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Chronicle AM: OK Legalizes MedMJ, Colombia Drug War Could Be Gearing Up, More... (6/27/18)

Oklahoma voters pass a very progressive medical marijuana initiative, legalizers win the Democratic gubernatorial nominations in Colorado and Maryland, Maine passes a major medical marijuana overhaul, and, with rightists now in power in Washington and Bogota, it looks like a new drug war is looming in Colombia.

Cocaine supply is at record levels and Colombia's newly elected president wants to do something about it. (CBP)
Marijuana Policy

Marijuana Legalizers Win Democratic Gubernatorial Nominations in Two States. Colorado US Rep. Jared Polis, a leading congressional proponent of marijuana legalization, won the nomination in his state, while former NAACP head Ben Jealous, who has also called for marijuana legalization, won the nomination in Maryland.

Florida Medical Marijuana Proponent Now Wants 2020 Legalization Initiative. Orlando attorney John Morgan, the man behind the state's successful 2016 medical marijuana initiative, now says he wants to put a legalization initiative on the 2020 ballot. It would "pass overwhelmingly," Morgan said. The longtime Democratic fundraiser pointed to President Trump's recent comments on marijuana: "And I believe in light of President Trump's position, America is ready and willing."

Texas Poll Has Narrow Majority for Legalization. More than half of Texas registered voters polled in the newest University of Texas/Texas Tribune poll support legalizing marijuana. Some 53% said they favored legalizing either small amounts (30%) or any amount (23%). Another 31% would support legalizing medical marijuana, leaving only 16% against legalizing marijuana in any form. A much larger majority -- 69% -- supported reduced penalties for the possession of small amounts.

Medical Marijuana

Maine Legislature Passes Medical Marijuana Overhaul. The legislature has passed a sweeping overhaul of the state's medical marijuana program. The bill removes current qualifying conditions and allows doctors to recommend medical marijuana for any ailment and allows caregivers to expand their operations in exchange for tighter regulations. The bill now goes to the desk of Gov. Paul LePage.

Oklahoma Legalizes Medical Marijuana. One of the reddest of red states went green on Tuesday. Voters in Oklahoma approved a remarkably progressive medical marijuana initiative by a healthy margin of 56% to 43%. The initiative, State Question 778, allows registered patients to possess up to three ounces of marijuana anywhere and up to eight ounces at home. Patients also have the right to grow up to six mature and six immature plants or have designated caregivers do it for them. It also creates a system of licensed dispensaries, cultivation, and processing facilities and sets taxes at a relatively low 7%. The initiative also bars localities from using zoning laws to block dispensaries (although they wouldn't be allowed within 1,000 feet of a school). But what is most striking about Question 778 is that it does not restrict access to medical marijuana to a list of qualifying conditions. In fact, the initiative language explicitly states that "[T]here are no qualifying conditions" and that the only limitation on a doctor's recommending medical marijuana is that it must be done "according to the accepted standards a reasonable and prudent physician would follow when recommending or approving any medication."

Harm Reduction

Ohio Officials Dragging Feet on Federal Needle Exchange Funds, Advocates Charge. The advocacy group Harm Reduction Ohio is accusing the state Health Department of using a bureaucratic delaying tactic to prevent needle exchange programs from accessing any of the funds the state is expected to receive for HIV prevention. Group head Dennis Cauchon said the department is failing to submit a necessary form to the federal Centers for Disease Control and Prevention. "Preventing HIV, hepatitis and drug overdoses are crucial health measures and save massive amounts of money and treatment," Cauchon wrote. Surrounding states submitted the necessary paperwork in 2016, he noted. "The Ohio Department of Health's refusal to support this would be nothing short of reckless, irresponsible and ignorant."

International

UNODC Says Cocaine, Opium Supplies at Record Levels. In its 2018 World Drug Report released Tuesday, the UN Office on Drugs and Crime (UNODC) reported that both cocaine and opium supplies were at their highest ever recorded levels last year. UNODC also described the non-medical use of prescription opioids, such as fentanyl, as a major threat to public health. "Drug markets are expanding, with cocaine and opium production hitting absolute record highs, presenting multiple challenges on multiple fronts," said UNODC Executive Director Yury Fedotov in a statement. "The real problematic issues for us have been the increase in opium production in Afghanistan and the massive increase in cocaine production, particularly because of Colombia," added Thomas Pietschmann, a drug research expert at the UNODC, and one of the lead authors of the report.

Colombia's New Rightist President-Elect Welcomes Trump's Support in New War on Drugs. President-elect Ivan Duque said Monday he welcomed Donald Trump's support for his agenda of a "head-on fight against drug trafficking" during a congratulatory phone call from the US leader. "Today I received a call from the US president where he congratulated us for the results achieved in the last elections and also his commitment to support our security, justice agenda, our agenda of a head-on fight against drug trafficking," Duque told reporters. The US wants Duque to clamp down hard on coca cultivation, which is at record levels. During the campaign, Duque vowed to reinstate the forced eradication of coca crops and the aerial spraying of herbicides over coca farms.

Colombia's Outgoing President Authorizes Use of Drones for Aerial Coca Eradication. Outgoing President Juan Manuel Santos on Tuesday authorized the use of drones to spray herbicides on coca crops. The move comes a day after the US said Colombian coca cultivation had increased 11% last year and cocaine production jumped 19%. Santos' government suspended aerial eradication of coca crops with glyphosate in 2015 after the World Health Organization linked it to cancer. Using low-flying drones would limit the dangers associated with glyphosate, he said.

(This article was prepared by StoptheDrugWar.org's 501(c)(4) lobbying nonprofit, the Drug Reform Coordination Network, which also pays the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

Chronicle AM: CA Pays for Fentanyl Test Strips, CA Marijuana Banking Bill Advances, More... (6/1/18)

The California Senate approves a bill to create financial services for the pot industry, the California public health department is paying needle exchanges to hand out fentanyl test strips, a New York bill would allow the use of CBD oil instead of opioids to treat pain, and more.

Marijuana Policy

California Marijuana Banking Bill Passes Senate. The state Senate voted 29-6 Wednesday to approve Senate Bill 930, which would allow financial institutions to offer limited banking services to legal marijuana businesses. The bill would create limited-charter licenses for banks and credit unions allowing them to issue special checks that could be used by the industry. The measure now goes to the Assembly.

