The Daily Briefing 5.19.2020

The seizure by narcotics police in Myanmar of a large quantity of liquid fentanyl is cause for alarm, as it provides evidence this region of Southeast Asia is ramping up production and global distribution of the dangerous synthetic opioid. Fentanyl is 30 to 50 times more powerful than heroin, and is largely responsible for a surge in overdose deaths across the United States, with substance users switching to the drug or mixing it with prescription painkillers or other substances.

Fentanyl is easier to make and smuggle than heroin, and is far more profitable than other opioids—as well as deadlier. Meanwhile, travel restrictions and lockdowns due to the corona virus pandemic are disrupting the flow of illicit drugs to the U.S., thereby increasing the potential for overdose as users adapt to shifting supply. Experts say the availability and prices of illegal drugs are changing in different areas of the country, creating a patchwork of new overdose risk as dealers lack supply and users can’t get money to buy what they need.

And finally, The Atavist publishes a remarkable story about a mother who dedicates her life to advocating for harm reduction programs following her son’s overdose death. The twist in the story is that the woman’s late husband was the inventor of nalaxone—the widely used overdose reversal drug that is now part of the standard emergency toolkit to save lives.

The Daily Briefing 5.18.2020

Governors who are facing huge budget shortfalls—due to the corona virus pandemic and the economic downturn—are eyeing cuts to Medicaid funding that would threaten critical drug treatment services. Medicaid consumes about 20 percent of state budgets and is therefore ripe for pruning as states reel from a drop in tax revenues that require substantial budget cuts. But Medicaid is also the country’s biggest payer of addiction and mental-health services—covering four in 10 individuals among the half a million Americans with opioid addiction— and is a lifeline from those struggling with substance abuse.

Medicaid is also crucial for millions of newly unemployed Americans who have lost their employee-based coverage, and for those who contracted Covid-19. Considering these circumstances, it’s time for the federal government, which jointly funds Medicaid with the states, to let governors know they will bolster resources to the states, to ensure the program is able to maintain services for drug treatment, and for those who have lost their insurance or are fighting the corona virus.

Meanwhile, recreational marijuana stores in Massachusetts will be back in business soon as a phased reopening of the state’s economy gets underway. Governor Baker had prohibited recreational pot sales during the pandemic, fearing that tourists would flock to the state to buy the stuff and spread the virus. Baker came under pressure by the pot lobby to relent and open the shops, and he should be commended for not backing down—and choosing public health over profit.

The Daily Briefing 5.15.2020

Doctors and public health officials in Appalachia, a region hit hard by the opioid epidemic, report a rise in relapses as those struggling with substance abuse react to forced isolation and reduced access to treatment and crucial support networks. The pandemic’s rules on sheltering in place and social distancing aggravate the drug crisis, as patients have too much unstructured time, are not able to attend recovery meetings in person, and suffer from anxiety—all triggers from those in recovery.

Treatment facilities are starting to adjust their practices to accommodate the new conditions, providing larger take-home doses of medication, using telemedicine to assess and prescribe drugs, and initiating counseling sessions by video conferencing to help at-risk communities. Maintaining access to treatment is also critical because people with substance use disorders are at heightened risk from the virus due damage caused by opioid abuse, which weakens the immune system and makes users more prone to infectious diseases.

Meanwhile, the United Nations says that while the pandemic has disrupted the global illicit drug trade in North America and Europe, it is still flourishing in the Asia-Pacific region. In Europe, tighter cross-border restrictions and tougher sheltering in place rules have made drug dealing more difficult. But in Asia, transnational crime groups have actually expanded the scale of drugs such as methamphetamine—the most popular drug in the region—and widened their distribution network while shifting to online sales.

The Daily Briefing: 5.14.2020

Substance abuse treatment centers are anticipating a crushing wave of new demand amid the corona virus pandemic and unfolding economic crisis, which is likely to trigger relapses and overdoses among patients struggling to recover from the opioid epidemic. Yet only a small portion of the $175 billion in federal emergency funding, approved by Congress for hospitals and healthcare facilities during the pandemic, will be allocated to drug treatment centers that are also facing severe financial difficulties.

These behavioral health centers, which serve nearly half a million people struggling with substance abuse, provide FDA-approved medication-assisted treatment (MAT). But they are not eligible for a bigger slice of funding due to a technicality: the money is earmarked for Medicare providers in 2019, but treatment providers weren’t eligible for Medicare payments until recently. While Medicaid is the biggest payer of addiction services, treatment is also provided through Medicare. It’s time for Congress to correct this situation and ensure that drug treatment centers are well funded and fully operational as the pandemic exacerbates the opioid epidemic and more patients require services.

