Overdose Prevention

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Chronicle AM: CA Safe Injection Site Blocked for Now, No Toronto Pot Lounges, More... (9/19/17)

The California safe injection bill comes up two votes short of passing this year, Toronto authorities ignore the pleas of pot lounge operators for a place under legalization, Virginia's Democratic attorney general comes out with a plan to fight opioid overdoses, and more.

No safe injection sites for California this year. Maybe next year. (vch.ca)
Marijuana Policy

New Mexico Democratic Gubernatorial Candidates Want to Legalize It; Republicans Not So Much. Three leading Democratic contenders for the party's gubernatorial nomination support legalization, while the sole Republican in the race does not. Democrat Peter DeBenedittis released a statement Monday calling for legalization, prompting Democrats Jeff Apodaca and US Rep. Michelle Lujan Grisham to come out for it as well. The sole Republican, U.S. Rep Steve Pearce opposes legalization, as does one Democrat, state Rep. Joseph Cervantes. But Cervantes noted the he has sponsored legislation reducing penalties for pot possession.

Medical Marijuana

Arkansas Deadline Sees Rush of Applicants for Grower, Distributor Licenses. A Monday deadline for grower and distributor applications saw applicants flood the state office building where the paperwork is delivered. Firm numbers weren't available, but applicants overwhelmed the clerks on duty and faced hours-long waits to get processed.

Heroin and Prescription Opioids

Virginia Attorney General Releases Plan to Fight Opioid Epidemic. State Attorney General Mark Herring (D) on Monday released a plan to address the growing number of deaths caused by the use of heroin, fentanyl, and prescription opioids. Among the proposals: harsher laws for people dealing in fentanyl, enhanced electronic prescription monitoring, requiring health insurers to cover alternative treatments for pain, teaching schoolchildren about opioids beginning in middle school, and an investigation into price gouging by companies selling naloxone. News accounts don't indicate any discussion in Herring's plan of the need to ensure the availability of opioid pain relievers to those patients who do need them, nor any critical examination of his proposal for increased sentences.

Harm Reduction

California Safe Injection Site Bill Falls Short in State Senate. A bill that would have opened the way to safe injection sites in the state has come up two votes short in the state Senate. The measure, Assembly Bill 186, is not dead, however. Even though the Senate did not vote to pass it, it did vote to reconsider it next year.

International

Toronto Just Says No to Marijuana Lounges. Despite the pleas of pot consumption lounge owners, some of whom have been open for years, the city's municipal standards and licensing committee voted 4-1 to limit marijuana businesses to government-run stores. The committee also voted to increase penalties for businesses that allow on-site consumption. The city is staying within the parameters set by the Ontario provincial government, which recently announced plans for a government monopoly on pot sales.

Lesotho Becomes First African County to Issue Medical Marijuana License. The country's health ministry has licensed a South African company, Verve Dynamics, to manufacture medical marijuana products, marking a first for the continent.

Peru Medical Marijuana Bill Advances. Spurred by a recent raid on a makeshift medical marijuana facility that mothers were using to soothe their sick children, the Peruvian congress is advancing a medical marijuana bill. The bill has now passed the congressional Committee on National Defense and heads to the full Congress for debate and a final vote. President Pablo Kucyzinski has supported the legislation.

Amnesty International Criticizes Indonesia Turn to Harsh Drug War. The government's tough stance against drug dealers is leading to an increasing death toll, the human rights group said. Amnesty's Indonesian affiliate said some 80 people had been killed by police in the drug war so far this year, more than four times as many as last year.

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

Chronicle AM: MA Gov Wants Harsh Sentences for Drug Deaths, More... (8/31/17)

Connecticut continues to grapple with opioids, the Massachusetts governor and cops want mandatory minimums and a possible life sentence for dealers whose clients die, and more.

MA Gov. Baker prefers 20th Century drug war mistakes over 21st century solutions. (mass.gov)
Heroin and Prescription Opioids

Fentanyl Overdoses Now Exceed Heroin Overdoses in Connecticut. The state saw 539 opioid overdose deaths in the first half of this year, and for the first time, more people died using fentanyl than heroin. While 257 people died of heroin overdoses, 322 died of fentanyl overdoses. The state medical examiner's office projects overdose deaths this year will reach 1,100, a 20% increase over last year.

