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Chronicle AM: New York Weed Wars, Huge NJ Dispensary Expansion, More... (6/4/19)

Tensions over the fate of marijuana legalization in New York are heating up as the legislative clock ticks down, Nevada becomes the latest state to enact an expungement law, a Vermont bid to decriminalize buprenorphine gets sidetracked, and more.

Governor Cuomo is getting some heat over stalled marijuana legalization. (Creative Commons)
Marijuana Policy

Nevada Governor Signs Measure Sealing Past Marijuana Convictions. Gov. Steve Sisolak (D) has signed into law a bill helping those with past marijuana convictions get their records sealed. Assembly Bill 192 permits those convicted of marijuana-specific activities which have since been decriminalized or legalized to submit a written request to the court to have those records sealed. Petitioners may not be charged a fee for submitting such a request, and any objections to the request must be filed within ten judicial days. The new law takes effect on July 1.

New York Governor Says Marijuana Legalization Unlikely This Year. Gov. Andrew Cuomo (D) said Monday he doesn't think there is sufficient support in the state Senate to pass a pending marijuana legalization bill. But Senate Majority Leader Andrea Stewart-Cousins (D-Yonkers) said legislators are still working to find a compromise. While there is broad support for legalization, there is disagreement over regulatory details and expunging past low-level marijuana convictions. The session ends June 19.

New York Reform Groups Say Governor Failing to Deliver on Marijuana Legalization. In a joint statement released Monday, organizations including the Drug Policy Alliance, Citizen Action and New York Communities for Change blamed Gov. Andrew Cuomo (D) for blocking proposals that he claims to support, such as legalizing marijuana. "Governor Cuomo, we demand that you cease your reckless efforts to block and water down these issues," the groups wrote in their statement. Other organizations signing on to the statement included VOCAL-NY, the Alliance for Quality Education, the Long Island Progressive Coalition and Make the Road New York. "Move. Act. Lead," suggested Kassandra Frederique, New York state director for the Drug Policy Alliance. "Do what we as the voters asked you to do."

Medical Marijuana

New Jersey Announces Massive Dispensary Expansion. The state Department of Health announced Monday plans to dramatically increase the number of dispensaries in the state -- from the currently existing six to more than a hundred! The move comes as the legislature is nearing passage of its own measure to expand the medical marijuana system.

Heroin and Prescription Opioids

Vermont Bid to Decriminalize Buprenorphine Stalled. A bill that would have decriminalized the possession of the opioid treatment drug buprenorphine, HB 162, has stalled in the statehouse. While proponents argued that it would save lives by making the medication more available to users and deter them from using deadlier substances, the bill was opposed by Gov. Phil Scott (R) and US Attorney Christina Nolan. It passed out of the House Judiciary Committee, but the chair of the House Human Services Committee, Rep. Ann Pugh (D-Burlington) refused to move it, so it sits there until next year.

Chronicle AM: Legal Pot Bill This Week in NJ, Global Drug War Human Rights Guidelines Issued, More... (3/18/19)

A New Mexico pot legalization bill dies and the governor says she will take it up next year, Minneapolis will quit charging small-time pot offenders, UN bodies and member states issue drug war human rights guidelines, a federal prisoner sues for access to methadone treatment, and more.

The state of New Jersey is banking on marijuana tax revenues. Now, to get that bill passed. (Creative Commons)
Marijuana Policy

Connecticut Democrats Unveil Legalization Package. A group of House Democrats held a press conference last Thursday to unveil a proposed package go bills to allow marijuana to be grown, processed, and sold to consumers in the state. The draft bills include a pilot plan for adult sales, but do not include letting people grow their own.

New Jersey Legalization Committee Votes Begin Today. The compromise legalization bill agreed to by Gov. Phil Murphy (D) and legislative leaders is due for committee votes Monday, with an eye toward final passage next Monday if all goes well. The bill would allow adults to possess up to an ounce, but not grow their own. It would also expunge records of past pot offenses and set up a system of taxed and regulated marijuana commerce.

New Mexico Decriminalization Bill Goes to Governor, But Legalization Bill Dies. In last minute action this past weekend, the legislature passed a pot decriminalization bill, SB 323, and sent it to the desk of Gov. Michelle Lujan Grisham (D). That’s some small consolation for the failure of a legalization bill, HB 356, which passed the House but died in the Senate Finance Committee.

New Mexico Governor Adds Marijuana Legalization to 2020 Agenda. Gov. Michelle Lujan Grisham said Sunday she will add marijuana legalization to the agenda of next year’s 30-day short session. The move comes after a bipartisan marijuana legalization bill managed to pass the House this session, only to be stalled in the Senate until the session expired on Saturday.

