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Looking Back: The Biggest Domestic Drug Policy Stories of the Past 20 Years [FEATURE]

As Drug War Chronicle marks the publication of its 1,000th issue (with yours truly having authored 863 of them going back to 2000), we reflect on what has changed and what hasn't in the past couple of decades. This piece recounts our domestic drug policy evolution in the US; a companion piece looks at the international picture.

A lot has happened. We've broken the back of marijuana prohibition, even if we haven't killed it dead yet; we've seen medical marijuana gain near universal public acceptance, we've seen harm reduction begin to take hold, we've fought long and hard battles for sentencing reform -- and even won some of them.

But it hasn't all been good. Since the Chronicle began life as The Week Online With DRCNet back in 1997, more than 30 million people have been arrested for drugs, with all the deleterious consequences a drug bust can bring, and despite all the advances, the drug war keeps on rolling. There's been serious progress made, but there's plenty of work left to do. 

Here are the biggest big picture drug stories and trends of the past 20 years:

1. Medical Marijuana

It was November, 1996, when California became the first state to legalize medical marijuana, five years after San Francisco became the first city in the country to pass a medical marijuana measure, thanks in large part to the efforts of activists who mobilized to make its use possible for AIDS patients. Two years later, Alaska, Oregon, and Washington came on board, and three years after that, Hawaii became the first state to allow it though the legislative process. Now, 29 states, the District of Columbia, Guam, and Puerto Rico allow for the use of medical marijuana, and public support for medical marijuana reaches stratospheric levels in polls.

But the battle isn't over. The federal government still refuses to officially recognize medical marijuana, potentially endangering the progress made so far, especially under the current administration, efforts to reschedule marijuana to reflect its medical uses remain thwarted, some of the more recent states to legalize medical marijuana have become perversely more restrictive, and in some of the more conservative states, lawmakers attempt to appease demands for medical marijuana legalization by passing extremely limited CBD-only laws.

2. Marijuana Legalization: In the War on Weed, Weed is Winning

Twenty years ago, pot wasn't legal anywhere, and Gallup had public support for legalization at a measly 25%. A lot has changed since then. It took repeated tries, but beginning in 2012, states started voting to free the weed, with Colorado and Washington leading the way, Alaska and DC coming on board in 2014, and California, Maine, Massachusetts, and Nevada joining the ranks last year. Now, about a fifth of the country has legalized weed, with more states lining up to do so next year, including most likely contenders Delaware, Michigan, New Jersey, and Vermont.

Now, Gallup has support for legalization at 64% nationwide, with even a slight majority (51%) of Republicans on board. The only demographic group still opposed to pot legalization is seniors, and they will be leaving the scene soon enough. Again, the battle is by no means over. Marijuana remains illegal under federal law, and congressional efforts to change that have gone nowhere so far. But it seems like marijuana has won the cultural war, and the rest is just cleaning up what's left of the pot prohibition mess.

3. Marijuana, Inc.: The Rise of an Industry

State-legal marijuana is already a $10 billion dollar a year industry, and that's before California goes on line next month. It's gone from outlaws and hippie farmers in the redwoods to sharp-eyed business hustlers, circling venture capitalists, would-be monopolists, and assorted hangers on, from accountants, lawyers, and publicists to security and systems mavens, market analysts, and the ever-expanding industry press.

These people all have direct pecuniary interests in legal marijuana, and, thanks to profits from the golden weed, the means to protect them. Marijuana money is starting to flow into political campaigns and marijuana business interests organize to make sure they will continue to be able to profit from pot.

Having a legal industry with the wherewithal to throw its weight around a bit is generally -- but not entirely -- a good thing. To the degree that the marijuana industry is able to act like a normal industry, it will act like a normal industry, and that means sometimes the interests of industry sectors may diverge from the interests of marijuana consumers. The industry or some parts of it may complain, for instance, of the regulatory burden of contaminant testing, while consumers have an interest in knowing the pot they smoke isn't poisoned.

And getting rich off weed is a long way from the justice-based demand that people not be harassed, arrested, and imprisoned for using it. Cannabis as capitalist commodity loses some of that outlaw cachet, some ineffable sense of hipster cool. But, hey, you're not going to jail for it anymore (at least in those legal states).

4. The Power of the People: The Key Role of the Initiative Process

The initiative and referendum process, which lets activists bypass state legislatures and put issues to a direct popular vote, has been criticized as anti-democratic because it allows special interests to use an apathetic public to advance their interests, as both car insurers and tobacco companies have attempted in California. It also gets criticized for writing laws without legislative input.

But like any political tool, it can be used for good or ill, and when it comes to drug reform, it has been absolutely critical. When legislatures refuse to lead -- or even follow -- as has been the case with many aspects of drug policy, the initiative process becomes the only effective recourse for making the political change we want. It was through the initiative process that California and other early states approved medical marijuana; it was five years later that Hawaii became the first state where the legislature acted. Similarly with recreational marijuana legalization, every state that has legalized it so far has done it through the initiative process; in no state has it yet made its way through the legislature, although we're hoping that will change next year.

And it's not just marijuana. The initiative process has also been used successfully to pass sentencing reforms in California, and now activists are opening the next frontier, with initiatives being bruited in California and Oregon that would legalize psychedelic mushrooms.

The bad news: Only 24 states have the initiative process. The good news: The ones that do lead the way, setting an example for the others.