Connecticut Governor Signs Opioid Bill. Gov. Dannel Malloy (D) on Thursday signed into law a bill aimed at slowing the state's opioid epidemic. The bill increases monitoring of opioid prescriptions and requires health insurers to cover inpatient detoxification. The bill passed the legislature unanimously. This is the third year in a row the state has passed bills aimed at the opioid epidemic.

Drug Policy

Massachusetts Governor Wants Harsher Penalties for Drug Deals That Lead to Death. Gov. Charlie Baker (R) has sent a letter to the legislature proposing a bill that would increase sentences for dealers who sold drugs to people who overdosed and died -- up to life in prison. "When illegal drug distribution causes a death, laws that were designed to punish the act are inadequate to recognize the seriousness of the resulting harm," Baker wrote, according to MassLive. "This legislation would provide for a penalty of up to life in prison and, like the offense of manslaughter while driving drunk, would also require a mandatory minimum sentence of at least five years," he added. The bill has the support of law enforcement.

Santa Fe Mayor to Introduce Resolution to Establish A Municipal Drug Strategy Task Force. Javier Gonzalez, the mayor of New Mexico's fourth largest city, will on Thursday introduce a resolution establishing a Municipal Drug Strategy Task Force charged with recommending innovative public health and safety approaches to problematic drug use in the city. "This isn't a problem we can solve by simply declaring a new, top-down policy. It has to be something we take on together, and the strategy has to come from the community. From harm reduction, to law enforcement, to prevention, to treatment, there is a huge range of expertise already developing in Santa Fe, and to find success we will need every one of those voices at the table," said Mayor Gonzales. He added, "So we're doing what we often can do best -- bringing people together."

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

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

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

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

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

Asset Forfeiture

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

Harm Reduction

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

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

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

Marijuana Policy

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

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

Medical Marijuana

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

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

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

Drug Testing

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

Heroin and Prescription Opioids

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

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

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

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

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

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

Medical Marijuana

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

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

Drug Testing

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

Harm Reduction

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

International

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

Chronicle AM: Key MJ Issues Dividing MA Pols, Some Coca Diverted, Says Morales, More... (6/27/17):

Massachusetts lawmakers are slugging it out over what legalization will look like this week, Bolivia's president acknowledges and decries the diversion of coca to the black market, and more.

Evo acknowledges and decries the diversion of Bolivian coca to the black market, and says he enjoys coca flour. (Wikimedia)
Marijuana Policy

Massachusetts Legalization Implementation: What Divides the House and Senate. As legislators work this week to seek compromise between competing legalization implementation bills passed by the House and Senate, six major issues are at play. They are: tax levels (the House wants more), whether localities need to put marijuana bans to a popular vote, expungement of past marijuana convictions (the House doesn't address it; the Senate does), governance structures, safety and packaging regulations, and racial equity provisions.

Virginia Marijuana Driving Law Goes Into Effect on Saturday. A law that ends automatic drivers' license suspensions for marijuana offenders goes into effect Saturday. Instead, judges will have the option of ordering community service instead of license suspension for marijuana offenders who were not behind the wheel when busted.

Heroin and Prescription Opioids

Kentucky Tighter Opioid Prescribing Rules Go Into Effect Friday. A new law restricting the prescribing of Schedule II opioids goes into effect Friday. Under the new law, patients being treated for acute pain will be prescribed no more than a three-day supply, with a number of specified exceptions.

International

Bolivia's Morales Acknowledges, Decries Coca Being Diverted to Black Market. In his closing remarks at last weekend's Coca Fair in Cochabamba, Bolivian President Evo Morales acknowledged and decried the diversion of coca into the cocaine black market. "Unfortunately, part of the coca crop goes to an illegal coca market in the West," Morales said. He also called for continued coca industrialization, saying it would bring economic benefits to Bolivia, and revealed that he consumes coca flour daily. "I'm not ashamed, since last year I have eaten coca flour twice a day, that's how I can build up my stamina," he said.

America, We Can Fix This: 24 Ways to Reduce Opioid Overdoses and Addiction [FEATURE]

Drugs, mainly opioids, are killing Americans at a record rate. The number of drug overdose deaths in the country quadrupled between 1999 and 2010 -- and compared to the numbers we're seeing now, those were the good old days.

