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Chronicle Book Review: American Cartel

American Cartel: Inside the Battle to Bring Down the Opioid Industry, by Scott Higham and Sari Horwitz (2022, Twelve Press, 400 pp., $30.00 HB)

Phillip S. Smith, with contributions from David Borden

https://stopthedrugwar.org/files/americancartel.jpg
Pulitzer Prize-winning Washington Post investigative reporters Scott Higham and Sari Horwitz have been on the opioid beat for years, teaming up (with others) on the Post's "The Opioid Files" series, which was nominated for a Pulitzer in 2020. Now, with American Cartel, the pair provide a deeply-sourced account of how opioid manufacturers, distributors, and pharmacies waged an all-out campaign to fend off DEA efforts to stanch the flow of billions of opioid pain pills, and to evade any culpability, even as the overdose death toll mounted year by year.

The picture Higham and Horwitz paint of corporate and political malfeasance is damning. But the laser sharp focus with which they paint it, omits much of the context in which the opioid crisis has unfolded. And that context is also very important.

An article in yesterday's Guardian shows one of the reasons why. In much of the world, very few pain patients are able to access opioids at all. Much suffering results, sometimes leading to suicide attempts. Dr. MR Rajagopal, chair of Pallium India, told the Guardian, "Pain is not visible. It happens in hospital beds or patients' rooms and is not visible to the world. Addiction, on the other hand, is very visible in headlines which quote the US epidemic and overdose deaths. No one talks about the western European success over decades; all the news is about the opioid crisis in the USA. This means that when we try to have discussions, our work becomes harder because many minds are primed against opioids."

In other words, by speaking too solely to one side of an issue, one risks adversely impacting the other sides. Whether "opiophobia" is real or significant in the US is another question. Higham and Horwitz don't venture a view on this, at least not in American Cartel.

One entity that has warned about opiophobia (without using the term) is the US Centers for Disease Control. In a 2019 memo, CDC writes that a 2016 guidance the agency issued on prescribing opioids for chronic pain had seen "misapplication[s]" by some physicians that put patients at risk. The memo cites a New England Journal of Medicine commentary by the authors of the 2016 guidance. It warns against "hard limits" on opioid dosages or cutting patients off; abrupt tapering of prescriptions; applying the guidance to acute pain situations patients face in situations like active treatment for cancer or sickle cell anemia or post-operative care; and applying it to medication-assisted treatment prescriptions for addiction.

Technically the CDC memo addressed a period of a few years beginning in 2016. But the dynamics it describes are inherent risks in a situation where providers are charged with supplying a substance that's useful but also addictive and potentially deadly if misused, and for which they can be sanctioned professionally or even prosecuted and imprisoned if things go wrong or someone disagrees. Pharma-driven promotion of their new opioid products was a factor in driving up prescribing rates to where they reached. But a part of the increase was also the medical community reacting to a real problem of under-treatment or non-treatment of pain for some patients, a problem that coexists with over-prescribing to some other patients. That increase in turn came with a learning curve.

The authors also give short shrift to the impact of today's woes and inequalities in driving the so-called deaths of despair -- a concept coined by Princeton professors Anne Case and Angus Deaton -- alienation and anomie, helplessness and hopelessness afflicting many Americans who have been left behind in the modern economy, especially in the opioid use heartlands of the Midwest and Appalachia. The Midwest deindustrialized beginning in the 1970s, and both regions largely missed out on the tech boom of the '90s and '00s. Then came even more pain with the Great Recession, followed by COVID and more economic and social disruption. People there (and elsewhere) are dying not just of opioids, but of smoking, drinking, and suicide. Big Pharma is easily (and oh so deservingly) demonized, but the laser focus on the companies allows us not to have to look in the mirror about the pain our society produces.

That factors like these should play a role in the opioid crisis, though, doesn't exonerate Big Pharma. Rather, the misleading promotions of their products carried out by pharma, took an even greater toll due to the vulnerabilities those other factors had brought to the fore.

Meanwhile, the death toll continues to mount -- over 100,000 per year, and with a new record high every year. Prescription opioids still figure prominently in overdoses. But the greatest part of the problem by far is black-market fentanyl, used deliberately by some high tolerance heavy users of opioids, but primariy causing overdose as an adulterant in heroin, counterfeit prescription pills, and other street drugs, essentially a poisoning crisis. But as Higham and Horwitz note, that is part of a wave of opioid use that began with pharmaceutical companies such as Purdue Pharma taking Oxycontin onto the market in the late 1990s. The first decade of this century also saw other prescription opioids -- oxycodone, hydrocodone, Vicodin, Percocet, Opana, et al. -- hit the market.

Higham and Horwitz are fond of tossing around astounding numbers of pills produced by manufacturers or sold by certain pharmacies, such as Mallinckrodt producing 3.5 billion 30 milligram hydrocodone pills in one year, and critics could protest that those numbers need context, too. A prescription for a medication doesn't just have a number of pills to take. It specifies how large a dosage there is inside each pill. A smaller number of pills that each contain a higher dose might mean more than a larger number that each contain a smaller dose. And a higher dose prescription sometimes reflects a patient's tolerance to opioids built up through past medical (or non-medical) use. Maybe West Virginia didn't really need 81 million pain pills during a five-year span. But maybe it did. Without more information, it's just not clear what these numbers mean.

