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Published: Tue, 12 Dec 2017 00:00:00 -0500

Last Build Date: Tue, 12 Dec 2017 11:47:10 -0500


Pressure Builds on Bureau of Prisons to Release Elderly and Sick Inmates

Fri, 08 Dec 2017 16:15:00 -0500

A coalition of political advocacy groups, criminal justice reformers, and religious organizations sent a letter Thursday to Federal Bureau of Prisons Director Mark Inch asking him to reform the bureau's compassionate release program. Compassionate release was created by Congress in 1984 to provide an administrative mechanism for shortening the sentences of prisoners in "extraordinary and compelling" circumstances. Since then, BOP has used compassionate very infrequently and only for terminally ill prisoners. But even folks knocking on death's door have been denied early release, or died while waiting for an answer. The letter campaign marks the latest major push in the last four years to get the BOP to help sick and elderly prisoners understand and apply for the program. The agency has ignored similar requests from the Justice Department Office of Inspector General and the U.S. Sentencing Commission. The BOP has also declined to explain to Congress or the public why compassionate release is so seldom used. "The BOP should take steps immediately to ensure that all prisoners and their families are aware of the compassionate release program and its eligibility requirements," reads the letter, which is signed by the American Civil Liberties Union, the Association of Prosecuting Attorneys, the Church of Scientology, FreedomWorks, R Street Institute, Families Against Mandatory Minimums*, and more than a dozen other groups across the ideological spectrum. "The Bureau should give clear guidance for submitting requests and commit to a meaningful and timely review of and response to requests. In addition, the BOP should make sure that all relevant staff, including medical care providers, case managers, and unit teams, are aware of the eligibility criteria." In July, Sen. Richard Shelby (R-Ala.) added language to the 2018 appropriations bill requiring the BOP to inform the Senate how many compassionate release requests it granted in the last five years, how many it denied, and how many people died while waiting for an answer. The DOJ Inspector General's Office and the U.S. Sentencing Commission have also called on the BOP to use the program more often due to the explosion of the BOP's elderly population and the fact that federal detention facilities were not designed to serve as nursing homes or hospitals. As a result, sick prisoners receive inadequate medical care. One institution reviewed by the Inspector General's Office did not have enough medical staff to treat its sick population, nor enough correctional officers to lead off-site medical trips. The lack of staffing meant prisoners at the center who needed specialized treatment for cardiology, neurosurgery, pulmonology, and urology had to wait an average of 114 days to see a physician. The OIG also reported that as of 2016, the BOP employed only 36 social workers for an inmate population of nearly 200,000 people, and that despite having an unprecedented number of wheelchair and walker-dependent inmates, the BOP has not conducted an accessibility review of its facilities in more than 20 years. Many of the people serving decades-long sentences at the federal level are drug offenders. While these sentences are disproportionately long for people in their 20s, they are absurd for the elderly. "We know that people age out of crime, especially violent crime," says Kevin Ring, president of Families Against Mandatory Minimums. "Compassionate release allows us to use that knowledge and to target expensive prison space for those who actually threaten public safety." In addition to appealing directly to Inch, FAMM has also released a series of videos highlighting the kinds of cases the BOP either ignores or denies. Readers may find the case of Warren Rossin, who received a 20-year sentence for his involvement in a marijuana conspiracy only to require nearly a million dollars worth of medical care while incarcerated, to be especially illustrative: src="" allowfullscreen="allowfullscreen" width="560" height="340" frameborder="0"> *Disclosure: I serv[...]

Los Angeles Reserves the Right to Decide Who May Sell You Pot

Thu, 07 Dec 2017 15:30:00 -0500

The City of Los Angeles voted yesterday to implement a host of licensing and regulatory guidelines that would usher in the legalized growing, manufacturing, and sale of recreational marijuana next year. For the most part, this is good news. One of the biggest cities in the United States is ending this particular segment of the drug war, assuming the Department of Justice doesn't come in and arrest everybody. L.A. is doing this for the money. When California approved recreational marijuana use, it gave local governments the authority to levy taxes on the trade. The Los Angeles Times reports that the city expects legal pot to generate $50 million in tax revenue in just its first year. (That sounds like a huge pile of cash, but it's nothing compared to the $1 billion the city spends annually on pensions and health care for retired city employees. The infusion of marijuana money is not going to solve L.A.'s spending problems.) Unfortunately, Los Angeles is handling this newly legal form of commerce the way it handles everything: with an incredibly complicated licensing system that favors certain people at the expense of others. This approach may mean that the black market for marijuana will continue in the city. L.A. is deliberately capping the number of shops and grow facilities that it will license, based on population and location. Officials calculate that fewer than 400 actual pot shops will be permitted, along with around 340 growers and 520 manufacturers. Fundamentally this means city officials, not the marketplace, will be deciding who gets to be a marijuana dealer. And that means influence matters. There's already going to be a licensing priority toward the entrenched medical marijuana interests who were early entrants as legal dispensaries. Note that when the city finally stopped resisting the opening of medical marijuana dispensaries, it did so in such a way that played favorites with these established businesses and deliberately helped them fend off competitors. In an attempt to be more inclusive, the city will also implement a "social equity" program to give some "priority processing" for people who qualify on the basis of being poor, or having previously been convicted of misdemeanor marijuana crimes, or having lived in areas who have been disproportionally impacted by pot enforcement. While that sounds nice, the rules are complicated enough that you can be sure they'll be gamed. And the city is imposing so many security and data retention requirements, that few actual poor people seem likely to get in before the license cap is reached. There are also all sorts of public hearing and notification requirements—not to mention the rules embedded in with the state's notoriously abused California Environmental Quality Act—that NIMBY types (and potential competitors) can use to keep pot shops out. If Los Angeles were really committed to help poor people and those chewed up and spit out by the drug war to start their own cannabis businesses, it wouldn't be capping the number of pot shops the city would permit. So we'll see how it goes. There are some empty storefronts in my Mid-City neighborhood that could host a pot shop. But there's also a rehab facility and an elementary school, and the regulations prohibit a shop from being within 700 feet of either of those, so I'm not holding my breath.[...]

