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

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

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

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

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

Medical Marijuana

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

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

Drug Testing

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

Harm Reduction

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

International

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

Chronicle AM: IL Passes Forfeiture Reform, House Heroin Task Force Proposals, More... (6/28/17)

Utah's new medical marijuana initiative is exposing fissures between the LDS leadership and membership, an asset forfeiture reform bill sits on the desk of Illinois' governor, a bipartisan House heroin task force releases its proposals, and more.

Utahns are ready for medical marijuana. (Harborside)
Medical Marijuana

Utah Poll Has Strong Support for Medical Marijuana. Just days after the Utah Patient Coalition took initial steps to put an initiative on the November 2018 ballot, a poll it sponsored showed that 73% of Utah voters support the initiative, with only 20% opposed. Support came from all demographic groups, including active Mormons, 63% of whom said they were in favor.

Mormon Church Opposes Utah Medical Marijuana Initiative. The powerful Salt Lake City-based Church of Jesus Christ of Latter Day Saints (Mormons) has come out in opposition to a medical marijuana initiative filed this week by the Utah Patients Coalition. The church acknowledged ongoing interest in medical marijuana and said it supported further research but argued that approval of medical marijuana should come after "the FDA approval process that all other drugs must go through before they are prescribed to patients."

Asset Forfeiture

Illinois Legislature Passes Asset Forfeiture Reform. The legislature last Friday gave final approval to an asset forfeiture reform measure, House Bill 303, that raises the standard of evidence for seizures from probable cause to a preponderance of the evidence and bars seizures of under $500 in most drug cases. The bill does not, however, require a criminal conviction before a seizure can occur -- a sop to prosecutors and law enforcement groups who lobbied for that provision to be dropped. The bill now awaits action from Gov. Bruce Rauner (R).

Heroin and Prescription Opioids

House Bipartisan Heroin Task Force Releases Proposals. A bipartisan group of House members released a raft of proposals Tuesday aimed at fighting the nation's drug problems as "an American issue," not a partisan one. The package of bills from the Bipartisan Heroin Task Force includes increased funding for drug-screening gear at the border, studies on the effects of synthetic drug use, greater flexibility for use of health savings accounts, and creation of treatment centers for infants exposed to opioids during their mothers pregnancy.

International

Georgia Parliament Takes Up Drug Decriminalization. The Parliamentary Health Committee has introduced a bill to decriminalize the possession of all drugs that was developed by the National Drug Policy Platform, a grouping of more than 40 NGOs. The bill would annul the country's much-criticized strict 2007 drug law, as well as making changes to at least 10 criminal and administrative laws. The core principle behind the bill is to shift the country's drug policy away from a criminal justice approach, treating drug use instead as a public health issue. Earlier this month, parliament gave initial approval to marijuana decriminalization. Both pot decrim and broader drug decrim should be addressed during parliament's looming autumn session.

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

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

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

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

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

Heroin and Prescription Opioids

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

International

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

Chronicle AM: Koch Bros Critical of Trump Drug Policies, FL Drug Treatment Fraud, More... (6/26/17)

Florida's medical marijuana regulatory system is now set, the conservative Koch network has some issues with Trump drug war policies, Support Don't Punish marches are going on worldwide, there's something rotten in the Florida drug treatment complex, and more.

Demonstrators took to the streets in more than 200 cities around the globe Monday to call for drug reforms.
Marijuana Policy

Alaska Regulators to Revisit On-Site Consumption Next Month. The state Marijuana Control Board will look at three different options for on-site marijuana use at its meeting next month. One proposal would allow people to try marijuana at retail shops before leaving. Another proposal would allow consumption of edibles, but wouldn't allow smoking. A third proposal would limit on-site use to pot purchased at the site. But none of it is likely to happen before 2018, since the matter won't come up for a vote until August, and there's a 30-day public comment period after that.

Medical Marijuana

Arkansas to Begin Accepting Medical Marijuana Applications. The state Medical Marijuana Commission will begin accepting applications from potential medical marijuana growers and distributors as of this Friday, while the state Health Department will begin accepting applications from patients the same day.

