A Kentucky company used court-ordered urine tests to defraud Medicare, Secretary of State Blinken addresses synthetic drugs at a UN side event, and more.

Marijuana Policy

SAFE Banking Act Negotiations Find "Sweet Spot," Senator Says. Senate Banking Committee member Sen. Kevin Cramer (R-ND) says senators have "probably found a sweet spot" in negotiations over the SAFE Banking Act (S.1323), which is set to have a committee vote, likely next week. Senators have reached an agreement to leave a key section favored by Republicans "intact, as it is," Cramer said.

That section deals with broad banking regulations, and Republicans have insisted that it remain in the bill.

Committee member Sen. Jack Reed (D-NV) had previously expressed concerns about the section—Section 10—but now says senators have "talked extensively about Section 10, and we’ve made some progress." However, he didn’t specify what that progress looks like. "I think we’ve resolved most of the issues we had—and I hope we have so we can get it out of the committee with a strong vote," he said.

Drug Policy

San Francisco Drug Crackdown Has Sparked Violent Turf Warfare in Center of City, Supervisor Says. Mayor London Breed's crackdown on drugs in the Tenderloin and South of Market (Soma) neighborhoods has resulted in hundreds of arrests and the seizure of hundreds of pounds of fentanyl, but is also generating violence in those neighborhoods, one city supervisor says.

"They’re poking a hornet’s nest," Supervisor Dan Preston said in an interview. "There are increased turf wars that are occurring because you have a raid here, and another group moves in. I mean, we’ve had gunfire and a murder during the middle of the day." 

Preston cited two shootings three days apart on Golden Gate Avenue, with the second shooting leaving one person dead.

Meanwhile, street-level drug activity remains undeterred, with overdose deaths on pace to exceed the number from last year.

Tenderloin resident and Public Defender's Office attorney Alexandra Pray said she would rather see more patrols than more arrests.

"I walk to work every day, and I walked through just groups of young men huddled around, and I know what they’re doing," Pray said. "And I just don’t know where the police are. It feels like the police are allowing this to happen, and then when they feel like it, they swoop in and pick people up, and we’re not really solving the problem."

Drug Testing

Kentucky Lab Owner, Exec Plead Guilty to $2.8M Lab Fraud Scheme That Billed Medicare for Non-Medical, Court Ordered Drug Testing. The owner

 and CEO of a Lexington, Kentucky-based lab and the lab's compliance officer have pleaded guilty to a $2.8 million healthcare fraud scheme in which they billed Medicare for court-ordered urine drug tests even though Medicare only pays for medical testing.

LabTox owner Ronald Coburn and LabTox compliance officer and director of operations Erica Baker copped the guilty pleas. Baker helped solicit urine test drug orders submitted by the company. The pair worked with a company Baker recruited, Blue Waters Assessment and Testing Services to refer court-ordered drug tests to LabTox. Despite being aware this was not medical testing, Coburn billed Medicare and Kentucky Medicaid, gaining payments of $1.9 million between June 2019 and March 2021.

Baker also sought out samples from nonmedical substance abuse treatment programs, putting some facility staff on the lab's payroll and compensating them based on the number of urine drug tests sent to the lab. LabTox billed Medicaid and Kentucky Medicare $937,594 for this testing.

Coburn has agreed to pay $3.6 million to the IRS, representing income tax he owed in 2017 through 2021. The pair will be sentenced in December and are looking at up to 10 years in federal prison.

Foreign Policy

US Secretary of State Addresses Global Synthetic Drug Threats at U.S.-Hosted Side Event at 78th United Nations General Assembly. On Monday, September 18, Secretary of State Antony J. Blinken hosted an event on the margins of the 78th United Nations General Assembly addressing the pressing issue of synthetic drug challenges worldwide.  The U.S.-sponsored side event, titled "Addressing the Public Health and Security Threats of Synthetic Drugs Through Global Cooperation," convened international leaders and representatives from international organizations, private sector, and civil society to discuss comprehensive strategies for combatting the public health and security threats posed by synthetic drugs and advance the work of the Global Coalition to Address Synthetic Drug Threats.

As synthetic drugs continue to devastate communities at home and abroad, this discussion underscores the United States’ commitment to engaging with international partners to address this critical issue, including the provision of more than $100 million in assistance from the Department of State to build the capacity of partners across the world to detect, identify, and interdict synthetic drugs.  This assistance also includes providing vital treatment, prevention, and recovery initiatives, as well as supporting alternatives to incarceration systems development with a focus on drug treatment. 

