The Daily Briefing 12.3.2020

Oregon is now the first state in the nation to decriminalize hard drugs such as heroin and cocaine—and other cities and states are closely following what happens to see if it could become a model to fight drug addiction. Public health officials in Philadelphia, for example, say they want to assess whether the measure eventually has an impact on drug overdose and accessing treatment. The Oregon plan calls for decriminalizing possession of small amounts of hard drugs and establishing a robust referral-and-treatment infrastructure making it easier to receive drug treatment services. The model, however, makes treatment entirely voluntary, which lets substance users avoid engagement with treatment.

Meanwhile, drug overdose deaths are surging in San Diego, as drug cartels ramp up sales of the powerful synthetic opioid, fentanyl, and substance users face growing isolation, fear and anxiety due to the COVID-19 pandemic. Over the summer the city experienced an average three overdose deaths a day, in part because many users are oftentimes unable to identify what they are consuming or its strength, with fentanyl mixed in with meth, cocaine, heroin and counterfeit Xanax.

And finally, drug overdose deaths are also spiking in Scotland, prompting one “man with a van” to start his own mobile safe injection site, in order to provide substance users with clean syringes and overdose reversal drugs. Such sites are illegal in the U.K., as they are in the United States, and remain controversial as they focus on harm reduction rather than helping addicts obtain life-changing treatment.

The Daily Briefing 12.2.2020

A United Nations commission has approved removing cannabis for medical purposes from a category of the world’s most dangerous drugs, such as heroin, opening the way for expanding research into medical marijuana and its use. The vote to reclassify medical cannabis won’t have any direct impact on global efforts to legalize the drug. But approval is considered a symbolic victory for advocates of reforming drug policy, as many countries look to the U.N. for guidance on health issues. The approval is likely to bolster research into medical marijuana—as well as legalization efforts that have accelerated over the past few years.

Meanwhile, a new study published in JAMA finds that even small amounts of THC, the psychoactive component of marijuana, can cause moderate but significant short-term driving impairment. While there was no similar finding for small amounts of CBD, researchers said the study showed the lower limit of clinically relevant driving impairment.

And it warned consumers not to assume they’re in good shape to drive after just four hours, or if they inhale higher doses or edible products. And finally, the San Francisco Board of Supervisors has approved a measure to ban tobacco smoking inside apartment buildings—but will continue to allow smoking marijuana. The ordinance is intended to protect residents from secondhand smoke, and originally included banning cannabis smoking. But outraged activists said this would take away their only legal place to smoke, as it’s illegal under California law to smoke pot in public places.

The Daily Briefing 12.1.2020

President-elect Joe Biden takes office vowing to tackle the COVID-19 pandemic, but he has not forgotten about the “other” epidemic stalking the nation—the opioid crisis. During the campaign, he unveiled a bold $125 billion plan to combat the opioid epidemic, with a focus on expanding drug treatment and ending incarceration for drug offenses. He is also assembling a team of public health experts with deep knowledge of addiction issues. What’s more, Biden is expected to bring back the head of the White House drug office—known as the “drug czar”—into the Cabinet, giving this position added visibility. The new approach comes at crucial time in the fight against drug addition, with overdose deaths spiking across the country and treatment providers hobbled by state budget deficits and social distancing regulations.

Meanwhile, OxyContin maker Purdue Pharmaofficially pleads guilty to criminal and civil charges related to its marketing of the highly addictive prescription painkiller, clearing the way for a $8.3 billion settlement with the Justice Department for the firm’s role in fueling the opioid epidemic. But because it is bankrupt, Purdue will only pay a fraction of that settlement, depriving victims of any rightful compensation for their suffering in what can only be described as a travesty of justice.

And finally, New Jersey residents who are eager to indulge in legal recreational marijuana after the state approved legalization last month will have to wait a bit longer. Attempts to finalize a decriminalization bill were derailed by a proposed amendment to include psychedelic mushrooms into the mix of legal drugs. Perhaps legislators are taking a cue from Oregon, where voters last month approved the use of psilocybin and other psychedelics for use in mental health treatment—a move opposed by psychiatrists who said there is not enough scientific evidence to warrant sanctioning its use for mental health conditions.