Florida Governor Signs Medical Marijuana Implementation Bills. Gov. Rick Scott last Friday signed into law Senate Bill 6A and Senate Bill 8A, which formalize the voter-approved constitutional amendment legalizing medical marijuana in the state and set up regulations for the new industry.

Utah Advocates Begin Medical Marijuana Initiative Campaign. Medical marijuana supporters organized as the Utah Patients Coalition delivered a proposed initiative to the lieutenant governor's office Monday. Frustrated by the state legislature's refusal to enact a medical marijuana law, the coalition wants to take the issue directly to voters. To qualify for the November 2018 ballot, supporters must hold at least seven public hearings around the state and collect 113,000 valid voter signatures. The measure would not allow smoking medical marijuana and the number of medical marijuana facilities would be limited. It creates a list of specified qualifying conditions.

Drug Policy

Koch Network Critical of Trump Administration on Drug Policy. The conservative Koch brothers political network isn't happy with Trump administration drug policy. At a meeting in Colorado over the weekend, one of the network's top leaders, Mark Holden, decried the administration's return to "the harsh sentencing era of the war on drugs" and added that "You are never going to win the war on drugs. Drugs won." Holden went on to criticize Attorney General Sessions' directive to reevaluate marijuana policies, saying "it's legal in a number of states, so we have to come to grips with that somehow" and that medical marijuana should be "off limits" in any federal crackdown.

Drug Treatment

Florida's Billion Dollar Drug Treatment Industry is Plagued With Fraud and Overdoses. An NBC News investigative report has found crooked treatment centers have created an "insurance fraud mill" by partnering with "body brokers" and operators of "sober homes" to find patients with good health insurance and then billing insurance companies tens of thousands of dollars "for often questionable counseling, costly and potentially unnecessary drug screens, and exotic laboratory tests." And some treatment centers actually encourage drug use because for them, relapse doesn't mean failure, it means more profits.

International

Thousands Take to Streets in Global Drug Reform Day of Action. Thousands of people took to the streets in more than 200 cities in more than 90 countries as part of the Support Don't Punish campaign's "Global Day of Action." Events range from concerts and debates in Belgium, to a float parade and dialogue with parliamentarians in Ghana, a capacity building workshop for religious leaders in Mauritius, drug user and NGO gatherings in Malaysia, Lithuania, Canada and Australia, street art in Portugal, Bolivia, Ecuador and Montenegro, a 250km bike tour to sensitize the general public in India, a football tournament between people who use drugs and service providers in Morocco, the launch of a global call in support for harm reduction in Brazil, and much, much more.

One Year Later, Philippines Drug War Has Killed Thousands, Yet Meth is Cheaper. Philippines President Rodrigo Duterte took power last June 30 and immediately embarked on a brutal campaign to end drug abuse that has left an estimated 9,000 people dead, but the street price of meth has fallen and Filipinos are still as anxious as ever about crime. "If prices have fallen, it's an indication that enforcement actions have not been effective," said Gloria Lai of the International Drug Policy Consortium, a global network of non-governmental groups focused on narcotics.

Chronicle AM: Mexico Legalizes MedMJ, China Bans More Synthetic Opioids, More... (6/20/17)

New Jersey pols look to legalize pot next year, Vermont pols look to legalize it this week, China bans more synthetic opioids, Mexico officially embraces medical marijuana, and more.

Medical marijuana is now officially legal in Mexico, but rules and regulations will take some time.
Marijuana Policy

New Jersey Legalization Bill Gets Hearing. The Senate Judiciary Committee held a hearing on a legalization measure, Senate Bill 3195, on Monday. The testimony was largely favorable, including from a former state Republican Committee head, the head of a doctors' organization favoring legalization, and from a long-time municipal prosecutor. "I believe by legalizing and regulating it and discouraging, officially as official government policy, like we do with tobacco and alcohol, we will be far better off than the status quo," prosecutor J.H. Barr told the committee. No vote was taken. The bill is strongly opposed by Gov. Chris Christie (R), but he'll be gone in January.

