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Tag: drug policy

  • Addressing the Opioid Epidemic: What the Research Says

    Addressing the Opioid Epidemic: What the Research Says

    Rehab? Safe injection sites? Sue Big Pharma? Find out how each of the Democratic presidential candidates plan to address and treat opioid use disorder, and which of these approaches are supported by evidence.

    In the lead-up to the 2020 elections, the Journalist’s Resource team is combing through the Democratic presidential candidates’ platforms and reporting what the research says about their policy proposals. We want to encourage deep coverage of these proposals — and to do our part to help deter horse race journalism, which research suggests can lead to inaccurate reporting and an uninformed electorate. Our criteria for the proposals we’re covering is simple: We’re focusing on proposals that have a reasonable chance of becoming policy, and for us that means at least 3 of the 5 top-polling candidates say they intend to tackle the issue. Here we look at candidates’ proposals to address the opioid epidemic. Candidates are divided in their approaches; while nearly all favor increasing funding for and access to treatment for opioid use disorder, fewer candidates support harm reduction policy interventions, such as safe injection sites and needle exchanges. A few candidates incorporate broader criminal justice-level changes or physician-level interventions into their policy proposals.

    Candidates favoring increased funding for and access to treatment

    Michael Bennet, Joe Biden, Cory Booker*, Pete Buttigieg, John Delaney, Amy Klobuchar, Bernie Sanders, Tom Steyer, Elizabeth Warren, Marianne Williamson*, Andrew Yang

    Candidates favoring harm reduction interventions

    Michael Bennet, Cory Booker, Pete Buttigieg, Amy Klobuchar, Bernie Sanders, Elizabeth Warren

    Candidates favoring action against pharmaceutical companies

    Michael Bennet, Cory Booker, Pete Buttigieg, John Delaney, Tulsi Gabbard,  Amy Klobuchar, Bernie Sanders, Elizabeth Warren, Andrew Yang

    Candidates favoring interventions that target physician prescribing behavior

    John Delaney, Amy Klobuchar, Andrew Yang

    Candidates favoring decriminalization of possession of opioids

    Pete Buttigieg, Andrew Yang

    What the research says

    Access to treatment: Medication-assisted treatment is an evidence-based treatment for opioid use disorder; it has been shown to reduce the risk of overdose death for people who use opioids. Methadone, buprenorphine and naltrexone are types of medication-assisted therapy for opioid use disorder. These medications reduce symptoms of craving and withdrawal. A systematic review and meta-analysis of medication-assisted treatment find that people receiving such treatment were less likely to die of an overdose or other causes than their peers with opioid use disorder who did not receive medication-assisted treatment.

    Harm reduction: Harm reduction initiatives attempt to reduce the risks associated with using drugs. Such initiatives include needle exchange programs, widespread distribution of the opioid overdose antidote naloxone and supervised injection facilities. Supervised injection facilities, also known as safe injection sites or supervised consumption facilities, are not legal in the U.S. They exist legally in other countries, such as Canada and Australia, however.

    Several studies have demonstrated a positive link between safe injection site use and entry into treatment. Safe injection sites also provide benefits to people who use drugs in the form of sterilized equipment and supervision to mitigate the dangers of overdose.

    Over a dozen studies have linked needle exchanges with lower rates of hepatitis C and HIV infection among people who inject drugs.

    A systematic review of research on take-home naloxone programs, which provide people at risk of opioid overdose with kits including the antidote, concludes that “there is overwhelming support of take-home naloxone programs being effective in preventing fatal opioid overdoses.”

    The pharmaceutical industry: Big Pharma’s role in marketing opioids spurred physicians to prescribe more opioids, research shows. This, in turn, fueled the opioid epidemic the country faces today. Policies targeted toward Big Pharma include proposals to hold industry players liable for their role in the opioid epidemic with criminal penalties and fines.

    Decriminalization: The rationale behind decriminalization of the personal use of narcotics is that criminal penalties essentially criminalize substance use disorder. Proponents of decriminalization argue that such drug use should, instead, be met with evidence-based treatment. There is not much research on the effects of decriminalization because it’s rare. However, in 2001, Portugal decriminalized personal acquisition, possession and use of illicit drugs. Research indicates that drug-related deaths have fallen since the southwestern European country decriminalized illicit drugs.