Drug Users In D.C. Can Now Legally Test Their Dope for Fentanyl. Now How About Over-the-Counter Naloxone?

Wed, 06 Dec 2017 15:25:00 -0500

In an emergency measure passed unanimously yesterday, the D.C. City Council voted to amend the Drug Paraphernalia Act of 1982 "to allow the use of testing kits for specified purposes." Portable drug testing kits, in which a reagent solution changes color based on the presence of certain compounds, are the cheapest and easiest way for non-medical users to figure out if their heroin contains fentanyl, if their MDMA contains PMA, etc. This site sells a box of 10 fentanyl test kits for only $15 (but only to cops). D.C.'s temporary repeal of the ban on drug testing kits will "allow syringe exchanges and community organizations to provide drug checking kits to help their clients detect fentanyl to prevent fatal overdoses," according to an email from the Drug Policy Alliance (DPA). If Mayor Muriel Bowser signs off, the repeal will be in effect for 90 days. The DPA, which shepherded the law through, expects the council to extend it by another 225 days once the initial repeal expires. I tip my hat to the council for putting the health of D.C.'s residents over whatever argument says it's politically preferable for heroin users to kill themselves than shoot up one more time. But it's a little alarming that the city has moved so slowly to address the opioid crisis. The fentanyl death rate in D.C. has tripled in the last three years, and the city still hasn't legalized over-the-counter sales of the overdose-reversal drug Naloxone. As of August, D.C. was buying and distributing the drug itself—rather inefficiently, according to groups that work with drug users. This is both surprising and disappointing, given that the city was a relatively early leader in legalizing clean needle exchanges. Paraphernalia laws, many of them passed decades ago, pose a massive obstacle to saving lives and helping people who want to be helped. In addition to being counterproductive, they are also absurdly broad: Under some circumstances, D.C. classifies dextrose, i.e., granulated sugar, as paraphernalia. Indiana offers another great example of what happens when legislators just say no to revisiting paraphernalia laws. For a very long time, the state prohibited the operation of clean needle exchanges. It took nearly 200 HIV cases in and around Scott County for then-Gov. Mike Pence to sign a repeal of the ban. Public health researchers have since concluded, based on the huge enrollment of participants in the exchange program after the outbreak, that repealing the ban earlier might have prevented the outbreak. Or legislators could've waited just a little longer and allowed Scott County (pop. 24,000) to achieve the distinction of hosting an HIV-positive population that's at least 1 percent of the overall population, the statistical threshold for declaring a generalized HIV epidemic. The evidence for testing kits is not as robust as it is for clean needle exchanges and supervised injection facilities, but what little research has been done suggests that the majority of opioid users don't know what they're taking and are less likely to overdose when they find out. That's a good enough reason to permanently repeal the D.C. ban.[...]

Don’t Register Anything

Tue, 05 Dec 2017 00:01:00 -0500

If we needed yet another demonstration that getting yourself on the government's radar is just a bad idea, Hawaii handed it to us in spades last week. That's when we learned that the Honolulu Police Department was putting the screws to people so honest—and trusting—as to comply with state laws requiring registration of certain goods and activities. They shouldn't have been so honest and trusting. Like too many jurisdictions, Hawaii requires gun owners to register their firearms. Also like an excess of other control-freaky places, the state requires medical marijuana users to register themselves with the state Department of Health. As it turns out, those who dutifully abide by both requirements find themselves in trouble. Hawaii may allow the use of marijuana for medicinal uses, and even require registration of its users, but the state continues to regard the practice as a violation of federal law. As a result, Honolulu residents who legally complied with requirements that they enter themselves in both registries have received threatening letters signed by officials including Honolulu Police Chief Susan Ballard. These letters read, in part: "Your medical marijuana use disqualifies you from ownership of firearms and ammunition. If you currently own or have any firearms, you have 30 days upon receipt of this letter to voluntarily surrender your firearms, permit and ammunition to the Honolulu Police Department or otherwise transfer ownership." Federal law restricts the possession of firearms by anybody who is an "unlawful user of or addicted to any controlled substance," and marijuana remains a controlled substance according to the folks in D.C. That's enough of an excuse for Honolulu police officials to try to disarm locals who've done their best to abide by state gun and marijuana laws. But it's not just a Hawaii problem. As Jacob Sullum previously noted, "Last year the U.S. Court of Appeals for the 9th Circuit, which includes Hawaii, upheld the ATF's policy of banning gun sales to people who are known to have medical marijuana cards, even if they do not currently consume cannabis." So putting your name on a medical marijuana registry anywhere has the potential to make it more difficult to legally buy a firearm. Actually, entering your information into a medical marijuana registry can put a red flag next to your name in so many ways. Colorado marijuana patients have been surprised during traffic stops to discover that cops knew they were registered users. Cops are supposed to have access to the registry only under limited circumstances, but the data has obviously been shared more widely than many people envisioned. Even so, the state's Board of Health rejected a petition to block sharing of registry information with law enforcement, with the head of the board insisting, "We don't know that we are doing anything wrong." The same issue developed in Oregon, where a 2012 news report noted that "Law enforcement ran more than 20,000 queries on potential patients and grow sites from March through October of this year." Unlike Colorado, Oregon deliberately gave police open access to the medical marijuana registry, and they apparently browsed it at will—at least until the courts gave them a slap. In 2010, a state judge told cops to stop running concealed carry permit applicants' names through the system, saying "the statute does not authorize the use of database information for purposes of helping to determine whether an individual uses, or may use, marijuana." Complaints about police in Colorado and Oregon browsing marijuana registries for excuses to hassle people seem to have subsided in recent years, perhaps because both states have legalized recreational use, which does not require people to put their names on lists that officials can easily peruse. On the other hand, states including Massachusetts, Connecticut, Rhode Island, and Vermont are now under pressure to share data from their medical marijuana registries with the federal government.[...]

