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Chronicle Book Review: American Cartel

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

Phillip S. Smith, with contributions from David Borden

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Russian Court Sentences American Basketball Star Brittney Griner to Nine Years in Prison

A Russian judge sentenced American basketball star Brittney Griner Thursday to nine years in a Russian penal colony after earlier being found of bringing cannabis oil into the country in her luggage. The guilty verdict was virtually a foregone conclusion in a criminal justice system that wins convictions in 99 percent of cases.

This is what got Brittney Griner a nine year sentence.
Russian authorities detained Griner, a two-time Olympic gold medalist and Women's National Basketball Association (WNBA) star, just a week before Russia invaded Ukraine, and she is widely viewed as having become a pawn in the conflict between Washington and Moscow over the war. Griner's attorneys say they will appeal the verdict.

President Biden, who has been under pressure to win her release from her wife and the athletic community and whose administration is attempting to negotiate a prisoner swap for Griner, called her sentence "unacceptable," and vowed to continue to make every effort to free her.

The US has offered a prisoner swap of Griner and another imprisoned American, Paul Whelan, in return for Russian arms dealer Victor Bout, who is currently serving a 25-year sentence in the US for conspiring to sell arms to Colombia's leftist rebels, the FARC. But the Russians have so far demurred, first saying that Griner's trial had to finish and, more recently, showing littler interest in the matter.

While Griner's sentence seems stiff to Western sensibilities, it is in line with Russia's draconian, zero-tolerance drug laws. Drug offenders make up a quarter of the country's prison population. As Penn State University law professor William Butler noted: "To many in the US, nine years' imprisonment may seem like a harsh penalty for cannabis possession. But in Russia, it is par for the course for this crime."

Another American citizen, 61-year old Marc Fogel, is currently serving a 14-year sentence in Russia for marijuana possession. Fogel and his wife were returning to Russia for the last year of a ten year teaching stint, when he was caught. According to family, Fogel uses marijuana to treat chronic back pain.

Feds Charge Four Louisville Cops in Fatal Breonna Taylor Drug Raid, Thai Cannabis Tourism, More... (8/4/22)

Arkansas election officials knock a marijuana legalization initiative off the ballot -- at least for now -- San Francisco's new DA cracks down on drug dealers, and more.

Kentucky did not do it, but maybe the federal government can obtain justice for Breonna Taylor.
Marijuana Policy

Arkansas Panel Rejects Marijuana Legalization Initiative. The state Board of Election Commissioners on Wednesday blocked a marijuana legalization initiative from Responsible Growth Arkansas from appearing on the ballot in November. The board rejected the popular name and ballot title for the measure, which has already accumulated enough voter signatures to qualify for the ballot. Responsible Growth Arkansas says it will appeal to the state Supreme Court. The board said it rejected the measure because members believed the ballot title didn't fully explain the measure's impact, but Responsible Growth Arkansas said the amount of detail demanded would make the ballot title "thousands and thousands of words long."

Law Enforcement

Feds Charge Four Louisville Cops in Breonna Taylor Case. The FBI has charged four Louisville police officers for their actions leading up to and during a March 2020 drug raid on the apartment of medical worker Breonna Taylor, who was killed by police gunfire after her boyfriend shot at what he believed to be intruders trying to break into the residence. Those charged include former Louisville Metro Police Department (LMPD) officers Joshua Jaynes, Brett Hankison, and Kelly Hanna Goodlett, as well as current LMPD sergeant Kyle Meany was also arrested Thursday by the feds. The feds are charging the four with civil rights violations, which include charges of obstruction of justice for actions they took after the raid. The four officers largely escaped justice at the state level, with only one charged, and later acquitted -- not for shooting Taylor but for endangering the lives of neighbors by wildly shooting several rounds into the building. The killing of Taylor became a major rallying cry in the summer of protests sparked by the killing of George Floyd by Minneapolis police.

San Francisco DA Cracks Down on Drug Dealers. Newly-elected District Attorney Brooke Jenkins on Wednesday announced tougher new policies to hold drug dealers accountable, saying anyone caught with more than five grams of drugs would no longer be referred to the city's drug court, that she will make use of sentencing enhancements for drug dealing within a thousand feet of a school, and will seek pretrial detention of fentanyl dealers in "extreme" cases. The move comes as Jenkins replaces former progressive prosecutor Chesa Boudin, who was recalled amidst rising public concern over crime and squalor in the city. But the city's Public Defender called Jenkin's approach "regressive," saying it will disproportionately affect communities of color. "If District Attorney Jenkins truly wants to address the issues facing our city, she should not be relying on outdated and politically expedient soundbites about harsher enforcement," said Public Defender Mano Raju.

