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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."

White House Drug Strategy Embraces Harm Reduction, But Prohibitionist Impulse Remains Strong [FEATURE]

The Biden White House sent its first National Drug Control Strategy to Congress on April 21. It breaks positive new ground by explicitly acknowledging harm reduction measures to prevent overdose and blood-borne diseases among drug users. At at the same time, though, it also relies heavily on the destructive and counterproductive pursuit of failed prohibitionist drug policies -- and funds more law enforcement much more heavily than harm reduction.

The strategy comes out just weeks after the Centers for Disease Control and Prevention (CDC) reported that drug overdose deaths hit an all-time high of 106,000 in the year ending last November. The administration is responding with what it calls a "whole of government" approach to the crisis.

"The strategy focuses on two critical drivers of the epidemic: untreated addiction and drug trafficking," the White House said. "It instructs federal agencies to prioritize actions that will save lives, get people the care they need, go after drug traffickers' profits, and make better use of data to guide all these efforts. Saving lives is our North Star, and the 2022 National Drug Control Strategy calls for immediate actions that will save lives in the short term and outlines long-term solutions to reduce drug use and its associated harms, including overdose."

While the strategy includes long-familiar categories such as drug treatment, prevention, supply reduction, and criminal justice and public safety, it also emphasizes an evidence-based approach, "building a recovery-ready nation," and for the first time, harm reduction.

"The Biden-Harris Administration's efforts focus on meeting people where they are and building trust and engagement with them to provide care and services," the White House said. "Specifically, the strategy calls for greater access to harm reduction interventions including naloxone, drug test strips, and syringe services programs. It directs federal agencies to integrate harm reduction into the US system of care to save lives and increase access to treatment. It also calls for collaboration on harm reduction between public health and public safety officials, and changes in state laws and policies to support the expansion of harm reduction efforts across the country."

The strategy calls for "the coordinated use of federal grant funds for harm reduction," and the administration last year broke new ground with a $30 million grant program for harm reduction providers. But in a sign of continued reliance on traditional law enforcement priorities, the strategy also envisions a $300 million increase for Customs and Border Patrol and another $300 million increase for the DEA. Those figures were released as part of the White House's FY 2023 budget released last month.

"Responding effectively to the illicit production, trafficking, and distribution methods of domestic criminal organizations and Transnational Criminal Organizations (TCOs) is a significant challenge and remains a Biden-Harris Administration priority," the White House said.

That kind of talk suited mainstream Democrats just fine.

"Illicit drugs cause immeasurable pain and loss in our communities. As the Chairman of the Senate Caucus on International Narcotics Control, I've pressed for an updated federal plan to tackle them," said Sen. Sheldon Whitehouse (D-RI). I've been clear that the plan must include a more coordinated approach to cracking down on drug trafficking and transnational criminal organizations, especially the ways in which they launder and protect their ill-gotten gains using US rule of law and financial networks; and more and better cooperation with our international partners to reduce the supply of precursor chemicals used to manufacture illicit drugs and to levy tougher sanctions against transnational drug syndicates. I'm pleased to see my priorities reflected in this new strategy, and I look forward to working with the Biden administration to deliver on those priorities."

Whitehouse also lauded the strategy's "tearing down barriers to treatment, including expanding access to life-saving naloxone and medication-assisted treatment; improving our data collection systems to better understand the effects of our intervention efforts."

Reform advocates offered praise -- sometimes lukewarm -- for the administration's tentative embrace of harm reduction, but blasted its reliance on tired, failed drug war paradigms.

In its analysis of the strategy, the Washington Office on Latin America (WOLA) called it "a major step forward" and lauded the administration for "focusing on ensuring access to treatment for substance use disorders and highlighting the crucial role of harm reduction services." But WOLA also noted that, "when measured against the scale of the nation's overdose problems and the urgency of the needs, Biden's new plan appears quite timid."

WOLA also warned that the strategy's "positive innovations regarding investment in treatment and harm reduction strategies risk being undermined by a continued commitment to the kinds of policies that have exacerbated the present crisis and that continue to absorb the lion's share of resources, namely, drug criminalization at home and wildly exaggerated expectations for what can be achieved through supply control efforts abroad."

Similarly, the libertarian-leaning Cato Institute called the attention to harm reduction a "positive," but noted steps that it did not take, such as making the opioid overdose reversal drug naloxone available over-the-counter and repealing the so-called Crack House Statute that stands in the way of federal approval of safe injection sites.

"On a negative note," Cato observed, "the remainder of the new report calls for doubling down on interdiction, border control, and other law enforcement measures aimed at curtailing the supply of illicit drugs -- as if repeating the same failed strategies of the past half century, only with more gusto, will somehow work."

