Overdoses

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

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

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

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

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

Medical Marijuana

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

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

Drug Testing

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

Harm Reduction

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

International

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

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

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

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

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

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

Harm Reduction

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

International

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

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

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

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

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

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

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

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

Medical Marijuana

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

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

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

Heroin and Prescription Opioids

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

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

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

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

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

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

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

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

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

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

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

Addiction Treatment

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

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

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

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

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

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

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

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

Harm Reduction

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

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

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

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

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

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

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

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

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

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

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

Prevention

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

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

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

CRIMINAL JUSTICE

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

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

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

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

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

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

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

Medical Marijuana

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

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

Harm Reduction

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

Chronicle AM: NYT Says ODs at Record High, WI Gov Advances Medicaid Drug Testing, More... (6/7/17)

Drug overdoses are at an all time high, drug war dinosaur senators want to return to harsh sentencing, Wisconsin's GOP governor moves forward with first in the nation plan to drug test Medicaid applicants, and more.

Fatal drug overdoses totaled nearly 60,000 last year, the New York Times reports. (Wikimedia)
Marijuana Policy

Connecticut House Debates Legalization, But There is No Vote. The House debated the pros and cons of marijuana legalization Tuesday night, but Democratic leaders then ended debate without any vote. They said a legalization bill would have failed in the House, but the debate could increase the chances of legalization being included as part of a budget bill, although observers describe that prospect as "a long shot."

Wichita Reduces Pot Penalties. The city council voted Tuesday to adopt an ordinance that would reduce the penalty for possession of up to 32 grams (slightly more than an ounce) of marijuana to $50 plus court costs.

ACLU, Drug Policy Alliance Sue Southern California City Over Pot Cultivation Ordinance. The ACLU of California and the Drug Policy Alliance are suing Fontana, claiming that the city's marijuana ordinance conflicts with rights granted to all Californians under Proposition 64. Under Prop. 64, every Californian 21 or older has a right to cultivate up to six marijuana plants for personal use. But the law also says cities or counties can ban outdoor gardens and "reasonably regulate" indoor grows.Fontana -- a city of 200,000 people that sits 50 miles east of Los Angeles -- passed an ordinance in January that requires residents who want to cultivate up to six plants inside their home to first get a $411 permit from the city and not have any drug convictions within the past five years, a policy the groups describe as both illegal and "egregious."

Medical Marijuana

Arkansas Finalizes Process for Medical Marijuana Applications. In a meeting Tuesday, the state Medical Marijuana Commission finalized the process for accepting applications for medical marijuana growers and sellers. The move comes after the commission developed a more detailed scoring system for ranking applicants. The application period will open June 30 and go on for 90 days. The commission will distribute 32 dispensary licenses and five cultivation facility licenses.

Florida Lawmakers Reach Agreement on Implementing Medical Marijuana. Lawmakers on Wednesday came to agreement on how to implement the state's voter-approved medical law. Under the agreement, ten new growers will be licensed this year, with five licenses going to previous applicants, five going to new applicants, and at least one reserved for a black farmer. The state current licenses only seven commercial grows. The agreement also caps the number of dispensaries each grower can operate at 25.

Oregon Bill to Let Medical Growers Sell Up to 20 Pounds in Recreational Market Advances. A bill that seeks to reshape the state's medical marijuana program so it can coexist with legal recreational marijuana is advancing. House Bill 2198, which would let medical growers sell up to 20 pounds in the recreational market in a bid to stay viable, passed the Joint Committee on Marijuana Regulation last week and is now before Joint Committee on Ways and Means.

Heroin and Prescription Opioids

New York Times Investigation Finds Drug Overdose Deaths Reached All-Time High in 2016. The New York Times published on Monday an investigative report that found that drug overdose deaths last year reached an all-time high, suggesting that the country's long-term opioid crisis continues to worsen and that younger age groups in the U.S. are experiencing record numbers of opioid overdoses than in the past. The Times looked at preliminary overdose data for 2016 provided by hundreds of state and local health authorities, concluding: "Drug overdoses are now the leading cause of death among Americans under 50, and all evidence suggests the problem has continued to worsen in 2017." The report estimates that more than 59,000 people died from a drug overdose in 2016 -- an increase of 19% from 2015. The report does not elaborate on which drugs are behind the estimated jump in overdose deaths last year, nor does the report indicate which age groups under 50 saw the largest increase in overdose deaths over prior years.