    Physician-level interventions: These interventions target prescriber behavior. Examples include physician education programs, guidelines or restrictions on the quantity of opioids physicians can prescribe, and prescription monitoring programs that allow physicians to view patients’ prescription history to avoid overprescribing or illegitimate prescribing. While education and prescribing policies have curtailed prescribing habits, prescription monitoring programs have been less successful, studies indicate.

    Key context

    In late 2017, the U.S. Department of Health and Human Services declared the nation’s opioid crisis a “public health emergency.” The problem has been building for over a decade, spurred by sharp increases in prescriptions for opioids, commonly used to treat both short-term and chronic pain.

    About 233.7 million opioid prescriptions were filled each year, on average, from 2006 to 2017, according to a March 2019 study in JAMA Network Open that looks at opioid prescriptions filled in retail pharmacies across the U.S.

    Prescription painkillers have a high risk of abuse — across the academic literature, rates of misuse among patients taking opioids for chronic non-cancer pain average between 21% and 29%. Research indicates that as of 2013, more than 2 million people in the U.S. had prescription opioid-related opioid use disorder.

    Prescription opioids can also pave the way for illegal drugs like heroin. Eighty percent of people who have used heroin have previously misused prescription opioids, according to an August 2013 analysis of national survey data collected from 2002 to 2011.

    As opioid use and misuse has increased, deaths linked to the drugs have increased. In 2017, opioids were involved in 47,600 drug overdose deaths, accounting for nearly 70% of all overdose deaths nationwide that year.

    Recent research

    Access to treatment:

    A review of randomized controlled trials comparing medication-assisted treatment of opioid use disorder to placebo or no medication finds that medication-assisted treatment “at least doubles rates of opioid-abstinence outcomes.”

    A study of 151,983 adults in England treated for opioid dependence between 2005 and 2009 finds that the risk of fatal drug overdose more than doubled for individuals who received only psychotherapy compared with those who received medication-assisted treatment.

    Harm Reduction:

    Two reviews — one published in Drug and Alcohol Dependence in 2014, and one published in Current HIV/AIDS Reports in 2017 — indicate that supervised consumption facilities promote help people access treatment. The more recent review looks at 47 studies published between 2003 and 2017 on supervised drug consumption facilities. The authors find a handful of studies that demonstrate a positive link between safe injection site use and starting treatment.

    One of these studies compared enrollment in detoxification programs among those who used Vancouver’s supervised injection facility the year before and after it opened in 2003. Researchers find the facility’s opening was linked to a 30% increase in detox program use, which, in turn, was linked to pursuing long-term treatment and injecting at the facility less often. A later study of the injection facility focused on use of detox services located at the facility. It finds that 11.2% (147 people) used these services at least once over the two years studied. The authors conclude that supervised injection facilities might serve as a “point of access to detoxification services.”

    A 2006 study of 871 people who injected drugs finds no substantial increase in rates of relapse among former users before and after the Vancouver site opened. However, the researchers also find no substantial decrease in the rate of stopping drug use among current users before and after the site opened. Another study of 1,065 people at this facility published in 2007 finds that only one individual performed his or her first injection at the site.

    Though supervised injection sites are illegal in the U.S., one opened underground in 2014. Researchers interviewed those who used the underground site during its first two years of operation and their findings were published in 2017 in the American Journal of Preventive Medicine. The site’s users were asked the same set of questions about their use patterns every time they injected drugs at the site. The authors conclude that the site offered several benefits, including safe disposal of equipment, unrushed injections and immediate medical response to overdoses. The authors add that if the site were sanctioned, it might be able to offer additional benefits, including health care and other services.

    Big Pharma:

    Research suggests that physicians targeted with marketing from pharmaceutical companies prescribe opioids at higher rates than doctors not exposed to their marketing.

    Several studies use data from the Centers for Medicare and Medicaid Services’ Open Payments database, which tracks payments made by drug and medical device companies to physicians. That information is used to analyze how relationships between physicians and drug companies are linked to prescriptions written.

    These studies define opioid-related payments as cash payments — for example, speaking fees associated with promoting a drug — and payments-in-kind — free meals pharmaceutical representatives provide to doctors’ offices, for instance. These studies find that physicians who receive opioid-related payments tend to prescribe more opioids.