Three Out of Four Florida Democratic Gubernatorial Contenders Support Legalization. Florida Democrats are seeing a near consensus for marijuana legalization among the current crop of gubernatorial candidates. Tallahassee Mayor Andrew Gillum, Winter Park entrepreneur Chris King and former Miami Beach Mayor Philip Levine all back legalization. Former Congresswoman Gwen Graham is the outlier; she only backs decriminalization.

Medical Marijuana

New York Bill Would Allow CBD Cannabis Oil to Be Used Instead of Opioids for Pain. State Sen. George Amedore (R) on Thursday filed Senate Bill 8820, which would allow the use of CBD cannabis oil in place of opioids. Amedore is co-chair of the Senate Task Force on Opioid and Heroin Addiction and said that the evidence is clear marijuana is less harmful and addictive than opioid painkillers.

Harm Reduction

California Paying Needle Exchanges to Provide Fentanyl Test Strips. For a year now, the state public health department has been paying needle exchanges to distribute fentanyl test strips to their clients in a bid to lower overdose deaths. The tests cost $1 each. Users mix a bit of their drugs in water and then dip the strip in for a few seconds and they get results back within five minutes. About half of the state's 45 needle exchanges are distributing the strips. The state has spent $57,000 on the project so far.

(This article was prepared by StoptheDrugWar.org's 501(c)(4) lobbying nonprofit, the Drug Reform Coordination Network, which also pays the cost of maintaining this website. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

Chronicle AM: NY Dems Endorse Marijuana Legalization, Surgeon General Talks Harm Reduction, More... (5/24/18)

The US Surgeon General has some surprisingly frank words about harm reduction and evidence-based drug policy, Cory Booker's Marijuana Justice Act picks up another sponsor, Arizona's Supreme Court throws out a state law criminalizing the use and possession of medical marijuana on campus and more.

The section on the Surgeon General's comments has an update, including a statement from the Department of Health and Human Services on the safe injection sites mention.

US Surgeon General Jerome Adams talks harm reduction and evidence-based opioid treatment. (Creative Commons)
Marijuana Policy

Jeff Merkley Signs on to Federal Marijuana Justice Act. And then there were five. Sen. Jeff Merkley (D-OR) has become the fifth cosponsor of Sen. Cory Booker's Marijuana Justice Act (S. 1689). The other cosponsors are Sens. Kirsten Gillibrand (D-NY), Kamala Harris (D-CA), Bernie Sanders (I-VT), and Ron Wyden (D-OR). Representatives Barbara Lee (D-CA) and Ro Khanna (D-CA) introduced a companion measure, H.R. 4815, in the House of Representatives earlier this year that has 35 cosponsors.

New York Democratic Party Officially Endorses Marijuana Legalization. Delegates to the state Democratic convention Wednesday adopted a resolution supporting marijuana legalization: "The New York State Democratic Committee supports the legalization of marijuana which should be regulated and taxed in a manner similar to alcohol," reads a resolution. The resolution adds that legalization is "an important social justice issue."

Medical Marijuana

Arizona Supreme Court Okays Medical Marijuana on College Campuses. The court ruled Wednesday that the state can't criminally charge card-carrying medical marijuana patients for possessing and using their medicine on campus. In Arizona v. Maestas, the court held that a 2012 law banning medical marijuana on campus violated the state's protections for voter-approved laws. The Supreme Court ruling upholds an appellate court ruling that also found in Maestas' favor.

Ohio Dispensary License Announcement Delayed. The state Board of Pharmacy announced Tuesday that its planned announcement of dispensary license awards Wednesday has been postponed and that provisional licenses will instead be issued in June. Legal medical marijuana sales are supposed to begin on September 8. Stay tuned.

Pennsylvania Judge Halts Medical Marijuana Research Program. A Commonwealth Court judge has granted a temporary injunction sought by numerous dispensaries and growers and processors to halt the state's medical marijuana research program. The plaintiffs worry that the regulations for the clinical research programs would give an unfair advantage to clinical research partners and growers. The Health Department is now pondering next steps.

Hemp

Illinois Governor Gets Bill Legalizing Industrial Hemp. With a 106-3 House vote Wednesday, the legislature has approved a bill legalizing industrial hemp, Senate Bill 2298. Now it's up to Gov. Bruce Rauner (R) to sign it.

Heroin and Prescription Opioids

US Surgeon General Urges ER Docs to Advocate for Evidence-Based Opioid Treatment. US Surgeon General Dr. Jerome Adams called Wednesday on emergency room physicians to advocate more vigorously for evidence-based opioid treatment, including harm reduction measures. Adams supported such harm reduction interventions as needle exchanges and safe injection sites. [The Department of Health and Human Services has issued a statement claiming that Dr. Adams does not support safe injection sites, and contesting the evidence on them. See update below.] He urged doctors to reach out to and educate stakeholders in their communities. "We have to understand that these policy interventions look different in different parts of the country," Adams said. "We have to understand that public policy means public and that we have to be able to go there and show them that we care before we can share what we know."

Update: A Department of Health and Human Services officer contacted us on Saturday, March 26th, claiming that the report news outlets relied on, including the one we linked to, was inaccurate in stating that Dr. Adams supports safe injection sites. We do not have other reports on his speech at this time to go on. The article linked above has been updated to include a copy of the HHS statement:

"The Administration and the Surgeon General do not support so-called 'safe' injection sites as a means to combat the opioid epidemic and its consequences. In addition, there is no evidence to demonstrate that these illegal sites reduce drug use or significantly improve health outcomes for those with opioid use disorder. So-called 'safe' injection sites lack the necessary scientific support to be considered a standardized evidence-based practice in the U.S."

Another article states that Adams mentioned safe injection sites as being "part of the conversation" in some communities.

