Drug War Chronicle #1152 - February 11, 2022

These States Could Still Approve Medical Marijuana in 2022 [FEATURE]

In the space of a quarter-century, the United States went from having no state where medical marijuana was legal to seeing it become the law of the land in three dozen states. The passage of Prop 215 by California voters in 1996 ushered in an era of rapid expansion of medical marijuana, first primarily via the initiative process, but also increasingly by state legislators attuned to the will of the public.

Mississippi became the 37^th state to legalize medical marijuana just this month as lawmakers in Jackson and a very cautious governor finally agreed on a bill to enact the will of the people as expressed in a 2020 initiative that was thwarted by a state Supreme Court ruling. But there are still seven states that allow only CBD oil (Georgia, Indiana, Iowa, Kentucky, Tennessee, Texas, Wisconsin) and six more states that don't allow any form of medical marijuana (Idaho, Kansas, Nebraska, North Carolina, South Carolina, Wyoming).

Moves are afoot in nearly all of them to catch up to the rest of the country this year. In some states, it is through the initiative process; in others, through the legislative process. But some states are already a lost cause for the year or face insurmountable odds: Georgia (bills filed, but set to die), Iowa (no bills filed), Indiana (bill never made it out of committee). Texas (no bills filed), and Wyoming (initiative did not qualify, no bills filed).

With a big tip of the hat to Ballotpedia, Marijuana Moment, and NORML, who are all keeping an eye on the action, here's the list of states working to legalize it at the ballot box this year, here are the states where hope still lives for medical marijuana in 2022:

Idaho

With a state legislature and governor stubbornly against marijuana in any form, the only medium-term prospect for medical marijuana is through the initiative process. One group, Kind Idaho, tried going down that path in 2020 but called off the effort in the midst of the coronavirus pandemic. They are back this year with the Idaho Medical Marijuana Act of 2022, which envisions a full-fledged program complete with long lists of qualifying conditions and taxed and licensed cultivation, production, and sales, as well as allowing patients or caregivers to possess up to four ounces. Only patients who qualify for a "hardship exemption" -- financial hardship, lack of access to transportation, lack of a dispensary "within a reasonable distance" -- could grow their own, up to six plants.

But the clock is ticking. The campaign said just last month that it had gathered only 10,000 raw signatures so far. It needs 64,945 valid voter signatures to qualify for the ballot and the mainly volunteer effort only has until May 1 to come up with them.

Kansas

The House last year passed a medical marijuana bill, House Substitute for SB 158, and that bill is still alive in the Senate, where it got hearings -- but no vote -- in the Committee on Interstate Cooperation in mid-January. The Senate is controlled by Republicans, who have resisted reform, but so is the House, which got the bill through. And Gov. Laura Kelly (D) also supports medical marijuana.

Legislative Democrats, meanwhile, introduced a pair of constitutional amendments to put the issues of marijuana legalization and access to medical marijuana directly to the voters. Democratic lawmakers next door in Iowa announced a similar move earlier this week. The Democrats are hoping that even if Republicans remains resistant to marijuana reform, they would at least pass the measures and let the voters decide.

Kentucky

Rep. Jason Nemes (R) got a medical marijuana bill passed in the House in 2020, but it died without a Senate vote in the midst of the pandemic. He tried again in 2021, but the bill stalled. After scaling back his bill in a bid to win conservative support, he is back this year with House Bill 136, which also has 40 cosponsors.

Under this year's version of the bill, there would be no home cultivation by patients or caregivers and there would be no smokeable medical marijuana allowed. Patients could consume flowers but would have to vape them. The bill leaves specific rules on qualifying conditions and possession limits up to regulators, but specifies that qualifying conditions will includecancer, epilepsy and seizure disorders, multiple sclerosis, nausea or vomiting and chronic, severe, intractable or debilitating pain.

The bill has a good shot of passing the House and even in the Senate if it is allowed to come up for a vote, but faces an obstacle in the person of Senate President Robert Stivers (R), who has "concerns" and wants "more studies."

