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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.

Chronicle AM: Opioid Prescriptions Drop, Trump Repeats False Border Wall Claims, More... (4/20/18)

A California marijuana banking bill advances, a Colorado marijuana deliveries bill dies, opioid prescriptions are declining, Trump repeats false claims about the border wall and drug smuggling, and more.

opioid prescriptions go down, down, down (IQVIA Institute)
Marijuana Policy

California Bill to Create Marijuana Banks Wins Committee Vote. A bill that would license special banks to handle billions of dollars from the legal marijuana market was approved by the Senate Banking and Financial Institutions Committee on a 7-0 vote Wednesday. The measure, Senate Bill 930, now heads to the Senate Government and Finance Committee. Companion legislation has been filed in the Assembly.

Colorado Marijuana Delivery Bill Killed. A bill that would have allowed pot shops to make deliveries got through the House only to die in a Senate committee Wednesday. House Bill 1092 was killed by a 3-2 vote of the Senate Judiciary Committee.

Ohio Attorney General Rejects Legalization Amendment Petition. State Attorney General Mike DeWine (R) rejected a petition for a proposed marijuana legalization amendment Thursday. DeWine wrote that he rejected the petition because its summary language did not match the actual amendment language. Campaign organizers can refile the petition if they wish.

Heroin and Prescription Opioids

Opioid Prescriptions Dropped In Every State Last Year. The number of opiod painkiller prescriptions dropped 10.2% in 2017, according to a new report from the ICVIA Institute, which collects data on pharmaceutical prescriptions from retail pharmacies. The number of high-potency opioid prescriptions declined even more, by 16.1% And using a measure called the morphine milligram equivalent saw a 12% decrease, the largest in a quarter century. "We're seeing declines across every state," said Murray Aitken, executive director of the IQVIA Institute. "The states that have the highest per capita consumption are also the states with the highest decline."

Drug Testing

Massachusetts High Court Rules Against State in PrisonVisitor Drug Dog Policy Fight. The state Supreme Judicial Court ruled Thursday that the Department of Corrections exceeded its authority when it started using drug dogs to search prison visitors without giving the public a chance to weigh in. The court held that the department should have followed a regulatory process that allows interested parties an opportunity to present their views. Still, the court is allowing the department to continue the drug dog searches while it follows the proper regulatory process.

Harm Reduction

Missouri Safe Injection Site Bill Filed. St. Louis state Rep. Karla May (D) has filed House Bill 2367, which "authorizes local health departments and community-based organizations to establish Safe Consumption Facilities." It is aimed at reducing overdoses and infectious diseases linked to injection drug use.

The Border

Trump Again Falsely Claims Border Wall Needed to Stop Drug Smuggling. The president is at it again: On Thursday, President Trump traveled to the Florida Keys to be briefed by the Joint Interagency Task Force South and said he received "a great education" about drugs flowing into the country, but then proceeded to make the errant claim that a border wall is needed to stop the flow of drugs. "Drugs are flowing into our country," Trump said. "We need border protection. We need the wall. We have to have the wall." But border experts, drug experts, and even the DEA all agree that the vast majority of drugs smuggled from Mexico go through ports of entry, not through the vast and barren unfenced expanses of the border.

International

Indonesia's New Anti-Drug Head Signals Softer Approach. New anti-drug chief Heru Winarko called Wednesday for an expansion of drug treatment centers in the country, signaling a new approach to the war on drugs there. Police would maintain their "stern" approach to drug traffickers and their "shoot to kill" policy toward armed suspects resisting arrest, he said, but added that Indonesia would not mimic the bloody drug policies of the neighboring Philippines under President Rodrigo Duterte.

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: Trump DEA Pick Has Issues, FL MedMJ Licenses Delayed, More... (10/2/17)

The man Trump will reportedly name to head the DEA has some racial profiling issues in his past, the Global Commission on Drugs issued recommendations on dealing with the opioid crisis, the 6th Circuit slaps down the DEA in an asset forfeiture case, and more.

