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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.

White House Outlines Policies on Overdoses and Opioid Epidemic, GOP Legal Pot Bill Could Get Hearing, More... (3/3/22)

Costa Rica becomes the latest country to legalize medical marijuana, an Oklahoma psychedelic study bill is moving, and more.

President Biden used the SOTU to outline policies on overdoses and the opioid epidemic. (whitehouse.gov)
Marijuana Policy

GOP Congresswoman Says Her Marijuana Legalization Bill Will Get a Hearing. Rep. Nancy Mace (R-SC), who has filed the States Reform Act legalization bill (HR 5977), said Thursday that she has received reassurances that her bill will get a hearing even though her party is in the minority. She also said that there was "no quid pro quo" requiring her to support House Judiciary Committee Chairman Jerrold Nadler's (D-NY) Marijuana Opportunity, Expungement and Reinvestment (MORE) Act (HR 3617). "Personally, I want to respect the process and MORE is going to come up again and let Democrats do MORE Act. It'll die in the Senate," she said. "And so when that's done, we will do our hearing, and there was nothing done in exchange for it. I just made the ask and we're making it happen."

Opiates and Opioids

Sacklers and Purdue Pharma Reach New Deal with States Over Opioids. Members of the Sackler family, who founded Purdue Pharma, have announced a deal with a group of states that had resisted Purdue's bankruptcy plan. Under the deal, which would settle thousands of pending lawsuits for the company's role in the opioid crisis and still must be approved by a judge, the family agrees to pay an additional one billion dollars, bringing the total they have now agreed to pay to $6 billion. "While the families have acted lawfully in all respects, they sincerely regret that OxyContin, a prescription medicine that continues to help people suffering from chronic pain, unexpectedly became part of an opioid crisis that has brought grief and loss to far too many families and communities," they said in a statement. While Purdue Pharma pleaded guilty to criminal charges of minimizing OxyContin's risk of addiction and misleading marketing, no Sackler family member has ever been criminally charged or admitted wrongdoing.

Psychedelics

Oklahoma Bill to Study Therapeutic Psychedelics Advances. A bill that seeks to allow research into the therapeutic uses of psychedelics, House Bill 3414, has been approved by the House Public Safety Committee and now heads for a House floor vote. The bill, sponsored by Rep. Daniel Pae (R-Lawton), would allow the state's universities and other research institutions to begin studying psilocybin and psilocyn, the psychoactive substances in magic mushrooms.

Drug Policy

Biden Uses State of the Union to Outline Policies on Addiction and Overdose Epidemic. The president outlined his comprehensive approach, including increased funding for public health and supply reduction. He is requesting a historic $41 billion for drug policy efforts that will further these efforts, including $10.7 billion for the Department of Health and Human Services "to fund research, prevention, harm reduction, treatment, and recovery support services, with a focus on meeting the needs of populations at greatest risk for overdose and substance use disorder." Overall, the president is proposing $23.5 billion for public health approaches to drug use and its consequences.

The Administration has prioritized funds for harm reduction. The American Rescue Plan included $30 million in support for harm reduction services -- a historic amount that will enhance interventions like syringe services programs. Additionally, CDC and the SAMHSA announced that federal funding may now be used to purchase fentanyl test strips in an effort to help curb the dramatic spike in drug overdose deaths.

The president also proposed spending $17.5 billion for supply reduction (read: enforcing drug prohibition), including $5.8 billion for interdiction efforts, an increase from the amount spent this year.

International

Costa Rica Legalizes Medical Marijuana. With the signature of President Carlos Alvarado on a revised medical marijuana bill, Costa Rica becomes the latest nation to legalize medical marijuana. Earlier in the year, Alvarado had vetoed the bill, but lawmakers made changes requested by the president. The bill also legalizes hemp, but not recreational marijuana. Alvarado is about to leave office, and the two presidential candidates seeking to replace him, José María Figueres and Rodrigo Chaves, have both spoken in favor of legalizing recreational use of marijuana.

New Zealand Medical Marijuana Patients Now Have Access to Smokeable Buds. Medical marijuana patients suffering from chronic pain will now be able to purchase smokeable buds after the Ministry of Health approved imports from an Australian firm. The buds are supposed to only be used to make a tea, but smoking or vaping them activates their soothing qualities more quickly, and patients and providers say it will be smoked and vaped.

