Teri Moore, Author at Reason Foundation Free Minds and Free Markets Thu, 14 May 2020 14:51:12 +0000 en-US hourly 1 https://reason.org/wp-content/uploads/2017/11/cropped-favicon-32x32.png Teri Moore, Author at Reason Foundation 32 32 Frequently Asked Questions About Chloroquine and Hydroxychloroquine In Treating Covid-19 https://reason.org/faq/frequently-asked-questions-about-chloroquine-and-hydroxychloroquine-in-treating-covid-19/ Thu, 14 May 2020 14:30:09 +0000 https://reason.org/?post_type=faq&p=34443 The global spread of novel virus Covid-19 has health care professionals scrambling to treat patients of varying severity. Yet currently, no treatment has definitely shown enough promise against the coronavirus to receive U.S. Food and Drug Administration (FDA) approval for … Continued

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The global spread of novel virus Covid-19 has health care professionals scrambling to treat patients of varying severity. Yet currently, no treatment has definitely shown enough promise against the coronavirus to receive U.S. Food and Drug Administration (FDA) approval for widespread use.

Many, including President Donald Trump, have touted the efficacy of two drugs currently in use in China and other countries: chloroquine (CQ) and hydroxychloroquine (HCQ). As a result, many argue that, due to the severe and volatile effects of Covid-19 and the lack of effective therapies, the FDA should streamline, compress or even skip the years-long clinical trials process for these drugs, especially for patients who have a high chance of succumbing to the virus.

To evaluate this position, it’s necessary to understand why and how clinical trials work and methods for working around them.

  1. How do clinical trials work?
  2. Is there any way for COVID-19 investigational drugs to bypass the clinical trials process, making them available for doctors to administer?
  3. What are chloroquine (cq) and hydroxychloroquine (hcq) and how do they work?
  4. What are the side effects of chloroquine and hydroxychloroquine?
  5. If hydroxychloroquine is 40 percent less toxic than chloroquine, why are we even bothering with chloroquine?
  6. Do the drugs work against COVID-19?
  7.  What other approaches are being sought?

Frequently Asked Questions About Chloroquine And Hydroxychloroquine In Treating Covid-19

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Massachusetts’ Legislation for Marijuana-Impaired Driving Needs Some Work https://reason.org/commentary/massachusetts-legislation-for-marijuana-impaired-driving-needs-some-work/ Fri, 25 Oct 2019 04:00:51 +0000 https://reason.org/?post_type=commentary&p=29457 Some of the state's recommendations have little or no connection to driving impaired by THC.

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On Oct. 7, Massachusetts Gov. Charlie Baker’s office issued a press release urging the passage of impaired driving legislation that is based on recommendations from the Special Commission of Operating Under the Influence and Impaired Driving.

“As Massachusetts continues to implement adult use of marijuana, including potential social consumption sites, it’s vital that we update our impaired driving laws to ensure the safety of everyone who uses the Commonwealth’s roads,” Gov. Baker said in the press release.

The proposed legislation, informed by input from several stakeholder groups and spurred by last month’s approval of regulations for social consumption of cannabis, seeks to implement the following (paraphrased) changes in the judicial approach to driving while impaired by THC (the intoxicating component of cannabis). The law would:

  1. Authorize courts to stipulate THC ingestion as impairing to driving.
  2. Extend implied consent authority to suspension of licenses for refusal of chemical testing, as with alcohol.
  3. Develop educational materials on drug impairment for trial court judges.
  4. Expand DRE (drug recognition expert) officer training and allow testimony as expert witnesses in civil and criminal cases.
  5. Statutorily prohibit open containers of marijuana, as is currently the case with alcohol. 
  6. Empower police to seek electronic search warrants for (blood-draw) evidence of chemical intoxication after probable cause is established.
  7. Permit judicial stipulation of the scientific validity and reliability of HGN (horizontal gaze nystagmus) to demonstrate intoxication.

Some of these proposed changes make sense and largely track with Reason Foundation’s recommendations in the study, “A Common Sense Approach to Marijuana-Impaired Driving.” THC is a proven intoxicant, and since drivers’ insobriety can cause, and has caused, fatalities, public safety dictates that implied consent must extend to all intoxicants, including legal cannabis products containing THC.

Trial court judges should have the means to educate themselves about drug impairment. Drug recognition experts (DREs), who are police officers trained and certified in the detection of intoxication and impairment in individuals, should be considered expert witnesses and should be trained in numbers commensurate with need. 

But a few of Massachusetts’ recommendations have little or no connection to driving impaired by THC, and therefore bear review. For example, prohibiting open containers of marijuana would parallel the open container prohibition of alcohol, but what exactly does that mean? Is a closed Ziploc bag containing legal cannabis considered an open container? If so, what would this mean for a medical marijuana card-holder transporting his medication? Unlike alcohol, marijuana has recognized medicinal uses, putting it more in the category of someone driving with intoxicating medications like, say, Valium. Thus, for medical marijuana card-holders, open-container laws should treat their prescription medication the same way other intoxicating medications are treated.

Even further afield is the commission’s recommendation on blood-draw evidence search warrants. While there is no legal problem allowing police to seek electronic search warrants for chemical evidence once probable cause (the grounds for arrest) has been established, blood evidence of THC ingestion is not conclusively linked to intoxication. THC processes differently in the body than alcohol and can be present in blood samples for weeks after ingestion (urine will show THC metabolites for even longer)—long after the subject is sober. While some states have set statutory per se blood plasma levels, seeking to parallel .08 blood alcohol content (BAC) for alcohol, THC blood levels don’t track with intoxication except at very high doses. A per se statute for blood evidence that sets the bar low enough to charge every THC-intoxicated driver could inadvertently punish sober drivers, while a bar set very high to charge only absolutely intoxicated drivers could fail to remove many intoxicated drivers from the roads.