    A study in PLoS One from December 2018 looks at physicians who received opioid-related payments, some in 2014 and some in 2015, compared with doctors who never received such payments. The authors find that physicians who received opioid-related payments had a larger increase in the number of daily doses of opioids dispensed, as well as in total opioid expenditures, prescribing pricier opioids per dose.

    Another study looking at the same data offers further detail. The study, published in Addiction in June 2019, focuses on 865,347 physicians across the country who filled prescriptions for Medicare patients from 2014 to 2016. “Prescribers who received opioid-specific payments prescribed 8,784 opioid daily doses per year more than their peers who did not receive any such payments,” the authors write.

    Other research geographically links opioid marketing and opioid-related overdose mortality. The paper, published in JAMA Network Open in January 2019, analyzes county-level prescription opioid overdose deaths and county-level opioid marketing payments.

    The authors find that deaths from prescription opioid overdoses increased with each standard deviation increase in opioid marketing as measured by dollars spent per capita, number of payments to physicians per capita and number of physicians receiving payments per capita. Standard deviation indicates the variation of a given value from the average. “Opioid prescribing rates also increased with marketing,” the authors write. They note that the higher prescription rate might be why overdose deaths increased.

    Physician-level interventions:

    An August 2018 study published in Science highlights the role physician education might play in addressing the nation’s opioid crisis. The intervention was simple: When a patient died of an opioid overdose, the county medical examiner sent the prescribing physicians a letter notifying them. The authors conducted a randomized trial of 861 physicians whose patients overdosed. The intervention group received the letter, which included a safe prescribing warning consisting of these recommendations:

    • Avoid co-prescribing an opioid and a benzodiazepine.
    • Minimize opioid prescribing for acute pain.
    • Taper long-term users off opioids.
    • Avoid prescriptions lasting for three consecutive months or longer and prescribe naloxone, an opioid overdose antidote.

    The control group received no communication.

    Physicians in the intervention group cut their opioid prescribing by 9.7% — as measured by milligram morphine equivalents in prescriptions filled — in the three months after the letter was sent. These physicians also started fewer patients on opioids and wrote fewer high-dose prescriptions than the control group.

    Prescribing policies and guidelines also have successfully curbed physicians’ distribution of opioids.

    In October 2017, the Michigan Opioid Prescribing Engagement Network released opioid prescribing guidelines for nine surgical procedures to clinicians participating in the Michigan Surgical Quality Collaborative, a statewide initiative to improve surgical care.

    Researchers compared opioid prescribing before and after these guidelines were released, analyzing data from 11,716 patients across 43 hospitals collected from February 2017 to May 2018. They find that prescriptions declined, on average, from 26 pills to 18 pills per month after the guidelines were released.

    Patients also took fewer of the pills they were prescribed. As measured by patient-reported survey data, opioid consumption following surgery dropped from 12 pills to nine, “possibly as a result of patients anchoring and adjusting their expectations for opioid use to smaller prescriptions,” explain the authors of the August 2019 New England Journal of Medicine study. Although patients received smaller prescriptions and used fewer pills after the guidelines were published, there were no substantial changes in the patients’ satisfaction and pain scores.

    Similar to the study of Michigan’s opioid prescribing guidelines is a February 2018 study in the American Journal of Emergency Medicine that tracks the effects of an emergency department opioid prescribing policy. The policy resulted in declines in opioid prescriptions. Compared with the control emergency department, the two intervention hospitals had a more pronounced decline in opioid prescribing. The authors conclude that emergency department-based policies might help reduce opioid prescribing.

    Prescription drug monitoring programs, which allow physicians to view patients’ prescription history to avoid overprescribing or prescribing opioids to people who don’t actually need them, have been shown to be less effective. A January 2018 study of national data published in Addictive Behaviors finds that there were not statistically significant differences in the likelihood that physicians would prescribe opioids for chronic pain when comparing states with prescription drug monitoring programs with those without.

    Further reading

    General overview

    Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic

    Allison L. Pitt, Keith Humphreys and Margaret L. Brandeau. American Journal of Public Health, October 2019.

    The gist: “Policies focused on services for addicted people improve population health without harming any groups. Policies that reduce the prescription opioid supply may increase heroin use and reduce quality of life in the short term, but in the long term could generate positive health benefits. A portfolio of interventions will be needed for eventual mitigation.”

