Overdoses

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Making Matters Worse: DEA's Move to Restrict Opioid Prescriptions Pushed Users to the Dark Web

By the end of 2013, the country's quiet opioid addiction crisis was no longer so quiet. Opioid overdose deaths that year topped 16,000, more than four times the same statistic for 1999. That prompted a number of measures at the state and federal level to rein in opioid prescriptions, including a move by the DEA in October 2014 to tighten its policies around some of the most commonly prescribed opioids.

Dark Web fentanyl sales rose after the DEA restricted some prescription opioids. (Creative Commons)
The new DEA policy -- aimed at popular opioids such as Vicodin and Lortab -- imposed restrictions on doctors' prescribing and made it more difficult for patients to get refills. In one sense, the policy was a success: Prescriptions for those drugs decreased almost immediately. But new research adds to an increasing body of evidence that restricting opioid prescribing has not solved the opioid crisis but instead worsened it.

Since the DEA policy shift, opioid overdose deaths continued to grow with more than 40,000 fatal opioid overdoses in 2016. And while prescription opioid overdose deaths have slightly decreased -- there were about 14,000 that year -- overdose deaths from heroin and non-prescription synthetic opioids such as fentanyl went through the roof. Heroin and illicit synthetics accounted for nearly two-thirds of all opioid overdose deaths in 2016.

In the new study, published this week in the British Medical Journal, researchers examining the impact of the DEA policy shift found evidence that while the change indeed lowered prescribing rates for the opioids in question, it was also linked to an increase in illicit online sales of those drugs in Dark Web drug markets.

The researchers used software called DATACRYPTO to crawl encrypted Dark Web marketplaces where people can anonymously buy damned near anything, from drugs to guns to credit card numbers. DATACRYPTO harvested data on which drugs were for sale, their country of origin, and the number of customer comments on each seller's comments page. Researchers used that last figure as a proxy for how much of a drug that seller sold. They examined sales of prescription opioids, sedatives, stimulants, and steroids, as well as heroin. It was only with prescription opioids that they found a significant Dark Web sales bump.

Here's what they found: "The sale of prescription opioids through US cryptomarkets increased after the schedule change, with no statistically significant changes in sales of prescription sedatives, prescription steroids, prescription stimulants, or illicit opioids."

According to their data, prescription opioids doubled their market share of U.S. Dark Web drug sales thanks to the DEA policy change. By July 2016, opioids represented 13.7% of all drug sales in U.S. cryptomarkets, compared with a modeled estimate of 6.7% of all sales.

While the researchers were careful to not make claims of causation -- only correlation -- their conclusion speaks for itself: "The scheduling change in hydrocodone combination products coincided with a statistically significant, sustained increase in illicit trading of opioids through online US cryptomarkets. These changes were not observed for other drug groups or in other countries. A subsequent move was observed towards the purchase of more potent forms of prescription opioids, particularly oxycodone and fentanyl."

Not only is the DEA policy change linked to increased Dark Web opioid sales, it is also linked to a move toward more powerful, and thus more dangerous, opioids. The researchers noted that while fentanyl was the least purchased Dark Web opioid in the summer of 2014, it was the second most frequently purchased by the summer of 2016. Fentanyl killed as many people as prescription opioids that year.

This study -- one of the few that examines supply reduction (as opposed to demand reduction) as a means reducing drug use -- strongly suggests that supply-side interventions carry unintended consequences, especially the resort to more dangerous and more powerful substitutes. The study's authors refer to this effect as "the iron law of prohibition, whereby interventions to reduce supply, such as increased enforcement and changes to drug scheduling, lead to illicit markets dominated by higher potency products."

Perhaps better than restricting opioid prescriptions, which has deleterious impacts on the tens of millions of Americans suffering chronic pain, or other supply-side interventions, would be increased access to addiction treatment, as well as greatly expanded harm reduction measures to try to get people off opioids and keep them alive in the meantime.

Chronicle AM: CO Gov. Vetoes Pot Tasting Rooms, WV First Responders Get Naloxone, More... (6/5/18)

Colorado's governor vetoes a pot tasting room bill and signs a medical marijuana in schools bill, Canada's legalization bill overcomes a last-ditch attempt to block it, and more.