THC is simply different metabolically from alcohol and for policymakers to pretend otherwise is unwise. While blood evidence can establish that a driver is a marijuana user, a need to establish intoxication rather than merely past use, especially for medical marijuana users, questions the relevance of such evidence.   

Finally, Massachusetts’ last recommendation judicially stipulates the scientific validity and reliability to demonstrate intoxication of horizontal gaze nystagmus (HGN). This involuntary jerking of the eyes when the gaze is held at the outermost edge of vision is indeed scientifically valid and reliable—but not for THC.

HGN occurs primarily with depressants, PCP, tranquilizers and alcohol. The degree of HGN corresponds to the degree of intoxication, most precisely with alcohol. A trained officer dealing with a driver intoxicated by alcohol alone can estimate the driver’s blood-alcohol level very accurately through observation of HGN. But this has nothing to do with cannabis.

It’s possible that such a recommendation seeks to redress an omission in the law related to alcohol-impaired driving. Or if this recommendation seeks to address the well-proven synergistic effects of alcohol and THC consumption—together they are more intoxicating than the sum of their parts—then it should be written as such, possibly something like: Authorizing courts to stipulate that concurrent intoxication by alcohol and THC is more impairing than both alone.   

So what should the judicial system use as grounds for arrest for driving under the influence of drugs? Just as police officers have been doing for decades with drivers intoxicated by prescription medication, designer and other drugs that labs can’t test for, and even for alcohol intoxication in drivers who are greatly impaired but below .08 BAC, the field sobriety test assesses divided attention skills—the very skills needed to drive a car safely. This approach directly targets impairment and is best done with the corroboration of body cam evidence when possible. A drug recognition expert’s evaluation seeks to identify the drug(s) involved for laboratory and prosecutorial purposes, but demonstrated impairment should be the focus and reason for getting the driver off the public roadways. 

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California’s Contractor Law Manages to Be Bad for Workers, Customers and Companies https://reason.org/commentary/californias-contractor-law-manages-to-be-bad-for-workers-customers-and-companies/ Mon, 23 Sep 2019 11:15:56 +0000 https://reason.org/?post_type=commentary&p=29076 The internet-based industries and services that form the on-demand or “freelance” economy have risen to fill holes in the market, creating opportunities for workers and consumers and boosting local economies across the state.

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California’s is often viewed as the nation’s leading state.

Unfortunately, its latest piece of landmark legislation risks lassoing the flourishing gig economy and dragging it back to the pre-internet age under the guise of protecting workers.

California’s Assembly Bill 5, headed to Gov. Gavin Newsom’s desk (and he’s said he’ll sign it), redefines how companies can define independent contractors and employees, which could dramatically alter the state’s economy.

The internet-based industries and services that form the on-demand or “freelance” economy have risen to fill holes in the market, creating opportunities for workers and consumers and boosting local economies across the state.

Digital platforms like Upwork, TaskRabbit and ridesharing companies like Uber and Lyft connect workers, goods and services to customers by offering contract work to part-timers, temporary workers and even some full-timers without the structures of traditional, full-time work.

This “gig” work fills market demand dynamically, something traditional work often fails to do.

For example, Uber and Lyft drivers make more money and have more opportunities when they choose to work during surges of consumer demand, making it a win-win for drivers, ride-hailing customers and companies.

Many drivers work for both companies so they can choose the best routes and trips from each, based on their locations at a given time. Drivers have the flexibility to choose their own hours, so one may elect to work 10 hours one week and 50 hours the next.

But this high independence comes with tradeoffs, including lower pay and more uncertainty than you’d get from what we think of as traditional jobs. Gig workers who elect to work during low demand periods don’t make a lot of money. They have no employment guarantees and typically no benefits, health insurance, paid leave or pension plans.

AB 5 seeks to change all that, requiring companies whose workers carry out the core missions of their businesses—like rides-sharing companies—to treat them as employees rather than contractors. AB 5’s well-intentioned supporters want workers get the benefits of full-time employees, with employers paying Social Security, Medicare, health benefits, guaranteed minimum wage, overtime pay, sick leave, and more.

Unfortunately, such a move subverts the gig economy’s “pick-up work” appeal— workers flexing hours as desired and meeting consumer demand. Moreover, AB 5 won’t achieve its aims and will bring several negative unintended consequences as it essentially rids the economy of an alternative work model many now depend on.

Many gig workers who have been putting in 40-plus hours a week would likely see their hours reduced to around 30 per week as the companies look for ways to keep costs down and prices lower, in part, by avoiding hiring full-time employees. Many workers who value moonlighting and making money beyond their full-time positions would be hurt too. Full-time workers who pick up a handful of driving shifts at peak hours to make extra money, part-timers like students, and retirees—who make up the majority of gig workers and often already have benefits to supplement their incomes—would all have fewer opportunities.

Customers will also feel the impact. Since, under AB 5, an Uber driver who now elects to clock in at 3 a.m. would be guaranteed a minimum wage— even if the driver is in a location where no customers are seeking rides— rideshare companies are likely to black out unprofitable hours and locations. This is liable to leave consumers—especially rural and suburban ones—underserved. Meanwhile, urban customers can expect longer waits and more-expensive rides as the companies pass along their higher costs onto customers.