Nebraska

After the state Supreme Court invalidated a 2020 medical marijuana initiative because it violated the state's single-subject rule for initiatives, initiative sponsors State Senators Anna Wishart (D) and Adam Morfeld (D) came back this year with a set of three separate initiatives to create a medical marijuana program. One is a constitutional amendment and two are statutory initiatives.

The Medical Marijuana Constitutional Amendment simply states that "Persons in the State of Nebraska shall have the right to cannabis in all its forms for medical purposes, while the Medical Cannabis Patient Protection Act protects patients from arrest for using medical marijuana and the Medical Cannabis Commission Act would regulate medical marijuana businesses that provide it to qualified patients.

An activist group, Nebraskans for Medical Marijuana (NMM) is in the middle of a signature gathering drive now. It has until July 7 to come up with approximately 86,000 valid voter signatures for the initiatives and 112,000 signatures for the constitutional amendment.

South Carolina

Senator Tom Davis (R-Beaufort) has been trying for seven years to get some sort of medical marijuana bill through the legislature, and just this week, this year's version, Senate Bill 150, saw a medical marijuana bill get a Senate floor debate for the first time ever, and then pass the Senate Wednesday night. Its fate in the House, though, is unclear; whether House Speaker Jay Lucas (R) will let the bill move in his chamber remains uncertain. And Gov. Henry McMaster (R) remains noncommittal on whether he would sign the bill, saying "that would depend on a lot of things."

Honed to advance in the conservative state, Davis's bill is also conservative. It bars the use of smokable marijuana, requires an in-patient doctor's visit and a written treatment plan, and limits the conditions that can be treated to a specified list including cancer, multiple sclerosis, glaucoma. sickle cell anemia and autism. And not only is home cultivation not allowed; possessing the plant form of marijuana would remain a misdemeanor.

Tennessee

State Rep. Jason Powell (D-Nashville) earlier this month introduced a bill that would create a medical marijuana program, House Bill 2458, which awaits committee assignment. Its companion legislation, Senate Bill 2477, has been referred to the Senate Judiciary Committee.

Whether these bills will go anywhere remains to be seen. Medical marijuana bills have all died in the past, and last year, the legislature voted down decriminalization. Republicans are in a solid majority in both the state House of Representatives and the Senate, but the year is young.

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This Week's Corrupt Cops Stories

A small-town Georgia cops gets caught slinging weed from his patrol car, a corrupt killer Puerto Rican cop heads for decades in prison, and more. Let's get to it:

In Warwick, Georgia, a Warwick police officer was arrested last Thursday for selling marijuana while on duty and in uniform. Officer Leon Mitchell, 32, went down after investigators with Southwestern Regional Drug Enforcement Office (SWRDEO) that he was slinging weed, and undercover agents began buying marijuana from him. After he was arrested, marijuana, scales, and plastic baggies were found in his police cruiser. He's facing two counts of sale/distribution of marijuana, one count of possession with intent to distribute marijuana, four counts of possession of a firearm during the commission of a felony, three counts of violation of oath of office, and last but not least, two counts of use of a communication device during the commission of a felony.

In Kokomo, Indiana, a Howard County corrections officer was arrested Tuesday after she was caught smuggling drugs into the county jail. Guard Emily Harvey, 32, went down after detectives received a tip that a guard was bringing in drugs and they then watched her enter a unit to which she was not assigned and meet with an inmate. A search of the inmate's cell yielded a vape pen, and a search of Harvey's vehicle in the parking lot turned up six grams of suboxone and "additional contraband." She is charged with dealing in a schedule I, II or III substance; two counts of trafficking with an inmate; official misconduct; and possession of a controlled substance.

