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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: DE Legalization Bill Filed, WV MedMJ Bill Fast Tracked, More... (3/31/17)

A marijuana legalization bill gets filed in Delaware, a medical marijuana bill gets fast tracked in West Virginia, a South African court rules to free the weed, the Argentine Senate okays CBD cannabis oil, and more.

It looks like West Virginia is about to hop on the medical marijuana bandwagon. (Creative Commons/Wikimedia)
Marijuana Policy

Delaware Lawmakers Filed Legalization Bill. State Rep. Helene Keeley (D-Dover) and cosponsors filed House Bill 110 on Thursday. The bill would legalize the possession of up to an ounce by adults 21 and over and to purchase it from state-regulated stores. The bill does not allow people to grow their own. It imposes a $50 an ounce tax on buds and a $15 an ounce tax on other parts of the plant. It now heads to the House Finance and Revenue Committee, which must hold a hearing within 12 days.

Medical Marijuana

Maryland Legislators Propose Using Marijuana to Treat Opioid Addiction. A House of Delegates committee has added "opioid use disorder" to the list of qualifying conditions for medical marijuana use. The bill was set to be heard by the House Friday.

West Virginia House Fast Tracks Medical Marijuana Bill. Less than a day after the Senate approved a full-fledged medical marijuana bill, Senate Bill 386, the House has put it on path to quick consideration. The bill passed the Senate Wednesday, and on Thursday, the House voted to allow the bill to skip consideration by committees there and proceed directly to House floor debate. The move came in response to constituent pressure. "Like every member of this body, I can't count the number of emails and phone calls I received on this subject today," said Del. Mike Pushkin, D-Kanawha.

New Psychoactive Substances

Federal Bill Would Add New "Designer Drugs" to CSA's Schedule I. US Rep. Charles Dent (R-PA) has filed House Resolution 1732, the Synthetic Drug Control Act of 2017. It adds dozens of substances to Schedule I of the Controlled Substance Act, including phenylalkylamines, cannabimimetic agents, arylcyclohexamines, tryptamines, benzodiazepines, benzylpiperidines, piperazines, and opioids and opioid-like substances. The bill has been referred to the House Judiciary and House Energy and Commerce committees.

Law Enforcement

Federal Bill Would Create Program to Divert Low-Level Drug Offenders. US Rep. Sean Maloney (D-NY has filed House Resolution 1763, the Keeping Communities Safe Through Treatment Act of 2017. The bill directs the Justice Department to create a pilot program to provide grants to localities to divert people with low-level drug offenses into treatment programs before they are booked. It has been referred to the House Judiciary Committee.

International

Argentine Senate Approves CBD Cannabis Oil Bill. The Senate on Wednesday gave final legislative approval to a bill allowing the use of CBD cannabis oil for medical reasons and setting up a regulatory framework for state-run cultivation, processing, and distribution. Until the state-run system is up and running, CBD imports will be allowed.

South Africa High Court Rules Adults Can Possess Marijuana at Home. The Western Cape High Court ruled on Friday that it's legal for adults to use, possess, and grow marijuana at home. The court also ruled that sections of the Drug Trafficking act and the Medicines Control Act must be amended to comply with the decision. The decision isn't final yet, though -- it must be confirmed by the Constitutional Court.

Chronicle AM: AL Bill Has Mandatory Life w/o Parole for Possessing Ounce of Fentanyl, More... (2/17/17)

The Alabama legislature ponders harsh drug sentences not seen since the last century, decriminalization is picking up some support in Texas, China announces scheduling controls on fentanyl, and more.

