Social Affairs

Ernesto CabralUpdated 
At least 1,089 people died from fentanyl poisoning in 2023, up 18.4% from the year before, preliminary data shows
As many as 7 in 10 counterfeit pills tested in 2023 contained a potentially lethal dose of fentanyl, or roughly the amount that fits on the tips of a pencil, national DEA laboratory testing showed. (Photo courtesy of Rocky Mountain Field Division of the Drug Enforcement Administration)

Fentanyl-related overdose deaths hit a new high in 2023 as law enforcement seized record amounts of the synthetic opioid, official data shows.

At least 1,089 people died from fentanyl poisoning last year, up 18.4% from 920 the year before, according to preliminary data released by the Colorado Department of Public Health and Environment.

A surge that started five years ago has continued, with the number of fentanyl-related deaths increasing more than 900% from the 102 recorded in 2018, data from the health department’s Center for Health and Environmental Data shows.

Denver recorded more deaths in 2023 than any other county with 321, compared with Adams (136), Arapahoe (133), Jefferson (124) and El Paso (116).

The health department anticipates releasing final data in June.

So far this year, 141 fatalities have been reported to the CDPHE, however the data is typically lagging by at least three months. Denver again leads with 37 deaths from fentanyl.

The Centers for Disease Control and Prevention’s records tell a similar story about Colorado. In 2023, 1,187 fatalities were registered provisionally in the “other synthetic narcotics” category, which mainly comprises fentanyl. Unlike the state agency, the CDC said it does not have an exact number of fentanyl deaths.

The numbers for 2023 mark a 22.2% rise from the previous year and a 785% surge since 2018, according to the CDC database.

“We are facing more than just an opioid crisis in the U.S”, said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health. “Stimulants like methamphetamine, which is more prevalent in use in the Western U.S., are now increasingly being contaminated or used together with fentanyl.”

News of the rising death toll comes days after the DEA announced a new strategy to combat fentanyl in the Rocky Mountain region. Earlier this month around 200 money service businesses and financial institutions that aid in sending money to people in other countries were asked to cooperate in an investigation into the cash flowing to support the illicit opioid market.

The probe, called Operation “Cash Out,” was launched in Colorado, Utah, Wyoming and Montana by the DEA, IRS and the Rocky Mountain High Intensity Drug Trafficking Area, the DEA said in a news release.

U.S. authorities say fentanyl constitutes a multi-billion-dollar enterprise for Mexican cartels such as Sinaloa and Jalisco, which operate near the U.S. border.

“The only thing they care about is their money. This interagency operation intends to target the networks and seize their assets through building stronger relationships with the private sector financial community,” said David Olesky, acting special agent in charge for DEA’s Rocky Mountain Field Division, in the release.

In recent years, new legislationofficial investigations and initiatives from families and schools have emerged to prevent and combat the rising number of fentanyl-related deaths in Colorado, a bill signed into law on April 22 making it legal for students and staff at public and charter schools to carry and administer opioid overdose reversal drugs such as naloxone.

“The Colorado Department of Public Health and Environment is committed to doing all we can to prevent drug overdoses, and one of our current strategies is to increase access to naloxone,” said the state agency in a statement.

Research published earlier this week in the monthly peer-reviewed scientific journal “Addiction,” showed that more than 17.7 million Americans used marijuana daily or near-daily in 2022 as compared to 14.7 million who reported drinking alcohol at the same rate.

Far more people consume alcohol than cannabis, research showed, but “high-frequency” drinking is less common. In 2022, the “median drinker” reported drinking on 4 to 5 days in the past month, compared to 15 to 16 days in the past month for the median cannabis user.

Regular cannabis use still pales in comparison to daily use of cigarettes, researchers noted. More than 24.1 million people smoked cigarettes daily or near-daily compared to the 17.7 million Americans who used cannabis regularly.

The research also showed that older Americans are using more regularly than younger.

“In 2022, people 35 and older accounted for (slightly) more days of use than did those under the age of 35,” the study notes.

Researchers used data compiled over more than 40 years from the National Household Survey on Drug Abuse, which showed cannabis use began to rise at a corresponding rate to changes in cannabis policies.

As of 2024, 24 states and the District of Columbia have legalized recreational marijuana use, according to the Pew Research Center. Another 14 states allow for medical use only.

Last week, the U.S. Department of Justice proposed new regulations that would designate cannabis a Schedule III drug, rather than its current designation of a Schedule I drug. Cocaine, methamphetamine and fentanyl are among the drugs that have received the Schedule II designation.

Schedule I drugs are those with the highest potential to create dependency issues and are considered to have “no currently accepted medical use.” The DOJ decision cites the use of marijuana in the medical field as one of the reasons it warrants reclassification.

The recently published research concluded that long-term trends in cannabis use have paralleled cannabis policy changes, with declines during periods of “greater restriction and growth during periods of policy liberalization.”

But researchers stressed that changes in laws regarding cannabis can’t be definitely attributed to the rise in use.

“Both could have been manifestations of changes in underlying culture and attitudes. However, whichever way causal arrows point, cannabis use now appears to be on a fundamentally different scale than it was before legalization,” researchers wrote.

To read the full study and read more about the findings and methodology used, click here.

Copyright 2024 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Source:https://www.yahoo.com/news/daily-cannabis-surpasses-daily-alcohol-211954850.html?

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

Australia won’t see any cannabis cafes selling brownies anytime soon, despite agreement that the use of marijuana should be prioritised as a health issue.

Eleanor Campbell  

https://www.dailytelegraph.com.au

 

A push to legalise the recreational use of cannabis on a national scale has been knocked back after experts expressed concerns it would lead to more use of the drug among young people.

A Senate committee rejected a bill introduced by Greens senator David Shoebridge on Friday, which calls to allow for cannabis possession for personal use in Australia, as well as the establishment of a national agency to regulate the growing of plants.

After receiving over 200 submissions the committee noted evidence from peak medical bodies including the Australian Medical Association (AMA) that warned wider access could exacerbate health risks, particularly for adolescents.

“Ultimately, the committee is concerned that the legalisation of cannabis for adult recreational use would create as many, if not more, problems than the bill is attempting to resolve,” the report said.

“While endeavouring to do so, the bill does not address several significant concerns, for example, ensuring that children and young people cannot access cannabis (particularly home-grow), managing risky cannabis use, and effective oversight of THC content.”

Multiple countries, including half of all US states have legalised recreational marijuana use. Picture: Ethan Miller/Getty Images/AFP

The committee report noted that the majority of submissions agreed that cannabis use “should be treated first and foremost as a health issue instead of a criminal issue.”

Cannabis remains the most commonly used illicit drug in Australia, according to the latest National Drug Strategy Household Survey, with more than 2.5 million people having used it recently.

In 2019, about 11.7 per cent of people aged 14 years reported having had used the drug at least once it in the past 12 months. The figure was higher for Aboriginal and Torres Strait Islander young people, at 16 per cent.

Under the Greens model, adults in Australia could legally grow six cannabis plants but it would remain a crime to sell the drug to anyone under the age of 18.

The bill also proposes the creation of licensed Amsterdam-style ‘cannabis cafes’ that sell marijuana products, such as edibles.

In his dissenting report, Senator Shoebridge argued the creation of a national cannabis market would generate thousands of jobs and remove “billions” from the black market.

“This inquiry shows clearly how evidence-based and human-centred reforms like this, we will need to break the stranglehold of politics as usual,” he said.

He said despite the committee’s findings the Greens plan to introduce the bill into parliament this year.

Senator Shoebridge claims up to 80,000 Australians could be flushed out of the criminal justice system if his Bill passed. Picture: NewsWire / Martin Ollman.

“The majority report in this inquiry reasonably fairly covers the evidence we had in the inquiry, although it does not detail the hundreds of individual submissions to the inquiry that, almost unanimously, asked us to vote this into law and to finally legalise cannabis,” he added.

Medical cannabis was legalised in Australia in 2016 and last year around 700,000 people reported having used cannabis for medical purposes.

Penalties for illicit use of marijuana, which remains illegal in all states and territories, vary based on jurisdiction.

In NSW, a first-time offender caught with a small amount of cannabis could be issued with a formal caution.

Offenders caught with up to 50 grams of cannabis in Queensland must be first offered a drug diversion program as an alternative to criminal prosecution.

In Western Australia, maximum fines can range from $2,000 to $20,000 and up to two years in prison.

 

Source: NCA NewsWire  June 3, 2024 – 5:10PM

 

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.

May 17, 2024
Rumpel Senior Legal Research Fellow
Paul is a Senior Legal Research Fellow in the Meese Center for Legal and Judicial Studies at The Heritage Foundation.

 SUMMARY

Novel Psychoactive Substances multiply the difficulties involved in protecting ourselves and our families, friends, and neighbors from falling victim to illicit drug use. Ingenious chemists have used the Internet to research the chemical structure of existing psychoactive substances and use their skills to escape a strict reading of the controlled substances schedules. The result is to make extraordinarily difficult our long-standing strategy of relying primarily on an aggressive, supply-side, law enforcement–focused approach to reducing the availability of dangerous drugs. We can—and should—pursue each worthwhile option to combat this even though we know that we cannot immunize society against the pernicious effects of all NPSs, change hearts bent on evil, or save everyone who succumbs to drug abuse.

KEY TAKEAWAYS

Novel Psychoactive Substances (NPSs) multiply the difficulties involved in protecting our-selves and our families, friends, and neighbors from illicit drug use.

NPSs like fentanyl and their illegitimate offspring like the nitazenes have brought an end to the era of drug experimentation.

We can—and should—pursue every worthwhile option to combat this scourge even though we know that we cannot save everyone who succumbs to drug abuse.

 

Source: https://www.heritage.org/crime-and-justice/report/twenty-first-century-illicit-drugs-and-their-discontents-the-challenges

 

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

The lowered rates of substance use that youth reported after the start of the COVID-19 pandemic remained steady into 2023. However, the rate of fatal drug overdoses among youth, which rose in 2020, remained increased well into 2022.

After the COVID-19 pandemic and its associated school closures began in 2020, youth reported that they were using illicit substances significantly less, according to the 2023 Monitoring the Future survey. Among 12th graders, use of any illicit substances in the previous year fell from 36.8% in 2020 to 32% in 2021. Among 10th graders, the rate fell from 30.4% to 18.7%, while it fell from 15.6% to 10.2% among 8th graders.


Rate of Reported Past-Year Illicit Substance Use Among 8th, 10th, and 12th Graders.

Many schools have returned to in-person learning since the fall of 2021, and yet the percentage of students reporting any illicit substance use in 2023 has held steady at the lowered levels reported during the pandemic, according to the most recent Monitoring the Future survey. In 2023, 31.2% of 12th graders, 19.8% of 10th graders, and 10.9% of 8th graders reported any illicit substance use in the past year.

Monitoring the Future has tracked national substance use among 8th, 10th, and 12th graders at hundreds of schools across the country annually since 1975. It is conducted by the University of Michigan and funded by the National Institute on Drug Abuse (NIDA).

Addressing substance use among youth, especially with regard to prevention, should involve not only reaching out to institutions like schools, but also connecting with families to engage them, said Anish Dube, M.D., M.P.H.

“This is encouraging news,” said Anish Dube, M.D., M.P.H., chair of APA’s Council on Children, Adolescents, and Their Families. “Peers have a huge influence on young people and the types of decisions they make. For better or worse, the pandemic limited the amount of time young people physically spent with their peers, and this may be at least one reason why we saw less risk-taking behavior among youth.”

Youth who responded to the survey most commonly reported drinking alcohol, vaping nicotine, and using cannabis in the past year. Compared with 2022 levels, past-year use of alcohol fell among 12th graders and remained stable for 10th and 8th graders. Nicotine vaping declined among 12th and 10th graders and remained stable among 8th graders. Finally, cannabis use remained stable among students in all three grades.

Unintentional Drug Overdose Death Rates Among U.S. Youth Aged 15-19.

Simultaneously, however, in recent years the rate of fatal overdoses among youth has increased. A 2022 study published in JAMA found that, beginning in 2020 until June 2021, adolescents experienced a greater relative increase in overdose mortality compared with the overall population. An analysis by NIDA published last December found that the upward trends previously reported continued into the summer of 2022. Between the end of 2019 and the beginning of 2020, the rate of unintentional overdose deaths per 100,000 population among youth aged 15 to 19 rose from 0.89 to 1.32. The rate has not declined since that increase. In the summer of 2022, the rate was 1.63.

“In my own clinical experience, one of the biggest challenges has been the widespread availability of fentanyl and its derivatives, their lethality, and the ease with which they can be laced into other substances that young people are trying,” Dube said.

When youth weren’t seeing their friends during the COVID-19 pandemic shutdowns, they did not have the peer interactions that may lead to substance use, said Oscar Bukstein, M.D., M.P.H.

The illicit substances available now are highly addictive and can provide a quick and intense high, said Oscar Bukstein, M.D., M.P.H. That is part of the reason the rate of overdose deaths among adults is so high, and the same is likely true for youth.

“Young people in particular are usually novice drug users,” Bukstein pointed out. Just like younger adolescents are more likely to experience alcohol poisoning, youth who are using other illicit substances may similarly be unaware of the true danger of what they are using, he explained. Bukstein is a member of APA’s Council on Children, Adolescents, and Their Families and a professor of psychiatry at Harvard Medical School.

Bukstein also noted that, because Monitoring the Future surveys youth in schools, those who are not in school due to high-risk behaviors such as truancy or dropping out are less likely to be included. That means the survey may not capture youth who are at the highest risk for substance use. These youth need far more resources than are available to them, such as residential treatment for those who need more than intensive outpatient care, Bukstein said.

Overall, Bukstein is optimistic about Generation Z, he added. “I’ve noticed that there’s a greater sense among the general adolescent population that they want something out of life,” he said. “They know these substances are dangerous, that they are not going to get them where they want to go, and they don’t need them.”

Source: https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2024.03.3.10

The United States is knee-deep in what some experts call the opioid epidemic’s “fourth wave,” which is not only placing drug users at greater risk but is also complicating efforts to address the nation’s drug problem.

These waves, according to a report from Millennium Health, were the crisis in prescription opioid use, followed by a significant jump in heroin use, then an increase in the use of synthetic opioids like fentanyl.
The latest wave involves using multiple substances at the same time, combining fentanyl mainly with either methamphetamine or cocaine, the report found. “And I’ve yet to see a peak,” said one of the co-authors, Eric Dawson, vice president of clinical affairs at Millennium, a specialty laboratory that provides drug-testing services to monitor use of prescription medications and illicit drugs.
The report, which takes a deep dive into the nation’s drug trends and breaks usage patterns down by region, is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug-addiction care.
Its findings offer staggering statistics and insights. Its major finding is how common polysubstance use has become. According to the report, an overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances. “That is huge,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.
The most concerning, Volkow and other addiction experts said, is the dramatic increase in the combination of methamphetamine and fentanyl use. Meth, a highly addictive drug often in powder form that poses several serious cardiovascular and psychiatric risks, was found in 60% of fentanyl-positive tests last year. That is an 875% increase since 2015.
“I never, ever would have thought this,” Volkow said.
Among the report’s other key findings:

  • The nationwide spike in methse alongside fentanyl marks a change in drug use patterns.
  • Polydrug use trends complicate overdose treatments. For instance, naloxone, an opioid-overdose reversal medication, is widely available, but there isn’t an FDA-approved medication for stimulant overdose.
  • Both heroin and prescribed-opioid use alongside fentanyl have dipped. Heroin detected in fentanyl-positive tests dropped by 75% since peaking in 2016. Prescription opioids were found at historic low rates in fentanyl-positive tests in 2023, down 89% since 2013.

But Jarratt Pytell, an addiction medicine specialist and assistant professor at the University of Colorado’s School of Medicine, warned these declines shouldn’t be interpreted as a silver lining.
A lower level of heroin use “just says that fentanyl is everywhere,” Pytell said, “and that we have officially been pushed by our drug supply to the most dangerous opioids that we have available right now.”
“Whenever a drug network is destabilizing and the product changes, it puts the people who use the drugs at the greatest risk,” he said. “That same bag or pill that they have been buying for the last several months now is coming from a different place, a different supplier, and is possibly a different potency.”
In the illicit drug industry, suppliers are the controllers. It may not be that people are seeking out methamphetamine and fentanyl but rather that they’re what drug suppliers have found to be the easiest and most lucrative product to sell.
“I think drug cartels are kind of realizing that it’s a lot easier to have a 500-square-foot lab than it is to have 500 acres of whatever it takes to grow cocaine,” Pytell said.
Dawson said the report’s drug use data, unlike that of some other studies, is based on sample analysis with a quick turnaround — a day or two.
Sometimes researchers face a months-long wait to receive death reports from coroners. Under those circumstances, you are often “staring at today but relying on data sources that are a year or more in the past,” said Dawson.
Self-reported surveys of drug users, another method often used to track drug use, also have long lag times and “often miss people who are active for substance use disorders,” said Jonathan Caulkins, a professor at Carnegie Mellon University. Urine tests “are based on a biology standard” and are good at detecting when someone has been using two or more drugs, he said.
But using data from urine samples also comes with limitations. For starters, the tests don’t reveal users’ intent.
“You don’t know whether or not there was one bag of powder that had both fentanyl and meth in it, or whether there were two bags of powder, one with fentanyl in it and one with meth and they took both,” Caulkins said. It can also be unclear, he said, if people intentionally combined the two drugs for an extra high or if they thought they were using only one, not knowing it contained the other.
Volkow said she is interested in learning more about the demographics of polysubstance drug users. “Is this pattern the same for men and women, and is this pattern the same for middle-age or younger people? Because again, having a better understanding of the characteristics allows you to tailor and personalize interventions.”
All the while, the nation’s crisis continues. According to the Centers for Disease Control and Prevention, more than 107,000 people died in the U.S. in 2021 from drug overdoses, most because of fentanyl.
Caulkins said he’s hesitant to view drug use patterns as waves because that would imply people are transitioning from one to the next.
“Are we looking at people whose first substance use disorder was an opioid use disorder, who have now gotten to the point where they’re polydrug users?” he said. Or, are people now starting substance use disorders with methamphetamine and fentanyl, he asked.
One point was clear, Dawson said: “We’re just losing too many lives.”

 

Source: https://lexingtonky.news/2024/02/24/opioid-epidemic-is-in-a-fourth-wave-with-multiple-substances-being-used-at-the-same-time-and-fentanyl-is-the-most-common/

Illicit fentanyl, the driving force behind the U.S. overdose epidemic, is increasingly being used in conjunction with methamphetamine, a new report shows.

The laboratory Millennium Health said 60% of patients whose urine samples contained fentanyl last year also tested positive for methamphetamine. Cocaine was detected in 22% of the fentanyl-positive samples.

Millennium officials said the report represents the impact of the “fourth wave” of the nation’s overdose epidemic, which began over a decade ago with the misuse of prescription opioids, then came a heroin crisis and more recently an increase in the use of illicit fentanyl. The study found that people battling addiction are increasingly using illicit fentanyl along with other substances, including stimulants such as methamphetamine and cocaine.

The report suggests heroin and prescription opioids are being abused less often than they were a decade ago. Of the urine samples containing fentanyl analyzed in the report, 17% also contained heroin and 7% showed the presence of prescription opioids.

The Millennium report is based on analyses of urine samples collected from more than 4.1 million patients in 50 states from Jan. 1, 2013, to Dec. 15, 2023. The samples were collected in doctors’ offices and clinics that see patients for pain, addiction and behavioral health treatment.

Overall, 93% of fentanyl samples tested positive for at least one other substance, a concerning finding, said Dr. Nora Volkow, director of the National Institute on Drug Abuse.

“I did not expect that number to be so high,” she said.

Overdose deaths climb

Drug overdose deaths in the United States surged past 100,000 in 2021 and increased again in 2022. Provisional data from the Centers for Disease Control and Prevention showed overdose deaths through September 2023 increased about 2% compared with the year before.

Other reports show that stimulants, mostly methamphetamine, are increasingly involved in fentanyl overdoses. In 2021, stimulants were detected in about 1 in 3 fentanyl overdose deaths, compared with just 1 in 100 in 2010.

The finding of methamphetamine in so many samples is especially concerning, said Eric Dawson, vice president of clinical affairs Millennium Health.

“Methamphetamine is more potent, more pure and probably cheaper than it’s ever been at any time in this country,” Dawson said. “The methamphetamine product that is flooding all of our communities is as dangerous as it’s ever been.”

Methamphetamine has no rescue drugs, treatments

As methamphetamine use appears to play a larger role in the addiction crisis, the medical community does not have the same tools to counter its misuse.

Naloxone and similar overdose reversal medications counteract opioid overdoses by blocking opioid receptors in the brain to quickly reverse the effects of an overdose. Narcan, a nasal spray version of naloxone, can be purchased and is kept in stock by public health departments, schools, police and fire departments and federal agencies nationwide. Chain retailers such as CVS, Walgreens, Rite Aid and Walmart began selling Narcan over the counter without a prescription.

But there is no medication approved by the Food and Drug Administration for overdoses involving stimulants such as methamphetamine.

Opioid substitute medications such as methadone and buprenorphine are used to reduce cravings and ease withdrawal symptoms from opioids. There are no equivalent medications, however, for people who are dependent on methamphetamine or other stimulants, Dawson said.

That deficit is glaring, Dawson said: “We need effective treatments for stimulant-use disorder.”

Meth samples more common in the West

The Millennium report also found that drug use differed by region, and methamphetamine samples were detected more frequently in the western U.S.

Methamphetamine was detected in more than 70% of fentanyl-positive urine samples in the Pacific and Mountain West states. Meth showed up least often in fentanyl-positive samples in the mid- and south-Atlantic states, the report said.

Cocaine appeared to be more prevalent in the eastern U.S. More than 54% of fentanyl-positive samples in New England also had cocaine. By comparison, fewer than 1 in 10 of the samples showed cocaine in the mountain region of the West, the report said.

Other findings from the report:

∎ The presence of cocaine samples in fentanyl-positive specimens surged 318% from 2013 to 2023.

∎ The presence of heroin in fentanyl-positive specimens dropped by 75% after a peak in 2016.

∎ The presence of prescription opioids in fentanyl-positive specimens dropped to an all-time low in 2023, which researchers cite as evidence that the U.S. addiction crisis has shifted from pain medications.

Nationwide, the addiction epidemic has evolved to a phase in which people are often using multiple substances, not just fentanyl, Volkow said. This polysubstance abuse complicates matters for public health authorities seeking to slow the nation’s overdose deaths.

Volkow said reports such as Millennium Health’s are important because they give researchers a snapshot of the nation’s evolving drug use and provide more timely data than death investigations from overdoses can offer.

 

Source: https://eu.usatoday.com/story/news/health/2024/02/21/methamphetamine-plays-increasing-role-in-addiction-crisis/72661430007/

“I never imagined that sports could do this”: UNODC celebrates the power of sports in preventing violence, crime, and drug use among youth on the International Day of Sports

 

Alice*, a 15-year-old living in a rural area in Nigeria, was struggling. Feeling lonely at home, subjected to punishment for the smallest of reasons, she had tried everything in an effort to cope. Running away from home. Cutting her wrists with a razor in a failed suicide attempt. Drinking alcohol. Taking too many sleeping pills.

Her drug use, once discovered by her father, threatened to further derail her young life, for he would delay paying her school fees, claiming her education had been a wasted investment. Cut off from her friends, Alice’s isolation deepened.

Eventually, Alice returned to school, where she was enrolled in the United Nations Office on Drugs and Crime (UNODC)’s “Line Up Live Up” (LULU) programme. LULU uses sports-based life skills training to empower youth and enhance their resilience to violence, crime, and drug use.

The programme struck a chord with Alice, who reported that the “LULU programme gave me a whole new meaning and understanding of life.” Alice recalled several lessons that stuck out for her during LULU, including one which required the students to run to the opposite side of the hall without being hit by balls flying from all directions. Each time the students were struck, they would have to start all over again.

Alice noted that at first, she was embarrassed each time a ball would hit her. It reminded her of the shame she had felt facing her friends after her father reported her drug use to the school. “I kept having to start all over again,” she said, but “I succeeded at the tail end and it taught me to never give up.”

Youth face many challenges that make them vulnerable to crime, violence, and victimization. Sports can offer vulnerable youth a sense of identity and belonging while also enhancing their physical and mental health and wellbeing. When used in an intentional, well-designed manner, sports can serve as a useful vehicle for cognitive, social, and emotional learning and key life skills. They can challenge harmful stereotypes and normative beliefs linked to violence and crime, including gender-based violence. Finally, sports can create safe spaces for young people and local communities to positively interact, promote tolerance, and contribute to building safe, just, and fair societies.

The UNODC Global Initiative on Youth Crime Prevention through Sport promotes the effective use of sport as a tool for addressing known risk and protective factors to youth violence and crime in order to reduce juvenile delinquency and offending and prevent drug use. It also supports the design and delivery of tailored sport-based interventions to prevent youth victimization and recruitment by organized criminal groups, including from gangs and violent extremist groups.

Alice’s principal attested to the transformation she witnessed among her students. “I thought that the LULU programme would be targeting drugs and academics,” she said. “Little did I know that this knowledge could be transferred to other, deeper personal and social life situations. The program digs for the biggest problems in the student’s lives and helps them solve them in their own ways.

Truly, I never imagined that sports could do this.”

 

Source: https://www.unodc.org/conig/en/stories/i-never-imagined-that-sports-could-do-this_-unodc-celebrates-the-power-of-sports-in-preventing-violence–crime–and-drug-use-among-youth-on-the-international-day-of-sports.html

The majority of adults with substance use disorders start during their adolescent years. That’s why experts say prevention efforts in schools are paramount, but many schools struggle with implementation.

According to a survey by the Education Week Research Center in 2022, 67% of school health workers say that dealing with students who are vaping and using alcohol, marijuana, or opioids is “a challenge” or “a major challenge.”

The moment to address a gap in school prevention could not be more prime for action, experts say, as more young people between the ages of 10 and 19 have died of overdoses across the U.S. The driving factor behind those deaths is fentanyl, a potent synthetic opioid.

“In the era of fentanyl, with experimentation, plenty of kids die because they just don’t know that that’s a risk,” said Chelsea Shover, an epidemiologist who studies substance use at the University of California, Los Angeles.

Even a tiny amount of fentanyl can kill. In 2021, the synthetic opioid was identified in more than three-quarters of adolescent overdose deaths.

Some experts pointed out that children may purchase pain medication or prescription stimulant pills on social media, which –– unbeknown to them –– can be counterfeit and laced with fentanyl.

The U.S. Drug Enforcement Administration has seized a record 86 million fentanyl pills in 2023, which already exceeds last year’s total of 58 million pills.

Shover said, with this rapidly changing landscape, schools are slow to adapt.

“Your [school’s] alcohol and tobacco curriculum can probably stay pretty much the same. But your curriculum around opioids and overdose and street drugs needs to be updated to what’s actually happening,” she said.

Prevention sometimes takes a backseat

Schools often have more robust processes in place to react when a student is known to use substances – prevention often takes a back seat.

The goal of these prevention efforts, experts say, should not be to tell kids to say no to drugs. Ideally, they would provide young people with facts about the health, social, and legal concerns that come with substance use and hone social skills and competencies that help kids cope with stressors.

Research suggests that social influences are central and powerful factors in both promoting and discouraging substance use among adolescents, and that many of them turn to substances to cope with anxiety or stress and some do it when they’re bored.

“When you’re talking about substance use prevention, what you’re really talking about is helping children develop the skills and competencies to withstand the pressures and to be able to prevent them from starting to use substances in the first place, or at least, knowing where to turn and those kinds of skills get built up very early,” said Ellen Quigley, vice president at the Richard M. Fairbanks Foundation. The foundation provides funding to 159 Indianapolis Schools through its Prevention Matters initiative.

Students who are not engaged in school or fail to develop or maintain relationships and those who fail academically are more likely to engage in substance use, one study found. Some of the crucial skills to teach as part of prevention efforts include conflict resolution, how to make friends, and how to deal with bullying, Quigley said.

Then, comes the messenger.

Experts say kids may be reluctant to ask for help from people who can get them in trouble like teachers and police officers. A report from the National Council for Mental Wellbeing found that only 17% of teenagers said they trust teachers or other educators. The report suggests that students have more trust in doctors, nurses and nonprofit workers.

“Drug education, it’s partly to tell students about what’s going on, and what tools are there, what risks there are, but it’s also to open a conversation for students who are struggling either themselves with substance use, or their friends are,” Shover at UCLA said.

Limited resources stand in the way

There has been substantial progress in developing and studying prevention programs for adolescent drug use, but challenges to effective implementation persist.

“While there was a lot of attention to treatment, which makes a lot of sense, there weren’t a lot of resources available for prevention,” said Quigley

Integrating prevention programs requires time and money, which some schools say they don’t usually have –– especially in lower-income communities where resources overall are limited.

One place where this is evident is Logansport School Corporation, the largest school district in Cass County, Ind. It’s a rural part of the state that is around an hour and a half north of Indianapolis, with a below-average income level. Major employers in the county are mostly manufacturing plants and meat processing facilities. Compared to most other rural communities in Indiana, the county has a large immigrant population.

Over the past few years, it has seen a steady increase in opioid use.

The school district has leaned in on peer mentorship as an approach for prevention and support to those who use substances, said Logansport School District Superintendent Michele Starkey.

“We know that those positive relationships are key to the success of students. And so that’s something that we have identified as being a huge need,” she added.

Experts say peer mentorship is a promising approach.

But the school district has had to halt other programs due to lack of funding, said Jennifer Miller, the principal of the Junior High.

“There used to be a program throughout the county that would specifically address substance abuse, vaping with the junior high level kids. And so, that doesn’t exist anymore. But there is such a need for it,” Miller said.

Tens of millions of dollars are coming to states across the country. It’s part of a major settlement with opioid manufacturers and distributors for their role in the opioid epidemic. There’s also federal and state funding available.

Logansport school district and 4C Health, a federally qualified healthcare center, got a million dollars in federal funding a few months ago.

Lisa Willis-Gidley, the Chief Revenue Officer at 4C Health, said they depend on such grants because prevention programs are not covered by insurance. Still, she says implementing effective programs can be a challenge.

