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Book Review: Drug Use for Grown-Ups

Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear, by Carl Hart (2021, Penguin Press, 290 pp., $28.00 HB)

Dr. Carl Hart is a one-man drug and drug user destigmatization machine. In his new book, Drug Use for Grown-Ups, the Columbia University psychology professor blasts drug prohibition as both an affront to the American dream of the pursuit of happiness and as a tool of racial oppression. And he makes a strong, informed argument that recreational drug use can be, and usually is, a good thing.

You could hardly find someone more qualified to make the case. Hart has spent years in the trenches of neuropsychopharmacology research, handed out drugs (or placebos) to thousands of research subjects, published numerous scientific papers and popular articles in the field, and risen to the top of his profession along the way. And here is his bottom line:

"[O]ver my more than 25-year career, I have discovered that most drug-use scenarios cause little or no harm and that some responsible drug-scenarios are actually beneficial for human health and functioning. Even 'recreational' drugs can and do improve day-to-day living... From my own experience -- the combination of my scientific work and my personal drug use, I have learned that recreational drugs can be used safely to enhance many vital human activities."

Hart is refreshingly -- and deliberately -- open about his own recreational drug use. Given the stigmatization and persecution of people identified as "drug users," he feels that justice demands privileged partakers come out of the closet and give voice to their own, non-destructive drug use histories as a necessary remedy for that demonization. He certainly does so himself, revealing a disciplined yet curious mind most definitely not averse to sampling various substances.

Those substances include heroin, which he describes as his current favorite drug, one that he's been using episodically for years now: "There aren't many things in life that I enjoy more than a few lines by the fireplace at the end of the day... Heroin allows me to suspend the perpetual preparation for battle that goes on in my head... The world is alright with me. I'm good. I'm refreshed. I'm prepared to face another day, another faculty meeting, another obligatory function. All parties benefit."

But Hart is not quite so mellow when it comes to people and institutions he sees as helping to perpetuate overly negative depictions of various drugs or the persecution of drug users. He rips into Dr. Nora Volkow, head of the National Institutes on Drug Abuse (NIDA) over her "addiction is a brain disease" mantra and the rigid ideological control she has over research funding. He rips into journalists for uncritically and sensationally reporting salacious scientific findings about the evils of drugs that he argues are not supported by the evidence they are supposedly based on. He even calls Bernie Sanders "ignorant" (that word shows up more than a few times) for complaining that marijuana shouldn't be in the same drug schedule as "killer drugs like heroin."

Dr. Carl Hart (Columbia University)
Hart doesn't deny the potential dangers of drug use but makes the case that they are dramatically overstated. In that sense, Drug Use for Grown-Ups is a corrective to more than a century of anti-drug propaganda. In a deep dive into opioids, for instance, he notes that most opioid overdose deaths are actually opioid/benzodiazepines/alcohol deaths, and that a large number of them are due to ignorance (there's that word again) -- in that, in the black market that currently exists, drug users do not and cannot know what exactly is in that pill or powder they purchased.

As long as we are in a prohibition regime, the least we can do is widespread drug testing for quality control, as is done at some European music festivals, Hart argues. But that's the only kind of drug testing he's down with; he calls the urine drug testing industry "parasitic," a sobriquet he also applies to the drug treatment industry.

But hang on, he's not done yet. Although he is an advocate for harm reduction practices, he has a bone to pick with the term itself: It's too damned negative! Drug use doesn't typically involve harm, he argues, but pleasure-seeking. As I pondered this, I came up with "benefit enhancement" as an upbeat alternative to harm reduction, but Hart went with "health and happiness."

And he's got a bone to pick with "psychedelic exceptionalism," the notion, dear to folks like Decriminalize Nature, that psychedelics, or better yet, "plant entheogens," are somehow "better" than dirty old drugs like meth or heroin and thus deserve to be treated differently, more gently. He also snarks at the notion that taking drugs for spiritual or religious purposes is of a higher order than taking them for fun and rebels at the notion of having a shaman or guide during a tripping session: "Some people find this comforting. I find it creepy and have never done so myself."

Drug Use for Grown-Ups is bracing, informative, and provocative contribution to the literature. Even the most ardent drug reformers and defenders would benefit from reading it and reexamining their own assumptions. Maybe Carl Hart is onto something.

AZ "Drug Trafficking Homicide" Bill Filed, HI Marijuana Legalization, Decrim Bills Advance, More... (2/17/21)

Hawaii legislators take up marijuana reform bills, Maryland legislators take up marijuana legalization, and more.

Fentanyl and its analogues are the object of a harsh new drug sentencing proposal in Arizona. (DEA)
Marijuana Policy

Hawaii Marijuana Legalization Bill Advances. The Senate Public Safety, Intergovernmental and Military Affairs Committee voted on Tuesday to approve a marijuana legalization bill, Senate Bill 767. It would legalize possession of one ounce of marijuana or less by anyone who is 21 years old or older.

