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Does Kratom Kill? [FEATURE]

Kratom, an herbal drug derived from a Southeast Asian tree that acts somewhat like an opioid, has become increasingly popular in recent years. Hundreds of thousands of people use it for energy and pain relief in small doses and as a substitute for or to get off of opioids such as heroin or prescription pain pills in larger doses.

kratom capsules (Creative Commons)
It is legal under federal law, although even though the DEA announced in 2016 it planned to criminalize it by placing it on Schedule I of the Controlled Substances Act -- a move it was forced to walk back following a loud public outcry. It is currently available online, as well as retail outlets across the country -- except in Alabama, Arkansas, Indiana, Tennessee, Vermont, Wisconsin and the District of Columbia, all of which have criminalized it at the state or municipal level.

With the DEA out of the way, the Food and Drug Administration (FDA) took up the regulatory mantle, issuing various recalls for contaminated kratom products and attempting to rein in the booming kratom market. In November 2017, the FDA issued a hair-on-fire press release about the "deadly risks" of kratom use, warning that some 36 deaths nationwide were "associated" with the Southeast Asian herb. In March 2018, the FDA revised the number of deaths "associated" with kratom to 44.

Those numbers were savaged by the American Kratom Association, representing both users and sellers, in a policy report released in response to the FDA claims. That report examined the 33 cases for which information was available and found that the vast majority of them involved the use of multiple drugs, and in none of the cases was kratom shown to actually be responsible for the death.

For example, one case cited by the FDA involved an individual who drank alcohol, smoked heroin and took Xanax and Narco as well as kratom on the evening of his death. In another case cited by the FDA, the cause of death was not even an overdose but the suicide by hanging by a person with alcohol and benzodiazepines in his system, as well as a history of mental health issues.

In yet another case the FDA called kratom-related, the victim was a 300-pound man who died of pulmonary thromboemboli caused by deep vein thrombosis, who, in addition to having kratom in his system, had also consumed opioids, benzodiazepines, cannabinoids, oxycodone, fluoxetine, norfluxoetine, trazodone, alprazolam, nordiazepan, and gabapentin.

"None of the case reports released to date support the evidentiary standard required by the CSA to prove there is a risk to the public health that relies primarily on the FDA claim of ‘numerous deaths associated with kratom,'" concluded report author Jane Babin.

Now, new research reported in a January 2 letter in the New England Journal of Medicine casts further doubt on the FDA's contentions about dangerousness. In that study, researchers at the University of Colorado examined 15 kratom-related deaths in the state and found that in all but one other opioids were present.

"When cases are considered kratom-only deaths, there really should be additional testing done, because in all of the cases we examined, we found other drugs involved when we did more comprehensive testing," said lead researcher Dr. Andrew Monte, an associate professor of emergency medicine.

Although the evidence that kratom is a killer is weak, Monte told it likely increases the risk of overdose when mixed with other drugs, but not when used alone. That led him to support a ban on the drug, although he acknowledged it could help people trying to get off opioids.

"It's probably worth examining what therapeutic role this may have," he said. "This may be a very good, reasonable option for opioid withdrawal for some patients."

In the meantime, hundreds of thousands of Americans are deciding for themselves that it works for them.

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

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

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

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

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

Heroin and Prescription Opioids

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

Harm Reduction

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

International

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

Chronicle AM: AZ Groups Want Needle Exchange, DE Judge Rules for Fired MedMJ User, More... (12/24/18)

A Delaware judge says a medical marijuana user fired for failing a drug test can sue his former employer, Arizona public health advocates want the governor to approve needle exchanges, and more.

Marijuana Policy

Incoming House Rules Committee Chairman Becomes Cosponsor of Marijuana Justice Act. What a difference an election makes! Outgoing House Rules Committee Chair Pete Sessions (R-TX) reliably blocked any marijuana reform legislation, but things are going to be different under incoming Chair Jim McGovern (D-MA). McGovern has already said he is "not going to block marijuana amendments like my predecessor has done," and now he has just signed on as a cosponsor of the Marijuana Justice Act (HR 4815).

