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CN NS: OPED: How Prepared Are Police For Drug-Related Impaired

Top Stories (MAP) - Fri, 06/16/2017 - 07:00
Amherst News, 16 Jun 2017 - Canada's law enforcement agencies, MADD Canada and other first responders took to the country's roads and highways recently in their annual campaign to promote safety on our highways over the summer holiday season. Adding to the complexity of addressing the issue of impaired driving is the steady increase in the numbers of drivers who have been stopped for drug impairment.
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CN NS: Column: How To Best Treat Society's Most Vulnerable?

Top Stories (MAP) - Fri, 06/16/2017 - 07:00
Amherst News, 16 Jun 2017 - Two questions: What drug is the most addictive and can give you a condition that can kill you? What other drug has the worse withdrawal effects and can destroy your brain? Answers! No. 1 is nicotine. It is so addictive because no matter how much you ingest your body still craves more and as it leaves your body the craving gets more intense.
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CN BC: Editorial: Uncertainty Lies Ahead On Marijuana Issue

Top Stories (MAP) - Fri, 06/16/2017 - 07:00
Peace Arch News, 16 Jun 2017 - Regardless of whether one agrees with the decision to legalize marijuana, that train has left the station and is scheduled to roll down the track on July 1, 2018. The focus now must shift to how those changes will affect the rights of citizens, law enforcement and the courts.
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CN ON: Smoking Out Strategies

Top Stories (MAP) - Fri, 06/16/2017 - 07:00
Ottawa Sun, 16 Jun 2017 - Some provinces already moving ahead with legal pot plans Several provinces are plowing full steam ahead with plans to ask the public how they should manage the introduction of legal recreational pot in Canada. But Ontario, it seems, isn't one of them.
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Chronicle AM: Federal CARERS Act Refiled, RI Legalization Commission Bill Advances, More... (6/15/17)

Drug War Chronicle - Thu, 06/15/2017 - 20:27

A bipartisan group of senators reintroduce the CARERS Act to protect medical marijuana in the states, marijuana legalization is keeping legislators busy in the Northeast, New York GOP senators want more drug war to fight opioids, and more.

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

Massachusetts Legal MJ Rewrite Bill Delayed By Errors, Concern at High Tax Rates. House Speaker Robert DeLeo (D-Winthrop) has postponed a vote on the legislature's rewrite of the marijuana legalization law approved by voters last fall after errors in the drafting of the bill and the high tax rate proposed -- 28% -- drew protests from Democratic lawmakers. "I think there are certain things that we have to clear up, so because of that, I think it's important that with a bill of this mag that we try to get it right or close to right this first time, so I'd rather do that than try to rush it through," DeLeo said, adding that there was a consensus among Democrats on the basics of the bill.

New Jersey Legalization Bill Gets Hearing Monday. The Senate Judiciary Committee will hold a hearing Monday morning on Senate Bill 3195, which legalizes the possession of small amounts of marijuana and sets up a system of taxed and regulated marijuana commerce. The Drug Policy Alliance has expressed "concern" that the bill "does not include essential components to create a fair and equitable marijuana market in New Jersey." Such legislation must include polices to repair past harms to minority communities, DPA said.

Rhode Island Legalization Study Commission Bill Passes House. A bill that creates a legislative commission to study marijuana legalization -- instead of just legalizing it -- passed the House Wednesday night. House Bill 551A now heads to the Senate. Regulate Rhode Island, the main advocacy group for legalization, has said it will not participate in the commission, which it describes as a delaying tactic.

Medical Marijuana

Bipartisan Bill to End Federal Prohibition of Medical Marijuana Reintroduced in US Senate. US Sens. Rand Paul (R-KY), Corey Booker (D-NJ), and Kirsten Gillibrand (D-NY) reintroduced a bill Thursday that would end the federal prohibition of medical marijuana. Sens. Mike Lee (R-UT) and Lisa Murkowski (R-AK) also signed on to the legislation as original cosponsors. The Compassionate Access, Research Expansion, and Respect States (or CARERS) Act of 2017 would allow individuals and entities to possess, produce, and distribute medical marijuana if they are in compliance with state medical marijuana laws. It would also open up avenues to medical marijuana research and allow physicians employed by the Department of Veterans Affairs to recommend medical marijuana to veterans in states where it is legal. The bill also proposes excluding cannabidiol, a non-psychoactive cannabinoid found in marijuana, from the federal government's definition of "marijuana."

Kentucky Lawsuit Challenges State's Medical Marijuana Ban. Three Kentuckians who say they have used marijuana to ease health problems have filed a lawsuit in state court charging that banning medical marijuana violates their constitutional privacy rights. The suit names as defendants Gov. Matt Bevin (R) and Attorney General Steve Beshear (D).

Rhode Island Governor Proposes Medical Marijuana Expansion. Gov. Gina Raimondo (D) has proposed a budget amendment that calls for "no less than six licensed compassion centers" and increased licensing fees that would generate $1.5 in revenues for the state's general fund. There are three existing dispensaries, which would each be allowed to open one more store front, plus the three additional ones proposed.

Heroin and Prescription Opioids

New York Republicans Want More Drug War to Fight Opioids. A Republican Senate task force says that adding funding for addiction treatment is good, but that it's time to increase heroin penalties "to get dealers off the street." The senators are proposing charging dealers with murder if one of their customers dies and increasing penalties based on the weight of the drugs sold. Assembly Democrats rejected the idea, calling the approach one that's been "tried and failed." The Assembly killed a similar approach last year.

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CN BC: Column: Downtown Eastside Tours Objectify Those Living With

Top Stories (MAP) - Thu, 06/15/2017 - 07:00
Vancouver 24hours, 15 Jun 2017 - Vancouver seems to have two seasons: Rain and tourists. Just as we make our way out of one, the other hits us full force. Nowhere is the throng of tourists thicker than Gastown, where they scramble for selfies with the steam clock. Trying to get away from those tourists while out for a quick post-lunch walk, I wandered further into the Downtown Eastside than I normally do and was surprised to see the camera-wielding crowd didn't stop there. In front of me were a man and woman - her stopping to snap photos of people lying on the street and him loudly explaining what he saw as the reason those addicted to drugs and living in the area didn't try to help themselves and turn their lives around.
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CN ON: Legalizing Cannabis Could Reduce Opioid Use: Experts

Top Stories (MAP) - Thu, 06/15/2017 - 07:00
The Record, 15 Jun 2017 - Research suggests a safer alternative to powerful painkillers OTTAWA - Leading medical experts say legalizing cannabis may offer new hope to one day reduce the use of opioids -powerful drugs frequently prescribed for the treatment of pain.
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CN AB: Beltline Tabbed For Safe Site

Top Stories (MAP) - Thu, 06/15/2017 - 07:00
Metro, 15 Jun 2017 - Province hopes to open public health service by end of 2017 The Sheldon M. Chumir Health Centre in the Beltline could soon be Calgary's first supervised consumption site, pending federal approval. Associate Minister of Health Brandy Payne confirmed on Thursday the province has applied to provide supervised consumption services in Calgary at the downtown health facility and will soon begin discussions with nearby residents.
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This Week's Corrupt Cops Stories

Drug War Chronicle - Wed, 06/14/2017 - 21:07

It's pretty quiet on the corrupt cop front week, except for one drug-gobbling Tennessee cop and Burritogate in Tulsa. Let's get to it:

[image:1 align:left]In Ripley, Tennessee, a former Ripley police officer was sentenced last Friday to four years' probation after turning up as a suspect in an undercover drug investigation. Stephen Michael Kirkpatrick wasn't the intended target, but information developed in the investigation led to him being charged on numerous counts. He pleaded guilty to two counts of official misconduct, 13 counts of cocaine possession, one count of marijuana possession, one count of meth possession, and one count of misuse of official information.

