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Drug Policy

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Published: Sun, 24 Sep 2017 00:00:00 -0400

Last Build Date: Sun, 24 Sep 2017 20:53:05 -0400


Fentanyl Importation Reaches 'Shocking' Levels, Says Prosecutor

Wed, 20 Sep 2017 13:15:00 -0400

Law enforcement in New York confiscated a record $30 million worth of illicit fentanyl, 195 pounds of it , in two combined seizures from four defendants over the past two months. The haul dwarfs the previous record of 97 pounds, set in June of this year by Drug Enforcement Administration agents in San Diego. We should expect to see more of it. JFK Airport receives one million pieces of international mail every day. U.S. Customs officials at the facility recently told USA Today they've been able to intercept 40 percent of the fentanyl that comes through their doors, which means most of the fentanyl bound for America passes right on through JFK. The same is likely true at other U.S. ports of entry as well as the Mexican and Canadian borders. "The sheer volume of fentanyl pouring into the city is shocking," New York City Prosecutor Bridget G. Brennan told NBC. We can thank our own stubborn refusal to embrace harm reduction strategies, and, of course, China. According to a report from the U.S.-China Economic Security Review Commission, the PRC and Hong Kong "continue to divert chemicals from legitimate pharmaceutical uses and adulterate legitimate pharmaceuticals during production" due to the "fragmented and disorganized administrative system overseeing chemical production and exports." With roughly 160,000 Chinese chemical facilities operating legally and illegally, it shouldn't surprise us that the second largest pharmaceutical market in the world and the largest global producer of chemical precursors has a major diversion problem. It also shouldn't surprise us that we don't have enough drug-sniffing dogs, Customs agents, or screening devices to catch all the fentanyl coming through the mail. We do have one thing going for us, however, which is that most of the people who use fentanyl-tainted heroin just want the heroin. A 2015 study in the Harm Reduction Journal found that 73 percent of heroin users whose urine tested positive for fentanyl didn't know they'd taken any fentanyl at all. The sample size for this study was small, but it squares with what I've heard from non-medicinal opioid users in the U.S.: Most people take fentanyl inadvertently. They'd rather not take it at all, considering both how deadly it is and the fact that a person needs substantially more naloxone to reverse an overdose. And before many Americans turned to heroin, many of them just wanted to use prescription pills, which is the safest option of the three. But we also made that incredibly difficult by cracking down on prescribing practices and requiring pharmaceutical companies to introduce tamper-proof formulations. Every day of this horrendous epidemic has been a good day to ask why we don't just allow people to take heroin. The Swiss pursued this line of investigation at the height of their own HIV/AIDS epidemic, which was driven by injectable drugs. After the launch of the country's first heroin-assisted treatment clinic in 1994, Switzerland saw huge declines in drug-related deaths, drug-related crime, and AIDS-related deaths. Participants were given clean, accurately-dosed heroin three times a day under doctor's supervision. As a result, researchers saw "major disengagement from criminal activities," reductions in the use of heroin obtained outside the program, and "marked improvements in social functioning." Heroin-assisted treatment isn't cheap: Countries with HAT programs spend roughly 15,000 Euros annually per patient, compared to roughly 2,000 Euros for medication-assisted treatment (which is also too scarce in the U.S.). But according to the European Monitoring Centre for Drugs and Drug Addiction, "If an analysis of cost utility takes into account all relevant parameters, especially related to criminal behaviour, [HAT] saves money." Or, you know, we could keep doing what we're doing.[...]

Philly D.A. Frontrunner Backs Safe Injection Sites for Drug Users

Thu, 14 Sep 2017 14:43:00 -0400

(image) Larry Krasner, the Democratic nominee for Philadelphia district attorney, has announced he would support "properly run and appropriately supervised injection facilities" for drug users. His Republican opponent has also expressed support for the idea, saying in April that "at the very least" a pilot program ought to be opened.

Krasner is the frontrunner in the heavily Democratic city's November election. In May the mayor's task force on the opioid crisis also recommended safe injection sites.

That sounds like a consensus, but success is hardly guaranteed. Yesterday in California, an effort to let local communities either allow or establish their own safe injection sites failed in the Senate. And in Seattle, where the city and county governments recently announced their intentions to open safe injection sites, a ballot initiative is aiming both to block those plans and to ban privately funded injection sites as well.

Safe injection sites operate in dozens of cities in nine countries, including Canada. They work well. At a minimum, private organizations should be permitted to establish such facilities.

A number of cities in states like Pennsylvania have tried syringe exchange programs without explicit state authorization before, according to a 2008 paper on the law and politics of safe injection facilities in the American Journal of Public Health. "Most local governments have some police power to protect public health, and they have the discretion to implement programs that are supported by reasonable evidence of effectiveness in combating existing health threats," the authors wrote.

The paper notes that locally authorized safe injection sites would "depend on an explicit or implicit agreement among stakeholders to avoid arrests and other legal challenges." The support of a district attorney, who decides how to prioritize criminal prosecutions, would therefore be crucial to making such sites possible.

