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The Public Stands Behind Oregon's Drug Decrim and Addiction Funding Law [FEATURE]

It has been nearly two years since Oregon voters approved Measure 110, a sweeping drug decriminalization and public health services funding initiative, and it still has strong public support. That could be because it is producing the kinds of results Oregonians want to see.

Measure 110 is bringing addiction recovery services not just to Portland, but to places like this, too. (Pixabay)
In voting for Measure 110, Oregonians sought to move the emphasis of drug policy from law enforcement to a public health approach, and that is what they are getting. Drug possession arrests, which had already dropped by half in 2020 because of the pandemic, significantly decreased after Measure 110 took effect on February 1, 2021, according to data from the Oregon Criminal Justice Commission, falling another 65 percent from the 2020 levels in the first six months of 2022.

And Measure 110, which tapped into marijuana tax revenues to fund a broad spectrum of addiction services -- from low-barrier drug treatment and peer support and recovery to overdose prevention and housing and employment support (but not drug treatment covered by Medicaid or insurance) -- is setting the stage for a massive expansion of those services by pumping hundreds of millions of dollars into the field.

Late last month, the Oversight & Accountability Council, the body tasked with overseeing the distribution of the funding, approved the remainder of the initial $302 million made available under Measure 110, and on Tuesday, the Oregon Health Authority announced that it had finished awarding that money to more than 237 service providers in the form of grants.

With the state suffering more than a thousand overdose deaths in the past year, there is criticism that authorities have moved too slowly. Oregon Health Authority behavioral health director Steve Allen acknowledged as much, saying the agency had learned it needed to give more support and technical assistance to the volunteer committee tasked with grantmaking decisions.

"We understand the frustration this caused in our communities," Allen said. "When you do something for the first time you're going to make mistakes."

But now the money is out there, and it will help fund 237 service providers in 36 Behavioral Health Regional Networks (BHRNs), aimed at ensuring that help is available in even the most remote rural corners of the state. That includes 111 groups providing screening and behavioral health needs assessments, 112 groups doing individual intervention planning, 113 groups doing low-barrier drug treatment, 172 groups doing peer support and mentoring, 88 groups providing housing services, 84 groups providing harm reduction services, and 51 groups doing job support.

The money is going to allow these groups to expand their services by hiring and training new staff, securing additional facilities, buying vehicles for mobile support services, and even purchasing housing.

"Measure 110 changes the system so that there is no wrong door to access services," said Tera Hurst, Executive Director of the Health Justice Recovery Alliance. "Thanks to Measure 110, you don't have to get arrested before you are maybe offered help. Measure 110 is changing the addiction recovery service landscape so that regardless of the path, supportive services will be more readily available closer to home."

"It's been a long road, but we're ecstatic to see all of the Measure 110 funding for the 2021-2023 biennium finally being approved and going out to service providers to expand critical addiction services in Oregon communities. This is the first step in ensuring Oregon delivers on its promise of replacing a criminal legal approach to drugs with a public health approach and offering the rest of the country a glimpse of what is ultimately possible when we offer people support instead of punishment," said Kassandra Frederique, Executive Director of the Drug Policy Alliance, which was a key supporter of Measure 110 and which is partnering with the Health Justice Recovery Alliance on implementation.

Even with the slow rollout, Oregonians are liking what they are seeing. A poll released this month by Data for Progress found majority support for Measure 110 in every region of the state -- even the conservative eastern an southwestern areas -- and a strong bipartisan majority who agree that problematic drug use should be treated as a public health issue, not one for the criminal justice system.

When asked whether Measure 110 should remain in place, 58 percent said yes. That included 82 percent of Democrats and 56 percent of independents, but only 31 percent of Republicans.

The polling suggests that tying drug decriminalization to the expansion of recovery services is key to getting it over the finish line. When asked about individual components of the program, 91 percent supported peer mentoring, 90 percent supported employment help, 86 percent supported funding addiction recovery, 84 percent supported housing assistance, but only 62 percent supported harm reduction measures and only 61 percent supported decriminalization itself.

It is almost as if Oregonians made a bargain with themselves: Give us strong measures to aid recovery and we will grudgingly accept such vanguard measures as harm reduction and decriminalizing drugs. These pollsresults should send a clear message to people contemplating future decrim initiatives about how to broaden support for them.

California Governor Vetoes Bill Allowing Safe Injection Site Pilot Programs [FEATURE]

Despite past comments that he was "very open" to allowing safe injection sites to operate in the state, California Gov. Gavin Newsom (D) on Monday vetoed a bill that would do just that, Senate Bill 57. He cited "concerns" about its implementation.

California Gov. Gavin Newsom (D) says he supports harm reduction but has "concerns." (gov.ca.gov)
Sponsored by Sen. Scott Wiener (D-San Francisco), the bill would have allowed for safe injection pilot programs in Los Angeles, Los Angeles County, Oakland, and San Francisco. In each of those jurisdictions, city councils or boards of supervisors had requested inclusion in the bill and were prepared to begin to implement the proven harm reduction intervention.

California embracing safe injection sites would have been a tremendous advance for harm reduction in the United States, where the first safe injection sites opened just months ago in New York City, and Rhode Island is the only other state to have okayed them. Such facilities have been operating for decades in Europe, Canada, and Australia and have a proven safety track record. At the 170 safe injection sites that have operated around the world, not a single overdose death has been reported. In New York City, in the first three months of operation, staff at these sites were able to halt over 150 overdoses.

The bill was supported by a broad coalition of organizations including the Drug Policy Alliance, San Francisco AIDS Foundation, California Society of Addiction Medicine, National Harm Reduction Coalition, Healthright 360, Tarzana Treatment Center, and the California Association of Alcohol & Drug Program Executives.

Support for the bill was also heightened by significant increases in drug use and overdoses since the beginning of the coronavirus pandemic. San Francisco saw a record number of overdose deaths in 2020, with 711 deaths in total. In 2021, 640 people died of overdoses, and the city is on track to exceed that number this year. Statewide, approximately 10,000 people died of drug overdoses from April 2020 to April 2021.

In his veto message, Gov. Newsom maintained that he has "long supported the cutting edge of harm reduction strategies," but was "acutely concerned about the operations of safe injection sites without strong, engaged local leadership and well-documented, vetted, and thoughtful operational and sustainability plans."