In New York City, a former Puerto Rico Police Department officer was sentenced last Thursday to 30 years in federal prison for agreeing to help a drug trafficking organization that shipped drugs from Puerto Rico to New York City, where they were distributed from a Bronx daycare. William Vazquez-Baez had pleaded guilty earlier to one count of participating in a racketeering conspiracy and one count of participating in a conspiracy to commit murder for hire. Prosecutors alleged that Vazquez-Baez conspired with the La ONU group, which sold thousands of pounds of cocaine and used violent methods to protect its operation. Vazquesz-Baez was on salary with the gang and provided it with intelligence obtained from the police narcotics unit and helped protect its shipments while in transit. Vazquez-Baez also informed gang members that a local resident, Freddy Mendez-Rivera, was complaining to police about drug dealing in his are, which led to his kidnapping and murder. And he was involved in two other murders for the gang.

In Warwick, Georgia, a Warwick police officer was arrested last Thursday for selling marijuana while on duty and in uniform. Officer Leon Mitchell, 32, went down after investigators with Southwestern Regional Drug Enforcement Office (SWRDEO) that he was slinging weed, and undercover agents began buying marijuana from him. After he was arrested, marijuana, scales, and plastic baggies were found in his police cruiser. He's facing two counts of sale/distribution of marijuana, one count of possession with intent to distribute marijuana, four counts of possession of a firearm during the commission of a felony, three counts of violation of oath of office, and last but not least, two counts of use of a communication device during the commission of a felony.

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House Passes Bill With SAFE Banking, Psilocybin Rescheduling Petition Filed, More... (2/4/22)

A key Maryland legislator rolls out a marijuana legalization bill, the Utah legislature approves employment protections for medical marijuana cardholders, and more.

Marijuana Policy

House Passes Manufacturing, Technology Bill That Includes SAFE Banking Act. For the second time this session, the House has voted to include the SAFE Banking Act in a larger bill it passed. It passed earlier as part of a defense spending bill only to be stripped out by Senate leaders seeking instead to promote full-on marijuana legalization legislation. The House approved the America COMPETES Act, complete with the SAFE Banking Act amendment, Thursday night by a vote 222-210, mainly along party lines. The Senate has already passed its version of the America COMPETES Act, which does not include the SAFE Banking Act language. It will now be up to House and Senate negotiators to decide whether to include it in the final bill.

Maryland Marijuana Legalization Bill Filed. A key member of the legislature, House Judiciary Committee Chair Luke Clippinger (D-Baltimore) filed a marijuana legalization bill, House Bill 837, on Thursday. Under the bill, Marylanders could possess up to 1.5 ounces of marijuana for recreational use. The bill would also automatically expunge convictions for simple possession. The bill also creates a plan for implementation of legalization, which is seen as a bridge to the House, whose leaders support a voter referendum on the issue. "While I feel strongly that the voters should decide this issue, it is the General Assembly that is charged with making sure we have a legally defensible, equity-driven plan in place should they choose legalization," said House Speaker Adrienne A. Jones (D-Baltimore County).

Virginia Coalition to Oppose Legal Marijuana Commerce Emerges. The usual suspects are back. A group of parents, substance abuse professionals, and law enforcement have created a coalition to try to block the state from establishing a legal marketplace for marijuana, as envisioned under the marijuana legalization bill passed last year. The doomsayers are being joined by Project SAM, a group that consistently opposes marijuana legalization. The new coalition claims that allowing legal marijuana sales will endanger Virginians. Their efforts may gain some traction in the legislature, which is now controlled by Republicans, as opposed to last year, when the Democrat-controlled body approved legalization.

Medical Marijuana

Utah Legislature Approves Bill Affirming That Medical Marijuana Should Be Treated Like Any Other Prescription Drug. With a final vote in the House on Wednesday, the legislature has approved Senate Bill 46, which reaffirms that medical marijuana cardholders are entitled to protections from job actions related to their medical marijuana use. The bill came after the Utah Patients Coalition complained that some first responders were having problems with local governments for even having a medical marijuana card. It is now up to Governor Spencer Cox (R) to sign or veto the measure.