J&J and Drug Distributors Settle Opioid Lawsuits, SD Gov Cool to MJ Legalization Bill, More... (2/25/22)

An Idaho legislator worried that substitute teachers are selling drugs to kids gets a teacher testing bill out of committee, Tennessee is the latest state to see a fentanyl test strip legalization bill, and more.

Marijuana Policy

South Dakota Governor Suggests Possible Veto of Marijuana Legalization Bill. Gov. Kristi Noem (R) sounded skeptical of a marijuana legalization bill, Senate Bill 3, which has just passed the Senate, at a Wednesday press conference. Noem did not give a direct answer when asked about the issue, saying "it's hard to talk in hypotheticals," and she's "not in favor of recreational marijuana." She added that, "I still believe I haven't seen anybody get smarter from smoking dope." Voters approved marijuana legalization in 2020, only to see their decision overturned by the state Supreme Court. The activists behind the 2020 campaign are now signature gathering for a new initiative, but say they will desist if a workable legalization bill becomes law.

Opiates and Opioids

Johnson & Johnson, Drug Distributors Reach Settlement Over Opioid Lawsuits. Three of the country's largest drug distributors -- McKesson, Cardinal Health and AmerisourceBergen -- and drug maker Johnson & Johnson announced Friday that they had reached a settlement with the vast majority of states and localities that had sued them over their role in the nation's early-century opioid crisis. The companies have agreed to pay out $26 billion to settle those thousands of claims, with the first checks set to go out in April with at least 85 percent of the payments dedicated to addiction treatment and prevention services. The distributors and Johnson & Johnson released statements Friday morning, noting that the deal is not an admission of wrongdoing and that they strongly dispute the allegations. The distributors said in a joint statement that they believed that "the implementation of this settlement is a key milestone toward achieving broad resolution of governmental opioid claims and delivering meaningful relief to communities across the United States that have been impacted by the epidemic."

Drug Testing

Idaho House Committee Advances Bill Requiring Drug Testing for Substitute Teachers. Ignoring the objections of state school officials, the House Education Committee voted 8-7 Thursday to approve a bill requiring mandatory pre-employment drug testing of all substitute teachers, at a time when school districts are scrambling for substitute teachers. School officials called the proposed law unworkable and noted that districts already have their own drug testing policies. "It is unnecessary, and further, we have a policy at the local level," Karen Pyron, superintendent of the Butte County School District, told the committee. "It adds cost and inconvenience and an additional burden to our rural schools," she said. But bill sponsor, Rep. Judy Boyle (R-Midvale) retorted that she had "tremendous concerns." Substitute teaching "is a very easy way to access children and sell drugs to them," she claimed. Her reasoning prevailed in the narrowly divided committee, and House Bill 651 now heads for a House floor vote.

Harm Reduction

Tennessee Fentanyl Test Strip Bill Filed State Sen. Richard Briggs (R-Knoxville) has filed a bill to legalize fentanyl testing strips, Senate Bill 2427. They are currently considered drug paraphernalia under state law. "SB 2427 is very important for Tennessee, especially East Tennesse, where we've had a very large number of deaths from drug overdoses," said Briggs. "This bill legalizes a tool that can help save lives from drug overdoses in our state." The bill would sunset after three years unless it was renewed. The House Criminal Justice Committee is set to discuss the bill on March 2.

CDC Prepares New Opioid Prescribing Guidelines, OH Senate Won't Take Up Legalization Voter Init, More... (2/10/22)

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)
Marijuana Policy

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.

Federal Judge Throws Out Purdue Pharma Oxycontin Settlement, 90-Year-Old Pot Prisoner Freed, More... (12/17/21)

The Ohio Senate approves a medical marijuana expansion bill, Baltimore will end pre-employment drug and alcohol screening for potential city government hires, and more.