He also left open the possibility that he could support similar legislation in the future, saying "We should strive to ensure our innovative efforts are well planned, even when they start as pilots, to help mitigate the potential for unintended impacts. Therefore, I am instructing the Secretary of Health and Human Services to convene city and county officials to discuss minimum standards and best practices for safe and sustainable overdose prevention programs. I remain open to this discussion when those local officials come back to the legislature with recommendations for a truly limited pilot program -- with comprehensive plans for siting, operations, community partnerships, and fiscal sustainability that demonstrate how these programs will be run safely and effectively."

Sen. Wiener and his allies, however, were not assuaged by Newsom's leaving the door open for future action.

"Today, California lost a huge opportunity to address one of our most deadly problems: the dramatic escalation in drug overdose deaths. By rejecting a proven and extensively studied strategy to save lives and get people into treatment, this veto sends a powerful negative message that California is not committed to harm reduction," Wiener said in a statement Monday. "SB 57 is not a radical bill by any stretch of the imagination. It simply gives permission to cities -- each of which has requested that permission -- to pilot safe consumption sites and get people into treatment."

California risks being left in the lurch as other cities and states move to embrace the harm reduction intervention, he said.

"Other states and cities in the US are already moving forward with this proven health model. New York City, with the vocal support of Mayor Eric Adams, has successfully implemented safe consumption sites. Indeed, Mayor Adams is advocating to expand the sites to operate 24 hours a day, due to their success in reducing public drug use. Rhode Island passed a law authorizing safe consumption sites, and Massachusetts is moving in that direction. Philadelphia is on the verge of settling with the Biden administration to potentially allow it to open safe consumption sites consistent with federal law," Wiener said.

"Today's veto is tragic," Wiener continued. "For eight years, a broad coalition has worked to pass this life-saving legislation. Each year this legislation is delayed, more people die of drug overdoses -- two per day in San Francisco alone. While this veto is a major setback for the effort to save lives and connect people to treatment, we must not -- and will not -- let it end this movement. We'll continue to fight for an end to the War on Drugs and a focus on drug use and addiction as the health issues they are."

Wiener's allies in the coalition pushing for safe injection sites were equally appalled by Newsom's veto.

"We are incredibly disappointed and heartbroken that Gov. Newsom has put his own political ambitions ahead of saving thousands of lives and vetoed this critical legislation," said Jeannette Zanipatin, California state director for the Drug Policy Alliance, which sponsored the bill. "Despite the governor's remarks, LA, San Francisco and Oakland have already designated this a priority by authorizing the programs locally and have been standing ready to implement them quickly. We have already engaged local stakeholders in a robust process and they have taken active steps towards implementation in order to be part of the pilot SB 57 would have put in place. We don't need additional processes. What we need is action. Without action, people are going to die," she said.

"While Newsom plays on the fears that an 'unlimited' number of Overdose Prevention Programs could have been opened, this would have been a limited pilot program that was only for five years and three jurisdictions, with an extremely thorough evaluation process. In 2021 alone, California lost over 10,000 residents to the overdose crisis, and we are continuing to see it disproportionately claim the lives of people of color throughout the state. Make no mistake, these deaths are 100 percent avoidable through common-sense, cost-effective measures, like SB 57, but because of his veto, people will continue to die alone and in the shadows."

"Harm reduction programs in three California cities were poised and ready to implement overdose prevention programs. Oakland, Los Angeles and San Francisco have done the groundwork, have local support, and this veto leaves entire communities of people who use drugs, the majority of them unhoused, without an essential lifesaving tool," said Laura Guzman, senior director of Capacity Building and Community Mobilization at the National Harm Reduction Coalition. "Newsom's veto of SB 57 comes at a time when we lose over 10,000 Californians every year to overdose and have skyrocketing racial disparities in deaths. This veto is completely unjustified."

"We are outraged that Governor Newsom has vetoed SB 57," said Tyler TerMeer, PhD, CEO of San Francisco AIDS Foundation. "Given the number of fatal overdoses that continue to happen every day in San Francisco and across California, now is the time for us to take bold action in establishing lifesaving overdose prevention programs. We are sending an urgent message to our elected officials that preventing these programs from operating will cost lives."

The coalition formed to pass SB 57 isn't going anywhere, and this fight is far from over. Look for renewed efforts on both the legislative and consultative fronts to make California safe injection sites a reality.

Chronicle Book Review: American Cartel

American Cartel: Inside the Battle to Bring Down the Opioid Industry, by Scott Higham and Sari Horwitz (2022, Twelve Press, 400 pp., $30.00 HB)

Phillip S. Smith, with contributions from David Borden

https://stopthedrugwar.org/files/americancartel.jpg
Pulitzer Prize-winning Washington Post investigative reporters Scott Higham and Sari Horwitz have been on the opioid beat for years, teaming up (with others) on the Post's "The Opioid Files" series, which was nominated for a Pulitzer in 2020. Now, with American Cartel, the pair provide a deeply-sourced account of how opioid manufacturers, distributors, and pharmacies waged an all-out campaign to fend off DEA efforts to stanch the flow of billions of opioid pain pills, and to evade any culpability, even as the overdose death toll mounted year by year.

The picture Higham and Horwitz paint of corporate and political malfeasance is damning. But the laser sharp focus with which they paint it, omits much of the context in which the opioid crisis has unfolded. And that context is also very important.

An article in yesterday's Guardian shows one of the reasons why. In much of the world, very few pain patients are able to access opioids at all. Much suffering results, sometimes leading to suicide attempts. Dr. MR Rajagopal, chair of Pallium India, told the Guardian, "Pain is not visible. It happens in hospital beds or patients' rooms and is not visible to the world. Addiction, on the other hand, is very visible in headlines which quote the US epidemic and overdose deaths. No one talks about the western European success over decades; all the news is about the opioid crisis in the USA. This means that when we try to have discussions, our work becomes harder because many minds are primed against opioids."

In other words, by speaking too solely to one side of an issue, one risks adversely impacting the other sides. Whether "opiophobia" is real or significant in the US is another question. Higham and Horwitz don't venture a view on this, at least not in American Cartel.

One entity that has warned about opiophobia (without using the term) is the US Centers for Disease Control. In a 2019 memo, CDC writes that a 2016 guidance the agency issued on prescribing opioids for chronic pain had seen "misapplication[s]" by some physicians that put patients at risk. The memo cites a New England Journal of Medicine commentary by the authors of the 2016 guidance. It warns against "hard limits" on opioid dosages or cutting patients off; abrupt tapering of prescriptions; applying the guidance to acute pain situations patients face in situations like active treatment for cancer or sickle cell anemia or post-operative care; and applying it to medication-assisted treatment prescriptions for addiction.

