President Biden came into office with moderate views on marijuana reform, backing the decriminalization of the drug and allowing states to go their own way while not endorsing any broad, federal-level changes. With the midterm elections looming, many liberals in Congress now aim to push the present into a more progressive position, believing that the issue would be popular with voters and advance the cause of criminal justice reform. Supporters are also encouraged by recent legislative victories, although they believe Biden could enact cannabis reform on the federal level through executive action (although it is usually done through Congress, where there is little consensus on legalization). Some Democratic candidates are already becoming more vocal about the cannabis reform, urging the president to remove the drug from the list of controlled substances and pardon those convicted of nonviolent marijuana-related crimes. Currently, 19 states have legalized recreational weed and 36 allow medical cannabis, without any intervention from federal authorities. Polls regularly show that a majority of Americans favor marijuana legalization, while at the same time a majority of communities in many legal states have opted out of allowing retail sales.
DRUG TESTING STRIPS CAN SAVE LIVES AND REDUCE OVERDOSES—BUT MANY STATES BAN USING THEM
The ultra-potent synthetic opioid fentanyl is fueling the unprecedented surge in overdose deaths to record numbers—yet a straightforward way to save lives using drug-testing strips is banned in more than a dozen states, depriving healthcare workers of a valuable tool to reduce fatalities. Testing illicit drugs for toxins can help those struggling with opioid use disorder avoid such substances. But test strips are illegal in more than a dozen states, including Florida and Texas, because they are classified as drug paraphernalia, making it a crime to possess or distribute them. These states contend that testing strips only facilitate drug use, while advocates argue that the ban on test strips only aggravates the crisis and further marginalizes drug users. Health officials say this misses an obvious reality: for millions of Americans, quitting cold turkey is simply not an option, and further, every possible tool should be made available—including testing strips—that can detect the presence of deadly fentanyl in heroin, methamphetamines, cocaine, and other drugs. This is especially important as the drug floods into the country, mostly from Mexico, and often in the form of counterfeit prescription pills. Test strips remain illegal in 19 states, many in the South, due to bills passed there in the 1970s at the urging of the DEA, which criminalized drug paraphernalia. The government must take action to not only legalize testing strips as part of harm reduction strategies but also to invest in new technologies that can identify and detect more precisely how much fentanyl is present and the level of danger it poses.
JUUL SETTLES LAWSUITS FOR $438.5 MILLION AND AGREES TO YOUTH MARKETING RESTRICTIONS
E-cigarette maker Juul Labs once ruled the vaping market in the U.S., with its sleek device and hip marketing aimed at young people that made it the leading brand in the sector. Now the company, fighting for its survival in a crowded marketplace, has agreed to pay $438.5 million to settle lawsuits from more than three dozen states alleging that its marketing and sales practices set off a teenage vaping epidemic. The deal, in which Juul did not acknowledge any wrongdoing, allows the company to continue to sell its products with certain restrictions, such as marketing to youth, funding education in schools, and misrepresenting the level of nicotine in its products. Juul has already stopped many of these practices, including selling flavored products that especially appeal to young people, after it came under public pressure to do so as the rate of teen vaping—even among middle school students—surged. The investigation found that previous practices, such as hiring young models and using social media to court teens, succeeded in attracting them to highly addictive e-cigarettes. Going forward, the company says it is focusing on its original mission—transitioning adult tobacco smokers to e-cigarettes. The FDA is also investigating Juul’s products and marketing, as part of its application for permanent sales. Meanwhile, the battle for youth vapers goes on, with new brands such as Vuse and Puff Bar becoming the most popular with young people and market leaders, and Juul is far behind. These companies use a new component—synthetic nicotine—in their products to evade FDA regulations. The FDA has been slow to provide adequate oversight for this industry, thereby allowing more and more young people to take up e-cigarettes and endanger their health as vaping companies continue to target the teen market.
