THE DAILY BRIEFING: Recent Episodes
ROSENTHAL CENTER FOR ADDICTION STUDIES
Tobacco use at any age is unsafe, as it is the leading cause of preventable disease, disability, and death among adults in the U.S. Youth use of tobacco is especially dangerous because nearly all tobacco use begins during youth and young adulthood. It is therefore disturbing that the latest data from the National Youth Tobacco Survey finds that 1 in 9 middle and high school students currently use tobacco products—more than 3 million in total—and that e-cigarettes are the most popular product overall for the ninth year in a row. Among those reporting tobacco use, more than 18 percent suffered from severe psychological distress and 27 percent had low academic achievement. Although cigarette smoking among U.S. youths has been steadily declining during the past 2 decades, the introduction of e-cigarettes has led to a vaping epidemic among this age group, mainly due to the sale of flavored vaping products that target youth. In response to the youth vaping crisis, in 2020 the FDA declared a nationwide ban on many flavored e-cigarette products. But this only applies to specific types of devices, such as cartridges or pre-filled pods, allowing teens to access other devices including nicotine vapes with disposable pods sold under the brand Puff Bars. As such, more stringent bans have been enacted on the state level. Last week, for example, Californians overwhelmingly voted to uphold a law banning all flavored tobacco products in the state, making it the largest state so far to prohibit such products after Rhode Island, New Jersey, and Massachusetts. We need the FDA to show leadership in the fight against youth vaping, with a ban on all flavored devices, broader education programs, better oversight of marketing, and a crackdown on underage access to these products.
Colorado has long been at the forefront of progressive drug policy reform, agreeing to legalize marijuana a decade ago while the city of Denver decriminalized psilocybin mushrooms in 2019. Now, an initiative on the midterm ballot to decriminalize psilocybin statewide and also allow the establishment of state-licensed “healing centers” that offer treatment appears to head for victory. Unlike the legal cannabis market, there won’t be dispensaries handing out psilocybin in Colorado. Rather, the state will certify “facilitators” who will administer the drug at "healing centers" or existing healthcare facilities. It’s not exactly clear how all of this will work, as Oregon is the only other state to have taken a similar step, and the regulated market is not yet operating. The yes vote comes amid a flurry of promising studies showing that psychedelics have the potential to help in the treatment of conditions such as depression, anxiety, PTSD, and even tobacco and drug addiction. However, opponents including the American Psychiatric Association argued that the measure was outpacing science, noting a lack of any approved therapies that use psychedelic mushrooms and scant scientific evidence that the proposition is good public policy. Much more research and clinical trials are needed to establish whether psychedelics are beneficial in a clinical setting, but once again legalization and decriminalization are moving too fast—and making these potentially dangerous drugs more widely available without safe regulations and oversight.
In midterm elections, there was little policy debate over the addiction and overdose crisis that last year killed more than 108,000 Americans, but voters were asked to decide on a number of ballot measures concerning marijuana legalization, flavored tobacco and vaping products, and legalizing psychedelics. On marijuana legalization, voters in Maryland and Missouri said yes to decriminalization, while Arkansas, and North and South Dakota rejected ballot measures. The latest results were not unexpected, as the “no” states lean conservative while “yes” votes were favored in more liberal Maryland. Currently, 19 states plus the District of Columbia already allow adult-use pot, and 40 states have legalized medical cannabis. Now, the newly legal pot states must work out the details of a regulatory structure for the new market, including rules governing marketing, packaging, THC levels in powerful marijuana products, and local opt-out provisions to ban dispensaries. Only two states—Vermont and Connecticut—have implemented dosing caps on THC, the psychoactive component of marijuana, which is linked to psychotic episodes. Meanwhile, Californians overwhelmingly approved a sweeping ban on all flavored tobacco products, including vapes, which are targeted at young people and fueling a vaping epidemic in this age group. Although further legal action might delay implementation, along with pending federal rules by the FDA, this would make California the biggest state so far to ban flavored products, a move seen as a rebuke to the tobacco and vaping industries which lobbied heavily against it. And in Colorado, a ballot measure to legalize the possession of a variety of certain psychedelics is still too close to call. The city of Denver has already legalized magic mushrooms but this initiative would be statewide and also includes the creation of so-called psilocybin “healing centers" opposed by psychiatrists and other mental health professionals.
In tomorrow’s midterm elections, voters will decide on a number of drug-related initiatives, including marijuana legalization in 5 states and a slew of cannabis-related questions elsewhere concerning local control over allowing dispensaries. At the same time, the opioid epidemic—and in particular, the synthetic opioid fentanylthat is fueling record overdose deaths—is the focus of attention, mostly from Republican congressional candidates. However, even though fatalities are soaring, they’re not focusing on the addiction and overdose crises and expanding treatment options. Rather, they are highlighting the influx of fentanyl into the U.S., using it to bolster their argument about law enforcement, crime, and border security. They have pledged to stop traffickers from bringing the drug n the country (mainly from Mexico), impose stiffer penalties, and provide more funding for law enforcement while attacking Democrats for supporting drug decriminalization and softer penalties for nonviolent drug offenses. Some Democrats are in this camp as well, including Rep. Tim Ryan of Ohio, who is running for Senate and introduced a bill earlier this year classifying fentanyl as a “weapon of mass destruction.” While drug interdiction is critical to help stop the flow of the deadly opioid into the country, playing politics with addiction policy is misguided. We need a comprehensive approach to stopping the overdose epidemic, with more resources to expand a wide range of treatment options and make treatment accessible to all who want it.
Five states will vote in the upcoming midterms on initiatives to legalize recreational marijuana, but attention is also focused on a slew of local-level ballot measures in dozens of municipalities across the country that would either expand or restrict the availability of the drug. The number of measures that voters will decide on reflects the nation’s evolving attitudes toward marijuana, the Pew Trust points out, with a majority of Americans saying they favor legalization. Currently, 19 states plus the District of Columbia already allow adult-use pot, and 40 states have legalized medical cannabis. If the five new states—Arkansas, Maryland, Missouri, and the Dakotas—approve legalization, nearly half of all states will allow a marijuana industry. But it’s the ballot measures in other states that tell the story of the legalization movement and the continuing skepticism about moving in this direction. In Colorado, for example, a legal state, voters in the city of Colorado Springs will decide whether 100 medical cannabis dispensaries will be allowed to expand to selling recreational weed, in part to offset the city’s ban on recreational sales after it opted out of allowing retail sales within the city limits. In Rhode Island, which legalized pot earlier this year, communities will decide whether to ban local dispensaries, while in Michigan, they will be asked whether to overturn such a ban. The measures suggest that there is still wariness on the local level about legalizing marijuana and increasing access to it, and the dangers that it poses to vulnerable young people and communities, as well as increasing traffic accidents due to driving under the influence.
The ongoing hype about the benefit of using psychedelics such as psilocybin to treat mental health conditions like depression has been tested in a recent study—and found to be not as “dazzlingly powerful” as had been suggested in previous research. The new study shows that the drug was indeed effective to reduce or eliminate symptoms in the short term in more than one-third of patients with treatment-resistant depression, but this was not as long-lasting as seen in earlier trials. While the results warrant further research, doctors say they are also sobering, in that the overall response rate of 37 percent was lower than in previous trials and also in another trial comparing psilocybin with more commonly used SSRI antidepressant medications for major depressive disorder. In addition, most participants in the new trial also experienced adverse events, such as headaches and nausea, while 5 percent had severe adverse events, such as suicidal ideation and self-injury. One issue concerning the psilocybin trial as is the difficulty of finding a convincing placebo, and because it is given alongside intensive therapy, it’s hard to differentiate between the presence of the therapist and the psychedelic experience. Much more research is needed into psychedelics before they will be ready for mainstream clinical practice, and like all such drugs, they should not be considered a panacea.
Another settlement deal has been reached in long-running nationwide opioid litigation, with two of the nation’s largest pharmacy chains—CVS and Walgreens—agreeing to a $10 billion tentative deal to end thousands of lawsuits brought by states, municipal, and tribal governments. If the deals are finalized, they would represent payouts from an arm of the pharmaceutical industry that was most resistant to settling, as most of the major opioid manufacturers and drug distribution companies have already reached agreements on payouts for their contribution to the opioid crisis. The pharmacy retailers had chosen instead to test their defense in court, while also reaching separate settlements in West Virginia and New York. But recent court decisions have gone against claims they were not liable in any way for turning a blind eye to the diversion of prescription opioids and ignoring red flags that the drugs were fueling addiction and overdoses across the country. As part of the deal, each company will pay $5 billion over 10 years for CVS, and 15 years for Walgreens, while not admitting to any wrongdoing for an epidemic that has claimed more than 500,000 American lives over the past decade. (Walmart, which was also part of the longstanding claims against pharmacies, is said to have reached a $3.1 billion settlement). The money will go to governments for social services related to opioid addiction, including education and prevention programs, but not to individuals or families impacted by the epidemic. With billions of dollars now being made available from the lawsuits, states are starting to use the money in different ways: Rhode Island, for example, is funding supervised injection sites. But as the final settlements come into focus, we need a clear and comprehensive blueprint for using these resources in the most effective way.
A growing number of startup companies are getting into the business of prescribing ketamine, an FDA-approved mind-altering anesthetic drug, to patients for mental health conditions such as depression, suicidal thoughts, and PTSD, for which it is not authorized. Increasingly, psychiatrists are voicing concerns about the practice, saying that prescribing the drug off-label and sometimes at very high doses poses, for use at home, considerable risks. Ketamine should only be used in hospitals with medical supervision for its intended purpose—anesthesia. Some studies suggest that ketamine can alleviate some symptoms of depression when other treatments have failed, but there is little data on the drug’s effectiveness for anxiety and PTSD, and no evidence of the impact of its long-term use. The companies sell ketamine in tablets and lozenges online, making use of relaxed, pandemic-era rules on prescriptions, based on a questionnaire and virtual evaluation. But physicians warn that taking ketamine at home and without proper medical supervision increases the risks of patients falling and hurting themselves. The drug, which is also popular with party goers, can be addictive and increase the risk of complications including stroke or heart attack at higher doses. With growing interest in ketamine and other mind-altering substances such as psychedelics, it’s essential to closely monitor prescribing and use, as research has not yet established clear guidelines on dosages, side effects, and best practices.
Pro-pot advocates routinely claim that marijuana is good for treating pain. Like so many other myths, this is not supported by scientific evidence. And a new study finds that marijuana might actually increase the pain people experience after surgery, as well as their consumption of opioids to cope with it. The study of some 35,000 patients undergoing elective surgery showed that those who used pot within 30 days after surgery experienced 14 percent more pain n the first 24 hours and consumed 7 percent more opioids. While some studies have shown that marijuana can help treat neuropathic pain—a type of chronic pain caused by damaged nerves—more research is needed to know whether it’s more effective than other options. Meanwhile, the International Association for the Study of Pain has said that there wasn’t enough high-quality research to endorse cannabis use for pain. This hasn’t stopped the cannabis industry from continually touting the drug’s purported pain-relieving properties, ever since California’s 1996 decision to legalize medical marijuana. Around 10 percent of consumers turn to pot products to ease pains—the fourth most-cited reason after relaxing, relieving stress, and improving sleep. Pain research is inherently difficult because of the subjectivity of pain, and medical experts caution that such claims are mostly anecdotal and highly individual, and influenced by marijuana marketing.
It has long been known that drugs such as methamphetamines, cocaine, and opiates can directly affect the heart and cause abnormal rhythms such as a-fib. A new study adds marijuana to this list, finding that the drug can increase the risk by 35 percent. This debunks the common perception that cannabis may be healthy because it’s natural, or that the drug is essentially benign for most users when it is not, and may, in fact, have adverse consequences that could substantially impact users' lives. A-fib reduces the quality of life and increases the risk of stroke, heart failure, kidney disease, and dementia. Although it does not prove that marijuana causes a-fib, it does provide strong evidence of correlation—enough so that the report urges users to consider cessation to see if it has a meaningful effect on arrhythmia. By comparison, meth increased a-fib risk by 86 percent, cocaine rose by 61 percent, and opiates, by 74 percent. The report concluded that these drugs can have dramatic effects on the link between the nervous system and the heart.
Research into the possible benefits of using psychedelic-related therapy to treat depression, PTSD, and substance abuse, as well as other mental health conditions, is growing at a rapid pace. Not surprisingly, cash-rich investors are pouring into the field with great expectations, even though studies about the impact of psychedelics such as psilocybin, LSD, and Ecstasy are only in their early, but promising stages and the drugs are still illegal on the federal level (although that is changing as many cities and states consider legalization). Many of the corporate newcomers to psychedelics are vying for a financial edge through a blizzard of patent claims, the New York Times reports. One seeks a monopoly on nearly all methods of delivering the drug to patients, while another asserts that its treatment rooms were unique because they feature “muted” colors and cozy furniture. The claims have alarmed many scientists and patient advocates, who warn that a corporate takeover of the fledgling sector could make the new therapies prohibitively expensive, or fail to place enough emphasis on the psychotherapy component of treatment, which is critical. While it’s possible that hallucinogens could eventually revolutionize the treatment of many conditions, for-profit companies are moving much faster than the science. There have been a number of promising studies in the field, and the National Institutes of Health has begun funding research, but the money rush could take nascent psychedelic therapy into potentially troubling directions.
High-achieving young professionals in New York City have long been attracted to using cocaine, but now the drug, brought to their homes by a DoorDash-type delivery service, is killing them. The Wall Street Journal looks at three of these young professionals—a lawyer, a Wall Street trader, and a social worker—who all died on the same day from an overdose after using cocaine laced with fentanyl, a powerful legal opioid prescribed for cancer patients and others with severe pain. More and more, traffickers mix it into drugs sold throughout the illicit market. The drug, up to 50 times more potent than heroin, is showing up in heroin and cocaine and pills stamped out to look like oxycodone or Adderall and other prescription medications, but which contain a lethal dose that is driving the surge in overdose fatalities nationwide. . Dealers cut it into cocaine to be more potent and addictive and to draw new users, who don’t suspect their stash is contaminated, or know that a tiny amount of fentanyl can kill unseasoned users. The professionals depicted in the article are just starting what would likely have been successful careers, but their casual cocaine use ends in tragedy. The drug costs around $200 and is delivered by couriers who service customers across Manhattan, according to phone texts. Of the nearly 1,000 cocaine-related deaths in New York in 2020, some 80 percent involved fentanyl, while the delivery service appears to operate relatively unhindered. While education and prevention campaigns are important to warn about the dangers of fentanyl-contaminated drugs, it’s time for law enforcement to crack down on such operations.
The corporate-backed marijuana industry has convinced most Americans that marijuana is essentially benign, using that myth to drive the legalization of recreational pot in 19 states and the District of Columbia. Five more states will vote on legalization in this year’s midterms, at a time when business interests including tobacco and food and drinks companies are investing in cannabis products and distribution and fueling sales in legal states. Yet even as the legalization movement continues to gain strength, there is a growing body of evidence that pot is anything but harmless. In a recent story in the New York Post, emergency room doctors in San Diego report a dramatic rise in cannabis-related cases every day, with the most common symptom being psychosis. Studies have routinely linked marijuana products with high levels of THC—the psychoactive ingredient of the drug—and now doctors say the number of patients experiencing psychosis is increasing, by up to 24 percent in one Colorado study, in the five years following the legalization of pot in the state a decade ago. This parallels the rise of high-potency pot with up to 90 percent THC in products such as edibles, compared to 25 percent in the strongest marijuana flower. Even a moderate dose of THC can cause psychotic symptoms in many individuals while prompting paranoia in others. As more and more states legalize the drug, we have to tell the truth about its potential risks and dangers and convince lawmakers to draft legislation that includes tough rules and regulations to safeguard public health.
The Biden administration has taken a decisive step to combat cases of opioid use disorder (OUD) and surging overdoses among pregnant women, unveiling a plan to significantly expand access to medications that reduce withdrawal cravings. The program will focus on making drugs such as buprenorphine and methadone more widely available, as a way to reduce dependency and save lives, at a time when overdoses nationwide are at a record high of more than 108,000 annually. While these drugs are not a cure-all for addiction, they can be part of medication-assisted treatment (MAT) that combines medications and behavioral therapy and has proven to be both safe and effective for many individuals. OUD among pregnant women has quadrupled in recent years and is associated with low birth weight, preterm labor, and miscarriage. Pregnant women are more likely to die of an overdose than the average woman of childbearing age. Yet pregnant women were 17 percent less likely to be accepted for opioid treatment than women who did not mention a pregnancy to a treatment provider, according to a recent study. Under the Biden plan, judges will be trained to incorporate opioid replacement drugs into sentencing for pregnant women, as part of a court-mandated treatment plan. Further, addiction experts will focus on improving access to medication in communities with the highest rate of addiction, such as American Indians and Alaska Natives. This is a bold and important step by the Biden administration to make addiction treatment more readily available to those who need it most and integrate such care into the criminal justice system.
Until recently, residents of Washington, D.C. had to get a doctor’s recommendation and a medical marijuana card to legally purchase weed. Health conditions that would qualify for a card included cancer, glaucoma, Parkinson’s disease, and Alzheimer’s disease, as well as chronic intractable pain. Now, however, under new laws approved by the city council, adult residents, as well as tourists, can now “self-certify” their need for medical cannabiswithout ever seeing a doctor. As expected, pot sales surged in July after the first ruling, which bypasses any kind of medical exam and makes a mockery of the concept of “medical marijuana” because any adult can prescribe it. The government says the goal is to create a more patient-centric medical marijuana program and draw more patients into the legal marketplace as well as “protect patients”—although it’s not clear how they will be protected if they can self-diagnose such serious medical conditions. Medical marijuana is now legal in 37 states, having been adopted much earlier than recreational cannabis on the premise that it provides certain medical benefits, although evidence of this is more anecdotal than scientific. However, with more and more states legalizing recreational pot—now legal in 19 states and the District—the line between recreational and medical is fast disappearing, as it becomes clear that medical weed was the wedge to drive more radical cannabis reform. Why even call it medical pot if there's no real connection to medicine? With this in mind, we need stronger laws and regulations to control the commercialization of both recreational and medical cannabis and safeguard public health.
It was only a decade ago when recreational marijuana was illegal nationwide. But after cannabis advocates won the approval of legalizing recreational cannabis in Colorado and Washington, the movement has grown into a sprawling, multi-billion dollar industry backed by corporate interests and focused on increasing sales rather than ensuring public safety. Today, recreational cannabis is now legal in 19 states, two territories, and Washington, D.C., while medical marijuana is legal in 37 states, three territories, and the District. In the upcoming midterm elections, voters in five, mostly conservative states—including Arkansas, and North and South Dakota—will face ballot initiatives to legalize recreational pot, and if approved, would make the drug legal in nearly half of all states. This has taken place amid rapidly shifting attitudes about marijuana: two-thirds of Americans say they want recreational pot legalized in their state as well as on the federal level, where it remains an illegal Schedule 1 drug, similar to heroin. On a local level, however, Americans are wary about allowing pot stores in their neighborhoods. Even in pro-pot states such as Oregon and Colorado, a majority of municipalities have opted out of allowing dispensaries due to concerns about its impact on vulnerable young people and driving while under the influence (a recent Gallup poll found that young Americans are smoking cannabis at the highest rate ever). As voters go to the polls, they should carefully consider the implications of legalizing marijuana, as well as the details in initiatives when it comes to commercialization and safeguarding public health.
Pandemic lockdowns significantly disrupted access to drug treatment for many struggling with substance abuse, exacerbating the already low levels of access and underuse of effective medication for opioid use disorder. In response, government agencies eased restrictions on security, licensing, prescribing, and reimbursement to allow for greater access via telehealth. For example, practitioners were no longer required to conduct an in-person examination to prescribe withdrawal medications; many insurers picked up payment costs, and location restrictions were lifted in many rural areas. These measures improved access to OUD medications and services, as more and more physicians began to take advantage of telehealth to treat addiction. A new survey of about 1,000 doctors finds that loosening telehealth regulations had a positive impact, with a majority saying it was more effective than expected and a viable treatment option. An overwhelming majority also favor making the changes permanent, as telehealth helps patients who have a prohibitive commute to a medical facility, high childcare arrangement costs, or inflexible employment, all of which may lead to medication delays that resulting debilitating withdrawal symptoms. These findings are critical at a time when overdose fatalities are soaring, and up to 90 percent of individuals with an OUD do not receive treatment of any kind, and of those who do about two-thirds do not receive safe and effective medications. Telehealth is not a panacea for addiction but can contribute to expanding access to treatment for many people.
A decade ago, Colorado passed the nation’s first marijuana legalization measure, ushering in a new and untested market for adult-use cannabis products. Now, voters in the upcoming midterms will decide whether the state will decriminalize and allow easier access to psychedelics—in particular, psilocybin and psilocin, the hallucinogenic compounds found in certain strains of mushrooms. These powerful substances would not be sold in retail dispensaries, as is the case with pot, but rather be made available to anyone over 21 in state-sponsored and regulated settings, and supervised by a trained facilitator. Personal use would be decriminalized, allowing anyone to grow, share, and gift these substances but not be allowed to sell them directly. The vote comes amid growing interest in psychedelics to potentially treat mental health conditions such as depression, anxiety, PTSD, and even drug addiction. In fact, supporters argue that decriminalization and establishing state-run treatment facilities would expand opportunities for addressing those with mental health disorders. Yet asking voters to decide on such a critical issue that impacts public health is risky. Although recent studies suggest that psilocybin and similar substances might be effective in clinical settings, the FDA has not approved their use. Moreover, the American Psychiatric Association says there is “currently inadequate scientific evidence for endorsing the use of psychedelics to treat any psychiatric disorder” outside of approved studies. Critics also say that the bill, if approved, would make it easier for young people to access psychedelics and consume them in a non-supervised setting, rather than as part of what's known as psychedelic-assisted therapy. Psychedelics certainly have the potential to be beneficial to patients but require much more study and clinical trials—as well as regulation and guidelines for use—so that voters genuinely know what the repercussions might be.
The opioid epidemic and subsequent litigation have focused largely on manufacturers such as Purdue Pharma and wholesalers like McKesson that enabled the flow of highly addictive prescription painkillers that have killed hundreds of thousands of Americans. Yet giant retail pharmacy chains CVS, Walgreens, and Walmart were also involved—and to a greater extent than was previously known, according to a review of litigation documents and trial testimony by STAT News. The documents, from cases against the pharmacy chains, show they were eager to keep filling opioid prescriptions and reaping the profits rather than ensure the health of their customers. They had weak and disorganized prescription control systems and executives often resisted improved monitoring. In one case, two CVS locations in Orlando, Flordia, knowingly filled dozens of prescriptions from a doctor whose license had been revoked amid allegations of illegal prescribing. This all took place amid an accelerating drug crisis in which opioids—mostly prescription painkillers like OxyContin, dispensed by the pharmacies—played a big part, as such drugs eventually led to thousands of cases of addiction and overdoses. Many of the documents revealed glaring gaps in the ability of pharmacies to track the powerful drugs changing hands at their counters. And even if a local pharmacy tried to alert higher-ups about the need for more scrutiny, and more controls on suspect physicians, they were routinely rebuffed. The documents also showed the inability of pharmacies to stem suspicious or fraudulent prescriptions. Like the manufacturers and distributors, pharmacies have also recently settled many of the lawsuits: CVS, for instance, agreed to pay $567 million and Walmart $650 million, although legal battles continue as the chains fight the allegations. The settlement money will go toward education, prevention, and treatment programs for those struggling with substance use, but the litigation is a reminder of the greed that fueled the opioid epidemic that the nation is still grappling with.
Reactions to President Biden’s surprise pot pardon last week for people convicted of simple marijuana possession as a federal crime continue to roll in, with some analysts arguing that it might help the Democrats in upcoming midterms while others noting that there are, in fact, are no prisoners currently in federal prisons for pot crimes. In the Washington Post, health columnist Dr. Leana S. Wren takes up an equally important topic: while decriminalization is long overdue as part of criminal justice reform, and misplaced drug policies, it should not be regarded as a signal that marijuana is safe for everyone or that recreational use—especially among youths—should be normalized. She deconstructs the dominant narrative about marijuana—that it s essentially harmless—detailing its genuine dangers, from addiction (cannabis use disorder) to its impact on cognitive ability, memory, motivation, and learning, as well as much research linking it to schizophrenia, depression, anxiety, and psychosis in some people. In the column, she quotes Nora Volkow, director of the National Institute on Drug Abuse, as saying that marijuana is not a benign drug," especially for children and adolescents. Volkow says that if legalization goes ahead, we should also be thinking about a public health structure to provide treatment for people who have harmful patterns of marijuana consumption. Dr. Wren concludes by noting that none of these observations, as well as a growing body of evidence debunking the myth of harmless pot, contradict Biden’s pardon or efforts to decriminalize the drug. Along with criminal justice reform, we need more robust education and prevention programs and more robust regulatory control to protect vulnerable young people.
Rhode Island’s decision to launch the nation’s first “legal” supervised drug consumption site again raises critical questions about the ultimate goals of such facilities and whether they can serve as a pathway to drug treatment. Rhode Island, faced with rising overdoses—435 individuals died last year, the highest year on record for the state—believes that safe sites, as they are known, can be effective to curb overdoses and infectious diseases, and also provide information about treatment as an option, rather than a requirement. After many years of legal battles, two safe sites opened last year in New York City, and other cities that are also faced with soaring overdoses are considering doing the same. Although they remain illegal under federal law, Rhode Island is officially sanctioning a two-year pilot project and in a novel strategy, is financing it with funds received from opioid legal settlements. As a harm reduction measure, safe safes allow users to shoot up in a safe setting, with medical personnel, drug testing strips, and clean needles on hand to reduce the chance of injury or death. While this is important to save lives, those running safe sites—including the Rhode Island project—say they will not force participants to enter treatment nor expect that they do so, but rather offer the option "if they are interested." This is a misguided approach that fails to recognize that substance users aren’t likely to accept, on their own, an offer or option to voluntarily enter treatment. Instead, it’s critical to provide incentives that could become a bridge to treatment—such as drug courts, or guaranteed employment after successfully completing a course of treatment—and motivate users to seek recovery. Harm reduction and treatment are often talked about as separate, opposite approaches. But instead should be considered together as part of a comprehensive strategy to ending the addiction and overdose crisis in America, which last year claimed more than 108,000 lives.
The latest data from the CDC and the FDA appears to show a downward trend in youth vaping rates, from an epidemic level of about 20 percent to 9 percent among middle and high schoolers this year compared to 2019. While this is good news, officials warn the finding may be distorted by pandemic disruptions that limited supply, and a change in survey methodology to online-only canvassing. Still, they say that even at this level vaping is at an unacceptably high rate for this age group and poses a risk to their health. Our nation’s youth, the report concluded, are still being enticed and hooked by an expanding variety of e-cigarette brands delivering flavored nicotine, as well as marijuana at extremely high levels. Tobacco control advocates note that while high school vaping peaked at an estimated 27.5 percent in 2019, more than 2.5 million kids still use e-cigarettes today. They are calling for the FDA to ban all flavored e-cigarette products that are overwhelmingly the most popular with young Americans, and to address new vaping products on the market from brands such as Puff Bar—the most popular brand for the second year in a row—that use disposable e-cigarette designs that are sold illegally. The FDA has moved too slowly to take on the e-cigarette industry, which continues to target young people in its product marketing and design.
Cannabis legalization has so far not played a significant role in national electoral politics. For the most part, it has been a state-level issue, as more and more states moved to legalize the drug through direct ballot initiatives or legislative actions. This year, however, cannabis reform has shifted to the national electoral level, according to Slate, with four major races in Texas, Florida, and Pennsylvania in which legalization plays a role and differentiates the candidates. With one month before the midterms—which take place exactly a decade after voters in Colorado and Washington legalized weed—marijuana is a hot-button issue in races for Texas governor, Pennsylvania senate, and both the gubernatorial and Senate races in Florida. This occurs amid a shift in attitude among Americans, with an estimated 16 percent saying they smoke the stuff, and with easier access to pot products in the 19 states that have legalized recreational marijuana and 29 that allow medical marijuana. Polls continually show that voters favor legalization, although they are much less enthusiastic about having pot shops in their neighborhoods and routinely vote against allowing retail operations. Nevertheless, President Biden, last week added to the mix by announcing a pardon for anyone convicted of pot possession on the federal level and calling for government agencies to assess whether to remove marijuana from the list of Schedule 1 drugs, including heroin. Some say Biden’s pardon was a purely political move to attract progressive voters. Others argue that politicians and pollsters underestimate the power of the weed vote, which attracts liberals and centrists, including Republicans. Among the most outspoken advocates for legalization in the midterms is John Fetterman, the Democratic Senate candidate in Pennsylvania, and it’s also an issue in the Senate race in Florida, the country’s largest medical-only weed market. As politicians battle it out, we are forgetting the most important problems with legalization: education to prevent underage use, and rules to better regulate products, packaging, and marketing.
In a surprise move, President Biden announced pardons for those convicted of marijuana possession under federal law and ordered his administration to review the drug’s status as a Schedule I substance similar to heroin and LSD. The move was largely unexpected, in that the President had previously signaled little interest in tackling the marijuana issue before the midterms. Still, the announcement reflects a fundamental shift in America’s response to cannabis, at a time when 19 states have legalized recreational pot and 39 medical marijuana, while it remains illegal under federal statutes. Biden stopped short of decriminalizing marijuana altogether, and the pardon is limited to crimes related to possession, not trafficking or distribution, and will affect around 6,500 people as well as thousands more in Washington, D.C. He also urged governors to do the same for those convicted on state charges of simple possession, who vastly outnumber those charged under federal laws. Advocates for minorities have long urged a pardon for such offenses, as part of criminal justice reforms, because minorities make up a disproportionate number of such convictions. Biden has made the right move, as nobody should be in jail for smoking a joint. But as legalization moves ahead in states, we must also focus on education and prevention programs for vulnerable young people, and instituting strong market rules and regulations to prevent sales to underage consumers and to protect them from highly potent THC products.
Harvard Health looks at the increasingly popular trend of taking small amounts of potent psychedelic drugs—a practice known as microdosing—in order to purportedly enhance one’s creativity, concentration, and mood, among other claims. The trend has become popular amid growing interest in psychedelics such as LSD and psilocybin which initial studies show has the potential to effect long-lasting improvements in the mental health of patients suffering from anxiety, PTSD, and treatment-resistant depression. Microdosing means taking a fraction of a regular dose that causes one to hallucinate, believing that this smaller amount—the exact dosage isn’t clear, as the potency of magic mushrooms can vary—can provide benefits without the risks of tripping, which can be traumatic. Yet even as more and more proponents tout microdosing, the scientific evidence is scant. In fact, there’s little research showing that this approach is either safe or effective. Some studies indicate a real benefit, whereas others are much less convincing and show little or no improvement in well-being and cognitive function. Studies that do show some improvement support the hypothesis that the effect people receive from these drugs is mostly an expectancy effect, and suggest that one needs to consume a higher dosage for any therapeutic benefit. These are powerful substances that hold much potential but can also cause considerable damage to patients, and require more study and regulation before becoming mainstream treatment tools.