Technically the CDC memo addressed a period of a few years beginning in 2016. But the dynamics it describes are inherent risks in a situation where providers are charged with supplying a substance that's useful but also addictive and potentially deadly if misused, and for which they can be sanctioned professionally or even prosecuted and imprisoned if things go wrong or someone disagrees. Pharma-driven promotion of their new opioid products was a factor in driving up prescribing rates to where they reached. But a part of the increase was also the medical community reacting to a real problem of under-treatment or non-treatment of pain for some patients, a problem that coexists with over-prescribing to some other patients. That increase in turn came with a learning curve.

The authors also give short shrift to the impact of today's woes and inequalities in driving the so-called deaths of despair -- a concept coined by Princeton professors Anne Case and Angus Deaton -- alienation and anomie, helplessness and hopelessness afflicting many Americans who have been left behind in the modern economy, especially in the opioid use heartlands of the Midwest and Appalachia. The Midwest deindustrialized beginning in the 1970s, and both regions largely missed out on the tech boom of the '90s and '00s. Then came even more pain with the Great Recession, followed by COVID and more economic and social disruption. People there (and elsewhere) are dying not just of opioids, but of smoking, drinking, and suicide. Big Pharma is easily (and oh so deservingly) demonized, but the laser focus on the companies allows us not to have to look in the mirror about the pain our society produces.

That factors like these should play a role in the opioid crisis, though, doesn't exonerate Big Pharma. Rather, the misleading promotions of their products carried out by pharma, took an even greater toll due to the vulnerabilities those other factors had brought to the fore.

Meanwhile, the death toll continues to mount -- over 100,000 per year, and with a new record high every year. Prescription opioids still figure prominently in overdoses. But the greatest part of the problem by far is black-market fentanyl, used deliberately by some high tolerance heavy users of opioids, but primariy causing overdose as an adulterant in heroin, counterfeit prescription pills, and other street drugs, essentially a poisoning crisis. But as Higham and Horwitz note, that is part of a wave of opioid use that began with pharmaceutical companies such as Purdue Pharma taking Oxycontin onto the market in the late 1990s. The first decade of this century also saw other prescription opioids -- oxycodone, hydrocodone, Vicodin, Percocet, Opana, et al. -- hit the market.

Higham and Horwitz are fond of tossing around astounding numbers of pills produced by manufacturers or sold by certain pharmacies, such as Mallinckrodt producing 3.5 billion 30 milligram hydrocodone pills in one year, and critics could protest that those numbers need context, too. A prescription for a medication doesn't just have a number of pills to take. It specifies how large a dosage there is inside each pill. A smaller number of pills that each contain a higher dose might mean more than a larger number that each contain a smaller dose. And a higher dose prescription sometimes reflects a patient's tolerance to opioids built up through past medical (or non-medical) use. Maybe West Virginia didn't really need 81 million pain pills during a five-year span. But maybe it did. Without more information, it's just not clear what these numbers mean.

They do provide some context, though, for example by comparing pain pill sales across all drug stores in a region and pointing out anomalies not easily explainable by, say, differing rates of cancer or other serious illness. And they demonstrate that plenty of businesses -- from Big Pharma to the drug store chains and individual pharmacies -- were either in it for the money or at best screwed up, both through detailed analysis and telling anecdote. For example, there was the guileless Florida pharmacist who explains to investigators that she fills pain pill prescriptions all day long, but always keeps a certain number of pills on reserve "for my real pain patients."

When the DEA cracked down first on Wild West internet sales of opioids and then on the "pill mills," medical practices with perfunctory examinations and huge numbers of opioid prescriptions whose entire business model seemed to be writing opioid prescriptions, it succeeded in reducing access to those drugs. But the people using opioids didn't stop; they went to black market drugs, fueling first a resurgence in heroin use and now an opioid crisis driven by fentanyl.

A key figure in the tale is Joe Rannazzisi, who as head of DEA's Office of Diversion Control from 2006 to 2015 oversaw the agency's endless effort to ensure that prescribed opioids are only prescribed for legitimate medical purposes and not leaking into the black market. We are inclined to think of the DEA as a prohibitionist agency, but in this case, it is acting as a regulatory agency. And what Higham and Horwitz uncover is a case of regulatory capture -- when the industry being regulated manages to set the terms under which it is regulated, for its own benefit, not that of the public.

Rannazzisi and his team of DEA lawyers spent years going after opioid manufacturers, distributors, and pharmacy chains who were repeatedly (administratively) busted for failing to do due diligence about just who was buying their products. The companies would pay huge fines, promise not to do it again, and then continue to pump massive amounts of opioids through the supply chain.

The companies mobilized against Rannazzissi and his campaign, forming industry front groups, undertaking lobbying efforts, hiring legions of high-priced law firms, and crafting legislation that would rein in what they saw as an out-of-control agency. As Higham and Horwitz document in great detail, it worked.

Sponsored by Rep. Tom Marino (R-PA) and Sen. Marsha Blackburn (R-TN), both of whom received substantial contributions from the industry, but written by industry lobbyists, the nicely named Ensuring Patient Access and Effective Drug Enforcement Act removed from the DEA tools that Ranizzisi had been using to try to force drug distributors to monitor and report suspicious orders, such as the 1.2 million oxycodone tablets one distributor bought from Mallinckrodt in one day, only to order another 1.2 million the next day.

The bill passed, only to be drastically revised amidst scandal after an earlier Post report on the opioid bill derailed then-President Trump's effort to name Marino drug czar. But Higham and Horwitz also detail rot inside the DEA, where the industry managed to get to high-ranking officials who sidelined Rannazzisi, forcing him into retirement and forcing many of his team members into bureaucratic Siberia. It's an ugly little story of money and power, the sort that is all too common in Washington.

If the first part of American Cartel reads like a detective novel, the second part is more like a legal thriller, It covers the massive wave of civil lawsuits filed against the drug companies, and it is not particularly edifying reading. You see hundreds of high-powered attorneys from the country's top litigating firms -- including dozens of former DEA attorneys working now working for the industry they regulated -- facing off against armies of lawyers for the thousands of states, cities, and counties. You see massive settlements from the companies and massive damages wrested from companies that went to court and lost. While it is unclear just how the moneys won or negotiated by the various plaintiffs is actually being used to help people who suffered from the opioid crisis, what is clear is that it has been a bonanza for the legal profession, with winnings -- excuse me, earnings -- by attorneys reaching well over a billion dollars.