International

Brittney Griner Sentenced to 9 Years in Russian Penal Colony for Possessing Small Quantity of Cannabis Oil. American basketball star Brittney Griner was sentenced Thursday to nine years in a Russian penal colony after earlier being found of bringing cannabis oil into the country in her luggage. The guilty verdict was virtually a foregone conclusion in a criminal justice system that wins convictions in 99 percent of cases. Griner was detained by Russian authorities just a week before it invaded Ukraine, and her case is widely seen as part of the broader conflict between Russia and the United States over that conflict. Griner's attorneys say they will appeal the verdict. President Biden, who has been under pressure to win her release from her wife and the athletic community and whose administration is attempting to negotiate a prisoner swap for Griner, called her sentence "unacceptable," and vowed to continue all-out efforts to get her home.

Cannabis Cafes Emerge in Thailand. "Several" cannabis cafes have opened in Bangkok since the country decriminalized cannabis in June, despite the government's warning that the law's relaxation did not include recreational marijuana use. Recreational use has exploded under the new law, something that government officials have tried to discourage. Now, a parliamentary committee is working on a bill that could rejigger the rules and possibly impact the cannabis cafes. In the meantime, one café owner said his place had "hundreds" of customers every day. "Europeans, Japanese, Americans -- they are looking for Thai sativa. Cannabis and tourism are a match," he said.

AR Legalization Init Has Enough Signatures, UN Experts Criticize Singapore Drug Executions, More... (7/29/22)

Marijuana seizures at the US-Mexican border are down again, Colombia's Gulf Clan is escalating its attacks on police as it jockeys for position in upcoming negotations, and more.

San Francisco could become the largest US city to decriminalize psychedelics. (Creative Commons)
Marijuana Policy

Feds Report Significant Year-Over-Year Decline in Marijuana Seizures at the US Border. The amount of marijuana seized at the US-Mexico border has dropped dramatically this fiscal year, with seizures averaging 408 pounds a day, down from an average of 874 pounds a day during FY 2021, according to the Department of Homeland Security. Other drug seizures at the border are up, but the decline in marijuana seizures is part of a consistent downward trend in recent year. As the DEA has noted, "In US markets, Mexican marijuana has largely been supplanted by domestic-produced marijuana."

Arkansas Marijuana Legalization Initiative Set to Qualify for Ballot. State officials have confirmed that a marijuana legalization initiative from Responsible Growth Arkansas has submitted enough valid voter signatures to qualify for the November ballot. But the state Board of Election Commissioners must first approve the popular name and ballot title of the measure. It would legalize the possession of up to an ounce by people 21 and over, but not home cultivation. It would also set up a system of taxed and regulated marijuana commerce.

Psychedelics

San Francisco Psychedelic Decriminalization Resolution Filed. Supervisors Dean Preston (D) and Hillary Ronen (D) have filed a resolution to decriminalize psychedelics such as psilocybin and ayahuasca. The resolution also calls for broader statewide reform. If the resolution is passed, San Francisco would be the most populous city in the country to decriminalize psychedelics.

International

Colombia's Gulf Clan Trafficking Group Stepping Up Attacks on Police. The Gulf Clan, the country's most powerful drug trafficking organization, is stepping up a campaign of violence against police that began in May, when its leader, Dario Antonio Usuga, known as "Otoniel," was extradited to the United States to face trafficking charges. But now, as the country approaches the transfer of power from conservative President Ivan Duque to leftist former guerrilla Gustavo Petro, is ratcheting up the violence, apparently in a bid to bolster its prospects in potential negotiations with the new government. At least 25 police officers have been killed by the Gulf Clan, 12 of them in the last month, and three in just the past week.

UN Experts Call for Immediate Moratorium on Singapore Executions for Drug Offenses. UN experts have condemned the execution of Nazeri Bin Lajim, a 64-year-old Malay Singaporean national convicted of drug offenses and urged the Government of Singapore to halt plans to execute individuals on death row for drug-related charges. There has been a sharp rise in execution notices issued in Singapore this year.

