Prescription Opiates

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WI City and County Votes for Legal Marijuana, FDA Warns on Animal Tranquilizer in Drug Supply, More... (11/10/22)

The Treasury Department is using an executive order to go after dark web drug suppliers, the FDA is warning health care workers to watch out for an animal tranquilizer that appears to be getting into the illicit drug supply, and more.

The veterinary tranquilizer and pain reliever xylazine is showing up in the illicit drug supply.
Marijuana Policy

Wisconsin Towns and County Vote for Marijuana Legalization Referendum. The cities of Kenosha and Racine joined Milwaukee County Tuesday in voting in favor of non-binding referenda showing community support for marijuana legalization. The measure was approved by 76 percent of voter in Racine, 74 percent in Milwaukee County, and 72 percent in Kenosha. The state lacks an effective initiative process, and the Republican-controlled legislature has blocked consideration of even medical marijuana, let alone adult use marijuana.

Adulterants

FDA Warns Health Care Workers to Watch Out for Potentially Lethal Animal Sedative in Illicit Drug Supply. The Food & Drug Administration (FDA) on Tuesday issued a warning to health care workers to watch out for patients who may have been exposed to a potentially deadly animal sedative through illicit drug use. The sedative in question is xylazine, which is showing up in fentanyl, heroin, and other illicit drug supplies after being diverted from the legal animal drug supply or produced illegally, the FDA said. The drug, known as "tranq" on the street is approved as an animal tranquilizer and pain reliever, but not approved for use in humans.

"FDA is aware of increasing reports of serious side effects from individuals exposed to fentanyl, heroin, and other illicit drugs contaminated with xylazine," the agency announced in a news release. Those serious side effects can resemble those linked to opioid use, making it difficult to determine whether one is facing an opioid overdose or xylazine exposure.

Moreover, naloxone, which can reverse the effects of some opioid drug overdoses, may not have the same effect on xylazine, the agency said. FDA still advised health care workers to continue administering naloxone if they suspect an opioid overdose.

Dark Web

Treasury Sanctions Internet-based Suppliers of Illicit Fentanyl and Other Synthetic Drugs. Acting in conjunction with the governments of the Netherlands and the United Kingdom, the Treasury Department's Office of Foreign Assets Control (OFAC) designated two Dutch nationals, Alex Adrianus Martinus Peijnenburg, Martinus Pterus Henri De Koning, and one British national, Matthew Simon Grimm, and nine entities pursuant to Executive Order (E.O.) 14059 for supplying illicit fentanyl, synthetic stimulants, cannabinoids, and opioids to US markets through internet sales and a host of shell companies.

The action represents the first use of E.O. 14059 to target those involved in the sale of illicit drugs purchased online and via darknet marketplaces. "The Treasury Department will continue to deploy its counternarcotics authorities to disrupt those involved in the fentanyl global supply chain," said Under Secretary of the Treasury for Terrorism and Financial Intelligence Brian E. Nelson. "Treasury is identifying over 50 virtual wallet addresses associated with this network's drug trafficking activities as we take further action to counter the abuse of virtual currency. I would like to thank our Dutch and UK partners and US law enforcement counterparts for their partnership and for enabling today's action."

Arkansas Legalization Init Cleared for November, Colorado Psilocybin Init Trailing, More... (9/23/22)

Republicans seek political advantage by calling Mexican cartels "terrorist organizations," the FDA eases rules for groups distributing the opioid overdose reversal drug nalxone, and more.

Colorado magic mushroom proponents have an uphill fight ahead of them, a new poll suggests. (Greenoid/Flickr)
Marijuana Policy

Arkansas Supreme Court Okays Marijuana Legalization Initiative for November Ballot. The state Supreme Court on Thursday held that the Responsible Growth Arkansas marijuana legalization initiative will be counted after all. The move comes after the Board of Election Commissioners ruled that the measure's ballot title was misleading, but the high court disagreed, holding that "initiative power lies at the heart of our democratic institutions" and that the board and prohibitionist groups who had intervened in the case "have not met their burden of proving that the ballot title is insufficient."