Minnesota’s Most Populous County Won’t Charge Small-Time Pot Offenders. Prosecutors in Hennepin County, the home of Minneapolis, will no longer prosecute people caught with small amounts of pot, County Attorney Mike Freeman said last Thursday. Under state law, possession of up to 42.5 grams is a misdemeanor, but possession of as little as 45 grams can be charged as a felony. Freeman said he will no longer charge anyone caught with less than 100 grams; instead, defendants will be considered for a diversion program.

Medical Marijuana

Missouri Posts Draft Rules for Medical Marijuana Program. The Department of Health and Senior Services released more drafts of rules for the state's emerging medical marijuana system last Thursday. The rules cover marijuana cultivation facilities, manufacturing facilities and medical marijuana establishments in general. Click on the link for a detailed analysis of the proposed regulations.

Oklahoma Governor Signs Medical Marijuana Rules into Law.  Gov. Kevin Stitt (R) last Thursday signed into law new regulations for the state’s nascent medical marijuana industry. The legislation sets guidelines for inventory testing and tracking, advertising, and packaging and labeling, among other things. It also allows employers to fire medical marijuana users in certain safety-sensitive positions, such as fire fighters and heavy machinery operators.

Hemp

Idaho Hemp Bill Moving. A bill to legalize hemp production, HB 122, passed out of a pair of committees last Thursday and is now headed for a House floor vote. The 2018 farm bill legalized hemp production, and 41 other states have already legalized hemp production.

Psychedelics

Oakland Psychedelic Decriminalization Initiative in Planning Stages. A coalition of advocacy groups in hosting a series of meetings in coming months aimed at building support for an initiative to decriminalize not only magic mushrooms but all “entheogenic plants, fungi, and natural sources.” The campaign is called Decriminalize Nature.

Drug Treatment

Incoming Federal Prisoner Sues Over Policy Banning Methadone Treatment. A Massachusetts woman who is about to enter federal prison and will not be permitted to continue methadone treatment for opioid addiction under prison rules has filed a lawsuit against the federal Bureau of Prisons over the policy. Stephanie DiPierro has to do a year for collecting disability benefits and food stamps without reporting income from a job and has been on methadone since 2005.

Massachusetts Bill Would Block Courts from Jailing Defendants in Treatment Who Fail Drug Tests. After the state’s highest court ruled last year that judges could order jail time for defendants who violate probation by using drugs, legislators have responded with S. 397, which would bar judges from incarcerating people who are in treatment and fail mandatory drug tests while on probation. The bill is currently before the Senate Judiciary Committee.

Human Rights

UN Member States, UN Bodies, and Human Rights Groups Launch International Legal Guidelines on Human Rights and Drug Policy. A coalition of UN Member States, UN entities and leading human rights experts meeting at the Commission on Narcotic Drugs on Monday launched a landmark set of international legal standards to transform and reshape global responses to the world drug problem. The International Guidelines on Human Rights and Drug Policy introduces a comprehensive catalogue of human rights standards. They are a guide for governments to develop human rights compliant drug policies, covering the spectrum of cultivation to consumption. Harnessing the universal nature of human rights, the document covers a range of policy areas from development to criminal justice to public health.  

International

Philippines Quits International Criminal Court Over Drug War Investigation. A year after the Philippines told the United Nations it was quitting the world’s only permanent war crimes tribunal because it is investigating human rights abuses in the bloody war on drugs led by President Rodrigo Duterte it has now officially withdrawn from the International Criminal Court. Manila moved to quit after the body launched a preliminary examination in 2018 into President Rodrigo Duterte's drug crackdown that has killed thousands and drawn international censure. However, the ICC said its preliminary investigation into Filipino drug war abuses would continue.

Faced with Fentanyl, Is It Time for Heroin Buyers' Clubs? [FEATURE]

In the past few years, the powerful synthetic opioid fentanyl and its derivatives have been the primary driver of the drug overdose death epidemic. A wave of addiction that began with prescription opioids two decades ago and morphed into one driven by heroin after the crackdown on pain pills one decade ago has now clearly entered a third phase: the era of fentanyl.

Pharmaceutical heroin. (Creative Commons)
Beginning in about 2014, fentanyl-related overdose death rates skyrocketed as Chinese chemical manufacturers and Mexican drug distribution gangs began flooding the country with the cheap, easily concealable narcotic—and not through unwalled borders but through points of entry and package delivery services, including the U.S. Postal Service. By 2017, fentanyl was implicated in some 28,000 overdose deaths, more than either heroin or prescription opioids, and involved in nearly half of all overdose deaths.