The Global Coalition provides a platform for the exchange of knowledge, ideas, and collaborative efforts aimed at dismantling the criminal networks responsible for the production and distribution of synthetic drugs and sharing universal best practices for substance use harm reduction and will continue expert-level engagement through monthly meetings launching in October.

In the face of the continuing overdose crisis and the regressive resort to punitive drug war tactics such as drug-induced homicide laws to combat it, a group of friends and family members of drug users, including many who have lost loved ones to drug overdoses, is calling on Congress to stand firm against looking to more criminalization and prosecution as a solution.

In collaboration with the Drug Policy Alliance, the group, Broken No More, last week sent an open letter to lawmakers urging them to oppose more failed drug war policies and instead embrace evidence-based health responses proven to save lives and prevent other families from suffering the loss of loved ones.

"Opportunistic politicians supported by law enforcement are using the overdose crisis and parents’ grief to pass harsh drug laws that will only continue to fill our morgues and prisons," the open letter says. "Punitive laws will not bring our loved ones back, but they will subject other parents’ children to more suffering and deny them the support that can keep them alive.

The group makes concrete demands of Congress about what it does and does not want. It says "no more" to drug-induced homicide laws, new mandatory minimum sentencing laws, or new laws increasing penalties for the possession of personal use amounts of illicit drugs.

Instead, it calls for "health-based solutions focused on overdose prevention, harm reduction, and drug treatment," including drug decriminalization (with the savings invested in addiction services and social supports), the panoply of harm reduction measures from needle exchanges and drug checking to safe injection sites, effective voluntary drug treatment options (including access on demand for opioid disorder medications buprenorphine and methadone_, "reality based drug education," and removing civil punishments for drug use  (in food, housing, and employment).

"As a mother who lost her 16-year-old son to overdose, I strongly oppose imposing harsher penalties for those involved in drug-related deaths," said Tamara Olt, MD, executive director of Broken No More. "It is enough that one family has been devastated by the loss of their loved one. It is cruel and unjust for a second family to lose their child to incarceration and the laws will increase deaths by making people afraid to get help for someone experiencing an overdose. I support a health-based approach, harm reduction, and safer supply to cease the senseless and preventable overdose deaths that are increasing exponentially. No one is disposable."

"I lost my son, my only child, Jeff, to an overdose. But he didn’t have to die. There were two people with Jeff that day, one of whom had sold him the heroin he used. They could have called for help but, instead, they pulled him from the SUV and left him on a lawn. And while people will say that they were monsters, they weren’t. The monster was fear. Fear of the police. Fear of arrest. Fear of spending 20 years to life in prison. It was fear that killed my son," said Denise Cullen, LCSW, co-founder of Broken No More. "Criminalization and punitive drug laws have resulted in nothing but more imprisonment, more deaths, and more devastated families. We must, instead, invest in health-based solutions that will save the lives of the ones we love. Laws that charge people with murder for a drug-related death may sound like a good idea. Until that is, it’s your child that dies on a lawn."

"We stand behind the families who are bravely fighting for the right policy solutions so that no one else has to go through the heartbreak and pain they have experienced. Their voices are abundantly clear that the best way to address the overdose crisis is through continued investment in public health resources and services rather than doubling down on the deeply flawed, unjust, and failed punitive approaches of the past," said Emily Kaltenbach, senior director of state advocacy and criminal legal reform at the Drug Policy Alliance. "Turning to health solutions instead of punishment is the right way forward. People all across the country are looking for answers to the problems of public safety, mass criminalization, racist policing, addiction, overdose, and homelessness.  But we know that punishing people for possessing drugs for personal use is not the answer to these issues."

For a complete list of signatories go here. And it is not too late for other parents and family members who have lost loved ones to sign the letter here.

A California bill allowing pot shops to sell food and drink goes to the governor, a new report from Harm Reduction International tracks US and EU aid that goes to support the drug war, and more.

Marijuana Policy

Fourteen GOP Lawmakers Tell DEA to Ignore HHS Recommendation, Keep Marijuana Schedule I. A dirty dozen plus two Republican House and Senate members have sent a letter to DEA Administrator Anne Milgram calling on her to reject a recommendation from the Department of Health and Human Services to down-schedule the drug. Instead, the conservative lawmakers wrote, marijuana should remain on Schedule I of the Controlled Substances Act.

