Whiteout: How Racial Capitalism Changed the Color of Opioids in Americaby Helena Hansen, David Herzberg, and Jules Netherland (2023, University of California Press, 369 pp., $29.95 HB)

Republican lawmakers in statehouses around the country who had built careers as fierce drug warriors now sponsored Good Samaritan bills (so that people overdosing and those seeking to help them did not face drug charges), the availability of medicine-assisted treatment (methadone and buprenorphine) spread—and went upscale, with bupe acting as white people's methadone.

While methadone, associated with the Black and Brown heroin addicts of the 1970s, remains heavily stigmatized, its administration heavily authoritarian, and its dispensing locations almost always deep within poor minority neighborhoods, buprenorphine –a drug for treating white opioid users of the 21st Century—is much more easily accessible, available in doctors' offices instead of grim industrial buildings, but also more expensive, limiting its access for people with little money or insurance.

In Whiteout, an addiction psychiatrist (Hansen), a drug historian (Herzberg), and a policy advocate (Netherland) tease apart the structures of Whiteness (the unspoken ideology of white virtue, purity, and superiority) and demonstrate how racial disparities have been cooked into American drug policies from the beginning—and how not only Black populations but white ones, too, have suffered for it.

In the first great wave of opioid addiction in the late 19th Century, it was middle class white women who suffered the grip of the poppy, and they were largely treated in the doctor's office. As relatively well-off people, they had the ability to access the health care system of the time, to be prescribed the pills they wanted, and to be helped off them if necessary.

Meanwhile, Black Americans more often lacked the money to gain access to the health care system, and once drug prohibition fell into place in the 1910s, they were shunted into the black market, criminalized, and stigmatized. Their neighborhoods became epicenters of the illicit drug trade. Black market drugs in the ghetto, white market drugs at the doctor's office and the drugstore.

But white privilege had its price—a price that hundreds of thousands of white opioid users have paid since the turn of the century as overdose deaths quintupled in 20 years. Affluent white drug consumers would be provided their drugs by a lightly regulated pharmaceutical industry that the authors demonstrate portrayed the users of its products as white people and marketed their products directly at white people. The poster child for this behavior is Purdue Pharma, the manufacturer of OxyContin, which zeroed in on mostly white Appalachia as its force of zealous sales reps went to work. This is the racial capitalism of the title.

Anyone who is uncomfortable with terms like "racial capitalism" is really going to be squirming when Critical Race Theory makes its entrance. Unlike the case with the moral panic around Critical Race Theory in children's schoolbooks (which it isn't), the academic tool is actually applied here and, indeed, is central to the argument the authors make.

It also colors their recommendations for what is to be done. In line with the critique of capitalism, a little more harm reduction here or a little more criminal justice reform there are not going to solve the social problems that give rise to the current opioid crisis. It is going to require real social change, things like universal health care and a real social safety net. And an ongoing interrogation of Whiteness.

Oregon's governor has vetoed a bill that would have moved toward a state bank to serve marijuana businesses, a coalition of public health and drug reform groups calls out the way some of the opioid settlement money is being spent, and more.

Ohio Will Vote on Marijuana Legalization in November. The Secretary of State's Office announced Wednesday that the Coalition to Regulate Marijuana Like Alcohol had gathered sufficient valid voter signatures to qualify its marijuana legalization initiative for the November ballot. The group had originally come up short on signatures but used a 10-day window to find more signatures to go over the top.

The proposal would legalize the possession of up to 2.5 ounces of marijuana or 15 grams of extract by adults. It would also legalize the home cultivation of up to 12 plants. It also envisages a taxed and regulated market in legal marijuana, with retail pot sales taxed at 10 percent.

Nearly six in 10 state voters support marijuana legalization. If it passes in November, Ohio will become the 24th state to free the weed.

Oregon Governor Vetoes Bill to Create State Bank for Marijuana Businesses. Gov. Tina Kotek (D) has vetoed House Bill 2673, which would have created a State Bank Public Task Force as the first step in an effort to create a state-owned bank to help the state's legal marijuana industry. As in other states, the industry is blocked from accessing most financial institutions because marijuana remains illegal under federal law.

The bill would have directed the task force to make recommendations regarding the establishment of a state bank and directed the task force to investigate the provision of financial services for marijuana businesses.

In her veto message, Kotek wrote only that: "While the Governor supports exploring the creation of a state bank, this bill has several logistical challenges, including directing the Oregon Business Development Department (OBDD), which already manages over 80 programs, to manage a new task force, establish an RFP process, and finalize a substantive report on an abbreviated timeline."

Drug Policy

Organizations Oppose "Problematic" Use of Opioid Settlement Money, Want "Evidence-Based" Solutions. A coalition of more than 130 public health and reform groups is charging that the ways some states are using funds from massive settlements with opioid manufacturers and distributors are "problematic" and is demanding that states use the settlement funds for "evidence-based solutions."

