Violence linked to cartel infighting continues to rock Mexico's state of Michoacan, a Vancouver clinic is now offering take-home prescription heroin to a small number of patients, and more.

Pharmaceutical heroin. Now available as a take-home prescription drug in Vancouver. (Creative Commons)

Vancouver Clinic Doing Take-Home Prescription Heroin. In a North American first, the Providence Crosstown Clinic in Vancouver has begun providing take-home medical grade heroin to a small number of addicted patients. The program began as an emergency response to the COVID epidemic, when the provincial health authority allowed clinic staff to deliver syringes filled with heroin to patients so they could stay isolated for 10 to 14 days. "Having done that and done that successfully without any problems, we were able to show and demonstrate the strict requirement of the medication to only be [administered] at the clinic was not necessary," said Dr. Scott MacDonald, head physician at the clinic. The program is currently serving only 11 patients, but MacDonald said expanding the program is a crucial step toward addressing the province's opioid crisis, which has seen more than a thousand overdose deaths so far this year. "Their lives can change dramatically. People can go from accessing street opioids, perhaps having unstable housing and unable to work to stabilized and being able to work, and some people working full-time," he said.

Mexico's Michoacan Sees More Cartel Violence. The Jalisco New Generation Cartel (CJNG) besieged the Michoacan municipality of Tepalcatepec last week, killing and beheading five local men who were manning a checkpoint aimed at keeping cartel gunmen out of town. The cartel had tried to seize control of the city but was met with resistance from local residents and the National Guard. Cartel gunmen then switched their focus to the community of La Estanzuela, located near the border between Tepalcatepec and the Jalisco municipality of Jilotlán. The CJNG has been trying to take control of the region for the past two years and is locked in battle with the Carteles Unidos over control of the region and the state.

Nepal Protest for Marijuana Legalization. Sparked by the September 6 arrest of prominent marijuana legalization advocate Rajiv Kafle for consumption, possession, and distribution of marijuana, a youth group from Kathmandu Valley staged a protest calling for legalization at Maitighar on Monday. Protesters chanted slogans and held up signs citing the medicinal and economic benefits of legalization. Nepal has a history of cannabis use dating back centuries and its charas was enjoyed by Western travelers on the Hippie Trail in the 1060s, but under US pressure canceled the licenses for all cannabis businesses in 1973, and then criminalized cannabis in 1976.

California wants to try a form of drug treatment where users are paid not to use, Vancouver activists plan to mark International Overdose Awareness Day with a "safe supply" drug giveaway, and more.

The DEA will review its international operations, although there is no sign it is looking at a paradigm shift.

DEA Announces Review of International Operations. The Drug Enforcement Administration on Thursday announced a comprehensive review of DEA’s international operations and foreign footprint, including administrative and financial support for those operations from DEA headquarters. Administrator Anne Milgram has recommended a top to bottom review of foreign operations that will be overseen by an independent team.  As part of the review, the team will talk to DEA personnel posted in DEA’s foreign offices and headquarters. DEA listed "international cartels, narco-terrorist violence, and precursor chemicals flowing from other countries" as global threats it faces. "This review will provide recommendations for my consideration upon completion.  Specifically, I expect the team to provide an assessment of DEA’s current international operational capacity, and to identify areas for improvement to ensure DEA’s international operations are impactful and effective, with the appropriate structures, procedures, and controls to ensure integrity and accountability," said Administrator Milgram. There is in indication the agency is undergoing a paradigm shift, though.

Drug Treatment

California Seeks Federal Permission to Do "Contingency Management" Drug Treatment. The state is seeking permission from the federal government to do "contingency management" drug treatment, in which users are paid money to stay sober, receiving increasing payments for each drug test passed. Such a program has been underway with military veterans for years, with research showing it is an effective way to get people off stimulants such as cocaine and methamphetamine, for which there are no pharmaceutical treatments available. Now, Gov. Gavin Newsom (D) is asking the federal government to allow the state to use federal tax dollars to pay for it through Medicaid. Meanwhile, state Sen. Scott Weiner (D-San Francisco) has filed a bill, Senate Bill 110, to do something similar. That bill has already passed the Senate with no  opposition and has a Republican co-sponsor in the Assembly, where it has already been approved by the Health Committee and is now before the Appropriations Committee. Wiener’s bill would require California’s Medicaid program to pay for the treatment while Newsom’s plan would let counties choose whether to participate.

