DEA

RSS Feed for this category

More Than 300,000 Pot Arrests in 2020, FDA Points Toward OTC Naloxone, More... (11/17/22)

Congress passes a marijuana research bill, a bipatisan pair of senators file a psychedelic research and rescheduling bill, and more,

The FDA is moving to make the opioid overdose reversal drug naloxone over-the-counter. (Creative Commons)
Marijuana Policy

Despite Legalization in Nearly Half the Country, More Than 300,000 People Were Arrested for Marijuana in 2020. Some 317,79 people were arrested on marijuana charges in 2020, according to the FBI. That is a 36 percent decline from 2019, but it still the equivalent of arresting every resident of a mid-size city such as Orlando, Corpus Christi, or Riverside, California. The marijuana arrest figure is also for the first time not the most common cause for a drug arrest, with 36 percent of drug arrests for stimulants such as cocaine and methamphetamine, compared to 27 percent for arresting marijuana. Black Americans continued to bear the brunt of marijuana law enforcement, accounting for 38 percent of all pot arrests despite making up only 13 percent of the population.

Congress Passes Marijuana Research Bill. With a final vote in the Senate Wednesday, both houses of Congress have approved the Medical Marijuana and Cannabidiol Research Expansion Act (HR 8454). The bill now goes to the desk of President Joe Biden (D). If he signs it, it will open the way to further research into the medical benefit of marijuana and CBD. Under the bill, the DEA must allow registered entities to manufacture, distribute, dispense, and possess marijuana for research purposes. "There is substantial evidence that marijuana-derived medications can and are providing major health benefits. Our bill will make it easier to study how these medications can treat various conditions, resulting in more patients being able to easily access safe medications,: said Sen. Dianne Feinstein (D-CA), who introduced the bill along with Sens. Chuck Grassley (R-IA) and Brian Schatz (D-HI). Oregon Rep. Earl Blumenauer (D) introduced the bill in the House.

Harm Reduction

FDA Announces Preliminary Assessment that Certain Naloxone Products Have the Potential to be Safe and Effective for Over-the-Counter Use. The US Food and Drug Administration on Wednesday issued a Federal Register notice, Safety and Effectiveness of Certain Naloxone Hydrochloride Drug Products for Nonprescription Use, that may help facilitate the development and approval of certain nonprescription naloxone drug products, including through the switch of certain naloxone drug products from prescription status to nonprescription status. Naloxone is a medicine that can help reduce opioid overdose deaths and when administered timely, usually within minutes of the first signs of an opioid overdose, can counter the overdose effects. "Today’s action supports our efforts to combat the opioid overdose crisis by helping expand access to naloxone," said FDA Commissioner Robert M. Califf, M.D. "The agency will keep overdose prevention and reduction in substance use disorders as a key priority and area of intense strategic focus for action as rapidly as possible."

Psychedelics

Cory Booker, Rand Paul File Bill to Reschedule Psychedelic Breakthrough Therapies and Remove Research Barriers. Sens. Cory Booker (D-NJ) and Rand Paul (R-KY) filed a bill on Thursday that would require the Drug Enforcement Administration (DEA) to transfer breakthrough therapies like psilocybin and MDMA from Schedule I to II, while also removing research barriers for strictly controlled substances, the Breakthrough Therapies Act. The move came on the same day that House lawmakers announced the formation of psychedelic caucus aimed at promoting new treatments from currently controlled substances. The bill would amend the Controlled Substances Act to create a procedure where current Schedule I drugs could be designated as breakthrough therapies could be transferred to a lower schedule that would make it easier to research them and promote drug development.

Poll Finds SAFE Banking Act Has Broad Support, DEA Fentanyl Scaremongering, More... (9/7/22)

Missouri's Republican governor rejects a call to include marijuana legalization in an upcoming special session, a DC court reverses the firing of a medical marijuana-using employee accused of being high on the job, and more.

