A new Canadian study looking at marijuana use and hospital visits finds that people who consume pot were 22 percent more likely to visit an emergency department or be hospitalized for an injury, either physical or mental. According to the survey, physical bodily injury was the leading cause of ED visits and hospitalizations among cannabis users, with respiratory reasons coming in a close second, compared to those who didn't consume the drug. Marijuana smokers had higher blood and urine levels of some smoke-related toxins. An earlier report revealed that teenagers were about twice as likely to report wheezing or whistling in the check after vaping marijuana, and other studies link heavy use among teens and young adults with mood disorders, such as depression and bipolar disorder, as well as self-harm, suicide attempts, and death. In addition, habitual users including teens are increasingly showing up in emergency rooms complaining of severe intestinal distress, nausea, as well as severe abdominal pain, and prolonged vomiting. At a time when healthcare systems are stretched to the limit due to the COVID pandemic, cannabis legalization and use are further straining the ability to provide treatment.
CALIFORNIA GIVES THE POT INDUSTRY A BIG TAX BREAK
California’s legal marijuana industry is expected to post $6.4 billion in sales this year, making the state the world’s largest legal pot economy. But despite surging growth over the past five years since weed was legalized, the state just granted growers and retailers a huge tax break after they complained about high costs and competition from the still-vibrant illegal pot market. The new law wiped out about 14 percent of state-level taxes on marijuana cultivation, or about $166 million, in 2021. The aim is to help marijuana businesses as well as the state, which is footing the bill for launching the market and funding costs created by the industry, such as dealing with drugged drivers. The businesses say they need help because of cheap illegal weed that isn’t taxed or screened for possible contamination and claim they face bankruptcy or consolidation without the fiscal stimulus. The tax package also includes $10,000 credits for so-called social equity operators, who were awarded licenses as part of an effort to redress the harm to communities of color that were disproportionately harmed by the war on drugs. Experts say the tax break may also help operators nationwide, who compete not only with illegal weed in their own state but also California pot that’s trafficked across state borders. California earmarks tax revenue for youth and environmental programs but has also discovered that pot profits also go to keep marijuana consumers safe from the ill effects of the drug.
A RENAISSANCE OF PSYCHEDELIC RESEARCH AT THE VA HOLDS PROMISE FOR NEW THERAPIES TO TREAT MENTAL ILLNESS
Psychedelic-assisted therapies at the Department of Veterans Affairs go back to the 1960s, but a political backlash at the time halted further research. Today, with psychedelics going mainstream to possibly treat a host of mental illnesses, the VA is leading studies into drugs such as MDMA or Ecstasy, and psilocybin to treat conditions that have been resistant to current therapies for many veterans, including PTSD. One study uses MDMA to explore the underlying roots of the distress caused by PTSD through traumatic memories. Another study looks at the potential of using psilocybin—the psychoactive ingredient in magic mushrooms—as a therapy for methamphetamine addiction, which is a leading cause of overdose deaths among vets. Reliable treatment options for meth addiction are scarce and there is a high rate of relapse, which is why psilocybin is emerging as an experimental treatment for substance abuse. The VA's research into powerful psychedelic drugs is critical to establish their potential to treat certain mental conditions and to identify possible dangers in order to establish critical guidelines for clinical use— both in the VA and among the general population.
