Figure 1. Drug Overdose Deaths by Substance

Source: Years 1999 to 2020 from CDC WONDER; Year 2021 reports preliminary data from NCHS.

Addiction in the United States has been dropping for the last 20 years (Figure 2). Opioid addiction, in particular, has been dropping for approximately 10 years. In 2002, 9.4 percent of Americans were addicted to a drug, including 0.7 percent of Americans addicted to opioids. In 2019, the last year measured with a comparable standard (DSM-IV), 7.4 percent of Americans were addicted to substances with 0.6 percent of those being addicted to opioids. Additionally, record levels of naloxone and addiction treatment medications are being distributed, which means more people received addiction treatment in 2021 than any other year in American history.

Figure 2. Addiction Rate (%) in the U.S. by Substance Over Time​​

Sources: Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health, SAMHSA; Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health, SAMHSA.

Fewer Americans are addicted to drugs and more of those who are addicted are receiving medication-assisted treatment for addiction, yet more people are dying from drug use. So, what is going on?

The reality is that drug addiction and drug-related deaths don’t have much of a relationship. Drug-related deaths are almost solely caused by the safety of the drug supply, which is made more dangerous by successful drug enforcement. 

Public health interventions like prescription drug monitoring programs (PDMPs), which have been implemented in recent years to reduce opioid prescribing—and have successfully reduced the numbers of opioids prescribed by doctors since 2012—have motivated more drug users to resort to the black market for their fix. And when law enforcement becomes more successful at seizing illegal drugs, traffickers increase the potency of their narcotics to evade detection.

For example, as the Drug Enforcement Administration (DEA) successfully seized increasing amounts of heroin between 2010 and 2014, they soon started to seize fentanyl instead in the years following. During this shift, overdoses by fentanyl replaced those caused by heroin, but at a higher rate. And now those with substance use disorder are dying at such a high rate that overdoses are spiking despite a shrinking population of regular drug users. That means addiction is dropping in the U.S., but our drug-enforcement policies are killing more drug users by driving them to potent, unregulated products like fentanyl.

Some media outlets are starting to better connect these relationships. U.S. News & World Report, for example, recently reported “Teen Overdose Deaths Have Soared, Even Though Drug Use Hasn’t,” which could have been written about most age groups in the U.S. Reason has written about this false relationship for decades. But if we are to finally address drug-related deaths in this country, we will need this insight to become common knowledge amongst policymakers, public health officials, and the public-at-large.

Lawmakers intentionally reduced the rates of legal opioid prescribing by doctors, but drug-related deaths in the United States continue to climb to unprecedented heights every single year. If the U.S. continues its failed drug war approach, Americans should, sadly, expect even more overdose deaths in the years to come, as black market drug producers will continue to have incentives to create more potent products. 

Americans can have fewer drug users or fewer drug overdoses, but it is unlikely to have both. Let’s hope that the country reconsiders its opioid policies and opts to be a humane society that leans towards more freedom and less death.

The post Over 100,000 died from drug overdoses in 2021 as public policy drives people to fentanyl appeared first on Reason Foundation.

The Centers for Disease Control and Prevention reported 70,630 drug overdose deaths for 2019 in the United States, 70.5 percent of which were opioid-related. Amid unprecedented drug-related mortality across the entire United States, Prescription Drug Monitoring Programs (PDMPs) are the most popular interventions states enact to address opioid addiction and overdoses. Prescription Drug Monitoring Programs allow health officials and law enforcement to review the prescribing histories among doctors and patients in hopes of reducing inappropriate prescribing that might lead to addiction or death. However, the inception of PDMPs has been followed by increasing rates of opioid overdose and stable rates of drug addiction. With 19 years of mortality data, this analysis assesses whether Prescription Drug Monitoring Programs have significant effects on either opioid prescribing or mortality.

This study finds that, although Prescription Drug Monitoring Programs’ intermediary purpose to reduce prescribing has been achieved by reducing opioid distribution by 7.7 percent, they have had inconsistent effects on prescription opioid overdoses, while increasing total opioid overdoses by 17.5 percent due to increased mortality from the black market varieties by 19.8 percent.

FIGURE ES1: STATE-LEVEL DEATH RATES FROM LICIT AND ILLICIT OPIOID OVERDOSES FOLLOWING PDMP IMPLEMENTATION BY STATE

Since Prescription Drug Monitoring Programs fail to achieve their ultimate goal of reducing opioid overdoses, their funding should be re-appropriated to more effective mechanisms to reduce addiction and overdose rates, such as providing access to prescription-quality opioids for medication-assisted treatment (MAT).

Introduction and History

Prescription Drug Monitoring Programs (PDMPs) have been used in the United States since the early 20th century. Prior to 1914, natural opiates—the predecessors to modern synthetic or semi-synthetic “opioids”—were unregulated by the federal government and widely available for purchase without prescription in most of the United States.¹ Use among the American public was quite commonplace. According to one article published in The New York Times, one in every 400 United States citizens had some type of opiate addiction by 1911, reportedly due to “the sudden emergence of street heroin abuse as well as iatrogenic [induced by medical treatment] morphine dependence.”²

In response to rising levels of Chinese immigration to the U.S., which was blamed for rising rates of opium use, states like California began outlawing the recreational consumption of various narcotics. San Francisco became the first U.S. municipality to enforce an anti-narcotics law in 1875, outlawing the operation of opium dens, which became state law in 1881. By 1907, California’s State Board of Pharmacy quietly lobbied for an amendment to the state’s poison laws, which prohibited the sale of opium, morphine, and cocaine except by a doctor’s prescription.³

Eventually, the U.S. Congress passed the Harrison Narcotics Tax Act in 1914, the first federal statute regulating the production and sale of opiates and cocaine, which was enforced as a ban on the recreational sale of both products. Under this law, physicians across the U.S. were also restricted from prescribing opiates to addiction patients, and all proprietors of opium products needed to be registered with the federal government, creating the ancestor to the modern PDMP databases.

In an effort to further combat overprescribing, states slowly began to develop their own monitoring programs, the first of which was created in New York in 1918. However, these early PDMPs were rather slow in their collection speeds and used inefficient paper reports to monitor the prescription history of patients. ⁴

These programs developed throughout the mid-20th century and were rather ineffective, as “[p]rescribers were required to report to databases within 30 days, too long a time to reasonably be useful in preventing real-time ‘doctor shopping’ or over-prescribing.”⁵ Additionally, there were no electronic databases tracking which patients had recently filled opioid prescriptions for doctors to reference.

Given the weaknesses of these early PDMPs, few states adopted any type of monitoring program over the course of the first half of the 20th century. However, the proliferation of PDMPs was greatly enabled by the ruling of Whalen v. Roe in 1977, a case that upheld the constitutionality of New York’s precursor of the PDMP under the broad police power given to the states by the Tenth Amendment. The plaintiffs of this case argued that the monitoring program constituted an invasion of patient privacy, due to its collection and storing of prescribing records. Writing for the majority, Justice John Paul Stevens held that, “[n]either the immediate nor the threatened impact of the patient identification requirement on either the reputation or the independence of patients…suffices to constitute an invasion of any right or liberty protected by the Fourteenth Amendment.”⁶ With the constitutionality of patient prescription monitoring upheld, states were able to pursue data collection on prescribing history more thoroughly. Empowered by this ruling, many more states began to operate some form of a PDMP.

By 1990, states such as Oklahoma and Nevada began to adopt electronic reporting systems, greatly expanding the capabilities of these programs. These improvements reduced operations costs and increased the accuracy of the databases, leading other states to consider them as a viable means to monitor opioid prescribing.⁷

In 2003, the PDMP seemed to be an effective way to combat opioid overdose deaths. Given that the majority of opioid deaths in 2003 were due to prescription drugs, the program’s intended purpose of limiting opioid prescribing seemed logical. In that year, Congress further increased funding for state PDMPs through the Harold Rogers Prescription Drug Monitoring Programs Grant, a competitive federal program that allows states to receive funding to “enhance the capacity of regulatory and law enforcement agencies and public health officials to collect and analyze controlled substance prescription data…through a centralized database administered by an authorized state agency.”⁸

Although PDMPs are implemented at the state level, federal law enforcement such as the Drug Enforcement Administration (DEA) has unfettered access to the prescribing records states collect. States such as Oregon and Utah have challenged this power on Fourth Amendment grounds, but federal courts ruled in favor of the DEA saying state law provides a “positive conflict…so that the two cannot consistently stand together” against Oregon in 2014 and “physicians and patients have no reasonable expectation of privacy from the DEA” against Utah in 2017.⁹

Due to increased access to funding and resources under the Harold Rogers Program, by 2016, every state with the exception of Missouri had enacted some form of a PDMP (see Table 1). States vary on the extent to which types of participation in these databases are mandatory and on what types of drugs are monitored. All states with PDMPs monitor at least Schedule II-IV opioids, and the majority of states also monitor prescriptions for Schedule V opioid products, such as codeine cough syrup. PDMPs are administered by state government agencies and compile accessible information on prescribing histories, which is entered into the database by health care providers. These systems are updated on a daily or weekly basis, depending on the state.“¹⁰

The PDMP is now widely regarded as an effective policy mechanism that states can use to combat the opioid crisis. Given the crisis’s wide-reaching effect across the United States, policies such as this aimed at curbing opioid overdoses are now considered a priority by politicians across the political spectrum. Legislators with ideologies as differing as Senators Bernie Sanders (D-VT) and Rob Portman (R-OH) have rallied in unison to support legislation aimed at lowering overdose deaths. In a time of unprecedented political divide and gridlock, it is exceptional for any policy to garner such universal support.