Horacio Estrada-Elias with family, 2014
Marijuana Policy

90-Year-Old Federal Prisoner Serving Life for Marijuana Offense Wins Compassionate Release. A seriously ill federal prison doing life in prison for a nonviolent marijuana trafficking offense has been freed after a judge granted him compassionate relief on Tuesday -- overruling his own previous order denying the release. Horacio Estrada-Ellis, 90, had served more than a dozen years in prison and suffers from congestive heart failure, atrial fibrillation and chronic kidney disease, and also contracted the coronavirus while in prison. His warden had recommended compassionate release but federal District Court Judge Danny Reeves denied the motion in July, saying a life sentence is "the only sentence that would be appropriate." But a three-judge panel of the 6th US Circuit Court that Reeves had "abused (his) discretion" by ignoring the fact that Estrada-Ellis was unlikely to reoffend and by "overly emphasizing" his nonviolent crimes, and Reeves then issued a new opinion approving his compassionate release. Estrada-Ellis left prison on Friday.

Medical Marijuana

Ohio Senate Approves Medical Marijuana Expansion. The state Senate on Wednesday approved a bill that would allow more dispensaries to sell medical marijuana, growers to grow more of it, and more patients to qualify for it by expanding the list of qualifying conditions to include any conditions for which a patients might "reasonably be expected" to find benefit or relief. The bill would also shift regulation of dispensaries from the pharmacy board to a new Division of Marijuana Control in the Commerce Department. The bill now heads to the House.

Opioids

Federal Judge Throws Out Purdue Pharma Opioid Settlement, Leaving Sackler Family Vulnerable to Civil Lawsuits. US District Court Judge Coleen McMahon on Thursday blew up a carefully negotiated settlement between Purdue Pharma and thousands of state, local, and tribal governments that had sued the company, which manufactured OxyContin, for its role in the rapid rise of opioid addiction beginning in the late 1990s. The agreement had shielded the Sackler family, which owned Purdue Pharma, from more civil lawsuits in return for a $4.5 billion payment. But McMahon ruled that the bankruptcy code does not allow such an agreement. Purdue has already said it will appeal, but lawyers for some government entities that had appealed the originally settlement were quite pleased: "This is a seismic victory for justice and accountability that will re-open the deeply flawed Purdue bankruptcy and force the Sackler family to confront the pain and devastation they have caused," said William Tong, the attorney general of Connecticut. The explosion of opioid use that began with OxyContin eventually resulted in a backlash, leading to restrictions on the availability of prescription opioid that left chronic pain patients in the lurch and prompted many opioid users to move to the black market, fueling a large increase in opioid overdose deaths in recent years.

Drug Testing

Baltimore to No Longer Require Pre-Employment Drug, Alcohol Screening for City Jobs. Mayor Brandon Scott announced Wednesday that the city government will no longer require pre-employment drug and alcohol screening for new hires. The new policy has exceptions for safety-sensitive positions, such as law enforcement, and positions that require driving or operating heavy equipment.

"We want the best and brightest candidates to help us provide efficient and effective City services to our residents," the mayor said. "Frankly, the outdated and costly pre-employment drug and alcohol screenings only served to block qualified and passionate residents from obtaining employment with the City. This policy disproportionately harmed the prospects of talented Black and Brown job candidates. I am grateful that we are making this change now so that we can continue to improve local government operations and better serve the people of Baltimore."

Purdue Consultant to Pay $573 Million in Settlements, Idaho Bill to Ban Marijuana Legalization Advances, More... (2/4/21)

Another massive settlement resulting from Purdue Pharma's aggressive marketing of OxyContin, a Maryland marijuana legalization bill gets filed with support from the leadership, South Dakota lawmakers begin working to implement their marijuana legalization initiative, and more.

(Creative Commons)
Marijuana Policy

Idaho Senate Passes Constitutional Amendment to Ban Marijuana Legalization.The state Senate on Wednesday approved a constitutional amendment that would make it impossible for voters or legislators to legalize marijuana -- or any other drug not approved by the federal Food and Drug Administration. The measure, Senate Joint Resolution 101, now heads to the House, where it must be approved by a two-thirds majority. If it passes the House, it would then have to be approved by a simple majority of voters in the November 2022 election.

Maryland Senate President Cosponsors Marijuana Legalization Bill. Senate Majority Leader Nancy King (D) is cosponsoring a marijuana bill, Senate Bill 708, that was introduced this week. Senate Finance Committee Vice-Chair Brian J. Feldman (D) is the lead sponsor, and he has several other powerful cosponsors, including Budget and Taxation Chair Guy J. Guzzone (D), Judicial Proceedings Committee Chair William C. Smith Jr (D), Vice-Chair Jeffrey D. Waldstreicher (D) and Senate President Bill Ferguson (D). The bill would tax and regulate marijuana sales, but also include several social equity provisions.

