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The Opioid Crisis Could Cost a Half Million Lives in the Next Decade

The most recent data from the Centers for Disease Control and Prevention, released in mid-August, showed a record 72,000 drug overdose deaths last year, with 49,000 related to heroin, fentanyl and prescription opioids. According to the authors of a study released last week in the American Journal of Public Health, that could be the new normal.

The study, by Stanford researchers Allison Pitt, Keith Humphreys, and Margaret Brandeau, attempts to assess the number of opioid-related deaths we could expect to see over the next decade, as well as the impact of different policy responses on reducing the death toll.

The researchers said there are steps that can be taken to reduce the death toll, but also that some seemingly simple solutions, such as cracking down on opioid prescribing for chronic pain, could actually increase the toll. And even those policies that could cut the opioid death rate are likely to do so only marginally.

Using a mathematical model, the researchers estimate that some 510,000 people will die over the next decade because of opioid use. The number includes not only drug overdoses but also other opioid-related deaths, such as HIV infections caused by shared needles.

Even including the non-overdose deaths, the number is staggering. Last year was the worst year ever for opioid-related overdose deaths, but this research suggests we are going to see year after year of similar numbers.

Making the overdose reversal drug naloxone more widely available could cut opioid-related deaths by 21,200 over the next decade, allowing greater access to medication-assisted therapies with drugs such as buprenorphine and methadone would save another 12,500 lives, and reducing opioid prescribing for acute pain would prevent another 8,000 deaths, the researchers said. But those three policy moves combined would shave less than 10 percent off the overall death toll.

"No single policy is likely to substantially reduce deaths over 5 to 10 years," the researchers wrote.

While harm reduction interventions such as those above would save lives, some aspects of tightening opioid prescribing would actually increase opioid-related deaths by as much as the tens of thousands -- because they increase heroin deaths more than they cut painkiller deaths. Moves such as reducing prescribing for chronic pain, up-scheduling pain relievers to further restrict their prescribing, and prescription drug monitoring programs all tend to push existing prescription opioid users into the illicit heroin and fentanyl markers all end up contributing to net increases in opioid deaths over the 10-year period, the researchers found.

On the other hand, other interventions on the prescribing front, such as reducing acute prescribing for acute pain (pain that may be signficant but is short-term), reducing prescribing for transitional pain, reformulating drugs to make them less susceptible to misuse, and opioid disposal programs, appear to prevent more deaths than they cause.

Ultimately, reducing the opioid death toll includes reducing the size of the opioid-using population, the researchers say. That implies making addiction treatment more available for those currently using and preventing the initiation of a new generation of opioid users. Restrictions on prescribing, while possibly driving some current users to dangerous illicit markets, can have a long-term impact by reducing the number of people who develop a dependence on opioids.

Whether that's a tolerable tradeoff for those pain patients who don't get the relief they need from other medications -- or for patients and others who end up dying from street heroin but might have lived despite their prescription opioid use -- is a different question.

By all appearances, when it comes to the loss of life around opioids, it looks like a pretty sad decade ahead of us.

This article was produced by Drug Reporter, a project of the Independent Media Institute.

Saying Goodbye to Mr. Methadone: Dr. Bob Newman Dead at Age 80

Dr. Robert Newman died earlier this month after being struck by an automobile earlier this summer. He was 80 years old.

Bob Newman at a Beth Israel staff meeting in 1985 (Arthur H. Aufses Jr. MD Archives at Mt. Sinai)
If any one man can be credited with carving out a space for the use of methadone as a treatment for heroin addiction, he is that man. Working as a New York City public health doctor in the 1960s, he was given the task of ensuring that heroin addicts who wanted treatment could get treatment with methadone. His boss, city health department head Gordon Chase, told him he would be known as "Mr. Methadone."

While he did not achieve the goal of providing treatment to everyone who wanted it, Newman oversaw the rapid expansion of the city's fledgling methadone program in the early 1970s. The number of patients on methadone went from a handful to more than 10,000 in two years, and 35,000 by 1975.

And he stood up for those patients. When the NYPD wanted Newman to turn over patients' methadone records, he refused. Instead, he took to the courts to defend his patients' right to privacy -- and he won.

