Treatment

Study: Crackdowns on Heroin, Pain Pills Gave Rise to Fentanyl Overdose Epidemic [FEATURE]

Treatment (STDW) - Mon, 12/10/2018 - 07:25

A new report on illicit US drug markets from researchers at the University of San Francisco has found that that the spread of fentanyl, a powerful synthetic opioid implicated in nearly 29,000 overdose deaths last year alone, is tied to enforcement-driven shortages of heroin and prescription opioids, as well simple economics for drug distributors -- not because users particularly desire the drug.

[image:1 align:right caption:true]Illicit fentanyl has swept through American drug markets in waves -- the super strong "China white" heroin of the 1970s was actually a heroin-fentanyl mixture -- most recently in the past decade after rising levels of opioid addiction and the spread of "pill mills" prompted multifaceted moves to restrict opioid prescribing.

From a drug distributor's perspective, fentanyl is a most excellent substitute for heroin or prescription pain pills. Produced entirely in labs or chemical factories, it is far more powerful and cheaper to produce than heroin. Because it's more potent, it is easier to smuggle -- often coming into the US via postal and delivery service parcels, not by the semi load. And it doesn't require months of growing time and period of intense peasant labor in lawless regions of weak states.

Fentanyl is typically sold deceptively -- marketed as heroin or prescription drugs such as OxyContin or Xanax -- and users and street-level dealers often don't even know that the drugs they are using or selling contain fentanyl, the researchers found. Fentanyl is making its way into the supply chain at the wholesale, not the retail level. That, the researchers said, suggests that demand is not the key driver in the drug's spread.

"Fentanyl is rarely sold as fentanyl," said Sarah Mars, PhD, a researcher in the Department of Family and Community Medicine at UCSF. "The dealers selling fentanyl directly to the users often don't know what's in it. Not only is this particularly dangerous, but it also means penalizing low-level dealers isn't going to make any difference in the fentanyl poisoning epidemic."

According to Mars, users are split on fentanyl, which produces a more sudden and powerful high than heroin, but one that fades faster. Some said fentanyl brought back the euphoria they had lost the ability to feel with long-term heroin use, but others said they feared fentanyl and found its effects too harsh.

"Whether or not they prefer fentanyl, users don't have any influence over what drugs are being sold," Mars said. "Without accurate information about these drugs, they can't make an informed choice about what they are buying. Also, very little drug slang has developed to describe fentanyl, which lends support to the notion that this is not a demand-driven epidemic."

The presence of drugs adulterated with fentanyl is uneven, Mars said.

"Most of the illicit fentanyl has been in the Northeast and Midwest," she specified. And that's where opioid overdose death rates are the highest.

Another contributing factor to the fentanyl overdose toll is that it has dozens of analogs with wildly varying potency. Some, like carfentanil, are amazingly powerful, as much as 10,000 times as potent as morphine. Some are so new they have not yet been made illegal.

"We believe it's the fluctuation in the potency of the drugs containing fentanyl that makes them so dangerous," said Daniel Ciccarone, MD, MPH, a professor of family and community medicine at UCSF and senior author of an ongoing National Institutes of Health-funded study, Heroin in Transition. "You might have one dose that had hardly any fentanyl in it or none at all. Then, you might have one with a different fentanyl analog, of different potency, or even mixtures of multiple fentanyls and heroin."

Here is the paradox of drug prohibition: Trying to crack down on drugs tends to lead not to less drug use but to more dangerous drugs, and in the case of opioids, tens of thousands of dead drug users. There is an inexorable logic at play: The more law enforcement comes down on a drug, the greater the tendency for suppliers to make it more potent and compact -- and dangerous.

Perhaps that's why we now see mainstream calls for a radically different approach, such as the one from Washington Post columnist Megan McArdle earlier this week. In her column "The Incredibly Unpopular Idea That Could Stem Heroin Deaths," McArdle argues that current drug policy is only running up the overdose death toll and that we need "to start talking about ways to make safe, reliable doses of opiates available to addicts who aren't ready to stop."