International

Vancouver Activists to Mark August 31 International Overdose Awareness Day by Handing Out Free "Safe Supply" of Drugs. A Vancouver-based safe supply advocacy group, the Drug Users Liberation Front (DULF), handed out free cocaine, heroin, and methamphetamine during a July event to dramatize the need for a "safe supply" of drugs" as the city faces a drug overdose crisis, and now, they are getting ready to do it again. DULF says the July event showed the "life-saving potential of a community-led response to the crisis of prohibition in Canada" as an alternative to Vancouver's proposed model of decriminalization. DULF will be joined at the Overdose Awareness Day Event by the Vancouver Area Network of Drug Users (VANDU), which has raised $13,000 to buy and test drugs to be distributed for free among registered VANDU members. "We recognize this a day to honor those we lost to the War on Drugs," said VANDU. "A senseless war fueled by colonial dispossession, racist violence, capitalist exploitation and police criminalization that has taken far too many lives.

The AMA Advocacy Update chronicles one doctor's problems trying to prescribe for chronic pain and addicted patients, Maine becomes the fourth state to end civil asset forfeiture, and more.

US Surgeon General Vivek Murthy says it is time to stop locking people up for marijuana. (hhs.gov)

US Surgeon General Says Time to Stop Locking People Up for Marijuana. Surgeon General Vivek Murthy said Sunday that it is time to stop locking up people for using marijuana. "When it comes to decriminalization, I don't think that there is value to individuals or to society to lock people up for marijuana use," Surgeon General Vivek Murthy said in a CNN appearance. "I don't think that serves anybody well." His comments came in response to a question about a new draft marijuana legalization bill, and are in line with President Biden, who supports marijuana decriminalization, but not commercial legalization. "When it comes to marijuana, I think we have to let science guide us," Murthy said in the CNN interview. "And we know that the science tells us that there are some benefits to marijuana from a medical perspective but there are also some harms that we have to consider -- and we have to put those together as we think about the right policy."

Heroin and Prescription Opioids

AMA on a Doctor's Trials Trying to Treat Pain Patients in the Context of Arbitrary Policies. The American Medical Association (AMA) Advocacy Update has published a piece on the travails of southern Illinois family medicine and addiction medicine specialist Dr. Aaron Newcomb, whose patients found themselves unable to refill prescriptions after he was "blacklisted" by a pharmacy chain citing 2016 Centers for Disease Control and Prevention (CDC) guidelines aimed at reducing opioid prescribing in the face of a rising opioid overdose death toll.

"When the CDC guidelines came down in 2016 basically saying we needed to take as many people as we could off opioids, I knew that my patients were in for a world of trouble," said Dr. Newcomb. "I was particularly concerned about my patients who were stable on low-dose opioid therapy for years. And my concerns have translated into an even worse reality for both me and my patients. Getting blacklisted by a national chain who had no clue about my practice was professionally wrong, but it also hurt my patients and my community."

Newcomb had to explain the nuances of pain prescribing to the pharmacy chain: "When they got back to us, they basically questioned a specific formulation of buprenorphine I was prescribing for stable patients with cost or tolerability problems that isn't a preferred type unless there is a clinical reason," Dr. Newcomb explained. "They were also concerned about opioid therapy in general as well as the dose of buprenorphine used to effectively treat patients, and their algorithm out of context painted a misrepresentative picture of my controlled-substance prescribing habits."

Newcomb was eventually able to get back in the chain's good graces and his patients are now receiving their medication, but his case illustrates the challenges faced by pain physicians and their patients in a time where the opioid-prescribing pendulum has swung so dramatically back to the conservative side.

Asset Forfeiture

Maine Becomes 4th State to End Civil Asset Forfeiture. A new law barring asset forfeiture without a criminal conviction went into effect without the signature of Gov. Janet Mills (D), making Maine the fourth state to abolish the practice of civil asset forfeiture. The legislature earlier this year passed LD 1521, which fully repeals the state's civil forfeiture laws, while also strengthening the criminal forfeiture process. While touted as a tool against drug dealers, one report found that half of all forfeitures in the state were under $1,670 dollars. The other three states that have ended civil asset forfeiture are North Carolina (1985), New Mexico (2915) and Nebraska (2016).

