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Schumer Says Marijuana Legalization Bill Coming in April, Study Questions Reliability of Maternal Drug Testing, More... (2/7/22)

Wisconsin's governor vetoes a bill that would have dramatically hiked criminal penalties for butane marijuana extraction, the Jalisco New Generation Cartel is now making bombs to deploy against the military, and more.

Marijuana legalization could be coming to the Senate in April. (Creative Commons)
Marijuana Policy

Schumer Says He Aims to File His Marijuana Legalization Bill in April. Senate Majority Leader Chuck Schumer (D-NY) announced last Friday that he plans to formally introduce his marijuana legalization bill in April. "In the coming weeks, we're ramping up our outreach -- and we expect to introduce final legislation. Our goal is to do it in April," Schumer said. "Then we begin the nationwide push, spearheaded by New York, to get the federal law done. As majority leader, I can set priorities. This is a priority for me." Schumer's bill, the Cannabis Administration and Opportunity Act (CAOA), was first released in draft from last July, and advocates had grown increasingly impatient with the lack of movement since then, especially after he blocked passage of the SAFE Banking Act, which the House had approved and attached to a defense spending bill. But now, Schumer has signaled movement ahead.

Wisconsin Governor Vetoes Bill to Ramp Up Penalties for Marijuana Extraction. Gov. Tony Evers last Friday vetoed a bill that would have significantly increased criminal penalties for people using butane or similar fuels to process marijuana for extracts. The measure, Assembly Bill 440, would have made using butane to extract marijuana a Class E felony punishable by up to 15 years in prison. It is currently a Class I felony with a maximum 3 ½ year sentence. In his veto message, Evers said, "I am vetoing this bill in its entirety because I object to increasing criminal offenses or penalties related to marijuana use," adding that "marijuana criminalization has had a disproportionate impact on communities of color, especially in Wisconsin." Evers supports marijuana legalization, but has made no headway with the Republican-led legislature.

Drug Testing

Study Questions Reliability of Maternal Drug Testing. A study presented at 2022 Pregnancy Meeting of the Society for Maternal-Fetal Medicine last Friday is raising more questions about the drug testing of pregnant women after it found that maternal urine samples and samples of the meconium from their newborn babies frequently produce different results. That disagreement (or "discordance") could trigger inappropriate interventions by child protective services, including separation of infants from their mothers, the researchers said.

"There's a very big debate right now in the obstetrics and perinatology communities about the utility of biochemical testing and the identification of high-risk women," said lead author Cassandra Heiselman, DO, MPH, clinical assistant professor in the Department of Obstetrics, Gynecology and Reproductive Medicine at the Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, told Medscape Medical News. "We know that each biochemical test has limitations, which can include basically the inability to detect all substances, especially synthetic opioids like fentanyl, [and] the possibility for false results."

Ironically, marijuana use was the most common factor associated with a positive meconium test. "Some studies have shown cannabis use in the second trimester can show up in meconium testing even if the mother has stopped that behavior," Heiselman said. "Then there is also cross-reactivity with other substances that can lead to higher false positive results, especially in the urine toxicology."

International

Mexican Drug Cartel Turns to IEDs to Use Against Army as Drug War Rages On. In a first in Mexico's drug wars, the Jalisco New Generation Cartel has deployed homemade bombs, or improvised explosive devices (IEDs) against the Mexican military. The attacks came on Saturday in Tepalcatepec in the western state of Michoacan, which has been riven with criminal conflicts for months. The bombs were described as pipe bombs with a cone-shaped cap to direct the explosion. Local self-defense forces fighting the cartel said the bombs did extensive damage to a military armored vehicle. This is just the latest escalation for the cartel, which last month resorted to dropping bombs from drones on its rivals.

House Passes Bill With SAFE Banking, Psilocybin Rescheduling Petition Filed, More... (2/4/22)

A key Maryland legislator rolls out a marijuana legalization bill, the Utah legislature approves employment protections for medical marijuana cardholders, and more.

