For nearly four years, the Philadelphia nonprofit Safehouse has seen its effort to open a safe injection site in the city stymied by a federal court case brought against it by the Trump administration Justice Department. And although the Trump administration is now history, the Biden Justice Department has continued to pursue the case even as the number of overdose deaths in the city mounts.

But now, Safehouse and the Justice Department (DOJ) have agreed to move their case about the legality of safe injection sites out of a federal district court and into mediation before a federal magistrate, a maneuver that advocates hope can speed up the resolution of the case and get the sites up and operating.

"We agreed with the Department of Justice to move in this direction to reach a settlement and get the lawsuit resolved," Safehouse vice-president Ronda Goldfein told the Philadelphia Inquirer. While declining to further characterize confidential settlement negotiations, she said the group's goals "have not changed" and that Safehouse seeks "a resolution that all parties can live with that give us the opportunity to save lives."

The move comes as the Biden DOJ has hinted at a possible softer stance toward safe injection sites. DOJ did not go to court to block local officials in New York City from allowing two safe injection sites to open in late 2021 or to block state officials from allowing them in early 2022. And DOJ had indicated it was engaged in settlement talks with Safehouse in February 2022.

At that time, DOJ said that it was "evaluating supervised consumption sites, including discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety."

But that was nearly a year ago, and Safehouse's patience is wearing thin. Just last month, after having repeatedly gone along with DOJ requests for continuances, Safehouse balked. It told the federal district court for the Eastern District of Pennsylvania that it would no longer agree to any additional delays, while the DOJ argued that it needed until February to proceed. The court compromised, requiring that DOJ reveal its position in the lawsuit by January 9.

With the mediation agreement between Safehouse and DOJ, that January 9 date is now moot, but Safehouse is convinced the move will result in a speedier resolution of the case and allow it to finally get into the business of saving lives.

"Since the DOJ commenced this litigation in 2019 until the end of 2021, more than 3,600 lives have been lost in Philadelphia to the opioid overdose crisis. Based on 2022 projections, that number will grow to almost 5,000 deaths," Safehouse said. "Safehouse and those that need its life-saving services have waited long enough."

Meanwhile, there are other signs the federal government may be warming to the harm reduction intervention. In a November report, the nonpartisan Congressional Research Service highlighted the "uncertainty" of the federal government's position on safe injection sites and suggested blockages could be overcome by approving an amendment to the annual DOJ funding bill precluding it from spending any funds to go after safe injection sites, much as has been successfully done to protect medical marijuana laws in the states.

And just days before that report was released, National Institute on Drug Abuse (NIDA) Director Nora Volkow tacitly endorsed the idea of authorizing safe consumption sites. Research has found that the intervention "has saved a significant [percentage of] patients from overdosing."

Now, if only the DOJ can find a way to get out of the way. Or if it cannot or will not, it will be time to go back to court.

The good, the bad, and the ugly in US domestic drug policy this year.

1. Overdose Deaths Appear to Have Peaked but Are Still at Horrid Levels

According to Provisional Drug Overdose Death Counts released by the Centers for Disease Control and Prevention (CDC) in December, the nation's fatal drug overdose epidemic has peaked. After reaching a record high of more than 110,000 fatal overdoses in the 12-month period ending in March, that number declined to 107,735 in the 12-month period ending in July, the last month for which data is available. That is a two percent decline from the March high.

While the decline is welcome, drug overdose numbers are still 25 percent higher than they were two years ago and double what they were five years ago. According to the CDC, synthetic opioids, mainly fentanyl, were implicated in more than two-thirds of overdose deaths and stimulants such as methamphetamine and cocaine were involved in nearly one-third. But some fraction of stimulant-implicated overdose deaths are not caused by the stimulants themselves but by stimulant users being exposed to drugs cut with fentanyl.

2. Neither Marijuana Legalization nor Banking Access Pass Congress

Senate Majority Leader Chuck Schumer (D-NY) vowed to make passage of a marijuana legalization bill a priority in this Congress, but it didn't happen. While the House passed a legalization bill, the Marijuana Opportunity Reinvestment and Expungement (MORE) Act (HR 3617) in April, Schumer and congressional allies didn't even roll out a draft version of their Cannabis Administration and Opportunity Act until this July -- 18 months after this Congress began -- and it never exhibited enough bipartisan support to go anywhere in the evenly divided Senate.

