In its latest move to confront the rapidly rising incidence of overdose deaths and other deleterious consequences of the combination use of the veterinary tranquilizer xylazine ("tranq") and fentanyl, the Biden administration on Tuesday released a National Response Plan to coordinate a whole-of-government approach to the threat.

The plan calls for a public health campaign of increased testing and treatment and more data collection to see how the drug combo spreads and contributes to overdose numbers. But it also calls for looking into whether to schedule xylazine and includes the reflex resort to law enforcement to try to suppress supply.

This is just the latest in a series of steps the administration has taken since late last year to address the emerging phenomenon. Last December, Office of National Drug Control Policy (ONDCP -- the drug czar's office) head Dr. Rahul Gupta hosted a listening session with public health and public safety leaders and subject matter experts from several states and territories about trends they are seeing related to xylazine and efforts to address these trends. In January, Dr. Gupta convened the Evolving and Emerging Threats Committee to discuss the emergence of fentanyl adulterated with xylazine in the illicit drug supply.

In February, the Food and Drug Administration took action to restrict the unlawful entry of xylazine active pharmaceutical ingredients and finished dosage form drug products into the country and in March, the Drug Enforcement Administration issued a public safety alert to warn the American public of a sharp increase in the trafficking of fentanyl mixed with xylazine. In April, Dr. Gupta named the xylazine-fentanyl combination an emerging public health threat, the first time such a designation has been used since Congress authorized it in 2018.

"Since we announced the emerging drug threat earlier this year, we've been working tirelessly to create the best plan of attack to address this dangerous and deadly substance head-on," said Dr. Gupta in a statement. "Now, with this National Response Plan, we are launching coordinated efforts across all of government to ensure we are using every lever we have to protect public health and public safety, and save lives. As a doctor, I have seen the devastating consequences of xylazine combined with fentanyl firsthand. And as President Biden's drug policy advisor, I am laser-focused on finding every tool we have and following the best evidence-based practices to take on this new challenge. This will be an all-hands-on-deck effort -- but I am confident we can take action together and eradicate this emerging threat."

Fentanyl first emerged as a significant actor in the illicit drug market in the early to mid-2010s, while xylazine entered the scene in the late 2010s. Now, xylazine has been detected in nearly every state in the country, and xylazine-involved overdose deaths are skyrocketing, albeit from very low initial levels. The Centers for Disease Control and Prevention (CDC) reported last month that the monthly percentage of fentanyl deaths with xylazine detected jumped from 2.9 percent in January 2019 to 10.9 percent in June 2022. CDC also found that the death rate from xylazine overdoses jumped 35-fold from 2018 to 2021.

Xylazine is a tranquilizer, not an opioid, and thus does not respond to opioid overdose reversal drugs such as naloxone. It also has other serious potential health effects, including wounds that may eventually require amputations, as well as breathing difficulties.

"If we thought fentanyl was dangerous, fentanyl combined with xylazine is even deadlier," Dr. Gupta said in a press call previewing the plan Monday.

But he warned that the plan will need Congress to step up with funding if it is to be be fully implemented. He noted that the Biden administration Fiscal Year 2024 budget request includes funding for emerging threats.

"We will do what we can with what we have until we get the resources from Congress," Dr. Gupta said. "It's a matter of utilizing what we have right now in order to save lives while we're encouraging Congress to pass the president's budget and provide those resources as quickly as possible. We're going to move ahead as quickly as possible because the fact is that lives are on the line."

White House holds summit on reducing overdose toll, Nevada psychedelic study bill goes to governor, and more.

Marijuana Policy

New Coalition of Major Marijuana Groups Launches Push for Scheduling Reform. A new coalition of marijuana companies and advocacy groups calling itself the Coalition for Cannabis Scheduling Reform announced Tuesday that it is launching a campaign to reschedule marijuana even as it pushes for full-on legalization. The group will work with advocates, stakeholders, lawmakers and administration officials to promote education about the need to remove marijuana from Schedule I of the Controlled Substances Act (CSA).

That is a less bold position than that held by advocacy groups calling for outright legalization, but the coalition says that moving marijuana to Schedules III, IV or V of the CSA would still represent "historic progress." that shouldn’t be discounted.

The coalition includes Acreage Holdings, American Trade Association for Cannabis & Hemp (ATACH), Columbia Care, Cresco Labs, Curaleaf, Dutchie, Green Thumb Industries, Marijuana Policy Project, National Cannabis Roundtable, Scotts Miracle-Gro, US Cannabis Council, Weldon Project, and Vicente LLP.

Advocates of full-on legalization warn that placing marijuana in another, less restrictive schedule (as opposed to completely descheduling it) could wreak havoc in existing legal marijuana markets and lead the way to further big business consolidation within the industry.

Psychedelics

Nevada Assembly Approves Psychedelic Task Force Bill. A bill to create a working group to study psychedelics and develop plans to allow for regulated access for therapeutic purposes that has already passed the Senate, Senate Bill 242, passed  the Assembly on Sunday. When introduced, the bill had language legalizing psilocybin and promoting research into the psychedelic, but it was amended in the Senate to now have only the working group, which would examine the use of psychedelics "in medicinal, therapeutic, and improved wellness." The bill now goes to the desk of Gov. Joe Lombardo (R).