Some 30,000 people died of drug overdoses in 2010. According to a new estimate from the New York Times, double that number died last year. And the rate of increase in overdose deaths was growing, up a stunning 19% over 2015.

The Times' estimate of between 59,000 and 65,000 drug overdose deaths last year is greater than the number of American soldiers killed during the entire Vietnam War, greater than that number of people killed in the peak year for car crash deaths, greater than the number of people who died in the year the AIDS epidemic peaked, and higher than the peak year for gun deaths.

In the first decade of the century, overdoses and addiction rose in conjunction with a dramatic increase in prescription opioid prescribing; since then, as government agents and medical professionals alike sought to tamp down prescribing of opioids, the overdose wave has continued, now with most opioid OD fatalities linked to illicit heroin and powerful black market synthetic opioids, such as fentanyl and carfentanil.

The Centers for Disease Control and Prevention says we are in the midst of "the worst drug overdose epidemic in history," and it's hard to argue with that.

So, what do we do about it? Despite decades of failure and unintended consequences, the prohibitionist reflex is still strong. Calls for more punitive laws, tougher prosecutorial stances, and harsher sentences ring out from state houses across the land to the White House. But tough drug war policies haven't worked. The fact that the overdose and addiction epidemic is taking place under a prohibition regime should make that self-evident.

More enlightened -- and effective -- approaches are now being tried, in part, no doubt, because today's opioid epidemic is disproportionately affecting white, middle class people and not the inner city black people identified with heroin epidemics of the past. But they are also being tried because for the past quarter-century an ever-growing drug reform movement has articulated the failures of prohibition and illuminated more effective alternatives.

The drug reform movement's most powerful organization, the Drug Policy Alliance, this spring published A Public Health and Safety Approach to Problematic Opioid Use and Overdose, which lays out more than two dozen specific policy prescriptions in the realms of addiction treatment, harm reduction, prevention, and criminal justice that have been proven to save lives and reduce dependency on opioids. These policy prescriptions are doable now -- and some are being implemented in some fashion in some places -- but require that political decisions be made, or that forces be mobilized to get those decisions made. Some would require a radical divergence from the orthodoxies of drug prohibition, but that's a small price to pay given the mounting death toll.

Here are 24 concrete policy proposals that can save lives and reduce addiction right now. All the facts and figures are fully documented in the heavily-annotated original. Consult it if you want to get down to the nitty-gritty. In the meantime:

Addiction Treatment

1. Create Expert Panel on Treatment Needs: States should establish an expert panel to address effective treatment needs and opportunities. The expert panel should evaluate barriers to existing treatment options and make recommendations to the state legislature on removing unnecessary impediments to accessing effective treatment on demand. Moreover, the panel should determine where gaps in treatment exist and make recommendations to provide additional types of effective treatment and increased access points to treatment (such as hospital-based on demand addiction treatment). The expert panel must also set evidence-based standards of care and identify the essential components of effective treatment and recovery services to be included in licensed facilities, especially with regards to medication-assisted treatment, admission requirements, discharge, continuity of care and/or after-care, pain management, treatment programming, integration of medical and mental health services, and provision of or referrals to harm reduction services. The expert panel should identify how to improve or create referral mechanisms and treatment linkages across various healthcare and other providers. The panel should establish clear outcome measures and a system for evaluating how well providers meet the scientific requirements the panel sets. And, finally, the expert panel should evaluate opportunities under the ACA to expand coverage for treatment.

2. Increase Insurance Coverage for Medication-Assited Treatment (MAT): Seventeen state medical plans under the Patient Protection and Affordable Care Act (ACA) do not provide coverage for methadone or buprenorphine for opioid dependence. Moreover, the Veterans Administration's (VA's) insurance system has explicitly prohibited coverage of methadone and buprenorphine treatment for active duty personnel or for veterans in the process of transitioning from Department of Defense care. As a result, veterans obtaining care through the VA are denied effective treatment for opioid dependence. Insurance coverage for these critical medications should be standard practice.