An Alabama bill would make possession of as little as an ounce of fentanyl a mandatory life sentence without parole.
Marijuana Policy

Cannabis, Drug Policy Reform Advocates Commend Congressional Members on Formation of Congressional Cannabis Caucus. In a joint statement Thursday, major marijuana and drug reform groups commended congress members for forming the Congressional Cannabis Caucus, led by Reps. Earl Blumenauer (D-OR), Dana Rohrabacher (R-CA), Jared Polis (D-CO), and Don Young (R-AK). After commending the representatives, the joint statement noted that "the establishment of a Cannabis Caucus will allow members from both parties, who represent diverse constituencies from around the country, to join together for the purpose of advancing sensible cannabis policy reform. It will also facilitate efforts to ease the tension between federal prohibition laws and state laws that regulate cannabis for medical and adult use."

Texas Decriminalization Bill Picks Up Some Support. Law enforcement officials joined House Criminal Jurisprudence Committee Chairman Joe Moody (D-El Paso) at the capitol Thursday to express support for a measure to decriminalize the possession of up to an ounce of weed, House Bill 81. The bill is currently before the committee. Harris County, the state's most populous, just announced plans to institute decriminalization there.

Medical Marijuana

Georgia Senate Passes Medical Marijuana Bill, But Advocates Say It's a Step Backwards. The Senate Thursday approved Senate Bill 16, but advocates said it was a retreat because it lowers the amount of allowable THC in cannabis oil from 7% to 3%. Some senators wanted to reduce it to 1%. The bill now goes to the House, where Rep. Allen Peake (R-Macon), who wrote the original CBD bill, said he hopes to rewrite it to restore the 7% figure.

Utah Medical Marijuana Research Bill Wins Committee Vote. The Senate Health and Human Services Committee voted Thursday to approve House Bill130, which would allow universities in the state to do research on the medicinal effects of marijuana. The bill has already passed the House and now awaits a Senate floor vote.

Hemp

Arizona Industrial Hemp Bill Advances. A bill that would legalize the production and processing of industrial hemp has passed two key committees. Senate Bill 1337 passed the Public Safety Committee on a 6-1 vote Monday and the Appropriations Committee Tuesday on a 10-0 vote. It still needs to go before the Senate Rules Committee before it heads for a floor vote.

Asset Forfeiture

North Dakota Asset Forfeiture Reform Bill Advances. The House Judiciary Committee approved House Bill 1170 on an 11-4 vote Thursday. The bill would require a criminal conviction before property could be seized in most situations and bans prosecutors from circumventing state law by handing cases off to the federal government. The measure now heads for a House floor vote.

Sentencing

Alabama Bills Would Increase Heroin, Fentanyl Sentences. Under bills currently before the state legislature, prison sentences would go up for people who possess or sell heroin and fentanyl. Under one bill, anyone convicted of their possession would face mandatory prison sentences, and under another, Senate Bill 154, people possessing as little as one ounce of fentanyl would face a mandatory sentence of life without parole. The state instituted sentencing reforms several years back; some legislators worry these bills would undo those efforts.

International

China Announces Scheduling Controls of Carfentanil and other Fentanyl Compounds. China announced Thursday that it will begin scheduling controls of four fentanyl-class substances -- carfentanil, furanyl fentanyl, valeryl fentanyl, and acryl fentanyl -- beginning March 1. Chinese pharmaceutical factories have been identified as major producers of the synthetic opioids, which are linked to thousands of drug overdose deaths in the US.

Chronicle AM: Obama Commutes More Sentences, ME Pot Opponents Give Up on Recount, More... (12/19/16)

President Obama has just commuted the sentences of another 153 drug offenders, Maine legalization foes concede their recount isn't going anywhere, Marc Emery's Montreal pot shops get raided in a hurry, and more.

Obama meets with prisoners at the El Reno, Oklahoma, federal detention facility. (whitehouse.gov)
Marijuana Policy

Guam Governor Calls for Marijuana Legalization. Guamanian Gov. Eddie Calvo (R) says it's time to legalize it. "I want us to look at how states navigated into recreational marijuana," Calvo, a Republican, said in a Facebook post on Monday. "Let's figure it out and then tax the heck out of it and use those taxes to help fund our hospital, public safety and education." The comments come just days after Calvo vetoed a bill that would have allowed medical marijuana patients to grow their own, saying it would "impose new and different duties upon our health and law enforcement agencies that will deplete their already strained resources."

