Poisoned Drug Supply

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Chronicle AM: MA Drug Lab Scandal Redux, PA MJ Support Strong and Rising, More... (9/22/17)

Pennsylvania support for marijuana legalization is strong and rising, Attorney General Sessions mixes drug and immigration policy, another federal court rules against Stingray, a second Massachusetts drug lab scandal could see thousands more cases dismissed, and more.

Massachusetts state drug testing labs continue to generate serious problems -- and thousands of case dismissals. (Wikimedia)
Marijuana Policy

California Will Issue Temporary Business Licenses. Regulators will introduce a temporary marijuana business licensing system to ensure a smooth start to regulated marijuana sales beginning on January 1, the state's top marijuana official announced Thursday. Businesses would only need to provide some "pretty basic information" for the temporary licenses, said Lori Ajax. The application will be available in early December, after temporary rulemaking is completed. "We don't have time to do regular rulemaking," she explained, adding that would come next year.

Pennsylvania Poll Shows Strong, Rising Support for Legalization. A Franklin & Marshall College poll released Thursday has support for marijuana legalization at 59%, with only 31% opposed and 9% undecided. The pro-legalization numbers are the highest ever in the poll, up three points since May and a whopping 19 points since June2015.

Immigration

Sessions Blames Lax Immigration Policies for Drug Gangs, Cartels. Attorney General Jeff Sessions used concerns over drug gangs and cartels to attack "loose" immigration policy in remarks in Boston Thursday. He specifically singled out MS-13 as an example, while failing to note the gang's origins among Salvadoran refugees fleeing a US-sponsored civil war there in the 1980s. He also attacked the Deferred Action for Childhood Arrivals (DACA) program, which offers protections to undocumented residents who were brought to the country as children. "The gangs use this program as a means to recruit members," Sessions said. "We cannot allow young people to be brought into this life of crime." Sessions did not mention that DACA participants are carefully vetted and must have no serious criminal records or that 90% of them are working or in college.

Law Enforcement

DC Court Latest to Rule Against Warrantless Stingray Searches. The DC Court of Appeals ruled Thursday that the warrantless use of a Stingray cell-site stimulator to monitor phone calls was unconstitutional. The ruling was only the latest in a string of recent federal appeals court judgments that ruled using the Stingray amounts to a search under the meaning of the Fourth Amendment. In the DC case, the court found the violation so egregious that it excluded all evidence derived from it, overturning the conviction of Prince Jones on drug charges.

ACLU Calls for Thousands More Massachusetts Drug Cases to Be Thrown Out in Drug Lab Scandals. Bay State judges have already dismissed more than 20,000 drug cases tainted by the misbehavior of state lab chemist Annie Dookhan, but now the ACLU is calling for judges and prosecutors to dismiss thousands more in a second case of lab tech misbehavior. Amherst state lab chemist Sonja Farak pleaded guilty in 2014 to stealing cocaine from the lab and admitted she was high nearly every day from 2004 to 2013 on cocaine, meth, and other stimulant drugs she pilfered from her job. The ACLU charges that prosecutors have sought to minimize Farak's misbehavior in a bid to preserve drug cases and convictions and failed to notify defendants that the evidence in their cases had been tainted. "Far worse than the Hinton scandal, the Amherst scandal combines a lab crisis with prosecutorial misconduct of unparalleled scope and irremediable consequence," the ACLU argued. "This latest systemic lapse in the justice system demands a most emphatic response." And that response would be mass dismissals.

International

Iceland Marijuana Legalization Bill Filed. Members of the Reform Party and the Pirate Party have banded together to file a bill that would legalize marijuana in the North Atlantic island nation. The bill would allow anyone 20 and over to possess and cultivate pot for personal use -- with a government permit. The bill would also allow retail sales and consumption lounges, but not at the same business.

