Last month, the Centers for Disease Control and Prevention (CDC) released provisional data indicating that the country's overdose crisis peaked in late 2017 and actually declined by 5.1 percent between then and late 2018. While that is long-awaited good news, it's not great news: The annual number of drug overdose deaths was still more than 68,000, and that number is still more than a third higher than in 2014, when the overdose epidemic was already well underway.

The fever may have broken, but the patient is still in critical condition. And there is one bit of data in the CDC report that is definitely not good news: While overall overdose deaths finally began to decline, overdose deaths involving stimulants were on the increase. For cocaine, the death toll started rising in about 2012; for psychostimulants (overwhelmingly methamphetamine), the climb began a couple of years earlier.

But the new data show a dramatic uptick in overdose deaths with stimulant involvement last year. Fatal overdoses where cocaine was mentioned were up 34 percent and those where methamphetamine was involved were up 37 percent. That's more than 14,000 people dying with cocaine in their systems and more than 10,000 dying with meth in their systems.

What is driving this spike in stimulant-involved overdose deaths? Some of it can be attributed to rising use levels for cocaine and meth, which can in turn be linked to increased supplies. Meth seizures were up dramatically last year and recent DEA reports suggest that cocaine availability has increased steadily since 2012, particularly in the south and east coast of the US. The UN Office of Drugs and Crime suggests that cocaine production and manufacture are at the highest rates ever recorded.

"There is some research to suggest that we are seeing slightly higher rates of recent cocaine and methamphetamine use compared to rates of use just a few years ago," said Sheila Vakharia, PhD, a researcher with the Drug Policy Alliance (DPA). "But increased rates of use do not always mean increased rates of addiction or overdose. Death rates are influenced by a variety of factors, including age of the user, the amount used, and other substances used, among other things."

They are also influenced by race, gender, and geographic location. A recent study looking at data from 2012 to 2015 and examining race and gender trends by drug found that white men had the highest rates of methamphetamine-involved overdose deaths more generally, while black men had highest rates of cocaine-involved overdose deaths. These racial differences persisted for women of each race as well, although their overdose rates were lower than the men in their racial groups.

"Methamphetamine-involved deaths are high on the West Coast and Midwest, while cocaine-involved deaths are high on the East Coast. We are actually seeing that in some Western states that methamphetamine is either the top drug involved in overdose deaths or among the top drugs included in overdose deaths," Vakharia noted.

"Based on the latest CDC data, Nevada’s overdose crisis has been driven by prescription opioids and methamphetamine for the past several years- in fact, methamphetamine has been the #1 drug involved in overdoses there since November 2016. Similarly, in November 2016, Oregon saw methamphetamine become the top drug involved in overdose deaths," she specified.

"Meanwhile, the East Coast is seeing the involvement of cocaine in overdoses increase as well. While no eastern state has cocaine driving their overdose crisis, places like DC are seeing fentanyl as the top driver of deaths followed by cocaine. Last year, while fentanyl contributed to the majority of overdose deaths, there were more cocaine-involved deaths than heroin or prescription opioids," Vakharia added.

It appears that it is not rising simulant use rates but the use of multiple substances that is largely driving the overall stimulant death toll upwards. A CDC report from May suggests that, from 2003 to 2017, almost three-quarters of cocaine-involved deaths involved an opioid while half of all methamphetamine involved deaths involved an opioid.

"Those CDC numbers are based on autopsy reports," said Daniel Raymond, deputy director of planning and policy for the Harm Reduction Coalition (HRC). "In a lot of cases, there are multiple drugs involved, and just because an overdose involves a stimulant, it doesn't mean it was caused by stimulants."

Overdose deaths caused by stimulants look different from those caused by opioids, Raymond noted: "Fatal stimulant overdoses come from strokes, seizures, heart attacks, and potentially overheating," he said. "It's not like an opioid overdose with respiratory depression," he said.

