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Chronicle Book Review: American Cartel

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

Phillip S. Smith, with contributions from David Borden

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

British Columbia to Become First Canadian Province to Decriminalize Drug Possession [FEATURE]

Faced with an unrelenting drug overdose crisis, British Columbia (BC) is now set to become the first Canadian province to decriminalize the possession of small amounts of drugs, effective for a three-year period beginning January 31, 2023, Health Canada announced Tuesday. The agency has approved a request from BC for an exemption under the Controlled Drugs and Substances Act (CDSA) to remove criminal penalties for small-time drug possession.

Vancouver, epicenter of British Columbia's drug overdose crisis. (Creative Commons)
The move will decriminalize the possession of up to 2.5 grams of cocaine, MDMA, methamphetamines, and opioids (including fentanyl and heroin). People found with these personal use amounts of drugs will no longer be arrested, charged or have their drugs seized. Instead of handcuffs, drug users will be offered information on health and social services available, as well as referrals. Provincial officials had sought a higher threshold of 4.5 grams.

"The shocking number of lives lost to the overdose crisis requires bold actions and significant policy change. I have thoroughly reviewed and carefully considered both the public health and public safety impacts of this request," said Carolyn Bennett, federal Minister of Mental Health and Addictions and Associate Minister of Health. "Eliminating criminal penalties for those carrying small amounts of illicit drugs for personal use will reduce stigma and harm and provide another tool for British Columbia to end the overdose crisis."

"Substance use is a public health issue, not a criminal one," said Sheila Malcolmson, BC's Minister of Mental Health and Addictions. "By decriminalizing people who use drugs, we will break down the stigma that stops people from accessing life-saving support and services."

The province faces a true public health emergency around overdoses, with the BC government reporting at least 2,224 overdose deaths in 2021, an all-time high and a 26 percent increase over 2020. The last two months of 2021 also saw record overdose numbers. Some 85 percent of the reported overdose deaths involved fentanyl.

"Over the past seven years, our province has experienced a devastating loss of life due to a toxic illicit drug supply," said Lisa Lapointe, BC's chief coroner. "This public health emergency has impacted families and communities across the province and shows no sign of abating. In the past seven years, the rate of death due to illicit drug toxicity in our province has risen more than 400%. Drug toxicity is now second only to cancers in BC for potential years of life lost. We cannot simply hope that things will improve. It is long past time to end the chaos and devastation in our communities resulting from the flourishing illicit drug market, and to ensure, on an urgent basis, access across the province to a safe, reliable regulated drug supply."

Decriminalization is not quite safe drug supply, although Health Canada and BC are working on that, too, but it will help, said Dr. Bonnie Henry, BC's provincial health officer.

"This exemption is a vital step to keeping people alive and help connect them with the health and social support they need," said Henry. "By removing the fear and shame of drug use, we will be able to remove barriers that prevent people from accessing harm reduction services and treatment programs."

"Decriminalizing possession of drugs is an historic, brave, and groundbreaking step in the fight to save lives from the poison drug crisis. Today marks a fundamental rethinking of drug policy that favors healthcare over handcuffs, and I could not be more proud of the leadership shown here by the Governments of Canada and British Columbia", said Vancouver Mayor Kennedy Stewart.

But while government officials were congratulating themselves on their bold move, critics such as the Canadian Drug Policy Coalition said it was not nearly bold enough. In a statement released Tuesday they called for "decriminalization for all."

"The government of Canada's latest move to decriminalize drug possession should go further to protect everyone, in particular those most endangered by drug prohibition and the drug toxicity crisis," the coalition maintained. "We support policy that moves the needle forward; however, it is disappointing that decriminalization under the model announced on May 31st will not protect all people who use drugs from the harms of criminalization. We support progress, but we dream bigger. We want full decriminalization for all."

The coalition took special issue with the 2.5 gram threshold, calling it "a missed opportunity."