Oregon Marijuana Social Equity Bill Filed. A coalition of legislators has filed House Bill 3112, which is also backed by numerous marijuana companies, the NuLeaf Project, the Oregon Cannabis Association, the Oregon Retailers of Cannabis Association, the City of Portland, Urban League, and law students from Willamette University. The bill would use marijuana tax revenues to invest in communities adversely affected by decades of marijuana prohibition. The bill includes automatic expungement of past marijuana convictions, direct investment in marijuana businesses owned by minorities and people with marijuana convictions, and equity licenses with reduced fees and modified requirements for those communities.

South Dakota Lawmakers Take Up Bill to Implement Voter-Approved Marijuana Legalization. A bill designed to implement taxed and regulated marijuana commerce, House Bill 1225, was filed Wednesday. Titled "An Act to establish provisions concerning the sale of adult-use retail marijuana," the bill contains 72 separate sections addressing a wide range of rules and regulations related to recreational marijuana. Also, a bipartisan group of legislators has formed a Cannabis Caucus to study issues around managing legalization. Meanwhile, a legal challenge to the constitutionality of the voter-approved marijuana legalization initiative backed by Governor Kristi Noem (R) remains pending.

Medical Marijuana

Mississippi Medical Marijuana Bill Moves. The Senate Finance Committee has approved Senate Bill 2765, which would make medical marijuana available to people with specified debilitating and chronic diseases. Last November, voters approved a broader medical marijuana initiative, but it is being challenged in court. The bill sponsor says if the court strikes down the initiative, there will be a bill ready to replace it.

Heroin and Prescription Opioids

Big Pharma Consulting Company Agrees to Pay $573 Million for Role in "Turbocharging" Prescription Opioid Sales, McKinsey & Company, a high-end consulting firm for big corporations, including major pharmaceutical companies, has agreed to pay $573 million to settle lawsuits that charged it with "turbocharging" the sale of prescription opioids. Attorneys general in 47 states, five US territories, and the District of Columbia sued the firm, unearthing documents showing how McKinsey worked to drive up the sales of Purdue Pharma's OxyContin -- even after Purdue pleaded guilty to federal charges of misleading doctors and regulators about OxyContin's risks.

Psychedelics

Cambridge Becomes Second Massachusetts City to Move to Decriminalize Psychedelics. The Cambridge city council voted Wednesday to decriminalize a broad range of psychedelics, following in the footsteps of Somerville, which passed a similar measure last month. The Cambridge resolution called for making enforcement of laws against the use and possession the city's lowest law enforcement priority, and it calls on police to stop arresting people for possessing or using any illicit drugs.

Purdue Pharma Pleads Guilty to Criminal Charges Over Oxycontin, House to Vote on Legal Pot This Week, More... (12/1/20)

It's now legal to possess and grow your own marijuana in Arizona, the House Rules Committee takes up the MORE Act on Wednesday, Purdue Pharma pleads guilty to three federal criminal charges, and more.

Marijuana Policy

House Rules Committee Takes Up Marijuana Legalization Bill Tomorrow Ahead of Looming Floor Vote. The House Rules Committee takes up the MORE Act (HR 3884) tomorrow, paving the way for a House floor vote on the bill later this week. House Judiciary Committee Chairman Jerrold Nadler (D-NY) sent the bill to the Rules Committee with some modifications, the most significant of which revolve around taxation. The bill originally imposed a 5% tax on marijuana products, but Nadler has amended the bill to remove that language and replace it with a scheme that would allow increases in the tax rate until it reaches 8%.

Arizona Marijuana Legalization Now in Effect. Marijuana is now legal in the state. It became so after the state secretary of state certified the election results, affirming that Prop 207 indeed passed. It is now legal to possess up to an ounce of marijuana and up to five grams of concentrates and to grow up to six plants for personal use. The legal, regulated marijuana market won't be in effect until sometime next year.

Virginia Legislative Working Group Issues Report Outlining Path to Legalization. A working group on marijuana legalization requested by the legislature issued its report Monday and concluded that the end of pot prohibition "cannot be created quickly." First, the state needs to invest in data collection, craft new regulations, and undertake a public education campaign, the report said. That pushes legalization down the road: "Setting up an adequate regulatory structure will require a significant up-front investment, in time, patience, and budgetary resources," the report reads. The report sets an 18-24-month timeline for legalization and up to five years before there is a fully developed legal marijuana industry.

