Decriminalization

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

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

Medical Marijuana

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

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

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

Drug Policy

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

Heroin and Prescription Opioids

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

Law Enforcement

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

International

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

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

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

Chronicle AM: OR Defelonizes Drug Possession, Iran Could Cut Drug Executions, More... (8/16/17)

Oregon is the latest state to decriminalize drug possession, Iran moves to reduce drug trafficking executions, Philippines President Duterte cheers on cops killing drug suspects, and more.

We could see less of this if a bill in Iran's parliament wins final approval. (handsoffcain.net)
Marijuana Policy

Maine Legal Pot Sales Won't Meet February Deadline. The legislative committee tasked with implementing marijuana legalization finished its preliminary work Tuesday, but with the committee's recommendations still having to be turned into a draft bill to be debated by legislators, the agencies that will oversee the recreational market will not be able to meet a February deadline for opening pot shops, committee co-chair Sen. Roger Katz (R-Augusta) said.

Michigan Legalization Signature Gathering Campaign Passes Halfway Mark. MI Legalize, the folks behind the 2018 marijuana legalization initiative, announced Wednesday that they will pass the 200,000 mark on raw signatures next week. The campaign has set a goal of collecting 366,000 raw signatures to meet a state requirement of 252,523 valid voter signatures to qualify for the ballot. The campaign needs to gather its signatures within a six-month window and appears to be easily on track to do so.

Drug Policy

Oregon Becomes Latest State to Defelonize Drug Possession. Governor Kate Brown (D) signed into law on Tuesday a bill that defelonizes the possession of personal amounts of all drugs, including cocaine, heroin, and methamphetamine. Possession of small amounts will now be a misdemeanor. The new law takes effect immediately. [Editor's Note: An earlier version of this article incorrectly described the law as decriminalizing drug possession.]

International

Iran Parliament Moves to Reduce Drug Executions. The Majlis on Sunday passed a long-discussed amendment to the country's drug laws that would limit imposition of the death penalty in drug trafficking cases to those involving more than 110 pounds of opium or more than 4.4 pounds of heroin, morphine, or cocaine. Iran carried out more than 500 executions last year, most of them for drug offenses, making it one of the world's leading executioners. An estimated 5,000 people are on death row for drug offenses in Iran, and the new law would save many of them from the gallows. But it's not a done deal yet: The measure still needs another parliamentary vote and then must be approved by the council of clerics.

Philippines Police Kill 32 in Drug Raids, Earn Praise from Duterte. In one of the bloodiest operations of a very bloody war on drug users, police killed 32 people on Monday in raids in Bulacan province. Police were doing a heck of a job, Duterte said in remarks reported by France 24 TV: "The ones who died recently in Bulacan, 32, in a massive raid, that was good," Duterte said. "If we could kill another 32 everyday, then maybe we can reduce what ails this country."

Belize Marijuana Decriminalization Bill Set for Parliament. An amendment to the country's Misuse of Drugs Act that would decriminalize the possession of up to 10 grams of marijuana is set to be filed in parliament on Friday, according to committee members and Solicitor General Nigel Hawke. The proposal has been in the works since 2015, when legal drafting got underway.

Chronicle AM: Uruguay Marijuana Pharmacy Sales Begin, DPA Names New Chief, More... (7/19/17)

All New England states have now either decriminalized or legalized marijuana, the Drug Policy Alliance names a new head, Uruguay begins legal pot sales at pharmacies, and more.

Marijuana Policy

Massachusetts Legalization Implementation Bill Could Go to Governor This Week. Legislative leaders defended their compromise pot bill, House Bill 3818, Wednesday, and votes on the bill could come at any time. The measure is expected to pass the legislature and then head to the desk of Gov. Charlie Baker (R), who is expected to sign it. The bill increases taxes from 12% to up to 20%, and would allow authorities in localities that didn't vote in favor of the legalization initiative to ban pot businesses without a popular vote.

New Hampshire Governor Signs Decriminalization Bill. Gov. Chris Sununu (R) has signed into law House Bill 640, which eliminates criminal penalties for the possession of up to three-quarters of an ounce of marijuana. Instead of jail time, violators will face a $100 fine for a first offense, $200 for a second, and $350 for a third offense within three years of the original offense. With the state now adopting decriminalization, all of New England has now either legalized or decriminalized marijuana possession.

