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The Top Ten Domestic Drug Policy Stories of 2019 [FEATURE]

As the clock ticks down toward 2020, it's worth taking a moment to look back and reflect on what has gone on in the world of drug policy this year. From marijuana to psychedelics to the lingering overdose crisis to the emergence of a new vaping-related illness, a lot happened. Here are ten of the biggest highs and lows of 2019, in no particular order:

It was a big year for marijuana in Congress. Less so in the states.
1, For the First Time, Marijuana Legalization Wins a Congressional Vote

In November, the House Judiciary Committee made history when it approved the Marijuana Opportunity Reinvestment and Expungement (MORE) Act (H.R. 3384). The bill would effectively legalize marijuana at the federal level by removing it from the Controlled Substance Act's drug schedules. It would also require federal courts to expunge prior convictions and conduct resentencing hearings for those still doing federal marijuana time. And it would assess a five percent tax on marijuana sales to create a fund to aid to people and communities most impacted by prohibition.

There's a good chance the MORE Act will get a House floor vote before the end of this Congress, but even if it does, its prospects in Sen. Mitch McConnell's Senate are dim at best. Still, step by step, Congress by Congress, the end of federal marijuana prohibition is drawing nearer.

2. Marijuana Banking Bill Passes the House

In September, the House passed the SAFE Banking Act, which would allow state-legal marijuana businesses to get access to banking and other financial services. The vote was 321-103, with near unanimous support from Democrats, as well as nearly half of Republicans.

The vote came although some civil rights and drug reform groups had called for it to be put off until more comprehensive marijuana or criminal justice reform, such as the MORE Act (see above) could be enacted. They argued that passage of a narrowly targeted financial services bill could erode momentum toward broader reforms. The MORE Act did win a House Judiciary Committee vote, but has yet to get a House floor vote.

And while SAFE passed the House, it must still get through the Senate, where it is not clear whether it will be allowed to a vote, much less whether it can pass. A companion version of SAFE, S.1200, was introduced in April by Sens. Jeff Merkley (D-OR), Cory Gardner (R-CO) and a bipartisan group of 21 original cosponsors. It currently has 33 total cosponsors. In September, Senate Banking Committee Chairman Mike Crapo (R-ID) said his committee would take up the cannabis banking issue this year and is working on preparing a new bill, but now it's December and little has happened.

3. Legalization in the States Didn't Have a Great Year

At the beginning of 2019, prospects looked good for as many as a half-dozen states to get legalization bills passed, but the year turned out to largely be a dud. Hopes were especially high in New Jersey and New York, where Democratic governors supported legalization, but it didn't come to pass this year in either state. In Albany, they'll be back at it next year, but in Trenton, it looks like the legislature is going to punt, opting instead to put the issue directly to the voters next year in a legislative referendum.

One state did make it all the way to the finish line: Illinois. After a legalization bill sailed through the legislature in the spring, Democratic Gov. J.B. Pritzker signed it into law in late June. With that signature, Illinois became the first state to create a system of taxed and regulated marijuana commerce through the legislative process, rather than through a voter initiative. (Vermont's legislature legalized possession and cultivation but not sales in early 2018.)

Getting bills through a state legislature is hard work, and it sometimes takes years. Still, that hard work that didn't quite make it over the top this year, is laying the groundwork for legalization in places like New Jersey and New York -- and maybe more -- next year. And next year is an election year, which means initiative campaigns that can bypass legislative logjams will be in play. There are already active campaigns in Arkansas, Florida, North Dakota and South Dakota, although none have yet qualified for the ballot. Look for 2020 to be a better year when it comes to freeing the weed.

4. Pot Prohibition Isn't Dead Yet: Despite Legalization, Marijuana Arrests Up in Latest FBI Crime Report

In late September, the FBI released its annual Uniform Crime Report for 2018, and once again, marijuana arrests were on the rise -- despite legalization in 11 states and DC, and decriminalization in 15 more states. There were some 663,367 marijuana arrests in 2018, up from 659,700 in 2017 and 653,249 in 2017. In all three years, simple possession cases accounted for about nine out of ten pot busts. Before 2016, marijuana arrests had been going down for more than a decade. Clearly, there is still work to do here.

5. US Supreme Court Unanimously Reins in Asset Forfeiture

In a February victory for proponents of civil libertarians, the US Supreme Court ruled in Timbs v. Indiana that the Eighth Amendment's Excessive Fines Clause applies to states, thereby prohibiting state and local governments from collecting excessive fines, fees and forfeitures. Justice Ruth Bader Ginsburg wrote the majority opinion. "The protection against excessive fines guards against abuses of government's punitive or criminal law-enforcement authority," Ginsburg wrote. The case involved the seizure of a $42,000 Land Rover over a drug sale of $225.

There was more progress on the asset forfeiture front on the state level, too: Bills to either end civil asset forfeiture entirely or to restrict it passed this year in Alabama, Arkansas, Michigan, and North Dakota, and in September, a South Carolina circuit court judge ruled civil asset forfeiture unconstitutional, setting up a fight in state appeals courts there.

6. Thousands of Federal Drug Prisoners Go Free Under First Step Act

President Trump signed the First Step Act into law at the end of last year, but the sentencing reform measure's true impact was felt in July, when the Bureau of Prisons released more than 3,000 prisoners and reduced the sentences of nearly 1,700 more. Almost all of those released were drug offenders. The First Step Act was aimed at redressing harsh sentences for federal prisoners excluded from the 2010 Fair Sentencing Act, which reduced -- but did not eliminate -- the infamous crack/powder cocaine sentencing disparity, but which did not include prisoners sentenced before its passage. Three states -- Florida, South Carolina and Virginia -- accounted for a whopping 25 percent of sentence reductions, and more than 90 percent went to African-American men.

