The Daily Briefing 8.23.2021

With the deadline nearing for municipalities in New Jersey to opt-out of allowing marijuana businesses, it’s estimated that about 50 percent will say no to allow retail shops, and warehousing and manufacturing facilities. As stipulated by the state’s legalization law, any locality can opt-out—while also forfeiting a share of potential tax revenue generated by marijuana sales. Many city officials say such businesses will adversely affect children; others are taking a wait-and-see approach (towns can later decide to opt-in), or want to first see the full slate of state regulations, which have not yet been announced. In Bergen County, 10 contiguous towns jointly banned cannabis stores, because they’d be located near residential neighborhoods and public places frequented by children. However, big cities including Newark and Atlantic City said yes, and also imposed their own rules. It’s a pattern familiar across the country: states approve marijuana legalization, based on broad popular support, but fail to recognize that pot is apparently not wanted on the local level.

Meanwhile, opting to wait-and-see may be a good idea, judging by the results of a study in California on compliance with state regulations concerning marijuana shops. Researchers from UCLA and UC San Diegofound that nearly 68 percent of facilities failed to comply with laws requiring age-limit outdoor signage, and only 12 percent checked ID before entry. This exposed young people to products designed to appeal to children, promote purported marijuana health benefits, and offer free samples and first-time purchase discounts.

And finally, more than half of teenagers who use e-cigarettes want to stop and about two-thirds have already tried to quit vaping, according to a survey of high school and middle school students. Providing new insights into the ongoing teen vaping epidemic, the survey noted that teens that wanted to quit tried an average of five times during the past year. And those who vaped Juul or other pod products—rather than a disposable e-cigarette—reported fewer attempts to give up the habit, due in part to the product’s sleek design, extensive marketing, and flavors, the report concluded.

The Daily Briefing 8.19.2021

Richard Sackler, a prominent member of the billionaire family that turned Purdue Pharma into a marketing juggernaut for the highly addictive prescription painkiller Oxycontin, has denied that he or any member of the family is responsible for the opioid epidemic. Testifying to a bankruptcy court overseeing a possible $4.5 billion settlement between Purdue and states, local governments, tribes, and other claimants, Sackler, a former president of the firm and board member,  also said he was ignorant of the company’s marketing tactics used to pump up sales and downplay the drug’s addictiveness. Sackler, making a rare appearance before the court, said he did not know how many people had died from using Oxycontin, which was aggressively marketed by Purdue and sold as safe and effective, even as overdose deaths surged. Over the past two decades, more than 500,000 Americans have died over drug overdose, the majority opioid-related.

If approved, the settlement would grant the company immunity from future civil legal claims and also shield the Sackler family from any further prosecution, which has become a sticking point for many of the litigants. They want the company to pay more and acknowledge its role in the epidemic. But the bankruptcy judge is expected to approve the settlement, which would also provide protection to the Sackler family from any future Purdue-related claims. The company would become a public-benefit corporation, with profits used to fund compensation over a decade, but would not prohibit Purdue from continuing its international opioid business.

Thousands of lawsuits against the opioid industry—including drug distributors and pharmacy chains, as well as manufacturers such as Purdue—are still pending. Some have gone to trial, while others have tentative agreements in place, including a $26 billion settlement with the country’s three largest drug distributors and opioid-maker Johnson & Johnson. States are trying to strike a balance between holding the industry accountable and guaranteeing funding for drug abatement and treatment at a time when overdoses reached a record 93,000 just last year. They also want to avoid protracted and expensive litigation that would take place if the deals are eventually scuttled, thereby denying states and communities of badly needed resources to fight the drug crisis.

The Daily Briefing 8.18.2021

Purdue Pharma’s founding Sackler family has threatened to pull out of a proposed $4.5 billion agreement to settle lawsuits against the Oxycontin maker unless it is granted total immunity from all current and future claims against the company. Board member David Sackler said that absent that release from liability, Purdue, which is accused of contributing to the opioid epidemic that has killed more than 500,000 Americans over the past two decades, would not support the deal. If approved, the agreement would bring to an end thousands of lawsuits against Purdue brought by states, cities, tribes, and other plaintiffs. But if the deal is scuttled by the lack of immunity for the billionaire Sackler family, Purdue says it would continue the legal fight—possibly for years—thereby depriving compensation to local and state governments that bore the cost of the addiction crisis, as well as to victims’ families. Under the terms of the deal, the family would relinquish control of Purdue, which would transform it into a public benefit company to fund the settlement over a decade. But it would allow the Sacklers to continue their international pharmaceutical business including marketing opioids for up to seven years.