For example, in October of 2018, the U.S. Senate passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act—a bill that strengthened state PDMPs by encouraging interstate sharing of data through nationwide databases such as PMPi Hub and RxCheck Hub and mandated PDMP use for all Medicaid providers—by a margin of 98-1 in the Senate, indicating the unified nature of mainstream political thought surrounding this crisis. Though all PDMPs are administered by the states, this legislation enhanced funding for state PDMPs and created a mechanism by which a patient’s prescription history could be accessed across state lines.¹¹

The dire magnitude of the opioid crisis has created an imperative for legislators, forcing them to act quickly in order to stem the rising level of overdose deaths. As Senator Ted Cruz (R-TX) stated in 2018 while endorsing the SUPPORT for Patients and Communities Act: “[t]oo many lives have been lost to the opioid crisis….I am proud of Congress’s actions today to take a stand in efforts to save millions from the ravages of drug addiction.”¹²

It is this sense of urgency—legislating in response to tens of thousands of overdose deaths every year—that has created almost universal support for these interventions, with little, if any, public debate or criticism of them. The only abstention in the Senate to the SUPPORT Act was Sen. Mike Lee (R-UT), who originally publicly endorsed congressional intervention at the American Enterprise Institute, but later expressed worry that the bill would be ineffective despite its good intentions:¹³

There are some very good elements in this opioid response bill, including strengthening U.S. Customs and Border Protection authority to discover and destroy packages containing illegal controlled substances. Unfortunately, the bill also includes dozens of new grant programs with little accountability for how the dollars will be spent and minimal measurement or analysis on their effectiveness. Good intentions are not enough. In the face of a crisis such as this, we cannot afford to waste precious funds on programs which likely won’t work.¹⁴

This study finds that Prescription Drug Monitoring Programs fail at their major goal to reduce opioid overdoses. Although Prescription Drug Monitoring Programs successfully decrease prescription rates, they also increase the use of black market opioids. Consequently, as Prescription Drug Monitoring Programs cut off users from legal channels of prescribing and force them to switch to more dangerous illicit drugs, this unforeseen substitution to illegally purchased heroin and fentanyl is the principal reason why Prescription Drug Monitoring Programs ultimately lead to more drug overdose deaths.

Full Policy Study— Prescription Drug Monitoring Programs: Effects on Opioid Prescribing and Drug Overdose Mortality

The post Prescription Drug Monitoring Programs: Effects on Opioid Prescribing and Drug Overdose Mortality appeared first on Reason Foundation.

Ballot measure 110, supported by 58.5 percent of Oregon voters, decriminalized the possession of small amounts of all drugs, including heroin and cocaine. The voter initiative reclassified possession of these substances from a misdemeanor to a simple violation. Instead of a jail sentence, individuals found with so-called hard drugs will face a completed health assessment or a $100 fine. The reclassification only applies to possession of amounts reflecting individual use, and criminal penalties remain for anyone found distributing or manufacturing illegal drugs.

Oregon has some of the highest rates of substance abuse in the country and a report from the Oregon Substance Use Disorder Research Committee found that one in 10 Oregonians struggle with a substance use disorder (including both drugs and alcohol).  The challenges posed by substance abuse disorders are worsened by Oregon’s particularly poor levels of accessibility to treatment services. Incarceration of those with substance use disorders has proven to be ineffective. It is not a deterrent to drug use, it does not make drug users any safer and it doesn’t reduce risks of overdose.

Beyond the relaxation in law enforcement efforts related to drug use, Measure 110 also places a greater focus on wellbeing and care for individuals with substance abuse issues in Oregon.

The measure, financed by a diversion of existing marijuana tax revenues, includes the creation of an oversight and accountability committee to distribute grants related to recovery and addiction treatment services. Committee members will include state residents who have struggled with substance abuse disorders, formerly incarcerated individuals, and experts within the drug treatment community. New 24/7 addiction recovery centers will be established to conduct health assessments and facilitate a path to sobriety for those who wish to avoid the $100 fines that may be assessed. Access to the treatment centers is available for everyone in the state—not just those who come into contact with the police.

All in all, Oregon’s new drug policy seeks to reduce high rates of substance abuse by removing the punitive aspect of drug policy and instead of treating individuals’ underlying mental health and addiction problems. Fundamentally, this approach recognizes that addiction is a mental health condition that often requires treatment to overcome.

Understandably, some Oregonians are concerned that decriminalization will lead to a surge in drug use. However, the data suggests otherwise. Several countries, including Switzerland and the Netherlands, have decriminalized the personal possession of drugs. The first country to do so was Portugal in 2001. Portugal’s decriminalization policy aimed to improve the worsening health of the country’s drug-using population, particularly those who injected drugs.

Like Oregon, one of the central aspects of Portugal’s policy was the establishment of free treatment facilities along with information campaigns about the harms of drug use and needle exchanges. Individuals found with drugs on their person were charged with an administrative offense that required them to be seen before a committee where they were either offered treatment or a small fine.

Interpretations of the drug use data in Portugal vary widely depending on the metrics used, however, a collation of figures from the Transformation Drug Policy Foundation found that decriminalization, on the whole, was not associated with a rise in drug usage. Drug use rates in Portugal are now below the European average for cocaine, methylenedioxymethamphetamine, and amphetamines.

With nearly 20 years of data and documentation to assess the success of the policy, it is unsurprising that Oregon’s Measure 110 was largely inspired by Portugal. A wide body of research has shown a lack of relationship between the severity of drug laws and rates of drug usage. The studies focusing on drug use amongst adolescents are particularly reassuring.

Tracking the drug use of adolescents (aged 15-to-34) over time in Portugal has shown a steady decline in the use of cocaine, amphetamines, and MDMA between 2007 and 2012. Figure 1 below shows that since 2012, there has been an even greater decline in cocaine use.  More generally, continuous drug usage (relating to individuals who use drugs regularly) has decreased since decriminalization. These results certainly do not constitute a surge in drug use.

Figure 1: Young Adults In Portugal Reporting Use of Drugs

(left to right: cocaine, methamphetamines, and amphetamines)

Source: European Monitoring Centre for Drugs and Addiction.

Data from Portugal suggests that many benefits arise from treating drug use with health services instead of criminalization including a reduced burden on the criminal justice system, a reduction in deaths caused by overdose or drug-related illnesses, and a reduction in addiction rates.

Although some still fear Oregon’s new policies may increase drug use, but history in Portugal and elsewhere shows these results are unlikely to materialize in the state. And should Oregon’s policy succeed in reducing the negative effects of substance abuse problems, other states should soon consider implementing similar policies.

The post Oregon Decriminalizes Drugs, Replaces Arrests With Health Care appeared first on Reason Foundation.

Drugmaker Purdue Pharma, the company behind the powerful prescription painkiller OxyContin that experts say helped touch off an opioid epidemic, will plead guilty to federal criminal charges as part of a settlement of more than $8 billion, the Justice Department announced Wednesday.

The deal does not release any of the company’s executives or owners — members of the wealthy Sackler family — from criminal liability, and a criminal investigation is ongoing. Family members said they acted “ethically and lawfully,” but some state attorneys general said the agreement fails to hold the Sacklers accountable.

The company will plead guilty to three counts, including conspiracy to defraud the United States and violating federal anti-kickback laws, the officials said, and the agreement will be detailed in a bankruptcy court filing in federal court.