Recognizing the issues drivers face, and struggling to maintain their lean and efficient business models, Uber and Lyft had been offering drivers pay raises, a fund for benefits and collective bargaining rights. Such an approach could tailor potential solutions to the actual problems raised by drivers instead of scratching the entire gig economy model as AB 5 threatens to do.

Now, California risks killing off the new economy by dragging it back to an obsolete approach to work that fits poorly with today’s technology-based jobs. When a piece of legislation is bad for the workers, customers and companies involved, it’s a bad idea.

This column was originally published in the Los Angeles Daily News.

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Is a Device to Detect Marijuana Impairment by Tracking Eye Movement in Virtual Reality Possible? https://reason.org/commentary/is-a-device-to-detect-marijuana-impairment-by-tracking-eye-movement-in-virtual-reality-possible/ Wed, 17 Jul 2019 13:00:15 +0000 https://reason.org/?post_type=commentary&p=27674 Such a device could determine whether a driver who has used marijuana is currently under the psychoactive influence of the drug.

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The National Institute of Health has contracted with Battelle Memorial Institute to study measuring marijuana impairment with a virtual reality device. Such a device could determine whether a driver who has used marijuana is currently under the psychoactive influence of the drug (a.k.a. impairment) much like a breathalyzer does with alcohol.

Currently, determining impairment through biological testing isn’t reliable, as chemicals identifying marijuana use remain in the blood and urine long after the subject has regained sobriety, and blood/saliva levels of THC (marijuana’s impairing substance) do not track reliably with impairment. Such a device would overcome these problems, proving especially useful in marijuana-legal states, where, as with alcohol, law enforcement must establish a driver’s impairment to arrest for DUI-drug.

The study aims to measure impairment through metrics:

  1. Rebound dilation (this means the pupil responds to continuous light stimulation initially by constricting and then dilating)
  2. Lack of convergence (this describes an inability of one’s eyes to converge when following a stimulus from in front of the face to the bridge of the nose)
  3. Horizontal gaze nystagmus (this describes an involuntary jerking of the eye that occurs after tracking a stimulus to the extreme outer corner of the eye and holding the eye there)

The study also describes the device as “measuring smooth eye pursuit,” which would provide a fourth metric. “Smooth eye pursuit” means that, when the eyes are tracking a stimulus side to side, they do so smoothly, not in a jerky manner like sticky windshield wipers. Would such a device reliably measure marijuana impairment? Let’s take each metric in turn.

  1. Rebound dilation is a reliable and unique sign of psychoactivity of marijuana in someone’s system, but this device would measure it via a “light flash.” It’s unclear how this might work because assessing rebound dilation requires a continuous light stimulus. It is also unclear that rebound dilation can be measured and correlated to intoxication levels. Law enforcement currently regards this as a “presence or absence” metric—not a measurement of presence.
  2. Lack of convergence is also a sign of psychoactivity of marijuana, but occurs frequently in the sober population, as not everyone can cross their eyes. It is therefore not a tell-tale sign of marijuana impairment alone, but in conjunction with other signs.
  3. Horizontal gaze nystagmus is not associated with marijuana use at all, but with alcohol, PCP and/or depressant drugs.
  4. Lack of smooth pursuit (sticky windshield wiper eye tracking) is also not associated with marijuana use, but alcohol, PCP and depressant drug use. When police officers ask a driver to hold their head still and follow a stimulus side to side with their eyes, they’re assessing lack of smooth pursuit and horizontal gaze nystagmus to determine alcohol and/or certain drug use (depressants and PCP), not marijuana.

It appears that the latter two metrics are designed to detect alcohol impairment with the same device. While a marijuana impairment measuring device would help police remove dangerously impaired drivers from the public roadways, the metrics have to be right to begin with. Other devices purporting to measure marijuana intoxication have hit the market and largely failed to be adopted—as the alleged evidence provided doesn’t stand up to prosecution. The good news is, with a great need out there for a device that addresses true markers of intoxication, rather than blood plasma, technology has bent its expertise in that direction.

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A Common Sense Approach to Marijuana-Impaired Driving https://reason.org/policy-study/a-common-sense-approach-to-marijuana-impaired-driving/ Tue, 22 Jan 2019 05:00:26 +0000 https://reason.org/?post_type=policy-study&p=25642 Identifying policies that protect public safety without penalizing legal marijuana users who are sober at the time they drive.

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Executive Summary

Recent wide-spread legalization of medical marijuana and, in many U.S. states, of recreational use of marijuana also, demands that officials must forge a just, coherent and effective law enforcement and legal response to marijuana-impaired driving. More and more states are legalizing marijuana for medical and recreational use, which demands policies toward marijuana-impaired driving that protect public safety without penalizing legal marijuana users who are sober at the time they drive.

Marijuana—or its more technical name, cannabis—and its effects are still quite literally under the microscope. Cannabis containing high levels of THC is typically used recreationally, but may also have therapeutic applications. Because it is the psychoactive component in cannabis, THC is the cannabinoid that impairs driving, and is therefore the focus of this study. This analysis examines the evidence on marijuana-impaired driving and lays the groundwork for a regulatory approach that is scientifically grounded, safety- minded and fair.