Drug prohibition can't be separated from the larger struggle for racial and social justice. (Creative Commons)
5. The Glaring Centrality of Race

It took Michelle Alexander's 2010 publication of The New Jim Crow: Mass Incarceration in the Age of Colorblindness to put a fine point on it, but the centrality of race in the prosecution of the war on drugs has been painfully evident since at least the crack hysteria of the 1980s, if not going back even further to the Nixonian law-and-order demagoguery of the late 1960s and early 1970s.

We've heard the numbers often enough: Blacks make up about 13% of the population and about 13% of drug users, but 29% of all drug arrests and 35% of those doing state prison time for drugs. And this racial disparity in drug law enforcement doesn't seem to be going away.

Neither is the horrendous impact racially-biased drug law enforcement has on communities of color. Each father or mother behind bars leaves a family exploded and usually impoverished, and each heavy-handed police action leaves a bitter aftertaste.

The drug war conveyor belt, feeding an endless number of black men and women into the half-life of prison, is clearly a key part of a system of racially oppressive policing that has led to eruptions from Ferguson to Baltimore. If we are going to begin to try to fix race relations in this country, the war on drugs is one of the key battlefronts. Thanks in part to Alexander's bestseller, civil rights organizations from the traditional to newer movements like Black Lives Matter have devoted increasing focus to criminal justice, including drug policy reform.

6. Harm Reduction Takes Hold

We don't think teenagers should be having sex, but we know they're going to, anyway, so we make condoms available to them so they won't get pregnant or STDs. That's harm reduction. So is providing clean needles to injection drug users to avoid the spread of disease, making opioid overdose drugs like naloxone widely available so a dosing error doesn't turn fatal, passing 911 Good Samaritan laws to encourage and OD victims' friends to call for help instead of run away, and providing a clean, well-lit place where drug users can shoot or smoke or snort their drugs under medical supervision and with access to social service referrals.

Two decades ago, the only harm reduction work going on was a handful of pioneering needle exchanges, thanks to folks like Dave Purchase at the North American Syringe Exchange Network (founded in 1988), and early activists faced harassment and persecution from local authorities. But it was the creation of the Harm Reduction Coalition in 1993 that really began to put the movement on the map.

In this century, harm reduction practices have gained ground steadily. Now, 33 states and DC allow needle exchange programs to operate, 40 states and DC have some form of 911 Good Samaritan laws, and every state in the county has now modified its laws to allow greater access to naloxone.

The next frontier for American drug war harm reduction is safe injection sites, and on the far horizon, opiate-assisted maintenance. There is not yet a single officially sanctioned operating safe injection in the country, but we are coming close in cities such as Seattle and San Francisco. And let's not forget drug decriminalization as a form of harm reduction. It should be the first step, but that's not the world we live in -- yet.

7. Sentencing Fever Breaks

Beginning in the Reagan years and continuing for decades, the number of prisoners in America rose sharply and steadily, driven in large part by the war on drugs. The phenomenon gained America infamy as the world's biggest jailer, whether in raw numbers or per capita.

But by early in the century, the fever had broken. After gradually slowing rates of increases for several years, the number of state and federal prisoners peaked around 2007 and 2008 at just over 1.6 million. At the end of 2015, the last year for which data is available, the number of prisoners was 1.527 million, down 2% from the previous year. And even the federal prison system, which had continued to increase in size, saw a 14% decline in population that year.

But most drug war prisoners are state prisoners, and that's where sentencing reform have really begun to make a difference. States from California to Minnesota to Texas, among others, enacted a variety of measures to cut the prison population, in some cases because of more enlightened attitudes, but in other cases because it just cost too damned much money for fiscal conservatives.

Current US Attorney General Jeff Sessions would like very much to reverse this trend and is in a position to do some damage, for instance, by instructing federal prosecutors to pursue tough sentences and mandatory minimums in drug cases. But he is hampered by federal sentencing reforms passed in the Obama era. Sessions may be able to bump up the number of people behind bars only slightly; the greater danger is that his policies serve as an inspiration for similarly inclined conservatives in the states to try to roll back reforms there.

8. The Rise (and Fall) of the Opioids

In 1996, Purdue Pharma introduced Oxycontin to the market. The powerful new pain reliever was pitched to doctors as not highly addictive by a high pressure company sales force and became a tremendous market success, generating billions for the Sackler family, the owners of the company. Opioid prescriptions became more common.

For many patients, that was a good thing. Purdue Pharma's marketing push coincided with a push by chronic pain advocates -- patients, doctors and others -- to ease prescribing restrictions that had kept many patients in feasibly treatable pain. And which in many cases still do: A 2011 report by the Institute of Medicine found that while "opioid prescriptions for chronic noncancer pain [in the US] have increased sharply . . . [tlwenty-nine percent of primary care physicians and 16 percent of pain specialists report they prescribe opioids less often than they think appropriate because of concerns about regulatory repercussions." As the report noted, having more opioid prescriptions doesn't necessarily mean that "patients who really need opioids [are] able to get them."

While it's popular to blame doctors and Big Pharma for getting a bunch of pain patients addicted to opioids, that explanation is a bit too facile. Many of the people strung out today were never patients, but instead obtained their pain pills on the black market. Through a perverse system of incentives, people on Medicaid could obtain the pills by prescription for next to nothing, then resell them for $40 or $60 apiece to people who wanted them. Some pain management practices were on the cutting edge of relieving pain for patients who needed the help. But others were little more than shady pill mills, popping up in places like Ohio, Kentucky, and Florida -- places that would become the epicenter of an opioid epidemic within a few years.