The ACLU and NAPW are sticking up for pregnant women subjected to non-consenual drug testing again. (Creative Commons)
Marijuana Policy

House Passes Manufacturing, Technology Bill That Includes SAFE Banking Act. For the second time this session, the House has voted to include the SAFE Banking Act in a larger bill it passed. It passed earlier as part of a defense spending bill only to be stripped out by Senate leaders seeking instead to promote full-on marijuana legalization legislation. The House approved the America COMPETES Act, complete with the SAFE Banking Act amendment, Thursday night by a vote 222-210, mainly along party lines. The Senate has already passed its version of the America COMPETES Act, which does not include the SAFE Banking Act language. It will now be up to House and Senate negotiators to decide whether to include it in the final bill.

Maryland Marijuana Legalization Bill Filed. A key member of the legislature, House Judiciary Committee Chair Luke Clippinger (D-Baltimore) filed a marijuana legalization bill, House Bill 837, on Thursday. Under the bill, Marylanders could possess up to 1.5 ounces of marijuana for recreational use. The bill would also automatically expunge convictions for simple possession. The bill also creates a plan for implementation of legalization, which is seen as a bridge to the House, whose leaders support a voter referendum on the issue. "While I feel strongly that the voters should decide this issue, it is the General Assembly that is charged with making sure we have a legally defensible, equity-driven plan in place should they choose legalization," said House Speaker Adrienne A. Jones (D-Baltimore County).

Virginia Coalition to Oppose Legal Marijuana Commerce Emerges. The usual suspects are back. A group of parents, substance abuse professionals, and law enforcement have created a coalition to try to block the state from establishing a legal marketplace for marijuana, as envisioned under the marijuana legalization bill passed last year. The doomsayers are being joined by Project SAM, a group that consistently opposes marijuana legalization. The new coalition claims that allowing legal marijuana sales will endanger Virginians. Their efforts may gain some traction in the legislature, which is now controlled by Republicans, as opposed to last year, when the Democrat-controlled body approved legalization.

Medical Marijuana

Utah Legislature Approves Bill Affirming That Medical Marijuana Should Be Treated Like Any Other Prescription Drug. With a final vote in the House on Wednesday, the legislature has approved Senate Bill 46, which reaffirms that medical marijuana cardholders are entitled to protections from job actions related to their medical marijuana use. The bill came after the Utah Patients Coalition complained that some first responders were having problems with local governments for even having a medical marijuana card. It is now up to Governor Spencer Cox (R) to sign or veto the measure.

Psychedelics

Seattle Doctors Files DEA Petition to Reschedule Psilocybin for Medical Use. Dr. Sunil Aggarwal, a Seattle end-of-life care specialist, has filed a formal petition with the DEA seeking to remove psilocybin from Schedule I of the Controlled Substances Act. The petition asks the DEA to reschedule as a less-restricted Schedule II drug. The substance has a low potential for abuse and shows "exceptional promise in relieving debilitating symptoms in those with intractable and otherwise untreatable illness," including the severe anxiety and depression that can result from a terminal illness. "The original placement of psilocybin," the document says, "was the result of a substantial overestimation of the risk of harm and abuse potential, not rigorous science."

Joining the suit, attorneys general from eight US states and the District of Columbia filed a friend-of-the-court brief in support of the patients, noting the therapeutic potential of not only psilocybin but also other currently illegal drugs, including as MDMA. "Here, dying patients seek access to promising new treatments still in the investigative process -- access expressly permitted under both state and federal law -- to help them live in peace," the amicus brief said.

Utah Psychedelic Study Bill Wins House Committee Vote. The House Health and Human Services committee on Thursday approved House Bill 167, which would create a task force to study the therapeutic potential of psychedelic drugs and make recommendations for their lawful use. The measure passed on a 10-1 vote and now heads for a House floor vote.

Drug Testing

Groups File Human Rights Complaint on Behalf of New Mother Over Non-Consensual Drug Test and False Positive. National Advocates for Pregnant Women (NAPW) and the ACLU of Illinois filed a charge of discrimination against Saint Alexius Hospital last week with the Illinois Department of Human Rights over a non-consensual drug test of a first-time mother before she went into labor. The test came back positive because of an Easter cake made with poppy seeds that the mother ate before entering the hospital, leading to the hospital initially holding the newborn in the Newborn Intensive Care Unit and then requiring the family to have someone besides the mother with the child at all times for three months.