A movement to decriminalize natural psychedelics emerged this year. (Greenoid/Flickr)
7. Psychedelic Decriminalization Becomes a Movement

After emerging in 2018, the movement to decriminalize natural psychedelics mushroomed this year. In May, voters in Denver narrowly approved the Denver Psilocybin Mushroom Decriminalization Initiative, making clear that they wanted to "deprioritize, to the greatest extent possible, the imposition of criminal penalties on persons 21 years of age and older for the personal possession of psilocybin mushrooms." The measure also "prohibits the city and county of Denver from spending resources on imposing criminal penalties on persons 21 years of age and older for the personal use and possession of psilocybin mushrooms."

That surprise victory sparked interest across the country, and the following month Oakland followed suit, only this time it was the city council -- not the voters -- who decriminalized magic mushrooms and other natural psychedelics. In September, Chicago became the next city to get on board, with the city council unanimously passing an advisory resolution expressing support for research on the potential use of psychoactive plants and pledging support for adult use of the substances. Meanwhile, activists in three more major cities -- Berkeley, Dallas, and Portland -- were pushing psychedelic decriminalization measures, either through ballot initiatives or city council actions. By December, Decriminalize Nature, the group behind the movement, reported that more than 100 cities across the country are now seeing efforts to open up to psychedelics.

And it's not just cities. In two states, psychedelic reformers have filed initiatives aimed at the November 2020 ballot. In the Golden State, the California Psilocybin Mushroom Initiative, which would decriminalize the possession, use, and gifting of magic mushrooms and the chemical compounds -- psilocybin and psilocin -- has been cleared for signature gathering. It has until April 21 to come up with 623,212 valid voter signatures to qualify for the November 2020 ballot. Just across the border to the north, the Oregon Psilocybin Service Initiative, which would allow magic mushrooms to be grown with a license, and would allow for therapeutic use of psilocybin, is in the midst of signature gathering. It needs 112,020 valid voter signatures by July 2 to make the ballot. The Oregon measure in October got a nice $150,000 donation from Dr. Bronner's Magic Soaps.

8. Overdose Deaths Decline Slightly, But Are Still Way Too High

In July, the CDC reported 2018 drug overdose death numbers and found that they had declined from 2017's record high of more than 70,000 to just under 68,000, a five percent decrease. The latest data from CDC, which measured drug deaths in the 12-month period ending in April 2019 showed deaths at 67,000, suggesting that the decline continues, but at a glacial pace. Still, the number of overdose deaths is about seven times higher than it was in 1995, at the start of the prescription opioid epidemic.

The recent decline has been driven by a decrease in heroin and prescription opioid overdoses, although overdoses involving the synthetic opioid fentanyl increased, as did those involving the stimulant drugs cocaine and methamphetamine. Many overdoses involved more than one drug, with benzodiazepines often implicated.

If some researchers are right, fentanyl overdoses could balloon to an even higher level, if distribution of the highly potent substance takes hold in the western US. Most users take fentanyl unknowingly, after it's been used to cut street heroin or counterfeit pills.

9. Vaping-Linked Illness Emerges, Sparking Broad Anti-Vaping Backlash

In the summer, reports of vaping or e-cig users being struck down by a mysterious, lung-damaging condition began to emerge. By the end of October, the Centers for Disease Control and Prevention (CDC) reported more than 1,600 cases of lung-damaged vapors, with the death toll rising to 34. (That number has since risen to 47.) The CDC also gave the condition a name: e-cigarette or vaping product use associated lung injury (EVALI).

A likely culprit soon emerged: black market THC vaping cartridges contaminated with new additives, particularly thinners including propylene glycol (PG) and polyethylene glycol (PEG), vitamin E acetate, and medium chain triglycerides (MCT oil). The FDA has begun investigating vitamin E acetate, while public health officials in New York have found the substance in a majority of seized vape cartridges there. The FDA also announced in August that it is proposing adding propylene glycol as a "respiratory toxicant" in its list of harmful tobacco product ingredients.

While the CDC and the FDA responded to the outbreak with recommendations targeting the suspect products, elected and public health officials in a number of states responded by going after not black market marijuana vaping cartridges but legal flavored tobacco vaping products.

Massachusetts banned all vaping products, Michigan banned flavored nicotine products, New York banned flavored e-cigarettes, Oregon banned all flavored vaping products for six months, as did Rhode Island, while Washingtonissued a four-month ban on flavored vaping products. President Trump threatened to move toward a national ban on flavored vaping products, but has since changed course, even making an anti-prohibitionist argument to do so.

In its latest update, the CDC reports the number of EVALI cases has risen to nearly 2,300 and the death toll has climbed to 47. But unlike those state governments that reacted with flavored vaping bans, the CDC takes a different approach: It points the finger strongly at vitamin E acetate, recommends that people not use THC vaping products at this point -- especially if obtained informally or in the black market -- and also warns people not to add any products to vaping cartridges that are not intended by the manufacturer.

10. Safe Injection Sites Win an Important Preliminary Legal Battle

In a case involving a proposed safe injection site in Philadelphia, a federal judge ruled that it would not violate federal law. With the backing of city officials and former Gov. Ed Rendell (D), the nonprofit group Safehouse pressed forward with plans for the facility even though the Justice Department had warned that it would not allow any safe injection sites to move forward. The Justice Department sued in February to halt the project, arguing that it violated the federal "crack house law."

But US District Judge Gerald McHugh ruled that the "crack house" provision of the Controlled Substances Act does not apply to the group's bid to assist opioid users. "No credible argument can be made that facilities such as safe injection sites were within the contemplation of Congress" when that body wrote the law in 1986 or amended it in 2003, McHugh wrote. "I cannot conclude that Safehouse [the safe injection site] has, as a significant purpose, the objective of facilitating drug use. Safehouse plans to make a place available for the purposes of reducing the harm of drug use, administering medical care, encouraging drug treatment and connecting participants with social services."