In Tulsa, Oklahoma, a Tulsa County jail guard was arrested last Friday after deputies found drugs hidden inside a burrito he brought into the jail. Guard Kevin Mayo, 20, went down after the burrito turned out to be filled with marijuana, methamphetamine, and prescription pain pill. He is charged with possession of contraband in a jail, conspiracy to commit a felony, possession of both marijuana and methamphetamine, possession of a schedule II drug, and possession of drug paraphernalia. He is now on unpaid leave and in jail.

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Medical Marijuana Update

Drug War Chronicle - Wed, 06/14/2017 - 20:51

Despite everything, Attorney General Sessions has medical marijuana on his mind, Florida lawmakers approve a no-smoking medical marijuana implementation bill, Vermont's governor signs a medical marijuana expansion bill, and more.

[image:1 align:right]National

On Monday, it was reported that Attorney General Sessions asked Congress to let him go after medical marijuana. Attorney General Sessions sent a letter to Congress last month asking leading members to reject a federal law letting medical marijuana states set their own policies. The Rohrabacher-Farr amendment to the Justice Department budget bars the use of federal funds to prevent states "from implementing their own State laws that authorize the use, distribution, possession or cultivation of medical marijuana." In a letter urging congress members to walk back the amendment, Sessions said the law would "inhibit [his department's] authority to enforce the Controlled Substances Act." Hat tip to Tom Angell at MassRoots, who first obtained the letter.

Arizona

Last Thursday, the state attorney general asked the state Supreme Court to reinstate a ban on campus medical marijuana. Attorney General Mark Brnovich (R) has asked the state Supreme Court to review an appeals court ruling that struck down a ban on medical marijuana on college campuses. The state is arguing that the legislature had the right to alter the voter-approved medical marijuana law so that college students with medical marijuana cards could face felony arrests for possession of any amount of marijuana.

Connecticut

Last Friday, the state took another step toward adding more qualifying conditions. Consumer Protection Commissioner Michelle Seagull announced that she would follow a recommendation from the Medical Marijuana Program Board of Physicians to include three new conditions among the list of qualifying conditions for medical marijuana use. They are hydrocephalus with intractable headaches, intractable migraines, and trigeminal neuralgia. Seagull will now draft a new regulation by the end of the month, and after that, there will be a 30-day public comment period, then a review by the office of the attorney general, and then the approval of the Regulation Review Committee of the General Assembly. The whole process could take another year.

Florida

Last Friday, the medical marijuana implementation bill passed the legislature. Lawmakers used a special session to come to an agreement on how to handle medical marijuana. Under the proposal approved by the legislature, which Gov. Rick Scott (R) says he will sign, the state will gain an additional ten medical marijuana operators within four months. Each operator can operate up to 25 dispensaries across the state. But the bill also bans the smoking of medical marijuana even though the constitutional amendment approved by voters last November expressly included a provision that allows smoking. That has led Orlando lawyer John Morgan, who largely bankrolled the amendment, to vow to sue the state over the no-smoking provision.

Vermont

Last Thursday, the governor signed a medical marijuana expansion bill. Gov. Phil Scott (R) signed into law Senate Bill 16, which expands the list of qualifying conditions for medical marijuana. The new conditions added are Parkinson's disease, Crohn's disease, and PTSD. The new law also increases the number of dispensaries in the state from four to five.

[For extensive information about the medical marijuana debate, presented in a neutral format, visit <MedicalMarijuana.ProCon.org.]

Categories: Latest News

Chronicle AM: Sessions Sought Free Rein on MedMJ, VT Legalization Still Alive, More... (6/14/17)

Drug War Chronicle - Wed, 06/14/2017 - 20:23

Lots of marijuana policy news today, plus GOP Rep. James Sensenbrenner files a bill to reauthorize the Second Chance Act.

[image:1 align:left]Marijuana Policy

California Pot Shops Could Sell Both Recreational and Medical Marijuana Under New Proposal. Gov. Jerry Brown (D) and state legislators proposed Monday to allow medical and recreational marijuana to be sold by the same shops. The move was one of dozens of new regulations aimed at merging the medical and recreational marijuana industries contained in budget bills released Monday.

Nevada Lawsuit That Threatens July 1 Sales Date Still Alive. A Carson City district court judge on Tuesday denied the state's motion to dismiss a lawsuit brought by liquor distributors seeking a cut of the action in the state's emerging legal marijuana industry. The liquor distributors have won a temporary restraining order holding up the implementation of the state's marijuana sales law until their lawsuit is settled. The distributors claim the state's regulations for licensing marijuana distributors are arbitrary and unfair. This means the state's early July 1 legal sales goal is in jeopardy.

Nevada Governor Signs Three Pot Bills, Vetoes One. Gov. Brian Sandoval (R) has signed a bill setting a 15% wholesale tax on both medical and recreational marijuana (Senate Bill 478), and bills adjusting medical marijuana regulations (Senate Bill 344 and Assembly Bill 422), but vetoed a bill that would have allowed those convicted of past marijuana-related crimes involving an equal or lesser amount of what's now legal to have that crime vacated from their criminal records (Assembly Bill 259).

Rhode Island Legislature to Vote on Study Bill, But Advocates Say No Thanks. Marijuana legalization supporters said Wednesday they will not participate in a legalization study commission if it is approved by the General Assembly, calling it "a flawed delay tactic." Instead, Regulate Rhode Island is calling on legislative leaders to vote on a bill that would legalize personal possession and cultivation, but include no immediate plans for taxed and regulated marijuana commerce.

Vermont Governor, Legislative Leaders Move Toward Compromise on Legalization. After Gov. Phil Scott (R) vetoed the legalization bill, Senate Bill 16, he said he didn't oppose legalization in principle, but had concerns about youth use and impaired driving. He also said he wanted a study commission in the bill to have more time to examine how the state could implement legal marijuana commerce. Now, legislative leaders say they have come up with compromise language that addresses his concerns, including tougher penalties for selling to children and longer sentences for smoking in a car when a child is present. A spokesman for the governor said "We're making good progress toward an agreement." Legislators will need Republicans to waive a rule to bring the issue up for consideration during a looming special session, but Scott said if an agreement on the bill could be reached, he would seek to persuade Republican legislators to allow it to be taken up.

Medical Marijuana

Attorney General Session Asked Congress to Let Him Go After Medical Marijuana. Attorney General Sessions sent a letter to Congress last month asking leading members to reject a federal law letting medical marijuana states set their own policies. The Rohrabacher-Farr amendment to the Justice Department budget bars the use of federal funds to prevent states "from implementing their own State laws that authorize the use, distribution, possession or cultivation of medical marijuana." In a letter urging congresspeople to walk back the amendment, Sessions said the law would "inhibit [his department's] authority to enforce the Controlled Substances Act." Hat tip to Tom Angell at MassRoots, who first obtained the letter.

Reentry/Rehabilitation

Rep. Sensenbrenner Files Second Chance Act Reauthorization Bill. Rep. Jim Sensenbrenner( R-WI) has filed House Resolution 2899 to reauthorize the Second Chance Act of 2007. That law provides funding to state, local, and tribal governments that are working to reduce recidivism and improve outcomes for people getting out of jail or prison.

Categories: Latest News

America, We Can Fix This: 24 Ways to Reduce Opioid Overdoses and Addiction [FEATURE]

Drug War Chronicle - Tue, 06/13/2017 - 07:06

Drugs, mainly opioids, are killing Americans at a record rate. The number of drug overdose deaths in the country quadrupled between 1999 and 2010 -- and compared to the numbers we're seeing now, those were the good old days.