"Rainbow" fentanyl--not aimed at kids, experts say. (Multnomah County Sheriff)
Marijuana Policy

Survey: Most Voters Support Federal Banking Reforms for Licensed Marijuana Retailers. The overwhelming majority of voters believe that federal law should be amended so that state-licensed marijuana businesses can readily utilize banks and other financial services, according to national survey data compiled by Morning Consult and commissioned by the Independent Community Bankers of America. Consistent with prior survey data, 65 percent of respondents “support allowing cannabis-related businesses to have access to banking services in states where cannabis is legal.” Moreover, 63 percent of voters agree that allowing cannabis-related businesses to access the banking system will help improve public safety, and 58 percent say that it is “important” that members of the U.S. Senate vote to establish a safe harbor for licensed cannabis businesses. The SAFE Banking Act (HR 1996), which would do just that, has repeatedly passed in the House only to be blocked in the Senate by Senate Majority Leader Charles Schumer (D-NY) and his allies, who are holding out for passage of a full-fledged marijuana legalization bill.

Missouri Governor Will Not Include Marijuana Legalization in Special Session. Efforts to do a legislative end run around a pending marijuana legalization constitutional amendment (Amendment 3) have come to naught after Gov. Mike Parson's office said Tuesday that he will not expand the scope of his upcoming legislative special session to consider legalizing marijuana. "The call will not be amended to include marijuana legalization," Kelli Jones, spokeswoman for Parson, said. Lawmakers hoping to blunt momentum for the measure had called on the governor to include marijuana legalization, but even though Parsons has called Amendment 3 "a disaster," he demurred.

Medical Marijuana

DC Court Reverses Firing of Government Worker Who Tested Positive for Marijuana. An administrative court in the DC Office of Employee Appeals (OEA) has reversed the firing of medical marijuana patient and city government employee who was accused of being high on the job and later tested positive for marijuana. The employee argued that the city's communications office falsely accused her of being impaired because her eyes were red and she was talking quietly. She pointed out that her eyes were red because she had spent the previous night at a hospital sitting beside a relative who had overdosed. She also presented a valid medical marijuana patient card. The court held that the communications office was negligent in how it handled the process for reasonable suspicion of impairment from drugs. The judge noted that supervisors allowed her to continue working after they accused her of being impaired: "Because Employee was allowed to perform her duties and did in fact adequately do so after being observed by her supervisors, I find that [the supervisors] did not reasonably believe that Employee’s ability to perform her job was impaired. As such, I further conclude that a reasonable suspicion referral was unwarranted," the judge wrote in the ruling. 

Opioids and Opiates

DEA Warning that Colored Fentanyl Pills Are Aimed at Kids is Nonsense, Experts Say. On August 30, the DEA warned the public about fentanyl in colorful pills being sold by "drug cartels" to "made to look like candy to children and young  people," calling it "Rainbow fentanyl" and charging that it is "a deliberate effort by drug traffickers to drive addiction amongst kids and young adults." But drug policy experts said such statements were misleading—and used harsh terms in doing so.

The charge is "typical drug war bullshit," said Dr. Nabarun Dasgupta, a pharmaceutical scientist at the University of Carolina at Chapel Hill. DEA's framing "was so divorced from any reality of what drug markets are actually like, it was almost laughable that our country's top drug enforcement folks are so out of touch.We've been talking about colored dope for years. This is like completely nothing new."

Claire Zagorski, a licensed paramedic, program coordinator and harm reduction instructor for the PhARM Program at The University of Texas at Austin College of Pharmacy, described the DEA announcement as "old recycled drug propaganda" that echoes the perennial myth of dope-laced Halloween candy. "Why would someone give away their expensive drugs to some random person they don't know, just so they might have a bad experience? It doesn't make sense," Zagorski told Salon. "At the end of the day, drug sellers are business people, and they're not going to invest in some kind of change to their supply if they don't think there's some good return on it … Kids don't have a lot of money that their parents don't supervise or give to them. So it just doesn't make sense from a business standpoint."

Gallup Poll Has Pot Use at All-Time High, DEA Walks Back Proposed Ban on Two Psychedelics, More... (8/29/22)

A trio of marijuana bills are on the California governor's desk, New York City cocaine users are adopting fentanyl test strips, Colombia's new president announces a coca growers' assembly, and more.

Everybody's doing it. Well, not everybody, but more people than ever. (Creative Commons)
Marijuana Policy

Gallup Poll Finds Marijuana Use at All-Time High. A new Gallup poll has marijuana use at a record high—and for the first time, more Americans reported smoking marijuana than smoking cigarettes. The new poll has 16 percent of respondents smoking marijuana within the past week, up from 12 percent a year ago and more than double the historic low of seven percent. The number of people who reported cigarette smoking in the past week was 11 percent. That's down from 16 percent last year and a whopping 45 percent during cigarette smoking's peak in the 1950s.

