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NE MedMJ Activists Take Aim at 2022, Study Finds Heroin, Fentanyl Use Up During Pandemic, More... (10/16/20)

Virginia's governor signs a minor marijuana reform bill into, the Mexican government has captured a major cartel leader, heroin and fentanyl use is up during the pandemic, and more. 

Fentanyl use has gone up during the COVID pandemic, data from Quest Diagnostics shows. (Creative Commons)
Marijuana Policy

Virginia Governor Signs Marijuana Reform Bill into Law. Gov. Ralph Northam (D) has signed into law a bill, SB 5013, that will allow people to issued summonses for decriminalized marijuana possession to prepay their fines rather than having to show up in court. Other marijuana-related bills are still alive in the session, including one already on the governor's desk that would bar police from conducting searches bases solely on the odor of marijuana and a set of competing expungement proposals that are now in conference committee.

Medical Marijuana

Nebraska Medical Marijuana Legalization Activists Get Working on 2022. After qualifying for the 2020 ballot and then getting stiffed by the state Supreme Court, which held that the initiative embraced more than one subject, the two state senators who lead Nebraskans for Medical Marijuana Anna Wishart and Adam Morfeld, recently filed new petition language with Secretary of State Bob Evnen for voters to consider for the 2022 ballot. The new language is simple and straightforward: "Persons in the State of Nebraska shall have the right to cannabis in all its forms for medical purposes." Now, they will have to recreate the successful 2020 signature-gathering campaign to get back on the ballot in 2022.

Drug Policy

Quest Diagnostics Health Trends Study Finds Fentanyl and Heroin Misuse Skyrockets During COVID-19 Pandemic. A new Quest Diagnostics Health Trends study indicates that misuse of fentanyl, heroin and nonprescribed opioids are on the rise, potentially due to the COVID-19 pandemic's impact on healthcare access and support for individuals most at-risk for substance use disorder. The full study, from researchers at Quest Diagnostics and published online in the peer reviewed journal Population Health Management, can be found here. The researchers compared testing positivity rates for January 1, 2019-March 14, 2020 and March 15-May 16, 2020 (during the onset of the COVID-19 outbreak). Among individuals tested, the drug positivity rate increased 35% for non-prescribed fentanyl and 44% for heroin during the pandemic compared to the period prior to the pandemic. Nonprescribed opioids also increased, by 10%. The study also found a massive surge in the positivity rate of drug combining with non-prescribed fentanyl during the pandemic compared to prior to the pandemic. Positivity for non-prescribed fentanyl increased substantially among specimens that were also positive for amphetamines (by 89%), benzodiazepines (48%), cocaine (34%), and opiates (39%; P <0.01 for all comparisons).

International

Mexico Captures Major Cartel Leader. Mexican security forces have captured the head of the Santa Rosa de Lima Cartel, Guanajuato Gov. Diego Sinhue announced Wednesday night. Adan Ochoa, known as "El Azul," rose to lead the cartel after the capture of its former leader Jose Antonio Yepez, known as "El Marro." The cartel has been involved in violent conflict with the Jalisco New Generation Cartel over which will control the drug trade in the central Mexican state.

Mexico Illicit Drug Prices Rising, OR Regulators Allow Curbside Pot Sales, More... (3/24/20)

States grapple with marijuana sales during a time of crisis, Ghana legalizes hemp and CBD, Mexican traffickers facing chemical shortages are raising prices, and more.

Meth and fentanyl from Mexico are about to get more expensive thanks to the coronavirus crisis. (Warner Robbins, GA, PD)
Marijuana Policy

Massachusetts Governor Shutters Recreational Pot Shops, Lets Medical Marijuana Outlets Remain Open. Gov. Charlie Baker (R) has ordered recreational marijuana outlets to close during the coronavirus crisis but has spared medical marijuana dispensaries. The emergency order issued Monday closed all non-essential businesses in the state for at least two weeks. Dispensaries are considered essential; recreational pot shops are not.

Ohio Marijuana Legalization Initiative Rejected for Lack of Signatures. State Attorney General Dave Yost on Monday announced he has rejected a petition for a proposed constitutional amendment to legalize marijuana because petitioners did not submit the minimum number of valid signatures required. This was a first step; organizers needed to submit summary language of their amendment along with at least 1,000 valid voter signatures. They didn't do that. "Of the 1,000 minimum signatures required to proceed with the constitutional amendment, those boards of elections reported receiving a total of only 271 valid signatures," Yost said. "Finally, because the petition failed to meet the signature threshold, I have not made any determination concerning the fairness and truthfulness of the proposed summary."