The Justice Department's New Opioid ‘Tools’ Are All About Escalating the Drug War

Wed, 29 Nov 2017 16:45:00 -0500

Attorney General Jeff Sessions and Robert Patterson, acting administrator for the Drug Enforcement Agency (DEA), announced new efforts to address opioid overdoses in America today. In line with his insistent (and mistaken) belief that what America needs to stop deaths is an escalation of the failed drug war, Sessions called for increased funding and staff for the purposes of arresting and prosecuting more people. Here are the basics of what he and Patterson announced today: More than $12 million in grant funding to state and local law enforcement agencies specifically engaged in investigating and arresting those involved in illicit opioid and meth manufacturing. A new DEA field division office in Louisville, Kentucky, focusing on drug enforcement in Kentucky, Tennessee, and West Virginia. This action expands an existing district office, and again, the goal here is investigating and arresting people for drug trafficking. A new "opioid coordinator" for each U.S. attorney's office in the United States to be named by mid-December. The memo from Sessions to these offices makes it clear that the emphasis for this coordinator is to provide legal advice to each attorneys' office to prosecute more opioid cases and calls for the office to keep track of opioid prosecution statistics from their offices. Separately, and somewhat mystifyingly, the administration announced that White House adviser Kellyanne Conway will be its lead representative in the opioid fight. Conway was already playing this role, previously saying the administration supports efforts to change the way doctors measure pain to keep drug-seekers from faking it in order to land prescriptions. Given that the Trump administration has been trying to overturn the Affordable Care Act as an intrusive government intervention into our healthcare, it's a bit hypocritical to see support for such a paternalistic and authoritarian meddling in people's personal pain management. The role prescription opioids have played in the overdose crisis has been misunderstood and exaggerated. As Jacob Sullum noted recently, the number of opioid users who ultimately become addicted any given year is relatively small (one to two percent) and the rate of fatal overdoses among users with prescriptions is even smaller. Overdose deaths are more likely to come from people combining drugs or combining opioids with alcohol, and these problems are actually exacerbated when you force people with drug addictions into the black market, where they'll end up taking opioids of unknown origins that may be laced with other drugs. That's exactly what will happen with an expanded anti-opioid effort. Alternatively, more and more scientific evidence is showing that medical marijuana is useful for helping people manage chronic pain and avoid addiction to opioids. But Sessions is completely opposed to marijuana use and the Justice Department is considering how or whether they're going to continue taking a hands-off approach toward state-level legalization. In short, the Department of Justice's current approach and attitude toward fighting opioid overdoses is incoherent and bound to make the problems worse. These are "tools" to cause more harm and pain to people's families, not to ease them.[...]

Hawaii, Which Registers Guns and Medical Marijuana Users, Starts Disarming Patients