Australia to See First Music Festival With On-Site Pill Testing. The Spilt Milk Festival in Canberra will provide on-site pill testing for attendees in a harm reduction move aimed at reducing overdoses and other bad drug interactions. The Australian Capital Territory government has given the okay for the project, which will be operated by the Safety Testing Advisory Service at Festivals and Events. That consortium consists of Harm Reduction Australia, the Australian Drug Observatory, the Noffs Foundation, DanceWize, and Students for Sensible Drug Policy.

Chronicle AM: Fed Bills Would Shrink CSA Reach, Slow Start to Sessions Drug War, More... (7/31/17)

New federal bills aim to remove state-legal marijuana and industrial hemp from the purview of the Controlled Substances Act, Jeff Sessions' drug war is slow getting off the ground, an Indian minister comes out for medical marijuana, and more.

What's in your Ecstasy? British festivalgoers could find out. (erowid.org)
Marijuana Policy

Federal Bill to Make CSA Inapplicable to Marijuana in Legal Marijuana States Filed. US Rep. Suzan DelBene (D-WA) filed House Resolution 3534 on Friday. The bill would "make the Controlled Substances Act inapplicable with respect to marijuana in states that have legalized marijuana and have in effect a statewide regulatory regime to protect certain Federal interests."

Industrial Hemp

Federal Bill to Exempt Hemp from CSA Filed. Rep. James Comer (R-KY) filed House Resolution 3530 on Friday. The bill would "amend the Controlled Substances Act to exclude industrial hemp from the definition of marihuana."

Drug Policy

Attorney General Sessions' Drug War Hasn't Taken Hold -- Yet. The attorney general has vowed to crack down on drugs, but data released last week show it isn't happening yet. Federal drug prosecutions are at historic lows, with experts pointing to a federal hiring freeze instituted by the Trump administration and the Senate's slow pace on appointing new US attorneys as potential causes. Without having key people in key positions, the Sessions Justice Department must rely on local investigators and prosecutors who may still be operating under Obama-era reforms.

International

Indian Minister Calls for Medical Marijuana Legalization. Indian Minister for Women and Child Development Maneka Gandhi has come out in favor of legalizing medical marijuana. "Marijuana should be legalized for medical purposes, especially as it serves a purpose in [treating] cancer," she said during a ministerial discussion on India's National Drug Demand Reduction. Although cannabis has been part of Indian culture for more than 3,000 years, the country banned it in 1985 under US pressure.

British Festival Allowed Pill Testing. Attendees at the Kendal Calling music festival in Cumbria this past weekend were able to get their pills and powders tested for potency and adulteration without fear of arrest thanks to an on-site lab operated by an NGO. Testers reported finding malaria medication, insecticide and concrete in some of the substances tested. "We accept that some people will get drugs on site and some people will be planning to take them so what we're doing is trying to address any potential health problems," said Professor Fiona Measham, director of the NGO The Loop. "This is a focus on public health rather than on criminal justice."

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: VT Gov Vetoes Legalization Bill, UCSB Ecstasy Pill Testing, More... (5/24/17)

Vermont's bid to be the first state to legalize marijuana through the legislative process gets derailed or at least delayed by the governor, a judge rules a Rhode Island company discriminated against a medical marijuana patient, UC Santa Barbara students start an ecstasy pill-testing program, and more.

What's in your ecstasy tablet? Students at UCSB will be able to find out. (Erowid.org)
Marijuana Policy

Vermont Governor Vetoes Legalization Bill, But Leaves Door Open. Vermont Gov. Phil Scott (R) today vetoed a marijuana legalization bill, ending for now an effort that would have seen the state become the first to legalize pot through the legislative process. But Scott left open a "path forward" for passing the bill later this year, saying that if a handful of changes were made in the bill, he could support it. He said he thought the legislature still has time to incorporate them and pass a revised bill during this summer's veto session.

Medical Marijuana

Florida Judge Backs Issuing Two More Medical Marijuana Licenses. Administrative Law Judge John Van Laningham ordered the state to issue two new licenses to medical marijuana operators. That would boost from seven to nine the number of entities licensed by the state to grow, process, and distribute marijuana to patients.

