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Chronicle AM: BC Calls for Radical Response to Opioid Crisis, 2nd MI Pot Init, More... (8/17/17)

BC health officials present some revolutionary recommendations for dealing with the opioid crisis, Alaska officials defend pot legalization, a second Michigan legalization initiative is okayed for signature gathering, and more.

British Columbia health officials say users should be provided drugs to take home, be able to grow opium poppies. (Wikimedia)
Marijuana Policy

Alaska Officials Defend Legalization in Letters to Sessions. Gov. Bill Walker (I) and Attorney General Jahna Lindemuth have sent two letters to Attorney General Sessions defending their state's marijuana law and the wishes of state voters. Their letters are a response to a letter Sessions sent to governors of legalization states in July. "Marijuana regulation is an area where states should take the lead," they said in the first letter, dated August 1. "We ask that the DOJ maintain its existing marijuana policies because the State relied on those assurances in shaping our regulatory framework, and because existing policies appropriately focus federal efforts on federal interests," they said in the second letter, dated August 14.

Second Michigan Legalization Initiative Gets Okay for Signature Gathering. The state Board of Canvassers on Thursday approved a second marijuana legalization initiative for signature gathering. The initiative, from a group called Abrogate Prohibition Michigan, would end "all prohibitions on the use of cannabis in any form by any person" and specify that no taxes could be imposed. Another group, MI Legalize, is already halfway through the signature gathering phase for its initiative, which envisions legalization, taxation, and regulation.

Los Angeles Gets a Cannabis Czar. The city council voted on Wednesday to approve Cat Packer as executive director of the city's newly fashioned Department of Cannabis Regulation. Packer is a former Drug Policy Alliance state policy coordinator for California. She was also a campaign coordinator for Californians for Responsible Marijuana Reform, part of the Prop 64 campaign. She will be charged with rolling out regulations for legal marijuana in the city.

Harm Reduction

Washington King County Initiative to Ban Safe Injection Sites Likely Won't Make Ballot. A measure to ban safe injection sites in Seattle's suburban King County is unlikely to be on the November ballot. Petition organizers handed in sufficient signatures on time, but it took two weeks for the petitions to get from the King County Council clerk to King County Elections, so the initiative has missed an August 1 deadline to be certified for the ballot. It could go on the ballot in a February special election, but initiative sponsors say they fear it will be too late to prevent safe injection sites by then.

International

British Columbia Health Authorities Call for Revolutionary Approach to Opioid Crisis. The BC Center for Disease Control has issued a set of recommendations for dealing with opioid use and overdoses that includes providing users with drugs they can take home with them and allowing people to grow their own opium. The current approach to addiction is backwards, BCCDC Executive Medical Director Mark Tyndall told the Globe and News: "We strongly advise people to stop using street drugs, and if they can’t do that, then we offer them … Suboxone or methadone, and if that doesn’t work, we basically tell them to go and find their own drugs even though there is a very real possibility of dying,” he said. "What we should be doing – especially in an environment of a poisoned drug supply – is to start with access to uncontaminated drugs so at least people don’t die, then move on to substitution therapy and eventually recovery."

Chronicle AM: Trump Says He Will Declare National Emergency on Opioids, More... (8/10/17)

The president says he will formally declare a national emergency on the opioid crisis, Latino legislators embrace marijuana legalization, Utah medical marijuana supporters can begin signature-gathering for their initiative, and more.

The president will declare a national emergency on the opioid crisis, he said Thursday. (Wikimedia/Gage Skidmore)
Marijuana Policy

Latino State Legislators Call for Marijuana Legalization. The National Hispanic Caucus of State Legislators adopted a resolution Wednesday calling for marijuana legalization. The group, which represents Latino legislators across the country, cited legalization's impact on reducing the black market and providing tax revenues, as well as the racist origins of marijuana prohibition.

Texas Bill to Reduce Pot Penalties Gets Hearing. The House Criminal Jurisprudence Committee held a hearing Wednesday on House Bill 334, which would decriminalize the possession of small amounts of marijuana. The bill was introduced last month by committee Chairman Joe Moody (D-El Paso) for the legislature's special session. The bill would decriminalize someone's first three pot possession offenses, but prosecutors could charge a misdemeanor for a fourth offense. No vote was taken.

Medical Marijuana

New York Proposes Regs to Expand State's Medical Marijuana Program. The state Health Department has released new proposed regulations that would ease access to the program. Among the proposals are reducing security requirements for registered groups, shortening the length of the course doctors must take to be able to recommend medical marijuana, and allowing two more types of marijuana products to be sold.