While the Justice Department has appealed the ruling, it is a good omen, and the case is being carefully watched in cities such as Denver, New York, San Francisco, and Seattle, all of which are pursuing similar plans.

West of the Mississippi, Meth -- Not Fentanyl -- Is the Deadliest Drug [FEATURE]

According to a report released last week by the Centers for Disease Control and Prevention (CDC) released last week, while fentanyl, heroin, and cocaine continue to account for most fatal drug overdoses in the Eastern US, it's a very different story once you cross the Mississippi River. Throughout the Western US, more people are dying from methamphetamines than those other three drugs.

crystal methamphetamine (Creative Commons)
The report, which examined the more than 70,000 drug overdose deaths in 2017, identified fentanyl as the deadliest drug nationwide, followed by heroin. Between them, the two opioids accounted for about 60 percent of all fatal overdoses. The third leading killer drug, cocaine, was involved in slightly more than 20 percent of overdoses. Meth came in fourth, accounting for 13.3 percent of overdoses nationwide.

Of the five geographic regions in the report east of the Mississippi, fentanyl was the leading killer, with heroin and cocaine alternating in second and third places. Meth never made it higher than fifth place among killer drugs in the East. It didn't even make the top 10 in Region 1 (New England) or Region 2 (New York and New Jersey), was in 7th place in Region 3 (the Mid-Atlantic states), and 5th place in Region 4 (the South) and Region 5 (the Midwest).

In the West, though, Region 7 (Iowa, Kansas, Missouri, Nebraska) was the only region where meth wasn't the leading cause of overdose deaths. There, it came in second behind fentanyl. But from Houston to Honolulu and San Diego to Sioux Falls, meth reigned supreme. In both Region 7 and Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, Texas), meth accounted for more than one-fifth of all overdose deaths, while in Region 8 (Northern Plains and Rockies), it accounted for more than a quarter of all ODs. In Region 9 (Arizona, California, Hawaii, Nevada) and Region 10 (Pacific Northwest and Alaska), meth was responsible for more than a third of all ODs.

Overall, the East has a significantly higher rate of drug overdose deaths. The age-adjusted death rate per 100,000 ranges from a low of 9.1 in the Southeast to a high of 22.5 in New England, while in the West, all regions except Region 7 had death rates of 1.7 or lower.

Clearly, many, many more drug users per capita are dying in the east, and the situation there, especially with fentanyl, requires and deserves serious attention. If some researchers are right, the western US is at risk of developing bigger fentanyl problems too, which could balloon opioid overdoses to even greater levels. Nevertheless, if anything is to be done about drug overdose deaths in the western US, dealing with methamphetamine is a key issue.

How to Legalize Ecstasy -- and Why [FEATURE]

Every weekend, hundreds of thousands of young club- and concert-goers buy and consume black market pills and powders they hope are MDMA, the methamphetamine relative with a psychedelic tinge known on the streets as Ecstasy or Molly. A tiny percentage of them -- a few dozen each year in the United States or Britain -- die. It doesn't have to be that way.

Ecstasy pills (Erowid.org)
Granted, those numbers are miniscule when compared with the tens of thousands who die each year in the US using opioids, benzos, and stimulants like cocaine and meth, much less from the legal substances alcohol and tobacco. But that relative handful of deaths could almost certainly be eliminated by bringing Ecstasy in from the cold -- making it legal and regulated instead of subjecting its users to black market Russian roulette.

And now somebody has a plan for that. The British Beckley Foundation, which has been advocating for research into psychoactive substance and evidence-based drug policy reform for the past two decades, has just released a new report, Roadmaps to Regulation: MDMA, that takes a good, hard look at the drug and charts a path to a saner, less harmful way of handling Ecstasy than just prohibiting it, which, the report notes, "has never meaningfully disrupted its supply, nor its widespread use."

That's because, despite it being illegal, for many, many people, Ecstasy is fun. And the Beckley report does something rare in the annals of drug policy wonkery: it acknowledges that. "Hundreds of thousands of people break the law to access its effects, which include increased energy, euphoria, and enhanced sociability," the report says.

The authors concede that Ecstasy is not a harmless substance, and take a detailed dive into acute, sub-acute, and chronic harms related to its use. They point to overheating (hyperthermia) and excess water intake (hypnoatraemia) as the cause of most Ecstasy deaths, and they examine the debate over neurotoxicity associated with the drug, very carefully pointing out that "there is evidence to suggest that heavy use of MDMA may contribute to temporary impairments in neuropsychological functions."

But they also point out that most of the problems with Ecstasy are artifacts of prohibition: "Our evidence shows that many harms associated with MDMA use arise from its unregulated status as an illegal drug, and that any risks inherent to MDMA could be more effectively mitigated within a legally regulated market," they write.

The most serious harmful effect of treating Ecstasy use and sales as a criminal matter is that users are forced into an unregulated, no-quality-control black market and they don't know what they're getting. Tablets have been found with as little as 20 milligrams of MDMA and as much as 300 milligrams. And much of what is sold as MDMA is actually adulterated with other substance, including some much more lethal ones, such as PMA (paramethoxyamphetamine) and PMMA (paramethoxymethamphetamine). This is how people die. As the authors note:

"The variability in MDMA potency and purity is a direct result of global and national prohibitionist policies. Recent developments around in situ drug safety testing are an attempt to mitigate the risks of such variability. These risks, such as overdose and/or poisoning, are by no means inevitable or inherent to the drug. If MDMA were clinically produced and legally distributed, users would be assured of the product content and appropriate dosage and be able to make more informed decisions regarding their MDMA use. In this way the principal risks we associate with MDMA use would be greatly reduced."

