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)

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.

A Calfornia Republican lawmaker wants to go back to the bad old days, Colorado now sees competing psychedelic legalization initiatives, and more.

fentanyl (Creative Commons)

California GOP Bill Would Make Unlicensed Marijuana Cultivation a Felony Again. Assemblyman Thurston Smith (R-Riverside) has filed a bill that would recriminalize growing marijuana plants without a license, Assembly Bill 1725. The bill would make growing more than six plants without a license a felony punishable by up to three years in jail. Smith said his bill was aimed at enormous illegal grow operations. "These illicit growers have been operating with impunity, knowing that the law allows them to grow with barely a hindrance. For far too long, (state lawmakers in) Sacramento (have) been soft on crime, and the illicit market has exploded with massive unlicensed grows popping up all around the state." The bill faces long odds in the Democratic-controlled legislature.

Massachusetts Marijuana Host Community, Social Equity Bill Advances. The Joint Committee on Cannabis Policy took up legislation aimed at putting tighter rules on legally required contracts between hosts communities and marijuana businesses and establishing a Cannabis Social Equity Trust Fund. The measure, House Bill 174 faced no opposition in the committee. The bill is a priority of House Speaker Ron Mariano (D), and takes on aspects of the state's pot laws that both regulators and the industry have said need to be addressed.

"The gap between the law's stated commitment to equity and the on-the-ground reality of the industry shows just how much work we have left to do," Sen. Sonia Chang-Diaz, co-chair of the Joint Committee on Cannabis Policy, said. "There's universal agreement about the problems: high costs of entry and lack of access to capital create a near-impossible barrier for many talented entrepreneurs. This bill addresses both sides of that coin. I'm thrilled we're finally advancing it."

Opioids

Connecticut Scare on Fentanyl-Tainted Marijuana Mostly Unfounded, State Says. The state Department of Health reported in November that nearly 40 overdoses were linked to fentanyl-tainted marijuana, but it now turns out that there was only one case -- and that case was most likely caused by accidental contamination. In the original report, the state said there had been 39 overdoses believed linked to fentanyl-tainted marijuana, that the patients required revival with naloxone, and they "denied any opioid use and claimed to have only smoked marijuana." But the health department says at least 30 of the 39 had histories of opioid use.

The department also said that only one marijuana sample tested positive for fentanyl. "Based on the information gathered since the positive confirmation of marijuana with fentanyl, the CT ORS [Connecticut Overdose Response Strategy] assesses that the positive confirmation of marijuana with fentanyl was likely accidental contamination and an isolated incident," a department spokesman said. Boyle wrote in an email to Hearst Connecticut Media. The contamination likely occurred when the dealer "failed to clean their instruments before processing the marijuana and cross-contaminated it with fentanyl," he said.

Psychedelics

Colorado Sees Second Psychedelic Initiative Filed. Activists with Decriminalize Nature Boulder County have filed an initiative that would allow people 21 and over to possess, cultivate, gift and deliver psilocybin, psilocyn, ibogaine, mescaline and DMT. The initiative would also allow psychedelic services for therapeutic, spiritual, guidance, or harm reduction purposes with or without accepting payment. A separate psychedelic initiative backed by New Approach PAC and David Bronner of Dr. Bronner's liquid soap company, the Natural Medicine Health Act, envisions a two-tiered regulatory model where only psilocybin would be legalized and regulated for therapeutic purposes until June 2026, after which regulators could add other psychedelics.

Wyoming marijuana legalization activists are forced to turn their aim to 2024, a New Mexico bill to legalize fentanyl test strips is coming, and more.

psilocybin molecule (Creative Commons)

Wyoming Activists to Focus on 2024 for Decriminalization, Medical Marijuana Initiatives. Having decided they cannot gather enough voter signatures in time to put marijuana decrim and medical marijuana initiatives on the 2022 ballot, reformers are turning their attention to 2024. They cited poor weather conditions, the pandemic, and slow action on their petitions by state officials for coming up short for this year. They would have needed 41,776 valid voter signatures by next month to make the 2022 ballot, and only have about 30 percent of that number at this point.

Medical Marijuana

Mississippi Legislature Convenes, Is Set to Take Up Medical Marijuana. The legislature is back in session, and medical marijuana is on the front burner. Voters approved medical marijuana at the polls in November 2020, only to have the results nullified by the state Supreme Court, and lawmakers have vowed to enact the will of the voters by passing a medical marijuana bill. It was supposed to have been done in a special session late last year, but Gov. Tate Reeves (R) never called it because he was unsatisfied with the proposed legislation. Now, the legislature will give it another try.

Psychedelics

Psilocybin Clinical Trial Confirms Safety of Group Psychedelic Sessions. A new study published in the The Journal of Psychopharmacology found no detrimental effects from administering psilocybin in a group setting. The study reported the results of a large clinical trial checking on both short- and long-term effects of administering the drug. While researchers in the 1960s studied the effects of psychedelics when administered in a group setting, since interest in medicinal applications of psychedelics rebounded in recent years, almost all research has focused on the administration of the drugs to individuals.

