Political Sector

Revitalizing anti-corruption efforts

Supporting anti-corruption efforts in Hong Kong was a major focus during Ms. Waly’s mission. In a speech delivered at the 8th Symposium of the Independent Commission Against Corruption (ICAC) of Hong Kong on the occasion of the Commission’s 50th anniversary, Ms. Waly said that “In this era of uncertainty, as crises rage and threats simmer, we need to re-think and revitalize anti-corruption efforts,” adding that “corruption underpins many of the biggest challenges facing humanity today.”

In her remarks, Ms. Waly outlined four key priorities that UNODC considers essential to pave a new path for anti-corruption efforts, namely to 1) future-proof responses to corruption by leveraging the positive role of technology and unleashing the potential of youth; 2) unlock the full potential of international and regional anti-corruption frameworks, and to streamline cross border cooperation; 3) addressing gaps in capacities through partnerships; and 4) better understand corruption and its trends, through robust measurement, research, and analysis.

“Corruption is undermining everything we fight for, and empowering everything we fight against,” she said. “As we stand at this historic crossroads of challenges and opportunities, we need to seize every chance […] to innovate in the face of growing corruption challenges, together.”

On the sidelines of the Symposium, Ms. Waly signed a Memorandum of Understanding with ICAC Commissioner Woo Ying-ming to solidify their partnership and expand joint technical assistance to advance anti-corruption efforts in Asia.

Ms. Waly also met with the Chief Executive of Hong Kong, Mr. John KC Lee, to discuss the importance of coordinated regional action in the fight against organized crime.

Ms. Waly later visited the Hong Kong Jockey Club (HKJC) where she met its Executive Director of Racing and the Secretary General of the Asian Racing Federation (ARF).

Illegal betting in sports has become a global problem, helping to drive corruption and money-laundering in sports. By running the ARF and Anti-Illegal Betting and Related Financial Crime Council, HKJC is working to address issues like illegal betting and financial crimes that affect the integrity of sports and racing.

Ms. Waly invited the HKJC and ARF to support UNODC’s GlobE4Sport initiative, which will be launched this year. The initiative will create a global network which will support anti-corruption efforts in sport through the informal sharing of information between criminal justice authorities and sports organizations.

Ms. Waly also visited Hong Kong customs facilities, where she was briefed by Commissioner Louise Ho Pui-shan on the equipment and measures used by law enforcement to inspect cargo shipments and tackle trafficking in drugs and wildlife.

Supporting compassionate rehabilitation

With fewer than 20 per cent of people with drug use disorders in treatment globally, UNODC is committed to supporting non-stigmatizing and people-centred health and social services to people who use drugs, as reflected by Ms. Waly’s visit to the Association of Rehabilitation of Drug Abusers of Macau (ARTM).

ARTM is a civil society organization offering voluntary, evidence-based prevention, treatment and harm reduction services to affected communities in Macau, China. Civil society organizations (CSOs) play a vital role in tackling drug related issues, including by combating stigma and delivering essential services to affected communities.

During the visit, Ms. Waly met with people in rehabilitation for drug use and learned about the work of ARTM in providing new life skills, such as painting, baking and ceramics classes, as well as treatment for women and classes for children.

ARTM was itself founded by a former user of drugs, Augusto Nogueira, whose experience helps the organization provide compassionate and inclusive rehabilitation. Augusto says that his main struggle when he was using drugs was not being able to identify a solution for his problem.

“My addiction was stronger than my will to stop using,” he said.

After undergoing his own challenging rehabilitation process, Augusto had ideas on how to professionalize the existing prevention and treatment activities in Macau. With the goal of providing evidence-based, personalized approaches to drug treatment and rehabilitation services, he founded ARTM in 2000.

ARTM belongs to the Asia-Pacific Civil Society Working Group on Drugs, supported by UNODC. Convened by the Vienna NGO Committee on Drugs (VNGOC), the Working Group aims to strengthen civil society action on drug related matters and the implementation of joint international commitments in the Asia-Pacific region.

ARTM also works to bring the voices of civil society to the international stage, including by presenting civil society recommendations on how best to implement drug policies at the Commission on Narcotic Drugs.

During her visit, Ms. Waly acknowledged the call from grassroot civil society organizations like ARTM for greater investment in evidence-based prevention, including through the implementation of the CHAMPS initiative. Ms. Waly praised ARTM’s cooperation with UNODC, including by delivering a training workshop on UNODC’s family-based prevention programme, Strong Families.

Ms. Waly also met with the Secretary of Security of Macau to discuss how Macau’s experience can help inform regional responses in tackling organized crime, illegal online gambling, and drug trafficking.

Source: https://www.unodc.org/unodc/en/frontpage/2024/May/unodc-executive-director-highlights-anti-corruption–fight-against-organized-crime–and-drug-prevention-on-visit-to-hong-kong-and-macau–china.html

The following Complaint was sent to BBC by David Raynes of the NDPA – the response is shown underneath the Complaint summary herein.

David judges the BBC response to be “very defensive, but a partial win” for NDPA.

************

BBC Radio programme – ‘PM’, Radio 4, 27 October 2022

Complaint

This edition of PM included a sequence prompted by Germany’s plan to legalise
recreational cannabis. A listener complained about the absence of an alternative view and a
lack of impartiality on the part of the presenter . The ECU considered whether the
programme met BBC standards for due impartiality.

Outcome

The presenter, Evan Davis, explained that other countries (including Canada) had already
taken this step, as well as many states in the USA. He introduced a report from New York
by a correspondent describing “how life has changed there” and then interviewed Professor
Akwasi Owusu-Bempah of Toronto University, described as an expert in drugs policy. In his
final question Mr Davis asked him “in three words” whether other countries should follow
Canada’s example: “Are you basically thinking it’s worked?”. Professor Owusu-Bempah
replied “Do it now, those are my three words” prompting laughter from Mr Davis.
In the ECU’s view the decriminalisation and/or legalisation of cannabis possession is a
controversial subject in the UK, even if the controversy is not “active” in the sense of there
being legislation before Parliament or immediate prospect of it. However, the question of
the social effects of legislation is not, on its own terms, a matter of controversy, and is open
to empirical exploration. It was therefore legitimate for the programme to question an
expert on those aspects, and there was no need for an alternative viewpoint in that
connection.
Taken as a whole the sequence highlighted negative as well as positive social consequences
of changing the law. The presenter’s laughter should be seen in the context of the succinct
nature of the response rather than any expression of a personal view. But in posing his final
question, he invited an opinion on a matter of controversy. Professor Owusu-Bempah
having expressed unqualified support for immediate legalisation, in the ECU’s view there
was a need to remind listeners of the existence of opposing opinions

BBC conclusion: 
Part Upheld

*******

British Broadcasting Corporation British Broadcasting Corporation BBC Wogan House, Level 1, 99 Great Portland
Street, London W1A 1AA
Telephone: 020 8743 8000 Email: ecu@bbc.co.uk

BBC

Executive Complaints Unit
David Raynes
pheon@cix.co.uk

Ref: CAS-7325932
2 March 2023

Dear Mr Raynes
PM, Radio 4, 27 October 2022
Thank you for your email to the Executive Complaints Unit about an item in this
edition of PM on a plan to legalise recreational cannabis use in Germany. The
presenter, Evan Davis, explained that other countries (including Canada) had already
taken this step, as well as many states in the USA. He introduced a report from New
York by a correspondent describing “how life has changed there”. She detailed the
proliferation of cannabis sellers in the city and the greater evidence of its use. He then
interviewed Professor Akwasi Owusu-Bempah of Toronto University, described as an
expert in drugs policy. He was asked how the law applied in Canada, the effect on
consumption, the relationship between the illegal trade and overall crime, and the
relation between the police and “certain groups” in the light of a “huge” drop in arrests
and convictions for the possession of cannabis. The professor observed that, in line
with the aims of the legislators, legal sales in cannabis had overtaken illegal sales. Mr
Davis then asked him “in three words” whether other countries should follow Canada’s
example: “Are you basically thinking it’s worked?”. Professor Owusu-Bempah replied
“Do it now, those are my three words”, prompting laughter from Mr Davis.
You complained about the absence of an alternative view in the item, drew attention
to reported ill effects on mental health from cannabis consumption and pointed to the
possible risks to younger listeners who might have heard the question of legalisation
discussed in these terms. You also objected to Mr Davis’ laughter.
The BBC’s Editorial Guidelines on impartiality say:
When dealing with ‘controversial subjects’, we must ensure a wide range of
significant views and perspectives are given due weight and prominence,
particularly when the controversy is active.
I would regard the decriminalisation and/or legalisation of cannabis possession as
being a controversial subject in this country, even if the controversy is not “active” in
the sense of there being legislation before Parliament or any immediate prospect of it.

However, the question of the social effects of legislation is not, on its own terms, a
matter of controversy, and is open to empirical exploration. I think it was therefore
legitimate for Mr Davis to question Professor Owusu-Bempah on those aspects, and
that there was no need for an alternative viewpoint in that connection. Taken as a
whole the piece highlighted negative as well as positive social consequences of
changing the law and seen through that prism was therefore more nuanced than you
suggest. But by posing his final question, as to whether other countries, including the
UK, should follow Canada’s example, Mr Davis invited an opinion on a matter of
controversy. Professor Owusu-Bempah having expressed unqualified support for
immediate legalisation, I think there was a need at least to remind listeners of the
existence of opposing opinions, preferably with some reference to the arguments here
in this country. In the absence of that or the inclusion of an alternative view elsewhere
in the item, I agree there was a breach of the BBC’s standards of impartiality and I am
upholding this element of your complaint.
On your point about the possible risk to children, the PM programme is aimed at an
adult audience – its average age is 60 – and accordingly I do not believe its output
should be judged on the basis of its potential effect on children. As for Mr Davis’
laughter at the end of the interview, I can see how it might have struck you as “humour
from a top and admired presenter about the concept of harmful cannabis legalisation in
the UK”. To my ear, though, it sounded like amused surprise at the fact that Professor
Owusu-Bempah, having been told “we’re entirely out of time”, had so precisely met his
request to state his opinion “in three words”. I am therefore not upholding these
aspects of your complaint.
Thank you for bringing this to the attention of the ECU. Please accept my apology for
this breach of standards. I attach a summary of the finding intended for publication on
the complaints pages of bbc.co.uk, at https://www.bbc.co.uk/contact/recent-ecu. It
will appear there later today. Meanwhile, as this letter represents the BBC’s final view
on your complaint, it is now open to you to take it to the broadcasting regulator,
Ofcom, if you are dissatisfied. You can find details of how to contact Ofcom and the
procedures it will apply at https://www.ofcom.org.uk/tv-radio-and-on-demand/howto-report-a-complaint. Alternatively, you can write to Ofcom, Riverside House, 2a
Southwark Bridge Road, London SE1 9HA, or telephone either 0300 123 3333 or 020
7981 3040. Ofcom acknowledges all complaints received.
Yours sincerely
Fraser Steel
Head of the Executive Complaints Unit

Source: David Raynes, NDPA.

Christian Haserot has tried to get clean a handful of times.

But during his most recent attempt, the once aspiring cyber security researcher encountered an insurmountable obstacle.

Everywhere he turned in Portland, he saw people smoking fentanyl.

Even when hunkered down in his sheltered housing bedroom, the fumes would waft up to his window.

“The temptation of having people outside my building, standing in a group smoking in plain sight.. it was too hard for me”, he says, dejected. “I relapsed.”

Three-years-ago Oregon became the first US state in history to decriminalise hard drugs after 58 per cent of voters backed the lenient legislation.

Measure 110 was meant to transform the “war on drugs”, with addicts given treatment and support instead of incarceration.

Tax income from cannabis sales were meant to fund drug treatment programmes.

But with few users seeking help and others flocking to the state in light of its relaxed laws, the state’s biggest city has transformed into a “zombie apocalypse” of drug addicts getting high in broad daylight.

Within 30 seconds of setting off on a patrol of the downtown area with Portland police Sergeant Jerry Cioeta, we see someone keeled over on the cold pavement, their arms wrapped around a red pole.

“This person is really high on fentanyl. That’s why they’re licking a telephone pole”, he says.

Pointing to a group of five men in hats, he adds: “These guys were dealing, that’s why they’re running away from me.”

Around them is a smattering of tents, a shopping trolley and a number of sleeping bags strewn in front of what used to be a hotel.

A significant number of local businesses are boarded up, with those that remain hiring private security to keep watch.

Before Measure 110 came into effect, Portland was “just like any other normal place”, said Mr Haserot, 29.

Dressed in a burgundy puffer jacket and clutching a woolen Oregon hat to protect from the cold, he adds: “Maybe there were some alcoholics out and about, but you didn’t see people holding foils in public and hitting stuff on foil.

“You didn’t see meth pipes out on the street. That was not around. And now it’s, you know, it’s everywhere.”

He says he also meets a “lot of people who moved here because of the drug laws”.

Under Measure 110, anyone caught with small amounts of hard drugs like fentanyl, heroin or meth is given a $100 ticket.

But, if they call a 24-hour hotline to complete an addiction screening within 45 days, the fine disappears. There is no penalty for failing to pay.

“We’ve written over 700 tickets since May, and to the best of our knowledge not a single one has called up and gone to treatment”, Sgt Cieota says. “Two out of two people don’t want help.”

Sgt Cioeta has been an officer in Portland for more than 26 years. When he started out he would respond to alcoholics or domestic violence, now more than 90 per cent of his job is taken up by open air fentanyl use and dealing.

Sgt Cioeta and a team of four other officers are tasked with tackling drug use on the streets, what he describes as a game of “whack-a-mole”.

Around another corner, a drug user is sitting between two carefully manicured city flower pots. He is desperately trying to scrape fentanyl residue out of a metal tin.

Behind him, around a metre a way, a man high on the synthetic opioid has passed out – the only thing keeping him upright is the pressure of his forehead leaning against a red, brick wall.

“Can you smell that?” Sgt Cioeta says. “It kind of smells like weed, but it isn’t, that’s fentanyl.”

Sgt Cioeta said things have become so bad because of a “perfect storm”: the pandemic, Measure 110 and the prevalence of fentanyl.

“It’s a drug like we have never seen on this planet. It’s highly addictive, that withdrawal is sudden, and is super cheap”, he says.

Areas of the city have been “decimated” by fentanyl use, where they’ve transformed “from vibrant to zombie land”.

“One time we had four fatal overdoses in three minutes within five feet of each other.”

Accidental drug overdose death rates in the state doubled from 472 in 2020 to 955 in 2022.

While residents had been in favour of Measure 110 initially, in a survey of 1,000 locals by Emerson College earlier this year [2023], 56 per cent said they wanted it repealed.

But for some, the drug laws are not relaxed enough.

User Quentin Sweet, who has just received a ticket for smoking fentanyl at a tram stop, said he thinks the only place people shouldn’t be able to smoke the drug is a nursery.

“Drugs are not bad for someone, but instead are enjoyable, and even so far as to say a healthy experience that is good for someone”, he says.

Mr Sweet, 23, who has painted his fingernails, and the skin around them, red, says he has no intention of paying the fine or calling the number on the back of the ticket.

“I’ve completely dismissed it as unimportant,” he says.

Keith Humphreys, professor of psychiatry and behavioral sciences who has studied the impact of Measure 110, says decriminalisation has been a “complete failure”.

“They’ve let drugs run the state”, he says.

Mr Humphreys said before the introduction of Measure 110, Oregon’s drug laws were already some of the most lenient in the country.

The complete overhaul “represented a misunderstanding of the nature of being addicted to fentanyl,” he says.

“Because drugs feel good in the short term, even though in the long term they’re wrecking your life, people are much more ambivalent about seeking treatment.

“You can’t throw away all those sticks and just hand out carrots. If you want people to access addiction treatment, there has to be some press from the other side. Otherwise they’ll just continue using drugs until they die.”

 

Source: https://www.telegraph.co.uk/world-news/2023/12/23/counting-the-cost-of-decriminalising-drugs-in-oregon/

This is the Executive Summary of the DEA’s 2024 National Drug Threat Assessment 

Fentanyl is the deadliest drug threat the United States has ever faced, killing nearly 38,000 Americans in the first six months of 2023 alone. Fentanyl and other synthetic drugs, like methamphetamine, are responsible for nearly all of the fatal drug overdoses and poisonings in our country. In pill form, fentanyl is made to resemble a genuine prescription drug tablet, with potentially fatal outcomes for users who take a pill from someone other than a doctor or pharmacist. Users of other illegal drugs risk taking already dangerous drugs like cocaine, heroin, or methamphetamine laced or replaced with powder fentanyl. Synthetic drugs have transformed not only the drug landscape in the United States, with deadly consequences to public health and safety; synthetic drugs have also transformed the criminal landscape in the United States, as the drug cartels who make these drugs reap huge profits from their sale.
Mexican cartels profit by producing synthetic drugs, such as fentanyl (a synthetic opioid) and methamphetamine (a synthetic stimulant), that are not subject to the same production challenges as traditional plant-based drugs like cocaine and heroin – such as weather, crop cycles, or government eradication efforts. Synthetic drugs pose an increasing threat to U.S. communities because they can be made anywhere, at any time, given the required chemicals and equipment and basic know-how. Health officials, regulators, and law enforcement are constantly challenged to quickly identify and act against the fentanyl threat, and the threat of new synthetic drugs appearing on the market. The deadly reach of the Mexican Sinaloa and Jalisco cartels into U.S. communities is extended by the wholesale-level traffickers and street dealers bringing the cartels’ drugs to market, sometimes creating their own deadly drug mixtures, and exploiting social media and messaging applications to advertise and sell to customers.
The Sinaloa Cartel and the Cartel Jalisco Nueva Generación (also known as CJNG or the Jalisco Cartel) are the main criminal organizations in Mexico, and the most dangerous. They control clandestine drug production sites and transportation routes inside Mexico and smuggling corridors into the United States and maintain large network “hubs” in U.S. cities along the Southwest Border and other key locations across the United States. The Sinaloa and Jalisco cartels are called “transnational criminal organizations” because they are not just drug manufacturers and traffickers; they are organized crime groups, involved in arms trafficking, money laundering, migrant smuggling, sex trafficking, bribery, extortion, and a host of other crimes – and have a global reach extending into strategic transportation zones and profitable drug markets in Europe, Africa, Asia, and Oceania.

Source: https://www.dea.gov/sites/default/files/2024-05/NDTA_2024.pdf May 2024

Appointing Jeff Sessions as US Attorney General infused new life into those of us who know that marijuana is destroying our nation from within. But were we premature in believing that Donald Trump would put an end to what Barack Obama and George Soros inflicted on this nation in the last eight years? After eight months, we still don’t have federal drug policy flowing from the President.

The pattern of past presidents is familiar. Bill Clinton moved the Office of National Drug Control Policy (ONDCP) to a backwater, and reduced its size by about 75 per cent. In 1996, with help from Hillary Clinton and investor George Soros, Clinton allowed California to violate federal laws and become the first victim of the ‘medical marijuana’ hoax. Soros, Peter Lewis and John Sperling, all out-of-state billionaires, financed that campaign with close to $7million (£5.3million).

Obama downgraded the position of Drug Czar from cabinet level to reporting to the Vice President. He then allowed, or directed, Attorney General Eric Holder to ignore the inherent responsibility of the Executive Branch to enforce federal law. Drug strategy in ONDCP was changed to focus on ‘harm reduction’, the subversive ploy of Soros to focus on treatment and rehabilitation, at the expense of primary prevention. The President espoused the claim that ‘marijuana is no worse than alcohol’, leaving most people with a flawed impression. Federal agencies such as the Substance Abuse and Mental Health Services Administration (SAMHSA) spent their fortunes on anything other than marijuana. Congress passed the Rohrabacher/Farr Bill which withheld federal dollars from the Drug Enforcement Administration (DEA) so they couldn’t even enforce the law. The result? Twenty-nine states now have some form of legalised pot. Marijuana users had increased from about 15million to 22.3million Americans at the last count.

Now comes President Trump. During the campaign he indicated he felt legalising marijuana should be a state’s right. He is wrong, but could be forgiven if he took the time to learn why. He was building a hotel empire while many of us have been fighting the drug problem for 40 years. The truth about marijuana has been so misrepresented and suppressed for the last 20 years that he, like most people, doesn’t know what to believe. He has the best scientific information in the world available to him, but the question is: who is giving him advice? Anyone? Or drug legalisers such as Rohrabacher, Peter Theil, Trump confidant Roger Stone? Or even George Soros?

The truth is, marijuana was a dangerous drug 50 years ago, when the potency was only 0.5 per cent to 2 per cent. Today’s highly potent pot, with an advertised range of 25 per cent (+/-) of the active ingredient THC, and up to 98 per cent as wax or oils used in edibles, dabbing and vaping, has the potential to destroy the country by ruining our collective health and intellectual capacity.

Experts such as Dr Stuart Reece from Australia or Dr Bertha Madras of Harvard will attest that marijuana use by either parent can cause congenital abnormalities in a foetus. What’s worse, these abnormalities can affect the next four generations.

Psychotic breaks, mental illness and addiction caused by marijuana have led to a substantial increase in crime, homelessness, erosion of the quality of our inner cities, academic failure, traffic fatalities and public health costs. The combined economic impact in the US is well over $1trillion per annum.

Only the federal government has the resources to combat billionaire-backed legalisation campaigns and the illicit drug trade; the enforcement of federal laws is the only thing that will save California and the nation. Hopefully the President will step up and get us back on track without further delay.

Roger Morgan

RogerMorgan is the Chairman of the Take Back America Campaign http://www.tbac.us

Source: https://www.conservativewoman.co.uk/roger-morgan-trump-must-clamp-marijuana-america-doomed/ October 2017

Abstract and Figures

In 2017 Iceland received word-wide attention for having dramatically reversed the course of teenage substance use. From 1998 to 2018, the percentage of 15-16-year-old Icelandic youth who were drunk in the past 30 days declined from 42% to 5%; daily cigarette smoking dropped from 23% to 3%; and having used cannabis one or more times fell from 17% to 5%. The core elements of the model are: 1) long-term commitment by local communities; 2) emphasis on environmental rather than individual change; 3) perception of adolescents as social attributes. This presentation describes how the Iceland prevention model is built upon collaboration between policy makers, researchers, parent organizations, and youth practitioners. These groups have created a system whereby youth receive the necessary guidance and support to live fun and productive lives without reliance on psychoactive substances. The Model is being replicated in 35 municipalities within 17 countries around the globe. The Icelandic Model: Evidence Based Primary Prevention – 20 Years of Successful Primary Prevention Work was featured for the past two years at the Special Session of the United Nations General Assembly on the World Drug Problem.

Source: https://www.researchgate.net/publication/330347576_Perspective_Iceland_Succeeds_at_Preventing_Teenage_Substance_Use February 2019

US DRUG CZAR EXPLAINS CAUSES AND RSDT TOOL TO PREVENT TEEN DRUG USE AND OVERDOSE DEATH INTERVIEW WITH U.S. DRUG CZAR JOHN WALTERS

Introduction:  In response to recent news of a huge increase in drug overdose deaths and arrests for drug trafficking among Fairfax County youths, Fox News TV5 reporter Sherri Ly interviewed U.S. Drug Czar John Walters for his expert views on the cause and potential cure for these horrific family tragedies.  Following is a transcript of that half-hour interview with minor editing for clarity and emphasis added.  The full original interview is available through the 11/26/08 Fox5 News broadcast video available at link:

WALTERS:  Well, as this case shows, while we’ve had overall drug use go down, we still have too many young people losing their lives to drugs, either through overdoses, or addiction getting their lives off track.  So there’s a danger.  We’ve made progress, and we have tools in place that can help us make more progress, but we have to use them

Q 1:  You meet with some of these parents whose children have overdosed.  What do they tell you, and what do you tell them?

WALTERS:  It’s the hardest part of my job; meeting with parents who’ve lost a child.  Obviously they would give anything to go back, and have a chance to pull that child back from the dangerous path they were on.  There are no words that can ease their grief.  That’s something you just pray that God can give them comfort.  But the most striking thing they say to me though is they want other parents to know, to actAnd I think this is a common thing that these terrible lessons should teach us.

Many times, unfortunately, parents see signs: a change in friends, sometimes they find drugs; sometimes they see their child must be intoxicated in some way or the other.  Because it’s so frightening, because sometimes they’re ashamed – they hope it’s a phase, they hope it goes away – they try to take some half measures.  Sometimes they confront their child, and their child tells them – as believably as they ever can – that it’s the first time.  I think what we need help with is to tell people; one, it’s never the first time.  The probability is low that parents would actually recognize these signs – even when it gets visible enough to them – because children that get involved in drugs do everything they can to hide it.  It’s never the first time.  It’s never the second time.  Parents need to act, and they need to act quickly.  And the sorrow of these grieving parents is, if anything, most frequently focused on telling other parents, “Don’t wait: do anything to get your child back from the drugs.”

Secondly, I think it’s important to remember that one of the forces that are at play here is that it’s their friends.  It’s not some dark, off-putting stranger – it’s boyfriends, girlfriends.  I think that was probably a factor in this case.  And it’s also the power and addictive properties of the drug.  So your love is now being tested, and the things you’ve given your child to live by are being pulled away from them on the basis of young love and some of the most addictive substances on earth.  That’s why you have to act more strongly.  You can’t count on the old forces to bring them back to safety and health.

Q 2:  When we talk about heroin – which is what we saw in this Fairfax County drug ring, alleged drug ring – what are the risks, as far as heroin’s concerned?  I understand it can be more lethal, because a lot of people don’t know what they’re dealing with?

WALTERS:  Well it’s also more lethal because one, the drug obviously can produce cardiac and respiratory arrest.  It’s a toxic substance that is very dangerous.  It’s also the case that narcotics, like heroin – even painkillers like OxyContin, hydrocodone, which have also been a problem – are something that the human body gets used to.  So what you can frequently get on the street is a purity that is really blended for people who are addicted and have been long time addicted.  So a person who is a new user or a naïve user can more easily be overdosed, because the quantities are made for people whose bodies have adjusted to higher purities, and are seeking that effect that only the higher purity will give them in this circumstance.  So it’s particularly dangerous for new users.  But we also have to remember, it almost never starts with heroin.  Heroin is the culmination here.  I think some of the – and I’ve only seen press stories on this — some of these young people may have gotten involved as early as middle school.

We have tools so that we don’t have to lose another young woman like this– or young men.  We now have the ability to use Random Student Drug Testing (RSDT) because the Supreme Court has, in the last five years, made a decision that says it can’t be used to punish.  It’s used confidentially with parents.  We have thousands of schools now doing it since the president announced the federal government’s willingness to fund these programs in 2004.  And many schools are doing it on their own.  Random testing can do for our children what it’s done in the military, what it’s done in the transportation safety industry– significantly reduce drug use.

First, it is a powerful reason not to start.  “I get tested, I don’t have to start.”  We have to remember, it’s for prevention and not a “gotcha!”  But it’s a powerful reason for kids to say, even when a boyfriend or girlfriend says come and do this with me, “I can’t do it, I get tested.  I still like you, I still want to be your friend; I still want you to like me, but I just can’t do this,” which is very, very powerful and important.  And second, if drug use is detected the child can be referred to treatment if needed.

Q 3:  Is the peer pressure just that much that without having an excuse, that kids are using drugs and getting hooked?

WALTERS:  Well one of the other unpleasant parts of my job is I visit a lot of young people in treatment; teenagers, sometimes as young as 14, 15, but also 16, 17, 18.  It is not uncommon for me to hear from them, “I came from a good family.  My parents and my school made clear what the dangers were of drugs.  I was stupid.  I was with my boyfriend (or girlfriend) and somebody said hey, let’s go do this.  And I started, and before I knew it, I was more susceptible.

We have to also understand the science, which has told us that adolescents continue to have brain development up through age 20-25.  And their brains are more susceptible to changes that we can now image from these drugs.  So it’s not like they’re mini-adults.  They’re not mini-adults.  They’re the particularly fragile and susceptible age group, because they don’t have either the experience or the mental development of adults.  That’s why they get into trouble, that’s why it happens so fast to them, that’s why it’s so hard for them to see the ramifications.

So what does RSDT do?  It finds kids early–­ if prevention fails.  And it allows us to intervene, and it doesn’t make the parent alone in the process.  Sometimes parents don’t confront kids because kids blackmail them and say “I’m going to do it anyway, I’m going to run away from home.”  The testing brings the community together and says we’re not going to lose another child.  We’re going to do the testing in high school – if necessary, in middle school.  We’re going to wrap our community arms around that family, and get those children help.  We’re going to keep them in school, not wait for them to drop out.  And we’re certainly not going to allow this to progress until they die.

Q 4:  And in a sense, if you catch somebody early, since you’re saying the way teenagers seem to get into drug use is a friend introduces it to a friend, and then next thing you know, you have a whole circle of friends doing it.  Are you essentially drying that up at the beginning, before it gets out of hand?

WALTERS:  That is the very critical point.  It’s not only helping every child that gets tested be safer, it means that the number of young people in the peer group, in the school, in the community that can transfer this dangerous behavior to their friends shrinks.  This is communicated like a disease, except it’s not a germ or a bacillus.  It’s one child who’s doing this giving it behaviorally to their friends, and using their friendship as the poison carrier here.  It’s like they’re the apple and the poison is inside the apple.  And they trade on their friendship to get them to use.  They trade on the fact that people want acceptance, especially at the age of adolescence.  So what you do is you break that down, and you make those relationships less prone to have the poison of drugs or even underage drinking linked to them.  And of course we also lose a lot of kids because of impaired driving.

Q 5:  And how does the drug testing program work, then, in schools– the schools that do have it.  Is it completely confidential?  Are you going to call the police the minute you find a student who’s tested positive for heroin or marijuana or any other illicit drug?

WALTERS:  That’s what is great about having a Supreme Court decision.  It is settled – random testing programs cannot be used to punish, to call law enforcement; they have to be confidential.  So we have a uniform law across the land.  And what the schools that are doing RSDT are seeing is that it’s an enormous benefit to schools for a relatively small cost.  Depending on where you are in the country, the screening test is $10-40.  It’s less than what you’re going to pay for music downloads in one month for most teenage kids in most parents’ lives.  And it protects them from some of the worst things that can happen to them during adolescence.  Not only dying behind the wheel, but overdose death and addiction.

 Schools that have done RSDT have faced some controversy; so you have to sit down and talk to people; parents, the media, young people.  You have to engage the community resources.  You’re going to find some kids and families that do have treatment needs.  But with RSDT you bring the needed treatment to the kids.

I tell, a lot of times, community leaders – mayors and superintendents, school board members – that if you want to send less kids into the criminal justice system and the juvenile justice system, drug test — whether you’re in a suburban area or in an urban area.

What does the testing do?  It takes away what we know is an accelerant to self-destructive behavior: crime, fighting in school, bringing a weapon, joining a gang.  We have all kinds of irrefutable evidence now – multiple studies showing drugs and drinking at a young age accelerate those things, make them worse, make them more violent, as well as increasing their risks of overdose deaths and driving under the influence.  So drug testing makes all those things get better.  And it’s a small investment to make everything else we do work better.

Again, drug testing is not a substitute for drug education or good parenting or paying attention to healthy options for your kid.  It just makes all those things work better.

Q 6:  And I know you’ve heard this argument before, but isn’t that big brother?  Aren’t there parents out there who say to you, “I’m the parent: why are you going to test my child for drugs in school; that’s my job?” 

WALTERS:  I think that is the critical misunderstanding that we are slowly beginning to change by the science that tells us substance abuse is a disease.  It’s a disease that gets started by using the drug, and then it becomes a thing that rewires our brain and makes us dependent.  So instead of thinking of this as something that is a moral failing, we have to understand that this is a disease that we can use the kind of tools for public health – screening and interventions – to help reduce it.

Look, let me give you the counter example.  It’s really not big brother.  It’s more like tuberculosis.  Schools in our area require children to be tested for tuberculosis before they come to school.  Why do they do that?  Because we know one, they will get sicker if they have tuberculosis and it’s not treated.  And we can treat them, and we want to treat them.  And two, they will spread that disease to other children because of the nature of the contact they will have with them and spreading the infectious agent.  The same thing happens with substance abuse.  Young people get sicker if they continue to use.  And they spread this to their peers.  They’re not secretive among their peers about it; they encourage them to use them with them.  Again, it’s not spread by a bacillus, but it’s spread by behavior.

If we take seriously the fact that this is a disease and stop thinking of it as something big brother does because it’s a moral decision that somebody else is making, we can save more lives.  And I think the science is slowly telling us that we need to be able to treat this in our families, for adults and young people.  We have public health tools that we’ve used for other diseases that are very powerful here, like screening – and that’s really what the random testing is.  We’re trying to get more screening in the health care system.  So when you get a check up, when you bring your child to a pediatrician, we screen for substance abuse and underage drinking.  Because we know we can treat this, and we know that we can make the whole problem smaller when we do. 

Q 7:  You have said there were about 4,000 schools across the country now that are doing this random drug testing.  What can we see in the numbers since the Supreme Court ruling in 2002, as far as drug use in those schools, and drug use in the general population?

WALTERS:  Well, what a number of those schools have had is of course a look at the harm from student drug and alcohol use.  Some of them have put screening into place, random testing, because they’ve had a terrible accident; an overdose death; death behind the wheel.  What’s great is when school districts do this, or individual schools do this, without having to have a tragedy that triggers it.  But if you have a tragedy, I like to tell people, you don’t have to have another one.  The horrible thing about a tragic event is that most people realize those are not the only kids that are at risk.

There are more kids at risk, obviously, in our communities in the Washington, DC area where this young woman died.  We know there’s obviously more children who are at risk of using in middle school and high school.  The fact is those children don’t have to die.  We cannot bring this young lady back.  Everybody knows that.  But we can make sure others don’t follow her.  And the way we can do that is to find, through screening, who’s really using.  And then let’s get them to stop – let’s work with their families, and let’s make sure we don’t start another generation of death.  So what you see in these areas is an opportunity to really change the dynamic for the better.

Q 8:  Now, although nationally drug use among our youth is going down – what does it say to you – when I look at the numbers specific to Virginia, the most recent that I could find tells me that 3% of 12th graders, over their lifetime, have used a drug like heroin?  What does it say to you?  To me, that sounds like a lot.

WALTERS:  Yeah, and it’s absolutely true.  I think the problem here is that when you tell people we are taking efforts that are making progress nationwide, they jump to the conclusion that that means that we don’t have a problem anymore.  We need to continue to make this disease smaller.  It afflicts our young people.  It obviously also afflicts adults, but this is a problem that starts during adolescence — and pre-adolescence in some cases — in the United States.  We can make this smaller.  We not only have the tools of better prevention but also better awareness and more recognition of addiction as a disease.  We need to make that still broader.  We need to use random testing.  If we want to continue to make this smaller, and make it smaller in a permanent way, random testing is the most powerful tool we can use in schools.

We want screening in the health care system.  We have more of that going on through both insurance company reimbursement and public reimbursement through Medicare and Medicaid for those who come into the public pay system.  That needs to grow.  It needs to grow into Virginia, it’s already being looked at in DC; it needs to grow into Maryland and the other states that don’t have it.  We are pushing that, and it’s relatively new, but it’s consistent with what we’re seeing – the science and the power of screening across the board.

We need to continue to look at this problem in terms of also continuing to push on supply.  We’re working to reduce the poisons coming into our communities, which is not the opposite of demand; that we have to choose one or the other.  They work together.  Keeping kids away from drugs and keeping drugs away from kids work together.  And where we see that working more effectively, we’ll save more lives.  So again, we’ve seen that a balanced approached works, real efforts work, but we need to follow through.  And the fact that you still have too many kids at risk is an urgent need.  Today, you have kids that could be, again, victims that you have to unfortunately tell about on tonight’s news, that we can save.  It’s not a matter we don’t know how to do this.  It’s a matter of we need to take what we know and make it reality as rapidly as possible.

Q 9:  Where are these drugs coming from?  Where’s the heroin that these kids allegedly got coming from?

WALTERS:  We do testing about the drugs to figure out sources for drugs like heroin.  Principally, the heroin in the United States today has come from two sources.  Less of it’s coming out of Colombia.  Colombia used to be a source of supply on the East Coast, but the Colombian government, as a part of our engagement with them on drugs, has radically reduced the cultivation of poppy and the output of heroin.  There still is some, but it’s dramatically down from what it was even about five years ago.  Most of the rest of the heroin in the United States comes from Mexico.  And the Mexican government, of course, is engaged in a historic effort to attack the cartels.  You see this in the violence the cartels have had as a reaction.  So we have promising signs.  There are dangerous and difficult tasks ahead, but we can follow through on that as well.

Most of the heroin in the world comes from Afghanistan; 90% of it.  And we are working there, of course, as a part of our effort against the Taliban and the forces of terror and Al Qaeda, to shrink that.  The good news is that last year we had a 20% decline in cultivation and a 30% decline in output there.  Most of that does not come here, fortunately.  But it has been funding the terrorists.  It’s been drained out of most of the north and the east of the country.  It’s focused on the area where we have the greatest violence today, in the southwest.  We’re working now – you see Secretary Gates talking to the NATO allies about bringing the counter-insurgency effort together with the counter-narcotics effort to attack both of these cancers in Afghanistan.  We have a chance to change heroin availability in the world in a durable way by being successful in Afghanistan.  We’ve started that path in a positive way.  Again, it’s a matter of following through as rapidly as possible.

Q 10:  Greg Lannes, the father of the girl in Fairfax County who died, told me that one of his main efforts, as you imagined, was to let people know that those drugs, they’re coming from where it is produced, outside our country; that they’re getting all the way down to the street level and into our neighborhoods– something that people don’t realize.  So when you hear that they busted a ring of essentially teenagers who have been dealing, using and buying heroin, what does that say to you as the man in charge of combating drugs in our country?

WALTERS:  Well again, we have tools that can make this smaller.  But we have to use those tools.  And we have multiple participants here.  Yes we need to educate.  And we need to make sure that parents know they need to talk to their children, even when their children look healthy and have come from a great home.  Drugs – we’ve learned, I think, over the last 25 years or more, drugs affect everybody; rich or poor, middle class, lower class or upper class.  Every family’s been touched by this, in my experience, by alcohol or drugs.  They know that reality– we don’t need to teach them that.

What we need to teach them is the tools that we have that they can help accelerate use of.  Again, I think – there is no question in my mind that had this young woman been in a school, middle school or high school that had random testing – since that’s where this apparently started, based on the information I’ve seen in the press – she would not be dead today.  So again, we can’t go back and bring her to life.  But we can put into place the kind of screening that makes the good will and obvious love that she got from her parents, the obvious good intentions that I can’t help but believe were a part of what happened in the school, the opportunities that the community has to have a lot of resources that she didn’t get when she needed them.  And now she’s dead.  Again, we can stop this: we just have to make sure we implement that knowledge in the reality of more of our kids as fast as possible.

Q 11:  Should anyone be surprised by this case?  And that such a hardcore drug like heroin is being used by young people?

WALTERS:  We should never stop being surprised when a young person dies.  They shouldn’t die.  They shouldn’t die at that young age, and we should always demand of ourselves, even while we know that’s sometimes going to happen today, that every death is a death too many.  I think that it is very important not to say we’re going to accept a certain level.  Never accept this.  Never!  That’s my attitude, and I know that’s the president’s  attitude as well here.  Never accept that heroin’s going to get into the lives of our teenagers.  Never accept that our children are going to be able to use and not be protected.  It’s our job to protect themThey have a role, also, obviously in helping to protect themselves.  But we need to give them the tools that will help protect them.

When I talk to children and young adults in high school or college, they know what’s going on among their peers.  And in some ways, when you get them alone and they feel they can talk candidly, they tell us they don’t understand why we, as adults who say this is serious, don’t act.  They know that we see children who are intoxicated; they know that we must see signs of this, because as kid’s lives get more out of control, they show signs of it.  They want to know why we don’t act.

We can use the tools of screening, and we can use the occasion of a horrible event like this to bring the community together and say it’s time for us to use the shock and the sorrow for something positive in the future.  I haven’t met a parent of a child who’s been lost who doesn’t say I just want to use this now for something positive.  And that’s understandable, and I think we ought to honor that wish.

Q 12:  Well, I guess I’m not asking should we accept that this is in our schools, but is it naïve for people not to understand or realize that these hardcore drugs are in our schools, and in our communities, and in our neighborhoods. 

WALTERS:  Yeah.  Where it is naïve, I think, is to not recognize the extent and access that young people have to drugs and alcohol.  I think we sometimes think that because they come from a home where this isn’t a part of their lives now, that it’s not ever going to be part of their lives.  Look, your viewers should go on the computer.  Type marijuana into the Google search engine and see how many sites encourage them to use marijuana, how to get marijuana, how to grow marijuana, the great fun of marijuana.  Go on YouTube and type in marijuana, and see how many videos come up using marijuana, joking around about marijuana.  And then when you start showing one, of course the system is designed to show you similar things.  Type in heroin.  See what kind of sites come up, and see what kind of videos come up on these sites.  Young people spend more time on these sites than they do, frequently, watching television.  Remember, there is somebody telling your children things about drugs.  And if it’s not you, the chances are they’re telling them things that are false and dangerous.  So there is a kind of naiveté about what the young peoples’ world, as it presents itself to them, tells them about these substances.  It minimizes the danger, it suggests that it’s something that you can do to be more independent, not be a kid anymore. 

We, from my generation — because I’m a baby boomer — unfortunately have had an association of growing up in America with the rebellion that’s been associated with drug use.  That’s been very dangerous, and we’ve lost a lot of lives.  We have to remember that it’s alive and well, and has become part of the technological sources of information that young people have.  I also see young people in treatment centers who got in a chat room and somebody offered them drugs or offered them to come and buy them alcohol and flattered them, and got them involved in incredibly self-destructive behavior.  The computer brings every predator and every dangerous influence into your own child’s home – into their bedroom in some cases, if that’s where that computer exists.  You wouldn’t let your kids go out and play in the park with drug dealers.  If you have a computer and it’s not supervised, those drug dealers are in that computer.  Remember that.  And they’re only a couple of keystrokes away from your child.

Q 13:  And you talk about the YouTube and the computers and all those things.  What about just the overall societal image?  Because we have this whole image with heroin, of heroin chic.  How much does that contribute to the drug use, and how difficult does it make your job, when a drug is being made out to be cool in society by famous people?

WALTERS:  There are still some elements of that.  It was more prominent a number of years ago.  I would say you see less of that now glamorized in the entertainment industry, or among people who are celebrities in and out of entertainment.  You see more cases of real harm.  But it’s still out there.  The one place that I think is replacing that, just to get people ahead of the game here, is prescription pharmaceuticals.  Those have been marketed to kids on the internet as a safe high.  They falsely suggest that you can overcome the danger of an overdose because you can predict precisely the dosage of OxyContin, hydrocodone, Vicodin.  And there are sites that suggest what combination of drugs to use.  We’ve seen prescription drug use as the one counter example of a category of drug use going up among teens.  We’re trying to work on that as well, but that’s something that’s in your own home, because many people get these substances for legitimate medical care.  Young people are going to the medicine cabinet of family or friends, taking a few pills out and using those.  And those are as powerful as heroin, they’re synthetic opioids, and they have been a source of overdose deaths. 

So let’s not forget – while this Fairfax example reminds us of the issues of heroin chic and of the heroin that’s in our communities, the new large problem today is a similar dangerous substance in pill form in our own medicine cabinets.  Barrier to access is zero.  They don’t have to find a drug dealer; they just go find the medicine cabinet.  They don’t have to pay a dime for it because they just take it and they share that with their friends.  We need to remember, that’s another dimension here.  Keep these substances out of reach – under our control when we have them in our home.  Throw them away when we’re done with them.  Make sure we talk to kids about pills.  Because people, again, are telling them that’s the place to go to avoid overdose death, is to take a pill.

Q 14:  When you see a lot of these celebrities checking in and out of rehab, does it sort of glamorize it for kids?  And teach them hey, you can use, you can check into rehab, you can come back, you can – you know.  Is there a mixed message there?

WALTERS:  There is.  Some young people interpret it the way you describe; of it’s something you do and you can get away with it by going into rehab.  We do a lot of research on young people’s attitudes for purposes of helping shape prevention programs in the media, as well as in schools and for parents.  We do a lot with providing material to parents.  I would say that compared to where we’ve been in the last 15 or 20 years, there’s less glamorization today.

I think we should also remember the positive, because we reinforce that.  A lot of young people – obviously not all or we wouldn’t have this death – believe that taking drugs makes you a loser.  They’ve seen that a lot of those celebrities are showing their careers going down the toilet because they can’t get away from the pills and the drugs and the alcohol.  And I think they see that even among some of their peers.  That’s a good thing.  We should reinforce that as parents: teaching our kids that drug and alcohol use may be falsely presented to you as something you do that would make you popular, make you seem like you should have more status in society generally.  But actually, look at a lot of these people; they’ve had enormous opportunities, enormous gifts, and they can’t stop themselves from throwing them away.  And they may not stop themselves from throwing away their lives. 

I think you could use these events as a teachable moment.  It can go two ways.  Help your child understand what the truth is here.  And I tell young people – and I think parents have to start this more directly – this is the way this is going to come to you:  Somebody you really, really want to like you; somebody you really, really like; someone you may even love — or think you love — they’re going to say come and do this with me.  If you can’t find any other reason to not do this with them, say, “Before we do this, let’s go to a treatment center.  Let’s go talk to people who stood where we stood and said it’s not going to happen to me.”  If everybody, when they got the chance to start, thought of an addict or somebody who was dead, they wouldn’t start.  The fact is that does not enter their mind. 

Many people in treatment centers understand that part of the task of recovery is helping other people avoid this.  So they’re willing to talk about it.  In fact, that’s part of their path of staying clean and sober, which not many kids are going to be able to do on their own.  But it makes them think that what presents itself as something overwhelmingly attractive has behind it a horrible dimension, for their friends as well as for themselves.  And more and more, I think kids understand this.

We can use the science of this as a disease, and the experience of many families.  Remember, uncle Joe didn’t used to be like this.  Especially Thanksgiving, when we have families getting together and all of a sudden mom’s going to get loaded and become ugly in the corner.  We also have to remember we have an obligation to reach out to those people, and to get them help.  We can treat them.  Nobody gets sober, in my experience, by themselves.  They have to take responsibility.  But you have to overcome the pushback, and addiction and alcoholism have, as a part of the disease, denial.  When you tell somebody they have a problem, they get angry with you.  They don’t say hey thanks, I want your help.  They don’t hit bottom and become nice.  That’s a myth.  They need to be grabbed and encouraged and pushed.  Almost everybody in treatment is coerced – by a family member, by an employer, sometimes by the criminal justice system.

So remember that, when you find your child using and they want to lie to you up down and sideways saying, “It’s the first time I’ve ever done it.”  No, no, no, no, no, that’s the drugs talking.  That shows you, if anything, you have a bigger problem than you realized and you need to reach out, get some professional help.  But don’t wait!

Source:    National Institute of Citizen Anti-drug Policy (NICAP)

DeForest Rathbone, Chairman, Great Falls, Virginia, 703-759-2215, DZR@prodigy.net

Jim Carroll is the former director of the White House Office of National Drug Control Policy — informally known as the U.S. Drug Czar — and said the three biggest factors in dealing with the drug epidemic locally and nationally is enforcement, treatment, and prevention.

“It’s the only way to really tackle this issue is one, reducing the availability of drugs in our community, recognizing that there are people who are suffering from addiction and that recovery is possible that if we can get them in to help, that they can recover,” Carroll said. “It’s important to do all three; it’s possible to reduce the number of fatalities.”

Carroll said the issue is getting worse, with the number of fentanyl deaths going up 50% in the last four years, up to around 115,000 from around 70,000 in 2019.

Uttam Dhillon is the former acting director of the Drug Enforcement Agency, and said that the reason the drug epidemic has become such a serious issue is because of the crisis at the southern border.

“The two biggest cartels are the Sinaloa cartel and the…CJNG, and they fight for territory and the ability to bring precursor chemicals in from China to make methamphetamine and fentanyl, and then transport those drugs into the United States,” Dhillon said. “The battle between the cartels is actually escalated and they are now actually using landmines in Mexico… so this is a brutal war in Mexico between the cartels.”

Dhillon said the reason the stakes are so high in Mexico is because the demand for illicit drugs in the United States is so large.

“Basically every state in the union has activity from the drug cartels in Mexico in them, and that’s really important to understand, because that’s why we are being flooded by drugs,” Dhillon said. “We never declared Mexico a narco state during the Trump Administration, but as I stand here today, I would say in my opinion, Mexico is a narco state.”

In terms of dealing with the nation’s drug epidemic, Dhillon said we first have to start by enforcing the law, which in part begins at the southern border.

Increased enforcement at the border, however, does not fully solve America’s drug epidemic. That is where the panel said local partners in prevention and recovery come in.

Kaitlyn Krolikowski is the director of administrative services at the Purchase District Health Department and said that prevention and treatment is about more than keeping people out of jail.

In January and February, there have been four overdoses in west Kentucky, according to the McCracken County coroner.

“Dead people don’t recover,” Krolikowski said. “We are here to help people recover and to help our community.  For our community to prosper, we need healthy community members and the way that we’re going to get that is by offering them treatment, saving lives, and giving them the resources that they need to be members of our community that we’re proud of.”

While many members of the audience were police officers, non-nursing students, and community leaders, the event was designed to help give clinicians more context about the world they will practice in after graduation.

Dina Byers is the dean of the School of Nursing and Health Professions at MSU, and said that its important to hear what is going on at the national, state, and local level when it comes to illicit drugs.

“It was important that they hear what’s going on,” Byers said. “And that was the purpose of this event was to provide a collaborative effort, a collaborative panel discussion around many topics today.”

If you or someone you know is struggling with addiction, you can call the police without fear of being arrested, or call your local health department to get resources that can help saves lives.

Source: https://www.wpsdlocal6.com/news/dead-people-don-t-recover-msu-panel-discusses-drug-epidemic-solutions-in-america/article_aa168e78-ebcf-11ee-9f07-0385030995de.html

Democratic Gov. Tina Kotek signed legislation Monday to recriminalize the possession of small amounts of certain drugs as the state grapples with a major overdose crisis, ending a legalization experiment backed by voters four years ago.

The new law makes keeping drugs such as heroin or methamphetamine a misdemeanor punishable by up to six months in prison. It also enables police to confiscate the drugs and crack down on their use on sidewalks and in parks.

Back in 2020, voters backed Measure 110, which made minor possession of personal-use amounts of certain drugs a non-criminal violation on par with a traffic ticket.

It took effect in February 2021, making Oregon the first state to officially decriminalize minor drug possession.

Since then, the Beaver State has seen a significant uptick in homelessness, homicides and overdose deaths.

In 2020, unintentional opioid overdose deaths clocked in at 472 and hit at least 628 in 2023, according to state data.

In 2022, Portland set a new record for murders with 101 — breaking the mark of 92 set the previous year.

Back in January, Kotek declared a fentanyl state of emergency in the city, saying at the time: “Our country and our state have never seen a drug this deadly and addictive, and all are grappling with how to respond.”

The new law, which will take effect Sept. 1, will let local law enforcement decide whether to give violators the chance to pursue treatment before booking them into jail

Another bill Kotek signed Monday, Senate Bill 5204, allocates $211 million to mobilize resources for behavioral health and education programs, including expanded access to substance abuse treatment and prevention education.

“Success of this policy framework hinges on the ability of implementing partners to commit to deep coordination at all levels,” Kotek emphasized in a letter to legislative leaders.

The governor further called on the Department of Corrections to ensure a “consistent approach for supervision when an individual is released” from detention and to “exhaust non-jail opportunities for misdemeanor sanctions.”

Source: https://nypost.com/2024/04/02/us-news/oregon-recriminalizes-drugs-after-upswing-in-overdose-deaths/

Nearly half of all U.S. citizens now live in a state where they can purchase cannabis from a recreational market, and all but 13 states have legalized medical use.  These state-level policies have all been developed and adopted under a federal prohibition, which may be changing soon as lawmakers in both the House and the Senate are developing federal proposals to legalize cannabis.

A new USC Schaeffer Center white paper shows how state-level cannabis regulations have weak public health parameters compared to other countries, leaving consumers vulnerable. Federal legalization is an opportunity to implement regulations that better protect consumers and promote reasonable use. Regulations policymakers should consider include placing caps on the amount of the main intoxicant (THC) allowed in products sold in the marketplace and placing purchase limits on popular high-potency cannabis products, like edibles and vape cartridges, as has been done in other legalized jurisdictions abroad.  

“Allowing the industry to self-regulate in the U.S. has generated products that are more potent and diverse than in other countries and has led to a variety of youth-oriented products, including cannabis-infused ice cream, gummies and pot tarts,” says Rosalie Liccardo Pacula, a senior fellow at the USC Schaeffer Center and Elizabeth Garrett Chair in Health Policy, Economics & Law at the USC Price School of Public Policy. “Current state regulations and public advisories are inadequate for protecting vulnerable populations who are more susceptible to addiction and other harm.”

High-potency cannabis products have been linked to short-term memory and coordination issues, impaired cognitive functions, cannabis hyperemesis syndrome, psychosis, and increased risks of anxiety, depression and dependence when used for prolonged periods. Acute health effects associated with high-potency products include unexpected poisonings and acute psychosis.

Policies should discourage excessive cannabis use

Product innovation within the legal cannabis industry has outpaced state regulations and our knowledge of health impacts of nonmedical, adult-use cannabis, write Pacula and her colleagues.  Cannabis concentrates and extracts can reach concentrated THC levels of 90% in certain cases – many, many times more potent than dried flower that ranges between 15-21%. These products are also increasingly popular – sales for concentrates like vape pens rose 145% during the first two years of legalization in Washington state.

But state approaches to regulation have insufficiently considered quantity and potency limits. Just two states, Vermont and Connecticut, have set potency limits on both flower and concentrates. Most states base sales limits on product weight and product type, an approach that allows individuals to purchase excessive amounts of high-potency products in a single transaction.

An individual in most states can purchase 500 10-milligram servings of concentrates in a single transaction. Six states allow purchases that exceed 1,000 servings. By comparison, a full keg of beer, which usually requires registration, provides 165 servings of alcohol.

“Voters in many of these states supported legalization because they were told we would regulate cannabis like alcohol, but in reality, when it comes to product innovation, contents and standard serving sizes, the cannabis market has largely been left on its own,” says Seema Pessar, a senior health policy project associate at the USC Schaeffer Center. “And that is what is concerning for public health.”

“We are seeing evidence of real health consequences from this approach, especially among young adults,” explains Pacula. For example, studies show a rise cannabis-related emergency department visits for acute psychiatric symptoms and cyclical vomiting in states that legalize recreational cannabis.

Key policies to support responsible cannabis use

To better regulate legal cannabis markets and products, researchers find four policy areas in which state laws and federal proposals can do more to encourage responsible use.

  • Placing limits on the amount of THC in legal products soldSetting clear and moderate caps on flower, concentrates and extracts.
  • Instituting potency-based sales limitsRestricting the amount of cannabis that a retailer can sell to an individual in a single transaction or over a period of time, based on the THC amount in the product.
  • Designing a tax structure based on the potency of productsTaxing cannabis in a manner similar to alcohol, based on intoxicating potential rather than by container weight or retail price.
  • Implementing seed-to-sale data-tracking systems: Allowing regulatory agencies to view every gram of legal cannabis that is cultivated and watch it as it migrates throughout supply chain, including the comprehensive monitoring of ingredients added to products that are eventually purchased in stores.

While generating tax revenue and reversing damages from prohibition are important, so is prioritizing public health — and prolonged use of high-potency cannabis products has health consequences, the researchers write.

“It is difficult to implement restrictive health regulations in markets that are already operating, generating jobs and revenue,” Pacula says. “Now is when the federal government has the best chance of ensuring a market that fully considers public health.”

Source: Cannabis Regulations Inadequate Given Rising Health Risks of High-Potency Products – USC Schaeffer July 2022

Democratic Gov. Tina Kotek signed legislation Monday to recriminalize the possession of small amounts of certain drugs as the state grapples with a major overdose crisis, ending a legalization experiment backed by voters four years ago.

The new law makes keeping drugs such as heroin or methamphetamine a misdemeanor punishable by up to six months in prison. It also enables police to confiscate the drugs and crack down on their use on sidewalks and in parks.