Oregon Regulators Approve Curbside Recreational Marijuana Sales. The Oregon Liquor Control Commission, which also regulates marijuana, has approved a temporary rule allowing recreational marijuana retailers to sell their products curbside. The rule permits retailers to take orders and deliver marijuana to a customer who is outside and within 150 feet of the licensed premises. The sales can take place only during normal business hours, no earlier than 7:00am and no later than 10:00pm.

Medical Marijuana

Pennsylvania Regulators Ease Medical Marijuana Rules Because of Coronavirus. State regulators trying to ensure that patients continue to have access to medical marijuana have removed a cap on the number of patients caregivers can serve and eliminated background checks for caregiver renewal applications. Curbside pickup has also been okayed, as have remote consultations for some practitioners.

International

Ghana Legalizes Hemp, CBD. The parliament has passed a bill legalizing the production of industrial hemp and its use for medicinal as well as commercial purposes. The bill also expands access to drug treatment and medical care and marks a shift from treating addiction as a legal issue to a public health issue.

Mexican Meth, Fentanyl Traffickers Raise Prices Amid Shortages of Precursor Chemicals. With supplies of Chinese precursor chemicals running low because of disruptions related to the coronavirus pandemic, Mexican drug traffickers are raising wholesale illicit drug prices. The Sinaloa Cartel is reportedly increasing the wholesale price of a pound of meth from $100 to $600. The price of fentanyl is also going up, although not yet as dramatically. Wholesale prices for a pound have reportedly increased from $35,000 to $42,000.

Chronicle AM: Drug Overdoses Declined in 2018, Bernie Sanders Marijuana Legalization Plan, More... (1/30/20)

The CDC reports that drug overdose deaths declined for the first time in decades in 2018, Colombia's coca farmers are increasingly unhappy, Bernie Sanders could use an executive order to legalize marijuana at the federal level, and more.

Bernie Sanders is looking at using an executive order to end federal marijuana prohibition. (senate.gov)
Marijuana Policy

Bernie Sanders Could Use Executive Order to End Federal Marijuana Prohibition. Aides to Vermont senator and Democratic presidential contender Bernie Sanders (I) have presented him with a list of executive orders he could use to unilaterally change federal policies, including one that would direct the Department of Justice to legalize marijuana at the federal level.

Virginia Marijuana Decriminalization Bill Advances. A bill that would decriminalize marijuana and hash oil for adults was approved Wednesday by the Senate Judiciary Committee. The measure, SB 2, now heads to the Finance and Appropriations Committee and, if it passes there, a Senate floor vote.

Cleveland, Ohio, City Council Approves Marijuana Decriminalization. The city council has voted 15-2 to approve a measure that would eliminates fines and jail time for low-level marijuana possession. And it's a pretty high low level: 200 grams. The legislation still needs to be approved by Mayor Frank Jackson (D), who has previously expressed support for it.

Heroin and Prescription Opioids

CDC Reports Drug Overdose Deaths Declined in 2018. For the first time this century, overall drug overdose deaths declined in 2018, according to a new report released by the Centers for Disease Control and Prevention on Thursday. The report put the total number of overdose deaths at 67,000 in 2018, down from over 70,000 in 2017, a decline of 4%. But that still makes 2018 the second-worst year for drug overdose deaths in US history. The majority of overdose deaths involved heroin and fentanyl.

Asset Forfeiture

South Carolina Prosecutor to Appeal Circuit Court Judge's Ruling that Civil Asset Forfeiture Law is Unconstitutional. 15th Circuit Solicitor Jimmy Richardson filed notice this week that he intends to appeal a local judge's 2019 ruling that the state's civil asset forfeiture law is unconstitutional under both state and federal law. The move comes a month after Circuit Court Judge Steven John reaffirmed his August ruling. Johns' decision struck down civil asset forfeiture in his district, but the appeal decision would apply statewide.

International

Colombia Coca Farmers Plan Mass Protests as Counternarcotics Strategy Collapses. Coca farmers are demanding the resignation of crop substitution program director Hernando London after he claimed that "coca substitution leaders have not been assassinated." The coca growers' federation says at least 56 community leaders promoting crop substitution programs have been killed since the program began in March 2017. The coca growers said they were fed up with the "bullshit" of President Ivan Duque's administration and would join national strikes set for next month. Duque's anti-coca policy faces collapse if the crop substitution program is not executed because it then cannot resume aerial spraying of coca crops, according to the Constitutional Court. Without voluntary eradication and aerial spraying, only labor-intensive and easily reversed manual eradication could be used -- and 80% of the destroyed crops are replanted.

