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Chronicle AM: HHS Sec Says "No Such Thing" as MedMJ, OR Opioid Treatment Bill, More... (3/5/18)

Seattle will join San Francisco is expunging past petty pot possession convictions, the HHS secretary denies the reality of medical marijuana, the DOJ wants to toughen up a bill aimed at opioid makers and distributors, Colombia and the US reach an agreement on drug policy goals, and more.

HHS Secretary Alex Azar, formerly of Eli Lilly, says "there is no such thing as medical marijuana." (Wikipedia)
Marijuana Policy

New Jersey Pot Legalization Hearing Today. The Assembly Oversight Committee is holding a hearing today on marijuana legalization, the first step in getting a legalization bill through the legislature. Sen. Nicholas Scutari (D) has filed Senate Bill 380, which would legalize the possession of small amounts of pot and allow for taxed and regulated sales, but other bills could also be filed, including bills that only decriminalize—not legalize—marijuana.

Oregon Senate Approves Bill to Fund Enforcement Against Black Market Operations. The state Senate voted last Friday to approve Senate Bill 1544, which would create the Illegal Marijuana Market Enforcement Grant Program within the Criminal Justice Commission. The program would offer $1.5 million a year over six years to help local governments with costs incurred in going after illicit cultivation and production. The bill now goes to the House of Representatives for consideration.

Seattle to Expunge Misdemeanor Pot Possession Convictions. Mayor Jenny Durkan and City Attorney Pete Holmes announced last Thursday that they will clear the records of people who were prosecuted for misdemeanor pot possession prior to the legalization of marijuana in 2012. The city estimates some 500 to 600 convictions dating back to 1977 will be overturned.

Medical Marijuana

Health and Human Services Secretary Says "No Such Thing" as Medical Marijuana. Health and Human Services Secretary Alex Azar refused last Friday to acknowledge that marijuana has any medicinal uses. In response to a question at an Ohio press conference about opioids about the role of medical marijuana in treating them, he replied: "There really is no such thing as medical marijuana," he said at an Ohio press conference on opioids. "There is no FDA-approved use of marijuana, a botanical plant. I just want to be very clear about that."

Heroin and Prescription Opioids

Justice Department Wants Congress to Stiffen Opioid Legislation. In a letter last Wednesday to the head of a congressional committee investigating the opioid industry, Assistant Attorney General Stephen E. Boyd urged Congress to rewrite a bill passed with the pharmaceutical industry's blessing that the DEA says undermines its efforts to go after companies suspected of violating the drug laws. The Ensuring Patient Access and Effective Drug Enforcement Act was pushed through Congress in 2016 by a small group of lawmakers backed by drug companies, including then Rep. Tom Marino (R-PA), who was forced to back away from a nomination to head the drug czar's office after a CBS News investigative report on the law last fall.

Oregon House Approves Opioid Treatment Access Bill. The House last Thursday approved House Bill 4143, which "requires Director of Department of Consumer and Business Services to study barriers to effective treatment for and recovery from substance use disorders, including addictions to opioids and opiates, and to report and make recommendations to Legislative Assembly not later than June 30, 2018." The bill now goes to Gov. Kate Brown (D) for her signature.

Pennsylvania Governor Says State Will Ease Access to Opioid Treatment Medications. Gov. Tom Wolf (D) announced last Thursday that the state is ending a policy that slowed treatment for people addicted to opioids. The state's Medicaid program will no longer require doctors to get prior approval when prescribing drugs such as Suboxone and Vivitrol, used in what's known as medication-assisted treatment (MAT). "MATs work — they’re part of an overall strategy that can help all kinds of people," Wolf said. "This step that I’m announcing today is going to increase access to this lifesaving treatment for those who suffer from substance use disorder across the commonwealth."

Foreign Policy

US, Colombia Agree to Expand Anti-Drug Cooperation, Set Goal of 50% Coca Reduction. The United States and Colombia reached an agreement last Friday on cooperation in their joint anti-drug campaigns. The two countries pledged to expand their anti-drug cooperation, which has as an expressed goal or reducing the country's coca and cocaine production by 50% by 2023.

Rick Steves Has Three Must-Sees for a Jeff Sessions European Drug Policy Trip

PBS star and prolific travel guidebook author Rick Steves is a prominent advocate of marijuana legalization and drug reform. For years, he has advocated for freeing the weed and adopting a more moderate, European-style approach to drug policy.

Rick Steves dishes out some travel tips for the attorney general. (Wikimedia)
He has enjoyed successes, playing a leading role in bringing the public around in Washington state, which legalized weed in 2012, and continuing to make his high-profile calls for more enlightened drug policies. But now, the Trump administration, and Attorney General Jeff Sessions in particular, is trying to put the brakes on, and that got Steves thinking.

In response, as Rolling Stone reports, Steves has now combined his travel savvy and his drug reform advocacy in proposing an eye-opening, pot-centric European travel itinerary tailor-made for Sessions in the hope that some of the Old World tolerance would rub off on him.

Here are the three must-sees on Steves' Sessions European drug policy itinerary:

1. Switzerland. "I would take him to Switzerland and we'd go to a heroin maintenance clinic," Steves said, referring to the country's pioneering and non-criminal approach to opioid addiction.

2. Barcelona. Cannabis clubs are allowed there. "In Spain they can't sell marijuana but they can grow it. In practice, they don't want to grow it so they join a club that grows it collectively, and they can enjoy the harvest."

3. The Netherlands. Steves said he would take the attorney general to one of those famous Dutch "coffee shops" where adults can legally purchase small amounts of weed. "After the coffee shop, we'd visit a mayor and a policeman and have [Sessions] listen to the mayor and policeman explain why they'd rather have coffee shops than have marijuana sold on the street," Steves says.

Although he didn't mention it, there is one other European destination that could be an eye-opener for Sessions:

4. Portugal.The Iberian nation decriminalized the possession of all drugs in 2001. And not only is it still standing, it has drug use levels similar to other European countries, but without all the arrests.

Of course, Sessions is unlikely to take Steves up on his offer and even more unlikely to be convinced by saner European approaches, but Steves' point is still made: There are better ways of dealing with drug use and abuse. We just have to acknowledge them.

Chronicle AM: Senate Sentencing Reform Bill Under Attack, DEA Threatens SIJs, More... (2/15/18)

The Marijuana Justice Act gets a third cosponsor, the DEA threatens to go after safe injection sites, the attorney general and leading law enforcement groups target the Senate sentencing reform bill, and much, much more.

Jeff Sessions and major law enforcement groups are trying to kill the Senate sentencing reform bill. (
Marijuana Policy

Federal Judge Suggests He Will Defer to DEA, Congress on Rescheduling Lawsuit. At a hearing Wednesday over a lawsuit seeking to have marijuana de- or rescheduled from Schedule I of the Controlled Substances Act, US District Court Judge Alvin Hellerstein suggested he would rule in the government's favor. He dismissed plaintiffs' claims that marijuana prohibition was motivated by racism and political concerns when it was passed 80 years ago and he said he didn't think he had the authority to reschedule the drug. "The law is the law," the judge said. "I'm sworn to enforce the law."

Cory Booker's Marijuana Justice Act Gets Third Sponsor. Sen. Kirsten Gillibrand (D-NY) announced Wednesday that she had signed on as a cosponsor of Sen. Cory Booker's (D-NJ) Marijuana Justice Act (S. 1689). The bill is also cosponsored by Sen. Ron Wyden (D-OR).

Federal Bill Filed to Protect Legal Marijuana States and Businesses. Rep. Lou Correa (D-CA) has filed the Sensible Enforcement Of Cannabis Act (no bill number yet), which would essentially codify the protections for state-legal marijuana embodied in the now-rescinded Cole memo. "To date, eight states have legalized recreational cannabis, and twenty-nine states and the District of Columbia, representing more than half of the American population, have enacted legislation to permit the use of cannabis," Correa said. "Attorney General Sessions' decision to rescind the 'Cole Memo' created great uncertainty for these states and legal cannabis businesses, and put citizens in jeopardy for following their state laws."