"A cumulative threshold quantity of 2.5 grams leaves many people who use drugs behind, namely those living in rural and remote communities who already bear the disproportionate brunt of drug prohibition and the drug toxicity crisis," the coalition protested. "People purchase larger quantities of drugs for myriad reasons: geographic restrictions, personal mobility reasons, and to limit interactions with the illicit drug market." Concerns over too-low threshold quantities were expressed repeatedly to BC and Health Canada by BC's own Core Planning Table for Decriminalization and the Board of the Vancouver Network of Drug Users (VANDU) -- to no avail.

The coalition also questioned the timing of the announcement, coming just one day ahead of a vote on a private member's decriminalization bill, Bill C-216, which was defeated Wednesday. "It is clear that the timing of the announcement is meant to hamper the progression of that bill through to committee stage, whereupon it could be further strengthened," the group noted.

The coalition called federal inaction on decriminalization "shameful," adding that "the piecemeal approach the government of Canada is now clearly taking does not adequately address the urgency of the drug poisoning crisis in the country."

Still, drug possession is about to be decriminalized in a Canadian province. Even with its shortcomings, that marks a striking conceptual shift in Canada's approach to drugs. And Toronto could be next. It has a similar exemption request pending.

CO Governor Signs Bill Increasing Fentanyl Penalties, SD Will Vote on Marijuana Legalization in November, More... (5/26/22)

The Louisiana House approves a bill to protect state workers who use medical marijuana, a South Dakota marijuana legalization initiative has qualified for the November ballot, and more.

South Dakota's Badlands. They could seem less bad after voters have another chance to legalize marijuana. (Creative Commons)
Marijuana Policy

South Dakota Will Vote on Marijuana Legalization in November -- Again. Secretary of State Steve Barnett (R) announced Wednesday that a marijuana legalization initiative sponsored by South Dakotans for Better Marijuana Laws has qualified for the November ballot. Initiative 27 will give voters a second chance to vote for marijuana legalization. In 2020, the same group sponsored a legalization initiative that won with 54 percent of the vote, only to see the will of the voters overturned by the state Supreme Court at the behest of Republican Gov. Kristi Noem.

Another Texas City Will Vote on Marijuana Decriminalization in November. After Austin voters earlier this month overwhelming approved a marijuana decriminalization measure, the Central Texas town of Killeen is now set to vote on a similar measure in November. Ground Game Texas, the progressive group behind both efforts, said Wednesday it had collected enough signatures to make the ballot.

Medical Marijuana

Louisiana House Approves Bill to Protect State Workers Who Use Medical Marijuana. The House on Tuesday voted 60-32 to approve House Bill 988, which would protect state employees from negative consequences for legal medical marijuana use. The bill would bar employees being fired for medical marijuana use and would prevent discrimination against potential hires for medical marijuana use. Public safety employees such as police and firefighters are not included, though. The bill now goes to the Senate.

Opiates and Opioids

Colorado Governor Signs Bill Increasing Fentanyl Penalties. Gov. Jared Polis (D) on Wednesday signed into law House Bill 22-1326, the "Fentanyl Accountability and Prevention Act." The bill lowers the threshold for a felony fentanyl possession charge from four grams to one and includes counterfeit pills that may contain only small amounts of the drug. As a last-minute change, lawmakers added a provision that will allow people to argue in court they did not "knowingly" possess fentanyl, which is a common phenomenon because the drug is often used in counterfeit pills. The bill also allocates $10 million for emergency health services and more than $25 million in harm reduction spending, primarily for overdose reversal drugs, but also for fentanyl test strips and a three-year education campaign.

RI Legal Pot Bill Heads for Final Votes Next Week, FL Governor Signs Fentanyl Murder Bill, More... (5/20/22)

A Delaware bill to tax and regulate marijuana comes up short but remains alive after a parliamentary manuever, Michigan uses court settlements to fund a massive response to the opioid crisis, and more.

