from the we-need-a-heroin dept.
"The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. If they don't start, they won't have a problem." – President Donald J. Trump
President Trump has declared the "Opioid Crisis" a nationwide public health emergency. This action will allow for "expanded access to telemedicine services" to remotely prescribe medicines for substance abuse, allow the Department of Health and Human Services to "more quickly make temporary appointments of specialists with the tools and talent needed to respond effectively to our Nation's ongoing public health emergency", allow the Department of Labor to issue dislocated worker grants for those "displaced from the workforce" due to the Opioid Crisis, and will help people with HIV/AIDS to receive substance abuse treatment. The press release lists several actions that the Trump Administration has taken to respond to the Opioid Crisis, including the July 2017 law enforcement action against AlphaBay.
The declaration has been criticized for not requesting any funds to respond to the Crisis. The "nationwide public health emergency" declaration is also distinct from a promised "national emergency declaration", which would have freed up money from the Disaster Relief Fund to be spent on the Crisis. 14 Senate Democrats have introduced a bill that would authorize $45 billion to address the Opioid Crisis. The Obama Administration called on Congress last year to pass just over $1 billion in funding for opioid treatment programs nationwide. This funding was included in the 21st Century Cures Act.
The Department of Justice has arrested and charged the founder and majority owner of Insys Therapeutics Inc., John Kapoor, along with other executives from his company. Kapoor is accused with leading a nationwide conspiracy to bribe doctors and illegally distribute the company's fentanyl spray, intended for cancer patients, so that it could be prescribed for non-cancer patients. Kapoor stepped down as CEO of Insys in January. Acting U.S. Attorney William D. Weinreb said, "Mr. Kapoor and his company stand accused of bribing doctors to overprescribe a potent opioid and committing fraud on insurance companies solely for profit. Today's arrest and charges reflect our ongoing efforts to attack the opioid crisis from all angles. We must hold the industry and its leadership accountable - just as we would the cartels or a street-level drug dealer." Six former Insys executives and managers were charged in December.
Walgreens has announced that it will stock Narcan® (naloxone) nasal spray in all of its over 8,000 pharmacies nationwide. Naloxone is a life-saving essential medicine that can reverse opioid overdoses and treat opioid withdrawal. Naloxone is available over-the-counter in 45 states, but still requires a prescription in Hawaii, Kansas, Missouri, Montana, and Wyoming. Delaware recently allowed over-the-counter sales of naloxone. Laws in Hawaii and Missouri are pending, and Montana has agreed to grant CVS wider access to the drug.
Maybe banning kratom was a mistake.
Previously: 4/20: The Third Time's Not the Charm
Jeff Sessions Reboots the Drug War
Development of a Heroin Vaccine
Goal of US's First Opioid Court: Keep People Alive
Chicago Jail Handing Out Naloxone to Inmates Upon Release
The Obama administration is loosening restrictions on buprenorphine/Suboxone prescriptions in order to fight the "heroin epidemic", while calling on Congress to act on a request for $1.1 billion in additional funding for opioid treatment programs across the U.S.:
The Obama administration is making it easier for people addicted to opioids to get treatment. Health and Human Services Secretary Sylvia Burwell announced new rules Wednesday to loosen restrictions on doctors who treat people addicted to heroin and opioid painkillers with the medication buprenorphine. Doctors who are licensed to prescribe the drug, which is sold mostly under the brand name Suboxone, will be allowed to treat as many as 275 patients a year. That's almost triple the current limit of 100, and HHS estimated that as many as 70,000 more people may have access to the drug as a result.
"There are a number of ways we are trying to increase access to medication-assisted treatment," said Michael Botticelli, the director of national drug control policy, on a conference call with reporters. "This rule itself expands access and gets more physicians to reach more patients."
Suboxone is itself an opioid. It eases withdrawal symptoms and cravings, but doesn't make people high. [...] Botticelli said an average 129 people a day die from opioid overdoses.
White House Announces Heroin Response Strategy for the US Northeast
Alarming Rise in Death Rates for Middle-Aged White Americans
Kroger Supermarkets to Carry Naloxone Without a Prescription
4/20: Half-Baked Headline
Kratom, an herbal drug made of ground-up tree leaves, is "temporarily" joining other natural substances such as cannabis, psilocybin, and peyote on the schedule I list of the Controlled Substances Act. The active ingredients in kratom, the indole alkaloids mitragynine and 7-hydroxymitragynine, are both being added to the list for up to three years, after which they can be added permanently.