The responses have ranged from the repressive to the pragmatic. Some state and federal legislation seeks a harsher criminal justice system response, whether it's increasing penalties for fentanyl trafficking or charging hapless drug sharers with murder if the person they shared with dies. In other cases, the opioid epidemic has emboldened harm reduction-based policies, such as the calls for safe injection sites in cities such as Denver, New York, Philadelphia, San Francisco, and Seattle.

Just a couple of hours up the road from Seattle, Vancouver, British Columbia, has been grappling with the same wave of opioid addiction and now, the arrival of fentanyl. And it has arrived with a real wallop: According to the British Columbia Coroner’s Service, fentanyl was implicated in 85 percent of overdose deaths in the province last year, up from only four percent just six years earlier. And with the arrival of fentanyl and, in 2016, its cousin, carfentanil, overdose deaths in B.C. jumped more than four-fold in that same period, from 333 in 2012 to 1,489 in 2018.

But while American cities are just now moving toward opening safe injection sites, Vancouver has had them for years, part of the city’s embrace of the progressive Four Pillars strategy—prevention, treatment, harm reduction, and enforcement—of dealing with problems around drug misuse and addiction. In fact, more than a dozen safe injection sites are now operating in the city, as well as a couple of programs that involve providing pharmaceutical grade heroin or other opioids to hard-core addicts who have proven unamenable to traditional forms of treatment.

Such harm reduction programs have not prevented all overdose deaths, but they have radically reduced the toll. B.C. Chief Coroner Lisa Lapointe has estimated that without those programs, B.C. would have seen triple the number of fatal overdoses.

Vancouver has been on the cutting edge of progressive drug policy reforms for the past 20 years, and now, faced with the fentanyl crisis, some researchers are proposing a radical next step: heroin buyers’ clubs.

In a report published last week, the B.C. Center on Substance Use, which has strong ties to the provincial government, called for the clubs as part of a broader plan for "legally regulated heroin sales in B.C." to protect users from fentanyl-adulterated heroin and cut the profits of organized crime.

The proposal "is inspired by cannabis compassion clubs and buyers' clubs, both of which emerged in the 1980s and 1990s in response to the AIDS epidemic," the authors note.

"The compassion or buyers' club would function as a cooperative (or ‘co-op’), as an autonomous and democratic enterprise owned and operated by its members," the report explains. "A member-driven purchasing cooperative is an arrangement among businesses or individuals whereby members agree to aggregate their demand in order to purchase a certain product at a lower price from a supplier," it continues. "By aggregating their purchase orders and relevant resources, members are able to take advantage of volume discounts, price protection, shared storage and distribution facilities and costs, and other economies of scale to reduce their overall purchasing costs."

It wouldn't exactly be the Dallas Buyers Club, the 2013 film that portrayed unorthodox methods of obtaining AIDS medications in the 1980s. There would be some structure: To be accepted into the club, people addicted to opioids would have to undergo a medical evaluation, and once admitted to the club, they would still have to buy their own heroin, but with many advantages over buying black market dope. The main advantage would be that they would be receiving pure, pharmaceutical grade heroin (known as diacetylmorphine in countries where it is part of the pharmacopeia)—not an unknown substance that is likely to contain fentanyl.

Club members could inject the drug at a designated location—the report suggests that existing safe injection sites could be used—or take small amounts of the drug with them for consumption at home. The report also calls for each club to include related services, such as overdose response training, access to the opioid overdose reversal drug naloxone, and options for members to access social services such as detox, rehab, and other treatment options.

Not only could buyers' clubs create a safer, cheaper heroin-using experience for members, the report argues, but they could also erode the black market and its tendency to produce more potent drugs—the so-called Iron Law of Prohibition.

"Fentanyl adulteration in the illicit drug supply is a predictable unintended consequence of drug prohibition," the report concludes. "The same forces that pushed the market away from relatively bulky opium towards heroin, a more concentrated opioid that was easier to transport clandestinely, have continued to push the opioid market to increasingly potent synthetic opioids, including a range of fentanyl analogs. A cooperative could undermine the illegal market wherever it is set up."

Such a plan faces legal and political challenges in Canada, but those can be overcome if the provincial and federal governments get on board. Obstacles to such a plan being rolled out in the United States are even greater, especially given an administration hostile toward harm reduction in general that would most likely view legal heroin sales as anathema.

But here in the U.S., we're a decade or so behind Vancouver when it comes to progressive drug policies, so it's time to get the conversation started. After all, these sorts of approaches to the problem are likely to be more effective than throwing addicts in jail or building boondoggle border walls. 

This article was produced by Drug Reporter, a project of the Independent Media Institute.

Chronicle AM: Brazil Call for Drug Decriminalization, HI Legalization Bill Advances, More... (2/8/19)

The first state-level bill to legalize some psychedelics has been filed in Iowa, a marijuana legalization bill advances in Hawaii, so does asset forfeiture reform in New Jersey, a Brazilian committee of experts recommends drug decriminalization, and more.

