With nearly 47,000 Americans dying of drug overdoses in 2014 -- more than from gunshots or car crashes -- the problem of heroin and prescription opioid (pain pill) addiction is getting well-deserved attention. From community town halls to state capitals, as well as in Congress and on the rival presidential campaigns, the crisis is spawning demands for solutions.
Dan Morhaim The response, in general, has been more sympathetic than to earlier waves of hard drug use, such as heroin in the 1960s or crack cocaine in the 1980s, which brought down the harsh drug war policies of Nixon and Reagan. Now, there are more calls for drug treatment than for further law enforcement crackdowns, police departments are carrying overdose reversal drugs, and public health agencies are taking on a more prominent role.
But addicts continue to be arrested, with all the deleterious consequences that entails, and, when it comes to policy, the problem of addiction remains largely in the realm of criminal justice. Harm reduction practices proven in other parts of the world improve both the lives of drug users and those of the communities they live in continue to be shunted aside in the US.
That could change in at least one state. Veteran Maryland Delegate Dan Morhaim (D-Baltimore County) has just introduced a paradigm-shifting package of bills that would begin to move the state's posture toward drug use from prohibition to public health and harm reduction. Morhaim, a practicing physician with three decades of frontline hospital ERs, brings to his approach a vision formed by that experience.
If enacted, Morhaim's package would mark a radical, but commonsensical, humane, and scientifically-supported shift in Maryland's drug policies. Here's what it includes:
- Emergency Room Treatment on Demand. House Bill 908 provides treatment on demand in emergency rooms and hospital settings. The bill requires acute care hospitals to have a counselor available or on-call at all times and specified arrangements for transferring patients to appropriate treatment settings. Addicted patients make up a large percentage of uninsured visits to ERs, making them an ideal place for initial therapeutic contact.
- Safe Consumption Sites. House Bill 1212 allows individuals to use drugs in approved facilities while supervised by trained staff who also provide sterile equipment, monitor the person for overdose and offer treatment referrals. Similar on-going programs in Australia, Canada, and several European countries have eliminated overdose deaths, reduced the spread of disease, and provided points of accessto the most hard-to-reach drug users.
- Drug Decriminalization. House Bill 1219 decriminalizes the possession and use of small quantities of drugs: one gram of meth or heroin, two grams of cocaine, 10 hits of MDMA, 150 micrograms of LSD. The object is to keep otherwise non-criminal drug users out of the criminal justice system, saving resources and avoiding saddling more residents with criminal records.
- Heroin Maintenance. House Bill 1267 allows a four-year pilot study of "poly-morphone assisted treatment" with pharmaceutical grade opioids, including heroin, to treat under medical supervision a small number of hardcore users who have proven resistant to other forms of treatment. Ongoing heroin maintenance programs in several European countries have been shown to reduce illegal drug use, decrease crime, reduce the black market for heroin, and lead to less chaotic lives for their participants.
The package didn't exactly come out of nowhere. Morhaim's experiences in the ER, where he dealt not only with direct consequences of drug use -- overdoses, infections -- but also direct consequences of drug prohibition -- old women injured in muggings for black market drug money, the toll of dead and wounded in black market drug turf battles -- colored his approach.
[image:2 caption:true align:right]"I'm a physician, not a prosecuting attorney," Morhaim told the Chronicle. "I come at this from a public health perspective. We talk about 'surges' to fight this and that, but what we haven't had in this country is a surge in the public health approach, real, substantive public health. This is different, and some will see it as controversial, but I'm comfortable with that. This is something that's really corroding the heart and soul of our society."
He wasn't alone.
"I've had a lot of conversations, and my district has generally been very supportive of these kind of innovative things. No negative feedback. There's a broad consensus that the war on drugs is a failure," Morhaim said. "People are really cognizant of that. And I'm an Emergency Room physician at a Level II trauma center, I've also done healthcare for the homeless. I've been on the front lines, seen the carnage, the death, the violence, and the way this affects the families, and I'm speaking from true experience, and people respect that."
