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Where Buying Marijuana Is Legal, But There’s Nowhere to Smoke It

Thu, 11/09/2017 - 09:02
Having a place for people in pot-legal states to indulge is the next frontier for marijuana.

This piece comes to us courtesy of Stateline. Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.

Las Vegas’ reputation as a place where you can indulge your vices and have a good time helps it lure some 43 million visitors a year. But tourists heading to Sin City hoping to consume newly legal cannabis have a problem: There are few places in town, other than private homes, where someone can legally light up a joint.

In Nevada and the seven other states that allow people to consume marijuana for fun, it’s typically illegal to smoke or ingest the drug in dispensaries, bars, restaurants, city parks and public streets. Hotels and landlords often ban people from using the drug on their property.

“The next frontier is: Where do people use it?” said Nevada state Sen. Tick Segerblom, a Democrat who advocated for marijuana legalization. He said that creating lounges where people can legally consume the cannabis products they buy is the logical solution.

Although lawmakers have tried, no state legislature has yet carved out rules for cannabis lounges, cafes or tasting rooms.

Policymakers in Colorado, Washington and Oregon have struggled to reconcile proposed rules with other state laws such as indoor smoking bans. Lawmakers also fear that marijuana lounges could create public health and safety problems — such as increasing drugged driving — and trigger a federal crackdown.

Some cities, including Denver and Colorado Springs, have created temporary rules for lounges. But cities run into the same legal issues as states.

Entrepreneurs are opening up marijuana lounges anyway, creating problems for law enforcement. It’s typically legal for people to get together to form a private club that permits marijuana consumption. But it can be difficult to determine what is truly a private club, and many of the pot clubs advertised online in states such as Colorado aren’t private, but are open to the public.   

The four states where ballot initiatives legalized recreational marijuana last year may have the best chance of finding a solution. Nevada allows smoking inside many bars and clubs, for instance, so pot lounge proposals raise fewer concerns about indoor air quality.

And the ballot initiatives approved in California and Maine last year open the door to legal lounges. California’s initiative says cities and counties can choose to allow smoking, vaporizing and ingesting marijuana at some retail stores and other businesses. Maine’s initiative included rules for licensed marijuana clubs.


A Murky Legal Area

Clean air rules, unanswered health and safety questions, and political divisions have all stalled progress on legalizing social consumption, said Andrew Freedman, a consultant who formerly served as Colorado’s director of marijuana coordination.

“It’s just a very divisive area,” he said. Even industry leaders are split on whether such lounges should be allowed.

In Oregon, the state’s ban on smoking cigarettes, e-cigarettes and other inhalants in workplaces has been a sticking point for lawmakers. A bill proposed this year to legalize pot lounges didn’t make it out of committee, derailed by concerns that it would weaken air quality rules and set a bad example. Similar criticism felled a Colorado bill that would have allowed consumption clubs to sell marijuana products and exempted them from clean indoor air requirements.

Alaska law permits people to consume marijuana at a dispensary. But for a year and a half, policymakers there have struggled to come up with rules for marijuana tasting rooms, dogged by questions about air quality, how to measure cannabis intoxication, and other issues such as whether to set purchase limits or ban happy hours.

In theory, it shouldn’t be this hard to come up with a policy solution. “The same questions that have been asked regarding public use of alcohol or smoking are the same kinds of questions that get presented when talking about cannabis,” said Colorado state Rep. Dan Pabon, a Democrat who represents part of Denver.

Policymakers ultimately have to weigh non-cannabis consumers’ right to be free of the drug against cannabis consumers’ right to use it, he said. But it’s harder to strike that balance for cannabis than for tobacco, because there’s not much research on how cannabis smoke affects bystanders. “That’s kind of keeping things at bay,” he said.

State inaction has left localities in a bind.

When the Clark County Commission, which has jurisdiction over the Las Vegas Strip, raised the marijuana lounge issue in a September meeting, they confronted a fundamental question: Does the county have legal authority to license such lounges?

The statewide ballot initiative that legalized the drug doesn’t make that explicit. Days before the commission met, lawyers for the state Legislature had found that localities have the authority to license marijuana lounges. But the Nevada attorney general hadn’t weighed in on whether pot lounges are legal — his office has since declined to do so — and Gov. Brian Sandoval, a Republican, had said marijuana lounges need to be regulated at the state level.

“I am concerned with these establishments popping up piecemeal throughout the state with differing rules and regulatory structure,” Sandoval said in a statement released to local news outlets. A fragmented system could fail to meet federal guidelines, he said.

Faced with so much uncertainty, the seven commissioners decided to table their discussion. Commissioner James Gibson suggested that they wait and see what other localities do. “I don’t see any reason why we have to be first,” he said. “But we certainly have to be right.”

How Denver Moved Forward

Denver is one of a handful of cities that have created rules for lounges, so officials around the country are watching it closely. Denver was forced to create rules for social consumption by a 2016 ballot initiative.

Initially proponents wanted to open the door to legal consumption in bars, restaurants and concert halls. But it soon became clear that that would be impossible, says University of Denver professor Sam Kamin, an expert on marijuana law.

The city’s lawyers could get around the state ban on “open and public consumption” of marijuana by defining a “public place” to be somewhere with no restrictions on public access. The ballot initiative already forbade people younger than 21 from entering a cannabis consumption area.

But other state laws and regulations left the city little room to maneuver. Colorado’s liquor licensing board bans marijuana consumption at establishments that hold a liquor license. Colorado’s Clean Indoor Air Act forbids smoking inside at almost all businesses, restricting marijuana consumption to vaping and edibles.

And under Colorado and Denver law, only licensed dispensaries can sell marijuana products. At the same time, people can’t consume marijuana at a dispensary. That meant that the city could create licenses only for “bring your own cannabis” venues.

Denver began accepting applications for social consumption licenses in July. No business or special event has yet been approved, officials say.

The biggest challenge for would-be pot lounge entrepreneurs is how to make money without selling marijuana products, said Molly Duplechian, a deputy director of policy at the Denver Office of Marijuana Policy. “They have to have something else to have a true business model.”

Emmett Reistroffer of Denver Relief Consulting, the firm that led the city ballot initiative campaign, said the biggest roadblock is the city’s zoning restrictions. Denver won’t issue licenses to businesses or events that are within 1,000 feet of schools, child care centers, alcohol and drug treatment facilities, and city recreation centers and pools — which, Reistroffer said, rules out most of the city.

Even with rules for social consumption on the books, Denver’s problems with public use are far from over. Officials still need to police illegal pot clubs, issue citations to people caught smoking joints in city streets, and monitor marijuana festivals that inspire crowds to light up in city parks.

If the state created rules for social consumption, Duplechian said, that would make Denver’s life easier.

State lawmakers will have to keep returning to the issue because Colorado has essentially legalized the sale and cultivation of marijuana while creating a black market for use, Pabon said. “I don’t think it’s an issue that’s going to go away.” 

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Backed By U.S. Anti-Drug Funds, the Mexican Military is Raping and Killing and Getting Away With It

Thu, 11/09/2017 - 08:54
A new report report details a culture of impunity and a complete lack of transparency as the Mexican military wages its war on drugs.



Mexican Military Is Raping And Torturing Civilians

Mexico's army is raping and torturing civilians in a brutal war on drugs, a new report revealed this week. ... unpunished, and the report details a culture of impunity and a complete lack of transparency as the Mexican military wages its war on drugs. “Violence has increased in the country while human rights violations ...

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The God Capsule: Can Psychedelics Prove a Biological Basis for Spirituality?

Wed, 11/08/2017 - 10:52
Click here for reuse options! A team of neuroscientists in London believes they can.

For a long time in western culture, transcendent consciousness was tightly linked with characters on the spiritual fringe: visionary prophets, ascetic sages, and ecstatic poets. Mystical states were like lightning bolts in the days before Ben Franklin’s kite—fleeting, unpredictable, and impossible to harness or measure. They were divine bolts that hit during the frenzies of ecstatic creation and desert wanderings. They were the ultimate mystery.

Then came psychedelics. In the 1950s, a small but significant coterie of researchers and artists used LSD, mescaline and psilocybin to achieve the states of consciousness described in the literature of ecstatic mysticism. It was an incredible discovery. By swallowing a pill in their living room, they could reliably reproduce the once-exotic case studies collected in books like Richard Bucke’s Cosmic Consciousness, William James’ The Varieties of Religious Experience and Aldous Huxley’s The Perennial Philosophy.