Connecticut Legalization Bills Filed. Twenty-two lawmakers filed a marijuana legalization bill Wednesday. The bill, House Bill 5112, would authorize the retail sale and taxation of the herb. Separately, House Deputy Majority Leader Rep. James Albis (D-East Haven) filed another legalization bill, House Bill 5111. Similar bills last year failed to get a floor vote in either chamber. Both bills were referred to the Joint Committee on General Law.

Massachusetts Legalization Advocates Protest "Intimidation Campaign" Aimed at Forcing Restrictive Regulations. Legalization advocates are criticizing Gov. Charlie Baker (R) and other officials, saying they have conducted a "coordinated intimidation campaign" against the state body charged with crafting rules and regulations, the Cannabis Control Commission. In a series of letters to the commission, officials from the governor's office have raised public health and safety concerns and recommended it scale back its framework of rules. Advocates took their concerns to the State House Thursday, where they held a press conference.

New Jersey Lawmakers, Wary of Legalization, File Decriminalization Bill Instead. A bipartisan group of legislators urging caution on pot legalization has filed a bill that would decriminalize the possession of small amounts of marijuana. Senate Bill 472 would make the possession of up to 15 grams a civil offense. Gov. Phil Murphy (D) campaigned on legalizing marijuana, and legalization bills have already been filed in the Assembly and Senate.

Jackson, Mississippi, City Council Votes to Decriminalize Weed. The city council voted unanimously Tuesday to decriminalize the possession of up to 30 grams of marijuana. Violators would face no more than a $100 fine. Under current Mississippi state law, marijuana possession is illegal, so effective implementation will depend on local law enforcement discretion. The possession of any amount of marijuana can result in up to 60 days in jail, a fine of up to $250, and a litany of collateral consequences that impacts employment, housing, family and life opportunities.

Asset Forfeiture

Alabama Senate Committee Votes to End Civil Forfeiture by Police. The Senate Judiciary Committee voted Wednesday to approve a bill that would end civil asset forfeiture in the state. Senate Bill 213 would require a criminal conviction before cash or property could be seized. Senators said they expected the bill to face additional negotiations before it goes to a Senate floor vote.

Drug Testing

Wisconsin Bill to Block Employers from Testing for Marijuana to Be Filed. Rep. David Bowen (D-Milwaukee) said he plans to introduce a bill that would block employers from drug testing for THC or disqualifying people from jobs because of a drug test with positive results for marijuana. The bill would apply to both public and private sector workers, but not those operating heavy equipment. "Consuming THC weeks or months out from a job interview should not disqualify someone from finding employment any more than someone who drank a few beers on another date should be kept out of work" Bowen told the Isthmus in an email. "While I am in favor of the safe legalization and regulation of marijuana for both recreational and medicinal use, until that happens, people should not be stigmatized for using a substance whose effect on society is less negative than society's reaction to it."

Heroin and Prescription Opioids

Congressional Republicans Try to Blame Sanctuary Cities for Opioid Crisis. GOP lawmakers used a hearing of the House Judiciary Subcommittee on Immigration and Border Security to try to scapegoat sanctuary cities for the country's opioid crisis. "We have heard countless stories of sanctuary practices and the havoc they wreck on public safety, national security, and the sanctity of the rule of law," said Rep. Raúl Labrador (R-ID), the committee chair. "Our public safety and our public health are tied to eradicating opioids, which can never be accomplished when the force multiplier that is ICE is sidelined." But committee Democrats and analysts rejected the link. Rep. Pramila Jayapal (D-WA) said There was no "factual basis in connecting so called sanctuary city policies with the opioid crisis," said Rep. Pramila Jayapal (D-WA). "It would be laughable if it weren't so serious," she said. "If it weren't so hurtful to the characterization of immigrants across this country." Last month, Republicans tried to blame Obama's expansion of Medicaid for worsening the epidemic.

Harm Reduction

Trump Administration Threatens to Go After Safe Injection Sites. Several US cities are moving forward with plans to open safe injection sites, but the DEA has just fired a shot across the bow. In an interview with Buzzfeed, DEA spokeswoman Katherine Pfaff said the agency may take action against the facilities because they are federally prohibited. "Supervised injection facilities, or so-called safe injection sites, violate federal law," Pfaff said. "Any facilitation of illicit drug use is considered in violation of the Controlled Substances Act and, therefore, subject to legal action." She cited a 1980s crack house law that could be used. But in Seattle, at least, local prosecutors say they welcome a legal challenge and think they can convince the courts that public health powers are superior to criminal laws against drug dens run for profit.

New Mexico Passes Legislation to Examine Administering Pharmaceutical-grade Heroin or Other Opioids by Medical Practitioners to People Struggling with Long-term Addiction. The state House Tuesday approved House Memorial 56, which charges the Legislative Health and Human Services Committee to take testimony on supervised injectable opioid treatment as a feasible, effective and cost-effective strategy for reducing drug use and drug-related harm among long-term heroin users who have not been responsive to other types of treatment. The bill was sponsored by Rep. Deborah Armstrong (D-Albuquerque), chair of the House Health and Human Services Committee. This memorial does not need to pass the Senate or be signed by the governor.

Sentencing Reform

Attorney General Sessions Slam Senate Sentencing Reform Bill. Attorney General Jeff Sessions came out against a painstakingly cobbled-together Senate sentencing reform bill Wednesday, sparking a public food fight with Sen. Chuck Grassley (R-IA), the head of the Senate Judiciary Committee and the very face of dour Corn Belt conservatism.In a letter reported by Reuters, Sessions warned the committee not to approve the sentencing reform bill, S. 1917, claiming it would reduce sentences for "a highly dangerous cohort of criminals." Passage of the bill would be "a grave error," Sessions said. The measure is actually a mixed bag, a product of lengthy discussions among senators seeking a compromise that could actually pass the Senate. While it has a number of progressive sentencing reform provisions, mainly aimed at nonviolent drug offenders, it also includes new mandatory minimum sentences for some crimes, including some drug offenses. Those provisions provide political cover to conservatives fearful of being tagged "soft on crime," but tired of perpetuating failed drug war policies.

Police Groups Slam Senate Sentencing Reform Bill. The National Sheriffs' Association and the Fraternal Order of Police have both come out against the Senate sentencing reform bill, calling on President Trump to reject the bill and saying it will put violent drug dealers back out on the street. "Sheriffs will have to arrest most of them again at the county level and that will shift the cost and responsibility to us without fixing the underlying problems of violent crime and drug and human trafficking in the country," said a letter to Trump from the National Sheriffs' Association. "At a time when our nation is being ravaged by an epidemic of overdoses from the use of heroin and opioids, it seems at variance with common sense and sound policy to drastically reduce sentences for drug traffickers and then apply these reduced sentences retroactively," said the National Fraternal Order of Police.

Chronicle AM: New Drug Czar Nominee, Purdue Pharma Stops Marketing Opioids to Docs, More... (2/12/18)

Good marijuana polling in Florida and New York, record marijuana sales in Colorado, the White House nominates a new drug czar, Purdue Pharma makes a big announcement, and more.