    Safe injection sites

    Attendance at Supervised Injecting Facilities and Use of Detoxification Services

    Evan Wood, Mark W. Tyndall, Ruth Zhang, Jo-Anne Stoltz, Calvin Lai, Julio S.G. Montaner and Thomas Kerr. New England Journal of Medicine, June 2006.

    The gist: A study of Vancouver’s supervised injection facility finds “an average of at least weekly use of the supervised injecting facility and any contact with the facility’s addictions counselor were both independently associated with more rapid entry into a detoxification program.”

    Injection Drug Use Cessation and Use of North America’s First Medically Supervised Safer Injecting Facility

    Kora DeBeck, Thomas Kerr, Lorna Bird, Ruth Zhang, David Marsh, Mark Tyndall, Julio Montaner and Evan Wood. Drug and Alcohol Dependence, January 2011.

    The gist: “These data indicate a potential role of SIF [supervised injecting facilities] in promoting increased uptake of addiction treatment and subsequent injection cessation.”

    “A Little Heaven in Hell”: The Role of a Supervised Injection Facility in Transforming Place

    Ehsan Jozaghi. Urban Geography, May 2013.

    The gist: “Participants’ narratives indicate that attending InSite [Vancouver’s supervised injection facility] has had numerous positive effects in their lives, including changes in sharing behavior, improving health, establishing social support and saving their lives.”

    Process and Predictors of Drug Treatment Referral and Referral Uptake at the Sydney Medically Supervised Injecting Centre

    Jo Kimber, Richard P. Mattick, John Kaldor, Ingrid Van Beek, Stuart Gilmour and Jake A. Rance. Drug and Alcohol Review, May 2009.

    The gist: Researchers conducted 1.5-year study at a supervised injection site in Sydney. They find that 16% of clients at the site referred to treatment by health and social welfare professionals went on to receive it, leading the authors to conclude that the center “engaged injecting drug users successfully in drug treatment referral and this was associated with presentation for drug treatment assessment and other health and psychosocial services.”

    Inability to Access Addiction Treatment and Risk of HIV Infection Among Injection Drug Users Recruited from a Supervised Injection Facility

    M.-J.S. Milloy, Thomas Kerr, Ruth Zhang, Mark Tyndall, Julio Montaner and Evan Wood. Journal of Public Health, September 2012.

    The gist: Many who use supervised injection facilities have the desire to access treatment. This study surveyed 889 people who were randomly selected to be surveyed at Vancouver’s supervised injection facility. “At each interview, ∼20 percent of respondents reported trying but being unable to access any type of drug or alcohol treatment in the previous 6 months,” the authors write. The main barrier to access, respondents said, was waiting lists for treatment.

    Big Pharma

    The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy

    Art Van Zee. American Journal of Public Health, February 2009.

    The gist: In the first six years it was on the market, Purdue Pharma spent about six to 12 times more to promote OxyContin than it had to promote another long-lasting opioid. The paper describes various marketing strategies including promotional giveaways and Pharma-funded medical education programs.

    Industry Payments to Physicians for Opioid Products, 2013-2015

    Scott E. Hadland, Maxwell S. Krieger and Brandon D. L. Marshall. American Journal of Public Health, September 2017.

    The gist: This study examines payments pharmaceutical companies make to physicians to market opioid products. The authors find that 375,266 opioid-related payments that weren’t related to research work were made to 68,177 physicians over the study period. The authors estimate that about 1 in 12 physicians in the U.S. received a payment from a pharmaceutical company to promote their opioid medications during the 29-month study period. The bulk of the money went toward speaking fees or honoraria, but the most common expense was food and beverages – 352,298 payments totaling $7,872,581.

    Association of Pharmaceutical Industry Marketing of Opioid Products to Physicians with Subsequent Opioid Prescribing

    Scott E. Hadland, Magdalena Cerdá, Yu Li, Maxwell S. Krieger and Brandon D. L. Marshall. JAMA Internal Medicine, June 2018.

    The gist: “Whereas physicians receiving no opioid-related payments had fewer opioid claims in 2015 than in 2014, physicians receiving such payments had more opioid claims,” the authors write.

    Physician-level interventions

    Differences in Opioid Prescribing Practices among Plastic Surgery Trainees in the United States and Canada

    David W. Grant, Hollie A. Power, Linh N. Vuong, Colin W. McInnes, Katherine B. Santosa, Jennifer F. Waljee and Susan E. Mackinnon. Plastic and Reconstructive Surgery, July 2019.