THE USE OF MARIJUANA AND PSYCHEDELICS SOARS AMONG YOUNG PEOPLE
The latest annual U.S. survey of substance use reports a number of worrying trends, including the growing use of marijuana and psychedelics among young people, as well as an increase in nicotine vaping and consumption of alcoholic drinks with high levels of THC, the psychoactive ingredient in cannabis. The survey notes that after a lull during the pandemic, more and more young people ages 19 to 30 are engaging in risky behavior with substances. For example, 43 percent of young people in this group used marijuana in the past 12 months, up from 34 percent in 2016, while daily consumption almost doubled to nearly 11 percent—a steep rise that parallels the ongoing legalization of recreational cannabis in states, which now number 19. Similarly, young people are dabbling in psychedelics, with 8 percent—a record high—saying they used such powerful drugs compared with 3 percent in 2011. This reflects increasing media coverage and social media chatter about the potential therapeutic values of hallucinogens such as psilocybin mushrooms and ecstasy, as well as moves by cities and states to legalize the consumption of psychedelics. At the same time, high levels of THC of up to 90 percent in vaping products have contributed to a spike in marijuana-related health problems, such as cannabis use disorder and a condition that causes recurrent vomiting. The findings are troubling, as the powerful marijuana industry continues to say that pot is relatively benign, while proponents of psychedelics downplay their potential for causing long-lasting harm. To protect consumers—especially young people—we need strong rules and regulations to govern the use of such drugs that are becoming mainstream without adequate safeguards and protections.
THAILAND'S RUSH TO DECRIMINALIZE MARIJUANA IS A CAUTIONARY TALE
Thailand became the first Asian country to decriminalize marijuana, an unusual step in a region known for harsh drug laws and punishment for drug trafficking, including the death penalty in Singapore. The government said the goal was to jumpstart the country’s participation in the multibillion-dollar medical-cannabis industry and give people more freedom to make healthcare decisions. But the legislature failed to establish market rules and regulations, giving entrepreneurs a green light to sell a wide range of products, from cannabis-infused cocktails and curries to exotic strains with a wide range of supposed benefits—relaxation, sexual arousal, energy boosting, and boosting creativity. While lawmakers have since rushed to issue directives to limit sales to pregnant women and anyone under 20, as well as smoking in public, the takeaway for consumers was that recreational use was now legal. Meanwhile, cannabis sellers are thriving in the chaotic situation, in which a doctor’s note is not required—unlike medical cannabis markets in the U.S.—and products are promoted without any scientific backing or warnings. As more U.S. states legalize weed, the situation in Thailand is a cautionary tale of what governments must do to protect public health before they establish a cannabis market.
LARGE PHARMACY RETAIL CHAINS ORDERED TO PAY $650.5 MILLION IN OHIO OPIOID CASES
Settlements continue to be reached in nationwide opioid litigation, with the latest agreement by the country’s largest pharmacy chains—CVS, Walgreens, and Walmart—to pay $650.5 million in damages for their role in the deadly opioid epidemic. It’s the first such ruling by a federal judge, following a jury trial and verdict that found the companies responsible for dispensing mass quantities of prescription painkillers over the years while ignoring flagrant warning signs that the pills were being abused. The latest deal—concerning two Ohio counties badly hit by the opioid epidemic—follows settlements with opioid manufacturers, including Purdue Pharma, and drug distributors, all part of thousands of cases brought by states, local governments, and Native American tribes to hold the opioid industry accountable for the deaths of more than one million Americans over the past two decades. The money will be paid out in installments over 15 years, which will supply a steady stream of funding to governments coping with the aftermath of the crisis, and for increasing drug treatment and prevention programs. For its part, Walgreens is facing another potentially large settlement in a San Francisco case, where a judge has already ruled the company is responsible for “looking the other way” as opioid abuse increased.
