The Daily Briefing 7.28.2020

The use of telehealth platforms to treat substance abuse has grown substantially during the COVID-19 pandemic, after federal authorities loosened regulations that had restricted virtual interactions between patients and medical professionals treating addiction disorders. Now a new Senate bill would expand and make permanent the emergency actions, allowing providers to continue to expand access to treatment beyond the corona virus period. Many providers have long lobbied for such changes, believing that new technologies would enable more patients to obtain treatment and medications. Overdose deaths have spiked during the pandemic, as substance abusers face isolation and economic losses and difficulties continuing in-person treatment.

Meanwhile, the Democratic Party platform committee has defeated yet another effort by progressives to add nationwide marijuana legalization to Joe Biden’s policy agenda, which instead calls instead for decriminalization, legalizing medical marijuana and letting states decide on recreational pot. It’s the second defeat for pro-pot forces within the party as Biden sticks with his more reasonable approach based on available science.

And finally, as contact tracing for COVID-19 expands across the country, a proposal has been made to add questions about mental health and substance abuse when screeners interact with people. While contact tracing has initially focused on containing the infection, it could also be used to identify people at risk from mental illness and substance abuse disorder.

The Daily Briefing 7.27.2020

As drug overdose deaths surge in the U.S., the Food and Drug Administration has ordered manufacturers of prescription painkillers to add information about the overdose reversal medication naloxone to labels. The move comes just weeks after the federal government released new data showing that overdose deaths rose to an all-time high last year, and are expected to continue climbing in 2020 as Americans face stress and economic losses during the COVID-19 pandemic. The FDA says the move will help raise awareness about the potentially life-saving treatment, and is part of a wider effort to increase the availability of the drug to reduce overdose fatalities.

Meanwhile, a report in the New York Review of Books says that medical boards have routinely failed to take action against physicians who have overprescribed opioids and also operate shadowy pain clinics. The lack of oversight, the article says, has exposed systemic failures in the way medical boards deal with egregious examples of misconduct by doctors—despite the harm caused by their conduct.

And finally, cases of vaping-related illness are spiking in Minnesota, signaling a possible resurgence of the respiratory ailment that flared last year across the country but subsequently subsided. Health officials in the state say 11 cases—with a median age of 18—have been reported in the past two months, but that the corona virus has made it more difficult to detect the illness, which is directly linked to e-cigarettes and THC, the psychoactive component of marijuana.

The Daily Briefing 7.17.2020

Despite the implementation of strict guidelines and prescription monitoring, doctors and dentists are still flooding the U.S. with addictive pain medications at twice the rates widely considered safe. With the annual death toll from drug overdose—much of it opioid-related—reaching a record 72,000 people in 2019, opioids are nevertheless being handed out in large volumes, with the U.S. consuming 80 percent of the world’s opioids.

Dentists are also part of the problem: data shows that half of all the painkillers handed out by dentists are unnecessary and inappropriate—especially for mild pain that could be treated with Tylenol and an ice pack. Even more disturbing, dentists regularly give powerful opioid pills to younger patients who are most vulnerable to addiction.

Meanwhile, Big Tobacco is trying to make up for lost profits from the collapse of the vaping market by introducing a new product—oral nicotine pouches, which are neither heated nor inhaled. The industry came under attack for marketing vaping devices to young people, which has led to a teen nicotine epidemic. And critics say the new nicotine products are also cause for alarm as they still raise long-standing health concerns.

And finally, the number of felony marijuana arrests are declining in California, a legal marijuana state—but not for Blacks and Hispanics. Overall arrests declined 27 percent, but Hispanics accounted for 42 percent and Blacks 22 percent. Law enforcement has long been criticized for disproportionate marijuana arrest rates for people of color, fueling the movement to decriminalize the drug.

The Daily Briefing 7.16.2020

Drug deaths in America, which fell for the first in 25 years in 2018, surged again in 2019 and are expected to be even higher this year in the shadow of the COVID-19 pandemic. Preliminary data from the Centers of Disease Control indicate that nearly 72,000 Americans died from drug overdose last year, a 5 percent increase from 2018.

And this year, drug deaths are already up an average of 13 percent across 35 states due in part to the social isolation and economic despair caused by the corona virus—although overdoses were already rising before the virus arrived. Equally troubling, the data shows that the powerful synthetic opioid fentanyl—once confined mostly to the East—is showing up in Western states. And that methamphetamines and cocaine are being mixed with the deadly drug. Yet, even as overdose deaths soar, cash-strapped states are cutting funding for addiction programs.

