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Chronicle AM: Trump Declares Opioid Emergency, SF SIJ Could Come Soon, More... (10/26/17)

The president declares the opioid crisis an emergency, but not enough of one to actually need funding; lawmakers go after the DEA over West Virginia pain pill deliveries, a St. Louis alderman files a marijuana legalization measure, the US Sentencing Commission issues a report on mandatory minimums, and more.

President Trump declares a public health emergency, but not a national emergency, on opioids. (Wikimedia)
Marijuana Policy

St. Louis Ordinance Would End Local Marijuana Prohibition. Alderman Megan Green has filed an ordinance that would end enforcement of any laws that allow "the civil or criminal punishment for the use or possession of marijuana or marijuana paraphernalia against any individual or entity," with some specified exceptions. Under the bill, pot could be used, sold, and grown in the city. The bill gets a first reading Friday, and Green says she's confident it can pass in coming weeks. Stay tuned.

Medical Marijuana

Lawmakers Call for VA to Research Medical Marijuana for Veterans. A group of lawmakers who sit on the House Veterans' Affairs Committee wrote a letter Thursday to Veteran Affairs Secretary David Shulkin urging him to use his agency to research medical marijuana. The VA "is uniquely situated to pursue research on the impact of medical marijuana on veterans suffering from chronic pain and PTSD given its access to world class researchers, the population it serves, and its history of overseeing and producing research resulting in cutting-edge medical treatments," the lawmakers wrote. Shulkin has yet to respond.

Heroin and Prescription Opioids

Trump Declares Opioid Crisis a Public Health Emergency, But Provides No Funds. President Trump announced Thursday that he had directed the Department of Health and Human Services to declare a public health emergency around the opioid crisis. But he declined to declare a national emergency, which would have allowed for the rapid allocation of monies to address it. Trump's declaration carries no funding with it, but would allow some grant money to be used to combat opioid abuse.

Lawmakers Take DEA to Task Over Spread of Opioids. Members of the House Energy and Commerce Committee threatened to subpoena the DEA over its slow response to their questions about how wholesale drug distributors poured millions of opioid pain pills into West Virginia. Members said the committee had been waiting six months for answers from the DEA about which companies had sent nine million pills to the town of Kermit, WV (pop. 392), over a two-year period. Members did not express any concerns about how a crackdown on pain pill prescribing might impact chronic pain patients.

Harm Reduction

San Francisco Could See Safe Injection Sites Within a Year, Official Says. Safe injection sites in the city could be open in eight to 12 months if a proposal to create them gets approved, Department of Public Health Director Barbara Garcia told supervisors on Wednesday. Even if the plan was approved immediately, it would take time to obtain funding, establish protocols, hire and train staff, and set up the program, she said.

Sentencing

Sentencing Commission Issues Report on Mandatory Minimums. The US Sentencing Commission has issued a report on the use and impact of mandatory minimum sentencing for drug offenses. The report finds, among other things, that mandatory minimums continue to be imposed and result in long sentences in the federal system, but that they were being used less often last year. The report also noted that mandatory minimums may be applied more broadly than Congress intended, but that laws allows for departures from the harsh sentences "result in significantly reduced sentences when applied."

International

Colombia Will Move to Decriminalize Small-Time Coca Farming. The government will introduce legislation that would make the cultivation of up to just under ten acres of coca a non-punishable offense. More than 100,000 families earn a living from coca farming, with the average planting being less than an acre. This move would provide some breathing room for farmers caught between drug gangs on one hand and police on the other. The move was part of the peace deal agreed to with the leftist rebels of the FARC, but this is the first step toward actually implementing it.

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Trump's Actions could make a difference

The President's speech on Opiods struck some new ground without a heavy reliance on law enforcement being citing as the solution. What striking was his announcement that his administration plan to file law suits against some of the abusive opiod distributors. This is the first sign that the government is taking steps substative actions to hold the industry accountable for flooding some communities with opiods and acting recklessly. The stocks of some of these companies tanked upon Trump's announcement. By delcaring the opiod crisis a public health crisis, the problem can be focussed on in the long term, not the short.

What's remarkable and significate about Trump's speech is that Jeff Sessions was no where in sight.  His absence was no accident as Sessions has a long history as a US Senator opposing resonable reforms at every instance. He is in total disagreement about the actions and approaches to reducing opiods offered by the President today.  So Trump's speech hit the right tone and got some keys elements of the opiod problem right. For that he deserves credit.