Schumer and his Senate allies also repeatedly blocked efforts to get a bill to allow state-legal marijuana businesses access to financial services through the Senate. The Secure and Fair Enforcement (SAFE) Banking Act (HR 1996) passed the House in April, and Senate allies tried repeatedly to attach it as an amendment to various spending bills, only to be stymied by Schumer and his holdouts for full-blown legalization. At year's end, though, while Schumer was finally ready to move forward with it, Senate Minority Leader Mitch McConnell (R-KY) came out in opposition, helping to scuttle one last effort to tie it to a defense appropriations bill.

3. With Biden's Signature, A Standalone Marijuana Reform Bill Becomes Law for The First Time Ever

For the first time ever, Congress passed and in December the president signed into law a stand-alone marijuana reform bill, the bipartisan Medical Marijuana and Cannabidiol Research Expansion Act (HR 8454). Some marijuana reform measures have been passed before, but only as part of much broader appropriations bills. The aim of the bill is to facilitate research on marijuana and its potential health benefits. The bill will accomplish this by streamlining the application process for scientific marijuana studies and removing existing barriers for research by allowing both private companies and research universities to seek DEA licenses to grow their own marijuana for research purposes.

4. Three More States Legalize Marijuana

In May, Rhode Island became the 19th state to legalize marijuana when the General Assembly passed and Gov. Dan McKee signed into law the Rhode Island Cannabis Act. Sales to any adult over 21 at medical marijuana dispensaries that acquired "hybrid retail licenses" began in December.

And in November, voters in Maryland and Missouri approved marijuana legalization initiatives. Maryland's Question 4 came not from the people but from the legislature and amends the state constitution and mandates that the General Assembly "shall provide for the use, distribution, possession, regulation and taxation of cannabis within the state." Missouri's Amendment 3 overcame multi-sided opposition not only from the usual suspects in law enforcement and the political establishment but also from civil rights groups and marijuana industry insiders to eke out a narrow victory. As of December 8, possession of up to three ounces by adults is no longer a crime, but sales to adults will not begin until next year.

But there were also losses at the ballot box this year. The Arkansas Adult Use Cannabis Amendment garnered only 43.8 percent of the vote, while North Dakota's Initiated Statutory Measure No. 1 managed only 45.1 percent, and South Dakota's Initiated Measure 27 came up short with only 46.6 percent of the vote. The South Dakota defeat was especially bitter, given that just two years ago, voters there approved a broader marijuana legalization initiative with 54 percent of the vote only to see it invalidated by the state Supreme Court.

5. The Year of Fentanyl Test Strip Decriminalization

Fentanyl test strips, which detect the presence of the powerful synthetic opioid in all different kinds of drugs (cocaine, heroin, methamphetamine, etc.) and formulations (pills, powders, and injectables) are recognized by the Centers for Disease Control and Prevention as a valuable harm reduction strategy and are increasingly seen by the states as a crucial tool in the fight to reduce drug overdose deaths. When the Biden White House first endorsed their use in 2021, they were considered illegal drug paraphernalia in a majority of states.

Not anymore. As of the end of 2022, 31 states have now legalized or decriminalized fentanyl test strips, with Alabama, Georgia, New Mexico, Tennessee, and Wisconsin doing so this year alone. But that leaves 19 states, mostly in the South and including Florida and Texas where they remain banned.

6. Colorado Becomes Second State to Approve Natural Psychedelic Reforms

Three years after voters in Denver opened the door to psychedelic reform by approving a municipal initiative that made possession of psilocybin mushrooms the lowest law enforcement priority, voters statewide have approved an initiative that decriminalizes plant- and fungi-derived psychedelics and creates a program for the therapeutic administration of such substances. On Election Day, voters approved Proposition 122, the Natural Medicine Health Act, with 53.55 percent of the vote. The victory makes Colorado the second state to enact reforms decriminalizing a natural psychedelic and setting up a program for therapeutic use. Oregon voters led the way on that by approving Measure 109 in 2020.

Proposition 122 has two main prongs: First, it decriminalizes the personal use, possession, and cultivation by people 21 and over of dimethyltryptamine (DMT), ibogaine, mescaline (not derived from peyote), psilocybin, and psilocyn, as well as providing for the sealing of conviction records of people who have completed sentences for the use or possession of those substances. The measure sets no personal possession limits. Second, it creates a "natural medicine services" program for the therapeutic administration of the specified psychedelics and creates a rubric for regulated growth, distribution, and sales of those substances to entities within the program. Only psilocybin and psilocin would be okayed for therapeutic use until 2026. Then regulators could decide on whether to allow the therapeutic use of DMT, ibogaine, and mescaline.