(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.)

Chronicle AM: NM MJ Legalization Bill Filed, San Francisco Heroin/Fentanyl ODs Double, More... (1/24/20)

A New Mexico marijuana legalization bill backed by the governor has been filed, Montana activists file a second legalization initiative, San Francisco authorities report a doubling of heroin and fentanyl overdose deaths last year, and more.

Heroin and fentanyl overdose deaths doubled in San Francisco last year. (Creative Commons)
Marijuana Policy

Montana Sees Second Marijuana Legalization Initiative Filed. The activist group MontanaCan filed a marijuana legalization initiative, Ballot Issue 13, on Monday. That makes two potential legalization initiatives that could be on the ballot in November. The MontanaCan initiative would legalize marijuana for people 18 and up and cap the tax rate at 5%. That contrasts with the New Approach Montana initiative, which sets the age of consumption at 21 and the tax rate at 20%. Both are waiting to be cleared for signature gathering.

New Hampshire Legislature Has Marijuana On Its Mind. As the legislative session gets underway, lawmakers are confronting at least a dozen marijuana bills that have already been filed. Some have to do with medical marijuana, including one that would allow patients to grow their own medicine. Similar legislation has passed the General Assembly in previous years, only to be vetoed by Gov. Chris Sununu (R). Also on the agenda is a marijuana legalization bill, HB 1686, which was set for a public hearing Friday. That bill would legalize the possession of up to ¾ ounce of marijuana and the cultivation of up to six plants, but does not envisage a legal commercial market.

New Mexico Marijuana Legalization Bill Filed. Reps. Javier Martínez (D-Albuquerque) and Antonio "Moe" Maestas (D-Albuquerque) filed marijuana legalization legislation, HB 160, on Thursday. The bill would create a system of taxed and regulated marijuana commerce, as well as emphasizing social equity and local entrepreneurship. There would be a 9% excise tax on sales. The bill heads first in the House Consumer & Public Affairs Committee and then in the House Judiciary Committee. Gov. Michelle Lujan Grisham (D) is pushing for the bill to be passed during the current 30-day legislative session.

Austin, Texas, City Council Walks Away from Marijuana Arrests. The city council approved a resolution Thursday directing city police to not spend city funds on newly necessary lab tests to distinguish marijuana from low-THC hemp. The measure passed unanimously, and effectively ends arrests and prosecutions for small-time pot busts in most cases.

Chicago Housing Authority Relaxes Policy on Evicting Marijuana Users. The Chicago Housing Authority has relaxed its hardline approach to marijuana after the state legalized weed this year. Under federal law, people living in subsidized housing are subject to eviction for any drug law violations, and the CHA last year sent letters to its 63,000 households warning that families could be evicted for marijuana violations. But under pressure from Mayor Lori Lightfoot (D), the CHA has revised its policy to now say that each marijuana complaint would lead to "consideration of relevant facts on a case-by-case basis."

Pine Ridge Oglala Sioux Reservation Will Vote on Marijuana Legalization in March. Members of South Dakota's Pine Ridge Indian Reservation will vote on legalizing medical and recreational marijuana and allowing alcohol in casinos in May. The move comes after council members voted in favor of a referendum earlier this month.

Heroin and Prescription Opioids

San Francisco Opioid Overdose Deaths Doubled Last Year. Preliminary statistics gathered by city officials show that overdose deaths involving heroin, fentanyl, or the two drugs together hit 290 last year, more than double the 134 reported in 2018. Of those 290 deaths, 234 resulted from fentanyl alone. Just a decade ago, the number of city residents who overdosed on fentanyl and/or heroin was only 17. "It's devastating. It's awful. It's the most deadly epidemic that we've seen in our city since the HIV/AIDS crisis was killing thousands of people," said Supervisor Matt Haney, who represents the Tenderloin district where the opioid crisis has hit the city hardest. "It is painful that this is not something being talked about every day at City Hall."

Drug Testing

Iowa Bill Would Make Cheating on a Drug Test a Crime. A bill that would make it a misdemeanor crime to cheat on a drug or alcohol test in a private-sector workplace has passed its first legislative hurdle, being approved Thursday by a Senate Commerce subcommittee. SSB 3013 is being advanced by business interests concerned about the use of synthetic urine and urine additives to beat drug tests.