Back in 2020, voters backed Measure 110, which made minor possession of personal-use amounts of certain drugs a non-criminal violation on par with a traffic ticket.

It took effect in February 2021, making Oregon the first state to officially decriminalize minor drug possession. Since then, the Beaver State has seen a significant uptick in homelessness, homicides and overdose deaths.

In 2020, unintentional opioid overdose deaths clocked in at 472 and hit at least 628 in 2023, according to state data.

In 2022, Portland set a new record for murders with 101 — breaking the mark of 92 set the previous year. Back in January, Kotek declared a fentanyl state of emergency in the city, saying at the time: “Our country and our state have never seen a drug this deadly and addictive, and all are grappling with how to respond.”

The new law, which will take effect Sept. 1, will let local law enforcement decide whether to give violators the chance to pursue treatment before booking them into jail .

Another bill Kotek signed Monday, Senate Bill 5204, allocates $211 million to mobilize resources for behavioral health and education programs, including expanded access to substance abuse treatment and prevention education.

“Success of this policy framework hinges on the ability of implementing partners to commit to deep coordination at all levels,” Kotek emphasized in a letter to legislative leaders.

The governor further called on the Department of Corrections to ensure a “consistent approach for supervision when an individual is released” from detention and to “exhaust non-jail opportunities for misdemeanor sanctions.”

 

Source: Oregon recriminalizes drugs after upswing in overdose deaths (nypost.com)

The sale and use of illegal drugs are among the most serious problems facing the UK, indeed, the entire world, right now. This issue is particularly prevalent within Britain’s night-time economy, where even the most stringently law-abiding and responsibly run premises are not guaranteed to be completely free from the presence of drugs and/or drug dealers.

As a security operative, especially a door supervisor, you are in a unique position to spot potential drug deals and put a stop to them. This is of benefit to both the venue as well as its patrons. Overall, it also helps to keep the public safe.

In this feature, we’ll show you to spot a probable drug deal, identify a likely drug dealer and offer advice on what to do once you’ve confirmed your suspicions. We will also examine the laws around drugs, including what is and isn’t allowed and who is liable if those laws are broken on the premises you’re guarding.

Drug Dealers in Popular Culture

The sale of drugs has, of course, existed for thousands of years. However, in prehistory and antiquity drug use probably had at least some religious or spiritual connotations.

Nevertheless, recreational drug use dates back at least as far as Ancient Mesopotamia (and probably a lot further than that). Ancient Sumerians freely traded opium along with other commodities, while the ancient Egyptians prized blue water lotus flowers for their hallucinogenic properties (King Tutankhamun was even buried with some). These drugs were not illicit or illegal in their respective eras and traders would have bought and sold them openly.

Notable books concerning drug use and purchase include Thomas De Quincey’s autobiographical account ‘Confessions of an English Opium Eater’ (1821) and William Burroughs’ 1953 debut ‘Junkie: Confessions of an Unredeemed Drug Addict’.

In 1966, The Beatles released their ‘Revolver’ album, which featured a song called ‘Dr. Robert’. The song, inspired by real-life figure Dr. Robert Freymann, tells the story of a supposedly legitimate medical doctor who abuses his prescription pad in order to get his ‘patients’ any kind of drug they want. The song is notable for being one of the first times a drug dealer was depicted overtly, as well as in a generally positive light.

One year later, New York alternative band ‘The Velvet Underground’ released their debut album, which featured the songs ‘Waiting for the Man’ (which described a drug deal) and ‘Heroin’, the meaning of which ought to be self-explanatory. These songs were even more explicit and frank about illegal drugs and the people that use them.

The popular culture of the early 21st century is replete with examples of drug dealers. The 1983 gangster film ‘Scarface’ starring Al Pacino tells the story of Tony Montana, a Cuban refugee and petty criminal who becomes a wealthy drug baron in America. Today, ‘Scarface’ looms large in popular culture, with its themes and iconography being referenced in everything from other movies and TV shows to poster art, video games and even song lyrics.

Drug use and the sale of drugs are staples of gangster movies, with the sale of illicit materials often being contrasted with the basic assumptions of American capitalism as a way to comment upon society in general.

Another good example of these themes can be seen in the 2007 film ‘American Gangster’ starring Denzel Washington and Russell Crowe. This film also depicts drug dealing as a pathway to riches among the downtrodden and dispossessed.

‘American Gangster’s story, essentially, mirrors that of both ‘Scarface’ and any number of other movies of the genre, as well as, not incidentally, the typical experience of any addict. Drugs are initially seen as empowering and fun before becoming uncontrollable and eventually leading to the central character’s downfall.

The media treats street-level drug dealers, however, in a variety of different ways.

The 1993 movie ‘Trainspotting’ (an adaptation of the novel of same name by Irvine Welsh), starring Ewan McGregor, was praised for its frank and hard-hitting discussion of heroin addiction. The movie depicts a blurred line between using and dealing.

Perhaps popular culture’s best-loved drug dealers are Jay & Silent Bob. Beginning with the debut of comedy writer/director Kevin Smith, 1994’s ‘Clerks’, Jay (Jason Mewes) and his ‘hetero life-mate’ Silent Bob (Kevin Smith) appear in almost all of Smith’s movies, occasionally as central characters.

The pair, who mainly deal marijuana, are depicted as loveable, if crass, figures, who often attempt to resolve the issues of other characters via either heartfelt advice (‘Clerks’, ‘Chasing Amy’) or direct action (‘Mallrats’, ‘Dogma’). The pair appear to be stereotypical 1990’s-era drug dealers, usually peddling their wares outside the local convenience store, but their behaviour frequently upends audience expectations for comic effect.

The AMC TV series ‘Breaking Bad’, which began in 2008, depicts a grittier take on drug dealing. In the series, chemist Walter White (Bryan Cranston) is diagnosed with inoperable lung cancer and resorts to manufacturing and selling methamphetamines as a way of securing his family’s finances after his death. This decision leads him down a bad road, which sees the character becoming progressively darker as the show continues.

Similarly, the Starz black comedy series ‘Weeds’ (beginning in 2005) details the misadventures of widowed mother-of-two Nancy Botwin (Mary-Louise Parker), who takes to dealing marijuana as a way of supporting her family.

The legal drama series ‘Suits’, which began in 2011, features a drug dealer by the name of Trevor (Tom Lipinski), who is, at the series’ outset, best friend of main character Mike Ross (Patrick J. Adams). Unlike a stereotypical dealer, Trevor wears expensive suits and poses as a software developer to peddle his wares to a rich clientele. A failed drug deal involving Mike is the series’ inciting incident.

So, the portrayal of drug dealers in popular culture tends to vary, usually according to what drugs they are selling. Those selling marijuana are often depicted in a positive or comedic light (such as the episode of ‘Curb Your Enthusiasm’ wherein Larry David buys marijuana for his father), while those selling cocaine, heroin and other, harder drugs are usually seen as villainous, or at least more complicated, characters.

On television, drug dealers (that are not main characters) are usually seen as scruffy, but still attired in the urban fashions of the period (punk style in the 80’s and early 90’s, Hip Hop fashions from the mid-90’s – 2000’s, etc). They are traditionally young males.

Sadly, a disproportionate number of television drug dealers are cast as ethnic minorities, which does not reflect reality and only serves to fuel any number of negative stereotypes.

Such stylistic choices are part of a visual shorthand that encourages the audience to make a quick ‘snap judgement’ about a character in order not to waste any time setting up the joke or scene. So, if a young man, dressed in urban wear approaches a character, the audience will understand that he is likely a drug dealer. By contrast, if an older woman, dressed perhaps in an evening gown, approached the character, they would have to remark on the perceived incongruity of this alleged dealer in order for the scene to work.

These sorts of visual codes may be very useful for the TV and film industries, but they don’t do any favours to the security operative that is hoping to spot -and stop – a real-life drug deal taking place.

So, what are drug dealers like in real life?

Drug Dealers in Real Life

After surveying 243 self-identified drug dealers, researchers from the American Addiction Centers created the following profile of the ‘average’ drug dealer.

According to this fascinating and insightful study, a drug dealer is slightly more likely to be male than female (their numbers were 63% male and 37% female) and is likely to start dealing at around the age of 19 and stop by 23. Drug dealing is much rarer over the age of 30, but it definitely does happen.

The principal motivations for drug dealing are apparently needing money (40%), wanting extra money (29%) and the dealers desiring popularity with their peers (19%). Other motivations include the idea that drug dealers live glamorous lives (5%), peer pressure (5%) and supporting their own addictions (2%).

Most dealers got started through a friend (57%), or else through their own dealer (27%), while 10% stated that they were introduced to drug dealing through a family member.

The average drug dealer’s clientele is primarily students (34%) and working professionals (28%), although high school students (remember that this study is American, so these students could be as old as 18) also featured prominently. 2% even claimed to have dealt drugs to law enforcement offers.

The study revealed that 43% of the average drug dealer’s clients were considered by them to be addicts, but that only 11% of females and 9% of males denied their wares to those they considered at risk of death.

In hindsight, 61% said that they felt regret for their actions, while 39% were at peace with them. Only 45% admitted to feeling guilty, however, with a 55% majority stating that they did not. A small percentage stated that their actions had resulted in the deaths of some friends or clients.

The data is clear. Whilst a drug dealer is statistically slightly more likely to be young and male, they can (and do) look like anyone. Where TV’s drug dealers often wear loud clothes and openly publicise their products like foul-mouthed market vendors, real-life drug dealers are usually very adept at simply ‘blending in’ to their surroundings and not drawing undue attention to themselves.

Pop culture often assumes that drug dealers must resemble stereotypical drug users, however this is also rarely the case. A lot of dealers don’t use any drugs themselves and sell their products after working all day at a regular, 9-5 job.

Drug dealers can range from relatively innocuous-seeming people who sell ‘soft’ drugs to a small group of friends and/or family, to individuals of considerable wealth and influence, who sell, indirectly, to large numbers of people.

Some dealers sell prescription pain medication for those who are addicted to it, or experience chronic pain, some sell drugs that they consider harmless (but are, in fact, quite dangerous) and others do not consider themselves to be drug dealers at all.

Drug dealers can be any sex, gender, age, race, or class. So how can they be spotted?

How to Spot a Drug Deal

Knowing what we now know, we must consider that drug dealers are likely to be hard to spot. A drug deal, on the other hand, usually displays certain distinguishing characteristics that can be readily identified.

One trait common to most drug dealers is that they tend to set up in the same place each time they visit a venue. They do this so that customers know where to find them. A drug dealer’s preferred location is usually somewhere dark, slightly away from prying eyes, as well as a place that is likely to always be available. In most cases, dealers will not set themselves up in direct view of bar staff or door supervisors.

Be aware of any regular who sets themselves up in one specific place all or most of the time and is visited by multiple, seemingly unrelated, patrons or makes regular trips to the toilet. This person is very possibly a drug dealer.

Watch also for conspiratorial behaviour, such as two or more people huddling together as if sharing a secret. More experienced dealers will avoid this type of behaviour, but some dealers can still be identified this way.

Some dealers use accomplices known as ‘runners’ or ‘minders’ who actually carry the drugs and/or money. In this way, if the dealer is searched, security operatives or police will find nothing on them. A runner may not liaise with the dealer directly, but if a suspected dealer is visited several times by the same person, you may be inclined to search that person as well.

Dealers will often have a larger-than-average amount of cash about their person (although online payment methods are making this trait less common than it was). If a person has an abundance of cash on them (and you don’t work security in a strip club), this could be a sign that they are a dealer.

In person, dealers are often friendly and amiable, many are even charming. They are, after all, salespeople. With many customers that are probably nervous, it stands to reason that a dealer would want to be somewhat approachable.

Drug dealers are often very uncomfortable around the subject of drugs, however. When spoken to on the subject, many dealers will assume that they’ve been found out and will avoid the subject before leaving in a hurry. If you approach a suspected dealer and ask them about drugs while dressed in your uniform, their reaction can be a good indicator of either innocence or guilt.

What the Law Says

The main laws surrounding illegal drugs, at least for the purposes of this feature, are the Misuse of Drugs Act 1971 and the Licensing Act 2003. The Misuse of Drugs Act 1971 states that heavy penalties can be imposed upon any premises found to be permitting the sale or use of illegal drugs

The act, which was created to ensure the UK’s adherence to various international treaty conditions, made it illegal to possess, sell, offer to sell, or supply without charge any controlled drug or substance.

Oddly enough, despite the act’s title, the Misuse of Drugs Act 1971 does not cover the actual use of illegal drugs, nor does it immediately define which drugs it is referring to. Instead, the act defines 4 classes of controlled substances.

Class A’ drugs (heroin, cocaine, MDMA, LSD, methadone, methamphetamines, and magic mushrooms) are the most dangerous and therefore carry the harshest sentences under the act.

Class B’ drugs (amphetamines, codeine, barbiturates, ketamine, cannabis, and related cannabinoids) and ‘Class C’ drugs (anabolic steroids, diazepam, piperazines) are seen as less dangerous and carry lesser sentences. The ‘4th’ class is a temporary class, intended for more specific requirements than the broad classifications found elsewhere in the legislation.

Alcohol and tobacco are subject to separate legislation and are not affected by the terms of the act.

Under the terms of the Licensing Act 2003, if any licensed premises is found to be permitting the sale or use of illegal drugs, either interim steps toward the suspension of the license will be taken, or else the outright suspension of the license will occur.

A premises can also be closed under the Anti-Social Behaviour, Crime and Policing Act 2014.

The Misuse of Drugs Act 1971 was preceded by both the Dangerous Drugs Act 1964 (which dealt primarily with the use of cannabis and was itself preceded by the Dangerous Drug Act 1951) and the Medicines Act 1968, this second law primarily discussed the prescriptions, quality control and advertising of legal medicine. Prior to this, the laws around drugs and drug use were somewhat lax and insufficient.

Also of note is the Psychoactive Substances Act 2016, which was created to stop the spread of so-called ‘legal highs’. ‘Legal highs’ were drugs created to exploit loopholes in the terms of the Misuse of Drugs Act.

These legal drugs gained popularity in the 2000’s and 2010’s and were readily available from a variety of sources. Despite their easy availability, they were also very dangerous, killing almost 100 people in 2012 alone. The Psychoactive Substances Act was created to make their manufacture, sale and use illegal.

At present, Home Office guidelines (specific to, but not limited to raves and other ‘dance events’) allow for free cold water to be given to patrons as requested, the availability of a space to cool down and rest, monitoring of temperatures and air quality, provision of information and advice regarding drugs, and door staff to be trained to handle drug-related issues that may arise. 

Is the Law Effective?

According to the government’s latest figures, drug offences are on the rise in the UK. From 2020-21, drug-related offences jumped up by a massive 19% from 2019 – 20.

However, while this data may indicate a worsening trend, we must also consider the effect of the current coronavirus pandemic on the data. During lockdown, while the sale of illegal substances no doubt occurred, it would have been at least partially diminished, gaining more momentum once lockdowns were lifted.

Historically, British authorities have taken multiple approaches to preventing the sale and use of illegal drugs.

In 1954, the Metropolitan Police set up the Dangerous Drugs Office. It comprised of just 4 officers. In fact, a 1961 report on drug addiction in the UK concluded that

“the incidence of addiction to dangerous drugs is still very small… no cause to fear that any real increase is at present occurring”.

By 1963, however, the Metropolitan Police had learned that some doctors were overordering medicinal drugs and selling the surplus for personal profit, as well as overprescribing to addicts. After the number of arrests for drug-related offences began to climb, Parliament passed the Dangerous Drugs Act 1964 and the Medicines Act 1968.  

Further legislation was passed in the 1970’s and 1980’s, as new drugs began to be featured in the national discourse. Solvent abuse began in earnest in the 1980’s, which prompted the passage of the Intoxicating Substances (Supply) Act 1985, while barbiturates, which had been a serious problem since the mid-late 1970’s, were added to the Misuse of Drugs Act in 1984.

By 1985, MDMA was beginning to appear, claiming its first life in 1986. Police were given extra powers of search and interrogation, with particular emphasis on drug-related crimes by the Police and Criminal Evidence Act 1984.

1985’s Controlled Drug (Penalties) Act increased sentences for drug-related offences and the arrival of AIDS (which had existed since the 70’s, but was formally labelled an epidemic  in the 80’s) issued a public crackdown on needle sharing. Accordingly, the Drug Trafficking Offences Act 1986 came into effect in 1987. This act was partially intended to help recover the profits from drug trafficking. 

As we have seen, the issue of drugs exploded between the 1960’s and the 1990’s. By 1994, drug use was being seen as a global epidemic. The government published its ‘green paper’, titled ‘Tackling Drugs Together: A consultation document on a strategy for England 1995–1998′. This document outlined a ‘new approach to strategic thinking on drugs issues’, with an emphasis on reducing the availability of illegal drugs and keeping communities safer from drug-related offences.

The government also passed the Criminal Justice and Public Order Act 1994, which attempted to control drug use in prisons, as well as at raves.

Some of these measures have been reasonably effective, others appear not to have worked at all. However, the problem continues to persist, at times worsening.

The law is certainly effective when it comes to arresting and detaining some dealers, but the fact that drug use continues to be so persistent and prevalent shows that no measure has ever been 100% successful.

Critics of the Misuse of Drugs Act 1971, for example, have suggested that the classification system is inadequate because it does not consider the relative dangers of the drugs it classifies. This argument was key to the decision to reclassify cannabis as a ‘Class C’ drug in 2004. Nevertheless, the drug was moved back to ‘Class B’ in 2009.

In this case, the law would appear to be somewhat out-of-step with public opinion. The Liberal Democrat Party has supported the legalisation and taxation of Cannabis since 2015, making them the first mainstream British political party to do so.

Public support has also drifted more towards sympathy with hard-drug users in recent years, as mental health issues and the nature of addiction become better understood by the public.

Britain’s anti-drug policies and legislation may appear harsh to some, but there are many other countries that are far less tolerant. In Malaysia, China, Vietnam, Iran, Thailand, Saudi Arabia, Singapore, Indonesia and The Philippines, drug dealers can be (and often are) executed by the state.  

Despite these brutal punishments, drug trafficking, dealing and use still occurs in all these countries. According to the U.N., domestic drug abuse in Vietnam has risen sharply since the 1990’s, while a 2020 review found that mental health conditions, arising from chronic drug use, are a problem in Saudi Arabia.

In addition to heroin and opium use, Thailand is currently facing the rise of a popular street drug known as ‘Yaba’, which is a mixture of caffeine and methamphetamine.

The notion that harsher punishments for crimes will somehow eliminate those crimes from occurring is a faulty one. It has been tried – and has failed, many times throughout history. The death penalty for murder, for example, does not prevent murder.

Is the law effective? Yes and no. As with drugs themselves and basically everything else, it depends on the individual.

Preventing Drug Dealing/Use on the Premises

There are a number of preventative methods that a bar, pub, club or venue can take if it wants to actively discourage drug dealers. Door supervisors are the first line of defence against these activities, so it is of vital importance that they remain vigilant at all times.

Firstly, we advise that proprietors keep their venues clean and tidy, with security cameras in clear view. A drug dealer is probably looking for a place with lax security. If it looks like the management can’t be bothered to clean up at the end of the night, a drug dealer may well feel more confident about ‘setting up shop’ there.

Ensuring that all CCTV, alarms, and other security equipment is up-to-date and functioning well is also a great way to deter drug dealers. 

We also recommend putting up notices that drug dealing on the premises will not be tolerated under any circumstances.  The venue should create a drugs policy and make every employee (including door staff) aware of it. All signage should reflect this policy.

Joining a local ‘Pubwatch‘ scheme is a great way for venues to share intel on specific troublemakers and get a sense of how widespread the problem is in the local area.

It is advisable also to always refuse entry to any known or suspected drug dealers. This can be part of the venue’s drugs policy. For example, it can be venue policy that any patron caught dealing drugs on the premises may be the recipient of a ‘lifetime ban’ and reported to other venues as well.

We also suggest that all security operatives keep an eye out for signs of drug use. Signs of drug use can include payment with tightly wound banknotes (occasionally showing a small amount of powder or blood at the edges), traces of powder left on surfaces (particularly in restrooms), as well as other ‘tell-tale trash’ left behind by drug users, such as small ‘sealie’ bags, torn beermats, empty pill bottles and sweet or chewing gum wrappers.

If the toilets turn up incongruous items such as burned spoons or tinfoil, drinking straws, lighters, razor blades, make-up mirrors, small squares of cling film, syringes or discarded tubes of glue, the venue has probably been visited by a drug user. Surfaces that have been wiped entirely clean before closing time can also be a giveaway.

You may also be alert to the signs of a person using drugs at the venue. These can include the more obvious behaviours (vacant expression, a sense of the person not truly being ‘present’, bloodshot eyes, dilated pupils, excessive chattering, giggling or noise for example), to ordering excessive amounts of water, sporting white marks around the nostrils, and appearing to be either hyperactive or extremely lethargic.

If your venue or premises appears to have a serious problem with drug dealing and/or use, we recommend contacting local police or drug squads. If these problems persist, the venue could lose its license, or be closed entirely. More importantly, lives could even be at stake.

A police licensing officer who has been informed of a potential situation at the venue will be far more likely to show compassion and sympathy to a venue that reaches out for help than they will if they must investigate it of their own volition. Where possible, we advise security staff and venue proprietors to liaise with police at regular intervals.

Door searches, though not always popular, may also be necessary in the more severe cases.

Of course, all drug-related instances, even small ones, must be recorded in the venue’s incident books and, where appropriate, referred to police.

Stopping a drug deal may seem like a small victory. Indeed, many security operatives simply deem it ‘part of the job’ and don’t give it much attention beyond that. However, there is no such thing as an inconsequential action. As the zen proverb has it, “the man who would move a mountain begins by carrying away small stones”.

Each drug deal thwarted contributes toward making Britain’s streets, establishments, and businesses safer, which in turn helps to ensure the safety of people everywhere – and that, more than anything else, is the reason security operatives do what they do in the first place.

Source: Drug Dealers: Dealing with Drugs and Dealers – Working The Doors

Source: 20-Reasons-to-Vote-NO-in-2020-SAM-VERSION-Cannabis.pdf (saynopetodope.org.nz) May 2020

A meta-analysis of all studies worldwide showing association between marijuana use and schizophrenia:

Moore TH, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370:319–328.
http://dirwww.colorado.edu/alcohol/downloads/Cannabis_and_behavior.pdf

“There was an increased risk of any psychotic outcome in individuals who had ever used cannabis…with greater risk in people who used cannabis most frequently. There is now sufficient evidence to warn young people that using cannabis could increase their risk of
developing a psychotic illness later in life.”

The most recent study conducted in the United States (Columbia University, New York), showing a high risk (odds ratio, “OR”) for schizophrenia spectrum disorders, particularly in those who become cannabis-dependent:

Davis GP, Compton MT, Wang S, Levin FR, Blanco C. Association between cannabis use, psychosis, and schizotypal personality disorder: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Schizophr Res. 2013 Dec;151(1-3):197-202.
“There was a similar dose-response relationship between the extent of cannabis use and schizotypal personality disorder (OR=2.02 for lifetime cannabis use, 95% CI 1.69-2.42; OR=2.83 for lifetime cannabis abuse, 95% CI 2.33-2.43; OR=7.32 for lifetime cannabis dependence, 95% CI 5.51-9.72). Likelihood of individual schizotypal features increased significantly with increased extent of cannabis use in a dose-dependent manner.”

Studies that corrected for general genetic background effects and many non-cannabis environmental variables by comparing siblings. The risk ratios are somewhat lower than general population studies, because genetic predisposition is more or less controlled for:

McGrath J, Welham J, Scott J, Varghese D, Degenhardt L, Hayatbakhsh MR, Alati R, Williams GM, Bor W, Najman JM. Association between cannabis use and psychosis-related outcomes using sibling pair analysis in a cohort of young adults. Arch Gen Psychiatry. 2010; 67(5):440-7.
“Longer duration since first cannabis use was associated with multiple psychosis-related outcomes in young adults… the longer the duration since first cannabis use, the higher the risk of psychosis-related outcomes…
Compared with those who had never used cannabis, young adults who had 6 or more years since first use of cannabis (i.e., who commenced use when around 15 years or younger) were twice as likely to develop a nonaffective psychosis…
This study provides further support for the hypothesis that early cannabis use is a risk-modifying factor for psychosis-related outcomes in young adults.”

Giordano GN, Ohlsson H, Sundquist K, Sundquist J, Kendler KS. The association between cannabis abuse and subsequent schizophrenia: a Swedish national co-relative control study.
Psychol Med. 2014 Jul 3:1-8. [Epub ahead of print]
http://journals.cambridge.org/download.php?file=%2FPSM%2FS0033291714001524a.pdf&code=79f795824a92c8eead870197ef071dd8

“Allowing 7 years from initial CA registration to later diagnosis, the risk for schizophrenia in discordant full sibling pairs remained almost twofold….The results of this study therefore lend support to the etiologic hypothesis, that CA is one direct cause of later schizophrenia.”

Those diagnosed with schizophrenia who also use recreational drugs are much more likely to be violent, including those who use cannabis:

Fazel S, Långström N, Hjern A, Grann M, Lichtenstein P. Schizophrenia, substance abuse, and violent crime. JAMA. 2009 May 20;301(19):2016-23.
“The risk was mostly confined to patients with substance abuse comorbidity (of whom 27.6% committed an offense), yielding an increased risk of violent crime among such patients (adjusted OR, 4.4; 95% CI,3.9-5.0), whereas the risk increase was small in schizophrenia patients without substance abuse comorbidity (8.5% of whom had at least 1 violent offense; adjusted OR,1.2; 95% CI, 1.1-1.4; P<0.001 for interaction).”

Fazel S, Gulati G, Linsell L, Geddes JR, Grann M. Schizophrenia and violence: systematic review and meta-analysis. PLoS Med. 2009 Aug;6(8):e1000120. doi: 10.1371/journal.pmed.1000120. Epub 2009 Aug 11.
“The effect of comorbid substance abuse was marked with….. an OR of 8.9” (as compared to the general population)

Arseneault L, Moffitt TE, Caspi A, Taylor PJ, Silva PA. Mental disorders and violence in a total birth cohort: results from the Dunedin Study. Arch Gen Psychiatry. 2000;57(10):979-86.
“for having more than two of these disorders at once…..the OR (odds ratio for violence) was, …..for marijuana dependence plus schizophrenia spectrum disorder, 18.4”

Harris AW, Large MM, Redoblado-Hodge A, Nielssen O, Anderson J, Brennan J. Clinical and cognitive associations with aggression in the first episode of psychosis. Aust N Z J Psychiatry. 2010 Jan;44(1):85-93.
‘The use of cannabis with a frequency of more than fourfold in the previous month was the only factor that was found to be associated with serious aggression’

Self-report of psychotic symptoms by otherwise healthy users (12% to 15%):

Thomas H. A community survey of adverse effects of cannabis use. Drug Alcohol Depend. 1996 Nov;42(3):201-7.
“This survey estimates the frequency of various adverse effects of the use of the drug cannabis. A sample of 1000 New Zealanders aged 18-35 years were asked to complete a self-administered questionnaire on cannabis use and associated problems. The questionnaire was derived from criteria for the identification of cannabis abuse which are analagous to criteria commonly used to diagnose alcoholism. Of those who responded 38% admitted to having used cannabis. The most common physical or mental health problems, experienced by 22% of users were acute anxiety or panic attacks following cannabis use. Fifteen percent reported psychotic symptoms following use.”

Smith MJ, Thirthalli J, Abdallah AB, Murray RM, Cottler LB. Prevalence of psychotic symptoms in substance users: a comparison across substances. Compr Psychiatry. 2009 May-Jun;50(3):245-50. doi: 10.1016/j.comppsych.2008.07.009. Epub 2008 Sep 23.
“Among all users of substances without a diagnosis of abuse or dependence, cannabis users reported the highest prevalence of psychotic symptoms (12.4%).”

Barkus EJ, Stirling J, Hopkins RS, Lewis S.. Cannabis-induced psychosis-like experiences are associated with high schizotypy Psychopathology 2006;39(4):175-8.
“In the sample who reported ever using cannabis (72%) the means for the subscales from the CEQ were as follows: ……Psychotic-Like Experiences (12.98%).”

Rates of psychotic symptoms in those with cannabis dependence as compared to non-dependent users and nonusers:

Fergusson DM, Horwood LJ, Swain-Campbell NR. Cannabis dependence and psychotic symptoms in young people. Psychol Med. 2003 Jan;33(1):15-21.
“Young people meeting DSM-IV criteria for cannabis dependence had elevated rates of psychotic symptoms at ages 18 (rate ratio = 3.7; 95% CI 2.8-5.0; P < 0.0001) and 21 (rate ratio = 2.3; 95% CI 1.7-3.2; P < 0.0001).”

Smith MJ, Thirthalli J, Abdallah AB, Murray RM, Cottler LB. Prevalence of psychotic symptoms in substance users: a comparison across substances. Compr Psychiatry. 2009 May-Jun;50(3):245-50. doi: 10.1016/j.comppsych.2008.07.009. Epub 2008 Sep 23.
“more than half of the respondents who were dependent on cocaine (80%), cannabis (63.5%), amphetamines (56.1%), and opiates (53.1%) reported psychotic symptoms. Among all users of substances without a diagnosis of abuse or dependence, cannabis users reported the highest prevalence of psychotic symptoms (12.4%)……. There was also a marked increase in the risk for psychotic symptoms when dependence became moderate or severe for cannabis (OR=25.1, OR=26.8; respectively).”

Studies on the psychotomimetic properties of THC administered to healthy individuals in the clinic:

D’Souza DC, Perry E, MacDougall L, Ammerman Y, Cooper T, Wu YT, Braley G, Gueorguieva R, Krystal JH. The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology. 2004 Aug;29(8):1558-72.
“∆-9-THC (1) produced schizophrenia-like positive and negative symptoms; (2) altered perception;(3) increased anxiety; (4) produced euphoria; (5) disrupted immediate and delayed word recall, sparing recognition recall; (6) impaired performance on tests of distractibility, verbal fluency, and working memory (7) did not impair orientation; (8) increased plasma cortisol. These data indicate that D-9-THC produces a broad range of transient symptoms, behaviors, and cognitive deficits in healthy individuals that resemble some aspects of endogenous psychoses.”

Morrison PD, Nottage J, Stone JM, Bhattacharyya S, Tunstall N, Brenneisen R, Holt D, Wilson D, Sumich A, McGuire P, Murray RM, Kapur S, Ffytche DH. Disruption of frontal θ coherence by ∆9-tetrahydrocannabinol is associated with positive psychotic symptoms. Neuropsychopharmacology. 2011;;36(4):827-36.
“Compared with placebo, THC evoked positive and negative psychotic symptoms, as measured by the positive and negative syndrome scale (p<0.001)…… The results reveal that the pro-psychotic effects of THC might be related to impaired network dynamics with impaired communication between the right and left frontal lobes.”

Bhattacharyya S, Crippa JA, Allen P, Martin-Santos R, Borgwardt S, Fusar-Poli P, Rubia K, Kambeitz J, O’Carroll C, Seal ML, Giampietro V, Brammer M, Zuardi AW, Atakan Z, McGuire PK. Induction of psychosis by ∆9-tetrahydrocannabinol reflects modulation of prefrontal and striatal function during attentional salience processing. Arch Gen Psychiatry. 2012 Jan;69(1):27-36. doi: 10.1001/archgenpsychiatry.2011.161.
“Pairwise comparisons revealed that 9-THC significantly increased the severity of psychotic symptoms compared with placebo (P<.001) and CBD (P<.001).”,

Freeman D, Dunn G, Murray RM, Evans N, Lister R, Antley A, Slater M, Godlewska B, Cornish R, Williams J, Di Simplicio M, Igoumenou A, Brenneisen R, Tunbridge EM, Harrison PJ, Harmer CJ, Cowen P, Morrison PD. How Cannabis Causes Paranoia: Using the Intravenous Administration of ∆9-Tetrahydrocannabinol (THC) to Identify Key Cognitive Mechanisms Leading to Paranoia. Schizophr Bull. 2014 Jul 15. pii: sbu098. [Epub ahead of print]
“THC significantly increased paranoia, negative affect (anxiety, worry, depression, negative thoughts about the self), and a range of anomalous experiences, and reduced working memory capacity.”

For data on dose-response (a very large study by Zammit et al., and another by van Os et al.) and the greater risk for psychosis posed by high strength marijuana (DiForti et al.):

Zammit S, Allebeck P, Andreasson S, Lundberg I, Lewis G, 2002, Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ. 2002 Nov 23;325(7374):1199. http://www.bmj.com/content/325/7374/1199.full.pdf
“We found a dose dependent relation between frequency of cannabis use and risk of schizophrenia, with an adjusted odds ratio for linear trend across the categories of frequency of cannabis use used in this study of 1.2 (1.1 to 1.4, P < 0.001). The adjusted odds ratio for subjects with a history of heaviest use of cannabis ( > 50 occasions) was 3.1 (1.7 to 5.5)………………Cannabis use is associated with an increased risk of
developing schizophrenia, consistent with a causal relation. This association is not explained by use of other psychoactive drugs or personality traits relating to social integration.”

van Os J, Bak M, Hanssen M, Bijl RV, de Graaf R, Verdoux H. Cannabis use and psychosis: a longitudinal population-based study. Am J Epidemiol. 2002 Aug 15;156(4):319-27.
“…..further evidence supporting the hypothesis of a causal relation is demonstrated by the existence of a dose-response relation.. between cumulative exposure to cannabis use and the psychosis outcome……. About 80 percent of the psychosis outcome associated with exposure to both cannabis and an established vulnerability to psychosis was attributable to the synergistic action of these two factors. This finding indicates that, of the subjects exposed to both a vulnerability to psychosis and cannabis use, approximately 80 percent had the psychosis outcome because of the combined action of the two risk factors and only about 20 percent because of the action of either factor alone.”

DiForti M, Morgan C, Dazzan P, Pariante C, Mondelli V, Marques TR, Handley R, Luzi S, Russo M, Paparelli A, Butt A, Stilo SA, Wiffen B, Powell J, Murray RM. High-potency cannabis and the risk of psychosis. Br J Psychiatry. 2009,195(6):488-91.
“78% (n = 125) of the cases group preferentially used sinsemilla (skunk) compared with only 31% (n = 41) of the control group (unadjusted OR= 8.1, 95% CI 4.6–13.5). This association was only slightly attenuated after controlling for potential confounders (adjusted OR= 6.8, 95% CI 2.6–25.4)………. Our most striking finding is that patients with a first episode of psychosis preferentially used high-potency cannabis preparations of the sinsemilla (skunk) variety…… our results suggest that the potency and frequency of cannabis use may interact in further increasing the risk of psychosis.”

DiForti M, Marconi A, Carra E, Fraietta S, Trotta A, Bonomo M, Bianconi F, Gardner-Sood P, O’Connor J, Russo M, Stilo SA, Marques TR, Mondelli V, Dazzan P, Pariante C, David AS, Gaughran F, Atakan Z, Iyegbe C, Powell J, Morgan C, Lynskey M, Murray RM. Proportion of
patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psychiatry, online February 18, 2015, http://dx.doi.org/10.1016/S2215-0366(14)00117-5.
“In the present larger sample analysis, we replicated our previous report and showed that the highest probability to suffer a psychotic disorder is in those who are daily users of high potency cannabis. Indeed, skunk use appears to contribute to 24% of cases of first episode psychosis in south London. Our findings show the importance of raising awareness among young people of the risks associated with the use of high-potency cannabis. The need for such public education is emphasised by the worldwide trend of liberalisation of the legal constraints on cannabis and the fact that high potency varieties are becoming much more widely available.”

For data on percent of those with marijuana-induced psychosis who go on to receive a diagnosis of a schizophrenia spectrum disorder:

Arendt M, Mortensen PB, Rosenberg R, Pedersen CB, Waltoft BL. Familial predisposition for psychiatric disorder: comparison of subjects treated for cannabis-induced psychosis and schizophrenia. Arch Gen Psychiatry. 2008;65(11):1269-74. http://archpsyc.ama-assn.org/cgi/reprint/65/11/1269
“Approximately half of the subjects who received treatment of a cannabis induced psychosis developed a schizophrenia spectrum disorder within 9 years after treatment…… The risk of schizophrenia after a cannabis-induced psychosis is independent of familial predisposition……. cannabis-induced psychosis may not be a valid diagnosis but an early marker of schizophrenia……. Psychotic symptoms after cannabis
use should be taken extremely seriously.”

Niemi-Pynttäri JA, Sund R, Putkonen H, Vorma H, Wahlbeck K, Pirkola SP. Substance-induced psychoses converting into schizophrenia: a register-based study of 18,478 Finnish inpatient cases. J Clin Psychiatry. 2013 74(1):e94-9.
“Eight-year cumulative risk to receive a schizophrenia spectrum diagnosis was 46% for persons with a diagnosis of cannabis-induced psychosis ….. chances for amphetamine-, hallucinogen-, opioid-, sedative- and alcohol-induced (schizophrenia spectrum diagnoses) were 30%, 24%, 21%, and 5% respectively.”

For cause and effect (which comes first: psychosis or marijuana use):
Arseneault L, Cannon M, Poulton R, Murray R, Caspi A, Moffitt TE, 2002, Cannabis use in
adolescence and risk for adult psychosis: longitudinal prospective study.BMJ. 2002 Nov 23;325(7374):1212-3.
“Firstly, cannabis use is associated with an increased risk of experiencing schizophrenia symptoms, even after psychotic symptoms preceding the onset of cannabis use are controlled for, indicating that cannabis use is not secondary to a pre-existing psychosis. Secondly, early cannabis use (by age 15) confers greater risk for schizophrenia outcomes than later cannabis use (by age 18). Thirdly, risk was specific to cannabis use, as opposed to use of other drugs….”

Henquet C, Krabbendam L, Spauwen J, et al. Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ. 2005;330:11–15. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC539839/pdf/bmj33000011.pdf
“Exposure to cannabis during adolescence and young adulthood increases the risk of psychotic symptoms later in life. Cannabis use at baseline increased the cumulative incidence of psychotic symptoms at follow up four years later…but has a much stronger effect in those with evidence of predisposition for psychosis……….Predisposition for psychosis at baseline did not significantly predict cannabis use four years later..”

and also:

Kuepper R, van Os J, Lieb R, Wittchen HU, Höfler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study.BMJ. 2011 Mar 1;342: d738 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047001/pdf/bmj.d738.pdf
“In individuals who had no reported lifetime psychotic symptoms and no reported lifetime cannabis use at baseline, incident cannabis use over the period from baseline to T2 increased the risk of later incident psychotic symptoms over the period from T2 to T3 (adjusted odds ratio 1.9, 95% confidence interval 1.1 to 3.1; P=0.021)…………There was no evidence for self medication effects, as psychotic experiences at T2 did not predict incident cannabis use between T2 and T3 (0.8, 0.6 to 1.2; P=0.3).”

For data on those who quit using when psychotic symptoms develop (further evidence against self-medication):

Fergusson DM, Horwood LJ, Ridder EM. Tests of causal linkages between cannabis use and psychotic symptoms. Addiction. 2005;100(3):354-66.

For degree of risk relative to other drugs:

Niemi-Pynttäri JA, Sund R, Putkonen H, Vorma H, Wahlbeck K, Pirkola SP. Substance-induced psychoses converting into schizophrenia: a register-based study of 18,478 Finnish inpatient cases. J Clin Psychiatry. 2013 74(1):e94-9.
“Eight-year cumulative risk to receive a schizophrenia spectrum diagnosis was 46% for persons with a diagnosis of cannabis-induced psychosis ….. chances for amphetamine-, hallucinogen-, opioid-, sedative- and alcohol-induced (schizophrenia spectrum diagnoses) were 30%, 24%, 21%, and 5% respectively.”

Smith MJ, Thirthalli J, Abdallah AB, Murray RM, Cottler LB. Prevalence of psychotic symptoms in substance users: a comparison across substances. Compr Psychiatry. 2009 May-Jun;50(3):245-50. doi: 10.1016/j.comppsych.2008.07.009. Epub 2008 Sep 23.
“more than half of the respondents who were dependent on cocaine (80%), cannabis (63.5%), amphetamines (56.1%), and opiates (53.1%) reported psychotic symptoms. Among all users of substances without a diagnosis of abuse or dependence, cannabis users reported the highest prevalence of psychotic symptoms (12.4%)……. There was also a marked increase in the risk for psychotic symptoms when dependence became moderate or severe for cannabis (OR=25.1, OR=26.8; respectively).”

Another angle on the potential confound of self-medication: genetic predisposition for schizophrenia does not predict cannabis use:

Veling W, Mackenbach JP, van Os J, Hoek HW. Cannabis use and genetic predisposition for schizophrenia: a case-control study. Psychol Med. 2008 Sep;38(9):1251-6. Epub 2008 May 19.
“BACKGROUND: Cannabis use may be a risk factor for schizophrenia. RESULTS: Cannabis use predicted schizophrenia [adjusted odds ratio (OR) cases compared to general hospital controls 7.8, 95% confidence interval (CI) 2.7-22.6; adjusted OR cases compared to siblings 15.9 (95% CI 1.5-167.1)], but genetic predisposition for schizophrenia did not predict cannabis use [adjusted OR intermediate predisposition
compared to lowest predisposition 1.2 (95% CI 0.4-3.8)].”

For data on potential benefits of cessation:

González-Pinto A, Alberich S, Barbeito S, Gutierrez M, Vega P, Ibáñez B, Haidar MK, Vieta E, Arango C. Cannabis and first-episode psychosis: different long-term outcomes depending on continued or discontinued use. Schizophr Bull. 2011 May;37(3):631-9. Epub 2009 Nov 13. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080669/pdf/sbp126.pdf
“OBJECTIVE: To examine the influence of cannabis use on long-term outcome in patients with a first psychotic episode, comparing patients who have never used cannabis with (a) those who used cannabis before the first episode but stopped using it during follow-up and (b) those who used cannabis both before the first episode and during follow-up….. CONCLUSION: Cannabis has a deleterious effect, but stopping use after the first psychotic episode contributes to a clear improvement in outcome. The positive effects of stopping cannabis use can be seen more clearly in the long term.”

Kuepper R, van Os J, Lieb R, Wittchen HU, Höfler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study.BMJ. 2011 Mar 1;342: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047001/pdf/bmj.d738.pdf
“The finding that longer exposure to cannabis was associated with greater risk for persistence of psychotic experiences is in line with an earlier study showing that continued cannabis use over time increases the risk for psychosis in a dose-response fashion. This is also in agreement with the hypothesis that a process of sensitisation might underlie emergence and persistence of psychotic experiences as an indicator of liability to psychotic disorder.”

For data on marijuana use resulting in an earlier age of onset of schizophrenia (suggestive of causality), see Dragt et al. and a meta-analysis (see Large et al.,); also: a very extensive (676 schizophrena patients) and therefore more statistically powered analysis (see DeHert paper); two papers showing that the age-of-onset effect may be specific to those without a family history (see Scherr et al. and Leeson et al., papers); two studies that evaluate the age of onset specific to gender (Veen et al. and Compton et al. ) which is important because comparing across genders can be confounded by the greater tendency of males to engage in risky behavior (the conclusions are not the same in terms of gender; the gender distribution was slightly better in the Veen et al. study) and finally, two papers of relevance to specificity of age of onset effect to cannabis, a meta-analysis of published studies on age of onset that shows another drug of abuse (tobacco) is not associated with
a decreased age of onset (Myles et al.) and a study showing that ecstasy, LSD, stimulants, or sedatives did not have an effect to lower age of onset whereas cannabis use did (Barnes et al.) :

Large M, Sharma S, Compton MT, Slade T, Nielssen O. Cannabis Use and Earlier Onset of Psychosis: A Systematic Meta-analysis. Arch Gen Psychiatry. 2011 68(6):555-61. http://www.ncbi.nlm.nih.gov/pubmed/21300939
“The results of meta-analysis provide evidence for a relationship between cannabis use and earlier onset of psychotic illness, and they support the hypothesis that cannabis use plays a causal role in the development of psychosis in some patients. The results suggest the need for renewed warnings about the potentially harmful effects of cannabis.”

Dragt S, Nieman DH, Schultze-Lutter F, van der Meer F, Becker H, de Haan L, Dingemans PM, Birchwood M, Patterson P, Salokangas RK, Heinimaa M, Heinz A, Juckel G, Graf von Reventlow H, French P, Stevens H, Ruhrmann S, Klosterkötter J, Linszen DH; on behalf of the EPOS group.Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis. Acta Psychiatr Scand. 2011 Aug 29. doi: 10.1111/j.1600-0447.2011.01763.x. [Epub ahead of print]
“Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis. Objective: Numerous studies have found a robust association between cannabis use and the onset of psychosis. Nevertheless, the relationship between cannabis use and the onset of early (or, in retrospect, prodromal) symptoms of psychosis remains unclear. The study focused on investigating the relationship between cannabis
use and early and high-risk symptoms in subjects at clinical high risk for psychosis. Results: Younger age at onset of cannabis use or a cannabis use disorder was significantly related to younger age at onset of six symptoms (0.33 < r(s) < 0.83, 0.004 < P < 0.001). Onset of cannabis use preceded symptoms in most participants. Conclusion: Our results provide support that cannabis use plays an important role in the development of psychosis in vulnerable individuals.”

De Hert M, Wampers M, Jendricko T, Franic T, Vidovic D, De Vriendt N, Sweers K, Peuskens J, van Winkel R.Effects of cannabis use on age at onset in schizophrenia and bipolar disorder. Schizophr Res. 2011 Mar;126(1-3):270-6.

“BACKGROUND: Cannabis use may decrease age at onset in both schizophrenia and bipolar disorder, given the evidence for substantial phenotypic and genetic overlap between both disorders….RESULTS:… Both cannabis use and a schizophrenia diagnosis predicted earlier age at onset. There was a significant interaction between cannabis use and diagnosis, cannabis having a greater effect in bipolar patients….DISCUSSION:…. Our results suggest that cannabis use is associated with a reduction in age at onset in both schizophrenic and bipolar patients. This reduction seems more pronounced in the bipolar group than in the schizophrenia group: the use of cannabis reduced age at onset by on average 8.9 years in the bipolar group, as compared to an average predicted reduction of 1.5 years in the schizophrenia group.”

Scherr M, Hamann M, Schwerthöffer D, Froböse T, Vukovich R, Pit schel-Walz G, Bäuml J.. Environmental risk factors and their impact on the age of onset of schizophrenia: Comparing familial to non-familial schizophrenia. Nord J Psychiatry. 2011 Aug 31. [Epub ahead of print]
“Background and aims: Several risk factors for schizophrenia have yet been identified. The aim of our study was to investigate how certain childhood and adolescent risk factors predict the age of onset of psychosis in patients with and without a familial component (i.e. a relative with schizophrenia or schizoaffective disorder). Results: Birth complications and cannabis abuse are predictors for an earlier onset of schizophrenia in patients with non-familial schizophrenia. No environmental risk factors for an earlier age of onset in familial schizophrenia have been identified.”

Leeson VC, Harrison I, Ron MA, Barnes TR, Joyce EM. The Effect of Cannabis Use and Cognitive Reserve on Age at Onset and Psychosis Outcomes in First-Episode Schizophrenia. Schizophr Bull. 2011 Mar 9. [Epub ahead of print] http://schizophreniabulletin.oxfordjournals.org/content/early/2011/03/09/schbul.sbq153.full.pdf+html
“Objective: Cannabis use is associated with a younger age at onset of psychosis, an indicator of poor prognosis, but better cognitive function, a positive prognostic indicator. We aimed to clarify the role of age at onset and cognition on outcomes in cannabis users with first-episode schizophrenia as well as the effect of cannabis dose and cessation of use……Conclusions: Cannabis use brings forward the onset of psychosis in people who otherwise have good prognostic features indicating that an early age at onset can be due to a toxic action of cannabis rather than an intrinsically more severe illness. Many patients abstain over time, but in those who persist, psychosis is more difficult to treat.”

Veen ND, Selten JP, van der Tweel I, Feller WG, Hoek HW, Kahn RS. Cannabis use and age at onset of schizophrenia. Am J Psychiatry. 2004 Mar;161(3):501-6. http://ajp.psychiatryonline.org/cgi/reprint/161/3/501
“The results indicate a strong association between use of cannabis and earlier age at first psychotic episode in male schizophrenia patients.”

Compton MT, Kelley ME, Ramsay CE, Pringle M, Goulding SM, Esterberg ML, Stewart T, Walker EF. Association of pre-onset cannabis, alcohol, and tobacco use with age at onset of prodrome and age at onset of psychosis in first-episode patients. Am J Psychiatry. 2009 Nov;166(11):1251-7. Epub 2009 Oct 1. http://ajp.psychiatryonlie.org/cgi/reprint/166/11/1251
“Whereas classifying participants according to maximum frequency of use prior to onset (none, ever, weekly, or daily) revealed no significant effects of cannabis or tobacco use on risk of (editor’s note: “timing of”) onset, analysis of change in frequency of use prior to
onset indicated that progression to daily cannabis and tobacco use was associated with an increased risk of onset of psychotic symptoms. Similar or even stronger effects were observed when onset of illness or prodromal symptoms was the outcome. A gender-by-daily-cannabis use interaction was observed; progression to daily use resulted in a much larger increased relative risk of onset of psychosis in females than in males.”

Myles N, Newall H, Compton MT, Curtis J, Nielssen O, Large M. The age at onset of psychosis and tobacco use: a systematic meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2011 Sep 8. [Epub ahead of print]
“Unlike cannabis use, tobacco use is not associated with an earlier onset of psychosis.”

Barnes TR, Mutsatsa SH, Hutton SB, Watt HC, Joyce EM. Comorbid substance use and age at onset of schizophrenia. Br J Psychiatry. 2006 Mar;188:237-42. http://bjp.rcpsych.org/content/188/3/237.full.pdf+html
“Alcohol misuse and any substance use (other than cannabis use) were not significant in relation to age at onset….. those patients in the sample who reported that they had used cannabis had an earlier age at onset of psychosis than other patients who did not report cannabis use but who shared the same profile with regard to the other variables (e.g. comparing men who reported alcohol misuse and use of both cannabis and other drugs with men who had the same characteristics apart from the fact that they had not used cannabis).”

Data from other cultures

Sarkar J, Murthy P, Singh SP. Psychiatric morbidity of cannabis abuse. Indian J Psychiatry. 2003 Jul;45(3):182-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952166/pdf/IJPsy-45-182.pdf
“The paper evaluates the hypothesis that cannabis abuse is associated with a broad range of psychiatric disorders in India, an area with relatively high prevalence of cannabis use. Retrospective case-note review of all cases with cannabis related diagnosis over a 11 -year period, for subjects presenting to a tertiary psychiatric hospital in southern India was carried out. Information pertaining to sociodemographic, personal, social, substance-use related, psychiatric and treatment histories, was gathered. Standardized diagnoses were made according to Diagnostic Criteria for Research of the World Health Organization, on the basis of information available.Cannabis abuse is associated with
widespread psychiatric morbidity that spans the major categories of mental disorders under the ICD-10 system, although proportion of patients with psychotic disorders far outweighed those with non-psychotic disorders. Whilst paranoid psychoses were more prevalent, a significant number of patients with affective psychoses, particularly mania, was also noted.”

Rodrigo C, Welgama S, Gunawardana A, Maithripala C, Jayananda G, Rajapakse S. A retrospective analysis of cannabis use in a cohort of mentally ill patients in Sri Lanka and its implications on policy development. Subst Abuse Treat Prev Policy. 2010 Jul 8;5:16. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910013/pdf/1747-597X-5-16.pdf
”BACKGROUND: Several epidemiological studies have shown that cannabis; the most widely used illegal drug in the world, is associated with schizophrenia spectrum disorders (SSD)……. CONCLUSIONS: Self reported LTC (editor’s note: life time cannabis) use was strongly associated with being diagnosed with SSD (editor’s note: schizophrenia spectrum disorders”.

Population study showing change in incidence rate in young when drug laws are eased

Ajdacic-Gross V, Lauber C, Warnke I, Haker H, Murray RM, Rössler W. Changing incidence of psychotic disorders among the young in Zurich. Schizophr Res. 2007 Sep;95(1-3):9-18. Epub 2007 Jul 16.
“There is controversy over whether the incidence rates of schizophrenia and psychotic disorders have changed in recent decades. To detect deviations from trends in incidence, we analysed admission data of patients with an ICD-8/9/10 diagnosis of psychotic disorders in the Canton Zurich / Switzerland, for the period 1977-2005. The data was derived from the central psychiatric register of the Canton Zurich. Ex-post forecasting with ARIMA (Autoregressive Integrated Moving Average) models was used to assess departures from existing trends. In addition, age-period-cohort analysis was applied to determine hidden birth cohort effects. First admission rates of patients with psychotic
disorders were constant in men and showed a downward trend in women. However, the rates in the youngest age groups showed a strong increase in the second half of the 1990’s. The trend reversal among the youngest age groups coincides with the increased
use of cannabis among young Swiss in the 1990’s.”

Estimates of how many men aged 20-40 would have to avoid regular marijuana use for one year in order to prevent one case of schizophrenia in that same year (but for number relevant to a 20 year avoidance of schizophrenia by avoiding regular marijuana use during
20 years, divide by 20):

Hickman M, Vickerman P, Macleod J, Lewis G, Zammit S, Kirkbride J, Jones P. If cannabis caused schizophrenia–how many cannabis users may need to be prevented in order to prevent one case of schizophrenia? England and Wales calculations. Addiction. 2009;104(11):1856-61.

“In men the annual mean NNP (number needed to prevent) for heavy cannabis and schizophrenia ranged from 2800 [90% confidence interval (CI) 2018–4530] in those aged 20–24 years to 4700 (90% CI 3114–8416) in those aged 35–39”.

Key studies interpreted to diminish the connection between marijuana and schizophrenia:

Proal AC, Fleming J, Galvez-Buccollini JA, Delisi LE. A controlled family study of cannabis users with and without psychosis. Schizophr Res. 2014 Jan;152(1):283-8.
“The results of the current study, both when analyzed using morbid risk and family frequency calculations, suggest that having an increased familial risk for schizophrenia is the underlying basis for schizophrenia in these samples and not the cannabis use. While cannabismay have an effect on theage of onset of schizophrenia it is unlikely to be the cause of illness.”

Rebuttal: Miller CL. Caution urged in interpreting a negative study of cannabis use and schizophrenia. Schizophr Res. 2014 Apr;154(1-3):119-20.
“The morbid risk reported for the relatives of the non-cannabis-using patients (Sample 3) was actually 1.4-fold higher than the cannabis using patients (Sample 4), but the study did not have enough power to statistically confirm or refute a less than 2-fold difference. An increase in sample size would be required to do so, and if the observed difference were to be confirmed, it would explain not only why the Sample 4 data fits poorly with a multigene/small environmental impact model but also would give weight to the premise that cannabis use significantly contributes to the development of this disease.”

Power RA, Verweij KJ, Zuhair M, Montgomery GW, Henders AK, Heath AC, Madden PA, Medland SE, Wray NR, Martin NG. Genetic predisposition to schizophrenia associated with increased use of cannabis. Mol Psychiatry. 2014 Jun 24. doi: 10.1038/mp.2014.51. [Epub ahead of print] http://emilkirkegaard.dk/en/wp-content/uploads/Genetic%20predisposition%20to%20schizophrenia%20associated%20with%20increased%20use%20of%20cannabis.pdf
“Our results show that to some extent the association between cannabis and schizophrenia is due to a shared genetic aetiology across common variants. They suggest that individuals with an increased genetic predisposition to schizophrenia are
both more likely to use cannabis and to use it in greater quantities.”

Rebuttal: Had this paper been titled “The causal genes for schizophrenia have been discovered” it would never have been published. In the absence of a consistent finding of genes of major effect size for schizophrenia, this study of inconsistently associated genes of low effect size is meaningless.