DON’T FORGET ABOUT METH IN THE RURAL OVERDOSE EPIDEMIC
The powerful synthetic opioid fentanyl is driving overdose deaths nationwide to record numbers, with more than 108,000 fatalities last year. But a new study reveals that this overshadows another epidemic playing out in rural America: the use of methamphetamines, often contaminated with fentanyl. The study found that nearly four of five people taking drugs in rural areas across 10 states used meth in the past 30 days. While using meth and opioids together was associated with greater odds of nonfatal overdose than using opioids or meth alone, participants with combined use reported greater difficulty accessing treatment, and those using meth alone rarely obtained overdose reversal medications. Equally important, combined opioid and meth use was more common among those who reported homelessness and binge drinking, as part of multiple substance use disorders. Compounding the problem is the lack of opioid use disorder treatment availability in rural areas along with programs that treat polysubstance use. There is an urgent need for interventions that address both opioids and methamphetamines and are tailored to the specific needs of rural communities.
CALIFORNIA CONSIDERS OPENING SAFE DRUG CONSUMPTION SITES
Governor Gavin Newsom of California has been a progressive advocate for marijuana legalization in his state, but he is said to be on the fence about another drug-related issue: whether to allow three pilot projects to go ahead that would establish safe consumption sites for addicts. The sites—in Los Angels, San Francisco, and Oakland—would allow users to shoot up in a safe setting, with drug testing available, and medical personnel to help if they overdose. Such sites are illegal on the federal level, but New York City opened two such facilities last year without any of the legal problems that have dogged safe sites in the past. More than 10,000 people died in California last year from a drug overdose, and there is a desperate need for resources to reduce fatalities. Safe sites are considered the centerpiece of harm reduction strategy and can save lives. But they often fail to change lives—like the facilities in New York—because they are not specifically designed as a pathway to treatment. They offer information to patients but do not encourage them or provide incentives to enter treatment, which means the sites become a virtual revolving door for drug use. Republicans in California want Newsom to veto the bill, exaggeratingly calling safe sites “drug dens,” and saying the state should instead expand substance abuse programs for all who need them. Why not do both? Safe sites save lives, but it would be even more compassionate for the facilities to also provide a gateway to life-changing treatment.
SF JUDGE RULES THAT WALGREENS CONTRIBUTED TO THE CITY'S OPIOID EPIDEMIC
A judge in San Francisco has ruled that retail pharmacy chain Walgreens is liable for helping fuel the opioid epidemic in the city, opening the way for a settlement with the company as nationwide opioid litigation heads to a conclusion. The judge said that Walgreens shipped and distributed addictive drugs without proper due diligence, and did not stop suspicious orders for prescription drugs that were later diverted for illicit use. The company was responsible for shipping 1 out of every 5 pills nationwide and was included in lawsuits that also aimed to hold manufacturers and drug distributors responsible for the current epidemic, which killed more than 108,000 Americans last year. Thousands of other lawsuits by states, cities, counties, and tribes remain to be resolved. Unlike other litigants—including drug manufacturers and drug distributors—who have settled, Walgreens has not reached a national settlement, while it did agree to pay $683 million to the state of Florida, to settle those claims. The San Francisco bench trial verdict—a separate trial will be held to determine damages therefore has national significance and could impact other outstanding lawsuits. Opioid overdoses have skyrocketed in San Francisco, with a nearly 480 percent increase in fatalities between 2015 and 2020.
NEW STUDY LINKS YOUTH VAPING TO MARIJUANA USE
Vaping remains a nationwide epidemic among young people, with 1 in 9 high school students saying that had vaped in the past year, according to the CDC. And increasingly, those kids are also vaping cannabis cartridges in their e-cigarettes. A new study confirms this “gateway” theory, finding that adolescents who use e-cigarettes are over three times more likely to use cannabis than those who don’t—and also that more than 1 in 10 youths who say they have never used cannabis go on to do so within a year. The research, published in JAMA Open Network, and focusing on the years 2017 to 2019, revealed that those who said they had used e-cigarettes were far more likely to move on to cannabis. Looking at sociological factors, youths who vape could be more likely to be friends with those who engage in risky behaviors, and as vaping devices can be sued for both tobacco and marijuana could account for the association. As more and more states legalize cannabis, and the FDA has been slow to regulate vaping products, we need to be more aware of the dangers posed by these products and educate young people accordingly.