Wed, 29 Nov 2017 09:35:00 -0500

Hawaii is one of 29 states that allow medical use of marijuana, but it is the only state that requires registration of all firearms. If you are familiar with the criteria that bar people from owning guns under federal law, you can probably surmise what the conjunction of these two facts means for patients who use cannabis as a medicine, which Hawaii allows them to do only if they register with the state. Some of them recently received a letter from Honolulu Police Chief Susan Ballard, instructing them to turn in their guns. "Your medical marijuana use disqualifies you from ownership of firearms and ammunition," Ballard says in the November 13 letter, which Leafly obtained this week after Russ Belville noted it in his Marijuana Agenda podcast. "If you currently own or have any firearms, you have 30 days upon receipt of this letter to voluntarily surrender your firearms, permit, and ammunition to the Honolulu Police Department (HPD) or otherwise transfer ownership. A medical doctor's clearance letter is required for any future firearms applications or return of firearms from HPD evidence." Although medical marijuana states typically register patients and/or issue them ID cards, Hawaii is unusual in making its registry both mandatory and accessible for purposes other than confirming eligibility, which is how Ballard knew where to send her warning. The letter, which comes just three months after Hawaii's first medical marijuana dispensary opened, does not say what will happen to gun owners who fail to "voluntarily" give up their weapons. But if police decide to pay them a visit, it should be easy enough to locate them by comparing the state's list of patients with its list of gun owners. As authority for disarming medical marijuana users, Ballard cites Section 134-7(a) of Hawaii's Revised Statutes, which says "no person who is a fugitive from justice or is a person prohibited from possessing firearms or ammunition under federal law shall own, possess, or control any firearm or ammunition." The relevant federal provision prohibits possession of firearms by anyone who is "an unlawful user of or addicted to any controlled substance." Since federal law does not recognize any legitimate reason for consuming cannabis, all use is unlawful use, as the Bureau of Alcohol, Tobacco, Firearms, and Explosives makes clear in a boldfaced warning on the form that must be completed by anyone buying a gun from a federally licensed dealer: "The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside." Last year the U.S. Court of Appeals for the 9th Circuit, which includes Hawaii, upheld the ATF's policy of banning gun sales to people who are known to have medical marijuana cards, even if they do not currently consume cannabis. The appeals court reasoned that possessing a medical marijuana card is a good if imperfect indicator of illegal drug use, which is in turn associated with violence, "impaired mental states," and "negative interactions with law enforcement officers." The 9th Circuit concluded that there is a "reasonable fit" between the ATF's policy and a substantial government objective, which means it passes "intermediate scrutiny" and is consistent with the constitutional right to keep and bear arms. Most people probably do not realize how casually the federal government strips Americans of their Second Amendment rights, because enforcement of these longstanding rules is spotty and haphazard. Federal law notionally bars gun ownership by all of America's 38 million or so cannabis consumers, along with millions of other unlawful users of controlled substances, including anyone who takes a medication prescribed for someone else or uses it for a purpose different from the one specified by a doctor (for back pain rather than tooth pain, say). But enforcing that ban is [...]

New Mexico Study Suggests Medical Cannabis Helps Chronic Pain Patients Reduce Opioid Use

Tue, 28 Nov 2017 17:20:00 -0500

Chronic pain patients who enroll in New Mexico's Medical Cannabis Program while using prescription opioids are likely to reduce their dosage of opioids and even to cease using opioids altogether, according to a new study from researchers at the University of New Mexico. Participants in the program also reported "improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP." Published earlier this month in the open access journal PLOS One, the study had a small sample size: 37 of the surveyed patients enrolled in the marijuana program, while 29 used opioids alone. The study also relied on a cohort model rather than a randomized control trial. That means investigators had no say over who ended up in the comparison group versus the Medical Cannabis Program (MCP) group. The UNM researchers concluded the "clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations." That finding dovetails neatly with a growing body of research that medical marijuana works as well as some prescription drugs for the treatment of pain, while imposing fewer side effects on users. Researchers at the University of Michigan, for instance, reported in 2016 that chronic pain patients participating in Michigan's medical marijuana program reported a large reduction in opioid use and improved quality of life. Other studies have found that doctors in medical marijuana states prescribe fewer prescription drugs, and that states with legal medical marijuana have experienced a smaller increase in opioid overdose rates compared to states where medical marijuana is not legal. Albert Einstein College of Medicine announced earlier this year it had received a $3.5 million grant from the National Institute of Health to conduct a five-year study on medical marijuana's potential to reduce opioid use in patients with chronic pain. The more of these studies I see, the more I'm reminded of something psychiatrist Scott Alexander noted about the renaissance in psychedelic research: "There's a morality tale to be told here about how the War on Drugs choked off vital research on some of the most powerful psychiatric compounds and cost us fifty years in exploring these effects and treating patients." Marijuana's schedule I status precluded it from competing with prescription opioids in the early 1990s as a treatment for chronic pain. That it remains in schedule I, despite a procession of state-level reforms, precludes today's medical professionals and patients from using it the way they use far more potent drugs. I'm not convinced we need marijuana to be a perfect substitute for prescription opioids, but it seems pretty obvious that chronic pain patients—like PTSD and anxiety patients who want to try MDMA, or depression patients who wish to try psilocybin—would benefit from a wider range of legal drug options than they currently have.[...]

Thomas Massie on Tax Reform, Shikha Dalmia on Deporting Americans

Thu, 16 Nov 2017 08:37:00 -0500

Today, the House of Representatives is expected to pass its long-awaited, short-gestated version of tax reform. Among the many questions associated with the bill is whether it will indeed add $1.7 trillion of new red ink to the national debt over the next decade (as per Congressional Budget Office guesstimates), or whether "dynamic scoring" and supply-side magic will whittle that figure down to insignificance; whether your average family of four will indeed save $1,182 on their next tax bill or whether the elimination of the State and Local Tax (SALT) deduction will hammer tens of millions; and perhaps above all whether the Senate will pay even one bit of attention to the House's exertions (and conversely, whether the House will demand a conference committee if the Senate ever passes its version, or simply fold like it did when the upper chamber passed a 10-year budget resolution with a $1.5 trillion deficit hole). All of which can mean only one thing: Time to get #SassyWithMassie! Today in the first hour of my 9-12 a.m. ET stint guest-hosting Stand UP! with Pete Dominick on SiriusXM Insight (channel 121), I will have on Kentucky's libertarian Republican congressman, Thomas Massie, to see whether and why he still stands by his recent comments to CNN that "I am going to vote for this. This is a new experience for me to be excited about a bill." Later in the program I'll also have on National Review staffer Kevin Williamson, who initially characterized the GOP plan as "An Anti-Growth Tax Cut." Also on the program: * Reason's own Shikha Dalmia, to talk about her marvelous new magazine piece, "How Immigration Crackdowns Screw Up Americans' Lives: The war on immigration has taken a great toll on unauthorized aliens, its targets. But it is also badly affecting Americans themselves, its intended beneficiaries." * Daniel Miller, founder of the Psychedelic Society of Brooklyn, to talk about the 79th birthday of acid, and why dosing (or micro-dosing) may well be good for you. * Bethany Mandel of The Federalist, to talk about her New York Times op-ed from yesterday, "Roy Moore Reminds Me of My Rabbi." As ever, please call in any old time, at 1-877-974-7487.[...]

