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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.

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.

Chronicle AM: IL, NY Governors Embrace Pot, PA Bid to Punish Drug Using Pregnant Women, More... (1/15/19)

William Barr suggests he'll keep hands off of state-legal marijuana, New York's governor unveils his marijuana legalization plan, government witnesses in the El Chapo trial undercut Trump's drug justification for his border wall, and more. 

Governors are seeing dollar signs in marijuana legalization. (Creative Commons)
Marijuana Policy

US Attorney General Nominee Says He Supports Federal Pot Prohibition, But Won't Go After State Law-Compliant Operations. During his confirmation hearing Tuesday, attorney general nominee William Barr said he would support banning marijuana “everywhere,” but that he did not want to “upset settled expectations” in states that have already legalized marijuana. “I’m not going to go after companies that have relied on the Cole Memorandum,” Barr told the committee. “However, we either should have a federal law that prohibits marijuana everywhere, which I would support myself because I think it’s a mistake to back off marijuana. But if we want a federal approach, if we want states to have their own laws, let’s get there and let’s get there the right way.”

Ilinois Governor Reiterates Pledge to Legalize Marijuana. In his inaugural address Monday night, incoming Gov. JB Pritzker (D) confirmed that he will indeed move ahead with a plan for marijuana legalization. “In the interests of keeping the public safe from harm, expanding true justice in our criminal justice system, and advancing economic inclusion, I will work with the legislature to legalize, tax and regulate the sale of recreational cannabis in Illinois,” Pritzker said. A placeholder bill has already been filed in the Senate.

New York Governor Unveils Marijuana Legalization Plan. Gov. Andrew Cuomo (D) on Tuesday unveiled his plan to legalize marijuana in the state. His plan calls for a 22% tax on wholesale sales and a per-gram tax on growers. It would also set up licensing programs for growers, distributors, and retailers, with growers barred from opening retail shops. The plan would allow cities and counties the option of banning marijuana sales in their jurisdictions. Cuomo also vowed to institute expungement for past pot possession convictions.

Pregnancy

Pennsylvania Senator Wants to Punish Women Who Use Drugs While Pregnant. Late last month, the state Supreme Court ruled that pregnant women who use drug cannot be charged with child abuse because a fetus is not a child. That was too much for state Sen. Don White (R-Indiana County), who issued a press release Monday announcing plans to file a bill that would allow the state to punish them. "Regardless of what the court may rule, a mother's responsibility begins before her child is born and that should not be erased by a perceived ambiguity in the law," White said in a press release. The move is opposed by the ACLU of Pennsylvania, which said the issue is much more complex.

The Border

Government Witnesses in El Chapo Trial Testify That They Trafficked Drugs Through Tunnels, Ports of Entry, Not Over Wall-less Border. Sinaloa cartel members testifying as government witnesses at the trial of imprisoned cartel leader Joaquin “El Chapo” Guzman testified that most of the drugs they smuggled into the US came in fishing boats, trains, semi-trucks, and passenger vehicles entering the country at ports of entry. They testified that they've also used tunnels under the border, but none testified that they pushed drugs across an unwalled border. 

How This Red State's Cruel Meth Laws Are Putting Women Behind Bars in Record Numbers [FEATURE]

Like other Great Plains states, South Dakota has a methamphetamine problem. But it's becoming increasingly evident that South Dakota also has a problem with the way it deals with meth.

South Dakota women's prison in Pierre (KELO-TV screen grab)
Because of its strict drug laws, the state is seeing a dramatic spike in women being sent to prison for meth. According to a new report from the nonprofit South Dakota News Watch, the number of women in prison in the state has jumped 35 percent since 2013, while the male prison population has increased at only one-quarter of that rate. Nearly two-thirds of all women prisoners in the state are there for nonviolent drug offenses. The state now has the fourth-highest incarceration rate for women in the country, trailing only Oklahoma, Wyoming, and Kentucky.

Overall, about one-third of all inmates in the state are doing time for drug-related offenses, the majority of them for simple drug possession. That's a higher percentage than most other states, where drug offenders tend to make up somewhere around 20 to 25 percent of the inmate population.

The high drug-related incarceration overall and for women in particular stems less from the prevalence of drug use than from the conservative, largely rural state's reaction to it. South Dakota has not responded to decades of failed war on drug policies by reforming them, but by doubling down on them.