Drug Policy

Drug Policy Alliance Names New Executive Director. The Drug Policy Alliance (DPA), the nation's most powerful drug reform organization, has selected a replacement for founder and long-time executive director Ethan Nadelmann, who stepped down earlier this year.The DPA board of directors announced Tuesday it had voted unanimously to appoint Maria McFarland Sánchez-Moreno as Nadelmann's successor. McFarland Sánchez-Moreno is moving over from Human Rights Watch, where for the past 13 years she served as Co-Director of the US Program, where she picked up plenty of domestic and international drug policy experience. She also pushed for the group to more directly take on the war on drugs as a human rights issue, and as a result, Human Rights Watch became the first major international human rights organization to call for drug decriminalization and global drug reform.

International

Uruguay Legal Marijuana Sales in Pharmacies Get Underway. Pharmacists in Uruguay began selling marijuana to customers Wednesday, the last step in a pioneering national legalization process that began more than three years ago. Uruguay is the first country in the world to completely legalize marijuana for recreational use. Canada is set to be next.

Chronicle AM: MI Init Signatures Coming Fast, OR Decriminalizes Drug Possession, More... (7/11/17)

Michigan legalizers are fast off the mark in their initiative signature-gathering campaign, the Drug Policy Alliance and 30 groups call for drug decriminalization, Oregon is set to defelonize drug possession, and more.

Marijuana Policy

Michigan Initiative Campaign Already Has 100,000 Raw Signatures. The Coalition to Regulate Marijuana Like Alcohol, which wants to put a legalization initiative on the November 2018 ballot, announced Monday that signature gathering was ahead of schedule and that the group had already passed the 100,000 mark. To qualify for the ballot, the group must collect 252,523 valid voter signatures within a six-month period. They began signature gathering in late May.

DC Public Use Marijuana Arrests Tripled Last Year. More than 400 people were arrested in the nation's capital last year for publicly using marijuana, a nearly three-fold jump over the 142 arrested in 2015. And this year so far the pace of arrests remains steady. Some advocates criticized the increase in arrests, with Adam Eidinger, the man behind DC's legalization law, saying the right to smoke marijuana in the District is effectively reserved for "those who own private property," with renters, residents of public housing, and visitors out of luck. "A lot of it is people not realizing they can't smoke in public," he said of the increase in arrests. "A lot of it is people who have no place else to go."

Medical Marijuana

Puerto Rico Governor Signs Medical Marijuana Bill. Gov. Ricardo Rosello, a former biomedical engineer, on Sunday signed into law a bill that legalizes and regulates medical marijuana in the US territory. The move comes after Rossello criticized an earlier executive order allowing medical marijuana as insufficient. "As a scientist, I know firsthand the impact that medicinal cannabis has had on patients with various diseases," he said. "The time has come for Puerto Rico to join the flow of countries and states that have created similar legislation."

Drug Policy

Drug Policy Alliance Report Calls for US Drug Decriminalization. In a new report endorsed by more than 30 organizations, the Drug Policy Alliance is calling for the end of arresting people simply for using or possessing drugs. "Our current laws have branded tens of millions of people with a lifelong criminal record that makes it hard to get a job or an apartment," said Art Way, senior director of national criminal justice strategy at the Drug Policy Alliance. "The experience of the last few decades shows that criminalization has been utterly ineffective in reducing problematic drug use."

Sentencing

Oregon Defelonizes Drug Possession. The state legislature has approved House Bill 2355, which makes simple possession of drugs such as heroin, MDMA, and meth a misdemeanor punishable by no more than a year in jail. Under current law, drug possession is a felony punishable by up to 10 years in prison. The bill also includes a provision aimed at reducing racial profiling by police. The legislature also approved House Bill 3079, which reduces penalties for property crimes often related to problematic drug use. Gov. Kate Brown (D) is expected to sign the bills into law shortly.

Chronicle AM: WHO Calls for Drug Decrim, NV Legal MJ Sales Start Saturday, More... (6/29/17)

Massachusetts pols continue to work on a legalization implementation compromise, Nevada legal marijuana sales begin Saturday, a pair of federal sentencing reform bills get introduced, the World Health Organization calls for global drug decriminalization, and more.