So there it is: The Biden administration's first crack at a national drug strategy deserves kudos for its embrace of harm reduction and evidence-based approaches, but beyond that, it is pretty much more of the same old same old.

White House Releases 2022 National Drug Control Strategy, NH Marijuana Legalization Bill Nixed, More... (4/21/22)

A pair of companion marijuana legalization initiatives are cleared for singature-gathering in Oklahoma, SAMSHA mantains a firm line on drug testing rules, and more.

A needle exchange. The White House is emphasizing harm reduction measures to take on the overdose crisis. (Creative Commons)
Marijuana Policy

New Hampshire Senate Committee Votes to Kill Marijuana Legalization Bill. The Senate Ways and Means Committee voted unanimously Wednesday to kill a bill that would have legalized marijuana and had it sold at state-owned retail outlets, House Bill 1598. The bill could still come up for a Senate floor vote, but the committee vote likely signals the end of the road for this legislative session. The House has repeatedly passed marijuana legalization bills in recent years, only to see them die in the Senate. And even if something were to make it to the desk of Gov. Chris Sununu (R), he remains opposed to legalization. At least one senator indicated he was stuck in a time warp: "Why would we want to join the herd of introducing to our culture legalization of a substance that is unquestionably a gateway drug?" asked Sen. Bob Giuda (R-Warren).

Ohio Lawmakers File Marijuana Legalization Bill That Mirrors Ongoing Legalization Initiative. Two Democratic lawmakers, Reps. Casey Weinstein and Terrance Upchurch, have filed a marijuana legalization bill with the same language as the legalization initiative from the Coalition to Regulate Marijuana Like Alcohol (CRMTA). CRMTA's initiative passed an initial signature threshold, starting a process where the legislature has four months to either pass legalization or let it go to the voters in November (provided CRMTA succeeds in another round of signature-gathering), but there is little indication that the Republican-controlled legislature is going to act on it.

Oklahoma Marijuana Legalization Initiatives Okayed for Signature-Gathering. The state Supreme Court has cleared the way for two companion marijuana legalization initiative campaigns to begin signature-gathering. State Question 819 and the companion State Question 818, would amend the state constitution to protect the right of residents age 21 and older to use marijuana. Because they amend the constitution, they face a higher signature-gathering hurdle than State Question 820, which has already been cleared for signature-gathering. It needs about 90,000 signatures within 90 days to qualify for the ballot, while State Questions 819 and 820 will need about 178,000 valid voter signatures.

Drug Policy

Biden Administration Releases 2022 National Drug Control Strategy. The White House released the 2022 National Drug Control StrategyThursday, focusing on treating drug addiction and fighting drug trafficking. The strategy calls for expanded harm reduction interventions, such as drug test strips, needle exchanges, and access to the opioid overdose reversal drug naloxone. The new strategy is “the first-ever to champion harm reduction to meet people where they are and engage them in care and service,” the White House said. But the strategy also envisions a $300 million increase for Customs and Border Patrol and another $300 million increase for the DEA, maintaining a law enforcement emphasis. Those figures were released as part of the FY 2023 budget released last month.

Drug Testing

SAMSHA Cuts No Slack for Medical Marijuana, Accidental Exposures in Updated Federal Drug Testing Rules. In a pair of notices published in the Federal Register earlier this month, the Substance Abuse and Mental Health Services Administration (SAMSHA) published a pair of notices about proposed changes to drug testing policies. One new notice clarifies that having a doctor's recommendation for medical marijuana is not a valid excuse for a positive drug test. The secondnew notice states that passive exposure to secondhand marijuana smoke or accidental ingestion of foods containing marijuana are not a legitimate medical explanation for a positive drug test. These are proposed rules, and  there is a 60-day public comment period on the proposals is open until June 6.

DEA Commits to Expanding Medication-Assisted Treatment, Human Rights Watch Calls for End to US Pot Prohibition, More... (3/23/22)

Rhode Island lawmakers are trying to thrash out agreement on a marijuana legalization bill, the Marijuana Policy Project releases a report on the states lagging behind on marijuana reform, and more.

Buprenorphine. The DEA says it is commited to expanding medication-assisted treatment (MAT), such as bupe. (Pixabay)
Marijuana Policy

Human Rights Watch Calls on US to End Marijuana Prohibition Now. Human Rights Watch is calling on the federal government to legalize marijuana as "a much-needed move toward a US drug policy grounded in human rights, harm reduction, and health." The group noted that in the last Congress, the House passed the historic Marijuana Opportunity Reinvestment and Expungement (MORE) Act and said a House floor vote on this year's version of the bill, HR 3617 is "an urgent step toward advancing long overdue reforms in the criminal justice system and beyond." It also called on members of Congress to "heed the call of a diverse coalition of organization and cosponsor the bill. House leadership should immediately bring the bill to a floor vote," the group said.