Responding to a dramatic increase in overdose deaths, San Francisco’s Department of Public Healthhas unveiled an ambitious plan to reduce fatalities by focusing on both harm reduction and drug treatment. Acknowledging that overdose is now a public health crisis in the city—which reported 625 deaths in 2021, involving opioids, cocaine, and methamphetamines, and driven by a dramatic increase in the presence of the synthetic opioid fentanyl—the plan calls for establishing “wellness hubs” as a cornerstone of a continuum of sevices. Treatment and harm reduction exist side by side on this continuum, the health department states, and will therefore couple overdose prevention services such as safe syringe sites with the expansion of treatment availability. While the hubs will offer overdose reversal medications, drug testing strips, and spaces for safe consumption of drugs, the plan calls for removing barriers to treatment and adding 70 new beds for residential treatment, and increasing the number of people receiving medication-assusted treatment (MAT) by 20 percent. The overall goal is to reduce fatal overdoses by 15 percent by 2025. Yet while the plan as outlined has many positive components, it falls short by decoupling harm reduction as a pathway to treatment services. It says that “treatment must be made available to people who seek it, whereas other services incouidng harm reduction and supplies, should be accessible to individuals NOT seeking treatment.” We must find ways to link these two elements with incentives that encourage and motivate users to enter treatment, rather than returning to a life of drugs.
More than 108,000 Americans died last year of drug overdose—and more than 1 million since the OxyContin plague began in the mid-1990s—but the U.S. still hasn’t gotten the message about the addiction and overdose crisis, argues Beth Macy, author of “Dopesick,” in a commentary in the Washington Post. While we know what fueled the crisis—the greed of pharmaceutical companies—there is also a way to end it by embracing treatment and making it easier to obtain than dope, Macy writes. She proposes offering free treatment on demand for those who can’t afford it, and making withdrawal medications such as buprenorphine and methadone—that curb craving and stave off withdrawal—readily available with much less red tape and regulation. Currently, these medicines are scandalously difficult to obtain, with only 5 percent of people with opioid use disorder able to get them in 2020. With the influx of high potency fentanyl that has poisoned the illicit drug supply and is driving overdose fatalities, morphine would be particularly helpful, but access is restricted by policies that go back to the Nixon administration’s “war on drugs." This restricted access to drugs and forced people to go to methadone clinics, which can be difficult and stigmatizing, especially in rural areas. Macy also mentions the need for programs in prisons and jails to screen for addiction, offer withdrawal medications, and refer the incarcerated to treatment programs along with peer support. She concludes by urging Congress to pass the Mainstreaming Addiction Act that would ease access to medications. For too long we have said there is nothing to be done about addiction and soaring overdoses, but these actions would be a step in the right direction.
The Wall Street Journal takes a closer look at the synthetic opioid fentanyl that is driving overdose deaths to record numbers across the country, finding that it has infiltrated every channel of the illicit drug supply and is more toxic than ever. The super powerful legal medication has become the dominant substance for opioid users craving a fix; it's killing users who seek it out to fuel a rising tolerance to prescription painkillers or heroin, as well as those who didn’t know they were taking it. Illicit drugs are deadlier than ever because of fentanyl’s pervasiveness and its mixture into a host of substances as dealers cut the drug into cocaine as well as tainted pills made to look like common medications such as Adderall, and even marijuana. Even though prescriptions for legal painkillers that started the opioid crisis in the first place have fallen by 44 percent over the past eight years to 2020, opioid-related overdose deaths nearly tripled in the same time span, reaching 82,000 out of the 108,000 overall fatalities last year. The drug is so strong that a tiny bit of it can kill, and users often have no idea they’re ingesting it, which makes it more difficult to administer overdose reversal medications. What’s more, the infiltration of fentanyl into the drug supply for cocaine and other stimulants has led to an increase in overdose deaths among Black people. In one country in Ohio alone, where cocaine and crack are still prevalent, deaths rose by nearly 30 percent. The drug is primarily produced in Mexico, after China cracked down on suppliers, and is then adulterated by dealers here to provide an extra kick to users or to hook them more intensely. Drug enforcement officials have stepped up seizures of the drug, but more must be done to halt the flow of fentanyl into the country as part of a comprehensive anti-drug strategy that also includes harm reduction and most importantly, easier access to treatment.
Medical marijuana, now legal in 39 states, has been the vanguard of cannabis legalization for years, spearheading the push for recreational sales. Selling medical pot is based on mostly anecdotal evidence that it’s good for treating a wide variety of illnesses—from morning sickness to anxiety and stress, as well as a host of other ailments, with scant scientific evidence to back it up. Relieving pain is one of the most commonly reported qualifying conditions although, again, there’s little scientific evidence to support the claim that it actually helps. Still, the medical marijuana market continues to grow by convincing consumers that it’s a panacea for just about anything. Originally, states with legal medical pot listed a number of diseases for which the drug could be certified. But now, some states, like New York, have dropped the list, and allow physicians and other medical practitioners to prescribe the drug for any condition if they feel it can be treated by cannabis. Virginia, for its part, still lists anorexia, autism, anxiety, Crohn’s Disease, and lupus, among other diseases, as qualifying conditions. How easy is it to get a certificate in the state? Very, as Axios,found out. Just call a practitioner, acknowledge you feel anxious, and pay $99, and a certificate can be yours to buy medical weed "or your money back." As with recreational cannabis, the market for medical pot has raced ahead of the science, thereby putting consumers—including those who are pregnant—at risk from high potency marijuana products.
Two years ago, Oregon passed a landmark law to decriminalize illicit hard drugs and channel hundreds of millions of dollars into drug treatment, with the hope that this approach would reduce addiction and overdoses. Yet the results so far have been dismal: Oregon still has one of the highest addiction rates in the country and fatal overdoses have increased by nearly 20 percent. And half of the addiction programs lack the capacity to meet demand due to a funding and staffing shortfall. As the first state to try this strategy, other states with soaring addiction and overdose rates are closely watching what happens—or in this case, doesn’t happen. Under the law, which makes small amounts of drugs such as heroin and cocaine punishable by civic citation and a $100 fine, which will be waived if an individual calls an addiction recovery hotline. Yet data now shows that most of the 3,000 citations issued have been ignored. Of the 16,000 people who requested services, 60 percent received “harm reduction” help such as needle exchanges and overdose medications, while about 15 percent with housing, and 12 percent were connected to peer support. While such measures are important, Oregon’s novel effort is failing because its voluntary approach does not provide any incentive or motivation for users to turn away from a life of drugs. Oregon should be praised for trying a new strategy to shift addiction from incarceration to healthcare, but it won’t be effective unless the program includes a clear and easy pathway to treatment.
There is a growing body of evidence showing that the controlled use of some psychedelic drugs could have therapeutic benefits, opening the door for a new range of treatments using these powerful substances. A new study published in JAMAPsychiatry, for example, found that just two doses of psilocybin magic mushrooms paired with psychotherapy led to an 83 percent decline in heavy drinking among some participants, compared to 51 percent taking a placebo. By the end of the eight-month trial, nearly half of those who received psilocybin had stopped drinking entirely, according to the small study. Although most psychedelics remain illegal under federal law, research is ramping up to determine is the drugs—including LSD and Ecstasy, in addition to psilocybin—can be effective for treating depression, anxiety, PTSD, and existential dread experienced by the terminally ill, as well as different types of substance use disorder. Nearly 15 million Americans struggle with excessive drinking, and such treatments offer hope. Yet we are still in the early stages of researching whether these drugs are effective in a clinical setting. As more and more cities and states consider rushing ahead to legalize psychedelics, we must move cautiously to explore the full range of possibilities these drugs could offer—as well as safeguards for protecting patients.
As more and more states legalize marijuana, law enforcement officials continue to express concern about the risks of driving while drugged. Many of today’s potent cannabis products contain high levels of THC, the psychoactive component of the pot, that is known to impair reflexes and cognition and has led to an increase in traffic accidents in legal pot states. To teach motorists about the dangers of driving while high, police in Maryland hold “green labs” in which participants are given cannabis to get stoned and then administered sobriety tests—such as walking a straight line (or not)—and using a driving simulator to test their reactions times. It’s illegal to drive while impaired by marijuana, but there isn’t any widely accepted standard for assessing pot impairment, as there is with alcohol. Maryland allows medical cannabis and a vote on recreational is coming up in November. For the police, green labs are also an opportunity to see how to identify drivers who may be stoned and incapable of operating a vehicle safely. Some participants had trouble walking a straight line and focusing—both signs of pot use. Law enforcement departments in Seattle and Ohio have launched similar programs in an effort to maintain public safety amid easier access to pot.
To stem a surge in drug overdose deaths, Canada is experimenting with a program that provides a steady and safe supply of illicit drugs to users instead of having them rely on street drugs. The program is part of an expanding movement in the country to provide government-funded, pharmaceutical-grade opioids so that users can feel the euphoric high without suffering withdrawal or worrying about the increasingly dangerous supply of drugs tainted by fentanyl or other substances. Critics of the “safe supply” program, a concept that is associated with the broader harm reduction strategies, argue that addicts should instead be directed toward treatment and that providers should be focused on reducing drug use—and not essentially promoting it. Others contend that users should be engaged in medication-assisted treatment (MAT), which combines effective withdrawal medications and counseling. A recent report on safe supply found that such programs echo the overprescribing of painkillers that drive the opioid addiction and overdose crisis in the first place. Supporters claim that the supply is just too dangerous and poses a very real risk of dying. And for those who are not yet ready for treatment, or for whom treatment hasn’t worked, safe supplies can help them avert death. While interest in the safe supply movement is growing in the U.S., it is still technically illegal, although similar strategies—such as safe injection sites—are receiving more attention as part of a harm reduction approach that is now backed by the Biden administration. A better way forward is to use harm reduction as the first step of a comprehensive strategy that eventually provides a pathway to treatment so that we not only save lives but also change them.
The market for products containing CBD, the nonpsychoactive component of marijuana, has been growing along with marijuana legalization and the influx of products containing the drug and its variants. Big food and drinks companies, including Molson Coors beer and Mondelez, the snack food giant, have expressed interest in cashing in on what is expected to be a booming market for CBD-infused products. For now, however, the Food and Drug Administration is staunchly opposed—setting up a food fight in that $1 trillion market. The FDA argues that there’s little research on the health impact on CBD in food and beverages; previously, the agency raised concerns that high levels of CBD consumption could cause liver damage. There are also concerns that CBD will show up in food products without consumers knowing. There are currently a number of CBD-infused “wellness” drinks on the market that claim to reduce stress and anxiety, yet there’s little evidence they live up to the hype. At the same time, the FDA has not taken such a hard line when it comes to CBD in dietary supplements, which are technically illegal too but represent a much smaller and less accessible market than food and drinks. Meanwhile, the FDA has warned Congress that any attempt to legalize CBD in food would pose a risk to public health after a bipartisan group of lawmakers proposed legislation to allow it in food and drink products. In response, the FDA has said the bill would put consumers, especially vulnerable populations such as children, the elderly, and those who are pregnant, at risk. The FDA is correct to resist allowing widespread use of CBD in the products we eat and drink withoutadequate scientific research about safety and how this will impact public health.
The powerful synthetic opioid fentanyl has been driving a surge in overdose deaths over the past few years to a record 108,000 in 20221. Now, drug-control officials say that two drugs even more powerful drugs than fentanyl—itself 50 times more potent than heroin—are entering the illicit market and are increasingly linked to overdose fatalities. One is a class of synthetic opioids called nitazines, which was responsible for a four-fold rise in overdose deaths in Tennessee in the last two years from none in 2019. Health officials are also finding traces of another drug, xylazine, a non-opioid animal tranquilizer, in fentanyl samples. This drug is usually used to sedate animals, including horses, and has been found laced in illicit injectable drugs, causing users to slip into a state of unconsciousness for hours. This profound sedation leaves people vulnerable to sexual assault and robbery, health care experts say, as well as suffocation if they are lying face down on a pillow. They also suffer skin abscesses at injection sites that are so severe they sometimes require amputations. These new drugs reflect a significant escalation of the drug and overdose crisis, increasing the risks for drug users who are often unaware of the dangers. To reduce the overdose rate, we need stronger efforts by federal and state authorities to stop the flow of such drugs, provide for adequate testing opportunities, and equally important, make available treatment on demand for al those struggling with substance use.
More than 1.1 million Medicare beneficiaries had diagnosed with opioid use disorders in 2021, and more than 50,000 Pard D beneficiaries died from a drug overdose, whether prescribed or illicit drugs. Yet a new federal oversight report finds that Medicare is vastly underserving older Americans, with only 18 percent of enrollees with the diagnosis receiving recommended medical care and drug treatment. The report highlights the fact that overdoses occur among older Americans, even if the overall rate is below those of other adults and hasn’t spiked as sharply in recent years to a record 108,000 in 2021. One barrier to providing drug treatment to Medicare enrollees is access to medications such as the withdrawal drug methadone, which is not covered by Medicare Part D because it is dispensed in special clinics rather than pharmacies. Another medication that helps ease withdrawal cravings—buprenorphine—requires providers to get a special waiver from the government, limiting the number of eligible clinicians. While opioid prescribing among beneficiaries has been on a downward trend over the past few years, due in part to closer prescription monitoring, Medicare must work harder to improve access to treatment for those with opioid use disorder and to prevent overdoses with the drugs and services that work.
Just a few years ago, the idea of drinking cannabisseemed far-fetched. But today, with recreational marijuana legal in 19 states and medical pot allowed in 39, the market for weed-infused drinks is booming. In 12 states, dollar sales of marijuana beverages rose 65 percent between 2020 and 2021. The number of marijuana beverages doubled during that time to nearly 750 different products in California alone, including lemon-flavored High Seltzer, THC-laden sparkling wine, and ready-to-go cannabis-infused drink mixes in foil packets. As with so much in the marijuana industry, the rush to introduce new pot products is outpacing scientific research into the potential risks and health effects. Even as more and more products flood the market, health officials and scientists say we still know very little about cannabis drinks, how they should be consumed, and their impact on the brain and body. Many of these drinks are marketed as “natural” or a healthier alternative to alcohol, which research and data do not support. Further, as these drinks contain THC, the psychoactive component of marijuana, it is easy to accidentally consume too much, especially for first-time or casual users, who don’t understand the labels. As a result, the high can be unpredictable, and potentially more intense, and with more psychoactive effects than cannabis that is smoked. To protect consumers, we need more robust research and data to formulate the best rules and guidelines for the safe use of cannabis-infused drinks.
As legal marijuana has become more common, its use during pregnancy has also grown exponentially, despite a growing body of strong scientific evidence that it can harm children. A new study published in JAMA Pediatrics builds on previous research linking prenatal cannabis exposure to behavior problems when children were 9 to 10 years old. The new analysis—which tracked some 12,000 children as they grew into young adults—connected prenatal cannabis exposure to mental disorders into adolescence, including attention, social, and behavioral difficulties, which could raise the risk of mental health disorders and substance use in later adolescence. As more and more states legalize cannabis, and its consumption becomes mainstream and considered largely benign, its use among women who are pregnant doubled to 12 percent between 2002 and 2017, the latest year that data is available. Doctors and public health officials continually warn women of the risk of using marijuana during pregnancy, even as cannabis dispensaries market their products as a way to curb morning sickness of nausea. One immediate consequence of marijuana use during pregnancy: studies show it is likely to lead to early and potentially dangerous delivery. As marijuana use clearly poses risks for the pregnant person and the child’s development, we need a more robust campaign among healthcare professionals to educate patients while the government must crack down on marijuana retailers who target people who are pregnant.
The World Anti-Doping Agency, which oversees drug testing in the Olympics and other sports, is likely to keep cannabis on its list of prohibited substances despite growing pressure to remove its ban on the drug. As more and more U.S. states legalize cannabis products, and many athletes promote its use for medical and recreational purposes, debate within the agency has grown over whether to suspend athletes who test positive from the competition. This was highlighted in 2021 after American springer Sha’Carri Richardson tested positive for pot and was not allowed to compete in the Tokyo Olympics. As the debate continues, the agency’s advisory group has recommended keeping the ban in place, noting that the drug still meets the criteria for inclusion because it could have a negative impact on performance. WADA has also concluded that marijuana meets other criteria because of its potential health risks (such as affecting an athlete’s balance) during competition, enhancing performance, and “violating the spirit of sport.” Increasingly, many pro athletes say they use cannabis products and have spoken out about the purported benefits of both medical and recreational marijuana. They also contend that if it is legal in many U.S. states, it should also be allowed in international sports competitions. But with a growing body of evidence highlighting the potential risks of cannabis use, especially products with high levels of psychoactive THC, we urge caution when considering removing it from the list of banned substances for professional athletes who always strive to perform at the highest level.
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.
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.
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 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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 Timesspeculates 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.
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’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.
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.
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.
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.
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.
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.
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.
This commentary in the New York Timesmakes 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.
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.
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.
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.
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.
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 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.”
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.
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.
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.
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.
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.
The Wall Street Journal reports that parents are so alarmed by the soaring rate of overdose deaths among young people, that they are changing the way they speak to their kids about drugs, especially the synthetic opioid fontanel that is fueling the spike in fatalities. With two-thirds of overdose deaths linked to such synthetic opioids, parents are more worried than ever that their children will get hold of tainted drugs, which are made to look like prescriptions medications such as Xanax and Percocet that young people are very familiar with, but don’t know are laced with deadly fentanyl. The drugs can be ordered easily on social media and delivered to your house like a pizza, making detection difficult. Now, parents are pressing their schools, doctors, coaches, and dance instructors to help warn and educate kids about the danger. They also want peer-to-peer student programs that would train volunteers to inform, counsel, and possibly administer overdose reversal medications. Because fentanyl is so powerful, parents are imploring kids to play it safe, and not assume a pill someone gave you came from a pharmacy and is the real thing. The role of parents is critical to preventing drug use, but we also need a government-led, national campaign to increase awareness about the current wave of opioid-related risks.
An article in the Washington Postlooks and the lives—and deaths—of two victims of the addiction and overdose epidemic, a drug dealer and the woman to whom he allegedly sold illicit drugs. The story highlights our tragic national drug crisis and how it impacts individuals and families, who are left to ponder how two lives might have been different. The victim was a 26-year-old woman who used illicit painkillers to ease her chronic anxiety and had struggled for years to break her addiction. The dealer ran a veritable pill factory from where he lived in his parents’ basement, making counterfeit oxycodone pills using a synthetic opioid similar to fentanyl that is 100-fold more potent than morphine. An autopsy found evidence of the chemical in the victim’s body. The dealer, who was later arrested following the suspicious death of another user, died in jail; the medical examiner has yet to rule on the cause of his death. With more than 107,000 overdose fatalities over the past year, the country is experiencing a public health crisis of unprecedented proportions, fueled by fentanyl-like synthetics that are sold as real prescription medications but are tainted and therefore deadly, and consumed unbeknownst to the user.
As New York State moves closer to implementing marijuana legalization and launching an adult-use market, its cannabis management board has announced strict rules to crack down on products designed to look like candy or other snacks, or otherwise appeal to children. As such, packaging regulations stipulate no cartoons, neon colors, and names that are any variation of “candy,” and packages must be children-resistant, non-toxic, and tamper-resistant.” Only one brand name can be featured on a cannabis item, with no pictures or graphics, except for what must be included—a new universal symbol that will be used to designate legal marijuana products. Perhaps more important, labels must contain details about the content and concentration of THC—the psychoactive component of pot—and the serving size for edible products, the weight, and lot number. This information is critical as concern grows about extremely high THC levels and its negative impact, especially on young people. It also addresses problems with underage access and consumption of marijuana in legal states—and hopefully, these rules will be enforced as New York opens its cannabis market.
The New York Times publishes another story about using psychedelic drugs as a potential treatment for mental health conditions, this time focusing on a U.S. war veteran suffering from PTSD who took part in a clinical trial for MDMA, the psychoactive drug commonly known as Ecstasy. The trial is part of renewed interest and research into psychedelics—including LSD, psilocybin, and poisonous toad venom—that early results indicate show promise in treating not only PTSD but also depression and some forms of addiction. While there’s no surefire cure for PTSD, with traditional medications and therapy, there's growing evidence that MDMA can significantly lessen or even eliminate symptoms in some patients. Psychiatrists say, however, that taking MDMA on its own does not automatically alleviate PTSD, but when paired with therapy, the drug does seem to catalyze a patient’s innate capacity for psychological healing.
Meanwhile, the Boston Globe reports that Massachusetts is still running prison-like facilities for men with substance use disorder, despite warnings from addiction specialists who have long decried the practice of forcing people into correctional settings for addiction treatment. The state says it’s not a prison but a medical facility, although those who have been involuntarily incarcerated say it felt like a prison. Some families regard the involuntary treatment as a last resort when addicted relatives refuse treatment or cannot find an opening in a treatment program, and thousands petition for commitment each year. But many addiction specialists say such an approach shames and traumatizes people who are sick, not criminals.
And finally, the Canadian province of British Columbia has won approval from the federal government to decriminalize small amounts of illicit drugs, including heroin, cocaine, and opioids, amid soaring overdose fatalities. The decision makes the province the first to decriminalize possession and follows similar moves by several cities and states in the U.S., which are also facing an unprecedented level of drug-related deaths. Officials emphasize that this does not legalize the trafficking, production, and importation of such drugs, but seeks to reduce the stigmatization of drug use which can lead many people to avoid seeking treatment. Overdose deaths have climbed dramatically in the province, increasing by 125 percent between 2016 and 2021, and is now the leading cause of death for people ages 19 to 39.
As interest grows in the potential of psychedelic drugs used to treat mental health conditions such as depression, addiction, and PTSD, there’s been a steady stream of stories about such emerging therapies, how they are administered, and their impact on patients. The latest comes from the New York Times which reports on a Mexican clinic that caters to female U.S. veterans who have experienced war and sexual assault and are seeking treatment that is not currently a standard of care at VA hospitals. Many former military members have become forceful advocates for psychedelic therapies—including a powerful hallucinogen derived from the poison of the Sonoran desert toad—and go to Mexico to get it, as the legal landscape in the U.S. is in a grey zone (some cities and states are decriminalizing such drugs but they are illegal on a federal level). In the Times story, participants go through a harrowing experience, but some report positive results and an improvement in their conditon. There is a growing body of evidence showing that psychedelics may be helpful for these conditions, and the field is attracting the attention of scientists and psychiatrists as well as venture capitalists interested in gaining a stakehold in what could be a lucrative market. Still, many are warning that the hype about the curative potential of psychedelics has so far outpaced hard evidence and that the risks—including episodes of psychosis—are considerable. We should move ahead with more studies about psychedelics to establish their safety, efficacy, and clinical best practices to administer them to ensure patients are not harmed.
With drug overdose deaths at a record 108,000 last year the New York Times looks at the synthetic drug phenomenon that’s driving fatalities, led by fentanyl and meth. Both drugs have proliferated because they are easy to make in a lab and ship around the world more directly and quickly than substances such as heroin and marijuana. Drug cartels no longer need to grow plants in a field with dozens of workers; all they need is a tucked-away warehouse or apartment and a few chemists. Drug users like synthetics too, as they are usually cheaper and more potent, but can be deadly. Last year fentanyl caused more overdose deaths in a single year than any other drug, followed by meth, which is also produced in labs. So far, law enforcement has not been very successful in stopping the flow of synthetics, compared to drugs grown on farms, and nobody now has come up with any alternatives.
Meanwhile, the L.A. Timeslooks at the fentanyl problem from a harm reduction perspective, noting that test strips are a simple solution to ensure that drugs are safe—but that drug mixing by users makes this so much more difficult. It says we need more sophisticated toos to identify both known and new dangers, as drug deaths are now tied to more than one drug. The year before the pandemic, nearly half of deadly overdoses across the country involved a combination of fentanyl, cocaine, heroin, or meth. While drug mixing is noting new, fentanyl is popping up in many kinds of drugs, so testing solely for one synthetic can miss other hazards. In addition, drug-testing strips are still officially illegal in about half of states, as they are classified as “drug paraphernalia” according to laws dating back decades. As part of harm reduction measures, we need to make drug testing tools legal, widely available, and capable of detecting a wide range of substances.
Drug overdose deaths among teens and young adults are climbing dramatically, as more and more of them buy fentanyl-laced pills bought online, unaware that they are contaminated with the deadly synthetic opioid. Law enforcement authorities say an alarming portion of the nearly 108,000 overdose fatalities over the past year were young people: overdoses are now the leading cause of preventable death among people ages 18 to 45, ahead of suicide, traffic accidents, and gun violence. Although experimental drug use by teens has been dropping since 2010, deaths from fentanyl have surged over the past few years, to 884 in 2021 from 253 in 2019. Social media apps such as Snapchat are TikTok are the leading online marketplace for drugs such as Percocet, Xanax, and other prescription medications. Suppliers have embraced the anonymity and privacy of social media—for example, using encrypted or disappearing messages—to sell their deadly wares, unbeknownst to buyers. The drugs, made to look like real medications, are pressed in Mexico with chemicals from China and India and leading to not only deaths from higher rates of addiction.
Meanwhile, what are the tech companies doing to crack down on the deadly merchandise that is trafficked on their sites? The nonprofit Ad Council recently announced a new campaign—backed by Snap, Meta, and Google—to alert teens and young adults about the dangers of fentanyl, using social media platforms Twitter, TikTok, Twitch, and Reddit to spread the word. Some companies are already targeting and interrupting drug exchanges, with Snap saying it took action on 144,000 drug-related accounts in the U.S. from July to December last year. A recent survey found that only 27 percent of teenagers knew that fentanyl could be found in counterfeit pills and 34 percent of adolescents said they didn’t know enough about the drug even to rank its danger level.
As more and more states take up marijuana legalization, Patrick Kennedy, a former U.S. representative from Rhode Island, has made a strong case for moving ahead with decriminalizing marijuana possession—while not normalizing and promoting its use. Pointing out the difference between the two, Kennedy says there are good reasons to end the criminalization of the drug, noting that over the past decades it has led to the mass incarceration of people, especially people of color. But he also believes that decriminalizing pot should not mean encouraging its use or downplaying its potentially harmful effects. While many people can use marijuana without it leading to problematic behavior, a growing body of evidence has shown that daily use of high-potency marijuana is linked to high rates of psychosis—especially in young people—as well as major depressive disorders and suicidal behavior and thoughts. Instead of helping what Kennedy calls the “addiction-for-profit” industry, the state must be a strong regulator of a marijuana market that prioritizes minimizing recreational use, educates the public about its harms, and expands the availability of robust mental health and substance use resources.
As psychedelics gain more respectability and even go mainstream for possibly treating some mental health disorders, the debate over the safety and effectiveness of these powerful drugs has shifted into high gear. A story in Vice looking at the fallout from one study, which touted psilocybin as a treatment for depression, is emblematic of the surging interest in psychedelics—as well as possible problems with the main players who are promoting its use. Recent landmark studies have suggested that such drugs could be used for treatment-resistant depression, PTSD, smoking, and more, sparking a broad consensus that they are worthy of further research. But as more studies are done, along with what many say is uncritical hype, there are now growing calls to be more circumspect and give these studies more scrutiny. This is also a pivotal moment, the article proposes, to reconsider how psychedelics are talked about and communicated to the public, especially when they are said to “liberate the mind” or “rewire the brain.” This is especially important in the growing for-profit psychedelic market, where results from small studies are routinely used to make advertising claims for psychedelic products and services. As this new ecosystem and interest in psychedelics mature, too much focus on tentative positive findings can obscure safety concerns and negative side effects. Let’s move ahead carefully to study the potential of these drugs, but remain cautious about overstating claims to protect patients.
The announcement this week by the CDC that drug overdose fatalities continue to surge—to a record 197,000 last year—has led to renewed calls for urgent action to confront the crisis. Noting that the spike in deaths was mainly due to the widespread presence of the powerful synthetic opioid fentanyl, Nora Volkow, director of the National Institute on Drug Abuse, called the latest numbers “truly staggering.” She added that many more people who use drugs both occasionally and even adolescents are now exposed to potent substances—often through counterfeit pills laced with fentanyl—that cause someone to overdose even with a relatively small exposure.
Meanwhile, Regina LaBelle, an addiction policy expert at Georgetown University, said the nearly108,000 estimated deaths were without precedent, adding that the increase during the first year of the pandemic did not seem to be letting up. Dr. Anne Zink, the chief health official in Alaska, which saw the largest overdose death percentage increase of any state in the nation, said that fentanyl kills many overdose victims before bystanders or emergency responders can revive them with naloxone, a medication that can quickly reverse an opioid overdose. “You don’t have a second chance if you don’t immediately have naloxone available,” she said.
And finally, the White House issued a statement calling the accelerating pace of overdose deaths "unacceptable." Dr. Rahul Gupta, the first medical doctor to oversee the White House Office of National Drug Control Policy, said that one person dies every five minutes from overdose and noted that deaths involving methamphetamines almost tripled. He called for implementing the Biden administration's recently announced national drug control strategy, which calls for measures such as harm reduction, connecting more people to treatment, disrupting drug trafficking, and expanding access to the overdose-reversing medication naloxone.
Provisional year-end data from the CDC finds that drug overdose deaths in the U.S. continued their unrelenting rise last year, surging to a record 108,000, and fueled by the powerful synthetic opioid fentanyl and, increasingly, methamphetamines. The increase of nearly 15 percent follows a much steeper spike of 30 percent in 2020, but the overall number of fatalities has gone over the country’s peak deaths from AIDS, car crashes, and guns, killing about a quarter as many Americans last year as COVID-19 (although San Francisco, for example, reported more overdose deaths than those from the virus). Deaths involving synthetic opioids — largely fentanyl — rose to 71,000 from 58,000, while those associated with stimulants like methamphetamine, which has grown cheaper and more lethal in recent years, increased to 33,000 from 25,000. Fentanyl, which is made in a lab, can be cheaper and easier to produce than heroin, enhancing its appeal to dealers and traffickers. But because it is strong and sold in varying formulations, small differences in quantity can mean the difference between a drug user’s usual dose and one that proves deadly. It is particularly dangerous when it is used unwittingly by drug users who do not usually take opioids. The White House recently issued its first national drug control strategy, calling for comprehensive programs combining arm reduction, treatment, and law enforcement. We need to move quickly to provide strong, committed leadership on both the federal and state level and to mobilize all available resources to confront this tragic public health crisis
While most Americans associate the opioid epidemic and nationwide opioid litigation with Purdue Pharma, the biggest maker of prescription painkillers was actually a company called Mallinckrodt, and its role in the epidemic is now being fully exposed. A cache of 1.4 million documents related to the company’s role has been made public after years of litigation and bankruptcy proceedings, revealing how Mallinckrodt sought to increase its market share through aggressive sales tactics as the epidemic and overdose deaths were raging across the country. Between 2006 and 2014 the company accounted for 27 percent of the opioid market, compared to 18 percent for Purdue. In Massachusetts, for example, Mallinckrodt’s pain pills were supplied to more than half of those who died of opioid-related overdoses during the past 12 years—nearly 10,000 individuals. The company also paid a key role in industry-wide efforts to convince the healthcare industry that addiction was rare among opioid users, although its opioid products were highly addictive, and marketed its drugs to specific segments of society.
Meanwhile, a judge in Ohio is set to rule on how much the nation’s three largest pharmacy chains—CVS, Walgreens, and Walmart should pay in damages as part of opioid litigation. All three pharmacy chains were found guilty by a jury for recklessly distributing massive amounts of pain pills in two Ohio counties—the first time such companies have been held responsible, along with opioid makers and drug distributors. Plaintiff’s attorneys say that each county needs about $1 billion to repair the damage caused by the flood of pills, which caused hundreds of overdose deaths. In one country, 80 million prescription painkillers were dispensed in a four-year period—about 400 for every county resident. Similar trials against the pharmacy chains are underway in West Virginia, Florida, and California.