An Iowa Republican has become the first legislator in the country to file a bill for the legalization of some psychedelics/
Marijuana Policy

US Senate Marijuana Legalization Bill S.420 Filed. Sen. Ron Wyden (D-OR) has filed a marijuana legalization bill, S.420. The bill would remove marijuana from the Controlled Substances Act, establish a federal excise tax on marijuana, and create a system for permitting legal marijuana commerce.

Hawaii Marijuana Legalization Bill Advances. The Senate Judiciary Committee voted unanimously Thursday to approve a marijuana legalization bill, SB 686. The bill would allow adults to grow, consume, and possess small amounts of marijuana, set up a regulated system of marijuana commerce, and enact a 15% excise tax. The bill will likely have to go through two more committees before heading for a Senate floor vote.

Oregon Bill to Allow Legal Marijuana Exports Gets Hearing. A bill that would open the way for Oregon to export surplus legal marijuana to adjoining states got a hearing in the in the legislature Thursday. The state is suffering from chronic legal marijuana surpluses, and SB 582 aims to address that by allowing for the export of surplus crops. There is little chance the bill will pass this year, but it should lay the groundwork for Oregon marijuana exports once the federal government ends pot prohibition.

Medical Marijuana

Colorado Bill to Protect Patients' Gun Rights Killed. A bill intended to protect the ability of medical marijuana patients to obtain and maintain concealed carry weapons permits died on a party-line vote Wednesday. SB 93, sponsored by Sen. Vicki Marble (R-Fort Collins), was killed in the Senate State, Veterans, and Military Affairs Committee. Marble said the Democrats' decision to kill the bill was unfair to medical marijuana users, but not unexpected. "They don’t want to pass a gun bill," Marble said of the committee, on which she also sits. "Anything to do with guns they’re not going to vote on."

Kansas Medical Marijuana Bill Filed. A bipartisan group of legislators has proposed a new medical marijuana bill, HB 2163. The bill would limit access to medical marijuana to only veterans for the first 60 days after the bill passes, but then open it up to the public.

Psychedelics

Iowa Bills Would Legalize Magic Mushrooms, Some Psychedelics for Medical Purposes. Rep. Jeff Shipley (R-Fairfield) has filed a pair of bills to open the door to the use of some psychedelics for medical purposes. One bill, HF 249, would allow the state board of pharmacy to reclassify such drugs for medicinal use, while the other bill, HF 248, would remove psilocybin and psilocin, the chemicals that put the magic in magic mushrooms, from the state's schedule of controlled substances. The filings mark the first time any legislature will have taken up the issue of legalizing drugs other than marijuana.

Asset Forfeiture

New Jersey Civil Asset Forfeiture Reform Package Advances. A package of bills that aim to increase fairness and transparency in civil asset forfeiture proceedings were approved by the Assembly Law and Public Safety Committee Thursday. AB 4969 would establish the “Fairness in Asset Forfeiture Proceedings Task Force” to study the nature, extent, and consequences of the lack of legal representation of certain New Jersey residents in asset forfeiture proceedings. AB 4970 would require a criminal conviction for forfeiture of certain seized property. AR 222 urges the New Jersey Supreme Court to study the reasonableness of lowering court fees in civil asset forfeiture cases, while AB 3442 establishes asset forfeiture reporting and transparency requirements. The legislation now heads to the Speaker for further consideration.

Harm Reduction

Maine Governor Moves to Increase Access to Medication-Assisted Treatment in Jails and Prisons. Gov. Janet Mills (D) issued an executive order Wednesday to increase access to medication-assisted treatment for opioid addiction among prisoners in the state's jails and prisons. Under Mills' predecessor, Tea Party Republican Paul LePage, the state Department of Corrections and most jails had policies explicitly prohibiting such treatment.

International

Brazil Committee Studying Country's Drug Laws Calls for Drug Decriminalization. A committee of legal scholars and health experts appointed last year by House Speaker Rodrigo Maia has presented its report, and the report calls for the decriminalization of up to 10 personal use doses of all illicit drugs. It also recommended what those amounts should be. The report is certain to stir controversy in what is now one of the most conservative legislatures in Brazilian history.