It’s easy to place all the blame on Purdue and other profit-motivated companies for the plight of opioid-afflicted communities, but that sort of surface-level examination by policymakers is part of the reason we have an overdose crisis. The most recent increase in opioid-related deaths has less to do with the number of OxyContin prescriptions and much more to do with drug users resorting to dangerous drugs sold by the black market after the government’s crackdowns on prescription drugs.

One of the main accusations against Purdue is that its marketing campaign underplayed the dangers of its opioid OxyContin and the risks of addiction for susceptible patients.  But according to the U.S. Substance Abuse and Mental Health Services Administration, non-medical use of opioid pain relievers remained stable during the period of increased opioid prescribing between 2002 and 2012. Following coordinated interventions across the country, the misuse of pain relievers did slightly decrease after 2012, but substitution to a black-market alternative, heroin, also increased in tandem.

Despite seeing record rates of opioid-related deaths recently, opioid addiction rates have actually dropped 33 percent since 2015. This trend seems to be consistent with most drugs. Cocaine addiction has dropped 33 percent since 2002, but cocaine-related deaths almost tripled over the same period. In fact, the data show that addiction rates for all substances tend to be unrelated to death rates.

Research shows that the increase in opioid-related deaths can sadly be attributed to the fact that people are using drugs, just as often as they always have, but the drug supply is more dangerous due to significant reductions in prescribing since 2012. The Centers for Disease Control and Prevention have even pointed to the fact that most of the recent opioid deaths have been caused by illegal opioids trafficked from China. As Jacob Sullum pointed out in Reason in October:

The perverse effect of restricting access to prescription opioids should not have been surprising, since the crackdown on pain pills pushed nonmedical users toward black-market substitutes that are far more dangerous because their potency is highly variable and unpredictable.

…Illegally produced drugs now account for the vast majority of opioid-related deaths. In 2018, according to the National Center for Health Statistics, the category of drugs that includes fentanyl and its analogs was involved in more than two-thirds of those deaths, while heroin was detected a third of the time. Prescription opioids like hydrocodone and oxycodone turned up in 27 percent of the cases, and many of those deaths also involved fentanyl or heroin.

Unfortunately, there’s too much scapegoating and money on the line for these facts to get in the way of the government’s crusade. For example, Mike Moore, the former attorney general of Mississippi who previously sued Big Tobacco companies for $246 billion, is now leading an effort in Cleveland, Ohio, to liquidate Purdue. He claims the pharmaceutical company falsely advertised to doctors that “if you prescribe your patients [OxyContin], there’s less than one percent chance they’ll get addicted. That was a lie, a big lie.”

But Moore’s claim is incorrect. When Purdue first introduced OxyContin in 1995, the one percent addiction rate that it advertised was conservative and studies show the chance of addiction is even less. In fact, despite opioid deaths that now number in the tens of thousands each year, there has only been one opioid overdose death for every 8,000 opioid prescriptions distributed since 2006.

Moore also claims “the Food and Drug Administration was asleep at the wheel while all this was happening.” That’s false, too. The FDA has actively addressed the concerns about OxyContin, fining Purdue $600 million in 2007 for misbranding and even encouraging the abuse-deterrent OxyContin reformulation in 2013. Unfortunately, it’s well-established that the government-mandated reformulation actually led to more heroin use and opioid overdoses.

Despite shaky accusations, Moore’s coalition of cases has added other pharmaceutical companies to the defendant list, which helps maximize the settlement amount possibilities. Four other companies have already settled for $260 million in Cleveland alone, and Moore is now pursuing hundreds of billions of dollars from the likes of Johnson & Johnson, CVS, and over 600 other defendants.

Individual states have also pursued their own cases but, unfortunately, their accusations tend to be equally littered with misinformation. In Florida, former Attorney General Pam Bondi filed a case against pharmacies that claimed CVS and Walgreens made “unconscionable efforts to increase the demand and supply of opioids into Florida” that “caused 5,725 deaths in Florida in 2016.” But neither company ever advertised their opioids—and there were actually 2,798 opioid deaths in Florida in 2016. Unfortunately, these types of inaccuracies aren’t limited to Florida, with others also frequently overstating their opioid death rates.

However, the precedent for these opioid-related cases shows massive settlements are possible, regardless of the accuracy of claims. During the one state-level case that went to trial, Oklahoma Attorney General Mike Hunter presented the following accusations:

“There are more prescription drug overdose deaths each year in Oklahoma than overdose deaths from alcohol and illegal drugs combined. Oklahoma leads the nation in non-medical use of opioid painkillers. And, in 2016, Oklahoma ranked number one in the nation in milligrams of opioids distributed … per adult.”

Every claim in Hunter’s statement was wrong but that didn’t stop him from getting a judge to rule Johnson & Johnson had to pay $572 million for Oklahoma’s opioid crisis. In contrast to Hunter’s claims, in 2016 deaths from illegal stimulants like cocaine and methamphetamine alone surpassed deaths from opioid painkiller prescriptions in Oklahoma. Likewise, contrary to his claims, alcohol-induced deaths, though not all technically overdoses by definition, nearly doubled prescription opioid deaths that same year. And Oklahoma was neither the leader in painkiller misuse nor opioid distribution per adult. It’s certainly clear that too many people were dying from opioids in Oklahoma, but Hunter’s blatant inaccuracies should’ve undermined his authority to assess damages.

It is clear that the government’s over-regulation of pharmaceutical products has been followed by more death. In this case, government policies have forced or encouraged pain patients to turn to more dangerous drugs, including heroin and fentanyl. But while it continues to target drugmakers, pharmacies, and others, do not expect the government to be held responsible for its own role in pushing prescription drug users to more dangerous drugs.

The post As Purdue Pharma Takes the Fall, Don’t Forget the Government’s Role In the Opioid Crisis appeared first on Reason Foundation.

There are still concerns over the increasing potency of marijuana and the impact it may have on users. 

California State Treasurer Fiona Ma publicly called out the state’s high cannabis taxes and burdensome regulations, saying, “…an estimated $8.7 billion is spent in our illegal market due to high taxes and a refusal by most cities to allow licensed shops, making it cheaper and easier for people to buy from illicit dealers.”

A new study by University of Washington scientists will seek to uncover whether cannabis use is safe during pregnancy or not. 

There are some in Oregon who think the oversupply of marijuana from the legal market is fueling black market operations, but federal laws, taxes, other legal complications are major contributors to the black market activity. 

Pennsylvania is set to expunge 30 million criminal records of low-level offenders over the next 12 months.

Harm reduction beats the drug war as a response to addiction.

A Massachusetts mayor was arrested and charged with extorting marijuana businesses in exchange for licenses and operations. 

Legislation, Regulation, and Markets

The global pharmaceutical industry is investing heavily in and preparing for the impending growth in demand for medical marijuana.

The Drug Enforcement Agency (DEA) has been ordered by a federal court to fulfill its 2016 policy of approving more suppliers for research purposes after the agency engaged in “unreasonable delays.” 

Maine looks to Portugal’s decriminalization experience for inspiration in expanding it’s already robust harm reduction programs.  

Businesses in California are offering mixed approaches to drug testing in the workplace, with some giving up testing altogether.  

The FDA is updating the graphic images placed on smoking warnings, but the attempt is unlikely to actually reduce smoking.

Florida Gov. Ron DeSantis signed a bill expanding needle exchange programs.

A roadside THC testing device used in Canada is being challenged in court over its ability to detect impairment.

British Columbia is selling less marijuana than expected due to lagging approval of licenses.

The Substance Abuse and Mental Health Services Administration, in its largest policy change in recent history, will now make more patient data available in prescription drug monitoring programs, including information about opioids. 

A new restrictive law in Illinois tells cannabis growers how much water and energy they are allowed to use. 

Evidence

A new analysis from RAND suggests that cannabis legalization has in aggregate reduced the flow of money to illicit marijuana operations in Washington state. 

A new study finds that crime rates dropped in neighborhoods where marijuana dispensaries opened.  

Pew examines how why estimating the demand for recreational marijuana is a difficult and unpredictable venture that has thus far been somewhat inaccurate.  

Using data from over 140 sellers, a new paper seeks to establish the price of cannabis on the dark web.

The University of Michigan’s annual national study suggests that cannabis use by US college students is at a 35-year high. 

New data about Colorado’s cannabis market has been released.

An online audit found that nearly 3,000 illegal cannabis businesses were found in California, dwarfing the number of legal dispensaries.

The post Reason Foundation’s Drug Policy Newsletter, September 2019 appeared first on Reason Foundation.

Proprietary Reason Foundation analysis shows there may not be a relationship between opioid prescribing, overdose deaths, and addiction, citing data from Germany. 