Utah Initiative Backers Get Okay to Begin Signature Gathering. The Utah Patients Coalition has received permission from state officials to begin signature gathering for their medical marijuana initiative. The group will need 113,000 valid voter signatures before April 15, 2018.

Heroin and Prescription Opioids

Trump Says He Will Declare National Emergency on Opioids. President Trump said on Thursday that the opioid epidemic is a national emergency and that he will act to officially declare it so. "The opioid crisis is an emergency and I'm saying officially right now it is an emergency," Trump said in remarks reported by Reuters. "We're going to draw it up and we're going to make it a national emergency. It is a serious problem, the likes of which we have never had." Trump's announcement comes a week after a White House commission on the opioid crisis urged him to declare a national emergency. The move could free up more resources to fight the overdose epidemic and give the government more flexibility to deal with the crisis.

Asset Forfeiture

Pair of Congressmen Urge Sessions to Reconsider on Asset Forfeiture. US Reps. John Conyers (D-MI) and Jim Sensenbrenner (R-WI) have sent a letter to Attorney General Jeff Sessions objecting to his plan to expand the Justice Department's civil asset forfeiture program. "I am deeply disappointed by the Justice Department's recent move to reverse its ban on adoptive seizures," said Conyers in a statement. "The prior policy, which was instituted in January of 2015, greatly curtailed this practice, which provides financial incentives for law enforcement to seize the property -- including the homes -- of individuals who may not even be guilty of a crime. I call on Senator Sessions to withdraw the new policy, which is contrary to the growing bipartisan effort to reform our civil forfeiture laws and practices. Indeed, the time has come for Congress to enact the DUE PROCESS Act, a bipartisan bill to significantly alter these laws and increase protections for innocent property owners."

Chronicle AM: WH Opioid Panel Calls for Declaration of National Emergency, More... (8/1/2017)

Federal bills to legalize marijuana and allow drug testing of people seeking unemployment benefits get filed, the presidential commission on opioids issues a preliminary reports, the NFL offers to work with the players' union on medical marijuana, and more.

Marijuana Policy

With overdoses at record levels, Trump's presidential commission takes a largely public health approach to the crisis.
Corey Booker Files Federal Marijuana Legalization Bill. Sen. Cory Booker (D-NJ) filed the Marijuana Justice Act on Tuesday. The bill would remove marijuana from the Controlled Substances Act, punish states for disproportionately arresting or imprisoning poor people or minorities for marijuana offenses, prevent deportation for marijuana offenses, provide for resentencing of federal marijuana prisoners, and create a $500 million "Community Reinvestment Fund" for communities most negatively impacted by the war on drugs.

South Dakota Legalization Initiative Imperiled by Wording Error. A legalization initiative sponsored by New Approach South Dakota could be in trouble over a wording error. The way the measure is worded, it would, according to Legislative Council analysts, only legalize pot paraphernalia, not marijuana itself. The campaign said the problem is only a "typo" and can be fixed. Friendly legislators have offered to author a legislative fix if the initiative passes. Because of state initiative deadlines, it is too late for petitioners to start over in time to get on the November 2018 ballot.

Medical Marijuana

NFL Offers to Work With Players Union on Marijuana for Pain Management. The NFL has sent a letter to the NFL Players Association offering to work together with the union to study the possibility of marijuana as a pain management tool for players. The NFLPA is already conducting its own study and has yet to respond to the league's offer.

Ohio Medical Marijuana Rules Get Settled. A bipartisan legislative panel has decided not to modify more than a hundred separate rules proposed by the state Pharmacy Board and Department of Commerce to govern the state's nascent medical marijuana industry. That means medical marijuana growers, processers, sellers, testers, and users can now begin to get down to business. Growing operations are expected to start being licensed next month, and the whole system is supposed to be up and running by September 1, 2018.

Utah Poll Finds "Supermajority" Support for Medical Marijuana. Nearly four out of five (78%) Utahns favor a medical marijuana initiative now in the signature gathering phase of its campaign, according to a Dan Jones & Associates poll commissioned by the Salt Lake Tribune. The campaign is headed by the Utah Patients Coalition, which is acting after the state legislature baling at approving medical marijuana.