Disjointed Coughs Out Some Tired Dope Humor

Fri, 08 Sep 2017 15:00:00 -0400

Disjointed. Available now on Netflix. Way back when, my college newspaper ran a review of a Cheech and Chong show under a headline that qualified as remarkably confessional for the time: "Dope Humor Has Its Limits." I don't know if we've got to make royalty payments to whatever youthful copy editor wrote that headline, but I can't think of a single other thing to say about Netflix's new sitcom Disjointed. Dopers so wrecked they can't talk. Dopers so wrecked they can't move. Dopers so wrecked they use the Heimlich maneuver to make each other exhale dope smoke rings. (Okay, that one's new, at least for the first five seconds.) Basically, there's not a gag in Disjointed that wouldn't have fit into—or worn itself out as quickly as—a Cheech and Chong sketch or an early 1970s give-me-another-brownie flick like The Groove Tube. But even back then, the driving force of cannabis comedy—hey, man, they're smoking weed right there on the screen, my parents would be so freaked—lasted about as long as the pizza you ordered to counter the munchies. These days, with reefer madness reduced to reefer eccentricity (one in five Americans lives in states where it's pretty easy to find a legal joint), the potency is even slighter. If Disjointed were actually dope, it would be growing-along-the-river skankweed. The wispy premise of Disjointed is that its dope-addled characters get wasted under the pretense of working in a Southern California medical-marijuana dispensary. Kathy Bates plays Ruth Whitefeather Feldman, the senescent hippie owner, who says she's preaching "the gospel of marijuana: the miraculous plant that has the power to heal the sick, calm the afflicted, and usher in a golden age of people of people not being such dicks all the time." Mostly, she's just oversampling her own product, with occasional timeouts to bicker with her son Travis (Aaron Moten, The Night Of), an MBA with more secular motives: "Petty soon, somebody is going to become the Walmart of cannabis. Why not us?" Then there are employees: Jenny (Elizabeth Ho, Melissa & Joey), who introduces herself in one of the clinic's Internet ads as "your tokin' Asian," whose tiger mom thinks she's a surgeon; Olivia (Elizabeth Alderfer, Game Day), a refugee from a meth-blighted midwestern town who harbors secret doubts about the benignity of drugs; and Carter (Tone Bell, Truth Be Told), who has a secret of his own, one not usually associated with comedy. If the substance of Disjointed seems straight out of 1972, so does its structure. It's less a sitcom than a muddled series of stream-of-semi-consciousness sketches, punctuated by cut-ins of the clinic's commercials, kind of a stoner version of Laugh-In. Though for you 1980s connoisseurs, there's a running gag in which Jennie speaks Chinese to her mother—that's it, no jokes, no punch lines, just the sound of Chinese—to the uproarious delight of the canned laugh track that's been appended to the show. Not since John Hughes foreshadowed every appearance of a Chinese character named Long Duck Dong with the crashing sound of a gong in 1984's Sixteen Candles has a producer or director deemed Asian ethnicity so innately amusing. The producer in question is Chuck Lorre, the mastermind of The Big Bang Theory, Mom, and Two and a Half Men, whose association with Disjointed is as inexplicable as quantum physics after a bong full of Maui Wowie. "Back in the day, marijuana was a cause," says Ruth. "Now it's just a commodity." Marijuana humor, too.[...]

Will California Beat Seattle in Building a Safe Drug Injection Facility?

Thu, 07 Sep 2017 13:45:00 -0400

California lawmakers are close to passing a bill allowing a handful of counties to experiment with safe injection sites, facilities where people addicted to drugs can safely get high with professional oversight. Seattle is trying to become the first community in the United States to do this, but opponents have launched a battle at the ballot box. If AB 186 is passed and signed by the governor, eight California counties or the cities within them may approve or establish safe drug consumption areas. Los Angeles and San Francisco are among the approved areas. The authorization to operate the facilities sunsets on Jan. 1, 2022. The bill neither mandates these communities allow these facilities, nor does it provide any funding for them. Citizens in Bakersfield, for example, will not be paying taxes to operate a facility in the Bay Area. If citizens and local officials in Humboldt County (one of the counties authorized in the bill) decide they don't want a safe injection facility, they're under no obligation to provide one. The bill authorizes communities that so choose to create drug consumption spaces where people can consume drugs under the watch of health care professionals. Facilities will not provide drugs, but professionals can provide sterile needles (and dispose of them), prevent fatal overdoses, provide references to addiction treatment services, and educate participants about HIV and hepatitis. Neither clients nor employees at these drug consumption sites will be subject to arrest under state law for the drug use. The bill, however, comes into conflict with federal law, as the state Senate's Public Safety Committee analysis notes. The people who own and operate the facility could face federal arrest and charges, not just the users. If AB 186 passes, it seems likely that the Department of Justice might have something to say about it, given Attorney General Jeff Sessions desire to fight the drug war by maximizing federal criminal sentences for drug crimes and cracking down on doctors who prescribe opioids. The bill passed the state's Assembly in June by a vote of 41-33. It has made it through both the Senate's Health Committee and Public Safety Committee and awaits a full Senate vote by next week. If it passes, San Francisco is likely poised to be the first community to consider it. San Francisco put together a task force in April to develop recommendations for creating safe injection facilities. Assembly member Susan Eggman, a Democrat who represents Stockton and other parts of San Joaquin County, introduced AB 186. Logan Hess, a legislative aide for Eggman, tells Reason these pilot communities were picked because they already have a history of using naloxone as a way of reversing opioid overdoses, and data shows, like many other communities, they're nevertheless struggling with the problem. That AB 186 was written pretty loosely was a deliberate choice, Hess explains. It does not tie these communities to a particular model of operation. It doesn't tell cities or counties that it must be a non-profit organization, or a hospital, or operated by a public health agency. Participants will make that call. "One of the reasons we didn't want to be too prescriptive is that certain models might not make as much sense," Hess says. While the injection site in Vancouver, British Columbia, tends to be touted as a role model—it's currently the only site in North American and is Seattle's inspiration—Hess notes that there are other types of operations out there that might be better suited for particular communities. But that matters only if the law gets past the Senate. The bill is opposed by the California Police Chiefs Association, the California State Sheriffs' Association, and the California District Attorneys Association (along with several other smaller law enforcement organizations and unions). David Stammerjohan, Eggman's chief of staff, notes that they face a close fight in the Senate. Given the Democratic Party domination of California's[...]

