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Chronicle Book Review: American Cartel

American Cartel: Inside the Battle to Bring Down the Opioid Industry, by Scott Higham and Sari Horwitz (2022, Twelve Press, 400 pp., $30.00 HB)

Phillip S. Smith, with contributions from David Borden

https://stopthedrugwar.org/files/americancartel.jpg
Pulitzer Prize-winning Washington Post investigative reporters Scott Higham and Sari Horwitz have been on the opioid beat for years, teaming up (with others) on the Post's "The Opioid Files" series, which was nominated for a Pulitzer in 2020. Now, with American Cartel, the pair provide a deeply-sourced account of how opioid manufacturers, distributors, and pharmacies waged an all-out campaign to fend off DEA efforts to stanch the flow of billions of opioid pain pills, and to evade any culpability, even as the overdose death toll mounted year by year.

The picture Higham and Horwitz paint of corporate and political malfeasance is damning. But the laser sharp focus with which they paint it, omits much of the context in which the opioid crisis has unfolded. And that context is also very important.

An article in yesterday's Guardian shows one of the reasons why. In much of the world, very few pain patients are able to access opioids at all. Much suffering results, sometimes leading to suicide attempts. Dr. MR Rajagopal, chair of Pallium India, told the Guardian, "Pain is not visible. It happens in hospital beds or patients' rooms and is not visible to the world. Addiction, on the other hand, is very visible in headlines which quote the US epidemic and overdose deaths. No one talks about the western European success over decades; all the news is about the opioid crisis in the USA. This means that when we try to have discussions, our work becomes harder because many minds are primed against opioids."

In other words, by speaking too solely to one side of an issue, one risks adversely impacting the other sides. Whether "opiophobia" is real or significant in the US is another question. Higham and Horwitz don't venture a view on this, at least not in American Cartel.

One entity that has warned about opiophobia (without using the term) is the US Centers for Disease Control. In a 2019 memo, CDC writes that a 2016 guidance the agency issued on prescribing opioids for chronic pain had seen "misapplication[s]" by some physicians that put patients at risk. The memo cites a New England Journal of Medicine commentary by the authors of the 2016 guidance. It warns against "hard limits" on opioid dosages or cutting patients off; abrupt tapering of prescriptions; applying the guidance to acute pain situations patients face in situations like active treatment for cancer or sickle cell anemia or post-operative care; and applying it to medication-assisted treatment prescriptions for addiction.

Technically the CDC memo addressed a period of a few years beginning in 2016. But the dynamics it describes are inherent risks in a situation where providers are charged with supplying a substance that's useful but also addictive and potentially deadly if misused, and for which they can be sanctioned professionally or even prosecuted and imprisoned if things go wrong or someone disagrees. Pharma-driven promotion of their new opioid products was a factor in driving up prescribing rates to where they reached. But a part of the increase was also the medical community reacting to a real problem of under-treatment or non-treatment of pain for some patients, a problem that coexists with over-prescribing to some other patients. That increase in turn came with a learning curve.

The authors also give short shrift to the impact of today's woes and inequalities in driving the so-called deaths of despair -- a concept coined by Princeton professors Anne Case and Angus Deaton -- alienation and anomie, helplessness and hopelessness afflicting many Americans who have been left behind in the modern economy, especially in the opioid use heartlands of the Midwest and Appalachia. The Midwest deindustrialized beginning in the 1970s, and both regions largely missed out on the tech boom of the '90s and '00s. Then came even more pain with the Great Recession, followed by COVID and more economic and social disruption. People there (and elsewhere) are dying not just of opioids, but of smoking, drinking, and suicide. Big Pharma is easily (and oh so deservingly) demonized, but the laser focus on the companies allows us not to have to look in the mirror about the pain our society produces.

That factors like these should play a role in the opioid crisis, though, doesn't exonerate Big Pharma. Rather, the misleading promotions of their products carried out by pharma, took an even greater toll due to the vulnerabilities those other factors had brought to the fore.

Meanwhile, the death toll continues to mount -- over 100,000 per year, and with a new record high every year. Prescription opioids still figure prominently in overdoses. But the greatest part of the problem by far is black-market fentanyl, used deliberately by some high tolerance heavy users of opioids, but primariy causing overdose as an adulterant in heroin, counterfeit prescription pills, and other street drugs, essentially a poisoning crisis. But as Higham and Horwitz note, that is part of a wave of opioid use that began with pharmaceutical companies such as Purdue Pharma taking Oxycontin onto the market in the late 1990s. The first decade of this century also saw other prescription opioids -- oxycodone, hydrocodone, Vicodin, Percocet, Opana, et al. -- hit the market.