It was Huxley who famously bridged the pre- and post-psychedelic scholarship of mysticism. In 1954, he announced the dawn of the psychedelic era in the form of his erudite Mescaline trip report, The Doors of Perception. But if Huxley anticipated psychedelics’ democratization of mystical bliss, he never claimed to know how they worked. How, exactly, did they replace the ego with the infinite? His guess—that psychedelics somehow wash clean the glass “doors” of perception, “revealing the world as it is… infinite”—was based not on science, but the visionary poetry of William Blake.

Fifty years after Huxley’s death, science is beginning to understand, with some precision, how these window cleaners go about their work. By pairing the controlled mysticism induced by psychedelics with modern imaging technology, scientists are mapping the biological underpinnings of spiritual bliss, the way psychedelics helped an earlier generation of researchers map the links among the serotonin system, joy and depression.

The key finding so far involves changes to a part of the outer brain called the posterior cingulate cortex.

“Our psychedelic imaging studies show a strong association between experiences of god and a breakdown in activity linking the posterior cingulate cortex to the frontal brain regions,” says David Nutt, co-director of the Beckley-Imperial College psychedelic research program in London.

“Growing evidence suggests religious and other belief systems are inevitable products of the ways in which the brain works.”

In a forthcoming book, Nutt describes the Beckley-Imperial team’s findings that indicate mystical “out of body” states are linked to reduced blood flow in the posterior cingulate cortex, a central hub in the creation of our sense of self, or ego.

“The posterior cingulate cortex integrates inputs from the senses, especially sight, plus inner sensations such as position-sense and time, in relation to the brains predictions or inferences,” writes Nutt. “It is the master controller of ‘normal’ consciousness, so when it is switched off, another less constrained form of consciousness emerges. In analogy, if the conductor of the orchestra is removed and the individual instruments play their own way in their own time, a different sound is produced.”

When LSD and other psychedelics forcibly remove the brain’s conductor, people report losing the sense of occupying a distinct place in space and time. Commonly known as ego-dissolution, this is the defining feature of mystical states, achieved by psychedelics or other means. Just like the Victorian monks populating William James’ Varieties of Religious Experience, subjects on LSD report a sense of leaving their bodies and fusing to “become one” with a loving universe, sometimes called god for lack of a better term.

“The sense that there is more to human beings than biological processes is common to all religions, and our research suggests this has a basis in brain function,” says Nutt. “Subjects reporting ego-dissolution are significantly more likely to report a spiritual experience. Since ego-dissolution correlates to a breakdown of [specific brain regions] we can predict spirituality might come from a similar change in this brain region, which can also be triggered by meditation, fasting, and ritual singing and dancing. These insights reveal the concept of God is an emergent property of our nervous systems.”

It’s not just LSD and ritual chanting that can trigger these mystical states. Nutt points to evidence that they can be induced by brain stimulation with direct low voltage electrical currents and magnetic pulses.

“[Our theory based on LSD experiments] has recently been confirmed in a more direct manner by blocking outflow from the posterior cingulate cortex region by direct electrical stimulation,” he says. Subjects who undergo this treatment before brain surgery often report leaving their bodies, floating off as if in a dream, and experiencing long-term positive effects in terms of wellbeing and “present-ness." These reports echo the testimony of mystics from the 16th century as loudly as they do microdosers from the 21st.

There is, of course, a deep irony to this exciting front in the global psychedelic research revival. There is every reason to believe Nutt is correct to think humans have a profound and salutary evolutionary need for spirituality and mystical states, to experience the “sense of there being more to a human being than simple biological processes.”

But by mapping the neurochemistry of these states, is science not reducing them to simple biological processes? As research proceeds in Nutt’s lab—his team is currently employing MRI to study the brains of people on DMT—it is bound to add another wrinkle to the already contentious debate around religion and spirituality. Many will resist “explanations” of something so long understood as beyond the reach of reason, language and science.

Even within the psychedelic community, there is a tradition of “non-dualism” that rejects biochemical explanations of consciousness.

“The non-dualists think the brain is a receiver picking up signals flowing throughout the universe,” says Robin Carhart-Harris, Imperial-Beckley’s lead investigator. “It’s fantasy, but there’s a kind of investment in these ideas, matched with an extreme anti-authoritarianism and suspicion of scientists.”

The gatekeepers of traditional religion, meanwhile, have always feared the anti-institutional thrust of direct chemically assisted revelation. They are right to fear it, as heavy anecdotal evidence—and increasing scientific evidence—shows that a brush with mystical states is likely to encourage a broad spirituality that is humanistic and anti-authoritarian, one more likely to lead to a meditation mat than a Catholic Church.

Nutt, for one, hopes the work being done at Beckley-Imperial will become a public dialogue between neuroscience and traditional religion. In his forthcoming book on psychedelic neuroscience, Nutt takes pains to distinguish his hypothesis from the position of New Atheists like Sam Harris and Richard Dawkins, who scornfully dismiss belief in god as a delusion.

“In technical psychiatric terms, ‘delusions’ are confined to beliefs that are outside societal norms,” he writes. “Since most people believe in some form of god, it is a social norm. I suspect spirituality isn’t located in a single brain region, but rather it emerges from a network change. Brain science tells us it’s time to put transcendence and spirituality, not politics and rituals, back into the heart of religious belief. Let the brain give religion back to god.”

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California Could Decriminalize Psychedelic Mushrooms

Wed, 11/08/2017 - 09:31
An initiative to do that has been okayed for signature gathering.



California Could Decriminalize Psychedelic Mushrooms

After legalizing weed, California politicians have set their sights on a new target — psychedelic mushrooms. Mayoral Candidate Kevin Saunders filed a ballot measure in the state Attorney General’s office on Friday.

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Marijuana Edibles Provide Better Pain And Anxiety Relief Than Smoking

Wed, 11/08/2017 - 09:25
The answer to why some cannabis consumers prefer to eat their weed.

For a growing number of cannabis consumers, eating the herb is better than smoking it. That is the conclusion of a qualitative report examining customer preferences.

The study, conducted by RTI International, an independent, nonprofit research institute, provides an understanding of consumer perceptions of edible marijuana products, including why users prefer edibles to other forms of marijuana and their concerns regarding the consumption of edibles.

“Our findings suggest that some people prefer edibles to smoking marijuana because there is no smell from smoke and no secondhand smoke,” explained Sheryl C. Cates, senior research public health analyst, the RTI lead for the study. “They also liked edibles over smoking for their convenience, discreetness, longer-lasting highs, and less intense highs. Some participants said that for them, consuming edibles provided better pain and anxiety relief than smoking.”

Regarding pain relief, Jane A. Allen, RTI Research Public Health Analyst adds, “Although this study did not examine whether edibles are used as a substitute for other drugs, a growing body of research suggests that greater availability of marijuana may reduce use of pain medications, and may reduce the frequency and amount of opioid consumption.”

The study also provides insights into consumers’ concerns regarding the consumption of edible marijuana, including delayed activation time, accidental ingestion, and dosing.

“Importantly, the delayed high from edibles vs. smoking or vaping marijuana, may contribute to consumers ingesting a greater than intended amount of the drug before they feel high,” said Cates. “Informing the public on delayed activation, accidental ingestion, proper dosing and harmful effects will help consumers make better decisions and help protect public health.”

A total of 62 adults in eight focus groups, four each in Denver, Colorado and in Seattle, Washington were conducted with consumers of edibles who were at least 21 years or older and met specific study criteria.  The findings suggest that outreach campaigns on recreational marijuana should provide information on the risks and benefits of different forms of marijuana so that consumers can make informed decisions about their use.


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Holding Co-Users Responsible for Fatal Drug Overdoses Is Draconian and Ineffectual

Tue, 11/07/2017 - 10:38
Click here for reuse options! While overdose deaths are skyrocketing, these laws only compound the tragedy.

A new report from the Drug Policy Alliance shines a harsh spotlight on a strategy that some police, prosecutors and elected officials are embracing in response to the opioid overdose crisis—charging sellers with drug-induced homicide, which the evidence suggests is intensifying, rather than helping the problem.

The opioid overdose crisis is real enough—a record of more than 60,000 people died of drug overdoses last year, most of them from opioids—but claims that charging drug sellers with murder is an effective deterrent are unproven, according to the report, An Overdose Death Is Not Murder: Why Drug-Induced Homicide Laws Are Counterproductive and Inhumane.

Instead, such laws actually deter people not from selling drugs but from seeking life-saving medical assistance in case of overdose. That's because drug-induced homicide prosecutions typically don't target high-level kingpins, but zero in on the very people best positioned to actually save lives in the event of an overdose: family, friends and low-level drug sellers, often addicts themselves.