Missouri Library Sued Over Refusal to Allow Activists to Meet. The ACLU filed a lawsuit Tuesday against the Rolla Public Library charging that it refused to allow a local man to hold a meeting in one of its rooms because he advocates for legalizing medical marijuana. Randy Johnson of New Approach Missouri had sought the room for a training session for initiative signature gatherers, but was unconstitutionally discriminated against because of his political views, the ACLU said.

Rhode Island Judge Rules Company Discriminated Against Medical Marijuana User. A Superior Court judge ruled Tuesday that the Darlington Fabrics Corporation had discriminated against a woman when she was denied an internship because she used medical marijuana to treat her migraine headaches. The company's action violated the state's Hawkins-Slater Medical Marijuana Act, which bars discrimination against registered medical marijuana users.

Drug Testing

Wisconsin Republicans Advance Welfare Drug Testing Plan. The GOP-controlled legislature's Joint Finance Committee voted 12-4 Tuesday to include a provision in the budget that would impose drug screening and testing requirements on some 14,000 parents who apply for Wisconsin Works job programs. A bill that would do the same thing has already passed the Assembly. The state already has similar requirements for four state-run work programs. In those programs, some 1,837 people were screened, 42 of those were referred to drug testing, and nine were referred to drug treatment. That's about one half of one percent.

Harm Reduction

University of California at Santa Barbara Students Roll Out Free Ecstasy Test Kits. UCSB Associated Students Off-Campus Senator Patrick Dohoney and the campus Students for Sensible Drug Policy (SSDP) chapter are providing test kits for students to test their pills for purity and contamination. "Me and a group of students, who are a part of SSDP, wanted to find a way to reduce the amount of drug-related emergencies," Dohoney said. "When people intend to take molly, it is often cut with other drugs, like amphetamines or bath salts. We wanted to make sure that if students decided to use drugs, they could do it in the safest, most responsible way possible."

Chronicle AM: Seattle Safe Injection Site "Die-In," ME MJ Init Vote Recount, More... (12/5/16)

Foes challenging the narrow legalization victory in Maine got their recount going today, patients take to the courts in Arizona and to the streets in Michigan, Seattle health care professionals do a die-in for safe injection sites, Ireland takes another step toward medical marijuana, and more.

Vancouver's safe injection site. Doctors and nurses in Seattle are agitating for something similar there. (vcha.ca)
Marijuana Policy

Maine Legalization Initiative Recount Begins. The Question 1 initiative legalizing marijuana won by less than 1% of the popular vote, garnering 381,692 votes to the opposition's 377,619 votes, a difference of 4,073 votes. Citing the narrow margin of victory, foes called a recount, and it began Monday. The recount could take up to a month, delaying putting legalization into effect until it is completed.

Medical Marijuana

Pair of Arizona Patients Sue Over Fees. Attorneys for patients Yolanda Daniels and Lisa Becker filed suit last Friday to force a reduction in the annual fee for registration cards that patients are legally required to obtain. The state health department is charging $150 a year, even though it has nearly $11.5 million in its medical marijuana account. "In a time when medication is more expensive than ever, the state should be helping to make it cheaper for Arizonans," the patients' attorney argued. "The state is deliberately squatting on the excess fund instead of refunding it to patients or using it in furtherance of the Arizona Medical Marijuana Act, such as to help patients."

Michigan Protestors Denounce Kent County Dispensary Raids. A couple of dozen people gathered outside the Plainfield Township Hall last Friday to protest a series of raids last Monday that shuttered three dispensaries in Plainfield. Demonstrators said they have nowhere to go to get their medicine, but Plainfield officials countered that dispensaries had been banned there since 2011.

Harm Reduction

Seattle Nurses, Doctors Do Die-In at City Hall in Protest Calling for Safe Injection Sites. As Seattle officials ponder whether to move toward allowing a safe injection site, doctors and nurses are turning up the heat. Last Friday, more than 30 members of Health Care Workers for Supervised Consumption Spaces held a die-in at City Hall to imitate the corpses that will be created if safe injection sites aren't allowed. City officials have been generally sympathetic to the idea, and a Seattle/King County opioid task force recommended the move in September.