Prior to this move, the U.S. has already been seizing shipments of kratom:
In 2014, the FDA issued an import alert that allowed US Customs agents to detain kratom without a physical examination. "We have identified kratom as a botanical substance that could pose a risk to public health and have the potential for abuse," said Melinda Plaisier, the FDA's associate commissioner for regulatory affairs. According to the DEA, between February 2014 and July 2016, nearly 247,000 pounds of kratom were seized.
Advocates say that kratom is a natural treatment for opioid addiction, an application that the Drug Enforcement Agency dismisses. Meanwhile, the heroin/opioid epidemic continues with "unprecedented" events like the recent 174 heroin overdoses in just six days in Cincinnati, Ohio.
Check out the implosion of this kratom subreddit, which is attempting to get 100,000 signatures on the White House petition site:
APATHY WILL GET US NOWHERE. IF THERE WAS EVER A TIME FOR US TO BAND TOGETHER, ITS NOW. stand with me brothers and sisters. hope is not lost.
Six former executives and managers from Arizona-based drugmaker, Insys Therapeutics, face conspiracy charges over what a federal prosecutor calls a "racketeering crime." In this case, according to the indictment, the former employees of the drug manufacturer are alleged to have rewarded doctors for prescribing their spray version of the opiate fentanyl, even when it wasn't medically appropriate.
[...] Three years ago on CNBC, Michael Babich demonstrated the company's drug, "Subsys," a prescription pain reliever for cancer patients which is delivered through a spray. The medication, which the company first sold in 2012, racked up $329 milllion in sales last year. "The device that I brought with me today allows the patient to simply with no priming spray the drug underneath their tongue," Babich explained.
According to the indictment, the defendants "conspired with one another to use bribes and kickbacks" for doctors who "wrote large numbers of... prescriptions, most often for patients who did not have cancer." The scheme allegedly funneled tens or even hundreds of thousands of dollars to practitioners, including one whom a sales representative boasted in an email was running "a very shady pill mill and only accepts cash."
Source: CBS News
Since this time last year, Ohio, Florida, North Dakota, and Arkansas legalized medical cannabis, Illinois decriminalized it, and California, Nevada, Maine and Massachusetts legalized recreational cannabis. An attempt to legalize recreational cannabis in Arizona narrowly failed.
29 U.S. states and the District of Columbia have legalized cannabis for medical use, although restrictions vary widely from state to state.
Germany's medical cannabis law was approved in January and came into effect in March. Poland has also legalized medical cannabis, and Georgia's Supreme Court has ruled that imprisonment for possession of small amounts of cannabis is unconstitutional.
🍁 Cannada: Not So Fast 🍁
Last week, Canadian Prime Minister Justin Trudeau unveiled (archive) legislation (archive) that would make Canada the first major Western country to legalize recreational cannabis (the only country to legalize it to date is Uruguay, although implementation has taken years), dealing a serious blow to the crumbling United Nations Single Convention on Narcotic Drugs. However, the Liberal Party of Canada intends to wait more than a year to act on its campaign promise, during which time Canadians can still face prosecution for possession of the drug:
True to form, this government has written down a series of talking points, in this case, trying to make it sound like it's cracking down on pot rather than legalizing it. And Justin Trudeau's ministers are sticking to the messaging from party central like a child reciting Dr. Seuss.
Not once in that As It Happens interview did [Justice Minister Jody] Wilson-Raybould explain why the government intends to keep on criminalizing Canadians so unfairly (see the Liberal party's website statement) for another year. Instead, literally every second time she opened her mouth, she re-spouted the line about "strictly regulating and restricting access." Off asked eight questions. Four times, Wilson-Raybould robotically reverted to the same phrase.
Meanwhile, Public Safety Minister Ralph Goodale, a parliamentary lifer who mastered the art of repetitive dronetalk sometime back in the last millennium, was out peddling more or less the same line, but with an added warning: Not only will the government continue to criminalize Canadians for what it considers a trifling offence, enforcement will be vigorous. "Existing laws prohibiting possession and use of cannabis remain in place, and they need to be respected," Goodale declared. "This must be an orderly transition. It is not a free-for-all." Why the government cannot simply decide to invoke prosecutorial and police discretion, and cease enforcing the cannabis laws it considers unjust, was not explained. Why that would necessarily be a "free for all" also went unexplained.