Higham and Horwitz are fond of tossing around astounding numbers of pills produced by manufacturers or sold by certain pharmacies, such as Mallinckrodt producing 3.5 billion 30 milligram hydrocodone pills in one year, and critics could protest that those numbers need context, too. A prescription for a medication doesn't just have a number of pills to take. It specifies how large a dosage there is inside each pill. A smaller number of pills that each contain a higher dose might mean more than a larger number that each contain a smaller dose. And a higher dose prescription sometimes reflects a patient's tolerance to opioids built up through past medical (or non-medical) use. Maybe West Virginia didn't really need 81 million pain pills during a five-year span. But maybe it did. Without more information, it's just not clear what these numbers mean.

They do provide some context, though, for example by comparing pain pill sales across all drug stores in a region and pointing out anomalies not easily explainable by, say, differing rates of cancer or other serious illness. And they demonstrate that plenty of businesses -- from Big Pharma to the drug store chains and individual pharmacies -- were either in it for the money or at best screwed up, both through detailed analysis and telling anecdote. For example, there was the guileless Florida pharmacist who explains to investigators that she fills pain pill prescriptions all day long, but always keeps a certain number of pills on reserve "for my real pain patients."

When the DEA cracked down first on Wild West internet sales of opioids and then on the "pill mills," medical practices with perfunctory examinations and huge numbers of opioid prescriptions whose entire business model seemed to be writing opioid prescriptions, it succeeded in reducing access to those drugs. But the people using opioids didn't stop; they went to black market drugs, fueling first a resurgence in heroin use and now an opioid crisis driven by fentanyl.

A key figure in the tale is Joe Rannazzisi, who as head of DEA's Office of Diversion Control from 2006 to 2015 oversaw the agency's endless effort to ensure that prescribed opioids are only prescribed for legitimate medical purposes and not leaking into the black market. We are inclined to think of the DEA as a prohibitionist agency, but in this case, it is acting as a regulatory agency. And what Higham and Horwitz uncover is a case of regulatory capture -- when the industry being regulated manages to set the terms under which it is regulated, for its own benefit, not that of the public.

Rannazzisi and his team of DEA lawyers spent years going after opioid manufacturers, distributors, and pharmacy chains who were repeatedly (administratively) busted for failing to do due diligence about just who was buying their products. The companies would pay huge fines, promise not to do it again, and then continue to pump massive amounts of opioids through the supply chain.

The companies mobilized against Rannazzissi and his campaign, forming industry front groups, undertaking lobbying efforts, hiring legions of high-priced law firms, and crafting legislation that would rein in what they saw as an out-of-control agency. As Higham and Horwitz document in great detail, it worked.

Sponsored by Rep. Tom Marino (R-PA) and Sen. Marsha Blackburn (R-TN), both of whom received substantial contributions from the industry, but written by industry lobbyists, the nicely named Ensuring Patient Access and Effective Drug Enforcement Act removed from the DEA tools that Ranizzisi had been using to try to force drug distributors to monitor and report suspicious orders, such as the 1.2 million oxycodone tablets one distributor bought from Mallinckrodt in one day, only to order another 1.2 million the next day.

The bill passed, only to be drastically revised amidst scandal after an earlier Post report on the opioid bill derailed then-President Trump's effort to name Marino drug czar. But Higham and Horwitz also detail rot inside the DEA, where the industry managed to get to high-ranking officials who sidelined Rannazzisi, forcing him into retirement and forcing many of his team members into bureaucratic Siberia. It's an ugly little story of money and power, the sort that is all too common in Washington.

If the first part of American Cartel reads like a detective novel, the second part is more like a legal thriller, It covers the massive wave of civil lawsuits filed against the drug companies, and it is not particularly edifying reading. You see hundreds of high-powered attorneys from the country's top litigating firms -- including dozens of former DEA attorneys working now working for the industry they regulated -- facing off against armies of lawyers for the thousands of states, cities, and counties. You see massive settlements from the companies and massive damages wrested from companies that went to court and lost. While it is unclear just how the moneys won or negotiated by the various plaintiffs is actually being used to help people who suffered from the opioid crisis, what is clear is that it has been a bonanza for the legal profession, with winnings -- excuse me, earnings -- by attorneys reaching well over a billion dollars.