Not only did Morhaim have support in his community, he had support from a strong group of advocates and experts.
"As things were coming to a head, Delegate Morhaim reached out to us at the Drug Policy Alliance (DPA)," said DPA staff attorney Lindsay LaSalle, who was involved in developing the proposals. "He said he felt like he could offer progressive solutions to the crisis and he wanted our subject matter expertise to help develop those proposals."
DPA, Law Enforcement Against Prohibition (LEAP), whose executive director, Neill Franklin, is a former Baltimore police officer, and the Open Society Foundations joined with academics, lawyers, doctors, and harm reductionists to develop and refine the policy proposals that became the bill package. Local institutions of higher learning, including the University of Maryland, the University of Baltimore, and Johns Hopkins University, had academics involved in the effort as well.
Passing the bills won't be easy, and it's not likely to happen this year, but Morhaim and his supporters are playing to win in the not-too-distant future.
"Dan is currently on the second year of a four year term," LaSalle said. "These bills were introduced strategically this term with the understanding that it would be a year of educating colleagues and generating positive media coverage. This is always a long game; we don't expect passage this year, but we hope to gain traction on one or more of these in the next two or three years."
"I've been in the legislature a long time, and I've learned you just have to be persistent, you listen and address concerns, maybe you accept an amendment to a bill," Morhaim said.
He pointed to the successful effort to get medical marijuana through the legislature.
"On that, people had suggestions, and we said let's fix it in the bill," he recalled. "Law enforcement didn't oppose it because I sat down and worked with them."
He also recalled legislative battles he had fought -- and won -- around smoking in restaurants and the use of safety seats for children.
"Banning smoking in restaurants seemed impossible in 1995, but now it's commonplace," he said. "The same with kids safety seats. Both of those were hard-fought on the political level, but when we talk to people, we can convince them. These things take time, but when you recognize what's not working, then you can explore what is. People are looking for answers."
Although Morhaim's package of bills is the most comprehensive, explicit harm reduction interventions are being considered in other places, too. California will see a safe consumption site bill introduced next week, and activists and officials in a number of cities, including New York City, San Francisco, and Seattle are laying the groundwork for such facilities at the local level.
"We're getting traction on these issues," said LaSalle. "Nevada was the first state with a heroin-assisted treatment bill, and while it didn't get out of committee, we had robust hearings, with international experts. And that California bill will be moving forward this session. Drug treatment and harm reduction don't always go hand in hand, but in this case the treatment community is cosponsoring or officially supporting safe consumption sites."
Meanwhile, some states are moving in the opposite direction. In Maine, the administration of Tea Party Gov. Paul Le Page (R) is seeking to reverse a law passed last year that defelonized drug possession. (The rambunctious Republican has also called for guillotining drug dealers, blamed black drug dealers for impregnating white Maine girls, and called for vigilantes to shoot drug dealers.) And next door in New Hampshire, the attorney general wants to start charging heroin suppliers with murder in the event of fatal overdoses. Prosecutors in other states have also dusted off long-unused statutes to bring murder or manslaughter charges.
"We need to ask those people why they're doubling down on a failed policy," said LaSalle. "Why would this work now when it's just more of the same that's been in place for four decades, and now we have use and overdoses and Hep C increasing."
"I understand the impulse to 'Do Something!' in response, and because criminalization has been our go-to response, it seems logical that increasing penalties or prosecutions is a way to solve the problem, but we know, we have shown, that it is not. It's frustrating."
It can be worse than frustrating, too, LaSalle noted.
"Using murder charges as a whipping stick in the case of overdoses is really counterproductive," she said. "If the goal is to reduce overdoses, this is going to reduce the likelihood of anyone calling 911. Maybe they shared their stash, and if they could face murder charges, they now have a serious disincentive to call."