Florida Gov. Ron DeSantis signs a punitive fentanyl bill into law. (fl.gov)
Marijuana Policy

Delaware Legal Marijuana Regulation, Sales Bill Falls Short—For Now. A bill that would have created a system of taxed and regulated marijuana sales, House Bill 372, failed in the House Thursday even though it won a majority of votes. The bill needed a two-thirds majority in the House because it had tax provisions, but cam up short on a 23-15 vote. But the bill is not dead because sponsor Rep. Ed Osienski (D-Newark), changed his vote to "no," which gives him three legislative days to rescind the roll call vote and bring the bill forward for reconsideration before the end of this year’s legislative session. With Osienski voting "yes" next time, along with a bill supporter who missed the vote because he is sick with COVID, the bill has the votes to pass next time.

Rhode Island Marijuana Legalization Bill Heads for House, Senate Floor Votes Next Week. With approval Wednesday from the Senate Judiciary and House Finance committees, an amended marijuana legalization bill, Senate Bill 2430, is now headed for final floor votes in the House and Senate, which are scheduled for next Tuesday. As well as setting up a system of taxed and regulated marijuana commerce, the bill contains social equity components and allows for automatic expungement of past marijuana possession offenses.

Opiates and Opioids

Florida Governor Signs Bill to Make Murder Charges Easier in Drug Overdose Deaths. Gov. Ron DeSantis (R) has signed into law House Bill 95, which would make it easier for prosecutors to seek first-degree murder charges against drug sellers if an overdose leads to someone's death. Currently, drug sellers face life in prison or the death penalty if the drug they sold verifiably caused the death of a consumer, but prosecutors complained it was hard to win convictions in cases involving multiple controlled substances and/or alcohol. Under the new law, prosecutors will only have to show that the drug was a "substantial factor" in the person's death. As the session wound down, legislators also added language that increased mandatory minimum sentences for trafficking between 4 and 14 milligrams of fentanyl and its analogs from three to seven years, and for trafficking between 14 and 28 milligrams of fentanyl to 15 to 20 years. They also stripped out a provision that would have legalized fentanyl test strips, signaling no room for compassion but plenty of space for punishing policies.

Michigan Governor Signs Bills Aimed at Opioid Crisis. Gov. Gretchen Whitmer (D) has signed into law a package of bills that invest $800 million in treatment, prevention, and mental health in response to the opioid crisis. Senate Bills 993, 994, and 995 will handle the disbursement of settlement funds from lawsuits against opioid manufacturers and distributors, as well as creating an Opioid Advisory Committee to help craft policies to prevent, treat, and support people using opioids. "The opioid crisis touches families across our state, which is why it’s so crucial to ensure that Michiganders facing substance use issues have the support and resources they need to get better," said Governor Whitmer. "The legislation I signed today will be instrumental in preventing more deaths and will provide Michigan families impacted by the devastating opioid epidemic with some semblance of relief. These funds will bring millions of dollars to support our neighbors, family, and friends in treatment and recovery. I will continue to work with anyone who wants to help those who are struggling."

Drug Overdose Deaths Hit Another Record High, DE Legal Pot Bill Goes to Governor, More... (5/16/22)

Gavin Newsom attempts to lend a hand to California's embattled legal marijuana growers, Ohioans will have to wait another year to vote on marijuana legalization, the first British drug checking service is set to open, and more.

More than 107,000 people died of drug overdoses last year, the CDC reports. (Creative Commons)
Marijuana Policy

California Governor's Budget Would Give Growers a Break by Eliminating Cultivation Tax. With wholesale marijuana prices cratering and growers screaming for help, Gov. Gavin Newsom (D) has included the elimination of the marijuana cultivation tax in his proposed FY 2022-2023 budget released Friday. That would eliminate one of the four taxes on marijuana—the cultivation tax of $10 an ounce for dry-weight flowers paid by growers, a state excise tax paid by retailers, a local excise tax paid by retailers, and the state sales tax. Despite cutting the cultivation tax, Newsom's budget still includes $670 million in annual funding for services currently funded by marijuana tax revenues. Newsom's proposal must be approved by the legislature and would go into effect July 1 if it is.

