The Daily Briefing 01.19.2022

With drug overdose deaths soaring across New York State—and one fatality alone every four hours in New York City—Governor Kathy Hochul has pledged $402 million in her first budget proposal to address drug prevention, recovery, and treatment programs, representing a much-needed 56 percent increase over the previous allocation. If approved, this would be a major step forward to fight the addiction and overdose crisis after budget cutbacks during the pandemic, which severely hampered the ability of treatment providers to maintain critical services. The budget calls for the money to go toward removing barriers to treatment, developing new and innovative treatment models, and expanding the number of treatment facilities in communities—including residential care. What’s more, healthcare workers will receive a salary increase and bonuses, and the Alcohol Awareness Program will be expanded to include recreational cannabis, an important measure following marijuana legalization. Funding will come from the opioid tax and opioid litigation settlement compensation as well as state resources outlined in the total $216 billion budget, with $113 million going directly to local municipalities for addiction programs.

Meanwhile, as overdose deaths continue to spike in Chicago, pressure is growing in the city to follow New York’s model and open supervised syringe sites—also known as overdose prevention centers—where users can inject drugs in a safe setting, with medical personnel an overdose reversal drugs available. Such harm-reduction facilities—which opened last year in New York City, the nation’s first—can reduce deaths but do not focus on engaging patients to enter life-changing treatment. Yet with twice as many overdose deaths in Chicago than homicides last year, officials are looking to supervised sites and other harm reduction approaches to quickly address this public health crisis.

 And finally, a new study finds that when incarcerated people receive medication to treat opioid use disorder, they were less likely to face re-arrest and reconviction after release from jail. The NIH study in two rural Massachusetts jails reveals a 32 percent reduction in rates of probation violations and re-incarceration when the facility offered the withdrawal drug buprenorphine, compared with when it did not. A growing body of evidence suggests that such medications hold great potential to improve outcomes among individuals after they’re released. But offering these treatments to those who pass through the justice system is not currently standard-of-care practice in U.S. jails and prisons, and most jails don’t offer them in large urban centers.

The Daily Briefing 01.17.2022

The nation’s first supervised injection sites opened in New York City at the end of last year, in a major victory for harm-reduction advocates who have been fighting for years for such facilities where addicts can inject drugs in a safe setting and overseen by medical personnel. Looking at the impact of the sites so far, the Washington Postreports that they have been used more than 3,000 times and workers have reversed 76 overdoses—a small victory, experts note, as the country’s overdose fatality rate has climbed to nearly 300 a day and one every four hours in New York. Saving lives is, of course, critical, but the article also points out that engaging patients in treatment will only be “encouraged” if a user first expresses interest in treatment first, which is unlikely to happen. Harm reduction can play a critical role in drug policy, but it must be accompanied by incentives to enter treatment and a substantial expansion of treatment options.

 Meanwhile, as more states legalize marijuana more children are inadvertently eating increasingly popular cannabis-infused foods and getting sick—sometimes critically. In Colorado, for example, an early legal state, unintentional marijuana exposures have continued to climb, and in Washington State, the number of exposures among children under 6 nearly tripled in the five years since pot stores opened. Nationally, exposures to children 12 and under grew from 187 in 2016 to 3,100 in 2020, with a majority of them children under 5 years old. Doctors say that many adults and teenagers alike generally assume that edibles are harmless, but they contain THC—the psychoactive component of pot—and can lead to cannabis use disorder and side effects including psychosis. But it’s easy to understand why kids want to consume them, as many products are packaged as mouthwatering chocolates, soft and chewy cookies, and fruity gummies.

 And finally, Colorado is at least changing its marijuana statutes to curb underage consumption: a new law will close a notorious loophole that allowed young people with valid medical marijuana cards to buy as much pot as they wanted—a practice called “looping.” Under the new regulation, there will be a tracking system that monitors sales in real-time, and limits purchases to one per day for card-holders between the age of 18 and 21. It’s the kind of sensible regulation that should become a model for other legal states where underage consumption of marijuana is widespread.