Clearly, the war on drugs is not over. But after half a century of relying predominantly on the forces of repression to deal with drug use, a new vision, both smarter and more humane, is emerging. Now comes the political fight to enact it.
This article was produced in collaboration with AlterNet and first appeared here.
[image:1 align:left caption:true]A Southeast Asian herb is gaining popularity among addicted heroin and prescription opiate users, pain sufferers, and hipsters looking for a nice buzz, and it's legal -- at least for now. It's usually consumed as a tea, and is now available at non-alcohol kratom bars in several states, as well as in powdered from in specialty shops and on the Internet.
It is regulated as an herbal supplement, not a controlled substance, but it is coming under some scrutiny by lawmakers and regulators. The FDA banned its import in 2014, and the DEA has it listed as a drug of concern, but has not moved to criminalize it. It is illegal in four states, though -- Indiana, Tennessee, Vermont and Wyoming -- and similar laws are now being proposed in Florida and New Jersey.
The stuff is called kratom, and was traditionally used in Thailand and Malaysia to help endure physical labor, relieve pain, and stop diarrhea. It was also good for relieving the symptoms of opium withdrawal.
That's because its active ingredients activate the same opioid receptors heroin and prescription pain pills do. And it behaves like an opiate -- with a couple of exceptions, one interesting and one quite important.
[image:2 align:right caption:true]Like other opiates, it relieves pain, slows bowel activity, produces euphoric feelings, and creates physical addiction and a whithdrawal syndrome. But unlike other opiates, it causes a pleasant, caffeine-type buzz in small doses. More significantly, it is apparently very difficult -- if not impossible -- to overdose on. The few deaths where kratom is implicated include poly-drug use, or as in a case reported by the New York Times, suicide by a young kratom user who was also being treated for depression.
"Direct kratom overdoses from the life-threatening respiratory depression that usually occurs with opioid overdoses have not been reported," says Oliver Grundmann, clinical associate professor of medicinal chemistry at the University of Florida, told journalist Maia Szalavitz at Vice. Grundmann should know; he just reviewed the research on kratom for the International Journal of Legal Medicine.
"It's a fascinating drug, but we need to know a lot more about it, Dr. Edward W. Boyer, a professor of emergency medicine at the University of Massachusetts Medical School and a co-author of several scientific articles on kratom, told the Times. "Recreationally or to self-treat opioid dependence, beware -- potentially you're at just as much risk" as with an opiate.
Well, except for that whole fatal overdose thing. And like the kratom high, the physical dependence appears much milder.
Szalavitz consulted Mark Swogger, an assistant professor of psychiatry at the University of Rochester Medical Center, who with his colleagues analyzed 161 "experience reports" posted by kratom users on the drug information site Erowid.org for a recent study in the Journal of Psychoactive Drugs.
"I think it's pretty safe to say that kratom has at least some addiction potential. The data is fairly strong on that and our study also found that people are reporting addiction," but "overall, we found that it's really mild compared to opioid addiction and it didn't seem to last as long."
About one in six of the users reported nausea or stomach pain and 6% actually vomited. There have been a handful of other handful of reports of liver problems.
All this makes kratom something like opium's mild-mannered little sister. And that is apparently something a lot of people are looking for.
One of them was Susan Ash, 46, who told the Times she began taking kratom while being treated for dependence on prescription pain relievers and now takes a small dose daily to ease chronic pain and depression.
She was so impressed with the results that last year, she founded the American Kratom Association to represent consumers. The group now has more than 2,000 members and lobbies against bills to ban the herb.
"We know from all our experiences that kratom has the potential to be a wonderful medicine," she said. "We're all experiencing that it's changing our lives. We do agree that more science is needed to actually prove this potential that we know it has."
Yes, more science is needed, and kratom does have its disaffected users, as the Times was quick to dig up, but so far, it looks like we have a drug like opium, but with attenuated effects. If people are taking kratom to get off heroin or prescription pills or to treat pain or just to get a nice buzz, and they're not overdosing by the tens of thousands, as they are with the opiates, that would seem like an overall good thing. If we want to reduce harm from heroin and prescription opiates, kratom should be studied and, perhaps, embraced, not proscribed.