They do provide some context, though, for example by comparing pain pill sales across all drug stores in a region and pointing out anomalies not easily explainable by, say, differing rates of cancer or other serious illness. And they demonstrate that plenty of businesses -- from Big Pharma to the drug store chains and individual pharmacies -- were either in it for the money or at best screwed up, both through detailed analysis and telling anecdote. For example, there was the guileless Florida pharmacist who explains to investigators that she fills pain pill prescriptions all day long, but always keeps a certain number of pills on reserve "for my real pain patients."

When the DEA cracked down first on Wild West internet sales of opioids and then on the "pill mills," medical practices with perfunctory examinations and huge numbers of opioid prescriptions whose entire business model seemed to be writing opioid prescriptions, it succeeded in reducing access to those drugs. But the people using opioids didn't stop; they went to black market drugs, fueling first a resurgence in heroin use and now an opioid crisis driven by fentanyl.

A key figure in the tale is Joe Rannazzisi, who as head of DEA's Office of Diversion Control from 2006 to 2015 oversaw the agency's endless effort to ensure that prescribed opioids are only prescribed for legitimate medical purposes and not leaking into the black market. We are inclined to think of the DEA as a prohibitionist agency, but in this case, it is acting as a regulatory agency. And what Higham and Horwitz uncover is a case of regulatory capture -- when the industry being regulated manages to set the terms under which it is regulated, for its own benefit, not that of the public.

Rannazzisi and his team of DEA lawyers spent years going after opioid manufacturers, distributors, and pharmacy chains who were repeatedly (administratively) busted for failing to do due diligence about just who was buying their products. The companies would pay huge fines, promise not to do it again, and then continue to pump massive amounts of opioids through the supply chain.

The companies mobilized against Rannazzissi and his campaign, forming industry front groups, undertaking lobbying efforts, hiring legions of high-priced law firms, and crafting legislation that would rein in what they saw as an out-of-control agency. As Higham and Horwitz document in great detail, it worked.

Sponsored by Rep. Tom Marino (R-PA) and Sen. Marsha Blackburn (R-TN), both of whom received substantial contributions from the industry, but written by industry lobbyists, the nicely named Ensuring Patient Access and Effective Drug Enforcement Act removed from the DEA tools that Ranizzisi had been using to try to force drug distributors to monitor and report suspicious orders, such as the 1.2 million oxycodone tablets one distributor bought from Mallinckrodt in one day, only to order another 1.2 million the next day.

The bill passed, only to be drastically revised amidst scandal after an earlier Post report on the opioid bill derailed then-President Trump's effort to name Marino drug czar. But Higham and Horwitz also detail rot inside the DEA, where the industry managed to get to high-ranking officials who sidelined Rannazzisi, forcing him into retirement and forcing many of his team members into bureaucratic Siberia. It's an ugly little story of money and power, the sort that is all too common in Washington.

If the first part of American Cartel reads like a detective novel, the second part is more like a legal thriller, It covers the massive wave of civil lawsuits filed against the drug companies, and it is not particularly edifying reading. You see hundreds of high-powered attorneys from the country's top litigating firms -- including dozens of former DEA attorneys working now working for the industry they regulated -- facing off against armies of lawyers for the thousands of states, cities, and counties. You see massive settlements from the companies and massive damages wrested from companies that went to court and lost. While it is unclear just how the moneys won or negotiated by the various plaintiffs is actually being used to help people who suffered from the opioid crisis, what is clear is that it has been a bonanza for the legal profession, with winnings -- excuse me, earnings -- by attorneys reaching well over a billion dollars.

They weren't all in it for the money, though. Some, like West Virginia attorney Paul Farrell, whose state was one of the epicenters of the pain pill epidemic, were sickened by the toll of addiction they saw all around them. Not willing to settle for the pittance the town and county he represented would receive under a massive settlement agreed to by most of the suing entities, he gambled on going it alone against the drug distributors. As this book went to print in April, he was still waiting for a decision. Earlier this month, he lost, with a federal judge ruling that drug distributors were not responsible for the area's opioid crisis.

The litigation goes on, and the dying goes on. Sometimes the drug companies settle, sometimes they lose and have to pay even more. But sometimes they win.

The profit-driven wave of opioids that engulfed the country in the last couple of decades is not an anomaly. The pharmaceutical companies have a historical pattern of creating and marketing drugs that later wreak havoc. That's what they did with amphetamines, that's what they did with barbiturates, that's what they did with benzodiazepines. It's almost enough to make one wonder if profit-driven capitalist enterprises should be in charge of the nation's drug supply.

Read Higham and Horwitz's book. But read Case and Deaton's too. And when you see the next "pill mill" story, don't assume that it is, or isn't, what it seems.

Supreme Court Rules for Crack Prisoners, CO Psychedelic Initiative Campaign Hands in Signatures, More... (6/28/22)

A major Swiss bank gets convicted of cocaine money laundering, a House committee wants a GAO report on federal psilocybin policy, and more.

