Overdose Prevention

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Chronicle AM: Key MJ Issues Dividing MA Pols, Some Coca Diverted, Says Morales, More... (6/27/17):

Massachusetts lawmakers are slugging it out over what legalization will look like this week, Bolivia's president acknowledges and decries the diversion of coca to the black market, and more.

Evo acknowledges and decries the diversion of Bolivian coca to the black market, and says he enjoys coca flour. (Wikimedia)
Marijuana Policy

Massachusetts Legalization Implementation: What Divides the House and Senate. As legislators work this week to seek compromise between competing legalization implementation bills passed by the House and Senate, six major issues are at play. They are: tax levels (the House wants more), whether localities need to put marijuana bans to a popular vote, expungement of past marijuana convictions (the House doesn't address it; the Senate does), governance structures, safety and packaging regulations, and racial equity provisions.

Virginia Marijuana Driving Law Goes Into Effect on Saturday. A law that ends automatic drivers' license suspensions for marijuana offenders goes into effect Saturday. Instead, judges will have the option of ordering community service instead of license suspension for marijuana offenders who were not behind the wheel when busted.

Heroin and Prescription Opioids

Kentucky Tighter Opioid Prescribing Rules Go Into Effect Friday. A new law restricting the prescribing of Schedule II opioids goes into effect Friday. Under the new law, patients being treated for acute pain will be prescribed no more than a three-day supply, with a number of specified exceptions.

International

Bolivia's Morales Acknowledges, Decries Coca Being Diverted to Black Market. In his closing remarks at last weekend's Coca Fair in Cochabamba, Bolivian President Evo Morales acknowledged and decried the diversion of coca into the cocaine black market. "Unfortunately, part of the coca crop goes to an illegal coca market in the West," Morales said. He also called for continued coca industrialization, saying it would bring economic benefits to Bolivia, and revealed that he consumes coca flour daily. "I'm not ashamed, since last year I have eaten coca flour twice a day, that's how I can build up my stamina," he said.

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

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

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

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

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

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

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

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

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

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

Addiction Treatment

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

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

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

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

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

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

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

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

Harm Reduction

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

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

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

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

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

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

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

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

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

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

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

Prevention

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

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

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

CRIMINAL JUSTICE

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

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

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

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

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

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

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

Medical Marijuana

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

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

Harm Reduction

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

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

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

Medical Marijuana

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

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

Harm Reduction

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

Law Enforcement

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

Chronicle AM: Dr. Bronner's $5 Million for MDMA Research, HRW Says More Naloxone, More... (4/27/17)

FDA-approved research on MDMA and PTSD gets a big monetary bump courtesy of Dr. Bronner's, Human Right Watch condemns the failure to make the opioid overdose reversal drug naloxone more available, a safe injection site bill is moving in California, and more.

Dr. Bronner's CEO (Cosmic Engagement Officer) David Bronner (maps.org)
Industrial Hemp

Nevada Senate Unanimously Approves Hemp Bill. The Senate has approved Senate Bill 396 by a unanimous vote. The bill would expand on existing state law, which allows colleges or the state Agriculture Department to grow hemp for research purposes. This bill would create "a separate program for the growth and cultivation of industrial hemp and produce agricultural hemp seed in this State," allowing the crop to be grown for commercial purposes. The bill now heads to the House.

Ecstasy

Dr. Bronner's Kicks In $5 Million for MDMA PTSD Research. Dr. Bronner's -- the family-owned maker of the popular soap brand -- is donating $5 million over five years to the Multidisciplinary Association for Psychedelic Studies (MAPS) to pursue its FDA-approved Stage 3 studies of the efficacy of MDMA for treating Post Traumatic Stress Disorder (PTSD). The announcement came ahead of last week's MAPS-sponsored psychedelic science conference in Oakland. "There is tremendous suffering and pain that the responsible integration of MDMA for treatment-resistant PTSD will alleviate and heal," said Dr. Bronner's CEO David Bronner. "To help inspire our allies to close the funding gap, my family has pledged $1 million a year for five years -- $5 million total-- by far our largest gift to an NGO partner to date. In part, we were inspired by the incredible example of Ashawna Hailey, former MAPS Board member, who gave MAPS $5 million when she died in 2011."