Indiana Governor Not Down With Marijuana Legalization. Gov. Eric Holcomb (R) has made it clear he will oppose any legislative moves to legalize marijuana. "I'm just not willing to look at that, especially since it is illegal right now according to the federal government," Holcomb said.

South Dakota Marijuana Legalization Initiative Filed. Attorney General Marty Jackley (R) has filed a statement on the language of an initiative to legalize marijuana, the first step in the process of getting the measure on the ballot. According to the attorney general's statement, the measure would allow anyone 21 and over to grow, possess, use, and sell marijuana. Localities would be barred from taxing or regulating marijuana businesses. And, the attorney general says, "it forbids prosecutions for driving under the influence of ingested marijuana," but the language of the initiative only bars prosecution for "consumed cannabis metabolites."

Medical Marijuana

Delaware Judge Rules Fired Medical Marijuana User Can Sue Former Employer. A factory worker fired from his job after failing a drug test can sue his former employer, Superior Court Judge Noel Primos ruled on Monday. Jeremiah Chance claims his firing violated the anti-discrimination provision of the state's medical marijuana law and that he was targeted for retaliation after pointing out safety issues with railroad ties manufactured by the Kraft Heinze plant in Dover. The company had argued that the anti-discrimination clause was preempted by the federal Controlled Substances Act, but the judge disagreed. The law does "not require employers to participate in an illegal activity... but instead merely prohibits them from discriminating based upon medical marijuana use," Primos wrote.

Oregon to Allow Medical Marijuana Deliveries in Areas That Ban Dispensaries. State regulators have approved medical marijuana deliveries in areas where dispensaries are banned effective December 28. The rules were approved last week after patient advocates voiced concern about rules that limited access to medical marijuana.

Drug Testing

Utah Bill Would Criminalize Using Fake Urine to Pass Drug Tests. Under a bill already approved by an interim legislative committee, it would be "a criminal offense to distribute, possess, or sell an adulterant or synthetic urine;" or "to defraud an alcohol or drug test using an adulterant, bodily fluid of another person, or bodily fluid expelled or withdrawn before collection for the test." The measure would make violations a misdemeanor.

Harm Reduction

Arizona Public Health Advocates Urge Governor to Legalize Needle Exchange Programs. In a letter delivered last week to Gov. Doug Ducey (R), more than 30 organizations involved in public health and addiction recovery called on him move to legalize the proven harm reduction intervention. "Arizona has fallen behind in its response to this national crisis, states like North Carolina, Indiana, and Kentucky have all implemented syringe service legislation and are seeing the benefits in their communities," the letter says. "Too many lives are on the line to continue with the status quo."

Chronicle AM: AK OKs Pot Social Clubs, Vancouver Ponders "Safe Supply" of Hard Drugs, More... (12/21/18)

Vancouver ponders another cutting-edge drug policy move, Alaska okays on-site pot consumption space rules, the president signs the farm bill legalizing hemp, and more.

From Amsterdam to Alaska? Dutch-style on-site consumption spaces win approval in Juneau. (Creative Commons)
Marijuana Policy

Alaska Approves Rules for On-Site Marijuana Consumption. The state's Marijuana Control Board on Thursday approved rules for businesses that want to offer on-site consumption of pot products. Now, businesses that want in will have to apply for a special onsite use endorsement and come up with plans for meeting ventilation and other standards for on-site use. This makes Alaska the first state to develop a regulatory framework for on-site use at the state level.

Medical Marijuana

FDA Begins Process of Allowing Hemp-Based CBD Products. After President Trump signed the 2018 farm bill into law Thursday, the Food and Drug Administration (FDA) issued a press release pledging to pursue means of allowing businesses to legally market products containing hemp or non-psychoactive cannabinoids, such as CBD. FDA also asserted its right to regulate such products. "In view of the proliferation of products containing cannabis or cannabis-derived substances, the FDA will advance new steps to better define our public health obligations in this area," FDA Commissioner Scott Gottlieb said. "We'll also continue to closely scrutinize products that could pose risks to consumers."

Industrial Hemp

Trump Signs Farm Bill, Final Step to Making Hemp Legal. President Trump signed the 2018 farm bill into law Thursday, the final step in the legalization of hemp. The hemp provision of the farm bill, championed by Senate Majority Leader Mitch McConnell (R-KY), received bipartisan support and now ends a ban going back more than seven decades.

