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Faced with Fentanyl, Is It Time for Heroin Buyers' Clubs? [FEATURE]

In the past few years, the powerful synthetic opioid fentanyl and its derivatives have been the primary driver of the drug overdose death epidemic. A wave of addiction that began with prescription opioids two decades ago and morphed into one driven by heroin after the crackdown on pain pills one decade ago has now clearly entered a third phase: the era of fentanyl.

Pharmaceutical heroin. (Creative Commons)
Beginning in about 2014, fentanyl-related overdose death rates skyrocketed as Chinese chemical manufacturers and Mexican drug distribution gangs began flooding the country with the cheap, easily concealable narcotic—and not through unwalled borders but through points of entry and package delivery services, including the U.S. Postal Service. By 2017, fentanyl was implicated in some 28,000 overdose deaths, more than either heroin or prescription opioids, and involved in nearly half of all overdose deaths.

The responses have ranged from the repressive to the pragmatic. Some state and federal legislation seeks a harsher criminal justice system response, whether it's increasing penalties for fentanyl trafficking or charging hapless drug sharers with murder if the person they shared with dies. In other cases, the opioid epidemic has emboldened harm reduction-based policies, such as the calls for safe injection sites in cities such as Denver, New York, Philadelphia, San Francisco, and Seattle.

Just a couple of hours up the road from Seattle, Vancouver, British Columbia, has been grappling with the same wave of opioid addiction and now, the arrival of fentanyl. And it has arrived with a real wallop: According to the British Columbia Coroner’s Service, fentanyl was implicated in 85 percent of overdose deaths in the province last year, up from only four percent just six years earlier. And with the arrival of fentanyl and, in 2016, its cousin, carfentanil, overdose deaths in B.C. jumped more than four-fold in that same period, from 333 in 2012 to 1,489 in 2018.

But while American cities are just now moving toward opening safe injection sites, Vancouver has had them for years, part of the city’s embrace of the progressive Four Pillars strategy—prevention, treatment, harm reduction, and enforcement—of dealing with problems around drug misuse and addiction. In fact, more than a dozen safe injection sites are now operating in the city, as well as a couple of programs that involve providing pharmaceutical grade heroin or other opioids to hard-core addicts who have proven unamenable to traditional forms of treatment.

Such harm reduction programs have not prevented all overdose deaths, but they have radically reduced the toll. B.C. Chief Coroner Lisa Lapointe has estimated that without those programs, B.C. would have seen triple the number of fatal overdoses.

Vancouver has been on the cutting edge of progressive drug policy reforms for the past 20 years, and now, faced with the fentanyl crisis, some researchers are proposing a radical next step: heroin buyers’ clubs.

In a report published last week, the B.C. Center on Substance Use, which has strong ties to the provincial government, called for the clubs as part of a broader plan for "legally regulated heroin sales in B.C." to protect users from fentanyl-adulterated heroin and cut the profits of organized crime.

The proposal "is inspired by cannabis compassion clubs and buyers' clubs, both of which emerged in the 1980s and 1990s in response to the AIDS epidemic," the authors note.

"The compassion or buyers' club would function as a cooperative (or ‘co-op’), as an autonomous and democratic enterprise owned and operated by its members," the report explains. "A member-driven purchasing cooperative is an arrangement among businesses or individuals whereby members agree to aggregate their demand in order to purchase a certain product at a lower price from a supplier," it continues. "By aggregating their purchase orders and relevant resources, members are able to take advantage of volume discounts, price protection, shared storage and distribution facilities and costs, and other economies of scale to reduce their overall purchasing costs."

It wouldn't exactly be the Dallas Buyers Club, the 2013 film that portrayed unorthodox methods of obtaining AIDS medications in the 1980s. There would be some structure: To be accepted into the club, people addicted to opioids would have to undergo a medical evaluation, and once admitted to the club, they would still have to buy their own heroin, but with many advantages over buying black market dope. The main advantage would be that they would be receiving pure, pharmaceutical grade heroin (known as diacetylmorphine in countries where it is part of the pharmacopeia)—not an unknown substance that is likely to contain fentanyl.