Drug Policy

Human Rights Watch Report Says US Drug Policy Failures Drive Preventable Drug Overdose Deaths. The US federal and state governments are taking insufficient action to ensure access to the life-saving medication naloxone to reverse opioid overdose, resulting in thousands of preventable deaths, Human Rights Watch said in a report released Thursday. The 48-page report, "A Second Chance: Overdose Prevention, Naloxone, and Human Rights in the United States," identifies federal and state laws and policies that are keeping naloxone out of the hands of people most likely to witness accidental overdoses, denying them the ability to save lives. "The easiest, most effective step that the federal and state governments can take to stem the tide of deaths from opioid overdoses is to make naloxone easier to get," said Megan McLemore, senior health researcher at Human Rights Watch. "Naloxone should be as easy to get as Tylenol. Criminal laws block access to harm reduction programs such as syringe exchanges; the price of the medication is too high; it is not available over the counter -- these and other obstacles are keeping naloxone out of the hands of those who need it the most."

Harm Reduction

California Committee Votes for Supervised Consumption Sites Bill. A bill supported by the Drug Policy Alliance, Assembly Bill 186, passed Assembly Public Safety Committee on Tuesday. It had already been approved by the Assembly Health Committee last month, which marked the first time a US legislative body has ever approved a safe drug consumption site measure. "This is a huge step toward establishing a more effective, treatment-focused approach to drug addiction and abuse in California," said bill sponsor Assemblymember Susan Talamantes Eggman (D-San Joaquin County). "The committee's input has done a great deal to refine the bill since I first introduced it last year, and its support clearly demonstrates the legislature's willingness to consider bold ideas to get people to treatment and counseling, to protect public health and safety and, most importantly, to save lives." The bill now heads for an Assembly floor vote.

Chronicle AM: NM GOP Gov Vetoes MedMJ & OD Bills, Canada MJ Bill Thursday, More... (4/10/17)

Congressional drug policy reform bills are piling up, New Mexico's GOP governor vetoes medical marijuana and overdose prevention bills, Canada's Liberals roll out their marijuana legalization bill Thursday, and more.

A federal marijuana rescheduling bill has been filed. (Wikimedia)
Marijuana Policy

Congressmen Gaetz and Soto Propose Legislation to Reschedule Marijuana, Two Florida GOP congressmen, Reps. Matt Gaetz and Darren Soto, have filed House Resolution 2020, "to provide for the rescheduling of marijuana into schedule III of the Controlled Substances Act." Rescheduling would make it easier to conduct research into medical marijuana, the congressmen said. "This drug should not be in the same category as heroin and LSD, and we do not need to continue with a policy that turns thousands of young people into felons every year," Gaetz added.

Medical Marijuana

Indiana Legislature Approves CBD Cannabis Oil Bills. Both houses of the legislature have approved measures allowing for expanded access to CBD cannabis oil But Senate Bill 15 and House companion legislation now have differences in the percentages of chemicals allowed, so the bills must go to conference committee to hammer out the differences.

New Mexico Governor Vetoes Medical Marijuana Changes. Gov. Susana Martinez (R) vetoed a measure that would have improved the state's medical marijuana law last Friday. House Bill 527 would have allowed people diagnosed with an opioid use disorder to use medical marijuana. In her veto message, Martinez wrote that allowing people addicted to opioids to seek medical marijuana "will likely cause a rapid increase in program enrollment, which the program is currently unable to sustain." But critics called that reasoning bogus, noting that the state Health Department sets the number of licensed producers and the amount they can grow.

Heroin and Prescription Opioids

West Virginia Legislators Approve Overdose Monitoring, Creation of Office of Drug Policy. The legislature has approved Senate Bill 2620, which would create a statewide program to monitor drug overdoses and establish an office of drug control policy to coordinate the response to the heroin and opioid crisis. The bill now goes to the desk of Gov. Jim Justice (D).

Harm Reduction

Kansas Governor Signs Naloxone Access Bill. Gov. Sam Brownback (R) last Friday signed into law House Bill 2217, which will allow first responders to administer the opioid overdose drug naloxone and which also allows pharmacists to dispense the drug without a prescription. Kansas was one of only three states without a naloxone access law, and the bill passed both houses unanimously.