The Daily Briefing 11.30.2020

A third of Americans now live in a state where adult-use marijuana is now legal, but don’t expect federal-level legalization anytime soon. While states continue to enact cannabis reform—including four states this past Election Day—efforts to remove federal prohibitions are likely to fail in the Senate, where opposition is still strong from older, more conservative members—even from states that have legalized. That’s why the latest move by the Democratic-led House to pass legislation to remove federal marijuana laws, expected this week, will likely be stopped in the Senate. This could change, however, as the next Senate will include 30 members who represent states where marijuana is legal—eight more than are in the chamber now, including six Republicans.

Meanwhile, anti-marijuana legalization groups have filed lawsuits in three states to overturn voter-approved pot legalization. The lawsuits in Mississippi, Montana and South Dakota seek to invalidate the results due to legal technicalities in the three states, in which voters overwhelmingly approved legalization ballot measures.

And finally, new guidelines concerning pediatric post-surgery opioid use have sparked debate about how to strike the right balance between the risks and dangers of prescription painkillers and frightening both parents and doctors from using them when required. Some say the guidelines weigh too heavily on risk factors—noting that evidence of increasing opioid use in children is very weak—and therefore may discourage use for legitimate pain management. The guidelines recommend non-opioid medications as first line postoperative drugs, including the use of regional anesthesia; if opioids are prescribed, then careful supervision is essential.

The Daily Briefing 11.24.2020

Oregon voters earlier this month approved a groundbreaking ballot measure decriminalizing hard drugs such as heroin and cocaine, ending incarceration for low-level possession and also mandating expanding treatment that would be paid for by marijuana tax revenues. Yet as officials prepare to implement this first-in-the-nation initiative in just over two months, the state isn’t prepared to offer treatment to anyone caught in possession of an illegal drug. Oregon lacks enough treatment providers and recovery centers, officials say, especially at a time when drug overdose deaths rose in Oregon 70 percent in April and May, compared to the same months last year, due in part to COVID-19 restrictions that have limited treatment services and the number of inpatient beds.

Meanwhile, an op-ed article in the New York Times observes that both Mexico and the U.S. are finally coming around to ending the war on drugs, considering the Oregon policy shift and fast-moving marijuana legalization in each country. This is the time, the article argues, for a change in drug policy that shifts resources from enforcement to treatment, which is in dire need of improvement (90 percent of Americans with substance use disorders do not receive treatment.)

And finally, a California judge has ruled that officials erred by allowing cannabis billboards along the state’s highways. Such ads were supposed to be banned under the 2016 initiative allowing the sale of recreational marijuana, but the state’s Bureau of Cannabis Control overstepped its power by allowing them, the court said.

The Daily Briefing 11.23.2020

A new study published in JAMA Network forecasts nearly 500,000 opioid overdose deaths over the next decade if the current circumstances regarding substance use prevention and treatment do not change. However, if interventions such as reducing opioid prescriptions, expanding treatment, and increasing the availability of overdose reversal medications are implemented, an estimated one-third reduction in fatalities is possible. The study, aimed at understanding how the crisis might evolve, analyzed multiple factors that have caused injuries and deaths in the past and the impact of interventions so far.

Meanwhile, an opinion piece published by NBC News praises the measure passed in Oregon this month to decriminalize small amounts of illicit drugs such as heroin and cocaine, and at the same time expand treatment opportunities. The writer says that drugs are rampant in jails and incarceration can therefore only make addiction worse due to the lack of treatment in prisons. Oregon’s effort to overhaul this dynamic is a worthwhile project to pursue, and should be closely followed to assess outcomes and understand how such a system might work.

And finally, e-cigarette use by young people is still at epidemic levels, despite a self-reported decline in vaping in 2019 by high school and middle school students. In 2016, ads for e-cigarettes reached nearly four in five of these students, and there’s evidence that kids who vape are four to five times more likely to experiment with cigarettes for the first time. They are also susceptible to serious lung injuries that have caused hospitalizations and death. As in decades past, the article concludes, the nation’s regulatory agencies have been slow to recognize this fast-growing threat to the health and development of young Americans.