The Federal Government Is Trying to Ban Kratom (Again)

Tue, 14 Nov 2017 11:28:00 -0500

A year after the Drug Enforcement Administration attempted to ban the plant-based drug kratom, only to back down when users claimed it helped them with opioid withdrawal symptoms, the Food and Drug Administration (FDA) announced on Monday that is has begun blocking the importation of kratom products. "To fulfill our public health obligations, we have identified kratom products on two import alerts and we are working to actively prevent shipments of kratom from entering the U.S.," FDA Commissioner Scott Gottlieb announced in a blog post today. His agency "has detained hundreds of shipments of kratom," Gottlieb adds. "We've used our authority to conduct seizures and to oversee the voluntary destruction of kratom products. We're also working with our federal partners to address the risks posed by these imports." Kratom is native to Southeast Asia and part of the coffee family. It works as a mild stimulant in low doses, and as a sedative in high doses. Users buy it as a nutritional or herbal supplement, and it has some rather well-known adherents in the internet community, including podcaster Joe Rogan and filmmaker Christopher Bell, who used kratom to ween himself off prescription painkillers after an injury. Gottlieb claims that the supplement is dangerous and has no demonstrated medical value: Calls to U.S. poison control centers regarding kratom have increased 10-fold from 2010 to 2015, with hundreds of calls made each year. The FDA is aware of reports of 36 deaths associated with the use of kratom-containing products. There have been reports of kratom being laced with other opioids like hydrocodone. The use of kratom is also associated with serious side effects like seizures, liver damage and withdrawal symptoms. But as Reason's Jacob Sullum reported last year, several hundred reports of adverse reactions to kratom are a miniscule number compared to other drugs: According to the U.S. Centers for Disease Control and Prevention, alcohol causes about 88,000 deaths a year in this country, while 28,000 deaths were attributed to heroin and opioid painkillers in 2014. Kratom looks pretty benign by comparison. Another point to keep in mind: "Deaths associated with kratom" are not necessarily caused by kratom. "Kratom is considered minimally toxic," noted a 2015 literature review in the International Journal of Legal Medicine. "Although death has been attributed to kratom use, there is no solid evidence that kratom was the sole contributor to an individual's death." As further proof of kratom's dangers, the DEA noted that "U.S. poison centers received 660 calls related to kratom exposure" from 2010 through 2015, an average of 110 a year. By comparison, exposures involving analgesics accounted for nearly 300,000 calls in 2014, while antidepressants and antihistamines each accounted for more than 100,000. In his announcement, Gottlieb revealed that the DEA asked the FDA to conduct a medical review of kratom, which is the first step in the traditional process of adding a subtance to the government's "schedule" of restricted drugs. While he encourages "those who believe in the proposed medicinal uses of conduct the research that will help us better understand kratom's risk and benefit profile," his postion right now is that "there are currently no FDA-approved therapeutic uses of kratom." Based on Gottlieb's tone, I expect the FDA will work with the DEA to put kratom in Schedule I—the most tightly regulated category of drugs—until researchers provide evidence of its therapeutic utility. A full clinical trial of the drug would likely take a decade to complete and cost tens of millions of dollars. In the meantime, moving the drug to sSchedule I would criminalize its purchase, use, sale, production, and importation. For more on kratom, here's filmmaker Chris Bell talking to about how the pla[...]

Jeff Sessions Used His Emergency Scheduling Powers Last Week. Here's What That Means.