Hawaii Marijuana Decriminalization Bill Advances. The Senate Committee on Public Safety, Intergovernmental, and Military Affairs also voted on Tuesday to approve Senate Bill 758 would increase from 3 grams to 1 ounce the minimum amount of marijuana that a defendant must possess to be charged with a petty misdemeanor. It would also permit persons previously convicted of possessing 1 ounce or less of marijuana to have the conviction expunged from their criminal record.

Maryland Legislators Hold First Committee Hearing on Marijuana Legalization. The House Judiciary Committee held a hearing Tuesday on a marijuana legalization bill, House Bill 32. No vote was taken. Another marijuana legalization bill, Senate Bill 708, is set to be heard in committee on March 4. HB 32 would legalize up to four ounces of pot by adults, allow home cultivation, allow an unlimited number of microbusiness licenses. That is the main difference with SB 708.

Sentencing Policy

Arizona Bill Would Charge Those Who Provide Drugs Linked to Overdoses with Murder. People who sell or share drugs linked to overdose deaths could face as much as 25 years in prison under a measure, House Bill 2779, that would create the crime of "drug trafficking homicide." The bill would also make people convicted under the charge ineligible for probation or early release. And it would create tougher mandatory minimum sentences for people caught selling or even possessing small amounts of heroin, fentanyl, and fentanyl analogues.

Biden IRS Doesn't Support Pot Shop's Tax Fight, Myanmar Opium Down But Meth Is Up, More... (2/15/21)

South Dakota's Republican attorney general won't defend the state's voter-approved marijuana legalization amendment any further, a Michigan court rules people on probation can use medical marijuana, and more.

Meth is making big bucks for Asian crime syndicates, the UN Office on Drugs and Crime reports. (DEA)
Marijuana Policy

Biden Administration Opposes Marijuana Dispensary's Tax Fight for Supreme Court Review. In one of the first actions regarding marijuana in the Biden administration, the IRS has argued against a Denver-based dispensary, Standing Akimbo LLC, having its case heard in the US Supreme Court. The dispensary is seeking to challenge an IRS rule that business tax deductions cannot be taken by marijuana businesses because marijuana remains illegal under federal law.

Delaware Marijuana Legalization Bill Coming Soon. State Rep Ed Osienski (D-Newark) says he plans to submit a marijuana legalization bill by the time lawmakers return from their February break on March 9 and that he is optimistic about its prospects. "It's close, it's close," he said. "We're talking one or two votes" away from approval in the House." Gov. John Carney (D) has consistently opposed legalization, but Osienski is suggesting Carney could let the bill become law without signing it.

South Dakota Attorney General Will Not Join Appeal of Ruling That Marijuana Legalization Amendment Is Unconstitutional. Although the attorney general's office generally defends state laws when they are challenged in court, SD Attorney General Jason Ravnsborg's (R) office will not help appeal a state judge's ruling that the marijuana legalization amendment passed by voters last November is unconstitutional. Ravnsborg's boss, Gov. Kristi Noem (R) opposes marijuana legalization. A deputy attorney general defended the amendment in lower court, and Ravnsborg's office says that satisfies the state law's requirements. An appeal to the state Supreme Court by attorneys associated with the campaign is ongoing.

(The South Dakota code states that ""... the attorney general shall... appear for the state and prosecute and defend all actions and proceedings, civil or criminal, in the Supreme Court, in which the state shall be interested as a party.")

Medical Marijuana

Michigan Appeals Court Upholds Right of People on Probation to Use Medical Marijuana. The state Court of Appeals has ruled that judges cannot prevent people from using medical marijuana as a condition of probation. The ruling came after a Traverse County district court judge barred Michael Thue from using medical marijuana while on probation, saying it was a policy of circuit court judges in the county. But the appeals court ruled that anyone who has a state-issued medical marijuana card is immune to such penalties.

Criminal Justice

Key Senate Judiciary Subcommittee Gets Booker, Cotton as Chair, Ranking Member. The Senate Judiciary Committee announced Sunday that the Subcommittee on Criminal Justice and Counterterrorism, where issues extremely relevant to drug and sentencing policy are the focus, will be chaired Senator Cory Booker (D-NJ), with Senator Tom Cotton (R-AR) named ranking member. Booker is a criminal justice and drug law reform stalwart; Cotton is one of the most regressive members of the Senate on criminal justice.

International

UNODC Reports That Myanmar Opium Production Drops While Meth Surges. A UN Office on Drugs and Crime (UNODC) report released last Thursday finds that opium production has dropped in Myanmar, the world's second-larges poppy producer after Afghanistan has dropped to around 405 metric tons, about half the amount recorded in 2013. Instead, the Golden Triangle drug trade is now dominated by methamphetamine production. "Opium production is down 11 to 12% on the previous year," said Jeremy Douglas, UNODC Southeast Asia and the Pacific Regional representative. "This decline is intimately linked to the surge of synthetic drugs."

Drug Companies Seek Big Tax Write-Offs for Opioid Settlements, VA Legal Pot Bill Advances, More... (2/12/21)

South Dakota's obstinate governor continues to get in the way of marijuana legalization, a freshman Kansas state representative files a drug decriminalization bill, and more.