The state has not moved toward the defelonization of drug possession, as at least 16 others have. Instead, it has moved in the opposite direction. South Dakota has mandatory sentencing laws that include prison for not only for the manufacture and distribution of meth but also for simple possession.

State lawmakers and cops have long favored tough drug laws, and they are still at it. This year, state Attorney General Marty Jackley (R) guided bills through the legislature that heighten penalties for meth dealing and increase sentences for dealers whose clients overdose and die.

But the state's most notorious and contentious drug law -- bone that is sending hundreds of people to prison -- is the state's "possession by ingestion" statute. Otherwise known as an "internal possession" law, the statute allows for a felony conviction if a drug test reveals the presence of illicit drugs in a suspect's system. (The law also applies to marijuana, but the penalty for testing positive for pot is only a misdemeanor.)

The strictest in the nation, that law was upheld by the state Supreme Court in 2004. Last year, a bipartisan group of lawmakers filed a measure that would have slightly tweaked the law by removing marijuana, but that bill was killed by a unanimous vote in the first committee that heard it.

As of August, about nine percent of the male prison population and an astonishing 21 percent of the female prison population was doing time for unauthorized ingestion of a controlled substance. That's right: More than one out of five women prisoners in South Dakota is behind prison bars for nothing more than having used drugs.

South Dakota law enforcement and lawmakers may be happy with the status quo, but the man who actually runs the prison system isn't. State Corrections Secretary Denny Kaemingk told South Dakota News Watch that the cops' and courts' proclivity for busting and imprisoning women on drug charges is creating an expensive and ineffective cycle of imprisonment, release, and recidivism.

"We seem to think that locking individuals up is going to solve their addiction problem," said Kaemingk, a former drug officer. "They're coming to us in corrections and we're thinking that solves the problem, and I think in many cases it makes the problem worse."

Criminalizing addiction, especially among women who are mothers, Kraemingk said, creates a situation where the children are more likely to end up in prison themselves. He pointed to national studies showing that up to 80 percent of children who have parents behind bars will end up there themselves.

"Imprisonment in South Dakota is generational," Kaemingk said. "The females behind prison walls have experienced that as a child. The generation we have back there now as inmates experienced the same things when they were children."

Kraemingk and other relatively enlightened actors in the state are pushing for enhanced treatment opportunities and expanding drug courts, among other measures, to better deal with the situation, but nobody seems to be talking about not involving these women in the criminal justice system in the first place. A first step would be getting rid of that hideous "possession by ingestion" statute. The next step would be defelonization or outright decriminalization of drug possession in the state. Drug use absent harm to others should not be the state's business.

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

Chronicle AM: Bad Drug Bill Dropped From Fed Opioid Package, Acapulco Cops Disarmed, More... (9/26/18)

A bad provision gets stripped out of the congressional opioid package, a Pennsylvania legislator files a legalization bill, Mexican Marines disarm Acapulco cops, and more.

The Mexican military disarms all the cops in Acapulco amidst allegations of drug gang links. (Creative Commons)
Marijuana Policy

Pennsylvania State Rep Files Bill to Legalize Marijuana. State Rep. Jake Wheatley (D-Allegheny) has introduced a bill to legalize marijuana for adults and expunge the records of people convicted of past pot-related crimes. "My bill would immediately release people jailed for crimes associated with cannabis," Wheatley said in a news release. "Those who have criminal histories related to cannabis would be expunged, and professional and driver's licenses that were revoked or suspended due to cannabis-related crimes would be reinstated. For far too long, the criminal justice system has unfairly punished Pennsylvanians, especially minorities, who are caught with cannabis." The bill also would create a system of taxed and regulated marijuana commerce. It's not yet available on the legislative website.

Drug Policy

Damaging Drug War Provision Excluded From Congressional Opioid Package. Late last night, the final text for the Congressional opioid package was released. SITSA, a sweeping bill expanding penalties on synthetic drugs and the broader war on drugs -- passed the House in July, and was expected to be included in the final bill. But a coalition of drug policy and criminal justice reform groups managed to push back against its inclusion, successfully keeping it out of the bill. "This is a huge win for public health over outdated drug war approaches," said Michael Collins of the Drug Policy Alliance's national office. "The bill would have expanded mass incarceration, while worsening the overdose crisis. It would have given Jeff Sessions unprecedented powers to schedule drugs and set draconian new criminal penalties. To pull this back from the brink after it easily passed the House only two months ago is a tremendous victory."