Meanwhile, although there have been advances made in machine learning algorithms that may be able to determine the risk of a drug overdose, a new study published in JAMA finds that such algorithms may be biased—and therefore miss patients at high risk of opioid misuse. The study concluded that Black patients at high risk were almost twice as likely to be missed as white patients. And those that fell in the false-negative group also had a higher mortality risk. Such bias could keep these patients from receiving education and treatment options, the study showed.

And finally, marijuana legalization and changing attitudes and perceptions about pot have led to a staggering increase in consumption, according to a Gallup poll. The percentage of U.S. adults who say they have tried the drug has ticked up to 49 percent—the highest measured to date. More than 50 years ago, just 4 percent admitted to using marijuana; that had climbed to 40 percent in 2015. By age group, around 50 percent of millennials, Generation Xers, and baby boomers have tried pot. But it is younger Americans who are more likely to have smoked marijuana (20 percent of millennials), suggesting that people tend to try marijuana at a younger age but as they get older, most no longer continue smoking it.

The Daily Briefing 8.16.2021

As lawyers and prosecutors hammer out the final details of nationwide opioid litigation and settlement terms, a growing number of families bereaved by the epidemic are speaking out—and criticizing the lack of accountability in the agreements. Specifically, family members are angered by what they regard as the persistent failure to hold pharmaceutical executives responsible for mass-describing narcotics and making false claims about safety and addictiveness. In two tentative deals—one for $26 billion with drug distributors and Johnson & Johnson, and another for $4 billion with Oxycontin maker Purdue Pharma—the companies do not admit any responsibility for contributing to the deaths of more than 500,000 Americans over the past two decades. Critics also say the restitution payments are relatively small for some of the country’s largest businesses, especially as the payout period of up to 18 years is too long. And in the case of Purdue, the firm’s founding, multi-billionaire Sackler family, will be shielded from any further litigation.

Meanwhile, although progress has been made in reducing opioid overprescribing among adults, a new study published in Pediatrics found that opioids are still being prescribed inappropriately for children. Almost half of the 4 million opioid prescriptions written in 2019 for children and young adults fit high-risk patterns known to increase the chances of overuse of overdose, according to the study. Dentists and surgeons wrote most of the problem prescriptions, and high-volume prescribers wrote more than half of them. 

And finally, there’s a growing movement among veterans to push for medical marijuana reform in the 14 states that have not yet enacted comprehensive marijuana legalization. Many of these remaining states are in the traditionally conservative South, which has generally been more reluctant to legalize the drug, even for medical purposes. Medical pot is believed to have benefits in treating PTSD and other debilitating conditions, but more research is needed to establish treatment protocols.

The Daily Briefing 8.11.2021

As opioid litigation against Purdue Pharma reaches its final stage, the judge overseeing the case has added a human dimension to the proceedings by including in the court documents dozens of personal letters from people who say their lives were ravaged by addiction. Purdue is accused of helping fuel the opioid epidemic by downplaying the addictiveness of its product Oxycontin and using devious marketing tactics to push the sale of prescription painkillers, resulting in the deaths of tens of thousands of individuals. These letters open a rare window into the tragic toll of the crisis on families and communities, describing the pain and suffering of those struggling with substance use and the grief over those who died of an overdose. Including the letters won’t change the terms of the $4.5 billion settlement deal offered to Purdue, or hold Purdue’s founding Sackler family, which denies any responsibility, accountable for the deaths. But it does provide a record of the opioid industry’s role in an epidemic in which more than 500,000 Americans have died.

Meanwhile, drug overdose fatalities are on the rise in Iowa—as they are across the country—but the governor of that state has a new take on why deaths are surging: it’s the fault of illegal immigrants. Gov. Kim Reynolds has repeatedly suggested that the uptick is due to illegal immigrants bringing drugs across the border from Mexico, although the drugs involved in opioid overdoses are mostly prescription painkillers or street drugs sold by dealers. China is the source of much of the fentanyl that is driving the increase in overdose deaths. Reynolds also says that COVID-19 restrictions are to blame, which is partly true, in the sense that lockdowns did increase isolation and make it more difficult to access services, but those measures were of course aimed at stopping a deadly and contagious virus.