In the past 10 years, the prevalence of alcohol use by drivers has fallen in the U.S., and use of marijuana has increased dramatically. Alcohol’s composition and effects on drivers have been thoroughly studied over the years and are well understood. It’s tempting to use a similar approach to that used for alcohol—the only other legal intoxicant—and to build policies around per se standards. But since cannabis body fluid levels don’t parallel impairment, that’s not a fair gauge of impairment as it is with alcohol. Indeed, it’s possible for some cannabis users to register above per se levels when completely sober. It’s also tempting to use the easy idea of zero tolerance, but that’s not fair to sober drivers who still have measurable cannabis in their systems.

The only fair solution is for police to assess drivers for impairment as we now do for low- blood-alcohol-content impaired drivers and drug-impaired drivers, and to conduct toxicology screens to corroborate that cannabis is present, rather than measuring irrelevant levels in body fluids. Fortunately, screenings are less expensive, quicker and easier to do than measuring body fluid levels. It’s concerning that this means impairment will be assessed entirely by police officers, but that is the most just option currently available. To address this concern, police should use dash- and bodycams to document impairing behavior—such as driving behavior leading to the traffic stop and impairing behavior on field sobriety tests—when possible.

This approach suggests that police departments should prioritize their funding toward training DRE-qualified and/or ARIDE-qualified officers, as well as purchasing dash- and bodycams. States should also prioritize funding toward toxicology labs to prevent current backlogs, to ensure the speedy trials guaranteed by the U.S. Constitution.

This evidence-of-impairment-based approach leads to these recommendations:

  1. Avoid per se standards and conduct THC detection screenings rather than assessing blood plasma levels, which don’t correlate to impairment.
  2. Mandate evidence of drug impairment as the main criterion for arrest. This targets the true danger to the public without penalizing sober users with detectable levels of marijuana in their systems.
  3. Prioritize law enforcement training in ARIDE/DRE and dashcams and bodycams for more accurate and corroborative identification and assessment of drug-impaired drivers, and to generate more useful data on marijuana-impaired drivers.
  4. Prioritize cutting down backlogs in toxicology laboratories so that justice for both impaired and unimpaired drivers is swift and fair. Rather than invasive testing of irrelevant blood plasma levels, use quicker and less expensive cannabis detection screenings.
  5. At the federal level, deschedule marijuana to encourage research into marijuana-impaired driving. This would remove obstacles to growing and procuring cannabis for research purposes. While some regulations have loosened recently, it is not enough to encourage cannabis research. As well, the federal government should prioritize on-going NHTSA and university research on marijuana use and driving, and encourage the development of reliable technology to aid in roadside impairment determination.

Full Study: A Common Sense Approach to Marijuana-Impaired Driving

Infographic: Marijuana-Impaired Driving

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How Dangerous Is Marijuana? https://reason.org/policy-brief/how-dangerous-is-marijuana/ Tue, 18 Dec 2018 14:00:36 +0000 https://reason.org/?post_type=policy-brief&p=25616 The majority of U.S. states have legalized medical marijuana, but the federal government continues marijuana’s Schedule 1 designation, identifying it as among the most dangerous drugs. Such a disparity makes Americans wonder about the health risks posed by marijuana, as opposed to the more familiar alcohol and tobacco.

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The majority of U.S. states have legalized medical marijuana, but the federal government continues marijuana’s Schedule 1 designation, identifying it as among the most dangerous drugs. Such a disparity makes Americans wonder about the health risks posed by marijuana, as opposed to the more familiar alcohol and tobacco. This brief looks at the evidence to provide health impact comparisons for alcohol, tobacco and marijuana.

Full Policy Brief: Just How Dangerous Is Marijuana? A Health Risk Comparison Of Alcohol, Tobacco And Marijuana

Infographic: How Dangerous Is Marijuana?

 

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Does Recreational Marijuana Legalization Contribute To Homelessness? https://reason.org/policy-brief/does-recreational-marijuana-legalization-contribute-to-homelessness/ Fri, 01 Jun 2018 22:14:12 +0000 https://reason.org/?post_type=policy-brief&p=23677 There is not a clear or predictable relationship between marijuana legalization and homelessness.

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Some assert that legalizing recreational marijuana directly causes increases in homelessness. Data suggest that factors other than marijuana legalization are likely responsible for changes in the rates of homelessness. At the very least, there is not a clear or predictable relationship between marijuana legalization and homelessness.

Policy Brief: Does Recreational Marijuana Legalization Contribute To Homelessness?

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Addressing the Problem of Marijuana-Impaired Driving https://reason.org/policy-brief/addressing-the-problem-of-marijuana-impaired-driving/ Fri, 25 May 2018 04:00:23 +0000 https://reason.org/?post_type=policy-brief&p=23671 States that have decriminalized or plan to decriminalize marijuana use are grappling with the challenge of establishing suitable measures to ensure traffic safety concerning marijuana-impaired drivers. This brief evaluates the options available. Policy Brief: Addressing the Problem of Marijuana-Impaired Driving

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States that have decriminalized or plan to decriminalize marijuana use are grappling with the challenge of establishing suitable measures to ensure traffic safety concerning marijuana-impaired drivers. This brief evaluates the options available.

Policy Brief: Addressing the Problem of Marijuana-Impaired Driving

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Marijuana Legalization Can Help Solve the Opioid Problem https://reason.org/commentary/marijuana-legalization-can-help-solve-the-opioid-problem/ Tue, 03 Apr 2018 16:12:20 +0000 https://reason.org/?post_type=commentary&p=23209 Legalization of marijuana would bring transparency to business transactions and address many goals that the War on Drugs has failed so miserably to achieve.

