The Daily Briefing 12.1.2021

One of the many promises made by proponents of marijuana legalization in California was that it would eliminate the illicit trade in the drug. But like so many other purported benefits, that hasn’t happened yet—and the continuing existence of illegal grow farms is also poisoning wildlife, siphoning precious water, and risking devastating wildfires. Cultivation sites in state forests have rerouted millions of gallons of water in the past two years alone, exacerbating the drought and species endangerment. Growers living on site have started fires—including last year’s 125000-acre Dolan Fire. What’s more, many of the pesticides that drug traffickers—who operate the farms—are so poisonous they’ve been outlawed in the U.S. for decades.  

Meanwhile, as more and more states legalize marijuana, they are adding regulations allowing public consumption, an issue that was not addressed in early legalization measures to win wider public support. But now, following Alaska’s move in 2019 to permit weed lounges, other states and cities are jumping on the bandwagon to further commercialization by enacting laws permitting lounges and pot cafes. New legalization laws in both New Mexico and New York allow on-site consumption, and Las Vegas—which currently restricts public use—may soon become home to luxury pot lounges after Nevada became the latest state to end rules on public consumption. Dispensaries are now racing to set up such lounges, as authorities grapple with how to oversee the new businesses.

And finally, an editorial in the Baltimore Sun takes up the issue of dentists who may be fueling the opioid epidemic by routinely prescribing strong prescription painkillers to teens for wisdom teeth extraction. Dentists are the sixth-highest prescribers of opioids in the U.S. to patients between the ages of 10 and 19 years old—the age group at the highest risk of developing opioid use disorder. In fact, a recent study found that hundreds of young people ages 13 to 30 who filled an opioid prescription after a wisdom tooth extraction went on to engage in persistent opioid use in the following year, even after the window for pain relief had closed. So far, the American Dental Association has recommended the use of NSAIDs as the first-line of treatment for dental pain, but has failed to provide clinical practice guidelines—and that is long overdue.  

The Daily Briefing 11.30.2021

The nation’s first supervised injection sites, where substance users can inject drugs in a safe setting, have opened in New York City—signaling what could become a broader trend as drug overdose deaths soar to record levels. The privately-run sites in New York had been operating as needle exchange facilities, but will now expand to also include the administration of overdose reversal drugs, and have medical personnel on hand, as well as offer information and options for addiction treatment. City officials say the two sites are in response to staggering increases in overdose fatalities: there were 600 overdose deaths in the first three months of 2021.  

Many cities including San Francisco, Boston, and Seattle have tried to open such sites, which are common in Europe and elsewhere, to address the public health crisis of addiction. But they have routinely faced obstacles over the legal and moral issues of effectively sanctioning illegal drug use. The mayor’s office and the Manhattan district attorney have indicated that no legal action would be taken to close the supervised sites. Substance users bring their own drugs to the facility, raising concerns among local residents about safety and drug use in their communities.

However, the most controversial aspect of supervised sites—part of harm-reduction programs—is that they don’t do enough to engage with users to enter effective treatment programs. After saving a life, addicts simply return to the streets and an endless cycle of drug use. While harm reduction is a critical component of addiction services, it is not a one-stop solution to a drug and overdose crisis that has led to the deaths of more than 100,000 Americans in the 12-month period that ended in April—a record number. Opening harm reduction facilities must take place alongside the expansion of treatment and easing access to effective services for anyone struggling with substance use. 

The Daily Briefing 11.29.2021

The co-use of multiple drugs including the powerful synthetic opioid fentanyl is driving the surge in overdose fatalities—so much so that addiction professionals are saying we’re no longer facing just an opioid epidemic, but also a more general addiction epidemic. Co-using drugs including opioids, methamphetamines, and cocaine as well as fentanyl distinguish this wave of the crisis from previous ones, which involved prescription painkillers and then heroin individually. Now, users are mixing drugs—intentionally, or unaware that drugs have been contaminated with fentanyl—with lethal consequences. More than 100,000 Americans died of an overdose in the year-long period ending in April, a record number of fatalities. While many say that harm reduction programs such as safe syringe sites and the wider availability of fentanyl test strips are the solution, what we really need is a massive government program to expand engagement with substance users and access to treatment. 

Meanwhile, Germany’s new coalition government has reached an agreement on nationwide cannabis reform, including legalization and establishing a regulated, adult-use commercial market for recreational pot. Currently, personal possession of marijuana is decriminalized and medical marijuana is legal with a doctor’s prescription. If the measure is approved, Germany—Europe’s most populous country—could give the legalization push more traction across the continent, which has lagged behind the U.S. in easing access to weed. Under the German measure, there would be provisions related to advertising, with the intent being to restrict the promotion of marijuana to deter youth use.