 

government still denying responsibility for effects of laws

The current "opioid crisis" is just a continuation of the century long "narcotic drug law crisis" America has suffered at the federal government's hands (and longer in many states at the hands of state governments). It is being exploited for political purposes which is another long political tradition and government is blaming others for what could not have happened absent the government's longtime harmful actions & policies which is another long political tradition. Indeed, it can be difficult for a "young" person of 65 (such as myself) to remember restrictive US drug laws have not always and only been implemented to oppress and exploit.

Until legal discrimination against opioid/narcotic drug users is abolished like legal chattel slavery was, America will always have "opioid law crises". And individual American people will continue to suffer the many consequences of this oppression.

 At the 1962 Kennedy administration's White House Council on Narcotic Use in the United States, Alfred Lindesmith advocated his long held position that the government response to narcotic use should be to mind its own business and let physicians prescribe narcotics to addicts so they could live normal lives which would benefit them and society. Unfortunately this position was not accepted despite decades of experience showing this had been a superior policy to the post-Harrison Narcotics Act prohibitory laws and policies of the US.

To solve the "opioid crisis" problem, whatever the problem is thought to be, I suggest starting with an examination of drug use, customs, attitudes laws and policies in the US from the 1700s to the present in full historical context. Or start with study of the actual pharmacological properties of the various narcotic drugs and what is actually known and unknown about addiction. Or start with an examination civil liberties and how our drug laws deprive us of our rights. Maybe consider the similarities of our intolerant drug laws and the intolerant religious laws of Britian and Europe which inspired the First Amendment to our Constitution.

 

IMO, the current "opioid crisis" moral panic is partly intended to distract attention from other matters. And that would be part of an historical pattern too.

Hmm.

The "Safe" Injection Movement is sponsored by the Drug Policy Alliance, an advocacy group that works to decriminalize drugs and is funded largely by billionaire George Soros. The group has pushed, thus far unsuccessfully, for similar legislation in New York, Maryland, Massachusetts and Vermont. Here's some examples of their thinking:  http://www.nadcp.org/sites/default/files/2014/NADCP%20Initial%20Response%20to%20DPA%20and%20JPI%20Reports.pdf http://www.nadcp.org/sites/default/files/nadcp/NADCP%20Response%20to%20DPA%20and%20JPI%20Media%20Attacks%20on%20Drug%20Courts.pdf

SISs?