Nazeri Bin Lajim was arrested in April 2012 and convicted for trafficking 33.39 grams of diamorphine under the 1973 Misuse of Drugs Act in September 2019. The mandatory death penalty was subsequently imposed in his case and enforced on 22 July 2022. "Under international law, States that have not yet abolished the death penalty may only impose it for the 'most serious crimes', involving intentional killing," the experts said. "Drug offences clearly do not meet this threshold."

The experts reiterated that, as per the Working Group on Arbitrary Detention's report on arbitrary detention relating to drug policies andits subsequent jurisprudence, imposing the death penalty for drug-related offenses is incompatible with international standards on the use of the death penalty.

White House Preps for MDMA Therapy Approval, MO Legalization Init Could Come Up Short, More... (7/28/22)

South Dakota's first state-licensed medical marijuana dispensary opens, the FDA is moving toward approval of MDMA-assisted therapy for PTSD, and more.

Psilocybin mushrooms. Legalizing them could be on the ballot in Medford, Oregon, this November. (Pixabay)
Marijuana Policy

Missouri Marijuana Legalization Initiative Campaign Needs More Signatures as Deadline Looms. Legal Missouri, the group behind an initiative to legalize marijuana in the state, handed in more than twice the number of signatures needed to qualify for the November election, but may still come up short because of the state's requirement that it meet signature thresholds in each of the state's congressional districts. The group is 1,144 signatures short in the 7th Congressional District and 1,573 short in the 6th. The campaign says it is double-checking signature counts from local election authorities in hopes of making up the shortfall. Secretary of State John Ashcroft (R) will announce by August 9 whether or not the campaign has qualified.

Medical Marijuana

South Dakota's First State-Licensed Medical Marijuana Dispensary Opens. The Unity Road Dispensary in the small town of Hartford opened its doors for business Wednesday, becoming the first state-licensed dispensary to open after voters approved a medical marijuana initiative in 2020. But it is not the first dispensary in the state: The Flandreau Santee Sioux Tribe opened Native Nations Cannabis in July 2021, saying it did not need to wait for the state to license it because it is on sovereign Native American territory. Another has since opened on the Pine Ridge reservation.

Psychedelics

Biden Administration Preparing for FDA Approval of MDMA-Assisted Therapy for PTSD. The Department of Health and Human Services released a letter Wednesday that described the Food and Drug Administration's "anticipated approval… within approximately 24 months" of psychedelic-assisted therapies. The letter said that the Substance Abuse and Mental Health Services Administration is exploring establishment of a Federal Task Force to address the complex issues associated with the commercialization of psychedelic medicines, including clinical, regulatory, and public policy matters.

The Multidisciplinary Association for Psychedelic Studies (MAPS), which has pioneered clinical trials on MDMA, was pleased: "We applaud the Biden Administration for taking psychedelic-assisted therapies, and their potential to treat life-threatening mental health conditions, seriously. A Federal Task Force on psychedelic-assisted therapies should take a multidisciplinary approach to ensuring that red tape, administrative delays, or insurance coverage questions don't leave Americans suffering as they seek to access approved treatments," said MAPS founder and executive director Rick Doblin.

Doblin continued, "For the first time, research that has been driven by philanthropists could additionally be supported by the same types of Federal grants that have funded other health care revolutions and develop patient access strategies that prioritize public benefit over profit. For decades, we have been making the case for what the Administration is now acknowledging: psychedelic-assisted therapies may become a key in addressing the most urgent mental health challenges of our time and reducing needless suffering."

Medford, Oregon, City Council Ponders Psilocybin Legalization. In a surprise move, the city council has scheduled a study session about psilocybin for tonight's meeting. No vote on an ordinance is expected, but the city council said it wants the study session to make an informed decision about putting an ordinance on the November ballot.

DEA Backs Off on Banning Five New Psychedelics, Colombia's ELN Hints at Peace Talks with New President, More... (7/25/22)

Signature gatherers are criss-crossing the Cowboy State for a pair of marijuana initiatives, the US and India sign a joint agreement on cooperating against the drug trade, and more.

tryptamine molecule (Creative Commons)
Marijuana Policy

Wyoming Marijuana Legalization Initiative Campaign Signature-Gathering Drive Chugging Right Along. Organizers of a pair of marijuana initiatives, the Wyoming Patient Cannabis Act and the Wyoming Cannabis Amendments, are at the midpoint of an 18-month-long signature-gathering window and already have about 17,000 raw voter signatures to qualify for the 2024 ballot. They need 41,776 valid voter signatures to make the ballot. One initiative would legalize medical marijuana; the other would remove criminal penalties for possessing or using marijuana.