"Some of this may be more a reflection that we still have lots of people dying from opioid-related overdoses, and it's just that more of them are also taking meth or cocaine, but the primary cause of death is the respiratory depression associated with opioid overdoses. In a lot of the cocaine deaths, medical examiners are finding both cocaine and opioids."

"We are seeing that toxicology reports of people who died with stimulants in their systems also had fentanyl or other opioids in their system," DPA's Vakharia concurred. She then listed a number of possible explanations:

1. "This is accidental. Cross-contamination of a stimulant with an opioid like fentanyl could have been accidental and occurred during transport or packaging, and opioid-naïve stimulant users were accidentally exposed to opioid-contaminated stimulants."
2. "This is due to co-use of opioids and stimulants in the form of speedballs (with cocaine) or goofballs (with methamphetamine), where both are used together for the desired effect of immediately stimulating high, followed by the euphoria of the opioid."
3. "Stimulants are being willfully adulterated with opioids by suppliers/sellers, and stimulant users naïve to opioids are overdosing because they have no tolerance. (We at DPA dispute this theory, because it makes little sense why a seller would want to kill off a customer.)
4. "Someone might have used a stimulant and opioids at different times within the past few days, but their toxicology could be showing the recency of use."

What Is to Be Done?

The Drug Policy Alliance and the Harm Reduction Coalition have both released reports on the rise in stimulant-involved overdose deaths, Stimulant Use: Harm Reduction, Treatment, and Future Directions from the former and Cocaine, Speed, and "Overdose": What Should We Be Doing? from the latter. Raymond and Vakharia took a few minutes to address those topics, too.

"There is no naloxone for stimulant overdose," Raymond pointed out. To reduce those overdoses "is about developing harm reduction strategies and outreach specifically targeting stimulant users," he said. "We spend so much time focusing on the opioid overdose crisis that our messages are oriented toward that. If we want to start a conversation, we need to not just tack it onto the opioid messaging. Even if you're not an opioid user, we want to talk about symptoms and warning signs."

HRC has moved in that direction, said Raymond. "We did some work on stimulant overdoses, we talked to a lot of people who used stimulants, we put out a guide -- Stimulant "Overamping”"Basics -- and went with the terms people used. Using 'overamping' opened a space for conversation for people who didn't identify as heroin users. If you talk overamping instead of overdosing, stimulant users have had that experience of using too much. Part of it is really just listening to the people who use the drugs. In harm reduction, we learn from the people we work with."

"People who use stimulants need access to sterile equipment beyond syringes, since many stimulant users smoke, so we are talking about sterile smoking equipment like pipes and filters," Vakharia said. "We need to teach users how to stay safe while using -- make sure to take breaks for hydration and to eat, get enough rest. It is easy to lose track of time when you've been up for days and when you have no appetite. This also puts undue stress on your heart and can exacerbate health issues," she noted.

"For many people, we should also talk about distributing safer sex supplies, because many people engage in risky sexual practices while they are using," Vakharia continued. "We also need to educate users on the risks associated with mixing different classes of drugs and the impact it can have on your body, knowing your limits, keeping naloxone on hand in case you are using opioids too, and not using alone."

It's not just harm reduction that's needed, though. Other policy prescriptions could help reduce the toll.

"Medicaid expansion and policies to increase access to basic health care and mental health care, as well as substance use treatment can greatly improve the health and well-being of people who use all drugs," Vakharia said. "And whether opioids are a person's primary drug or not, expanding access to naloxone helps anyone who is using them. Similarly, expanding Good Samaritan laws that reduce barriers to calling 911 can only help."

And then there's not treating drug uses like criminals.

"Decriminalizing drugs and paraphernalia would be a huge step forward," said Vakharia. "We know that contact with the criminal justice system increases harms and also presents barriers to going into recovery, which impacts job prospects, the ability to find work, and things like that."

"Drug decriminalization is crucial," said Raymond. "Criminalization just makes everything worse. It makes people more fearful of seeking help, and ends up locking so many people up in ways such that when they leave jail or prison, they're even more vulnerable. All of our work in harm reduction takes place in this context of mass criminalization. That keeps us swimming against the tide."

