Rhode Island's first safe injection site is likely to be open by this summer, the FDA renews its warning on "gas station heroin," and more.

[image:1 align:left caption:true]Marijuana Policy

Texas Attorney General Sues Cities That Relaxed Marijuana Laws, Attorney General Ken Paxton (R) on Wednesday sued five cities that have moved in recent years to soften laws against small-time marijuana possession.

"I will not stand idly by as cities run by pro-crime extremists deliberately violate Texas law and promote the use of illicit drugs that harm our communities," the hard-right Republican who's facing trial in April for securities fraud said Wednesday. He also accused those cities of trying to "create anarchy by picking and choosing the laws they enforce."

The cities being sued are the state capital, Austin, along with Denton, Elgin, Killeen, and San Marcos. In 2022, those cities passed ordinances restricting the prosecution of minor marijuana offenses at the municipal level.

Paxton argues that the municipal ordinances are preempted by state law, and he wants the courts to overturn those ordinances and force those cities to "fully enforce the drug laws" of the state.

The state has increasingly warmed to marijuana despite Paxton. A December poll from the Texas Policy Project at the University of Austin found that just 17 percent of Texas think marijuana should be illegal, and only 23 percent of Texas Republicans think so.

Drug Policy

FDA Renews Warning on "Gas Station Heroin." The Food and Drug Administration (FDA) on Wednesday renewed an earlier warning about a substance called tianeptine, commonly known as "gas station heroin" because it is commonly sold at gas stations and convenience stores.

Tianeptine is not a controlled substance and is mixed into pills and liquid products. Vendors often claim it improves brain function and treats anxiety and depression. But FDA says there are numerous adverse event reports around it, with some people having seizures or losing consciousness.

Late last year, the FDA sent a letter to gas stations, convenience stores, and other vendors urging retailers to stop selling the products. But that has not stopped them.

Harm Reduction

Rhode Island Nonprofits Announce Location of First State-Regulated Safe Injection Site. A state-regulated safe injection site should be open as soon as this summer after a pair of nonprofits announced Wednesday that they had signed a lease agreement for the site at a building next to the campus of Rhode Island Hospital in Providence.

Project Weber/RENEW, a peer-led harm reduction and recovery group, and its partner, the clinical services provider VICTA, plan to open the "overdose prevention center" as renters until they raise the rest of the $3 million it will cost to buy the building. The state has already allocated $2.6 million in opioid settlement funds to open the site, including money for salaries.

The opening needs approval from the Providence City Council, which has signaled that it supports the project. A resolution to authorize the site is today's council meeting agenda.

The 20,500-square-foot building will have space for medical, clinical and social support services. The center will allow people to use their own drugs under the supervision of trained professionals. The clients also will be able to test their drugs for fentanyl and other substances and be supervised by people who can administer naloxone, known as Narcan, in case of an overdose.

Rhode Island became the first state to authorize safe injection site, approving them in 2020. The only other safe injection sites operating with official sanction are in New York City, where the city government approved them. Their legality remains questionable under federal law. Other safe injection sites in major American cities operate underground.

HHS Updates Opioid Treatment Program Regulations for First Time in 20 Years, Eases Access to Methadone. On Thursday, the Department of Health and Human Services (HHS) marked two years of its Overdose Prevention Strategy by announcing new actions to combat overdoses. These actions include finalizing a rule that will dramatically expand access to life-saving medications for opioid use disorder, announcing that certain grant funds may now be used to purchase xylazine test strips (XTS), and releasing the Substance Abuse and Mental Health Services Administration's (SAMHSA) updated Overdose Prevention and Response Toolkit.

"Drug overdoses reach every corner of our society, taking lives and causing immeasurable pain to families and communities. That's exactly why President "With these announcements, we are dramatically expanding access to life-saving medications and continuing our efforts to meet people where they are in their recovery journeys. The Biden-Harris Administration continues to take action to lower barriers to treatment and increase support for individuals and communities affected by opioids," said HHS Secretary Xavier Becerra.

HHS, through SAMHSA, published a final rule to comprehensively update regulations governing Opioid Treatment Programs (OTPs), the only programs where people can access methadone treatment for opioid use disorder. The final rule seeks to dramatically expand access to life-saving medications for opioid use disorder (MOUD) and to reduce stigma. Today's updates are the first substantial changes to these regulations in more than two decades.

"This final rule represents a historic modernization of OTP regulations to help connect more Americans with effective treatment for opioid use disorders," said Miriam E. Delphin-Rittmon, PhD, the HHS Assistant Secretary for Mental Health and Substance Use, and the leader of SAMHSA. "While this rule change will help anyone needing treatment, it will be particularly impactful for those in rural areas or with low income for whom reliable transportation can be a challenge, if not impossible. In short, this update will help those most in need."

The final rule incorporates critical feedback submitted by treatment providers, advocates, and patients. Major provisions of the final rule that will expand access to medications for opioid use disorder while ensuring high-quality care include:

• Making permanent COVID-19 era flexibilities that expand eligibility for patients to receive take-home doses of methadone. This will help reduce the burden of transportation for frequent clinic visits. Research has shown that patients receiving take-home doses are more likely to remain in treatment and less likely to use illicit opioids.
• Allowing initiation of treatment via telehealth, including methadone via audio-visual telehealth technology and buprenorphine via audio-only technology, to remove transportation barriers.
• Expanding provider eligibility to allow nurse practitioners and physician assistants to order medications in OTPs, where state law allows, to reduce the burden on OTP operations and increase patient access to medications.
• Breaking down barriers to entry for treatment by removing the stringent admission criteria that had previously required patients to have a history of addiction for a full year before being eligible for treatment. This will help open more doors to treatment for more people when they need it and ensure that everyone can get the care they need.
• .Expanding access to interim treatment, allowing patients to initiate medication treatment while awaiting further services to ensure people have access to care as soon as they are ready and reduce the barriers of treatment waitlists.
• .Promoting patient-centered models of care that are aligned with management approaches for other chronic conditions.

Psychedelics

California Assembly Approves Psychedelic Workgroup Bill. On a unanimous vote Tuesday, the Assembly approved a bill to create a workgroup to explore a regulatory framework to provide therapeutic access to psychedelic substances such as psilocybin and ibogaine, Assembly Bill 941.

"These therapies have the potential to save countless lives," bill sponsor Assemblymember Marie Waldron (R) said during debate. "As we know, California is experiencing a severe mental health crisis with rising rates of anxiety, depression, substance use, PTSD, suicide and other debilitating conditions. AB 941 proposes a solution to this crisis through the exploration of the therapeutic possibilities of psychedelic-assisted therapy."

The bill envisions the state Health and Human Services agency as a regulator and would also allow health practitioners to lawfully administer psychedelics in a therapeutic setting.

"We need the data, the research and the recommendations of experts in this promising field of therapeutics," Waldron said. "Above all, AB 941 is a proactive and forward-thinking approach to the mental health crisis in California -- and key to unlocking the therapeutic potential of psychedelics for use in clinical settings. We must prioritize the accessibility of innovative treatments for our frontline heroes, veterans and first responders who urgently need these transformative interventions."

The bill has now gone to the Senate.