Like Amy Shemberger. In August 2014, she took a ride to score some heroin for herself and her boyfriend, Peter Kucinski. She snorted one bag on the way home and gave the other to Kucinski when she got home. Suffering from severe alcohol withdrawal, he needed the heroin to feel better. He snorted a $10 bag, then stopped breathing. Shemberger called 911, but it was too late. She lost her boyfriend of 18 years. Their 5-year-old son was later taken into custody by child protective services.

Two months later, Shemberger was charged with drug-induced homicide for sharing her score with her life partner. She's now serving seven years in state prison.

Amy Shemberger is not an outlier. Police and prosecutors routinely abuse their discretion by going after people best positioned to actually save the lives of overdose victims—their friends, family members, fellow drug users, and small-time drug sellers. The report offers several examples: In New Jersey, 25 of 32 drug-induced homicide prosecutions in the 2000s targeted friends of the victims who were not involved in significant drug sales. In Wisconsin, 90% of the most recent cases targeted friends or relatives of the victim. In Illinois, a study of these prosecutions found that prosecutors typically charged the last person known to be with the victim.

As with everything else in the war on drugs, it's worse if you're not white. Hampered by a felony record, when James Linder, 36, lost his job at a bakery, he resorted to selling small amounts of drugs, making enough money to get a haircut for his son and to help out his sister. But in January 2015, he sold three packets of heroin to Cody Hillier. Hillier's girlfriend, Danielle Barzyk, died of an overdose later that same day. Despite never even meeting Barzyk, Linder was charged with drug-induced homicide in her death. He was sentenced by an all-white jury in rural Illinois. Unlike Shemberger, he didn't get seven years; he got 28 years in prison.

Drug-induced homicide laws, originally passed in the depths of 1980s drug war excess, lay largely dormant until rising drug overdose numbers led police and prosecutors to revive them. Currently, 20 states (Delaware, Colorado, Florida, Illinois, Kansas, Louisiana, Michigan, Minnesota, New Hampshire, New Jersey, North Carolina, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Vermont, Washington, West Virginia, Wisconsin, and Wyoming) have drug-induced homicide laws on the books. Other states without such laws also manage to charge these people with the offense of drug delivery resulting in death under various felony-murder, depraved heart, or involuntary or voluntary manslaughter laws.

"This is a wasteful, punitive policy that compounds the tragedy of an overdose by locking up even more people in the name of the failing war on drugs," said Lindsay LaSalle, senior staff attorney at the Drug Policy Alliance and author of the report. "By placing the blame for an overdose death on the single person who supplied the drugs, all the structural factors that lead to addiction and overdose are ignored, as are the solutions that could actually make a difference. While there’s no evidence in support of the effectiveness of drug-induced homicide laws, the good news is that there are proven health and harm reduction interventions that can save lives."

Those include policies and practices such as 911 Good Samaritan laws, which protect people reporting drug overdoses from arrest; expanded access to the opioid overdose reversal drug naloxone (Narcan), expanded access to opioid-assisted treatment, and expansion of harm reduction programs such as supervised drug injection sites, where users can shoot up under medical supervision and be connected with social service agencies.

There is no national database of drug-induced homicide prosecutions, so the Drug Policy Alliance report relied on media mentions of such cases to chart their spread. It found 363 articles mentioning such cases in 2011, but by 2016, that number had jumped to 1,178, a 300% increase in just five years. And this without any evidence of their effectiveness in reducing drug use or sales or preventing overdose deaths.

The resort to drug-induced homicide charges varies from state to state. Midwestern states such as Wisconsin, Ohio, Illinois, and Minnesota have been the most aggressive in prosecuting drug-induced homicides, with northeastern states Pennsylvania, New Jersey, and New York and southern states Louisiana, North Carolina, and Tennessee rapidly expanding their use of these laws. And the move remains politically popular: This year alone, elected officials in at least 13 states (Connecticut, Idaho, Illinois, Maine, Maryland, Massachusetts, New Hampshire, New York, Ohio, South Carolina, Tennessee, Virginia, and West Virginia) introduced bills to create new drug-induced homicide offenses or strengthen existing drug-induced homicide laws.

But the increased criminalization of people who use and sell drugs only exacerbates the very problem prosecutors are supposedly trying to address. It increases stigma, drives people away from needed care, and will likely result in the same racial disparities now synonymous with other drug war tactics. 

"This is no time to ratchet up enforcement responses to addiction and overdose; we can’t afford to repeat the mistakes of the past," warned LaSalle. "Overdose deaths are skyrocketing and it could be your loved one who dies from a preventable drug overdose, simply because someone was too scared to call 911."

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"Narcan Party" Hysteria Puts a Value on Drug Users' Lives

Tue, 11/07/2017 - 08:43
The real objection is that Narcan for laypeople--especially drug users--allows them to save lives without the cessation of drug use as a requirement.

While the country is obsessing over the idea of “fake news,” let’s talk about some actual fake news: Narcan parties. Increasingly, media outlets are publishing stories with attention-grabbing headlines such as Narcan Parties Becoming Disturbing Trend, Police Say and People Intentionally OD to be Revived at ‘Narcan Parties.’ The stories usually involve grave reports that the increasing availability of Narcan (naloxone), a medicine that reverses opioid overdose, is causing people to overdose on purpose because they know that Narcan can be used to save them. The reports often originate from paramedics and law enforcement responding to overdose-related 911 calls, though most harm reductionists and drug users vehemently deny the existence of so-called Narcan parties. So who is telling the truth?

As with many controversial issues, the story of “Narcan parties” starts with a truth, which then becomes distorted. Here’s what’s real: Yes, people often use drugs in groups or at parties. That’s not new. Drug use at parties has been happening long before Narcan became easily accessible. What is new is that Narcan is increasingly available to the public and used by laypeople to reverse an overdose. So when first responders arrive at the scene of an overdose they might see a party and they might see that Narcan was administered to the overdose victim, hence the term “Narcan party.”

But from there, facts get twisted.

First, some articles claim that “people are overdosing in houses or public places, knowing responders are nearby with Narcan.” I admit I have trouble keeping a straight face when I hear this. There are two things most drug users avoid at all costs: withdrawal and police. Overdosing and having first responders show up to administer Narcan summons both. Narcan blocks the effects of opioids, provoking the rapid onset of withdrawal symptoms such as pain, vomiting, diarrhea, muscle cramping, hypertension, and anxiety. That’s not an experience anyone would invite on purpose. Plus, the relationship between most illicit drug users and law enforcement isn’t exactly chummy. Neither is the relationship with many paramedics. Under the best-case overdose scenario, an opioid user could wake up in agony and possibly handcuffs. Under the worst case, they could die. So no, people aren’t overdosing on purpose because paramedics and police might be nearby with Narcan.

No one engages in risky behaviors just because first responders are a phone call away. People don’t leave their doors unlocked thinking that if someone tries to rob their home while they’re away, neighbors can call the police. People don’t light fires in their fireplaces in the winter believing that if their house goes up in flames, someone will call the fire department. People leave their doors unlocked and light fires because they believe nothing bad will happen. And in most cases, they’re right.

The same logic applies to drug use. Except in cases of suicide, people who take drugs do not think anything bad will happen. Yes, they know there is a risk of death if they overdose. Yes, they may have overdosed in the past. Yes, they may know someone who died of an overdose. But before you start thinking that drug users are irrational and deserve what they get, consider your own thought process every time you step into a car. You know car accidents are one of the leading causes of unintentional death. You may have had an accident in the past. You probably have known of someone who died in a car accident. Yet you still drive because it’s convenient and because you feel sure that nothing bad will happen—not because you feel comforted that if you do have an accident, nearby paramedics might pull you from the twisted wreckage of your car.

Because of stigma and misinformation, people inflate the risks associated with taking drugs and consider drug users more reckless than non-drug users, who also take deadly risks every day. Eliza Wheeler, Director of the DOPE Project of the Harm Reduction Coalition in Oakland, California, points out that no one claims that EpiPens cause people with nut allergies to gorge on peanuts. She explains, “The concept of ‘Narcan parties’ became distorted because drugs are involved and so everyone immediately thinks something bad must be happening. Instead of EMTs saying, ‘Hey, we responded to a call today and someone else had already saved a life with Narcan. That’s great!’ they think, ‘Oh, we responded to a call today and someone had overdosed on purpose because they had Narcan.’”