International

British Town to Allow Drug Testing at Clubs. In a harm reduction first for the United Kingdom, a town in Lancashire will be the first in the country to offer testing of drug samples provided by club-goers at night clubs. The tests will examine samples of cocaine and MDMA to test the strength and purity of the drugs in a bid to reduce deaths related to "adulterated or highly potent" drugs. The National Police Chief's Council reportedly said the scheme could be useful but was still not yet endorsed on a national basis.

Ireland Takes Another Step Toward Medical Marijuana. The Dáil Éireann, the lower house of parliament, last Thursday approved an amendment allowing for the medicinal use of marijuana. But the measure still has to undergo another round of approval before it becomes law.

Poll: More Irish Support Marijuana Legalization Than Not. As the parliament ponders medical marijuana, a new poll finds that more Irish than not support full-blown legalization. A poll asking "Should cannabis be legalized for recreational use?" had 48% saying yes, 41% saying no, and 11% undecided.

Chronicle AM: AAA Slams Per Se Marijuana Drugged Driving Laws, Brit College Hands Out Pill Test Kits, More... (5/10/16)

In a major study, AAA finds no scientific basis for drugged driving laws that assume impairment based on THC levels, Orlando becomes the latest city to downgrade small-time pot possession, the Ohio House approves a medical marijuana bill--but no smoking--an English university begins handing out pill test kits to students, and more.

Pill testing kits distributed by Britain's Newcastle University and its local SSDP chapter. (SSDP Newcastle)
Marijuana Policy

AAA Study: No Scientific Basis for Laws Regulating Marijuana and Driving. A new study from the American Automobile Association's Safety Foundation has found that per se limits (those that base an assumption of impaired driving on a specified level of THC in one's system) are "arbitrary and unsupported by the evidence."  Six states have  per se marijuana impaired driving laws, while nine states have zero tolerance marijuana DUID laws, and the AAA calls for scrapping them. They should be replaced by police officers trained to detect impairment, with a THC test as a back-up, the automobile club said.

Orlando "Decriminalizes" Pot Possession. The city council voted 4-3 Tuesday to adopt a revised measure that makes possession of 20 grams or less of weed a violation of city code. Police officers will have the discretion to issue civil citations instead of arresting violators. The fine is $100 for a first offense, $200 for a second,  and a third offense will generate a mandatory court appearance.  Small-time pot possession remains a misdemeanor under state law.

Medical Marijuana

Ohio House Approves Medical Marijuana Bill. The House voted 71-26 Tuesday to approve a medical marijuana bill, House Bill 523. Patients under a doctor's supervision could use marijuana oils, tinctures, edibles, and vapors, but could not smoke it, nor could they grow their own.  The bill specifies 18 conditions for which medical marijuana could be used and now goes to the Senate.  Meanwhile, activists are working to get a more patient-friendly medical marijuana initiative on the November ballot.

Harm Reduction

Maryland Governor Signs Needle Access Expansion Bill. Gov. Larry Hogan (R) Tuesday signed into law Senate Bill 97, which will allow thousands of Marylanders to access life-saving needle exchange programs.  The bill passed both chambers with overwhelming support. Maryland ranks 2nd nationally in new per capita HIV infections, and needle exchanges are a proven method of reducing and preventing new infections.

International

British University Handing Out Drug Test Kits to Students. In what as described as a first of its kind harm reduction effort, Newcastle University and the local Students for Sensible Drug Policy (SSDP) chapter have joined forces to distribute drug test kits so students can check and see if they drugs they are about to consume are safe or not.  “Although drugs are illegal, statistics suggest lots of young people still use illegal drugs, and that the prevalence of this use is even higher within student communities," said SSDP President Holly Robinson.  “We recognize the safest way to take drugs is not to take drugs but, as some individuals will always choose to take them, we believe it is important to make information and services available to minimise the risks."