FDA REVERSES COURSE ON JUUL E-CIGARETTES—AND NOBODY REALLY KNOWS WHY
Earlier this month, the Food and Drug Administration took a surprising step by banning the sale of all products made by Juul, once the vaping market leader, saying that the agency had cause for concern about caustic chemicals in its e-cigarettes. The industry had been waiting for an FDA decision on Juul based on the purported addictiveness of e-cigarettes, and its marketing tactics, particularly directed at teens. Now, the FDA has reversed course on the Juul ban, noting that the company’s application to sell vaping products requires a second look due to “scientific issues” and that there are, in fact, more Juul documents to review. It’s not unusual for the FDA to do this, but the flip-flop with such a high-profile company that has been routinely chastised by lawmakers, anti-tobacco advocates, and the press for its role in fueling the underage nicotine epidemic is embarrassing. At a time when teens as young as middle school students are vaping both nicotine and marijuana in record numbers, the FDA should be acting responsibly to assess e-cigarettes and their potential health impacts. It has also given the vaping industry hope that thousands of other vaping products under FDA review will find favor and soon be back on store shelves. The FDA needs to get its act together, assess the science, take a firm stand on e-cigarettes, and decide on tough regulations that protect vulnerable populations from these highly addictive products.
NEW CANNABIS PRODUCT IS MAKING USERS SICK—AND WORRYING PUBLIC HEALTH OFFICIALST
A new cannabis product called delta-8 is growing in popularity—but also worrying public health experts who say it is potentially dangerous and has already resulted in thousands of accidental poisonings. The drug is also known as delta-8 THC, designating the psychoactive component of marijuana, but is derived from the hemp plant rather than the marijuana plant that produces delta-9 THC. Delta-8’s rise started with the legalization of hemp growing in 2018 and grew once users spread the word that it produces less of a high than its delta-9 cousin and with fewer of the distressing side effects that occur when you get too high such as feeling paranoid and anxious. Delta-8 is also legal in states where cannabis is not, and does not fall under federal regulations outlawing marijuana is delta-9. Yet like so many new and untested cannabis products in the booming market for the drug, experts say delta-8 is unregulated and therefore potentially risky, with studies showing that it can contain contaminants including heavy metals such as lead and mercury, depending on who is producing and selling it. The CDC has issued a health advisory about delta-8, as has the FDA, after receiving more than 100 reports of adverse events including hallucinations, vomiting, tremor, anxiety, dizziness, confusion, and loss of consciousness. In addition, poison control centers handled more than 2,000 calls about delta-8 between 2021 and 2022, many concerning children. Facing a lack of federal regulation, 14 states have banned delta-8—including several states where recreational cannabis is legal, including Colorado and New York. Experts recommend not using delta-8 because there is no way to ensure its safety, and we urge all legal pot states to also ban its sale.
The Daily Briefing 07.05.2022
More than 1,700 people died last year in Los Angeles County from an overdose involving methamphetamines, prompting the state to start a research program offering a reward—in this case, a $10 or $20 Target gift card—to encourage addicts to enter drug treatment. It’s a simple idea: giving individuals rewards, week by week, to get them to do difficult things, and there’s strong evidence suggesting that it can work with drug addicts. Such “contingency management” programs use the rewards system in the brain to nudge people away from drug use. Yet across the country, there are laws against paying patients under federal health programs, inhibiting wider use of such systems. Studies show that it can be highly effective, especially for meth, for which there are no FDA-approved medications. While there are some federal exceptions to drug programs, there are also philosophical objections to providing rewards for abstinence to those who have chosen to misuse or abuse drugs. Last year Governor Newsome vetoed a bill that would have placed incentive programs under Medi-Cal, saying he wanted a pilot program first. That will launch soon with state reimbursement, allowing people to earn up to $600 in gift cards to stay off meth and other stimulants. One question is whether the positive results have staying power or eventually wear off, with one study finding that 22 percent of patients in incentive programs were more likely to remain abstinent than people who received other treatments. Scientific data suggests that such programs provide an intervention that is worthy of continued investment and study.