The coalition, which includes the Drug Policy Alliance and AIDS United, wants the funds to be used for easing access to all FDA-approved medications for addiction treatment (methadone, buprenorphine) and the whole panoply of harm reduction measures, including safe injection sites. They also call for expanding housing, outreach, and wraparound services for current drug users and people with drug convictions, and supporting second-chance employment opportunities, recovery-to-work programs, and expungement of criminal records.

"Secured through the suffering of people who use drugs and their loved ones, these funds should be used to help individuals directly impacted by the failed 'War on Drugs,'" according to a brief from the organizations. "Sadly, in many places, people are not seeing opioid settlement dollars put toward things that would actually improve their lives."

Based on the drug companies' role in the opioid addiction crisis of the past quarter-century, the settlements are estimated to amount to at least $50 billion over the next 18 years and require recipients to spend at least 85 percent of the funds to "abate the opioid epidemic." But the coalition points to a program in Louisian where 20 percent of the funding is going to sheriffs, one in Wyoming that is buying new police cruisers, and one in New York that is paying overtime for narcs as evidence that the terms of the settlement are not always being followed.

Psychedelics

California Natural Psychedelic Legalization Bill One Step Closer to Final Assembly Committee Vote. A bill that would legalize the possession and facilitated use of certain natural psychedelics is one step closer to a final Assembly committee vote after clearing a procedural hurdle Wednesday. The bill, Senate Bill 58, has already passed the upper house.

The Assembly Appropriations Committee advanced the measure to its suspense file, meaning it is set for final action to see whether it advances to the floor. That decision should come by September 1.

The bill would legalize the "possession, preparation, obtaining, transfer, as specified, or transportation of" specific amounts of psilocybin, psilocyn, DMT, ibogaine and mescaline for personal or facilitated use. The bill would legalize up to two grams of DMT, psilocybin, and psilocyn, as well as up to four ounces of "a plant or fungi containing psilocybin or psilocyn. It would also legalize the possession of up to 15 grams of ibogaine.

Another Republican files another border fentanyl bill, Seattle's mayor has a plan to deal with open-air drug use, and more.

As part of a criminal justice reform bill signed into law by Gov. Pritzker (D), Illinois will reduce drug testing of parolees.

Hickenlooper Reintroduces Bill to Prepare Federal Government for Marijuana Legalization. Sen. John Hickenlooper (D-CO) recently reintroduced the Preparing Regulators Effectively for a Post-Prohibition Adult Use Regulated Environment (PREPARE) Act, a bill that directs the Attorney General to develop a framework for federal cannabis regulation. Though cannabis is currently illegal at the federal level, many states have followed Colorado's safe and legal model. The PREPARE Act establishes a federal commission, modeled after Colorado's regulatory commission, to advise the government on proper safeguards for federal cannabis legalization.

>"Colorado's is the model for a safe, well-regulated marijuana market," said Hickenlooper. "Let's build on that success with federal regulation."

The PREPARE Act-established federal commission would advise on the development of a federal regulatory framework modeled after state cannabis regulations, consider barriers and suggestions for regulating cannabis similar to alcohol, identify ways to remedy the disproportionate impact cannabis prohibition has had on minority, low-income, and veteran communities, and include representatives from relevant federal agencies and offices, individuals nominated by Senate and House leadership, industry representatives, and representatives of state and local governments.

Drug Policy

House Republican Files Bill to Confiscate Cartel Assets, Use Them to Pay for Border Wall. Rep. Randy Feenstra (R-IA) has filed the Build the Wall and Fight Fentanyl Act, which would allow US authorities to seize the assets of Mexican drug cartels and use them to construct a wall at the southern border and to fight fentanyl.

The measure would establish two funds at the Treasury Department, the "Southern Border Wall Fulfillment Fund" and the "Combating the Fentanyl Epidemic Fund." Both funds would be run by the Department of Homeland Security.

"Criminal drug traffickers have smuggled enough fentanyl into our country to kill every man, woman, and child in the United States, and tragically, too many families know the pain of losing a loved one to this deadly crisis. We must fight fire with fire to protect our families, our children, and our communities," Feenstra said in a statement.

According to the DEA, however, the vast majority of drugs smuggled into the US from Mexico go through ports of entry, not unwalled portions of the border.

Seattle Mayor Unveils New Proposal to Fight Open-Air Drug Use. Mayor Bruce Harrell (D) on Monday announced a new plan to cut down on open-air drug use in the city and increase access to addiction treatment. The plan will include guidance to police on when to make an arrest and make drug possession a gross misdemeanor, bringing the city into conformity with state law. The state's drug possession statute had to be redone after the state Supreme Court threw it out in the Blake case in 2021.