House Rules Committee Blocks Amendment Protecting Medical Marijuana

Thu, 07 Sep 2017 12:50:00 -0400

Yesterday the House Rules Committee blocked a floor vote on an amendment barring the Justice Department from interfering with state laws allowing medical use of marijuana. The amendment, which was first enacted in 2014 and has been renewed twice since then, could still be included in the final spending bill, since it has been approved by the Senate Appropriations Committee. Any differences between the House and Senate versions of the bill will be worked out by a bicameral conference committee. "By blocking our amendment, Committee leadership is putting at risk the millions of patients who rely on medical marijuana for treatment, as well as the clinics and businesses that support them," said the amendment's current sponsors, Reps. Dana Rohrabacher (R-Calif.) and Earl Blumenauer (D-Ore.). "This decision goes against the will of the American people, who overwhelmingly oppose federal interference with state marijuana laws. These critical protections are supported by a majority of our colleagues on both sides of the aisle. There's no question: If a vote were allowed, our amendment would pass on the House floor, as it has several times before." Attorney General Jeff Sessions urged Congress to block the Rohrabacher-Bluemnauer amendment last May, arguing that "it would be unwise to restrict the discretion of the Department to fund particular prosecutions, particularly in the midst of an historic drug epidemic and potentially long-term uptick in violent crime." Exactly what medical marijuana had to do with any of that was unclear, but the Justice Department generally opposes limits on its prosecutorial discretion, and Sessions' anti-pot prejudices are well-known. In a Washington Post op-ed piece this week, Rohrabacher rebutted Sessions' clumsy attempt to blame medical marijuana for recent increases in opioid use and opioid-related deaths. To the contrary, he said, marijuana is a safer alternative to opioids. "The drug-war apparatus will not give ground without a fight," he wrote, "even if it deprives Americans of medical alternatives and inadvertently creates more dependency on opioids. When its existence depends on asset seizures and other affronts to our Constitution, why should anti-medical-marijuana forces care if they've contributed inadvertently to a vast market, both legal and illegal, for opioids?" Unlike Sessions, Donald Trump has repeatedly said he supports medical marijuana and thinks states should be free to allow it. So even if the Rohrabacher-Blumenauer amendment is not renewed for the next fiscal year, it is not clear that Sessions will try to shut down state-licensed medical marijuana suppliers. The amendment does not cover state-legal marijuana merchants serving the recreational market, who nevertheless have escaped prosecution so far, even though they are openly committing federal felonies every day. A cannabis crackdown would not be popular. In the most recent Quinnipiac University poll, 61 percent of registered voters said marijuana should be legal for recreational use, while a whopping 94 percent said medical use should be allowed. Seventy-five percent opposed enforcement of the federal ban in states that have legalized marijuana for either purpose. "When an overwhelming majority of Americans oppose federal interference in state medical marijuana programs, it is unconscionable not to let their representatives vote on whether to continue this policy," said Don Murphy, director of conservative outreach at the Marijuana Policy Project. "Unless Congress chooses the Senate budget version, millions of seriously ill patients and the legitimate businesses that provide them with safe access to their medicine will be at risk of prosecution. This vote is a slap in the face of patients, their families, their elected representatives, and the 10th Amendment."[...]

How Many More People Have to Die From Heroin and Fentanyl Before We Try Something Different?