States facing budget shortfalls due to corona virus-related economic losses are paring back aid to critical addiction treatment services as well as to Medicaid, which supports 21 percent of the country’s spending on substance use disorder programs.

New York’s Governor Cuomo has said he is withholding one-third of funding for addiction treatment—a devastating blow to those struggling with substance abuse. Instead of slashing funding, now is the time to significantly ramp up resources to confront the surge in overdose deaths and implement long-term plans to fight an epidemic that has killed more than 400,000 Americans over the past decade.

The Daily Briefing 7.15.2020

Opioid overdose deaths are surging in the Chicago area, with Black residents accounting for more than half of the nearly 1,200 deaths this year—although they make up only a quarter of the population. The number of deaths began to rise months before the COVID-19 pandemic, but the subsequent lockdown, economic losses, existing social inequities and the lack of adequate healthcare services have added new challenges. Officials warn that the corona virus pandemic has overshadowed the growing opioid crisis in Cook County, and have called for measures including greater availability of overdose-reversal drugs.

Meanwhile, New Jersey Governor Phil Murphy says the state will have to be innovative to make up for budget shortfalls due to the COVID-19 economic slump—including marijuana legalization, which he described as a “no-brainer” solution to raise tax revenues and also promote social justice. Murphy said he hopes New Jersey will get there sooner rather than later because legalization is “an incredibly smart thing to do.”

And finally, what isn’t smart when it comes to marijuana legalization is pot brands that falsely claim their product can be used to treat opioid addiction. A JAMA study found that a large proportion of medical marijuana dispensaries make unsupported claims about the effectiveness of cannabis for opioid use disorder, including that marijuana could replace FDA-approved medications for treating opioid addiction. It's further evidence that regulations and curbs on commercialization are critical to control a legal marijuana market. 

The Daily Briefing 7.14.2020

Joe Biden’s resolute stance against nationwide marijuana legalization continues to draw criticism in many quarters—as well as support from those who say his go-slow approach makes sense. Kevin Sabet, head of the organization Smart Approaches to Marijuana, commends the former vice president for siding with science, not politics. Writing in Newsweek, Sabet says every single medical association in the country backs Biden’s position, noting that today’s more potent pot can be dangerous—sending nearly 300,000 people to the emergency room each year and increasing traffic fatalities.

The real risk, he adds, is that Big Pot is now backed by a for-profit, Big Tobacco-style industry, which is pushing for legalization. Despite Biden’s moderate stance—he favors decriminalization, legalized medical pot, and letting states set their own policy on recreational—one Democratic Senator believes legalization would have the votes to pass in any case if Biden wins the White House and Democrats take the Senate. Senator Ed Markey of Massachusetts said that lawmakers would “move very quickly” on legalization if they have the votes despite Biden’s opposition, and would also put national protections in place, without elaborating on what those might be.

And finally, researchers are increasingly hopeful of finding new pain management solutions that do not involve highly addictive opioid painkillers, which led to the misuse of such drugs and the subsequent opioid epidemic. The novel approaches being investigated would target customized care rather than a one-pill cure-all for both acute and chronic pain as well as treating opioid addiction.

The Daily Briefing 7.13.2020

There’s troubling news from New York State, where governor Cuomo has notified drug and alcohol treatment providers he will immediately slash their funding by 31 percent, despite the recent surge in drug overdoses and fatalities related to the COVID-19 pandemic and lockdown. Providers—who were given no warning about the surprisingly large cuts—say the consequences are likely to be dire and further strain a mental health network already struggling to provide treatment.

Facilities could close and treatment curtailed, leading to more drug-related deaths, say the providers. The governor had said cutbacks were needed unless Washington comes through with a financial bailout package for the state.

Meanwhile, residents of Washington, D.C. will likely vote this fall on decriminalizing certain plant-based hallucinogenic substances, including psychedelic mushrooms—becoming the latest jurisdiction to take up the issue of effectively decriminalizing possession of mushrooms containing psilocybin, a psychoactive substance.  Although supporters say the drug—currently illegal under state and federal law—can deliver mental-health benefits scientists caution that more research is required to determine whether hallucinogenic drugs can be addictive.

