The South Dakota legislature continues to tangle with marijuana policy, Pennsylvania's Republican-led legislature is dithering on making fentanyl test strips legal, and more.

A manufacturing issue at Pfizer is contributing to naloxone shortages and price hikes. (pa.gov)

Oregon County Asks for National Guard Help to Fight Illegal Marijuana Grows. With unlicensed marijuana grows and marijuana grows disguised as hemp operations running rampant in southern Oregon, commissioners in Jackson County have asked Gov. Kate Brown (D) to send in the National Guard "to assist, as able, in the enforcement of laws related to the production of cannabis." The move came last week, the same day police near Medford raided a site that had 17,500 pot plants and two tons of processed marijuana. That was only the latest massive bust in Jackson and neighboring Josephine counties this year, which act as a northern extension of California's Emerald Triangle of Humboldt, Mendocino, and Trinity counties. In both southern Oregon and northern California, marijuana cultivation has been entrenched for half a century. Gov. Brown has rejected the request for National Guard troops but could reconsider next year, her office said.

South Dakota Lawmakers Ponder Bill to Scrap Medical Marijuana Law but Legalize Adult Use. The legislature's Adult-Use Marijuana Committee on Tuesday is considering a bill that would undo the state's voter-approved medical marijuana law but would instead legalize the use and possession of marijuana by people 21 and over. The bill was drafted by committee chair Rep. Hugh Bartels (R), who characterized it as a compromise between factions that oppose and support legalization. Voters also approved legalization last year but allied of Gov. Kristi Noem (R) filed suit to block it. That case remains before the state Supreme Court. In the meantime, local activists have begun a signature-gathering drive to put a new legalization initiative on the ballot next year. Under the Bartels bill, people 21 and over could possess up to an ounce of weed and up to 22 grams of waxes, oils, and edibles, but home cultivation would not be allowed. Bartels said the medical marijuana law would not be needed if his bill passed, but the Health Department would issue medical marijuana cards for patients under 21.

Harm Reduction

Naloxone Price Soars, Shortages Occur Amid Overdose Surge. As the nation confronts all-time high overdose deaths, the opioid overdose reversal medication naloxone is increasingly scarce and increasingly expensive. Harm reduction and other community groups are now paying as much as 30 times more for the life-saving medication—when they can obtain it at all. "Not having this life-saving medication to reduce overdose deaths, during a time when we’re seeing the greatest increase we’ve ever seen, is a public health crisis," said Amanda Latimore, director of the Center for Addiction Research and Effective Solutions. "There hasn’t been a more important time than right now to have an overdose reversal drug available. And now that we’re seeing this shortage, we can expect even more fatal overdoses," she said. The shortages are a result of manufacturing problems at Pfizer, which has been providing the drug at low cost to harm reduction groups, and are expected to be resolved by year's end. But in the meantime, other pharmaceutical manufacturers could have ramped up production, but have not done so, no have they cut prices. The reason? "Profit. There’s no other way to put it," said Nabarun Dasgupta, an epidemiologist at the University of North Carolina at Chapel Hill.

Pennsylvania's Republican-Dominated Legislature Stalls on Allowing Fentanyl Test Strips. Under current state law, fentanyl test strips are considered drug paraphernalia and are illegal, but even as the state and the nation face unprecedented numbers of opioid overdose deaths, the Republican-dominated state legislature is sitting on bills that would amend the law to allow people to use the test strips. House Bill 1393 and its companion measure, Senate Bill 845, are both languishing in committee. While the legislature dithers, the state attorney general, the Philadelphia DA, and the Philadelphia mayor have announced a commitment to not prosecute people for possessing fentanyl test strips.

Law Enforcement

Baltimore’s No-Prosecution Policy for Low-Level Drug Possession and Prostitution Finds Almost No Rearrests for Serious Offenses. A new report from researchers at Johns Hopkins Bloomberg School of Public Health found that Baltimore’s no-prosecution policy for minor drug possession and prostitution, enacted at the start of the COVID-19 pandemic, led to fewer new low-level drug and prostitution arrests, almost no rearrests for serious crimes for those who had charges dropped, and fewer 911 calls. The findings suggest the new policies did not result in increased public complaints about drug use or sex work, and that those who had charges dropped did not go on to commit serious crimes. Baltimore State’s Attorney Marilyn Mosby announced that Baltimore would stop prosecuting low-level drug and drug paraphernalia possession and prostitution in March 2020, chiefly as an infection-reduction measure at the start of the COVID-19 pandemic. A year later she announced that the policy would remain in place—even after the pandemic winds down—as a way of reducing the burdens on city police and on the poorer, predominantly Black city residents who are traditionally arrested for such crimes. The report’s key findings, covering the 14 months following the policy change (April 2020 to May 2021), include:

• An estimated 443 new drug/paraphernalia-possession and prostitution arrests were averted as a result of the new no-prosecution policy, 78 percent of which were averted in the Black community. This analysis was based on Baltimore Police Department arrest data.
• Of the 741 people whose drug and prostitution charges were dropped, six—less than 1 percent—had new arrests for serious crimes during the study period. This analysis was based on Maryland Courts Judicial Information System data.
• Calls to 911 about drug/paraphernalia and prostitution declined significantly in the post-policy change period.