New Mexico Governor Vetoes Overdose Prevention Bill. Gov. Susana Martinez vetoed Senate Bill 47, the 911 Good Samaritan Overdose Prevention Act, on Friday. The bill would have expanded the state's existing Good Samaritan law to include alcohol-related overdoses and to limit the prospect of arrest of people, who are on probation or parole or who have a restraining order, when they call 911 on behalf of someone experiencing a drug or alcohol overdose. The bill passed the Senate unanimously and the House by a 58-5 vote.

Law Enforcement

Sheila Jackson Lee Files Bill to Raise Evidentiary Standards for Federal Drug Offenses. US Rep. Sheila Jackson Lee (D-TX) has filed House Resolution 1979 "to increase the evidentiary standard required to convict a person for a drug offense, to require screening of law enforcement officers or others acting under color of law participating in drug task forces, and for other purposes." The bill text is not yet available on the congressional website. The bill has been referred to the House Judiciary Committee.

Reentry

Corey Booker, Elijah Cummings File Federal "Ban the Box" Bills. US Sen. Cory Booker (D-NJ) and US Rep. Elijah Cummings (D-MD) have filed identical bills in the Senate and House that would prevent employers from asking about applicants' criminal backgrounds until a job offer has been made. The bill would only apply to government agencies and federal contractors. The Senate measure is Senate Bill 842; its House companion is House Bill 1906. The bill text is not yet available on the congressional website.

International

Canada Marijuana Legalization Bill to Be Unveiled Thursday. The governing Liberals will roll out their marijuana legalization bill on Thursday, a "senior government source" said Monday. The government has said it wants legal marijuana to be a done deal on or before July 1, 2018.

FEATURE: Ohio Opioid Overdose Outrage: One Town's Ugly Effort to Punish Victims

The article was prepared in collaboration with AlterNet.

Ohio is state with a serious opioid problem. It's tied with neighboring Kentucky for the third-highest overdose death rate in the county, and the state Department of Health reports that fatal overdoses, mostly due to opioids, have jumped eight-fold in the past 15, killing more than 3,000 Ohioans in 2015.

In a bid to address the problem, the state passed a 911 Good Samaritan law last year. Such laws, which are also in place in 36 other states, provide limited immunity from prosecution for drug possession offenses for overdose victims and people who seek medical assistance to help them. The idea is to encourage people to seek help for their friends rather than hesitate, perhaps with lethal consequences, out of fear of being busted.

But one Ohio town is getting around the intent of the law by using an unrelated statute to go after overdose victims. If you OD in the city of Washington Court House, you can expect to be charged with -- wait for it -- "inducing panic," which is used for cases that "cause serious public inconvenience or alarm."

In the last two months, Washington Court House police have used the "inducing panic" statute at least a dozen times to charge overdose victims. The charge is a first-degree misdemeanor punishable by up to 180 days in jail and a $1,000 fine.

The move has drawn fire from the ACLU of Ohio, which sent a demand letter to city officials urging the city to "immediately end its practice of charging people experiencing a health crisis under this vague and inappropriate criminal statute." The city's "unlawful application of this statute will intensify the dangers of heroin use -- not help to control them," the ACLU argued.

The arrests have also caught the attention of Human Rights Watch, which called them "misguided and counterproductive." The advocacy group added that "increasing penalties for drug use is not the solution to Ohio's opioid crisis" and "what city of Washington Court House should be providing is access to health and harm reduction services, including clean syringes, the overdose reversal medication naloxone, and access to treatment."

But the city isn't heeding those warnings. Instead, in the face of the criticism, the city last week dug in its heels, saying the arrests weren't about punishment, but were a means to help addicts.

"We are not after jail time. We are not after fine money. We are simply looking to get these people some assistance. Obviously they need it, but they are not seeking it willingly upon themselves to get the assistance," said Police Chief Brian Hottinger.

City Manager Joe Denen added that the city is not planning any changes to its policy.

"In challenging circumstances, charging some individuals with inducing panic provides the court system with a means of connecting people in need of treatment with treatment opportunities," he said.

Or they could just offer them treatment.

Chronicle AM: Trump Signs Unemployment Drug Test Bill, WVA MedMJ Bill House Vote, More... (4/3/17)

President Trump signs a bill that will expand the drug testing of people seeking unemployment benefits, the West Virginia House is taking up medical marijuana, Colorado legislators have crafted a plan to deal with any federal attack on recreational marijuana, and more.