DEADLY FENTANYL IS NOW THE DRUG OF CHOICE FOR MANY USERS
The synthetic opioid fentanyl is a killer—more powerful than heroin—and a drug that, until recently, those with substance use disorder tried to avoid as it was increasingly found in illicit drugs that dealers contaminated, leading to a staggering rise in overdose fatalities. Now, however, users are seeking out this once hidden killer and intentionally using it to get high. Many experts say users have become so tolerant of drugs like heroin that they are turning to fentanyl, a worrying trend that could lead to even more deaths. In medical settings, fentanyl is used to treat severe pain in patients, but a decade ago fentanyl made its way into the illicit drug supply, and also as counterfeit versions of prescription drugs such as cocaine and marijuana, and prescription drugs like oxycontin. By 2021, fentanyl was involved in the vast majority of overdose deaths. Today, users are even smoking fentanyl, which some say could become the norm and eventually increase use. While a fentanyl-related overdose can be reversed with overdose reversal medications, the high potency of the drug means that more medication is needed, but isn’t always on hand. This new development in the ongoing opioid epidemic points once again to the need for federal leadership and action to address every aspect of the crisis—sooner, rather than later.
RUSSIAN ARREST OF BASKETBALL STAR PROMPTS RENEWED DEBATE ABOUT POT AND PAIN
The arrest of W.N.B.A. star Brittney Griner in Russia after customs officials found vape cartridges with hashish oil she was carrying has caused a diplomatic dust-up—and also prompted debate over whether cannabis is effective for relieving sports injury-related pain, especially in elite athletes. Griner says she was authorized to use medical cannabis in Arizona, and like a growing number of professional athletes, who say they use the drug for pain management. As more and more states legalize weed, professional organizations such as the NFL and the NBA have eased their rules on marijuana use and testing. Nobody should be imprisoned for using pot—anywhere—but the evidence is still out whether cannabis does in fact relieve pain, as the marijuana industry often claims. Most of what we know so far is anecdotal, and research has yet to support or refute any of these personal observations. What’s certain though is that marijuana use poses risks, including harming adolescent brain development, causing cannabis use disorder and respiratory problems, and most worrying for elite athletes—a decrease in athletic performance. Much more research is needed to determine whether cannabis can be useful in pain management, and the best ways to administer the drug safely and effectively.
WHAT IF WE TOOK THE MAGIC OUT OF MAGIC MUSHROOMS?
New studies find that psychedelic drugs like magic mushrooms, psilocybin, and LSD may be useful to treat mental health conditions such as depression, anxiety, and PTSD. Research is continuing by government organizations and pharmaceutical companies and startups, hoping to gather enough evidence to support FDA approval and more widespread clinical applications. But even if the drugs are sanctioned, they will likely be used only by a select few, as treatments are expected to be expensive and both physically and emotionally taxing, involving full-day, intensive trips, and not recommended for those with a history of schizophrenia or underlying psychosis. But, many in the field are wondering, what if we could harness the potential healing powers of such drugs but without the hallucinations? Now, scientists are working to develop molecules based on psychedelics that provide the therapeutic benefits but without the trip experience. This is based on the idea that what gives the psychedelics their healing benefit is not the trip itself but the effect on the brain, which may have anti-depressant properties. Some are skeptical of this hypothesis, but others argue that the pursuit of an answer to how psychedelics treat depression brings us a step closer to understanding not only how to relieve the symptoms of mental illness, but also potentially how to remove them.