And finally, an op-ed in the San Francisco Chronicle notes that as San Francisco-based e-cigarette maker Juul prepares to quit the city and move to Washington, D.C., it’s a good time for parents to speak to kids about quitting vaping. Vaping is highly addictive—as the teen nicotine epidemic proves—and poses significant health risks, so we need to support teens that want to stop.

The Daily Briefing: 5.13.2020

Social distancing and sheltering in place rules to stop the spread of Covid-19 are changing our behavior patterns in multiple ways, including more alcohol and marijuana consumption while waiting out the pandemic. But as more people turn to these substances to counter stress and fear or to simply relax while isolated, a psychoanalyst warns that pot and booze are a bad combination for lockdown. They can offer temporary relief and comfort, but the benefit is usually short-lived and ultimately can be self-destructive. Both can contribute to psychological distress, fatigue and even paranoia when used regularly. What’s more, smoking or vaping pot everyday can exacerbate despair, insomnia and panic attacks—and can also lead to addiction that will outlast the virus.

There’s no panacea for the anxiety and depression the pandemic is causing but alcohol and marijuana tend to make these things worse, rather than better. And finally, Colorado was the first state to legalize marijuana but it is now in go-slow mode when it comes to allowing widespread home delivery of pot. While a new state law would allow home delivery, it requires individual municipalities to opt in, and so far only two cities—Boulder and Superior—have done so, forcing residents of Denver, the largest city, to fend for themselves (although some rogue businesses are delivering illegally). City officials say they want to enact the law only after careful and thoughtful deliberation and with public feedback, which is a win for community control of marijuana distribution.

The Daily Briefing: 5.12.2020

As the Covid-19 virus spread across the U.S., addiction doctors and policy experts feared the worst for the estimated half-million Americans battling opioid addiction, knowing that isolation, stress and financial hardship could trigger overdose and relapse. But those fears have eased since federal authorities moved quickly to enact far-reaching policy changes—easing strict regulations and access to addiction treatment and medications.

By using telemedicine instead of in-person visits to evaluate and prescribe withdrawal drugs, and making it easier to obtain larger doses of those medications—including home delivery—patients were able to maintain their treatment without risk of spreading the virus or becoming infected. Now, many in the field say they want these long-sought policies to become the new normal—hoping to transform patient care for those with substance abuse issues for decades to come.

Supporters argue the new allowances could result in even greater expansion of services and treatment, especially in rural areas, where there are few qualified doctors to treat addiction and prescribe medications. Others, however, are more cautious, saying that the new rules do little for Americans addiction to other drugs including meth, cocaine and alcohol. As we look ahead, we must evaluate and adopt the regulatory practices that make sense and enable the widest access to a full range of treatment services.

The Daily Briefing: 5.11.2020

The largely unregulated market for products with CBD—the non-psychoactive component of marijuana—is booming, as consumers fall for false marketing claims the substance is a cure all for everything from anxiety and arthritis to cancer. Now, the conservative world of professional golf is getting into the game, with many pro golfers using and becoming paid endorsers for CBD products they say relieve aches and pains and helps them sleep, although there’s no scientific evidence they do any of those things.

The endorsements are controversial because while using CBD is legal for golfers, marijuana and its psychoactive ingredient THC are not and drug tests often find traces of THC in CBD products. As one anti-doping official put it, “there’s no guarantee that what is on the label is contained in the product.” Meanwhile, a report in Scientific American offers insight into ongoing studies concerning the long-term effects of marijuana, which remain a mystery. As access to pot eases in the U.S., and more people use it—especially young people—it’s critical we know the impact on cognitive abilities, as this will help determine outcomes in education, employment and job performance.

For the moment however, scientific studies have not be able to accurately figure out the effects on adolescent minds, so that parents, teachers and social planners can respond according to restrict use. And finally, American winemakers are facing headwinds as Millennial buyers shy away from premium vintages in favor of craft beer and spirits—and, increasingly, liquid marijuana products.

The Daily Briefing 5.8.2020

In a new report looking at the collective impact of Covid-19, the Well Being Trust estimates that in addition to tens of thousands of deaths in the U.S. as a direct result of the virus, there will also be an accompanying surge of preventable “deaths of despair” from drugs, alcohol and suicide.