    The gist: Plastic surgery trainees were asked about their opioid prescribing education, factors contributing to their prescribing practices and what they would prescribe for eight different procedures. The authors find that, of the 162 respondents, 25% of U.S. plastic surgery trainees received opioid-prescriber education, compared with 53% of Canadian trainees. For all but one of the eight procedures, U.S. physicians prescribed significantly more morphine milligram equivalents than their Canadian counterparts.

    Source list

    Caleb Alexander, professor and co-director of the Center for Drug Safety and Effectiveness. Johns Hopkins University.

    Michael L. Barnett, assistant professor. Harvard T.H. Chan School of Public Health.

    Chinazo Cunningham, professor. Albert Einstein College of Medicine.

    Scott Hadland, assistant professor. Boston University School of Medicine.

    David N. Juurlink, scientist. Sunnybrook Research Institute.

    Thomas Kerr, associate professor. The University of British Columbia.

     

    For more, check out JR’s long read on the opioid prescribing problem, our summary of research on where opioids are prescribed the most and our tip sheet for reporting on fentanyl and synthetic opioids.

    This piece adheres to suggestions offered by the National Institute on Drug Abuse’s media guide, which recommends language that avoids the potentially stigmatizing term “addict” in the context of substance use. It states: “In the past, people who used drugs were called ‘addicts.’ Current appropriate terms are people who use drugs and drug users.”

    *Dropped out of race since publication date.

    This article first appeared on Journalist’s Resource on December 9, 2019 and is republished here under a Creative Commons license.

  • The Never-Ending Drug Hustle Behind Bars

    The Never-Ending Drug Hustle Behind Bars

    “While I went to high school with casual weed smokers and worked at various jobs with weekend coke snorters, I was entirely unprepared for what I’ve seen in state prison.”

    This article was originally published by The Marshall Project, a nonprofit news organization covering the U.S. criminal justice system. Sign up for their newsletter, or follow The Marshall Project on Facebook or Twitter.

    I was on the phone with my wife as usual on a Saturday evening a few months ago when my prison’s P.A. system crackled and a stressed-out voice announced: “All rec yards are closed; offenders will report back to their dorms immediately.”

    Something big was clearly afoot, and everyone rushed to the front windows to get a better view. People spoke in hushed voices, not the usual clowning, speculating about what might have happened.

    It turns out that eight people had overdosed at once, most likely on “spice.” They passed out on the recreation yard, laid out side-by-side on the concrete while nurses and guards ran around with stretchers and wheelchairs trying to keep control and render medical assistance, in that order.

    As far as I know, one of them is now dead, while seven have since recovered and were transferred to other compounds. I think the one who died only had about 30 days left on his sentence.

    You can bet on two things following from that sort of trainwreck. One, the addicts in here will continue snorting and smoking anything they can find. And two, the rest of us will pay for the mess they’re making.

    I guess I was a little naive when I was first locked up, thinking it must be hard to obtain drugs and get high while incarcerated. But to my shock, it was as common or more so than on the outside. (I’m probably in the minority in here because I don’t use, it’s that pervasive.) Spice, weed, Suboxone, Neurontin, Seroquel, orange peels—people try to get high on whatever they can find, everywhere I’ve been locked up, and no matter what security measures are in place to prevent it.

    When I was first in the jail in Washington, D.C., inmates openly smoked “K2” while gathered in cell doorways. You smelled that synthetic stuff more often than weed or cigarettes, though those were common too. Some bothered to try and conceal it by blowing the smoke down the toilet, but most didn’t.

    I would see correctional officers walk by and pretend not to notice; they aren’t paid enough to care. People knew which C.O.’s would write them up, and that was an awfully short list.

    And while I went to high school with casual weed smokers and worked at various jobs with weekend coke snorters, I was entirely unprepared for what I’ve seen in state prison. These are mostly desperate addicts with little else to organize their days around besides the next fix. Getting high is their whole bid. The money they hustle up or that their family sends them, every hard-earned dime of it, is spent on drugs. All they get is small amounts of low-quality stuff, but they’ll take it. Because even at the ridiculously high prices this stuff sells for behind bars, that crummy, overpriced little piece will keep the shakes away for another day.