They weren't all in it for the money, though. Some, like West Virginia attorney Paul Farrell, whose state was one of the epicenters of the pain pill epidemic, were sickened by the toll of addiction they saw all around them. Not willing to settle for the pittance the town and county he represented would receive under a massive settlement agreed to by most of the suing entities, he gambled on going it alone against the drug distributors. As this book went to print in April, he was still waiting for a decision. Earlier this month, he lost, with a federal judge ruling that drug distributors were not responsible for the area's opioid crisis.

The litigation goes on, and the dying goes on. Sometimes the drug companies settle, sometimes they lose and have to pay even more. But sometimes they win.

The profit-driven wave of opioids that engulfed the country in the last couple of decades is not an anomaly. The pharmaceutical companies have a historical pattern of creating and marketing drugs that later wreak havoc. That's what they did with amphetamines, that's what they did with barbiturates, that's what they did with benzodiazepines. It's almost enough to make one wonder if profit-driven capitalist enterprises should be in charge of the nation's drug supply.

Read Higham and Horwitz's book. But read Case and Deaton's too. And when you see the next "pill mill" story, don't assume that it is, or isn't, what it seems.

Chronicle Book Review: Opium's Orphans

Chronicle Book Review: Opium's Orphans: The 200-Year History of the War on Drugs by P.E. Caquet (2022, Reaktion Books, 400 pp., $35.00 HB)

The history of drug prohibition is increasingly well-trodden territory, but with Opium's Orphans, British historian P.E. Caquet brings a fascinating new perspective embedded in a sweeping narrative and fortified with an erudite grasp of the broad global historical context. Although Asian bans on opium pre-dated 19th Century China (the Thai monarchy announced a ban in the 1400s), for Caquet, the critical moment in what became a linear trajectory toward global drug prohibition a century later came when the Qing emperor banned opium in 1813 and imposed severe penalties on anything to do with it, including possessing it. Precisely 100 years later, after two Opium Wars imposed opium on the empire followed by decades of diplomatic wrangling over how to suppress the trade (and for moralizing Americans, how to win favor with China), the 1913 Hague Opium Convention ushered in the modern war on drugs with its targeting not just of opium (and coca) producers or sellers but also of mere users for criminal prosecution. It urged countries to enact such laws, and they did.

What began at the Hague would eventually grow into an international anti-drug bureaucracy, first in the League of Nations and then in United Nations bodies such as the Commission on Narcotic Drugs and the International Narcotics Control Board. But it is a global prohibition regime that has, Caquet writes, straight-jacketed itself with an opium-based perspective that has proven unable or unwilling to recognize the differences among the substances over which it seeks dominion, reflexively resorting to opium and its addiction model. Drugs such as amphetamines, psychedelics, and marijuana don't really fit that model -- they are the orphans of the book's title -- and in a different world would be differently regulated.

But Opium's Orphans isn't just dry diplomatic history. Caquet delves deep into the social, cultural, and political forces driving drug use and drug policies. His description of the spread of opium smoking among Chinese elites before it spread into the masses and became declasse is both finely detailed and strangely evocative of the trajectory of cocaine use in the United States in the 1970s, when it was the stuff of rock musicians and Hollywood stars before going middle class and then spreading among the urban poor in the form of crack.

Along the way, we encounter opium merchants and colonial opium monopolies, crusading missionary moralists, and early Western proponents of recreational drug use, such as Confessions of an English Opium Eater author Thomas De Quincey and the French habitues of mid-19th Century hashish clubs. More contemporaneously, we also meet the men who achieved international notoriety in the trade in prohibited drugs, "drug lords" such as Khun Sa in the Golden Triangle, Pablo Escobar in Colombia and El Chapo Guzman in Mexico, as well as the people whose job it is to hunt them down. Caquet notes that no matter how often a drug lord is removed -- jailed or killed, in most cases -- the impact on the trade is negligible.

For Caquet, drug prohibition as a global phenomenon peaked with the adoption of the 1961 Single Convention on Narcotic Drugs. Coming as it did amidst a post-World War II decline in drug use around the world, the treaty criminalizing coca, cocaine, opium and opioids, and marijuana seemed to ratify a successful global prohibitionist effort. (In the US, in the 1950s, when domestic drug use was at low ebb, Congress passed tough new drug laws.) But before the decade was over, drug prohibition was under flamboyant challenge from the likes of LSD guru Timothy Leary and a horde of hippie pot smokers. The prohibitionist consensus was seeing its first cracks.