Study: Crackdowns on Heroin, Pain Pills Gave Rise to Fentanyl Overdose Epidemic [FEATURE]

A new report on illicit US drug markets from researchers at the University of San Francisco has found that that the spread of fentanyl, a powerful synthetic opioid implicated in nearly 29,000 overdose deaths last year alone, is tied to enforcement-driven shortages of heroin and prescription opioids, as well simple economics for drug distributors -- not because users particularly desire the drug.

meet the law of unintended consequences (Creative Commons)
Illicit fentanyl has swept through American drug markets in waves -- the super strong "China white" heroin of the 1970s was actually a heroin-fentanyl mixture -- most recently in the past decade after rising levels of opioid addiction and the spread of "pill mills" prompted multifaceted moves to restrict opioid prescribing.

From a drug distributor's perspective, fentanyl is a most excellent substitute for heroin or prescription pain pills. Produced entirely in labs or chemical factories, it is far more powerful and cheaper to produce than heroin. Because it's more potent, it is easier to smuggle -- often coming into the US via postal and delivery service parcels, not by the semi load. And it doesn't require months of growing time and period of intense peasant labor in lawless regions of weak states.

Fentanyl is typically sold deceptively -- marketed as heroin or prescription drugs such as OxyContin or Xanax -- and users and street-level dealers often don't even know that the drugs they are using or selling contain fentanyl, the researchers found. Fentanyl is making its way into the supply chain at the wholesale, not the retail level. That, the researchers said, suggests that demand is not the key driver in the drug's spread.

"Fentanyl is rarely sold as fentanyl," said Sarah Mars, PhD, a researcher in the Department of Family and Community Medicine at UCSF. "The dealers selling fentanyl directly to the users often don't know what's in it. Not only is this particularly dangerous, but it also means penalizing low-level dealers isn't going to make any difference in the fentanyl poisoning epidemic."

According to Mars, users are split on fentanyl, which produces a more sudden and powerful high than heroin, but one that fades faster. Some said fentanyl brought back the euphoria they had lost the ability to feel with long-term heroin use, but others said they feared fentanyl and found its effects too harsh.

"Whether or not they prefer fentanyl, users don't have any influence over what drugs are being sold," Mars said. "Without accurate information about these drugs, they can't make an informed choice about what they are buying. Also, very little drug slang has developed to describe fentanyl, which lends support to the notion that this is not a demand-driven epidemic."

The presence of drugs adulterated with fentanyl is uneven, Mars said.

"Most of the illicit fentanyl has been in the Northeast and Midwest," she specified. And that's where opioid overdose death rates are the highest.

Another contributing factor to the fentanyl overdose toll is that it has dozens of analogs with wildly varying potency. Some, like carfentanil, are amazingly powerful, as much as 10,000 times as potent as morphine. Some are so new they have not yet been made illegal.

"We believe it's the fluctuation in the potency of the drugs containing fentanyl that makes them so dangerous," said Daniel Ciccarone, MD, MPH, a professor of family and community medicine at UCSF and senior author of an ongoing National Institutes of Health-funded study, Heroin in Transition. "You might have one dose that had hardly any fentanyl in it or none at all. Then, you might have one with a different fentanyl analog, of different potency, or even mixtures of multiple fentanyls and heroin."

Here is the paradox of drug prohibition: Trying to crack down on drugs tends to lead not to less drug use but to more dangerous drugs, and in the case of opioids, tens of thousands of dead drug users. There is an inexorable logic at play: The more law enforcement comes down on a drug, the greater the tendency for suppliers to make it more potent and compact -- and dangerous.

Perhaps that's why we now see mainstream calls for a radically different approach, such as the one from Washington Post columnist Megan McArdle earlier this week. In her column "The Incredibly Unpopular Idea That Could Stem Heroin Deaths," McArdle argues that current drug policy is only running up the overdose death toll and that we need "to start talking about ways to make safe, reliable doses of opiates available to addicts who aren't ready to stop."

That would involve increasing access to opioid substitutes such as methadone and buprenorphine, "but lowering the death toll may require a more drastic step: legalizing prescriptions of stronger opiates," McArdle writes.

"Prescription heroin?" she continues. "Remember, I said you might not like the solution. I don't like it, either -- and frankly, neither do the drug policy researchers who told me it may be necessary. But when fentanyl took over the US illicit drug markets, it also got a lot of addicts as hostages. We'll never be able to rescue them unless we can first keep them alive long enough to be saved."

There is a better way to deal with the opioid crisis than relegating tens of thousands of American opioid users to early, preventable deaths. We know what it is. Now it's a matter of implementing smarter, more humane policies, and that's an ongoing political struggle -- one where lives are literally at stake.

The Opioid Crisis Could Cost a Half Million Lives in the Next Decade

The most recent data from the Centers for Disease Control and Prevention, released in mid-August, showed a record 72,000 drug overdose deaths last year, with 49,000 related to heroin, fentanyl and prescription opioids. According to the authors of a study released last week in the American Journal of Public Health, that could be the new normal.