Psychedelics

Colorado Poll Has Psilocybin Initiative Trailing. A new poll has the magic mushroom decriminalization initiative, Proposition 122, well south of the 50 percent plus one votes needed to pass in November. The Fox 31/Chennel2/Emerson College/The Hill poll had only 36 percent supporting the measure, with 41 percent opposed and 23 percent undecided. While the large number of undecideds leaves room for hope, they would have to break pretty decisively in favor of the initiative for it to get over the top. Only Democrats favored the initiative (53 percent), while 61 percent of Republicans opposed it. Two racial/ethnic groups emerge as opponents: 64 percent of Blacks oppose it, as do 63 percent of multiracial voters.

Harm Reduction

Opioid Reversal Drug Access to Ease Under Relaxed FDA Rules. The Food & Drug Administration (FDA) announced Thursday that harm reduction programs distributing the opioid overdose reversal drug naloxone will not have to comply with certain federal product tracing requirements. The agency said it would not enforce certain Drug Supply Chain Security Act requirements on programs that are distributing the drug to at-risk communities while an opioid public health emergency exists. "Combating the opioid overdose epidemic is an urgent public health priority for FDA," the agency wrote in the guidance. The FDA "is committed to advancing solutions to reduce opioid overdose deaths in the United States, including by supporting efforts to increase public availability of and access to naloxone."

Foreign Policy

GOP Senators File Bill Designating Drug Cartels as Terrorist Organization. Sens. Roger Marshall (R-KS) and Rick Scott (R-FL) filed a bill Tuesday to formally designate Mexican drug cartels as foreign terrorist organizations. The Drug Cartel Terrorist Designation Act. "The illicit drugs and other deadly activities being carried out by cartels are killing Americans at record rates. Since Joe Biden and the Democrats continue to turn a blind eye, we are going to do something about it by designating the drug cartels as Foreign Terrorist Organizations," said Sen. Marshall. "As these cartels continue to invade our porous southern border in an increasingly militarized approach, this designation is needed to ramp up our efforts to combat them. We will not rest in our fight to stop fentanyl's terrible scourge wreaking havoc in Kansas and across the US." Nonetheless, Mexican cartels are not foreign terrorist organizations; they are drug trafficking organizations.

GOP Texas Governor Designates Mexican Cartels as Terrorist Organizations. Gov. Gregg Abbott issued an executive order Tuesday that designated specified Mexican drug cartels as foreign terrorist organizations, although since Texas does not set US foreign policy it is not clear just exactly what that means. The order instructs the state Department of Public Safety (DPS) "to take immediate action to keep Texans safe amid the growing national fentanyl crisis." Abbott also directed DPS to identify Texas gangs that support the cartels and seize their assets.

MO Judge Okays Legal Pot Initiative, Taliban War on Opium a Dud So Far, More... (9/12/22)

Fentanyl has largely replaced heroin in the nation's capital and that's being reflected in overdose statistics, India creates a national drug trafficker registry, and more.

In Afghan fields, the poppies grow. Despite the Taliban's announced ban. (UNODC)
Marijuana Policy

Missouri Judge Rejects Challenge to Marijuana Legalization Initiative. Show Me State voters will have the chance in November to show the country whether they support marijuana legalization or not after a Cole County judge dismissed a lawsuit from anti-marijuana groups seeking to keep Amendment 3 off the ballot. Opponents sued, arguing that some signatures were invalid because they were verified by the state instead of county election officials, but the judge dismissed the lawsuit, ruling that the Colorado-based plaintiff did not provide evidence that she was a Missouri resident. But the judge also said he would have ruled against the lawsuit regardless of residency because the initiative met state signature-gathering requirements.