Drug Testing

Federal Appeals Court Upholds Florida School District's Suspicionless Drug Testing of Substitute Teachers. A three-judge panel of the 11th US Circuit Court of Appeals has rejected a constitutional challenge to the Palm Beach County School Board's policy requiring substitute teachers to undergo suspicionless drug testing. Federal courts have generally held drug testing to be a search under the Fourth Amendment and barred drug testing by government entities, but have carved out exceptions for students, people involved in safety-sensitive positions, and law enforcement personnel. Although this case doesn't appear to fall into any of those categories, the appeals court nonetheless ruled in the district's favor. "We think that the School Board has a sufficiently compelling interest in screening its prospective teachers to justify this invasion of the privacy rights of job applicants, and thus conclude that the School Board has not violated the constitutional mandate barring unreasonable searches and seizures," said the 54-page opinion, written by Judge Stanley Marcus and joined by Chief Judge Ed Carnes and Judge David Ebel. "As we see it, ensuring the safety of millions of schoolchildren in the mandatory supervision and care of the state, and ensuring and impressing a drug-free environment in our classrooms, are compelling concerns."

International

Vancouver Looks to Pioneer "Safe Supply" for Hard Drug Users. The city council met Thursday to discuss the Mayor's Overdose Emergency Task Force report and how and whether to implement its 23 specific recommendations for action. One key recommendation is to find a location in or near the epicenter of the city's Downtown Eastside hard drug scene for "a clinical space where we could evaluate and enroll people" for a "low-barrier dispersal program for pharmaceutical opioids." Supporters are using the phrase "safe supply" to describe the concept aimed at reducing skyrocketing overdose deaths linked to illicit fentanyl.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

4. Marijuana Legalization Advances in the States

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

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

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

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

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

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

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

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

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

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

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

7. Industrial Hemp Becomes Federally Legal

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

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

8. Here Come the 'Shrooms

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

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

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

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

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

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

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

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

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

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

1. Fentanyl -- 18,335

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

2. Heroin -- 15,961

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

3. Cocaine -- 11,316

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

4. Methamphetamine -- 6,762

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

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

6. Oxycodone -- 6,199

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

7. Morphine -- 5,014

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

8. Methadone -- 3,493

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

9. Hydrocodone -- 3,199

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

10. Diazepam -- 2,022

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

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

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

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

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

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

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

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

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

Medical Marijuana

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

Industrial Hemp

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

Opioids

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

International

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Chronicle AM: Feds Warn on Denver Safe Injection Site, It's J-Day in Michigan, More... (12/6/18)

Michigan became the first legal marijuana state in the Midwest today, the feds send a shot across the bow of an effort to get a safe injection site up and running in Denver, cartel violence challenges Mexico's new president, and more.

[Errata: This article initially reported incorrectly that driving under the influence of marijuana under MIchigan's legalization law would result in a ticket. DUI remains a felony in Michigan.]

Today Michigan becomes the first legal marijuana state in the Midwest.
Marijuana Policy

Michigan Marijuana Legalization Now in Effect. As of today, it is legal to possess up to 2.5 ounces of marijuana and grow up to 12 plants in Michigan. There is no public smoking allowed and driving under the influence remains a crime. The state's system of taxed and regulated marijuana sales, however, is not expected to be up and running until 2020. [This article initially reported incorrectly that marijuana DUIs would result in getting a ticket. DUI remains a felony in Michigan.]

New Yorkers Want to Legalize Marijuana to Fix the Subway. Lawmakers are eyeing legal marijuana tax revenues as a means of helping to modernize New York City's subway system. Subway officials say they'll need $40 billion to upgrade, and legal weed could help. "The biggest issue we hear about as elected officials is the state of the subway system," said Corey Johnson, the New York City Council speaker. "To be able to tie these things together is something that could be highly impactful and potentially transformative."