"Saint Alexius violated [this mother's] civil rights by subjecting her to a non consensual and medically unnecessary drug test," said Emma Roth, staff attorney at NAPW. "She will never be able to get back those precious first months with her baby. The fact that Ms. F. was reported on the basis of a false positive due to poppy seed consumption highlights the absurdity of Saint Alexius's non consensual testing and reporting practices. Yet routine drug testing and reporting of pregnant patients is never justified in light of the harmful consequences for families."

Fighting Back Against the Non-Consensual Drug Testing of Pregnant Women [FEATURE]

Two New York state women reported to Child Protective Services after their consumption of poppy seeds resulted in false positives, on drug tests they were never aware of nor consented to as they were giving birth, have filed a complaint against the hospital that ran the tests and then reported them.

The two women, identified only as Crystal H. and Jane Doe, are being represented by the New York Civil Liberties Union (NYCLU) and National Advocates for Pregnant Women (NAPW). The complaints against Garnet Health Medical Center (GHMC) in Middletown were filed with the state Division of Human Rights. They charge that Garnet Health discriminated against both women on the basis of sex and pregnancy by drug testing them without their consent, then interfering with their ability to breastfeed their babies, and referring them and their families to the State Central Registry of Child Abuse and Maltreatment. (SCR), which subjected them to invasive searches.

Crystal's complaint details how, having been routinely providing urine samples to check for blood and proteins during her pregnancy, one urine sample taken after she was admitted for delivery was used without telling her or seeking her consent "for the purpose of testing it for drugs, including opiates." The complaint notes that "GHMC had no medical reason, necessity, or justification" for the test and that the American College of Obstetricians and Gynecologists rejects the practice of drug testing pregnant patients.

To Crystal's surprise, the drug test came back "presumptive positive," and she was then "met with accusatory and dismissive treatment from the primarily white nursing staff." Although Crystal explained that she had eaten a bagel containing poppy seeds, and a staff physician conceded that the poppy seeds could cause the positive result for opiate, GHMC did not run the more accurate confirmatory test as recommended.

After Crystal gave birth, GHMC drug tested her child -- again without her consent -- and he tested negative. Despite even that, Even after the infant's negative test result, and even though Crystal had asked for a second drug test, and even though the initial test result meant "the test provides a preliminary result only, positive results are unconfirmed," GHMC then reported her to the SCR. GHMC only agreed to retest Crystal after it had reported her, and when that test came back negative, it refused to withdraw the report to SCR or inform SCR of the second, negative test result. (Crystal also took a hair follicle drug test that can detect use for up to three months and came up negative for opiates on that.)

That report to SCR resulted in the Oneida County Department of Social Services conducting an invasive search of her home within 12 hours of her release from the hospital. Crystal remained under for suspicion for two months, until the department closed the abuse and maltreatment investigation as "unfounded."

"Garnet Health turned the joy of becoming a new mom into an absolute nightmare. Right after delivery, hospital staff didn't permit me to nurse because of a false positive drug test result after having eaten a poppy seed bagel. Those bonding moments with my newborn are moments I will never get back," Crystal H. said in a press release announcing the legal action. "Across New York State, low income, and Black and Latinx pregnant New Yorkers are threatened with family separation and discriminated against by their healthcare providers based on accusations of drug use alone. I'm taking action today to ensure that our hospitals' care for newborns and their parents is grounded in principles of public health, not racist stereotypes."

Jane Doe's complaint is eerily similar to Crystal H.'s. She, too, innocently partook of a food item containing poppy seeds -- a Sam's Club kale salad with poppy seed dressing -- she, too, was drug tested without her consent or knowledge and deemed a drug user, not allowed to breastfeed her infant, and reported to SCR despite her protestations of innocence. And she, too, suffered the emotional trauma of the experience.