Something good came out of the US Supreme Court on Monday. (Pixabay)
Psychedelics

House Appropriations Committee Calls for Review of Federal Psilocybin Policy. In reports accompanying new spending bills, the leaders of the House Appropriations Committee are calling for a federal review of psilocybin policy, as well as letting researchers study marijuana from dispensaries and using hemp as an alternative to Chinese plastics. The report for the spending bill for Commerce, Justice, Science and Related Agencies calls for the Government Accountability Office (GAO) to analyze barriers to state, local, and tribal programs using psilocybin. The committee said the GAO should study the impact of federal drug prohibition in jurisdictions that allow psilocybin. The call comes as a psilocybin reform movement is gaining momentum across the country.

Colorado Activists Turn in Signatures for Psychedelic Initiative. The Natural Medicine Colorado campaign, the group behind an initiative to legalize psychedelics and create licensed psilocybin "healing centers," announced Monday that it had turned in 222,648 raw signatures. The campaign only needs 124,632 valid voter signatures, and this cushion of nearly 80,000 excess raw signatures suggests that the initiative will qualify for the November ballot. The measure would legalize the possession, use, cultivation, and sharing of psilocybin, ibogaine, mescaline (not derived from peyote), DMT, and psilocyn for people 21 and over. It does not set specific possession limits, nor does it envision recreational sales. The measure would also place responsibility for developing rules for a therapeutic psilocybin with the Department of Regulatory Agencies.

Drug Policy

At Oversight Hearing, Director of National Drug Control Policy Highlighted Biden-Harris Administration's Commitment to Tackling Overdose and Addiction Crisis. On Monday, Rep. Carolyn B. Maloney, Chairwoman of the Committee on Oversight and Reform, held a hearing with Dr. Rahul Gupta, Director of the Office of National Drug Control Policy (ONDCP -- the drug czar's office), to examine the federal government's response to the overdose and addiction crisis, including the Biden-Harris Administration's 2022 National Drug Control Strategy.

During the hearing, Director Gupta highlighted illicit drug seizures at the southern border and disruption of drug trafficking across the US; the need to expand treatment services; steps such as telehealth services to expand access to care for people in underserved communities; and overdose prevention efforts funded by the bipartisan Restoring Hope for Mental Health and Well-Being Act of 2022. Gupta and committee members also highlighted Chairwoman Maloney's Comprehensive Addiction Resources Emergency (CARE) Act.

Supreme Court Rules Judges Can Weigh New Factors in Crack Cocaine Cases. The Supreme Court ruled Monday that the First Step Act allows district court judges to consider post-sentencing changes in law or fact in deciding whether to re-sentence people convicted under the harsh crack cocaine laws of the past.

While the penalties are still harsh, they are not quite as much as they were prior to passage of the 2010 Fair Sentencing Act, which reduced the ratio of quantity triggers for the worst sentences for powder vs. crack cocaine from 100:1 to 18:1. The First Step Act made those sentencing changes retroactive, giving prisoners the chance to seek reduced sentences. The decision was 5-4, with conservative Justices Clarence Thomas and Neil Gorsuch joining the court's liberal minority in the opinion.

The case is Concepcion v. United States, in which Carlos Concepcion was sentenced to 19 years for a crack offense in 2009, a year before passage of the Fair Sentencing Act. He sought resentencing "as if" the Fair Sentencing Act provisions "were in effect at the time the covered offense was committed." That is proper, Justice Sonia Sotomayor wrote in the majority opinion: "It is only when Congress or the Constitution limits the scope of information that a district court may consider in deciding whether, and to what extent, to modify a sentence, that a district court's discretion to consider information is restrained. Nothing in the First Step Act contains such a limitation."

International

Swiss Court Convicts Credit Suisse of Cocaine Money-Laundering. The Swiss Federal Criminal Court has found the bank Credit Suisse guilty of failing to prevent money-laundering by a Bulgarian cocaine trafficking organization. One former bank employee was convicted of money-laundering in the case against the country's second-largest bank. The trial included testimony about murders and cash-filled suitcases. The court held that Credit Suisse demonstrated deficiencies in both the management of client relations with criminal groups and the implementation of money-laundering rules. "These deficiencies enabled the withdrawal of the criminal organization's assets, which was the basis for the conviction of the bank's former employee for qualified money laundering," the court said. Credit Suisse said it would appeal.

House Advances SAFE Banking Act (Again), MI Psychedelic Legalization Initiative Filed, More... (2/3/22)

Mountains of meth are being cooked up in Myanmar's Shan state, UNODC reports. (dea.gov)
Marijuana Policy

House Approves Marijuana Banking on Voice Vote, Final Approval with Roll Call Vote Expected Today. The House on Wednesday gave preliminary approval to a marijuana banking amendment to a science and technology bill, with a roll call voice vote expected Thursday. The amendment is the SAFE Banking Act, which is aimed at providing access to financial services for state-legal marijuana businesses. The measure has repeatedly been approved by the House, most recently as part of a defense appropriations bill, but Senate negotiators more interested in passing a full-on marijuana legalization bill killed it then.