[image:1 align:left]Some 30,000 people died of drug overdoses in 2010. According to a new estimate from the New York Times, double that number died last year. And the rate of increase in overdose deaths was growing, up a stunning 19% over 2015.

The Times' estimate of between 59,000 and 65,000 drug overdose deaths last year is greater than the number of American soldiers killed during the entire Vietnam War, greater than that number of people killed in the peak year for car crash deaths, greater than the number of people who died in the year the AIDS epidemic peaked, and higher than the peak year for gun deaths.

In the first decade of the century, overdoses and addiction rose in conjunction with a dramatic increase in prescription opioid prescribing; since then, as government agents and medical professionals alike sought to tamp down prescribing of opioids, the overdose wave has continued, now with most opioid OD fatalities linked to illicit heroin and powerful black market synthetic opioids, such as fentanyl and carfentanil.

The Centers for Disease Control and Prevention says we are in the midst of "the worst drug overdose epidemic in history," and it's hard to argue with that.

So, what do we do about it? Despite decades of failure and unintended consequences, the prohibitionist reflex is still strong. Calls for more punitive laws, tougher prosecutorial stances, and harsher sentences ring out from state houses across the land to the White House. But tough drug war policies haven't worked. The fact that the overdose and addiction epidemic is taking place under a prohibition regime should make that self-evident.

More enlightened -- and effective -- approaches are now being tried, in part, no doubt, because today's opioid epidemic is disproportionately affecting white, middle class people and not the inner city black people identified with heroin epidemics of the past. But they are also being tried because for the past quarter-century an ever-growing drug reform movement has articulated the failures of prohibition and illuminated more effective alternatives.

The drug reform movement's most powerful organization, the Drug Policy Alliance, this spring published A Public Health and Safety Approach to Problematic Opioid Use and Overdose, which lays out more than two dozen specific policy prescriptions in the realms of addiction treatment, harm reduction, prevention, and criminal justice that have been proven to save lives and reduce dependency on opioids. These policy prescriptions are doable now -- and some are being implemented in some fashion in some places -- but require that political decisions be made, or that forces be mobilized to get those decisions made. Some would require a radical divergence from the orthodoxies of drug prohibition, but that's a small price to pay given the mounting death toll.

Here are 24 concrete policy proposals that can save lives and reduce addiction right now. All the facts and figures are fully documented in the heavily-annotated original. Consult it if you want to get down to the nitty-gritty. In the meantime:

Addiction Treatment

1. Create Expert Panel on Treatment Needs: States should establish an expert panel to address effective treatment needs and opportunities. The expert panel should evaluate barriers to existing treatment options and make recommendations to the state legislature on removing unnecessary impediments to accessing effective treatment on demand. Moreover, the panel should determine where gaps in treatment exist and make recommendations to provide additional types of effective treatment and increased access points to treatment (such as hospital-based on demand addiction treatment). The expert panel must also set evidence-based standards of care and identify the essential components of effective treatment and recovery services to be included in licensed facilities, especially with regards to medication-assisted treatment, admission requirements, discharge, continuity of care and/or after-care, pain management, treatment programming, integration of medical and mental health services, and provision of or referrals to harm reduction services. The expert panel should identify how to improve or create referral mechanisms and treatment linkages across various healthcare and other providers. The panel should establish clear outcome measures and a system for evaluating how well providers meet the scientific requirements the panel sets. And, finally, the expert panel should evaluate opportunities under the ACA to expand coverage for treatment.

2. Increase Insurance Coverage for Medication-Assited Treatment (MAT): Seventeen state medical plans under the Patient Protection and Affordable Care Act (ACA) do not provide coverage for methadone or buprenorphine for opioid dependence. Moreover, the Veterans Administration's (VA's) insurance system has explicitly prohibited coverage of methadone and buprenorphine treatment for active duty personnel or for veterans in the process of transitioning from Department of Defense care. As a result, veterans obtaining care through the VA are denied effective treatment for opioid dependence. Insurance coverage for these critical medications should be standard practice.

3. Establish and Implement Office-Based Opioid Treatment for Methadone: Currently, with a few exceptions, methadone for the treatment of opioid dependence is only available through a highly regulated and widely stigmatized system of Opioid Treatment Programs (OTPs). Moreover, several states have imposed moratoriums on establishing new OTPs that facilitate methadone treatment despite large, unmet treatment needs for a growing opioid-dependent population. Patients enrolled in methadone treatment in many communities are often limited to visiting a single OTP and face other inconveniences that make adherence to treatment more difficult. Initial trials have suggested that methadone can be effectively delivered in office-based settings and that, with training, physicians would be willing to prescribe methadone to their patients to treat their opioid dependence. Office-based methadone may help reduce the stigma associated with methadone delivered in OTPs as well as provide a critical window of intervention to address medical and psychiatric conditions. Office-based opioid treatment programs offering methadone have been implemented in California, Connecticut, and Vermont.

4. Provide MAT in Criminal Justice Settings, Including Jails/Prisons and Drug Courts: Individuals recently released from correctional settings are up to 130 times more likely to die of an overdose than the general population, particularly in the immediate two weeks after release. Given that approximately one quarter of people incarcerated in jails and prisons are opioid-dependent, initiating MAT behind bars should be a widespread, standard practice as a part of a comprehensive plan to reduce risk of opioid fatality. Jails should be mandated to continue MAT for those who received it in the community and to assess and initiate new patients in treatment. Prisons should initiate methadone or buprenorphine prior to release, with a referral to a community-based clinic or provider upon release. In addition, drug courts should be mandated to offer participants the option to participate in MAT if they are not already enrolled, make arrangements for their treatment, and should not be permitted to make discontinuation of MAT a criterion for successful completion of drug court programs. The Substance Abuse and Mental Health Services Administration will no longer provide federal funding to drug courts that deny the use of MAT when made available to the client under the care of a physician and pursuant to a valid prescription. The National Association of Drug Court Professionals agrees: "No drug court should prohibit the use of MAT for participants deemed appropriate and in need of an addiction medication."

[image:2 align:right caption:true]5. Offer Hospital-Based MAT: Emergency departments should be mandated to inform patients about MAT and offer buprenorphine to those patients that visit emergency rooms and have an underlying opioid use disorder, with an appointment for continued treatment with physicians in the community. Hospitals should also offer MAT within the inpatient setting, and start MAT prior to discharge with community referrals for ongoing MAT.

6. Assess Barriers to Accessing MAT to Increase Access to Methadone and Buprenorphine: A number of known barriers prevent MAT from being as widely accessible as it should be. The federal government needs to reevaluate the need for and effectiveness of the OTP model and make necessary modifications to ensure improved and increased access to methadone. And, while federal law allows physicians to become eligible to prescribe buprenorphine for the treatment of opioid dependence, it arbitrarily caps the number of opioid patients a physician can treat with buprenorphine at any one time to 30 through the first year following certification, expandable to up to potentially 200 patients thereafter. Moreover, states need to evaluate additional barriers created by state law, including, among others, training and continuing education requirements, restrictions on nurse practitioners, insurance enrollment and reimbursement, and lack of provider incentives.

