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Chronicle AM: RI Governor Ready to Legalize Weed, Myanmar Opium Crop Drop, More... (1/14/19)

Rhode Island's governor is ready to hop on the pot legalization bandwagon, Vermont solons are moving to legalize pot commerce, Ohio's governor rolls out a response to the opioid crisis, and more.

Opium production is down in Myanmar, the UNODC says. But synthetics are on the rise. (unodc.org)
Marijuana Policy

Rhode Island Governor Proposes Marijuana Legalization. Gov. Gina Raimondo (D) is proposing marijuana legalization as part of her budget plan for the fiscal year beginning July 1. Her proposal would allow for regulated marijuana commerce but would ban home cultivation and place limits on the potency of products available for sale. The proposal would also limit the amount of THC in edibles to do more than 5 milligrams per serving. Raimondo has been slow to jump on the legalization bandwagon but said the state should now move in that direction because most of its neighbors are.

Vermont Legislators Prepare Bill to Allow Marijuana Sales. The Senate Judiciary Committee is planning to introduce a bill that would legalize marijuana commerce in the state. The state legalized marijuana possession last year but did not include a system of taxed and regulated sales. This bill would tax sales at 10%, with a 1% local option tax. The state's Marijuana Advisory Commission had recommended a 26% tax and funneling much of the tax revenues into the departments of public safety and health to pay for new enforcement and prevention efforts, but Judiciary Committee Chair Sen. Dick Sears (D-Bennington) wants the revenues to go into the general fund. He says the bill could pass the Senate within a month, but it faces a rockier path in the House.

Kratom

Utah Bill Would Regulate—Not Ban—Kratom. State Sen. Curt Bramble (R-Provo) has filed SB 58, the “Kratom Consumer Protection Act.” The bill would create regulations about how the substance is sold in the state and would bar the sale and distribution of adulterated kratom.

Heroin and Prescription Opioids

Ohio Governor Confronts Opioid Crisis. Republican Gov. Mike DeWine signed an executive order Monday to create RecoveryOhio, an initiative aimed at confronting the state's opioid crisis. He appointed Alisha Nelson, who oversaw drug abuse policy in the attorney general's office to work"every day with a single-minded focus of fighting the drug epidemic," according to the executive order.

International

UN Says Opium Cultivation Down in Myanmar, Cites Rise of Synthetics. Opium cultivation in Myanmar declined for the fourth year in a row last year, the UN Office on Drugs and Crime said last Friday. UNODC said the 2018 crop was 10% smaller than the previous years. The agency also said the decline was due to a growing regional market in synthetic drugs. 

Of All People: The DEA Demolishes One of Trump's Main Claims About the Border Wall

As the president attempts to make his case for a wall on the US-Mexico border, one of his main selling points is that the wall would reduce the flow of illicit drugs into the country. Of all people, it's not our favorite agency that has rebutted the claim.

That agency is the Drug Enforcement Administration (DEA), which in its 2018 National Drug Threat Assessment released just two months ago makes clear that at best Trump is uninformed and at worst that he is lying to the American people.

The vast majority of drugs smuggled into the US from Mexico come through ports of entry. (Creative Commons)
"Remember drugs. The drugs are pouring into this country. They don't go through the ports of entry. When they do, they sometimes get caught," Trump claimed at a Rose Garden news conference last Friday.

It's not a new claim for the president; it has been a pillar of his claim that there is a "crisis" on the border. But repeating a false claim doesn't make it any less false. What is true, as the DEA reports, is that the southwest border "remains the primary entry point for heroin into the United States," but it is not being lugged across the desert via a wall-less border.

According to the DEA, "the majority of the flow is through POVs [privately owned vehicles] entering the United States at legal ports of entry, followed by tractor-trailers, where the heroin is co-mingled with legal goods. Body carriers represent a smaller percentage of heroin movement and they typically smuggle amounts ranging from three to six pounds taped to their torso, or in shoes and backpacks."

To be clear, the body carriers the DEA is talking about are people coming through ports of entry -- not across an open border. The agency reported that only "a small percentage of all heroin seized" along the border was seized between ports of entry.

It's the same thing with fentanyl. According to the DEA, which says fentanyl imports are split between China and Mexico, Mexican drug traffickers "most commonly smuggle multi-kilogram loads of fentanyl concealed in POVs before trafficking the drugs through Southwest Border ports of entry." In the San Diego sector, which saw the biggest fentanyl seizures, 74 percent off seizures were from cars at ports of entry. In the Tucson sector, which had the next highest fentanyl seizure numbers, that figure was 91 percent.

Claiming that building a border wall would reduce the flow of drugs into the country is probably not the biggest lie Trump and his allies have told about the wall, but it is patently false.

Chronicle AM: Federal Marijuana Bill Filed, Ciudad Juarez Drug War Killings Surge, More... (1/4/19)

Wow, that was fast: The first marijuana bill of the new Congress has already been filed, an Arizona sheriff finally hops on board the naloxone train, Ciudad Juarez drug war killings are way up, and more.