When the inevitable crackdowns on pain pill prescribing came, legitimate prescribers of course got caught in the crossfire sometimes, especially those who served the poor or the patients who in the worst chronic pain. Their being targeted, or others reining in their prescribing practices, left many patients in the lurch again. And the closure of pill mills left addicted people in the lurch. But there was plenty of heroin to make up for the missing pills the addicted used to take. Mexican farmers have been happy to grow opium poppies for the American market for decades, and Mexican drug trafficking organizations know how to get it to market.

The whole thing has been worsened by the arrival of fentanyl, a synthetic opioid dozens of times stronger than pure heroin, which seems to be coming mostly from rogue Chinese pharmaceutical labs (although the Mexicans appear to be getting in on the act now, too).

And now we have a drug overdose crisis like the country has never seen before, with around 60,000 people estimated to die from overdoses this year, most of them from opioids (by themselves or in combination with alcohol and/or other drugs). The crisis is inspiring both admirable harm reduction efforts and an execrable turn to harsher punishments, while making things harder again for many pain patients. While many argue that the gentle side of the response to this epidemic is because the victims are mainly white, I would suggest that argument pays short shrift to all the years of hard work advocates and activists of all ethnicities have put in to creating more enlightened drug policies.

9. Policing for Profit: The Never Ending Fight to Rein in Asset Forfeiture

Twenty years ago, pressure was mounting in Washington over abuses of the federal civil asset forfeiture program, just as it is now. Back then, passage of the Civil Asset Forfeiture Reform Act (CAFRA) of 2000 marked an important early victory in the fight to rein in what has tartly described as "policing for profit." It was shepherded though the house by then Judiciary Committee Chairman Rep. Henry Hyde, an Illinois Republican.

How times have changed. Now, with federal agents seizing billions of dollars each year though civil forfeiture proceedings and scandalous abuse after scandalous abuse pumping up the pressure for federal reform, the Republican attorney general is calling for more asset forfeiture. And Jeff Sessions isn't just calling for it; he has undone late Obama administration reforms aimed at reining in one of the sleaziest aspects of federal forfeiture, the Equitable Sharing program, although he is having problems getting Congress to go along.

In the years since CAFRA, a number of states have passed similar laws restricting civil asset forfeiture and directing that seized funds go into the general fund or other designated funds, such as education, but state and local police have been able to evade those laws via Equitable Sharing. Under that program, instead of seizing money under state law, they instead turn it over to the federal government, which then returns 80% of it to the law enforcement agency -- not the general fund and not the schools.

This current setup, with its perverse incentives for police to evade state laws and pursue cash over crime, makes asset forfeiture reform a continuing battlefield at both the state and the federal levels. A number of reform bills are alive in the Congress, and year by year, more and more states pass laws limiting civil asset forfeiture or, even better, eliminating it and requiring a criminal conviction before forfeiture can proceed. Fourteen states have now done that, with the most recent being Connecticut, New Mexico and Nebraska. That leaves 36 to go.

10. Despite Everything, the Drug War Grinds On

We have seen tremendous progress in drug policy in the past 20 years, from the advent of the age of legal marijuana to the breaking of sentencing fever to the spread of harm reduction and the kinder, gentler treatment of the current wave of opioid users, but still, the drug war grinds on.

Pot may be legal in eight states, but that means it isn't in 42 others, and more than 600,000 people got arrested for it last year -- down from a peak of nearly 800,000 in 2007, but still up by 75,000 or 12% over 2015.

It's the same story with overall drug arrests: While total drug arrest numbers peaked at just under 1.9 million a year in 2006 and 2007 -- just ahead of the peak in prison population -- and had been trending downward ever since, they bumped up again last year to 1.57 million, a 5.6% increase over 2015.

There are more options for treatment or diversion out of jail or prison, but people are still getting arrested. Sentencing reforms mean some people won't do as much time as they did in the past, but people are still getting arrested. And the drug war industrial complex, with all its institutional inertia and self-interest, rolls on. If we want to actually end the drug war, we're going to have to stop arresting people for drugs. That would be a real paradigm shift.

Chronicle AM: DPA Decries Resort to Drug Courts, OSU Creates Drug Policy Center, More... (11/02/17)

The Drug Policy Alliance takes aim at some of the opioid commission's recommendations, Michigan dispensaries can stay open during the shift to the new regime, Ohio State creates a Koch-funded drug policy center, and more.

Pennsylvania patients are a step closer to being able to legally buy their medicine. (Sondra Yruel/DPA)
Marijuana Policy

Colorado Budget Plan Would Use Pot Tax Money to Fund Task Force Aimed at Illegal Marijuana Operations. Gov. John Hickenlooper's (D) budget proposal for FY 2018-2019 includes directing $1.2 million in pot tax revenues to create a task force with the state Bureau of Investigation to "investigate black marker marijuana operations across Colorado." Such operations are on the increase, the governor complained.

Medical Marijuana

FDA Cracks Down on Marijuana Cancer Treatment Claims. The Food and Drug Administration sent letters Tuesday to four companies warning them they cannot market their products as treatments for cancer. The letter is directed at companies who claim their products can combat tumors and kill cancer cells. "We don't let companies market products that deliberately prey on sick people with baseless claims that their substance can shrink or cure cancer and we're not going to look the other way on enforcing these principles when it comes to marijuana-containing products," FDA Commissioner Scott Gottlieb said in a statement.

Michigan Medical Marijuana Dispensaries Can Stay Open During Shift to New Regime. After ferocious blowback from patients concerned they could lose access to their medicine, the state Department of Licensing and Regulatory Affairs on Wednesday reversed an earlier decision forcing dispensaries to shut down while the licensing process for them under a new state law is completed. Now, the dispensaries will be able to stay open past December 15, the day they were supposed to have to shut down.