Legal marijuana sales begin a minute after midnight Saturday -- but don't light up on the Strip! (Wikimedia)
Marijuana Policy

Possible Tax Compromise in Massachusetts. House Speaker Robert DeLeo (D-Winthrop) has said he may be willing to move away from the House's position that retail marijuana sales be taxed at 28%, more than twice the 12% envisioned in the legalization initiative and the competing Senate bill. "I suppose there could be some negotiation," he said, referring to a legislative conference committee trying to reach agreement. "I found they are having fruitful conversations, so to speak, so I am hopeful," DeLeo said.

Nevada Legal Sales Begin at 12:01 a.m,Saturday. Nevadans and visitors will be able to legally purchase marijuana as of a minute after midnight Saturday. A few dozen medical marijuana dispensaries have been licensed to sell their products to anyone 21 and over with a proper ID as a stopgap measure before the recreational marijuana sales system goes online next year, and at least some of them will be open Saturday night to take advantage of the commencement of early legal sales. But tourists in particular will have to figure out where to smoke it -- there's no smoking on the strip, in casinos, or hotel rooms.

Medical Marijuana

Nevada Dispensaries Get Tougher Regulations on Edibles as Legal Sales Loom. Gov. Brian Sandoval (R) Monday signed a Taxation Department emergency regulation that will impose tougher regulations beginning Saturday, the same day legal recreational pot sales through dispensaries begins. Under the new regulations, edibles can't contain more than 10 milligrams of THC per dose or 100 per package, they can't resemble lollipops or other products marketed to children, they can't look like real or fictional characters or cartoons, and they can't have images of cartoon characters, action figures, toys, balloons or mascots on the packaging.

Sentencing

Cory Booker Files Bill to Encourage States to Reduce Prison Populations. Sen. Cory Booker (D-NJ) has filed Senate Bill 1458, "to establish a grant program to incentivize states to reduce prison populations, and for other purposes." The bill is not yet available on the congressional web site.

Keith Ellison Files Bill to Defelonize Drug Possession, End Crack/Powder Cocaine Sentencing Disparity. Rep. Keith Ellison (D-MN) has filed House Resolution 3074, "to reclassify certain low-level felonies as misdemeanors, to eliminate the increased penalties for cocaine offenses where the cocaine involved is cocaine base, to reinvest in our communities, and for other purposes. The bill is not yet available on the congressional website.

International

UN World Health Organization Calls for Global Drug Decriminalization. The call came in a joint United Nations statement on ending discrimination in health care. One way that nations can do that, WHO said, is by: "Reviewing and repealing punitive laws that have been proven to have negative health outcomes and that counter established public health evidence. These include laws that criminalize or otherwise prohibit gender expression, same sex conduct, adultery and other sexual behaviors between consenting adults; adult consensual sex work; drug use or possession of drugs for personal use; sexual and reproductive health care services, including information; and overly broad criminalization of HIV non-disclosure, exposure or transmission."

Human Rights Watch Calls Duterte's First Year a Human Rights Calamity. The New York-based human rights watchdog said Wednesday Philippine President Rodrigo Duterte's first year in office was "a human rights calamity" with thousands of people killed in Duterter's war on drugs. "President Duterte took office promising to protect human rights, but has instead spent his first year in office as a boisterous instigator for an unlawful killing campaign," Phelim Kine, deputy Asia director at Human Rights Watch said in a statement. "Duterte has supported and incited 'drug war' killings while retaliating against those fearless enough to challenge his assault on human rights," he added. Human Rights Watch also slammed Duterte for subjecting critics of his anti-drug campaign to harassment, intimidation, and even arrest. "A UN-led international investigation is desperately needed to help stop the slaughter and press for accountability for Duterte's human rights catastrophe," the group said.

Chronicle AM: IL Passes Forfeiture Reform, House Heroin Task Force Proposals, More... (6/28/17)

Utah's new medical marijuana initiative is exposing fissures between the LDS leadership and membership, an asset forfeiture reform bill sits on the desk of Illinois' governor, a bipartisan House heroin task force releases its proposals, and more.