Pennsylvania Supreme Court to Decide Whether Maternal Drug Use Equals Child Abuse. The state's highest court on Tuesday began weighing whether women who abuse drugs during their pregnancies can be punished under state law as child abusers. The court has never addressed the matter, which is again igniting debate as the opioid crisis spawns a new generation of babies born dependent on their mothers' drugs. The justices heard oral arguments in the case of a woman who gave birth in January 2017 to a child who spent 19 days in the hospital being treated for drug withdrawal. The woman had tested positive for marijuana, opioids, and anxiety drugs. The child was taken into custody by Children and Youth Services, and the mother was charged with child abuse.

New Psychoactive Substances

DC Mayor Backs Bill Penalizing Dealers of Synthetic Cannabinoids. Mayor Muriel Bowser has proposed emergency legislation to go after dealers in synthetic cannabinoids as the District suffers from a spike in "fake weed" overdoses. "This is not marijuana," Bowser said at a Tuesday news conference. "The effects are very different, and they can be deadly." The city already prohibits the sale of synthetic drugs, but this bill would expand that ban.

International

Mexican Marines Disarm Entire Acapulco Police Force Over Links to Drug Gangs. Authorities in the state of Guerrero disarmed and placed under investigation the entire police force of Acapulco, the state's largest city, claiming the local police were infiltrated by drug gangs. Two top Acapulco police commanders were also charged with homicide. Last year, Acapulco had a murder rate of 103 per 100,000 residents, one of the highest in the world.

Venezuela Calls on Colombia to Take Action on Drug Trafficking. The Foreign Ministry called Tuesday for its eastern neighbor to "assume international responsibilities for the damage caused by the drug trafficking industry." Caracas wants Bogota to redouble its anti-trafficking efforts in light of the "alarming increase" in coca cultivation in Colombia reported by the UN Office on Drugs and Crime last week. "For the government of the Bolivarian Republic of Venezuela, it is even more worrisome that, according to said report, one of the most affected departments is precisely the north of Santander, bordering Venezuela, from where groups of drug trafficking and paramilitary violence are constantly attacking the population, the economy, and Venezuelan institutions. Venezuela urges the Colombian authorities to make sincere and effective efforts to assume international responsibilities for the damage caused by the drug trafficking industry to neighboring countries and the world," the ministry said.

[Disclosure: Drug Policy Alliance is a funder of the organization that publishes this newsletter.]

Horrible Wisconsin "Cocaine Mom" Law Could Finally Be Repealed

For 20 years, Wisconsin prosecutors have used a state law, the Unborn Child Protection Act of 1998 (Act 292), to jail adult pregnant women suspected of using drugs or alcohol. Supporters claim the "cocaine mom" law protects fetuses from maternal drug abuse, but critics say the law's language is vague, that it deters pregnant women from seeking prenatal and other health care, and that it unnecessarily and unconstitutionally forces some pregnant women into treatment and state supervision.

The law was found unconstitutional by a federal court last year, but state Attorney General Brad Schimel appealed, and the US Supreme Court allowed the law to stay in effect until the case was decided. But in June, the 7th US Circuit Court of Appeals dismissed the lawsuit on the grounds that the plaintiff, Tammy Loertscher, had left the state.

Loertscher was 14 weeks pregnant and residing in Medford in 2014 when she tested positive for methamphetamine. Although she told her doctor she had stopped using the drug when she realized she was pregnant, a judge ordered her into inpatient drug treatment. She was then jailed until she agreed to be drug tested throughout her pregnancy. She gave birth to a healthy male child in 2015.

Loertscher was by no means alone -- hundreds of pregnant women have been accused of "unborn child abuse" under the law -- and the dismissal of the case means pregnant women in the state remain in jeopardy.

At the time of the dismissal, attorney Nancy Rosenbloom, director of legal advocacy for National Advocates for Pregnant Women (NAPW), decried the ruling.