Chronicle AM: Federal Marijuana Prosecutions Drop, Drug Czar Touts Reduced Overdoses, More... (1/17/20)

A New Mexico pot legalization bill gets filed, Rhode Island's governor calls for legalization, the drug czar touts a drop in drug overdose deaths, and more.

Federal marijuana prosecutions declined significantly last year, a new report finds. (Creative Commons)
Marijuana Policy

Federal Prosecutions Decline. Federal marijuana prosecutions declined by 28% from September 30, 2018 to September 30, 2019, according to a report from Supreme Court Justice John Roberts. The year-end report also found that total federal filings for drug crimes was up 5% over the same period, with some 83,000 cases.

New Mexico Legalization Bill Filed. State Sen. Jerry Ortiz y Pino (D) and Rep. Javier Martinez (D) have filed a bill, Senate Bill 115, that would allow adults in the state to possess and purchase cannabis from licensed retailers. The move comes just a day after Gov. Michelle Lujan Grisham (D) signaled that she supported legalizing marijuana this year. The bill would also automatically expunge prior possession convictions and promote participation by small and tribal-owned businesses. The bill would not allow home cultivation, but would decriminalize the growing up of to three plants and six seedlings.

Rhode Island Governor Includes Marijuana Legalization Proposal in State Budget Plan. Gov. Gina Raimondo (D) has included marijuana legalization as a priority in the state budget plan she released Thursday. The plan envisions state-contracted private marijuana retailers with the state controlling location, price, potency, and quantity of sales. Revenues would be divvied up among the state (61%), the private contractors (29%), and local communities (10%). This is the second year Raimondo is including adult-use cannabis legalization in the state budget; she introduced a similar proposal last year, which was ultimately unsuccessful.

Heroin and Prescription Opioids

Drug Czar Touts Decline in Overdose Deaths. Jim Carroll, the director of the Office of National Drug Control Policy (ONDCP -- the drug czar's office), said Friday that the country had seen a decline in drug overdose deaths for the first time in 30 years. "For the first time in almost 30 years, we've seen a decline in the number of Americans dying from an overdose -- it's a 5 percent reduction," he said. According to the Centers for Disease Control and Prevention (CDC), more than 70,000 people died of a drug overdose in 2017, with synthetic opioids such as fentanyl being the main driver behind those deaths.

Foreign Policy

US, Mexico Agree on Plan to Reduce Illegal Guns, Drug Trade. The Mexican government said Thursday it had reached agreement with the United States on a plan to combat the illicit trafficking of arms, drugs, and money. The announcement came after a meeting between US Attorney General William Barr and Mexican officials. The two countries said they agreed to cooperate on reducing drug consumption and combating addiction. The agreement came after President Trump threatened in November to designate Mexican drug cartels as terrorist organizations, prompting Mexican officials to quickly seek talks.

International

Canadian Health Minister Says Time Not Right for Drug Decriminalization. Health Minister Patty Hadju said Thursday that talk about decriminalizing drugs to deal with the country's opioid crisis is premature until people have enough help to fight their addictions. "My personal perspective on decriminalization is that it can't be done in a broad sweep," she said. "I think that having a comprehensive kind of approach that includes things like prevention, treatment, harm reduction, enforcement, housing, those are the kind of things that are actually going to start to move the needle," Hajdu said. "It's too premature to have a conversation about full decriminalization of substances until we get to the place where we have comprehensive support for people to get well."

Chronicle AM: DEA Takes Aim at Fentanyl Precursors, CA Governor Takes Aim at Vaping Crisis, More... (9/17/19)

California Gov. Gavin Newsom (D) issues an executive order on vaping, the DEA designates some fentanyl precursors as controlled substances, and more.

California Gov. Gavin Newsom (D) takes aim at the vaping crisis. (Creative Commons)
Marijuana Policy

California Governor Issues Executive Order on Vaping. Responding to rising concerns over vaping-related deaths and illnesses, Gov. Gavin Newsom (D) on Monday issued an executive order launching a new crackdown on the industry, for both tobacco-related companies and marijuana businesses. The order jump-starts a new public awareness campaign focused on the potential dangers of vaping both tobacco and marijuana, seeks recommendations on mandating additional warning signs on vaping products and at stores, and heightens enforcement against counterfeit e-cigs and marijuana products. It requests the California Department of Public Health (CDPH) begin developing recommendations for warnings on vaping products and at retail locations -- possibly including cannabis retailers -- and increasing enforcement against retailers that sell vaping products to minors. While Newsom focused on e-cigs, he also made clear that he was looking at the marijuana industry, too. "This is about these vaping products that are used for both cannabis and tobacco products," Newsom said. "We're getting serious about this issue and we're going to drive these issues as far as we can through executive authority."

