The Minnesota marijuana legalization bill continues to advance, so does a North Carolina medical marijuana bill, and more.

Marijuana Policy

Minnesota Marijuana Legalization Bill Wins One More Committee Vote. The bill, House File 100, won its 10th House committee vote Tuesday, passing out of the House Finance and Policy Committee. Meanwhile, the companion bill in the Senate is before the Health and Human Services Committee, which acted on several amendments but ran out of time before finishing its work on the bill for the day.

Medical Marijuana

North Carolina Medical Marijuana Bill Advances in Senate. A year after the Senate approved a medical marijuana bill only to see it die in the House, the bill, Senate Bill 3, is back and moving again. The measure passed the Senate Judiciary Committee on Tuesday. The bill now heads to two more committees, the Senate Finance Committee and the Senate Rules and Operations Committee before heading for a Senate floor vote. Although the House last year declined to take up the measure, the Republican House Speaker, Rep. Tim Moore, has suggested that the bill could pass with "the right restrictions." The bill would allow medical marijuana for a list of specified medical conditions and an advisory board could expand that list.  

Anti-Depressants

Mississippi Bill Would Ban Anti-Depressant Known as "Gas Station Heroin." The anti-depressant drug tianeptine, which works as an opioid agonist, is being sold as a "dietary supplement" in pill form in products such as Za Za and Tianaa. The drug is not sold as a pharmaceutical product or scheduled in the US, but a bill that would ban it, House Bill 4 has passed the House and is pending in the Senate. It would make it a schedule one drug, effectively banning it. Some state residents blame it for deaths, although it is unclear whether it is actually to blame.

Methamphetamine

Meth-Related Deaths Skyrocketed in Past 20 Years, But Most Also Involved Opioids. A new study from the University of Illinois finds that methamphetamine-related deaths increased a staggering 50-fold between 1999 and 2021, but that most of those deaths also involved heroin or fentanyl. In 1999, 608 deaths were attributed to meth. By 2021, the number had skyrocketed to nearly 52,400. In 2021, 61 percentof fatal meth overdoses also involved heroin or fentanyl, "The staggering increase in methamphetamine-related deaths in the United States is largely now driven by the co-involvement of street opioids," said lead researcher Rachel Hoopsick, an assistant professor of epidemiology at UI. "Mixing methamphetamine and opioids isn’t a new phenomenon. Although there has been an increase in the popularity of using these types of substances together, what has truly changed is the toxicity of the unregulated street drug supply, predominantly of fentanyl and other synthetic opioids. I believe that this is the primary driver of the increase in deaths."

The North Dakota House kills an effort to allow medical marijuana patients to use edibles, a Republican congressman files a marijuana rescheduling bill, and more.

Marijuana Policy

GOP Congressman Files Marijuana Rescheduling Bill. For the third Congress in a row, Rep. Greg Steube (R-FL) has filed a bill that would move marijuana from Schedule I to Schedule III. The measure, HR 610, says "the Attorney General of the United States shall, by order not later than 60 days after the date of enactment of this section, transfer marijuana…from schedule I of such Act to schedule III of such Act." Such a move would not legalize marijuana, but would, Steube says, "drastically expand" opportunities for research and study.

Minnesota Marijuana Legalization Bill Wins More Committee Votes. The marijuana legalization bill continues to move forward. The House State and Local Government Finance and Policy Committee approved the bill, House File 100, on Tuesday, becoming the fifth House committee to do so. Meanwhile, the Senate version of the bill passed the Senate Jobs and Economic Development Committee on Monday, becoming the fourth Senate committee to do so. Lawmakers have said the bill could face as many as 12 committee votes, meaning the measure is currently three-fourths of the way home. Democrats hold majorities in both houses, as well as the governorship, and are confident the bill will pass and be signed into law in short order.

Medical Marijuana

North Dakota House Kills Bill to Allow Edibles. The House on Tuesday killed a pair of bills that would have made medical marijuana edibles legally available to patients. The House Human Services Committee had amended elements of House Bill 1202 and House Bill 1164 into HB 1202, but the full House killed HB 1202 on a 55-37 vote (it needed two-thirds to pass) and killed HB 1164 on a 20-72 vote. Under the initiative approved by voters in 2016, patients are limited to using dried buds or THC products such as concentrates and tinctures—not edibles. Bill supporters said edibles are a healthier and more accurate means of dosing medical marijuana, but the legislature wasn't listening.