"By drug testing me without my consent and reporting a false presumptive positive result to child welfare authorities, Garnet Health turned what should have been the most meaningful moment of my life into the most traumatic one," she said in the press release. "All because I ate a salad with poppy seed dressing, Garnet Health treated me like an unfit mother, told me I wasn't allowed to breastfeed, repeatedly denied my requests for a confirmatory test, and ensured my name would be on the New York State Central Register of Child Abuse and Maltreatment. At a time when I should be focused on bonding with the baby I have been dreaming of my whole life, I have been forced to grapple with the heartbreaking effects of Garnet Health's discriminatory actions."

The practice of drug testing pregnant women without their knowledge or consent is common in New York, according to NAPW and NYCLU, but is not supported by leading medical organizations. Here, for example, is a 2019 policy statement from the American Medical Association:

"Our AMA will oppose any efforts to imply that the diagnosis of substance use disorder during pregnancy represents child abuse; support legislative and other appropriate efforts for the expansion and improved access to evidence-based treatment for substance use disorders during pregnancy; oppose the removal of infants from their mothers solely based on a single positive prenatal drug screen without appropriate evaluation; and advocate for appropriate medical evaluation prior to the removal of a child, which takes into account the desire to preserve the individual's family structure, the patient's treatment status, and current impairment status when substance use is suspected."

The NYCLU and NAPW are fighting to end the kind of abuses Crystal and Jane Doe faced.

"No parent should ever endure what Crystal and her husband endured," said Gabriella Larios, Equal Justice Works Fellow at the New York Civil Liberties Union. "Nonconsensual drug tests prioritize stigma over science and are a relic of racist War on Drugs myths. Garnet Health, and all hospitals across New York State, must immediately stop drug testing pregnant people in secret, and Albany must pass legislation so that no drug test can take place without a pregnant person's informed consent."

"Garnet Health's practice of drug testing all pregnant patients without their informed consent and reporting test results to child welfare authorities has devastating consequences for new families and constitutes illegal sex discrimination," said NAPW attorney Emma Roth. "We're filing the complaint to shine a light on Garnet Health's discriminatory practices and we hope other hospitals take notice. No new mother should ever face such traumatic and discriminatory treatment."

No More Pot Tickets in St. Louis, NY Hospital Sued Over Nonconsensual Drug Testing of Pregnant Women, More... (12/21/21)

An Ohio marijuana legalization initiative campaign hands in initial signatures, St. Louis becomes the latest city to give up on policing small-time pot possession, and more.

No more pot tickets in St. Looey. (Pixabay)
Marijuana Policy

Ohio Legalization Campaign Submits Signatures Needed to Force Vote. The Coalition to Regulate Marijuana Like Alcohol handed in more than 200,000 raw signatures Monday for its proposed initiative to legalize the personal possession and cultivation of marijuana. They need only 132,887 valid voter signatures for the measure to be valid This is not a typical, direct-to-the-voters initiative; instead, if the signatures are verified, the legislature would then have four months to act on the measure. If the legislature rejects or fails to act on the measure, campaigners would then have to gather another 132,887 valid voter signatures to put the issues before the voters in the next general election.

St. Louis Police No Longer Issuing Marijuana Citations. People found with up to two ounces of marijuana or growing up to six plants will no longer be cited by city police. That's because Mayor Tishaura Jones last week signed into law an ordinance that virtually legalizes marijuana in the city. The ordinance bars police from issuing citations for two ounces or less, bars police from initiating a search based on the "odor or visual presence" of marijuana, and provides that city workers who test positive for marijuana can cite their state-issued medical marijuana cards to avoid "adverse employer actions."

Drug Testing

New York Civil Liberties Union and National Advocates for Pregnant Women File Complaints Against New York Hospital Over Drug Testing Mothers Without Consent. Last Friday, the New York Civil Liberties Union and the activist group National Advocates for Pregnant Women filed human rights complaints against Garnet Health Medical Center in Middletown on behalf of two mothers who were drug tested while hospitalized to give birth. The hospital reported both mothers to Child Protective Services after the testing generated false positives caused by eating poppy seeds. The groups say the hospital conducted the drug tests without the knowledge or consent of the women, that the pattern of hospital maternal drug testing is discriminatory, and that the practice drives mothers of color away from health services, increasing infant mortality in minority communities. They want the state to pass legislation to end the nonconsensual drug testing of pregnant women.