And finally, physicians at a Colorado children’s hospital report that medical marijuana use for nausea and similar symptoms was considered potentially unsafe in nearly two-thirds of oncology patients. The finding is important as more states adopt medical marijuana laws and hospitals establish treatment policies.

The Daily Briefing 7.10.2020

A letter in the New England Journal of Medicine offers insights into health outcomes at an illegal safe injection site in the U.S., and its impact on substance abuse. The evaluation of the unsanctioned site in an undisclosed location found that after 5 years and some 10,000 injections, there were 33 opioid-involved overdoses—all of which were reversed by administering naloxone—and no deaths or referrals to an outside medical institution. Because the study was limited to one city and one site, the results cannot be generalized. But they do offer preliminary evidence that such sites could reduce mortality at a time when nearly 70,000 individuals die each year from drug overdose.

As is often the case with safe consumption models, what’s missing is the treatment component: this study concludes that safe sites could allow substance users to link to other services including treatment, but does not require it. The Rosenthal Center supports safe injection site pilot projects that would create a continuum of care allowing individuals to enter treatment and rebuild their lives—rather than offering only a safe and controlled environment to shoot up drugs.

Meanwhile, a new study from Finland analyzing vaping ads on Instagram shows that vaping companies clearly target young people. About 40 percent of the hundreds of thousands of images that appeared over 6 months promoted flavored e-liquid devices that are very popular with young people.

And finally, the New York City Council as approved a list of occupations that will still require pre-employment testing for cannabis—adding obvious categories such as workers who operate heavy machinery, fuel aircraft and regularly operate a motor vehicle. The original bill said police officers and anyone supervising or caring for children would be tested for pot use.

The Daily Briefing 7.9.2020

Joe Biden is standing firm in his opposition to full marijuana legalization, as a joint Biden-Sanders task force issues policy proposals to bridge the gap between the Democratic Party’s moderate and progressive voters. Progressives have been pushing the presumptive Democratic nominee to embrace nationwide legalization, but he has resisted out of concern for public health—and the lack of scientific evidence on the drug’s impact on teens as well as adults. Under the joint policy statement, Biden endorses decriminalization of pot, federal legalization of medical use, and letting the states decide on recreational use. This is a win for Biden’s thoughtful and scientifically sound go-slow policy until we can assess the risks and dangers of marijuana legalization.

Meanwhile, a crackdown on online sales of e-cigarettes to minors is moving closer after the U.S. Senate passed a bill banning such purchases, opening the way for full adoption by Congress. The measure would also implement strict rules for sales to adults—including age verification—in an effort to control the teen vaping and nicotine epidemic.

And finally, an initiative in Oregon to use tax revenues from marijuana sales to fund drug treatment will be on the ballot in November, but critics say it doesn’t go far enough to expand treatment and also reduces penalties for possession of heroin and meth.

The Daily Briefing 7.8.2020

Joe Biden has taken a principled, and thoughtful stand on marijuana legalization—one based on available science and meant to safeguard public health. The presumptive Democratic presidential nominee favors decriminalization and expunging criminal records, but a go-slow approach on nationwide legalization until researchers determine the impact of long-term use.

The Rosenthal Center supports Biden’s uncompromising stance even as he comes under growing pressure to embrace legalization to win votes from young people and progressives.  More politicians should be made aware of Americans’ changing perceptions about pot: our 2020 Cannabis Study found growing support for pausing legalization and curbing commercialization—and policymakers must keep this in mind as they formulate election platforms.

Meanwhile, Mexican drug cartels are profiting from the COVID-19 pandemic, ramping up illicit trade in heroin, fentanyl and meth. The surge in illegal drug activity comes amid a spike in overdoses in the U.S., exacerbated by the corona virus lockdown.

And finally, investors in cannabis companies are taking executives to task for not coming through on promises of boundless growth.  Shareholder litigation accuses leaders of making false claims about potential profit and defrauding investors, as interest in the pot market sours.

The Daily Briefing 7.7.2020

Presumptive Democratic nominee Joe Biden is under pressure to embrace nationwide marijuana legalization as a policy objective, but he has so far refused out of concern for public health and the lack of scientific evidence about pot’s safety. Pundits believe Biden could pick up the youth and progressive vote by going all in on legalization, as the movement for cannabis reform accelerates amid calls for changes to the criminal justice system. Yet Biden is holding out, saying he wants to be assured that legalizing won’t lead to serious mental or physical problems, in teens or adults, and he has asked for the latest science to guide his policymaking.