Psychedelics

DEA Reverses Course, Will Not Ban Five New Psychedelics. Back in January, the DEA announced that it was moving to place five new psychedelics, all tryptamines, on Schedule I of the Controlled Substances Act. Schedule I is reserved for substances with a high potential for abuse and no currently accepted medical use. But there was significant public pushback on the proposed role, including at a DEA public hearing where researchers and advocates made the case for not regulating the substances. Last Friday, DEA announced it had withdrawn the potential rule. The five new psychedelics are 4-Hydroxy-N,N-diisopropyltryptamine (4-OH-DiPT), 5-Methoxy-alphamethyltryptamine (5-MeO-AMT), N-Isopropyl-5-Methoxy-N-Methyltryptamine (5-MeO-MiPT), N,N-Diethyl-5-methoxytryptamine (5-MeO-DET), and N,N-Diisopropyltryptamine (DiPT).

Foreign Policy

US, India Ink Agreement on Fighting Drug Traffic. The State Department announced last Friday that India and the United States have signed an Amended Letter of Agreement (ALOA) in the field of narcotics control and law enforcement cooperation. The signing took place during the third meeting of the India-US Counternarcotics Working Group (CNWG) held in New Delhi on July 7-8. "Representatives from relevant agencies responsible for law enforcement, policy formulation, drug demand reduction, and other drug-related matters, participated in the deliberations on wide-ranging issues related to drug demand, narcotics trafficking, regulatory and control efforts, and cooperation on enforcement and criminal investigations," the State Department said. Both countries agreed to increase coordination and information-sharing on the drug trade, as well as fighting unregulated chemicals and pharmaceuticals being diverted into the black market. They also agreed to include drug demand reduction topics in the working group.

International

Colombia's ELN Hints at Peace Talks with Incoming President. After the FARC laid down its arms in 2016 as part of an agreement with the Colombian government, the largest remaining leftist rebel group in the countryis the National Liberation Army (ELN). Now, ELN leader Eliécer Erlinto Chamorro says that the group is interested in reaching a peace deal with leftist incoming President Gustavo Petro. "We hear voices from the new government about a different policy against drug trafficking: 'the war on drug trafficking must be ended', for being a policy that did not produce positive results. We agree, but it is not enough," he explained. "The new government says it is interested in peace in Colombia, the ELN too. We have listened to their messages and we are in the best disposition to resume talks to fill peace, with contents of social justice and democracy," the revolutionary leader said. "It is about ending drug trafficking once and for all. To build that solution, the country can count on us," he added. The ELN is one of numerous armed actors on the left and right that have financed their activities through the drug trade.

Chronicle Book Review: Opium's Orphans

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

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

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

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

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

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

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

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

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

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

AZ Churches Sue Feds Over Ayahuasca Seizures, Schumer's Legalization Bill Coming Within Days, More... (7/20/22)

Indonesia's Constitutional Court rejects medical marijuana but calls for "immediate" study, DC Mayor signs bill providing workplace protections for marijuana users, more.

Weed will be on the Senate's mind next week. (Creative Commons)
Marijuana Policy

Senate Hearing on Marijuana as Filing of Legalization Bill Looms. The Senate Judiciary Subcommittee on Crime and Terrorism has scheduled a hearing for next Tuesday on "Decriminalizing Cannabis at the Federal Level: Necessary Steps to Address Past Harms." The hearing, led by Sen. Cory Booker (D-NJ), a strong proponent of Senate Majority Leader Chuck Schumer's pending legalization bill, the Cannabis Administration and Opportunity Act, comes amid word that the bill will drop any day now. Schumer has blocked incremental marijuana reforms, such as the SAFE Banking Act, saying he wants a full-blown legalization bill.

Kentucky Democrats Announce Plan for Legalization Bill. Frustrated by the failure of the Republican-controlled state legislature to act even on medical marijuana, state Democrats announced Thursday they will be filing legislation to legalize marijuana for both medical and recreational use. They said they would fill "LETT's Grow" bills in both house. LETT is short for Legalizing sales, Expunging crimes, Treating medical needs, and Taxing sales. "Our legislation is the comprehensive plan that Kentuckians deserve, and it builds on what's worked in other states while avoiding their mistakes," said Rep. Roberts of Newport. "This would be a boon for our economy and farmers alike, plus give state and local governments a major new source of revenue."