Psychedelics

Seattle Doctors Files DEA Petition to Reschedule Psilocybin for Medical Use. Dr. Sunil Aggarwal, a Seattle end-of-life care specialist, has filed a formal petition with the DEA seeking to remove psilocybin from Schedule I of the Controlled Substances Act. The petition asks the DEA to reschedule as a less-restricted Schedule II drug. The substance has a low potential for abuse and shows "exceptional promise in relieving debilitating symptoms in those with intractable and otherwise untreatable illness," including the severe anxiety and depression that can result from a terminal illness. "The original placement of psilocybin," the document says, "was the result of a substantial overestimation of the risk of harm and abuse potential, not rigorous science."

Joining the suit, attorneys general from eight US states and the District of Columbia filed a friend-of-the-court brief in support of the patients, noting the therapeutic potential of not only psilocybin but also other currently illegal drugs, including as MDMA. "Here, dying patients seek access to promising new treatments still in the investigative process -- access expressly permitted under both state and federal law -- to help them live in peace," the amicus brief said.

Utah Psychedelic Study Bill Wins House Committee Vote. The House Health and Human Services committee on Thursday approved House Bill 167, which would create a task force to study the therapeutic potential of psychedelic drugs and make recommendations for their lawful use. The measure passed on a 10-1 vote and now heads for a House floor vote.

Drug Testing

Groups File Human Rights Complaint on Behalf of New Mother Over Non-Consensual Drug Test and False Positive. National Advocates for Pregnant Women (NAPW) and the ACLU of Illinois filed a charge of discrimination against Saint Alexius Hospital last week with the Illinois Department of Human Rights over a non-consensual drug test of a first-time mother before she went into labor. The test came back positive because of an Easter cake made with poppy seeds that the mother ate before entering the hospital, leading to the hospital initially holding the newborn in the Newborn Intensive Care Unit and then requiring the family to have someone besides the mother with the child at all times for three months.

"Saint Alexius violated [this mother's] civil rights by subjecting her to a non consensual and medically unnecessary drug test," said Emma Roth, staff attorney at NAPW. "She will never be able to get back those precious first months with her baby. The fact that Ms. F. was reported on the basis of a false positive due to poppy seed consumption highlights the absurdity of Saint Alexius's non consensual testing and reporting practices. Yet routine drug testing and reporting of pregnant patients is never justified in light of the harmful consequences for families."

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Schumer Says Marijuana Legalization Bill Coming in April, Study Questions Reliability of Maternal Drug Testing, More... (2/7/22)

Wisconsin's governor vetoes a bill that would have dramatically hiked criminal penalties for butane marijuana extraction, the Jalisco New Generation Cartel is now making bombs to deploy against the military, and more.

Marijuana Policy

Schumer Says He Aims to File His Marijuana Legalization Bill in April. Senate Majority Leader Chuck Schumer (D-NY) announced last Friday that he plans to formally introduce his marijuana legalization bill in April. "In the coming weeks, we're ramping up our outreach -- and we expect to introduce final legislation. Our goal is to do it in April," Schumer said. "Then we begin the nationwide push, spearheaded by New York, to get the federal law done. As majority leader, I can set priorities. This is a priority for me." Schumer's bill, the Cannabis Administration and Opportunity Act (CAOA), was first released in draft from last July, and advocates had grown increasingly impatient with the lack of movement since then, especially after he blocked passage of the SAFE Banking Act, which the House had approved and attached to a defense spending bill. But now, Schumer has signaled movement ahead.

Wisconsin Governor Vetoes Bill to Ramp Up Penalties for Marijuana Extraction. Gov. Tony Evers last Friday vetoed a bill that would have significantly increased criminal penalties for people using butane or similar fuels to process marijuana for extracts. The measure, Assembly Bill 440, would have made using butane to extract marijuana a Class E felony punishable by up to 15 years in prison. It is currently a Class I felony with a maximum 3 ½ year sentence. In his veto message, Evers said, "I am vetoing this bill in its entirety because I object to increasing criminal offenses or penalties related to marijuana use," adding that "marijuana criminalization has had a disproportionate impact on communities of color, especially in Wisconsin." Evers supports marijuana legalization, but has made no headway with the Republican-led legislature.