And finally, as psychedelic drugs slowly become mainstream so too are high-end psychedelic retreats catering to travelers who want to experience the drugs in pastoral settings such as Costa Rica and Jamaica. The interest is being wrapped in the booming global wellness industry, but there is good reason for caution: Psychedelics are powerful drugs and can cause psychosis and long-term mental health issues. While research is continuing into the potential for psychedelics to treat conditions such as depression, anxiety, and PTSD, there is potential for harm if patients at retreats are not properly monitored and controlled while using the drugs. Psychiatrists say that while there has been a paradigm shift with psychedelics and more interest in their application for treating certain disorders, we need to go slowly and be mindful of the possible dangers. So when considering booking an expensive psychedelic retreat, buyer beware. 

The Daily Briefing 11.24.2021

The first jury verdict in an opioid case has found that the nation’s three largest pharmacy chains had substantially contributed to the opioid epidemic and crisis of overdoses, a big win for plaintiffs in thousands of similar lawsuits against the drug industry. The verdict, in a federal court in Cleveland, was surprising as it was based on the legal strategy of “public nuisance” laws, a concept that was rejected twice this month in judicial rulings in California and Oklahoma in similar cases against opioid manufacturers. Still, the jury agreed that the pharmacy chains—CVS, Walmart, and Walgreens—had turned a blind eye to countless red flags about suspicious opioid orders, thereby fueling an epidemic that has killed more than 500,000 Americans over the past two decades. 

For their part, the pharmacies argued that they were fulfilling legal prescriptions by doctors for a drug approved by the FDA and regulated by the Drug Enforcement Agency. Whether the verdict survives on appeal isn’t certain. Other cases involving the pharmacies ended with a $26 million settlement in New York this past summer, while opioid makers and distributors—also facing thousands of lawsuits for allegedly fueling the epidemic—have committed billions of dollars in settlement offers, some nationwide.

The lawsuits are playing out in courtrooms and behind the scenes as the opioid epidemic and a surge in fatal overdoses rages on. A record 100,000 individuals died in the year-long period ending in April—a 30 percent increase of the same time period the year before, driven largely by the powerful synthetic opioid fentanyl, now a popular street drug sold on the black market. Compensation from settlements would be channeled in part to victims’ families and also to drug treatment and prevention programs, but we also need a massive infusion of funding from the federal government to tackle a public health crisis of such magnitude.  

The Daily Briefing 11.23.2021

With drug overdoses surging to record levels—more than 200,000 Americans died in the year-long period ending in April—the New York Times takes a closer look at the powerful synthetic opioid fentantyl, which is driving the spike in fatalities. The painkiller was developed in the 1950s and is used to treat cancer and post-surgery pain, but today it is a major street drug sold on the black market, sprayed on marijuana, and made into counterfeit pills resembling oxycodone and Xanax. Users unaware they are consuming fentanyl-laced drugs die quickly, as it is 100 times more powerful than morphine. This is the third wave of the opioid epidemic after prescription painkillers and heroin and is now the main cause of death from a drug overdose. Fentanyl is mainly made in China, shipped to Mexico, and then transported over the border, and its spread has been “stealthy, steady and deadly.” To stop this killer drug we need better interdiction, more controls on online sales, and extensive education and prevention programs to warn people about the dangers of consuming fentanyl. 

Meanwhile, a new study finds that vaping can be just as dangerous as smoking regular cigarettes, triggering inflammation and changes in blood chemistry. At first, vaping was touted as a “healthy” smoking cessation tool, but after a wave of vaping-related deaths and an epidemic of teen use, the study shows that vapers experience a similar gene disruption as smokers do. This could potentially lead to cardiovascular disease, metabolic diseases, and cancer, the study concluded.

And finally, many states implemented telehealth services during the COVID-19 pandemic and expanded telemedicine practices for treating opioid use disorder (OUD), but progress overall has been uneven. A report in JAMA Health Forum reveals that few states are comprehensive in their approach, such as easing access to medications for OUD treatment. Other moves—including loosening licensing requirements—have been applied unevenly. And despite these federal and state policy changes, overdose deaths and substance abuse still rose during the pandemic.