Drug Testing

Federal Unemployment Drug Testing Bill Filed. Rep. Buddy Carter (R-SC) has filed the Ensuring Quality in the Unemployment Insurance Program (EQUIP) Act, which would require people applying for unemployment assistance to undergo substance abuse screening and possible drug testing to receive benefits. "Unemployment is not for people who are abusing drugs and using that money to buy drugs but instead to help them get back on their feet," said Rep. Carter. "And we want to make sure that is what they are doing with it." People applying for those benefits have been laid-off from jobs for lack of work, not let go for drug abuse.

Heroin and Prescription Opioids

Presidential Commission Issues Belated Preliminary Report, Calls for Declaration of National Emergency. The presidential Commission on Combating Drug Addiction and the Opioid Crisis led by Gov. Chris Christie (R-NJ) issued a preliminary report on Monday whose lead recommendation is for the president "to declare a national emergency under either the Public Service Act or the Stafford Act." The report largely takes a public health approach to the issue, calling as well for expanding drug treatment capacity under Medicaid, increasing the use of medication-assisted treatment for opioid disorders, mandating that all police officers carry the opioid overdose reversal drug naloxone, broadening Good Samaritan laws, and encouraging the development of non-opioid pain relievers.

Chronicle AM: MA Legal MJ Bill Heads to Gov, DOJ Restarts Forfeiture Sharing, More .... (7/20/17)

Massachusetts lawmakers approve the legal marijuana bill, the Justice Department officially resurrects "adoptive sharing" for asset forfeitures, Gallup says more Americans have smoked pot than ever, and more.

California is on the verge of approving a state law to allow supervised injection sites to operate in the state. (vch.ca)
Marijuana Policy

Gallup Poll Has Number Who Say They've Used Marijuana at All-Time High. Some 45% of American adults have tried marijuana, according to Gallup. That's an all-time high, and it's more than ten times the number (4%) who admitted smoking pot in 1969, the first year Gallup asked the question. About 12% said they currently use marijuana.

Massachusetts Legislature Approves Compromise Legalization Bill. The House and Senate both approved a compromise measure to implement marijuana legalization Wednesday. House Bill 3818 now heads to the desk of Gov. Charlie Baker (R), who is expected to sign it. The bill increases taxes from 12% to up to 20%, and would allow authorities in localities that didn't vote in favor of the legalization initiative to ban pot businesses without a popular vote.

Medical Marijuana

Texas Bid to Expand Medical Marijuana Defeated. An effort to expand medical marijuana in the state was stopped by the House State Affairs Committee Wednesday. Rep. David Knoll (R) had tried to add an amendment to a special session bill authorizing the Texas Medical Board and other agencies, but the amendment never got enough support to come up for a vote.

Asset Forfeiture

Justice Department Brings Back Aggressive Asset Forfeiture Policy. As Attorney General Sessions vowed earlier this week, the Justice Department on Wednesday formally unrolled a revamped "adoptive forfeiture" policy that will allow state and local law enforcement agencies to hand drug cases over to the feds to ensure that the cops get the great bulk -- 80% -- of the proceeds from seizures, in many cases doing an end-run around state asset forfeiture law. The program was halted by then-Attorney General Eric Holder in 2015 after a rising outcry over abuses. The move was praised by law enforcement but criticized by civil rights groups and even some members of Congress.

Heroin and Prescription Opioids

Rhode Island Governor Signs Package of Bills to Fight Opioid Epidemic. Gov. Gina Raimondo (D) Wednesday signed into law three bills aimed at the state's opioid problem. One allows law enforcement to access an electronic prescription database without a warrant, one requires doctors to discuss the risks of addiction with patients when prescribing opioids, and one expands the kind of drugs that can be electronically prescribed. "Every Rhode Island community has been touched by this crisis, and I'll take every step I can to fight back," Raimondo said in a signing statement.

Harm Reduction

California Safe Injection Site Bill Awaits Senate Floor Vote. A bill that would allow supervised injection sites in the state has already passed the Assembly and has now been approved by both the Senate Health Committee and the Public Safety Committee. Assembly Bill 186, sponsored by Assemblywoman Susan Talamantes Eggman (D-Stockton) now awaits a Senate floor vote. If the bill passes, it will go back to the Assembly for concurrence, and then to Governor Jerry Brown's desk.

Chronicle AM: Dark Web Drug Sales Site AlphaBay Busted, Owner Kills Self in Jail, More... (7/14/17)

AlphaBay is history, Nevada moves to ease its legal pot shortage, the White House opioid commission misses a deadline -- again -- and more.