The Daily Briefing 01.13.2022

There’s nothing like a report linking pot with preventing COVID to whip up a social media frenzy—and jokes from late-night comedians—even if the purportedly definitive findings are not what pro-marijuana advocates, always eager to find another benefit of the drug, had hoped to hear. It all started with a scientific paper from researchers at Oregon State University that found that certain cannabis-derived preparations, given in the right amount, might help people fight off COVID-19. Nowhere does it say that smoking weed helps protect you from the coronavirus, or that contracting the virus (or avoiding it) has any relation to marijuana products that are currently available on the market. The study was looking for natural compounds that could possibly help humans fright off the virus; neither THC nor CBD, the main components of cannabis, were effective, the report noted, while two compounds from hemp plants did “prevent entry” into isolated human cells. Not exactly a compelling argument to run over to your local dispensary to buy some weed to prevent COVID. As Dr. Peter Grinspoon, a physician at Massachusetts General Hospital put it, “these compounds need to be tested in animals and then in humans, and actually demonstrate effectiveness against Covid. This is a long way off, assuming they work, which is by no means guaranteed.”

The Daily Briefing 01.12.2022

Minnesota was one of the dozens of states that pushed for a settlement in sprawling nationwide opioid litigation, and now that a massive $26 billion deal has been reached, officials are pressing for assurances that the money will go toward the intended purpose: addiction prevention and recovery programs. In an editorial, the Star Tribune newspaper notes that tens of millions of dollars will be sent to communities that have suffered the brunt of opioid overdoses, a welcome infusion of funds that can be used to expand addiction treatment programs, intervention, additional law enforcement, child protection and other expenses from the epidemic. It urges the state legislature to ensure that the money is preserved and used for its intended purpose, and not siphoned off to the general budget, as is what happened with the tobacco settlement.

Meanwhile, a new study finds that opioid deaths have soared among older adults and also indicates racial disparities, particularly among African American men. Over the past two decades, fatal overdoses in people over 55 increased from 518 in 1999 to more than 10,000 in 2019. About half the deaths were among those aged 55 to 64, and African American men were four times as likely as other men to die from opioids—and more likely to use illicit rather than prescription drugs. The researchers point to racism and ageism to try to explain the disparities, as older patients are often overlooked for opioid use disorder and Blacks have less access to health care and face bias in pain treatment. 

And finally, when California legalized marijuana five years ago, the pro-pot lobby promised that teens would be shielded from increased exposure to marijuana. But guess what? The state’s powerful cannabis industry has managed to evade regulations and use loopholes in the law to target advertising to those under age 21—sometimes using cartoon characters—and plaster highways with billboards, which is clearly prohibited. The trend is troublesome because teen brains are still developing and research shows that using marijuana at an early age increases the likelihood of developing a problematic level of use. It’s up to Governor Newsom, legislators, and regulators to buck pot industry pressure that favors more and more advertising.

The Daily Briefing 01.10.2022

New York Governor Kathy Hochul has outlined a number of harm-reduction measures to deal with the state’s soaring drug overdose rate, giving the first indication of her new administration’s drug policy priorities. In her state-of-the-state address, Hochul proposed forming a new department of harm reduction, and expanding access to safe syringes, overdose reversal drugs, and fentanyl test strips as part of a broader effort to cut the overdose rate, which increased by 33 percent during the pandemic year, the governor said. While the address signaled her interest in harm reduction as a strategy, it is not too late for her to include other measures in the upcoming state budget aimed at expanding access to drug treatment. Over the past few years, treatment providers have been struggling to maintain services during the pandemic and funding shortfalls.

And finally, Around half of New York cities and towns don’t want marijuana dispensaries or consumption lounges, according to the latest tracking data on how municipalities have decided on the opt-out provision in the state’s new marijuana legalization law. After the end-of-year deadline to choose had closed, 47 percent of the state’s 1,521 municipalities opted out of having dispensaries and 54 percent said no to on-site consumption lounges. While some 60 percent of voters say they support legalization, the “not in my backyard” mentality prevails when it comes to allowing local cannabis businesses, a trend seen in other legal pot states including Oregon, Colorado, and California. In many localities, there was strong organized resistance to opting in, and in others, local leaders simply decided to wait until the state finalizes its rules and regulations for the market, and can opt-in at a later date.

The Daily Briefing 01.06.2022

Psychedelic drugs are all the rage, with city and state governments starting to legalize the mind-altering substances and Wall Street investors pumping billions into companies selling them. Although psychedelics such as LSD and psilocybin are mostly still illegal, universities are studying their impact and users are championing new ways to take them, such as microdosing LSD, to reduce the potency. But as psychedelics become more commonplace, scientists and researchers warn that while the drugs hold potential to create altered states of consciousness—and are unlikely to lead to overdose—they also pose considerable risks, such as life-changing negative experiences. For example, psilocybin can cause distressing hallucinations or feelings of panic and anxiety in some patients, especially at high doses. And although LSD users have reported feelings of bliss during their trip, they can also suffer last psychological trauma. If you want to use these drugs, do so with professional guidance and make sure the drugs are safe and are in the appropriate dosage. 