7. Establish and Implement a Heroin-Assisted Treatment Pilot Program: Heroin-assisted treatment (HAT) refers to the administering or dispensing of pharmaceutical-grade heroin to a small and previously unresponsive group of chronic heroin users under the supervision of a doctor in a specialized clinic. The heroin is required to be consumed on-site, under the watchful eye of trained professionals. This enables providers to ensure that the drug is not diverted, and allows staff to intervene in the event of overdose or other adverse reaction. Permanent HAT programs have been established in the United Kingdom, Switzerland, the Netherlands, Germany and Denmark, with additional trial programs having been completed or currently taking place in Spain, Belgium and Canada. Findings from randomized controlled studies in these countries have yielded unanimously positive results, including: 1) HAT reduces drug use; 2) retention rates in HAT surpass those of conventional treatment; 3) HAT can be a stepping stone to other treatments and even abstinence; 4) HAT improves health, social functioning, and quality of life; 5) HAT does not pose nuisance or other neighborhood concerns; 6) HAT reduces crime; 7) HAT can reduce the black market for heroin; and, 8) HAT is cost-effective (cost-savings from the benefits attributable to the program far outweigh the cost of program operation over the long-run). States should consider permitting the establishment and implementation of a HAT pilot program. Nevada and Maryland have introduced legislation of this nature and the New Mexico Legislature recently convened a joint committee hearing to query experts about this strategy.

8. Evaluate the Use of Cannabis to Decrease Reliance on Prescription Opioids and Reduce Opioid Overdose Deaths: Medical use of marijuana can be an effective adjunct to or substitute for opioids in the treatment of chronic pain. Research published last year found 80 percent of medical cannabis users reported substituting cannabis for prescribed medications, particularly among patients with pain-related conditions. Another important recent study reported that cannabis treatment "may allow for opioid treatment at lower doses with fewer [patient] side effects." The result of substituting marijuana, a drug with less side effects and potential for abuse, has had profound harm reduction impacts. The Journal of the American Medical Association, for instance, documents a relationship between medical marijuana laws and a significant reduction in opioid overdose fatalities: "[s]tates with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws."Another working paper from the RAND BING Center for Health Economics notes that "states permitting medical cannabis dispensaries experienced a 15 to 35 percent decrease in substance abuse admissions and opiate overdose deaths." There is also some emerging evidence that marijuana has the potential to treat opioid addiction, but additional research is needed.

Harm Reduction

9. Establish and Implement Safe Drug Consumption Services: States and/or municipalities should permit the establishment and implementation of safe drug consumption services through local health departments and/or community-based organizations. California and Maryland have introduced legislation to establish safe drug consumption services, and the City of Ithaca, New York has included a proposal for a supervised injection site in their widely-publicized municipal drug strategy. In Washington State, the King County Heroin an Prescription Opiate Addiction Task Force has recommended the establishment of at least two pilot supervised consumption sites as part of a community health engagement program designed to reduce stigma and "decrease risks associated with substance use disorder and promote improved health outcomes" in the region that includes the cities of Seattle, Renton and Auburn.

10. Maximize Naloxone Access Points, Including Lay Distribution and Pharmacy Access, As Well As Immunities for Prescription, Distribution and Administration:Naloxone should be available directly from a physician to either a patient or to a family member, friend, or other person in a position to assist in an overdose, from community-based organizations through lay distribution or standing order laws, and from pharmacies behind-the-counter without a prescription through standing order, collaborative agreement, or standardized protocol laws or regulations. Though some states, including California, New York, Colorado and Vermont, among others, have access to naloxone at each of these critical intervention points, many others only provide naloxone through a standard prescription. Civil and criminal immunities should be provided to prescribers, dispensers and lay administrators at every access point. In addition, all first responders, firefighters and law enforcement should be trained on how to recognize an overdose and be permitted to carry and use naloxone. Naloxone should also be reclassified as an over-the-counter (OTC) medication. Having naloxone available over-the-counter would greatly increase the ability of parents, caregivers, and other bystanders to intervene and provide first aid to a person experiencing an opioid overdose. FDA approval of OTC naloxone is predicated on research that satisfies efficacy and safety data requirements. Pharmaceutical companies, however, have not sought to develop an over-the-counter product.88 Federal funding may be needed to meet FDA approval requirements.

11. Provide Dedicated Funding for Community-Based Naloxone Distribution and Overdose Prevention and Response Education: Few states provide dedicated budget lines to support the cost of naloxone or staffing for community-based opioid overdose prevention programs. The CDC, however, reports that, between 1996 and 2014, these programs trained and equipped more than 152,280 laypeople with naloxone, who have successfully reversed 26,463 opioid overdoses.89 Without additional and dedicated funding, community-based opioid overdose prevention programs will not be able to continue to provide naloxone to all those who need it, and the likelihood of new programs being implemented is slim. A major barrier to naloxone access is its affordability and chronic shortages in market supply, 90 which overdose prevention programs, operating on shoestring budgets, can have a difficult time navigating.

12. Improve Insurance Coverage for Naloxone: Individuals who use heroin and other opioids are often both uninsured and marginalized by the healthcare system.91 States should insure optimal reimbursement rates for naloxone to increase access to those who need it most – users themselves.

[image:3 align:left caption:true]13. Provide Naloxone to Additional At-Risk Communities: People exiting detox and other treatment programs as well as periods of incarceration are at particularly high risk for overdose because their tolerance has been substantially decreased. After their period of abstinence, if they relapse and use the same amount, the result is often a deadly overdose. States should require overdose education and offer naloxone to people upon discharge from detox and other drug treatment programs and jails/prisons. The Substance Abuse and Mental Health Services Administration has declared that prescribing or dispensing naloxone is an essential complement to both detoxification services as well as medically supervised withdrawal. Vermont passed legislation making naloxone available to eligible pilot project participants who are transitioning from incarceration back to the community. In addition, there are other programs/studies that provide naloxone to recently released individuals on a limited basis, including in San Francisco, California, King County, Washington and Rhode Island.

14. Encourage Distribution of Naloxone to Patients Receiving Opioids: Physicians should be encouraged to prescribe naloxone to their patients and opioid treatment programs should inform their clients about naloxone, if prescribing or dispensing an opioid to them. Pharmacists should similarly be encouraged to offer naloxone along with all Schedule II opioid prescriptions being filled, for syringe purchases (without concurrent injectable medication), and for all co-prescriptions (within 30 days) of a benzodiazepine (such as Valium™, Xanax™ or Klonopin™) and any opioid medication. The Rhode Island Governor's Overdose Prevention and Intervention Task Force found that offering naloxone to those prescribed a Schedule II opioid or when co-prescribed a benzodiazepine and any opioid would have reached 86% of overdose victims who received a prescription from a pharmacy prior to their death, and could have prevented 58% of all overdose deaths from 2014 to 2015.

15. Expand Good Samaritan Protections: "Good Samaritan" laws provide limited immunity from prosecution for specified drug law violations for people who summon help at the scene of an overdose. But, protection from prosecution is not enough to ensure that people are not too frightened to seek medical help. Other consequences, like arrest, parole or probation violations, and immigration consequences, can be equal barriers to calling 911. States with Good Samaritan laws already on the books should evaluate the protections provided and determine whether expansion of those protections would increase the likelihood that people seek medical assistance.

16. End the Criminalization of Syringe Possession: Syringes should be exempt from state paraphernalia laws in order to provide optimal access to people who inject drugs. Twenty-two states criminalize syringe possession. Thus, even if there is a legal access point, such as pharmacy sales, paraphernalia laws still permit law enforcement to arrest and prosecute individuals in possession of a syringe. Public health and law enforcement authorities should not be working at cross-purposes.

17. Reduce Barriers to Over-The-Counter Syringe Sales and Permit Direct Prescriptions of Syringes: While the non-prescription, over-the-counter sale of syringes is now permitted in all but one U.S. state, access is still unduly restricted.States should evaluate the potential barriers to accessing syringes over-thecounter and implement measures to improve access. Moreover, doctors should be permitted to prescribe syringes directly to their patients, a practice few states currently permit.