Another media claim distorted by stigma is that during “Narcan parties,” a designated person is standing by to revive people who overdose, thus allowing party-goers to engage in riskier drug use, knowing a friend will save them. This claim is false. The rumors originate from the concept of a designated driver, a person whose presence may indeed encourage some people at parties to drink more alcohol, knowing they will not have to drive home. But there is a major difference between driving someone home and giving them Narcan. As mentioned above, Narcan induces agonizing opioid withdrawal, something that opioid users avoid at all costs. Drinkers do not fear the consequences of being driven home by a sober friend after a fun night of drinking.

People are not overdosing on purpose to be revived with Narcan, although, yes, more drug users carry Narcan now and may use it if an accidental overdose occurs. But guess what? That’s a good thing!

Lee Hertel, Director of Lee’s Rig Hub, a syringe exchange program in Minneapolis, Minnesota, explains, “People who have Narcan on hand when using in groups are doing exactly what they should be doing. The golden rule of harm reduction is to never use alone and to have Narcan around if you use opiates. People who keep Narcan on them are looking out for each other and saving lives. Isn’t that the whole point of making Narcan available in the first place?”

Yes, having a life-saving antidote on hand in case of an accidental overdose is the entire point of making Narcan available to laypeople. But the controversy surrounding “Narcan parties” persists due to fears and misconceptions that drug users will take anything and misuse it. For example, the media peddles stories of drug dealers selling Narcan and dope as a package deal. In fact, many drug dealers do sell Narcan along with heroin or other opiates—but how is that any different from physicians co-prescribing Narcan with opioid pain relievers? In both cases, the goal is to prevent patients or customers from dying of an accidental overdose. But while physicians are actively encouraged to co-prescribe Narcan, when drug dealers do the same, the story is twisted to sound sinister.

I admit that as a harm reductionist, I sometimes feel a sense of fatigue that derives from constantly having to point out the obvious: Drug users make decisions based on perceived risk and reward, as we all do. It is the unique stigma against drugs and people who use them that causes drug-related decisions to be viewed as irrational and fundamentally different from the ways in which non-drug users engage in other risky behaviors every day.

I think the real pushback against the widespread availability of Narcan is not about whether it encourages riskier drug use. Empirical studies have disproven that theory time and time again. The real concern is that Narcan access for laypeople--especially drug users--allows them to save lives without the cessation of drug use as a requirement. It means we believe in saving the lives of people who might use drugs again. And again. And again. To many people, this outcome is unacceptable, so they propose policies like limits to the number of times Narcan can be administered to the same person, or forcing people into treatment after an overdose and other measures that imply that only a person who does not use drugs (or will stop immediately) deserves to be saved.

There is certainly a place for compassionate, voluntary intervention after an overdose, and evidence-based treatment options such as medication-assisted treatment should be more affordable and more available. But no one is arguing against that. The real disagreement is over whether or not drug users have the right to make their own choices about what they put in their bodies. Spreading false stories about parties where people overdose on purpose is exactly the kind of news that can whip up anger against harm reduction and create public support for punitive policies that once again show drug users that their lives are considered less valuable than those of non-drug users.


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3 Harmful Myths About the Opioid Epidemic

Tue, 11/07/2017 - 08:18
These myths about opioids, addiction, and people with substance use disorders persist and may even prevent people from getting treatment, say experts.

Between 2015 and 2016, drug overdose deaths went from 33,095 to 59,000, the largest annual jump ever recorded in the United States. That number is expected to continue unabated for the next several years.

Myth #1: Opioid addiction is just a psychological disorder and people who are dependent simply need better willpower.

“It’s important to define opioid addiction carefully, because the stigma is so strong. Someone who is prescribed opioid medications for pain for prolonged periods may develop tolerance, which means they need a higher dose to get pain relief. Or they may experience withdrawal symptoms when they stop taking the medication. But these are not considered cases of opioid addiction.

“Opioid addiction, or technically ‘opioid use disorder,’ is defined as loss of control over use of opioids. This means that the person continues to use opioids despite negative consequences or is unable to stop using opioids despite wanting to. This person may also have a preoccupation with using opioids, obtaining opioids, or craving for opioids. These patients may also develop tolerance or experience withdrawal when they stop using, but those symptoms by themselves do not define an opioid use disorder.

“Some people think that an opioid addiction is just psychological or a weakness of character, and that people who are addicted simply don’t have the willpower to stop. But it’s more complicated than that.

“Long-time use of opioids in an addictive way actually alters brain functioning. It causes chronic and lasting changes in the brain reward system, causing the person to feel less motivation and get less pleasure from other, naturally occurring rewards. Opioids become the primary reward and the primary focus of the person’s life, and they need more of it to activate the reward system.”<

—Richard Schottenfeld, psychiatry

Myth #2: The best way to combat an opioid addiction is without medication.

“The idea of treating opioid addiction without medication is attractive, especially because such programs can be effective for some patients with alcohol use disorder. A lot of people think that the goal of treatment for opioid use disorder is not taking any medication at all. However, the truth is that the many people in abstinence only programs for opioid use disorder will relapse.

“Research shows that medication-based treatments are the most effective treatment. Opioid use disorder is a medical condition just like depression, diabetes, or hypertension, and just like those conditions, it is most effectively treated with a combination of medication and counseling.

“There are two common medications used to treat opioid use disorder: methadone and buprenorphine. These medications help address patients’ withdrawal symptoms and block the reward or the ‘high’ that people get from using opioids. They help restore ‘normal’ brain functioning. In certain cases, other medications can help improve impulse control and treat any underlying psychiatric disorders.

“Buprenorphine and methadone are opioids agonists. This means that they bind to the same opioid receptors in the brain that opioids like oxycodone, heroin, and fentanyl do, and provide relief from withdrawal symptoms. Some people misinterpret that to mean that we’re just replacing one addiction for another. However, this is not the case.

“Most of the time, patients use opioids not to get high, but to avoid the withdrawal symptoms such as body aches, nausea, vomiting, diarrhea, cramping, muscle aches, insomnia, abdominal pain, and anxiety. Buprenorphine and methadone help patients avoid withdrawal symptoms, but don’t offer the high, which means they are less addictive. Their effects also last much longer (24-36 hours), which allows patients to get on with their day without having to think about their opioids.

“In addition, with buprenorphine and methadone, the risk of overdose is much lower for patients receiving these medications through a treatment program.”

—David A. Fiellin, internal medicine

Myth #3: It’s ok if we call people with opioid use disorder ‘addicts,’ ‘users,’ or ‘junkies.’

“The words we use to describe addiction and people with addiction are important. Negative terms such as ‘addict,’ ‘user,’ ‘junkie,’ and phrases such as ‘needs to get clean’ contribute to stigma against people with opioid use disorder and create barriers to accessing effective treatment. This can ultimately contribute to overdose.

“When we talk about people with diabetes, we don’t talk about them being ‘dirty,’ we talk about their sugars. Similarly, we should focus on measurable changes to health for people with opioid use disorders.

“Studies have shown that people who were referred to as ‘substance users’ were more likely to be considered a threat or be responsible for their condition, whereas people who were referred to as having “substance use disorder” were more likely to be seen as needing help. This is a really key component to getting people into treatment and stemming the opioid crisis.

“A person is not defined by their disease. We need to keep that in mind as doctors, media, and lay-people when thinking about the opioid crisis.”

--Jeannette Tetrault, internal medicine

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Trump Misses the Mark: Real Drug Education Should Say 'Just Say Know'

Mon, 11/06/2017 - 12:59
Click here for reuse options! Trump and Sessions have no idea how to prevent drug abuse.

It felt like Goundhog Day last week when the president and attorney general, in response to the overdose crisis, advocated a resurrection of “just say no”-style anti-drug advertising. It’s been 30 years since Mrs. Reagan’s famous advice and the proliferation of the DARE drug prevention program, which has been widely researched and consistently debunked.

Even the Partnership for Drug-Free Kids, formerly known as the Partnership for a Drug-Free America, which sponsored those “egg in the frying pan” ads, has changed its tune. Not long ago, they advised me to refrain from critiquing DARE because “it’s like beating a dead horse.”

Evidently the White House didn’t get that message.

In her suggestions for what Trump should have said about drug education and prevention, DPA’s executive director, Maria McFarland Sánchez-Moreno wrote: “Rather than resorting to fear-mongering we will equip our young people with knowledge, warning them about the risks of drug misuse in a realistic and scientifically grounded way. We cannot control all their choices, but by treating them with respect and giving them sound information, we can ensure they have what they need to make good choices…”
There is lots of talk these days about the value of prevention. Specifically, the Drug Policy Alliance has recommended that drug education should be:

Scientifically accurate.