The lead authors on the letter were Sen. James Lankford (R-OK) and Rep. Pete Sessions (R-TX). They were joined by Sens. Michael Rounds (R-SD), James Risch (R-ID), Marsha Blackburn (R-TN), Mike Crapo (R-ID), Ted Budd (R-NC), Markwayne Mullin (R-OK) and Tom Cotton (R-AR), as well as Reps. Chuck Edwards (R-NC), Robert Aderholt (R-AL), Hal Rogers (R-KY), Buddy Carter (R-GA) and Andy Biggs (R-AZ).

Any decision to reschedule marijuana "should be based on proven facts and science—not popular opinion, changes in state laws, or the preferred policy of an administration," they wrote, ignoring HHS's science-based review that led to the call for down-scheduling.

"It is irresponsible for HHS to recommend that marijuana be removed from Schedule I. It would also be irresponsible for DEA to act on this recommendation," the letter concludes. "Our country relies on DEA to enforce our nation’s drug laws. We ask you to uphold your mission by rejecting any effort to remove marijuana from Schedule I."

California Marijuana Café Bill Heads to Governor's Desk. After a final concurrence vote in the Assembly to approve amendments made in the Senate, the legislature on Tuesday approved Assembly Bill 374, which would allow marijuana retailers to offer food and drinks in they get local approval. It now heads to the desk of Gov. Gavin Newsom (D).

The bill would let local governments authorize the preparation and sell of non-marijuana food and drinks. Sale of alcohol would continue to be prohibited, as would the smoking of tobacco.

The bill would also authorize "live musical or other performances on the premises of a retailer or microbusiness licensed under this division in the area where the consumption of cannabis is allowed, and the sale of tickets for those performances."

International

Led By Colombia and Mexica, 19 Latin American and Caribbean Nations Call for Rethink of War on Drugs. After meeting at the Latin American and Caribbean Conference on Drugs over the weekend, 19 Latin American and Caribbean nations have signed onto a joint statement calling for a rethinking of the war on drugs and instead focusing on "life, peace and development" within the region.

Under the current prohibitionist approach to drug policy, "the expected results have not been obtained when combating the world drug problem, leaving in many cases the underlying problems to be solved and exploiting and exacerbating vulnerabilities of our territories and societies."

The governments of Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Dominican Republic, Uruguay and Venezuela all signed on.

Colombia and Mexico "are the biggest victims of this policy," said Colombian President Gustavo Petro, who likened the drug war to "genocide."

"What I propose is to have a different and unified voice that defends our society, our future and our history and stops repeating a failed discourse," Petro said. He argued that it was wrong to look at drug control "as a military problem and not as a health problem in society."

Supply-side solutions have been counterproductive, he argued. "Every dollar that is dedicated to cutting the supply makes the price grow," he said. "If the price increases, drug traffickers have more money to buy rifles, to buy armored vehicles, to buy missiles, to buy politicians, to buy senators, to buy generals, to buy judges, to buy presidents."

"The fundamental thing to face the scourge of drug addiction and violence is to address the causes, with a new criterion, not to think only of coercive measures," López Obrador, the Mexican president, said at the conference. "We have to put first the criterion that peace is the result of justice. We have to fight first against poverty, against inequality."

America and European Union Have Spent a Billion Dollars in Past Decade to Fight Drug War, Fueling Human Rights Abuses, New Report Finds. Between 2012 and 2021, the US and the European Union spent nearly a billion dollars of their budgets on programs supporting drug control policies, fueling human rights abuses as they did so, according to a new report from Harm Reduction International.

EU funding has been used to support surveillance capabilities in Colombia, Mozambique and the Dominican Republic, and undercover policing in Peru, while American funding has been used by the DEA train police and special units in Vietnam and Honduras, which have been accused of arbitrary arrests and killings.

"When you think about development, you don’t really think about it being used for those kinds of activities – you think of poverty reduction, working towards development goals on health or education," said Catherine Cook, sustainable financing lead at HRI, which monitors the impact of drug policies. "This money is actually being used to support punitive measures – so policing, prisons, essentially funding the ‘war on drugs’, even though we know the ‘war on drugs’ and punitive policies have repeatedly failed."

Garden State Democrats take flak for voting for a harsh fentanyl analog bill, a clandestine San Francisco safe injection site saved lives, and more. 

Drug Policy

New Synthetic Opioids Raising Alarms. A group of new synthetic opioids called nitazenes are emerging in illicit drug markets and may be more powerful than fentanyl, a thousand times more potent that morphine, and may require even greater doses of opioid overdose reversal drugs to reverse overdoses, according to a study published Tuesday in the journal JAMA Network Open.

Researchers found most patients who overdosed on nitazenes required two doses of the overdose reversal drug naloxone to recover, while most patients overdosing on fentanyl required only a single dose.