CT Governor Includes Marijuana Legalization in Budget Proposal, Baltimore Announces Policing Reform, More... (2/11/21)

The appetite for busting pot smokers grows weaker in Fort Lauderdale and Milwaukee, Idaho could this year finally legalize hemp, and more.

Baltimore police are reforming some of their stop and search practices. (Pixabay)
Marijuana Policy

Connecticut Governor Includes Marijuana Legalization Plan in Budget Proposal. Gov. Ned Lamont (D) on Wednesday released his budget request, which includes a plan to legalize marijuana. His plan would involve creating a "comprehensive framework for the cultivation, manufacture, sale, possession, use, and taxation of cannabis that prioritizes public health, public safety, and social justice," Lamont said. "The proposal builds on the significant work that the Legislature has done on adult-use cannabis in recent sessions and ensures alignment with the approaches pursued by regional states," a summary of the plan says.

Florida's Broward County Gives Up on Misdemeanor Pot Prosecutions. Broward County (Ft. Lauderdale) State Attorney Harold Pryor has told county police agencies not to bother referring misdemeanor marijuana possession cases for prosecution. "Prosecuting these cases has no public safety value and is a costly and counterproductive use of limited resources," Pryor wrote in a memo to the law enforcement agencies. He asked them to refer violators to drug-treatment programs instead of the criminal justice system. Possession of up to 20 grams is a misdemeanor under state law. Neighboring Miami-Dade County enacted a similar policy six months ago. Dade and Broward are the state's two most populous counties.

Milwaukee County Board to Consider $1 Fine for Pot Possession. Board Supervisor Sylvia Ortiz-Velez has proposed an ordinance that would make the maximum penalty for possession of up to 25 grams of marijuana a $1 fine. Currently, possession is punished with fines of between $250 and $500. The board's Judiciary Committee will take up the ordinance on March 11.

Hemp

Idaho House Committee Files Hemp Bill. Acting on the behest of the state Farm Bureau, the House Agriculture Committee voted unanimously Wednesday to file legislation to legalize industrial hemp in the state -- the only state yet to do so. The committee vote sets the stage for a full hearing on the bill, which agriculture leaders say they hope will end years of debate on legalizing the crop.

Drug Testing

Utah Bill Would Ban Hair Follicle Drug Tests in Child Welfare Cases. Rep. Christine Watkins (R-Price) has filed House Bill 73, which would ban the use of hair follicle drug tests in child welfare cases. "It discriminates against people with dark hair," she said in a House Judiciary Committee hearing Tuesday. "This is very, very disturbing," Watkins said. "Melanin in dark hair binds with the drugs for a longer time." That means Black and Hispanic parents disproportionately test positive in those tests, she added. The bill has the support of the state Department of Child and Family Services, which said it had been moving away from using the tests.

Law Enforcement

Baltimore Police Unveil New Stop and Search Policies to Comply with Federal Consent Decree. Police Commissioner Michael Harrison announced Wednesday that the department has implemented a new "stops, searches and arrests" policy as the department seeks to comply with a federal consent decree and eliminate unconstitutional interactions with the public. Under the policy, officers will be trained in what constitutes "reasonable, articulable suspicion" for stopping a citizen. The new policy makes clear that someone fleeing when he sees police is not an adequate reason to stop and investigate him. Police had frequently resorted to "jump outs at corners," jumping out of their vehicles at corners known for drug trafficking and detaining anyone who ran away. No more.

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.

Fed Judge Approves Purdue Pharma Settlement, US Drops Case Against Ex-Mexican Defense Minister, More... (11/18/20)

Mississuppi's higest court agrees to a hear a challenge to the voter-approved medical marijuana initiative, New York City public hospitals say no more drug testing pregnant women without their consent, and more.