And finally, was it fentanyl or not that caused a San Diego police detective to be taken to the hospital purportedly suffering from overdose symptoms?  The detective became the star of a now controversial police public service video about the dangers of the powerful synthetic opioid, in which he supposedly touches a powdery white substance and subsequently collapses. Addiction experts point out that fentanyl would have to be injected or ingested—rather than simply touched—to have that effect. Now, the police say a lab report shows the substance was in fact a mixture of fentanyl and meth, further complicating what should have been an important and straightforward warning to the public about the risk of fentanyl.

The Daily Briefing 8.10.2021

The Marshall Project reports on an ambitious project to expand access to drug treatment in prisons and jails that has failed despite tens of millions of dollars in funding. Initiated by Congress in 2018, the program was aimed at reducing soaring overdose deaths among inmates. But so far only a small fraction—less than 2 percent of the 15,000 eligible for treatment—has received it. The article blames bureaucratic inertia and resistance to medication-assisted treatment (MAT) among correctional administrators for the disappointing rollout. While hundreds of facilities now provide such services, it’s still a small number of the nation’s 3,000 jails. At the same time, overdose deaths jumped by more than 600 percent inside prisons and by more than 200 percent inside jails in the last two decades, according to federal data. In Maine, preliminary data shows a huge reduction in overdose deaths through the MAT program: people were 60 percent less likely to die of an overdose in their first year out of prison if they had participated.

Meanwhile, New Jersey’s largest needle exchange program in Atlantic City is set to close despite a surge in overdoses across the state. The city council has ordered the facility to shut down, saying that as the only place in southeast New Jersey where intravenous drug users can trade in needles, it attracts too many transient addicts. Gov. Phil Murphy is trying to block the move, and harm-reduction advocates haven’t ruled out a last-minute deal to relocate the site outside the city’s tourist district. 

And finally, an editorial in the Connecticut Post argues that opioid settlement funds should be used solely for combatting opioid addiction. As nationwide opioid litigation leads to multibillion-dollar settlement agreements, many states want to ensure that the money is not siphoned off for other purposes—as was the case with tobacco settlement funds. Connecticut’s share of the $26 billion settlement with drug distributors will total about $300 million, which could disappear quickly into the state budget, the editorial points out.

The Daily Briefing 8.9.2021

Overdose deaths from fentanyl are increasing across the country, leaving health officials scrambling to inform the public about the dangers of the powerful synthetic opioid. But a public service video released by the San Diego County Sherriff’s Department has come under criticism for providing misinformation concerning the danger of simple exposure to fentanyl powder. The video shows a deputy trainee collapsing while investigating a substance believed to be fentanyl, and then receiving the overdose reversal drug naloxone before be taken to the hospital by emergency medical workers. While the video was intended to raise awareness, medical experts say it is impossible to overdose on fentanyl simply through exposure (the drug would have to be injected or ingested to have this effect). With overdoses are on the rise in San Diego county, it is critical for officials to correctly inform the public if they want to help curb the opioid crisis.

Meanwhile, an opinion essay in the New York Times looks at the recent opioid litigation settlements and concludes that there’s more reason for hope than despair to combat the opioid epidemic. While acknowledging that the amount of money is “atrocious,” and that opioid companies are getting off easy, the writer believes the settlement will offer some relief to communities, help expand access to drug treatment, and compel the Biden administration to boost funding, for both harm-reduction programs and treatment. What is missing from this piece is an acknowledgment that harm reduction is only one component of a comprehensive drug policy or a proposal for the government to step in and close the funding gap between the settlement and Biden’s promised decade-long, $125 billion effort to confront the opioid epidemic.

And finally, for decades the U.S. tried to stop Mexican drug gangs from illegally trafficking marijuana across the border. Now, with pot legalized in California, Americans are making money transporting legal weed to Mexico, where it is still illegal. The Washington Post reports that traffickers from California load suitcases with U.S.-grown marijuana before hopping on planes to Mexico, or just walk across the pedestrian border crossing into Tiajuana, to supply a booming boutique market for American pot products. They can also be easily purchased at outlet malls near the border and brought to Mexico.

The Daily Briefing 8.6.2021

As nationwide opioid litigation brings to light the inside story of the epidemic, questions are also being raised about the role of the American Medical Association in the crisis, and its relationship with Purdue Pharma, the maker of OxyContin. An in-depth investigation in Mother Jones suggests that the foremost organization of the medical community had a too-cozy relationship with Purdue, receiving donations from the drugmaker and funding the AMA’s philanthropic arm and pain management education—well after the opioid crisis had morphed into a full-blown epidemic. In 2000, the AMA said that addiction “seemed to occur infrequently” with opioids, and noted that for many patients, prescription painkillers are often the only treatment options that provide relief. The article says this relationship may have violated the AMA’s own code of medical ethics, while also contributing to physician overprescribing that contributed to the opioid crisis.