And the prohibitionist response was to crack down even harder, which in turn begat its own backlash. Drug use of all sorts began rising around the world in the 1960s and hasn't let up yet, and the increasingly omnivorous drug war machine grew right along with it, as did the wealth and power of the illicit groups that provided the drugs the world demanded. As the negative impacts of the global drug war -- from the current opioid overdose crisis in the US to the prisons filled with drug offenders to the bloody killing fields of Colombia and Mexico -- grew ever more undeniable, the critiques grew ever sharper.

In recent years, the UN anti-drug bureaucrats have been forced to grudgingly accept the notion of harm reduction, although they protest bitterly over such interventions as safe injection sites. For them, harm reduction is less of an erosion of the drug war consensus than all that talk of drug legalization. As Caquet notes, perhaps a tad unfairly, harm reduction doesn't seek to confront drug prohibition head-on, but to mitigate its harms.

The man is a historian, not a policymaker, and his response to questions about what to do now is "I wouldn't start from here." Still, at the end of it all, he has a trio of observations: First, supply reduction ("suppression" is his word) does not work. Sure, you can successfully wipe out poppies in Thailand or Turkey, but they just pop up somewhere else, like the Golden Triangle or Afghanistan. That's the infamous balloon effect. Second, "criminalization of the drug user has been a huge historical blunder." It has no impact on drug use levels, is cruel and inhumane, and it didn't have to be that way. A century ago, countries could have agreed to regulate the drug trade; instead, they tried to eradicate it in an ever-escalating, never-ending crusade. Third, illicit drugs as a group should be seen "as a historical category, not a scientific one." Different substances demand different approaches.

Opium's Orphans is a fascinating, provocative, and nuanced account of the mess we've gotten ourselves into. Now, we continue the work of trying to get out of that mess.

The Taliban Announces a Ban on Opium. Really? [FEATURE]

On April 3, the Taliban announced a ban on drug cultivation in Afghanistan, for years the world's dominant opium producer, accounting for more than 80 percent of the global supply of the substance, from which heroin is derived, throughout this century. But the ban announcement raised as many questions as it answered and has been met with a degree of skepticism, not only around the motives of the Taliban but also because opium plays such a key role in an Afghan economy that is now in especially dire straits.

The opium poppy is an economic mainstay in Afghanistan. Can the Taliban really suppress it? (UNODC)
"As per the decree of the supreme leader of the Islamic Emirate of Afghanistan, all Afghans are informed that from now on, cultivation of poppy has been strictly prohibited across the country," said an order from the Taliban's supreme leader Haibatullah Akhundzada. "If anyone violates the decree, the crop will be destroyed immediately and the violator will be treated according to the Sharia law," the order said.

The order also banned the cultivation, manufacture, transportation, or use of other drugs. (Afghanistan is also one of the world's leading cannabis producers and is seeing rapidly increasing methamphetamine production.)

The Taliban presided over the only other opium ban in modern Afghan history back in 2000, but that effort faltered amidst a popular backlash against repressing a crop that provided incomes for hundreds of thousands of families, and eventually withered away before the Taliban were overthrown by the invading Americans late in 2001.

During two decades of foreign occupation, repressing the opium trade largely played second fiddle to the war on terror, and the Afghan opium economy prospered. By the end of 2021, the UN Office on Drugs and Crime (UNODC) estimated that the opium trade was worth between $1.8 and $2.7 billion, constituting as much as 11 percent of the country's Gross National Product (GNP). UNODC also noted that the departure of Western development assistance after the Taliban takeover in August, which accounted for 22 percent of GNP, will only make drug markets a larger share of the economy.

So, is the ban for real? And if the Taliban are serious, can they actually do it, given the crucial role the crop plays in the devasted national economy? The Chronicle consulted with a couple of experts on the topic, and opinions were divided.

Sher Jan Ahmadzai is director of the Center for Afghanistan Studies at the University of Nebraska-Omaha. He is skeptical.

"If you look at the Taliban's historical approach to opium, they only banned it when prices went down to increase demand," said Ahmadzai. "A second goal has been to respond to international pressure that opium should be banned. But looking strategically at opium, where their funding comes from, it doesn't seem to me that they will really pursue this."

"There are a couple of reasons for that," Ahmadzai continued. "One, they have been dependent on the income from opium. Although opium production is haram, they didn't ban it for religious reasons. Instead, they taxed it, and many of their leaders have been involved in drug trafficking and depend on this. To me, it seems very difficult to accept the ban as a fact.

"Second, most of rural Afghanistan, especially the southwest, has traditionally been dependent on opium production, and it will really hurt them economically, which will create political problems among the Taliban. Their support base is opium-growing farmers, and a ban will attract their anger," he argued.