Buchy L, Perkins D, Woods SW, Liu L, Addington J. Impact of substance use on conversion to psychosis in youth at clinical high risk of psychosis. Schizophrenia Res 156 (2-3): 277–280.
“Results revealed that low use of alcohol, but neither cannabis use nor tobacco use at baseline, contributed to the prediction of psychosis in the CHR sample”.
Rebuttal: The study was small in size and the age range of their subjects at study onset was large (12 to 31) which included both subjects that had not reached the peak age of risk for schizophrenia even by the end of the study as well as subjects who were well past the peak age of onset of schizophrenia. The fact that the study screened out psychotic individuals was problematic for the latter group, in that those who were most vulnerable to the psychosis inducing effects of cannabis would already have converted to psychosis by that age.

Overview of Key Public Health Issues Regarding the Mental Health Effects of Marijuana

For the monetary cost of schizophrenia to the U.S. annually ($63 billion in 2002 dollars):

Wu EQ, Birnbaum HG, Shi L, Ball DE, Kessler RC, Moulis M, Aggarwal J. The economic burden of schizophrenia in the United States in 2002. J Clin Psychiatry. 2005 Sep;66(9):1122-9.

For the trends in adolescent drug, alcohol and cigarette use, showing an upward tick in marijuana use as medical marijuana has become more prevalent, and that the mind-altering drug legal for adults (alcohol) is still more commonly used by teens than is marijuana:

Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2012). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2011. Ann Arbor, MI: Institute for Social Research, The University of Michigan.

For a summary of Sweden’s drug law experience:
Hallam C., 2010, Briefing paper 20, The Beckley Foundation: What Can We Learn from Sweden’s Drug Policy Experience? www.beckleyfoundation.org/pdf/BriefingPaper_20.pdf
“in the case of Sweden, the clear association between a restrictive drug policy and low levels of drug use is striking. In his foreword to the article on Sweden’s Successful Drug Policy, Antonio Maria Costa is frank enough to confess that, “It is my firm belief that the generally positive situation of Sweden is a result of the policy that has been applied to address the problem”.

For data showing the relationship between drug enforcement policies in Europe and drug use, such that Sweden has a zero tolerance policy on drugs and has one of the lowest rates of “last month use” in Europe (1%), 4-fold lower than the Netherlands and 7-fold lower than Spain and Italy, two countries that have liberalized their enforcement policies so that marijuana possession carries no substantive penalty.

European Monitoring Centre for Drugs and Addiction, 2012 Annual report
http://www.emcdda.europa.eu/attachements.cfm/att_190854_EN_TDAC12001ENC_.pdf

Source: Microsoft Word – 2015- Summary of literature on marijuana and psychosis.doc (momsstrong.org) January 2016

Alex Azar
Secretary of Health and Human Services
US Department of Health and Human Services
200 Independence Avenue SW
Washington D.C, 20201
November 5, 2019

Dear Secretary Azar:
This letter is to bring to your attention a study underway at the University of Washington referred to as the “Moms and Marijuana Study” and granted under the title: “Olfactory Activation and Brain Development in Infants with Prenatal Cannabis Exposure.” The Office of Human Research Protections issued a decision against opening a case on this research, and we are asking you, as the Secretary of Health and Human Services, to overturn that decision based on the scientific concerns we outline in this letter.

Women who are in their first trimester of a pregnancy, who are frequent users of marijuana for morning sickness, are being recruited. The study seeks to assess the damage marijuana prenatal exposure may have on the babies by means of various testing, including an MRI scan of the infants at six months of age. The recruited women will receive $300.00 + for their participation. The study is solely funded by NIDA. This study calls into question serious issues over human rights and raises ethical questions, including mandatory reporting pertaining to substance abuse in pregnancy. This open letter seeks to gather support from you in seeing that this study is re-evaluated at the federal level. The study’s website is at the following link: https://depts.washington.edu/klab/infoMM.html

We are of the view that the Kleinhans study does not meet the requirements set forth by the Office of Human Research Protections (https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr46/ ): “Subpart B presumption that pregnant women may be included in research, provided certain conditions are met. According to Subpart B, the permissibility of research with pregnant women hinges on a judgment of the potential benefits and risks of the research. Approval of proposed research carrying no “prospect of direct benefit” to the woman or fetus requires that the risk to the fetus be judged “not greater than minimal”. Fetal risk that exceeds that standard is permissible only when the proposed research offers a prospect of direct benefit to the pregnant woman, the fetus, or both.

Notably, if the proposed research does not fit within either of those two parameters, Subpart B offers an additional mechanism at the national level for approval by the Secretary of Health and Human Services.”

The federal definition of minimum risk reads: “That the magnitude and probability of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests.” Although the primary harm at issue is exposure to marijuana, the use of MRI or fMRI has not yet been proven safe for otherwise healthy infants, where an unknown risk would come with no benefit, as there is no diagnosis being sought. The UW study consent form reads on page 3:“There are no known side effects associated with MRI or fMRI when earphones are used to protect your hearing.” …. “There may be risks associated with the use of magnetic resonance which are not known at this time.” It is precisely questions about the potential for MRI risks that should be investigated in an animal model first. In principle, any study that recruits subjects and then tracks the consequences of drug transfer to a developing fetus should be carried out in animal models first, and not in humans until the animal results point towards safety. The evidence of decades of research on marijuana in pregnancy does not point to safety but rather to risk and harm.

Two basic principles in bioethics are relied upon to determine the merit of research that involves human subjects: Is the study necessary and can the research be done without the use of human subjects? There now exists a significant body of scientific evidence that warrants and justifies warning women not to use marijuana products at pre-conception, while pregnant, or breast-feeding. The University of Washington study is not necessary to conclude that marijuana use is associated with risk to the child (and also the mother). The National Academies, a lead authority, concluded in a scientific literature review in 2017: There is substantial evidence of a statistical association between maternal cannabis smoking and lower birth weight of the offspring. Studies have already shown that prenatal use is associated with a 50 percent increased likelihood of low birth weight. The Surgeon General’s advisory of August 29, 2019 is also relied upon here. What is the “necessity” that this study addresses? The conclusion has already been made by the findings of science – pregnant women should refrain from marijuana use in order to protect the life and health of their child.

Yet, in spite of existing scientific literature of concern, a highly misleading recruitment statement appears on the University of Washington study’s website introductory page: “We do not expect to find anything of medical concern during the infant MRI scans…If you’re interested in helping us learn more about whether cannabis is safe to use for morning sickness, click the Sign Up button and let us know!” Their lack of concern about the potential for adverse medical outcomes directly contradicts the findings of Grewen et al. (2015) which similarly evaluated postnatal outcomes using MRI scans on infants that had been exposed to marijuana in utero. As compared to controls, the exposed infants showed hypoconnectivity between brain regions: ” Marijuana-specific differences were observed in insula and three striatal connections: anterior insula–cerebellum, right caudate–cerebellum, right caudate–right fusiform gyrus/inferior occipital, left caudate–cerebellum. +MJ neonates had hypo-connectivity in all clusters compared with −MJ and CTR groups.” While an imperfect study because the cases included a proportion of women in the case group who used not only marijuana but also alcohol, tobacco, opiates and SSRIs, one of the two control groups was matched to the cases for use of those drugs, while the other was completely drug free. Notably, work in an animal model by Tortoriello et al. (2014) presents a plausible mechanism for the observed effect of marijuana seen between cases and controls. The combined evidence points towards harm, and confirmation could easily be sought in an animal model that parallels the intent of the University of Washington study.

Furthermore, the ethics are clearly different between the Kleinhans et al. and Grewen et al. studies, because unlike the protocol for the former, the study of Grewen et al. did not recruit women while the fetus was developing but recruited shortly before or after the time of birth. Being unaware of marijuana use until the time of birth, the researchers could not intervene to encourage abstinence for the sake of the fetus, whereas the University of Washington team could intervene, but their protocols do not allow them to. As a further point of distinction, the University of Washington protocol states that infants enrolled in the study will be screened and excluded if they have been in an NICU for 24 hours. This will, for obvious reasons, result in a biased outcome in reporting overall harm from marijuana use during pregnancy.

Typical morning sickness affects up to 91% of pregnancies (Castillo and Phillippi, 2015), and is regarded by many medical practitioners as being a reflex protecting against consumption of dangerous foods or beverages, as well as a sign of a healthy pregnancy because the absence of morning sickness is associated with a higher rate of miscarriage (reviewed by Sherman and Flaxman, 2002). The rare condition when morning sickness becomes pathologic, hyperemesis gravidarum, affects on average 1.1% of pregnancies, and is defined as a loss of 5% or more of the pre-pregnancy weight (Castillo and Phillippi, 2015). Maintenance of fluid and electrolyte balance may become problematic in this situation and pharmacologic intervention may become necessary, both for the health of the mother and the baby. To date, the serious documented outcomes include an increased risk for preterm births and low birth weight (Dodds et al., 2006).

Thus, if the Kleinhans study were to be proposing to recruit only those with hyperemesis gravidarum, the ethics might be more favorable. They would, however, have to exclude women whose marijuana use may have triggered the hyperemesis, which may occur in a subset of pregnant users (Alaniz et al., 2015). The study recruitment website is definitely remiss in not making that possibility clear to those interested in enrolling, and the research protocol describes no effort to ascertain if marijuana might be triggering hyperemesis in their study subjects.

In summary, there is already sufficient scientific evidence to answer the question as to whether or not marijuana is safe to use for typical morning sickness. That answer is no. Please see additional references for numerous research publications showing harm at the end of this letter.
Complaints have been filed with NIDA, The University of Washington, The World Medical Association regarding the Helsinki Declaration, The Office of Human Research Protections, and two doctors have filed a human rights complaint on behalf of the children involved. Complaint documents will be forwarded on request.

Thank you for your time in reviewing this serious situation.

Best regards,
Pamela McColl
Child Rights Activist
pjmccoll@shaw.ca

and

Christine L. Miller, Ph.D.
Neuroscientist
MillerBio
6508 Beverly Rd
Baltimore, Maryland 21239
cmiller@millerbio.com

et al.

Correspondence with the OHRP in regards to the University of Washington study began in September
of 2019. On October an email was received from the OHRP to Pamela McColl:
October 25, 2019

Hello,
OHRP has reviewed the study and will not be opening a case.
Sincerely,
Division of Compliance Oversight OHRP

September 25, 2019
“OHRP is now reviewing your complaint and this study. We are currently gathering the information about the research being conducted before a full review is started. Once OHRP completes a full review of the study, the research conducted and the study’s approval process, we will contact you with our findings. Please remember, this does not mean you can’t contact OHRP again before we finish the full review. You can contact us using this email address to update your complaint at any time.
Thank-you,
Division of Compliance Oversight (OHRP)

September 17, 2019
Thank you for contacting the Office for Human Research Protections (OHRP). OHRP has responsibility for oversight of compliance with the U.S. Department of Health and Human Services (HHS) regulations for the protection of human research subjects (see 45 CFR Part 46 at
www.hhs.gov/ohrp/regulations-and-policy/guidance/index.html

In carrying out this responsibility, OHRP reviews allegations of noncompliance involving human subject research projects conducted or supported by HHS or that are otherwise subject to the regulations, and determines whether to conduct a for-cause compliance evaluation. For further details see OHRP’s guidance, “Compliance Oversight Procedures for Evaluating Institutions,” at www.hhs.gov/ohrp/compliance-and-reporting/evaluating-institutions/index.html.

OHRP has jurisdiction only if the allegations involve human subject research (a) conducted or supported by HHS, or (b) conducted at an institution that voluntarily applies its Assurance of Compliance to all research regardless of source of support. Since this requirement appears to be met by the circumstances described in your email, OHRP appears to have jurisdiction.
Sincerely,
Division of Compliance Oversight
cc. Surgeon General Jerome Adams
cc. Director NIDA Dr. Nora Volkow

In-text citations:
Alaniz VI, Liss J, Metz TD, Stickrath E. Cannabinoid hyperemesis syndrome: a cause of refractory nausea and vomiting in pregnancy. Obstet Gynecol. 2015 Jun;125(6):1484-6.
Castillo MJ, Phillippi JC. Hyperemesis gravidarum: a holistic overview and approach to clinical assessment and management. J Perinat Neonatal Nurs. 2015;29(1):12-22.
Dodds L, Fell DB, Joseph KS, Allen VM, Butler B. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol. 2006;107(2, pt 1):285–292.
Grewen K, Salzwedel AP, Gao W. Functional Connectivity Disruption in Neonates with Prenatal Marijuana Exposure. Front Hum Neurosci. 2015;9:601.
Sherman PW, Flaxman SM. Nausea and vomiting of pregnancy in an evolutionary perspective. Am J Obstet Gynecol. 2002;186(5 Suppl Understanding):S190-7.
The National Academies of Sciences, Engineering, and Medicine, 2017, The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. National Academies Press, Washington, D.C. 20001
Tortoriello G, et al. Miswiring the brain: Δ9-tetrahydrocannabinol disrupts cortical development by inducing an SCG10/stathmin-2 degradation pathway. EMBO J. 2014;33(7):668-85.

Additional references on specific neonatal outcomes:
Lower birth weight, animal studies
Benevenuto SG et al., Recreational use of marijuana during pregnancy and negative gestational and fetal outcomes: An experimental study in mice. Toxicology. 2017;376:94-101.
“Five minutes of daily (low dose) exposure during pregnancy resulted in reduced birthweight…..females from the Cannabis group presented reduced maternal net body weight gain, despite a slight increase in their daily food intake compared to the control group”

Lower birth weight, human studies
Gunn,JKL, Rosales CB, Center KE, Nunez A, Gibson SJ, Christ C, and Ehiri EJ. Prenatal exposure to cannabis and maternal and child health outcomes: A systematic review and meta-analysis. BMJ Open 2016; 6(4):e009986.
“Infants exposed to cannabis in utero had a decrease in birth weight (low birth weight pOR=1.77: 95% CI 1.04 to 3.01; pooled mean difference (pMD) for birth weight=109.42 g: 38.72 to 180.12) compared with infants whose mothers did not use cannabis during pregnancy. Infants exposed to cannabis in utero were also more likely to need placement in the neonatal intensive care unit compared with infants whose mothers did not use cannabis during pregnancy (pOR=2.02: 1.27 to 3.21).”
Brown SJ, Mensah FK, Ah Kit J, Stuart-Butler D, Glover K, Leane C, Weetra D, Gartland D, Newbury J, Yelland J. Use of cannabis during pregnancy and birth outcomes in an Aboriginal birth cohort: a crosssectional, population-based study. BMJ Open. 2016;6(2):e010286.
“Controlling for education and other social characteristics, including stressful events/social health issues did not alter the conclusion that mothers using cannabis experience a higher risk of negative birth outcomes (adjusted OR for odds of low birth weight 3.9, 95% CI 1.4 to 11.2).”
Fergusson, D. M., L. J. Horwood, and K. Northstone. 2002. Maternal use of cannabis and pregnancy outcome. British Journal of Obstetrics and Gynaecology 109(1):21–27.
“Over 12,000 women expecting singletons at 18 to 20 weeks of gestation who were enrolled in the Avon Longitudinal Study of Pregnancy and Childhood……the babies of women who used cannabis at least once per week before and throughout pregnancy were 216g lighter than those of non-users.”

Preterm birth, animal studies
Wang H, Xie H, Dey SK. Loss of cannabinoid receptor CB1 induces preterm birth. PLoS One. 2008;3(10):e3320.
“CB1 deficiency altering normal progesterone and estrogen levels induces preterm birth in mice…. CB1 regulates labor by interacting with the corticotrophin-releasing hormone-driven endocrine axis.”

Preterm birth, human studies
Luke S, Hutcheon J, Kendall T. Cannabis Use in Pregnancy in British Columbia and Selected Birth Outcomes. J Obstet Gynaecol Can. 2019;41(9):1311-1317.
“Using cannabis in pregnancy was associated with a 47% increased risk of SGA (adjusted OR 1.47; 95% CI 1.33–1.61), a 27% increased risk of spontaneous preterm birth (adjusted OR 1.27; 95% CI 1.14–1.42), and a 184% increased risk of intrapartum stillbirth (adjusted HR [aHR] 2.84; 95% CI 1.18–6.82).”
Corsi DJ, Walsh L, Weiss D, Hsu H, El-Chaar D, Hawken S, Fell DB, Walker M. Association Between Selfreported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal Outcomes. JAMA. 2019;322(2):145-152.
“In a cohort of 661 617 women…. The crude rate of preterm birth less than 37 weeks’ gestation was 6.1%among women who did not report cannabis use and 12.0% among those reporting use in the unmatched cohort (RD, 5.88% [95%CI, 5.22%-6.54%]). In the matched cohort, reported cannabis exposure was significantly associated with an RD of 2.98%(95%CI, 2.63%-3.34%) and an RR of 1.41 (95% CI, 1.36-1.47) for preterm birth. Compared with no reported use, cannabis exposure was significantly associated with greater frequency of small for gestational age (third percentile, 6.1% vs 4.0%; RR, 1.53 [95%CI, 1.45-1.61]), placental abruption (1.6%vs 0.9%; RR, 1.72 [95% CI, 1.54-1.92]), transfer to neonatal intensive care (19.3%vs 13.8%; RR, 1.40 [95%CI, 1.36-1.44]), and 5-minute Apgar score less than 4 (1.1% vs 0.9%; RR, 1.28 [95%CI, 1.13-1.45]).”
Saurel-Cubizolles MJ, Prunet C, Blondel B. Cannabis use during pregnancy in France in 2010. BJOG. 2014;121(8):971-7.
“Cannabis users had higher rates of spontaneous preterm births: 6.4 versus 2.8%, for an adjusted odds ratio (aOR) of 2.15 (95% CI 1.10–4.18).”
Leemaqz SY, Dekker GA, McCowan LM, Kenny LC, Myers JE, Simpson NA, Poston L, Roberts CT;

SCOPE Consortium. Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common late pregnancy complications. Reprod Toxicol. 2016;62:77-86. “continued maternal marijuana use at 20 weeks’ gestation was associated with” spontaneous preterm birth “independent of cigarette smoking status [adj OR2.28 (95% CI:1.45–3.59)] and socioeconomic index (SEI) [adj OR 2.17 (95% CI:1.41–3.34)]. When adjusted for maternal age, cigarette smoking, alcohol and SEI, continued maternal marijuana use at 20 weeks’ gestation had a greater effect size [adj OR 5.44 (95% CI 2.44–12.11)].”

Impacts on the neonatal immune system, animal study
Zumbrun EE et al. Epigenetic Regulation of Immunological Alterations Following Prenatal Exposure to Marijuana Cannabinoids and its Long Term Consequences in Offspring. J Neuroimmune Pharmacol. 2015; 10(2):245-54.
“Data from various animal models suggests that in utero exposure to cannabinoids results in profound T cell dysfunction and a greatly reduced immune response to viral antigens

Impacts on cortical wiring and development, animal studies
Tortoriello G, et al. Miswiring the brain: Δ9-tetrahydrocannabinol disrupts cortical development by inducing an SCG10/stathmin-2 degradation pathway. EMBO J. 2014;33(7):668-85.
“Here, we show that repeated THC exposure disrupts endocannabinoid signaling, particularly the temporal dynamics of CB1 cannabinoid receptor, to rewire the fetal cortical circuitry….these data highlight the maintenance of cytoskeletal dynamics as a molecular target for cannabis”
DiNieri JA, Wang X, Szutorisz H, Spano SM, Kaur J, Casaccia P, Dow-Edwards D, Hurd YL. Maternal cannabis use alters ventral striatal dopamine D2 gene regulation in the offspring. Biol Psychiatry. 2011 Oct 15;70(8):763-9.
“we exposed pregnant rats to THC and examined the epigenetic regulation of the NAc Drd2 gene in their offspring at postnatal day 2, comparable to the human fetal period studied, and in adulthood…. Decreased Drd2 expression was accompanied by reduced D2R binding sites and increased sensitivity to opiate reward in adulthood”
Rodríguez de Fonseca F, Cebeira M, Fernández-Ruiz JJ, Navarro M, Ramos JA. Effects of pre- and perinatal exposure to hashish extracts on the ontogeny of brain dopaminergic neurons. Neuroscience. 1991;43(2-3):713-23.
“Perinatal exposure to cannabinoids altered the normal development of nigrostriatal, mesolimbic and tuberoinfundibular dopaminergic neurons, as reflected by changes in several indices of their activity”.

Impacts on cortical wiring and development, human studies
Grewen K, Salzwedel AP, Gao W. Functional Connectivity Disruption in Neonates with Prenatal Marijuana Exposure. Front Hum Neurosci. 2015;9:601.

“+MJ (marijuana-exposed) neonates had hypo-connectivity in all clusters compared with –MJ (marijuana unexposed) and CTR (control) groups. Altered striatal connectivity to areas involved in visual spatial and motor learning, attention, and in fine-tuning of motor outputs
involved in movement and language production may contribute to neurobehavioral deficits reported in this at-risk group. Disrupted anterior insula connectivity may contribute to altered integration of interoceptive signals with salience estimates, motivation, decision-making, and later drug use.”
El Marroun H, Tiemeier H, Franken IH, Jaddoe VW, van der Lugt A, Verhulst FC, Lahey BB, White T. Prenatal Cannabis and Tobacco Exposure in Relation to Brain Morphology: A Prospective Neuroimaging Study in Young Children. Biol Psychiatry. 2016;79(12):971-9.
“prenatal cannabis exposure was associated with differences in cortical thickness….. it may be possible that the frontal cortex in cannabis-exposed children undergoes altered neurodevelopmental maturation (i.e., having differences in cortical trajectories) as compared with
nonexposed control subjects”
Wang X, Dow-Edwards D, Anderson V, Minkoff H, Hurd YL. In utero marijuana exposure associated with abnormal amygdala dopamine D2 gene expression in the human fetus. Biol Psychiatry. 2004; 56:909–915.
“Adjusting for various covariates, we found a specific reduction, particularly in male fetuses, of the D(2) mRNA expression levels in the amygdala basal nucleus in association with maternal marijuana use. The reduction was positively correlated with the amount of maternal marijuana intake during pregnancy.”

Received by email

The 2018 Monitoring the Future College Students and Young Adults survey shows trends in the use of marijuana, alcohol, nicotine, and synthetic drugs in college students and non-college peers.

 

Marijuana Use

Annual Marijuana Use at Historic Highs among College and Non-College Peers*
Marijuana use is nearly the same for college students and their non-college peers at about 43%. This is approximately a 7% increase over five-years for college students. These rates for both groups are the highest in 35 years.

Daily/Near Daily Use** of Marijuana Twice as High among Non-College Group
Approximately one in nine non-college respondents reporting daily or near daily use, (11.1%) compared to about one in 17 college students (5.9%).

** Used on 20 or more occasions in the past 30 days

Past Month Nicotine Vaping Doubles Among College Students

This jump is among the greatest one-year increase seen for any substance in the history of the survey.
Between 2017 and 2018, nicotine vaping increased in college students from 6.1% to 15.5% and from 7.9% to 12.5% in non-college adults. 

Rx Drug Misuse has Mixed Results

Rx Opioid Misuse: Significant Five Year Drop in Both Groups
Past year misuse of prescriptions opioids dropped from 5.4% in 2013 to 2.7% among college students and from 9.6% in 2013 to 3.2% among non-college adults.

Adderall® Misuse: Significant Gender Differences
Past year misuse rates of Adderall® were 14.6% among college men and 8.8% among college women.  Rates were higher, however, in non-college women than in non-college men (10.1% and 5.3% respectively).

Overall Adderall® misuse is higher among college students (11.1%) than their non-college peers (8.1%)

Binge Drinking (five or more drinks in a row in the past two weeks) Fell Below 30% for the First Time among College Students

In 2018, binge drinking declined among college students (28%) and non-college adults (25%).

*Please note, the college-age adults are ages 19-22.

Source: Drug and Alcohol Use in College-Age Adults in 2018 | National Institute on Drug Abuse (NIDA) (nih.gov) September 2019

Nearly 10% of cannabis users in the United States report using it for medicinal purposes.
As of August 2019, 33 states and the District of Columbia have initiated policies allowing the use of cannabis or cannabinoids for the management of specific medical conditions.
Yet, the federal government still classifies cannabis as illegal, complicating its medical use and research into its effectiveness as a treatment for the various conditions purported to benefit from cannabis pharmacotherapy. Because of this conflict and restrictions on cannabis research, evidence of the efficacy of cannabis to manage various diseases is often lacking.

This article updates a review published in the June 23, 2015, issue of JAMA2 and describes newer evidence regarding what is known and not known about the efficacy of cannabis and cannabinoids for managing various conditions.

Indications for Therapeutic Use Approved by the US Food and Drug Administration
Cannabis has numerous cannabinoids, the most notable being tetrahydrocannabinol, which accounts for its psychoactive effects. Individual cannabinoids have unique pharmacologic profiles enabling drug development to manage various conditions without having the cognitive effects typically associated with cannabis.

Only a few cannabinoids have high-quality evidence to support their use and are approved for medicinal use by the US Food and Drug Administration (FDA). The cannabinoids dronabinol and nabilone were approved by the FDA for chemotherapy-induced nausea and vomiting in 1985, with dronabinol gaining an additional indication for appetite stimulation in conditions that cause weight loss, such as AIDS, in 1992. Recently, a third cannabinoid, cannabidiol (CBD), was approved by the FDA for the management of 2 forms of pediatric epilepsy, Dravet syndrome and Lennox-Gastaut syndrome, based on the strength of positive randomized clinical trials (RCTs).

Other Medical Indications
Cannabinoids are often cited as being effective for managing chronic pain. The National Academies of Science, Engineering, and Medicine examined this issue and found that there was conclusive or substantial evidence that cannabis or cannabinoids effectively managed chronic pain, based on their expert committee’s assessment that the literature on this topic had many supportive findings from good-quality studies with no credible opposing findings.

The panel relied on a single meta-analysis of 28 studies, few of which were from the United States, that assessed a variety of diseases and compounds. Although they concluded that cannabinoids effectively managed pain, the CIs associated with these findings were large, suggesting unreliability in the meta-analysis results.
A more recent meta-analysis of 91 publications found cannabinoids to reduce pain 30% more than placebo (odds ratio, 1.46 [95% CI, 1.16 1.84]), but had a number needed to treat for chronic pain of 24 (95% CI, 15-61) and a number needed to harm of 6 (95% CI, 5-8).While a moderate level of evidence supports these recommendations, most studies of the efficacy of cannabinoids on pain are for neuropathic pain, with relatively few high-quality studies examining other types of pain. Taken together, at best, there is only inconclusive evidence that cannabinoids effectively manage chronic pain, and large numbers of patients must receive treatment with cannabinoids for a few to benefit, while not many need to receive treatment to result in harm.
There is strong evidence to support relief of symptoms of muscle spasticity resulting from multiple sclerosis from cannabinoids as reported by patients, but the association is much weaker when outcomes are measured by physicians. There is insufficient evidence to support or refute claims that cannabinoids provide relief for spinal cord injury–related muscle spasms.

Recent Clinical Trials
Two multicenter, international trials with substantial numbers of patients (n = 120 and n = 171) demonstrated the efficacy of CBD as an add-on drug to manage some seizure disorders. Over 14 weeks, 20mg/kg of CBD significantly reduced the median frequency of convulsive seizures in children and young adults with Dravet syndrome as well as the estimated median difference in monthly drop seizures between CBD and placebo in patients with Lennox-Gastaut syndrome. Although promising, these results were found in relatively uncommon disorders and the studies were limited by the use of subjective end points and incomplete blinding that is typical of cannabinoid studies because these drugs have readily identifiable side effects.
Numerous other medical conditions, including Parkinson disease, posttraumatic stress disorder, and Tourette syndrome, have a hypothetical rationale for the use of cannabis or cannabinoids as pharmacotherapy based on cannabinoid effects on spasticity, anxiety, and density of cannabinoid receptors in areas implicated in development of tics, such as the basal ganglia and cerebellum. The strength of the evidence supporting the use of cannabinoids for these diseases is weak because most studies of patients with these diseases have been small, often uncontrolled, or crossover studies.

Few pharmaceutical companies are conducting cannabinoid trials. Thus, it is not likely that additional cannabinoids will be approved by the FDA in the near future. Public interest in cannabis and cannabinoids as pharmacotherapy continues to increase, as does the number of medical conditions for which patients are utilizing cannabis and CBD, despite insufficient evidence to support this trend.

Neurologic Adverse Effects Are Better Defined Than Physical Adverse Effects
Acute cannabis use is associated with impaired learning, memory, attention, and motor coordination, areas that can affect important activities of daily living, such as driving. Acute cannabis use can also affect judgment, potentially resulting in users making risky decisions that they would not otherwise make. While there is consensus that acute cannabis use results in cognitive deficits, residual cognitive effects persisting after acute intoxication are still debated, especially for individuals who used cannabis regularly as adolescents.

Chronic cannabis use is associated with an increased risk of psychiatric illness and addiction. There is a significant association— possibly a causal relationship—between cannabis use and the development of psychotic disorders, such as schizophrenia, particularly among heavy users. Chronic cannabis use can lead to cannabis use disorder (CUD) and contributes to impairment in work, school, and relationships in up to 31% of adult users.  Regular cannabis use at levels associated with CUD (near-daily use of more than one eighth ounce of cannabis per week) is associated with worsening functional status, including lower income, greater need for socio-economic assistance, criminal behavior, unemployment, and decreased life satisfaction.

Cannabis use is associated with adverse perinatal outcomes as well; a 2019 study showed the crude rate of preterm birth was 12.0% among cannabis users and 6.1% among nonusers (risk difference, 5.88% [95% CI, 5.22%-6.54%]).

Inadequate Evidence Supporting the Use of Cannabinoids for Many Medical Conditions
The quality of the evidence supporting the use of cannabinoids is suboptimal. First, studies assessing pain and spasticity are difficult to conduct, in part because of heterogeneity of the outcome measures used in these studies. Second, most RCTs that have evaluated cannabinoid clinical outcomes were small, with fewer than 100 participants in each, and small trials may overestimate treatment effects. Third, the timeframe for most studies is too short to assess the long-term effects of these medications. Fourth, tolerance, withdrawal, and potential for drug-drug interactions may affect the usefulness of cannabis, and these phenomena are not well understood for cannabinoids.

The lack of high-quality evidence results in outsized claims of the efficacy of cannabinoids for numerous medical conditions. There is a need for well-designed, large, multisite RCTs of cannabis or cannabinoids to resolve claims of efficacy for conditions for which there are claims of efficacy not supported by high quality evidence, such as pain and spasticity.

Conclusions
Insufficient evidence exists for the use of medical cannabis for most conditions for which its use is advocated. Despite the lack of evidence, various US state governments have recommended cannabis for the management of more than 50 medical conditions. Physicians may be appropriately reticent to recommend medical cannabis for their patients because of the limited scientific evidence supporting its use or because cannabis remains illegal in federal law. Cannabis is useful for some conditions, but patients who might benefit may not get appropriate treatment because of insufficient awareness regarding the evidence supporting its use or confusion from federal law deeming cannabis illegal.

Source: Medical Use of Cannabis in 2019 | Clinical Pharmacy and Pharmacology | JAMA | JAMA Network August 2019

INTRODUCTION

In 2013, Uruguay became the first country in fully regulating the marijuana market that now operates under state control.

In a Washington Post feature article on Uruguay’s cannabis laws, they reported that Uruguay is socially liberal and has a wide separation of church and state. Gambling and prostitution are legal and regulated. Uruguay is also the only Latin American nation outside Cuba that has broadly legalised abortion, and it was one of the first to recognize civil unions and adoption by same-sex couples. Uruguay also is accustomed to relatively high levels of regulation and a big state role in the economy, with an array of government-owned banks, gas stations and utilities. Over the years, activists began to argue: Why not weed?

As early as 1974, Uruguay decriminalised possession of “a minimum quantity [of illicit substances], intended solely for personal use.” Exactly what constituted a “minimum quantity” was never clarified, giving judges broad discretion in its interpretation.

The initiative of marijuana regulation was by the then president José Mujica. Lawmakers in Uruguay (population: 3.3m) signed the country’s cannabis bill into law in December 2013 and pharmacies began selling two strains of legal marijuana cultivated by two government-authorised firms in July 2017.

The text of the law expresses its goals through three main objectives, which included reducing drug trafficking-related violence by taking cannabis off the black market, and promoting public health through education and prevention campaigns, thereby “minimising the risks and reducing the harm of cannabis use”.

Uruguay was the first country to leave behind the global ban on non-medical cannabis that began with the United Nations’ 1961 Single Convention on Narcotic Drugs, and despite repeated criticisms from the International Narcotics Control Board (INCB), as in the Board’s report for 2016, which states:

The Board notes the continued implementation by the Government of Uruguay of measures aimed at creating a regulated market for the non-medical use of cannabis… [T]he Board wishes to reiterate its position that such legislation is contrary to the provisions of the international drug control conventions… according to which States parties are obliged to ‘limit exclusively to medical and scientific purposes the production, manufacture, export, import, distribution of, trade in, use and possession of drugs.’

Concerned that their policy would come under intense scrutiny from their neighbours and from the broader international community, Uruguayan authorities deliberately opted for a strict approach to regulation, such as a user registry and monthly sales limits.

In an attempt to reassure the international public opinion, President José Mujica, said that his government would not allow unlimited use of marijuana and illicit drug dealing: “And if somebody buys 20 marijuana cigarettes, he will have to smoke them. He won’t be able to sell them“.

And in order to convince the majority of the Uruguayan population, the President Mujica promised to launch at the same time “a campaign aimed at young people on how to consume marijuana. Avoid, for example, to smoke to not damage the lungs but inhale or consume it with food“.

In response to public opposition, the Open Society Foundation headed by the financier George Soros announced the launch of a massive media campaign across the nation to manipulate the public consensus. Time magazine (5 Aug 2013) reported that “a massive media campaign, with television ads funded partly by Soros’ Open Society Foundations group, were required to convince opponents of legalisation”.

STATE CONTROL – HOW IT WORKS

There are three ways to legally obtain cannabis in Uruguay. The first alternative is autocultivo, which allows individuals to grow up to six marijuana plants per household and yield an annual crop of 480 grams per year, or 40 grams per month. All individuals must register with the government agency for the regulation and control of cannabis—called the Instituto de Regulación y Control de Cannabis (Cannabis Regulation and Control Institute) to grow these plants in their home and no person may register more than one location for domestic growth. The second alternative is the Cannabis Club, which allows between 15 to 45 members of a duly-registered civil association to farm up to 99 marijuana plants in specific locations. Each club may not supply any individual with more than 480 grams of marijuana per year. The third alternative is sale through pharmacies. This alternative will allow a registered consumer to buy up to 40 grams of marijuana per month and 480 per year in person from pharmacies that are registered with the IRCCA and the Ministry of Public Health. On July 19, 2017, Uruguay launched the last remaining stage of the cannabis law, with sales finally beginning in 16 pharmacies across the country.

PUBLIC DISAPPROVAL

Public opinion surveys have consistently shown most Uruguayans to be doubtful about the government’s initiative.

According to the results of the 2014 AmericasBarometer survey in Uruguay, only 34% of Uruguayans approved the new regulations regarding the liberalization of marijuana use, while 60.7% showed their disapproval to the new policies. Perhaps not surprisingly, approval for the new regulation of cannabis is closely related to previous personal experimentation with marijuana and a history of marijuana consumption among relatives and close friends.

PUBLIC SKEPTICISM

As of 2014, most Uruguayans remained skeptical about the benefits the new regulation will bring. For instance, 42% of Uruguayans considered that the general situation of the country would worsen as a result of regulation, while only 19% believed that the situation would improve. Among the most negative opinions expressed, 70% of Uruguayans stated that public safety and public health conditions would either worsen or remain the same. The issue that seemed to generate the most positive opinions was related to the fight against drug trafficking organisations.

Source: https://www.vanderbilt.edu/lapop/insights/ITB020en.pdf

PUBLIC USAGE

In 20015.3% of the population admitted to having consumed marijuana.

By 2014, life prevalence had quadrupled with 22.1% of Uruguayans acknowledging some consumption.

Since Uruguay legalised the sale of marijuana, underage use increased from 14% to 21%. Use by those aged 19 to 24 increased from 23% to 36% Those aged 25 to 34 increased from 15% to 25%.

Source: https://wdr.unodc.org/wdr2019/prelaunch/WDR19_Booklet_5_CANNABIS_HALLUCINOGENS.pdf

TEENS

Prevalence doubled among secondary school students from 2003 to 2014. In 20038.4% of students had consumed marijuana during the previous twelve months. in 201417% had.

Almost a quarter of the high-frequency users of Montevideo had their first experience with marijuana before age turning 15 (24.1%).

Prevalence is also higher among 18-25 year-olds than other age categories.

NON-COMPLIANCE

As at February 2018, 8,125 individuals and 78 cannabis clubs with a total of 2,049 members were registered in addition to the 20,900 people registered through pharmacy sales for cannabis. The system potentially provides cannabis to around 30,000 of the 140,000 past-month cannabis users estimated in Uruguay in 2014.

A recent survey found that almost 40% said they would probably or definitely flout the law which requires registration. (19.6% state that it is not probable that they will register, and another 19.6% said that they are certain that they will not register.)

MONITORING AND EVALUATION

A 2018 Brookings Institute report details how the Ministerio de Salud Pública is required to submit an annual report on the impacts of the legalization since 2014 – but the ministry has only submitted such a report once, in 2016, and the findings were not made public.

According to a report by WOLA (funded by Open Society Foundations – aka George Soros) and posted on the Monitor Cannabis Uruguay site, in spite of President Vázquez’s support for monitoring and evaluation, his administration has provided the public with relatively little in the way of hard data on the early effects of initial implementation of the cannabis measure.

The IRCCA’s limited staff – it has a team of six inspectors who are responsible for ensuring compliance – does not realistically allow the institute to check the annual plant yields for all 8,000+ homegrowers and approximately 80 registered clubs.

 PRODUCTS

A recent study of marijuana consumers in Montevideo found that users had consumed it in several different ways during the past year, including vaporizers (15.7%), edibles, such as brownies, cakes, cookies (26.4%), and drinks, such as mate, milkshakes, daiquiris (9.4%).

PERCEPTION OF RISK

The study of marijuana consumers in Montevideo also found that users had a very low perception of risk associated with undertaking several activities while under the influence of marijuana. For instance: 21.4% of respondents drove a car under the influence of marijuana; 28.4% rode a motorcycle; 11.2% operated heavy equipment. More than half of the respondents (55.4%) declared that they consumed marijuana and went to work before four hours had passed.

More than one in every four of those women who were pregnant (26.1%) reported to having continued consuming marijuana while pregnant.

BLACK MARKET

Three years after legalisation, seven out of every ten cannabis consumers still acquire the product on the black market. Authorities admit that “street selling points have multiplied in recent years, along with criminal acts related to micro trafficking.”

Marcos Baudeán, a member of the study group Monitor Cannabis Uruguay, suggests it may be worse than that: “Consider the fact that there are 55,000 regular consumers who are responsible for 80% of the marijuana consumption in the country, but currently only 10% are consuming from the legal market, the rest are buying the drug off the illegal market.”

Others have pointed to the very low concentration of THC in the legal drug as another reason why some users may turn to the black market. Though the price may be higher — a gram of high-potency illegal marijuana can cost as much as $20— some users may be willing to pay this premium in exchange for access to a more powerful drug.

Because sales to tourists are prohibited, some Uruguayan homegrowers and clubs have attempted to get around the ban by offering ‘cannabis tours’, which are framed more as social and educational experiences, in which participants are free to sample cannabis while on a paid tour. Others simply sell directly to tourists behind closed doors, a grey market quietly operating via word of mouth.

FINANCIAL IMPLICATIONS

An unexpected consequence of Uruguay’s marijuana law is that the U.S. government invoked the Patriot Act which prohibits U.S. banks from handling funds for distributors of marijuana.  In Uruguay, this is by way of the pharmacies only.  International banks – both those with U.S. headquarters such as Citibank and European banks such as Santander have advised their Uruguayan branches that they are prohibited from providing services to the distributors of marijuana.

As a result, pharmacies tasked with the sale and distribution of marijuana have been cut off from the entire financial services market because the banks in Uruguay announced that every business associated with the newly legal marijuana industry risked being in violation of the U.S. drug laws and would lose their access to U.S. banks and dollar transactions.

SUMMARY

What we have learned from the data so far indicates that frequency of consumption has significantly increased, especially in the 15-24 age group. The perception of risk with drug use is low, and risky behaviours have increased with the frequency of consumption, including use of marijuana during pregnancy. The black market is alive and well. And the overwhelming support for the regulation among high-frequency marijuana users does not immediately translate into willingness to comply with it. Of most concern is that monitoring and reporting of the effects of legalisation is minimal, and not made public.

The drug-friendly website CannabisWire in July 2018 summed it up perfectly. “What Have We Learned From the First Nation to Legalize Cannabis? Not Enough.”

Source: Uruguay – Say Nope to Dope 2019

The House of Representative threw a pot party in Washington last week under the guise of a hearing on the racial impact of marijuana laws. Shamefully, Judiciary Chairman Jerry Nadler refused to allow groups opposed to the mass commercialization of marijuana to participate.

Equally disturbing was the behavior of ranking Republican Doug Collins, who refused to invite witnesses who could offer a counterpoint to Big Marijuana and its Big Tobacco investors.

Had these lawmakers not bought the industry’s propaganda and allowed the committee to hear opposing viewpoints, they would have heard the truth about how an addiction-for-profit industry has been targeting and victimizing minority communities across the country, not providing social justice.

The reality is that marijuana legalization is going too far, too fast. We need to press pause.

In one moment of reality, Dr. Malik Burnett, who previously worked on staff for the pro-pot lobbying group Drug Policy Alliance and now profits from the pot industry, acknowledged that the people making money off of the commercial pot industry are wealthy men — not minorities. He also highlighted that the industry’s federal legalization bill, the STATES Act, being pushed by former Speaker of the House John Boehner, includes no provisions for social justice or equity.

Let’s get real: Legalizing pot isn’t about social justice. It’s about making money. Period. And it’s about profit, usually off the backs of low-income and minority communities and other vulnerable populations, like young people. The idea that opportunity, equality and justice will spring from bongs, joints and drug-laced gummy bears is simply nonsensical. If common sense doesn’t make that case, the facts do.

Grand promises of social justice have repeatedly failed to materialize in states that have legalized.

African-American arrest rates for marijuana-related crimes in Colorado are nearly twice that of whites. And despite claims that pot legalization can cure mass incarceration, most states that have legalized marijuana have seen no corresponding drop in prison population.

Like its predecessor, Big Tobacco, the pot industry sees low-income and minority communities as profit centers. In Los Angeles, the majority of pot shops have opened in predominantly African-American communities. In Denver, where there are now more pot shops than McDonald’s and Starbucks combined, shops are located disproportionately in lower income and minority neighborhoods.

Even more concerning is the connection between pot shops and crime. Studies have shown that the density of marijuana retailers is directly linked to increased rates of property crimes. In Denver, neighborhoods adjacent to pot businesses saw roughly 85 more property crimes each year than neighborhoods without a pot shop nearby.

Big Pot doesn’t want the public and lawmakers to know these facts. Apparently, neither do congressmen Nadler and Collins. The industry has spent millions of dollars employing well-heeled lobbyists and PR teams to convince lawmakers and the general public that marijuana use is safe, and legalization has no appreciable negative consequences. It’s a lie.

Today’s high-potency pot products, up to 99 percent THC, is being mass produced and mass marketed in kid-friendly forms such as gummies, candies, sodas and ice creams. The use of these products has recently been linked in a growing body of medical research to the onset of severe psychosis.

These consequences are real. States with “legal” pot are now seeing dramatic increases in mental health issues, emergency room visits due to children accidently ingesting pot products (pets too), and spikes in drugged driving fatalities.

Marijuana legalization and normalization has the money-hungry titans of addiction salivating. Altria, Big Tobacco giant and maker of Marlboro cigarettes, has already dumped billions into a Canadian pot grower. Alcohol conglomerates are doing the same. Even the former head of OxyContin producer Purdue Pharma went on to lead a commercial marijuana business. If you think these guys care one bit about racial or social equity, think again.

Marijuana policy can be reformed without creating another legal addiction-for-profit industry. Expunging prior records and decriminalizing possession of small amounts of pot is a start. Effective drug policy discourages use and gets people the help needed for issues with substance abuse. That’s true social justice.

Getting real social justice requires a real debate about this issue, not a sham, one-sided congressional hearing stacked in Big Marijuana’s favor.

Source: Time to Hit Pause on Marijuana Legalization – InsideSources July 2019

IS the Home Office really supporting a scheme which will allow drug users to get their illegal class A drugs tested for ‘purity and quality’ without fear of prosecution? 

Is Sajid Javid really stupid enough to back this idea? The naive justification is that it will reduce ‘overall harm’. While it will not, it will certainly become a licence for addiction and for normalising intrinsically harmful and destructive class A drug use.

Pity the poor children of such drug-users who, on top of putting their habit above their family’s needs and wellbeing, will now be able to take into their homes drugs which they can claim the government has deemed safe.

Such a process gives the misleading impression that that it is only any impurities in these toxic substances that can cause harm. As if impurities in the drugs were the top of drug addicts’ list of concerns; or as if you could take any drug with impunity providing it had been tested and declared pure.

Hello, Sajid! Wake up! I think you are being taken for a ride! Why else is diamorphine so carefully controlled and prescribed? Maybe despite being Home Secretary perhaps you’ve not visited any rehabs or talked to former addicts. They’d put you straight pretty quickly.

Have you not in your time in government visited enough drug ridden estates to know that it is drug use that is the problem that corrupts and endangers families and young people’s lives?

Have you not seen cocaine burn-out amongst your former City colleagues? Have you not seen the fall-off of any moral sense in the lives of those for whom their drug use inevitably becomes paramount, at the expense of everything and everyone else?

In case it has escaped your notice, there is a sustained campaign going on driven by middle-class libertarians to chip away at drug controls and to legalise drug use. It may well suit their selfish sensibilities to be free to do what they like but it is a disaster for those with fewer choices, fewer buffers and more vulnerability. That includes fatherless families, the poor and children, particularly children in care.

We’ve seen it in the campaign, coming from the heart of the establishment, to allow onsite drug-testing at festivals, driven by Dr Fiona Measham, a member of the Government’s Advisory Council on the Misuse of Drugs. Never mind that such experiments cannot but encourage and pressurise immature young people to use drugs for the first time. They are safe and legal – hey, you can’t say no!

The elites who are pushing this, just like the elites – headed currently by Crispin Blunt MP  – pushing to legalise cannabis are blind to the harm it wreaks on vulnerable communities. This is what police officer Richard Cooke confirms in the Telegraph, and he is right: cannabis does have a pernicious influence on society. Users are disproportionately found among the underprivileged, criminals and the mentally ill. The consequential knock-on effects do stoke violence both in the home and on the streets.

Yet the last year or so has seen increasingly well-funded and pretty much nonstop attempts to erode our drug laws, from decriminalising or legalising cannabis to the recent costly and non-effective heroin prescription plan. 

And going along with the libertarian Mr Blunt (who last year set up a lobbying firm funded by overseas cannabis corporations) and the well heeled drug advocates of his All Party Parliamentary Group on Drug Policy Reform are too many liberalising Chief Constables and Police and Crime Commissioners, no longer up for their real task, which is to crack down on crime, and who see legalisation as the easy route out.

This is the sustained pressure that Sajid Javid appears to be capitulating to, as he did before under pressure from the so-called ‘medicinal cannabis’ lobby, only to have both Dame Sally Davis, the Chief Medical Officer retract and Simon Stevens, head of the NHS, warn that we are making a big mistake with it.

If Mr Javid lets his subversive civil servants and lobbyists at the Home Office and in Parliament push him into licensed testing of illegal class A drugs, he’ll be making another; the country is going to be in very serious long-term trouble. It is not so much a slippery slope as the runaway rapids we’ll find we are heading down.

Source:  https://www.conservativewoman.co.uk/wake-up-home-secretary-this-drug-scheme-is-a-recipe-for-chaos/    June 2019

 

(Image Credit: 7raysmarketing via Pixabay)

Contrary to advocates’ promises, legalizing pot has spurred new illegal enterprises. https://t.co/1k9twTCrmg via @cjstevempic.twitter.com/VKND92hjl5

— City Journal (@CityJournal) June 12, 2019

Unintended consequences of legislation are more commonplace than they should be, but minimizing them would require more nuanced political debate and that option has probably left us forever.

A new article in City Journal details just how legal marijuana is the gateway drug to illegal marijuana enterprises:

Though advocates claim that one of the benefits of  legalizing recreational marijuana is that the black market will disappear and thus end the destructive war on drugs, the opposite is happening. States that have legalized pot have some of the most thriving black markets, creating new headaches for law enforcement and prompting some legalization advocates to call for a crackdown—in effect, a new war on drugs.

Unlicensed pot businesses have already become a problem for Los Angeles just a year and a half after legalization. The city is devoting police resources that are already stretched thin to address the situation.

City Journal notes that it’s not just mom and pop scofflaws that are problematic:

Legal-pot states are attracting international criminal cartels. Mexican drug gangs have smuggled illegals into Colorado to set up growing operations, former U.S. prosecutor Bob Troyer  wrote last September, explaining why his office was stepping up enforcement. Rather than smuggle pot from Mexico, the cartels grow it in Colorado and smuggle it elsewhere—spurring violence. In 2017, seven homicides in Denver were directly connected to marijuana growers. “I would love to be able to shift some of my resources away from marijuana to other things,” Denver lieutenant Andrew Howard said last year. “But right now, the violence is marijuana or marijuana-related.”

More cartel violence and more illegal immigration…yay legal weed!

I’m no anti-pot Puritan, but I am on record as always having been frustrated by the discussions surrounding legalization efforts. They are rarely in-depth and mostly focus on marijuana’s medicinal uses. It is often portrayed as harmless, which is nonsensical. It’s not heroin, but it’s also not baby aspirin.

What were almost never discussed pre-Colorado were the consequences of legalizing a black market drug. It’s a bit naive to think that the major players from the black market would flee into the shadows once their commodity became legit.

Cartels may be illegal enterprises, but they are still businesses. They can adapt to changing markets. It would appear they are also adept at outreach:

Legal-marijuana businesses are getting in on the game, too. Last year, Denver authorities arrested the owners of a licensed chain of pot shops that employed 350 people for supplying the black market. In January, three owners of the business  pled guilty to drug and racketeering charges. In Oregon, federal prosecutors  arrested six individuals in 2018 and charged them with “vast” interstate-trafficking schemes that supplied black-market pot to Texas, Virginia, and Florida. Some of the suspects were also charged with kidnapping, money-laundering, and use of a firearm in a drug-trafficking crime.

So much for the harmless stoner sales pitch.

None of this is surprising for advocates of smaller government. Legalization and regulation were supposed to make the marijuana black market and its problems go away. Instead, as the City Journal conclusion observes, it’s merely created “Black Market 2.0.”

High times indeed.

Source:  https://pjmedia.com/trending/legal-marijuana-a-boon-to-illegal-cartels/  June 2019

The title of “Cannabis in Medicine: An Evidence-Based Approach” contains an irony. In chapter after chapter in this multi-authored book written predominately by providers associated with mainstream medical facilities in Colorado, the authors point out the inadequacy of the evidence we have and the absence of the evidence we need to determine how – or even if – cannabis has medical legitimacy. The foreword’s title, “Losing Ground: The Rise of Cannabis Culture,” sets the tone. David Murray, a senior fellow at the Hudson Institute, argues convincingly that “the current experiment with cannabis, underway nationwide [is] leading us towards a future of unanticipated consequences, a future already established in the patterns of use ‘seeded’ in the population but as yet unmanifested.” In other words, the cannabis horse has not only fled the barn but has been breeding prolifically to the point that we couldn’t get rid of it and its progeny if we wanted to!

The 20 chapters following the foreword are divided into basic science (three chapters) and clinical evidence (17 chapters) sections. Over and over in the clinical evidence chapters, individual authors remind the reader of the lack of quality control in production, the dearth of strong evidence from adequately designed research trials, and the intensifying potency of cannabis with attendant dangers, particularly for youth. The organization of this section lacks consistency in that some chapters focus on specialty (e.g. pulmonary medicine), others on patient groups (e.g. the pediatric and adolescent population), others on physiological implications (e.g. clinical cardiovascular effects; neuropsychiatric effects), others on specific diseases (e.g. gastrointestinal disorders; ocular conditions), and still others on public health topics (e.g. cannabis-impaired driving). While all are relevant, a specialty or organ system focus, with a separate public health section might lend the book more coherence. It would also be worth exploring how “cannabis culture” has become in essence a parallel medical system, with many of cannabis’s most ardent proponents as dropouts from establishment medicine after its nostrums for diagnoses like chronic pain, anxiety, and depression have failed to bring them relief.

I would have liked a chapter specifically grappling with the porous boundary between federal and state jurisdictions over cannabis as medicine and marijuana as recreational substance. Lawyer David G. Evans’ admirable chapter on “The Legal Aspects of Marijuana as Medicine” moves in that direction when he writes that, “‘medical marijuana’ is not a ‘states’ rights’ issue.” To wit, for no other drug than cannabis has the federal government ceded regulatory responsibility to states that are variably (but mostly not) equipped to handle it. The truth, complex in its contradictions and inconsistencies, is that in the United States, marijuana remains a Schedule I drug without recognized medical value; the Federal Drug Administration overseeing American pharmaceuticals throws roadblocks in the way of studying it, thereby interfering with the development of a robust evidence base; the federal government has looked the other way and even colluded with the states as one after another has legalized cannabis medically, recreationally, or both; and physicians risk their federal licenses to prescribe if they do more than recommend this drug. In a nutshell, any effort to impose logic is doomed because the American scene vis-à-vis cannabis is seemingly irretrievably illogical.

The editor of this volume, Kenneth Finn, MD, a PMR and pain management specialist in Colorado Springs, Colorado, is to be commended for encouraging individual chapter authors to develop encyclopedic bibliographies. The book can thus serve as a resource for practitioners wishing to delve into a vast and growing literature that continues to offer little that is conclusive. The book can also serve as a primer on what is known about cannabis as medicine, keeping in mind a slant throughout – not necessarily unjustified, at least from an allopathic or osteopathic perspective – that cannabis is neither legitimate as medicine nor safe, even for recreational use.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723137/ Sept-Oct 2020

‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Drug consumption rooms are a particularly contentious form of harm reduction, viewed on one hand as a practical, humane, life-saving approach to dangerous drug use, and on the other, as an endorsement of drugtaking and a dereliction of the duty to treat people dependent on drugs.

STEP-BY-STEP THROUGH SOME OF THE KEY ISSUES

Drug consumption rooms provide hygienic and supervised spaces for people to inject or otherwise consume illicit drugs. When counted at the end of 2018, there were 117 sanctioned drug consumption rooms in 11 countries around the world, generating an evidence base of ‘real world’ trials for scrutinising their biggest appeals and detractors’ greatest fears. Evidence of their effectiveness is one motivation for introducing drug consumption rooms; another is that they provide a common sense solution to the suffering and risks associated with public injecting.

The Scottish Government has recognised mounting harms to the health, wellbeing, and dignity of people who use drugs, and supports trialling drug consumption rooms as part of an approach to substance use based on public health objectives and human rights principles. However, the UK Government based in Westminster (London) has repeatedly blocked any such action. This stalemate provides the backdrop for a hot topic exploring the following questions:
• In communities dealing with the consequences of public injecting, could drug consumption rooms be part of the solution?
• Knowing the human cost of unsafe public injecting practices, would it be negligent for governments not to consider them at this point?

The mounting harms of public injecting

People who inject in public typically have nowhere else to go, and for complex reasons are unable or unwilling to engage with treatment for their drug dependence, or are in treatment but still using illicit drugs. They are very often homeless, and have reached a ‘boiling point’ of risk where they live with the daily prospect of bacterial infections, contracting blood-borne viruses, overdosing, and in the absence of someone witnessing the overdose and stepping in with life-saving support at the right time, dying on our streets.

Injecting in public places is a high-risk practice associated with an inability to inject in a sterile way, both due to unhygienic environments and difficulty maintaining personal hygiene, and hasty, unsafe injecting practices due to the threat of being seen by the public or police.