Pills, pills, pills. (Pixabay)
Marijuana Policy

Kentucky Marijuana Legalization Bill Filed. Rep. Rachel Roberts (D-Campbell County) has filed a marijuana legalization bill, House Bill 467. The bill would legalize the possession of up to an ounce, provide free expungement of marijuana-related offenses, and dedicate up to 25% of the state's marijuana tax revenues to funding addiction treatment. Personal cultivation of up to five plants would be allowed but would require a $250 permit.

North Carolina Poll Has Majority Support for Marijuana Legalization. An Elon University poll released Thursday has support for marijuana legalization at 54%, with 34% opposed. That's a big swing in favor of legalization since 2017, when another Elon University poll had 51% opposed.

South Dakota Bill to Expunge Some Marijuana Convictions Advances. The Senate Judiciary Committee voted Thursday to approve Senate Bill 141, which would expunge some misdemeanor marijuana convictions from background checks. The bill would provide for the automatic expungement of marijuana possession convictions from public background reports. It still faces a Senate floor vote and action in the House.

South Dakota Governor Likely to Veto Any Marijuana Legalization Bills This Year. Gov. Kristi Noem (R), who has already moved to invalidate a voter-approved marijuana legalization initiative, said Thursday she would probably veto any effort to achieve legalization through the legislature. She said at a news conference she would "not be inclined" to sign such a bill. Some legislators have indicated support for a legalization bill, saying it would reflect the will of the voters.

Virginia Marijuana Legalization Effort Advances. With both chambers having already approved marijuana legalization bills last week, the House General Laws Committee this week approved Substitute Senate Bill 1406, which amends the Senate bill to conform with the House's legalization bill. The Senate bill had allowed localities to opt-out of retail marijuana sales, the House bill doesn't.

Heroin and Prescription Opioids

Drug Companies Seek Billions in Tax Deductions from Opioid Settlement. A major pharmaceutical company and three drug distribution companies who have agreed to pay $26 billion to settle claims related to their role in stoking the opioid epidemic are now seeking to write off some of those costs from their taxes and pocket about $1 billion each. The companies are drug maker Johnson & Johnson and distributors Cardinal Health, Amerisource-Bergen, and McKesson.

Psychedelics

Texas Bill to Study Therapeutic Potential of Psychedelics Filed. Rep. Alex Dominguez (D-Brownsville) has filed a bill, HB 1802, that would mandate a state study of the therapeutic potential of psilocybin, MDMA and ketamine in the treatment of certain mental health conditions. The Department of State Health Services would conduct the study along with the Texas Medical Board and issue a report by December 2022.

Drug Policy

Kansas Drug Decriminalization Bill Filed. Rep. Aaron Coleman (D-Kansas City), a 20-year-old freshman legislator, has filed a bill to decriminalize the possession of personal use amounts of illicit drugs. HB 2288 would make drug possession a civil offense punishable by a fine of $100, but it would also create the offense of "failure to comply with drug abuse treatment." The bill is currently before the House Committee on Corrections and Juvenile Justice.

SD Judge Throws Out Marijuana Legalization Init, IL Drug Defelonization Bill Coming, More... (2/10/21)

A South Dakota court throws out the voter-approved marijuana legalization amendment, Idaho medical marijuana campaigners can begin signature-gathering for 2022, and more.

A bill to requiring reporting on COVID in federal prisons is about to be filed. (Creative Commons)
Marijuana Policy

New National Poll Has Three-Fifths Saying Marijuana Legalization is a "Good Idea." A new national survey from Emerson College Polling has 61% of respondents saying marijuana legalization is a "good idea." The poll asked about various issues -- new pathways for citizenship, raising the minimum wage, for example -- but none had as much support as marijuana legalization.

Connecticut Bill Would Require "Labor Peace" for Marijuana Businesses. A bill now before the Labor and Public Employees Committee, HB 6377, would require that marijuana businesses enter into labor peace agreements with a union before being granted licenses. The bill would require an agreement "between a cannabis establishment and a bona fide labor organization that protects the state's interests by, at minimum, prohibiting the labor organization from engaging in picketing, work stoppages or boycotts against the cannabis establishment." Under the bill, marijuana employers would give up some rights, including the right to speak to employees about union organizing efforts.

South Dakota Judge Rejects Amendment Legalizing Marijuana. A circuit court judge in Pierre appointed by marijuana legalization opponent Gov. Kristi Noem (R) has thrown out the constitutional amendment legalizing marijuana that was approved by 54% of the voters in November. The judge held that the measure violated the state's requirement that constitutional amendments deal with just one subject and would have created broad changes to state government. Amendment sponsors led by former US Attorney Brendan Johnson said they would appeal the ruling to the state Supreme Court.