Bipartisan Coalition of House Members Call for Quick Vote on Marijuana Legalization. A bipartisan group of House members sent a letter to congressional leaders Wednesday demanding that Congress move "expeditiously" to pass a bill to legalize marijuana. The bill in question is the Marijuana Opportunity, Reinvestment and Expungement (MORE) Act (HR 3617), which passed the House in 2020 and passed the House Judiciary Committee this session, but has yet to be scheduled for a floor vote.

The MORE ACT is "is foundational in righting systemic injustices and removing barriers for families and individuals nationwide" and so it should be "expeditiously considered by the House and Senate," the letter said. The letter was led by Rep. Marilyn Strickland (D-WA) and cosigned by Reps. Nikema Williams (D-GA), Matt Gaetz (R-FL), Marie Newman (D-IL), Ted Lieu (D-CA), Dina Titus (D-NV), Dean Phillips (D-MN), Salud Carbajal (D-CA), Lou Correa (D-CA), Angie Craig (D-MN) and Bonnie Watson Coleman (D-NJ).

Drug Policy

Grassley, Whitehouse Implore Biden Administration to Quickly Release National Drug Control Strategy for 2022. On Wednesday, Sens. Chuck Grassley (R-IA) and Sheldon Whitehouse (D-RI), co-chairs of the Senate Caucus on International Narcotics Control, pushed the Biden administration to finish its work on and release the 2022 National Drug Control Strategy. Their bipartisan letter comes after Dr. Rahul Gupta -- Director of the White House Office of Drug Control Policy (ONDCP) -- indicated last week that their 2022 strategy could be delayed until the end of June, far past the statutorily required date of February 7, 2022.

"We are pleased that your office is taking a thoughtful look and share your sentiments, especially in light of the record overdose deaths. Despite this, we are disappointed in the delay. The Strategy is critical in informing the federal government's approach to drug enforcement, prevention, and treatment. Now more than ever, a timely and whole-of-government Strategy is necessary," the senators wrote.

Psychedelics

Michigan Activists File Psychedelic Legalization Ballot Initiative. The national group Decriminalize Nature, its state affiliate, and Students for Sensible Drug Policy (SSDP) have filed paperwork for an initiative to legalize the possession, cultivation, and non-remunerated sharing of psychedelics, as well as setting up a system to enable therapeutic and spiritual use. The measure would legalize a broad range of psychedelics for people 18 and over. Sales would be allowed to provide psychedelics to people whose doctors have issued written recommendations for them.

International

Colombian Army Kills Nine in Raid on Gulf Clan Cartel. Defense Minister Diego Molina announced late Tuesday evening that at least nine people were killed in an army raid on the Gulf Clan Cartel in northwest Colombia. The raid took place in Ituango, a Gulf Clan stronghold. The Gulf Clan is a major drug trafficking organization, considered responsible for about a third of the cocaine being smuggled out of the country. It's leader, Dario Antonio Usuga, also known as Otoniel, was arrested in October in a raid involving 500 police and military, an event that President Ivan Duque said marked "the end" of the Guld Clan. Apparently not quite yet.

Myanmar Illicit Drug Production Surges Since Coup. The UN Office on Drugs and Crime (UNODC) said this week that political turmoil and instability in the wake of a military coup has resulted in massive increases in drug production and trafficking in the country. Last month alone, authorities in Laos, Thailand, and Myanmar seized a mind-boggling 90 million methamphetamine tablets and 4.4 tons of crystal meth, with the bulk of it reportedly produced in Myanmar's Shan state. "Meth production increased last year from already extreme levels in northern Myanmar and there is no sign it will slow down," said Jeremy Douglas, the UNODC's regional representative in Southeast Asia.

SAFE Banking Act Gets Another Chance in the House, Opioid Makers Settle with Native American Tribes, More... (2/2/22)

An Arizona judge upholds social equity provisions in the state's marijuana law, the SAFE Banking Act will get another House floor vote, and more.

Marijuana Policy

SAFE Banking Act Heading for Another House Floor Vote. The House Rules Committee has cleared the way for the Secure and Fair Enforcement (SAFE) Banking Act to get another chance at passage. The bill, which aims to provide protections for financial institutions doing business with state-legal marijuana businesses, had passed out of the House as part of a defense appropriations bill but was killed by Senate negotiators who favored a vote on marijuana legalization first. Last week, bill sponsor Rep. Ed Perlmutter (D-CO) offered it as an amendment to a large-scale tech and manufacturing research and innovation bill, and on Tuesday, the Rules Committee determined the proposal to be in order, meaning it will be taken up by the House as part of that larger bill.

Arizona Judge Upholds Rules for Social Equity Marijuana Licenses. Maricopa County Superior Court Judge Randall Warner on Tuesday threw out a lawsuit challenging the state's rules implementing a program aimed promoting social equity in the marijuana industry. The program is reserving 26 marijuana business licenses for "people from communities disproportionately impacted by the enforcement of previous marijuana laws." The lawsuit filed by the Greater Phoenix Urban League and a business argued that the rules lack a means to prevent license transfers and to ensure that profits remain in communities, but Judge Randall held that the rules satisfied the broad mandates under the state's voter-approved marijuana legalization law.