Opiates and Opioids

Fentanyl Replaces Heroin as Leading Cause of Overdose Deaths in DC. Fentanyl has now almost completely replaced heroin in Washington, DC, with heroin being detected in only 15 of the city's 166 opioid overdose deaths in the first five months of 2022. Heroin is now killing fewer Washingtonians than fentanyl, cocaine, alcohol, or prescription drugs. Public health experts say public health strategies must be adapted to adjust to the city's changing drug use profile. Most of the city's drug overdoses in the last year were among people between 40 and 70, and 84 percent of them were Black.

International

Taliban Make Little Progress in Countering Drugs. The Taliban banned opium in April, shortly after the last harvest, but as the next poppy growing season approaches, less than 250 acres of poppy have been eradicated and only 4,270 kilograms of opium have been seized, far behind the performance of previous Afghan governments. In 2020, for example, the government seized 80,000 kilos of opium, nearly 20 times as much as this year. And that has some experts questioning the Taliban's commitment to the ban. "There is serious doubt on the intentions of the current rulers whether they really want to eradicate poppy," said Javid Qaem, a former deputy minister for counternarcotics in Afghanistan and now a researcher at Arizona State University. "At the time of the Republic, security was a big challenge. Police could not go to the areas where poppy was cultivated. Taliban claim that they have all the areas under their control. They should be able to do it easily," he told said.

India's "Narco Files" Hold Over 500,000 Names. India's first registry of drug traffickers, launched only a month ago, now has more than 500,000 names on it. The National Integrated Database on Arrested Narco-offenders (NIDAAN) - a database of arrested narcotics offenders from states and union territories, developed by Narcotics Control Bureau (NCB) - aims to profile each narco-offender by integrating with Inter Operable Justice System (ICJS) and Crime and Criminal Tracking Network and System (CCTNS), officials said. It holds the names of all people convicted of drug trafficking offenses in the past 10 years.

Poll Finds SAFE Banking Act Has Broad Support, DEA Fentanyl Scaremongering, More... (9/7/22)

Missouri's Republican governor rejects a call to include marijuana legalization in an upcoming special session, a DC court reverses the firing of a medical marijuana-using employee accused of being high on the job, and more.

"Rainbow" fentanyl--not aimed at kids, experts say. (Multnomah County Sheriff)
Marijuana Policy

Survey: Most Voters Support Federal Banking Reforms for Licensed Marijuana Retailers. The overwhelming majority of voters believe that federal law should be amended so that state-licensed marijuana businesses can readily utilize banks and other financial services, according to national survey data compiled by Morning Consult and commissioned by the Independent Community Bankers of America. Consistent with prior survey data, 65 percent of respondents “support allowing cannabis-related businesses to have access to banking services in states where cannabis is legal.” Moreover, 63 percent of voters agree that allowing cannabis-related businesses to access the banking system will help improve public safety, and 58 percent say that it is “important” that members of the U.S. Senate vote to establish a safe harbor for licensed cannabis businesses. The SAFE Banking Act (HR 1996), which would do just that, has repeatedly passed in the House only to be blocked in the Senate by Senate Majority Leader Charles Schumer (D-NY) and his allies, who are holding out for passage of a full-fledged marijuana legalization bill.

Missouri Governor Will Not Include Marijuana Legalization in Special Session. Efforts to do a legislative end run around a pending marijuana legalization constitutional amendment (Amendment 3) have come to naught after Gov. Mike Parson's office said Tuesday that he will not expand the scope of his upcoming legislative special session to consider legalizing marijuana. "The call will not be amended to include marijuana legalization," Kelli Jones, spokeswoman for Parson, said. Lawmakers hoping to blunt momentum for the measure had called on the governor to include marijuana legalization, but even though Parsons has called Amendment 3 "a disaster," he demurred.