Ed: We are in a position to address the administration's characterization of the evidence on safe injection sites, and it is false to the point of absurdity. There is significant evidence that safe injection sites improve health outcomes for persons with opioid use disorders. In fact, multiple journal articles to this effect are available on the website of the National Institutes of Health, a division of Health and Human Services. Here are a few of them:

  • A 2017 study in Canadian Family Physician found that "SISs are associated with lower overdose mortality (88 fewer overdose deaths per 100 000 person-years [PYs]), 67% fewer ambulance calls for treating overdoses, and a decrease in HIV infections."
  • A 2017 article in Harm Reduction Journal notes with citations that evaluation of Vancouver's Insite program showed it was "meeting its objectives of reducing public disorder, infectious disease transmission, and overdose and was successfully referring individuals to a range of external programs, including detoxification and addiction treatment programs.". The article further states that "over 40 peer-reviewed studies have been published which speak to the many benefits and lack of negative impacts of this site."
  • A 2008 article in the American Journal of Public Health reported that the supervised injection facilities in Sydney and Vancouver were "negatively associated with needle sharing... and positively associated with less-frequent reuse of syringes... less outdoor injecting... using clean water for injection... cooking or filtering drugs prior to injecting... and injecting in a clean location," that "[b]oth... were effective gateways for addiction treatment, counseling, and other services," and that there were no "reported overdose deaths in a SIF."
  • A 2014 article in Drug and Alcohol Dependence found that "[s]eventy-five relevant articles... converged to find that SISs were efficacious in attracting the most marginalized PWID, promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency" and that "SISs were found to be associated with reduced levels of public drug injections and dropped syringes."
  • A 2008 article in the Canadian Medical Association Journal found "Vancouver's supervised injection site is associated with improved health and cost savings."
  • A 2010 article in Addiction found that if Vancouver's supervised injection facility "were closed, the annual number of incident HIV infections among Vancouver IDU would be expected to increase from 179.3 to 262.8. These 83.5 preventable infections are associated with $17.6 million (Canadian) in lifetime HIV-related medical care costs, greatly exceeding Insite's operating costs, which are approximately $3 million per year."

Chronicle AM: Hemp News, San Antonio Could Finally Get a Legal Needle Exchange, More... (5/17/18)

There's good and bad news on hemp today, a new Rhode Island marijuana legalization bill is filed, San Antonio moves toward the first legal needle exchange in Texas, and more.

Hemp fields are starting to pop up. (Vote Hemp)
Marijuana Policy

Rhode Island Marijuana Legalization Bill Introduced. Sen. Joshua Miller (D-Providence) Thursday filed a bill to tax and regulate marijuana. He's been introducing similar bills since 2014. The bill would tax pot at 10% in addition to the state's 7% sales tax, as well as allowing up to another 3% in local taxes. Adults could possess up to an ounce and grow up to two plants. The bill is not yet available on the legislative web site.

Hemp

House Republicans Block Votes on Hemp Amendments. The House Republican leadership has blocked several proposed industrial hemp amendments from being considered on the House floor. Proponents had hoped to add the amendments to the farm bill now under consideration, but the House Rules Committee put the kibosh on that. Chairman Rep. Pete Sessions (R-TX) has a reputation for blocking marijuana-related measures, and he just upheld it again.

Arizona Governor Signs Hemp Bill. Gov. Doug Ducey (R) has signed into law Senate Bill 1098, which will create a state pilot program allowing the study and cultivation of industrial hemp. Growing, processing, and transporting hemp will require permits from the state Department of Agriculture.

Indiana Lawmakers Will Study Hemp -- Not Medical Marijuana -- This Summer. An interim legislative committee will spend the summer considering the legalization of hemp, but the panel "will not look into issues related to medical marijuana."

Harm Reduction

Ithaca Mayor Calls on New York Governor to Approve Safe Injection SitesThere. Mayor Svante Myrick (D) has asked Gov. Andrew Cuomo (D) to approve a safe injection site in Ithaca. The move comes after New York City announced a plan for four safe injection sites there. "The overdose crisis is statewide and the pilot intervention should be too," Myrick wrote to Cuomo. "This epidemic is also a rural epidemic and our solutions will need to address that reality. Start with Ithaca." The Ithaca Municipal Drug Policy Committee recommended in February 2016 that a supervised consumption pilot program should be implemented in Ithaca.

San Antonio Could Become First Legal Needle Exchange Site in Texas. A decade after a local prosecutor arrested three volunteers for a clean needle program, city officials are set to sing a different tune. Next week, city and county officials, health care providers, drug treatment providers, law enforcement, and nonprofits will meet to discuss how to make San Antonio the first city in the state to have a legal needle exchange program. Stay tuned.

Law Enforcement

Justice Department to Add More Than 300 New Prosecutors. DOJ announced Thursday that it is creating 311 new assistant US attorney positions, the largest increase in prosecutors in decades. More than half will focus on violent crime, 86 on civil enforcement, and 35 on immigration-related crime. Most of the new positions in civil enforcement will be focused on his department's newly created task force targeting opioids. "Under President Trump's strong leadership, the Department of Justice is going on offense against violent crime, illegal immigration, and the opioid crisis -- and today we are sending in reinforcements," Attorney Geneal Sessions said in a statement.

International

Thai Interim Cabinet Approves Medical Marijuana, Decriminalizes Hemp, Kratom, Opium. The interim cabinet has approved a bill that would allow the use of marijuana for medical reasons, as well as decriminalizing the consumption of hemp, kratom, and opium. "The approval of this bill is an important matter," government spokesman Sansern Kaewkamnerd said. "Class 5 narcotics were allowed for cultivation and extraction… but not for consumption, which made it impossible to use them for research on humans. The bill now goes before the interim assembly.

Chronicle AM: Another Record Pot Poll, Brit Docs Call for Drug Legalization, More... (4/30/18)

A new Quinnipiac poll has the highest support yet for marijuana legaization, Maine's Tea Party governor again vetoes a legalization implementation bill, cartel murders spark a mass demonstration in Mexico, the British Royal College of Physicians calls for drug legalization, and more.

Marijuana Policy

New Quinnipiac Poll Has Support for Legalization Surging. Support for marijuana legalization has hit a new high in the latest Quinnipiac poll, released last Thursday. Pollsters found that 63% support federally legalizing marijuana, the highest number yet for this poll and in line with other recent polls showing support above 60%. "Voters are more favorable to legalizing marijuana than in any previous Quinnipiac survey," said Peter A. Brown, assistant director of the poll.

California Marijuana Banking Bill Advances. A bill that would make it easier for state marijuana businesses to use financial services has been approved by a second Senate committee. Senate Bill 930 would create a special class of state-chartered banks and credit unions that could process transactions from legal marijuana businesses. The bill won the approval of the Senate Banking and Financial Institutions Committee last week and now heads for an Appropriations Committee vote. A favorable vote there would take the bill to the Senate floor.

Illinois Bill to Expunge Old Possession Convictions Advances. A bill that would allow people convicted of possessing small amounts of marijuana or paraphernalia to expunge their criminal records has been approved by the House Restorative Justice Committee. House Bill 2367 now heads to the House Rules Committee.