    To give you some idea, a 16th of a strip of Suboxone (a “piece” in our parlance) can sell for $15 here, when supply is scarce. Go Google what a Suboxone strip looks like, imagine that cut in fourths, and then fourths again. It’s miniscule. And then remember that those $15 could have bought that addict 50 ramen soups from the commissary.

    Even at the normal price of $5 for a piece, it’s a terrible waste. Five dollars is a lot of money in lockup.

    They hustle to get it—they steal from the kitchen and sell the food, they gamble on sports or cards, they iron shirts or wash dishes, whatever it takes. Sometimes they even use sex as currency for the price of a high, or are coerced into it to cover their drug debt.

    Or their families, or girlfriends, or buddies back home, are sending money, thinking it’s going toward keeping them well-fed and well-clothed. It’s likely money that was hard to come by, because most people in here are decidedly not wealthy. Rich drug abusers go to treatment, not prison.

    Plenty of inmates have prison jobs, but those pay on average about a couple bucks a day—and you can’t get high too often on just that.

    Most drugs only come in here in one of three ways: mail, visits, and corrupt C.O.’s.

    Prison officials can take steps to block the first two kinds of smuggling, of course. Blocking the mail route is easy: Prisons are moving to give inmates photocopies of letters instead of the originals. And at visitation, they can strip-search us and make us wear embarrassing jumpsuits that zip up the back (the officers have to do that part). They also harass our visitors about what they’re wearing and their feminine hygiene products, to make sure that nothing gets in.

    And then when people overdose, they lock us all down, and shake down our lockers, and take away our recreation time. They do random drug tests, and run drug-sniffing dogs through the dorms now and then.

    But it doesn’t change anything. Until they pay correctional officers a decent wage, or strip-search them every day, there’ll always be a few guards who will take the risk of bringing in small quantities of drugs to sell, given the enormous paydays at stake. Again: Have you ever seen a Suboxone strip? It’s so small and nondescript, it’s like it was made to be smuggled.

    The news media has reported statistics that highlight the scale of the problem: Virginia has just under 30,000 inmates spread across more than 40 facilities; they received almost two million pieces of mail in 2018 and 225,000 visits. That year, there were 562 seizures of drugs inside those penitentiaries; 57 emergency-transport runs to hospitals carrying overdose patients; six interceptions of substances coming in through the mail; four prison employees prosecuted and 13 who resigned or were fired for smuggling. The numbers say that the state is barely scratching the surface of the problem.

    Meanwhile, treatment programs just don’t work in here. Prison is dismal and there isn’t much that’s positive to focus on, to keep an addict’s mind more productively occupied. The incarcerated person who is secure and self-aware enough to admit he has a problem and needs help is a rare breed.

    “It’s wide open over there,” you’ll hear addicts say with glee in their voice, when they’re called to pack their belongings because they’re being shipped off to the two-year residential treatment facility that Virginia runs.

    The big picture—that we incarcerate people for their addictions and then don’t give them adequate treatment—is a silent national disgrace. But it’s the little picture that I have to live with every day, that angers me and breaks my heart. It’s the individual human beings who have been failed by the system, and the often-already-poor families who are devastated even further by loved ones caught up in the cruelties of a vast enterprise.

    One of my last bunkies was pitiful: a lying, scheming, thieving addict who ended up having two fistfights within hours over his drug debts and the stealing that he was doing to support his habit. He was about the worst I ever saw, snorting stuff about six times a day. “I have sinus issues,” he’d often claim with a straight face, as he fit the toothpaste cap to his nostril and threw back his head once again. One day I came back from work to find him frantically rummaging through his mostly empty locker, and crawling around on the floor.

    “What’s up?” I asked, somewhat reluctant to involve myself.

    “Someone stole a piece out of my locker,” he said, panicky.

    This was certainly possible, since the addicts always seemed to be taking anything they could get their hands on, especially from each other. But instead I told him, “You probably just lost it,” hoping for less drama. I also pointlessly reminded him that a piece looks a lot like a paint chip, and those are everywhere.

    Around that time I’d started composing a country song titled, “My Bunkie Is a Junkie,” but I found that not much rhymes with Suboxone. Now he’s in another housing unit, pulling the same stunts. Still, I can’t hate him for any of that, or for stealing some food from me to support his habit; it’s just too depressing.

