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Don't Believe the Hype: "Fentanyl-Laced Marijuana" is a Dangerous Myth [FEATURE]

This article was produced in collaboration with AlterNet and first appeared here.

Fentanyl is serious business. The synthetic opioid is 50 times stronger than heroin and is linked to huge numbers of opioid overdose deaths. It may be mixed in with heroin or other powder drugs, producing a more potent high than users expect, and the results are too often fatal.

fentanyl... not marijuana (Creative Commons)
So it's not surprising that claims that fentanyl has shown up in marijuana causes alarm bells to ring. But there's not a scintilla of evidence for it, and the claims are doubly damaging. Scaring pot smokers away from a substance that has no overdose potential is not a good thing, and neither is raising fears about opiated weed when weed may actually help people suffering from opioid addiction.

Still, like a vampire, the myth of marijuana laced with the deadly opioid fentanyl refuses to die. It first went nationwide in June, thanks to an Ohio U.S. senator's press conference, and while a VICE debunking at the time should have driven a stake through its heart, it has reared up once again this month, most recently thanks to a local prosecutor in Tennessee.

"There are some marijuana dealers that will tell their clients that I have no doubt there is fentanyl in it and some of the more addictive folks, especially folks that also use other drugs, will get that marijuana laced with fentanyl in hopes of getting a better high," District 24 Attorney General Matthew Stowe told a credulous WKRN-TV in an interview last week. "The bottom line is, anyone, anywhere could mix fentanyl and marijuana and there's no way of knowing it until it's too late."

But wait, there's more: "Marijuana laced with fentanyl can be extremely deadly and to anyone who touches it, taste it, smokes it [or] anything else of that nature," Stowe claimed. "If it's laced with fentanyl, marijuana can be the deadliest drug there is."

Marijuana laced with fentanyl would be deadly -- if such a thing existed. There is no evidence it does.

There are a couple of reasons such a concoction is unlikely. First, fentanyl is typically a white powder and, unlike drugs such as heroin or even cocaine, which are also powders, marijuana is green plant material. Buds adulterated with white powders would look like buds adulterated with white powders.

Secondly, no one even seems to know if smoking fentanyl in weed would even work. Chemist Kirk Maxey, who helps law enforcement agencies like the DEA test suspected synthetic opioids, told VICE he doesn't know if it's scientifically possible.

"Documenting the pipe chemistry of fentanyl in leaf material would be a research paper," he said. "And I don't think it's been done yet."

Still, such obvious objections haven't stopped the spread of the myth, which may have originated in a February Facebook post from the Painesville Township Fire Department in northeast Ohio. That post, which quickly went viral, reported that three men had reported overdosing after smoking "marijuana laced with an unknown opiate." It was picked up by a local ABC TV affiliate, which reported "three separate incidents, but all with the same result -- overdoses from opiate-laced marijuana."

It wasn't true. As Cleveland.com reported shortly afterward, toxicology results showed that "the three people who claimed they had overdosed on marijuana laced with an unknown opiate actually used crack cocaine and other drugs."

The media hubbub died down, but the seed was planted, growing through the spring in the fertile soil of an Ohio gripped by a deadly opioid epidemic and filled with policemen and politicians willing to fertilize it with healthy doses of manure. In June, it blossomed.

marijuana... not fentanyl (Creative Commons)
"Marijuana laced with fentanyl: police warn of another potentially dangerous drug mixture," News 5 Cleveland reported on June 14. There weren't any actual cases of the pot/fentanyl mixture showing up, but "police said the warning was necessary to alert people, especially parents, to the potential risk."

And politicians. Five days later, Ohio U.S. Senator Rob Portman (R) held a Cincinnati press conference on the opioid crisis with Hamilton County Coroner Lakshmi Sammarco, whose reported remarks helped give the myth new life.

"We have seen fentanyl mixed with cocaine," said Sammarco. "We have also seen fentanyl mixed with marijuana."

The comment rocketed around the web, rousing alarm and raising the specter of innocent pot smokers felled by deadly adulterants, but there was less to it than meets the eye. When, unlike other media outlets that simply ran with the story, VICE actually reached out to Sammarco, the story fell apart.

Sammarco said her quote had been misinterpreted and that her office hadn't actually seen any fentanyl-laced weed. Sammarco told VICE that Sen. Portman had mentioned to her that it had been spotted in northeast Ohio -- apparently based on that erroneously News 5 Cleveland report.