“Schools don’t have a ton of time,” she said. “They’ve got to focus on their goals and their academics. And so, you have to look at can we give them these pieces of valuable material in a manner that’s not going to be totally disruptive to their academic goals and performance?”

Experts say federal and state legislation can help set standards for substance use education and ensure enough funding for schools that need it.

Source:  https://www.wbaa.org/health-and-science/2024-03-13/school-substance-use-prevention-efforts-are-crucial-the-question-is-how-to-do-it

 

Foreword
The National Institute on Drug Abuse (NIDA) is pleased to publish in its Research Monograph series the proceedings of the 48th Annual Scientific Meeting of the Committee on Problems of Drug Dependence, Inc. (CPDD). This meeting was held at Tahoe City, Nevada, in June 1986.

The scientific community working in the drug abuse area was saddened by the untimely death of one of its very productive and active leaders: Joseph Cochin, M.D., Ph.D. Joe was a talented scientist who was greatly admired by his students and colleagues. For the past five years, Joe had served as the Executive Secretary of the CPDD. This monograph includes papers from a symposium on “Mechanisms of Opioid Tolerance and Dependence,” dedicated to his memory. These papers were presented by many of his friends and colleagues, who took the opportunity to express their high esteem for Joe.
The CPDD is an independent organization of internationally recognized experts in a variety of disciplines related to drug addiction. NIDA and the CPDD share many interests and concerns in developing knowledge that will reduce the destructive effects of abused drugs on the individual and society. The CPDD is unique in bringing together annually at a single scientific meeting an outstanding group of basic and clinical investigators working in the field of drug dependence. This year, as usual, the monograph presents an excellent collection of papers. It also contains progress reports of the abuse liability testing program funded by NIDA and carried out in conjunction with the CPDD. 

This program continues to represent an example of a highly successful government/private sector cooperative effort. I am sure that members of the scientific community and other interested readers will find this volume to be a valuable “state-of-the art” summary of the latest research into the biological, behavioral, and chemical bases of drug abuse.

Charles R. Schuster, Ph.D.
Director
National Institute on Drug Abuse

For the full contents, please go to: 

Source: https://babel.hathitrust.org/cgi/pt?id=ien.35557000188076&seq=11 This version September 2023

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

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)

A CONVERSATION WITH … Dr. Nora Volkow, who leads the National Institutes of Drug Abuse, would like the public to know things are getting better. Mostly. Volkov says:  “People don’t really realize that among young people, particularly teenagers, the rate of drug use is at the lowest risk that we have seen in decades,” 

NYTimes    April 6, 2024

Historically speaking, it’s not a bad time to be the liver of a teenager. Or the lungs.

Regular use of alcohol, tobacco and drugs among high school students has been on a long downward trend.

In 2023, 46 percent of seniors said that they’d had a drink in the year before being interviewed; that is a precipitous drop from 88 percent in 1979, when the behavior peaked, according to the annual Monitoring the Future survey, a closely watched national poll of youth substance use. A similar downward trend was observed among eighth and 10th graders, and for those three age groups when it came to cigarette smoking. In 2023, just 15 percent of seniors said that they had smoked a cigarette in their life, down from a peak of 76 percent in 1977.

Illicit drug use among teens has remained low and fairly steady for the past three decades, with some notable declines during the Covid-19 pandemic.

In 2023, 29 percent of high school seniors reported using marijuana in the previous year — down from 37 percent in 2017, and from a peak of 51 percent in 1979.

Dr. Nora Volkow has devoted her career to studying use of drugs and alcohol. She has been the director of the National Institute on Drug Abuse since 2003. She sat down with The New York Times to discuss changing patterns and the reasons behind shifting drug-use trends.

What’s the big picture on teens and drug use?

People don’t really realize that among young people, particularly teenagers, the rate of drug use is at the lowest risk that we have seen in decades. And that’s worth saying, too, for legal alcohol and tobacco.

What do you credit for the change?

One major factor is education and prevention campaigns. Certainly, the prevention campaign for cigarette smoking has been one of the most effective we’ve ever seen.

Some of the policies that were implemented also significantly helped, not just making the legal age for alcohol and tobacco 21 years, but enforcing those laws. Then you stop the progression from drugs that are more accessible, like tobacco and alcohol, to the illicit ones. And teenagers don’t get exposed to advertisements of legal drugs like they did in the past. All of these policies and interventions have had a downstream impact on the use of illicit drugs.

Does social media use among teens play a role?

Absolutely. Social media has shifted the opportunity of being in the physical space with other teenagers. That reduces the likelihood that they will take drugs. And this became dramatically evident when they closed schools because of Covid-19. You saw a big jump downward in the prevalence of use of many substances during the pandemic. That might be because teenagers could not be with one another.

The issue that’s interesting is that despite the fact schools are back, the prevalence of substance use has not gone up to the prepandemic period. It has remained stable or continued to go down. It was a big jump downward, a shift, and some drug use trends continue to slowly go down.

Is there any thought that the stimulation that comes from using a digital device may satisfy some of the same neurochemical experiences of drugs, or provide some of the escapism?

Yes, that’s possible. There has been a shift in the types of reinforcers available to teenagers. It’s not just social media, it’s video gaming, for example. Video gaming can be very reinforcing, and you can produce patterns of compulsive use. So, you are shifting one reinforcer, one way of escaping, with another one. That may be another factor.

Is it too simplistic to see the decline in drug use as a good news story?

If you look at it in an objective way, yes, it’s very good news. Why? Because we know that the earlier you are using these drugs, the greater the risk of becoming addicted to them. It lowers the risk these drugs will interfere with your mental health, your general health, your ability to complete an education and your future job opportunities. That is absolutely good news.

But we don’t want to become complacent.

The supply of drugs is more dangerous, leading to an increase in overdose deaths. We’re not exaggerating. I mean, taking one of these drugs can kill you.

What about vaping? It has been falling, but use is still considerably higher than for cigarettes: In 2021, about a quarter of high school seniors said that they had vaped nicotine in the preceding year. Why would teens resist cigarettes and flock to vaping?

Most of the toxicity associated with tobacco has been ascribed to the burning of the leaf. The burning of that tobacco was responsible for cancer and for most of the other adverse effects, even though nicotine is the addictive element.

What we’ve come to understand is that nicotine vaping has harms of its own, but this has not been as well understood as was the case with tobacco. The other aspect that made vaping so appealing to teenagers was that it was associated with all sorts of flavors — candy flavors. It was not until the F.D.A. made those flavors illegal that vaping became less accessible.

My argument would be there’s no reason we should be exposing teenagers to nicotine. Because nicotine is very, very addictive.

We also have all of this interest in cannabis and psychedelic drugs. And there’s a lot of interest in the idea that psychedelic drugs may have therapeutic benefits. To prevent these new trends in drug use among teens requires different strategies than those we’ve used for alcohol or nicotine.

For example, we can say that if you take drugs like alcohol or nicotine, that can lead to addiction. That’s supported by extensive research. But warning about addiction for drugs like cannabis and psychedelics may not be as effective.

While cannabis can also be addictive, it’s perhaps less so than nicotine or alcohol, and more research is needed in this area, especially on newer, higher-potency products. Psychedelics don’t usually lead to addiction, but they can produce adverse mental experiences that can put you at risk of psychosis.

Matt Richtel is a health and science reporter for The Times, based in Boulder, Colo. More about Matt Richtel

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

In a study published this week, researchers asked tens of thousands of individuals over 12 years of age about their use of tobacco products, e-cigarettes, and their health, and conducted follow-up questions over three years.1 They found the development of lung problems like emphysema, bronchitis, asthma, and chronic obstructive pulmonary disease in individuals who had used e-cigarettes in the past or currently use them. Combined use of e-cigarette and tobacco products dramatically increased lung disease risks by an incredible 330 percent. The researchers concluded that, “Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking.” The study’s senior author, Stanton Glantz, told CNN, “I was a little surprised that we could find evidence on incident lung disease in the longitudinal study, because three years is a while but most studies that look at the development of lung disease go over 10 to 20 years.”

The Centers for Disease Control (CDC) reports that, as of December 10, 2019, there are 2,409 hospitalization cases of vaping-related lung injuries in the U.S., resulting in 52 deaths across 26 states and Washington, D.C.2 The FDA has found THC in most of the samples it’s studying from these cases and has highlighted Vitamin E acetate as a chemical linked to some of the lung injuries. But the CDC warns that it still does not know how many other chemicals and products may be involved, and says that, “the best way for people to ensure that they are not at risk while the investigation continues is to consider refraining from the use of all e-cigarette, or vaping, products.” NIDA just reported that 3.5 percent of 12th graders and 3 percent of 10th graders say they vape on a daily basis, with 14 percent of 12th graders also saying that they vaped marijuana in the previous month. That figure is twice as large as it was last year.

Though federal officials have reportedly backed away from banning flavored vaping products3, some states have implemented such restrictions. And other national lawmakers are still considering similar options to confront the vaping epidemic.4 Dr. Scott Gottlieb, the former FDA Commissioner, has now recommended banning all cartridge-based e-cigarette products, which would include popular devices like Juul.5 Gottlieb, along with other experts, is worried about the epidemic of youth vaping, nicotine use and dependence which can lead to the use of tobacco-based products, the number one cause of preventable death, and other substances later in life.

Stories about vaping-related severe lung diseases, the epidemic of youth use, and public policy responses are important for patients, families, medical professionals, and consumers to follow. But we should also continue to monitor research that paints an even more distressing picture of e-cigarette products. In a recent study, researchers looked at the association between e-cigarette use and cancer.

What did this study find about e-cigarette use and cancer in mice?

This study found that exposure to e-cigarettes led to tumors and precancerous growths in the lungs and bladders of mice. The nicotine vapor from e-cigarettes damaged DNA in the exposed mice’s organs.

When tobacco burns, it can change nicotine into carcinogens called nitrosamine ketone. In individuals who use electronic cigarettes, these carcinogens in saliva and urine are 95 percent lower than they are individuals who smoke tobacco. That’s why the UK government says that electronic cigarettes are 95 percent safer than tobacco products. But it’s not as certain that nicotine from e-cigarettes gets turned into these carcinogens, so it’s also not clear if their levels in saliva and urine of individuals using e-cigarettes are a good guide to possible damage. The body can also absorb these carcinogens in other ways, as harmful to DNA. This study looked at DNA damage in mice to see if e-cigarettes might cause lung and bladder cancer, instead of carcinogenic impact in blood and urine. It’s also important to note that no experts suggest that vaping or smoking is good for you.

Researchers exposed the full bodies of 40 mice to e-cigarette vapor for 54 weeks. 22.5 percent of these mice developed lung tumors and, in their bladders, 57.5% ended up with precancerous growths. 20 mice in a control group, subjected to e-cigarette vapor but not nicotine, did not develop tumors. E-cigarette exposure in this study is comparable to human e-cigarette use over three to six years. The study’s authors believe that the results probably indicate e-cigarette aerosol nicotine reaching far into lung tissue and causing DNA damage. They also say that, “The public should not equate the risk of ECS [e-cigarette smoke] with that of TS [tobacco smoke]. Our data simply suggest, on the basis of experimental data in model systems, that this issue warrants in-depth study in the future.” This study also had limitations. It used a small sample size and did not focus on the inhalation of e-cigarette nicotine vapor. And animal studies are not necessarily clear guides for related effects in humans.

Why is this important?

This is the first study finding an association between e-cigarette use and cancer. Though the authors are careful to offer caveats about the research’s limitations, not drawing inferences about the relative safety of e-cigarettes and tobacco products, and the need for more extensive studies, this is still a significant and troubling result.  It took many decades for experts to agree that tobacco smoke caused cancer. It seems more logical to assume that smoking and vaping are dangerous until proven otherwise. Some countries have seen enough and banned e-cigarettes completely, such as Argentina, Saudi Arabia, and Singapore. Others do not think it is safe but consider e-cigarettes as part of a harm reduction strategy. The study’s lead, New York University’s Dr. Moon-Shong Tang told CNBC, “It’s foreseeable that if you smoke e-cigarettes, all kinds of disease comes out. Long term, some cancer will come out, probably. E-cigarettes are bad news.” He also suggested that because e-cigarette products have only existed for a relatively short period of time, it may take a while for more research to measure their health effects more comprehensively—possibly up to a decade.

It’s always appropriate for researchers to be cautious about their findings and to point to countervailing factors and the need for supplemental work and corroborating studies. Even experts can be surprised. But more studies continue to indicate the dangers of e-cigarette use. It’s also worth pointing out that there are dangers beyond these studies: inhaling nicotine vapors is likely to stimulate its own continued use, while costing time, energy and money. The cost of a pack of cigarettes is quite cheap even with current taxes. Actual costs are difficult to understand. In general, we assume smoking two packs of cigarettes a day for 20 years is more expensive than the $75,000 for the cost of the cigarettes. The long-term costs are closer to $2 million, after factoring in treatments for tobacco-related cancer, lung and heart disease, and the reduction in lifespan and productivity of the individual using cigarettes.

Prevention of adolescent smoking initiation is a very important health goal, one that we were much closer to attaining before vaping. Experts warn that vaping is causing a new nicotine addiction epidemic.6 They estimate, for example, that, because of vaping, almost 500,000 individuals between the ages of 12 and 29 who used e-cigarettes also end up using tobacco products.7 Use of e-cigarettes paves the way for use of tobacco-based cigarettes, as research suggests.8 If the full costs to society were included at the point of purchase, each pack of cigarettes would cost at least $75. Very few people would choose to spend $75/pack. Similarly, we could find a price at which vaping is less attractive to consumers. The science, in other words, is clear about the risks, and tobacco-like public health-related tax initiatives may be appropriate. Vermont recently passed a 92% wholesale tax on vaping and e-cigarette products. Federal lawmakers are also considering tax changes.

Keeping in mind that it took decades, if not centuries, to prove that cigarette smoking causes cancer, these new e-cigarette studies suggest that the products aren’t just understudied and possibly dangerous, but increasingly just dangerous, associated more frequently with chronic disease, heart problems, and even cancer.9 This study is also interesting in its full-body exposure of mice to e-cigarette vapor, which suggests that secondhand vaping may be dangerous, too. Other reports are coming out suggesting that e-cigarette inhalation is dangerous for everyone, include individuals who do not use the products but may be exposed to them. Mounting evidence shows that e-cigarette use is a highly risky proposition for current and potential consumers and that officials and experts are justified in pursuing ways to curb use. Reversing use trends will require a great deal of work given the near exponential increases in youth vaping.

References:

  1. Bhatta, D.N., Glantz, S.A. (2019) Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis. American Journal of Preventive Medicine

  2. Centers for Disease Control and Prevention (CDC). (2019) Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Retrieved from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

  3. Karni, A., Kaplan, S. (2019) Trump Warns a Flavor Ban Would Spawn Counterfeit Vaping Products. New York Times. Retrieved from https://www.nytimes.com/2019/11/22/health/trump-vaping.html

  4. Hellmann, J. (2019) House Democrats to vote on flavored e-cigarettes ban next year. The Hill. Retrieved from https://thehill.com/policy/healthcare/474184-house-democrats-to-vote-on-flavored-e-cigarettes-ban-next-year

  5. Florko, N. (2019) Former FDA commissioner calls for a full ban on pod-based e-cigarettes. Stat. Retrieved from https://www.statnews.com/2019/11/12/gottlieb-ban-pod-based-e-cigarettes/

  6. Dinardo, P., Rome, E.S. (2019) Vaping: The new wave of nicotine addiction. Cleve Clin J Med.

  7. Soneji, S., Wills, T.A. (2019) Challenges and Opportunities for Tobacco Control Policies in the 21st Century. JAMA Pediatr

  8. National Academies of Sciences, Engineering, and Medicine. (2018) Public health consequences of e-cigarettes. The National Academies Press, Washington, DC

  9. Proctor, R.N. (2012) The history of the discovery of the cigarette-lung cancer link: evidentiary traditions, corporate denial, global toll. Tob Control

Citation:

1. Tang, M., et al. (2019) Electronic-cigarette smoke induces lung adenocarcinoma and bladder urothelial hyperplasia in mice. PNAS

Source: We know vaping can cause serious lung problems. A new study says it might also cause cancer (addictionpolicy.org) December 2019

I, Surgeon General VADM Jerome Adams, am emphasizing the importance of protecting our Nation from the health risks of marijuana use in adolescence and during pregnancy. Recent increases in access to marijuana and in its potency, along with misperceptions of safety of marijuana endanger our most precious resource, our nation’s youth.

BE PREPARED. GET NALOXONE. SAVE A LIFE.

Background

Marijuana, or cannabis, is the most commonly used illicit drug in the United States. It acts by binding to cannabinoid receptors in the brain to produce a variety of effects, including euphoria, intoxication, and memory and motor impairments. These same cannabinoid receptors are also critical for brain development. They are part of the endocannabinoid system, which impacts the formation of brain circuits important for decision making, mood and responding to stress.

Marijuana and its related products are widely available in multiple forms. These products can be eaten, drunk, smoked, and vaped. Marijuana contains varying levels of delta-9-tetrahydrocannabinol (THC), the component responsible for euphoria and intoxication, and cannabidiol (CBD). While CBD is not intoxicating and does not lead to addiction, its long-term effects are largely unknown, and most CBD products are untested and of uncertain purity.

Marijuana has changed over time. The marijuana available today is much stronger than previous versions. The THC concentration in commonly cultivated marijuana plants has increased three-fold between 1995 and 2014 (4% and 12% respectively). Marijuana available in dispensaries in some states has average concentrations of THC between 17.7% and 23.2%. Concentrated products, commonly known as dabs or waxes, are far more widely available to recreational users today and may contain between 23.7% and 75.9% THC.

The risks of physical dependence, addiction, and other negative consequences increase with exposure to high concentrations of THC and the younger the age of initiation. Higher doses of THC are more likely to produce anxiety, agitation, paranoia, and psychosis. Edible marijuana takes time to absorb and to produce its effects, increasing the risk of unintentional overdose, as well as accidental ingestion by children and adolescents. In addition, chronic users of marijuana with a high THC content are at risk for developing a condition known as cannabinoid hyperemesis syndrome, which is marked by severe cycles of nausea and vomiting.

This advisory is intended to raise awareness of the known and potential harms to developing brains, posed by the increasing availability of highly potent marijuana in multiple, concentrated forms. These harms are costly to individuals and to our society, impacting mental health and educational achievement and raising the risks of addiction and misuse of other substances.  Additionally, marijuana use remains illegal for youth under state law in all states; normalization of its use raises the potential for criminal consequences in this population. In addition to the health risks posed by marijuana use, sale or possession of marijuana remains illegal under federal law notwithstanding some state laws to the contrary.

Watch the Surgeon General Answer FAQs on Marijuana

Marijuana Use during Pregnancy

Pregnant women use marijuana more than any other illicit drug. In a national survey, marijuana use in the past month among pregnant women doubled (3.4% to 7%) between 2002 and 2017. In a study conducted in a large health system, marijuana use rose by 69% (4.2% to 7.1%) between 2009 and 2016 among pregnant women. Alarmingly, many retail dispensaries recommend marijuana to pregnant women for morning sickness.

Marijuana use during pregnancy can affect the developing fetus.

  • THC can enter the fetal brain from the mother’s bloodstream.
  • It may disrupt the endocannabinoid system, which is important for a healthy pregnancy and fetal brain development
  • Studies have shown that marijuana use in pregnancy is associated with adverse outcomes, including lower birth weight.
  • The Colorado Pregnancy Risk Assessment Monitoring System reported that maternal marijuana use was associated with a 50% increased risk of low birth weight regardless of maternal age, race, ethnicity, education, and tobacco use.

The American College of Obstetricians and Gynecologists holds that “[w]omen who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use. Women reporting marijuana use should be counseled about concerns regarding potential adverse health consequences of continued use during pregnancy”. In 2018, the American Academy of Pediatrics recommended that “…it is important to advise all adolescents and young women that if they become pregnant, marijuana should not be used during pregnancy”.

Maternal marijuana use may still be dangerous to the baby after birth. THC has been found in breast milk for up to six days after the last recorded use. It may affect the newborn’s brain development and result in hyperactivity, poor cognitive function, and other long-term consequences. Additionally, marijuana smoke contains many of the same harmful components as tobacco smoke. No one should smoke marijuana or tobacco around a baby.

Marijuana Use during Adolescence

Marijuana is also commonly used by adolescents, second only to alcohol. In 2017, approximately 9.2 million youth aged 12 to 25 reported marijuana use in the past month and 29% more young adults aged 18-25 started using marijuana. In addition, high school students’ perception of the harm from regular marijuana use has been steadily declining over the last decade. During this same period, a number of states have legalized adult use of marijuana for medicinal or recreational purposes, while it remains illegal under federal law. The legalization movement may be impacting youth perception of harm from marijuana. 

The human brain continues to develop from before birth into the mid-20s and is vulnerable to the effects of addictive substances. Frequent marijuana use during adolescence is associated with:

  • Changes in the areas of the brain involved in attention, memory, decision-making, and motivation. Deficits in attention and memory have been detected in marijuana-using teens even after a month of abstinence.
  • Impaired learning in adolescents. Chronic use is linked to declines in IQ, school performance that jeopardizes professional and social achievements, and life satisfaction.
  • Increased rates of school absence and drop-out, as well as suicide attempts.

Risk for and early onset of psychotic disorders, such as schizophrenia. The risk for psychotic disorders increases with frequency of use, potency of the marijuana product, and as the age at first use decreases. 

  • Other substance use. In 2017, teens 12-17 reporting frequent use of marijuana showed a 130% greater likelihood of misusing opioids23.

Marijuana’s increasingly widespread availability in multiple and highly potent forms, coupled with a false and dangerous perception of safety among youth, merits a nationwide call to action. 

You Can Take Action

No amount of marijuana use during pregnancy or adolescence is known to be safe. Until and unless more is known about the long-term impact, the safest choice for pregnant women and adolescents is not to use marijuana.  Pregnant women and youth–and those who love them–need the facts and resources to support healthy decisions. It is critical to educate women and youth, as well as family members, school officials, state and local leaders, and health professionals, about the risks of marijuana, particularly as more states contemplate legalization.

Science-based messaging campaigns and targeted prevention programming are urgently needed to ensure that risks are clearly communicated and amplified by local, state, and national organizations. Clinicians can help by asking about marijuana use, informing mothers-to-be, new mothers, young people, and those vulnerable to psychotic disorders, of the risks. Clinicians can also prescribe safe, effective, and FDA-approved treatments for nausea, depression, and pain during pregnancy. Further research is needed to understand all the impacts of THC on the developing brain, but we know enough now to warrant concern and action. Everyone has a role in protecting our young people from the risks of marijuana.

Information for Parents and Parents-to-be

You have an important role to play for a healthy next generation.

Information for Youth:

You have an important role to play for a healthy next generation.

Information for States, Communities, Tribes, and Territories:

You have an important role to play for a healthy next generation.

Information for Health Professionals:

You have an important role to play for a healthy next generation.

Source: Surgeon General’s Advisory: Marijuana Use & the Developing Brain | HHS.gov August 2019

Police forces in the province collected 795 blood samples from motorists suspected of driving while under the influence.

One year after the legalization of recreational use of cannabis in Canada, the black market for the drug — as well as its use behind the wheel — continues to keep Quebec police forces busy.

In 2018, police collected 795 blood samples from motorists suspected of driving while under the influence, and sent them to Quebec’s medical legal centre for processing. That’s 254 more than in the previous year.

The presence of cannabis was detected in 46 per cent of those cases.

The Sûreté du Québec says cannabis is the most commonly detected drug in its traffic stops.

The provincial force said that since legalization, cannabis was detected in the systems of 113 persons pulled over for impaired driving, compared with 73 cases a year earlier — an increase of 54 per cent.

More than 670 officers trained in drug use evaluation have been deployed across the province.

In a statement issued Thursday detailing its operations over the past year, the SQ said it had opened 1,409 investigations into the illegal production, supply and distribution of cannabis, which led to 1,458 warrants being executed and charges filed against 1,403 individuals.

Meanwhile, raids on illegal outdoor cannabis fields were carried out in August and September, and saw 37,000 plants seized.

Over the past year, the SQ seized 71,500 cannabis plants, 161 kilograms of cannabis, 15.8 kilograms of cannabis oil and resin, 23,460 units of edible cannabis and $180,000 in cash.

Source:  https://montrealgazette.com/news/local-news/quebec-pot-arrests-behind-the-wheel-up-54-since-legalization October 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

‘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)

Hemp plants are visible inside several structures on Sept. 16, 2020, in Shiprock, New Mexico.

NOEL LYN SMITH/THE FARMINGTON DAILY TIMES USA TODAY NETWORK – NEW MEXICO

Leaders on the Navajo Nation have cracked down on one of its members who they say has used immigrant labor to transform 400 acres of crop land into hemp farms in the reservation’s northeastern corner.

The crops — illegal under Navajo law — have pitted residents and reservation officials against entrepreneur Dineh Benally, who has formed a partnership with a Las Vegas company that says it develops hemp and cannabis businesses on Native American lands.

Navajo Nation leaders took Benally to court and got an initial victory last week: District of Shiprock Judge Genevieve Woody granted a temporary restraining order halting the hemp farming.

Navajo Nation President Jonathan Nez said the order grants tribal law enforcement officers’ authority to stop hemp production. Navajo Nation police have begun asking some workers on the hemp farms — people law enforcement officials claim are immigrant workers from Asia — to leave tribal land.  

The ruling appears to provide a brief break in the dispute that came to a head this summer over the legality of Benally’s operation, which he claims has also provided employment for more than 200 members of the tribal nation.

The hemp farms are located around Shiprock on the Navajo Nation, which encompasses northeastern Arizona, northwest New Mexico and a sliver of southeastern Utah. 

The farms have prompted protests and allegations that Benally is illegally growing marijuana under the guise of a hemp farm with the help of foreign nationals. 

Both crops are illegal on tribal land. “The hemp will not stay here,” Nez said. 

A few hundred Navajo tribal members also work on the farms, officials say.

The battle over the farms has resulted in protests and last week’s showdown in the District Court of the Navajo Nation Judicial District of Shiprock.

“We strongly urge everyone to respect the ruling of the court and move forward peacefully to ensure the safety of community members, police officers and everyone in the impacted area,” Nez said after the hearing.

Benally said in a statement that he was disappointed by the court’s decision, saying it will have a “chilling effect” on Navajo business and economic development.

But residents like Beatrice Redfeather, 75, said the hemp farms have made her fear opening her front door.

“I see marijuana plants. I see a bunch of foreign workers, armed security guards. I see a security patrol 32 feet from my front door,” Redfeather said during a court hearing last week. “Those security guards have made it known they will attack, and they have shown their guns to our family. We are mentally afraid to walk outside … The smell of marijuana is so strong that I have had to go to the hospital because of my severe headaches.”

In an investigation published Wednesday by Searchlight New Mexico, people who said they had worked on the farms described growing marijuana, and said some people who worked there were teenagers or younger. 

Legal marijuana: Pros and cons

An attorney for Benally says his client is growing hemp, a less potent form of cannabis. Products made from it are commonly used and sold across the United States at major supermarkets and convenience stores. 

Benally argued in court filings that the 2018 Farm Bill, signed into law by President Donald Trump, allows him to grow hemp on reservation land. 

But tribal leaders say harvesting both hemp and marijuana is illegal on the Navajo Nation — except for a government-backed pilot project.  Navajo law, however, has no penalty for growing hemp, Nez said, so the nation took Benally to court. 

Navajo Nation Attorney General Doreen McPaul filed a lawsuit against Benally in June, charging Benally and his company of illegally growing industrial hemp and unlawfully issuing land use permits.

Nez said tribal leaders believe the potency of Benally’s crops is well above the federal threshold that defines hemp as no more than 0.3% tetrahydrocannabinol. or THC, the main active ingredient of cannabis. 

Regardless, the controversy has prompted heated skirmishes in recent months.

Benally has hired guards who patrol the farms wearing bulletproof vests and body cameras, according to court testimony that claimed arsonists torched at least one farm. Benally’s top security officer, Duane Billey, said in court that protesters have attacked him, but his force doesn’t carry guns. Locals say otherwise.

Officials also are critical of the use of what they believe are Asian migrants who have come to the reservation during a global pandemic and camped on the farms, where they work in greenhouses. 

Sonya Sengthong, a Glendale resident whose family lives near Shiprock, said relatives have told her vans and sport utility vehicles with California and Texas license plates continually drop off what she believes are workers for the farms.

The volcanic spire, seen from town in New Mexico.

MEGAN FINNERTY/THE REPUBLIC

“We are concerned some of these visitors may be mistreating our people,” Nez said in an interview with The Arizona Republic. “There are large areas that they are using to put up housing on these farms.” 

Nez said the laborers also are breaking the law as visitors have been banned from the reservation during the COVID-19 pandemic, which has ravaged the Navajo Nation. 

Nez said he does not know when scores of workers started arriving on the reservation, adding that some live in nearby Farmington. 

“Workers are coming in and they are not citizens. They are from other areas,” Navajo Nation police Chief Philip Francisco said during last week’s hearing. “There’s a general worry about a criminal element coming in, and there’s a belief that the hemp is not hemp but marijuana.”

“We have seen a lot of Asian people working on the farms, and there’s a law in place to not allow visitors on the Navajo Nation,” Nez said in an interview. “Because of the high population of these visitors, there are concerns about human waste.”

Nez and other Navajo officials confronted some of the workers during an unannounced visit to one of the farms on Sept. 3.   “They claim they don’t speak English, so we started talking back to them in Navajo,” Nez said. 

Benally and his attorney, David Jordan, have declined to answer questions about how employees came to work on the farms. But Jordan claims the Asian workers have been racially profiled and attacked by Navajos who oppose Benally’s business venture. 

“They want to blame my client for the violent protests and that they threaten the safety of the Navajo Nation,” Jordan said in court. “But they have a fear of other people who are different.”

‘Blatant disregard’

Benally has used his position on the San Juan River Farm Board, which represents a half-dozen or so communities or chapters on the Navajo Nation, to grant land use permits to grow hemp, and his ownership of the Native American Agricultural Company to produce the crops.