West Virginia first responders will now be carrying the opioid overdose reversal drug naloxone. (PA Health Dept.)
Marijuana Policy

Colorado Governor Vetoes Marijuana "Tasting Rooms" Bill. Gov. John Hickenlooper (D) has vetoed House Bill 18-1258, which would have allowed customers at marijuana retailers to consume edibles or vape on premises. Hickenlooper said the bill violated Amendment 64, which said marijuana consumption could not be done "openly" or "publicly." Hickenlooper also cited fears of stoned driving.

Medical Marijuana

Colorado Governor Signs Medical Marijuana at School Bill. Gov. John Hickenlooper (D) has signed into law House Bill 18-1286, which will allow school nurses to administer medical marijuana to students with medical marijuana patient cards. Hickenlooper said that bill would expand current law to "allow school personnel to administer medical marijuana in a non-smokable form to students qualifying for medical marijuana use."

Harm Reduction

West Virginia Begins Statewide Distribution of Naloxone to First Responders. The state Department of Health and Human Services announced Tuesday that it is beginning the distribution of the opioid overdose reversal drug to first responders. Naloxone is going out to the state police, the fire marshal's office, and emergency medical service providers, with eight high priority counties also being allocated additional doses.

 

 

 

 

International

Canada's Conservatives Thwarted in Bid to Block Legalization Bill. An attempt by Conservative senators to slow down the marijuana legalization bill failed on Monday night on 50-29 vote. Sen. Leo Housakos (C) had filed an amendment to delay passage until the government releases a report on how it will deal with marijuana-related border issues. Now, the bill is set for a final Senate vote Thursday.

 

 

Chronicle AM: CA Pays for Fentanyl Test Strips, CA Marijuana Banking Bill Advances, More... (6/1/18)

The California Senate approves a bill to create financial services for the pot industry, the California public health department is paying needle exchanges to hand out fentanyl test strips, a New York bill would allow the use of CBD oil instead of opioids to treat pain, and more.

Marijuana Policy

California Marijuana Banking Bill Passes Senate. The state Senate voted 29-6 Wednesday to approve Senate Bill 930, which would allow financial institutions to offer limited banking services to legal marijuana businesses. The bill would create limited-charter licenses for banks and credit unions allowing them to issue special checks that could be used by the industry. The measure now goes to the Assembly.

Three Out of Four Florida Democratic Gubernatorial Contenders Support Legalization. Florida Democrats are seeing a near consensus for marijuana legalization among the current crop of gubernatorial candidates. Tallahassee Mayor Andrew Gillum, Winter Park entrepreneur Chris King and former Miami Beach Mayor Philip Levine all back legalization. Former Congresswoman Gwen Graham is the outlier; she only backs decriminalization.

Medical Marijuana

New York Bill Would Allow CBD Cannabis Oil to Be Used Instead of Opioids for Pain. State Sen. George Amedore (R) on Thursday filed Senate Bill 8820, which would allow the use of CBD cannabis oil in place of opioids. Amedore is co-chair of the Senate Task Force on Opioid and Heroin Addiction and said that the evidence is clear marijuana is less harmful and addictive than opioid painkillers.

Harm Reduction

California Paying Needle Exchanges to Provide Fentanyl Test Strips. For a year now, the state public health department has been paying needle exchanges to distribute fentanyl test strips to their clients in a bid to lower overdose deaths. The tests cost $1 each. Users mix a bit of their drugs in water and then dip the strip in for a few seconds and they get results back within five minutes. About half of the state's 45 needle exchanges are distributing the strips. The state has spent $57,000 on the project so far.

(This article was prepared by StoptheDrugWar.org's 501(c)(4) lobbying nonprofit, the Drug Reform Coordination Network, which also pays the cost of maintaining this website. 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.)

Chronicle AM: RI Senate OKs Life Sentence for ODs Bill, Guatemala's First Coca Crop, More... (5/30/18)

A bill that would mandate life sentences for selling drugs involved in fatal overdoses is moving in Rhode Island, a California US attorney says he's too busy with the black market to go after legal marijuana, another Utah poll has a medical marijuana initiative winning, Guatemala gets its first coca crop and more.