California Interstate Marijuana Commerce, Other Pot Bills Go to Governor's Desk. Bills to create a framework for interstate marijuana commerce, streamline expungement for past marijuana convictions, and safeguard companies providing insurance to the legal marijuana industry have all passed out of the legislature and are on the desk of Gov. Gavin Newsom (D). A passel of other marijuana bills are also advancing as the session end approaches. The interstate commerce bill is Senate Bill 1326, the marijuana convictions bill is Assembly Bill 1706, and the insurance bill is Assembly Bill 2568.

Harm Reduction

Fentanyl Test Strips Are ‘Catching On’ Among Cocaine Users. Rising overdoses are prompting some drug users to make testing their stashes for the presence of fentanyl a regular part of their drug-taking ritual. New York City cocaine users say their fear of overdosing on fentanyl-contaminated cocaine has made them wary of using any cocaine that has not been tested. Dozens of bars, clubs, and restaurants in the city are now offering fentanyl test strips as well. A Lower East Side taco restaurant owner said he began stocking the strips this spring after two people he knew died from fentanyl-adulterated cocaine. "It was a no-brainer for us," he said. "When we first put them out, we had customers say, ‘What is that?’ They were like, ‘Let me get one for my friend,’" Mr Tirado said. "It’s catching on."

New Mexico Now Providing Fentanyl Test Strips. Thanks to a change in the state's Harm Reduction Act, state officials are now distributing fentanyl test strips by the thousands. The Department of Health has handed out 15,000 test strips since May and has already ordered another 30,000. At least 1,215 people in the state have died from an overdose involving fentanyl since 2019, but more than 12,000 people have been saved from overdoses by the opioid overdose reversal drug naloxone.

Psychedelics

DEA Walks Back Plan to Ban Two Obscure Psychedelics. The DEA has backed away from plans to place two obscure psychedelics, DOI (dimethoxy-4-iodoamphetamine) and DOC (dimethoxy-4-chloroamphetamine), on Schedule I of the Controlled Substances Act. The retreat came after the proposal encountered strong opposition about psychedelic companies and academic researchers. The Panacea company filed a motion requiring the DEA to respond by today, with the possibility of a public hearing to defend its proposal. Instead, the DEA folded without stating any specific reasons.

International

Colombia President Announces First Assembly of Coca Growers.  President Gustavo Petro announced last Friday that the country's first assembly of coca growers will be held in the Catatumbo region in the northwest of the country. "I propose you to get out of that first place (in hectares of coca) last year and build the peace capital of Colombia. That here in Catatumbo the talks of society can be developed and that somewhere talks can begin to leave the weapons behind and move to the era of peace," he said. "I have admitted the idea of carrying out in Catatumbo the first assembly of coca leaf farmers (…) with one intention: to show this government the ways (…) that allow us to achieve that a peasant family that today is dedicated to coca leaf can substitute this for an activity that guarantees them more quality of life", he explained to local residents. Colombia is the world's largest coca and cocaine producer. 

DEA Moves to Ban Two Obscure Psychedelics, Odd SD Pot Poll, More... (8/25/22)

Colombia's new president says he will not extradite drug traffickers who quit the trade and comply with surrender conditions, a California bill to protect employees who use marijuana off-the-job is moving, and more.

Marijuana Policy

California Bill to Protect Marijuana-Using Employees Awaits Senate Floor Vote. A measure that would ban employers from firing or punishing workers who use marijuana outside of work hours has already passed the Assembly and now awaits a Senate floor vote. Assembly Bill 2188, sponsored by Assemblyman Bill Quirk (D-Hayward), would bar the use of hair, urine, and other bodily fluid tests for marijuana for employment purposes, with exemptions for workers subject to federal regulations or in safety-sensitive positions. The bill would, however, allow for saliva testing, which picks up the presence of active THC, not the inactive metabolites detected in hair and urine tests. If the bill passes, it is not clear Gov. Gavin Newsom (D) would sign it; he is subject to competing pressures on the topic, with the Chamber of Commerce and other business and retail groups opposing it.