Delaware Legislature Approves Marijuana Legalization Bill. With a final vote by the Senate last Thursday, the legislature has approved a marijuana legalization bill, House Bill 371. The bill would legalize the possession of up to an ounce of weed by people 21 and over. But the fate of the bill is uncertain given Gov. John Carney's (D) staunch opposition to legalization, which he has called a "bad idea." If, however, Carney does veto the bill, it would need a three-fifths majority vote in both chambers, which is achievable. But the last time the legislature overrode a gubernatorial veto was 45 years ago.

Ohio Marijuana Legalization Vote Delayed Until 2023. The Coalition to Regulate Marijuana Like Alcohol announced last Friday that it will forego attempting to get a vote on its marijuana legalization initiative this year after state officials agreed to allow the campaign to keep more than 140,000 signatures it had gathered this year and use them to get on the ballot next year. The move came after House Republicans said the group handed in signatures too late to qualify for this year. The group is undertaking an initiated statute campaign under which it gathers enough signatures to place the issue before the legislature and if the legislature does not enact legalization, it would go before voters. But now, it will go before voters next year—provided the campaign comes up with a second round of signatures—not this year.

Overdoses

Drug Overdoses in 2021 at Highest Level on Record According to CDC, Driven by Opioids. The Centers for Disease Control and Prevention (CDC) published data last Wednesday showing that drug overdoses had hit 107,622 in 2021, an all-time high. The figure is 15 percent higher than the previous year and represents a 49 percent increase in overdose deaths since 2019. Synthetic opioids such as fentanyl were implicated in two-thirds of overdose deaths.

International

United Kingdom's First Drug Checking Service to Open This Month. The British Home Office has approved the nation's first drug checking service, where illicit drugs can be tested for purity, strength, and contaminants. The move is aimed at reducing the harms associated with high-risk drug taking and at providing a fuller picture of the illicit drug market. The drug checking will be undertaken by a harm reduction organization called The Loop, working with the Bristol Drugs Project and the People's Republic of Stokes Croft, a community organization. The service is set to begin May 28 and will run once a month, with additional operating hours to be scheduled around significant local events, such as concerts and festivals. 

Schumer Vows Legal Pot Bill Coming This Summer, CO House Passes Fentanyl Felony Bill, More... (4/25/22)

A South Carolina Republican congresswoman who filed a marijuana legalization bill faces an attack by a primary challenger, Alabama Democrats come up with a "Free Weed" website, and more.

Is marijuana legalization coming to the Senate this summer? Stay tuned. (Creative Commons)
Marijuana Policy

Schumer Promises Marijuana Activists Legalization Bill Will Come Before August Recess. Senate Majority Leader Chuck Schumer (D-NY) last Friday promised activists he would file his marijuana legalization bill before the August recess. He and colleagues such as a Sens. Cory Booker (D-NJ) and Ron Wyden (D-NJ) have been working for more than a year on the bill and have blocked incremental reform legislation, such as the SAFE Banking Act, from being considered in the Senate before the legalization bill is taken up. Schumer had earlier vowed to have his bill out by this month, but last week said that was not going to happen. The draft version of his Cannabis Administration & Opportunity Act (CAOA) has been floating around since last summer.

Alabama Democrats Launch "Free Weed" Website to Push Legalization. The state Democratic Party has launched a Free Weed website in a bid to garner support for its effort to legalize marijuana in the state. The website mixes policy advocacy and promotion of the state Democratic Party. It argues that legalizing marijuana would be an economic boon for the state and that arresting and prosecuting people for possession of small amounts of weed is a waste of criminal justice resources. The party rolled the website out on 4/20.