The study, by Stanford researchers Allison Pitt, Keith Humphreys, and Margaret Brandeau, attempts to assess the number of opioid-related deaths we could expect to see over the next decade, as well as the impact of different policy responses on reducing the death toll.

The researchers said there are steps that can be taken to reduce the death toll, but also that some seemingly simple solutions, such as cracking down on opioid prescribing for chronic pain, could actually increase the toll. And even those policies that could cut the opioid death rate are likely to do so only marginally.

Using a mathematical model, the researchers estimate that some 510,000 people will die over the next decade because of opioid use. The number includes not only drug overdoses but also other opioid-related deaths, such as HIV infections caused by shared needles.

Even including the non-overdose deaths, the number is staggering. Last year was the worst year ever for opioid-related overdose deaths, but this research suggests we are going to see year after year of similar numbers.

Making the overdose reversal drug naloxone more widely available could cut opioid-related deaths by 21,200 over the next decade, allowing greater access to medication-assisted therapies with drugs such as buprenorphine and methadone would save another 12,500 lives, and reducing opioid prescribing for acute pain would prevent another 8,000 deaths, the researchers said. But those three policy moves combined would shave less than 10 percent off the overall death toll.

"No single policy is likely to substantially reduce deaths over 5 to 10 years," the researchers wrote.

While harm reduction interventions such as those above would save lives, some aspects of tightening opioid prescribing would actually increase opioid-related deaths by as much as the tens of thousands -- because they increase heroin deaths more than they cut painkiller deaths. Moves such as reducing prescribing for chronic pain, up-scheduling pain relievers to further restrict their prescribing, and prescription drug monitoring programs all tend to push existing prescription opioid users into the illicit heroin and fentanyl markers all end up contributing to net increases in opioid deaths over the 10-year period, the researchers found.

On the other hand, other interventions on the prescribing front, such as reducing acute prescribing for acute pain (pain that may be signficant but is short-term), reducing prescribing for transitional pain, reformulating drugs to make them less susceptible to misuse, and opioid disposal programs, appear to prevent more deaths than they cause.

Ultimately, reducing the opioid death toll includes reducing the size of the opioid-using population, the researchers say. That implies making addiction treatment more available for those currently using and preventing the initiation of a new generation of opioid users. Restrictions on prescribing, while possibly driving some current users to dangerous illicit markets, can have a long-term impact by reducing the number of people who develop a dependence on opioids.

Whether that's a tolerable tradeoff for those pain patients who don't get the relief they need from other medications -- or for patients and others who end up dying from street heroin but might have lived despite their prescription opioid use -- is a different question.

By all appearances, when it comes to the loss of life around opioids, it looks like a pretty sad decade ahead of us.

This article was produced by Drug Reporter, a project of the Independent Media Institute.

Saying Goodbye to Mr. Methadone: Dr. Bob Newman Dead at Age 80

Dr. Robert Newman died earlier this month after being struck by an automobile earlier this summer. He was 80 years old.

Bob Newman at a Beth Israel staff meeting in 1985 (Arthur H. Aufses Jr. MD Archives at Mt. Sinai)
If any one man can be credited with carving out a space for the use of methadone as a treatment for heroin addiction, he is that man. Working as a New York City public health doctor in the 1960s, he was given the task of ensuring that heroin addicts who wanted treatment could get treatment with methadone. His boss, city health department head Gordon Chase, told him he would be known as "Mr. Methadone."

While he did not achieve the goal of providing treatment to everyone who wanted it, Newman oversaw the rapid expansion of the city's fledgling methadone program in the early 1970s. The number of patients on methadone went from a handful to more than 10,000 in two years, and 35,000 by 1975.

And he stood up for those patients. When the NYPD wanted Newman to turn over patients' methadone records, he refused. Instead, he took to the courts to defend his patients' right to privacy -- and he won.

After that, he devoted his career to advocating for evidence-based treatment, traveling the country and the world and picking up a second moniker, "the methadone pope," as he advanced harm reduction ideas decades before they became popularized.

He faced opposition from abstinence and 12-step proponents, as well as from elected officials like New York City Mayor Rudy Giuliani, who in 1998 tried to shut down the city's methadone program on the moralistic grounds that it merely substituted one addiction for another. The diplomatic Newman didn't challenge Giuliani head on but instead used interviews to make his case that methadone treatment allowed addicts to lead productive lives.

Newman also advocated for a humane approach toward addicted mothers and pregnant women, supporting groups such as National Advocates for Pregnant Women in their fight against the demonization and criminalization of those women. He was a drug policy reformer who served for decades on the board of the Drug Policy Foundation and then its successor the Drug Policy Alliance.