Chronicle AM: Thousands of Federal Drug Prisoners to Be Freed, Ohio Early Voting, More (10/6/15)

Major sentencing news today; early voting starts today in Ohio (marijuana legalization is on the ballot), a North Carolina hemp bill has gone to the governor, Colombia will still spray a nasty herbicide on coca crops, and more.

Federal prisons will be a little less crowded a month from now. (nadcp.org)
Marijuana Policy

California Governor Vetoes Law Criminalizing Hash Oil Explosions. Gov. Jerry Brown (D) Monday vetoed Assembly Bill 849, which would have made it a crime to cause an explosion causing bodily harm. The bill was inspired by a series of butane hash oil lab explosions, but in his veto message, Brown said the conduct is already proscribed and another law on the matter "creates increasing complexity without commensurate benefit."

Early Voting Starts Today on Ohio Legalization Initiative. Ohioans can vote for or against Issue 3, the controversial ResponsibleOhio initiative beginning today. Early voters can mail in absentee ballots or visit early-voting locations across the state.

Oregon's Multnomah County (Portland) Issues Report on Legalization. The Multnomah County Health Department has issued a report saying there are drawbacks and benefits from marijuana legalization, but that more research is needed. The report recommends implementing policies to address impaired driving, teen use, and dependence; there should be warnings for pregnant and nursing women, and there should be limits on the potency of pot, as well as on contamination from pesticides and other substances.

Medical Marijuana

Washington State Issues Emergency Medical Marijuana Rules. The state Health Department has just released emergency rules as the state moves to merge medical marijuana into the recreational pot regulatory system. The rules set standards for packaging "High THC compliant products," testing requirements, safe handling, employee training, and labeling. Click on the rules link for all the details.

Hemp

North Carolina Hemp Bill Heads to Governor's Desk. A measure legalizing industrial hemp production has been approved by the state legislature and now heads to the desk of Gov. Pat McCrory (R). The measure is Senate Bill 313. McCrory must veto it to block it; if he fails to act, it is approved.

Heroin and Prescription Opiates

An Overdose an Hour in Chicago Last Week. In the middle of last week, Chicagoans were overdosing on heroin, prescription opiates, or drug combinations at a rate of more than one an hour. Authorities reported responding to 74 overdose calls in 72 hours between last Tuesday and last Friday. ER doctors are suggesting that heroin cut with the powerful opioid fentanyl is behind the outbreak.

Sentencing

Feds to Free 6,000 Drug Prisoners at Month's End, More to Follow. The Justice Department has announced that some 6,000 federal drug war prisoners will get early release from prison between October 30 and November 2. Most will go to halfway houses and home confinement before being freed on supervised release. This is the result of actions by the US Sentencing Commission, which cut sentences for some drug offenders last year and later made the chance retroactive, affecting currently serving inmates. An estimated 46,000 of nearly 100,000 federal drug prisoners should eventually qualify for the program.

International

Colombia Will Continue to Use Glyphosate, Just Won't Aerially Spray It Anymore. Colombian police will continue to use the herbicide glyphosate to eradicate coca plants, even though it won't apply it with aerial sprays, the chief of police said. The National Narcotics Council outlawed aerial spraying earlier this year, after glyphosate was found to contain massive amounts of carcinogens, but eradicators will now spray by hand, Police Chief Rodolfo Palomino said. "We will continue with other forms of manual eradication and land fumigation with glyphosate," said Palomino.

Chronicle AM: WA Gets Big Bucks From First Year Pot Taxes, Synthetic Drugs Now Banned in NH, More (7/6/15)

Marijuana sales tax revenues exceeded expectations in Washington state, New Hampshire bans new synthetics, Colombia's FARC rebels say they're ready to move on implementing drug provisions of the long-negotiated peace plan, and more.