International

Drug Possession is Now Decriminalized in Canada's British Columbia. An exemption to the country's federal drug laws that allows British Columbia to engage in a three-year experiment with drug decriminalization is now in effect. The move is an effort to fight the province's drug overdose crisis. BC accounts for about a third of all Canadian drug overdose deaths, with more than  10,000 overdose deaths in the province since 2016, more than 4,500 of them in the last two years. Under the decriminalization program, possession of up to 2.5 grams of substances such as heroin, fentanyl, cocaine, and methamphetamine is no longer a criminal offense. Supporters of the program say it will reduce stigma and enable healthier outcomes for drug users. 

For nearly four years, the Philadelphia nonprofit Safehouse has seen its effort to open a safe injection site in the city stymied by a federal court case brought against it by the Trump administration Justice Department. And although the Trump administration is now history, the Biden Justice Department has continued to pursue the case even as the number of overdose deaths in the city mounts.

But now, Safehouse and the Justice Department (DOJ) have agreed to move their case about the legality of safe injection sites out of a federal district court and into mediation before a federal magistrate, a maneuver that advocates hope can speed up the resolution of the case and get the sites up and operating.

"We agreed with the Department of Justice to move in this direction to reach a settlement and get the lawsuit resolved," Safehouse vice-president Ronda Goldfein told the Philadelphia Inquirer. While declining to further characterize confidential settlement negotiations, she said the group's goals "have not changed" and that Safehouse seeks "a resolution that all parties can live with that give us the opportunity to save lives."

The move comes as the Biden DOJ has hinted at a possible softer stance toward safe injection sites. DOJ did not go to court to block local officials in New York City from allowing two safe injection sites to open in late 2021 or to block state officials from allowing them in early 2022. And DOJ had indicated it was engaged in settlement talks with Safehouse in February 2022.

At that time, DOJ said that it was "evaluating supervised consumption sites, including discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety."

But that was nearly a year ago, and Safehouse's patience is wearing thin. Just last month, after having repeatedly gone along with DOJ requests for continuances, Safehouse balked. It told the federal district court for the Eastern District of Pennsylvania that it would no longer agree to any additional delays, while the DOJ argued that it needed until February to proceed. The court compromised, requiring that DOJ reveal its position in the lawsuit by January 9.

With the mediation agreement between Safehouse and DOJ, that January 9 date is now moot, but Safehouse is convinced the move will result in a speedier resolution of the case and allow it to finally get into the business of saving lives.

"Since the DOJ commenced this litigation in 2019 until the end of 2021, more than 3,600 lives have been lost in Philadelphia to the opioid overdose crisis. Based on 2022 projections, that number will grow to almost 5,000 deaths," Safehouse said. "Safehouse and those that need its life-saving services have waited long enough."

Meanwhile, there are other signs the federal government may be warming to the harm reduction intervention. In a November report, the nonpartisan Congressional Research Service highlighted the "uncertainty" of the federal government's position on safe injection sites and suggested blockages could be overcome by approving an amendment to the annual DOJ funding bill precluding it from spending any funds to go after safe injection sites, much as has been successfully done to protect medical marijuana laws in the states.

And just days before that report was released, National Institute on Drug Abuse (NIDA) Director Nora Volkow tacitly endorsed the idea of authorizing safe consumption sites. Research has found that the intervention "has saved a significant [percentage of] patients from overdosing."

Now, if only the DOJ can find a way to get out of the way. Or if it cannot or will not, it will be time to go back to court.

The good, the bad, and the ugly in US domestic drug policy this year.

1. Overdose Deaths Appear to Have Peaked but Are Still at Horrid Levels

According to Provisional Drug Overdose Death Counts released by the Centers for Disease Control and Prevention (CDC) in December, the nation's fatal drug overdose epidemic has peaked. After reaching a record high of more than 110,000 fatal overdoses in the 12-month period ending in March, that number declined to 107,735 in the 12-month period ending in July, the last month for which data is available. That is a two percent decline from the March high.

While the decline is welcome, drug overdose numbers are still 25 percent higher than they were two years ago and double what they were five years ago. According to the CDC, synthetic opioids, mainly fentanyl, were implicated in more than two-thirds of overdose deaths and stimulants such as methamphetamine and cocaine were involved in nearly one-third. But some fraction of stimulant-implicated overdose deaths are not caused by the stimulants themselves but by stimulant users being exposed to drugs cut with fentanyl.