South Dakota Poll Suggests Marijuana Legalization Could Lose in November. A new poll from Mason-Dixon Polling & Strategy has the IM 27 marijuana legalization initiative with the support of only 43.8 percent of respondents, with 54.4 percent opposed to legalization. But the poll of 500 registered voters is raising some eyebrows, given that just two years ago, voters in the state approved a marijuana legalization initiative with 54 percent of the vote (only to see it overturned by the state Supreme Court).

Matthew Schweich, campaign director for South Dakotans for Better Marijuana Laws, pointed to some anomalous findings, such as support in the Sioux Falls metro area being at only 38.6 percent. But in 2020, the Sioux falls metro area state Senate districts all reported at least 57 percent approval for legalization and one had the highest support of any district in the state at 72.7 percent.

"When I look a little deeper, I found things that do not make sense to me," said Schweich. "Some of the numbers don't really make sense and conflict strongly with previous data that we've seen. I see this as a flawed poll, but one that I still need to keep in the back of my head as motivation to keep working hard," Schweich said. "I'm not going to dismiss this poll entirely, and it's a reminder that we have to work really hard and not take anything for granted because in recent times, it's gotten harder and harder to predict what an electorate will look like."

Psychedelics

DEA Moves to Ban Two Obscure Psychedelics. The DEA is moving to place two obscure psychedelics on Schedule I of the Controlled Substances Act, despite little evidence regarding addiction or other harms. The two substances are DOI (dimethoxy-4-iodoamphetamine) and DOC (2,5-dimethoxy-4-chloroamphetamine), first synthesized by psychedelic researcher Alexander Shulgin. Little research has been done on the hallucinogens, but they are said to have subjective effects similar to LSD but lasting longer. DEA says the two drugs have "potential" for abuse, but also says "To date, there are no reports of distressing responses or death associated with DOI in medical literature" and "The physiological dependence liability of DOI and DOC in animals and humans is not reported in scientific and medical literature. DEA also notes that in the past 17 years there has been one death of someone using DOC, but that was "in combination with other drugs."

International

Colombia's President Says Will Not Extradite Drug Traffickers Who Fulfill Deals with the Government. President Gustavo Petro on Wednesday said that drug traffickers who abandon the trade and comply with government surrender conditions will not be extradited to the United States. He also said his government, which was sworn in this month on a vow to bring "total peace" to the country, was reaching out to various armed groups who want to negotiate an end to the conflict.

The US views extradition as a vital tool against the drug trade, but Petro has questioned its effectiveness, and it has been a sore point for many Colombians. "Drug traffickers who do not negotiate with the state will be extradited, drug traffickers who negotiate with the state and re-offend will be extradited, without any kind of negotiation, to the United States," Petro said after a meeting with Spanish Prime Minister Pedro Sanchez. "Drug traffickers who negotiate legal benefits with the Colombian state and definitively stop being drug traffickers will not be extradited," he said.

Cheaper and More Accessible Naloxone In the Works, Colombian Drug War Critic is Now President, More... (8/8/22)

A Congressional Research Service report zeroes in on the Jalisco New Generation Cartel, the Remedy Alliance is easing naloxone bottlenecks, and more.

Colombian President Gustavo Petro (Creative Commons)
Harm Reduction

Naloxone Access About to Get Easier. Thanks to an informal buyers' club for naloxone that has morphed into an entity known as the Remedy Alliance, access to inexpensive naloxone -- the opioid overdose reversal drug -- is getting easier. The Alliance credits two major developments for the urgently needed breakthrough. First, they have managed to reach agreements with drug manufacturers to get the drug at a discount rate, and second, they have restructured to a system that allows local harm reduction groups to order the drug through an online store, getting around a labyrinthine web of federal regulations that has bottlenecked the flow of the drug amidst the ongoing overdose crisis.

"We think this will totally change the landscape of naloxone in the United States," said Nabarun Dasgupta, the nonprofit's board president and a scientist at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. The group, formerly known as the Opioid Safety and Naloxone Network Buyers Club, has already reversed thousands of opioid overdoses and distributed 1.3 million doses of naloxone last year. Now, the Alliance expects to distribute 2 million doses this year.

International

Ex-Leftist Rebel, Drug War Critic Assumes Office as Colombia's President. Gustavo Petro, a former member of the leftist M-19 guerrilla army, was sworn into office Sunday, helping to cement an emerging leftist bloc around the region, consisting of Bolivia, Chile, Mexico, Peru, Venezuela and, most likely, Brazil after its October election. He said Colombia was getting a "second chance" to fight violence and poverty. He also said he was preparing to start peace talks with various armed groups around the country, and he called on the United States to change its prohibitionist approach to drug policy. "It's time for a new international convention that accepts that the war on drugs has failed," he said. "Of course, peace is possible. But it depends on current drug policies being substituted with strong measures that prevent consumption in developed societies."