A crack appears in Pennsylvania Republicans' opposition to legalizing marijuana, that DEA agent killed in Tucson on Monday died enforcing marijuana prohibition, and more.

A proposed Michigan bill would let community-based organization dispense the opioid overdose reversal drug naloxone. (CC)

Pennsylvania Sees Bipartisan Effort to Legalize Marijuana. A Republican state senator has joined forces with a Democrat in a bid to garner bipartisan support for marijuana legalization. Senator Mike Regan (R) and Rep. Amen Brown (D) are teaming up on Regan's proposed bill, which would legalize marijuana, includes social equity provisions, and seeks to create a tax and regulatory structure for legal weed. Democratic politicians in the state, including Gov. Tom Wolf, have been calling for legalization, but the Republican-controlled legislature has so far resisted such entreaties. It's time for us to move forward in Pennsylvania," said Regan, a former US marshal who played a role in crafting the state's medical marijuana program. "If we can take the violence out of it and we can regulate it and tax it and let police focus on the really serious crimes, I think it's a huge step forward."

Opioids

Michigan House Committee Takes Up Opioid Treatment Expansion. The House Health Policy Committee has met to discuss several pieces of health-related legislation, including a pair of bills that would expand access to treatment for opioid use disorder, HB 5163 and HB 5166. "HB 5163 will expand capacity to treat opioid overdoses in emergency departments, a key interception point for people who use drugs where we see a high risk of overdose upon discharge," said bill sponsor Rep. Angela Witwer. The bill would allow emergency departments to provide medication-assisted treatment, create specific hospital overdose care protocols, and provide referrals to community-based care organizations. HB 5166 would increase access to the opioid overdose reversal drug naloxone by allowing community-based organizations to distribute the drug. Currently, under a 2016 standing order law, pharmacists can give the drug without a prescription, similar to an over-the-counter drug. No votes were taken on the bills.

Law Enforcement

DEA Agent Killed in Tucson Was Enforcing Marijuana Prohibition. DEA Agent Michael Garbo, who was killed Monday in a shootout on an Amtrak passenger train in Tucson, died attempting to enforce federal laws against marijuana. The accused shooter, known only as D.T., opened fire on drug task force agents after they found 2.4 kilograms of marijuana, 50 packages of edibles, and "other marijuana and cannabis products," according to the court documents. D.T. and his partner, Devonte Okeith Mathis, were targeted by the DEA, whose agents were given a list "that contained names of several individuals on an Amtrak train that was arriving in Tucson" as part of their routine investigative activities. Task force officers saw Mathis move several bags a few rows away from where he and his partner were sitting, then took the bags off the train to inspect them and found marijuana. When agents then attempted to approach D.T., he opened fire, killing Garbo and wounding another DEA agent and a Tucson police officer. D.T. was then fatally shot.

Protections for banks dealing with state-legal marijuana businesses will get a House floor vote as part of a defense spending bill, the Congress is poised to temporarily extend the ban on fentanyl analogues, and more.

Overdose deaths rose while opioid prescriptions declined. Go figure. (Pixabay)

Amendment to Protect Banks That Service Marijuana Industry Will Get House Vote. The House Rules Committee on Tuesday approved an amendment to the National Defense Authorization Act (NDAA) to provide protections to financial institutions that service the state-legal marijuana industry. The amendment is identical to the SAFE Banking Act, which has already passed the House four times. A House floor vote could come as soon as this week. But advocates were disappointed that other reform measures, including an amendment to promote research into the therapeutic uses of certain psychedelics, were rejected by the committee. Adding non-related amendments to spending bills that are difficult to vote against is often used to get legislation passed that is otherwise stalled.