The farm board on which Benally sits is composed of elected members from various chapters or communities within the Navajo Nation. Its purpose is to develop and sustain farmland and water systems for economic development.

The initial lawsuit filed against Benally says farm boards are not authorized to issue agricultural land use permits for hemp. Instead, according to Navajo law, it only is authorized to review and recommend approval of permits to the Resources Committee of the Navajo Nation Council, the legislative branch of the reservation’s government.

Tracy Raymond, a former farm board member, stated in a court filing that Benally has used his farm board position to “serve his personal interests without approval or authorization.”  “It is a great disappointment to me to have to watch those growing hemp openly flouting the law just to make a quick profit,” Raymond, a corn farmer, said.  

He added the farm board never took a vote to authorize the issuance of hemp licenses.

Benally, on his personal website, said he’s used his leadership position to “collaborate with government delegates, grazing officials, and chapter officials to protect native water rights and improve the economy and livelihood of the Navajo People.”

Benally’s business partners

His company partnered with One World Ventures, a Las Vegas-based penny-stock company with shares worth about 2 cents each, to operate the farms, financial records show. 

Some financing came from SPI Energy Co., a Hong Kong-based firm that specializes in solar panels but has diversified its portfolio.   One World Ventures placed Benally on its board in March 2019.

One World Ventures CEO DaMu Lin last year issued a news release lauding One World’s relationship with Benally’s company and the San Juan River Farm Board, stating the company was well positioned for the upcoming hemp growing season.  Calls to the company and Lin were not returned.

One World Ventures has posted combined losses of $1.48 million the past two years, financial records show.  After Benally and Lin struck a deal, they obtained financing from SPI Energy Co., a publicly traded company on the NASDAQ.

SPI launched a hemp business last year and agreed to invest $1.1 million into the Shiprock farms.   But investments from SPI dried up last year after Benally’s company failed “to deliver any of the hemp plants” and refused to return an initial instalment of $324,125, SPI financial records show. 

SPI officials visited the Shiprock farms after making their first payment by the July 31, 2019, deadline and found “the plants and growing operations appeared to be deficient and not up to industry standards,” according to a company filing. Further, SPI alleges Benally didn’t deliver updates or financial reports as required.

“Finally, NAAC failed to deliver any of the hemp plants by Nov. 30, 2019 … and refused to return the company’s down payment and to make whole the damages the company has suffered,” a filing says.

SPI said Benally’s company also did not respond to two demand letters late last year.

‘Crisis situation’

Benally — whose Facebook page describes him as a “politician” despite his losing races for Navajo Nation president and Congress — claims he’s become a political target.

Benally declined to be interviewed. Benally was scheduled to be a witness during last week’s hearing but didn’t testify. His attorney had a farm owner and a security guard to testify.

Redfeather was among those who testified against Benally. Others included Navajo Nation Environmental Protection Agency Director Oliver Whaley and the tribal police chief.   Whaley said in court that during a Sept. 9 visit to one of Benally’s farms, he found septic tanks discharging sewer water into soil and groundwater, pesticides not being properly applied and petroleum leakage. He also said Benally didn’t have permits to operate.

Francisco, the police chief, testified after Whaley and said about a year ago a “crisis situation” began in the community, noting his office has been flooded with calls to maintain peace on the Shiprock farms. All of the calls have taken officers from other emergencies, he said. 

Francisco has previously said his agency was working with the Navajo Department of Criminal Investigation and the Bureau of Indian Affairs Division of Drug Enforcement regarding potential criminal violations on the farms.

“It’s a disruption to the community, and the smell is causing problems. And there’s encroachment on people’s land,” Francisco said in court. “There has been discord and unrest.”  Residents near the farms said in court that Benally’s crews have flooded their fields, making it impossible to harvest, and destroyed a corn crop with constant dust from Benally’s operation.   Loretta Bennett, a 69-year-old farmer, said in court that the workers on Benally’s farms also don’t wear masks, and she’s concerned about the spread of COVID-19. 

Arlando Teller, an Arizona state representative from Chinle, said in an interview that while the hemp farms are in New Mexico, he’s concerned about “how the operation has taken place as far as the transparency of a business operation.”

Hemp farms may remain

Benally, a 43-year-old father of four, has said in press releases and on his website that he brought hemp farms to Shiprock as an economic driver, and he’s been successful in partnering with tribal members on his website. 

He has paid $2,000 a month to childhood friend and farmer Farley Blueyes to use up to 150 acres of his farm for hemp production.

Blueyes said his land was fallow until Benally put people to work. Security officers were needed because residents have become confrontational. 

Hoop houses at a hemp farm are visible from U.S. Highway 64 in Hogback, New Mexico, on Sept. 16, 2020.

NOEL LYN SMITH/THE FARMINGTON DAILY TIMES

Despite Friday’s ruling, the battle is likely not over. Attorneys for Benally say they will pursue “all legal channels” to keep fighting, and many Asian workers remained on the farms after Friday’s ruling.

Sengthong, the Glendale resident, said she went to visit her relatives near Shiprock on Saturday after learning about the court order.

She told The Republic that a hemp farm on a relative’s property, about 10 miles west of Shiprock, was still operating this past weekend. She said when Navajo Nation police visited the site, workers fled the farm.  Sengthong was taking pictures of the activity and said after police left, one of the workers tried to “smack” her cellphone and other workers were confrontational.   “I’ve been intimidated for what I did,” she said. “They are still working and the camp is huge.”

Benally’s attorneys said the court decision violated their client’s civil rights and put many tribal members out of work.  Jordan, Benally’s attorney, declined to say how his client would respond to the court order. Jordan said in court filings that such an order would destroy the “entire crop

Source:  https://eu.azcentral.com/story/news/local/arizona/2020/09/22 September 24, 2020

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/   

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

This Notice of Liability Memo and attached Affidavit of Harms give formal notification to all addressees that they are morally, if not legally liable in cases of harm caused by making toxic marijuana products legally available, or knowingly withholding accurate information about the multiple risks of hemp/marijuana products to the Canadian consumer.  This memo further gives notice that those elected or appointed as representatives of the people of Canada, by voting affirmatively for Bill C45, do so with the knowledge that they are breaching international treaties, conventions and law.  They do so also with the knowledge that Canadian law enforcement have declared that they are not ready for implementation of marijuana legalization, and as they will not be ready to protect the lives of Canadians, there may arise grounds for a Charter of Rights challenge as all Canadian citizens are afforded a the right to security of self.

Scientific researchers and health organizations raise serious questions about the safety of ingesting even small amounts of cannabinoids. Adverse effects include risk of harm to the cardio-vascular system, respiratory tract, immune system, reproductive and endocrine systems, gastrointestinal system and the liver, hyperemesis, cognition, psychomotor performance, psychiatric effects including depression, anxiety and bipolar disorder, schizophrenia and psychosis, a-motivational syndrome, and addiction.  The scientific literature also warns of teratogenicity (causing birth deformities) and epigenetic damage (affecting genetic development) and clearly establishes the need for further study. The attached affidavit cites statements made by Health Canada that are grounded in scientific evidence that documents many harms caused by smoking or ingesting marijuana.  

Putting innocent citizens in “harm’s way” has been a costly bureaucratic mistake as evidenced by the 2015 Canadian $168 million payout to victims of exposure to the drug thalidomide. Health Canada approved thalidomide in 1961 to treat morning sickness in pregnant women but it caused catastrophic birth defects and death.

It would be instructive to reflect on “big tobacco” and their multi-billion-dollar liability in cases of misinformed sick and dead tobacco cigarette smokers. Litigants won lawsuits for harm done by smoking cigarettes even when it was the user’s own choice to obtain and smoke tobacco. In Minnesota during the 1930’s and up to the 1970’s tobacco cigarettes were given to generally healthy “juvenile delinquents’ incarcerated in a facility run by the state.  One of the juveniles, now an adult, who received the state’s tobacco cigarettes, sued the state for addicting him. He won.

The marijuana industry, in making public, unsubstantiated claims of marijuana safety, is placing itself in the same position, in terms of liability, as the tobacco companies.
In 1954, the tobacco industry published a statement that came to be known during Minnesota’s tobacco trial as the “Frank Statement.” Tobacco companies then formed an industry group for the purposes of deceiving and confusing the public.

In the Frank Statement, tobacco industry spokesmen asserted that experiments linking smoking with lung cancer were “inconclusive,” and that there was no proof that cigarette smoking was one of the causes of lung cancer. They stated, “We believe the products we make are not injurious to health.” Judge Kenneth Fitzpatrick instructed the Minnesota jurors: “Jurors should assume in their deliberations that tobacco companies assumed a “special duty” by publishing the ad (Frank Statement), and that jurors will have to determine whether the industry fulfilled that duty.” The verdict ruled against the tobacco industry.

Effective June 19, 2009, marijuana smoke was added to the California Prop 65 list of chemicals known to cause cancer. The Carcinogen Identification Committee (CIC) of the Office of Environmental Health Hazard Assessment (OEHHA) “determined that marijuana smoke was clearly shown, through scientifically valid testing according to generally accepted principles, to cause cancer.”

Products liability and its application to marijuana businesses is a topic that was not discussed in the Senate committee hearings. Proposition 65, requires the State to publish a list of chemicals known to cause cancer, birth defects or other types of reproductive harm. Proposition 65 requires businesses to provide their customers with notice of these cancerous causing chemicals when present in consumer products and provides for both a public and private right of action.

The similarities between the tactics of “Big Tobacco” and the “Canadian Cannabis Trade Alliance Institute” and individual marijuana producers would seem to demand very close scrutiny. On May 23, a witness testified before the Canadian Senate claimed that marijuana is not carcinogenic. This evidence was not challenged.

The International Narcotics Control Board Report for 2017 reads: “Bill C-45, introduced by the Minister of Justice and Attorney General of Canada on 13 April 2017, would permit the non-medical use of cannabis. If the bill is enacted, adults aged 18 years or older will legally be allowed to possess up to 30 grams of dried cannabis or an equivalent amount in non-dried form. It will also become legal to grow a maximum of four cannabis plants, simultaneously for personal use, buy cannabis from licensed retailers, and produce edible cannabis products. The Board wishes to reiterate that article 4 (c) of the 1961 Convention restricts the use of controlled narcotic drugs to medical and scientific purposes and that legislative measures providing for non-medical use are in contravention of that Convention….

The situation pertaining to cannabis cultivation and trafficking in North America continues to be in flux owing to the widening scope of personal non-medical use schemes in force in certain constituent states of the United States. The decriminalization of cannabis has apparently led organized criminal groups to focus on manufacturing and trafficking other illegal drugs, such as heroin. This could explain why, for example, Canada saw a 32 per cent increase from 2015 to 2016 in criminal incidents involving heroin possession….The Canadian Research Initiative in Substance Misuse issued “Lower-risk cannabis use guidelines” in 2017. The document is a health education and prevention tool that acknowledges that cannabis use carries both immediate and long-term health risks.”

https://www.incb.org/documents/Publications/AnnualReports/AR2017/Annual_Report_chapters/Chapter_3_Americas_2017.pdf

Upon receipt of this Memo and Affidavit, the addressees can no longer say they are ignorant or unaware that promoting and/or distributing marijuana cigarettes for recreational purposes is an endangerment to citizens. Receipt of this Memo and Affidavit removes from the addressees any claim of ignorance as a defense in potential, future litigation.

Pamela McColl www.cleartheairnow.org

pam.mccoll@cleartheairnow.org

 

AFFIDAVIT May 27, 2018

I, Pamela McColl, wish to inform agencies and individuals of known and potential harm done/caused by the use of marijuana (especially marijuana cigarettes) and of the acknowledgement the risk of harm by Health Canada. 

Marijuana is a complex, unstable mixture of over four hundred chemicals that, when smoked, produces over two thousand chemicals.  Among those two thousand chemicals are many pollutants and cancer-causing substances.  Some cannabinoids are psychoactive, all are bioactive, and all may remain in the body’s fatty tissues for long periods of times with unknown consequences. Marijuana smoke contains carcinogenic (cancer-causing) substances such as benzo(a)pyrene, benz(a)anthracene, and benzene in higher concentrations than are present in tobacco smoke.  The mechanism by which benzo(a)pyrene causes cancer in smokers was demonstrated scientifically by Denissenko MF et al. Science 274:430-432, 1996. 

Health Canada Consumer Information on Cannabis reads as follows:  “The courts in Canada have ruled that the federal government must provide reasonable access to a legal source of marijuana for medical purposes.”

“Cannabis is not an approved therapeutic product and the provision of this information should not be interpreted as an endorsement of the use of cannabis for therapeutic purposes, or of marijuana generally, by Health Canada.”

“Serious Warnings and Precautions: Cannabis (marihuana, marijuana) contains hundreds of substances, some of which can affect the proper functioning of the brain and central nervous system.”

“The use of this product involves risks to health, some of which may not be known or fully understood. Studies supporting the safety and efficacy of cannabis for therapeutic purposes are limited and do not meet the standard required by the Food and Drug Regulations for marketed drugs in Canada.”

Health Canada – “When the product should not be used: Cannabis should not be used if you:-are under the age of 25 -are allergic to any cannabinoid or to smoke-have serious liver, kidney, heart or lung disease -have a personal or family history of serious mental disorders such as schizophrenia, psychosis, depression, or bipolar disorder-are pregnant, are planning to get pregnant, or are breast-feeding -are a man who wishes to start a family-have a history of alcohol or drug abuse or substance dependence Talk to your health care practitioner if you have any of these conditions. There may be other conditions where this product should not be used, but which are unknown due to limited scientific information.

Cannabis is not an approved therapeutic product and the provision of this information should not be interpreted as an endorsement of the use of this product, or cannabis generally, by Health Canada.”

Prepared by Health Canada Date of latest version: February 2013, accessed May 2018. https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-use-marijuana/information-medical-practitioners/information-health-care-professionals-cannabis-marihuana-marijuana-cannabinoids.html

A report published by survey company RIWI Corp. (RIWI.com) can be found at: https://riwi.com/case-study/measuringcanadians-awareness-of-marijuanas-health-effects-may-2018

The report measures Canadians’ awareness of marijuana’s health effects as determined by Health Canada and published on Health Canada’s website. RIWI data indicates: 1. More than 40% of those under age 25 are unaware that marijuana impacts safe driving. Further, 21% of respondents are not aware that marijuana can negatively impact one’s ability to drive safely. Health Canada: “Using cannabis can impair your concentration, your ability to make decisions, and your reaction time and coordination. This can affect your motor skills, including your ability to drive.” 2. One in five women aged 25-34 believes marijuana is safe during pregnancy, while trying to get pregnant, or breastfeeding. • RIWI: “For women of prime childbearing age (25-34), roughly one in five believe smoking marijuana is safe during pregnancy, planning to get pregnant, and breastfeeding.” • Health Canada: “Marijuana should not be used if you are pregnant, are planning to get pregnant, or are breastfeeding. … Long-term use may negatively impact the behavioural and cognitive development of children born to mothers who used cannabis during pregnancy.” 3. One in three Canadians do not think that marijuana is addictive. • Health Canada: “Long term use may result in psychological dependence (addiction).” 4. One in three Canadians believe marijuana aids mental health. • Health Canada: “Long term use may increase the risk of triggering or aggravating psychiatric and/or mood disorders (schizophrenia, psychosis, anxiety, depression, bipolar disorder).” 5. One in two males were unaware that marijuana could harm a man’s fertility • “Marijuana should not be used if you are a man who wishes to start a family.”

ClearTheAirNow.org, a coalition of concerned Canadians commissioned the survey.

Affiant is willing to provide further sources of information about the toxicity of marijuana.

Pamela McColl

www.cleartheairnow.org

pam.mccoll@cleartheairnow.org

Source: From email sent to Drug Watch International May 2018

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

The police explanation that more black and Hispanic people are arrested on marijuana charges because complaints are high in their neighborhoods doesn’t hold up to scrutiny.

There are many ways to get arrested on marijuana charges, but one pattern has remained true through years of piecemeal policy changes in New York City: The primary targets are black and Hispanic people

They sit in courtroom pews, almost all of them young black men, waiting their turn before a New York City judge to face a charge that no longer exists in some states: possessing marijuana. They tell of smoking in a housing project hallway, or of being in a car with a friend who was smoking, or of lighting up a Black & Mild cigar the police mistake for a blunt.

There are many ways to be arrested on marijuana charges, but one pattern has remained true through years of piecemeal policy changes in New York: The primary targets are black and Hispanic people.

Across the city, black people were arrested on low-level marijuana charges at eight times the rate of white, non-Hispanic people over the past three years, The New York Times found. Hispanic people were arrested at five times the rate of white people. In Manhattan, the gap is even starker: Black people there were arrested at 15 times the rate of white people.

With crime dropping and the Police Department under pressure to justify the number of low-level arrests it makes, a senior police official recently testified to lawmakers that there was a simple reason for the racial imbalance: More residents in predominantly black and Hispanic neighborhoods were calling to complain about marijuana.

An analysis by The Times found that fact did not fully explain the racial disparity. Instead, among neighborhoods where people called about marijuana at the same rate, the police almost always made arrests at a higher rate in the area with more black residents, The Times found.

In Brooklyn, officers in the precinct covering Canarsie arrested people on marijuana possession charges at a rate more than four times as high as in the precinct that includes Greenpoint, despite residents calling 311, the city’s help line, and 911 to complain about marijuana at the same rate, police data show. The Canarsie precinct is 85 percent black. The Greenpoint precinct is 4 percent black.

In Queens, the marijuana arrest rate is more than 10 times as high in the precinct covering Queens Village as it is in precinct that serves Forest Hills. Both got marijuana complaints at the same rate, but the Queens Village precinct is just over half black, while the one covering Forest Hills has a tiny portion of black residents.

And in Manhattan, officers in a precinct covering a stretch of western Harlem make marijuana arrests at double the rate of their counterparts in a precinct covering the northern part of the Upper West Side. Both received complaints at the same rate, but the precinct covering western Harlem has double the percentage of black residents as the one that serves the Upper West Side.

The Times’s analysis, combined with interviews with defendants facing marijuana charges, lawyers and police officers, paints a picture of uneven enforcement. In some neighborhoods, officers expected by their commanders to be assertive on the streets seize on the smell of marijuana and stop people who are smoking. In others, people smoke in public without fear of an officer passing by or stopping them.

Black neighborhoods often contend with more violent crime, and the police often deploy extra officers there, which can lead to residents being exposed more to the police.

“More cops in neighborhoods means they’re more likely to encounter somebody smoking,” said Jeffrey Fagan, a Columbia Law School professor who also advised The Times on its marijuana-arrest analysis.

But more officers are historically assigned to black neighborhoods than would be expected based on crime rates, according to a study by Professor Fagan. And research has found “there is no good evidence” that marijuana arrests in New York City are associated with reductions in serious crime.

Officers who catch someone smoking marijuana are legally able to stop and search that person and check for open warrants. Some defense lawyers and criminologists say those searches and warrant checks are the real impetus for enforcing marijuana laws more heavily in some neighborhoods.

The analysis by The Times shows that at least some quality-of-life arrests have more to do with the Police Department’s strategies than with residents who call for help, undermining one of the arguments the police have used to defend mass enforcement of minor offenses in an era of declining serious crime.

The analysis examined how marijuana arrests were related to the marijuana-complaint rate, race, violent-crime levels, the poverty rate and homeownership data in each precinct. It also considered the borough where an arrest took place to account for different policing practices across the city. The arrests represent cases in which the most serious charge against someone was low-level marijuana possession.

Government surveys have shown that black and white people use marijuana at roughly the same rate. Marijuana smoke wafts down streets all over the city, from the brownstones in upper-middle-class areas of Manhattan to apartment buildings in working-class neighborhoods in other boroughs.

Mayor Bill de Blasio said in late 2014 that the police would largely give summonses instead of making arrests for carrying personal marijuana, and reserve arrests mainly for smoking in public. Since then, the police have arrested 17,500 people for marijuana possession on average a year, down from about 26,000 people in 2014, and issued thousands of additional summonses. Overall, arrests have dropped sharply from their recent peak of more than 50,000 during some years under Mayor Michael R. Bloomberg.

About 87 percent of those arrested in recent years have been black or Hispanic, a proportion that has remained roughly the same for decades, according to research led by Harry G. Levine, a sociology professor at Queens College.

“What you have is people smoking weed in the same places in any neighborhood in the city,” said Scott Levy, a special counsel to the criminal defense practice at the Bronx Defenders, who has studied marijuana arrests. “It’s just those neighborhoods are patrolled very, very differently. And the people in those neighborhoods are seen very differently by the police.”

Responding to The Times’s analysis, the Police Department said pockets of violent crime — and the heavier deployments that result — push up marijuana arrests in some neighborhoods. J. Peter Donald, an assistant commissioner in the department’s public information office, also said more people smoke in public in some neighborhoods than others, driving up arrests. He said 911 and 311 complaints about marijuana had increased in recent years.

“N.Y.P.D. police officers enforce the law fairly and evenly, not only where and when they observe infractions but also in response to complaints from 911 and 311 calls, tenant associations, community councils and build-the-block meetings,” Mr. Donald said in a statement.

Appearing before the City Council in February, Chief Dermot F. Shea said, “The remaining arrests that we make now are overlaid exactly in the parts of the city where we are receiving complaints from the public.” He asked, “What would you have the police do when people are calling?”

Police data do show that neighborhoods with many black and Hispanic residents tend to generate more 311 and 911 complaints about marijuana. Criminal justice reform advocates said that is not because more people are smoking marijuana in those areas. Rather, people in poor neighborhoods call the police because they are less likely to have a responsive landlord, building superintendent or co-op board member who can field their complaints.

Rory Lancman, a councilman from Queens who pressed police officials for the marijuana data at the February hearing, said with the police still arresting thousands of people for smoking amid a widespread push for reform, the police “blame it on the communities themselves because they’re the ones calling on us.”

The city’s 77 precincts, led by commanders with their own enforcement priorities, show erratic arrest patterns. In Sunset Park, Brooklyn, for example, the police made more than twice as many marijuana arrests last year as in 2016, despite receiving roughly the same number of annual complaints. And in a precinct covering a section of northwestern Harlem, arrests dropped to 90 last year from almost 700 a year earlier, even though complaints fell only slightly from one year to the next.

Criticism of marijuana arrests provided fuel for Mr. de Blasio’s campaign for mayor in 2013, when he won promising to “reverse the racial impact of low-level marijuana arrests.” The next year the new Brooklyn district attorney, Ken Thompson, defied the Police Department and said his office would stop prosecuting many low-level marijuana arrests.

Yet the disparities remain. Black and Hispanic people are the main targets of arrests even in mostly white neighborhoods. In the precinct covering the southern part of the Upper West Side, for example, white residents outnumber their black and Hispanic neighbors by six to one, yet seven out of every 10 people charged with marijuana possession in the last three years are black or Hispanic, state data show. In the precinct covering Park Slope, Brooklyn, where a fifth of the residents are black or Hispanic, three-quarters of those arrested on marijuana charges are black or Hispanic.

The question of how to address those disparities has divided Democratic politicians in New York. Cynthia Nixon, who is campaigning for the Democratic nomination for governor against Gov. Andrew M. Cuomo, has vowed to legalize marijuana and clear people’s arrest records. Mr. de Blasio and Mr. Cuomo have been reluctant to support the same measures.

In Criminal Court in Brooklyn on a recent Monday, the people waiting in the crowded pews to be arraigned on marijuana charges were almost all black men. In interviews, some declined to give their full names for fear of compounding the consequences of their arrests.

They had missed work or school, sometimes losing hundreds of dollars in wages, to show up in court — often twice, because paperwork was not ready the first time. Their cases were all dismissed so long as they stayed out of trouble for a stretch, an indication of what Scott Hechinger, a senior staff lawyer and director of policy at Brooklyn Defender Services, said was the low value the court system places on such cases.

Eli, 18, said he had been smoking in a housing project hallway because his parents preferred him to keep it out of the apartment. Greg, 39, said he had not even been smoking himself, but was sitting in his car next to his wife, who he said smokes marijuana to relieve the symptoms of multiple sclerosis.

“They do it because that’s the easiest way to arrest you,” Greg said.

Rashawn Nicol, 27, said officers found his female friend holding a lit blunt on a third-floor stairwell landing in a Brooklyn housing project. They backed off arresting her once she started crying, he said, but said they needed to bring their supervisor an arrest because he had radioed over a noise complaint. “Somebody’s got to go down for this,” Mr. Nicol said an officer told him. So they let her go, but arrested him.

Several people asked why the police hound residents for small-time infractions like marijuana in more violent neighborhoods, but are slow to follow up about serious crimes. “The resources they waste for this are ridiculous,” Mr. Nicol said.

Source: Surest Way to Face Marijuana Charges in New York: Be Black or Hispanic – The New York Times (nytimes.com) May 2018

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

SEPARATING MARIJUANA FACT FROM FICTION IN NEW YORK RESPONSE TO THE “ASSESSMENT OF THE POTENTIAL IMPACT OF REGULATED MARIJUANA IN NEW YORK STATE”

AUGUST 2018

Executive Summary
Recently, New York State (NYS) released what they claimed to be “an extensive assessment of current research and literature to evaluate the cost-risk benefit of legalizing the recreational adult use of marijuana.”
The overall conclusion of this assessment was that marijuana poses little public health risk and should be considered for legalization. But a closer look finds several flaws in the report that questions its purpose and conclusions. Unfortunately, it appears that the conclusion of the NYS report was written before the data were analyzed. The legalization of recreational marijuana is presented in the introduction as a fait accompli: “It has become less a question of whether to legalize but how to do so responsibly.” Much of the report discusses how to decrease the dangers of legal recreational marijuana. The best way to lessen the danger is to keep it from being commercialized, normalized, promoted – and legalized.
The report conflates the issues of medical marijuana and commercial sales of recreational marijuana. The potential medical benefits of medical cannabis are already available in New York. Adding indiscriminate recreational use does not increase any health benefit to New Yorkers.
Smart Approaches to Marijuana (SAM) is advised by a scientific advisory board of researchers from institutions such as Harvard and Johns Hopkins. SAM believes in the need for rational, well-informed public policy – legislation that maximizes public health benefits and minimizes harms.
This state-issued report reads more like a marijuana lobbyist’s manifesto, as we found no credible opposing evidence cited.
Based on our findings, the reference to unlisted “subject-matter experts” that the report apparently relied on, and the fact that state medical groups like the New York Society for Addiction Medicine (NYSAM) were not consulted with, we are formally requesting that the state of New York publicly disclose all sources that were consulted and those that contributed to creation of the document. We believe that National Institute of Health (NIH) scientists, NYSAM physicians, and other experts should have the chance to review these findings.
Below are the top claims from the report and rebuttals.

CLAIM: “A 2017 Marist Poll showed that 52 percent of Americans 18 years of age or older have tried marijuana at some point in their lives, and 44 percent of these individuals currently use it.”
CORRECTION:
The best usage data are not found in polls, but rather scientific studies conducted by the National Institutes of Health. According to the most recent National Survey on Drug Use and Health (NSDUH) data, 10.58% of Americans 12 or older and 10.84% of New York State residents reported being current users and 44% of Americans have tried marijuana at some point in their life (NSDUH, 2016).

CLAIM: “In 1999 the Institute of Medicine (IOM) found a base of evidence to support the benefits of marijuana for medical purposes.”
CORRECTION:
This report is supposed to be about non-medical marijuana. We should not conflate the two issues. Still, there have been several reviews since this was published almost twenty years ago. The 1999 IOM report stated: “Because of the health risks associated with smoking, smoked marijuana should generally not be recommended for long-term medical use” and called for a “heavier investment in research.”
Released at the beginning of 2017, the most recent National Academy of Sciences report said: “Despite increased cannabis use and a changing state-level policy landscape, conclusive evidence regarding the short- and long-term health effects—both harms and benefits—of cannabis use remains elusive.” The July 24, 2018 issue of the Annals of Internal Medicine stated that “Americans’ view of marijuana use is more favorable than existing evidence supports.”
Again, this NYS report recommended recreational legalization, and we should separate the issue of the possible therapeutic benefits from this study.

CLAIM: “Most women who use marijuana stop or reduce their use during pregnancy.”
CORRECTION:
Dr. Nora Volkow, NIH’s drug abuse director, published a report last year in response to an alarming trend being seen across the country of increased cannabis use during pregnancy and warned of the detrimental health risks of in utero cannabis exposure (Volkow et al., 2017).
Even more alarming is a recent study that was not included in this report where researchers found nearly 70% of 400 Colorado dispensaries surveyed in a scientific, undercover study were recommending cannabis products to mothers experiencing morning-sickness in the first trimester (Dickson et al., 2018).
A clinically-controlled study published this year found that mothers vulnerable to mental illness who smoked during pregnancy put their child at higher risk to develop significantly more psychotic symptoms earlier in life compared to mothers who didn’t smoke marijuana, but had similar vulnerabilities (Bolhuis et al., 2018).

CLAIM: “Data from multiple sources indicate that legalization in Colorado had no substantive impact on youth marijuana use.”
CORRECTION:
Despite widely publicized reports by the state of Colorado, pro-legalization lobbyists, and others with revenue-producing interests; reliable data sources say otherwise. According to NSDUH state estimates, Colorado now leads the nation in the percentage of 12- to 17-year olds who have tried marijuana for the first time (NSDUH, State Estimates, 2017). In adolescents and adults, Colorado is well above the national average.
All state-collected data related to adolescent substance use is done via the Healthy Kids Colorado Survey – a state sponsored assessment to replace all other national and state surveys administered in school. Until 2017, these data have not met the CDC’s standard qualifications for sampling methodology since 2011 – the year before recreational marijuana became legal in Colorado. The 2015 HKCS has been widely criticized for misrepresenting and promoting misleading messages surrounding adolescent drug use (Murray, 2016).

As a result of questionable reports publicized by the state of Colorado and pro-legalization activists, local investigative journalists at the Denver Post interviewed numerous law enforcement officers, educators and advocates; in addition to analyzing databases. They ultimately concluded that state-produced data appears to be unreliable (Migoya, 2017). “Records do not account for many young offenders who either are not reported to police, are not ticketed because police say there’s too little to cite or have infractions that are not tabulated because of programs designed to protect minors from blemished records.”