OVERDOSE DEATHS SWEEP THROUGH AMERICAS PRISONS AND JAILS
As the opioid crisis ravages America, driving the overdose rate last year to a record 108,000, we are also experiencing an even more considerable increase in overdose fatalities in the country’s prisons and jails. Between 2009 and 2109, overdose deaths in those facilities rose fivefold compared to the national rate has tripled in the same period. One problem is the lack of drug treatment and mental health services for the incarcerated, where drugs use is rampant. For decades, drug use in the U.S. has been mainly addressed through the penal system, with 1 in 5 people behind bars for a drug offense instead of being treated in community-based facilities. There are solutions: California, for example, reported a 60 percent reduction in overdose deaths in its prisons in 2020 after the state started a substance use treatment program and the widespread availability of medication-assisted therapy. Pilot programs are also running in other states, including in New York jails, to divert drug users before they are incarcerated. Yet today, prisons are still the largest mental health and substance abuse treatment facilities in the country. This problem must be addressed on the federal level to reduce overdose deaths and help inmates lead drug-free lives once they re-enter society.
NEW DOCUMENTS REVEAL THE FULL EXTENT OF MCKINSEY’S INVOLVEMENT IN THE OPIOID EPIDEMICE
Much has already been disclosed about how global consulting firm McKinsey helped Purdue Pharma turbocharge sales of its prescription opioid OxyContin, making the company a leading supplier and marketer of the highly addictive drug. Now, new documents that were part of a repository from the nationwide opioid lawsuits have revealed the full extent of McKinsey’s involvement with opioid makers. According to a New York Timesanalysis of more than 100,000 documents, MckInsey not only advised Purdue but also other opioid makers including Endo, Mallinckrodt, and Johnson & Johnson. As more and more Americans were dying of an opioid misuse-related overdose, McKinsey was trading on its reputation and connections to help the companies flood the market with ever-more opioids, fueling an epidemic that has claimed the lives of more than half a million Americans. The documents show that McKinsey vetted deals, advised on corporate strategy and aggressive sales tactics, and helped secure approval for new, and more powerful products. It also devised ways to persuade doctors to prescribe more opioids, even if they were reluctant to do so due to concerns about addiction. As the lawsuits progressed and more documents appeared, McKinsey eventually acknowledged its role in the crisis, apologized for the “terrible consequences” of its actions, and agreed to a $600 million settlement—but did not admit any wrongdoing.
WE HAVE THE TOOLS TO FIGHT ADDICTION, SO WHY ARE MORE AMERICANS DYING OF OVERDOSE THAN EVER?E
This commentary in the New York Times makes a compelling case for treating drug addiction and mental health conditions as co-occuring disorders. While science has made it clear that addiction is a legitimate medical condition that is often triggered or exacerbated by mental illness or social forces such as poverty, the systems by which we treat this disorder have yet to shift accordingly. Today, too many systems treat people who suffer from both mental health and substance use disorders as the exception, whereas it is in fact the rule, making up more than half of all people who seek treatment for one disorder or the other. Addiction professionals suggest restructuring the treatment system with these people in mind, yet practical hurdles have made this difficult to put into practice. Clinicians accustomed to treating one are not necessarily compatible with the order, for example. Now, efforts are underway to fix addiction care in it entirely—from how agencies are structured to how clinicians treat patients, to what kids are taught in school. Many families, once silent due to shame and stigma, are also speaking out about the need for integrated care, and perhaps merging state agencies in New York that deal with mental health and substance use.
The Daily Briefing 06.28.2022
Amid historic decisions concerning abortion and gun control, the Supreme Court also weighed in on the opioid epidemic—in a case concerning two doctors who had been convicted of running pill mills that fueled the staggering increase in overdose deaths over the past decade. The doctors were convicted of unlawful drug distribution under the Controlled Substances Act, including a clinic in Alabama that issued nearly 300,000 prescriptions for controlled substances in a little more than four years—making it one of the nation’s leading sources of prescriptions for deadly fentanyl-based drugs. The other doctor was accused of writing prescriptions for payments that roughly tracked the street prices of the drugs, and accepted payment in cash and firearms. The judges, ruling unanimously, differed however in interpreting a phrase in the regulation act, noting that a doctor had to show intent that they were acting in an unauthorized manner. Some analysts argued that the ruling did not let the pill mill doctors off the hook, but may make further prosecutions of prescribers more difficult. The case, which now goes back to the appeals court, highlights the role played by doctors in dispensing legal prescription drugs that have led to an epidemic that last year claimed more than 108,000 lives from a drug overdose.