International

Mexico President Makes Rare Call for Dismissal of a State Attorney General. President Andres Manuel Lopez Obrador called last Friday for the resignation of Guanajuato state Attorney General Carlos Zamarripa after the state registered 1,562 murders in the first five months of this year. That figure is higher than any other state, even though Guanajuato is only the country's sixth most populous states. He also suggested there was corruption or collusion with some of the drug cartels battling to control the state. "If he [Zamarripa] were the manager of a company, with this kind of performance they would have fired him," López Obrador said Friday. "When officials do not act with honesty, with rectitude, when there is no division between criminals and the authorities, no progress can be made." López Obrador said.

Zammaripe, who has been attorney general for 12 years, has been accused by businessmen and local experts of being close to the Santa Rosa de Lima cartel, which had such control over an oil refinery that it could brazenly steal fuel in and around the plant, leading to a federal troop deployment. "Carlos Zamarripa for many years protected El Marro," the leader of the Santa Rosa de Lima gang who was arrested in 2020," said security expert David Saucedo. But now, said Saucedo, Zamarripa seems to have changed sides, expecting the Santa Rosa gang to fall apart as the Jalisco New Generation cartel moved in. Instead, the Sinaloa cartel sent reinforcements to assist the Santa Rosa gang, and the death toll has skyrocketed. "Definitely, Zamarripa is part of the problem," Saucedo said.

A group of US senators is seeking some help for state-legal marijuana businesses, Chicago moves to expand a program that diverts drug arrestees into treatment citywide, and more.

Chicago police are expanding a drug diversion program so they can devote resources to fighting violent crime. (Creative Commons)

Senators Ask That Marijuana Businesses Get Access to Federal SBA Loans. A group of 10 senators led by Sen. Jacky Rosen (D-NV) have sent a letter to Appropriations Committee leadership asking that language allowing marijuana businesses to access loans and other aid through the federal Small Business Administration (SBA) be included in an upcoming spending bill report. Allowing such loans to marijuana businesses "would fill gaps left by the private sector and help mitigate the effects of the COVID-19 pandemic." They are asking that Senate Appropriations Committee and the Appropriations Financial Services and General Government (FSGG) issue a report that specifically includes such language and stop the Small Business Administration (SBA) to stop "denying loan applications for the 7(a) Loan Guarantee Program, Disaster Assistance Program, Microloan Program, and 504/Certified Development Company Loan Program to legally operating cannabis small businesses in states that have legalized cannabis sale and use."

Law Enforcement

Chicago to Expand Drug Diversion Program. The Chicago Police Department and Public Health Department have announced they will expand the city's Narcotics Arrest Diversion Program to include the entire city by the end of the year. Under the program, people arrested on drug possession charges who meet certain qualifying criteria can be diverted from the criminal justice system toward rehabilitation programs instead. The program began in one district in 2018 and has expanded to 11 of the city's 22 districts already. More than 700 people have been diverted from the arrest track so far, and city officials say the move helps police focus on issues such as violent crime instead.

The program appears to be similar to Law Enforcement Diversion Programs (LEAD), which began in Seattle in 2014 and has now expanded to at least 42 cities nationwide. LEAD uses a harm reduction and community-based model; the Chicago program includes social service programs among its alternatives, not just drug treatment, according to reports. The Chicago program offers walk-in access to drug treatment; one doesn't have to face arrest or its prospect first. The LEAD Bureau web site says that they have added purely voluntary access to its programs as well, in response to recent movement in the issue.

While drug reformers generally see diverting drug users out of the criminal justice system as an important step, the devil is in the details -- not every program presented as diversion does a convincing job of it, and how for example treatment programs respond to relapses or continued drug use by some clients determines how many people ultimately will be helped.

Prosecution

ACLU Sues Arizona County over Threats of Harsher Sentences for Drug Defendants to Force Guilty Pleas. The American Civil Liberties Union filed a federal class-action lawsuit Wednesday charging that the Maricopa County (Phoenix) Attorney's Office routinely threatens people arrested for drug possession with "substantially harsher" punishments in order to coerce them into pleading guilty before prosecutors even have to turn over evidence. The threat is typically issued in writing, the lawsuit alleges, and explicitly warns that defendants who reject initial plea deals will face substantially worse plea offers in the future. The ACLU argues that the policy is unconstitutional because it punishes people for exercising their rights to a preliminary hearing and a jury trial and that it illustrates the '"vast racial and economic discrepancies in plea bargaining techniques used across the county."