Club members could inject the drug at a designated location—the report suggests that existing safe injection sites could be used—or take small amounts of the drug with them for consumption at home. The report also calls for each club to include related services, such as overdose response training, access to the opioid overdose reversal drug naloxone, and options for members to access social services such as detox, rehab, and other treatment options.

Not only could buyers' clubs create a safer, cheaper heroin-using experience for members, the report argues, but they could also erode the black market and its tendency to produce more potent drugs—the so-called Iron Law of Prohibition.

"Fentanyl adulteration in the illicit drug supply is a predictable unintended consequence of drug prohibition," the report concludes. "The same forces that pushed the market away from relatively bulky opium towards heroin, a more concentrated opioid that was easier to transport clandestinely, have continued to push the opioid market to increasingly potent synthetic opioids, including a range of fentanyl analogs. A cooperative could undermine the illegal market wherever it is set up."

Such a plan faces legal and political challenges in Canada, but those can be overcome if the provincial and federal governments get on board. Obstacles to such a plan being rolled out in the United States are even greater, especially given an administration hostile toward harm reduction in general that would most likely view legal heroin sales as anathema.

But here in the U.S., we're a decade or so behind Vancouver when it comes to progressive drug policies, so it's time to get the conversation started. After all, these sorts of approaches to the problem are likely to be more effective than throwing addicts in jail or building boondoggle border walls. 

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

Chronicle AM: Denver Psilocbyin Init Will Go to Voters, White House Issues Drug Strategy, More... (2/4/19)

The White House belatedly released the National Drug Control Strategy, a Denver magic mushroom initiative has qualified for the May ballot, Northeastern marijuana legalizers are busy, and more.

Denver will vote on removing criminal penalties for psychedelic mushrooms. (Greenoid/Flickr)
Marijuana Policy

World Health Organization Urges Removal of Marijuana from Drug Treaties. The World Health Organization (WHO) last Friday published a letter to the United Nations advising that marijuana and cannabis resin should no longer be considered controlled substances under international drug treaties. WHO specifically asked that the substances be moved out of Schedule IV of the Single Convention on Narcotic Drugs, which includes drugs thought to have no therapeutic value.

Cory Booker Enters Presidential Race With Call for Marijuana Legalization, Criminal Justice Reform. Sen. Cory Booker (D-NJ) formally entered the race for the Democratic presidential nomination last Friday and called for marijuana legalization and broader criminal justice reforms. There is a need for "changing our drug laws," including "ending the prohibition against marijuana," he said. "We do not have equal justice under the law," Booker said of the disproportionate rate at which black people are incarcerated under the country's drug laws. I believe in redemption."

New York Governor Wants Marijuana Legalized by April 1. Gov. Andrew Cuomo (D) said last Friday he wanted to see marijuana legalized by the state budget deadline of April 1. His remarks came after Assembly Speaker Carl Heastie said that lawmakers might have to wait until after the budget to take up legalization. But Cuomo said Friday he isn't giving up on his timetable and that a lot can happen in the legislature in six weeks.

Pennsylvania Legalization Bill Coming. Rep. Jake Wheatley (D-Allegheny County) will file a legalization bill that expunges criminal records for past pot convictions, releases inmates currently serving time for such offenses, and allows people 21 and over to use, buy, and grow marijuana.

Vermont Attorney General Supports Legalizing Pot Sales. Vermont became the first state to legalize marijuana legislatively last year but did not legalize marijuana commerce. Now, there's an effort underway to do so with SB 54, and Attorney General TJ Donovan supports it. "We have to have a regulated market," he said last Thursday. "This is common sense." The bill is currently before the Senate Judiciary Committee.

Medical Marijuana

Wyoming Medical Marijuana Bill Filed. Republican House Majority Leader Eric Barlow has filed a bill to legalize medical marijuana, HB 278. The bill would create a strictly regulated system for the use and distribution of medical marijuana in the state.

Psychedelics

Denver Will Vote on Magic Mushroom Initiative in May. City officials announced last Friday that the Decriminalize Denver initiative to make adult use and possession the lowest law enforcement priority and bar the city from using its resources to arrest and prosecute people for the hallucinogenic fungi has qualified for the ballot and will go before voters in the May municipal election. This marks the first time any jurisdiction in the US will have voted on decriminalizing psychedelics.