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The U.S. has spent over a trillion dollars during four decades on the “War on Drugs,” with little to show for it. That “war” has sought to eliminate certain drugs rather than the harms associated with them (such as addiction, overdoses, and harmful acts perpetrated by drug users). Ironically, many of these harms have been partially mitigated at surprisingly low costs—not by the ill-conceived War on Drugs, but by ending the war on one drug, marijuana. Legalizing marijuana is reducing the social harms related to drug use by exerting its own pincer movement through simple supply and demand.

DEMAND

Proponents of the War on Drugs have the “opioid crisis” in their sights. According to a report by the Council of Economic Advisors, opioid use cost U.S. taxpayers about $500 billion in 2015, primarily as a result of additional health care expenditures and losses in productivity, on top of the $8 billion spent on criminal justice enforcement.

It’s difficult to measure the extent of opioid use—and therefore demand—because so much of it is illegal. Illegal use is typically observed primarily through the arrest, death or hospitalization of users. If those statistics increase sharply (which they have), we can assume that use has increased, but such metrics do not capture the actual extent of use.

But while demand for opioids seems to have risen, the rate of increase has been higher in some places than others. In particular, in places where medical cannabis is legal, marijuana has likely at least partially displaced opioids.

Canada has had a comprehensive national program of legalized medical cannabis since 2014. A recent University of British Columbia patient survey found 63 percent of Canadian opioid prescription drug patients had substituted cannabis for prescription drugs, 30 percent of which were for opioids. These patients cited fewer side effects, less addictivity and better symptom management.

In the states where it’s legal, medical marijuana is likely serving the same purpose for many U.S. opioid users. Twenty-nine states and the District of Columbia have legalized medical marijuana. A 2014 study found that in states that had legalized medical marijuana between 1999 and 2010, the incidence of opioid mortality was lower than in states where marijuana was not legalized for medical purposes. Meanwhile, a more recent study found that medical marijuana legalization was associated on average with 23 percent fewer opioid-related hospitalizations.

Opioids are powerful analgesics and as such have substantial benefits for pain management. However, opioid users may have trouble gauging safe dosage, especially when they are unaware of the actual dose of the opioid they are taking—a common problem with opioids purchased illegally. But they don’t have that problem if they switch to marijuana, which has no known lethal dose. According to the National Cancer Institute, “Because cannabinoid receptors, unlike opioid receptors, are not located in the brainstem areas controlling respiration, lethal overdoses from Cannabis and cannabinoids do not occur.” For those opioid users who have become addicted to opioids, substituting a drug that is not physically addictive and has no known lethal dose can only be a positive step.

While legalized medical marijuana results in relatively fewer opioid deaths, legalizing marijuana for recreational use seems to have resulted in an absolute reduction in such deaths. A 2017 study published in the American Journal of Public Health found that opioid mortality rates in Colorado fell following the legalization of recreational marijuana, reversing an upward trend in opioid deaths.

The stated preference of many opioid users for marijuana, combined with lower opioid hospitalization and mortality, means legalized marijuana likely correlates to a lower demand for opioids and a higher demand for marijuana.

SUPPLY

Over time, the price of recreational marijuana in Colorado and Washington has fallen. That’s because legalization, when it’s done right, drives competition and that drives innovation, leading to more efficient production and distribution. Ideally, prices fall below black market rates, thereby supplanting the black market created by prohibition.

Illegal substances are more risky to produce, transport and sell because every party faces the possibility of criminal sanction. Moreover, the inability to enforce agreements legally means that enforcement typically comes by way of a gun. So the prices of illegal substances tend to be higher than their legal equivalents—to compensate parties for the additional risks they face and because illegal markets tend to be subject to local monopolies. This results in a cascade of unintended, harmful consequences to society. Full legalization removes these risks to producers, sellers and users, thereby eliminating the associated violence and related social harms. 

ENDING THE WAR ON DRUGS AND WINNING THE WAR ON SOCIAL HARMS FROM DRUGS

Legalization of marijuana would bring transparency to business transactions and address many goals that the War on Drugs has failed so miserably to achieve:

Reduced harmful drug use: With legal options, both recreational and therapeutic drug users are less likely to use and become addicted to more-dangerous substances, as found above with opioids.

Decreased overdose mortality: According to the American Society of Addiction Medicine, “Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015.” When legal or illegal opioid use is displaced by legal marijuana use, overdose mortality declines, as found in Colorado. And it does so at no cost to the taxpayer (indeed, since legal weed is taxed, it actually generates revenue). As such, it is a highly cost-effective way to address this tragic problem.

Mortality from illegal opioids is typically due to overdose. That can be simply the result of a mistake on the part of an addict. But it is often caused or exacerbated by drugs that do not contain what vendors claim they contain. Often fentanyl is cut into or sold as heroin. With fentanyl’s vastly lower lethal dose, heroin users are more likely to overdose.

Tainted drugs also play a part. Sellers can derive greater profits when cutting heroin or fentanyl with visually similar substances, such as laundry detergent and strychnine. Opioid users who substitute marijuana also run the risk of tainted product in states where marijuana is illegal. Illegal marijuana is sometimes moistened with water or even Windex as a means of increasing weight or volume and masking the smell of mold.