Maine Legalization Opponents Give Up on Recount. The anti-legalization group that challenged the narrow victory of Question 1 in last month's elections has given up the ghost. No on 1 said Saturday it was apparent that the recount would not change the outcome. "We promised folks that if we came to a point where we could not see any chance of reversing the result, we would not drag the process out,"said Newell Augur, legal counsel for the No on 1 campaign. "We are satisfied that the count and the result are accurate." Now, the election result can be certified by the secretary of state, and legalization should go into effect sometime next month.

Medical Marijuana

Imprisoned California Dispensary Operators Seek Presidential Commutation. Luke Scarmazzo and Ricardo Montes operated a medical marijuana dispensary in Modesto, California, until their arrest by federal drug agents 10 years ago. They were prosecuted and convicted of federal drug crimes for their efforts and sentenced to 21 years 10 months and 20 years, respectively. Now, they are formally seeking sentence commutations from President Obama, who has cut the sentences of more than a thousand other federal drug prisoners so far this year. The pair point out that they would not have been prosecuted under current federal policies largely turning a blind eye to marijuana in states where it is legal, whether recreationally or merely for medical purposes.

Pardons and Commutations

Obama Issues Another Round of Sentence Commutations. The White House announced Monday that President Obama has commuted the sentences of another 153 federal prisoners, bringing the total this year to more than 1,100. A list of the prisoners and their offenses is not yet available, but Obama's earlier commutations had been directed almost entirely at people serving draconian drug sentences.

International

Marc Emery's Montreal Pot Shops Raided One Day After Opening. Long-time Canadian pot gadfly Emery and nine others were arrested after a series of raids Friday on his chain of Cannabis Culture pot shops. While Canada is moving to legalize marijuana, it hasn't done so yet, and authorities are working to keep the lid on the bubbling industry. Emery slammed Montreal Mayor Denis Coderre for the raids. "The mayor's behavior is despicable," he said. "If the mayor of Montreal wants to keep his city backward, behind and full of oppression, then that is the statement he just made to the world." As conditions of his bond, Emery cannot consume marijuana, communicate with anyone involved in the Cannabis Culture shops, or be in the province of Quebec except to show up for court dates.

China Denies Being Source of New Synthetic Drugs. Chinese officials have called assertions that China is the source of synthetic opioids linked to the deaths of thousands of drug users "unsubstantiated." Such statements "lack the support of sufficient numbers of actual, confirmed cases," China's National Narcotics Control Commission told DEA's Beijing office in a fax dated Friday. The DEA has said that China is the predominant source of fentanyl, the synthetic opioid many times more powerful than heroin, which has been implicated in thousands of drug overdose deaths.

In Legal Marijuana States, Consumers Are Turning to Buds Over Beer

A new industry study says access to legal marijuana is having a negative impact on beer sales. That's bad news for the brewing industry, but good news from a public health perspective.

According to the industry site Brewbound, the research firm Cowen & Company analyzed the beer industries in Colorado, Oregon, and Washington -- three states that have recreational pot shops -- and found that their beer markets have "collectively underperformed" in the past two years.

The "magnitude of the underperformance has increased notably" as beer volumes have dropped more than 2% year-to-date in the trio of pot states, with big mainstream brewers like MillerCoors and Anheuser-Busch InBev seeing the biggest declines, with volumes down 4.4%. Craft beers have done a little better, but are down, too, seeing a 2.2% drop.

"While [marijuana] retail sales opened up in these markets at different points of time, with all three of these states now having fully implemented a retail infrastructure, the underperformance of beer in these markets has worsened over the course of 2016," wrote Vivien Azer, Cowen and Company's managing director and senior research analyst.

