggests.
Psychedelics

Studies Suggest Magic Mushrooms Could Help Cancer Patients Deal With Fear. A pair of studies published Thursday in the Journal of Psychopharmacology suggest that psilocybin, the psychedelic drug in magic mushrooms, could help terminal cancer patients cope with fear and anxiety around impending death. "The findings are impressive, with good safety data and large effect sizes," says Robin Carharrt-Harris, who studies psychedelic drugs at Imperial College London. "My feeling is that these studies will play a significant role in waking up the scientific and medical mainstream to the therapeutic potential of psychedelics."

Asset Forfeiture

Ohio Legislature Poised to Pass Civil Asset Forfeiture Reform, Despite Police and Prosecutors' Opposition. Legislative leaders say they expect to pass a civil asset forfeiture reform bill in the state Senate next week. The measure, House Bill 347, passed the House in the spring, but was delayed in the Senate when a committee approved an amendment to address concerns raised by prosecutors. The bill originally would have eliminated civil asset forfeiture, but now has been softened to allow it if the property owner is dead, the suspect cannot be located, or the owner does not claim the property. It also allows for civil forfeiture post-conviction.

Harm Reduction

It's World AIDS Day. We Can't End AIDS Until We End the War on Drugs. "Today, December 1, is World AIDS Day," writes the Drug Policy Alliance's Laura Thomas. "In 1989, I was arrested in front of the White House on World AIDS Day, demanding that then-President Bush take action on HIV/AIDS. Among the issues we were demanding action on then, so many years ago, was the availability of sterile syringes for people who inject drugs, so they could stop the transmission of HIV. In the decades since, we have celebrated amazing victories against HIV/AIDS. We now have treatments we could only dream of then. We have pills that will prevent HIV. We have a National HIV/AIDS Strategy. We even have an effective cure for hepatitis C. And we are keeping many, many more people with HIV alive now. And yet, it is syringe access -- needle exchange -- that we have been the slowest to win…" Click on the link for the whole post.

Chronicle AM: Calls for Obama to Cut More Sentences, Iran Drug Death Penalty Moves, More... (11/29/16)

Scholars, advocates, and a US congressman are calling on Obama to ramp up the commutation process in the final weeks of his term, the CDC issues a report calling for expanded syringe exchange, Maryland moves to address racial diversity (or the lack thereof) in the medical marijuana business, and more.

There are new calls for Obama to ramp up the commutation process as the clock ticks down on his term. (nadcp.org)
Marijuana Policy

Massachusetts Marijuana Victory Faces Certification Delay. Secretary of State William Galvin said Monday that the November 8 election results may not be certified in time for marijuana legalization to go into effect on December 15, that date it is supposed to become legal. Ballot initiatives in the state do not become law until they are officially certified, and a December 14 meeting is the earliest date voting tallies on the initiative are likely to presented, Galvin said. But if not by December 15, certainly by early next year, he added: "All those tokers can hold their breath a little longer, but they'll be able to exhale" by early 2017, Galvin quipped.

Medical Marijuana

Maryland Moving to Improve Diversity in Medical Marijuana Industry. The state Cannabis Commission announced Monday that it is hiring a consultant to advise it on steps it can take to improve racial diversity in the nascent industry. The consultant will decide whether a study can be conducted to determine whether minorities have been unfairly excluded. If such a finding is made, that would allow the state to consider race when awarding medical marijuana licenses.

Harm Reduction

Groundbreaking Report from CDC Calls for Expansion of Syringe Access Programs. In a report on HIV and injection drug use released Tuesday, the Centers for Disease Control and Prevention (CDC) calls strongly for expanding needle exchange programs. "Syringe services programs (SSPs) can play a role in preventing HIV and other health problems among people who inject drugs (PWID)," the report found. "They provide access to sterile syringes and should also provide comprehensive services such as help with stopping substance misuse; testing and linkage to treatment for HIV, hepatitis B, and hepatitis C; education on what to do for an overdose; and other prevention services. State and local health departments can work with their lawmakers and law enforcement to make SSPs more available to PWID."