The Daily Briefing 11.18.2021

Political leaders, addiction professionals, and public health officials are reacting to the troubling new data reported yesterday that a record 100,000 Americans died from drug overdose in the yearlong period ending in April—more than fatalities from car accidents and gun violence combined. Dr. Rahul Gupta, director of the Office of National Drug Policy Control, focused on the need for states to broaden the availability of overdose reversal medications like naloxone, noting that “access often depends a great deal on where you live.” Dr. Joseph E. Lee, chief executive of the Hazelden BettyFord Foundation, blamed the increase in deaths in part on the “community and social support that was lost during the pandemic,” as treatment providers struggled to maintain services. The numbers for the past year are grim, reflecting not only barriers to treatment that arose during the pandemic and subsequent lockdowns but also the influx of the powerful synthetic opioid fentanyl, which is increasingly found in counterfeit pills made to look like oxycodone or Xanax and sold by street dealers. There’s little hope that the current situation will change. “It’s telling us that 2021 looks like it will be worse than 2021,” predicted Robert Anderson, chief of the mortality statistics branch of the CDC’s National Center for Health Statistics. For his part, President Biden said “we cannot overlook his epidemic of loss, which as touched families and communities across the country.” But he failed to announce any new programs or funding, and instead repeated his administration’s call to implement harm reduction strategies, which are regarded as a stop-gap measure to save lives—but not the most effective way to get substance users into drug treatment.

The Daily Briefing 11.17.2021

Drug overdose deaths reached a record high with more than 100,000 American fatalities in the yearlong period ending in April—a 30 percent increase over the same period last year. The rise in deaths was fueled by both the loss of access to drug treatment during the pandemic, and the widespread use of potent street drugs such as fentanyl, which is 100 times more powerful than morphine, and now more widely available than ever before to increase the potency of counterfeit pills. Overdose deaths related to stimulants like methamphetamines and cocaine as well as prescription pain medication also increased. President Biden’s American Rescue Plan Act includes $1.5 billion for the prevention and treatment of substance use disorders, but that is an inadequate response given the magnitude of the public health emergency.  

Meanwhile, nationwide opioid litigation moves into a new phase with the opening in Seattle of the trial against the three large drug distributors in the U.S. for their alleged role in the opioid epidemic. Prosecutors in Washington State accuses the companies—McKesson, Cardinal Health, and AmerisourceBergen—of failing to monitor and prevent illegitimate sales and distribution of prescription painkillers that have contributed to the opioid crisis, and more than 93,000 overdose deaths just last year. The trial, in which the state is seeking up to more than $95 billion in compensation, follows lawsuits against opioid manufacturers and pharmacy chains for their part in the epidemic. Some of the nearly 5,000 cases brought by state and federal authorities against the opioid industry have been settled and others are in trial, with a so-called master settlement proving elusive. In a previous development, judges in both California and Oklahoma have struck down a major argument against the industry—that their actions constituted a “public nuisance”—placing in doubt the outcome of all the opioid lawsuits. 

And finally, not many people may have noticed it but slipped into the $12 trillion infrastructure bill signed this week by President Biden are several new funding streams for marijuana research. One allows scientists to study weed sold in dispensaries that consumers are actually buying, rather than being limited to pot grown in government-run facilities, which has been the norm. This will give researchers better insights into the high-potency pot sold in legal marijuana states, and its impact on consumers. Equally important, money will be available to law enforcement and others to establish education and prevention programs to reduce drug-impaired driving in states where the drug is legal. It also funds the training of “drug recognition experts” to help police identify drivers under the influence, as well as DWI-drug courts that offer individuals a choice between jail time and substance use treatment. 

The Daily Briefing 11.16.2021

A spate of overdose deaths linked to counterfeit, fentanyl-contaminated pills is roiling Boulder, Colorado, panicking parents and young people, and public health officials in the city. At least a dozen people ranging in age from 18 to 68, including college students—have died recently by fentanyl, either on its own or in combination with other drugs. Fentanyl-laced pills have been circulating in the county for the past couple of years, part of a national trend: in fact, two in five of all the counterfeit pills circulating in the country contain drugs make in Mexico to look like oxycodone and Xanax tablets, and contain enough fentanyl to kill a person instantly. More prevention and education efforts are therefore needed, along with interdiction, which is already at a high level: in any given week, DEA officials in the Denver field office seize between 5,000 to 100,000 counterfeit pills

There’s a growing body of evidence connecting cannabis use during pregnancy to negative health impacts—with the latest study warning that marijuana can lead to anxiety, aggression, and hyperactivity in children from age 3 to 6. This survey, based on 322 mother-child pairs, analyzed hair samples, placental tissue, and behavioral studies, finding higher levels of the stress hormone cortisol. National guidelines recommend against the consumption of cannabis products while pregnant because of its effects on fetal health and child development.

