Congress has passed a bill to legalize hemp, the CDC issues a new report on overdose deaths, St. Vincent and the Grenadines legalizes medical marijuana, and more.

Fentanyl is now the leading drug implicated in overdose deaths, according to the CDC. (Creative Commons)

Colorado Senator Seeks to Add Marijuana Amendment to Criminal Justice Bill. Sen. Cory Gardner (R-CO) will try to add an amendment to the pending prison and sentencing reform bill that would effectively end federal marijuana prohibition. Gardner seeks to add his STATES Act (S.3032) as the amendment. That would allow states to implement their own pot laws without fear of federal interference.

California Regulators Issue Final Version of Regulations. California marijuana regulations are now set after regulators issued their third and final version of the rules. Among the highlights: Deliveries will be allowed statewide, contract manufacturing will be allowed (licensed companies make and package products for unlicensed companies), and regulations for childproof packaging have changed to place the burden on retailers.

St. Paul City Council Backs Resolution To Legalize Recreational Marijuana. Minnesota's second largest city now officially supports marijuana legalization. The city council voted 6-1 Wednesday to support a resolution calling for it. Governor-Elect Tim Walz (DFL) is also down with the idea.

Medical Marijuana

Nebraska Medical Marijuana Initiative Campaign Gets Underway. Two state senators, Anna Wishart, and Adam Morfeld, both Democrats from Lincoln, announced Thursday that they had created a campaign committee to put a medical marijuana constitutional amendment on the 2020 ballot. The committee is Nebraskans for Sensible Marijuana Laws.

Industrial Hemp

Congress Approves Industrial Hemp Legalization. Hemp, hemp, hooray! With a final vote in the House on Wednesday, the 2018 Farm Bill, complete with a provision legalizing domestic hemp production, was approved by Congress and now heads for the president's desk. The bill clears the way for American farmers to participate in what is already a billion-dollar domestic hemp industry that is currently reliant on foreign imports.

Opioids

Fentanyl Now the Most Common Drug in Fatal Overdoses, CDC Reports. Fentanyl is now the most commonly used drug involved in drug overdoses, according to a new report from the Centers for Disease Control and Prevention. Fentanyl was involved in more than 30,000 overdose deaths, while second place heroin was implicated in more than 27,000 deaths. There were some 63,000 overdose deaths in 2016, many of them involving multiple substances.

International

Saint Vincent and the Grenadines Pass Medicinal Marijuana Bill. Saint Vincent and the Grenadines (SVG) has become the first Organization of Eastern Caribbean States Member State to decriminalize marijuana for medical purposes and scientific research. "There is broad recognition and buy-in of the economic benefits this tightly controlled and regulated industry is expected to bring in terms of direct employment, the creation of support industries and foreign investment," said Agriculture Minister Saboto Ceaser.

A new report on illicit US drug markets from researchers at the University of San Francisco has found that that the spread of fentanyl, a powerful synthetic opioid implicated in nearly 29,000 overdose deaths last year alone, is tied to enforcement-driven shortages of heroin and prescription opioids, as well simple economics for drug distributors -- not because users particularly desire the drug.

meet the law of unintended consequences (Creative Commons)

From a drug distributor's perspective, fentanyl is a most excellent substitute for heroin or prescription pain pills. Produced entirely in labs or chemical factories, it is far more powerful and cheaper to produce than heroin. Because it's more potent, it is easier to smuggle -- often coming into the US via postal and delivery service parcels, not by the semi load. And it doesn't require months of growing time and period of intense peasant labor in lawless regions of weak states.

Fentanyl is typically sold deceptively -- marketed as heroin or prescription drugs such as OxyContin or Xanax -- and users and street-level dealers often don't even know that the drugs they are using or selling contain fentanyl, the researchers found. Fentanyl is making its way into the supply chain at the wholesale, not the retail level. That, the researchers said, suggests that demand is not the key driver in the drug's spread.