At the moment, his marijuana plan calls for decriminalization, expunging criminal records, and moving de-listing pot as a Schedule 1 narcotic, while allowing states that are legal to stay that way. What Biden is proposing sounds like a sensible plan, but in a tight electoral year he might eventually bow to pressure to adopt a more liberal stance on marijuana.

Meanwhile, drug treatment facilities are adopting hospital-level safety protocols to protect patients and staff from COVID-19. In many rehab centers, they are testing incoming patients for corona virus and maintaining social distancing. In part, the new measures are necessary because many people suffering from substance abuse suffer from a number of underlying conditions that might increase their susceptibility to COVID-19.

And finally, Colorado has filed a lawsuit against e-cigarette maker Juul, accusing the company of marketing its products to young people and downplaying the health risks of vaping. The legal action comes after a study showed that in 2018 Colorado had the nation’s highest youth vaping rate.

The Daily Briefing 7.6.2020

The House of Representatives has approved legislation allowing for more research into marijuana and also directing states to educate people about the dangers of impaired driving from cannabis. Tucked into a massive infrastructure bill, the marijuana provisions acknowledge the need for more research into the impact of the drug as the push to legalize pot ramps up in the post-pandemic period. The bill allows researchers access to samples and strains of marijuana being offered to consumers—in other words, at dispensaries in legal states—instead of only from limited, government-grown sources under the current law.

Equally important, the bill authorizes states to conduct research into impaired driving from cannabis and to create a national clearinghouse to study marijuana’s impact on driving. Together, the measures would begin to fill in the gaps of scientific knowledge and evidence about the ways marijuana can change behavior, cognition and capabilities.

Meanwhile, the renowned Harvard psychiatry professor and advocate for marijuana decriminalization and legalization, Lester Grinspoon, has died at 92. Dr. Grinspoon was at first skeptical about marijuana and considered it a dangerous drug. But he later changed his opinion, calling it a relatively safe intoxicant that should be regulated like alcohol. Dr. Grinspoon also carried out thoughtful research on the damage that marijuana laws —and the criminal justice system—inflicted on poor and troubled youth, which has particular resonance today as the movement for criminal justice reform addresses many of these issues.

And finally, regulators in Oklahoma say slushie machines dispensing drinks infused with marijuana component THC are not in compliance with state regulatory guidelines. The drink machines have been popping up at medical dispensaries in the state, but they don’t meet the requirement that pot products be packaged in child-resistant containers.

The Daily Briefing 7.2.2020

 The outbreak of vaping-related illness—known as EVALI—sickened thousands and killed 68 people, leading to investigations into the safety and marketing of e-cigarettes and vaping products, especially those targeted to young people. The CDC eventually stopped tracking the disease, but reports now suggest EVALI is still with us—and might be confused with symptoms of COVID-19.

A report says 8 new EVALI cases have emerged in California, with all the victims between 18 and 25 years old and all having vaped both nicotine and THC, the psychoactive component of marijuana. Doctors say there might be more cases that were missed due to the corona virus, which means the dangers of vaping and flavored e-cigarettes are still present. The outbreak is not surprising, given the surge in e-cigarette use among young Californians, according to a UCLA study. That found the use of pot and e-cigs jumped dramatically between 2017 and 2018, with vaping up nearly 50 percent and marijuana 19 percent.

Researchers said one-third of young adults in California, about 1.7 million people, were currently using one, or sometimes, more of the products, especially flavored products. These troubling findings support further measures to curb not only the sale of flavored e-cigarettes but all vaping products that still pose great risks to public health.

The Daily Briefing 7.1.2020

Federal and local officials nationwide report alarming spikes in drug overdoses during the COVID-19 pandemic, confirming anecdotal evidence that the social isolation, economic losses and lack of access to treatment experienced during the lockdown are having a tragic impact on substance abusers.

While final numbers are not yet available, suspected overdoses—not all of them fatal—jumped 18 percent in March, 29 percent in April and 42 percent in May, according to a federal tracking program. In Milwaukee County, dispatch calls for overdoses have increased more than 50 percent. Health professionals had reckoned with an uptick in overdoses, prompted in part by social distancing that can trigger relapse and the closing of many treatment centers, drug courts and rehab facilities for financial and safety reasons.

