Overdose Prevention

RSS Feed for this category

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Chronicle AM: St. Louis Ends Small MJ Prosecutions, House Passes Opioid Package, More... (6/13/18)

St. Louis prosecutors will no longer go after people with less than 100 grams of marijuana, a Delaware legislator amends her legalization bill to address concerns, the House passes an opioid package, the Canadian federal government rejects some Senate marijuana amendments, and more.

Marijuana Policy

Delaware Legalization Bill Amended. State Rep. Helene Keeley (D-Wilmington) has filed an amendment to her legalization bill, House Bill 110, aimed at addressing concerns around regulations and public safety. The amendment would more tightly regulate legal marijuana production and distribution and prohibit products that look like candy or cartoon characters. The amendment also clarifies employer protections and sets aside 10% of tax revenues to pay for drugged driving enforcement. The bill has already passed committee votes and now awaits a House floor vote.

St. Louis Ends Marijuana Prosecutions for Less Than 100 Grams. St. Louis Circuit Attorney Kim Gardner announced Tuesday that her office will stop prosecuting marijuana possession cases involving less than 3 ½ ounces (100 grams) of the weed. "Effective immediately we will no longer issue possession of marijuana cases under 100 grams as the lead charge!" Gardner wrote. Gardner said her staff would also begin reviewing and dismissing pending pot cases.

Medical Marijuana

South Carolina Voters Approve Medical Marijuana Question On Democratic Ballot. Voters in the state's Democratic primary overwhelmingly approved a non-binding question asking if they supported passing a law to allow doctors to prescribe marijuana to patients. The question passed with 81% of the vote. While medical marijuana bills have moved in the legislature, none has yet passed.

Heroin and Prescription Opioids

House Passes Package of 25 Bills Addressing Opioid Crisis. The House on Tuesday approved a package of 25 bills that nibble at the edge of the nation's opioid-related public health crisis. The bills range from addressing the disposal of opioid medications after a patient's death to encouraging overdose awareness in hospital emergency rooms to raising awareness of synthetic opioids and more. For a complete list of the bills and what they do, click on the title link.

Harm Reduction

Delaware Law Giving First Responders Immunity from Lawsuits for Administering Opioid Overdose Reversal Drug Goes into Effect. Gov. John Carney (D) on Tuesday signed into law Senate Bill 147, which provides immunity from lawsuits for public safety personnel for trying to save lives by administering Naloxone. Paramedics and police had previously been granted immunity, and laypersons also have immunity under the state's Good Samaritan law. This bill specifies that volunteer firefighters and other emergency responders will also have immunity.

International

Canadian Federal Government Rejects Some Senate Marijuana Legalization Bill Amendments. The federal government has said it accepts some 26 technical proposed amendments to the C-45 legalization bill but rejects amendments to allow provinces to bar home cultivation and prohibit producers from handing out branded merchandise. "We have looked carefully at all of the amendments that have been brought forward and today we respectfully submit to the Senate the amendments that we've accepted, and the ones that we haven't," Health Minister Ginette Petitpas Taylor told reporters Wednesday. Now, it will be up to the Senate to accept the government's position. If not, the legislative haggling could continue for some time.

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

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

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

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

Medical Marijuana

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

Harm Reduction

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

 

 

 

 

International

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

 

 

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

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

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

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

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

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

Medical Marijuana

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

Sentencing

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

International

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

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

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

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

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

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

Medical Marijuana

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

Harm Reduction

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

International

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

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

Chronicle AM: DOJ to Clamp Down on Pain Pills, Sanders Files Opioid Bill, More... (4/18/18)

Maine lawmakers pass another legal marijuana implementation bill, this time with veto-proof majorities; the Justice Department eyes a crackdown on pain pill production, Bernie Sanders takes aim at opioid makers and distributors, and more.

The Justice Department wants to crack down on pail pill production. And Congress is eyeing action, too. (Wikimedia)
Marijuana Policy

Maine Legislature Passes Legal Marijuana Implementation Bill, Governor Vows Veto. The state Senate on Tuesday approved the bill that would finally allow retail marijuana sales. The bill passed the House earlier and now goes to the desk of Gov. Paul LePage, who has threatened to veto it because it doesn't combine the state's adult use marijuana and medical marijuana regimes. LePage vetoed a similar bill last year. But this time around, the bill passed with enough support to overcome a veto. LePage has 10 days to sign, veto, or let the bill become law without his signature.