That's not exactly a shock, Azer wrote, since government survey data has shown "consistent growth in cannabis incidence among 18-25 year olds" in those three states at the same time that age group has seen declines "in alcohol incidence (in terms of past month use)." The change is most evident in Denver, one of the centers of the legal pot culture, where beer volumes have dropped 6.4%.

Numbers like these, if they continue, should soothe the concerns of public health advocates and academics worried that legal marijuana could complement alcohol use instead of substitute for it. Would legal pot mean more drinking or less? If legal pot meant increased alcohol consumption, with all its dangers, that would be a bad thing from a public health perspective. But if legal pot leads to less alcohol consumption, such problems can be alleviated.

And this bad news for the brewing industry suggests it does. It's not the only evidence suggesting a substitution effect, either.

In a review in the Journal of Policy Analysis and Management, Montana State University economist D. Mark Anderson and University of Colorado economist Daniel Rees reported that "studies based on clearly defined natural experiments generally support the hypothesis that marijuana and alcohol are substitutes."

They pointed to one study that found a higher drinking age increases teen pot consumption and that pot smoking drops off sharply at 21, when alcohol becomes legal, "suggesting that young adults treat alcohol and marijuana as substitutes."

Maybe we need to start talking about the public health benefits of marijuana legalization.

Chronicle AM: ME Recount Possible, DEA Bans "Pink," WI Welfare Drug Tests Start, More... (11/14/16)

Cannabis cafes are coming, Maine legalization foes seek a recount, Massachusetts legislators are threatening to "improve" the legalization initiative, the DEA bans "pink," and more.

Philippines President Rodrigo Duterte wants to get rid of habeas corpus as he wages lethal drug war. (Creative Commons/Wikimedia
Marijuana

Marijuana Victories Will See Cannabis Cafes Coming. The victories for marijuana legalization initiatives in California, Maine, Massachusetts, and Nevada last week will set the stage for social marijuana consumption at licensed venues. Three of the states make provisions for social consumption, while the fourth leaves the issue for legislators. And in Denver, voters approved a local initiative that will allow local businesses to designate "consumption areas" for customers who bring their own weed.

Maine Legalization Foes Seek Recount After Narrow Defeat. Unofficially, the Question 1 legalization initiative won by a mere 5,000 votes out of about 750,000 cast, and that's too close a call for the "no" campaign to just accept. "No" spokesmen are threatening to seek a recount. They have until the end of work Wednesday to collect a hundred signatures in order to seek a recount from the secretary of state's office.

Massachusetts Legislators Turn Eyes on "Improving" Legalization Initiative. Senate President Stan Rosenberg said last Thursday said the Question 4 initiative will need "improvements" to address issues such as marijuana sales taxes, infused edible products, and driving while high. Rosenberg said the legislature could take up the issues shortly after returning in January. But the Question 4 campaign pushed back, saying that legislators should "respect the will of the voters," let regulators do their job crafting regulations, then see if anything needs fixing.

New Psychoactive Substances

DEA Bans Synthetic Opioid Known as "Pink." Using its emergency scheduling powers, the DEA has banned the synthetic opioid U-47700, commonly known as "pink." Effective today, the drug is now a Schedule I controlled substance. The drug has been linked to dozens of confirmed fatalities, and is now banned for 24 months while the DEA decides if it should be permanently placed in Schedule I.

Drug Testing

Wisconsin Welfare Drug Testing Starts Today. As of Monday, people seeking welfare benefits will be subject to drug testing. Republican Gov. Scott Walker painted the move as helping families and employers. "Employers across the state frequently tell me they have good-paying jobs available in high-demand fields, but need their workers to be drug-free," Walker said in a statement. "These important entitlement reforms will help more people find family-supporting jobs, moving them from government dependence to true independence."