Medical Marijuana

Utah Legislature Passes Changes to Medical Marijuana Law, Allows More Dispensaries. The legislature on Tuesday approved changes in the state's medical marijuana law that will allow for 14 medical marijuana dispensaries, and possibly more in the future. But lawmakers said they still need to make further "tweaks" in the law, including removing a state-operated "central fill pharmacy" after local officials expressed concerns about possibly violating federal laws. The state's program is supposed to be up and running by March 1, 2020.

Heroin and Prescription Opioids

DEA Proposes to Control Three Precursor Chemicals Used in Illicit Fentanyl Manufacture. The DEA has proposed to control three substances used by operators of clandestine laboratories to illicitly manufacture the deadly Schedule II controlled substance fentanyl. The DEA proposed on September 13 that benzylfentanyl and 4-anilinopiperidine be controlled as list I chemicals under the Controlled Substances Act. On Tuesday, DEA proposed to designate norfentanyl as an immediate precursor (i.e., a substance from which another is formed) for fentanyl and to make it a Schedule II controlled substance under the CSA. Both Notices are based on findings that these substances are important precursors used in the illegal production of fentanyl. Most illicit fentanyl manufacturing is done outside the United States.

Chronicle AM: Mexico Marijuana Legalization Bill, US-China Exchange Fentanal Complaints, More... (9/4/19)

Half of Arizonans area ready to legalize marijuana, a Mexican senator files a marijuana legalization bill, US and China officials trade fentanyl complaints, more.

A marijuana legalization bill has been filed in Mexico as a Supreme Court deadline looms. (Creative Commons)
Marijuana Policy

Arizona Poll Has 50% for Legalization. A new OH Predictive Insights poll has 50% in favor and 40% opposed, with 10% undecided. The poll comes as organizers of a 2020 legalization initiative campaign seek to qualify for the ballot. The support level is not enough to be comfortable, but greater than a narrowly defeated 2016 initiative ever had.

Foreign Policy

China Says Only "Limited" Cooperation with US on Fentanyl. Responding to complaints from Washington that it is not doing enough to stop the export of fentanyl from illicit labs there, China responded Tuesday by saying it and the United States have only "limited" cooperation on stopping fentanyl smuggling. Liu Yuejin, Vice Commissioner of the China National Narcotics Control Commission, told a news conference that China was cracking down on illicit fentanyl production: "The National Narcotics Control report states that looking at cases, counternarcotics law enforcement departments from China and the United States have for many years maintained a good cooperative relationship," Liu said. "But cooperation on investigating and prosecuting fentanyl-related substances is extremely limited." Since 2012, Liu said the US has only provided "clues" on six fentanyl smuggling cases to the Chinese government, with only three of those resulting in arrests. Liu also denied that China is the source of most fentanyl smuggled into the US.

International

Mexican Senator Files Marijuana Legalization Bill as Supreme Court Deadline Looms. Sen Julio Menchaca Salazar, a member of the ruling MORENA Party, filed a bill to legalize marijuana on Tuesday. The move comes only a month ahead of a deadline imposed by the country's Supreme Court to end marijuana prohibition. The measure also addresses hemp and medical marijuana. The bill comes as the Senate continues with a series of events designed to foster dialogue about how to legalize marijuana. The Supreme Court ruled last year that the existing ban on personal use and cultivation is unconstitutional and gave the congress until next month to remedy the country's drug laws.

Chronicle AM: No CBD for Military Members, Hawaii Decriminalizes Pot Possession, More... (8/22/19)

The Defense Department makes it crystal clear that service members can't use CBD products, Hawaii's governor fails to veto a decriminalization bill -- thus allowing it to become law -- and more.

The drug czar's office has announced new moves against fentanyl. (Creative Commons)
Marijuana Policy

Hawaii Decriminalizes as Governor Fails to Veto Bill. A decriminalization bill passed earlier this year by the legislature became law on Tuesday without the signature of Gov. David Ige (D). Ige didn't sign the bill, but neither did he veto it, so now it has become law. The bill decriminalizes the possession of up three grams of marijuana with a fine of up to $130. The new law will go into effect on January 11, 2020.