The Liberal Party of Canada has taken pains to remind everyone that the Conservative Party will "do everything they can to stop real change and protect a failed status quo". Unfortunately, they did not get the memo that "marijuana" is a term with racist origins.
Make like a tree and legalize it, Cannadia... Cannibinoidia.
President Trump and Attorney General Jeff Sessions
Backtrack to April 20th, 2016. Bernie Sanders still seemingly had a shot at becoming the President of the United States. Sanders, as well as Hillary Clinton (though begrudgingly), supported decriminalization of cannabis, medical use, and the continuation of states making decisions about recreational use. The #2 Republican candidate Ted Cruz also had a "let the states sort it out" stance.
One contender stood out, and he went on to become the @POTUS to #MAGA. The widely predicted "third term" was prevented, and that outcome may greatly affect a burgeoning semi-legal cannabis industry. One recent casualty are Amsterdam-style "cannabis clubs" (think: brewpubs). Colorado's legislature has backed off on a bill that would have allowed on-site consumption of cannabis at dispensaries due to the uncertain future of federal enforcement of cannabis prohibition.
Trump's position on cannabis has been ill-defined, although he supports medical use and has indicated that states should handle the issue. But the same can't be said of his Attorney General, former Senator Jeff Sessions. Here are some quotes about the drug from Mr. Sessions:
We need grown-ups in charge in Washington to say marijuana is not the kind of thing that ought to be legalized, it ought not to be minimized, that it's in fact a very real danger.
I think one of [President Obama's] great failures, it's obvious to me, is his lax treatment in comments on marijuana... It reverses 20 years almost of hostility to drugs that began really when Nancy Reagan started 'Just Say No.
You can't have the President of the United States of America talking about marijuana like it is no different than taking a drink... It is different... It is already causing a disturbance in the states that have made it legal.
Good people don't smoke marijuana.
Cannabis advocates are becoming increasingly paranoid about the federal government's stance towards the states (and a certain District) that have legalized cannabis. And this is following an Obama administration that was criticized for conducting raids in states with legalization. It is too early to tell how the Trump administration will choose to deal with cannabis, but there are signs that harsher policies and greater enforcement could be coming:
On Wednesday, [April 5th,] Jeff Sessions directed Justice Department lawyers to evaluate marijuana enforcement policy and send him recommendations. And some state officials are worried. This week the governors of Alaska, Colorado, Oregon and Washington wrote the attorney general. They asked Sessions and the new Treasury secretary to consult with them before making any changes to regulations or enforcement.
At the White House, press secretary Sean Spicer said recently that the president is sympathetic to people who use marijuana for medical reasons. He pointed out that Congress has acted to bar the Justice Department from using federal money to interfere in state medical cannabis programs. But Spicer took a harsh view of recreational marijuana. "When you see something like the opioid addiction crisis blossoming in so many states around this country, the last thing we need to be doing is encouraging people. There is still a federal law we need to abide by," Spicer said.
Really, Spicer? Recreational cannabis use shouldn't be encouraged during an opioid addiction crisis? Read on.
Politics nexus unavailable for comment.
The Opioid Crisis Drags On (it's relevant)
Heroin use has become more dangerous as dealers have increasingly added other substances that massively increase potency without affecting the size of a dose significantly. Carfentanil, which is used as an elephant tranquilizer, has led to hundreds of deaths over very short timespans. It is impossible for the average user to predict the potency and potential danger of street heroin. While there have been international responses to these compounds, new chemical analogues are being created all the time:
Chinese labs producing the synthetic opiates play hide-and-seek with authorities. On their websites, they list fake addresses in derelict shopping centers or shuttered factories, and use third-party sales agents to conduct transactions that are hard to trace. The drugs themselves are easy to find with a Google search and to buy with a few mouse clicks. A recent check found more than a dozen Chinese sites advertising fentanyl, carfentanil, and other derivatives, often labeled as "research chemicals," for sale through direct mail shipments to the United States. On one website, carfentanil goes for $361 for 50 grams: tens of thousands of lethal doses.