International

Philippines President Threatens Drug War Suspension of Habeas Corpus. President Rodrigo Duterte said he is considering suspending habeas corpus because it's just too much work to build cases against individual drug suspects. And he doesn't worry about legality. "I am the president. Of course I have the powers," he said Friday. "I can be ordered by the Supreme Court to stop it, but there are things that they cannot, and maybe, I will not, stop I can go to jail. File all the charges that you can think of. But this country, in my time, will not deteriorate any further." The Philippines constitution says the president may suspend habeas corpus "in case of invasion or rebellion, when the public safety requires it."

Berlin Set to Move on Marijuana Liberalization. The city's governing coalition of Social Democrats, Greens, and the Left Party has agreed to push for partial decriminalization of marijuana. The move would require a waiver from federal authorities to allow experimenting with drug policies that contradict the Federal Intoxicants Law.

Chronicle AM: CA Legalization Ads Roll Out, NFL Bans "Synthetic Marijuana," More... (10/6/16)

Tennessee's two largest cities have semi-decriminalized small-time marijuana possession, California pro-legalization ads roll out, the NFL bans "fake weed," and more.

Marijuana Policy

California Marijuana Legalization Ads Hit the Airwaves Statewide. TV ads in support of marijuana legalization hit the airwaves Monday up and down the state of California. The campaign's ads in support of Proposition 64, the Adult Use of Marijuana Act, are running on both broadcast and cable channels. The first ad highlights in a straightforward way how the tough restrictions will keep marijuana out of the hands of young people. It explains how only adults 21 and older will be allowed to purchase at licensed businesses. The initiative bans ads directed at kids, there are strict labeling and child proof packaging and would ban edibles that appeal to children. The second ad also reinforces that marijuana will only be legal for adults over 21 and bans marijuana use in public. The ad also explains that the money in new revenue will fund after school job training and placement initiatives.

Maine ACLU Endorses Legalization Initiative."Legalizing, regulating and taxing the use of marijuana by adults 21 and older will bring a new approach to our marijuana laws, making them more fair, more compassionate and better at improving public health and increasing public safety. For those reasons, the ACLU endorses a 'yes' vote on Question 1 in November, wrote ACLU of Maine executive director Alison Beyea.

Memphis Decriminalizes (Sort of). The Memphis city council Tuesday night voted 7-6 to approve an ordinance that gives police the discretion to issue a fine instead of arresting people possessing less than a half ounce of marijuana. Nashville approved a similar ordinance last month. Full decriminalization would make the penalty for small-time possession only a fine and would not give police officers the ability to choose which offenders get ticketed and which get arrested.

Medical Marijuana

Massachusetts Regulators Propose Expansions in Medical Marijuana Program. The Department of Public Health has submitted a collection of proposed changes to the Public Health Council. The proposals include allowing nurse practitioners to certify patients and allowing dispensaries to post prices online. Allowing nurse practitioners to certify would boost patient numbers and allowing online price posting should encourage competition and drive prices down, the department said.

New Psychoactive Substances

NFL Bans "Synthetic Marijuana". The National Football League has added synthetic cannabinoids ("fake weed") to its list of banned substances in an agreement with the NFL Players Association announced Wednesday. Players whose drug tests reveal more than 2.5 nanograms per milliliter of synthetic cannabinoids will be considered in violation of the league's drug policies and subject to intervention and discipline.

Chronicle AM: Chelsea Clinton "Misspoke" on MJ Dangers, NYC Safe Injection Sites?, More... (9/29/16)

No, medical marijuana doesn't kill patients, Chelsea Clinton's spokeswoman admits, New York City is about to embark on a study of supervised injection facilities, and more.