Deputies in Pima County, Arizona, will finally start carrying the overdose reversal drug naloxone. (pa.gov)
Marijuana Policy

The New Congress Just Saw Its First Marijuana Bill Filed. That didn't take long. Reps. Steve Cohen (D-TN) and Don Young (R-AK) on Thursday reintroduced the Compassionate Access, Research Expansion and Respect States (CARERS) Act. The bipartisan bill would protect state medical marijuana programs from federal interference and open the way for doctors at the Veterans Administration to recommend medical marijuana. The bill is not yet available on the congressional website, but you can view last year's version here. Sen. Cory Booker (D-NJ) is expected to file the Senate version soon.

Heroin and Prescription Opioids

Georgia Joins List of States Suing Opioid Makers for Fueling Drug Crisis. Georgia has now become the latest of more than 30 states that have filed lawsuits against pharmaceutical companies for what they say is their role in fueling the opioid crisis. The state is suing nine opioid makers and distributors in state court for what it calls racketeering and for creating the crisis. "We have over a 1,000 Georgians that died last year, more Georgians dying every day. We have over 1,000 Georgians right now that are suffering from an opioid misuse disorder," said Attorney General Chris Carr. The state is seeking both monetary damages to repay it for costs incurred fighting the epidemic, as well as punitive damages.

Harm Reduction

Arizona's Pima County Sheriff Finally Gets on Board With Deputies Carrying Naloxone. Pima County, home to the state's second largest city, Tucson, has gotten with the program and the sheriff's department will now issue the overdose reversal to deputies. Deputies in eleven of the state's 15 counties already carry it. Department officials had previously argued it was necessary for deputies because paramedics already carried it and because it might become unstable in the Arizona summer heat, but Sheriff Mark Napier admitted Wednesday that medical experts had told him the worse that could happen was that it might not work.

International

Mexico's Ciudad Juarez Had Nearly 1,250 Murders Last Year. The border city just across the Rio Grande from El Paso saw a big spike in murders last year, most of them drug prohibition-related. The state attorney general's office reported 1,247 killings last year, a big increase from the 772 people killed in 2017 and nearly triple the number killed in 2014. Most of the violence is related to the revival of the Juarez Cartel and to the defection of a key Los Aztecas leader to La Linea. Los Aztecas are also in the midst of internal factional strife. But wait, there's more: There's also a factional fight within Los Artistas Asesinos (Assassin Artists), a street enforcement gang with links to the Sinaloa Cartel, which is also working in the area.

Chronicle AM: NYC Mayor Backs Legal Weed, Report Chides DEA & Drug Companies on WV Opioids, More... (12/20/18)

A report from congressional Democrats explores the economic benefits of marijuana legalization, a report from the House Energy and Commerce Committee scolds the DEA and drug distributors over massive shipments of opioids to West Virginia, New York City Mayor Bill De Blasio climbs on board the legalization bandwagon, and more.

Marijuana Policy

Congressional Democrats Release Report On Marijuana Legalization's Economic Benefits. Democratic members of the congressional Joint Economic Committee released a report Tuesday emphasizing the economic benefits legal marijuana can bring at both the state and federal levels. The report is The National Cannabis Economy, and it predicts marijuana sales revenues will jump from $8 billion last year to $23 billion by 2022. "It's time we legalize marijuana, but at the minimum, we must reduce the conflicts between federal and state laws so that the industry can continue to create jobs and bolster state economies," Senator Martin Heinrich, (D-NM), the ranking member of the panel, said in a press release. "This conflict hurts small businesses and constrains the economic benefits of legal cannabis -- an industry that is estimated to reach $11 billion in sales this year and $23 billion by 2022. But in order to realize the benefits, we must act on legislation such as the STATES Act to help these businesses thrive."

West Hollywood, California, Approves Cannabis Cafes, Consumption Lounges. The city announced Wednesday that it had approved licenses for eight edibles-only consumption cafes an eight consumption lounges where marijuana can be smoked, vaped, drunk, or eaten. The businesses now have a year to obtain a West Hollywood business license and a place to operate. The move could nearly double the number of consumption lounges nationwide: there are seven such facilities in San Francisco, one in Oakland, and one in Denver.

New York City Mayor Backs Marijuana Legalization. Just days after Gov. Andrew Cuomo (D) said he wants to legalize marijuana next year, New York City Mayor Bill De Blasio hopped on board the legal pot train, saying it represents "a once-in-a-generation opportunity to get a historic issue right for future New Yorkers." De Blasio's remarks came as the Mayor's Task Force on Cannabis Legalization released a report recommending that the city tax sales, automatically expunge old pot possession offenses, and work to ensure "diverse participants" get a shot in the legal industry.

Brooklyn, New York, District Attorney Throws Out Hundreds of Old Pot Convictions. Brooklyn DA Eric Gonzales appeared in court Wednesday to vacate outstanding warrants related to low-level pot offenses, as well as expunging past misdemeanor pot convictions. "To fail to address these past convictions would be hypocritical and it would be to turn a blind eye on all the harm caused by marijuana enforcement in prior years," Gonzalez said.

Pennsylvania Governor Suggests He Could Get Behind Marijuana Legalization. Gov. Tom Wolf (D) said Wednesday that it's time for the state to consider legalizing marijuana. "More and more states are successfully implementing marijuana legalization," he noted, adding that it's time for "a serious look" at doing it. The statements mark a change of heart for Wolf, who previously had shied away from legalization talk.