And finally, it seems there’s something that both Democrats and Republicans can agree on—marijuana legalization. A growing number of Republicans, generally more conservative than Democrats on the pot question, are getting behind a GOP House bill to lift the federal prohibition on marijuana. The measure would also impose a nationwide 21-year age limit with an exception for medical use, and allow states to make their own rules and around cannabis—including banning sales within state borders. Analysts say the push and pull between the parties may lead to a compromise with Democrats over their more progressive legislation, and eventually lead to national legalization.  

The Daily Briefing 11.11.2021

In Oklahoma and California, two recent court rulings threaten to upend the carefully crafted—and, so far, successful—a legal strategy being deployed in thousands of lawsuits against the opioid industry. Those rulings cast doubt on the novel legal approach focusing on "public nuisance” laws, alleging that the pharmaceutical sector overplayed the benefits of their highly addictive opioid products and downplayed risks, therefore creating a nuisance by impeding public health. Both decisions agreed with the companies being sued—including opioid manufacturers, drug distributors, and pharmacy chains—that they were selling a federally approved, legal product prescribed by doctors and supposedly monitored by state and federal authorities. As opioid trials continue in many states, and settlement talks are at an advanced stage for thousands of the cases, the rulings could prod states, local governments, and tribes to capitulate and also fuel the resolve of plaintiffs to fight harder against giving in. The losers, once again, will be the families of those who died of opioid overdose, and efforts to win enough settlement money to expand the fight against the opioid epidemic.

Meanwhile, the long-awaited results of the largest-ever study of psilocybin have been announced, revealing that the psychedelic drug was highly efficacious as a therapy for treatment-resistant depression. The study found that patients who were given the highest dose had a significant decrease in depressive symptoms compared to those given the lowest amount, essentially a placebo. Overall, nearly 30 percent of patients given a high dose were in remission, compared to 7 percent for the control group. It was the most rigorous trial so far on psilocybin, also known as magic mushrooms, and adds to a growing body of evidence to earlier studies that were promising.

And finally, big cannabis companies are lining up celebrity comedians to push for marijuana legalization—although not everybody is laughing at the new campaigns, including a website that makes it easier for supporters to contact their congressional representatives. Kevin Sabet, of Smart Approaches to Marijuana, described the campaign as an “egregious example of profit over public health,” while even pro-legalization The Drug Policy Alliance, criticized the effort as overly corporate and not helping communities most hurt by marijuana laws.

The Daily Briefing 11.9.2021

The Drug Enforcement Agency is cracking down on the illicit use of a drug to treat opioid use disorder, but this policy may be fueling the opioid crisis. But because the drug, buprenorphine, is a controlled substance—used to treat cravings during withdrawal—can be misused, the DEA has taken an aggressive stance to stop its diversion to the streets. This often means stopping pharmacies from dispensing the drug when it’s desperately needed amid record drug overdose deaths. The ramifications are particularly acute in rural areas, where there is a lack of treatment providers and a stigma against these medications that already create barriers. Pharmacies are therefore reluctant to both order and distribute the drugs, fearing that the DEA will revoke their license.  

Meanwhile, a new study published by the American Heart Association found that a growing number of people under 50 diagnosed with cannabis use disorder were later hospitalized for a heart attack. The rising trend parallels the legalization of marijuana in many states and adds to the growing body of evidence concerning the potential risks of cannabis use. The finding was most pronounced in those 18 to 32, among men, and African Americans, among the nearly 900,000 medical records analyzed. The study revealed that the proportion of patients hospitalized for heart attacks who had CUD nearly tripled to 6.7 percent between 2007 to 2018. The study was observational and did not control for use of other substances such as tobacco or alcohol, and therefore did not show a direct cause, suggesting that long-term studies are needed to determine the link between cannabis and heart disease.

And finally, cannabis stocks were once flying high, after Canada legalized the drug and more states in the U.S. approved both medical and recreational sales, and revenues boomed. But now, investors have a bad hangover, Politico reports, because the Biden administration and Congress have done nothing to ease restrictions on cannabis companies accessing financial markets, or move to end federal prohibition of pot. The result: plummeting stock prices and nervous investors who sank billions into the fledgling industry, hoping for a big payoff. At the same time, big pot states like California say sales are declining after a pandemic surge, the illicit market is still large, and promises of achieving social equity as a result of legalization have not been realized.