DC Mayor Signs Bill Providing Workplace Protections for Marijuana Users, Mayor Muriel Bowser (D) has signed into law a bill that most employers from firing or refusing to hire workers because they use marijuana. The bill would "prohibit employers from firing, failing to hire, or taking other personnel actions against an individual for use of cannabis, participating in the medical cannabis program, or failure to pass an employer-required or requested cannabis drug test, unless the position is designated safety sensitive or for other enumerated reasons." There are exceptions for police, safety-sensitive construction workers, people whose jobs require a commercial drivers' license, and people who work with children or medical patients. The new law must still be approved by Congress before it can go into effect.

Psychedelics

Arizona Churches Sue Over Seizure of Sacramental Ayahuasca. Two Arizona churches, the Arizona Yagé Assembly and the Church of the Eagle and the Condor, have filed suit in federal court over the seizure of ayahuasca, a key element in their religious practice, by federal agencies. In separate lawsuits, the two churches charge that the federal government has violated the constitutional right to the free exercise of religion, citing the Religious Freedom Restoration Act. That law bars the government from burdening the exercise of religion unless there is a compelling government interest and only if that action if the least restrictive means of furthering that interest.

The Church of the Eagle and the Condor says that US Customs and Border Protection has been seizing and destroying its ayahuasca since 2020. The churches say drinking ayahuasca is "an essential mode of worship" for members, but federal agencies say any possession of ayahuasca, a Schedule I substance, violates the Controlled Substances Act. "The church and its members are aware that their sacrament is proscribed by law, but they have partaken in their sacrament both before and after the United States made a credible threat of enforcement of the CSA against them," the suit says. "Plaintiffs are violating and intend to continue to violate applicable law, rather than compromise or terminate their sincerely held religious beliefs and practices."

International

Indonesia High Court Rejects Medical Marijuana But Calls for Immediate Study. The Constitutional Court on Wednesday nixed a judicial review of the country's drug law that could have opened the door for medical marijuana. Three mothers of children with cerebral palsy backed by civil society groups had sought the review, arguing that marijuana could be used medicinally to treat medical conditions. The court held there was insufficient research to rule in favor of the plaintiffs, but called on the government to "immediately" conduct research on the medicinal use of the herb… The results of which can be used to determine policies, including in this case the possibility of changing the law," said judge Suhartoyo.

Big Increase in Injection Drug Use, House Passes Another Spending Bill with SAFE Banking, More... (7/18/22)

British Tories audition a new scheme for punishing drug users that effectively decriminalizes somebody's first two drug busts, a new study finds racial disparities in Pennsylvania marijuana arrests are increasing, and more.

The number of Americans injecting drugs increased five-fold in the past decade. (Creative Commons)
Marijuana Policy

House Passes Defense Spending Bill with Marijuana Amendments. The House last Thursday approved the National Defense Authorization Act, which includes nine amendments pertaining to marijuana and other drug policies. Included in the House version of the bill is language from the Secure and Fair Enforcement (SAFE) Banking Act, language allowing Department of Veterans Affairs doctors to allow medical marijuana recommendations, and two psychedelic research amendments. The SAFE language, which the legal marijuana industry is clamoring for, has been passed in the House as part of several earlier omnibus spending bills, only to be killed in the Senate by Majority Leader Charles Schumer (D-NY) and his allies, who have been holding out for passage of a full-blown marijuana legalization bill. We shall see if it turns out any differently this time.

Black Pennsylvanians See More Racial Bias in Marijuana Arrests. A new study from the National Organization for the Reform of Marijuana Laws (NORML) finds that racial disparities in marijuana arrests jumped upward in 2020, even though overall pot arrests declined. Black Pennsylvanians were five times more likely to be arrested for marijuana statewide. The largest disparity was in Cumberland County, where Blacks were 18 times more likely to be arrested for pot than Whites. "I will say that the numbers moving in the wrong direction is certainly a concern," said Executive Director of the Pennsylvania Cannabis Coalition Meredith Buettner. "This is all the more reason that we really need to dig into adult use policy here in Pennsylvania, Pennsylvanians." The Republican-controlled state legislature has so far blocked any moves toward legalization.