18. Authorize and Fund Sterile Syringe Access and Exchange Programs; Increase Programs: States should explicitly authorize and fund sterile syringe access and exchange programs, and states that have already authorized them should evaluate how to increase the number or capacity of programs to ensure all state residents – whether in urban centers or rural communities -- have access to clean syringes, as well as evaluate any possible barriers to access such as unnecessary age restrictions.

19. Provide Free Public, Community-Level Access to Drug Checking Services: Technology exists to test heroin and opioid products for adulterants via GC/MS analysis, but it has so far been unavailable at a public level in the US (aside from a mail-in service run by Ecstasydata.org). Making these services available in the context of a community outreach service or academic study would lower the number of deaths and hospitalizations and also allow for real-time tracking of local drug trends.

Prevention

20. Establish Expert Panel on Opioid Prescribing: Though the CDC has issued guidelines for prescribing opioids for chronic pain, the guidelines are voluntary and are likely to exacerbate disparities in treatment that already exist. Research has shown, for example, that African Americans are less likely than whites to receive opioids for pain even when being treated for the same conditions. Moreover, the CDC guidelines only address prescribing practices for chronic pain, not prescribing practices more broadly. States should accordingly establish an expert panel to undertake an assessment as to whether prescribing practices, such as co-prescriptions for benzodiazepines and opioids or overprescribing of opioids, have contributed to increased rates of opioid dependence, and, if so, the expert panel should develop a plan to address any such linkages as well as any treatment disparities. The plan must account for the potential negative effects of curtailing prescribing practices or swiftly reducing prescription opioid prescribing volume. A task force in Rhode Island found that while changes in opioid supply can have the intended effect of reducing availability of abuse-able medications, they have also been linked to an increase in transition to illicit drug use and in more risky drug use behaviors (e.g., snorting and injecting pain medications). The plan must also account for chronic pain patients, particularly those already underserviced, and not unduly limit their access to necessary medications. Finally, to the extent prescribing guidelines are issued as part of the plan, they should be mandatory and applied across the board.

21. Mandate Medical Provider Education: States should mandate that all health professional degree-granting institutions include curricula on opioid dependence, overdose prevention, medication-assisted treatment, and harm reduction interventions, and that continuing education on these topics be readily available.

22. Develop Comprehensive, Evidence-Based Health, Wellness, and Harm Reduction Curriculum for Youth: State education departments, in conjunction with an expert panel consisting of various stakeholders that ascribe to scientific principles of treatment for youth, should develop a comprehensive, evidence-based health, wellness, and harm reduction curriculum for use in schools that incorporates scientific education on drugs, continuum of use, and contributors to problematic drug use (e.g., coping and resiliency, mental health issues, adverse childhood experiences, traumatic events and crisis), as well as how reduce harm (e.g., not mixing opioids with benzodiazepines). Education departments should also establish protocols and resources for early intervention, counseling, linkage to care, harm reduction resources, and other supports for students.

CRIMINAL JUSTICE

23. Establish Diversion Programs, Including Law Enforcement Assisted Diversion (LEAD): LEAD is a pre-booking diversion program that establishes protocols by which police divert people away from the typical criminal justice route of arrest, charge and conviction into a health-based, harm-reduction focused intensive case management process wherein the individual receives support services ranging from housing and healthcare to drug treatment and mental health services. Municipalities should create and implement LEAD programs and states and the federal government should provide dedicated funding for such programs. Various other forms of diversion programs exist and can be implemented should LEAD prove unsuitable to a particular population or municipality.

24. Decriminalize Drug Possession: Decriminalization is commonly defined as the elimination of criminal penalties for drug possession for personal use. In other words, it means that people who merely use or possess small amounts of drugs are no longer arrested, jailed, prosecuted, imprisoned, put on probation or parole, or saddled with a criminal record. Nearly two dozen countries have taken steps toward decriminalization. Empirical evidence from the international experiences demonstrate that decriminalization does not result in increased use or crime, reduces incidences of HIV/AIDs and overdose, increases the number of people in treatment, and reduces social costs of drug misuse. All criminal penalties for possession of small amounts of controlled substances for personal use should be removed.

Categories: Latest News

America, We Can Fix This: 24 Ways to Reduce Opioid Overdoses and Addiction [FEATURE]

Top Stories (STDW) - Tue, 06/13/2017 - 07:06

Drugs, mainly opioids, are killing Americans at a record rate. The number of drug overdose deaths in the country quadrupled between 1999 and 2010 -- and compared to the numbers we're seeing now, those were the good old days.

[image:1 align:left]Some 30,000 people died of drug overdoses in 2010. According to a new estimate from the New York Times, double that number died last year. And the rate of increase in overdose deaths was growing, up a stunning 19% over 2015.

The Times' estimate of between 59,000 and 65,000 drug overdose deaths last year is greater than the number of American soldiers killed during the entire Vietnam War, greater than that number of people killed in the peak year for car crash deaths, greater than the number of people who died in the year the AIDS epidemic peaked, and higher than the peak year for gun deaths.

In the first decade of the century, overdoses and addiction rose in conjunction with a dramatic increase in prescription opioid prescribing; since then, as government agents and medical professionals alike sought to tamp down prescribing of opioids, the overdose wave has continued, now with most opioid OD fatalities linked to illicit heroin and powerful black market synthetic opioids, such as fentanyl and carfentanil.

The Centers for Disease Control and Prevention says we are in the midst of "the worst drug overdose epidemic in history," and it's hard to argue with that.

So, what do we do about it? Despite decades of failure and unintended consequences, the prohibitionist reflex is still strong. Calls for more punitive laws, tougher prosecutorial stances, and harsher sentences ring out from state houses across the land to the White House. But tough drug war policies haven't worked. The fact that the overdose and addiction epidemic is taking place under a prohibition regime should make that self-evident.

More enlightened -- and effective -- approaches are now being tried, in part, no doubt, because today's opioid epidemic is disproportionately affecting white, middle class people and not the inner city black people identified with heroin epidemics of the past. But they are also being tried because for the past quarter-century an ever-growing drug reform movement has articulated the failures of prohibition and illuminated more effective alternatives.

The drug reform movement's most powerful organization, the Drug Policy Alliance, this spring published A Public Health and Safety Approach to Problematic Opioid Use and Overdose, which lays out more than two dozen specific policy prescriptions in the realms of addiction treatment, harm reduction, prevention, and criminal justice that have been proven to save lives and reduce dependency on opioids. These policy prescriptions are doable now -- and some are being implemented in some fashion in some places -- but require that political decisions be made, or that forces be mobilized to get those decisions made. Some would require a radical divergence from the orthodoxies of drug prohibition, but that's a small price to pay given the mounting death toll.

Here are 24 concrete policy proposals that can save lives and reduce addiction right now. All the facts and figures are fully documented in the heavily-annotated original. Consult it if you want to get down to the nitty-gritty. In the meantime:

Addiction Treatment

1. Create Expert Panel on Treatment Needs: States should establish an expert panel to address effective treatment needs and opportunities. The expert panel should evaluate barriers to existing treatment options and make recommendations to the state legislature on removing unnecessary impediments to accessing effective treatment on demand. Moreover, the panel should determine where gaps in treatment exist and make recommendations to provide additional types of effective treatment and increased access points to treatment (such as hospital-based on demand addiction treatment). The expert panel must also set evidence-based standards of care and identify the essential components of effective treatment and recovery services to be included in licensed facilities, especially with regards to medication-assisted treatment, admission requirements, discharge, continuity of care and/or after-care, pain management, treatment programming, integration of medical and mental health services, and provision of or referrals to harm reduction services. The expert panel should identify how to improve or create referral mechanisms and treatment linkages across various healthcare and other providers. The panel should establish clear outcome measures and a system for evaluating how well providers meet the scientific requirements the panel sets. And, finally, the expert panel should evaluate opportunities under the ACA to expand coverage for treatment.