The next DEA head? New Jersey State Police Superintendent Joseph Fuentes (Wikimedia)
Medical Marijuana

Florida Will Miss Deadline for Issuing Grower Licenses. Florida officials were supposed to distribute ten medical marijuana cultivation licenses Tuesday, but that's not going to happen. Officials said last Friday said the delay would be brief and pointed fingers at Hurricane Irma and a recently-filed lawsuit from a black farmer challenging the state's effort to achieve racial diversity among growers. That farmer charged that the state's guidelines were too restrictive.

Heroin and Prescription Opioids

Global Commission on Drug Policy Releases Position Paper on North America Opioid Crisis. The Global Commission on Drug Policy Monday released a position paper on The Opioid Crisis in North America. The members of the Global Commission, several of whom faced similar crises while occupying the highest levels of government, share their views and recommendations on how to mitigate this epidemic. The Commission warns against cutting the supply of prescription opioids without first having supporting measures in place, and emphasizes the need to improve and expand proven harm reduction services and treatment options, including opioid substitution therapy and heroin-assisted treatment. Regulation of prescription opioids needs to become well-balanced to provide effective pain care while minimizing misuse. The Global Commission also calls for the de facto decriminalization of drug use and possession for personal use at the municipal, city or State/Province levels, so that people in need of health and social services can access them freely, easily, and without fear of punishment. Finally, the Global Commission suggests allowing pilot projects for the responsible legal regulation of currently illicit drugs including opioids, to bypass criminal organizations that drive and benefit from the black market.

Asset Forfeiture

6th Circuit Slaps Down DEA Cleveland Airport Cash Seizure. Even when it looks like they have the perfect case, the DEA and the courts can't cut corners in their efforts to seize suspected drug money, the court held in a case decided late last month. Agents had seized $41,000 in cash from two men with previous drug convictions who had purchased tickets to -- gasp! -- California, and their drug dog told them the money was tainted. The men appealed the seizure, saying the cash was legally obtained, but the DEA moved to strike their claim, saying they had provided no proof, and a lower court agreed. But the DEA and the lower court erred, the appeals court ruled, by shifting the burden of proof to the claimants at that early stage of the proceedings: "Finally, we note our concern that the government's approach would turn the burden of proof in forfeiture actions on its head. Under the Civil Asset Forfeiture Reform Act of 2000 (CAFRA), the government bears the burden of proving by a preponderance of evidence that the subject of a civil forfeiture action is, in fact, forfeitable," the opinion concluded. "Requiring a forfeiture claimant to explain the nature of his ownership at the pleading stage would be asking the claimant to satisfy the government's burden of proof, or at least go a long way toward doing so."

Drug Policy

Trump Could Name Racial Profiling Apologist to Head DEA. The Washington Post has reported that President Trump will name New Jersey State Police Superintendent Joseph Fuentes to head the Drug Enforcement Administration (DEA). In 2000, Fuentes, then a state police trooper, wrote a paper defending "suspect profiling" as the state was embroiled in controversy over "driving while black" and police tactics like asking hotel clerk to report guests who were "suspicious" because they had dreadlocks or spoke Spanish. "Because of the disproportionate involvement of minorities in these... arrests, civil rights groups have branded the whole process of highway drug enforcement as racist," he wrote. But when pressed during his nomination to head the state police, Fuentes disavowed that position and denied being an apologist for racial profiling.

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: Drug Policies Fueling Hep C Rise, MI Init Begins Signature Drive, More... (5/19/17)

The CDC issues a damning report about drug policy and Hep C, the clock is ticking on the Vermont legalization bill as the governor ponders his choices, Michigan legalizers hit the streets with petitions for 2018, and more.