Extensive research has shown that fear-based messaging designed to frighten teens does not deter them from experimenting with alcohol and other drugs. All information presented must be backed up by valid sources such as peer-reviewed publications. All websites should be balanced—neither advocating for nor condemning the use of a particular drug.

Realistic and honest.

It’s important to be honest about the real reasons people use drugs, including self-medication and simply “having fun.” Without acknowledging both sides, we lose teens’ attention. There are also very tangible risks associated with drug use, such as driving while intoxicated (on anything!), leaving a friend who is passed out, or simply using too much and too often. And of course, the reality of zero tolerance policies and the implications of getting caught up in the criminal justice system should be part of drug education.


Didactic, top-town lectures don’t work for teens. They need to participate in their own drug education by having the opportunity to share their experience and ask tough questions in a non-judgmental setting.


Some teens will have used, even sold drugs, or have family who have done so. Demonizing people who use drugs tends to isolate and stigmatize those who are most in need of support. Drug education programs must be careful not to isolate these teens and cause them to “tune out.”

Harm reduction-oriented.

Although, of course, abstinence and/or delaying use is the safest choice, national surveys show that a significant number of teens will choose to try alcohol, marijuana, or even other drugs. All programs, therefore, should contain information about actions that can reduce potential harm.  This is not “enabling.” It is accepting reality and taking action to ensure safety, which ought to be the bottom line.

The good news is that DPA already has a number of drug education resources—free of charge and available with a click—and more to come in 2018.

DPA’s drug education resources include reality-based, harm reduction information about young people and drug use, abuse, and treatment. Notable examples are our Drug Facts series, as well as “8 Tips for Talking to Your Teen About Alcohol and Other Drugs.”

Unlimited, free-of-charge hard copies of the popular booklet, Safety First: A Reality-Based Approach to Teens and Drugs, can be ordered online. (Spanish-language versions of the booklet are also available.) The booklet is also available for download in Chinese, Hebrew, Portuguese, Russian, Czech, Greek and Papiamento.

In the coming year, DPA will be piloting and evaluating our first-ever high school drug education curriculum, written by an educator and consistent with National Health Education Standards. Stay tuned for updates on this exciting new resource.

Trump and Sessions are clueless about what really prevents teens from getting into problematic patterns with drugs – and it’s not worn-out, ineffective slogans.

It’s long past time to bury “just say no” and replace it with “just say KNOW.”

This piece first appeared on the Drug Policy Alliance Blog.

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Bill Nye The Science Guy Doesn't Get High But He Is Into Pot Legalization

Mon, 11/06/2017 - 12:56
“One time in college I tried it, and I’m not good at smoking. I didn’t put in the hours to get good at smoking. But you guys… knock yourselves out.”

Bill Nye, colloquially titled “The Science Guy,” said in a NowThisinterview that he welcomes the societal benefits of legalization, though he isn’t a fan of using the drug himself.

“I lived in Washington State for a long time, and Washington State legalized it in 2012. We legalized marijuana, we tax it,” Bill Nye told NowThis. “We have a lot of tax revenue. It’s no longer criminalized. We don’t spend money on the police department. We spend money regulating the industry in the same way we regulate other substances.”

He wants law enforcement and the legislative community to look at marijuana the way the medical community does.

“What’s happened with marijuana is it’s a Schedule I drug, which means it’s presumed to be addictive and it’s presumed to have no medical value. Yet people are using it for all these medical applications,” he reasoned. “So well, let’s study it. Well, you’re not allowed to study it because it’s a Schedule I drug… So that has to be sorted out.”

Nye isn’t throwing his hat into the legalization ring because he likes the stuff, but rather as a long-time proponent of evidence-backed legislation—once being involved in a spat with Sarah Palin over climate change.

In fact, he backs legalization despite really not liking pot at all. “I gotta tell you guys, I love you all, but I don’t like the smell. I just don’t like it,” he admitted. “One time in college I tried it, and I’m not good at smoking. I didn’t put in the hours to get good at smoking. But you guys… knock yourselves out.”

In his experience, high people aren’t much fun. “When I played ultimate frisbee very seriously, these guys I would play with would get high and they sucked when they were high,” he recalled.

His words are in line with fellow science communicator Neil deGrasse Tyson and their mutual mentor, Carl Sagan.

“If you really analyze it, relative to other things that are legal, there’s no reason for it to ever have been made illegal in the system of laws,” deGrasse Tyson said in a StarTalk interview. “Alcohol is legal and it can mess you up way more than smoking a few j's.”


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Can Legal Marijuana Fix America’s Binge Drinking Problem?

Mon, 11/06/2017 - 10:18
Examining the data suggests cannabis helps ameliorate this expensive social issue.

There’s nothing wrong with sharing a cocktail or two with friends and family. But binge drinking is a different matter.

As more states legalize marijuana, is the problem getting better or worse? Does more cannabis use cut down on binge drinking? The data, so far, is inconclusive. But public health researchers are urging agencies and universities to focus more on the dangers posed by alcohol, and less on the dangers of less toxic drugs, such as marijuana.


Here is what we know about binge drinking and cannabis:

The Costs Of Binge Drinking Are Staggering

Binge drinking accounted for about half of the 80,000 alcohol-related deaths in the United States in 2010, according to a report by the Centers for Disease Control and Prevention.

The CDC reports:

  • Excessive alcohol consumption cost the United States $249 billion in 2010. This amounts to about $2.05 per drink, or about $807 per person.
  • The costs due to excessive drinking largely resulted from losses in workplace productivity (72% of the total cost), health care expenses (11%), and other costs due to a combination of criminal justice expenses, motor vehicle crash costs, and property damage.
  • Excessive alcohol use cost states and DC a median of $3.5 billion in 2010, ranging from $488 million in North Dakota to $35 billion in California.
  • Binge drinking was responsible for about three-quarters (77%) of the cost of excessive alcohol use in all states and DC.
  • About $2 of every $5 of the economic costs of excessive alcohol use were paid by federal, state, and local governments.

What Is The Actual Definition Of Binge Drinking?

Binge drinking is defined as four or more drinks for women and five or more drinks for men on a single occasion, More than 17 percent of all people in the United States are binge drinkers, and more than 28 percent of people age 18 to 24.

Binge drinking is more common among people with a household income of at least $75,000.

Does Marijuana Legislation Have An Effect On Binge Drinking?

Researchers at the University of Washington reviewed more than 750 studies on marijuana and alcohol, in search of evidence as to whether people use alcohol and marijuana together or whether one is preferred when both are available. No clear pattern emerged.

The researchers concluded that there’s evidence of marijuana and alcohol being both substitutes and complements. Given the rapidly evolving landscape of marijuana policy, they say further study will be important to understand how changes in marijuana laws impact the use of alcohol and other drugs.


“This is a complicated issue and requires a nuanced approach,” said lead author Katarína Guttmannová, a researcher in the UW’s Social Development Research Group. “We were hoping to have more clear-cut answers at the end of our research. But you know what? This is the science of human behavior, and it’s messy, and that’s OK.”

Marijuana Protects Against Brain Damage From Binge Drinking

If you are prone to binge drinking, cannabis may play a role in protecting your brain from further damage. A study published online by the journal Neurotoxicology and Teratology suggests that marijuana may protect the brain from some of the damage caused by binge drinking. “It is possible that marijuana may have some neuroprotective properties in mitigating alcohol-related oxidative stress or excitotoxic cell death,” according to the report.

“This study suggests that not only is marijuana safer than alcohol, it may actually protect against some of the damage that booze causes,” said Steve Fox, co-author of the new book, Marijuana Is Safer: So Why Are We Driving People to Drink?  “It’s far better for teens not to drink or smoke marijuana, but our nation’s leaders send a dangerous message by defending laws that encourage the use of alcohol over marijuana.”

In fact, the US government has a patent on cannabinoids as neuroprotectants.

Which States Have The Biggest Problem With Binge Drinking?

North Dakota has the highest binge drinking problem, with 24.9 percent of residents in the state falling into the category, the Daily Mail reported on Thursday. Wisconsin and the District of Columbia (both 24.2 percent) were tied for second.

Tennessee has the lowest population of binge drinkers in the country at 10.9 percent.


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Under Trump, It's The War On Drugs All Over Again

Mon, 11/06/2017 - 07:28
Click here for reuse options! Our leaders are set to punish addicts just as they're getting back on their feet.