After that, he devoted his career to advocating for evidence-based treatment, traveling the country and the world and picking up a second moniker, "the methadone pope," as he advanced harm reduction ideas decades before they became popularized.

He faced opposition from abstinence and 12-step proponents, as well as from elected officials like New York City Mayor Rudy Giuliani, who in 1998 tried to shut down the city's methadone program on the moralistic grounds that it merely substituted one addiction for another. The diplomatic Newman didn't challenge Giuliani head on but instead used interviews to make his case that methadone treatment allowed addicts to lead productive lives.

Newman also advocated for a humane approach toward addicted mothers and pregnant women, supporting groups such as National Advocates for Pregnant Women in their fight against the demonization and criminalization of those women. He was a drug policy reformer who served for decades on the board of the Drug Policy Foundation and then its successor the Drug Policy Alliance.

As this century's opioid epidemic deepened, Newman was cautiously optimistic that the work he had begun decades earlier would help further destigmatize addiction. "I'm hoping that pragmatism will win out," he said. "As more and more Congresspeople, people in the general community and physicians have children who develop a problem with prescription drug use and can't get treatment for it, I think it will make people more receptive to opening doors to treatment."

Newman was not only an influential physician in addiction issues, he was a giant in the hospital world as a whole. He served as President of Beth Israel Medical Center in New York, and then of the entity that acquired Beth Israel along with other facilities -- and then of the entity that acquired that entity. But one could still talk him at a drug policy conference, or send him an email, and you'd get an email back.

Dr. Robert Newman's contribution to an enlightened approach to addiction cannot be overstated. He will be missed, but his legacy lives on.

(Read Bob Newman's 1998 interview with this newsletter here.)

Chronicle AM: Norway Heroin-Assisted Treatment Plan, NJ Pol Says Marijuana Legalization "Soon," More... (8/10/18)

New Jersey's Senate president says marijuana legalization is coming "soon," the Norwegians begin moving toward heroin-assisted treatment, and more.

diacetylmorphine AKA pharmaceutical heroin -- coming soon to Norway to treat hardcore addicts (Creative Commons)
Marijuana Policy

Key New Jersey Pol Says Legalization Coming "Soon." "I think it's gonna happen soon," State Senate President Stephen Sweeney (D-Gloucester) told NJ Advance Media Thursday, saying it could happen as early as next month. "We'll have the legislation done. Then you have to do the regulations and everything else." He said he hoped to see a final draft of the bill, next week, hold hearings quickly, and vote in September. "We're getting much closer," Sweeney said.

International

British Police Commissioner Calls for Marijuana Freedom. Police and Crime Commissioner for North Wales Arfon Jones has called for marijuana users to be able to grow and sell the plant without fear of arrest in cannabis clubs. He is calling for the country to adopt Spanish-style marijuana "collectives" where members sell homegrown weed to each other. At least 75 cannabis clubs currently exist in Britain, all operating with a wink and a nod from local police.

Norway to Begin Providing Free Heroin to Hardcore Addicts. Norwegian Health Minister Bent Hoie has asked the Directorate of Health to create a list of heroin addicts must suitable for receiving heroin-assisted treatment and to assess the economic consequences of creating such a program. "We want to help those addicted who are difficult to reach, those who are not part of LAR (drug-assisted rehabilitation) and who are difficult to treat," he said. The pilot program is set to start in 2020 or 2021. Local governments in Oslo and Bergen are reportedly applying to participate.

Chronicle AM: PA Gov Says State Not Ready for Legal Pot, New FDA Guidelines on MATS, More... (8/9/18)

The FDA has issued new draft guidance aimed at expanding the use of medication-assisted treatments (MATs) for opioid addiction, Pennsylvania's governor says the state isn't ready for legal weed, the Oklahoma medical marijuana fight isn't over yet, and more.

Pennsylvania Gov. Tom Wolf (D) isn't on the same page as his counterparts in New York and New Jersey. (Creative Commons)
Marijuana Policy

Pennsylvania Governor Says State Not Ready for Marijuana Legalization. Gov. Tom Wolf (D) said during a radio interview on Tuesday that he doesn't think the state is ready to legalize marijuana. "There are, what, six states that have legalized recreational marijuana in the United States," Wolf said. (The actual number is nine.). "I don't think the citizens of Pennsylvania are ready for it, and so the answer I would say is no… I don't think Pennsylvania's actually ready for recreational marijuana." The position puts Wolf at odds with two neighboring Democratic governors, Phil Murphy of New Jersey, who is strongly pushing legalization, and Andrew Cuomo of New York, who just signed off on the notion.