Pennsylvania Starts Signing Up Patients. The state Health Department announced Wednesday that it had launched its patient and caregiver registry, bringing patients one step closer to being able to legally access their medicine. Medical marijuana should be available for patients by May 1, the department said.

Heroin and Prescription Opioids

Advocates Denounce White House Opioid Commission's Emphasis on Drug Courts and Proposed Increase in Drug Sentences. The Drug Policy Alliance attacked the emphasis on drug courts, saying research does not support their continued expansion. "Most drug courts do not reduce imprisonment, do not save money or improve public safety, and ultimately fail to help people struggling with drug problems. Today's drug courts are no more effective -- but are considerably more costly -- than voluntary treatment, with participants often spending more time behind bars than those whose cases are handled by conventional courts. While the commission has recommended that drug courts provide access to medication-assisted treatments, it would be far more valuable to offer such treatments on a voluntary basis, without subjecting people who are struggling with addiction to the criminal justice system," the group said in press release Wednesday.

Drug Policy

Ohio State Creates Center to Study Impact of War on Drugs. The Ohio State University announced Wednesday the creation of a center to study the social impacts of the war on drugs. The Drug Enforcement and Policy Center will be funded with a $4.5 million grant from the Charles Koch Foundation. It will be headed by Professor Robert Berman, who has had a long-term interest in drug policy reform and is perhaps best known as the author of the Sentencing Law and Policy blog.

Chronicle AM: Trump Opioid Commission Calls for More Drug Courts, More... (11/1/17)

President Trump's opioid commission issues its recommendations, El Paso becomes the latest Texas locale to ease marijuana possession penalties, would-be Arkansas medical marijuana providers file suit over an application process that excluded them, and more.

The Trump opioid commission has called for drug courts nationwide to help ease the crisis.(virginia.gov)
Marijuana Policy

Delaware Marijuana Task Force Report to Be Delayed. The legislative task force studying whether to legalize marijuana has delayed issuing its final report from the end of January to the end of February. The delay was requested by the Keep Delaware Safe and Healthy Coalition, a coalition of influential groups opposed to legalization.

New Jersey Court Rules State Must Consider Reclassifying Marijuana. An Appellate Division court ruled 2-1 Tuesday that the state must at least consider removing marijuana from its list of controlled substances. The ruling came in a case brought by two plaintiffs, a man serving a life sentence for marijuana trafficking and a young girl with epilepsy who uses marijuana for medical reasons. The court did not order the state to reclassify the herb, but said the head of the Division of Consumer Affairs should have considered reclassification instead of just flatly denying a petition to do so.

El Paso Becomes Latest Texas Locale to Not Automatically Arrest for Marijuana Offenses. El Paso county commissioners voted on Monday to approve a program under which first-time offenders caught with less than two ounces of weed can avoid arrest and criminal charges. The state passed a law allowing for the down-grading of pot possession offenses in 2014, but it has only been implemented in Austin, Dallas, and Houston.

Medical Marijuana

Arkansas Business Applicants Sue Over Rejected Bids. A group of applicants seeking to open some of the first medical marijuana businesses in the state filed lawsuits last week charging that the state Medical Marijuana Commission erred in its initial assessment of applications, where it rejected several applicants for failing to meet minimum requirements. The lawsuits seek a temporary restraining order to force the commission to include the plaintiffs' applications during a final scoring review.

Heroin and Prescription Opioids

White House Opioid Commission Issues Recommendations. President Trump's commission on the opioid crisis called Wednesday for the nationwide expansion of drug courts and more access to alternatives to opioids for people suffering pain as part of a series of recommendations for shaping drug policy to more effectively address the crisis. The 56 recommendations also include requiring doctors to show they have training in the safe provision of such drugs before their DEA licenses are renewed, requiring health care providers to use prescription drug monitoring databases, and easing Medicaid and insurance payments for opioid drug treatment. The recommendations contain no provision for increased funding.

Chronicle AM: Second Australia SIJ Coming, DEA Adds Heroin Enforcement Teams, More... (10/30/17)

The Victoria state government has approved a safe injection site in Melbourne, a new report warns that high taxes on legal marijuana could push people to the black market, New Jersey adds some new qualifying conditions for medical marijuana use, and more.

Australia's second safe injection site will open in Melbourne next year. (vch.ca)
Marijuana Policy

Report: High Legal Pot Taxes Could Push Consumers to Black Market. California retail marijuana taxes, which could reach as high as 45% in some cases, could potentially push consumers out of legal pot shops and into the black market, according to a new report from the credit rating agency Fitch Ratings. "The existing black market for cannabis may prove a formidable competitor to legal markets if new taxes lead to higher prices than available from illicit sources," the report says.

Medical Marijuana

New Jersey Adds Five New Qualifying Conditions. The state's Medical Marijuana Review Panel has officially approved five new qualifying conditions for medical marijuana use. They are anxiety, chronic pain related to musculoskeletal disorders, migraines, chronic pain of visceral origin, and Tourette's Syndrome. The panel rejected adding chronic fatigue syndrome and asthma as qualifying conditions.

Heroin and Prescription Opioids

DEA Creates Six New Heroin Enforcement Teams. The DEA has announced the establishment of six new enforcement teams focused on heroin and fentanyl. The teams will operate in New Bedford, Massachusetts; Charleston, West Virginia; Cincinnati, Ohio; Cleveland, Ohio; Raleigh, North Carolina; and Long Island, New York. The DEA got funding in its Fiscal Year 2017 appropriations to pay for the teams.