A number of factors will lead to this surge, including economic failure due to massive unemployment, the impact of mandated social isolation, and the stress and uncertainty about the pandemic that will contribute to worsening mental health. We can, however, mobilize to limit the impact by investing in solutions that can help heal the nation’s isolation, pain, and suffering by addressing the structural inequalities in our society. In addition, it is critical to ensure people are connected, working, and that mental health services are accessible and integrated into healthcare.

Meanwhile, it appears that government warnings in South Korea about the dangers of vaping are having an impact: e-cigarette maker Juul says it is leaving that market after failing to gain a foothold.

And finally, a mother who lost two sons to drug overdose speaks out in a poignant essay about her loss—and how, as a society, we must talk openly about addiction and substance abuse. “We must not be silent,” she writes in USA Today. “If we are to begin to heal as a society, we must dispel stigma by coming forward and sharing our stories.”

The Daily Briefing 5.7.2020

The growing popularity of products containing CBD, the non-psychoactive component of marijuana, has alarmed public health officials wary about false marketing claims these products are a panacea for many ailments—from anxiety and acne to Alzheimer’s.

Now, the Federal Trade Commission is taking action to stop a California firm from selling three CBD supplements as effective cancer treatments, without citing any clinical or scientific evidence. The company, Whole Leaf, said the products were proven to reduce inflammation and minimize the way cancer cells manipulate other cells—a false claim, as there is no CBD product that is considered a cancer treatment, the FTC complaint noted. Increasingly, the FTC and Federal Drug Administration are cracking down on the booming CBD market—which is rife with fraudulent marketing and exaggerated claims concerning the product’s powers—and providing much needed scrutiny.

And finally, as more states legalize medical and recreational marijuana, homeowners are up in arms about the pungent smell of pot wafting over from their neighbor’s property. Complaints to homeowner associations and lawsuits have followed, pitting pro-pot residents against those who dislike the odor. The fast pace of legalization, however, has left a patchwork of laws and regulations that makes it difficult to resolve this knotty issue.

The Daily Briefing 5.6.2020

Marijuana legalization was a hot topic during the recent Democratic presidential campaign, with progressive candidates Bernie Sanders and Elizabeth Warren arguing in favor and Joe Biden taking a more cautious stance.

Now, Biden, the presumptive winner, is getting more specific on his plans for pot. He has issued a criminal justice reform agenda that includes full decriminalization and expunging all prior cannabis convictions—but stops short of nationwide legalization. In addition, Biden wants to end all incarceration for drug use alone and instead divert individuals to drug courts and treatment.

It is a reasonable, sensible approach that will likely draw the ire of the cannabis industry and younger voters, as well as social justice advocates. They believe legalization is a pathway to economic equality for many communities—particularly those of color—who were disproportionately harmed by the failed drug policies of the past, although these gains have so far failed to materialize. If Biden is the candidate, it’s not clear what Trump’s pot strategy will be, although in the past he has opposed legalization and other reform measures.

And finally, cannabis companies in Massachusetts claim they face “extinction” if the state’s ban on adult-use recreational marijuana continues. But so far Governor Charlie Baker is holding firm in his conviction that such sales would encourage tourists to flock to the state and thereby increase the spread of Covid-19.

The Daily Briefing 5.5.2020

E-cigarette maker Juul was once the darling of Silicon Valley, attracting huge investment as sales of its sleek vaping products boomed—that is, until the company came under siege for marketing to young people and fueling an underage vaping epidemic. Now, Juul is abandoning San Francisco for Washington, D.C., to be closer to lawmakers and regulators who will determine the firm’s future.

The company, beset by regulatory crackdowns, lawsuits and federal investigations, thinks it’s better to be near the lawmakers and agencies—including the Federal Drug Administration—that will decide whether its products, and those of its competitors, can remain on the market. Analysts say Juul also wants to shed Silicon Valley’s growth-at-all-costs ethos in order to gain the market’s trust—while it continues to sell vaping devices under partial federal restrictions on flavored products targeted to young people. Another reason to leave San Francisco: Juul’s hometown has enacted tough anti-vaping policies, including an e-cigarette sales ban.

And finally, a new study from Columbia University’s Mailman School of Public Health points to the benefits of long-term treatment with the addiction-withdrawal medication buprenorphine. The study found that those who continued using the drug had significantly lower rates of prescription opioid use and medically treated overdoses than participants who stopped—confirming that such medications should play a critical role in drug treatment.