Purdue Pharma, the manufacturer of Oxycontin says it will no longer market its opioid products to doctors. (
Marijuana Policy

Sessions Slams Colorado GOP Senator in Fight Over Marijuana. Sen. Cory Gardner (R-CO) has been sticking up for his state by blocking Department of Justice nominees from consideration until Attorney General Sessions backs away from his decision to rescind Obama-era guidance to prosecutors allowing states to generally implement marijuana legalization without federal interference. And Jeff Sessions doesn't like it. He went after Gardner -- without mentioning his name -- in a speech at the National Sheriffs' Association Monday. "Too often, we've seen bad judgements, even politics enter into the work that we do," Sessions complained. "We're trying to confirm a number of important component heads at the Department of Justice. It's just getting to be frustrating, I've gotta tell you. Our nominee to the National Security Division -- the anti-terrorism division -- was approved unanimously in the committee. But because right now one senator's concerns over unrelated issues -- like reversing federal law against marijuana -- we can't even get a vote."

Colorado Sold a Billion and Half Dollars' Worth of Marijuana Last Year. It was a record-breaking year for the Rocky Mountain State. The Department of Revenue reported last Friday that legal marijuana sales topped $1.51 billion last year, with $1.09 billion coming from adult use sales and $416.52 million coming from medical marijuana sales. Those sales generated more than $247 million in taxes and fees for the state.

Florida Poll Has Healthy Majority for Legalization. A new poll from the University of North Florida finds that 62% of registered voters would back a state law regulating marijuana like alcohol, and 45% said they would "strongly support" such a law. The poll comes weeks after backers of a legalization initiative in the state conceded they did not have enough signatures to qualify for the ballot.

Massachusetts DAs Want Licenses Delayed for Cannabis Cafes, Delivery Services. In a letter last Friday to the Cannabis Control Commission, the Massachusetts District Attorneys Association called on the commission to hold off on issuing licenses for cannabis social clubs and delivery services. "We have security concerns for these businesses, their employees and their customers," the prosecutors wrote. "Moreover, these businesses heighten our concerns relative to such issues as operating under the influence, increased marijuana access by persons under the age of 21, theft and diversion to the black market." The DAs also warned that immediately licensing such businesses would be "irresponsible, ill-informed, and dangerous."

Michigan Legalization Initiative Campaign Sees Organized Opposition. A political action committee has been formed to oppose the state's legalization initiative, which is currently awaiting confirmation that it has met signature-gathering requirements to appear on the November ballot. The Healthy and Productive Michigan Committee has $150,000, courtesy of a donation from anti-legalization crusader Kevin Sabet and his group Smart Approaches to Marijuana. Sabet says there could be more money coming, too.

New York Poll Has Healthy Majority for Marijuana Legalization. A Siena College released Monday has support for marijuana legalization at 56%. The figure was 60% for New York City, 55% for downstate suburbs, and even 52% in conservative upstate. Three-quarters of voters under 35 supported legalization, while voters 55 and older were evenly split. The poll comes as Gov. Andrew Cuomo (D) is proposing a study to examine whether the state should legalize the weed.

Medical Marijuana

Utah House Fails to Pass Crucial Medical Marijuana Measure. The House last Friday voted to pass one medical marijuana bill, but failed to pass a crucial companion bill. The House passed House Bill 195, allowing terminally ill patients to use medical marijuana, but then failed to pass House Bill 197, which would have actually implemented the law by instructing the state Department of Agriculture and Food to write rules on growing marijuana and contract with a third party grower to grow the plant. "One is dependent on the other," said the bills' sponsor, Rep. Brad Daw (R-Orem), who is now second-guessing his decision to file the two bills separately. "Maybe it was the wrong policy, maybe it was the wrong decision." Meanwhile, a campaign to put a medical marijuana initiative before the voters in December is well underway.

Heroin and Prescription Opioids

Oxycontin Maker Will Quit Marketing Opioids to Doctors. Purdue Pharma, the manufacturer of Oxycontin, announced last Friday that it will stop marketing its opioid products to doctors. The move has been a key demand of numerous lawsuits blaming the company for helping to trigger the current wave of opioid misuse. Purdue said it had eliminated more than half its sales staff and will no longer send sales people to doctors' offices to discuss opioid drugs.

Drug Policy

Trump Nominates White House Staffer to Head Drug Czar's Office. The White House confirmed last Friday that White House staffer Jim Carroll has been nominated to head the Office of National Drug Control Policy (ONDCP -- the drug czar's office). Carroll has been a top aide to White House chief of staff John Kelly. Before that, he was an executive at Ford Motor Company, and before that, he was an assistant state prosecutor in Fairfax, Virginia, where he prosecuted some drug cases. He appears to have no public health experience. The drug czar's office has been empty throughout the Trump administration -- a previous nominee, Tom Marino, was forced to step down after he was linked to a bill DEA officials said limited their ability to prosecute corporate opioid cases -- and just last week, the administration once again threatened to drastically cut its budget.


Philippine Senator Jailed for Opposing Duterte's Drug Crackdown Calls on Him to Support ICC Probe of Drug War Deaths. Sen. Leila de Lima, who has been imprisoned for a year now on trumped up charges for opposing President Rodrigo Duterte's bloody drug war, challenged Duterte in a statement Saturday to support a probe by the International Criminal Court into "the rash of extrajudicial killings" unleashed by Philippines police. "Thousands of Filipinos are getting killed, and sadly, President Duterte remains unperturbed," said De Lima. "He chooses to ignore reports of glaring human rights violations and abuses by police and security forces who put law in their hands instead of facing the issue head-on. If he has nothing to hide, then it's high time for the President to support the independent investigation into the human rights violations and abuses incessantly happening under his regime," she added.

Britain's West Midland Police Announce Plan for Prescription Heroin, Safe Injection Sites. West Midlands Police and Crime Commissioner David Jamieson has proposed allowing the provision of medicinal heroin to users unresponsive to other treatments, as well as a panoply of harm reduction measures, including "special consumption rooms," or safe injection sites. Jamieson said he hoped to see the proposals implemented by 2020.

Chronicle AM: BC Pilot Program Will Provide Free Opioids to Entrenched Users, More... (12/21/17)

Austin mellows out on pot policy, the VA lets doctors talk about -- but not recommend -- medical marijuana to patients, British Columbia is set to begin a pilot project of giving medical-grade opioids to chronic users, and more.

BC health officials are going to start giving hydromorphone (Dilaudid) to chronic opioid users. (Wikimedia)
Marijuana Policy

Austin, Texas, to Allow Small-Time Marijuana Possessors to Take Class, Avoid Charges. People caught with less than two ounces of marijuana will be able to avoid criminal charges if they take a four-hour class on drug abuse and the effects of marijuana on the body under a policy unanimously adopted by Travis County commissioners Wednesday. Houston is already doing something similar. About 2,000 people get arrested for pot each year in Travis County, a disproportionate number of whom are black or Hispanic.

Medical Marijuana

New Veterans Administration Rules Let Docs Talk About -- But Not Recommend -- Medical Marijuana. Under a new VA directive, doctors can "discuss with the veteran marijuana use, due to its clinical relevance to patient care, and discuss marijuana use with any veterans requesting information about marijuana." But they can't recommend it: "Providers are prohibited from completing forms or registering veterans for participation in a state-approved marijuana program."

Utah Poll Has Strong Support for Medical Marijuana Initiative. A new UtahPolicy poll finds that nearly three-quarters (73%) of respondents support a proposed medical marijuana initiative. That figure includes 61% of people who describe themselves as "very active" Mormons. The church opposes the initiative. The initiative will go on the November 2018 ballot if petitioners can come up with 113,000 valid voter signatures by the spring.


British Columbia Pilot Project to Hand Out Free Opioids to Users. The BC Center for Disease Control has won permission to begin a pilot project where medical-grade opioids will be provided at no cost to at-risk users. The move is aimed at reducing fatal drug overdoses, as well as reducing costs associated with drug use and addiction. Under the program, chronic opioid users registered with the agency will be given three free doses of hydromorphone (Dilaudid) daily. The annual cost for the drug for each user will be under $700, less than the cost of a single emergency call to medical first-responders. The program is set to begin in April.