Los Angeles Won't Vote on Raising Pot Tax in November. The city council has reversed a decision to place a 1% marijuana tax increase on the November ballot. The city estimated it would raise approximately $30 million per year from the tax increase, but faced immediate blowback from industry groups who said pot taxes were already too high and are driving consumers to the black market.

Medical Marijuana

Oklahoma Agencies Still Have "Concerns" Over Legal Medical Marijuana. Interim health commissioner Tom Bates told lawmakers Wednesday that the Health Board still has concerns about how medical marijuana will be implemented and that a special session of the legislature may be needed to see the program properly implemented. The board wants lawmakers to amend the law so that, among other changes, commercial grows are indoor only, patient home grows are prohibited or require a special license, smokable marijuana is prohibited, THC levels are limited to 12% or less, a pharmacist is required on-site at dispensaries, and that a list of qualifying conditions for patients be created. Some of the changes are among those recommended in the Health Board's first try at setting interim rules, which were retracted in the face of loud public opposition. Any effort to re-adopt them is certain to lead to renewed clamor.

Heroin and Prescription Opioids

FDA Seeks to Expand Use of Medication-Assisted Therapies for Addiction. The Food & Drug Administration (FDA) on Monday released new draft guidance aimed at promoting the creation and more widespread use of medication-assisted therapies (MATs) for opioid use disorder. The guidance adjusts how FDA evaluates new treatments for opioid addiction. Instead of only determining whether a treatment lowers opioid use, the agency will now assess whether the medication could help lower overdose rates and limit the spread of infectious disease. "We must consider new ways to gauge success beyond simply whether a patient in recovery has stopped using opioids, such as reducing relapse overdoses and infectious disease transmission," said Scott Gottlieb, FDA commissioner.

How to Prevent Opioid Overdoses? Provide Hard-Core Addicts Free Pharmaceutical Heroin

With Ohio beset by a massive public health crisis around opioid use and overdoses -- more than 4,000 Ohioans died of opioid overdoses in 2016 -- the Cleveland Plain Dealer sent travel editor Susan Glaser to Amsterdam in search of innovative approaches to the problem. While there, she rediscovered Holland's longstanding, radical, and highly-effective response to heroin addiction and properly asked whether it might be applied to good effect here.

The difference in drug-related death rates between the two countries is staggering. In the US, the drug overdose death rate is 245 per million, nearly twice the rate of its nearest competitor, Sweden, which came in second with 124 per million. But in Holland, the number is a vanishingly small 11 per million. In other words, Americans are more than 20 times more likely to die of drug overdoses than Dutch.

For Plain Dealer readers, the figures that really hit home are the number of state overdose deaths compared to Holland. Ohio, with just under 12 million people, saw 4,050 drug overdose deaths in 2016; the Netherlands, with 17 million people, saw only 235.

What's the difference? The Dutch government provides free heroin to several score hardcore heroin addicts and has been doing so for the past 20 years. Public health experts there say that in addition to lowering crime rates and improving the quality of life for users, the program is one reason overdose death rates there are so low. And the model could be applied here, said Amsterdam heroin clinic operator Ellen van den Hoogen.

"It's been an enormous success. I think it would work elsewhere," she told Glaser.

It already has. The Dutch program was modeled on a similar effort in Switzerland, which has also proven successful. Germany and Canada are among the several other countries with similar programs.

The Dutch approach is an example of the country's policy of gedogen (pragmatic tolerance), the same principle that led the Dutch to pioneer quasi-legal access to marijuana in the 1980s. It is also rooted in the notion that, for some, drug addiction is a chronic disorder, not a condition to be "cured," and one that can be treated with supervised drug use under clinical supervision. And the complete cessation of drug use need not be the ultimate goal; rather, the Dutch look for reductions in criminal activity and increases in the health and well-being of the drug users.