Meanwhile, the Biden administration continues its drug policy shift away from the failed “war on drugs” to harm reduction strategies. It is offering grant money to draft model laws that support harm reduction programs and backs removing the long-standing ban on federal dollars being used to purchase syringes, in a bid to prevent deaths from drug use. The change in policy makes some sense, considering the surge in overdose fatalities last year to a record 93,000. Yet while harm reduction strategies, such as safe consumption sites, do save lives and help reduce the spread of infectious diseases, they should only be a short-term measure that eventually leads to drug treatment. 

And finally, one of the main components of harm reduction is providing the overdose reversal drug naloxone—but that drug is now in short supply. The drugmaker, Pfizer, has said that production has been interrupted, probably by its accelerated COVID vaccine rollout, causing the worst naloxone shortage since at least 2012, when overdose levels were less than half of what they are now. As a result, organizations across the country are scrambling to provide their communities with information about how to counter overdoses with alternative medications. We need a better production and distribution system for naloxone, to ensure that law enforcement, healthcare professionals, and organizations can easily access adequate supplies of the drug.

The Daily Briefing 8.4.2021

As more states legalize marijuana, pot entrepreneurs are becoming ever more innovative. Take the global beverage giants—especially beer brewers—who are eying a potentially lucrative multibillion-dollar market for weed-based drinks. There are already many pot-infused products, including seltzers, teas, colas, and cocktails, but the beverage sector is only a small part of the $20 billion legal weed marketplace. Now the industry sees potential in a wider range of marijuana drinks, mainly because they have negligible calories, you don’t have to smoke or inhale them, and there’s no risk of a hangover—at least, that’s what the marketing strategy will be. As the beverage makers ponder how to get more drinkers high, they’re also recalibrating the THC component to a lower level, as most cannabis beverages have traditionally packed a wallop—not exactly what the casual customer may be expecting as they get behind the wheel of their car.

Such concerns are apparently not bothering officials in Modesto, California, a city with some 200,000 residents in the state’s Central Valley. In what is believed to be the first sanctioned citywide cannabis tourism program, Modesto is promoting its pot dispensaries as a tourism draw, hoping to increase revenue as drivers make a stop in the town, which is midway between San Francisco and Los Angeles. The message would be, take a break, get gas, and something to eat, pop into the weed shop, and then back on the road. Currently, about 40 percent of the customer base at the city’s roughly two-dozen dispensaries is from out of town, so this gimmick may actually work. No word however about the risk of driving while drugged after fuelling up and getting high in Modesto.

And finally, The Guardian newspaper investigates whether medical cannabis is really a magic bullet for many maladies or if it’s too soon to make any definitive conclusions. While research suggests that extracts from the plant can be effective n treating pain, anxiety, and epilepsy, experts still preach caution around recreational use. The article notes that medical pot is still a contentious field due to fragmented data collection based mainly on the experiences of recreational users and that THC has been linked with an increased risk of psychosis and schizophrenia. There’s only one cannabis-based drug approved by the FDA—for a rare form of epilepsy—but advocates for medical marijuana and CBD often make unfounded claims about its effectiveness in treating a wide range of illnesses and disorders.

The Daily Briefing 8.2.2021

Overdose deaths are surging in Canada, as they are in the U.S., and the province of British Columbia is responding with a controversial strategy to give out highly addictive opioids to those struggling with substance abuse. The program includes distributing tablets of powerful fentanyl, with the hope that such drugs obtained from pharmacies and clinics are safer alternatives to street drugs, which increasingly are laced with lethal amounts of opioids and tranquilizers. Many say that the plan is an ineffective half-measure, as it does not include access to any form of drug treatment or a requirement that an addict must enroll in treatment. More than five people die every day from a drug overdose in the province, and while this approach may reduce fatalities at first, it won’t, in the long run, help substance users on the road to recovery.

