As the clock ticks down toward 2020, it's worth taking a moment to look back and reflect on what has gone on in the world of drug policy this year. From marijuana to psychedelics to the lingering overdose crisis to the emergence of a new vaping-related illness, a lot happened. Here are ten of the biggest highs and lows of 2019, in no particular order:

It was a big year for marijuana in Congress. Less so in the states.

In November, the House Judiciary Committee made history when it approved the Marijuana Opportunity Reinvestment and Expungement (MORE) Act (H.R. 3384). The bill would effectively legalize marijuana at the federal level by removing it from the Controlled Substance Act's drug schedules. It would also require federal courts to expunge prior convictions and conduct resentencing hearings for those still doing federal marijuana time. And it would assess a five percent tax on marijuana sales to create a fund to aid to people and communities most impacted by prohibition.

There's a good chance the MORE Act will get a House floor vote before the end of this Congress, but even if it does, its prospects in Sen. Mitch McConnell's Senate are dim at best. Still, step by step, Congress by Congress, the end of federal marijuana prohibition is drawing nearer.

2. Marijuana Banking Bill Passes the House

In September, the House passed the SAFE Banking Act, which would allow state-legal marijuana businesses to get access to banking and other financial services. The vote was 321-103, with near unanimous support from Democrats, as well as nearly half of Republicans.

The vote came although some civil rights and drug reform groups had called for it to be put off until more comprehensive marijuana or criminal justice reform, such as the MORE Act (see above) could be enacted. They argued that passage of a narrowly targeted financial services bill could erode momentum toward broader reforms. The MORE Act did win a House Judiciary Committee vote, but has yet to get a House floor vote.

And while SAFE passed the House, it must still get through the Senate, where it is not clear whether it will be allowed to a vote, much less whether it can pass. A companion version of SAFE, S.1200, was introduced in April by Sens. Jeff Merkley (D-OR), Cory Gardner (R-CO) and a bipartisan group of 21 original cosponsors. It currently has 33 total cosponsors. In September, Senate Banking Committee Chairman Mike Crapo (R-ID) said his committee would take up the cannabis banking issue this year and is working on preparing a new bill, but now it's December and little has happened.

3. Legalization in the States Didn't Have a Great Year

At the beginning of 2019, prospects looked good for as many as a half-dozen states to get legalization bills passed, but the year turned out to largely be a dud. Hopes were especially high in New Jersey and New York, where Democratic governors supported legalization, but it didn't come to pass this year in either state. In Albany, they'll be back at it next year, but in Trenton, it looks like the legislature is going to punt, opting instead to put the issue directly to the voters next year in a legislative referendum.

One state did make it all the way to the finish line: Illinois. After a legalization bill sailed through the legislature in the spring, Democratic Gov. J.B. Pritzker signed it into law in late June. With that signature, Illinois became the first state to create a system of taxed and regulated marijuana commerce through the legislative process, rather than through a voter initiative. (Vermont's legislature legalized possession and cultivation but not sales in early 2018.)

Getting bills through a state legislature is hard work, and it sometimes takes years. Still, that hard work that didn't quite make it over the top this year, is laying the groundwork for legalization in places like New Jersey and New York -- and maybe more -- next year. And next year is an election year, which means initiative campaigns that can bypass legislative logjams will be in play. There are already active campaigns in Arkansas, Florida, North Dakota and South Dakota, although none have yet qualified for the ballot. Look for 2020 to be a better year when it comes to freeing the weed.

4. Pot Prohibition Isn't Dead Yet: Despite Legalization, Marijuana Arrests Up in Latest FBI Crime Report

In late September, the FBI released its annual Uniform Crime Report for 2018, and once again, marijuana arrests were on the rise -- despite legalization in 11 states and DC, and decriminalization in 15 more states. There were some 663,367 marijuana arrests in 2018, up from 659,700 in 2017 and 653,249 in 2017. In all three years, simple possession cases accounted for about nine out of ten pot busts. Before 2016, marijuana arrests had been going down for more than a decade. Clearly, there is still work to do here.

5. US Supreme Court Unanimously Reins in Asset Forfeiture

In a February victory for proponents of civil libertarians, the US Supreme Court ruled in Timbs v. Indiana that the Eighth Amendment's Excessive Fines Clause applies to states, thereby prohibiting state and local governments from collecting excessive fines, fees and forfeitures. Justice Ruth Bader Ginsburg wrote the majority opinion. "The protection against excessive fines guards against abuses of government's punitive or criminal law-enforcement authority," Ginsburg wrote. The case involved the seizure of a $42,000 Land Rover over a drug sale of $225.

There was more progress on the asset forfeiture front on the state level, too: Bills to either end civil asset forfeiture entirely or to restrict it passed this year in Alabama, Arkansas, Michigan, and North Dakota, and in September, a South Carolina circuit court judge ruled civil asset forfeiture unconstitutional, setting up a fight in state appeals courts there.