Senate Drug Warriors Feinstein and Grassley Prepare Bill With Tough New Penalties for Synthetic Opioids. The senior members of the Senate Judiciary Committee are preparing a bill that would create tough new penalties for people caught with synthetic opioids. A draft of the bill would give the attorney general the power to ban all kinds of synthetic drugs and it would impose a 10-year maximum sentence on people caught selling them for a first offense. A second offense would see the sentence double. The bill would penalize people selling drugs at a low level in the US, critics said.

Drug Testing

Wisconsin Submits Request to Drug Test Medicaid Applicants. Gov. Scott Walker (R) on Wednesday officially submitted a request for a federal waiver to become the first state in the country to drug test applicants for Medicaid benefits. Walker said the plan would provide drug addicts with treatment and make them employable. "Healthy workers help Wisconsin employers fill jobs that require passing a drug test," Walker's administration said in a press release Wednesday announcing the waiver. But critics called the notion a waste of money and an insult to people who need Medicaid.

Chronicle AM: VT Gov Will Act on Legalization, Trump Retreats from ONDCP Defunding, More... (5/23/17)

Vermont Gov. Phil Scott says he will act on marijuana legalization tomorrow, the Trump budget reverses earlier plans to radically defund the drug czar's office, a new Michigan poll has good news for activists, and more.

Will Vermont's governor sign or veto the marijuana legalization bill? Check back tomorrow to find out. (Wikimedia.org)
Marijuana Policy

Michigan Poll Has Strong Majority for Legalization. A new poll from the Marketing Resource Group has support for marijuana legalization at 58%, if it is taxed and regulated like alcohol. The strongest support came from Democrats and people under 40. The poll comes as the Michigan Coalition to Regulate Marijuana Like Alcohol is beginning a signature gathering campaign to put its legalization initiative on the November 2018 ballot. "While attitudes toward marijuana may be mellowing, most Republican voters and those 65 and older still are not ready to legalize it," said Tom Shields, president of MRG. "Support for legalizing recreational use of marijuana has grown from 41 percent in 2013 to 58 percent in just the last four years. I would not be surprised to see a successful ballot proposal within the next few years."

Vermont Governor to Act on Legalization Bill Tomorrow. Gov. Phil Scott (R) said Tuesday he would either sign or veto Senate Bill 22 on Wednesday, the last possible day for him to act. Under state law, the bill could become law if Scott fails to act, but Scott said he would not let that happen and would either veto or sign the bill. If he signs it, Vermont becomes the first state to legalize marijuana through the legislative process.

Hemp

Arizona Governor Vetoes Hemp Bill. Gov. Doug Ducey vetoed an industrial hemp bill on Monday. Ducey said he vetoed Senate Bill 1337 because it did not provide funding for the state Agriculture Department to administer the program.

Drug Policy

Trump Backs Away From De-Funding the Drug Czar's Office. President Trump has reversed a proposal to cut 95% of the funding for the Office of National Drug Control Policy (ONDCP -- the drug czar's office). In his budget proposal released Tuesday, ONDCP funding is still reduced, but only by 3%, in line with other non-defense-related spending cuts.

Harm Reduction

San Francisco Supervised Injection Site Task Force Launched. A 15-member task force charged with developing a report to the Board of Supervisors on the feasibility and potential costs and benefits of a supervised drug consumption site got to work on Monday. The task force will meet three times over the next three months before issuing its report. The city has bout 22,000 injection drug users and a hundred overdose deaths a year, mostly from heroin and opioids.

Chronicle AM: DEA Wants Prosecutor Corps, ME Gov Wants ODers to Pay for Naloxone, More... (5/4/17)

The DEA proposes its own corps of prosecutors to go after opioids, Maine's governor wants to force repeat overdosers to pay for the naloxone they use, and more.

Medical Marijuana

Colorado Legislature Approves Adding PTSD as Qualifying Condition. A bill to "Allow Medical Marijuana Use for Stress Disorders," Senate Bill 17, was sent to the governor's desk on Monday after the Senate last week approved a final concurrence vote to amendments accepted in the House. Gov. John Hickenlooper (D) is expected to sign it.

New York Assembly Approves PTSD as Qualifying Condition. The Assembly voted overwhelmingly on Tuesday to approve Assembly Bill 7006, sponsored by Health Committee Chairman Dick Gottfried (D-Manhattan), which would add PTSD to the state's list of qualifying conditions for medical marijuana. The bill now heads to the Senate.