"Today's decision means that all women in Wisconsin have to worry that when they seek health care, if there's even a chance they might be pregnant, the state can take them into custody, lock them up in a drug treatment program, a mental hospital or a jail -- whether or not drug treatment is really needed," she said.

Now, Rosenbloom and NAPW are taking the fight to a new arena: the court of public opinion. They have joined forces with a three-year-old national group, Reproaction, to take on the law. The group is forthright about what it wants: "Reproaction is a new direct action group forming to increase access to abortion and advance reproductive justice. We are proud of our left-flank analysis, and are not in this fight to protect the past or maintain the status quo," the group says on its web site.

Reproaction has created the #WIFights 292 campaign to take the fight to the public. The campaign is planning educational fora across the state, a social media campaign, and information pickets, among other tactics.

"All people who experience pregnancy, including pregnant women in Wisconsin, deserve access to appropriate, confidential health care without fear of losing their rights to medical decision making, privacy, and liberty," #WIFight292 explains on its web site.

"At Reproaction, we center our work around the women in Wisconsin who may be targeted by enforcement of Act 292. We are organizing activists and community leaders across Wisconsin to demand action from those in power and channel community into a movement to advance reproductive justice that will ultimately dismantle Act 292. We know that direct action gets the job done, and we will take bold action to educate the public about and put a stop to enforcement of Act 292."

For Rosenbloom and the medical and public health groups that oppose the law, the hope is that the campaign can do what the courts have failed to do: kill a bad law.

"This law only harms women and children," she said.

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

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

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

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

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

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

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

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

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

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

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

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

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

Four Ways Using Even Legal Marijuana Makes You a Second Class Citizen [FEATURE]

Marijuana is now legal in nine states constituting about one-fifth of the US population, and medical marijuana is recognized in a total of 29 states. That means people in those states can possess and use marijuana without fear of criminal prosecutions (if they have a doctor's recommendation in the medical marijuana-only states).

people enjoying marijuana (Darrin Frisby Harris/Drug Policy Alliance)
But even in legal marijuana states, pot smokers face restrictions that in effect turn them into second-class citizens, unable to do things non-drug users or users of legally sanctioned drugs, such as alcohol, can do, or somehow punished for doing them. While legalizing marijuana is a giant breakthrough, as long as marijuana users face stigma, discrimination, and worse over their choice of substances, the job is only half-done.

Here are four ways even legal marijuana users get screwed:

1. Employment Rights

You may be able to smoke pot legally, but it can still cost you your job. Even in legal marijuana states, legalization laws generally are careful not to intrude on the rights of employers to conduct drug testing for pot and to fire people who test positive -- even if they're not high or impaired at work.

Legal cases in California, Colorado, Montana, and Washington have all upheld the right of employers to fire or refuse to hire workers who test positive for marijuana even if they have a medical marijuana recommendation. But the law is rapidly evolving, and a recent case from Connecticut, a nursing home that refused to hire a medical marijuana patient after he tested positive for THC was ordered to reinstate the job offer.

A thriving economy and growing social acceptance of marijuana may also bring some solace to pot smokers. As Bloomberg noted just last month, we are now seeing a "slow decline in pre-employment drug screening," with some major employers abandoning the practice in the face of a tight job market. That trend, unsurprisingly, is being led by companies in the marijuana legal states. In Colorado, for instance, the percentage of employers using pre-employment drug tests declined from 77% in 2016 to 66% last year.

But still, if you smoked a joint on Friday night, Walmart still doesn't think you're fit to stock their shelves on Monday morning.

2. Gun Rights

If you smoke pot, you can't legally purchase or own a gun. As more states move toward legalization, the Bureau of Alcohol, Tobacco & Firearms (ATF) has clarified its Form 4473, the federal Firearms Transaction Record that purchaser must fill out to buy a gun: "Are you an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance?" the form asks.

And just so you stoners get it, ATF has added the following language: "Warning: The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside."

That means marijuana users who want to legally purchase a weapon have to lie on Form 4473. And that's a federal crime. (Unlikely to be caught and prosecuted, but still.)