Drug Policy

Trump Administration Unveils National Drug Control Strategy. The White House last Thursday released its long-awaited National Drug Control Strategy, which typically is released annually, but which the Trump administration failed to do last year. The document contains little new policy but instead emphasizes existing Trump priorities: reducing drug supply through stricter law enforcement, lowering first-time opioid prescription rates, and expanding access to addiction treatment. Despite its emphasis on supply reduction, it acknowledges the risk of reducing access for chronic pain patients. Although it talks about drugs coming across the Mexican border, the strategy does not contain the words "border wall."

Drug Testing

North Dakota School Board and Employee Drug Testing Bills Die. A pair of bills that would have mandated random, suspicionless drug tests for school employees and school board members have been killed in the Senate. SB 2310 was aimed at school employees, while SB 2337 was aimed at board members.

Sentencing

Mississippi Bill Targets People Who Provide Drugs in Fatal Overdoses. After a conviction for "depraved heart" murder in the case of a fatal overdose was overturned on appeal, state legislators have filed HB 867, which would allow sentences of 20 years to life without parole for people charged with selling drugs that result in the deaths of others. The bill would also increase penalties for the sale of heroin or fentanyl. The bill passed out of the House Judiciary Committee last week and is now headed for the House floor.

(This article was prepared by StoptheDrugWar.org's 501(c)(4) lobbying nonprofit, the Drug Reform Coordination Network, which also pays the cost of maintaining this website. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

Chronicle AM: Israel OKs MedMJ Exports, MA Gov Wants Opioid Pain Pill Tax, More... (1/28/19)

Massachusetts' governor wants a tax on prescription pain pills, Minnesota sees marijuana legalization bills filed, Israel becomes the third country to allow medical marijuana exports, and more.

With final approval from the cabinet, Israel becomes the third country to allow medical marijuana exports.
Marijuana Policy

California Lawmakers File Bill to Rein in Black Market Marijuana by Lowering Tax Rates. Assemblymember Rob Bonta (D-Oakland) and several cosponsors on Monday introduced AB 286, which would fight the illicit black market of cannabis by encouraging consumers to purchase the product from licensed and regulated businesses. This bill would reduce the price disparity between legal cannabis businesses and black market sources. The bill is not yet available on the legislative website. An identical bill was introduced in 2017 and passed two committees with strong support but was stalled in the Assembly Appropriations Committee.

Minnesota Legalization Bills Filed. State Sen. Melisa Franzen (DFL) and Rep. Mike Freiberg (DFL) on Monday filed identical legalization bills. The bills are not yet available on the legislative website. Gov. Tim Walz (DFL) has previously expressed his support for such legislation, and last week a bill was filed that would put legalization on the ballot as a constitutional amendment.

New Hampshire Governor's Commission Opposes Legalization. The Governor's Commission on Alcohol and Other Drugs has recommended against legalizing marijuana in the state. Republican Gov. Chris Sununu has already made his opposition clear, and the commission's move to oppose a particular bill, HB 481, was described by the local press as “unusual.” The bill will have a hearing next week.

Heroin and Prescription Opioids

Massachusetts Governor Wants to Tax Opioid Manufacturers. Republican Gov. Charlie Baker has included a 15% excise tax on sales of prescription opioids as part of his state budget proposal. The proceeds would go to “address the significant and growing costs associated with opioid misuse,” Baker explained. New York passed a similar law last year, which is being challenged in the courts, but with one significant difference: The New York law expressly prohibited pharmaceutical companies from passing on the cost of the tax to consumers, but Baker's proposal doesn't, which means if it is enacted, state residents will pay higher prices for their pain medications.

Drug Courts

West Virginia Bill Would Implement Family Drug Court Pilot Program. The House Committee on Prevention and Treatment of Substance Abuse last Thursday filed a bill to implement a pilot program for family drug courts. They would specialize in cases of abuse and neglect involving substance abuse. The bill, which is not yet available on the legislative website, will be taken up by the House Judiciary Committee.

International

Israeli Cabinet Approves Medical Marijuana Exports. The cabinet on Sunday gave final approval to a law allowing the export of medical marijuana. The move came a month after the Knesset unanimously approved the idea. Israel is now the third country, after Canada and the Netherlands, to allow medical marijuana exports. 

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.

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