They weren't all in it for the money, though. Some, like West Virginia attorney Paul Farrell, whose state was one of the epicenters of the pain pill epidemic, were sickened by the toll of addiction they saw all around them. Not willing to settle for the pittance the town and county he represented would receive under a massive settlement agreed to by most of the suing entities, he gambled on going it alone against the drug distributors. As this book went to print in April, he was still waiting for a decision. Earlier this month, he lost, with a federal judge ruling that drug distributors were not responsible for the area's opioid crisis.

The litigation goes on, and the dying goes on. Sometimes the drug companies settle, sometimes they lose and have to pay even more. But sometimes they win.

The profit-driven wave of opioids that engulfed the country in the last couple of decades is not an anomaly. The pharmaceutical companies have a historical pattern of creating and marketing drugs that later wreak havoc. That's what they did with amphetamines, that's what they did with barbiturates, that's what they did with benzodiazepines. It's almost enough to make one wonder if profit-driven capitalist enterprises should be in charge of the nation's drug supply.

Read Higham and Horwitz's book. But read Case and Deaton's too. And when you see the next "pill mill" story, don't assume that it is, or isn't, what it seems.

Chronicle Book Review: Opium's Orphans

Chronicle Book Review: Opium's Orphans: The 200-Year History of the War on Drugs by P.E. Caquet (2022, Reaktion Books, 400 pp., $35.00 HB)

The history of drug prohibition is increasingly well-trodden territory, but with Opium's Orphans, British historian P.E. Caquet brings a fascinating new perspective embedded in a sweeping narrative and fortified with an erudite grasp of the broad global historical context. Although Asian bans on opium pre-dated 19th Century China (the Thai monarchy announced a ban in the 1400s), for Caquet, the critical moment in what became a linear trajectory toward global drug prohibition a century later came when the Qing emperor banned opium in 1813 and imposed severe penalties on anything to do with it, including possessing it. Precisely 100 years later, after two Opium Wars imposed opium on the empire followed by decades of diplomatic wrangling over how to suppress the trade (and for moralizing Americans, how to win favor with China), the 1913 Hague Opium Convention ushered in the modern war on drugs with its targeting not just of opium (and coca) producers or sellers but also of mere users for criminal prosecution. It urged countries to enact such laws, and they did.

What began at the Hague would eventually grow into an international anti-drug bureaucracy, first in the League of Nations and then in United Nations bodies such as the Commission on Narcotic Drugs and the International Narcotics Control Board. But it is a global prohibition regime that has, Caquet writes, straight-jacketed itself with an opium-based perspective that has proven unable or unwilling to recognize the differences among the substances over which it seeks dominion, reflexively resorting to opium and its addiction model. Drugs such as amphetamines, psychedelics, and marijuana don't really fit that model -- they are the orphans of the book's title -- and in a different world would be differently regulated.

But Opium's Orphans isn't just dry diplomatic history. Caquet delves deep into the social, cultural, and political forces driving drug use and drug policies. His description of the spread of opium smoking among Chinese elites before it spread into the masses and became declasse is both finely detailed and strangely evocative of the trajectory of cocaine use in the United States in the 1970s, when it was the stuff of rock musicians and Hollywood stars before going middle class and then spreading among the urban poor in the form of crack.

Along the way, we encounter opium merchants and colonial opium monopolies, crusading missionary moralists, and early Western proponents of recreational drug use, such as Confessions of an English Opium Eater author Thomas De Quincey and the French habitues of mid-19th Century hashish clubs. More contemporaneously, we also meet the men who achieved international notoriety in the trade in prohibited drugs, "drug lords" such as Khun Sa in the Golden Triangle, Pablo Escobar in Colombia and El Chapo Guzman in Mexico, as well as the people whose job it is to hunt them down. Caquet notes that no matter how often a drug lord is removed -- jailed or killed, in most cases -- the impact on the trade is negligible.

For Caquet, drug prohibition as a global phenomenon peaked with the adoption of the 1961 Single Convention on Narcotic Drugs. Coming as it did amidst a post-World War II decline in drug use around the world, the treaty criminalizing coca, cocaine, opium and opioids, and marijuana seemed to ratify a successful global prohibitionist effort. (In the US, in the 1950s, when domestic drug use was at low ebb, Congress passed tough new drug laws.) But before the decade was over, drug prohibition was under flamboyant challenge from the likes of LSD guru Timothy Leary and a horde of hippie pot smokers. The prohibitionist consensus was seeing its first cracks.

And the prohibitionist response was to crack down even harder, which in turn begat its own backlash. Drug use of all sorts began rising around the world in the 1960s and hasn't let up yet, and the increasingly omnivorous drug war machine grew right along with it, as did the wealth and power of the illicit groups that provided the drugs the world demanded. As the negative impacts of the global drug war -- from the current opioid overdose crisis in the US to the prisons filled with drug offenders to the bloody killing fields of Colombia and Mexico -- grew ever more undeniable, the critiques grew ever sharper.

In recent years, the UN anti-drug bureaucrats have been forced to grudgingly accept the notion of harm reduction, although they protest bitterly over such interventions as safe injection sites. For them, harm reduction is less of an erosion of the drug war consensus than all that talk of drug legalization. As Caquet notes, perhaps a tad unfairly, harm reduction doesn't seek to confront drug prohibition head-on, but to mitigate its harms.

The man is a historian, not a policymaker, and his response to questions about what to do now is "I wouldn't start from here." Still, at the end of it all, he has a trio of observations: First, supply reduction ("suppression" is his word) does not work. Sure, you can successfully wipe out poppies in Thailand or Turkey, but they just pop up somewhere else, like the Golden Triangle or Afghanistan. That's the infamous balloon effect. Second, "criminalization of the drug user has been a huge historical blunder." It has no impact on drug use levels, is cruel and inhumane, and it didn't have to be that way. A century ago, countries could have agreed to regulate the drug trade; instead, they tried to eradicate it in an ever-escalating, never-ending crusade. Third, illicit drugs as a group should be seen "as a historical category, not a scientific one." Different substances demand different approaches.

Opium's Orphans is a fascinating, provocative, and nuanced account of the mess we've gotten ourselves into. Now, we continue the work of trying to get out of that mess.

Biden Signs Criminal Justice Reform Executive Order, RI Legislature Approves Marijuana Legalization, More... (5/25/22)

Rhode Island is set to become the 19th legal marijuana state, West Virginia announces a big settlement with drug manufacturers over their role in the opioid crisis, and more.