In August 2016, a federal appeals court upheld the ban on gun sales to medical marijuana patients. The 9th US Circuit Court of Appeals in San Francisco ruled that the federal government's ban on gun sales to medical marijuana cardholders does not violate the 2nd Amendment. The decision came in the case of a Nevada woman turned away from a gun shop after obtaining a medical marijuana card. The ruling sets precedent for all nine states in the circuit, including California, Oregon, and Washington.

There have been proactive efforts by law enforcement in a handful of states to, for example, order registered medical marijuana patients to turn in their guns, but those have so far been aborted in the face of loud opposition. In Pennsylvania, the state Health Department is no longer providing the names of patients to law enforcement after newspapers there reported the patients would not be able to buy firearms; in Illinois, regulators removed a rule that would have barred legal gun owners from becoming patients; and in Hawaii, police had to walk back a plan to force patients to hand in their guns.

Still, as long as the federal government maintains marijuana prohibition and as long as ATF considers marijuana a controlled substance, pot smokers' gun rights are at risk. And the NRA doesn't seem to care.

3. Parental Rights

In both medical marijuana states and full-blown legal pot states, parents have lost custody of their children over their marijuana use. Part of the problem is that marijuana remains federally illegal, turning the pot-using parent into a criminal in the eyes of courts of child protective services workers. Another part of the problem is discrimination and subjectivity about what constitutes "the best interest of the child." If a child protective bureaucracy or even an individual case worker harbors anti-marijuana sentiments, even non-problematic recreational use of pot can be used to take children from the home or deny custody to the offending parent.

Marijuana use is especially likely to pop up in divorces where custody of the child or children is contested. If your spouse griped about your pot-smoking while you were married, be prepared for him or her to try to use it against you in a nasty divorce case. Divorce attorneys warn parents facing this prospect to quit smoking pot now, well ahead of any court dates and court-ordered drug tests.

That's another way pot-smoking parents get hammered. Courts may demand onerous drug testing for months or year or require that visits with children be supervised.

Medical marijuana support groups report hundreds of cases of parents losing custody of their kids, some merely for having registered as medical marijuana patients. But there are small signs of positive change on the horizon: California's Prop 64, for instance, includes a provision saying courts can no longer rescind or restrict a parent's custodial rights solely because they have a medical marijuana recommendation.

That's a start, but we still have a long way to go before pot-smoking parents can rest easy.

4. Housing Rights

You can be kicked out of your home for using marijuana if you are poor and live in HUD, Section 8, or other federally-subsidized housing. Under a 1999 HUD Memorandum Regarding Medical Marijuana in Public Housing still in effect, any activity relating to controlled substances, including even medical marijuana, can get you evicted.

And it doesn't have to be just you. If you live in federally-subsidized housing and your grandson gets caught smoking a joint in the parking lot, you can find yourself tossed out on the street.

Even people who don't live in federally-subsidized housing face problems, especially if they live in rental housing. Landlords can prohibit tenants from using marijuana, and rental apartment industry associations typically counsel their members that "banning the use or possession of marijuana on site does not violate any landlord/tenant or fair housing laws, even when marijuana has been legalized by local ordinance or state statute." Nor, they argue, is allowing the use or cultivation of medical marijuana a "reasonable accommodation" required by law, even if it's been medically recommended.

Marijuana is increasingly legal and accepted, but the progress is uneven, and the battle to be treated like normal citizens remains unfinished.

Chronicle AM: AZ Bill Would Speed Adoption of Drug-Exposed Babies, CT Pot Bill Advances, More... (4/5/18)

A Connecticut legalization bill advances, Michigan GOP lawmakers are worried a legalization initiative there will drive turnout and drive them from office, Tennessee lawmakers pass a bill to end civil asset forfeiture, and more.

In a historic first, a marijuana legalization bill wins a committee vote in Connecticut. (Wikimedia)
Marijuana Policy

Connecticut Legalization Bill Advances in Historic Committee Vote. For the first time, a marijuana legalization bill has won a committee vote in Hartford. The Assembly Appropriations Committee voted 27-24 Thursday to approve House Bill 5394, which calls for a developing a plan for legalization and regulation of sales, along with funding for drug prevention and treatment programs. The bill will now go before the full General Assembly.