BIDEN'S DRUG CZAR BACKS SHIFT TO HARM REDUCTION DRUG CONTROL STRATEGY
President Biden’s “drug czar,” Dr. Rahul Gupta, appears to support a radical shift in U.S. drug control policy toward harm reduction, a controversial approach that many believe is needed as the nation deals with surging rates of drug addiction and overdose. In an interview with the New York Times, Dr. Gupta, the first medical doctor to be drug czar, voiced guarded support for the administration’s apparent acceptance of harm reduction as a a major component of drug strategy, which would include safe consumption where users can inject drugs in a supervised setting. Two such sites, the country’s first, opened last year in New York City, and the Justice Department is currently weighing whether others could operate, in what would be a major shift in direction. Harm reduction is focused not on helping users achieve abstinence but on lowering the risk of them dying or acquiring infectious diseases, by distributing sterile syringes and fentanyl testing strips, and making overdose reversal medications widely available. Dr. Gupta has talked up harm reduction, the article notes and has encouraged city and state health departments to start syringe exchange programs. While harm reduction will undoubtedly save lives, to actually change lives it must also function as a bridge to drug treatment, and not simply as a revolving door for drug use.
VA STUDY SUGGESTS ADVANTAGES OF USING TELEHEALTH FOR DRUG TREATMENT
As healthcare shifted from in-person visits to telehealth during the pandemic, more and more patients with substance abuse were allowed to receive medications and treatment remotely, adding a new and positive alternative way to receive care. The Veterans Administration also moved in this direction, and a new study finds that medication treatment for opioid use disorder increased with this shift. The study showed that the number of VA patients who received the drug buprenorphine for drug withdrawal increased by 14 percent in the first year of the pandemic compared with the preceding months. This coincided with a huge jump in the use of telephone and video telehealth visits. The drug is part of a medication-assisted treatment strategy that should also include behavioral therapies and peer-based counseling, although it’s not clear if the study took these other components into account. The study adds to a growing body of evidence about the benefits of telehealth, which allows physicians to prescribe the drug without an in-person visit normally required for controlled substances, thereby increasing the number of patients with access to the medication. With the public health emergency set to expire, many experts are calling on the government to maintain the ruling on easier prescribing. This is worth considering as telehealth can play an important role in expanding treatment for many but not all patients.
TEVA REACHES $4.25 BILLION DEAL TO END THOUSANDS OF OPIOID LAWSUITS
The Israeli pharmaceutical company Teva was a lesser-known manufacturer of prescription painkillers during the height of the opioid epidemic, but it was one of the largest makers of generic versions of the drug that fuelled the crisis and spiraling overdoses. Now, Teva has reached a tentative $4.25 billion settlement deal to end thousands of lawsuits brought by local governments, states, and tribes for contributing to the deadly epidemic that led to more than 108,000 overdoses last year. Teva is among many drug makers—including Purdue Pharma—that have reached settlements in a complex web of lawsuits and trials and settlement arrangements that are now wending their way to a close. If the deal is approved, Teva will make payouts over 13 years to fund opioid prevention and treatment programs, or overdose reversal medications. New York is one state that hasn’t signed on to the deal, after winning a civil jury trial against Teva last year, but is still in talks with the company. As the thousands of cases come to a close, with billions of dollars being directed to state and local governments, it’s critical to provide oversight of what happens to the money, and how it is used and distributed to drug treatment providers.
SENATE BILL TO LEGALIZE WEED ON THE FEDERAL LEVEL UNLIKELY TO PASS
More than 50 years after Congress made marijuana illegal, Senate Majority Leader Chuck Schumer has introduced sweeping legislation to decriminalize weed on the federal level and allow states to set their own marijuana laws without fear of punishment from Washington. But the bill, which has some bipartisan support, isn’t likely to pass, even with Democratic control of the White House and Congress. Currently, 19 states have legalized recreational pot, and 37 states have medical marijuana programs, and polls show that a majority of Americans approve of legalization, although on the local level a majority of municipalities in legal states have banned retail sales. Gaining congressional approval will be tricky due to competing interests. Republicans who favor decriminalization are unhappy with the provision to expunge cannabis-related convictions and grants to promote social equity among pot entrepreneurs. Even some Democrats from states where is legal don't support federal-level decriminalization. It’s also uncertain if Biden, who has in the past said he does not support federal weed legalization, would sign it. Many of the last-minute changes added to the bill came from Republicans seeking more clarity about pot and public health; they include law enforcement grants, a nationwide youth prevention campaign, and traffic safety research into the impact of pot on driving. Still, passage remains uncertain, especially with mid-term elections looming.