That would involve increasing access to opioid substitutes such as methadone and buprenorphine, "but lowering the death toll may require a more drastic step: legalizing prescriptions of stronger opiates," McArdle writes.

"Prescription heroin?" she continues. "Remember, I said you might not like the solution. I don't like it, either -- and frankly, neither do the drug policy researchers who told me it may be necessary. But when fentanyl took over the US illicit drug markets, it also got a lot of addicts as hostages. We'll never be able to rescue them unless we can first keep them alive long enough to be saved."

There is a better way to deal with the opioid crisis than relegating tens of thousands of American opioid users to early, preventable deaths. We know what it is. Now it's a matter of implementing smarter, more humane policies, and that's an ongoing political struggle -- one where lives are literally at stake.

Categories: Treatment

Chronicle AM: Denver to Expunge Pot Convictions, Columnist Calls for Prescription Heroin, More... (12/5/18)

Treatment (STDW) - Wed, 12/05/2018 - 20:51

 A Washington Post columnist calls for prescription heroin, the federal hemp bill will apparently ban the participation of people with drug felonies, Denver joins the movement to expunge old pot convictions, and more.

[image:1 align:left caption:true]Marijuana Policy

Denver Becomes Latest City to Expunge Low-Level Marijuana Offenses. Mayor Michael Hancock announced Tuesday that his administration will "move to vacate low-level marijuana convictions for Denver residents." The move comes after months of preliminary work by the Office of Marijuana Policy and the City Attorney's Office. "For too long, the lives of low-income residents and those living in our communities of color have been negatively affected by low-level marijuana convictions," Hancock said in a press release. "This is an injustice that needs to be corrected, and we are going to provide a pathway to move on from an era of marijuana prohibition that has impacted the lives of thousands of people."

Industrial Hemp

Federal Bill to Legalize Hemp Bans Drug Felons from Participating. Congressional negotiators have agreed on compromise language for the hemp provision of the farm bill that would ban people with felony drug convictions from participating in the hemp industry. The ban was inserted into the Senate version of the bill late in the process and over the objections of drug policy reformers. It's not quite a done deal—the language could be changed in conference committee—but at this point, it looks like the ban is in.

Heroin and Prescription Opioids

Washington Post Columnist Calls for Prescription Heroin. In a piece published Tuesday, Washington Post columnist Megan McArdle has called for access to prescription heroin in a bid to prevent fentanyl-related overdose deaths. In the column titled An Incredibly Unpopular Idea That Could Stem Heroin Deaths, McArdle notes that "most people don't want addiction made safer or easier; they want it stopped, cold…but you don’t free slaves by killing them, and as long as fentanyl suffuses the illicit drug markets, that’s what a 'tough love' policy amounts to." Harm reduction measures and increased access to treatment would help, McArdle writes, but "lowering the death toll may well require a more drastic step: legalizing prescriptions of stronger opiates. Prescription heroin? Remember, I said you might not like the solution. I don’t like it, either — and frankly, neither do the drug policy researchers who told me it may be necessary. But when fentanyl took over the U.S. illicit drug markets, it also got a lot of addicts as hostages. We’ll never be able to rescue them unless we can first keep them alive long enough to be saved."

Asset Forfeiture

Nashville Bends to Police Pressure, Extends Federal "Equitable Sharing" Program. Under pressure from local law enforcement and seeking to avoid raising taxes, the Nashville Metro Council voted 25-5 to renew its participation in the federal asset forfeiture equitable sharing program, which allows state and local law enforcement agencies to divert drug-related cash seizures to the federal government, which in turn returns 80% of the booty back to the seizing agency. 

Categories: Treatment

US HI: Marijuana Found To Reverse Heart Failure, University Of Hawaii

Treatment (MAP) - Thu, 11/29/2018 - 08:00
Honolulu Star-Advertiser, 29 Nov 2018 - University of Hawaii researchers have discovered that the use of marijuana may reverse heart failure. A recent study shows that drugs can protect and reverse damage to the heart from the stress that progresses the disease. Heart failure can be caused by heart attacks, leaky valves, hypertension and other illnesses.
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Chronicle AM: First Step Act Fight Continues, MI Gets Legal Marijuana December 6, More... (11/28/18)

Treatment (STDW) - Wed, 11/28/2018 - 20:49

Senate Republicans are trying to find a way to keep the First Step Act alive, marijuana use and possession becomes legal in Michigan next week, and more.