Meanwhile, states are eager to get their hands on a portion of the proposed $26 billion opioid settlement and this may eventually lead to competing interests vying for a share of the money. If the deal is approved, the money would be shared among some 40 states that brought lawsuits against three big drug distributers and the opioid maker Johnson & Johnson. The settlement arrangement does include guidelines for how the money should be spent on addiction and treatment services, but legislatures could still squabble with governors and counties over priorities such as abatement programs. To get ahead of the process, Tennesse has established a special council to allocate funding, while New York set up a “lockbox” for money to ensure it goes to addiction services. Still, public health officials are still concerned about how exactly the states will allocate their dollars, and which programs will be funded.

And finally, the judge overseeing the opioid trial underway in West Virginia –part of the sprawling opioid litigation involving thousands of lawsuits—will have to answer a critical question: was it “reckless” for drug distributors to ship 81 million doses of a highly addictive opioid to one small Rust Belt city? And if so, can the deaths and addiction that followed be described as a public nuisance? The ruling, expected in a month, could shape precedents concerning corporate accountability for the opioid epidemic, in which more than 500,000 Americans have died. The West Virginia trial is taking place as more than 40 states are deciding whether to accept a proposed $26 billion settlement for a portion of the opioid cases, in which big drug distributors and opioid maker Johnson & Johnson are accused of contributing to the opioid epidemic. 

The Daily Briefing 7.29.2021

Closing arguments are being made in the landmark federal opioid trial taking place in West Virginia, with communities across the country watching closely what may happen and how this might impact proposed settlements in thousands of other opioid cases. The trial is focusing on two counties in West Virginia that were shipped more than 81 million prescription painkillers for an area with a population of fewer than 100,000 people; today, officials say 1 in 10 individuals are now opioid-dependent and there are more than 2,000 children diagnosed with developmental damage linked to opioids. The three big drug distributors on trial in West Virginia recently agreed to a $21 billion settlement to end other cases brought by more than 40 states, for their role in the epidemic, which has killed more than 500,000 Americans over the past two decades.

Meanwhile, the Washington Post publishes an in-depth story about one community in West Virginia and its struggle to contain the opioid crisis during the COVID-19 pandemic. It notes that overdoses were already at record levels when the lockdowns increased the fear, despair, and loneliness of those struggling with substance use. As the human connection is at the heart of addiction treatment, those support systems disintegrated in the shutdowns, cutting off a vital part of achieving and maintaining sobriety. Along with widespread job losses and the increasingly dangerous supply of illicit drugs, this contributed to a spike in overdose fatalities in West Virginia and nationwide, which last year reached a record 93,000.

And finally, officials in drought-stricken California say that water theft is on the rise—including from illegal marijuana growers. They say the pot cultivators are tapping into fire hydrants and drilling unauthorized wells to raise their water-intensive plants, threatening the water supply for residents. The illegal marijuana market was supposed to disappear once the state legalized pot, but that apparently hasn’t happened yet.

The Daily Briefing 7.28.2021

A majority of creditors seeking compensation from Purdue Pharma for its role in the opioid epidemic have agreed to a $4.5 billion settlement with the OxyContin maker, clearing the way for the deal to be approved. More than 120,000 creditors—including cities, states, tribes, and families and caregivers of children born addicted to opioids—are seeking payment from Purdue, which is ready to settle but will not admit responsibility for contributing to the opioid epidemic. The company will pay out the money over nine years to fund addiction treatment and prevention programs and exit the opioid market. Many states at first objected to the deal but then extracted further concessions from the firm, including the release of millions of documents related to the case and its painkiller business.

Meanwhile, the opposition is growing to another proposed opioid settlement between the states and the country’s largest drug distributors and opioid maker Johnson & Johnson. Washington State and West Virginia, as well as the city of Philadelphia, say the $26 billion settlement is too little and the payout timeframe of nearly two decades too long, faced as they are with a growing drug crisis and surge in overdose deaths today. They also want the companies, which underplayed the addictive nature of opioids and failed to control their distribution, to be held accountable. If a majority of states back out of the deal, it could reduce the total amount of compensation or scuttle the settlement altogether.

And finally, the World Health Organization has warned for the first time about the dangers of e-cigarettes, describing vaping as an emerging health threat. In a new report, the WHO said that nearly 85 countries do not have safeguards to protect against the rising popularity of vaping; only 32 countries have banned e-cigarettes, and 79 have adopted at least one measure—such as health warnings on the packaging—to curb sales. The report concluded that e-cigarettes are harmful and must be better regulated. In the U.S., there is an epidemic of youth vaping, which has prompted the Food and Drug Administration to consider stricter regulation of the industry.