2006 study involving 100 people from Glasgow, Edinburgh, Bristol and London, whose day-to-day life at home or at work was likely to expose them to public drug use or its aftereffects, identified three types of locations used for public injecting:
• open areas including alleyways, car parks, cars, derelict or rubble/rubbish strewn open spaces, and train stations;
• neglected property including disused and seldom used parts of buildings, building sites, drug houses, and squats;
• publicly accessible places held as residential or commercial property including houses, cafés, pubs, toilets, gardens, bushes, backyards, doorsteps, stairwells, bin shelters, and garages.

However, participants’ sympathy for people who used drugs was often offset with blame and resentment for the impact public injecting had on them personally. Drawing a line in the sand, participants talked of people who used drugs as a group distinct from residents, tourists, workers, and patrons. This ranged from expressing their appreciation for people who used drugs “keep[ing] away from residential areas”, to condemning them for “blighting an area’s reputation and their own quality of life”.

Public injecting can indeed have an impact on other people, but as these participant responses illustrated, there is a danger of people who inject in public being represented as public order problems to communities to the exclusion or minimisation of the personal and individual harms they experience. Furthermore, the ‘public impact’ narrative can overlook the fact that people who inject in public are also members of communities, and rather than being held responsible for ‘blighting’ those communities, there could be recognition that they are carrying the burden of some of the worst health and social inequalities in society.

Scenes of public injecting in Birmingham documented by harm reduction advocate Nigel BrunsdonScenes of public injecting in Birmingham documented by Nigel Brunsdon

“Time for safer spaces”: Scenes of public injecting in Birmingham documented by Nigel Brunsdon

 

In August 2016, harm reduction advocate and photographer Nigel Brunsdon spent a day walking around Birmingham, documenting evidence of public injecting. He visited three known injecting areas – two on waste grounds next to car parks, and one in a main walkway in the centre of town – and found the ground covered in injecting equipment and general waste; needles alongside garbage and human excrement. “No one ‘chooses’ to inject in these spaces”, he said, “this is where the most desperate people in our society have been driven”.

A few years earlier in 2012, Philippe Bonnet explored these key issues in a documentary produced by Social Impact Films. He toured known injecting sites in Birmingham, and interviewed outreach workers, healthcare professionals, and people who were currently injecting (or had injected) drugs in public places. Injecting equipment was already available to the city’s population, and services were providing this equipment knowing that it would be used by people to inject illicit drugs. Many vulnerable people would go on to inject those illicit drugs in unsafe spaces – places that were cold, unhygienic, with poor lighting and no washing facilities. Describing the conditions as “completely appalling’, he said:

“The aim of this video is to highlight the problem we have in this city. Can we let people inject in these situations? Can we let the harm carry on?”

A core demographic of drug consumption rooms is homeless people who use drugs, due to links between homelessness and high-risk behaviours such as public injecting, sharing injecting equipment, and poor injecting hygiene.

The term homelessness covers a spectrum of living situations. Though traditionally associated with ‘rough sleeping’, someone who has a roof over their head can still be homeless. The broad categories of homelessness described by Crisis, the UK national charity for homeless people, are:
• ‘rough sleeping’;
• in temporary accommodation (night/winter shelters, hostels, B&Bs, women’s refuges, and private/social housing);
• hidden homeless (people dealing with their situation informally, ie, people who stay with family and friends, ‘couch-surf’, and ‘squat’);
• statutory homeless (people deemed ‘priority need’ who their local authority have a duty to house).

By its very nature, homelessness exposes people to materially poor living conditions – increasing their exposure to risky situations and decreasing their capacity to protect themselves from harm. This supplementary text details some of the life-limiting diseases and disorders experienced by homeless people, some of which are complications of risky drinking and drug use, and many of which are preventable and treatable. The Guardian drew attention to this in 2019 (for original data source, see NHS Digital website), writing:

“Thousands of homeless people in England are arriving at hospital with Victorian-era illnesses such as tuberculosis, as well as serious respiratory conditions, liver disease and cancer.”

In 2011, when UK homelessness charity Crisis reviewed deaths among homeless people, the situation was very bleak. They found that homeless people die on average 30 years before the general population (48 for men and 43 for women, compared to 74 and 80 respectively), and a third of these deaths are related to drink and drugs. According to recent assessments, the situation may be getting worse rather than better. Figures from the Office for National Statistics revealed that 597 homeless people died in England and Wales in 2017, an increase of 24% from the 482 deaths recorded in 2013. Most of these were men (84%), with an average age of 44 years old (44 years for men, 42 years for women), and more than half died from causes related to drugs (32%), alcohol (10%) or suicide (13%) – much higher than the 3% of deaths attributable to drugs, alcohol, or suicide in the general population the same year.

A 2018 study analysed the social distribution of homelessness and found that in the UK homelessness is not randomly distributed across the population – the odds of experiencing it are systematically structured around a set of identifiable individual, social and structural factors, most of which are outside the control of those directly affected. Poverty (especially childhood poverty) is central to understanding people’s pathways to homelessness, and on the flipside, the ‘protective effect’ of social support networks is key to understanding how people can avoid homelessness.

Where harm is concentrated in the general population and what that harm looks like are of critical relevance to the question of whether to introduce drug consumption rooms. The heightened level of risk among homeless people suggests that at the very least the debate needs to be able to navigate the different environments and contexts in which people take illicit drugs. Just as not all drugs were created equal, not all people who use drugs were created equal. As Nigel Brunsdon said: “No one ‘chooses’ to inject in these spaces, this is where the most desperate people in our society have been driven”.

What happens inside a drug consumption room?

Cubicles for hygienic, supervised injecting inside a drug consumption room

Cubicles for hygienic, supervised injecting inside a drug consumption room

 

Drug consumption rooms are legally sanctioned spaces where people can bring their own pre-obtained illegal or illicit drugs, and either inject or inhale them using sterile equipment under the supervision of nurses or other medical professionals. This differentiates them from:
• illegal ‘shooting galleries’ run for profit by drug dealers – though colloquial references to drug consumption rooms in the media can blur this line (1 2);
• hostel or housing services that tolerate drug use among residents but provide no medical supervision;
• programmes which prescribe pharmaceutical heroin (diamorphine) for consumption by their patients under medical supervision (1 2).

Until the 1970s there were informal, ad hoc facilities including the ‘fixing rooms’ of London’s Hungerford and Community Drug Projects, and Blenheim in west London, which had a toilet where people routinely injected. These stopped running primarily due to the knock-on effects of people using barbiturates, a sedative which can result in ‘drunken’ behaviour. Staff felt unable to support users safely and were disillusioned at facilities becoming ‘crash pads’ for people turning up already stoned.

The first officially approved supervised consumption room opened in Bern (Switzerland) in 1986. Rooms were then introduced in Germany and the Netherlands in the 1990s, and in Spain, Australia and Canada in the early 2000s. As of April 2018, when the European Monitoring Centre for Drugs and Drug Addiction updated their overview of provision and evidence (for earlier version, click here), there were 31 facilities in 25 cities in the Netherlands, 24 in 15 cities in Germany, five in four cities in Denmark, 13 in seven cities in Spain, two in two cities in Norway, two in two cities in France, one in Luxembourg, and 12 in eight cities in Switzerland. Outside Europe, at the time of the 2018 Global State of Harm Reduction report there were two facilities in Australia and 26 in Canada.

Most rooms are integrated into existing, easy-access (or ‘low threshold’) services for people who use drugs and/or homeless people, giving them access to ‘survival-orientated’ services including food, clothing and showers, needle exchange, counselling, and activity programmes. Less common are facilities exclusively for people who use drug consumption rooms that offer a narrow range of services directly related to supervised consumption (1 2). Spain, Germany and Denmark also have mobile facilities offering a more flexible service (ie, going where people who use drugs are) but with limited capacity.

The most recent drug consumption room census, facilitated by the International Network of Drug Consumption Rooms in 2017, included 51 responses collected from 92 drug consumption rooms operating in Australia, Canada, Denmark, France, Germany, Luxembourg, Netherlands, Norway, Spain and Switzerland. This found that almost all drug consumption rooms (94%) provided referrals to treatment and distributed sterile injecting equipment for taking away. Many also provided condoms (89%) and HIV-related counselling (70%), personal care (76%), including shower and laundry facilities, and support with financial and administrative affairs (74%). Frequently provided were HIV testing (54%), outpatient counselling (46%), mental health care (44%), hepatitis B vaccinations (41%), legal counselling (39%), take-home naloxone (37%), and opioid substitution treatment (24%), as well as meals (61%), recreational activities (57%), work and reintegration projects (41%) and use of a postal address (39%). Almost half of services also reported offering tours or open days to the public (49%).

Demystifying what happens within the four walls of a drug consumption room, Marianne Jauncey from the University of New South Wales described the operating practices of a facility in North Richmond, Victoria (Australia):
• Stage one: First-time visitors register with the service. This involves them talking to a member of trained nursing or counselling staff, and providing a brief medical history. If they wish, people attending can use an alias; they are not required to leave either their full names or their real names. Once registered, attendees are asked what drug they are seeking to use, as well as what other drugs they have used recently, which gives staff a sense of what to expect.
• Stage two: Staff provide clean injecting equipment, typically including small 1 ml syringes, swabs to clean the skin, a tourniquet, water, filters, and a spoon. Clients sit at one of eight stainless steel booths, and inject themselves. Staff are not legally able to inject a client, but their role as clinicians trained in harm reduction is to reduce the risks associated with that injection. This may involve talking to someone about where and how they inject, encouraging them to wash their hands and use swabs, ensuring they don’t share any equipment, and other techniques aimed at ensuring they understand the risks of blood-borne virus transmission.
• Stage three: After the injection, clients safely dispose of their used equipment, and move to a more relaxed space in the next room. Drawing on the therapeutic relationship they build, staff and clients have discussions about health and wellbeing, what to do in the event of an overdose (eg, the recovery position and rescue breathing), and how to access other services, including mental health treatment, dental services, hepatitis C treatment, wound care, relapse prevention, counselling and referral to specialised treatment.

For now the closest contemporary Britain comes to having safer injecting centres are the few clinics where patients inject legally prescribed pharmaceutical heroin (diamorphine) under clinical supervision. These clinics are unlikely to engage the target group of drug consumption rooms, but nonetheless provide a service to people who have not benefitted from more conventional treatment. Furthermore, it could be argued, they provide an experience- and skills-base for drug consumption rooms in the UK as they have to exercise the same monitoring of patients and have the same capacity to respond to overdose incidents as drug consumption rooms.

Determining whether they produce sufficient benefits (with no countervailing problems)

Evidence of the need for and impact of drug consumption rooms tends to be divided into “public harms which affect communities, such as discarded syringes in public parks and toilets”, and “private harms which affect individuals, such as overdose death and blood-borne viruses”. The extent to which each is used to justify the introduction of drug consumption rooms differs from country to country. For example, overdose deaths were a key driving force in Norway, Spain, Canada and Switzerland, while public disorder and local concerns about drugtaking in public places were important in Canada, pivotal in the Netherlands, and have been raised in towns and cities around the UK, such as Neath Port TalbotBrighton and Hove, and Manchester, though Britain is yet to see a single drug consumption room.

Outcomes from the first drug consumption rooms were “relatively inaccessible to the international research community” until 2003/2004, at which time Professor John Strang, a leading figure in British substance use practice and policy, cautioned that “claims” of harm reduction from drug consumption rooms would need to be more robustly tested. Although the evidence base has grown considerably since then, it remains difficult to evaluate the rooms’ impacts in ways that meets the scientific ‘gold standard’.

Randomised controlled trials feature at the top of “traditional evidence hierarchies”. They involve researchers randomly allocating participants to two or more groups – an intervention versus an alternative intervention, a ‘dummy’ intervention, or no intervention at all. The following extract explains the logic behind randomised controlled trials, and hence why they prove to be so desirable:

“When a new treatment is administered to a patient and an improvement in her condition is observed, the possibility of drawing a conclusion from the fact is hindered by the absence of a counterfactual: possibly the patient would have recovered anyways if left untreated, or maybe a different treatment would have been more effective. In [a randomised controlled trial], participants are divided into two groups, one that receives the experimental treatment and another that acts like a control, providing the answer to the ‘what if’ counterfactual question. For the concept to work as intended, though, the administration of the experimental treatment should be the sole difference between the experimental and the control group.”

As drug consumption rooms tend to emerge from local initiatives aimed at reducing the harms of public drug consumption, they are not designed or implemented with the random allocation of people in mind. Instead, researchers undertake evaluations in ‘real world’ circumstances, for example comparing changes in outcomes in a neighbourhood that opened a drug consumption rooms versus a comparison area that did not. The limitation of this approach is that the effects of drug consumption rooms are obscured by complex sets of factors not under a researcher’s control. In Sydney, for instance, calculating lives saved by harm reduction measures has been complicated by “dramatic changes in the availability of heroin”. What was colloquially referred to as the ‘Australian heroin drought’ affected the amount of heroin being used, and probably resulted in a reduction in associated problems such as heroin-related overdose.

Expecting evidence for drug consumption to rooms come from randomised controlled trials also raises ethical issues. Drug consumption rooms provide a range of services, some of which are unique to this intervention. If one group of people who inject drugs were randomly allocated to drug consumption rooms, that would mean another group of people who inject drugs would be denied access. If the study was recruiting participants from the target group of drug consumption rooms – a particularly vulnerable and marginalised cohort of people who typically have nowhere else to go, and for complex reasons are unable or unwilling to engage with treatment for their drug dependence, or are in treatment but still using illicit drugs – participants without access to a drug consumption room would likely continue to inject in public places with the extremely high levels of risk this carries.

ASSESSING IMPACT

Europe’s monitoring centre on drugs described (1) improving survival and (2) increasing social integration as the overarching aims of drug consumption rooms. Indicators that these aims are being achieved include:
✔ establishing contact with hard-to-reach populations;
✔ identifying and referring clients needing medical care;
✔ reducing immediate risks related to drug consumption;
✔ reducing morbidity and mortality;
✔ stabilising and promoting clients’ health;
✔ reducing public disorder;
✔ increasing client awareness of treatment options and promoting clients’ service access;
✔ increasing chances that client will accept a referral to treatment.

Even without a randomised trial, it is possible to at least estimate the likelihood that an intervention (in this case, a drug consumption room) is having a positive or negative impact. For example, it may not be possible to determine impact on the transmission of infectious diseases, but it is possible to observe impacts on self-reported needle and syringe sharing, the key cause of transmission among people who use drugs. Furthermore, there are other high-quality research methods that instill confidence in the results, including ‘natural experiments’ that compare changes in outcomes in neighbourhoods where a drug consumption room had opened to control areas where they had not, and simulation studies that estimate the costs and benefits of existing drug consumption rooms at reducing disease transmission and overdose.

As the Joseph Rowntree Foundation’s Independent Working Group on Drug Consumption Rooms put it, “the methodological problems involved here should not detract from [drug consumption rooms’] considerable success” and their mechanisms for improving the health and wellbeing of their clients – ensuring hygienic and (relatively) safe injecting in the facility, providing personalised advice and information on safe injecting practices, recognising and responding to emergencies, and providing access to a range of other on-site and off-site interventions and support. Below we look at some of the outcomes and mechanisms for achieving those outcomes referred to by the Joseph Rowntree group.

Forging therapeutic relationships

Drug consumption rooms are aimed at “limited and well-defined groups of problem drug users” – typically, people who inject on the streets, who are not in treatment, and who are characterised by extreme vulnerability to harm, for example due to social exclusion, poor health and homelessness. The temperament and attitude of staff, as well as the ‘house style’, are critical to whether drug consumption rooms can engage with their target client groups – for example, the extent to which they encourage rather than deter potential clients, and are sympathetic and non-judgemental towards people with multiple problems who may be ostracised in other spaces.

In Danish drug consumption rooms, staff strive to be welcoming, and have prioritised forging relations with people who use drugs. The effect is that both clients and staff see the facilities as providing a ‘safe haven’ – one in which acceptance can clear the path for prevention, treatment and support. This view of drug consumption rooms as ‘sanctuaries’ and ‘spaces of healing’ was shared by a colleague in Victoria (Australia):

“An injecting centre provides the setting and the possibility for a new type of connection with our clients. The power of suspending judgement for those who are the most judged and vilified in our society can be transformative.”

For highly marginalised people who use drugs in particular, drug consumption rooms can be the first step into the health and social care system. Though they do not guarantee that clients access treatment – making use of the drug consumption room conditional on accepting treatment would undermine the ethos of harm reduction – they do remove some of the traditional barriers to treatment, which can ultimately make treatment a more realistic prospect. To support this suggestion, reviews have consistently found that drug consumption rooms are associated with an increase in the uptake of treatment including opioid substitution therapy and supervised withdrawal (1 2).

Though little is known about the potential of co-locating drug consumption rooms with services for supervised withdrawal, findings from the Insite facility in Vancouver (Canada) suggest that drug consumption rooms may be a useful point of access to “detoxification services” for high-risk people who inject drugs. Between 2010 and 2012, 11% of people injecting drugs who used the safer injecting facility (147 of 1316 total) reported enrolling in withdrawal programmes at least once. This was more likely among people residing near the consumption room, frequently attending the consumption room, and among people who reported enrolling in methadone maintenance therapy, injecting in public, injecting frequently, and recently overdosing.

Reducing public injecting

How much drug consumption rooms can significantly reduce public drug use depends on their accessibility, opening hours, and capacity. Understanding the characteristics of drugtaking among local people is essential for providing sufficient capacity to meet demand, remain accessible, encourage regular use, and achieve adequate coverage of the injecting population. For example, facilities focusing on or seeking to explicitly include sex workers may need to remain open in the evening and at night.

A 2014 survey by the International Network of Drug Consumption Rooms found that (among participating organisations) drug consumption rooms across Europe were open for an average of eight hours a day. Despite 20 of the 34 also opening on weekends, this left large periods of time when clients who would otherwise use the facilities had to inject elsewhere. In Hamburg, over a third of people surveyed who attended drug consumption rooms had also used drugs in public during the past 24 hours, citing among their main reasons waiting times at injecting rooms, distance from place of drug purchase, and limited opening hours.

Germany has the strictest admission criteria in Europe, which includes excluding people in opioid substitution treatment. In an unnamed consumption room, potential clients were denied access on 544 occasions because they were:
• not residing in the vicinity of the drug consumption room (250);
• drunk or intoxicated (150 times);
• in opioid substitution treatment (109);
• first-time or occasional users (four);
• under 18 years of age without permission from their parents (two).

Even when admission criteria are strongly justified – for example, on the basis that they protect clients and staff, and enable staff to run a safe facility – they do leave a proportion of people who, without access to a drug consumption room, may continue to inject in public. For reasons outside of admission criteria, studies of existing facilities suggest that drug consumption rooms may not yet be accessible to all groups at risk from public injecting, especially pregnant women and those who cannot self-inject, or people whose patterns of drug use mean that they need 24-hour access, for instance people primarily using cocaine who might “go without sleep for days on end”.

Litter and public disorder

The chief political defence for drug consumption rooms is to mitigate the public nuisance, disorder and crime associated with public injecting. Consequently they are usually sited where concentrated public drug use and discarded paraphernalia ‘spoil’ the environment, and hamper or undermine regeneration. Service user Nick Goldstein, whose article “The Right Fix?” was published in the November 2018 edition of Drink and Drugs News, and who was admittedly not enamoured of drug consumption rooms as an approach, stressed the imbalance inherent in this:

“I must admit that one of my pet peeves is that drug treatment is rarely designed for the primary purpose of helping drug users. Instead it tends to be designed to protect wider society from drug users by reducing crime, reducing the spread of [blood-borne viruses] in society and even by attempting to make drug users more economically productive.”

“At my most cynical I feel there’s something disturbing about an approach that can easily be seen as saying ‘come in for half an hour, have a shot so you don’t scare the public and then fuck off back to your cardboard box’.”

This is an understandable criticism considering that the more vulnerable and desperate people become, the more ostracised and stigmatised they tend to be in our communities. However, it could be argued that ‘moving injecting drug use off the streets’ directly serves vulnerable people who use drugs in two key ways: (1) it recognises the dignity of homeless people by considering the impact of discarded paraphernalia and public injecting drug use on them too, including homeless people who might be forced to inject drugs where they live; and (2) gives an opportunity to build the political profile of this considerably underrepresented population by bringing people together under one roof.

Compelling evidence about the impact of drug consumption rooms on litter and public disorder comes from Vancouver (Canada), where acceptance of the facility among residents and workers had been generated by the distressing sight of public injecting and injecting-related litter, and despite a large local needle exchange, risky injecting, disease and overdose deaths had remained high. After the facility opened there was a significant reduction in people seen injecting in public places from a daily average of 4.3 to 2.4. Also roughly halved were discarded syringes and injecting-related litter in the surrounding area. In Barcelona a fourfold reduction was reported in the number of unsafely disposed syringes being collected in the vicinity of safer injecting facilities from a monthly average of over 13,000 in 2004 before they opened to around 3,000 in 2012 after they opened (source paper in Spanish).

Injecting- and drug-related harm

In Vancouver alone, 88% of drug consumption room clients were found to have hepatitis C, and up to a third had HIV. This baseline level of harm exemplified the need for drug consumption rooms to function not only as a means of preventing harm among clients themselves – and facilitating access to treatment for blood-borne viruses and infections – but preventing harm being transmitted to others (eg, by sharing contaminated needles and syringes).

Regular use of drug consumption rooms has been linked to the use of sterile injecting equipment, and in particular a self-reported decrease in syringe sharing and re-use of syringes. Furthermore, although studies generally focus on harm reduction outcomes inside facilities, reductions have been seen outside drug consumption rooms in clients’ risk-taking behaviour, and it seems likely that ‘safer use’ messages could be transmitted to a wider population of people who use drugs via consumption room attendees.

While reducing risky behaviours such as syringe sharing could be expected to reduce risk of HIV and hepatitis C, the impact of drug consumption rooms on this is not directly observable. Drug consumption rooms have limited coverage and tend to go hand-in-hand with other services, and therefore it would be difficult to isolate their effect.

A point that is becoming increasingly salient as governments pay attention to new psychoactive substances is the potential for frontline staff in drug consumption rooms to “play [a role] in the early identification of new and emerging trends among the high-risk populations using their services”. In the UK, the national response to new psychoactive substances has been focused on legislation (the Psychoactive Substances Act 2016) and its effectiveness, while relatively little consideration has been given to developing a treatment response. Research undertaken in Manchester (England) between January and June 2016 uncovered two changes – the first of which may have consequences for traditional drug consumption room clients, and both of which represent new challenges for harm reduction services: (1) a shift away from heroin and crack cocaine among homeless people to spice; and (2) a change in the ingestion route of drugs within the emergent chemsex scene among men who have sex with men from the conventional recreational use of substances such as ecstasy and cocaine (1 2) to intravenous injection of crystal methamphetamine or mephedrone.

Mortality

While drug consumption rooms do provide safer spaces for injecting, “dangerous situations that require intervention arise frequently … (as they do in any drug-injecting context)”; the difference is the capacity to respond to these emergencies and prevent them progressing to serious harm or death:

“The aim of an injecting centre is to physically accommodate the injection of drugs that would normally occur somewhere inherently more dangerous, and often public.”

Because there is no quality control for illicitly sourced drugs, part of the harm comes from simply not knowing what may or may not be in the mixture, so staff are always on the look-out for unexpected reactions.

Recommended reading

Essay on overdose deaths in the UK

The main cause of opioid-related deaths is respiratory failure, caused by opiate-type drugs switching off the part of the brain that reminds you to breathe. If no one intervenes in the event of this type of overdose, oxygen will be depleted and eventually the heart will stop, causing death. Staff can prevent overdoses becoming fatal by: protecting a person’s airway; providing supplemental oxygen; providing resuscitation (artificially breathing for the person using a bag/valve/mask); and administering the opiate overdose antidote naloxone.

Staff in two facilities in Hamburg (Germany) estimated that nearly three quarters of emergencies were related to heroin use. More difficult to manage, they suggested, were cocaine-related emergencies characterised by increased anxiety, psychotic states, or epileptic seizures. Whereas the response to opioids was driven by the need to aid breathing, interventions after problematic cocaine use generally involved calming and protecting the person who had used drugs.

Only one death has been documented in a drug consumption room since the first opened in 1986, and this was not linked to the drug consumption room itself; in 2002, a person who used drugs died from anaphylaxis (an acute allergic reaction) in a German facility (1 2). While ‘nobody has died from an overdose inside a drug consumption room’ serves as a strong argument for them having a positive effect, this in itself is not a principal and necessary measure of success, but rather a comment or observation on the history of drug consumption rooms to date.

Conservative estimates of lives saved by drug consumption rooms include the prevention of four fatal overdoses per year in Sydney (Australia), and ten deaths per year in Germany. In Vancouver (Canada), there was a 35% decrease in fatal overdoses, and an estimated two to 12 fatal overdoses were prevented each year.

Costs and benefits

Costs for supervising drug use (the most distinctive function of drug consumption rooms) have been estimated at roughly the same in Vancouver and Sydney – the equivalent in Canadian currency of C$7.50–C$10 per injection. This would bring the cost of supervising all injections for someone who injects twice a day to about C$5,500–C$7,300 per year, which is in the same ballpark as the cost of providing methadone for a year to a patient in the United States.

Focusing almost exclusively on Vancouver, simulation studies have found that the value of averting a fatal overdose or HIV infection is so high that drug consumption rooms can pass the cost–benefit test even if the number of people affected is small (1 2). However, many other interventions also pass that test, including medication-assisted treatment, needle and syringe exchanges and naloxone, raising the question of how best to distribute scarce financial resources across such interventions.

It is unclear whether greater benefit would be achieved by investing the same amount of resources in interventions other than drug consumption rooms due to a lack of evidence about the magnitude of population-level benefits – firstly, because the literature can blur the lines between the impact of a drug consumption room’s entire suite of interventions and its supervision of consumption, and secondly, because supervised consumption can have spillover effects on behaviour outside drug consumption rooms as well as within the four walls.

Though other interventions may serve some of the functions of drug consumption rooms, they may not all be equally accessible to the target group of drug consumption rooms. For example, some would seem to be appointment-based rather than, as with drug consumption rooms, attended on a drop-in basis. Therefore, while it is understandable to question whether greater benefit would be achieved by investing the same amount of resources in interventions other than drug consumption rooms, this excludes the more fundamental argument about why drug consumption rooms should be considered in addition to existing interventions.

Adverse effects

Honeypot

‘Honeypot effect’ applies to bees, not consumption rooms

The published literature is large and almost unanimous in its support for drug consumption rooms, and there is little to no basis for concern about drug consumption rooms producing adverse effects. However, fears of adverse effects persist.

One of the concerns about drug consumption rooms is that they will aggravate public disorder and crime in surrounding local areas by attracting people who use drugs and dealers from elsewhere – termed the ‘honeypot effect’. While if this did happen it would also presumably extend the benefits of drug consumption rooms to non-local people who use drugs, neither the adverse nor the beneficial results of the honeypot effect have materialised in practice; where used, the term is alluding to a ‘phenomenon’ based in fear (or fear-mongering) rather than fact.

The European Union’s drug misuse monitoring centre found no evidence that drug consumption rooms result in higher rates of drug-related crimes in the vicinity (eg, trafficking, assaults, robbery). Most consumption room users live locally, and typically reflect the profiles of people buying drugs in local markets, and for this reason, facilities located any distance from drug markets tend to attract very few users. Explaining why, people who use drugs and gave evidence to the Joseph Rowntree Foundation’s Independent Working Group pointed out that:

“…An addicted injecting heroin user is likely to be primarily driven by the need to obtain their drugs. If they have the money, their first port of call will be a dealer. If there is somewhere nearby where they can safely use their drug (and obtain a clean syringe), then this is likely to be their next step. If they need to go any distance to reach such a place, their need to inject their drug is likely to lead to them using somewhere else (often a public area nearby).”

Although, on balance, research suggests that drug consumption rooms make drug use safer (eg, increasing access to health and social services, identifying and responding to emergencies, and reducing public drug use), and that fears (eg, encouraging drug use, delaying treatment entry, or aggravating problems arising from local drug markets) are not grounded in evidence (1 2 3), policy is not informed by evidence alone.

Evidence ‘just one ingredient in the policymaking process’

Drug consumption rooms have been seriously considered in the UK on several occasions since the turn of the millennium, but have arguably never been a realistic prospect because of government opposition. Though each time there has been genuine concern about harms associated with injecting drug use, followed with a review to understand the effectiveness of drug consumption rooms in mitigating these harms, ultimately the evidence base did little to convince decision-makers.

In 2002, a Home Affairs Select Committee on drugs policy recommended that drug consumption rooms be piloted in the UK:

“We recommend that an evaluated pilot programme of safe injecting houses for heroin users is established without delay and that if, as we expect, this is successful, the programme is extended across the country.”

However, the ‘New Labour’ government rejected this recommendation, arguing that the evidence appraised by the committee was insufficient to justify implementation, despite the pilot programme being proposed at least in part to generate evidence specific to the UK.

Looking at the wider context, it seems the political conditions were “not ripe for drug consumption rooms”. Concerns which likely had a prohibitive effect on the policy included (1 2):
• the potential for public confusion between drug consumption rooms and existing supervised heroin prescribing pilots;
• the potential for drug consumption rooms to be perceived as inconsistent with the government’s commitment to being “tough on crime, tough on the causes of crime”;
• the potential for the government to be accused by the media and others of opening ‘drug dens’;
• being open to legal challenges.

For this government, their future electoral success largely depended on being (and appearing to voters as) “tough on crime”, and drug consumption rooms risked appearing to condone the use of illegally bought drugs. ‘Heroin prescribing’, on the other hand, was a policy that New Labour was amenable to; the UK Government agreed to expanding diamorphine prescribing, approving a trial of three heroin prescription maintenance clinics in London, Brighton, and Darlington between 2005 and 2007. Unlike drug consumption rooms, this could be framed as ‘tough on crime’ – obviating the need for patients to commit acquisitive crimes to fund dependent heroin use.

Two years later, the British Medical Journal published a paper arguing that “the case for piloting supervised injecting centres in the United Kingdom [was] strong”, and that its rejection should be overturned. Diamorphine prescribing was an important tool in the box, the authors acknowledged, but would appeal to, and benefit, different groups to drug consumption rooms – the former, long-term heroin addicts who have not responded to traditional treatment, and the latter, people who are socially excluded and homeless:

“…Neither is a panacea…holistic provision should include both”.

The next time drug consumption rooms came under review in the UK was in 2006 by the Independent Working Group on Drug Consumption Rooms, made up of senior police officers, senior academics, a GP consultant, and a barrister specialising in drug offences. The group found that while there were “high levels of injecting drug use in particular areas of the UK, these did not appear to be associated with the sort of extensive public injecting that had been instrumental in the setting up of some of the European [drug consumption rooms]”. Although this did not deter them from making a strong recommendation in favour of piloting drug consumption rooms, their comment revealed that without these large open drug scenes associated with serious health and public order problems, the case for drug consumption rooms might appear weaker to politicians and the wider public. Nevertheless, their conclusion was:

“The [Independent Working Group] considers [drug consumption rooms] to be a rational and overdue extension to the harm reduction policy that has produced substantial individual and public benefits in the UK. They offer a unique and promising way to work with the most problematic users, in order to reduce the risk of overdose, improve their health and lessen the damage and costs to society.”

The political response to the Independent Working Group report was warm. However, the proposition was once again rejected.

Moving away from the national stage, cities have often taken the lead in continental Europe, and in Britain too they have not simply accepted the central government’s position. An important case study in this respect is Brighton, which had an unenviable reputation for one of the nation’s highest rates of drug-related mortality. Prompted by a call from Brighton’s Green Party MP, an Independent Drugs Commission was set up in Brighton in 2012. The following year the commission agreed that “where it is not possible to stop users from taking risks, it is better that they have access to safe, clean premises, rather than administer drugs on the streets or in residential settings”. Brighton’s Safe in the City Partnership should, they recommended, consider the feasibility of incorporating “consumption rooms into the existing range of drug treatment services in the city,” focusing on ‘hard-to-reach’ groups and those not engaged in treatment. These points were key: drug consumption rooms were to be deliberated as part of a larger framework of services; and drug consumption rooms were to be focused on a particularly vulnerable and marginalised cohort, as opposed to all injecting people who use drugs.

The feasibility study was undertaken, but in 2014 the commission’s final report concluded “that a consumption room was not a priority for Brighton and Hove at this time – the working group was convinced by the international evidence on the potential benefit from these facilities, but thought that they would have little impact on the types of factors that were contributing to deaths in the city”. Perhaps more importantly, “members of the working group were…concerned at the cost implications, in a time of budget pressure, and also advice from the Home Office that opening such facilities would contravene UK law”.

Drink and Drugs News article on what would persuade a city to accept a drug consumption room

Drink and Drugs News article on what would persuade a city to accept a drug consumption room

 

A month later in June 2014, the feasibility working group explained that there was insufficient support at the time to consider drug consumption rooms; both the Association of Chief Police Officers and Sussex Police were opposed, as were other organisations. Resistance was partially attributed to a “shift in focus for substance misuse services from harm reduction to recovery [which placed…] a greater emphasis on abstinence”. It was unclear whether as a group stakeholders were aligned with the values of abstinence-based recovery, or whether the policy and funding climate was forcing their hand. However, Brighton’s local paper The Argus reported that weeks after the feasibility study was launched, several stakeholders spoke out against drug consumption rooms, revealing a less than open mind in advance of the enquiry being concluded. This included Andy Winter, chief executive of Brighton Housing Trust, who said he wanted to see “something far more positive [done] with addiction and recovery”. Frustrated at what he considered a ‘distraction’ from recovery, treatment and abstinence, he resolved to “oppose any further waste of public funds, time and effort on exploring [their] feasibility”. With members like this on the group, whose minds were made up from the beginning, it would have been a surprise if drug consumption rooms were deemed feasible in Brighton.

In 2016, the Advisory Council for the Misuse of Drugs recommended that “consideration be given – by the governments of each UK country and by local commissioners of drug treatment services – to the potential to reduce [drug-related deaths] and other harms through the provision of medically-supervised drug consumption clinics in localities with a high concentration of injecting drug use”. However, a 2017 letter from the Home Office to the advisory council clarified that the government would not change its position on drug consumption rooms. The following year the government restated its position in public (1 2):

“We have no intention of introducing drug consumption rooms, nor do we have any intention of devolving the United Kingdom policy on drug classification and the way in which we deal with prohibited drugs to Scotland” (Home Office Minister Victoria Atkins, January 2018, House of Commons debate on drug consumption rooms).

“There is no legal framework for the provision of drug consumption facilities in the UK and we have no plans to introduce them” (Prime Minister Theresa May, July 2018, Prime Minister’s Questions).

In 2017, an advisory panel on substance misuse in Wales pledged to address the feasibility of establishing “enhanced harm reduction centres” – the term preferred by service providers to “reflect a desire to consider much more than simply providing a safe, clean place for individuals to inject but to expand the services on offer to include other harm reduction interventions (such as advice, wound care, blood borne virus testing, sexual health provision and links with wraparound services such as housing)”. Reminiscent of other ‘serious considerations’, the panel concluded just under a year later that, “based on the current available evidence”, it could not recommend the implementation of drug consumption rooms:

“In summary, there is evidence to suggest that [drug consumption rooms] are effective in decreasing drug-related mortality and morbidity […and, drug consumption rooms] should therefore be considered a successful tool as part of broader harm reduction interventions and strategies.”

“However…uncertainty about the generalisability of available research to the Welsh context must be taken into account in any consideration.”

Leaving the door ajar, the panel suggested a feasibility study “to inform decisions about possible implementation”, including what outcomes such facilities would seek to achieve, how these could be measured, operating procedures, and the inward and outward referral pathways.

‘Lack of evidence’ has repeatedly been cited as a barrier to implementing drug consumption rooms, despite reviews of the international evidence indicating that drug consumption rooms more likely than not remove harm (and do not cause harm), and despite the fact that pilot drug consumption rooms have been recommended in Britain at least in part to generate evidence of their viability and effectiveness in the domestic context. For cities like Glasgow in the midst of a crisis, calls for more rigorous research with no clearly defined end in sight is difficult to comprehend – “no reasonable person would wait for a randomized control trial evaluating parachutes before donning one when leaping from a plane”. The satirical paper published in the British Medical Journal that inspired this quote highlighted the absurdity of claiming that only randomised controlled trials will suffice in every scenario. As for resolving “whether parachutes are effective in preventing major trauma related to gravitational challenge”, the authors suggested two options for moving forward:

“The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial.”

Growing acceptance of safer injecting facilities and increasing concern about overdoses in Canada prompted a rapid escalation in efforts to establish consumption rooms in various cities. However, for a long time only one facility existed, and this remained in “perpetual pilot status for over a decade”. For Canada, political opposition to drug consumption rooms was the most significant barrier to expansion. The shift came in October 2015 with the election of a new government, which had expressed support for safer injecting facilities. Between 2016 and 2018 the country went from having two facilities to 26.

Through successive political parties, the UK Government has remained opposed to drug consumption rooms. Recent statements ( view above) exemplify unwavering commitment to the prohibition of drugs, which drug consumption rooms are perceived to contradict or undermine.

The ‘legal hurdles’

The message that has filtered down from government is that drug consumption rooms are incompatible with UK law. In Brighton, one of the reasons that stakeholders were collectively unwilling to recommend trialling drug consumption rooms was “advice from the Home Office that opening such facilities would contravene UK law”. However, that is not the end to the story. Though there may be some legal barriers, they could be easily overcome if the political will were there.

In 2016, plans to open a consumption room in Scotland were reported to be ‘pressing forward’, with advocates awaiting approval from James Wolffe QC, Scotland’s chief legal officer, in order to ensure compliance with the law. However, his legal opinion put the brakes on their perceived momentum (1 2). While the Lord Advocate had the power to instruct police not to refer people caught with illegal drugs for criminal proceedings, he said he could not remove the designation of those acts as illegal. In 2017, the Lord Advocate ruled that a change to the Misuse of Drugs Act 1971 would be necessary before drug consumption rooms could be introduced. Speaking to the Scottish Affairs Committee in 2019, he said:

“The introduction of such a facility would require a legislative framework that would allow for a democratically accountable consideration of the policy issues that arise and would establish an appropriate legal regime for its operation.”

To this end, the Supervised Drug Consumption Facilities Bill 2017–19 was introduced to the House of Commons in March 2018, containing provisions to make it lawful to take controlled substances within supervised consumption facilities. This included amendments to the Misuse of Drugs Act 1971, which would protect anyone employed within or using the drug consumption facilities.

The following year, a cross-party group of ConservativeLabourLiberal DemocratScottish National PartyGreen, and Crossbench politicians wrote a letter to The Telegraph urging the government to reconsider its “failing” approach to illicit drug use:

“These rooms have proved successful in many countries, including Germany, Canada and Australia. As it stands, they sit in a legal grey zone. It’s time for Britain to catch up with the rest of the world by providing a clear legal framework to trial drug consumption rooms in areas with high levels of drug-related harm.”

Clarifying the law, Release, the national centre of expertise on drugs law, has said that the Misuse of Drugs Act 1971 does not in fact make it illegal to allow someone to possess or inject controlled drugs on your premises, but does make it illegal to allow their production or supply or the smoking of cannabis and opium, which would suggest that a carefully managed facility could operate within the law despite its clients breaking laws prohibiting possession of controlled drugs – though this may not relieve concerns among professionals such as nurses and doctors about their liability in the event of a serious issue and the coverage of their medical insurance.

Asking the police to turn a ‘blind eye’ to illicit drugs may seem like it is asking them not to fulfil one of their key obligations – enforcing the law. However, this is not their only role; the police also have a responsibility for maintaining public order and public safety. Indeed, there are already examples of criminal justice objectives being compromised or reconsidered at the discretion of police forces for the ‘greater good’ – including to facilitate treatment and harm reduction, and better utilise limited resources – which could translate to drug consumption rooms if the political, institutional, and social will was there. Recent comparable examples include the following:
• Thames Valley Police are trialling an approach whereby police will urge people found with small quantities of controlled drugs to engage with support services, rather than arresting them. Dismissing allegations of being ‘soft on crime’, Assistant Chief Constable Jason Hogg said there is “nothing soft about trying to save lives”.
• Drug safety testing services have been piloted at a UK festival with the support of local police, who agreed to ‘tolerance zones’ where they would not search or prosecute for possession in order for members of the public to be able to bring drugs for testing and receive results as part of an individually tailored brief intervention.

Police and Crime Commissioners, who would be essential to build the local support for drug consumption rooms, have been prominent among those lobbying for the facilities. Several key figures have used their unique positions to advocate for a compassionate and pragmatic harm reduction-based approach to drugs, which they say should include drug consumption rooms. At least four have publicly come forward – Ron Hogg (Durham), Arfon Jones (North Wales), David Jamieson (West Midlands), and Martyn Underhill (Dorset) – and seven in total signed a letter to the Home Secretary, Sajid Javid MP, which called on him to end the government’s ‘policy’ of blocking the implementation of drug consumption rooms.

As part of its remit, the Independent Working Group on Drug Consumption Rooms commissioned an analysis by a leading expert on UK drugs law, Rudi Fortson. While he concluded that some adjustments of the law might further shield rooms from legal challenge, the group was “not persuaded that this would be a necessary and unavoidable first step. Pilot [drug consumption rooms] could be set up with clear and stringent rules and procedures that were shared with – and agreed by – the local police (and crime and disorder partnerships), the Crown Prosecution Service (CPS), the Strategic Health Authority and the local authority.” Despite this information being added to the public discourse, ambiguity over the legal footing of drug consumption rooms has prevailed.

Rudi Fortson has also investigated how facilities in Canada (see Effectiveness Bank analysis of the Insite project) and Australia operate, providing a glimpse into the workings of drug consumption rooms in countries with legal systems similar to that of the UK. For more click here.

In terms of international law, signatories to the United Nations’ international drug control conventions (including the UK, Australia and Canada) have another issue to consider: whether drug consumption rooms violate their obligations under those conventions. Charged with policing adherence to the conventions is the International Narcotics Control Board. From in 1999 an extreme condemnation claiming the rooms breach the conventions because they “facilitate illicit drug trafficking”, by 2015 the board seemed to admit that if a facility “provides for the active referral of [persons suffering from drug dependence] to treatment services”, they might be admitted within the spirit and letter of the conventions. For more click here.

For Rudi Fortson the thousands of words on whether drug consumption rooms contravene UN conventions had missed the wood for the trees. He observed that there has been a tendency to focus on the parts that impose restrictions and prohibitions, yet “conventions often embody statements of political will, intent, or hope”, and in this case prohibition was intended to be at the service of promoting public health and wellbeing, not its opposite. Moreover, none of the three main UN conventions have direct application in the UK; they are interpreted into UK law by parliament, and it is those interpretations on which the courts rely in their judgements.

When countries view drinking and illicit drug use through the lens of public health, laws often follow that prioritise the safety and wellbeing of people who use drugs and those around them, instead of prioritising the inviolability of prohibition. For instance, so-called ‘Good Samaritan laws’ have been enacted in the context of overdose-related deaths in Canada and various states in the US. In Canada, the Good Samaritan Drug Overdose Act was introduced in 2017, providing legal protections (eg, from charges for possession of a controlled substance or breach of parole) for people who experience or witness an overdose and call the emergency services.

Acceptance is at the root of benefits and criticisms

Recommended reading

Essay on harm reduction

Drug consumption rooms seek to minimise the harms of drugtaking for a cohort of people who, for complex reasons, are unable or unwilling to engage with treatment for their drug dependence, or are in treatment but still using illicit drugs.

What makes drug consumption rooms distinct from and more disruptive than other harm reduction approaches such as needle exchanges, is that they employ staff who bear witness to illicit drug use, as opposed to staff who advise and provide resources but are ultimately absent for the act of drugtaking. This enables the dissemination of specific (rather than generic) harm reduction advice based on direct observation of “consumption patterns, risky dosages and improper handling of equipment”:

“In order to successfully promote harm reduction topics, staff expressed that safer-use messages must be related to drug use practice, connected to daily life experiences and be given in one-on-one conversations.”

It also enables people who inject drugs to be fully seen and accepted – even and especially while engaging in behaviour that is typically shrouded with so much stigma and shame.

“…There’s no doubt that for the drug users this is a really, really good step in the right direction. Before they used to shoot up outside in the cold, in staircases, or in playgrounds using water from puddles. They shared syringes and they lived miserable lives. For many years they have been crying out: ‘…Maybe I cannot help using drugs but give me a decent life and some dignity’…It has been horrible for them. So I think that it means a lot to get off the streets, and to not be looked down on by other people.” (Nurse, Danish drug consumption room)

What drug consumption rooms set out to achieve is to “fundamentally reconfigure…each event of drug use”, producing “pleasurable and positive modes of engagement” that can improve survival and increase social integration.

However, the features above are not universally viewed as strengths; critics have persistently positioned drug consumption rooms as legitimising drug use, and therefore doing rather than alleviating harm. Speaking out against proposed consumption room pilots in Brighton in 2013, Kathy Gyngell from the right-wing Centre for Policy Studies questioned the premise of a ‘safe space’ for injecting altogether, saying that drug consumption rooms are “described as safe despite the very unsafe street drugs used in them, and despite the intrinsic risk of addicts continuing to inject drugs at all”. In 2016 a pilot drug consumption room opened in Paris near a busy central station where drug crime is common. For France’s health minister it was “a very important moment in the battle against the blight of addiction”, but for a politician from the centre-right opposition, the country was “moving from a policy of risk reduction to a policy of making drugs an everyday, legitimate thing. The state is saying ‘You can’t take drugs, but we’ll help you to do so anyway’” – wildly differing perspectives on the same facility.

Though the loudest voices may be people totally in favour of, or totally against, harm reduction services, many people sit somewhere in the middle – perhaps accepting the need for needle exchanges, but instinctively opposed to drug consumption rooms, believing that they cross an ideological red line from reducing harm to facilitating drug use. It is in this space that misunderstandings and misrepresentations of drug consumption rooms can flourish.

Claims that drug consumption rooms ‘enable’ drug use are hard to shake, but fail at face value. The target group of drug consumption rooms do not need help or encouragement to take drugs; they need support to take drugs without preventable risks. If harm reduction measures aren’t in place, they will likely continue to take drugs, just in a riskier way. Introducing a Bill to the House of Commons which would make the necessary legal provisions for drug consumption rooms, Alison Thewliss MP said in March 2018:

“On Monday, one of my constituents mentioned to me that Glasgow already has drug consumption facilities: they are behind the bushes near his flat and in his close when it rains. Right now, they are also in bin shelters, on filthy waste ground and in lonely back lanes. They are in public toilets and in stolen spaces where intravenous drug users can grasp the tiniest modicum of dignity and privacy for as long as it takes to prepare and inject their fix. Often they are alone, and, far too regularly, drug users will die as a result. As a society, we can and must do much better than that.”

Drug consumption rooms recognise these realities and ‘meet people where they’re at’ – creating a bubble of acceptance of drugtaking within a broader context of criminalisation. With stigma and shame alleviated, and relationships forged with harm reduction professionals, this may open a door to treatment further down the line. However, it may also ‘just’ lead to safer injecting practices; it may ‘just’ lead to overdoses being prevented, lives being saved, health and wellbeing improved, and dignity and social connections restored.

If there is an ideological ‘green line’ over which people must cross to support drug consumption rooms, that line is agreement with the idea that where harms can be minimised or prevented, they should be – even if that means a degree of toleration of illegal drug use. One can still hold that position while believing that people’s lives would be improved if they stopped taking drugs, or even that illicit drugs have a deleterious impact on society overall. This perspective prioritises the current health, wellbeing and dignity of people, over judgements about their behaviour or wishes for their future selves.

Reframing drug consumption rooms and the people who use them

Drug consumption rooms go by many names, including overdose prevention centres, safer injecting facilities, enhanced harm reduction centres, medically supervised injecting centres, safe injecting sites, drug injection rooms, and drug fixing rooms. Each have different connotations. For example, ‘safer injecting facility’ refers narrowly to venues where people can more safely inject illicit drugs, though there are also consumption rooms where people can inhale or inject, depending on the landscape of harms in the locality. The term ‘enhanced harm reduction centres’ takes an expanded view of the harm reduction services and routes into treatment on offer, but could have the (unintended) consequence of minimising the importance of the supervised drug consumption element.

In academia and the news media, drug consumption rooms are often framed as a controversial prospect, highlighting how far they lean away from the status quo of prohibition and law enforcement. Sometimes articles use the word ‘controversial’, sometimes they imply it by listing concerns (even if unfounded or so far disproved by the evidence base) about drug consumption rooms, and sometimes articles achieve it through innuendo, for example referring to them as ‘shooting galleries’, which are illegal venues run for profit by drug dealers.

In the UK, this can have the effect of cementing (rather than merely reflecting) their political reality as ‘extreme’ and ‘unrealistic’ – perpetuating the thinking that current drug policy is the neutral position to take, and ignoring the fact that drug consumption rooms have become a “normalised harm reduction approach across Europe and other countries”. It also embeds a debate defined around the problem of implementing drug consumption rooms, rather than drug consumption rooms being a potential solution to the problem of public injecting.

“Words matter,” stressed commentators in North America in an article about the role of language in advancing or inhibiting evidence-based responses to the worldwide opioid crisis. Our choice of words can have an impact on how people who inject drugs are perceived, and the extent to which we advance solutions to drug-related harm based on a person’s “individual responsibility” versus wider situational, environmental, political and social factors such as inadequate distribution of naloxone, contaminated drug supply, social isolation, and lack of social support.

An analysis of how the UK news media represented proposals to introduce drug consumption rooms in Glasgow identified the use of derogatory language (such as ‘junkies’) to describe people who inject, and this was not confined to articles that opposed drug consumption rooms, but also present in articles that supported drug consumption rooms. Articles also tended to define individuals primarily by their drug use, reducing their humanity to a stigmatised behaviour, and doing nothing to contest the “morally charged” perception of individuals causing harm to themselves and wider society through their continued drug use.

The UK Government’s approach to illicit drugs is built on the pillars of prohibition and abstinence, which themselves rest on the belief that drugs are inherently harmful to people who use them, and to wider society. Therefore, any messages which contradict or soften the prioritisation of drug criminalisation and abstinence-based approaches are seen as undermining the ability of criminal justice and treatment systems to ‘protect’ people from harm.

While proponents of drug consumption rooms may be able to see drug consumption rooms as compatible with services based on both harm reduction and abstinence, opponents tend to position them as mutually exclusive – arguably because of what they represent, as well as what they do. Drug consumption rooms challenge the dominant interpretation of where harm (and subsequently blame) lies, showing how the environment in which drugs are consumed can decrease or increase, mitigate or compound, the harms people experience; in other words, drugs may produce harms (as well as benefits), but a fatal overdose or blood-borne virus need not be the price a person pays for taking drugs. Drug consumption rooms were specifically established to address the disproportionate level of harm that disadvantaged people who use drugs experience. They radically change the conditions in which people take drugs, and serve as a brick and mortar reminder of the structural inequalities that make it necessary to offer this alternative to public injecting.

“Current discussions about drug consumption rooms risk excluding, minimising, or erasing the current, specific, and urgent problem of public injecting”Philosophical differences between “those calling for a change in UK drug policy to incorporate harm reduction, and those who attempt[…] to maintain status quo responses based on abstinence[,…] recovery” and prohibition account for a large part of the disagreement about drug consumption rooms. Though understandable, discussion framed around these higher-level philosophical differences may risk excluding, minimising, or erasing the current, specific, and urgent problem of public injecting.

One thing proposed which could help interested parties navigate their differences in “harmony” is a better appreciation for how and why someone’s professional and intellectual background informs their view of drug consumption rooms, and specifically their appraisal of the evidence base. Published in the Addiction journal (and analysed in the Effectiveness Bank), a paper by Caulkins and colleagues distinguishes between three types of decision-makers (the politician, the planner, and the pioneer), and three types of thinkers (the academic, the advocate, and the allocator of scarce resources), arguing that there is plenty of nuance between the commonly-heard extreme positions.

This nuance is helpful, particularly introducing concerns that may hold people back in a practical sense from endorsing drug consumption rooms. For instance, commissioners – people allocating already stretched resources – may support drug consumption rooms personally or politically, but also need to know on paper how drug consumption rooms fare against interventions already in place (or themselves needing expansion) such as naloxone and opioid substitute medications:

‘Would drug consumption rooms save more lives per dollar than other available alternatives?’

‘Would we need to disinvest in other services to pay for drug consumption rooms?’

What the paper did not do, was acknowledge the power dynamics between stakeholders, for example the way that politicians may act as or be perceived as gatekeepers or roadblocks to lifesaving interventions. It didn’t recognise that the status quo in countries like the UK, maintained by stakeholders including politicians, represents unwavering opposition to drug consumption rooms. Stakeholders may have different perspectives about these facilities, informed by their decision-making responsibilities and intellectual backgrounds, but how is the power to make decisions and influence public opinion distributed, and how close are the people in positions of power and influence to the day-to-day realities of the target groups of drug consumption rooms?

Time for safer injecting spaces in Britain?

In Scotland, record-breaking levels of drug-related deaths and an outbreak of HIV among people who inject drugs have been at the forefront of discussions about the need to expand services for people with drug and alcohol problems – without which it is feared that substance use in the context of deprivation and homelessness will remain a threat to the life and quality of life of vulnerable people.

“…A public health and humanitarian crisis which must be addressed urgently”Figures released by National Records of Scotland in July 2019 showed that drug-related deaths in Scotland had increased by 27% from 2017 to 2018. At 1,187 in 2018, Scotland was looking at the highest rate of drug-related deaths since records began in 1996 – three times that of the UK as a whole, and indeed higher than reported for any other EU country. In a press release for the National AIDS Trust, Director of Strategy Yusef Azad said: “The high rate of drug-related deaths constitutes a public health and humanitarian crisis which must be addressed urgently.”

In Glasgow city centre there were 47 new diagnoses of HIV among people who inject drugs in 2015, compared to an annual average of 10. This problem caught the attention of the European Monitoring Centre for Drugs and Drug Addiction, which reported 119 new cases of HIV in Glasgow between November 2014 and January 2018, specifically among homeless people who inject drugs. The agency described this as “the largest cluster of people who inject drugs infected with HIV…in the United Kingdom since the 1980s”. An important feature of this outbreak was its strong link to cocaine use, which surveillance data from needle and syringe programmes using dried blood testing and data from syringe residues in 2017 indicates is increasingly being injected (with or without heroin). Critically, harm reduction services (including the provision of injecting equipment and opioid substitution treatment) were available before and during the outbreak – needle and syringe programmes in Glasgow distribute over one million syringes per year – suggesting that circumstances had changed or were changing and required a different or intensified response.

The_Times_Scotland_HIVDaily_Record_Scotland_deaths
In Taking away the chaos, the local health service and Glasgow’s drug service coordinating partnership reviewed the health and service needs of people who inject drugs in public places in the city centre. Resulting recommendations were to develop existing services, including extending assertive outreach services and developing a peer network for harm reduction, and to introduce new services, such as a pilot safer injecting facility in the city centre to “address the unacceptable burden of health and social harms caused by public injecting”. However, to date the Scottish Government has been constrained by legal judgements that drug consumption rooms would fall under the purview of the UK Government (and UK-wide Misuse of Drugs Act 1971).

The Scottish Government’s approach to drugs and alcohol reflects the belief that substance use problems are predominantly public health and human rights issues, which enables it to pursue policies that save and improve lives. This puts it at odds with the UK Government, which has been unwilling to depart from treating substance use as a criminal justice issue. As with minimum unit pricing, Scotland has been nudging the UK position on drug consumption rooms, referring in a 2018 strategy to the Scottish Government’s efforts to “press the UK Government to make the necessary changes in the law, or if they are not willing to do so, to devolve the powers in this area so that the Scottish Parliament has an opportunity to implement this life-saving strategy in full.” Not letting this be a footnote in the strategy, the Minister for Public Health, Sport and Wellbeing Joe FitzPatrick used drug consumption rooms in his opening remarks (see page 3) as an example of “supporting responses which may initially seem controversial or unpopular”:

“Adopting a public health approach also requires us all to think about how best to prevent harm, which takes us beyond just health services. This, requires links into other policy areas including housing, education and justice. It also means supporting responses which may initially seem controversial or unpopular, such as the introduction of supervised drug consumption facilities, but which are driven by a clear evidence base.”