Sentencing

Calls Mount For Obama to Ramp Up Commutations as Term Nears End. A coalition of scholars and activists as well as a US congressman are calling on President Obama to expand clemency efforts in the final weeks of his administration -- including considering granting clemency to entire groups of people without case-by-case review. Obama has commuted the sentences of more than a thousand people sentenced under draconian drug war sentencing laws, but thousands more have applied for commutations without those applications yet being acted on.

International

Iran Keeps Moving Toward Ending the Death Penalty for Drugs. The Iranian parliament last week agreed to expedite deliberations on a measure that would dramatically limit the number of people facing execution for drug offenses in the Islamic Republic. Now, the proposal will get top priority in the Legal and Social Affairs Committee before heading before the full parliament. The measure would limit the death penalty to "organized drug lords," "armed trafficking," "repeat offenders," and "bulk drug distributors." Iran is one of the world's leading drug executioners, with drug offenders accounting for the vast majority of the more than a thousand people it executed last year.

Chronicle AM: MT MedMJ Patients Out of Luck, Christie Signs Needle Exchange Funding, More... (9/1/16)

It the end of easy access for Montana medical marijuana patients, the Arizona Supreme Court rejects the last challenge to that state's legalization initiative, the second Arkansas medical marijuana initiative is now officially on the ballot, Chris Christie signs a needle exchange funding bill, and more.

Chris Christie does the right thing on needle exchange. (Creative Commons/Gage Skidmore)
Marijuana Policy

More Smoke Pot, Fewer Find it Risky, Survey Reports. Survey data shows more adults are using marijuana, they are using it more often, and they're less inclined to think it's risky than in the past, research results reported in The Lancet found. The number of adults using marijuana in the past year has jumped to 32 million -- going from one in ten in 2002 to one in eight in 2014. Only one-third of adults thought weekly marijuana use was risky, down from half in 2002.

Alaska Attorney General Says Pot Social Clubs Are Illegal. State Attorney General Jahna Lindemuth said in a legal opinion Wednesday that marijuana social clubs are illegal. "Under Alaska law, a business cannot sell or provide marijuana or allow marijuana to be consumed on the premises unless it is licensed as a retail marijuana store by the Marijuana Control Board," Lindemuth wrote. The ruling does not apply to retail pot shops, for which state regulators are considering rules that would allow on-site cannabis consumption.

Arizona Supreme Court Rejects Challenges to Pot Legalization Initiative. Arizonans will be voting on Proposition 205 on November 8. The state Supreme Court has thrown out the last challenges to the measure, which accused it of misleading voters with its language, but the high court upheld a lower court ruling that Prop 205 substantially complies with legal requirements for initiatives.

Medical Marijuana

It's Official: Second Arkansas Initiatives Qualifies for the Ballot. Secretary of State Mark Martin's office said Wednesday that the Arkansas Medical Marijuana Amendment had submitted sufficient valid voter signatures to qualify for the November ballot. That means Arkansas voters will have two medical marijuana initiatives to vote on. The Arkansas Medical Cannabis Act was approved for the ballot in July. If both pass, the one with the most votes goes into effect.

Delaware Governor Signs Bill Allowing Medical Marijuana for Terminally Ill. Gov. Jack Markell (D) Wednesday signed into law "Bob's Bill," named for lung cancer patient Robert Jester, who died in 2014 without being able to legally use marijuana to ease his suffering. The bill allows for medical marijuana for terminally ill patients, including those under 18 who are suffering pain, anxiety, or depression.

Montana Medical Marijuana Patients Now Out of Luck. In the biggest medical marijuana rollback ever, as of September 1, medical marijuana dispensaries are now illegal, and up to 12,000 patients have lost legal access to marijuana. Medical marijuana providers are now limited to three patients, and thousands of patients have no provider. This is the end result of the GOP-led legislature's 2011 move to gut the state's voter-approved medical marijuana law. An initiative that would restore the state's medical marijuana system, I-182, has been approved for the November ballot.

Harm Reduction

New Jersey Governor Signs Needle Exchange Funding Bill. Gov. Christ Christie (R) Wednesday signed into law Assembly Bill 415, which creates permanent funding for five locally run needle exchange programs. Three of them, in Atlantic City, Camden, and Paterson, had already run out of funds and were close to closing their doors. "These programs not only distribute clean syringes to intravenous drug users, but also deliver lifesaving education, treatment, and testing to their participants," according to Christie's bill-signing statement.