Medical Marijuana

Florida Legal Battle Over Medical Marijuana Takes Another Turn. A state appeals court this week agreed to stay a circuit court judge's ruling that the legislature and the Department of Health violated the state's voter-approved medical marijuana amendment. The ruling comes in a case involving a Tampa marijuana grower, which challenged caps placed on the number of medical marijuana licensees. While the 1st District Appeals Court approved the stay, it also said its final decision on the case would be "expedited."

Heroin and Prescription Opioids

Congressional Report Scolds DEA, Drug Distributors on Flood of Opioids to West Virginia. Massive shipments of prescription opioids to West Virginia -- 20.8 million pounds opioids sent to one town of 3,000 over a ten-year period, for example -- reflect failures by the DEA and drug distribution companies to conduct effective oversight of their customers and failures to recognize obvious red flags, a bipartisan report from the House Energy and Commerce Committee found. These lapses helped make the state "the epicenter of the nation's opioid epidemic and the state with the highest drug overdose death rate in the country," the report said. And it's not just West Virginia: "Taken all together, the Committee's report outlines a series of missteps and missed opportunities that contributed to the worsening of the opioid epidemic in West Virginia," the report said. "While focused on a narrow part of West Virginia, the report raises grave concerns about practices by the distributors and the DEA nationwide."

The Year in Drugs I: The Top Domestic Drug Policy Stories of 2018 [FEATURE]

This is a year that just about everybody is eager to see come to an end, but when it comes to drug policy, 2018 hasn't been half-bad, at least in the US. (Check back next week for our Top International Drug Policy Stories.)

We've seen marijuana legalization spread further, we're on the verge of seeing Congress pass major sentencing reform legislation, and the ban on domestic hemp cultivation is coming to an end, among other things.

A lot went on in drug policy in 2018. Here are eight stories that helped define the year:

1. Overdose Deaths Remain Unconscionably High But Appear to Have Leveled Off

That's enough fentanyl to kill you. It killed thousands this year. (dea.gov)
The nation's fatal drug overdose crisis is far from over, but it now looks like it at least didn't get any worse this year. Driven in large part by the rise of fentanyl, overdose deaths reached a stunning 72,000 in 2017, a figure ten times the number in 1980 and double that of only a decade ago.

But preliminary reports on the 2018 overdose numbers suggest that this may be the year the crisis began to ease. In June, the Centers for Disease Control and Prevention released provisional data showing that overdose deaths had declined for six straight months, dropping 2.8 percent from their 2017 peak. That report also found that opioid overdose deaths had declined by 2.3 percent.

With both heroin and prescription opioid deaths declining, fentanyl has emerged as the most common drug involved in overdoses, being implicated in about a quarter of all drug overdose deaths. While the apparent decline in opioid overdose deaths this year is good news, the recent increases in cocaine and methamphetamine overdose deaths is not. And while any break in a years-long climb in overdose deaths is certainly welcome, another 70,000 or so Americans will still have died from them this year. We have a long, long way to go.

2. Safe Injection Sites Draw Nearer, But Feds Fire Warning Shots

Safe injection sites -- also known as supervised consumption sites, among other names -- where drug users can consume their doses under medical supervision and with an opportunity to engage with social services are a proven harm reduction intervention. More than a hundred cities around the world, mainly in Europe, Canada, and Australia have resorted to such facilities as a means of providing better outcomes, not only for drug users but also for the communities in which they live.

There are no legally permitted safe injection sites in the United States (although some underground ones are reportedly operating in Seattle, and there may be more in hiding), but this year saw mounting pressure and serious efforts to get them up and running in a number of American states and cities. It also saw mounting resistance from federal officials.

At the state level, California, Colorado, Missouri, and New York all saw safe injection site bills filed. Only the bill in California made it out of the legislature, but to the great frustration of reformers, it was vetoed by Gov. Jerry Brown (D), who cited long outdated beliefs about substance use in his veto message. Still, the fact that bills are being filed shows the issue is gaining momentum.

The momentum is even stronger among a handful of major cities. Denver, New York City, Philadelphia, and Seattle have all taken steps to clear the way for safe injection sites this year, although none are yet in place.

While like California's Gov. Brown, some state and local level political figures are hesitant to embrace them, a major reason none is yet in place is federal hostility. As the clamor for the facilities grows louder, so does opposition from the Trump administration. As Denver publicly pondered opening one, the local DEA and the US Attorney loudly warned they would be illegal, and the Philadelphia US Attorney did the same thing. Early in the year, the DEA in Washington issued a warning against safe injection sites, and in August, Deputy Attorney General Rod Rosenstein authored an op-ed in the New York Times issuing similar dire threats.