Mexico to Legalize Marijuana-Based Products Next Year. The country's health regulatory agency, Cofepris, announced Wednesday that Mexico will legalize the sales of marijuana-based foods, drinks, cosmetics, and other products early next year. Mexico has legalized the use of marijuana for medical and scientific, but not recreational purposes.

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

With a thousand issues of Drug War Chronicle under our belts, we look back on the biggest international drug and drug policy stories of the past 20 years. (A companion piece looks at the biggest US domestic drug policy stories.) Here's what we find:

The 1998 UN General Assembly Special Session on Drugs. We've made some progress since then. (Creative Commons)
1. Global Prohibitionist Consensus Starts to Crumble

In 1998, the UN General Assembly Special Session on Drugs (UNGASS), with anti-prohibitionist voices in the room but metaphorically on the outside, pledged itself to eradicating drugs in 10 years. That didn't happen. Now, nearly 20 years later, it is duly chastened, and the chorus of critics is much louder, but the UN still remains a painfully slow place to try to make change in global drug policy.

Yet, despite the foot-dragging in Vienna and New York, albeit at a glacial pace. The 2016 UNGASS couldn't bring itself to actually say the words "harm reduction," but acknowledged the practice in its documents. It couldn't bring itself to resolve to be against the death penalty in drug cases, but a large and growing number of member states spoke out against it. It couldn't officially acknowledge that there is "widespread recognition from several quarters, including UN member states and entities and civil society, of the collateral harms of current drug policies, and that new approaches are both urgent and necessary," even though that's what the UN Development Program said. And the UN admitted to having dropped the ball on making opioid analgesics available in the developing world.

It certainly wasn't ready to talk about drug legalization in any serious fashion. But despite the rigidity within the global anti-drug bureaucracy, driven in part by the hardline positions of many Asian and Middle Eastern member states, the global prohibitionist consensus is crumbling. Many European and Latin America states are ready for a new direction, and some aren't waiting for the UN's imprimatur. Bolivia has rejected the 1961 Single Convention on Narcotic Drugs' provision criminalizing the coca plant, and Canada and Uruguay have both legalized marijuana with scant regard for UN treaty prohibitions. And of course there is Portugal's broad decriminalization system, encompassing all drugs.

There's a real lesson in all of this: The UN drug treaties, the legal backbone of global drug prohibition, have proven to be toothless. There is no effective mechanism for punishing most countries for violating those treaties, at least not relative to the punishing effects they suffer from prohibition. Other countries will take heed.

2. Afghanistan Remains the World's Opium Breadbasket

When the US invaded Afghanistan in late 2001, it entered into a seemingly endless war to defeat the Taliban and, along with it, the opium trade. Sixteen years and more than a trillion dollars later, it has defeated neither. Afghanistan was already the world's leading producer of opium then, and it still is.

According to the UN Office on Drugs and Crime, in 2000, the country produced more than 3,000 tons of opium. The following year, with the Taliban imposing a ban on poppy planting in return for US aid and international approval, production dropped to near zero. But in 2002, production was back to more than 3,000 tons, and Afghan poppy farmers haven't looked back since.

In the intervening years, Afghanistan has accounted for the vast majority of global opium production, reaching 90% in 2007 before plateauing to around 70% now (as production increases in Latin America). It has consistently produced at least 3,000 tons a year, with that amount doubling in selected years.

For years, US policymakers were caught in a dilemma, and drug war imperatives were subordinated to anti-Taliban imperatives. The problem was that any attempt to go after opium threatened to push peasants into the hands of the Taliban. Now, the Trump administration is bombing Taliban heroin facilities. But it hasn't bombed any heroin facilities linked to corrupt Afghan government officials.

Holland's famous cannabis cafes were the first break with global marijuana prohibition. (Creative Commons)
3. Movement Toward Acceptance of Recreational Marijuana

Twenty years ago, only the Netherlands had come to terms -- sort of -- with marijuana, formally keeping it illegal, but, in a prime example of the Dutch's policy of gedogen (pragmatic tolerance), with possession and sale of small amounts allowed. (The Dutch are only now finally dealing with the "backdoor problem," the question of where cannabis cafes are supposed to get their supplies if it can't be grown legally).

The first entities to legalize marijuana were the US states of Colorado and Washington in 2012, and Uruguay became the first country in the world to legalize marijuana in 2014. Canada will become the second country to do so next year. In the meantime, six more US states and the District of Columbia have also jumped on the bandwagon.

While full legalization may yet be a bridge too far for most European and Latin American countries, marijuana decriminalization has really taken hold there, with numerous countries in both regions having embraced the policy. Marijuana has now been decriminalized in Argentina, Austria, Belgium, Belize, Bolivia, Brazil, Chile, Colombia (you can possess up to 22 grams legally), Costa Rica, Croatia, the Czech Republic, Equador, Estonia, Georgia, Greece, Italy, Jamaica, Luxembourg, Malta, Mexico, Moldova, Paraguay, Peru, Portugal, Slovenia, Spain, Switzerland, and Ukraine, among others. Oh, and Iran, too.

4. Andean Whack-A-Mole: The Fruitless Quest to Quash Cocaine

The United States, and to a much lesser degree, the European Union, have spent billions of dollars trying to suppress coca leaf cultivation and cocaine production in Bolivia, Colombia, and Peru. It hasn't worked.

According to the UN Office on Drugs and Crime (UNODC), coca leaf cultivation was just under 500,000 acres in 1998; this week, UNODC reported that coca leaf cultivation was at 470,000 acres last year -- and that's not counting the 75,000 acres under legal cultivation in Bolivia.

When it comes to actual cocaine production, it's pretty much the same story: Again according to the UNODC, cocaine production was at 825 tons in 1998, peaked at just over a million tons a year in 2004-2007, and is now at just under 800 tons. There have been peaks and troughs, but here we are, pretty much in the same place we started.

Military intervention didn't stop it. Military and anti-drug assistance hasn't stopped it. Alternative development programs haven't stopped it. The global cocaine market is insatiable, and nothing has been able to tear Andean peasant farmers from what is by far their best cash crop. Bolivia, at least, has largely made peace with coca -- although not cocaine -- providing a legal, regulated market for coca farmers, but in Peru and Colombia eradication and redevelopment efforts continue to spark conflict and social unrest.

5. Mexico's Brutal Drug Wars

During the 1980s and 1990s, accusations ran rampant that in a sort of pax mafiosi, the Mexican government cut deals with leading drug trafficking groups to not so much fight the drug trade as manage it. Those were the days of single party rule by the PRI, which ended with the election of Vicente Fox in 2000. With the end of single party rule, the era of relative peace in the drug business began to unravel.

As old arrangements between drug traffickers and political and law enforcement figures fell apart, so did the informal codes that governed trafficker behavior. When once a cartel capo would accept his exemplary arrest, during the Fox administration, the gangsters began shooting back at the cops -- and fighting among themselves over who would control which profitable franchise.

Things took a turn for the worse with the election of Felipe Calderon in 2006 and his effort to burnish his political credentials by sending in the army to fight the increasingly wealthy, violent, and brazen cartels. And they haven't gotten any better since. While American attention to Mexico's drug wars peaked in 2012 -- a presidential election year in both countries -- and while the US has thrown more than a billion dollars in anti-drug aid Mexico's way in the past few years, the violence, lawlessness, and corruption continues. The death toll is now estimated to be around 200,000, and there's no sign anything is going to change anytime soon.

Well, unless we take leading 2018 presidential candidate Andres Manuel Lopez Obrador (AMLO) at his word. This week, AMLO suggested a potential amnesty for cartel leaders, indicating, for some, at least, a pax mafiosi is better than a huge, endless pile of corpses.

6. Latin America Breaks Away from US Drug War Hegemony

The US imports its drugs and exports its prohibition-related violence, and the region grows tired of paying the price for America's war on its favorite vices. When once Latin American leaders quietly kowtowed to drug war demands from Washington, at least some of them have been singing a different tune in recent years.