Vanda Felbab-Brown is a senior fellow in the Center for Security, Strategy, and Technology in the Foreign Policy program at the Brookings Institute. She thinks the ban is for real but will come with a high price.

"For several years, Taliban interlocutors were saying they were moving toward the ban," said Felbab-Brown. "It didn't work out for them in 2000, and later they were deeply engaged in poppy cultivation, but the leadership now is very conservative, very inward-looking, very doctrinaire, and is trying to restore 1990 policies. The more internationalist factions within the Taliban are much weaker and have not been successful in implementing policies.

"There is good reason to believe they will try to implement the ban, but that will have significant impacts on the implementers, including fighters, who have not gotten paid," she continued. "This will impact relations among the various factions and the ability of commanders to pay their fighters, which will be negatively affected by the ban.

"The question is how long will they maintain it, how long are they willing to squeeze the people and deal with compounding rifts within the Taliban. They don't want to alienate various factions, but in this case, we see a very conservative policy that will compound those rifts," she predicted.

Ahmadzai was not convinced that the ban reflected factional differences between conservatives and internationalists within the Taliban.

"I don't see any big differences in their policies," he said. "I haven't seen any breakups, so it's hard to say it's a power struggle between the factions. No one has spoken out against it; even those who were stationed in Doha have not spoken out against anything the conservatives have done. If there is a power struggle, it is not around differences over banning."

For Ahmadzai, the ban is little less than a publicity stunt, especially given harsh economic conditions and Afghanistan's desperate need to mollify the international community in order to get sanctions removed and assistance flowing again.

"The urban economy was already seeing its own share of destruction in the last eight months, and the rural economy is more or less based on opium," he said, "so more than anything this looks like another cosmetic step to let the international community know they are doing something. They want to make Iran or Russia happy. Russia is a huge market for Afghan drugs, and the Russians want them to come down hard on opium production."

Felbab-Brown disagreed.

"There is also a possible international dimension to this; the Taliban may be trying to curry favor with Iran or Russia, but that is not the principal reason," said Felbab-Brown.

Whatever the reason for the ban announcement, if it actually happens, it is going to make tough times in Afghanistan -- the UN last month reported that the country is facing a food insecurity and malnutrition crisis of "unparalleled proportions" -- even tougher.

"The Taliban are not promising help or advising people what to do; their attitude is just cope with it. But the country is already in a drastic humanitarian situation, and this will not just hurt farmers, there will be significant knock-on effects," said Felbab-Brown. "The economy has dried up since the Taliban took power, and heroin has been one of the sources of liquidity. As problematic as the bans and eradication were in 2000, eventually they were not enforced and eradication was not funded, and now the economy is so much worse. The economic impact of the Western withdrawal is already awful; this will make it just tragic."

RI Drug Decrim Bill Filed, Myanmar Drug Trade Ramping Up Amidst Civil War, More... (3/8/22)

Oklahoma Republicans move to take on what they see as an out of control medical marijuana system, Afghan farmers are planting more opium poppies this year, and more.

Opium production is surging in Afghanistan's poppy heartlands of Helmand and Kandahar. (UNODC)
Medical Marijuana

Oklahoma GOP Lawmakers Move to Rein in "Wild West" Medical Marijuana System. The House's Republican Caucus on Monday rolled out a package of bills aimed at reining in the state's free-wheeling medical marijuana program. The move comes after state agents seized more than 150,000 marijuana plants in a bust last month. "We have seen black market elements competing with legitimate Oklahoma businesses. They are putting our citizens at risk. They're doing things in an illegal, unethical manner," said Rep. Jon Echols (R-Oklahoma City). The package of 12 bills includes full implementation of a seed to sale system, grants to county sheriffs to fund law enforcement, making the Oklahoma Medical Marijuana Authority a stand-alone agency, provisional licensing with pre-licensing inspections, separate licensing for wholesalers, tough electrical and water data reporting by growers, annual inspection, and more. "If you're an illegal operator of the state of Oklahoma, your time is up," warned Rep. Scott Fetgatter (R-District 16).

Drug Policy

Rhode Island Drug Decriminalization, Therapeutic Psilocybin Bills Filed. Lawmakers filed a pair of drug reform bills last week, one of which, House Bill 7896, would decriminalize the possession of up to an ounce of all drugs except fentanyl, while the second bill, House Bill 7715, would allow doctors to prescribe psilocybin and would decriminalize psilocybin and buprenorphine. Buprenorphine is an opioid often used as a harm reduction tool to help people transition away from more addictive compounds. The broader decriminalization bill, would make possession of up to an ounce of any drug other than fentanyl a civil violation punishable by a $100 fine for a first offense and up to $300 for subsequent offenses.