Medical Marijuana

Minnesota Patients Can Buy Buds Beginning in March. Patients registered in the state's Medical Cannabis Program will be eligible to buy dried cannabis flower for smoking from the state's medical cannabis dispensaries starting March 1. In preparation for the change, registered patients interested in smokable cannabis can make an appointment for a consultation with a medical cannabis dispensary pharmacist beginning Feb. 1 so they will be pre-approved to buy pre-packaged dried flower and pre-rolls once available. Consultations, which can be in-person or virtual, are required when a patient changes the type of medical cannabis they receive. Smokable cannabis may be available a few days before March 1, if the state's relevant administrative rules are finalized early. Patients should check with their medical cannabis dispensary for further details. The sale of smokable cannabis is limited to patients and caregivers who are 21 years or older and who are registered with the Medical Cannabis Program.

Opioids

Drug Distributors, Johnson & Johnson Settles with Native American Tribes Over Opioid Distribution. Three drug distributors -- McKesson, Cardinal Health, and AmerisourceBergen -- and drug manufacturer Johnson & Johnson have reached a $665 million settlement with Native American tribes regarding the flood of prescription opioids into Native communities. More than 400 tribes sued the companies for producing and shipping opioids to the tribes regardless of concerns about overdoses and other health issues. The companies maintain they followed federal law and did nothing wrong but agreed to the settlement anyway. The lawsuit is part of a broader push-back after an expansion of opioid prescribing in the late 1990s and early 200s that has seen numerous lawsuits against drug companies, as well as reductions in opioid prescribing, which has left some chronic pain patients in the lurch.

Duterte Will "Never Apologize" for Drug War Killings, Oklahoma MJ Legalization Init Filed, More... (1/6/22)

It's January and marijuana legalization efforts are winding up, Manhattan's new DA will refuse to prosecute some drug crimes, and more.

Marijuana Policy

Iowa Lawmakers Release Proposal to Put Marijuana Legalization on the Ballot. Three state Senate Democrats have filed a constitutional amendment to legalize marijuana in the state. The proposal would put the state's Alcoholic Beverage Commission in charge of regulations, would allow people 21 and over to possess and purchase marijuana, and set up a system of taxed and regulated production and sales. To become law, the amendment would have to be approved by two General Assemblies and then put on the next election ballot. Senators Joe Bolkcom (D-Iowa City), Sarah Trone Garriott (D-Windsor Heights), and Janet Petersen (D-Des Moines) introduced the proposal.

New Hampshire House Refuses to Pass or Kill Marijuana Legalization Bill. The House on Tuesday voted down an attempt to kill a marijuana legalization bill, House Bill 237, but then also refused to pass it. The bill would have legalized recreational marijuana use for adults 21 years old and older, regulated its use and commercial sales, and tax those sales. The motion to kill the bill failed on a 171-158 vote, while a motion to pass the bill failed on a 170-163 vote. The House then decided on a 300-32 vote to table the bill.

New York Governor Announces $200 Fund for Social Equity Marijuana Businesses. The state will create a $200 million fund to assist social equity applicants trying to get marijuana business licenses, Gov. Kathy Hochul (D) announced during her State of the State address Wednesday. But the funding mechanism -- a "public/private" model based on licensing fees and taxes -- has some minority industry members concerned that the funding will only be available after the industry has already been established, still leaving social equity applicants in an adverse position.

Oklahoma Activists File New Marijuana Legalization Initiative. Activists on Tuesday filed a new marijuana legalization initiative with state officials. This time, the local activists are being backed by the national New Approach PAC, which has backed a number of successful initiatives in other states. A different group of state activists has already filed its own legalization initiative. This newest measure would allow people 21 and over to possess up to an ounce, grow up to six plants and six seedlings, and set up a system of taxed and regulated marijuana sales. If and when the initiative is approved for signature-gathering, the campaign will have 90 days to come up with 94,911 valid voter signatures to qualify for the ballot.

Medical Marijuana

Mississippi Governor Says Proposed Current Dosage Amount for Medical Marijuana is Too High. Governor Tate Reeves (R) is digging in his heels on concerns about how much marijuana medical marijuana patients could use under proposed legislation. "If 10 percent of the Mississippi population gets a marijuana card, that's 300-thousand Mississippians," he said. "At 11 joints a day, that's 3.3 million joints a day, 100 million joints a month,1.2 billion joints on the streets of Mississippi a year and I just think that's too much to be on the streets." Voters approved medical marijuana in the November 2020 elections, only to see it thrown out by the state Supreme Court. Both Reeves and the legislature have vowed to enact medical marijuana legislation, but they have yet to reach an agreement.

Prosecution

Manhattan DA Announces Office Will Not Prosecute Certain Offenses, Including Some Drug Offenses. New Manhattan District Attorney Alvin Bragg issued a memo this week directing his prosecutors to seek jail or prison time only for the most serious offenses and not prosecute charges such as marijuana misdemeanors, fare-jumping, trespass, unlicensed vehicle operation, prostitution, or resisting arrest unless the offense is accompanied by another misdemeanor or felony. Also, small-time drug sellers will not be charged with felonies and will be eligible for diversion. Bragg is only the latest big city progressive prosecutor to embrace such an approach to prosecution; prosecutors in places like Houston, Los Angeles, Philadelphia, and San Francisco have been leading the way.