State-level policies toward injection drug users can influence Hep C rates -- for better or worse. (Wikimedia)
Marijuana Policy

Michigan Legalization Initiative Signature Gathering Gets Underway. The state Board of Canvassers Thursday gave its go-ahead for the Coalition to Regulate Marijuana Like Alcohol to begin signature gathering for its marijuana legalization initiative, and the group immediately sent canvassers onto the streets. The measure would legalize up to 2.5 ounces and 12 plants for adults and create a system of legal marijuana commerce. The campaign needs a little more than 252,000 valid voter signatures within six months to qualify for the November 2018 ballot.

Texas Poll Has Majority Support for Legalization. A new University of Texas/Texas Tribune poll has a slight majority for marijuana legalization, with 32% saying small amounts should be legalized and 21% saying any amount should be legalized. That's 53% for some form of legalization. Some 30% said only medical marijuana should be legal, while only 17% said no form of marijuana should be legal.

Vermont Clock Ticking on Legalization Bill -- Governor Has Five Days to Veto or Not. The state legislature sent the legalization bill it approved -- Senate Bill 22 -- to Gov. Phil Scott (R) on Thursday. Under state law, he has five days to sign or veto the bill. If he fails to act, the bill becomes law without his signature. He is facing heavy pressures on all sides. Stay tuned.

Drug Policy

High Hep C Rates Linked to Drug Policy Failures. A report from the Center for Disease Control and Prevention finds that 17 states had high rates of Hep C because they lacked laws and Medicaid policies to prevent drug users from being infected with the disease or obtaining treatment once they did. Seven of those states had a Hep C rate more than twice the national average, and all the others also had above average rates. The report said the states needed to focus more on reducing intravenous drug users' Hep C risk by enacting laws such as allowing pharmacies to sell syringes to the public and by enacting Medicaid policies that do not require patients to be drug free for a certain people before getting treatment. "It is important for policy makers and public health officials to work together to understand the various needs of particular populations to prevent HCV transmission and disease," the report concluded.

International

Trump-Santos Meeting Shows Divergence on Drug Policy. As President Trump and Colombian President Juan Manuel Santos addressed reporters at a White House press conference Thursday, clear drug policy differences emerged. While Trump emphasized "building the wall," or an interdiction-based strategy, Santos declined to endorse that strategy, explaining that drug policy is a complex international issue that requires innovation and collaboration. "We declared the war on drugs 40 years ago -- the world declared the war on drugs -- and it's a war that has not been won. We must be more effective and more efficient," Santos said.

Chronicle AM: NV Syringe Vending Machines, Good and Bad CO MJ Bills, More... (4/17/17)

Nevada will soon see the first syringe vending machines in the country, the Colorado legislature responds to a threatened federal crackdown -- for better and worse -- Wisconsin Gov. Scott Walker is moving forward with plans to drug test Medicaid recipients, and more.

Syringe vending machines -- coming first to Nevada. (wikimedia.org)
Marijuana Policy

A Majority of American Adults Have Tried Marijuana, Poll Finds. A new Marist/Yahoo poll finds that 52% of American adults have tried marijuana at least once, and that 56% find the drug "socially acceptable. The same poll has support for legalization at 49%, with 47% opposed.

DC Marijuana Activists to Hand Out Free Joints on Capitol Hill for 4/20. The same folks who brought legal marijuana to the nation's capital are planning to hand out more than a thousand free marijuana joints on Capitol Hill Thursday, 4/20, the unofficial marijuana holiday. Anyone over 21 who has a congressional ID is eligible for the free weed, said DCMJ. The activists said the action was meant to life the "special interest smokescreen" blocking marijuana reform in Congress.