Oregon's federal representatives fight to protect marijuana advertising, medical marijuana and CBD bills are moving in the states, a Maryland delegates files bills for drug treatment on demand, supervised injection sites, opiate maintenance (including heroin), and drug decriminalization -- quite a package! -- and more.
[image:1 align:right caption:true]Marijuana Policy
Oregon Federal Reps File Bill to Allow Published Marijuana Ads. Responding to warnings from the US Postal Service that mailing newspapers or magazines with marijuana advertising is prohibited even in states where it is legal, Oregon's two Democratic senators, Ron Wyden and Jeff Merkley, have joined with two Democratic House members, Earl Blumenauer and Suzanne Bonamici, to file the Marijuana Advertising in Legal States (MAILS) Act (HR 4467). The bill would reverse the USPS policy. "Federal agencies must respect the decisions made by law-abiding Oregonians and small business owners in the state," Wyden said. "Our bill updates the federal approach to marijuana, ending the threat to news publications that choose to accept advertising from legal marijuana businesses in Oregon and other states where voters also have freely decided to legalize marijuana."
Michigan Legalization Campaign Getting Close to Signature Goal. The MILegalize campaign says it has already collected some 240,000 raw signatures and is seeking another 100,000 to ensure a comfortable cushion for invalidated signatures. The state requires 252,000 valid voter signatures to qualify for the November ballot.
Alabama Bill Would Expand Access to CBD Cannabis Oil. Rep. Mike Ball (R-Madison County) has introduced House Bill 61, which would expand access to CBD beyond a limited study program at the University of Alabama-Birmingham. The new bill would allow parents with a valid recommendation for CBD cannabis oil to possess it in the state.
Delaware Bill Would Allow CBD Cannabis Oil for Kids in Schools. Sen. Ernie Lopez (R-Lewes) has filed Senate Bill 181, which would allow authorized caregivers to possess and administer CBD cannabis oil to pupils in school as needed.
Utah Medical Marijuana, CBD Cannabis Oil Bills Move. Two medical marijuana-related bills are headed for the Senate floor after winning committee votes. Senate Bill 73, filed by Rep. Mark Madsen (R-Saratoga Springs), would allow whole plant medical marijuana, while Senate Bill 89, sponsored by Sen. Evan Vickers (R-Cedar City), would expand on CBD cannabis legislation passed last year.
Florida Bill to Ban Kratom Advances. A bill that would ban the increasing popular Southeast Asian herb, which some are using as an alternative to opiates or as a means to withdraw from them, has passed the House Criminal Justice Subcommittee. The bill, House Bill 73, would make possession of kratom a misdemeanor. A similar measure seeking to make possession a felony failed last year.
New Synthetic Drugs
Kentucky Bill to Toughen Penalties for New Synthetic Drugs Advances. A bill that would increase penalties for possessing or selling new synthetic drugs has passed the House Judiciary Committee. The bill is House Bill 66.
Maryland Bill Package Attempts Comprehensive Drug Decriminalization, Harm Reduction Approach. A set of four bills being filed today would upend the way the state deals with drug use and related problems. One bill would provide for drug treatment on demand in emergency rooms and hospital settings, a second bill would allow for safe injection facilities (there are currently none in the US), a third bill would allow for opiate maintenance therapy, including with heroin, and a fourth bill would decriminalize the use and possession of personal use quantities of illicit drugs. The package is being sponsored by Delegate Dan Morhaim (D-Baltimore County).
Utah Bill Would Repeal Welfare Drug Testing Law. Since Utah approved a welfare drug testing law, only 47 applicants out of nearly 14,000 have tested positive for drugs. That's enough for Rep. Angela Romero (D-Salt Lake City) to call for an end to the program. Her House Bill 172 would do just that. It is currently before the House Economic Development and Workforce Services Committee.