The cat-and-mouse game extends to chemistry, as the makers tinker with fentanyl itself. Minor modifications like adding an oxygen atom or shifting a methyl group can be enough to create whole new entities that are no longer on the list of sanctioned compounds. Carfentanil itself was, until recently, unregulated in China.
2016 saw the addition of kratom to Schedule I of the Controlled Substances Act in the U.S. Advocates for the tree leaf drug, which was formerly classified as a supplement, believe that its painkiller effects and low risk factors make it a useful replacement for the oft-deadly opioids that millions of Americans are addicted to. Kratom users have treated their pain and opioid withdrawal symptoms using the formerly "legal high". The DEA has refused to acknowledge this application and points out the "skyrocketing" number of calls to the Poison Control Center regarding kratom in recent years. One skeptic of kratom, Dr. Josh Bloom of the American Council on Science and Health, has looked at the same evidence and concluded that the trail of bodies left by substances like fentanyl and the scarce number of deaths (perhaps wrongly) attributed to kratom make it clear that the substance is the better "poison". He also notes that:
The number of calls to poison control centers is not reliable for determining how many poisonings actually occurred. It is a crude approximation at best.
Much like kratom, medical cannabis has been touted as a solution to the opioid crisis. States with legalized medical cannabis have seen a reduction in reported instances of opioid dependence [DOI: 10.1016/j.drugalcdep.2017.01.006] [DX] So it is puzzling that White House Press Secretary Sean Spicer would use opioids as a bludgeon against cannabis legalization while AG Sessions expresses astonishment over the suggestion of using cannabis as a "cure" for the opioid crisis.
Bonus: Here's a video (2m14s) of a woman getting administered Narcan/naloxone. Here's an alternate video (2m39s) in which a man who overdosed on heroin is able to sit up in about a minute after being administered naloxone.
⚚ The Slow March for Science ⚕
While the Drug Enforcement Agency has refused to reclassify cannabis from its current Schedule I status, citing the supposedly rigorous conclusions reached by the Food and Drug Administration, it will allow more than one institution to grow cannabis for research purposes, ending the monopoly held by the University of Mississippi. However, the Schedule I status of cannabis remains an impediment to further research:
[...] DEA's decision not to reschedule marijuana presents a Catch-22. By ruling that there is not enough evidence of "currently accepted medical use"—a key distinction between the highly restrictive Schedule I classification and the less restrictive Schedule II—the administration essentially makes it harder to gather such evidence.
"They're setting a standard that can't be met," says David Bradford, a health economist at the University of Georgia, Athens. "That level of proof is never going to be forthcoming in the current environment because it requires doing a really extensive clinical trial series, and given that a pharmaceutical company can't patent whole plant marijuana, it's in no company's interest to do that."
Schedule I status presents obstacles for clinical researchers because of restrictions on how the drugs must be stored and handled, Bradford says. Perhaps more significant, that listing may evoke skittishness at funding agencies and on the institutional review boards that must sign off on research involving human subjects.
"It doesn't resemble cannabis. It doesn't smell like cannabis," Sisley told PBS NewsHour last week.
Jake Browne, a cannabis critic for the Denver Post's Cannabist marijuana news site, agrees. "That is, flat out, not a usable form of cannabis," he said. Browne should know: He's reviewed dozens of strains professionally and is running a sophisticated marijuana growing competition called the Grow-Off.
"In two decades of smoking weed, I've never seen anything that looks like that," Browne said. "People typically smoke the flower of the plant, but here you can clearly see stems and leaves in there as well, parts that should be discarded. Inhaling that would be like eating an apple, including the seeds inside it and the branch it grew on."
Research on cannabinoids and psychedelics is proceeding, slowly. One study published yesterday (74 years after the first LSD trip) came to an astounding conclusion: Psychedelics can induce a "heightened state of consciousness":
Healthy volunteers who received LSD, ketamine or psilocybin, a compound found in magic mushrooms, were found to have more random brain activity than normal while under the influence, according to a study into the effects of the drugs. The shift in brain activity accompanied a host of peculiar sensations that the participants said ranged from floating and finding inner peace, to distortions in time and a conviction that the self was disintegrating.