The Daily Briefing 11.19.2020

A bankruptcy judge approved an $8.3 billion settlement between opioid maker Purdue Pharma and the Justice Department, but the company that manufactures OxyContin will only pay a fraction of that amount for its role in the nationwide opioid epidemic. Members of the Sackler family, founders of Purdue, will pay $225,000 to resolve civil charges—despite making billions in profits from opioid sales. Two dozen states opposed settling the lawsuit, which is among thousands of cases still pending against Purdue and other drug manufacturers, as well as drug distributors and pharmacy chains, accused of contributing to the opioid crisis.

Meanwhile, an opinion piece in the Wall Street Journal says that despite recent victories for marijuana legalization and decriminalizing illicit substances in Oregon, the scourge of drugs for young children remains. In 2019 parental substance use was listed as the cause for a child’s removal to foster care 38 percent of the time. The article argues that decriminalization will likely exacerbate such problems, as more drug use means more drug use.

And finally, the American Medical Association has recommended that marijuana possession be treated as a pubic health problem, rather than a reason for incarceration. In a report, the AMA also urged states to better regulate sales, marketing, and promotion of cannabis products in order to reduce use among adolescents and pregnant women.

The Daily Briefing 11.18.2020

Now that New Jersey voters have approved recreational marijuana legalization, NJ Senator Cory Booker is pushing for the incoming Biden administration to go further and support federal-level legalization. Booker says that Biden’s support for decriminalizing pot and expunging criminal records—a policy that stops short of nationwide legalization—is “not enough.” His comments reflect growing strains in the Democratic Party concerning drug laws, with the progressive wing advocating more far-reaching cannabis reform, and moderates backing Biden’s approach, which also includes legalizing medical marijuana and letting states decide on their own about recreational.

Meanwhile, as the New Jersey state legislature hammers out laws to regulate the new marijuana market, big cannabis companies and startup entrepreneurs are laying the groundwork to set up shop in the state. The market could be huge, as New Jersey is the most populous state in the region that permits cannabis sales, and is expected to attract buyers from neighboring New York and Pennsylvania, which are also considering legalization measures.

Analysts say, however, that the likely tax structure wouldn’t leave much room to fund new programs—as pro-pot groups have promised—as most of the money would go toward law enforcement to deal with wider access to the drug.

The Daily Briefing 11.17.2020

The Daily Briefing 11.16.2020

Big victories in four states for marijuana legalization are a signal to President-elect Joe Biden to adopt a more progressive national agenda, according to Sens. Bernie Sanders and Elizabeth Warren. Writing in separate op-ed articles, the Senators make the case that wins for cannabis reform—and Oregon’s approval of a measure to decriminalize illicit drugs such as heroin and cocaine—should influence Biden and lawmakers as they craft a post-Trump agenda. Both Sanders and Harris ran on full legalization platforms, along with Vice President-elect Harris, but Biden’s policy avoids federal-level legalization in favor of decriminalization and letting states decide on legalization.

Meanwhile, a new study published in JAMA finds that e-cigarette use—even among those who quit—is associated with a nearly 30 percent higher risk of respiratory diseases. The survey of more than 21,000 individuals also shows that those who continue to vape have a 70 percent higher risk of emphysema and a 30 percent higher risk of chronic bronchitis or asthma.

And finally, the New York Times Style section takes up a critical issue concerning marijuana: Whether legalization in New Jersey will finally make the state cooler than New York. No answer is provided, but it does quote a state lawmaker who is helping draft legislation saying that he’d like to see New Jersey be like Amsterdam, with takeout services, marijuana cafes and other public consumption areas so that pot is “infused, literally, into the culture and society.”

The Daily Briefing 11.12.2020

Marijuana legalization and drug decriminalization won big on Election Day, with four more states approving cannabis reform and Oregon allowing small amounts of illicit drugs such as heroin and cocaine. But in the wake of these victories—that were supported by social-justice groups—it remains unclear what impact if any there will be on communities of color, which were disproportionately targeted in the decades-long war on drugs. Legalization of marijuana in many states has not yet eased disparities in law enforcement: Drug-related violations were the most frequent cause for arrest in 2018, with 40 percent for marijuana possession. Black people make up 27 percent of drug arrests, but only 13 percent of the population. Now it is up to state legislators to enact laws to govern this new market. But the lure of huge profits from the legal weed industry might derail efforts to include racial equity measures.