Drug Policy

At White House Summit, Biden Administration Vows Renewed Effort to Fight Drug Overdoses. At a White House summit held jointly with public health officials from Canada and Mexico, the Biden administration vowed to improve its fight to combat drug overdoses, which took 109,000 lives last year. Administration officials pledged a multifaceted approach to tackling illicit drugs, especially fentanyl.

"Today's summit is needed because the global and regional drug environment has changed dramatically from just even a few years ago," Rahul Gupta, director of the White House Office of National Drug Control Policy (ONDCP, the drug czar's office), told the summit. "Synthetic drugs have truly become a global threat," he added. "Today, we're here to ... look at how our collective response can be improved, and the role data collection has on saving lives," Gupta said.

International

Taliban Opium Ban Is Taking Hold. An April 2022 prohibition on opium-growing from Taliban leader Hibatullah Akhundzada did not result in significant reductions in cultivation last year, but this year is different. The BBC traveled the country, consulted with farmers, government ministers, and experts, and used satellite analysis to report the following:

"The Taliban leaders appear to have been more successful cracking down on cultivation than anyone ever has. We found a huge fall in poppy growth in major opium-growing provinces, with one expert saying annual cultivation could be 80% down on last year. Less-profitable wheat crops have supplanted poppies in fields - and many farmers saying they are suffering financially."

"It is likely that cultivation will be less than 20% of what it was in 2022," said Afghanistan drug trade expert David Mansfield. "The scale of the reduction will be unprecedented. The high resolution imagery of Helmand province shows that poppy cultivation is down to less than 1,000 hectares when it was 129,000 hectares the previous year," said Mansfield, noting that would be a 99 percent reduction in the crop in that formerly key opium-producing province.

Farmers aren't happy, though: "You're destroying my field, God destroy your home," one woman shouted angrily at a Taliban eradication unit as they razed her poppy field.

San Francisco's mayor is ready to roll out a pilot program to arrest public drug users, yet another federal bill aimed at the fentanyl trade gets filed, and more.

Marijuana Policy

New Hampshire Poll Has Strong Support for Marijuana Legalization. After Gov. Chris Sununu (R) last week signaled he was now open to marijuana legalization and as the legislature for the last time this session attempts to pass a marijuana legalization bill, a new Granite State poll shows strong popular support for doing just that. The poll had 72 percent supporting legalization -- 52 percent strongly and 20 percent somewhat -- and only 21 percent opposed -- 13 percent strongly and eight percent somewhat. Seven percent were neutral.

Opiates and Opioids

Federal Fentanyl Bill Would Get US Military Involved. The ongoing fentanyl crisis has generated yet another bill in Congress, this one led by Sens. oni Ernst (R-IA) and Tim Kaine (D-VA) in the Senate and Reps. Stephanie Bice (R-OK) and Salud Carbajal (D-CA) in the House of Representatives. The Disrupt Fentanyl Trafficking Act of 2023 would:

• Declare fentanyl trafficking a national security threat stemming from drug cartels in Mexico,
• Direct the Pentagon to develop a fentanyl-specific counter-drug strategy, including enhanced cooperation with Mexican defense officials,
• Require the Secretary of Defense to increase security cooperation with the Mexican military, and
• Address coordination efforts between the military and federal law enforcement agencies.

Drug Policy

San Francisco to Set Up Pilot Program to Arrest Public Drug Users. On Tuesday, the city's Department of Emergency Management confirmed that a pilot program that would allow police to arrest people using drugs in public and "address situations when someone is so far under the influence of drugs that they may pose a danger to themselves or others" will be part of Mayor London Breed's budget proposal due June 1.

The move came just hours before Breed was forced to cut short a UN Plaza news conference on the topic as she faced protestors and heckling, including one protestor who threw a brick, injuring a teenager.

Breed's approach to the rising clamor over public drug use and disorder is drawing critics not only in the street but on the Board of Supervisors. Supervisor Dean Preston called the pilot program "reactionary, cruel and counterproductive."

Harm Reduction

New York Safe Injection Site Bill Wins Committee Vote. The Senate Health Committee on Tuesday approved a bill to authorize the establishment of state-approved safe injection sites, S. 00399. Companion legislation is also moving in the Assembly. The bill would require the Department of Health to authorize at least one safe injection site with medical personnel on hand that also must provide syringe exchange services, educate clients on safe consumption practices, provide naloxone to reverse opioid overdoses and collect aggregate data on participants and their experiences. Staff and participants would be given immunity from prosecution for the sanctioned activities.

"Harm reduction works. Harm reduction is a modality -- a way to approach dealing with an issue which assumes, first, that a person who uses drugs is a person, and that they have to be met where they are," bill sponsor Sen. Gustavo Rivera (D) said at the hearing. "Fact number two, criminalization has not worked. Over decades of the drug war, it is pretty clear that we have lost said war," he said. "The notion that we could arrest our way out of addiction -- that we could arrest our way out of overdoses and deaths -- has been proven to be a lie based on all of these years of experience. Criminalization does not work."