South Carolina Republican Representative Who Sponsored Legalization Bill Faces Call for Drug Test from Primary Opponent. US Rep. Nancy Mace (R-SC), who filed a marijuana legalization bill this year, is now facing a primary opponent, Katie Arrington, who thinks Mace may have been "high" while representing the state and has demanded she submit to a drug test. "While residents of the Lowcountry continue to be crushed by skyrocketing inflation and record high gas prices, Nancy Mace opted to spend 4/20 at a pot conference in Miami rather than with her constituents. Nancy should disclose who paid for this trip (to Miami), and should also take a drug test and make the results public. Maybe then the Lowcountry will understand why she has done nothing to combat the disastrous policies of the Biden administration,” " said Arrington. She also pointed to a recent Huffington Post article where Mace declined to say whether she still used marijuana. The Mace campaign within hours accused Arrington of engaging in "a desperate PR stunt by a desperate campaign."

Opiates and Opioids

Colorado House Passes Bill Making Fentanyl Possession a Felony but With No Prison Time. In an effort to address the opioid overdose crisis, the House last Friday approved House Bill 22-1326, which would make possession of between one and four grams of fentanyl a felony, but with no possibility of a prison sentence. The House approved the bill after fending off an amendment that would possession of any amount of fentanyl a felony. The bill would be a step backward from a 2019 law that made possession of up to four grams of most controlled substances a misdemeanor. The bill now heads to the Senate. 

(This article was prepared by StoptheDrugWar.org's 501(c)(4) lobbying nonprofit, the Drug Reform Coordination Network, which also pays the cost of maintaining this website. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code and does not pay for reporting that could be interpreted or misinterpreted as doing so.

Overdoses Hit Another All-Time High, DE Marijuana Legalization Bills Advance, More... (4/14/22)

Tennessee lawmakers approve a bill allowing retroactive cuts for people sentenced under the state's old school zone drug sentencing enhancement laws, the Pennsylvania Senate has approved a bill protecting banks and insurers who do business with marijuana businesses from being hassled by state regulators, and more. 

More than 106,000 people died of drug overdoses in a 12-month period, the CDC reports. (Creative Commons)
Marijuana Policy

Delaware Marijuana Legalization Bills Advance. After an earlier attempt to pass marijuana legalization foundered, bill sponsor Rep. Ed Osienski (D) tried again, presenting two bills: House Bill 371 would simply legalize the possession of up to an ounce of marijuana and needs only a majority vote to pass. House Bill 372 would tax and regulate marijuana like alcohol and needs three-fifths to pass. House Bill 371 was approved by the House Health and Human Development Committee Wednesday, while House Bill 372 was approved by the House Revenue and Finance Committee.

Medical Marijuana

Pennsylvania Senate Approves Marijuana Banking Bill. The Senate on Wednesday gave final approval to Senate Bill 1167, which would protect banks and insurers from being penalized by state financial regulators for working with state-legal medical marijuana businesses. The bill flew through the Senate, passing through two committees in recent days before passing on a 46-3 vote. The bill now heads to the House. "Federal prohibition has forced the cannabis industry to deal with cash, as proceeds may be considered a federal crime," DiSanto said on the floor on Wednesday, adding that the cash-intensive nature of the existing marketplace "makes dispensaries a target for armed robbery."

Public Health

CDC Reports Yet Another Record Number of Drug Overdose Deaths. The nation's overdose crisis continues, with the Centers for Disease Control and Prevention (CDC) reporting Wednesday that according to new provisional data, 106,854 people died of drug overdoses in the 12-month period ending in November 2021. Overdose deaths jumped 16 percent over the previous 12-month period and have more than doubled since 2016. Synthetic opioids, predominantly fentanyl, were implicated in about two-thirds of those deaths over the past year. But the number of deaths from stimulants has also nearly doubled in the past two years. Five states accounted for one-third of all overdose deaths: California, Florida, Pennsylvania, Ohio, and Texas.

