Prescription Opiates

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Chronicle AM -- November 19, 2013

Hmmm, on the same day the DEA warns that "marijuana availability seems to be on the increase," hundreds of people apply for licenses to sell pot in Washington state. Times are changing, and somebody needs to let the DEA know. And there's more news, too. Let's get to it:

Crackdowns on pain pills are leading the way to comeback for heroin. (wikipedia.org)
Marijuana Policy

Hundreds Apply for Pot Business Licenses in Washington State. Monday was the first day budding ganjapreneurs could apply for licenses to open marijuana cultivation, processing, and retail facilities, and interest was intense. By 2:00pm Monday, 299 applications had been submitted. The state envisions up to 334 marijuana retail shops opening next year; it is unclear how many production and processing facilities will be licensed, although regulators have said they want to limit cultivation to two million square feet statewide. Applications are being accepted through December 17.

Arkansas Attorney General Rejects Another Marijuana Initiative. The Arkansas attorney general's office Monday rejected the proposed language of an initiative that would repeal the state's marijuana laws. The initiative isn't clear about what it seeks to achieve, the office said. The attorney general's office has been busy with initiatives this year; it has already approved two separate medical marijuana initiatives, and the author of this one can come back with new language if she wishes.

Drug Policy

DEA Releases 2013 National Drug Threat Assessment. The DEA Monday released the annual drug threat assessment, which includes looks at drug use and trafficking trends. The report identifies the illicit use of controlled prescription drugs as "the nation's fastest growing drug problem," warns that heroin use and supply is up, as is methamphetamine, but that cocaine use and supply is down. Also, "marijuana availability seems to be increasing," and synthetic drugs "have emerged as a serious problem in the United States."

New Yorkers to Map Out City Drug Policies on Saturday. New York City residents just elected a self-described progressive -- Bill de Blasio -- as mayor. Now, they will have a chance to let him know what direction they want the city to take on drug policy. As part of Talking Transition, "an open conversation about the future of New York City," hundreds of people are expected to attend a Saturday forum on "Ending the New Jim Crow: Mapping the Future of Drug Policy in New York City," then break into small groups to make recommendations on issues ranging from racially-biased marijuana arrests, lack of effective drug treatment, and overdose prevention strategies. Click on the main link for more details.

Heroin

Ohio Attorney General Declares War on Heroin. Ohio Attorney General Mike DeWine Monday announced he had created a new heroin unit within his office to fight back against what he called "an epidemic" of heroin use. The move comes as heroin overdose deaths have doubled in recent years, from 292 in 2010 to 606 last year. DeWine said his office will spend an additional $1 million a year on increased assistance to law enforcement, community outreach workers, and lab technicians. The rise in heroin use in Ohio comes after Gov. John Kasich cracked down on pain clinics in 2011, leaving illicit heroin as the last resort for people strung out on opioids.

International

China to Turn "Re-Education" Labor Camps into Drug Treatment Centers. At its recent Third Plenary meeting, the Chinese Communist Party announced it was abolishing its controversial "re-education" labor camps. Now, it turns out that the camps won't be closing, but will instead be converted into drug treatment and rehabilitation centers. "The new rehab centers will provide compulsory drug rehabilitation treatment for addicts, and help them find self-confidence again," one official explained. There are 1.8 million "officially registered" addicts in China, but the number of actual addicts could run as high as 12 million.

Canadian Students for Sensible Drug Policy Meets in Vancouver This Weekend. Canadian SSDP is holding its annual national conference this weekend in Vancouver. In addition to panels and speeches, there will be tours of Insite, Vancouver's supervised injection facility, a Downtown Eastside Walking Tour, and rides on the Sensible BC bus. For more details, click the link.

DEA Targets FedEx, UPS in Online Pharmacy Battle

Charged with cracking down on the diversion of prescription drugs, the DEA has pursed doctors, pharmacists, pharmacy chains, and wholesale drug suppliers. It has now turned a baleful eye on shipping companies as well, with differing results -- at least so far.

The Orlando Sentinel reported Tuesday that both UPS and FedEx had admitted in corporate filings that they were the targets of DEA probes into packages of pills shipped from online pharmacies. Prescriptions filled by online pharmacies are illegal if there is not a real doctor-patient relationship, and the DEA maintains that prescriptions written by "cyber doctors" relying on online questionnaires are not legal.

FedEx has strongly pushed back against the DEA probe, but UPS has now buckled under the pressure. In a Friday statement, the DEA announced that UPS had agreed to forfeit $40 million it had been paid for shipments by online pharmacies and to enter into a "compliance program" to ensure online pharmacies can't use its services. The deal was part of a non-prosecution agreement the shipper signed with federal prosecutors in Northern California.