What’s needed now is emergency funding to ensure services remain available and recovery centers stay open in this critical time. Meanwhile, an editorial in the American Journal of Psychiatry looks at the issue of using cannabis for treating chronic pain. Although marijuana has shown some promise in this regard, more evidence is required for it to be used safely and more widely in clinical practice—as chronic use of marijuana carries the risk of a patient developing cannabis use disorder.

And finally, city officials in Boulder, Colorado have imposed a hefty 40 percent sales tax on e-cigarettes as part of a more comprehensive initiative to curb an epidemic of teen vaping and nicotine use. It has also banned the sale of flavored vaping products, after public health authorities estimated that 33 percent of high school students in the city vaped.

The Daily Briefing 6.30.2020

At the height of the opioid epidemic, Native Americans overdosed and died at a rate that rivaled some of the hardest-hit regions in Appalachia—but their suffering was often overlooked. An investigative report in the Washington Post takes a closer look at the addiction crisis among tribal communities in Oklahoma. Native Americans have higher-than-average injury rates from work in industries such as farming and logging, and lack access to quality healthcare and non-pharmacological treatment options, making them an easy target for manufacturers, distributors and pharmacy chains.

The opioid industry shipped more than 5.4 million prescription pain pills to Oklahoma’s Jefferson Country alone, an average of 94 pills per person per year. Nationwide, from 2006 to 2014, Native Americans were nearly 50 percent more likely to die of an opioid overdose than non-natives.  Now, tribal communities are among the thousands of plaintiffs in lawsuits seeking a windfall payout from the opioid industry—to be used to fight the opioid crisis among Native Americans and expand treatment.

Meanwhile, marijuana legalization was always touted as a tool to help end systemic racism by encouraging cannabis entrepreneurs in communities of color that were disproportionately incarcerated during the war on drugs. But the reality is that pot businesses are overwhelmingly white-owned, a fact that helps perpetuate racism and also exacerbates white supremacy, a column in Forbes argues.

And finally, HBO is getting into the marijuana trade: the cable network is teaming up with a cannabis maker to sell edible pot gummies to promote a new animated series. While the series isn’t really about marijuana, it seems HBO is simply embracing the culture of consuming weed while binge watching shows.

The Daily Briefing 6.29.2020

Many religious leaders, especially in African-American communities, once warned their congregations about the dangers of marijuana—even calling it a plague on their communities. But now, as marijuana legalization gathers strength, and in the wake of the movement for criminal justice reform, some leaders are weighing the damage the drug might cause against the number of people of color who have been sent to prison, and the benefits it can provide to those in physical pain.

While some leaders remain staunch opponents of pot—saying it is neither medicine nor a harmless recreational drug—others find themselves in the middle of a heated debate over health, race and law enforcement. Many are embracing cannabis reform, with one church even launching its own like of CBD products, with its pastor saying he wants to raise awareness about holistic medicine and entrepreneurial opportunities.

The debate within religious communities echoes a wider conversation taking place across the country about marijuana’s increasingly important role in our society—and how our perceptions and attitudes about put will impact policymaking.

And finally, a Canadian study in Pediatrics finds that restricting e-cigarette ads aimed at young people could help prevent teens from taking up vaping. Canadian provinces that allow retail displays promoting e-cigarettes had nearly three times the teen vaping rate, and teens that said they noticed ads were more likely to start vaping. The study also revealed that the rate of teen vaping more than doubled to nearly 18 percent after e-cigarette laws were relaxed—a finding that should be taken into consideration as the U.S. continues to debate partial bans on flavored vaping devices and e-cigarette advertising.

The Daily Briefing 6.25.2020

Drug policy often comprises efforts to reduce the supply of drugs, expand health and social services to addicted individuals, and prevent addiction in the first place. As the opioid epidemic rages on, with troubling spikes in overdoses and fatalities during the Covid-19 lockdown, a new report from Brookings says there are now new opportunities to focus on prevention.

These measures could include promoting safer opioid prescribing, issuing public health warnings about the dangers of the super powerful synthetic opioid fentanyl, and ensuring prescription opioids are locked up and out of the reach of children. The audience for such measures, the report notes, includes prescribers and pharmacists—not just potential users—with the goal of achieving greater control over supply, as most of the opioids that are misused come from legal and regulated distribution. In addition, regions not yet exposed to black market fentanyl should use every tool available to delay its arrival through law enforcement, although this is not a long-term solution.