3. Establish and Implement Office-Based Opioid Treatment for Methadone: Currently, with a few exceptions, methadone for the treatment of opioid dependence is only available through a highly regulated and widely stigmatized system of Opioid Treatment Programs (OTPs). Moreover, several states have imposed moratoriums on establishing new OTPs that facilitate methadone treatment despite large, unmet treatment needs for a growing opioid-dependent population. Patients enrolled in methadone treatment in many communities are often limited to visiting a single OTP and face other inconveniences that make adherence to treatment more difficult. Initial trials have suggested that methadone can be effectively delivered in office-based settings and that, with training, physicians would be willing to prescribe methadone to their patients to treat their opioid dependence. Office-based methadone may help reduce the stigma associated with methadone delivered in OTPs as well as provide a critical window of intervention to address medical and psychiatric conditions. Office-based opioid treatment programs offering methadone have been implemented in California, Connecticut, and Vermont.

4. Provide MAT in Criminal Justice Settings, Including Jails/Prisons and Drug Courts: Individuals recently released from correctional settings are up to 130 times more likely to die of an overdose than the general population, particularly in the immediate two weeks after release. Given that approximately one quarter of people incarcerated in jails and prisons are opioid-dependent, initiating MAT behind bars should be a widespread, standard practice as a part of a comprehensive plan to reduce risk of opioid fatality. Jails should be mandated to continue MAT for those who received it in the community and to assess and initiate new patients in treatment. Prisons should initiate methadone or buprenorphine prior to release, with a referral to a community-based clinic or provider upon release. In addition, drug courts should be mandated to offer participants the option to participate in MAT if they are not already enrolled, make arrangements for their treatment, and should not be permitted to make discontinuation of MAT a criterion for successful completion of drug court programs. The Substance Abuse and Mental Health Services Administration will no longer provide federal funding to drug courts that deny the use of MAT when made available to the client under the care of a physician and pursuant to a valid prescription. The National Association of Drug Court Professionals agrees: "No drug court should prohibit the use of MAT for participants deemed appropriate and in need of an addiction medication."

Medication-Assisted Treatment (MAT) can help.
5. Offer Hospital-Based MAT: Emergency departments should be mandated to inform patients about MAT and offer buprenorphine to those patients that visit emergency rooms and have an underlying opioid use disorder, with an appointment for continued treatment with physicians in the community. Hospitals should also offer MAT within the inpatient setting, and start MAT prior to discharge with community referrals for ongoing MAT.

6. Assess Barriers to Accessing MAT to Increase Access to Methadone and Buprenorphine: A number of known barriers prevent MAT from being as widely accessible as it should be. The federal government needs to reevaluate the need for and effectiveness of the OTP model and make necessary modifications to ensure improved and increased access to methadone. And, while federal law allows physicians to become eligible to prescribe buprenorphine for the treatment of opioid dependence, it arbitrarily caps the number of opioid patients a physician can treat with buprenorphine at any one time to 30 through the first year following certification, expandable to up to potentially 200 patients thereafter. Moreover, states need to evaluate additional barriers created by state law, including, among others, training and continuing education requirements, restrictions on nurse practitioners, insurance enrollment and reimbursement, and lack of provider incentives.

7. Establish and Implement a Heroin-Assisted Treatment Pilot Program: Heroin-assisted treatment (HAT) refers to the administering or dispensing of pharmaceutical-grade heroin to a small and previously unresponsive group of chronic heroin users under the supervision of a doctor in a specialized clinic. The heroin is required to be consumed on-site, under the watchful eye of trained professionals. This enables providers to ensure that the drug is not diverted, and allows staff to intervene in the event of overdose or other adverse reaction. Permanent HAT programs have been established in the United Kingdom, Switzerland, the Netherlands, Germany and Denmark, with additional trial programs having been completed or currently taking place in Spain, Belgium and Canada. Findings from randomized controlled studies in these countries have yielded unanimously positive results, including: 1) HAT reduces drug use; 2) retention rates in HAT surpass those of conventional treatment; 3) HAT can be a stepping stone to other treatments and even abstinence; 4) HAT improves health, social functioning, and quality of life; 5) HAT does not pose nuisance or other neighborhood concerns; 6) HAT reduces crime; 7) HAT can reduce the black market for heroin; and, 8) HAT is cost-effective (cost-savings from the benefits attributable to the program far outweigh the cost of program operation over the long-run). States should consider permitting the establishment and implementation of a HAT pilot program. Nevada and Maryland have introduced legislation of this nature and the New Mexico Legislature recently convened a joint committee hearing to query experts about this strategy.