3. A Major Federal Sentencing Reform Bill Is Set to Pass

A rare example of bipartisanship on the Hill. (Creative Commons)
The first major federal sentencing reform bill in eight years is now one vote away from passing Congress. The bill, known as the First Step Act (S.3649), is the culmination of years of work by the likes of Senate Judiciary Committee Chairman Charles Grassley (R-IA) and Sen. Dick Durbin (D-IL), and includes prison reform language as well as provisions that would reduce sentences for certain drug offenses. It very nearly died earlier this month when Senate Majority Leader Mitch McConnell (R-KY) announced he would not bring it to a Senate floor vote, but under broad pressure, including from President Trump, McConnell relented, and the bill passed the Senate Tuesday

The sentencing reforms include retroactivity for the Fair Sentencing Act (the 2010 law that reduced the crack/powder cocaine sentencing disparity), allowing the potential release of around 2,600 people; expansion of the "safety valve" allowing judges more discretion to sentence beneath mandatory minimum sentences; reform of the "three strikes" law, reducing the "second strike" mandatory minimum of 20 years to 15 years, and reducing the "third strike" mandatory minimum of life-in-prison to 25 years.

The late word is that the bill will pass the House easily, but that hasn't happened as of this writing. If and when it does, the country will have taken a significant step toward a more just and humane federal criminal justice system. The passage has also drawn major media attention as a rare example of bipartisanship in Washington today.

4. Marijuana Legalization Advances in the States

At the beginning of the year, marijuana for adult recreational use was legal in eight states, all in the West or New England and all thanks to the initiative process. As 2018 comes to a close, that number has jumped to ten, with Vermont in January becoming the first state to legalize it through the legislature and Michigan in November becoming the first Midwest state to legalize it.

The initiative process is available in only half the states, and when it comes to legalizing weed, the low-hanging fruit has already been picked. A legalization initiative in conservative Nebraska went down to defeat this year, and remaining initiative states like the Dakotas, Nebraska, Oklahoma, and Arkansas are among the most socially conservative and least likely to free the weed. But prospects are rosier in initiative states Arizona, Missouri, and Ohio. We are likely to see pot on the ballot in all three in 2020.

Vermont remains the sole state to legalize it legislatively, but a handful of states edged ever closer close this year. New Jersey Gov. Phil Murphy (D) wanted pot legalized in his first 100 days. That didn't happen, and legalization hasn't gotten through the legislature yet, but there is a small chance it could still happen this year and a very good chance it will be a done deal by early next year. Legislatures throughout the Mid-Atlantic states and Northeast grappled with the issue, laying the groundwork for next year and the year beyond, and just this week, New York Gov. Andrew Cuomo (D) called for legalization next year. The long march continues.

5. Marijuana Is Still Federally Illegal, But the Crackdown Never Came

As the year comes to end, legal weed is still here and Jeff Sessions isn't. President Trump's first attorney general was an avowed foe of marijuana (as well as drug and criminal justice reform in general), but despite rescinding the Obama-era Cole memo, which basically told federal prosecutors to leave state law-abiding pot businesses alone, the much-feared crackdown on the industry never came.

Federal prosecutors, for the most part, continue to view legal marijuana businesses as a low priority, especially when faced with much more serious drug problems, such as the opioid overdose epidemic. But Sessions was also undercut by his own boss, who in April arranged a deal with Colorado Republican Sen. Cory Gardner in which he agreed to support a bill protecting states that have broken with federal pot prohibition in return for Gardner's allowing Justice department appointments to move forward.

This year saw a plethora of federal marijuana reform bills, but with Republican leadership in both houses firmly opposed, the Capitol was where marijuana reform went to die. With Democrats in control of the House next year, things promise to be different next year, although the GOP-led Senate will remain an obstacle. But with pot consistently polling in the 60s, those Republican senators may grudgingly start coming on board.

6. Marijuana Legalization is Nice, But We Need Social Justice, Too

This year saw social justice concerns around marijuana legalization move front and center in two distinct ways: demands for the expungement of marijuana arrest records for people whose offenses are no longer crimes and demands for restorative racial justice from communities that have suffered the brunt of the war on drugs.

The year started with two major West Coast cities, San Francisco and Seattle, leading the way on expungement. The, in September, California became the first state to put state-level automatic expungement into effect. Delaware and Rhode Island, which have both decriminalized but not legalized pot, also passed expungement bills this year. Expungement is also a contentious issue in the ongoing battle to get legalization passed in New Jersey.

After a half-dozen years of legalization and well-heeled white guys making bank off legal weed, the call for racial justice, whether in terms of set-asides to guarantee minority participation in the industry or for funding streams aimed at restoring drug war-ravaged communities, is growing too loud to be ignored. This is an ongoing struggle now being played out not only in pot-legal states, but especially in states on the cusp of legalization. Moving forward, it's likely that every successful state legalization bill is going to have to address issues of social and racial justice. As they should.

7. Industrial Hemp Becomes Federally Legal

The sun rises on the American domestic hemp industry. (votehemp.org)
Finally, the absolutely most ridiculous aspect of federal marijuana prohibition is dead. Recreational marijuana's country cousin, hemp can't get anyone high, but is extremely useful in a broad range of industries, from foods to textiles and beyond. Thanks to a lawsuit from hemp interests more than a decade ago, hemp could be imported for American firms to use in their products, but because the DEA refused to recognize any distinction between hemp and recreational marijuana, American farmers were forced to stand on the sidelines as their competitors in China, Canada, and other countries raked in the rewards.

But having a hemp-friendly senator from a hemp-friendly state allowed hemp legalization to move this year. Senate Majority Leader Mitch McConnell (R-KY) actually fought for the hemp bill, shepherding it into the must-pass farm appropriations bill and keeping it in there through negotiations with the House. President Trump has signed the farm bill, including the hemp provision, into law.