Medical Marijuana

Idaho Campaigners Cleared to Begin Signature Gathering for 2022 Medical Marijuana Initiative. Kind Idaho, the group leading the campaign for a 2022 medical marijuana initiative, has been cleared to begin signature gathering. A 2020 signature-gathering campaign was disrupted by the coronavirus and ultimately failed to back the ballot. This move comes as a medical marijuana bill has just been introduced in the legislature and as the legislature also considers legislation that would prevent the state from legalizing any currently illicit drugs.

South Dakota Governor Seeks Delay in Implementing Medical Marijuana Initiative. Gov. Kristi Noem (R) said Wednesday that while she will not stand in the way of implementing a voter-approved medical marijuana initiative, the state will need more time to get the program up and running. "We are working diligently to get IM 26 implemented safely and correctly," Noem said. "The feasibility of getting this program up and running well will take additional time." Under state law, voter-approved ballot measures are supposed to take effect the following July 1, but Noem and the state's Republican legislative leadership say they will delay implementation until July 1, 2022.

Incarceration

Progressive Lawmakers Will Reintroduce COVID-19 in Corrections Data Transparency Act. United States Senators Elizabeth Warren (D-MA), Senators Patty Murray (D-WA) and Cory Booker (D-NJ), along with Congresswoman Ayanna Pressley (D-MA) and Congresswoman Sylvia Garcia (D-TX) will reintroduce of the COVID-19 in Corrections Data Transparency Act, bicameral legislation that would require the Federal Bureau of Prisons (BOP), the United States Marshals Service (USMS), and state governments to collect and publicly report detailed data about COVID-19 cases, hospitalizations, deaths, and vaccinations in federal, state, and local correctional facilities. "As a result of their confinement, incarcerated people are at increased risk of contracting COVID-19, and reports show that COVID-19 has spread like wildfire in correctional facilities across the country. This bill takes a necessary step towards containing the pandemic and supporting the health and safety of incarcerated individuals, correctional staff, and the general public by strengthening data collection, reporting, and transparency," Senator Warren said.

Sentencing Policy

Illinois Drug Defelonization Bill Coming. Criminal justice reform advocates were thwarted in getting a drug defelonization bill passed in 2019, and now they are preparing to try again. The proposed bill would not only defelonize drug possession, it would also seek to divert drug users from the criminal justice system.

NJ Governor Signs Bill to Reduce Psilocybin Penalties, VA Drug Decrim Bill Killed, More... (2/8/21)

New Jersey reduces penalties for possession of psychedelic mushrooms, an Idaho medical marijuana bil lis filed, a Minnesota asset forfeiture reform bill advances, and more.

psilocybin molecule (Creative Commons)
Marijuana Policy

New Jersey Deadline for Marijuana Legalization Legislation Extended. Assembly Speaker Craig Coughlin (D) last Friday bumped back a procedural deadline for gubernatorial action on two already-passed marijuana legalization implementation and decriminalization measures from Monday to February 18. Governor Phil Murphy (D) and legislative leaders are making progress on changes to those bills to address concerns raised by the governor.

South Dakota Bill to Ban Smoking Marijuana in a Motor Vehicle Gets Hearing. A bill that would ban smoking marijuana in a motor vehicle got a hearing Monday. The bill, House Bill 1061, is a response to the voter-approved marijuana legalization initiative that passed in November.

Wisconsin Governor Proposes Legalizing Marijuana. Governor Tony Evers (D) announced Sunday that he is proposing that the state legalize marijuana. Evers' plan would allow people 21 and over to possess up to two ounces and grow up to six plants, as well as set up a system of taxed and regulated marijuana commerce. Medical marijuana would be available for people 18 and over.

Medical Marijuana

Idaho Medical Marijuana Bill Filed. The House Health and Welfare Committee has filed a bill to allow for medical marijuana in the state. In a hearing Friday, witnesses including a prominent medical oncologist urged support for the legislation. No action was taken.

Pennsylvania Marijuana Workers Can't Unionize, NLRB Rules. The National Labor Relations Board (NLRB) has squashed an attempt to unionize workers at a medical marijuana facility near Philadelphia. Workers at the AgriKind growing operation cannot be unionized because they are agricultural workers, the NLRB held. Agricultural and farm workers are usually considered to be exempt from federal labor law. The NLRB has ruled in favor of unionizing marijuana workers if their work includes packaging or delivering marijuana.

Psychedelics

New Jersey Governor Signs Bill to Reduce Penalties for Psilocybin Possession. Governor Phil Murphy (D) has signed into law A 5084 / S 3256, which reduces the penalty for people caught with small amounts of psilocybin from up to five years in state prison to a maximum of six months in jail and a $1,000 fine. Sen. Nicholas Scutari (D), who first introduced the mushroom amendment, said Thursday the change mushrooms are still illegal in New Jersey, "but it's not going to ruin lives for a first offense."

Asset Forfeiture

Minnesota Asset Forfeiture Reform Bill Advances. A bill that would limit cash seizures to amounts greater $1,500 unless drug trafficking is alleged and bar the seizure of vehicles except for repeat drunk driving offenders or vehicles used for drug trafficking -- not possession -- passed the House last Friday. HF 75 passed the House Judiciary Finance and Civil Law Committee and will now be considered by the House State Government Finance and Elections Committee.

