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

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

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

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

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

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

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

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

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

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

Oregon's most populous county backs away from a widely criticized harm reduction program, California pot companies tied to fake labor unions could lose their licenses, and more.

Marijuana Policy

California Pot Companies Tied to Fake Unions Could Lose Their Licenses. In a bid to evade state law that requires marijuana businesses to sign a "labor peace" agreement with a "bona fide" labor union, at least a dozen marijuana businesses signed agreements with a bogus "labor union." Now, they stand to lose their licenses. Those businesses have not yet been named.

Who has been named is a group calling itself Professional Technical Union Local 33 (ProTech), which the state Agricultural Labor Relations Board (ALRB) last Thursday designated as "not a bona fide labor organization." A bona fide labor organization demonstrates "a sincere and good faith intent to organize and represent employees as a collective bargaining representative, including the capacity or ability to do so," the ALRB wrote in its ruling. ProTech failed "to respond to basic inquiries," such as providing information on membership and organization, suggesting "impropriety," the ALRB added.

After the ALRB ruling last week, the Department of Cannabis Control on Monday issued a bulletin warning marijuana businesses that "any labor peace agreements entered into by licensees with (ProTech) are null and void" and any "(l)icensees who have entered into a labor peace agreement with (ProTech) will be notified that they are out of compliance with licensure requirements."

The ALRB said that, according to ProTech president Joe Senense, ProTech has signed between "20 and 100" labor peace agreement with state marijuana businesses.

Psychedelics

Massachusetts Therapeutic Psychedelic Initiative In the Works. A newly formed group calling itself Massachusetts for Mental Health Options has quietly submitted initial documents to the state Office of Campaign and Political Finance in a bid to put a therapeutic psychedelic initiative on the 2024 ballot.

An organization statement the group filed last week says its purpose is to "expand mental health treatment options in Massachusetts by providing new pathways to access natural psychedelic medicine therapy." The filing adds that the initiative would focus on "creating access to natural psychedelic medicine therapy and removing criminal penalties for personal possession of these medicines."

The effort appears to be backed by New Approach PAC, which played a major role in getting psychedelic initiatives on the ballot in Colorado and Oregon in 2022. At the Psychedelic Science conference in Denver last month, David Bronner of Dr. Bronner's Magic Soaps, a major contributor to New Approach PAC, said he was supporting reform efforts in Massachusetts, as well as Arizona.

The state already has active psychedelic reform groups that have waged successful campaigns to decriminalize psychedelics is six localities, and there are murmurs that New Approach PAC needs to be consulting with them. Bronner said initiative backers are trying to do that.

"Conversations are happening in all directions to see if it is viable, and if so the policy will reflect input from all stakeholders and iterate / learn from / improve on CO, on both decrim and regulated access, within Mass's single issue constraints," he said, referring to a rule that says ballot initiatives in the state must only cover a single subject.

Those conversations need to happen quickly. The deadline to submit an initiative petition is August 3.

Harm Reduction

Oregon's Multnomah County Suspends Distribution of Drug Paraphernalia in Wake of Backlash. The county, home to Portland, has suspended a harm reduction program that handed out drug paraphernalia, such as crack pipes, tin foil, and straw following intense criticism. County Chair Jessica Vega Pederson said the health department had proceeded with the program without "proper implementation protocols."

"In that light, I am suspending the program pending further analysis," she said in a statement. "My focus has been on saving lives. We've seen overdose deaths from fentanyl increase 8-fold since 2019, from 26 deaths to 209 deaths in 2022."

The health department said it will continue to push for the program: "For the time being, our focus will be on expanding our legal analysis to deepen our confidence and assurance in the scope of our operations. Additionally, we are collaborating with the chair's office and the full board of county commissioners to establish resources and communications to support the public's understanding of the roles of harm reduction in our communities," Multnomah County Health Communications Coordinator Sarah Dean said.

The policy faced opposition from the time it was announced, with Portland Mayor Ted Wheeler calling it "deeply misguided" and saying it encourages "illegal drug use." And the county buckled under the pressure.

A British festival organizer is reaming the Home Office over its sudden requirement that pill testing efforts be licensed, another Republican politician wants to use the US military to fight Mexican drug cartels, and more.

Medical Marijuana

Florida Governor Signs Bill Barring Medical Marijuana at Sober Living Facilities. Gov. Ron DeSantis (R) has signed into law Senate Bill 210, which bars sober living facilities from allowing residents to use or possess medical marijuana, even if that use is medically authorized. The law does not apply to any other doctor-approved drugs. Now, people seeking licenses to run recovery residences will need to certify that they don't allow the use of marijuana, "which includes marijuana that has been certified by a qualified physician for medical use."

He also signed Senate Bill 1676, which bars the sale of smokeless hemp products such as "snuff, chewing gum, and other smokeless products" to people under 21. Previously, hemp regulations only barred the sale of smokable hemp products to people under 21.

Foreign Policy

Senator JD Vance Endorses Use of Military Against Mexican Drug Cartels. Freshman Senator JD Vance (R-OH), an acolyte of former President Donald Trump, has suggested giving American presidents the power to use the US military to go after drug trafficking organizations in Latin America.