The Daily Briefing 5.4.2020

As the coronavirus pandemic escalated, public health officials quickly warned that the lockdown and social distancing rules might have a harsh impact on substance abusers unable to receive medications, counseling and other treatment services. Now, we’re starting to see evidence this is happening, with some cities and states, already hard hit by the opioid epidemic, reporting spikes in fatal drug overdoses.  Dayton, Ohio, for example, which has made great strides to curb the opioid epidemic, has seen overdoses jump 50 percent over the past year.

Authorities in counties across Florida, Texas, Pennsylvania and New York are also reporting rises in overdoses as isolation and despair trigger relapses in recovery, and make it more difficult for first responders to reach overdose victims, and for addicts to receive withdrawal medications. New federal guidelines are easing that problem—including methadone vans in New York City that make home deliveries—but we must undertake greater efforts to ensure the important gains we have made to stop the opioid crisis are not lost during the pandemic.

And finally, a new study in JAMA Pediatrics sheds new light on why teens are so attracted to vaping products such as Juul. While flavored vapes, which have now been partially banned, are attractive to teens, what’s more important are social factors—in other words, they think vaping is cool. The study, based on teen text messages, found that young people know vaping is addictive and dangerous and could lead to fatal lung ailments, but they still want to be part of the gang. That’s why social anti-vaping messaging, starting in middle school, should focus on social aspects of vaping, the study concluded.

The Daily Briefing 5.1.2020

The popularity of e-cigarettes for consuming both tobacco and marijuana is driving a teen vaping epidemic, with an estimated 25 percent of high schools using such devices. Now, a tooldeveloped by Cornell Tech will be able to monitor when and where people vape, how deeply they inhale and how much nicotine or pot they consumer, which could provide clues to why vaping is so addictive—and help users curtail use. The tool could enable vapers to track their consumption and tell researchers more about drug cravings, as well as what interventions might help people quit.

In the national opioid lawsuits, a judge is allowing two more Ohio counties to join the trial against pharmacy chains accused of contributing to the opioid epidemic and more than 400,000 deaths by dispensing hundreds of millions of prescription painkillers. It’s not certain which pharmacies will be involved in the expanded trial, but those named so far in other cases include CVS, Rite Aid, Walgreens and Walmart. And finally, a coalition of marijuana businesses, churches and advocacy groups are urging Governor Newsom of California to cut the state’s hefty pot tax. The coalition says the coronavirus pandemic and subsequent lockdown is taking a heavy toll on business—especially pot shops—run by minorities and communities of color that were disproportionately targeted during the war on drugs.

The Daily Briefing 4.30.2020

In its Parenting column, the New York Times tackles a question that is apparently vexing many parents who are cooped up at home with kids during the pandemic lockdown: whether to give children who might be anxious and emotional a dose of CBD, the non-psychoactive component of marijuana. More adult Americans are turning to CBD than ever before, with a 2019 Gallup poll finding that 14 percent used such products, mostly for pain, anxiety and sleep—although there’s no scientific proof of their effectiveness.

Now, parents are giving CBD to their kids. Currently, there’s only one CBD-based drug approved by the FDA, to treat a rare form of childhood epilepsy, and there’s no proof CBD works and is safe for children for any other ailment. The few studies that have been conducted rely mostly on parents’ perceptions, rather than measured changes in comparison to placebo groups. So it is disturbing that parents are experimenting with CBD products for their kids, who have been diagnosed with autism and A.D.H.D., for which there are no reported controlled trials. This is potentially risky, because it’s impossible to know what’s really in a CBD product without independent testing, and what the side effects might be. For homebound parents dealing with the stress of volatile kids, CBD is definitely not the answer.

The Daily Briefing 4.29.2020

E-cigarette maker Juul helped get a younger generation of Americans hooked on vaping with its sleek products and youth-targeted marketing—but now it’s paying a price for its success. Juul has announced it is cutting a third of its workforce as the company, under attack by public health advocates and government agencies, grapples with falling market share and regulatory crackdowns. Once the buzz of Wall Street and Silicon Valley, Juul came under attack as vaping surged among high school students, and an outbreak of vaping-related illnesses and deaths alarmed parents and health officials. Partial bans were issued on flavored e-cigarettes aimed at young people and many states implemented stricter rules on sales of vaping products, causing Juul’s revenues to plummet.