Sentencing

Virginia Drug Defelonization Bill Killed in Committee. A bill that would have eliminated felony drug possession charges and shift the focus toward drug treatment instead of punishment, House Bill 2303, was defeated in the Committee on Courts and Justice last Friday.

VA Poll Finds 2/3 Support for MJ Legalization, Reformers Urge End to Fed Cocaine Sentencing Disparity, More... (2/3/21)

An Alabama bill would let police use wiretaps against suspected drug felons, another Alabama bill would legalize medical marijuana, a New Jersey court hears a key medical marijuana licensing case, and more.

FAMM and the Prison Fellowship call on Congress to end the federal cocaine sentencing disparity. (Pixabay)
Marijuana Policy

Virginia Poll Has More Than Two-Thirds Support for Marijuana Legalization. A new poll from the Wason Center for Civic Leadership at Christopher Newport University has support for marijuana legalization at 68% among registered voters. The poll comes as legalization bills are moving rapidly through the legislature and just days ahead of a Friday deadline for getting bills through at least one house of the legislature.

Medical Marijuana

Alabama Senate Committee Approves Medical Marijuana Legalization Bill. A bill to legalize medical marijuana, Senate Bill 46, was approved by the Senate Judiciary Committee on Wednesday. Sponsored by Sen. Tim Melson (R), the bill would set up a state medical marijuana commission, but would limit access to patients who have been diagnosed with one of about 20 qualifying conditions.

New Jersey Court Hears Oral Arguments in Medical Marijuana Expansion Case. A panel of three appellate court judges heard oral arguments Tuesday in a case where rejected medical marijuana applicants sued the state over its licensing procedures. The rejected business applicants argue that the state incorrectly rejected their applications. The case has stalled the expansion of the state's medical marijuana program.

Law Enforcement

Alabama Bill Would Let Police Secretly Wiretap Suspected Drug Felons. Lawmakers in Montgomery are taking up House Bill 17, which would allow state and local police to place wiretaps on phone lines and monitor the online communications of drug suspects without involving federal law enforcement. The bill is sponsored by Rep. Rex Reynolds (R-Huntsville), the former Huntsville police chief. "This is for drug traffickers," he said. "There are people that are bringing illicit drugs into our counties, drugs that are killing our youth." But critics say the bill uses a low standard of proof, requiring only probable cause, and that it could be used even for some marijuana possession offenses.

Sentencing Policy

Prison Fellowship, FAMM Urge Congress to End Crack/Powder Cocaine Sentencing Disparity. Prison Fellowship, the nation's largest Christian nonprofit serving prisoners, former prisoners, and their families, is partnering with FAMM to launch the #EndTheDisparity campaign and to urge Congress to eliminate the disparity between how crack and powder cocaine-related offenses are punished. Both organizations are circulating petitions and are planning a series of activities to build public support for reform. "We have been fighting to repeal unjust sentencing laws for 30 years, and we've seen no greater injustice than the crack-powder disparity," FAMM President Kevin Ring said. "We were glad Congress reduced the disparity in 2010, but it's time to finish the job. We must remove this racially discriminatory scheme from the criminal code."

Book Review: Three Takes on the Opioid Crisis [FEATURE]

RX Appalachia: Stories of Treatment and Survival in Rural Kentucky, by Lesly-Marie Buer (2020, Haymarket Books, 264 pp., $22.95 PB)

Death in Mud Lick: A Coal Country Fight Against the Drug Companies That Delivered the Opioid Epidemic, by Eric Eyre (2020, Scribner, 289 pp., $28.00 HB)

White Market Drugs: Big Pharma and the Hidden History of Addiction in America, by David Herzberg (2020, University of Chicago Press, 365 pp., $27.50 HB)

America remains in the grip of what is arguably its third great opioid addiction and overdose crisis. It began in the late 1990s as doctors tried to address an historic problem of under-prescribing and unavailability of opioids for chronic pain treatment that affected many patients. But mistakes were made along the way, and a massive tide of not always well targeted prescription opioids swamped the country. As regulators and law enforcement cracked down on pain pills, that morphed into a deadly wave of heroin addiction. And then we got fentanyl, which quickly took first place as a cause for overdose deaths. Produced mostly in China and Mexico, fentanyl is used by some hardcore addicts with high tolerance, but mainly appears as an adulterant added to heroin or in counterfeit prescription pills.

The authors of the three books reviewed here take on various aspects of the phenomenon, from the granular nitty-gritty of the lives of poor, white, female drug users ensnared in the treatment and rehab system in present-day Appalachia, to a state-level look at how drug distribution companies flooded West Virginia with literally billions of prescription opioids, to a long-term overview of the effort to regulate drugs and the subsequent -- and enduring -- historic division of drug use and users into markets black and white. (And by white markets, we are referring not only to legality but also, sadly yet unsurprisingly, skin color.)