The Daily Briefing 11.8.2021

A year ago, Oregon embarked on a bold program to right the wrongs of the failed war on drugs, decriminalizing low-level possession and boosting access to drug treatment, all the while hoping that this would become a model for other states. But a new report from Pew Trusts finds that it’s not clear yet if the effort is working, noting that it’s easier to eliminate criminal penalties for drugs than to ramp up behavioral health services and get more people to use them—and to do this during a pandemic. So far, Oregon’s inpatient facilities, detox clinics, and recovery-focused nonprofits have only received $30 million of an expected $300 million in funding, paid for from legal marijuana sales revenue. The facilities have also been battered by COVID worker shortages, and have not been able to expand services. Also, without the incentives provided by drug-court referrals, fewer than half of the 1,300 people cited for low-level possession have voluntarily shown up in court to make their case against paying the small fine. Only 51 people have called the state’s drug help hotline. Nevertheless, lawmakers in Massachusetts, Rhode Island, and Vermont are all considering drug decriminalization bills. 

Meanwhile, global consulting firm McKinsey is again coming under Congressional scrutiny for its role in the opioid crisis. Congress is asking for company records related to its business practices, conflicts of interest, and management standards connected to its work with opioid manufacturers, distributors, and pharmacy chains, as well as its work for the Food and Drug Administration. Earlier this year, McKinsey agreed to pay all 50 states more than $600 million to settle investigations into how it helped “turbocharge” opioid sales that contributed to the epidemic, which has killed more than 500,000 Americans over the past two decades. That settlement focused mainly on the firm’s work with Purdue Pharma, the maker of OxyContin, which is seeking a settlement to end thousands of opioid-related lawsuits.

And finally, five years after Massachusetts legalized marijuana many of the promises made by pro-pot groups have not been realized, according to an analysis by the Boston Globe. While sales have boomed—generating more than $2.2 billion in revenue—social equity goals have fallen short, with just 16 of the 194 companies that have opened a marijuana facility owned by participants in the equity and economic empowerment program. Legalization does not appear to have markedly boosted youth usage of pot, although experts say that a proportion of cannabis consumers overuse the drug and find it hard to stop and that a relatively small number of prolific consumers account for an outsized share of legal cannabis sales. State police say there has not been an increase in driving while high arrests, but that may be due to an overall decline in driving during the pandemic, and the fact that there’s no breathalyzer-like device to accurately detect cannabis impairment. 

The Daily Briefing 11.4.2021

Dentists routinely prescribe opioids for patients 18 years old or younger, a trend that can open the door to potential misuse, diversion, and addiction, according to a new study from the American Dental Association. Although dentists comprise only 8 percent of all opioid prescribers in the U.S., they account for the highest number of prescriptions to young people. And while an overwhelming majority of dentists surveyed said that a combination of nonsteroidal anti-inflammatory drugs such as ibuprofen and acetaminophen are equally or even more effective than opioids, 43 percent still reported regularly prescribing opioid medications. The focus on those under 18 is particularly worrying, the report noted, because the first exposure to opioids for many people occurs in their teens following common dental procedures like third molar extractions. 

Meanwhile, as more states legalize both recreational and medical marijuana its use during pregnancy is increasing, along with the potential for abuse or dependence. A new study from Columbia University and Well Cornell Medicine captured the magnitude of marijuana use among prenatal hospitalizations, finding that the proportion of pregnant patients with cannabis use disorder—defined as cannabis use with clinically significant impairment or distress—rose 150 percent between 2010 and 2018. Researchers say legalization has likely lessened fears about the risks of using marijuana during pregnancy, leading many patients to consume cannabis instead of prescribed medications, thinking it’s a safer choice. Physicians recommend against using cannabis while pregnant, chiefly because of both known and unknown fetal effects such as low birth weight and other adverse outcomes.

And finally, an commentary in the Wall Street Journal looks at the issue of allowing truck drivers to get behind the wheel while taking medications routinely prescribed to treat opioid use disorder, such as methadone and buprenorphine. The authors argue that in the face of a trucker shortage that is exacerbating supply chain woes, drivers should be permitted to hit the road, and not have their licenses revoked, as some states have done. Federal regulations offer no clear guidance, but studies show that patients who start on these medications can experience sedation and cognitive impairment as their doses are stabilized, and then rapidly adapt within a few weeks. Still, it may be difficult to closely monitor the condition of such patients, which may fluctuate, and therefore poses a possible risk to other drivers. 

The Daily Briefing 11.2.2021

Drug manufacturers won a rare victory in nationwide opioid litigation as a California judge cleared two opioid makers of liability for causing the opioid epidemic. The case is one of the thousands across the country against drug companies, drug distributors, and pharmacy chains for their role in the opioid crisis, which has led to the deaths of more than 500,000 Americans over the past two decades. Many of the lawsuits have been settled before going to trial, resulting in billions of dollars of compensations for states, cities, and victims’ families who brought the suits. But the California case against drugmakers Johnson & Johnson and Endo, the judge believed the companies’ claims that they made a federally-regulated product that helped people in pain and was not responsible for widespread opioid addiction. Other trials are ongoing or awaiting rulings in New York, West Virginia, and Ohio, while settlement discussions continue in other jurisdictions.