Clark University will offer a first-of-its-kind certificate program to prepare students for careers in cannabis policy and regulatory issues.   

Law students from Harvard and Stanford argue that the only way to end the opioid crisis is to end the war on drugs entirely. 

The significant presence of black market dispensaries in California and elsewhere demonstrates how black markets will continue to compete with legal marijuana markets in the future. 

Regulating marijuana to limit its potency has no firm scientific basis and leaves high-end products to be supplied by the black market. 

Shady practices in Florida pain clinics and may have contributed to the high number of opioid pills distributed in the state. 

Legislation, Regulation, and Markets

Illinois’ marijuana legalization bill will place the burden on employers to prove ‘identifying articulable symptoms’ in order to drug test for marijuana, providing one of the most employee-friendly environments in the country. 

To avoid falling behind in the CBD market, California is considering a bill that “clarifies that food, drinks, and cosmetics that contain hemp-derived CBD are legal for sale in California.”

Colorado Gov. Jared Polis recently signed legislation that will legalize marijuana delivery in the state, starting in January 2020.

A state attorney in Florida has ordered his assistant state attorneys to drop marijuana possession cases filed on or after July 1. 

Utah is considering a state-run medical marijuana dispensary system.

Evidence

The Competitive Enterprise Institute sent a letter to the federal government arguing that the Department of Health and Human Services’ 2015 evaluation of marijuana was incomplete due to lack of peer review and should be withdrawn.

A new study compared counties in Colorado that legalized recreational marijuana with those that did not and found no significant differences in the level of high school marijuana use.

The International City and County Management Association published a report on the local impacts of commercial cannabis. 

Researchers in Washington state analyzed wastewater for the presence of cannabinoids and concluded that legal marijuana use has increased and that the illicit market has significantly diminished. 

New data show recreational marijuana users drink more alcohol than medical users. 

The Center for Disease Control and Prevention recently released provisional drug overdose data, showing the first decline since 2014.  

A paper studying data from 2004-to-2014 found no significant decrease in opioid abuse after medical marijuana legalization. 

A new survey finds that people using cannabis reduce their use of painkillers and alcohol.

Adolescent exposure to marijuana may not be as damaging to brain development as previously thought. 

The post Reason Foundation’s Drug Policy Newsletter, August 2019 appeared first on Reason Foundation.

Drug-checking kits contain various tools to check drugs to ensure they are pure and not laced with anything dangerous. Currently, most states outlaw drug-checking kits because they are almost exclusively used by drug users. But drug paraphernalia laws only exist to reduce drug use and keep communities safe, and neither argument applies to drug-checking kits. In fact, subjecting drug users to mysterious black market drugs does just the opposite.

Maryland and Washington, D.C. are the latest places to remove drug-checking kits from their lists of illegal drug paraphernalia, and Colorado will soon join them. With synthetic opioid panics and stories regarding other contaminated drugs dominating the news, the technology that allows users to test the type and potency of substances could be the difference between death and life, allowing them another day to seek treatment.

Of course, there’s no regulation in the illegal drug industry, so it’s almost never clear what you’re actually getting when you purchase drugs. Someone attempting to buy LSD (or “acid”), for example, might end up with mint strips from the local pharmacy instead. A user could request methamphetamine, but actually end up with a substance cut with hydrochloric acid, which is never safe to consume. Some adulteration is harmless, but often it’s incredibly deadly.

Consider the case of cocaine, a drug that Americans have used consistently for years. Despite stable rates of consumption, cocaine-related overdose deaths increased more than 33 percent between 2016 and 2017. But that’s only because deaths involving cocaine are hardly ever due to the cocaine itself — they’re usually caused by fentanyl, a cheap synthetic opioid that’s about 50 times stronger than heroin and used to boost profit on cocaine sales.

After law enforcement started successfully seizing increasing amounts of heroin, traffickers sought to market a new product with a higher concentration to more easily conceal it and fentanyl was the perfect drug. Now that it’s flooding the United States mail system, the deadly synthetic opioid is finding its way into almost every black-market drug. Indeed, fentanyl was found in 52 percent of cocaine-related overdoses in 2017, but it doesn’t have to be this way.

There are legitimate ways to test for the presence of fentanyl and other adulteration in drugs. The only problem is that the tests are illegal and many users won’t bother with the inconvenience of illegally testing their drugs since paraphernalia is often used by prosecutors to increase punishment.

No matter what your position on the war on drugs, everyone should welcome innovations that can save lives. It’s inevitable that many people with addictions will continue consuming drugs regardless of the law, but when they do, we need to keep them alive so they can receive treatment later.

Drug-checking kits, like fentanyl testing strips, can prevent people from unknowingly consuming dangerous foreign substances and only enhance public health. They should be embraced by Colorado and other states that recognize our current approach to the war on drugs has been a tragic failure.

The article was co-written by Molly Davis, a policy analyst at the Libertas Institute.

This column originally appeared in the Pueblo Chieftain.

The post In Colorado, and Other States, Legalizing Drug Checking Kits Would Save Lives appeared first on Reason Foundation.

In California’s proposal, opioid makers would be taxed based on how many grams of opioids they distribute. Drugmakers would pass these costs on to patients. Thus, cancer patients, wounded veterans, and many others suffering from incurable pain would consistently be paying the state’s opioid tax. Since prescriptions for chronic pain are used for extended periods of time, people with chronic illnesses would disproportionately pay the tax. And since many of these patients have disabilities that prevent them from working, the tax could be an incredible financial burden for many people.

Given that less than one percent of both acute and chronic pain patients who are given opioids go on to become addicted, this tax would do little to prevent future opioid addiction. Indeed, the vast majority of those who become opioid addicts are people who already recreationally use other drugs. In fact, 78 percent of those abusing common prescription opioids never obtained their drugs via prescriptions from their doctors. And as opioid prescribing has continued to decrease, heroin use has increased. That’s why the majority of drug overdoses are now caused by injectable opioids like fentanyl and heroin, not prescription pills. It is also why the American Medical Association blames illegal drugs, not prescription medications, for most of the increase in drug overdoses in recent years.

For those suffering chronic pain, decreasing their access to medications and raising their taxes would be cruel and unnecessary. Instead of a tax, the state should look to policies that would reduce obstacles that are preventing patients from getting the medications and treatments they need.

For addicts in need of treatment, the state could increase the number of licenses available that allow doctors to provide medication-assisted addiction treatment. With medication-assisted treatment, people who are addicted to heroin or prescription opioids can be given medications like buprenorphine and methadone to reduce their cravings and risk of overdosing while receiving counseling.

Approximately 90 percent of substance abusers in California have never received treatment, so helping them can produce significantly positive results. In 2016, for example, Massachusetts expanded the number of licenses to provide medication-assisted treatment. And it issued a standing order to allow naloxone, which can reverse opioid overdoses, to be purchased without a prescription at pharmacies. A year later, Massachusetts was one of a small number of states that saw a reduction in total opioid overdoses.

California has already moved to provide access to naloxone and removed its step therapy laws, which require patients to try — and fail — with one treatment before moving on to the next. But there are currently not enough medication-assisted treatment licenses in California to treat everyone who has an opioid addiction so increasing the number of doctors who can help is the logical next step in reducing addiction and overdoses in the state.

An opioids tax that will ultimately be passed on to pain patients isn’t the answer. Californians should resist an opioid tax that would reduce access to chronic pain treatment, fail to prevent addiction, increase health insurance premiums, and possibly push more patients to seek out dangerous drugs on the black market.

This article first appeared in the Orange County Register.

The post California’s Proposed Opioid Tax Would Hurt Patients appeared first on Reason Foundation.

The NAACP and ACLU have come together to officially ask the DEA to suspend its drug enforcement activities as part of a shift “to treat drugs as a health issue, not a criminal issue.”  

There are key qualities about state legislatures and the political process that make it difficult to pass marijuana legalization bills legislatively, as opposed to voter ballot measure initiatives.

Navigating marijuana legalization and related issues, such as criminal justice reform and revenue allocation, are creating challenges in legislatures controlled by Democrats. 

Florida should embrace harm reduction approaches to the opioid crisis instead of doubling down on ineffective policies of the past.

Lawmakers in Connecticut have increased penalties for fentanyl sales, mirroring policies of the failed drug war.

The National Cannabis Industry Association has released its six goals for social equity in marijuana reform.  

Legislation, Regulation, and Markets

Illinois will become the first state to legislatively enact recreational marijuana instead of a ballot measure, as the governor has vowed to sign the bill on his desk.

Washington state passed a new law making it easier to vacate misdemeanor marijuana crimes.  