When VICE contacted Portman's office about the origin of the fentanyl in weed story, spokesman Kevin Smith replied only "I don't have anything on that," before hanging up the phone.

Despite the baselessness of the claim, it was back again this month. Police and health officials in London, Ontario, sent out warnings after people who claimed to have only smoked pot came back positive for opioids on urine drug tests, without ever considering the possibility that those people weren't telling the truth.

Canadian Federal Health Minister Jane Philpott had to step in to put a stop to the nonsense: "We have confirmed this with chiefs of police [and] law enforcement officials across this country -- there is zero documented evidence that ever in this country cannabis has been found laced with fentanyl," she told the London Free Press. "It's very important that we make sure that that message is clear."

That didn't stop police in Yarmouth, Massachusetts, from generating a similar story just days later. It was another case of a man who overdosed on opioids claiming to have only smoked pot. Police there said they "believe that is possible that the marijuana was laced with fentanyl, which police are starting to see more and more across the country."

Except they're actually not. That first batch of fentanyl-laced marijuana is yet to be discovered. But that hasn't stopped prosecutor Stowe any more than it's stopped the other cops, politicians, and hand-wringing public health officials from propagating the misinformation. This is Reefer Madness for the 21st Century.

Chronicle AM: Federal Judge Slams Indianapolis PD Car Seizures, More... (8/23/17)

It's slow in the dog days of August, but there is a bit of news out there: Indianapolis cops have to revise their vehicle seizure practices, Alaska regulators are seeking public comment on proposed on-site pot consumption regulations, and more.

Alaska wants to let pot buyers smoke their purchases where they got them. Public comments being sought now. (Sandra Yruel/DPA)
Marijuana Policy

Alaska Regulators Seek Public Comment on Onsite Marijuana Consumption. The state's Marijuana Control Board has created a draft proposal that would allow some pot shops to provide a space for on-premises consumption of products bought there. Now it's giving the public a chance to weigh in. People who want to comment have until October 27.

Nevada Gaming Commission to Discuss Marijuana-Related Issues. The state Gaming Commission will hold a special meeting Thursday to address problems the gambling industry may have to confront after the state legalized marijuana. The commission is likely to discuss ways to keep gaming companies from being associated with marijuana businesses, which are illegal under federal law.

Asset Forfeiture

Indiana Federal Judge Restricts Indianapolis Police Seizure Practices. The Indianapolis Metro Police Department may no longer hold seized vehicles for up to six months before deciding whether to file formal asset forfeiture paperwork, a federal district court judge ruled on Monday. The ruling came in a class action lawsuit challenging such seizures. "The Court concludes that the statutory provisions allowing for the seizure and retention of vehicles without providing an opportunity for an individual to challenge the pre-forfeiture deprivation are unconstitutional," US District Chief Judge Jane Magnus-Stinson ruled in remarks reported by The Indianapolis Star.

Harm Reduction

Kentucky First Responders Get Naloxone. Gov. Matt Bevin (R) joined officials from northern Kentucky and executives from Aetna to announce Wednesday that first responders in the northern and Appalachian regions will receive720 doses of the overdose reversal drug naloxone in a bid to prevent overdose deaths. Drug overdose deaths in the state were at record levels last year, up more than 7% over 2015.

Chronicle AM: Secret Safe Injection Site in US City, VT "Blue Ribbon" MJ Panel, More... (8/8/17)

The body representing state legislatures again calls for marijuana reforms, Vermont's governor is about to empanel on commission to study legalization issues, a safe injection site has been operating secretly in a US city for the past three years, and more.

The Vancouver safe injection site has a hidden counterpart somewhere in the US. (vch.ca)
Marijuana Policy

National Conference of State Legislatures Urges De-Scheduling Marijuana. The National Conference of State Legislatures has approved a resolution calling for marijuana to be removed from the Controlled Substances Act. The resolution approved on Monday specifically references access to banking, saying such a move would result in "… enabling financial institutions the ability to provide banking services to cannabis related businesses." This marks the third year in a row the conference has passed a resolution on marijuana, going a bit further each time. In 2015, it resolved that federal laws should be amended to allow states to set their own pot policies, and last year, it resolved that marijuana should be down-scheduled.