Sentencing Policy

Tennessee Lawmakers Approve Bill Allowing People Imprisoned for School Zone Drug Offenses to Seek Sentence Cuts. With final votes in the House and Senate this week, lawmakers have approved House Bill 1449, which would allow people sentenced to long prison terms under the state's draconian school zone sentencing enhancement laws to go to court to seek shorter sentences. Since the 1980s, anyone caught selling drugs withing 1,000 feet of a school, park, daycare, public library, or recreation center faced long years in prison. Last year, legislators approved a bill to shrink the zone to 500 feet and give judges the discretion not to add extra years if they don't think children were put in danger. But there were 300 people already stuck in prison under the old rules, and this bill makes updated sentencing criteria retroactive. The bill now goes to the desk of Gov. Bill Lee (R), who has not said whether he would sign the legislation, but who ran on a platform of criminal justice reform and has already offered to fast-track clemency applications for those still doing time under the old law. 

SD Marijuana Legalization Advances, Congress Extends Fentanyl Analog Criminalization Again, More... (2/18/22)

the latest victim of the drug war (Creative Commons)
Marijuana Policy

Kentucky Democrats Roll Out Marijuana Legalization Bill. A group of Democratic lawmakers on Thursday rolled out a bill that would legalize sales, expunge marijuana crimes, treat people with medical marijuana, and tax sales for recreational use. They are calling it the "L.E.T.T.'s GROW" act (Senate Bill 186). If passed, it would create a Cannabis Control Board of seven members to establish regulations from seed to sale. The state hasn't managed to get even a medical marijuana bill passed yet, but the Democrats say legalization's economic benefits could make it attractive.

South Dakota Marijuana Legalization Bill Wins Committee Vote. The Senate Commerce and Energy Committee voted 5-3 Thursday to approve Senate Bill 3, which would legalize marijuana in the state. The bill would legalize the possession of up to two ounces by people 21 and over, but possession of between four ounces and one pound would be a misdemeanor and possession of more than one pound would be a Class 5 felony. There is no provision for home cultivation. The state Department of Revenue would be responsible for regulating the adult-use program and promulgating rules related to issues such as transportation and registration. State voters approved marijuana legalization in 2020, only to see it overturned by the state Supreme Court.

Medical Marijuana

South Dakota Tribe Aids Legal Defense of Customers Arrested by State, Local Police. The Flandreau Santee Sioux Tribe reported this week that more than a hundred people who have tribal medical marijuana cards have been arrested since it opened the state's first dispensary last year. State officials do not recognize cards issued by the tribe, and local police departments have arrested non-tribe members carrying cards and medical marijuana. "They're taking the cards and handing out fines," Tribal chairman Tony Reider said. "But most we don't know about, because most people are just paying the fines." Last year, the tribe promised to aid customers facing legal problems, and this week, it said it is currently engaged in defending at least 10 active marijuana cases involving non-members. "I don't think the state has the authority to revoke a license issued by another jurisdiction," said tribal Attorney General Seth Pearman.

Opioids

Congress Extends Trump-Era Fentanyl Analog Criminalization for Sixth Time. A group of leading civil rights advocates, grassroots community leaders, and policy experts strongly criticized the inclusion of a provision in the stopgap spending bill passed by Congress that would extend the temporary classification of fentanyl-related substances as Schedule I drugs, opting for indiscriminate criminalization over proven public health solutions. The temporary order will now last until March 11. Congress has repeatedly acted to extend it instead of investing in public health and harm reduction solutions, and President Biden is advocating for making the classification permanent -- despite promising real criminal justice reform.

International

US Suspends Mexican Avocado Exports Over Drug Cartel Threats. The US government has banned all imports of Mexican avocados after an agricultural inspector was threatened by a suspected drug cartel enforcer. Control of the avocado trade in Michoacan is contested by growers and differing drug trafficking cartels, especially the Jalisco New Generation Cartel. The threat came last Saturday via text message, one day before Mexican growers launched an expensive Superbowl ad. Guacamole lovers, act now! Prices could rise.