Marijuana Policy

Nevada Regulators Approve Emergency Measures to Ease Pot Shortage. The state Tax Commission voted Thursday to let the Department of Taxation to again determine whether limiting marijuana transport licenses to licensed alcohol distributors would result in a shortage of legal marijuana distributors. If the department does make that determination, it could then award transport licenses to previous medical marijuana distributors. "When businesses operate we get the tax revenue and that's what the state wants," testified Deonne Contine, director of the Department of Taxation. "We need to do everything we can to get more distributors licensed so these businesses can continue operating."

Industrial Hemp

Utah Regulators Give Initial Approval for Hemp Research Grows. The state Agricultural Advisory Board on Thursday gave initial approval to a new rule that would allow limited marijuana cultivation for research purposes. The rule would allow anyone with a permit to grow industrial hemp. State universities are already able to cultivate hemp for research purposes under the 2014 federal Farm Bill, but this rule now expands who can grow the plant. The rule is open for public review through the summer and if finalized, would allow the state to begin issuing permits next January.

Heroin and Prescription Opioids

White House Opioid Commission Again Misses Deadline. The president's Commission on Combating Drug Addiction and the Opioid Crisis, led by New Jersey Gov. Chris Christie (R), will miss a second deadline for filing an interim report. Under a Trump executive order establishing the commission, the panel had until June 27 to file its interim report, but failed to do so and said it would on July 17. Now, in a notice printed in the Federal Register Friday, the commission said it would reschedule its July 17 call until July 31, again missing its deadline. The commission has until October 1 to issue a final report.

Law Enforcement

Dark Web Giant AlphaBay Busted, Owner Hangs Himself in Thai Jail. AlphaBay, one of the largest drug sales websites on the Dark Web, has gone dark. It wasn't, as some suspected, a scam and rip-off by the owners, but the result of a joint law enforcement operation by police in Canada, the US, and Thailand. Canadian citizen Alexandre Cazes, identified as AlphaBay's owner, was arrested July 5 in Thailand, where he owned three luxurious homes. He was found hanged in a Thai jail cell Wednesday.

Chronicle AM: IL Passes Forfeiture Reform, House Heroin Task Force Proposals, More... (6/28/17)

Utah's new medical marijuana initiative is exposing fissures between the LDS leadership and membership, an asset forfeiture reform bill sits on the desk of Illinois' governor, a bipartisan House heroin task force releases its proposals, and more.

Utahns are ready for medical marijuana. (Harborside)
Medical Marijuana

Utah Poll Has Strong Support for Medical Marijuana. Just days after the Utah Patient Coalition took initial steps to put an initiative on the November 2018 ballot, a poll it sponsored showed that 73% of Utah voters support the initiative, with only 20% opposed. Support came from all demographic groups, including active Mormons, 63% of whom said they were in favor.

Mormon Church Opposes Utah Medical Marijuana Initiative. The powerful Salt Lake City-based Church of Jesus Christ of Latter Day Saints (Mormons) has come out in opposition to a medical marijuana initiative filed this week by the Utah Patients Coalition. The church acknowledged ongoing interest in medical marijuana and said it supported further research but argued that approval of medical marijuana should come after "the FDA approval process that all other drugs must go through before they are prescribed to patients."

Asset Forfeiture

Illinois Legislature Passes Asset Forfeiture Reform. The legislature last Friday gave final approval to an asset forfeiture reform measure, House Bill 303, that raises the standard of evidence for seizures from probable cause to a preponderance of the evidence and bars seizures of under $500 in most drug cases. The bill does not, however, require a criminal conviction before a seizure can occur -- a sop to prosecutors and law enforcement groups who lobbied for that provision to be dropped. The bill now awaits action from Gov. Bruce Rauner (R).

Heroin and Prescription Opioids

House Bipartisan Heroin Task Force Releases Proposals. A bipartisan group of House members released a raft of proposals Tuesday aimed at fighting the nation's drug problems as "an American issue," not a partisan one. The package of bills from the Bipartisan Heroin Task Force includes increased funding for drug-screening gear at the border, studies on the effects of synthetic drug use, greater flexibility for use of health savings accounts, and creation of treatment centers for infants exposed to opioids during their mothers pregnancy.

International

Georgia Parliament Takes Up Drug Decriminalization. The Parliamentary Health Committee has introduced a bill to decriminalize the possession of all drugs that was developed by the National Drug Policy Platform, a grouping of more than 40 NGOs. The bill would annul the country's much-criticized strict 2007 drug law, as well as making changes to at least 10 criminal and administrative laws. The core principle behind the bill is to shift the country's drug policy away from a criminal justice approach, treating drug use instead as a public health issue. Earlier this month, parliament gave initial approval to marijuana decriminalization. Both pot decrim and broader drug decrim should be addressed during parliament's looming autumn session.