Meanwhile, with Germany’s new government signaling that it is ready to legalize marijuana, startups are eying the potential of a pot bonanza in Europe’s most populated nation while health officials fret about potential negative consequences. While no bill has yet been tabled, the plan is to sell cannabis in licensed distribution sites, where quality can be ensured, sales taxes collected, and regulations put in place to keep the drug away from underage consumers. The most likely route is pharmacies, which already sell medical marijuana—unlike in U.S. states that have legalized weed and have established a commercial market for it through private companies and with a social-equity component. Germans, and Europeans in general, have been slower than Americans to support marijuana legalization, with a recent survey showing for the first time a slim majority of respondents now in favor of legalization.  

And finally, the Biden administration's nominee to run the Food and Drug Administration has appeared before Congress but didn’t say much about one of the country’s deadliest public health crises: the opioid epidemic. Although Robert Califf took some heat from legislators about how the FDA handled opioids during his previous first term at the agency—including its reluctance to crack down on long-term opioid prescribing and its recent approval of high-dose opioids—he insisted that he took the crisis seriously and promised a “very progressive approach” if confirmed, which is likely. 

The Daily Briefing 01.04.2022

Preliminary data suggests that so far about 50 percent of the more than 1,500 municipalities across New York State have decided to opt-out of allowing cannabis commerce, under the marijuana legalization law approved last year. Cities, towns, and villages had until the end of the year to decide whether to permit pot dispensaries and on-site consumption lounges (or both) within their borders. Another option was to do nothing and thereby automatically opt-in or to say no now while awaiting further guidance and regulations from the Cannabis Control Board, before formulating a pot policy right for a community. A final count is expected in the next few weeks, but so far it looks like New York may resemble neighboring New Jersey—which also legalized weed in 2021—with more than half of localities choosing bans. This result would also align with early legal states such as California, Oregon, and Colorado where municipalities overwhelmingly said they didn’t want marijuana businesses. 

And finally, perhaps newly legal pot states could learn a lesson from early adopters like Colorado, which legalized medical marijuana 20 years ago, a physician writes in the opinion section of the Colorado Sun. The goal at that time was to help patients with certain medical conditions that were known to be accompanied by chronic pain, nausea and vomiting, weight loss, muscle spasms, and some other physiological symptoms. Even though the number of such patients was said to be small, tens of thousands of 18- to 25-year-old residents were suddenly suffering from such conditions, opening the floodgates of “medical” marijuana use, as well as recreational pot legalization and an increase in adverse effects including cognitive functioning and psychosis. Physicians in the state now see an epidemic of acute transient psychotic symptoms, particularly among adolescents. The commentary concludes with a please to stop the charade that medical marijuana is medicine, noting that this drug is not sanctioned by the FDA for safety and effectiveness, the dosage is not checked or controlled, physicians don’t prescribe it, and pharmacies don’t dispense it. 

The Daily Briefing 01.03.2022

In a landmark decision in the sprawling opioid litigation, a jury in New York has found the Israeli-based pharmaceutical company Teva guilty of contributing to the opioid epidemic. It’s only the second opioid case to reach a jury verdict, among thousands of similar claims across the country brought by states, municipalities, and tribes. Many of those cases have been settled out of court, including a $26 billion agreement with drug distributors that was originally part of the Teva lawsuit. In other cases, rulings have been overturned in favor of the opioid industry, including manufacturers, distributors, and pharmacy chains. Prosecutors in New York had accused Teva of downplaying the addictiveness of opioids and failing to adhere to safeguards to stop the flood of drugs reaching the marketplace, which contributed to the deaths of more than 500,000 people over the past two decades. Money from all the opioid settlements will be distributed piecemeal to the communities hardest hit by the epidemic, and for prevention and treatment programs, at a time when the nation faces a tragic addiction and overdose crisis.

With one fatal drug overdose occurring every four hours in New York City, health officials are groping for solutions to address the escalating crisis. One solution was to open supervised syringe sites late last year, to provide a safe space and medical services for addicts to inject drugs. While this harm reduction measure has its flaws—for not engaging patients and getting them into treatment—the latest move is completely misguided: installing vending machines on street corners to dispense sterile needles and the overdose reversal medication naloxone. This is unlikely to stem the tide of overdoses and does nothing to encourage drug users to seek treatment. Instead of useless vending machines, health officials should be focused on expanding services to those struggling with substance use.