But the report also addresses a whole litany of other prohibition-related harms around Ecstasy that exacerbate the risks of its use. From making users less likely to seek medical help for fear of prosecution to making venues adopt "zero tolerance" policies that actually increase risks (such as drug dog searches that encourage users to take all their drugs at once before entering the venue) to the rejection of pill testing and other harm reduction measures, prohibition just makes matters worse.

In addition to harms exacerbated by prohibition, there are harms created by prohibition. These include "a lucrative illegal MDMA market that generates wealth for entrenched criminal organizations," the saddling of young users with criminal records, the risk that people who share or sell drugs among their friends could be charged as drug dealers, and the development of black markets for new psychoactive substances (NSPs), many of which are more dangerous than Ecstasy. Also not to be forgotten is the loss of decades of research opportunities into the therapeutic use of MDMA, research that was showing tremendous potential before the drug was prohibited in the mid-1980s.

Prohibition of Ecstasy is not only not working but is making matters worse. So what should we do instead? Beckley is very clear in its conclusions and recommendations. First, these preliminary steps:

  • Reschedule MDMA from Schedule I to Schedule II of the Controlled Substances Act (the Misuse of Drugs Regulations in Britain) in order to reduce barriers to research and to improve our understanding of its physiological effects.
  • "Decriminalize the possession of MDMA and all drugs to remove the devastating social and economic effects of being criminalized for drug possession or limited social supply."
  • Use decriminalization to comprehensively roll out drug safety testing (pill testing) and other proven harm reduction measures.

Once those preliminary steps are done, it's time to break big:

  • Award licenses to selected pharmaceutical manufacturers to produce MDMA under strict manufacturing requirements.
  • Allow licensed MDMA products to be sold at government licensed MDMA outlets. The report suggests pharmacies in the first instance.
  • For harm reduction purposes, retail outlet staff would need to be specially trained to educate users on the risks associated with MDMA.
  • Users who wish to purchase licensed MDMA products would be required to obtain a "personal license" to do so. Such a license would be granted after an interview with trained sales staff demonstrates that the would-be user understands the risks and how to reduce them.
  • Develop adults-only MDMA-friendly spaces where the risks associated with the drug can be combatted with the full panoply of harm reduction measures.
  • "User controls" to encourage responsible MDMA use. These would include "a strictly enforced age limit, pricing controls, mandated health information on packaging and at point of sale, childproof and tamperproof packaging, a comprehensive ban on marketing and advertising, and a campaign to minimize the social acceptability of driving under the influence of MDMA and to promote alternatives such as designated drivers."
  • "Sales of MDMA would be permitted to adults over 18 years of age. Prohibitive penalties would be in place to restrict underage sales."
  • Education campaigns focusing on MDMA safety and responsible use that would cover sales outlets and schools and universities. Such campaigns would include information about how to recognize and manage adverse events related to MDMA products.
  • Monitor and evaluate the impact of these changes to continue an evidence-based approach and allow feedback into policymaking.

There you have it, a step-by-step plan to break with prohibitionist orthodoxy and create a legal, regulated market for a popular recreational drug. Whether you or I agree with every plank of the plan, it is indeed a roadmap to reform. The evidence is there, a plan is there; now all we need is the political pressure to make it happen somewhere. It could be the United Kingdom, it could be the United States, it could be the Netherlands, but once somebody gets it done, the dam will begin to burst.

The Vaping Crisis is Real, But the Response by States Misses the Point [FEATURE]

According to the October 18 update from the Centers for Disease Control and Prevention (CDC), 1,299 cases of severe lung injury associated with the use of vaping products have now been reported since cases first started appearing this summer. They've been reported in 49 states and the District of Columbia. And 26 people have died.

The update also provides this new syndrome with a name: E-cigarette or Vaping, product use Associated Lung Injury (EVALI).

In the update, the CDC notes that "all patients have reported a history of using e-cigarette, or vaping, products" and that "most patients report a history of using THC-containing products."

As EVALI cases began piling up this fall, the Food and Drug Administration (FDA) warned consumers early this month to "stop using THC-containing vaping products and any vaping products obtained off the street." The CDC was on the same page, recommending that people "should not use e-cigarette or vaping products that contain THC," buy black market vaping or e-cig products, especially those containing THC, or modify or add any substances to e-cig and vaping products.

Something new is going on. Marijuana and nicotine vaping products have been around for more than a decade by now -- who remembers the massive Volcano vape from early in this century? -- and the most popular nicotine vaping brand, Juul, has been on the market for more than four years. Yet this wave of vaping-related illness only broke out this summer.

The culprit increasingly appears to be black market THC vaping cartridges contaminated with new additives, particularly thinners including propylene glycol (PEG), Vitamin E acetate, and medium chain triglycerides (MCT oil). The FDA has begun investigating Vitamin E acetate, while public health officials in New York have found the substance in a majority of seized vape cartridges there. The FDA also announced in August that it is proposing adding PEG as a "respiratory toxicant" in its list of harmful tobacco product ingredients.

While federal health officials have been busy trying to find the actual cause of the EVALI outbreak, elected and public health officials at the state level have typically responded with much broader restrictions on vaping products overall, especially flavored vaping products for both nicotine and marijuana.