Hemp

Defense Department Bars Service Members from Using Hemp-Derived CBD. The Defense Department is making crystal clear that members of the armed forces are not allowed to use cannibidiol (CBD). "It's completely forbidden for use by any service member in any of the services at this point of time," said Patricia Deuster, director of the Human Performance Laboratory at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Heroin and Prescription Opioids

White House Announces Actions to Crack Down on Trafficking of Fentanyl and Synthetic Opioids. The Office of National Drug Control Policy (ONDCP -- the drug czar's office) announced Wednesday that it had sent a series of advisories to help domestic and foreign businesses protect themselves from being used to traffic illicit fentanyl and "foster deeper public-private collaboration to curb the production and sale of illicit fentanyl, fentanyl analogues, and other synthetic opioids." The advisories are focused on four facets of the trafficking of illicit fentanyl, fentanyl analogues, and synthetic opioids destined for the United States: manufacturing, marketing, movement and money. It also announced that it is "identifying two Chinese nationals and a China-based Drug Trafficking Organization as significant foreign narcotics traffickers pursuant to the Foreign Narcotics Kingpin Designation Act (Kingpin Act) and designated one associate and a China-based entity for being owned or controlled by one of the Chinese nationals."

Why Are Meth- and Cocaine-Related Overdose Deaths on the Increase? [FEATURE]

August 31 is International Overdose Awareness Day, overdoseday.com
Last month, the Centers for Disease Control and Prevention (CDC) released provisional data indicating that the country's overdose crisis peaked in late 2017 and actually declined by 5.1 percent between then and late 2018. While that is long-awaited good news, it's not great news: The annual number of drug overdose deaths was still more than 68,000, and that number is still more than a third higher than in 2014, when the overdose epidemic was already well underway.

The fever may have broken, but the patient is still in critical condition. And there is one bit of data in the CDC report that is definitely not good news: While overall overdose deaths finally began to decline, overdose deaths involving stimulants were on the increase. For cocaine, the death toll started rising in about 2012; for psychostimulants (overwhelmingly methamphetamine), the climb began a couple of years earlier.

But the new data show a dramatic uptick in overdose deaths with stimulant involvement last year. Fatal overdoses where cocaine was mentioned were up 34 percent and those where methamphetamine was involved were up 37 percent. That's more than 14,000 people dying with cocaine in their systems and more than 10,000 dying with meth in their systems.

What is driving this spike in stimulant-involved overdose deaths? Some of it can be attributed to rising use levels for cocaine and meth, which can in turn be linked to increased supplies. Meth seizures were up dramatically last year and recent DEA reports suggest that cocaine availability has increased steadily since 2012, particularly in the south and east coast of the US. The UN Office of Drugs and Crime suggests that cocaine production and manufacture are at the highest rates ever recorded.

"There is some research to suggest that we are seeing slightly higher rates of recent cocaine and methamphetamine use compared to rates of use just a few years ago," said Sheila Vakharia, PhD, a researcher with the Drug Policy Alliance (DPA). "But increased rates of use do not always mean increased rates of addiction or overdose. Death rates are influenced by a variety of factors, including age of the user, the amount used, and other substances used, among other things."

They are also influenced by race, gender, and geographic location. A recent study looking at data from 2012 to 2015 and examining race and gender trends by drug found that white men had the highest rates of methamphetamine-involved overdose deaths more generally, while black men had highest rates of cocaine-involved overdose deaths. These racial differences persisted for women of each race as well, although their overdose rates were lower than the men in their racial groups.

"Methamphetamine-involved deaths are high on the West Coast and Midwest, while cocaine-involved deaths are high on the East Coast. We are actually seeing that in some Western states that methamphetamine is either the top drug involved in overdose deaths or among the top drugs included in overdose deaths," Vakharia noted.

"Based on the latest CDC data, Nevada’s overdose crisis has been driven by prescription opioids and methamphetamine for the past several years- in fact, methamphetamine has been the #1 drug involved in overdoses there since November 2016. Similarly, in November 2016, Oregon saw methamphetamine become the top drug involved in overdose deaths," she specified.

"Meanwhile, the East Coast is seeing the involvement of cocaine in overdoses increase as well. While no eastern state has cocaine driving their overdose crisis, places like DC are seeing fentanyl as the top driver of deaths followed by cocaine. Last year, while fentanyl contributed to the majority of overdose deaths, there were more cocaine-involved deaths than heroin or prescription opioids," Vakharia added.

It appears that it is not rising simulant use rates but the use of multiple substances that is largely driving the overall stimulant death toll upwards. A CDC report from May suggests that, from 2003 to 2017, almost three-quarters of cocaine-involved deaths involved an opioid while half of all methamphetamine involved deaths involved an opioid.