And finally, the New York Times investigates a company that is selling marijuana edibles with the promise that the product is an effective weight loss and diet control method—when in fact, there is no scientific evidence supporting such claims. The Times found that a clinical trial the company cites as proving its claim does not exist and that the Mayo Clinic and National Institutes of Health—also mentioned by the edible's makers as sponsoring the study—have no record of such research. As more states legalize cannabis under different regulatory mandates, companies are devising new ways to attract customers. Many play into modern-day consumer needs such as help with sleep, libido, self-improvement, and prolonging the workday (or ending it). But as competition heats up, so do the false claims. Increasingly, marijuana marketers sell pot products to relieve pain and manage stress and provide feelings of bliss, among other unproven benefits that are based mostly on anecdotal evidence. With the cannabis industry cashing in on these false promises, it’s time for regulatory agencies to take a closer look at marijuana companies that are deceiving the public—and possibly endangering their health. 

The Daily Briefing 12.29.2021

Oklahoma is staunchly conservative and has yet to legalize recreational marijuana, but it has become a boom state for weed entrepreneurs from all over the country to set up cannabis businesses, from grow sites to dispensaries. Lured by low taxes and lax rules, Oklahoma has become one of the easiest places in the U.S. to launch a weed business, and now boasts more retail cannabis stores than Colorado, Oregon, and Washington combined—and it has eclipsed California with the largest number of licensed cannabis farms. Today, there are some towns with more dispensaries than food stores, and battles are growing between legacy ranchers and pot growers, who are accused of straining rural water and electricity supplies and driving up prices for land. 

Perhaps Oklahoma should learn from California and its experience with the cannabis industry. In an editorial, the LA Times writes that five years after legalization, the state’s marijuana market is a mess, with many of the promises of legalization remaining unfulfilled. The black market is thriving, illegal pot farms are degrading sensitive environmental habitat, untrusted and unregulated products still flood the market, and the pledge to help communities disadvantaged by the War on Drugs is a work in progress. Instead of creating a vibrant legal market, the vast majority of marijuana consumed in the state is not legal. Most concerning, the editorial points out that some advocates blame the situation on the opt-out provision in the legalization—which entitles municipalities to not allow cannabis businesses—and suggests that this should be right should be eliminated, in order to curb the black market.

And finally, the opt-out provision is the focus of attention now in New York State, as the end-of-year deadline nears for municipalities to decide whether to allow cannabis dispensaries and on-site consumption lounges. At last count, nearly 600 of more than 1,500 localities have said no to marijuana retailers, including many suburban areas around New York City, while cities large and small—including New York, White Plains, Peekskill, among others—have opted out. A commentary in the New York Post suggests that the right to opt-out should be extended to communities and neighborhoods within cities, say, Central Harlem in NYC if they don’t want pot businesses in their area. It adds that every community board in a city should have the same rights as municipalities in the suburbs to say no to cannabis outlets.

The Daily Briefing 12.23.2021

As drug overdose deaths surge across the country, the AP looks at Native American communities that have been especially hard hit, and now report the highest levels of fatalities. Like elsewhere across the country, the powerful synthetic opioid fentanyl is fueling the rise in deaths, but in Indian tribes, people are also dying from a deadly cocktail of drugs including methamphetamines, with Native Americans 12 times more likely to die from it. For these communities, which have been neglected for years, lack access to good health care, and suffer from high unemployment rates and poverty, overdoses are considered deaths of despair. The national average for health care spending is just over $11,000 per person, but tribal health systems receive only about a third of that and urban Indian groups even less.

Meanwhile, initial data from the nation’s first supervised Injection sites—also known as overdose prevention centers—in New York City show that 2,000 substance users visited the facilities in the first three weeks of operation and that 59 lives had been saved from an overdose. The statement from the New York health department did not say how many individuals had been referred to and entered treatment. Supervised sites and other harm reduction programs are critical to saving lives, but are most effective if they facilitate treatment.

And finally, as the end-of-year deadline nears for municipalities across New York State to opt-out of allowing cannabis businesses within their borders, more and more localities are saying no to marijuana dispensaries and on-site consumption lounges. So far, 10 percent of cities, 28 percent of towns, and 19 percent of villages have notified the Office of Cannabis Management that they added one or both of the restrictions. Dozens more have passed their own rules, such as prohibiting pot storefronts. In some communities, clusters of local governments are barring cannabis businesses, including a large swath of Orange County just north of New York City. If New York follows other legal pot states, a majority of localities will say no; in neighboring New Jersey, which also legalized pot last year, 70 percent have opted out.