Psychedelics

Missouri GOP Lawmaker Files Therapeutic Psychedelics Bill. State Rep. Tony Lovasco (R) on Tuesday filed House Bill 2850, which would legalize a range of natural psychedelics for therapeutic use and decriminalize small-time possession. Under the bill, patients with specified conditions such as treatment-resistant depression, PTSD, and terminal illnesses access to substances such as psilocybin, DMT, mescaline, and ibogaine at designated care facilities or the patients' or caregiver's residence. Patients would be allowed to possess and use up to four grams of the substances. The bill decriminalizes the possession of less than four grams outside the medical model but makes possession of more than four grams a class A misdemeanor punishable by up to a year in jail.

International

Afghan Opium Production Surges in Kandahar and Helmand. Opium and other drugs are being sold in open markets, and farmers in the country's opium heartland of southern Helmand and Kandahar provinces are sowing more poppies this year amidst the country's economic collapse after the Taliban's seizure of power last summer and the subsequent withdrawal of all Western assistance to the country. "There is nothing else to cultivate. We were growing wheat before. This year -- we want to cultivate poppy. Previously they were asking for bribes every day but we don't have that problem this year," one farmer said. "If we don't cultivate poppy, we don't get a good return, the wheat doesn't provide a good income," farmer Mohammed Kareem said. "There are no restrictions this year. If the Taliban wanted to ban it, they must let us grow it this year at least," added farmer Peer Mohammad.

Myanmar Militias, Rebel Armies Ramp Up Drug Dealing Amidst Civil War. Armed groups on both sides of Myanmar's civil war are ramping up drug production amidst the turmoil, with much of the methamphetamine and heroin supply going to Asian countries through the porous Laotian border, a UN Office on Drugs and Crime (UNODC) official said this week. The $60 billion trade based largely in Shan state is now going into overdrive, he said. "Seizures in Laos and Thailand are off the charts and it is not because of suddenly improved law enforcement -- some other countries' seizures are up too, but in Thailand and Laos the connection to trafficking patterns and locations in Shan is very clear," said Jeremy Douglas, UNODC representative for Southeast Asia and the Pacific.

The Taliban Says It Will Stop the Opium Trade, But Is That Likely? [FEATURE]

One of the first announcements the Taliban made as it seized power in Afghanistan last month was that they were going to end illicit drug production. But, as with other promises of change from the Taliban -- like women's rights or press freedoms -- there is a whole lot of skepticism about the claim.

Afghan opium harvest
At its first press conference in Kabul after entering the city and solidifying their control over the country, Taliban spokesman Zabihullah Mujahid vowed that their new government would not let Afghanistan become a full-fledged narco-state: "We are assuring our countrymen and women and the international community that we will not have any narcotics produced,"Mujahid said. "From now on, nobody's going to get involved (in the heroin trade), nobody can be involved in drug smuggling."

But in addition to the general skepticism about the Taliban's plans for the country, the notion of them imposing a ban on opium production runs afoul of economic and political realities on the ground. The challenge is that the opium crop is a key component of the Afghan economy, accounting for somewhere between seven and 11 percent the country's Gross Domestic Product, and bringing in as much as $2 billion in 2019, more than Afghanistan's entire licit agricultural sector.

It is also a job creator in a country where opportunities are scarce. The opium harvest employs the equivalent of 119,000 full-time jobs, not counting the farmers themselves and their family members. The broader opium economy also supports untold thousands in the domestic trade (opium traders, heroin producers, domestic dealers) and as service providers for that trade (packers, transporters), as well as internationally connected individuals working in the international trade. The opium economy is especially strong in areas of key Taliban support, such as Helmand and Kandahar provinces in the south.

Afghanistan has accounted for between 80 percent and 90 percent of global opium production throughout this century, a pattern that began, ironically enough, in the 1980s, when the CIA waged a secret war against the Soviet occupation of the country and enlisted both Islamic radicals and the opium trade in the battle. Opium "is an ideal crop in a war-torn country since it requires little capital investment, is fast growing and is easily transported and traded,"the State Department reported in 1986.

As noted by global drug historian Alfred W. McCoy, author of the groundbreaking "The Politics of Heroin: CIA Complicity in the Global Drug Trade,"in a 2018 article:

"As relentless warfare between CIA and Soviet surrogates took its toll, Afghan farmers began to turn to opium 'in desperation', since it produced 'high profits' that could cover rising food prices. At the same time, the state department reported that resistance elements took up opium production and trafficking 'to provide staples for [the] population under their control and to fund weapons purchases'."