Maine Governor Vetoes Marijuana Legalization Implementation Bill. Tea Party Gov. Paul LePage has for the second time vetoed a measure aimed at implementing the state's voter-approved law allowing for legal marijuana commerce. The veto came last Friday, with LePage complaining that he didn't want separate medical marijuana and recreational marijuana programs and worrying about highway safety. The bill passed both houses by veto-proof margins, but LePage's veto could erode GOP support, allowing the veto to stand. Stay tuned.

Vermont Effort to Revive Marijuana Legalization Bill Fails. A last-minute push to resurrect the state's marijuana legalization bill emerged last Thursday, but fizzled out on Friday. The end came when the House's Democratic leadership decided it had other, more important, priorities for the last days of the legislative session.

Seattle Moves to Vacate Past Misdemeanor Marijuana Convictions. The city of Seattle has filed a motion in municipal court to vacate all past misdemeanor marijuana convictions in the city. The motion would affect some 542 people. The city is also requesting the dismissal of all outstanding misdemeanor marijuana charges.

Medical Marijuana

Arkansas Justices to Expedite Medical-Marijuana Case. The state Supreme Court has agreed to speed up its review of a ruling that has blocked the issuance of the state's first medical marijuana grow licenses. Some 220 medical marijuana dispensary applications are also on hold, and the state argued before the court that getting the licenses rolled out is a matter of significant public interest.

California Bill to Protect Patients' Employment Rights Advances. The Assembly Labor and Employment Committee voted last Wednesday to approve Assembly Bill 2069,which aims to end employment discrimination against medical marijuana patients by treating medical marijuana the same way current law treats prescription opioids and other drugs, by granting it "reasonable accommodation" under the state's Fair Employment and Housing Act. The bill now goes to the Assembly Appropriations Committee.

Idaho Medical Marijuana Petitioners Give Up. There will be no medical marijuana initiative in Idaho this year. The head of the Idaho Medical Marijuana Association says she has stopped collecting signatures and dissolved the group to care for her ailing son. The group needed 36,000 signatures by Monday and wasn't close.Utah Democrats Make Support for Medical Marijuana a Platform Plank. At the state party convention Saturday, the Democratic Party added medical marijuana to the party platform. A ballot initiative to legalize medical marijuana is likely to be on the ballot in November.

Heroin and Prescription Opioids

Charleston, West Virginia, Gives Up on Needle Exchanges. Even though West Virginia is the epicenter of the American opioid crisis, Charleston has shut down the city's needle exchange program, at least for now. City officials called the program a "mini-mall for junkies and drug dealers," and the chief of police imposed onerous restrictions on it, prompting Health Department officials to suspend the program rather than comply with them. The city's move is suggestive of the problems needle exchanges have in winning public acceptance, particularly in the smaller cities of the interior, where they are a relatively new phenomenon.

Drug Testing

Federal Judge Throws Out DC Random Drug Screening of Teachers. A federal district court judge ruled last Thursday that the District of Columbia's random drug screening policy violates the Fourth Amendment rights of teachers. The language mandating drug testing was rooted in a 2004 law that was largely neglected until 2013, when DC school officials issued a memorandum saying the facilities would be subject to the rule. A private school, two teachers, and a private school advocacy group sued the city. Now, they've won.

International

Zimbabwe Legalizes Medical Marijuana. The African country has approved the production and cultivation of marijuana for medicinal and research purposes. The health ministry issued an order saying individuals and companies can apply for licenses.

Mexico Cartel Murder of Three Students Results in Massive Peace Demonstration. More than 10,000 people took to the streets of Mexico's second largest city, Guadalajara, last Thursday to call for peace and demand justice for three film students who were kidnapped and murdered by members of the Jalisco New Generation Cartel. "The absurd war on drugs is taking our classmates and we will not allow it anymore,"said Jesus Medina, a student leader from the University of Guadalajara.

British Royal College of Physicians Calls for Drug Legalization. The Royal College of Physicians, representing some 26,000 British doctors, has called for the legalization of both soft and hard drugs, saying the criminal justice system fails to serve the interests of addicts. Instead of arresting drug users, they should be given "timely" care and support, the group said. "The criminal justice system is not the place to address the often complex needs of people addicted to drugs," said Jane Dacre, president of the RCP. "We are committed to ensuring that all people who need to do so are able to access timely and appropriate prevention and care services." The RCP adopted the policy at meeting of its general council.

Chronicle AM: DEA Deploys Against Opioids, NY Gov's Criminal Justice Plan, More... (3/29/18)

Mucho medical marijuana, a Connecticut legalization bill gets a hearing, the DEA is deploying 250 agents to fight opioids, Louisiana could get a full-fledged needle exchange program, and more.

The DEA is ready to fight some more drug war.
Marijuana Policy

Third Connecticut Legalization Bill Gets Hearing. A marijuana legalization bill that also includes funding for drug treatment and prevention got a hearing in the House Appropriations Committee Wednesday. House Bill 5394 calls for drafting a plan to legalize and regulate weed by October 1, as well as requiring a treatment and prevention plan by the same date.  The bill did not get a vote. Two other legalization bills before the legislature do not contain the treatment and prevention funding provisions.

Medical Marijuana

Arkansas Judge Puts Hold on State Medical Marijuana Program. A state judge last week put the state's program on hold because of objections to the licensing process, but was apologetic for imposing the delay. "Amendment 98 to the Constitution of Arkansas, an initiative by the people, exists because Arkansans want to provide medical marijuana to persons who suffer from chronic, debilitating, and life-threatening health challenges," Pulaski County Circuit Judge Wendell Griffen wrote in his order last week. "The prospect that Arkansans must now endure more delay before gaining much needed access to locally grown medical marijuana should be unpleasant to anyone concerned about providing relief to people who suffer from serious illnesses."

Kansas House Votes Down Medical Marijuana. As they debated changes to the state's drug laws, lawmakers in the House voted down an amendment that would have allowed the use of medical marijuana. The amendment was offered by Rep. Cindy Holscher (D-Lenexa), who said her own daughter, who suffers from juvenile rheumatoid arthritis, could benefit from access to the medicine. "Please don’t make us lawbreakers," Holscher said. "Give us an option for something that has been proven to work." But the underlying bill contains a provision that allows for the limited use of CBD cannabis oil.

Louisiana House Committee Approves Medical Marijuana for Autism. The House Health and Welfare Committee on Wednesday approved a bill that would add certain types of autism to the list of qualifying conditions for medical marijuana. The move comes as dispensaries are set to open in the state just four months from now. The measure, House Bill 627, now goes to the full House.

