A Congressional Research Service report zeroes in on the Jalisco New Generation Cartel, the Remedy Alliance is easing naloxone bottlenecks, and more.

Colombian President Gustavo Petro (Creative Commons)

Naloxone Access About to Get Easier. Thanks to an informal buyers' club for naloxone that has morphed into an entity known as the Remedy Alliance, access to inexpensive naloxone -- the opioid overdose reversal drug -- is getting easier. The Alliance credits two major developments for the urgently needed breakthrough. First, they have managed to reach agreements with drug manufacturers to get the drug at a discount rate, and second, they have restructured to a system that allows local harm reduction groups to order the drug through an online store, getting around a labyrinthine web of federal regulations that has bottlenecked the flow of the drug amidst the ongoing overdose crisis.

"We think this will totally change the landscape of naloxone in the United States," said Nabarun Dasgupta, the nonprofit's board president and a scientist at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. The group, formerly known as the Opioid Safety and Naloxone Network Buyers Club, has already reversed thousands of opioid overdoses and distributed 1.3 million doses of naloxone last year. Now, the Alliance expects to distribute 2 million doses this year.

International

Ex-Leftist Rebel, Drug War Critic Assumes Office as Colombia's President. Gustavo Petro, a former member of the leftist M-19 guerrilla army, was sworn into office Sunday, helping to cement an emerging leftist bloc around the region, consisting of Bolivia, Chile, Mexico, Peru, Venezuela and, most likely, Brazil after its October election. He said Colombia was getting a "second chance" to fight violence and poverty. He also said he was preparing to start peace talks with various armed groups around the country, and he called on the United States to change its prohibitionist approach to drug policy. "It's time for a new international convention that accepts that the war on drugs has failed," he said. "Of course, peace is possible. But it depends on current drug policies being substituted with strong measures that prevent consumption in developed societies."

Jalisco New Generation Cartel Present in 27 of Mexico's 37 States, Congressional Report Finds. The Jalisco New Generation Cartel (CJNG), the country's most powerful, now operates in 27 states and Mexico City, according to a new report from the Congressional Research Service (CRS). The report, "Mexico: Organized Crime and Drug Trafficking Organizations," says that the CJNG is the dominant criminal force in six states: Jalisco, Nayarit, Colima, Guerrero, Mexico, and Veracruz. It is weakest in Mexico's northwest, where the Sinaloa Cartel still dominates. CRS described the CJNG as an "extremely powerful cartel" that has a "reputations for extreme and intimidating violence." It also noted that the DEA "considers the CJNG a top US threat and Mexico's best-armed criminal group."

"The CJNG built its dominance internationally first through extending its presence through a rapid expansion inside Mexico," CRS said. "In 2016, many analysts maintained the CJNG controlled a territory equivalent to almost half of Mexico. The group has battled Los Zetas and Gulf Cartel factions in Tabasco, Veracruz, and Guanajuato, as well as the Sinaloa… [Cartel] in the Baja Peninsula and Chihuahua." The CJNG's ambitious expansion campaign was characterized by high levels of violence, particularly in Ciudad Juárez and Tijuana.

By taking over key ports on both the Atlantic and Pacific coasts, the CJNG has consolidated "important components of the global narcotics supply chain," the CRS said. "In particular, the CJNG maintains reported control over the ports of Veracruz, Manzanillo, and Lázaro Cárdenas, which has given the group access to precursor chemicals that flow into Mexico from China and other parts of Latin America," the report said. As a result, according to some analysts, the CJNG has pursued an aggressive growth strategy underwritten by US demand for Mexican methamphetamine, heroin, and fentanyl… Despite leadership losses, the CJNG has extended its geographic reach and maintained its own cohesion while exploiting the infighting among factions of the Sinaloa organization."

A Washington state county commissioner demonstrates her cluelessness about harm reduction, Senate drug warriors file the END FENTANYL Act, and more.

pain pills (Creative Commons)

California Governor Signs Bill Ending Cultivation Tax on Marijuana Growers. Gov. Gavin Newsom (D) has signed into law Assembly Bill 195, a wide-ranging bill to restructure the state's legal marijuana system whose most striking feature is the removal of the wholesale tax on marijuana growers. The aim of the bill is to provide relief to the struggling industry and further erode the marijuana black market. The bill also shifts collection of the state's 15 percent excise tax from the distributor level to the retail level, and it freezes the excise tax for at least the next three years. Aiming at unlicensed operators, the bill allows for fines of up to $10,000 per day for property managers who knowingly rent or lease space to unlicensed marijuana businesses. It also includes $40 million in tax credits, half for equity operators and half for microbusinesses. Social equity operators will also be eligible for a $10,000 tax credit and will be able to keep 20 percent of excise tax revenues for reinvesting in their businesses.