Drug Testing

Study Questions Reliability of Maternal Drug Testing. A study presented at 2022 Pregnancy Meeting of the Society for Maternal-Fetal Medicine last Friday is raising more questions about the drug testing of pregnant women after it found that maternal urine samples and samples of the meconium from their newborn babies frequently produce different results. That disagreement (or "discordance") could trigger inappropriate interventions by child protective services, including separation of infants from their mothers, the researchers said.

"There's a very big debate right now in the obstetrics and perinatology communities about the utility of biochemical testing and the identification of high-risk women," said lead author Cassandra Heiselman, DO, MPH, clinical assistant professor in the Department of Obstetrics, Gynecology and Reproductive Medicine at the Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, told Medscape Medical News. "We know that each biochemical test has limitations, which can include basically the inability to detect all substances, especially synthetic opioids like fentanyl, [and] the possibility for false results."

Ironically, marijuana use was the most common factor associated with a positive meconium test. "Some studies have shown cannabis use in the second trimester can show up in meconium testing even if the mother has stopped that behavior," Heiselman said. "Then there is also cross-reactivity with other substances that can lead to higher false positive results, especially in the urine toxicology."

International

Mexican Drug Cartel Turns to IEDs to Use Against Army as Drug War Rages On. In a first in Mexico's drug wars, the Jalisco New Generation Cartel has deployed homemade bombs, or improvised explosive devices (IEDs) against the Mexican military. The attacks came on Saturday in Tepalcatepec in the western state of Michoacan, which has been riven with criminal conflicts for months. The bombs were described as pipe bombs with a cone-shaped cap to direct the explosion. Local self-defense forces fighting the cartel said the bombs did extensive damage to a military armored vehicle. This is just the latest escalation for the cartel, which last month resorted to dropping bombs from drones on its rivals.

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DOJ Signals Openness to Safe Injection Sites, Congressional Commission Issues Overdose Strategy Report, More... (2/8/22)

Pennsylvania sees its first ever legislative debate on marijuana legalization, Tennessee sees a slew of marijuana-related bills, and more.

Marijuana Policy

Pennsylvania Sees First Legislative Debate on Marijuana Legalization. For the first time ever, Keystone State lawmakers took up the topic of marijuana legalization as the Senate Law & Justice Committee held a hearing on Monday. The hearing was on a proposal from committee Chair Sen. Mike Regan (R-York County), but focused largely on unsafe practices in the industry and products going through existing black markets. The committee heard from lawmakers, medical marijuana industry representatives, and law enforcement officials. Another, bipartisan marijuana legalization bill, Senate Bill 473, which includes expungement and social equity provisions, is also before the committee. No votes were taken. Regan said the committee would hold another hearing in coming months to see what "trials and tribulations" other states had endured.

Tennessee Marijuana Legalization, Medical Marijuana Bills Filed. Lawmakers in the Volunteer State are facing a slew of marijuana legalization, decriminalization, and medical marijuana bills filed this session. So far, the legislative web site shows at least 28 bills, most of them addressing legalization. The state is one of seven that have allowed for the use of CBD cannabis oil, but that is as far down the road as the legislature has gone so far. An attempt to decriminalize marijuana possession was killed last session, as was a broader medical marijuana bill.

Opioids

Congressional Commission Urges Five-Pronged Strategy to Confront Overdose Crisis. A bipartisan congressional commission. the Commission on Combating Synthetic Opioid Trafficking released a report Tuesday calling for a multipronged strategy to confront the nation's overdose crisis. The commission called for the strategy to be based around five pillars: Restoring the head of the Office of National Drug Control Policy to cabinet rank, disrupting the drug supply through better coordinated law enforcement, demand reduction through treatment and harm reduction measures, using diplomatic means to cut off the supply of fentanyl precursor chemicals, and developing surveillance tools to monitor new drug trends. In other words, new, improved drug war, albeit with a slightly gentler touch regarding harm reduction.