2. Increase Insurance Coverage for Medication-Assited Treatment (MAT): Seventeen state medical plans under the Patient Protection and Affordable Care Act (ACA) do not provide coverage for methadone or buprenorphine for opioid dependence. Moreover, the Veterans Administration's (VA's) insurance system has explicitly prohibited coverage of methadone and buprenorphine treatment for active duty personnel or for veterans in the process of transitioning from Department of Defense care. As a result, veterans obtaining care through the VA are denied effective treatment for opioid dependence. Insurance coverage for these critical medications should be standard practice.

3. Establish and Implement Office-Based Opioid Treatment for Methadone: Currently, with a few exceptions, methadone for the treatment of opioid dependence is only available through a highly regulated and widely stigmatized system of Opioid Treatment Programs (OTPs). Moreover, several states have imposed moratoriums on establishing new OTPs that facilitate methadone treatment despite large, unmet treatment needs for a growing opioid-dependent population. Patients enrolled in methadone treatment in many communities are often limited to visiting a single OTP and face other inconveniences that make adherence to treatment more difficult. Initial trials have suggested that methadone can be effectively delivered in office-based settings and that, with training, physicians would be willing to prescribe methadone to their patients to treat their opioid dependence. Office-based methadone may help reduce the stigma associated with methadone delivered in OTPs as well as provide a critical window of intervention to address medical and psychiatric conditions. Office-based opioid treatment programs offering methadone have been implemented in California, Connecticut, and Vermont.

4. Provide MAT in Criminal Justice Settings, Including Jails/Prisons and Drug Courts: Individuals recently released from correctional settings are up to 130 times more likely to die of an overdose than the general population, particularly in the immediate two weeks after release. Given that approximately one quarter of people incarcerated in jails and prisons are opioid-dependent, initiating MAT behind bars should be a widespread, standard practice as a part of a comprehensive plan to reduce risk of opioid fatality. Jails should be mandated to continue MAT for those who received it in the community and to assess and initiate new patients in treatment. Prisons should initiate methadone or buprenorphine prior to release, with a referral to a community-based clinic or provider upon release. In addition, drug courts should be mandated to offer participants the option to participate in MAT if they are not already enrolled, make arrangements for their treatment, and should not be permitted to make discontinuation of MAT a criterion for successful completion of drug court programs. The Substance Abuse and Mental Health Services Administration will no longer provide federal funding to drug courts that deny the use of MAT when made available to the client under the care of a physician and pursuant to a valid prescription. The National Association of Drug Court Professionals agrees: "No drug court should prohibit the use of MAT for participants deemed appropriate and in need of an addiction medication."

[image:2 align:right caption:true]5. Offer Hospital-Based MAT: Emergency departments should be mandated to inform patients about MAT and offer buprenorphine to those patients that visit emergency rooms and have an underlying opioid use disorder, with an appointment for continued treatment with physicians in the community. Hospitals should also offer MAT within the inpatient setting, and start MAT prior to discharge with community referrals for ongoing MAT.

6. Assess Barriers to Accessing MAT to Increase Access to Methadone and Buprenorphine: A number of known barriers prevent MAT from being as widely accessible as it should be. The federal government needs to reevaluate the need for and effectiveness of the OTP model and make necessary modifications to ensure improved and increased access to methadone. And, while federal law allows physicians to become eligible to prescribe buprenorphine for the treatment of opioid dependence, it arbitrarily caps the number of opioid patients a physician can treat with buprenorphine at any one time to 30 through the first year following certification, expandable to up to potentially 200 patients thereafter. Moreover, states need to evaluate additional barriers created by state law, including, among others, training and continuing education requirements, restrictions on nurse practitioners, insurance enrollment and reimbursement, and lack of provider incentives.

7. Establish and Implement a Heroin-Assisted Treatment Pilot Program: Heroin-assisted treatment (HAT) refers to the administering or dispensing of pharmaceutical-grade heroin to a small and previously unresponsive group of chronic heroin users under the supervision of a doctor in a specialized clinic. The heroin is required to be consumed on-site, under the watchful eye of trained professionals. This enables providers to ensure that the drug is not diverted, and allows staff to intervene in the event of overdose or other adverse reaction. Permanent HAT programs have been established in the United Kingdom, Switzerland, the Netherlands, Germany and Denmark, with additional trial programs having been completed or currently taking place in Spain, Belgium and Canada. Findings from randomized controlled studies in these countries have yielded unanimously positive results, including: 1) HAT reduces drug use; 2) retention rates in HAT surpass those of conventional treatment; 3) HAT can be a stepping stone to other treatments and even abstinence; 4) HAT improves health, social functioning, and quality of life; 5) HAT does not pose nuisance or other neighborhood concerns; 6) HAT reduces crime; 7) HAT can reduce the black market for heroin; and, 8) HAT is cost-effective (cost-savings from the benefits attributable to the program far outweigh the cost of program operation over the long-run). States should consider permitting the establishment and implementation of a HAT pilot program. Nevada and Maryland have introduced legislation of this nature and the New Mexico Legislature recently convened a joint committee hearing to query experts about this strategy.

8. Evaluate the Use of Cannabis to Decrease Reliance on Prescription Opioids and Reduce Opioid Overdose Deaths: Medical use of marijuana can be an effective adjunct to or substitute for opioids in the treatment of chronic pain. Research published last year found 80 percent of medical cannabis users reported substituting cannabis for prescribed medications, particularly among patients with pain-related conditions. Another important recent study reported that cannabis treatment "may allow for opioid treatment at lower doses with fewer [patient] side effects." The result of substituting marijuana, a drug with less side effects and potential for abuse, has had profound harm reduction impacts. The Journal of the American Medical Association, for instance, documents a relationship between medical marijuana laws and a significant reduction in opioid overdose fatalities: "[s]tates with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws."Another working paper from the RAND BING Center for Health Economics notes that "states permitting medical cannabis dispensaries experienced a 15 to 35 percent decrease in substance abuse admissions and opiate overdose deaths." There is also some emerging evidence that marijuana has the potential to treat opioid addiction, but additional research is needed.

Harm Reduction

9. Establish and Implement Safe Drug Consumption Services: States and/or municipalities should permit the establishment and implementation of safe drug consumption services through local health departments and/or community-based organizations. California and Maryland have introduced legislation to establish safe drug consumption services, and the City of Ithaca, New York has included a proposal for a supervised injection site in their widely-publicized municipal drug strategy. In Washington State, the King County Heroin an Prescription Opiate Addiction Task Force has recommended the establishment of at least two pilot supervised consumption sites as part of a community health engagement program designed to reduce stigma and "decrease risks associated with substance use disorder and promote improved health outcomes" in the region that includes the cities of Seattle, Renton and Auburn.

10. Maximize Naloxone Access Points, Including Lay Distribution and Pharmacy Access, As Well As Immunities for Prescription, Distribution and Administration:Naloxone should be available directly from a physician to either a patient or to a family member, friend, or other person in a position to assist in an overdose, from community-based organizations through lay distribution or standing order laws, and from pharmacies behind-the-counter without a prescription through standing order, collaborative agreement, or standardized protocol laws or regulations. Though some states, including California, New York, Colorado and Vermont, among others, have access to naloxone at each of these critical intervention points, many others only provide naloxone through a standard prescription. Civil and criminal immunities should be provided to prescribers, dispensers and lay administrators at every access point. In addition, all first responders, firefighters and law enforcement should be trained on how to recognize an overdose and be permitted to carry and use naloxone. Naloxone should also be reclassified as an over-the-counter (OTC) medication. Having naloxone available over-the-counter would greatly increase the ability of parents, caregivers, and other bystanders to intervene and provide first aid to a person experiencing an opioid overdose. FDA approval of OTC naloxone is predicated on research that satisfies efficacy and safety data requirements. Pharmaceutical companies, however, have not sought to develop an over-the-counter product.88 Federal funding may be needed to meet FDA approval requirements.