Opiates and Opioids

Bipartisan Group of Senate Drug Warriors File END FENTANYL Bill. Sens. Rick Scott (R-FL), Mike Braun (R-IN), Diane Feinstein (D-CA), and Maggie Hassan (D-NH) have filed the cutely-acronymed Eradicating Narcotic Drugs and Formulating New Tools to Address National Yearly Losses of Life (END FENTANYL) Act (Senate Bill 4440). The bill would require the Commissioner of US Customs and Border Protection (CBP) to update its policies at least once every three years to ensure drug interdiction guidance is up to date. The legislation was prompted by a 2019 GAO report, Land Ports of Entry: CBP Should Update Policies and Enhance Analysis of Inspections, which found drug interdiction guidance has not been updated in 20 years. Scott used a press release about the bill to slam President Biden for his "failed open border policies" even though DEA figures show that 80 percent of fentanyl comes through ports of entry, not in the backpacks of refugees, asylum seekers, and undocumented border crossers.

Federal Judge Rules for Opioid Distributors in West Virginia Lawsuit. A federal judge ruled against West Virginia plaintiffs in a lawsuit seeking damages from three major drug distributors who they accused of causing a public health crisis by distributing 81 million pills in eight years in one county hard hit by opioid addiction. Cabell County and the city of Huntington had sued AmerisourceBergen Drug Company, Cardinal Health, and McKesson Corp.

Plaintiffs argued that the companies sent a "tsunami" of prescription pain pills into the county and that their conduct was unreasonable, reckless, and disregarded the public health. "The opioid crisis has taken a considerable toll on the citizens of Cabell County and the City of Huntington. And while there is a natural tendency to assign blame in such cases, they must be decided not based on sympathy, but on the facts and the law," US District Judge David Faber wrote in the 184-page ruling. "In view of the court's findings and conclusions, the court finds that judgment should be entered in defendants' favor. Plaintiffs failed to show that the volume of prescription opioids distributed in Cabell/Huntington was because of unreasonable conduct on the part of defendants," Faber wrote, noting that the plaintiffs supplied no evidence that the companies distributed opioids to any entity that was not properly registered with the DEA or the state Board of Pharmacy. The city and the county had sought more than $2.5 billion that would have gone toward opioid efforts. The goal of the 15-year abatement plan would have been to reduce overdoses,

Harm Reduction

WA County Commissioner Fears "Normalization" of Naloxone. Amanda McKinney, a Republican Yakima County Commissioner, is concerned that the use of the opioid overdose reversal drug naloxone will be "normalized." She was responding to a presentation by the Board of Health about the increase in drug overdose deaths and the district's overdose awareness campaign, but zeroed in on one sentence: Among the goals of the campaign was "Increase awareness and education about the benefits of naloxone to normalize its use."

That set off McKinney: I'm really concerned about that last slide where it says normalize use. I would really like for us to expand on what that means," McKinney said. "I'm just wondering if there is a better term than normalize, 'cuz normalize to me means we're accepting this and promoting this as part of our daily lives and I think that that word is inappropriate."

Apparently unfamiliar with the notion of harm reduction, she also questioned the effectiveness of needle exchanges and fentanyl test strips. "I'd really like to know what the effectiveness is of fentanyl testing strips and syringe exchange services for actually successfully getting people off and away from being someone who is a habitual drug user," McKinney said. "I question those methods as being methods that are successful in getting people actually off the drugs." Following McKinney's comments, Health District Director Andre Fresco explained that harm reduction's primary goal is not to end drug use, but to save lives, and added that the district is involved in efforts to get people off drugs.

On May 11, the Centers for Disease Control and Prevention (CDC) released data showing that more than 107,000 people died of drug overdoses in 2021, the most overdose deaths ever recorded in a single year. The figure marks a 15 percent increase over 2020, with the number of overdose deaths more than quadrupling since 1999. And this is only provisional data; the actual death toll could be even higher.