If there was an evidentiary threshold for trialling drug consumption rooms in the UK, the Home Affairs Select Committee on drugs policy, Independent Working Group on Drug Consumption Rooms, and Advisory Council on the Misuse of Drugs were confident in 20022006, and 2016 (respectively) that this had been passed. That successive governments have not accepted recommendations for a pilot study indicates that factors outside of the evidence base are fundamental to determining the acceptability and feasibility of drug consumption rooms in Britain.

2004 briefing explained that in order for drug consumption rooms to be accepted and allowed to supplement the UK’s repertoire of substance use interventions, three broad areas inhibiting policymakers would need resolving:
• Principle: “How do policy makers justify providing a service that enables people to engage legitimately in activities that are both harmful and illegal?”
• Messages: “Do [drug consumption rooms] legitimise drug use, encourage more people to use hard drugs or – at the local level – increase drug-related problems in the areas where they are situated?”
• Effectiveness: “Do [drug consumption rooms] reduce drug related harms and, even if they do, are they the most appropriate and cost effective way of reducing these harms?”

The last two points are arguably the easiest to address. On messages, the answer is clear: there is an evidence base of ‘real world’ trials determining that drug consumption rooms produce sufficient benefits, with no countervailing problems; specifically, there is no evidence that they encourage more people to use ‘hard drugs’ or increase drug-related problems in the vicinity of drug consumption rooms. On effectiveness, there is sufficient evidence that drug consumption rooms reduce drug-related harms among the target population, however: (1) this evidence does not rise to the ‘gold standard’ of randomised controlled trials, though the ethics of holding harm reduction interventions to this bar before implementation should be rigorously challenged; and (2) there is a need to pilot them in the UK context to understand how they could respond to local drug-using populations and fit within wider communities. The principle on which drug consumption rooms rest is where most of the conflict lies.

Despite similar levels of drug-related harm in Germany and the UK, only Germany has responded to the problem with drug consumption rooms (accruing 24 at the time of publication). Researchers from both countries identified differences that could account for this, pointing in particular to:
• limited local powers in the UK compared to Germany, enabling German cities to introduce drug consumption rooms, which could eventually lead to federal support;
• large open drug scenes in Germany (not found to the same degree in the UK), which are associated with serious health and public order problems and played a pivotal role in persuading communities and local politicians that something had to be done;
• historical tendency of the British press to stoke up fears around drug use and people who use drugs; whenever the issue has been discussed, much of the reporting has been negative, with frequent derogatory references to ‘shooting galleries’.

Should the outrage and solutions proposed in Scotland start to shift mindsets, Britain already has a good-practice blueprint to guide implementation. In 2008, the Joseph Rowntree Foundation published guidance for local multi-agency partnerships looking into opening a drug consumption room. It addressed minimum operational standards, domestic and international legal issues, as well as the commissioning process, operational policies and procedures, monitoring and evaluation. It also stressed that local agreement is absolutely essential – something not generated previously in Brighton ( above), though with “accumulating evidence of poor health and social outcomes for [people who inject drugs]” in Scotland and the political will, the story may end differently.

Concluding thoughts

When we first published this hot topic on drug consumption rooms in 2016 we suggested “there seem two scenarios in which support for drug consumption rooms could be generated in the future”:

“…firstly, if there were to be a policy shift towards harm reduction, not just as a mechanism to engage drug users with treatment, but as a legitimate goal in itself; and secondly, if the UK were to reach a ‘tipping point’ in the degree of distress and nuisance perceived to be caused by public injecting, or the degree of concern over the concentration of overdose fatalities and infectious diseases in certain locations.”

Three years on, central government’s position on drug consumption rooms in the face of mounting harms to vulnerable and socially-excluded people injecting in public casts doubt of the notion of reaching such a ‘tipping point’.

Drug consumption rooms are not a replacement for abstinence, treatment, or law and order; they provide respite from public injecting, restore a vital connection to healthcare and social support services for a highly-marginalised and highly-stigmatised group of people, and put the interest and wellbeing of people who use drugs at the heart of drug policy. Consistent evidence of their effectiveness suggests that it would be prudent and overdue to trial drug consumption rooms in UK cities. Whether Westminster will reconsider remains to be seen. Meanwhile, as more and more countries integrate this pragmatic harm reduction approach into their drugs policy, any claim to the moral high ground in Westminster seems easily refuted.

Thanks for their comments on this entry in draft to Blaine Stothard (Co-Editor, Drugs and Alcohol Today), Dr Will Haydock (Visiting Fellow, Bournemouth University), Claire Brown (Editor, Drink and Drugs News), Philippe Bonnet (Chair, National Needle Exchange Forum), and Naomi Burke-Shyne (Executive Director, Harm Reduction International). Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 30 July 2020. First uploaded 27 October 2016

Source: Time for safer injecting spaces in Britain? (findings.org.uk)

A growing number of countries are deciding to ditch prohibition. What comes next?

In an anonymous-looking building a few minutes’ drive from Denver International Airport, a bald chemotherapy patient and a pair of giggling tourists eye the stock on display. Reeking packets of mossy green buds—Girl Scout Cookies, KoolAid Kush, Power Cheese—sit alongside cabinets of chocolates and chilled drinks. In a warehouse behind the shop pointy-leaved plants bask in the artificial light of two-storey growing rooms. Sally Vander Veer, the president of Medicine Man, which runs this dispensary, reckons the inventory is worth about $4m.

America, and the world, are going to see a lot more such establishments. Since California’s voters legalised the sale of marijuana for medical use in 1996, 22 more states, plus the District of Columbia, have followed suit; in a year’s time the number is likely to be nearer 30. Sales to cannabis “patients” whose conditions range from the serious to the notional are also legal elsewhere in the Americas (Colombia is among the latest to license the drug) and in much of Europe. On February 10th Australia announced similar plans.

Now a growing number of jurisdictions are legalising the sale of cannabis for pure pleasure—or impure, if you prefer. In 2014 the American states of Colorado and Washington began sales of recreational weed; Oregon followed suit last October and Alaska will soon join them. They are all places where the drug is already popular (see chart 1). Jamaica has legalised ganja for broadly defined religious purposes. Spain allows users to grow and buy weed through small collectives. Uruguay expects to begin non-medicinal sales through pharmacies by August.  

Canada’s government plans to legalise cannabis next year, making it the first G7 country to do so. But it may not be the largest pot economy for long; California is one of several states where ballot initiatives to legalise cannabis could well pass in America’s November elections. A majority of Americans are in favour of such changes (see chart 2).

Legalisers argue that regulated markets protect consumers, save the police money, raise revenues and put criminals out of business as well as extending freedom. Though it will be years before some of these claims can be tested, the initial results are encouraging: a big bite has been taken out of the mafia’s market, thousands of young people have been spared criminal records and hundreds of millions of dollars have been legitimately earned and taxed. There has so far been no explosion in consumption, nor of drug-related crime.

To get the most of these benefits, though, requires more than just legalisation. To live outside the law, Bob Dylan memorably if unconvincingly claimed, you must be honest; to live inside it you must be regulated. Ms Vander Veer points to a “two-inch thick” book of rules applicable to Medicine Man’s business.

Such rules should depend on which of legalisation’s benefits a jurisdiction wants to prioritise and what harms it wants to minimise. The first consideration is how much protection users need. As far as anyone has been able to establish (and some have tried very hard indeed) it is as good as impossible to die of a marijuana overdose. But the drug has downsides. Being stoned can lead to other calamities: in the past two years Colorado has seen three deaths associated with cannabis use (one fall, one suicide and one alleged murder, in which the defendant claims the pot made him do it). There may have been more. Colorado has seen an increase in the proportion of drivers involved in accidents who test positive for the drug, though there has been no corresponding rise in traffic fatalities.

The chronic harm done by the drug is still a matter for debate. Heavy cannabis use is associated with mental illness, but researchers struggle to establish the direction of causality; a tendency to mental illness may lead to drug use. It may also be the case that some are more susceptible to harm than others.

Jonathan Caulkins of Carnegie Mellon University has found that cannabis users are more likely than alcohol drinkers to say the drug has caused them problems at work or at home. It is an imperfect comparison because most cannabis users are, by definition, lawbreakers, and therefore perhaps more prone to such problems. Nonetheless it is clear that pot is, in Mr Caulkins’ words, a “performance-degrading drug”.

What’s more, some struggle to give it up: in America 14% of people who used pot in the past month meet the criteria by which doctors define dependence. As in the alcohol and tobacco markets, about 80% of consumption is accounted for by the heaviest-using 20% of users. Startlingly, Mr Caulkins calculates that in America more than half of all cannabis is consumed by people who are high for more than half their waking hours.

To complicate matters, the public-health effects of cannabis should not be looked at in isolation. If taking up weed made people less likely to consume cigarettes or alcohol it might offer net benefits. But if people treat cannabis and other drugs as complements—that is, if doing more pot makes them smoke more tobacco or guzzle more alcohol—an increase in use could be a big public-health problem.

No one yet knows which is more likely. A review of mostly American studies by the RAND Corporation, a think-tank, found mixed evidence on the relationship between cannabis and alcohol. Demand for tobacco seems to go up along with demand for cannabis, though the two are hard to separate because, in Europe at least, they are often smoked together. The data regarding other drugs are more limited. Proponents of the Dutch “coffee shop” system, which allows purchase and consumption in specific places, argue that legalisation keeps users away from dealers who may push them on to harder substances. And there is some evidence that cannabis functions as a substitute for prescription opioids, such as OxyContin, which kill 15,000 Americans each year. People used to worry that cigarettes were a “gateway” to cannabis, and that cannabis was in turn a gateway to hard drugs. It may be the reverse: cannabis could be a useful restraint on the abuse of opioids, but a dangerous pathway to tobacco.

More bong for your buck

Danger and harm are not in themselves a reason to make or keep things illegal. But the available evidence persuades many supporters of legalisation that cannabis consumption should still be discouraged. The simplest way to do so is to keep the drug expensive; children and heavy users, both good candidates for deterrence, are particularly likely to be cost sensitive. And keeping prices up through taxes has political appeal that goes beyond public health. Backers of California’s main legalisation measure make much of the annual $1 billion that could flow to state coffers.

Setting the right level for the tax, though, is challenging. Go too low and you encourage use. Aim too high and you lose one of the other benefits of legalisation: closing down a criminal black market.

Comparing Colorado and Washington illustrates the trade-off. Colorado has set its pot taxes fairly low, at 28% (including an existing sales tax). It has also taken a relaxed approach to licensing sellers; marijuana dispensaries outnumber Starbucks. Washington initially set its taxes higher, at an effective rate of 44%, and was much more conservative with licences for growers and vendors. That meant that when its legalisation effort got under way in 2014, the average retail price was about $25 per gram, compared with Colorado’s $15. The price of black-market weed (mostly an inferior product) in both states was around $10.

The effect on crime seems to have been as one would predict. Colorado’s authorities reckon licensed sales—about 90 tonnes a year—now meet 70% of total estimated demand, with much of the rest covered by a “grey” market of legally home-grown pot illegally sold. In Washington licensed sales accounted for only about 30% of the market in 2014, according to Roger Roffman of the University of Washington. Washington’s large, untaxed and rather wild-west “medical” marijuana market accounts for a lot of the rest. Still, most agree that Colorado’s lower prices have done more to make life hard for organised crime.

Uruguay also plans to set prices comparable to those that illegal dealers offer. “We intend to compete with the illicit market in price, quality and safety,” says Milton Romani, secretary-general of the National Drug Board. To avoid this competitively priced supply encouraging more use, the country will limit the amount that can be sold to any particular person over a month. In America, where such restrictions (along with the register of consumers needed to police them) would probably be rejected, it will be harder to stop prices for legal grass low enough to shut down the black market from also encouraging greater use. Indeed, since legalisation consumption in Colorado appears to have edged up a few percentage points among both adults and under-21s, who in theory shouldn’t be able to get hold of it at all; that said, a similar trend was apparent before legalisation, and the data are sparse.

If, starved of sales, the black market shrinks beyond a point of no return, taxes could later go up, restoring the deterrent. There is precedent for this. When the prohibition of alcohol ended in 1933, Joseph Choate of America’s Federal Alcohol Control Administration recommended “keeping the tax burden on legal alcoholic beverages comparatively low in the earlier post-prohibition period in order to permit the legal industry to offer more severe competition to its illegal competitor.” After three years, he estimated, with the mob “driven from business, the tax burden could be gradually increased.” And so it was (see chart 3).

Those taxes reflected the strength of what was for sale; taxing whiskey more than beer made sense as a deterrent to drunkenness. Here, so far, the regulation of cannabis lags behind. The levies on price or weight used by America’s legalising states are easy to administer, but could push consumers towards stronger strains. In the various lines sold by Medicine Man, for example, the concentration of tetrahydrocannabinol (THC), the chemical compound that gets you high, varies from 7% to over 20%. The prices, though, are mostly the same, and there is no difference in tax. Some like it weak, but on the whole, Ms Vander Veer says, the stronger varieties are what people ask for. If they cost no more, why not? The average potency on sale in Denver is now about 18%, roughly three times the strength of the smuggled Mexican weed that once dominated the market.

Barbara Brohl, the head of Colorado’s Department of Revenue, says THC-based taxation is something the state may try in the future. But the speed with which the regulatory apparatus was set up—sales began just over a year after the ballot initiative passed in November 2012—meant that they had to move fast. “We’re building the airplane while we’re in the air,” she says. Uruguay, clear that it wants to be “a regulated market, not a free market”, as Mr Romani puts it, plans a more direct way of discouraging the stronger stuff. Dispensaries will sell just three government-approved strains of cannabis, their potencies ranging from 5% to 14%.

Another issue for regulators is the increasing number of ways in which cannabis is consumed. The star performer of the legalised pot market is the “edibles” sector, which includes THC-laced chocolates, drinks, lollipops and gummy bears. There are also concentrated “tinctures” to be dropped onto the tongue and vaping products to be consumed through e-cigarettes. Foria, a California company, sells a THC-based personal lubricant (“For all my vagina knew, I was laying on one of San Diego’s fabulous beaches!” reads one testimonial).

The popularity of these products looks set to grow; users appreciate the discretion with which they can be consumed, producers like the ease with which their production can be automated (no hand-picking of buds required). But edibles, in particular, make it easy to take more than intended. A hit on a joint kicks in quickly; cakes or drinks can take an hour or two. Inexperienced users sometimes have a square of chocolate, feel nothing and wolf down the rest of the bar—only to spend the next 12 hours believing they are under attack by spiders from Mars.

The three cannabis-related deaths in Colorado all followed the consumption of edibles. Hospitals in the state also report seeing an increasing number of children who have eaten their parents’ grown-up gummy bears. In response the authorities have tightened their rules on packaging, demanding clearer labelling, childproof containers, and more obvious demarcation of portions.

A second concern about new ways of taking the drug is that they could attract new customers. Ms Vander Veer says that edibles offer a “good way to get comfortable with how THC makes you feel”; women, older people and first-timers are particularly keen on them. If you see cannabis as a harmless high, this is not a problem. If you want to keep usage low, it is.

The innovation seen to date is just a taste of what entrepreneurs might eventually dream up. On landing in Denver—which, uncoincidentally, is now the most popular spring-break destination for American students—you can call a limo from 420AirportPickup which will drive you to a dispensary and then let you smoke in the back while you cruise on to a cannabis-friendly hotel (some style themselves “bud ‘n’ breakfast”). You can take a marijuana cookery course, or sign up for joint-rolling lessons. Dispensaries offer coupons, loyalty points, happy hours and all the other tricks in the marketing book.

Legalisation has also paved the way for better branding. Snoop Dogg, a rap artist, has launched a range of smartly packaged products called “Leafs by Snoop”. The estate of Bob Marley has lent its name to a range of “heirloom marijuana strains” supposedly smoked by the man himself.

Roll up for the mystery tour

Branding means advertising, which may itself promote use. Many in America would like to follow Uruguay’s example and ban all cannabis advertising, but the constitution stands in their way. When Colorado banned advertising in places where more than 30% of the audience is likely to be under-age cannabis companies objected on the grounds of their right to free speech, though the suit was later dropped.

As well as moving into advertising, the industry is growing more professional in its lobbying. In legalisation initiatives the “Yes” side increasingly outspends the “No” side: in Alaska by four to one, in Oregon by more than 50 to one. Rich backers help—in California Sean Parker, an internet billionaire, has donated $1m to the cause. In some states, ballot initiatives have been heavily influenced by the very people who are hoping to sell the drugs once they are legalised. In November 2015 voters in Ohio soundly rejected a measure that would have granted a cannabis-cultivation oligopoly to the handful of firms that had backed it.

Worries about regulatory capture will increase along with the size of the businesses standing to gain. Big alcohol and tobacco firms currently deny any interest in the industry. But they said the same in the 1960s and 1970s, a time when Philip Morris and British American Tobacco, it has since been revealed, were indeed looking at the market. Brendan Kennedy, the chief executive of Privateer Holdings, a private-equity firm focused on the marijuana industry, says that several alcohol distributors have invested in American cannabis firms.

Even without such intervention big companies are likely to emerge. Sam Kamin, a law professor at Denver University who helped draft Colorado’s regulations, suspects that eventual federal legalisation, which would make interstate trade legal, could well see cannabis cultivation become something like the business of growing hops, virtually all of which come from Washington, Oregon and Idaho. Big farms supplying a national market would be much cheaper than the current local-warehouse model, driving local suppliers out of the market, or at least into a niche.

The industry has so far been helped by the fact that many on the left who might normally campaign against selling harmful substances to young people are vocal supporters of legalisation. That could change with the growth of a business lobby that, although understanding that an explosion in demand would trigger a backlash, may have little long-term interest in restraint. The prospect of such a lobby could also serve as an incentive for states to take the initiative on legalisation, rather than waiting for their citizens to demand it. Fine-tuning Colorado’s regime, Mr Kamin says, has been made harder by the fact that the ballot of 2012 enshrined legalisation in the state constitution. Other states “might want [their rules] to be defined instead by legislation, not citizens’ initiative,” suggests Ms Brohl, the Colorado tax chief.

Different places will legalise in different ways; some may never legalise at all; some will make mistakes they later think better of. But those that legalise early may prove to have a lasting influence well beyond their borders, establishing norms that last for a long while. It behoves them to think through what needs regulating, and what does not, with care. Over-regulation risks losing some of the main benefits of liberalisation. But as alcohol and tobacco show, tightening regimes at a later date can be very difficult indeed.

Source:  http://www.economist.com/news/briefing/21692873   13 Feb. 2016

Tragically, the last few months of music festivals repeatedly resembled scenes from a hospital emergency ward, witnessing this season’s highest number of drug related hospitalisations and the deaths of predominately young adults ranging from 19 to 25 years-old.
In the aftermath of these heart wrenching events, harm reduction advocates have taken to media on mass advocating for pill testing as the next risk minimisation strategy that could potentially save lives.
Often, supporters are quick to highlight that pill testing is “not a silver bullet”, just one measure among a plethora of strategies. But the metaphor is a false equivocation. Rather, pill testing is more like Russian Roulette.
Similar to Russian Roulette, taking psychotropic illicit drugs is a deadly, unpredictable high stakes ‘game’. It’s the reason they’re illegal. There is no ‘safe’ way to play.
But arguments and groups supporting pill testing construct this false perception, regardless of how strenuously advocates claim otherwise. Organisations such as STA-SAFE, Unharm, Harm Reduction Australia, the ‘Safer Summer’ campaign all exploit the context of harm and safety within an illicit drug taking culture.
To continue the metaphor of Russian Roulette, it’s rather like insisting on testing a ‘bullet’ for velocity or the gun for cleanliness and handing both back. It’s pointless. The bullet might not kill at first, but the odds increase exponentially after each attempt.

No Standard Dose Available and the Limitations of Pill Testing
In reality, no testing of the hundreds of new psychoactive substances flooding nations every year can make a dose safe.

As Drug Watch International succinctly puts it, “Most people have been conned into using the word ‘overdose’ regarding illicit drugs. No such thing. Why? Because it clearly implies there is a ‘safe’ dose which can be taken – and everyone knows that’s a lie. The same goes for the words, ‘use’ and ‘abuse’. Those terms can only be applied to prescribed pharmaceuticals because they have a prescribed safe dose. I have asked each jurisdiction in Australia if the legal amount of alcohol when driving, up to 0.49, is considered safe for driving. All said no – they would not state that.”
These substances remain prohibited because they are not manufactured to a pharmaceutical standard and are poisonous, unpredictable toxins that make it impossible to test which dose either in isolation or in a myriad of combinations proves fatal.
The limitations of pill testing4 have been discussed by Dr John Lewis (University of Technology Sydney) and prominent toxicologist Dr John Ramsey, emphasising that it is:
• Complex process
• Costly and time consuming
• Detects mainly major components of a sample that may not be the active substance
For example, even a relatively small amount of ingredients such as Carfentanil are lethal.
Speaking after Canberra’s pill trial in 2017, forensic toxicologist, Andrew Leibie, warned that pill testing trial is no “magic bullet” for preventing drug deaths but also expressed deep concern surrounding the freedom for scientific debate because public sector employees feared repercussions.

Leading harm reduction activist, Dr David Caldicott, in a 2015 interview admitted that the quality and type of pill testing would affect pill taking behaviour at festivals. When told that users potentially wouldn’t get their drugs back and the lengthy 45-minute process involved, “‘I think there’ll be a lot of people who will say forget it completely.’ His reasoning being that a lot of young people don’t have the money to spare a pill and it would slow down the momentum of the party.”

Could this be the motivation behind current trial of pill testing at Goovin’ the Moo where volunteering attendees where given the choice between testing the entire pill – effectively destroying it – or scraping the contents and handing back the remainder, despite the fact that the latter approach brings even less accuracy. This is another example of drug users, not evidence informing policy procedure.
The irony of course is that many of the advocates for pill testing would object to sugary drinks, foods and caffeinated energy drinks in school cafeterias on the basis these hinder the normal development of healthy children but do not object to the infinitely direr situation facing kids at music festivals.

Purity vs Contaminated – Another Misleading Contrast
The fallacious arguments surrounding safe dosage remain the same irrespective of whether the substance is tested as seemingly pure. Take MDMA that goes by various street names Molly and Ecstasy. It is the most popular recreational drug in Australia and was responsible for many of the deaths at music festivals.
In 1995, 15-year old, Anna Woods, died after several hours from consuming a single pill of pure MDMA at a Rave Party. Pill testing would not have changed this outcome. Anna’s case also highlights the idiosyncratic nature of drug taking in that while her three friends ingested the same tablets, Anna was the only one to have a reaction. Russian Roulette is again the most appropriate metaphor.
The Coroner’s report on Anna Wood’s death stated, “It is not unlikely that a tragedy such as this will occur again in N.S.W. In an effort to reduce the chance of that happening, I propose to recommend that the N.S.W. Health Department publishes a pamphlet, which will have the twofold effect of educating those who use the drug as to its dangers, and also educating the community as to the appropriate care of the individual who becomes ill following ingestion of the drug.”
Nearly twenty-five years later the fatalities involving MDMA keep mounting. In the only Australian study of 82 drug related deaths between 2001 to 2005, MDMA featured predominately. The fluctuating potency of this drug is further established as it is not only fifteen-year-old girls but grown men dying.

“The majority of decedents were male (83%), with a median age of 26 years. Deaths were predominantly due to drug toxicity (82%), with MDMA the sole drug causing death in 23% of cases, and combined drug toxicity in 59% of cases. The remaining deaths (18%) were primarily due to pathological events/disease or injury, with MDMA a significant contributing condition.”
The indiscriminate nature of MDMA was also witnessed with the latest fatalities at music festivals. For example, very different amounts of MDMA accounted for the five young people that died across New South Wales.
“In one case, a single MDMA pill had proved lethal while another young man who ingested six to nine pills over the course of the day had an MDMA purity of 77 per cent… (That is) a very high rate of purity,” Dr Dwyer said.”
Comparable stories are found all over the world including the UK case of Stephanie Jade Shevlin that is eerily similar to Anna Woods.
Drug dealers aware of the naïvely misleading narrative of pure and impure illicit drugs have been caught bringing pill testing kits to concerts in a bid to convince potential buyers of quality and hike up prices.

High Risk-Taking Culture

The prevailing culture at music festivals is one of blissful abandon and haste. It is a no longer fringe groups at the edges of society but the mainstream choice for generations of children and young adults fully embracing the legacy of, “tune in, turn on and drop out”.
Yet despite the prevailing culture, harm reductionists insist that pill testing will better inform partygoers of drug contents and provide the necessary platform for ‘further conversations about the drug dangers.’ (All of which of course can be achieved outside a venue.)
But this is conjecture and another attempt at experimental based policy.
As cited earlier, Dr Caldicott admitted, anything that stops the party momentum experience is likely rejected. This is because when dealing with high-risk behaviour removing too many risks takes away the thrill of reward.

In an age that has more educated men and women than ever before, it’s not the lack of information that is driving this level of experimentation but the growing indifference to it.
In the aftermath of the death of 25-year-old pharmacist, Sylvia Choi (2015), it was discovered that security staff at the Stereosonic festival were consuming and dealing drugs.
Further, the report often cited purporting to show a growing body of research for drug users wanting pill testing actually confirms that those with college degrees were less likely than those with high school qualifications to test their pills.
This seems to be a trend in Australia also with one judge fed up with groups of “well-off pill poppers” and “privileged” young professionals, including nurses and bankers – filling the court.
Another article describes the attitude of drug taking among festival goers (including University students) as not so much concerned about what is on offer but demand for cheap designer drugs.
The author notes, “A few deaths don’t deter experimentation, and if you’re going to experiment, you need to be sure you don’t die.”
But the determination for experimentation with different forms of self-destructive drugs is making staying alive increasingly less likely, as the levels of polydrug use is also on the rise.
According to Global Drug Survey, “Over 90% of people seeking Emergency Medical Treatment each year after MDMA have used other drugs (often cocaine or ketamine) and/or alcohol and more frequent use of MDMA is associated with the higher rates of combined MDMA use with other stimulant drugs and ketamine.”

Australia’s enquiry into MDMA supports this finding, “Nevertheless, the fact that half of the toxicology reports noted the detection of methamphetamine in the blood is consistent with the polydrug use patterns of living MDMA users.”

Pill Testing Overseas Failing to Stop Drug Demand and Supply

The push continues for Australia to adopt front of house or front-line pill testing at music festivals as in Europe and the UK. But not everyone is convinced of its resounding success.
Last year, UK’s largest festival organiser reversed its previous support for drug testing facilities. Managing director, Melvyn Benn, stating, “Front of house testing sounds perfect but has the ability to mislead I fear.”
Mr Benn details those fears, “Determining to a punter that a drug is in the ‘normal boundaries of what a drug should be’ takes no account of how many he or she will take, whether the person will mix it with other drugs or alcohol and nor does it give you any indicator of the receptiveness of a person’s body to that drug.”
In 2001, The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) produced its scientific report, On-Site Pill-Testing Interventions In The European Union.
Incomplete evaluation procedures have hindered the availability for empirical evidence on the effectiveness of pill testing. “The conclusions one can draw from that fact remain ambiguous.”
Perhaps the most disturbing feature of the report is the admission that decreasing black market activity isn’t within the scope of pill testing goals. “Overall, to alter black markets is ‘not a primary goal’ or ‘no goal at all’ for most pill-testing projects.” Within that same report drug users are classed as ‘consumers’ with an entitlement to know what their pills contain.
The report goes on to list the range of services offered alongside pill testing at venues. These include everything from: brain machines, internet consultations, needle exchange, presenting on-site results of pill-testings, chill-out zones, offering massage, giving out fruits, giving out free drinking water and giving out condoms.
And in another twist of just how far the common sense boundaries are stretched, for number of participating nations, tax payer funded pill testing is also offered at illegal rave venues.

Given the overwhelming lack of evidence that pill testing indeed saves lives, Australian toxicologist, Andrew Liebie’s claim is not easily dismissed, “the per capita death rate from new designer drugs was higher in Europe – where pill testing was available in some countries – than in Australia.”
The antipathy to drug taking was also witnessed by the Ambulance Commander at the latest pill testing trial, again in Canberra, Groovin’ the Moo.

No War on Drugs Just a Submission to Harm Reduction Promotion
The narrative for pill testing will at some stage mention the failed “war on drugs” and by association hard line but failing law enforcement measures either explicitly or implicitly such as in the statement below.
“Regardless of the desirability of treating it as a criminal issue rather than a health one, policing at festivals has limited impact on drug consumption, as research presented at the Global Cities After Dark conference last year suggests: 69.6 per cent of survey respondents said they would use drugs if police were present.”
But what this article completely fails to grasp is that police presence makes little impact because the law is rarely or, at best, laxly enforced and a climate of de facto decriminalisation has been the norm for decades. This was the situation with Portugal before finally decriminalising drugs for personal use in 2001.
Journalists for The Weekend Australian attempting to report events at a recent dance party stated sniffer dogs did nothing to stop the “rampart” stream of drugs. They described a scene of disarray; discarded condoms with traces of coffee grounds within toilets (believed to mask the smell of drugs), bodies strewn on the ground littered with drug paraphernalia, others were rushed to waiting ambulances, while one attendant told them “I got away with it” and another admitting popping two pills a night was “average”. Had they been allowed to stay longer maybe more party goers would be openly stating what many know, drugs supply and demand are at all-time highs irrespective of police presence.

Journalists instead were treated as criminal trespassers, threatened by security and ordered to leave under police escort.
The basis of Australia’s National Drug Strategy includes harm minimisation efforts as part of an overall strategy that also supports reductions in drug supply and demand.
The inadvertent admission that pill testing is not about curbing drug demand comes from another harm reduction stalwart, Alex Wodak, “It’s a supposition that this (pill testing) might increase drug use, but if it does increase drug use but decrease the number of deaths, surely that’s what we should be focusing on.”
In fact, Dr Wodak confirms that pill testing would incentivise drug dealers to provide a better product. “There was no commercial pressure on drug dealers to ensure their products were safe. But if we had testing and 10% of drug dealer A’s supply was getting rejected at the drug testing counter, then word would get around.”
A similar focus on consequences rather than causes is expressed by Dr David Caldicott, “I don’t give a s**t about the morality or philosophy of drug use. All I care about is people staying alive.”
In other words, take the pill, just don’t die…this time. What the long-term affects are to those drug users that survive hospitalisation, the impact on development, mental health, employment loss, families, the growing cost to taxpayers and the crushing weight on emergency services, hospitals and physicians let alone the constant appetite and entrenchment for more drugs will have to wait. Just don’t die.
The ongoing dilution of law enforcement is also seen by various experts all but demanding that police and sniffer dogs be removed entirely from music festivals. No doubt to be replaced with on-site massages, electrolyte drinks, brain machinery, chill out zones, fruit and more free condoms.
Prof Alison Ritter from the University of NSW and Fiona Measham from the University of Durham both agree that intensive policing combined with on-site dealing “could significantly increase drug related harm.” How intensive could police efforts be with such blatant on-site dealing was not explained.

The Unrelenting Push for Drug Legalisation
The real end game behind the dubious safety and harm messaging is drug legalisation. Pill testing, minus the caveat of being called a ‘trial’, would unlikely find full approval without a corresponding change in the law.
The limitations of pill testing and the legal ramifications in giving back a tested pill that proved lethal would become a public liability minefield.
This is clearly seen from the article in the Daily Telegraph, Pill Test Death Waiver Revealed, Jan 5, “The testing capabilities are so limited that revellers would be required to sign a death waiver, which includes a warning that tests cannot accurately determine drug purity levels or give any indication of safety.”
Later the article reports, “Mr Vumbaca said he had been given extensive legal advice to include the warnings on the waiver because of the limitations of testing information … we are not a laboratory and we have one piece of equipment … the test gives you an indication of purity, but you can’t tell the exact amount.”
The waiver would release everyone in testing from, “any liability for personal injury or death suffered … in any way from the services.”
Scattered within the pages of countless articles on pill testing released over the last few months, this admission of pill testing tied in within a broader agenda of drug legalisation is repeatedly made but easily missed among the hype.
Gary Barns from the Australian Lawyers Alliance said the latest deaths could be avoided or risk of death could be minimised with a “law change”.
Sydney Criminal Lawyers are more explicit, “And it seems clear that if adults were able to purchase quality controlled MDMA over the counter in plain packaging with the contents marked on the side, it would be far safer than buying from some backyard manufacturer with no oversight or guarantees.”
And disappointingly, even former AFP and DPP speaking on Four Corners state drug legalisation as a necessary public conversation.
It seems that these same advocates for policy and law change are willing to give a platform for the rights of those determined to self-destruct but not the rest of the law abiding community and their common good.

Pill testing – The Climate Change of Drugs
If comparing pill testing as a ‘silver bullet’ was an inaccurate metaphor, then the comparison to climate change shows the extent of not only erroneous but deliberate obfuscation. “This issue of pill-testing is climate change for drugs,” says Dr David Caldicott.
And yet the dark environment which produces the pills and wreaks so much unnecessary destruction to countless thousands of people all over the world is never fully understood or exposed to those that would blissfully take one small pill for a few hours of entertainment.
But talk of boycotting products that pollute the atmosphere, meat that is packaged from abused animals, clothing produced from exploited workers, or products genetically modified, most likely those same illicit pill takers would passionately relinquish and possibly even risk their personal safety to protest these injustices.
Yet, these are dwarfed by illicit drugs. The most barbaric network of human, economic and environmental exploitation.
Some of the social miseries are well known, including international crime syndicates and narco-terrorism. While others such as environmental damage due to deforestation, chemical waste and the recent drug toxicity detected in Adelaide waterways are often overlooked in an age of socially conscientious consumerism.
But the list of downward consequences is always local and personal, with illicit drugs linked to preventable death, disease and poverty. In cases of domestic violence, alcohol and drugs contributed to 49 per cent of women assaulted in the preceding 12 months.

Those who suffer the most are those who can least afford the consequences; the poor, young, vulnerable, indigenous and rural communities as revealed in the Australian Criminal Intelligence Commission report.
Faced with such overwhelming statistics pro-drug lobbyists use inevitability mantras such as, “they’re doing it anyway” to sway public opinion toward legalisation; but fail to apply the same arguments to other societal abuses such as paedophilia, obesity, gambling, domestic violence, alcohol or tobacco.
It is time to stop the dishonest rhetoric of harm reductionist activists and the deliberate intellectual disconnect that has greatly influenced the Australian government drug strategy and peak medical bodies toward policies emphasising reducing drug harms (injecting rooms, needle distribution, methadone and now pill testing) while minimising the need to reduce demand and supply.
Eleni Arapoglou
– Writer and Researcher, Drug Advisory Council of Australia (DACA)

Source: PillTestingDACA_PoliticianBrief05-02-19.pdf (drugfree.org.au) February 2019

Three decades ago, I would have been over the moon to see marijuana legalized. It would have saved me a lot of effort spent trying to avoid detection, constantly looking for places to hide a joint. I smoked throughout my teens and early 20s. During this period, upon landing in a new city, my first order of business was to score a quarter-ounce. The thought of a concert or a vacation without weed was simply too bleak.

These days it’s hard to find anybody critical of marijuana.

The drug enjoys broad acceptance by most Americans — 63 percent favoured ending cannabis prohibition in a recent Quinnipiac poll — and legislators on both sides of the aisle are becoming more likely to endorse than condemn it. After years of loosening restrictions on the state level, there are signs that the federal government could follow suit: In April, Senate Minority Leader Charles E. Schumer (D-N.Y.) became the first leader of either party to support decriminalizing marijuana at the federal level, and President Trump (his attorney general notwithstanding) promised a Republican senator from Colorado that he would protect states that have legalized pot.

And why not? The drug is widely thought to be either benign or beneficial. Even many of those apathetic toward its potential health benefits are ecstatic about its commercial appeal, whether for personal profit or state tax revenue. Legalization in many cases, and for many reasons, can be a good thing. I’m sympathetic.

But I am also a neuroscientist, and I can see that the story is being oversimplified. The debate around legalization — which often focuses on the history of racist drug laws and their selective enforcement — is astoundingly naive about how the widespread use of pot will affect communities and individuals, particularly teenagers. In our rush to throw open the gate, we might want to pause to consider how well the political movement matches up with the science, which is producing inconveniently alarming studies about what pot does to the adolescent brain.

Marijuana for sale at a Colorado dispensary.    (Matthew Staver/Bloomberg Creative Photos)

I took a back-door route to the science of marijuana, starting with a personal investigation of the plant’s effects. When I was growing up in South Florida in the 1980s, pot was readily available, and my appreciation quickly formed the basis for an avid habit. Weed seemed an antidote to my adolescent angst and ennui, without the sloppiness of alcohol or the jaw-grinding intensity of stimulants.

Of the many things I loved about getting high, the one I loved best was that it commuted the voice in my head — usually peevish or bored — to one full of curiosity and delight. Marijuana transformed the mundane into something dramatic: family outings, school, work or just sitting on the couch became endlessly entertaining when I was stoned.

Like any mind-altering substance, marijuana produces its effects by changing the rate of what is already going on in the brain. In this case, the active ingredient delta-9-THC substitutes for your own natural endocannabinoids and mimics their effects. It activates the same chemical processes the brain employs to modulate thoughts, emotions and experiences. These specific neurotransmitters, used in a targeted and judicious way, help us sort the relentless stream of inputs and flag the ones that should stand out from the torrent of neural activity coding stray thoughts, urges and experience. By flooding the entire brain, as opposed to select synapses, marijuana can make everything, including the most boring activities, take on a sparkling transcendence.

Why object to this enhancement? As one new father told me, imbibing made caring for his toddler much more engrossing and thus made him, he thought, a better parent. Unfortunately, there are two important caveats from a neurobiological perspective.

As watering a flooded field is moot, widespread cannabinoid activity, by highlighting everything, conveys nothing. And amid the flood induced by regular marijuana use, the brain dampens its intrinsic machinery to compensate for excessive stimulation. Chronic exposure ultimately impairs our ability to imbue value or importance to experiences that truly warrant it.

In adults, such neuro-adjustment may hamper or derail a successful and otherwise fulfilling life, though these capacities will probably recover with abstinence. But the consequences of this desensitization are more profound, perhaps even permanent, for adolescent brains. Adolescence is a critical period of development, when brain cells are primed to undergo significant organizational changes: Some neural connections are proliferating and strengthening, while others are pared away.

Although studies have not found that legalizing or decriminalizing marijuana leads to increased use among adolescents, perhaps this is because it is already so popular. More teenagers now smoke marijuana than smoke products with nicotine; between 30 and 40 percent of high school seniors report smoking pot in the past year, about 20 percent got high in the past month, and about 6 percent admit to using virtually every day. The potential consequences are unlikely to be rare or trivial.

The decade or so between puberty and brain maturation is a critical period of enhanced sensitivity to internal and external stimuli. Noticing and appreciating new ideas and experiences helps teens develop a sense of personal identity that will influence vocational, romantic and other decisions — and guide their life’s trajectory. Though a boring life is undoubtedly more tolerable when high, with repeated use of marijuana, natural stimuli, like those associated with goals or relationships, are unlikely to be as compelling.

It’s not surprising, then, that heavy-smoking teens show evidence of reduced activity in brain circuits critical for  flagging newsworthy experiences, are 60 percent less likely to graduate from high school, and are at substantially increased risk for heroin addiction and alcoholism. They show alterations in cortical structures associated with impulsivity and negative moods; they’re seven times more likely to attempt suicide.

Recent data is even more alarming: The offspring of partying adolescents, specifically those who used THC, may be at increased risk for mental illness and addiction as a result of changes to the epigenome — even if those children are years away from being conceived. The epigenome is a record of molecular imprints of potent experiences, including cannabis exposure, that lead to persistent changes in gene expression and behavior, even across generations. Though the critical studies are only now beginning, many neuroscientists prophesize a social version of Rachel Carson’s “Silent Spring,” in which we learn we’ve burdened our heirs only generations hence.

Might the relationship between marijuana exposure and changes in brain and behavior be coincidence, as tobacco companies asserted about the link between cancer and smoking, or does THC cause these effects? Unfortunately, we can’t assign people to smoking and nonsmoking groups in experiments, but efforts are underway to follow a large sample of children across the course of adolescent development to study the effects of drug exposure, along with a host of other factors, on brain structure and function, so future studies will probably be able to answer this question.

In the same way someone who habitually increases the volume in their headphones reduces their sensitivity to birdsong, I followed the “gateway” pattern from pot and alcohol to harder drugs, leaping into the undertow that eventually swept away much of what mattered in my life. I began and ended each day with the bong on my nightstand as I floundered in school, at work and in my relationships. It took years of abstinence, probably mirroring the duration and intensity of my exposure, but my motivation for adventure seems largely restored. I’ve been sober since 1986 and went on to become a teacher and scholar. The single-mindedness I once directed toward getting high came in handy as I worked on my dissertation. I suspect, though, that my pharmacologic adventures left their mark.

Now, as a scientist, I’m unimpressed with many of the widely used arguments for the legalization of marijuana. “It’s natural!” So is arsenic. “It’s beneficial!” The best-documented medicinal effects of marijuana are achieved without the chemical compound that gets users high. “It’s not addictive!”  This is false, because the brain adapts to marijuana as it does to all abused drugs, and these neural adjustments lead to tolerance, dependence and craving — the hallmarks of addiction.

It’s true that a lack of benefit, or even a risk for addiction, hasn’t stopped other drugs like alcohol or nicotine from being legal, used and abused. The long U.S. history of legislative hypocrisy and selective enforcement surrounding mind-altering substances is plain to see. The Marihuana Tax Act of 1937, the first legislation designed to regulate pot, was passed amid anti-Mexican sentiment (as well as efforts to restrict cultivation of hemp, which threatened timber production); it had nothing do with scientific evidence of harm. That’s true of most drug legislation in this country. Were it not the case, LSD would be less regulated than alcohol, since the health, economic and social costs of the latter far outweigh those of the former. (Most neuroscientists don’t believe that LSD is addictive; its potential benefits are being studied at Johns Hopkins and New York University, among other places.)

Still, I’m not against legalization. I simply object to the astounding lack of scepticism about pot in our current debate. Whether or not to legalize weed is the wrong question. The right one is: How will growing use of delta-9-THC affect individuals and communities?

Though the evidence is far from complete, wishful thinking and widespread enthusiasm are no substitutes for careful consideration. Instead of rushing to enact new laws that are as nonsensical as the ones they replace, let’s sort out the costs and benefits, using current scientific knowledge, while supporting the research needed to clarify the neural and social consequences of frequent use of THC. Perhaps then we’ll avoid practices that inure future generations to what’s really important.

                                       By Judith Grisel,    May 25, 2018

Source:  https://www.washingtonpost.com/ posteverything/wp/2015/04/30/yes-pot-should-be-legal-but-it-shouldnt-be-sold-for-a-profit/   

(Denver, CO) – Today, a new study on the impact of marijuana legalization in Colorado conducted by the Centennial Institute found that for every one dollar in tax revenue from marijuana, the state spends $4.50 as a result of the effects of the consequences of legalization.

This study used all available data from the state on hospitalizations, treatment for Cannabis Use Disorder (CUD), impaired driving, black market activity, and other parameters to determine the cost of legalization. Of course, calculating the human cost of addiction is nearly impossible, we can assume the cost estimated for treating CUD is a gross underestimate due to the fact that it is widely believed among health officials that CUD goes largely untreated…yet rates have been increasing significantly in the past decade.

That, in conjunction with the fact that there is no way of quantifying the environmental impact the proliferation of single use plastic packaging common within the marijuana industry, leads us to believe this is indeed a very conservative estimate.

“Studies such as this show that the only people making money off the commercialization of marijuana are those in the industry who profit at the expense of public health and safety,” said Dr. Kevin Sabet, president of Smart Approaches to Marijuana (SAM). “The wealthy men in suits behind Big Marijuana will laugh all the way to the bank while minority communities continue to suffer, black markets continue to thrive, and taxpayers are left to foot the bill.”

“The data collected in this study, as in similar studies before it, continues to show the scope of the cost of commercialization. The effects of legalization are far and wide, and affect just about every resident in the state directly and indirectly,” said Jeff Hunt, Vice President of Public Policy for Colorado Christian University.

“The pot industry doesn’t want this dirty truth to be seen by law makers and the taxpayers, who were promised a windfall in tax revenue,” said Justin Luke Riley, president of the Marijuana Accountability Coalition. “The MAC will continue to shine a light on the industry and urge our lawmakers to reign in Big Pot before it brings more harm on Coloradans.”

Source: New Colorado Report: Cost of Marijuana Legalization Far Outweighs Tax Revenues – Smart Approaches to Marijuana (learnaboutsam.org) November 2018

Tell Your Children:
The Truth About Marijuana, Mental Illness, and Violence

by alex berenson

free press, 272 pages, $26

The smoking of marijuana, with its careful preparation of the elements and the solemn passing around of the shared joint, was the unholy communion of the counterculture in the late 1960s, when our present elite formed its opinions. Many of them allowed their children to follow their bad examples, and resent that this exposes their young to a (tiny) risk of persecution and career damage. As a result, those who still disapprove of marijuana are much disliked. The book I wrote on the subject six years ago, The War We Never Fought, received a chilly reception and remains so obscure that I don’t think Alex ­Berenson, whose book has received much friendlier coverage, even knows it exists. As a writer who naturally covets readers and sales, I find this mildly infuriating.

But let me say through clenched teeth that it is of course very good news that a fashionable young metropolitan person such as Mr. ­Berenson is at last prepared to say openly that marijuana is a dangerous drug whose use should be severely discouraged. For, as ­Berenson candidly admits, he was until recently one of the great complacent mass of bourgeois bohemians who are pretty relaxed about it. He confesses in the most important passage in the book that he once believed what most of such people believed. He encapsulates this near-universal fantasy thus:

Marijuana is safe. Way safer than alcohol. Barack Obama smoked it. Bill Clinton smoked it too, even if he didn’t inhale. Might as well say it causes presidencies. I’ve smoked it myself, I liked it fine. Maybe I got a little paranoid, but it didn’t last. Nobody ever died from smoking too much pot.

These words are a more or less perfect summary of the lazy, ignorant, self-serving beliefs of highly educated, rather stupid middle-class metropolitans all over the Western world in such places as, let’s just say for example, the editorial offices of the New York Times. Thirty years from now (when it’s too late), they will look as crass and irresponsible as those magazine advertisements from the 1950s in which pink-faced doctors wearing white coats recommended certain brands of cigarettes. But just now, we are in that foggy zone of consciousness where the truth is known to almost nobody except those with a certain kind of direct experience, and can be ignored by everyone else.

One of the experienced ones, thank heaven, is Alex ­Berenson’s wife Jacqueline. She is a psychiatrist who specializes in evaluating mentally ill criminals. One evening, the Berensons were discussing one of her cases, a patient who had committed a terrible, violent act. Casually, Jacqueline remarked, “Of course he was high, been smoking pot his whole life.” Alex doubtfully interjected, “Of course?,” and she replied, “Yeah, they all smoke.” (She didn’t mean tobacco.) And she is right. They all do. You don’t need to be a psychiatrist to know this. You just have to be able to do simple Internet searches.

Most violent crime is scantily reported, since local newspapers lack the resources they once had. The exceptions are rampage mass killings by terrorists (generally in Europe) and non-political crazies (more common in the United States). These crimes are intensively reported, to such an extent that news media find things out they were not even looking for, such as the fact that the perpetrator is almost always a long-term marijuana user. Where he isn’t (and it is almost always a he), some other legal or illegal psychotropic, such as steroids or “antidepressants,” is ­usually in evidence. But you do have to look, and most people don’t. Then you have to see a pattern, one that a lot of important, influential people specifically do not want to see.

That husband-and-wife conversation in the Berenson apartment is the whole book in a nutshell, the epiphany of a former apostle of complacency from the college-­educated classes who suddenly discovers what has been going on around him for years. What he repeats over and over again is very simple: Marijuana can make you permanently crazy. (This is a long-term cumulative effect, not the effect of immediate intoxication.) And once it has made you crazy, it can make you violent, too.

You’ll only find out if you’re susceptible by taking it. It is not soft. It is not safe. It is one of the most dangerous drugs there is, and we are on the verge of allowing it to be advertised and put on open sale. Berenson has gotten into predictable trouble for asserting that the connection is pretty much proved. Alas, this is not quite so. But the correlation is hugely powerful. The chance that it is meaningful is great. Who would be surprised if a drug with powerful psychotropic effects turned out to be the cause of mental illness in its users? Correlation is not causation, but it is one of the main tools of ­epidemiology. Causation, ­especially in matters of the brain, is extraordinarily difficult to prove, and so we may have to base our actions, or our refusals to take action, on something short of total certainty.

Tell Your Children is filled with persuasive, appalling individual case histories of wild violence, including the abuse of small children. It also lists and explains the significance of powerful, large-scale surveys of Swedish soldiers and New Zealand students, which connect the drug to mental illness and lowered school performance. Berenson provides facts and statistics about violent crime in places where marijuana is widely available, and anecdotes so repetitive that they cease to be anecdotes. The puzzle remains as to why it is necessary to say all this repeatedly when a sensible person would listen the first time.

Perhaps it is because of the large, and very well-funded, campaigns for marijuana legalization described by Berenson. People who drink fair-trade coffee and eat vegan, who loathe other greed lobbies—such as pharmaceuticals, tobacco, fast food, or sugary drinks—smile on this campaign to make money from the misery of others.

Berenson shows how mental illness has grown in our midst without being noticed in public statistics. A comparable growth in, say, measles or tuberculosis would have shown up. But deteriorating mental health does not, thanks to privacy concerns, and to the fact that mental illness is not easily classified. It is also a sad truth that rich, advanced Western societies nowadays begrudge money for the mental hospitals needed to house and protect those who have overthrown their own minds. They are reluctant to record the existence and prevalence of the very real suffering that ought to be treated in the hospitals they have sold off, demolished, or never built.

Berenson also witheringly describes the propaganda devised by those who want to legalize the drug, from the mind-expanding zealots who view drug use as liberating to the hard-headed entrepreneurs and political professionals. Argue against them at your peril. Your audience may learn something, but your opponents will not. Wilful ignorance is the most powerful barrier to communication. It seals the human mind up like a fortress. You might as well read the works of Jean-Paul Sartre to a hungry walrus as try to debate with such people. I have attempted it. They don’t hear a word you say, but they hate you for getting in their way.

Berenson gives a fairly thorough account of the “medical marijuana” campaign, an almost comically absurd attempt to portray a poison as a medicine. This campaign is so bogus that it will vanish from the earth within days of full legalization, because in truth there is very little evidence that marijuana-based medicines are of much use. Berenson quotes one refreshingly candid marijuana defender as admitting, “Six percent of all marijuana users use it for medical purposes. Medical marijuana is a way of protecting a subset of society from arrest.”

In the U.S., legalizers are poised to win the modern civil war over the legalization of marijuana which has been dividing the country for half a century. It looks now as if marijuana will soon be legalized, on general sale, advertised and marketed and taxed. This worrying process has already begun in Canada. The United States has approached the issue sideways, conceding states’ rights in a way that would have delighted the Confederates.

The United Kingdom has taken a similar route: It pretends to maintain the law and, when asked, insists it has no plans to change it. But the police and the courts have gradually ceased to enforce it, so that it is now impossible to stroll through central London without nosing the reek of marijuana. Europe has gone the same way, with minor variations. Among the free law-governed nations, only Japan and South Korea still actively and effectively enforce their drug possession laws, and benefit greatly from it. But how long can they hold out?

The legalization campaigners are working like termites to undo the 1961 U.N. Convention that is the basis of most national laws against narcotics, using all the money and dishonesty at their command. They have plenty of both. So, besides the two disastrous, irrevocably legal poisons of alcohol and tobacco, we shall before long have a third—and probably a fourth and fifth not long afterward. If marijuana is legal, how will we keep cocaine and ecstasy illegal for long? Next will come heroin and LSD.

One reason for the default in favor of legalization and non-enforcement is the false association made by so many between marijuana and liberty. The belief that a dangerous, stupefying drug is an element of human liberty has taken hold of two, perhaps three generations. They should know better. Aldous Huxley warned in his much-cited but infrequently read dystopian novel Brave New World that modern men, appalled by the disasters of war and social conflict, would embrace a world where thinking and knowledge were obsolete and pleasure and contentment were the aims of a short life begun in a test-tube and ended by euthanasia. He predicted that they would drug themselves and one another to banish the pains of real life, and—worst of all—come to love their own servitude. In one terrible scene, the authorities spray protesting low-caste workers with the pleasure drug soma, and the workers end up hugging one another and smiling vaguely before returning to their drudgery. (Soma, unlike its real-life modern equivalents, is described as harmless, something easier to achieve in fiction than in reality.) What ruler of a squalid, wasteful, unfair, and ugly society such as ours would not prefer a stupefied, flaccid population to an angry one? Yet somehow, the freedom to stupefy oneself is held up quite seriously by educated people as the equal of the freedoms of thought, speech, and assembly. This is the way the world ends, with a joint, a bong, and a simper.

Whatever was wrong with my intense little segment of the 1960s revolutionary generation (and plenty was wrong with it), we believed that when we saw injustice we should fight it, not dope ourselves into a state of mind where it no longer mattered. But my tiny strand of puritan Bolsheviks was long ago absorbed into a giggling mass of cultural revolutionaries, who scrawled “Sex, Drugs, and Rock and Roll” on their banners instead of “Liberty, Equality, and Fraternity,” or even “Workers of All Lands, Unite!”

While Berenson’s facts are devastating, his own response to the crisis is feeble. He opposes marijuana legalization—and what intelligent person does not? He babbles of education and warning our children. But he declares that “decriminalization is a reasonable compromise.” Actually, it is not. It cannot be sustained. If matters are left as they are, legalization—first de facto and then de jure—will follow, because there will be no impetus to resist it. Unless the law decisively disapproves of and discourages the actual use of the drug, it is neither morally consistent nor practically effective.

The global drug trade would be nowhere without the dollars handed over to it by millions of individuals who are the end-users. We search for Mr. Big and never catch him. But we ignore or even indulge Mr. Small, regarding him as a victim, when in truth he keeps the whole thing going. In the end, the logic leads relentlessly to the stern prosecution and deterrent punishment of individual users. It is because I recognize this grim necessity that I remain a pariah. It is because he doesn’t that Alex Berenson is still just about acceptable in the part of the Western world that believes marijuana is a torch of ­freedom. 

Peter Hitchens is a columnist for The Mail on Sunday.

Source:  https://www.firstthings.com/article/2019/05/reefer-sadness

DRP0013

 1.Aims Cannabis Skunk Sense (also known as CanSS Ltd) provides straight-forward facts and research-based advice on cannabis. We raise awareness of the continued and growing dangers to children, teenagers and their families of cannabis use.

2.We provide educational materials and information for community groups, schools, colleges and universities; and guidance to wide range of professions, Parliament and the general public – with a strong message of prevention not harm reduction.

3.The Inquiry document says: ‘Government’s stated intention in its 2017 drug strategy is to reduce all illicit and other harmful drug use…….’

4.Missing from this Inquiry document is the following 2017 Strategy statement: ‘preventing people – particularly young people – from becoming drug users in the first place’. Prevention should be first and foremost in any statement as well as in the minds of us all. FRANK was mentioned just once in this strategy; ‘develop our Talk to FRANK service so that it remains a trusted and credible source of information and advice for young people and concerned others’. This claim will be challenged in this report.

5.If prevention (pre-event) were to be successful, there would be little need for a policy of reducing harmful use. Unfortunately, for fifteen or sixteen years now, prevention has taken a back seat.

6.In 1995 Prime Minister John Major’s government produced ‘Tackling Drugs Together’ saying, ‘The new programme strengthens our efforts to reduce the demand for illegal drugs through prevention, education and treatment’.

7.Objectives included: ‘to discourage young people from taking drugs’ and to ensure that schools offer effective programmes of drug education, giving pupils the facts, warning them of risks, and helping them to develop the skills and attitudes to resist drug use – all good common sense.

8.On harm reduction, the government said, ‘The ultimate goal is to ensure people do not take drugs in the first place, but if they do, they should be helped to become and remain drug-free. Abstinence is the ultimate goal and harm reduction should be a means to that end, not an end in itself’.