8. Evaluate the Use of Cannabis to Decrease Reliance on Prescription Opioids and Reduce Opioid Overdose Deaths: Medical use of marijuana can be an effective adjunct to or substitute for opioids in the treatment of chronic pain. Research published last year found 80 percent of medical cannabis users reported substituting cannabis for prescribed medications, particularly among patients with pain-related conditions. Another important recent study reported that cannabis treatment "may allow for opioid treatment at lower doses with fewer [patient] side effects." The result of substituting marijuana, a drug with less side effects and potential for abuse, has had profound harm reduction impacts. The Journal of the American Medical Association, for instance, documents a relationship between medical marijuana laws and a significant reduction in opioid overdose fatalities: "[s]tates with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws."Another working paper from the RAND BING Center for Health Economics notes that "states permitting medical cannabis dispensaries experienced a 15 to 35 percent decrease in substance abuse admissions and opiate overdose deaths." There is also some emerging evidence that marijuana has the potential to treat opioid addiction, but additional research is needed.

Harm Reduction

9. Establish and Implement Safe Drug Consumption Services: States and/or municipalities should permit the establishment and implementation of safe drug consumption services through local health departments and/or community-based organizations. California and Maryland have introduced legislation to establish safe drug consumption services, and the City of Ithaca, New York has included a proposal for a supervised injection site in their widely-publicized municipal drug strategy. In Washington State, the King County Heroin an Prescription Opiate Addiction Task Force has recommended the establishment of at least two pilot supervised consumption sites as part of a community health engagement program designed to reduce stigma and "decrease risks associated with substance use disorder and promote improved health outcomes" in the region that includes the cities of Seattle, Renton and Auburn.

10. Maximize Naloxone Access Points, Including Lay Distribution and Pharmacy Access, As Well As Immunities for Prescription, Distribution and Administration:Naloxone should be available directly from a physician to either a patient or to a family member, friend, or other person in a position to assist in an overdose, from community-based organizations through lay distribution or standing order laws, and from pharmacies behind-the-counter without a prescription through standing order, collaborative agreement, or standardized protocol laws or regulations. Though some states, including California, New York, Colorado and Vermont, among others, have access to naloxone at each of these critical intervention points, many others only provide naloxone through a standard prescription. Civil and criminal immunities should be provided to prescribers, dispensers and lay administrators at every access point. In addition, all first responders, firefighters and law enforcement should be trained on how to recognize an overdose and be permitted to carry and use naloxone. Naloxone should also be reclassified as an over-the-counter (OTC) medication. Having naloxone available over-the-counter would greatly increase the ability of parents, caregivers, and other bystanders to intervene and provide first aid to a person experiencing an opioid overdose. FDA approval of OTC naloxone is predicated on research that satisfies efficacy and safety data requirements. Pharmaceutical companies, however, have not sought to develop an over-the-counter product.88 Federal funding may be needed to meet FDA approval requirements.

11. Provide Dedicated Funding for Community-Based Naloxone Distribution and Overdose Prevention and Response Education: Few states provide dedicated budget lines to support the cost of naloxone or staffing for community-based opioid overdose prevention programs. The CDC, however, reports that, between 1996 and 2014, these programs trained and equipped more than 152,280 laypeople with naloxone, who have successfully reversed 26,463 opioid overdoses.89 Without additional and dedicated funding, community-based opioid overdose prevention programs will not be able to continue to provide naloxone to all those who need it, and the likelihood of new programs being implemented is slim. A major barrier to naloxone access is its affordability and chronic shortages in market supply, 90 which overdose prevention programs, operating on shoestring budgets, can have a difficult time navigating.

12. Improve Insurance Coverage for Naloxone: Individuals who use heroin and other opioids are often both uninsured and marginalized by the healthcare system.91 States should insure optimal reimbursement rates for naloxone to increase access to those who need it most – users themselves.