In doing so, they are conflating two separate concerns -- youth vaping and this new vaping illness -- and coming up with responses that use the latter to take broad aim at the former. The problem with vaping illness increasingly appears to be not flavored vapes nor legal THC vapes; it's black market THC vapes using specific additives. Nonetheless, here's how governments have responded:

  • In Massachusetts, Gov. Charlie Baker (R) last month declared a public health emergency and banned all vaping products and devices. "The use of e-cigarettes and marijuana vaping products is exploding, and we are seeing reports of serious lung illnesses, particularly in our young people," Baker said as he announced the ban. Medical marijuana patients can still vape, though.
  • In Michigan, Gov. Gretchen Whitmer (D) used emergency administrative regulatory powers to make Michigan the first state to announce a ban on flavored nicotine products. "As governor, my No. 1 priority is keeping our kids safe," Whitmer said in a statement. "And right now, companies selling vaping products are using candy flavors to hook children on nicotine and misleading claims to promote the belief that these products are safe. That ends today."
  • In New York, Gov. Andrew Cuomo (D) announced a ban on the sale of flavored e-cigarettes in September, citing both the outbreak of lung injury and concerns over teenage e-cig vaping. But that ban has been temporarily blocked in the courts in response to a challenge from the vaping industry.
  • In Oregon, Gov. Kathleen Brown (D) ordered a six-month ban on all flavored vaping products early this month. In a joint statement, the Oregon Liquor Control Commission (which regulates marijuana) and the Oregon Health Authority said the emergency rules "are significant steps toward stemming the well-documented tide of e-cigarette use and vaping by youth, as well as keeping products that may expose people to unsafe chemicals and other contaminants off store shelves." But a state appeals court last week temporarily blocked the ban on nicotine vaping product, but not marijuana ones.
  • In Rhode Island, state health officials issued emergency health regulations at the end of September banning all flavored vaping products. Gov. Gina Raimondo (D) said she was concerned about the spread of e-cigarette use among teens and wanted to end the sale of flavored vaping products.
  • In Washington, Gov. Jay Inslee (D) issued an executive order in late September banning flavored nicotine and marijuana vaping products for four months. "We need to act for the public health of our people," said Inslee. "I'm confident this executive order will save lives."

One state, though, has had a more reasoned and measured response. In Colorado, regulators this month proposed a ban not on flavored vape products or THC vape products, but one specifically targeting the additives that are in question: PEG, MCT Oil, and Vitamin E acetate. The move came after public hearings and consultations with industry stakeholders.

The plan also includes requiring labels that identify any additives to vaping products and vaping cartridge packaging for products that include additives will have to say "Not FDA Approved."

Drug reform advocates, while acknowledging the seriousness of the vaping illness, are critical of what they see as exaggerated and heavy-handed responses and suggest that the outbreak is all the more reason to legalize marijuana.

"All the vape bans really accomplish is to stoke more fear and stigma around yet another substance," Matt Sutton, director of media relations for the Drug Policy Alliance, said in an emailed statement. "What we are seeing play out right now is a real-life drama of how various substances are criminalized without justified reasoning and reliable research to do so. Taking this approach, we fail to consider the harm that may result from its removal from the marketplace, such as people turning to the black market or more harmful substances."

"Banning vapes will only stop legal vapes, with no known problems," said Dale Gieringer, long-time head of California NORML. "Illegal vapes won't be affected. There is a concerted campaign by public health officials, led by the FDA, the CDC, and the California Department of Public Health trying to demonize vaping in general, even though there's strong evidence that vaping in general is much safer than smoking, for all sorts of obvious reasons," said Gieringer. "In other countries, such as Britain, public health authorities are encouraging vaping to reduce smoking."

For concerns about vaping marijuana products, the policy prescription is obvious, said Sutton: "For THC, the issue is undoubtedly the lack of regulation, which cannot be put in place so long as it remains illegal at the federal level," he argued. "At this point, with these illnesses becoming a growing concern, it is incumbent on policymakers to legalize marijuana in the interest of public health."

For CANORML's Gieringer, the current vaping panic is just that -- a sort of moral panic that creates a demand for action, whether or not that action addresses the actual problem and whether or not that action leads to negative consequences.

"During this entire scare, teen vaping goes up and up and up, but teen smoking has gone down, down, down. There's no public health crisis evident, but the anti-smoking crowd is trying to misinform the public, and they've succeeded. Polls now show over 50 percent believe vaping is as dangerous as smoking. They've succeeded in panicking the public and misinforming it about the advantage of vaping over smoking," he argued.

"Another irony of this current hysteria is the resort to policies that ban flavored nicotine vapes when one of the attractions of vaping is flavor," said Gieringer. "Losing flavored vapes could drive people back to menthol cigarettes. If they're smart, they would at least keep menthol or some flavors on the market. The FDA could ban menthol cigarettes and smokers would go to vapes, which is a public health benefit."

Amidst all the concern about THC vaping, Gieringer had some simple advice for pot vapers: "Don't use underground products," he suggested. "There are also herbal vaporizers with no additives, just pot. And vape pens that operate on pure cannabis oil are also safe. That's the safest bet. There are a lot of reputable manufacturers who do nothing else."

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.

Chronicle AM: Nation's First Cannabis Cafe Opens Doors, Dutch Supreme Court Rules Against Ayahuasca, More... (10/2/19)

Los Angeles sees the nation's first legal cannabis cafe, the Arizona legalization initiative draws industry opposition, the Justice Department says DEA didn't adequately regulate opioid manufacturing, and more.

Ayahuasca-inspired art. The Dutch Supreme Court has ruled the substance illegal. (Pinterest)
Marijuana Policy

Senators Introduce Federal Student Financial Aid Bill. US Sens. Jeff Merkley (D-OR) and Ron Wyden (D-OR) announced new bipartisan legislation Tuesday they say would allow students with a felony drug conviction access to the American Opportunity Tax Credit for higher education. The Eliminating Discrimination and Creating Corridors to Expand Student Success Act of 2019 (ED ACCESS Act) would fix this inequity by repealing the lifetime ban. The measure does not yet have a bill number.

Arizona Legalization Initiative Campaign Draws Industry Opponents. A new marijuana industry group has formed to fight the Smart and Safe Arizona Act, which itself is backed by other industry groups. The new group calls itself the Arizona Cannabis Chamber of Commerce and has its own ideas about what legalization should look like. The group complains that the initiative is tailored to the needs of existing dispensary owners, that there wouldn't be enough licenses available, and that the proposed 16% sales tax rate is too high.