"Clinicians should be aware of these opioids in the drug supply so they are adequately prepared to care for these patients and anticipate needing to use multiple doses of naloxone," the researchers, from the Icahn School of Medicine at Mount Sinai in New York, Lehigh Valley Health Network based in Pennsylvania, and other US institutions, wrote in the study. "In addition, to date there has been a lack of bystander education on repeat naloxone dosing."

The data came from a small study of 537 adults admitted to emergency rooms between 2020 and 2022, 11 of which tested positive only for fentanyl and nine who tested positive only for nitazenes. The researchers found that two-thirds of patients overdosing on nitazenes required two or more doses of naloxone, compared with only one-third of those overdosing on fentanyl.

Among the nitazenes are brorphine, isotonitazene, metonitazene, or N-piperidinyl etonitazene. Metonitazene appears to be the most dangerous.

"In the present study, metonitazene appears to have the most severe clinical toxicity given that both patients in which metonitazene was detected presented in cardiac arrest," the researchers wrote. Among those two patients who were found to have metonitazene, one patient died despite receiving six milligrams of naloxone in three separate doses. The other patient survived after receiving a total of 10 milligrams of naloxone in three doses.

New Jersey Congressional Democrats Take Flak for Voting for Mandatory Minimums for Fentanyl Analogs. Three New Jersey Democrats joined with three New Jersey Republicans to vote for the Halt All Lethal Trafficking of Fentanyl (HALT) Act (HR 467), which ramped up mandatory minimum sentences for fentanyl analogs, and now they are facing bitter criticism for doing so. The bill assumes that fentanyl analogs are harmful and criminalizes people despite a lack of scientific evidence.

Supported the drug war legislations were conservative Democrats Josh Gottheimer, Mikie Sherrill, and Donald Norcross, as well as Republicans Jeff Van Drew, Chris Smith, and Thomas Kean Jr.

"This shoot-first, ask-questions-later legislation would permanently schedule all fentanyl-related substances as Schedule I without first testing them for benefits or harm," said civil rights advocate Lisa McCormick. "By putting fentanyl-related substances on that list, they are among the most harshly criminalized drugs regardless of the science."

"This bill also imposes mandatory minimum sentences of 10 to 20 years in prison for fentanyl analog cases, hearkening back to failed drug war strategies of the past that have led to a stronger, more potent illicit drug supply," said McCormick. "Yet, Republican members of Congress and their corporate-controlled Democratic allies continue to double down on the disproven, failed approach of drug prohibition at the expense of people’s lives. "Of the nearly two million people incarcerated in the U.S. today, one in five is locked up for a drug offense," said McCormick, who said the legislation was strongly condemned by a variety of non-partisan civil rights, public health, drug policy, faith, law enforcement, criminal legal reform, and public policy research organizations.

"Our communities deserve real health solutions to the overdose crisis, not political grandstanding that is going to cost us more lives," said Maritza Perex Medina, director of the Office of Federal Affairs at the Drug Policy Alliance. "Yet, sadly, in passing the HALT Fentanyl Act, the House seems intent on doubling down on the same failed strategies that got us here to begin with."

"It’s sad to see lawmakers revert to over-criminalization once again when we have 50 years of evidence that the war on drugs has been an abject failure," said Laura Pitter, deputy director of the US Program at Human Rights Watch. "A vote for this bill was a vote against evidence and science."

Advocates are calling on Congress to reject drug war-style legislation and instead support public health approaches like the Support, Treatment, and Overdose Prevention of Fentanyl (STOP Fentanyl) Act of 2021 (HR 2366) and the Test Act (SB 1950). The former proposes increased access to harm reduction services and substance use disorder treatment, improved data collection, and other evidence-based methods to reduce overdose, while the latter would require the federal government to test all fentanyl-related substances that are currently classified as Schedule I substances and remove those that are proven medically beneficial or otherwise unharmful.

Harm Reduction

San Francisco's Clandestine Safe Injection Site Saved Hundreds of Lives. According to a study published Tuesday in the International Journal of Drug Policy, the Tenderloin Center, a clandestine safe injection site that operated throughout 2022 saw 333 overdoses—with no fatalities and every single one of them reversed. That was out of 124,000 visits.

The Tenderloin Center was "an effective harm-reduction strategy to save lives," wrote lead author Dr. Leslie Suen of the University of California, San Francisco. " 

The site has since shuttered, with neither City Attorney David Chiu nor Mayor London Breed willing to keep it open against federal law. Now, the city is on track for its highest recorded number of drug overdoses yet.