Michigan's Looming Initiative Prompts GOP Lawmakers to Ponder Passing Preemptive Legalization Bill. There is a specter haunting the state's Republican lawmakers: The fear that a legalization initiative likely to appear on the ballot will encourage voter turnout and depress their chances of retaining control of the legislature. So now, GOP lawmakers are muttering about the possibility of approving marijuana legalization before the November election to thwart that possibility. Stay tuned.

Oregon County Sues State to Invalidate Legalization Law. Josephine County filed a lawsuit in US district court in Medford Tuesday challenging the state's marijuana legalization laws. The county seeks to invalidate the laws on the grounds they conflict with strict federal drug laws.

Medical Marijuana

Missouri Medical Marijuana Bill Killed in Committee. The Legislative Oversight Committee voted Wednesday to kill a medical marijuana bill, House Bill 1554. The bill would only have allowed some people suffering from terminal illnesses to use medical marijuana, but even that was too much for the committee. Show Me State residents will likely be able to vote directly on medical marijuana come November; a medical marijuana initiative campaign is now in the final stages of signature gathering and should qualify for the ballot.

Asset Forfeiture

Tennessee Legislature Passes Bill to End Civil Asset Forfeiture. The House on Wednesday and the Senate on Thursday have approved an asset forfeiture reform bill, Senate Bill 316. The bill ends civil asset forfeiture, requires "clear and convincing evidence" the asset is linked to a crime, and provides that all forfeited goods go into the state general fund. The bill now goes to the governor's desk.

Families

Arizona Legislature Passes Bill to Cut Off Parental Rights for Drug-Exposed Babies After One Year. The legislature has approved Senate Bill 1473, which would allow babies born exposed to drugs and whose parents have substance abuse problems to be put up for adoption by the first birthday. The bill would also let courts consider foster parents who have cared for an infant or toddler for at least nine months as equal to the child's family members when deciding who gets custody. Current law only allows adoption to take place after they are two years old. The bill is now on the desk of Gov. Doug Ducey (R).

International

France Apologizes to Italy Over Migrant Drug Test Incident. France apologized to Italy Wednesday after French border patrol agents used a train station in an Italian border town to conduct a drug test on a Nigerian immigrant. "I'm sorry for the misunderstanding," France's Budget Minister Gérald Darmanin, who is also responsible for customs, said in an interview with the Italian daily Corriere della Sera. "It was an unfortunate incident, which arose over a misunderstanding between French customs and Italian railways about the use of a facility located at Bardonecchia railway station."

Culture Shock: American Activists Confront Compassionate Portuguese Drug Policy [FEATURE]

The American activists couldn't wrap their heads around it. Sitting in a dingy office in a nondescript building in central Lisbon, they were being provided a fine-grained explanation of what happens to people caught with small amounts of drugs in Portugal, which decriminalized the possession of personal use amounts of drugs 17 years ago.

partial view of Lisbon, looking toward the Tagus River (Wikimedia)
The activists, having lived the American experience, wanted desperately to know when and how the coercive power of the state kicked in, how the drug users were to be punished for their transgressions, even if they had only been hit with an administrative citation, which is what happens to people caught with small quantities of drugs there.

Nuno Capaz was trying to explain. He is Vice Chairman of the Lisbon Dissuasion Commission, the three-member tribunal set up to handle people caught with drugs. He had to struggle mightily to convince the Americans that it wasn't about punishment, but about personal and public health.

"The first question," he explained, "is whether this person is a recreational user or an addict."

If the person is deemed only a recreational user, he may face a fine or a call to community service. If he is deemed an addict, treatment is recommended -- but not required.

"But what if they don't comply?" one of the activists demanded. "Don't they go to jail then?"

No, they do not. Instead, Capaz patiently explained, they may face sanctions for non-compliance, but those sanctions may be little more than a demand that they regularly present themselves to a hospital or health center for monitoring.

In a later hallway conversation, I asked Capaz about drug users who simply refused to go along or to participate at all. What happens then? I wanted to know.

Capaz shrugged his shoulders. "Nothing," he said. "I tell them to try not to get caught again."

Welcome to Portugal. The country's low-key, non-headline-generating drug policy, based on compassion, public health, and public safety, is a stark contrast with the US, as the mind-boggled response of the activists suggests.