And finally, if you are in need of drug treatment, the go-to site is often the one run by the government (FindTreatment.gov), which was launched in 2019 by the Substance Abuse and Mental Health Services Administration to help hundreds of thousands of Americans who are seeking services. But now, an investigation finds that the site—which lists some 13,000 state-licensed treatment facilities—has critical flaws, including inaccurate and outdated information, a lack of filtering options, and little guidance on how to identify high-quality treatment. For example, the site does not indicate which types of care are most likely to be successful—even though the government funds research on that subject. The site does only minimal vetting of the facilities displayed, which can lead patients to spend thousands of dollars on ineffective treatment or predatory facilities. With overdose deaths reaching record highs, it’s time to fix the site and help those struggling with addiction find the best, most effective, and safest treatment.
As fentanyl-related drug overdose deaths continue to soar, more and more states are legalizing the use of fentanyl test strips as part of harm-reduction programs to help save lives. Test strips are cheap and easy to use, and although they don’t gauge the amount of fentanyl in the drug they can detect its presence, which is critical as even a small amount of the powerful synthetic opioid can kill the user. Using testing strips seems like a no-brainer with more than 100,000 Americans dying each year from an overdose, a majority of such cases related to fentanyl. But due to drug paraphernalia laws enacted decades ago, many states still consider test strips off limits, including Florida, which recently rejected decriminalization. Test strips are illegal in about half of all states, including many in which overdose fatalities are spiking. In others, like Ohio, test strips are more easily available, including in vending machines, alongside the overdose-reversal drug naloxone. Test strips are all the more important now, as drug dealers increasingly contaminate all types of illicit drugs such as heroin and meth as well as legal ones like Xanax and marijuana with fentanyl to increase the high that many users crave. But many individuals take the drugs unknowingly and quickly overdose. Reversing old laws that define drug paraphernalia to include test strips—thereby blocking their large-scale use—is a simple and easy way to expand usage and save lives.
The deadly synthetic opioid fentanyl is fueling the spike in overdose deaths across the country, but where is the drug coming from? As law enforcement and investigators try to stop the flow, they say that both fentanyl and fentanyl-laced contaminated drugs made to look like prescription medications and illicit drugs are coming in from China and across the U.S.-Mexican border. Despite government crackdowns on production in China, experts say drug suppliers there send the ingredients to Mexican cartels who make the drug either in raw powder or pill form and then ship them across the border in trucks. Last year more than 11,000 pounds of fentanyl made its way into the U.S., and more than half of that came through the border of Mexico and San Diego. More than 107,000 individuals died of a drug overdose over the past 12-months—a record—with many victims unknowingly taking drugs they believed were Xanax or heroin and the like but were contaminated with lethal doses of fentanyl.
Meanwhile, overdose deaths are surging among many ethnic groups, including Blacks, and a recent study found that the fatality rate is also spiking for Indigenous Americans, with fatalities increasing five-fold from 1999 to 2019, while the number has quadrupled nationwide. The study looked at overdose deaths attributed to opioids in combination with alcohol and other drugs such as meth, cocaine, and benzodiazepines, and deaths linked to specific types of opioids among American Indians and Alaska natives aged 12 and older.
And finally, Washington State has reached a $518 million agreement with the nation’s large drug distributors for their role in the opioid crisis. Under the settlement with McKesson Corp., Cardinal Health, and AmerisourceBergen, the state is obliged to spend $476 of the total to address the crisis, including on substance abuse treatment, expanding access to overdose-reversal drugs, and providing housing, job placement, and other services to those struggling with addiction. The deal came months into a complex trial in Washinton against the drug distributors after the state decided not to participate in a national settlement reached last summer with these companies and Johnson & Johnson. Other trials are underway in West Virginia, Florida, and California as part of far-reach opioid litigation involving thousands of cases, many of which have been settled out of court for hundreds of millions of dollars, and will be used for prevention, education, and drug treatment.
States that legalized marijuana a decade ago are now studying the public health implications of a variety of high-potency cannabis products after doctors and medical researchers reported possible links to psychosis. Oregon and Washington State, which pioneered cannabis reform, are now looking into the potential dangers of marijuana concentrates and considering placing limits on levels of THC, the psychoactive ingredient in marijuana. Such products can have THC levels of up to 90 percent compared to about 5 percent 20 years ago. Emergency room doctors in Colorado prompted the state to study such products, after finding that they were seeing increasing cases of psychosis connected to marijuana concentrates, which led to a bill to curb access to powerful pot products. Researchers in Washington concluded that the more THC consumed, the worse the negative effects, especially among young people, who are particularly vulnerable to addiction. To be sure, the cannabis industry is pushing back against efforts to curtail concentrates, saying the products are popular with consumers and falsely claiming there’s no evidence to suggest widespread risk from THC. It would have been more prudent to consider the dangers of high-potency pot before legalization, but it’s not too late for state legislatures to act to impose THC caps to protect public health and vulnerable populations.
Meanwhile, major food companies are warning the public about the rise of so-called copycat edibles that look like “real” food products but actually contain cannabis and incidental amounts of THC. The Consumer Brands Association says that while marijuana may be legal in some states, the misuse of these famous rands has created serious health and safety risks for consumers, particularly, children, who cannot tell the difference between these brands’ true products and copycat THC products “that leverage the brand’s fame for profit.” A recent study by New York University found that policies to prevent cannabis packaging from appealing to children haven’t stopped such products from entering the market.
And finally, the CDC features marijuana use disorder as its “disease or health condition of the week,” warning consumers about the dangers of cannabis. It says that approximately 3 in 10 people who use marijuana have the disorder, meaning that they are unable to stop using marijuana even though it is causing health and or social problems in their lives. Those risks include stroke, heart disease, other vascular diseases, and psychosis.
Methadone has long been regarded as a life-saving medication for opioid use disorder that keeps people from experiencing debilitating withdrawal or seeking dangerous street drugs. But to the U.S. government, it’s a highly regulated Schedule II substance akin to cocaine, meth, or fentanyl, making the drug difficult to access. As the nation’s overdose crisis worsens, the New Republic looks at how methadone could be more widely used to help those struggling with addiction—but isn’t due to price, over-regulation, and stigmatization. Strict rules curtail access to methadone and dictate how and where it is dispensed, mostly in specialized urban clinics that are out of reach to those in rural areas. The federal government bans primary care doctors from prescribing it and pharmacies from dispensing it. And unlike buprenorphine, another medical treatment for OUD, methadone can only legally be dispensed at one of these clinics, which usually have long waitlists or financial costs. For patients, breaking one of the rules can lead to dismissal from the program which was likely difficult to get into in the first place. The Biden administration has recently signaled its intention to make such medications more widely available, via mobile methadone vans, for example, as part of broader harm reduction initiatives. This would be welcome at a time when overdose rates have reached record levels and we have the tools and resources to start reducing fatalities today—but are not taking advantage of them.
A new study finds that a pilot program to reduce drug overdose fatalities in California prisons has been hugely successful, with the death rate dropping nearly 60 percent over the past two years. The California program—the largest of its kind in the country—provides medicated-assisted treatment (MAT) to prisoners, including addiction withdrawal medications and cognitive therapy. This large-scale experiment with MAT in incarceration facilities adds to a growing body of evidence that such therapy is both safe and effective, and can significantly reduce overdose deaths and hospitalizations in prison settings. In California, officials estimate that up to 65 percent of inmates have a substance abuse problem, but until recently only a small fraction of them receive any kind of treatment services. Before the program began, overdose was the third-leading cause of death for inmates, but that has fallen to eighth in 2020, the lowest ranking in nearly a decade, while at the same time the overdose fatality rate climbed dramatically nationwide to more than 105, 000 annually. Currently, Gov. Gavin Newsom is seeking $162.5 million annually to expand the program—money that would be well spent on a program that should be replicated among the general population.
Meanwhile, as statewide marijuana legalization continues across the country, new studies continue to uncover evidence of the negative impact of cannabis—this time, secondhand smoke. Research shows that bystanders may inhale air pollutants from pot smoke at concentrations more than twice federal air quality limits. The study, at UC Berkeley, measured bong smoke in an ordinary household living room where young adults socially smoked marijuana for several hours. The smoke increased background levels of pollution by at least 100-fold and above the air quality levels. Such fine particulate matter can travel deep into the respiratory tract, damaging the lungs and affecting their function.
And finally, while we’re on the subject of pot: with New York about to implement legalization, the classic New York slice (of pizza) is being pushed as the next pot-infused food product.Pizzamakers have been discussing such a savory topping and a few are even experimenting with it, but the state’s cannabis regulatory agency says no decision has yet been made. Advocates say the law doesn’t explicitly mention food, but neither does it prohibit such products. Still, as the law does establish a 21-year old age limit for consumption, it might be tough to keep kids away from a high-inducing slice of pot-laced pepperoni.
The Biden administration has finally released its inaugural national drug control strategy, with an emphasis on “saving lives, getting people the care they need, going after drug traffickers, and making better use of data to guide these efforts.” The comprehensive plan is the first such effort that puts harm-reduction strategies front and center—including making overdose reversal medications and drug testing strips more available, among other measures—while also promoting the expansion of drug treatment, educating young people about the dangers of drug use, reducing drug trafficking and the flow of illicit drugs into the country, and building what the administration calls a “recovery-ready nation” that provides housing and workplace opportunities for those in recovery. In other words, the strategy is aimed at meeting “people where they are” to address their substance use issues and provide a continuum of care. Equally important, it recognizes the drug problem in prisons and jails, where drug use is overrepresented in the incarcerated population and treatment services are very limited. Additionally, it promotes expanding the treatment workforce and the use of peer-based specialists as an integral part of services. Still, it’s not exactly clear if there is additional funding available to pay for all of these programs, except for the $4 billion appropriated in the American Rescue Plan to expand access to vital mental health and substance use disorder services.
As New York State prepares to introduce a legal, adult-use marijuana market, Governor Kathy Hochul is rolling out a public service ad campaign to warn New Yorkers about the potential dangers of using legal pot. The campaign, called Cannabis Conversations, is the state’s first public service campaign and goes into depth about the dangers of impaired driving while high, the risks of youth cannabis use, how to store cannabis safely in your home, and to respectfully consume cannabis in public. The ads bluntly tell consumers that it is never safe to drive under the influence of marijuana, and that cannabis can damage growing brains in youth—a finding supported by a growing body of scientific evidence, but which was passed over during debates about legalization. According to the state’s cannabis control board, legalization is grounded in the principles of public safety, social justice, and equitable economic development. Yet if safety were a primary concern, there would have been stricter measures included regarding underage consumption and impaired driving.
Meanwhile, public safety concerning pot apparently wasn’t on the agenda for a bride in Florida, who is accused along with her caterer of spiking the food at her wedding reception with enough marijuana to make many guests feel sick, nauseated, and dizzy. The bride and the caterer were arrested and charged with two felony counts including food tampering and distribution of marijuana, in a state where recreational cannabis is still illegal. The effects underscore warnings from the medical community about the possible dangers of ingesting or smoking marijuana, which can include disorientation, vomiting, impaired driving as well as other health issues.
And finally, another drug danger—the growing use of psychedelic drugs—was highlighted in an investigation by STAT News into the case of an elderly man who was allegedly taken advantage of by a caregiver who gave him hallucinogenics to treat depression and suicidal ideation. The case reflects not only the mainstreaming of psychedelics but also the growing industry around its use and so-called therapists who administer these very powerful drugs and “guide” patients through the experience. They are sometimes used to ease patients’ anxieties at the end of life, and therefore have the potential for an increase in elder abuse, the report points out. Psychedelic drugs, which are still largely illegal for treating depression and PTSD, are becoming more popular, and researcher is opening up in the field. As this happens, there’s a critical need for strong regulations to protect users of psychedelic medicines against potential abuse from unlicensed therapists—especially the elderly, who experience cognitive decline, are often frail, and are at risk of being taken advantage of financially.
Business stories about the newly legal marijuana industry portray the sector as both booming and imperiled, depending on the U.S. state or country. The New York Times, for example, reports from Toronto that pot shops are flourishing in several areas of the city, thanks to loosened regulations that were first implemented during the pandemic and have been allowed to continue. In 2020, just 12 retail stores existed in the city of 2.8 million, but today there are 430 with another 88 in the approval process. On one street, there are more than 13 shops along a 2-mile stretch, which are changing the character of an iconic neighborhood. Unlike other provinces, the Ontario government favored unbridled competition, introducing just one simple restriction on shops: they must be located no closer than 150 meters to a school. In only three years, sales of legal marijuana in Ontario boosted the economy by an estimated $10.6 billion and today, more Canadians consume the drug than ever before—including 25 percent of people 16 and up. While sales are booming, there’s no mention in the story about health impacts.
Meanwhile, things are not going so well in California’s legal market, according to the Los Angeles Business Journal. When the state legalized weed in 2016, there were promises of a great retail surge and the elimination of the black market. However, legal marijuana sales are slumping and the illicit market is going gung ho; today, there are roughly 850 licensed dispensaries statewide, a staggering drop of nearly 90 percent over just five years. In fact, retailers say they’re in a struggle for survival, due to high taxes and stringent regulations. And contrary to popular belief, the black market isn’t only the stereotypical drug dealer on the street corner, but hundreds of shops that look like licensed dispensaries but don’t pay taxes or comply with regulations—yet another example of how rushing to legalize marijuana has led to a poor business model and potential harm to consumers.
And finally, New York City Mayor Eric Adams has come up with an unusual idea now that the state is about to implement its marijuana legalization law: set up cannabis greenhouses on the rooftops of public housing buildings. This would not only increase the supply of pot in a city with little space for agriculture, the mayor believes, but also provide jobs for residents, part of the state’s efforts to use legalization as a way to help communities disproportionately harmed by the war on drugs. Several complications here: one is that marijuana remains illegal under federal law, and the NYC public housing authority—known as NYCHA—receives half of its annual subsidies from the federal government. Equally important, marijuana is still illegal in public housing. And, nobody has apparently asked residents if they want marijuana growing up on the roof.
For years the Food and Drug Administration has been in a running battle with the e-cigarette industry over rules and regulations of the now booming vaping sector, especially with teens. Now, Congress has finally given the federal agency the legal authority to close the largest loophole in the industry: cracking down on companies that use synthetic rather than plant-based nicotine, including those in fruit- and candy-flavored products popular among young people. The law targets companies like Puff Bar that had switched their recipes to lab-made nicotine to avoid FDA control. Synthetic nicotine will now be subject to the same sales restrictions as nicotine products, allowing the FDA to stop companies from targeting kids, at a time when vaping among middle and high school students has reached epidemic proportions. After launching in 2019, Puff Bar became the most popular e-cigarette among teenagers, with flavors such as blueberry, strawberry banana, and mango—a typical marketing tactic that is particularly sinister when it is applied to highly addictive e-cigarettes. Meanwhile, the FDA continues to exert control of the vaping industry, reviewing applications for a vast array of vaping devices that are seeking market approval—and rejecting more than one million so far for their potential appeal to teenagers.
More troubling news as the addiction and overdose epidemic continues to spiral out of control: a new study finds that the rate of fatal teen overdoses in the U.S. nearly doubled in 2020 after staying flat for a decade. The report, published in JAMA Network, showed that fatalities are spiking not because of a surge in drug use among 14- to-18-year olds, but rather because of the supply of increasingly deadly drugs such as fentanyl, which is also driving the overall death toll to more than 100,000 annually—a grim record. In fact, the survey showed that fewer teens are actually experimenting with drugs, including during the pandemic despite lockdowns and isolation, and other factors that increase stress. What is killing teens now is drugs such as Xanax or marijuana that are diverted from the legal supply and contaminated with fentanyl by drug dealers, and consumed unawares by young people. In 2020, 954 adolescents fatally overdosed, a rate of 4.5 per 100,000; for the first six months of 2021, the rate rose another 20 percent to 5.5 percent. The new study also noted that the highest adolescent mortality rate was among American Indian or Alaska Native teens; as of 2020, this group had the highest overall overdose mortality rate—some 30 percent higher than white people. To protect young people, we need a nationwide education, prevention, and awareness campaign warning of the dangers of drug use—and especially, contaminated legal drugs laced with powerful fentanyl.
As more and more states legalize both recreational and medical marijuana, sales in the U.S. are expected to top $33 billion by the end of this year, a 32 percent increase over last year. And if the market continues to grow as expected, sales could exceed $52 billion by 2026. In the latest state to open its market—New Jersey—the first licenses have been awarded to medical-marijuana stores. As weed becomes more widely available, concerns are also growing about the risks of driving while high on pot. Is it more dangerous than driving while drunk? The New York Times answers this question by saying that getting behind the wheel after smoking a joint poses distinctive risks. Research shows that THC, the psychoactive component of cannabis, impairs a number of behaviors related to driving, including the ability to weave between lanes, and delays response times in general. Psychoactive effects can also make cannabis dangerous, such as the paranoia that some people experience while high could induce a panic attack while on the road. Weed can muddle perceptions of safety, and also create an altered sense of time and the sludgy sense that everything around you is moving slower than it actually is. What’s more, unlike alcohol, where there’s a definite quantity that constitutes a single drink, marijuana has no agreed-upon dosage. It's tricky for pot users to predict how exactly they’ll be impaired, especially with edibles, which take longer to be absorbed into your system. Debates over legalization often focus on the driving-while-high issue, with many critics voicing concerns that law enforcement has no way to measure how impaired a driver might be, even as traffic accidents have increased in legal states. But that isn’t stopping the powerful cannabis industry from pushing for legalization and lax regulations and oversight of sales.
The House has passed a bill to legalize marijuana on the federal level, but Democratic backers of the measure face a tough uphill climb to win approval in the Senate. The bill—which would remove marijuana from the federal controlled substances list—faces staunch opposition from Republicans, as well as a few Democratic Senators, including Joe Manchin of West Virginia and Jeanne Shaheen of New Hampshire. Both senators have voiced concerns about legalizing recreational cannabis (Manchin is supportive of legal medical marijuana) given the substance abuse crisis in the country, and the lack of comprehensive data on how people are affected by pot. The uncertainty comes as more and more states legalize marijuana on their own and establish cannabis markets. Polls show broad support for legalization, although in many legal states municipalities have invoked the opt-out clause to ban retail cannabis sales and on-site consumption lounges, indicating a grassroots reluctance to sanction commercial cannabis sales. The Democratic House bill, knowns as the MORE Act, would not only remove marijuana from the controlled substances list but also expunge certain marijuana-related convictions, and impose a tax on marijuana sales to help communities disproportionately impacted by the nation’s war on drugs. While legislators argue over how to move the bill forward, there’s unfortunately little discussion of how to regulate and monitor the marijuana market and impose restrictions to protect public health and safety on a federal level.
The federal Drug Enforcement Agency has sent a letter to law enforcement officials across the country warning of a nationwide spike in fentanyl-related mass-overdose events. The DEA raised the alarm following a surge of nearly 30 fatalities in at least seven cities in recent months, as drug traffickers continue to push fentanyl and mix the powerful synthetic opioid with other illicit drugs. Mass-overdose events—defined as three or more overdoses occurring close in time and at the same location—have taken place in cities including Austin, Texas, Omaha, and Washington, D.C. The usual scenario, the agency says, is when drug dealers sell their product as “cocaine,” when it contains fentanyl, or when they sell pills designed to appear nearly identical to legitimate prescriptions but are actually fake pills containing pills—a frightening trend where many victims are dying after unknowingly ingesting fentanyl. The warning comes as fentanyl poisoning fuels the nationwide opioid epidemic that last year killed more than 100,000 Americans. In response, the DEA says it is working to trace mass-overdose events back to the local drug trafficking organization and international cartels responsible for the surging domestic supply of the drug.
As fentanyl-related overdose fatalities surge across the country, to more than 100,000 annually, efforts are underway to both reduce the availability of the drug and increase penalties for those with sell it or mix it with other drugs—one of the main causes of overdose deaths, as users consume the product unaware that it is contaminated. One way to reduce accidental overdoses is to make fentanyl test strips—which can detect the drug’s presence—more widely available; strips are currently used at safe syringe sites and other harm reduction facilities, and sometimes at concert venues where drugs are being taken. Lawmakers in some states also want to hand down harsher sentences for those caught dealing fentanyl or contaminating other drugs with it, although much of the fentanyl coming into the U.S. is from China or comes over the border from Mexico. Since last year, at least half a dozen states have enacted laws to legalize fentanyl strips and a dozen others are considering them.
Meanwhile, as New York State gears up to implement a marijuana legalization law passed last year, a government website called Cannabis Conversations has been launched to inform consumers about this new market—and the potential dangers of cannabis. It bluntly says that there can be real health risks and impacts, especially if you are pregnant, and can be addictive and lead to cannabis use disorder (up to 3 in 10 people who use pot develop this condition.) The site tells consumers that certain cannabis compounds like THC, the drug's psychoactive ingredient, can affect the developing brain in young people, with possible effects such as difficulty thinking and solving problems, memory and learning issues, reduced coordination, difficulty maintaining attention, and problems with school and social life. At least the government is being honest about the risks, but with all these downsides and potential health hazards, it’s a wonder that legalization happened at all.
And finally, The New York Times looks into another myth about marijuana —that it can improve your sex life—and casts some doubts about taking the drug as an aphrodisiac. According to the paper, the research so far on the subject is so thin that it’s hard to say with certainty whether cannabis will increase or decrease desire or improve your sex life. It adds that anecdotal evidence suggests that the right dose and delivery method can make a positive difference with some people by enhancing the senses, but also warns that it could inhibit desire.
Psychedelic drugs are becoming mainstream, with calls for their legalization and more research into their impact and possible use in the treatment of certain mental health conditions such as depression anxiety, and PTSD. Now, scientists are focusing on psilocybin, the active ingredient in psychedelic mushrooms, as a promising treatment for drug and alcohol addiction, as well as tobacco, according to limited early studies. One of the reasons addictions are so hard to treat is that most are more than chemical dependency, with people suffering cravings long after short-term withdrawals have waned, as their brains often divert them back to the familiar territory of their addiction. Some experts say psilocybin addresses this psychological need. Still, it’s uncertain how effective using psilocybin to treat addiction is in the long term and whether some individuals are more likely to benefit than others. Some study participants had troubling experiences during their trips, and experts say that people should not be taking the drug outside of legitimate research studies or without medical supervision, so we should move ahead with caution to evaluate the potential of psychedelics.
Meanwhile, the House has passed a far-reaching bill to legalize marijuana on the federal level, but there is no clear pathway for the legislation to be approved in the Senate. It’s the second go-around in less than two years for the House on the measure, which was approved largely along party lines, with Democrats in favor and Republicans largely against. Known as the MORE Act, it would have decriminalized cannabis, scrapped some old marijuana-related convictions, and allowed states to make their own decisions about marijuana markets—which they are already doing anyway. The bill faltered mainly on the issue of whether the government should provide financial incentives to individuals and communities who were the most harshly impacted by the war on drugs; Republicans, for the most part, say no, while Democrats cast the MORE Act as a criminal-justice initiative. There’s little chance the bill would gather enough support to pass the Senate, and if the Republicans make gains in the midterm elections, the future of the legislation would be further in doubt. Currently, 18 states plus the District of Columbia have, on their own, legalized marijuana, and established robust commercial markets for both recreational and medical cannabis.
And finally, new data indicates that post-surgery opioid prescribing for kids has plummeted over the past few years, in the wake of research linking opioids to such harms as respiratory depression, and the risk of continued opioid use, when non-opioid painkillers work just as well. Once routinely ordered for children to relieve moderate pain after outpatient surgery from tonsillectomies or knee arthroscopy, prescriptions written for teens declined to 48 percent from 78 percent between 2014 and 2017, and for preschoolers to 12 percent from 30 percent, based on a study of more than 124,000 patients.
While some states are considering capping the potency levels in pot products, due to adverse health outcomes, Oregon is moving in the opposite direction—increasing levels to nearly twice as strong as those allowed under previous limits. The new cannabis rules allow licensed shops to sell edibles containing up to 100mg of THC, the psychoactive component of marijuana, per serving. For its part, a bill being considered in Colorado would more strictly regulate high-potency marijuana and limit how much pot a consumer could purchase in a day, following studies showing negative physical and mental health effects. Oregon doesn’t apparently care about such things, although the state’s Liquor and Cannabis Commission did warn that with higher potency products “consumers must know their limits,” and choose products that have the desired effect but not unwanted side effects. It’s not clear if product labels will be changed to reflect that warning to help guide consumers to the right edible. Stronger edibles could mean more cases of cannabis overconsumption, the agency said, as recent data showed that of the 386 cannabis-related calls to Oregon Poison Control in 2019, 34 percent were the result of edible consumption, and nearly half of the calls required further medical attention. We need more oversight, stronger regulations, and stricter caps on THC levels in order to protect public health.
The sprawling nationwide opioid litigation continues to move toward a conclusion, with a settlement agreement announced in Florida in which CVS Health will pay $484 million to settle opioid-related claims by the state—the first pharmacy chain to do so. Compensation will be paid out over 18 years and includes no admission of wrongdoing by the drug retailer. CVS and other pharmacy chains face hundreds of lawsuits involving the opioid crisis, in which the company has argued that they had tried to stop pills from being illegally diverted and followed procedures to comply with federal and state regulations. In the Florida case, Wallgreens did not reach an agreement and will go to trial in April; at the same time, lawsuits against drugmakers Teva and Allergan also reached settlements for $170 million and $134 million, respectively. Many of the thousands of lawsuits have been settled, or are nearing agreement, including a $6 billion deal with OxyContin-maker Purdue Pharma for its role in the crisis. More than 600,000 Americans have died of a drug overdose over the past two decades, a majority of them opioid-related.
And finally, one year after New York State legalized marijuana, a new Siena College poll finds that a majority of voters oppose ensuring that those with previous marijuana convictions, or their family members, get first dibs on cannabis retail licenses—a major component of the legislation. Strong majorities of Republicans, independents, voters outside New York City, and white voters give it a strong thumbs down, while Latino and Black voters approve. Giving preference to those with marijuana convictions is an attempt to redress wrongs that occurred during the failed war on drugs, in which a disproportionate number of drug arrests were in communities of color. As New York finally rolls out its legalization framework, which includes financial support for those most impacted by drug convictions, it also appears to be trying to avoid pitfalls encountered in other states that have seen designated “social equity” applicants struggle with issues like lack of capital or competition from deep-pocketed corporations.
Marijuana legalization and shifting cultural attitudes surrounding cannabis use are driving up positive marijuana tests among U.S. workers. According to a report by drug-testing lab Quest Diagnostics, nearly 4 percent of screenings for marijuana came back positive last year, an increase of more than 8 percent from 2020. That figure is up 50 percent from 2017, as the number of states that have legalized recreational cannabis grew from to 18 from eight, plus the District of Columbia. At the same time, the evolving legal landscape and ongoing labor shortage have compelled many employers to stop testing for marijuana altogether, and in some states, they are barred from factoring test results into hiring decisions. Overall, Quest reported that the proportion of U.S. workers who were positive for various drugs rose to 4.6 percent, the highest level since 2001. With legalization moving ahead, it’s important to lay down clear rules, regulations, and standards concerning marijuana use on the job to ensure workplace safety.
Meanwhile, if you’re wondering why marijuana sales have been soaring over the past two years—blame the COVID-19 pandemic, according to a report in the Guardian newspaper. Among the many shake-ups in the social order, the paper explains was the creation of a new cohort of pandemic-era stoners, not only due to the lockdowns but also the de-stigmatization of the drug and ongoing legalization. Legal marijuana sales increased by 120 percent in 2020 and 61 percent in 2021, with one report noting that Americans bought $18 billion worth of cannabis during the first coronavirus year.
And finally, a new study in the American Journal of Psychiatrfound that long-term cannabis users show deficits in cognition and small hippocampal volume by midlife. Results showed that long-term cannabis users’ IQ declined from childhood to midlife, with resultant poorer learning and processing speed relative to their childhood IQ, as well as memory and attention problems, that could not be explained by habitual use of tobacco, alcohol, or other illicit drugs.
Medical marijuana is legal in 36 states and its use has soared in popularity with easier availability and aggressive marketing touting the drug as a panacea for myriad health conditions, although there's scant scientific evidence to support those claims. Now, a new study from Massachusetts General Hospital, looking at users with medical marijuana cards, finds that pot use does not improve the symptoms of people suffering from anxiety, pain, and depression—as many medical marijuana makers promise—and may also lead to the onset of cannabis use disorder (CU), a condition of frequent marijuana use that impairs psychological, physical, or social functioning. According to the study, people seeking cannabis to treat symptoms of anxiety and depression were at the greatest risk of CUD, with symptoms such as difficulty overcoming drug tolerance. Overall, the research revealed that there can be negative consequences to using cannabis for medical purposes. As such, there is a need for stronger safeguards over the dispensing and use of medical cannabis, as well as better guidance to patients around a system that currently allows them to choose their own products, decide their own dosing, and often receive no professional follow-up care.
Big Tech aims to help those struggling with substance use, as startups in the new field of addiction tech attract investment and look for ways to aid in drug treatment and rehab. Dozens of addiction telemedicine startups already exist, offering consultations with a physician to obtain addiction medications, and many provide virtual rehab with digital cognitive behavior treatment through connected devices, peer support, and coaching, and even include mail-in urine tests to monitor compliance with sobriety. With more than 100,000 overdose doses during the past 12 months, it’s not surprising that Silicon Valley is turning its attention to addiction and overdose to gain a foothold in a potential $40 billion market for addiction-related products and treatment. But many experts say that while these may be helpful to some patients, flashy technology is not geared to expanding treatment options for the less privileged, and will never be able to reach those in the throes of addiction who are often on the wrong side of the digital divide and face issues such as lack of housing and low incomes.
Meanwhile, overdoses are spiking nationwide among the incarcerated, with drug deaths in Tennessee, for example, jumping more than eightfold in prisons in just the past two years. Nearly half were from the highly potent synthetic opioid fentanyl, which is circulating widely in correctional institutions. Until recently, fatal overdoses in Tennesse prisons were rare, but in the last two years at least 68 people have died from drugs in both state-run and for-profit facilities. Unfortunately, one of the most proven therapies for addiction, medication-assisted treatment (MAT), is nearly impossible to access in Tennesee prisons, with only five people in custody receiving MAT among 20,000 individuals in prison.
And finally, as the use of psychedelic drugs becomes more mainstream, fueling the growth of a retreat industry offering expensive treatments with hallucinogens, scientists say that the venom of a toad used in such therapies is putting the species at risk of population collapse. In a sign of the unintended consequences of the psychedelic resurgence, there is concern that the scramble to use the secretions of the Sonoran desert toads could lead to poaching, over-harvesting, and illegal trafficking. When the toad is threatened, it excretes toxins strong enough to kill a full-grown dog; a substance in those toxins can be dried into crystals and smoked in a pipe, producing an intense psychedelic experience. Like all such substances, these are powerful drugs with the potential to treat disorders such as depression and PTSD, but caution is advised as we are only just starting to research their full impact and whether they are safe and effective as a treatment.
The use of telehealth services grew rapidly during the COVID-19 pandemic, helping patients access care remotely during lockdowns and social distancing regulations. But as the pandemic eased, the use of telehealth has declined for outpatient care—except for mental health and substance use disorders. Data gathered from some 126 million patients found that mental health and substance use services by telehealth have remained elevated and continue to grow as a share of all telehealth visits, especially for rural residents who find it difficult to access medical services. At its pandemic peak, telehealth represented 40 percent of mental health and substance use outpatient visits; as in-person care returned, telehealth visits dropped off overall but remained at 36 percent for mental health and substance use. This reflects the potential of telehealth to increase access to drug treatment, and although this should not replace in-person care, it can help many individuals receive critical services.