Meanwhile, a new study looking at ways to reduce chronic pain and opioid use finds that talk therapy and yoga can help ease the pain but do not have a  significant impact on usage. When such practices were compared to usual care for chronic pain patients, more people in the intervention group said pain dropped by at least 30 percent, although opioid use stayed the same. Nevertheless, researchers noted that despite this limited efficacy, the results are encouraging and that the treatment may be an attractive option given that the problem of opioid use is so large.  

And finally, when California legalized marijuana five years ago, the state and legalization supporters imagined that a new, thriving market would evolve to benefit the economy and provide compensation for communities of color that were disproportionately hurt during the decades-long war on drugs. But it hasn’t exactly turned out that way, the Guardian reports. In fact, the legal weed industry is in disarray. Despite the cheery façade of celebrity pot products and home-delivery services, the illicit market is still thriving and black and brown entrepreneurs who were supposed to benefit have been locked out of the market or have ended up losing money. Consumers remain confused about what’s legal and what’s not, and many municipalities have used the law's opt-out clause to ban pot sales.  

The Daily Briefing 11.1.2021

Incarcerated people in prisons and jails have high rates of substance use, but there are few programs that offer them drug treatment. That’s set to change in New York State, with a new law allocating nearly $20 million to establish medication-assisted programs (MAT) in each of the state’s prisons and jails. Today, such treatment is offered at only seven or eight of the state’s 50 prisons, and at 42 county jails statewide, plus Rikers Island, which includes the five counties comprising New York City. Nationwide, an estimated 85 percent of incarcerated individuals have active substance use but only a fraction receive treatment. The new law also requires treatment programs to provide preparing for release with information about community-based treatment facilities and a one-week supply of medications that were prescribed during their incarceration.

Meanwhile, a new study based on input from Michigan emergency departments found that neuropsychiatric toxicity (NPS) was common among patients presenting with cannabis toxicity. Of the nearly 40 percent diagnosed with NPS, more than a third had severe anxiety and altered mental status. Toxicity symptoms included nausea, vomiting, or abdominal pain and those consistent with intoxication such as blurry vision, giddiness, and disorientation. 

And finally, Gov. Newsom of California has signed a law imposing an excise tax on e-cigarette sales in a bid to slow the teen vaping epidemic. The aim is to discourage vaping by minors by bringing taxes on e-cigarettes more in line with levies on other tobacco products. Making vaping devices more expensive is likely to reduce the number of purchases by those younger than 21, the legal age of purchase. The tax comes after Newsome signed legislation to ban the sale of all flavored vaping products, but that has been held up by a tobacco industry-backed referendum on the November 2022 ballot.

The Daily Briefing 10.28.2021

The latest survey from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) finds that Americans consumed large quantities of illicit drugs in 2020. Blame the pandemic, or marijuana legalization, or the opioid crisis: more than 20 percent of people ages 12 or older (or 59.3 million individuals) used such drugs last year, including 18 percent who consumed marijuana. Of that number, young adults ages 18 to 25 were the most likely to use pot (nearly 35 percent) compared to 16 percent of those ages 26 or older. Nearly 3 million Americans initiated marijuana use. Almost 10 million people misused opioids last year, mostly prescription pain medications. The survey, based exclusively on in-person interviews, also revealed that nearly two-thirds of adolescents who vape didn’t use any other tobacco products, unlike older nicotine users.

Meanwhile, with marijuana legalization comes changing perceptions about the drug, and how and why consumers use it. A story in Ad Week tells us that the clichéd image of the lazy stoner who only lives to get high is being replaced by the legal-weed generation which integrates cannabis into work, fitness, intimacy, and hobbies, according to a new study of weed fans in California by a cannabis delivery platform. For example, 43 percent of those surveyed said they “microdose” marijuana before clocking in for their job, while others pair cannabis with cooking and workouts. However, more than 20 percent use cannabis to relieve stress and improve their mental health than for any other reasons.

And finally, while Californians are finding new ways to integrate pot into their lives, the New York Times reports that the Japanese government has doubled down on its hardline position toward the drug. It is even ramping up arrests of citizens who indulge and is trying to stop the influx of marijuana-friendly information into the country. Unlike the U.S, where 19 states have legalized recreational marijuana, Japan has some of the most restrictive cannabis laws in East Asia, a region known for its intolerance of drugs. Only 2 percent of Japanese have reported using pot, compared to almost half of all Americans.   