The InSite supervised injection facility in Vancouver. New York City will study whether to have them, too. (vch.ca)
Medical Marijuana

Chelsea Clinton "Misspoke" About Risk of Marijuana Fatalities. Chelsea Clinton "misspoke" when she suggested that using medical marijuana along with other medications could be fatal, a spokeswoman has conceded. "While discussing her and her mother's support for rescheduling marijuana to allow for further study of both its medical benefits and possible interactions with other medications, Chelsea misspoke about marijuana's interaction with other drugs contributing to specific deaths," the spokeswoman said. While campaigning for her mother, the former first daughter told students at Youngstown State University in Ohio over the weekend that "some of the people who were taking marijuana for those [medicinal] purposes, the coroner believes, after they died, there was drug interactions with other things they were taking."

Harm Reduction

New York City to Study Supervised Injection Facilities. The city council has agreed to fund a $100,000 study into the pros and cons of supervised injection facilities. "The Council's new supervised injection impact study will assess the feasibility and impact of New York City having a program that provides a safe, clean haven to high-risk, vulnerable New Yorkers and will help prevent drug overdoses and disease transmissions, "Council Speaker Melissa Mark-Viverito said after passage of the proposal.

Law Enforcement

GOP Congressman's Bill Would Subject Heroin Spiked with Fentanyl Dealers to the Death Penalty. Rep. Tom Reed (R-NY) has filed a bill that would allow federal prosecutors to seek the death penalty for dealers linked to an overdose death caused by heroin laced with fentanyl. The measure is HR 6158, the Help Ensure Lives are Protected (HELP) Act. The move was quickly criticized by drug reform advocates. "This bill is a doubling down on the very ineffective, harsh and punitive policies that characterized the early war on drugs and which have widely been proven ineffective at reducing drug use," said Lindsay LaSalle, senior staff attorney for the Drug Policy Alliance.

(This article was prepared by StoptheDrugWar.org's lobbying arm, 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: OR Top Cops Want Defelonization, SC County Wants to Jail Overdosers, More... (9/27/16)

NORML updates its congressional scorecard, Bay State legalizers cry foul over a misleading voter guide, the number of babies suffering from opioid withdrawals has jumped dramatically, Oregon top cops want to defelonize simple drug possession, and more.

Oregon sheriffs and police chiefs jointly call for defelonizing simple drug possession. (Creative Commons)
Marijuana Policy

NORML Releases Updated and Revised 2016 Congressional Scorecard. To mark national Voter Registration Day, NORML has released its updated and revised guide to members of Congress. The guide gives letter grades to our representatives based on the comments and voting records. Only 22 of the 535 senators and congressmen got "A" grades, while 32 members got an "F" grade.

Massachusetts Legalizers Cry Foul Over State-Issued Voter Guide. Campaigners behind the Question 4 legalization initiative say a state-issued guide sent to voters across the state inaccurately describes the fiscal consequences of the measure. The guide says they are "difficult to project due to lack of reliable data" and cites a report from a committee headed by a top opponent of legalization to the effect that taxes and fee revenues from legal marijuana sales "may fall short of even covering the full public and social costs. The Yes on 4 campaign points out that there is "reliable data" from legal marijuana states and that those states have easily covered administrative and other expenses.

Heroin and Prescription Opioids

Study: Number of Babies Born Suffering Withdrawal Symptoms More Than Doubles in Four Years. Researchers studying neonatal abstinence syndrome, which results from withdrawal from opioids to which fetuses were exposed in utero, report that the incidence of the syndrome has jumped from 2.8 cases per thousand live births in 2009 to 7.3 cases in 2013. At least some of the surge may be a result of drug policies aimed at cracking down on prescription drug use. "The drug policies of the early 2000s were effective in reducing supply -- we have seen a decrease in methamphetamine abuse and there have been reductions in some aspects of prescription drug abuse," said lead study author Dr. Joshua Brown. "However, the indirect results, mainly the increase in heroin abuse, were likely not anticipated and we are just starting to see these." The researchers also noted wide variations by state, from 0.7 cases per thousand in Hawaii to 33.4 cases in West Virginia.