Harm Reduction

New Mexico Attorney General to Push Bill Legalizing Fentanyl Test Strips. Faced with a 25 percent increase in drug overdose deaths from 2019 to 2020, Attorney General Hector Balderas (D) says he is getting behind pending legislation to make fentanyl test strips legal. Under current state law, they are considered drug paraphernalia. State Rep. Tara Lujan (D-Santa Fe) says she will file the bill this week and that it also has the support of the governor and the state health department.

International

Abu Dhabi Court Sentences Two Filipinos to Death for Drug Dealing. The Abu Dhabi Criminal Court has sentenced two unnamed Filipinos to death after convicting them of possessing and selling "narcotics and psychotropic substances."

The death sentences contradict the position of the UN Office on Drugs and Crime, as in this 2019 statement: "As part of the United Nations Secretariat, the United Nations Office on Drugs and Crime (UNODC) does not support the use of the death penalty. Just last December [2018], more countries than ever before -- 121 Member States -- supported a General Assembly resolution calling for a moratorium on the use of the death penalty. The three international drug control conventions, which form the foundation of the global drug control system that has been agreed by nearly every country in the world, cannot be used to justify the use of the death penalty for drug-related offences alone. Application of the death penalty may also impede international cooperation to fight drug trafficking, as there are national laws that do not allow the exchange of information and extradition with countries which may impose capital punishment for the offences concerned. The dangers posed by illicitly-trafficked drugs are evident and lives are at stake. But use of the death penalty cannot provide durable solutions or protect people."

A new bipartisan federal bill aims to help states and localities with marijuana expungement efforts, New York state adjusts its COVID quarantine policies for drug treatment facilities, and more.

Fentanyl and its analogs are the subject of a battle over draconian emergency scheduling. (Creative Commons)

Bipartisan Federal Bill to Incentive State-Level Expungements Filed. Reps. Dave Joyce (R-OH) and Alexandria Ocasio-Cortez (D-NY) filed a bill Thursday that would provide incentives for state and local governments to expunge marijuana arrest and conviction records in their jurisdictions. The bill is the Harnessing Opportunities by Pursuing Expungement (HOPE) Act. It would create a State Expungement Opportunity Grant Program that would help fund administrative costs in identifying clearing eligible cases at the rate of $2 million a year through 2032.

Medical Marijuana

Florida Bill to Protect Patient Privacy Filed. A bill to protect patient privacy by blocking the scheduled repeal of an exemption from public records requirements for certain information held by the state Department of Health relating to patients, caregivers, & qualified physicians for medical use of marijuana was filed Thursday. HB 7005 was filed by the House Government Operations Subcommittee. A companion bill is pending in the Senate.

Drug Treatment

New York to Alter Covid-Related Policy That Hindered the Work of Drug Treatment Facilities. For months, the state's Office of Addiction Services and Support (OASAS) has had a policy requiring drug treatment admitting new patients for long-term care for 14 days after a COVID case was discovered on the property. Drug treatment providers say the rule has hindered their work, and OASAS has now responded to their complaints. Now, it is altering the policy to review COVID positives in those facilities on a "case by case" basis. "At the height of the COVID-19 pandemic this policy was issued consistent with CDC and DOH guidance. It is specific to OASAS congregate settings since the population we serve is high-risk because of high rates of co-morbidities, lower vaccination rates, and high turnover rates in these facilities. People with an SUD diagnosis are at higher risk for COVID-19 complications, including hospitalization and death. We have since updated our policy to make these decisions on a case by case basis," OASAS said.

Sentencing

Groups Say Congress Should Reject Biden's Harmful Sentencing Proposal on Fentanyl-Related Drugs. A coalition of civil rights and drug reform advocacy groups called Thursday for Congress to reject the Biden administration's proposal to permanently reclassify fentanyl-related substances as Schedule I drugs, calling the approach toward the synthetic opioids a dangerous continuation of the so-called war on drugs that will do little to quell what is a public health issue. The Biden proposal would a Trump-era policy would continue by permanently placing fentanyl-related substances, or fentanyl analogues, into Schedule I -- a designation that currently covers substances including ecstasy and heroin, is aimed at drugs with "no currently accepted medical use and a high potential for abuse," and can lead to stiffer penalties. "Congress must chart a new course to save lives," said Maritza Perez, director of the Office of National Affairs at the Drug Policy Alliance, in a statement noting the record number of drug overdose deaths, which have been driven in part by fentanyl. "The only way forward," she said, "is moving health-centered legislation that can provide lifesaving harm reduction services and evidence-based treatment for people who use drugs. Anything less is not a solution -- it's a cop-out for Congress."