Homeland Security Chief Says Marijuana "Not a Factor" in Drug War. DHS Secretary John Kelly said Sunday that marijuana is "not a factor" in the country's drug war and that "arresting a lot of users" will not solve the country's drug problems. Kelly responded to a question about whether legalizing marijuana in the US would help or hinder his work attempting to interdict drug shipments to the US. "Yeah, marijuana is not a factor in the drug war," Kelly responded, adding later: "It's three things. Methamphetamine. Almost all produced in Mexico. Heroin. Virtually all produced in Mexico. And cocaine that comes up from further south." And rather than arresting users: "The solution is a comprehensive drug demand reduction program in the United States that involves every man and woman of goodwill. And then rehabilitation. And then law enforcement. And then getting at the poppy fields and the coca fields in the south."

Colorado Social Consumption Bill Dies. A bill that would have set up the country's first statewide law allowing for on-premises marijuana consumption at licensed businesses is dead, with legislators citing fear of a federal crackdown for its demise. The House voted last Thursday to amend Senate Bill 17-184 to remove the provision that would have allowed adults to bring their own weed to businesses and consume it on-premises.

Colorado Senate Approves Bill to Shift Legal Marijuana Inventories Over to Medical Marijuana in Event of Federal Crackdown. The state Senate has approved Senate Bill 17-192, which would allow adult-use marijuana businesses to transfer their inventory to medical marijuana status if a federal crackdown on adult-legal weed happens. The bill now goes to the House.

Nevada Legislature Still Faces Heavy Load of Marijuana Bills. The legislative session marked its first key deadline last Friday when all proposed bills had to have passed out of their committee of introduction or be declared dead. And fourteen marijuana-related bills remain alive, including one, Senate Bill 302, that would allow dispensaries to begin selling marijuana to any adult beginning in July. Click the link for the rest of the bills and their status.

Tennessee Governor Signs Bill Killing Decrim in Memphis and Nashville. Gov. Bill Haslam (R) last Friday signed into law House Bill 173, which bars cities in the state from crafting marijuana penalties lesser than state law. The bill was a response to moves by the state's two largest cities, Memphis and Nashville, which had passed municipal decriminalization ordinances.

Medical Marijuana

Arkansas Regulators Finalize Medical Marijuana Rules. The state Medical Marijuana Commission last Tuesday gave final approval to rules governing dispensaries and cultivation facilities. The rules must still be approved by the legislature, which has passed some legislation that appears to conflict with them. The legislature only has until May 8 to modify the rules or the state will be out of compliance with the Medical Marijuana Act, which is now part of the state constitution.

Heroin and Prescription Opioids

Alabama House Approves Tougher Penalties for Heroin, Fentanyl. The House voted last week to approve harsh new penalties for the possession and sale of heroin and fentanyl. In a unanimous vote, the chamber approved a one-year mandatory minimum sentence for simple possession and increased penalties for trafficking, including a mandatory life sentence without parole for trafficking 10 or more kilos of either drugs. The bill is House Bill 203, which is now before the Senate.

Maryland General Assembly Passes Package of Heroin/Opioid Bills. The Assembly last week approved a package of bills aimed at tackling the state's heroin and prescription opioid crisis. One bill would create 24/7 drug treatment centers for addicts, increase reimbursements for drug treatment, and ease access to the opioid overdose reversal drug naloxone. A second bill would create drug awareness programs in schools and allow school nurses to stock and dispense naloxone. A third bill would require doctors to follow best practices when prescribing opioids, while a fourth bill increases prison sentences for people convicted of fentanyl offenses. The bills now await the governor's signature.

Asset Forfeiture

Arizona Governor Signs Civil Asset Forfeiture Reform Bill. Gov. Doug Ducey (R) last week signed into law House Bill 2477, which requires a higher evidentiary standard before police and prosecutors can seize assets from suspects. Instead of a "preponderance" of the evidence, cops must now provide "clear and convincing evidence" that the assets are linked to a crime.

Drug Policy

New York City Council Passes Bill to Coordinate Drug Policy Among City Departments. The city council recently passed legislation to create a coordinated municipal drug strategy. The bill empowers the Mayor to designate a lead agency or office to convene stakeholders including city agencies, outside experts, and communities impacted by drug use to develop a city-wide, health-focused plan for a coordinated approach in addressing issues related to drug use.