Overdose reversal drugs need to be made much more widely available -- and affordable. (health.pa.gov)
13. Provide Naloxone to Additional At-Risk Communities: People exiting detox and other treatment programs as well as periods of incarceration are at particularly high risk for overdose because their tolerance has been substantially decreased. After their period of abstinence, if they relapse and use the same amount, the result is often a deadly overdose. States should require overdose education and offer naloxone to people upon discharge from detox and other drug treatment programs and jails/prisons. The Substance Abuse and Mental Health Services Administration has declared that prescribing or dispensing naloxone is an essential complement to both detoxification services as well as medically supervised withdrawal. Vermont passed legislation making naloxone available to eligible pilot project participants who are transitioning from incarceration back to the community. In addition, there are other programs/studies that provide naloxone to recently released individuals on a limited basis, including in San Francisco, California, King County, Washington and Rhode Island.

14. Encourage Distribution of Naloxone to Patients Receiving Opioids: Physicians should be encouraged to prescribe naloxone to their patients and opioid treatment programs should inform their clients about naloxone, if prescribing or dispensing an opioid to them. Pharmacists should similarly be encouraged to offer naloxone along with all Schedule II opioid prescriptions being filled, for syringe purchases (without concurrent injectable medication), and for all co-prescriptions (within 30 days) of a benzodiazepine (such as Valium™, Xanax™ or Klonopin™) and any opioid medication. The Rhode Island Governor's Overdose Prevention and Intervention Task Force found that offering naloxone to those prescribed a Schedule II opioid or when co-prescribed a benzodiazepine and any opioid would have reached 86% of overdose victims who received a prescription from a pharmacy prior to their death, and could have prevented 58% of all overdose deaths from 2014 to 2015.

15. Expand Good Samaritan Protections: "Good Samaritan" laws provide limited immunity from prosecution for specified drug law violations for people who summon help at the scene of an overdose. But, protection from prosecution is not enough to ensure that people are not too frightened to seek medical help. Other consequences, like arrest, parole or probation violations, and immigration consequences, can be equal barriers to calling 911. States with Good Samaritan laws already on the books should evaluate the protections provided and determine whether expansion of those protections would increase the likelihood that people seek medical assistance.

16. End the Criminalization of Syringe Possession: Syringes should be exempt from state paraphernalia laws in order to provide optimal access to people who inject drugs. Twenty-two states criminalize syringe possession. Thus, even if there is a legal access point, such as pharmacy sales, paraphernalia laws still permit law enforcement to arrest and prosecute individuals in possession of a syringe. Public health and law enforcement authorities should not be working at cross-purposes.

17. Reduce Barriers to Over-The-Counter Syringe Sales and Permit Direct Prescriptions of Syringes: While the non-prescription, over-the-counter sale of syringes is now permitted in all but one U.S. state, access is still unduly restricted.States should evaluate the potential barriers to accessing syringes over-thecounter and implement measures to improve access. Moreover, doctors should be permitted to prescribe syringes directly to their patients, a practice few states currently permit.

18. Authorize and Fund Sterile Syringe Access and Exchange Programs; Increase Programs: States should explicitly authorize and fund sterile syringe access and exchange programs, and states that have already authorized them should evaluate how to increase the number or capacity of programs to ensure all state residents – whether in urban centers or rural communities -- have access to clean syringes, as well as evaluate any possible barriers to access such as unnecessary age restrictions.

19. Provide Free Public, Community-Level Access to Drug Checking Services: Technology exists to test heroin and opioid products for adulterants via GC/MS analysis, but it has so far been unavailable at a public level in the US (aside from a mail-in service run by Ecstasydata.org). Making these services available in the context of a community outreach service or academic study would lower the number of deaths and hospitalizations and also allow for real-time tracking of local drug trends.

Prevention

20. Establish Expert Panel on Opioid Prescribing: Though the CDC has issued guidelines for prescribing opioids for chronic pain, the guidelines are voluntary and are likely to exacerbate disparities in treatment that already exist. Research has shown, for example, that African Americans are less likely than whites to receive opioids for pain even when being treated for the same conditions. Moreover, the CDC guidelines only address prescribing practices for chronic pain, not prescribing practices more broadly. States should accordingly establish an expert panel to undertake an assessment as to whether prescribing practices, such as co-prescriptions for benzodiazepines and opioids or overprescribing of opioids, have contributed to increased rates of opioid dependence, and, if so, the expert panel should develop a plan to address any such linkages as well as any treatment disparities. The plan must account for the potential negative effects of curtailing prescribing practices or swiftly reducing prescription opioid prescribing volume. A task force in Rhode Island found that while changes in opioid supply can have the intended effect of reducing availability of abuse-able medications, they have also been linked to an increase in transition to illicit drug use and in more risky drug use behaviors (e.g., snorting and injecting pain medications). The plan must also account for chronic pain patients, particularly those already underserviced, and not unduly limit their access to necessary medications. Finally, to the extent prescribing guidelines are issued as part of the plan, they should be mandatory and applied across the board.

