What's Up with the FDA and Juul?
Deaths Sweep Through America's Prisons
ROSENTHAL REPORT - JULY 2022
LEGAL MARIJUANA MARKETS NEED TIGHTER REGULATION
TO SAFEGUARD PUBLIC HEALTH
Marijuana legalization in the U.S. was supposed to usher in a new era of safe consumption of the drug with well-regulated adult-use markets, among other promises. While some of these goals have been realized—such as boosting states’ tax revenues—we’re also seeing serious health downsides, especially among young people. With 19 states plus Washington, D.C., now operating recreational cannabis markets, and 37 states sanctioning medical marijuana, reliable data indicates there has been a significant increase in cannabis use and addiction, psychotic episodes, and even cases of chronic vomiting related to marijuana consumption.
High THC levels cause concern
Particularly troubling is the ease with which teenagers can get their hands on high-potency marijuana oils and waxes whose levels of THC—the psychoactive component of the drug—often exceed 60 percent and can reach 90 percent (up from an average 17 percent in 2017). Although recreational cannabis is illegal for those under 21, it has become more accessible in legal states through dispensaries that are not diligent about checking identities, online sales, the illegal market, and in e-cigarettes that have grown in popularity among both middle and high school students. And while cannabis is not quite as dangerous (and deadly) as the opioids and hard drugs such as heroin, cocaine, and meth that are fueling the nationwide rise in overdose deaths, high-THC marijuana products pose their own risks—and are proving especially harmful to the still-developing brains of teenagers.
A growing body of evidence shows that adolescents who frequently use cannabis products may experience anxiety, agitation, paranoia, and psychosis, which could eventually lead to lifetime psychiatric disorders such as depression and suicidal ideation, changes in brain anatomy, and poor memory. Cases of cannabis use disorder (and addiction) are also increasing, along with emergency room visits for a condition known as “cannabinoid hyperemesis syndrome” that causes chronic vomiting.
Regulations are sorely lacking
Of course, this could all have been avoided had those advocating legalization only considered the possible health risks and implemented tighter market controls before the markets launched. Today, the potency of cannabis products remains largely unregulated in legal states. Only two of those states—Vermont and Connecticut—have imposed caps on THC levels (60 percent for e-cigarette pods, and 30 percent for plants). But even those may not be having on impact. Not surprisingly, the cannabis industry opposes any type of limitations on THC, fearing that curbs may dent sales, and the Food and Drug Administration has been slow to act, as marijuana is still federally illegal.
We support the recent efforts of doctors and lawmakers in Colorado and California to mandate mental health-warning labels on cannabis products and in advertising and packaging. Educational materials should also be distributed to first-time customers outlining the risks marijuana poses to youth, drivers, and those who are pregnant. Equally important are caps on THC levels, which should be implemented in all legal marijuana states. There is no doubt that legalization will continue, so it’s critical to ensure that all consumers are safe—especially our youth and other vulnerable population groups.
Marijuana Potency Must Be Regulated
Five Years after Legalizing Marijuana, California Considers Stronger Regulations
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Dr. Mitch Rosenthal on the Large Number of Americans Seeking Psychedelic Therapy
ROSENTHAL REPORT - JUNE 2022
The Rosenthal Report, published each month by the Rosenthal Center for Addiction Studies,
brings its readers insights and commentary on current issues of drug use.
WE URGENTLY NEED SMART AND EFFECTIVE PROGRAMS
TO REDUCE SOARING OVERDOSE DEATHS
Drug overdose deaths rose to yet another record level in 2021, reaching nearly 108,000 as synthetic opioids such as fentanyl and methamphetamines fueled an ever-worsening addiction and overdose crisis. Although this 15 percent increase is lower than the year before, drug-related fatalities have been spiking for decades and now account for more deaths than from AIDS, gun violence, and even traffic accidents. Fentanyl alone killed 71,000 last year, while meth—which in recent years has become cheaper and more lethal—claimed the lives of another 58,000.
Equally disturbing is the alarming increase in drug deaths among teens and young adults. Even as experimental drug use has declined significantly for this demographic since 2010, deaths from fentanyl in this age group have nearly quadrupled over the past two years, from 253 in 2019 to 884 in 2021. While this represents only a fraction of total fatalities, overdoses are now the leading cause of preventable death among people ages 18 to 45. Perhaps just as troubling is how young people can easily purchase these drugs online using popular social media apps such as TikTok and Snapchat. Illicit dealers take advantage of the anonymity and encrypted message capabilities these websites provide to sell their wares to young people seeking prescription medications such as Xanax and Percocet—but are unaware that many of the pills they receive are laced with deadly fentanyl.
What can be done? The Biden administration has recently laid out a comprehensive strategy backed by $1.5 billion in new funding that combines different harm reduction measures, expands drug treatment, and increases law enforcement. While such measures are important in the long term, the immediate challenge is to reduce the nearly 300 daily overdose deaths nationwide. To accomplish this, as part of harm reduction efforts, we must first ensure that fentanyl drug-testing strips are made more widely available to help prevent users from mistakenly ingesting the synthetic opioid. Currently, drug-testing strips are technically illegal in about half the states, as they fall under arcane “drug paraphernalia” laws that date back decades. Repealing these antiquated laws while at the same time developing more sophisticated test strips that are capable of finding multiple drugs—including methamphetamines—would be an impactful first step, as more and more users mix substances that may be contaminated.