"Fentanyl is rarely sold as fentanyl," said Sarah Mars, PhD, a researcher in the Department of Family and Community Medicine at UCSF. "The dealers selling fentanyl directly to the users often don't know what's in it. Not only is this particularly dangerous, but it also means penalizing low-level dealers isn't going to make any difference in the fentanyl poisoning epidemic."

According to Mars, users are split on fentanyl, which produces a more sudden and powerful high than heroin, but one that fades faster. Some said fentanyl brought back the euphoria they had lost the ability to feel with long-term heroin use, but others said they feared fentanyl and found its effects too harsh.

"Whether or not they prefer fentanyl, users don't have any influence over what drugs are being sold," Mars said. "Without accurate information about these drugs, they can't make an informed choice about what they are buying. Also, very little drug slang has developed to describe fentanyl, which lends support to the notion that this is not a demand-driven epidemic."

The presence of drugs adulterated with fentanyl is uneven, Mars said.

"Most of the illicit fentanyl has been in the Northeast and Midwest," she specified. And that's where opioid overdose death rates are the highest.

Another contributing factor to the fentanyl overdose toll is that it has dozens of analogs with wildly varying potency. Some, like carfentanil, are amazingly powerful, as much as 10,000 times as potent as morphine. Some are so new they have not yet been made illegal.

"We believe it's the fluctuation in the potency of the drugs containing fentanyl that makes them so dangerous," said Daniel Ciccarone, MD, MPH, a professor of family and community medicine at UCSF and senior author of an ongoing National Institutes of Health-funded study, Heroin in Transition. "You might have one dose that had hardly any fentanyl in it or none at all. Then, you might have one with a different fentanyl analog, of different potency, or even mixtures of multiple fentanyls and heroin."

Here is the paradox of drug prohibition: Trying to crack down on drugs tends to lead not to less drug use but to more dangerous drugs, and in the case of opioids, tens of thousands of dead drug users. There is an inexorable logic at play: The more law enforcement comes down on a drug, the greater the tendency for suppliers to make it more potent and compact -- and dangerous.

Perhaps that's why we now see mainstream calls for a radically different approach, such as the one from Washington Post columnist Megan McArdle earlier this week. In her column "The Incredibly Unpopular Idea That Could Stem Heroin Deaths," McArdle argues that current drug policy is only running up the overdose death toll and that we need "to start talking about ways to make safe, reliable doses of opiates available to addicts who aren't ready to stop."

That would involve increasing access to opioid substitutes such as methadone and buprenorphine, "but lowering the death toll may require a more drastic step: legalizing prescriptions of stronger opiates," McArdle writes.

"Prescription heroin?" she continues. "Remember, I said you might not like the solution. I don't like it, either -- and frankly, neither do the drug policy researchers who told me it may be necessary. But when fentanyl took over the US illicit drug markets, it also got a lot of addicts as hostages. We'll never be able to rescue them unless we can first keep them alive long enough to be saved."

There is a better way to deal with the opioid crisis than relegating tens of thousands of American opioid users to early, preventable deaths. We know what it is. Now it's a matter of implementing smarter, more humane policies, and that's an ongoing political struggle -- one where lives are literally at stake.

There's a bunch of medical marijuana news today, and President Trump misstates a Chinese position on fentanyl.

The president was unclear on just what China promised regarding fentanyl and synthetic opioids. (Gage Skidmore/Creative Commons)

Minnesota Adds Alzheimer's to List of Qualifying Conditions. The state Department of Health announced Monday that it was adding the degenerative neurological disorder to the medical marijuana program, despite concerns about the effectiveness of treatment with marijuana. "Any policy decisions about cannabis are difficult due to the relative lack of published scientific evidence," said state Health Commissioner Jan Malcolm. "However, there is some evidence for potential benefits of medical cannabis to improve the mood, sleep and behavior of patients suffering from Alzheimer’s disease." Minnesota will become the 13th state to okay medical marijuana for Alzheimer's.