Vermont Legislators Will Try to Get Weed Legalized in Special Session This Week. Gov. Phil Scott (R) vetoed the legalization bill in May, saying he had public safety concerns. Supporters of legalization have come back with a bill that now has stiffer penalties for drugged driving, smoking pot in cars with kids, providing pot to kids, and selling pot in school zones -- all in a bid to win the governor's support. The bill does not include "impairment testing mechanism" requested by Scott, largely because there are no marijuana breathalyzers on the market. Scott has declined to comment on the revised bill. The special session begins Wednesday.

Harm Reduction

Boston Ponders Supervised Injection Sites. With six people a day dying of opioid overdoses in the city so far this year, the city council has set a hearing next Monday to explore the potential impact of supervised injection sites. The move comes after the Massachusetts Medical Society urged state officials to open at least two of the facilities.

International

China Bans Synthetic Opioids Linked to US Overdose Deaths. China announced on Monday that it is banning the ultra-potent synthetic opioid U-47700 and three others. The DEA says China is the chief source of synthetic opioids, including fentanyl and carfentanil, which China has already banned. U-47700, MT-45, PMMA, and 4,4-DMAR will be added to the country's list of controlled substances as of July 1, said Deng Ming, deputy director of the National Narcotics Control Commission.

Mexico Legalizes Medical Marijuana. President Enrique Pena Nieto issued a decree on Monday officially legalizing medical marijuana in the country. Legislation authorizing medical marijuana sailed through the Senate in December and passed the lower house on a 347-7 vote in April. Now, the Ministry of Health will be tasked with drafting and implementing rules and regulations.

Chronicle AM: Federal CARERS Act Refiled, RI Legalization Commission Bill Advances, More... (6/15/17)

A bipartisan group of senators reintroduce the CARERS Act to protect medical marijuana in the states, marijuana legalization is keeping legislators busy in the Northeast, New York GOP senators want more drug war to fight opioids, and more.

Kirsten Gillibrand (D-NY) is among a bipartisan group of senators who reintroduced the CARERS Act today. (senate.gov)
Marijuana Policy

Massachusetts Legal MJ Rewrite Bill Delayed By Errors, Concern at High Tax Rates. House Speaker Robert DeLeo (D-Winthrop) has postponed a vote on the legislature's rewrite of the marijuana legalization law approved by voters last fall after errors in the drafting of the bill and the high tax rate proposed -- 28% -- drew protests from Democratic lawmakers. "I think there are certain things that we have to clear up, so because of that, I think it's important that with a bill of this mag that we try to get it right or close to right this first time, so I'd rather do that than try to rush it through," DeLeo said, adding that there was a consensus among Democrats on the basics of the bill.

New Jersey Legalization Bill Gets Hearing Monday. The Senate Judiciary Committee will hold a hearing Monday morning on Senate Bill 3195, which legalizes the possession of small amounts of marijuana and sets up a system of taxed and regulated marijuana commerce. The Drug Policy Alliance has expressed "concern" that the bill "does not include essential components to create a fair and equitable marijuana market in New Jersey." Such legislation must include polices to repair past harms to minority communities, DPA said.

Rhode Island Legalization Study Commission Bill Passes House. A bill that creates a legislative commission to study marijuana legalization -- instead of just legalizing it -- passed the House Wednesday night. House Bill 551A now heads to the Senate. Regulate Rhode Island, the main advocacy group for legalization, has said it will not participate in the commission, which it describes as a delaying tactic.

Medical Marijuana

Bipartisan Bill to End Federal Prohibition of Medical Marijuana Reintroduced in US Senate. US Sens. Rand Paul (R-KY), Corey Booker (D-NJ), and Kirsten Gillibrand (D-NY) reintroduced a bill Thursday that would end the federal prohibition of medical marijuana. Sens. Mike Lee (R-UT) and Lisa Murkowski (R-AK) also signed on to the legislation as original cosponsors. The Compassionate Access, Research Expansion, and Respect States (or CARERS) Act of 2017 would allow individuals and entities to possess, produce, and distribute medical marijuana if they are in compliance with state medical marijuana laws. It would also open up avenues to medical marijuana research and allow physicians employed by the Department of Veterans Affairs to recommend medical marijuana to veterans in states where it is legal. The bill also proposes excluding cannabidiol, a non-psychoactive cannabinoid found in marijuana, from the federal government's definition of "marijuana."