Heroin and Prescription Opioids

Purdue Pharma Pleads Guilty to Federal Criminal Charges Over Oxycontin Role in Opioid Crisis. OxyContin maker Purdue Pharma pleaded guilty Tuesday to one count of conspiracy to defraud the United States and violate the Food, Drug, and Cosmetic Act, as well as two counts of conspiracy to violate the Federal Anti-Kickback Statute. The move came after a plea deal agreed to in October that also includes a historic $3.544 billion fine and a $2 billion criminal forfeiture. The company will now be dissolved and its assets used to incorporate a "public benefit company" designed to serve the public, not the company's bottom line.

Chronicle AM: Nation's First Cannabis Cafe Opens Doors, Dutch Supreme Court Rules Against Ayahuasca, More... (10/2/19)

Los Angeles sees the nation's first legal cannabis cafe, the Arizona legalization initiative draws industry opposition, the Justice Department says DEA didn't adequately regulate opioid manufacturing, and more.

Ayahuasca-inspired art. The Dutch Supreme Court has ruled the substance illegal. (Pinterest)
Marijuana Policy

Senators Introduce Federal Student Financial Aid Bill. US Sens. Jeff Merkley (D-OR) and Ron Wyden (D-OR) announced new bipartisan legislation Tuesday they say would allow students with a felony drug conviction access to the American Opportunity Tax Credit for higher education. The Eliminating Discrimination and Creating Corridors to Expand Student Success Act of 2019 (ED ACCESS Act) would fix this inequity by repealing the lifetime ban. The measure does not yet have a bill number.

Arizona Legalization Initiative Campaign Draws Industry Opponents. A new marijuana industry group has formed to fight the Smart and Safe Arizona Act, which itself is backed by other industry groups. The new group calls itself the Arizona Cannabis Chamber of Commerce and has its own ideas about what legalization should look like. The group complains that the initiative is tailored to the needs of existing dispensary owners, that there wouldn't be enough licenses available, and that the proposed 16% sales tax rate is too high.

Pennsylvania Bill Filed to Legalize via State-Run Model. State Rep. David Delloso (D) on Monday filed a bill that would legalize marijuana and allow adults 21 and older to possess, consume, cultivate and purchase marijuana through a state stores system run by the Liquor Control Board. Retail pot shops would be taxed at 19%, and all of that revenue would go toward the state general fund. The bill would also create a distinct regulatory scheme for industrial hemp. The bill is not yet available on the state legislative web site.

Tennessee Steps Back from Marijuana Enforcement. The Tennessee Bureau of Investigation has announced that it will no longer test amounts of marijuana less than a half ounce, making it virtually impossible for prosecutors to build a case against small-time possessors.

Nation's First Cannabis Café Opens in Los Angeles. The first-ever licensed cannabis café in the US has opened in Los Angeles. The Lowell Café opened its doors to the public in West Hollywood on Tuesday. The café is a hybrid marijuana lounge and restaurant where you can order some weed along with your meal.

Heroin and Prescription Opioids

Justice Department Says DEA Failed to Properly Regulate Opioids. In a new report from the agency's inspector general, the Justice Department found that the DEA fell short in regulating the supply of prescription opioids in the past two decades. The agency continued to raise manufacturing quotas for opioids with little regard to oversupply or misuse, the report found. The DEA "ill-equipped to effectively monitor ordering patterns for all pharmaceutical opioids, which could enable the diversion of these prescription drugs and compromise public safety." Although alarm bells were already ringing by the turn of the century, the DEA allowed manufacturing levels of oxycodone -- sold as OxyContin by Purdue Pharma -- to nearly quadruple between 2000 and 2013.

International

Dutch Supreme Court Rules Ayahuasca Illegal. The Dutch Supreme Court ruled Tuesday that ayahuasca falls under the country's hard drug laws and that its import is illegal. The ruling came in the case of a woman who had imported about 70 pounds of ayahuasca tea from Brazil for use in Santo Daime church rituals. Because the substance contains DMT, which is covered by Dutch drug laws, ayahuasca is covered as well.