"Those CDC numbers are based on autopsy reports," said Daniel Raymond, deputy director of planning and policy for the Harm Reduction Coalition (HRC). "In a lot of cases, there are multiple drugs involved, and just because an overdose involves a stimulant, it doesn't mean it was caused by stimulants."

Overdose deaths caused by stimulants look different from those caused by opioids, Raymond noted: "Fatal stimulant overdoses come from strokes, seizures, heart attacks, and potentially overheating," he said. "It's not like an opioid overdose with respiratory depression," he said.

"Some of this may be more a reflection that we still have lots of people dying from opioid-related overdoses, and it's just that more of them are also taking meth or cocaine, but the primary cause of death is the respiratory depression associated with opioid overdoses. In a lot of the cocaine deaths, medical examiners are finding both cocaine and opioids."

"We are seeing that toxicology reports of people who died with stimulants in their systems also had fentanyl or other opioids in their system," DPA's Vakharia concurred. She then listed a number of possible explanations:

  1. "This is accidental. Cross-contamination of a stimulant with an opioid like fentanyl could have been accidental and occurred during transport or packaging, and opioid-naïve stimulant users were accidentally exposed to opioid-contaminated stimulants."
  2. "This is due to co-use of opioids and stimulants in the form of speedballs (with cocaine) or goofballs (with methamphetamine), where both are used together for the desired effect of immediately stimulating high, followed by the euphoria of the opioid."
  3. "Stimulants are being willfully adulterated with opioids by suppliers/sellers, and stimulant users naïve to opioids are overdosing because they have no tolerance. (We at DPA dispute this theory, because it makes little sense why a seller would want to kill off a customer.)
  4. "Someone might have used a stimulant and opioids at different times within the past few days, but their toxicology could be showing the recency of use."

What Is to Be Done?

The Drug Policy Alliance and the Harm Reduction Coalition have both released reports on the rise in stimulant-involved overdose deaths, Stimulant Use: Harm Reduction, Treatment, and Future Directions from the former and Cocaine, Speed, and "Overdose": What Should We Be Doing? from the latter. Raymond and Vakharia took a few minutes to address those topics, too.

"There is no naloxone for stimulant overdose," Raymond pointed out. To reduce those overdoses "is about developing harm reduction strategies and outreach specifically targeting stimulant users," he said. "We spend so much time focusing on the opioid overdose crisis that our messages are oriented toward that. If we want to start a conversation, we need to not just tack it onto the opioid messaging. Even if you're not an opioid user, we want to talk about symptoms and warning signs."

HRC has moved in that direction, said Raymond. "We did some work on stimulant overdoses, we talked to a lot of people who used stimulants, we put out a guide -- Stimulant "Overamping”"Basics -- and went with the terms people used. Using 'overamping' opened a space for conversation for people who didn't identify as heroin users. If you talk overamping instead of overdosing, stimulant users have had that experience of using too much. Part of it is really just listening to the people who use the drugs. In harm reduction, we learn from the people we work with."

"People who use stimulants need access to sterile equipment beyond syringes, since many stimulant users smoke, so we are talking about sterile smoking equipment like pipes and filters," Vakharia said. "We need to teach users how to stay safe while using -- make sure to take breaks for hydration and to eat, get enough rest. It is easy to lose track of time when you've been up for days and when you have no appetite. This also puts undue stress on your heart and can exacerbate health issues," she noted.

"For many people, we should also talk about distributing safer sex supplies, because many people engage in risky sexual practices while they are using," Vakharia continued. "We also need to educate users on the risks associated with mixing different classes of drugs and the impact it can have on your body, knowing your limits, keeping naloxone on hand in case you are using opioids too, and not using alone."

It's not just harm reduction that's needed, though. Other policy prescriptions could help reduce the toll.

"Medicaid expansion and policies to increase access to basic health care and mental health care, as well as substance use treatment can greatly improve the health and well-being of people who use all drugs," Vakharia said. "And whether opioids are a person's primary drug or not, expanding access to naloxone helps anyone who is using them. Similarly, expanding Good Samaritan laws that reduce barriers to calling 911 can only help."

And then there's not treating drug uses like criminals.

"Decriminalizing drugs and paraphernalia would be a huge step forward," said Vakharia. "We know that contact with the criminal justice system increases harms and also presents barriers to going into recovery, which impacts job prospects, the ability to find work, and things like that."