The Daily Briefing 10.27.2021

More and more people are turning to medical cannabis products to alleviate mental health problems such as anxiety, depression, and insomnia—although there is little science indicating that the drug is safe and effective to treat these problems. Advocates of medical marijuana legalization have convinced many consumers that their problems can be solved with cannabis, even as some evidence suggests that it can make their conditions worse. Therapists say they are seeing more patients using pot in place of antidepressant drugs, which can have unpleasant side effects. But some studies have found that cannabis use is linked to even more severe symptoms, prompting the American Psychiatric Association to warn that “there’s no current scientific evidence that cannabis is in any way beneficial to the treatment of any psychiatric disorder.”

Meanwhile, an alarming new study in JAMA Pediatrics has found that the number of teens who vape marijuana increased 7-fold between 2013 and 2020, as young people seek a more intense high than what they would get from smoking a joint. Vape pens deliver an intense high with more THC, the psychoactive component of marijuana. Researchers point out that vaping pot poses serious health dangers for teens, including a risk of dependence on marijuana and other substances, pulmonary disorders, and social and behavioral problems later in life. It’s time to impose better regulation of vaping products and ban advertising that targets young people.

And finally, some good news on the drug interdiction front: law enforcement agencies on three continents have disrupted a global drug trafficking operation on the dark web, one of the world’s largest online marketplaces for illicit goods including opioids and other dangerous drugs. Authorities in Europe, the U.S., and Australia arrested more than 150 people and seized large quantities of drugs including opioids, cocaine, and methamphetamines. Sales of drugs and drug-making equipment on the dark web have helped fuel the opioid crisis.  

The Daily Briefing 10.22.2021

A new form of methamphetamine, known as P2P, is sweeping the U.S., causing a wave of mental illness and homelessness. Developed in Mexico by drug traffickers, P2P gained popularity as states legalized marijuana, according to an article in The Atlantic. As pot revenue faltered, many producers switched to making meth, which was easy to make and transport. In the Southwest, the drug quickly became more prevalent, and then spread all the way to New England. And is P2P took over, an unprecedented shift took place in American drug use: opioid addicts began using meth en masse and meth overdoses soared, even though you don’t typically die overdose or die on meth. In many states where substance users took withdrawal meds to get off drugs, they began substituting meth to get high. Traffickers were therefore able to create a new population of mentally ill Americans.

Meanwhile, a new national study has found widespread misperceptions about medical marijuana: about 42 percent of breast cancer patients use medical marijuana to treat symptoms—and that half of these individuals believe that medical cannabis could treat the disease itself, although there is no scientific evidence from human trials to support that idea. Patients use pot to relieve pain and for insomnia, as well as for anxiety, stress, or nausea. Most were unaware that the quality of cannabis products can vary widely, and saw the drug as a natural product that is better than “chemicals.” The study warned that patients and doctors need more information about marijuana because the drug could interfere with some treatments or make patients vulnerable to new side effects.  

And finally, as more and more states legalize marijuana, law enforcement has voiced concerns about the impact of drugged driving, noting that there is no equivalent of the Breathalyzer test for drugs. Now, scientists say they have developed a rapid test that reliably detects THC—the psychoactive component of pot—in saliva in under 5 minutes. Currently, THC can be tested in the bloodstream or urine, but this takes days to process. THC in saliva reflects use within the past 12 hours, which means it could become a critical tool in determining drugged driving as marijuana becomes legal and more drivers casually use the drug, with a resulting increase in traffic crashes and fatalities.

The Daily Briefing 10.21.2021

The New York Times finally weighs in on the risks to kids from marijuana edibles, noting that many teens underestimate the dangers associated with the drug. With pot legalization making pot more widely available, young people have come to believe marijuana is less dangerous creating a perfect storm or risk, especially for edibles that are heavily marketed to young people. Edibles can indeed appear harmless, as they are packaged to look like candies, and appeal to impulsive, thrill-seeking youth. But they can pack a strong punch with high levels of THC, the psychoactive component of pot, that may cause lethargy, confusion, impaired coordination, intense anxiety, rapid heart rate, and vomiting, as well as seizures and respiratory depression. The Times suggests that parents talk to their teens about these risks, but the government should also act to impose stricter rules and regulations to curb underage access and use. 

Meanwhile, the Times doesn’t always speak so bluntly when it comes to marijuana. A recent story in the Style section noted that fake pot plants are all the rage as decor in homes and businesses, as a way to "counter negative attitudes" toward marijuana and supposedly destigmatize the drug. The owner of one fake pot plant company was quoted as saying she was inspired to start the business by her father, who said that using marijuana oil had helped treat his skin cancer. Perhaps the paper of record should have also pointed that pot is NOT an effective treatment for skin cancer.