Medical Marijuana

DC Court Reverses Firing of Government Worker Who Tested Positive for Marijuana. An administrative court in the DC Office of Employee Appeals (OEA) has reversed the firing of medical marijuana patient and city government employee who was accused of being high on the job and later tested positive for marijuana. The employee argued that the city's communications office falsely accused her of being impaired because her eyes were red and she was talking quietly. She pointed out that her eyes were red because she had spent the previous night at a hospital sitting beside a relative who had overdosed. She also presented a valid medical marijuana patient card. The court held that the communications office was negligent in how it handled the process for reasonable suspicion of impairment from drugs. The judge noted that supervisors allowed her to continue working after they accused her of being impaired: "Because Employee was allowed to perform her duties and did in fact adequately do so after being observed by her supervisors, I find that [the supervisors] did not reasonably believe that Employee’s ability to perform her job was impaired. As such, I further conclude that a reasonable suspicion referral was unwarranted," the judge wrote in the ruling. 

Opioids and Opiates

DEA Warning that Colored Fentanyl Pills Are Aimed at Kids is Nonsense, Experts Say. On August 30, the DEA warned the public about fentanyl in colorful pills being sold by "drug cartels" to "made to look like candy to children and young  people," calling it "Rainbow fentanyl" and charging that it is "a deliberate effort by drug traffickers to drive addiction amongst kids and young adults." But drug policy experts said such statements were misleading—and used harsh terms in doing so.

The charge is "typical drug war bullshit," said Dr. Nabarun Dasgupta, a pharmaceutical scientist at the University of Carolina at Chapel Hill. DEA's framing "was so divorced from any reality of what drug markets are actually like, it was almost laughable that our country's top drug enforcement folks are so out of touch.We've been talking about colored dope for years. This is like completely nothing new."

Claire Zagorski, a licensed paramedic, program coordinator and harm reduction instructor for the PhARM Program at The University of Texas at Austin College of Pharmacy, described the DEA announcement as "old recycled drug propaganda" that echoes the perennial myth of dope-laced Halloween candy. "Why would someone give away their expensive drugs to some random person they don't know, just so they might have a bad experience? It doesn't make sense," Zagorski told Salon. "At the end of the day, drug sellers are business people, and they're not going to invest in some kind of change to their supply if they don't think there's some good return on it … Kids don't have a lot of money that their parents don't supervise or give to them. So it just doesn't make sense from a business standpoint."

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.

CA Safe Injection Site Bill Goes to Governer, WV Cities and Counties Settle with Opioid Distributors, More... (8/2/22)

Louisiana police can no longer search homes based on the odor of marijuana without a warrant, there is good polling for marijuana legalization in Missouri, and more.

The Vancouver safe injection site. California cities could soon follow suit. (vch.ca)
Marijuana Policy

Louisiana Cops Can No Longer Use Marijuana Odor as Excuse to Search Homes. As of Monday, police in the state are prohibited from searching people's residences based on the odor of marijuana unless they have a warrant. That is because the legislature this year passed and the governor signed into law Act 473, which mandates that: "Notwithstanding any provision of law to the contrary, the odor of marijuana alone shall not provide a law enforcement officer with probable cause to conduct a search without a warrant of a person's place of residence." Another new law, this one banning vaping or smoking marijuana in a vehicle, also went into effect Monday.

Missouri Poll Shows Strong Support for Marijuana Legalization. A new SurveyUSA poll of registered voters has support for marijuana legalization at 62 percent, including majorities of every demographic group except those over 65 and Republicans. While GOP voters did not show majority support, more Republicans supported legalization (47 percent) than opposed it (40 percent). The poll comes as marijuana legalization initiative awaits a decision a week from today on whether it has turned in enough valid voter signatures to qualify for the November ballot.

Opioids

West Virginia Cities and Counties Settle with Drug Firms Over Opioid Crisis. A group of cities and counties that sued drug distribution firms, accusing them of fueling a deadly wave of opioid use, have settled with three distributors for $400 million. The companies, AmerisourceBergen, Cardinal Health, and McKesson, were facing imminent trial in state court when they settled. Last month, a federal judge ruled against Cabell County and Huntington in similar claims. They are not included in the settlement announced Monday and plan to appeal the ruling that rejected most arguments made against the drug companies.