Public Health Experts Issue Report With Comprehensive Recommendations for Opioid Crisis.
Experts from the Johns Hopkins Bloomberg School of Public Health in collaboration with the Clinton Foundation have issued a report with comprehensive recommendations for stemming the opioid crisis. Among its 10 priority recommendations are: expanded electronic opioid prescription monitoring, policies in line with CDC Opioid Prescribing Guidelines, clear guidance on opioid disposal and "take back" programs, increased federal funding for drug treatment in the most hard hit communities, and cheaper naloxone.

International

Taliban Now Making Heroin -- and Increased Profits. For years, Afghanistan's Taliban have profited from opium poppy production, using the proceeds to finance their war, but now, Afghan and Western officials say that more than half of Afghan opium is being processed in-country, and that is leading for increased profits for the Taliban, for whom the drug trade consists of about 60% of its income.

Australia to Get Second Safe Injection Site, in Melbourne. The Victoria state government cabinet has approved a safe injection site for the North Richmond area of Melbourne. It is set to open next year. At the same time, the state government is also moving to crack down on heroin traffickers by reducing the amounts of heroin needed to impose harsh sentences.

Chronicle AM: Atlanta A Step Closer to MJ Decrim, Drug Treatment Privacy Threat, More... (10/3/17)

Atlanta is one step away from decriminalizing marijuana possession, patient advocacy and health care groups unite behind a campaign to protect the privacy of drug treatment patients, and more.

It was a 15-0 vote for marijuana decriminalization in the Atlanta city council chambers Monday.
Marijuana Policy

Delaware Panel Meets Again This Week, Has Issues. The state task force charged with examining issues around the legalization of marijuana is set to meet again on Wednesday. Members said that before legalization could occur, several issues would have to be addressed, including public and workforce safety, taxation and banking rules, insurance and liability issues, and concerns about the long-term effects of marijuana use.

Massachusetts Regulators Urged to Avoid "Walmart of Weed" Situation. State pot grower advocates urged regulators Monday to institute a tiered licensing system for marijuana cultivation to avoid out-of-state corporate control of the state's legal pot crops. Peter Bernard, president of the Massachusetts Grower Advocacy Council, said a 1 million square foot grow facility being funded by "Colorado money" makes his "New England blood boil" because it could signal that locals will be shut out in the nascent industry. Instead of a "Walmart of Weed" approach, Bernard said, the state should encourage craft cooperatives. "Craft cooperative grows will provide that top shelf product that commands a top shelf price, much like a fine bottle of wine commands a higher price than box wine. Only the tourists and occasional tokers will waste their money on Walmart Weed," he said in testimony reported by MassLive.

Atlanta City Council Unanimously Approves Decriminalization Ordinance. The city council voted 15-0 Monday to decriminalize the possession of up to an ounce of marijuana. The mayor now has eight days to sign or veto this bill. If the mayor does not act, the ordinance becomes law. State law allows for up to six months in jail for pot possession, but the Atlanta ordinance would limit punishment to a $75 fine.

Heroin and Prescription Opioids

As Opioid Crisis Rages, Campaign to Protect Patients' Privacy Rights Launched. More than a hundred of the nation's leading patient advocacy and health care organizations have launched the Campaign to Protect Patient Rights to advocate for maintaining the confidentiality of substance abuse disorder patients. The campaign comes as moves are afoot to eradicate existing protections in a misguided bid to address the crisis. Under federal substance abuse disorder confidentiality rules, treatment providers are barred from disclosing information about a patient's drug treatment without his or her consent. Proposals to replace those rules with the more relaxed HIPAA standards "would not sufficiently protect people seeking and receiving SUD treatment and could expose patients to great harm," the groups said.

Chronicle AM: Democratic Senators Call Out Trump on Opioid Inaction, More... (9/12/17)

Democratic senators want Trump to do more than say pretty words about the opioid epidemic, California's second largest city gets on board with marijuana legalization, Canadian cops seek a delay in rolling out legalization north of the border, and more.

Last month, President Trump said the opioid epidemic was a national emergency. Since then...nothing. (Gage Skidmore/Wikipedia)
Marijuana Policy

San Diego City Council Votes to Legalize Marijuana Cultivation, Manufacturing. California's second most populous city has gotten on board with legalization. The city council voted 6-3 Monday night to approve a regulatory framework for the looming legal recreational pot industry instead of trying to ban it.

Medical Marijuana

Michigan Dispensaries Given Three Months to Shut Doors. Existing unlicensed dispensaries must shut their doors by December 15, the state Department of Licensing and Regulatory Affairs said Monday. On that date, the department begins accepting applications to operate under new medical marijuana regulations approved this year. While closing up shop and then applying for a license isn't exactly a thrill for existing dispensary owners, it's better than an alternative proposal that called for the dispensaries to be shut down immediately.

Pennsylvania Medical Marijuana Program Roll-Out Imperiled by Lawsuit. A would-be medical marijuana operator who failed to win a permit to operate in an initial round of permit-issuing filed a lawsuit last Friday challenging the process and seeking an injunction that would require the state to rescind all awarded permits and start over. That's raising concerns about medical marijuana supporters that it could cause needless suffering.