President Trump has signed a bill undoing Obama administration rules limiting unemployment drug testing. (Wikimedia)
Marijuana Policy

Colorado Bill Seeks to Avoid Thwart Possible Fed Crackdown by Classifying Legal Marijuana as Medical. In what the Associated Press called "the boldest attempt yet by a US marijuana state to avoid federal intervention in its weed market," the legislature is considering Senate Bill 17-192. The bill would allow retail marijuana licenses to be transferred into medical marijuana licenses. The measure has already passed out of the Senate Business, Labor, and Technology Committee and the Senate Finance committee and has a hearing before the Senate Appropriations Committee on Thursday.

Michigan Hash Bash Draws 10,000+. Ann Arbor's annual celebration of marijuana drew the largest crowd in years this past weekend, with more than 10,000 people showing up to light up and voice support for marijuana legalization. Michigan nearly became the first Midwest state to put legalization to a vote last year -- coming up just short on signature gathering -- and activists there are vowing to try again in 2018.

Kansas City Voters to Decide on Decriminalization Tomorrow. Residents of Kansas City, Missouri, will vote Tuesday on whether to approve the Question 5 decriminalization ordinance. Under the proposal, people 21 and over caught with less than an ounce would face no more than a $25 ticket.

Wichita Pot Defelonilization Initiative Campaign Getting Underway. Wichita activists hope the second time is the charm. A successful 2015 defelonization initiative was stuck down by the state Supreme Court on a technical issue. Now, the activists say they are preparing a new campaign to put the issue on the August municipal ballot. Under their proposal, small-time pot possessors would face a misdemeanor charge and a maximum $50 fine.

Medical Marijuana

Arkansas Governor Signs a Dozen Medical Marijuana Bills. Gov. Asa Hutchinson has signed into law a dozen bills aimed at regulating the state's voter-approved medical marijuana law. Bills that actually modified the law required a two-thirds majority in both houses of the legislature. For a complete list of the bills and what they do, click on the link.

West Virginia Medical Marijuana Bill Gets House Hearing Today. After a delay over the weekend at the request of House Judiciary Committee Chairman John Shott, the House is taking up the medical marijuana bill, Senate Bill 386, today. Shott was expected to introduce an amendment during today's hearing before a vote is taken.

Drug Testing

Trump Signs Unemployment Drug Testing Bill Into Law. President Trump last Friday signed into law a bill sponsored by Sen. Ted Cruz (R-TX) that will allow states to expand the pool of unemployment benefits applicants who can be drug tested. The bill undid an Obama administration rule that limited unemployment drug testing to professions where drug screenings are the norm. The bill passed Congress with no Democratic support in the Senate and only four Democrats in the House.

Harm Reduction

JAPA Issue Focuses on Naloxone. The March-April issue of the Journal of the American Pharmacists Association is devoted to the opioid overdose reversal drug naloxone. It contains nearly 30 letters, research reports and research notes on issues related to pharmacists and naloxone. The articles appear to be all open access, too. Click on the link to check 'em out.

One Simple Way to Reduce Deadly Heroin and Pain Pill Overdoses

The United States is in the grips of the worst drug overdose crisis ever, with prescription opioids and illicit opiates like heroin killing tens of thousands of people each year, but many of those people aren't dying from opioids alone. Another class of prescription drugs is too often involved.

Those drugs are the benzodiazepines -- with brand names like Valium and Xanax -- and are prescribed by the millions to treat anxiety, They can be deadly on their own, with federal data showing nearly 9,000 fatal benzo ODs in 2015. But here's the kicker: Nearly half of all fatal benzo ODs involve both them and opioids.

And a new study published in the British Medical Journal provides further evidence of the risks of doing benzos and opioids together. That study drew on a sample of more than 300,000 patients continuously enrolled in private health insurance plans between 2001 and 2013, and researchers looked at emergency room visits for drug overdoses among those prescribed only opioids versus those prescribed both opioids and benzos.

The results were dramatic: People prescribed both types of drugs had nearly double the risk of an ER or inpatient visit for a drug overdose. Based on the results, researchers estimated that cutting benzo prescriptions for opioid users reduced the risk of ER visits by 15%. If that figure holds true for overdose deaths, some 2,630 opioid-related overdose deaths could have been prevented in 2015 alone.