Mexican Marijuana Legalization Bill Would Create State-Run System. Diputado Mario Delgado Carrillo, coordinator of the ruling MORENA Party's bench in the Chamber of Deputies, filed a bill Tuesday that would legalize marijuana through a government-run system. Under the bill, a regulatory body called Cannsalud would be in charge of the legal market, which would be the "exclusive property of the federal government, with a technical, operational and management autonomy for the realization of its primary purpose" to create a legal, regulated system. "With this, the cannabis market is not left to autonomous regulation by individuals, but the state is involved as a constant supervisor and controller of the activity of this substance within a margin of legality that guarantees a benefit for all," Delgado said. "This is a first step towards the opening of a new lawful market, and a public company is proposed as an obligatory intermediary in order to identify and contain the risks inherent in the establishment of a new market, when there are already international commercial interests that seek to maximize its utilities above the protection of people's health," he said.

Chronicle AM: House MJ Banking Bill to Get Floor Vote, Purdue Pharma Files for Bankruptcy, More... (9/16/19)

A bill to open up financial services for the marijuana industry will get a House floor vote this month, the maker of OxyContin files for bankruptcy, the marijuana industry places the blame for vaping deaths on marijuana prohibition, and more.

Is marijuana prohibition to blame for vaping deaths? The industry is pointing a finger. (Creative Commons)
Marijuana Policy

House Will Vote This Month on Marijuana Banking Bill. The office of House Majority Leader Steny Hoyer (D-MD) has confirmed that he intends to bring the SAFE Banking Act to the House floor for a vote this month. Hoyer announced the move at a whip meeting last Thursday. The bill passed out of the House Financial Committee in March on a 45-15 vote. It would provide protections for banks that work with marijuana companies since the substance is still illegal under federal law, despite several states having legalized medical or recreational marijuana.

Marijuana Industry Blames Vaping Deaths on Failed Prohibition Policies.The National Cannabis Industry Association (NCIA) has blamed the recent wave of vaping deaths -- a total of six so far -- on "failed prohibition policies" and called on Congress to legalize and regulate marijuana. "These unfortunate illnesses and deaths are yet another terrible, and largely avoidable, consequence of failed prohibition policies," said NCIA Executive Director Aaron Smith. "Current federal laws interfere with research, prevent federal regulatory agencies from establishing safety guidelines, discourage states from regulating cannabis, and make it more difficult for state-legal cannabis businesses to displace the illicit market. It is now the responsibility of Congress to end prohibition and regulate cannabis without delay," Smith added. "By removing cannabis from the schedule of controlled substances and instituting a clear regulatory framework through existing agencies, the federal government can provide helpful guidance to states that have or wish to establish regulated cannabis control systems while helping put irresponsible illicit market producers out of business for good."

Medical Marijuana

Utah Lawmakers Meet to Revise Medical Marijuana Law. Legislators returned to the state capitol Monday to once more amend the state's medical marijuana law. One issue is how and where patients will obtain medical marijuana products. The state had contemplated a central government-run pharmacy that would distribute the drug to a system of private pharmacies, but local leaders have balked at having government employees distributing a federally illegal drug.

Heroin and Prescription Opioids

Purdue Pharma Files for Bankruptcy. Purdue Pharma, the manufacturer of OxyContin, filed for bankruptcy on Sunday, the first step of a tentative agreement the company and its owners, the Sackler family, reached last week to settle thousands of lawsuits blaming it for its involvement in the opioid epidemic. The deal is estimated at between $10 and $12 billion, with $3 billion coming from the Sacklers' personal fortunes.

Psychedelics

Ann Arbor Group Wants to Decriminalize Natural Psychedelics. A local group calling itself Decriminalize Nature Ann Arbor is planning to ask the city council to decriminalize natural psychedelics, such as peyote and magic mushrooms. They are calling on the council to approve a resolution to prohibit the use of city funds to investigate, arrest, or prosecute anyone for use or possession of such plants.

International

British Labor Party Wants Royal Commission on Drug Policy, Would Follow Its Recommendation to Decriminalize Drugs. A Labor government would consider decriminalizing all drugs if that was recommended by a royal commission, shadow home secretary Diane Abbott said. "There is nothing more important than preserving the life of our citizens," she said. "Our current approach to drugs is simply not doing that." Safe injection sites would also be considered, she added.