The Daily Briefing 12.22.2021

The COVID-19 pandemic and lockdowns caused seismic shifts in behavior, especially in the day-to-day lives of adolescents, including illicit drug consumption.  A new survey reported significant decreases in use among young people across many substances in 2021, including those most commonly used in adolescence—alcohol, marijuana, and vaped nicotine. It's the largest one-year decrease in overall illicit drug use since the Monitoring the Future survey began in 1975. The decrease in vaping for both marijuana and tobacco follows sharp increases in use between 2017 and 2019, which then leveled off in 2020. Contributing factors behind the reduced consumption are likely to include drug availability, family involvement and monitoring, and differences in peer pressure under the long lockdown environment.  

Meanwhile, although New York State legalized recreational marijuana earlier this year, commercial operations are now not likely to start until late 2022 or even in 2023, due to the long lag time between the passage of the legislation and implementation. First, more than 1,500 municipalities have until the end of 2021 to whether to opt-out of allowing cannabis dispensaries and on-site consumption lounges and then the new Cannabis Control Board must overcome bureaucratic delays and issue licenses, of which half must be given to social and economic equity applicants. The law stipulates that 40 percent of tax revenue must go to communities disproportionately harmed by the war on drugs, although other states have had difficulties applying this provision.

And finally, an opinion piece in the New York Times makes a strong case for supporting the proposed Medicaid Re-entry Act, which would make it easier for formerly incarcerated people to get the help they need—including drug treatment—to re-enter society. The article notes that overdose is one of the leading causes of death for this population group, with higher rates within the first two weeks after release. While effective treatment is almost impossible to get behind bars, returning to the community without a support system can be equally difficult, because people suddenly find themselves without the counseling and drugs they need to survive. If enacted, the bill before Congress would significantly help those leaving imprisonment who are the most susceptible to overdose.

The Daily Briefing 12.21.2021

Marijuana legalization in California was supposed to establish a safe, legal, and regulated cannabis market. But according to an investigative report, violent Mexican drug cartels have established a presence in the state, turning Northern California—the state's main growing region—into a “Wild West” of crime and environmental degradation, as well as the main supplier of an illegal black market. The report says that the gangs are responsible for exploiting workers, robbing and shooting adversaries, poisoning wildlife, and poaching water. The cartels have apparently abandoned Mexico, and recognizing America’s push toward legal cannabis—and more liberal attitudes north of the border—have moved their operations to California. Police in the region, which includes Mendocino, Humboldt, and Trinity counties, and is known as the Emerald Triangle, do not have the capacity to stop the violence or crackdown on illegal grow sites. 

Meanwhile, the Mediterranean island nation of Malta has become the first member of the European Union to legalize marijuana, in the latest sign of a more liberal approach to the drug across the 26-member bloc. So far, EU nations have been less reluctant to legalize weed than many states in the U.S. While countries including Portugal, Spain, and the Netherlands have decriminalized pot, the market remains in a grey area in which possession of small amounts of cannabis can still be a civil offense and consumption sites, such as cafes, are tolerated. That may change this year with the new German government saying it wants to decriminalize marijuana and a growing legalization movement in Italy.  

And finally, as Connecticut prepares to implement its marijuana legalization law, an opinion writer in the CT Post warns that the legislation may lead to many more recreational marijuana stores in disproportionately impacted areas where the bulk of the arrests and convictions for pot possession occurred in the last 40 years. That would lead to a ratio of about four times more pot shops per capita for communities of color than for the rest of the state, at a time when we are facing addiction, overdose, and opioid crises. Pointing out the potential risks of marijuana use, the writer wonders what the situation will be 15 years from now when the rate of marijuana use, brain damage, anxiety, paranoia, and suicidal ideation increase as a result.

The Daily Briefing 12.20.2021

San Francisco Mayor London Breed has declared a public health state of emergency in the city’s Tenderloin District, amid a surge of overdose deaths, illicit drug dealing, and homelessness. The mayor said the move would allow the city to quickly implement emergency services, including drug treatment centers and harm reduction measures, adding that drug users would be offered a stark choice: face arrest or enter treatment. Overdose deaths have been surging in San Francisco—as they have across the country—and twice as many people died of an overdose last year than from coronavirus. The Tenderloin has been ground zero for drug dealing, overdoses, and homeless for years, with people now openly peddling fentanyl and methamphetamines, the mayor said. Finally, the government is taking action. 