Jalisco New Generation Cartel Present in 27 of Mexico's 37 States, Congressional Report Finds. The Jalisco New Generation Cartel (CJNG), the country's most powerful, now operates in 27 states and Mexico City, according to a new report from the Congressional Research Service (CRS). The report, "Mexico: Organized Crime and Drug Trafficking Organizations," says that the CJNG is the dominant criminal force in six states: Jalisco, Nayarit, Colima, Guerrero, Mexico, and Veracruz. It is weakest in Mexico's northwest, where the Sinaloa Cartel still dominates. CRS described the CJNG as an "extremely powerful cartel" that has a "reputations for extreme and intimidating violence." It also noted that the DEA "considers the CJNG a top US threat and Mexico's best-armed criminal group."

"The CJNG built its dominance internationally first through extending its presence through a rapid expansion inside Mexico," CRS said. "In 2016, many analysts maintained the CJNG controlled a territory equivalent to almost half of Mexico. The group has battled Los Zetas and Gulf Cartel factions in Tabasco, Veracruz, and Guanajuato, as well as the Sinaloa… [Cartel] in the Baja Peninsula and Chihuahua." The CJNG's ambitious expansion campaign was characterized by high levels of violence, particularly in Ciudad Juárez and Tijuana.

By taking over key ports on both the Atlantic and Pacific coasts, the CJNG has consolidated "important components of the global narcotics supply chain," the CRS said. "In particular, the CJNG maintains reported control over the ports of Veracruz, Manzanillo, and Lázaro Cárdenas, which has given the group access to precursor chemicals that flow into Mexico from China and other parts of Latin America," the report said. As a result, according to some analysts, the CJNG has pursued an aggressive growth strategy underwritten by US demand for Mexican methamphetamine, heroin, and fentanyl… Despite leadership losses, the CJNG has extended its geographic reach and maintained its own cohesion while exploiting the infighting among factions of the Sinaloa organization."

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.

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.

Federal Pot Busts Continue Decade-Long Decline, VT Governor Vetoes Drug Decrim Study Bill, More... (5/23/22)

Luxembourg is on a path to be the first European Union country to legalize marijuana, Alabama Medicaid is being challenged for blocking access to Hep C treatment for people who use drugs or alcohol, and more.

Vermont Gov. Phil Scott (R) has vetoed a bill that could have led the way to drug decriminalization. (vt.gov)
Marijuana Policy

Federal Pot Busts Continue to Decline. The DEA arrested 2,576 people on federal marijuana charges in Fiscal Year 2020, down dramatically from 2010, when the DEA made 8,215 pot arrests. Arrests have declined on an average of 11 percent a year in the past decade. Some of the decline is because of the coronavirus pandemic, which the Bureau of Justice Statistics said, "drove an 81 percent decline in arrests and 77 percent decline in cases charged from March to April 2020." But the decline also reflects discretionary decisions by the Justice Department as state after state legalizes marijuana.

Drug Policy

Alabama Medicaid Sued for Denying Hep C Treatment for People Who Use Drugs. The Center for Health Law and Policy Innovation and AIDS Alabama have filed an administrative complaint with the Justice Department, charging that Alabama Medicaid is discriminating against people with substance use disorder by denying "[Hep C] treatment to otherwise eligible Medicaid enrollees who cannot prove they did not use drugs or alcohol within the last six months." Prospective enrollees must promise not to use illegal drugs or alcohol, even though only alcohol has an effect on the liver. Alabama Medicaid patients who are found to be using drugs, including alcohol, could see their access to treatment, which otherwise costs tens of thousands of dollars, blocked. "On an individual level, for a single person seeking hep C treatment, it means the difference between being cured of hepatitis C and continuing to live with this very dangerous illness that, in many cases, can lead to liver scarring, liver cancer and even death," said Suzanne Davies, an attorney and CHLPI clinical fellow.