"It's not a program that is meant to help you stop," acknowledged van den Hoogen. "It keeps you addicted."

That's not a sentiment sits well with American moralizers, such as George W. Bush's drug czar, John Walters, whom Glaser consulted for the story. He suggested that providing addicts with drugs was immoral and not "real treatment," but he also resorted to lies about what the Dutch are doing.

He claimed the Dutch are "keeping people addicted for the purpose of controlling them" and that the Dutch have created "a colony of state-supported, locked-up addicts."

Actually, the Dutch are dealing with older, hardcore addicts who have repeatedly failed to quit after repeated stints in treatment, including methadone maintenance therapy, and they are neither "controlling them" or locking them up. Instead, the people in the program show up at the clinic twice a day, get their fix, then go about their business. This heroin-assisted treatment (HAT) allows those hardcore users to live less chaotic and more productive lives.

And heroin-assisted treatment is "real treatment," said Peter Blanken, a senior researcher with the Parnassia Addiction Research Centre in Rotterdam. He pointed out that one-quarter of program participants make a "complete recovery," including better health and quitting illegal drugs and excessive drinking. Many others continue to use heroin, but do so with better outcomes, he said.

There is also a real safety benefit to using state-supplied pharmaceutical heroin. It's potent, but it's a known quantity. Users face no risk of adulteration with more dangerous drugs, such as fentanyl, which is deeply implicated in the current US overdose crisis.

In the current political atmosphere in the United States, providing heroin to hardcore addicts is a hard sell indeed. Other, lesser, harm reduction interventions, such as needle exchanges remain controversial, and the country has yet to see its first officially sanctioned safe injection site. And drug decriminalization, which has led to a dramatic reduction in heroin addiction and overdose deaths in Portugal, remains off the table here, too. But with an annual drug overdose death toll of more than 50,000 people a year, it may time to start asking how many more Americans we are willing to sacrifice on the altar of moralistic drug prohibition.

Advocates Claim "Overdose Prevention" Bill Would Drive People Out of Treatment and Increase Overdoses [FEATURE]

A bill ostensibly aimed at reducing opioid overdoses passed the House last month, but rather than cheering it on, drug treatment and recovery advocates are lining up to block it in the Senate. That's because instead of being aimed at reducing overdoses, the bill is actually a means of removing patient privacy protections from some of the most vulnerable people with opioid problems, including people using methadone-assisted therapy to control their addictions.

The measure is now before the Senate. (Creative Commons)
And that, advocates say, is likely to increase -- not decrease -- opioid overdoses by pushing users away from drug treatment out of fear the information they reveal could be used against them. The fear is real: Unlike other medical conditions, drug addiction leaves patients open to criminal prosecution, as well as stigmatization and other negative social consequences if their status as drug treatment or maintenance patients is revealed.

This bill, H.R. 6082, the Overdose Prevention and Patient Safety Act, would remove drug treatment patients' ability to control the disclosure of information to health plans, health care providers, and other entities, leaving them with only the lesser privacy protections afforded to all patients under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

"The confidentiality law is often the only shield between an individual in recovery and the many forms of discrimination that could irreparably damage their lives and future," said Paul Samuels, President/Director of the Legal Action Center. "Unfortunately, there is a very real danger of serious negative consequences for people whose history of substance use disorder is disclosed without their explicit consent."

The Legal Action Center is spearheading the effort to block this bill with the Campaign to Protect Patients' Privacy Rights, which counts more than a hundred organizations, including the American Association for the Treatment of Opioid Dependence, AIDS United, Community Catalyst, Faces and Voices of Recovery, Facing Addiction, Harm Reduction Coalition, National Advocates for Pregnant Women, National Alliance for Medication Assisted Recovery and the, National Council on Alcoholism and Drug Dependence.

The current patient privacy protections, known as 42 C.F.R. Part 2 ("Part 2"), were established more than 40 years ago to ensure that people with a substance use disorder are not made more vulnerable to discriminatory practices and legal consequences as a result of seeking treatment. The rules prevent treatment providers from disclosing information about a patient's substance use treatment without patient consent in most circumstances. The bill's plan to replace Part 2's confidentiality requirements with HIPAA's more relaxed standards would not sufficiently protect people seeking and receiving SUD treatment and could expose patients to great harm, the advocates charge.