Vermont Governor About to Convene "Blue Ribbon Commission" on Legalization. Gov. Phil Scott (R) says he will shortly convene a commission to study issues around marijuana legalization, but it looks like his emphasis will be on how to detect marijuana impairment in drivers rather than examining models for legalization. Earlier this year, Scott vetoed a legalization bill, citing concerns about driving and youth, and he says now that he will not sign a bill that doesn't have stringent standards on impaired driving.

Virginia Gubernatorial Candidates Split on Decriminalization. Democratic nominee Lt. Gov. Ralph Northam sent a letter Monday to the State Crime Commission, which is studying decriminalization, in support of the notion. That position contrasts with Republican nominee Ed Gillespie, who says he opposes legalization or decriminalization, but is open to exploring reforms to ensure that penalties are commensurate with the offense committed. Polling shows a majority of Virginians favor decrim. Libertarian candidate Cliff Hyra, meanwhile, says just tax and legalize it.

Medical Marijuana

Indiana Republican Will File Medical Marijuana Bill to Fight Opioid Overdoses. State Rep. Jim Lucas (R-Seymour) says he plans to file a medical marijuana bill in a bid to combat opioid abuse. He said he was acting after hearing from constituents. "People telling me their personal stories, how they've been helped by this product, how far behind Indiana is on this issue," he told the Indianapolis Star. "That right there, we have a responsibility to at least investigate it and determine the facts, and if there is something positive out there, we have to pursue that."

Asset Forfeiture

Arizona Asset Forfeiture Reforms Go Into Effect Wednesday. A new law limiting civil asset forfeiture reform goes into effect Wednesday. House Bill 2477 does not end civil asset forfeiture, but raises the standard of proof necessary for seizures from "a preponderance of the evidence" to "clear and convincing evidence."

Harm Reduction

Underground Safe Injection Site Has Been Operating in a US City for Three Years. In a report released Tuesday, two researchers revealed that they've been studying an unpermitted safe injection site in operation since 2014. They reported that no one died while using drugs at the site and that two overdoses were reversed by staff members administering naloxone. The report comes as pressure to authorize such sites is mounting, with lawmakers in states like California and New York and cities including San Francisco, Seattle, and Ithaca, New York, backing such efforts.

(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.)

Chronicle AM: British Drug Deaths at Record High, Another Good Poll for Pot, More... (8/3/17)

A new poll shows extremely low support for marijuana prohibition, Maine lawmakers want to restrict how much pot landowners can allow for personal grows, drug deaths are up dramatically in the UK, and more.

Aging "trainspotters" are driving drug deaths in Britain, experts say. (Wikimedia)
Marijuana Policy

Poll: Fewer Than One Out of Seven Believe Marijuana Should Be Fully Illegal. A new Harvard-Harris poll finds that only 14% of Americans believe marijuana should be fully illegal, with a near majority 49% favoring legalization for recreational purposes and a supermajority of 86% in favor of legal medical marijuana. The 49% figure is lower than most recent polls, which have had support for legalization in the fifties, but still demonstrates a huge gap between support for and opposition to legalization.

Maine Lawmakers Propose Personal Grow Limit of 12 Plants Per Property. The legislative committee working to establish rules for marijuana legalization in the state have proposed limiting the number of personal use plants grown on a single property to 12 in a bid to prevent leakage to the black market. But the move is controversial: The state's pot law allows anyone to grow up to six mature plants on their own or someone else's property with the property owner's permission, and some rural landholders have plans to allow multiple people to do personal grows on their property. It's not a done deal; just a proposal at this point. It does not apply to commercial or medical marijuana grows.

Medical Marijuana

North Dakota Reports Heavy Interest in Medical Marijuana Industry. The Health Department's medical marijuana division reported Wednesday that it has received 97 nonbinding letters of intent from potential medical marijuana producers. The level of interest exceeded the division's expectations, and the director of the Health Department's medical marijuana division, Kenan Bullinger, told the Associated Press, "I'm pretty sure we're going to have the ability to have a dispensary in each part of the state." The department is looking to name final selections by November, and is eyeing a late spring or early summer timeline for dispensary sales to begin.

International

Drug Deaths in England and Wales at Record High. British government figures published on Wednesday show that deaths from heroin, cocaine, and ecstasy are at all-time highs and have more than doubled in the past five years. Some experts partially attributed the rise in drug deaths to an aging "trainspotting" generation, noting that the most deaths occurred in the 40-49 age group. Critics used the figures to assail the government's drug policies.