"I want to empower the president of the United States, whether that's a Democrat or Republican, to use the power of the US military to go after these drug cartels," Vance said on Meet the Press on Sunday. "We have to recognize the Mexican government is being, in a lot of ways, destabilized by the constant flow of fentanyl," Vance added.

Vance is only the latest Republican office holder to call for the US military to be deployed against the cartels. Florida Gov. Ron DeSantis, said last week that he supported using "deadly force" to fight them, and fellow Republican presidential contender Sen. Tim Scott (SC) said he would dispatch US special forces to fight the cartels.

Mexican President Andres Manuel Lopez Obrador is having none of it. "We are not going to permit any foreign government to intervene in our territory, much less that a government's armed forces intervene," he said at a news conference in March.

International

WHO Report Calls Out Global Disparities in Use of Morphine to Relieve Pain. The World Health Organization (WHO) has issued a report saying the use of morphine to treat pain, ease end-of-life experiences, and helping people get through medical emergencies is vital but suffers from great disparities. "Millions of people continue to suffer preventable pain," the report notes.

In the Western Hemisphere, for example, the US utilizes nearly 80 percent of the supply, leaving Latin America in the lurch. More broadly, wealthy countries consumed an estimated 125.9 does per million people a day in 2021, compared with just two doses per million people in low-income countries.

The report's authors recommend establishing affordable pricing policies worldwide, expanding access to people beyond those suffering from cancer and HIV/AIDS, and setting up distribution hubs.

"Leaving people in pain when effective medicines are available for pain management, especially in the context of end-of-life care, should be a cause of serious concern for policymakers," said Yukiko Nakatani, WHO assistant director general for medicines and health products.

British Festival Head Threatens Legal Action over Ban on Pill Checking. Sacha Lord, founder of the Parklife music festival, has formally threatened legal action against the government over its moves against checking pills and powders that attendees turn it at festivals and other events. The Home Office recently barred other festivals from doing pill checking, saying they needed licenses to do so, even though pill checking has gone on at festivals for the past 10 years.

Large festivals, such as Glastonbury and Reading, have used private companies to do the pill checking, while smaller festivals have relied on charities such as The Loop, which has agreements with local police and governments to be able to test at events.

In a letter to the Home Office, Lord said the Home Office was "well aware" of those arrangements and that former ministers had publicly stated that they would not interfere with them. He also chided the Home Office for announcing the licensing requirement just two days ahead of the Parklife festival, making it impossible to obtain in time and jeopardizing the health of festival-goers. The letter demands that the government allow testing without a license to proceed or to take steps to ensure festivals have enough time to comply with the license requirement.

(This article was prepared by StoptheDrugWar.org's 501(c)(4) lobbying nonprofit, the Drug Reform Coordination Network, which also pays the cost of maintaining this website. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

A House committee has approved a defense spending bill with a pair of drug provisions, the Maine Senate kills a safe injection site bill but offers a study substitute, and more.

Medical Marijuana

House Committee Approves Medical Marijuana, Psychedelic Study Amendments to Military Appropriations Bill. The House Armed Services Committee approved the National Defense Authorization Act on Wednesday after first accepting amendments to create a medical marijuana pilot program and mandate a study into the potential therapeutic benefits of psychedelics for active-duty military members.

Rep. Nancy Mace (R-SC) offered the medical marijuana amendment, which would create a pilot program studying the health impacts of marijuana use by veterans and service members who are Department of Veterans Affairs (VA) patients. The program would be limited to VA patients suffering from PTSD, depression or anxiety, or who have been prescribed pain management.

Rep Morgan Luttrell (R-TX offered the therapeutic psychedelic amendment.

Pennsylvania Medical Marijuana Expansion Bill Package Advances. The Senate Law and Justice Committee has approved a package of bills that would broaden the state's medical marijuana program, including permitting the sale of edibles and removing the need to have a specified qualifying condition. The package won on a near-unanimous vote. The package now heads for a Senate floor vote.

Psychedelics

At Psychedelic Science Conference, NFL Quarterback Aaron Rodgers Calls for Psychedelic Legalization. NFL quarterback and ayahuasca aficionado Aaron Rodgers advocated for psychedelic legalization as he addressed the Psychedelic Science conference in Denver Wednesday.

"Is it not ironic that the things that actually expand your mind are illegal and the things that keep you in the lower chakras and dumb you down have been legal for centuries?" said Rodgers.

He also discussed his use of ayahuasca, calling it "radically life-changing" and said many pro athletes had reached out to him after he spoke out earlier about his experiences. "The response from other people in the sports industry has been incredible. To see basketball players and baseball players and surfers, entertainers and my own teammates and colleagues across the league reach out and either share their story about their own medicine journey or ask to be a part of an upcoming one was pretty special."

Harm Reduction

Maine Senate Kills Safe Injection Site Bill. The Senate on Wednesday killed a bill that would have allowed for safe injection sites, but advanced a different version of the bill that would require Gov. Janet Mills (D) to create a study group the issue before deciding on whether to allow them. Gov. Mills has opposed safe injection sites.