Utahns are ready for medical marijuana. (Harborside)
Medical Marijuana

Utah Poll Has Strong Support for Medical Marijuana. Just days after the Utah Patient Coalition took initial steps to put an initiative on the November 2018 ballot, a poll it sponsored showed that 73% of Utah voters support the initiative, with only 20% opposed. Support came from all demographic groups, including active Mormons, 63% of whom said they were in favor.

Mormon Church Opposes Utah Medical Marijuana Initiative. The powerful Salt Lake City-based Church of Jesus Christ of Latter Day Saints (Mormons) has come out in opposition to a medical marijuana initiative filed this week by the Utah Patients Coalition. The church acknowledged ongoing interest in medical marijuana and said it supported further research but argued that approval of medical marijuana should come after "the FDA approval process that all other drugs must go through before they are prescribed to patients."

Asset Forfeiture

Illinois Legislature Passes Asset Forfeiture Reform. The legislature last Friday gave final approval to an asset forfeiture reform measure, House Bill 303, that raises the standard of evidence for seizures from probable cause to a preponderance of the evidence and bars seizures of under $500 in most drug cases. The bill does not, however, require a criminal conviction before a seizure can occur -- a sop to prosecutors and law enforcement groups who lobbied for that provision to be dropped. The bill now awaits action from Gov. Bruce Rauner (R).

Heroin and Prescription Opioids

House Bipartisan Heroin Task Force Releases Proposals. A bipartisan group of House members released a raft of proposals Tuesday aimed at fighting the nation's drug problems as "an American issue," not a partisan one. The package of bills from the Bipartisan Heroin Task Force includes increased funding for drug-screening gear at the border, studies on the effects of synthetic drug use, greater flexibility for use of health savings accounts, and creation of treatment centers for infants exposed to opioids during their mothers pregnancy.

International

Georgia Parliament Takes Up Drug Decriminalization. The Parliamentary Health Committee has introduced a bill to decriminalize the possession of all drugs that was developed by the National Drug Policy Platform, a grouping of more than 40 NGOs. The bill would annul the country's much-criticized strict 2007 drug law, as well as making changes to at least 10 criminal and administrative laws. The core principle behind the bill is to shift the country's drug policy away from a criminal justice approach, treating drug use instead as a public health issue. Earlier this month, parliament gave initial approval to marijuana decriminalization. Both pot decrim and broader drug decrim should be addressed during parliament's looming autumn session.

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. (health.pa.gov)
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 Ecstasydata.org). 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.

Prevention

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.

CRIMINAL JUSTICE

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.

Chronicle AM: Pot SWAT Raids Kill More People Than Pot, Aussie Bigwigs Call for Decrim, More... (3/21/17)

The New York Times reports on fatal SWAT drug raids, Australian former premiers and police chiefs call for drug decriminalization, medical marijuana keeps statehouses busy, and more.

Medical marijuana is keeping state legislatures busy. (Creative Commons/Wikimedia)
Marijuana Policy

Colorado Poll Shows Support for Plant Limits. A new Keating Research poll has support for limiting home marijuana grows to 12 plants at 57%, with only 36% opposed. The poll comes as lawmakers consider House Bill 1220, which originally imposed a 12-plant limit, but was amended to up the limit to 16 plants. That bill has already passed the House and is now before the Senate.

Medical Marijuana

Arkansas House Votes to Kill Bill Banning Edibles. The House voted 52-40 Monday to kill House Bill 1991, which would have banned the commercial production of medical marijuana edibles in the state. Bill sponsor Rep. Robin Lundstrum (R-Springdale) argued that patients could make their own and that medical marijuana is medicine, not candy, but her arguments failed to sway her peers.

Nevada Bill Would Let Medical Marijuana Patients Carry Guns. State Sen. Kevin Atkinson (D-Las Vegas) filed Senate Bill 351 Monday. That measure would allow medical marijuana users to possess a firearm and a concealed carry permit. Current state law requires sheriffs to deny such permits for medical marijuana users.

New Hampshire Senate Committee Approves Use of Medical Marijuana for Ehlers-Danlos Syndrome. The Senate Health, Human Services, and Elderly Committee has approved a bill that would add Ehlers-Danlos syndrome to the state's list of qualifying conditions for medical marijuana. The measure now heads for a Senate floor vote. If it passes there, the House will take it up.