After congressional inaction, President Biden issues an executive order on criminal justice reform. (whitehouse.gov)
Marijuana Policy

Georgia Voters Approve Marijuana Legalization Ballot Question. State voters sent a strong signal to lawmakers Tuesday by overwhelmingly approving a non-binding ballot question on marijuana policy. Voters were asked: "Should marijuana be legalized, taxed and regulated in the same manner as alcohol for adults 21 years of age or older, with proceeds going towards education, infrastructure and health care programs?" A whopping 80 percent of them answered "yes."

Rhode Island Legislature Approves Marijuana Legalization. Both the House and the Senate voted Tuesday to approve a marijuana legalization bill, Senate Bill 2430. Gov. Dan McKee (D) is set to sign it into law today. The law will allow people 21 and over to possess, grow, and purchase limited amounts of marijuana. It also includes expungement and social equity provisions. Once the bill is signed into law, Rhode Island will become the 19th state to free the weed. Look for our feature story on this later today.

Opiates and Opioids

West Virginia Announces Settlement with Opioid Manufacturers. State Attorney General Patrick Morrisey announced Wednesday that the state had reached a $161.5 million settlement with two drug companies over their role in the opioid epidemic. The settlement came as the trial in the state's lawsuit against Allergan and Teva was nearing its end. Morrisey touted the settlement as "record-breaking," saying it was the highest per capita settlement in the country and blasted the two companies as "helping fuel the opioid epidemic in West Virginia by engaging in strategic campaigns to deceive prescribers and misrepresent the risks and benefits of opioid painkillers."

Criminal Justice

President Biden Signs Executive Order to Advance Accountable Policing, Strengthen Public Safety. Marking the second anniversary of the killing of George Floyd at the hands of Minneapolis police, President Biden on Wednesday issued a broad-ranging executive order to advance accountable policing and enhance public safety. The move comes after Congress largely failed to act on policing reform in the wake of the killing and the mass protests it generated. Among other provisions, the order creates a new national database of police misconduct, restricts the use of no-knock search warrants, bans the use of chokeholds and carotid restraints unless deadly force is authorized, requires new standards limiting the use of force for all federal agencies, restores the Obama administration's restrictions on the transfer of military equipment to law enforcement agencies, requires an updated approach to recruitment, hiring, promotion, and retention of law enforcement officers; requires all federal law enforcement agencies to track data on use of force; directs a government-wide strategic plan to propose interventions to reform the criminal justice system; and requires full implementation of the First Step Act.

Federal Pot Busts Continue Decade-Long Decline, VT Governor Vetoes Drug Decrim Study Bill, More... (5/23/22)

Luxembourg is on a path to be the first European Union country to legalize marijuana, Alabama Medicaid is being challenged for blocking access to Hep C treatment for people who use drugs or alcohol, and more.

Vermont Gov. Phil Scott (R) has vetoed a bill that could have led the way to drug decriminalization. (vt.gov)
Marijuana Policy

Federal Pot Busts Continue to Decline. The DEA arrested 2,576 people on federal marijuana charges in Fiscal Year 2020, down dramatically from 2010, when the DEA made 8,215 pot arrests. Arrests have declined on an average of 11 percent a year in the past decade. Some of the decline is because of the coronavirus pandemic, which the Bureau of Justice Statistics said, "drove an 81 percent decline in arrests and 77 percent decline in cases charged from March to April 2020." But the decline also reflects discretionary decisions by the Justice Department as state after state legalizes marijuana.

Drug Policy

Alabama Medicaid Sued for Denying Hep C Treatment for People Who Use Drugs. The Center for Health Law and Policy Innovation and AIDS Alabama have filed an administrative complaint with the Justice Department, charging that Alabama Medicaid is discriminating against people with substance use disorder by denying "[Hep C] treatment to otherwise eligible Medicaid enrollees who cannot prove they did not use drugs or alcohol within the last six months." Prospective enrollees must promise not to use illegal drugs or alcohol, even though only alcohol has an effect on the liver. Alabama Medicaid patients who are found to be using drugs, including alcohol, could see their access to treatment, which otherwise costs tens of thousands of dollars, blocked. "On an individual level, for a single person seeking hep C treatment, it means the difference between being cured of hepatitis C and continuing to live with this very dangerous illness that, in many cases, can lead to liver scarring, liver cancer and even death," said Suzanne Davies, an attorney and CHLPI clinical fellow.

Vermont Governor Vetoes Drug Decrim Study Bill. Gov. Phil Scott (R) has vetoed House Bill 505, which would have created a Drug Use Standards Advisory Board as a first step toward drug decriminalization. The board would have been charged with determining a way to decriminalize the personal possession of currently illicit drugs, as well as ending the legal distinction between powder and crack cocaine. But in his veto message, Scott complained that the bill "places no limits on which drugs can be contemplated for legalization or the amounts, and while rightly saying we need to view substance abuse as a public health matter -- a point where I agree -- it includes absolutely no recognition of the often-disastrous health and safety impacts of using drugs."

International

Jordanian Armed Forces Kill Four Drug Smugglers from Syria. Four people trying to smuggle a large quantity of drugs from Syria into Jordan have been killed, with an unspecified number of others wounded and others escaping back into Syria, the Jordanian armed forces said. Jordan is both a destination and a transit route for captagon, an amphetamine now manufactured in Syria. The military did not specify who killed the smugglers, but in January, Jordanian soldiers killed 27 armed smugglers as they crossed the border.

Luxembourg Council of Government Set to Review Draft Marijuana Legalization Bill Next Month. The Council of Government will review a draft of a marijuana legalization bill next month. The government has committed to legalization, and in the current draft, would allow for home cultivation and would legalize the possession of up to three grams of marijuana. If the bill passes, Luxembourg would be the first country in the European Union to legalize marijuana, although Germany is now following a similar process.

White House Drug Strategy Embraces Harm Reduction, But Prohibitionist Impulse Remains Strong [FEATURE]

The Biden White House sent its first National Drug Control Strategy to Congress on April 21. It breaks positive new ground by explicitly acknowledging harm reduction measures to prevent overdose and blood-borne diseases among drug users. At at the same time, though, it also relies heavily on the destructive and counterproductive pursuit of failed prohibitionist drug policies -- and funds more law enforcement much more heavily than harm reduction.

The strategy comes out just weeks after the Centers for Disease Control and Prevention (CDC) reported that drug overdose deaths hit an all-time high of 106,000 in the year ending last November. The administration is responding with what it calls a "whole of government" approach to the crisis.

"The strategy focuses on two critical drivers of the epidemic: untreated addiction and drug trafficking," the White House said. "It instructs federal agencies to prioritize actions that will save lives, get people the care they need, go after drug traffickers' profits, and make better use of data to guide all these efforts. Saving lives is our North Star, and the 2022 National Drug Control Strategy calls for immediate actions that will save lives in the short term and outlines long-term solutions to reduce drug use and its associated harms, including overdose."