Bolivia under Evo Morales has resolutely followed its own path on legalizing coca cultivation, despite bellows from Washington, successive Mexican presidents weary of the bloodshed turn an increasingly critical eye toward US drug war imperatives, Colombian President Juan Manuel Santos sees what Washington-imposed prohibitionist policies have done to his county and cries out for something different, and so did Guatemalan President Otto Perez Molina before he was forced out of office on corruption charges.

Latin American countries are also increasingly pursuing their own drug policies, whether it's constitutionally protected legalization of personal use amounts of drugs in Colombia, decriminalization of marijuana across the continent, or downright legalization in Uruguay, Latin American leaders are no longer taking direction from Washington -- although they generally remain happy to take US anti-drug dollars.

A North American first: Vancouver's safe injection site opened in 2003. (Creative Commons)
7.Safe Injection Sites Start Spreading

The notion of providing a place where intravenous drug users could shoot up under medical supervision and get access to referrals to public health and welfare services was derided by foes as setting up "shooting galleries" and enabling drug use, but safe injection sites have proven to be an effective intervention, linked to reduced overdoses, reduced crime, and moving drug users toward treatment.

These examples of harm reduction in practice first appeared in Switzerland in the late 1980s; with facilities popping up in Germany and the Netherlands in the 1990s; Australia, Canada, Luxembourg, Norway, and Spain in the 2000s; and, most recently, Denmark and France.

By now, there are nearly a hundred safe injection sites operating in at least 61 cities worldwide, including 30 in Holland, 16 in Germany, and eight in Switzerland. We are likely to see safe injection sites in Ireland and Scotland very soon.

It looks like they will soon be appearing in the United States, too. Officials in at least two cities, San Francisco and Seattle, are well on the way to approving them, although the posture of the federal government could prove an obstacle.

8. And Heroin Maintenance, Too

Even more forward looking as a harm reduction measure than safe injection sites, heroin maintenance (or opiate-assisted treatment) has expanded slowly, but steadily over the past two decades. The Swiss did the first trials in 1994, and now such programs are available there (after decisively winning a 2008 referendum on the issue), as well as Germany and the Netherlands.

Such programs have been found to reduce harm by helping users control their drug use, reducing overdoses, reducing drug-related disease, and promoting overall health and well-being, while also reducing social harms by reducing crime related to scoring drugs, reducing public use and drug markets, and promoting less chaotic lifestyles among participants, leading to increased social integration and better family life and employment prospects.

A Canadian pilot program, the North American Opiate Medication Initiative (NAOMI) produced similar results. Maybe the United States will be ready to get it a try one of these years.

9. New Drugs, New Markets

So far, this has been the century of new drugs. Known variously as "research chemicals," "designer drugs," or fake this and that, let's call them new psychoactive substances (NSPs). Whether it's synthetic cannabinoids, synthetic cathinones, synthetic benzodiazepines, synthetic opioids, or something entirely novel, someone somewhere is producing it and selling it.

In its 2017 annual review, the European Monitoring Center on Drugs and Drug Addictions (EMCDDA) reported in was monitoring 620 NSPs, up from 350 in 2013, and was adding new ones at the rate of over one a week.

These drugs, often of unknown quality or potency, in some cases have wreaked havoc among drug users around the world and are a prime example of the bad things that can happen when you try to suppress some drugs: You end up with worse ones.

The communications technology revolution that began with the world wide web impacts drug policy just as it impact everything else. Beginning with the infamous Silk Road drug sales website, the dark web and the Tor browser have enabled drug sellers and consumers to hook up anonymously online, with the drugs delivered to one's doorstep by Fedex, UPS, and the like.

Silk Road has been taken down and its proprietor, Ross Ulbricht, jailed for decades in the US, but as soon as Silk Road was down, new sites popped up. They got taken down, and again, new sites popped up. Rinse and repeat.

European authorities estimate the size of the dark web drug marketplace at about $200 million a year -- a fraction of the size of the overall trade -- but warn that it is growing rapidly. And why not? It's like an Amazon for drugs.

10.Massacring Drug Suspects in Southeast Asia

Philippines President Rodrigo Duterte has drawn international condemnation for the bloody war he unleashed on drug suspects upon taking office last year. Coming from a man who made his reputation for leading death squads while Mayor of Davao City, the wave of killings is shocking, but not surprising. The latest estimates are that some 12,000 people have been killed.

What's worse is that Duterte's bad example seems to be gaining some traction in the neighborhood. Human rights groups have pointed to a smaller wave of killings in Indonesia, along with various statements from Indonesian officials expressing support for Duterte-style drug executions. And most recently, a Malaysian member of parliament urged his own country to emulate Duterte's brutal crackdown.

This isn't the first time Southeast Asia has been the scene of murderous drug war brutality. Back in 2003, then Thai Prime Minister Thaksin Shinawatra launched a war on drugs that saw 2,800 killed in three months.

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.


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%.

Chronicle AM: BC Calls for Radical Opioid Response, 2nd MI MJ Init, More... (8/17/17)

BC health officials present some revolutionary recommendations for dealing with the opioid crisis, Alaska officials defend marijuana legalization, a second Michigan legalization initiative is okayed for signature gathering, and more.

British Columbia health officials say users should be provided drugs to take home, be able to grow opium poppies. (Wikimedia)
Marijuana Policy

Alaska Officials Defend Legalization in Letters to Sessions. Gov. Bill Walker (I) and Attorney General Jahna Lindemuth have sent two letters to Attorney General Sessions defending their state's marijuana law and the wishes of state voters. Their letters are a response to a letter Sessions sent to governors of legalization states in July. "Marijuana regulation is an area where states should take the lead," they said in the first letter, dated August 1. "We ask that the DOJ maintain its existing marijuana policies because the State relied on those assurances in shaping our regulatory framework, and because existing policies appropriately focus federal efforts on federal interests," they said in the second letter, dated August 14.

Second Michigan Legalization Initiative Gets Okay for Signature Gathering. The state Board of Canvassers on Thursday approved a second marijuana legalization initiative for signature gathering. The initiative, from a group called Abrogate Prohibition Michigan, would end "all prohibitions on the use of cannabis in any form by any person" and specify that no taxes could be imposed. Another group, MI Legalize, is already halfway through the signature gathering phase for its initiative, which envisions legalization, taxation, and regulation.

Los Angeles Gets a Cannabis Czar. The city council voted on Wednesday to approve Cat Packer as executive director of the city's newly fashioned Department of Cannabis Regulation. Packer is a former Drug Policy Alliance state policy coordinator for California. She was also a campaign coordinator for Californians for Responsible Marijuana Reform, part of the Prop 64 campaign. She will be charged with rolling out regulations for legal marijuana in the city.

Harm Reduction

Washington King County Initiative to Ban Safe Injection Sites Likely Won't Make Ballot. A measure to ban safe injection sites in Seattle's suburban King County is unlikely to be on the November ballot. Petition organizers handed in sufficient signatures on time, but it took two weeks for the petitions to get from the King County Council clerk to King County Elections, so the initiative has missed an August 1 deadline to be certified for the ballot. It could go on the ballot in a February special election, but initiative sponsors say they fear it will be too late to prevent safe injection sites by then.


British Columbia Health Authorities Call for Revolutionary Approach to Opioid Crisis. The BC Center for Disease Control has issued a set of recommendations for dealing with opioid use and overdoses that includes providing users with drugs they can take home with them and allowing people to grow their own opium. The current approach to addiction is backwards, BCCDC Executive Medical Director Mark Tyndall told the Globe and News: "We strongly advise people to stop using street drugs, and if they can't do that, then we offer them… Suboxone or methadone, and if that doesn't work, we basically tell them to go and find their own drugs even though there is a very real possibility of dying," he said. "What we should be doing -- especially in an environment of a poisoned drug supply -- is to start with access to uncontaminated drugs so at least people don't die, then move on to substitution therapy and eventually recovery."