You can't sell or possess this stuff in New Hampshire anymore. (wikipedia.org)
Marijuana Policy

Washington State Collected $70 Million in Marijuana Taxes During Its First Year of Sales. As its first year of legal marijuana sales came to an end, state officials reported that pot sales had generated $70 million in tax revenues and that sales are now topping more than $1.4 million a day. The state had originally forecast it would take in about $36 million in marijuana taxes in the first year. More much at the link.

New Synthetic Drugs

New Hampshire Governor Signs Synthetic Drug Ban Bill. Gov. Maggie Hassan (D) today signed into law Senate Bill 106, which bans the sale and possession of new synthetic drugs. Businesses that sell the drugs could be hit with fines and civil violations, while people caught in possession will have their drugs seized and be hit with a fine. The new law goes into effect immediately.

International

FARC Says It's Ready to Move Forward With Implementing Drug Provisions of Colombia Peace Plan. FARC negotiators in peace talks with the Colombian government said they were ready to agree on procedures necessary for implementing that part of the peace plan. "To establish the basis for building a stable and lasting peace it is necessary, among other things, to find a definitive solution to the problem of illicit drugs, including the cultivation for illicit use and the production and commercialization of illicit drugs. One step in that direction, accompanied by other gestures of de-escalation, which in a short time may lead the parties to definitively suspend armed actions, would not only restore the confidence and credibility of the process but would also put it in a new place, safe from pressures and provocations of its enemies," said a communique read by FARC commander Carlos Antonio Lozada, whose real name is Luis Antonio Losada. The agreement on drugs includes three provisions: crop substitution programs, public health efforts toward prevention, and dealing with drug trafficking.

Call for Ecstasy to Be Sold Over the Counter in Australia. A leading Australian pharmacist and a drug policy expert are calling for ecstasy to be sold legally to make it safer. Pharmacist Joshua Donelly, former chair of the Victoria drug policy drug policy advisory committee, and Professor David Pennington said most of the risks associated with ecstasy are a result of users taking adulterated black market pills. "Australians are one of the highest consumers of MDMA in the world, yet we resolutely resist exploring the fact that most of the uncommon ill consequences of its use arise from impurities in the illicitly manufactured drug and the 'illicit', uncontrolled circumstances of its use," Professor Penington said. Donnelly added that ecstasy caused "negligible" harm to users and people around them and was less harmful than alcohol and tobacco.

Check Those Pills! Harm Reduction and Club Drugs [FEATURE]

[This article was written in partnership with Alternet, and was originally published here.]

With the holiday break coming up soon, millions of young Americans will be looking to party. And tens, perhaps hundreds of thousands of them will be looking to stimulant drugs, especially Ecstasy (MDMA), to help them dance to the throbbing beats far into the night. MDMA is a synthetic stimulant with a chemical structure related to both methamphetamine and mescaline. It's great at providing the energy for partying the night away with a psychedelic tinge. The new scene drug, Molly, is simply Ecstasy in powdered form.

According to the 2013 National Household Survey on Drug Use and Health, some 17 million Americans have taken Ecstasy at least once, more than a half million reported taking it within the past month, and about three-quarters of a million reported taking it for the first time that year. Those monthly-use and first-use figures have been roughly stable for the past few years.

Some of those fun-seekers are going to take too much. And some of them are going to end up ingesting something they thought was Ecstasy, but wasn't. And one or two or three of them might die. Despite breathless media reports, people dying from Ecstasy or from what they thought was Ecstasy or what they thought was a drug like Ecstasy, is not that big a problem, especially compared with the 16,000 or so people who died last year from opiate overdoses. The number of Ecstasy-related deaths each year ranges from the single digits to the low dozens.

Still it is a problem. Any avoidable death is a problem, and those deaths are largely avoidable. They occur because of varying combinations of ignorance, greed and bad public policy. Some people are working to prevent those deaths, and the work extends from the club or rave or festival door to the halls of power in Washington.

The harm reduction group Dance Safe is among those doing that work. The small non-profit offers educational services, encourages people to submit their pills for testing ("drug checking"), and has informational booths at venues that will let them.

Where 20 years ago, the Ecstasy and party drug scene was largely limited to word-of-mouth raves, things have changed, said Dance Safe executive director Missi Wooldridge.

