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 leading international human rights group gets behind the MORE Act, a psychedelic research bill goes to the governor in Texas and another is filed in New York, and more.

Buprenorphine. A new Vermont law allows people to possess a two-week supply without a prescription. (Creative Commons)

Human Rights Watch Urges Congress to Support the MORE Act. In a letter to House leaders of both parties, the international human rights organization Human Rights Watch urges passage of the Marijuana Opportunity Reinvestment and Expungement (MORE) Act (HR 3617)and calls on leadership figures to show their support by signing on as cosponsors of the bill. "Human Rights Watch again calls upon members of Congress to take the necessary steps to further racial justice by swiftly ending marijuana prohibition and repairing the harm it has caused," the letter said.

Idaho Activists Launch Limited Legalization Initiative Campaign for 2022 Ballot. Idaho activists have launched a new campaign for limited marijuana legalization aimed at the 2022 ballot. The proposed initiative would make it legal for people 21 and over to possess up to three ounces on private property and provide protections for people who travel to neighboring states to procure legal marijuana there by specifying that "transporting a personal amount of marijuana from a jurisdiction where the marijuana was legally purchased" would be legal. Campaigners have until May 1, 2022 to collect about 65,000 valid signatures from registered voters to make the ballot.

Harm Reduction

Vermont Becomes First State to Legalize Limited Possession of Buprenorphine. With the signature of Gov. Phil Scott (R) on House Bill 225 Tuesday, Vermont has become the first state to legalize the possession of buprenorphine, a prescription drug used to treat opioid use disorder. The new law will allow people to possess a roughly two-week supply of the drug without a doctor's prescription. The new law, however, sunsets in two years unless the legislature decides to renew it.

Psychedelics

New York Bill to Create State Sponsored Psychedelic Research Institute. Assemblywoman Linda Rosenthal (D/WF-Manhattan) this week filed a bill that would mandate that the state create an institute to study the therapeutic potential of psychedelic drugs. "There is growing evidence to suggest that psychedelics, including psilocybin, can be a useful tool in treating symptoms of depression, anxiety, post-traumatic stress disorder and to help individuals recover from a substance use disorder," Rosenthal explained. "Psychedelics provide a host of benefits without the same risk of overdose or dependency that other medications may provide. This bill would provide New York State the opportunity to research the use of psychedelics and the many benefits they can provide."

Texas Psychedelic Research Bill Heads for Governor's Desk. Both houses of the legislature have now approved House Bill 1802, which would expand research on therapeutic psychedelics. The bill is now on the desk of Governor Greg Abbott (R).

A drug decriminalization bill is winning support in Maine, so is a buprenorphine legalization bill in Vermont, and more.

White House staffers held a virtual meeting with formerly incarcerated people to talk policy last Friday. (Whitehouse.gov)

Maine Drug Decriminalization Bill Garners Support at Committee Hearing. A bill that decriminalize the possession of personal use amounts of illicit drugs, LD 967, won support from medical and religious groups during a hearing before the House Criminal Justice and Public Safety Committee last Thursday. Testifying in support of the bill were the Maine Medical Association and a coalition of religious groups. The bill would make drug possession a civil violation punishable by a $100 fine. The fine could be avoided if people submit to an "evidence-based assessment for proposed treatment for substance use disorder." No vote was taken in committee, but the testimony suggested strong support for the move.

Harm Reduction

Vermont Senate Committee Poised to Pass Buprenorphine Legalization Bill. The Senate Judiciary Committee and the Senate Health Committee heard testimony largely in support of a bill to legalize the possession of small amounts of buprenorphine, a drug used to treat opioid addiction. The bill, House Bill 225 , has already passed the House. The Judiciary Committee didn’t vote on the bill because it is currently before the House Rules Committee, but they did express unanimous support for it and expected to approve it once it reaches the committee. The Health Committee must also approve it before it goes for a House floor vote.

Sentencing

White House Officials Meet Virtually with Formerly Incarcerated Criminal Justice Reform Advocates. White House officials met virtually last Friday with a group of former drug war and other prisoners to listen to ideas about how to change criminal justice policies to advance prison and sentencing reform. Domestic policy advisor Susan Rice, public engagement director Cedric Richmond, and White House counsel Dana Remus heard recommendations on how "to reduce incarceration, end racial disparities, and facilitate successful reentry," they said in a White House readout of the event. The trio heard from 10 differerent advocacy groups, including Forward Justice and JustLeadershipUSA.

International

Mexican Drug Cartels Are Attacking Security Forces with Explosive-Laden Drones, Defense Minister Says. Mexican Defense Minister Luis Sandoval said last Wednesday that drug cartels are employing bomb-carrying drones to attack security forces. "We have found that there are some cartels using drones with explosives," the general said during President Andres Manuel Lopez Obrador’s daily news conference. The Jalisco New Generation cartel is among those using the drones, Sandoval said, pointing to an attack last Monday in Aguilla, Michoacan, where police clearing roads that had been blocked by cartel members came under attack, leaving two wounded. But the drones are big enough to carry more lethal loads, Sandoval said. "They cannot carry amounts (of explosives) that are harmful to personnel or to a facility," Sandoval said.

A bill to decriminalize buprenorphine is heading for the Vermont Senate, New Zealand makes a pilot pill testing program permanent, and more.

A deadly amount of fentanyl. The White House has approved federal funds for test strips to prevent overdoses. (DEA)

Biden Administration Allows Federal Funds to Be Used to Buy Rapid Fentanyl Test Strips. The Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMSHA) announced Thursday that federal funds can now be used to purchase rapid fentanyl test strips. According to a press release, organizations previously awarded funding through the CDC's Overdose Data to Action cooperative agreement program can use funds to purchase the test strips. SAMSHA grants can be used to buy the strips so long as doing so aligns with "the purpose of the grant," a CDC spokesperson explained. "This is a major step forward in the ongoing and critical work to prevent overdose and connect people who have substance use disorders to evidence-based treatment options," said Tom Coderre, the interim leader at the Substance Abuse and Mental Health Services Administration (SAMSHA). "This will save lives by providing tools to identify the growing presence of fentanyl in the nation's illicit drug supply."

Vermont House Approves Bill Decriminalizing Buprenorphine. The House on Thursday voted overwhelmingly to approve House Bill 225, which would decriminalize the possession of small amounts of buprenorphine, a drug used to treat opioid dependence. The bill would people to possess up to 224 milligrams of the drug -- about two weeks' worth -- even if they don't have a doctor's prescription. The bill now heads to the Senate.

International

Mexico Marijuana Legalization Bill Hits Last-Minute Snag, Another Extension May Be Sought. The bill, which is just a Senate vote away from passage after being approved in the Senate and then amended in the Chamber of Deputies, has run into opposition from senators unhappy with the revised version of the bill. Senate Majority Leader Ricardo Monreal said Thursday he may seek an extension of the Supreme Court's latest deadline to end marijuana prohibition, which the court has held is unconstitutional. Under the current deadline, lawmakers only have until the end of the month to get it done. Now, action could be delayed until the legislature meets again in September.

New Zealand Makes Pill Testing Program Permanent. Pleased with the results of a one-year pilot program to allow drug users to get their drugs tested without penalty, the government of Prime Minister Jacinda Ardern announced Friday that it is making the program permanent. During the pilot program, nearly half of all samples tested contained contaminants, with cathinones being especially common in pills marketed as MDMA. The pill (or powder) testing has most commonly taken place at music festivals.