8. Here Come the 'Shrooms

Initiative campaigns to legalize or decriminalize the use and possession of psilocybin-containing magic mushrooms began popping up in 2018. Actually, the first state-level initiative came last year in California, but this past summer it failed to qualify for the fall ballot.

Right now, there are two psilocybin initiatives in the signature-gathering phase, a municipal initiative in Denver that would decriminalize the use, possession, and cultivation of psilocybin-containing mushrooms, and the statewide Oregon Psilocybin Service Initiative, which would decriminalize possession of psilocybin, allow magic mushrooms to be grown with a license, and would allow for therapeutic use of psilocybin. The Denver initiative would go before voters in May 2019, while the Oregon initiative aims at the 2020 election.

If psilocybin initiatives follow the pattern set by marijuana legalization initiatives, the first time may not be the charm. But more will follow.

What's Killing Us: The Ten Drugs Most Implicated in Overdose Deaths [FEATURE]

While there are signs that the country's drug overdose crisis may have plateaued, the number of people dying from drug overdoses continues to be unconscionably high. Shockingly, the number of overdose deaths has increased tenfold since 1980 when there were only 6,000 nationwide and nearly doubled just in the past decade to more than 72,000 last year.

The number of drug overdose deaths remains unconscionably high.
Now, in a new report, the Centers for Disease Control and Prevention (CDC) sheds some new light on precisely which drugs are most implicated in these deaths. While the report examines overdose deaths from 2011 to 2016, we're going to zero in on the 2016 data to get as close as possible to the present.

Three drug classes are involved: prescription and non-prescription opioids, benzodiazepines, and stimulants. Often, fatal overdoses involve more than one drug, whether it is drugs in the same class (heroin and fentanyl) or combinations of drug classes (heroin and benzos or fentanyl and cocaine.

Before we get into the number-crunching, it's worth taking a moment to consider that each single overdose death is a tragedy. A human life has been lost prematurely, the potential snuffed out, and friends and family members suffer greatly. It doesn't have to be that way. While we're going to look at deadly drugs, it behooves us to remember that many of these deaths are a function not just of the drugs themselves, but of drug prohibition.

People overdose on fentanyl, for example, because in a black market there is no packaging, no quality control, no dosage information to inform them of just how powerful is that powder they're snorting or injecting. Added to heroin or crafted into counterfeit prescription opioids by unscrupulous black market operators, fentanyl kills people who didn't even know they were taking it. Even more insidiously, fentanyl is turning up in black market cocaine and methamphetamine, whose users aren't even looking for an opioid high and haven't developed any tolerance to them (although some may be speedballing, that is, taking both an upper and a downer at the same time.

That said, here are the drugs making the greatest contributions to the 63,352 overdose deaths in 2016. (The numbers add up to more than that figure because in some overdoses, more than one drug is mentioned.)

1. Fentanyl -- 18,335

In 2016, fentanyl vaulted into first place in the deadly drug sweepstakes. As recently as 2011, the synthetic opioid was in 10th place, with some 1,660 overdose deaths attributed to it, but the death toll has increased more than tenfold in just five years. More than two-thirds of fentanyl overdose deaths also involved other drugs, and fentanyl is involved in more than a quarter (28.5 percent) of all overdose deaths, including 40 percent of cocaine overdose deaths and nearly a third (32 percent) of heroin deaths.

2. Heroin -- 15,961

At the tail end of the prescription opioid phase of the current overdose crisis in 2011, more people died from oxycodone than heroin, but between 2012 and 2015, heroin resumed its role as the leading opioid linked to fatal overdoses, only to be overtaken by fentanyl in 2016. The vast majority -- 70 percent -- of people who died from heroin were also using other drugs. More than a third were also using fentanyl, while nearly a quarter (23.8 percent) were also using cocaine. As prescription opioids became more difficult to obtain, the number of people dying from heroin skyrocketed, nearly tripling in the five years ending in 2016.

3. Cocaine -- 11,316

Cocaine deaths rose dramatically beginning in 2015 and by 2016 the annual death toll was double what it had been five years earlier. With bumper crops in Colombia in recent years, cocaine is cheap and plentiful. It is also increasingly being cut with fentanyl, which is implicated in 40 percent of cocaine deaths, and mixed with heroin, which is implicated in a third of them. Cocaine is named in 17.8 percent of all overdose deaths.

4. Methamphetamine -- 6,762

Meth-related overdose deaths tripled between 2011 and 2016, a dramatic increase in what has become America's forgotten drug problem. In 2016, slightly more than one out of ten drug overdose deaths involved meth. Of the top ten overdose drugs, meth is by far the one most likely to have been the sole drug implicated in the death, but even so, fentanyl was implicated in one out five meth deaths and heroin in one out of ten.

5. Alprazolam -- 6,209You know it as Xanax. This short-acting benzodiazepine is a favorite of stimulant users seeking to take the edge off, but also often forms part of a sedative cocktail with opioids or other benzos. About three-quarters of Xanax overdose deaths involve other drugs, with fentanyl, heroin, and oxycodone each involved in about one-quarter of Xanax deaths. Xanax deaths increased by about 50 percent over the five year period.