This article was produced by Drug Reporter, a project of the Independent Media Institute.

The Drug Policy Alliance is a funder of both Drug Reporter and Drug War Chronicle.

Philadelphia District Attorney Larry Krasner made waves last week by reportedly saying he is "very close" to implementing a policy that would decriminalize the possession of all drugs, but that was just the latest salvo in the former criminal defense and civil rights lawyer's war on the war on drugs.

Since taking office in January 2018, Krasner has made a number of policy moves that are helping to cement his reputation as one of the country's most radical prosecutors, and he's doing it in one of America's largest cities. His progressive approach didn't come out of nowhere, though.

Krasner's decades of experience in the defense bar -- as opposed to rising through the ranks of prosecutors -- have provided him with a unique perspective on the social and racial impacts of the drug war, one deeply at odds with the law-and-order views of most DAs. For 30 years, Krasner represented the poor, the oppressed, and the brutalized, filing civil rights and police brutality lawsuits.

He often represented protestors and activists, including 400 people arrested at the 2000 Republican National Convention, AIDS activists, and members of the Black Lives Matter movement. He helped hundreds of imprisoned on false charges by a notoriously corrupt drug squad. And he sued the Philadelphia police dozens of times in civil rights and police brutality cases. This is not the career path of your average DA.

In an early sign that a new era is at hand, one of Krasner's first acts was to demand the resignations of 31l ine prosecutors and supervisors he saw as obstructionist and to see them escorted from the building to ensure they didn't take anything with them other than personal effects. Krasner said he made the quick move on the advice of Houston's reformist DA, Kim Ogg, who told him that when she gave inherited personnel two weeks' notice she would be asking for resignations, recalcitrant employees deleted massive amounts of emails, wiped hard drives, and took other steps to sabotage her efforts.

Critics called his move a purge, but for Krasner, it was lessons learned: "We had some awareness from working as attorneys in this city -- and interacting with people [in the office] -- of who was really never going to get with this program," he says. "I felt we couldn't take the risk that there might be some effort at sabotage here."

Krasner got national attention the following month when he issued a revolutionary memo on prosecuting policies designed to "end mass incarceration and restore balance to sentencing." The memo said prosecutors must decline certain charges, namely marijuana possession and prostitution. The ban on pot prosecutions held regardless of weight, and included not charging for paraphernalia or for getting caught buying weed. The ban on prostitution prosecutions applied to anyone who had fewer than three previous prostitution convictions; those with three or more convictions could be charged and sent to a special problem-solving court set up to get prostitutes out of the life.

Philadelphia had already decriminalized small time marijuana possession in 2014, but police continued to arrest people for larger amounts and under a rarely used state law making it a crime to purchase the drug. Krasner's memo brought a further decline to already dramatically shrinking marijuana arrests numbers, mainly by ending the prosecutions for buying it.

Arrests for that offense haven't completely vanished, as police continue to make them despite knowing they won't be prosecuted, but 2018 saw a 30 percent decline in such busts. Still, racial disparities persist: Blacks made up 85 percent of all arrested pot buyers.

The memo more broadly called for plea bargains to have the lightest sentences possible under state guidelines and, most dramatically, mandated that prosecutors assess how much the defendant's incarceration would cost and why it was worth spending public money on it.

He has worked assiduously to ensure that city residents who unlawfully had cash or property seized under a city asset forfeiture program deemed unconstitutional by the court are made whole. His office is administering a $3 million fund for victims of the city's lawless practices, which saw thousands of people lose their homes, cars, cash, and other property to profit-driven policing and prosecutions.

"What happened was that there was a 'keep what you kill' approach," Krasner said. "And all that it did was incentivize prosecutors to always try to take grandma's house, always try to take a working person's car, and often to do it simply because someone's nephew did something illegal out of the basement. And the owner, who may have been at church, didn't know."