Meanwhile, opioid litigation involving Purdue Pharma has taken a new turn, with a federal judge ruling that a $4.5 billion settlement reached between the OxyContin-maker and the states is invalid because it shields the firm’s founding Sackler family from future liabilities. This has been a sticking point since the deal was reached, and could now scuttle the settlement altogether. Critics say the family should pay more for its role in fueling the opioid crisis, while the majority of states suing Purdue are ready to accept the settlement instead of pursuing a trial that could take years, at a time when overdose deaths are at record levels. Purdue is appealing the ruling; yet even if the settlement goes ahead, payouts would only take place piecemeal over the next decade. That’s why the federal government must step in now and allocate massive funding for drug prevention and treatment. 

And finally, as the deadline nears in New York State for more than 1,500 municipalities to decide whether to allow cannabis businesses, the tally so far shows that some 400 localities have already said “no” to pot. Under the state’s marijuana legalization law, they must decide if they want to sanction both marijuana dispensaries and on-site consumption lounges within their jurisdictions, or by taking no action, passively accept them. Some towns and villages are taking a wait-and-see approach until they know more about the state’s plans for regulation and control of the drug, as municipalities can change their decisions at a later date. But the relatively large number of localities that are opting out reflects concerns about the impact of pot on young people and drugged driving. In neighboring New Jersey, which is also implementing cannabis reform, more than 70 percent of municipalities have rejected marijuana enterprises, similar to many legal states including California, Oregon, Colorado, and Michigan.

The Daily Briefing 12.16.2021

The Wall Street Journal looks at the rising death toll from fentanyl-laced pills sold on the illegal drug market, concluding that the nation’s illicit drug supply has become more toxic and dangerous than ever before. A record number of fatal overdoses—more than 100,000 fatal overdoses in the 12-month period ending in April—are being fueled by the bootleg fentanyl, which is made mainly by Mexican drug cartels and is now present in all corners of the country. Increasingly, it shows up in fake pills for medications such as oxycodone, which are now harder to obtain, as well as anti-depressants, and are taken by people who believe they are consuming less-potent drugs. Overdoses from a combination of drugs including cocaine and methamphetamines and fentanyl are also on the rise. Users who have no tolerance for opioids often end up ingesting a high dose of potent fentanyl, which kills quickly and cannot be detected. 

Meanwhile, the Biden administration is moving ahead with efforts to expand harm-reduction programs such as supervised syringe sites, publishing a draft model law for states to follow to expand access to these facilities. Noting that the availability of such programs is limited, due mostly to legal issues and outdated legislation, the White House is putting its weight behind harm reduction as a way to reduce overdose deaths. The law says that required components of these laws must directly provide, or offer referrals to, services for substance use disorder treatment. Supervised syringe sites are critical to saving lives, but they are not by themselves the solution to the addiction and overdose crisis. Some studies show that such sites can increase the chances of an individual entering treatment, but the evidence is not conclusive.  

And finally, there’s another good reason not to take up vaping addictive e-cigarettes: a new study finds that healthy men between the ages of 20 and 65 who vaped nicotine were more than twice as likely to report experiencing erectile dysfunction. The association held true even for men without any other health concerns or habits connected to sexual dysfunction. This is concerning, the report pointed out, due to the epidemic of teen vaping in the U.S., as more than 2 million middle- and high school kids say they use e-cigarettes. 

The Daily Briefing 12.15.2021

New data from the CDC finds that counterfeit prescription pills made to look like oxycodone or other painkillers but contaminated with fentanyl are now responsible for two-thirds of all drug overdose deaths across the country, which reached a record 100,000 in the 12-month period ending in April. The report indicates steep increases in counterfeit pills, which surged 33 percent in the Midwest, 54 percent in the South, and 94 percent in the West, in 2019 and 2020. It also shows that four in 10 of the people who died had also used stimulants and just over half had no pulse when first responders found them. In response, the CDC calls for urgent action to slow and reverse overdose deaths involving fentanyl, including harm reduction and expanding access to substance use disorder treatment.  

 Meanwhile, corrections officials in Colorado say fentanyl is flooding the state’s prisons and jails and driving an increase in overdose fatalities. There have been a least three overdose deaths in the past 13 months, as more and more hard-to-detect, fentanyl-laced narcotics show up in state facilities. There have been more drug seizures by guards, but these drugs can be absorbed in paper and mailed to inmates. Officials are calling for the use of drug-sniffing dogs to stop the flow, but it would also be important to expand drug treatment programs for incarcerated individuals. 