And finally, as drug overdoses soar in the U.S, the availability of the overdose reversal drug Naloxone is dwindling as the price of the effective, and easy-to-use drug increases, which is causing a dangerous shortage. The drug’s manufacturer, Pfizer, ran into problems making the drug earlier this year, and temporarily stopped shipping it to community groups battling the drug epidemic. Pfizer says the supply chain has been fixed, but the price is still far more expensive for the providers at a time when they need it most. Now is the time for the government to step in and secure the production and availability of a critical drug that can save lives, and help substance users enter treatment.  

The Daily Briefing 10.18.2021

Fatal drug overdoses are soaring in San Francisco, and the city’s mayor London Breed is coming under increasing pressure to declare a public health emergency as she did with COVID-19. Advocates say this would not only bring more attention to the crisis but also provide an incentive to flout federal and state laws to open safe syringe sites, where users can shoot up in a controlled setting. Last year twice as many people in the city died from drug overdose as from coronavirus, and this year drug deaths continue to climb. Mayor Breed generally supports safe syringe sites but says it’s not clear whether an emergency declaration would help get around current laws banning them. Similar fights have raged in several cities with increasing overdose deaths, although none have yet opened in the U.S. In the meantime, Breed has committed an additional $13.2 million to expand the city’s overdose prevention program, including street outreach teams, treatment beds, and wider distribution of overdose reversal drugs.

Meanwhile, streaming service Hulu tackles the opioid epidemic with its new series Dopesick, which offers dramatic and emotional insights into the crisis focusing on a small town in Appalachia, where the epidemic started in mostly white, working-class communities. The series, starring Michael Keaton as a local doctor, looks at the crisis from multiple angles: doctors and patients, law enforcement, and prosecutors trying to hold OxyContin maker Purdue Pharma accountable for essentially lying about the addictiveness of the drug, which fueled addiction and overdoses. The series debuts as opioid litigation against drugmakers, distributors, and pharmacies for their role in the crisis plays out and provokes controversy over proposed settlements that many believe do not adequately compensate victims' families.

And finally, you may have noticed that supermarket shelves are now overflowing with beverages suffused with ingredients such as CBD, purporting to reduce stress and help you calm down—which sounds great, even though there’s very limited research supporting such claims. CBD, the non-psychoactive component of marijuana, is showing up everywhere, including drinks, wellness products, and even dog food. But the New York Times points out that little evidence exists showing that it does what the products promise. Although one company noted that customers have reported “lifted moods and cleared minds,” what they may actually be experiencing is the placebo effect, the power of suggestion being so strong that they believe they’re consuming a magical cure.  

The Daily Briefing 10.13.2021

E-cigarettes have been on the market for almost a decade, but controversy continues to surround the devices, which were first pitched as a smoking cessation tool but eventually led to an epidemic level of use among underage consumers. Now, the FDA has given the first market authorization to an e-cigarette—R.J. Reynold’s Vuse—as a way to help smokers quit. But the agency, which says this does not mean the product is “FDA-approved,” also denied a request to sell flavored pods for the device. And it imposed strict marketing regulations on the company, including digital advertising restrictions in order to greatly reduce the potential for youth exposure to these products. Industry leaders say this is a good sign that the FDA doesn’t intend to drive e-cigarette makers out of business, while also being careful about allowing products that target young people, amid an epidemic of youth vaping. The FDA hasn’t yet ruled on products from former market leader Juul, and continues to deny pre-market requestions from thousands of applications from potential c-cigarette makers.

Meanwhile, the American Heart Association is not mincing words about its position on e-cigarettes: it calls on the FDA to reject all the remaining pre-market tobacco applications for flavored products, regulate synthetic nicotine, and prohibit the sale of any flavored tobacco product. It also called on states to pass laws and policies that remove flavored tobacco products, including menthol, from the market. The Heart Association was responding to a recent survey that found that more than 80 percent of high school and middle school students who vape prefer flavored products, as well as a preference for disposable products that those with synthetic tobacco—both of which are not under FDA jurisdiction.

And finally, a clinical trial has begun of the first potential opioid vaccine in humans. The trial, at Columbia University, will first test the safety and efficacy of a vaccine designed to trigger the patient’s own immune system to develop antibodies to the target: if the individual uses opioids, for example, the antibodies would bind to it and prevent it from getting to the brain. The vaccine would not prevent cravings for the drug, but it could serve as an added layer of protection for people at high risk.