[image:1 align:right caption:true]Marijuana Policy

Michigan Marijuana Legalization Goes into Effect December 6. As of a week from tomorrow, it will be legal to possess and use small amounts of marijuana. But it will probably take until sometime in 2020 for pot shops to open for business. The state says it will start taking business applications late in 2019.

Medical Marijuana

Michigan Unlicensed Dispensaries Can Stay Open Until Year's End. Medical marijuana dispensaries will be able to continue operating until at least December 31 as they await state licenses, the Bureau of Medical Marijuana Regulation announced Tuesday. Some 40 dispensaries have received state licenses so far; another 98 await licenses.

Psychedelics

Oregon Attorney General Approves Psilocybin Ballot Measure Language. An initiative that would allow licensed medical professionals to administer psilocybin for therapeutic purposes has had its ballot language approved. The next step is signature-gathering to get the measure on the 2020 ballot. The measure will need 140,000 valid voter signatures to qualify.

Drug Treatment

Massachusetts Federal Court Judge Orders Jail to Provide Methadone. A federal court in Massachusetts granted a preliminary injunction this week, requiring that the plaintiff in the case be provided continued access to methadone treatment for his opioid use disorder while incarcerated. The ruling requires a jail in Essex County to provide medication-assisted treatment (MAT) to a man who is about to be sentenced for conduct that occurred two years ago, before he first started his recovery. The court held that the plaintiff is likely to succeed on his claim that the jail's refusal to provide methadone treatment violates both the Americans with Disabilities Act (ADA) and the 8th Amendment of the US Constitution, which prohibits cruel and unusual punishment.

Sentencing Reform

Senate Republicans Seek Way to Get Sentencing Reform Bill Moving Again. Senate Republicans are pondering changing the First Step Act (S.2795) to make it more palatable for some conservatives, but which could blow up the bipartisan compromise that supports the bill as is. Some of the changes being discussed include tightening the safety valve provision, getting tougher on fentanyl offenders, and backing away from an ending the "stacking" regulation, which adds more time to sentences of people convicted of drug offenses while possessing a firearm. President Trump, meanwhile, continues to push Senate Majority Leader Mitch McConnell (R-KY) to bring the bill to a Senate vote.

Categories: Treatment

US NJ: N.J. Lawmakers Unveil Legislation Legalizing Marijuana

Treatment (MAP) - Wed, 11/21/2018 - 08:00
The Philadelphia Inquirer, 21 Nov 2018 - TRENTON -- New Jersey lawmakers have unveiled their latest proposal to legalize recreational marijuana use for people 21 and over. A joint Democrat-led Assembly and Senate committee is expected to discuss the package Monday. One bill provides for legalizing an ounce of marijuana for adults 21 and older, setting up a five-person cannabis commission, and taxing the sale of the substance at 12 percent.
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US: Where Marijuana Is On The Ballot Today

Treatment (MAP) - Tue, 11/06/2018 - 08:00
The Philadelphia Inquirer, 06 Nov 2018 - Stateside, recreational marijuana use became legal in Vermont on July 1, Oklahoma voters approved one of the country's most progressive medical marijuana bills in June, the New York Department of Health officially recommended legalization to the governor and the Commonwealth of the Northern Mariana Islands legalized recreational use. Now, legalization advocates are hoping to build on these successes with a number of statewide ballot measures up for consideration Tuesday, including full recreational legalization in two states and medical marijuana in two more. Here's a rundown of what the measures say and where the polling on them currently stands.
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Chronicle AM: Mexico Supreme Court Ends Marijuana Prohibition, Feds Reject WI Medicaid Drug Tests, More... (11/1/18)

Treatment (STDW) - Thu, 11/01/2018 - 19:06

Mexico's Supreme Court strikes a fatal blow against marijuana prohibition, medical marijuana is now available by prescription in the United Kingdom, a Colorado jury rejects an effort to blow up the state's legal marijuana system, and more.