Fri, 01 Sep 2017 14:45:00 -0400

A panel of experts recently projected that 500,000 Americans could die of opioid-related overdoses between now and 2027, surpassing the annual death toll from AIDS during the worst years of that epidemic. Some of the experts polled put the potential opioid-related death toll at 650,000 over the next 10 years. We can reach that grizzly milestone with our eyes closed if we just keeping doing what we've done for the last decade. But a future in which opioid and opiate-related overdoses claim more lives than a deadly communicable disease is no more inevitable than our present moment was a decade ago. We got here by reacting poorly to the increase in prescription opioid abuse and associated deaths. There may be no point in asking how many more people would be alive today if we had made different choices when we first recognized this problem, but it's instructive to revisit the early days of this crisis anyway. According to data from the Centers for Disease Control, just over 2,000 people died from heroin-related overdoses in 2005. In 2015, heroin killed 12,989 people. The total number of drug overdose deaths in 2005 was 29,813. In 2015, 52,404. We have a pretty good idea of what happened between 2005 and 2015. Law enforcement cracked down on pill mills, the Food and Drug Administration admonished pharmaceutical companies to make their drugs harder to snort and inject, and the CDC and Health and Human Services discouraged doctors from prescribing pain medication. In addition to being public health policies, these were also price signals. The black market responded accordingly with cheap heroin and then cheap illicit fentanyl. As Vox recently reported, there are many places throughout the U.S. where black market heroin and fentanyl now kill far more people than prescription pills. With each new death record—and we are setting them every year now—the overdose problem moves further out of a realm regulators can control into one they can't and never will. Oddly enough, they don't seem to realize it. Earlier this summer, Kentucky's legislature passed a law creating a three-day limit on opioid prescriptions for acute pain, meaning that no prescription can be for more than three days worth of pain relievers. In Massachusetts, Gov. Charlie Baker wants a five-year mandatory minimum for any person who provided the illicit drugs that led to an overdose death. The Justice Department recently asked the U.S. Sentencing Commission to require every person convicted of distributing fentanyl to serve prison time, regardless of how little fentanyl is involved, whether they knew they were distributing fentanyl at all, and whether anyone died as a result. As Dr. Jeffrey A. Singer writes at Townhall, there's also a push to conduct more surveillance of doctors and their patients. These are the same strategies that got us here. The list of things we refuse to try, meanwhile, is depressingly long. Heroin maintenance programs—of which there is not a single one in the U.S.—would provide fentanyl-free gear to people who can't or don't want to enter medication-assisted therapy; and safe injection sites—which we also don't have, despite their success in our neighbor to the north (and, uh, Iran)—would provide a place for those people to use under medical supervision. We should be removing barriers to offering medication-assisted therapy; there should be no limit on how many patients a doctor can help at one time and HHS shouldn't require days' worth of training in order to administer the associated medicines. Anybody should be able to buy naloxone wherever they can buy Tylenol. No one should face incarceration or arrest for reporting a drug overdose. There are more libertarian policies, of course, but the ones I've just listed wouldn't require the U.S. to do something novel or break any international agreements. They would require us to accept that our problems with drugs, like most problems that universally af[...]

Seattle Ballot Initiative Would Block Safe Drug Injection Centers

Wed, 30 Aug 2017 16:15:00 -0400

Leaders in Seattle and King County are pushing forward with plans to open two sites where drug addicts may shoot up safely, but local voters are going to get the chance to block it. At the start of the year, Seattle's mayor and King County's executive announced they were going to build two safe-consumption facilities, based on recommendations from a local task force. The goal is to reduce the likelihood of heroin and opioid overdoses by giving addicts a place to shoot up (that's also out of public view) that is monitored for safety. The model they're pursuing is similar to a facility that has been operating for years in Vancouver. Like many other communities in the United States, King County is seeing a surge in drug overdose deaths: 332 for 2016. They've seen increases in drug overdose deaths every year for the past seven years. But there are some who think reducing the possibility of harm through with an injection facility endorses drug decriminalization and even legalization. So opponents of the facility have gathered signatures in order to force a vote. From the Seattle Times: Opponents of safe-injection sites argue they amount to the government condoning heroin injection. State Sen. Mark Miloscia, R-Federal Way, a leading critic, has said the sites are a step toward legalization and decriminalization. "We are losing control when we're de-stigmatizing these dangerous drugs," Miloscia said earlier this year. "We need to teach our children and promote not taking these dangerous drugs and stigmatize people who get hooked on drugs to get into treatment." Initiative 27 would ban any public expenditures to create a supervised drug consumption site. It also makes it a civil violation with fines of up to $5,000 for any private organization to operate a facility to supervise the consumption of any federally prohibited drug, except for marijuana. So to be clear, this is not just about keeping the government from spending taxpayer money to subsidize addiction. The libertarian-minded private solution to reduce the potential harms of drug addiction would also be forbidden. Unfortunately, what we've been left with is the typical drug war mentality of hitting drug addicts and dealers with harsher criminal penalties and mandatory minimums. Rather than investing in tools and mechanisms to prevent drug overdoses, we increasingly see communities attempting to prosecute the people who provided these drugs with homicide instead. So instead of fewer dead people, you get dead people and somebody sentenced to decades or life in prison. The initiative has been scheduled to appear on a ballot in February. But a public health group has just recently filed a lawsuit attempting to block it from a public vote.[...]

Researcher Says V.A. Obstruction Jeopardizes Study of Marijuana As PTSD Treatment

