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

Drug overdoses hit a record high in 2022, but may have peaked. (Creative Commons)

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.

Some Texas town officials are trying to run roughshod over the will of the voters on marijuana enforcement, sponsors of the SAFE Banking Act are not giving up hope yet, and more.

State-legal pot businesses seek access to financial services through the SAFE Banking Act. (Creative Commons)

Last Minute Push for SAFE Banking Act. With the curtain about to close on the current Congress, Senate sponsors of the SAFE Banking Act (HR 1996) are still trying to get the bill passed. Sens. Jeff Merkley (D-OR) and Steve Daines (R-MT) tried and failed to get the bill attached to the National Defense Authorization Act, but now they're trying to get it attached to the omnibus funding bill, but again face Republican opposition, including from Senate Minority Leader Mitch McConnell (R-KY). Nine Republicans have previously sponsored the bill, but it would need 10 votes to overcome a filibuster. Earlier in the session, the bill was blocked by the Democratic leadership, which was holding out for a comprehensive marijuana legalization bill.

New Hampshire Lawmakers Filed Marijuana Legalization Bill. Incoming Democratic House leader Matt Wilhelm (D-Manchester) is a main sponsor of a new marijuana legalization bill filed in the House last week. The bipartisan bill would legalize marijuana for people 21 and over and set up a system of taxed and regulated retail sales. While similar bills have failed in years past, Wilhelm said it is "long past" time for the state to stop "wasting scarce tax dollars and valuable local and state policing resources by continuing a restriction that has failed for decades and needlessly ruined the lives of many young and poor Granite Staters."

Texas Towns Seek to Undo Will of Voters on Marijuana Ordinances. Voters in five Texas towns and cities approved ending criminal enforcement of marijuana prohibition by voting for local ballot measures that ban arrests and tickets for possessing less than four ounces of weed. But elected officials in those localities are balking, with some saying the effort violates state laws and hinders police officers.

In Harker Heights, the city council repealed the ordinance two weeks after the vote. In Killeen, the Bell County DA attempted to undo the ordinance, but the city council approved it anyway. In San Marcos, the Hays County Criminal DA has asked for the state attorney general's opinion about enforceability of the ordinance, while in Denton, the city council certified the initiative, but the city manager opposes implementing part of it.

A push is on to get marijuana on the ballot in Ohoi next year, the UNODC warns Bolivia about synthetic drugs such as fentanyl, and more.

Fentanyl test strips can save lives. (Creative Commons)

Poll: Nearly Three in Four Likely Voters Support "Ending the Federal Ban" on Marijuana, Other Federal Reforms. A new poll from the progressive-leaning Data for Progress finds 74 percent of likely voters say that they "support ending the federal ban on marijuana." Eighty-five percent of Democrats, along with 74 percent of Independents and 63 percent of Republicans, endorsed repealing federal prohibition. Similar levels of support were evidenced for allowing state-legal marijuana programs "lawful access to US financial systems," not barring workers in the marijuana industry from accessing federal benefits, and not removing people from federally assisted housing in jurisdictions where marijuana is legal.

Ohio Advocates Push to Get Adult-Use Cannabis Legalization Measure on 2023 Ballot. The Coalition to Regulate Marijuana Like Alcohol has begun signature gathering to put a marijuana legalization initiative on the November 2023 ballot. The campaign now has about eight weeks to collect 130,000 valid voter signatures to qualify for the ballot. In the meantime, under a court settlement, the legislature will take up the measure in January, and i-- it fails to pass it, it will go before voters—provided the campaign has come up with the required signatures. The initiative would allow people 21 and over to possess and consume marijuana, which would come with a 10 percent sales tax.

Harm Reduction

Ohio Fentanyl Test Strip Decriminalization Bill Wins Committee Vote. A bill to try to reduce drug overdose deaths by decriminalizing the possession of fentanyl test strips, House Bill 456, won a final House committee vote Monday before heading to a House floor vote Wednesday. The bill’s sponsor, Rep. Kristin Boggs(D-Columbus)described the change as "one more avenue"to avoid overdose.  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.