As a doctor completing an addiction medicine fellowship, I treat many patients who have worked incredibly hard to gain a measure of stability in their lives after a period of problematic drug use. Often they were dealt a bad hand—many were exposed to childhood traumatic events such as physical, sexual, or emotional abuse or have anxiety or depression that makes them more prone to perceive pain as intolerable, and also more likely to fall prey to addiction. They are often the first to admit they could have played their cards differently. But they have scratched and clawed their way back to a life that most people take for granted—one that the war on drugs could take away from them again. They have escaped addiction, but can they escape the drug war?

Many of my patients have been coming to the clinic for years and are remarkably stable, avoiding heroin and pills as documented by repeatedly negative urine screenings. They have patched things up with their family and their community. They have found a job and stable housing and in many cases have gone on to become mentors for others struggling with similar issues. But more than a few of my patients smoke marijuana, explaining that it calms their nerves and helps with their depression. In my brief visits with patients we usually have bigger fish to fry than their marijuana use, although I sometimes broach the issue as a conversation starter around potential signs of self-medication, for which there is scant research.

But my conversations with my patients about marijuana use have changed recently because of my concerns surrounding the Trump Administration’s approach to drug policy. Donald Trump advocated for a return of stop and frisk policing during his campaign and continues his tough-on-crime rhetoric to this day. He has been accused of encouraging police brutality in a speech in Long Island, NY on July 28th, ultimately resulting in the acting DEA administrator declaring Trump “condoned police misconduct.” Attorney General Jeff Sessions has vocally expresseddesires to be more aggressive on the federal enforcement of marijuana possession. Although the specifics of such a plan have not been released to date, memos ordering his staff to “charge and pursue the most serious, readily provable offense” give judges no room to make judgment calls for non-violent offenses such as marijuana possession.

This makes me terrified for my patients who have fought their way out of the criminal justice system and a life of debilitating addiction—but could now be ensnared again by possessing a small amount of marijuana for personal use. This isn’t just hypothetical: Last year in New York City, more than 18,000 people were arrested for simple marijuana possession—the overwhelming majority of whom were young black and Latino men, despite lower use rates than young white men.

I now find myself warning my patients, especially young men of color, about the heightened legal risks of marijuana use, whether for medical purposes or not. I think about the war on drugs and how it has set my patients back. How incarceration can cripple a person’s life. How a struggling family is shattered after another hit from the criminal justice system. I think of how the individual’s family no longer can provide support to their friends and neighbors because they are barely holding on themselves. I think of how the war on drugs has created a stigma where mothers, fathers, and children cannot discuss their addictions and therefore don’t receive the help they need. The war on drugs has been shown to be ineffective (at best) and I am concerned we will fall right back from where we came in an effort to “make America great again.”

My heart bleeds for my patients who have shown incredible growth and perseverance who might have their legs taken out just as they were finding solid ground. For what? Our leaders are set to repeat the same failed drug war policies under the guise of “cleaning up” communities. I hope I am proven wrong and the new administration heeds the lessons learned during the previous four decades of the war on drugs. But in the meantime, I will warn my patients that things can change instantly in this unpredictable era in which we now find ourselves. I will also advocate for policy reform that will keep my patient’s feet firmly planted on the path forward, like Canada’s recently unveiled national legalization for those 25 years and older, Governor Cuomo’s efforts to decriminalize marijuana in New York (although the provision was not included in the final budget legislation), and Senator Booker’s recent bill that would re-schedule marijuanaunder the Controlled Substances Act, which also reinvests in communities most harmed by the war on drugs. In the meantime, I’ll do everything I can and hope none of my patients become another victim of the war on drugs.

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6 of the Strongest Marijuana Strains

Fri, 11/03/2017 - 12:12
Click here for reuse options! Some of the strains have incredible THC content--near the limits of the physically possible for dried buds.

Cannabis consumers are confronted by a bewildering variety of strain names, but most of us are just looking for a good buzz.  While the marijuana high is created by the interaction of cannabinoids, mainly THC, and terpenes and flavonoids, nobody has yet figured out a way to quantify the stoniness of any particular strain based on those interactions.

What we have managed to do is figure out ways to measure the THC content of marijuana. Until we can manage a more multi-factorial analysis, THC content is the best way we have of measuring marijuana potency.

And by that measure, today's weed is definitely not your father's marijuana.  Pot seized back in the 1970s and 1980s had THC content in the single digits, while some of today's strains are pushing 30%--the physical limit for how much cannabinoid can fit on a flower structure.

This is not, as drug warriors would have you believe, necessarily a bad thing. Higher THC content means you smoke less to achieve the same high.

If you want to get really high without smoking a lot of pot, which strains to choose?  We now have an idea, thanks to Leafly, which tabulated lab results for a number of strains based on Washington state’s I-502 data. Below are the six strongest strains and their THC content and, as a bonus, below that we will present five of the most popular strains and their THC content.

  1. Ghost OG: 28.7% THC
  2. Wappa: 26.6% THC
  3. OG Chem: 26.4% THC
  4. White Fire Alien OG: 24.9% THC
  5. Head Cheese: 24.7% THC
  6. Bruce Banner: 24.6% THC

What's really striking about this list—apart from the mind-melting THC levels—is that several of the top strains are OG Kush variants. Ghost OG's origins are mysterious, but include OG Kush. Why these particular OG strains are so powerful is unclear, especially given that OG Kush comes in at under 20% THC, but is most likely a combination of genetics, environment, and horticultural skills.

The strains above are hardcore, maybe too stony for the mass market. The most popular strains look to be about a quarter less strong than the strongest. Here are the top six stoniest popular strains:

  1.   Blue Dream: 18.4% THC
  2. Girl Scout Cookies: 19.1% THC
  3. Sour Diesel: 18.5% THC
  4. Guerrilla Glue #4: 21.4% THC
  5. OG Kush: 19.4% THC
  6. Granddaddy Purple: 17.5% THC

Happy shopping. 


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Stop Claiming Marijuana Cures Cancer -- FDA Warns Against Unproven Claims

Fri, 11/03/2017 - 08:14
The industry isn't immune to hucksterism.



Stop claiming marijuana cures cancer -- FDA warns against unproven claims

As more and more marijuana supplements producers start to make dubious and unproven claims, it's important that consumers have access to accurate information. Marijuana is still a controversial topic.

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To Stop the Opioid Epidemic, the White House Should Embrace Prevention

Fri, 11/03/2017 - 07:50
If you never start using opioids, you're not going to get strung out on them.

There’s an old adage that states “An ounce of prevention is worth a pound of cure.”

President Donald Trump declared a public health emergency on opioid use on Oct. 24. He outlined several strategies to address the crisis, including plans to establish drug courts in every federal judicial district; to adjust reimbursement rates for addiction treatment; and to streamline federal funding for drug treatment programs.

These plans focus primarily on treating opioid addiction after the problem is detected. In our response to the opioid crisis, the “pound of cure” is prominent. But where can we find the ounce of prevention?

Any comprehensive response to a health issue must consider those who have not developed the problem. When public health and medical professionals responded to the H1N1 crisis several years ago, for example, a great deal of time and resources were devoted to teaching people how to avoid contracting this potentially life-threatening disease.

People are dying from the opioid overdose epidemic, and we must mount an aggressive response in order to save lives. But let’s not forget the needs of those who haven’t developed opioid addiction, or those who are at risk for addiction. Their life trajectories could be changed with the support of timely and responsive prevention efforts.

Why prevention matters

What does prevention entail? At a basic level, prevention means stopping a behavior, like opioid abuse, from ever occurring in the first place. To experts in public health and related professions, it can also entail delaying the onset of that problem behavior or reducing its impact.

Most importantly, prevention also means strengthening individual and community-level health and resilience, as well as promoting policies that improve physical, social and emotional well-being.

Research clearly shows that prevention is effective at enhancing human functioning and reducing psychological and physical distressPrevention services help to further the health and well-being of both individuals and entire communities across many areas – for example, reducing the negative consequences of alcohol abuse, sexually transmitted infections, diabetes and many other conditions.

There’s clear evidence that expanding preventive services reduces the costs of substance abuse and mental health care. Prevention allows health care workers to address problems early, before costly treatment is necessary.

Prevention policies have been effective in reducing death rates. For example, states that raised the legal drinking age to 21 saw a 16 percent median decline in motor vehicle crashes.

Prevention services can also mitigate the consequences of health issues that may disproportionately affect demographic groups by race, gender, disability, socioeconomic class and other factors.

The importance of prevention is affirmed by the U.S. National Prevention Strategy, a government initiative that aims to shift our nation’s focus from sickness and disease to wellness and prevention.

Preventing opioid abuse

With regard to prevention strategies for opioid abuse and addiction, the federal government has laid out some potentially promising strategies. However, the current opioid emergency response places most of the federal focus – and, likely, available funding – on the needs of a relatively small segment of the population: those with existing opioid use disorders and addiction.