Cocaine traffickers are beginning to move coca production from South America to Central America. (Pixabay)
Marijuana Policy

California US Attorney Says Too Much Black Market Work to Focus on Legal Market. Sacramento-based McGregor Scott, US Attorney for the Northeastern District of California, said Tuesday there is so much marijuana being grown illegally on federal lands and trafficked to other states that he doesn't have the resources to go after state-legal marijuana operations. Scott said he would focus on interstate trafficking, organized crime, and damage to public lands.

New Jersey Legalization Advocate Wants to Tie Legalization, Medical Marijuana. State Sen. Nicholas Scutari (D-Union) is working on a plan to combine a marijuana legalization push with a bid to expand medical marijuana, but some lawmakers are warning the effort could blow up chances for either to pass this year. The medical marijuana expansion plan has broad support; the move to legalize marijuana is much more contentious.

Northern Marianas Legalization Bill Advances. The Commonwealth of the Northern Marianas Islands (CNMI) has taken another step toward legalizing marijuana. The House Committee on Judiciary and Government Operations has unanimously approved a bill that would allow adults to grow, possess, and consume marijuana and set up a system of taxed and regulated sales and production. The bill has already passed the Senate and now awaits a House floor vote.

Medical Marijuana

Yet Another Utah Poll Has Medical Marijuana Initiative Winning. A new poll from Dan Jones & Associates finds that nearly three out of four Utah residents support the Utah Patients Coalition medical marijuana initiative. The poll had 72% either "strongly" or "somewhat" in support, with 25% opposed, and only 2% undecided. While the LDS Church has come out against the measure, even 59% of self-described very active Mormons say they are for it.

Sentencing

Rhode Island Senate Approves Bill Allowing Life Sentences in Overdose Deaths. The state Senate on Tuesday approved Senate Bill 2279A, which allows prison sentences of up to life for those convicted of selling, delivering, or distributing an illegal drug that results in a fatal overdose. The bill passed 22-11 over the objections of treatment professionals, mental health advocates, and civil liberties organizations, which argued that tougher sentences will only make it harder to fight drug overdoses. "We know, based on decades of criminal justice based drug policy, that harsher penalties do not decrease drug using activity. So, this bill's disturbing message will not decrease drug use, nor drug trafficking -- the economics ensure this -- but it will further marginalize people who use drugs and increase their fears," a joint letter to the Senate said. "Use of a public health approach, not lengthy criminal sentences for users and small-time dealers, is essential for our state's ability to continue to make headway in this crisis." The bill now goes to the House.

International

Guatemalan Authorities Bust First Coca Farm. The National Civil Police announced over the weekend that they had found and destroyed a 2 ½ plot of coca plants sown between coffee plants, the first discovery of coca cultivation in the country. The crops were found in a remote area of Alta Verapaz department. Honduras recently saw its first and second discovery of coca plantings, too, suggesting that traffickers are attempting to cut risk and transport costs by planting the cocaine-producing crop nearer to US markets.

Chronicle AM: House Dems Want Action on Naloxone Pricing, German Decrim Hint, More... (5/21/18)

There's too much marijuana in Oregon, Utah medical marijuana foes try another tack to block the initiative, Africa gets its first medical marijuana dispensary, and more.

Price gouging on the opioid overdose reversal drug needs to stop, Democratic House members say. (PA Health Department)
Marijuana Policy

Oregon US Attorney Warns of "Significant Overproduction" of Legal Marijuana, Will Target Diversion. US Attorney Billy Williams said last Friday that the state has a "significant overproduction" problem and that he would prioritize enforcement of overproduction, diversion to other states, and organized crime. The state currently has nearly a million pounds of marijuana buds in inventory, and it's estimated that Oregon's billion dollar a year industry includes about $300 million worth of pot to diverted to the black market.

Pennsylvania State Senator Calls on DAs to Quit Prosecuting Small-Time Pot Cases. One of the Keystone State's leading voices for marijuana law reform, state Sen. Daylin Leach (D), last Friday published an open letter to the state's district attorneys urging them to quit prosecuting pot possession and smoking cases. Leach cited the nine states that have already legalized marijuana and warned, "If people are convicted this year, and legalization occurs next year or the year thereafter, thousands of people will have a stain on their record that will be extremely difficult or impossible to remove."