The policy implications are clear, said study coauthor and Stanford University drug policy expert Keith Humphreys: Don't prescribe benzos to people being prescribed opioids.

"Even if we didn't change opioid prescribing at all, the data here suggest that we could cut overdoses dramatically just by getting prescribers to not put people on a benzodiazepine at the same time," Humphreys said.

That would require a real shift in prescribing practices. The number of patients in the study being prescribed both benzos and opioids nearly doubled between 2001 and 2013, from 9% to 17%.

Reducing co-prescriptions could be problematic for some patients. If they are suffering both pain and anxiety, they and their doctors will have to work together to decide which issue is most serious and which could be treated with alternatives. But making such tough choices could lead to a reduced risk of fatal overdose.

The BMJ study has its limits. It looked only at legally prescribed benzos and opioids, missing the effects of concurrent use of illicit drugs, and it looked only at ER and inpatient visits, not fatal overdoses. And it only demonstrated correlation, not causation. It's possible some factor other than co-prescribing was driving up overdose rates among study patients, but given that the overdose risks of mixing benzos and opioids are well established, suggesting that co-prescribing them results in increased overdoses is not exactly controversial.

Doctors can do their part to reduce the number of overdose deaths by reducing benzo and opioid co-prescribing, but since much benzo and opioid use occurs outside legal medical channels, users in non-medically supervised settings are also going to have to be keenly aware of the dangers of mixing those drugs. If they are, the evidence suggests they can save some lives.

Chronicle AM: American College of Physicians Says Addiction Not a Moral Failing, More... (3/28/17)

A leading doctors' group comes out for a progressive approach to opioid addiction, new research suggests medical marijuana can reduce opioid-related emergencies and overdoses, the Tennessee legislature slaps down pot decriminalization in Memphis and Nashville, and more.

The ACP sees an opioid crisis and has some progressive approaches. (Creative Commons/Wikimedia)
Marijuana Policy

Tennessee Bill to Block Municipal Decriminalization Passes Legislature. After the state's two largest cities, Memphis and Nashville, passed municipal marijuana decriminalization ordinances, the legislature has struck back. The Senate on Monday approved House Bill 173, which bars cities in the state from crafting marijuana penalties lesser than state law. The measure passed the House last week and now head's for the governor's desk.

Medical Marijuana

Legalized Marijuana Could Help Curb the Opioid Epidemic, Study Finds. A new study reported in the journal Drug and Alcohol Dependence finds that in states with medical marijuana, hospitalization rates for opioid pain pill dependence and abuse dropped by nearly a quarter (23%), while opioid overdose rates dropped by 13%. Researchers had expected to see an increase in marijuana-related visits. "Instead, medical marijuana laws may have reduced hospitalizations related to opioid pain relievers," said study author Yuyan Shi, a public health professor at the University of California, San Diego.

Maine Bill Would Make Medical Marijuana Users Eligible for Organ Transplants. Legislators heard powerful testimony from patients removed from life-saving organ transplant lists because they used marijuana as they considered Legislative Document 764 Monday. The bill would targets the Maine Medical Center, the only transplant center in the state, whose transplant policy states that "use of prescribed or recreational marijuana by any route of administration is absolutely prohibited." No vote was taken, and the bill is scheduled for more hearings next month.

Heroin and Prescription Opioids

American College of Physicians Calls for Opioid Addiction to Be Treated as Chronic Condition, Not Moral Failing. In a position paper in the Annals of Internal Medicine, the American College of Physicians released a comprehensive set of public policy recommendations for the prevention and treatment of substance use disorders that calls for treating addiction as a treatable chronic condition, not a moral failing or criminal activity. The guidelines call for expanded access to the overdose reversal drug naloxone and opioid maintenance therapies, as well as urging physicians to avoid opioids as first-line treatments for most chronic pain and to limit opioids for acute pain to the lowest possible dose for the shortest possible time. And they suggest that it is time to consider drug decriminalization or legalization: "Stakeholders should assess the risks and benefits of removing or reducing criminal penalties for nonviolent offenses involving illicit drugs."

Drug War Issues

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