But with legalization comes known supply chains, reputation and liability (customers can sue if they are sold a tainted product). That means cannabis bought legally is far less likely to be cut with unknown and possibly toxic substances, or let to mold. Customers of legalized marijuana can know the strength of what they’re buying, unlike buying in the black market, which means a more informed consumer who can make better choices about product and dose.

Reduced drug-related incarceration rates: By definition, legalization brings a lower incarceration rate, but that’s not the goal here. After all, legalizing murder would cause the homicide incarceration rate to plummet! An incarcerated murderer is less likely to murder others. But when a substance that is far less lethal than alcohol is banned, arguably justice is out of whack and incarceration is uncalled for. The ACLU found that in 2010 American police arrested more people for (typically small amounts of) marijuana than for all other illegal drugs combined. This has cost taxpayers billions of dollars and has inflicted pain on many young lives unnecessarily and unfairly, and not only through incarceration. Merely having an arrest record prevents many from gainful and productive employment. Legalization rectifies this imbalance of justice, relieves overwhelmed prisons, and does not arbitrarily favor alcohol over marijuana. 

Reduced dangerous drug availability: We’ve learned through the failed War on Drugs that availability (supply) cannot be legislated away. The only effective recourse is lowered demand. While demand for marijuana has increased in states where it is legal, it appears to be displacing use for more-dangerous drugs—a welcome trade-off.

Reduced social harms: With marijuana legalization cutting the black market price, drug cartels have had to abandon marijuana trafficking in favor of heroin and other opioids that can still turn a profit on the black market. With a reduced share of the market comes reduced illicit drug activity and all the social harm it engenders, such as rampant theft and other property crime, street violence, territorial shootings and other gang-related illicit drug activity. This decreases violence, which often spills over into mainstream society, especially in places with high illicit drug use and trafficking.

Marijuana legalization is chipping away at the social and personal harms of dangerous drug use more effectively and vastly less expensively than the failed War on Drugs. While it’s less offensive to blame other nations than ourselves, interdiction doesn’t lessen demand for illegal drugs in this country: it makes them scarce and expensive, and drives a host of black market, underground, violent criminal enterprises. Moreover, it costs billions of dollars that could be used for other more socially useful purposes, including prevention and treatment of addiction. Conversely, marijuana legalization moves transactions into legal markets, allowing a vastly safer alternative for recreational and medical opioid users.

In economics 101, students learn about the “laws” of supply and demand. The War on Drugs has been waged in ignorance of this lesson. Legalization of marijuana shows that those laws still prevail and can be used to win the war on social harms from drugs.

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How Illicit Drug Policies Undermine Good Police Work, or ‘The Toothpaste Effect’ https://reason.org/commentary/how-illicit-drug-policies-undermine-good-police-work-or-the-toothpaste-effect/ Wed, 14 Mar 2018 18:33:43 +0000 https://reason.org/?post_type=commentary&p=22986 Years ago I was at the airport trying to sneak a small tube of toothpaste through security. This is not because I enjoy bedeviling the TSA, but it was a long trip and I wanted to be able to brush … Continued

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Years ago I was at the airport trying to sneak a small tube of toothpaste through security. This is not because I enjoy bedeviling the TSA, but it was a long trip and I wanted to be able to brush my teeth during a layover. But of course I got caught. The TSA agent looked at her x-ray monitor, then thrust her hand into a small inner pocket of my purse and withdrew the offending tube with a flourish. She brandished it in front of me, saying, “now you know you can’t have toothpaste!” Then she blithely tossed it in the trash on top of sewing scissors, water bottles and other contraband.

Her words struck me. I believed she knew that the tube contained nothing but toothpaste, but, having equated toothpaste, water and any number of substances with bomb-building materials and terrorism, her mind had transferred the danger of bombs to these substances: Toothpaste itself had become evil.  

Unfortunately, if we don’t remain vigilant, police work can suffer the same fallacy of transference. I found this to be true in the LAPD South Bureau Narcotics unit, where I had gained a coveted spot after working years of patrol.

Patrol officers respond to radio calls, citizen flagdowns, and whatever they might observe while patrolling the streets of their beat, often assisting people in crisis or danger, and quelling angry disputes through interpersonal skills or, if necessary, force. The common domestic dispute provides a great example. While many clear cases of domestic abuse terminate with arrest, police often arrive when tensions are escalating, but no crime has yet occurred—likely just a lot of pushing, screaming and threats that cause neighbors to call the police. But the children are terrified, there are holes in the wall, items are broken, and even police presence is no deterrence as the couple continues their dispute. What do police do in such a case? They do what they can to calm the situation at the time, which is usually finding a way to separate the couple temporarily to give them a chance to cool down. First, run the most out-of-control person for warrants and make an arrest. No warrants? Then ask if one of the two people can go to a relative’s or friend’s house for the night, and sometimes even provide the transport there, reducing the chance for harm, at least for that night. The point is, the police are doing what they do best—focusing their authority and applying the law in the service of mitigating harm to people. When law enforcement’s done right, with a focus on the people involved, it’s good police work.