Harm Reduction

Denver DEA, US Attorney Warn City on Safe Injection Sites. As city and county officials move toward establishing a safe injection site for drug users, representatives of the federal government are warning that they are illegal and anyone involved could be looking at years in federal prison. In a joint statement, the feds were blunt: "Foremost, the operation of such sites is illegal under federal law. 21 U.S.C. Sec. 856 prohibits the maintaining of any premises for the purpose of using any controlled substance. Potential penalties include forfeiture of the property, criminal fines, civil monetary penalties up to $250,000, and imprisonment up to 20 years in jail for anyone that knowingly opens, leases, rents, maintains, or anyone that manages or controls and knowingly and intentionally makes available such premises for use (whether compensated or otherwise). Other federal laws likely apply as well." The feds also argued that safe injection sites don't actually produce claimed harm reduction benefits and that "these facilities will actually increase public safety risks" by "attracting drug dealers, sexual predators, and other criminals." Those claims are, at best, debatable.

International

Mexican Cartel Gunmen Kill Six Cops in Deadliest Attack of the AMLO Era. In the deadliest attack since President Andres Manuel Lopez Obrador (AMLO) took office last Saturday, gunmen of the Jalisco New Generation Cartel attacked police transporting a prisoner in Jalisco state, leaving six police officers dead. The attackers came in three vehicles and escaped, setting up roadblocks of burning vehicles they had commandeered. AMLO came into office pledging to quell widespread cartel violence.

Chronicle AM: Denver to Expunge Pot Convictions, Columnist Calls for Prescription Heroin, More... (12/5/18)

 A Washington Post columnist calls for prescription heroin, the federal hemp bill will apparently ban the participation of people with drug felonies, Denver joins the movement to expunge old pot convictions, and more.

Prescription heroin--Washington Post columnist suggests it could save lives in the face of fentanyl. (Creative Commons)
Marijuana Policy

Denver Becomes Latest City to Expunge Low-Level Marijuana Offenses. Mayor Michael Hancock announced Tuesday that his administration will "move to vacate low-level marijuana convictions for Denver residents." The move comes after months of preliminary work by the Office of Marijuana Policy and the City Attorney's Office. "For too long, the lives of low-income residents and those living in our communities of color have been negatively affected by low-level marijuana convictions," Hancock said in a press release. "This is an injustice that needs to be corrected, and we are going to provide a pathway to move on from an era of marijuana prohibition that has impacted the lives of thousands of people."

Industrial Hemp

Federal Bill to Legalize Hemp Bans Drug Felons from Participating. Congressional negotiators have agreed on compromise language for the hemp provision of the farm bill that would ban people with felony drug convictions from participating in the hemp industry. The ban was inserted into the Senate version of the bill late in the process and over the objections of drug policy reformers. It's not quite a done deal—the language could be changed in conference committee—but at this point, it looks like the ban is in.

Heroin and Prescription Opioids

Washington Post Columnist Calls for Prescription Heroin. In a piece published Tuesday, Washington Post columnist Megan McArdle has called for access to prescription heroin in a bid to prevent fentanyl-related overdose deaths. In the column titled An Incredibly Unpopular Idea That Could Stem Heroin Deaths, McArdle notes that "most people don't want addiction made safer or easier; they want it stopped, cold…but you don’t free slaves by killing them, and as long as fentanyl suffuses the illicit drug markets, that’s what a 'tough love' policy amounts to." Harm reduction measures and increased access to treatment would help, McArdle writes, but "lowering the death toll may well require a more drastic step: legalizing prescriptions of stronger opiates. Prescription heroin? Remember, I said you might not like the solution. I don’t like it, either — and frankly, neither do the drug policy researchers who told me it may be necessary. But when fentanyl took over the U.S. illicit drug markets, it also got a lot of addicts as hostages. We’ll never be able to rescue them unless we can first keep them alive long enough to be saved."

Asset Forfeiture

Nashville Bends to Police Pressure, Extends Federal "Equitable Sharing" Program. Under pressure from local law enforcement and seeking to avoid raising taxes, the Nashville Metro Council voted 25-5 to renew its participation in the federal asset forfeiture equitable sharing program, which allows state and local law enforcement agencies to divert drug-related cash seizures to the federal government, which in turn returns 80% of the booty back to the seizing agency. 

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