Harm Reduction

Maine Governor Wants Repeat Overdosers to Pay for Naloxone Used to Revive Them. Gov. Paul LePage (R) has submitted a bill, Legislative Document 1558, that would require Maine communities to recover the cost of naloxone from repeat users and fine them $1,000 per incident if they don't go after the money. But doctors and advocates said the bill would make it harder to stop the state's wave of drug overdoses. Le Page is no friend of naloxone, saying it "does not truly save lives; it merely extends them until the next overdose." He has twice vetoed naloxone bills, only to see them overridden both times.

Law Enforcement

DEA Wants Own Prosecutor Corps to Go After Opioids. In a little-noticed proposal published in the Federal Register in March, the DEA said it wants to hire as many as 20 prosecutors to help it enhance its resources and target large offenders. The new prosecutor corps "would be permitted to represent the United States in criminal and civil proceedings before the courts and apply for various legal orders." Funding for the program would come from drug manufacturers regulated by the DEA. If approved, the move would mark the first time the DEA had its own dedicated prosecutors to go after drug offenses. But critics say the plan "exceeds DEA's authority under federal law" because it would require funding from the drug diversion registration program. "In this notice, the DEA effectively proposes a power grab and is trying to end-run the congressional appropriations process," said Michael Collins, deputy director at the Drug Policy Alliance.

Chronicle AM: No Fed $$$ for Anti-MedMJ, MA Docs Call for Safe Injection Sites, More... (5/2/17)

Congress won't fund federal medical marijuana enforcement in states where it's legal, the Massachusetts Medical Society calls for a pilot safe injection site, a Wisconsin federal judge throws out that state's "cocaine mom" law, and more.

Chris Christie is back to attacking marijuana legalization. (Creative Commons/Wikimedia/Gage Skidmore)
Marijuana Policy

Chris Christie Accuses Democrats of Wanting to "Poison Our Kids" With Pot to Raise Tax Revenues. New Jersey Gov. Chris Christie (R) on Monday criticized efforts to legalize marijuana and claimed Democrats were willing to "poison our kids" to get marijuana tax revenues. A reference to a recent report saying the state could earn $300 million in pot taxes set him off. "This is the part that liberals love the most: We can tax it. Sweet Jesus, we can tax it! More money for us!" Christie exclaime. "I can say this now because I'm not running for anything again: $300 million is nothing. We have a $35.5 billion budget; $300 million is a rounding error. I'm sorry. It's true. Think about it, that's 1 percent, less than 1 percent, of the entire state budget for a year. And we're going to poison our kids for 1 percent more money that they can spend on some God awful, stupid program that they can put in the mailer and send out and say, 'I delivered $300 million more for this.'" There's more, too; just click on the link.

Medical Marijuana

Congress Rolls Out Interim Budget With No Funding for Medical Marijuana Enforcement. The budget bill crafted by Congress to keep the federal government working in the short term includes the Farr-Rohrabacher amendment language barring the spending of federal dollars to enforce federal pot prohibition in states that have legalized medical marijuana. The language is only good through September, though.

Federal CBD Bill Filed. US Rep. Scott Perry (R-PA) on Monday filed House Resolution 2273, which would amend the Controlled Substances Act to exclude cannabidiol (CBD) and CBD-rich plants from the definition of marijuana. It's been referred to the House Judiciary, Financial Services, and Energy and Commerce committees.

Florida House Passes Medical Marijuana Implementing Bill. The House on Tuesday approved a medical marijuana regulation measure, House Bill 1397, after altering several provisions opposed by patients and the industry. The measure removes the ban on using low-THC marijuana products in public, increases the number of dispensaries to 17 statewide, and allows patients to only have to see a doctor once every seven months to get renewed. The bill now goes to the Senate.

Heroin and Prescription Opioids

Baltimore Cops Begin Investigating Overdoses in Bid to Nail Dealers. A task force of five Baltimore police detectives have begun investigating drug overdoses in an effort to build criminal cases against drug dealers. But with 800 fatal overdoses in the city las year, five detectives may not be able to keep up. The state lacks a law allowing prosecutors to charge dealers in the death of an overdose victim, but prosecutors say there exists "a wide range" of ways they can bring related charges.

Harm Reduction

Massachusetts Docs Call for Supervised Drug Consumption Sites. The Massachusetts Medical Society has endorsed lobbying state and federal policymakers to allow the state to begin a safe injection site pilot program. At the group's annual meeting last Saturday, the membership adopted a policy calling for "a pilot supervised injection facility program in the state, to be under the direction and oversight of the state" as well as wider use of naloxone and more treatment for substance use disorder. The policy calls for the organization to lobby for a federal exemption and state legislation to allow such a facility.