6. Oxycodone -- 6,199

It's most infamous formulation is OxyContin, but it is also sold as Roxicodone, Xtampza ER, and Oxaydo. It may have been the primary killer opioid a decade ago, but has chugged along at around 5,000 deaths a year before going over 6,000 in 2016. Four out of five people who overdose on oxycodone were also using another drug, most often Xanax (25.3 percent), followed by fentanyl (18.6 percent).

7. Morphine -- 5,014

The granddaddy of opioids. Morphine deaths increased slowly beginning in 2011, but have still increased by about 40 percent since then. More than eight out of 10 morphine deaths involve other drugs as well, particularly fentanyl, which is involved in one out three morphine deaths. Cocaine (16.9 percent) and heroin (13.7 percent) are also frequent contributors to morphine ODs.

8. Methadone -- 3,493

Prescribed as an opioid maintenance drug, methadone is one of the few drugs on this list to have seen the number of deaths decline between 2011 and 2016. They've dropped from more than 4,500 a year down to less than 3,500, a drop of roughly a quarter. Nearly three-fourths of all methadone deaths implicate other drugs, with Xanax being most common (21.5 percent), followed by fentanyl (15.1) and heroin (13.8).

9. Hydrocodone -- 3,199

This semi-synthetic opioid is sold under a variety of brand names, including Vicodin and Norco, and has proven remarkably stable in its overdose numbers. Between 2011 and 2016, it never killed fewer than 3,000 or more than 4,000, almost always (85 percent of the time) in concert with other drugs. Xanax was implicated in one-quarter of all hydrocodone overdoses, followed by oxycodone (17.2 percent) and fentanyl (14.9 percent).

10. Diazepam -- 2,022

The most well-known diazepam is Valium. Like Xanax, this anti-anxiety drug can be used to take the edge off a stimulant binge, but it's not coke heads and speed freaks who are dying from it. In more than nine out of 10 fatal Valium overdoses, other drugs are involved, most commonly the opioids oxycodone and fentanyl, each implicated in about a quarter of the deaths, and heroin, implicated in a fifth.

Using these drugs is dangerous. Using them under a prohibition regime is even more so. Users don't always know what they're getting, and that lack of knowledge can be fatal. If you're going to be messing with these substances, be extremely cautious. Try a test dose first. And don't do it alone. Stay safe out there.

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

Chronicle AM: Senate Passes Sentencing Reform Bill, NM Sued Over MedMJ Rules and Fees, More... (12/19/18)

A major sentencing reform bill takes a major step toward becoming law, a New Mexico medical marijuana producer is suing the state over rules and fees, and more.

Some federal drug prisoners will get relief under the bill passed by the Senate Tuesday. (nadcp.org)
Medical Marijuana

Arkansas Delays Dispensary License Announcement. The state Medical Marijuana Commission announced Tuesday it would delay its meeting to announce licenses for state dispensaries. The commission was originally scheduled to meet today but postponed that meeting until January 9. The state plans to allow dispensaries to operate in somewhere between 20 and 32 sites.

New Mexico Sued Over Edibles Rules. The state's largest medical marijuana producer has filed a lawsuit against the state health department over regulations governing edibles, salves, lotions, and other products infuse with marijuana. Ultra Health argues that the department doesn't have the authority to license legal marijuana manufacturers and that the fees are too high.

Heroin and Prescription Opioids

DC Council Votes to Approves Opioid Treatment Bill. The DC Council voted Tuesday to advance the Opioid Use Disorder Treatment & Safe Access Amendment Act of 2018, legislation that would help curb the overdose crisis in the Nation's capital. The omnibus bill includes provisions that make the temporary emergency measure that decriminalizes drug checking kits permanent, removes restrictions on syringe exchange programs, and expands access to medication-assisted treatment in the District. The bill now goes to the mayor for final approval.

Sentencing Reform

Senate Passes Prison and Sentencing Reform Bill. The Senate approved the First Step Act (S.3649) on a vote of 87-12 on Tuesday. The bill contains prison reform language as well as provisions that would reduce sentences for certain drug offenses, including retroactivity for the Fair Sentencing Act (the 2010 law that reduced the crack/powder cocaine sentencing disparity), allowing the potential release of around 2,600 people; expansion of the "safety valve" allowing judges more discretion to sentence beneath mandatory minimum sentences; reform of the "three strikes" law, reducing the "second strike" mandatory minimum of 20 years to 15 years, and reducing the "third strike" mandatory minimum of life-in-prison to 25 years; and eliminating "stacking" for firearm offenses, meaning that prosecutors cannot add sentencing enhancements to individuals who may possess a firearm while committing their first federal offense. The bill now goes back to the House, which is expected to easily pass, and then to the desk of President Trump, who has vowed to sign it.

Chronicle AM: Congress Passes Hemp Bill, CDC Report on Overdose Deaths, More... (12/13/18)

Congress has passed a bill to legalize hemp, the CDC issues a new report on overdose deaths, St. Vincent and the Grenadines legalizes medical marijuana, and more.