Medical Marijuana

Bipartisan Bill to Let VA Study Medical Marijuana Filed. A group of House Democrats and Republicans have filed HR 5520, the VA Medicinal Cannabis Research Act. The bill would clarify that the Veterans Administration has the authority to study medical marijuana and encourages the agency to do so. The bill would require the VA to report regularly to Congress about its progress on medical marijuana research. The bill is being championed by leaders in the House Veterans Affairs Committee and has 34 cosponsors.

Massachusetts High Court Urges Lawmakers to Clarify Law on Home Cultivation. In an opinion in a case of a medical marijuana patient arrested for growing 22 pot plants, the state's Supreme Judicial Court has urged lawmakers to revisit the law around home grows by patients. The law allows patients to grow enough marijuana to create a 60-day supply, defined in the state as 10 ounces. But the justices found the current law problematic and suggested a plant-based limit would be clearer. "Statutory and regulatory clarification would be most beneficial," wrote Justice Scott Kafker in the opinion in the case, Commonwealth vs. Richardson.

Hemp

Oklahoma Hemp Bill Heads to Governor's Desk. The Senate on Tuesday approved House Bill 2913, which would legalize industrial hemp production. The measure has already passed the House, so it now goes to the desk of Gov. Mary Fallin (R).

Heroin and Prescription Opioids

Justice Department Proposes New Regulations to Limit Prescription Opioid Production. Attorney General Jeff Sessions on Tuesday proposed new regulations for how the DEA sets opioid production quotas that could severely limit the amount of pain pills produced. "Under this proposed new rule, if DEA believes that a company's opioids are being diverted for misuse, then they will reduce the amount of opioids that company can make," Sessions said in prepared remarks. The proposed change must still go through the federal rule-making process before going into effect. It will be published in the Federal Register and opened to public comment in coming days.

Bernie Sanders Files Bill to Rein in Big Pharma on Opioids. Sen. Bernie Sanders (I-VT) on Tuesday filed Senate Bill 2961, which would ban drug companies from marketing opioids as non-addictive and fines them 25% of their profits if they violate the rule. The bill also seeks to stop pharmaceutical companies from distributing amounts of opioids "not medically reasonable," in a bid to stop distributors from flooding small towns with pills. "We know that pharmaceutical companies lied about the addictive impacts of opioids they manufactured," Sanders said in a statement. "They knew how dangerous these products were but refused to tell doctors and patients," he said. "Yet, while some of these companies have made billions each year in profits, not one of them has been held fully accountable for its role in an epidemic that is killing tens of thousands of Americans every year."

Harm Reduction

Maine Bill to End Age Restrictions on Naloxone Heads to Governor's Desk. Both houses of the legislature have approved Legislative Document 1892, which ends age restrictions on the opioid overdose reversal drug naloxone. Gov. Paul LePage (R) wants to limit naloxone access without a prescription to people 21 and over and has vetoed other naloxone access bills, but this bill has passed with a veto-proof majority. LePage has 10 days to act.

International

The Bangladeshi Department of Narcotics Control has proposed new drug legislation for the country which includes the use of the death penalty for people caught selling more than 200 grams of methamphetamine. Under current law, the maximum punishment is 15 years in prison. Bangladeshi law already allows the death penalty for some other drug offenses, including heroin trafficking, but its use is actually very rare in the country. The last execution for a drug offense was in 2009.

Culture Shock: American Activists Confront Compassionate Portuguese Drug Policy [FEATURE]

The American activists couldn't wrap their heads around it. Sitting in a dingy office in a nondescript building in central Lisbon, they were being provided a fine-grained explanation of what happens to people caught with small amounts of drugs in Portugal, which decriminalized the possession of personal use amounts of drugs 17 years ago.

partial view of Lisbon, looking toward the Tagus River (Wikimedia)
The activists, having lived the American experience, wanted desperately to know when and how the coercive power of the state kicked in, how the drug users were to be punished for their transgressions, even if they had only been hit with an administrative citation, which is what happens to people caught with small quantities of drugs there.