CLAIM: “There has been no increase in violent crime or property crime rates around medical marijuana dispensaries.”
CORRECTION:
The relationship between marijuana establishments and crime is mixed at best. A study funded by the National Institutes of Health showed that the density of marijuana dispensaries was linked to increased property crimes in nearby areas (Freisthler, et al., 2017). Colorado Public Radio reported similar findings – particularly in Denver and Pueblo – and noted the visible association with increased gang violence seen in both cities likely due to a high density of dispensaries and illegal activity, including the black market (Markus, 2017).

CLAIM: “Marijuana is an effective treatment for pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to most opioid-based medications.”

CORRECTION:
This is inaccurate and is confounding medical and recreational use. This statement was based on a survey that 17 medical marijuana patients took while being prescribed opioids. Self-report data can be useful but have no value in informing serious public health risks. Several recent and widely-circulated studies show strong contradictory evidence to this claim.
Researchers found that patients reporting marijuana use actually experienced more pain on average when admitted to the hospital following a traumatic injury than those that did not. Compared to non-users, they required more opioid medication to cope with the pain and consistently rated their pain higher during the duration of their stay (Salottolo et al., 2018).
A 4-year prospective study in the highly respected Lancet journal followed medical marijuana patients with a dual opioid prescription and found that marijuana use did not reduce opioid use or prescribing. Users reported greater pain severity and more day-to-day interference than those that did not use marijuana (Campbell et al., 2018).

CLAIM: “Regulated marijuana introduces an opportunity to reduce harm for consumers through labeling.”
CORRECTION:
Non-FDA approved commercially-produced products have received only minimal regulatory attention. Recent studies have shown rampant mislabeling of the active cannabinoid ingredients in concentrates and edibles (Peace et al., 2016).
The FDA has published warning letters on the severe mislabeling of commercial products consistently seen on the market since 2015 (FDA, 2015-17). This claim was cited from the Drug Policy Alliance website. The DPA and its affiliates have directly funded campaigns to legalize all forms of marijuana including edible products throughout the US. They also call for the legalization of all drugs. This is not a credible source.

CLAIM: “The status quo (i.e., criminalization of marijuana) has not curbed marijuana use.”

CORRECTION:
Non-public, personal use of Marijuana is not criminalized in NYS nor are possession of small amounts for personal amounts – often a reason for imprisonment. In 2016 23.5% Americans reported using legal drugs compared to 10.6% using illegal ones – signaling that the law matters in preventing drug use (NSDUH, 2016). In 2017 in New York State, marijuana made up 0.003% of non youthful-offender felony sentences to prison. There were no youthful offender felony marijuana sentences for prison. Misdemeanor marijuana arrests made up 8.5% of all state
misdemeanor arrests (NY State Division of Criminal Services, 2018). The recent rush to legalization across the country has pushed marijuana to the number one spot for recent first-time drug users aged 12 or older in 2016 compared to any other illicit drug (NSDUH, 2016).

CLAIM: “Legalizing marijuana results in a reduction in the use of synthetic cannabinoids.”
CORRECTION:
This claim is inaccurately attributed to the report Global Drug Survey which indicates that countries that decriminalize marijuana have lower rates of synthetic marijuana use. The claim cannot be found in that reference. And, even if there is an association between decreased synthetic use and decriminalized marijuana, it does not follow that legalizing marijuana will cause a reduction in synthetic use. We emailed Professor Adam R Winstock, Founder & CEO of the Global Drug Survey, to ask his opinion. He replied, ”It’s not clear cut,” indicating uncertainty. There is not much data on decreased synthetic use in countries with decriminalization (Zucker doesn’t even say “countries with legalization” which is actually the issue at hand because only Uruguay would fall into that category).

CLAIM: “The over-prosecution of marijuana has had significant negative economic, health, and safety impacts that have disproportionately affected low-income communities of color.”
CORRECTION:
Marijuana does not need to be legalized to address valid social justice concerns. Although overall drug-related offenses have decreased in states that have legalized; minorities have still disproportionately been targeted for the arrests that do still occur. Such as in 2014, two years after legalization in Colorado, the marijuana arrest rates for African‐ Americans (348 per 100,000) was almost triple that of Whites (123 per 100,000) (Co. Dept. of Public of Safety, 2016).
Colorado has seen an increase in crime in regions that attract recreational users. Although the rise in crime cannot be attributed to legalization of marijuana alone, much of the violence has been attributed to increased gang violence where dispensaries are densest (Markus, 2017). Current drug policies can be changed without legalization.

CLAIM: “The negative health consequences of marijuana have been found to be lower than alcohol, tobacco, and illicit drugs including heroin and cocaine.”

CORRECTION:
This statement is questionable because it was based on a theoretical model that estimated human consumption averages for each substance and calculated a risk ratio using lethal doses reported in animal studies. Basic research is necessary for understanding the biology underlying addiction; however, the transferability of dosing schedules between species has not been conclusively established. Much of the reason alcohol and tobacco exert more costs to society than many illegal drugs is because those two drugs are legalized and commercialized. As Dr. Nora Volkow, head of NIH’s drug abuse institute stated, “Repeated marijuana use during adolescence may result in long-lasting changes in brain function that can jeopardize educational, professional, and social achievements.
“However, the effects of a drug (legal or illegal) on individual health are determined not only by its pharmacologic properties but also by its availability and social acceptability.” “In this respect, legal drugs (alcohol and tobacco) offer a sobering perspective, accounting for the greatest burden of disease associated with drugs not because they are more dangerous than illegal drugs but because their legal status allows for more widespread exposure.”

CLAIM: “The impact of legalization in surrounding states has accelerated the need for NYS to address legalization.”
CORRECTION:
This statement reads as if two wrongs somehow make a right. NYS should not be forced into legalizing marijuana because other states are considering it (several surrounding states, it should be noted, have considered and then defeated proposals to legalize marijuana). Even if a surrounding state or two legalizes marijuana, NYS can stand out as the state promoting health, well-being, family-centered tourism – not more drug use.
This statement totally ignores newer polls such as the 2018 Emerson College poll that found that the majority of New Yorkers do not support the legalization of marijuana. A plurality support either decriminalization or the current policy.
“The poll — conducted by the same college that recently conducted a poll for pro-marijuana groups Marijuana Policy Project (MPP) and the Drug Policy Alliance (DPA) — reported that 56% of respondents did not favor legalizing the recreational sales of marijuana.”

REFERENCES
Bolhuis, K., Kushner, S. A., Yalniz, S., Hillegers, M. H., Jaddoe, V. W., Tiemeier, H., & El Marroun, H. (2018). Maternal and paternal cannabis use during pregnancy and the risk of psychotic-like experiences in the offspring. Schizophrenia research.

Campbell, G., Hall, W. D., Peacock, A., Lintzeris, N., Bruno, R., Larance, B., … & Blyth, F. (2018). Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study. The Lancet Public Health, 3(7), e341-e350.

Center for Behavioral Health Statistics and Quality. (2017). 2016 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.

Commissioner, O. O. (n.d.). Public Health Focus – Warning Letters and Test Results for Cannabidiol-Related Products. Retrieved from https://www.fda.gov/newsevents/publichealthfocus/ucm484109.htm

Colorado Dept. Public Safety. (2016, March). Marijuana Legalization in Colorado: Early Findings. Retrieved from https://cdpsdocs.state.co.us/ors/docs/reports/2016-SB13-283-Rpt.pdf

Copyright © 2018 National Academy of Sciences. All Rights Reserved. (2017, November 08). Retrieved from http://nationalacademies.org/hmd/Activities/PublicHealth/MarijuanaHealthEffects.aspx

Dickson, B., Mansfield, C., Guiahi, M., Allshouse, A. A., Borgelt, L., Sheeder, J., … & Metz, T. D. (2018). 931: Recommendations from cannabis dispensaries on first trimester marijuana use. American Journal of Obstetrics and Gynecology, 218(1), S551.

Emerson College. (2018, June). June 2018 Public Opinion Survey of New York Registered Voters Attitudes on Marijuana Policy. Retrieved from https://learnaboutsam.org/wp-content/uploads/2018/06/nyspoll-1.pdf Commissioned by Smart Approaches to Marijuana

Freisthler, B., Ponicki, W. R., Gaidus, A., & Gruenewald, P. J. (2016). A micro‐temporal geospatial analysis of medical marijuana dispensaries and crime in Long Beach, California. Addiction, 111(6), 1027-1035.

Green, M. C. (2018, June). Criminal Justice Case Processing Arrest through Disposition New York State January – December 2017. Retrieved from http://www.criminaljustice.ny.gov/crimnet/ojsa/dar/DAR-4Q-2017-NewYorkState.pdf

Keyhani, S., Steigerwald, S., Ishida, J., Vali, M., Cerdá, M., Hasin, D., . . . Cohen, B. E. (2018). Risks and Benefits of Marijuana Use. Annals of Internal Medicine. doi:10.7326/m18-0810

Markus, B. (2017, July 31). A Dive Into Colorado Crime Data In 5 Charts. Retrieved from http://www.cpr.org/news/story/a-dive-into-colorado-crime-data-in-5-charts

Migoya, D. (2017, December 22). Police across Colorado questioning whether youths are using marijuana less. Retrieved from https://www.denverpost.com/2017/12/22/police-across-colorado-questioning-youth-marijuana-use/

Murray, D. W. (2016, July 2). Misrepresenting Colorado Marijuana – by David W. Murray. Retrieved from https://www.hudson.org/research/12615-misrepresenting-colorado-marijuana

National Families in Action. (n.d.). Colorado | The Marijuana Report.org. Retrieved from http://themarijuanareport.org/colorado/.

Peace, M. R., Butler, K. E., Wolf, C. E., Poklis, J. L., & Poklis, A. (2016). Evaluation of two commercially available cannabidiol formulations for use in electronic cigarettes. Frontiers in pharmacology, 7, 279.

Salottolo, K., Peck, L., Tanner II, A., Carrick, M. M., Madayag, R., McGuire, E., & Bar-Or, D. (2018). The grass is not always greener: a multi-institutional pilot study of marijuana use and acute pain management following traumatic injury. Patient Safety in Surgery, 12(1), 16.

Volkow, N. D., Compton, W. M., & Wargo, E. M. (2017). The risks of marijuana use during pregnancy. Jama, 317(2), 129-130.

Smart Approaches to Marijuana (SAM) is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals, scientists, and other concerned citizens opposed to marijuana legalization who want health and scientific evidence to guide marijuana policies. SAM was co-founded by former Congressman Patrick Kennedy and former Obama Administration senior drug policy advisor, Dr. Kevin Sabet. SAM has affiliates in more than 30 states.

Source: NY-Rebuttal-Absolute-Final.pdf (learnaboutsam.org) August 2018

A meta-analysis reviewing the evidence on safe injection sites has been retracted due to “methodological weaknesses.”

Update (September 27, 2018): The study, published by the International Journal of Drug Policy, has been retracted by the journal due to “methodological weaknesses.” As such, it should no longer be taken seriously. What follows is Vox’s original piece on the study.

In response to the opioid epidemic, several cities, from New York City to Seattle, are considering a controversial policy: allowing spaces where people can, under supervision, inject heroin and use other drugs. The idea is that if people are going to use drugs anyway, there might as well be places where those using drugs can be supervised in case something goes wrong.

“After a rigorous review of similar efforts across the world, and after careful consideration of public health and safety expert views, we believe overdose prevention centers will save lives and get more New Yorkers into the treatment they need to beat this deadly addiction,” New York City Mayor Bill de Blasio said in a statement earlier this year.

But a new study has found that these places, known as supervised drug consumption sites, safe injection sites, and many other names, may not be as effective at preventing overdose deaths and other drug-related problems as once thought. According to a new review of the research published in the International Journal of Drug Policy, safe consumption sites appear to have only a small favorable relation to drug-related crimes but no significant effect on several other outcomes, including overdose mortality and syringe sharing.

“The contrast between the claims that are being made and what the evidence actually says” stuck out to Keith Humphreys, a drug policy expert at Stanford University who was not involved in the review. The new research review’s results, he said, “are fairly disappointing.”

In the past, experts, advocates, and journalists (including myself) have said that supervised consumption sites have a lot of evidence supporting them — pointing to past reviews of the research that concluded the sites are effective in several areas. But this latest review of the research is more rigorous than those done before it, and it detected little to no effect from supervised consumption sites in the best studies the researchers could find.

That is not to definitively say that supervised consumption sites don’t work; it’s more that we simply don’t know yet. One of the problems the review found is that the research is seriously lacking in this area. Out of the dozens of studies on the topic they found, the researchers concluded that only eight were rigorous and transparent enough to include in the review. With such a small pool of studies included, it’s possible — maybe even likely — that these few studies were in some ways biased, so future research could produce entirely different findings.

As a result, several experts who support supervised consumption sites said that the new review of the research is fundamentally flawed. “They excluded, almost systematically, a lot of the studies that had demonstrated benefits on the metrics that they have selected,” Leo Beletsky, a professor of law and health sciences at Northeastern University, told me.

The review does not show that supervised consumption sites lead to, as detractors claim, more drug use and crime. In fact, the findings speak against that, if anything, as the sites appear to be linked to slightly lower drug-related crime.

But the review indicates that the sites are not as evidence-based as supporters often claim, and more research is needed to reach hard conclusions about supervised consumption sites one way or the other.

What the new review of the research found

The new review of the research, from Tom May, Trevor Bennett, and Katy Holloway at the University of South Wales in the UK, was a standard meta-analysis. The researchers first searched for previous studies on supervised drug consumption sites, pulling out 40, most of which looked at sites in Vancouver, Canada, and Sydney, Australia.

They then tried to weed out the weaker studies — meaning, in scientific terms, those that didn’t provide fully replicable data and those that didn’t have a comparison group. That left them with eight studies total.

The researchers then looked through the eight studies to measure the possible effects of the sites on several outcomes, including ambulance attendances relating to opioid-related events, overdose mortality, drug-related crime, borrowing or sharing syringes and injecting equipment, and problematic heroin use or injection.

Ultimately, the researchers concluded that supervised consumption sites had no significant effect on most outcomes. The sites only had a small favorable relation with drug-related crimes, and a small unfavorable association to problematic heroin use or injection.

The unfavorable result, however, does not necessarily mean that supervised consumption sites lead to more problematic heroin use or injection. By their very nature, these sites are built for people who are using heroin in a problematic way — that’s why these people may need such an intervention and supervision in the first place. In other words, the finding may only speak to the existing population that supervised consumption sites attract.

The researchers noted as much: Supervised consumption sites “have been found to attract the most problematic heroin users.” They went on: “This might influence outcomes as a result of comparing pre-existing risk behaviours and related health harms with less serious behaviours among the non-[site] group.”

Rebecca Goldin, director of STATS.org, said this reflects a common problem in this kind of research: “No meta-analysis can overcome systematic bias or problems that occur with the body of literature it incorporates. To mind, a risk in this particular literature is that a higher risk population is taking part in [supervised consumption sites], resulting in a diminished effect in the assessment.”

Still, as the first meta-analysis of supervised consumption sites to look at a more thorough list of outcomes, it presents disappointing findings — suggesting that these sites may have little to no impact overall.

There are limitations in the review. The researchers might have missed some potentially strong studies, particularly those that weren’t in English and didn’t provide fully replicable data. The researchers also acknowledged that “there were relatively few studies suitable for meta-analysis,” and once the body of research grows, it could lead to different conclusions.

The review contradicts past research

The new review’s conclusions also sharply contradict previous reviews of the research.

For example: Drawing on more than a decade of studies, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in 2018 concluded that safe injection sites led to “safer use for clients” and “wider health and public order benefits.” Among those benefits: reductions in risky behavior that can lead to HIV or hepatitis C transmission, drops in drug-related deaths and emergency service call-outs related to overdoses, and greater uptake in drug addiction treatment, including highly effective medications for opioid addiction.

But EMCDDA’s review wasn’t a traditional meta-analysis, so it wasn’t as rigorous or selective in what studies — and what quality of studies — were included in the review. That allowed EMCDDA to include more studies, but many of those studies may have been of poor quality.

For Humphreys, the new review is more reliable than EMCDDA’s look at the research. As he put it, “If you impose even a modest methodological bar, and then those [studies’] effects go away, to me that’s worrisome.”

Beletsky pushed back — pointing out that the review of the evidence only looked at eight studies, none of which were randomized controlled trials. “That signals in and of itself that they’re not literally looking at the full picture,” Beletsky said. That’s why he favors the systematic reviews that have been done in the past and included far more studies, such as EMCDDA’s.

The eight studies, though, were meant to be the best that the researchers could find. The studies that were excluded were those for which the researchers couldn’t get full data sets and which didn’t have comparison groups — fairly big methodological gaps.

This is typical in meta-analyses: The ideal is randomized controlled trials. But if none exist, researchers start looking at other kinds of studies, while maintaining some level of rigor, to tease out the evidence that is available.

David Wilson, a criminologist at George Mason University, said the review “is a solid meta-analysis and adheres to basic practice standards for this type of study.” But he took issue with one of the models the researchers used, and felt they could have paid more attention to publication bias.

Others were more critical. Michael Lavine, a statistician at the University of Massachusetts Amherst, acknowledged that the methodology in the meta-analysis is “very common in medical and social science research.” But he called that methodology “bad,” and warned that the outcome measure it uses — known as “odds ratio” — doesn’t tell us how many people are helped by supervised consumption sites.

Regina Nuzzo, a statistician at Gallaudet University, echoed Lavine’s concerns. She also emphasized that not only did the review analyze just eight studies, but that those eight studies only looked at four supervised consumption sites total — which she said is “a bit like double-dipping.”

Another way to look at this, though, is not that this review is flawed, but that the underlying research is flawed — if these truly are the eight most rigorous studies in the field — and, as a result, the research can’t give us much information about the effectiveness of supervised consumption sites.

“If you are an advocate, you could say correctly that if we assume these are effective, we do not have sufficient information to confidently overturn that presumption,” Humphreys said. “But it’s equally true if you took another view — just look at it as a cold, scientific question — you could say we also don’t have the evidence to overturn the presumption that these don’t make any difference.”

The potential problem: supervised consumption sites may not scale well

One thing supervised consumption sites do is reverse overdoses — thousands over the years, by some advocates’ estimates. That’s why the sites’ staff have naloxone, the opioid overdose antidote, and oxygen tanks on-site. So how could it possibly be that the sites don’t reduce overdose mortality, perhaps the most important metric in an increasingly deadly opioid crisis, when they’re reversing all these overdoses?

Part of it, Humphreys suggested, is most overdoses are not fatal. It’s also possible that the sites may enable more drug use, leading to more overdose deaths even as others are stopped — although the there’s no good evidence to support this possibility.

The bigger problem, though, seems to be that supervised consumption sites may not have enough reach to have a significant impact.

The review of the research speaks to this point, noting that “facilities are limited in the number of users they can accommodate.” Consider that Vancouver, for example, was previously estimated to have about 5,000 people who inject drugs. A site that can hold at most a dozen or so people at a time and is closed for some parts of the day is simply not going to have much of a reach in such a large population — servicing, the review suggested, “a small fraction of users each day.”

That’s made worse by further restrictions on who supervised consumption sites will accept. They often won’t, for example, allow people to share drugs or assist each other in injecting. So people who share drugs or need assistance from others will simply use elsewhere — in the streets, at home, in a motel, wherever. That further limits these sites’ reach.

Beletsky agreed: “It’s not surprising to me that the population-level impact is limited because the capacity of these facilities is limited in terms of hours, throughput of people, and so forth.”

Humphreys guessed that the likely truth is supervised consumption sites work “really little.” It’s not that they don’t have any effect, but that the effect is likely so small that it’s not going to be picked up at a population level by the research.

To this end, some advocates are trying to expand the reach of supervised consumption sites. In Canada, for instance, activists have deployed more mobile pop-up sites that can reach communities where a fully staffed building may not always be needed or available.

Another point, made by Beletsky, is perhaps single supervised consumption sites aren’t supposed to have big effects on a population scale. Maybe it’s fine if the sites just help a limited group of people who need them.

But by scaling them up through other means — like pop-up sites — you may start seeing a broader community effect, Beletsky argued. “Thus far, these interventions have been limited,” he said. “They’ve been mired in legal and political battles. They’ve been artificially suppressed. They could be doing a lot more.”

There are plenty of evidence-backed solutions to the opioid epidemic

Despite the disappointing results for supervised consumption sites, Humphreys said that he’s not discouraged about the country’s ability to fight the opioid epidemic. “We have plenty of other things that we know, with much more confidence, that work,” he explained.

At the top of those other things is treatment — specifically, medications like methadone and buprenorphine. There is decades of evidence behind these medications, showing that they reduce the mortality rate among opioid addiction patients by half or more and keep people in treatment better than other approaches. When France relaxed restrictions on doctors prescribing buprenorphine in response to its own opioid crisis in 1995, the number of people in treatment rose and overdose deaths fell by 79 percent over the following four years.

But these medications, and addiction treatment in general, remain largely inaccessible in the US. A 2016 surgeon general report concluded that only 10 percent of people with a substance use disorder get specialty treatment, in large part due to a lack of affordable and accessible treatment options. And even when treatment is available, other federal data suggests that fewer than half of treatment facilities offer opioid addiction medications.

Sticking exclusively to the realm of harm reduction, the US could do a lot more there too. Consider needle exchanges, where people can pick up sterile syringes and trade in used needles. The decades of research show needle exchanges combat the spread of bloodborne diseases like hepatitis C and HIV, cut down on the number of needles thrown out in public spaces, and link more people to treatment — all without enabling more drug use.

Yet needle exchanges remain scarce in the US, as Josh Katz reported for the New York Times: “According to the North American Syringe Exchange Network, 333 such programs operate across the country, up from 204 in 2013. In Australia, a country with less than a tenth as many people, there are more than 3,000.”

Even some more innovative, controversial solutions appear to have more evidence than supervised consumption facilities. Humphreys said that the evidence behind prescription heroin sites, as one example, is “much stronger.”

The idea behind prescription heroin sites: Some people with opioid addiction are going to use heroin no matter what. For whatever reason, traditional therapies just aren’t going to work for them — just like some treatments for, say, heart disease or cancer don’t work for some patients. So if that happens, it’s better to give them a safe source of the drug they’re seeking and a safe place to inject it, rather than letting them pick it up on the street — laced with who knows what — and possibly overdose without medical supervision.

Researchers credit the European prescription heroin programs with better health outcomes, reductions in drug-related crimes, and improvements in social functioning, such as stabilized housing and employment. Canadian studies also deemed prescription heroin effective for treating heavy heroin use. A review of the research — which included randomized controlled trials from Switzerland, the Netherlands, Spain, Germany, Canada, and the UK — reached similar conclusions, noting sharp drops in street heroin use among people in the treatment.

There is no prescription heroin program in the US.

Humphreys argued that, in a world with limited financial resources and finite political and cultural capital, governments should try to first support the more evidence-based approaches than those with less.

“Should you have a culture war over something that barely engages the population and at most has a teeny effect when we still have people who can’t get methadone and buprenorphine, which have a whopping effect and can engage a huge number of people?” Humphreys said. “For me, that would be an obvious decision.”

Beletsky rejected the idea that we have to choose between different approaches, arguing that safe consumption sites can complement other interventions in the opioid epidemic.

“We should be doing all those things that you mentioned,” Beletsky said. “But there are challenges in reaching some of the most at-need populations who can benefit from those interventions. And I think that safe consumption facilities provide a platform for reaching those folks.” He added, “Safe consumption facilities really operate as a low-threshold doorway for people who typically will not seek care in other settings.”

For example, someone who uses heroin may have had bad experiences with the criminal justice system or health care system in the past. That may make him skeptical of going to these institutions — or any other official institutions — for help. A supervised consumption site, though, can be different, since it’s an environment in which people are less judgmental about drug use. If the people running supervised consumption sites take advantage of this, they could use their better stature with people who use heroin to guide them to treatment and recovery.

But there’s no strong evidence to support the sites as an effective intervention for getting people into treatment and recovery — given that the new review of the research found no good studies that adequately evaluated for this.

That goes back to the core problem: There is a lot out there about supervised consumption sites that certainly seems promising, even intuitive. But until the empirical research backs it up, pouring time and money into this kind of intervention may not be as evidence-based as people think.

Source: A study questioning the evidence for safe injection sites has been retracted – Vox August 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

 

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

|Assemblyman Jim Wood (D-Healdsburg), who has crafted cannabis regulations, said the licensing system had not yet lived up to its promise.

The state licensing process this past year has been a painful one,” said Wood, adding that the complex rules are particularly difficult for small businesses. “I recognize that this has been a significant undertaking for the state, and you combine that with the cannabis industry learning how to navigate the process — it’s been difficult for them both.”

The legalization of recreational pot has also created tension in areas of the state where cannabis growers are operating close to residents.

Jesse Jones said he moved his family to Petaluma from Marin County six months ago so his three children could enjoy more open space, but he is now fighting a proposal for a cannabis farm to operate a few hundred feet from his home, in part because of safety issues.

“You are going to have what is still a [Schedule 1] narcotic being produced in line of sight of my kids’ trampoline, on a shared road that was never intended for this type of commercial operation,” said Jones, an energy industry executive.

Sanjay Bagai, a former investment banker who lives with his family next door to a new cannabis farm in Sonoma County, is a leader of a residents group called Save Our Sonoma Neighborhoods, which has obtained a preliminary court ruling against one cannabis-growing operation.

Bagai said his group was “not anti-cannabis” but added that pot cultivation “is not something that fits into our neighborhood here.”

“The smell is horrific,” he said of the marijuana plants. “It’s like rotting flesh. And the traffic is insane.”

Quality-of-life complaints have also surfaced in neighborhoods where cannabis sellers have set up shop.

Van Nuys Neighborhood Council President George Thomas said he had received about a dozen complaints in the last year from residents living near pot stores who were concerned about loitering, the smell of marijuana smoke and other issues. Thomas, who is the publisher of the Van Nuys News Press and is an LAPD volunteer, passes complaints on to police officers.

“If they are not in compliance,” Thomas said, “if they are within a thousand feet of a school or church, we are totally against them and we are happy to work with the neighborhood prosecutor in the city attorney’s office to shut them down.”

By Kurtis Lee  Dec 19, 2018

 

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

Abstract
Background—As an increasing number of states liberalize cannabis use and develop laws and local policies, it is essential to better understand the impacts of neighborhood ecology and marijuana dispensary density on marijuana use, abuse, and dependence. We investigated associations between marijuana abuse/dependence hospitalizations and community demographic and environmental conditions from 2001–2012 in California, as well as cross-sectional associations between local and adjacent marijuana dispensary densities and marijuana hospitalizations.

Source: Drug Alcohol Depend. 2015 September 1; 154: 111–116. doi:10.1016/j.drugalcdep.

 

(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

 

Outbreak Alert Update: Potential Life-Threatening Vitamin K-Dependent Antagonist Coagulopathy Associated With Synthetic Cannabinoids Use

Summary

 

Since the index case was identified on March 8, 2018 in Illinois, at least 160 people have presented to Healthcare facilities with serious unexplained bleeding. The preponderant number of patient presentations were in Illinois with other cases being reported from Florida, Indiana, Kentucky, Maryland, Missouri, Pennsylvania, Virginia, and Wisconsin. Laboratory investigation confirms brodifacoum exposure in at least 60 patients. There are at least 3 fatalities. At least 7 synthetic cannabinoids product samples related to this outbreak have tested positive for brodifacoum. At least one synthetic cannabinoids product has tested positive for both synthetic cannabinoid AB-FUBINACA and brodifacoum.

 

Lessons Learned:

Patients with a history of synthetic cannabinoids (e.g., K2, Spice, and AK47) use may:

  • Present with complaints unrelated to bleeding (e.g., appendicitis) and have numerical coagulopathy.
  • Be asymptomatic and ignorant of their numerical coagulopathy.

The issue with vitamin K treatment is cost, not availability. The cost of oral vitamin K for two weeks treatment can be $8,000 and treatment may be for months. Options are being explored to address these issues.

What are the Clinical Signs of Coagulopathy?

 

Clinical signs of coagulopathy include bruising, nosebleeds, bleeding gums, bleeding disproportionate to injury, vomiting blood, coughing up blood, blood in urine or stool, excessively heavy menstrual bleeding, back or flank pain, altered mental status, feeling faint or fainting, loss of consciousness, and collapse.

 

 

What Do Health Care Providers Need To Do?

 

Healthcare providers should maintain a high index of suspicion for vitamin K-dependent antagonist coagulopathy in patients with a history of synthetic cannabinoids (e.g., K2, Spice, and AK47) use:

 

  • Presenting with clinical signs of coagulopathy, bleeding unrelated to an injury, or bleeding without another explanation; some patients may not divulge use of synthetic cannabinoids.
  • Presenting with complaints unrelated to bleeding (e.g., appendicitis).

 

Healthcare providers should be aware that patients with vitamin K-dependent antagonist coagulopathy associated with synthetic cannabinoids use may have friends or associates who have used the same synthetic cannabinoids product but are asymptomatic and ignorant of their numerical coagulopathy.

 

All patients should be asked about history of illicit drug use. All “high-risk” patients (e.g., synthetic cannabinoids users), regardless of their presentation, should be screened for vitamin K-dependent antagonist coagulopathy by checking their coagulation profile (e.g., international normalized ratio (INR) and prothrombin time (PT)).

 

  • Proceduralists (e.g., trauma/general/orthopedic/oral/OB-GYN/cosmetic surgeons, dentists, interventional cardiologists/radiologists, and nephrologists) should be aware that patients with a history of synthetic cannabinoids (e.g., K2, Spice, and AK47) use may be anti-coagulated without clinical signs of coagulopathy. These patients should be screened for vitamin K-dependent anti-coagulant coagulopathy prior to their procedure.

 

  • Contact your local Poison Information Center (1-800-222-1222) for questions on diagnostic testing and management of these patients.
  • Promptly report suspected cases to your local health department or your state health department, if your local health department is unavailable. In addition, report any similar cases encountered since 01 February 2018 to your local health department.