Chronicle AM: Obama Wants $1 Billion to Fight Opioids, Legal Pot Sales Hit $5.4 Billion, More... (2/2/16)
A new report finds marijuana is a booming market, California doctors get on board with the AUMA legalization initiative, the White House wants nearly a billion bucks to fight opioid addiction -- with most of it going for "medication-assisted treatment" -- and more.
[image:1 align:left caption:true]Marijuana Policy
Legal Pot Sales Hit $5.4 Billion Last Year, Report Says. Legal marijuana sales increased 17.4% last year to $5.4 billion, according to data released this week by the ArcView Group. Nearly 80% of the sales were for medical marijuana, but $998 million was for legal adult use, up dramatically from $351 billion in 2014. Overall sales should grow to $6.7 billion this year, the group predicted.
California Medical Association Endorses AUMA Legalization Initiative. The CMA, the largest doctors' group in the state, announced Monday that is will support the Adult Use of Marijuana Act legalization initiative. The initiative, funded by tech billionaire Sean Parker and supported by Lt. Gov. Gavin Newsom (D), has as one of its proponents Dr. Donald Lyman, who authored the CMA's 2011 policy called for decriminalization. "The California Medical Association believes the Adult Use of Marijuana Act is a comprehensive and thoughtfully constructed measure that will allow state officials to better protect public health by clarifying the role of physicians, controlling and regulating marijuana use by responsible adults and keeping it out of the hands of children," Dr. Steven Larson, CMA's president, said in prepared remarks.
New Hampshire Patient Who Sued Over Medical Marijuana Access Dies. Linda Horan, who sued the state in November to issue her a medical marijuana card so she could get her medicine in Maine because New Hampshire dispensaries hadn't opened, died Monday at age 64. The ailing labor leader won her lawsuit and was able to procure medical marijuana out of state, but succumbed to cancer. The court ruling applied only to Horan, but days after the ruling, the states began sending out ID cards to patients.
Wyoming Medical Marijuana Initiative Won't Qualify for Ballot. A spokesman for Wyoming NORML, which organized the campaign, said Monday that the group had only managed to gather some 7,000 raw signatures ahead of next week's deadline and will fall far short of the more than 25,000 valid voter signatures required to make the ballot. The group will try again in 2018, it said.
Twenty States Have Hemp Bills This Year, Vote Hemp Says. The industry group has issued its annual report and says 20 states are working to legalize or expand hemp production. There's much more in the report, too.
White House Seeks $1 Billion to Fight Heroin and Prescription Opiate Abuse. The Obama administration Tuesday proposed a billion dollars in new funds over the next two years to combat widespread opioid use. More than $900 million of the newly sought funding would go for medication-assisted treatment (opioid maintenance), which also includes therapy. The administration said that 2.2 million people have been identified as needing treatment for opioid addiction, but only one million are receiving it.
West Virginia Lawmaker Proposes Drug Testing Legislators. State lawmakers have once again introduced a bill to drug test welfare applicants, and in response, Delegate Shawn Fluharty (D-Wheeling) has introduced House Bill 2925, which would subject legislators to the same sort of testing. "There's no reason why state legislators should get a pass, simply because we wear suits," he said.
Chronicle AM: Maine Legalization Initiative On Target for Ballot, Narcan in the News, More... (2/1/16)
Maine's legalization initiative looks like it will qualify for the ballot, Tommy Chong endorses Bernie Sanders, a new federal bill would fund needle exchanges, naloxone is in the news, and more.
[image:1 align:right caption:true]Marijuana Policy
Obama Says Marijuana Reform Not on His Agenda in Final Year. In a Friday press briefing, White House press secretary Josh Earnest said any progress on further federal marijuana reform would have to come from Congress, not the president. "There are some in the Democratic Party who have urged the president to take this kind of action. The president's response was, 'If you feel so strongly about it, and you believe there is so much public support for what it is that you're advocating, then why don't you pass legislation about it and we'll see what happens.'"