Portugal is held up as the gold standard for "decriminalizing" drugs and not "judging" the addict.  Their programs has some success due to wrap-around services and is mandatory.  Drug dealing is still illegal and dealt with harshly.  Other EU countries tried to emulate the program.  With the 2008 recession, their budgets were slashed for the addicts in program and caused overdoses, increased crime, and increased disease transmission, increased homelessness.  Can you see us having an Injections Site AND wrap-around services?  I don't believe there will be funding for both.  Why not use any proposed funding and increase needed detox/rehab facilities and sober living environments along with all the needed physical/mental health and social services.  The way I see it, Injections Sites are prolonging the suffering and misery of the addict with the usual end result of death.  Which would be more compassionate? http://www.vancouversun.com/little+evidence+harm+reduction+reduces+harm+more+than+good/8679087/story.html?fref=gc&dti=189308553419 “The four pillar approach only works when each pillar is properly funded. Prevention reduces the flow of people into addiction. Treatment reduces the number of addicts including those living in the DTES. Policing keeps a lid on the open drug dealing and the affects of the associated problems on the community. Only after these three pillars are properly funded can we afford to spend money on Harm Reduction initiatives that do not encourage abstinence. Putting HR first is like running up debt on your credit card and never paying more than your minimum payments.” http://www.globaldrugpolicy.org/Issues/Vol%201%20Issue%203/A%20Critical%20Evaluation.pdf THE JOURNAL OF GLOBAL DRUG Policy AND PRACTICEA Critical Evaluation of the Effects of Safe Injection Facilities Garth Davies, Simon Fraser University Conclusion: Taking Causality SeriouslyOn the subject of the effects of SIFs, the available research is overwhelmingly positive. Evidence can be found in support of SIFs achieving each of the goals listed at the beginning of the evaluation. In terms of our level of confidence in these studies,the assessment offered here is far less sanguine. In truth,none of the impacts attributed to SIFs can be unambiguously verified. As a result of the methodological and analytical problems identified above, all claims remain open to question. http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php Vancouver's INSITE service and other Supervised injection sites: What has been learned from research? Final report of the Expert Advisory Committee http://www.kiro7.com/news/local/councilwomans-idea-for-seattle-safe-injection-site-locations-belltown-lake-city/466411868 "At the Vancouver site, the manager said since opening in 2003, the overdose death rate in the area around the clinic has dropped 35 percent. But the clinic also estimates 15 to 20 percent of people using the site come from other parts of the country specifically for it." http://www.seattletimes.com/seattle-news/health/is-vancouvers-safe-drug-use-site-a-good-model-for-seattle/"Although research appears to bear that out, many of the studies that attest to Insite’s success are small and limited to the years after the center opened. For instance, a 2011 study published in the journal The Lancet found a 35 percent reduction in overdose deaths in the blocks surrounding Insite, versus 9 percent in the rest of Vancouver. But that often-cited study looked only at the period two years before and two years after the center opened, not the ensuing decade." http://www.seattletimes.com/seattle-news/health/is-vancouvers-safe-drug-use-site-a-good-model-for-seattle/        "Although Insite is paired with a drug-treatment center, called Onsite, Berner and other critics point out that completion rates are low. Of the 6,500 people who visited Insite last year, 464 were referred to Onsite’s detox center. Of those, 252 finished treatment." The Vancouver Insite was placed in a crime-ridden, drug-ridden, low-income neighborhood. It only got worse. http://www.seattletimes.com/seattle-news/health/is-vancouvers-safe-drug-use-site-a-good-model-for-seattle/  "Although the Insite center is a model, the Vancouver neighborhood surrounding it is nothing to emulate, advocates acknowledged. “If I came from a city like Seattle and I went to that Insite place, it would scare the hell out of me,” Kral said. “I would think, ‘Are we going to create one of those?’ ”"  http://news.nationalpost.com/news/vancouvers-gulag-canadas-poorest-neighbourhood-refuses-to-get-better-despite-1m-a-day-in-social-spendingVancouver’s ‘gulag’: Canada’s poorest neighbourhood refuses to get better despite $1M a day in social spending What do you think would happen if this was placed in a middle-class neighborhood, or, ANY neighborhood? https://www.youtube.com/watch?v=audzsuRMWBE&t=586shttps://www.youtube.com/watch?v=wwJkqTZ5H_s http://news.nationalpost.com/news/canada/brian-hutchinson-thousands-of-used-drug-needles-have-become-the-new-normal-for-vancouver4/27/2016Brian Hutchinson: Finding used drug needles in public spaces has become the new normal for Vancouver http://www.huffingtonpost.ca/mark-hasiuk/insite-vancouver_b_3949237.html "Ten years later, despite any lofty claims, for most addicts, InSite's just another place to get high." The 100% positive studies on Vancouver's Insite (Safe Injection Facility) was done  "Early last decade, Montaner and Kerr lobbied for an injection site. In 2003, the Chretien Liberals acquiesced, gave the greenlight to B.C.'s Ministry of Health, which, through Vancouver Coastal Health, gave nearly $1.5 million to the BC Centre (that's Montaner and Kerr, you remember them) to evaluate a three-year injection site trial in Vancouver. I asked him about the potential conflict of interest (lobbyists conducting research) and he ended the interview with a warning. "If you took that one step further you'd be accusing me of scientific misconduct, which I would take great offense to. And any allegation of that has been generally met with a letter from my lawyer." Was I being unfair? InSite is a radical experiment, new to North America and paid for by taxpayers. Kerr and company are obligated to explain their methods and defend their philosophy without issuing veiled threats of legal action." In the media, Kerr frequently mentions the "peer review" status of his studies, implying that studies published in medical journals are unassailable. Rubbish. Journals often publish controversial studies to attract readers -- publication does not necessarily equal endorsement. The InSite study published in the New England Journal of Medicine, a favourite reference of InSite champions, appeared as a "letter to the editor" sandwiched between a letter about "crush injuries" in earthquakes and another on celiac disease." Really? What kind of "science" produces dozens of studies, within the realm of public health, a notoriously volatile research