Nuno Capaz was trying to explain. He is Vice Chairman of the Lisbon Dissuasion Commission, the three-member tribunal set up to handle people caught with drugs. He had to struggle mightily to convince the Americans that it wasn't about punishment, but about personal and public health.

"The first question," he explained, "is whether this person is a recreational user or an addict."

If the person is deemed only a recreational user, he may face a fine or a call to community service. If he is deemed an addict, treatment is recommended -- but not required.

"But what if they don't comply?" one of the activists demanded. "Don't they go to jail then?"

No, they do not. Instead, Capaz patiently explained, they may face sanctions for non-compliance, but those sanctions may be little more than a demand that they regularly present themselves to a hospital or health center for monitoring.

In a later hallway conversation, I asked Capaz about drug users who simply refused to go along or to participate at all. What happens then? I wanted to know.

Capaz shrugged his shoulders. "Nothing," he said. "I tell them to try not to get caught again."

Welcome to Portugal. The country's low-key, non-headline-generating drug policy, based on compassion, public health, and public safety, is a stark contrast with the US, as the mind-boggled response of the activists suggests.

Organized by the Drug Policy Alliance and consisting of members of local and national groups that work with the organization, as well as a handful of journalists, the group spent three days in-country last month seeing what an enlightened drug policy looks like. They met with high government officials directly involved in creating and implementing drug decriminalization, toured drug treatment, harm reduction, and mobile methadone maintenance facilities, and heard from Portuguese drug users and harm reduction workers as well.

The Portuguese Model and Its Accomplishments

They had good reason to go to Portugal. After nearly two decades of drug decriminalization, there is ample evidence that the Portuguese model is working well. Treating drug users like citizens who could possibly use some help instead of like criminals to be locked up is paying off by all the standard metrics -- as well as by not replicating the thuggish and brutal American-style war on drugs, with all the deleterious and corrosive impacts that has on the communities particularly targeted for American drug law enforcement.

Here, according to independent academic researchers, as well as the UN Office on Drugs and Crime and the European Monitoring Center of Drugs and Drug Abuse, is what the Portuguese have accomplished:

Drug use has not dramatically increased. Rates of past year and past month drug use have not changed significantly or have actually declined since 2001. And Portugal's drug use rates remain among the lowest in Europe, and well below those in the United States.

Both teen drug use and "problematic" drug use (people who are dependent or who inject drugs) have declined.

Drug arrests and incarceration are way down. Drug arrests have dropped by 60% (selling drugs remains illegal) and the percentage of prisoners doing time for drug offenses has dropped from 44% to 24%. Meanwhile, the number of people referred to the Dissuasion Commission has remained steady, indicating that no "net-widening" has taken place. And the vast majority of cases that go before the commission are found to be non-problematic drug users and are dismissed without sanction.

More people are receiving drug treatment -- and on demand, not by court order. The number of people receiving drug treatment increased by 60% by 2011, with most of them receiving opiate-substitution therapy (methadone). Treatment is voluntary and largely paid for by the national health system.

Drug overdose deaths are greatly reduced. Some 80 people died of drug overdoses in 2001; that number shrunk to just 16 by 2012. That's an 80% reduction in drug overdose deaths.

Drug injection-related HIV/AIDS infections are greatly reduced. Between 2000 and 2013, the number of new HIV cases shrank from nearly 1,600 to only 78. The number of new AIDS cases declined from 626 to 74.

"We came to the conclusion that the criminal system was not the best suited to deal with this situation," explained Capaz. "The best option should be referring them to treatment, but we do not force or coerce anyone. If they are willing to go, it's because they actually want to, so the success rate is really high. We can surely say that decriminalization does not increase drug usage, and that it does not mean legalizing drugs. It's still illegal to use drugs in Portugal, it's just not considered a crime. It's possible to deal with these users outside the criminal system."

Dr. Joao Goulao, who largely authored the decriminalization law and who is still General Director for Intervention on Addictive Behaviors -- the Portuguese "drug czar" -- pointed to unquantifiable positives resulting from the move: "The biggest effect," he said, "has been to allow the stigma of drug addiction to fall, to let people speak clearly and to pursue professional help without fear."