    In my time in the jails and prisons in D.C. and Virginia, I’ve been astonished by just how many people are locked up for drug crimes or, it’s important to note, drug-related ones. Black, white, Hispanic, it doesn’t matter: In state prisons and local jails, 15 percent and 25 percent of inmates are there for drug offenses, respectively. In federal prison, it’s even worse: More than 45 percent of inmates are there on drug-related charges.

    That’s a mind-boggling number of human beings locked up because of their addictions, either directly or indirectly. Our response to this problem is to put them in prison, where they’ll get little to no help and have all the time in the world to sit around scheming about getting high.

    I don’t have some smart solution for all of this. Just like on the street, little works for people who don’t want to quit using. But I know that most of these addicts don’t belong in here. Trying to incarcerate our way out of the problem is not helping them, and it’s not making society any safer either.

    Because these people will all be out on the street again in a few years—and all they learned in prison was how to cheat and steal and hustle more creatively to get high.

    Daniel Rosen, 49, currently resides at the Greensville Correctional Center in southern Virginia, where he is serving a five-year sentence for computer solicitation of a minor. He spent 15 years working for the departments of State and Defense on national security issues.

    The District of Columbia Department of Corrections did not respond to requests for comment about allegations of drug use in its facilities. A spokesperson for the Virginia Department of Corrections declined to answer questions about the incident in which eight inmates overdosed.

    View the original article at thefix.com

  • Andrew Yang Wants To Invest In Safe Consumption Sites

    Andrew Yang Wants To Invest In Safe Consumption Sites

    “I would not only decriminalize opiates for personal use but I would also invest in safe consumption sites around the country.”

    Democratic presidential candidate Andrew Yang discussed his plans to decriminalize opioids and the need for harm reduction sites during an interview featured on The Hill released this week. 

    “I would not only decriminalize opiates for personal use but I would also invest in safe consumption sites around the country,” Yang told Krystal Ball in a recent interview. “You go home and you’re still addicted and you wind up in many cases overdosing again. We need to refer these people to counseling, treatment and safe consumption sites as needed.”

    Yang took Purdue Pharma and the government to task for their roles in the ongoing opioid epidemic.

    “At this point we have to say this was a systemic failure of capitalism run amok in the worst and most destructive way possible and that our government should come clean, claw back the resources from the drug companies and put them to work in communities to try to make people stronger and healthier—but also say to individuals who are struggling with addiction that this is not a crime of personal character, this is a systemic problem and if you’re using drugs and addicted, we should be referring you to counseling and treatment and not a prison cell,” he said.

    Julian Castro Is In Favor Of Safe Consumption Sites Too

    Julian Castro, another Democratic presidential candidate has made headlines recently for his statements on safe consumption sites. Castro discussed his views and policies while speaking at a forum hosted by the Iowa Harm Reduction Coalition. 

    “I would like these communities to be able to pursue these safe consumption spaces and essentially pilot out how they work,” he said, according to Marijuana Moment. “I believe that we owe it to the effort to see how we can make sure that we avoid [overdose deaths].

    “We’ve been trying it one way for so long and I also believe, having been a mayor of a city, that one of the values of local communities is that they can try out policy in their own community and measure the results and see how it works. The system that we have in place right now doesn’t seem to be working very much at all. Whether it’s Philadelphia or its some of the other cities that have tried it, I believe that we should allow for the piloting of these programs and that that will help us come to a determination nationally about the approach.”

    Sanders & Warren

    Bernie Sanders and Elizabeth Warren have also expressed support for safe consumption sites in their platforms. 

    View the original article at thefix.com

  • Overdose Deaths: Not an Epidemic or a Crisis, and Not by Accident

    Overdose Deaths: Not an Epidemic or a Crisis, and Not by Accident

    Overdoses are not mysterious, they result from predictable causes like criminalizing drug use, ineffective policies, poverty, lack of stable housing, and persistent racism.

    Opioid-related overdoses are not a crisis or an epidemic, and should not be described as either. Both words stigmatize the victims of a phenomenon that is not happening by accident. Such overdoses have been steadily increasing throughout the United States and are especially high in Appalachia (where we both work). Yet overdoses are not a natural or mysterious phenomenon. They result primarily not from individual, but from larger structural factors — criminalization of drug use, ineffective social policies, poverty, lack of stable housing, historical and persistent racism, and other forms of systemic oppression — which are all the result of deliberate policy decisions.