Purdue Pharma will cop to serious felonies and pay $2 billion in a settlement with the DOJ. (Creative Commons)
Medical Marijuana

Mississippi High Court Takes Up Challenge To Medical Marijuana Measure. Whether voters will actually get the medical marijuana program they approved at the polls earlier this month is now in question after the state Supreme Court announced Tuesday it will take up a challenge to its validity. The challenge was filed by the mayor of the town of Madison days before the election. It argues that the measure is invalid because of a state signature-gathering requirement that is impossible for any initiative to actually comply with. Initiatives are supposed to only get one-fifth of their signatures from each congressional district, but the state now has only four.

Heroin and Prescription Opioids

Federal Judge Approves Purdue Pharma OxyContin Settlement. A federal judge in New York has approved a settlement in a case brought by the Justice Department against Purdue Pharma, the maker of OxyContin. Under the agreement, the company must plead guilty to "multiple serious felonies" in coming days. It will cop to conspiracy to defraud the United States, breaking laws against kickbacks, and one other count. The settlement also includes a $2 billion payout, with the federal government getting $225 million and states getting $1.775 billion to fight opioid addiction.

Drug Testing

New York City Public Hospitals Will Stop Drug Testing of Pregnant Women. Responding to an announcement that the city's Commission on Human Rights is investigating racial bias in the drug testing and reporting to child welfare authorities of pregnant women at three major hospitals, the city's public hospitals have announced they will no longer drug test pregnant women unless they have written consent. This is a change from the previous policy of the City Health and Hospitals Corporation, under which doctors and nurses did not need to inform pregnant patients they were being drug tested.

Foreign Policy

US Abandons Drug Case Against Former Mexican Defense Minister. Federal prosecutors made the surprise announcement Tuesday that they are dropping drug charges against former Mexican Defense Minister Salvador Cienfuegos, who was arrested at LAX after arriving in the US last month. The announcement came in a joint statement with Mexican attorney general's office. "The United States has determined that sensitive and important foreign policy considerations outweigh the government's interest in pursuing the prosecution of the defendant," prosecutors said. Cienfuegos was accused of using his position to shield the H2 cartel and going after its rivals. But his arrest without prior notification of Mexican officials has strained ties between the two countries, with Mexican President Andres Manuel Lopez Obrador threatening to look again at agreements allowing DEA agents to operate in the country.

International

Thailand Loosens Drug Laws to Allow Sale and Possession of Drugs for Research Purposes. The Public Health Ministry has issued new regulations loosening controls on Category II drugs, such as cocaine, opiates and opioids, and ketamine. Under the new rules, such drugs can be sold and possessed for medical and scientific research, medical treatment and disease prevention, or for other government purposes. The new rules go into effect in 240 days.

NJ Decrim Advances in Wake of Legalization Vote, NYC to Investigate Hospital Drug Test Racial Bias, More... (11/16/20)

Virginia's governor says he supports marijuana legalization, New Jersey does marijuana and mushrooms decrim in wake of initiative, the White House releases Bolivian coca production estimates, and more.

Marijuana legalization is advancing in Mexico. (Creative Commons)
Marijuana Policy

Michigan Man Imprisoned Since 1994 for Selling Marijuana Seeks Release. The Michigan parole board will take up the case of Michael Thompson on Tuesday. He was convicted in 1994 of selling three pounds of marijuana to a snitch and has been behind bars ever since. Given that marijuana is now legal in the state, Thompson's bid for early release has the support of Michigan Attorney General Dana Nessel and the prosecutor's office that convicted him. He has suffered serious health problems in prison, including testing positive for COVID-19.

New Jersey Legislature Approves Marijuana Decriminalization, Magic Mushrooms, Too. The state Senate and Assembly have approved a measure that decriminalizes the possession of up to six ounces of marijuana, and defelonized the possession of magic mushrooms, too. The move is an interim measure until legalization takes place in January after voters approved it on Election Day. It also includes expungement of past nonviolent marijuana offenses.

Virginia Governor Supports Marijuana Legalization. Following the release of a study that found the state could generate $300 million in marijuana taxes, Gov. Ralph Northam said Monday that he supports marijuana legalization. He plans to work with the General Assembly once it convenes in January, but the process could take up to two years to play out. The state decriminalized possession last year.