Marijuana legalization was supposed to usher in a new era of cannabis retailing—making pot widely available for medical and recreational use, and a tool to advance social equity and help communities disproportionately impacted by the war on drugs. Well, things are not going exactly as planned. In California, for example, an early adopter of equity licenses to spur minority-owned businesses, entrepreneurs say they are facing a high rate of theft, vandalism, racism, and high taxes, which are eating into profits and making it hard to remain open. Some states legalized cannabis largely to stop cannabis-related arrests and ensure that those same communities can profit from the legalized industry. Fact is, as the New York Times reports, many of these entrepreneurs are struggling while the largely white-dominated industry is making a fortune. They say that thefts are on the rise, often by well-organized gangs, and that police often fail to respond, while high state taxes and difficulty obtaining financing add to their woes. As big players, including tobacco companies, have swooped in to take a large stake in the industry, we have seen rampant commercialization that often flouts state laws on advertising and marketing—including billboards along highways in California—and ads targeted to underage consumers.
Meanwhile, New York State is trying to get around some of these problems by making giving priority for retail marijuana licenses to those who have been convicted of a marijuana-related offense. Gov. Kathy Hochul has said that early business owners in the state’s projected billion-dollar marijuana industry will be those most affected by the nation’s decades-long failed war on drugs. They will also have access to stockpiles of the drug grown by local farmers to stock shelves, and storefronts leased by the state—all part of a $200 million effort by Albany to advance racial equity in the new industry.
Fatal overdose fatalities are soaring among the Black population, fueled by fentanyl and exacerbated by lack of treatment options and poor access to healthcare. New data from researchers at UCLA showed that through 2020, the rate of drug deaths among Black people eclipsed the rate in the white population for the first time since 1999. There were more than 15,000 overdoses in 2020 among Blacks, more than double the number from four years earlier, at a time when overdoses are soaring across the country to more than 100,000 over the past year. Researchers said the findings demonstrate the need to close gaps in access to drug treatment for opioid use disorder and harm-reduction services for Black communities, and that ending routine incarceration of drug users could help prevent fatal overdoses among people after they leave prison.
Meanwhile, Florida police have confirmed that several West Point cadets were among six young men who overdosed this week on what was believed to be cocaine laced with fentanyl while on spring break. There were no fatalities, but two of the cadets were in critical condition in hospital and on ventilators.
And finally, marijuana is almost legal in New York State—the law was passed last year, but regulations have not yet been worked out—yet that hasn’t stopped unlicensed vendors from setting up shops in New York City selling all manner of products, without any control or oversight. In Washington Square Park, for example, an open-air market has emerged, where sellers chat up buyers “as if welcoming visitors with canapés,” the New York Times reported. With sales now in a grey area, police and parks officials sometimes issue a summons for illegal vending, but largely ignore the new market.
As the sprawling, nationwide opioid lawsuits come to an end with massive settlement payouts going to local and state governments, the families who had lost loved ones to addiction and overdose have been heard for the first time. As part of the deal to end litigation against Purdue Pharma and its billionaire founding Sackler family, an extraordinary hearing took place that for the first time allowed victims’ families to confront three members of the family to express their pain and range and how they suffered. More than 600,000 Americans died from a drug overdose over the past two decades, many after becoming addicted to prescription painkillers such as those sold by Purdue and aggressively marketed as non-addictive. Speakers held up photos of the dead and hurled invectives at the Sacklers, cursed them for their greed, and called them cruel, callous, and murderers as the Sackler family watched and listened impassively on Zoom, not saying a word (by agreement, one family member was allowed to have the camera turned on). The Sacklers will pay nearly $6 billion over 18 years to settle thousands of cases against Purdue, but have never admitted responsibility for contributing to the opioid crisis, and are shielded from further civil lawsuits. The majority of money from all the cases—which include other drug manufacturers, as well as drug distributors and pharmacy chains—will go toward drug prevention and treatment programs, but the Purdue settlement also includes compensation for individual victims and parents of children born with neonatal abstinence syndrome, ranging from $3,000 to $48,000. As this sad chapter in American public health comes to an end, it’s time to focus on an addiction and overdose epidemic that is still raging—and requires our immediate attention.
Starting in 2023, Oregon will be the first state with widely legalized psychedelic drugs, and although the law didn’t approve psychedelic therapy, there’s already a burgeoning network of businesses, pharmaceutical companies, and nonprofits trying to get a foothold in what could become a booming industry. These include shops selling the drugs, training for psychedelic therapy, and operating clinics where the drugs would be used. This comes as the psychedelic legalization movement gains ground as a way to treat psychiatric conditions such as depression, and win FDA approval of drugs and treatment methods. While psychedelics have shown some promise in early research, it’s still not clear what effect they might have on patients, what controls are necessary, and how they should be used in mental health or clinical settings. Generally considered safe, psychedelics such as magic mushrooms also come with risks. They can be emotionally destabilizing, potentially exacerbate psychosis for people with pre-existing conditions, and create feelings of susceptibility. As more states consider legalizing these powerful drugs, we must ask serious questions about how to make them safe and accessible at scale—particularly for vulnerable populations.
One company that is backing psychedelic legalization is, unusually, the liquid soap maker Dr. Bronner’s, which has become one of the biggest financial contributors to the movement to win mainstream acceptance of these drugs. Since 2015, Dr. Bronner’s Magic Soaps has donated more than $23 million to drug advocacy and research organizations, following on from its hefty contributions toward cannabis legalization.
Two years ago a Food and Drug Administration crackdown had virtually wiped out the use of flavored e-cigarettes that had become a teenage favorite and fueled a vaping epidemic among young people. But the ever-inventive vaping industry managed to come back by swapping out one of the product’s key ingredients—tobacco-derived plants—and instead use synthetic nicotine, made in a lab, thereby circumventing FDA monitoring and oversight. The result: sales of highly addictive, disposable, flavored e-cigarettes are soaring, raising concerns about another teen vaping crisis and a new generation addicted to nicotine. Overall, sales of disposable devices filled with candy flavors and synthetic nicotine nationwide grew from nonexistent in 2020 to take up shelf space in two-thirds of U.S. vape shops, with sales of disposable fruit- and candy-flavored devices increasing by 290 percent to 56.5 million a month by the end of 2021.
Meanwhile, lawmakers are within striking are of closing the legal loophole that allows such companies to escape FDA oversight of vaping products containing synthetic nicotine. A draft bill would give the agency explicit authority to regulate such products, posing a challenge to vaping companies that switched to synthetic nicotine to defy the agency’s earlier crackdown on flavored e-cigarettes. The bill, if signed, would be a major win for tobacco control advocates who have urged the FDA to do more to regulate synthetics, despite its lack of authority. The FDA also made e-cigarette companies, including then-market leader Juul, apply for authorization to remain in the market, thereby limiting the number of products for sale.
The expanding legalization of recreational marijuana has led to wider availability of cannabis edibles—so much so that the pot-laced, candy-like products have replaced vaping as the stealth way for teens to get high, especially at school. Although legalization supporters promised safeguards to protect vulnerable populations, such as young people, the cannabis industry is failing to monitor and stop underage use. In Colorado, for example, which, like most states, has an age limit for the sale of cannabis products—21 for recreational use, 18 with a medical marijuana card—it is fairly easy for high schools students to get them from older siblings and friends, according to doctors and school officials, who say they are finding edibles more often on school premises.
Edibles are popular because, unlike joints and even vape pens, with their puffs of smoke and distinctive smell, they are almost impossible to spot, and can look just like regular candy and cookies. They are also more likely to lead to overconsumption: one small cookie or gummy can contain multiple oses of THC, the psychoactive component of marijuana. And since edibles take an hour or more to kick in, impatient kids can easily ingest too much.
Also concerning is that kids view edibles as less dangerous than smoking or vaping because they are not inhaled, and they, therefore, underestimate the potential for harm. But they are dangerous, with one candy bar or cookie packing about 10 doses of THC, five times the standard unit of 5 milligrams. There is a growing body of evidence confirming the negative impact of THC on the developing brain, and its links to poor performance in school and deficits in attention and memory. But this apparently means little to the booming cannabis industry, which still markets marijuana as an essentially harmless product. It’s time for states, which are leading the legalization charge, to implement stronger measures to control underage use and to protect young people.
After years-long litigation, members of the billionaire Sackler family and their company, Purdue Pharma, have reached a nearly $6 billion deal to settle thousands of lawsuits against the company for its role in the opioid epidemic. Under the agreement, the Sacklers won immunity from further civil prosecution—one of the final sticking points—but not from possible criminal liability. The family agreed to add $1 billion to the settlement, and also to issue a so-called apology statement in which it expressed “regret” that its drug OxyContin “unexpectedly” became part of an opioid crisis. Family members have never acknowledged wrongdoing or any personal responsibility for the public health crisis, which has killed more than 600,000 Americans over the past two decades.
If approved by a bankruptcy court judge, the deal brings to an end a series of sprawling and contentious legal battles in which pharmaceutical companies such as Purdue were blamed for fueling the crisis by falsely marketing their highly addictive prescription painkillers as safe. The last hurdle for eight holdout states was accepting the additional $1 billion, as well as the Sacklers agreeing to their demand for a hearing that would allow people who suffered from addiction to OxyContin to describe what they endured, with at least one member of the Sackler family present. Also, the Sackler name—long associated with philanthropy—would have to be removed from cultural and other institutions if asked to do so.
The holdout states will receive a bigger portion of the settlement payout, which will go toward drug treatment, education, and prevention programs, as well as smaller payments to more than 100,000 individual victims. The Sacklers did win more time to distribute the extra money—now to be doled out over 18 years—with the remainder coming over the next 9 years. Experts say the states eventually agreed to the conditions of the deal because they didn’t want to fight another lengthy legal battle, and with the addiction and overdose crisis raging, they need the money sooner rather than later. But others believe the Sacklers are getting off easy, without any accountability for their actions and the pain and deaths they have caused. Still, with other opioid lawsuits also being settled for billions of dollars—including those against drug distributors and pharmacy chains—there will now be significant funding available to fight the epidemic and help those struggling with drug abuse.
President Biden’s Unity Agenda, unveiled in his first State of the Union Address, included a pledge to combat the opioid epidemic and help those struggling with drug addiction. While no new programs or initiatives were outlined, he called for increased funding for prevention, treatment, harm reduction, and recovery. In particular, he suggested getting rid of outdated rules that stop doctors from prescribing treatments for opioid use disorder, and for law enforcement to stop the flow of illicit drugs by working with state and local officials to go after traffickers. He reached out to those suffering from drug addiction, telling them “know you are not alone,” and he celebrated the 23 million Americans who are in recovery. No new programs or initiatives were outlined, such as a proposal in 2020 by then-candidate Biden to launch a $125 billion effort of the next decade to fight the opioid epidemic.
Psychedelics are emerging as a promising new field of research for possible benefits to treat conditions such as depression and PTSD, but studies have mostly focused on full doses of powerful drugs such as psilocybin. Now, however, the concept of micro-dosing psychedelics has become popular, with many claiming that small amounts enhance feelings of attention and cognition, well-being and relief from anxiety. Yet as more and more consumers dabble with these drugs, scientists are warning them to be careful, as evidence is still limited about their effect, and there’s no proof they help people—or if there’s any positive impact at all. Much of early research has been anecdotal, consisting of enthusiastic survey responses from users, but these have been small studies that did not compare a microdose to a placebo. The studies are therefore tied to users’ expectations and not reliable, so caution is required when using psychedelics, especially when it comes to sourcing and accurate dosing. There is a growing movement to decriminalize such drugs—but we should first conduct clinical trials to ascertain whether widespread use of psychedelics, in full or microdoses, poses a public health risk.
Meanwhile, although more than two in three Americans support legalizing marijuana, and a majority of states have legalized the sale of either recreational or medical cannabis (or both), federal-level legalizationstill appears to be far off. Although Democrats currently control Congress and the White House—which pro-pot groups believed would usher in a new era of cannabis reform—the Biden administration has been slow to move on the issue. And with midterm elections coming up, and the Democrats portrayed as soft on crime relaxing marijuana laws is not a priority. Also, some moderate Democrats say they want to see more research before legalizing at a time when rates of abuse of other drugs have risen, along with a surge in overdose in opioid-related deaths. President Biden has essentially avoided the issue, having previously supported allowing states to legalize on their own but not addressing marijuana’s status as a controlled substance.
And finally, the lack of federal legalization isn’t stopping the growth of marijuana sales—especially for cannabis-infused beverages, which are regarded among enthusiasts as a less invasive way to consume the drug. A report in Forbesnotes that while the flower market share is declining in both the U.S. and Canada, the beverage category is one of the new product categories that saw positive market share growth, up 45 percent last year. As the rapid commercialization of cannabis follows legalization, expect more innovative marijuana products to go on sale—hopefully with oversight from government agencies.
Two cases involving doctors who were prolific prescribers of prescription opioid painkillers, and are currently in prison on charges related to pill mills, are going to the Supreme Court. The doctors doled out hundreds of thousands of prescriptions for quick-release fentanyl drugs for common ailments such as neck aches, and back and joint pain, disregarding guidelines stating that the drugs were approved for severe pain in cancer patients. They’re doing up to 20 years time in federal prison and paying millions of dollars in fines, and their assets have been seized. Now lawyers want the convictions overturned, arguing that the criminal standard the physicians faced was applied inconsistently among federal circuit courts. Experts say there’s little chance the doctors would be set free, but the court’s decision may impact the latitude medical professionals can take in prescribing potentially addictive painkillers and other addictive medications. It also raises questions about how well-meaning doctors might also be negligent, and where this stands in criminal law, with some saying they were acting as drug dealers. The opioid epidemic started with the overprescribing of these drugs, but even after strict prescription monitoring was introduced, the rate of overdose deaths has skyrocketed to record levels.
Three of the nation’s largest drug distributors have agreed to go ahead with a nearly $20 billion settlement of the majority of opioid lawsuits filed by state and local governments, bringing to an end a years-long legal battle over their role in the opioid epidemic. The three companies—AmerisourceBergen, Cardinal Health, and McKesson—will pay out the money over the course of 18 years to communities affected by the abuse of prescription painkillers. The deal covers about 90 percent of the lawsuits against the companies and comes as thousands of other cases against drug manufacturers and pharmacy chains are also headed toward some form of settlement. Under the agreement, the money must be spent on social services to address the harms of opioid addiction, such as treatment programs, education, prevention, addiction programs for the homeless, or for opioid-addicted babies. The settlement payouts provide a huge opportunity to address the addiction and overdose crisis and the staggering rise of fatalities to more than 100,000 annually.
Meanwhile, New York Magazine reports from the nation’s first supervised syringe sites in New York City, part of an effort to introduce harm reduction programs as the overdose fatality rate soars, both in the city and across the country. So far, the sites have saved more than 100 lives, by providing substance users with a safe setting for intravenous drug use, including clean needles, medical personnel, and fentanyl test strips. However, the sites do not provide drug treatment; instead, they hand out information about treatment and can refer a patient if they voluntarily want to try rehab. While such sites save lives, the lack of focus on treatment means they don’t really change lives, as the user will return to a life of drug use. If cities are experiencing high rates of drug overdose deaths and are looking to New York as a model, to be most effective and better serve their patients they should include a bridge to treatment as part of the harm reduction effort.
And finally, a new poll shows that while most parents do not know much about the cannabis-derivative CBD, the non-psychoactive component of the drug, they would be open to giving it to their kids under certain conditions. An overwhelming majority said they would consider CBD for treating anxiety, sleep problems, ADHD, and even autism, although there is only one FDA-approved product that contains CBD, and that’s for children with a rare form of epilepsy. The parents, however, would also like to know more about possible side effects and have the drug regulated by the FDA and prescribed by a doctor. CBD is widely marketed as a cure-all for any number of ailments—from insomnia to PTSD and stress—despite the fact that there is little scientific evidence that it is safe and effective for any of these ailments. The FDA is considering new rules and regulations for CBD sales, in response to the wave of false marketing claims by companies that sell the product.
Nearly 300 Americans die every day from a drug overdose, but instead of confronting this tragic public health crisis politicians from both parties are spreading misinformation about the goal of harm reduction programs—thereby endangering the Biden administration’s addiction policy. The latest fracas erupted after a conservative newspaper alleged that federal funds would be used to distribute “crack pipes” as part of safe smoking kits, which contain clean syringes, fentanyl testing strips, as well as sterile pipes to encourage addicts to switch from intravenous drug use to smoking, as that is considered a safer option. Yet instead of applauding this science-backed approach to help those struggling with substance use, politicians accused the administration of handing out "crack pipes" to Black communities—a racist trope in itself going back to the crack epidemic. There’s no evidence whatsoever that Biden wanted to do any such thing; no matter, this led to frenzied media activity and the introduction of legislation to curb the distribution of the kits, and the first federally-financed harm reduction programs. Harm reduction by itself is not a panacea for addiction or the overdose crisis, but it is a critical step to save lives, and ideally, engage patients in drug treatment programs.
Meanwhile, the Sackler family says it’s offering another $1 billion to sweeten the deal to end sprawling opioid litigation against Purdue Pharma, bringing the total to about $6 billion. But there’s a catch: the billionaire family members still insist that the settlement include a provision to shield them from any further civil liabilities—a demand that has already been rejected by 8 states and the District of Columbia (more than 30 states have said ok to the offer). It’s not clear if the extra $1 billion will help persuade the holdouts to settle, leaving the litigation in limbo, while at the same time, other opioid cases against drug distributors and pharmacy chains head toward a conclusion. While this settlement money—to be doled out over more than a decade—is badly needed by states and local authorities to pay for drug treatment and prevention programs, and to compensate victims’ families, it should not be a substitute for a massive increase in federal funding that can help people right now and reduce overdose deaths.
And finally, although there’s no scientific evidence showing that medical marijuana is effective to treat opioid addiction—that isn’t stopping a number of cannabis companies in Pennsylvania from saying it does and promoting pot as a substitute for opioid withdrawal medications. An investigation revealed that the companies use a wide range of misleading tactics, cherry-pick data, misrepresent only parts of studies, and make broad claims without citing scientific research. Most alarmingly, they suggest that medical pot can be a viable substitute for buprenorphine, one of three FDA-approved drugs to treat opioid use disorder, which health experts say can be dangerous for patients. If states are going to legalize marijuana, they must closely monitor and push back against false marketing claims that may be detrimental to consumers.
Lawmakers have asked the Department of Justice to explore whether criminal charges should be brought against members of the Sackler family who control Purdue Pharma, opening a possible new front in sprawling nationwide opioid litigation. The senators made their move as a potential $4.5 billion settlement between the Sackler family and prosecutors in some 3,000 lawsuits hangs in the balance. That settlement initially included a provision shielding the family from further liabilities, a clause that angered victims’ families and was recently rejected by a judge. In pressing their action, the senators noted that the Sacklers directed and oversaw operations and marketing that falsely claimed its premier product, OxyConton, was non-addictive, which fueled the opioid addiction and overdose crisis. Whether the Justice Department will take up the matter isn’t clear, nor is how this would impact other billion-dollar settlements.
Meanwhile, Pew Trusts has released an in-depth look at the addiction crisis, and how the states should address it. First, they must expand their treatment offerings and remove unnecessary regulations so that more people can access life-saving treatment for opioid use disorder. Although medication is the most effective treatment for OUD, only a fraction (just 18 percent) of the 1.6 million people with OUD receive medication. Pew also calls for more flexible approaches to treatment—such as mobile methadone treatment, to make access easier— and to provide integrated medical and mental health care.
And finally, one of the hallmarks of marijuana legalization laws approved by states is the opt-out provision, allowing municipalities to ban cannabis businesses in their neighborhoods. Although polls show that a majority of Americans generally favor legalization, in most legal states a majority of localities have nevertheless opted out and said no to dispensaries as well as on-site consumption lounges, fearing an uptick in drug use and a negative impact on vulnerable populations, such as young people. Now, however, the powerful cannabis lobby in California appears to be mounting a campaign to rescind the opt-out provision, arguing that this has led to a growth in the illicit market for pot. Citing a “disappointment gap" between what legalization promised and today’s still booming black market, an industry lobbyist says that today there are fewer licensed retail outlets in the state than there were before cannabis reform. Not a very compelling reason to take away the right of communities to say they don’t want pot stores in their backyard.
The death in 2019 of 27-year old Los Angeles Angels baseball player Tyler Skaggs from an opioid overdose raised serious questions about drug use in Major League Baseball. Now, the trial of a communications executive accused of supplying drugs to the player (he has denied the charges) is revealing the possible extent of drug-taking in the majors. According to trial testimony, four other players have come forward to say they too used opioids while playing for the Angels, pointing to the prevalence of drugs inside the game. This is putting increased scrutiny on the Angels for failing to recognize what was happening in the clubhouse and the league’s efforts to address opioid addiction in its ranks. Players began mandatory opioid testing only in 2020, decades after the opioid epidemic was sweeping the country, and now kills more than 100,000 Americans a year. Given the extent of the opioid problem across the country, experts say it was inevitable that opoid use was more widespread than previously known. Baseball players and other professional athletes could be particularly susceptible to opioid addiction, as they must frequently deal with pain and the pressure to perform in spite of it.
With more than 100,000 American deaths from a drug overdose over the past 12 months, the New York Times looks at the root causes behind this tragic crisis, noting that the U.S. is the only developed nation in the world dealing with a comparable problem. It blames the crisis on the easy availability of prescription painkillers over the past decades, followed by the wave of heroin use after prescription monitoring was put in place, and the current situation in which the powerful synthetic opioid fentanyl is fueling the surge in overdose fatalities. Compounding the problem, the Times observes, is that Americans have insufficient access to both mental health and drug treatment. A better treatment network would have mitigated the damage—but the U.S. has never had such a system. Over time, the lack of leadership and resources to confront addiction and overdose has led us to the current public health crisis, in which we have effectively made it easier to get high than to get help, the article notes.
Meanwhile, Forbes reports that tech giant Apple has quietly swung its support and corporate muscle behind cannabis reform—joining Amazon and other companies in efforts to open a federally legal, commercial cannabis industry across the U.S. For years, large tech companies such as Facebook and Google didn’t get involved in marijuana policy, but that changed over the summer when Apple, without much fanfare, changed its policy to allow apps handling the sales and delivery of both medical and recreational cannabis in legal marijuana states. Not surprising that corporate America is backing legal pot, as more and more states adopt legalization. But they should also be lobbying for tough rules and regulations governing this booming market, in order to protect vulnerable populations such as young people.
And finally, many people who consume marijuana say it helps them stave off nausea during pregnancy and treatment for cancer. But new studies show that for some daily, long-term pot users the effect is the opposite: nearly uncontrollable vomiting. The condition, known as cannabinoid hyperemesis syndrome, is receiving more attention with the growing use of marijuana in legal states. Those with the syndrome can suffer bouts of vomiting so severe that they may need to be hospitalized along with dehydration, weight loss, and life-threatening electrolyte disorders—shattering the image of the drug as a largely benign substance.
More than 300 Americans die every day from a drug overdose, but instead of focusing on this public health crisis Republicans and right-wing media have been whipped into a frenzy over government grants to supply people with safe smoking kits, among other harm reduction measures. According to the misinformation campaign, the smoking kits—along with overdose reversal medication, fentanyl test strips, and infectious disease testing supplies—are allegedly aimed at handing out crack pipes to the Black community. While this is patently false, and based on racist tropes perpetuated during the crack era which disproportionately impacted Black people, Fox News, and Republican politicians, are claiming that Biden wants more “Black people to smoke more crack and meth.” In fact, safe smoking supplies, distributed through harm reduction programs, is an evidence-based practice that helps people who inject drugs to switch to smoking, which is considered a less risky mode of consumption. Other benefits include reduction of injection-related harm and risks such as infection and blood-borne disease transmission, as well as reduced risk of overdose, as inhalation involves lower doses of the drug. At a time when more than 100,000 Americans have died of a drug overdose in the past 12 months, spreading lies about giving crack pipes to Blacks diverts us from the critical task of confronting the tragic addiction and overdose crisis.
As the nation grapples with addiction and opioid-fueled overdose epidemic, the federal government has proposed new guidelines for prescribing opioid painkillers in the first comprehensive revision of the rules since 2016. The CDC proposalremoves a previously recommended ceiling on doses for chronic pain patients, while also urging physicians to first turn to “nonopioid therapies” such as over-the-counter ones like ibuprofen as well as physical therapy, massage, and acupuncture. The guidelines—which do not apply to patients suffering pain from cancer, sickle cell, or end-of-life palliative care—remove lower dosing levels that many chronic pain patients felt were unfair, but which led to a large reduction in prescriptions as part of efforts to curb the opioid epidemic. The CDC wants doctors to have more flexibility on dosing, while clearly stating the potential risks of prescribing highly addictive opioids.
Meanwhile, the Supreme Court will address a related issue when it takes up the case of two doctors convicted of unlawfully dispensing opioid painkillers. The question before the court is, what threshold do physicians have to cross—and what sort of intent do they need to have—for prescribing to be considered a crime? Doctors are free to prescribe controlled substances such as opioids, but can also be criminally liable if they prescribe the medication in dangerous ways. Health officials are grappling with these questions in the wake of the opioid epidemic, which was fuelled by massive overprescribing of prescription painkillers.
And finally, the American Heart Associationsays that despite the perception that marijuana is harmless, there’s a growing body of evidence challenging that belief, and there are many unanswered questions about its impact on brain health. At a time when both recreational and medical marijuana is more available due to legalization, current research suggests that actively using the drug can impact verbal memory, driving ability, cognitive functions in children, as well as clot-caused stroke.
Drug overdose deaths are surging across the U.S., driven by the powerful synthetic opioid fentanyl. But fatalities are also increasing due to a combination of opioids and stimulants such as cocaine and methamphetamines—and when looked at along racial lines, the number was even more dramatic among Black Americans, according to new research from NYU Langone. While overdose fatalities from opioids and stimulants rose across all racial groups and across the country, Black Americans died at three times the rate as non-Hispanic White people—particularly in eastern states. Investigators found that the rate of Black overdose deaths climbed by 575 percent, compared to 184 percent for White people. The report blamed a lack of access to healthcare and substance use disorder treatment services as the main cause of the increase.
Meanwhile, a report released by a congressional commission estimated that the opioid epidemic costs the U.S. roughly $1 trillion annually, up from $700 billion just a few years ago. The estimate is based on the fact that overdose fatalities have more than doubled in recent years, from about 44,000 in 2013 to more than 100,000 last year—and now outpace deaths from firearms, suicide, homicide, or car crashes. The report recommends expanding mental health services and access to treatment for those suffering from addiction.
And finally, the same report named Mexico as the main source of deadly fentanyl in the U.S., and warned that if policies are not changed to address the challenges of the addiction and overdose crisis, more lives will be lost. Last year, fentanyl accounted for nearly two-thirds of the more than 100,000 overdose deaths, as the powerful synthetic drug was taken directly by addicts or mixed by dealers into other drugs unbeknownst to users. While China had previously been the dominant source of fentanyl, Mexico is now the primary supplier, with the drug produced cheaply there and easily transported over the border.
A bipartisan congressional commission is urging the Biden administration to adopt a strong leadership role to fight the nationwide addiction and overdose epidemic, as part of a new multi-pronged strategy. With overdose fatalities at record levels—more than 100,000 over the past year alone—the commission’s report says the anti-drug effort requires Cabinet-level leadership, including reinstating the White House “drug czar” and the Office of National Drug Control Policy to a cabinet post in order to direct a far-reaching federal effort. The strategy should include law enforcement as well as expanding evidence-based treatment and establishing pathways for addicts to re-enter society and rebuild their lives. The Rosenthal Center has long advocated such measures, including reinstating the ONDCP and drug czar positions to the cabinet to oversee and coordinate sprawling state and federal programs. Whether President Biden eventually will act on these recommendations is uncertain, as he has so far shown little interest in significantly expanding the government’s role in fighting addiction, boosting funding, or reforming the structures that are currently in place to confront the addiction and overdose crises.
At the same time, what the Biden administration has spoken out about is the importance of advancing harm reduction programs, which have received much media attention recently with the opening last year in New York City of the country’s first safe injection sites, otherwise known as overdose prevention centers. This happened after a long legal battle with federal authorities, but now it appears that the Justice Department is signaling a change in policy that would allow these types of facilities to flourish. The Department says it is currently evaluating such sites and looking into what appropriate guardrails would be needed to safeguard public health—a drastic change in tone after vigorously fighting harm reduction programs in the past. Safe sites have existed for decades in Canada and Europe, and while these facilities are critical to saving lives they fail when it comes to engaging substance users and encouraging them to enter treatment. If safe sites are to expand on a national level we need to ensure they not only reduce harm but also become a bridge to life-changing treatment
Opioid litigation settlements are coming at a rapid pace, with the latest deal valued at $590 million dollars between more than 400 Native American tribes and opioid maker Johnson & Johnson, and three of the nation’s largest drug distributors. Native American communities, which were hard hit by the opioid crisis, accused the companies of fueling the crisis, causing tribal governments to spend millions of dollars in healthcare, social services, and other costs. The deal follows a separate $26 billion settlement last year between the same companies and state and local governments, which were among some 3,300 lawsuits blaming the wholesalers for failing to monitor shipments and J& of downplaying the risk of highly-addictive opioids.
As part of the settlement, the wholesalers — McKesson, AmerisourceBergen, and Cardinal Health— will pay nearly $440 million over seven years, while the Janssen unit at Johnson & Johnson agreed to $150 million over two years. This is a significantly faster timetable than in previous settlements with states and local governments. By contrast, the drug manufacturer will pay thousands of local governments and states $5 billion over nine years, with the distributors paying $21 billion over 18 years. The money will go to tribal governments for education, prevention, and treatment programs that have been sorely lacking within the Indian health service.
Native Americans suffered the highest per capita rate of opioid overdoses, the highest drug overdose death rates in 2015, and the largest percentage increase in the number of deaths over time from 1999 to 2015 compared to other racial and ethnic groups, according to federal government data and statements made at a congressional hearing. Even as settlements are made, the addiction and overdose crisis continues, with more than 100,000 Americans dying of an overdose in the 12-month period ending this April. While the settlement money is welcome, and will eventually help slow the rate of fatalities, we also need massive government funding now to confront this ongoing public health crisis.
One of the many myths of marijuana legalization was that it would end the black market for pot and the illegal drug trade—at least, that’s what pro-cannabis supporters have promised. But that’s not what has happened: some of the states with the largest legal markets are dealing with rampant illegal production. So much so that legal states such as Oregon and California are still furnishing the majority of America’s illegal weed, and the black market is booming across the country, according to a report in Politico. In California, most of the state continues to purchases pot from unlicensed sources. What is happening in the woods of southern Oregon—which has become a center for illegal cannabis grow farms, as well as drug cartels—is one of the most confounding paradoxes of legalization. Illegal farms scare local residents, scar the landscape, and attract criminal activity. Some say it’s an economic problem, due to high taxes on legal weed, but critics argue that legalization has created greater demand, thereby attracting more sellers, both legal and illegal.
Meanwhile, the opioid addiction and overdose epidemic continues unabated, with Washington, D.C. reporting a 46 percent increase in 2020 from the previous year. Recently, there were 10 overdoses in the District in a matter of hours—three of them fatal. Before the pandemic, Mayor Muriel Bowser promised to cut the number of opioid deaths in half, but now such fatalities outpace homicides. Health officials say that two years ago, most of the cases in D.C. were 18 to 26 years old, but today that has shifted to 46 to 55-year olds, many of them with medical conditions that make an overdose harder to survive.