Marijuana Policy Project Releases Report on the States Lagging Behind on Marijuana Reform. Recognizing the 50-year anniversary of the report issued by the Shafer Commission, which investigated the effects of cannabis use on specific communities and found that small amounts of cannabis do not harm society and should not result in criminalization or jail time, the Marijuana Policy Project (MPP) released a new report on Tuesday, Behind the Times: The 19 States Where a Joint Can Still Land You in Jail. The report examines the laws that lag the furthest behind public opinion: the 19 states and federal government, which have not even "decriminalized" simple possession of cannabis. In those states, it examines penalties for simple possession, arrest rates, and racial disparities in arrests and provides a glimpse at some of the damage inflicted by draconian laws. It also reviews unsolved crime rates in the states that continue to use limited law enforcement resources to arrest and jail adults for possessing a substance that is safer than alcohol.

Rhode Island Lawmakers Meet to Ponder Competing Marijuana Legalization Proposals. The House Finance Committee met on Tuesday to discuss competing marijuana legalization proposals from the House and Senate leadership and Gov. Dan McKee (D). McKee proposed a legalization plan in his budget package, House Bill 7123, while the legislative leaders are backing Senate Bill 2430. At the hearing, advocates complained of inadequate equity provisions in the Senate bill, with members saying they were open to feedback. The governor's bill on the other hand, has provisions to automatically expunge past convictions.

Drug Treatment

DEA Commits to Expanding Access to Medication-Assisted Treatment. DEA Administrator Anne Milgram on Wednesday announced the Drug Enforcement Administration’s continued commitment to expanding access to medication-assisted treatment to help those suffering from substance use disorder. "In this moment, when the United States is suffering tens of thousands of opioid-related overdose deaths every year, the DEA’s top priority is doing everything in our power to save lives," said Administrator Milgram. "Medication-assisted treatment helps those who are fighting to overcome substance use disorder by sustaining recovery and preventing overdoses. At DEA, our goal is simple: we want medication-assisted treatment to be readily and safely available to anyone in the country who needs it." The agency has recently been championing a number of initiatives to expand access to medication-assisted treatment for those suffering from opioid-related substance use disorder, including a loosening of restrictions around buprenorphine and methadone prescribing, reaching out to pharmacists and practitioners to let them know DEA supports medication-assisted treatment, and increasing the number of mobile methadone clinics. 

Challenge to DEA Tryptamines Ban Will Get Hearing, VA Senate Approves Early Marijuana Sales, More... (2/15/22)

A marijuana legalization bill gets filed in Missouri, a marijuana decriminalization bill is filed in Wyoming, and more.

Tryptamines. The DEA wants to ban five of the psychedelic substances, but the ban is being challenged. (streetdrugs.org)
Marijuana Policy

Missouri Marijuana Legalization Bill Filed. State Rep. Ron Hicks (R) on Tuesday filed a marijuana legalization bill, the Cannabis Freedom Act. Under the act, people 21 and over can possess an unlimited amount of marijuana, grow up to 12 plants, and/or purchase marijuana from licensed retailers. The bill also contains expungement provisions and resentencing for people currently behind bars on pot charges. The state Department of Agriculture would have responsibility for setting up rules and regulations. The bill is House Bill 2704.

Virginia Senate Approves Bill to Start Legal Marijuana Sales September 15. The state Senate voted Tuesday to pass a bill allowing legal marijuana sales to begin on September 15. That bill is Senate Bill 391. Sales were originally set to begin on January 1, 2024, but this bill allows sales at existing medical dispensaries to commence in September, with a full retail market taking shape in 2024. The bill now heads to the GOP-controlled House of Delegates, where its fate is uncertain.

Wyoming Marijuana Decriminalization Bill Filed. Rep. Mark Baker (R-Green River) has filed a marijuana decriminalization bill, House Bill 106. The bill removes criminal penalties for marijuana use and possession but faces a high hurdle for passage. Because this is a budget session, the bill must get a two-thirds introductory vote in the House to be considered. The bill would decriminalize the possession of up to three ounces.

Psychedelics

Judge Grants Hearing for Opposition to DEA Proposal to Criminalize 5 More Psychedelics. A federal judge has granted a hearing to petitioners challenging the DEA's recent proposal to add five psychedelic compounds to Schedule I of the Controlled Substances Act. The agency announced plans in January to criminalize 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); not just for possession, distribution, import, export or manufacturing, but even research, instructional activities and chemical analysis.Administrative Law Judge Teresa A. Wallbaum issued an order Tuesday for a May 4 hearing date after receiving four different requests from industry entities and researchers.

Drug War Issues

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