Tue, 29 Aug 2017 18:15:00 -0400

The first U.S. study to test marijuana as a treatment for posttraumatic stress disorder, which had been in the works since 2009, finally got under way last February and has enrolled 25 subjects since then. But the lead researcher, Phoenix psychiatrist Sue Sisley, says the study, which needs a total of 76 subjects, has been jeopardized by a lack of cooperation from the local Veterans Health Administration hospital. "Despite our best efforts to work with the Phoenix VA hospital and share information about the study," Sisley writes in a recent letter to Secretary of Veterans Affairs David Shulkin, "they have been unwilling to assist by providing information to their patients and medical staff about a federally legal clinical trial happening right in their backyard that is of crucial importance to the veteran community." At the current recruitment rate, she says, the study will not be completed within the time required by a $2.2 million grant from the Colorado Department of Public Health and Environment. According to Sisley's letter, the hospital's director, RimaAnn Nelson, "is citing regulations that she cannot support research that does not utilize VA personnel." Sisley is asking Shulkin to intervene so that she can post flyers advertising the study at the hospital, distribute referral letters that can be used by interested patients, and present a lecture about the research to the medical staff. (She says she gave a talk at the hospital four years ago and was told she'd be invited back once the study had received all the approvals needed to proceed with recruitment.) Sisley also asks that the hospital "include information about the PTSD/cannabis study in any kind of electronic communications that are shared with VA staff and patients." Sisley and her colleagues are looking for veterans in the Phoenix area with "chronic, treatment-resistant PTSD arising from their combat-related service in the US armed forces and with duration of PTSD lasting at least six months." The FDA-approved protocol for the study, which is sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS), lists 14 inclusion criteria and seven exclusion criteria. Sisley says she and the other researchers had to screen more than 300 potential subjects to identify 25 who met the criteria. They need 51 more, which Sisley figures will require screening another 700 or so veterans. "If we cannot recruit enough veterans," Sisley writes in her letter to Shulkin, "we will need to change the inclusion criteria to allow subjects with PTSD from any cause to enroll in the study. This is a change that we do not want to make if at all possible." Sisley says the subjects enrolled so far have nearly completed the study. "Once those vets are through, there will be no reason to pay lab staff to sit aimlessly waiting for more veterans to miraculously appear," Sisley says. "There will be no improvement in veteran volunteers until the Phoenix V.A. hospital agrees to start cooperating with us. They have blocked access to appropriate Phoenix area veterans with PTSD for the past two years now." When I ask Paul Coupaud, director of communication at the Phoenix V.A. hospital, why Sisley can't advertise her study there, he notes that "marijuana is still considered federally illegal," adding that "we can't tell people to go and try something that's illegal." When I point out that the study has been approved by the Food and Drug Administration and is therefore legal under federal as well as state law, Coupaud says the real obstacle is that department regulations say "we cannot advertise any research study other than what V.A. is doing; we can't advertise outside research." He said Secretary Shulkin could amend that rule. I emailed the Department of Veterans Affairs about Sisley's complaints last week but have not heard back. The MAPS study has been focused on veterans from the beg[...]

New Study Finds Heroin Users Less Likely to Overdose If They Know What Drugs They're Actually Taking

Fri, 25 Aug 2017 13:00:00 -0400

(image) Drug users are 10 times more likely to reduce their doses if they know the drug they're consuming contains fentanyl, according to a new study from Vancouver's supervised injection site. Designed as a safe place where drug users can get high under the supervision of medical professionals, Insite found that providing fentanyl test kits reduced the odds of an overdose by 25 percent.

According to the Globe and Mail, Insite offers a simple reagent test, in which a small amount of the drug is tested using a solution and a strip. Other reagent tests use just a solution and the drug itself, mixed together on a white surface. While reagent testing won't tell you every compound present, it's an effective way to identify substances you definitely don't want to take.

Reagent testing has been popular among synthetic drug users for two decades now, particularly the MDMA/ecstasy crowd. But there are limits, one of them being that reagent testing reveals presence, not dosing. And at least one reagent vendor says it's difficult to distinguish between fentanyl and other synthetic opioids, which could lead to false positives.

According to the data gathered by Insite, 1,000 different reagent tests revealed fentanyl in 83 percent of drugs thought to be heroin, 82 percent of drugs thought to be meth, and 40 percent of drugs thought to be cocaine. A recent Washington Post investigation found cases across the U.S. of cocaine contaminated with fentanyl, including 12 emergency department admissions at a Connecticut hospital in just eight hours.

Supervised injection sites and easy reagent testing are good ideas. But you know what would work even better? Letting people buy the drugs they want in a legal market where drug producers have an incentive to create safe products. Because as helpful as reagent testing is, it's not good enough just to know that you're taking what you think you're taking; it's also important to know how much you're taking. Britain is witnessing an increase in MDMA-related deaths. Is it because of contaminants? No, it's because the MDMA is more pure than ever, with larger doses in smaller packages.

Reagent testing won't tell you whether a given MDMA pill contains 25 mg or 100 mg, or whether your heroin contains a little fentanyl or a lot. That kind of knowledge requires a regulatory regime in which heroin (and MDMA and cocaine) is produced with the same attention to detail and accuracy as Tylenol. Or cannabis! As the marijuana market has turned from black to grey, consumers can now choose the ratio of THC to CBD and talk with retailers about optimal dosing based on their tolerance, experience, and desired effect.

In the short term, America needs harm reduction strategies like the kind offered at Incite. In the long term, we need to surrender to reality.

The Federal Government Is Finally Exploring Marijuana As a Medical Alternative to Opioids

Mon, 14 Aug 2017 16:00:00 -0400

(image) Medical marijuana advocates have claimed for years that cannabis is an effective and safe alternative to prescription opioids for the treatment of pain. But no one put up the money to prove it until last week.

On Tuesday, the Albert Einstein College of Medicine and Montefiore Health System announced a forthcoming study to ascertain whether medical marijuana can alleviate the need for opioids in both HIV-positive and HIV-free patients who suffer from chronic pain. The National Institutes of Health (NIH) is putting $3.5 million towards the investigation.

A study published last year suggests the Albert Einstein College of Medicine is on the right track.

In 2016, researchers at the University of Michigan published two years' worth of survey results collected from 185 medical marijuana patients suffering from various ailments. Patients reported a 45 percent improvement in quality of life and a 64 percent reduction in the use of prescription opioids.

"We would caution against rushing to change current clinical practice towards cannabis," said Michigan study leader Kevin Boehnke, "but note that this study suggests that cannabis is an effective pain medication and agent to prevent opioid overuse."