Vermont Governor Vetoes Drug Decrim Study Bill. Gov. Phil Scott (R) has vetoed House Bill 505, which would have created a Drug Use Standards Advisory Board as a first step toward drug decriminalization. The board would have been charged with determining a way to decriminalize the personal possession of currently illicit drugs, as well as ending the legal distinction between powder and crack cocaine. But in his veto message, Scott complained that the bill "places no limits on which drugs can be contemplated for legalization or the amounts, and while rightly saying we need to view substance abuse as a public health matter -- a point where I agree -- it includes absolutely no recognition of the often-disastrous health and safety impacts of using drugs."

International

Jordanian Armed Forces Kill Four Drug Smugglers from Syria. Four people trying to smuggle a large quantity of drugs from Syria into Jordan have been killed, with an unspecified number of others wounded and others escaping back into Syria, the Jordanian armed forces said. Jordan is both a destination and a transit route for captagon, an amphetamine now manufactured in Syria. The military did not specify who killed the smugglers, but in January, Jordanian soldiers killed 27 armed smugglers as they crossed the border.

Luxembourg Council of Government Set to Review Draft Marijuana Legalization Bill Next Month. The Council of Government will review a draft of a marijuana legalization bill next month. The government has committed to legalization, and in the current draft, would allow for home cultivation and would legalize the possession of up to three grams of marijuana. If the bill passes, Luxembourg would be the first country in the European Union to legalize marijuana, although Germany is now following a similar process.

Record Overdose Death Numbers Prompt Calls for Harm Reduction, Drug Decriminalizaion [FEATURE]

On May 11, the Centers for Disease Control and Prevention (CDC) released data showing that more than 107,000 people died of drug overdoses in 2021, the most overdose deaths ever recorded in a single year. The figure marks a 15 percent increase over 2020, with the number of overdose deaths more than quadrupling since 1999. And this is only provisional data; the actual death toll could be even higher.

More people died of drug overdoses last year than from gunfire and traffic accidents combined, and the ever-rising death toll is leading to ever-louder calls for effective policy prescriptions and harm reduction interventions to reduce the carnage.

Opioids were implicated in nearly 80,000 overdose deaths, with synthetic opioids, primarily fentanyl and its derivatives, involved in more than 68,000. Cocaine was mentioned in more than 23,000 overdose deaths and psychostimulants, primarily methamphetamine, mentioned in more than 30,000.

To its credit, the Biden administration has recognized the urgency of the problem, embracing harm reduction interventions such as needle exchanges, drug testing, and access to the opioid overdose reversal drug naloxone in its 2022 National Drug Control Strategy. The strategy includes $30 million for harm reduction grants, but also $300 million increases for the DEA and Customs and Border Patrol. While the prohibitionist impulse remains strong, at least the administration has explicitly recognized the need for harm reduction.

But that isn't enough, advocates say.

"New data from CDC has confirmed our worst fears. The combined pressures of the COVID-19 pandemic, an increasingly potent illicit drug supply, and an overwhelmed and under-resourced public health system have driven the overdose crisis to catastrophic levels," said Daliah Heller, Vice President of Drug Use Initiatives at Vital Strategies, in a statement.

>Vital Strategies is a global public health organization that in February, launched "Support Harm Reduction," a campaign to highlight five key interventions for preventing overdose that many people in the United States still don’t have access to: naloxone, drug checking resources, medications for opioid use disorder, safer drug use supplies, and overdose prevention centers. 

>"What we’re doing now isn’t working, because the decades-old punitive response to drug use still predominates: The transition to a health-first, harm reduction approach has been slow and piecemeal," Heller continued. "Anemic levels of funding and policy support are woefully insufficient to stem the tide of overdose we are experiencing. These data are an urgent call to action for government at all levels: we need to mount a massive public health response to overdose that centers harm reduction and support instead of criminalization and punishment for people who use drugs.  

"Far too few people have access to any of the five key interventions we know will reduce overdose deaths," Heller added. "Most of these services are available in some form, in some locations in the majority of states, but they all need to be massively scaled up with an emergency investment. Until such actions are taken, the continued escalation of this overdose crisis seems inevitable," she said.

"The devastating rise in overdose deaths is falling most heavily on Black and Indigenous communities, where the need for relief now is more urgent than ever before," Heller noted. "A massive surge in funding and support for a harm reduction public health response will save lives immediately, engaging people who use drugs with lifesaving resources and support. The time for action is now."