21. Mandate Medical Provider Education: States should mandate that all health professional degree-granting institutions include curricula on opioid dependence, overdose prevention, medication-assisted treatment, and harm reduction interventions, and that continuing education on these topics be readily available.

22. Develop Comprehensive, Evidence-Based Health, Wellness, and Harm Reduction Curriculum for Youth: State education departments, in conjunction with an expert panel consisting of various stakeholders that ascribe to scientific principles of treatment for youth, should develop a comprehensive, evidence-based health, wellness, and harm reduction curriculum for use in schools that incorporates scientific education on drugs, continuum of use, and contributors to problematic drug use (e.g., coping and resiliency, mental health issues, adverse childhood experiences, traumatic events and crisis), as well as how reduce harm (e.g., not mixing opioids with benzodiazepines). Education departments should also establish protocols and resources for early intervention, counseling, linkage to care, harm reduction resources, and other supports for students.

CRIMINAL JUSTICE

23. Establish Diversion Programs, Including Law Enforcement Assisted Diversion (LEAD): LEAD is a pre-booking diversion program that establishes protocols by which police divert people away from the typical criminal justice route of arrest, charge and conviction into a health-based, harm-reduction focused intensive case management process wherein the individual receives support services ranging from housing and healthcare to drug treatment and mental health services. Municipalities should create and implement LEAD programs and states and the federal government should provide dedicated funding for such programs. Various other forms of diversion programs exist and can be implemented should LEAD prove unsuitable to a particular population or municipality.

24. Decriminalize Drug Possession: Decriminalization is commonly defined as the elimination of criminal penalties for drug possession for personal use. In other words, it means that people who merely use or possess small amounts of drugs are no longer arrested, jailed, prosecuted, imprisoned, put on probation or parole, or saddled with a criminal record. Nearly two dozen countries have taken steps toward decriminalization. Empirical evidence from the international experiences demonstrate that decriminalization does not result in increased use or crime, reduces incidences of HIV/AIDs and overdose, increases the number of people in treatment, and reduces social costs of drug misuse. All criminal penalties for possession of small amounts of controlled substances for personal use should be removed.

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

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

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

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

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

Medical Marijuana

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

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

Harm Reduction

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

Chronicle AM: DEA Wants Prosecutor Corps, ME Gov Wants ODers to Pay for Naloxone, More... (5/4/17)

The DEA proposes its own corps of prosecutors to go after opioids, Maine's governor wants to force repeat overdosers to pay for the naloxone they use, and more.

Medical Marijuana

Colorado Legislature Approves Adding PTSD as Qualifying Condition. A bill to "Allow Medical Marijuana Use for Stress Disorders," Senate Bill 17, was sent to the governor's desk on Monday after the Senate last week approved a final concurrence vote to amendments accepted in the House. Gov. John Hickenlooper (D) is expected to sign it.

New York Assembly Approves PTSD as Qualifying Condition. The Assembly voted overwhelmingly on Tuesday to approve Assembly Bill 7006, sponsored by Health Committee Chairman Dick Gottfried (D-Manhattan), which would add PTSD to the state's list of qualifying conditions for medical marijuana. The bill now heads to the Senate.

Harm Reduction

Maine Governor Wants Repeat Overdosers to Pay for Naloxone Used to Revive Them. Gov. Paul LePage (R) has submitted a bill, Legislative Document 1558, that would require Maine communities to recover the cost of naloxone from repeat users and fine them $1,000 per incident if they don't go after the money. But doctors and advocates said the bill would make it harder to stop the state's wave of drug overdoses. Le Page is no friend of naloxone, saying it "does not truly save lives; it merely extends them until the next overdose." He has twice vetoed naloxone bills, only to see them overridden both times.