The Albert Einstein College of Medicine is right to point out that we have far less data than one might expect, considering the first state to legalize medical marijuana did so 21 years ago. Most research into Schedule I drugs is paid for by the federal government, which has historically underwritten only those studies that either show the harms of such substances or explain their mechanism of action. The federal monopoly on research marijuana, meanwhile, makes studying the drug's therapeutic qualities an exercise in bureaucratic kowtowing.

But we do know there is a correlation between medical marijuana legalization and opioid use. A 2014 study that looked at 11 years of overdose data found that death rates from opioids increased in both states with liberalized marijuana laws and those without, but that "medical cannabis laws were associated with lower rates of opioid analgesic overdose mortality."

When University of Georgia economist David Bradford looked at Medicare prescribing rates, he found that physicians in medical marijuana states prescribed "1,826 fewer doses of conventional pain medication each year."

In addition to receiving funding from NIH—itself a noteworthy development—the Albert Einstein College of Medicine will conduct its study using marijuana provided by New York medical marijuana dispensaries, rather than the moldy ditchweed provided to researchers by the Drug Enforcement Administration's operation at the University of Mississippi.

Cannabis research has turned another corner.

The Justice Department Wants to Put Small-Time Fentanyl Dealers in Federal Prison

Sat, 12 Aug 2017 12:30:00 -0400

(image) If there was any question that Attorney General Jeff Sessions has little patience for treating opioid addiction as a public health issue, a Department of Justice letter to the U.S. Sentencing Commission from July 31 provides some troubling clarity. In addition to asking for longer sentences for immigration and gun offenses, the Department insists that the commissioners change federal sentencing guidelines so "that defendants who distribute seemingly small quantities of fentanyl face prison time."

How small?

Distribution of any amount of fentanyl up to four grams, or one gram of a fentanyl analog, is currently a level 12 offense, punishable by 10-to-16 months in federal prison for people with little to no criminal history, all the way up to 30-to-37 months for someone with considerable criminal history.

But because fentanyl can be lethal in doses as small as two milligrams and because four grams is "sufficient to kill 2,000 persons," according to the DOJ, "a base offense level of 12 is wholly inadequate for a person who has placed that many deadly doses of fentanyl onto our streets."

There are problems with this approach. For one thing, quantity does not equal culpability. Many of the people who move fentanyl-laced heroin at the street level do not know how much fentanyl is contained in the bags they sell. In fact, powdered fentanyl is often marketed as pure heroin or pressed into pills and marketed as some other opioid. That a street level dealer wouldn't exactly know the ratio shouldn't come as a surprise. Fentanyl is imported into the U.S. by the kilogram. As the quantities get smaller, so do the operators.

The other issue is that the street level dealers most likely to sell the smallest amount of fentanyl--intentionally or not--are also the dealers most likely to be fentanyl-laced heroin users themselves. Increasing the sentence lengths at the low end would likely mean imprisoning addicts.

The DOJ knows this. In a footnote, the department points out a rule under consideration by the USSC that would allow level-12 defendants who plead guilty to receive a level reduction that would result in probation in lieu of prison time. That rule is intended to separate small fish from big fish and divert defendants into rehabilitation programs. For the DOJ to cite that rule suggests the department knows imprisoning small-time fentanyl dealers belies its claim that federal prosecutors only target major dealers.

The USSC is an obscure agency in the federal criminal justice system. Commissioners don't try or hear criminal cases and they lack the authority to change federal statutes (such as mandatory minimums). But they nevertheless play a major role in determining sentence lengths by creating sentencing guidelines used by federal judges, probation officers, prosecutors, and public defenders.

Increasing the base offense level for the smallest quantities of fentanyl would undermine the spirit of every reform they've passed in the last decade. What it says about the DOJ is even more troubling: Sessions thinks incarceration can fix this crisis. He's wrong, and poor Americans will continue to pay the price.

What China's Growing Role in Illegal Drug Production Tells Us About the Future of the Drug War