The Daily Briefing 7.27.2021

The recent successes of the marijuana legalization movement can be attributed to many factors—including, as it turns out the financial support of a boatload of billionaires, from conservative political activist Charles Koch to Jeff Bezos and Elon Musk, who are on the front lines of the cannabis revolution. For his part, Koch told Forbes he supports legal pot because prohibition is a basic infringement on personal freedom, as well as a destructive policy that adds to America’s mass-incarceration problem. That’s why the devout libertarian is spending a fortune to help end federal marijuana prohibition.

Before they write some more checks, however, perhaps the deep-pocketed businessmen should take a look at this new study that found an increase in overdoses among children who ingest marijuana edibles. The number of children under 12 who have ingested edibles at home jumped from 132 in 2015 to almost 2,500 last year, according to the Association of Poison Control Centers, and those requiring medical attention jumped astronomically, too. This parallels the legalization of marijuana in many states. One reason for the rise, doctors say, is that the packaging for these substances looks very attractive to kids.

And finally, an analysis of the most popular vaping-related TikTok videos on a single day last year showed that nearly two-thirds portrayed potentially dangerous e-cigarettes in a positive light. The videos promoted vape use, joked about e-cigarette use, and showed tricks to do with a vape pen, all at a time when vaping has reached epidemic levels among young people. Collectively, the videos were viewed more than 1.5 billion times. Although other social media platforms have taken steps to ban such content, TikTok remains a ready source for positive messaging about vaping despite the risks posed by e-cigarettes.

The Daily Briefing 7.26.2021

Opposition is growing to the landmark $26 billion opioid settlement announced last week, as a growing number of states and cities say the amount isn’t enough and the 18-year payout period is too long. So far, West Virginia and Washington State, as well as Philadelphia, have said they won’t sign on to the deal, noting that we need more money right now and upfront to tackle the nationwide drug crisis.  Critics also say that the proposed settlement does not hold the companies in the opioid industry accountable for contributing to the opioid epidemic, because they do not admit responsibility for an epidemic that has killed more than 500,000 Americans over the past two decades. States have only 30 days to opt into the deal, and if there’s not enough support the settlement could be reduced. This settlement involved the country’s 3 largest drug distributors and the opioid maker Johnson & Johnson, but thousands of cases remain against pharmacy chains and other opioid makers.

Meanwhile, the AP carries a story marking the 50th anniversary this summer of the “war on drugs,” launched by former President Richard Nixon, and concludes that this approach has been an abject failure. The so-called war did not lead to an end to drug addiction—as we are in the middle of a raging overdose crisis, with a record 93,000 fatalities last year—and mass incarceration of millions of people, mostly Black and Hispanic Americans. Between 1975 and 2019, the U.S prison population jumped from around 250,000 to 1.4 million, with 1 in 5 people incarcerated with a drug offense. Today, there is a correct policy shift underway from sending addicts to prison and focusing instead on engaging them in drug treatment and harm reduction.

And finally, an opinion piece in the New York Times picks up on this topic, arguing that harm reduction—including needle exchanges and safe injection sites—should be the cornerstone of our national drug policy, without mentioning the importance of drug treatment. While harm reduction is of course critical to save lives, reduce criminality, and stop the spread of infectious diseases, it should only be a short-term measure that engages individuals to pursue drug treatment. It’s not an end, in and of itself, but part of a broader and comprehensive approach to confronting addiction. The writer says that the humane treatment offered by harm reduction can spur self-care rather than self-destruction, but what is truly humane would be to help those struggling with substance use get on the road to recovery.

The Daily Briefing 7.22.2021

President Biden has spoken out forcefully for establishing mandatory drug treatment for addicts—and keeping those struggling with substance abuse out of prisons and jails altogether. Addressing a town hall meeting in Ohio, one of the epicenters of the opioid epidemic, the president also advocated for post-incarceration services including housing and job training, in addition to drug treatment. The statement suggests that Biden will pursue this controversial approach as he gears up his drug policy team at the White House to confront a drug overdose epidemic that last year killed a record 93,000 Americans. Oregon has already decriminalized hard drugs in favor of paying a small fine and entering voluntary treatment, but the program has so far not been successful.