New Hampshire Senate Approves Bill to Add More Dispensaries. The state Senate last week approved a bill that would allow for two additional dispensaries in the state.  The state currently has four medical marijuana outlets. The bill now goes to the House.

South Carolina Senate Committee Advances Medical Marijuana Bill. The Senate Medical Affairs Committee approved a medical marijuana bill on Thursday. The measure, Senate Bill 212, now heads for a Senate floor vote.  But advocates worry the bill will die for lack of action in the House. The House has declined to hear its own medical marijuana bill so far this year, and the deadline for doing so is April 10.

Tennessee Medical Marijuana Bill Wins Second House Committee Vote. The House Criminal Justice Committee on Wednesday approved House Bill 1749, which would allow for the use of medical marijuana for a dozen qualifying conditions.  The bill now heads for a House floor vote.

Utah Poll Shows Enduring Strong Support for Medical Marijuana. More than three-quarters (77%) of Utahns "strongly" or "somewhat" favor legalizing medical marijuana, according to a new poll from Dan Jones & Associates. The poll is in line with other recent state polls show high levels of support, undaunted by the legislature's passage of a bill that allows for a "right to try" medical marijuana for terminally ill patients. An initiative that would create a full-blown medical marijuana system in the state will likely be on the ballot in November.

Heroin and Prescription Opioids

Federal Spending Plan Has Nearly $5 Billion to Deal With Opioid Crisis. The omnibus spending bill signed into law by President Trump last week contains some $4.6 billion. The biggest chunk of the money will go to states and tribes, especially those with the highest overdose mortality rates. Some 63,000 Americans died of drug overdoses last year. The funding is less than the $7 billion for fighting AIDS, which killed 42,000 Americans last year.  

DEA Deploying 250 Additional Agents to Fight Opioid Crisis. The DEA announced Tuesday that it is deploying 250 additional task force officers and dozens of analysts across the country in a bid to crack down on opioids. The additional agents and analysts will go to areas hardest hit by the epidemic.

Oregon Governor Signs Opioid Bills into Law. Gov. Kate Brown (D) on Tuesday signed into law two bills and an order setting deadlines for a drug policy commission that has been plagued with staffing and other issues. The order declares addiction a public health crisis in the state. Two bills, House Bill 4137 and House Bill 4143, cover similar ground and require studying barriers to addiction treatment.

Criminal Justice

New York Governor Launches Campaign to Overhaul Criminal Justice System. Gov. Andrew Cuomo (D) on Monday launched a "Campaign to Restore Fairness in New York’s Criminal Justice System." The governor's package would eliminate cash bail for misdemeanor and non-violent felony offenses, ensure access to speedy trials, improve the disclosure of evidence, reform asset forfeiture, and improve reentry programs for people leaving prison.

Harm Reduction

Louisiana House Approves Needle Exchange Bill. A bill that would expand needle exchange programs by allowing them without seeking approval from local governments was approved by the House Committee on Administration of Criminal Justice on Wednesday. House Bill 661 also expands the types of materials and programs a needle exchange can offer, including access to naloxone. The bill now heads for a House floor debate and vote next week.

International

Colombia Coca Growers Threaten to Suspend Cooperation With Peace Process. The federation that represents coca growers, COCCAM, said in a statement on Tuesday it is consulting its members "to define whether to suspend our participation" with the government program that seeks to substitute legal crops for coca.  The federation cited continuing violence, noting that more than 200 coca farmers have been killed since the beginning of the peace process in December 2016. The growers are also unhappy with the government's response to their complaints with Justice Minister Enrique Gil for proposing a law shielding coca growers from criminal prosecution, but which excludes families that have already signed up for the program. The bill also more than halved the amount of land to be considered a small grower, changes the federation called a "flagrant betrayal of the peasants, Afro-descendants and indigenous people who put their trust in the peace process by joining the program."

Georgia Drug Decriminalization Bill on Hold After Controversial Rewrite. A bill that would decriminalize drug use and possession has been held up after an interagency commission expressed support for a new draft drug policy law that activists say no longer talks about decriminalization.  The new draft also fails to differentiate quantities of drugs for personal use from those for distribution except in eight cases, meaning people caught with any amount of other drugs face years in prison. "Nobody mentioned decriminalisation at today’s hearing, which is alarming," Guram Imnadze, a lawyer from local rights group the Human Rights Education and Monitoring Centre (EMC) said after it was over. The current draft doesn't address the key problem with the country's drug policy, which, he said, was that "people spend years in prison for drugs they intended for personal use."

Chronicle AM: Trump Nixed Israeli MedMJ Exports, Duterte Faces ICC Investigation, More... (2/8/18)

Israeli Prime Minister says he barred medical marijuana exports because of Donald Trump, the International Criminal Court begins a "preliminary examination" of the Philippines' bloody drug war, and more.

Israeli PM Netanyahu says he barred medical marijuana exports at Trump's request. (Gage Skidmore/Wikimedia)
Medical Marijuana

Florida Lawmakers Shame Regulators Over Medical Marijuana Program. A joint legislative oversight committee tore into state medical marijuana czar Christian Bax on Monday. The Joint Administrative Procedures Committee used four separate unanimous votes to clarify its displeasure with rules and regulations promulgated by the Office of Medical Marijuana Use. Lawmakers are also unhappy that the office failed to respond to more than a dozen letters from lawmakers over the past four months identifying problems with the rules.

Nebraska Poll Has Strong Support for Medical Marijuana. A new Nebraska poll has 77% of respondents saying they would support allowing doctors to prescribe medical marijuana. Some 52% said they would definitely vote yes, while 22% would probably vote yes, and 3% were undecided but leaning toward yes. The poll comes as the legislature ponders a bill that would allow voters to weigh in on a constitutional amendment allowing medical marijuana.

Texas Sees First Dispensary, But CBD Only. Compassion Cultivation opened Thursday in Austin. It's the first dispensary to open under the state's CBD cannabis oil medical marijuana law. The state saw its first cannabis oil delivery to a patient earlier this week.

Harm Reduction

Iowa Needle Exchange Bill Advances. A three-member panel of the Senate Judiciary Committee voted unanimously Wednesday to approve a bill that would legalize needle exchanges in the state. Senate File 219 now heads for a vote of the whole committee.

San Francisco Regulators Back Safe Injection Site. The city's Health Commission voted unanimously Tuesday to approve a resolution supporting supervised injection services. The resolution endorses the recommendations of the Safe Injection Services Task Force, which calls for safe injection sites in the city. The matter does not need to go before the Board of Supervisors. The first two supervised injection sites could open as soon as July 1, Health Director Barbara Garcia said.