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: NH Decrim Goes to Governor, VA Secretary Open to MedMJ for PTSD, More... (6/1/2017)

A decriminalization bill is heading to the New Hampshire governor's desk, Vermont's governor holds out hope for a legalization bill, Trump's opioid addiction commission will meet in a couple of weeks, and more.

Marijuana Policy

Nevada Pot Shop Rollout Could Be Delayed By Lawsuit. A state district court judge on Tuesday issued a temporary restraining order prohibiting the state Department of Taxation from enforcing a Wednesday deadline for license applications for the state's program to get legal marijuana sales off to an early start. The order came in response to a lawsuit from the Independent Alcohol Distributors of Nevada, who complain that the ballot measure that legalized weed in the state gave liquor wholesalers exclusive rights to distribution licenses for the first 18 months of sales. Distributors are those responsible for transporting marijuana from grows and production facilities to dispensaries.

New Hampshire Legislature Gives Final Approval to Decriminalization Bill. The House on Thursday voted to accept Senate changes to House Bill 640, which will decriminalize the possession of up to three-quarters of an ounce of marijuana. The bill now goes to the desk of Gov. Chris Sununu (R) is expected to sign the bill into law within the next couple of weeks.

North Dakota Legalization Signature Drive Will Begin in Fall. Proponents of a 2018 legalization initiative campaign say they will begin a signature gathering campaign in the fall, once students return to classes. A core group of individuals is working on a draft to be submitted to the secretary of state's office later this summer.

Vermont Governor Says Talks Continue on Marijuana Legalization Bill. Gov. Phil Scott (R) said Wednesday he thought it was still possible to pass a marijuana legalization bill during a two-day veto session set for later this month. Republican legislative leaders have said they wouldn't allow a parliamentary maneuver necessary to pass a revised legalization bill, but Scott said that if his public safety concerns are addressed, he could reach out to GOP leaders.

Medical Marijuana

VA Secretary Says He's Open to Medical Marijuana for PTSD. Department of Veterans Affairs Secretary David Shulkin on Wednesday said he is open to expanding the use of medical marijuana to treat soldiers with post-traumatic stress disorder in states where it is legal. "There may be some evidence that this is beginning to be helpful and we're interested in looking at that and learning from that," Shulkin said during a press conference. "Right now, federal law does not prevent us at VA to look at that as an option for veterans... I believe that everything that could help veterans should be debated by Congress and by medical experts and we will implement that law."

Drug Policy

Trump Addiction Commission Set to Meet June 16. The Office of National Drug Control Policy (ONDCP -- the drug czar's office) has announced that the President's Commission on Combating Drug Addiction and the Opioid Crisis will hold an inaugural meeting on June 16. The commission, which is loaded with drug policy conservatives, is charging with providing "advice and recommendations for the President regarding drug issues." The meeting will be at 12:30pm ET and will be available for public viewing via live stream.

International

Peru Takes First Casualties in Offensive in Key Coca Growing Region. A week after Peru announced that security forces were entering the region known as the Valleys of the Apurimac, Ene, and Mantaro Rivers (VRAEM) in a bid to suppress the coca crop in the country's largest coca growing region, two policemen were killed in an ambush by presumed drug traffickers Wednesday. Police said they were killed in the Luricocha district, where traffickers have allegedly allied themselves with remnants of the Shining Path guerrillas.

Canada Tories Want to Remove Home Grow Provisions From Legalization Bill. Conservatives in parliament are criticizing a provision in the legalization bill that would allow adults to grow up to four marijuana plants per household. "Is there any easier way to get marijuana than if your parents and everybody have got plants in the kitchen?" Tory justice critic Rob Nicholson, a former attorney general, asked in a speech to the House. Another Tory MP, Marilyn Gladu, warned that children could eat the plants. "Kids eat plants all the time because their parents do not put them up in the cupboard,” she said, ignorant of the fact that THC in marijuana plants must be heated in order to convert non-psychoactive THCA to THC, the stuff that gets people high.

Chronicle AM: DE Legalization Bill Advances, NH Decrim Bill Passes, More... (5/11/17)

A legalization bill in Vermont awaits the governor's signature, and so does a decrim bill in New Hampshire, Trump names an anti-reform drug commission, Senate Democrats signal their concerns over Trump drug policies, and more.