 

In an effort to better understand the scope of this outbreak, ask your Medical Examiners’ office to report suspected cases, especially those without an alternative diagnosis. If individuals are identified after death or at autopsy showing signs of suspicious bleeding as described above, coroners are encouraged to report the cases to their local health department.

 

For updated information about the Illinois outbreak—connect with the Illinois Department of Health http://www.dph.illinois.gov/topics-services/prevention-wellness/medical-cannabis/synthetic-cannabinoids

 

 

Source:  Coca @ CDC

 

 

 

 

 

 

There exists sufficient empirical data from cellular to epidemiological studies to warrant caution in the use cannabinoids including cannabidiol as recreational and therapeutic agents.

Cannabinoids bind to CB1R receptors on neuronal mitochondrial membranes where they can directly disrupt key functions including cellular energy generation, DNA maintenance and repair, memory and learning.

Empirical literature associates cannabinoid use with CB1R-mediated vasospastic and vasothrombotic strokes, myocardial infarcts and arrhythmias.  Cannabis has been associated with increased cardiovascular stiffness and vascular aging, a major surrogate for organismal aging.  In the pediatric-congenital context CB1R-mediated cannabis vasculopathy forms a major pathway to teratogenesis including VSD, ASD, endocardial cushion defects, several other cardiovascular anomalies  and, via the omphalo-vitelline arterial CB1R’s, gastroschisis.  Cannabis has been linked with several other malformations including hydrocephaly.  Cannabinoids also induce epigenetic perturbations; and, like thalidomide, interfere with tubulin polymerization and the stability of the mitotic spindle providing further major pathways to genotoxicity.

Assuming validity of the above data, increased levels of both adult and neonatal morbidity should accompany increased cannabis use. The “Colorado Responds to Children with Special Needs” program tracked congenital anomalies 2000-2013.  Importantly this data monitors the teratological history of Colorado since 2001 when the state was first advised that intrastate cannabis would not be prosecuted by the Federal Government.

Over the period 2000-2013 Colorado almost doubled its already high congenital anomaly rate rising from 4,830 anomalies / 65,429 births (7.4%) to 8,165 / 65,004 (12.6%); the US mean is 3.1%.  Major cardiovascular defects rose 61% (number and rate); microcephaly rose 96% (from 30 to 60 cases peaking at 72 in 2009); and chromosomal anomalies rose 28% (from 175 to 225, peaking at 264 in 2010).  Over the whole period this totals to 87,772 major congenital anomalies from 949,317 live births (9.25%).

The use of cannabis in Colorado can be determined from the SAMHSA National Survey on Drug Use and Health.  A close correlation is noted between major congenital anomaly rates and rates of cannabis use in Coloradans >12 years (R=0.8825; P=0.000029; Figure 1).  Although data is not strictly comparable across U.S. registries, the Colorado registry is a passive rather than active case-finding registry and so might be expected to underestimate anomaly rates.  Given the Colorado birth rate remained almost constant over the period 2000-2013, rising only 3.6%, a simple way to quantitate historical trends is to simply project forwards the historical anomaly rate and compare it to the rise in birth numbers.  However rather than remaining relatively stable in line with population births, selected defects have risen several times more than the birth rate.

Colorado had an average of 67,808 births over the period 2000-2013 and experienced a total of 87,772 birth defects, 20,152 more than would have been predicted using 2000 rates.  Given the association between cannabis use and birth defects and the plausible biological mechanisms, cannabis may be a major factor contributing to birth congenital morbidity in Colorado. If we accept this and apply the “Colorado effect” to the over 3,945,875 births in USA in 2016 we calculate an excess of 83,762 major congenital anomalies annually nationwide if cannabis use rises in the US to the level that it was in Colorado in 2013.

In reality both cannabis use and cannabis concentration is rising across USA following legalization which further implies that the above calculations represent significant underestimations.  This data series terminates in 2013 prior to full legalization in 2014.  Moreover parents of children harbouring severe anomalies may frequently elect for termination, which will again underestimate numbers of abnormal live births.

In California 7% of all pregnant mothers were recently shown to test positive for cannabis exposure, including almost 25% of teenage mothers in 2015  so cannabinoids clearly constitute a significant population-wide teratological exposure.  This is particularly relevant to cannabis genotoxicity as many studies show a dramatic up-tick in genotoxic effect in the dose-response curve for both tetrahydrocannabinol and cannabidiol above a certain threshold dose as higher, sedating levels are reached.  Cannabis is usually used amongst humans for its sedative effects.

Other examples of high congenital anomaly rates accompanying increased cannabis use include North Carolina, Mexico, Northern Canada, New Zealand and the Nimbin area in Australia.

The above data leave open the distinct possibility that the rate of congenital anomalies from significant prenatal paternal or maternal cannabis exposure may become substantial.

With over 1,000 trials listed on clincaltrials.gov the chance of a type I experimental error for cannabinoid therapeutics and a falsely positive trial finding is at least 25/1,000 trials at the 5% level.

The major anomaly rate is just the “tip of the iceberg” of the often subtle neurobehavioral teratology of Foetal Cannabinoid Syndrome (FCS) following antenatal cannabinoid exposure characterized by attention, learning, behavioral and social deficits which in the longer term impose significant educational, other addiction and welfare costs – and is clearly more common .  Foetal Alcohol Syndrome (FAS) is known to be epigenetically mediated and foetal alcohol is known to act via CB1R’s.  Cannabis has significant and heritable epigenetic imprints in neural, immune and germ cell (sperm) tissues, and epigenomic disruption has been implicated in FCS.  CB1R-mediated disruption by disinhibition of the normal gamma and theta oscillatory rhythms of the forebrain which underpin thinking, learning and sanity have been implicated both in adult psychiatric disease and the neurodevelopmental aspects of FCS.

All of this implies that in addition to usually short-term therapy-oriented clinical trials, longer term studies and careful twenty-first century next generation studies will be required to carefully review inter-related genotoxic, teratologic, epigenetic, transcriptomic, metabolomic, epitranscriptomic and long term cardiovascular outcomes which appears to have been largely overlooked in extant studies – effects which would appear rather to have taken Coloradans by surprise.  Congenital registry data also needs to be open and transparent which it presently is not.  We note that cannabidiol is now solidly implicated in genotoxicity.  Governments are duty-bound to carefully weigh and balance the implications of their social policies; lest like Colorado, we too unwittingly create a “Children with Special Needs Program”.

Source :

Albert Stuart Reece

39 Gladstone Rd.,                                                                                               

Highgate Hill,

Brisbane, Queensland, Australia.   

Source:   e-mail from FamilyFirst.org.nz / March 2019

 

Human sperm stained for semen quality testing in the clinical laboratory.
Credit: Bobjgalindo/Wikipedia

 

As legal access to marijuana continues expanding across the U.S., more scientists are studying the effects of its active ingredient, tetrahydrocannabinol (THC), in teens, adults and pregnant women.

New research from Duke Health suggests men in their child-bearing years should also consider how THC could impact their  and possibly the children they conceive during periods when they’ve been using the drug.

Much like previous research that has shown , pesticides, flame retardants and even obesity can alter sperm, the Duke research shows THC also affects epigenetics, triggering structural and regulatory changes in the DNA of users’ sperm.

Experiments in rats and a study with 24 men found that THC appears to target genes in two major cellular pathways and alters DNA methylation, a process essential to normal development.

The researchers do not yet know whether DNA changes triggered by THC are passed to users’ children and what effects that could have. Their findings will be published online Dec. 19 in the journal Epigenetics.

“What we have found is that the effects of cannabis use on males and their  are not completely null, in that there’s something about cannabis use that affects the genetic profile in sperm,” said Scott Kollins, Ph.D., professor in psychiatry and  at Duke and senior author of the study.

“We don’t yet know what that means, but the fact that more and more young males of child-bearing age have legal access to cannabis is something we should be thinking about,” Kollins said.

National research has shown a steady decline in the perceived risk of regular marijuana use. This, combined with the demand and wide availability of marijuana bred specifically to yield higher THC content, make this research especially timely, Kollins said.

The study defined regular users as those who smoked marijuana at least weekly for the previous six months. Their sperm were compared to those who had not used marijuana in the past six months and not more than 10 times in their lifetimes.

The higher the concentration of THC in the men’s urine, the more pronounced the genetic changes to their sperm were, the authors found.

THC appeared to impact hundreds of different genes in rats and humans, but many of the genes did have something in common—they were associated with two of the same major cellular pathways, said lead author Susan K. Murphy, Ph.D., associate professor and chief of the Division of Reproductive Sciences in obstetrics and gynecology at Duke.

One of the pathways is involved in helping bodily organs reach their full size; the other involves a large number of genes that regulate growth during development. Both pathways can become dysregulated in some cancers.

“In terms of what it means for the developing child, we just don’t know,” Murphy said. It’s unknown whether sperm affected by THC could be healthy enough to even fertilize an egg and continue its development into an embryo, she said.

The study was a starting point on the epigenetic effects of THC on sperm and is limited by the relatively small number of men involved in the trial, Murphy said. The findings in men also could be confounded by other factors affecting their health, such as their nutrition, sleep, alcohol use and other lifestyle habits.

The Duke team plans to continue its research with larger groups. They intend to study whether changes in sperm are reversed when men stop using marijuana. They also hope to test the umbilical cord blood of babies born to fathers with THC-altered sperm to determine what, if any epigenetic changes, are carried forward to the child.

“We know that there are effects of cannabis use on the regulatory mechanisms in sperm DNA, but we don’t know whether they can be transmitted to the next generation,” Murphy said.

“In the absence of a larger, definitive study, the best advice would be to assume these changes are going to be there,” Murphy said. “We don’t know whether they are going to be permanent. I would say, as a precaution, stop using cannabis for at least six months before trying to conceive.”

 

Source: https://medicalxpress.com/news/2018-12-exposure-cannabis-genetic-profile-sperm.html

DECEMBER 19, 2018

The legalization of recreational marijuana is associated with an increase in its abuse, injury due to overdoses and car accidents, according to a study of 28million hospital records by University of California San Francisco.

 

The legalization of recreational marijuana is associated with an increase in its abuse, injury due to overdoses, and car accidents, but does not significantly change health care use overall, according to a study by researchers at UC San Francisco.

In a review of more than 28 million hospital records from the two years before and after cannabis was legalized in Colorado, UCSF researchers found that Colorado hospital admissions for cannabis abuse increased after legalization, in comparison to other states. But taking the totality of all hospital admissions and time spent in hospitals into account, there was not an appreciable increase after recreational cannabis was legalized.

The study, appearing online May 15, 2019, in BMJ Open, also found fewer diagnoses of chronic pain after legalization, consistent with a 2017 National Academy of Sciences report that concluded substantial evidence exists that cannabis can reduce chronic pain.

“We need to think carefully about the potential health effects of substantially enhancing the accessibility of cannabis, as has been done now in the majority of states,” said senior author Gregory Marcus, MD, MAS, a UCSF Health cardiologist and associate chief of cardiology for research in the UCSF Division of Cardiology.

“This unique transition to legalization provides an extraordinary opportunity to investigate hospitalizations among millions of individuals in the presence of enhanced access,” Marcus continued. “Our findings demonstrate several potential harmful effects that are relevant for physicians and policymakers, as well as for individuals considering cannabis use.”

According to the 2014 National Survey on Drug Use and Health, more than 117 million Americans, or 44.2 percent of all Americans, have used cannabis in their lifetime, and more than 22 million Americans report having used it within the past 30 days. While its use is a federal crime as a controlled substance, 28 states and the District of Columbia now allow it for treating medical conditions. Nine of those states have legalized it for recreational use.

To understand the potential shifts in health care use resulting from widespread policy changes, Marcus and his colleagues reviewed the records of more than 28 million individuals in Colorado, New York and Oklahoma from the 2010-2014 Healthcare Cost and Utilization Project, which included 16 million hospitalizations. They compared the rates of health care utilization and diagnoses in Colorado two years before and two years after recreational marijuana was legalized in December 2012 to New York, as a geographically distant and urban state, and to Oklahoma, as a geographically close and mainly rural state.

The researchers found that after legalization, Colorado experienced a 10 percent increase in motor vehicle accidents, as well as a 5 percent increase in alcohol abuse and overdoses that resulted in injury or death. At the same time, the state saw a 5 percent decrease in hospital admissions for chronic pain, Marcus said.

“There has been a dearth of rigorous research regarding the actual health effects of cannabis consumption, particularly on the level of public health,” said Marcus, holder of the Endowed Professorship of Atrial Fibrillation Research in the UCSF School of Medicine. “These data demonstrate the need to caution strongly against driving while under the influence of any mind-altering substance, such as cannabis, and may suggest that efforts to combat addiction and abuse of other recreational drugs become even more important once cannabis has been legalized.”

The study findings may be beneficial in guiding future decisions regarding cannabis policy, the researchers said.

“While it’s convenient and often most compelling to simplistically conclude a particular public policy is ‘good’ or ‘bad,’ an honest assessment of actual effects is much more complex,” Marcus said. “Those effects are very likely variable, depending on each individual’s idiosyncratic needs, propensities and circumstances. Using the revenues from recreational cannabis to support this sort of research likely would be a wise investment, both financially and for overall public health.”

The researchers could not explain why overall health care utilization remained essentially neutral, but said the harmful effects simply may have been diluted among the much larger number of total hospitalizations. They said it also may be that some beneficial effects, either at the individual or societal level, such as violent crime, counterbalanced the negatives.

Source:  https://www.eurekalert.org/pub_releases/2019-05/uoc–lmr051319.php

The program focuses on giving Icelandic youth “better options” than drugs and alcohol.

In 1999, a study following the long-term impact of D.A.R.E. (Drug Abuse Resistance Education) concluded that the popular anti-drug program did little to prevent American youth from experimenting with drugs and alcohol.

That same year, the Icelandic Centre for Social Research and Analysis (ICSRA) was born. The institute went on to develop Iceland’s own anti-drug strategy, which did away with old and ineffective strategies (like D.A.R.E.) and instead focused on access to sports, music and art, and parental involvement.

A recent feature by AP News explored the impact of Planet Youth, one of the most successful youth drug and alcohol prevention programs in the world.

The Program’s Approach

“The key to success is to create healthy communities and by that get healthy individuals,” said Inga Dora Sigfusdottir, who founded Planet Youth (formerly “Youth of Iceland”).

Iceland has invested in providing activities (sports, music, art) and facilities (youth centers) to “give kids alternative ways to feel part of a group, and to feel good, rather than through using alcohol and drugs,” according to the Planet Youth website.

The program “is all about society giving better options,” said Reykjavik Mayor Dagur B. Eggertsson.

Prior to Planet Youth, Iceland, too, was contending with problematic substance use among its youth. The government tried to discourage drug and alcohol use through anti-drug “education” (like D.A.R.E.) that we’ve seen for a long time in the United States. But after observing the inefficacy of this approach, Iceland changed course. Rather than fixating on the potential harms of using drugs and alcohol, Planet Youth emphasizes interesting activities and better ways to spend one’s time.

“Telling teenagers not to use drugs can backlash and actually get them curious to try them,” said Sigfusdottir.

Today, Icelandic youth have among the lowest rates of substance abuse in Europe.

Other strategies employed by the Icelandic government to address youth substance abuse include imposing curfews for those under age 16, getting parents more involved in their kids’ lives, banning tobacco and alcohol advertising, and evolving the program based on current data.

The success of Planet Youth has gained the attention of other countries.

According to AP News, ICSRA currently advises 100 communities in 23 countries. Cities in Portugal, Malta, Slovakia, Russia and Kenya have also learned from the Planet Youth model.

Source:  https://www.thefix.com/iceland-anti-drug-program-curbed-substance-abuse  8/01/19

 

NEARLY 800 babies were born suffering the effects of their mother’s drug addiction in the past three years in Scotland – with experts warning the true toll is likely to be higher.

 

New figures show 774 babies were recorded as affected by addiction or suffering withdrawal symptoms from drugs between 2014 and 2017.

The drugs pass from mother to foetus through the bloodstream, resulting in babies suffering a range of withdrawal symptoms after birth and developmental delays in childhood.

Consultant neonatologist Dr Helen Mactier, honorary secretary of the British Association of Perinatal Medicine, said there was a “hidden” number of women who took drugs in pregnancy and varying definitions of drug misuse in pregnancy which meant figures were likely to be an underestimate.

She said: “The problem largely in Scotland is opioid withdrawal – heroin and methadone.

“The baby withdraws from these substances and they are very irritable, cross, unhappy children who can be quite difficult to feed until they finally get over the withdrawal.”

Dr Mactier said at birth the babies were usually small, and had small heads and visual problems. She added there is evidence they suffer developmental delays in early childhood.

The figures, revealed in a written parliamentary answer, show an increase of 80% in cases from the three-year period from 2006-9, when 427 babies were born with the condition.

However, it said the data over time should be treated with caution as there has been an improvement in recording drug misuse.

The highest numbers over the past three years were recorded in Grampian, which had 169 cases. Glasgow had 137 cases, while Tayside recorded 90, Lanarkshire 78 and Lothian 72.

Numbers have been dropping since 2011-14, when a peak of 1,073 cases were recorded.

Dr Mactier, who works at Glasgow’s Princess Royal Maternity Hospital, said having to treat babies born addicted to drugs was becoming less common in recent years.

She said: “The numbers are coming down, but we are not sure why. It is partly because women who use drugs intravenously tend to be older, so are becoming too old to have children.”

However, she pointed out one controversial area was stabilising pregnant addicts on heroin substitutes such as methadone.

She added: “That may be good for the mum, to keep her more stable and out of criminality. It is not entirely clear if that is safe for the babies, so we need more research.”

Scottish Conservative health spokesman Miles Briggs, who obtained the figures, said: “It’s a national tragedy that we see such numbers of babies being born requiring drug dependency support – we need to see action to help prevent this harm occurring.”

Martin Crewe, director of Barnardo’s Scotland, said: “We know how important it is for children to get a good start in life. We would like to see no babies born requiring drug dependency support.”

Source:   Sunday Post  15th October 2018

 

Fentanyl overdoses share many characteristics with heroin overdoses – with some important differences, according to an addiction specialist at Boston Medical Center’s Grayken Center for Addiction.

“Fentanyl is faster acting and more potent than heroin, so overdoses evolve in seconds to minutes, instead of minutes to hours, as we see with heroin overdoses,” says Alexander Walley, M.D., Director of the Boston University Addiction Medicine Fellowship Program and the Inpatient Addiction Medicine Consult Service at Boston Medical Center. “The window during which a bystander can respond shrinks substantially with fentanyl,” said Dr. Walley, who spoke about fentanyl overdoses at the recent annual meeting of the College on Problems of Drug Dependence. He noted that people may not know they are using fentanyl. In addition to being mixed into heroin, fentanyl can be sold as cocaine or counterfeit prescription opioids.

Dr. Walley was the principal investigator of a study published last year by the Centers for Disease Control and Prevention that included interviews with 64 people who survived or witnessed an opioid overdose, as well as a review of medical examiner records of 196 people who died of an opioid overdose.

He found 75 percent of people who witnessed a suspected fentanyl overdose described symptoms as occurring within seconds to minutes. Among people who witnessed the opioid overdose antidote naloxone being administered, 83 percent said that two or more naloxone doses were used before the person responded.

When Dr. Walley and colleagues analyzed death records for people who died of an opioid overdose, they found 76 percent tested positive for fentanyl in March 2015 – up from 44 percent in October 2014. They found 36 percent of fentanyl deaths had evidence of an overdose occurring within seconds to minutes after drug use, and 90 percent of people who died from a fentanyl overdose had no pulse by the time emergency medical services arrived.

Only 6 percent of fentanyl overdose deaths had evidence of lay bystander-administered naloxone. “Although bystanders were frequently present in the general location of overdose death, timely bystander naloxone administration did not occur because bystanders did not have naloxone, were spatially separated or impaired by substance use, or failed to recognize overdose symptoms,” the researchers concluded. “Findings indicate that persons using fentanyl have an increased chance of surviving an overdose if directly observed by someone trained and equipped with sufficient doses of naloxone.”

Dealing With the Fentanyl Crisis

The approach to fentanyl overdoses should be similar to heroin overdoses – except that time is especially of the essence, Dr. Walley noted. “The best way to reduce overdose risk is to not use opioids in the first place,” he said. “But if a person is using opioids, he or she should make sure someone else is observing and is prepared to use naloxone quickly.”

He stressed that for people who use fentanyl or heroin and stop because of treatment or incarceration, and then start taking the drug again upon release, the risk of an overdose is especially high because their tolerance for the drug has decreased.

Early treatment for addiction is especially important in the age of fentanyl, Dr. Walley said. “We need to make a better effort to reach people sooner,” he said. “Fentanyl is so deadly we can’t afford to wait.”

As with other types of opioid use disorders, the recommended treatment for fentanyl addiction is medication – methadone, buprenorphine (Suboxone) or naltrexone (Vivitrol).

“We need to figure out ways to make effective treatments work for patients, rather than make the patients work for the treatment,” Dr. Walley said. “That means making treatment more convenient and patient-centered. We also need to start treatment in in-patient detox programs. We know these people are more vulnerable to overdose when they are discharged, so we should start treatment before then. We also need to engage people who seek help in the emergency room in overdose prevention, harm reduction and treatment.”

 

Source:  https://drugfree.org/drug-and-alcohol-news/featured-news-rapid-response-fentanyl-overdose-critical/?utm_source=pns&utm_medium=email&utm_campaign=featured-news-rapid-response-fentanyl-overdose-critical

A new study finds the rise in drug overdose deaths in the United States has contributed to an increase in organ transplants, CNN reports.

Overdose death donors accounted for 1.1 percent of donors in 2000 and 13.4 percent in 2017, representing a 24-fold rise, the researchers report in the Annals of Internal Medicine.

The study also found many organs from overdose-death donors were not used to save lives when they could have been.

“The current epidemic of deaths from overdose is a tragedy. It would also be tragic to continue to underutilize life-saving transplants from donors,” said lead researcher Dr. Christine Durand of Johns Hopkins University. “We have an obligation to optimize the use of all organs donated. The donors, families and patients waiting deserve our best effort to use every gift of life we can.”

 

Source:   https://drugfree.org/drug-and-alcohol-news/rise-drug-overdose-deaths-contributes-increase-organ-transplants/?utm_source=pns&utm_medium=email&utm_campaign=rise-drug-overdose-deaths-contributes-increase-organ-transplants

 

 

 

FDA Approved Epidiolex®, a purified form of CDB, this week.

 

Families whose children suffer seizures from epilepsy have asked legislators in several states to “legalize” cannabidiol (CBD), “medicinal” marijuana, and “whole-plant extracts” so they can use them to reduce their children’s seizures. The marijuana industry has been happy to accommodate, helping parents lobby legislators and, when successful, producing CBD products.

But none of these products is approved by FDA as safe or effective. All make unsubstantiated medical claims. Few contain what their labels claim. Some contain contaminants. Recently, the Centers for Disease Control and Prevention reported that 52 people in Utah were poisoned by an unregulated CBD product, which contained a synthetic cannabinoid. The agency warned regulations are needed to address “this emerging public health threat.”

This week, FDA approved Epidiolex to treat two forms of epilepsy in patients ages 2 and older. Epidiolex is an extract of marijuana called cannabidiol (CBD) that is purified and delivers a reliable, consistent dose. Clinical trials proved it reduces epileptic seizures. Now families have a choice. They no longer need to risk giving their children unregulated products that may harm their already fragile health.
Epidiolex

FDA approved
Proven to be safe
Proven to reduce seizures
A purified extract of marijuana that is 99% CBD, less than 1% THC, marijuana’s psychoactive ingredient
Doctors prescribe.
Patients buy at pharmacies.
Likely to be insured.
Likely moved to a lower Schedule
CBD Products States Have Legalized

Not FDA approved
Not proven to be safe
Not proven to reduce seizures
Unpurified extracts containing up to 20% CBD, THC, other components. Some are contaminated.
Doctors recommend.
Patients buy at dispensaries.
Not insured.
Likely to remain in Schedule 1
Many media outlets are reporting that FDA’s approval of Epidiolex means CBD will be placed in a lower schedule of the federal Controlled Substances Act. But FDA Commissioner Scott Gottlieb clarifies, “This is the approval of one specific CBD medication for a specific use . . . based on well-controlled clinical trials evaluating the use of this compound in the treatment of a specific condition.” Just as Marinol, Cesamet, and Syndros, FDA-approved forms of THC, are in lower schedules but THC remains in Schedule I, Epidiolex is likely to be placed in a lower Schedule while CBD likely will remain in Schedule I.

Commissioner Gottlieb says FDA continues to support rigorous scientific research into potential medical treatments using marijuana or its components but is concerned about the proliferation and illegal marketing of unapproved CBD-containing products making unproven medical claims. FDA will continue to act to end such behavior, he says.

Action is certainly needed. Searching for CBD Oil on Amazon brings up 929 results. All unregulated.


 

 

Examples of unregulated CBD products. None has applied to FDA to conduct clinical trials for FDA approval.

 

 

Read the Centers for Disease Control and Prevention’s warning about unregulated CBD products here.
Read the FDA announcement of its approval of Epidiolex here.
Read See FDA CBD warning letters here.
Download The Marijuana Report Issue Paper on CBD here.

Disclosure: The author holds stock in GW Pharmaceuticals, the company that makes Epidiolex®.
 

Marijuana reporter Joel Warner asks if the media is currently biased in support of marijuana legalization.

He cites a recent incident brought to his attention by Kevin Sabet, founder of SAM (Smart Approaches to Marijuana), who had received a tip that the next-day release of the 2014 National Survey on Drug Use and Health would show that marijuana use in Colorado has reached the highest levels in the nation. Sabet wrote a press release which fell on deaf ears. A Google analysis shows only 17 stories were written about this consequence of legalization in Colorado.

In contrast, a few weeks before, the release of the 2015 Monitoring the Future Survey showed a slight downturn in past-month marijuana use among 8th, 10th, and 12th grade students nationwide. It was hyped by some in the press as a signal that legalization is of no consequence. A total of 156 news stories covered the results of this survey.

Warner notes that there are now “marijuana-business newspapers and marijuana culture magazines, full-time marijuana-industry reporters (this writer included), and even a marijuana-editorial division at the Denver Post called the Cannabist, staffed with a marijuana editor and cannabis strain reviewers,” like Jake Browne, pictured above.
 
He asks if the data supports it, could marijuana journalists “be expected to conclude that legalization has been a failure, if that means they would also be writing the obituaries for their own jobs?”
 
Read Joel Warner’s thoughtful International Business Times article here.

Source: Email from Monte Stiles, National Families in Action January 2016

Source: http://archive.unu.edu/events/files/2008/Santos_SharedRespnsibility_presentation_200810.pdf 2008

Two major public health issues are colliding,’ CDC official warns

Public health officials grappling with record-high syphilis rates around the nation have pinpointed what appears to be a major risk factor: drug use.

“Two major public health issues are colliding,” said Dr. Sarah Kidd, a medical officer at the Centers for Disease Control and Prevention and lead author of a new report issued Thursday on the link between drugs and syphilis.
The report shows a large intersection between drug use and syphilis among women and heterosexual men. In those groups, reported use of methamphetamine, heroin and other injection drugs more than doubled from 2013 to 2017.
The data did not reveal the same increases in drug use among gay men with syphilis, the group with the highest rates of the disease.

Researchers said the results suggest that drug use — and the risky sexual behaviors associated with it — may be driving some of the increase in syphilis transmission among heterosexuals.
People who use drugs are more likely to engage in unsafe sexual behaviors, which put them at higher risk for sexually transmitted diseases, experts said. The CDC also saw increases in syphilis among heterosexuals during the crack cocaine epidemic of the 1980s and 1990s, and use of the drug was associated with higher syphilis transmission.
“The addiction takes over,” said Patricia Kissinger, an epidemiology professor at Tulane University School of Public Health and Tropical Medicine.

For example, people using drugs may avoid condoms, have multiple sex partners or exchange sex for drugs or money — all significant risk factors for sexually transmitted diseases, said Dr. Sara Kennedy, medical director of Planned Parenthood Northern California.
“I think it’s impossible to eradicate syphilis and congenital syphilis unless we are simultaneously addressing the meth-use and IV-use epidemic,” Kennedy said.
Syphilis rates are setting records nationally. They jumped by 73 percent overall and 156 percent for women from 2013 to 2017. The highest rates were reported in Nevada, California and Louisiana.
Syphilis — which had been nearly eradicated before its resurgence in recent years — is treatable with antibiotics, but if left untreated it can lead to organ damage and even death. Congenital syphilis, which occurs when a mother passes the disease to her unborn baby, can lead to premature birth and newborn deaths.

The study’s authors analyzed syphilis cases from 2013 to 2017 and determined which patients had also reported using drugs. They discovered methamphetamine was the biggest problem: More than one-third of women and one-quarter of heterosexual men with syphilis reported using methamphetamine within the previous year.
Substance use among both populations was highest in 13 Western states and lowest in the Northeast. In California, methamphetamine use by people with syphilis nearly doubled for women and heterosexual men from 2013 to 2017, according to the California Department of Public Health.

‘OPPORTUNITY LOST’

The intersecting epidemics of sexually transmitted infections and substance abuse make it harder to identify and treat people with syphilis because drug use makes people less likely to go to the doctor and to report their sexual partners, Kidd said.
Pregnant women also may be reluctant to seek prenatal care and get syphilis testing and treatment because of concerns their doctor will report the drug use.
To stem the transmission of syphilis, the CDC urges more collaboration between programs that address STDs and programs that treat substances abuse.

Drug use is an “incredibly huge contributing factor” to somebody getting an STD and transmitting it, said Jennifer Howell, sexual health program coordinator for the health district in Washoe County, Nev.
“Everybody needs to see that we are dealing with a lot of the same clients,” she said.
Fresno County has the highest rate of congenital syphilis in California. Its health department analyzed 25 cases of congenital syphilis in 2017 and determined that more than two-thirds of the mothers were using drugs, said Joe Prado, the county’s community health division manager.
The county has started offering STD testing for people entering inpatient drug treatment facilities, Prado said. “That’s our opportunity to get them screened,” he said.
Those who return for the results are offered incentives such as gift cards. The county also gives people in drug treatment a care package that contains condoms and education materials about sexually transmitted infections, Prado said.