Pennsylvania Bill Filed to Legalize via State-Run Model. State Rep. David Delloso (D) on Monday filed a bill that would legalize marijuana and allow adults 21 and older to possess, consume, cultivate and purchase marijuana through a state stores system run by the Liquor Control Board. Retail pot shops would be taxed at 19%, and all of that revenue would go toward the state general fund. The bill would also create a distinct regulatory scheme for industrial hemp. The bill is not yet available on the state legislative web site.

Tennessee Steps Back from Marijuana Enforcement. The Tennessee Bureau of Investigation has announced that it will no longer test amounts of marijuana less than a half ounce, making it virtually impossible for prosecutors to build a case against small-time possessors.

Nation's First Cannabis Café Opens in Los Angeles. The first-ever licensed cannabis café in the US has opened in Los Angeles. The Lowell Café opened its doors to the public in West Hollywood on Tuesday. The café is a hybrid marijuana lounge and restaurant where you can order some weed along with your meal.

Heroin and Prescription Opioids

Justice Department Says DEA Failed to Properly Regulate Opioids. In a new report from the agency's inspector general, the Justice Department found that the DEA fell short in regulating the supply of prescription opioids in the past two decades. The agency continued to raise manufacturing quotas for opioids with little regard to oversupply or misuse, the report found. The DEA "ill-equipped to effectively monitor ordering patterns for all pharmaceutical opioids, which could enable the diversion of these prescription drugs and compromise public safety." Although alarm bells were already ringing by the turn of the century, the DEA allowed manufacturing levels of oxycodone -- sold as OxyContin by Purdue Pharma -- to nearly quadruple between 2000 and 2013.

International

Dutch Supreme Court Rules Ayahuasca Illegal. The Dutch Supreme Court ruled Tuesday that ayahuasca falls under the country's hard drug laws and that its import is illegal. The ruling came in the case of a woman who had imported about 70 pounds of ayahuasca tea from Brazil for use in Santo Daime church rituals. Because the substance contains DMT, which is covered by Dutch drug laws, ayahuasca is covered as well.

Mexican Marijuana Legalization Bill Would Create State-Run System. Diputado Mario Delgado Carrillo, coordinator of the ruling MORENA Party's bench in the Chamber of Deputies, filed a bill Tuesday that would legalize marijuana through a government-run system. Under the bill, a regulatory body called Cannsalud would be in charge of the legal market, which would be the "exclusive property of the federal government, with a technical, operational and management autonomy for the realization of its primary purpose" to create a legal, regulated system. "With this, the cannabis market is not left to autonomous regulation by individuals, but the state is involved as a constant supervisor and controller of the activity of this substance within a margin of legality that guarantees a benefit for all," Delgado said. "This is a first step towards the opening of a new lawful market, and a public company is proposed as an obligatory intermediary in order to identify and contain the risks inherent in the establishment of a new market, when there are already international commercial interests that seek to maximize its utilities above the protection of people's health," he said.

Chronicle AM: House MJ Banking Bill to Get Floor Vote, Purdue Pharma Files for Bankruptcy, More... (9/16/19)

A bill to open up financial services for the marijuana industry will get a House floor vote this month, the maker of OxyContin files for bankruptcy, the marijuana industry places the blame for vaping deaths on marijuana prohibition, and more.

Is marijuana prohibition to blame for vaping deaths? The industry is pointing a finger. (Creative Commons)
Marijuana Policy

House Will Vote This Month on Marijuana Banking Bill. The office of House Majority Leader Steny Hoyer (D-MD) has confirmed that he intends to bring the SAFE Banking Act to the House floor for a vote this month. Hoyer announced the move at a whip meeting last Thursday. The bill passed out of the House Financial Committee in March on a 45-15 vote. It would provide protections for banks that work with marijuana companies since the substance is still illegal under federal law, despite several states having legalized medical or recreational marijuana.

Marijuana Industry Blames Vaping Deaths on Failed Prohibition Policies.The National Cannabis Industry Association (NCIA) has blamed the recent wave of vaping deaths -- a total of six so far -- on "failed prohibition policies" and called on Congress to legalize and regulate marijuana. "These unfortunate illnesses and deaths are yet another terrible, and largely avoidable, consequence of failed prohibition policies," said NCIA Executive Director Aaron Smith. "Current federal laws interfere with research, prevent federal regulatory agencies from establishing safety guidelines, discourage states from regulating cannabis, and make it more difficult for state-legal cannabis businesses to displace the illicit market. It is now the responsibility of Congress to end prohibition and regulate cannabis without delay," Smith added. "By removing cannabis from the schedule of controlled substances and instituting a clear regulatory framework through existing agencies, the federal government can provide helpful guidance to states that have or wish to establish regulated cannabis control systems while helping put irresponsible illicit market producers out of business for good."

Medical Marijuana

Utah Lawmakers Meet to Revise Medical Marijuana Law. Legislators returned to the state capitol Monday to once more amend the state's medical marijuana law. One issue is how and where patients will obtain medical marijuana products. The state had contemplated a central government-run pharmacy that would distribute the drug to a system of private pharmacies, but local leaders have balked at having government employees distributing a federally illegal drug.

Heroin and Prescription Opioids

Purdue Pharma Files for Bankruptcy. Purdue Pharma, the manufacturer of OxyContin, filed for bankruptcy on Sunday, the first step of a tentative agreement the company and its owners, the Sackler family, reached last week to settle thousands of lawsuits blaming it for its involvement in the opioid epidemic. The deal is estimated at between $10 and $12 billion, with $3 billion coming from the Sacklers' personal fortunes.