International

Duterte Says He Will "Never Apologize" for Drug War Deaths. Outgoing Philippines President Rodrigo Duterte remains unrepentant about the thousands of people killed in his bloody war on drugs. In a major speech Tuesday, he said police doing their duty had a right to fight back when their lives were endangered, and that he would not apologize for his actions. "I will never, never apologize for the deaths of those bastards," he said in English, before adding in Tagalog, "Kill me, imprison me, I will never apologize." Official government numbers put the death toll in Duterte's drug war at 6,200, but human rights groups say the real toll is more than 30,000. The Duterte administration is currently trying to fend off an International Criminal Court investigation of human rights abuses in its drug war.

OR Has Another $270 Million for Drug Treatment Programs, Germany to Legalize Marijuana, More... (11/19/21)

Germany is moving to legalize marijuana, DC is moving to legalize marijuana sales, and more.

Employers are beginning to move away from drug testing workers and job applicants, a new survey finds. (Creative Commons)
Marijuana Policy

DC Council Holds Hearing on Legal Marijuana Sales Bill. The DC Council on Friday held its first public hearing on a bill to legalize the sale of marijuana in the District. Marijuana has been legal in the District since voters approved Initiative 71 in 2014, but not sales, which has instead emerged as a sort of gray market via the practice of "gifting" marijuana. There is widespread support for legalizing sales, from Mayor Muriel Bowser (D) to members of the Council. That would require ending a six-year-old congressional prohibition on sales, which Democrats are already moving to repeal, but which may not happen this year. And then there's the possibility that Republicans can take back control of the House next year and reinstate the ban. But at the Council, the debate is now underway.

Drug Testing

Survey: Nearly One-in-Ten Employers Dropping Drug Testing Requirements to Attract Workers. A survey of some 45,000 employers in North America and Europe finds that about one out of 10 are dropping drug testing requirements as a way to attract new hires and keep current employees. Nine percent of those responding said they had "eliminated job screenings or drug tests" as a way to either attract or keep their employees. Sixty-nine percent of respondents acknowledged experiencing "difficulty" in filling staffing positions in the current job market, a 15-year high. The increasing number of states that have legalized marijuana is also having an impact, with Amazon dropping pre-employment marijuana testing in June, and a number of cities and states have enacted policies restricting testing for marijuana.

Drug Treatment

Oregon Set to Spend $270 Million on Drug Treatment Centers as Part of Decriminalization Law. The state Oversight and Accountability Council, created as part of the successful Measure 110 drug decriminalization initiative passed last November, is set to distribute $270 million to groups treating people addicted to drugs. The council has now opened the grant process for groups to seek a share of those funds, which come from legal marijuana tax revenues as mandated by Measure 110. Meanwhile, the council is continuing to craft rules for the new Behavioral Health Resource Networks to increase access to treatment and other services. "Our vision is that by funding BHRNs, there will be a collaboration of networks that include culturally and linguistically specific and responsive, trauma-informed and gender affirming care that will meet the needs of anyone seeking services who have been negatively affected by substance use and the war on drugs," said Oversight & Accountability Tri-chair LaKeesha Dumas.

International

German Coalition Parties Agree to Legalize Marijuana. The three parties set to form the country's next governing coalition have agreed to legalize marijuana and its sale. The Social Democrats, the Greens, and the Free Democrats are prepared to "introduce the regulated sale of cannabis to adults for consumption purposes in licensed stores," according to the coalition's health group's findings paper. Legalization would ensure quality control, protect minors, and prevent the distribution of contaminated products, the paper said. It is not clear, however, whether home cultivation will be allowed.

Congress to Temporarily Extend Fentanyl Analogue Ban, House to Vote on Marijuana Banking, More... (9/22/21)

Protections for banks dealing with state-legal marijuana businesses will get a House floor vote as part of a defense spending bill, the Congress is poised to temporarily extend the ban on fentanyl analogues, and more.

Overdose deaths rose while opioid prescriptions declined. Go figure. (Pixabay)
Marijuana Policy

Amendment to Protect Banks That Service Marijuana Industry Will Get House Vote. The House Rules Committee on Tuesday approved an amendment to the National Defense Authorization Act (NDAA) to provide protections to financial institutions that service the state-legal marijuana industry. The amendment is identical to the SAFE Banking Act, which has already passed the House four times. A House floor vote could come as soon as this week. But advocates were disappointed that other reform measures, including an amendment to promote research into the therapeutic uses of certain psychedelics, were rejected by the committee. Adding non-related amendments to spending bills that are difficult to vote against is often used to get legislation passed that is otherwise stalled.