"As the mujahideen guerrillas gained ground against the Soviet occupation and began to create liberated zones inside Afghanistan in the early 1980s, the resistance helped fund its operations by collecting taxes from peasants who grew the lucrative opium poppies, particularly in the fertile Helmand valley. Caravans carrying CIA arms into that region for the resistance often returned to Pakistan loaded down with opium -- sometimes, reported the New York Times, 'with the assent of Pakistani or American intelligence officers who supported the resistance.'"

And nearly four decades later, Afghanistan remains the world's number one supplier of opium and its derivative, heroin, with the latter going into the veins of habitues from Lahore to London. And now, with the withdrawal of the West and all its billions of dollars of economic assistance and with the key role opium plays in the economy, the Taliban is going to ban it?

It would be a risky move for the Taliban, said Vanda Felbab-Brown, a senior fellow for foreign policy at the Brookings Institution.

"The Taliban can risk a ban, but it would be politically costly in ways that are more complex than in 2000 [when they also banned it] and it could lead to tremendous destabilization,"she told the Chronicle in a phone interview. "This is a country where 90 percent of the population lives in poverty. It's also a situation where many mid-level Taliban commanders are dependent on opium for their income and livelihoods for their fighters. To impose a ban would require the Taliban to maintain a high level of aggression, which would create political fissures and fractures and would play into the hands of other actors. One reason local warlords didn't fight the Taliban this summer was that the Taliban was promising them access to the local economy, and in many places, that means opium."

Even in the best of circumstances, replacing a lucrative illicit economy with legal alternatives is a long-term project, and these are not the best of circumstances, to say the least.

"The Afghan economy is more or less tanking,"Felbab-Brown said. "A massive influx of foreign aid has been an inescapable component of the economic life of the country, and now, the Taliban does not have any way of dealing with stopping opium by delivering alternative livelihoods. Even if they had a well-designed program, you are looking at decades to suppress it,"she said.

Still, the Taliban has done it before.

"When it comes to banning opium, we are looking at a possible replay of the 1990s,"said Felbab-Brown. "What the Taliban want is international recognition. In the 1990s, they kept promising they would ban poppies in return for international recognition, but then said they could not do it because they could not starve their people, until in 2000, they did it. Will they risk that again? My expectation is that we are going to see the same bargaining with the international community, but as I said, if the Taliban does try to do a ban, they will struggle to enforce it."

The Taliban also face a possible loss of the opioid market share if they enact a ban and then change their mind because of adverse circumstances, Felbab-Brown said.

"The difference now is the synthetic opioids,"she said, alluding to the production of fentanyl and its derivatives coming from Chinese and Indian chemical factories. "If the Taliban move to ban and then decide it is too difficult to sustain politically or financially, it might not find it easy to just return to the same markets; the European markets, for instance, could be snatched away by synthetic opioids."

As for how the much vaunted "international community"should approach Afghan opium production, that's a complicated question.

"There is no unity in the international community on how to deal with Afghanistan,"Felbab-Brown said. "The Chinese and Iranians are warming up to the Taliban, and the Russians will be urging the Taliban to go for a ban. I suspect the ban talk is mainly to satisfy the Russians. But we should not be pushing the ban; that would be catastrophic in terms of humanitarian consequences."

Afghan government and Western efforts to suppress the opium trade proved futile throughout the Western occupation, and now the likelihood of any sort of robust international campaign to suppress Afghan poppies appears next to nil. Outside of legalization of the trade, which does not appear even remotely likely, the only alternative for suppressing opium production is to cajole farmers to grow other crops in a bid to wean them off the poppy, but even those sorts of programs are now in question.

"Should the international community be working with the Taliban to try to implement alternatives livelihoods?"asked Felbab-Brown. "It's a difficult question and can't be considered in isolation. It will be part of the bargaining over a whole set of policies, including women's rights and human rights."

Uncertainty abounds over what the Taliban's opium policy will actually look like. In the meantime, the farmers are planting the seeds for next year's crop right now.

Book Review: Drug Use for Grown-Ups

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sentencing Policy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NE MedMJ Activists Take Aim at 2022, Study Finds Heroin, Fentanyl Use Up During Pandemic, More... (10/16/20)

Virginia's governor signs a minor marijuana reform bill into, the Mexican government has captured a major cartel leader, heroin and fentanyl use is up during the pandemic, and more. 