And finally, the New York Times reports that consumption of edible marijuana and CBD products soared in the run-up to the election, as stressed out consumers tried to calm their nerves. While noting that there’s now an edible for every type of anxiety, the article fails to point out that studies show pot can actually increase anxiety as well as depression and psychotic episodes. It does say however that medical professionals warn that edibles do carry some risk if consumers get impatient and eat too many before the drugs kick in.

The Daily Briefing 11.11.2020

 Oregon’s approval last week of drug decriminalization amounts to a fundamental rejection of the decades-long failed war on drugs—and could set the stage for a wave of drug reform that rejects incarceration in favor of treatment, according to a Vox analysis. The Oregon bill decriminalizes low-level possession of hard drugs including heroin and cocaine, while at the same time boosting funding for drug treatment to $100 million from $25 million. Ensuring that individuals enter treatment rather than being sent to jail or prison must be a key component of any such initiative, as just 1 in 10 people with addictions receive treatment. For this initiative to work, substance users must not only be encouraged to seek treatment but also compelled to do so. This experiment, focusing on decriminalization, treatment and public health, should be closely watched as a potentially effective model for confronting the drug crisis.

Meanwhile, cannabis companies are celebrating the victory of Joe Biden in anticipation of a relaxation of marijuana laws. They believe a Biden administration might move ahead with federal-level legalization—although the former VP campaigned on the promise of decriminalization and letting states go their own way on recreational and medical marijuana.

And finally, Mexico is moving toward legalizing marijuana, despite the fact that polls show a majority favor keeping the drug illegal. Supporters argue that legalization—which would make Mexico the largest legal pot market—will dent the illicit trade, create jobs and cut down on crime. Mexico has already decriminalized low-level possession, in an attempt to refocus resources on fighting large drug cartels. As legislators move ahead, they are expected to keep in mind the views of the fairly conservative population who reject legalization.

The Daily Briefing 11.10.2020

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What will marijuana policy look like under a Biden administration? As Biden and Harris prepare to take office amid a wave of marijuana legalization —four states approved legal recreational cannabis on Election Day—analysts say the fate of cannabis legislation rests more with Congress than the White House. Republican control of the Senate would likely stall far ranging moves such as federal legalization, which Democratic leaders have pledged to push through if they win the majority after the Georgia runoff. For his part, Biden’s official line is that he favors decriminalization and letting states decide on recreational use, while Harris has in the past supported federal-level legalization. In the meantime, states will continue to legalize pot on their own and move ahead with state-level regulatory structures.

Meanwhile, a roundup of studies on marijuana use shows that 30 percent of users have some level of cannabis use disorder, characterized by dependency and often, addiction. They also find increased risk of psychiatric disorders including psychosis and depression, as well as impaired cognitive functioning and driving. With the increasing availability of stronger forms of marijuana, these dangers may become more severe.

And finally, a University of Michigan study finds that nearly one-third of students who reported misusing prescription opioids as high school seniors between 1997 and 2000 later used heroin by age 35. This likely reflects the trend of overprescribing opioids, a major factor in the opioid epidemic.

The Daily Briefing 11.9.2020

Reflecting on last week’s election results, the New York Times comes to the conclusion that while Democrats and Republicans are still miles apart on most major policy issues, there is a growing consensus on one thing: ending America’s disastrous war on drugs. Ballot measures on Election Day overwhelmingly point toward drug reform, with four states legalizing marijuana and Oregon decriminalizing small amounts of hard drugs such as heroin and cocaine, as well as allowing the hallucinogen psilocybin for mental-health treatment. Voters in Washington, D.C., also decriminalized psilocybin, the organic compound in psychedelic mushrooms.

Decriminalization is popular, one Times article suggests, because Americans believe too many people—disproportionately so for people of color—are in jails and prisons on drug charges, and the drug crisis has not gone away. In the wake of the opioid epidemic, which has killed tens of thousands, they also recognize the drug crisis as a public health issue. Columnist Nicholas Kristof goes further in his analysis, saying that while decriminalization is the right direction we should not downplay the threat posed by drugs—or stop talking about their dangers. The goal of the Oregon measure, he points out, is to steer people into treatment to get help for their addictions, and this should be critical to any effort to change drug policy.