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

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

Marijuana Policy

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

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

Medical Marijuana

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

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

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

Drug Testing

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

Heroin and Prescription Opioids

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

Chronicle AM: Canada Expanding Safe Injection Sites, FL Sued Over MedMJ Smoke Ban, More... (7/6/17)

Canada is expanding the use of safe injection sites, the man behind Florida's successful medical marijuana constitutional amendment is suing the state over a smoking ban enacted by lawmakers, Massachusetts lawmakers continue to struggle with how to implement marijuana legalization, and more.

Vancouver's Insite supervised injection facility (vch.ca)
Marijuana Policy

Massachusetts House Speaker Wants Marijuana Talks Suspended Until Budget is Passed. Legislators locked in a battle over how to implement the state's voter-approved pot legalization law are being told to put the issue on hold until solons can get a budget passed. House Speaker Roberto DeLeo (D), whose chamber is backing a plan that radically increases taxes and would allow localities to ban marijuana businesses without a popular vote, called Wednesday for setting the issue aside to take on the budget. But Senate President Stan Rosenberg (D) countered that the Senate could work on both bills and that "mischief makers are once again at work."

Nevada Opening Pot Sales Exceed Store Owners' Expectations. Legal marijuana sales that began just after midnight Saturday have exceeded the expectations of pot shop operators. Long lines formed in the wee hours Saturday morning, and shops are continuing to report heavy interest, with lines forming again before shops opened for business on Monday. "I'm very happy with the way sales have gone and continue to go, especially when you consider that the word didn't really get out ahead of time," Andrew Jolley, president of the Nevada Dispensary Association and a store owner told Leafly. "The public really only had a couple of weeks' notice, whereas Colorado had a full year to prepare."

Medical Marijuana

Florida Sued Over No Smoking Provision in Medical Marijuana Law. Orlando attorney John Morgan, the mastermind and chief funder of the state's voter-approved medical marijuana law, filed a lawsuit Thursday challenging a legislative ban on smoking medical marijuana. He is asking the courts to throw out the implementing law, saying legislators violated the will of the voters by altering the constitutional amendment they approved last November. "Inhalation is a medically effective and efficient way to deliver Tetrahydrocannabinol (THC), and other cannabinoids, to the bloodstream," the lawsuit argues. "By redefining the constitutionally defined term 'medical use' to exclude smoking, the Legislature substitutes its medical judgment for that of 'a licensed Florida physician' and is in direct conflict with the specifically articulated Constitutional process."

West Virginia Medical Marijuana Law Now in Effect. The state's Medical Cannabis Act went into effect Wednesday, but it could still be months or years before Mountain State patients are able to medicate with marijuana. But now an advisory board has been appointed to create a regulatory framework for medical marijuana regulations, and it could be 2019 before patients are able to legally purchase their medicine.

Drug Testing

Colorado Employers Begin to Walk Away from Testing for Marijuana. Changing social attitudes and a tight labor market are pushing employers in the state to drop screenings for marijuana from pre-employment drug tests, said a spokesman for the Mountain States Employers Council. "We're finding that for employers, it's such a tight labor market, that they can't always afford to have a zero-tolerance approach to somebody's off-duty marijuana use, Curtis Graves told Colorado Public Radio.

Harm Reduction

Mississippi Law Easing Naloxone Access Now in Effect. As of July 1, health care providers can write "standing prescriptions" for the opioid overdose reversal drug for family members of people strung out on opioids. "This will save many lives," said Rep. Tommy Reynolds (D-Water Valley).

International

Canada Expanding Safe Injection Sites. Once there was only InSite, the Vancouver safe injection site under constant assault from the Conservative federal government. But now, the Liberals are in power, and the number of safe injection sites has expanded to seven, including three in Montreal and another in Vancouver. Another Montreal site is set to open soon, and so are three in Toronto, with more than a dozen other potential sites being considered.

Chronicle AM: Mexico Legalizes MedMJ, China Bans More Synthetic Opioids, More... (6/20/17)

New Jersey pols look to legalize pot next year, Vermont pols look to legalize it this week, China bans more synthetic opioids, Mexico officially embraces medical marijuana, and more.