[...] What we find is that under each of these psychedelic compounds, this specific measure of global conscious level goes up, so it moves in the other direction. The neural activity becomes more unpredictable," said Anil Seth, a professor of neuroscience at the University of Sussex. "Until now, we've only ever seen decreases compared to the baseline of the normal waking state."
Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin (open, DOI: 10.1038/srep46421) (DX)
♯ Ending on High Notes ♯
And now to scrape the bottom of the barrel:
- Americans Don't Care If Their Parents Know They Smoke Weed, Survey Says
- California Today: At Newspapers, Covering Pot Like Wine (archive)
- Nation's first public needle vending machine for drug users debuts in Las Vegas
- GRiZ Won the Celebrity Weed Game Without Selling Out
- Secret A.T.F. Account Paid for $21,000 Nascar Suite and Las Vegas Trip (archive)
- Legal Marijuana Ends at Airport Security, Even if It's Rarely Stopped (archive)
- Anti-Heroin Video From a Florida Sheriff Appalls Critics but Impresses Constituents (archive)
Attorney General Jeff Sessions said Friday that he has directed his federal prosecutors to pursue the most severe penalties possible, including mandatory minimum sentences, in his first step toward a return to the war on drugs of the 1980s and 1990s that resulted in long sentences for many minority defendants and packed U.S. prisons.
[...] In the later years of the Obama administration, a bipartisan consensus emerged on Capitol Hill for sentencing reform legislation, which Sessions opposed and successfully worked to derail.
In a two-page memo to federal prosecutors across the country, Sessions overturned former attorney general Eric H. Holder's sweeping criminal charging policy that instructed his prosecutors to avoid charging certain defendants with offenses that would trigger long mandatory minimum sentences. In its place, Sessions told his more than 5,000 assistant U.S. attorneys to charge defendants with the most serious crimes, carrying the toughest penalties.
Dr. Lowe, from In The Pipeline, writes about the development of a vaccine for heroin:
At first thought, that might seem like a weird idea. Drugs of abuse, such as heroin, cocaine, methamphetamine et al. are small molecules, and as such are too small to set off immune responses on their own. But a strategy could be to attach them to some larger protein that can raise antibodies – if those antibodies recognize the drug-labeled part of the protein conjugate, they may well retain activity against the drug molecule in its free state.
[...] It's been a long road. The first morphine immunoconjugate was described in 1970, and a morphine vaccine was tested in rabbits in 1975. But very little progress in the field occurred over the next twenty years or so, partly because methadone treatment for heroin addiction had become widely used. It's interesting to note, though, that vaccine development work against amphetamine seems to have followed a roughly similar path
[...] It would seem that we really are getting close to human clinical trials for some of these, which will be quite interesting. A drug-abuse vaccine is not going to be magic, though. Because of the specificity of the immune response, someone who's been vaccinated against heroin would almost certainly still respond to morphine, and most definitely would to compounds like fentanyl or oxycodone [...] But vaccines could, at the same time, provide the extra help needed for people to finally break free of a particular drug, and addicts who are really trying to quit need all the help that they can get.
I'd say that last part is the key. One of the big issues in drug addiction is (in the end) a philosophical argument about free will (which would explain why it never gets resolved!) Is drug addiction a disease, a choice, a behavior, a biochemical problem. . .the arguments go on forever, complicated by the way that different people attach different meanings to those terms.
The Associated Press newswire reports:
After three defendants fatally overdosed in a single week last year, it became clear that Buffalo's ordinary drug treatment court was no match for the heroin and painkiller crisis.
Now the city is experimenting with the nation's first opioid crisis intervention court, which can get users into treatment within hours of their arrest instead of days, requires them to check in with a judge every day for a month instead of once a week, and puts them on strict curfews. Administering justice takes a back seat to the overarching goal of simply keeping defendants alive.
[...] Buffalo-area health officials blamed 300 deaths on opioid overdoses in 2016, up from 127 two years earlier. That includes a young couple who did not make it to their second drug court appearance last spring. The woman's father arrived instead to tell the judge his daughter and her boyfriend had died the night before.
[...] "This 30-day thing is like being beat up and being asked to get in the ring again, and you're required to," 36-year-old Ron Woods said after one of his daily face-to-face meetings with City Court Judge Craig Hannah, who presides over the program.