The city of Long Beach sends a mobile clinic to drug treatment facilities, where it provides HIV testing, said Dr. Anissa Davis, the city’s health officer. She said Long Beach hopes to expand services to include screening for other sexually transmitted infections.
Although increased collaboration between drug treatment providers and STD clinics is essential, it’s not always easy because they traditionally have not worked together, said Kissinger of Tulane.
“The STI people are hyper-focused on STIs and the substance abuse people are focused on substance abuse,” she said. It is an “opportunity lost” if people in drug treatment aren’t screened for syphilis and other sexually transmitted infections, she added.

Fighting the rising rates of syphilis will also require more resources, said Dr. Jeffrey Klausner, a professor of medicine and public health at UCLA.
“The STD workforce has almost entirely disappeared,” he said. “While policies could be put in place that require syphilis testing, those policies also have to come with resources.”

SOURCE: ANNA GORMAN, KAISER HEALTH NEWS 15TH FEB2019

People who are mentally ill or addicted can’t work effectively, if at all, so they have to turn to crime and/or public support for survival.  Marijuana escalates the risk of mental illness 5 times.[i] On average, 17% of adolescents and 9% of adults  will become addicted.[ii]Based on federal research  7,000 people use marijuana for the first time each day.[iii] Taking an average of 13%, nationally over 332,000 new marijuana addicts will be created.  California’s share at 13% of the population will be over 33,000 new addicts annually, adding another 1.3 billion in cost at $40,000 each.  Instead of preventing these problems, we can expect more academic failure, lost productivity, mental illness, addiction and crime. In Sacramento, 59% of all arrestees for any crime tested positive just for marijuana; 83% for any drug[iv]. Jail overcrowding is also a factor as those deemed mentally ill languish there for weeks and months, waiting for space in a mental health facility.

Marijuana causes permanent brain damage and loss of IQ for anyone under 25.[v]  It causes psychotic breaks leading to gruesome acts, including decapitations, stabbings, mass murders and suicides. Other harms include DNA damage causing birth abnormalities[vi] not just in the next generation, but the next four (100 years).  Because marijuana is fat soluble, it stays in the body and brain for one month, compounding with each additional use.  The impairment adversely affects cognition, judgement and memory all of which contribute to traffic deaths. [vii]

MARIJUANA – THE ECONOMIC COSTS 
Aside from the devastating environmental cost, the social costs are huge.  For alcohol and tobacco, the social costs exceed tax revenues by 9 to 1. The black market won’t disappear. In Colorado the black market is still about 50% of the total.  In California only about 16% of cultivators have signed up to be licensed and taxed. The rest will avoid taxes and sell to the black market throughout the US. In 2009, a study called Shoveling Up: The Impact of Substance Abuse on Federal, State and Local Governments[viii] was done which showed in 2005, California spent 19.5% of its budget ($19.9 billion) on substance abuse, of which only $38 million (1/3rd of 1%) on prevention, and the rest shoveling up the damage. This is horrible economic policy, and its much worse today.  Instead of preventing this preventable disease, we cultivate it.

Voters bought the Gavin Newsom lie that Prop 64 would be a good thing. The orchestrated legislative analysis, approved by our Attorney General, Secretary of State, et al., suggested the state would save $100 million in prison costs, get rid of the black market and earn up to $1 billion in tax revenues. No mention of the environmental devastation and reclamation costs.  It outrageously suggested marijuana had no serious health impacts.  To cap it off, the illicit drug trade and out-of-state billionaires spent $35 million to back the campaign. If we care about our kids, and our future, its time to fight back.

[i] https////health.harvard.edu/Teens who smoke pot at risk for later schizophrenia

[ii] www.drugabuse.gov

[iii] www.theatlantic.com/Everyday 7,000 Americans try weed for the first time

[iv] www.ncjrs.gov/pdfiles1/ondcp/ADAMII Arrestee Drug Abuse Monitoring Program

[v] www.healthline.com.  The Effects of Marijuana on your body.

[vi] www.sciencedaily.com.  Marijuana Damages DNA and may cause cancer

[vii] www.nbcnews.com/health/healt-news/Pot Fuels Surge In Driving Deaths

[viii] www.casacolumbia.org/Shoveling Up:  The Impact of Substance Abuse on Federal, State and Local Budgets

Source: http://tbac.us/2018/09/15/marijuana-causes-mental-illness-and-addiction-in-turn-more-homelessness-poverty-and-crime/ September 2018

You’re aware America is under siege, fighting an opioid crisis that has exploded into a public-health emergency. You’ve heard of OxyContin, the pain medication to which countless patients have become addicted. But do you know that the company that makes Oxy and reaps the billions of dollars in profits it generates is owned by one family?

The newly installed Sackler Courtyard at London’s Victoria and Albert Museum is one of the most glittering places in the developed world. Eleven thousand white porcelain tiles, inlaid like a shattered backgammon board, cover a surface the size of six tennis courts. According to the V&A;’s director, the regal setting is intended to serve as a “living room for London,” by which he presumably means a living room for Kensington, the museum’s neighborhood, which is among the world’s wealthiest. In late June, Kate Middleton, the Duchess of Cambridge, was summoned to consecrate the courtyard, said to be the earth’s first outdoor space made of porcelain; stepping onto the ceramic expanse, she silently mouthed, “Wow.”

The Sackler Courtyard is the latest addition to an impressive portfolio. There’s the Sackler Wing at New York’s Metropolitan Museum of Art, which houses the majestic Temple of Dendur, a sandstone shrine from ancient Egypt; additional Sackler wings at the Louvre and the Royal Academy; stand-alone Sackler museums at Harvard and Peking Universities; and named Sackler galleries at the Smithsonian, the Serpentine, and Oxford’s Ashmolean. The Guggenheim in New York has a Sackler Center, and the American Museum of Natural History has a Sackler Educational Lab. Members of the family, legendary in museum circles for their pursuit of naming rights, have also underwritten projects of a more modest caliber—a Sackler Staircase at Berlin’s Jewish Museum; a Sackler Escalator at the Tate Modern; a Sackler Crossing in Kew Gardens. A popular species of pink rose is named after a Sackler. So is an asteroid.

The Sackler name is no less prominent among the emerald quads of higher education, where it’s possible to receive degrees from Sackler schools, participate in Sackler colloquiums, take courses from professors with endowed Sackler chairs, and attend annual Sackler lectures on topics such as theoretical astrophysics and human rights. The Sackler Institute for Nutrition Science supports research on obesity and micronutrient deficiencies. Meanwhile, the Sackler institutes at Cornell, Columbia, McGill, Edinburgh, Glasgow, Sussex, and King’s College London tackle psychobiology, with an emphasis on early childhood development.

The Sacklers’ philanthropy differs from that of civic populists like Andrew Carnegie, who built hundreds of libraries in small towns, and Bill Gates, whose foundation ministers to global masses. Instead, the family has donated its fortune to blue-chip brands, braiding the family name into the patronage network of the world’s most prestigious, well-endowed institutions. The Sackler name is everywhere, evoking automatic reverence; the Sacklers themselves, however, are rarely seen.

The descendants of Mortimer and Raymond Sackler, a pair of psychiatrist brothers from Brooklyn, are members of a billionaire clan with homes scattered across Connecticut, London, Utah, Gstaad, the Hamptons, and, especially, New York City. It was not until 2015 that they were noticed by Forbes, which added them to the list of America’s richest families. The magazine pegged their wealth, shared among twenty heirs, at a conservative $14 billion. (Descendants of Arthur Sackler, Mortimer and Raymond’s older brother, split off decades ago and are mere multi-millionaires.) To a remarkable degree, those who share in the billions appear to have abided by an oath of omertà: Never comment publicly on the source of the family’s wealth.

That may be because the greatest part of that $14 billion fortune tallied by Forbes came from OxyContin, the narcotic painkiller regarded by many public-health experts as among the most dangerous products ever sold on a mass scale. Since 1996, when the drug was brought to market by Purdue Pharma, the American branch of the Sacklers’ pharmaceutical empire, more than two hundred thousand people in the United States have died from overdoses of OxyContin and other prescription painkillers. Thousands more have died after starting on a prescription opioid and then switching to a drug with a cheaper street price, such as heroin. Not all of these deaths are related to OxyContin—dozens of other painkillers, including generics, have flooded the market in the past thirty years. Nevertheless, Purdue Pharma was the first to achieve a dominant share of the market for long-acting opioids, accounting for more than half of prescriptions by 2001.

According to the Centers for Disease Control, fifty-three thousand Americans died from opioid overdoses in 2016, more than the thirty-six thousand who died in car crashes in 2015 or the thirty-five thousand who died from gun violence that year. This past July, Donald Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, led by New Jersey governor Chris Christie, declared that opioids were killing roughly 142 Americans each day, a tally vividly described as “September 11th every three weeks.” The epidemic has also exacted a crushing financial toll: According to a study published by the American Public Health Association, using data from 2013—before the epidemic entered its current, more virulent phase—the total economic burden from opioid use stood at about $80 billion, adding together health costs, criminal-justice costs, and GDP loss from drug-dependent Americans leaving the workforce. Tobacco remains, by a significant multiple, the country’s most lethal product, responsible for some 480,000 deaths per year. But although billions have been made from tobacco, cars, and firearms, it’s not clear that any of those enterprises has generated a family fortune from a single product that approaches the Sacklers’ haul from OxyContin.

Even so, hardly anyone associates the Sackler name with their company’s lone blockbuster drug. “The Fords, Hewletts, Packards, Johnsons—all those families put their name on their product because they were proud,” said Keith Humphreys, a professor of psychiatry at Stanford University School of Medicine who has written extensively about the opioid crisis. “The Sacklers have hidden their connection to their product. They don’t call it ‘Sackler Pharma.’ They don’t call their pills ‘Sackler pills.’ And when they’re questioned, they say, ‘Well, it’s a privately held firm, we’re a family, we like to keep our privacy, you understand.’ ”

The family’s leaders have pulled off three of the great marketing triumphs of the modern era: The first is selling OxyContin; the second is promoting the Sackler name; and the third is ensuring that, as far as the public is aware, the first and the second have nothing to do with one another.

To the extent that the Sacklers have cultivated a reputation, it’s for being earnest healers, judicious stewards of scientific progress, and connoisseurs of old and beautiful things. Few are aware that during the crucial period of OxyContin’s development and promotion, Sackler family members actively led Purdue’s day-to-day affairs, filling the majority of its board slots and supplying top executives. By any assessment, the family’s leaders have pulled off three of the great marketing triumphs of the modern era: The first is selling OxyContin; the second is promoting the Sackler name; and the third is ensuring that, as far as the public is aware, the first and the second have nothing to do with one another.


If you head north on I-95 through Stamford, Connecticut, you will spot, on the left, a giant misshapen glass cube. Along the building’s top edge, white lettering spells out ONE STAMFORD FORUM. No markings visible from the highway indicate the presence of the building’s owner and chief occupant, Purdue Pharma.

Originally known as Purdue Frederick, the first iteration of the company was founded in 1892 on New York’s Lower East Side as a peddler of patent medicines. For decades, it sustained itself with sales of Gray’s Glycerine Tonic, a sherry-based liquid of “broad application” marketed as a remedy for everything from anemia to tuberculosis. The company was purchased in 1952 by Arthur Sackler, thirty-nine, and was run by his brothers, Mortimer, thirty- six, and Raymond, thirty-two. The Sackler brothers came from a family of Jewish immigrants in Flatbush, Brooklyn. Arthur was a headstrong and ambitious provider, setting the tone—and often choosing the path—for his younger brothers. After attending medical school on Arthur’s dime, Mortimer and Raymond followed him to jobs at the Creedmoor psychiatric hospital in Queens. There, they coauthored more than one hundred studies on the biochemical roots of mental illness. The brothers’ research was promising—they were among the first to identify a link between psychosis and the hormone cortisone—but their findings were mostly ignored by their professional peers, who, in keeping with the era, favored a Freudian model of mental illness.

Concurrent with his psychiatric work, Arthur Sackler made his name in pharmaceutical advertising, which at the time consisted almost exclusively of pitches from so-called “detail men” who sold drugs to doctors door-to-door. Arthur intuited that print ads in medical journals could have a revolutionary effect on pharmaceutical sales, especially given the excitement surrounding the “miracle drugs” of the 1950s—steroids, antibiotics, antihistamines, and psychotropics. In 1952, the same year that he and his brothers acquired Purdue, Arthur became the first adman to convince The Journal of the American Medical Association, one of the profession’s most august publications, to include a color advertorial brochure.

In the 1960s, Arthur was contracted by Roche to develop an advertising strategy for a new antianxiety medication called Valium. This posed a challenge, because the effects of the medication were nearly indistinguishable from those of Librium, another Roche tranquilizer that was already on the market. Arthur differentiated Valium by audaciously inflating its range of indications. Whereas Librium was sold as a treatment for garden- variety anxiety, Valium was positioned as an elixir for a problem Arthur christened “psychic tension.” According to his ads, psychic tension, the forebear of today’s “stress,” was the secret culprit behind a host of somatic conditions, including heartburn, gastrointestinal issues, insomnia, and restless-leg syndrome. The campaign was such a success that for a time Valium became America’s most widely prescribed medication—the first to reach more than $100 million in sales. Arthur, whose compensation depended on the volume of pills sold, was richly rewarded, and he later became one of the first inductees into the Medical Advertising Hall of Fame.

As Arthur’s fortune grew, he turned his acquisitive instincts to the art market, quickly amassing the world’s largest private collection of ancient Chinese artifacts. According to a memoir by Marietta Lutze, his second wife, collecting, exhibiting, owning, and donating art fed Arthur’s “driving necessity for prestige and recognition.” Rewarding at first, collecting soon became a mania that took over his life. “Boxes of artifacts of tremendous value piled up in numerous storage locations,” she wrote, “there was too much to open, too much to appreciate; some objects known only by a packing list.” Under an avalanche of “ritual bronzes and weapons, mirrors and ceramics, inscribed bones and archaic jades,” their lives were “often in chaos.” “Addiction is a curse,” Lutze noted, “be it drugs, women, or collecting.”

When Arthur donated his art and money to museums, he often imposed onerous terms. According to a memoir written by Thomas Hoving, the Met director from 1967 to 1977, when Arthur established the Sackler Gallery at the Metropolitan Museum of Art to house Chinese antiquities, in 1963, he required the museum to collaborate on a byzantine tax-avoidance maneuver. In accordance with the scheme, the museum first soldArthur a large quantity of ancient artifacts at the deflated 1920s prices for which they had originally been acquired. Arthur then donated back the artifacts at 1960s prices, in the process taking a tax deduction so hefty that it likely exceeded the value of his initial donation. Three years later, in connection with another donation, Arthur negotiated an even more unusual arrangement. This time, the Met opened a secret chamber above the museum’s auditorium to provide Arthur with free storage for some five thousand objects from his private collection, relieving him of the substantial burden of fire protection and other insurance costs. (In an email exchange, Jillian Sackler, Arthur’s third wife, called Hoving’s tax-deduction story “fake news.” She also noted that New York’s attorney general conducted an investigation into Arthur’s dealings with the Met and cleared him of wrongdoing.)

In 1974, when Arthur and his brothers made a large gift to the Met—$3.5 million, to erect the Temple of Dendur—they stipulated that all museum signage, catalog entries, and bulletins referring to objects in the newly opened Sackler Wing had to include the names of all three brothers, each followed by “M.D.” (One museum official quipped, “All that was missing was a note of their office hours.”)

Hoving said that the Met hoped that Arthur would eventually donate his collection to the museum, but over time Arthur grew disgruntled over a series of rankling slights. For one, the Temple of Dendur was being rented out for parties, including a dinner for the designer Valentino, which Arthur called “disgusting.” According to Met chronicler Michael Gross, he was also denied that coveted ticket of arrival, a board seat. (Jillian Sackler said it was Arthur who rejected the board seat, after repeated offers by the museum.) In 1982, in a bad breakup with the Met, Arthur donated the best parts of his collection, plus $4 million, to the Smithsonian in Washington, D. C.


Arthur’s younger brothers, Mortimer and Raymond, looked so much alike that when they worked together at Creedmoor, they fooled the staff by pretending to be one another. Their physical similarities did not extend to their personalities, however. Tage Honore, Purdue’s vice-president of discovery of research from 2000 to 2005, described them as “like day and night.” Mortimer, said Honore, was “extroverted—a ‘world man,’ I would call it.” He acquired a reputation as a big-spending, transatlantic playboy, living most of the year in opulent homes in England, Switzerland, and France. (In 1974, he renounced his U. S. citizenship to become a citizen of Austria, which infuriated his patriotic older brother.) Like Arthur, Mortimer became a major museum donor and married three wives over the course of his life.

Mortimer had his own feuds with the Met. On his seventieth birthday, in 1986, the museum agreed to make the Temple of Dendur available to him for a party but refused to allow him to redecorate the ancient shrine: Together with other improvements, Mortimer and his interior designer, flown in from Europe, had hoped to spiff up the temple by adding extra pillars. Also galling to Mortimer was the sale of naming rights for one of the Sackler Wing’s balconies to a donor from Japan. “They sold it twice,” Mortimer fumed to a reporter from New York magazine. Raymond, the youngest brother, cut a different figure—“a family man,” said Honore. Kind and mild-mannered, he stayed with the same woman his entire life. Lutze concluded that Raymond owed his comparatively serene nature to having missed the worst years of the Depression. “He had summer vacations in camp, which Arthur never had,” she wrote. “The feeling of the two older brothers about the youngest was, ‘Let the kid enjoy himself.’ ”

Raymond led Purdue Frederick as its top executive for several decades, while Mortimer led Napp Pharmaceuticals, the family’s drug company in the UK. (In practice, a family spokesperson said, “the brothers worked closely together leading both companies.”) Arthur, the adman, had no official role in the family’s pharmaceutical operations. According to Barry Meier’s Pain Killer, a prescient account of the rise of OxyContin published in 2003, Raymond and Mortimer bought Arthur’s share in Purdue from his estate for $22.4 million after he died in 1987. In an email exchange, Arthur’s daughter Elizabeth Sackler, a historian of feminist art who sits on the board of the Brooklyn Museum and supports a variety of progressive causes, emphatically distanced her branch of the family from her cousins’ businesses. “Neither I, nor my siblings, nor my children have ever had ownership in or any benefit whatsoever from Purdue Pharma or OxyContin,” she wrote, while also praising “the breadth of my father’s brilliance and important works.” Jillian, Arthur’s widow, said her husband had died too soon: “His enemies have gotten the last word.”


The Sacklers have been millionaires for decades, but their real money—the painkiller money—is of comparatively recent vintage. The vehicle of that fortune was OxyContin, but its engine, the driving power that made them so many billions, was not so much the drug itself as it was Arthur’s original marketing insight, rehabbed for the era of chronic-pain management. That simple but profitable idea was to take a substance with addictive properties—in Arthur’s case, a benzo; in Raymond and Mortimer’s case, an opioid—and market it as a salve for a vast range of indications.

In the years before it swooped into the pain-management business, Purdue had been a small industry player, specializing in over-the-counter remedies like ear-wax remover and laxatives. Its most successful product, acquired in 1966, was Betadine, a powerful antiseptic purchased in industrial quantities by the U. S. government to prevent infection among wounded soldiers in Vietnam. The turning point, according to company lore, came in 1972, when a London doctor working for Cicely Saunders, the Florence Nightingale of the modern hospice movement, approached Napp with the idea of creating a timed-release morphine pill. A long-acting morphine pill, the doctor reasoned, would allow dying cancer patients to sleep through the night without an IV. At the time, treatment with opioids was stigmatized in the United States, owing in part to a heroin epidemic fueled by returning Vietnam veterans. “Opiophobia,” as it came to be called, prevented skittish doctors from treating most patients, including nearly all infants, with strong pain medication of any kind. In hospice care, though, addiction was not a concern: It didn’t matter whether terminal patients became hooked in their final days. Over the course of the seventies, building on a slow-release technology the company had already developed for an asthma medication, Napp created what came to be known as the “Contin” system. In 1981, Napp introduced a timed-release morphine pill in the UK; six years later, Purdue brought the same drug to market in the U. S. as MS Contin.

“The Sacklers have hidden their connection to their product,” said Keith Humphreys, a professor of psychiatry at Stanford University School of Medicine. “They don’t call it ‘Sackler Pharma.’ They don’t call their pills ‘Sackler pills.’”

MS Contin quickly became the gold standard for pain relief in cancer care. At the same time, a number of clinicians associated with the burgeoning chronic-pain movement started advocating the use of powerful opioids for noncancer conditions like back pain and neuropathic pain, afflictions that at their worst could be debilitating. In 1986, two doctors from Memorial Sloan Kettering hospital in New York published a fateful article in a medical journal that purported to show, based on a study of thirty-eight patients, that long-term opioid treatment was safe and effective so long as patients had no history of drug abuse. Soon enough, opioid advocates dredged up a letter to the editor published in The New England Journal of Medicine in 1980 that suggested, based on a highly unrepresentative cohort, that the risk of addiction from long-term opioid use was less than 1 percent. Though ultimately disavowed by its author, the letter ended up getting cited in medical journals more than six hundred times.

As the country was reexamining pain, Raymond’s eldest son, Richard Sackler, was searching for new applications for Purdue’s timed-release Contin system. “At all the meetings, that was a constant source of discussion—‘What else can we use the Contin system for?’ ” said Peter Lacouture, a senior director of clinical research at Purdue from 1991 to 2001. “And that’s where Richard would fire some ideas—maybe antibiotics, maybe chemotherapy—he was always out there digging.” Richard’s spitballing wasn’t idle blather. A trained physician, he treasured his role as a research scientist and appeared as an inventor on dozens of the company’s patents (though not on the patents for OxyContin). In the tradition of his uncle Arthur, Richard was also fascinated by sales messaging. “He was very interested in the commercial side and also very interested in marketing approaches,” said Sally Allen Riddle, Purdue’s former executive director for product management. “He didn’t always wait for the research results.” (A Purdue spokesperson said that Richard “always considered relevant scientific information when making decisions.”)

Perhaps the most private member of a generally secretive family, Richard appears nowhere on Purdue’s website. From public records and conversations with former employees, though, a rough portrait emerges of a testy eccentric with ardent, relentless ambitions. Born in 1945, he holds degrees from Columbia University and NYU Medical School. According to a bio on the website of the Koch Institute for Integrative Cancer Research at MIT, where Richard serves on the advisory board, he started working at Purdue as his father’s assistant at age twenty-six before eventually leading the firm’s R&D; division and, separately, its sales and marketing division. In 1999, while Mortimer and Raymond remained Purdue’s co-CEOs, Richard joined them at the top of the company as president, a position he relinquished in 2003 to become cochairman of the board. The few publicly available pictures of him are generic and sphinxlike—a white guy with a receding hairline. He is one of the few Sacklers to consistently smile for the camera. In a photo on what appears to be his Facebook profile, Richard is wearing a tan suit and a pink tie, his right hand casually scrunched into his pocket, projecting a jaunty charm. Divorced in 2013, he lists his relationship status on the profile as “It’s complicated.”

When Purdue eventually pleaded guilty to felony charges in 2007 for criminally “misbranding” OxyContin, it acknowledged exploiting doctors’ misconceptions about oxycodone’s strength.

Richard’s political contributions have gone mostly to Republicans—including Strom Thurmond and Herman Cain—though at times he has also given to Democrats. (His ex-wife, Beth Sackler, has given almost exclusively to Democrats.) In 2008, he wrote a letter to the editor of The Wall Street Journaldenouncing Muslim support for suicide bombing, a concern that seems to persist: Since 2014, his charitable organization, the Richard and Beth Sackler Foundation, has donated to several anti-Muslim groups, including three organizations classified as hate groups by the Southern Poverty Law Center. (The family spokesperson said, “It was never Richard Sackler’s intention to donate to an anti-Muslim or hate group.”) The foundation has also donated to True the Vote, the “voter-fraud watchdog” that was the original source for Donald Trump’s inaccurate claim that three million illegal immigrants voted in the 2016 election.

Former employees describe Richard as a man with an unnerving intelligence, alternately detached and pouncing. In meetings, his face was often glued to his laptop. “This was pre-smartphone days,” said Riddle. “He’d be typing away and you would think he wasn’t even listening, and then all of the sudden his head would pop up and he’d be asking a very pointed question.” He was notorious for peppering subordinates with unexpected, rapid-fire queries, sometimes in the middle of the night. “Richard had the mind of someone who’s going two hundred miles an hour,” said Lacouture. “He could be a little bit disconnected in the way he would communicate. Whether it was on the weekend or a holiday or a Christmas party, you could always expect the unexpected.”

Richard also had an appetite for micromanagement. “I remember one time he mailed out a rambling sales bulletin,” said Shelby Sherman, a Purdue sales rep from 1974 to 1998. “And right in the middle, he put in, ‘If you’re reading this, then you must call my secretary at this number and give her this secret password.’ He wanted to check and see if the reps were reading this shit. We called it ‘Playin’ Passwords.’ ” According to Sherman, Richard started taking a more prominent role in the company during the early 1980s. “The shift was abrupt,” he said. “Raymond was just so nice and down-to-earth and calm and gentle.” When Richard came, “things got a lot harder. Richard really wanted Purdue to be big—I mean really big.”

To effectively capitalize on the chronic-pain movement, Purdue knew it needed to move beyond MS Contin. “Morphine had a stigma,” said Riddle. “People hear the word and say, ‘Wait a minute, I’m not dying or anything.’ ” Aside from its terminal aura, MS Contin had a further handicap: Its patent was set to expire in the late nineties. In a 1990 memo addressed to Richard and other executives, Purdue’s VP of clinical research, Robert Kaiko, suggested that the company work on a pill containing oxycodone, a chemical similar to morphine that was also derived from the opium poppy. When it came to branding, oxycodone had a key advantage: Although it was 50 percent stronger than morphine, many doctors believed—wrongly—that it was substantially less powerful. They were deceived about its potency in part because oxycodone was widely known as one of the active ingredients in Percocet, a relatively weak opioid- acetaminophen combination that doctors often prescribed for painful injuries. “It really didn’t have the same connotation that morphine did in people’s minds,” said Riddle.

A common malapropism led to further advantage for Purdue. “Some people would call it oxy-codeine” instead of oxycodone, recalled Lacouture. “Codeine is very weak.” When Purdue eventually pleaded guilty to felony charges in 2007 for criminally “misbranding” OxyContin, it acknowledged exploiting doctors’ misconceptions about oxycodone’s strength. In court documents, the company said it was “well aware of the incorrect view held by many physicians that oxycodone was weaker than morphine” and “did not want to do anything ‘to make physicians think that oxycodone was stronger or equal to morphine’ or to ‘take any steps . . . that would affect the unique position that OxyContin’ ” held among physicians.

Purdue did not merely neglect to clear up confusion about the strength of OxyContin. As the company later admitted, it misleadingly promoted OxyContin as less addictive than older opioids on the market. In this deception, Purdue had a big assist from the FDA, which allowed the company to include an astonishing labeling claim in OxyContin’s package insert: “Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.”

The theory was that addicts would shy away from timed-released drugs, preferring an immediate rush. In practice, OxyContin, which crammed a huge amount of pure narcotic into a single pill, became a lusted-after target for addicts, who quickly discovered that the timed-release mechanism in OxyContin was easy to circumvent—you could simply crush a pill and snort it to get most of the narcotic payload in a single inhalation. This wasn’t exactly news to the manufacturer: OxyContin’s own packaging warned that consuming broken pills would thwart the timed-release system and subject patients to a potentially fatal overdose. MS Contin had contended with similar vulnerabilities, and as a result commanded a hefty premium on the street. But the “reduced abuse liability” claim that added wings to the sales of OxyContin had not been approved for MS Contin. It was removed from OxyContin in 2001 and would never be approved again for any other opioid.

The year after OxyContin’s release, Curtis Wright, the FDA examiner who approved the pharmaceutical’s original application, quit. After a stint at another pharmaceutical company, he began working for Purdue. In an interview with Esquire, Wright defended his work at the FDA and at Purdue. “At the time, it was believed that extended-release formulations were intrinsically less abusable,” he insisted. “It came as a rather big shock to everybody—the government and Purdue—that people found ways to grind up, chew up, snort, dissolve, and inject the pills.” Preventing abuse, he said, had to be balanced against providing relief to chronic-pain sufferers. “In the mid-nineties,” he recalled, “the very best pain specialists told the medical community they were not prescribing opioids enough. That was not something generated by Purdue—that was not a secret plan, that was not a plot, that was not a clever marketing ploy. Chronic pain is horrible. In the right circumstances, opioid therapy is nothing short of miraculous; you give people their lives back.” In Wright’s account, the Sacklers were not just great employers, they were great people. “No company in the history of pharmaceuticals,” he said, “has worked harder to try to prevent abuse of their product than Purdue.”


Purdue did not invent the chronic-pain movement, but it used that movement to engineer a crucial shift. Wright is correct that in the nineties patients suffering from chronic pain often received inadequate treatment. But the call for clinical reforms also became a flexible alibi for overly aggressive prescribing practices. By the end of the decade, clinical proponents of opioid treatment, supported by millions in funding from Purdue and other pharmaceutical companies, had organized themselves into advocacy groups with names like the American Pain Society and the American Academy of Pain Medicine. (Purdue also launched its own group, called Partners Against Pain.) As the decade wore on, these organizations, which critics have characterized as front groups for the pharmaceutical industry, began pressuring health regulators to make pain “the fifth vital sign”—a number, measured on a subjective ten-point scale, to be asked and recorded at every doctor’s visit. As an internal strategy document put it, Purdue’s ambition was to “attach an emotional aspect to noncancer pain” so that doctors would feel pressure to “treat it more seriously and aggressively.” The company rebranded pain relief as a sacred right: a universal narcotic entitlement available not only to the terminally ill but to every American.

The company rebranded pain relief as a sacred right: a universal narcotic entitlement available not only to the terminally ill but to every American. By 2001, annual OxyContin sales had surged past $1 billion.