11. Provide Dedicated Funding for Community-Based Naloxone Distribution and Overdose Prevention and Response Education: Few states provide dedicated budget lines to support the cost of naloxone or staffing for community-based opioid overdose prevention programs. The CDC, however, reports that, between 1996 and 2014, these programs trained and equipped more than 152,280 laypeople with naloxone, who have successfully reversed 26,463 opioid overdoses.89 Without additional and dedicated funding, community-based opioid overdose prevention programs will not be able to continue to provide naloxone to all those who need it, and the likelihood of new programs being implemented is slim. A major barrier to naloxone access is its affordability and chronic shortages in market supply, 90 which overdose prevention programs, operating on shoestring budgets, can have a difficult time navigating.

12. Improve Insurance Coverage for Naloxone: Individuals who use heroin and other opioids are often both uninsured and marginalized by the healthcare system.91 States should insure optimal reimbursement rates for naloxone to increase access to those who need it most – users themselves.

[image:3 align:left caption:true]13. Provide Naloxone to Additional At-Risk Communities: People exiting detox and other treatment programs as well as periods of incarceration are at particularly high risk for overdose because their tolerance has been substantially decreased. After their period of abstinence, if they relapse and use the same amount, the result is often a deadly overdose. States should require overdose education and offer naloxone to people upon discharge from detox and other drug treatment programs and jails/prisons. The Substance Abuse and Mental Health Services Administration has declared that prescribing or dispensing naloxone is an essential complement to both detoxification services as well as medically supervised withdrawal. Vermont passed legislation making naloxone available to eligible pilot project participants who are transitioning from incarceration back to the community. In addition, there are other programs/studies that provide naloxone to recently released individuals on a limited basis, including in San Francisco, California, King County, Washington and Rhode Island.

14. Encourage Distribution of Naloxone to Patients Receiving Opioids: Physicians should be encouraged to prescribe naloxone to their patients and opioid treatment programs should inform their clients about naloxone, if prescribing or dispensing an opioid to them. Pharmacists should similarly be encouraged to offer naloxone along with all Schedule II opioid prescriptions being filled, for syringe purchases (without concurrent injectable medication), and for all co-prescriptions (within 30 days) of a benzodiazepine (such as Valium™, Xanax™ or Klonopin™) and any opioid medication. The Rhode Island Governor's Overdose Prevention and Intervention Task Force found that offering naloxone to those prescribed a Schedule II opioid or when co-prescribed a benzodiazepine and any opioid would have reached 86% of overdose victims who received a prescription from a pharmacy prior to their death, and could have prevented 58% of all overdose deaths from 2014 to 2015.

15. Expand Good Samaritan Protections: "Good Samaritan" laws provide limited immunity from prosecution for specified drug law violations for people who summon help at the scene of an overdose. But, protection from prosecution is not enough to ensure that people are not too frightened to seek medical help. Other consequences, like arrest, parole or probation violations, and immigration consequences, can be equal barriers to calling 911. States with Good Samaritan laws already on the books should evaluate the protections provided and determine whether expansion of those protections would increase the likelihood that people seek medical assistance.

16. End the Criminalization of Syringe Possession: Syringes should be exempt from state paraphernalia laws in order to provide optimal access to people who inject drugs. Twenty-two states criminalize syringe possession. Thus, even if there is a legal access point, such as pharmacy sales, paraphernalia laws still permit law enforcement to arrest and prosecute individuals in possession of a syringe. Public health and law enforcement authorities should not be working at cross-purposes.

17. Reduce Barriers to Over-The-Counter Syringe Sales and Permit Direct Prescriptions of Syringes: While the non-prescription, over-the-counter sale of syringes is now permitted in all but one U.S. state, access is still unduly restricted.States should evaluate the potential barriers to accessing syringes over-thecounter and implement measures to improve access. Moreover, doctors should be permitted to prescribe syringes directly to their patients, a practice few states currently permit.

18. Authorize and Fund Sterile Syringe Access and Exchange Programs; Increase Programs: States should explicitly authorize and fund sterile syringe access and exchange programs, and states that have already authorized them should evaluate how to increase the number or capacity of programs to ensure all state residents – whether in urban centers or rural communities -- have access to clean syringes, as well as evaluate any possible barriers to access such as unnecessary age restrictions.

19. Provide Free Public, Community-Level Access to Drug Checking Services: Technology exists to test heroin and opioid products for adulterants via GC/MS analysis, but it has so far been unavailable at a public level in the US (aside from a mail-in service run by Ecstasydata.org). Making these services available in the context of a community outreach service or academic study would lower the number of deaths and hospitalizations and also allow for real-time tracking of local drug trends.

Prevention

20. Establish Expert Panel on Opioid Prescribing: Though the CDC has issued guidelines for prescribing opioids for chronic pain, the guidelines are voluntary and are likely to exacerbate disparities in treatment that already exist. Research has shown, for example, that African Americans are less likely than whites to receive opioids for pain even when being treated for the same conditions. Moreover, the CDC guidelines only address prescribing practices for chronic pain, not prescribing practices more broadly. States should accordingly establish an expert panel to undertake an assessment as to whether prescribing practices, such as co-prescriptions for benzodiazepines and opioids or overprescribing of opioids, have contributed to increased rates of opioid dependence, and, if so, the expert panel should develop a plan to address any such linkages as well as any treatment disparities. The plan must account for the potential negative effects of curtailing prescribing practices or swiftly reducing prescription opioid prescribing volume. A task force in Rhode Island found that while changes in opioid supply can have the intended effect of reducing availability of abuse-able medications, they have also been linked to an increase in transition to illicit drug use and in more risky drug use behaviors (e.g., snorting and injecting pain medications). The plan must also account for chronic pain patients, particularly those already underserviced, and not unduly limit their access to necessary medications. Finally, to the extent prescribing guidelines are issued as part of the plan, they should be mandatory and applied across the board.

21. Mandate Medical Provider Education: States should mandate that all health professional degree-granting institutions include curricula on opioid dependence, overdose prevention, medication-assisted treatment, and harm reduction interventions, and that continuing education on these topics be readily available.

22. Develop Comprehensive, Evidence-Based Health, Wellness, and Harm Reduction Curriculum for Youth: State education departments, in conjunction with an expert panel consisting of various stakeholders that ascribe to scientific principles of treatment for youth, should develop a comprehensive, evidence-based health, wellness, and harm reduction curriculum for use in schools that incorporates scientific education on drugs, continuum of use, and contributors to problematic drug use (e.g., coping and resiliency, mental health issues, adverse childhood experiences, traumatic events and crisis), as well as how reduce harm (e.g., not mixing opioids with benzodiazepines). Education departments should also establish protocols and resources for early intervention, counseling, linkage to care, harm reduction resources, and other supports for students.

CRIMINAL JUSTICE

23. Establish Diversion Programs, Including Law Enforcement Assisted Diversion (LEAD): LEAD is a pre-booking diversion program that establishes protocols by which police divert people away from the typical criminal justice route of arrest, charge and conviction into a health-based, harm-reduction focused intensive case management process wherein the individual receives support services ranging from housing and healthcare to drug treatment and mental health services. Municipalities should create and implement LEAD programs and states and the federal government should provide dedicated funding for such programs. Various other forms of diversion programs exist and can be implemented should LEAD prove unsuitable to a particular population or municipality.