FDA BANS E-CIGARETTE MAKER JUUL OVER TOXIC CHEMICAL CONCERNS—NOT YOUTH MARKETING
E-cigarette maker Juul was a pioneer in the market, launching its once-dominant alternative smoking devices as the vaping industry boomed. But since then it has been under attack from tobacco-control groups and the Food and Drug Administration for its marketed tactics that allegedly target underage consumers, at a time when vaping among young people—of both tobacco and marijuana—has skyrocketed. Now, the FDA has taken the unusual step of banning the sale of all Juul products in the U.S.—not over its historic appeal to youth but due to concerns that toxic chemicals might be seeping out of the company’s e-liquid pods, which store nicotine-containing juice before it is heated into vapor. Juul denies the claim and is appealing the ruling. The FDA has been reviewing e-cigarette products on the market following complaints about targeting young people and the addictiveness of e-cigarettes. Vaping’s popularity among youth over the past few years has waned, and the once-popular Juul has also been dethroned as the preferred brand for young vapers as other competitors, such as the also-controversial puff bar, have entered the market.
ADDICTION, PSYCHOSIS, CHRONIC VOMITING—HIGHLY POTENT LEGAL POT SICKENS TEENS
As New York State gears up to open its legal marijuana market, the New York Times has published a comprehensive study of how high THC levels in today’s cannabis products are making some teenagers dangerously ill—from psychosis, addiction, and chronic vomiting. The Times, which usually runs lighthearted weed stories in its Style section, explores the growing evidence that pot isn’t as benign as many of its advocates routinely proclaim. While marijuana is not as dangerous or life threatening as opioids, the paper says, it is potentially harmful for young people, whose brains are still developing, and has also led to an increase in cases of cannabis addiction, uncontrollable vomiting, and psychotic episodes that could eventually lead to lifelong psychatric disorders iincluding depression and suicidal ideation. Despite these risks, new legal pot markets in the U.S. remain largely unregulated, with dispensaries free to sell cannabis products such as oils and edibles that have high levels of THC—the psychoactive component of marijuana—that in some cases exceed 95 percent, up from about 4 percent in 1995. Although cannabis is now legal in 19 states and Washington, D.C., only Vermont and Connecticut ban concentrates above 60 percent and do not permit plant material to exceed 30 percent. One particular concern is that many of these dangerously high levels of pot are consumed in e-cigarettes by young people, with the number of kids who reported vaping marijuana rising among all grades between 2017 and 2019 and nearly tripled among high school seniors. In California, which legalized marijuana nearly five years ago without a word about health dangers, doctors and lawmakers are now considering mental health warning labels on cannabis products, specifying that the drug may contribute to psychotic disorders—a model that should be made mandatory on a national level in all legal states.
AS COVID REGULATIONS EXPIRE, PATIENTS WITH OPIOID USE DISORDER COULD LOSE ACCESS TO VIRTUAL CARE
Federal regulations that allowed virtual or telehealth care during COVID-19 for opioid addiction are likely to end soon, raising questions about how people struggling with substance abuse can continue to receive medications and services online. The rules allowed practitioners to prescribe life-saving medications—such as the withdrawal drug buprenorphine—without in-person visits that are normally required to get a prescription. Patients could seek care through their phones, computers, or tablets, which are faster, easier, and more private than going to a doctor’s office or clinic. But these regulations are set to expire as early as October. Public health officials fear therefore they may lose one of the most valuable tools to fight addiction—at a time when overdoses are soaring to record levels and such services are needed more than ever. The Drug Enforcement Agency is clamping down on access to buprenorphine due to misuse, although the drug is a critical component of medication-assisted drug treatment (MAT). Only about 10 percent of individuals with opioid use disorder receive MAT, due in part to barriers to access and the scarcity of doctors who can prescribe it. Although telehealth is not a panacea for the addiction and overdose crisis, the availability of such options during COVID was a positive experience, providers, and patients say, and offers a unique opportunity to expand services to those in need, especially in rural areas where services are hard to find and get to. While companies providing solely telehealth for addiction have expanded since COVID, so too has the number of traditional in-person treatment providers who offer both types—a model that has proven critical to expanding access to services.