INVESTORS PUMP MONEY INTO PSYCHEDELICS HOPING FOR BIG PROFITS
As psychedelics make the jump from party drugs to prescription medication for potentially treating several mental health conditions, investors are already pumping money into startups and research and development in hopes of big profits. This is based on early clinical research showing that psychedelics such as LSD, MDMA (the main ingredient of Ecstacy), and psilocybin (the hallucinogenic compound in magic mushrooms) may be effective for treating anxiety, depression, and PTSD, as well as addictions and even traumatic brain injuries. Phase 1 trials are also taking place to assess psychedelics for treating stroke and Alzheimer’s disease. The Food and Drug Administration is expected to rule next year on MDMA-assisted therapy and on psilocybin in the next few years. Investors are also bankrolling the infrastructure and accessories around psychedelics, such as clinics and software to support the clinics. Still, research is only beginning to uncover how the drugs work, how they should be applied in a treatment setting, and what protocols, training, and guidelines are required to ensure patient safety. Much of how these powerful psychedelics affect the brain is unknown and critics worry about potential long-term damage or psychosis from excessive use. Media reports have already highlighted the dangers of a growing, unregulated psychedelics industry that exploits patients eager to try the drugs without a proper framework and best practices for treatment.
AMERICA'S FIRST SAFE DRUG CONSUMPTION SITES SAVE LIVES—BUT WITHOUT A FOCUS ON TREATMENT
The country’s first safe drug consumption sites opened in New York City late last year and the first report by JAMA Network on the results shows benefits in the first two months of operation, including preventing 125 overdoses. There were no overdoses at the two sites, at a time when overdose fatalities are at record highs in the city and across the country. More than 600 people utilized the sites, mainly using either heroin or fentanyl intravenously, and were revived using naloxone and oxygen. The sites, opened after years of controversy, are aimed at lowering the rate of overdose, providing safe and clean environments for drug use, and offering medical care if needed. About 75 percent of participants said they would have otherwise used drugs in public. About half of those visiting the sites also received healthcare services including hepatitis C testing and holistic treatments such as acupuncture—as well as “counseling.” However, it was not spelled out what this entailed. There was also no mention of how many patients were referred to and actually entered treatment. Safe sites are a critical component of harm reduction strategies promoted by the city and the Biden administration and are the front line of saving lives in the overdose epidemic. The NYC sites show promise in this direction, but they must focus more on engaging individuals and encouraging them to seek and enter truly life-changing treatment.
VIRAL VIDEOS SHOWING POLICE OVERDOSING FROM FENTANYL EXPOSURE ARE BUNKR
Videos purportedly showing police officers overdosing due to exposure to the potentially deadly synthetic opioid fentanyl have gone viral on social media. Many of these depict an officer who collapsed on the ground and was rushed to the hospital, supposedly for having had superficial contact with the drug. While fentanyl is fueling the nationwide surge in overdose deaths, there’s no scientific evidence to support the claim that mere“fentanyl exposure” is enough for the opioid to enter the bloodstream and cause an overdose. What’s going on here? The New York Times speculates that the videos are proliferating because police officers now on the front lines of the epidemic face a very different landscape than they did in the past, as the human misery of the epidemic is largely mostly hidden from view, a tragedy that is borne by the users and their families. Every hour, 12 Americans die from a fatal overdose, usually alone and with nobody there to revive them. The videos seek to identify the new villain in this drama and the shocking peril of the drug, but inadvertently invert reality—in that, it’s not the officers who are in danger. There is concern that these videos will worsen that danger and also drive the use of criminal charges to punish people for exposing officers or emergency responders to the drug.