As this century's opioid epidemic deepened, Newman was cautiously optimistic that the work he had begun decades earlier would help further destigmatize addiction. "I'm hoping that pragmatism will win out," he said. "As more and more Congresspeople, people in the general community and physicians have children who develop a problem with prescription drug use and can't get treatment for it, I think it will make people more receptive to opening doors to treatment."

Newman was not only an influential physician in addiction issues, he was a giant in the hospital world as a whole. He served as President of Beth Israel Medical Center in New York, and then of the entity that acquired Beth Israel along with other facilities -- and then of the entity that acquired that entity. But one could still talk him at a drug policy conference, or send him an email, and you'd get an email back.

Dr. Robert Newman's contribution to an enlightened approach to addiction cannot be overstated. He will be missed, but his legacy lives on.

(Read Bob Newman's 1998 interview with this newsletter here.)

Chronicle AM: Norway Heroin-Assisted Treatment Plan, NJ Pol Says Marijuana Legalization "Soon," More... (8/10/18)

New Jersey's Senate president says marijuana legalization is coming "soon," the Norwegians begin moving toward heroin-assisted treatment, and more.

diacetylmorphine AKA pharmaceutical heroin -- coming soon to Norway to treat hardcore addicts (Creative Commons)
Marijuana Policy

Key New Jersey Pol Says Legalization Coming "Soon." "I think it's gonna happen soon," State Senate President Stephen Sweeney (D-Gloucester) told NJ Advance Media Thursday, saying it could happen as early as next month. "We'll have the legislation done. Then you have to do the regulations and everything else." He said he hoped to see a final draft of the bill, next week, hold hearings quickly, and vote in September. "We're getting much closer," Sweeney said.

International

British Police Commissioner Calls for Marijuana Freedom. Police and Crime Commissioner for North Wales Arfon Jones has called for marijuana users to be able to grow and sell the plant without fear of arrest in cannabis clubs. He is calling for the country to adopt Spanish-style marijuana "collectives" where members sell homegrown weed to each other. At least 75 cannabis clubs currently exist in Britain, all operating with a wink and a nod from local police.

Norway to Begin Providing Free Heroin to Hardcore Addicts. Norwegian Health Minister Bent Hoie has asked the Directorate of Health to create a list of heroin addicts must suitable for receiving heroin-assisted treatment and to assess the economic consequences of creating such a program. "We want to help those addicted who are difficult to reach, those who are not part of LAR (drug-assisted rehabilitation) and who are difficult to treat," he said. The pilot program is set to start in 2020 or 2021. Local governments in Oslo and Bergen are reportedly applying to participate.

Chronicle AM: PA Gov Says State Not Ready for Legal Pot, New FDA Guidelines on MATS, More... (8/9/18)

The FDA has issued new draft guidance aimed at expanding the use of medication-assisted treatments (MATs) for opioid addiction, Pennsylvania's governor says the state isn't ready for legal weed, the Oklahoma medical marijuana fight isn't over yet, and more.

Pennsylvania Gov. Tom Wolf (D) isn't on the same page as his counterparts in New York and New Jersey. (Creative Commons)
Marijuana Policy

Pennsylvania Governor Says State Not Ready for Marijuana Legalization. Gov. Tom Wolf (D) said during a radio interview on Tuesday that he doesn't think the state is ready to legalize marijuana. "There are, what, six states that have legalized recreational marijuana in the United States," Wolf said. (The actual number is nine.). "I don't think the citizens of Pennsylvania are ready for it, and so the answer I would say is no… I don't think Pennsylvania's actually ready for recreational marijuana." The position puts Wolf at odds with two neighboring Democratic governors, Phil Murphy of New Jersey, who is strongly pushing legalization, and Andrew Cuomo of New York, who just signed off on the notion.

Los Angeles Won't Vote on Raising Pot Tax in November. The city council has reversed a decision to place a 1% marijuana tax increase on the November ballot. The city estimated it would raise approximately $30 million per year from the tax increase, but faced immediate blowback from industry groups who said pot taxes were already too high and are driving consumers to the black market.

Medical Marijuana

Oklahoma Agencies Still Have "Concerns" Over Legal Medical Marijuana. Interim health commissioner Tom Bates told lawmakers Wednesday that the Health Board still has concerns about how medical marijuana will be implemented and that a special session of the legislature may be needed to see the program properly implemented. The board wants lawmakers to amend the law so that, among other changes, commercial grows are indoor only, patient home grows are prohibited or require a special license, smokable marijuana is prohibited, THC levels are limited to 12% or less, a pharmacist is required on-site at dispensaries, and that a list of qualifying conditions for patients be created. Some of the changes are among those recommended in the Health Board's first try at setting interim rules, which were retracted in the face of loud public opposition. Any effort to re-adopt them is certain to lead to renewed clamor.