They Take the Kids! (with them to treatment)

The American activists know all about fear and stigma. And the cultural disconnect -- between a country that treats drug users with compassion and one that seeks to punish them -- was on display again when a smaller group of the activists met with Dr. Miguel Vasconcelos, the head psychologist at the Centro Taipa, a former mental hospital that now serves as the country's largest drug treatment center.

As Dr.Vasconcelos explained the history and practice of drug treatment in Portugal, one of his listeners asked what happened to drug users who were pregnant or had children.

"They take the kids," Vasconcelos said, smiling. But his smile turned to puzzlement as he saw his listeners react with resignation and dismay.

For the Americans, "they take the kids" meant child protective services swooping in to seize custody of the children of drug-using parents while the parents go to jail.

But that's not what Vasconcelos meant. After some back and forth, came clarity: "No, I mean they take the kids with them to treatment."

Once again, the Americans, caught firmly in the mind set of their own punishing society, expected only the worst of the state. But once again, light bulbs came on as they realized it doesn't have to be like that.

Now that cadre of activists is back home, and they are going to begin to try to apply the lessons they learned in their own states and communities. And although they had some abstract understanding of Portuguese drug decriminalization before they came, their experiences with the concrete reality of it should only serve to strengthen their desire to make our own country a little less like a punitive authoritarian state and bit more like Portugal.

Chronicle AM: Opioid 'Scrips Decline in Legal Weed States, Swiss Consider Legal MJ Sales Pilot Program, More... (4/2/18)

Two new studies find that opioid prescriptions and daily doses decline in legal marijuana states, the Swiss are on the verge of a legal marijuana sales pilot program, and more.

Southern California's Coachella music festival will have to allow marijuana, a state judge has ruled. (Flickr/Feverblue)
Marijuana Policy

After States Legalize Weed, Opioid Prescriptions Decline, Studies Find. Two papers published Monday in the JAMA Internal Medicine that analyzed more than five years of Medicare Part D and Medicaid prescription data found that the number of opioid prescription and the daily dose of opioids declined after states legalized marijuana. "In this time when we are so concerned -- rightly so -- about opiate misuse and abuse and the mortality that's occurring, we need to be clear-eyed and use evidence to drive our policies," said W. David Bradford, an economist at the University of Georgia and an author of one of the studies. "If you're interested in giving people options for pain management that don't bring the particular risks that opiates do, states should contemplate turning on dispensary-based cannabis policies."

Medical Marijuana

 

Maryland Senate Committee Approves Medical Marijuana Expansion Bill. The Senate Finance Committee voted last Friday to approve a bill that would increase the number of licenses for medical marijuana growers from 15 to 20 and the number of licenses for processors from 15 to 25 -- largely in a bid to increase minority business ownership in the industry. None of the companies licensed so far has a black owner. House Bill 0002 has already passed the House and now heads for a Senate floor vote.

International

Swiss Legislature Considers Legal Marijuana Sales Pilot Program. The country is the verge of approving a trial program that could allow up to a thousand people to purchase weed legally from government approved establishments. The measure has already passed the lower house with unanimous approval and is now headed to the National Council for final approval. Switzerland decriminalized the possession of small amounts five years ago.

Italy, France in Diplomatic Spat Over Forced Drug Test of Migrant. Armed French border patrol agents used an Italian train station to force a Nigerian passenger to provide a urine sample for a drug test, provoking the Italians to summon the French ambassador for consultations. The Italians said they had launched a "firm protest" and that border cooperation between the two countries was now undermined. France claimed it had the right to use the facility at the train station under a 1990 agreement, but Italy said it had told French authorities last month that the station was now off limits because it was being used by a humanitarian aid group.

Chronicle AM: Govs Seek Fed Help for Opioid Crisis, KY GOP Leader Files Legal MJ Bill, More... (1/18/18)

Governors call for more help with the opioid crisis from the federal government, a Kentucky GOP leader files a marijuana legalization bill, the ACLU of Montana warns an overzealous prosecutor, and more.