Massachusetts’ Cannabis Control Commission advanced plans to create social use consumption sites.

Delaware may be considering marijuana legalization in the near future.

Vermont and New Hampshire could both see delays in their legalization processes.

States are still wrestling with how to regulate workplace drug testing policies in both medical and recreational settings.

Most legal states only allow for marijuana consumption in the privacy of a home, potentially limiting an entire industry of cannabis-friendly hotels and consumption sites.

Florida may issue new hemp permits before the year is over.

Evidence

A new study shows a reduction in illegal marijuana grows in Oregon’s national forests since legalization.

Privately collected data from Leafly shows that the presence of dispensaries does not induce violent crime, but instead may actually improve home values.

A graduate student at the University of Colorado shows that THC blood concentration from cadavers varied dramatically depending on where on the body the sample was taken from.

Massachusetts’ attorney general still mistakenly believes that the opioid crisis is generated by pharmaceutical companies pushing legal scripts, which cause people to become addicted.  

A report from the Congressional Research Service concludes that there is no clearly discernible increase in traffic deaths since legalization, but that better data is needed before final conclusions are drawn.

Delivery services are an extension of legalization itself and do not represent any special social or economic costs.

Drug addiction in Europe is relatively lower than in the United States, according to the annual European Drug Report.

The post Reason Foundation’s Drug Policy Newsletter, June 2019 appeared first on Reason Foundation.

The federal government estimates that retail prescription drugs cost $333 billion in 2017, with pharmaceuticals administered in hospitals and medical offices adding about $150 billion more. A large share of third-party payments for prescription drugs are shouldered by state and local governments, which usually provide employee health insurance and other post-employment benefits.

The Legislative Analyst’s Office finds California’s Medi-Cal program spends around $8 billion a year on prescription drugs. The Los Angeles County Department of Health Services spends $242 million a year on prescription drug purchases, according to County Supervisor Janice Hahn.

Across the state, California’s public agencies have almost $200 billion of unfunded other post-employment benefit obligations (OPEBs). About one-seventh of those unfunded liabilities can be attributed to prescription drugs. OPEB burdens fall most heavily on certain local governments, with the Los Angeles Unified School District’s $15 billion worth of unfunded OPEB liabilities being the most visible case in Southern California.  Aside from providing retiree health coverage, the school district, like most public sector employers, shoulders the high cost of covering active employees and their dependents.

Given taxpayers’ exposure to prescription drug prices, advocates of small, efficient government should welcome parts of Gov. Gavin Newsom’s efforts to come to grips with this problem. Upon taking office, Newsom issued an executive order centralizing state drug purchasing into a single agency which will use its enhanced bargaining power to negotiate with pharmaceutical companies.  The order also invited local governments and private sector entities to join the state’s bulk purchasing initiative. Los Angeles County recently announced it would join Newsom’s initiative, further increasing its buying power and spreading the potential savings. Other counties could follow suit.

At first blush, this plan may seem like an attack on pharmaceutical companies who bear steep costs for securing the Food and Drug Administration’s (FDA’s) approval for new drugs. But it’s important to note that bulk purchasing is not the same as price controls: Newsom’s order does not compel drug companies to sell their products at a legislated price. It simply gives a state agency the ability to drive a hard bargain with suppliers on behalf of taxpayers.

Drug companies might not like that aspect of it, but there are other ways in which they clearly benefit from government interventions in the pharmaceutical market. In a pure free market, competition would restrain drug prices to a relatively small margin over the cost of production. But federal laws and regulations create monopolies for many prescription medications.

Patents, which often provide 10-to-20 years of protection against competitors, are usually justified as a return for companies bearing the costs of research and obtaining FDA approval. But, in many cases, companies receive lucrative patent protection without making large investments. For example, drug companies have learned to work the system by creating “me-too” drugs, which are very similar to existing medications but still qualify for extra patent protection.

AstraZeneca used this tactic when the patent on Prilosec, its gastro-esophageal reflux disease medicine, was expiring.  The company patented an almost identical medication named Nexium and urged doctors to prescribe it in lieu of Prilosec, which was switched from prescription to over-the-counter dispensing. Many patients opted for Nexium over Prilosec despite a massive price difference, because their insurance would cover the prescription drug —Nexium— while Prilosec OTC was not covered by most plans.

Overhauling the patent process along with shortening and streamlining the FDA’s long and expensive drug-approval process would increase competition and lower drug prices. Until that happens, the state, county and local government purchasers are wise to use their negotiating power to lower prescription drug prices borne by taxpayers.

This article first appeared in the Orange County Register.

The post High Prescription Drug Prices Hit Pension Plans, Hurt State and Local Taxpayers appeared first on Reason Foundation.

That’s clearly a crisis that needs to be addressed. The standard playbook, which we have been following so far, is to double down on prohibition, trying to arrest more drug dealers and users. Never mind that decades of that approach have not reduced drug use or deaths.

The latest twist with opioids is to go after prescriptions, and the state has dramatically restricted opioid prescriptions and targeted pill mills.

While this may seem sensible, it ignores that last year in Sarasota County there were about 306,000 opioid prescriptions, while, based on national data, there were likely around 6,500 to 7,000 opioid abusers.

Roughly speaking, there are two abusers for every 100 legitimate pain patients. Surgery patients, accident victims, veterans, cancer patients, and chronic pain sufferers in vast numbers need opioids to manage their pain.

Asking doctors to take more care (tracking prescriptions, expanding education on careful use of prescription narcotics) makes sense. But limiting prescriptions intrudes on the doctor-patient relationship and leads many physicians to fear prescribing according to their medical judgment rather than the judgment of the Legislature.

Restricting access for the 100 to get at the two doesn’t work, either. Between 2011 and now, opioid prescription rates in Sarasota County declined 15 percent. For the first couple of years, opioid deaths fell, but in 2014 they spiked again, reaching a record high in 2017.

The same thing happened nationwide: As opioid prescriptions rates fell in the last few years, opioid deaths skyrocketed.

According to the Centers for Disease Control and others, this is at least in part because restrictions on prescription opioids drive some people to get other, much riskier, black-market opioid-based drugs.

Opioid death rates are rising much faster than the rate of opioid use — meaning opioid use is getting deadlier. Statewide in Florida, deaths from fentanyl, a particularly risky synthetic opioid, and similar drugs increased over 10 times between 2013 and 2017. These are overwhelmingly consumed in the black market.

It’s time to change approaches. Rather than doubling down on what hasn’t worked for decades, we need to embrace harm-reduction approaches.

That means dealing constructively with the problems of drug abuse, rather than trying ineffectively to stamp it out. It entails using public health options, including medical-assisted treatment, needle-exchange programs, safe-use sites, and deregulation of naloxone (a drug that revives those dying of an overdose). It means trying to help people get off drugs and, meanwhile, keeping them alive, rather than locking them up, which won’t help them.

Decades of international experience with these policies show they reduce overdose deaths, the spread of diseases, and abuse of drugs.

A Miami-Dade pilot project started in 2016 has proved this efficacy, replacing hundreds of thousands of dirty needles with clean ones, reversing more than 1,000 overdoses with naloxone, and enrolling over 1,000 drug abusers in programs to help them. The county saw a decline in opioid-related deaths while they spiked elsewhere in 10 states.

The state is taking an important step to helping Florida’s local governments pursue this approach. The state House and Senate have both passed version of a bill to expand this pilot program to counties that want it.

This would be a huge opportunity for Sarasota County to constructively and effectively tackle our increasing opioid crisis. We should grab it with both hands.

This article first appeared in the Sarasota Herald-Tribune.

The post How to Modify Florida’s Approach to the Opioid Crisis appeared first on Reason Foundation.

On January 15, 2019, Massachusetts Attorney General Maura Healey filed a 274-page pre-hearing memorandum alleging the Sackler family and their company Purdue Pharma “created the [opioid] epidemic and profited from it through a web of illegal deceit” by enticing doctors to prescribe their medication and peddling “falsehoods to keep patients away from safer alternatives.”

“We are confident the court will look past the inflammatory media coverage generated by the misleading complaint and apply the law fairly by dismissing all of these claims,” the Sackler’s attorneys said in a statement.

This is no small accusation from Massachusetts. If the state is going take this action against Purdue Pharma, one would hope that their case rests on solid evidence. But, unfortunately, the facts do not seem to support the commonwealth’s claims.