Harm Reduction

Justice Department Signals It Could Allow Safe Injection Sites. In a statement to the Associate Press, the Justice Department said it is "evaluating" the harm reduction intervention and seeking guidance from regulators on "appropriate guardrails." That is a drastic change from the Trump administration, under which the department successfully sued to block a Philadelphia safe injection site, and is the first hint, after months of silence, that DOJ is open to safe injection sites. "Although we cannot comment on pending litigation, the Department is evaluating supervised consumption sites, including discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety," DOJ said in the statement last Friday.

DOJ isn't the only federal government entity to edge closer to supporting safe injection sites. In December, the National Institutes of Health mentioned them in a call for harm reduction research, and that same month, Office of National Drug Control Policy (ONDCP -- the drug czar's office) head Dr. Rahul Gupta said he was "interested in looking at the science and data behind all of the emerging harm reduction practices."

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Washington Drug Decrim Init Ready for Signature Gathering, Crack Pipe Funding Furor, More... (2/9/22)

Thailand removes cannabis from its schedule of controlled substances (but marijuana legalization is still down the road a bit), a Washington state drug decriminalization initiative is cleared to begin signature gathering, and more.

Marijuana Policy

Colorado Bill Would Protect Workers from Being Fired for Off-Job Marijuana Use. Rep. Brianna Titone (D-Arvada) has filed a bill, House Bill 1152, that would bar employers from either refusing to hire or firing workers because of their off-duty marijuana use. The measure also includes a provision requiring employers to consumer medical marijuana at work, with some exemptions for safety-sensitive positions. "Marijuana is legal in Colorado," said state Rep. Titone. "And what people do in their spare time that doesn't impact their work shouldn't really be a problem for them. They should be able to enjoy the legal things that we have here in Colorado and not be penalized for it." The state Supreme Court has previously ruled on the side of employers on the issue, particularly in the 2015 case of Brandon Coats v. Dish Network.

Drug Policy

Washington Drug Decriminalization, Treatment Initiative Ready to Begin Signature Gathering. A drug decriminalization and treatment funding initiative that was filed last month by the group Commit to Change WA, which is backed by the state ACLU, is ready to begin signature gathering in a bid to qualify for the November ballot. The move comes after a Monday deadline for challenges to its ballot title passed without any challenges. The initiative would remove the state's existing penalties for drug use and possession, expunge past drug use and possession convictions, and appropriate more than $100 million a year for drug prevention, treatment, outreach, and recovery, including at least $10 million a year for harm reduction. The campaign now has until July 8 to come up with 324,516 valid voter signatures to make the ballot.

Harm Reduction

Cowed by Criticism from the Right, Biden Administration Drops Funding for Safer Crack Pipes. Office of National Drug Control Policy (ONDCP -- the drug czar's office) head Dr. Rahul Gupta announced that a harm reduction grant program for drug users will not fund safer pipes for crack or meth smokers. "No federal funding will be used directly or through subsequent reimbursement of grantees to put pipes in safe smoking kits," Gupta and Health and Human Services Secretary Xavier Becerra said in a statement.

There is $30 million in federal funding for harm reduction, and the Substance Abuse and Mental Health Services Administration had listed "safe smoking kits/supplies" among the items that could be purchased with taxpayer money. Other items included included overdose prevention drugs, medication lockboxes, test kits for infectious diseases, and syringe disposal containers. The tender did not actually mention pipes, but it did trigger online reports that the Biden administration was using taxpayer dollars to buy "crack pipes."

International

Thailand Officially Drops Cannabis from List of Controlled Substances. As of today, cannabis is no longer a Category 5 controlled substance. Public Health Minister Anutin Charnvirakul signed a ministerial announcement officially removing it on Tuesday. The delisting means that all parts of the plant can be legally consumed, but THC extracts above 0.2 THC will remain illegal. The change will go into effect in 120 days. This means that production of hemp and hemp-based CBD products can commence, but it will still be against the law to grow and consume marijuana until a bill is submitted to parliament in order to establish a regulatory framework for production and sales.