"They should call this the Taking Away Protections Act," said Jocelyn Woods, head of the National Alliance for Medication-Assisted Recovery. "People will be afraid to go into treatment. I'm getting emails from people who want to leave treatment before this happens. If I were going into a program and they can't tell me my information will be safe, I would think about turning around and walking out," she said.

"Many of us would not have gone to treatment or accepted services if we thought that our information would have been shared with other entities without our permission. We would not have put our careers, reputation or families at risk of stigma and discrimination if we were not assured that information about our substance use disorder was safe and would only be shared with our consent," added Patty McCarthy Metcalf, executive director of Faces and Voices of Recovery.

The push for the bill is being led by health information software companies and behavioral health providers, such as Hazelden and the Betty Ford Center, and it prioritizes convenience over patient privacy.

"This is because the behavioral health people see complying with the privacy requirements as a pain in the ass," said Woods. "They're going to have to fix their computer systems to block out any treatment program licensed by the federal government -- not just methadone programs -- and they don't want to do that. One of the software companies, Netsmart, complained that they don't want to mess with their programming," she said.

"We need Part 2," Woods continued. "It keeps police out of the program. Without it, police can walk right in. They already sit outside methadone clinics and bust people for DUI on the way out. If this passes, they will walk right in. If the police see anyone they think has a warrant or committed a crime, they're gone."

While the bill has made its way through the House, advocates are hopeful it will stall in the Senate.

"The House pushed this through because they wanted to look like they were doing something and because the behavioral health people were pushing for it," Woods said, "but my sense is that it's moving slowly in the Senate. We have this crazy president, and there's immigration, and the congressional break, and then campaign season. My hope is we can push this past the elections and a blue wave in November will give us a fighting chance."

But the campaign isn't taking any chances and is mobilized to fight on the Hill in the next few months to block the bill. As Mark Parrino, President of the American Association for the Treatment of Opioid Dependence warned: "In the midst of the worst opioid epidemic in our nation's history, we cannot afford to have patients fearful of seeking treatment because they do not have faith that their confidentiality will be protected."

Culture Shock: American Activists Confront Compassionate Portuguese Drug Policy [FEATURE]

The American activists couldn't wrap their heads around it. Sitting in a dingy office in a nondescript building in central Lisbon, they were being provided a fine-grained explanation of what happens to people caught with small amounts of drugs in Portugal, which decriminalized the possession of personal use amounts of drugs 17 years ago.

partial view of Lisbon, looking toward the Tagus River (Wikimedia)
The activists, having lived the American experience, wanted desperately to know when and how the coercive power of the state kicked in, how the drug users were to be punished for their transgressions, even if they had only been hit with an administrative citation, which is what happens to people caught with small quantities of drugs there.

Nuno Capaz was trying to explain. He is Vice Chairman of the Lisbon Dissuasion Commission, the three-member tribunal set up to handle people caught with drugs. He had to struggle mightily to convince the Americans that it wasn't about punishment, but about personal and public health.

"The first question," he explained, "is whether this person is a recreational user or an addict."

If the person is deemed only a recreational user, he may face a fine or a call to community service. If he is deemed an addict, treatment is recommended -- but not required.

"But what if they don't comply?" one of the activists demanded. "Don't they go to jail then?"

No, they do not. Instead, Capaz patiently explained, they may face sanctions for non-compliance, but those sanctions may be little more than a demand that they regularly present themselves to a hospital or health center for monitoring.

In a later hallway conversation, I asked Capaz about drug users who simply refused to go along or to participate at all. What happens then? I wanted to know.

Capaz shrugged his shoulders. "Nothing," he said. "I tell them to try not to get caught again."

Welcome to Portugal. The country's low-key, non-headline-generating drug policy, based on compassion, public health, and public safety, is a stark contrast with the US, as the mind-boggled response of the activists suggests.

Organized by the Drug Policy Alliance and consisting of members of local and national groups that work with the organization, as well as a handful of journalists, the group spent three days in-country last month seeing what an enlightened drug policy looks like. They met with high government officials directly involved in creating and implementing drug decriminalization, toured drug treatment, harm reduction, and mobile methadone maintenance facilities, and heard from Portuguese drug users and harm reduction workers as well.