Kentucky Lawsuit Challenges State's Medical Marijuana Ban. Three Kentuckians who say they have used marijuana to ease health problems have filed a lawsuit in state court charging that banning medical marijuana violates their constitutional privacy rights. The suit names as defendants Gov. Matt Bevin (R) and Attorney General Steve Beshear (D).

Rhode Island Governor Proposes Medical Marijuana Expansion. Gov. Gina Raimondo (D) has proposed a budget amendment that calls for "no less than six licensed compassion centers" and increased licensing fees that would generate $1.5 in revenues for the state's general fund. There are three existing dispensaries, which would each be allowed to open one more store front, plus the three additional ones proposed.

Heroin and Prescription Opioids

New York Republicans Want More Drug War to Fight Opioids. A Republican Senate task force says that adding funding for addiction treatment is good, but that it's time to increase heroin penalties "to get dealers off the street." The senators are proposing charging dealers with murder if one of their customers dies and increasing penalties based on the weight of the drugs sold. Assembly Democrats rejected the idea, calling the approach one that's been "tried and failed." The Assembly killed a similar approach last year.

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

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

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

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

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

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

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

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

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

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

Addiction Treatment

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

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

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

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

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

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

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

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

Harm Reduction

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

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

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

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

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

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

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

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

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

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

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

Prevention

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

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

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

CRIMINAL JUSTICE

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

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

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

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

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

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

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

Medical Marijuana

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

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

Harm Reduction

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

Chronicle AM: Mexico Drug War Violence Roils Reynosa, RI MJ Commission Expanded, More... (6/8/17)

A Rhode Island legislative commission studying marijuana legalization gets an expanded membership, including more seats favorable to legalization, cartel infighting leaves a bloody toll in Reynosa, British public health experts call for festival pill testing, and more.

No let up in prohibition-related violence along the Rio Grande. (Borderlands Beat/Creative Commons)
Marijuana Policy

Rhode Island Legalization Commission Gets Expanded. The House Judiciary Committee has voted to expand the membership of a commission studying legalization by adding five more people. The five new members will add heft to the commission's pro-legalization contingent. They include the head of the local NAACP branch, a representative of Doctors for Cannabis Regulation, a criminal defense attorney, and the director of the local chapter of Direct Action for Rights and Equality. This brings the size of the commission to 22. The panel would report recommendations on legalizing marijuana to the General Assembly by March 2018.

Drug Policy

Wisconsin Seeks to Keep Locking Up Pregnant Women Suspected of Drug Use Despite Court Ruling. The state Department of Justice has asked the 10th US Circuit of Appeals to let it continue to apply a law allowing it to detain pregnant women it suspects of drug use even though a US district court judge struck it down in April. State officials first sought an emergency stay to block the ruling while they appeal, but when that was denied Monday, on Tuesday they asked to continue to apply the law to pending cases while it appeals the denial to the US Supreme Court.

International

British Public Health Group Calls for Pill Testing at Festivals. Citing the danger of "serious health harm" from stronger ecstasy in the UK, the Royal Society for Public Health is calling for a program to allow festival goers to test their drugs on site. The society reported than a one-off pill testing pilot program last year resulted in 18% of people bringing their drugs in deciding to through them in the garbage after they turned out to be counterfeit or adulterated.

Mexico Drug War Violence Continues to Roil Reynosa. At least 50 people have been killed in the past month in the Mexican border town of Reynosa, just across the Rio Grande River from McAllen, Texas, according to unofficial counts in local media. Most of the dead are reportedly gunmen from rival factions of the Gulf Cartel, who are fighting for control of local drug trafficking routes, but at least one civilizan -- a taco cart vendor -- is among the dead.