Medical Marijuana

Pennsylvania Advisory Board Rejects Insomnia as Qualifying Condition. The state Medical Marijuana Advisory Board has refused to add insomnia as a qualifying condition for medical marijuana use. Board members said they hesitated because insomnia is often caused by an underlying medical issue. The board voted 7-4 against adding insomnia last week.

Drug Testing

New York City to Investigate City Hospitals Over Possible Racial Bias in Drug Testing. The City Commission on Human Rights announced Monday that is investigating allegations of racial bias at three top city hospitals over their policies around the drug testing of pregnant women and newborns. Advocates said that Black and Hispanic families are being reported to state child abuse authorities following a single positive drug test, even though, they said, just a single positive test result does not merit a report. The commission cited studies that show Black women are much more likely to be subjected to maternal drug testing than white women, even though both groups use drugs at similar rates.

Foreign Policy

ONDCP Releases Data on Coca Cultivation and Cocaine Production in Bolivia. Last Friday, the White House Office of National Drug Control Policy (ONDCP) released the United States Government's annual estimates of coca cultivation and cocaine production potential for the Plurinational State of Bolivia. According to these estimates, Bolivia remains the third largest producer of cocaine in the world. Bolivia's coca cultivation totaled 42,180 hectares in 2019, an increase of 28 percent over 2018. Commensurate cocaine production potential increased 20 percent to 301 metric tons. The Yungas region remained the largest coca cultivation area in Bolivia, while the Chapare region represents the second largest. Cultivation exceeded the 22,000 hectares limit established by the Bolivian government by an estimated 20,180 hectares, or 92 percent.

International

Mexican Senate Committees Approve Marijuana Legalization Bill with Floor Vote Planned Soon. Last Friday, three Senate committees gave preliminary approval to a marijuana legalization bill, with a formal vote set for this week. The bill would let people 18 and over possess up to an ounce and grow up to four plants for personal use. Advocates are still hoping for further revisions to promote consumers' rights and social equity in the legal market.

MT Supreme Court Throws Out Lawsuit Against Pot Initiatives, US Imprisonment Rate at 25-Year Low, More... (10/22/20)

The Montana marijuana legalization initiatives have survived a last-minute legal challenge, the ACLU and DPA challenge the murder conviction of a meth-using California woman whose fetus was stillborn, and more.

There are fewer people behind bars in the US again this year. (Pixabay)
Marijuana Policy

Montana Supreme Court Quickly Rejects Lawsuit Against Marijuana Ballot Initiatives. The Montana Supreme Court denied and dismissed a lawsuit seeking to remove CI-118 and I-190, the complementary marijuana legalization initiatives, from the November ballot. I-190 is a statutory initiative that would legalize, regulate, and tax marijuana for adults 21 and over. CI-118 is a constitutional initiative that would allow I-190 to set the minimum age at 21. The initiatives are complementary and work together to establish a careful framework for legalizing marijuana in Montana. 

Reproductive Rights

ACLU, DPA File Brief in Support of Motion to Reopen Case of Meth-Using California Woman Convicted of Murder for Stillborn Birth. The ACLU of Northern California and Drug Policy Alliance filed briefs in support of a motion to allow for Adora Perez, who is serving 11 years in prison for manslaughter after delivering a stillbirth baby, to appeal her case. Attorneys Mary McNamara and Audrey Barron of Swanson & McNamara LLP and Matthew Missakian of the Law Office of C. Matthew Missakian filed the motion, arguing that "Ms. Perez was prosecuted for a crime that doesn’t exist and is now imprisoned basedon a plea that shouldn’t have been accepted." Perez was charged with murder in 2017 for taking methamphetamines while pregnant, even though "California law explicitly exempts women from murder liability for any actions they take that may end their pregnancy." Her attorney at the time told her to plead guilty to manslaughter and serve 11 years in prison to avoid worse charges.