OxyContin’s sales started out small in 1996, in part because Purdue first focused on the cancer market to gain formulary acceptance from HMOs and state Medicaid programs. Over the next several years, though, the company doubled its sales force to six hundred—equal to the total number of DEA diversion agents employed to combat the sale of prescription drugs on the black market—and began targeting general practitioners, dentists, OB/GYNs, physician assistants, nurses, and residents. By 2001, annual OxyContin sales had surged past $1 billion. Sales reps were encouraged to downplay addiction risks. “It was sell, sell, sell,” recalled Sherman. “We were directed to lie. Why mince words about it? Greed took hold and overruled everything. They saw that potential for billions of dollars and just went after it.” Flush with cash, Purdue pioneered a high-cost promotion strategy, effectively providing kickbacks—which were legal under American law—to each part of the distribution chain. Wholesalers got rebates in exchange for keeping OxyContin off prior authorization lists. Pharmacists got refunds on their initial orders. Patients got coupons for thirty- day starter supplies. Academics got grants. Medical journals got millions in advertising. Senators and members of Congress on key committees got donations from Purdue and from members of the Sackler family.

It was doctors, though, who received the most attention. “We used to fly doctors to these ‘seminars,’ ” said Sherman, which were, in practice, “just golf trips to Pebble Beach. It was graft.” Though offering perks and freebies to doctors was hardly uncommon in the industry, it was unprecedented in the marketing of a Schedule II narcotic. For some physicians, the junkets to sunny locales weren’t enough to persuade them to prescribe. To entice the holdouts—a group the company referred to internally as “problem doctors”—the reps would dangle the lure of Purdue’s lucrative speakers’ bureau. “Everybody was automatically approved,” said Sherman. “We would set up these little dinners, and they’d make their little fifteen-minute talk, and they’d get $500.”

Between 1996 and 2001, the number of OxyContin prescriptions in the United States surged from about three hundred thousand to nearly six million, and reports of abuse started to bubble up in places like West Virginia, Florida, and Maine. (Research would later show a direct correlation between prescription volume in an area and rates of abuse and overdose.) Hundreds of doctors were eventually arrested for running pill mills. According to an investigation in the Los Angeles Times, even though Purdue kept an internal list of doctors it suspected of criminal diversion, it didn’t volunteer this information to law enforcement until years later.

As criticism of OxyContin mounted through the aughts, Purdue responded with symbolic concessions while retaining its volume-driven business model. To prevent addicts from forging prescriptions, the company gave doctors tamper-resistant prescription pads; to mollify pharmacists worried about robberies, Purdue offered to replace, free of charge, any stolen drugs; to gather data on drug abuse and diversion, the company launched a national monitoring program called RADARS.

Critics were not impressed. In a letter to Richard Sackler in July 2001, Richard Blumenthal, then Connecticut’s attorney general and now a U. S. senator, called the company’s efforts “cosmetic.” As Blumenthal had deduced, the root problem of the prescription-opioid epidemic was the high volume of prescriptions written for powerful opioids. “It is time for Purdue Pharma to change its practices,” Blumenthal warned Richard, “not just its public-relations strategy.”

It wasn’t just that doctors were writing huge numbers of prescriptions; it was also that the prescriptions were often for extraordinarily high doses. A single dose of Percocet contains between 2.5 and 10mg of oxycodone. OxyContin came in 10-, 20-, 30-, 40-, and 80mg formulations and, for a time, even 160mg. Purdue’s greatest competitive advantage in dominating the pain market, it had determined early on, was that OxyContin lasted twelve hours, enough to sleep through the night. But for many patients, the drug lasted only six or eight hours, creating a cycle of crash and euphoria that one academic called “a perfect recipe for addiction.” When confronted with complaints about “breakthrough pain”—meaning that the pills weren’t working as long as advertised—Purdue’s sales reps were given strict instructions to tell doctors to strengthen the dose rather than increase dosing frequency.

Sales reps were encouraged to downplay addiction risks. “It was sell, sell, sell,” recalled Sherman. “We were directed to lie. Why mince words about it?”

Over the next several years, dozens of class-action lawsuits were brought against Purdue. Many were dismissed, but in some cases Purdue wrote big checks to avoid going to trial. Several plaintiffs’ lawyers found that the company was willing to go to great lengths to prevent Richard Sackler from having to testify under oath. “They didn’t want him deposed, I can tell you that much,” recalled Marvin Masters, a lawyer who brought a class-action suit against Purdue in the early 2000s in West Virginia. “They were willing to sit down and settle the case to keep from doing that.” Purdue tried to get Richard removed from the suit, but when that didn’t work, the company settled with the plaintiffs for more than $20 million. Paul Hanly, a New York class-action lawyer who won a large settlement from Purdue in 2007, had a similar recollection. “We were attempting to take Richard Sackler’s deposition,” he said, “around the time that they agreed to a settlement.” (A spokesperson for the company said, “Purdue did not settle any cases to avoid the deposition of Dr. Richard Sackler, or any other individual.”)

When the federal government finally stepped in, in 2007, it extracted historic terms of surrender from the company. Purdue pleaded guilty to felony charges, admitting that it had lied to doctors about OxyContin’s abuse potential. (The technical charge was “misbranding a drug with intent to defraud or mislead.”) Under the agreement, the company paid $600 million in fines and its three top executives at the time—its medical director, general counsel, and Richard’s successor as president—pleaded guilty to misdemeanor charges. The executives paid $34.5 million out of their own pockets and performed four hundred hours of community service. It was one of the harshest penalties ever imposed on a pharmaceutical company. (In a statement to Esquire, Purdue said that it “abides by the highest ethical standards and legal requirements.” The statement went on: “We want physicians to use their professional judgment, and we were not trying to pressure them.”)

Fifty-three thousand Americans died from opioid overdoses in 2016, more than the thirty-six thousand who died in car crashes in 2015 or the thirty-five thousand who died from gun violence that year.

No Sacklers were named in the 2007 suit. Indeed, the Sackler name appeared nowhere in the plea agreement, even though Richard had been one of the company’s top executives during most of the period covered by the settlement. He did eventually have to give a deposition in 2015, in a case brought by Kentucky’s attorney general. Richard’s testimony—the only known record of a Sackler speaking about the crisis the family’s company helped create—was promptly sealed. (In 2016, STAT, an online magazine owned by Boston Globe Media that covers health and medicine, asked a court in Kentucky to unseal the deposition, which is said to have lasted several hours. STAT won a lower-court ruling in May 2016. As of press time, the matter was before an appeals court.)

In 2010, Purdue executed a breathtaking pivot: Embracing the arguments critics had been making for years about OxyContin’s susceptibility to abuse, the company released a new formulation of the medication that was harder to snort or inject. Purdue seized the occasion to rebrand itself as an industry leader in abuse-deterrent technology. The change of heart coincided with two developments: First, an increasing number of addicts, unable to afford OxyContin’s high street price, were turning to cheaper alternatives like heroin; second, OxyContin was nearing the end of its patents. Purdue suddenly argued that the drug it had been selling for nearly fifteen years was so prone to abuse that generic manufacturers should not be allowed to copy it.

On April 16, 2013, the day some of the key patents for OxyContin were scheduled to expire, the FDA followed Purdue’s lead, declaring that no generic versions of the original OxyContin formulation could be sold. The company had effectively won several additional years of patent protection for its golden goose.


Opioid withdrawal, which causes aches, vomiting, and restless anxiety, is a gruesome process to experience as an adult. It’s considerably worse for the twenty thousand or so American babies who emerge each year from opioid-soaked wombs. These infants, suddenly cut off from their supply, cry uncontrollably. Their skin is mottled. They cannot fall asleep. Their bodies are shaken by tremors and, in the worst cases, seizures. Bottles of milk leave them distraught, because they cannot maneuver their lips with enough precision to create suction. Treatment comes in the form of drops of morphine pushed from a syringe into the babies’ mouths. Weaning sometimes takes a week but can last as long as twelve. It’s a heartrending, expensive process, typically carried out in the neonatal ICU, where newborns have limited access to their mothers.

But the children of OxyContin, its heirs and legatees, are many and various. The second- and third-generation descendants of Raymond and Mortimer Sackler spend their money in the ways we have come to expect from the not-so-idle rich. Notably, several have made children a focus of their business and philanthropic endeavors. One Sackler heir helped start an iPhone app called RedRover, which generates ideas for child-friendly activities for urban parents; another runs a child- development center near Central Park; another is a donor to charter-school causes, as well as an investor in an education start-up called AltSchool. Yet another is the founder of Beespace, an “incubator for emerging nonprofits,” which provides resources and mentoring for initiatives like the Malala Fund, which invests in education programs for women in the developing world, and Yoga Foster, whose objective is to bring “accessible, sustainable yoga programs into schools across the country.” Other Sackler heirs get to do the fun stuff: One helps finance small, interesting films like The Witch; a second married a famous cricket player; a third is a sound artist; a fourth started a production company with Boyd Holbrook, star of the Netflix series Narcos; a fifth founded a small chain of gastropubs in New York called the Smith.

Holding fast to family tradition, Raymond’s and Mortimer’s heirs declined to be interviewed for this article. Instead, through a spokesperson, they put forward two decorated academics who have been on the receiving end of the family’s largesse: Phillip Sharp, the Nobel-prize-winning MIT geneticist, and Herbert Pardes, formerly the dean of faculty at Columbia University’s medical school and CEO of New York-Presbyterian Hospital. Both men effusively praised the Sacklers’ donations to the arts and sciences, marveling at their loyalty to academic excellence. “Once you were on that exalted list of philanthropic projects,” Pardes told Esquire, “you were there and you were in a position to secure additional philanthropy. It was like a family acquisition.” Pardes called the Sacklers “the nicest, most gentle people you could imagine.” As for the family’s connection to OxyContin, he said that it had never come up as an issue in the faculty lounge or the hospital break room. “I have never heard one inch about that,” he said.

Pardes’s ostrichlike avoidance is not unusual. In 2008, Raymond and his wife donated an undisclosed amount to Yale to start the Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences. Lynne Regan, its current director, told me that neither students nor faculty have ever brought up the OxyContin connection. “Most people don’t know about that,” she said. “I think people are mainly oblivious.” A spokesperson for the university added, “Yale does not vet donors for controversies that may or may not arise.”

In May, a dozen lawmakers in Congress sent a bipartisan letter to the World Health Organization warning that Sackler-owned companies were preparing to flood foreign countries with legal narcotics.

The controversy surrounding OxyContin shows little sign of receding. In 2016, the CDC issued a startling warning: There was no good evidence that opioids were an effective treatment for chronic pain beyond six weeks. There was, on the other hand, an abundance of evidence that long-term treatment with opioids had harmful effects. (A recent paper by Princeton economist Alan Krueger suggests that chronic opioid use may account for more than 20 percent of the decline in American labor-force participation from 1999 to 2015.) Millions of opioid prescriptions for chronic pain had been written in the preceding two decades, and the CDC was calling into question whether many of them should have been written at all. At least twenty-five government entities, ranging from states to small cities, have recently filed lawsuits against Purdue to recover damages associated with the opioid epidemic.

The Sacklers, though, will likely emerge untouched: Because of a sweeping non-prosecution agreement negotiated during the 2007 settlement, most new criminal litigation against Purdue can only address activity that occurred after that date. Neither Richard nor any other family members have occupied an executive position at the company since 2003.

The American market for OxyContin is dwindling. According to Purdue, prescriptions fell 33 percent between 2012 and 2016. But while the company’s primary product may be in eclipse in the United States, international markets for pain medications are expanding. According to an investigation last year in the Los Angeles Times, Mundipharma, the Sackler-owned company charged with developing new markets, is employing a suite of familiar tactics in countries like Mexico, Brazil, and China to stoke concern for as-yet-unheralded “silent epidemics” of untreated pain. In Colombia, according to the L.A. Times, the company went so far as to circulate a press release suggesting that 47 percent of the population suffered from chronic pain.

Napp is the family’s drug company in the UK. Mundipharma is their company charged with developing new markets.

In May, a dozen lawmakers in Congress, inspired by the L.A. Timesinvestigation, sent a bipartisan letter to the World Health Organization warning that Sackler-owned companies were preparing to flood foreign countries with legal narcotics. “Purdue began the opioid crisis that has devastated American communities,” the letter reads. “Today, Mundipharma is using many of the same deceptive and reckless practices to sell OxyContin abroad.” Significantly, the letter calls out the Sackler family by name, leaving no room for the public to wonder about the identities of the people who stood behind Mundipharma.

The final assessment of the Sacklers’ global impact will take years to work out. In some places, though, they have already left their mark. In July, Raymond, the last remaining of the original Sackler brothers, died at ninety-seven. Over the years, he had won a British knighthood, been made an Officer of France’s Légion d’Honneur, and received one of the highest possible honors from the royal house of the Netherlands. One of his final accolades came in June 2013, when Anthony Monaco, the president of Tufts University, traveled to Purdue Pharma’s headquarters in Stamford to bestow an honorary doctorate. The Sacklers had made a number of transformational donations to the university over the years—endowing, among other things, the Sackler School of Graduate Biomedical Sciences. At Tufts, as at most schools, honorary degrees are traditionally awarded on campus during commencement, but in consideration of Raymond’s advanced age, Monaco trekked to Purdue for a special ceremony. The audience that day was limited to family members, select university officials, and a scrum of employees. Addressing the crowd of intimates, Monaco praised his benefactor. “It would be impossible to calculate how many lives you have saved, how many scientific fields you have redefined, and how many new physicians, scientists, mathematicians, and engineers are doing important work as a result of your entrepreneurial spirit.” He concluded, “You are a world changer.”

Source: https://www.esquire.com/news-politics/a12775932/sackler-family-oxycontin/ October 2017

MOUNT SHASTA, Siskiyou County (KPIX 5) — It’s happening in the shadow of Mount Shasta — hundreds of marijuana gardens pockmarking the landscape in neighborhoods that have little in the way of housing.

For law enforcement officials in Siskiyou County, it’s a state of emergency.

“This is a monumental effort but, then again, we’ve got a monumental problem,” says Sheriff Jon E. Lopey.

What’s unfolding in this county is a race between growers and the law to see who can get to the countless grow gardens first.

“We’re in harvest season. We’re really putting a lot of resources into it and a lot of personnel, trying to take out as much as we can before it gets harvested and goes off back east or wherever it’s going,” said Siskiyou County Sheriff’s Deputy Mike Gilley.

You can see the enormous extent of the grow gardens from space. Fire up Google Earth and you can count grow after grow dotting the high desert landscape like an outbreak of measles.

“I have a one-mile-square photograph and you can pick out 80 gardens in that one square mile,” said Sgt. Gilley.

All of this is happening in a county that is decidedly not part of the “Emerald Triangle.” In fact, elected officials and voters have passed laws aimed at keeping marijuana out of Siskiyou County.

“Our county does not allow outdoor cultivation of cannabis,” asserts Sheriff Lopey.

Siskiyou County has some of the cheapest — as well as most scenic — land you can find in California. You can purchase nearly three acres for about $16,000. That brings in people who see an opportunity. The sheriff thinks those people represent a nationwide problem.

“I think … that this is an organized-crime effort. (They) basically take over large geographic areas to grow illegal marijuana. That’s basically what it amounts to,” Lopey said.

Source: https://sanfrancisco.cbslocal.com/2017/10/27/marijuana-illegal-grow-mount-shasta-siskiyou-county/(contains video report)  October 2017

The Washington County drug court graduation ceremony for Maria Kestner. Photograph: Fred R Conrad

Photographer  visited a Virginia drug court last year and saw how individuals and families had been given a second chance – so when he went back this summer he had a question: did they take it?

“Opioid and methamphetamine abuse tore through this area like a wildfire.”

This is the view of Rebecca Holmes, who is responsible for mental health and drug use outpatient treatment in Abingdon, Washington County, Virginia, as she looks back at the decision to set up a drug court.

Holmes, the medical director of Highlands Community Services, had seen how the growing crisis around opioids had taken such a heavy toll on families in the town, which is home to just over 8,000 people.

 

There was a growing need for a small group of addicts that did not respond to treatment or programs offered by the existing court or probation, she said, so five years ago she applied for a grant to use a federal model for a drug court that had first emerged in 1989.

The county’s drug court has been in place for several years now and Holmes feels that it has never been more needed. Last year in Virginia there were more deaths from heroin and opioids than highway fatalities for the first time, and the governor declared a public health emergency.

Nationally, opioids are said to be killing 90 people a day.

  • The Washington County court house. Inside the county court room where the drug court meets every week.

Judge Lowe presides over the court and the program, which is a year and half long for those who are placed on it. It combines therapy with a structured program of court visits, random drug screens, curfews and full-time employment for participants.

  • Judge Lowe poses with Wayne Smith, who has completed the second phase of the four-phase drug court. Participants are rewarded for good behavior.

There is the ever-present threat of court sanctions if a participant relapses. Lowe says: “The point of drug court is not just to treat the addict, it’s to make that person a model for the rest of their family so that they can break the cycle of drug abuse.”

The Guardian visited last year and again this year in late summer to see how people who had gone through the court – and who worked there – were getting on.

Bubba

  • Bubba and Ginger in their bedroom.

Bubba Rouse started abusing painkillers when he was a young teenager. He then stole various pills he could get his hands on. At 17 Bubba started smoking meth. He also became a father for the first time.

Bubba continued to use drugs and found a new girlfriend, Ginger, whose father had been sent to prison for meth when she was eight years old. Bubba and Ginger were both using meth and heroin when Ginger got pregnant. “The reason I stopped using was because I knew I had a future coming with my baby and I didn’t want to bring a child into a world like the one I grew up in.”

  • Family pictures of the Rouse family are displayed throughout the home where Bubba Rouse grew up.
  • Playing with her Barbie dolls.

Ginger was able to get sober and her baby was born without any complications while Bubba was in prison. While in prison he was offered a place in the Washington County drug court program. Drug court can be very difficult, especially at the beginning. There are mandatory therapy meetings, frequent random drug screens, curfew calls in the middle of the night and you have to have to be employed full time. It was even more difficult for Bubba because he could not legally drive. Ginger became both chauffeur and workmate for Bubba this past year.

  • Bubba with his daughter. 

They have managed to work together in a factory, on a construction crew and now at a fast-food restaurant. Bubba and Ginger moved in with Bubba’s parents where Bubba was able to able to get closer to his oldest daughter. For most of the year his younger daughter, with Ginger, was taken care of by Ginger’s mother.

The family is now reunited and Bubba and Ginger have taken over the payments on a double wide trailer that they hope to move next to Bubba’s parents home. After drug court graduation in six months, Bubba hopes to start working construction with Ginger’s stepfather.

Bubba said: “Drug court has been good for me but there are not many programs in this area and I wish there were more things to help people quit early rather than when things get really bad.”

Chris Brown

  • Maria Kestner is hugged by Chis Brown at her drug court graduation ceremony.

Chris Brown is a retired police officer with nearly 30 years on the job. “As a police officer you get jaded after a while. You go to the same addresses and visit the same families all the time. It hit me when I started arresting the grandchildren of people I arrested when I was a rookie cop. You realize early on that you can’t incarcerate your way out of this drug problem.”

After retiring from the police force, Chris was looking for a job where he could help people. “When the job of drug court coordinator became available, I jumped at the chance.

  • Bubba hands a drug test cup filled with his urine to Chris Brown.

“This is a wonderful way to help people. I found my humanity with this job.” Chris takes his job very seriously. He’s on call 24/7. He handles compliance with spot drug screens, curfew calls as well as issues of transportation, housing and dealing with family issues of those in the program.

You realize early on that you can’t incarcerate your way out of this drug problem

He is not judgmental and he is a good listener. “I remember talking with a drug addict years ago and asking him how he wanted to be treated. He told me he just wanted to be treated like a human being. That’s what I try to do with everyone in the program: treat them like human beings rather than drug addicts.”

Joyce Yarber

  • Joyce Yarber manages a cattle ranch and hay farm with her husband.

Joyce Yarber, age 59, has always walked with a limp. She has suffered with hip dysplasia and osteoarthritis for most of her life. For over 20 years, her doctor had prescribed a painkilling cocktail that included Lortab, Percocet and oxycodone. When her doctor was arrested for over prescribing opiates she became desperate and eventually wrote half a dozen prescriptions for herself. She was arrested and offered drug court. Because she had written scripts in both Virginia and Tennessee, it took two years of legal wrangling before she could start the drug court program in Washington County, Virginia.

Before starting drug court, she was required to get a hip replacement operation, the hope being that the operation would eliminate the pain that caused her to become a drug addict. Determined to stay sober, Joyce refused to take any opiates after the operation. Her only post-operation painkiller was an over-the-counter one. That determination impressed the drug court team. “When I first started drug court, I was a drug snob. I thought that because I got my drugs from a doctor rather than buying them on the street, I was somehow better. It didn’t take long for me to realize I was wrong. I was no better than anyone else in the program. I was just as much an addict as they all were.”

  • The start of a therapy session at Highlands Community Services for drug court participants.

Joyce has been a model client in drug court and because of her age and her outgoing personality, she has become a mother figure for the group. The only time she missed a therapy meeting was when she was trapped in a tree without her cellphone by a young bull on the cattle farm that she and her husband operate. That bull was culled from the herd the next day.

I thought that because I got my drugs from a doctor rather than buying them on the street, I was somehow better. It didn’t take long for me to realize I was wrong

A few months into the drug court program, Joyce went to her doctor and was diagnosed with stage four lung cancer. Because the pain caused by the cancer was so great, she knew that she would have to go back on to opiate pain medication just to get through her chemotherapy. She offered to resign from the program but the team insisted that she stay. Her medication level is monitored by the drug court and she still attends all of the meetings. “I got a call from the probation office in Tennessee and they gave me a date that I need to call them by after I complete drug court. I sure hope I’m around and that I can remember to call. This chemo brain is a real pain.”

Zac Holt

Zac Holt was always a gifted athlete. His goal after graduating from college was to attend seminary and become a Presbyterian minister. Those plans were delayed after Zac fell 45ft while free climbing. He broke a leg and fractured a vertebra. While in hospital, he was given narcotic pain medication. Zac had experimented with marijuana and cocaine in high school and college but drugs were never a major part of his life.

  • Zac trains daily and has competed in two triathlons since beginning drug court

That changed after he was exposed to percocet and oxycodone. After he was released from the hospital, he began doctor shopping and getting multiple prescriptions. He went off to seminary and continued using drugs. “I became a raging drug addict. I would do anything for my drugs. I lied, cheated and stole, mostly from my family. I dropped out of school. I went through therapy several times but always came back to my drugs.” Zac’s drug use went on for nine years.

  • Zac Holt was addicted to opioids for nearly nine years.

When he was arrested for possession and put on probation he continued to use drugs. He confessed this to his probation officer who then sent him to jail. While in jail his jaw was broken in a lunch room fight. He had reached bottom when he was offered drug court earlier this year. “Drug court was the best thing in the world for me. I wanted to change my life and drug court gave me a way to change.” Zac embraced the discipline and structure of drug court. He went back to live with his parents and started reconnecting with his family. He also started training for a triathlon. It seemed like an impossible goal for someone who had never competed in one. The regimen of drug court and constant training fills every waking moment. Zac has 10 more months of drug court before graduating. He is active in his church and is contemplating a return to seminary. He has also completed two triathlons.

  • Zac is thinking about returning to seminary and becoming a Presbyterian minister after he completes drug court.

Drug use in south-western Virginia shows no sign of decline. Use of Suboxone is on the rise and meth is still entrenched in the hills of Appalachia. Brown, the drug coordinator for the Washington County drug court said: “You can’t let yourself get discouraged by the numbers. You just work and fight drug addiction one family at a time.”

Source: https://www.theguardian.com/us-news/2017/oct/23/drug-court-opioids-virginia-second-chance October 2017

Filed under: Addiction,Crime/Violence/Prison,Heroin/Methadone,Prescription Drugs,Social Affairs,Treatment and Addiction :

In a backpacking hostel during a stag weekend 10 years ago, I fell asleep on a top bunk next to an open window. Of course, that now strikes me as a stupid thing to have done, but at the time I didn’t give it a thought. I was on a weekend away, not a health-and-safety awareness course. At some point during the night, I tried getting out of the bunk, but instead of turning left and using the ladder, I turned right and hopped straight out of the window.

I fell 24ft on to concrete. From a survival point of view, I was lucky to land on my feet. The downside was that some rather important sections of my legs did not come out of it so well.

My left heel was crushed, while over on the right, my tibia and fibula – the two long bones in the lower leg – detached from their couplings and shattered. The next few weeks involved operations, plates, screws and quite unimaginable levels of agony. At one point, I felt a kind of blinding calm, as though the pain had gone all the way up the scale and rung a bell at the top.

While those pain levels have never returned, over the years there have been generous helpings of it; my legs didn’t take too kindly to being smashed up and bolted back together, and they seem to enjoy reminding me of this. After trying many different ways of managing the pain, eight months ago I started taking cannabidiol, or CBD for short – a non-psychoactive compound found in both hemp and cannabis plants.

The effect on the pain has been profound. It comes as an oil that I put under my tongue whenever pain moves from a dull niggle to the kind that is difficult to ignore.

CBD influences the release and uptake of neurotransmitters such as dopamine and serotonin, leading to many potential therapeutic uses. Crucially, it does not contain any THC, the psychoactive component of cannabis; in other words, CBD does not get you high. Since last year, it has been legal to buy in the UK, after the government’s Medicines and Healthcare Products Regulatory Agency (MHPR) approved its use as a medicine under licence.

CBD oil has since been prescribed to an 11-year-old British boy suffering from epilepsy, in what is believed to be the first instance of a cannabis-derivative being prescribed on the NHS.

Last month, a cancer patient diagnosed four years ago with an incurable brain tumour and given just six months to live, ascribed her incredible recovery to turning to cannabis oil as a last resort.

While research into the medical benefits of CBD oil is in its infancy, it is certainly encouraging. Recent reports suggest it could be a more useful anti-inflammatory than ibuprofen.

“There has been some early scientific evidence that CBD can help with inflammation,” says Dr Henry Fisher, of drug policy thinktank Volteface. “There is also a lot of anecdotal evidence that it helps people who do contact sports, because of the tendency to get inflamed joints. Taking other anti-inflammatories like ibuprofen on a long-term basis – as many sportspeople do – is not a good idea because of potential damage to your liver.”

It also has distinct advantages over opioid medicines, says Dr Fisher. “With CBD, there is no evidence of any long-term negative impact, and no likelihood of addiction. And, of course, there are no known cases of anybody overdosing on CBD.”

The comparison to prescription medicine is particularly pertinent for me. For several months after my accident, I took Oxycontin, a common opioid painkiller. It was very useful at that time because it gave me a warm fuzzy feeling, making everything seem okay. But after a while, I started waking up feeling groggy and crushed. So I decided to stop, and the withdrawal was horrendous. It was several days of indescribable misery, so bad that it made the pain from the injuries feel like a slightly over-zealous massage.

Q&A | CBD and cannabis oil

What is CBD oil?

Cannabidiol, or CBD, is one of more than 80 cannabinoids, natural compounds found in the marijuana plant. It is extracted from the plant via steam distillation and usually bottled with a dropper. Unlike THC, Tetrahydrocannabinol – the most abundant cannabinoid, CBD does not have an intoxicating effect.

What does it do?

Most studies of CBD’s effects are preclinical, but is been shown useful in treating social anxiety and lessening episodes of schizophrenia. The most complete research on the benefits of CBD is on treatment of childhood epilepsy and a plant-based medicine, Epidiolex is scheduled for FDA approval in the US.

Another cannabis-based drug, Sativex, is already approved to relive the pain of muscle spasms in people suffering from multiple sclerosis. Clinical trials are also underway to test this category of drugs for cancer pain, glaucoma and appetite loss in people with HIV or AIDS.

Is it legal?

A low-concentration CBD oil is available in UK pharmacies as a health supplement. Campaigners have called for a high-concentration oil to also be made legal here. In December 2016, the government’s Medicines and Healthcare Products Regulatory Agency ruled that “products containing CBD used for medical purposes are a medicine”.

Read more from the NHS on Cannabis: the facts

Getting off that heavy-duty medicine was key for my recovery. Because this kind of medication saps your energy, and the one thing you need to fight back to full fitness is energy. I spent months in a wheelchair, then on crutches, then finally I was able to start taking slow, painful steps on legs that had forgotten what their purpose was. I had always done a lot of sport, particularly martial arts – I got my black belt in kickboxing when I was 21 and spent some time working as an instructor. This training helped after the accident because I was in reasonably good shape – mashed bones notwithstanding – and I was used to pushing myself.

I never thought I would be able to fight again. So I just concentrated on simply being able to take care of myself. I also just got on with my life, somehow managing to acquire a lovely wife, daughter and son along the way. Then three years ago, I decided that the legs must have healed as much as they were ever going to, and I started doing martial arts again.

Rather than risk going back to kickboxing, I took up Brazilian jiu-jitsu, a grappling discipline where you subdue your opponent with chokes and joint-locks. If you watch beginners, it can look a bit like playground wrestling, but done properly it is graceful but deadly. I started off gently, but after a while I put the injuries behind me and trained as hard as ever. It was through the men I train with that I found out about CBD.

Everyone that uses it tells a similar story: they sleep better and feel less pain. While there are ongoing trials for CBD as a treatment for everything from multiple sclerosis to Parkinson’s disease, all I know is that for me it can make the difference being sitting on the sofa and being able to go training. I can now lift and carry my children without wincing.

CBD does not make the pain go away completely, but that is okay – a bit of pain is necessary, an alarm system to warn of imminent peril. But once the message has been received, it is nice to be able to turn the volume down a little bit.

Source: https://www.telegraph.co.uk/health-fitness/body/could-cannabis-extract-cbd-replace-ibuprofen-painkiller/ October 2017

Filed under: Cannabis/Marijuana,Health,Marijuana and Medicine,Social Affairs :

Marijuana advocates can no longer claim legalization is devoid of catastrophic results.

The Denver Post, which has embraced legalization, analyzed federal and state data and found results so alarming they published a story last week under the headline “Traffic fatalities linked to marijuana are up sharply in Colorado. Is legalization to blame?”

Of course legalization is to blame. It ushered in a commercial industry that encourages consumption and produces an ever-increasing supply of pot substantially more potent than most users could find when the drug was illegal.