Mon, 13 Nov 2017 11:55:00 -0500

We're about to see a sea change in how the feds plan to tackle overdose deaths, and it will likely have some very ugly unintended consequences. The Department of Justice (DOJ) announced last week that it has used its emergency scheduling powers to place all fentanyl analogs in schedule I. What does that mean? Glad you asked: What is emergency scheduling? The Controlled Substances Act allows the attorney general "to temporarily place a substance into Schedule I of the Controlled Substances Act for two years" without the consent of any other federal body "if he finds that such action is necessary to avoid an imminent hazard to the public safety." The Justice Department used emergency scheduling to place MDMA in schedule I in the 1980s. Physicians challenged that decision at the time, and lost. Absent emergency scheduling, getting a drug into or out of any scheduling category requires either legislation or a "scientific and medical evaluation" by the Department Health and Human Services. Why is the DOJ using its emergency powers? Under federal law, the Justice Department can prosecute a person for drug trafficking if the drug in question is a controlled substance, or if an unscheduled drug closely resembles a controlled substance and is intended to mimic it. Fentanyl, a highly potent analgesic used in surgeries and for pain management, is in schedule II, which is the legal and regulatory category for drugs with proven medical benefits that are also habit-forming, potentially dangerous, and prone to abuse. But many of fentanyl's analogs—drugs that are chemically different but work in a similar way—are not scheduled. And that makes prosecuting analog cases harder. Consider marijuana. Prosecuting a marijuana case requires proving only that the drug being sold was marijuana. But prosecuting a marijuana analog case, absent that specific compound having already been scheduled, requires proving that the drug in question is either chemically similar to marijuana or produces similar effects, and is intended for human consumption. This is why synthetic marijuana is frequently labeled as potpourri and why synthetic cathinones are marketed as bath salts. In short, prosecuting drug analog cases is a pain in the ass. Prosecutors have two particular reasons to dislike current federal analog laws. One is that chemists make new analogs faster than the feds can ban them. Between 2009 and 2014, the Drug Enforcement Administration (DEA) identified 233 new synthetic drugs in the American market that were designed to mimic the effects of controlled substances. But according to a 2014 presentation delivered by DEA agents at the National Conference on Pharmaceutical and Chemical Diversion, the process of adding analogs to the drug schedule lags far behind the development and importation of new compounds: To get a new compound on the schedule, the DEA has to analyze the compound, describe its chemical structure, and explain how it relates to an already scheduled drug. That's labor-intensive work, and the DOJ doesn't want to do it for every compound it comes across. There are a lot of analogs, and some of them may not be circulating in large enough volumes to justify the work that goes into identifying and then prohibiting them. The second reason prosecutors don't like the current laws is that drugs that haven't gone through scheduling process essentially have to be litigated. Courts have divided over the chemistry arguments made by prosecutors, and even when DOJ prevails, due process is still arduous. "The chemical composition of these drugs is ever evolving, and the current legal framework (both the statutes and the guidelines) is inadequate to ensure that the criminals who sell these deadly poisons face appropriate punishment," the Justice Department complained in a July letter to the United States S[...]

Trump's Weak Response to Opioid Overdoses

Sun, 29 Oct 2017 00:01:00 -0400

You'd think it would be impossible to kill 100 people a day, every day, without inducing widespread shock and deafening demands for action. But that's what opioids have been doing for the past decade, and Americans have given it only passing attention. This year, the toll is expected to rise to 175 a day—64,000 in all. On Thursday, it looked as though President Donald Trump would address the problem with the urgency it demands. But his speech was blighted by his usual oratorical crimes: deep self-infatuation ("I've never had a drink"), bloated adjectives ("tremendous," "horrible"), cheap promises (changes "will come very, very fast"), and swipes at President Barack Obama ("not like in the past"). Trump went through a roster of fraudulent cures, such as building a border wall, demanding that China crack down on shipments of the powerful opioid fentanyl, and "really tough, really big, really great advertising" to discourage drug use. We know from experience that no amount of enforcement can stamp out the demand for or the supply of illicit substances. If fentanyl stopped arriving from China, which isn't likely, it would soon pour in from black-market labs in other countries, including this one. Anti-drug ads are irrelevant to those who develop a dependence on opioids prescribed for severe pain. And people in communities where opioid-laced corpses are piling up don't need to be informed that these drugs are dangerous. The public health offensive Trump declared is mostly a form of yoga: lots of posturing while staying in one place. More innovative remedies will be needed to actually turn back the relentless onslaught of overdose fatalities. Some people around the president are better connected to reality. On Wednesday, the commissioner of the Food and Drug Administration acknowledged to a House committee that the biggest need is a huge expansion of treatment for those dependent on opioids. Scott Gottlieb testified that therapies using methadone or buprenorphine have been proved safe and effective in combating addiction. Massachusetts, for example, found that they cut the risk of death by overdose by 50 percent among people who had survived previous overdoses. But the remedy works only for those who get it. "Unfortunately, far too few people who are addicted to opioids are offered an adequate chance for treatment that uses medications," Gottlieb said. He intends to encourage doctors to offer such remedies for anyone who is treated for an overdose. He hopes to banish the stigma of being on methadone or buprenorphine—and get people to recognize that a patient's medication-assisted treatment may last indefinitely, if not forever. We don't think diabetics should conquer their need for insulin. Why suppose that heroin addicts who are successfully treated with methadone should learn to live without it? The FDA can help by preaching the value of medication-assisted treatment and encouraging health insurance companies to cover it. The commissioner said this task is "part of our existing public health mandate to promote the appropriate use of medicine." Trump offered a couple of useful small ideas, including greater access to telemedicine services—so that people in remote areas can get medications needed for drug treatment or mental illness—and letting states use HIV/AIDS funds for treatment. But the humane, evidence-based solutions generally got short shrift. He would have done better to embrace the proposals of his Commission on Combating Drug Addiction and the Opioid Crisis, whose preliminary report stressed the need to "rapidly increase treatment capacity." Right now, it lamented, only 10 percent of drug treatment facilities offer medication-assisted treatment for opioid dependence. The commission, chaired by New Jersey Gov. Chris Christie, recommended m[...]