Heroin and Prescription Opioids

FDA Seeks to Expand Use of Medication-Assisted Therapies for Addiction. The Food & Drug Administration (FDA) on Monday released new draft guidance aimed at promoting the creation and more widespread use of medication-assisted therapies (MATs) for opioid use disorder. The guidance adjusts how FDA evaluates new treatments for opioid addiction. Instead of only determining whether a treatment lowers opioid use, the agency will now assess whether the medication could help lower overdose rates and limit the spread of infectious disease. "We must consider new ways to gauge success beyond simply whether a patient in recovery has stopped using opioids, such as reducing relapse overdoses and infectious disease transmission," said Scott Gottlieb, FDA commissioner.

How to Prevent Opioid Overdoses? Provide Hard-Core Addicts Free Pharmaceutical Heroin

With Ohio beset by a massive public health crisis around opioid use and overdoses -- more than 4,000 Ohioans died of opioid overdoses in 2016 -- the Cleveland Plain Dealer sent travel editor Susan Glaser to Amsterdam in search of innovative approaches to the problem. While there, she rediscovered Holland's longstanding, radical, and highly-effective response to heroin addiction and properly asked whether it might be applied to good effect here.

The difference in drug-related death rates between the two countries is staggering. In the US, the drug overdose death rate is 245 per million, nearly twice the rate of its nearest competitor, Sweden, which came in second with 124 per million. But in Holland, the number is a vanishingly small 11 per million. In other words, Americans are more than 20 times more likely to die of drug overdoses than Dutch.

For Plain Dealer readers, the figures that really hit home are the number of state overdose deaths compared to Holland. Ohio, with just under 12 million people, saw 4,050 drug overdose deaths in 2016; the Netherlands, with 17 million people, saw only 235.

What's the difference? The Dutch government provides free heroin to several score hardcore heroin addicts and has been doing so for the past 20 years. Public health experts there say that in addition to lowering crime rates and improving the quality of life for users, the program is one reason overdose death rates there are so low. And the model could be applied here, said Amsterdam heroin clinic operator Ellen van den Hoogen.

"It's been an enormous success. I think it would work elsewhere," she told Glaser.

It already has. The Dutch program was modeled on a similar effort in Switzerland, which has also proven successful. Germany and Canada are among the several other countries with similar programs.

The Dutch approach is an example of the country's policy of gedogen (pragmatic tolerance), the same principle that led the Dutch to pioneer quasi-legal access to marijuana in the 1980s. It is also rooted in the notion that, for some, drug addiction is a chronic disorder, not a condition to be "cured," and one that can be treated with supervised drug use under clinical supervision. And the complete cessation of drug use need not be the ultimate goal; rather, the Dutch look for reductions in criminal activity and increases in the health and well-being of the drug users.

"It's not a program that is meant to help you stop," acknowledged van den Hoogen. "It keeps you addicted."

That's not a sentiment sits well with American moralizers, such as George W. Bush's drug czar, John Walters, whom Glaser consulted for the story. He suggested that providing addicts with drugs was immoral and not "real treatment," but he also resorted to lies about what the Dutch are doing.

He claimed the Dutch are "keeping people addicted for the purpose of controlling them" and that the Dutch have created "a colony of state-supported, locked-up addicts."

Actually, the Dutch are dealing with older, hardcore addicts who have repeatedly failed to quit after repeated stints in treatment, including methadone maintenance therapy, and they are neither "controlling them" or locking them up. Instead, the people in the program show up at the clinic twice a day, get their fix, then go about their business. This heroin-assisted treatment (HAT) allows those hardcore users to live less chaotic and more productive lives.

And heroin-assisted treatment is "real treatment," said Peter Blanken, a senior researcher with the Parnassia Addiction Research Centre in Rotterdam. He pointed out that one-quarter of program participants make a "complete recovery," including better health and quitting illegal drugs and excessive drinking. Many others continue to use heroin, but do so with better outcomes, he said.

There is also a real safety benefit to using state-supplied pharmaceutical heroin. It's potent, but it's a known quantity. Users face no risk of adulteration with more dangerous drugs, such as fentanyl, which is deeply implicated in the current US overdose crisis.

In the current political atmosphere in the United States, providing heroin to hardcore addicts is a hard sell indeed. Other, lesser, harm reduction interventions, such as needle exchanges remain controversial, and the country has yet to see its first officially sanctioned safe injection site. And drug decriminalization, which has led to a dramatic reduction in heroin addiction and overdose deaths in Portugal, remains off the table here, too. But with an annual drug overdose death toll of more than 50,000 people a year, it may time to start asking how many more Americans we are willing to sacrifice on the altar of moralistic drug prohibition.

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