7. Marijuana Social Consumption Lounges Spread

Ever since the first states legalized marijuana a decade ago, one question for users was where to go to smoke their newly legal product. Most states ban smoking outdoors in public or indoors pretty much anywhere except one's home -- and even that can be an issue if your landlord isn't down with it. One solution is allowing places for marijuana users to toke up in a convivial setting, the marijuana social consumption lounge, whether as part of a retail shop or as a standalone business.

Social consumption lounges are now legal in 11 states -- Alaska, California, Colorado, Illinois, Massachusetts, Michigan, Missouri, New Jersey, New Mexico, New York, and Nevada -- although they are not actually up and running yet in some of them. Massachusetts has two lounges now operating; in New Jersey, regulators just approved rules for them; in Nevada, regulators just issued 20 provisional licenses; in New York, they're still waiting for regulators to act; and in California, the state's dozen or so lounges are set to double in number as more localities okay them. Meanwhile, the nation's capital could be next: In the District of Columbia, the city council just approved a bill allowing them.

8. Safe Injection Sites Are Operating in the United States

Safe injection sites, the harm reduction intervention proven to save lives after years of operation in more than a hundred cities in Australia, Canada, and Europe, are finally getting a toehold in the US. New York City's two safe injection sites have just celebrated their first birthdays after opening in late 2021, and in Rhode Island, a two-year pilot program is underway.

But there will be no safe injection sites in California after Gov. Gavin Newsom (D) vetoed a bill that would have allowed pilot programs in major cities across the state. And the fate of a proposed Philadelphia safe injection site -- and the Biden administration's attitude toward them -- remains in doubt. That facility was initially blocked by the Trump Justice Department, and two years later, the Biden Justice Department has yet to substantively respond to lawsuit from the site's would-be operators. Just this month, a federal judge gave DOJ just 30 more days to respond. A positive response would remove the obstacle to further expansion of such sites that fear of federal prosecution brings. Meanwhile, the Congressional Research Service has thoughtfully released a report about other options for getting them up and running, such as passing budget amendments similar to those blocking the Justice Department from interfering in marijuana laws.

9. In DC and New York City, Gray Market Weed Finds a Way

In both the nation's capital and the nation's largest city, unregulated marijuana vendors have popped up to supply pent up demand as both cities endure legalization without legal marijuana sales. In New York City, it's only a matter of time before taxed, licensed, and regulators marijuana retailers are able to open, but in the interregnum between legalization and legal access, the pot scene has gone hog wild with marijuana being sold everywhere -- head shops, bodegas, even from folding tables on street corners -- with one particularly hysterical estimate putting the number at "likely tens of thousands of illicit cannabis businesses." The market isn't waiting for the regulators, and its emergence could undercut the legal businesses waiting in the wings. The city has undertaken limited enforcement efforts, but to little effect so far.

In Washington, DC, a congressional rider barring taxed and regulated marijuana sales has seen something similar, but with a DC twist: a multitude of shops that will "gift" you marijuana when you purchase some other item. The stores call themselves I-71 shops, after the 2014 initiative that legalized marijuana in the city and they even have their own industry association, which estimates there are a hundred or so of them. The city vowed a crackdown in August, but put that on hold the following month.

10. For the First Time, SAMSHA Funds Harm Reduction

In December 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that it would for the first time ever make grants available to harm reduction groups to "help increase access to a range of community harm reduction services and support harm reduction service providers as they work to help prevent overdose deaths and reduce health risks often associated with drug use." SAMSHA would make available $10 million a year in grants for the next three years.

And this year, the first tranche went out. Some 25 different programs from the Lost Dreams Awakening Center in New Kensington, Pennsylvania, to the Mile High Council on Alcoholism and Drug Abuse in Denver, to the Los Angeles County Health Department got grants this year, almost all of them for $398,960. It's a drop in the bucket compared to federal spending on prohibition -- and compared to harm reduction's full funding needs -- but it's a start.

Moves are afoot to rein in Oregon's underground marijuana production, an Iowa law is blocking health authorities from including fentanyl test strips in harm reduction boxes, and more.