Two city-sanctioned safe injection sites in New York City have been operating since the end of 2021.

A major civil and human rights group comes out against one federal fentanyl bill, bipartisan senators and representatives file another one, and more.

Marijuana Policy

Minnesota Marijuana Legalization Bill Ready for Final Votes This Week. House and Senate conference committee negotiators have resolved the remaining differences between the House and Senate marijuana legalization bills and ready to send the final bill to floor votes in both chambers this week. The final sticking points were on the marijuana tax rate and appropriating revenue. Negotiators agreed to the 10 percent retail sales tax in the Senate bill (the House had voted for 8 percent to be adjusted every two years) and agreed that 80 percent of marijuana revenues will go to the state and 20 percent to local governments to cover expenses related to implementing legalization.

Medical Marijuana

Nebraska Activists File Papers for 2024 Medical Marijuana Initiative. The group Nebraskans for Medical Marijuana has filed papers to mount petition drives to put a pair of medical marijuana initiatives on the 2024 ballot. One would set up the doctor/patient system, while the other would regulate the industry. Activists have been trying for eight years to get the legislature to pass a medical marijuana bill, to no avail. Last year, a signature-gathering effort for a medical marijuana initiative came up short because financial problems blocked the group from hiring professional petitioners.

"We have no choice but to keep petitioning our government," said group spokeswoman Crist Eggers. "The legislature refuses to act despite the will of over 80% of Nebraskans, from all parties, regions, ages, etc., supporting this."

Asset Forfeiture

New York Senate Committee Passes Bill to End Civil Asset Forfeiture and Opt State Out of Federal Forfeiture Program. The Senate Codes Committee on Monday approved a bill that would end civil asset forfeiture, Senate Bill 2192. Under the bill filed by Sen. Jamaal Bailey (D) forfeiture could only occur if the "prosecuting authority secures a conviction of a crime that authorizes the forfeiture of property and the prosecuting authority establishes by clear and convincing evidence the property is an instrumentality of or proceeds derived directly from the crime for which the state secured a conviction." The bill would also address "policing for profit" by requiring that forfeiture proceeds go to the state general fund. Currently, the seizing agency gets to keep up to 60 percent of the proceeds. And the bill would opt the state out of the federal "equitable sharing" program that allows law enforcement agencies to skirt state asset forfeiture laws by handing cases off to the feds, who then return most of the money to the seizing agency. The bill now heads to the Senate Finance Committee.

Drug Policy

Bipartisan Bill Aims to Counter National Security Threat of Illicit Drug Trafficking. US Reps. Salud Carbajal (D-CA) and Stephanie Bice (R-OK) and Sens. Joni Ernst (R-IA) and Tim Kaine (D-VA) are leading a bipartisan effort directing increased federal attention to fentanyl trafficking by utilizing the tools of the Department of Defense (DoD) and involving Mexico as an active partner to combat this crisis and disrupt drug cartel and trafficking activity.

The Disrupt Fentanyl Trafficking Act of 2023 would attempt to address cross-border drug trafficking by:

• Declaring fentanyl trafficking a national security threat stemming from drug cartels and smugglers,
• Directing the Pentagon to develop a fentanyl-specific counter-drug strategy, including enhanced cooperation with foreign nations,
• Requiring the Secretary of Defense to increase security cooperation with the Mexican military, and
• Addressing coordination efforts between the military and federal law .enforcement agencies.

Leadership Conference on Civil and Human Rights Opposes HALT Fentanyl Act. The Leadership Conference on Civil and Human Rights on Wednesday sent a letter to the House leadership to express its "strong opposition" to H.R. 467, the HALT Fentanyl Act.

"This bill permanently schedules fentanyl-related substances (FRS) on schedule I of the Controlled Substances Act (CSA) based on a flawed class definition," the letter says. "Additionally, it imposes mandatory minimums and fails to provide an offramp for removing inert or harmless substances from the drug schedule. The class wide scheduling that this bill would impose would exacerbate pretrial detention, mass incarceration, and racial disparities in the prison system, doubling down on a fear-based, enforcement-first response to a public health challenge. Under the class wide control, any offense involving a "fentanyl-related substance" is subject to federal criminal prosecution, even if the substance in question is helpful or has no potential for abuse."

The Leadership Conference represents more than 230 national organizations.

International

Singapore Executes Marijuana Offender for Second Time in Three Weeks. For the second time in three weeks, Singapore has hung a man for trafficking marijuana. The unnamed 37-year-old Malay Singaporean was executed at dawn Wednesday at Changi Prison for trafficking about 3.3 pounds of pot. On April 26, Singapore executed Tangaraju Suppiah, 46, for trafficking 2.2 pounds of pot despite an international outcry. Under Singapore law, trafficking more than 1.1 pounds of pot can garner a death sentence. The city-state halted all executions during the coronavirus pandemic, but hanged 11 people last year -- all for drug offenses.

"If we don't come together to stop it, we fear that this killing spree will continue in the weeks and months to come," said Kokila Annamalai of the Transformative Justice Collective, which campaigns for the abolition of the death penalty in Singapore.