Chronicle AM: WH Opioid Panel Calls for Declaration of National Emergency, More... (8/1/2017)

Federal bills to legalize marijuana and allow drug testing of people seeking unemployment benefits get filed, the presidential commission on opioids issues a preliminary reports, the NFL offers to work with the players' union on medical marijuana, and more.

Marijuana Policy

With overdoses at record levels, Trump's presidential commission takes a largely public health approach to the crisis.
Corey Booker Files Federal Marijuana Legalization Bill. Sen. Cory Booker (D-NJ) filed the Marijuana Justice Act on Tuesday. The bill would remove marijuana from the Controlled Substances Act, punish states for disproportionately arresting or imprisoning poor people or minorities for marijuana offenses, prevent deportation for marijuana offenses, provide for resentencing of federal marijuana prisoners, and create a $500 million "Community Reinvestment Fund" for communities most negatively impacted by the war on drugs.

South Dakota Legalization Initiative Imperiled by Wording Error. A legalization initiative sponsored by New Approach South Dakota could be in trouble over a wording error. The way the measure is worded, it would, according to Legislative Council analysts, only legalize pot paraphernalia, not marijuana itself. The campaign said the problem is only a "typo" and can be fixed. Friendly legislators have offered to author a legislative fix if the initiative passes. Because of state initiative deadlines, it is too late for petitioners to start over in time to get on the November 2018 ballot.

Medical Marijuana

NFL Offers to Work With Players Union on Marijuana for Pain Management. The NFL has sent a letter to the NFL Players Association offering to work together with the union to study the possibility of marijuana as a pain management tool for players. The NFLPA is already conducting its own study and has yet to respond to the league's offer.

Ohio Medical Marijuana Rules Get Settled. A bipartisan legislative panel has decided not to modify more than a hundred separate rules proposed by the state Pharmacy Board and Department of Commerce to govern the state's nascent medical marijuana industry. That means medical marijuana growers, processers, sellers, testers, and users can now begin to get down to business. Growing operations are expected to start being licensed next month, and the whole system is supposed to be up and running by September 1, 2018.

Utah Poll Finds "Supermajority" Support for Medical Marijuana. Nearly four out of five (78%) Utahns favor a medical marijuana initiative now in the signature gathering phase of its campaign, according to a Dan Jones & Associates poll commissioned by the Salt Lake Tribune. The campaign is headed by the Utah Patients Coalition, which is acting after the state legislature baling at approving medical marijuana.

Drug Testing

Federal Unemployment Drug Testing Bill Filed. Rep. Buddy Carter (R-SC) has filed the Ensuring Quality in the Unemployment Insurance Program (EQUIP) Act, which would require people applying for unemployment assistance to undergo substance abuse screening and possible drug testing to receive benefits. "Unemployment is not for people who are abusing drugs and using that money to buy drugs but instead to help them get back on their feet," said Rep. Carter. "And we want to make sure that is what they are doing with it." People applying for those benefits have been laid-off from jobs for lack of work, not let go for drug abuse.

Heroin and Prescription Opioids

Presidential Commission Issues Belated Preliminary Report, Calls for Declaration of National Emergency. The presidential Commission on Combating Drug Addiction and the Opioid Crisis led by Gov. Chris Christie (R-NJ) issued a preliminary report on Monday whose lead recommendation is for the president "to declare a national emergency under either the Public Service Act or the Stafford Act." The report largely takes a public health approach to the issue, calling as well for expanding drug treatment capacity under Medicaid, increasing the use of medication-assisted treatment for opioid disorders, mandating that all police officers carry the opioid overdose reversal drug naloxone, broadening Good Samaritan laws, and encouraging the development of non-opioid pain relievers.

America, We Can Fix This: 24 Ways to Reduce Opioid Overdoses and Addiction [FEATURE]

Drugs, mainly opioids, are killing Americans at a record rate. The number of drug overdose deaths in the country quadrupled between 1999 and 2010 -- and compared to the numbers we're seeing now, those were the good old days.

Some 30,000 people died of drug overdoses in 2010. According to a new estimate from the New York Times, double that number died last year. And the rate of increase in overdose deaths was growing, up a stunning 19% over 2015.

The Times' estimate of between 59,000 and 65,000 drug overdose deaths last year is greater than the number of American soldiers killed during the entire Vietnam War, greater than that number of people killed in the peak year for car crash deaths, greater than the number of people who died in the year the AIDS epidemic peaked, and higher than the peak year for gun deaths.

In the first decade of the century, overdoses and addiction rose in conjunction with a dramatic increase in prescription opioid prescribing; since then, as government agents and medical professionals alike sought to tamp down prescribing of opioids, the overdose wave has continued, now with most opioid OD fatalities linked to illicit heroin and powerful black market synthetic opioids, such as fentanyl and carfentanil.

The Centers for Disease Control and Prevention says we are in the midst of "the worst drug overdose epidemic in history," and it's hard to argue with that.

So, what do we do about it? Despite decades of failure and unintended consequences, the prohibitionist reflex is still strong. Calls for more punitive laws, tougher prosecutorial stances, and harsher sentences ring out from state houses across the land to the White House. But tough drug war policies haven't worked. The fact that the overdose and addiction epidemic is taking place under a prohibition regime should make that self-evident.

More enlightened -- and effective -- approaches are now being tried, in part, no doubt, because today's opioid epidemic is disproportionately affecting white, middle class people and not the inner city black people identified with heroin epidemics of the past. But they are also being tried because for the past quarter-century an ever-growing drug reform movement has articulated the failures of prohibition and illuminated more effective alternatives.

The drug reform movement's most powerful organization, the Drug Policy Alliance, this spring published A Public Health and Safety Approach to Problematic Opioid Use and Overdose, which lays out more than two dozen specific policy prescriptions in the realms of addiction treatment, harm reduction, prevention, and criminal justice that have been proven to save lives and reduce dependency on opioids. These policy prescriptions are doable now -- and some are being implemented in some fashion in some places -- but require that political decisions be made, or that forces be mobilized to get those decisions made. Some would require a radical divergence from the orthodoxies of drug prohibition, but that's a small price to pay given the mounting death toll.

Here are 24 concrete policy proposals that can save lives and reduce addiction right now. All the facts and figures are fully documented in the heavily-annotated original. Consult it if you want to get down to the nitty-gritty. In the meantime:

Addiction Treatment

1. Create Expert Panel on Treatment Needs: States should establish an expert panel to address effective treatment needs and opportunities. The expert panel should evaluate barriers to existing treatment options and make recommendations to the state legislature on removing unnecessary impediments to accessing effective treatment on demand. Moreover, the panel should determine where gaps in treatment exist and make recommendations to provide additional types of effective treatment and increased access points to treatment (such as hospital-based on demand addiction treatment). The expert panel must also set evidence-based standards of care and identify the essential components of effective treatment and recovery services to be included in licensed facilities, especially with regards to medication-assisted treatment, admission requirements, discharge, continuity of care and/or after-care, pain management, treatment programming, integration of medical and mental health services, and provision of or referrals to harm reduction services. The expert panel should identify how to improve or create referral mechanisms and treatment linkages across various healthcare and other providers. The panel should establish clear outcome measures and a system for evaluating how well providers meet the scientific requirements the panel sets. And, finally, the expert panel should evaluate opportunities under the ACA to expand coverage for treatment.