International

International Criminal Court Begins Moving on Philippines Drug War Complaints. The ICC has begun "preliminary examinations" to determine whether there is sufficient evidence to establish a case before the court in connections with the thousands of killings perpetrated in the course of President Rodrigo Duterte's bloody war on drugs. The preliminary examination is the first step in the ICC prosecution process. Duterte said he welcomed the examination because he is "sick and tired of being accused," a spokesman said.

Israel Put Hold on Medical Marijuana Exports Because of Trump, Netanyahu Says. The Israeli prime minister said President Trump called him and expressed his objection to marijuana exports. Netanyahu nixed exports earlier this week, putting potential export earnings of $1 to $4 billion a year at risk.

Lesotho Becomes First African Nation to Allow Legal Marijuana Cultivation. Lesotho has granted the first licenses for commercial marijuana cultivation, but the licenses are restricted to two foreign-owned companies. On Tuesday, Corix Bioscience announced that it received "the first license issued by the Government of Lesotho that enables them to import and export cannabis and cannabis resin in various forms." The product would be exported to any country that permits it.

Chronicle AM: VT Governor Will Sign Legalization Bill, IL MedMJ at School Lawsuit, AZ Syringe Access Bill, More... (1/12/18)

Vermont is set to become the first state in the nation to legalize marijuana through the legislative process, New York gets a hearing on legalization, Arizona's legislature gets a Republican-sponsored syringe access bill, the parents of an Illinois child sue over access to medical marijuana at school, and more.

Vermont Gov. Phil Scott (R) says he will sign a marijuana legalization bill. (vermont.gov)
Marijuana Policy

New York Hearing on Marijuana Legalization. The Assembly Health Committee took up the topic of marijuana legalization at a hearing Thursday. Committee Chair Assemblyman Dick Gottfried (D-Manhattan) said he called the hearing because the state needed to take a serious look at its antiquated drug laws. The committee heard from medical professionals, nonprofit groups, and individuals, most of whom said the state would benefit from legalization. A representative of the State Sheriff's Association, though, worried about drugged driving and voiced concern that legal marijuana could add to the state's opioid epidemic, although he didn't say precisely how. [Ed: Multiple studies, including this recent one, have found that legal marijuana availability reduces opioid overdose deaths.]

Vermont Governor Says He Will Sign Legalization Bill. At a press conference Thursday, Gov. Phil Scott (R) said he plans to sign House Bill 511, which legalizes the possession and cultivation of small amounts of marijuana, but not sales. Scott said once he receives the bill from the legislature, his staff will review it to make sure it is "technically" correct. "Then I'll sign the bill," he said. Once he does, Vermont will become the first state to have legalized marijuana via the legislative process.

Medical Marijuana

Illinois Parents Sue Over Medical Marijuana Access at School. The parents of an 11-year-old suffering from leukemia have sued the state and a suburban Chicago school district over a state law that bars her from taking her medicine at school. The medical marijuana law the state passed in 2014 prohibits the possession or use of marijuana on public school property. The family argues that provision of the law denies their child due process and violates the Individuals with Disabilities Education Act and the Americans with Disabilities Act. The school district involved is School District 54 in Schaumburg.

Indiana Sees Bevy of CBD Bills, But Only a Restrictive One Gets a Hearing. Responding to an attorney general's opinion last November that restricted the use of CBD to epileptics on a state registry, lawmakers have filed a number of bills to ease access to the substance, but the only one yet set for a hearing, Senate Bill 294, would actually make access even more restrictive. That bill, filed by Sen. Michael Young (R-Indianapolis), would mandate bar-coded cards for people on the registry and limit sales to card holders.

Harm Reduction

Arizona Needle Exchange Bill Filed. Rep. Tony Rivero (D-Peoria) has filed a needle exchange bill, House Bill 2389. The bill would allow a city, town, or nonprofit organization to establish and operate "a needle and hypodermic syringe access program." The bill has not yet been assigned to a committee.

International

Portugal Moves Toward Legalizing Medical Marijuana. Portugal is on the cutting edge when it comes to drug reform, having decriminalized the possession of any drug in 2001, but it lags behind other European countries when it comes to medical marijuana. Perhaps for not much longer, though: The parliament has now begun considering a bill that would legalize medical marijuana, and it is debating a draft bill that allows for personal cultivation. But that provision could be excised from the final bill, as the bill's sponsor, the Left Bloc, ponders concessions to make it more palatable to other parties.

Looking Back: The Biggest Domestic Drug Policy Stories of the Past 20 Years [FEATURE]

As Drug War Chronicle marks the publication of its 1,000th issue (with yours truly having authored 863 of them going back to 2000), we reflect on what has changed and what hasn't in the past couple of decades. This piece recounts our domestic drug policy evolution in the US; a companion piece looks at the international picture.

A lot has happened. We've broken the back of marijuana prohibition, even if we haven't killed it dead yet; we've seen medical marijuana gain near universal public acceptance, we've seen harm reduction begin to take hold, we've fought long and hard battles for sentencing reform -- and even won some of them.

But it hasn't all been good. Since the Chronicle began life as The Week Online With DRCNet back in 1997, more than 30 million people have been arrested for drugs, with all the deleterious consequences a drug bust can bring, and despite all the advances, the drug war keeps on rolling. There's been serious progress made, but there's plenty of work left to do. 

Here are the biggest big picture drug stories and trends of the past 20 years:

1. Medical Marijuana

It was November, 1996, when California became the first state to legalize medical marijuana, five years after San Francisco became the first city in the country to pass a medical marijuana measure, thanks in large part to the efforts of activists who mobilized to make its use possible for AIDS patients. Two years later, Alaska, Oregon, and Washington came on board, and three years after that, Hawaii became the first state to allow it though the legislative process. Now, 29 states, the District of Columbia, Guam, and Puerto Rico allow for the use of medical marijuana, and public support for medical marijuana reaches stratospheric levels in polls.

But the battle isn't over. The federal government still refuses to officially recognize medical marijuana, potentially endangering the progress made so far, especially under the current administration, efforts to reschedule marijuana to reflect its medical uses remain thwarted, some of the more recent states to legalize medical marijuana have become perversely more restrictive, and in some of the more conservative states, lawmakers attempt to appease demands for medical marijuana legalization by passing extremely limited CBD-only laws.