West Virginia Legislature Passes Bill Creating Drug Policy Office. A bill that would create an Office of Drug Control Policy within the Department of Health and Human Services has passed both houses of the legislature and awaits the governor's signature. The measure, House Bill 2620, passed last Friday, the final day of the session. Gov. Jim Justice (D) has fifteen days to sign the bill.

Drug Testing

Wisconsin Governor Moving Forward With Plan to Drug Test Medicaid Recipients. Gov. Scott Walker (R) on Monday posted his proposal for moving people off state Badgercare Medicaid, which includes a provision requiring drug screenings for Medicaid recipients. People suspected of illegal drug use after screening would be ineligible for coverage until they are tested. People who test positive would be offered drug treatment, while people who refuse the test would lose benefits for six months.

Harm Reduction

Nevada Becomes First State to Install Needle Vending Machines. In a bid to combat the spread of HIV/AIDS and Hep C, a needle exchange program in Las Vegas is now providing clean needles in vending machines. The Las Vegas Harm Reduction Center worked together with the Southern Nevada Health District and the Nevada AIDS Research and Education Society to install the new machines. Each client will be limited to two kits per week, with the kits including syringes, alcohol wipes, condoms, and a needle disposal box.

International

Canada Unveils Plan for Legal Marijuana Sales by June 2018. The Liberal government of Prime Minister Justin Trudeau last Thursday filed legislation designed to implement marijuana legalization by June of next year. The bill would allow adults 18 and over to possess up to 30 grams of dried marijuana and would allow the federal government to regulate producers, while the provinces would regulate sales to consumers. Other issues, such as pricing, taxation, and packaging are still to be worked out.

The Top Ten International Drug Policy Stories of 2016 [FEATURE]

(See our Top Ten Domestic Drug Policy Stories of 2016 feature story too.)

The year that just ended has seen a serious outbreak of bloody violence against drug users and sellers in one country, it has seen drug offenders hung by the hundreds in another, it has seen efforts to fight the spread of drug-related HIV/AIDS falter for lack of funding, and it has seen the tenacity of the prohibitionist apparatus in the halls of the United Nations.

But there was also good news emanating from various corners of the world, including advances in marijuana legalization in Canada, the US, and Europe and the flouting of the proscription against the coca trade in the UN anti-drug treaties. And speaking of treaties, alhough we didn't include it this year because the drug policy implications remain unclear, the fruition of years'-long peace negotiations between Colombia and the leftist rebels of the FARC, which brings an end to the Western hemisphere's longest-running guerrilla war, is certainly worth noting.

Here are the ten most notable international drug policy events of 2016, the good, the bad, and the ugly:

The UN General Assembly Special Session on Drugs saw progress, but achingly little. (Wikimedia.org)
1. The UN General Assembly Special Session (UNGASS) on Drugs

The global prohibitionist consenus was under growing strain at the UNGASS on Drugs, as civil society pressed the UN bureaucracy and member states for reforms as never before. But changes come at a glacial pace at the level of global diplomacy, and the vision of the UNGASS as a platform for discussing fundamental issues and plotting a new course ran up against the resistance of drug war hard-liners like Russia and China, and the studied indifference of European governments, who preferred that the UN drug policy center of gravity remain at the Commission on Narcotic Drugs in Vienna. And while the US delegation advocated for some good stances, it, too, opposed any meddling with the trio of UN conventions that form the legal backbone of global drug prohibition.

Still, there were some incremental victories. UN agencies submitted their own position papers, many highly progressive, as were the submissions from some countries and international organizations. EU states and others fought hard for language opposing the death penalty for drug offenses, though unsuccessfully. And while the UNGASS Outcome Document avoids most big issues, it puts strong emphasis on treatment and alternatives to incarceration. It acknowledges the importance of human rights and proportionate sentencing. It has support for naloxone (the overdose antidote), medication-assisted treatment (e.g. methadone and buprenorphine), and safe injecting equipment, though avoiding the term "harm reduction" itself. And it calls for addressing obstacles to opioid availability. (Read a detailed report on UNGASS by some of our colleagues here, and read about some of our own work for the UNGASS here.)