"We've seen a real explosion in the scene that has been transformed from an underground rave culture to a real mainstream electronic dance music culture," she said. "People are likely to experiment with drugs at raves and dances, as well as with friends at parties or night clubs."

They are also likely to be ingesting either adulterated Ecstasy or other new synthetic drugs misleadingly marketed as Ecstasy. That is reflected in reports on drug checking websites such as Pill Reports and Ecstasy Data, as well as drug discussion forums like Bluelight.

Pill Reports warns that Yellow Pacman tablets found earlier this month in Kansas and Texas contain not MDMA but the synthetic methylone, a methcathinone stimulant that is a chemical analog to MDMA, but is not MDMA. And at least two different pills currently being peddled in Canada as Ecstasy are actually methamphetamine.

"A lot of what we're seeing is the new psychoactive substances infiltrating the market and the scene," said Wooldridge. "People can purchase these substances online. I see a lot of positive results for methcathinone, MDPV, methylone, and the like. Similarly, people think they're taking LSD, but it's actual N-Bomb, or maybe ketamine. People operate under misconceptions about what they're taking, and that can be serious because there are lots of differences in things like onset, duration and potency."

Educated, sophisticated drug consumers may take advantage of drug checking services, as well as have advanced understandings of drug potency, duration and the like, but they are a minority. Most people just want to party, and they want to do it with Ecstasy.

"In contrast with some places in Europe, the market for people seeking out new synthetics is very small in the US," said Stefanie Jones, nightlife community engagement manager at the Drug Policy Alliance "But that doesn't mean they're not here. Many of the people buying them are after MDMA, but here in the US, the market is young people, and many are not that well-informed or familiar with notions like drug checking to see what's in that powder. It's largely an uninformed market, so there's a lot of adulteration."

Dance Safe's Wooldridge concurred.

Web sites like Pillreports.com will tell you whether your pills are bunk. Don't eat the Yellow Pacman! It's methylone.
"People are taking these substances unknowingly for the most part, rather than checking them out," the Denver-based activist said. "There is a relatively small segment that is into the experimentation and the understanding, but most users are not that sophisticated and are taking these drugs without really knowing what they are."

When people die, as two people did at New York's massive Electric Zoo festival last year, the pressure is on promoters and club owners to crack down on drugs, to increase security, even to decrease or do away with harm reduction measures out of fear of appearing to encourage drug use. In large part, that's because of the RAVE Act, a 2003 law sponsored by then Sen. Joe Biden (D-DE) that threatens owners and promoters with possible criminal sanctions for encouraging drug use.

"The RAVE Act is the elephant in the room," said Wooldridge. "Its intent wasn't to harm or prosecute legitimate event producers, but to expand the crack house laws and go after people solely having events for drug use or sales. But there has been an unintended consequence. People in the industry fear that if they attempt to address drug use they'll be help legally liable for overdoses or other emergencies. Their legal teams and insurance companies say to stay clear, turn a blind eye, but that increases the risks. We need to educate the lawyers and insurers on this. Show me a case where an event producer has been prosecuted for doing harm reduction."

"If the law is making owners scared, we should change the law so they are explicitly protected," said Jones. "Put the focus on the health and safety of the patrons. Including harm reduction shouldn't be seen as encouraging drug activity, but as prioritizing health and safety. Changing the law at the federal level would send a message to the industry that harm reduction is valuable and you won't get in trouble, and that could change the landscape of festivals."

One woman is working to do just that. Dede Goldsmith didn't mean to become a reformer, but when her daughter, Shelley, a University of Virginia student, died after taking Ecstasy at Washington, DC electronic music show the same weekend at the Electonic Zoo last year, that's what happened.

She told Vox in an October interview that when one of Shelley's friends told her Shelley had taken Molly, her first response was, "Who is Molly?" In her search for answers, she came to the realization that Molly didn't kill her daughter; federal drug prohibition and policies that discourage education about safe drug use did.