Heroin and Prescription Opioids

Democratic Senators Demand Trump Take Action on Opioid Epidemic. On Monday, Sen. Ed Markey (D-MA) and nine Democratic senatorial colleagues sent a letter to President Trump asking the administration what it is doing about the recommendation that it declare an emergency around the opioid epidemic. Trump called it a national emergency more than a month ago, but nothing has happened since. "Regardless of whether you choose to declare a state of emergency, continued inaction on this issue is deeply concerning," the senators wrote. "Your lack of action -- coupled with your support of policies that would make access to substance use disorder care more difficult for millions of Americans -- causes us to question your commitment to ending the opioid use disorder and overdose crisis," the letter said.

International

Canadian Cops Want Delay in Marijuana Legalization Rollout. Representatives of various Canadian police forces testifying before the House of Commons said they would not be ready for the roll-out of marijuana legalization next summer and urged a delay. They also urged lawmakers to think again about allowing personal home cultivation, because it would be hard to police.

Colombia Clashes Leave One Coca Grower Dead, Two Wounded. The casualties occurred as coca growers in Morales, Cauca, clashed with soldiers taking part in forced eradication of coca crops. Farmers began throwing rocks at the soldiers, who apparently opened fire on the protestors. This is the second clash between angry coca growers and government forces in the past month, and reflects growing tensions over forced eradication.

UN High Commissioner on Human Rights Slams Philippines Drug War. Zeid Ra'ad Al Hussein called out President Rodrigo Duterte for his "lack of respect for due process rights for all Filipinos" and his "open support for a shoot-to-kill policy." Al Hussein added that he was "gravely concerned" not only about the killings, but also about the lack of credible investigations into them.

Chronicle AM: Ontario Goes With State-Owned Pot Shops, DEA Agent's Sordid Affair, More... (9/11/17)

Canada's most populous province is going with a state monopoly on legal marijuana sales, the CARERS Act is back, last week's surprise budget deal preserves protections for legal medical marijuana states for a few more months, and more.

Medical Marijuana

Congressional Budget Deal Preserves Medical Marijuana Protections -- For Now. The budget deal agreed to last week between President Trump and congressional leaders extends federal protections to state-legal medical marijuana programs through December 8. This provides an opportunity for House GOP leaders to rectify their decision last week not to allow a vote on the amendment that for the past four years has blocked the Justice Department from spending federal funds to go after medical marijuana in states where it is legal.

Bipartisan Group of Senators Reintroduce CARERS Act. Sens. Cory Booker (D-NJ), Al Franken (D-MN), Kirsten Gillibrand (D-NY), Lisa Murkowski (R-AK), and Rand Paul (R-KY) refiled the CARERS Act (Senate Bill 1764) last Wednesday. The bill aims to "extend the principle of federalism to State drug policy, provide access to medical marijuana, and enable research into the medicinal properties of marijuana."

Iowa Attorney General Cites Fed Fears to Block CBD from Out of State Dispensaries. The attorney general's office has advised the Department of Public Health not to implement a part of the state's CBD medical marijuana law that would have licensed two dispensaries from bordering states to supply CBD to Iowa patients. "It is possible that state's program may come under increased scrutiny from the federal government," a spokesman told the Des Moines Register, adding that the halt would remain "until the federal government provides further guidance regarding state medical marijuana programs."

Drug Policy

Florida Attorney General Pam Bondi Joins Trump's Drug Task Force. A Republican and Trump supporter, Bondi has been appointed to the Presidential Commission on Drug Addiction and the Opioid Crisis, her office announced last Friday. The other commission members are chairman and New Jersey Gov. Chris Christie (R), Massachusetts Gov. Charlie Baker (R), North Carolina Roy Cooper (D), former US Rep. Patrick Kennedy (D-MA), and Harvard professor Dr. Bertha Madras. The commission is supposed to issue a final report by October 1.

Heroin and Prescription Opioids

New York Congressman Files Bill to Broaden Medication Assisted Treatment. Rep. Paul Tonko (D-NY) has filed House Resolution 3692 to "amend the Controlled Substances Act to provide additional flexibility with respect to medication-assisted treatment for opioid use disorders."

Law Enforcement

DEA Agent's Scandalous Affair Unveiled. A Justice Department inspector general's report released last Thursday revealed one bit of juicy scandal: A DEA agent carried on a wild affair with a convicted drug criminal for five years, and let her listen to active wiretaps, roam the evidence room unattended, and had sex with her in his office and official vehicle. The whole thing unraveled when she got pregnant, he reacted unfavorably, and she ratted him out to superiors. The unnamed agent was originally only suspended for 45 days, but was eventually fired.

International

Ontario Will Only Allow Legal Pot Sales in Government Monopoly Shops. Canada's most populous province announced last Friday that it will open 150 standalone pot shops operated by the Liquor Control Board of Ontario (LCBO), as well as eventually allowing an online order service. Dispensaries that have sprouted up in the province are out of luck: "Illicit cannabis dispensaries are not and will not be legal retailers," the province explained in a news release. "The province will pursue a coordinated and proactive enforcement strategy, working with municipalities, local police services, the OPP and the federal government to help shut down these illegal operations."

Canadian Prime Minister Just Says No to Drug Decriminalization. Prime Minister Justin Trudeau has rejected calls from British Columbia public health and political figures to embrace drug decriminalization as part of a solution to the country's opioid crisis. "We are making headway on this and indeed the crisis continues and indeed spreads across the country but we are not looking at legalizing any other drugs than marijuana for the time being," Trudeau told a news conference in BC last Thursday.

German Poll Finds Solid Majority for Marijuana Legalization. A Mafo Market Research Institute poll has found signs of a rapid shift in support for freeing the weed in Germany. Polls going back to 2001 have had support hovering around 19%, but things began to change around 2014. That year, a poll had 30% supporting legalization. In November 2015, another poll had support at 42%. The new Mafo poll has support at 57.5%.