Thu, 10 Aug 2017 13:35:00 -0400

Despite what you may have heard about Mexico and its cartels, the global drug war's biggest Whac-A-Mole hole for nearly two decades has been China. The bath salts and "spice" that dominated American drug headlines in recent years? Those came from Chinese chemical factories. The Mexican cartels that have made most of our meth since regulators snuffed out America's artisanal speed industry? They buy their precursor chemicals from China. Nearly every synthetic drug you can buy in the U.S.—legally or illegally, from cathinones to steroids to the heart medication your doctor prescribed—probably came from China. And if it wasn't made in China, it was made in India, which is a good place to make illegal things for the same reasons: It's massive, loosely regulated, increasingly population-dense, and home to hundreds of millions of people looking to turn a buck. In what is now becoming a full-fledged drug reporting genre, MSNBC published a short video from Jacob Soboroff explaining just how easy it is to order fentanyl—a growing cause of overdose deaths in the U.S.—through Chinese websites accessible on the open internet: Deadly opioid fentanyl is being ordered online & shipped direct to USA from China. Here's how. #OneNationOverDosed — Jacob Soboroff (@jacobsoboroff) August 9, 2017 In a New York Times piece from 2015, reporter Dan Levin did something similar, calling up a Chinese chemical factory and running through an incomplete list of drugs available for purchase through Chinese websites: spice, bath salts, precursors for meth, the stimulant "flakka" (remember when that was popular for 10 minutes or so?), and an entire universe of "research chemicals" that mimic banned substances but technically aren't illegal. "We're seeing cases nationwide and ground zero always seems to be China," an assistant district attorney from New York told Levin. On top of that, a 2016 study from the Office of the US Trade Representative reported that 97 percent of the counterfeit prescription drugs intercepted at U.S. points of entry came from China, Hong Kong, India, or Singapore. Soboroff seems genuinely shocked that it's so easy to order drugs this way. I will confess to also being rather surprised when a Chinese chemical factory representative reached out to me after Reason published my recent feature on steroids. The rep sent me links to a reddit thread featuring reviews of his factory and a list of illegal compounds they could make in whatever quantity I desired. He also offered to send me free samples and guaranteed free re-shipping in the event my package was intercepted by U.S. Customs. (I did not take him up on his offer.) A few of the underground lab operators I've spoken to here in the U.S. say that ordering from China is a relatively safe, hassle-free, and common way to do business. Many nutritional supplement companies, meanwhile, order their research chemicals from vendors on Alibaba, which is like the Chinese version of Amazon, if Amazon were also a B2B hub. This is the 21st century drug trade. Global supply chains work nearly as well for illegal goods as they do for legal ones. Research chemists are producing very effective analogs faster than anyone can regulate them. The sheer import volume of first-world countries all but guarantees vast amount of banned goods will escape detection. We will hear more in the coming months and possibly years about the threat posed by drug makers in China and India. Law enforcement bodies will claim they're taking the necessary steps to curtail the practice. China has added more than 100 new substances to its list of illegal compounds and promised to crack down on factories that sell opioids through unapproved channels. The U.S. Justice Department, meanwhile, has asked[...]

NFL Owners Agree To Consider Letting Players Use Medical Marijuana

Sun, 06 Aug 2017 09:31:00 -0400

The National Football League is back in action this weekend—if you count preseason games as "action"—after taking a tiny step toward maybe, possibly, someday letting players use marijuana to treat pain. NFL owners agreed to work together with the NFL Players Association on a study to determine the effectiveness of marijuana as a medical treatment. Yes, there have already been numerous studies on the medical value of marijuana—29 states have legalized the drug for that reason—but this seemingly small step is a pretty big shift for the league, which has always maintained a strict prohibitionist stance on pot. "Certainly the research about marijuana and really more particularly cannabinoid compounds as they may relate to the treatment of both acute and chronic pain, that is an area of research that we need a lot more information on and we need to further develop," Allen Sills, a Vanderbilt University neurosurgeon hired earlier this year to be the NFL's chief medical officer, said in an interview with The Washington Post. Sills said examining the feasibility of players using marijuana to manage the pain that comes from repeated full-speed collisions with other muscle-bound athletes was "really important" to players' long term health. While the NFL has never allowed players to use marijuana for any reason—the players' union is also reportedly seeking reduced punishments for recreational use as well—there is a well-documented history of teams handing out pharmaceutical pain-killers by the handful. The NFL currently is fighting a lawsuit from several former players who allege that official team doctors literally handed out piles of opioids and other painkillers—ignoring federal laws for prescription drugs and disregarding medical guidance—before, during, and after games. "The medicine being pumped into these guys is just killing people," former player Nate Jackson told Rolling Stone last year, as part of an excellent piece on the league's nonsensical marijuana rules and how they've led to an over-reliance on opioids. The NFL's slowly changing stance on the issue comes a few months after Jerry Jones, the Dallas Cowboys' owner and possibly the most powerful billionaire in the NFL's inner circle of powerful billionaires, floated the idea of loosening the ban on marijuana. Much as it pains me to admit it, Jones is absolutely right. The NFL's anti-marijuana stance simply doesn't make sense as more state governments adopt more liberal views toward medical and recreational weed. A player on the Seattle Seahawks or Denver Broncos (or any of the California-based teams in the league) can buy and use marijuana legally in the state where he spends most of his time during the season, but could face a suspension and a fine if he's caught with it in his system. Twenty of the 32 NFL teams play in states where medical marijuana is legal. This, too, mirrors the society-wide debate over the relationship between legal recreational weed and employment contracts that prohibit the use of marijuana. The league, and individual teams, are within their rights to require certain behavior from their players as a condition of employment, of course, but given the NFL's troubled history with punishing more serious offenses like, say, serial sexual assaults or domestic violence by star players, enforcing an absolute prohibition against marijuana use seems like it should be a lesser priority. Sills seems to recognize the NFL is both influenced by the changing views on marijuana in society, and in a position to reinforce that shift. "These really aren't just football issues," Sills told the Post. "These are society issues, right? We know right now that as a society that the treatment of both acute and chronic pain is a huge [...]