Fentanyl use has gone up during the COVID pandemic, data from Quest Diagnostics shows. (Creative Commons)
Marijuana Policy

Virginia Governor Signs Marijuana Reform Bill into Law. Gov. Ralph Northam (D) has signed into law a bill, SB 5013, that will allow people to issued summonses for decriminalized marijuana possession to prepay their fines rather than having to show up in court. Other marijuana-related bills are still alive in the session, including one already on the governor's desk that would bar police from conducting searches bases solely on the odor of marijuana and a set of competing expungement proposals that are now in conference committee.

Medical Marijuana

Nebraska Medical Marijuana Legalization Activists Get Working on 2022. After qualifying for the 2020 ballot and then getting stiffed by the state Supreme Court, which held that the initiative embraced more than one subject, the two state senators who lead Nebraskans for Medical Marijuana Anna Wishart and Adam Morfeld, recently filed new petition language with Secretary of State Bob Evnen for voters to consider for the 2022 ballot. The new language is simple and straightforward: "Persons in the State of Nebraska shall have the right to cannabis in all its forms for medical purposes." Now, they will have to recreate the successful 2020 signature-gathering campaign to get back on the ballot in 2022.

Drug Policy

Quest Diagnostics Health Trends Study Finds Fentanyl and Heroin Misuse Skyrockets During COVID-19 Pandemic. A new Quest Diagnostics Health Trends study indicates that misuse of fentanyl, heroin and nonprescribed opioids are on the rise, potentially due to the COVID-19 pandemic's impact on healthcare access and support for individuals most at-risk for substance use disorder. The full study, from researchers at Quest Diagnostics and published online in the peer reviewed journal Population Health Management, can be found here. The researchers compared testing positivity rates for January 1, 2019-March 14, 2020 and March 15-May 16, 2020 (during the onset of the COVID-19 outbreak). Among individuals tested, the drug positivity rate increased 35% for non-prescribed fentanyl and 44% for heroin during the pandemic compared to the period prior to the pandemic. Nonprescribed opioids also increased, by 10%. The study also found a massive surge in the positivity rate of drug combining with non-prescribed fentanyl during the pandemic compared to prior to the pandemic. Positivity for non-prescribed fentanyl increased substantially among specimens that were also positive for amphetamines (by 89%), benzodiazepines (48%), cocaine (34%), and opiates (39%; P <0.01 for all comparisons).

International

Mexico Captures Major Cartel Leader. Mexican security forces have captured the head of the Santa Rosa de Lima Cartel, Guanajuato Gov. Diego Sinhue announced Wednesday night. Adan Ochoa, known as "El Azul," rose to lead the cartel after the capture of its former leader Jose Antonio Yepez, known as "El Marro." The cartel has been involved in violent conflict with the Jalisco New Generation Cartel over which will control the drug trade in the central Mexican state.

MO Pot Legalization Campaign Falls Victim to COVID-19, Border Smugglers Have to Innovate, More... (4/16/20)

The Show Me State won't be able to show us legal weed this year, the DEA says meth and heroin prices are going up, and more. 

How the US-Mexico border used to look. Now, reduced traffic because of COVID-19 is forcing drug smugglers to innovate. (CC)
Marijuana Policy

Missouri Legalization Campaign Killed by Coronavirus. The marijuana legalization initiative sponsored by Missourians for a New Approach is no more. While activists with the campaign had sought alternative avenues for signature gathering, they have now conceded that is impossible. The campaign needed more than 160,000 valid voter signatures and only has 80,000 raw signatures now.

Law Enforcement

DEA Says Meth, Heroin Prices Going Up. Dante Sorianello, the assistant special agent in charge of the DEA in the San Antonio district, says meth and heroin prices are going up even though there's been no let up in drug trafficking across the border. "We have seen an increase in the price of narcotics domestically. Now does that mean there’s a shortage of the narcotics here, that could be an indicator of that. Could it also be price gouging by some of the traffickers? It could be that, also using the virus as an excuse," said Sorianello.

Reduced Border Traffic Forcing Cartels to Innovate. Mexican drug cartels are sitting on large stockpiles of synthetic drugs, but international travel restrictions have greatly reduced traffic at border ports of entry, allowing Customs and Border Patrol officers more time to search vehicles for drugs, which in turn is leading to large seizures and forcing drug traffickers to innovate, mainly by returning to old smuggling tactics, such as sending drug mules across the desert or having them swim across the Rio Grande River, Customs and Border Patrol says.

Drug War Issues

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