CALIFORNIA MAY CRACK DOWN ON THE CANNABIS INDUSTRY TO PROTECT PUBLIC HEALTH
Nearly five years after California legalized marijuana, a growing number of doctors and lawmakers are urging cannabis producers to warn consumers of the health risks associated with the drug, as part of proposed new rules to curb the commercial excesses of the market. They also want them to distribute health brochures to first-time customers outlining the risks cannabis poses to youth, drivers, and those who are pregnant—especially pot with high levels of THC, the psychoactive element of marijuana. More and more scientific studies point to an increased risk of developing psychiatric disorders, including schizophrenia, with such high-potency marijuana, compared with those who have never used it. Since legalization in California, emergency room visits for cannabis-induced psychosis rose 54 percent across the state, part of the reason why new rules would crack down on the commercialization and marketing of cannabis, along with adding caps on THC levels. The proposed rules are modeled after Canada, with rotating health warnings about risks to mental health, kids and teens, as well as brain development, and to those who are pregnant and breastfeeding. The pot industry, of course, considers such warnings “excessive” and expensive and says it would put "undue burdens" on marijuana businesses—all at the expense of ensuring public health. While California and other states should have considered the health implications of legalizing pot before legalizing and launching the new market, they can now take action to protect its most vulnerable populations.
CALIFORNIA CREATES MODEL PROGRAM FOR DRUG TREATMENT IN PRISONS
“California is leading the way in expanding drug addiction services in prisons, using a model program of medication-assisted treatment that has reduced overdose deaths by 60 percent—a remarkable achievement that should be replicated across the country.”
HARM REDUCTION PROGRAMS, EMBRACED BY THE BIDEN ADMINISTRATION, FACE FIERCE OPPOSITION ON THE GROUND
The Biden administration has embraced harm reductionas a critical component of its drug control strategy—the first time the federal government has supported such measures to curb drug overdoses, now at a record 107,000 per year. But the plan, which includes a $30 million grant, faces fierce local opposition and legal obstacles. Harm reduction programs operate on the fringes of legality and often with scant budgets, a maze of conflicting local and state laws, and hostile law enforcement. Many states have legalized aspects of harm reduction, but fentanyl test strips, which can detect the presence of the deadly synthetic opioid, are illegal in about half of states, as they are considered “drug paraphernalia” under arcane laws. Seven states don’t have any programs offering people clean needles, which prevents the spread of infectious diseases. And New York is the only city operating safe injection sites, where individuals can use drugs under the supervision of medical personnel. Harm reduction also faces backlash in progressive cities and states, where some residents believe they foster and encourage drug use. While harm reduction advocates understand that such programs won’t on their own stop overdose deaths, they recognize that they will save lives and hopefully allow the user to enter treatment. Such programs must therefore include incentives and a pathway to treatment in order to change lives.
For Gen Z, marijuana is the drug of choice—even though studies show health issues among young people
A new study shows a promising future for cannabis companies targeting Gen Z—the generation aged 18 to 24—who overwhelmingly prefer marijuana to alcohol. This young, digital native cohort is of particular interest to marketers, as they are heavily influenced by social media and are already reshaping everything from shopping to how society unwinds. They are also coming of age and entering the market with around $360 billion in disposable income, and at a time when more and more states are legalizing weed, while the cannabis industry is ramping up marketing efforts to reach them. For example, beer companies are launching products with THC, the psychoactive component of marijuana. Gen Z’s preference for weed is a shift, the study said, noting that between 2002 and 2008 this age group thought smoking cannabis once or twice a week was riskier than having five drinks; now, that perception has flipped in favor of cannabis, as young people use it for relaxation, sleep, emotional release, and fun. Still, the report stressed the dangers of marijuana, noting that young brains, which are still in a critical developmental phase until around age 25, are particularly vulnerable. The National Institute of Health warns that cannabis is linked to a high risk of schizophrenia, other severe mental illnesses, and cannabis use disorder.