"Drug decriminalization is crucial," said Raymond. "Criminalization just makes everything worse. It makes people more fearful of seeking help, and ends up locking so many people up in ways such that when they leave jail or prison, they're even more vulnerable. All of our work in harm reduction takes place in this context of mass criminalization. That keeps us swimming against the tide."

This article was produced by Drug Reporter, a project of the Independent Media Institute.

The Drug Policy Alliance is a funder of both Drug Reporter and Drug War Chronicle.

Chronicle AM: US & China Spar Over Fentanyl, Honduran President Named Trafficking Conspirator, More... (8/5/19)

Federal prosecutors accuse the president of Honduras of participating in a drug trafficking conspiracy, the US and China squabble over fentanyl, Colombia coca production declined slightly last year, and more.

The Trump administration and China are sparring over fentanyl exports and who is responsible for the opioid crisis. (CC)
Medical Marijuana

Iowa Panel Backs Including Chronic Pain, But Not PTSD, Opioid Dependency. The Iowa Medical Cannabidiol Board last Friday approved a recommendation to add chronic pain as a qualifying condition under the state's medical marijuana law. But the board drew criticism from patients advocates for not making the same recommendation regarding PTSD, opioid dependency, and other medical conditions. The board could revisit the issue in November if more data or research is available.

Nebraska Attorney General Argues Legalizing Medical Marijuana Is Unconstitutional. State Attorney General Doug Peterson (R) issued an opinion last Thursday saying federal law preempts state medical marijuana laws and that an effort to legalize medical marijuana in the state "would be, therefore, unconstitutional." On the other hand, more than 30 states have legalized medical cannabis since 1996, but the Supreme Court has never ruled that state legalization regimes are preempted by federal law. [Ed: This Cato brief by Vanderbilt law profession Robert Mikos explains why federal law probably does not preempt state law in ways that would interfere with state legalization laws. -DB]

Foreign Policy

Trump Accuses China of Failing to Halt Fentanyl Exports to US. President Trump last Thursday accused Chinese President Xi Jinping of failing to honor a pledge to stem the flow of fentanyl from Chinese chemical factories to the United States. "My friend President Xi said that he would stop the sale of fentanyl to the United States -- this never happened, and many Americans continue to die," Trump said in a tweet. "We're losing thousands of people to fentanyl," he later told reporters. Xi had promised Trump in December that he would act, and China announced on May 1 that it had expanded its list of narcotics subject to state control to include more than 1,400 known fentanyl analogues.

China Rejects Trump Criticism on Fentanyl. Chinese state media fired back at President Trump on Sunday, with Xinhua editorializing that "the United States has only itself to blame" for the country's opioid crisis. A day earlier, Liu Yaojin, deputy director of the China National Narcotics Control Commission also hit back, saying "China is not the main resources of fentanyl in the United States… I think that the United States should solve the problem of the widespread abuse of fentanyl domestically."

[Ed: I've never been inclined to accept the word of China's government, much less of their counternarcotics officials. Nor, however, can one rely on President Trump's word about anything either. On this one, the Chinese are probably more right than wrong. As this commentary by RAND scholars Beau Kilmer and Bryce Pardo suggests (following a report on Asian drug policy, link a few paragraphs in), China's regulatory capacity (unlike its surveillance capacity) falls very far short of what's needed to monitor all the chemical companies that could be involved in fentanyl, some of which produce it legally for the medicinal market. If they were to succeed in stamping out illicit production by such businesses, it could have unintended consequences, such as sparking increased activity by groups operating entirely outside the law. -DB]

International

UNODC Reports Slight Drop in Colombia Coca Production Last Year. The UN Office on Drugs and Crime (UNODC) reported last Friday that coca production had declined by a modest 1.2% in 2018 from record levels the year before. In areas where voluntary and forced eradication took place, production dropped 18%, but that was largely offset by increases in areas dominated by violent drug trafficking organizations.

Honduran President Accused of Drug Conspiracy by US Prosecutors. In documents filed in federal court in New York City last Friday, prosecutors refer to Honduran President Juan Orlando Hernandez as a co-conspirator in a drug trafficking scheme with his brother, Juan Antonio Hernandez, and former President Porfirio Lobo "to use drug trafficking to help assert power and control in Honduras." It says that the president and his predecessor "relied on drug proceeds" to fund political campaigns and cites "evidence of high-level political corruption." The US government has been a staunch supporter of Hernandez's government, pouring millions of dollars into security cooperation to stop cocaine headed to the US from South America.

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