And finally, Connecticut Governor Ned Lamont has come up with a new rationale for legalizing marijuana. While most state leaders say it’s a good idea to boost badly-needed tax revenues, or promote social justice, Lamont argues that legalization would help the state slow the spread of COVID-19 by stopping pot tourism—to nearby New Jersey, which legalized recreational marijuana last week, or to Massachusetts. Legalizing the drug, he added, is one way to keep people closer to home.

The Daily Briefing 11.6.2020

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More details are emerging from the proposed $26 billion legal settlement with major drug distributors, as states review the deal to end a portion of the nationwide opioid lawsuits. Under the agreement, most of the money will go toward treatment and prevention programs in communities ravaged by the opioid epidemic and the deaths of more than 230,000 Americans from prescription opioid overdoses. The amount each state receives will be determined by population, overdose deaths, volume of pills sold, and diagnoses of substance use disorders, and each state will decide how to distribute the payout.

The distributors—McKesson, Cardinal Health, and AmerisourceBergen—shipped more than three-quarters of the nation’s opioids to pharmacies, which are also being sued along with drug manufacturers for their contribution to the opioid crisis. The three firms will pay about $21 billion over 18 years, with an additional $5 billion from Johnson & Johnson. There was no information about guarantees the money would be used solely for treatment and prevention, to deter states from siphoning off funds for other purposes.

Meanwhile, Governor Andrew Cuomo of New York says he wants to add a marijuana legalization proposal to his January budget, because the state is “desperate for funding.” In an interview, Cuomo said New York is now under pressure since neighboring New Jersey legalized adult-use pot this week. Cuomo has tried this before but failed to persuade legislators to pass a bill, with the debate now centering not on public health but who will control a new cannabis regulator and how any revenue would be distributed.

And finally, voters in New Zealand have narrowly rejected a marijuana legalization measure that would have made the country the third—after Canada and Uruguay—to legalize the drug.

The Daily Briefing 11.5.2020

The surge of state-level marijuana legalization victories on Election is already having a ripple effect as nearby states—hoping to get in on the expected gold rush—start to push for cannabis reform too. The win in New Jersey, for example, is putting pressure on neighboring New York and Pennsylvania to fast track legalization there. Connecticut Governor Ned Lamont said the wins underscore the need for his state to enact policy changes in a regionally coordinated manner. And in the Southwest, a legalization victory in Arizona is emboldening pro-pot groups in New Mexico to jump on the bandwagon, with policymakers noting that 40 percent of sales in legal-state Colorado are from out-of-state visitors.

Meanwhile, the Wall Street Journal reports that despite the state legalization victories, federal-level cannabis reform would be unlikely if Republicans maintain control of the Senate. In that scenario, full legalization is probably off the table until after the midterm elections, keeping cannabis companies effectively locked out of the capital markets—while they are still able to significantly expand their retail market reach in legal states.

And finally, big drug distributors may have agreed to a $21 billion settlement in the opioid lawsuits, some $3 billion more than a previous offer last year. The companies—McKesson, Cardinal Health and AmerisourceBergen—would pay that amount over 18 years to resolve lawsuits brought by cities, states, counties, the federal government and Native American tribes over the firm’s mishandling of deliveries of opioid painkillers and fueling a public-health crisis.

The Daily Briefing 11.4.2020

In Election Day results, pro-marijuana forces notched big wins as voters in New Jersey, Arizona, Montana, and South Dakota approved ballot measures to legalize adult-use recreational marijuana. New Jersey is considered crucial to opening the cannabis market in the Northeast, and the win there and in other states came about after millions of dollars were spent by cannabis companies to convince voters that pot is not only safe but also a potential source of revenue to rebuilt corona-ravaged state economies, without considering the associated increase in healthcare costs.

Meanwhile, in Oregon, voters approved a measure to decriminalize the possession of all illegal drugs, such as heroin and cocaine, as well as the use of the hallucinogen psilocybin in mental-health treatment. Both are the first of their kind in the U.S., and represent the next frontier in the relaxation of drug laws beyond marijuana. The decriminalization measure includes a provision to divert tax revenues from pot sales to expand and provide drug treatment for individuals instead of incarceration, although how and to what extent this would be done is still unclear. Before the vote, the American Psychiatry Association criticized the ballot measure on using hallucinogens, saying there’s not enough scientific evidence on the safety and efficacy of the treatment to warrant widespread use at this time.