FDA Commissioner Scott Gottlieb Goes to Bat For Evidence-Based Opioid Policies

Fri, 27 Oct 2017 16:05:00 -0400

Food and Drug Administration Commissioner Scott Gottlieb is now the highest-ranking member of the Trump administration to say in plain language that America can't address the opioid crisis by relying on outdated prevention campaigns or forcing dependent and addicted users to quit cold turkey. "[G]iven the scale of the epidemic, with millions of Americans already affected, prevention is not enough," Gottlieb said in a statement to the House Committee on Energy and Commerce this week. He also pledged his agency would do everything in its power to "break the stigma associated with medications used for addiction treatment." A physician and former resident fellow at the American Enterprise Institute, Gottlieb's testimony provided a dramatic and welcome contrast to the blunt and shallow statements of other Trump administration officials. Whereas former Health and Human Services Secretary Tom Price said that methadone and buprenorphine therapy—which can reduce opioid-related mortality by 50 percent—amount to "just substituting one opioid for another," Gottlieb acknowledged this week that some people with opioid use disorders will need "a lifetime of treatment." His agency, he added, is "revising the labels of these medical products to reflect this fact." He has also instructed Food and Drug Administration staff to develop more extensive guidelines for "non-abstinence-based" products that "address a fuller range of the symptoms of addiction such as craving." Lastly, Gottlieb delivered a rousing rebuttal to the idea that addiction and dependence are no different: Because of the biology of the human body, everyone who uses opioids for any length of time develops a physical dependence—meaning there are withdrawal symptoms after the use stops. Even a cancer patient requiring long-term treatment for the adequate treatment of metastatic pain develops a physical dependence to the opioid medication. That's very different than being addicted. Addiction requires the continued use of opioids despite harmful consequences. Addiction involves a psychological craving above and beyond a physical dependence. Someone who neglects his family, has trouble holding a job, or commits crimes to obtain opioids has an addiction. But someone who is physically dependent on opioids as a result of the treatment of pain but who is not craving more or harming themselves or others is not addicted. The same principle applies to medications used to treat opioid addiction. Someone who requires long-term treatment for opioid addiction with medications—including those that cause a physical dependence—is not addicted to those medications. Here's the bottom line: We should not consider people who hold jobs, re-engage with their families, and regain control over their lives through treatment that uses medications to be addicted. Rather, we should consider them to be role models in the fight against the opioid epidemic. Others have drawn this distinction before, so I hesitate to applaud Gottlieb for acknowledging what his peers have said for years. But this is Washington, a place where drug policy experts are often drowned out by quacks, drug cops, and prosecutors. Gottlieb is not the most progressive reformer in this debate—he may end up calling for the removal of still more opioids from the market, which will hurt legitimate pain patients and likely drive non-medical users to the black market—but his perspective on using opioid therapy to treat opioid addiction puts him head and shoulders above the D.C. status quo.[...]

Massachusetts Mulls Whether to Classify Drug Dealers as Murderers

Fri, 27 Oct 2017 14:20:00 -0400

(image) Massachusetts state senators approved a massive criminal justice reform bill last night that would eliminate many drug-related mandatory minimum sentences (including those arbitrarily connected to "school zones"), restrict the use of solitary confinement, decriminalize sex between minors of similar ages, and set the age the criminal justice system considers you an adult at 19.

Unfortunately, it will also introduce a terrible new tool to the drug war.

To satisfy the urges of the state's Republican governor, Charlie Baker, the reform bill (S.2185) was amended yesterday to charge anybody who deals drugs with second-degree murder if someone they sold drugs to dies of an overdose.

Here's the amendment:

Any person while in the course of trafficking or unlawfully distributing a controlled substance as defined in Section 32E who knowingly or intentionally manufactures, distributes, dispenses, delivers, gives away, barters, administers or provides any amount of a controlled substance or counterfeit substance which results in death shall be punished as murder in the second degree as defined by section 1 of chapter 265. (b) Lack of knowledge of any previous health conditions shall not be a defense to any person who violates the provisions of this section.

According to WBUR, this amendment has itself been amended in order to make it clear that the law is intended to go after dealers, not people who share drugs. If that's the actual intent, Massachusetts Senate Minority Leader Bruce Tarr may have underestimated the creativity of prosecutors by including the words "barters," "administers," and "provides."

Just look at Florida to see how this legislation goes astray. The state has had a law on the books that allows prosecutors to charge drug dealers with first-degree murder when somebody dies of an overdose. The law's application has absolutely not been limited to trying to lock away drug dealers. A woman was recently charged with murder when her friend died of a drug overdose. The woman had taken money from her friend and introduced her to the dealer, but she was not a drug dealer herself.

It's a frustrating and chronic problem. Even as they recognize that heavy mandatory minimum sentences have not been successful in stopping drug use, politicians—and, honestly, a significant part of the population—cannot set aside the idea that this crisis can be stopped by harshly punishing the right people.

Jeff Sessions Says MS-13 Is a Major Player in the Narcotics Trade. The DEA Disagrees.