DEA accused UPS of knowingly shipping the illegally-prescribed drugs between 2003 and 2010 because "it was on notice, through some employees" that such activities were occurring. DEA also accused UPS of failing to do anything about it.

"DEA is aggressively targeting the diversion of controlled substances, as well as those who facilitate their unlawful distribution," said DEA Administrator Michele Leonhart. "This investigation is significant and DEA applauds UPS for working to strengthen and enhance its practices in order to prevent future drug diversion."

FedEx may prove a tougher nut to crack. Officials there called the federal probe "absurd and disturbing" and said it threatened customer privacy. They also accused the DEA of failing to cooperate with them in efforts to resolve the problem.

"We are a transportation company -- we are not law enforcement, we are not doctors and we are not pharmacists," FedEx spokesman Patrick Fitzgerald said in a prepared statement. "We have no interest in violating the privacy of our customers by opening and inspecting their packages in an attempt to determine the legality of the contents. We stand ready and willing to support and assist law enforcement. We cannot, however, do their jobs for them."

FedEx complained that rather than working with the shipping industry to come up with solutions, the Justice Department appeared focused on finding ways to prosecute shippers.

"This is unwarranted by law and a dangerous distraction at a time when the purported illegal activity by these pharmacies continues," Fitzgerald said.

FedEx has been a major campaign contributor to US Rep. John Mica (R-FL), whom the Sentinel reported had sent a letter to Leonhart and Attorney General Eric Holder asking them to recognize "the difficulty and unfairness of requiring those carriers to assume responsibility for the legality and validity of the contents of the millions of sealed packages that they pick up and deliver ever day."

Mica told the Sentinel that while he is "concerned about prescription drugs," it was inefficient to try to turn shipping companies into drug policy enforcers. "You can't stop commerce; you can't open every package," Mica said. "I'm only asking them for a reasonable approach."

But it doesn't appear that DEA and the Justice Department see things the same way as Rep. Mica does.

San Francisco, CA
United States

FDA Panel Wants Tighter Control over Pain Pills

A US Food and Drug Administration advisory panel voted last Friday to recommend that popular pain relievers containing the opioid hydrocodone be moved from Schedule III to Schedule II of the Controlled Substances Act. Popular prescription drugs containing hydrocodone include Vicodin and Lortab.

That would put Lortab and Vicodin in the same schedule as morphine and Oyxcontin, which contains oxycodone.

If the FDA agrees with its advisory panel and reschedules hydrocodone, pain patients using the drug will have to go the doctor's office to get prescriptions written twice as frequently as now. Schedule III drugs can be prescribed for up to six months at a time, while Schedule II drugs can only be prescribed for three months without another visit to the doctor.

The FDA has for years resisted efforts to tighten controls over hydrocodone, saying it could limit patients' access to pain medicine, but as overdose deaths and addiction rates from prescription pain relievers have jumped in recent years, pressure has been mounting on the agency. The agency is acting now after receiving a request from the DEA to consider rescheduling.

The advisory panel's 19-10 vote received mixed reviews from experts consulted by the Milwaukee Journal-Sentinel.

Andrew Kolodny, a psychiatrist and addiction specialist who heads Physicians for Responsible Opiate Prescribing lauded the vote, saying it will lead to fewer people getting addicted to opiates.

"Doctors have had a false sense of security (about prescribing the drugs)," said Kolodny. "This is a clear message that hydrocodone is addictive," he told the Wisconsin newspaper.

"It seemed pretty clear to me that the preponderance of the evidence supported rescheduling," said Peter Kaboli, associate professor at the University of Iowa Carver College of Medicine.

But Jan Chambers, president of the National Fibromyalgia and Chronic Pain Association, said she voted against the proposal because she has heard so much from family members of people who have committed suicide because they are in such pain.

"Millions of people don't have access to the pain specialist or the doctors who can prescribe these Schedule III drugs," she said.

And Lynn Webster, president-elect of the American Academy of Pain Medicine, said putting tighter controls on hydrocodone will reduce prescribing and abuse, but worried about the impact on pain patients.

"I hope chronic pain patients and acute pain patients don't suffer as a result," said Webster, who spoke at the panel hearing but was not a panel member.

The FDA has not said when it will make a final decision on the issue. Now, the FDA and the National Institutes of Health must make a recommendation to the assistant secretary for health, who will make a final recommendation to the DEA.