New Psychoactive Substances

California Bill Would Make Possession of Synthetic Cannabinoids, Stimulants a Crime. The legislature has approved a bill requested by the California Narcotics Officers Association that would make first-time possession of specified synthetic cannabinoids or stimulants an infraction, with subsequent offenses treated as misdemeanors. Under current state law, selling the drugs is a crime, but possessing them isn't. The measure, Senate Bill 139, now goes to the desk of Gov. Jerry Brown (D). It is opposed by the ACLU and the Drug Policy Alliance.

International

EU Wants to Ban New, Powerful Synthetic Cannabinoid. The European Commission announced Wednesday that it wants to ban MDMB-CHMICA, also known as "Black Mamba," a synthetic cannabinoid reportedly 10 times stronger than already banned synthetic cannabinoids. The European Monitoring Center on Drugs and Drug Abuse reported that it has been linked to at least 42 "acute intoxications" and 29 deaths.

Philippines President Snubs UN Effort to Meet Over Drug Killings. President Rodrigo Duterte has turned down a meeting with UN Secretary-General Ban Ki-moon after threatening last month to quit the UN over its criticism of the mass killings of drug users and dealers since he came to office three months ago. Officials from Duterte's office said he was too busy to meet with the head of the global body. One UN official said it was "basically unheard of" for a national leader to be "too busy" to meet the secretary-general.

Chronicle AM: Gallup Finds MJ Users Nearly Double in Three Years, MO MedMJ Fights On, More... (8/8/16)

A Gallup poll shows a dramatic increase in admitted marijuana use by adults, a Barna poll shows little support for drug prohibition, Garden State needle exchanges are scrambling for money after their funding was vetoed, and more.

Marijuana use is becoming more acceptable. (Darren Frisby Harris/Drug Policy Alliance)
Marijuana Policy

Gallup: Number of American Adult Marijuana Users Nearly Doubles in Three Years. A new Gallup poll reports that the number of people who smoke pot has nearly doubled since 2013. That year, 7% of adults said they were current marijuana users; this year, the number jumped to 13%. It's not clear whether or to what degree the reported sharp increase is attributable to an actual increase in regular marijuana users or whether it's because people are more willing to admit their pot use in an era of growing acceptance of marijuana and spreading legalization of the herb.

Medical Marijuana

Missouri Initiative Campaign Asks Court to Overturn Invalidated Signatures. New Approach Missouri announced Monday that it will go to court this month to overturn invalidated signatures so that its medical marijuana initiative can appear on the November ballot. The campaign has enough valid signatures to qualify in every congressional district except the state's second, where local election officials invalidated more than 10,000 signatures, leaving the campaign roughly 2,200 short of the 32,337 required in that district.

Drug Policy

Poll: Only One-Third Thinks All Drugs Should Be Illegal. A new poll from Barna, a firm that surveys on religious issues, finds that only 32% of respondents think all drugs should be illegal. Some 40% think hard drugs should be illegal, but not marijuana, while another 13% think all drugs should be legal and regulated and another 3% believe all drugs should be legal and should not be regulated. If you add those all up, it's 56% for marijuana legalization and 16% for legalizing all drugs.

Harm Reduction

New Jersey Needle Exchanges Are Strapped for Cash. The operators of the state's five needle exchange programs have launched an online fundraising drive this week with a GoFundMe account after a one-time federal grant has run out. Lawmakers had allocated $95,000 to cover program costs, but Gov. Chris Christie (R) line item vetoed that funding in June. "Our governor claims to be fiscally conservative and pro-life. So, how is it that he refuses to fund a simple, inexpensive, effective intervention that saves lives at significantly lower cost than the cost of medical care after a person has been infected with HIV or Hepatitis C or both?" said Diana McCague, the founder of the first underground needle exchange program in the mid-90s called The Chai Project. "Can it be that he's willing to risk the lives of human beings because they use drugs? I think 'pro-life' means pro-all-life."

Drug War Issues

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