24. Decriminalize Drug Possession: Decriminalization is commonly defined as the elimination of criminal penalties for drug possession for personal use. In other words, it means that people who merely use or possess small amounts of drugs are no longer arrested, jailed, prosecuted, imprisoned, put on probation or parole, or saddled with a criminal record. Nearly two dozen countries have taken steps toward decriminalization. Empirical evidence from the international experiences demonstrate that decriminalization does not result in increased use or crime, reduces incidences of HIV/AIDs and overdose, increases the number of people in treatment, and reduces social costs of drug misuse. All criminal penalties for possession of small amounts of controlled substances for personal use should be removed.

Categories: Latest News

CN ON: Non-Med Pot Restrictions Sought

Top Stories (MAP) - Tue, 06/13/2017 - 07:00
Toronto Sun, 13 Jun 2017 - Recreational marijuana should be treated like tobacco in public places and alcohol in motor vehicles, the City of Toronto health board recommends. In a wide-ranging report that will go to Toronto Council, board members asked that non-medical cannabis be sold by a provincial-controlled agency - but not with alcohol - and that the minimum age for purchase be set at 19.
Categories: Latest News

CN BC: Comox Valley RCMP Shut Down Athadawoosh Dispensary Thursday

Top Stories (MAP) - Tue, 06/13/2017 - 07:00
Comox Valley Record, 13 Jun 2017 - A marijuana dispensary located on the K'omoks First Nation was shut down by police Thursday, resulting in two arrests and seizure of drugs and cash. Cpl. Tammy Douglas of the RCMP Island District said in an email officers from the Comox Valley RCMP Drug Section confirmed the presence of marijuana and several derivatives in the storefront at the Athadawoosh Dispensary located on Comox Road after receiving information that drugs were being illegally trafficked out of that location.
Categories: Latest News

Chronicle AM: FL Solons Reach MedMJ Accord, CO Gov Signs Asset Forfeiture Bill, More... (6/12/17)

Drug War Chronicle - Mon, 06/12/2017 - 21:01

Florida lawmakers finally reach agreement on implementing the medical marijuana constitutional amendment, Colorado's governor signs an asset forfeiture reform bill, and more.

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

House Effort to Help Marijuana Businesses With Banking Thwarted. Two Florida representatives, Matt Gaetz (R-Fort Walton Beach) and Darren Soto (D-Orlando), filed an amendment to the Financial CHOICE Act of 2017 that would have eased federal restrictions on banking services for marijuana businesses. The bill was approved by the House last Thursday, but not before the House Rules Committee stripped the amendment from the bill.

Colorado Governor Signs Bills Limiting Plant Counts, Caregivers. Gov. John Hickenlooper (D) last Thursday signed into law House Bill 17-1220, which limits personal cultivation to 12 plants per residence unless a local government allows more, and House Bill 17-1221, which says that only caregivers can grow plants for other people and sets up a grant program to fund police efforts to prosecute crimes related to black market weed.

Medical Marijuana

Connecticut Takes Another Step Toward Adding More Qualifying Conditions. Consumer Protection Commissioner Michelle Seagull announced last Friday that she would follow a recommendation from the Medical Marijuana Program Board of Physicians to include three new conditions among the list of qualifying conditions for medical marijuana use. They are hydrocephalus with intractable headaches, intractable migraines, and trigeminal neuralgia. Seagull will now draft a new regulation by the end of the month, and after that, there will be a 30-day public comment period, then a review by the office of the attorney general, and then the approval of the Regulation Review Committee of the General Assembly. The whole process could take another year.

Florida Legislature Passes Medical Marijuana Implementation Bill. Lawmakers used a special session to come to an agreement on how to handle medical marijuana last Friday. Under the proposal approved by the legislature, which Gov. Rick Scott (R) says he will sign, the state will gain an additional ten medical marijuana operators within four month. Each operator can operate up to 25 dispensaries across the state. But the bill also bans the smoking of medical marijuana even though the constitutional amendment approved by voters last November expressly included a provision that allows smoking. That has led Orlando lawyer John Morgan, who largely bankrolled the amendment, to vow to sue the state over the no-smoking provision.

Vermont Governor Signs Medical Marijuana Expansion Bill. Gov. Phil Scott (R) last Thursday signed into law Senate Bill 16, which expands the list of qualifying conditions for medical marijuana. The new conditions added are Parkinson's disease, Crohn's disease, and PTSD. The new law also increases the number of dispensaries in the state from four to five.

Asset Forfeiture

Colorado Governor Signs Asset Forfeiture Reform Bill. Gov. John Hickenlooper (D) last Friday signed into law a civil asset forfeiture reform bill, House Bill 17-1313, which blocks state and local law enforcement from handing forfeiture cases off to the feds if the total value of the seized property is less than $50,000. In cases prosecuted by the federal government, the local law enforcement agency receives 80% of the proceeds, while under state law, the proceeds go to a general fund. Under the new law, police must also report all asset forfeitures and how they were used to the state.

International

Facing Mass Protests, Georgian Prime Minister Vows to Soften Harsh Drug Policies. After large crowds gathered in the capital Tbilisi to protest the arrest of two rappers who claim police planted drugs on them, Prime Minister Giorgi Kvirikashvili unexpectedly weighed in a vowed to soften the country's drug laws. "I call on the parliament to accelerate the work [on the issue of softening drug legislation] in order at last to adopt a modified and humane law for the fall session in line with European standards," said in a statement published on the government website.

Categories: Latest News

CN AB: Weed In The Workplace

Top Stories (MAP) - Mon, 06/12/2017 - 07:00
Edmonton Sun, 12 Jun 2017 - Increasing popularity of prescription pot highlights a growing issue for employers Apprentice ironworker Johnathan Dickson says his union wouldn't send him out to construction jobs last year while he was using medical marijuana.
Categories: Latest News

CN BC: Pot Shop Rules Yield Mixed Results

Top Stories (MAP) - Mon, 06/12/2017 - 07:00
Metro, 12 Jun 2017 - One dispensary owner says licensing process is too strict It's been almost two years since Vancouver city councillors adopted new pot-shop regulations, but after dishing out more than 1,600 tickets, the city is still dealing with 57 marijuana retail businesses that are not abiding by the rules.
Categories: Latest News

Canada: Column: The Smoke Between Neighbourly Rights

Top Stories (MAP) - Mon, 06/12/2017 - 07:00
Globe and Mail, 12 Jun 2017 - THE QUESTION I am a long-time closeted cannabis user and I am looking forward to the legalization of pot next summer. But until then, my question has to do with my rights as a homeowner and a pot smoker versus the rights of my neighbour to not smell said marijuana. Now, I don't spend the whole day out there smoking, just one joint here or there. Yesterday afternoon, they smelled my J and proceeded to speak loudly to each other within earshot of me as to how rude this is. Is it rude Dave? Am I allowed to indulge in a smoke in my own yard? Legalization is going to change how much smoke you smell walking down the street, I think it's already changed. Whether we want it or not, it's coming … stinky smoke and all. Who's got the right though?
Categories: Latest News

CN NF: If You Build It, They Might Come

Top Stories (MAP) - Sat, 06/10/2017 - 07:00
The Telegram, 10 Jun 2017 - Advocates support idea of supervised injection and consumption site in St. John's, but unsure if drug users would use it Advocates endorse supervised injection and consumption site in St. John's The number of supervised injection and consumption facilities - often referred to as safe-injection sites - in Canada will soon grow exponentially.
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