2. Neither Marijuana Legalization nor Banking Access Pass Congress

Senate Majority Leader Chuck Schumer (D-NY) vowed to make passage of a marijuana legalization bill a priority in this Congress, but it didn't happen. While the House passed a legalization bill, the Marijuana Opportunity Reinvestment and Expungement (MORE) Act (HR 3617) in April, Schumer and congressional allies didn't even roll out a draft version of their Cannabis Administration and Opportunity Act until this July -- 18 months after this Congress began -- and it never exhibited enough bipartisan support to go anywhere in the evenly divided Senate.

Schumer and his Senate allies also repeatedly blocked efforts to get a bill to allow state-legal marijuana businesses access to financial services through the Senate. The Secure and Fair Enforcement (SAFE) Banking Act (HR 1996) passed the House in April, and Senate allies tried repeatedly to attach it as an amendment to various spending bills, only to be stymied by Schumer and his holdouts for full-blown legalization. At year's end, though, while Schumer was finally ready to move forward with it, Senate Minority Leader Mitch McConnell (R-KY) came out in opposition, helping to scuttle one last effort to tie it to a defense appropriations bill.

3. With Biden's Signature, A Standalone Marijuana Reform Bill Becomes Law for The First Time Ever

For the first time ever, Congress passed and in December the president signed into law a stand-alone marijuana reform bill, the bipartisan Medical Marijuana and Cannabidiol Research Expansion Act (HR 8454). Some marijuana reform measures have been passed before, but only as part of much broader appropriations bills. The aim of the bill is to facilitate research on marijuana and its potential health benefits. The bill will accomplish this by streamlining the application process for scientific marijuana studies and removing existing barriers for research by allowing both private companies and research universities to seek DEA licenses to grow their own marijuana for research purposes.

4. Three More States Legalize Marijuana

In May, Rhode Island became the 19th state to legalize marijuana when the General Assembly passed and Gov. Dan McKee signed into law the Rhode Island Cannabis Act. Sales to any adult over 21 at medical marijuana dispensaries that acquired "hybrid retail licenses" began in December.

And in November, voters in Maryland and Missouri approved marijuana legalization initiatives. Maryland's Question 4 came not from the people but from the legislature and amends the state constitution and mandates that the General Assembly "shall provide for the use, distribution, possession, regulation and taxation of cannabis within the state." Missouri's Amendment 3 overcame multi-sided opposition not only from the usual suspects in law enforcement and the political establishment but also from civil rights groups and marijuana industry insiders to eke out a narrow victory. As of December 8, possession of up to three ounces by adults is no longer a crime, but sales to adults will not begin until next year.

But there were also losses at the ballot box this year. The Arkansas Adult Use Cannabis Amendment garnered only 43.8 percent of the vote, while North Dakota's Initiated Statutory Measure No. 1 managed only 45.1 percent, and South Dakota's Initiated Measure 27 came up short with only 46.6 percent of the vote. The South Dakota defeat was especially bitter, given that just two years ago, voters there approved a broader marijuana legalization initiative with 54 percent of the vote only to see it invalidated by the state Supreme Court.

5. The Year of Fentanyl Test Strip Decriminalization

Fentanyl test strips, which detect the presence of the powerful synthetic opioid in all different kinds of drugs (cocaine, heroin, methamphetamine, etc.) and formulations (pills, powders, and injectables) are recognized by the Centers for Disease Control and Prevention as a valuable harm reduction strategy and are increasingly seen by the states as a crucial tool in the fight to reduce drug overdose deaths. When the Biden White House first endorsed their use in 2021, they were considered illegal drug paraphernalia in a majority of states.

Not anymore. As of the end of 2022, 31 states have now legalized or decriminalized fentanyl test strips, with Alabama, Georgia, New Mexico, Tennessee, and Wisconsin doing so this year alone. But that leaves 19 states, mostly in the South and including Florida and Texas where they remain banned.

6. Colorado Becomes Second State to Approve Natural Psychedelic Reforms

Three years after voters in Denver opened the door to psychedelic reform by approving a municipal initiative that made possession of psilocybin mushrooms the lowest law enforcement priority, voters statewide have approved an initiative that decriminalizes plant- and fungi-derived psychedelics and creates a program for the therapeutic administration of such substances. On Election Day, voters approved Proposition 122, the Natural Medicine Health Act, with 53.55 percent of the vote. The victory makes Colorado the second state to enact reforms decriminalizing a natural psychedelic and setting up a program for therapeutic use. Oregon voters led the way on that by approving Measure 109 in 2020.