2. Increase Insurance Coverage for Medication-Assited Treatment (MAT): Seventeen state medical plans under the Patient Protection and Affordable Care Act (ACA) do not provide coverage for methadone or buprenorphine for opioid dependence. Moreover, the Veterans Administration's (VA's) insurance system has explicitly prohibited coverage of methadone and buprenorphine treatment for active duty personnel or for veterans in the process of transitioning from Department of Defense care. As a result, veterans obtaining care through the VA are denied effective treatment for opioid dependence. Insurance coverage for these critical medications should be standard practice.

3. Establish and Implement Office-Based Opioid Treatment for Methadone: Currently, with a few exceptions, methadone for the treatment of opioid dependence is only available through a highly regulated and widely stigmatized system of Opioid Treatment Programs (OTPs). Moreover, several states have imposed moratoriums on establishing new OTPs that facilitate methadone treatment despite large, unmet treatment needs for a growing opioid-dependent population. Patients enrolled in methadone treatment in many communities are often limited to visiting a single OTP and face other inconveniences that make adherence to treatment more difficult. Initial trials have suggested that methadone can be effectively delivered in office-based settings and that, with training, physicians would be willing to prescribe methadone to their patients to treat their opioid dependence. Office-based methadone may help reduce the stigma associated with methadone delivered in OTPs as well as provide a critical window of intervention to address medical and psychiatric conditions. Office-based opioid treatment programs offering methadone have been implemented in California, Connecticut, and Vermont.

4. Provide MAT in Criminal Justice Settings, Including Jails/Prisons and Drug Courts: Individuals recently released from correctional settings are up to 130 times more likely to die of an overdose than the general population, particularly in the immediate two weeks after release. Given that approximately one quarter of people incarcerated in jails and prisons are opioid-dependent, initiating MAT behind bars should be a widespread, standard practice as a part of a comprehensive plan to reduce risk of opioid fatality. Jails should be mandated to continue MAT for those who received it in the community and to assess and initiate new patients in treatment. Prisons should initiate methadone or buprenorphine prior to release, with a referral to a community-based clinic or provider upon release. In addition, drug courts should be mandated to offer participants the option to participate in MAT if they are not already enrolled, make arrangements for their treatment, and should not be permitted to make discontinuation of MAT a criterion for successful completion of drug court programs. The Substance Abuse and Mental Health Services Administration will no longer provide federal funding to drug courts that deny the use of MAT when made available to the client under the care of a physician and pursuant to a valid prescription. The National Association of Drug Court Professionals agrees: "No drug court should prohibit the use of MAT for participants deemed appropriate and in need of an addiction medication."

Medication-Assisted Treatment (MAT) can help.
5. Offer Hospital-Based MAT: Emergency departments should be mandated to inform patients about MAT and offer buprenorphine to those patients that visit emergency rooms and have an underlying opioid use disorder, with an appointment for continued treatment with physicians in the community. Hospitals should also offer MAT within the inpatient setting, and start MAT prior to discharge with community referrals for ongoing MAT.

6. Assess Barriers to Accessing MAT to Increase Access to Methadone and Buprenorphine: A number of known barriers prevent MAT from being as widely accessible as it should be. The federal government needs to reevaluate the need for and effectiveness of the OTP model and make necessary modifications to ensure improved and increased access to methadone. And, while federal law allows physicians to become eligible to prescribe buprenorphine for the treatment of opioid dependence, it arbitrarily caps the number of opioid patients a physician can treat with buprenorphine at any one time to 30 through the first year following certification, expandable to up to potentially 200 patients thereafter. Moreover, states need to evaluate additional barriers created by state law, including, among others, training and continuing education requirements, restrictions on nurse practitioners, insurance enrollment and reimbursement, and lack of provider incentives.

7. Establish and Implement a Heroin-Assisted Treatment Pilot Program: Heroin-assisted treatment (HAT) refers to the administering or dispensing of pharmaceutical-grade heroin to a small and previously unresponsive group of chronic heroin users under the supervision of a doctor in a specialized clinic. The heroin is required to be consumed on-site, under the watchful eye of trained professionals. This enables providers to ensure that the drug is not diverted, and allows staff to intervene in the event of overdose or other adverse reaction. Permanent HAT programs have been established in the United Kingdom, Switzerland, the Netherlands, Germany and Denmark, with additional trial programs having been completed or currently taking place in Spain, Belgium and Canada. Findings from randomized controlled studies in these countries have yielded unanimously positive results, including: 1) HAT reduces drug use; 2) retention rates in HAT surpass those of conventional treatment; 3) HAT can be a stepping stone to other treatments and even abstinence; 4) HAT improves health, social functioning, and quality of life; 5) HAT does not pose nuisance or other neighborhood concerns; 6) HAT reduces crime; 7) HAT can reduce the black market for heroin; and, 8) HAT is cost-effective (cost-savings from the benefits attributable to the program far outweigh the cost of program operation over the long-run). States should consider permitting the establishment and implementation of a HAT pilot program. Nevada and Maryland have introduced legislation of this nature and the New Mexico Legislature recently convened a joint committee hearing to query experts about this strategy.

8. Evaluate the Use of Cannabis to Decrease Reliance on Prescription Opioids and Reduce Opioid Overdose Deaths: Medical use of marijuana can be an effective adjunct to or substitute for opioids in the treatment of chronic pain. Research published last year found 80 percent of medical cannabis users reported substituting cannabis for prescribed medications, particularly among patients with pain-related conditions. Another important recent study reported that cannabis treatment "may allow for opioid treatment at lower doses with fewer [patient] side effects." The result of substituting marijuana, a drug with less side effects and potential for abuse, has had profound harm reduction impacts. The Journal of the American Medical Association, for instance, documents a relationship between medical marijuana laws and a significant reduction in opioid overdose fatalities: "[s]tates with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws."Another working paper from the RAND BING Center for Health Economics notes that "states permitting medical cannabis dispensaries experienced a 15 to 35 percent decrease in substance abuse admissions and opiate overdose deaths." There is also some emerging evidence that marijuana has the potential to treat opioid addiction, but additional research is needed.

Harm Reduction

9. Establish and Implement Safe Drug Consumption Services: States and/or municipalities should permit the establishment and implementation of safe drug consumption services through local health departments and/or community-based organizations. California and Maryland have introduced legislation to establish safe drug consumption services, and the City of Ithaca, New York has included a proposal for a supervised injection site in their widely-publicized municipal drug strategy. In Washington State, the King County Heroin an Prescription Opiate Addiction Task Force has recommended the establishment of at least two pilot supervised consumption sites as part of a community health engagement program designed to reduce stigma and "decrease risks associated with substance use disorder and promote improved health outcomes" in the region that includes the cities of Seattle, Renton and Auburn.

10. Maximize Naloxone Access Points, Including Lay Distribution and Pharmacy Access, As Well As Immunities for Prescription, Distribution and Administration:Naloxone should be available directly from a physician to either a patient or to a family member, friend, or other person in a position to assist in an overdose, from community-based organizations through lay distribution or standing order laws, and from pharmacies behind-the-counter without a prescription through standing order, collaborative agreement, or standardized protocol laws or regulations. Though some states, including California, New York, Colorado and Vermont, among others, have access to naloxone at each of these critical intervention points, many others only provide naloxone through a standard prescription. Civil and criminal immunities should be provided to prescribers, dispensers and lay administrators at every access point. In addition, all first responders, firefighters and law enforcement should be trained on how to recognize an overdose and be permitted to carry and use naloxone. Naloxone should also be reclassified as an over-the-counter (OTC) medication. Having naloxone available over-the-counter would greatly increase the ability of parents, caregivers, and other bystanders to intervene and provide first aid to a person experiencing an opioid overdose. FDA approval of OTC naloxone is predicated on research that satisfies efficacy and safety data requirements. Pharmaceutical companies, however, have not sought to develop an over-the-counter product.88 Federal funding may be needed to meet FDA approval requirements.