Fentanyl is now the leading drug implicated in overdose deaths, according to the CDC. (Creative Commons)
Marijuana Policy

Colorado Senator Seeks to Add Marijuana Amendment to Criminal Justice Bill. Sen. Cory Gardner (R-CO) will try to add an amendment to the pending prison and sentencing reform bill that would effectively end federal marijuana prohibition. Gardner seeks to add his STATES Act (S.3032) as the amendment. That would allow states to implement their own pot laws without fear of federal interference.

California Regulators Issue Final Version of Regulations. California marijuana regulations are now set after regulators issued their third and final version of the rules. Among the highlights: Deliveries will be allowed statewide, contract manufacturing will be allowed (licensed companies make and package products for unlicensed companies), and regulations for childproof packaging have changed to place the burden on retailers.

St. Paul City Council Backs Resolution To Legalize Recreational Marijuana. Minnesota's second largest city now officially supports marijuana legalization. The city council voted 6-1 Wednesday to support a resolution calling for it. Governor-Elect Tim Walz (DFL) is also down with the idea.

Medical Marijuana

Nebraska Medical Marijuana Initiative Campaign Gets Underway. Two state senators, Anna Wishart, and Adam Morfeld, both Democrats from Lincoln, announced Thursday that they had created a campaign committee to put a medical marijuana constitutional amendment on the 2020 ballot. The committee is Nebraskans for Sensible Marijuana Laws.

Industrial Hemp

Congress Approves Industrial Hemp Legalization. Hemp, hemp, hooray! With a final vote in the House on Wednesday, the 2018 Farm Bill, complete with a provision legalizing domestic hemp production, was approved by Congress and now heads for the president's desk. The bill clears the way for American farmers to participate in what is already a billion-dollar domestic hemp industry that is currently reliant on foreign imports.

Opioids

Fentanyl Now the Most Common Drug in Fatal Overdoses, CDC Reports. Fentanyl is now the most commonly used drug involved in drug overdoses, according to a new report from the Centers for Disease Control and Prevention. Fentanyl was involved in more than 30,000 overdose deaths, while second place heroin was implicated in more than 27,000 deaths. There were some 63,000 overdose deaths in 2016, many of them involving multiple substances.

International

Saint Vincent and the Grenadines Pass Medicinal Marijuana Bill. Saint Vincent and the Grenadines (SVG) has become the first Organization of Eastern Caribbean States Member State to decriminalize marijuana for medical purposes and scientific research. "There is broad recognition and buy-in of the economic benefits this tightly controlled and regulated industry is expected to bring in terms of direct employment, the creation of support industries and foreign investment," said Agriculture Minister Saboto Ceaser.

Trump's Ghoulish Call for Even More Chinese Drug Executions [FEATURE]

In a pair of tweets last Wednesday, President Trump urged China to crack down on fentanyl, which he described as a "horror drug," and predicted "incredible results" if China would start executing people for fentanyl-related offenses.

Trump urges the Chinese to kill more drug offenders. (Flickr/Gage Skidmore)
Fentanyl is an extremely powerful synthetic opioid linked to tens of thousands of overdose deaths in the US in recent years. Chinese chemical factories are believed to be the primary producers of fentanyl and related synthetic opioid analogs, which are then mixed in with other illicit drugs, making them even more dangerous than they were on their own.

Trump's tweets came just days after he errantly praised China's President Xi Jinping for agreeing that China would "designate Fentanyl as a Controlled Substance, meaning that people selling Fentanyl to the United States will be subject to China's maximum penalty under the law."

In reality, China made fentanyl and five fentanyl products controlled substances back in 2015 and promised President Obama it would "crack down" on it in 2016. Yet, the flow of fentanyl continued and fentanyl-related overdose deaths continued to climb.

And in reality, China is already most likely the world's leading drug executioner. The only reason for any doubt is that China does not provide data on how many people it executes for drug offenses, but according to Amnesty International, "thousands of executions… were believed to have been carried out in China" last year.

China's closest competitor in the gruesome race to execute drug offenders has been Iran, where Amnesty says more than 200 were hung in 2017, but recognizing the futility of the hardline approach and heeding pressure from European funders of Iranian anti-drug efforts, the Islamic Republic has now moved to greatly reduce the number of drug executions.

But as has been evident from his support of bloody-handed Philippine President Rodrigo Duterte, who was presided over a war on drug sellers and users that has left thousands dead, Trump has a fondness for the death penalty. And despite the lack of any evidence that killing drug offenders actually leads to a reduction in drug use or trafficking, he wants more.

That brought a quick response from the Drug Policy Alliance, which ripped into Trump's cheerleading the death penalty in China as "morally repugnant" and instead urged responses to the fentanyl crisis that might actually achieve something.

"Draconian criminal punishments for fentanyl will actually make the problems associated with this drug much worse than they are now," said Grant Smith, the group's deputy director of national affairs. "This won't reduce addiction and overdose deaths in the US, but it will incentivize the proliferation of even more potent drugs that will further exacerbate the crisis. President Trump's push for China to execute more of its citizens for drug offenses is morally repugnant and ignores the decades-long failure of extremely harsh drug policies here in the US."

Instead of lobbying for harsh, but inhumane and ineffective, drug policies in China, Trump would better address the overdose crisis by implementing proven harm reduction measures, Smith added.