2. Marijuana Legalization: In the War on Weed, Weed is Winning

Twenty years ago, pot wasn't legal anywhere, and Gallup had public support for legalization at a measly 25%. A lot has changed since then. It took repeated tries, but beginning in 2012, states started voting to free the weed, with Colorado and Washington leading the way, Alaska and DC coming on board in 2014, and California, Maine, Massachusetts, and Nevada joining the ranks last year. Now, about a fifth of the country has legalized weed, with more states lining up to do so next year, including most likely contenders Delaware, Michigan, New Jersey, and Vermont.

Now, Gallup has support for legalization at 64% nationwide, with even a slight majority (51%) of Republicans on board. The only demographic group still opposed to pot legalization is seniors, and they will be leaving the scene soon enough. Again, the battle is by no means over. Marijuana remains illegal under federal law, and congressional efforts to change that have gone nowhere so far. But it seems like marijuana has won the cultural war, and the rest is just cleaning up what's left of the pot prohibition mess.

3. Marijuana, Inc.: The Rise of an Industry

State-legal marijuana is already a $10 billion dollar a year industry, and that's before California goes on line next month. It's gone from outlaws and hippie farmers in the redwoods to sharp-eyed business hustlers, circling venture capitalists, would-be monopolists, and assorted hangers on, from accountants, lawyers, and publicists to security and systems mavens, market analysts, and the ever-expanding industry press.

These people all have direct pecuniary interests in legal marijuana, and, thanks to profits from the golden weed, the means to protect them. Marijuana money is starting to flow into political campaigns and marijuana business interests organize to make sure they will continue to be able to profit from pot.

Having a legal industry with the wherewithal to throw its weight around a bit is generally -- but not entirely -- a good thing. To the degree that the marijuana industry is able to act like a normal industry, it will act like a normal industry, and that means sometimes the interests of industry sectors may diverge from the interests of marijuana consumers. The industry or some parts of it may complain, for instance, of the regulatory burden of contaminant testing, while consumers have an interest in knowing the pot they smoke isn't poisoned.

And getting rich off weed is a long way from the justice-based demand that people not be harassed, arrested, and imprisoned for using it. Cannabis as capitalist commodity loses some of that outlaw cachet, some ineffable sense of hipster cool. But, hey, you're not going to jail for it anymore (at least in those legal states).

4. The Power of the People: The Key Role of the Initiative Process

The initiative and referendum process, which lets activists bypass state legislatures and put issues to a direct popular vote, has been criticized as anti-democratic because it allows special interests to use an apathetic public to advance their interests, as both car insurers and tobacco companies have attempted in California. It also gets criticized for writing laws without legislative input.

But like any political tool, it can be used for good or ill, and when it comes to drug reform, it has been absolutely critical. When legislatures refuse to lead -- or even follow -- as has been the case with many aspects of drug policy, the initiative process becomes the only effective recourse for making the political change we want. It was through the initiative process that California and other early states approved medical marijuana; it was five years later that Hawaii became the first state where the legislature acted. Similarly with recreational marijuana legalization, every state that has legalized it so far has done it through the initiative process; in no state has it yet made its way through the legislature, although we're hoping that will change next year.

And it's not just marijuana. The initiative process has also been used successfully to pass sentencing reforms in California, and now activists are opening the next frontier, with initiatives being bruited in California and Oregon that would legalize psychedelic mushrooms.

The bad news: Only 24 states have the initiative process. The good news: The ones that do lead the way, setting an example for the others.

Drug prohibition can't be separated from the larger struggle for racial and social justice. (Creative Commons)
5. The Glaring Centrality of Race

It took Michelle Alexander's 2010 publication of The New Jim Crow: Mass Incarceration in the Age of Colorblindness to put a fine point on it, but the centrality of race in the prosecution of the war on drugs has been painfully evident since at least the crack hysteria of the 1980s, if not going back even further to the Nixonian law-and-order demagoguery of the late 1960s and early 1970s.

We've heard the numbers often enough: Blacks make up about 13% of the population and about 13% of drug users, but 29% of all drug arrests and 35% of those doing state prison time for drugs. And this racial disparity in drug law enforcement doesn't seem to be going away.

Neither is the horrendous impact racially-biased drug law enforcement has on communities of color. Each father or mother behind bars leaves a family exploded and usually impoverished, and each heavy-handed police action leaves a bitter aftertaste.

The drug war conveyor belt, feeding an endless number of black men and women into the half-life of prison, is clearly a key part of a system of racially oppressive policing that has led to eruptions from Ferguson to Baltimore. If we are going to begin to try to fix race relations in this country, the war on drugs is one of the key battlefronts. Thanks in part to Alexander's bestseller, civil rights organizations from the traditional to newer movements like Black Lives Matter have devoted increasing focus to criminal justice, including drug policy reform.

6. Harm Reduction Takes Hold

We don't think teenagers should be having sex, but we know they're going to, anyway, so we make condoms available to them so they won't get pregnant or STDs. That's harm reduction. So is providing clean needles to injection drug users to avoid the spread of disease, making opioid overdose drugs like naloxone widely available so a dosing error doesn't turn fatal, passing 911 Good Samaritan laws to encourage and OD victims' friends to call for help instead of run away, and providing a clean, well-lit place where drug users can shoot or smoke or snort their drugs under medical supervision and with access to social service referrals.

Two decades ago, the only harm reduction work going on was a handful of pioneering needle exchanges, thanks to folks like Dave Purchase at the North American Syringe Exchange Network (founded in 1988), and early activists faced harassment and persecution from local authorities. But it was the creation of the Harm Reduction Coalition in 1993 that really began to put the movement on the map.

In this century, harm reduction practices have gained ground steadily. Now, 33 states and DC allow needle exchange programs to operate, 40 states and DC have some form of 911 Good Samaritan laws, and every state in the county has now modified its laws to allow greater access to naloxone.

The next frontier for American drug war harm reduction is safe injection sites, and on the far horizon, opiate-assisted maintenance. There is not yet a single officially sanctioned operating safe injection in the country, but we are coming close in cities such as Seattle and San Francisco. And let's not forget drug decriminalization as a form of harm reduction. It should be the first step, but that's not the world we live in -- yet.

7. Sentencing Fever Breaks

Beginning in the Reagan years and continuing for decades, the number of prisoners in America rose sharply and steadily, driven in large part by the war on drugs. The phenomenon gained America infamy as the world's biggest jailer, whether in raw numbers or per capita.