[image:1 align:left]Marijuana Policy

Colorado Federal Jury Throws Out RICO Case Threatening State Marijuana Law. That didn't take long. A Denver federal court jury took only a few hours Wednesday to reach a verdict against a couple who claimed a marijuana cultivation operation was ruining their property values and threatening their lifestyle. The couple, aided by anti-marijuana attorneys, had attempted to use federal RICO statutes to undermine the state law, arguing that because marijuana is still federally illegal, its production violates federal racketeering laws. But the jury didn't buy it.

Drug Testing

Wisconsin Governor's Plan to Require Drug Testing for Medicaid Rejected. The federal Center for Medicare and Medicaid Services has rejected a proposal from Gov. Rick Scott (R) to require drug testing as a condition for receiving Medicaid benefits. Walker had proposed several changes to the state program, known as BadgerCare, and the administration approved requiring childless adults to work or lose coverage, but not the proposed drug testing. Instead of requiring drug screening and testing, Medicaid applicants will now have to complete a health assessment with questions about drug use. If the assessment indicates concerns about drug use, the applicant will be referred to treatment, but not required to go.

Harm Reduction

New York City Legislation Would Expand Opioid Treatment at Homeless Shelters. City Councilman Stephen Levin (D-Brooklyn) Wednesday filed legislation to increase access to opioid treatment at city homeless shelters. The bill would allow for easier access "We can't continue to sit by and do nothing," said Levin. "As we've seen in New York City and throughout the country, the status quo is not working. People are overdosing on opioids every day in New York City -- more than homicides and traffic fatalities combined."

International

Mexico Supreme Court Strikes Down Marijuana Prohibition. In a pair of rulings Wednesday, the Supreme Court of Mexico ruled that the country's ban on marijuana violates individual autonomy protections in the Mexican constitution. The court said adults have the right to grow, possess, and use marijuana, but that the government retains the right to regulate consumption. It also directed the federal health agency to begin to develop regulations reflecting the decision. The ruling does not legalize marijuana commerce; it would be up to the Mexican congress to take up that issue.

Medical Marijuana Now Legal in Great Britain. As of Thursday, November 1, some medical marijuana patients will be able to legally seek and obtain their medicine. Legal access to medical marijuana will be limited to patients who have "an unmet special clinical need that cannot be met by licensed products." It will be up to a special panel to determine who meets that condition, but there are worries that the system may prove too unwieldy to satisfy the needs of hundreds of thousands of potential patients.

Categories: Treatment

US: Colorado Jury's Pot Verdict May Discourage Similar Cases

Treatment (MAP) - Thu, 11/01/2018 - 07:00
The Philadelphia Inquirer, 01 Nov 2018 - A federal jury in Denver on Wednesday rejected claims involving the odor from a pot farm made in a case that was closely watched by the marijuana industry. It was the first such lawsuit to reach a jury. Three others are pending in California, Massachusetts and Oregon.
Categories: Treatment

Chronicle AM: FDA Grants "Breakthrough Therapy" Status for Psilocybin, MI Pot Poll, More... (10/29/18)

Treatment (STDW) - Mon, 10/29/2018 - 18:16

The Michigan marijuana initiative still has a healthy lead as Election Day nears, the FDA has granted "breakthrough therapy" status for psilocybin for treatment-resistant depression, and more.

[image:1 align:right caption:true]Marijuana Policy

Michigan Poll Has Legalization Initiative With Comfortable Lead. A new Detroit Free Press poll has the Proposal 1 legalization initiative favored by a margin of 57% to 41%. That's nearly unchanged from the previous Detroit Free Press poll in September, which had the issue winning 56% to 41%. "Even though there are some law-enforcement groups and others that are putting out information against the proposal, it seems to have pretty solid support," the pollsters noted. "There has always been a perception that there are far too many people in jail for a minimal amount of use and that it prohibits the police from spending time on more serious crimes."