Utah 2018 Medical Marijuana Initiative Drive Gearing Up. Medical marijuana advocates are gearing up to try to put an initiative on the state's 2018 ballot. They said they would begin the process of signature gathering next month, and they cite promising polling. The state legislature has so far thwarted efforts to create a robust medical marijuana program.

Law Enforcement

Marijuana Raids Kill More People Than Pot Ever Did. According to data compiled by the New York Times, since 2010, at least 20 SWAT raids involving suspected marijuana dealers have resulted in deaths, including those of four police officers. The toll for all drug SWAT raid deaths is, of course, higher, with 81 people killed, including 13 cops.

International

Australian Police Chiefs, Former Premiers Call for Drug Decriminalization. A group of former premiers, police commissioners, and legal advocates have called for an end to the criminalization of drug users. The call comes in the Australia 21 report, which was released Monday. The report, titled "Can Australia Respond to Drugs More Effectively and Safely," makes 13 recommendations for reducing drug-related harms, such as supervised drug use rooms and other harm reduction measures, but also called for eliminating penalties for possession and drug use.

Chronicle AM: US Senate Okays Unemployment Drug Testing, NM Decrim Advances, More... (3/15/17)

The US Congress has voted to allow states to force drug tests on people seeking unemployment benefits, decriminalization bills get filed in Florida and advance in New Mexico, another mass grave is uncovered in Old Mexico, and more.

A bill that would decriminalize small-time marijuana possession is moving in Santa Fe. (irin.org)
Marijuana Policy

Florida Decriminalization Bills Filed. A pair of lawmakers have filed identical decriminalization bills. Rep. Carlos Guillermo Smith (D-Orlando) filed House Bill1403, while Sen. Jeff Clemens (D-Lake Worth) filed Senate Bill1662. Under the bills, possession of up to an ounce would be decriminalized, with a maximum $100 fine. Under current law, possession of up to an ounce is punishable by up to a year in jail and/or a $1,000 fine.

New Mexico Decriminalization Bill Advances. A bill that would decriminalize the possession of up to a half ounce of marijuana has passed out of the House Consumer and Public Affairs Committee and now faces only one more vote in the House Judiciary Committee before heading to the House floor. The measure, Senate Bill 258, has already passed the Senate.

Heroin and Prescription Opioids

Washington State Bill Would Force Heroin and Opioid Users into Treatment. State Sen. Steve O'Ban (R-University Place) has filed a bill that could force opioid users into involuntary drug treatment by declaring them "gravely disabled" under the Involuntary Treatment Act. The measure, Senate Bill 5811, had a hearing Tuesday in the Senate Committee on Human Services, Mental Health, and Housing, but no vote was taken, and O'Ban said he didn't think the bill was going anywhere this year.

Asset Forfeiture

Mississippi Governor Signs Civil Asset Forfeiture Reform Bill into Law. Gov. Phil Bryant (R) Monday signed into law House Bill 812, under which state law enforcement agencies will have to report their seizures, create a searchable website for seizure information, and submit civil seizure warrants to judges within 72 hours. The new law doesn't end civil asset forfeiture in the state, but advocates said "it's a start."

Drug Testing

Senate Votes to Allow States to Drug Test People Seeking Unemployment Benefits. The Senate voted 51-48 along party lines to roll back an Obama-era regulation that blocks states from demanding drug tests of people seeking unemployment benefits. Under a 2012 law, states can only drug test individuals applying for unemployment benefits if they were previously fired for drug use or work in jobs for which workers are regularly drug tested. The Obama rule specified a list of jobs that could be included under the law. The measure has already passed the House, and President Trump is expected to sign it.

International

Mass Grave Discovered in Mexico's Veracruz. Searchers have uncovered a series of mass graves on the outskirts of the city of Veracruz where scores, if not hundreds, of people believed to have been killed in drug gang violence have been buried. On Tuesday, local prosecutor Jorge Winkler told reporters that 250 human skulls had been found at the sites. An estimated 100,000 people have been killed in Mexico's drug wars in the past decade, and tens of thousands more have gone missing.