Medical marijuana is now officially legal in Mexico, but rules and regulations will take some time.
Marijuana Policy

New Jersey Legalization Bill Gets Hearing. The Senate Judiciary Committee held a hearing on a legalization measure, Senate Bill 3195, on Monday. The testimony was largely favorable, including from a former state Republican Committee head, the head of a doctors' organization favoring legalization, and from a long-time municipal prosecutor. "I believe by legalizing and regulating it and discouraging, officially as official government policy, like we do with tobacco and alcohol, we will be far better off than the status quo," prosecutor J.H. Barr told the committee. No vote was taken. The bill is strongly opposed by Gov. Chris Christie (R), but he'll be gone in January.

Vermont Legislators Will Try to Get Weed Legalized in Special Session This Week. Gov. Phil Scott (R) vetoed the legalization bill in May, saying he had public safety concerns. Supporters of legalization have come back with a bill that now has stiffer penalties for drugged driving, smoking pot in cars with kids, providing pot to kids, and selling pot in school zones -- all in a bid to win the governor's support. The bill does not include "impairment testing mechanism" requested by Scott, largely because there are no marijuana breathalyzers on the market. Scott has declined to comment on the revised bill. The special session begins Wednesday.

Harm Reduction

Boston Ponders Supervised Injection Sites. With six people a day dying of opioid overdoses in the city so far this year, the city council has set a hearing next Monday to explore the potential impact of supervised injection sites. The move comes after the Massachusetts Medical Society urged state officials to open at least two of the facilities.

International

China Bans Synthetic Opioids Linked to US Overdose Deaths. China announced on Monday that it is banning the ultra-potent synthetic opioid U-47700 and three others. The DEA says China is the chief source of synthetic opioids, including fentanyl and carfentanil, which China has already banned. U-47700, MT-45, PMMA, and 4,4-DMAR will be added to the country's list of controlled substances as of July 1, said Deng Ming, deputy director of the National Narcotics Control Commission.

Mexico Legalizes Medical Marijuana. President Enrique Pena Nieto issued a decree on Monday officially legalizing medical marijuana in the country. Legislation authorizing medical marijuana sailed through the Senate in December and passed the lower house on a 347-7 vote in April. Now, the Ministry of Health will be tasked with drafting and implementing rules and regulations.

Chronicle AM: Federal CARERS Act Refiled, RI Legalization Commission Bill Advances, More... (6/15/17)

A bipartisan group of senators reintroduce the CARERS Act to protect medical marijuana in the states, marijuana legalization is keeping legislators busy in the Northeast, New York GOP senators want more drug war to fight opioids, and more.

Kirsten Gillibrand (D-NY) is among a bipartisan group of senators who reintroduced the CARERS Act today. (senate.gov)
Marijuana Policy

Massachusetts Legal MJ Rewrite Bill Delayed By Errors, Concern at High Tax Rates. House Speaker Robert DeLeo (D-Winthrop) has postponed a vote on the legislature's rewrite of the marijuana legalization law approved by voters last fall after errors in the drafting of the bill and the high tax rate proposed -- 28% -- drew protests from Democratic lawmakers. "I think there are certain things that we have to clear up, so because of that, I think it's important that with a bill of this mag that we try to get it right or close to right this first time, so I'd rather do that than try to rush it through," DeLeo said, adding that there was a consensus among Democrats on the basics of the bill.

New Jersey Legalization Bill Gets Hearing Monday. The Senate Judiciary Committee will hold a hearing Monday morning on Senate Bill 3195, which legalizes the possession of small amounts of marijuana and sets up a system of taxed and regulated marijuana commerce. The Drug Policy Alliance has expressed "concern" that the bill "does not include essential components to create a fair and equitable marijuana market in New Jersey." Such legislation must include polices to repair past harms to minority communities, DPA said.

Rhode Island Legalization Study Commission Bill Passes House. A bill that creates a legislative commission to study marijuana legalization -- instead of just legalizing it -- passed the House Wednesday night. House Bill 551A now heads to the Senate. Regulate Rhode Island, the main advocacy group for legalization, has said it will not participate in the commission, which it describes as a delaying tactic.