Thailand Bill Would Allow for Six Marijuana Plants for Personal Use. A member party in the country's ruling coalition government has proposed a bill that would let Thais grow up to six marijuana plants per household for medicinal use. "The principle is for medical use, you can have it at home for ailments, but not smoke it on the street," said Bhumjaithai Party lawmaker Supachai Jaisamut. The bill would also allow the sale of plants to institutions licensed by a Plant-based Drug Institute that would have the authority to purchase, extract, and export CBD.

Chronicle AM: Tentative Oxycontin Settlement, Philippines Says No to UN Investigators, More... (9/12/19)

It looks like the thousands of lawsuits against Purdue Pharma over Oxycontin are about to be settled, a new audit finds California's unlicensed pot shops greatly outnumber licensed ones, Florida's attorney general seeks to block a marijuana legalization initiative, and more.

Purdue Pharma and the Sackler family will reportedly pay out billions to settle Oxycontin lawsuits. (Creative Commons)
California's Legal Pot Shops Are Outnumbered Three-to-One by Black Market Ones. According to an audit conducted by the United Cannabis Business Association, there are more than three times as many unlicensed marijuana shops as there are regulated ones. The audit found about 2,850 unlicensed dispensaries and delivery services, compared to only 873 licensed sellers in the state. The audit was based on Weedmaps listings. Fewer than 20% of California cities allow regulated pot shops, and though many large cities, including Los Angeles, San Diego, and San Francisco, do allow them, unlicensed dispensaries proliferate there as well. Earlier this year, Weedmaps showed 220 unlicensed pot shops in Los Angeles, compared to only 187 licensed ones.

Florida Attorney General Challenges Legalization Initiative. State Attorney General Ashley Moody (R) is challenging a proposed constitutional amendment that would legalize marijuana in the state… on the grounds that it is too detailed. The amendment is 10 pages long. "There is no way 10 pages of the law can be summarized clearly in 75 words or less and would adequately convey to the voters what exactly they will be voting on," the attorney general said. There are two significant legalization initiative campaigns underway in the state; the one Moody is challenging is the "Regulate Marijuana in a Manner Similar to Alcohol to Establish Age, Licensing, and Other Restrictions" initiative. Now it will be up to the state Supreme Court to determine whether the initiative comports with the legal requirements.

New Mexico Task Force Opposes State-Run Pot Shops. Gov. Michelle Lujan Grisham's (D) Cannabis Legalization Working Group, which is looking at regulatory options for marijuana legalization, has come out against state-run marijuana stores. Instead, it is endorsing a system of licensing commercial entities. The working group also recommends barring local governments from banning pot shops, although they would be allowed to impose zoning and similar restrictions.

Medical Marijuana

Ohio Medical Board Rejects Anxiety, Autism as Qualifying Conditions. The State Medical Board voted Wednesday to reject adding anxiety and autism spectrum disorder to the state's list of qualifying conditions for the use of medical marijuana. Earlier this year, the state's Medical Marijuana Expert Review Committee recommended adding the conditions, but the board overruled them. It did say it might revisit the issue later "if additional studies or evidence are brought forth in the petition process."

Heroin and Prescription Opioids

Purdue Pharma, Sackler Family Agree to Oxycontin Settlement. Purdue Pharma and the Sackler family have reportedly agreed to a tentative settlement of thousands of lawsuits filed by states and other localities over the role of Oxycontin in the current opioid epidemic. According to news reports, Purdue will file for bankruptcy and effectively dissolve, while a new company will form and continue selling Oxycontin, with the revenues going to the plaintiffs in the lawsuit settlement. The deal is expected to be worth between $10 and $12 billion, including $3 billion from the Sackler family, the owners of Purdue.

International

Philippines Refuses to Grant UN Access to Investigate Bloody Drug War. The Philippines will not allow visits by the United Nations to investigate its brutal war on drugs, Foreign Minister Teodoro Locsin said Wednesday. He called the UN experts "bastards" who had already prejudged his country. Asked if UN investigators should be allowed to work in the country, he said: "No. Because they have already prejudged. I already said those bastards -- especially that woman acting like the queen in Alice in Wonderland -- first, the judgment, then the trial. No." That was a reference to Agnes Callamard, the UN special rapporteur on extrajudicial, summary and arbitrary executions, who has been a staunch critic of Filipino President Rodrigo Duterte.

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