Organized by the Drug Policy Alliance and consisting of members of local and national groups that work with the organization, as well as a handful of journalists, the group spent three days in-country last month seeing what an enlightened drug policy looks like. They met with high government officials directly involved in creating and implementing drug decriminalization, toured drug treatment, harm reduction, and mobile methadone maintenance facilities, and heard from Portuguese drug users and harm reduction workers as well.

The Portuguese Model and Its Accomplishments

They had good reason to go to Portugal. After nearly two decades of drug decriminalization, there is ample evidence that the Portuguese model is working well. Treating drug users like citizens who could possibly use some help instead of like criminals to be locked up is paying off by all the standard metrics -- as well as by not replicating the thuggish and brutal American-style war on drugs, with all the deleterious and corrosive impacts that has on the communities particularly targeted for American drug law enforcement.

Here, according to independent academic researchers, as well as the UN Office on Drugs and Crime and the European Monitoring Center of Drugs and Drug Abuse, is what the Portuguese have accomplished:

Drug use has not dramatically increased. Rates of past year and past month drug use have not changed significantly or have actually declined since 2001. And Portugal's drug use rates remain among the lowest in Europe, and well below those in the United States.

Both teen drug use and "problematic" drug use (people who are dependent or who inject drugs) have declined.

Drug arrests and incarceration are way down. Drug arrests have dropped by 60% (selling drugs remains illegal) and the percentage of prisoners doing time for drug offenses has dropped from 44% to 24%. Meanwhile, the number of people referred to the Dissuasion Commission has remained steady, indicating that no "net-widening" has taken place. And the vast majority of cases that go before the commission are found to be non-problematic drug users and are dismissed without sanction.

More people are receiving drug treatment -- and on demand, not by court order. The number of people receiving drug treatment increased by 60% by 2011, with most of them receiving opiate-substitution therapy (methadone). Treatment is voluntary and largely paid for by the national health system.

Drug overdose deaths are greatly reduced. Some 80 people died of drug overdoses in 2001; that number shrunk to just 16 by 2012. That's an 80% reduction in drug overdose deaths.

Drug injection-related HIV/AIDS infections are greatly reduced. Between 2000 and 2013, the number of new HIV cases shrank from nearly 1,600 to only 78. The number of new AIDS cases declined from 626 to 74.

"We came to the conclusion that the criminal system was not the best suited to deal with this situation," explained Capaz. "The best option should be referring them to treatment, but we do not force or coerce anyone. If they are willing to go, it's because they actually want to, so the success rate is really high. We can surely say that decriminalization does not increase drug usage, and that it does not mean legalizing drugs. It's still illegal to use drugs in Portugal, it's just not considered a crime. It's possible to deal with these users outside the criminal system."

Dr. Joao Goulao, who largely authored the decriminalization law and who is still General Director for Intervention on Addictive Behaviors -- the Portuguese "drug czar" -- pointed to unquantifiable positives resulting from the move: "The biggest effect," he said, "has been to allow the stigma of drug addiction to fall, to let people speak clearly and to pursue professional help without fear."

They Take the Kids! (with them to treatment)

The American activists know all about fear and stigma. And the cultural disconnect -- between a country that treats drug users with compassion and one that seeks to punish them -- was on display again when a smaller group of the activists met with Dr. Miguel Vasconcelos, the head psychologist at the Centro Taipa, a former mental hospital that now serves as the country's largest drug treatment center.

As Dr.Vasconcelos explained the history and practice of drug treatment in Portugal, one of his listeners asked what happened to drug users who were pregnant or had children.

"They take the kids," Vasconcelos said, smiling. But his smile turned to puzzlement as he saw his listeners react with resignation and dismay.

For the Americans, "they take the kids" meant child protective services swooping in to seize custody of the children of drug-using parents while the parents go to jail.

But that's not what Vasconcelos meant. After some back and forth, came clarity: "No, I mean they take the kids with them to treatment."

Once again, the Americans, caught firmly in the mind set of their own punishing society, expected only the worst of the state. But once again, light bulbs came on as they realized it doesn't have to be like that.

Now that cadre of activists is back home, and they are going to begin to try to apply the lessons they learned in their own states and communities. And although they had some abstract understanding of Portuguese drug decriminalization before they came, their experiences with the concrete reality of it should only serve to strengthen their desire to make our own country a little less like a punitive authoritarian state and bit more like Portugal.

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