Now the FDA will review all vaping products to see if they meet health standards—a much-needed step to fight the teen vaping epidemic. And there’s more bad news for the vaping industry: a new study in the Journal of the American Heart Association found e-cigarettes may be as dangerous for your heart as smoking conventional cigarettes. Research showed that those who use cigarettes or e-cigarettes or both had stiffer arteries than those who do not smoke or vape. Cardiovascular disease is a major cause of death for smokers, and e-cigarette manufacturers have suggested that switching to their product might prove less harmful to health—a claim that this study calls into question.  

The Daily Briefing 4.28.2020

The global marijuana market is continuing an unprecedented boom: fueled by legalization in many countries, and easier access to medical pot, worldwide sales in 2019 reached a record $14.7 billion, according to a cannabis industry report. The 46 percent growth rate—the highest annual to-date—far outpaced the 16 percent increase the year before. Sales in Canada, as well as California and Massachusetts, were the largest contributors, supplemented by expanding medical markets in Florida and Oklahoma. In the U.S., sales grew 37 percent year-over-year to $12.3 billion, as more states legalized pot despite growing evidence of the drug’s potential risks and angers, especially to young people.

Looking ahead, market researchers say the marijuana market shows no sign of slowing, forecasting global sales of $47 billion by 2025. Why are marijuana sales growing so rapidly? According to the Food and Drug Administration, one gimmick is for e-cigarette makers to hawk vaping products—for both tobacco and marijuana—that look like toys and candy and help minors hide their devices from parents. The products include backpacks and sweatshirts with stealth pockets for e-cigarettes, and vaping devices that look like smartwatches, videogame systems and fidget spinners, said the FDA, which has sent warning letters to the companies. Especially disturbing are companies that market e-liquid vaping cartridges in packaging meant to look like candy or featuring cartoon characters—a practice that must stop.

The Daily Briefing 4.27.2020

Western Pennsylvania and parts of Ohio and Appalachia form what’s known as “addiction alley,”a region where drug use has soared over the past two decades and the opioid epidemic has claimed tens of thousands of lives. As residents struggling with substance abuse adhere to sheltering-in-place regulations due to the coronavirus pandemic, those isolated from friends, family, jobs and basic routines are particularly vulnerable to relapse and overdose due to isolation.

Many suffer from anxiety and depression, and fewer are seeking drug treatment services, worried officials say. And although telemedicine and video conferencing has enabled many to stay in touch with facilities and counselors, that isn’t always the optimal approach for those in the early stages of treatment. The region is also dealing with a resurgence of methamphetamine use, compounding the difficulties of the opioid epidemic. Says one addiction expert, “the reality is that a deadly disease like the coronavirus will not stop addiction.”

And finally, the Brookings Institute has come up with recommendations for the U.S. and Canada—two countries grappling with the opioid crisis—to combat the epidemic. Looking at countries such as Germany, where prescriptions for opioid painkillers for chronic non-cancer pain are uncommon, the report suggests that flooding the healthcare system with prescription opioids is not needed for population pain management. Second, it says limits to healthcare access—due to lack of adequate insurance, for example—can make the epidemic worse. And finally, Brookings says we need strict rules under which opioids are prescribed (Germany, for example, does not have an opioid epidemic.)

The Daily Briefing 4.24.2020

An article in the Philadelphia Inquirer looks at Portugal’s radical move to decriminalize all drug use in 2001 and expand harm reduction and access to treatment, and whether this could provide a useful model for the U.S. to tackle its ongoing drug crisis. In Portugal, the experience has been generally positive: while addiction still exists, overdose deaths have plummeted, along with HIV infections from intravenous drug use.

Outreach to substance abusers is widespread, including “methadone vans” and counseling facilities, with the goal of keeping users alive so they can enter treatment. Some U.S. cities are doing this on a piecemeal basis, so it’s unclear whether the Portuguese approach would work on a large scale. More importantly, Portugal changed its attitude about drugs, making recovery a priority—a goal that should also be adopted n the U.S.

Meanwhile, a new CDC report on methamphetamines shows that 1.6 million adults used the drug and 25 percent injected it, based on data from 2015 to 2018. Despite such widespread use, the report says that less than one third of adults received substance abuse treatment—a troubling finding highlighting the lack of resources dedicated to the growing meth crisis.

And finally, medical marijuana registrations in Massachusetts—which require a physician’s recommendation—spiked 245 percent during the coronavirus pandemic after Governor Charlie Baker closed recreational pot shops. It’s the biggest monthly increase since pot was legalized, as consumers scramble to stock up on the drug as the coronavirus lockdown continues.