Debunking a Republican Myth About Medicaid and Opioids

This article was produced in collaboration with AlterNet and first appeared here

Obamacare foes desperate for a new angle of attack on the increasingly popular health care program have come up with an intriguing new theory: The expansion of Medicaid to low-income adults under the Affordable Care Act (ACA) may be driving the opioid epidemic.

For the right, tying "failed socialist" Obamacare to the drug epidemic is a two-fer. They get to decry the very notion of government programs as something good for society and they get to link "bleeding heart" efforts to help poor people with outcomes that actually hurt them.

It would be a nice little argument for cutting Medicaid -- if only it were true. But there's little evidence to suggest it is true and a lot of evidence to suggest it isn't.

The notion began circulating in the conservative media echo chamber after the Health and Human Services Department did a private analysis for Sen. Ron Johnson (R-WI) that said the opioid overdose rate rose nearly twice as much in states that expanded Medicaid under the ACA than those that didn't.

"These data appear to point to a larger problem," Johnson wrote. "Medicaid expansion may be fueling the opioid epidemic in communities across the country." Johnson pulled up just short of blaming Medicaid, saying more research is needed.

But if Johnson was looking for help from fellow Obamacare foe and Health and Human Services Secretary Tom Price, it wasn't exactly forthcoming. HHS wouldn't address questions about Johnson's analysis and instead issued a statement saying "correlation does not necessary prove causation," but that, yes, more research would be helpful.

But based on what we know so far, here are four reasons the charge that Medicaid is fueling the opioid epidemic is bogus:

1. Medicaid is actually increasing treatment for opioid addiction.

That's according to Temple University economist Catherine Maclean and Brendan Saloner of Johns Hopkins Bloomberg School of Public Health, who recently published a paper on Medicaid expansion and drug treatment: "Medicaid-reimbursed prescriptions for medications used to treat Substance Use Disorders in outpatient settings increased by 33% in expanding states relative to non-expanding states. Among patients admitted to specialty SUD treatment, we find that in expanding states Medicaid insurance and use of Medicaid to pay for treatment increased by 58% and 57% following the expansion. In an extension to the main analyses we find no evidence that the expansions affected fatal alcohol poisonings or drug-related overdoses," they wrote.

"Medicaid is doing its job," she told the Associated Press last week. "As more time passes, we may see a decline in overdoses in expansion states relative to non-expansion states."

2. States that expanded Medicaid did so in part because they already suffered higher overdose rates.

That same research by Maclean and Saloner also found that overdose rates were higher to begin with in states that expanded Medicaid. That suggests that pre-existing drug problems may have played a role in states deciding to expand Medicaid so they could leverage more federal money to fight addiction.

Republican labor economist Craig Garthwaite of Northwestern University's Kellogg School of Management told the AP that such a desire helped propel Ohio Republican Gov. John Kasich toward expanding Medicaid. When Kasich talks about why, he said, "it has a lot to do with mental health and substance use disorders." The claim that Medicaid is fueling opioid overdoses is "fundamentally flawed," Garthwaite added.

In other words, overdoses aren't increasing because of Medicaid; instead, Medicaid is expanding in part because of an effort to reduce overdoses.

3. Counties where insurance coverage has expanded the most have seen smaller increases in overdose deaths than those with smaller coverage gains.

A recent analysis by Vanderbilt University economist Andrew Goodman-Bacon and Harvard researcher Emma Sandoe compared trends in drug-related deaths at the county level, contrasting counties that had high levels of uninsured residents pre-ACA with those that didn't. Under the theory that Medicaid expansion is causing increased overdose deaths, we would expect to see the largest increase in deaths in those high-insured counties because that's where more people took advantage of expanded Medicaid. But that wasn't the case:

"Drug-related deaths increased at a lower rate in high-uninsurance counties than in low-uninsurance counties," the researchers found. "This does not support the notion that the ACA worsened the opioid epidemic."

In other words, the more people on expanded Medicaid, the lower the rate of increase in overdose deaths.

4. The Medicaid theory lumps all opioid overdose deaths together when many are not caused by prescription opioids.

This is bad science. If you want to measure prescription opioid deaths, you need to measure only prescription opioid deaths. But the HHS analysis for Sen. Johnson didn't do that. Instead, it lumped in deaths from non-prescription street drugs, such as heroin or illicitly manufactured fentanyl. Having a Medicaid card doesn't provide access to street drugs, and it is precisely heroin and illicit fentanyl that are driving the surge in opioid deaths since 2010.

"It's worrisome because this is the type of numerical evidence that's used to propose bad policy," Garthwaite told the AP.

Chronicle AM: MA Gov Wants Harsh Sentences for Drug Deaths, More... (8/31/17)

Connecticut continues to grapple with opioids, the Massachusetts governor and cops want mandatory minimums and a possible life sentence for dealers whose clients die, and more.

MA Gov. Baker prefers 20th Century drug war mistakes over 21st century solutions. (mass.gov)
Heroin and Prescription Opioids

Fentanyl Overdoses Now Exceed Heroin Overdoses in Connecticut. The state saw 539 opioid overdose deaths in the first half of this year, and for the first time, more people died using fentanyl than heroin. While 257 people died of heroin overdoses, 322 died of fentanyl overdoses. The state medical examiner's office projects overdose deaths this year will reach 1,100, a 20% increase over last year.