Medical Marijuana

Utah Medical Marijuana Foes Sue to Block Initiative from Going to Voters. Drug Safe Utah, a group formed to oppose the medical marijuana initiative, went to court last Thursday to try to block it. In court filings, the group argued that the lieutenant governor, whose office oversees elections, doesn't have the authority to allow campaigners to gather signatures. Drug Safe Utah argued that state officials couldn't act on the initiative because it "conflicts with federal law."

Harm Reduction

House Democrats Call on Trump Administration to Lower Naloxone Price. A group of House Democrats led by Reps. Lloyd Doggett (D-TX) and Peter Welch (D-VT) have sent a letter to White House Kellyanne Conway asking for executive action to curb rising prices for naloxone, the opioid overdose reversal drug. "Federal agencies have the authority to use patented inventions… when in the interest of the public good," the lawmakers wrote. "The current opioid crisis requires invoking this provision."

International

German Drug Official Hints at Move Toward Marijuana Decriminalization. In a report released last week, German drug commissioner Marlene Mortler appeared to call for marijuana decriminalization. "Anyone caught by the police in the future for possession of cannabis for personal consumption should be allowed to choose whether to pay a fine or voluntarily seek help from the expert," she said. German drug arrests were up more than 6% last year, while marijuana arrests were up 14%. About 80% of all marijuana cases were for simple possession.

Africa Gets First Medical Marijuana Dispensary. A medical marijuana dispensary has opened in Durban, South Africa, making it the first on the continent. The store is currently only selling products without THC. "We want to break the stigma on cannabis, to showcase that cannabis can be used effectively to treat a number of conditions and to integrate medical professionals as well as traditional healers to allow the whole of South Africa a holistic approach to health care," said dispensary spokesperson Kirithi Thaver.

Chronicle AM: 2019 Ohio Init Gears Up, Fed Treatment Bill Advances, More... (5/19/18)

Michigan legalization initiative foes urge the legislature to legalize it, an Ohio legalization initiative can begin signature gathering, a federal drug treatment bill exclusively targeting opioids advances, and more.

Marijuana Policy

Michigan Legalization Initiative Foes Urge Legislature to Pass Legalization. In a surprise move, a campaign committee formed to oppose the pending marijuana legalization initiative is now asking the legislature to preemptively pass legalization. Keep Pot Out of Neighborhoods and Schools issued a press release Thursday calling on the legislature to approve the initiative. Under state law, the legislature can just pass the initiative, or, if it rejects it or fails to act, the initiative would go before voters in November. State Republicans worry that interest in the initiative will drive turnout at the polls, worsening their chances in the election.

Ohio Legalization Initiative Cleared for Signature Gathering. The state Ballot Board on Thursday cleared a legalization initiative, the Marijuana Rights and Regulation Act, for signature gathering. Campaigners need to come up with some 305,000 valid voter signatures to qualify for the initiative. The deadline to make the November ballot is in July, but campaigners say there are instead aiming at 2019.

Medical Marijuana

House Panel Approves Medical Marijuana Protections. The House Appropriations Committee on Thursday approved an amendment from Rep. David Joyce (R-OH) to continue to protect state-legal medical marijuana programs from federal interference. The amendment is now part of the House's Commerce, Justice and Science appropriations bill. The amendment, previously known as the Rohrabacher-Blumenauer amendment, bars the expenditure of federal funds to go after state-legal medical marijuana.

Illinois Legislature Approves Medical Marijuana in Schools. The Senate on Thursday approved a bill that would allow for the use of medical marijuana in elementary and middle schools. The bill has already passed the House and now goes to the desk of Gov. Bruce Rauner (R). The bill would let parents administer marijuana-infused products, but not smoked marijuana, to their child on school grounds.

Missouri Medical Marijuana Bill Dies. A medical marijuana bill, House Bill 1554, has died in conference committee, leaving the path open for at least one medical marijuana initiative to go before the voters in November. The bill came as an amendment to a healthcare bill and would only have allowed patients with terminal illnesses to use non-smokable marijuana.