And finally, the Sackler family, founders of opioid maker Purdue Pharma, are said to be near an agreement upping their share of a settlement to resolve years-long opioid litigation. Reports say the Sacklers might boost their more than $4 billion offer in order to overcome objections from 8 states who opposed the deal because it shielded the family from further legal liability. Recently, a judge agreed with this claim, noting that members of the Sackler family had not individually filed for bankruptcy protection. Billions of dollars in settlement money are currently in the pipeline from the sprawling litigation against opioid manufacturers, drug distributors, and retail pharmacies, with the money going toward drug prevention, education, and treatment programs.
With drug overdoses at an all-time high in the U.S., a new study sheds light on the path many patients take from their first opioid prescription to a fatal overdose. A study of more than 236,000 adults identified several factors that people had in common: they were more likely to be men, over 75, insured by Medicaid or Medicare, and have substance use disorder or depression and underlying medical conditions. In addition, they were at higher risk if they were first prescribed oxycodone or tramadol, and fill their prescriptions at three or more pharmacies. Flagging these factors, the study noted, might help doctors see which patients are most likely to be harmed when given these drugs.
Meanwhile, a recent analysis of previous research on the impact of cannabis on young people’s cognition finds that many of the known learning and memory difficulties—such as slowed processing speed, and difficulties in focusing—could linger for weeks. Verbal learning, retention, and recall were especially affected for longer periods when the person was no longer high. There’s also a suggestion that cannabis use in teen and young adult years, when the brain is especially vulnerable, may have lasting residual effects, such as poor academic and job performance.
And finally, despite such findings of the impact of pot on teens, the cannabis industry continues to flout rules and regulations intended to curb marketing to this age group. In fact, many recreational marijuana companies market their product in a way that specifically appeals to children and teens, and is also easily viewed by people of all ages on social media platforms, according to a new study. It found content designed to appeal to youth culture—with young models or recognizable characters—or budget limitations, such as promotions and discounts, despite current regulations. Many pot companies generate dozens of social media posts per day, and there is currently no system in place to monitor them and enforce rules. As more and more pro-pot groups tout safety precautions in the push for legalization, such studies point to the industry’s flagrant disregard for the health of consumers—especially vulnerable populations including young people.
More than 1,500 municipalities across New York State decided at the end of 2021 whether to opt-out of allowing marijuana businesses, with about half of all cities, towns, an villages banning dispensaries and 57 percent saying ‘no’ to on-site consumption lounges. Although pro-pot groups like to point out that an overwhelming majority of Americans favor legalization, there is still much debate when it comes to opening neighborhood cannabis businesses. In New York, many of these local discussions led to fractious board meetings, strident social media posts, and political challenges from citizens and interested groups, reflecting the depth of divided opinions about cannabis reform. Those who want to opt out cite the following reasons: state regulations are not yet complete, a fear of encouraging drug use, especially for young people; changing the character of a town; and finally, worries about drugged driving. Supporters point out the economic benefits of job creation and tax revenue. As legalization is likely to move forward in a slew of states this year, this debate is far from over.
Meanwhile, concerns about drugged driving in the age of legal weed is not an overreaction, at least according to yet another study about the impact of marijuana on driving. The research, published in JAMA Psychiatry, showed that regular cannabis users may be driving more impaired and for longer than they may think. Worse driving performance is evident for several hours post smoking in many users, according to the study. What’s more, the consistent and frequent use of cannabis negatively affects cognitive function and reduces driving ability. Those in the study who had smoked THC, the psychoactive component of pot, showed reduce driving performance including being more likely to leave their lane, and this persisted even after three hours, in which they showed lingering signs of impaired driving ability.
And finally, in addition to avoiding drugged driving, you may also want to avoid marijuana when pregnant, as yet another study makes very clear. Published in JAMA Open Network, the analysis found that people who smoke marijuana during pregnancy are at a higher risk for having low birth weight babies and preterm delivery, among other complications, compared to those not exposed to the drug. The drug takers are also more likely to require admission to neonatal intensive care units due to birth complications. This latest report adds to a growing body of evidence underscoring the risks and dangers of marijuana during pregnancy, and the potential harm it may cause to your baby.
In or out? That was the question for more than 1,500 municipalities across New York State under its new marijuana law, which asked localities to decide whether to allow cannabis businesses in their areas. With the final count in, the State Office of Cannabis Management says that 34 percent of all municipalities have said no to both dispensaries and on-site consumption lounges, including 10 percent of all cities with a total population of almost 120,000. Although polls show that Americans overwhelmingly favor marijuana legalization, legal states including Colorado, California, and Washington have seen large numbers of local governments opt-out, citing reasons such as the potential for negative impact on vulnerable young people and the danger of drugged driving. In New York, any municipality that has initially said no can opt back in at any time.
Meanwhile, the American Lung Association warns in its annual tobacco report that while adult smoking rates have fallen from 22 percent in 2003 to 14 percent in 2019, vaping and flavored cigarettes products threaten to turn back the progress made in reducing tobacco use. The organization notes that high school smoking rates have dropped significantly since 2002, but that more than 2 million high school and middle school students said they use e-cigarettes in 2020. The report says that companies are exploiting loopholes in regulations by introducing products with synthetic nicotine, some of them flavored, that have become the most popular e-cigarette products among teens. The Association has called on the Food & Drug Administration to regulate synthetic nicotine as a drug.
And finally, the movement to decriminalize possession of hard drugs is growing across the U.S., with states including Massachusetts, Vermont, and possibly California considering following the lead of Oregon, the first state to do so. In an opinion piece in the New York Times, Maia Szalavitz writes that these states are coming around to the conclusion that it is impossible to treat addiction as a disease and a crime simultaneously. Noting that 80 percent of prisons and jails offer medications to treat substance use, she says the lack of treatment while incarcerated deters people from seeking further help. However, it’s still too early to evaluate the effectiveness of Oregon’s approach, which includes a significant expansion of treatment availability that has not yet happened. So far, however, very few of those who have been cited for possession make a required follow-up call to get the required treatment evaluation.
America’s longest war is the war on drugs—and we lost. That’s the focus of a thoughtful essay in the Wall Street Journal, looking at the losses over the past half-century: untold lives and billions of dollars spent on both law enforcement and the military. Since President Nixon’s declaration of war in 1971, drug use has soared in the U.S., drugs are more potent than ever, and the power of criminal narcotics gangs has exploded. Accidental overdoses kill more than 100,000 Americans a year, and the powerful synthetic opioid fentanyl has now killed far more people than all U.S. conflicts since World War Two combined. We declared war on drugs—and drugs won. The way forward, the article suggests, is to focus less on law enforcement and decriminalization and more on a health-based approach, with special attention to medication-assisted treatment.
Meanwhile, New York State’s cannabis control board has quietly revised regulations so that a licensed practitioner can certify a patient for medical weed for any condition they believe the drug can treat—rather than from a list of approved conditions. This change will vastly expand the market for medical marijuana and also pose risks to patients. Not that the list of conditions made much sense anyway: doctors could, for example, certify pot for those suffering from Alzheimer’s disease, although patients-rights groups warn that there’s no scientific evidence showing that cannabis is an effective treatment, and might even be dangerous. Now, a doctor can simply say they believe pot will help with whatever is ailing a patient and issue a medical cannabis card, without any clinical data to back that up. So much for science and best medical practices.
And finally, the recent social media frenzy surrounding a study purportedly showing that cannabis can stop COVID is yet another example of how the hype and promise of pot products far outweigh the reality. The researchers stressed that the early-stage study was not definitive, and would require clinical trials and that consumers should not turn to untested pot products in hopes that it might protect them from the coronavirus. These facts, however, did not stop widespread media attention and speculation that smoking a joint would keep you safe from the disease.
With the nation experiencing a record number of drug overdoses, former U.S. Rep. Patrick J. Kennedy has taken the Biden administration to task for not doing enough to confront the overdose and addiction crises—and has called on the president to announce a “coordinated federal strategy to address it. Reviewing the first year of Biden’s presidency in a commentary in The Hill, Kennedy fault the administration for describing the small incremental changes as progress, and urges the administration to invoke every power of the executive branch to reverse the trend of fatal overdoses. A new strategy should focus on several areas: widen the availability of overdose response resources; shut down illicit fentanyl mills; provide insurance parity for mental health and substance use, and increase access to medication-assisted treatment (MAT). Finally, Kennedy says Biden should show leadership at the federal level to guide policies and programs for state and local governments.
Meanwhile, NPR looks at new studies that add to a growing body of evidence confirming that drug treatment works—and that most people who experience alcohol and drug addiction not only survive but eventually recover and go on to live full and healthy lives. Studies show that life after addiction is not only possible, it’s the norm: Roughly 22.3 million Americans—or more than 9 percent of adults—living in recovery after some form of substance use disorder. Unfortunately, most Americans only see the destructive side of addiction, rather than those who make it through rehab to rebuild their lives. Both available data and live experience contradict a widespread misperception that substance use disorder is a permanent and often fatal affliction, when in fact people who use hare drugs for long periods do typically recover.
And finally, AARP reports there has been an alarming increase in fatal overdoses among older adults, with nearly 80,000 Americans age 55 and older dying due to an opioid overdose between 1999 and 2019. During this time, the number of those in this age group who had died spiked from just over 500 to more than 10,000. The surge in fatalities was due to a number of factors, including an increase in the number of opioids used to treat chronic medical conditions—such as arthritis and cancer, among others—most commonly diagnosed in this demographic, as well as a lack of screening for substance misuse among older adults.
A series of new studies and reports contributes to a growing body of evidence about the potential risks and dangers of marijuana and its derivative products containing CBD, the non-psychoactive component of the drug. In many cases, the findings contradict the claims of the marijuana legalization movement and the booming CBD industry. In one study published in JAMA Psychiatry, researchers looking into the “substantial and alarming” increase in suicide attempts in the U.S. over the past decade found that the largest increases were among women, young adults, and those who regularly use substances such as alcohol or cannabis. As more and more states legalize marijuana, pro-pot groups continue to falsely assert that pot is a mostly benign substance.
Meanwhile, the problem of drugged drivingwas addressed in a Canadian study looking at the prevalence of psychoactive THC in drivers who were moderately injured in traffic accidents. The result: the number had more than doubled since cannabis legalization in the country, which bolsters existing data showing an increase in driving-while-drugged traffic accidents in legal pot states and underscoring concerns that legalization is likely to lead to more injuries and death. Currently, there are no devices available to accurately measure the presence and level of marijuana and THC in the body.
Finally, as the market for CBD products continues to grow amid little or no government or industry regulation, a studyshows that consumer CBD products vary greatly in formulation, purity, and label accuracy—with beverages being particularly inconsistent. Many of these products also contain THC. Overall, the products—often touted as a panacea for stress, insomnia, pain, and other conditions, without scientific backing—show inconsistent labeling and vary in their label claims, thereby exposing patients and consumers to risks such as side effects, interactions, and failed drug tests. It’s time for federal agencies and public health organizations to finally crackdown on the CBD industry’s dubious claims and dangerous marketing.
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 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.
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.”
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.
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.
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.
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.
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 Timesinvestigates 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.
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.
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 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 Timesmakes 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.
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.
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 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.
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 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.
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.
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.
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 Globehighlights 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 Timesreveals 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.
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.
One of the many promises made by proponents of marijuana legalization in California was that it would eliminate the illicit trade in the drug. But like so many other purported benefits, that hasn’t happened yet—and the continuing existence of illegal grow farms is also poisoning wildlife, siphoning precious water, and risking devastating wildfires. Cultivation sites in state forests have rerouted millions of gallons of water in the past two years alone, exacerbating the drought and species endangerment. Growers living on site have started fires—including last year’s 125000-acre Dolan Fire. What’s more, many of the pesticides that drug traffickers—who operate the farms—are so poisonous they’ve been outlawed in the U.S. for decades.
Meanwhile, as more and more states legalize marijuana, they are adding regulations allowing public consumption, an issue that was not addressed in early legalization measures to win wider public support. But now, following Alaska’s move in 2019 to permit weed lounges, other states and cities are jumping on the bandwagon to further commercialization by enacting laws permitting lounges and pot cafes. New legalization laws in both New Mexico and New York allow on-site consumption, and Las Vegas—which currently restricts public use—may soon become home to luxury pot lounges after Nevada became the latest state to end rules on public consumption. Dispensaries are now racing to set up such lounges, as authorities grapple with how to oversee the new businesses.
And finally, an editorial in the Baltimore Sun takes up the issue of dentists who may be fueling the opioid epidemic by routinely prescribing strong prescription painkillers to teens for wisdom teeth extraction. Dentists are the sixth-highest prescribers of opioids in the U.S. to patients between the ages of 10 and 19 years old—the age group at the highest risk of developing opioid use disorder. In fact, a recent study found that hundreds of young people ages 13 to 30 who filled an opioid prescription after a wisdom tooth extraction went on to engage in persistent opioid use in the following year, even after the window for pain relief had closed. So far, the American Dental Association has recommended the use of NSAIDs as the first-line of treatment for dental pain, but has failed to provide clinical practice guidelines—and that is long overdue.
The nation’s first supervised injection sites, where substance users can inject drugs in a safe setting, have opened in New York City—signaling what could become a broader trend as drug overdose deaths soar to record levels. The privately-run sites in New York had been operating as needle exchange facilities, but will now expand to also include the administration of overdose reversal drugs, and have medical personnel on hand, as well as offer information and options for addiction treatment. City officials say the two sites are in response to staggering increases in overdose fatalities: there were 600 overdose deaths in the first three months of 2021.
Many cities including San Francisco, Boston, and Seattle have tried to open such sites, which are common in Europe and elsewhere, to address the public health crisis of addiction. But they have routinely faced obstacles over the legal and moral issues of effectively sanctioning illegal drug use. The mayor’s office and the Manhattan district attorney have indicated that no legal action would be taken to close the supervised sites. Substance users bring their own drugs to the facility, raising concerns among local residents about safety and drug use in their communities.
However, the most controversial aspect of supervised sites—part of harm-reduction programs—is that they don’t do enough to engage with users to enter effective treatment programs. After saving a life, addicts simply return to the streets and an endless cycle of drug use. While harm reduction is a critical component of addiction services, it is not a one-stop solution to a drug and overdose crisis that has led to the deaths of more than 100,000 Americans in the 12-month period that ended in April—a record number. Opening harm reduction facilities must take place alongside the expansion of treatment and easing access to effective services for anyone struggling with substance use.
The co-use of multiple drugs including the powerful synthetic opioid fentanyl is driving the surge in overdose fatalities—so much so that addiction professionals are saying we’re no longer facing just an opioid epidemic, but also a more general addiction epidemic. Co-using drugs including opioids, methamphetamines, and cocaine as well as fentanyl distinguish this wave of the crisis from previous ones, which involved prescription painkillers and then heroin individually. Now, users are mixing drugs—intentionally, or unaware that drugs have been contaminated with fentanyl—with lethal consequences. More than 100,000 Americans died of an overdose in the year-long period ending in April, a record number of fatalities. While many say that harm reduction programs such as safe syringe sites and the wider availability of fentanyl test strips are the solution, what we really need is a massive government program to expand engagement with substance users and access to treatment.
Meanwhile, Germany’s new coalition government has reached an agreement on nationwide cannabis reform, including legalization and establishing a regulated, adult-use commercial market for recreational pot. Currently, personal possession of marijuana is decriminalized and medical marijuana is legal with a doctor’s prescription. If the measure is approved, Germany—Europe’s most populous country—could give the legalization push more traction across the continent, which has lagged behind the U.S. in easing access to weed. Under the German measure, there would be provisions related to advertising, with the intent being to restrict the promotion of marijuana to deter youth use.
And finally, as psychedelic drugs slowly become mainstream so too are high-end psychedelic retreats catering to travelers who want to experience the drugs in pastoral settings such as Costa Rica and Jamaica. The interest is being wrapped in the booming global wellness industry, but there is good reason for caution: Psychedelics are powerful drugs and can cause psychosis and long-term mental health issues. While research is continuing into the potential for psychedelics to treat conditions such as depression, anxiety, and PTSD, there is potential for harm if patients at retreats are not properly monitored and controlled while using the drugs. Psychiatrists say that while there has been a paradigm shift with psychedelics and more interest in their application for treating certain disorders, we need to go slowly and be mindful of the possible dangers. So when considering booking an expensive psychedelic retreat, buyer beware.
The first jury verdict in an opioid case has found that the nation’s three largest pharmacy chains had substantially contributed to the opioid epidemic and crisis of overdoses, a big win for plaintiffs in thousands of similar lawsuits against the drug industry. The verdict, in a federal court in Cleveland, was surprising as it was based on the legal strategy of “public nuisance” laws, a concept that was rejected twice this month in judicial rulings in California and Oklahoma in similar cases against opioid manufacturers. Still, the jury agreed that the pharmacy chains—CVS, Walmart, and Walgreens—had turned a blind eye to countless red flags about suspicious opioid orders, thereby fueling an epidemic that has killed more than 500,000 Americans over the past two decades.
For their part, the pharmacies argued that they were fulfilling legal prescriptions by doctors for a drug approved by the FDA and regulated by the Drug Enforcement Agency. Whether the verdict survives on appeal isn’t certain. Other cases involving the pharmacies ended with a $26 million settlement in New York this past summer, while opioid makers and distributors—also facing thousands of lawsuits for allegedly fueling the epidemic—have committed billions of dollars in settlement offers, some nationwide.
The lawsuits are playing out in courtrooms and behind the scenes as the opioid epidemic and a surge in fatal overdoses rages on. A record 100,000 individuals died in the year-long period ending in April—a 30 percent increase of the same time period the year before, driven largely by the powerful synthetic opioid fentanyl, now a popular street drug sold on the black market. Compensation from settlements would be channeled in part to victims’ families and also to drug treatment and prevention programs, but we also need a massive infusion of funding from the federal government to tackle a public health crisis of such magnitude.
With drug overdoses surging to record levels—more than 200,000 Americans died in the year-long period ending in April—the New York Times takes a closer look at the powerful synthetic opioid fentantyl, which is driving the spike in fatalities. The painkiller was developed in the 1950s and is used to treat cancer and post-surgery pain, but today it is a major street drug sold on the black market, sprayed on marijuana, and made into counterfeit pills resembling oxycodone and Xanax. Users unaware they are consuming fentanyl-laced drugs die quickly, as it is 100 times more powerful than morphine. This is the third wave of the opioid epidemic after prescription painkillers and heroin and is now the main cause of death from a drug overdose. Fentanyl is mainly made in China, shipped to Mexico, and then transported over the border, and its spread has been “stealthy, steady and deadly.” To stop this killer drug we need better interdiction, more controls on online sales, and extensive education and prevention programs to warn people about the dangers of consuming fentanyl.
Meanwhile, a new study finds that vaping can be just as dangerous as smoking regular cigarettes, triggering inflammation and changes in blood chemistry. At first, vaping was touted as a “healthy” smoking cessation tool, but after a wave of vaping-related deaths and an epidemic of teen use, the study shows that vapers experience a similar gene disruption as smokers do. This could potentially lead to cardiovascular disease, metabolic diseases, and cancer, the study concluded.
And finally, many states implemented telehealth services during the COVID-19 pandemic and expanded telemedicine practices for treating opioid use disorder (OUD), but progress overall has been uneven. A report in JAMA Health Forum reveals that few states are comprehensive in their approach, such as easing access to medications for OUD treatment. Other moves—including loosening licensing requirements—have been applied unevenly. And despite these federal and state policy changes, overdose deaths and substance abuse still rose during the pandemic.
Political leaders, addiction professionals, and public health officials are reacting to the troubling new data reported yesterday that a record 100,000 Americans died from drug overdose in the yearlong period ending in April—more than fatalities from car accidents and gun violence combined. Dr. Rahul Gupta, director of the Office of National Drug Policy Control, focused on the need for states to broaden the availability of overdose reversal medications like naloxone, noting that “access often depends a great deal on where you live.” Dr. Joseph E. Lee, chief executive of the Hazelden BettyFord Foundation, blamed the increase in deaths in part on the “community and social support that was lost during the pandemic,” as treatment providers struggled to maintain services. The numbers for the past year are grim, reflecting not only barriers to treatment that arose during the pandemic and subsequent lockdowns but also the influx of the powerful synthetic opioid fentanyl, which is increasingly found in counterfeit pills made to look like oxycodone or Xanax and sold by street dealers. There’s little hope that the current situation will change. “It’s telling us that 2021 looks like it will be worse than 2021,” predicted Robert Anderson, chief of the mortality statistics branch of the CDC’s National Center for Health Statistics. For his part, President Biden said “we cannot overlook his epidemic of loss, which as touched families and communities across the country.” But he failed to announce any new programs or funding, and instead repeated his administration’s call to implement harm reduction strategies, which are regarded as a stop-gap measure to save lives—but not the most effective way to get substance users into drug treatment.
Drug overdose deaths reached a record high with more than 100,000 American fatalities in the yearlong period ending in April—a 30 percent increase over the same period last year. The rise in deaths was fueled by both the loss of access to drug treatment during the pandemic, and the widespread use of potent street drugs such as fentanyl, which is 100 times more powerful than morphine, and now more widely available than ever before to increase the potency of counterfeit pills. Overdose deaths related to stimulants like methamphetamines and cocaine as well as prescription pain medication also increased. President Biden’s American Rescue Plan Act includes $1.5 billion for the prevention and treatment of substance use disorders, but that is an inadequate response given the magnitude of the public health emergency.
Meanwhile, nationwide opioid litigation moves into a new phase with the opening in Seattle of the trial against the three large drug distributors in the U.S. for their alleged role in the opioid epidemic. Prosecutors in Washington State accuses the companies—McKesson, Cardinal Health, and AmerisourceBergen—of failing to monitor and prevent illegitimate sales and distribution of prescription painkillers that have contributed to the opioid crisis, and more than 93,000 overdose deaths just last year. The trial, in which the state is seeking up to more than $95 billion in compensation, follows lawsuits against opioid manufacturers and pharmacy chains for their part in the epidemic. Some of the nearly 5,000 cases brought by state and federal authorities against the opioid industry have been settled and others are in trial, with a so-called master settlement proving elusive. In a previous development, judges in both California and Oklahoma have struck down a major argument against the industry—that their actions constituted a “public nuisance”—placing in doubt the outcome of all the opioid lawsuits.
And finally, not many people may have noticed it but slipped into the $12 trillion infrastructure bill signed this week by President Biden are several new funding streams for marijuana research. One allows scientists to study weed sold in dispensaries that consumers are actually buying, rather than being limited to pot grown in government-run facilities, which has been the norm. This will give researchers better insights into the high-potency pot sold in legal marijuana states, and its impact on consumers. Equally important, money will be available to law enforcement and others to establish education and prevention programs to reduce drug-impaired driving in states where the drug is legal. It also funds the training of “drug recognition experts” to help police identify drivers under the influence, as well as DWI-drug courts that offer individuals a choice between jail time and substance use treatment.
A spate of overdose deaths linked to counterfeit, fentanyl-contaminated pills is roiling Boulder, Colorado, panicking parents and young people, and public health officials in the city. At least a dozen people ranging in age from 18 to 68, including college students—have died recently by fentanyl, either on its own or in combination with other drugs. Fentanyl-laced pills have been circulating in the county for the past couple of years, part of a national trend: in fact, two in five of all the counterfeit pills circulating in the country contain drugs make in Mexico to look like oxycodone and Xanax tablets, and contain enough fentanyl to kill a person instantly. More prevention and education efforts are therefore needed, along with interdiction, which is already at a high level: in any given week, DEA officials in the Denver field office seize between 5,000 to 100,000 counterfeit pills
There’s a growing body of evidence connecting cannabis use during pregnancy to negative health impacts—with the latest study warning that marijuana can lead to anxiety, aggression, and hyperactivity in children from age 3 to 6. This survey, based on 322 mother-child pairs, analyzed hair samples, placental tissue, and behavioral studies, finding higher levels of the stress hormone cortisol. National guidelines recommend against the consumption of cannabis products while pregnant because of its effects on fetal health and child development.
And finally, it seems there’s something that both Democrats and Republicans can agree on—marijuana legalization. A growing number of Republicans, generally more conservative than Democrats on the pot question, are getting behind a GOP House bill to lift the federal prohibition on marijuana. The measure would also impose a nationwide 21-year age limit with an exception for medical use, and allow states to make their own rules and around cannabis—including banning sales within state borders. Analysts say the push and pull between the parties may lead to a compromise with Democrats over their more progressive legislation, and eventually lead to national legalization.
In Oklahoma and California, two recent court rulings threaten to upend the carefully crafted—and, so far, successful—a legal strategy being deployed in thousands of lawsuits against the opioid industry. Those rulings cast doubt on the novel legal approach focusing on "public nuisance” laws, alleging that the pharmaceutical sector overplayed the benefits of their highly addictive opioid products and downplayed risks, therefore creating a nuisance by impeding public health. Both decisions agreed with the companies being sued—including opioid manufacturers, drug distributors, and pharmacy chains—that they were selling a federally approved, legal product prescribed by doctors and supposedly monitored by state and federal authorities. As opioid trials continue in many states, and settlement talks are at an advanced stage for thousands of the cases, the rulings could prod states, local governments, and tribes to capitulate and also fuel the resolve of plaintiffs to fight harder against giving in. The losers, once again, will be the families of those who died of opioid overdose, and efforts to win enough settlement money to expand the fight against the opioid epidemic.
Meanwhile, the long-awaited results of the largest-ever study of psilocybin have been announced, revealing that the psychedelic drug was highly efficacious as a therapy for treatment-resistant depression. The study found that patients who were given the highest dose had a significant decrease in depressive symptoms compared to those given the lowest amount, essentially a placebo. Overall, nearly 30 percent of patients given a high dose were in remission, compared to 7 percent for the control group. It was the most rigorous trial so far on psilocybin, also known as magic mushrooms, and adds to a growing body of evidence to earlier studies that were promising.
And finally, big cannabis companies are lining up celebrity comedians to push for marijuana legalization—although not everybody is laughing at the new campaigns, including a website that makes it easier for supporters to contact their congressional representatives. Kevin Sabet, of Smart Approaches to Marijuana, described the campaign as an “egregious example of profit over public health,” while even pro-legalization The Drug Policy Alliance, criticized the effort as overly corporate and not helping communities most hurt by marijuana laws.
The Drug Enforcement Agency is cracking down on the illicit use of a drug to treat opioid use disorder, but this policy may be fueling the opioid crisis. But because the drug, buprenorphine, is a controlled substance—used to treat cravings during withdrawal—can be misused, the DEA has taken an aggressive stance to stop its diversion to the streets. This often means stopping pharmacies from dispensing the drug when it’s desperately needed amid record drug overdose deaths. The ramifications are particularly acute in rural areas, where there is a lack of treatment providers and a stigma against these medications that already create barriers. Pharmacies are therefore reluctant to both order and distribute the drugs, fearing that the DEA will revoke their license.
Meanwhile, a new study published by the American Heart Association found that a growing number of people under 50 diagnosed with cannabis use disorder were later hospitalized for a heart attack. The rising trend parallels the legalization of marijuana in many states and adds to the growing body of evidence concerning the potential risks of cannabis use. The finding was most pronounced in those 18 to 32, among men, and African Americans, among the nearly 900,000 medical records analyzed. The study revealed that the proportion of patients hospitalized for heart attacks who had CUD nearly tripled to 6.7 percent between 2007 to 2018. The study was observational and did not control for use of other substances such as tobacco or alcohol, and therefore did not show a direct cause, suggesting that long-term studies are needed to determine the link between cannabis and heart disease.
And finally, cannabis stocks were once flying high, after Canada legalized the drug and more states in the U.S. approved both medical and recreational sales, and revenues boomed. But now, investors have a bad hangover, Politico reports, because the Biden administration and Congress have done nothing to ease restrictions on cannabis companies accessing financial markets, or move to end federal prohibition of pot. The result: plummeting stock prices and nervous investors who sank billions into the fledgling industry, hoping for a big payoff. At the same time, big pot states like California say sales are declining after a pandemic surge, the illicit market is still large, and promises of achieving social equity as a result of legalization have not been realized.
A year ago, Oregon embarked on a bold program to right the wrongs of the failed war on drugs, decriminalizing low-level possession and boosting access to drug treatment, all the while hoping that this would become a model for other states. But a new report from Pew Trusts finds that it’s not clear yet if the effort is working, noting that it’s easier to eliminate criminal penalties for drugs than to ramp up behavioral health services and get more people to use them—and to do this during a pandemic. So far, Oregon’s inpatient facilities, detox clinics, and recovery-focused nonprofits have only received $30 million of an expected $300 million in funding, paid for from legal marijuana sales revenue. The facilities have also been battered by COVID worker shortages, and have not been able to expand services. Also, without the incentives provided by drug-court referrals, fewer than half of the 1,300 people cited for low-level possession have voluntarily shown up in court to make their case against paying the small fine. Only 51 people have called the state’s drug help hotline. Nevertheless, lawmakers in Massachusetts, Rhode Island, and Vermont are all considering drug decriminalization bills.
Meanwhile, global consulting firm McKinsey is again coming under Congressional scrutiny for its role in the opioid crisis. Congress is asking for company records related to its business practices, conflicts of interest, and management standards connected to its work with opioid manufacturers, distributors, and pharmacy chains, as well as its work for the Food and Drug Administration. Earlier this year, McKinsey agreed to pay all 50 states more than $600 million to settle investigations into how it helped “turbocharge” opioid sales that contributed to the epidemic, which has killed more than 500,000 Americans over the past two decades. That settlement focused mainly on the firm’s work with Purdue Pharma, the maker of OxyContin, which is seeking a settlement to end thousands of opioid-related lawsuits.
And finally, five years after Massachusetts legalized marijuana many of the promises made by pro-pot groups have not been realized, according to an analysis by the Boston Globe. While sales have boomed—generating more than $2.2 billion in revenue—social equity goals have fallen short, with just 16 of the 194 companies that have opened a marijuana facility owned by participants in the equity and economic empowerment program. Legalization does not appear to have markedly boosted youth usage of pot, although experts say that a proportion of cannabis consumers overuse the drug and find it hard to stop and that a relatively small number of prolific consumers account for an outsized share of legal cannabis sales. State police say there has not been an increase in driving while high arrests, but that may be due to an overall decline in driving during the pandemic, and the fact that there’s no breathalyzer-like device to accurately detect cannabis impairment.
Dentists routinely prescribe opioids for patients 18 years old or younger, a trend that can open the door to potential misuse, diversion, and addiction, according to a new study from the American Dental Association. Although dentists comprise only 8 percent of all opioid prescribers in the U.S., they account for the highest number of prescriptions to young people. And while an overwhelming majority of dentists surveyed said that a combination of nonsteroidal anti-inflammatory drugs such as ibuprofen and acetaminophen are equally or even more effective than opioids, 43 percent still reported regularly prescribing opioid medications. The focus on those under 18 is particularly worrying, the report noted, because the first exposure to opioids for many people occurs in their teens following common dental procedures like third molar extractions.
Meanwhile, as more states legalize both recreational and medical marijuana its use during pregnancy is increasing, along with the potential for abuse or dependence. A new study from Columbia University and Well Cornell Medicine captured the magnitude of marijuana use among prenatal hospitalizations, finding that the proportion of pregnant patients with cannabis use disorder—defined as cannabis use with clinically significant impairment or distress—rose 150 percent between 2010 and 2018. Researchers say legalization has likely lessened fears about the risks of using marijuana during pregnancy, leading many patients to consume cannabis instead of prescribed medications, thinking it’s a safer choice. Physicians recommend against using cannabis while pregnant, chiefly because of both known and unknown fetal effects such as low birth weight and other adverse outcomes.