Law Enforcement

DEA Wants Own Prosecutor Corps to Go After Opioids. In a little-noticed proposal published in the Federal Register in March, the DEA said it wants to hire as many as 20 prosecutors to help it enhance its resources and target large offenders. The new prosecutor corps "would be permitted to represent the United States in criminal and civil proceedings before the courts and apply for various legal orders." Funding for the program would come from drug manufacturers regulated by the DEA. If approved, the move would mark the first time the DEA had its own dedicated prosecutors to go after drug offenses. But critics say the plan "exceeds DEA's authority under federal law" because it would require funding from the drug diversion registration program. "In this notice, the DEA effectively proposes a power grab and is trying to end-run the congressional appropriations process," said Michael Collins, deputy director at the Drug Policy Alliance.

Chronicle AM: Dr. Bronner's $5 Million for MDMA Research, HRW Says More Naloxone, More... (4/27/17)

FDA-approved research on MDMA and PTSD gets a big monetary bump courtesy of Dr. Bronner's, Human Right Watch condemns the failure to make the opioid overdose reversal drug naloxone more available, a safe injection site bill is moving in California, and more.

Dr. Bronner's CEO (Cosmic Engagement Officer) David Bronner (maps.org)
Industrial Hemp

Nevada Senate Unanimously Approves Hemp Bill. The Senate has approved Senate Bill 396 by a unanimous vote. The bill would expand on existing state law, which allows colleges or the state Agriculture Department to grow hemp for research purposes. This bill would create "a separate program for the growth and cultivation of industrial hemp and produce agricultural hemp seed in this State," allowing the crop to be grown for commercial purposes. The bill now heads to the House.

Ecstasy

Dr. Bronner's Kicks In $5 Million for MDMA PTSD Research. Dr. Bronner's -- the family-owned maker of the popular soap brand -- is donating $5 million over five years to the Multidisciplinary Association for Psychedelic Studies (MAPS) to pursue its FDA-approved Stage 3 studies of the efficacy of MDMA for treating Post Traumatic Stress Disorder (PTSD). The announcement came ahead of last week's MAPS-sponsored psychedelic science conference in Oakland. "There is tremendous suffering and pain that the responsible integration of MDMA for treatment-resistant PTSD will alleviate and heal," said Dr. Bronner's CEO David Bronner. "To help inspire our allies to close the funding gap, my family has pledged $1 million a year for five years -- $5 million total-- by far our largest gift to an NGO partner to date. In part, we were inspired by the incredible example of Ashawna Hailey, former MAPS Board member, who gave MAPS $5 million when she died in 2011."

Drug Policy

Human Rights Watch Report Says US Drug Policy Failures Drive Preventable Drug Overdose Deaths. The US federal and state governments are taking insufficient action to ensure access to the life-saving medication naloxone to reverse opioid overdose, resulting in thousands of preventable deaths, Human Rights Watch said in a report released Thursday. The 48-page report, "A Second Chance: Overdose Prevention, Naloxone, and Human Rights in the United States," identifies federal and state laws and policies that are keeping naloxone out of the hands of people most likely to witness accidental overdoses, denying them the ability to save lives. "The easiest, most effective step that the federal and state governments can take to stem the tide of deaths from opioid overdoses is to make naloxone easier to get," said Megan McLemore, senior health researcher at Human Rights Watch. "Naloxone should be as easy to get as Tylenol. Criminal laws block access to harm reduction programs such as syringe exchanges; the price of the medication is too high; it is not available over the counter -- these and other obstacles are keeping naloxone out of the hands of those who need it the most."

Harm Reduction

California Committee Votes for Supervised Consumption Sites Bill. A bill supported by the Drug Policy Alliance, Assembly Bill 186, passed Assembly Public Safety Committee on Tuesday. It had already been approved by the Assembly Health Committee last month, which marked the first time a US legislative body has ever approved a safe drug consumption site measure. "This is a huge step toward establishing a more effective, treatment-focused approach to drug addiction and abuse in California," said bill sponsor Assemblymember Susan Talamantes Eggman (D-San Joaquin County). "The committee's input has done a great deal to refine the bill since I first introduced it last year, and its support clearly demonstrates the legislature's willingness to consider bold ideas to get people to treatment and counseling, to protect public health and safety and, most importantly, to save lives." The bill now heads for an Assembly floor vote.

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