9.In 1998 the Second National Plan for 2001-2, ‘Tackling Drugs to Build a Better Britain’ was published. Although prevention was still the aim, the phrase ‘informed choice’ appeared, the downhill slide from prevention had started.

10.The` Updated Strategy in 2002 contained the first high-profile mention of ‘Harm Minimisation (Reduction)’. David Blunkett in the Foreword said, ‘Prevention, education, harm minimisation, treatment and effective policing are our most powerful tools in dealing with drugs’.

Some bizarre statements appeared, e.g.: ‘To reduce the proportion of people under 25 reporting use of illegal drugs in the last month and previous year substantially’. Is  infrequent use of drugs acceptable?

In October 2002 at a European Drugs Conference, Ashford, Kent, Bob Ainsworth, drugs spokesman for the Labour government, said that harm reduction was being moved to the centre of their strategy. Prevention was abandoned, ‘informed choice’ and ‘harm reduction’ ruled.

The official government website for information on drugs is FRANK set up in 2003. It continued with the harm reduction policy of the Labour Government.

From the beginning, FRANK was heavily criticised. The Centre for Social Justice (CSJ), founded by Iain Duncan-Smith MP in 2004, consistently criticised FRANK for being ill-informed, ineffective, inappropriate and shamefully inadequate, whilst citing a survey conducted by national treatment provider Addaction who found that only one in ten children would call the FRANK helpline to talk about drugs. Quite recently, when asked about sources where they had obtained helpful information about alcohol or smoking cigarettes, young people put FRANK at the bottom.

The CSJ recommended that FRANK be scrapped, and an effective replacement programme developed to inform young people about the dangers of drug and alcohol abuse based on prevention rather than harm reduction.

The IHRA (International Harm Reduction Alliance) gives the following definition of harm reduction:

Harm reduction refers to policies, programmes and practices that aim to minimise negative health, social and legal impacts associated with drug use, drug policies and drug laws. Harm reduction is grounded in justice and human rights – it focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that they stop using drugs as a precondition of support.   

The use of Harm reduction instead of Prevention is tantamount to condoning drug use – a criminal activity. The legitimate place for harm reduction is with ‘known users’ on a one to one basis as part of a treatment programme to wean them off completely and attain abstinence in a safer manner than abrupt stoppage which can be very dangerous. One example of this is to inhale the fumes of heroin rather than injection, thus avoiding blood-borne diseases such as AIDS, hepatitis and septicaemia.

An opioid substitute drug for heroin addiction, methadone has the advantage of being taken orally and only once/day. As the dosage is reduced, abstinence will be attained more safely. However, methadone users are often ‘parked’ for months on this highly addictive drug without proper supervision or monitoring. In 2008 in Edinburgh, more addicts died of methadone than heroin.

Harm reduction is a green light. If children are encouraged to use drugs by being given tips on how to use them more safely, many will do it. The son of a friend told his mother. ‘It’s OK we go on to the FRANK website and find out how to take skunk safely by cutting our use and inhaling less deeply’. He is now psychotic!

Prevention works. Between 1997 and 1991 America saw drug use numbers plummet from 23 to 14 million, cocaine and cannabis use halved, daily cannabis use dropped by 75%.

In 2005, Jonathan Akwue of In-Volve writing in Drink and Drugs News, criticised the campaign for lacking authenticity; its ill-judged attempts at humour which try to engage with youth culture; and diluting the truth to accommodate more socially acceptable messages.

The conservatives regained power under David Cameron. FRANK did not change.

In 2005, Mr Iain Duncan Smith again criticised FRANK, saying “Drugs education programmes, such as Talk to FRANK, have failed on prevention and intervention, instead progressively focussing on harm reduction and risk minimisation, which can be counter-productive”

In 2011 it was announced FRANK would be re-launched and the team commissioned ‘A Summary of Health Harms of Drugs’ from The John Moore’s University Liverpool, a hotbed of harm reduction. A psychiatrist from The FRANK Team was involved. Their section on cannabis is totally inadequate, out of date, no recognition of deaths, brain shrinkage, violence, homicides, suicides, the huge increase of strength of THC etc. Professor Sir Robin Murray’s research on mental illness (2009) and the discovery that CBD is virtually absent from skunk are of vital importance.

Many worrying papers have been written since, especially about brain development, all of which are ignored.  CanSS met with the FRANK team prior to their re-launch in 2011 where it was agreed that the cannabis section would, with their assistance, be re-written. All but two very small points were ignored, one about driving after taking alcohol with cannabis and the effect on exam results. The harm reduction advice about cannabis was removed at the request of CanSS.

Scientific evidence detailing FRANK’s inaccuracies was given to the Government by CanSS and other drug experts over the years – all of it ignored. Complaints and oral evidence were submitted to the HASC in April and September 2012 and the Education Select Committee in 2014. Government drugs spokesmen have also been contacted with concerns about FRANK.

As the official government source of information on drugs for the UK public, the FRANK site must be regularly updated and contain the many new accurate findings from current scientific research. The public is owed a duty of care and protection from the harm of drugs, especially cannabis, the most commonly used.

The following list contains some of the glaring omissions and vital details from the FRANK website:

Deaths from cancers except lung, road fatalities, heart attacks/strokes, violent crime, homicides, suicides. Tobacco doesn’t cause immediate deaths either.

Alcohol with cannabis can be fatal. An alcohol overdose can be avoided by vomiting but cannabis suppresses the vomiting reflex.

Cases of severe poisoning in the USA in toddlers are increasing, mostly due to ‘edibles’ left within reach. Accidental ingestion by children should be highlighted.

Hyperemesis (violent vomiting) is on the increase.

Abnormally high levels of dopamine in the brain cause psychosis (the first paper on this was written in 1845) and schizophrenia, especially in those with genetic vulnerabilities, causing violence, homicides and suicides. Skunk-induced schizophrenia costs the country around £2 billion/year to treat.

Young people should understand how THC damps down the activities of the whole brain by suppressing the chemical messages for several weeks. It is fat soluble and remains in the cells. Messages to the hippocampus (learning and memory) fail to reach its cells, some die, causing permanent brain damage. IQ points are lost. Few children using cannabis even occasionally will achieve their full potential.

Serotonin is depleted, causing depression and suicides. The huge increase in the strength of THC in cannabis due to the prevalence of skunk (anything from 16% to over 20%) and the almost total lack of CBD is ignored as is the gateway theory, medical cannabis, passive smoking and lower bone mineral density, bronchitis, emphysema and COPD.

They need to be taught that there is reduced ability to process information, self-criticise and think logically. Users lack attention and concentration, can’t find words, plan or achieve routines, have fixed opinions, whilst constantly feeling lonely and misunderstood. They should know of the risk of miscarriages and ectopic pregnancies.

Amazingly, the fact THC damages our DNA is virtually unknown among the public. In the 1990s, scientists found new cells being made in the adult body (white blood, sperm and foetal cells), suffered premature ‘apoptosis’ (programmed cell death) so were fewer in number. Impotence, infertility and suppressed immune systems were reported.  This is important.

In 2016 an Australian paper discovered THC badly interferes with cell division i.e. where chromosomes replicate to form new cells. They fail to segregate properly causing numerous mutations as chromosomes shatter and randomly rejoin.  Many cells die (about 50% of fertilized eggs (zygotes). Any affected developing foetus will suffer damage. Resultant foetal defects include gastroschisis (babies born with intestines outside the body), now rising in areas of legalisation, anencephaly (absence of brain parts) and shortened limbs (boys are about 4 inches shorter). Oncogenes (cancer-causing) can be switched on. Bladder, testicle and childhood cancers like neuroblastoma have all been reported. The DNA in mitochondria (energy producers in cells) can also be damaged.

Parliament controls the drug laws, so why are the police able to decide for themselves how to deal with cannabis possession?

Proof of the liberalisation of the law on cannabis possession appeared in the new Police Crime Harm Index in April 2016, where it appeared 2nd bottom of the list of priorities. In the following November it fell to the bottom. Class ‘A’ drug possession was immediately above. Possession has clearly become a very low priority. In 2015, Durham Police decided they would no longer prosecute those smoking the drug and growing it ‘for their own use’. Instead, officers will issue a warning or a caution. Then Durham Chief Constable Mike Barton announced that his force will stop prosecuting all drug addicts from December 2017 and plans to use police money to give free heroin to addicts to inject themselves twice a day in a supervised ‘shooting gallery’.  This surely constitutes dealing. The police can it seems, alter and ‘soften’ laws at will. 

Several weeks ago, I happened to check the FRANK website. Quietly, stealthily and without fanfare, a new version had appeared – completely changed. Absent were the patronising videos, games and jokes. Left were A to Z of Drugs, News, Help and Advice (e.g. local harm reduction information) and Contact.

There is poor grammar, i.e. ‘are’ instead of ‘is’ and ‘effect’ where it should be ‘affect’. Mistakes like these do not enhance its credibility.

The drug information is still inadequate with scant essential detail, little explanation and still out of date. This is especially true of cannabis. THC can stay in the brain for many weeks – still sending out its damping-down signals.

What shocked me though were the following:

Our organisation recently received an email about a call to FRANK requesting advice. A friend, a user who also encouraged others to use as well, had lied in a court case where her drug use was a significant factor. He contacted FRANK about her disregard for the law for a substance that was illegal. The advisor raised his voice whilst stating the friend has the right to do what she wants in her own home and mocked him about calling the police. He was shocked and upset by the response.

Ecstasy – Physical health risks

  • Because the strength of ecstasy pills are so unpredictable, if you do decide to take ecstasy, you should start by taking half or even a quarter of the pill and then wait for the effects to kick in before taking anymore – you may find that this is enough.
  • If you’re taking MDMA, start by dabbing a small amount of powder only, then wait for the effects to kick in.
  • Users should sip no more than a pint of water or non-alcoholic drink every hour.

The ‘NEWS’ consisted of 8 pictures with text. In 2 of the 8 items, opportunity is taken to give more ecstasy harm reduction advice. One is titled, ‘Heading out this weekend with Mandy or Molly?’ This is blatant normalisation. The others aren’t ‘news’ items either, but more information about problems.

The section on each drug entitled, ‘Worried about drug x’ mostly consists of giving FRANK’s number. ‘If you are worried about your use, you can call FRANK on 0300 1236600 for friendly, confidential advice’. Any perceptions that FRANK is anything but a Harm Reduction advice site are dispelled completely.

Mentor International is a highly respected worldwide Prevention Charity.  Government-funded Mentor UK is in charge of school drug-education with their programme, ADEPIS (Alcohol and Drug Education and Prevention Information Service). Mentor UK masquerades as a ‘Prevention’ charity but practices ‘Harm Reduction’ and has done so from its inception in 1998. A founding member, Lord Benjamin Mancroft, is currently prominent in the APPG: Drug Policy Reform, partly funded by legaliser George Soros’s Open Society Foundation.

Professor Harry Sumnall of John Moores University Liverpool, a trustee on Mentor UK’s board, signed a ‘Legalisation’ letter in The Telegraph 23rd November 2016 along with the university, Professor David Nutt, The Beckley Foundation, Nick Clegg, Peter Lilley, Transform, Volte-face and other well-known legalisation advocates. Eric Carlin, former Mentor UK CEO (2000-2009), is now a member of Professor David Nutt’s Independent Scientific Committee on Drugs (ISCD). At a July 2008 conference in Vienna, he said “we are not about preventing drug use, we are about preventing harmful drug use”.

Examples of their activities:

The ‘Street Talk’ programme, funded by the Home Office, carried out by the charities Mentor UK and Addaction and completed in March 2012 was aimed to help vulnerable young people aged 10 – 19, to reduce or stop alcohol and drug misuse. Following the intervention, the majority of young people demonstrated a positive intention to change behaviour as follows: “I am confident that I know more about drugs and alcohol and can use them more safely in the future” – 70% agreed, 7% disagreed’.

 Two CanSS members attended a Mentor UK meeting on 7th January 2014 at Kent University, where Professor Alex Stevens, a sociology professor favouring the opening of a ‘coffee shop’ in Kent and supporting ‘grow your own’ was the main speaker. The audience consisted mainly of young primary school teachers. He became increasingly irritated as CanSS challenged his views, becoming incandescent when told knowledge of drug harms is the most important factor in drug education. The only mention of illegality (by CanSS) was met by mirth!

In a Mentor UK project ‘Safer at school’ (2013), the greatest number of requests from pupils, by 5 to 6 times, were: – effects of drugs, side-effects, what drugs do to your body and consequences. Clearly it had been ignored. Coggans 2003 said that, ‘the life skills elements used by Mentor UK may actually be less important than changing knowledge, attitudes and norms by high quality interactive learning’.

Paul Tuohy, the Director of Mentor UK in February 2013 emailed CanSS, ‘Harm reduction approaches are proven and should be part of the armoury for prevention……..there are many young people harming their life chances who are already using and need encouragement to stop, or where they won’t, to use more safely’.

In 2015 Mentor incorporated CAYT (Centre for Analysis of Youth Transitions) with their ‘The Climate Schools programmes’. Expected Outcomes: ‘To show that alcohol and drug prevention programmes, which are based on a harm minimisation approach and delivered through the internet, can offer a user-friendly, curriculum-based and commercially-attractive teaching method’.

In November 2016, Angelus and Mentor UK merged, ‘The Mentor-Angelus merger gives us the opportunity to reach a wider audience through the delivery of harm-prevention programs that informs young people of the harms associated with illicit and NPS drug-taking, to help support them in making conscientious healthy choices in the future’.

The under-developed brains in young people are quite incapable of making reasoned choices. Nor should they. Drug-taking is illegal.

Michael O’Toole (CEO 2014 –2018) said in an ACMD Briefing paper.

Harm reduction may be considered a form of selective prevention – reducing frequency of use or supporting a narrowing range of drugs used’. “It is possible to reduce adverse long-term health and social outcomes through prevention without necessarily abstaining from drugs”. 

It is a puzzle that any organisation, including the Government, can condone drug-taking, an illegal activity, either by testing drugs or dishing out harm reduction advice, without being charged with ‘aiding and abetting’ a crime.

Mary Brett, Chair CanSS and Lucy Dawe,Administrator CanSS www.cannabisskunksense.co.uk    

Source: http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-and-social-care-committee/drugs-policy/written/97965.html March 2019

At the center of America’s deadly opioid epidemic, non-pharmaceutical fentanyl appears to be finding its way into illegal stimulants that are sold on the street, such as cocaine. Adulteration with fentanyl is considered a key reason why cocaine’s death toll is escalating. Cocaine and fentanyl are proving to be a lethal combination – cocaine-related death rates have increased according to national survey data. This has important emergency response and harm reduction implications as well—naloxone might reverse such overdoses if administered in time. A recent study by Nolan et. al. assessed the role of opioids, particularly fentanyl, in the increase in cocaine-involved overdose deaths from 2015 to 2016 and found these substances to account for most of this increase.

Fentanyl and Cocaine

Fentanyl is a synthetic, short-acting opioid that is 50 to 100 times more powerful than morphine and increasingly associated with a heightened risk of fatal overdose. The combination of heroin and cocaine, also known as “speedballing,” was popular in the 1970s.  Recently, there has been an uptick in cocaine being adulterated with other powerful substances like the synthetic opioid fentanyl. Unlike in the intentional combination of cocaine with other substances in the 70s, many modern users are not aware that their cocaine may be mixed with another substance, leaving them vulnerable to an accidental overdose.

Cocaine deaths have moved up to the second most common substance present in fatal overdoses—after opioids. Before 2015, fentanyl was involved in fewer than 5% of all overdose deaths each year. This rate increased to 16% in 2015 and continues to rise. At the beginning of 2016, 37% of cocaine-related overdose deaths in New York City involved fentanyl. By the end of the year, fentanyl was involved in almost half of all overdose deaths in NYC. Since then, several US cities have reported similar outbreaks of overdose fatalities involving fentanyl combined with heroin or cocaine. The combination of fentanyl and cocaine has been a considerable driver of the rising death toll since 2015, and opioid-naive cocaine users are at an especially high risk of unintentional opioid overdose.

Why is Fentanyl Appearing in Cocaine?

One theory is that the adulteration is an accident and occurs by residual fentanyl being present in the same space and on the same surfaces where cocaine is being processed. Another theory is that the increasing presence of fentanyl in cocaine concerns cost and supply. Drug cartels can add other cheaper drugs and medications as fillers to stretch out their product.1 By adding fentanyl they may also be producing a more potent and addictive product to expand their market. This, however, is risky since even a small amount of fentanyl can result in death. The Drug Enforcement Agency (DEA) explains that even 2 milligrams of fentanyl, about the size of a grain of rice, can be deadly to an adult. In light of that fact, it’s distinctly possible that street-level illicit drug dealers do not have insight into the contents of their product and are unknowingly selling cocaine adulterated with fentanyl.

Present Study

Data in this study was acquired from death certificates from the New York City Bureau of Vital Statistics and toxicology results from the New York City Office of the Chief Medical Examiner. Age-adjusted rates per 100,000 residents were calculated for 6-month intervals from 2010 to 2016.

Results suggested that individuals using cocaine in New York City were vulnerable to a greater risk of a fatal overdose due to the increasing presence of fentanyl in the city’s drug supply. In fact, 90% of the increase in cocaine overdose fatalities from 2010 to 2016 also involved fentanyl.

Public Health Challenges

This study highlighted some public health challenges caused by fentanyl-adulterated cocaine:

  1. First responders and those present at the scene of a cocaine overdose may consider administering Naloxone even if the patient denied using opioids.

  2. Fentanyl is very dangerous and powerful and dramatically increases the risk of lethal overdose.

  3. Opioid-naïve individuals that have been using fentanyl-free cocaine lack a potentially life-saving tolerance for opioids. Adding fentanyl to their drug of choice puts this group at an even higher risk of fatal overdose.

  4. Opioid-naïve cocaine users are typically not targeted by current harm reduction strategies and public messages concerning opioid overdose. A lack of education and access to critical resources, including naloxone —the lifesaving overdose reversal drug— render this population more vulnerable to a fatal overdose.

Looking to the Future

As the issue continues to get worse — 19,000 of the 42,000 reported opioid overdose deaths in 2016 were related to fentanyl — the authors of the study emphasize the importance of overdose prevention intervention for cocaine users, with a strong emphasis on access to naloxone and information about fentanyl.

Future prevention efforts must be widened to include cocaine users, especially those who are opioid-naïve, to prevent more fatal overdoses. Cocaine overdose awareness, treatment for dependence, and relapse prevention must be prioritized in a comprehensive response to addiction that puts us on a better path forward and ensures that this country does not repeat past mistakes by implementing substance-centric policy and education efforts.

Citation

Nolan, M. L., Shamasunder, S., Colon-Berezin, C., Kunins, H. V., & Paone, D. (2019). Increased presence of fentanyl in cocaine-involved fatal overdoses: implications for prevention. Journal of Urban Health, 1-6.

Source: Fentanyl-adulterated Cocaine: Strategies to Address the New Normal (addictionpolicy.org) Updated October 16th 2022

It is not all that long since people seriously tried to pretend that cigarettes were safe. Most of them were motivated by greed, and by fear that the truth would destroy their profits.

Everyone now agrees that cigarettes cause lung cancer and many other diseases. But we forget the struggle that doctors and scientists had to fight, against Big Tobacco, to get this accepted.

Sir Richard Doll and Sir Austin Bradford-Hill established in 1950 that there was a clear link between smoking and cancer. A wider study in 1954 absolutely confirmed this.

Yet such was the power and wealth of the tobacco giants that it was decades before anything serious was done to discourage smoking. It was not until 1971 that the first feeble warning was placed on cigarette packets in this country.

As late as 1962, the cigarette-makers were still pretending there hadn’t been enough research, and even that tobacco was good for you, claiming ‘smoking has pharmacological and psychological effects that are of real value to smokers’.

A Tory MP, Ted Leather, denounced the doctors’ warnings as ‘unscientific tosh’ and ‘hysterical nonsense’. Lung cancer was blamed on air pollution. The prominent journalist Chapman Pincher proclaimed ‘cigarette risks are being exaggerated’. It was seriously argued that restrictions on smoking were an attack on liberty.

I’d guess that many who made such claims lived to regret, bitterly and with some embarrassment, their part in covering up a terrible danger. Those who listened to them died, early and often horribly. They are still dying now, in cancer wards up and down the country.

Earlier, firmer action would have saved them and their families from much grief. Those tobacco apologists all have their parallels now.

I know, but will not name here, drug lobbyists, a Tory MP and several prominent journalists, who make the same excuses for marijuana, just as the evidence of its grave dangers piles up. They claim the evidence against it is exaggerated. They claim it has medical benefits. They claim its effects are caused by something else. May God forgive them. I cannot.

Our society, learning nothing from the tobacco disaster, has for years been appallingly complacent about this terribly dangerous drug, whose effect on the brains and minds of its users can be utterly devastating. Knowledge of its dangers does not show up in statistics which pay little attention to the sort of damage it does.

The victims of marijuana seldom die (though they increasingly frequently kill others, in mad car crashes and violent crime).

School failure, delinquency, delusional behaviour, persecution mania, young lives wholly blighted and continued only thanks to a devastating cocktails of antipsychotic drugs, do not register much in NHS figures. Nor do the special miseries of the families of these people, compelled to care, for life, for a husk of the person they once knew and had hopes for, and still love. Such families keep their grief to themselves. But there are many of them.

Look, I am right about this. But it is no good being right if you are not believed. I and my allies are roughly where the doctors who warned against lung cancer were in the mid-1950s. The evidence keeps on coming. Last week’s report linking marijuana use to depression and suicidal feelings among the young is just the latest in a great mountain of such studies. But the popular culture continues to act as if there’s nothing to worry about.

It is now seven years since I published a book which pointed out the truth – that the police and courts have given up prosecuting the major crime of marijuana possession. Back in 2012 I was denounced, snubbed, sneered at and told by distinguished academics that I was wrong and that there was a stern regime of cruel prohibition.

Now everybody recognises that what I said seven years ago is absolutely true. It is hard not to do so when so much of our country openly stinks of marijuana. Even if the Commissioner of the Metropolitan Police, Cressida Dick, cannot smell it, the rest of us can.

Sooner than seven years from now, I suspect that the connection between marijuana and severe mental illness will also be widely understood and accepted. But will it be too late?

Today’s Big Dope lobby wants to silence warnings about the dangers of marijuana until they have it legalised, and we can’t go back. They are like the Big Tobacco of the 1950s, a cynical greed campaign prepared to cause misery to others in the pursuit of riches.

This is the reason for its busy Trojan Horse operation to portray marijuana as a medicine, a claim for which there is very little evidence. And in any case, what use would a medicine be whose users risked irreversible mental illness?

Thalidomide was wonderful at treating morning sickness. But what does that matter compared with its terrible side effects?

Be on your guard. Make sure your MP isn’t fooled by Big Dope propaganda. Write to your MP when you see reports of crimes whose perpetrators were cannabis smokers. Your local papers will be full of them, if you look. Ask your MP to read the many reports linking this drug with mental illness.

And don’t be fooled. All of us sympathise with the mothers of very sick children who seek remedies for them. But beware of the shadowy figures who often stand behind such stories, and who use this suffering to promote a nasty cause.

It’s a race against time. If we lose it, the suffering which follows will be at least as bad as the suffering caused by cigarettes, and probably far worse.

Peter Hitchens  Mail on Sunday  

Source: Cigarettes are healthy! (And if you believe that, you’ll fall for Big Dope’s marijuana propaganda, too) – Mail Online – Peter Hitchens blog (mailonsunday.co.uk) February 2019

DEA says Houston is both a big market for synthetic pot and a major source

More than 1 million packets of a dangerous, unpredictable new breed of drug were seized in the Houston area by the DEA in the past two years, yet criminal charges are rare for those who make, sell or use them.

The packets, sold as potpourri or incense, are among the more popular brands of so-called synthetic marijuana taking center stage in a new front in the war on drugs.

On a recent afternoon, glossy packets of strawberry-flavored “Kush” lay side by side in a lighted glass display case, just past the bongs and pipes, at a Houston-area shop. The mixture inside looks like dried, finely crushed green leaves. It is smoked like pot but packs a far different punch – and is fueling the never-ending search for ways to get high.

“This is a new frontier for drugs and drug traffickers,” said Rusty Payne, a spokesman for the Drug Enforcement Administration. “I want to shout it from the roof tops: This is nasty stuff.”

Despite pressure from law enforcement, users still don’t have to go to underground dealers to score. Instead, they just visit smoke shops and convenience stores that sell the products.

Houston has a key role in the popularity of the drugs. It is not only a large marketplace for them, but they are covertly made here and shipped to other regions, according to court documents.

Doctors said the substances – technically classified as synthetic cannabinoids – can be aggressive, unstable and damaging.

Hearts race. Blood pressure soars. Seizures can be unleashed.

Paranoia is known to grip some users, as well as agitation and suicidal tendencies that can last five or six hours and land them in emergency rooms.

“They come in, and they are wild and psychotic and sometimes have a distinct smell,” said Dr. Spencer Greene, director of medical toxicology for Baylor College of Medicine. “They are going to be kind of wild and kind of crazy, and potentially very sick.”

Part of the problem is that the potency of the drugs can vary so greatly, and that users can never be sure what they are smoking.

Emily Bauer, a 17-year-old former user who lives in Cypress, learned just how bad they can be on a Friday night in 2012.

She smoked a packet, as she had done many times before, and ended up suffering what her family has been told was a series of strokes.

“I am improving constantly, and my vision is getting better,” she said, noting that she continues with high school thanks to people who read textbooks aloud to her and help her write.

Bauer and her parents have been sharing her story publicly in hopes that others will avoid the drugs. She said it just is not accurate to compare what she smoked to marijuana.

“It is more like smoking bleach,” she said.

Banned at trade shows

They come in colorful packets with dozens of other brand names, including Scooby Snax and Hello Kitty. The packages look like packets of candy and cost from $6 to $20, depending on the size.

They carry warnings that the contents are not for human consumption and sometimes incorrectly note contents are legal.

Authorities contend the language is just an attempt to dodge state and federal laws.

In schemes reminiscent of the popular crime drama “Breaking Bad,” rogue chemists repeatedly tweak compounds to create new generations of designer drugs faster than laws can catch them.

“Trained chemists know exactly what they are doing,” said Jeff Walterscheid, a toxicologist with the Harris County Institute of Forensic Sciences.

He noted that tweaking one molecule can make a new drug.

Dozens of such deviations of synthetic cannabinoids have been identified in the past few years, according to the DEA, and the list of what is out there is believed to be growing weekly.

To prepare the drugs for consumption, chemicals – usually white powdery mixtures – are often imported from China where they were prepared by chemists who keep an eye on U.S. laws, according to the DEA.

After U.S.-based manufacturers get those chemicals, they are often dissolved in acetone and then sprayed over leafy material, dried and spritzed with flavors such as grape, strawberry or cherry. Then they are poured into packages that are delivered in bulk to stock the shelves of retailers.

A manufacturing operation in Stafford was shut down by police in September after five day laborers staggered to an ambulance company looking for help. They had been overcome by fumes.

The factory was in an industrial park and a few hundred yards from a day care center. All that was left behind on a recent visit to the site was a scattering of crushed leaves in a carpeted office and a small black and blue packet labeled Amsterdam Dreams Potpourri.

Manufacturers of these substances aren’t considered nearly as violent as drug-cartel gangsters, but turf wars flare up.

Authorities point to a brutal dispute between two manufacturers. One stormed into the other’s business on Harwin, doused him with gasoline, and threatened to set him ablaze if he didn’t stop stealing a brand name.

The dispute faded. No one was arrested.

Jeff Hirschfeld, president of Champs, which holds national trade shows for thousands of smoke shop owners, said two years ago he decided to ban synthetic marijuana vendors from his events.

“There are so many states that don’t allow it, we just did not think it was proper,” he said.

“I am a grandfather of six, and I would not really recommend it for my grandkids,” he said. “I have not tried it, but I know people who have. Some say good, some say bad, but I’m not comfortable with it.”

Users vary from high school kids to working professionals. The drug also doesn’t show up in urine tests for marijuana, which might appeal to people on parole or job applicants.

Not meant for humans

In the past two years in Houston, synthetic cannabinoids were in the system of a person who hanged himself, another who was hit by an allegedly drunken driver while walking along a tollway, and another who was shot to death, according to the Harris County Institute of Forensic Sciences.

Users are playing roulette with their lives, said Walterscheid, the Harris County toxicologist.

“You cannot look at a container of Kush Apple and know what is in it,” he said. “When buying a package that looks the same every day for a year, you could be getting something different every single time.”

John Huffman, a South Carolina chemist who years ago led a team that developed synthetic cannabinoids while researching under a federal grant, said some strains now being copied could easily be 50 times more potent than marijuana.

“They are all dangerous. Don’t use them,” said Huffman, who retired four years ago. “They were never designed for this.”

The substances were tested on animals but were never to be used by humans.

Criminal charges rarely are filed as cases involving these emerging drugs bring on a host of new scientific, medical and legal complexities.

Clinical tests have not yet been conducted on humans on any of these drugs, so it can be tough to prove the extent of their harm. Experts could also clash over whether the ingredients of a given drug make it illegal, among other issues.

People who knowingly make or sell synthetic cannabinoids for human consumption can face federal charges. Possession of some of those substances, regardless of weight, can in some cases be a misdemeanor in Texas.

“We have been taking an active role trying to classify more of these, make more of them fall in the penal code,” said Marcy McCorvey, division chief of the major narcotics division of the Harris County District Attorney’s Office.

She said that prosecutors are handcuffed by insufficient laws, but if they can make a case, they will take it to court.

“It is very frustrating. I know of police officers who are out there trying to combat the problem,” McCorvey said. “I understand parents who want it off the shelves. I wish I could prosecute sellers and suppliers in a more harsh manner, but the state law does not allow for a harsher penalty as it is written.”

Few criminal charges

Despite the DEA seizing more than 1 million packets of the drugs, as well as the pending forfeitures of more than $8 million, federal prosecutors in Houston have yet to charge anyone, according to officials.

The U.S. Attorney for the Southern District of Texas, who is based in Houston, declined to comment.

In June, federal authorities in San Antonio announced Operation Synergy. At least 17 people were arrested in San Antonio, Houston and elsewhere for alleged roles in a synthetic cannabinod ring.

In another case, Houston resident Issa Baba was charged federally in Pennsylvania with using the Web to sell synthetic pot and other designer drugs. More than $5 million was seized from his bank accounts. Baba has signed a guilty plea.

Another Houston-area man has not been charged with a crime, but more than $2 million was taken from him in May on the grounds that it was proceeds from making synthetic cannabinoids. Bundles of $100 bills wrapped in rubber bands were stashed at his ex-wife’s home in La Marque.

Lawyer Chip Lewis, who represents Baba and the other man, said the cases against his clients come at a tricky time, as the Department of Justice has decided not to challenge laws that permit the medical and recreational use of marijuana.

“It is a slippery slope we are on here,” Lewis said. “Yes, we will prosecute you for this. No, we are not going to prosecute you for something else on the books.”

Javier Pena, chief of the DEA’s Houston Division, said getting this breed of drugs off the streets has become a moral mission as much as a legal one.

“We are trying to say to store owners: You know who you are. You need to stop selling this poison.”

Source: https://www.houstonchronicle.com/news/investigations/article/Houston-gains-key-role-in-synthetic-marijuana-5024607.php  November 2013

Kevin Sabet was a drug control policy adviser in the White House for both Republicans and Democrats

When most people talk about Canada’s impending legalization of marijuana, they talk about the future. When Kevin Sabet talks about it, he worries about history repeating. 

“There are huge misconceptions, I often feel like we’re living in 1918, not 2018,” he said.” When I say 1918, I mean 1918 for tobacco when everyone thought that smoking cigarettes was no problem and we had a new industry that was just starting.”

In 1918, soldiers returning home from the trenches of the First World War brought cigarettes home with them and unwittingly sowed the seeds of one of 20th century’s biggest health epidemics. 

“We hadn’t had tobacco related deaths before the 20th century because we hadn’t had a lot of cigarettes, which actually gave us the most deadly form of tobacco we’ve ever seen. I feel like we’re like that with marijuana.”

Kevin Sabet is the president of Smart Approaches to Marijuana, or SAM, a non-profit agency in the United States devoted to ‘preventing another big tobacco.’ (Smart Approaches to Marijuana)

A former drug control policy adviser to the White House under both the Democrats and Republicans, Sabet is the President and CEO of Smart Approaches to Marijuana, a public health organization opposed to marijuana legalization and commercialization in the United States. 

He said the sudden about-face by Ontario’s newly-elected Progressive Conservative government away from a public monopoly on marijuana sales to a mixed public-private is “a really bad move.” 

“When I see the government monopoly being tossed out the window in favour of a private program that really puts private profit over public health.. I worry about that,” he said. “I think it’s a really bad move.” 

“They are moving from a government monopoly to private retail and that’s going to open the door to all the marketing and promotion and normalization that already is a huge problem for our already legal drugs.”

“We’ve seen how that turned out for pharmaceuticals like opiates, which are highly dangerous and we’ve seen how that turned out for tobacco and alcohol.”

Big investors lining up to cash-in on pot

With legalization still months away, there are growing signs that marijuana and big business are starting to become best buds. (Nicolas Pham/Radio-Canada)

In fact, Sabet points out, some of the same players have already expressed their willingness to provide Canadians with legal marijuana on a massive scale. 

Constellation Brands, the maker of some of the most popular wines and beers in the world, has already paid $5 billion for Canopy Growth, the world’s largest publicly traded licensed producer of marijuana in Smith Falls, Ont. 

Several notable Canadian brands have also expressed an interest in legal bud, including Molson, which has mused publicly about a THC infused beer and Shopper’s Drug Mart, which hopes to branch out in sales of medical marijuana online. 

“We’re already seeing the private market salivating in Canada, waiting to be that next addiction for profit substance and I don’t see how that helps us.” 

‘Not your Woodstock weed’

Why that worries Sabet is the combination of savvy corporate marketing and increasingly intense levels of THC, or tetrahydrocannabinol, the active ingredient in marijuana. 

“Today’s marijuana is not your Woodstock weed,” he said. “I think there’s a wild misperception about what today’s marijuana experience really is.” 

There are signs too that marijuana sold on the street is stronger than it used to be. According to a 2017 report from the Hazelden Betty Ford Foundation, an American healthcare organization that helps people struggling with addiction, said the concentration of THC in marijuana has risen three-fold in the last two decades, from four per cent in 1994 to 12 per cent in 2014. 

Sabet notes that marijuana sold commercially in some states goes even further and is available in highly concentrated forms, such as hash, wax, or shatter with no rules or limits on the concentration of marijuana’s active ingredient. 

“It’s not four per cent THC, which is the ingredient that gets you high. It’s up to 99 per cent THC and there are no limits on THC,” he said. “I’m really concerned especially how today’s high potent marijuana is going to contribute to mental illness.” 

Potent pot and drug-induced psychosis

Anecdotally, one only has to look as far as the story of Mark Phillips, a lawyer from a prominent Toronto family, who pleaded guilty to assault causing bodily harm in April, after he attacked a St. Thomas family with a baseball bat, calling them terrorists. 

During Phillips’ court appearance, his lawyer and psychiatrist said he was suffering from a drug-induced psychosis.

His lawyer, Steve Kurka told Justice John Skowronski that Phillips, whose mental health had been declining in the months and weeks leading up to the December 2017 baseball bat attack, smoked three or four joints before driving to London and then nearby St. Thomas, getting into arguments with people he believed to be Muslims targeting him along the way.

“[It] doesn’t shock me,” Sabet said of the Phillips case. “Today’s highly potent THC can have an aggressive violent effect. I’m not going to say everybody is going to have a psychotic breakdown. We’re going to see stuff like this become more and more common.”

Despite his concerns about pot, Sabet said he doesn’t want to see Canada go back to the days of arresting people for simple pot possession, nor does he see a problem with people growing the plant at home on a small scale either. 

“I don’t care about that,” he said. “The issue is when you make this a legal market and advertise it and throw it to the forces who are in the business of promotion. They are in the business of advertising and commercialization and pot shops next to your kid’s school and billboards and coupons and products, that’s my worry.” 

Sabet believes the real Reefer Madness is giving private companies control of retail sales, where they can use marijuana as a tool in their pursuit of profit at the cost of public health. 

“I worry that Canada is following the example of the United States in terms of this new industry which promotes, recklessly advertises, makes wild claims, ignores all harms and absolutely focuses on advertising to kids.” 

Source: Ontario’s new retail pot plan ‘puts profit over public health’ says former Obama drug adviser | CBC News August 2018

An investor in a major Canadian cannabis company has had longstanding ties, including business dealings, with influential Mafia members and drug traffickers, Radio-Canada has learned.

Another investor in the same company has links with a prominent member of the Rizzutos, the powerful Montreal crime family.

In still another case, an individual managed to sell his cannabis business to one of the big players in the industry, despite his connections to drug traffickers. In return, he received shares in the company and rented out space for a cannabis grow-op.

Prime Minister Justin Trudeau’s legalization plan was supposed to cut out organized crime, but an investigation by Radio-Canada’s Enquête shows Health Canada has granted production licences to companies with individuals with links to the criminal underworld.

Enquête examined hundreds of documents as part of its investigation, including reviews conducted by Canadian securities oversight bodies. Enquête is not naming the companies or individuals involved.

For its part, Health Canada says it has not seen any cases of organized crime infiltration of more than 130 licensed cannabis producers since 2013.

To produce cannabis, those who hold certain positions in companies must first obtain a permit from Health Canada by taking a security screening.

Any past connections with individuals related to organized crime are part of the analyzed information.

Red flags raised

To secure a licence, Health Canada first checks if the individual has a criminal record.

Second, the RCMP consults police databases to review information that may indicate an applicant’s links to criminals.

Health Canada makes its final decision with the information provided by the RCMP.

The RCMP says it raised red flags on about 10 per cent of the applicants it was asked to check out in 2016 and 2017.

“It’s really criminal associations,” says Supt. Yves Goupil, who gives the example of a person “associated with individuals who have criminal records.”

In a statement, Health Canada said it can “categorically confirm” that it didn’t issue “security clearance to an individual when the RCMP provided evidence to the department that it was associated with organized crime.”

“Health Canada has found no evidence that organized crime has infiltrated one of more than 130 federally registered producers,” spokesperson Eric Morrissette said in an email.

Security checks only scratch the surface

Throughout the period in which Canada’s cannabis industry was developing, primarily for medical purposes, only individuals who directly ran the companies were required to obtain a security clearance.

This approach, says Conservative Senator Claude Carignan, demonstrates a naiveté about the workings of high-level organized crime.

“If there is someone who has a criminal record, it is not that person they will put to apply for the licence,” Carignan said. “It would be completely naive to think that.”

Last spring, Carignan and his Senate colleagues tried, unsuccessfully, to amend Bill C-45 on the legalization of cannabis in order to demand more transparency from companies entering the industry.

Several companies have opaque and complex structures.

“You never see who the real licence holders are,” said lawyer and tax expert Marwah Rizqy, who raised the issue before a Senate committee last spring and has since been elected Liberal MNA for the Quebec riding of Saint-Laurent.

The black hole of trusts

It’s not uncommon for cannabis companies to be funded through family trusts.

Originally designed for estate and tax planning, trusts are an ideal way to hide individuals with interests in a business, said Marie-Pierre Allard, who studies tax policy at the Université de Sherbrooke.

“The beneficiaries of the trust are not disclosed publicly. It’s anonymous,” she said, adding that it is “one of the great vulnerabilities of the Canadian legal system.”

“If we want to eliminate the Mafia cannabis market, we cannot allow them to use tax havens or trusts to enter indirectly through the back door,” Carignan said.

A report by the federal Department of Finance and several international organizations identifies trusts as one of the vehicles most at risk for money-laundering in Canada.

In a Senate appearance last April, Rizqy suggested refusing to grant production licences to companies financed through trusts.

“Maybe it would be wise to deny the licence outright because you are not able to unequivocally establish that the security clearance is really valid,” said Rizqy.

The recommendation was not accepted. The federal cannabis legislation adopted this summer, however, did include more extensive background checks into individuals who back cannabis companies.

Too many requirements for the cannabis industry?

Carignan has faced criticism for his efforts to make cannabis companies more transparent.

Line Beauchesne, a criminologist at the University of Ottawa, believes Health Canada’s investigations are adequate and consistent with the government’s desire to ensure the quality of the product and to prevent smuggling.

“Why especially for the cannabis industry?” Beauchesne asked.

If there were to be new rules of transparency, “all industries moving into Canada” should be affected, she said.

She acknowledged, however, that Health Canada “is absolutely not equipped to conduct financial investigations.”

Its traditional role is to ensure a product meets certain standards.

“Health Canada’s job is to make sure that when I eat cheese, it’s cheese. When it’s eggs, it’s eggs. And when [it comes to] cannabis, it’s cannabis.”

The limits of police investigations

The number of audits to be conducted in the cannabis industry is so great investigators have to make choices, said the RCMP’s Goupil.

The work of police is complicated considerably when the sources of financing for businesses come from abroad, including from tax havens.

“Technically, there is nothing illegal there. But it’s hard for [the RCMP] and for Health Canada to go out and check in those countries,” he said.

“Often, it’s going to be the janitor who will sign the company documents or a law firm in country X. At some point, we cannot do the research. It’s a lot of investment, a lot of time, a lot of money,” Goupil said.

“We cannot have a fully bulletproof system. If organized crime has an opportunity to make a profit, it will exploit it. “

Tax havens are not the only barrier to police work. Secrecy also exists in some companies in Canada.

“We need to use other more advanced techniques such as physical surveillance and wiretapping that will help us identify who is behind the company and who operates it,” he said.

These survey techniques, however, require considerable resources and cannot be deployed for all cannabis companies.

“We cannot afford it.”

Source: Licensed cannabis growers have ties to organized crime, Enquête investigation finds | CBC News November 2018

Last June, under huge and hysterical media pressure, Home Secretary Sajid Javid opened the lid on the Pandora’s box of ‘medicinal’ cannabis. He issued emergency licences to allow access for two young boys with severe forms of epilepsy and at the same time ordered a review into evidence of its therapeutic efficacy, falling for what soon transpired to be a well-orchestrated campaign. Coordinated by Volteface, the openly pro-legalising recreational cannabis think tank funded by Paul Birch, a multi-millionaire British tech tycoon, it was aided by the journalist and campaigner Ian Birrell, who has disclosed his membership of its advisory panel. Mrs Caldwell and her sick child had, the Daily Mail argued, been hijacked by a pro-cannabis lobby that stands to make billions. She herself has a vested interest as the director of a company marketing cannabis oil which she sells online.

With useful idiots like Lord Hague ready to make two and two add up to five by arguing that the current law is indefensible and therefore we must legalise cannabis altogether, the campaign had got off to a flying start.

Since then the media onslaught of the metro-elite’s demands for legal access to this drug has not stopped. Fuelled by Canada’s ill-considered decision to legalise recreational use, it reached peak volume last week. Kate Andrews of the Institute of Economic Affairs made her case for it based on a startlingly under-informed account of post-legal pot Colorado (she cannot have read the latest impact update) and arrest stats from the American Civil Liberties Union. Whatever their reliability, she should know that here you are unlikely to receive a custodial sentences before at least seven previous convictions or cautions, and that 50 per cent sent to prison for the first time have at least 15 ‘previous’. As to cannabis possession, it is a myth that is anything other than decriminalised already.

Then we had former Met Chief Lord Hogan-Howe adding his pennyworth. He has no reason not to know the devasting evidence from Colorado and Washington State, yet he thinks we need a two-year review of legalisation. Philip Collins of the Times seems equally gung-ho about Colorado’s descent into a dangerous drugs products free-for-all.

In the most sickeningly selfish article of all, the gloating Simon Jenkins raised his ‘glass of cannabis wine’ to the drug culture that no legalisation will ever sanitise.

Unmentioned was that Canada’s decision was based on no evidence at all that it would either reduce youth use or meaningfully curtail the black market, the stated goals for taking the country down this path

Nor was the fact that Canada’s ‘journey’ had started – where else? – with medicinal cannabis, the cannabis lobby’s admitted and cynical strategy to buy the drug a good name and lower the public’s defences.

This is the wheeze our Home Secretary has fallen for. He has already made good his promise of June 26 and given the all-clear for clinical specialists routinely to prescribe cannabis oil and similar products for epilepsy and multiple sclerosis. Taking effect on November 1, this decision is based on the hastily prepared recommendation of his Chief Medical Officer, Dame Sally Davies, that vaguely designated ‘cannabis based medicinal products’ should be ‘rescheduled’ (in other words, legalised for ‘prescription’).

This comes before the Advisory Council on the Misuse of Drugs (ACMD) recommendations have been followed through for a clear definition of what a cannabis-derived medicinal product is, and ‘additional frameworks’ and clinical guidance for ‘checks and balances’ for safe prescribing.

Yet these are products neither clinically tested nor of proven efficacy, which doctors will be under great pressure to prescribe and which will leak into the illegal market.

In this one misguided action, oblivious to those interests ruthlessly exploiting the medicinal cannabis pipe dream, the Home Secretary has casually trashed the UK’s world class and purposefully onerous pharmaceutical approval system.

The Home Secretary cannot have read the small print of Dame Sally’s review, or he chose not to, in his rush to get the Billy Caldwell story off the front pages. It has the hallmarks of a dodgy dossier. For the American evidence on which it relies states that there is ‘no or insufficient evidence to support or refute the conclusion that cannabis or cannabinoids are an effective treatment for epilepsy’.* Likewise the meta-analysis Dame Sally leant on provided her with no evidence for epilepsy.

The only ‘conclusive or substantial’ the American evidence finds is for the treatment of chronic pain in adults, chemotherapy-induced nausea and vomiting and for improving patient-reported multiple sclerosis spasticity symptoms. For these conditions the licensed cannabis-based drugs Sativex, Marinol and Nabilone exist.

Elsewhere the serious problems associated with the medicalisation of cannabis have been set out. The testimonial evidence it largely relies on falls short of the standards required for the approval of other drugs – which are ‘adequately powered, double blind, placebo controlled randomised clinical trials’.

Against this absence of evidence is the very real evidence of the drug’s harm which has presented itself again in rising hospital cannabis admissions. These include alarmingly high numbers of teens urgently admitted with psychosis. Had Dame Sally had taken more time, extended her search and listened to recent warnings, she would have found that this is far from the only public health risk associated with cannabis.

A long, well-written and referenced article in the BMJ by an Australian academic, Professor Albert Reece, entitled Known Cannabis Teratogenicity Needs to be Carefully Considered, published shortly after the Davies review, raises the alarming question of whether exposure to cannabis has significance for rising birth defects; and whether full-spectrum cannabis (unlike the FDA-approved drug Epidiolex) could have some of the problems of thalidomide.

Reece’s concern is that even were the clinical efficacy of cannabinoids to be demonstrated, ‘their teratogenic potential, from both mother and father’ would need to be carefully balanced with their clinical utility. A teratogen, for the uninitiated, is an agent that can disrupt the development of the embryo or foetus and halt the pregnancy or produce a congenital malformation (a birth defect).

Professor Reece reports that ‘gestational cannabis has been linked with a clear continuum of birth defects’ in a range of longitudinal studies, and increased foetal death, and reflects a worldwide increase in high cannabis-using areas.

He is not alone to be concerned. The website of NHS Wales carries a warning about cannabis which indicates that it is taking its gastroschisis (a condition in which the bowel herniates out of the abdomen during foetal development) outbreak seriously.

The question of whether cannabis is to blame for rising rates of gastroschisis has been raised elsewhere and those puzzled by it cite drug use as a risk factor, as does the NHS. 

Professor Reece’s warning needs heeding. Only once before has a known teratogen been marketed globally: thalidomide. What the Home Secretary and his Chief Medical Officer need reminding of, as Reece makes clear, is that the thalidomide disaster is ‘the proximate reason for modern pharmaceutical laws’. These are laws that Sajid Javid, Dame Sally Davies and the AMCD are prematurely prepared to overturn.

Previously supportive commentators have begun to express their reservations about the implications of ‘medicinal’ cannabis. It can’t be allowed to become a free-for-all, writes Alice Thomson in the Times.

She is right to worry, and the dangers could be worse than anything she has imagined.

This is why the Home Secretary needs to stop and take stock. He still has time to review and revoke his ill-advised and media-pressured decision. As for the vested interests behind legalising cannabis, he should know that as far as medicinal cannabis is concerned more will never be enough.

*Epidiolex, the GW Pharmaceuticals CBD-based epilepsy drug which has recently been approved for Dravet Syndrome in the US and which we can expect to be approved in Europe, does not fall into this category. One must presume that GW Pharma with twenty years of research would have included the psychoactive ingredient that Mrs Caldwell and her campaign claim is necessary, had they been able to justify it clinically.

Source: The Home Secretary has acted prematurely and dangerously on medical cannabis – The Conservative Woman October 2018

The fact that 1 in 6 infants and toddlers admitted to a Colorado hospital with symptoms of bronchiolitis tested positive for marijuana exposure should concern Canadians as they move to legalization on 17 October. The dangers of 2nd-hand, carcinogenic and psychoactive chemically-laden marijuana smoke were ignored by the Trudeau government in its push to legalize pot, Pamela McColl writes.

PAMELA McCOLL’S STATEMENT IN FULL…

What About Us? October 17 2018

No amount of second-hand smoke is safe. Children exposed to second-hand smoke are more likely to develop lung diseases and other health problems.  Second hand-smoke is a cause of sudden infant death syndrome (SIDS). The fact that one in six infants and toddlers admitted to a Colorado hospital with symptoms of bronchiolitis tested positive for marijuana exposure should be of grave to Canadians as they too have moved to legalization.

The dangers of second-hand, carcinogenic and psychoactive chemically-laden marijuana smoke were ignored by the Trudeau government in their push to legalize pot. This government in fact sanctioned the smoking of marijuana in the presence of children.

The government did not commission an in-depth child risk assessment of the draft legalization framework, a study called for by child advocates across the country.

The Alberta Ministry of Children’s Services’ – Child, Youth and Family Enhancement Act Placement Resource Policy on Environmental Safety states; that a foster parent must be aware of, and committed to provide a non-smoking environment by not allowing smoking in the home when a foster child is placed; not allowing smoking in a vehicle when a foster child is present; and not allowing use of smokeless tobacco when a foster child is present. As the Alberta government’s policy contains all-inclusive language of “non-smoking environment,” the same rules have been extend to legalized marijuana. Some children in the province of Alberta have been protected under policy while the majority of Albertan children and other children in Canada should rightly ask: “What About Us?”

The Canadian Charter of Rights and Freedoms secures the safety of children from threats to their health and their life. Section 15 of the Charter prohibits discrimination perpetrated by the governments of Canada. The Equality Rights section states that every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination. The provisions that protect children in foster care should extend to every child.

Section 7 of the Charter is a constitutional provision that protects an individual’s personal legal rights from actions of the government of Canada, the right to life, liberty and security of the person. The Cannabis Act fails to protect Canadian children’s right to security of the self. The right to security of the person consists of the rights to privacy of the body and its health and of the right protecting the “psychological integrity” of an individual.  Exposure to marijuana in poorly ventilated spaces exposes the non-user to the impact of a psychotropic high, including the distortion of one’s sense of reality.

Canada is a party to the Rights of the Child Treaty, the most widely ratified piece of human rights law in history.  The treaty establishes the human rights of children to health and to protection under law. Placing marijuana products and plants into children’s homes fails to protect their rights under international treaty obligations.

A petition, before the BC Government Legislative Assembly via the Minister of Municipal Affairs and Housing, seeks to make all multi-unit dwellings in BC smoke-free. Smoke-free housing is needed to protect the non-user’s health. Smoke travels, it escapes and contaminates beyond a single unit. Law consists, primarily, in preserving a person from death and violence and in securing their free enjoyment of their property. The Cannabis Act fails to preserve the rights of non-users of marijuana. It rests with citizens to stand up for their rights and those of children. Be prepared this will be an ugly, costly and lengthy process.

“We think that the true rule of law is, that the person who for his own purposes brings on his land and collects and keeps there anything likely to do mischief if it escapes, must keep it at his peril, and, if he does not do so, is prima facia answerable for all the damage which is the natural consequence of its escape. “ House of Lords Rule. Doctrine of Strict Liability of Dangerous Conditions Rylands versus Fletcher – 1868. Successful argued in Delta, Canada 1983. Individual prevented from smoking in his residence.

Provincial governments can correct the mistakes made by the federal government. Concerned citizens must see that they do.

Pamela McColl – www.cleartheairnow.org

Source: What about the children? | DB Recovery Resources October 2018

Free-marketeers are ignoring the devastating harm it can do as they champion consumer rights.

Four men had to be rescued last weekend from England’s highest mountain, Scafell Pike, after becoming “incapable of walking due to cannabis use”. Said Cumbria police: “Words fail us.”

Well, yes. Does everyone agree that these men placed an irresponsible burden on a public service? Apparently so. Does everyone agree that the use of cannabis should be discouraged to reduce its irresponsible burden on society? Well, no; quite the opposite.

Last week Prince William raised the “massive issue” of drug legalisation. Although he expressed no opinion, merely to raise it was inescapably to express one, since the only people for whom it is a “massive issue” are those who promote it.

At the Labour Party conference yesterday the comedian Russell Brand called for drugs to be decriminalised. At next week’s Conservative conference, the free-market Adam Smith Institute will be pushing for the legalisation of cannabis. Legalisation means more users. That means more harm, not just to individuals but to society. The institute, however, describes cannabis as “a low-harm consumer product that most users enjoy without major problems”. What? A huge amount of evidence shows that far from cannabis being less harmful than other illicit drugs, as befits its Class B classification, its effects are far more devastating. Long-term potheads display on average an eight-point decline in IQ over time, an elevated risk of psychosis and permanent brain damage.

Cannabis is associated with a host of biological ill-effects including cirrhosis of the liver, strokes and heart attacks. People who use it are more likely than non-users to access other illegal drugs. And so on.

Ah, say the autonomy-loving free-marketeers, but it doesn’t harm anyone other than the user. Well, that’s not true either. It can destroy relationships with family, friends and employers. Users often display more antisocial behaviour, such as stealing money or lying to get a job, as well as a greater association with aggression, paranoia and violent death. According to Stuart Reece, an Australian professor of medicine, cannabis use in pregnancy has also been linked to an epidemic of gastroschisis, in which babies are born with intestines outside their abdomen, in at least 15 nations including the UK.

Long-term potheads display on average an eight-point drop in IQ

The legalisers’ argument is that keeping cannabis illegal does not control the harm it does. Yet wherever its supply has been liberalised, its use and therefore the harm it does have both gone up. In 2001 Portugal decriminalised illegal drugs including cocaine, heroin and cannabis. Sparked by a report by the American free-market Cato Institute, which claimed this policy was a “resounding success”, Portugal has been cited by legalisers everywhere as proof that liberalising drug laws is the magic bullet to erase the harm done by illegal drugs.

The truth is very different. In 2010 Manuel Pinto Coelho, of the Association for a Drug Free Portugal, wrote in the BMJ: “Drug decriminalisation in Portugal is a failure . . . There is a complete and absurd campaign of manipulation of facts and figures of Portuguese drug policy . . .”

According to the Portuguese Institute for Drugs and Drug Addiction, between 2001 and 2007 drug use increased by 4.2 per cent, while the number of people who had used drugs at least once rose from 7.8 per cent to 12 per cent. Cannabis use went up from 12.4 per cent to 17 per cent.

The latest evidence about Portugal, a study by the Intervention Service for Addictive Behaviours and Dependencies, shows “a rise in the prevalence of every illicit psychoactive substance from 8.3 per cent in 2012 to 10.2 per cent in 2016-17”, with most of that rise down to increased cannabis use.

For free-marketeers, this evidence of devastating harm to individuals and society is irrelevant. Nothing can be allowed to dent their dogmatic belief that all human life is a transaction, market forces are a religion and the rights of the consumer are sacrosanct. Says the Adam Smith Institute about cannabis legalisation: “The object isn’t harm elimination, it’s not even harm reduction alone, it’s utility maximisation.” In other words, they want as many people as possible to be puffing on those spliffs.