A much larger segment of the population is affected in other ways. Many may have a family member or friend experiencing such addiction. Or they may themselves be at risk of starting to abuse opioids. These people need help to ensure that opioid use problems do not develop in the first place.

There are a few ways that the government can ensure that its current plan addresses the need for prevention.

The White House commission addressing the opioid abuse issue recommended a system for distributing federal funding. This system mirrors the process for obtaining block grants, allocations to states to support substance abuse services. While this recommendation is encouraging, we should ensure that some of these funds are designated to address the needs and build the strengths of individuals and communities who have not yet been affected by the opioid crisis.

The commission also plans to coordinate with private sector and nonprofit groups to implement a national media campaign. This campaign will address addiction stigma and the danger of opioids. As part of this recommendation, it would be important to include messaging indicating that most members of the population do not use opioids, as well as specific steps that communities can take to remain healthy and drug-free.

Finally, the government says it will implement policies that ensure patients are adequately educated about the risks, benefits and alternatives of taking opioids before receiving an opioid prescription for chronic pain. Just as important is the provision promoting the use of nonpharmacological alternatives for pain management by health care professionals.

A comprehensive approach

A comprehensive public health-informed approach to address the opioid crisis may involve responses that affect an entire population, offer early intervention for people who may be at risk for opioid abuse and provide treatment and referral for individuals with already established opioid addiction.

Mapping a comprehensive approach to the opioid crisis. M. Dolores Cimini and Estela M. Rivero, CC BY

As a psychologist who works in alcohol and drug abuse prevention, I believe that public health professionals need to better understand what makes some individuals gravitate to opioid abuse and addiction. Such findings can help to develop strategies to promote health and resilience.

What’s more, we need to expand federal funding to support research across the spectrum of substance use. Substance abuse in all its forms compromises the health and welfare of millions across our nation. President Trump’s heartfelt comments about his brother, Fred, who died as a result of his addiction to alcohol, underscored this point.

One individual and community at a time, we must focus on supporting the millions of people who haven’t developed opioid addiction. That way, we can stem the tide associated with this devastating public health crisis.


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White House Opioid Commission Blows Teachable Moment

Thu, 11/02/2017 - 14:17
Click here for reuse options! The "just say no" approach is not only ineffective, it's harmful to preventing drug abuse.

The White House Commission on the opioid crisis released its final report on November 1st. The report contained a range of recommendations including increasing the number of drug courts and launching a public campaign to prevent abuse of opioids and to challenge the stigma associated with its use.  

While much of the focus on the Commission’s final report is understandably on critiquing its recommendations, there is a larger issue at play—what is absent from the report altogether. The Commission blew an opportunity to share with the public what is well-known and understood by public health and addiction experts on the frontlines of the opioid epidemic—that there are proven harm reduction and treatment interventions that will be far more effective at curbing overdose fatalities than any supply reduction or enforcement strategy.

By adopting an integrated approach to prevention, education, harm reduction, including ensuring widespread distribution of naloxone, and evidence-based treatment it is possible to dramatically reduce the number of deaths related to opioid use.

Prevention programs should focus on empowering and educating people, especially young people who are dying preventable deaths, about opioids. While understanding the root causes of problematic drug use is complicated, educating and empowering those who use or may be considering using opioids is a move away from the hopelessness that appears to be driving opioid use in young people.

What we do know is that campaigns based on orders to “just say no” fail in part because they do not engage young people or provide realistic and safe options for people who may choose to use despite potentially negative consequences.

Harm reduction strategies and programs have a strong track record of improving the health of people using opioids and preventing overdose deaths.  There are a wide range of well-established harm reduction practices.  Some are as simple of teaching young people how to stay safe when partying. Other proven measures are setting up safe consumption sites, enacting Good Samaritan laws that encourage people to seek help when someone is in distress without fear of punishment and ensuring that people in the best position to reverse an overdose—people who use drugs themselves or their friends and families—have easy access to the overdose antidote medication naloxone.

Another life-saving harm reduction technique is to give people who use opioids a means of testing the substance they are using to see if it has been adulterated with fentanyl or some other substance that could lead to an overdose or other adverse reaction.

Harm reduction programs enable people with expertise in drug use to engage with those who are using problematically, earn their trust, and potentially guide them toward voluntary treatment programs. Judgment and the threat of being punished for drug use drives people who use drugs underground and into greater danger of an overdose or other adverse reaction. Harm reduction, on the other hand, saves lives.  And yet, the term “harm reduction” is not even mentioned throughout the Commission’s 100+ page report.

There were, however, some glimmers of hope in the Commission’s recommendations, such as calling for increased access to evidence-based addiction treatment with medications such as methadone and buprenorphine. But, there are serious reservations about how President Trump’s analysis will influence the implementation of even the best recommendations and legitimate concerns that ramping up a failed war on drugs will lead to more preventable deaths.

Punitive responses to opioid drug use, including the promotion of drug courts which are integrated into the criminal justice system, not only fail to protect the lives of people who use drugs, but by portraying opioids and fentanyl as “bad” drugs, people seeking palliative care are also made to suffer. Opioids, including fentanyl, can be used to great effect therapeutically. Opioids can also lead to deadly overdoses. Doubling down on a punitive approach to drug use will impact both people’s access to pain medicines as well as their willingness to voluntarily seek help and treatment for any problematic drug use. Creating drug policies that are grounded in public health principles and informed by compassion, not judgment, means that the government can implement measures that save lives and reduce suffering.

This piece originally appeared on the Drug Policy Alliance blog.


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The Feds Think Pot Is a Greater Threat Than Opioids

Thu, 11/02/2017 - 10:31
Click here for reuse options! Prosecutorial priorities appear skewed.

By now, anyone who is awake is aware that the country is experiencing a lethal opioid crisis. Opioid overdose deaths are at record highs, President Trump has declared a national public health emergency, and Congress is considering an ever-growing number of bills aimed at addressing the crisis.

Someone needs to tell the DEA and the Justice Department. While their public policy pronouncements identify opioids as a key concern, a look at who is actually being prosecuted for federal drug offenses shows that heroin and prescription opioid cases account for only a small fraction of all federal drug cases.

Most tellingly, at a time when more than 60 million Americans enjoy legal marijuana in their home states and when opinion polls show strong and increasing majorities in favor of legalization nationwide, drug agents and federal prosecutors are still devoting more resources to marijuana than to heroin.

And it's not just marijuana. The feds also pursued more cases against methamphetamine offenders and cocaine offenders than they did against heroin dealers, even though the number of heroin and prescription opioid users far outnumbers either the meth or the cocaine using populations and even though meth and cocaine are far less implicated in the overdose crisis than heroin and prescription opioids.

Rhetoric is one thing; what actually happens on the ground is another. And as these 2016 statistics from United States Sentencing Commission demonstrate, heroin and prescription opioids have not been a high priority for either the DEA agents who bring cases or the US Attorneys' offices that prosecute them.  

According to the data, only 14.2% of federal drug prosecutions went after heroin. That's a 29% increase over 2012, but still only a small percentage of all drug cases. An additional 2.8% of cases involved oxycodone, but that figure has been declining for the past several years and is largely a remnant of pill mill prosecutions from early in this decade. Many of the oxycodone cases came from the Eastern District of Kentucky, one of the epicenters of the pill mill phenomenon.

Marijuana cases, on the other hand, made up 17.6% of all federal drug prosecutions last year—more than the heroin and oxycodone cases combined. And remember, this was last year, when the Obama administration was in power. While it's too early for 2017 statistics, it's probably safe to assume that a Justice Department led by marijuana foe Jeff Sessions is not going to oversee a decrease in pot cases.

But what the feds really have their eyes on is meth and cocaine. Meth accounted for a full third (33.6%) of all federal drug prosecutions, while powder and crack cocaine cases accounted for another 27.9%. The numbers don't lie: Federal drug enforcement efforts emphasize meth and coke, and then marijuana, over heroin and prescription opioids.

Anti-prohibitionists will argue that there should be no drug prosecutions; that drug prohibition only exacerbates the problems related to drug use, and that's a fair point. But we live in a prohibition regime, and the priorities of DEA agents and US attorneys in that regime are fair game. That the feds make marijuana a higher prosecutorial priority than heroin is just absurd. 

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If You Can't Afford $4,500 for a Dose of Medicine, You Don't Get to Live

Thu, 11/02/2017 - 08:51
"We face a choice—watch as price-gouging constricts access to naloxone or do something about it."