The Portuguese Model and Its Accomplishments

They had good reason to go to Portugal. After nearly two decades of drug decriminalization, there is ample evidence that the Portuguese model is working well. Treating drug users like citizens who could possibly use some help instead of like criminals to be locked up is paying off by all the standard metrics -- as well as by not replicating the thuggish and brutal American-style war on drugs, with all the deleterious and corrosive impacts that has on the communities particularly targeted for American drug law enforcement.

Here, according to independent academic researchers, as well as the UN Office on Drugs and Crime and the European Monitoring Center of Drugs and Drug Abuse, is what the Portuguese have accomplished:

Drug use has not dramatically increased. Rates of past year and past month drug use have not changed significantly or have actually declined since 2001. And Portugal's drug use rates remain among the lowest in Europe, and well below those in the United States.

Both teen drug use and "problematic" drug use (people who are dependent or who inject drugs) have declined.

Drug arrests and incarceration are way down. Drug arrests have dropped by 60% (selling drugs remains illegal) and the percentage of prisoners doing time for drug offenses has dropped from 44% to 24%. Meanwhile, the number of people referred to the Dissuasion Commission has remained steady, indicating that no "net-widening" has taken place. And the vast majority of cases that go before the commission are found to be non-problematic drug users and are dismissed without sanction.

More people are receiving drug treatment -- and on demand, not by court order. The number of people receiving drug treatment increased by 60% by 2011, with most of them receiving opiate-substitution therapy (methadone). Treatment is voluntary and largely paid for by the national health system.

Drug overdose deaths are greatly reduced. Some 80 people died of drug overdoses in 2001; that number shrunk to just 16 by 2012. That's an 80% reduction in drug overdose deaths.

Drug injection-related HIV/AIDS infections are greatly reduced. Between 2000 and 2013, the number of new HIV cases shrank from nearly 1,600 to only 78. The number of new AIDS cases declined from 626 to 74.

"We came to the conclusion that the criminal system was not the best suited to deal with this situation," explained Capaz. "The best option should be referring them to treatment, but we do not force or coerce anyone. If they are willing to go, it's because they actually want to, so the success rate is really high. We can surely say that decriminalization does not increase drug usage, and that it does not mean legalizing drugs. It's still illegal to use drugs in Portugal, it's just not considered a crime. It's possible to deal with these users outside the criminal system."

Dr. Joao Goulao, who largely authored the decriminalization law and who is still General Director for Intervention on Addictive Behaviors -- the Portuguese "drug czar" -- pointed to unquantifiable positives resulting from the move: "The biggest effect," he said, "has been to allow the stigma of drug addiction to fall, to let people speak clearly and to pursue professional help without fear."

They Take the Kids! (with them to treatment)

The American activists know all about fear and stigma. And the cultural disconnect -- between a country that treats drug users with compassion and one that seeks to punish them -- was on display again when a smaller group of the activists met with Dr. Miguel Vasconcelos, the head psychologist at the Centro Taipa, a former mental hospital that now serves as the country's largest drug treatment center.

As Dr.Vasconcelos explained the history and practice of drug treatment in Portugal, one of his listeners asked what happened to drug users who were pregnant or had children.

"They take the kids," Vasconcelos said, smiling. But his smile turned to puzzlement as he saw his listeners react with resignation and dismay.

For the Americans, "they take the kids" meant child protective services swooping in to seize custody of the children of drug-using parents while the parents go to jail.

But that's not what Vasconcelos meant. After some back and forth, came clarity: "No, I mean they take the kids with them to treatment."

Once again, the Americans, caught firmly in the mind set of their own punishing society, expected only the worst of the state. But once again, light bulbs came on as they realized it doesn't have to be like that.

Now that cadre of activists is back home, and they are going to begin to try to apply the lessons they learned in their own states and communities. And although they had some abstract understanding of Portuguese drug decriminalization before they came, their experiences with the concrete reality of it should only serve to strengthen their desire to make our own country a little less like a punitive authoritarian state and bit more like Portugal.

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. (senate.gov)
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.

Drug War Issues

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