Enrollment in medical cannabis programs soars despite a lack of evidence of effectiveness
A new study finds that enrollment in medical cannabis programs rose nearly five-fold between 2016 and 2020, as more and more states legalized the drug’s use for a range of different health problems. Researchers said that enrollment was clustered in states with medical-only cannabis reform, while it is flatlining or declining in states with legal recreational marijuana. This is mostly due to the fact that medical marijuana requires a visit to a doctor and a processing fee, thereby driving up costs, while buying recreational marijuana only requires proper identification and age verification. The study identified chronic pain as the most commonly listed condition on medical license applications, followed by PTSD, although another study showed that there’s scant scientific evidence showing that marijuana is effective for treating chronic pain. Chronic pain patients also happen to be targeted with cannabis ads. In addition, the study found that the proportion of medical cannabis patients listing conditions not supported by substantial evidence increased between 2016 and 2020, indicating that more studies must be done in order to determine whether medical marijuana is safe and effective. And it also suggests that we need more oversight and regulation of medical marijuana advertising to crack down on false claims and scams.
The Daily Briefing 06.13.2022
As more and more states rush to legalize medical marijuana, a new study finds scant evidence to support widespread claims that cannabis can be effectively used to treat chronic pain—one of the many conditions for which it is approved and used. In fact, evidence to support such claims is surprisingly thin, according to an analysis of existing studies by Oregon Health & Science University. Although there was short-term benefit from an FDA-approved synthetic marijuana product for pain—along with notable side effects such as dizziness—a study concluded that there’s very little scientifically valid research into most of these products in states that allow medical cannabis, and such studies were not designed to answer important questions about patients with chronic pain. The authors found that there are only sparse and imprecise estimates about the effect of the products, and many of the studies had methodological limitations. Of some 3,000 studies in the scientific literature, only 25 had sufficient scientifically valid evidence, including 18 randomized control studies. Before states legalize medical marijuana for a multitude of conditions, it would be prudent to consult such studies in order to establish if such products actually work, so we can safeguard patient health and safety.
The Daily Briefing 06.08.2022
More people died in San Francisco last year from fentanyl overdoses than COVID-19, a fact that fueled the historic recall election of the city’s District Attorney Chesa Boudin. While he was blamed for rising crime rates in the city, what angered many voters most was the staggering number of overdoses, drug dealing, and an open-air tent city that became a marketplace for fentanyl, the powerful synthetic opioid that is driving overdose deaths across the country. Boudin’s approach was to avoid prosecuting low-level drug possession while trying to divert substance abusers to treatment, but the drug dealing inextricably led to a surge in other crimes such as theft, property break-ins, and carjackings. Just three people were convicted for possession with intent to sell in 2021—for meth, heroin, and cocaine. Boudin says his office pursued diversion programs for drug users or agreed to lesser charges in many cases, but it’s not clear how many individuals eventually entered treatment. The tent city near City Hall, which offered food, medical care, and counseling paid for by taxpayers, reflected the idea that drug users should be free to make their own medical decisions. And then fentanyl came along and changed everything. The recall comes as many cities and states are considering decriminalizing low-level drug possession, and focusing instead on engaging with users so they enter treatment. But as seen in San Francisco, this is a complex and vexing problem for those struggling with substance abuse as well as the government and communities, who must get the balance right between maintaining safe streets and putting in place systems to curb drug dealing and provide a pathway to treatment.