Medical Marijuana

Bipartisan Bill to End Federal Prohibition of Medical Marijuana Reintroduced in US Senate. US Sens. Rand Paul (R-KY), Corey Booker (D-NJ), and Kirsten Gillibrand (D-NY) reintroduced a bill Thursday that would end the federal prohibition of medical marijuana. Sens. Mike Lee (R-UT) and Lisa Murkowski (R-AK) also signed on to the legislation as original cosponsors. The Compassionate Access, Research Expansion, and Respect States (or CARERS) Act of 2017 would allow individuals and entities to possess, produce, and distribute medical marijuana if they are in compliance with state medical marijuana laws. It would also open up avenues to medical marijuana research and allow physicians employed by the Department of Veterans Affairs to recommend medical marijuana to veterans in states where it is legal. The bill also proposes excluding cannabidiol, a non-psychoactive cannabinoid found in marijuana, from the federal government's definition of "marijuana."

Kentucky Lawsuit Challenges State's Medical Marijuana Ban. Three Kentuckians who say they have used marijuana to ease health problems have filed a lawsuit in state court charging that banning medical marijuana violates their constitutional privacy rights. The suit names as defendants Gov. Matt Bevin (R) and Attorney General Steve Beshear (D).

Rhode Island Governor Proposes Medical Marijuana Expansion. Gov. Gina Raimondo (D) has proposed a budget amendment that calls for "no less than six licensed compassion centers" and increased licensing fees that would generate $1.5 in revenues for the state's general fund. There are three existing dispensaries, which would each be allowed to open one more store front, plus the three additional ones proposed.

Heroin and Prescription Opioids

New York Republicans Want More Drug War to Fight Opioids. A Republican Senate task force says that adding funding for addiction treatment is good, but that it's time to increase heroin penalties "to get dealers off the street." The senators are proposing charging dealers with murder if one of their customers dies and increasing penalties based on the weight of the drugs sold. Assembly Democrats rejected the idea, calling the approach one that's been "tried and failed." The Assembly killed a similar approach last year.

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: LA County Deputies to Carry Naloxone, Florida MedMJ Bill Advances, More... (6/9/17)

New York lawmakers are beginning a new push for marijuana legalization, the Florida Senate has passed a medical marijuana implementation bill, LA County Sheriff's deputies begin carrying the overdose reversal drug Naloxone, and more.

The LA County Sheriff's Department becomes the largest police agency in the land to carry Naloxone. (pa.gov)
Marijuana Policy

New York Lawmakers Prepare Legalization Effort. State Sen. Liz Krueger (D-Manhattan) and Rep. Crystal Peoples-Stokes (D-Buffalo), along with advocates organized by the Drug Policy Alliance, will hold a press conference Monday to announce the reintroduction of the Marijuana Regulation and Taxation Act, Senate Bill 3040 and its Assembly companion, Assembly Bill 3506. The legislation would establish a legal market for adult-use cannabis in the state, with marijuana taxed and regulated in a fashion similar to how alcohol is regulated for adults over 21.

Rhode Island Legal MJ Backers Propose Compromise. Lawmakers trying to salvage a marijuana legalization effort have proposed a two-stage process where marijuana possession would be legalized first, but the legalization of marijuana commerce would come later. The proposal from Sen. Joshua Miller (D-Cranston) and Rep. Scott Slater (D-Providence) does not have the support of state Senate and House leaders, though. They are supporting a rival bill that would delay legalization by creating a legislative commission to study the issue.

Medical Marijuana

Arizona Attorney General Asks State Supreme Court to Reinstate Ban on Campus Medical Marijuana. Attorney General Mark Brnovich (R) has asked the state Supreme Court to review an appeals court ruling that struck down a ban on medical marijuana on college campuses. The state is arguing that the legislature had the right to alter the voter-approved medical marijuana law so that college students with medical marijuana cards could face felony arrests for possession of any amount of marijuana.

Florida Senate Passes Law Implementing Medical Marijuana. The state Senate on Friday approved a bill that would implement the state's constitutional amendment expanding the use of medical marijuana on a vote of 28-8. A similar bill fell apart during the legislature's regular session, but now, during a special session, it is moving. It must still past the House and be signed into law by Gov. Rick Scott (R) to become law. The bill would cap the number of medical marijuana cultivation operations at 25 statewide and it would not allow for the smoking of medical marijuana.

Harm Reduction

Los Angeles County Deputies to Start Carrying Naloxone. The Los Angeles County Sheriff's Department is about to become the largest law enforcement agency in the US to equip its members with the life-saving opioid overdose reversal drug. Some 600 Naloxone spray kits are being handed out this week, and the department plans to get the kits in the hands of 3,000 of its deputies by year's end.

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