Tommy Chong Endorses Bernie Sanders. This is not exactly a shocker, but every endorsement helps. Iconic stoner comedian Tommy Chong has endorsed Sen. Bernie Sanders (I-VT) for the Democratic presidential nomination, citing his support of marijuana legalization. "Bernie does support that… legalization that I care so deeply about, legalization of the super-medicine marijuana. So I know this year, you and I are going to 'Feel the Bern,' go up to the polling booths, and light up, man, for progress and change." Chong also touted Sanders' positions on immigration, equality, and a living wage, and he jokingly referred to Sanders as the "commander-in-Kush."
Maine Legalization Group Submits Nearly Double the Signatures Needed to Qualify for Ballot. It looks like Mainers will be voting on legalization in November. Today, the Campaign to Regulate Marijuana Like Alcohol turned in more than 103,000 raw signatures for its petition drive. It only needs 61,000 valid voter signatures to qualify for the November ballot.
Seattle Medical Marijuana Shops Sue State Over Licensing Process. A handful of long-time Seattle dispensaries filed a lawsuit last Friday against the state Liquor and Cannabis Control Board, saying the agency isn't following its own rules in issuing a new round of licenses for retail pot shops. The agency is supposed to give priority to dispensaries that have played by the rules, but the plaintiffs say it isn't doing that.
Illinois Refuses to Expand List of Qualifying Medical Conditions. The administration of Republican Gov. Bruce Rauner will not allow patients suffering from eight conditions to use medical marijuana. The Department of Public Health announced last Friday that no new conditions would be added despite pleas from patients, advocates, and medical marijuana business owners. The Medical Cannabis Alliance of Illinois issued a statement calling the decision "a gross injustice to patients."
New York Medical Marijuana Expansion Bill Filed. Assemblyman Richard Gottfried (D-Manhattan), chair of the Assembly Health Committee, last Friday filed a bill that would double the number of medical marijuana manufacturers and dispensaries in the state. The bill is not yet available on the legislative website.
Heroin and Prescription Opiates
Federal Bill Would Provide Funding for Needle Exchange Programs. Rep. Frank Pallone (D-NJ) last Friday introduced HR 4396 to address heroin and prescription opiate use. The bill has provisions for prevention, treatment, and recovery, as well as grant programs for needle exchanges and to reduce overdose deaths. The bill has been assigned to four different committees.
Utah Bill to Make Police Prove Seized Property Was Involved in Crime Wins Committee Vote. Rep. Brian Greene's (R-Pleasant Grove) House Bill 22, which would require police to prove seized property is involved in a crime, reversing the burden of proof requirement under the state's civil asset forfeiture law, has unanimously passed the House Judiciary Committee. The bill also includes a provision making the state pay citizens' attorney fees and costs is property is wrongfully seized. It now heads for a House floor vote.
Overdose Prevention Drug Has Saved 2,000 Lives in North Carolina. The North Carolina Harm Reduction Coalition reported last Thursday that the number of people whose opiate overdoses were reversed by naloxone (Narcan) had surpassed 2,000.
CVS to Make Overdose Prevention Drug More Widely Available in Ohio. The pharmacy chain announced today that it will make naloxone (Narcan) more available at stores throughout the state. Law enforcement had been skittish about using the drug, but as Lucas County Sheriff John Tharp noted, "We are in a heroin epidemic and this is just another tool to save lives."
New Orleans to Make Overdose Reversal Drug Available Over the Counter. People seeking naloxone (Narcan) will be able to pick it up without a prescription at the University Medical Center, city officials announced last Friday. City Medical Director Dr. Joseph Kanter has ordered the move in a bid to reduce fatal overdoses."There are no side effects. There is no abuse potential," Kanter said. "The primary effect of this medicine is to save a life."
(This article was prepared by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also pays the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)