Evaluating the Massachusetts Attorney General’s Accusations

Massachusetts’ accusation that Purdue Pharma “created” the opioid epidemic by intentionally getting pain patients addicted to their products is not supported by the relevant academic literature on the subject. An abundance of evidence suggests that long-term opioid management for chronic pain does not lead to high rates of addiction. A comprehensive literature review of 26 studies found that addiction occurred in only .27 percent of patients treated with opioid painkillers for chronic pain. Another study found that for opioid pain patients with “no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19 percent.”

Purdue Pharma advertised that the addiction rate for OxyContin was one percent, and studies continually agree or suggest that claim was conservative.

Contrary to the commonwealth’s narrative, prescription opioid addiction rates have not been on the rise. While prescribing rates have fluctuated over the past 15 years, nonmedical prescription opioid use has remained constant since 2002. Furthermore, the most recent spike in opioid overdose deaths reflects not prescription opioid deaths, but those of illicit opioids such as heroin and fentanyl—street narcotics that are not manufactured or sold by Purdue. In fact, the Journal of the American Medical Association has documented that opioid overdoses related to fentanyl “account for nearly all the increase in drug overdose deaths from 2015 to 2016” and after.

Additionally, the introduction of “safer alternatives” to OxyContin has only increased overdoses. Facing public pressure, Purdue Pharma introduced an “abuse-deterrent” reformulation of OxyContin on August 9, 2010. According to Evans et al. (2018), “[w]hen the new pills were crushed, they did not turn into a fine powder, but instead a gummy substance that was much more difficult to snort or inject.” But the reformulation of OxyContin only exacerbated the problem. The authors concluded “[t]he new abuse-deterrent formulation led many consumers to substitute to an inexpensive alternative, heroin” and to a quadrupling in heroin deaths.

Evaluating the Impact of the State’s Restrictions on Prescribing

Over the past five years, in its efforts to curb opioid use, Massachusetts has adopted several policies that make it more difficult for pain patients to receive prescription opioids from physicians.

In 2016, the Massachusetts State Legislature voted to limit first-time opioid prescriptions to a seven-day supply for adult chronic pain patients. Yet, there are unintended consequences of this law. When a suffering patient is cut off from legal opioids, but still desires to use the drug, the black market meets this demand. Drugs acquired through illicit sources, however, are inherently more dangerous than those purchased legally for a variety of reasons, including consumers’ lack of information about the true contents, potency, and quality of the substances. Shifting people from doctor-prescribed opioids to the black market contributes to the number of overdoses on highly potent illicit drugs, such as fentanyl.

In Massachusetts and many other states, deaths from opioids that are most commonly acquired on the black market accelerated the number of opioid deaths only after prescribing rates decreased, which indicates the troubling relationship between restrictions on prescribing opioids and increased overdose deaths.

Concurrently in 2016, Massachusetts strengthened its Prescription Drug Monitoring Program (PDMP), a statewide database that requires physicians to check a patient’s prescribing history before issuing them drugs. However, academic evidence examining PDMPs in other states suggests that they may also be associated with increased overdose deaths. According to one National Institutes of Health study examining the implementation of a PDMP in New York, “[p]rescription opioid morbidity leveled off following the implementation of a mandated PDMP” but “morbidity attributable to heroin overdose continued to rise.”

It’s understandable for state leaders and the public to seek answers to, and assign blame for, opioid-related problems. But Massachusetts should look inward at its own policies. By increasing access to opioids through legal channels, lawmakers could work to decrease the harms of the black markets and reduce overdoses and the risks surrounding drug use. Massachusetts actually reduced overdose deaths with this approach when it expanded medication-assisted treatment in 2017.  But the attorney general’s unfounded lawsuit ignores what has worked and runs the risk of undermining the commonwealth’s current public health success. 

Massachusetts Data:

The post Examining the Lawsuit Massachusetts Filed Against Purdue Pharma Over the Opioids Problem appeared first on Reason Foundation.

As cannabis becomes more popular for treating a variety of ailments, such as morning pregnancy sickness and insomnia, policymakers and consumers should be encouraged to exercise common sense on cannabis therapy.   

As states legalize marijuana and develop impaired driving laws, policymakers need to ensure they do not penalize safe, sober drivers who merely have detectable levels of marijuana remaining in their systems.

Drug Recognition Experts continue to be the best option in enforcing impaired marijuana driving laws, instead of unscientific biometric tests.  

Examining the history of marijuana regulation provides a good perspective on current state regulations and the possible paths forward.

There is a fine line between legal and illegal marijuana markets, and regulations and tax rates can play a large role in determining the size and shape of both.

As the nation deals with a growing overdose problem, some argue that harm reduction practices such as supervised safe injection sites are a good way forward. 

Florida could improve its handling of the opioid problem by focusing on harm reduction, including needle exchange programs.

Presidential candidate Beto O’Rourke has long argued against the war on drugs but recently incorrectly blamed legal pharmacy prescriptions as a root cause of the opioid crisis.   

Police can quickly obtain e-warrants, sometimes within 10 minutes, in order to draw blood from suspects at roadside traffic stops as evidence of impairment.  

Denver voters narrowly approved a measure to decriminalize psilocybin mushrooms.  

Legislation, Regulation, and Markets

The STATES Act would federally legalize all marijuana-related activities in states that have legalized, but would not remove marijuana from its Schedule I narcotic status, marking a positive sign but also creating confusion.

In some cases, medical marijuana patients, by legally admitting they use marijuana, are then being denied their 2nd Amendment rights due to a federal law that is still being enforced despite general tolerance of medical marijuana legalization.

With the data and experience of several states, there is a developing and cohesive conceptual framework of best practices that policymakers should use for improving their existing marijuana markets or establishing new ones.

Despite the seeming attractiveness of it, many are concluding that a state-run marijuana bank is not a viable solution to the banking and financial hurdles the cannabis industry faces.

Government-generated estimates for the potential size of newly legalized marijuana markets are often inaccurate and can fuel misguided policies.  

Florida continues to face market access and monopoly issues, as the state has allowed one dispensary company to open more locations ahead of schedule.

California and Code for America are partnering to expunge over 50,000 marijuana convictions.

The Washington House of Representatives passed a bill that would vacate most misdemeanor marijuana convictions.  

Some 25 counties and cities in California are suing the state because it allows marijuana deliveries in their jurisdictions.

Employers are still wrestling to find the right marijuana workplace policies.

Some argue that even if cannabis were de-scheduled, the market would not explode as some anticipate due to FDA requirements.

New York City is considering eliminating drug testing for marijuana for people on probation.

Congress is considering raising the legal age to purchase tobacco to 21.

Evidence

A new study claims that marijuana legalization reduces opioid prescriptions.  

The overall social impact of cannabis legalization has to be weighed across a spectrum of metrics, including the cost savings of no longer enforcing the prohibition.    

One analysis estimates that New York’s cannabis industry could be as large as $4.1 billion dollars and employ some 30,000 people in the state.

Marijuana legalization does not cause an increase in traffic fatalities, a new study finds. 

The post Reason Foundation’s Drug Policy Newsletter, May 2019 appeared first on Reason Foundation.

O’Rourke is reasonable for promoting marijuana legalization to address racial injustice, but his characterization of the opioid crisis is terribly uninformed. O’Rourke advocated jailing Purdue Pharma executives, claiming “the vast majority of those addicted to opioids today began with a legal prescription, and those [Purdue] executives understood the addictive properties of [OxyContin] and did not share that with the public, and not a single one of them has done a single day in jail.” But that claim lacks proper context.

Yes, most people addicted to opioids started with prescription opioids — but not from their doctors. About 78 percent of OxyContin addicts were never prescribed OxyContin, as the pharmaceutical opioids that often prelude addiction are usually diverted from legitimate sources and consumed by those already addicted to drugs. Purdue did advertise that OxyContin had a 1 percent addiction rate — but studies show that claim was actually conservative.

The notion that Purdue Pharma and opioid prescribing caused the overdose crisis is blatantly false. New Hampshire, for example, had almost no increase in opioid overdose deaths between 1999 and 2012, despite increasing opioid prescribing rates during the same period. But after doctors were coerced into reducing prescribing after being forced to participate in New Hampshire’s Prescription Drug Monitoring Program in 2012, overdose death rates tripled within five years.

Government officials and the media typically do not acknowledge that the Substance Abuse and Mental Health Services Administration has reported constant nonmedical (opioid) pain reliever use rates since 2002, which undermine any notion that the pharmaceutical industry caused more addiction. But this ignorance might be supported by the implications of the alternative narrative: If increases in opioid deaths were actually caused by a constant number of opioid users using more dangerous black-market substances after being cut off from their legal opioid prescriptions, the interventions to reduce prescribing by the government may be the real culprit of the crisis.