We must also reach out to young people—and their parents—to warn them about not only drug addiction but also the possible presence of fentanyl in the drugs they are buying online. To this end, the nonprofit Ad Council—backed by social media and tech companies that claim they are already cracking down on illicit drug sales by closing suspicious accounts—will be launching public service announcements this summer specifically aimed at increasing fentanyl awareness. The campaign is intended to reach the target age group 16 to 24 that spends on average more than three hours a day on social media platforms. But there is still much more that could be done to combat this crisis: a sweeping federal government-sponsored initiative to reach all Americans through various media formats—both physical and digital—wherever they live and however they engage with news and information.
The unrelenting overdose crisis is tragic, and tears at the fabric of our society. But there is an opportunity to slow fatalities and ultimately engage affected individuals in treatment by mobilizing all our resources to implement smart and effective programs—that work.
Dr. Mitch Rosenthal on How Drug Overdose Deaths Are Soaring Among Teens
Dr. Mitch Rosenthal: We Need More Research Into Psychedelics
Dr. Mitch Rosenthal: It's Time to Utilize Fentanyl Test Strips Nationwide
Dr. Mitch Rosenthal on the New Study Showing the Success of Drug Treatment in Prisons
ROSENTHAL REPORT - MAY 2022
President Biden Announces Inaugural Drug Control Policy
More than a year after the Biden administration first submitted a list of drug policy priorities to Congress, the White House has released a more substantive document outlining how it intends to implement a nationwide strategy to tackle the addiction and overdose crises. With overdose fatalities at record levels—more than 105,000 have died over the past 12 months—the government aims to save lives by simultaneously expanding harm-reduction measures and access to drug treatment, while at the same time reducing the supply of illicit drugs through targeted law enforcement. It’s a comprehensive, well-thought-out strategy with wide-ranging measures that would provide a continuum of care for those struggling with substance use—and if instituted, has a good chance of reducing surging overdoses and high levels of addiction.
It starts with prevention and early intervention, with a focus on adolescents and the social factors that put youth more at risk. Harm reduction is another key component, including increasing the availability of overdose-reversal medications, syringe-exchange programs, and drug-testing strips. Recognizing that reducing harm is only the first step toward recovery, the strategy rightly calls for substantially expanding access to quality treatment, noting that only a tiny fraction of the 20 million people living in the U.S. who need it are currently receiving much-needed treatment. Another element of the strategy entails building a “recovery-ready nation,” with programs to eliminate barriers to safe and supportive housing, education, and employment for people in recovery. And finally, it calls for combating both cultivated and synthetic drug production and trafficking—an effort to stop the flow of deadly fentanyl that now accounts for the majority of overdose deaths.
To help accomplish these goals, the strategy smartly maps out plans to train and build a treatment workforce to address shortages, expand treatment infrastructure at community health centers and in rural areas, and finance peer recovery support services—a critical factor in recovery. Equally important, it focuses attention on criminal justice reform to ensure that, among the 2.3 million people in federal, state, and local corrections facilities—as well as the roughly 8 million who cycle through short-term incarceration in jails—those with substance use disorder have access to drug treatment.
If implemented, these programs would have far-reaching benefits. They would not only help to reduce overdose deaths, but also establish a national infrastructure of services, care, and support that is sorely lacking. I have advocated for many of these measures—including in our criminal justice initiative that would pilot a peer-counseling model for the incarcerated from prison through release.
It’s not clear how many of these programs would be funded. While the administration has allocated $4 billion as part of the American Rescue Plan for substance abuse services, more would be needed. Also, I would rather it had made a stronger statement about creating a pathway from harm reduction to treatment, instead of merely noting that they should be “linked.” Still, the administration is finally showing real leadership regarding the addiction and overdose crises, with a strategy that shows great promise.
Dr. Mitch Rosenthal on President Biden Announcing Comprehensive Drug Strategy
Dr. Mitch Rosenthal on Teen Drug Overdose Fatalities Doubling
Dr. Mitch Rosenthal on the Role of Fentanyl in the Overdose Crisis
Dr. Mitch Rosenthal on Oregon Increasing THC Potency Levels for Edibles
ROSENTHAL REPORT - APRIL 2022
New York State offers a model for addressing the addiction and overdose epidemics
Faced with surging rates of addiction and overdose fatalities, more and more states are preparing new strategies to deal with this crisis—and New York, in particular, is moving in the right direction. A comprehensive package of programs and initiatives aims to reduce overdose deaths—there’s one every four hours in New York City alone—and expand access to treatment as well as a full range of recovery services. After pandemic-related cutbacks, states are gearing up to take action backed by new federal outlays and payments from opioid litigation settlements that are mandated for drug prevention, education, and treatment over the next two decades.
New York’s two-pronged approach includes harm reduction on the front lines of the epidemic—including overdose-prevention facilities such as safe syringe sites—and making it easier to obtain substance use medications and treatment, as well as recovery-treatment centers for individuals facing a crisis. For example, mobile methadone vans will be deployed in cities, while those in rural areas, who are often overlooked when it comes to accessing treatment, will benefit from a regional transportation system. At the same time, New York will expand medication-assisted treatment—and equally important, long-term residential treatment capacities. And it will also launch programs to secure housing and employment as part of a continuum of care with a vital support network for individuals to ease their reintegration into society.
It is important to remember however that harm reduction alone cannot end this crisis. Testing street drugs for safety and having trained medical personnel on hand to administer overdose reversal medications are critical, as we have seen in the first safe syringe sites in the U.S. that opened last year in New York City. But the question remains, what will happen to these people after we’ve reduced the harm they’ve experienced yet failed to offer a bridge to treatment?
To be most effective, there must be a direct link between life-saving harm reduction efforts and life-changing drug treatment. Both state and federal programs must therefore ensure that treatment is the cornerstone of anti-drug efforts. By focusing on treatment and ensuring everyone who requires it has access—regardless of income level, insurance status, or where they live—New York offers a model for other states to follow to confront this unprecedented public health crisis.