Medical Marijuana

Pennsylvania Bipartisan Bill to Remove DUI Penalties for Medical Marijuana Users Filed. State Reps. Chris Rabb (D-Philadelphia} and Todd Polinchock (R-Bucks) have introduced legislation that would ensure the rights of the more than 500,000 medical cannabis patients in Pennsylvania, protecting them from DUI penalties. Under current state law, the presence of marijuana metabolites, which remain present for days or weeks after ingestion, is considered evidence of impairment. "A medical cannabis user can take a miniscule amount of medicine for their ailment and weeks later, with traces of cannabis still in their system, be subject to arrest on a DUI charge if pulled over -- not because they've driven impaired, but because our state laws haven't caught up with the science," Rabb said. "And, if you think you don't know someone who falls into this category -- a person who has been prescribed medical cannabis and who drives and is fearful of the potential DUI charge they could face -- you're wrong. I am a card-carrying medical cannabis patient, and I drive regularly, including in and around Philadelphia and to Harrisburg conducting the people's business."

Opioids

Congress to Temporarily Extend Fentanyl Analogue Ban. Rather than make a final decision on whether to make permanent a ban on fentanyl analogues, the House is preparing to vote to extend a temporary ban set to expire October 22, pushing the expiration date to January 28 as part of a stopgap spending bill. The White House has asked Congress to permanently schedule all fentanyl-related substances as Schedule I, but advocates and some lawmakers say such a move is wrongheaded and will lead to over-policing. Sen. Cory Booker (D-NJ) has made such arguments and says he is "not a fan" of extending the deadline. "We have consistently said that this anti-science policy must expire," Maritza Perez, director of the Drug Policy Alliance's Office of National Affairs, said. "This extension will hopefully give Congress ample time to come up with a public health solution that is desperately needed to save lives."

Overdoses Climbed as Opioid Prescriptions Declined, AMA Report Finds. Both fatal and non-fatal drug overdoses have increased over the past decade, even as physicians have prescribed 44 percent fewer opioids during the same period, the American Medical Association said in a new report. The report cited the rise of prescription drug monitoring programs as a key factor in reducing prescribing. The AMA said lawmakers need to "act now" to address the overdose crisis. "The nation's drug overdose and death epidemic has never just been about prescription opioids," said AMA President Gerald E. Harmon, MD. "Physicians have become more cautious about prescribing opioids, are trained to treat opioid use disorder and support evidence-based harm reduction strategies. We use PDMPs as a tool, but they are not a panacea. Patients need policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and help us remove barriers to evidence-based care." The AMA is calling for an end to requiring prior authorization for medications to treat opioid use disorder, evidence-based care including opioid therapy for patients with pain, and support for harm reduction services, such as needle exchanges and the wide distribution of the opioid overdose reversal drug naloxone.

Will the SAFE Marijuana Banking Act Break Through to the Senate? [FEATURE]

For the second time in as many years, the House of Representatives passed the Secure and Fair Enforcement (SAFE) Banking Act (H.R. 1996) on Monday. The bill is designed to allow state-legal marijuana businesses access to banking and financial services. The bill would bar federal regulators from imposing civil or even criminal penalties on financial institutions that serve those businesses.

In an indication of broad political support for normalizing marijuana, the bill was approved on a bipartisan vote of a 321 to 101, with 91 Republicans and one Independent joining with the Democratic majority. It is not at all clear, however, whether any Republicans in the Senate can be persuaded to follow the lead of their House colleagues when they are presented with a chance to vote on companion legislation, S. 910, in the evenly-divided Senate.

Still, the measure is endorsed by a wide variety of groups, including the National Association of State Treasurers and governors from 21 states and territories.

The bill was authoredby US Rep. Ed Perlmutter (D-CO), who has been introducing it since 2013, sponsored by Reps. Nydia M. Velázquez (D-NY), Steve Stivers (R-OH), and Warren Davidson (R-OH), and cosponsored by 180 members.

"After years of bringing up this issue, I'm thrilled to see overwhelming support for this bipartisan, commonsense legislation in the US House once again. I feel optimistic about the path forward for the SAFE Banking Act and, more broadly, reforms to our federal cannabis laws," said Perlmutter in a statement after the vote.

"Congress needs to act in order to catch up with the will of the majority of voters across this county and to ensure we are reducing the public safety risk for our constituents and communities," he continued. "I look forward to working with [Senate cosponsors] Senators Merkley and Daines to get the SAFE Banking Act passed in the Senate and signed into law."

For years, state-legal marijuana businesses have been hampered by the lack of access to such business necessities as checking accounts, payroll accounts, and lines of credit because of the financial services industry's fear of running afoul of federal law enforcement. That has required a multi-billion-dollar industry to operate in cash, which poses obvious security problems, as well as depriving banks and other lending institutions access to that capital to invest it productively.

"This bill would finally allow business in states that have legalized cannabis to access to the banking system, just as any other business currently enjoy," said Velasquez. "Doing so will help create jobs in communities throughout America, while stimulating the economy as we recover from the fallout of the pandemic."

"This bill is not about being for or against marijuana, but rather being for the safety and wellbeing of our communities," said Stivers.

The Marijuana Policy Project (MPP) was pleased with the vote.

"This vote marks a meaningful first step in establishing a more equitable cannabis industry and improves the likelihood that other cannabis legislation will advance at the federal level," MPP executive director Steve Hawkins said in a statement.