Although O’Rourke touts the misguided standard narrative surrounding opioid use, he did introduce ideas that need more discussion.

“[America] has the largest prison population on the face of the planet, disproportionately comprised of people of color, far too many there for possession of a substance that is legal in most states in this country, marijuana. And though Americans of all races and ethnicities use marijuana at the same rate, only some are more likely than others to be arrested, to serve time, to upon release be forced to check a box so that they are unlikely to get that job because of that past conviction, ineligible for student loans and scholarships to attend [Keene State] and better themselves. We need real criminal justice reform. We need to end the prohibition on marijuana,” O’Rourke said.

The data suggests he has a point.

Beto O’Rourke displayed much charisma announcing his presidential candidacy and is now considered a front-runner in the Democratic presidential primary race. But if O’Rourke wants to sustain his success, he will need a nuanced perspective of the opioid crisis that is devastating America.

A version of this column first appeared in the Washington Examiner. 

The post To Succeed, Beto O’Rourke Needs a More Nuanced Perspective on the Opioid Crisis appeared first on Reason Foundation.

Breaking News: “Purdue Pharma has agreed to pay over $200 million to settle a historic lawsuit brought by the Oklahoma attorney general who accused the OxyContin maker of aggressively marketing the opioid painkiller,” CNN reports.

There still isn’t a scientific test for marijuana impairment, so states that have legalized marijuana should rely, in part, on Drug Recognition Experts (DREs) to determine impairment on the scene.  

When states limit marijuana business licenses, they effectively introduce oligopolies —undermining goals of legalization such as black market elimination and creating inequities in the industry by making it harder for small business owners to enter the market.   

Scientists are close to “turning yeast into microscopic chemical factories that manufacture cannabinoids found in the marijuana plant.”

Opioid prescriptions have gone down recently, but some doctors and advocates argue that this is hurting patients with serious pain ailments who are turned away due to federal guidelines.

Legislation, Regulation, and Markets

“Top state lawmakers have canceled a planned vote Monday on a bill that would legalize recreational marijuana for adults 21 and older in New Jersey, saying they simply haven’t gathered enough support in the state Senate,” NJ.com reports.

Colorado may soon allow money from outside the state to invest in the growing cannabis industry.

Denver has launched a new pilot program that aims at giving drug addicts, homeless, and other vulnerable members of the community actual treatment instead of just incarceration.  

Florida’s new attorney general appears committed to continuing a misguided lawsuit against opioid companies.

In better news, Florida is coming closer to ending its ban on smokable marijuana.  

It may not be a good idea to regulate marijuana just like alcohol, Massachusetts’ chief marijuana regulator recently said.   

Republicans in New Mexico have proposed that a legal marijuana market should be owned and operated entirely by a state government monopoly.  

California’s burdensome marijuana regulations are still hurting the growth of the legal market.

Several companies reported to the state of New York that it should ban home grow for several fallacious reasons.  

States are still exploring how to regulate marijuana testing in the workplace.

Portugal’s experience with decriminalizing all drugs has gone well, with notable positive outcomes in crime and health.  

Evidence

Colorado recently released its “Monitoring Health Concerns Related to Marijuana” report for 2018, showing small increases in adult use and no increase in adolescent youth, among other interesting findings.  

Contrary to common fears, marijuana use among teens has actually dropped in states with medical marijuana laws.   

Claims that marijuana legalization increases violent crime rates are not backed up by data.

The post Reason Foundation’s Drug Policy Newsletter, March 2019 appeared first on Reason Foundation.

Unfortunately, Bondi misdiagnosed both the problem and the solution. And new state Attorney General Ashley Moody seems determined to continue these mistakes.

“I will continue the lawsuit brought by Attorney General Bondi against opioid manufacturers and distributors to curb abuse and recover costs to Florida,” Moody wrote before last November’s election. “We must hold accountable those responsible without regard to whether it is an individual doctor knowingly and wrongfully prescribing drugs or some of the largest companies in the world engaged in the conduct described in the complaint.”

Opioid overdoses and deaths have been rising and there’s nearly universal agreement that something needs to be done. But Bondi and Moody scapegoating doctors, pharmacies and pharmaceutical companies is neither accurate nor sensible.

The state’s lawsuit suggests drug companies tricked doctors into overprescribing opioids and that pharmacies knowingly dispensed more opioids than was necessary, which led to addictions and overdoses. In reality, over 99 percent of patients who receive prescriptions for pain relief medications don’t abuse them. These are people experiencing real pain from accidents and ailments. Nationally each year, three million people are injured in car accidents, two million are seriously injured at work, 20 million veterans are suffering chronic pain, and America’s aging population is battling a variety of ailments, including cancer. Drug companies, doctors, and pharmacies are overwhelmingly serving those people, not targeting the small percentage of users who abuse pain medications.

The Substance Abuse and Mental Health Services Administration (SAMHSA) finds that prescription drug abuse has been falling for years. About five percent of Floridians abused prescription drugs in 2002 but that number fell to three percent in 2014. It’s also important to note that in Florida, opioid prescriptions have decreased by 30 percent since their peak in 2010. But restricting prescriptions has not been effective in reducing opioid overdoses, which have increased by over 73 percent since 2010. In fact, restrictions on prescriptions likely made overdose rates worse. During the peak period of prescriptions being written, prescription abuse was actually at a record low. But after the mandated decrease in opioid prescriptions, some people who previously received opioids from their pharmacists lost their prescriptions and turned to the black market where drugs are much less safe.

For example, black market-produced fentanyl, a synthetic opioid up to 100 times stronger than morphine and much more dangerous to consume than pharmaceutical-grade painkillers, is now the leading cause of drug overdoses. As drug overdoses increased in Florida, illegally-produced fentanyl and heroin went from causing 11 percent of opioid overdoses in 2010 to causing almost 75 percent of opioid overdoses by 2017.

The lawsuit Bondi filed also claims, “Opioids killed 5,725 Floridians in 2016.” That’s false. The Centers for Disease Control and Prevention report opioids caused 2,798 overdose deaths in Florida in 2016. The 5,725 figure includes people who happened to have opioids in their systems when they died of other causes.

Attorney General Moody said she wants to confront the opioid problem with a “targeted, data-backed approach, focusing on law enforcement, addiction, and education.” If that’s the case, Moody should ditch the lawsuit because Florida’s pain patients and sufferers are better off working with legitimate doctors and pharmacists than with black market drug cartels.

This column first appeared in the Orlando Sentinel. 

The post Florida Needs a New Approach to the Opioid Problem appeared first on Reason Foundation.

The cannabis black market in California is still thriving, mostly due to onerous taxes and complex regulations in the legal market.

More federal grant money is now available to train police officers to recognize drug impairment.  

Florida could be on a path to legalize recreational cannabis by 2020.

With Democrats now in control of the House of Representatives, there may be a renewed push to legalize cannabis at the federal level.

The recent increase in cannabis use creates a strong need for more data and research.  

While some claim that cannabis legalization has coincided with a rise in violent crime, a closer look at the data shows that claim to be untrue.

New data show that opioid and fentanyl-related overdose deaths increased markedly in 2017

Legislation, Regulation, and Markets

Rhode Island is considering legalizing cannabis after neighboring Massachusetts recently opened its market.   

One opioid company is attempting to get out of the opioid business and into cannabis.

Massachusetts is considering applying a penalty to drivers who refuse roadside cannabis tests.  

Pennsylvania will no longer provide the names of medical marijuana users to law enforcement agencies, effectively allowing medical card holders to buy and own guns.

There appears to be no rise in cannabis-impaired driving in Canada since legalization.  

The Arizona Supreme Court will decide if edibles made from cannabis extracts will be sold in medical dispensaries.   

Evidence

Pay for Success programs and better interagency collaboration could be keys to reducing the opioid crisis.

Heroin Assisted Treatment (HAT) and Supervised Consumptions Sites (SCS) could be more effective than alternative treatments.  

A new study advocates harm reduction strategies, such as medication-assisted treatment, needle exchange programs, safe injection sites, heroin-assisted treatment, deregulation of naloxone, and deregulation of cannabis to address the increase in opioid overdoses.

Cannabis poses significantly fewer health risks than either tobacco or alcohol.  

Some data show that youth cannabis use has not increased in Washington state after legalization.

A new analysis shows that 60 percent of cause and effect claims made on popular cannabis websites were based on low-quality evidence. 

The post Reason Foundation’s Drug Policy Newsletter, January 2019 appeared first on Reason Foundation.