Washington, DC
United States

Chronicle Review Essay: Opium Dreams

Opium: Reality's Dark Dream, by Thomas Dormandy (2012, Yale University Press, 366 pp., $40.00 HB)

Opium Fiend: A 21st Century Slave to a 19th Century Addiction, by Steven Martin (2012, Villard Books, 400 pp., $26.00 HB)

Social Poison: The Culture and Politics of Opiate Control in Britain and France, 1821-1926, by Howard Padwa (2012, Johns Hopkins University Press, 232 pp., $55.00 HB)

Ah, blessed opium, the beloved bringer of sweet relief from pain, of the body or the soul, the deliverer of bliss and sweet surcease from suffering. From it and its derivatives come the most effective pain relievers known to man. Morphine, codeine, Percocets, Lortabs, Vicodin, Oxycontin, hydrocodone, Fentanyl and rest of the opiates and opioids (synthetic opiates) fill the medicine cabinets of those dying of cancers and other horrifyingly painful conditions and they work wonders with acute pain, from a broken limb to dental surgery, turning agony into pleasantly numb nirvana.

But, oh, cursed opium, death with a needle in its arm, and a trail of wasted junkies left like whispering wraiths in its lee. Thief not only of lives, but also of souls as those in her thrall bend before the sultry temptress enslaved before her insatiable demands.

Opium -- inspiration of writers and artists, tool of physicians, cash crop for peasant farmers, boon of the pained, bane of the moralist. Prototypical commodity of global trade, subject of wars, and funder of armies.

https://stopthedrugwar.org/files/opium-reality.jpg
It's safe to say we have a love-hate relationship with papaver somniferum, the opium poppy. And, as Thomas Dormandy points out in his magisterial history Opium: Reality's Dark Dream, it goes back a long way. Poppy seeds were found in the excavation of a lakeside Swiss village dated to 6000 BC, and the use of the poppy as medicine was part of Egyptian practice as early as 4500 BC. (Interestingly, concern about its deadly and addictive properties came only much later, although, in a gripe that could have come from the online comment section of any newspaper today, grumpy old man Cato the Elder complained about doped-up youth hanging around the Forum in imperial Rome.)

Dormandy takes the reader from that prehistoric Swiss village to the poppy fields of Afghanistan, carrying us along with a graceful narrative and subtle wit as he surveys colonial machinations and imperial intrigue, evolving medical knowledge, literary and artistic output associated with the poppy, and opium's own transformation from consumed resin to alcohol-based tincture (laudanum) to smoked opium (curiously thanks to Dutch and British sailors who brought their new-found tobacco smoking habits, perhaps with a pinch of poppy thrown in, and paraphernalia to the Far East, which didn't have tobacco, but did have plenty of opium to smoke), on to injectable morphine, "heroic" heroin, and now, the newer synthetic opioids.

Along the way, we check in with doctors and scientists, junkies and kings, de Quincey and Coleridge and the the tubercular Romantics. Dormand surveys some well-trodden territory, but brings to the subject refreshing insights and entrancing prose. And he is a model of moderation.

He is loathe to cheerlead for legalization, given the downsides of death and addiction, but is equally skeptical of claims that prohibition -- short of the Maoist model, which even China couldn't get away with now -- can somehow make the poppy and its derivatives go away.

https://stopthedrugwar.org/files/opium-fiend.jpg
"Criminalization is justified if it deters potential delinquents and protects the innocent," he writes. "Little if any evidence suggests that current legislation does either."

Dormandy's main prescription -- education, and presumably, prevention -- is unlikely to satisfy partisans on either side of the policy debate, but may, after decriminalization and adoption of a public health approach, be the best we can hope for in the foreseeable future.

Steven Martin's Opium Fiend is not a history of opium, although it contains plenty, but a fascinating memoir of his journey from nerdy teenage compulsive collector to full-blown chaser of the dragon in the back alleys and hidden byways of Southeast Asia. Martin made a career for himself writing for off-the-beaten-path travel series, such as the Rough Guides and Lonely Planet, but his obsession was collecting, and he eventually turned to collecting the paraphernalia of opium smoking.

From collecting opium pipes to seeing how they actually work is a very short leap, one that Martin was quick to take, once he managed to find some of the last real-life opium dens left in the region (and some of the characters who inhabited them). And before he realized it, he had become enslaved to the pipe.