Law Enforcement

Federal Judge Blocks Wisconsin "Cocaine Mom" Law. A US district court judge in Madison ruled last Friday that the state's "cocaine mom" law, which allows the state to detain a pregnant woman suspected of drug or alcohol abuse, is so vague as to be unconstitutional. The law is "void for vagueness," Judge James Peterson held. "Erratic enforcement, driven by the stigma attached to drug and alcohol use by expectant mothers, is all but ensured." The law allowed the state to treat fetuses like children in need of protection if the "expectant mother habitually lacks self-control in the use of alcohol beverages, controlled substances or controlled substance analogs, exhibited to a severe degree, to the extent that there is a substantial risk that the physical health of the unborn child, and of the child when born, will be seriously affected or endangered." But Peterson ruled that such terminology is not "amenable to reasonably precise interpretation."

International

Uruguay Begins Registering Users to Buy Pot in Pharmacies. The first country to legalize marijuana took another step toward implementing that decision on Tuesday as it opened a registry for people who wish to buy marijuana from pharmacies beginning in July. All potential pharmacy pot customers must register before availing themselves of the service. Pot will go for about $1.30 a gram, with each user limited to 10 grams per week.

Chronicle AM: Nevada MJ Bills Moving, NY Safe Consumption Campaign Underway, More... (4/26/17)

A group of DAs have published a report critical of marijuana legalization, Nevada marijuana bills are moving, a New York campaign for the establishment of safe drug consumption rooms gets underway, and more.

Will El Chapo pay for the border wall? Ted Cruz thinks it's a swell idea.
Marijuana Policy

In New Report, Prosecutors Slam Marijuana Legalization. The National District Attorneys' Association has released a report, Marijuana Policy: The State and Local Prosecutors' Perspective, that criticizes legalization as leading to greater access by children and creating challenges for impaired driving enforcement. The DAs also criticized state-level legalization and decriminalization as "an obstacle to the comprehensive federal framework." The report will be used by the Trump administration to help fashion its marijuana policy.

Massachusetts House Passes Bill Barring Use of Cash Welfare Benefits to Buy Pot. The House on Tuesday passed House Bill 3194, which would bar the use of cash welfare benefits to purchase marijuana. State law already prohibits cash benefits from being used to purchase alcohol, lottery tickets, cigarettes, and pornography. The measure now goes to the Senate.

Nevada Marijuana Bills Advance. In a frenzy of last-minute activity, legislators approved a series of marijuana bills on Tuesday. Senate Bill 375, which advocates for tribes' right to establish marijuana facilities; Senate Bill 344, which establishes packaging standards; Senate Bill 236, which would allow for on-site consumption; and Senate Bill 374, which would allow the use of medical marijuana for opioid addiction, all passed the Senate and head for the Assembly. Meanwhile, the Assembly passed Assembly Bill 259, which would allow courts to seal the records of people charged with possessing an ounce or less. That bill now heads for the Senate.

Medical Marijuana

Florida Medical Marijuana Regulation Bill Wins Committee Vote. The House Health and Human Services Committee on Monday approved House Bill 1397, which aims to regulate the state's voter-approved medical marijuana system. Critics call the House bill too restrictive and are calling on legislators to instead support a rival bill in the Senate.

Drug Policy

Ted Cruz Files Bill to Make El Chapo Pay for the Border Wall. US Sen. Ted Cruz (R-TX) has filed Senate Bill 939, "to reserve any amounts forfeited to the US government as a result of the criminal prosecution of Joaquin Archivaldo Guzman Loera (commonly known as "El Chapo"), or of other felony convictions involving the transportation of controlled substances into the United States, for security measures along the Southern border, including the completion of a border wall.

Harm Reduction

Safe Shape Tour across New York State Calls for "Safer Consumption Spaces" to Combat Skyrocketing Overdoses. In response to New York State's overdose and opioid epidemic, a coalition of healthcare professionals, public health experts, advocates, and people with a history of drug use are launching a statewide campaign calling for the creation of safer consumption spaces (SCS) supervised injection facilities (SIF) where people can legally consume previously-purchased illicit drugs with supervision from peers and healthcare professionals who help make their use safer and connect them with medical care, drug treatment, and social services. Click on the link for much more information and how to register for events.

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