While the strategy includes long-familiar categories such as drug treatment, prevention, supply reduction, and criminal justice and public safety, it also emphasizes an evidence-based approach, "building a recovery-ready nation," and for the first time, harm reduction.

"The Biden-Harris Administration's efforts focus on meeting people where they are and building trust and engagement with them to provide care and services," the White House said. "Specifically, the strategy calls for greater access to harm reduction interventions including naloxone, drug test strips, and syringe services programs. It directs federal agencies to integrate harm reduction into the US system of care to save lives and increase access to treatment. It also calls for collaboration on harm reduction between public health and public safety officials, and changes in state laws and policies to support the expansion of harm reduction efforts across the country."

The strategy calls for "the coordinated use of federal grant funds for harm reduction," and the administration last year broke new ground with a $30 million grant program for harm reduction providers. But in a sign of continued reliance on traditional law enforcement priorities, the strategy also envisions a $300 million increase for Customs and Border Patrol and another $300 million increase for the DEA. Those figures were released as part of the White House's FY 2023 budget released last month.

"Responding effectively to the illicit production, trafficking, and distribution methods of domestic criminal organizations and Transnational Criminal Organizations (TCOs) is a significant challenge and remains a Biden-Harris Administration priority," the White House said.

That kind of talk suited mainstream Democrats just fine.

"Illicit drugs cause immeasurable pain and loss in our communities. As the Chairman of the Senate Caucus on International Narcotics Control, I've pressed for an updated federal plan to tackle them," said Sen. Sheldon Whitehouse (D-RI). I've been clear that the plan must include a more coordinated approach to cracking down on drug trafficking and transnational criminal organizations, especially the ways in which they launder and protect their ill-gotten gains using US rule of law and financial networks; and more and better cooperation with our international partners to reduce the supply of precursor chemicals used to manufacture illicit drugs and to levy tougher sanctions against transnational drug syndicates. I'm pleased to see my priorities reflected in this new strategy, and I look forward to working with the Biden administration to deliver on those priorities."

Whitehouse also lauded the strategy's "tearing down barriers to treatment, including expanding access to life-saving naloxone and medication-assisted treatment; improving our data collection systems to better understand the effects of our intervention efforts."

Reform advocates offered praise -- sometimes lukewarm -- for the administration's tentative embrace of harm reduction, but blasted its reliance on tired, failed drug war paradigms.

In its analysis of the strategy, the Washington Office on Latin America (WOLA) called it "a major step forward" and lauded the administration for "focusing on ensuring access to treatment for substance use disorders and highlighting the crucial role of harm reduction services." But WOLA also noted that, "when measured against the scale of the nation's overdose problems and the urgency of the needs, Biden's new plan appears quite timid."

WOLA also warned that the strategy's "positive innovations regarding investment in treatment and harm reduction strategies risk being undermined by a continued commitment to the kinds of policies that have exacerbated the present crisis and that continue to absorb the lion's share of resources, namely, drug criminalization at home and wildly exaggerated expectations for what can be achieved through supply control efforts abroad."

Similarly, the libertarian-leaning Cato Institute called the attention to harm reduction a "positive," but noted steps that it did not take, such as making the opioid overdose reversal drug naloxone available over-the-counter and repealing the so-called Crack House Statute that stands in the way of federal approval of safe injection sites.

"On a negative note," Cato observed, "the remainder of the new report calls for doubling down on interdiction, border control, and other law enforcement measures aimed at curtailing the supply of illicit drugs -- as if repeating the same failed strategies of the past half century, only with more gusto, will somehow work."

So there it is: The Biden administration's first crack at a national drug strategy deserves kudos for its embrace of harm reduction and evidence-based approaches, but beyond that, it is pretty much more of the same old same old.

CA Psilocybin Legalization Initiative Falls Short on Signatures, Ukraine War Deepens Suffering of Drug Users, More... (3/18/22)

Medical marijuana bills advance in Georgia and Kentucky, Honduras' former "narcopresidente" is a step closer to being extradited to the United States on drug charges, and more. 

Fomer Honduran President Juan Orlando Hernandez can be extradited to face US drug charges, a court there ruled. (CC)
Marijuana Policy

Rhode Island Governor Has "Concerns" About Marijuana Legalization Bill's Cannabis Control Commission. Gov. Dan McKee (D) has "significant constitutional concerns" with Senate Bill 2430, the marijuana legalization bill backed by House and Senate leadership. The concerns are around the proposed three-member cannabis control commission's members are to be appointed—and removed if necessary. The governor's office argues that the bill would give the Senate "unfettered discretion" on whether to remove a commissioner, which is says is a violation of the separation of powers. But one of the key sponsors of the bill, which was crafted after long deliberation, Sen. Joshua Miller (D-Cranston), said the governor's objection is not an insurmountable obstacle. "It’s not a big impediment," said Miller. "It’s solvable." 

Medical Marijuana

Georgia House, Senate Pass Separate Medical Marijuana Bills. The House approved a bill to revamp the state's dysfunctional medical marijuana system, House Bill 1425 on Tuesday. The bill would allow the provision of low-THC cannabis oil "from any available legal source" by August 1 and begin providing it to patients now on the state registry by August 15. The state had passed a low-THC cannabis oil law in 2015, but legal challenges have left Georgians without any legal supply. The Senate, meanwhile, approved its own medical marijuana bill, Senate Bill 609, which would require the medical cannabis commission to issue its initial licenses by May 31. Tuesday was the last day for bills to pass their original chamber, so both bills remain alive.

Kentucky House Approves Medical Marijuana Bill. The House on Thursday approved House Bill 136, which would legalize medical marijuana in the state. The legislation now heads to the Senate. This is the third try for bill sponsor Rep. Jason Nemes (R), who got a similar bill through the House in 2020 only to see in die in the Senate and whose 2021 effort got nowhere in the midst of the pandemic. The bill now heads to the Senate, where Senate Judiciary Chairman Whitney Westerfield (R) says he will back it despite personal reservations.

Psychedelics

California Psilocybin Legalization Initiative Falls Short on Signatures. Decriminalize California, the group behind a psilocybin legalization initiative campaign, announced Wednesday that it had failed to gather enough valid voter signatures to qualify for the November ballot. The all-volunteer effort faltered during the winter outbreak of the omicron variant of the coronavirus. "We were doing great there collecting and then in mid-December just about everyone of our core volunteers got COVID and most of the events we were scheduled at either closed, postponed or had an extremely weak turnout," campaign manager Ryan Munevar said in an email to supporters. The group will now do fundraising in coming months to determine whether it is feasible to start a second effort in either June or October of next year for 2024.