2. Global Harm Reduction for AIDS Remains Tragically Underfunded, and Facing Worse. Despite the repeatedly-proven positive impact of harm reduction measures in reducing the spread and prevalence of HIV/AIDS, donors continue to refuse to pony up to pay for such measures. The UNAIDS program estimates that $2.3 billion was needed to fund AIDS-related harm reduction programs last year, but only $160 million was actually invested by donors as most member states cut their aid levels. That's only 7% of the requested funding level. That's after 2015 saw the first drop in support in five years (see pages 21-22) in funding for AIDS efforts in low- and middle-income countries. The world spends an estimated $100 billion a year on fighting drugs, but it can't come up with 2.3% of that figure to fight drug-related AIDS harms. Harm Reduction International has proposed a "10x20" shift of 10% of law enforcement funding toward harm reduction services by 2020 to address the gap.

Harm reduction's global funding challenges are further impacted by the global AIDS-fighting budget, which has taken a hit as the rise in the dollar has reduced the spending power of contributions from donor countries that use other currencies. Even worse, many of the countries currently benefiting from UN harm reduction funding have progressed economically to a point at which they are supposed to begin funding their own programs according to the UN development framework. But that may not be a realistic expectation, especially for the sometimes politically fraught programs needed to address disease transmission related to drug use.

3. America's Most Populous State Legalizes Marijuana, and So Do Several More. You know the global prohibitionist consensus is crumbling when the rot sets in at home, and that's what happened in November's US elections. California, Nevada, Maine, and Massachusetts all voted to legalize marijuana, joining Alaska, Colorado, Oregon, and Washington, which had led the way in 2012 and 2014. Now, some 50 million Americans live in pot-legal states, and that's going to mean increasing pressure on the government in Washington to end federal pot prohibition. It's also an example to the rest of the world.

4. Europe's Prohibitionist Consensus Begins Crumbling Around the Edges. No European nation has legalized marijuana, but signs are increasing that somebody is going to do it soon. If 2016 was any indication, the best candidates may be Italy, where a broadly supported legalization bill got a parliamentary hearing this year before surprise election results upset the country's political apple cart; Germany, where "legalization is in the air" as Berlin moves toward allowing cannabis coffee shops and Dusseldorf moves toward total marijuana legalization; and Denmark, where Copenhagen is trying yet again to legalize weed. In both Denmark and Germany, legalization isn't currently favored by the central governments, while in Italy, everything is in limbo after Europe's populist uprising swept the prime minister out of office. Still, the pressure is mounting in Europe.

Amsterdam's famed cannabis coffee houses look set to final get a legal source of supply. (Wikimedia.org)
5. The Dutch Are Finally Going to Do Something About the "Back Door Problem." The Dutch have allowed for the sale of marijuana at "coffee shops" since the 1980s, but never made any provision for a legal pot supply for retailers. Now, after 20 years of blocking any effort to decriminalize marijuana production, Prime Minister Mark Rutte's VVD party has had a change of heart. At a party conference in November, the VVD voted to support "smart regulation" of marijuana and "to redesign the entire domain surrounding soft drugs." The full text of the resolution, supported by 81% of party members, reads: "While the sale of cannabis is tolerated at the front door, stock acquisition is now illegal. The VVD wants to end this strange situation and regulate the policy on soft drugs in a smarter way. It's time to redesign the entire domain surrounding soft drugs. This redevelopment can only take place on a national level. Municipalities should stop experiments with cannabis cultivation as soon as possible." The opposition political parties are already in support of solving the long-lived "back door problem."