Free-market libertarians are nothing if not consistent. They oppose policies to reduce social harm across the board. Smoking curbs, mandatory seat-belts, speed cameras, gambling restrictions, controls to end unmanageable immigration — they’ve been against them all.

Despite how they are viewed, there’s nothing conservative about the free-marketeers. Far from conserving legal or social constraints, they want to tear them down in the name of consumer choice. The classical political thinkers they quote in support of applying market principles to every aspect of society never in fact subscribed to such a doctrine. Far from putting the autonomous self on a pedestal, Adam Smith himself in his Theory of Moral Sentiments put personal rights last and the interests of others first.

The distortion of such thinking is why Russell Brand and the Adam Smith Institute are soul mates. In a fearful symmetry, both the left and the free-market right deny the importance of conserving the social good. One calls it paternalism, the other the nanny state. Both are radically irresponsible and destructive. The only difference is the gender. And even that, in our current lifestyle free-for-all, is now surely up for grabs.

Source: Thinking is warped on cannabis legalisation (thetimes.co.uk) September 2017

The Internet hosts many unregulated marketplaces for otherwise regulated products. If extended to marijuana (or cannabis), online markets can undermine both the U.S. Controlled Substances Act, which bans marijuana sales, and the regulatory regimes of states that have legalized marijuana. Consequently, regardless of the regulatory regime, understanding the online marijuana market should be a public health
priority. Herein, the scale and growth trajectory of the online marijuana marketplace was assessed for the first time by analyzing aggregate Internet searches and the links searchers typically find.

METHODS
First, the fraction of U.S. Google searches including the terms marijuana, weed, pot, or cannabis relative to all searches was described monthly from January 2005 through June 2017 using data obtained from Google. Searches were also geotagged by state (omitting Alaska, Montana, North Dakota, South Dakota, Vermont, West Virginia, and Wyoming because of data access restrictions). The subset of shopping searches was then monitored by tracking queries that also included buy, shop, and order (e.g., buy marijuana) in aggregate. Searches that included killer, cooking, or clay (e.g., weed killer) were considered unrelated and excluded from all analyses.
Linear regressions were used to compute pooled means to compare between time periods and log-linear regressions were used to compute average growth. Raw search volumes were estimated based on total Google search volume using comScore (www.comscore.com).
Searches in a Google Chrome browser without cached data were executed during July 2017 using the 12 combinations of marijuana and shopping root terms (i.e., buy marijuana). The results would be indicative of a Google user’s typical search results. The first two pages of links, including duplicates (N¼279, with seven to 12 links per page), were analyzed (because nearly all searchers click a link on the first two pages, with as much as 42% selecting the first link). Investigators recorded whether each linked site advertised mail-order marijuana (excluding local deliveries in legal marijuana states) and its order in the search results. Two authors agreed on all labels. Analyses were computed using R, version 3.4.1.

RESULTS
Marijuana searches grew 98% (95% CI¼84%, 113%) as a proportion of all searches from 2005 through the partial 2017 year (Figure 1). The subset of marijuana searches indicative of shopping grew more rapidly over the same period (199%, 95% CI¼165%, 243%), with 1.4–2.4
million marijuana shopping searches during June 2017. Marijuana shopping searches were highest in Washington, Oregon, Colorado, and Nevada. The compounding annual growth rate for marijuana shopping searches since 2005 was significantly positive (po0.05) in 42 of
the 44 studied locations (all but Alabama and Mississippi), suggesting demand is growing across the nation. Forty-one percent (95% CI¼35%, 47%) of shopping search results linked to retailers promising mail-order marijuana (Table 1). Retailers occupied 50% (95% CI¼42%, 59%) of the first page results and for eight (of 12) searches, the first link led to a mail-order marijuana retailer. For some searches (e.g., order marijuana), all of the first-page links were marijuana retailers.

Table 1: Online Mail-Order Marijuana Retailers on Internet Search Engines, 2017

Search results
Retailer First link First page Second page Total
Yes 8 (67) 66 (50) 48 (32) 114 (41)
No 4 (33) 65 (50) 100 (68) 165 (59)

Note: Data were collected by executing searches in July 2017. Cells show the frequency and percent of links (by column) in the first two
pages of Google search results that claim to sell mail-order marijuana in response to 12 searches that contained unique combinations of the
following terms: cannabis, marijuana, pot, or weed with buy, order, or shop, such as buy cannabis, buy marijuana, buy pot, or buy weed.
Searches were executed on a new Google browser without cached data. Two authors agreed on the labels 100% of the time.

DISCUSSION
Millions of Americans search for marijuana online, and websites where marijuana can be purchased are often the top search result.
If only a fraction of the millions of searches and thousands of retailers are legitimate, this online marketplace poses a number of potential public health consequences. Children could purchase marijuana online. Marijuana could be sold in states that do not currently allow it.

Initiation and marijuana dependence could increase. Products may have inconsistent potency or be contaminated. State and local tax revenue (which can fund public health programs) could be negatively impacted.
Regulations governing online marijuana markets (even if policy changes favor legalized marijuana) need to be developed and enforced. Policing online regulations will require careful coordination across jurisdictions at the local, state, and federal level with agreements on how to implement regulations where enforcement regimes conflict. Online sales are already prohibited under virtually every regulatory regime—all sales are illegal under federal statute and legal marijuana states like Colorado ban online sales—yet the market appears to be thriving.
Government agencies might work with Internet providers to purge illicit marijuana retailers from search engines, similar to how Facebook removes drug-related pages. Moreover, online payment facilitators could refuse to support marijuana-related online transactions.
This study was limited in that who is buying/selling and the quantity of marijuana exchanged cannot be measured. Further, some searches may be unrelated to seeking marijuana retailers, and some retailers may be illegitimate, including scams or law enforcement bait. The volume of searches and placement of marijuana retailers in search results is a definitive call for public health leaders to address the previously unrecognized dilemma of online marijuana.

ACKNOWLEDGMENTS
This work was supported by a grant from the National Institutes of Mental Health (R21MH103603). Mr. Caputi acknowledges scholarships from the Joseph Wharton Scholars and the George J. Mitchell Scholarship programs. Dr. Leas acknowledges a training grant from the National Heart, Lung, and Blood Institute (T32HL007034). No other financial disclosures were reported by the authors of this paper.

Source: Online Sales of Marijuana: An Unrecognized Public Health Dilemma – American Journal of Preventive Medicine (ajpmonline.org) March 2018

  • Thousands gathered at crowded ‘420’ rally calling for legalisation of cannabis 
  • Possession of the Class B drug carrying maximum jail sentence of five years
  • Met Police defended lack of action saying it meant rally passed ‘largely without incident’

It’s a sight that makes a mockery of Britain’s drug laws.

As families relaxed in the warm sunshine, thousands of drug users gathered in a Central London park to smoke cannabis – in full view of the police.

Officers stood by in Hyde Park and watched, smiling, as plumes of pungent smoke filled the air.

Revellers, including some teen-agers, lay sprawled on the grass, confident the police would do nothing at the crowded ‘420’ rally, an annual event which calls for the legalisation of cannabis.

One man said: ‘I’m not that bothered about being arrested. The police will just take it off us – and we’ve got more anyway.’

There were no arrests at Friday’s rally, even though possession of the Class B drug carries a maximum jail sentence of five years.

The shocking failure to enforce the law comes as The Mail on Sunday today reveals nine out of ten teenagers in drug clinics are being treated for cannabis abuse.

A Met Police spokesman last night defended their lack of action, saying its approach to enforcing drug laws ‘meant [the rally] passed off largely without incident’ and was ‘no different from any other day’.

Their leniency is mirrored by new figures showing the police and courts are increasingly going soft on drugs. The number of ‘proven drug law offenders’ plummeted to 102,948 in 2016 – a fall of a quarter in two years, according to the Focal Point on Drugs report.

Of these, ‘the majority were dealt with outside court’, with 41,831 sentenced in court, the rest given a warning or caution. The ‘most common sentence was a fine’, meted out to a third, while a fifth were jailed, including 1,009 for possession and 7,459 for trafficking.

The ‘420’ event is believed to have been named after a group of 1970s Californian youngsters who met after school at 4.20pm to smoke marijuana. The day April 20 has since become an informal festival to celebrate the drug.

Source: Fury as thousands gather to smoke cannabis in Hyde Park and not a SINGLE ONE of them is charged  | Daily Mail Online April 2018

Veterans are twice as likely as non-veterans to die from accidental overdoses involving prescription opioids. In an effort to lower opioid intake, some veterans are turning to hemp products, like CBD oil, to treat chronic pain and PTSD. Now some veterans are saying they want more research and access, reports CBS News correspondent Nancy Cordes. 

They are not your typical lobbyists. They’re veterans whose lives were nearly ruined — first by their injuries, and then by their meds. 

“I was at a higher than likely rate of committing suicide from pain,” Navy veteran Veronica Wayne told lawmakers. She took opioids for 17 years after an airplane maintenance hatch hit her head.

“I basically became a walking zombie,” Wayne said.
 
She tried medical marijuana, but still felt impaired. That’s when she heard about hemp.

“It’ll still kill all the pain symptoms and give you the relief that you need, but you’re not going to feel high,” Wayne said.

Now she uses CBD oil. But, she notes, “You can’t get it from the VA. It’s not, it’s not legal.”

Like marijuana, hemp is derived from the cannabis plant. But hemp does not contain THC, the chemical that makes you high. Still both hemp and marijuana are classified as Schedule 1 controlled substances, restricting the VA and other federally funded entities from conducting research. The American Legion is leading the push to change that.

“Anything that makes a veteran feel better — especially something that’s non-toxic — is something we’re going to support,” said Louis Celli, national director of Veterans Affairs and rehabilitation at the American Legion.
 
Currently hemp products are marketed as unregulated supplements, which makes many doctors reluctant to recommend them.

“We’re not exactly sure how to use them, what the right dose is, how they interact,” said Wayne Jonas, the former director of the NIH office of alternative medicine.

But lawmakers on both sides are pushing to change the law.
 
“I’m actually cautiously optimistic if we get something on the floor, that it will pass,” Rep. Earl Blumenauer, D-Ore., said.

Until then, Army reservist Dale Rider said many of his buddies are wary of the product that he said helps his back pain.
 
“For them, they’re all worried that because it’s so closely related to marijuana, that it could pop up on a drug test randomly,” Rider said.

The industry has a powerful ally in Senate Majority Leader Mitch McConnell, who represents Kentucky, where hemp is seen as a potential cash crop. Last month he introduced a bill in the Senate that has bipartisan support to legalize hemp as an agricultural commodity.

Veterans push lawmakers to legalize hemp products – CBS News April 2018

Polysubstance use—when more than one drug is used or misused over a defined period of time—can occur from either the intentional use of opioids with other drugs or by accident, such as if street drugs are contaminated with synthetic opioids. In the first half of 2018, nearly 63% of opioid overdose deaths in the United States also involved cocaine, methamphetamine, or benzodiazepines, signaling the need to address polysubstance use as part of a comprehensive response to the opioid epidemic. Fentanyl, a highly potent synthetic opioid, has been identified as a driver of overdose deaths involving other opioids, benzodiazepines, alcohol, methamphetamine, and cocaine.

Two classes of drugs are frequently co-used with opioids: depressants and stimulants. Although there are medical uses for some drugs in these classes, they also all have high potential for misuse. Mixing opioids—which are depressants—with other depressants or stimulants, either intentionally or unknowingly, has contributed to the rising number of opioid overdose deaths, which have more than doubled since 2010. Efforts to reduce opioid overdose deaths should incorporate strategies to prevent, mitigate, and treat the use of multiple substances. 

Depressants

Depressants act on the central nervous system to induce relaxation, reduce anxiety, and increase drowsiness. Opioid use concurrent with the use of another sedating drug compounds the respiratory depressant effect of each drug, creating a higher risk for overdose and fatal overdose than when either drug is used alone.

Benzodiazepines

Benzodiazepines are prescribed for medical use as sedatives but are commonly misused for nonmedical purposes and in combination with prescription and illicit opioids. In 2018, just over 9,000 U.S. deaths involved both opioids and benzodiazepines, more than twice the number of 2008 deaths due to such co-use. Moreover, in 2018, nearly half (47.2%) of benzodiazepine overdose deaths involved synthetic opioids (e.g., fentanyl). Fatal overdoses involving both prescription opioids and benzodiazepines nearly tripled from 2004 to 2011.

Alcohol

In 2017, 15% of opioid overdose deaths involved alcohol. From 2012 to 2014, more than 2 million people who misused prescription opioids were also binge drinkers of alcohol (defined as more than five drinks for a man or more than four drinks for a woman within a two-hour period); compared with nondrinkers, binge drinkers were associated with being twice as likely to misuse prescription opioids. Evidence indicates that about 23% of people with an opioid use disorder have a concurrent alcohol use disorder.

Stimulants

Stimulants increase arousal and activity in the brain. In 2017, opioids were involved in more than half of stimulant-involved overdose deaths—about 15,000 total. The co-use of stimulants with synthetic opioids such as fentanyl either intentionally or through drug contamination has increased the number of stimulant-involved overdose deaths. The opposing impacts of increased arousal from stimulants and sedation from opioids on the body can make the outcomes of co-use less predictable and raise the risk of overdose.

Methamphetamine

About 12% of opioid overdose deaths from January to June 2018 involved methamphetamine, an illicit drug. In 2017, opioids were involved in 50% of methamphetamine-involved deaths, and recent data suggests synthetic opioids are driving increases in methamphetamine-involved deaths. One study found that 65% of those seeking opioid treatment had reported a history of methamphetamine use, with more than three-quarters of them indicating that they had used methamphetamines and opioids mostly at the same time or on the same day.

Cocaine

Of the nearly 15,000 cocaine overdose deaths in 2018, nearly 11,000 also involved opioids; this number accounts for about 23% of the total opioid overdose deaths that year. In fact, since 2010 the number of deaths caused by a combination of opioids and cocaine has increased more than fivefold. People who primarily use cocaine but sometimes co-use opioids are at high risk for overdose because of the increasing presence and potency of fentanyl in the drug supply and a lower tolerance for opioids than someone who regularly uses them.

What should be done?

It is critical that state policies addressing the rise in polysubstance use and its link to increased risk of overdose span across prevention, harm reduction, and treatment strategies. To effectively accomplish this, states should:

  • Enact policies that increase provider use of prescription drug monitoring programs (PDMPs) to reduce the co-prescription of opioids and benzodiazepines. PDMPs, state-based electronic databases that contain information on controlled substance prescriptions, allow prescribers and pharmacists to monitor patients’ prescription drug use and can promote safer prescribing practices that help prevent overdoses. High rates of benzodiazepine prescribing are correlated with the drug’s involvement in opioid overdose deaths.
  • Expand naloxone distribution to reach people who use stimulants. Naloxone reverses the respiratory depression effects of opioids to safeguard against a fatal overdose and remains effective when people use opioids in combination with other drugs. Considering that opioids are frequently implicated in cocaine and methamphetamine overdose deaths, people who primarily use stimulants are recognized as an at-risk population for opioid overdose. Laws that allow for increased community distribution of naloxone can help safeguard against polysubstance use overdoses.
  • Amend drug paraphernalia laws to allow possession of fentanyl test strips. Fentanyl test strips can detect the presence of fentanyl in a person’s drug supply when dipped into a solution of a small amount of the drug in water. People who use drugs have indicated that if a test strip found fentanyl in their supply, they would take measures to prevent an overdose, such as injecting at a slower pace or using less of the drug at a time. Fentanyl test strips are mainly used by people who inject opioids but can also be helpful for those who use stimulants and fear fentanyl contamination by preventing unintentional co-use that could lead to a fatal overdose. Amending drug paraphernalia laws to allow the possession of drug-checking devices, including fentanyl test strips, would permit agencies and organizations to distribute test strips to people who use drugs and help to prevent fentanyl-related overdose deaths.
  • Prohibit the discharge of patients from publicly funded opioid use disorder (OUD) treatment programs for their continued substance use. Treatment programs often discharge patients from treatment involuntarily because of their continued illicit drug use (a practice commonly called administrative discharge). This practice poses a particular risk for patients being treated for OUD with methadone or buprenorphine who are at high risk for overdose if discharged without medication. Although co-use of other drugs, such as stimulants, with medications for OUD can interfere with treatment, it remains safer for patients to continue medication treatment because of their high risk for overdose from using illicit opioids. People with OUD who use benzodiazepines are particularly at higher risk for overdose when not on medication treatment. Federal guidelines recommend avoiding administrative discharge and instead suggest that treatment programs re-evaluate a patient’s needed level of care if the current treatment plan proves ineffective.

Conclusion

As the increase in opioid use evolves into an increase in polysubstance use, understanding how different substances interact may inform strategies that help prevent overdose. Though some individuals knowingly combine or co-use opioids with stimulants or other depressants, an additional and growing concern is the adulteration of other drug supplies with fentanyl. Strengthening policy efforts across the continuum of prevention, harm reduction, and treatment to address the risks of polysubstance use can slow the rates of drug overdose deaths in the United States.

Source: https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2020/10/opioid-overdose-crisis-compounded-by-polysubstance-use October 2020

Oregon farmers have grown three times what their customers can smoke in a year, causing bud prices to plummet and panic to set in
A recent Sunday afternoon at the Bridge City Collective 

Little wonder: a gram of weed was selling for less than the price of a glass of wine.

The $4 and $5 grams enticed Scotty Saunders, a 24-year-old sporting a gray hoodie, to spend $88 picking out new products to try with a friend. “We’ve definitely seen a huge drop in prices,” he says.

Across the wood and glass counter, Bridge City owner David Alport was less delighted. He says he’s never sold marijuana this cheap before.

“We have standard grams on the shelf at $4,” Alport says. “Before, we didn’t see a gram below $8.”

The scene at Bridge City Collective is playing out across the city and state. Three years into Oregon’s era of recreational cannabis, the state is inundated with legal weed.

It turns out Oregonians are good at growing cannabis – too good.

In February, state officials announced that 1.1m pounds of cannabis flower were logged in the state’s database.

If a million pounds sounds like a lot of pot, that’s because it is: last year, Oregonians smoked, vaped or otherwise consumed just under 340,000lb of legal bud.

That means Oregon farmers have grown three times what their clientele can smoke in a year.

Yet state documents show the number of Oregon weed farmers is poised to double this summer – without much regard to whether there’s demand to fill.

The result? Prices are dropping to unprecedented lows in auction houses and on dispensary counters across the state.

Wholesale sun-grown weed fell from $1,500 a pound last summer to as low as $700 by mid-October. On store shelves, that means the price of sun-grown flower has been sliced in half to those four-buck grams.

For Oregon customers, this is a bonanza. A gram of the beloved Girl Scout Cookies strain now sells for little more than two boxes of actual Girl Scout cookies.

But it has left growers and sellers with a high-cost product that’s a financial loser. And a new feeling has descended on the once-confident Oregon cannabis industry: panic.

“The business has been up and down and up and down,” says Don Morse, who closed his Human Collective II dispensary in south-west Portland four months ago. “But in a lot of ways it has just been down and down for dispensaries.”

This month, WW spoke to two dozen people across Oregon’s cannabis industry. They describe a bleak scene: small businesses laying off employees and shrinking operations. Farms shuttering. People losing their life’s savings are unable to declare bankruptcy because marijuana is still a federally scheduled narcotic.

To be sure, every new market creates winners and losers. But the glut of legal weed places Oregon’s young industry in a precarious position, and could swiftly reshape it.

Oregon’s wineries, breweries and distilleries have experienced some of the same kind of shakeout over time. But the timetable is faster with pot: for many businesses, it’s boom to bust within months.

Mom-and-pop farms are accepting lowball offers to sell to out-of-state investors, and what was once a diverse – and local – market is increasingly owned by a few big players. And frantic growers face an even greater temptation to illegally leak excess grass across state lines – and into the crosshairs of US attorney general Jeff Sessions’ justice department.

“If somebody has got thousands of pounds that they can’t sell, they are desperate,” says Myron Chadowitz, who owns the Eugene farm Cannassentials. “Desperate people do desperate things.”

In March, Robin Cordell posted a distress signal on Instagram.

“The prices are so low,” she wrote, “and without hustling all day, hoping to find the odd shop with an empty jar, it doesn’t seem to move at any price.”

Cordell has a rare level of visibility for a cannabis grower. Her Oregon City farm, Oregon Girl Gardens, received glowing profiles from Dope Magazine and Oregon Leaf. She has 12 years of experience in the medical marijuana system, a plot of family land in Clackamas county, and branding as one of the state’s leaders in organic and women-led cannabis horticulture.

She fears she’ll be out of business by the end of the year.

“The prices just never went back up,” she says.

Cordell ran headlong into Oregon’s catastrophically bountiful cannabis crop.

The Oregon Liquor Control Commission (OLCC) handed out dozens of licenses to new farmers who planted their first crop last spring. Mild weather blessed the summer of 2017 and stretched generously into the fall. And growers going into their second summer season planted extra seeds to make up for flower lost to a 2016 storm, the last vestige of a brutal typhoon blown across the Pacific from Asia.

“That storm naturally constrained the supply even though there were a lot of cultivators,” says Beau Whitney, senior economist for New Frontier Data, which studies the cannabis industry.

It kept supply low and prices high in 2017 – even though the state was handing out licenses at an alarming rate.

“It was a hot new market,” Whitney says. “There weren’t a whole lot of barriers to entry. The OLCC basically issued a license to anyone who qualified.”

Chadowitz blames out-of-state money for flooding the Oregon system. In 2016, state lawmakers decided to lift a restriction that barred out-of-state investors from owning controlling shares of local farms and dispensaries.

It was a controversial choice – one that many longtime growers still resent.

“The root of the entire thing was allowance of outside money into Oregon,” Chadowitz says. “Anyone could get the money they needed. Unlimited money and unlimited licenses, you’re going to get unlimited flower and crash the market.”

As of 1 April, Oregon had licensed 963 recreational cannabis grows, while another 910 awaited OLCC approval.

That means oversupply is only going to increase as more farms start harvesting bud.

The OLCC has said repeatedly that it has no authority to limit the number of licenses it grants to growers, wholesalers and dispensaries (although by contrast, the number of liquor stores in Oregon is strictly limited).

Since voters legalized recreational marijuana in 2014, many industry veterans from the medical marijuana years have chafed at the entrance of new money, warning it would destroy a carefully crafted farm ecosystem.

The same problem has plagued cannabis industries in other states that have legalized recreational weed. In 2016, Colorado saw wholesale prices for recreational flower drop 38%. Washington saw its pot drop in value at the same time Oregon did.

The OLCC remains committed to facilitating a free market for recreational marijuana in which anyone can try their hand at growing or selling.

“[The law] has to be explicit that we have that authority to limit or put a cap on licenses,” says OLCC spokesman Mark Pettinger. “It doesn’t say that we could put a cap on licenses. The only thing that we can regulate is canopy size.”

The demand for weed in Oregon is robust – the state reeled in $68m in cannabis sales taxes last year – but it can’t keep pace with supply.

Whitney says it’s not unusual for a new industry to attract speculators and people without much business savvy.

“Whenever you have these emerging markets, there’s going to be a lot of people entering the market looking for profit,” he says. “Once it becomes saturated, it becomes more competitive. This is not a phenomenon that is unique to cannabis. There used to be a lot of computer companies, but there’s not so many anymore.”

Across rolling hills of Oregon farmland and in Portland dispensaries as sleek as designer eyewear shops, the story plays out the same: Business owners can’t make the low prices pencil out.

Nick Duyck is a second-generation farmer and owner of 3D Blueberry Farms in Washington county. “I was born and raised on blueberries,” he says.

But last June, Duyck launched Private Reserve Cannabis, a weed grow designed to create permanent jobs for seasonal workers.

“By starting up the cannabis business,” says Duyck, “it keeps my guys busy on a year-round basis.”

He invested $250,000 in the structural build-outs, lighting, environmental controls and other initial costs to achieve a 5,000 sq ft, Tier I, OLCC-approved indoor canopy.

Ongoing labor and operational costs added another $20,000 a month.

Weed prices were high: Duyck forecast a $1,500 return per pound. If Duyck could produce 20lb of flower a week, he’d make back his money and start banking profits in just three months.

October’s bumper crop tore those plans apart.

“We got in at the wrong time,” Duyck says. “The outdoor harvest flooded the market.”

By the start of the new year, Duyck was sitting on 100lb of ready-to-sell flower – an inventory trickling out to dispensaries in single-pound increments.

So he turned to a wholesaler, Cannabis Auctions LLC, which holds monthly fire sales in various undisclosed locations throughout Oregon.

Weed auctions operate under a traditional model: sellers submit their wares, and buyers – dispensary owners, intake managers and extract manufacturers – are given an opportunity to inspect products before bidding on parcels awarded to the highest dollar.

Duyck sent 60lb of pot to the auction block in December. He had adjusted his expectations downward: he hoped to see something in the ballpark of $400 a pound.

It sold for $100 a pound.

“The price per pound that it costs us to raise this product is significantly higher than the hundred dollars a pound,” says Duyck. (A little light math points to a $250-per-unit production cost.) “Currently, we’re operating at a $15,000-per-month loss,” Duyck says.

If prices don’t improve soon, Duyck says he won’t be able to justify renewing his OLCC license for another year.

“The dispensaries that are out there, a lot of them have their own farms, so they don’t buy a lot of product from small farms like us’” Duyck says. “If you really want to grow the product, you almost have to own the store also.”

Middlemen – store owners without farms – are also suffering. Take Don Morse, who gave up selling weed on New Year’s Eve.

Morse ran Human Collective II, one of the earliest recreational shops in the city, which first opened as a medical marijuana supplier in 2010. At times, Morse stocked 100 strains in his Multnomah Village location.

Morse lobbied for legal recreational weed and founded the Oregon Cannabis Business Council.

The shift to recreational was costly. With his business partner Sarah Bennett, Morse says he invested more than $100,000 in equipment to meet state regulations.

By last summer, new stores were popping up at a rapid pace. Morse’s company wasn’t vertically integrated, which means it did not grow any of its own pot or run a wholesaler that might have subsidized low sales.

“Competition around us was fierce, and the company started losing money, and it wasn’t worth it anymore,” Morse says. “At our peak, we had 20 employees. When we closed, we had six.”

Prices went into free fall in October: the average retail price dropped 40%.

Morse couldn’t see a way to make the numbers work. Human Collective priced grams as low as $6 to compete with large chains like Nectar and Chalice, but it struggled to turn a profit.

“When you’re the little guy buying the product from wholesalers, you can’t afford to compete,” he says. “There’s only so far you can lower the price. There’s too much of everything and too many people in the industry.”

So Morse closed his shop: “We paid our creditors and that was that. That was the end of it.”

Despite losing his business, Morse stands behind Oregon’s light touch when it comes to regulating the industry.

“It’s just commercialism at its finest,” he says. “Let the best survive. That’s just the way it goes in capitalism. That’s just the way it goes.”

Just as mom-and-pop grocery stores gave way to big chains, people like Morse are losing out to bigger operations.

Chalice Farms has five stores in the Portland area and is opening a sixth in Happy Valley. La Mota has 15 dispensaries. Nectar has 11 storefronts in Oregon, with four more slated to open soon.

Despite the record-low prices in the cannabis industry, these chains are hiring and opening new locations, sometimes after buying failed mom-and-pop shops.

The home page on Nectar’s website prominently declares: “Now buying dispensaries! Please contact us if you are a dispensary owner interested in selling your business.”

Nectar representatives did not respond to a request for comment.

Because the federal government does not recognize legal marijuana, the industry cannot access traditional banking systems or even federal courts. That means business owners can’t declare bankruptcy to dissolve a failed dispensary or farm, leaving them with few options. They can try to liquidate their assets, destroy the product they have on hand and eat the losses.

Or they can sell the business to a company like Nectar, often for a fraction of what they’ve invested.

“This time last year, it was basically all mom-and-pop shops,” says Mason Walker, CEO of Cave Junction cannabis farm East Fork Cultivars. “Now there are five or six companies that own 25 or 30%. Stores are selling for pennies on the dollar, and people are losing their life savings in the process.”

Deep-pocketed companies can survive the crash and wait for the market to contract again.

“What this means is, the market is now in a position where only the large [businesses] or the ones that can produce at the lower cost can survive,” Whitney says. “A lot of the craft growers, a lot of the small-capacity cultivators, will go out of business.”

Oregon faces another consequence of pot businesses closing up shop: leftover weed could end up on the black market.

Already, Oregon has a thriving illegal market shipping to other states.

US attorney for Oregon, Billy Williams, has said he has little interest in cracking down on legal marijuana businesses, but will prosecute those shipping marijuana to other states.

“That kind of thing is what’s going to shut down our industry,” Chadowitz says. “Anything we can do to prevent Jeff Sessions from being right, we have to do.”

Ask someone in the cannabis industry what to do about Oregon’s weed surplus, and you’re likely to get one of three answers.

The first is to cap the number of licenses awarded by the OLCC. The second is to reduce the canopy size allotted to each license – Massachusetts is trying that. And the last, equally common answer is to simply do nothing. Let the market sort itself out.

Farmers, such as Walker of East Fork Cultivars, argue that limiting the number of licensed farms in Oregon would stunt the state’s ability to compete on the national stage in the years ahead.

“We’re in this sort of painful moment right now,” says Walker, “but I think if we let it be a painful moment, and not try to cover it up, we’re going to be better off for it.”

Walker and other growers hope selling across state lines will someday become legal.

Every farmer, wholesaler, dispensary owner and economist WW talked to for this story said that if interstate weed sales became legal, Oregon’s oversupply problem would go away.

Under the current presidential administration, that might seem a long shot. But legalization is sweeping the country, Donald Trump is signaling a looser approach, and experts say Oregon will benefit when the feds stop fighting.

“The thing about Oregon is that it is known for its cannabis, in a similar way to Oregon pinot noir,” Whitney says. “For those who are able to survive, they are positioned extremely well not only to survive in the Oregon market but also to take advantage of a larger market – assuming things open up on a federal level.”

Source: How do you move mountains of unwanted weed? | Cannabis | The Guardian May 2018

America’s largest drug companies saturated the country with 76 billion oxycodone and hydrocodone pain pills from 2006 through 2012 as the nation’s deadliest drug epidemic spun out of control, according to previously undisclosed company data released as part of the largest civil action in U.S. history.

The information comes from a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — from manufacturers and distributors to pharmacies in every town and city. The data provides an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which has resulted in nearly 100,000 deaths from 2006 through 2012.

Just six companies distributed 75 percent of the pills during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by WAPO. Three companies manufactured 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; ­Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.

[Top takeaways from The Post’s analysis of the DEA database]

Purdue Pharma, which the plaintiffs allege sparked the epidemic in the 1990s with its introduction of OxyContin, its version of oxycodone, was ranked fourth among manufacturers with about 3 percent of the market.

The volume of the pills handled by the companies skyrocketed as the epidemic surged, increasing about 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. By contrast, doses of morphine, a well-known treatment for severe pain, averaged slightly more than 500 million a year during the period.

Those 10 companies along with about a dozen others are now being sued in federal court in Cleveland by nearly 2,000 cities, towns and counties alleging that they conspired to flood the nation with opioids. The companies, in turn, have blamed the epidemic on overprescribing by doctors and pharmacies and on customers who abused the drugs. The companies say they were working to supply the needs of patients with legitimate prescriptions desperate for pain relief.

The database reveals what each company knew about the number of pills it was shipping and dispensing and precisely when they were aware of those volumes, year by year, town by town. In case after case, the companies allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market, according to the lawsuits.

Plaintiffs have long accused drug manufacturers and wholesalers of fueling the opioid epidemic by producing and distributing billions of pain pills while making billions of dollars. The companies have paid more than $1 billion in fines to the Justice Department and Food and Drug Administration over opioid-related issues, and hundreds of millions more to settle state lawsuits.  But the previous cases addressed only a portion of the problem, never allowing the public to see the size and scope of the behavior underlying the epidemic. Monetary settlements by the companies were accompanied by agreements that kept such information hidden.

The drug companies, along with the DEA and the Justice Department, have fought furiously against the public release of the database, the Automation of Reports and Consolidated Order System, known as ARCOS. The companies argued that the release of the “transactional data” could give competitors an unfair advantage in the marketplace. The Justice Department argued that the release of the information could compromise ongoing DEA investigations. Until now, the litigation has proceeded in unusual secrecy. Many filings and exhibits in the case have been sealed under a judicial protective order. The secrecy finally lifted after The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, waged a year-long legal battle for access to documents and data from the case.

On Monday evening, U.S. District Judge Dan Polster removed the protective order for part of the ARCOS database. Lawyers for the local governments suing the companies hailed the release of the data. “The data provides statistical insights that help pinpoint the origins and spread of the opioid epidemic — an epidemic that thousands of communities across the country argue was both sparked and inflamed by opioid manufacturers, distributors, and pharmacies,” said Paul T. Farrell Jr. of West Virginia, co-lead counsel for the plaintiffs.

In statements emailed to The Post on Tuesday, the drug distributors stressed that the ARCOS data would not exist unless they had accurately reported shipments and questioned why the government had not done more to address the crisis. “For decades, DEA has had exclusive access to this data, which can identify the total volumes of controlled substances being ordered, pharmacy-by-pharmacy, across the country,” McKesson spokeswoman Kristin Chasen said. A DEA spokeswoman declined to comment Tuesday “due to ongoing litigation.”

Cardinal Health said that it has learned from its experience, increasing training and doing a better job to “spot, stop and report suspicious orders,” company spokeswoman Brandi Martin wrote.

AmerisourceBergen derided the release of the ARCOS data, saying it “offers a very misleading picture” of the problem. The company said its internal “controls played an important role in enabling us to, as best we could, walk the tight rope of creating appropriate access to FDA approved medications while combating prescription drug diversion.”

While Walgreens still dispenses opioids, the company said it has not distributed prescription-controlled substances to its stores since 2014. “Walgreens has been an industry leader in combatting this crisis in the communities where our pharmacists live and work, ” said Phil Caruso, a Walgreens spokesman.

Mike DeAngelis, a spokesman for CVS, said the plaintiffs’ allegations about the company have no merit and CVS is aggressively defending against them. Walmart, Purdue and Endo declined to comment about the ARCOS database.  A Mallinckrodt spokesman said in a statement that the company produced opioids only within a government-controlled quota and sold only to DEA-approved distributors.Actavis Pharma was acquired by Teva Pharmaceutical Industries in 2016, and a spokeswoman there said  the company “cannot speak to any systems in place beforehand.”

A virtual road map  –  The Post has been trying to gain access to the ARCOS database since 2016, when the news organization filed a Freedom of Information Act request with the DEA. The agency denied the request, saying some of the data was available on its website. But that data did not contain the transactional information the companies are required to report to the DEA every time they sell a controlled substance such as oxycodone and hydrocodone.

 

The drug companies and pharmacies themselves provided the sales data to the DEA. Company officials have testified before Congress that they bear no responsibility for the nation’s opioid epidemic. The numbers of pills the companies sold during the seven-year time frame are staggering, far exceeding what has been previously disclosed in limited court filings and news stories. Three companies distributed nearly half of the pills: McKesson with 14.1 billion, Walgreens with 12.6 billion and Cardinal Health with 10.7 billion. The leading manufacturer was Mallinckrodt’s SpecGx with nearly 28.9 billion pills, or nearly 38 percent of the market.

The states that received the highest concentrations of pills per person per year were: West Virginia with 66.5, Kentucky with 63.3, South Carolina with 58, Tennessee with 57.7 and Nevada with 54.7. West Virginia also had the highest opioid death rate during this period. Rural areas were hit particularly hard: Norton, Va., with 306 pills per person; Martinsville, Va., with 242;  Mingo County, W.Va., with 203; and Perry County, Ky., with 175.   In that time, the companies distributed enough pills to supply every adult and child in the country with 36 each year.

The database is a virtual road map to the nation’s opioid epidemic that began with prescription pills, spawned increased heroin use and resulted in the current fentanyl crisis, which added more than 67,000 to the death toll from 2013 to 2017. The transactional data kept by ARCOS is highly detailed. It includes the name, DEA registration number, address and business activity of every seller and buyer of a controlled substance in the United States. The database also includes drug codes, transaction dates, and total dosage units and grams of narcotics sold. The data tracks a dozen different opioids, including oxycodone and hydrocodone, which make up three-quarters of the total pill shipments to pharmacies.

Under federal law, drug manufacturers, distributors and pharmacies must report each transaction of a narcotic to the DEA, where it is logged into the ARCOS database. If company officials notice orders of drugs that appear to be suspicious because of their unusual size or frequency, they must report those sales to the DEA and hold back the shipments. As more and more towns and cities became inundated by pain pills, they fought back. They filed federal lawsuits against the drug industry, alleging that opioids from the companies were devastating their communities. They alleged the companies not only failed to report suspicious orders, but they also filled those orders to maximize profits. As the hundreds of lawsuits began to pile up, they were consolidated into the one centralized case in U.S. District Court in Cleveland. The opioid litigation is now larger in scope than the tobacco litigation of the 1980s, which resulted in a $246 billion settlement over 25 years.

Judge Polster is now overseeing the consolidated case of nearly 2,000 lawsuits. The case is among a wave of actions that includes other lawsuits filed by more than 40 state attorneys general and tribal nations. In May, Purdue settled with the Oklahoma attorney general for $270 million. In the Cleveland case, Polster has been pressing the drug companies and the plaintiffs to reach a global settlement so communities can start receiving financial assistance to mitigate the damage that has been done by the opioid epidemic.  To facilitate a settlement, Polster had permitted the drug companies and the towns and cities to review the ARCOS database under a protective order while barring public access to the material. He also permitted some court filings to be made under seal and excluded the public and press from a global settlement conference at the outset of the case. Last June, The Post and the Charleston Gazette-Mail asked Polster to lift the protective order covering the ARCOS database and the court filings. A month later, Polster denied the requests, even though he had said earlier that “the vast oversupply of opioid drugs in the United States has caused a plague on its citizens” and the ARCOS database reveals “how and where the virus grew.” He also said disclosure of the ARCOS data “is a reasonable step toward defeating the disease.”

 Lawyers for The Post and the Gazette-Mail appealed Polster’s ruling. They argued that the ­ARCOS material would not harm companies or investigations because the judge had already decided to allow the local government plaintiffs to collect information from 2006 through 2014, withholding the most recent years beginning with 2015 from the lawsuit. “Access to the ARCOS Data can only enhance the public’s confidence that the epidemic and the ensuing litigation are being handled appropriately now — even if they might not have been handled appropriately earlier,” The Post’s lawyer, Karen C. Lefton, wrote in her Jan. 17 appeal. The lawyers also noted the DEA did not object when the West Virginia attorney general’s office provided partial ARCOS data to the Gazette-Mail in 2016. That data showed that drug distribution companies shipped 780 million doses of oxycodone and hydrocodone into the state between 2007 and 2012.

On June 20, the 6th Circuit Court of Appeals in Ohio sided with the news organizations. A three-judge panel reversed Polster, ruling that the protective order sealing the ARCOS database be lifted with reasonable redactions and directed the judge to reconsider whether any of the records in the case should be sealed.  On Monday, Polster lifted the protective order on the database, ruling that all the data from 2006 through 2012 should be released to the public, withholding the 2013 and 2014 data.

‘Prescription tourists’  –  The pain pill epidemic began nearly three decades ago, shortly after Purdue Pharma introduced what it marketed as a less addictive form of opioid it called OxyContin. Purdue paid doctors and nonprofit groups advocating for patients in pain to help market the drug as a safe and effective way to treat pain. But the new drug was highly addictive. As more and more people were hooked, more and more companies entered the market, manufacturing, distributing and dispensing massive quantities of pain pills. Purdue ending up paying a $634 million fine to the Food and Drug Administration for claiming OxyContin was less addictive than other pain medications.

 

Annual opioid sales nationwide rose from $6.1 billion in 2006 to $8.5 billion in 2012, according to industry data gathered by IQVIA, a health care information and consulting company. Individual drug company revenues ranged in single years at the epidemic’s peak from $403 million for opioids sold by Endo to $3.1 billion in OxyContin sales by Purdue Pharma, according to a 2018 lawsuit against multiple defendants by San Juan County in New Mexico.

During the past two decades, Florida became ground zero for pill mills — pain management clinics that served as fronts for corrupt doctors and drug dealers. They became so brazen that some clinics set up storefronts along I-75 and I-95, advertising their products on billboards by interstate exit ramps. So many people traveled to Florida to stock up on oxycodone and hydrocodone, they were sometimes referred to as “prescription tourists.”  The route from Florida to Georgia, Kentucky, West Virginia and Ohio became known as the “Blue Highway.” It was named after the color of one of the most popular pills on the street — 30 mg oxycodone tablets made by Mallinckrodt, which shipped more than 500 million of the pills to Florida between 2008 and 2012.

 When state troopers began pulling over and arresting out-of-state drivers for transporting narcotics, drug dealers took to the air. One airline offered nonstop flights to Florida from Ohio and other Appalachian states, and the route became known as the Oxy Express.

A decade ago, the DEA began cracking down on the industry. In 2005 and 2006, the agency sent letters to drug distributors, warning them that they were required to report suspicious orders of painkillers and halt sales until the red flags could be resolved. The letter also went to drug manufacturers. Even just one distributor that fails to follow the law “can cause enormous harm,” the 2006 DEA letter said. DEA officials said the companies paid little attention to the warnings and kept shipping millions of pills in the face of suspicious circumstances.  As part of its crackdown, the DEA brought a series of civil enforcement cases against the largest distributors.

The corporations to date have paid nearly $500 million in fines to the Justice Department for failing to report and prevent suspicious drug orders, a number that is dwarfed by the revenue of the companies.

But the settlements of those cases revealed only limited details about the volume of pills that were being shipped.

In 2007, the DEA brought a case against McKesson. The DEA accused the company of shipping millions of doses of hydrocodone to Internet pharmacies after the agency had briefed the company about its obligations under the law to report suspicious orders. “By failing to report suspicious orders for controlled substances that it received from rogue Internet pharmacies, the McKesson Corporation fueled the explosive prescription drug abuse problem we have in this country,” the DEA’s administrator said at the time.  In 2008, McKesson agreed to pay a $13.25 million fine to settle the case and pledged to more closely monitor suspicious orders from its customers.

That same year, the DEA brought a case against Cardinal Health, accusing the nation’s ­second-largest drug distributor of shipping millions of doses of painkillers to online and retail pharmacies without notifying the DEA of signs that the drugs were being diverted to the black market. Cardinal settled the case by paying a $34 million fine and promising to improve its suspicious monitoring program.

Some companies were repeat offenders.  In 2012, the DEA began investigating McKesson again, this time for shipping suspiciously large orders of narcotics to pharmacies in Colorado. One store in Brighton, Colo., population 38,000, was ordering 2,000 pain pills per day. The DEA discovered that McKesson had filled 1.6 million orders from its Aurora, Colo., warehouse between 2008 and 2013 and reported just 16 as suspicious. None involved the Colorado store. DEA agents and investigators said they had amassed enough information to file criminal charges against McKesson and its officers but they were overruled by federal prosecutors. The company wound up paying a $150 million fine to settle, a record amount for a diversion case.

Also in 2012, Cardinal Health attracted renewed attention from the DEA when it discovered that the company was again shipping unusually large amounts of painkillers to its Florida customers. The company had sold 12 million oxycodone pills to four pharmacies over four years. In 2011, Cardinal shipped 2 million doses to a pharmacy in Fort Myers, Fla. Comparable pharmacies in Florida typically ordered 65,000 doses per year.  The DEA also noticed that Cardinal was shipping unusually large amounts of oxycodone to a pair of CVS stores near Sanford, Fla. Between 2008 and 2011, Cardinal sold 2.2 million pills to one of the stores. In 2010, that store purchased 885,900 doses — a 748 percent increase over the previous year. Cardinal did not report any of those sales as suspicious. Cardinal later paid a $34 million fine to settle the case. The DEA suspended the company from selling narcotics from its warehouse in Lakeland, Fla. CVS paid a $22 million fine.  As the companies paid fines and promised to do a better job of stopping suspicious orders, they continued to manufacture, ship and dispense large amounts of pills, according to the newly released data. “The depth and penetration of the opioid epidemic becomes readily apparent from the data,” said Peter J. Mougey, a lawyer for the plaintiffs from Pensacola, Fla. “This disclosure will serve as a wake up call to every community in the country. America should brace itself for the harsh reality of the scope of the opioid epidemic. Transparency will lead to accountability.”

Aaron Williams, Andrew Ba Tran, Jenn Abelson, Aaron C. Davis and Christopher Rowland contributed to this report.

Scott Higham is a Pulitzer-Prize winning investigative reporter at WAPO; has worked on Metro, National and Foreign projects since 2000.

Sari Horwitz is a Pulitzer-Prize winning reporter who covers DOJ, law enforcement &  criminal justice issues for WAPO, where she has been a reporter for 34 years.

Steven Rich is the database editor for investigations at WAPO; has worked on investigations involving the NSA,, police shootings, tax liens & civil forfeiture; reporter on two teams to win Pulitzer Prizes, for public service in 2014 and national reporting in 2016.

Source:   https://www.washingtonpost.com  Feb. 4th 2019

CBD IS NOT SAFE AS A MEDICINE UNLESS IT ACQUIRES FDA APPROVAL AFTER RIGOROUS TESTING DEMONSTRATING EFFICACY AND SAFETY.

Cannabidiol (CBD) and Tetrahydrocannabinol (THC) come from the cannabis plant. A pure form of CBD (Epidiolex) is approved by the FDA as a medicine for two rare disorders to be used only under proper medical protocols. Other CBD products sold as medicines, or food or food supplements, that are not approved by the FDA are Black-Market and are illegally trafficked and sold.

In addition, CBD cosmetics must be properly labeled under FDA law and not be adulterated by deleterious substances. Black Market CBD products have not been evaluated by the FDA to determine if they are effective or safe for any medical use, and if safe, what the proper dosage would be. In addition, they are not administered with any federally approved medical protocols as are prescription drugs and there may be no warnings for how they interact with other drugs, or whether they have dangerous side effects.

CBD IS NOT SAFE TO BE PUT INTO FOODS OR FOOD SUPPLEMENTS
Under the federal Food, Drug and Cosmetic Act it’s illegal to introduce THC and CBD into the food supply, or to market them as dietary supplements. It is not safe to do so unless approved by the FDA.

MULTIPLE STUDIES SHOW BLACK MARKET CBD PRODUCT CONTAMINATION
The FDA has tested the chemical contents of many Black-Market CBD products and many were found to not contain the levels of CBD they claimed to contain. Black Market CBD often contains THC and/or contaminants such as pesticides, heavy metals, bacteria, and fungus. Synthetic CBD use has caused adverse reactions, including altered mental status, seizures, confusion, and loss of consciousness.

CBD CAUSES PHYSICAL DISEASE AND SAFETY RISKS
The marijuana industry has touted CBD as a “wonder drug.” * They may claim it is perfectly safe and legal and can be used for all that ails you or makes you uncomfortable physically. People are consuming CBD under the misapprehension that it is safe to do so. It is not. CBD has known health risks based on FDA clinical studies in humans and other clinical reports. The known adverse reactions include:
1. Hepatocellular Injury (liver injury) – inflammation or damage to cells
2. Somnolence and Sedation
3. Suicidal Behavior and Ideation
4. Hypersensitivity Reactions – allergic reactions
5. Negative interaction with anti-epilepsy drugs such as Tegretol, Dilantin, Luminal, Solfoton,
Tedral, Primidone (anti-seizure)
6. Interactions with immunosuppressive drugs used in transplants or chemotherapy and with
warfarin.
7. CBD use can impair kidney function and cause anemia.

We advocate for no use of illegal drugs and no illegal use of legal drugs.

CBD AND PREGNANCY
The FDA strongly advises that during pregnancy and while breastfeeding you should not use CBD or THC. You may put yourself or your baby at serious risk by using these marijuana products. CBD products may also be contaminated with substances that may pose a risk to the fetus or breastfed baby such as pesticides, heavy metals, bacteria, and fungus. Studies in laboratory animals show male reproductive toxicity, including in the male offspring of CBD-treated pregnant females. This includes decrease in testicular size, inhibition of sperm development, and decreased testosterone.

TAKING CBD CAN BE DANGEROUS WHEN DRIVING OR USING MACHINERY
Recent FDA studies show that CBD can cause sleepiness, sedation and that may make operating a motor vehicle or machinery dangerous after consuming CBD products.

DRUG TESTS
CBD may affect drug test results. A truck driver lost his job when he tested positive for THC on a drug test after being told by the manufacturer that a CBD product had no THC.

FDA Reports
To make a report to the FDA about CBD being used as a medicine or as a food or food supplement go to:
https://www.accessdata.fda.gov/scripts/email/oc/buyonline/english.cfm#whattoreport

www.aalm.info POB 158 Carmichael, CA 95609 Phones 916-708-4111, 619-990-7480

March 6, 2020

Source: CBD.POSITION.3.6.2020.pdf (squarespace.com)

 

When Californians voted in 2016 to allow the sale of recreational marijuana, advocates of the move envisioned thousands of pot shops and cannabis farms obtaining state licenses, making the drug easily available to all adults within a short drive.

But as the first year of licensed sales comes to a close, California’s legal market hasn’t performed as state officials and the cannabis industry had hoped. Retailers and growers say they’ve been stunted by complex regulations, high taxes and decisions by most cities to ban cannabis shops. At the same time, many residents are going to city halls and courts to fight pot businesses they see as nuisances, and police chiefs are raising concerns about crime triggered by the marijuana trade.

Gov.-elect Gavin Newsom, who played a large role in the legalization of cannabis, will inherit the numerous challenges when he takes office in January as legislators hope to send him a raft of bills next year to provide banking for the pot industry, ease the tax burden on retailers and crack down on sales to minors.

Hundreds of new California laws take effect Jan. 1. How will they affect you? »

“The cannabis industry is being choked by California’s penchant for over-regulation,” said Dale Gieringer, director of California NORML, a pro-legalization group. “It’s impossible to solve all of the problems without a drastic rewrite of the law, which is not in the cards for the foreseeable future.”

After voters legalized marijuana two years ago under Proposition 64, state officials estimated in there would be as many as 6,000 cannabis shops licensed in the first few years. But the state Bureau of Cannabis Control has issued just 547 temporary and annual licenses to marijuana retail stores and dispensaries. Some 1,790 stores and dispensaries were paying taxes on medicinal pot sales before licenses were required starting Jan. 1.

(Los Angeles Times)

State officials also predicted that legal cannabis would eventually bring in up to $1 billion in revenue a year. But with many cities banning pot sales, tax revenue is falling far short of estimates. Based on taxes collected since Jan. 1, the state is expected to bring in $471 million in revenue this fiscal year — much less than the $630 million projected in Gov. Jerry Brown’s budget.

“I think we all wish we could license more businesses, but our system is based on dual licensing and local control,” said Alex Traverso, a spokesman for the state Bureau of Cannabis Control, referring to the requirement that cannabis businesses get permission from the state and the city in which they want to operate.

Less than 20% of cities in California — 89 of 482 — allow retail shops to sell cannabis for recreational use, according to the California Cannabis Industry Assn. Cities that allow cannabis sales include Los Angeles, Oakland, San Francisco and San Diego.

Coverage of California politics »

Eighty-two of Los Angeles County’s 88 cities prohibit retail sales of recreational marijuana, according to Alexa Halloran, an attorney specializing in cannabis law for the firm Solomon, Saltsman & Jamieson. Pot shops are not allowed in cities including Burbank, Manhattan Beach, Alhambra, Beverly Hills, Inglewood, Compton, Redondo Beach, El Monte, Rancho Palos Verdes and Calabasas.

“While some cities have jumped in headfirst, we’ve taken a deliberate approach,” said Manhattan Beach Mayor Steve Napolitano, “to see how things shake out elsewhere before further consideration. I think that’s proven to be the smart approach.”

Voters have also been reluctant to allow cannabis stores in their communities.

Of the 64 California cities and counties that voted on cannabis ballot measures in the November midterm election, eight banned the sale of cannabis or turned down taxation measures, seven allowed sales and 49 approved taxes on pot businesses, said Hilary Bricken, an attorney who represents the industry. Among them, voters in Malibu approved pot shops while Simi Valley residents voted for an advisory measure against allowing retail sales.

Javier Montes, owner of Wilmington pot store Delta-9 THC, says he is struggling to compete with a large illicit market unburdened by the taxes he pays as a licensed business.

“Because we are up against high taxes and the proliferation of illegal shops, it is difficult right now,” Montes said. “We expected lines out of our doors, but unfortunately the underground market was already conducting commercial cannabis activity and are continuing to do so.”

Montes, who received his city and state licenses in January, says his business faces a 15% state excise tax, a 10% recreational marijuana tax by the city of Los Angeles and 9.5% in sales tax by the county and state — a markup of more than 34%.

He says there isn’t enough enforcement against illegal operators, and the hard times have caused him to cut the number of employees at his shop in half this year from 24 to 12.

“It’s very hard whenever I have to lay people off, because they are like a family to me,” said Montes, who is vice president of the United Cannabis Business Assn., which represents firms including the about 170 cannabis retailers licensed by the city of Los Angeles.

DELTA-9 faces a 15% state excise tax, a 10% recreational cannabis tax by the city of Los Angeles and 9.5% in sales tax by the county and state, the shop owner says. (Marcus Yam / Los Angeles Times)

Sky Siegel, who operates a cannabis business in Studio City, said he recently gave up trying to open another store in Santa Monica because of its restrictions on such businesses.

“It turns into this ‘Hunger Games’ to try to get a license,” said Siegel, who is general manager of Perennial Holistic Wellness Center, which has a dozen employees in Studio City and also operates a delivery service.

He says his firm is up against thousands of unlicensed delivery services going into cities where storefronts are banned.

“To me, it doesn’t make sense” that many cities have prohibited shops, he said. “Banning does nothing. It’s already there. Why not turn this into a legitimized business, which is what the people want.”

Marijuana use is rising among pregnant patients. Not so fast, doctors warn »

California has also issued fewer cultivation licenses than expected in the first year of legalization, with about 2,160 growers registered with the state; an estimated 50,000 commercial cannabis cultivation operations existed before Proposition 64, according to the California Growers Assn. Some have given up growing pot, but many others are continuing to operate illegally.

The trade group hoped to see at least 5,000 commercial growers licensed in the first year, said Hezekiah Allen, the group’s former executive director who is now chairman of Emerald Grown, a cooperative of 130 licensed cultivators.

“We are lagging far behind,” Allen said. “It’s woefully inadequate. Most of the people in California who are buying cannabis are still buying it from the unregulated market. There just isn’t a reason for most growers to make the transition.”

 

Patrick McGreevy Dec 27, 2018

(Marcus Yam / Los Angeles Times)

Source:  http://www.latimes.com/politics/la-pol-ca-marijuana-year-anniversary-review-20181227-story.html

 

At the same time, he said, the neighborhood council has worked with licensed cannabis stores to get them involved in improving the community and has asked the Los Angeles City Council to devote some of the tax revenue from Van Nuys shops to solving local problems, including homelessness and crime.

Meanwhile, despite concerns from law enforcement, the state is finalizing a proposal to allow deliveries throughout California — including in cities that ban retail stores. The new rule by Lori Ajax, chief of the state Bureau of Cannabis Control, is expected to be implemented in January.

Ajax says she believes that as the system is refined and is shown to operate successfully in some cities, other local governments will allow retail pot sales. But opponents of pot legalization, including Kevin Sabet, president of Smart Approaches to Marijuana, are happy that most cities are saying “no” to selling the drug.

“The residents of Compton and these other cities have seen the ills that come with allowing marijuana in the door,” Sabet said, “including skyrocketing drugged driving; the promise, then failure of social justice; and the targeting of children through the use of colorful and deceptive candies, gummies and sodas.”

Even in cities that allow cannabis sales, businesses face big hurdles.

The various taxes and fees could drive up the cost of legal cannabis in parts of California by 45%, according to the global credit ratings firm Fitch Ratings.

There is less of a tax burden in Oregon, where voters legalized recreational pot in 2014, and state and local taxes are capped at 20%. With nearly a tenth of the population of California, that state has more licensed cannabis shops — 601. On a per capita basis, Alaska has also approved more pot shop licenses than California, — 94 so far. The state imposes a tax on cultivation, but there is no retail excise tax on pot.