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CDC Prepares New Opioid Prescribing Guidelines, OH Senate Won't Take Up Legalization Voter Init, More... (2/10/22)

The South Carolina Senate approves a medica marijuana bill, a new Rand study tracks opioid prescribing declines, and more.

Marijuana Policy

Ohio GOP Senate Leader Says He Will Not Bring Marijuana Legalization Initiative to a Vote. State Senate President Matt Huffman (R-Lima) says he will not bring the Coalition to Regulate Marijuana Like Alcohol's marijuana legalization initiative to a vote in the Senate. Under Ohio law, petitioners who collect the requisite number of valid voter signatures for a ballot initiative then place the proposal before the legislature, which has four months to act on it. If the legislature refuses to act on the proposal or rejects it, petitioners can undertake a second round of signature gathering and, if successful, present the issue to directly to the voters.

"I don't want anybody to misunderstand my position," Huffman said. "I'm not going to bring it to the Senate floor. And if that means people want to go put it on the ballot, have at it." While the Coalition has yet to comment on Huffman's remarks, it has previously indicated it will indeed proceed to that second round of signature gathering. They will need to come up with 132,887 valid voter signatures to make the November ballot.

Medical Marijuana

South Carolina Senate Approves Medical Marijuana Bill. After the debate on medical marijuana made it to the Senate floor last week, the Senate on Wednesday approved the South Carolina Compassionate Care Act (Senate Bill 150). The bill gets a final vote in the Senate Thursday, before heading to the House, where its fate is unclear. Whether House Speaker Jay Lucas (R) will let the bill move in his chamber remains uncertain. And Gov. Henry McMaster (R) remains noncommittal on whether he would sign the bill, saying "that would depend on a lot of things."

Opioids

Opioid Prescribing Declines, but Cuts Are Not Uniform Across Locations, Age Groups, or Type of Prescriber. The volume of prescription opioids dispensed from retail pharmacies declined by 21% from 2008 to 2018, but the decline was not uniform across geographic areas, among types of patients, or by type of prescriber, according to a new RAND Corporation study. The study, published by the Annals of Internal Medicine, is the first to examine the decline in opioid prescriptions filled at retail pharmacies based on both volume and potency of the drugs dispensed.

The study found that over the study period, per capita MME (morphine milligram equivalents) volume declined the most in metropolitan counties (more than 22%) and in counties with higher rates of fatal opioid overdoses (a 35% decline). Substantial variation existed both within and across states. In some states, MME volume per capita increased in multiple counties. In many other states, there were both counties with increases and others with substantial decreases. Counties that experienced substantial decreases in per capita MME often were adjacent to counties with per capita increases.

Most clinical specialties recorded declines in the MME volume per practicing clinician. The greatest decrease in MME volume per practicing clinician was among adult primary care physicians (40% decline) and pain specialists (15% decline) -- the clinicians with the highest MME volume per clinician in 2008 -- 2009. The greatest percentage decrease was among emergency physicians (71% decline) -- clinicians who are likely prescribing opioids predominantly to patients experiencing acute pain in acute care settings.

"These results suggest the effects of clinician and policymaker efforts to reduce opioid prescribing have affected populations differently," Stein said. "Future efforts to enhance clinically appropriate opioid prescribing may need to be more clinically nuanced and targeted for specific populations."

CDC Proposes New, Slightly Looser Opioid Prescribing Guidelines. The Centers for Disease Control and Prevention (CDC) on Thursday released new draft guidelines for prescribing opioids for pain relief. The new guidelines remove previously recommended ceilings on doses for chronic pain patients, leaving it instead for doctors to use their own best judgment. But they also urge doctors to first resort to "nonopioid therapies" for both chronic and acute pain.

The new guidelines are the first comprehensive revisions of the CDC's 2016 guidelines, and attempt to find the proper balance between alleviating severe pain and exposing patients to the perils of opioids. The new guidelines have now been published in the Federal Register and are open for comments. Comment here.

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