And finally, at a time when overdoses are soaring, the arrival of two new, high-dose versions of the overdose reversal drug naloxone would usually be welcomed. But the drugs, recently approved by the FDA in response to the growing presence of powerful fentanyl, are controversial. Some critics say they are unnecessary and could even make matters worse, causing survivors to go into abrupt and dangerous withdrawal. Prescriptions for naloxone have surged in recent years in a bid to increase access, but it’s not clear if the new high-dose versions—up to 12 times as strong as the original—are more effective than the original lower-dose version.

The Daily Briefing 12.14.2021

The Canadian province of British Columbia declared a public health emergency as early as 2016 as drug overdose deaths spiked amid the escalating opioid epidemic. But that, along with supervised injection sites, has done little to stop a new rise in overdose fatalities to the highest levels ever recorded in the province: more than 200 people died from overdoses in October—the most ever in a single month—and the cumulative total of 1,782 is the highest in one year. The spike in deaths is evident across Canada and in the U.S., where more than 100,000 died in the 12-month period ending in April, mostly due to the synthetic opioid fentanyl. Officials in British Columbia are now considering decriminalizing drug possession and using the funds saved from policing to “non-coercive, voluntary policies, programs, and services” for drug users, including housing, social services, education, and health services.”

Meanwhile, the Metropolitan Museum of Art in New York has removed the Sackler name from seven exhibition spaces amid outrage over the family’s ties to opioid manufacturer Purdue Pharma and its role in fueling the opioid crisis. The break between the world’s largest museum and one of the art world’s most generous benefactors came after years of pressure from artists and cultural figures to break with the Sackler family. This may compel other institutions that are wavering over removing the Sackler name—including the National Gallery in London—to do the same. The move is important but largely symbolic, commentators point out, and will not help the families of the victims who became addicted and died or provide them with compensation.

And finally, as the deadline nears for municipalities across New York State to decide whether to opt-out of allowing cannabis businesses, more than 400 towns and villages out of some 1,500 across the state have already said “no.” Under the state’s new marijuana legalization laws, localities have the right to decide whether to permit cannabis dispensaries and on-site consumption lounges, or by taking no actions passively allowing such businesses to operate. With three weeks left to act, relatively few big cities have officially opted out, while more than a quarter of New York’s towns and 31 percent of its villages has chosen to bar cannabis operations. In California, 70 percent of cities ban retail marijuana operations, and in New Jersey, which like New York is implementing legalization, about 70 percent of municipalities entirely opted out, although localities can change course at a later date.

The Daily Briefing 12.9.2021

There are new developments in the sprawling opioid litigation as efforts continue to bring thousands of cases against the industry to a close. In New York, the pharmaceutical manufacturer Allergan agreed to pay $200 million to settle its case just before closing arguments in a months-long trial. This follows multimillion-dollar settlements with other defendants on trial—Johnson & Johnson and pharmacy chain CVS—before and during the trial. Earlier this year, three of the nation's largest drug distributors settled for more than $1 billion as part of an overarching $26 billion nationwide deal to end more than 3,000 lawsuits filed by states, municipalities, and tribes that accused companies up and down the opioid supply chain of fueling a drug crisis that has killed hundreds of thousands of Americans in the last decade.

Meanwhile, another proposed settlement—this one between states and influential opioid maker Purdue Pharma and its founding Sackler family—is still undecided. A final deal hinges on a decision by a federal judge concerning the roughly $10 billion in dividends distributed to the family before Purdue filed for bankruptcy, which triggered the settlement proposal for the drugmaker’s role in the opioid epidemic. Some states say the Sacklers took too much from the company, thereby watering down the $4.5 billion offered to settle the lawsuit, in exchange for broad legal protection against opioid-related lawsuits. Some states involved in prosecuting Purdue and the Sacklers oppose the settlement because it ends their ability to bring civil complaints seeking more money from the family. Settlement money would go toward compensating victims' families as well as for drug prevention, abatement, and treatment programs, at a time when drug overdoses fatalities are soaring across the country.

And finally, as opioid litigation talks drag on, people are dying—with a huge increase in overdose deaths among Black Americans. The rate of opioid overdose deaths for Blacks rose 38 percent from 2018 to 2019, according to a study of hard-hit communities in four states. During this time, there was no change in the number of overdoses among other racial groups. Another study found that Black and white patients have been prescribed opioids at similar rates since the early 2000s. The opioid epidemic first hit the white population in regions such as Appalachia but has now spread more widely across the country.