Most recently, a May 1 interview that Krasner did for Axios on HBO that will air next month was teased by with the headline "Scoop: Philly prosecutor may stop charging drug users as criminals" and this lede: "Philadelphia District Attorney Larry Krasner, one of the most progressive district attorneys in the country, told 'Axios on HBO' that he is 'very close' to implementing a policy that would relax the penalties for drug possession laws."

"One of the things we're looking at is essentially diverting all possession of drugs cases," he said in the interview. "Possession is different than dealing. It's different than carrying a bunch of drugs that you intend to sell or deliver later… We are talking about people who are using drugs, the vast majority of them suffering from addiction. I do not see value in convicting people like that, thereby making it harder for them to get a job."

The Axios interview garnered lots of attention, but Axios -- and many of the outlets that ran with the story -- oversold it as Krasner endorsing drug decriminalization. Even Krasner isn't quite ready to go that far, although it's an approach that has worked in Portugal for nearly 20 years.

Instead, Krasner spokesman Ben Waxman said late last week that Axios got the story wrong. Krasner was talking diversion, not decriminalization, Waxman said. Diversion means people charged with drug possession could enter a treatment program and, if they successfully completed it, end up with no prison time and no criminal record. Decriminalization means they wouldn't be arrested and charged in the first place. "The Axios piece really conflated a bunch of different stuff," Waxman said. "I don't think they understood the difference between diversion and decriminalization."

Axios is sticking to its guns, though. "Axios went to extraordinary lengths to clarify the specifics of this story with Krasner's team, as well as other experts, to ensure the article's accuracy given the complexity and nuances of the topic," a spokesperson wrote in a statement. "This interview was recorded on video. We stand by our reporting."

Meanwhile, drug diversion is already going on in Philadelphia -- last year almost half of the 5,458 arrests for drug possession ending up in already existing diversions programs -- so Krasner was actually talking about expanding existing programs. That's a good thing, but not nearly as sexy or sensational as drug decriminalization.Still, Larry Krasner has been a model of what a progressive prosecutor can do, and he's got time to do more. But maybe he should take a couple weeks off and visit Portugal.

This article was produced by Drug Reporter, a project of the Independent Media Institute.

San Francisco's Tenderloin is a heavily populated, racially mixed neighborhood in the heart of one of America's iconic progressive cities. Yet when the San Francisco Police Department and the DEA targeted the neighborhood to crack down on drug dealing between 2013 and 2015 as part of "Operation Safe Schools," the only people they managed to roll up were black.

When 37 black defendants -- and no defendants of any other race -- got hauled away, nobody noticed. That is until the defendants started showing up looking for federal public defenders. The federal public defenders noticed, and they began making noise about racial disparities and selective enforcement of the drug laws.

Their charges only grew louder with the posting in 2015 of undercover police surveillance video to YouTube revealing a police officer muttering "fucking BMs," police code for black males, as he monitored a group of young men on the street. The video also apparently showed an undercover informant turning down drugs being offered by an Asian woman to instead buy drugs from a black woman.

In January 2017, 12 of those charged in the operation won a discovery motion from a judge who found there was "substantial evidence suggestive of racially selective enforcement" in their arrests. Instead of allowing the proceedings to continue so a full accounting of police conduct could occur, prosecutors instead dropped the charges.

At the time, the presiding judge, US District Court Judge Edward Chen, made clear that while he was granting the dismissals because they were in the best interest of the defendants, he was concerned that doing so would prevent the allegations of police bias from being aired.

"These are serious issues, serious allegations regarding claims of discriminatory enforcement patterns," Chen said. "I think the defendants in this case have raised a very substantial prima facie case that, at the very least, raises some serious questions that would warrant a response and a full airing of the issues."

Now, a year and a half later, the ACLU of Northern California on Thursday filed a federal civil lawsuit on behalf of six of those rolled up in the busts. The lawsuit alleges the plaintiffs were targeted because of their race and cites a survey of Tenderloin drug users to bolster its case. That survey found racial diversity among Tenderloin drug sellers. About half were black, but 20 percent were Latino and 17 percent were white.