Psychedelics

Ann Arbor Group Wants to Decriminalize Natural Psychedelics. A local group calling itself Decriminalize Nature Ann Arbor is planning to ask the city council to decriminalize natural psychedelics, such as peyote and magic mushrooms. They are calling on the council to approve a resolution to prohibit the use of city funds to investigate, arrest, or prosecute anyone for use or possession of such plants.

International

British Labor Party Wants Royal Commission on Drug Policy, Would Follow Its Recommendation to Decriminalize Drugs. A Labor government would consider decriminalizing all drugs if that was recommended by a royal commission, shadow home secretary Diane Abbott said. "There is nothing more important than preserving the life of our citizens," she said. "Our current approach to drugs is simply not doing that." Safe injection sites would also be considered, she added.

Thailand Bill Would Allow for Six Marijuana Plants for Personal Use. A member party in the country's ruling coalition government has proposed a bill that would let Thais grow up to six marijuana plants per household for medicinal use. "The principle is for medical use, you can have it at home for ailments, but not smoke it on the street," said Bhumjaithai Party lawmaker Supachai Jaisamut. The bill would also allow the sale of plants to institutions licensed by a Plant-based Drug Institute that would have the authority to purchase, extract, and export CBD.

Chronicle AM: No CBD for Military Members, Hawaii Decriminalizes Pot Possession, More... (8/22/19)

The Defense Department makes it crystal clear that service members can't use CBD products, Hawaii's governor fails to veto a decriminalization bill -- thus allowing it to become law -- and more.

The drug czar's office has announced new moves against fentanyl. (Creative Commons)
Marijuana Policy

Hawaii Decriminalizes as Governor Fails to Veto Bill. A decriminalization bill passed earlier this year by the legislature became law on Tuesday without the signature of Gov. David Ige (D). Ige didn't sign the bill, but neither did he veto it, so now it has become law. The bill decriminalizes the possession of up three grams of marijuana with a fine of up to $130. The new law will go into effect on January 11, 2020.

Hemp

Defense Department Bars Service Members from Using Hemp-Derived CBD. The Defense Department is making crystal clear that members of the armed forces are not allowed to use cannibidiol (CBD). "It's completely forbidden for use by any service member in any of the services at this point of time," said Patricia Deuster, director of the Human Performance Laboratory at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Heroin and Prescription Opioids

White House Announces Actions to Crack Down on Trafficking of Fentanyl and Synthetic Opioids. The Office of National Drug Control Policy (ONDCP -- the drug czar's office) announced Wednesday that it had sent a series of advisories to help domestic and foreign businesses protect themselves from being used to traffic illicit fentanyl and "foster deeper public-private collaboration to curb the production and sale of illicit fentanyl, fentanyl analogues, and other synthetic opioids." The advisories are focused on four facets of the trafficking of illicit fentanyl, fentanyl analogues, and synthetic opioids destined for the United States: manufacturing, marketing, movement and money. It also announced that it is "identifying two Chinese nationals and a China-based Drug Trafficking Organization as significant foreign narcotics traffickers pursuant to the Foreign Narcotics Kingpin Designation Act (Kingpin Act) and designated one associate and a China-based entity for being owned or controlled by one of the Chinese nationals."

Chronicle AM: Bernie Sanders Criminal Justice Proposals, British Drug Deaths at All-Time High, More... (8/19/19)

Bernie Sanders rolls out a radical criminal justice reform package, marijuana legalization initiatives get moving in Arizona and South Dakota, Atlanta rejects expansion of drug-free commercial zones, and more.

Marijuana Policy

Arizona Legalization Initiative Details Released. The Arizona Dispensaries Association last Friday released details of their proposed marijuana legalization initiative, the Smart and Safe Act. Supporters will need 237,645 valid voter signatures by July 2, 2020, to qualify for the November 2020 ballot. The act would legalize the possession of up to an ounce by people 21 and over, allow adults to grow up to six plants each (with a maximum of 12 per home), and provide for expungement of past pot convictions. Employers and property owners would have the right to forbid use at their workplaces and on their property. Marijuana sales would carry a 16% excise tax.

South Dakota Legalization Initiative Advances One Step. State Attorney General Jason Ravnsborg (R) last Friday filed an official explanation of a proposed initiative to legalize marijuana. The initiative would legalize adult use through a constitutional amendment and require the legislature to pass legislation creating rules for medical cannabis and hemp. Organizers will have until November 3 to come up with16,961 valid voter signatures to qualify for the November 2020 ballot.

Medical Marijuana

Idaho Medical Marijuana Initiative Approved for Signature Gathering. Secretary of State Lawrence Denney (R) announced last Friday that an initiative to legalize medical marijuana has been approved for signature gathering. The measure would allow qualified patients to possess up to four ounces and grow up to six plants. It also would protect medical marijuana production facilities and medical marijuana dispensaries from civil forfeitures and penalties under state law and make it illegal to discriminate against registered medical marijuana users in education, housing or employment. Organizers have until April 30, 2020, to gather some 55,000 valid voter signatures, with at least 6% of voters from all 18 state legislative districts signing on.

Criminal Justice

Bernie Sanders Unveils Proposal for Massive Overhaul of Criminal Justice System. Democratic presidential contender Vermont Sen. Bernie Sanders (I) on Sunday unveiled a sweeping plan aimed at cutting the country's prison population in half and eliminating "institutional racism and corporate profiteering" in the criminal justice system. The proposal seeks to reform the nation's prisons, police departments, courts, drug laws and treatment of people who have mental illnesses. Sanders is calling for an end to cash bail, solitary confinement, the death penalty, and civil asset forfeiture while at the same time looking to legalize marijuana and safe injection sites for hard drug users, among other proposals.