CDC Prepares New Opioid Prescribing Guidelines, OH Senate Won't Take Up Legalization Voter Init, More... (2/10/22)

The South Carolina Senate approves a medica marijuana bill, a new Rand study tracks opioid prescribing declines, and more.

Opioid pain prescribing practices are in the news. (Creative Commons)
Marijuana Policy

Ohio GOP Senate Leader Says He Will Not Bring Marijuana Legalization Initiative to a Vote. State Senate President Matt Huffman (R-Lima) says he will not bring the Coalition to Regulate Marijuana Like Alcohol's marijuana legalization initiative to a vote in the Senate. Under Ohio law, petitioners who collect the requisite number of valid voter signatures for a ballot initiative then place the proposal before the legislature, which has four months to act on it. If the legislature refuses to act on the proposal or rejects it, petitioners can undertake a second round of signature gathering and, if successful, present the issue to directly to the voters.

"I don't want anybody to misunderstand my position," Huffman said. "I'm not going to bring it to the Senate floor. And if that means people want to go put it on the ballot, have at it." While the Coalition has yet to comment on Huffman's remarks, it has previously indicated it will indeed proceed to that second round of signature gathering. They will need to come up with 132,887 valid voter signatures to make the November ballot.

Medical Marijuana

South Carolina Senate Approves Medical Marijuana Bill. After the debate on medical marijuana made it to the Senate floor last week, the Senate on Wednesday approved the South Carolina Compassionate Care Act (Senate Bill 150). The bill gets a final vote in the Senate Thursday, before heading to the House, where its fate is unclear. Whether House Speaker Jay Lucas (R) will let the bill move in his chamber remains uncertain. And Gov. Henry McMaster (R) remains noncommittal on whether he would sign the bill, saying "that would depend on a lot of things."

Opioids

Opioid Prescribing Declines, but Cuts Are Not Uniform Across Locations, Age Groups, or Type of Prescriber. The volume of prescription opioids dispensed from retail pharmacies declined by 21% from 2008 to 2018, but the decline was not uniform across geographic areas, among types of patients, or by type of prescriber, according to a new RAND Corporation study. The study, published by the Annals of Internal Medicine, is the first to examine the decline in opioid prescriptions filled at retail pharmacies based on both volume and potency of the drugs dispensed.

The study found that over the study period, per capita MME (morphine milligram equivalents) volume declined the most in metropolitan counties (more than 22%) and in counties with higher rates of fatal opioid overdoses (a 35% decline). Substantial variation existed both within and across states. In some states, MME volume per capita increased in multiple counties. In many other states, there were both counties with increases and others with substantial decreases. Counties that experienced substantial decreases in per capita MME often were adjacent to counties with per capita increases.

Most clinical specialties recorded declines in the MME volume per practicing clinician. The greatest decrease in MME volume per practicing clinician was among adult primary care physicians (40% decline) and pain specialists (15% decline) -- the clinicians with the highest MME volume per clinician in 2008 -- 2009. The greatest percentage decrease was among emergency physicians (71% decline) -- clinicians who are likely prescribing opioids predominantly to patients experiencing acute pain in acute care settings.

"These results suggest the effects of clinician and policymaker efforts to reduce opioid prescribing have affected populations differently," Stein said. "Future efforts to enhance clinically appropriate opioid prescribing may need to be more clinically nuanced and targeted for specific populations."

CDC Proposes New, Slightly Looser Opioid Prescribing Guidelines. The Centers for Disease Control and Prevention (CDC) on Thursday released new draft guidelines for prescribing opioids for pain relief. The new guidelines remove previously recommended ceilings on doses for chronic pain patients, leaving it instead for doctors to use their own best judgment. But they also urge doctors to first resort to "nonopioid therapies" for both chronic and acute pain.

The new guidelines are the first comprehensive revisions of the CDC's 2016 guidelines, and attempt to find the proper balance between alleviating severe pain and exposing patients to the perils of opioids. The new guidelines have now been published in the Federal Register and are open for comments. Comment here.

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