The lawsuit is "an opportunity to hold the actors in the San Francisco Police Department and the city itself accountable for the police department's longstanding practices of engaging in racially discriminatory law enforcement," said ACLU attorney Novella Coleman, who is representing the plaintiffs.

It's also about financial relief for the plaintiffs, Coleman allowed. "The court will determine how to monetize that," she said.

Not an Anomaly

Racially biased policing is nothing new in San Francisco. In fact, as Ezekiel Edwards, director of the national ACLU's Criminal Law Reform Project, pointed out in a post announcing the lawsuit, the city has the dubious honor of setting precedent for the idea that law enforcement targeting people based on their race is unconstitutional. In an 1886 case, Yick Wo v. Hopkins, the city attempted to deny laundry permits to Chinese people while granting them to non-Chinese. Such an action could only be explained by the city's "hostility to the race and nationality" of the applicants, a violation of the 14th Amendment's guarantee of equal protection under the law.

Fast forward to the 21st century, and the evidence that the city's penchant for targeting non-whites for harsher treatment remains intact just keeps piling up. Numerous studies in the past few years have documented racially biased policing practices, including a 2002 ACLU report on SFPD racial profiling and a city-commissioned study by a national expert on biased policing.

Those studies uncovered a range of bias-related problems and made concrete recommendations for reform. Those were ignored. As the rotten policing practices festered, more reports detailing racial and ethnic disparities across the criminal justice system came out in 2013 and 2015.

Then, in 2015, as "Operation Safe Schools" was winding down, SFPD was hit by a new scandal when officers were caught exchanging racist text messages. Some used the N-word, others referenced cross burnings. Officers were caught calling black residents "savages," "wild animals," and "barbarians," and one officer told his sergeant "All n[ -- ] must fucking hang." Another officer sent a text with an image of a white man spraying a black child with a hose above the caption "Go be a n -- somewhere else."

That finally got the attention of city fathers -- as well as the Obama-era Justice Department. The city district attorney convened a Blue Ribbon Panel on Transparency, Accountability, and Fairness in Law Enforcement that documented SFPD's history of racially disparate enforcement and concluded that it was "in urgent need of important reforms." In 2016, the Justice Department weighed in with its own report finding that the department still engaged in racially biased policing, especially around traffic stops and police use of deadly force.

It's Not Just San Francisco

The ACLU's Edwards concisely makes the case that San Francisco is no exception when it comes to racially biased policing:

"Unequal treatment by race is commonplace among police departments large and small in cities across a range of ideological leanings. This is the reason for the racial profiling lawsuits filed in New York City, Chicago, Philadelphia, and Maricopa County, Arizona. This is the motivation, prior to Attorney General Jeff Sessions, for Justice Department consent decrees seeking to end racially discriminatory police practices in Seattle, Los Angeles County, New Orleans, Baltimore, Newark, East Haven CT and Ferguson MO. This is why the ACLU has found racial disparities in marijuana possession arrests across the country, in drug possession arrests more broadly, in stops and frisks in Boston, in seatbelt enforcement in Florida, and in arrests for low-level offenses in Minneapolis."

When will things ever change?

This article was produced by Drug Reporter, a project of the Independent Media Institute.

Progressive voters in battleground Ohio will have one more reason to head to the polls next month. Not only do they have a chance to put a Democrat in the governor's mansion and reelect US Senator Sherrod Brown, but they also will have the opportunity to enact a dramatic sentencing reform that will keep thousands of non-violent drug offenders out of prison and help inmates currently serving time for drug possession get back into their communities sooner.

Issue 1, the smartly named Neighborhood Safety, Drug Treatment, and Rehabilitation Amendment, would:

• Reclassify drug possession offenses as misdemeanor crimes, except for drug possession or trafficking offenses currently categorized as first-, second- or third-degree felonies;
• Prohibit jail sentences for drug possession until an individual's third offense within 24 months;
• Allow inmates convicted of nonviolent crimes to reduce their sentences up to 25 percent for completing rehabilitative, work or educational programming;
• Apply cost savings from reduced prison expenses to drug treatment programs and crime victim services.