Opioids were implicated in nearly 80,000 overdose deaths, with synthetic opioids, primarily fentanyl and its derivatives, involved in more than 68,000. Cocaine was mentioned in more than 23,000 overdose deaths and psychostimulants, primarily methamphetamine, mentioned in more than 30,000.

To its credit, the Biden administration has recognized the urgency of the problem, embracing harm reduction interventions such as needle exchanges, drug testing, and access to the opioid overdose reversal drug naloxone in its 2022 National Drug Control Strategy. The strategy includes $30 million for harm reduction grants, but also $300 million increases for the DEA and Customs and Border Patrol. While the prohibitionist impulse remains strong, at least the administration has explicitly recognized the need for harm reduction.

But that isn't enough, advocates say.

"New data from CDC has confirmed our worst fears. The combined pressures of the COVID-19 pandemic, an increasingly potent illicit drug supply, and an overwhelmed and under-resourced public health system have driven the overdose crisis to catastrophic levels," said Daliah Heller, Vice President of Drug Use Initiatives at Vital Strategies, in a statement.

>Vital Strategies is a global public health organization that in February, launched "Support Harm Reduction," a campaign to highlight five key interventions for preventing overdose that many people in the United States still don’t have access to: naloxone, drug checking resources, medications for opioid use disorder, safer drug use supplies, and overdose prevention centers. 

>"What we’re doing now isn’t working, because the decades-old punitive response to drug use still predominates: The transition to a health-first, harm reduction approach has been slow and piecemeal," Heller continued. "Anemic levels of funding and policy support are woefully insufficient to stem the tide of overdose we are experiencing. These data are an urgent call to action for government at all levels: we need to mount a massive public health response to overdose that centers harm reduction and support instead of criminalization and punishment for people who use drugs.  

"Far too few people have access to any of the five key interventions we know will reduce overdose deaths," Heller added. "Most of these services are available in some form, in some locations in the majority of states, but they all need to be massively scaled up with an emergency investment. Until such actions are taken, the continued escalation of this overdose crisis seems inevitable," she said.

"The devastating rise in overdose deaths is falling most heavily on Black and Indigenous communities, where the need for relief now is more urgent than ever before," Heller noted. "A massive surge in funding and support for a harm reduction public health response will save lives immediately, engaging people who use drugs with lifesaving resources and support. The time for action is now."

Likewise, the new CDC numbers prompted the Drug Policy Alliance (DPA) to call on Congress to urgently support harm reduction services and move toward drug decriminalization.

"Once again, we are devastated by these numbers," said Jules Netherland, DPA Managing Director of the Department of Research & Academic Engagement. "Over 107,000 of our friends, family and neighbors lost their lives to drug overdose last year. And sadly, we know the numbers will only continue to climb unless our policymakers actually do what is necessary to curb them. The United States has spent over 50 years and well over a trillion dollars on criminalization - and this is where it has gotten us. It's clearly not working. It's time we start investing where it actually matters - in our communities, specifically Black, Latinx and Indigenous communities where we are now seeing the sharpest rise in overdose deaths. The evidence shows us, that in order to actually make a difference, we have to replace these approaches with those centered in public health, such as drug decriminalization coupled with increased access to evidence-based treatment and harm reduction services, overdose prevention centers, and legal regulation and safer supply to reduce the likelihood of accidental overdose," Nederland said.

It is time for safe injection sites, too, DPA insisted.
 
"We are grateful that the Biden Administration has embraced harm reduction as part of their National Drug Control Strategy, but we need to see that commitment met with Congressional funding and a massive scaling up of these health services," Nederland said. "It's also essential that Overdose Prevention Centers be implemented, which decades of evidence-based, peer-reviewed studies and utilization in over 14 countries show us are one of the most effective ways to save lives now. While it may not always be politically convenient, it’s time to be guided by the evidence about what works. Overdose deaths are avoidable and a policy failure—it’s time we stop recycling the same policies that got us here and take the actions that are necessary to save lives."

The Biden White House sent its first National Drug Control Strategy to Congress on April 21. It breaks positive new ground by explicitly acknowledging harm reduction measures to prevent overdose and blood-borne diseases among drug users. At at the same time, though, it also relies heavily on the destructive and counterproductive pursuit of failed prohibitionist drug policies -- and funds more law enforcement much more heavily than harm reduction.