Taken together, the three books weave a damning indictment of pharmaceutical companies, the people and entities that are supposed to regulate them, and the moral crusaders who -- too often, successfully -- use the issue of drug use to call for repressive policies, especially aimed at people who aren't "good people;" that is, poor and/or non-white people.

There are also some things the books don't do more than tangentially. They don't touch on the issue of access to pain medications for chronic pain patients. These are people who often suffer not from too-easy access to prescription opioids, but from obstacles to access, and who have suffered even more as politicians and regulators moved to rein in what they argue is massive overprescribing of such medications.

Whether it's being prosecuted for seeking their medicine in the black market or being forced to jump through hoops to obtain their medicine or being refused it altogether in the white market, these are people whose access to the medicines they need is encumbered. Their story is an important part of the debate over opioids (and drug policy more generally), but it gets only a side mention in one of these three works. But over-prescribing of opioids and under-prescribing of them continue to coexist.

The books also don't attempt to disentangle supply-driven opioid abuse, from the so-called "deaths of despair." The same social and economic factors that have driven up the suicide rate in recent decades, and which arguably helped to elect Donald Trump, increase the rates at which drugs are used and abused, including opioids. That in turn leads to more overdose deaths, and some apparent overdoses actually are suicides.

And the authors don't ask their readers to question whether any given "pill mill" or seemingly too large prescription, is really what it looks like. If we accept that abuses in the supply system have played a role in the opioid crisis, that doesn't mean that any given doctor or pharmacist or distributor is guilty as charged. A medical practice with patients treating patients from hundreds of miles away, could be a "pill mill," but it could also have the one doctor who understands pain treatment and is willing to work with poor people whom other doctors view as too risky. A prescription that seems huge because of the number of pills, could represent diversion to the underground market – or it could mean that a long-term pain patient who needs a large dosage because of tolerance built up over time, and who doesn't use technology like a medically-inserted morphine pump, is reliant on pills and their standard-sized dosages that are designed for less tolerant patients. Without considering those contexts, pill numbers can be a misleading metric, at least some of the time.

The books do discuss some options for making effective opioid addiction treatments more easy for more patients to obtain, or for reducing the likelihood of a user coming to serious harm. But the most effective treatment for this type of addiction is the use of other opioids, in what's known as Medication Assisted Treatment (MAT). Through controlled use of methadone or buprenorphine supplied by clinics, people with opioid addictions are able to stabilize their lives and avoid catastrophic physical harms, while maintaining responsibilities like work and family needs. Making MAT available through a doctor's office, while training doctors in their use, would reduce the harm of opioid addiction by providing a legal alternative that works -- in this case a quality-controlled opioid. Offering HAT, too -- heroin assisted treatment, or heroin maintenance, as Canada and some European countries do for people who have tried methadone or buprenorphine without succeeding -- would do more.

And that begs the question about prohibition itself. Though some may find it counterintuitive to talk about legalization as a solution to a problem driven by increased drug availability, it is the case that this opioid crisis in its entirety has transpired under the current system – a system in which all drugs of this type are illegal unless one has a prescription, and in which most people are usually not supposed to be given prescriptions. Fentanyl, which today accounts for 2/3 of US opioid deaths and has room to spread geographically and increase further, is a textbook example of the consequences of prohibition -- most people taking it, and nearly all of those who die from it, thought they were taking something else. If people who developed addiction problems had access to predictable, (relatively) safe, easy to access and financially affordable options, that might be better even than a less heavy-handed system but still prohibition-based system.

All that said, there is an opioid crisis. These three books provide an eye-opening and important look at some critical sides of the phenomenon.

Lesly-Marie Buer is a Knoxville-based harm reductionist and medical anthropologist whose RX Appalachia is a compelling examination of the socially constructed suffering of mainly poor, white women who use drugs in a cluster of eastern Kentucky counties. She spent months living in the area, followed the women to court, to drug treatment, and opioid maintenance programs, and interviewed them extensively over time.

The result is a nuanced portrayal of these women's lives and struggles as they contend with the demands of institutions of social control even as they have to deal with poverty, child custody issues, and their stigmatization as drug users and therefore bad mothers. In that very important sense, RX Appalachia gives voice to the voiceless.

It also voices an unrelenting critique of a social and political system that provides unequal access to resources, chronically underfunds services to the poor and needy -- including but not limited to drug treatment and mental health services -- and is more willing to impose social controls on these women than to help them deal with the complexities of their lives. Appalachia RX is an important contribution to our understanding of the way drug policies, as well as broader social and economic trends, play out on the bodies of these multiply oppressed women.

How some of those women got strung out in the first place is the subject matter of Death in Mud Lick, still in Appalachia and just across the West Virginia line from those Kentucky women. Charleston Gazette-Mail reporter Eric Eyre won a Pulitzer Prize for his years of doggedly chasing down the story of how drug distribution companies pumped billions of opioid pain pills into the state in just a few years, and here, he puts that reporting in book form. It's quite a tale.