11. Provide Dedicated Funding for Community-Based Naloxone Distribution and Overdose Prevention and Response Education: Few states provide dedicated budget lines to support the cost of naloxone or staffing for community-based opioid overdose prevention programs. The CDC, however, reports that, between 1996 and 2014, these programs trained and equipped more than 152,280 laypeople with naloxone, who have successfully reversed 26,463 opioid overdoses.89 Without additional and dedicated funding, community-based opioid overdose prevention programs will not be able to continue to provide naloxone to all those who need it, and the likelihood of new programs being implemented is slim. A major barrier to naloxone access is its affordability and chronic shortages in market supply, 90 which overdose prevention programs, operating on shoestring budgets, can have a difficult time navigating.

12. Improve Insurance Coverage for Naloxone: Individuals who use heroin and other opioids are often both uninsured and marginalized by the healthcare system.91 States should insure optimal reimbursement rates for naloxone to increase access to those who need it most – users themselves.

Overdose reversal drugs need to be made much more widely available -- and affordable. (
13. Provide Naloxone to Additional At-Risk Communities: People exiting detox and other treatment programs as well as periods of incarceration are at particularly high risk for overdose because their tolerance has been substantially decreased. After their period of abstinence, if they relapse and use the same amount, the result is often a deadly overdose. States should require overdose education and offer naloxone to people upon discharge from detox and other drug treatment programs and jails/prisons. The Substance Abuse and Mental Health Services Administration has declared that prescribing or dispensing naloxone is an essential complement to both detoxification services as well as medically supervised withdrawal. Vermont passed legislation making naloxone available to eligible pilot project participants who are transitioning from incarceration back to the community. In addition, there are other programs/studies that provide naloxone to recently released individuals on a limited basis, including in San Francisco, California, King County, Washington and Rhode Island.

14. Encourage Distribution of Naloxone to Patients Receiving Opioids: Physicians should be encouraged to prescribe naloxone to their patients and opioid treatment programs should inform their clients about naloxone, if prescribing or dispensing an opioid to them. Pharmacists should similarly be encouraged to offer naloxone along with all Schedule II opioid prescriptions being filled, for syringe purchases (without concurrent injectable medication), and for all co-prescriptions (within 30 days) of a benzodiazepine (such as Valium™, Xanax™ or Klonopin™) and any opioid medication. The Rhode Island Governor's Overdose Prevention and Intervention Task Force found that offering naloxone to those prescribed a Schedule II opioid or when co-prescribed a benzodiazepine and any opioid would have reached 86% of overdose victims who received a prescription from a pharmacy prior to their death, and could have prevented 58% of all overdose deaths from 2014 to 2015.

15. Expand Good Samaritan Protections: "Good Samaritan" laws provide limited immunity from prosecution for specified drug law violations for people who summon help at the scene of an overdose. But, protection from prosecution is not enough to ensure that people are not too frightened to seek medical help. Other consequences, like arrest, parole or probation violations, and immigration consequences, can be equal barriers to calling 911. States with Good Samaritan laws already on the books should evaluate the protections provided and determine whether expansion of those protections would increase the likelihood that people seek medical assistance.

16. End the Criminalization of Syringe Possession: Syringes should be exempt from state paraphernalia laws in order to provide optimal access to people who inject drugs. Twenty-two states criminalize syringe possession. Thus, even if there is a legal access point, such as pharmacy sales, paraphernalia laws still permit law enforcement to arrest and prosecute individuals in possession of a syringe. Public health and law enforcement authorities should not be working at cross-purposes.

17. Reduce Barriers to Over-The-Counter Syringe Sales and Permit Direct Prescriptions of Syringes: While the non-prescription, over-the-counter sale of syringes is now permitted in all but one U.S. state, access is still unduly restricted.States should evaluate the potential barriers to accessing syringes over-thecounter and implement measures to improve access. Moreover, doctors should be permitted to prescribe syringes directly to their patients, a practice few states currently permit.

18. Authorize and Fund Sterile Syringe Access and Exchange Programs; Increase Programs: States should explicitly authorize and fund sterile syringe access and exchange programs, and states that have already authorized them should evaluate how to increase the number or capacity of programs to ensure all state residents – whether in urban centers or rural communities -- have access to clean syringes, as well as evaluate any possible barriers to access such as unnecessary age restrictions.

19. Provide Free Public, Community-Level Access to Drug Checking Services: Technology exists to test heroin and opioid products for adulterants via GC/MS analysis, but it has so far been unavailable at a public level in the US (aside from a mail-in service run by Making these services available in the context of a community outreach service or academic study would lower the number of deaths and hospitalizations and also allow for real-time tracking of local drug trends.


20. Establish Expert Panel on Opioid Prescribing: Though the CDC has issued guidelines for prescribing opioids for chronic pain, the guidelines are voluntary and are likely to exacerbate disparities in treatment that already exist. Research has shown, for example, that African Americans are less likely than whites to receive opioids for pain even when being treated for the same conditions. Moreover, the CDC guidelines only address prescribing practices for chronic pain, not prescribing practices more broadly. States should accordingly establish an expert panel to undertake an assessment as to whether prescribing practices, such as co-prescriptions for benzodiazepines and opioids or overprescribing of opioids, have contributed to increased rates of opioid dependence, and, if so, the expert panel should develop a plan to address any such linkages as well as any treatment disparities. The plan must account for the potential negative effects of curtailing prescribing practices or swiftly reducing prescription opioid prescribing volume. A task force in Rhode Island found that while changes in opioid supply can have the intended effect of reducing availability of abuse-able medications, they have also been linked to an increase in transition to illicit drug use and in more risky drug use behaviors (e.g., snorting and injecting pain medications). The plan must also account for chronic pain patients, particularly those already underserviced, and not unduly limit their access to necessary medications. Finally, to the extent prescribing guidelines are issued as part of the plan, they should be mandatory and applied across the board.

21. Mandate Medical Provider Education: States should mandate that all health professional degree-granting institutions include curricula on opioid dependence, overdose prevention, medication-assisted treatment, and harm reduction interventions, and that continuing education on these topics be readily available.

22. Develop Comprehensive, Evidence-Based Health, Wellness, and Harm Reduction Curriculum for Youth: State education departments, in conjunction with an expert panel consisting of various stakeholders that ascribe to scientific principles of treatment for youth, should develop a comprehensive, evidence-based health, wellness, and harm reduction curriculum for use in schools that incorporates scientific education on drugs, continuum of use, and contributors to problematic drug use (e.g., coping and resiliency, mental health issues, adverse childhood experiences, traumatic events and crisis), as well as how reduce harm (e.g., not mixing opioids with benzodiazepines). Education departments should also establish protocols and resources for early intervention, counseling, linkage to care, harm reduction resources, and other supports for students.


23. Establish Diversion Programs, Including Law Enforcement Assisted Diversion (LEAD): LEAD is a pre-booking diversion program that establishes protocols by which police divert people away from the typical criminal justice route of arrest, charge and conviction into a health-based, harm-reduction focused intensive case management process wherein the individual receives support services ranging from housing and healthcare to drug treatment and mental health services. Municipalities should create and implement LEAD programs and states and the federal government should provide dedicated funding for such programs. Various other forms of diversion programs exist and can be implemented should LEAD prove unsuitable to a particular population or municipality.

24. Decriminalize Drug Possession: Decriminalization is commonly defined as the elimination of criminal penalties for drug possession for personal use. In other words, it means that people who merely use or possess small amounts of drugs are no longer arrested, jailed, prosecuted, imprisoned, put on probation or parole, or saddled with a criminal record. Nearly two dozen countries have taken steps toward decriminalization. Empirical evidence from the international experiences demonstrate that decriminalization does not result in increased use or crime, reduces incidences of HIV/AIDs and overdose, increases the number of people in treatment, and reduces social costs of drug misuse. All criminal penalties for possession of small amounts of controlled substances for personal use should be removed.

Drug War Issues

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