Pennsylvania to Consider Adding Qualifying Conditions. The state Medical Marijuana Advisory Board has approved a new process for expanding the state's list of qualifying conditions for medical marijuana and in coming weeks will begin accepting petitions for new qualifying conditions to be added to the list. Patient advocates are expected to petition for conditions such as depression, anxiety, and insomnia, among others.

Utah's Voter-Approved Medical Marijuana Law Amended. Lawmakers on Monday passed sweeping changes to the state's voter-approved medical marijuana law and Gov. Gary Herbert (R) immediately signed them into effect. The changes ban many marijuana edibles, prevent people from growing their own marijuana if they live far from a dispensary, and narrow the list of eligible medical conditions for which the drug can be obtained. Smoking medical marijuana wasn't allowed under the original ballot measure and still isn't. Opponents of the meddling with measure said the changes will create major obstacles for patients and are planning to sue to block the changes. "It's an almost complete disregard for the will of the people," attorney Rocky Anderson said.

Foreign Policy

Trump Misstated Changes in China's Fentanyl Policy. This past weekend, President Trump claimed he had persuaded the Chinese to make fentanyl a controlled substance, but he was mistaken. Fentanyl is already a controlled substance in China. What the Chinese announced was that they would shift the way it regulates synthetic opioids. Now, "China has decided to list all the fentanyl-like substances as controlled substances and start working to adjust related regulations," China's foreign ministry clarified.

New York City marijuana possession arrests plummet (finally), Utah patients will have some legal protection beginning next month, federal fentanyl sentences just increased, and more.

a lethal dose of fentanyl (DEA.gov)

Michigan US Attorneys Warn That Federal Prohibition Remains in Force. In a joint statement released Thursday, US Attorneys for Michigan Matthew Schneider and Andrew Birge warned that even though voters there legalized marijuana on Tuesday, "marijuana continues to be an illegal drug under federal law" and that they "will not unilaterally immunize anyone from prosecution for violating federal laws simply because of the passage of Proposal 1." That said, the federal prosecutors then conceded "our offices have never focused on the prosecution of marijuana users or low-level offenders" and that "as we weigh the interests in enforcing a law, we must also consider our ability to prosecute with our limited resources."

Arrests for Low-Level Marijuana Possession have Decreased 90 Percent Following New NYPD Marijuana Guidelines. Arrests for low-level marijuana possession have plummeted 90 percent since new NYPD marijuana enforcement guidelines took effect in September. There were 151 arrests for low-level marijuana in the entire city of New York in September 2018, less than 10 percent of the 1,500+ arrests last September and 3 percent of the 4,300+ arrests that took place in September 2010. However, racial disparities in enforcement still persist, with Blacks and Latino people comprising around 80 percent of the 1,000 summonses issued for marijuana.

Medical Marijuana

Utah Patients Will Have Legal Protections Beginning December 1. Although it could take months or years for the state to get a medical marijuana cultivation and distribution system up and running, medical marijuana patients will win some protections from arrest and prosecution beginning on December 1. That's because the Prop 2 initiative approved by voters includes an "affirmative defense" provision protecting them from a criminal conviction. It doesn't explicitly protect patients from arrest, but the hope is that with little likelihood of a successful prosecution, police will have little incentive to actually arrest patients.

Heroin and Prescription Opioids

Harsher Federal Penalties for Selling Fentanyl-Laced Drugs Are Now in Effect. New federal sentencing guidelines that went into effect November 1 significantly increase the possible prison sentence faced by people who sell heroin or cocaine laced with fentanyl. The new guidelines "create a four-level enhancement for a defendant who knowingly misrepresents or knowingly markets as another substance a mixture containing fentanyl or a fentanyl analog," which translates into sentences nearly twice as long as previously. While the guidelines only apply to someone who intentionally sought to deceive buyers, the realities of the federal criminal justice system -- where the vast majority of cases end with plea bargains -- mean that prosecutors will rarely have to prove the intent to deceive.