"What's the same is it adopts the state law that we call the post-Blake Fix, and under the post-Blake Fix, you may recall, the officers were required to give referrals before arrests were made," said Harrell. "The legislature came out with the fix. That's what's the same, is that we are adopting the state law. What's quite different is we went more specific on what an arrest looks like and what it should not look like. It also brings in the threat of harm standard, which makes it clear, that if people are a threat to others, if they are in an area where people are trying to catch the bus, or where they are trying to shop or bring their kids in a stroller, these areas need to be safe, and it gives us the ability to make arrests when they need to happen," said Mayor Harrell.

The plan also includes $27 million to invest in facilities, treatments and services to address the opioid crisis. The measure needs to be approved by city council members, which Harrell said he is confident will happen and before a two-week break at the end of the month.

Drug Testing

Illinois Governor Signs Bill to Limit Drug Testing of Parolees. Gov. JB Pritzker (D) has signed into law a criminal justice reform bill, Senate Bill 423, that limits drug testing of parolees, among other provisions.

"Today, I will sign legislation that focuses our Mandatory Supervised Release system on creating successful outcomes for those who were formerly incarcerated and improves the safety and peace of our communities," Pritzker said in a statement last Friday. "This legislation supports the reintegration of individuals into the community while lowering the possibility of recidivism, increasing public safety, and lowering taxpayer costs," he added.

In its latest move to confront the rapidly rising incidence of overdose deaths and other deleterious consequences of the combination use of the veterinary tranquilizer xylazine ("tranq") and fentanyl, the Biden administration on Tuesday released a National Response Plan to coordinate a whole-of-government approach to the threat.

The veterinary tranquilizer and pain reliever xylazine is bad news in combo with fentanyl. (NY OASAS)

This is just the latest in a series of steps the administration has taken since late last year to address the emerging phenomenon. Last December, Office of National Drug Control Policy (ONDCP -- the drug czar's office) head Dr. Rahul Gupta hosted a listening session with public health and public safety leaders and subject matter experts from several states and territories about trends they are seeing related to xylazine and efforts to address these trends. In January, Dr. Gupta convened the Evolving and Emerging Threats Committee to discuss the emergence of fentanyl adulterated with xylazine in the illicit drug supply.

In February, the Food and Drug Administration took action to restrict the unlawful entry of xylazine active pharmaceutical ingredients and finished dosage form drug products into the country and in March, the Drug Enforcement Administration issued a public safety alert to warn the American public of a sharp increase in the trafficking of fentanyl mixed with xylazine. In April, Dr. Gupta named the xylazine-fentanyl combination an emerging public health threat, the first time such a designation has been used since Congress authorized it in 2018.

"Since we announced the emerging drug threat earlier this year, we've been working tirelessly to create the best plan of attack to address this dangerous and deadly substance head-on," said Dr. Gupta in a statement. "Now, with this National Response Plan, we are launching coordinated efforts across all of government to ensure we are using every lever we have to protect public health and public safety, and save lives. As a doctor, I have seen the devastating consequences of xylazine combined with fentanyl firsthand. And as President Biden's drug policy advisor, I am laser-focused on finding every tool we have and following the best evidence-based practices to take on this new challenge. This will be an all-hands-on-deck effort -- but I am confident we can take action together and eradicate this emerging threat."

Fentanyl first emerged as a significant actor in the illicit drug market in the early to mid-2010s, while xylazine entered the scene in the late 2010s. Now, xylazine has been detected in nearly every state in the country, and xylazine-involved overdose deaths are skyrocketing, albeit from very low initial levels. The Centers for Disease Control and Prevention (CDC) reported last month that the monthly percentage of fentanyl deaths with xylazine detected jumped from 2.9 percent in January 2019 to 10.9 percent in June 2022. CDC also found that the death rate from xylazine overdoses jumped 35-fold from 2018 to 2021.

Xylazine is a tranquilizer, not an opioid, and thus does not respond to opioid overdose reversal drugs such as naloxone. It also has other serious potential health effects, including wounds that may eventually require amputations, as well as breathing difficulties.

"If we thought fentanyl was dangerous, fentanyl combined with xylazine is even deadlier," Dr. Gupta said in a press call previewing the plan Monday.

But he warned that the plan will need Congress to step up with funding if it is to be be fully implemented. He noted that the Biden administration Fiscal Year 2024 budget request includes funding for emerging threats.

"We will do what we can with what we have until we get the resources from Congress," Dr. Gupta said. "It's a matter of utilizing what we have right now in order to save lives while we're encouraging Congress to pass the president's budget and provide those resources as quickly as possible. We're going to move ahead as quickly as possible because the fact is that lives are on the line."