The Daily Briefing 11.3.2020

Voters go to the polls today to decide on marijuana legalization in four states, and whatever the result might be, one thing is clear: tens of millions of dollars have been spent on cannabis reform campaigns. But in a big switch from previous years, some of the largest contributors to the legalization movement are now the leading cannabis companies themselves, rather than deep-pocketed philanthropists and social-justice organizations. While organizations such as the ACLU are still backing legalization efforts, Big Pot is now spending to the hilt after realizing they need larger markets to make more money—and are willing to pay for it. That is likely to pay off as polls indicate voters will probably approve legalization in New Jersey, Arizona and Montana, bringing to 14 the number of states with legal adult-use marijuana.

Meanwhile, on the eve of the vote, a coalition of state medical societieshas issued a strong statement criticizing legal pot. The medical societies of Delaware, New Jersey, New York, Ohio and Pennsylvania said that while they understand the economic challenges facing states as a result of the corona virus pandemic, they do not support legalization as a way to address the issue—as many state leaders have proposed. They are concerned that the long-term public health costs associated with hospitalizations and treatment for addictive disorders significantly outweigh whatever revenues the state might receive—a position backed by the Rosenthal Center.

And finally, a new study shows that ER visits are on the rise in western Michigan for patients diagnosed with edible cannabis toxicity since the state legalized marijuana. The study also finds that ER diagnoses for inhaled cannabis toxicity soared from fewer than 20 a month to 70 between 2018 and 2020.

The Daily Briefing 11.2.2020

Voters go to the polls tomorrow in a bitterly contested presidential election, and in four states they will also decide on ballot measures to legalize recreational marijuana. Currently, 11 states allow adult-use marijuana, but Arizona, New Jersey, Montana and South Dakota could be added to the list. Passage appears likely in New Jersey and Arizona as well as in traditionally conservative Montana, backed by state leaders and pro-pot lobbyists who have convinced many voters that the drug is not only safe but perhaps even health-promoting—despite sound scientific research showing it poses considerable risks to public health.

Medical marijuana is also on the ballot in Mississippi and South Dakota. In a last ditch effort to sway the vote against marijuana legalization, critics in Arizona launched attack ads focusing on the potential harm to young people, and the dangers of impaired driving and workplace accidents. But in New Jersey, Gov. Phil Murphy is using the final hours of the campaign to stump for legalization, saying it would bring both economic and social-justice benefits, while ignoring the potential for increased indirect healthcare and law enforcement costs.

Meanwhile, voters in Oregon will decide on a ballot measure that would allow psilocybin mushrooms to be used for medical purposes, an initiative criticized by the American Psychiatric Association. They are also voting on a measure that would decriminalize low-level possession of illicit drugs such as heroin, and divert revenues from marijuana sales to expand drug treatment. Activists regard both initiatives as key to ending the country’s war on drugs, and thereby promoting criminal justice reform.

The Daily Briefing 10.29.2020

President Trump has not only fumbled the national response to COVID-19, his administration has also failed to tame another public health crisis—the opioid epidemic, according to NPR. Despite vowing in 2016 to confront the crisis as overdose deaths soared, Trump has not shown clear and concise leadership and made serous missteps that have hampered federal efforts to contain the epidemic and reduce overdose fatalities. The lack of a national strategy has led to a record 72,000 overdose deaths in 2019, with nearly 50,000 opioid-related. Trump’s attack on the Affordable Care Act (ACA) and expanded Medicaid coverage, which pays for substance use treatment, could worsen the situation if the Supreme Court strikes down the law.

Meanwhile, recent victories by pro-marijuana legalization groups can be tied to conservative politicians and voters who are increasingly on board with cannabis reform. Three of the four states voting next week on recreational use—Arizona, South Dakota and Montana—are traditionally conservative, but the ballot initiatives are expected to pass. As more Republicans swing their support behind legalization, it’s increasingly likely that bipartisan efforts to advance reform measures on the federal level will succeed for the first time.

And finally, pro-pot groups in New Jersey are so confident of victory that some legislators want adult-use sales to being immediately after the votes are counted. One state legislator says this could happen within a month, through existing medical dispensaries. The ballot measure does not outline rules and regulations for the new market—so rushing to start retail sales without guidelines could pose a danger to public health.