Or had he been liberated? As his world shrank to the confines of his Bangkok apartment and the home of his fellow pipe-head and opium supplier (another American expatriate and antiquities expert whose death in US detention casts a somber shadow over the tale), he congratulated himself on his withdrawal from -- and rejection of -- what he increasingly saw as a brutal and thuggish world. "There was euphoria in what felt like the ultimate act of rebellion against modern society," he wrote. "Opium was setting me free."

https://stopthedrugwar.org/files/social-poison.jpg
Except it wasn't, as his ghastly recounting of his efforts to kick the habit demonstrated. What was once liberation was now addiction. But how much of Martin's addiction was tied up with his own obsessive-compulsive personality?

Martin's memoir combines the typical obsessive descriptions of drug effects with a survey of the broader historical and cultural traditions surrounding opium, as well as the (surprisingly brief; it was largely extinguished a century ago) history of opium smoking, as well as taking the reader into the strange world of collecting Asian antiques. Opium Fiend is a worthwhile, engaging, and enlightening read, and stands not only as a valuable contribution to the literature of opiate use, but on its own literary merits.

Howard Padwa's Social Poison will attract a much more limited audience, and that's too bad. While it concentrates on the rather esoteric topic of 19th Century approaches to opiate control in Britain and France, it, too, provides interesting insights on the politics of drug control. But this has the appearance of a PhD dissertation turned into a book, and its likely readership is probably a very small number of graduate students in related subjects--who will probably only check it out from university libraries, given its $55.00 price tag.

Still, Padwa is able to disentangle various threads and offer an explanation for the divergent courses of the two countries. While Britain demonstrated an amenability to opiate maintenance and its practitioners, France has historically come down firmly on the side of criminalizing opiate users and the doctors who prescribed to them. Padwa traces the divergence to national conceptions of citizenship and the shifting nature of the drug-using populations in the two countries. His comparative study is well-constructed, and its a shame few are likely to ever even pick up the book.

Opium and its derivatives remain both bane and boon. Prescription pain pills (opiates) are driving the current drug overdose epidemic in the US. At the same time, they are bringing blessed relief to pain sufferers. Opium production is putting foods in the mouths of families in Afghanistan and Myanmar. At the same time, it is corrupting governments and buying guns to fight remote wars. Cheap heroin is creating new generations of addicts. At the same time, it is in some ways making bearable the misery in the lives of the miserable.

Now, if we can only figure out how to end opium (and opiate) prohibition without being engulfed by the downside of opiate use. As Dormandy noted, in 18th and 19th Century England, laudanum was viewed as mother's little helper; it sent baby to sleep. But sometime baby never woke up.

Utah Cops Interrupt Husband's Last Goodbyes to Grab Dead Woman's Pain Pills

Barbara Alice Mahaffey, an elderly resident of Vernal, Utah, died at home of colon cancer on May 21 as her husband of 58 years stood at her side. The death of his long-time spouse was bad enough, but what came next has Ben Mahaffey furious -- and heading to court.

Barbara Alice Mahaffey (family photo)
Mahaffey, 80, filed a lawsuit against the city of Vernal earlier this month charging that Vernal police interrupted his last goodbyes by searching his house for her prescription pain medication without a warrant within minutes after her death. Mahaffey said he was distraught and trying to ensure that his wife's body would be transported to a funeral home with dignity when police insisted he help them look for drugs.

"I was holding her hand and saying goodbye when all the intrusion happened," he told the Deseret News.

According to Mahaffey, his wife died at 12:35am with him and an EMT at her side. About 10 minutes later, a mortician and hospice worker arrived, accompanied by police. Mahaffey says he doesn't know how police came to be there, but that they treated him as if he were going to sell the drug on the street.

His wife had prescriptions for Oxycontin, oxycodone, and morphine. Such heavy-duty opiates are commonly used by people in end-stage cancer. They are also highly sought after by people who are self-medicating, using them for recreational purposes, or addicted to them.

"I was indignant to think you can't even have a private moment. All these people were there and they're not concerned about her or me. They're concerned about the damned drugs. Isn't that something?" he said. "I had no interest in those drugs. I'm no addict."

According to the lawsuit, Mahaffey asked Vernal city officials and police leaders how they could search his home without a warrant and was told that they could do so under the Utah Controlled Substances Act. The lawsuit also claims that city manager Ken Bassett pooh-poohed his concerns, saying he was being "overly sensitive" and that police were just trying to protect the public from diverted prescription drugs. Mahaffey described city officials as "rude" and "condescending."

His attorney, Andrew Fackrell, told the Deseret News the warrantless search was both unlawful and uncalled for. There is nothing in the state's drug law that permits entering homes to search for prescription drugs without a warrant, he said.