6. Thousands of Federal Drug Prisoners Go Free Under First Step Act

President Trump signed the First Step Act into law at the end of last year, but the sentencing reform measure's true impact was felt in July, when the Bureau of Prisons released more than 3,000 prisoners and reduced the sentences of nearly 1,700 more. Almost all of those released were drug offenders. The First Step Act was aimed at redressing harsh sentences for federal prisoners excluded from the 2010 Fair Sentencing Act, which reduced -- but did not eliminate -- the infamous crack/powder cocaine sentencing disparity, but which did not include prisoners sentenced before its passage. Three states -- Florida, South Carolina and Virginia -- accounted for a whopping 25 percent of sentence reductions, and more than 90 percent went to African-American men.

A movement to decriminalize natural psychedelics emerged this year. (Greenoid/Flickr)

After emerging in 2018, the movement to decriminalize natural psychedelics mushroomed this year. In May, voters in Denver narrowly approved the Denver Psilocybin Mushroom Decriminalization Initiative, making clear that they wanted to "deprioritize, to the greatest extent possible, the imposition of criminal penalties on persons 21 years of age and older for the personal possession of psilocybin mushrooms." The measure also "prohibits the city and county of Denver from spending resources on imposing criminal penalties on persons 21 years of age and older for the personal use and possession of psilocybin mushrooms."

That surprise victory sparked interest across the country, and the following month Oakland followed suit, only this time it was the city council -- not the voters -- who decriminalized magic mushrooms and other natural psychedelics. In September, Chicago became the next city to get on board, with the city council unanimously passing an advisory resolution expressing support for research on the potential use of psychoactive plants and pledging support for adult use of the substances. Meanwhile, activists in three more major cities -- Berkeley, Dallas, and Portland -- were pushing psychedelic decriminalization measures, either through ballot initiatives or city council actions. By December, Decriminalize Nature, the group behind the movement, reported that more than 100 cities across the country are now seeing efforts to open up to psychedelics.

And it's not just cities. In two states, psychedelic reformers have filed initiatives aimed at the November 2020 ballot. In the Golden State, the California Psilocybin Mushroom Initiative, which would decriminalize the possession, use, and gifting of magic mushrooms and the chemical compounds -- psilocybin and psilocin -- has been cleared for signature gathering. It has until April 21 to come up with 623,212 valid voter signatures to qualify for the November 2020 ballot. Just across the border to the north, the Oregon Psilocybin Service Initiative, which would allow magic mushrooms to be grown with a license, and would allow for therapeutic use of psilocybin, is in the midst of signature gathering. It needs 112,020 valid voter signatures by July 2 to make the ballot. The Oregon measure in October got a nice $150,000 donation from Dr. Bronner's Magic Soaps.

8. Overdose Deaths Decline Slightly, But Are Still Way Too High

In July, the CDC reported 2018 drug overdose death numbers and found that they had declined from 2017's record high of more than 70,000 to just under 68,000, a five percent decrease. The latest data from CDC, which measured drug deaths in the 12-month period ending in April 2019 showed deaths at 67,000, suggesting that the decline continues, but at a glacial pace. Still, the number of overdose deaths is about seven times higher than it was in 1995, at the start of the prescription opioid epidemic.

The recent decline has been driven by a decrease in heroin and prescription opioid overdoses, although overdoses involving the synthetic opioid fentanyl increased, as did those involving the stimulant drugs cocaine and methamphetamine. Many overdoses involved more than one drug, with benzodiazepines often implicated.

If some researchers are right, fentanyl overdoses could balloon to an even higher level, if distribution of the highly potent substance takes hold in the western US. Most users take fentanyl unknowingly, after it's been used to cut street heroin or counterfeit pills.

9. Vaping-Linked Illness Emerges, Sparking Broad Anti-Vaping Backlash

In the summer, reports of vaping or e-cig users being struck down by a mysterious, lung-damaging condition began to emerge. By the end of October, the Centers for Disease Control and Prevention (CDC) reported more than 1,600 cases of lung-damaged vapors, with the death toll rising to 34. (That number has since risen to 47.) The CDC also gave the condition a name: e-cigarette or vaping product use associated lung injury (EVALI).

A likely culprit soon emerged: black market THC vaping cartridges contaminated with new additives, particularly thinners including propylene glycol (PG) and polyethylene glycol (PEG), vitamin E acetate, and medium chain triglycerides (MCT oil). The FDA has begun investigating vitamin E acetate, while public health officials in New York have found the substance in a majority of seized vape cartridges there. The FDA also announced in August that it is proposing adding propylene glycol as a "respiratory toxicant" in its list of harmful tobacco product ingredients.

While the CDC and the FDA responded to the outbreak with recommendations targeting the suspect products, elected and public health officials in a number of states responded by going after not black market marijuana vaping cartridges but legal flavored tobacco vaping products.