Narcotics works differently, changing the incentives for officers and thereby changing the nature of police work. Mandatory minimum sentences have made the illicit drug trade so consequential that many drug dealers, especially in customer-heavy places like South L.A., are extremely picky about who they’ll sell to. As a result, it’s virtually impossible for even the most convincing undercover officer to buy there. Our team employed a “CI” (confidential informant) to buy for us, so we could show that a certain house was selling illicit drugs, as grounds for a search warrant. Our CI looked the part because she was a crack addict herself who lived on the streets. We gave her a $20 bill we’d photographed for ID purposes for her to buy with, and from a distance watched with binoculars as she bought the drugs. She then swapped the drugs with us for her own payment of $20, which she then left with to buy crack. CI drug buys are extremely dangerous, because if the sellers get even a whiff of suspicion that she’s working for the police, they’ll put a hit out on her. Our team often bemoaned how dangerous this was for her and were genuinely worried for her safety, but since the job of narcotics units is seizing large quantities of illegal drugs, the team had developed an ends-justify-the-means mentality—we needed the CI to get to the drugs, no matter how dangerous the buy was.

Soon after, we’d serve the search warrant, pulling off the front doors, rushing in through the house, and yelling for everyone to lie down on the floor. Such rush tactics were necessary to preclude suspects’ destroying the drugs we wished to seize. Often these drug-selling operations had children milling about, and while officers—many of whom have children themselves—tried not to scare the children, it was inevitable, given our military-style clothing, helmets, automatic rifles, and the fact that we were forcing the adults who cared for them onto the floor against their will. Once everyone was handcuffed, the situation calmed. We seized the drugs, guns (which were always plentiful), and often money (to include the photographed bill our CI used, as proof of sale) and determined which suspects to arrest. Eventually we left the scene with these items and arrestees, but that left behind children and people we’d let go, who may not have had any other shelter, in a house without a front door.

It’s a different mindset from back on patrol, where the law is supposed to be used to protect people from harm. In narcotics, the goal was “dope on the table”—the more the better. Back at the station we carefully weighed it and booked it all into evidence, which generally resulted in fairly long sentences for the individuals we had arrested. These drug sellers were typically hardened gang members who lived by the sword themselves—not Citizen of the Year material—but it’s difficult to conclude that those arrests and seizures were worth the upheaval caused, especially to those who were not charged (who were still part of the drug selling operation, but not main players), or the truly innocent bystanders—children, or neighbors who might have been injured if we did shoot someone, as bullets often go through walls.

Illegal drug activity is certainly responsible for widespread collateral violence due to the territoriality of selling in the black market and the desperate nature of addiction. But when laws and practices prioritize seizure of the drugs themselves, they encourage police to see the drugs as the primary target, with little regard for potential or actual damage to people. This transference of focusing on the social harms caused by illegal drug activity to targeting the drugs themselves rewards officers for disregarding human harm. These narcotics search warrants create dangerous environments—the opposite of what police work is intended to do. This is because, for narcotics units, success is not measured in crime but in kilos.

My patrol sergeant used to tell us about our cop conscience, saying it was something we had to consciously develop. “If you’re doing something and you get a bad feeling about it, you better listen to that because it’s probably your cop conscience,” he would say. “Stop and make sure you have the legal grounds to do what you’re doing, and that it’s right morally.” That works on patrol, where officers are focused on harm to people, but not in narcotics. The longer that officers work in the drug interdiction environment, continuing to view the drugs themselves as the danger, the more their cop conscience erodes, as “dope on the table” replaces preventing harm to people as the moral objective.

When illegal drugs are considered evil themselves, then soon police officers can’t tell the bombs from the toothpaste. My narcotics unit teammates had been fine patrol officers—which is why they were selected for the narcotics unit to start with—but laws, policies and public attitudes that reward looking for “toothpaste,” not “bombs,” undermine what good police work should be. Surely there’s a more effective way to deal with our society’s pervasive drug problems. But recognizing that good police work should “first, do no harm” is a solid first step.

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How Do Police Officers Determine Marijuana Impairment in Drivers? https://reason.org/commentary/how-do-police-officers-determine-marijuana-impairment-in-drivers/ Thu, 22 Feb 2018 05:01:04 +0000 https://reason.org/?post_type=commentary&p=22494 Now that several states have legalized medical and recreational marijuana, police have to come up with a strategy for determining when drivers under the influence of marijuana are impaired.

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Now that several states have legalized medical and recreational marijuana, police have to come up with a strategy for determining when drivers under the influence of marijuana are impaired. Obviously, in states where marijuana use is illegal, a driver with any cannabis on board is committing a crime. But for states where it is legal, levels and impairment are key to assessing whether the driver should be taken off the road. Some states rely on chemical testing alone and/or per se standards, such as with alcohol, even though blood level of cannabis is not directly correlated to impairment level. Others states rely on officers evaluating impairment via Drug Recognition Expert evaluations.

Typically, a patrol officer conducting a traffic stop of a driver who appears to be impaired looks to ascertain first whether the driver is under the influence of alcohol or not. If the impairment is more than a simple alcohol-based DUI, a Drug Recognition Expert (DRE) is summoned to the scene (in departments that have them). The DRE will do a quick roadside assessment to determine whether a full DRE evaluation at the station is necessary. The roadside assessment allows the DRE to rule out medical pathologies and gain basic information.