Eyre starts with a single drug overdose death, and by the time he's done, has unraveled a tangled tale of negligence, indifference, and profit-driven decision-making that left 1,728 West Virginians dead of drug overdoses in a six-year period. Thanks to Eyre's journalistic persistence and to a legal team determined to get to the bottom of the flood of pain pills that overwhelmed the state (and the region and the nation), we now know that drug companies dumped some 780 million hydrocodone and oxycodone tablets into the state during that same period.

There's plenty of blame to go around. Pharmaceutical corporations such as Purdue aggressively promoted their opioid products, doctors turned medical practices into pill-prescribing machines, pharmacies blithely filled numberless prescriptions, and drug distribution companies such as Cardinal and McKesson just as blithely delivered all those pills to the pharmacies, despite warning signs.

And regulators failed to regulate. Whether it was the state Board of Pharmacy or the DEA, regulators were asleep at the switch as an opioid epidemic grew right in front of them. And state officials were compromised by ties with the pharmaceutical industry and the distributors.

Eyre tells his tale with journalistic panache, taking the reader with him as he and his struggling newspaper take on the state political establishment and the distributors in the court battles that ultimately forced the companies and the DEA to release the records that documented the deluge of opioids. Death in Mud Lick is a real eye-opener.

But for David Hertzberg, an associate professor of history at the University of Buffalo and author of White Market Drugs, Eyre's story is just the latest chapter in the long history of America's effort to control drugs. Hertzberg begins with the opioid crisis of the late 19th Century and ably describes how the competing forces seeking to deal with it -- therapeutic reformers, repressive moral entrepreneurs, pharmaceutical companies, the medical profession -- created a class- and race-based bifurcation of the world of psychoactive substances into "medicines" and "drugs."

If it was prescribed by a physician, it was medicine. If not, not. The world of legal, regulated drugs became Hertzberg's white market. The world of repressed, prohibited drugs is the familiar black market. One serves middle-class white people and is concerned with consumer safety. The other serves the poor, the unconnected, the immigrant, the people of color, whose drug use and sales are considered crimes.

The history of drugs in America is well-trodden ground, but Hertzberg brings both new revelations and a new perspective to the subject. The drug reform movement's archvillain, Harry Anslinger, the master of Reefer Madness propaganda, becomes more than one-dimensional as Hertzberg tells the story of his strict scientific approach to opioids. As head of the Federal Bureau of Narcotics, Anslinger enlisted a Committee on Drug Addiction to closely study opioids, and those scientists even developed their own new opioids (they were market flops), as well as closely measuring the addictive potential of other potential new opioid products. Here, Anslinger was acting not as the heavy-handed lawman, but as the protector of white market consumers.

And as he tells the story of pharmaceutical companies continually coming up with new psychoactive products, patterns begin to occur. After the original drug prohibition laws a century ago effectively suppressed opioid use for decades, the pharmaceutical companies came up with barbiturates in the 1930s, amphetamines in the 1940s and 1950s, benzodiazepines in the 1970s and 1980s, before hitting it big again with opioids in the OxyContin-led bonanza beginning in the 1990s and lingering like a bad hangover to the present day. In all those cases, the profit motives of the drug makers overwhelmed regulatory structures designed to protect those good, deserving consumers of the white market -- even as the drug companies demonized black market drug users for causing the problems.

Given this history of pharmaceutical and regulatory fecklessness, Hertzberg comes to a shocking, but not really surprising conclusion: Left to their own devices, profit-drive drug companies peddling addictive products will function in ways that are incompatible with the public health. In Hertzberg's words:

"Profit-driven drug markets follow a predicably damaging cycle. Companies hype new medicines as safe and beneficial and sell with insufficient regard for consumer safety; a health crisis ensues as consumers are left ill-equipped to make informed decisions; authorities respond with consumer protections and destructive drug wars; the pharmaceutical industry devises strategies to circumvent the new restrictions and start the cycle again. After umpteen repetitions of this cat and mouse game, it may be time to acknowledge the impossibility of establishing a safe, for-profit market for addictive drugs. Alternatives exist: state monopolies, for example, or public utility models. We need to consider these and other creative ideas for dramatically minimizing or even eliminating profit from psychoactive capitalism."

Whether a shift to models of that type is what's needed, or just better regulation, is a question for debate. But it's clear that ending drug prohibition isn't enough. Reimagining the white market is necessary, too.

Canada Considers Decrim, DOJ Rescinds Sessions-Era Sentencing Guidance, More... (1/29/21)

State legislatures are dealing with marijuana bills, the Justice Department reverts to less harsh charging and sentencing policies, and more.

Faced with a spiraling drug overdose crisis, the Canadian federal government ponders drug decriminalization. (Pixabay)
Marijuana Policy

Idaho Bill to Amend Constitution to Bar Marijuana Legalization Advances. The measure, a joint resolution, would ban all psychoactive drugs not already legal in the state, but was inspired by fears of marijuana legalization. It was approved Friday in the Senate State Affairs Committee on a party line vote. To become law, the measure would have to pass both the House and the Senate with a two-thirds majority and then be approved by a simple majority of the electorate in the November 2022 general election.