Connecticut Governor Signs Opioid Bill. Gov. Dannel Malloy (D) on Thursday signed into law a bill aimed at slowing the state's opioid epidemic. The bill increases monitoring of opioid prescriptions and requires health insurers to cover inpatient detoxification. The bill passed the legislature unanimously. This is the third year in a row the state has passed bills aimed at the opioid epidemic.

Drug Policy

Massachusetts Governor Wants Harsher Penalties for Drug Deals That Lead to Death. Gov. Charlie Baker (R) has sent a letter to the legislature proposing a bill that would increase sentences for dealers who sold drugs to people who overdosed and died -- up to life in prison. "When illegal drug distribution causes a death, laws that were designed to punish the act are inadequate to recognize the seriousness of the resulting harm," Baker wrote, according to MassLive. "This legislation would provide for a penalty of up to life in prison and, like the offense of manslaughter while driving drunk, would also require a mandatory minimum sentence of at least five years," he added. The bill has the support of law enforcement.

Santa Fe Mayor to Introduce Resolution to Establish A Municipal Drug Strategy Task Force. Javier Gonzalez, the mayor of New Mexico's fourth largest city, will on Thursday introduce a resolution establishing a Municipal Drug Strategy Task Force charged with recommending innovative public health and safety approaches to problematic drug use in the city. "This isn't a problem we can solve by simply declaring a new, top-down policy. It has to be something we take on together, and the strategy has to come from the community. From harm reduction, to law enforcement, to prevention, to treatment, there is a huge range of expertise already developing in Santa Fe, and to find success we will need every one of those voices at the table," said Mayor Gonzales. He added, "So we're doing what we often can do best -- bringing people together."

Supervised Injection Sites Could Be Coming Soon to California [FEATURE]

This article was produced in collaboration with AlterNet and first appeared here.

As we mark International Overdose Awareness Day on August 31, California is on the verge of taking a serious, yet controversial, step to cut down on drug deaths. A bill that would allow a number of counties in the state to set up supervised drug consumption sites -- Assembly Bill 186 -- is now only a Senate floor vote away from landing on the desk of Gov. Jerry Brown (D).

The long-operating InSite safe injection site in Vancouver (Creative Commons)
Such facilities, also known as safe injection sites, typically allow drug users to inject their own drugs under medical supervision on premises with needles and related equipment provided by the site. The sites also serve as a point of contact between injection drug users and social service and treatment providers. But they infuriate social conservatives, who see them as coddling or condoning illicit drug use.

Although such facilities operate in a number of European countries, as well as Australia and Canada, and have been shown to provide numerous public health benefits, including a reduction in overdose deaths, no sanctioned supervised drug consumption sites are operating in the US.

Which is not to say there are none operating: Earlier this month, two researchers published a report on an unsanctioned -- and potentially illegal -- supervised drug consumption site operating since 2014 in an unnamed US city. They offered little data, but their main finding was that no one had died injecting drugs at the site. Two people overdosed, but were revived with naloxone administered by on-site medical staff.

And efforts are well underway in Seattle and surrounding King County, Washington, to get sites up and operating there. But no state has passed a law authorizing the widespread use of the facilities. California came close last year, and of the six states where such legislation has been filed this year, it's the nearest to victory.

That's only somewhat consoling to Assemblywoman Susan Eggman Talamantes (D-Stockton), the author of the bills both this year and last. In a Tuesday conference call, she decried the legislature's blocking of this proven public health policy intervention in 2016 and pointed to the cost of a year's delay.

California Assemblywoman Susan Eggman (D-Stockton) is leading the fight. (ca.gov)
"The studies show they work. Treatment goes up, overdoses go down, and we also see a reduction in street use around facilities, as well as reductions in HIV and Hep C," Eggman noted. "But that doesn't always make sense in politics. Some 3,600 Californians have died of drug overdoses since we couldn't pass this last year."

The bill allows eight counties -- Alameda, Fresno, Humboldt, Los Angeles, Mendocino, San Francisco, San Joaquin, and Santa Cruz -- or cities within those counties to establish safe injection sites under a pilot program that would expire in January 2022. Sites would be required to do the sorts of things sites are supposed to do: "provide a hygienic space supervised by health care professionals, as specified, where people who use drugs can consume pre-obtained drugs, and provide sterile consumption supplies;" administer needed medical treatment; provide access to referrals for drug treatment, mental health, medical, and social services; and provide education on overdose and infectious disease prevention.

The bill also bars safe injection workers and clients from being charged with drug-related crimes for actions within a safe injection site program.

"I'm a social worker," Eggman explained. "During the 1980s, I did drug and alcohol counseling, and I saw the epidemic g from heroin to crack to meth. And now we're seeing more and more suffer from addiction. I had to ask myself what made sense from a public policy perspective."

A clean, well-lit place to shoot dope. (vch.ca)
Safe drug consumption sites are one response that do make sense from a public policy perspective, but they can be a hard sell, and not just with social conservatives. In laid-back Santa Cruz, a preemptive NIMBY campaign has appeared.

"Santa Cruz is known as a progressive place, willing to try new things, so I was surprised at the pushback," Eggman confessed. "I think some activists found out about it early and were very vocal, but we've been working very carefully with them since then. We've had to explain the bill doesn't force them to do anything, that there has to be a lot of input before anything happens, that there has to be public hearings and a vote by an elected body."

But before any of that happens, the bill needs to actually pass the Senate, where its prospects are good, and then be signed into law by Gov. Brown, who has not pronounced one way or the other on it.

"We're trying to provide data for the governor to get a signature for this pilot program," Eggman said. "It's not for everybody, but it is a tool for saving lives and reducing addiction."

Will California actually get it done this year? Stay tuned.

CA
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