And finally, an commentary in the Wall Street Journal looks at the issue of allowing truck drivers to get behind the wheel while taking medications routinely prescribed to treat opioid use disorder, such as methadone and buprenorphine. The authors argue that in the face of a trucker shortage that is exacerbating supply chain woes, drivers should be permitted to hit the road, and not have their licenses revoked, as some states have done. Federal regulations offer no clear guidance, but studies show that patients who start on these medications can experience sedation and cognitive impairment as their doses are stabilized, and then rapidly adapt within a few weeks. Still, it may be difficult to closely monitor the condition of such patients, which may fluctuate, and therefore poses a possible risk to other drivers.
Drug manufacturers won a rare victory in nationwide opioid litigation as a California judge cleared two opioid makers of liability for causing the opioid epidemic. The case is one of the thousands across the country against drug companies, drug distributors, and pharmacy chains for their role in the opioid crisis, which has led to the deaths of more than 500,000 Americans over the past two decades. Many of the lawsuits have been settled before going to trial, resulting in billions of dollars of compensations for states, cities, and victims’ families who brought the suits. But the California case against drugmakers Johnson & Johnson and Endo, the judge believed the companies’ claims that they made a federally-regulated product that helped people in pain and was not responsible for widespread opioid addiction. Other trials are ongoing or awaiting rulings in New York, West Virginia, and Ohio, while settlement discussions continue in other jurisdictions.
Meanwhile, a new study looking at ways to reduce chronic pain and opioid use finds that talk therapy and yoga can help ease the pain but do not have a significant impact on usage. When such practices were compared to usual care for chronic pain patients, more people in the intervention group said pain dropped by at least 30 percent, although opioid use stayed the same. Nevertheless, researchers noted that despite this limited efficacy, the results are encouraging and that the treatment may be an attractive option given that the problem of opioid use is so large.
And finally, when California legalized marijuana five years ago, the state and legalization supporters imagined that a new, thriving market would evolve to benefit the economy and provide compensation for communities of color that were disproportionately hurt during the decades-long war on drugs. But it hasn’t exactly turned out that way, the Guardian reports. In fact, the legal weed industry is in disarray. Despite the cheery façade of celebrity pot products and home-delivery services, the illicit market is still thriving and black and brown entrepreneurs who were supposed to benefit have been locked out of the market or have ended up losing money. Consumers remain confused about what’s legal and what’s not, and many municipalities have used the law's opt-out clause to ban pot sales.
Incarcerated people in prisons and jails have high rates of substance use, but there are few programs that offer them drug treatment. That’s set to change in New York State, with a new law allocating nearly $20 million to establish medication-assisted programs (MAT) in each of the state’s prisons and jails. Today, such treatment is offered at only seven or eight of the state’s 50 prisons, and at 42 county jails statewide, plus Rikers Island, which includes the five counties comprising New York City. Nationwide, an estimated 85 percent of incarcerated individuals have active substance use but only a fraction receive treatment. The new law also requires treatment programs to provide preparing for release with information about community-based treatment facilities and a one-week supply of medications that were prescribed during their incarceration.
Meanwhile, a new study based on input from Michigan emergency departments found that neuropsychiatric toxicity (NPS) was common among patients presenting with cannabis toxicity. Of the nearly 40 percent diagnosed with NPS, more than a third had severe anxiety and altered mental status. Toxicity symptoms included nausea, vomiting, or abdominal pain and those consistent with intoxication such as blurry vision, giddiness, and disorientation.
And finally, Gov. Newsom of California has signed a law imposing an excise tax on e-cigarette sales in a bid to slow the teen vaping epidemic. The aim is to discourage vaping by minors by bringing taxes on e-cigarettes more in line with levies on other tobacco products. Making vaping devices more expensive is likely to reduce the number of purchases by those younger than 21, the legal age of purchase. The tax comes after Newsome signed legislation to ban the sale of all flavored vaping products, but that has been held up by a tobacco industry-backed referendum on the November 2022 ballot.
The latest survey from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) finds that Americans consumed large quantities of illicit drugs in 2020. Blame the pandemic, or marijuana legalization, or the opioid crisis: more than 20 percent of people ages 12 or older (or 59.3 million individuals) used such drugs last year, including 18 percent who consumed marijuana. Of that number, young adults ages 18 to 25 were the most likely to use pot (nearly 35 percent) compared to 16 percent of those ages 26 or older. Nearly 3 million Americans initiated marijuana use. Almost 10 million people misused opioids last year, mostly prescription pain medications. The survey, based exclusively on in-person interviews, also revealed that nearly two-thirds of adolescents who vape didn’t use any other tobacco products, unlike older nicotine users.
Meanwhile, with marijuana legalization comes changing perceptions about the drug, and how and why consumers use it. A story in Ad Week tells us that the clichéd image of the lazy stoner who only lives to get high is being replaced by the legal-weed generation which integrates cannabis into work, fitness, intimacy, and hobbies, according to a new study of weed fans in California by a cannabis delivery platform. For example, 43 percent of those surveyed said they “microdose” marijuana before clocking in for their job, while others pair cannabis with cooking and workouts. However, more than 20 percent use cannabis to relieve stress and improve their mental health than for any other reasons.
And finally, while Californians are finding new ways to integrate pot into their lives, theNew York Timesreports that the Japanese government has doubled down on its hardline position toward the drug. It is even ramping up arrests of citizens who indulge and is trying to stop the influx of marijuana-friendly information into the country. Unlike the U.S, where 19 states have legalized recreational marijuana, Japan has some of the most restrictive cannabis laws in East Asia, a region known for its intolerance of drugs. Only 2 percent of Japanese have reported using pot, compared to almost half of all Americans.
More and more people are turning to medical cannabis products to alleviate mental health problems such as anxiety, depression, and insomnia—although there is little science indicating that the drug is safe and effective to treat these problems. Advocates of medical marijuana legalization have convinced many consumers that their problems can be solved with cannabis, even as some evidence suggests that it can make their conditions worse. Therapists say they are seeing more patients using pot in place of antidepressant drugs, which can have unpleasant side effects. But some studies have found that cannabis use is linked to even more severe symptoms, prompting the American Psychiatric Association to warn that “there’s no current scientific evidence that cannabis is in any way beneficial to the treatment of any psychiatric disorder.”
Meanwhile, an alarming new study in JAMA Pediatrics has found that the number of teens who vape marijuana increased 7-fold between 2013 and 2020, as young people seek a more intense high than what they would get from smoking a joint. Vape pens deliver an intense high with more THC, the psychoactive component of marijuana. Researchers point out that vaping pot poses serious health dangers for teens, including a risk of dependence on marijuana and other substances, pulmonary disorders, and social and behavioral problems later in life. It’s time to impose better regulation of vaping products and ban advertising that targets young people.
And finally, some good news on the drug interdiction front: law enforcement agencies on three continents have disrupted a global drug trafficking operation on the dark web, one of the world’s largest online marketplaces for illicit goods including opioids and other dangerous drugs. Authorities in Europe, the U.S., and Australia arrested more than 150 people and seized large quantities of drugs including opioids, cocaine, and methamphetamines. Sales of drugs and drug-making equipment on the dark web have helped fuel the opioid crisis.
A new form of methamphetamine, known as P2P, is sweeping the U.S., causing a wave of mental illness and homelessness. Developed in Mexico by drug traffickers, P2P gained popularity as states legalized marijuana, according to an article in The Atlantic. As pot revenue faltered, many producers switched to making meth, which was easy to make and transport. In the Southwest, the drug quickly became more prevalent, and then spread all the way to New England. And is P2P took over, an unprecedented shift took place in American drug use: opioid addicts began using meth en masse and meth overdoses soared, even though you don’t typically die overdose or die on meth. In many states where substance users took withdrawal meds to get off drugs, they began substituting meth to get high. Traffickers were therefore able to create a new population of mentally ill Americans.
Meanwhile, a new national study has found widespread misperceptions about medical marijuana: about 42 percent of breast cancer patients use medical marijuana to treat symptoms—and that half of these individuals believe that medical cannabis could treat the disease itself, although there is no scientific evidence from human trials to support that idea. Patients use pot to relieve pain and for insomnia, as well as for anxiety, stress, or nausea. Most were unaware that the quality of cannabis products can vary widely, and saw the drug as a natural product that is better than “chemicals.” The study warned that patients and doctors need more information about marijuana because the drug could interfere with some treatments or make patients vulnerable to new side effects.
And finally, as more and more states legalize marijuana, law enforcement has voiced concerns about the impact of drugged driving, noting that there is no equivalent of the Breathalyzer test for drugs. Now, scientists say they have developed a rapid test that reliably detects THC—the psychoactive component of pot—in saliva in under 5 minutes. Currently, THC can be tested in the bloodstream or urine, but this takes days to process. THC in saliva reflects use within the past 12 hours, which means it could become a critical tool in determining drugged driving as marijuana becomes legal and more drivers casually use the drug, with a resulting increase in traffic crashes and fatalities.
The New York Times finally weighs in on the risks to kids from marijuana edibles, noting that many teens underestimate the dangers associated with the drug. With pot legalization making pot more widely available, young people have come to believe marijuana is less dangerous creating a perfect storm or risk, especially for edibles that are heavily marketed to young people. Edibles can indeed appear harmless, as they are packaged to look like candies, and appeal to impulsive, thrill-seeking youth. But they can pack a strong punch with high levels of THC, the psychoactive component of pot, that may cause lethargy, confusion, impaired coordination, intense anxiety, rapid heart rate, and vomiting, as well as seizures and respiratory depression. The Times suggests that parents talk to their teens about these risks, but the government should also act to impose stricter rules and regulations to curb underage access and use.
Meanwhile, the Times doesn’t always speak so bluntly when it comes to marijuana. A recent story in the Style section noted that fake pot plants are all the rage as decor in homes and businesses, as a way to "counter negative attitudes" toward marijuana and supposedly destigmatize the drug. The owner of one fake pot plant company was quoted as saying she was inspired to start the business by her father, who said that using marijuana oil had helped treat his skin cancer. Perhaps the paper of record should have also pointed that pot is NOT an effective treatment for skin cancer.
And finally, as drug overdoses soar in the U.S, the availability of the overdose reversal drug Naloxone is dwindling as the price of the effective, and easy-to-use drug increases, which is causing a dangerous shortage. The drug’s manufacturer, Pfizer, ran into problems making the drug earlier this year, and temporarily stopped shipping it to community groups battling the drug epidemic. Pfizer says the supply chain has been fixed, but the price is still far more expensive for the providers at a time when they need it most. Now is the time for the government to step in and secure the production and availability of a critical drug that can save lives, and help substance users enter treatment.
Fatal drug overdoses are soaring in San Francisco, and the city’s mayor London Breed is coming under increasing pressure to declare a public health emergency as she did with COVID-19. Advocates say this would not only bring more attention to the crisis but also provide an incentive to flout federal and state laws to open safe syringe sites, where users can shoot up in a controlled setting. Last year twice as many people in the city died from drug overdose as from coronavirus, and this year drug deaths continue to climb. Mayor Breed generally supports safe syringe sites but says it’s not clear whether an emergency declaration would help get around current laws banning them. Similar fights have raged in several cities with increasing overdose deaths, although none have yet opened in the U.S. In the meantime, Breed has committed an additional $13.2 million to expand the city’s overdose prevention program, including street outreach teams, treatment beds, and wider distribution of overdose reversal drugs.
Meanwhile, streaming service Hulu tackles the opioid epidemic with its new series Dopesick, which offers dramatic and emotional insights into the crisis focusing on a small town in Appalachia, where the epidemic started in mostly white, working-class communities. The series, starring Michael Keaton as a local doctor, looks at the crisis from multiple angles: doctors and patients, law enforcement, and prosecutors trying to hold OxyContin maker Purdue Pharma accountable for essentially lying about the addictiveness of the drug, which fueled addiction and overdoses. The series debuts as opioid litigation against drugmakers, distributors, and pharmacies for their role in the crisis plays out and provokes controversy over proposed settlements that many believe do not adequately compensate victims' families.
And finally, you may have noticed that supermarket shelves are now overflowing with beverages suffused with ingredients such as CBD, purporting to reduce stress and help you calm down—which sounds great, even though there’s very limited research supporting such claims. CBD, the non-psychoactive component of marijuana, is showing up everywhere, including drinks, wellness products, and even dog food. But the New York Timespoints out that little evidence exists showing that it does what the products promise. Although one company noted that customers have reported “lifted moods and cleared minds,” what they may actually be experiencing is the placebo effect, the power of suggestion being so strong that they believe they’re consuming a magical cure.
E-cigarettes have been on the market for almost a decade, but controversy continues to surround the devices, which were first pitched as a smoking cessation tool but eventually led to an epidemic level of use among underage consumers. Now, the FDA has given the first market authorization to an e-cigarette—R.J. Reynold’s Vuse—as a way to help smokers quit. But the agency, which says this does not mean the product is “FDA-approved,” also denied a request to sell flavored pods for the device. And it imposed strict marketing regulations on the company, including digital advertising restrictions in order to greatly reduce the potential for youth exposure to these products. Industry leaders say this is a good sign that the FDA doesn’t intend to drive e-cigarette makers out of business, while also being careful about allowing products that target young people, amid an epidemic of youth vaping. The FDA hasn’t yet ruled on products from former market leader Juul, and continues to deny pre-market requestions from thousands of applications from potential c-cigarette makers.
Meanwhile, the American Heart Association is not mincing words about its position on e-cigarettes: it calls on the FDA to reject all the remaining pre-market tobacco applications for flavored products, regulate synthetic nicotine, and prohibit the sale of any flavored tobacco product. It also called on states to pass laws and policies that remove flavored tobacco products, including menthol, from the market. The Heart Association was responding to a recent survey that found that more than 80 percent of high school and middle school students who vape prefer flavored products, as well as a preference for disposable products that those with synthetic tobacco—both of which are not under FDA jurisdiction.
And finally, a clinical trial has begun of the first potential opioid vaccine in humans. The trial, at Columbia University, will first test the safety and efficacy of a vaccine designed to trigger the patient’s own immune system to develop antibodies to the target: if the individual uses opioids, for example, the antibodies would bind to it and prevent it from getting to the brain. The vaccine would not prevent cravings for the drug, but it could serve as an added layer of protection for people at high risk.
The underage vaping epidemic is being fueled by a new e-cigarette brand called Puff Bar that targets young people with products that come in fruity flavors—such as Watermelon and Lemon Ice—favored by this age group. A report in theWall Street Journalsays that Puff Bar has replaced Juul as the top-selling disposable brand among young people, with sales of more than $126 million last year. So far, Puff Bar has been able to evade FDA scrutiny by reformulating its products with synthetic nicotine, which is not under the agency’s purview. The company was founded by two 27-year-old entrepreneurs, who say they are doing everything they can to stop underage use, although a recent survey found that more than 25 percent of high-school vapers use Puff Bar. The FDA must find a way to regulate products like Puff Bar that are contributing to the teen vaping crisis.
Meanwhile, Gov. Gavin Newsom of California has signed a bill that bars opponents of needle exchange programs from using environmental laws to try to stop such services. For years, groups that want to shut down exchange sites have claimed that such programs promote drug use and homelessness. But recently they have deployed a new tactic, saying that they are a source of needle waste, which is an environmental hazard, and have closed down programs in several counties. Under the new law, lawsuits to stop needle exchange are still allowed under other grounds. The bill comes at a time when drug overdose deaths are soaring in the state, and around the country, and harm reduction programs such as needle exchanges are seen as an important component of efforts to save lives.
And finally, the marijuana legalization model used most frequently by states can lead to rampant commercialization and Big Tobacco dominating local markets, according to an article in Vox that looks at alternative ways to legalize weed. Currently, for-profit companies are growing, cultivating, and selling marijuana, expanding across state and national lines, and doing more advertising, creating a marijuana market that will look a lot like the market for alcohol. There are alternatives, the article suggests, such as allowing the government to run the supply chain and becoming a weed dealer, which means it would have greater say over public health and safety and implementing regulations to mitigate the real risk of addiction and overuse.
One of the consequences of the COVID-19 pandemic was an increase in marijuana consumption—including among pregnant women. In California, cannabis use by women in early pregnancy shot up 25 percent during the pandemic, according to a new Kaiser Permanent study of more than 100,000 pregnancies in northern California. Patients were, on average 31 years old, and were more likely to use pot if they had experienced depression, anxiety, or trauma. Although pot use during pregnancy has been linked to low birth weight and impaired neurodevelopment, such use has been creeping up over time, the study said and is consistent with the overall rise in cannabis sales in California over the time period studied, 2019-2020. The study noted that women also seek out advice from peers and online communities supportive of cannabis when choosing whether to use such products during pregnancy, which adds to the confusion, along with dispensaries that market pot as a safe and effective way to manage pregnancy symptoms.
Meanwhile, another study of marijuana found that increased use may lead to a significantly higher risk of contracting a COVID-19 breakthrough infection. The study, published in World Psychiatry, focused on fully vaccinated people with substance use disorder, a condition that involves uncontrolled dependence on substances including marijuana, alcohol, cocaine, opioids, and tobacco. Patients with cannabis use disorder had a higher risk for breakthrough infection even after they were matched for adverse socioeconomic determinants. The study speculated that the higher risk could be due to behavioral differences or the effects that the drug has on the lungs or the immune system.
And finally, California Gov. Gavin Newsome is expected to sign a novel law that would allow the state Medicaid agency to pay people not to use methamphetamines and cocaine—making it the first state to do so. The payments are part of an addiction treatment program called contingency management, which incentivizes drug users with money or gift cards to stay off drugs. Some studies—and the experience of a Veterans Administration program—suggest that such positive reinforcement works, especially for meth or cocaine addiction. As drug overdoses surge across the country, many states are seeking new approaches to treatment, and are appealing to federal authorities to make contingency management more widely available.
Evidence revealed at the landmark opioid trial in Ohio shows that pharmacy chain employees warned about the dispensing of highly addictive prescription painkillers—but to no avail, allowing a flood of opioids to continue. The trial, which accuses the nation’s biggest pharmacy chains—including CVS, Walgreens, and Walmart—of fueling the opioid epidemic, is being closely watched as the sprawling opioid litigation plays out across the country. The documents showed that employees told superiors that the company was not verifying the legitimacy of suspicious orders and that the chains were not doing enough to reduce the growth of prescription painkillers. Laws require drugstore chains to implement strict monitoring and safety programs. But the companies claim they did nothing wrong, and instead blame doctors for writing the prescriptions and federal regulators for failing to crack down on so-called pill mills that doled out tens of millions of doses. The case is widely seen as a test to determine whether companies should be liable for the epidemic and shoulder part of the cost of responding to the crisis. Thousands of opioid lawsuits are either at trial or under a proposed settlement against not only pharmacy chains but also drug manufacturers and drug distribution companies, for their role in the epidemic.
Meanwhile, a new study released by the FDA and the CDC found that more than 2 million middle and high school students used e-cigarettes in 2021, with more than 8 in 10 of those youth using flavored e-cigarettes. Despite increased warnings and prevention programs, vaping remains extremely popular with kids, the report said, noting that 25 percent of high school students who used e-cigarettes said they vaped every day. The FDA says it is continuing to take action against companies that sell or target e-cigarettes and e-liquids to kids, including recently denying more than one million premarket applications for flavored electronic nicotine delivery systems. But obviously, the agency is not doing enough to discourage young people from using e-cigarettes and contributing to the nationwide vaping epidemic among underage users.
And finally, California is poised to clamp down on CBD products to ensure they are accurately labeled and safe, following the explosive growth of the sector and a flow of merchandise that is mislabeled and untested. CBD, the nonpsychoactive component of marijuana, can be found in soap, food, and other wellness goods, and its use has grown significantly since Congress legalized hemp in 2018. But in the absence of federal oversight, states are stepping up efforts to regulate untested products that make unfounded claims about their efficacy and safety—often claim that CBD is a wonder drug promising relief for ailments including pain, anxiety, and depression. The regulatory bill in California, which Gov. Gavin Newsom is expected to sign, would hold manufacturers to rigorous testing and labeling guidelines.
The third phase of the sprawling, nationwide opioid litigation opens a new front this week as the trial begins in Cleveland of giant pharmacy chains accused of fueling the opioid epidemic. With lawsuits against drug makers and drug distributors either settled or at trial, this litigation takes aim at pharmacies that allowed hundreds of millions of prescription painkillers to be doled out to patients, fuelling the opioid epidemic. The case, involving two counties in Ohio, says that 10 pharmacies dispensed nearly 49 million prescription pain pills in a span of eight years—enough to provide a dozen doses to each man, woman, and child who lived there every 12 months. The mostly rural, blue-collar countries claim that CVS, Walgreens, Giant Eager, and Walmart failed to stop mass quantities of opioid drugs from reaching the black market and therefore contributed to hundreds of overdose deaths—and one of the worst public health crises in the nation’s history. Pharmacies say they were merely filling prescriptions for legal medications, but despite warnings from the Drug Enforcement Agency, they continued to dispense pills and also implemented performance metrics and quotas for their retail stores.
Meanwhile, celebrities are piling into the emerging legal marijuana market, hoping that adding their name and glamour will boost sales of the drug. The latest entry is popstar Justin Bieber, who is launching a product called Peaches—named after one of his songs—that contains a $32 pack of pre-rolled joints. When asked about why he’s getting into the business, Bieber said he wanted to help destigmatize pot, especially for those who find it helpful for their mental health. Scientists say this is a popular belief about pot that has yet to be proven in research studies, and that marijuana use may in fact worsen outcomes for people with mental health conditions.
And finally, speaking of celebrities, actor Clint Eastwood has won a $6 million lawsuit against a company that used his image and likeness to make it appear that he was endorsing their products. The companies and online retailers concocted a fake interview with the actor and used a photo from an actual appearance in he seemed to endorse their products, which contain CBD, the non-psychoactive component of marijuana. Eastwood has no connection whatsoever with CBD, a product with few proven health benefits that is experiencing booming sales based on false marketing messages.
San Francisco is in the grips of an unprecedented drug epidemic as fentanyl floods the street-drug marketplace, intensifying the risk of addiction and leading to a staggering number of overdose deaths. While overdose deaths have surged across the country to a record 93,000 last year, fatalities linked to fentanyl have skyrocketed in San Francisco—increasing by nearly 500 percent between 2018 and 2020. Illicit fentanyl, which can be as much as 50 times more powerful than heroin, was detected in the blood of 519 of the 712 individuals who died. Last year the regional office of the DEA seized 74 kilograms of fentanyl—an amount that could kill up to 37 million people—compared with 15 kilograms in 2016. The synthetic opioid was developed in the 1960s to manage pain after surgery, but today is made illegally in China and India and is now stamped into counterfeit pills to increase the potency of drugs that look like legitimate prescription medications such as OxyContin and Xanax.
Meanwhile, the nation’s three largest drug distributors have reached a $75 million opioid settlement with the Cherokee Nation Native American Tribe in Oklahoma, to settle allegations that the companies helped fuel a public health crisis by allowing the distribution of highly addictive prescription painkillers. This settlement is separate from a proposed $26 billion deal to end thousands of lawsuits brought by states and local governments against Cardinal Health, McKesson Corpl, and AmerisourceBergen. The Cherokee Nation was the first to sue the distributors in 2017, accusing them of supplying millions of pills that caused addictions and fatal overdoses.
And finally, the Wall Street Journal reports that the legalization of marijuana around the U.S. is bringing weed into the workplace in new ways—and raising questions about boundaries and behaviors when it comes to the drug. For example, companies debate whether they should continue to test employees and job candidates for marijuana, how to talk about pot socially, and if it should be used in team-building exercises. And then there’s always the tricky issue of whether to get stoned with a client, the paper noted.
The Drug Enforcement Agency has issued its first public warning in six that a growing number of fake pills bought online through e-commerce websites—and promoted by social media sites—are laced with potentially lethal amounts of the powerful synthetic opioid fentanyl. Noting that we are in the midst of an overdose crisis—with more than 93,000 fatalities last year—the DEA said that the counterfeit pills are driving the surge in deaths. Fentanyl, even in much smaller amounts, is deadlier than street heroin, and more and more online sellers, as well as dealers, are adding the deadly drug to prescription pills. The agency said it has seized more than 9.5 million fake pills so far this year, more than the last two years combined, and that two out of every five fake pills with fentanyl contain a potentially lethal dose of the drug.
Meanwhile, a new study published in the journal Jama Psychiatry finds that methamphetamine use is surging as a major cause of high-risk addiction and overdose death, in part due to meth containing fentanyl. From 2015 to 2015, there was a 180 percent increase in the number of deaths linked to meth, from more than 5,500 a year to nearly 15, 500, according to pre-pandemic data. The researchers found Native Americans and Alaska Natives still have the highest rate of methamphetamine use disorder and have seen sharp increases in drug deaths in recent years, while Black Americans saw a tenfold increase in meth use over the same five-year period. In addition, there was increased use of needles to inject the drug, and a rapid transition from casual and recreational meth use to full-blown addiction.
And finally, the American Medical Association has issued a report showing the disparities between efforts to fight the opioid epidemic and outcomes. It noted that while there has been a 44 percent drop in opioid prescribing in the past decade, due mostly to stricter prescription monitoring, the country is still facing a worsening epidemic of drug-related overdoses and deaths. Overdoses and deaths are spiking even though physicians have increased the use of monitoring programs—more than 910 million times in 2020, according to the AMA. It also reports that although more than 106,000 physicians and other health professionals have received the required waiver allowing them to prescribe opioid withdrawal medications to treat opioid-use disorder, between 80 percent and 90 percent of people with substance use disorder receive no treatment whatsoever.
Selling marijuana on tribal lands in New York State has become a booming business for Native Americans, who are capitalizing on the slow pace of regulating the state’s newly legal marijuana industry. The New York Times reports from an upstate reservation, on the northern border with Canada, which is doing a brisk trade in pot products, drawing customers from across the region. However, the new enterprises exist in a sort of gray area, moving faster to set up dispensaries than the government in Albany can impose a regulatory body to oversee the new cannabis industry. There’s also a dispute within the tribal government, with some groups claiming the businesses are operating outside the laws of the reservation. Once again, we see that legalization is moving ahead before rules and regulations can be established to oversee and monitor the new industry.
Meanwhile, it’s no surprise that after pot sales boomed during the pandemic, employment in the sector nationwide would also post extraordinary growth. Today, more than 320,000 Americans work in the industry, a 32 percent increase from ast year, making marijuana one of the nation’s fastest-growing sectors. The industry added nearly 80,000 jobs last year, many coming from the restaurant and retail, and other service sectors, which was hit by the lockdowns. The growth of the industry has indeed been dynamic: the U.S. now has more cannabis workers than dentists, paramedics, or electrical engineers.
And finally, all that pot for sale has consequences for consumers: a new report shows that cases of marijuana over-consumption have led to an increase in cannabis-related intoxication requiring medical attention. Poison control centers have documented a dramatic increase in the number of reports involving edible cannabis, rising from 8.4 percent to 31 percent between 2017 and 2019—especially for children under 10, with these products making up 48 percent of reported cases. Such cases of intoxication in children are associated with coma, severe respiratory depression that can lead to death.
A new study finds that there is a growing racial disparity in opioid deaths among the Black population and other racial and ethnic groups. The National Institute on Drug Abuse research analyzed data from four states—Kentucky, Ohio, Massachusetts, and New York—and found that opioid deaths among Blacks increased by 38 percent between 2018 and 2019, while rates for other groups did not rise a all. In earlier waves of the epidemic, African Americans had lower rates of overdose deaths than whites, amid heavy prescribing of prescription painkillers in white communities. Experts say the shift in populations is due in part to structural differences in healthcare, including access to effective treatment options, and data suggesting that Blacks are less likely to be prescribed opioid withdrawal medications.
Meanwhile, in an opinion piece in the Boston Globe, two psychiatrists at Beth Israel Deaconess Medical Center write that it is critical for society to recognize the opioid crisis and to understand how secrets and stigma allow it to grow. Writing in honor of National Recovery Months, the physicians urge patients battling addiction—and their families—to talk about their experiences in order to expose the truth about the disease, and help others understand the magnitude of the issue Also, they say that although progress has been made in the areas of prevention, diagnosis, and treatment, these efforts simply have not matched the breadth of the problem. And finally, they point out that addicts must overcome stigma, which is greater than other mental illnesses such as depression and anxiety and leads to silence about the opioid epidemic.
And finally, an op-ed in the Baltimore Sun looks at the growing market for legal adult-use medical marijuana, pointing out that medical cannabis is not really a medication just because states say so. Unlike medications sold in a pharmacy, which comes in plain bottles and has specific instructions on how to use it and what the side effects might be, medical marijuana is dispensed by a “budtender” who has no way to assess possible reactions or warn about potential interactions. In the end, the article notes, the patient is largely left to determine for themselves what constitutes a reasonable medication regimen and dosage that will both treat their ailments and not develop into dependency. As legalization of medical cannabis continues, amid increasingly far-reaching claims about what it does, we need more research into the effects of the drug—as well as tighter regulation of how it is sold and what it purports to do.
A new study in the journal JAMA Network Open reports troubling symptoms for many young people who are habitual users of marijuana: more and more teenagers, it says, are showing up in emergency rooms complaining of severe intestinal distress. The unusual illness—called cannabis hyperemesis syndrome—leaves them writhing, complaining of bad abdominal pain, and nausea, and they suffer from vomiting that can go on for hours. The report said there were more than 800,000 cases in Colorado between 2013 and 2019, a 29 percent increase since marijuana was legalized in the state. And more than a third of the vomiting cases were people under 25 years of age and younger. With more states legalizing marijuana, physicians say this is no longer a rare problem.
Meanwhile, marijuana legalization was supposed to end the black market for pot and provide a regulatory structure for the new industry to monitor and control the product. But guess what? California’s most-wanted pot products are ending up on the shelves of high-end dispensaries in New York City. Apparently, rule-breakers are selling untold millions of pounds of legally grown cannabis on the illicit market. And state cannabis regulators, who are fully aware of the industry’s worst kept secret, aren’t bothering to do anything about it. Under the law, this shouldn’t be happening—another example of the many promises that have been made about legalization that have not been fulfilled.
And finally, marijuana is now legal in Connecticut, but don’t think about light up a joint in a courthouse. The law does place some limits on where pot can be consumed, including public buildings, most workplaces, stores, and state parks. The judicial branch has also put in place a rule preventing possession inside a building—but because that hasn’t stopped people from lighting up, new signs are being posted that say “no cannabis allowed.”
The Justice Department is taking action to stop the Purdue Pharma opioid litigation settlement, arguing that it is wrong to grand broad legal immunity to the firm’s founding Sackler family. The controversial deal, approved earlier this month, forces the family to pay $4.5 billion in compensation, as part of an estimated $10 billion deal over the next decade, with the majority of funds going to drug abatement and treatment programs. But the settlement has been widely criticized by patients’ rights groups and others who say the family—which has reaped billions from the sale of its highly addictive OxyContin painkiller—should be shielded from further. The Justice Department said in its filing that the deal takes away the rights of those with a valid legal claim against the Sacklers. Those who support the deal, including a majority of states, say that it would provide much-needed funding for drug treatment programs.