"Restricting cannabis businesses from accessing financial services creates an unnecessary burden for the industry and limits economic growth," Hawkins added. "If enacted into law, the SAFE Banking Act would strengthen efforts to increase the diversity of the cannabis industry by providing resources for those with limited access to capital and increasing the chances of success for state-level social equity initiatives. Further, it would protect the 321,000 employees directly affected by the cannabis industry's lack of access to financial services."

Now it is up to the Senate. Majority Leader Chuck Schumer (D-NY) is working with Sens. Cory Booker (D-NJ) and Ron Wyden (D-OR) on a full marijuana legalization bill, and there are indications he is concerned that passing more modest reforms before that could undermine that push. But there is also considerable pressure to move on the SAFE Banking Act. Stay tuned.

CA Marijuana Arrests Decline But Disparities Persist, AR MedMJ Growers Sue to Block Competition, More... (7/17/20)

California marijuana felonies are at the lowest level since 1954, Argentina moves to make its medical marijuana program more patient-friendly, and more.

Black and Hispanic Californians are still more likely to be arrested for marijuana than whites. (Creative Commons)
Marijuana Policy

California Felony Marijuana Arrests Decline After Legalization, But Racial Disparities Persist. Felony marijuana arrests continued to decline in the wake of legalization, dropping from 1,617 in 2018, the first year of broad legalization, to 1,181 last year, a decline of 27%. But minorities remained subject to disproportionate arrests, with Hispanics accounting for 42%, Blacks for 22%, and whites at 21%. The percentage of Black and Hispanic arrests "is troubling, especially now that we've legalized it," said Ellen Komp, deputy director of the California arm of the National Organization for the Reform of Marijuana Laws. "It's legal if you have the venture capital to open up on Main Street." The number of felony arrests last year marked the lowest figure since 1954, NORML said.

Medical Marijuana

Arkansas Medical Marijuana Growers Sue to Keep Out Competition. Five companies with medical marijuana cultivation permits are suing to stop three more cultivation licenses from being issued. The growers argue that the new licenses issued in June violated state law because the law requires they only be issued if the original permit holders couldn't meet patient demand.

International

Argentina to Allow Home Cultivation, Pharmacy Sales for Medical Marijuana. The Health Ministry on Wednesday met with stakeholders Wednesday to finalize details on draft regulations for medical marijuana cultivation and sales. The draft regs will allow for home cultivation by patients and the sale of oils and topicals by local pharmacies. The regs also guarantee access to medical marijuana for all patients free of charge. The new regulations are aimed at addressing deficiencies in the country's 2017 law that legalized medical marijuana, but failed to adequately cover patient needs.

House Includes Marijuana Banking in COVID Bill, Mexico Soldiers to Stay on Streets, More... (5/12/20)

A Mexican cartel leader is struck down by the coronavirus, the House leadership is including help for state-legal marijuana businesses in the latest coronavirus relief bill, and more.

The House leadership has included relief for state-legal marijuana businesses in the new COVID bill. (Creative Commons)
Marijuana Policy

House COVID Package Includes Cannabis Banking Relief, But Not Small Business Support. The House leadership has included banking relief for the state-legal marijuana industry in its latest coronavirus relief package, the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act. It has done so by incorporating HR 1595, the SAFE Banking Act, within it. That bill amends federal law so that banks and other financial institutions may work directly with state-legal marijuana businesses. The House already approved the SAFE Banking Act back in September. Still, language to amend eligibility for Small Business Administration loans for small businesses was not included.

Maine's Long, Long Road to Legal Marijuana Sales. Nearly four years ago, the state approved a marijuana legalization initiative, but it has yet to see a legal marijuana retailer open. Then Tea Party Republican Gov. Paul LePage threw up obstacles until he left office, and nearly a year ago, the state adopted rules for adult-use marijuana businesses, and the hope was to launch retail this spring, but then coronavirus appeared. This is as the state is waiting for approval from state and local government, including Portland, the state's largest city. The city council there could vote on a local ordinance later this month, but the state says it still can't provide a timeline for the launch of legal sales. Any year now...

International

Mexican President Renews Orders Keeping Military on Streets to Curb Rising Violence. President Andres Manuel Lopez Obrador has ordered the military to take on organized crime and violence for another four years, extending a policy he had previously criticized. He ordered the military to participate "in an extraordinary, regulated, and complementary manner with the National Guard" in public security tasks. Lopez Obrador won office in 2018 with a plan to reduce crime and violence by focusing on the root causes of crime, but the violence has only continued, with a record 35,000 people killed in 2019. "His security strategy is not working and that is why he has had to order with this decree for the Armed Forces to support public security," security specialist Juan Ibarrola told the Milenio newspaper.

Mexican Los Zetas Leader Killed by Coronavirus in Jalisco Prison. Moises Escamilla May, a Los Zetas leader imprisoned for beheading 12 people in Cancun has died of coronavirus at the Puente Grande Federal Prison in Jalisco. He was 45 years old. Security analysts have warned that the impact of the virus on the leadership of criminal organizations, which tend to be older males, could be destabilizing as more experienced leaders who have developed negotiating skills are killed off by the bug, only to be replaced by less experienced and more violent mid-level commanders.

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