Meanwhile, in the wake of the proposed $26 billion opioid settlement announced this week between states and major players in the opioid industry, public health officials and advocacy organizations are pushing for state governments to sign on to a set of principles for how the money should be used. Instead of flowing to a state’s general fund, they want the money set aside in a dedicated fund for addiction services. They fear a repeat of the $206 billion tobacco settlement of 1998, in which most of the money was siphoned off to balance state budgets and never used for smoking cessation and abatement programs. The opioid settlement does contain provisions for using the money for addiction services, but it’s not clear if it enforceable. Some states, including New York, have already passed laws guaranteeing the money will be used for that purpose.

And finally, there may be another settlement in the opioid litigation on the horizon: fifteen states that had previously blocked a bankruptcy plan by OxyContin maker Purdue Pharma have now abandoned the fight, opening the way to a final agreement. The bankruptcy would allow the $4.2 billion settlement to go forward, but absolve the company’s billionaire founding Sackler family of any responsibility and shield it from any further liabilities. Thousands of other opioid cases are still pending against opioid manufacturers and pharmacy chains.

The Daily Briefing 7.21.2021

Senator Chuck Schumer has finally unveiled long-awaited legislation to end the federal-level prohibition of marijuana, reflecting a milestone in shifting public opinion about pot and efforts to end the decades-long war on drugs. The draft bill would remove cannabis from the Controlled Substances Act and begin regulating and taxing it under federal authority rather than the current situation in which states that have legalized the drug control sales, taxes, and usage. The bill also calls for expunging previous marijuana-related arrests and programs to help communities affected by cannabis prohibition. Winning passage of the bill, however, isn’t likely, as the measure faces significant opposition from both and moderate Democrats, and President Biden has not endorsed it.

Not surprisingly, the Schumer proposal received a frosty reception from across the board—including the cannabis industry. The bill’s authors even admitted that there are no standards to measure drugged driving or the impact of pot on fetal health. Critics such as Smart Approaches to Marijuana said it did not contain a cap on potency, limits on advertising, and a ban on flavored products that would be attractive to children. The union representing cannabis workers said it lacked support for creating good-paying jobs in the industry. Schumer no doubt believes that by simply introducing the legislation he will curry favor with progressives in his next reelection bid.

And finally, while the federal government can’t find a way forward, municipalities in newly legal pot states New York, New Jersey, and Connecticut are scrambling to figure out whether to allow marijuana dispensaries in their neighborhoods. Debate is heating up as localities debate the potential risks—including traffic fatalities and underage use—and the purported financial benefits for communities. Many have already said no, but others are putting out the welcome mat, believing that additional tax revenues and new jobs and businesses outweigh the possible pitfalls. The article points out that a majority of municipalities in Colorado have opted out of commercial sales, but fails to mention the same "not in our backyard" trend in California, Oregon, and Michigan, reflecting a grassroots opposition to rampant marijuana commercialization.

The Daily Briefing 7.20.2021

After years of legal wrangling, a tentative agreement has been reached to settle thousands of opioid lawsuits for an estimated $26 billion—with the money destined for addiction treatment and prevention services. The deal must still be approved by the 40 states and dozens of municipalities that brought the lawsuits against drug distributors Cardinal Health, AmeriSourceBergen and McKesson, and opioid maker Johnson & Johnson.  In a separate agreement, drug distributors would give $1.1 billion to New York State to end a trial currently underway there.

Yet thousands of other cases are still outstanding against opioid makers and pharmacy chains for their role in the epidemic, in which more than 500,000 Americans died over the past two decades from drug overdose, mostly opioids. Experts say however that the settlement provides an incentive for these companies to avoid trial without having to admit responsibility and be shielded from further litigation.

The settlement money is badly needed at a time when overdose are surging—to a record 93,000 last year—and treatment providers were forced to curtail services due to funding cutbacks. Money will be distributed to the states based on a formula including population an overdose deaths, with a provision that funds be used solely for addiction services, and not to balance state budgets. Some states, including New York, have passed a law stipulating that all funds be used to address the drug crisis.

If approved, the settlement is a major step forward to hold accountable the companies responsible for so many deaths and misery and a tragic drug crisis. But it does not end the opioid epidemic. Instead, it should be part of a comprehensive strategy that requires leadership, massive funding and a commitment to expanding drug treatment.

The Daily Briefing 7.19.2021

Drug overdose deaths rose nearly 30 percent in 2020 to a record 93,000, according to preliminary estimates by the CDC—the largest single-year increase ever as fatalities surged for opioid, meth, and fentanyl-related deaths across the country. Deaths rose in every state but two, with pronounced increases in the South and West and among Black and Hispanic populations. The data showed that fatalities had accelerated pre-pandemic and grew even more pronounced during lockdowns, social distancing, and the closing of drug treatment facilities. The national rise in deaths—which now exceed car crashes, gun violence or the AIDS epidemic—came as fentanyl became more entrenched in the drug supply, replacing heroin and finding its way into meth. What can the Biden administration do?