International

At Urging of US, CND Acts Against Precursor Chemical Used to Produce Illicit Fentanyl. The UN Commission on Narcotic Drugs (CND) voted Friday to control three chemicals used by drug traffickers to produce illicit fentanyl, a powerful synthetic opioid that is driving overdose deaths in the United States. At the request of the United States, and with the recommendation of the International Narcotics Control Board, the Commission’s Member States voted unanimously to take international action and control the acquisition, production, and export of three precursors used to manufacture illicit fentanyl and its analogues. "President Biden has made clear that ending the overdose epidemic is a top priority. As part of the Administration’s efforts to reduce the supply of illicit fentanyl driving overdose deaths, the United States called on the global community to regulate three chemicals commonly used to produce it, and today that call was answered," said Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy (ONDCP). "This new action makes it more difficult for drug traffickers to obtain and use these chemicals for illicit purposes. It will also help disrupt synthetic drug trafficking that not only leads to deaths caused by overdose, but also corruption, drug-related violence, and insecurity. The collective work of the international community to address global drug-related challenges has never been more important. The Biden-Harris Administration is committed to building on today’s progress."

Honduran Judge Okays Extradition of Former President to Face US Drug Charges. A judge in Honduras has ruled the former President Juan Orlando Hernandez can be extradited to the United States to face drug charges. Hernandez was president from 2014 until last month, after he lost an election, and was considered a US ally even though federal prosecutors alleged he was involved in drug trafficking throughout his presidency. He was detained last month by the new government at the request of the US. The "narcopresidente" has until Saturday to appeal the Wednesday ruling, after which he could be extradited. Meanwhile, he remains in prison in Honduras.

War Deepens Suffering for Ukraine's Drug Users. Drug users in the country are facing shortages of methadone and street drugs as the Russian military campaign in the country disrupts daily life. "Today, I went around five pharmacies where I used to get methadone on prescription. None were open. Another place was open today, but there was a queue of at least 200 people and I didn’t want to go into withdrawal right there, and so I went home," one drug user said. In the city of Kyiv, there were 45 fee-based centers serving opioid-dependent patients each; now they are all closed after the doctors evacuated. Similar clinics in the Crimean Peninsula were shut down when Russian forces took over in 2014; since then, of approximately 800 Crimean methadone patients, at least 80 have killed themselves, died of fatal overdoes, or died of other narcotic causes. 

US Prison, Parole, Probation Population Continues Slow Decline; $26 Billion Opioid Settlement, More... (7/22/21)

Florida's Republican establishment may not be ready for marijuana legalization but the public is, the Justice Department drops an effort to send some First Step Act releasees back to prison, and more.

Drug distributors agree to pay out big-time for their role in the opioid crisis. (Pixabay)
Marijuana Policy

Florida Poll Shows Strong Support for Marijuana Legalization. A new poll from Public Policy Polling has support for marijuana legalization at 59%. Two different efforts to get an initiative before the voters last year were quashed by the state Supreme Court, and the Republican-led state legislature this year passed a bill making it more difficult to finance initiatives, which Republican Gov. Ron DeSantis signed into law. Translating public support into marijuana reform is going to be more difficult than ever now.

Opioids

Major Drug Distributors Reach Agreement on $26 Billion Opioid Settlement. The three largest US pharmaceutical drug distributors -- McKesson, Cardinal Health, and AmerisourceBergen -- and drugmaker Johnson & Johnson have reached an agreement with a group of state attorneys general to pay out $26 billion to settle lawsuits related to their roles in the widespread prescribing of prescription opioids and the subsequent wave of addiction and overdose deaths. "The numerous companies that manufactured and distributed opioids across the nation did so without regard to life or even the national crisis they were helping to fuel," said New York Attorney General Letitia James, one of the attorneys general from 15 states involved in the deal. "Today, we are holding these companies accountable and infusing tens of billions of dollars into communities across the nation." Responding to that wave of addiction and overdoses, the states and the federal government have moved to restrict opioid prescribing, even though chronic pain patients have found their access to their medications more difficult.

Sentencing

US Correctional Population Drops for 12th Straight Year. The Bureau of Justice Statistics (BJS) reports that in 2019, the number of people in the US in jail or prison or on probation or parole was 6,344,000, down 65,200, or 1%, over the previous year and marking the 12th year in a row that that figure has declined. At the end of 2019, 4,357,700 people were under community supervision (probation or parole), while there were 2,086,000 people behind bars in jails or prisons. The BJS report did not discuss the types of offenses for which people were under correctional supervision, but a 2020 Prison Policy Initiative report found 190,000 doing time for drug offenses in state prisons, 157,000 in local jails, and 78,000 in the federal prison system, meaning drug prisoners account for about one-fifth of the US incarcerated population.

Justice Department Drops Appeal of First Step Act Releases. The Justice Department has dropped an effort to re-imprison four New Jersey men who were released from prison under the First Step Act's retroactive crack cocaine sentencing provision. The men had been released in November 2019 after serving more than 20 years on crack charges, but the Trump Justice Department then sought to send them back to prison. The Biden Justice Department had been under pressure from groups such as Families Against Mandatory Minimums (FAMM), which applauded the decision, saying: "We raised this case among others with the Biden transition team as an appeal that should be dropped right away. It would have been cruel and unjust it would be to send these guys back."

Federal Appeals Court Taps the Brakes on Drug Induced Homicide Prosecutions of Drug Users [FEATURE]

A woman who bought heroin with a pair of friends, one of whom shortly afterward suffered a fatal overdose on the drug, is not a murderer, at least according to the US 3rd Circuit Court of Appeals. That was the June 1 ruling in US v. Semler, a case that may not set binding precedent, but does send a signal to the prosecutors and the judiciary that the federal courts do not want to see a federal law aimed at so-called drug kingpins applied to mere drug users.

As described in the decision, the case began when two heroin-addicted Philadelphia women, Emma Semler and her old drug rehab buddy Jennifer Werstler, went to score heroin together at Wertsler's request. They were joined by Semler's sister Sarah, who drove them to the West Philadelphia locale where they bought their heroin. It is unclear who actually purchased and then shared the heroin. The trio then shot up in the restroom of a nearby KFC restaurant. Werstler began to show signs of overdosing, and the Semler sisters "attempted to revive Werstler by splashing cold water on her, then left the bathroom and called their mother for a ride home. They did not call 911 or alert anyone to Werstler's condition."