Atlanta Kills Expansion of Drug-Free Commercial Zones. The city council's Public Safety/Legal Administration Committee voted last Tuesday to kill an ordinance that would expand the geographic boundaries of Atlanta's Drug-Free Commercial Zones. Those are areas where there are heightened penalties for drug crimes and where drug offenders can be banished from returning. Opponents of the expansion cited research showing the zones exacerbate racial disparities in drug policing.

International

England, Wales Drug Overdose Deaths Hit All-Time High. The British Office of National Statistics has released drug-related death numbers for 2018 and reports there were 4,359 drug-related deaths in England and Wales last year, the highest number and the highest percentage increase (16%) since the series started in 1993. Between 2017 and 2018, there were increases in the number of deaths involving a wide range of substances, though opiates, such as heroin and morphine, continued to be the most frequently mentioned type of drug. Deaths involving cocaine doubled between 2015 and 2018 to their highest ever level, while the numbers involving new psychoactive substances (NPS) returned to their previous levels after halving in 2017.

Mexico's Top Court Demands Action on Medical Marijuana Regulation. After months of delays, the country's supreme court last week ordered the health ministry to issue regulations within six months on medical marijuana use. The court said the government's failure to act had put rights at risk for patients, including children. The health ministry said it would comply with the court order. The ruling comes as the country is moving toward recreational marijuana legalization.

(This article was prepared by StoptheDrugWar.org's 501(c)(4) lobbying nonprofit, the Drug Reform Coordination Network, which also pays the cost of maintaining this website. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

Chronicle AM: Bernie Sanders Would Legalize Marijuana by Executive Order, CDC Says More Naloxone, More... (8/8/19)

That New Jersey legalization bill may yet rise from the dead, the CDC wants more naloxone access in rural areas, Ohio's largest city just quit prosecuting small-time pot busts, Bernie Sanders vows to use an executive order to federally legalize marijuana, and more.

Bernie Sanders stays in the marijuana legalization vanguard. (Creative Commons)
Marijuana Policy

Bernie Sanders Says He Will Legalize Marijuana Via Executive Order. If elected president, Vermont Sen. Bernie Sanders (I) will legalize marijuana by executive order, he told podcast host Joe Rogan in a recent interview. "When I ran for president for the Democratic nomination in 2016, I talked about a broken criminal justice system, which ends up having in the United States more people in jail than any other country," Sanders said. "And what I call for then, and I call for now, is the legalization of marijuana in America." It sounds like he wants to modify the Controlled Substances Act, which puts marijuana in the same category as heroin. "That is insane. Heroin is a killer drug," he said on the episode. "You can argue the plusses and minuses of marijuana, but marijuana ain't heroin. So we have to end that and that's what I will do as President of the United States. I believe we can do that through executive order and I will do that."

New Jersey Marijuana Legalization Effort May Come Back at Year's End. Although lawmakers gave up on trying to get a legalization bill passed three months ago, with Senate President Stephen Sweeney (D) saying it would likely be up to the state's voters at the 2020 election, Sweeney was singing a slightly different tune this week. "I'm not going to give up trying," he said. "I would love to do it. We'll make one more run at it."

Ohio's Largest City Quits Prosecuting Misdemeanor Marijuana Cases. Columbus City Attorney Zach Klein said Wednesday his office will no longer prosecute misdemeanor possession charges because current drug tests make it difficult to determine the exact amount of THC in the samples. This is a direct result of the legislature passing a law that legalizes hemp and CBD. Field drug tests cannot differentiate between hemp and recreational marijuana.

Heroin and Prescription Opioids

CDC Says Naloxone Not Getting Where Most Needed. In a new report, the Centers for Disease Control and Prevention (CDC) said prescriptions for the opioid overdose reversal drug naloxone doubled from 2017 to 2018, but rural counties, which are often hard-hit by the opioid epidemic, were far less likely to dispense the drug. The CDC is asking doctors and pharmacists to allow more access to the drug. "Efforts to improve naloxone access and distribution work most effectively with efforts to improve opioid prescribing, implement other harm-reduction strategies, promote linkage to medications for opioid use disorder treatment, and enhance public health and public safety partnerships," the CDC said.

Search and Seizure

Pennsylvania Court Rules Smell of Marijuana Doesn't Justify Car Search. Pennsylvania is a medical marijuana state and thus police cannot use the smell of marijuana as probable cause to search a vehicle once the suspect has showed proof he is a medical marijuana patients, a Lehigh County judge ruled last week. It was "illogical, impractical, and unreasonable" for police to suspect illegal activity once the medical marijuana card was produced, he said. "Pennsylvania legislators did not contemplate that people with legal medical marijuana cards would be arrested and prosecuted for possession of marijuana in a package that is not clearly marked with a dispensary name on it. Such actions are merely means of hampering the legalization of marijuana for medical purposes," the judge wrote as he threw out the marijuana charge.

International

British Columbia Nurses Endorse Drug Decriminalization. British Columbia nurses collectively called for the province to save lives by decriminalizing drug possession. "[We] call on the B.C. government to take immediate steps to move toward the decriminalization of people who use drugs," reads a statement issued Thursday by the Nurses and Nurse Practitioners of British Columbia (NNPBC), a professional organization with more than 3,800 members, and the Harm Reduction Nurses Association (HRNA), a national organization with members across Canada. "As nurses who work in B.C. and provide frontline care in the midst of this public health emergency, we see firsthand the impact of criminalization on our clients, on their families, on our practice and our communities," it continues. "As nurses, we see decriminalization as an essential step to remove barriers to care and support, reduce stigma and discrimination, improve health and socioeconomic outcomes, and work toward a more just and compassionate society."

(This article was prepared by StoptheDrugWar.org's 501(c)(4) lobbying nonprofit, the Drug Reform Coordination Network, which also pays the cost of maintaining this website. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

Why Are Meth- and Cocaine-Related Overdose Deaths on the Increase? [FEATURE]

August 31 is International Overdose Awareness Day, overdoseday.com
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.

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