On the anniversary of her daughter's death in August, Goldsmith launched the Amend the RAVE Act campaign. Its goal, Goldsmith says, is "to make EDM festivals and concerts safer for our young people. Specifically, I am asking for language to be added to the law to make it clear that event organizers and venue owners can implement safety measures to reduce the risk of medical emergencies, including those associated with drug use, without fear of prosecution by federal authorities. As the law currently stands, many owners believe that they will be accused of 'maintaining a drug involved premises' under the act if they institute such measures, opening themselves to criminal or civil prosecution."

Irony alert: Shelley Goldsmith meets RAVE Act author Joe Biden a year before she died on Ecstasy. (amendtheraveact.org)
"It's not that producers don't care, it's that they're terrified," said Wooldridge. "Amending the RAVE Act can be a way to organize the community so people don't fear law enforcement if they're addressing drug use. What's more detrimental -- a fatal overdose or having harm reduction teams and medical teams on site?"

"The campaign is just getting underway," said Jones. "They're collecting signatures, and Dede is just having first meetings with legislators to try to get them on board, to try to get some bipartisan support."

In the meantime, other steps can be taken.

"One of the biggest things we can do is to educate with a true public health approach," Wooldridge said. "We need to have honest conversations and we need to implement drug testing; we have to have that opportunity to create an early warning system when these substances begin to appear."

"Education is really, really critical," said Jones. "We need to be able to get real drug education out to young people and meet them where they are. We need to be explicit about what the drugs are, what they look like, what the common dose it. Integrating harm reduction practices into the culture is also really important, and Dance Safe is great at that."

An effective means of tracking new and available drugs, such as a publicly funded, more comprehensive version of the drug checking websites would also be useful. But that requires someone willing to spend the money.

"We don't really have a surveillance system set up to track these new psychoactive substances," Wooldridge complained. "We don't have the public health monitoring. As a nonprofit, we do some of that on a small scale, but we don't have the capacity or the resources to really do the job. What are the priorities and where is the funding to collect the data?"

"Changing policy to allow for drug checking is also an important avenue to pursue," said Jones. "If we're going to be in a world where drugs remain illegal, we will continue to have problems with imitations and new synthetics, with people not knowing what they're getting. That would be the least we can do."

There is one other obvious response.

"It's unrealistic to think we can keep drugs out of clubs and bars and festivals. Trying to do that causes more harm than good," Wooldridge said. "We need to be realistic and recognize drug use first and foremost as a health concern, not a criminal justice issue. These drugs are often being sold as something they're not, and that's because of prohibition and the black market," said Wooldridge. "One obvious option is legalization and regulation. Then you'd have quality control and you wouldn't need all this drug-checking."

But we're not there yet. Until we are, people are going to have to watch out for themselves and for each other. Check those drugs, kids!

Police Refuse to Release Description of Toxic Ecstasy Pills, Increasing the Danger of More Deaths

A string of recent overdose deaths in British Columbia has a lot of people deeply concerned. But this reaction by law enforcement is certain to make the problem worse.

VANCOUVER — Police in B.C. are reluctant to tell the public what unique markings are on ecstasy pills suspected to contain a lethal additive linked to five deaths in the province.

That's because they don't want users thinking they're sanctioning the rest of the pills. [CTV]

That is some sick logic right there. Listen, if you don't want people to think you're sanctioning the other pills, then say something like, "we're not sanctioning the other pills." What's so hard about that? But for the sake of saving human lives, at least tell people what the poison pills look like. 

Drug users are people, you know. They don't want to kill their friends. If everyone knows what the poisoned pills look like, they can help get them off the street. Everyone in the ecstasy scene will be on the lookout for the toxic doses and the people supplying that garbage will be strongly incentivized to toss it, or face serious consequences within their own social circle. This will work like 900% better than just telling everyone to stop taking ecstasy altogether.

We'll save for another day the conversation about why poisoned ecstasy exists in the first place (hint: the manufacturing process is dangerously unregulated).  

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