Medical Marijuana

Pennsylvania Bipartisan Bill to Remove DUI Penalties for Medical Marijuana Users Filed. State Reps. Chris Rabb (D-Philadelphia} and Todd Polinchock (R-Bucks) have introduced legislation that would ensure the rights of the more than 500,000 medical cannabis patients in Pennsylvania, protecting them from DUI penalties. Under current state law, the presence of marijuana metabolites, which remain present for days or weeks after ingestion, is considered evidence of impairment. "A medical cannabis user can take a miniscule amount of medicine for their ailment and weeks later, with traces of cannabis still in their system, be subject to arrest on a DUI charge if pulled over -- not because they've driven impaired, but because our state laws haven't caught up with the science," Rabb said. "And, if you think you don't know someone who falls into this category -- a person who has been prescribed medical cannabis and who drives and is fearful of the potential DUI charge they could face -- you're wrong. I am a card-carrying medical cannabis patient, and I drive regularly, including in and around Philadelphia and to Harrisburg conducting the people's business."

Opioids

Congress to Temporarily Extend Fentanyl Analogue Ban. Rather than make a final decision on whether to make permanent a ban on fentanyl analogues, the House is preparing to vote to extend a temporary ban set to expire October 22, pushing the expiration date to January 28 as part of a stopgap spending bill. The White House has asked Congress to permanently schedule all fentanyl-related substances as Schedule I, but advocates and some lawmakers say such a move is wrongheaded and will lead to over-policing. Sen. Cory Booker (D-NJ) has made such arguments and says he is "not a fan" of extending the deadline. "We have consistently said that this anti-science policy must expire," Maritza Perez, director of the Drug Policy Alliance's Office of National Affairs, said. "This extension will hopefully give Congress ample time to come up with a public health solution that is desperately needed to save lives."

Overdoses Climbed as Opioid Prescriptions Declined, AMA Report Finds. Both fatal and non-fatal drug overdoses have increased over the past decade, even as physicians have prescribed 44 percent fewer opioids during the same period, the American Medical Association said in a new report. The report cited the rise of prescription drug monitoring programs as a key factor in reducing prescribing. The AMA said lawmakers need to "act now" to address the overdose crisis. "The nation's drug overdose and death epidemic has never just been about prescription opioids," said AMA President Gerald E. Harmon, MD. "Physicians have become more cautious about prescribing opioids, are trained to treat opioid use disorder and support evidence-based harm reduction strategies. We use PDMPs as a tool, but they are not a panacea. Patients need policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and help us remove barriers to evidence-based care." The AMA is calling for an end to requiring prior authorization for medications to treat opioid use disorder, evidence-based care including opioid therapy for patients with pain, and support for harm reduction services, such as needle exchanges and the wide distribution of the opioid overdose reversal drug naloxone.

Wisconsin Democrats cross the state line to an Illinois pot shop to roll out their marijuana legalization bill, there's bad news for people who might need the opioid overdose reversal drug naloxone, and more.

The opioid overdose reversal drug naloxone. Supplies are running short after a manufacturing problem. (Creative Commons)

Wisconsin Democrats Unveil Marijuana Legalization Bill—At Illinois Dispensary. Democratic lawmakers crossed the state line to use an Illinois marijuana sales outlet as the backdrop for their rollout of a marijuana legalization bill Tuesday. Rep. Mark Spreitzer (D-Beloit), Rep. David Bowen (D-Milwaukee) and Sen. Melissa Agard (D-Madison) are filing a bill that would legalize the possession of small amounts of marijuana and set up a system of taxed and regulated sales. But the bill's prospects are iffy at best in the GOP-controlled state legislature, which has fended off similar efforts for the past eight years. "However you feel about cannabis use, keeping it illegal isn’t helping anything. It’s only hurting. The people of Wisconsin are ready for legalization," Spreitzer said.

Medical Marijuana

Mississippi Lawmakers "Very, Very Close" to Deal on Medical Marijuana. Senate and House negotiators working on a medical marijuana program to replace the one approved by voters but killed by the state Supreme Court, say they are "very, very close" to having a draft bill that could prompt a special legislative session as early as this month. "I believe we have basically most of the major issues resolved,” said Sen. Kevin Blackwell (R-Southaven), who’s leading the Senate’s medical marijuana work. "… We’re very, very close." Gov. Tate Reeves (R), who has the sole authority to call a special session, has said he is willing to do, but not until the House and Senate have reached broad agreement on a proposal.

Harm Reduction

Naloxone Shortage Looms. Pfizer, the maker of single-dose injectable naloxone, the opioid overdose reversal drug, has halted production of the drug since April because of an unspecified manufacturing issue, and that is making the life-saving drug more difficult to obtain and more expensive in the midst of an opioid overdose crisis that has taken tens of thousands of lives in the last year. Pfizer offers the drug at a discount to a national buyers' club of harm reduction programs, but says it may be February before it can meet demand again. That effectively means the life-saving drug will have to be rationed until then. "Who do you stop supplying? Jennifer Plumb of Utah Naloxone said. "Who do you stop prioritizing? Who do you stop making sure has naloxone?"