Sentencing Policy

US Imprisonment Rate at Lowest Rate Since 1995.he combined state and federal imprisonment rate of 419 sentenced prisoners per 100,000 U.S. residents in 2019 was the lowest imprisonment rate since 1995, the Bureau of Justice Statistics announced Thursday. The imprisonment rate in 2019 marked a 17% decrease from 2009 and a 3% decrease from 2018, and it marked the 11th consecutive annual decrease. The imprisonment rate—the portion of U.S. residents who are in prison—is based on prisoners sentenced to more than one year. An estimated 14% of sentenced state prisoners were serving time for murder or non-negligent manslaughter at year-end 2018, and 13% were serving time for rape or sexual assault. At the end of fiscal-year 2019, 46% of sentenced federal prisoners were serving time for a drug offense (99% for drug trafficking), and 8% were serving time for a violent offense. The total prison population in the U.S. declined from 1,464,400 at year-end 2018 to 1,430,800 at year-end 2019, a 2% decrease. This marked the fifth consecutive annual decrease of at least 1% in the prison population. At year-end 2019, the prison population had declined 11% from its peak of 1,615,500 prisoners in 2009.

Vets' MedMJ Bills Advance in House, OR Psilocybin Init Looking Good on Signatures, More... (3/12/20)

The Pine Ridge Reservation votes to legalize weed, a pair of veterans' medical marijauna bills move in the House, signature gathering for the Oregon Psychedelic Service Act initiative is looking good, and more. 

Psilocybin molecule. An Oregon initiative would allow for its therapeutic use. (Creative Commons)
Marijuana Policy

Oglala Sioux Tribe Approves Medical, Recreational Marijuana. Oglala Sioux Tribe members on the Pine Ridge Reservation in South Dakota voted Wednesday to legalize medical and recreational marijuana. Both passed by wide margins, with 82% approving medical marijuana and 74% approving recreational marijuana. A proposal to legalize alcohol sales failed with only 44% of the vote. The tribe is now set to be the only one in the nation to legalize marijuana in a state where it otherwise remains illegal.

Medical Marijuana

Congressional Committee Approves Marijuana Bills for Military Veterans. The House Veterans' Affairs Committee has approved two bills focused on marijuana and military veterans. The committee voted 15-11 to approve the Veterans Equal Access Act (HR 1647), sponsored by Rep. Earl Blumenauer (D-OR), which would allow doctors at the U.S. Department of Veterans Affairs (VA) to recommend medical marijuana to their patients in states where it’s legal. The committee also approved the VA Medical Cannabis Research Act (HR 712), sponsored by Rep. Lou Correa (D-CA),  which would require VA to conduct clinical trials on the medical potential of cannabis in the treatment of conditions that commonly afflict veterans. It was approved in a voice vote.

Iowa House Approves Medical Marijuana Expansion Bill. The House on Wednesday passed a bill that adds more qualifying conditions, allow more doctors to recommend patients for the program, and raise limits on THC content. The bill now heads to the Senate. Although Gov. Kim Reynolds (R) vetoed a similar bill last year, she said she is comfortable with this bill.

Tennessee Senate Committee Advances Medical Marijuana Bill, But Poison Pill Added. A medical marijuana bill, SB 2334, was approved by the Senate Health and Welfare Committee, but only after a poison pill amendment that would only allow the bill to take effect if marijuana is rescheduled as a Schedule II substance under federal law. A similar bill is moving in the House.

Drug Testing

Pennsylvania Mom Sues Hospital over Drug Test That Led to Child Abuse Probe. A mother who gave birth in the University of Pittsburgh Medical Center hospital has now filed a suit against the facility charging that it collected and tested her urine for drugs without her consent while she was in labor and reported a false positive result to protective services that resulted in a child abuse investigation. This is the second such lawsuit filed against the hospital since 2014.

Psychedelics

Oregon Psilocybin Initiative Already Has 100,000 Raw Signatures. Campaigners for IR 34, the Oregon Psilocybin Service Act, say they already have 100,000 raw signatures. They need 112,000 valid voter signatures by July to qualify for the November ballot. The initiative would allow adults to visit licensed facilities to have the drug administered under the supervision of medical professionals.

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