"Fentanyl has indeed become the leading cause of overdose deaths in the US, but health-based measures are far more effective than criminalization," he said. "Interventions like drug checking, naloxone, supervised consumption spaces, and expanding access to evidence-based treatment are urgently needed to reduce fentanyl-related deaths."

But the Trump administration isn't into that. In fact, the Trump Justice Department just recently went out of its way to promise a crackdown on any cities that try to open safe injection sites as a means of reducing overdose deaths and the spread of blood-borne diseases. He would rather American drug users die and Chinese drug sellers be killed than come up with effective responses that would actually save lives.

Study: Crackdowns on Heroin, Pain Pills Gave Rise to Fentanyl Overdose Epidemic [FEATURE]

A new report on illicit US drug markets from researchers at the University of San Francisco has found that that the spread of fentanyl, a powerful synthetic opioid implicated in nearly 29,000 overdose deaths last year alone, is tied to enforcement-driven shortages of heroin and prescription opioids, as well simple economics for drug distributors -- not because users particularly desire the drug.

meet the law of unintended consequences (Creative Commons)
Illicit fentanyl has swept through American drug markets in waves -- the super strong "China white" heroin of the 1970s was actually a heroin-fentanyl mixture -- most recently in the past decade after rising levels of opioid addiction and the spread of "pill mills" prompted multifaceted moves to restrict opioid prescribing.

From a drug distributor's perspective, fentanyl is a most excellent substitute for heroin or prescription pain pills. Produced entirely in labs or chemical factories, it is far more powerful and cheaper to produce than heroin. Because it's more potent, it is easier to smuggle -- often coming into the US via postal and delivery service parcels, not by the semi load. And it doesn't require months of growing time and period of intense peasant labor in lawless regions of weak states.

Fentanyl is typically sold deceptively -- marketed as heroin or prescription drugs such as OxyContin or Xanax -- and users and street-level dealers often don't even know that the drugs they are using or selling contain fentanyl, the researchers found. Fentanyl is making its way into the supply chain at the wholesale, not the retail level. That, the researchers said, suggests that demand is not the key driver in the drug's spread.

"Fentanyl is rarely sold as fentanyl," said Sarah Mars, PhD, a researcher in the Department of Family and Community Medicine at UCSF. "The dealers selling fentanyl directly to the users often don't know what's in it. Not only is this particularly dangerous, but it also means penalizing low-level dealers isn't going to make any difference in the fentanyl poisoning epidemic."

According to Mars, users are split on fentanyl, which produces a more sudden and powerful high than heroin, but one that fades faster. Some said fentanyl brought back the euphoria they had lost the ability to feel with long-term heroin use, but others said they feared fentanyl and found its effects too harsh.

"Whether or not they prefer fentanyl, users don't have any influence over what drugs are being sold," Mars said. "Without accurate information about these drugs, they can't make an informed choice about what they are buying. Also, very little drug slang has developed to describe fentanyl, which lends support to the notion that this is not a demand-driven epidemic."

The presence of drugs adulterated with fentanyl is uneven, Mars said.

"Most of the illicit fentanyl has been in the Northeast and Midwest," she specified. And that's where opioid overdose death rates are the highest.

Another contributing factor to the fentanyl overdose toll is that it has dozens of analogs with wildly varying potency. Some, like carfentanil, are amazingly powerful, as much as 10,000 times as potent as morphine. Some are so new they have not yet been made illegal.

"We believe it's the fluctuation in the potency of the drugs containing fentanyl that makes them so dangerous," said Daniel Ciccarone, MD, MPH, a professor of family and community medicine at UCSF and senior author of an ongoing National Institutes of Health-funded study, Heroin in Transition. "You might have one dose that had hardly any fentanyl in it or none at all. Then, you might have one with a different fentanyl analog, of different potency, or even mixtures of multiple fentanyls and heroin."

Here is the paradox of drug prohibition: Trying to crack down on drugs tends to lead not to less drug use but to more dangerous drugs, and in the case of opioids, tens of thousands of dead drug users. There is an inexorable logic at play: The more law enforcement comes down on a drug, the greater the tendency for suppliers to make it more potent and compact -- and dangerous.

Perhaps that's why we now see mainstream calls for a radically different approach, such as the one from Washington Post columnist Megan McArdle earlier this week. In her column "The Incredibly Unpopular Idea That Could Stem Heroin Deaths," McArdle argues that current drug policy is only running up the overdose death toll and that we need "to start talking about ways to make safe, reliable doses of opiates available to addicts who aren't ready to stop."

That would involve increasing access to opioid substitutes such as methadone and buprenorphine, "but lowering the death toll may require a more drastic step: legalizing prescriptions of stronger opiates," McArdle writes.

"Prescription heroin?" she continues. "Remember, I said you might not like the solution. I don't like it, either -- and frankly, neither do the drug policy researchers who told me it may be necessary. But when fentanyl took over the US illicit drug markets, it also got a lot of addicts as hostages. We'll never be able to rescue them unless we can first keep them alive long enough to be saved."

There is a better way to deal with the opioid crisis than relegating tens of thousands of American opioid users to early, preventable deaths. We know what it is. Now it's a matter of implementing smarter, more humane policies, and that's an ongoing political struggle -- one where lives are literally at stake.

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