"I don't believe the public would intend for the government to be rummaging through your cupboards while your wife is lying in the next room being prepared to be taken to her final resting place," Fackrell said. "That's an extraordinary invasion of privacy."

Fackrell added that it is apparently common practice for Vernal police to search for prescription drugs without a warrant after someone dies, but that it is done selectively. While some cities have prescription drug "take back" programs, he said, the Vernal police approach takes that to  "an absurd level."

Mahaffey said he was concerned about eroding rights.

"The whole thing, when think about it after the fact, is so stupid," he said. "My basic motivation was 'Gee, I don't want this to happen to other people.'"

The lawsuit names the city of Vernal, city manager Bassett, and four members of the Vernal Police. It alleges the action by police violated Fourth Amendment rights to be free of unwarranted search and seizure and 14th Amendment rights to equal protection under the law.

The city and the individual plaintiffs have not publicly commented on the lawsuit.

Vernal, UT
United States

Naloxone Cheap Way to Prevent Drug OD Deaths, Study Finds

Drug overdose deaths are now the leading cause of accidental death in the US, surpassing automobile accidents, but a new study suggests that distributing naloxone to opioid drug users could reduce the death toll in a cost-effective manner. The study was published this week in the Annals of Internal Medicine.

Naloxone package (wikimedia.org)
Opioids, including not just illicit heroin but also widely used prescription pain pills, are responsible for about 80% of drug overdose deaths. Naloxone, an opioid antagonist, works by blocking opioid receptors in the brain, making it possible to reverse the effects of overdoses.

At least 183 public health programs around the country have trained some 53,000 people in how to use naloxone. These programs had documented more than 10,000 cases of successful overdose reversals.

In the study published in the Annals, researchers developed a mathematical model to estimate the impact of more broadly distributing naloxone among opioid drug users and their acquaintances. Led by Dr. Phillip Coffin, director of Substance Use Research at the San Francisco Department of Public Health, and Dr. Sean Sullivan, director of the Pharmaceutical Outcomes Research and Policy Program at the University of Washington, the researchers found that if naloxone were available to 20% of a million heroin users, some 9,000 overdose deaths would be prevented over the users' lifetimes.

In the basic research model, one life would be saved for every 164 naloxone kits handed out. But using more optimistic assumptions, naloxone could prevent as many as 43,000 overdose deaths, saving one life for every 36 kits distributed.

Providing widespread naloxone distribution would cost about $400 for every year of life saved, a figure significantly below the customary $50,000 cut-off for medical interventions. That's also cheaper than most accepted prevention programs in medicine, such as checking blood pressure or smoking cessation.

"Naloxone is a highly cost-effective way to prevent overdose deaths," said Dr. Coffin. "And, as a researcher at the Department of Public Health, my priority is maximizing our resources to help improve the health of the community."

Naloxone has proven very effective in San Francisco, with heroin overdose deaths declining from 155 in 1995 to 10 in 2010. The opioid antagonist has been distributed there since the mid-1990s, and with the support of the public health department since 2004. But overdose deaths for opioid pain medications (oxycodone, hydrocone, methadone) remain high, with 121 reported in the city in 2010. Efforts are underway in the city to expand access to naloxone for patients receiving prescription opioids as well. This study is the latest to suggest that doing so will save lives, and do so cost-effectively.

New Jersey Good Samaritan Overdose Bill Passes

A bill designed to reduce drug overdose deaths by providing some legal protection to people who witness them and summon medical assistance has been approved by the state legislature and now awaits the signature of Gov. Chris Christie (R). The bill passed the Senate Monday on a 21-10 vote; it had cleared the Assembly back in May.

fatal drug overdose (wikimedia.org)
The bill, Assembly Bill 578, also known as the Good Samaritan Emergency Response Act, would provide limited legal protection against drug possession charges for people who witness an overdose and call 911. It is aimed at reducing drug overdose deaths by reducing the fear of arrest for those might call for assistance.

According to the Centers for Disease Control and Prevention, drug overdoses are now the leading cause of accidental death, replacing automobile accidents. More than 27,000 people died from drug overdoses in 2007, most of them from prescription opiates, either by themselves or in combination with other drugs, including alcohol.

Many drug overdose deaths occur in the presence of others and take hours to occur, meaning that there is time and opportunity to call for help. But strict enforcement of drug possession laws against would-be Samaritans discourages some from making that call.

Advocates are applauding the passage of the life-saving bill.

"Calling 911 should never be a crime. Our current policies focus on punishment and drive people into the shadows and away from help," said Roseanne Scotti, New Jersey State Director of the Drug Policy Alliance. "Saving lives should always take priority over punishing behavior.  A Good Samaritan law will encourage people to get help."