The war on opioids is in full force, and we are losing. More than 64,000 Americans will die overdose deaths this year. Tighter regulations on prescription narcotics may just be shifting those with opioid addictions back to heroin cartels. During his last term, President Obama signed a bill funding $1 billion into programs combating opioid addiction, including programs that increased access to naloxone, the antidote for opioid overdoses. The current administration announced this year its plan to grant $485 million from the Department of Health and Human Services (HHS) to states to fight opioid addiction. At the same time, synthetic opioids like carfentanil are proving highly resistant to common doses of naloxone, sometimes requiring 10 or more doses of naloxone to reverse an overdose.

The opioid crisis quickly became a state of emergency. More than 40 states responded by making naloxone available without a prescription for the express purpose of enabling family members to revive their loved ones in case of overdose. Other local initiatives have involved the push to make naloxone available to all first responders, including the police and even their K9s who may be exposed to lethal levels of opioids at crime scenes.

While these initial strides have helped to combat deaths from opioid overdose, the financial burden is becoming exhausting. Naloxone has been on the market since 1971 and became generic in 1985. The drug itself is cheap, with current wholesale price cited as $0.33 for a 2ml vial or $11.70 for 10 2ml vials by the International Medical Product Guide. Comparatively, in the US, a simple vial of naloxone is 40 times that price. Price-gauging poster child Mylan of the now infamous EpiPen scandal sells naloxone at $23.72/ml, Hospira sells it at $14.25/ml, Amphastar at $19.8/ml and West-Ward at $20.40/ml.

These prices are for the drug naloxone only, and do not include any of the delivery devices like auto-injectors or nasal injectors. As a result, they are only helpful to medically-trained persons like paramedics, often funded by state and local taxpayer dollars. Citing cost concerns, communities have begun to propose "one and done" or "three strikes" rules where people are limited on the number of overdose responses they get from city ambulance services -- so the next time they call, the city will just let them die. Middletown, Ohio, was one of those cities -- a town that is on track to spend over $2 million this year responding to opioid addiction problems, with $100,000 on Narcan alone.

With government capabilities already limited by cost, the burden of life-saving shifts to private (usually lay, non-medically trained) consumers of naloxone, almost always family members of an opiate user. These loved ones need a naloxone option that is easy to deliver in a crisis, without the training required for syringes and measurements needed to use simple vials of naloxone. This is where the price gouging becomes more appalling. For a drug that costs as low as $0.16/ml, current naloxone options for the lay consumer are exorbitantly cost prohibitive. The naloxone auto-injector by Kaleo Pharma costs $4,500, and the naloxone nasal spray by Adapt Pharma, a simple plastic nasal sprayer that could be manufactured for pennies, now costs $110. This is the price to save a life now, with a generic drug that has been on the market for nearly 50 years.

This is concerning, especially for people living in poverty who are disproportionately affected by addiction. Concerned by the public health ramifications of this, earlier this year,  31 US senators sent a letter to Kaleo, maker of Evzio, demanding an explanation for not only the cost of the drug, but also the 600 percent price hike in the drug. Like Mylan during the EpiPen scandal, Kaleo responded by citing donations of its product to various agencies, as well as a complicated web of rebates and discounts. These do make the drug more affordable for some patients, usually those with insurance, but more often than not, this results in increased market share as consumers are swayed to use the product and not enough impact from a population health perspective. Already, Kaleo has maxed its donations of product, but many that received those devices now rely on it. Meanwhile, Kaleo is enjoying a 20 percent overall market share on the retail naloxone dispensed. For the 40-64-year-olds that most often need naloxone, Kaleo holds an even more solid 50 percent of the market share.

Pharmaceutical price gouging has created a situation where access to life-saving medicines is limited by profit margins. As government agencies are already struggling with costs, the burden gets shifted to the private consumer. In that market, the message is clear: If you can't afford $4,500 for a dose of medicine, you don't get to live. In a way, haven't these pharmaceutical companies now become the "death panels" in the "rationing of health care" that we once so feared during the initial Affordable Care Act debates?

Naloxone is a life-saving drug, one that serves the public in an increasingly important way as we continue to search for other ways to limit the devastation caused by the ongoing opioid crisis.

As one example, Harm Reduction Therapeutics is a nonprofit pharmaceutical company that is working to maximize naloxone's over-the-counter availability while minimizing the price and financial burdens to consumers, first responders, and state and local governments. Co-founder and CEO Michael Hufford noted that "philanthropic foundations backing this new nonprofit pharmaceutical model will help with an urgently needed response to the opioid crisis, while realizing a tremendous return on their investment, measured not in dollars, but in lives saved."

With such public impact, it is time to stop relying on "pharma bros" and start creating and incentivizing nonprofit or government and academic-sponsored institutions for an alternative.  Store shelves need to be flooded with easy-to-use naloxone devices that are sold for what they cost to make and distribute. Only then will the supply of this life-saving generic drug begin to meet the tragic demand for it.

In the words of Hufford, "As lives are lost every day from opioid overdoses, and debate continues as to whether it formally constitutes a crisis, we face a choice -- watch as price-gouging constricts access to naloxone or do something about it. We have chosen to do something about it."

Correction: This article incorrectly stated the amount of funding for fighting opioid addiction provided by legislation signed by President Obama. The 21st Century Cures Act, a bill signed into law by Obama last year, provides $1 billion in opioid funding. 

Copyright, Truthout. Reprinted with permission. 

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Could Cigarettes and Booze Be the Real "Gateway Drugs"?

Thu, 11/02/2017 - 08:37
Using these legal substances preps the brain for cocaine addiction, new research suggests.



Alcohol reshapes the brain in ways that make rats more likely to become cocaine addicts

The idea of a "gateway drug" may sound like a throwback to the "Just say no" era. But new research offers fresh evidence that alcohol and nicotine — two psychoactive agents that are legal, ubiquitous and widely used during adolescence — ease the path that leads from casual cocaine use to outright addiction.

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Marijuana Legalization And Crime: The Only Facts You Need To Know

Thu, 11/02/2017 - 08:25
Researcher: Cannabis legislation 'is not predictive of higher crime rates.'

It’s been one of the primary claims made by the opponents of cannabis regulation for generations: Increased marijuana use will lead to more violent crime. Here are the facts about marijuana legalization and crime.

Earlier this year, Attorney General revived the debate when he declared:

“We’re seeing real violence around that (marijuana legalization). Experts are telling me there’s more violence around marijuana than one would think and there’s big money involved.”

The nation’s top cop didn’t provide any data or clarify where he received his information. (“Experts are telling me ..” is clearly not verifiable.)

But data provided by official state agencies simply does not support the claims of the attorney general. States that regulate and license the production and distribution of cannabis have not seen “more violence around marijuana.” Nor have they seen an increase in violent crime. Statistics demonstrate that many jurisdictions have experienced a drop in violent crime following legalization efforts.

An important caveat: Advocates on both sides of the issue will toss around numbers in an attempt to support their argument. But correlation does not necessarily imply causation. One thing is certain: The fear-mongering of increased crime surrounding marijuana regulation is a canard.

A 2014 study published by researchers at the University of Texas demonstrated that the enactment of “medical marijuana laws precedes a reduction in homicide and assault. … In sum, these findings run counter to arguments suggesting the legalization of marijuana for medical purposes poses a danger to public health in terms of exposure to violent crime and property crimes.”

Robert Morris from the University of Texas, analyzed data supplied from the FBI and found:

“[Medical marijuana legislation] is not predictive of higher crime rates and may be related to reductions in rates of homicide and assault. … Given the relationship between alcohol and violent crime, it may turn out that substituting marijuana for alcohol leads to minor reductions in violent crimes.”

Another study published by researchers at UCLA reported that the growth of medical marijuana outlets in urban areas “was not associated with violent crime or property crime rates.” The researchers suggested that medical marijuana dispensaries may reduce neighborhood crime because of the security precautions taken by business owners.

In the state of Washington, which legalized adult recreational consumption three years ago,  violent crime fell 10 percent statewide.

In Seattle, the state’s largest city, overall crime numbers in February 2017 were the lowest in five years. So far this year, there has been a major drop in crime rates.

Rates of violent crime and property crime fell in the city of Denver following legalization. Crime rates have similarly declined in Portland, Oregon according to a recent CATO think-tank policy report.

According to CATO’s researchers:

“The absence of significant adverse consequences is especially striking given the sometimes dire predictions made by legalization opponents.”

No credible data exists that supports an association between increased violent crime and regulated cannabis.  Studies suggest that violent crime goes down in states with legalized medical marijuana.

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