Harm Reduction

California Safe Injection Site Bill Heads to Governor's Desk. A bill that would allow four safe injection site pilot programs to get underway is now on the desk of Gov. Gavin Newsom (D). Sponsored by Sen. Scott Wiener (D-San Francisco), Senate Bill 57 got final approval in the Senate Monday. It had already passed the Senate earlier, but was amended in the House, necessitating a final concurrence vote. Under the bill, Los Angeles, Los Angeles County, Oakland, and San Francisco could open harm reduction centers as pilot programs lasting through January 1, 2028. "We're seeing an escalation in overdose deaths," Wiener said after Monday's vote. "These sites are a proven strategy to save lives and get folks into treatment. It's time." A similar bill passed in 2018, only to be vetoed by then-Gov. Jerry Brown (D). If Gov. Newsom signs the bill, California would follow Rhode Island as states that have okayed safe injection sites. A municipal safe injection site program is currently underway in New York City.

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.

Biden Signs Criminal Justice Reform Executive Order, RI Legislature Approves Marijuana Legalization, More... (5/25/22)

Rhode Island is set to become the 19th legal marijuana state, West Virginia announces a big settlement with drug manufacturers over their role in the opioid crisis, and more.

After congressional inaction, President Biden issues an executive order on criminal justice reform. (whitehouse.gov)
Marijuana Policy

Georgia Voters Approve Marijuana Legalization Ballot Question. State voters sent a strong signal to lawmakers Tuesday by overwhelmingly approving a non-binding ballot question on marijuana policy. Voters were asked: "Should marijuana be legalized, taxed and regulated in the same manner as alcohol for adults 21 years of age or older, with proceeds going towards education, infrastructure and health care programs?" A whopping 80 percent of them answered "yes."

Rhode Island Legislature Approves Marijuana Legalization. Both the House and the Senate voted Tuesday to approve a marijuana legalization bill, Senate Bill 2430. Gov. Dan McKee (D) is set to sign it into law today. The law will allow people 21 and over to possess, grow, and purchase limited amounts of marijuana. It also includes expungement and social equity provisions. Once the bill is signed into law, Rhode Island will become the 19th state to free the weed. Look for our feature story on this later today.

Opiates and Opioids

West Virginia Announces Settlement with Opioid Manufacturers. State Attorney General Patrick Morrisey announced Wednesday that the state had reached a $161.5 million settlement with two drug companies over their role in the opioid epidemic. The settlement came as the trial in the state's lawsuit against Allergan and Teva was nearing its end. Morrisey touted the settlement as "record-breaking," saying it was the highest per capita settlement in the country and blasted the two companies as "helping fuel the opioid epidemic in West Virginia by engaging in strategic campaigns to deceive prescribers and misrepresent the risks and benefits of opioid painkillers."

Criminal Justice

President Biden Signs Executive Order to Advance Accountable Policing, Strengthen Public Safety. Marking the second anniversary of the killing of George Floyd at the hands of Minneapolis police, President Biden on Wednesday issued a broad-ranging executive order to advance accountable policing and enhance public safety. The move comes after Congress largely failed to act on policing reform in the wake of the killing and the mass protests it generated. Among other provisions, the order creates a new national database of police misconduct, restricts the use of no-knock search warrants, bans the use of chokeholds and carotid restraints unless deadly force is authorized, requires new standards limiting the use of force for all federal agencies, restores the Obama administration's restrictions on the transfer of military equipment to law enforcement agencies, requires an updated approach to recruitment, hiring, promotion, and retention of law enforcement officers; requires all federal law enforcement agencies to track data on use of force; directs a government-wide strategic plan to propose interventions to reform the criminal justice system; and requires full implementation of the First Step Act.

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