Massachusetts banned all vaping products, Michigan banned flavored nicotine products, New York banned flavored e-cigarettes, Oregon banned all flavored vaping products for six months, as did Rhode Island, while Washingtonissued a four-month ban on flavored vaping products. President Trump threatened to move toward a national ban on flavored vaping products, but has since changed course, even making an anti-prohibitionist argument to do so.

In its latest update, the CDC reports the number of EVALI cases has risen to nearly 2,300 and the death toll has climbed to 47. But unlike those state governments that reacted with flavored vaping bans, the CDC takes a different approach: It points the finger strongly at vitamin E acetate, recommends that people not use THC vaping products at this point -- especially if obtained informally or in the black market -- and also warns people not to add any products to vaping cartridges that are not intended by the manufacturer.

10. Safe Injection Sites Win an Important Preliminary Legal Battle

In a case involving a proposed safe injection site in Philadelphia, a federal judge ruled that it would not violate federal law. With the backing of city officials and former Gov. Ed Rendell (D), the nonprofit group Safehouse pressed forward with plans for the facility even though the Justice Department had warned that it would not allow any safe injection sites to move forward. The Justice Department sued in February to halt the project, arguing that it violated the federal "crack house law."

But US District Judge Gerald McHugh ruled that the "crack house" provision of the Controlled Substances Act does not apply to the group's bid to assist opioid users. "No credible argument can be made that facilities such as safe injection sites were within the contemplation of Congress" when that body wrote the law in 1986 or amended it in 2003, McHugh wrote. "I cannot conclude that Safehouse [the safe injection site] has, as a significant purpose, the objective of facilitating drug use. Safehouse plans to make a place available for the purposes of reducing the harm of drug use, administering medical care, encouraging drug treatment and connecting participants with social services."

While the Justice Department has appealed the ruling, it is a good omen, and the case is being carefully watched in cities such as Denver, New York, San Francisco, and Seattle, all of which are pursuing similar plans.

Supposed free-market conservative Sen. Tom Coburn (R-OK), who is also an MD, called last week on the Senate floor for cigarettes and other tobacco products to be outlawed. Coburn may have been merely seeking to score political points against the Democrats as the Senate debated a bill to have tobacco regulated by the Food & Drug Administration (FDA) -- it passed Thursday and is now headed for the president's desk-- but nonetheless, the prohibitionist impulse towards tobacco has now been clearly articulated in the Congress.

Tom Coburn

Instead of authorizing the FDA to regulate tobacco sales, marketing, and manufacture, the stuff should simply be banned, Coburn said. "If we really want to make a difference in health and we want to eliminate dependence on tobacco, what we have to do is to stop the addiction."

Placing tobacco under FDA regulation would just confuse the agency, the Oklahoma Republican argued. The agency's mission is to ensure the safety of food and drugs, and there is nothing safe about tobacco, he said. And regulating tobacco means not banning it, he added. "In this bill, we allow existing tobacco products not ever to be eliminated," he said.

With smokers the target of growing social ostracism and increasingly pervasive regulation, as well as being favorite subjects for targeted taxation, outright prohibition could be the eventual end game. But Coburn suggested Democrats, who back the regulation legislation, would seek to block outright prohibition because they seek to benefit a key interest group: trial lawyers. "We have had all of these lawsuits through the years where billions of dollars have gone into attorneys' coffers," he said.

Coburn was doubtless trying to score political points by accusing the majority of being in the pocket of the trial lawyers, but now someone in Congress may take him up on his crusade. Goodness knows prohibitionist sentiment still runs very deep in that august deliberative body.

Ah, the unintended -- if not unforeseeable -- consequences of prohibition. The Cleveland Plain Dealer reported Sunday that in the wake of a crackdown on strip joints and smoking in bars, a new, if shadowy, presence has made itself known on the back streets of the city: the smokehouse. These unlicensed premises offer what legal clubs and bars cannot: a place for tipplers to smoke while they drink and watch strippers after midnight. Vice cops say they also provide a haven for prostitution.

The smokehouses are a response to laws that took effect last year banning smoking in public places and nude dancing after midnight.

One Cleveland vice detective, Tom Shoulders, compared the smokehouses to the gin houses of the Prohibition era. "You put too many restrictions on people, they're going to find someplace else to go for their entertainment," he said.

According to what snitches are telling the cops, the smokehouse patrons, mainly suburban white guys, bring their own liquor, cigarettes, and cigars, while doormen at the clubs collect entry fees of up to $25 for a "buffet."

"They have succeeded in creating this underground, sleazy, cash-only business that cannot be regulated, taxed or secured by police," said Skip Lazzaro, an attorney who represents legal nightclubs in court -- although it isn't clear if he should be referring to the proprietors and clients or to the legislature.

While the combination of after-hours strippers and underground smoking is a new twist, the smokeasy isn't. In fact, smokeasies, or clubs that covertly allow smoking despite laws prohibiting it, seem to pop up just about everywhere smoking bans do. From New York to San Francisco, and many places in between, you can find them... if you only know whom to ask.