Heroin and Prescription Opioids

House Panel Advances Bill to Expand Drug Treatment, But Only for Opioids. The House Committee on Energy and Commerce on Thursday advanced a bill that would free up Medicaid dollars for spending on treatment for opioid addictions, but some lawmakers warned that the country is facing a polydrug crisis. "I'm troubled that this bill would expand treatment only to people with opioid use disorder as opposed to those with other substance use disorders like alcohol, crack-cocaine, methamphetamine," said Rep. Jan Schakowsky (D-IL). "This bill is not only blind to the reality faced by people suffering from substance use disorder but it's also discriminatory." The measure is HR 5797.

One of the World's Most Prestigious Medical Journals Just Called for Legalizing All Drugs

Embracing a harm reduction and public health perspective, one of the world's most prestigious medical journals has released a signed editorial calling for the legalization, taxation, and regulation of currently illegal drugs.

In a editorial last Thursday entitled Drugs Should Be Legalised, Regulated, and Taxed, Fiona Godlee, editor in chief of the British Medical Journal, notes that under drug prohibition, the global trade "fuels organized crime and human misery," and asks, "Why should it not instead fund public services?"

Citing an opinion piece in the same issue of the BMJ from British members of the Law Enforcement Action Partnership (LEAP, formerly known as Law Enforcement Against Prohibition) Jason Reed and Paul Whitehouse, Godlee notes that in the United Kingdom (as in the United States) "vast sums are spent prosecuting individuals and trying vainly to interrupt the flow of drugs into cities" while that money would be much better "spent on quality control, education, treatment for drug users, and child protection." Under legalization, "revenues could be diverted from criminal gangs into government coffers," she writes.

Godlee notes that the global drug prohibition consensus is fraying around the edges, and points to the example of Portugal, which decriminalized the possession of all drugs in 2001. There, drug use remains in line with levels in other European countries, but the harms associated with drug use under prohibition have decreased dramatically, particularly in terms of fatal drug overdoses and the spread of injection drug-related infectious disease.

Godlee also pointed to the Netherlands, the United States, and soon, Canada, where "regulated markets for the sale of cannabis generate substantial tax revenues."

Again returning to the opinion piece by Reed and Whitehouse, Godlee writes that "when law enforcement officers call for drugs to be legalized, we have to listen." Ditto for when doctors speak up, she adds, noting that just last month, the Royal College of Physicians came out in favor of drug decriminalization, joining the British Medical Association, the Faculty of Public Health, and the Royal Society of Public Health in supporting drug policy reform.

"This is not about whether you think drugs are good or bad," Godlee concludes. "It is an evidence based position entirely in line with the public health approach to violent crime… The BMJ is firmly behind efforts to legalize, regulate, and tax the sale of drugs for recreational and medicinal use. This is an issue on which doctors can and should make their voices heard."

Unfortunately for the BMJ and the other public health advocates, as in the United States, the political class in the United Kingdom isn't yet on board with evidence-based best practices on drug policy. But this editorial loosens another brick in the wall -- on both sides of the Atlantic.

Chronicle AM: McConnell Just Says No to Legal Weed, Walmart Tightens Prescribing, More... (5/9/18)

Mitch McConnell just says no, a House committee advances a VA medical marijuana bill, Pennsylvania's governor and attorney general aren't down with a Philadelphia safe injection site, and more.

Mitch McConnell is down with hemp, but not pot. (Flickr/Gage Skidmore)
Marijuana Policy

Mitch McConnell Confirms GOP Still the Party of "No" on Legal Marijuana. Senate Majority Leader Mitch McConnell (R-KY) said he was not interested in legalizing marijuana, even though his Democratic counterpart, Minority Leader Chuck Schumer (D-NY) has endorsed it. "I do not have any plans to endorse legalization of marijuana," McConnell said. McConnell is pushing for the legalization of hemp, though: "These are two entirely separate plants," McConnell said. "I hope everybody understands that. It is a different plant. It has an illicit cousin which I choose not to embrace."

Medical Marijuana

House Committee Advances Veterans Affairs Medical Marijuana Research Bill. The House Veterans' Affairs Committee Tuesday unanimously approved a measure that aims to increase VA research on medical marijuana. The bill would specify that the agency has the ability to research the herb for conditions including PTSD. The measure is part of a package of bills lawmakers hope to pass this month.