Chronicle AM: Supreme Court Restricts Forfeiture, Rejects College Drug Test Bid, More... (6/6/17)

The Supreme Court makes two good drug policy-related rulings in one day, the California Assembly approves both a marijuana "sanctuary" bill and a supervised injection site bill, last-ditch efforts to free the weed in Connecticut hit a bump, and more.

The Supreme Court rules favorably on two drug policy-related issues. (Wikimedia)
Marijuana Policy

California Assembly Passes Marijuana "Sanctuary" Bill. The Assembly has approved Assembly Bill 1578, which would prohibit state resources from being used to help enforce federal marijuana laws that conflict with state law. The bill from Assemblyman Reggie Jones-Sawyer (D-Los Angeles) now goes to the state Senate.

Connecticut Legalization Measure Still Stalled. The last-ditch effort to get legalization passed through the budget process broke down early Monday just minutes before a press conference announcing a compromise was to be announced. Rep. Melissa Ziobron (R-East Haddam) complained that she didn't see a copy of the legalization amendment until just minutes earlier, when she learned that Rep. Josh Elliot (D-Hamden) and other Democrats had been crafting the measure since last Friday. "This isn't about headlines. This isn't about a news conference," Ziobron said. "This is about what's good for the state of Connecticut, and doing it last-minute, doing it in a way that is not bipartisan, is very worrisome and should be for every single person in this state."

Nevada Republicans Kill Governor's Pot Tax Bill. A bill supported by Gov. Brian Sandoval (R) that would have imposed a 10% tax on recreational marijuana sales has been defeated in the Senate after Republicans refused to support it because of unrelated budget issues. The vote was 12-9 in favor, but because it was a budget bill, it needed a two-thirds majority, or 14 votes, to pass.

Medical Marijuana

Florida Governor Uses Line-Item Veto to Kill Medical Marijuana Research Projects. Gov. Rick Scott (R) used his line-item veto power to kill three line items that would have provided more than $3 million dollars to the Moffitt Cancer Center and the University of Florida for medical marijuana research. In his veto message, Scott wrote that the institutions had plenty of money to fund the research on their own.

Asset Forfeiture

Supreme Court Restricts Asset Forfeiture in Drug Cases. In a decision handed down Monday, the US Supreme Court has moved to restrict prosecutorial efforts to seize money or goods from drug defendants. In Honeycutt v. US, brothers Terry and Tony Honeycutt were convicted of selling methamphetamine precursor chemicals, and the feds then swooped in to seize $200,000 of the estimated $270,000 profits from the sales. But they then sought to seize the remaining $70,000 from Terry Honeycutt, who was only an employee at his brother's hardware store, and that crossed a line, the court said. "Congress did not authorize the government to confiscate substitute property from other defendants or coconspirators," Sotomayor said. "It authorized the government to confiscate assets only from the defendant who initially acquired the property and who bears responsibility for its dissipation."

Drug Testing

Supreme Court Refuses to Hear Appeal from Missouri Tech College That Wanted to Drug Test All Students. The US Supreme Court on Monday declined to hear an appeal from the State Technical College of Missouri of an appeals court ruling that its mandatory drug testing policy is unconstitutional when applied to all students. Lower courts had upheld mandatory suspicionless drug testing of only a handful of the school's disciplines where safety was a key element. "This case establishes -- once and for all -- that under the Fourth Amendment, every person has the right to be free from an unreasonable search and seizure, including college students," the ACLU, which filed the class-action lawsuit in 2011, said in a statement Monday.

Harm Reduction

California Assembly Passes Supervised Injection Sites Bill. The Assembly last Thursday approved Assembly Bill 186, which would allow for the provision of supervised drug consumption sites. The pioneering harm reduction measure sponsored by Assemblywoman Susan Talamantes Eggman (D-Stockton) now moves to the state Senate. "California is blazing a new trail toward a policy on drug addiction and abuse that treats it as the medical issue and public health challenge that it is, and not as a moral failing," said Talamantes Eggman. "We are in the midst of an epidemic, and this bill will grant us another tool to fight it -- to provide better access to services like treatment and counseling, to better protect public health and safety, and to save lives."

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