New Hampshire Marijuana Legalization, Home Cultivation Bills Killed. The House Criminal Justice and Public Safety Committee voted Wednesday to retain a marijuana legalization bill, effectively killing it for the rest of the legislative session. The committee also voted to kill a bill that would allow home cultivation of marijuana.

New Jersey Home Cultivation Bill Filed. Even as the legislature and the governor continue to spar over bills decriminalizing and legalizing marijuana after voters approved it in November, Sen. Gerald Cardinale (R-Bergen) has filed S 3407 (not yet available on the legislative website), which would legalize the cultivation of up to six plants by individuals once a legalization bill is signed into law. "The people of New Jersey made it clear in November that they want to lift the prohibition on cannabis," Cardinale said in a statement. "Since then, the Legislature has spent three months fumbling around with what should have been a simple task, and complicated the legalization effort with countless fees, licensing and extra layers of bureaucracy."

Pennsylvania Governor Calls for Adult-Use Marijuana Legalization in 2021 Agenda. Gov. Tom Wolf (D) is calling for marijuana legalization as part of his 2021 agenda, which was released Thursday. "The revenue generated from legalization will be used to support historically disadvantaged small businesses through grant funding and provide them the assistance they need to build back from the economic crisis and strengthen our economy," Wolf said. "Additionally, a portion of the revenue will support restorative justice programs to help the individuals and communities that have been adversely harmed by the criminalization of marijuana."

Medical Marijuana

North Dakota Lawmakers Kill Home Cultivation for Medical Marijuana Patients. A bill that would have allowed registered medical marijuana patients to grow their medicine was unanimously defeated in the Senate Judiciary Committee Thursday.

Sentencing Policy

Justice Department Rescinds Harsh Charging and Sentencing Policy, Reverts to Obama-Era Policy. Acting Attorney General Monty Wilkinson has revoked harsh Justice Department guidance to federal prosecutors imposed by then-Attorney General Jeff Sessions in 2017. Wilkinson reverted to guidance issued by then-Attorney General Eric Holder in 2010, which, in a bid to reduce imprisonment, directed prosecutors to do an individualized assessment of relevant facts in deciding what cases to charge and what sentences to seek. That guidance, though, does not include a 2013 Holder memo directing prosecutors not to seek mandatory minimum sentences in some drug cases.

International

Canada Ponders Drug Decriminalization in Bid to Fight Overdoses. The Canadian federal government is pondering whether to decriminalize drug possession in a bid to tamp down rising drug overdose numbers, a government official told Reuters this week: "A spokesman for Health Minister Patty Hajdu said on Wednesday that decriminalization was under consideration and that discussions with Vancouver were under way but would not comment further." Vancouver has already called on the federal government to let it decriminalize drugs inside the city limits.

Trump Final Pardon Actions Include Drug War Prisoners, AZ Adult MJ Sales to Begin, More... (1/20/21)

A marijuana legalization bill gets filed in North Dakota, organized opposition to marijuana legalization rears its head in Virginia, and more.

We're glad for the drug prisoner clemencies. Still, don't let the door hit you on the way out. (Creative Commons)
Marijuana Policy

Arizona Recreational Marijuana Sales Could Start as Early as This Week. State health officials have told existing medical marijuana dispensaries that they are poised to issue them licenses for recreational sales and that they could be open for recreational sales as soon as this week. Dispensary owners are waiting for imminent notice that licenses have arrived. "I'm sitting here at my computer hitting refresh, refresh," said Raúl Molina, a partner and senior vice president of operations for The Mint dispensaries in Mesa and Guadalupe.

North Dakota Marijuana Legalization Bill Filed. Even as a marijuana legalization initiative campaign gears up for 2022, some legislators aren't waiting to take the issue to the voters. Rep. Jason Dockter (R-Bismarck) and a handful of cosponsors have filed House Bill 1420, which would allow adults 21 and older to legally purchase and possess up to one ounce of marijuana from a licensed retail outlet. The measure does not appear to have any provision for home cultivation.

Virginia Legalization Bill Gets Organized Opposition. After a Tuesday hearing in the Senate Rehabilitation and Social Service Subcommittee on Marijuana on a bill to legalize marijuana in the state, organized opposition reared its head. Members of Smart Approaches to Marijuana complained to anyone who would listen that freeing the weed would threaten the health and safety of Virginians. No vote was taken after the hearing.

Pardons and Commutations

Trump Pardons or Commutes Sentences for Dozens of Drug Offenders. In one of his last acts in office, now ex-President Trump pardoned or commuted the sentences of dozens of people with drug convictions, including at least a dozen serving prison sentences for marijuana who had been the object of campaigns to free them. In a series of moves that damage the pardon/clemency practice for the future, Trump also pardoned or commuted the sentences of corrupt Republican politicians, political allies such as Steve Bannon, a handful of felonious health care industry executives, and connected celebrities such as Li'l Wayne. For a full list, click on the link.

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