Woods said his heroin use started with an addiction to painkillers prescribed after cancer treatments that began when he was 21. He was arrested on drug charges in mid-May and agreed to intervention with the dual hope of kicking the opioids that have killed two dozen friends and seeing the felony charges against him reduced or dismissed.
[...] "I don't want to die in the streets, especially with the fentanyl out there," Sammy Delgado, one of the handcuffed defendants, said.
An international investigation has taken down two dark web marketplaces:
Two of the largest dark web marketplaces have been shut down following a "landmark" international law enforcement investigation.
The AlphaBay and Hansa sites had been associated with the trade in illicit items such as drugs, weapons, malware and stolen data.
According to Europol, there were more than 250,000 listings for illegal drugs and toxic chemicals on AlphaBay.
Hansa was seized and covertly monitored for a month before being deactivated.
The agency said it believed the bust would lead to hundreds of new investigations in Europe.
"The capability of drug traffickers and other serious criminals around the world has taken a serious hit today," said Europol's executive director Rob Wainwright.
[Ed. addition] The US Department Of Justice announcement goes into considerable detail about the size of the site and the products carried there, as well as the agencies around the world which assisted with the takedown.
Further, Ars Technica UK explains the critical opsec mistake that lead to the takedown:
Cook County now gives at-risk inmates the overdose-reversing drug naloxone upon their release from jail and Los Angeles is poised to follow suit, putting the antidote in as many hands as possible as part of a multifaceted approach to combatting the nation's opioid epidemic.
Cook County Jail, the largest single-site jail in the country, has trained about 900 inmates how to use naloxone nasal spray devices since last summer and has distributed 400 of them to at-risk men and women as they got out. The devices can undo the effects of an opiate overdose almost immediately and are identical to those used by officers in many of the country's law enforcement agencies.
[...] It is too soon to gauge the effectiveness of Cook County's program, but Dart said anecdotal evidence suggests that the kits have saved lives, including a man who was arrested again, returned to jail, and told of how a friend he had trained to use the kit had done so when he overdosed. In New York City, more than 4,000 kits have been distributed to friends and relatives of inmates at the city's jail at Rikers Island since the program there was launched in 2014.
Related: Kroger Supermarkets to Carry Naloxone Without a Prescription
Obama Administration Expands Access to Suboxone Treatment
One Upside to Opioid Overdoses: More Organ Donors
Development of a Heroin Vaccine
New Jersey Gov. Chris Christie, head of the presidential commission on opioids, warned of the dangers of marijuana in a letter to President Donald Trump earlier this month about the panel's findings, saying the current push for marijuana legalization could further fuel the opioid epidemic.
"There is a lack of sophisticated outcome data on dose, potency, and abuse potential for marijuana. This mirrors the lack of data in the 1990s and early 2000s when opioid prescribing multiplied across health care settings and led to the current epidemic of abuse, misuse and addiction," Christie wrote in the letter, which was released with the commission's final report.
"The Commission urges that the same mistake is not made with the uninformed rush to put another drug legally on the market in the midst of an overdose epidemic."
[...] But some experts say the commission's fixation on marijuana was bizarre and troubling, lending credence to outdated views of marijuana as a gateway drug. And these experts want to nip such thinking in the bud.
They emphasized that they support efforts to curb the nation's opioid epidemic, but not the demonization of marijuana in the process.
"I was surprised to see negative language about marijuana in the opioid report," said Dr. Chinazo Cunningham, a professor of medicine at the Albert Einstein College of Medicine. "Research that examines pain and marijuana shows that marijuana use significantly reduces pain. In addition, the majority of studies examining marijuana and opioids show that marijuana use is associated with less opioid use and less opioid-related deaths."
You had one job.
Study Finds That Legalized Medical Cannabis Led to a Decline in Medicare Prescriptions
New Attorney General Claims Legal Weed Drives Violent Crime; Statistics be Damned
4/20: The Third Time's Not the Charm
Jeff Sessions Reboots the Drug War
President Trump Declares the Opioid Crisis a National Emergency
According to Gallup, American Support for Cannabis Legalization is at an All-Time High
Opioid Crisis Official; Insys Therapeutics Billionaire Founder Charged; Walgreens Stocks Narcan
FDA Blocks More Imports of Kratom, Warns Against Use as a Treatment for Opioid Withdrawal