The Daily Briefing 12.8.2021

As the end-of-year deadline approaches for municipalities across New York State to decide on how to implement marijuana legalization, there is heated debate in town halls about what to do and also many unknowns concerning the new and burgeoning cannabis industry. According to the new legalization law, towns can either opt-out of allowing retail dispensaries and consumption sites or by taking no action, passively accept allowing these businesses. In some cases, local officials are so sure about allowing cannabis that they say the public discussion isn’t even needed. But elsewhere, there is considerable debate about issues such as tax revenue, legal flexibility, and community impact, as is to be expected from such a sweeping legal change.

Some localities are taking the route of a passive referendum, in which a local law is introduced and then brought to a municipality-wide vote for residents to decide. To get many points of view, officials are calling in educational speakers to share information and experiences, including representatives from the cannabis industry and law enforcement. In the Hudson Valley town of Rhinebeck, residents then voted to opt-out.  In Saugerties, another idea has surfaced: to passively opt into allowing cannabis stores and lounges, while at the same time implementing zoning laws to limit where businesses can operate—such as away from schools, churches, and residential areas. Municipalities can also choose a hybrid approach, such as allowing dispensaries but banning consumption sites.  

What happens across New York is being closely watched by other states that are contemplating legalization, which invariably includes the opt-out provision to give local communities more control. While opinion polls routinely find that a majority of Americans favor legalization, they prefer not to have pot stores nearby: an overwhelming majority of towns eventually decide to opt-out, even in such early legal states as Oregon, Washington, and Colorada, as well as in California, the largest cannabis market. The reasons most often cited for barring pot commerce include uncertainty about the impact on young people and concerns about driving while drugged.

The Daily Briefing 12.6.2021

Drug courts have operated in the U.S. for more than 30 years, and have been heralded as an effective way to divert people with addictions away from the criminal justice system. An estimated 150,000 individuals are enrolled in the system at any given time, allowing them to avoid jail time if they begin a regime of drug rehab. Recently, drug courts have been evolving away from punitive approaches, including one run by district court judge Jason Lidyard in northern New Mexico profiled in the Washinton Post. Lidyard accepts that some participants may stumble in recovery and therefore need more support, and not jail time. He won’t impose sanctions for failing a drug test and develops strong relationships with clients. He believes that this more compassionate approach—known as problem-solving courts—is better suited to the realities of addiction and the struggle to get sober.

Meanwhile, an opinion piece in the Boston Globe highlights the need for a massive public health response to the overdose epidemic, which has been overshadowed by COVID-19. Noting that more than 100,000 Americans died of an overdose over the past 12 months ending in April—the highest drug death toll ever—it says that law enforcement and public health officials know how to prevent such fatalities and create better access to treatment. But at the moment, America’s response to the epidemic is flawed and lacks the urgency to save lives, noting that 4 in five individuals with drug disorders do not receive treatment of any kind.

And finally, an investigation by the New York Times reveals that Syria has emerged as a major “narcostate” and is now a leading producer and seller of illegal amphetamines. It says the illicit drug industry, which emerged from the ruins of the decades-long civil war, is run by powerful associates and relatives of President Assad, and has become a multi-billion-dollar operation that stretches across Syria to the rest of the Middle East. The main drug exported is called captagon, an addictive amphetamine that was banned internationally in the late 1980s. Currently, the street value of the drugs seized has outstripped the value of Syria's legal exports with a street value of about $2.9 billion.  

The Daily Briefing 12.2.2021

In a disturbing new development in the addiction and overdose crisis, forensic analysts in Washington, D.C., have identified a new form of synthetic opioid in the city’s illicit drug supply that is even more powerful than fentanyl, which has been driving a spike in fatalities. The new opioids, known as “nitazenes” and found on syringes, are estimated to be at least several times more potent than fentanyl, and therefore pose a dire threat to substance users. The District saw nearly 500 fatal overdoses over the past 12 months, eclipsing the city’s high homicide toll—which reflects a nationwide surge in overdose deaths to a record 100,000 in the 12-month period ending in April, due largely to the growing presence of fentanyl. It’s not clear yet how widespread the new opioids are, and fentanyl remains the number one killer, as it is now found in contaminated counterfeit medications sold by street dealers as well as sprayed on marijuana. Still, the new opioids carry significant risks because they may not be detected by fentanyl testing strips used to determine the presence of the drug, and might require several doses of overdose reversal drugs to be effective to revive a patient. In addition to Washington, the new drugs have already surfaced in the Midwest, the South, as well as on the Eastern Seaboard, officials say.