That's right, passage of Issue 1 would effectively defelonize drug possession in the Buckeye State. At least 16 states have already taken similar steps to ratchet down the drug war, including California, New York, and neighboring Pennsylvania. And now, thanks to local grassroots organizing backed by some big outside money, Ohio could be next.

It could use the help. The state's prison population has hovered around 50,000 for nearly two decades after rising dramatically during the height of drug war repression in the 1980s and 1990s, and nearly a quarter of inmates are doing time for drug offenses. Unsurprisingly, Ohio suffers the same sort of racial disparities as the rest of the country, with blacks more than five times as likely to be imprisoned as whites, and Latinos nearly twice as likely. The state's resort to mass incarceration costs it around $2 billion a year in corrections costs.

The initiative is the brainchild of the Ohio Organizing Collaborative, a coalition of 20 community organizations, faith institutions, labor unions, and policy groups across the state, and its Ohio Safe and Healthy Communities campaign. Its aim is to reduce mass incarceration and racial disparities in the criminal justice system and increase access to drug treatment. Issue 1 would "invest in proven treatment for addiction instead of more spending on bloated prisons," explained campaign manager Amanda Hoyt.

While the initiative is homegrown, the funding for it is coming mainly from out-of-staters. Facebook founder Mark Zuckerberg's Chan Zuckerberg Initiative has kicked in $1 million, and Facebook co-founder Dustin Moskovitz's Open Philanthropy Project ponied up another $1 million. George Soros's Open Society Policy Center provided $1.5 million, while California businessman Nicholas Pritzker and his wife Susan added another $60,000. Of the $4.8 million raised by the campaign, all but $19,000 came from out of state.

"Relying on incarceration to solve addiction and the conditions that drive lower-level crimes actually doesn't make communities safer, and it results in huge expenses to taxpayers with devastating impact to individuals, families, and entire communities," said Ana Zamora, criminal justice manager at the Chan Zuckerberg Initiative, in a statement.

Issue 1 will "put taxpayer dollars to better use by reducing reliance on prisons to address certain nonviolent offenses, including drug use and possession," Zamora added.

The opposition to Issue 1 isn't nearly as deep-pocketed, but it represents much of the state's criminal justice and Republican political establishment. No opposition political action committees have reported donations, but groups such as the Ohio Prosecuting Attorneys Association, the Ohio Common Pleas Judges' Association, the Association of Municipal and County Court Judges of Ohio, the Buckeye State Sheriff's Association, and the Ohio Association of Chiefs of Police have all come out against Issue 1.

And while Democratic gubernatorial candidate Richard Cordray has endorsed Issue 1, current Republican Gov. John Kasich, GOP gubernatorial candidate Mike DeWine, all the Republicans running for statewide office, and the state Republican Party itself have all announced their opposition.

"Unfortunately, Issue 1 is a one-sided proposal that will weaken the tools available to our elected representatives, county prosecutors, and judges to make and enforce laws. It will eliminate important incentives to encourage drug treatment for the addicted, and allow the drug dealers who prey on addiction to freely roam the streets," said former secretary of state Ken Blackwell in rhetoric typical of the opposition.

Other opponents resorted to hyperbolic "sends the wrong message" arguments. "The message to children is that these drugs are not dangerous; the message to drug dealers is that doing business in Ohio is low-risk," warned Louis Tobin, executive director of the prosecutors' association, and Paul Pfeifer, executive director of the Ohio Judicial Conference, in their official argument.

It must be noted that Issue 1 defelonizes only drug possession -- not drug distribution.

There has been no polling to determine what kind of support the measure has, at least none announced publicly. Will an energized Democratic base carry the day for Democrats and Issue 1 in a closely divided state on Election Day? That remains to be seen, but all those millions in campaign funds should help buy plenty of TV ads and influence voters in these final weeks. Stay tuned.