Michigan Marijuana Foes Spending Big Bucks. The organized opposition to Proposal 1, known as Healthy and Productive Michigan, has collected more than $1 million in the past quarter, nearly double the $529,000 raised by the Coalition to Regulate Marijuana Like Alcohol Coalition, which is leading the "yes" campaign. The opposition still has $600,000 in the bank, which it is using for a series of cable TV ads. But the polling suggests the ads aren't working. Smart Approaches to Marijuana (SAM) ponied up more than $600,000 to defeat the measure, while executives from DTE Energy have donated more than $300,000.

Oregon County's Lawsuit Challenging State Legalization Thrown Out. A federal judge has dismissed a lawsuit from Josephine County contending that federal law criminalizing marijuana preempts the state's law allowing commercial production and sales. US District Court Judge Michael McShane ruled last Thursday that cities and counties don't have standing to sue a state in federal court. The county has not yet decided whether it will appeal the ruling.

Medical Marijuana

Oklahoma Medical Marijuana Dispensaries Celebrate First Day of Legal Sales. The Sooner State saw its first legal medical marijuana dispensary sales last Friday. Some 600 dispensary licenses have already been approved, but only a handful of stores were actually open on opening day. That will change in the coming months.

Psychedelics

FDA Grants "Breakthrough Therapy" Status for Psilocybin to Treat Depression. The Food & Drug Administration (FDA) has granted Breakthrough Therapy status to psilocybin -- the psychedelic ingredient in magic mushrooms -- for use in treating depression after early experimental results showed promise. The designation allows the FDA to expedite research and review of psilocybin-based treatments. It is aimed specifically at a Phase IIb trial currently underway investigating the optimal dose range for psilocybin used for severe treatment-resistant depression.

Categories: Treatment

Chronicle AM: NY Senate Report on Opioids, WY Marijuana Poll, More... (10/25/18)

Treatment (STDW) - Thu, 10/25/2018 - 15:54

A new poll has marijuana legalization on the cusp of majority support even in Wyoming, the New York state Senate releases its report on the state's opioid crisis, and more.

[image:1 align:left caption:true]Marijuana Policy

New Jersey Marijuana Activists Urges Quick Action on Legalization. As the governor and the legislature work to find an agreement on a marijuana legalization bill, legalization supporters are growing impatient. "There's been hearings, there's been committee meetings, there's a lot of discussions, there's a lot of science behind it but right now it's getting very frustrating," said. New Jersey CannaBusiness Association President Scott Rudder. "We understand the process takes time -- but enough is enough. "We need to get past this, we need to resolve some of these issues. It's very frustrating." Gov. Phil Murphy (D) had called for legalization within 90 days of his January inauguration, then it was supposed to be voted on this month, and the latest is by year's end. Stay tuned.

Wyoming Poll Has Legalization on Cusp of Majority Support. A new poll from the Wyoming Survey and Analysis Center at the University of Wyoming shows nearly half of Wyoming residents -- 49 percent -- support legalization of marijuana for recreational use. That number is significantly higher when the question comes to medical marijuana, with 86 percent supporting legalization in that form. And 69 percent of residents think possession of a small amount of the drug shouldn't lead to jail time. The poll also notes that there has been a a statistically significant increase in positive views on marijuana legalization compared to polls from 2014 and 2016.

Heroin and Prescription Opioids

New York Senate Heroin Task Force Releases Recommendations, Findings in New Report. The State Senate Task Force on Heroin and Opioid Addiction on Wednesday released its 2017-2018 report, including 11 recommendations on ways the state should address the opioid crisis. The committee wants the state to create "Centers for Excellence on Substance Use Disorder" as a way to improve access to treatment in rural parts of the state, as well as increasing resources to healthcare workers trained to treat substance abuse disorders. The task force also calls for reducing the cost of Naloxone, limits on opioid prescriptions, and tougher penalties for dealers whose drug sales result in fatal overdoses.

International

Russia Moves Toward Allowing Medicinal Opium Planting. A government commission has approved a draft law that would allow the cultivation of opium for medicinal purposes, citing the fact that most legal medicinal opium producing countries are participating in sanctions against Russia. "It is proposed to abolish the existing ban and determine the order of cultivation of plants for the production for medical purposes and veterinary medicine of narcotic drugs and psychotropic substances," the government press service reported.

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