"The strategy focuses on two critical drivers of the epidemic: untreated addiction and drug trafficking," the White House said. "It instructs federal agencies to prioritize actions that will save lives, get people the care they need, go after drug traffickers' profits, and make better use of data to guide all these efforts. Saving lives is our North Star, and the 2022 National Drug Control Strategy calls for immediate actions that will save lives in the short term and outlines long-term solutions to reduce drug use and its associated harms, including overdose."

While the strategy includes long-familiar categories such as drug treatment, prevention, supply reduction, and criminal justice and public safety, it also emphasizes an evidence-based approach, "building a recovery-ready nation," and for the first time, harm reduction.

"The Biden-Harris Administration's efforts focus on meeting people where they are and building trust and engagement with them to provide care and services," the White House said. "Specifically, the strategy calls for greater access to harm reduction interventions including naloxone, drug test strips, and syringe services programs. It directs federal agencies to integrate harm reduction into the US system of care to save lives and increase access to treatment. It also calls for collaboration on harm reduction between public health and public safety officials, and changes in state laws and policies to support the expansion of harm reduction efforts across the country."

The strategy calls for "the coordinated use of federal grant funds for harm reduction," and the administration last year broke new ground with a $30 million grant program for harm reduction providers. But in a sign of continued reliance on traditional law enforcement priorities, the strategy also envisions a $300 million increase for Customs and Border Patrol and another $300 million increase for the DEA. Those figures were released as part of the White House's FY 2023 budget released last month.

"Responding effectively to the illicit production, trafficking, and distribution methods of domestic criminal organizations and Transnational Criminal Organizations (TCOs) is a significant challenge and remains a Biden-Harris Administration priority," the White House said.

That kind of talk suited mainstream Democrats just fine.

"Illicit drugs cause immeasurable pain and loss in our communities. As the Chairman of the Senate Caucus on International Narcotics Control, I've pressed for an updated federal plan to tackle them," said Sen. Sheldon Whitehouse (D-RI). I've been clear that the plan must include a more coordinated approach to cracking down on drug trafficking and transnational criminal organizations, especially the ways in which they launder and protect their ill-gotten gains using US rule of law and financial networks; and more and better cooperation with our international partners to reduce the supply of precursor chemicals used to manufacture illicit drugs and to levy tougher sanctions against transnational drug syndicates. I'm pleased to see my priorities reflected in this new strategy, and I look forward to working with the Biden administration to deliver on those priorities."

Whitehouse also lauded the strategy's "tearing down barriers to treatment, including expanding access to life-saving naloxone and medication-assisted treatment; improving our data collection systems to better understand the effects of our intervention efforts."

Reform advocates offered praise -- sometimes lukewarm -- for the administration's tentative embrace of harm reduction, but blasted its reliance on tired, failed drug war paradigms.

In its analysis of the strategy, the Washington Office on Latin America (WOLA) called it "a major step forward" and lauded the administration for "focusing on ensuring access to treatment for substance use disorders and highlighting the crucial role of harm reduction services." But WOLA also noted that, "when measured against the scale of the nation's overdose problems and the urgency of the needs, Biden's new plan appears quite timid."

WOLA also warned that the strategy's "positive innovations regarding investment in treatment and harm reduction strategies risk being undermined by a continued commitment to the kinds of policies that have exacerbated the present crisis and that continue to absorb the lion's share of resources, namely, drug criminalization at home and wildly exaggerated expectations for what can be achieved through supply control efforts abroad."

Similarly, the libertarian-leaning Cato Institute called the attention to harm reduction a "positive," but noted steps that it did not take, such as making the opioid overdose reversal drug naloxone available over-the-counter and repealing the so-called Crack House Statute that stands in the way of federal approval of safe injection sites.

"On a negative note," Cato observed, "the remainder of the new report calls for doubling down on interdiction, border control, and other law enforcement measures aimed at curtailing the supply of illicit drugs -- as if repeating the same failed strategies of the past half century, only with more gusto, will somehow work."

So there it is: The Biden administration's first crack at a national drug strategy deserves kudos for its embrace of harm reduction and evidence-based approaches, but beyond that, it is pretty much more of the same old same old.