Fentanyl remains the leading cause of overdose deaths and is disproportionately responsible for the increase in drug overdose rates from 2016. Fentanyl is a synthetic opioid that is up to 100 times stronger than morphine and is often produced and mailed in from China. Fentanyl was found in 40 percent of drug overdose deaths in 2017, up from 30 percent in 2016. Fentanyl or heroin was found in 51 percent of the total drug overdose deaths and 75 percent of opioid overdose deaths in 2017, up from 45 percent and 68 percent respectively in 2016.

In 2017, natural and semisynthetic opioid (prescriptions like oxycodone and hydrocodone) death rates that did not involve heroin or fentanyl decreased 9 percent from 2016. The cocaine-related death rate increased 33 percent from 2016 to 2017, but this is likely due to fentanyl adulteration, which was found in 52 percent of cocaine-related overdose victims, up from 40 percent compared to 2016. The cocaine overdose death rate with no fentanyl reported increased 7 percent from 2016.

These phenomena can be mostly attributed to the increased use of black-market opioids. Pennsylvania had the most drug overdose deaths in 2017, at 5,388 (37 percent fentanyl, 78 percent fentanyl for opioid overdose deaths), Ohio had the most opioid overdose deaths at 4,293 (82 percent fentanyl, 69 percent fentanyl for all drug deaths), and West Virginia had both the highest rates of total drug overdose deaths and opioid overdose deaths at 53.6 and 45.9 people per 100,000 respectively.

Below are the complete rankings of states and Washington, D.C., by total drug overdose deaths, opioid overdose deaths, total drug overdose death rates, and opioid overdose death rates according to CDC data. 

(Figures are not mutually exclusive.)

States Ranked by Total Drug Overdoses

States ranked by Opioid Overdoses

States Ranked by Total Drug Overdose Rate

States Ranked by Opioid Overdose Rate

The post Examining CDC’s State-by-State Data on Drug and Opioid Overdose Deaths appeared first on Reason Foundation.

President Trump recently signed a bill that will reduce legal opioid prescriptions, which is likely to drive users seeking pain relief deeper into the more dangerous black market for similar drugs.

The Little Rock Police Department has regularly conducted no knock door raids based on sometimes questionable evidence and probable cause according to an investigative report by The Washington Post’s Radley Balko.       

In an encouraging development, an increasing number of states no longer consider needle exchange programs to be a criminal offense, which is leading to the formation of new organizations aimed at harm reduction for drug users.

With Michigan voters legalizing recreational marijuana, Geoff Lawrence explains why the state should look to set up its regulatory structure and why past marijuana crimes should be expunged.

Drug cartels may ultimately miss former Attorney General Jeff Sessions’ heavy-handed approach to drug enforcement.

In what the Harvard Political Review calls a “competing narrative,” Jacob Rich argues that reducing legal opioid prescriptions ignores the evidence that fewer legal prescriptions for patients mean more illicit and dangerous drug usage.  

Legislation, Regulation, and Markets

Via ballot initiative, Michigan voters approved recreational adult marijuana use. Utah and Missouri approved medical marijuana programs, and North Dakota voters rejected a legal regime.

An anti-marijuana organization is calling for states to send citizens into a mandatory assessment of problem drug use after just one illegal possession of marijuana charge.

A California town will bring nurses to roadside traffic stops to draw blood of drivers suspected of impaired driving to give officers more real-time data about whether to arrest.

Utah will lower the legal driving threshold for alcohol from 0.8 percent to 0.5 percent BAC, which will be the lowest in the country.  

There has been a lot of marijuana legalization activity via ballot initiatives, but the country is reaching the point where state legislatures will increasingly need to be involved in the cannabis legalization process.

More money is being raised by private firms to continue to change not just the business but the culture around cannabis.  

States should exercise restraint when setting cannabis tax rates or they risk marginalizing the legal market.

New York’s cannabis laws are starting to take shape.  

Voters approved legalization in Michigan, but many challenges and questions must still be faced down, like how to determine impairment while driving.    

California’s social equity programs aim at redressing the harms of the drug war but may be causing confusion and inefficiency for business owners and investors.

Evidence

A new study claims that traffic accidents are occurring more frequently in states that have legalized marijuana, but the study fails to make important controls and draws causal connections.  

A new study estimates that adolescent marijuana use could be anywhere from 12 percent to 18 percent.

Colorado has released its most recent report on the impacts of cannabis legalization.  

New Hampshire released a new report exploring legalization for the state.  

A new report claims that a health-based approach instead of a criminal one would produce a net benefit to society.   

A new study finds that counties with medical marijuana dispensaries experience 6 percent-8 percent fewer opioid-related deaths.  

The post Reason Foundation’s Drug Policy Newsletter, December 2018 appeared first on Reason Foundation.

In the last decade, the media failed to discuss the opioid crisis, although regulators started to notice a steady rise in opioid-related deaths and opioid prescribing. As early as 2002, this observation prompted federal funding for state-level prescription drug monitoring programs (PDMPs), which are electronic databases that allow the government to surveil its citizens’ medical prescribing history. At first, PDMPs were an optional service for doctors, but as opioid overdoses rose more than 180 percent between 1999 and 2012, many states started mandating various forms of doctor participation.

Since the Controlled Substances Act allows the Drug Enforcement Administration broad authority to circumvent Fourth Amendment judicial approval for warrants in drug-related cases, federal authorities have been secretly accessing these doctors’ prescribing records en masse. Fearing large crackdowns by authorities like the Department of Justice, physicians drastically decreased their opioid prescribing. But this government intervention had one major flaw — the crisis was not caused by prescribing. After a 28 percent decrease in opioid prescribing since 2012, opioid overdose death rates have now doubled.

The government’s own data show non-marijuana illicit drug use has actually remained stable since 2002. The only difference now is that users are exposed to less pharmaceutical-grade options. When drugs aren’t supplied by the legal market and clean, they’ll inevitably be supplied by the illegal market and dirtier. Of course, clean drugs can be found on the streets — if you can pay premium price, you can have a bottle of oxycodone dropped off by your dealer. But if you don’t have $600 for a couple weeks’ supply, you must consider cheaper options — like injectable heroin laced with fentanyl, which is 100 times more potent than morphine. You may be able to find the same oxycodone pills from less expensive sources, but if they are counterfeit and adulterated with fentanyl, you risk the same tragic death as Prince.

Regulators sometimes concede that substitution to the black market from decreased prescribing is a necessary evil to prevent new addictions caused by pain pills ending up with whom they were not prescribed. But pain reliever abuse rates have also been relatively stable since 2002, meaning we can’t blame the current opioid crisis on pain pill “overprescribing” or big pharma. Some users are responsible, some are addicts, but all are at higher risk of overdose from decreased prescribing.

The bill that Trump just signed touts “evidence-based” approaches, but they’re nowhere to be found. States only exacerbate their opioid crises when they reduce prescribing. When doctors are forced to report their patients’ medical records to authorities, opioid prescribing decreases and the number of deaths immediately increases in almost every state. For example, there was little change in New Hampshire’s opioid death rate before it forced doctors to register with its PDMP in 2012 — but afterwards the state’s death rate tripled by 2016.

The omnibus opioid bill will increase state support for PDMPs and encourage states to mandate doctor participation. This will further lower prescribing and drive demand for opioids to the deadly black market. Instead, we should resume trusting doctors to treat their patients and terminate PDMPs.

The bill also seeks to increase the cap of licensed doctors to prescribe buprenorphine from 100 patients to 275. A move in the right direction, but given that more than 2 million people abuse opioids, and there are currently only 2,471 buprenorphine licenses to treat 100 patients, it will be illegal for most to obtain treatment for a long time. We should instead follow France’s lead and suffocate the black market by allowing all physicians to prescribe buprenorphine.

If the Trump administration wants to make meaningful change, there are plenty of actions it can take that don’t waste taxpayer resources. For example, it could direct Secretary of Health and Human Services Alex Azar to request a reschedule of naloxone so that it’s available over-the-counter. Naloxone is an opioid overdose reversal agent that is easy to administer, nonaddictive, and safe to consume for anyone in any situation. Since naloxone has already saved thousands of lives, this move should not be controversial.

Walden may be right that his bill is significant, but it will do little more than exacerbate the problems government itself created. Though the government seldom admits its own wrongdoing, we shouldn’t allow Congress and the president to further restrict access to opioids through a police state of prescribing. In the end, we’ll be doing a disservice to those already suffering and only cause more overdoses. And when government is by the people, its people are responsible for its sins.

This article originally appeared in the Washington Examiner.

The post The Opioid Fix That Wasn’t appeared first on Reason Foundation.