The post reported a 40 percent increase in the number of all drivers, impaired or otherwise, involved in fatal crashes in Colorado between 2013 and 2016. That’s why the Colorado State Patrol posts fatality numbers on electronic signs over the highways.

“Increasingly potent levels of marijuana were found in positive-testing drivers who died in crashes in Front Range counties, according to coroner data since 2013 compiled by The Denver Post. Nearly a dozen in 2016 had levels five times the amount allowed by law, and one was at 22 times the limit. Levels were not as elevated in earlier years,” The Post explained.

All drivers in marijuana-related crashes who survived last year tested at levels indicating use within a few hours of the tests.

“The trends coincide with the legalization of recreational marijuana in Colorado that began with adult use in late 2012, followed by sales in 2014,” the Post reported.

Greenwood Village Police Chief John Jackson called the trend “a huge public safety problem.”

Colorado Springs Councilwoman Jill Gaebler, who wants a ballot measure to legalize recreational pot in Colorado Springs, tried to downplay the Post’s findings in a comment on Gazette.com.

“…33% or 196 of all traffic deaths that occurred in 2016 were alcohol-related,” Gaebler wrote. “Yet you don’t hear anyone trying to ban alcohol, even though it is far more dangerous, in every regard, to marijuana.”

The Post found fatal crashes involving drivers under the influence of alcohol grew 17 percent from 2013 to 2015. Figures for 2016 were not available. Drivers testing positive for pot during that span grew by 145 percent, and “prevalence of testing drivers for marijuana use did not change appreciably, federal fatal-crash data show.”

The entire country has an enormous problem with alcohol-related traffic fatalities. Given our inability to resolve that problem, it is arguably idiotic to throw another intoxicating substance into the mix with the predictable result of more traffic deaths caused by impairment.

El Paso County Commissioner Longinos Gonzalez gets it, as shown by a comment he left on gazette.com

“Recent data indicates crime is up statewide, homelessness up, black and Hispanic teen arrests related to MJ are up a lot,” Gonzalez wrote. “A Denver TV station did a month long data poll last year at a hospital in Pueblo (which has fully embraced MJ) and found that nearly half of all newborns were testing positive for THC in their bloodstream at birth. Who would want to expand MJ sales in face of such data? And the big supporters of rec MJ can only fall back on their ‘go-to’ arguments, that ‘it isn’t as bad as alcohol’ or that the negative articles are biased or not credible.”

Another Gazette commenter expressed surprise at Gaebler’s “casual attitude” about the Denver Post’s findings.

“…We already have alcohol, let’s add MJ, and why stop there — people want and need their opioids. Let there be drinking, toking, shooting up in our beautiful city,” the commenter wrote.

One must stretch the imagination to deny that legalized pot has caused a substantial increase in Colorado highway deaths. Pot is an intoxicating, psychoactive drug. That means it cannot be harmless. Expect emerging and troubling data to make this fact increasingly clear.

Source: https://gazette.com/editorial-surprise-legal-pot-correlates-with-rising-traffic-deaths/article_2b2d9b27-4ab5-56fa-a042-028433ae1044.html August 2017

Filed under: Cannabis/Marijuana,Drugs and Accidents,Global Drug Legalisation Efforts,Social Affairs :

Illegal pot growers have turned public lands into industrial agricultural sites. And the ecosystem effects are alarming.

Research ecologist Mourad Gabriel is one of the few scientists studying illegal grow sites in California’s overrun national forests.

On a hot August morning, Mourad Gabriel steps out of his pickup onto the gravel road that winds up the side of Rattlesnake Peak. Dark-bearded and muscular, the research ecologist sports a uniform of blue work clothes, sturdy boots and a floppy, Army-style camo hat. He straps on a pistol. “Just to let you know,” Gabriel says, sensitive to the impression the gun makes, “it’s public land, so I open-carry.”

Another 100-degree day is promised. Gabriel and his four field assistants are headed to work in California’s Plumas National Forest, a few hours’ drive from Lake Tahoe, at the northern terminus of the Sierra Nevada. The U.S. Forest Service (USFS) has enlisted Gabriel to assess the scars from rampant marijuana cultivation. Today’s field site: an illegal marijuana plantation known as the Rattlesnake Grow.

Gabriel doesn’t take chances because he’s been threatened personally. In 2014, someone poisoned his family dog with a pesticide that’s used at the grow sites. The intruder crept onto Gabriel’s property at night and scattered poisoned meat in his backyard. And last year during raids on plots elsewhere in California, two police dogs were stabbed by men fleeing the scene.

So whenever Gabriel enters a cultivation site with his research team — even one that’s been abandoned, as this one is — he always goes in first.

U.S. Forest Service officers collect coils of plastic pipe used to divert water from springs to marijuana plants at an illegal grow site on public lands.

Most of the U.S. domestic marijuana supply is raised in California. Some pot is grown on private property for legal use by medical marijuana patients. These operations can be monitored, and with Californians having legalized recreational pot last November, the regulation is sure to tighten. But in popular pot-growing regions like Humboldt, Mendocino and Trinity counties — closer to the Northern California coast in the so-called Emerald Triangle — environmental regulation has been slow to catch up. Commandeering streams, growers divert the water into high-tech greenhouses, to the detriment of the aquatic life lower in the drainage, including the threatened coho salmon. Biologists for the California Department of Fish and Wildlife have shown that thirsty marijuana plantations can dry up water sources.

What’s more, the rest of the crop — the vast black-market portion — is planted on public or tribal lands by people who ignore the environmental consequences of their activity. When they’re captured, some turn out to be Mexican drug cartel workers, and others come from smaller independent groups. U.S. authorities concede that the great majority of these “trespass grows” are never detected. Even after sites are cleared, the shadowy growers may reclaim them the next year.

“The public doesn’t understand the industrial scale of this,” says wildlife biologist Craig Thompson.

But if you have heard anything about streams being polluted or animals and birds being poisoned by marijuana production, it’s almost certainly because of Gabriel, a soft-spoken scientist who now and then unleashes his inner Rambo.

After the Bust

Gabriel takes his team of biologists over the top of an open, sunbaked ridge and down the other side of the mountain. Immediately, burnt and toppled trunks of pine and fir and head-high tangles of wild lilac shrubs impede the way.

Ten years ago, the Moonlight Fire destroyed 65,000 acres of forest in the Plumas. The marijuana growers stole into the broad footprint left by the blaze in dozens of places. In the section we’re hiking, they cut trails and cleared a series of plots on a steep slope above a ravine. Then the trespassers dug out three springs and diverted their flow into half-inch black plastic piping, which they threaded through the cover of vegetation to their network of plots below. The waterlines emptied into tarp-sealed pits that could store hundreds of gallons of water. Having started thousands of marijuana seedlings in plastic cups, the growers planted them among the shrubs throughout the plots. Each bright green plant was irrigated via drip lines, some triggered by a battery-powered timer. Although the mountainside faced north and east, light was no problem. Where it used to be blocked by trees, the strong California sun now slathered the crop.

Gabriel was with the rangers and deputies when they busted the site in 2015 and uprooted more than 16,000 plants. Judging by bags left around the site back then, he suspects at least 4,000 pounds of potent fertilizer were used. He also recorded several empty containers of a concentrated organophosphate insecticide — a lethal nerve poison that’s toxic to wildlife.

Gabriel’s non-profit organization, Integral Ecology Research Center (IERC), was hired to assess the damage to water sources, soils and sensitive plants and animals. They also inventoried toxic waste, piping, camp materials and trash. Now it’s up to the Forest Service to decide how to repair the damage. Gabriel, enlisting local volunteer groups, will assist with the cleanup, too. The service he offers is soup-to-nuts.

“He’s passionate. He’s a character,” says USFS’s Thompson, who collaborates with Gabriel on research. “He has continued to shine a light on the issue, though it’s still under the radar.”

Connecting the Dots

The first glimmer of impacts to wildlife came to Gabriel from fishers. A fisher — a type of weasel whose body is about the size of a housecat’s — is a denizen of deep woods. It has a wide face and long furry tail, and it can run up and down trees like the woodrats and squirrels it hunts. Fishers have never been overly abundant in the mountains of the West Coast, and their population plummeted after a century of logging and trapping. In the 21st century, biologists have tried to restore the Pacific fisher by reintroducing young animals and tracking them with radio collars. But the fishers’ expansion has been slow because they have been dying more rapidly than researchers expected.

Gabriel joined the fisher reintroduction project in 2009. At the time, he was completing his Ph.D. at the University of California, Davis. He credits an uncle for interesting him in the outdoors. The uncle was also a taxidermist; hence, young Mourad developed an interest in the interiors of animals. In high school, a vocational aptitude test suggested that he could be a game warden, park ranger or biologist. As an undergrad at Humboldt State University, he took courses supporting all three. Gabriel met his future wife, Greta Wengert, while they were both studying wildlife biology in college. After marrying, the two founded IERC in Blue Lake, Calif.

Craig Thompson, a USFS biologist, drops a water filter into a High Sierra stream near a marijuana grow site. Tests have turned up pesticides and fertilizers coming from the grows.

Gabriel’s work for the fisher reintroduction project was lab-based. He conducted necropsies of dead animals that Thompson’s field researchers had picked up. Examining a fisher carcass one day, Gabriel found that its organs had turned to mush. The fisher had been poisoned by a compound that blocks clotting and prompts unchecked internal bleeding, a so-called second-generation anticoagulant rodenticide (AR). D-CON, commonly used against mice and rats, is a familiar brand of AR. But how did a forest carnivore absorb a pesticide typically used around farms and houses?

Gabriel remembers wondering if this one fisher was an outlier. “So we went back to the archival liver tissue,” he says. When he inspected frozen specimens and collected additional carcasses from colleagues, Gabriel discovered that rodenticides had, if not killed, then at least tainted 85 percent of expired fishers.

“It took a while to connect the dots,” he says. From his field experience he was familiar with illegal pot grows, which had plagued the backcountry terrain for 20 years or more. “We’ve all run into it. We’ve been trained,” Gabriel says. “If you come upon a site, you do a 180 and walk away.”

Mounds of Pesticide

Law enforcement officers from different agencies asked him if rat bait from grow sites might be the culprit. It made sense; woodrats and squirrels would gnaw the marijuana plants.

If the growers scattered AR and the rodents were sapped by internal bleeding, they would become easier prey for fishers. Bioaccumulation, as the process is known, would pass the rodenticide up the food chain, where concentrations increase. The fishers in turn might have become prey for bobcats and mountain lions.

Wildlife biologist Greta Wengert (above) carefully handles a suspected neurotoxin found in a Gatorade bottle.

Raids turned up empty bags of AR and sometimes even mounds of the pesticide. To test their hypothesis about bioaccumulation, Thompson, Gabriel and state toxicologists tried to tie the levels of AR exposure in fishers with the locations of grow sites found by law enforcement.

The researchers analyzed 46 female fishers that died over five years. Their results showed that the animals that lived longest had the least rodenticide in their livers and the fewest grow sites within their home ranges. Conversely, animals with roughly four or more grow sites nearby died the soonest.

In a 2015 paper in the journal PLoS ONE, the researchers stepped back and examined all the causes of mortality in their collared fishers. Predation accounted for 70 percent of the deaths, disease an additional 16 percent, and poisoning, which until lately hadn’t been considered, 10 percent. The new factor might explain why fishers weren’t rebounding as fast as they might be. Pesticides might be the major factor in most of the deaths, even those not poisoned outright. “You can argue that the animals that are affected by rodenticide are weaker,” Thompson says, “and that the predation rates on them, as I suspect, are higher.”

Sounding the Siren

In a parallel case, rodenticides have worked their way into some of California’s northern spotted owls, a threatened species. The owls also eat tainted rodents near grow sites. The evidence here is less direct, and depends on analyses of a competing species, the barred owl. For decades, barred owls from Eastern states have been invading the breeding territory of the northern spotted owl in California, Oregon and Washington. Already on the ropes from the logging of old-growth woods, spotted owls were disappearing, and so biologists tried a desperate measure: shooting barred owls.

At the Hoopa Valley Indian Reservation in Humboldt County, forestry biologist Mark Higley, who has helped with the fisher project, also takes part in the culling of barred owls. Higley says he and his staff have had run-ins with illegal growers, “taking risks we shouldn’t take.” After Gabriel’s breakthrough with AR and fishers, Higley sent him liver samples of more than 155 barred owls that had been collected at Hoopa. More than half were positive for rodenticide. Gabriel also had positive results from two spotted owls that were hit by cars. Since spotted owls are endangered, Higley and Gabriel use barred owls as a surrogate — their dietary habits are similar — and infer that up to half of spotted owls near grow sites might be exposed to rodenticide. Now Thompson is looking for other examples of bioaccumulation. He’s testing mountain lion scat for rat poison and pesticides.

Researchers examine a Pacific fisher carcass (left). The animals are struggling in part due to rat poison used by illegal marijuana growers

Only Gabriel, Thompson and a handful of other biologists are investigating the ecological effects of toxins from the trespass grows. The funding opportunities are scant, and the fieldwork is hard and potentially dangerous. Although growers who have been surprised at their plots haven’t hurt anybody — usually they just run away — sometimes shots are fired.Adding to the frustration, many important questions are nearly impossible to answer. At what levels do agricultural chemicals and rodenticide interfere with fishers’ reproduction? How much poison does it take to weaken an animal enough that it becomes easy prey for fishers and bobcats? Wildlife toxicology’s pitfall is that lab experiments can’t be performed on wild populations, let alone on sensitive and rare species.

“You have these snippets of field-based evidence,” Gabriel says. “Maybe you could do a liver biopsy on a captive fisher, but it would cause bleeding, and if an anticoagulant were affecting the animal, [the test] could push it over the edge. I’ll leave that work to someone else.” His role, as he sees it, is sounding the siren. “The problem is getting worse,” he says, frustrated. “Who’s documenting this?”

The Unseen Grower

Amid the lilac shrubs, pungent with pollen, marks of the Rattlesnake Grow aren’t immediately obvious. Soon the paths and waterlines of the growers can be spotted, and then other items like fertilizer bags, heavy-duty plant shears and matted clothing, which the wilderness is swallowing up.

As Gabriel investigates a stream angling toward the ravine, the four techs split into pairs. Two young field biologists push off in opposite directions, using their GPS trackers to measure plot boundaries.

The slanting plot, still faintly pocked with bare spots where the marijuana grew, is about 50 yards wide and 100 yards long. They crisscross the area with cans of spray paint, tagging empty bags of chemicals as they count them. When they take a break, they huddle in the shade thrown by the charred trees.

Walking on a diagonal line across the site, the biologists collect at least five samples of soil in plastic bags. The samples will be tested for various pesticides. Five samples for 1,500 square yards might not seem like much. “That’s all we can get funded for,” says Gabriel, who has rejoined the others. He reports spotting boot tracks. “I think they came back and took the tent and sleeping bags, probably sometime last spring.”

Growers often squat in primitive camps on public lands, leaving their mess to the Forest Service after harvest time.

Of all the species Gabriel studies, the human animal — the unseen grower — is the hardest for him to figure out. “I’ve visited between 100 and 200 grow sites,” he says, leaning against a fallen tree. He wonders, why would growers plant so high up on this ridge with limited water?

“We saw a different approach last week,” Gabriel says. “Just 60 meters from a paved road they were growing 5,000 plants. Maybe one criminal organization decides, ‘We’ll go deep in the wilderness,’ and another, ‘Let’s put it by the road.’ You’re trading easier access for greater risk.”

He sees each site as a piece of a larger puzzle. If researchers could better understand the selection process, it might be possible to better handle these trespass grows.

Later, over a beer in his motel room, Gabriel says, “There’s no way I can do this physically 15 or 20 years from now.” He figures he’s got eight more years, after which he hopes the field will be big enough for him to exit and do something else, leaving others to carry on the research. He’s trying to spur other biologists to study illegal grows too. He wants to track the long-term effects of the chemicals by incorporating specialties like hydrology and soil science.

“As an ecologist, I love working on species of conservation concern,” he says. “I want a stable population of fishers and owls. I want basic research and applied management. Not science just for the sake of science but science as a solution.”

 

 

[This article originally appeared in print as “High Consequences.”]

Source:  http://discovermagazine.com/2017/sept/high-consequences September 2017

Filed under: Cannabis/Marijuana,Environment,Global Drug Legalisation Efforts,Social Affairs :

Since the mid-1990s, the percentage of prime-age American men who don’t have a job — and aren’t looking for one — has risen dramatically. Over the same time period, per-capita sales of opioid painkillers in the United States has more than quadrupled. A new study suggests that there may be a relationship between these two facts.

In a paper published by the Brookings Institution on Thursday, Princeton economist Alan Krueger compares county-level data on opioid-prescription rates and labor-force participation, and finds that the more opioids were prescribed in a given region, the more likely that region was to have seen a significant decline in workforce participation.

The correlation was so dramatic, Krueger estimates that rising opioid prescriptions could plausibly account for one-fifth of the decline in the labor-force participation among American men between 1999 and 2015.

In previous research, Kreuger revealed that nearly half of all American men between the ages of 25 and 54 who were not in the labor force took pain medication on a daily basis. For two-thirds of those men, that daily pain medication was the kind that requires a prescription.

Critically, Krueger’s new research suggests that the counties where opioids are most widely prescribed aren’t, necessarily, places where the population is exceptionally ill or disabled. Rather, they are places where doctors seem to be exceptionally comfortable writing opioid prescriptions to treat pain.

Currently, America’s overall labor-force participation rate is 62.9 percent, unchanged from three years ago, and well below the 67 percent level that was typical in the late 1990s. Most of this decline can be attributed to benign factors — the retirement of the baby boomers, and a rising percentage of young Americans delaying work to pursue higher education. But the drop in participation by prime-age men has been sharp — right now, America has the second-lowest such rate among OECD countries — and very much malign: Krueger finds that prime-age men who have dropped out of the labor force are significantly less happy than their employed and unemployed peers.

There is still some ambiguity in Krueger’s findings. It’s possible that, to some extent, labor-force detachment increases demand for prescription opioids, rather than vice versa. Nonetheless, his paper offers compelling evidence that America’s painkiller habit isn’t just producing 100 overdose deaths in our country each day, but also impairing our economy’s capacity to grow.

Notably, the prescription opioid industry has achieved all this without actually reducing the levels of pain that Americans report.

“Despite the massive rise in opioid prescriptions in the 2000s,” Krueger notes in his paper, “there is no evidence that the incidence of pain has declined.”

http://nymag.com/intelligencer/2017/09/the-opioid-crisis-is-taking-a-toll-on-the-american-workforce.html

Filed under: Drug use-various effects,Heroin/Methadone,Prescription Drugs,Social Affairs :

Tens of thousands of people are ending up in hospital with cannabis-related health problems, official figures have revealed.

There were 27,501 admissions linked to cannabis in England in 2016/17, a 15 per cent rise in just two years from 23,866 in 2014/15.

Labour MP Jeff Smith, who requested the figures on cannabis-related hospitalisations, said the large increase was ‘a concern’.

The influential medical journal The Lancet has just taken the unprecedented step of branding cannabis a ‘huge risk to health’.

Mr Smith, an ex-DJ who has admitted taking drugs, said: ‘It could be that the rise in hospital admissions is associated with rises in particular types of cannabis being used – street cannabis now tends to be more “skunk”.’

‘Skunk’ has a high concentration of the main psychoactive compound THC, which is strongly linked to increased risk of psychosis.

A recent study based on drugs seized by police found that 94 per cent of cannabis now sold on UK streets is ‘skunk’. Academics say this super-strength cannabis could be behind the rise in mental health problems linked to the drug.

Now,The Lancet has warned in a hard-hitting editorial that with the ‘increasing liberalisation of laws’, users need to be made ‘aware of risks to their health and wellbeing.

The journal was reflecting on results from the 2018 Global Drug Survey, which asked 130,000 people in 44 nations about their use of drugs. The Lancet said: ‘Globally, cannabis is still the top illicit drug used and, with the concurrent use of tobacco, remains a huge health risk.’

Its position is in marked contrast to 1995 when it stated: ‘The smoking of cannabis, even long-term, is not harmful to health.’

Mr Smith claimed: ‘Legalisation and regulation is a better way of reducing harm than leaving the trade in the hands of criminals.’

Source: Mail Online July 11th 2018

Filed under: Cannabis/Marijuana,Drug use-various effects,Effects of Drugs,Health,Social Affairs :

SUMMARY

Background

Interest in the use of cannabis and cannabinoids to treat chronic non-cancer pain is increasing, because of their potential to reduce opioid dose requirements. We aimed to investigate cannabis use in people living with chronic non-cancer pain who had been prescribed opioids, including their reasons for use and perceived effectiveness of cannabis; associations between amount of cannabis use and pain, mental health, and opioid use; the effect of cannabis use on pain severity and interference over time; and potential opioid-sparing effects of cannabis.

Methods

The Pain and Opioids IN Treatment study is a prospective, national, observational cohort of people with chronic non-cancer pain prescribed opioids. Participants were recruited through community pharmacies across Australia, completed baseline interviews, and were followed up with phone interviews or self-complete questionnaires yearly for 4 years.

Recruitment took place from August 13, 2012, to April 8, 2014. Participants were asked about lifetime and past year chronic pain conditions, duration of chronic non-cancer pain, pain self-efficacy, whether pain was neuropathic, lifetime and past 12-month cannabis use, number of days cannabis was used in the past month, and current depression and generalised anxiety disorder. We also estimated daily oral morphine equivalent doses of opioids.

We used logistic regression to investigate cross-sectional associations with frequency of cannabis use, and lagged mixed-effects models to examine temporal associations between cannabis use and outcomes.

Findings

1514 participants completed the baseline interview and were included in the study from Aug 20, 2012, to April 14, 2014. Cannabis use was common, and by 4-year follow-up, 295 (24%) participants had used cannabis for pain. Interest in using cannabis for pain increased from 364 (33%) participants (at baseline) to 723 (60%) participants (at 4 years). At 4-year follow-up, compared with people with no cannabis use, we found that participants who used cannabis had a greater pain severity score (risk ratio 1·14, 95% CI 1·01–1·29, for less frequent cannabis use; and 1·17, 1·03–1·32, for daily or near-daily cannabis use), greater pain interference score (1·21, 1·09–1·35; and 1·14, 1·03–1·26), lower pain self-efficacy scores (0·97, 0·96–1·00; and 0·98, 0·96–1·00), and greater generalised anxiety disorder severity scores (1·07, 1·03–1·12; and 1·10, 1·06–1·15).

We found no evidence of a temporal relationship between cannabis use and pain severity or pain interference, and no evidence that cannabis use reduced prescribed opioid use or increased rates of opioid discontinuation.

Interpretation

Cannabis use was common in people with chronic non-cancer pain who had been prescribed opioids, but we found no evidence that cannabis use improved patient outcomes. People who used cannabis had greater pain and lower self-efficacy in managing pain, and there was no evidence that cannabis use reduced pain severity or interference or exerted an opioid-sparing effect. As cannabis use for medicinal purposes increases globally, it is important that large well designed clinical trials, which include people with complex comorbidities, are conducted to determine the efficacy of cannabis for chronic non-cancer pain. Funding National Health and Medical Research Council and the Australian Government.

Source:https://www.thelancet.com/pdfs/journals/lanpub/PIIS2468-2667(18)30110-5.pdf July 2018

Filed under: Australia,Cannabis/Marijuana,Drug use-various effects,Health,Marijuana and Medicine,Social Affairs :

Parents’ greatest fear is that their kids will become addicted to drugs and alcohol

This is according to a Parent Co. survey with over 1500 participants. Fear of drug and alcohol addiction vastly outweighed concerns about terrorism, economic collapse, crime, and war. When we shared the results of this survey, comments from readers could be grouped into three categories:

1. Parents saying “Of course this is our biggest fear!”

2. Parents asking if it’s possible to analyze their kids’ behavior and attitudes for signs of future addiction.

3. Parents asking about the factors that contribute to future addiction. We set out to research these answers with help from AddictionWise, an online service for families and friends of addicts. (More on AddictionWise below.)

From harmful substance abuse of alcohol or drugs or cigarettes to gambling, sex, food, or exercise, addiction can manifest in many forms.

While research continues to explore the scope of addiction and addictive behavior, the bottom line is that science has yet to isolate an “addictive personality.”

However, there’s strong evidence that some people are born vulnerable to addiction. It’s also often possible to predict a child’s’ risk of future addiction.

Genetics, relationships in childhood, environmental and social influences, adolescent experimentation, and the existence of an underlying personality disorder may ultimately contribute to the development of addiction and addictive behaviors.

The biggest indicators of future addiction problems are:

* Genetics – a family history of addiction

* Association with drug-abusing peers

* Drug and alcohol experimentation in adolescence

It’s important to note that parental understanding of the mechanics of addiction is a powerful preventive tool.

Addiction is a medical condition that is characterized by compulsive engagement in rewarding stimuli, despite adverse consequences. It can be thought of as a disease or biological process leading to such behaviors. The two properties that characterize all addictive stimuli are that they are reinforcing (i.e., they increase the likelihood that a person will seek repeated exposure to them) and intrinsically rewarding (i.e., something perceived as being positive or desirable). – Wikipedia

Genetics

A history of family addiction may be the strongest indicator of future addiction.

Many studies have shown that children of addicts have a much greater chance of becoming addicts themselves. Environmental factors may play a role, but a history of family addiction may be the strongest indicator of a child’s future addiction risks.

According to Doug Sellman of the National Addiction Center, heritability runs at about 50% of the cause of addiction.

Dr. A. Thomas McLellan has determined that though more research is needed on the topic, genetics has a critical role in whether or not an individual will develop an addiction, just as chronic illness can be passed from one generation to another.

Undercontrolled Temperament

“[We] have firmly established that undercontrolled temperament comes before any involvement in gambling.” – Wendy Slutske, who is a professor of psychological science at the University of Missouri

In the past few years, research has focused on how “undercontrolled” temperaments in children strongly correlate to a future probability of addiction. A large-scale, long-term, longitudinal study from New Zealand found that undercontrolled three-year-0lds were more than three times as likely to become addicted to drugs and twice as likely to have problems with gambling as young adults than their peers with the most self-control.”

Aspects of an “undercontrolled temperament” include:

* a lack of self-control, including rapidly shifting emotions

* impulsive and willful behavior

* relatively high levels of negative feelings such as alienation and negative emotion

* less conscientiousness and less social agreeability compared to peers

Even after factors like IQ, gender, and socioeconomic status were accounted for the association with addiction still held. And when the “undercontrolled” children were assessed as adults, they hadn’t changed all that much. (This is also shown in this California Child Q-Set study.)

About 10% of children in the study exhibited an undercontrolled temperament.

Relationships With Peers and Adults

Children who have poor relationships with peers and adults are more at risk for addiction.

A child’s environment and family additionally can affect the development of addictive habits. Dr. Robert B. Millman has advocated that children who have poor relationships with peers and adults are more at risk for addiction whereas those with positive relationships are at less risk. Dr. Hatterer also confers with this perspective and elaborates a child who suffers abuse is also at risk for developing an addiction later in life.

Moreover, Dr. Hatterer articulates that a lack of consistent parenting throughout childhood also influences future addictive behavior patterns.

Drug experimentation in adolescence

Association with drug-abusing peers is often the most immediate risk for exposing adolescents to drug abuse and delinquent behavior. – Drugabuse.gov

A 30-year prospective study found that early-exposed adolescents remained at an increased risk for poor outcomes. Approximately 50% of adolescents exposed to alcohol and drugs before age 15 had no conduct-problem history, yet were still at an increased risk for adult substance dependence.

Likewise, children who feel isolated or alienated are at risk for addictions. They may lack self-confidence and not know how to reach out to others for their emotional needs. .These children may eventually turn to addictive substances to cope.

According to David Sack M.D: “For peer groups where substance abuse is the norm, the future looks bleak. Nine out of 10 people who end up addicted started drinking, smoking or using drugs by age 18, CASA reports. One in four high school students who drinks or uses drugs becomes addicted. Drinking at an early age is linked to dangerous binge drinking in young adulthood. Many people come to treatment with histories of drug abuse spanning decades, or the majority of their young lives, making the recovery process more challenging.”

Childhood Trauma

When a child has suffered a trauma such as physical, mental, or sexual abuse; the death of a parent; or neglect, she may turn to addictive behaviors or substances to help cope with her pain and stress. This is especially true if she hasn’t been taught healthy coping strategies.

Changes in Brain Chemistry vs. “Addictive Personality.”

There’s aren’t always signs of addictive traits in childhood. For many people, addiction is a progressive disease.

Addiction isn’t necessarily the consequence of an “addictive personality” (which technically doesn’t exist; see below) as much as a result of changes in brain chemistry. Dr. Alan Leshner, director of the National Institute on Drug Abuse, contends that “voluntary and controllable” drug and alcohol use can eventually morph into a daily addiction. Continued drug use alters the brain’s functioning and structure.

Leshner even considers drug addiction a form of brain disease.

“The development of addiction is like a vicious cycle: Chronic drug use not only realigns a person’s priorities but also may alter key brain areas necessary for judgment and self-control, further reducing the individual’s ability to control or stop their drug use. This is why, despite popular belief, willpower alone is often insufficient to overcome an addiction. Drug use has compromised the very parts of the brain that make it possible to “say no.” – Drugabuse.gov

Summing Up

A child with increased risk of addiction isn’t destined to become an addict.

Addiction typically begins as a symptom, not a cause, of personal and social maladjustment.

Addiction is a complex process. Many people gamble, drink, and take drugs without becoming addicted.

Addiction should always be viewed in the context of an person’s developmental history. It’s most often the result of a biological or behavioral predisposition. For example, many studies show that depressed or impulsive people are more likely to drink and take drugs.

But addictive tendencies don’t mean a child will inevitably become an addict. Parental understanding of the mechanics of addiction is also a powerful preventive tool. Families can help provide protection from later drug abuse when there is:

* a strong bond between children and parents

* parental involvement in the child’s life; and

* clear limits and consistent enforcement of discipline.

Research shows that parents and caregivers can help kids learn to practice self-control, which is a major factor in future prevention. Even undercontrolled children can outgrow self-control problems over time, and learned