New England is happening! A Vermont legalization bill is on the governor's desk, so is a New Hampshire decrim bill. (Wikimedia)
Marijuana Policy

Delaware Legalization Bill Wins Committee Vote. The House Revenue and Finance Committee on Wednesday approved House Bill 110, which would allow people 21 and over to possess marijuana and buy it from marijuana shops, which would be limited to 75. There is no provision for people to grow their own. The bill now goes to the House floor.

New Hampshire Legislature Approves Decriminalization Bill. With approval by the Senate on Thursday, a decriminalization bill is now headed to the desk of Gov. Chris Sununu (R). House Bill 640 would make possession of an ounce or less of marijuana a civil infraction. It is currently a misdemeanor.

Pennsylvania Poll for First Time Has Majority for Legalization. For the first time, the Franklin and Marshall College Poll is reporting a majority of Keystone Staters favoring marijuana legalization. The poll had support at 56%, a whopping 16-point increase over the last time Franklin and Marshall asked the question in June 2015. But only 44% of Republicans supported it, and the GOP has huge majorities in the state legislature.

Vermont Legalization Bill Awaits Governor's Action. In a historic move, the legislature has approved Senate Bill 22, which would legalize the possession of up to an ounce of marijuana possession and allow for limited cultivation by people 21 and over, as well las creating a commission to study the best ways to tax and regulate marijuana commerce in the future. Now the question is whether Gov. Phil Scott (R) will sign the bill into law. He has expressed concerns about drugged driving, but also said he thinks legalization is "inevitable." He says he will "review" the bill and did not commit to vetoing it.

Medical Marijuana

Calls Grow for Florida Special Session to Deal With Medical Marijuana. House Speaker Richard Corcoran has joined a growing number of people calling for a special legislative session to come up with rules for the state's voter-approved medical marijuana amendment. Senate President Joe Negron has also said the legislature should be responsible for crafting the rules. The session ended earlier this week without the legislature reaching agreement on how to regulate medical marijuana. If the legislature doesn't come back into session to deal with the issue, it will be left up to the state Health Department.

Drug Policy

Trump Names Members of Commission to Combat Drug Addiction. President Trump has named the members of his new commission to combat drug addiction, and the list of names is heavy with opponents of marijuana legalization. The members are New Jersey Gov. Chris Christie (R), North Carolina Gov. Roy Cooper (D), Massachusetts Gov. Charlie Baker (R), Project SAM co-founder and former US Rep. Patrick Kennedy, and former Deputy Director for Demand Reduction at the Office of National Drug Control Policy Dr. Bertha Madras.

Senate Dems Send Letter Raising Concerns on Trump's Opioids, Marijuana Policy. Six Senate Democrats this week sent a letter to the acting director of the Office of National Drug Control Policy (ONDCP -- the drug czar's office) saying they were concerned with the administration's "open hostility" to legal marijuana states and possible budget cuts they said could aggravate the opioid crisis. "We appreciate any sincere efforts to combat substance use disorders. We are concerned that this administration may revert to a policy that focuses on the criminal justice system over public health efforts," the letter reads. The senators referenced Trump's threat to radically defund ONDCP, as well as the repeal of other Obama-era policies responding to the opioid epidemic. "A meaningful effort to combat substance use disorders must focus on the full implementation of the Comprehensive Addiction and Recovery Act, adequate funding for the Substance Abuse and Mental Health Services Administration, and improving the Affordable Care Act by expanding access to mental health and substance use disorder services and health insurance," the letter says. Repealing the Affordable Care Act (Obamacare) would be "a major step backwards in the prevention and treatment of drug addiction," they wrote. "We are very concerned that this administration will exacerbate the opioid epidemic rather than alleviate it," the letter said. And then, there's pot: "We are also concerned by the administration's open hostility to state policies legalizing or decriminalizing the possession and use of medical or recreational marijuana," the senators wrote. "Particularly given the severity of the ongoing opioid use epidemic, federal resources should be targeted at providing comprehensive substance use disorder programs and cutting off the flow of deadly drugs rather than interfering with state regulatory regimes for marijuana," the letter said.

International

Medical Marijuana Now Available in Chilean Pharmacies. Pharmacies in Santiago will begin selling medical marijuana this week, a first for Latin America. Chile legalized the use of medical marijuana in 2015, but until now, patients could only obtain it by importing it or from a small number of dedicated farms set up by a charity. The Congress is currently debating a bill that would allow people to grow their own.

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

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

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

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

Medical Marijuana

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

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

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

Heroin and Prescription Opioids

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

Harm Reduction

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

Law Enforcement

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

International

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

Drug War Issues

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