New Psychoactive Substances

Bill to Criminalize More New Synthetics Passes House. A bill sponsored by Rep. Charlie Dent (R-TX) to add several new synthetic cannabinoids and opioids to the Controlled Substances Act passed the House Monday. The measure, HR 3537, now goes to the Senate.

Law Enforcement

Oregon Law Enforcement Calls for Defelonizing Drug Possession. The Oregon Association of Police Chiefs and the Oregon State Sheriff's Association have jointly called for people caught with "user amounts" of illegal drugs to face misdemeanor charges -- not felonies -- and be sent to treatment. Elected officials and prosecutors should "craft a more thoughtful approach to drug possession when it is the only crime committed," the top cops said, because felony charges "include unintended and collateral consequences including barriers to housing and employment and a disparate impact on minority communities."

South Carolina County Ponders Mandatory Jail Time for People Who Overdose. The chairman of the county council in Horry County, where Myrtle Beach is located, has inquired during a council meeting about whether to make people who suffer opioid overdoses spend three days in jail. Chairman Mark Lazarus would also like to see mandatory drug treatment required. He added that jailing people who overdose wouldn't discourage them from getting medical help because they're usually unconscious and someone else calls for emergency assistance.

Chronicle AM: DEA Issues Carfentanil Warning, Malaysia to Hang Man for MJ Trafficking, More... (9/23/16)

The DEA issues a warning on a powerful emerging opioid, Michigan marijuana legalizers turn their eyes to 2018, Malaysia sentences a man to death for pot dealing, and more.

Marijuana Policy

This Year's Legalization and Medical Marijuana Initiatives Could Add $7.8 Billion to US Economy. A new report highlighting the rush of capital into the legal pot business estimates that expanding the legal marijuana market into the states that have initiatives on the ballot this year could add $7.8 billion to the nation's economy by 2020. The report is from New Frontier Data and Arcview Market Research. The report said legalization could generate a billion in taxes in California alone.

Undaunted Michigan Legalizers Lay Plans for 2018. After losing their battle in the courts to get all their signatures counted, the folks at MI Legalize are already gearing up for 2018. The group turned in 354,000 signatures for this year, but some were not counted because they were gathered outside a 180-day window. The group said is going to restructure itself in preparation for another petition drive.

Heroin and Prescription Opioids

DEA Issues Carfentanil Warning to Police and Public. "DEA has issued a public warning to the public and law enforcement nationwide about the health and safety risks of carfentanil. Carfentanil is a synthetic opioid that is 10,000 times more potent than morphine and 100 times more potent than fentanyl, which itself is 50 times more potent than heroin. DEA, local law enforcement and first responders have recently seen the presence of carfentanil, which has been linked to a significant number of overdose deaths in various parts of the country. Improper handling of carfentanil, as well as fentanyl and other fentanyl-related compounds, has deadly consequences," a DEA press release said.

Drug Policy

Sen. Leahy Files Bill to Fund Heroin and Methamphetamine Task Forces. Sen. Patrick Leahy (D-VT) has filed S 3359, which would allocate $17 million a year in grants to state law enforcement to fund drug task forces aimed at heroin, prescription opioid, and methamphetamine trafficking.

International

Dutch Moving Toward Allowing Legal Marijuana Cultivation. Draft legislation that would regulate legal marijuana cultivation now appears to have backing from a majority of members of parliament. The bill had been pushed by the liberal D66 Party, with backing from Labor, Green Links, the Socialists, and an animal rights party. That was not quite enough. But now, two MPs who left the anti-Islamic PVV to form their own breakaway party say they will support the measure, and that should be enough to pass it. Stay tuned.

Malaysia Sentences Unemployed Man to Death for Marijuana Trafficking. The High Court in Kuala Lumpur Friday sentenced Ibrahim Musa Rifal, 32, to be hanged after he was convicted of trafficking about 20 pounds of marijuana. Under the country's 1952 Dangerous Drugs Act, such a charge carries a mandatory death sentence.

Drug War Issues

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