6. Canada's Move Toward Marijuana Legalization Continues Apace. Justin Trudeau and the Liberals swept the Tories out of power in October 2015 with a platform that included a clear-cut call for marijuana legalization. Movement toward that goal has been slow but steady, with the task force charged with clearing the way calling for wide-ranging legalization in a report report issued in December. The Liberals say they expect to file legalization bills in the parliament this spring, and Canada remains on track to free the weed.

7. Bolivia Ignores UN Drug Treaty, Agrees to Export Coca to Ecuador. Bolivian President Evo Morales, a former coca grower union leader himself, opened the year campaigning to decriminalize the coca trade and closed it without waiting for the UN to act by inking an agreement with Ecuador to export coca there. The agreement would appear to violate the UN Single Convention on Narcotic Drugs, which bans the export of coca leaf because it contains the cocaine alkaloid, but neither Bolivia nor Ecuador seem to care.

Mexico's latest drug war marked its 10th anniversary last month. (Wikimedia.org)
8. Mexico Marks a Decade of Brutal Drug Wars. In December, 2006, then-President Felipe Calderon sent the Mexican army into the state of Michoacan in what he said was a bid to get serious about fighting the drug trade. It didn't work, and in fact, led to the worst prohibition-related violence in the country's history, with an estimated 100,000 + killed and tens of thousands more gone missing. Attention to the cartel wars peaked in 2012, which was a presidential election year in both the US and Mexico, and the level of killing declined after that, but has now risen back to those levels. Calderon's replacement, Enrique Pena Nieto, has publicly deemphasized the drug war, but has not substantially shifted the policy. The arrest of Sinaloa Cartel leader Joaquin "El Chapo" Guzman has weakened his cartel, but that has only led to more violence as new competitors vie for supremacy.

There are signs of hope on the policy front though, if early ones, with medical marijuana being implemented, attitudes toward legalization softening, and the government playing a role in forwarding the international debate on drug policy reform.

9. Iran Has Second Thoughts About the Death Penalty for Drugs. The Islamic Republic is perhaps the world's leading drug executioner, with drug offenders accounting for the vast majority of the more than a thousand people it executed in 2015 (2016 numbers aren't in yet), but there are increasing signs the regime could change course. In November, the parliament agreed to expedite deliberations on a measure that would dramatically limit the number of people facing execution for drugs. Now, the proposal will get top priority in the Legal and Social Affairs Committee before heading before the full parliament. The measure would limit the death penalty to "organized drug lords," "armed trafficking," "repeat offenders," and "bulk drug distributors."

10. The Philippines Wages a Bloody War on Drug Users and Sellers. With the election of former Davao City Mayor Rodrigo Duterte as president, the country descended into a veritable blood-bath, as police and "vigilantes" seemingly competed to see who could kill more people faster. Duterte has brushed off criticism from the US, the UN, and human rights groups, and even insulted his critics, although he did have kind words to say about Donald Trump, who had kind words to say about him. As of year's end, the death toll was around 6,000, with the vigilantes claiming a slight lead over the cops.

Chronicle AM: World AIDS Day, Psilocybin Could Help Terminal Patients, More... (12/1/16)

New studies suggest psychedelics could help terminal patients deal with their fears, the Ohio legislature prepares to pass asset forfeiture reform, and more.

Psilocybin, the psychedelic ingredient in magic mushrooms, can help terminal patients cope, a pair of new studies suggests.
Psychedelics

Studies Suggest Magic Mushrooms Could Help Cancer Patients Deal With Fear. A pair of studies published Thursday in the Journal of Psychopharmacology suggest that psilocybin, the psychedelic drug in magic mushrooms, could help terminal cancer patients cope with fear and anxiety around impending death. "The findings are impressive, with good safety data and large effect sizes," says Robin Carharrt-Harris, who studies psychedelic drugs at Imperial College London. "My feeling is that these studies will play a significant role in waking up the scientific and medical mainstream to the therapeutic potential of psychedelics."