Missouri Senate Gives Initial Approval to Medical Marijuana Bill. The Senate Tuesday gave initial approval to House Bill 1554, which would allow people suffering from specified serious illnesses to use non-smokeable medical marijuana. The bill has already passed the House and now goes to the Senate Committee on Health and Pensions for a second reading. If it survives that, it then goes to the full Senate for a floor vote.

Utah "Right To Try" CBD Medical Marijuana Law Now in Effect. A limited medical marijuana law is now in effect. Under House Bill 195, which passed in March, terminally ill patients will be able to access CBD cannabis oil under a provision that expands the state's 2015 Right to Try Act. Also now in effect is House Bill 197, which establishes a medical marijuana cultivation program in the state. Both of these laws could soon be irrelevant, though: A much broader medical marijuana initiative will be on the ballot in November.

Heroin and Prescription Opioids

Study: Prescription Drug Monitoring Programs Have Little Effect on Overdose Deaths. A new study from Columbia University's Mailman School of Public Health finds that prescription drug monitoring programs may be only "marginally effective" in reducing drug overdose deaths. "What it really offers is this cautionary tale that says a few things. One, the amount of money and resources that are going into these programs need to be evaluated to understand what their ultimate costs are," social epidemiologist David Fink said. "Studies have come out in the past looking at reduced prescribing behavior, but we're taking it to the next level -- looking at fatal or nonfatal overdoses. And what we're seeing is that when you actually look at the literature, it isn't that strong to support" the programs. The study also found that half the studies looking at heroin overdose rates found a significant increase after prescription drug monitoring programs were implemented.

Walmart Tightens Opioid Prescription Policies. The nation's largest pharmacy chain announced Monday that beginning within 60 days, it will only fill first-time acute opioid prescriptions for a week or less nationwide. It will also limit dosages to 50 morphine milligram units per day. Walmart didn't say what it would do about patients who require greater dosages than that.

Harm Reduction

Officials in Philadelphia want a safe injection site in a bid to reduce drug overdoses that killed more than 1,200 people in the city last year, but the Democratic governor and attorney general aren't on board. A spokesman for Gov. Tom Wolf said the idea "presents a number of serious public health and legal concerns, while a spokesman for Attorney General Josh Shapiro said changes in federal law would have to come before he could support a safe injection site.

NYC Mayor de Blasio Endorses Safe Injection Site Plan

Just a day after close to a hundred community activists, reform advocates, and local elected officials took to the streets outside New York City's City Hall Wednesday to demand that Mayor Bill de Blasio (D) move on a long-delayed feasibility study on safe injection sites, the mayor has moved -- and further than they expected.

New York City Mayor Bill de Blasio comes out for safe injection sites. (Flickr)
On Thursday evening, the mayor's office announced de Blasio's support for a plan to open four of the sites, which the office refers to as Overdose Prevention Centers, a year from now, after a period of consultation with stakeholders.

"After a rigorous review of similar efforts across the world, and after careful consideration of public health and safety expert views, we believe overdose prevention centers will save lives and get more New Yorkers into the treatment they need to beat this deadly addiction," de Blasio said in a statement.

Safe injection sites (SISs) -- or safe injection facilities or supervised injection facilities or supervised consumption sites or overdose prevention centers -- allow drug users to inject (or sometimes inhale) their own drugs under medical supervision. They typically also have a social services component that aims to assist drug users in finding drug treatment and other services.

Operating in around 90 cities in Europe, Australia, and Canada, they are a proven harm reduction intervention. Numerous peer-reviewed scientific studies have shown they reduce public disorder; increase access to treatment, reduce the risk of HIV, Hep C, and bacterial infections; reduce drug overdose deaths; and reduce medical costs thanks to a reduction in disease and overdose, while at the same time increasing access to cost-saving preventive healthcare. What SISs don't do, the studies have found, is increase crime, injection drug use, or the initiation of new drug users.