Meanwhile, more and more college football teams that suffered financial losses during the pandemic year are throwing their moral qualms about “sin” industries out the window, and are hooking with booze and cannabis companies to gain sponsorships and the rights to sell their products. The result is a lot more alcohol for sale in stadiums and sponsorship money from the marijuana industry. Colorado, for example, became the first major university to add a cannabis company as a corporate sponsor. It’s not clear yet if pot products will be sold along with beer and hot dogs.
And finally, Maine residents are known for having an independent streak—and that’s true too when it comes to selling recreational marijuana. More than 90 percent of towns in Maine still do not allow adult-use pot sales after opting out or passing ordinances banning dispensaries, even as the industry has taken off in the state (marijuana was legalized in 2016 but sales only began in 2020). The resistance is largely due to fears about harder drugs, including opioids and methamphetamines that have ravaged many Maine communities.
As the sprawling opioid litigation draws to close promising large settlements for states, Maia Szalavitz writes in Scientific American that the windfall compensation should be used narrowly and smartly for addiction services—and not for cutting the supply of opioids. Comparing this settlement to the $246 billion tobacco agreement, in which most of the money went to state governments and not for smoking cessation programs, she says we now have an opportunity to help those struggling with substance use. Instead of focusing on prescription monitoring and other control methods, she argues, we should expand the use of medications to treat addiction and allow doctors who diagnose opioid addiction to prescribe withdrawal drugs.
Meanwhile, following the recent controversy over marijuana use at the Olympics, the World Anti-Doping Agency says it will launch a review of its ban on consuming pot with high levels of THC during competitions. Marijuana has been on the agency’s list of prohibited substances for decades, but the international body has come under pressure to revise the rule as marijuana legalization has gained momentum, and a top U.S. track star tested positive and was subsequently disqualified to participate in the Tokyo games. Substances are banned if they are deemed to enhance performance or pose a health risk to athletes.
And finally, the CDC has issued a warning about the dangers of consuming marijuana-infused foods that contain high levels of THC, saying they could cause “adverse effects.” It issued the alert because of the increased availability of such cannabis edibles and insufficient labeling of products with both THC and CBD, the non-psychoactive component of the drug. Edibles are among the fastest-growing cannabis categories, but manufacturers have come under criticism for how they package and market such products.
The Purdue Pharma opioid litigation settlement announced last week continues to draw scrutiny as well as criticism. In an op-ed in the New York Times, Ryan Hampton, who worked on the case on behalf of victims, writes that the settlement does not provide justice for some 130,000 family members, who will receive only about $750 million of the $4.5 billion paid in by the firm’s founding Sackler family. “Purdue’s victims find themselves double victimized,” Hampton writes, noting that the amount they will receive is far less than will be paid to a handful of lawyers and consultants in the case. He also says that a controversial bankruptcy mechanism used by Purdue ended up shielding the Sacklers from ever being sued in civil court for its role in the overdose crisis.
Meanwhile, the Food and Drug Administration has finally issued its long-awaited verdict on e-cigarettes, rejecting applications for nearly 1 million products, mainly due to their potential appeal to underage teens. But the FDA did not rule on products from Juul, the most popular brand with adult smokers and many teens, saying more work needs to be done to complete the reviews. The action is part of a sweeping review by the agency to bring scientific oversight to the multibillion-dollar vaping industry after years of regulatory delays, and accusations that manufacturers are deliberately targeting young people.
And finally, Colorado legalized marijuana in 2013, promising that the system established to sell legal weed would not endanger public health. But a new report indicates that easy access to pot is hardly safe: traffic deaths where drivers tested positive for marijuana had increased by 138 percent compared to 29 percent for all Colorado traffic deaths, and that past months use of marijuana for those 12 and older increased 26 percent. And the percent of suicide incidents in which toxicology results were positive for marijuana has increased from 14 percent in 2013 to 29 percent in 2020.
As pro-pot supporters continue the push for marijuana legalization, a new international report finds that medical cannabis—which is often the prelude to recreational legalization, because of its purported health benefits—is unlikely to help most people suffering from chronic pain. The report, based on three dozen medical cannabis studies, says that although it might help some people, there’s not enough evidence for the drug to be widely recommended for those with chronic pain. In fact, researchers were quoted as saying the benefits are “quite modest,” debunking the argument that medical pot is a panacea for a variety of ills, as supporters continually claim. The guidance is important, as 36 states and Washington, D.C., have legalized medical uses of cannabis. Another problem, they noted, is that even if patients decide to try medical cannabis, there are so many products, formulations, and varieties to choose from, but no definitive information on which components are most effective at treating certain symptoms.
Meanwhile, the National Institute of Health’s 2020 Monitoring the Future Study finds that college-age adults are using marijuana more than ever before. Among college students, 44 percent reported using marijuana in 2020 compared to 38 percent in 2015. This represents the highest levels of marijuana use recorded since the 1980s. There was also a significant increase in the use of hallucinogens—including LSD and psilocybin—among college-age kids, according to the annual survey. Some good news: while pot use was thriving, college students reported significantly lower alcohol use, with 56 percent imbibing compared to 62 percent in 2019, and a decrease in binge drinking to 24 percent from 32 percent.
And finally, marijuana legalization was touted as a way to promote social equality and economic equity among populations of color who were disproportionately discriminated against during the failed war on drugs. But guess what? It isn’t working out that way. Instead of providing benefits to people of color who want to get into the cannabis industry, many Black Americans—who were four times as likely to get arrested on cannabis charges—are finding the riches out of reach. In many states, the licensing process is difficult to navigate and favors those with more access to capital, such as big weed companies.
A Wall Street Journal iinvestigation reveals that social media site TikTok serves up a continual stream of content about sex and promoting drug use—to minors. The article used a series of fake accounts linked to underage users to to examine the site’s powerful algorithms and how they quickly drive minors—among the biggest users of TikTok—to endless spools of content that often glorifies drugs and drug use. They also found that even with the site’s filters in place, videos about drugs tend to proliferate, creating what one expert called a perfect sotrm in which social media normalizes and influences the way they view drugs or other topics. With tens of thousands of videos being uploaded to the site every minute, young people are exposed to more dubious content than ever before, and it becomes extremeley difficult for moderators to screen and delete questionable content. We need stronger regulation and control of social media sites like TikTok and the content they distribute to young people.
Meanwhile, a new German study finds that e-cigarettes are a gateway to cannabis use for young people. Researchers studied students who had never used marijuana, and during that time nearly 30 percent reported using e-cigarettes at least once, and of those 17.4 percent began using marijuana. The marijuana initition rate among this group was 34.5 percent compared to 10.4 percent of those who never used e-cigarettes.
And finally, a bill pending before the California Assembly reads like a wish list of demands by the powerful cannabis industry. If approved, the bill would allow food and beverages like soda adulterated with psychoactive THC in quanitites exceeding legal cannabis edibles. It would also permit THC foods to be sold in regular food stores outside of the legal cannabis market. The expanded guidelines would also legalize hemp cigarettes and e-cigarettes, including flavored products like those the California legislature banned for tobacco in 2020.
The $4.5 billion opioid settlement with Purdue Pharma announced last week ended lengthy litigation with the OxyContin maker and secures funding over the next decade for drug abatement and treatment programs. But for many families who lost children and other loved ones in the opioid epidemic, the deal has left many families conflicted, deflated, and angry. Under the terms of the agreement, the firm’s founding Sackler family did not apologize for their role in fueling the epidemic by underplaying the addictiveness of prescription painkillers, nor will they have to give up their vast fortune to make the payouts. The family is shielded from all further opioid-related liabilities. And the families will not have an opportunity to confront the Sacklers face-to-face in court about the lives lost to opioids. Yet other families—who will receive between $3,500 and $48,000 in compensation—also realize that this was probably the best deal they could get and will avoid years of costly litigation at a time when funding for drug treatment programs is badly needed.
Meanwhile, a new study finds that adults under 45 who consume marijuana suffer from nearly double the number of heart attacks as those who do not use the drug. The study, published in the Canadian Medical Association Journal, said that whether users smoke, vape, or consume pot as an edible, there may be a significantly higher risk of having a heart attack. Researchers examined health data for more than 33,000 adults ages 18 to 44 and found that of the 17 percent who reported using cannabis, 1.3 percent later had a heart attack while only 0.8 percent of non-cannabis users reported the same. The study did not reach a conclusion about why pot has this effect, but previous research has shown it can cause an irregular heartbeat.
And finally, perhaps Amazon should have a look at this new data before it drops a requirement to test delivery drivers for marijuana use. The company says it is so short of drivers that the best way to recruit more is to advertise that they no longer screen applicants for marijuana use. This may boost applications by as much as 400 percent, as that’s the main reason why potential candidates fail, the company, which is lobbying the federal government to legalize marijuana, explains. Amazon would still test drivers for opiates and amphetamines and requires drivers to not be impaired while on the job. But if your package is late or lost, this may be the reason why.
The bankruptcy judge overseeing the Purdue Pharma opioid litigation has approved the OxyContin maker’s proposed $4.5 billion settlement, ending a years-long legal battle and opening the way for funding to flow to states for addiction treatment and compensation to victims’ families. The controversial agreement largely absolves the firm’s founding Sackler family and shields members from any liability, and as such, it will remain among the richest families in the country. In a personal note, the judge acknowledged that the settlement was “bitter” for many involved, adding that the Sacklers had never really apologized for downplaying the addictiveness of their prescription painkiller and using aggressive marketing strategies to push sales of a drug, which, along with other opioids, are linked to the deaths of more than 500,000 Americans over the past two decades.
Payments will be made to the states and the federal government over nine years, making it easier for the billionaire Sackler family to continue to make money from investments and continued sales of other Purdue drugs, although the company will be dissolved in its current form. The amount of the settlement and the long payout period has been criticized by many states, but a majority of the plaintiffs supported the plan, reasoning that it’s the best way to pay for a problem that has only worsened during the pandemic year, in which more than 93,000 died from a drug overdose. According to the agreement, more than 130,000 individuals and victims’ families will receive between $3,500 and $48,000 each, and states will receive money from a national opioid abatement trust to be distributed to local governments.
The Purdue settlement brings to a close a portion of the thousands of lawsuits against the opioid industry, including opioid manufacturers, drug distributors, and retail pharmacy chains, accused of contributing to the epidemic. A $26 billion deal is pending with the drug distributors, and other smaller settlements are also in the process of being resolved. Funding received from the litigation is welcome and will go a long way to help states and communities expand treatment and opioid-abatement programs. But it is far too little by itself when compared to the scope and scale of the massive drug crisis facing the country.
As overdose deaths due to fentanyl-laced street drugs are soaring across the country, the New York Times reports on a series of six deaths over three days along Long Island’s North Fork, a rural area about 100 miles from New York City. Police said the deaths were caused by cocaine mixed with highly lethal fentanyl, a drug more commonly mixed with heroin. The tragedy is part of a national trend, due in part to pandemic-linked drug shortages that have forced addicts to turn to substitutes like fentanyl. The dead were not hardened drug users, the article points out, but mostly recreational users seeking “a fleeting high,” that unfortunately included fentanyl, a drug so powerful that a mere speck of it can kill.
Meanwhile, the long-running legal battle to open a safe drug injection site in Philadelphia may be decided by the Supreme Court. Hoping to clarify a series of contradictory lower court rulings, the group lobbying for the site—where users can shoot up in a safe, supervised setting—filed a petition with the Court to hear the case. Safe sites have operated for years in Europe and other countries, but are technically illegal in the U.S., and efforts to open the first American facility have failed in many cities, even as drug overdose deaths have surged due to the opioid epidemic. The latest legal move would force the Biden administration to take a stand on the issue, at a time when its drug policy appears to be shifting toward harm reduction programs including safe injection sites. Harm reduction is a critical component to save lives, but must be accompanied by drug treatment.
And finally, Colorado has unveiled a framework for distributing more than $400 million in opioid litigation settlement funds, which will go toward drug treatment and abatement programs. This could serve as a model for other states that are also in line to receive huge payouts from the opioid cases, including a share of the $26 billion settlement with drug distributors and a smaller amount from Purdue Pharma, if those agreements are eventually approved. In Colorado, most of the money will be distributed to regional health centers that are in desperate need of funding to confront the drug crisis. The plan stands in stark contrast to the way money was distributed in 1998 from tobacco companies, when funds flowed to state budgets for general purposes and not to smoking cessation initiatives.
New York Governor Kathy Hochul, in her first days in office after succeeding Andrew Cuomo, has spoken of the need to address the opioid epidemic and soaring overdose deaths. But on marijuana she has taken another approach, vowing to quickly implement the state’s stalled legal weed market without apparently addressing safety issues for the evolving cannabis industry. Legal marijuana was approved earlier this year, but Cuomo was locked in a dispute with the legislature on nominations to the cannabis regulatory board, which Hochul says she will resolve to ensure the market can get moving. So far, there’s no word from Hochul on critical issues such as amending the law to place caps on the psychoactive component THC, or extending the too-short deadline for municipalities to opt-out of allowing marijuana businesses—both critical issues to safeguard public health.
Meanwhile, pioneering legal weed state Colorado is moving to the next frontier in the marijuana market by ending its ban on public consumption of pot and allowing smoking lounges, tasing rooms, and tour busesfilled with stoned customers. Denver and Aurora would be the first cities to adopt on-site and mobile cannabis consumption, reversing a provision in the 2014 legalization law that prohibited using pot in open places. The new rules would allow pot lounges, either in brick and mortar form or on wheels. Luckily, the rules would force bus operators to put up a partition between the pot smokers and the driver, as well as install special filter systems. And the buses would not be able to stop outside schools, hospitals, or substance abuse facilities.
And finally, a recent report finds that many hospital ERs do not address addiction, despite greater awareness of the effectiveness of addiction treatment and surging overdose deaths. ERs routinely fail to screen for substance use, offer medications to treat opioid use disorder, or connect patients to treatment or follow-up care. Now, new programs are being launched to train ER doctors, medical students, nurses, and other staff in addiction-related issues, and to help them refer patients for treatment.
Senate Majority Leader Chuck Schumer’s bill to legalize marijuana on the federal level is the wrong approach to cannabis reform, argues Kevin Sabet in the Wall Street Journal. A better way, he suggests, would be decriminalization for low-level possession and heavy regulation of the new industry to protect public health, along with a ban on the role of Big Tobacco in the emerging market. In particular, he proposes caps on the psychoactive component THC and curbs on concentrated marijuana products, as well as on any products designed to appeal to younger users. Keeping marijuana away from underage consumers is critical, he says, as use among children under 15 has increased in legal weed states including California, Nevada, and Oregon.
As such, there should be severe limits on any form of flavored or child-friendly products such as vapes and candies, as well as advertising. He also wants to stop Big Tobacco from taking a big stake in the industry, as the cigarette industry increases its investments in the new market. Overall, Sabet says we should enact measures that put public safety first—and help stop the rampant Colorado-style commercialization of the drug.
New Jersey voters overwhelmingly supported marijuana legalization in a referendum last year, with nearly 68 percent saying they wanted legal weed. But as the deadline passed this week for municipalities to opt-out of allowing cannabis businesses, more than 70 percent said “no,” passing ordinances that prohibit cultivation facilities, manufacturing, wholesale distribution, and dispensaries. Only 98 localities passed ordinances allowing pot sales, but also imposed strict zoning regulations, such as limiting them to one particular redevelopment area or zone. Others prohibited dispensaries while permitting cultivation.
The decisions were based on a number of factors. Some city officials are simply opposed to legal weed, believing the drug would adversely affect children. But many also opted out simply to buy more time as the six-month window to draw up rules for a new industry was too short. Some localities said they also lacked guidance from the state cannabis regulatory commission, which has not yet issued rules and regulations to govern the new market. Municipalities, which can opt back in at any time, were under deadline pressure because failure to pass an ordinance would mean dispensaries automatically receive conditional use in a retail zone.
Invoking opt-out clauses follows a similar pattern across the country in legal weed states, where majorities in even pro-pot states such as California and Oregon have banned sales. While legalization enjoys overall popular support, there are apparently widespread misgivings at the local level about the impact of pot on vulnerable populations, and easy access to the drug. Many municipalities, therefore, chose to forego potential tax revenues from pot sales, in order to protect public health, while reserving the right to say “yes” to marijuana in the future when more robust controls are in place.
With the deadline nearing for municipalities in New Jersey to opt-out of allowing marijuana businesses, it’s estimated that about 50 percent will say no to allow retail shops, and warehousing and manufacturing facilities. As stipulated by the state’s legalization law, any locality can opt-out—while also forfeiting a share of potential tax revenue generated by marijuana sales. Many city officials say such businesses will adversely affect children; others are taking a wait-and-see approach (towns can later decide to opt-in), or want to first see the full slate of state regulations, which have not yet been announced. In Bergen County, 10 contiguous towns jointly banned cannabis stores, because they’d be located near residential neighborhoods and public places frequented by children. However, big cities including Newark and Atlantic City said yes, and also imposed their own rules. It’s a pattern familiar across the country: states approve marijuana legalization, based on broad popular support, but fail to recognize that pot is apparently not wanted on the local level.
Meanwhile, opting to wait-and-see may be a good idea, judging by the results of a study in California on compliance with state regulations concerning marijuana shops. Researchers from UCLA and UC San Diegofound that nearly 68 percent of facilities failed to comply with laws requiring age-limit outdoor signage, and only 12 percent checked ID before entry. This exposed young people to products designed to appeal to children, promote purported marijuana health benefits, and offer free samples and first-time purchase discounts.
And finally, more than half of teenagers who use e-cigarettes want to stop and about two-thirds have already tried to quit vaping, according to a survey of high school and middle school students. Providing new insights into the ongoing teen vaping epidemic, the survey noted that teens that wanted to quit tried an average of five times during the past year. And those who vaped Juul or other pod products—rather than a disposable e-cigarette—reported fewer attempts to give up the habit, due in part to the product’s sleek design, extensive marketing, and flavors, the report concluded.
Richard Sackler, a prominent member of the billionaire family that turned Purdue Pharma into a marketing juggernaut for the highly addictive prescription painkiller Oxycontin, has denied that he or any member of the family is responsible for the opioid epidemic. Testifying to a bankruptcy court overseeing a possible $4.5 billion settlement between Purdue and states, local governments, tribes, and other claimants, Sackler, a former president of the firm and board member, also said he was ignorant of the company’s marketing tactics used to pump up sales and downplay the drug’s addictiveness. Sackler, making a rare appearance before the court, said he did not know how many people had died from using Oxycontin, which was aggressively marketed by Purdue and sold as safe and effective, even as overdose deaths surged. Over the past two decades, more than 500,000 Americans have died over drug overdose, the majority opioid-related.
If approved, the settlement would grant the company immunity from future civil legal claims and also shield the Sackler family from any further prosecution, which has become a sticking point for many of the litigants. They want the company to pay more and acknowledge its role in the epidemic. But the bankruptcy judge is expected to approve the settlement, which would also provide protection to the Sackler family from any future Purdue-related claims. The company would become a public-benefit corporation, with profits used to fund compensation over a decade, but would not prohibit Purdue from continuing its international opioid business.
Thousands of lawsuits against the opioid industry—including drug distributors and pharmacy chains, as well as manufacturers such as Purdue—are still pending. Some have gone to trial, while others have tentative agreements in place, including a $26 billion settlement with the country’s three largest drug distributors and opioid-maker Johnson & Johnson. States are trying to strike a balance between holding the industry accountable and guaranteeing funding for drug abatement and treatment at a time when overdoses reached a record 93,000 just last year. They also want to avoid protracted and expensive litigation that would take place if the deals are eventually scuttled, thereby denying states and communities of badly needed resources to fight the drug crisis.
Purdue Pharma’s founding Sackler family has threatened to pull out of a proposed $4.5 billion agreement to settle lawsuits against the Oxycontin maker unless it is granted total immunity from all current and future claims against the company. Board member David Sackler said that absent that release from liability, Purdue, which is accused of contributing to the opioid epidemic that has killed more than 500,000 Americans over the past two decades, would not support the deal. If approved, the agreement would bring to an end thousands of lawsuits against Purdue brought by states, cities, tribes, and other plaintiffs. But if the deal is scuttled by the lack of immunity for the billionaire Sackler family, Purdue says it would continue the legal fight—possibly for years—thereby depriving compensation to local and state governments that bore the cost of the addiction crisis, as well as to victims’ families. Under the terms of the deal, the family would relinquish control of Purdue, which would transform it into a public benefit company to fund the settlement over a decade. But it would allow the Sacklers to continue their international pharmaceutical business including marketing opioids for up to seven years.
Meanwhile, although there have been advances made in machine learning algorithms that may be able to determine the risk of a drug overdose, a new study published in JAMA finds that such algorithms may be biased—and therefore miss patients at high risk of opioid misuse. The study concluded that Black patients at high risk were almost twice as likely to be missed as white patients. And those that fell in the false-negative group also had a higher mortality risk. Such bias could keep these patients from receiving education and treatment options, the study showed.
And finally, marijuana legalization and changing attitudes and perceptions about pot have led to a staggering increase in consumption, according to a Gallup poll. The percentage of U.S. adults who say they have tried the drug has ticked up to 49 percent—the highest measured to date. More than 50 years ago, just 4 percent admitted to using marijuana; that had climbed to 40 percent in 2015. By age group, around 50 percent of millennials, Generation Xers, and baby boomers have tried pot. But it is younger Americans who are more likely to have smoked marijuana (20 percent of millennials), suggesting that people tend to try marijuana at a younger age but as they get older, most no longer continue smoking it.
As lawyers and prosecutors hammer out the final details of nationwide opioid litigation and settlement terms, a growing number of families bereaved by the epidemic are speaking out—and criticizing the lack of accountability in the agreements. Specifically, family members are angered by what they regard as the persistent failure to hold pharmaceutical executives responsible for mass-describing narcotics and making false claims about safety and addictiveness. In two tentative deals—one for $26 billion with drug distributors and Johnson & Johnson, and another for $4 billion with Oxycontin maker Purdue Pharma—the companies do not admit any responsibility for contributing to the deaths of more than 500,000 Americans over the past two decades. Critics also say the restitution payments are relatively small for some of the country’s largest businesses, especially as the payout period of up to 18 years is too long. And in the case of Purdue, the firm’s founding, multi-billionaire Sackler family, will be shielded from any further litigation.
Meanwhile, although progress has been made in reducing opioid overprescribing among adults, a new study published in Pediatrics found that opioids are still being prescribed inappropriately for children. Almost half of the 4 million opioid prescriptions written in 2019 for children and young adults fit high-risk patterns known to increase the chances of overuse of overdose, according to the study. Dentists and surgeons wrote most of the problem prescriptions, and high-volume prescribers wrote more than half of them.
And finally, there’s a growing movement among veterans to push for medical marijuana reform in the 14 states that have not yet enacted comprehensive marijuana legalization. Many of these remaining states are in the traditionally conservative South, which has generally been more reluctant to legalize the drug, even for medical purposes. Medical pot is believed to have benefits in treating PTSD and other debilitating conditions, but more research is needed to establish treatment protocols.
As opioid litigation against Purdue Pharma reaches its final stage, the judge overseeing the case has added a human dimension to the proceedings by including in the court documents dozens of personal letters from people who say their lives were ravaged by addiction. Purdue is accused of helping fuel the opioid epidemic by downplaying the addictiveness of its product Oxycontin and using devious marketing tactics to push the sale of prescription painkillers, resulting in the deaths of tens of thousands of individuals. These letters open a rare window into the tragic toll of the crisis on families and communities, describing the pain and suffering of those struggling with substance use and the grief over those who died of an overdose. Including the letters won’t change the terms of the $4.5 billion settlement deal offered to Purdue, or hold Purdue’s founding Sackler family, which denies any responsibility, accountable for the deaths. But it does provide a record of the opioid industry’s role in an epidemic in which more than 500,000 Americans have died.
Meanwhile, drug overdose fatalities are on the rise in Iowa—as they are across the country—but the governor of that state has a new take on why deaths are surging: it’s the fault of illegal immigrants. Gov. Kim Reynolds has repeatedly suggested that the uptick is due to illegal immigrants bringing drugs across the border from Mexico, although the drugs involved in opioid overdoses are mostly prescription painkillers or street drugs sold by dealers. China is the source of much of the fentanyl that is driving the increase in overdose deaths. Reynolds also says that COVID-19 restrictions are to blame, which is partly true, in the sense that lockdowns did increase isolation and make it more difficult to access services, but those measures were of course aimed at stopping a deadly and contagious virus.
And finally, was it fentanyl or not that caused a San Diego police detective to be taken to the hospital purportedly suffering from overdose symptoms? The detective became the star of a now controversial police public service video about the dangers of the powerful synthetic opioid, in which he supposedly touches a powdery white substance and subsequently collapses. Addiction experts point out that fentanyl would have to be injected or ingested—rather than simply touched—to have that effect. Now, the police say a lab report shows the substance was in fact a mixture of fentanyl and meth, further complicating what should have been an important and straightforward warning to the public about the risk of fentanyl.
The Marshall Project reports on an ambitious project to expand access to drug treatment in prisons and jails that has failed despite tens of millions of dollars in funding. Initiated by Congress in 2018, the program was aimed at reducing soaring overdose deaths among inmates. But so far only a small fraction—less than 2 percent of the 15,000 eligible for treatment—has received it. The article blames bureaucratic inertia and resistance to medication-assisted treatment (MAT) among correctional administrators for the disappointing rollout. While hundreds of facilities now provide such services, it’s still a small number of the nation’s 3,000 jails. At the same time, overdose deaths jumped by more than 600 percent inside prisons and by more than 200 percent inside jails in the last two decades, according to federal data. In Maine, preliminary data shows a huge reduction in overdose deaths through the MAT program: people were 60 percent less likely to die of an overdose in their first year out of prison if they had participated.
Meanwhile, New Jersey’s largest needle exchange program in Atlantic City is set to close despite a surge in overdoses across the state. The city council has ordered the facility to shut down, saying that as the only place in southeast New Jersey where intravenous drug users can trade in needles, it attracts too many transient addicts. Gov. Phil Murphy is trying to block the move, and harm-reduction advocates haven’t ruled out a last-minute deal to relocate the site outside the city’s tourist district.
And finally, an editorial in the Connecticut Postargues that opioid settlement funds should be used solely for combatting opioid addiction. As nationwide opioid litigation leads to multibillion-dollar settlement agreements, many states want to ensure that the money is not siphoned off for other purposes—as was the case with tobacco settlement funds. Connecticut’s share of the $26 billion settlement with drug distributors will total about $300 million, which could disappear quickly into the state budget, the editorial points out.
Overdose deaths from fentanyl are increasing across the country, leaving health officials scrambling to inform the public about the dangers of the powerful synthetic opioid. But a public service video released by the San Diego County Sherriff’s Department has come under criticism for providing misinformation concerning the danger of simple exposure to fentanyl powder. The video shows a deputy trainee collapsing while investigating a substance believed to be fentanyl, and then receiving the overdose reversal drug naloxone before be taken to the hospital by emergency medical workers. While the video was intended to raise awareness, medical experts say it is impossible to overdose on fentanyl simply through exposure (the drug would have to be injected or ingested to have this effect). With overdoses are on the rise in San Diego county, it is critical for officials to correctly inform the public if they want to help curb the opioid crisis.
Meanwhile, an opinion essay in the New York Times looks at the recent opioid litigation settlements and concludes that there’s more reason for hope than despair to combat the opioid epidemic. While acknowledging that the amount of money is “atrocious,” and that opioid companies are getting off easy, the writer believes the settlement will offer some relief to communities, help expand access to drug treatment, and compel the Biden administration to boost funding, for both harm-reduction programs and treatment. What is missing from this piece is an acknowledgment that harm reduction is only one component of a comprehensive drug policy or a proposal for the government to step in and close the funding gap between the settlement and Biden’s promised decade-long, $125 billion effort to confront the opioid epidemic.
And finally, for decades the U.S. tried to stop Mexican drug gangs from illegally trafficking marijuana across the border. Now, with pot legalized in California, Americans are making money transporting legal weed to Mexico, where it is still illegal. The Washington Post reports that traffickers from California load suitcases with U.S.-grown marijuana before hopping on planes to Mexico, or just walk across the pedestrian border crossing into Tiajuana, to supply a booming boutique market for American pot products. They can also be easily purchased at outlet malls near the border and brought to Mexico.
As nationwide opioid litigation brings to light the inside story of the epidemic, questions are also being raised about the role of the American Medical Association in the crisis, and its relationship with Purdue Pharma, the maker of OxyContin. An in-depth investigation in Mother Jones suggests that the foremost organization of the medical community had a too-cozy relationship with Purdue, receiving donations from the drugmaker and funding the AMA’s philanthropic arm and pain management education—well after the opioid crisis had morphed into a full-blown epidemic. In 2000, the AMA said that addiction “seemed to occur infrequently” with opioids, and noted that for many patients, prescription painkillers are often the only treatment options that provide relief. The article says this relationship may have violated the AMA’s own code of medical ethics, while also contributing to physician overprescribing that contributed to the opioid crisis.
Meanwhile, the Biden administration continues its drug policy shift away from the failed “war on drugs” to harm reduction strategies. It is offering grant money to draft model laws that support harm reduction programs and backs removing the long-standing ban on federal dollars being used to purchase syringes, in a bid to prevent deaths from drug use. The change in policy makes some sense, considering the surge in overdose fatalities last year to a record 93,000. Yet while harm reduction strategies, such as safe consumption sites, do save lives and help reduce the spread of infectious diseases, they should only be a short-term measure that eventually leads to drug treatment.
And finally, one of the main components of harm reduction is providing the overdose reversal drug naloxone—but that drug is now in short supply. The drugmaker, Pfizer, has said that production has been interrupted, probably by its accelerated COVID vaccine rollout, causing the worst naloxone shortage since at least 2012, when overdose levels were less than half of what they are now. As a result, organizations across the country are scrambling to provide their communities with information about how to counter overdoses with alternative medications. We need a better production and distribution system for naloxone, to ensure that law enforcement, healthcare professionals, and organizations can easily access adequate supplies of the drug.
As more states legalize marijuana, pot entrepreneurs are becoming ever more innovative. Take the global beverage giants—especially beer brewers—who are eying a potentially lucrative multibillion-dollar market for weed-based drinks. There are already many pot-infused products, including seltzers, teas, colas, and cocktails, but the beverage sector is only a small part of the $20 billion legal weed marketplace. Now the industry sees potential in a wider range of marijuana drinks, mainly because they have negligible calories, you don’t have to smoke or inhale them, and there’s no risk of a hangover—at least, that’s what the marketing strategy will be. As the beverage makers ponder how to get more drinkers high, they’re also recalibrating the THC component to a lower level, as most cannabis beverages have traditionally packed a wallop—not exactly what the casual customer may be expecting as they get behind the wheel of their car.
Such concerns are apparently not bothering officials in Modesto, California, a city with some 200,000 residents in the state’s Central Valley. In what is believed to be the first sanctioned citywide cannabis tourism program, Modesto is promoting its pot dispensaries as a tourism draw, hoping to increase revenue as drivers make a stop in the town, which is midway between San Francisco and Los Angeles. The message would be, take a break, get gas, and something to eat, pop into the weed shop, and then back on the road. Currently, about 40 percent of the customer base at the city’s roughly two-dozen dispensaries is from out of town, so this gimmick may actually work. No word however about the risk of driving while drugged after fuelling up and getting high in Modesto.