Colombia Coca Cultivation at Two-Decade High, US Says. The US estimates that coca production in Colombia increased 18% last year over 2015, with nearly half a million acres under production. The spike in production comes as the country begins implementing a peace accord with FARC rebels, and be the result of a "perverse incentive" for farmers to grow coca last year in order to qualify for subsidies for switching to substitute crops.

Chronicle AM: NH House Passes Decrim, FL GOP Files Restrictive MedMJ Bill, More... (3/8/17)

Marijuana policy continues to play out in state legislatures across the land, asset forfeiture reform is moving in Iowa, the Ohio Supreme Court reverses itself on cocaine sentencing, and more.

The bud is keeping state legislatures busy. (Flickr)
Marijuana Policy

Alaska Cannabis Cafes Are Back Under Consideration. The Marijuana Control Board met Tuesday afternoon in Anchorage and agreed to try again to come up with rules for on-site marijuana consumption at businesses. The notion was shot down at the last board meeting, but revived on a 4-1 vote.

Connecticut Legalization Bills Get Hearing. Lawmakers went into the evening hours Tuesday as they engaged in heated debate over several bills before the General Assembly that would legalize marijuana. Click the link to get the flavor of the dewbate.

New Hampshire House of Representatives Overwhelmingly Approves Bill to Decriminalize Marijuana Possession. The House voted 318-36 Wednesday to approve House Bill 640, which would decriminalize the possession of up to an ounce of marijuana. Similar bills have failed in years past, but opposition seems to have largely evaporated this year. The measure now heads to the Senate.

Los Angeles Voters Approved Marijuana Regulation Initiative. Voters in Los Angeles approved Measure M with nearly 80% voting in favor. The measure would allow the city to regulate legal marijuana businesses when the legal recreational commerce comes on line next year.

Medical Marijuana

Florida Bill Would Ban Smoking and Edibles. Florida voters overwhelmingly approved a medical marijuana initiative in November, but now Rep. Ray Rodrigues (R-Fort Myers) has filed a medical marijuana regulation bill that would ban people from smoking it or using it in edible form. The measure, House Bill 1397, is not yet available on the legislative website. Rodrigues is a member of the Republican House leadership, and the bill represents the Republican approach to expanding medical marijuana access in the state. "It goes further than the current statute in terms of restricting medical marijuana," says Ben Pollara, the medical marijuana initiative's campaign director. "There was unanimous agreement that the new amendment would expand use."

Utah Lawmakers Pass Medical Marijuana Study Bill; Advocates Call it a Trojan Horse. The House voted Wednesday to concur with earlier Senate amendments to House Bill 130 and sent it to the desk of Gov. Gary Herbert (R). The bill allows state universities to study cannabinoid products for their medicinal potential, but doesn't allow for any actual use. Medical marijuana advocates called the bill "a Trojan horse," saying it is merely a delaying tactic.

Wisconsin Legislature Passes CBD Bill. The Assembly voted Tuesday night to approve Senate Bill 10, which would allow for the use of CBD cannabis oil by children suffering seizures. The bill now goes to the desk of Gov. Scott Walker (R), who is expected to sign it.

Asset Forfeiture

Iowa Senate Committee Passes Bill Taking on Asset Forfeiture; Closes Federal Loophole. The Senate Judiciary Committee voted Monday to approve Senate File 446, which would severely limit asset forfeiture without a criminal conviction and which would bar prosecutors from doing an end run around state law by passing cases off to the feds. The bill now heads for a Senate floor vote.

Sentencing

Ohio Supreme Court Reverses Itself, Declares Filler Must Be Included in Drug Weights. Two months after ruling that prosecutors must prove the actual amount of pure cocaine possessed -- not inert filler -- to secure longer sentences, the state Supreme Court has done a U-turn. In a ruling Monday, the court sided with prosecutors and held that the total weight of drug plus filler must be used when determining sentences. The reversal comes after two new judges were named to the court earlier this year, and dissenting Justice Bill O'Neill said that was the only thing that changed. "The logic is unassailable. The possession of baby formula, talcum powder, or baking soda does not pose the same risk to the public's health and safety as possession of cocaine does," O'Neill wrote.

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