For example, the officer can tell a lot by looking at the pupils:

unequal—medical pathology; call an ambulance.

horizontal gaze nystagmus (HGN)—This is the involuntary horizontal jerking of the eyes, especially at the outer corners, as they track an object. When an officer asks you to keep your head straight and follow the movement of a pen or some other object, he’s probably looking for HGN. It signals alcohol or depressant use, and possibly other drug classes, but not typically marijuana. If alcohol is the only drug on board, the DRE can gauge the blood-alcohol content (BAC) roadside to determine if it matches the driver’s impairment or not. If the HGN is egregious, the DRE will look for VGN–vertical gaze nystagmus.

vertical gaze nystagmus—This is the involuntary vertical jerking of the eyes. Any substance, including alcohol, that produces HGN will also produce VGN in a high dose (varies by individual), but no drug causes VGN without HGN. Such an event would suggest a medical pathology. If alcohol is the only drug believed to be on board, this suggests a high rate of intoxication and medical intervention should be considered.

resting nystagmus—This is the involuntary jerking of the eyes horizontally and vertically when facing straight. This signals the DRE to look for other drugs on board, typically PCP, especially if the subject has a distinct chemical odor and is sweating profusely.

extreme dilation/constriction of pupils (beyond normal range)—This sign often reflects the use of stimulants (meth/cocaine) or opiates, respectively.

pulsating pupils—This is useful information for the officer, as it signals withdrawal from certain drugs and/or indicates multi-drug use.

The DRE will also check for markers of medical reasons for impairment—diabetic shock, stroke, concussion, injuries, etc. Based on this roadside assessment, if the DRE forms the opinion that drugs other than alcohol are the likely cause of impairment, it’s time to conduct a full evaluation at the station.

The full DRE evaluation is a 12-step process that must occur in controlled conditions, such as are provided at the station. It includes several physiological measures such as blood pressure and heart rate, as well as asking the subject about any prescription drug use. As well, an expanded field sobriety test (FST) evaluates divided attention, coordination and time-assessment skills—the skills specifically needed for driving. Subjects have to walk in line and turn, stand with eyes closed and estimate time, stand on one leg, and touch a finger to nose. Whether the subject fails, and if so, how they fail, correlates to impairment by different drug classes.

Cannabis has many FST “markers,” but there are also important clinical markers. For example, physiological markers for cannabis include elevated pulse, dilated pupils (in all light conditions), lack of eye convergence (you can’t cross your eyes—but some folks can’t do this anyway), rebound dilation (dilation of pupils after a light has been applied and after eyes initially constrict), bloodshot eyes, eyelid tremors when eyes are closed, and body tremors while standing.

How did DREs arrive at these markers for cannabis? Back in the 1960s, when illicit drug use, including marijuana, became popular in the U.S., LAPD traffic officers noted that heavily impaired drivers were blowing zeroes on alcohol breathalyzers, forcing officers to hand them back their keys because there was no law on the books to arrest them. A team of these LAPD traffic officers compiled lists of the correlations between physiological markers present during the psychoactive phase of drug use and chemical test results showing which drugs were in a subject’s system, and worked with medical experts to correlate drug categories with signs and symptomatology. These markers concentrate on physiological markers a subject can’t voluntarily control and present themselves only when drugs (to include alcohol) are psychoactive in the subject’s system.

From these correlations, a step-by-step evaluation process, which includes a urine or blood test, evolved. DRE officers used these evaluations to form an opinion as to the source of impairment. These opinions were confirmed by toxicology tests over 90% of the time. This does not imply a 10% error rate, as sample collection times, lab capabilities, etc. play a part, and many drugs cannot be effectively tested (some hallucinogens, designer drugs, not to mention Tide pods and other oddball drug fads). This accuracy rate allowed officers to make these arrests—taking these dramatically impaired drivers off the road—and work within the court system to prosecute these offenses. Currently, nationwide tracking allows state DRE coordinators to monitor toxicological confirmation of DRE findings, ensuring DRE accountability.

While not all cannabis users will display all the physiological characteristics (and some people have a few of these characteristics cold sober), it’s a matter of forming an opinion through the aggregation of the symptoms and signs. As my sergeant used to say, “If you have a round flat piece of bread, do you have a pizza? No. If you put tomato sauce on it, do you have a pizza? No. But when you add in cheese and pepperoni, now you have a pizza.”

The officer has to “have a pizza” to call cannabis. Rogue officers don’t live up to this standard, but there are few of them (really there are—they just get a lot of media attention, like everything else now), and there should be zero tolerance for them.

Since the evolution of DRE evaluations, NHTSA and IACP (International Association of Chiefs of Police) and other organizations have conducted studies of impaired subjects vs. controls for each drug class evaluation by DREs. Regarding marijuana specifically, here’s the best of these studies I found on cannabis markers in DRE evaluations.

These correlations are not easy to study outside of a scientific setting, as—what most people don’t realize—the number of drugged subjects encountered by police who have only one drug in their system is quite small. Almost all have at least two on board, and street addicts commonly have five or six, especially in large urban areas. Such “cocktailing” makes DRE evaluations complicated, as users on drugs with opposing signs, such as, for example, stimulants and opiates, at the same time can have normal blood pressure, pulse rates and pupil size. But are they impaired? Yes, they are. So that’s when other markers come into play.

DREs are especially important in cases of marijuana-impaired drivers, because of the nature of marijuana itself. As with other non-alcohol drugs, marijuana impairment varies tremendously by individuals, even under the same dose. As with other non-alcohol drugs, marijuana does not break down in the body in a manner that correlates with psychoactivity of the drug (alcohol is the exceptional drug in this regard, not the norm), making chemical testing results of little use in determining impairment. In contrast, with few exceptions, the signs and symptomatology of marijuana ingestion that DREs evaluate will not appear when the drug is no longer psychoactive in the subject, but can still appear in chemical testing for weeks after use. For these reasons, DRE evaluations are far more accurate in determining marijuana impairment in drivers, and police departments should make use of these highly trained officers, especially in states with legalized marijuana use.

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