Drug Policy

CDC Finds Huge Increase in Number of People Injecting Drugs. A new study from the Coalition for Applied Modeling for Prevention (CAMP) and funded by the Centers for Disease Control and Prevention (CDC) shows a rapid increase in the number of people shooting up drugs in the past decade. The most recent data, from 2018, put the number of injection drug users at about 4 million, five times the number in 2011, the last previous estimate. The study also found that overdoses -- both fatal and non-fatal -- had also increased dramatically, with deaths related to injection drug use rising threefold during that period, which was before the current spike in overdose deaths, now around 100,000 a year. For every fatal injection drug overdose, there were 40 non-fatal ones, the study found. The CDC estimates that a third of people who inject drugs share syringes, needles or other drug injection equipment.

International

British Tories Plan to Punish Drug Users, Could Seize Their Drivers' Licenses, Passports. The Home Office has announced a scheme to punish drug users in a bid to "tackle the scourge of drug abuse in society." Under the "three-strikes" proposal, first-time illicit drug offenders, including marijuana offenders, would have to pay for and attend a drug awareness course. A second offense would merit a formal warning, another drug awareness course, and up to three months of mandatory random drug testing. For a third offense, people would be criminally charged and, upon conviction, could be banned from nightclubs and other entertainment venues and could have their drivers' licenses and passports confiscated. But, hey, that is effectively decriminalization for the first two offenses. The proposal will now undergo a three-month consultation period before being amended or implemented as is.

House Approves SAFE Banking Again, Colombia Cocaine Production Down Slightly, More... (7/15/22)

The NYPD reverses course on testing cops for marijuana, Colorado's governor signs an executive order protecting marijuana-using workers from discrimination, and more.

Marijuana Policy

Coca and cocaine production remained relatively stable at high levels last year. (Pixabay)
House Approves More Marijuana Amendments as Part of Defense Spending Bill. The House on Thursday approved a half dozen marijuana amendments to the National Defense Authorization Act, including amendments to protect banks that work with state-legal marijuana businesses and allow Department of Veterans Affairs doctors to recommend medical marijuana to patients. The banking amendment came from Rep. Ed Perlmutter (D-CO) and contains the language of the Secure and Fair Enforcement (SAFE) Banking Act, which has been included in other omnibus spending bills only to be stripped out in conference committee by Senate leadership, which is still holding out for a full-fledged marijuana legalization bill.

Colorado Governor Issues Executive Order to Protect Marijuana Users from Workplace Discrimination. Gov. Jared Polis (D) has issued an executive order designed to protect workers from being punished or denied a professional license for using, possessing, or growing marijuana. The order includes people from other states. "The exclusion of people from the workforce because of marijuana-related activities that are lawful in Colorado, but still criminally penalized in other states, hinders our residents, economy and our State," said Polis. The order also directs the state Department of Regulatory Agencies to not provide information to aid in professional investigations related to legal marijuana-related activities in the state.

NYPD Says It Will Stop Testing Cops for Weed, Then Reverses Course. The NYPD on Wednesday announced it would quit drug testing officers for marijuana, only to reverse course within a matter of hours. "The New York City Law Department has directed the NYPD to cease all random, scheduled and pre-employment testing for marijuana," an NYPD spokeswoman said early Wednesday. "The Department will continue to administer marijuana screenings to personnel when there are indications of impairment and is reviewing its current policies in light of this directive." But later in the day, an NYPD spokesman said that the department was in discussions with the Law Department about possible conflicts with federal law and that in the meantime, it was back to the old policy. "While these discussions continue, there is no change in NYPD policies, procedures, or testing protocols regarding the use of Marijuana by uniformed members of the service," the spokesperson announced.

International

Colombian Coca, Cocaine Production Fell Slightly Last Year, Drug Czar's Office Says. The Office of National Drug Control Policy (ONDCP -- the drug czar's office) reported Thursday that Colombia had seen slight reductions in coca cultivation and cocaine production in 2021. Estimated coca cultivation dropped from 600,000 acres to 578,000, while estimated cocaine production dropped from 994 tons in 2020 to 972 tons last year. Despite billions of dollars in US anti-drug and counter-insurgency funding over the past several decades, Colombia remains one of the world's top cocaine producer, with leftist rebel factions, former rightist paramilitaries, and criminal gangs competing earn black market profits from the trade. ONDCP also reported that Peruvian cocaine production and coca cultivation dropped slightly as well last year, but production was up slightly in Bolivia, leaving global cocaine production at near record levels.

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