Beware, Pain-Sufferers: Jeff Sessions Is Coming for Your Doctor

Wed, 02 Aug 2017 15:40:00 -0400

I praised a new report from a federal opioid commission yesterday because its proposals to stop the increase in deadly drug overdoses did not include harsher laws or criminal sentences. It should have occurred to me that Attorney General Jeff Sessions didn't need the encouragement. Today Sessions announced a new task force devoted to fighting opioid overdoses by going after doctors who overprescribe the drugs. He's not even trying to sugarcoat it—he wants to put doctors in prison cells. From the Justice Department's press release: Speaking at the Columbus Police Academy today, Attorney General Sessions said that the new Opioid Fraud and Abuse Detection Unit will focus specifically on opioid-related health care fraud using data to identify and prosecute individuals that are contributing to this prescription opioid epidemic. Additionally, as part of the program, the Department will fund twelve experienced Assistant United States Attorneys for a three year term to focus solely on investigating and prosecuting health care fraud related to prescription opioids, including pill mill schemes and pharmacies that unlawfully divert or dispense prescription opioids for illegitimate purposes. The Department of Justice is clearly suggesting that it will focus on practices that simply hand out prescriptions like perfume samples and don't actually keep an eye on dosages or signs of addiction. But if you read further, you'll see the department is going to decide what the appropriate amount of opioid use is. And the consequences for falling outside the norms could be severe. From Sessions' speech: This sort of data analytics team can tell us important information about prescription opioids—like which physicians are writing opioid prescriptions at a rate that far exceeds their peers; how many of a doctor's patients died within 60 days of an opioid prescription; the average age of the patients receiving these prescriptions; pharmacies that are dispensing disproportionately large amounts of opioids; and regional hot spots for opioid issues. With this data in hand, I am also assigning 12 experienced prosecutors to focus solely on investigating and prosecuting opioid-related health care fraud cases in a dozen locations around the country where we know enforcement will make a difference in turning the tide on this epidemic. These prosecutors, working with FBI, DEA, HHS, as well as our state and local partners, will help us target and prosecute these doctors, pharmacies, and medical providers who are furthering this epidemic to line their pockets. When you get a bunch of prosecutors together to tell them to fight opioid abuse, we know what's going to happen. They're going to look for doctors to prosecute, and they're certainly not going to go back to Sessions and tell him they don't see any likely targets. Every single doctor who prescribes pain medication in the areas the Department of Justice is monitoring now has a target on his or her back. Every chronic pain-sufferer who turns to these doctors for assistance will now be treated as a potential addict and faces heightened chances of being denied medication. The most logical outcome is that more people will turn to the black market to try to find some relief or to fulfill their cravings if they're addicts (or both—those aren't exclusive states). This ultimately increases the possibility that addicts and pain-sufferers will take drugs whose origins and contents are not known, and thus increases the risk of harm. This is not a recipe for reducing drug overdoses. Furthermore, this crackdown on doctors comes alongside Sessions' push to attack the illegal drug market as well. Bafflingly, in a speech Sessions gave today at a police academy i[...]

Cory Booker's Revolutionary Marijuana Reform Bill Doesn't Have a Snowball's Chance in Hell

Tue, 01 Aug 2017 15:15:00 -0400

Sen. Cory Booker (D-NJ) today introduced a far-reaching marijuana reform bill that will likely never come up for a vote or obtain a single Republican co-sponsor. In a universe where it stood even the slightest chance of being passed into law, the Marijuana Justice Act of 2017 would remove marijuana from the federal drug schedule, allow all current federal marijuana prisoners to petition for new sentences, expunge the convictions of former federal marijuana prisoners, withhold federal law enforcement funding from states that do not liberalize their own marijuana laws, and create a community reinvestment fund for communities affected by the drug war, to which Congress will appropriate $500 million a year, every year, until 2040. Booker's bill essentially forces all of the states to legalize marijuana--or go without federal funding for law enforcement and prisons--and currently has zero co-sponsors. Booker is not the first person to introduce a federal marijuana reform bill that will never see the Senate (or House) floor. Reps. Ron Paul and Barney Frank introduced the first federal repeal bill way back in 2011. That bill called for the repeal of federal prohibition and for states to set their own marijuana policies. In addition to Paul and Frank, there were four Democratic co-sponsors. Booker addressed the incoherence of maintaining federal prohibition while states forge ahead with various legalization schemes during a Facebook Live event at 12:30 p.m. today. He decried the cruelty of denying veterans an alternative to prescription drugs, and outlined the disparate impact marijuana laws have on communities of color. His reasons for reforming federal marijuana laws are as good as his legislation is bad. Congress is closer to revisiting marijuana's place in Schedule I than it has ever been. Just last week, Rep. Trey Gowdy, a Republican congressman from South Carolina and a former prosecutor, grilled the interim director of the Office of National Drug Control Policy as to why marijuana is in a more restrictive schedule than cocaine and amphetamines. But if you wanted to craft a bill that would alienate Republicans in Washington, D.C., and governors and state legislators of both parties across the country, you'd be hard pressed to surpass the Marijuana Justice Act of 2017. Booker's bill would ensure the federal government would provide nothing for prison maintenance, construction, or staffing to any state in which the percentage of minorities arrested or convicted for a marijuana-related offense exceeded the percentage of minorities in the overall state population. And reduce federal funding for state and local law enforcement by 10 percent. Recidivism reduction and drug rehab funding would be exempt from this rule, but you'd need an army of Government Accountability Office inspectors to keep state facilities compliant. As with equitable sharing reviews, inspectors would be able to tackle only a few facilities at a time, and only several years after the fact. (In the alternate universe where this bill gets so much as a committee hearing, congressional delegates from states likely to be affected strangle this provision before lunch.) And then there's the $500 million-per-year Community Reinvestment Fund, some of which would be diverted from non-compliant states. The rest would simply be appropriated. Booker chose not to include a federal excise tax on marijuana sales. (Could it be that this is not a serious bill?) The fund would pay for reentry services, job training, and "expenses related to the expungement of convictions," as well as "public libraries, community centers, and programs and opportunities dedicated to youth." Library funding in a marijuan[...]