Werstler was later discovered by a KFC employee, who called 911, but EMTs arrived too late to save her and she was pronounced dead. Her official cause of death was "adverse reaction to heroin."

Semler was then indicted by a federal grand jury in the Eastern District of Pennsylvania with "distribution of heroin resulting in death," punishable by a 20-year mandatory minimum prison sentence. As an added bonus, she was also charged with doing so within 1,000 feet of a school, as well as aiding and abetting on both counts. She was found guilty at trial and sentenced to 21 years in prison.

Semler appealed, arguing that friends sharing jointly procured drugs did not qualify as drug distribution and that the district court had erred in refusing to allow a jury instruction to that effect, as well as erring in failing to instruct the jury that there had to be a "proximate cause" for it to convict.

Scott Burris, JD, is a professor of both law and public health at Temple University and directs Temple's Center for Public Health Law Research. He is also Semler's appellate counsel and coauthor of an amicus curiae brief supporting Semler, which nicely laid out the issues at play.

"This case presents the Court with an opportunity to determine the proper scope of the Drug Distribution Resulting in Death (DDRD) sentencing enhancement provision," the abstract explains. "The provision, its parent statute, and the totality of modern federal law and policy to stem the overdose crisis are intended to target major drug traffickers. Research suggests that DDRD prosecutions routinely pervert this intent, indiscriminately deploying DDRD and similar provisions to target end consumers of illicit drugs affected by addiction. Rather than deterring drug trafficking, such prosecutions deter help-seeking during overdose events and interfere with overdose prevention measures. This cuts at cross purposes to overdose crisis response, leading to more, not fewer deaths."

The 3rd District Court of Appeals agreed, vacating Semler's conviction and sending her case back for retrial using proper legal instructions for jurors. "We hold that the definition of 'distribute' under the Controlled Substances Act does not cover individuals who jointly and simultaneously acquire the possession of a small amount of a controlled substance solely for their personal use," wrote Judge Jane Richard Roth.

It was a victory, if not a complete exoneration, for Emma Semler and any other drug user federal prosecutors in the 3rd Circuit might have been thinking about charging under that statute. Hopefully it also serves as a distant early warning signal for states that have passed drug induced homicide laws, as well as for state-level prosecutors, who are zealously embracing them to convict low-level drug users as murderers.

The Health in Justice Action Lab at Northeastern University School of Law reported that the number of states with such laws jumped from 15 to 25 in from 2009 to 2019, while the number of drug induced homicide prosecutions hovered at near zero from the 1970s until the early 2000s. Then, as overdose deaths jumped, so did prosecutions, rising to 100 per year by 2011 before skyrocketing to nearly 700 per year by 2018.

In a 2019 Utah Law Review article, Northeastern law professor and faculty director of the Health in Justice Action lab faculty adviser Leo Beletsky found while the laws are ostensibly aimed at drug dealers, "half of those charged with drug induced homicide were not, in fact, 'dealers' in the traditional sense, but friends and relatives of the deceased." He also found that in cases that involved a traditional "drug dealer," half of those prosecuted were black or brown people who sold drugs to whites -- a fact he noted does not fit the demographics of the United States or of drug dealers.

"In view of that context," he wrote, "these findings suggest that drug-induced homicide charges are being selectively and disproportionately deployed to target people of color. This disparate application can further reinforce already dire racial disparities, particularly in the enforcement of drug laws and the length of sentencing for drug-related crimes."

And, as the Drug Policy Alliance (DPA) pointed out in its 2017 report, An Overdose Death is Not a Murder: Why Drug Induced Homicide Laws Are Ineffective and Inhumane, those laws don't work to reduce overdoses: "Prosecutors and legislators who champion renewed drug induced homicide enforcement couch the use of this punitive measure, either naively or disingenuously, as necessary to curb increasing rates of drug overdose deaths. But there is not a shred of evidence that these laws are effective at reducing overdose fatalities. In fact, death tolls continue to climb across the country, even in the states and counties most aggressively prosecuting drug-induced homicide cases."

"The Semler case is one more example of how the Drug War has warped our legal system and led to mass incarceration," DPA senior staff attorney Grey Gardner told the Chronicle in an email exchange. "Prosecutors twisted the law to criminalize this young woman and subject her to a more than 20-year sentence after several friends bought drugs to use together and one suffered a tragic fatal overdose. Urging the jury to convict one of them of drug distribution when each of these users were suffering from substance use disorder and using together was not only overreaching, it highlights the arbitrary nature of our drug laws."

It is also counterproductive, he added: "This prosecution and those like it do nothing to make people safer, but instead put people in greater danger. By elevating the threat of prosecution, they make it less likely that people close to an overdose victim will call for help," he pointed out.

"Thankfully in this case the Court of Appeals rejected the prosecution's overbroad definition of distribution, but what's clear is that we need an entirely new approach," said DPA's Gardner. "Instead of the failed War on Drugs, we need to stop turning to the criminal legal system and spending billions on these ineffective policing strategies. Instead we need better approaches -- such as investments in drug checking, overdose prevention centers, and expanded access to naloxone -- to protect those who are experiencing addiction and are at the greatest risk."

"The court seemed sympathetic to the view that criminal law is not the best way to get at substance use disorder and the behavior of people coping with it," Burris told the Chronicle in an email exchange.

The appeals court labeled its decision as non-precedential, meaning it is not binding on federal district courts in its region, but it still may have a broader impact in the federal courts, Burris explained.

"I think her lawyers are going to ask the court to reconsider that," he said. "It is at least what we call 'persuasive authority' in that its reasoning may be adopted voluntarily by other courts."

As for impact on state and local prosecutions, not so much, he added.

"It has no impact other than as persuasive authority," Burris said. "The state attorney general and local district attorneys pursuing these cases seem to think they are sensible and just, and they are hard to shake," he confessed.

"The overdose crisis is just one symptom of the fundamental disease of inequality and inequity in our country," was Burris's bottom line. "Getting at that root cause requires a sea change in policy such that government at all levels -- and the people who elect the government -- commit to ensuring the basics of decent life to everyone: good work, good housing, good education, good transportation, and a place of respect in the community. In this the 'deaths of despair' idea seems to be to get the problem just right. Of course, short of that, there are many things to do: stop criminalizing drug use; create safe injection sites everywhere they are needed; eliminate regulations that make methadone and buprenorphine harder to get than the drugs whose use they are meant to reduce."

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