Proposition 122 has two main prongs: First, it decriminalizes the personal use, possession, and cultivation by people 21 and over of dimethyltryptamine (DMT), ibogaine, mescaline (not derived from peyote), psilocybin, and psilocyn, as well as providing for the sealing of conviction records of people who have completed sentences for the use or possession of those substances. The measure sets no personal possession limits. Second, it creates a "natural medicine services" program for the therapeutic administration of the specified psychedelics and creates a rubric for regulated growth, distribution, and sales of those substances to entities within the program. Only psilocybin and psilocin would be okayed for therapeutic use until 2026. Then regulators could decide on whether to allow the therapeutic use of DMT, ibogaine, and mescaline.

7. Marijuana Social Consumption Lounges Spread

Ever since the first states legalized marijuana a decade ago, one question for users was where to go to smoke their newly legal product. Most states ban smoking outdoors in public or indoors pretty much anywhere except one's home -- and even that can be an issue if your landlord isn't down with it. One solution is allowing places for marijuana users to toke up in a convivial setting, the marijuana social consumption lounge, whether as part of a retail shop or as a standalone business.

Social consumption lounges are now legal in 11 states -- Alaska, California, Colorado, Illinois, Massachusetts, Michigan, Missouri, New Jersey, New Mexico, New York, and Nevada -- although they are not actually up and running yet in some of them. Massachusetts has two lounges now operating; in New Jersey, regulators just approved rules for them; in Nevada, regulators just issued 20 provisional licenses; in New York, they're still waiting for regulators to act; and in California, the state's dozen or so lounges are set to double in number as more localities okay them. Meanwhile, the nation's capital could be next: In the District of Columbia, the city council just approved a bill allowing them.

8. Safe Injection Sites Are Operating in the United States

Safe injection sites, the harm reduction intervention proven to save lives after years of operation in more than a hundred cities in Australia, Canada, and Europe, are finally getting a toehold in the US. New York City's two safe injection sites have just celebrated their first birthdays after opening in late 2021, and in Rhode Island, a two-year pilot program is underway.

But there will be no safe injection sites in California after Gov. Gavin Newsom (D) vetoed a bill that would have allowed pilot programs in major cities across the state. And the fate of a proposed Philadelphia safe injection site -- and the Biden administration's attitude toward them -- remains in doubt. That facility was initially blocked by the Trump Justice Department, and two years later, the Biden Justice Department has yet to substantively respond to lawsuit from the site's would-be operators. Just this month, a federal judge gave DOJ just 30 more days to respond. A positive response would remove the obstacle to further expansion of such sites that fear of federal prosecution brings. Meanwhile, the Congressional Research Service has thoughtfully released a report about other options for getting them up and running, such as passing budget amendments similar to those blocking the Justice Department from interfering in marijuana laws.

9. In DC and New York City, Gray Market Weed Finds a Way

In both the nation's capital and the nation's largest city, unregulated marijuana vendors have popped up to supply pent up demand as both cities endure legalization without legal marijuana sales. In New York City, it's only a matter of time before taxed, licensed, and regulators marijuana retailers are able to open, but in the interregnum between legalization and legal access, the pot scene has gone hog wild with marijuana being sold everywhere -- head shops, bodegas, even from folding tables on street corners -- with one particularly hysterical estimate putting the number at "likely tens of thousands of illicit cannabis businesses." The market isn't waiting for the regulators, and its emergence could undercut the legal businesses waiting in the wings. The city has undertaken limited enforcement efforts, but to little effect so far.

In Washington, DC, a congressional rider barring taxed and regulated marijuana sales has seen something similar, but with a DC twist: a multitude of shops that will "gift" you marijuana when you purchase some other item. The stores call themselves I-71 shops, after the 2014 initiative that legalized marijuana in the city and they even have their own industry association, which estimates there are a hundred or so of them. The city vowed a crackdown in August, but put that on hold the following month.

10. For the First Time, SAMSHA Funds Harm Reduction

In December 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that it would for the first time ever make grants available to harm reduction groups to "help increase access to a range of community harm reduction services and support harm reduction service providers as they work to help prevent overdose deaths and reduce health risks often associated with drug use." SAMSHA would make available $10 million a year in grants for the next three years.

And this year, the first tranche went out. Some 25 different programs from the Lost Dreams Awakening Center in New Kensington, Pennsylvania, to the Mile High Council on Alcoholism and Drug Abuse in Denver, to the Los Angeles County Health Department got grants this year, almost all of them for $398,960. It's a drop in the bucket compared to federal spending on prohibition -- and compared to harm reduction's full funding needs -- but it's a start.