And finally, The Guardiannewspaper investigates whether medical cannabis is really a magic bullet for many maladies or if it’s too soon to make any definitive conclusions. While research suggests that extracts from the plant can be effective n treating pain, anxiety, and epilepsy, experts still preach caution around recreational use. The article notes that medical pot is still a contentious field due to fragmented data collection based mainly on the experiences of recreational users and that THC has been linked with an increased risk of psychosis and schizophrenia. There’s only one cannabis-based drug approved by the FDA—for a rare form of epilepsy—but advocates for medical marijuana and CBD often make unfounded claims about its effectiveness in treating a wide range of illnesses and disorders.
Overdose deaths are surging in Canada, as they are in the U.S., and the province of British Columbia is responding with a controversial strategy to give out highly addictive opioids to those struggling with substance abuse. The program includes distributing tablets of powerful fentanyl, with the hope that such drugs obtained from pharmacies and clinics are safer alternatives to street drugs, which increasingly are laced with lethal amounts of opioids and tranquilizers. Many say that the plan is an ineffective half-measure, as it does not include access to any form of drug treatment or a requirement that an addict must enroll in treatment. More than five people die every day from a drug overdose in the province, and while this approach may reduce fatalities at first, it won’t, in the long run, help substance users on the road to recovery.
Meanwhile, states are eager to get their hands on a portion of the proposed $26 billion opioid settlement and this may eventually lead to competing interests vying for a share of the money. If the deal is approved, the money would be shared among some 40 states that brought lawsuits against three big drug distributers and the opioid maker Johnson & Johnson. The settlement arrangement does include guidelines for how the money should be spent on addiction and treatment services, but legislatures could still squabble with governors and counties over priorities such as abatement programs. To get ahead of the process, Tennesse has established a special council to allocate funding, while New York set up a “lockbox” for money to ensure it goes to addiction services. Still, public health officials are still concerned about how exactly the states will allocate their dollars, and which programs will be funded.
And finally, the judge overseeing the opioid trial underway in West Virginia –part of the sprawling opioid litigation involving thousands of lawsuits—will have to answer a critical question: was it “reckless” for drug distributors to ship 81 million doses of a highly addictive opioid to one small Rust Belt city? And if so, can the deaths and addiction that followed be described as a public nuisance? The ruling, expected in a month, could shape precedents concerning corporate accountability for the opioid epidemic, in which more than 500,000 Americans have died. The West Virginia trial is taking place as more than 40 states are deciding whether to accept a proposed $26 billion settlement for a portion of the opioid cases, in which big drug distributors and opioid maker Johnson & Johnson are accused of contributing to the opioid epidemic.
Closing arguments are being made in the landmark federal opioid trial taking place in West Virginia, with communities across the country watching closely what may happen and how this might impact proposed settlements in thousands of other opioid cases. The trial is focusing on two counties in West Virginia that were shipped more than 81 million prescription painkillers for an area with a population of fewer than 100,000 people; today, officials say 1 in 10 individuals are now opioid-dependent and there are more than 2,000 children diagnosed with developmental damage linked to opioids. The three big drug distributors on trial in West Virginia recently agreed to a $21 billion settlement to end other cases brought by more than 40 states, for their role in the epidemic, which has killed more than 500,000 Americans over the past two decades.
Meanwhile, the Washington Post publishes an in-depth story about one community in West Virginia and its struggle to contain the opioid crisis during the COVID-19 pandemic. It notes that overdoses were already at record levels when the lockdowns increased the fear, despair, and loneliness of those struggling with substance use. As the human connection is at the heart of addiction treatment, those support systems disintegrated in the shutdowns, cutting off a vital part of achieving and maintaining sobriety. Along with widespread job losses and the increasingly dangerous supply of illicit drugs, this contributed to a spike in overdose fatalities in West Virginia and nationwide, which last year reached a record 93,000.
And finally, officials in drought-stricken California say that water theft is on the rise—including from illegal marijuana growers. They say the pot cultivators are tapping into fire hydrants and drilling unauthorized wells to raise their water-intensive plants, threatening the water supply for residents. The illegal marijuana market was supposed to disappear once the state legalized pot, but that apparently hasn’t happened yet.
A majority of creditors seeking compensation from Purdue Pharma for its role in the opioid epidemic have agreed to a $4.5 billion settlement with the OxyContin maker, clearing the way for the deal to be approved. More than 120,000 creditors—including cities, states, tribes, and families and caregivers of children born addicted to opioids—are seeking payment from Purdue, which is ready to settle but will not admit responsibility for contributing to the opioid epidemic. The company will pay out the money over nine years to fund addiction treatment and prevention programs and exit the opioid market. Many states at first objected to the deal but then extracted further concessions from the firm, including the release of millions of documents related to the case and its painkiller business.
Meanwhile, the opposition is growing to another proposed opioid settlement between the states and the country’s largest drug distributors and opioid maker Johnson & Johnson. Washington State and West Virginia, as well as the city of Philadelphia, say the $26 billion settlement is too little and the payout timeframe of nearly two decades too long, faced as they are with a growing drug crisis and surge in overdose deaths today. They also want the companies, which underplayed the addictive nature of opioids and failed to control their distribution, to be held accountable. If a majority of states back out of the deal, it could reduce the total amount of compensation or scuttle the settlement altogether.
And finally, the World Health Organization has warned for the first time about the dangers of e-cigarettes, describing vaping as an emerging health threat. In a new report, the WHO said that nearly 85 countries do not have safeguards to protect against the rising popularity of vaping; only 32 countries have banned e-cigarettes, and 79 have adopted at least one measure—such as health warnings on the packaging—to curb sales. The report concluded that e-cigarettes are harmful and must be better regulated. In the U.S., there is an epidemic of youth vaping, which has prompted the Food and Drug Administration to consider stricter regulation of the industry.
The recent successes of the marijuana legalization movement can be attributed to many factors—including, as it turns out the financial support of a boatload of billionaires, from conservative political activist Charles Koch to Jeff Bezos and Elon Musk, who are on the front lines of the cannabis revolution. For his part, Koch told Forbes he supports legal pot because prohibition is a basic infringement on personal freedom, as well as a destructive policy that adds to America’s mass-incarceration problem. That’s why the devout libertarian is spending a fortune to help end federal marijuana prohibition.
Before they write some more checks, however, perhaps the deep-pocketed businessmen should take a look at this new study that found an increase in overdoses among children who ingest marijuana edibles. The number of children under 12 who have ingested edibles at home jumped from 132 in 2015 to almost 2,500 last year, according to the Association of Poison Control Centers, and those requiring medical attention jumped astronomically, too. This parallels the legalization of marijuana in many states. One reason for the rise, doctors say, is that the packaging for these substances looks very attractive to kids.
And finally, an analysis of the most popular vaping-related TikTok videos on a single day last year showed that nearly two-thirds portrayed potentially dangerous e-cigarettes in a positive light. The videos promoted vape use, joked about e-cigarette use, and showed tricks to do with a vape pen, all at a time when vaping has reached epidemic levels among young people. Collectively, the videos were viewed more than 1.5 billion times. Although other social media platforms have taken steps to ban such content, TikTok remains a ready source for positive messaging about vaping despite the risks posed by e-cigarettes.
Opposition is growing to the landmark $26 billion opioid settlement announced last week, as a growing number of states and cities say the amount isn’t enough and the 18-year payout period is too long. So far, West Virginia and Washington State, as well as Philadelphia, have said they won’t sign on to the deal, noting that we need more money right now and upfront to tackle the nationwide drug crisis. Critics also say that the proposed settlement does not hold the companies in the opioid industry accountable for contributing to the opioid epidemic, because they do not admit responsibility for an epidemic that has killed more than 500,000 Americans over the past two decades. States have only 30 days to opt into the deal, and if there’s not enough support the settlement could be reduced. This settlement involved the country’s 3 largest drug distributors and the opioid maker Johnson & Johnson, but thousands of cases remain against pharmacy chains and other opioid makers.
Meanwhile, the AP carries a story marking the 50th anniversary this summer of the “war on drugs,” launched by former President Richard Nixon, and concludes that this approach has been an abject failure. The so-called war did not lead to an end to drug addiction—as we are in the middle of a raging overdose crisis, with a record 93,000 fatalities last year—and mass incarceration of millions of people, mostly Black and Hispanic Americans. Between 1975 and 2019, the U.S prison population jumped from around 250,000 to 1.4 million, with 1 in 5 people incarcerated with a drug offense. Today, there is a correct policy shift underway from sending addicts to prison and focusing instead on engaging them in drug treatment and harm reduction.
And finally, an opinion piece in the New York Times picks up on this topic, arguing that harm reduction—including needle exchanges and safe injection sites—should be the cornerstone of our national drug policy, without mentioning the importance of drug treatment. While harm reduction is of course critical to save lives, reduce criminality, and stop the spread of infectious diseases, it should only be a short-term measure that engages individuals to pursue drug treatment. It’s not an end, in and of itself, but part of a broader and comprehensive approach to confronting addiction. The writer says that the humane treatment offered by harm reduction can spur self-care rather than self-destruction, but what is truly humane would be to help those struggling with substance use get on the road to recovery.
President Biden has spoken out forcefully for establishing mandatory drug treatment for addicts—and keeping those struggling with substance abuse out of prisons and jails altogether. Addressing a town hall meeting in Ohio, one of the epicenters of the opioid epidemic, the president also advocated for post-incarceration services including housing and job training, in addition to drug treatment. The statement suggests that Biden will pursue this controversial approach as he gears up his drug policy team at the White House to confront a drug overdose epidemic that last year killed a record 93,000 Americans. Oregon has already decriminalized hard drugs in favor of paying a small fine and entering voluntary treatment, but the program has so far not been successful.
Meanwhile, in the wake of the proposed $26 billion opioid settlement announced this week between states and major players in the opioid industry, public health officials and advocacy organizations are pushing for state governments to sign on to a set of principles for how the money should be used. Instead of flowing to a state’s general fund, they want the money set aside in a dedicated fund for addiction services. They fear a repeat of the $206 billion tobacco settlement of 1998, in which most of the money was siphoned off to balance state budgets and never used for smoking cessation and abatement programs. The opioid settlement does contain provisions for using the money for addiction services, but it’s not clear if it enforceable. Some states, including New York, have already passed laws guaranteeing the money will be used for that purpose.
And finally, there may be another settlement in the opioid litigation on the horizon: fifteen states that had previously blocked a bankruptcy plan by OxyContin maker Purdue Pharma have now abandoned the fight, opening the way to a final agreement. The bankruptcy would allow the $4.2 billion settlement to go forward, but absolve the company’s billionaire founding Sackler family of any responsibility and shield it from any further liabilities. Thousands of other opioid cases are still pending against opioid manufacturers and pharmacy chains.
Senator Chuck Schumer has finally unveiled long-awaited legislation to end the federal-level prohibition of marijuana, reflecting a milestone in shifting public opinion about pot and efforts to end the decades-long war on drugs. The draft bill would remove cannabis from the Controlled Substances Act and begin regulating and taxing it under federal authority rather than the current situation in which states that have legalized the drug control sales, taxes, and usage. The bill also calls for expunging previous marijuana-related arrests and programs to help communities affected by cannabis prohibition. Winning passage of the bill, however, isn’t likely, as the measure faces significant opposition from both and moderate Democrats, and President Biden has not endorsed it.
Not surprisingly, the Schumer proposal received a frosty reception from across the board—including the cannabis industry. The bill’s authors even admitted that there are no standards to measure drugged driving or the impact of pot on fetal health. Critics such as Smart Approaches to Marijuana said it did not contain a cap on potency, limits on advertising, and a ban on flavored products that would be attractive to children. The union representing cannabis workers said it lacked support for creating good-paying jobs in the industry. Schumer no doubt believes that by simply introducing the legislation he will curry favor with progressives in his next reelection bid.
And finally, while the federal government can’t find a way forward, municipalities in newly legal pot states New York, New Jersey, and Connecticut are scrambling to figure out whether to allow marijuana dispensaries in their neighborhoods. Debate is heating up as localities debate the potential risks—including traffic fatalities and underage use—and the purported financial benefits for communities. Many have already said no, but others are putting out the welcome mat, believing that additional tax revenues and new jobs and businesses outweigh the possible pitfalls. The article points out that a majority of municipalities in Colorado have opted out of commercial sales, but fails to mention the same "not in our backyard" trend in California, Oregon, and Michigan, reflecting a grassroots opposition to rampant marijuana commercialization.
After years of legal wrangling, a tentative agreement has been reached to settle thousands of opioid lawsuits for an estimated $26 billion—with the money destined for addiction treatment and prevention services. The deal must still be approved by the 40 states and dozens of municipalities that brought the lawsuits against drug distributors Cardinal Health, AmeriSourceBergen and McKesson, and opioid maker Johnson & Johnson. In a separate agreement, drug distributors would give $1.1 billion to New York State to end a trial currently underway there.
Yet thousands of other cases are still outstanding against opioid makers and pharmacy chains for their role in the epidemic, in which more than 500,000 Americans died over the past two decades from drug overdose, mostly opioids. Experts say however that the settlement provides an incentive for these companies to avoid trial without having to admit responsibility and be shielded from further litigation.
The settlement money is badly needed at a time when overdose are surging—to a record 93,000 last year—and treatment providers were forced to curtail services due to funding cutbacks. Money will be distributed to the states based on a formula including population an overdose deaths, with a provision that funds be used solely for addiction services, and not to balance state budgets. Some states, including New York, have passed a law stipulating that all funds be used to address the drug crisis.
If approved, the settlement is a major step forward to hold accountable the companies responsible for so many deaths and misery and a tragic drug crisis. But it does not end the opioid epidemic. Instead, it should be part of a comprehensive strategy that requires leadership, massive funding and a commitment to expanding drug treatment.
Drug overdose deaths rose nearly 30 percent in 2020 to a record 93,000, according to preliminary estimates by the CDC—the largest single-year increase ever as fatalities surged for opioid, meth, and fentanyl-related deaths across the country. Deaths rose in every state but two, with pronounced increases in the South and West and among Black and Hispanic populations. The data showed that fatalities had accelerated pre-pandemic and grew even more pronounced during lockdowns, social distancing, and the closing of drug treatment facilities. The national rise in deaths—which now exceed car crashes, gun violence or the AIDS epidemic—came as fentanyl became more entrenched in the drug supply, replacing heroin and finding its way into meth. What can the Biden administration do?
The Washington Post points out that the president has a number of ideas and strategies at his disposal, including expanding drug treatment, medication-assisted programs, and residential services, as well as harm reduction, boosting drug interdictions, and more education and prevention initiatives. But he may also consider some novel approaches, such as complete decriminalization of hard drugs, as Oregon has done. Treatment and access to anti-addiction medications are critical to this response; just 18 percent of people with substance use disorder receive such drugs and less than 10 percent of facilities nationwide offer residential treatment.
And finally, one thing that President Biden has done is to finally nominate a new “drug czar” to head the White House Office of National Drug Policy Control to oversee and help coordinate national drug policies. Biden tapped former West Virginia Health Commissioner Dr. Rahul Gupta for the job—a good choice for his experience dealing with the opioid epidemic in his state. Gupta would be the first physician to take the post, which was created in 1982. However, Biden is not expected to reverse President Obama’s decision to demote the office from a cabinet-level position, thereby denying Gupta a more prominent platform to advocate for drug policies during a national crisis.
Fifteen states including New York and Massachusetts have reached agreement with Purdue Pharma to settle some of the opioid lawsuits against the maker of prescription painkiller OxyContin, opening the way to $4.5 billion deal. The lawsuits are among thousands across the country against opioid makers, drug distributors and pharmacy chains for their role in the opioid epidemic. Nine other states—including California and the District of Columbia—that are suing Purdue continue to oppose the agreement, holding out for more money from the company, which is currently in bankruptcy proceedings. The deal was struck after Purdue agreed to an additional $50 million from members of the founding Sackler family, who are believed to worth more than $11 billion, as well as the release of millions of documents to be used in some 3,000 opioid-related lawsuits brought by cities, counties, states, and tribes. Several of those cases are currently at trial, including the first jury trial in New York.
Meanwhile, drug overdose deaths are on the rise last year in the Washington, D.C., area, with Black residents disproportionately effected. Health officials blame the increase—from 281 in 2019 to 411 last year—on fentanyl-laced heroin, marijuana and cocaine. More than four out of five individuals who die of overdose in the city are Black, according to city officials.
And finally, the governor of Rhode Island has signed into law a bill calling for a pilot project for controversial safe consumption sites in the state, where drug users can get receive medical care and clean needles. Several cities including San Francisco and Philadelphia have tried to open such harm reduction facilities, but were eventually stopped by Justice Department authorities. It’s not clear how the Biden administration would respond, although the president has indicated he generally supports harm reduction strategies. Safe sites do reduce fatalities, crime, and the spread of infectious diseases, but so far do not have a mandatory treatment component that makes them less effective.
Juul Labs was once the high-flying, market dominating company that fueled a global e-cigarette boom—and with it a teenage nicotine epidemic. Today, the company is under siege amid thousands of lawsuits accusing it of marketing to underage users, potential government regulations, and widespread health concerns about its vaping products. The biggest threat to staying in business is an upcoming FDA ruling on whether Juul’s devices and nicotine pods have enough public health benefit to continue selling them in the U.S. Major health organizations have asked the agency to reject the application, fearing it would lay the groundwork for the company to expand its reach once again.
Meanwhile, there is continuing debate over the decision by the World Anti-Doping Agency to disqualify American track star Sha’Carri Richardson from the upcoming Tokyo Olympics after she tested positive for marijuana. The drug is on the list of the agency’s prohibited substances, because it can be performance enhancing, and negatively effect hand-eye coordination, concentration and endurance, according to the agency. Some say the rules should be changed to allow athletes to consume cannabis products, as they are now legal in many states and countries.
And finally, pundits are speculating that the Sha’Carri Richardson pot scandal may be mellowing President Biden’s views on marijuana. Commenting on the suspension, Biden praised the athlete on the way she responded to the decision, but said “rules are rules.” Then he seemed to leave the door open to change, adding, “whether [the rules] should remain that way is a different issue.” Biden has been more cautious about marijuana legalization than many fellow Democrats and has not endorsed lifting the federal prohibition on pot, while saying states should be able to go their own way.
As the first jury trial in nationwide opioid litigation gets underway in New York’s Long Island, jurors will be asked to decide whether drugmakers and drug distributors created a public health crisis and should pay for it—possibly as much as $57 billion for the opioid manufacturers alone. Prosecutors say the companies illegally marketed the highly addictive prescription painkillers and ignored warning signs and suspiciously large orders, leading to more than 500,000 overdose deaths over the past two decades. Jurors on Long Island will be familiar with the crisis, as Suffolk County on Long Island was hard hit by drug overdoses. Other opioid lawsuits are taking place in California and West Virginia, part of thousands of cases across the country to gain compensation from companies accused of fueling the epidemic.
Meanwhile, school districts say they have collectively spent at least $127 billion helping students affected by the opioid epidemic, and are pushing in court to receive compensation as well from the opioid industry. Lawyers representing the schools say the figure almost certainly underestimates the true cost of special education services and social-emotional supports for students whose physical, mental, and emotional health was hurt by the crisis.
And finally, an editorial in the Stamford Advocate newspaper in Connecticut calls on state leaders to use the potential windfall from opioid lawsuits for stopping addiction. With opioid overdose deaths in Connecticut soaring from 298 in 2012 to 1,273 last year, the editorial says the money should not be siphoned off for other purposes, as the state does with funds from the $27.5 billion tobacco settlement in 1998. New York Governor Andrew Cuomo recently signed a “lockbox” bill that guarantees such funds will go exclusively to addiction prevention and treatment.
Colorado was a pioneer legal marijuana state when it decriminalized the drug in 2014, amid great expectations it would usher in a new era of economic prosperity and social justice, and eliminate the black market. It may have succeeded on some levels, with cannabis sales soaring—especially during the pandemic—but for public health, it has been an abject failure, according to a comprehensive review by the Hudson Institute. The black market is flourishing, youth usage and college-age use have increased, as has the use of other drugs, suicides, traffic fatalities, and THC concentrations in marijuana products. “There’s a high cost to making an addictive substance a commercial product,” the report concludes.
With that in mind, it’s not surprising that Colorado Governor Polis has just signed a bipartisan bill that reins in the powerful cannabis industry in the state, and places long-overdue restrictions on THC levels—reducing them to one-fifth of what they currently are— and youth access to medical marijuana. The law also mandates specific warning labels and real-time monitoring of sales, all in response to a report by Colorado physicians concerning the impact of pot on youth mental health, including an “alarming” rise in the number of psychotic episodes among young people using marijuana concentrates.
And finally, conservative Supreme Court Justice Clarence Thomas may be an unlikely hero of the marijuana legalization movement, after he attacked the federal ban on marijuana and questioned whether the government has the authority to intrude on state-legal cannabis markets. His views appeared in a statement, not a court ruling, but do indicate how he would likely decide if the push for lifting the federal ban ends up before the Court.
The first jury trial in nationwide opioid litigation opens in New York today, with leading drug manufacturers and drug distributors accused of fueling the ongoing opioid epidemic that has claimed more than 800,000 lives over the past two decades. The case, brought by Nassau and Suffolk counties, is one of several thousand lawsuits brought by states, counties, Native Tribes, and the federal government seeking compensation for the devastation caused by the crisis. Other trials underway in West Virginia and California are before a judge, but in New York prosecutors will tell the jury about the machinery that powered a drug scourge via overdoses of prescription and street opioids. Pharmacy chains were also named in the New York complaint, but they reached a settlement before the trial opened, as many companies in the wide-ranging litigation have already done. Last year, a record 90,000 Americans died from a drug overdose, the majority opioid-related.
Meanwhile, a “lockbox” bill that would guarantee that funds from opioid settlements would go only toward education, prevention, and drug treatment is still on Governor Cuomo’s desk. The bipartisan measure would change the usual practice of placing the money in the state’s general fund, which could divert funding for other purposes.
And finally, in another legal development, e-cigarette maker Juul has reached a $40 million settlement in a North Carolina case, in which the once industry-leading company was accused of deceptive marketing practices that contributed to a wave of teen nicotine addiction. Thirteen other states have filed similar lawsuits against Juul, alleging that its sleek vaping device—originally aimed at helping smokers quit—actually targeted teens and young adults who had never smoked and hooked them on nicotine and marijuana.
With the support of the Biden administration, Congress has for the first time allocated funding for harm-reduction services, prompting renewed debate about this controversial approach to help substance users. Harm reduction programs can include overdose prevention, distribution of clean syringes, and so-called safe consumption sites with healthcare professionals on hand to provide assistance if needed. Such facilities can save lives and prevent the spread of disease, and they also offer information about drug treatment and referral services. But they usually do not but do not require patients to enter treatment, a flaw that makes them less effective than they could be to assist more individuals struggling with substance abuse to get clean.
Meanwhile, nearly five months into Oregon’s initiative to decriminalize hard drugs and expand treatment, the first results are discouraging. Under the law, anyone caught with heroin or other illicit substances receives a citation (akin to a parking ticket) and $100 fine, which is waived if the individual agrees to get a health screening through an addiction recovery hotline. So far, just 29 people have called the hotline, as there is no mandatory treatment.
And finally, Johnson & Johnson has agreed pay New York State $230 million to resolve an opioid lawsuit against the drug company, one of thousands of such cases that are pending against opioid makers, drug distributors and pharmacy chains for their role in the opioid epidemic. The New York deal came on the eve of a jury trial in the state, and may boost efforts to reach a master settlement similar to the $206 billion agreement in the 1990s against tobacco companies.
Now that Connecticut has legalized recreational marijuana, how long will it be before the last two holdouts in New England—Rhode Island and New Hampshire—fall in line and allow legal weed? Marijuana supporters say the victory in Connecticut will grease the wheels for the final two states, believing that the lure of tax revenues and new jobs will spur legislators to take action. If Rhode Island and New Hampshire do move in that direction, they should take a page from the Connecticut law that includes much stricter guardrails and protections for public health than in many other legal states. Defying the powerful cannabis industry, lawmakers approved rules including a cap on intoxicating THC levels and an opt-out provision that allows municipalities to ban not only dispensaries but also home-delivery services.
Meanwhile, a Congressional committee has blasted the FDA for lax oversight of the vaping industry, and is urging the agency director to crackdown on e-cigarette manufacturers. The FDA is currently assessing new rules on vaping, after allowing the sale of flavored vaping products, so long as the device cannot be refilled—an approach many say contributed to a youth vaping epidemic of disposable products.
And finally, a new United Nations report finds that the number of people using drugs globally is projected to rise 11 percent by 2030, fueled by the socioeconomic and health impacts of the COVID-19 pandemic as well as easier online drug accessibility. While the number of individuals with drug use disorders has increased, the report noted, the availability of treatment interventions has remained low, with just one in eight of those suffering from drug use receiving professional help in 2019.
Connecticut became the 19th sate to legalize recreational marijuana, completing a Northeastern block of new legal weed states including New Jersey and New York. But unlike those states, Gov. Ned Lamont signed a bill that includes unusually strong public health protections, including a 30 percent limit on levels of intoxicating THC—only the second state to do so after Vermont. In addition, advertising and products designed to appeal to children are forbidden, and municipalities can invoke an opt-out provision to not only prohibit dispensaries but also delivery services, and can set limits on the number of businesses, operating hours and signage. The safeguards are generally opposed by the powerful cannabis industry, but are increasingly being recognized as necessary as states—including Colorado—assess the impact of legal marijuana on health and vulnerable populations, including young people.
Meanwhile, a new study published in JAMA finds that increased marijuana use was associated with greater risks of thoughts of suicide, suicide plan, and suicide attempt among young adults ages 18-35. The large-scale study showed that the associations remained regardless of whether someone was also experiencing depression, and the risks were greater for women than for men. Even those who used cannabis on a non-daily basis were more likely to have suicidal ideation or attempt suicide than those who did not use the drug at all.
And finally, the city of Somerville, Mass., near Boston, is considering opening the country’s first supervised drug consumption site amid a 5 percent increase in drug overdose deaths in the state. Attempts to open such facilities—which provide medical attention, clean needles and overdose reversal drugs—have already faltered in New York, San Francisco and Philadelphia due to legal complications. Safe sites in other countries have proven to be effective to reduce overdose deaths and the transmission of infectious diseases, but are unlikely to engage users in drug treatment.
As New Yorkers go to the polls today to elect a new mayor, one of the leading candidates, Eric Adams, has expressed concern about the state’s new marijuana legalization law, saying it may “send the wrong message” to young people. Although Adams supports the law and legalization, he’s worried that it implies it’s okay to smoke a joint and go to school, or operate heavy equipment. He said it’s important to let people know about the medical benefits as well as the concerns related to marijuana. Legal pot has not been a hot topic during the mayoral campaign, except during one debate in which the candidates discussed whether to allow smoking the drug in public housing.
Meanwhile, implementing marijuana legalization in New York may be delayed due to a tussle between Governor Cuomo and his critics over his nominations to the marijuana control board. Some accuse Cuomo of not being fully committed to legalization, although he negotiated and signed the bill.
And finally, doctors report that an experimental treatment for drug addiction, known as deep brain stimulation, has helped one patient stay off drugs. If successful, the treatment—which involves inserting an electronic device in the brain—may also allow scientists to better understand the root causes of addiction and reduce the stigma that it is a moral failing. Yet for all the possibilities, deep brain stimulation does not address the psychological, social and socioeconomic factors that complicate the disease, and therefore remains on the outer edge of drug addiction therapy.
On the 50th anniversary of the War on Drugs, which began under President Richard Nixon, experts are looking back on the effort and assessing the impact—concluding that locking up individuals struggling with drug addiction was largely ineffective. As the nation continues to reel from multiple drug crises—including a record 90,000 drug overdoses last year—they say the war on drugs simply didn’t work, noting that the response to drugs should be handled by doctors and therapists, not cops and prison guards. Today, roughly 20.3 million people have a substance use disorder and nearly half of the inmates in federal prisons are held on drug charges. Meanwhile, America’s streets are flooded with more potent drugs than every before, such as meth and the synthetic opioid fentanyl, as well as high-potency marijuana concentrates. Instead of punishing drug users, many states now advocate decriminalizing all drugs, which would have to be accompanied by mandatory treatment to have the most impact.
Meanwhile, a new study shows the impact of marijuana legalization: first-time cannabis use surged last year among women and Gen Z consumers. The Brightfield Group study found that 50 percent of new cannabis customers indulged in the drug five or more days per while 22 percent of are using multiple times per day. Female users skew younger and are heavier users than men, the report concluded, and nearly one-quarter of users were Gen Z (born after 1997).
And finally, as the Connecticut legislature debates marijuana legalization, a Colorado lawyer who helped to write that state’s law has warned lawmakers about the consequences, including harming children. The lawyer, Robert Corry, said legalization would create another industry like Big Tobacco that targets children and leads to abuse. He also called for tighter regulation and limits on the high levels of intoxicating component of pot, THC, which in Colorado has led to an alarming increase in the number of psychotic episodes among younger users. Colorado recently passed a revised legalization law that includes a crack down on THC levels to curb youth misuse.
Audio Block
Double-click here to upload or link to a .mp3.
Learn more The nationwide effort to monitor opioid prescribing to curb the opioid epidemic has worked to reduce prescriptions, but it has had a knock on effect for those in pain who legitimately need painkillers and can no longer obtain medications. Since the CDC issued monitoring guidelines in 2016, more than 500 laws and policies have been put into effect to help wipeout pill mills that fuelled the opioid crisis. Yet the pendulum may have swung to far: one in six Americans, or some 50 million individuals, suffer from chronic pain so extreme it prevents them from working or participating in daily activities, and these people must have access to drugs that ease their suffering.
Meanwhile, as the Connecticut legislature moves forward with a marijuana legalization bill, Yale University professor Cyril Desouza continues to study cannabis addiction, noting that approximately three out of ten people are developing a cannabis use disorder. The main reason is the elevated level of intoxicating THC—up to 90 percent in some edible marijuana products—that is a huge increase over the past. All the more reason for the Connecticut legalization bill to include THC curbs.
And finally, the Upstate New York Poison Center is warning about a drastic increase in calls for young children who have ingested marijuana products and are having frightening reactions. Such edibles often come in bright-colored, kid-friendly packaging that look just like popular candy products. The Center says it is preparing for even more marijuana-related calls now that New York has legalized marijuana.
The California legislature has come up with $100 million to help the state’s struggling cannabis industry, which is still competing with the large illicit pot market nearly five years after voters approved legalization. Despite predictions that the pot market would flourish, marijuana businesses complain that bureaucracy is stifling growth and high taxes are keeping consumers away from legal dispensaries. Another reason: about three-quarters of all California cities have opted out of allowing cannabis shops, putting a big dent in legal sales. Now the state has to bail out the industry rather than, say, putting the money into combating the opioid epidemic.
Meanwhile, the Supreme Court has declined to hear a case challenging the authority of the Food and Drug Administration to regulate the e-cigarette industry. This ensures that the agency will be able to continue monitoring and issuing guidelines concerning e-cigarettes and therefore addressing the youth vaping epidemic.
And finally, an opinion piece in STAT calls on the government to step up its oversight of increasingly popular marijuana edibles, arguing that officials are once again oblivious to a growing public health threat—as they were e-cigarettes—and are more concerned with promoting the marijuana industry than protecting families and young people from a potentially harmful product. The risks of edibles should not be dismissed, the authors point out, noting that national data show that teens are turning to these modes of marijuana consumption and are more likely to use the drug on a daily basis than those who smoke it. In addition, marijuana companies are using the same marketing playbook for edibles—including cartoon characters and fruity flavors— as e-cigarette makers did with great success.