The nation's governors want Trump and the Congress to step up on dealing with the opioid crisis. (Wikimedia)
Marijuana Policy

Congressmen Reintroduce Bill to Protect Marijuana from Civil Asset Forfeiture. Reps. Ted Lieu (D-CA) and Justin Amash (R-MI) reintroduced the Stop Civil Asset Forfeiture Funding for Marijuana Suppression Act on Wednesday. The bill would block seized funds from being used to in the DEA's Domestic Cannabis Eradication/Suppression program. This year's version of the bill is not yet available on the congressional website, but the 2015 version is available here.

Kentucky Republican Leader Files Marijuana Legalization Bill. State Sen. Dan Seum (R-Fairdale), a member of the Republican leadership team, filed a marijuana legalization bill on Wednesday. The bill would allow people 21 and over to legally use marijuana, and it would also legalize the production and sales of pot. The measure is Senate Bill 80.

New Jersey Legalization Bid Must Overcome Democratic Wavering. Newly seated Democratic Gov. Phil Murphy vowed to legalize marijuana in his first 100 days in office, but he's going to have to whip some Democratic senators into shape first. At least a half dozen Democratic senators say they plan to vote against any legalization bill. The state Senate has 40 seats; the Democrats hold 25 of them. If all six Democrats actually vote no, that means passage would depend on at least two Republicans voting yes. There are two GOP senators, Chris Brown of Atlantic and Dawn Addiego of Burlington, who have said they are leaning toward supporting the bill.

Wisconsin Democratic Gubernatorial Candidate Would Pardon Marijuana Offenders. A leading contender for the Democratic gubernatorial nomination, former state Democratic Party chairman Matt Flynn, said Wednesday he would pardon all low-level, non-violent marijuana offenders if elected. Flynn has repeatedly called for marijuana legalization in the state.

Medical Marijuana

Georgia Voters Ready for Full-Fledged Medical Marijuana Program, Poll Finds. A new poll from the Atlanta Journal-Constitution finds that more than three-quarters of those surveyed want to see the state's limited medical marijuana program expanded. Some 77% said they want greater access to medical marijuana. The poll comes as the legislature considers a measure, House Bill 645, that would allow for medical marijuana dispensaries. The poll also found that support for recreational marijuana was at an all-time high in the state, with 50% saying legalize it.

Heroin and Prescription Opioids

Governors Call on Trump, Congress to Do More to Solve Opioid Crisis. In its first coordinated response to the opioid crisis, the National Governors Association called Thursday for the administration and Congress to provide more money and coordination to fight against it. "While progress has been made, the consequences of opioid addiction continue reverberating throughout society, devastating families and overwhelming health care providers, law enforcement and social services," the governors said as they released a set of 22 recommendations. Among other suggestions, the governors are calling for increased access to the overdose reversal drug naloxone, increased efforts to block illicit fentanyl shipments into the country, and a requirement that drug prescribers undergo substance abuse training and register to use state prescription monitoring databases.

Law Enforcement

Montana ACLU Vows to Challenge County DA's Crackdown on Pregnant Drug and Alcohol Users The ACLU of Montana said Wednesday it will fight any action by Big Horn County Attorney Jay Harris to arrest or incarcerate pregnant women based on alleged harm to the fetus. Harris announced last week that he would seek protection orders barring pregnant women from using any non-prescribed drugs or alcohol and seek contempt orders and jail for any woman who violates them. The ACLU called Harris's move "an egregious abuse of power" and noted that a similar effort in Ravalli County in 2014 was killed in the courts. "If these reports are accurate, then Big Horn County's 'crackdown' on pregnant women is not only counterproductive, paternalistic and cruel, it is also illegal. If your office actively attempts to enforce such a policy, ACLU is prepared to challenge those actions in Court," the group said in a letter sent to Harris.

Sentencing

New Jersey Enacts Law to Examine Racial and Ethnic Impact of Sentencing Changes. On his last day in office, former New Jersey Governor Chris Christie signed racial and ethnic impact statement legislation this week that will provide an opportunity for lawmakers to address the state's high rate of racial disparity in incarceration. Similar to fiscal or environmental impact statements, racial impact statements provide legislators with a statistical analysis of the projected impact of criminal justice policy changes prior to enactment. Armed with the data analysis, policymakers can make more informed decisions about public safety issues without aggravating existing racial disparities. Four other states -- Connecticut, Iowa, Minnesota, and Oregon -- have similar policies.

Drug War Issues

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