International

UN Says Growth of Bolivian Coca Crop Slows but Warns of Synthetic Drugs. The UN Office on Drugs and Crime (UNODC) and the European Union warned Bolivia about the presence of synthetic drugs in the national market even as they acknowledged a slow-down in the increase of coca production. UNODC said coca cultivation had increased 4 percent in 2021, the lowest increase in recent years, but the Bolivian government challenged that figure, saying there had actually been a slight decrease. But fentanyl was also on the UNODC's mind: "There were seizures of synthetic drugs including fentanyl, an opioid that causes a large number of deaths in Europe. There is a national market. This is a problem for us and it will be for Bolivia", said Trolls Wester, UNODC Bolivia representative.

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.

Magic mushrooms and other natural entheogens are now decriminalized in Colorado. (Creative Commons)

Last week's 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.

As part of the "natural medicine services" program, Proposition 122 will also create the Natural Medicine Advisory Board to craft rules and regulations for implementing the program. The board can also make recommendations to the Department of Regulatory Agencies on adding additional substances.

With the help of more than $3.825 million in funding from the New Approach PAC, which has bankrolled numerous drug reform initiatives across the country, Natural Health Colorado zipped through signature-gathering in a quick three months and qualified for the ballot back in June.

That irked groups such as Decriminalize Colorado and the Society for Psychedelic Outreach Reform and Education (SPORE).

"I do not personally align with I-58 [Proposition 122] and the heavy out-of-state influence calling the shots in Colorado," said Melanie Rose Rodgers, co-proponent of the Decriminalize Nature initiative. "What happened with cannabis is happening with mushrooms. Folks from marginalized communities, People of Color are being left out -- once again. With all the inequality and rolling back of freedoms that exist today, let us not create new industries that will cater and serve the rich and wealthy while opening the floodgates for anyone able to buy Colorado 'healing center' licenses. I am opposed to the corporate takeover of sacred earth medicines and psychedelics written in I-58 [Proposition 122]."

"While this may sound like a good thing to people who want to see increased access to psychedelics, this initiative is designed for corporate control, largely restricting access to corporate-owned healing centers Frankly, the NMHA is not a step in the right direction. It is a leap in the wrong direction," said Matthew Duffy, cofounder of SPORE. "The NMHA is a corporate power grab, setting a corrupt foundation for the future of medicine stewardship in Colorado."

But Natural Health Colorado and its backers beg to differ, and they are emphasizing the therapeutic aspects of the measure as they bask in the glow of victory.

"This is a truly historic moment. Colorado voters saw the benefit of regulated access to natural medicines, including psilocybin, so people with PTSD, terminal illness, depression, anxiety and other mental health issues can heal," Natural Medicine Colorado said in a post-election statement. "We look forward to working with the regulatory and medical experts and other stakeholders to implement this new law."

"The Natural Medicine Health Act puts the well-being of patients and communities first," added Josh Kappel, chair of the Natural Medicine Colorado campaign. "It was purposefully designed, with a multi-phase implementation process that sets clear safety rules, while allowing the details of the regulatory structure to be developed by the community and regulators working together."

For David Bronner, CEO (Cosmic Engagement Officer) of Dr. Bronner's soaps, which endorsed the initiative, it combines two important means of access to the mind-altering substances. "I see what [Proposition 122] does as one seamless policy: making natural medicines -- psychedelic plant and fungal medicines containing psilocybin, DMT, ibogaine or mescaline (peyote) -- available to all adult Coloradans in two powerful healing modalities: via a regulated access model in a therapeutic context; and the self-regulating community healing model in a decriminalized context," Bronner said.

Now that the voters have spoken, it is time to begin ensuring that Proposition 122 in practice more resembles the vision of its proponents than its opponents.