The Washington Post points out that the president has a number of ideas and strategies at his disposal, including expanding drug treatment, medication-assisted programs, and residential services, as well as harm reduction, boosting drug interdictions, and more education and prevention initiatives. But he may also consider some novel approaches, such as complete decriminalization of hard drugs, as Oregon has done. Treatment and access to anti-addiction medications are critical to this response; just 18 percent of people with substance use disorder receive such drugs and less than 10 percent of facilities nationwide offer residential treatment.

And finally, one thing that President Biden has done is to finally nominate a new “drug czar” to head the White House Office of National Drug Policy Control to oversee and help coordinate national drug policies. Biden tapped former West Virginia Health Commissioner Dr. Rahul Gupta for the job—a good choice for his experience dealing with the opioid epidemic in his state. Gupta would be the first physician to take the post, which was created in 1982. However, Biden is not expected to reverse President Obama’s decision to demote the office from a cabinet-level position, thereby denying Gupta a more prominent platform to advocate for drug policies during a national crisis.

The Daily Briefing 7.9.2021

Fifteen states including New York and Massachusetts have reached agreement with Purdue Pharma to settle some of the opioid lawsuits against the maker of prescription painkiller OxyContin, opening the way to $4.5 billion deal. The lawsuits are among thousands across the country against opioid makers, drug distributors and pharmacy chains for their role in the opioid epidemic. Nine other states—including California and the District of Columbia—that are suing Purdue continue to oppose the agreement, holding out for more money from the company, which is currently in bankruptcy proceedings. The deal was struck after Purdue agreed to an additional $50 million from members of the founding Sackler family, who are believed to worth more than $11 billion, as well as the release of millions of documents to be used in some 3,000 opioid-related lawsuits brought by cities, counties, states, and tribes. Several of those cases are currently at trial, including the first jury trial in New York.

Meanwhile, drug overdose deaths are on the rise last year in the Washington, D.C., area, with Black residents disproportionately effected. Health officials blame the increase—from 281 in 2019 to 411 last year—on fentanyl-laced heroin, marijuana and cocaine. More than four out of five individuals who die of overdose in the city are Black, according to city officials.

And finally, the governor of Rhode Island has signed into law a bill calling for a pilot project for controversial safe consumption sites in the state, where drug users can get receive medical care and clean needles. Several cities including San Francisco and Philadelphia have tried to open such harm reduction facilities, but were eventually stopped by Justice Department authorities. It’s not clear how the Biden administration would respond, although the president has indicated he generally supports harm reduction strategies. Safe sites do reduce fatalities, crime, and the spread of infectious diseases, but so far do not have a mandatory treatment component that makes them less effective.

The Daily Briefing 7.6.2021

Juul Labs was once the high-flying, market dominating company that fueled a global e-cigarette boom—and with it a teenage nicotine epidemic. Today, the company is under siege amid thousands of lawsuits accusing it of marketing to underage users, potential government regulations, and widespread health concerns about its vaping products. The biggest threat to staying in business is an upcoming FDA ruling on whether Juul’s devices and nicotine pods have enough public health benefit to continue selling them in the U.S. Major health organizations have asked the agency to reject the application, fearing it would lay the groundwork for the company to expand its reach once again.

Meanwhile, there is continuing debate over the decision by the World Anti-Doping Agency to disqualify American track star Sha’Carri Richardson from the upcoming Tokyo Olympics after she tested positive for marijuana. The drug is on the list of the agency’s prohibited substances, because it can be performance enhancing, and negatively effect hand-eye coordination, concentration and endurance, according to the agency. Some say the rules should be changed to allow athletes to consume cannabis products, as they are now legal in many states and countries.

And finally, pundits are speculating that the Sha’Carri Richardson pot scandal may be mellowing President Biden’s views on marijuana. Commenting on the suspension, Biden praised the athlete on the way she responded to the decision, but said “rules are rules.” Then he seemed to leave the door open to change, adding, “whether [the rules] should remain that way is a different issue.” Biden has been more cautious about marijuana legalization than many fellow Democrats and has not endorsed lifting the federal prohibition on pot, while saying states should be able to go their own way.