At the same time the clinicians, patients and pharmacies need nudges and system redesign, not just education, to avoid become unwitting accomplices in the opioid crisis. While the educational component of prevention is important, it will probably remain only modestly effective, mainly because it is mostly adults, rather than adolescents, who initiate opioid use through prescription drugs.

The Daily Briefing 6.24.2020

Los Angeles was once seen as a potential showcase for the nascent marijuana industry in California, which legalized recreational pot in 2018 and was poised to become the world’s largest legal market for the drug. But it hasn’t turned out that way. In L.A., illicit trade continues despite legal marijuana dispensaries. And a much- touted program to encourage social-equity and minority-owned pot businesses—to help communities disproportionately impacted by the long-running war on drugs—has been slow to take shape.

While the city council proposes changes to laws regulating the market, the failure of the cannabis industry in L.A. is further evidence that legalization is not a cure-all for many problems facing state governments, including a shortfall in tax revenues and social inequality.

Meanwhile, a thoughtful op-ed in The Hill by Dr. Adam Bruggeman, an addiction medicine physician in Texas, argues that in order to fight the opioid epidemic, we must all work together—including physicians, patients, the government and insurance companies. He points out that only a small fraction of physicians are certified to prescribe addiction medications, and that and insurance companies should re-evaluate the high cost of treatment to make it more widely available.

And finally, a new CDC report says nearly 11 percent of adult Americans over the age of 20 used prescription painkillers between 2015 and 2018. Prescription opioid use was higher among women than men, and use increased with age—important data that can be used to determine further measures to control prescription opioid use.

The Daily Briefing 6.23.2020

Marijuana legalization was on course for a big year in 2020 as dozens of states prepared to tackle the issue either through legislative measures or public voting. But when the corona virus hit, social distancing regulations and other priorities blunted that momentum. Now analysts believe cannabis reform might get a boost as states seek ways to plug huge budget shortfalls due to the economic downturn and subsequent decline in tax revenues.

Many states that have been weighing legalization already are facing some of the biggest shortfalls of more than 10 percent, which might encourage state leaders to accelerate efforts to legalize marijuana. Before doing so, however, legislators might want to read new studies noting a correlation between increased traffic fatalities in the first four states to legalize recreational pot.

One study published in JAMA Internal Medicine found an excess 75 traffic deaths per year after retail sales began in Colorado in 2014. If every state legalized recreational marijuana sales, the study concluded, an extra 6,800 people would die each year in traffic accidents.

Although the studies did not determine if the drivers were stoned—which can impair driving—supporters of legal weed should look carefully at such results, and the potential risks of pot, as they push for cannabis reform. And finally, it’s the end of vaping in Australia after the country bans nearly all imports of e-cigarettes.

Consumers had turned to buying overseas products after the sale of e-cigarettes was made illegal, citing health concerns. The prohibition will last for 12 months while the government concludes a public consultation on the regulation of nicotine products.

The Daily Briefing 6.19.2020

Native Americans in Washington State have been hit hard by the opioid epidemic. They die of opioid overdoses at a rate nearly three times higher than non-natives, and access to drug treatment is scarce in rural areas such as Clallam County, which has been flooded with prescription pain pills and black tar heroin. But when a tribe proposed opening a multimillion-dollar, state-of-the-art drug treatment center for both native and non-native patients struggling with substance abuse, local residents fought back—arguing that it would draw “addiction tourists” to the small town, hurt housing prices and overwhelm schools ad law enforcement.

The center would have combined native healing practices with medication-assisted treatment (MAT), which combines withdrawal medications with therapy and peer-based counseling. Yet one year later, the death toll continues to mount as the fight over the facility drags on, dividing the community and raising uncomfortable questions about racism, the nature of addiction treatment and the intentions of the tribe itself, which traces its roots to the area for centuries. Meanwhile, a documentary by Frontline and the Financial Times traces the story of opioid maker Insys, and how its executives became the first pharmaceutical bosses to get prison terms for bribing doctors to prescribe prescription painkillers, fueling the opioid epidemic.

And finally, the battle over dangerous flavored e-cigarettes and vaping devices moves to Montana, where a temporary state ban on such products has expired and the vaping industry vows to fight a new plan by the state health agency to impose permanent restrictions on sale. With an estimated 30 percent of Montana high school students using e-cigarettes the officials say concerns over vaping—and the outbreak of vaping-related lung illnesses—are as urgent now as they were last year, before being overshadowed by the Covid-19 pandemic.