"When a life is on the line we can ill afford to waste time weighing the consequences of calling 911 or deciding whether or not to be truthful about what substance was used to overdose," said Senate bill sponsor Sen. Joseph Vitale (D-Middlesex). "By narrowly eliminating the criminal consequences one might face after calling 911 to report an overdose, I hope to diminish any hesitation one might have about doing the right thing."

"I and my family are so grateful to the senate for passing this life-saving legislation," said Patty DiRenzo, whose son Salvatore died of an overdose at age 27. "We, and the other families who have lost loved ones to overdose, will be advocating with Gov. Christie to urge him to sign this bill. It's extremely important that we prevent future overdose deaths and spare other families the grief that mine has endured."

If Gov. Christie signs the bill into law, New Jersey will become the ninth state to enact a Good Samaritan law. The others are Colorado, Connecticut, Florida, Illinois, New Mexico, New York, Rhode Island, and Washington. Similar legislation is pending in several other states.

Trenton, NJ
United States

Bipartisan Bill to Fight Overdoses Filed in Congress

A bipartisan group of legislators led by Reps. Donna Edwards (D-MD) and Mary Bono Mack (R-CA) last Thursday introduced a bill designed to reduce the number of overdose deaths related to the use of opioid pain medications. Among other measures, the bill seeks to ramp us the use of naloxone, an opioid antagonist that quickly reverses overdoses among heroin and opioid pain reliever users.

naloxone package (wikimedia.org)
The bill, known as the Stop Overdoses Stat Act, did not have a bill number and was not yet available online as of last Thursday afternoon. [Update: It is now online as H.R. 6311.] It would create federal support for overdose prevention, education, and training programs run by cities, states, tribal governments, and community groups.

It is aimed primarily at the rapid increase in fatal prescription opioid overdose deaths that have accompanied the massive increase in opioid pain pill prescriptions over the past decade. Since the late 1990s, roughly the time Oxycontin appeared on the scene, the number of fatal overdose deaths have jumped more than 140%, claiming more than 28,500 lives in 2009 (the latest year data is available). While overdoses from illegal drugs persist as a major public health problem, fatal overdoses from prescribed opioid pain relievers such as oxycodone account for more than 40% of all overdose deaths.

Fatal drug overdoses now exceed the number of deaths from firearms and are second only to car crashes as the leading cause of accidental death. Currently, somebody dies of a drug overdose every 14 minutes in the US.

Despite growing recognition among federal health authorities and lawmakers that overdose prevention programs employ techniques and resources that are highly effective at saving lives at low-cost to taxpayers, few federal dollars are dedicated to supporting these critical programs. A February report from the Centers for Disease Control credits overdose prevention programs with saving more than 10,000 lives since 1996.

"Local health officials and frontline workers engaged in overdose prevention are saving lives every day using straightforward, low-cost interventions. With federal support, we could be saving many more lives and spare countless families from enduring the heart wrenching, yet completely preventable, loss of a loved one," said Grant Smith, federal policy coordinator for the Drug Policy Alliance. "The Drug Policy Alliance applauds Congresswoman Edwards and Congresswoman Bono Mack for introducing this live-saving legislation and showing leadership on this issue in Congress."

"The SOS Act will fight a growing health crisis that is going largely unnoticed in our country," said Edwards. "Approximately 30,000 Americans die each year from drug overdoses, yet the national response to combat this ongoing crisis remains woefully inadequate. It is time that the federal government took on an active role in promoting proven treatments recommended by medical associations. I want to thank Congresswoman Mary Bono Mack for joining me in introducing the SOS Act, and I look forward to working with all my colleagues to pass this bill into law."

Local overdose prevention programs have been successfully implemented in more than 180 locations nationwide, including pioneering statewide programs in Massachusetts, New Mexico, and New York, and in major cities including Baltimore, Boston, Los Angeles, Pittsburg, and San Francisco. Passage of the SOS Act would make federal funds available to support these and similar programs and add new ones.

"As Americans, we rally around efforts to fight breast cancer, childhood diseases and other serious health threats. But for far too long, there have only been hushed whispers about prescription drug abuse -- now the fastest growing drug problem in America. So as the death toll from prescription drug overdoses continues to rise sharply, it's time to move this story from the obituary page to the front page where it belongs," said Bono Mack. "It's time to realize that we can't simply wish this horrific problem away. Not with more than 20,000 people a year dying from it. Not when the number of newborn babies who must be withdrawn from opiate dependence at birth has tripled in the past decade. Not when nearly one out of 4 high school seniors has used prescription painkillers. This is nothing less than a national tragedy. If 20,000 people died each year from food poisoning, Americans would demand immediate action."