Wed, 25 Oct 2017 17:25:00 -0400

Attorney General Jeff Sessions announced Monday that a gang called La Mara Salvatrucha, or MS-13, will now be "a priority" for the Justice Department's Organized Crime Drug Enforcement Task Forces. These inter-agency task forces "all have one mission," Sessions said this week at a gathering of the International Association of Chiefs of Police this week. "To go after drug criminals and traffickers at the highest levels." Historically, MS-13 has not trafficked drugs at the "highest levels." Founded in the 1980s by El Salvadoran immigrants in Los Angeles, the group's original purpose was to protect other El Salvadoran refugees of the country's 1980s civil war (in which the U.S. played an ugly role) from Southern California street gangs. It has since evolved into a more sinister and violent organization. But according to the Drug Enforcement Administration and other groups, MS-13 is still a small fry in the drug trafficking business. In a post pushing back against Sessions' remarks, Sarah Kinosian of the human rights group Washington Office on Latin America writes that MS-13 focuses mostly on extortion, street-level drug sales, and inter-gang violence in El Salvador and in the U.S. Federal indictments of MS-13 members reflect that claim. The State Department's 2017 International Narcotics Control Strategy report, released in March of this year, says that "[c]riminal street gangs such as Mara Salvatrucha (MS-13) and 18th Street [another El Salvadoran gang with an American presence, and the sworn enemies of MS-13] do not yet appear to be a formal part of the transnational drug logistics chain, except as facilitators of trafficking through Honduras." The DEA, meanwhile, says in its 2017 Threat Assessment—which the agency released on the same day that Sessions announced MS-13 was now drug enemy number one—that Mexico's Transnational Criminal Organizations (TCOs) "remain the greatest criminal drug threat to the United States; no other group is currently positioned to challenge them." (If that sounds familiar, recall that a DEA spokesperson said this to the Post in August: "Mexican cartels, Mexican transnational organizations are the greatest criminal threat to the United States. There's no other group currently positioned to challenge them. Whenever drug investigations that we do involve MS-13, we respond, but right now the No. 1 drug threat in the U.S. is the Mexican cartels.'') MS-13 not harmless, in other words, but they also aren't driving the heroin and fentanyl crises. We've known for several months now that the DEA and Sessions are at odds about which transnational drug groups to prioritize. In August, the Washington Post reported that acting DEA Administrator Chuck Rosenberg and Sessions went head to head over the focus on MS-13 "despite warnings from Rosenberg and others at the DEA that the gang, which draws Central American teenagers for most of its recruits, is not one of the biggest players when it comes to distributing and selling narcotics." (Though Rosenberg left the DEA earlier this month, he wrote the 2017 Threat Assessment introduction.) Why does any of this matter? Because Mexican CTOs are somehow stronger now than ever before. After two decades of splitting the U.S. heroin market with Colombia—Mexico used trucks to get black tar heroin to the west coast, Colombia used planes and boats to get white powder heroin to the eastern seaboard—the DEA says Mexico is now the dominant supplier to the eastern U.S.: Mexico also sends us a substantial amount of fentanyl, which it obtains from China. It also matters because more than 80,000 people have died in Mexico since 2006, when then-newly elected Mexico President Felipe Calderon kicked off a U.S.-funded offensiv[...]

Why Are Local Officials Shutting Down Needle Exchange Programs During a Crisis?

Mon, 23 Oct 2017 13:20:00 -0400

Back when he was governor of Indiana, Mike Pence, after much praying and pressure, relented and signed legislation that permitted counties to establish needle exchange programs if they could show they were having an HIV or hepatitis C epidemic. Rural Indiana was indeed having such an epidemic at the time, and even the sheriff of Scott County, where the number of new HIV cases had seen a dramatic increase, determined that a needle exchange program was needed. He told Pence as much. After the needle exchange program began, Scott County saw a notable drop in new HIV cases. It has been a small but important success as America figures out how to deal with an increase in heroin use. But those efforts are potentially at risk now. Two counties in Indiana have shut down their relatively new needle exchange programs, expert advice and actual outcomes be damned. Lawrence County, Indiana, saw its Hepatitis C infection rate more than double in the early part of the decade, thanks to intravenous drug use; it's tough to determine trends on the basis of just two years of data, but numbers from the state indicate that there will be fewer infections in 2017 than in 2016. But the county council voted last week not to continue the program. One council member, Rodney Fish, told NBC that he voted against it for "moral reasons": I did not approach this decision lightly. I gave it a great deal of thought and prayer. My conclusion was that I could not support this program and be true to my principles and my beliefs. He claims that he spoke to several health professionals before his vote, and he said he would possibly support a hospital-based program. In August, the council for Madison County, in northern Indiana, also voted to end its needle exchange program over the objections of local health officials. In both counties, opponents of the program argued that operationally it was less about needle "exchange" than needle "distribution." Critics were concerned that they were facilitating drug abuse rather than decreasing the health risks of drug abuse. Indiana's not the only place where local leaders are turning their backs on a needle-exchange-based solution to reduce the spread of HIV and Hepatitis C. In Camden, New Jersey, bureaucratic maneuvers appear to have shut down a needle exchange van that was serving hundreds of drug-users a week. Journalist April Saul reports that property development in Camden forced the van off a vacant lot last year. The program organizers worked with the city to come up with a new location, and in April they identified one. But the mayor of Camden has not signed off on the new agreement, so the program has had to return tens of thousands of dollars in state funding and lay off an employee. So to summarize the state of affairs: Government officials at various levels (including the Department of Justice) want to make it harder for doctors to prescribe opioids as a long-term pain-fighting solution. The result is that people are turning to heroin on the black market. This heroin is often adulterated with other drugs like fentanyl and opioids, causing an increased risk of overdoses and an increased risk of transmitting HIV and Hepatitis C. And government officials are standing in the way of medical solutions to those problems because of moral judgment about people with addictions and a public distaste for funding a solution that makes it seem like we're subsidizing self-harm. If government officials don't like handing out needles to heroin users, they could let nonprofits take the whole thing over, including the funding. Or maybe they could think a little more carefully about how they approach opioid addiction in the first place.[...]