Likewise, the new CDC numbers prompted the Drug Policy Alliance (DPA) to call on Congress to urgently support harm reduction services and move toward drug decriminalization.

"Once again, we are devastated by these numbers," said Jules Netherland, DPA Managing Director of the Department of Research & Academic Engagement. "Over 107,000 of our friends, family and neighbors lost their lives to drug overdose last year. And sadly, we know the numbers will only continue to climb unless our policymakers actually do what is necessary to curb them. The United States has spent over 50 years and well over a trillion dollars on criminalization - and this is where it has gotten us. It's clearly not working. It's time we start investing where it actually matters - in our communities, specifically Black, Latinx and Indigenous communities where we are now seeing the sharpest rise in overdose deaths. The evidence shows us, that in order to actually make a difference, we have to replace these approaches with those centered in public health, such as drug decriminalization coupled with increased access to evidence-based treatment and harm reduction services, overdose prevention centers, and legal regulation and safer supply to reduce the likelihood of accidental overdose," Nederland said.

It is time for safe injection sites, too, DPA insisted.
 
"We are grateful that the Biden Administration has embraced harm reduction as part of their National Drug Control Strategy, but we need to see that commitment met with Congressional funding and a massive scaling up of these health services," Nederland said. "It's also essential that Overdose Prevention Centers be implemented, which decades of evidence-based, peer-reviewed studies and utilization in over 14 countries show us are one of the most effective ways to save lives now. While it may not always be politically convenient, it’s time to be guided by the evidence about what works. Overdose deaths are avoidable and a policy failure—it’s time we stop recycling the same policies that got us here and take the actions that are necessary to save lives."

Drug War Issues

Criminal JusticeAsset Forfeiture, Collateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Court Rulings, Drug Courts, Due Process, Felony Disenfranchisement, Incarceration, Policing (2011 Drug War Killings, 2012 Drug War Killings, 2013 Drug War Killings, 2014 Drug War Killings, 2015 Drug War Killings, 2016 Drug War Killings, 2017 Drug War Killings, Arrests, Eradication, Informants, Interdiction, Lowest Priority Policies, Police Corruption, Police Raids, Profiling, Search and Seizure, SWAT/Paramilitarization, Task Forces, Undercover Work), Probation or Parole, Prosecution, Reentry/Rehabilitation, Sentencing (Alternatives to Incarceration, Clemency and Pardon, Crack/Powder Cocaine Disparity, Death Penalty, Decriminalization, Defelonization, Drug Free Zones, Mandatory Minimums, Rockefeller Drug Laws, Sentencing Guidelines)CultureArt, Celebrities, Counter-Culture, Music, Poetry/Literature, Television, TheaterDrug UseParaphernalia, Vaping, ViolenceIntersecting IssuesCollateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Violence, Border, Budgets/Taxes/Economics, Business, Civil Rights, Driving, Economics, Education (College Aid), Employment, Environment, Families, Free Speech, Gun Policy, Human Rights, Immigration, Militarization, Money Laundering, Pregnancy, Privacy (Search and Seizure, Drug Testing), Race, Religion, Science, Sports, Women's IssuesMarijuana PolicyGateway Theory, Hemp, Marijuana -- Personal Use, Marijuana Industry, Medical MarijuanaMedicineMedical Marijuana, Science of Drugs, Under-treatment of PainPublic HealthAddiction, Addiction Treatment (Science of Drugs), Drug Education, Drug Prevention, Drug-Related AIDS/HIV or Hepatitis C, Harm Reduction (Methadone & Other Opiate Maintenance, Needle Exchange, Overdose Prevention, Pill Testing, Safer Injection Sites)Source and Transit CountriesAndean Drug War, Coca, Hashish, Mexican Drug War, Opium ProductionSpecific DrugsAlcohol, Ayahuasca, Cocaine (Crack Cocaine), Ecstasy, Heroin, Ibogaine, ketamine, Khat, Kratom, Marijuana (Gateway Theory, Marijuana -- Personal Use, Medical Marijuana, Hashish), Methamphetamine, New Synthetic Drugs (Synthetic Cannabinoids, Synthetic Stimulants), Nicotine, Prescription Opiates (Fentanyl, Oxycontin), Psilocybin / Magic Mushrooms, Psychedelics (LSD, Mescaline, Peyote, Salvia Divinorum)YouthGrade School, Post-Secondary School, Raves, Secondary School