The bill currently has two dozen cosponsors.

Washington, DC
United States

Obama's 2012 Drug Strategy: The Same Old Same Old [FEATURE]

The Obama administration released its 2012 National Drug Control Strategy and accompanying 2013 drug budget Tuesday, and while the administration touted it as a "drug policy for the 21st Century," it is very much of a piece with anti-drug policies going back to the days of Richard Nixon.

Drug war spending continues to exceed treatment and prevention spending (ONDCP)
"We will continue to pursue a balanced approach… in a national effort to improve public health and safety," wrote Office of National Drug Control Policy (ONDCP) head Gil Kerlikowske in the introduction to the strategy. "We will work to prevent illicit drug use and addiction before their onset and bring more Americans in need of treatment into contact with the appropriate level of care. We will continue to build on the administration’s progress in reforming the justice system, ensuring that laws are applied fairly and effectively -- protecting public safety while also ensuring that drug-involved offenders have the opportunity to end their drug use and rebuild their lives."

But that's only one half of the administration's approach. The other half, as Kerlikowske makes clear, it continued adherence to classic war on drugs strategies.

"We will continue to counter drug produc­tion and trafficking within the United States and will implement new strategies to secure our borders against illicit drug flows," the drug czar wrote. "And we will work with international partners to reduce drug production and trafficking and strengthen rule of law, democratic institutions, citizen security, and respect for human rights around the world."

The federal government will spend more than $25 billion on drug control under the proposed budget, nearly half a billion dollars more than this year. And despite the administration's talk about emphasizing prevention and treatment over war on drugs spending, it retains the same roughly 60:40 ratio of law enforcement and interdiction spending over treatment and prevention training that has obtained in federal drug budgets going back years. In fact, the 58.8% of the proposed budget that would go to drug war programs is exactly the same percentage as George Bush's 2008 budget and even higher than the 56.8% in Bush's 2005 budget.

ONDCP director Gil Kerlikowske
In the 2013 drug budget, treatment and early intervention programs would be funded at $9.2 billion, an increase of more than $400 billion over this year, but most of that increase is for treatment covered under the Medicaid and Medicare programs. Grant programs under the Substance Abuse and Mental Health Services Administration (SAMHSA), including Access to Recovery, early screening and referral, and drug courts are all reduced under the 2013 budget, although drug courts would see an increase in funding under the Department of Justice's Problem Solving Justice Program.

One area where treatment funding is unequivocally increased is among the prison population. Federal Bureau of Prisons treatment spending would jump to $109 million, up 17% over this year, while the Residential Substance Abuse Treatment Program for state prisoners would be funded at $21 million, up nearly 50% over this year.

The drug strategy's rhetorical emphasis on prevention is not reflected in the 2013 budget, which calls for a 1% decrease in funding. SAMHSA prevention grants and Drug Free Communities funding would decrease slightly, while the administration seeks $20 million to restart the much maligned and congressionally zeroed-out Youth Drug Prevention Media Campaign.

On the drug war side of the ledger, domestic anti-drug law enforcement spending would increase by more than $61 million to $9.4 billion, with the DEA's Diversion Control Program (prescription drugs) and paying for federal drug war prisoners showing the biggest increases. The administration anticipates shelling out more than $4.5 billion to imprison drug offenders.

But domestic law enforcement is only part of the drug war picture. The budget also allocates $3.7 billion for interdiction, a 2.5% increase over the 2012 budget, and another $2 billion for international anti-drug program, including assistance to the governments of Central America, Colombia, Mexico, and Afghanistan.

Critics of the continued reliance on prohibition and repression were quick to attack the new drug strategy and budget as just more of the same.

"The president sure does talk a good game about treating drugs as a health issue but so far it's just that: talk," said Neill Franklin, executive director of Law Enforcement Against Prohibition (LEAP) and a former narcotics officer in Baltimore. "Instead of continuing to fund the same old 'drug war' approaches that are proven not to work, the president needs to put his money where his mouth is."

"This budget is appalling. The drug czar is trying to resurrect those stupid TV ads, like the one where a teenager gets his fist stuck in his mouth," said Rob Kampia, executive director of the Marijuana Policy Project. "The budget intentionally undercounts the federal government's expenditures on incarcerating drug offenders, who comprise more than half of the federal prison population. And the budget dangerously proposes a massive escalation in using the military to fight drugs domestically. Congress should just ignore this budget and start from scratch. Specifically, Congress should not provide the Obama administration with any money to go after nonviolent marijuana users, growers, or distributors."