Asset Forfeiture

Ohio Legislature Poised to Pass Civil Asset Forfeiture Reform, Despite Police and Prosecutors' Opposition. Legislative leaders say they expect to pass a civil asset forfeiture reform bill in the state Senate next week. The measure, House Bill 347, passed the House in the spring, but was delayed in the Senate when a committee approved an amendment to address concerns raised by prosecutors. The bill originally would have eliminated civil asset forfeiture, but now has been softened to allow it if the property owner is dead, the suspect cannot be located, or the owner does not claim the property. It also allows for civil forfeiture post-conviction.

Harm Reduction

It's World AIDS Day. We Can't End AIDS Until We End the War on Drugs. "Today, December 1, is World AIDS Day," writes the Drug Policy Alliance's Laura Thomas. "In 1989, I was arrested in front of the White House on World AIDS Day, demanding that then-President Bush take action on HIV/AIDS. Among the issues we were demanding action on then, so many years ago, was the availability of sterile syringes for people who inject drugs, so they could stop the transmission of HIV. In the decades since, we have celebrated amazing victories against HIV/AIDS. We now have treatments we could only dream of then. We have pills that will prevent HIV. We have a National HIV/AIDS Strategy. We even have an effective cure for hepatitis C. And we are keeping many, many more people with HIV alive now. And yet, it is syringe access -- needle exchange -- that we have been the slowest to win…" Click on the link for the whole post.

Trump VP Pick Mike Pence is Bad News on Marijuana, Drug Policy

The Republican nominee's choice of Indiana Gov. Mike Pence as his running mate means Trump has selected a man who is the very embodiment of last century's "tough on drugs" prohibitionist attitudes.

Trump VP pick Mike Pence doesn't have a great record on drug policy. (flickr.com/gage skidmore)
Pence's anti-drug reform stances are part and parcel of his overall social conservative, Tea Party positions. He has also been a strong opponent of gay marriage and abortion rights and a strong supporter of "religious freedom."

Indiana has tough marijuana laws, with possession of even the smallest amount of pot worth up to six months in county jail and possession of more than 30 grams (slightly more than an ounce) a felony punishable by up to 2 ½ years in prison. Selling any amount more than 30 grams is also a felony, again punishable by up to 2 ½ years in prison.

Mike Pence is just fine with that. In fact, three years ago he successfully blocked a move in the legislature to reduce some of those penalties, saying that while he wanted to cut prison populations, he didn't want to cut penalties to achieve that end.

"I think we need to focus on reducing crime, not reducing penalties," he said. "I think this legislation, as it moves forward, should still seek to continue to send a way strong message to the people of Indiana and particularly to those who would come into our state to deal drugs, that we are tough and we're going to stay tough on narcotics in this state."

Pence did sign emergency legislation allowing for needle exchange programs in some Indiana counties last year, but only after initial resistance, during which more than 150 cases of HIV/AIDS were reported in one county alone. His hesitance was in line with his anti-drug values, as evidenced by his 2009 vote as a US representative to keep intact a federal ban on funding for needle exchanges.

Pence is also a gung-ho drug warrior when it comes to the Mexican border, having voted to support billions in funding for Mexico to fight drug cartels and for using the US military to conduct anti-drug and counter-terror patrols along the border.

Bizarrely enough, there is one drug Pence has no problems with, but it's a legal one: nicotine. That's right, the drug warrior is an apologist and denier for Big Tobacco.

"Time for a quick reality check," he said in 2000. "Despite the hysteria from the political class and the media, smoking doesn't kill."

Pence has been handsomely compensated by tobacco companies for his advocacy against anti-smoking public health campaigns, even though they have proven wildly successful in driving down smoking rates. Pence can be viewed as a man who rejects proven public health interventions for one dangerous substance while insisting on failed punitive, prohibitionist policies for another, less dangerous, substance.

(This article was prepared by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also pays the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

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