But by early in the century, the fever had broken. After gradually slowing rates of increases for several years, the number of state and federal prisoners peaked around 2007 and 2008 at just over 1.6 million. At the end of 2015, the last year for which data is available, the number of prisoners was 1.527 million, down 2% from the previous year. And even the federal prison system, which had continued to increase in size, saw a 14% decline in population that year.

But most drug war prisoners are state prisoners, and that's where sentencing reform have really begun to make a difference. States from California to Minnesota to Texas, among others, enacted a variety of measures to cut the prison population, in some cases because of more enlightened attitudes, but in other cases because it just cost too damned much money for fiscal conservatives.

Current US Attorney General Jeff Sessions would like very much to reverse this trend and is in a position to do some damage, for instance, by instructing federal prosecutors to pursue tough sentences and mandatory minimums in drug cases. But he is hampered by federal sentencing reforms passed in the Obama era. Sessions may be able to bump up the number of people behind bars only slightly; the greater danger is that his policies serve as an inspiration for similarly inclined conservatives in the states to try to roll back reforms there.

8. The Rise (and Fall) of the Opioids

In 1996, Purdue Pharma introduced Oxycontin to the market. The powerful new pain reliever was pitched to doctors as not highly addictive by a high pressure company sales force and became a tremendous market success, generating billions for the Sackler family, the owners of the company. Opioid prescriptions became more common.

For many patients, that was a good thing. Purdue Pharma's marketing push coincided with a push by chronic pain advocates -- patients, doctors and others -- to ease prescribing restrictions that had kept many patients in feasibly treatable pain. And which in many cases still do: A 2011 report by the Institute of Medicine found that while "opioid prescriptions for chronic noncancer pain [in the US] have increased sharply . . . [tlwenty-nine percent of primary care physicians and 16 percent of pain specialists report they prescribe opioids less often than they think appropriate because of concerns about regulatory repercussions." As the report noted, having more opioid prescriptions doesn't necessarily mean that "patients who really need opioids [are] able to get them."

While it's popular to blame doctors and Big Pharma for getting a bunch of pain patients addicted to opioids, that explanation is a bit too facile. Many of the people strung out today were never patients, but instead obtained their pain pills on the black market. Through a perverse system of incentives, people on Medicaid could obtain the pills by prescription for next to nothing, then resell them for $40 or $60 apiece to people who wanted them. Some pain management practices were on the cutting edge of relieving pain for patients who needed the help. But others were little more than shady pill mills, popping up in places like Ohio, Kentucky, and Florida -- places that would become the epicenter of an opioid epidemic within a few years.

When the inevitable crackdowns on pain pill prescribing came, legitimate prescribers of course got caught in the crossfire sometimes, especially those who served the poor or the patients who in the worst chronic pain. Their being targeted, or others reining in their prescribing practices, left many patients in the lurch again. And the closure of pill mills left addicted people in the lurch. But there was plenty of heroin to make up for the missing pills the addicted used to take. Mexican farmers have been happy to grow opium poppies for the American market for decades, and Mexican drug trafficking organizations know how to get it to market.

The whole thing has been worsened by the arrival of fentanyl, a synthetic opioid dozens of times stronger than pure heroin, which seems to be coming mostly from rogue Chinese pharmaceutical labs (although the Mexicans appear to be getting in on the act now, too).

And now we have a drug overdose crisis like the country has never seen before, with around 60,000 people estimated to die from overdoses this year, most of them from opioids (by themselves or in combination with alcohol and/or other drugs). The crisis is inspiring both admirable harm reduction efforts and an execrable turn to harsher punishments, while making things harder again for many pain patients. While many argue that the gentle side of the response to this epidemic is because the victims are mainly white, I would suggest that argument pays short shrift to all the years of hard work advocates and activists of all ethnicities have put in to creating more enlightened drug policies.

9. Policing for Profit: The Never Ending Fight to Rein in Asset Forfeiture

Twenty years ago, pressure was mounting in Washington over abuses of the federal civil asset forfeiture program, just as it is now. Back then, passage of the Civil Asset Forfeiture Reform Act (CAFRA) of 2000 marked an important early victory in the fight to rein in what has tartly described as "policing for profit." It was shepherded though the house by then Judiciary Committee Chairman Rep. Henry Hyde, an Illinois Republican.

How times have changed. Now, with federal agents seizing billions of dollars each year though civil forfeiture proceedings and scandalous abuse after scandalous abuse pumping up the pressure for federal reform, the Republican attorney general is calling for more asset forfeiture. And Jeff Sessions isn't just calling for it; he has undone late Obama administration reforms aimed at reining in one of the sleaziest aspects of federal forfeiture, the Equitable Sharing program, although he is having problems getting Congress to go along.

In the years since CAFRA, a number of states have passed similar laws restricting civil asset forfeiture and directing that seized funds go into the general fund or other designated funds, such as education, but state and local police have been able to evade those laws via Equitable Sharing. Under that program, instead of seizing money under state law, they instead turn it over to the federal government, which then returns 80% of it to the law enforcement agency -- not the general fund and not the schools.

This current setup, with its perverse incentives for police to evade state laws and pursue cash over crime, makes asset forfeiture reform a continuing battlefield at both the state and the federal levels. A number of reform bills are alive in the Congress, and year by year, more and more states pass laws limiting civil asset forfeiture or, even better, eliminating it and requiring a criminal conviction before forfeiture can proceed. Fourteen states have now done that, with the most recent being Connecticut, New Mexico and Nebraska. That leaves 36 to go.

10. Despite Everything, the Drug War Grinds On

We have seen tremendous progress in drug policy in the past 20 years, from the advent of the age of legal marijuana to the breaking of sentencing fever to the spread of harm reduction and the kinder, gentler treatment of the current wave of opioid users, but still, the drug war grinds on.

Pot may be legal in eight states, but that means it isn't in 42 others, and more than 600,000 people got arrested for it last year -- down from a peak of nearly 800,000 in 2007, but still up by 75,000 or 12% over 2015.

It's the same story with overall drug arrests: While total drug arrest numbers peaked at just under 1.9 million a year in 2006 and 2007 -- just ahead of the peak in prison population -- and had been trending downward ever since, they bumped up again last year to 1.57 million, a 5.6% increase over 2015.

There are more options for treatment or diversion out of jail or prison, but people are still getting arrested. Sentencing reforms mean some people won't do as much time as they did in the past, but people are still getting arrested. And the drug war industrial complex, with all its institutional inertia and self-interest, rolls on. If we want to actually end the drug war, we're going to have to stop arresting people for drugs. That would be a real paradigm shift.

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.

Drug War Issues

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