field, with positive outcomes 100 per cent of the time? Those results should raise the eyebrows of any first-year stats student." And who's more likely to be swayed by personal bias? InSite opponents, questioning government-sanctioned hard drug abuse? Or Montaner, Kerr and their handful of acolytes who've staked their careers on InSite's survival? From 2003 to 2011, the BC Centre received $2,610,000 from B.C. taxpayers to "study" InSite. How much money have InSite critics received?" There has never been an independent analysis of InSite, yet, if you base your knowledge on Vancouver media reports, the case is closed. InSite is a success and should be copied nationwide for the benefit of humanity. Tangential links to declining overdose rates are swallowed whole. Kerr's claims of reduced "public disorder" in the neighbourhood go unchallenged, despite other mitigating factors such as police activity and community initiative. Journalists note Onsite, the so-called "treatment program" above the injection site, ignoring Onsite's reputation among neighbourhood residents as a spit-shined flophouse of momentary sobriety." http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php   Reducing the Transmission of Blood-Borne Viral Infections & Other Injection Related Infections      "Self-reports from users of the INSITE service and from users of SIS services in other countries indicate that needle sharing decreases with increased use of SISs. Mathematical modeling, based on assumptions about baseline rates of needle sharing, the risks of HIV transmission and other variables, generated very wide ranging estimates for the number of HIV cases that might have been prevented. The EAC were not convinced that these assumptions were entirely valid.      SISs do not typically have the capacity to accommodate all, or even most injections that might otherwise take place in public. Several limitations to existing research were identified including:      Caution should be exercised in using mathematical modelling for assessing cost benefit/effectiveness of INSITE, given that:        There was limited local data available regarding baseline frequency of injection, frequency of needle sharing and other key variables used in the analysis;        While some longitudinal studies have been conducted, the results have yet to be published and may never be published given the overlapping design of the cohorts;        No studies have compared INSITE with other methods that might be used to increase referrals to detoxification and treatment services, such as outreach, enhanced needle exchange service, or drug treatment courts.    Some user characteristics relevant to understanding their needs and monitoring change have not been reported including details of baseline treatment histories, frequency of injection and frequency of needle sharing.    User characteristics and reported changes in injection practices are based on self-reports and have not been validated in other ways. More objective evidence of sustained changes in risk behaviours and a comparison or control group study would be needed to confidently state that INSITE and SISs have a significant impact on needle sharing and other risk behaviours outside of the site where the vast majority of drug injections still take place." "It has been estimated that injection drug users inject an average six injections a day of cocaine and four injections a day of heroin. The street costs of this use are estimated at around $100 a day or $35,000 a year. Few injection drug users have sufficient income to pay for the habit out through employment. Some, mainly females get this money through prostitution and others through theft, break-ins and auto theft. If the theft is of property rather than cash, it is estimated that they must steal close to $350,000 in property a year to get $35,000 cash. Still others get the money they need by selling drugs." http://www.vancouversun.com/little+evidence+harm+reduction+reduces+harm+more+than+good/8679087/story.html?fref=gc&dti=189308553419 "In addition, the federal government’s Advisory Committee on Drug Injection Sites report only five per cent of drug addicts use the injection site, three per cent were referred for treatment and there was no indication the crime rate has decreased, as well as no indication of a decrease in AIDS and hepatitis C since the injection site was opened." https://www.scientificamerican.com/article/massive-price-hike-for-lifesaving-opioid-overdose-antidote1/Massive Price Hike for Lifesaving Opioid Overdose Antidote Suddenly in demand, naloxone injector goes from $690 to $4,500 Should we follow the money?  Who would be profiting bigly from the increased use of naloxone? https://www.bramptonguardian.com/community-story/7520683-money-and-resources-for-drug-rehabilitation-sorely-needed-in-peel-say-advocates/ "Setting up free injection sites to deal with the recent spate of drug overdoses does not address the root of the opioid problem, says Ted Brown, executive director of Brampton’s Regeneration Outreach Community. Instead, Queen’s Park and other tiers of governments should consider investing resources and dollars toward rehabilitation programs to help those dealing with addiction and mental health issues, said Brown. " http://www.bcmj.org/premise/supervised-injection-sites%E2%80%94-view-law-enforcementSupervised injection sites—a view from law enforcement Jamie Graham, former chief of Vancouver Police has outlined the successful model of dealing with an epidemic: Support, mandatory treatment, abstinence, and counseling as all part of the solution. My recover(ed)(ing) addict friends say they would agree. https://mosaicscience.com/story/iceland-prevent-teen-substance-abuseIceland knows how to stop teen substance abuse but the rest of the world isn’t listening In Iceland, teenage smoking, drinking and drug use have been radically cut in the past 20 years. Emma Young finds out how they did it, and why other countries won’t follow suit. http://www.vancouversun.com/little+evidence+harm+reduction+reduces+harm+more+than+good/8679087/story.html?fref=gc&dti=189308553419 "The current campaign reports significant reductions in drug overdoses, yet the Government of British Columbia Selected Vital Statistics and Health Status Indicators show that the number of deaths from drug overdose in Vancouver’s Downtown Eastside has increased each year (with one exception) since the site opened in 2003." https://www.usatoday.com/story/news/nation-now/2017/05/05/pigeon-nest-needles-highlights-vancouvers-drug-problem/101323878/ Pigeon nest of needles highlights Vancouver's drug problem Some graphs about how overdoses in Vancouver, BC have increased:   https://uploads.disquscdn.com/images/4937e3e285c02900541696be294c99859dd986654fc2ea3b3b1f41f673618dc7.png One more: https://uploads.disquscdn.com/images/d2f8aa542d4033a1f198a3b0e3e802482a4becf1e45b04e77079e989e5c6460a.jpg

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