Assemblyman Rob Bonta (D-Alameda) tried and failed this year to push for a temporary reduction in California’s pot taxes to help the industry get on its feet.

“It’s a work in progress,” Bonta said of the current regulatory system. “We knew we weren’t going to get it exactly right on Day 1, and so we’re always looking for ways to achieve the original intentions and goal.”

Bonta said he may revisit the taxation issue in 2019 and is exploring the idea of having the state do more to get cities to approve businesses, possibly by providing advisory guidelines for local legalization that address cities’ concerns.

California cannabis businesses, like their counterparts in Colorado and Oregon, also face costs to test marijuana for harmful chemicals.

“The testing costs are excessive — $500 to $1,000 per batch, and most crops involve multiple batches,” said Gieringer, the director of California NORML. “No other agricultural product is required to undergo such costly or sensitive tests.”

Another problem hampering the legal market is a lack of banking for cannabis businesses. Federally regulated banks are reluctant to handle cash from pot, which remains an illegal drug under federal law.

“Banking continues to be an issue in terms of creating a real public safety problem with significant amounts of cash being moved for transactions,” said Bonta, who co-wrote a bill this year that would have created a state-sanctioned bank to handle money from pot sellers. It failed to pass after legislative analysts said the proposal faced “significant obstacles,” including no protection from federal law enforcement.

Industry leaders and activists said they knew it would be a slow process to establish a strong legal market, noting other states with legal pot, including Colorado, Washington and Oregon, also faced growing pains and problems along the way.

But Ajax, the state pot czar, says her agency has had a productive first year, issuing initial licenses, refining the rules and stepping up action against unlicensed operations, including partnering with the Los Angeles Police Department to seize $2 million worth of marijuana products from an unlicensed shop in Sylmar in October.

“I am optimistic about the coming year, where our focus will be primarily on getting more businesses licensed and increasing enforcement efforts on the illegal market,” Ajax said.

By Kurtis Lee   Oct 15, 2018

Source:  http://www.latimes.com/politics/la-pol-ca-marijuana-year-anniversary-review-20181227-story.html

 

(February 22, 2018 – Denver, CO) – The Marijuana Accountability Coalition (MAC), along with Smart Approaches to Marijuana (SAM), launched a new report today examining marijuana legalization in Colorado, joining Colorado Christian University and the Centennial Institute in an open press event. SAM honorary advisor, former Congressman Patrick Kennedy, also delivered the report to Colorado House Speaker Crisanta Duran earlier today. MAC is an affiliate of SAM Action, SAM’s 501 c-4 organization, started by former Obama and Bush Administration advisors.

“We will continue to investigate, expose, challenge, and hold the marijuana industry accountable,” said Justin Luke Riley, founder of MAC. “We will not remain silent anymore as we see our state overtaken by special marijuana interests.”

 

The report also comes with a two-page report card synopsis giving Colorado an “F” on many key public health and safety indicators.

Future MAC initiatives include an effort to expose politicians taking marijuana industry money, and exposing the harms of 4/20 celebrations.

“I am increasingly concerned that legalized marijuana is wrecking our state. Communities across Colorado are suffering because of it, and it is absolutely necessary to continue to give voice to the people, families and communities being harmed. I’m glad MAC has stepped up to be that voice,”  said Frank McNulty, former Speaker of the House of Representatives in the U.S. State of Colorado.

The new report card discussed the following impacts in the state:

  • Colorado currently holds the top ranking for first-time marijuana use among youth, representing a 65% increase in the years since legalization (NSDUH, 2006-2016). Young adult use (youth aged 18-25) in Colorado is rapidly increasing (NSDUH, 2006-2016).
  • Colorado toxicology reports show the percentage of adolescent suicide victims testing positive for marijuana has increased (Colorado Department of Public Health & Environment [CDPHE], 2017).
  • Colorado marijuana arrests for young African-American and Hispanic youth have increased since legalization (Colorado Department of Public Safety [CDPS], 2016).
  • The gallons of alcohol consumed in Colorado since marijuana legalization has increased by 8% (Colorado Department of Revenue [CDR], Colorado Liquor Excise Tax, 2017).
  • In Colorado, calls to poison control centers have risen 210% between the four-year averages before and after recreational legalization (Rocky Mountain Poison and Drug Center [RMPCD], 2017 and Wang, et al., 2017).

“As a university we are entrusted to help shape and guide the minds of younger generations. Marijuana has been proven to be harmful to the developing brains of young people. We should not live in a state where marijuana companies have a financial interest in hooking as many people as they can on this dangerous drug,” said Jeff Hunt, Vice President of Public Policy, Colorado Christian University
Director, Centennial Institute.

“The promotion of marijuana use may be part of the driving force behind the negative societal effects Colorado has been seeing for the past several years which annually continues to worsen and include increased prevalence in overall and teen suicides,” said Dr. Kenneth Finn, a physician Board Certified in Pain Medicine, Physical Medicine and Rehabilitation, Pain Management in Colorado.

“Isn’t it sad to think about how we are more concerned with how many plants we are legally entitled to grow, rather than how this drug is devastating the growth and potential of MY generation, and generations to come? We are growing plants, yet stunting growth. And I’m sick of it. I am craving cultural redemption and a redefined identity,” said Courtney Reiner, Student at Colorado Christian University.

“My family, my community, and my state have not benefited from the legalization of marijuana. The costs and harms outweigh any tax revenue. Our state has developed a deep drug bias where the negative effects of marijuana are minimized,” said Aubree Adams, who is also part of a group of mothers called Moms Strong.

Other data highlighted in the report include:

  • In Colorado, the annual rate of marijuana-related emergency room visits increased 35% between the years 2011 and 2015 (CDPHE, 2017).
  • Narcotics officers in Colorado have been busy responding to the 50% increase in illegal grow operations across rural areas in the state (Stewart, 2017).
    • In 2016 alone, Colorado law enforcement confiscated 7,116 pounds of marijuana, carried out 252 felony arrests, and made 346 highway interdictions of marijuana headed to 36 different U.S. states (RMHIDTA, 2017).
  • The U.S. mail system has also been affected by the black market, seeing an 844% increase in marijuana seizures (RMHIDTA, 2017).
  • The crime rate in Colorado has increased 11 times faster than the rest of the nation since legalization (Mitchell, 2017), with the Colorado Bureau of Investigation reporting an 8.3% increase in property crimes and an 18.6% increase in violent crimes (Colorado Bureau of Investigation [CBI], 2017).
    • The Boulder Police Department reported a 54% increase in public consumption of marijuana citations since legalization (Boulder Police Department [BPD], 2017).
  • Marijuana urine test results in Colorado are now double the national average (Quest Diagnostics, 2016).
  • Insurance claims have become a growing concern among companies in legalized states (Hlavac & Easterly, 2016).
  • The number of drivers in Colorado intoxicated with marijuana and involved in fatal traffic crashes increased 88% from 2013 to 2015 (Migoya, 2017). Marijuana-related traffic deaths increased 66% between the four-year averages before and after legalization (National Highway Traffic Safety Administration [NHTSA], 2017).
    • Driving under the influence of drugs (DUIDs) have also risen in Colorado, with 76% of statewide DUIDs involving marijuana (Colorado State Patrol [CSP], 2017).
 

www.MarijuanaAccountability.CO

__________________________________________________________________

About SAM Action

SAM Action is a non-profit, 501(c)(4) social welfare organization dedicated to promoting healthy marijuana policies that do not involve legalizing drugs. Learn more about SAM Action and its work at visit www.samaction.net.

www.samaction.net

 Big things are happening for the humble marijuana (or cannabis) plant. On July 21, Senate Majority Leader Chuck Schumer (D-NY) introduced a bill to legalize marijuana at the federal level with Senators Ron Wyden (D-Ore.) and Cory Booker (D-N.J.).

Booker released a statement on the bill on July 21, saying this can undo the damage done by the War on Drugs.

Meanwhile anti-legalization advocates like Kevin A. Sabet are doing all they can to prevent the bill from passing the Senate and becoming law.

However, regardless of the outcome, this bill is likely to change the discourse around cannabis for years to come.

State legalization and subsequent commercialization of marijuana has given the drug a glow up. The drug, once associated with potheads, illicit dealings, and pungent herbal smells is fast becoming a legal, family-friendly, trendy, and Instagram-worthy herbal medicine.

The expectation was that after legalization, marijuana would become more controlled and safe. The states that have made moves to legalize first medical marijuana, then recreational marijuana, however, observed increases in illicit dealings, hospital admission rates, and cannabis addiction and use.

Potency and concentration of cannabis and its derivatives, car crashes involving cannabis and abuse, and use in young people have also met new highs.

Marijuana is getting a foothold into medicine and households. It has been the most-consumed illicit drug globally and in the United States (pdf) for decades, though marijuana use is still far behind alcohol and tobacco.

The two words cannabis and marijuana are often used interchangeably, but there are differences in nuance. Cannabis generally refers to the entire cannabis plant, while marijuana refers to products made from cannabis such as dried leaves, or flowers. The word marijuana also implies that it is a cannabis product high in tetrahydrocannabinol (THC), the main constituent and the psychoactive derivative of cannabis.

Since legalization and commercialization, the THC content of cannabis products has been increasing. It has gone up from less than 2 percent (prior to the 1990s) to the current levels of 17 percent, and possibly even 30 percent as consumers seek bigger highs.

Gummi Bears are displayed in a glass jar on April 3, 2009 in San Francisco, California. Candy with marijuana in it has been handed out by mistake to fifth-grade children. (Justin Sullivan/Getty Images)

Recreational Marijuana: A Changed Product

Some parents’, grandparents’, and educators’ memory of recreational weed is that of its humbler eras of 2 to 4 percent THC. There is a mismatch in perception, as high-THC level products are being packaged into innocent-looking gummies, candies, vapes, drinks, and many more. Though these are only legal for adult consumption, younger people are using it more than ever. Teenagers and young adults, whose brains are still in development, are consuming marijuana at unprecedented potencies. Marijuana use is linked with mental disorders, and memory and cognitive decline, with younger people the most at risk.

To add the cherry on top, researchers such as psychiatrist and professor Dr. Deepak D’Souza from Yale University, believes the high potencies, longer periods of use, may make findings from studies in the ’70s, ’80s, ’90s irrelevant to the current marijuana landscape.

“It’s the potency…the weed that’s available now [is] so different from what it was in the 1960s,” D’Souza told The Epoch Times.

Back then, weed was less accessible, less potent, and most people used it sporadically. Today, marijuana is more accessible, easily obtained in both licensed and unlicensed stores, increasingly potent, with an increased demographic of people taking the drug in the long-term.

“Studies done in the past would suggest that only about one in 10 people would develop a cannabis use disorder (addiction to cannabis),” D’Souza said. “I think more recent studies … in the current landscape of marijuana would suggest that that number is actually a lot higher than we previously thought.”

An assortment of marijuana for sale at Catalyst Cannabis Dispensary in Santa Ana, Calif., on Feb. 18, 2021. (John Fredricks/The Epoch Times)

How Marijuana Works

Marijuana acts on the endocannabinoid system that exists in the brain and spinal cord.

Researchers are not exactly sure how marijuana creates its euphoric effects, but studies suggest that it is the binding of THC to the endocannabinoid receptors in the brain that creates euphoria. There are two endocannabinoid receptors, CB1 receptors are in the brain and CB2 receptors are in the spinal cord. THC and most cannabinoids can bind to both.

Apart from THC, there is also another common cannabinoid: cannabidiol (CBD).

CBD, the second most common cannabinoid, also interacts with the endocannabinoid system, though its actions are more complex. CBD, however, does not give users the high found in THC. CBD is generally the active ingredient in medicinal marijuana, and there are many studies linking the cannabinoid with therapeutic properties including pain and seizures.

Since the 1900s, the potency of THC in recreational marijuana has been increasing, while CBD percentage has decreased. One can find 99 percent THC oils being dispensed. Consumers can add this to their vapes, or for other forms of consumption.

Recreational Marijuana: The Young and Mental Health

Though the general advice for younger people is to stay off the drug until adulthood, D’Souza senses that an increasing number of younger people are using weed recreationally, often unaware of the exact implications of consumption.

“More and more young people … are using cannabis, and they are getting younger,” he said. “And they’re using more potent forms.”

He is not wrong. Cannabis use in young people is reaching record rates, increasing from 37 percent in 2014 to 43 percent in 2019. Teenagers of today are also more likely to consume marijuana than tobacco.

Many studies have suggested that cannabis, especially its THC component, may affect neurodevelopment in growing brains, as it disrupt processes in the brain. The brain only completes its full maturation at about the age of 25 to 26. Some studies suggest maturation may come even later than that. During adolescence, brains go through “pruning,” which is a process where necessary brain cells and connections are strengthened and the unnecessary neurons are removed.

“The process of pruning is important, it’s really important in preparing the brain for the demands of adulthood,” D’Souza said.

The endocannabinoid system is also important in neurodevelopment. In our bodies we produce two chemicals that can bind to CB1 and CB2 receptors.

“One is called anandamide, named after the Sanskrit word meaning bliss,” he said. “And the other is called 2-AG.”

When the endocannabinoid system is activated, these chemicals will be released and bind to the receptors.  The chemicals are specific. They act on a small targeted area and “produce the effects for just milliseconds before…they are inactivated.”

Researchers believe that the binding of these chemicals allows the brain to select what neurons will be strengthened and what neurons will be removed in neurodevelopment, according to D’Souza.

Whilst these two natural chemicals act for a very short, transient time, THC does not.

THC in the body can last for minutes to hours, smoked joints give a quick and strong burst in minutes but consumed THC in gummies and other food start slow and last for hours. THC is also non-selective and will bind to all the areas of the brain with these receptors, distorting the targeted communication in the brain.

“The scientific term we use is that THC produces effects that are … non physiological effects, and those … effects may have far reaching consequences.”

If the endocannabinoid system is, as researchers believe, “really important in directing … neurodevelopmental processes, you could imagine that when an adolescent whose brain is still maturing smokes cannabis, it may disrupt that process,” said D’Souza.

The prefrontal cortex, the area of the brain in charge of critical thinking and decision making, is the last area to fully mature. Research suggests that the maturation in this area is what separates teenagers and young adults from fully matured adults.

Brain scans of drug abusers often show a decreased brain matter volume in the prefrontal cortex, suggesting increased in impulsivity and poor decision making.

Since younger people have immature prefrontal cortexes, this may be why early marijuana use increases risks of addiction and brain impairment. A study found 10.7 percent of teenagers between the age of 12 and 17 developed an addiction to cannabis within 12 months of use, and 20.1 percent developed addiction after 3 years.  For young adults aged 18 to 25, 6.4 percent developed addiction in a year, and 10.9 percent in three years.

Cannabis use is also linked to mental health disorders, especially in younger people, particularly those at risk of certain mental health disorders, including depression, psychosis, and schizophrenia.

Though it should be noted that not everyone who uses cannabis will develop mental health disorders and other health conditions, studies in younger people have linked the drug with various mental disorders including psychosisschizophrenia (some studies suggest a causal link)anxietyand depression. Some studies also link cannabis consumption with an exacerbation of present psychiatric symptoms. Schizophrenia has lifelong consequences and patients will need to be treated or monitored over their lifetime.

The majority of endocannabinoid receptors in the brain reside in the hippocampus, a seahorse structure deep in the brain important for memory formation and storage. Studies on long-term and short-term effects of cannabis have both found that cannabis affects learning and episodic memory.

Studies on adolescents have also found that cannabis use was associated with a reduced brain matter volume, a 2021 study found that it has been linked with brain aging, especially in the prefrontal cortex. Persistent use of cannabis in adolescence has also been associated with permanently reduced IQ by 5 to 13 points.

Topographical overlap between age-related thinning, cannabis effect, and cannabinoid 1 (CB1) receptor availability (courtesy of Dr. Matthew D. Albaugh and the Journal of the American Medical Association)

Though parenting plays a role in preventing teens from abusing cannabis and severe adverse effects, it can be hard for parents and educators to make the connection when their image of cannabis is mostly benign.

The industry is also trying to make cannabis appealing to the younger generations despite regulations prohibiting minor use.

D’Souza argued that the age limit that has been set is “disingenuous,” due to the investment in products that are enticing to pre-teens and teenagers.

“Companies are making gummy bears, gummy bears, I would hardly think that adults would be interested in gummy bears. That’s just a disingenuous way of marketing to young adults below the age,” D’Souza said.

“We really have done a poor job at educating the public.”

Marijuana is weighed at a medical marijuana dispensary in Vancouver, Feb. 5, 2015. (The Canadian Press/Jonathan Hayward)

Medical Cannabis: A Ticket to Becoming Recreational?

Studies shown that medicinal cannabis does have therapeutic effects against pain, chemo-therapy induced nausea and vomiting, and spasticity from multiple sclerosis.

There is also anecdotal evidence of the drug’s effects against seizures in neurodegenerative diseases and epilepsy.

However, regulation of medicinal marijuana use varies drastically across different states.

Connecticut, for example, approves medicinal marijuana use for over 40 conditions including cancer, amyotrophic lateral sclerosis, cystic fibrosis, multiple sclerosis, and many others. New York sets no limit on the number and type of conditions.

There are also states with strict laws; Wyoming only approved CBD-oils in 2015 and limited its use to seizures only.

Some studies also suggest benefits in Alzheimer’s disease, cancer, and depression, but “for the overwhelming majority of those conditions, there is very little evidence to support the benefits of marijuana for these conditions, with some exceptions,” said D’Souza.

Studies also found that most (around 90 percent) people taking medical marijuana reported that it reduced their symptoms, and two-thirds of them used less prescription medicines.

For the medical marijuana users that report addiction, around 80 percent use recreational marijuana.

Medical marijuana has helped people, but D’Souza argued that there are political motivations behind medicinal marijuana legalization. “Those who wanted to legalize marijuana realized and planned very early on that if they could get the public at large to accept medical marijuana, then it would be a very short step from there to make marijuana completely legal.”

“And that is exactly what is happening.”

Currently, 38 states have approved medical marijuana and 18 of these states also approved recreational marijuana use in adults.

The states first to approve marijuana medically were often also the first to approve it recreationally, with some exceptions:

Colorado and California were leaders in approving medical marijuana, doing so long before the movement for legalization gained momentum. Recreational approval only came after the movement gained momentum, thus these two states took 12 and 20 years respectively to legalize recreational marijuana. There are also states that were late to the overall medical marijuana program, but quickly approved recreational use, such as Massachusetts, and the district Washington DC. They legalized medical marijuana just ahead of the push for legal recreational marijuana use, and it took these two states only around 4 years to approve recreational marijuana.

Full legalization of cannabis often opened doors to commercialization. Each new policy further opened the doors for cannabis access, but these are not without health implications.

A study on youths from 2008 to 2016 in four states that legalized recreational cannabis (Colorado, Washington, Alaska, and Oregon) found that cannabis addictions reported in teenagers 12 to 17 increased from 2.18 to 2.72 percent—a 25 percent increase.

Colorado: A Case Study

Colorado legalized medical marijuana in 2000, and was the first state to legalize recreational marijuana in 2012, before commercializing it in 2014.

Since its legalization, it saw increases in marijuana-involved traffic accidents, use and abuse in teenagers, hospital presentation from cannabis adverse effects, and poison center presentation for children and pets who unwittingly ingested cannabis from medicinal cabinets.

Hospitalizations for cannabis related adverse effects increased by 45 percent (pdf) between 2006 and 2008 (pre-commercialization of medical marijuana) to 2009 to 2012.

From Colorado’s post-commercialization period to 2013 to 2014 (legalization and commercialization period for recreational marijuana), hospitalizations for cannabis-related conditions increased by another 66 percent (pdf).

These hospitalizations do not come without repercussions, and hospitals are reporting financial losses from cannabis-related treatments. A study (pdf) examining one hospital in a municipality in Colorado found that from 2009 to 2014, hospitalizations from cannabis-related bills increased by 375 percent and emergency department (ED) submissions increased from 9 percent to 15.3 percent.

It should be noted that the municipality did not legalize cannabis under Amendment 64, however the hospital saw an increasing presentation to the ED for people experiencing adverse effects from marijuana, with the majority of hospitalizations mental health involved, including suicide ideation, depression, and so on.

From 2009 to 2014, the hospital incurred at least $20 million in losses from cannabis patients not paying their bills. Other studies examining hospital presentations in Colorado found that from 2000 to 2015, hospitalization rates with marijuana-related billing codes doubled from 274 in 2000 to 593 per 100,000 hospitalizations in 2015. ED visits from mental illness were five times higher for bills that had marijuana-related codes than bills without.

A study on poison center reports in Colorado found that child reports of cannabis ingestion doubled from 1.2 per 100 000 population in 2009 to 2.3 per 100,000 population in 2015, and half of these reports were from children ingesting cannabis-containing gummies, and brownies, both of which are appealing to children. Though arguably, the reports are less than crayon poisoning reports every year, however as legalization invariably increases marijuana exposures, poisoning from cannabis in children is only going to increase as the drug becomes increasingly socially acceptable.

Additionally, traffic deaths involving drivers who tested positive for marijuana also increased since legalization of recreational marijuana. Traffic deaths involving marijuana more than doubled from 55 people killed in 2013 to 115 in 2018. In 2019, there were 163 alcohol-impaired traffic deaths in Colorado.

Cannabis use in teenagers and young adults in Colorado have also mostly showed an increasing trend. In 2019, 15.5 percent of teenagers aged 15 and younger consumed cannabis in the past 30 days, compared to 15.4 percent in 2013. Teenagers aged 16 to 17, and 18 and older also saw general increases, reaching 24.4 and 27.5 percent respectively as compared to 22.5 and 25.3 percent in 2013.

D’Souza likened the popularity among the younger generation and commercialism of cannabis with tobacco and alcohol. “Even though alcohol is supposed to be sold only to people over the age of 21, it’s very easy for young people, adolescents to get their hands on alcohol, and likewise I would expect no different…with cannabis.”

Correction: A previous version of this article marked the 2009 to 2012 period as “(post-commercialization)” under the section Colorado: A Case Study. The terminology quoted from the report caused confusion and has since been removed. Colorado legalized recreational marijuana use in 2012 and state-licensed retail sales, or commercialization, in 2014. 

Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times. Epoch Health welcomes professional discussion and friendly debate. To submit an opinion piece, please follow these guidelines and submit through our form here.

Source: How Modern Marijuana Changes the Brain (theepochtimes.com)

BY HEALTH 1+1 AND MARINA ZHANG TIMEAUGUST 1, 2022

The National Institute for Health and Care Excellence (NICE) has today published new guidelines which are intended to support the safe prescribing and withdrawal of medicines that can cause dependence, including antidepressants, opioids, gabapentinoids and benzodiazepines.

There are several positive changes in this new guidance, including the need for doctors to offer alternatives to these drugs, as well as the requirement for a written management plan at the start of a prescription.

However, the guidelines fail to provide simple instructions for slow tapering, which is the most important intervention for safe withdrawal.  Currently many patients report being taken off their drugs too quickly, which can lead to devastating and long-lasting withdrawal symptoms.

This method of slow, ‘hyperbolic’ tapering (often over many months or longer) has been developed over many years based on the experience of thousands of patients, and is supported by several articles in medical journals.  And yet the new guidelines provide no information on how slowly to taper, how frequently to reduce and by how much. Without these details, doctors are unlikely to change their current practice.

NICE claims on its website that it takes ‘a comprehensive approach to assessing the best evidence that is available.’  However for these guidelines it has not done so.  The APPG for Prescribed Drug Dependence wrote to the NICE committee as part of the guidelines consultation process to point out this failure to include this patient-developed evidence and to provide relevant links to published research.  

In response, the committee claimed that only ‘randomised controlled trials were prioritised’ and that our proposed evidence was not of ‘sufficient quality’ and as result ‘none of the suggested recommendations are relevant for inclusion’.

Yet NICE states on its website that acceptable evidence ‘can include qualitative and quantitative evidence, from the literature or submitted by stakeholders. It can also include observational data and testimonies from experts.’   

Danny Kruger, chair of the APPG for Prescribed Drug Dependence, said: ’It is very disappointing that these new guidelines fail to include the simple instructions for slow tapering which are desperately needed by doctors to support safe withdrawal from these drugs.  This is because important evidence developed with patient groups has been ignored, as it doesn’t meet NICE quality standards.  We will be urging NICE to reconsider both this evidence and their process to ensure that patient experience is properly represented in future.’

Source:  https://prescribeddrug.org/appg-for-prescribed-drug-dependence-press-release-new-nice-guidance-to-tackle-prescribed-drug-dependence-fails-to-listen-to-patient-evidence/

Date: April 2022

Three months ago, National Families in Action published a report, Tracking the Money that is Legalizing Marijuana and Why It Matters, that details where the money comes from to legalize marijuana for medical and recreational use. Most of it was raised by three billionaires and two organizations they fund, the Drug Policy Alliance (DPA) and the Marijuana Policy Project (MPP) to do the work of legalization. The first decade of legalization was accomplished via ballot measures which DPA and/or MPP wrote, paid for collecting voters’ signatures, and paid heavily for advertising with less than accurate information to convince voters to pass them. This effort created a medical marijuana industry that made so much money it began contributing to the legalization effort as well.

In February 2017, five US Representatives formed the Congressional Cannabis Caucus to issue a spate of bills that would set the stage and then ultimately legalize marijuana at the federal level. It turns out that DPA and MPP donations to Congressional campaigns are over-represented among Caucus members and other legislators who are partnering with them to reach this goal. Together, Caucus members, pictured above, and colleagues have introduced more than 20 bills since February.

Rep. Earl Blumenauer (D-OR), who received $3,000 from MPP, has introduced three of those bills and is co-sponsoring seven more.

Rep. Ed Perlmutter (D-CO) received $2,000 from MPP, has introduced one bill, and co-sponsored four more.

Rep. Ed Polis (D-CO), the only Caucus member who has not received donations from either group, has introduced one bill and co-sponsored six more.

Rep. Young (R-AK) received $1,000 from MPP, introduced one bill, and co-sponsored five more.

Rep. Dana Rohrabacher (R-CA) received $7,000 from MPP and $4,700 from DPA, introduced one bill, and co-sponsored five more bills.

Here are the representatives and senators who signed on as co-sponsors of the 20-plus bills who also received donations from DPA and/or MPP as of June 28:

  • Rep. Ruben Gallego (D-AZ) — $5,000/MPP – co-sponsoring 1 bill.
  • Rep. Raul Grijalva (D-AZ) — $1,000/MPP – co-sponsoring 2 bills.
  • Rep. Pete Aguilar (D-CA) — $8,000/MPP — co-sponsoring 1 bill.
  • Rep. Jared Huffman (D-CA) — $3,000/MPP – co-sponsoring 2 bills.
  • Rep. Duncan Hunter (R-CA) — $1,000/MPP – co-sponsoring 3 bills.
  • Rep. Barbara Lee (D-CA) — $4,500/MPP/$500/DPA – sponsoring 1 bill, co-sponsoring 5 bills.
  • Rep. Alan Lowenthal (D-CA) — $1,000/MPP — co-sponsoring 1 bill.
  • Rep. Mike Coffman (R-CO) — $1,000/MPP — sponsoring 1 bill, co-sponsoring 3 bills.
  • Rep. Diana DeGette (D-CO) — $1,000/DPA – sponsoring 1 bill, co-sponsoring 2 bills.
  • Rep. Joe Courtney (D-CT) — $2,600/MPP – co-sponsoring 2 bills.
  • Rep. Carlos Curbelo (R-FL) — $1,000/MPP – co-sponsoring 1 bill.
  • Rep. Ted Yoho (R-FL) — $1,000/MPP — co-sponsoring 1 bill.
  • Rep. Thomas Massie (R-KY) — $1,000/MPP — co-sponsoring 1 bill.
  • Sen. Rand Paul (R-KY) — $3,500/MPP – co-sponsoring 3 bills.
  • Rep. Jamie Raskin (D-MD) — $5,000/MPP — co-sponsoring 2 bills.
  • Rep. Justin Amash (R-MI) — $5,750/MPP/$1,000/DPA — co-sponsoring 3 bills.
  • Rep. John Conyers (D-MI) — $2,500/DPA – co-sponsoring 1 bill.
  • Sen. Roy Blunt (R-MO) — $1,000/MPP — co-sponsoring 1 bill.
  • Rep. Ruben Kihuen (D-NV) — $1,00/MPP – co-sponsoring 2 bills.
  • Sen. Cory Booker (D-NJ) — $1,000/DPA — sponsoring 1 bill.
  • Rep. Steve Cohen (D-TN) — $5,500/MPP — sponsoring 1 bill, co-sponsoring 7 bills.
  • Rep. Jim Cooper (D-TN) — $1,000/MPP – co-sponsoring 1 bill.
  • Rep. Beto O’Rourke (D-TX) — $6,000/MPP/$4,500/DPA — co-sponsoring 5 bills.
  • Rep. Mark Pocan (D-WI) — $4,000/MPP — co-sponsoring 3 bills.
  • Sen. Tammy Baldwin (D-WI) — $1,500/MPP — co-sponsoring 1 bill.

People who don’t want to see Congress legalize marijuana nationwide can pay to play too. With few exceptions, these are not large amounts of money. They could be matched to replace MPP’s and DPA’s donations so legislators can work for healthy families and healthy communities instead of the marijuana industry.

The Cannabist, the Denver Post’s marijuana website, published a list of bills these folks have introduced in Congress since the Caucus was formed in February. You can read it here.
Note: a few bills in the list do not deal with legalization.

Source: Email from National Families In Action  June 2017

America’s opioid crisis was caused by rapacious pharma companies, politicians who colluded with them and regulators who approved one opioid pill after another.

Of all the people Donald Trump could blame for the opioid epidemic, he chose the victims. After his own commission on the opioid crisis issued an interim report this week, Trump said young people should be told drugs are “No good, really bad for you in every way.”

The president’s exhortation to follow Nancy Reagan’s miserably inadequate advice and Just Say No to drugs is far from useful. The then first lady made not a jot of difference to the crack epidemic in the 1980s. But Trump’s characterisation of the source of the opioid crisis was more disturbing. “The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place,” he said.

That is straight out of the opioid manufacturers’ playbook. Facing a raft of lawsuits and a threat to their profits, pharmaceutical companies are pushing the line that the epidemic stems not from the wholesale prescribing of powerful painkillers – essentially heroin in pill form – but their misuse by some of those who then become addicted.

In court filings, drug companies are smearing the estimated two million people hooked on their products as criminals to blame for their own addiction. Some of those in its grip break the law by buying drugs on the black market or switch to heroin. But too often that addiction began by following the advice of a doctor who, in turn, was following the drug manufacturers instructions.

Trump made no mention of this or reining in the mass prescribing underpinning the epidemic. Instead he played to the abuse narrative when he painted the crisis as a law and order issue, and criticised Barack Obama for scaling back drug prosecutions and lowering sentences.

But as the president’s own commission noted, this is not an epidemic caused by those caught in its grasp. “We have an enormous problem that is often not beginning on street corners; it is starting in doctor’s offices and hospitals in every state in our nation,” it said.

heroin
 ‘This is an almost uniquely American crisis.’ Photograph: Spencer Platt/Getty Images

Opioids killed more than 33,000 Americans in 2015 and the toll was almost certainly higher last year. About half of deaths involved prescription painkillers. Most of those who overdose on heroin or a synthetic opiate, such as fentanyl, first become hooked on legal pills.

This is an almost uniquely American crisis driven in good part by particular American issues from the influence of drug companies over medical policy to a “pill for every ill” culture. Trump’s commission, which called the opioid epidemic “unparalleled”, said the grim reality is that “the amount of opioids prescribed in the US was enough for every American to be medicated around the clock for three weeks”.

The US consumes more than 80% of the global opioid pill production even though it has less than 5% of the world’s population. Over the past 20 years, one federal institution after another lined up behind the drug manufacturers’ false claims of an epidemic of untreated pain in the US. They seem not to have asked why no other country was apparently suffering from such an epidemic or plying opioids to its patients at every opportunity.

With the pharmaceutical lobby’s money keeping Congress on its side, regulations were rewritten to permit physicians to prescribe as many pills as they wanted without censure. Indeed, doctors sometimes found themselves hauled before ethics boards for not supplying enough.

Unlike most other countries, the US health system is run as an industry not a service. That gives considerable power to drug manufacturers, medical providers and health insurance companies to influence policy and practices.

Too often, their bottom line is profits not health. Opioid pills are far cheaper and easier than providing other forms of treatment for pain, like physical therapy or psychiatry. As Senator Joe Manchin of West Virginia told the Guardian last year: “It’s an epidemic because we have a business model for it. Follow the money. Look at the amount of pills they shipped in to certain parts of our state. It was a business model.”

But the system also gives a lot of power to patients. People coughing up large amounts of money in insurance premiums and co-pays expect results. They are, after all, more customer than patient. Doctors complain of patients who arrive expecting a pill to resolve medical conditions without taking responsibility for their own health by eating better or exercising more.

In particular, the idea has taken hold, pushed by the pharmaceutical industry, that there is a right to be pain free. Other countries pursue strategies to reduce and manage pain, not raise expectations that it can simply be made to disappear. In all of this, regulators became facilitators. The Food and Drug Administration approved one opioid pill after another.

As late as 2013, by which time the scale of the epidemic was clear, the FDA permitted a powerful opiate, Zohydro, onto the market over the near unanimous objection of its own review committee. It was clear from the hearing that doctors understood the dangers, but the agency appeared to have put commercial considerations first.

US states long ago woke up to the crisis as morgues filled, social services struggled to cope with children orphaned or taken into care, and the epidemic took an economic toll. Police chiefs and local politicians said it was a social crisis not a law and order problem.

Some state legislatures began to curb mass prescribing. All the while they looked to Washington for leadership. They did not get much from Obama or Congress, although legislation approving $1bn on addiction treatment did pass last year. Instead, it was up to pockets of sanity to push back.

Last year, the then director of the Centers for Disease Control, Tom Frieden, made his mark with guidelines urging doctors not to prescribe opioids as a first step for chronic or routine pain, although even that got political pushback in Congress where the power of the pharmaceutical lobby is not greatly diminished.

There are also signs of a shift in the FDA after it pressured a manufacturer into withdrawing an opioid drug, Opanathat should never have been on sale in the first place. It was initially withdrawn in the 1970s, but the FDA permitted it back on to the market in 2006 after the rules for testing drugs were changed. At the time, many accused the pharmaceutical companies of paying to have them rewritten.

Trump’s opioid commission offered hope that the epidemic would finally get the attention it needs. It made a series of sensible if limited recommendations: more mental health treatment people with a substance abuse disorder and more effective forms of rehab.

Trump finally got around to saying that the epidemic is a national emergency on Thursday after he was criticised for ignoring his own commission’s recommendation to do so. But he reinforced the idea that the victims are to blame with an offhand reference to LSD.

Real leadership is still absent – and that won’t displease the pharmaceutical companies at all.

Source: https://www.theguardian.com/commentisfree/2017/aug/13/dont-blame-addicts-for-americas-opioid-crisis-real-culprits August 2017

VIENNA: The United Nations Commission on Narcotic has unanimously adopted Pakistan’s resolution on strengthening efforts to prevent drug abuse in educational settings.

The resolution was adopted during the commission’s sixty first regular session in Vienna. The resolution drew attention of the Commission towards the common challenges of drug abuse among children and youth in schools colleges and universities.

It underscored the need for enhancing efforts including policy interventions and comprehensive drug prevention programmes to protect children and youth from the scourge of illicit drugs and to make educational institutions free from drug abuse.

The resolution emphasized upon the important role of educational institutions in promoting healthy lifestyles among young people and calls for close coordination among law enforcement agencies, educational centres and health authorities at domestic level.

It reflected political commitment of the global community to promote international cooperation through exchange of experiences and good practices and technical assistance to address drug abuse in educational institutions. Pakistan’s initiative to table this resolution was widely appreciated.

Source: https://www.thenews.com.pk/print/294734-un-adopts-pakistan-s-resolution-for-efforts-to-prevent-drug-abuse  March 2018

Marijuana legalization is on the ballot in 2016 in California, Arizona, Nevada, and elsewhere
The marijuana movement received a big jolt last November. No, it wasn’t another celebrity endorsement or cable news special glorifying the drug. Rather, in the midst of what we’ve been told was an inevitable march to victory, marijuana lost. And it lost big.

Many of us interested in this off-year Ohio race were expecting to be up all night. But at 8:32 p.m. Nov. 3, the Associated Press recorded one of the biggest losses ever for pot, as voters rejected legalization there by more than 2-1. (Full disclosure: The organization I head up, SAM, played a role in the campaign and defeat through our affiliate partners.)

Sure, the question was asked in a year no one usually votes, taking place in a sensible Midwestern state not known for its indulgences. Most of us thought it would lose, despite the victory “polls” constantly trumpeted out by the legalizers , but none of us thought it would lose this big.

What does that tell us for the 2016 races, when five states — California, Arizona, Nevada, Massachusetts, and Maine — are likely to have ballot questions on full legalization? A lot. Here’s what we’ve learned:

Big business wants to take over the marijuana movement — and voters don’t like that, even if profiteers do.

The Ohio initiative would have legalized a constitutionally mandated oligopoly for a few dozen investors to make millions on marijuana. The “No” campaign quickly pivoted from “marijuana is bad” to “marijuana monopolies with people making tons of cash are bad” — and it worked. The Ohio election was the first that tested the “Big Marijuana” message out. Groups like SAM have been saying it now for years, and videos showing the parallels are out there on social media, but it had not been tested out in a real campaign.

Money isn’t everything.

The pro side in Ohio spent more than $12 million to convince Buckeye voters that legalizing a pot monopoly was a good thing, and they still lost bad. While it’s true that money is required to get political messages out, especially when spent in a smart(er) way via targeted social media campaigns, Ohio proved that money isn’t everything.

The “no” side, while gathering an impressive group of organizations to oppose the measure, didn’t even pass the $1-million spending mark. But the message of opposing Big Pot stuck, and the amount of free media gained was remarkable. Every article mentioned the investor scheme.

Marijuana legalization isn’t inevitable.
The five states up for grabs in 2016 are critical, and voters will decide pot’s fate in an important presidential election year. But, all five states have different critical issues.

The granddaddy of the 2016 states, California will once again vote on legalized pot. In 2010, despite outspending the opposition by more than 5-1, voters soundly rejected a marijuana measure. This year, some traditional activists (notably the Reform CA folks) were pushed out by the billionaire Napster-founder Sean Parker, who is pouring his fortune into legalized pot via the “Control, Regulate and Tax Adult Use of Marijuana Act.” Parker’s net worth will likely take the effort a long way, but given the importance of the Hispanic voter bloc, a group of people traditionally against legalization, the campaign won’t be a cakewalk.

A state known for sin and vice — Nevada — might seem the perfect one to try legalizing pot. Except for one man: Sheldon Adelson. The billionaire is dead-set against legalization, and he put his money where his mouth is in 2014 when he helped narrowly defeat a pot initiative in Florida. This time around, legalizers are gunning for his home state, but there’s talk of a well-respected state legislator and a handful of other bipartisan officials coming out against Nevada’s initiative. Stay tuned.

In Arizona, a legalization push has barely gotten off the ground, but is already finding opposition. And in Massachusetts, Democrat Attorney General Maura Healey and Republican Gov. Charlie Baker both oppose the initiative. In Maine, legalizers are trying to sanction pot smoking “social clubs,” though a recent conference highlighted dissension among traditional allies.

If we have learned anything from the brief time marijuana has been legal in Colorado, it is this: We have now entered the age of ‘corporate cannabis’ — slick advertising, child-friendly product placement.

In all of these states, laws are being written largely by lobbyists who have one goal — to make money. And one does not get rich in the drug business from casual users. They must rely on heavy users.

If we have learned anything from the brief time marijuana has been legal in Colorado it is this: We have now entered the age of ‘corporate cannabis’ — slick advertising, child-friendly product placement and companies that spend more on PR and lawyers than they do creating safe products.

The sky may not fall if legalization passes in these states, but voters should ask themselves something before getting into the ballot box. Are your relationships enhanced when your friends or family are smoking marijuana? Does marijuana make for safer roads? Better workplaces? Smarter students?

Despite strong evidence to the contrary, we are being told pot will fund our schools, get rid of drug cartels and cure cancer, all at once. And worst of all, we’re being sold this false dichotomy — that our only choices for drug policy are legalize or lock ‘em up. Promote Pot Tarts or fund private prisons. Give a kid a criminal record for holding a joint or allow another addictive industry to take over meetings in state capitals.

But that is false. No one I know wants to see a young kid marred forever because he happened to get caught with a joint in his pocket. But the alternative to that is not simply to ignore an unhealthy, unproductive behavior and promote its use. With the increasing research linking mental illness and marijuana, we at least should press the pause button before going any further.

We can’t build a great, compassionate society by promoting addiction for profit.

BY 

Source: https://www.lifezette.com/2015/12/legalized-pot-no-its-not-inevitable/
December 2015

President Donald Trump took a few minutes in his State of the Union address to acknowledge what he called the “terrible crisis of opioid and drug addiction – never been has it been like it is now”.

The American President told Congress that “we have to do something about it”, stating that 174 drug-addiction caused  deaths a day meant that “we must get much tougher on drug dealers and pushers”.

This should come as no surprise. The crisis, which claimed well over 100,000 lives between 2015 and 2016, is now so widespread and catastrophic it was declared a public health emergency by President Trump in October.

The rate of American deaths caused by overdoses of heroin-like synthetic opioids has doubled since 2015, in a tragic symptom of the opioid epidemic ravaging the United States.

The US’s Centre for Disease Control and Prevention has published figures showing that the rate of deaths due to synthetic opioids excluding methadone, such as fentanyl and tramadol, jumped from 3.1 per 100,000 in 2015 to 6.2 per 100,000 in 2016.

The total number of deaths due to opioid overdoses also climbed from 52,400 to 63,600, a 21 per cent increase – marking a steady rise since 1999.

Synthetic opioids are the biggest killers

The dramatic rise in the use of synthetic opioids owes more to practicality than demand, Dr David Herzberg, a University of Buffalo expert in the history of drug addiction, told The Telegraph.

“Fentanyl [the most widely used synthetic opioid] is much easier to smuggle than heroin because you need less of it,” he said.

Since synthetic opioids are made in labs rather than from plants, like traditional heroin, they can be made anywhere in the world, and vary dramatically in strength.

Fentanyl is around 50 times stronger than heroin – and some new strains are up to 10,000 times stronger.

This huge variation in potency is what makes makes synthetic opioids so deadly, since users are often completely unaware of the strength of the substance they are injecting, said Dr Jon Zibbell, a Senior Public Health Scientist at RTI International, a nonprofit that funds opioid research.

“I know a kid who buys carfentanil [a newer strand of fentanyl] online and that’s all he injects; he argues it’s totally safe but people mixing it with other stuff don’t really know what they’re doing.

“It’s not the drugs themselves that are killing people but the inability of people to adapt to the uneven potency in the illicit market,” he said.

The rise in fentanyl dates back to 2013, when drug traffickers in Mexico started adding it to heroin to stretch their product further to meet growing demand.

Now fentanyl has also grown in popularity with small drug dealers within the US who buy it online from China, which Dr Zibbell said has led to a bloated supply of fentanyl with no standardization of strength.

Rise of drug overdose death most pronounced among men

Fentanyl is not the only heroin-like drug experiencing a boom in users in the US; the country’s mushrooming opioid crisis is well documented, with the overall rate of opioid drug overdoses increasing every year since 1999.

This owes much, Dr Herzberg said, to a history of over-prescription of painkillers dating back more than three decades to the Reagan administration, when tight controls on opioid sales were relaxed: “Opioid markets were opened up to the full range of strategies drug companies use to sell their products. So a large volume of these drugs were pumped into the market without adequate warnings about the risks.”

While data shows a higher rate of overdoses in men, recent research has found the serious health impacts for women are just as severe.

A recent paper by Dr Zibbell published in the American Journal of Public Health demonstrated that those regions of the US particularly ravaged by the opioid epidemic have also seen an outbreak of new cases of the degenerative blood disease hepatitis C.

While the rate of death by opioid overdose is lower for women, the rate of new hepatitis C cases developing is much higher. This is particularly concerning as researchers have also documented a large increase in babies born to infected mothers, along with a rise in neonatal abstinence syndrome (babies born physically dependent on opioids).

The trouble in poor, white states may be spreading

Rust belt states such as Ohio, Pennsylvania and West Virginia – with an astonishing rate of 52 drug overdose deaths per 100,000 – have shouldered the brunt of the opioid crisis.

This is partly due to the poverty of these states, but race is also a huge factor – areas with large white populations are disproportionately impacted since the epidemic is rooted in prescription drug abuse, said Dr Herzberg.

“Studies prove that physicians are less likely to prescribe opioids to African Americans or other racial minorities – even when they need them – because of the stereotypes associating them with drug abuse,” he said.

There are signs, however, that the problem has spread to other communities. The mostly non-white District of Columbia, for example, had a rate of death by drug overdose of 38.8 per 100,000 – almost most twice the national average of 19.8.

Dr Zibbell’s research also found high rates of drug treatment and new hepatitis C cases among hispanics. “That was a big deal because the epidemic has been described as mostly affecting the white population,” he said.

Experts say the spread of the opioid crisis beyond the mostly white rust belt states is particularly worrying as it highlights the nationwide extent of the crisis.

“The Trump administration is not putting action or money behind its pronouncements on the problem. If the present trajectory continues it will claim many more young lives,” he said.

President Trump remained defiant in his speech, however.

“The struggle will be long and it will be difficult,” he acknowledge, before adding “we will succeed”.

Source: https://www.telegraph.co.uk/news/2018/01/31/deadly-fentanyl-behind-dramatic-doubling-synthetic-opioid-death/ January 2018

Smaller cities and towns carry a unique burden when it comes to drug addiction.

I grew up in Mounds, Ill. It’s a small farming community of about 800 people in the southernmost part of the state. It may seem an unlikely place for a drug epidemic, but opioid addiction and substance abuse have plagued families there for decades. Years ago, the first of my close relatives died after a long struggle with prescription opioids.

That’s one reason why, as deputy secretary of the U.S. Department of Health and Human Services, or HHS, I keep the victims of this crisis close to my heart.

Under President Donald Trump, HHS has made the opioid crisis a top priority because it leaves no corner of our country untouched. When the crisis began, we worked mostly in rural areas to address overdoses and opioid-use disorder. The opioid crisis is nationwide and claimed approximately 116 American lives every day in 2016.

The most recent data from the Centers for Disease Control and Prevention provides even more grim details. Nearly 64,000 Americans died of drug overdoses in 2016, a 21 percent increase from the previous year and the largest increase on record. More than 42,000 of those deaths involved opioids, more than the total number of all drug overdose deaths in 2012. Further, provisional data indicate that approximately 72,000 Americans died of drug overdoses in 2017. In 2015, there were more than 1 million opioid-related hospital stays and emergency-room visits in the U.S.

A publication from the University of Minnesota’s College of Pharmacy brings the crisis closer to this region. Titled “Combating the Opioid Crisis in Northern Minnesota,” it found that the Duluth area in particular has been hit hard. St. Louis County has the highest opioid overdose death rate in the state.

As part of the Trump administration’s focused mission to support states and local communities on the front lines of this fight, one of our primary strategies is to learn directly from those on the ground so we may be able to benefit from the experience and understanding of local leaders and communities. Over the last few months I have traveled to Illinois, Ohio, Florida, Texas, California, Kentucky, Minnesota, and Wisconsin to exchange ideas with medical experts, local officials, and, especially, individuals currently receiving treatment for opioid addiction.

My visit to Duluth in July was part of the same journey — and a personal one as well. My mother was born in Esko. I consider your remarkable region a second home.

While I was there, one family told me of tragic loss. Their son was injured on the job, was prescribed opioids for pain, and soon became addicted. After only a few months, he lost his life to opioid overdose.

I also heard inspiring stories of people in recovery and how well they know the severe hurdles to battling addiction. They are now providing crucial help by connecting others to treatment and educating the public about lifesaving overdose-reversing drugs.

I was particularly encouraged visiting Duluth’s Lake Superior Health Clinic and learning how grants from the Health Resources and Services Administration at HHS are aiding in the clinic’s vital mission of care.

My message that day was clear: HHS stands ready to assist local heroes helping to end this epidemic in their communities. We are backing up that commitment in Minnesota by awarding more than $10.7 million in state-targeted opioid-crisis grants, $6 million in medication-assisted treatment, and more than $24 million in substance-abuse prevention and treatment block grants last year. Additional awards will be announced in the coming months.

As an indication of the priority he places on this effort, President Trump donated a quarter of his salary last year to the planning and design of a large-scale public-awareness campaign to enhance understanding of the dangers of opioid misuse and addiction. He hopes his example will spur Congress to take even more action.

We at HHS recognize that the American people, in local communities like Duluth and all across our great country, will be the ones to end this terrible crisis. It will require nothing less than a united effort from not just government but the business community, our churches, our schools, and all of civil society.

We can win this battle in Minnesota and all across the country.

Source: https://www.duluthnewstribune.com/opinion/columns/4481662-deputy-secretarys-view-opioids-battle-can-be-won-beginning-minnesota-and August 2018

University of Pennsylvania researchers performed Internet searches for slightly more than a month in 2016 to identify CBD products that displayed contents on their labels and were for sale online. They bought 84 products from 31 companies, blinded their labels, and had their contents tested.

A full 70 percent of the labels turned out to be incorrect. The products either contained more CBD than their labels specified, or less. Thirty percent of the labels were “accurate” within a range of 10 percent.

Of particular concern was that testing detected THC in 18 of the 84 samples, and the amounts of THC in some products were sufficient to cause intoxication or impairment, especially in children.

The publication of this article in JAMA took place just days after the FDA sent warning letters to four major CBD producers asking them to eliminate all medical claims they make for their products. All have been marketing their products with unproven medical claims. They have 15 business days from last week to remove the claims or FDA can seize their merchandise and put them out of business.

Source: Email from National Families In Action http://www.nationalfamilies.org November 2017

The typical overdose victim is becoming younger and more urban

EVERY 25 minutes an American baby is born addicted to opioids. The scale of both use and abuse of the drugs in the United States is hard to overstate: in 2015, the most recent year for which figures are available, an estimated 38% of adults took prescription opioids. Of those, one in eight (11.5m people in total) misused their prescription. Around 1m Americans overdosed last year, and 64,000 of them died.

The scourge of opioid abuse gained political salience last year, as voters in parts of the country with high levels of drug overdoses swung strongly towards Donald Trump. The president has taken few steps to combat the opioid crisis since taking office, but on October 26th he is expected to direct his secretary of health and human services to declare a public-health emergency. His national drug commission is due to publish a report on November 1st recommending a mix of rehabilitation, awareness-building and policing as the best response the epidemic.

Politically, it stands to reason that Mr Trump would show interest in the opioid crisis, given that press reports paint the typical abuser as an archetypal older, rural Trump voter, perhaps with a prescription to treat back pain. Yet the government runs the risk of fighting the last war in its effort to quell the epidemic, because the causes and victims of drug overdoses in America are changing fast.

The number of deaths from prescription opioids has continued to rise, from around 11,000 in 2013 to 15,000 a year now. But the rate of growth has slowed, and many forecasters predict it may be nearing its peak. By contrast, the toll from fentanyl, a synthetic opioid 50 times stronger than heroin, is soaring. After claiming just 3,000 lives in 2013, it killed 22,000 people in America last year, more than either heroin or prescription opioids. Deaths from heroin have become far more frequent as well: after being roughly a quarter as common as fatal prescription overdoses in the mid-2000s, they overtook deaths from prescription opioids in 2015.

This change in the leading causes of opioid-related deaths has been accompanied by a shift in the profile of the average victim. The highest rates of prescription-opioid abuse can be found among middle-aged rural whites, including women. By contrast, both fentanyl and heroin users tend to be much younger, more likely to live in cities, somewhat more racially diverse and overwhelmingly male (see heat map above). Reaching people at high risk of exposure to these more potent opioids cannot be done by offering services to former Rust Belt factory workers or Appalachian coal miners, but will require a different approach.

Similarly, most media attention has focused on substance abuse in states Mr Trump won, such as West Virginia, Kentucky and Ohio. But blue states like Maryland, Delaware and Massachusetts also figure among the current top ten for deaths from drug overdoses. That means Mr Trump will need to extend the government’s efforts far beyond his electoral base if he hopes to address the opioid epidemic.

Source: https://www.economist.com/graphic-detail/2017/10/26/the-shifting-toll-of-americas-drug-epidemic October 2017

Waiheke Island lawyer and meth researcher Chloe Barker is thrilled to see Jacinda Ardern, who acted on her findings, become Prime Minister.

For her Master’s thesis, Barker carried out heart-breaking research on the impacts on children of growing up in methamphetamine laboratories in New Zealand.

She found that through contact with contaminated environments, children sometimes had levels of meth in their hair, blood and urine that were higher that that of addicts.

Although the impacts on children are devastating, the laws are “toothless” and often fail to protect them, Barker said.

After her research findings were published in a police magazine in 2012, Jacinda Ardern contacted her and suggested meeting over coffee.

“She was amazingly passionate and obviously really cared about the issue,” Barker said.

A Labour list MP at the time, Ardern arranged for broader publication of Barker’s research, helping to raise awareness of the issue.

Ardern cited Barker’s research in parliament to support law changes to make it a crime for people to manufacture meth when a child is present.

However, the Sentencing (Protection of Children from Criminal Offending) Amendment Bill never made it into law.

Police can prosecute meth manufacturers under general child abuse laws, but the rates of conviction are low, because it is hard to prove children have been intentionally harmed by P [methamphetamine] manufacture, Barker said.

Ardern campaigned for a protocol to be introduced assigning responsibilities to the police and Child, Youth and Family (CYF) when children are found in P labs. New protocols have since been developed.

“I was really impressed that she had a million things on her plate, but she cared enough to be proactive and make practical changes that have assisted the police.

“I’m absolutely stoked about Jacinda becoming the Prime Minister.

“I think she’s going to give a voice to a lot of people who don’t have a voice currently,” Barker said.

Examining police files, Barker found that from 2006 to 2010, 191 children were living in the presence of methamphetamine laboratories that were shut down by police.

In 2002, children were living in 34 percent of the houses where laboratories were discovered.

The dangers of growing up in P laboratories include exposure to toxic chemicals, risks of explosions and fires, and a higher likelihood of having weapons in the house.

Children in meth laboratories also face higher risks of physical, sexual and emotional abuse, she said. 

“Given everybody can clearly see the dangers to children, there should be a specific law that says if you cook meth in the presence of a child, you’re committing a crime,” Barker said.

The 39-year-old has returned to her full time job as a commercial lawyer after completing her Master of Forensic Science degree at the University of Auckland.

Barker said Ardern won’t provide a “magic answer” for all life’s ills, but she is hopeful children might yet get the legal protection from meth exposure that they deserve.

“There is obviously a problem with P on Waiheke and I’m sure there are lots of communities around New Zealand that are exactly the same,” she said. 

Source: https://www.stuff.co.nz/national/politics/98147222/meth-researcher-thrilled-with-new-prime-minister October 2017

From afar, America’s opioid epidemic may seem like just another sensationalised scare story in a country constantly at war with drugs. But this is not a fad, nor an overblown segment on morning television. It is real, it is decimating entire counties, and it represents the summation of the country’s failures towards its own citizens over decades.

Twenty million Americans have some form of opioid addiction, and those addictions kill almost 150 people every day.

The CDC estimates that 64,000 Americans died of drug overdoses last year

Twenty million is a shocking number of people for whom the ordinary act of living is crushing. An opioid addiction is fundamentally an instinct to numb, to sleep, to exist unencumbered. It is made possible by over-prescription from doctors and aggressive lobbying from pharmaceutical companies, but it reflects the deeper malaise of places and people whose lives have few prospects for dramatic improvement.

As we saw last November, that malaise has become desperation, and that desperation now covers a vast swathe of the electorate.

America was never a feudal society, and so our national mythology does not include a character who exemplifies the nobility of poverty; in a country of pilgrims and pioneers, driven by Calvinist mores, being poor suggests that you’re just not working hard enough.

Faced with a society where poverty is considered a deficiency of both morals and material wealth, and where it has become more difficult to outdo your parents, it is easy to see how