Yet no such sites operate in the United States. Pushes are underway in several cities, including Philadelphia, San Francisco, and Seattle, but all have faced challenges ranging from moralism and NIMBYism to the fact that they would appear to violate federal law. Just this week, DEA spokesman Melvin Patterson said they violate the Controlled Substances Act and are "subject to being prosecuted." Given the proclivities of the Trump administration, that is probably not a threat to be taken lightly.

Still, the cities are willing to push on the issue, the American Medical Association has endorsed the notion, and legislatures in a number of states are pondering bills to allow them. And now, with the country's largest city coming on board, momentum for the sites is only growing stronger.

In New York City, where the SIF NYC Campaign, a coalition of dozens of community, drug reform, public health, medical, and religious groups has been pressuring the administration to act for months, the mayor's announcement was greeted with relief.

"Mayor de Blasio's embrace of safer consumption spaces is a critical step forward in preventing overdose deaths in New York City. We know that safer consumption spaces are an evidence-based solution that can help dramatically in saving lives, reducing criminalization, and improving public health," said Kassandra Frederique, New York state director at the Drug Policy Alliance. "New York can and must be a leader now in saving lives by opening safer consumption spaces swiftly."

That will take some political acumen in dealing with city district attorneys and the state Health Department, which answers to Gov. Andrew Cuomo, with whom de Blasio's relations are strained at best. It will also take some political fortitude in taking on the Sessions Justice Department and the DEA.

De Blasio's announcement marks the successful culmination of the campaign to bring the city on board with safe injection sites as a harm reduction and overdose prevention measure, but it's just the beginning of the fight to actually get them up and running.

Drug War Issues

Criminal JusticeAsset Forfeiture, Collateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Court Rulings, Drug Courts, Due Process, Felony Disenfranchisement, Incarceration, Policing (2011 Drug War Killings, 2012 Drug War Killings, 2013 Drug War Killings, 2014 Drug War Killings, 2015 Drug War Killings, 2016 Drug War Killings, 2017 Drug War Killings, Arrests, Eradication, Informants, Interdiction, Lowest Priority Policies, Police Corruption, Police Raids, Profiling, Search and Seizure, SWAT/Paramilitarization, Task Forces, Undercover Work), Probation or Parole, Prosecution, Reentry/Rehabilitation, Sentencing (Alternatives to Incarceration, Clemency and Pardon, Crack/Powder Cocaine Disparity, Death Penalty, Decriminalization, Defelonization, Drug Free Zones, Mandatory Minimums, Rockefeller Drug Laws, Sentencing Guidelines)CultureArt, Celebrities, Counter-Culture, Music, Poetry/Literature, Television, TheaterDrug UseParaphernalia, ViolenceIntersecting IssuesCollateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Violence, Border, Budgets/Taxes/Economics, Business, Civil Rights, Driving, Economics, Education (College Aid), Employment, Environment, Families, Free Speech, Gun Policy, Human Rights, Immigration, Militarization, Money Laundering, Pregnancy, Privacy (Search and Seizure, Drug Testing), Race, Religion, Science, Sports, Women's IssuesMarijuana PolicyGateway Theory, Hemp, Marijuana -- Personal Use, Marijuana Industry, Medical MarijuanaMedicineMedical Marijuana, Science of Drugs, Under-treatment of PainPublic HealthAddiction, Addiction Treatment (Science of Drugs), Drug Education, Drug Prevention, Drug-Related AIDS/HIV or Hepatitis C, Harm Reduction (Methadone & Other Opiate Maintenance, Needle Exchange, Overdose Prevention, Pill Testing, Safe Injection Sites)Source and Transit CountriesAndean Drug War, Coca, Hashish, Mexican Drug War, Opium ProductionSpecific DrugsAlcohol, Ayahuasca, Cocaine (Crack Cocaine), Ecstasy, Heroin, Ibogaine, ketamine, Khat, Kratom, Marijuana (Gateway Theory, Marijuana -- Personal Use, Medical Marijuana, Hashish), Methamphetamine, New Synthetic Drugs (Synthetic Cannabinoids, Synthetic Stimulants), Nicotine, Prescription Opiates (Fentanyl, Oxycontin), Psilocybin / Magic Mushrooms, Psychedelics (LSD, Mescaline, Peyote, Salvia Divinorum)YouthGrade School, Post-Secondary School, Raves, Secondary School