Marijuana Policy

Oregon 1Bill Would Double Penalties for Illicit Marijuana Grows. Faced with massive unpermitted marijuana growing—police have seized 105 tons of weed this year—and a rising chorus of complaints from police, legal growers, and neighbors, lawmakers have prepared a draft bill that would double maximum prison sentences and fines for unlawful manufacture of more than 100 plants and possession of more than two pounds in public or eight pounds at home. Under the proposed bill, the maximum sentence would jump from five years to 10 and the maximum fine  would jump to $250,000. The bill would also punish property owners for environmental damage and prohibit the use of water (which is owned by the state) for unlicensed marijuana grows. Voters approved legalization in 2014, at least partly on the grounds it would reduce illegal grows, but legalization proponents now say illicit grows will be a problem until the plant is legalized nationwide.

Harm Reduction

Federal Court Gives Justice Department One Month to Respond in Philadelphia Safe Injection Site Case. A federal judge has given the Justice Department just a one-month extension before it has to respond in a lawsuit about the legality of a proposed Philadelphia safe injection site. The Trump administration Justice Department sued to block Safehouse from opening in 2019, and the Biden Justice Department has continued the case while seeking repeated extensions as it talked with Safehouse But when Justice asked for another extension, Safehouse balked at the requested two-month delay, and the judge subsequently cut that request in half. Once it comes, the Justice Department's response should shed some light on whether the agency will or will not continue to challenge the legality of safe injection sites. The department said in February it was evaluating the sites, including discussions about appropriate "guardrails" for them, but with yet another extension request this month, Safehouse's patience is growing thin. "Safehouse did not consent to today’s DOJ request for more time," the group said the day of the filing, noting that the case "has been pending for almost four years." As the group noted, "more than 3,600 lives have been lost in Philadelphia to the opioid overdose crisis" while the case has been ongoing.

Iowa Law Blocks Fentanyl Test Strips from Being Included in Harm Reduction Boxes. The Polk County (Des Moines) Health Department is adding harm reduction boxes at its office and urgent care locations around the city. The boxes will include tourniquets, cotton filters, and needle disposal containers, but not fentanyl test strips, which are considered drug paraphernalia under state law. The Health Department said it supports changing that law, but that has not happened yet. Lawmakers in at least five other states—Alabama, Georgia, New Mexico, Tennessee, and Wisconsin—have taken that action this year.  

A global coalition is calling on UN drug bureaucracies to condemn the sudden resumption of drug executions in Saudi Arabia, a new Gallup poll has continuing high support for marijuana legalization, and more.

Marijuana Policy

Gallup Poll Finds Support for Marijuana Legalization Steady at 68 Percent. A new Gallup poll finds that support for marijuana legalization remains at a record high 68 percent for the third year in a row. It's a remarkable evolution in public opinion over the past half-century, with support at a measly 12 percent in 1969, rising to 31 percent in 2000, and achieving majority support in 2013. In every Gallup poll since 2016, at least 60 percent have supported legalization.

Rhode Island Recreational Marijuana Sales Have Begun. As of today, five existing medical marijuana dispensaries are now "hybrid" stores, selling recreational as well a medical marijuana. The first sale was shortly after 5 a.m., when Mother Earth Wellness in Pawtucket opened its doors.

Harm Reduction

Ohio House Approves Fentanyl Test Strip Decriminalization Bill. The House on Wednesday approved a bill to try to reduce drug overdose deaths by decriminalizing the possession of fentanyl test strips, House Bill 456. Ohio saw 5,204 people die of drug overdoses in 2020, 81 percent of them involving fentanyl. Similar legislation has been filed in the Senate.

Psychedelics

Berkeley Health Commissioners Recommend Decriminalization of Use of Hallucinogens, Including LSD. The Bay area city's health commissioners voted unanimously Tuesday night to recommend that the city council decriminalize the use of psychedelics, and they did not limit themselves to natural psychedelics, explicitly embracing the decriminalization of LSD as well. The city is now in line to become the first to decriminalize LSD if the city council approves it. Fifteen cities across the country have decriminalized natural psychedelics, but those measures excluded synthetic psychedelics such as LSD.

International

Global Coalition Calls on International Bodies to Condemn Saudi Arabia Drug Executions. The European Saudi Organization for Human Rights, Harm Reduction International, and the World Coalition Against the Death Penalty along with 32 other NGOs have called on the International Narcotics Control Board and the United Nations Office on Drugs and Crime to act on urgent measures in response to the series of drug-related executions carried out by the Kingdom. Saudi Arabia since November 10, 2022. The groups called on both organisms to seek confirmation from the Saudi government of the status of dozens of people on death row and at imminent risk of execution and to demand that the Saudi government immediately halt all drug-related executions. The Saudi government had halted drug executions in January 2020, but suddenly and without warning resumed them on November 10 and announced 20 such executions on November 24.