In the 2013 drug strategy, the administration is highlighting a renewed emphasis on drugged driving and is encouraging states to pass "zero tolerance" drugged driving laws. It is also emphasizing attacking the massive increase in non-prescription use of opioid pain pills.

While the strategy calls for lesser reliance on imprisonment for drug offenders, it also calls for increased "community corrections" surveillance of them, including calling for expanded drug testing with "swift and certain" sanctions for positive tests. But drug testing isn't just for parolees and probationers; the drug strategy calls for expanded drug testing in the workplace, as well.

The drug strategy acknowledges the calls for recognition of medical marijuana and marijuana legalization, but only to dismiss them.

"While the Administration supports ongoing research into determining what components of the marijuana plant can be used as medicine, to date, neither the FDA nor the Institute of Medicine has found the marijuana plant itself to meet the modern standard for safe or effective medicine for any condition," the strategy said. "The Administration also recognizes that legalizing marijuana would not provide the answer to any of the health, social, youth education, criminal justice, and community quality of life challenges associated with drug use."

For Bill Piper, director of national affairs for the Drug Policy Alliance, the 2012 drug strategy was all too familiar.

"This strategy is nearly identical to previous national drug strategies," he said. "While the rhetoric is new -- reflecting the fact that three-quarters of Americans consider the drug war a failure -- the substance of the actual policies is the same. In reality, the administration is prioritizing low-level drug arrests, trampling on state medical marijuana laws, and expanding supply-side interdiction approaches -- while not doing enough to actually reduce the harms of drug addiction and misuse, such as the escalating overdose epidemic."

The release of the drug budget comes just days after President Obama returned from the Summit of the Americas meeting, where he was pressed to open up a debate on legalizing and regulating drugs by sitting Latin American presidents like Juan Manuel Santos of Colombia and Otto Perez Molina of Guatemala. And it comes as marijuana legalization is at the cusp of majority support and trending upward.

It is past time to keep making minor adjustments -- a slight funding increase here, a decrease there, a shift of emphasis over there -- in what is fundamentally a flawed and failed policy, said LEAP's Franklin.

"The chorus of voices calling for a real debate on ending prohibition is growing louder all the time," said Franklin. "President Obama keeps saying he is open to a discussion but he never seems willing to actually have that discussion. The time for real change is now. This prohibition strategy hasn't worked in the past and it cannot work in the future. Latin American leaders know it, and President Obama must know it. Let's stop the charade and begin to bring drugs under control through legalization."

Washington, DC
United States

Most of North Carolina Grand Jury's Cases Are Drugs

A Pitt County (Greenville), North Carolina, grand jury offered up a batch of indictments on April 9 that suggest that the war on drugs is generating most of the criminal justice system activity in the county. This snapshot offers a revealing glance at just what law enforcement and prosecutors are spending their resources on, at least with this grand jury.

City Hall, Greenville (wikimedia.org)
Grand juries are empanelled by local prosecutors to bring charges when prosecutors believe they have evidence a person can be charged with a crime. Grand jury indictments are a strong indicator of law enforcement and prosecutorial priorities.

Overall, the April grand jury indicted 37 people felony charges. Only two were for violent offenses, both of which were assaults with a deadly weapon. Another two people were indicted for child sex offenses.

One person was indicted for possession of a stolen firearm and carrying a concealed weapon, one for obstruction of justice, one for breaking and entering, and four more for various theft offenses (obtaining property under false pretenses, larceny by an employee, larceny of a merchant, financial card theft).

Overall, 15 people were indicted on non-drug offenses. But 22 were indicted in cases where drugs were the leading charge, and eight of them were indicted for possession of marijuana with the intent to sell and deliver. That's 22% of all the indictments, or nearly one-quarter of the grand jury's business.

Another four people were charged with possession of cocaine with intent to sell and deliver, three people were charged with trafficking heroin/opium, three with trafficking a Schedule II controlled substance (pain pills), two with conspiracy to traffic cocaine, one with possession of cocaine, and one with attempting to obtain a controlled substance by fraud.

Drug possession or sales cases thus accounted for a whopping 60% of all indictments by the April 9 grand jury. If drug possession and sales were not criminal offenses, police and prosecutors could use those resources elsewhere, or elected officials could decide that police and prosecutors don't need as many resources and reallocate those taxpayer dollars to more fruitful ventures. Or they could lower taxes.

Greenville, NC
United States

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