    We are told by the media, CDC, and state governments that the region where we live and work is ground zero for a drug “crisis.” Yet those same entities contribute to the problem through policies, funding allocations, and covering-up of underlying systemic causes. We must shift our language to reflect this. Substance use and overdose happen in predictable contexts and disproportionately affect marginalized communities.

    Terms Like “Epidemic” and “Crisis” Cause Alarm and Hysteria, Stigmatizing People Who Deserve Compassion

    More than 67,000 people in the United States died from opioid-related overdose in 2018. Alarmist headlines, even well-intended reports, do not justify an inaccurate framing. We advocate instead for the use of the term impact, or other language that indicates the underlying roots of suffering, instead of epidemic or crisis.

    Epidemic is most accurately used to describe infectious or viral spread of a disease within a population over a short period of time. Substance use, even for the relatively low 18% of people who use “chaotically,” does not meet this criteria. People who overdose or suffer negative consequences of substance use may be more socially or genetically vulnerable to a substance use disorder but in basic epidemiological principles, that does not an epidemic make. Calling structural violence that leads to specific overdose patterns an epidemic or a crisis feeds into a hysteria that marginalizes drug users and their loved ones. Both words take the focus away from the underlying causes of suffering; naturalizing it and leaving the conversation at a surface level without motivating real change. 

    We both work in and study harm reduction and overdose prevention in North Carolina: a microcosm of opioid-related deaths and specific patterns of suffering repeated elsewhere in Appalachia and throughout the country. Daily, we observe the dynamics of economic policies, limited healthcare access, and stigmatization that impact people already at greater risk for substance use and overdose. Later in this essay we discuss how it plays out in North Carolinians’ overdose risks — making it more likely they and their loved ones will be blamed if they do.

    How Misguided Drug Policies Blame the Victims While Ignoring the Causes

    Like the thousands of lives lost to fentanyl poisoning in the context of increased drug use criminalization today, there was nothing natural about the thousands of lives lost to alcohol poisoning during prohibition a century ago; or the increase in deaths and drug-related arrests that ravaged inner-cities during the government-manufactured “crack era” of the 80s and 90s. Consequences of drug use, like mass incarceration, have never been a natural disaster. Instead, policy responses to drug use tend to create systemic storms that rage in vulnerable communities. This is a classic example of blaming the victims of problems while ignoring the causes.

    If a “crisis” is happening to those around you, you may feel bad for them, you may vote for a politician who promises to address it — but you probably won’t ask how the same politicians or political system contributed to creating it, or how arresting and jailing poor and Black and Brown people will fail to fix it. Overdose deaths in the U.S. have always been both a symptom and outcome of discriminatory policies. 

    Suffering is further exacerbated by punitive policies such as drug-induced homicide laws that increase overdose deaths, weaken Good Samaritan legislation intended to reduce overdose, and criminalize drug users and their loved ones. For example, opioid de-prescribing mandates in 19 states appear to result in an increase in heroin overdose deaths. And, healthcare policy is an oft-overlooked aspect of overdose prevention — states that did not expand Medicaid (which increases coverage of treatment) are disproportionately states with higher overdose and substance use.

    Mainstream media portrays sympathetic stories of the middle-class sons and daughters of urban politicians dying of overdose, while the stigmatized partners and friends of poor Appalachians who disproportionately die of overdose from drugs often laced with fentanyl fear being arrested under ‘drug-induced homicide’ and ‘death by distribution’ laws if they call 911. The ways that drug users are talked about serve political agendas that further contribute to patterns of suffering.*

    We must acknowledge and address what is missing, obscured, and ignored when we promote an inaccurate framing of drug use as a “crisis” or “epidemic,” rather than something caused by policy decisions. Who is disproportionately blamed? Who is left out of the conversation? 

    When we fail to address how a combination of economic, political, biological, behavioral, genetic, and social factors intersect within the lives of drug users and their wider communities, we legitimize the use of simplistic and punitive approaches to complex issues. Where we live and work, North Carolina policy makers used the 2016-2017 increase in drug overdose deaths to justify an argument for harsher punishments despite a wealth of research that shows that such approaches increase the very health consequences they claim to reduce. Further, these approaches do nothing to address economic disparities in North Carolina where 13 of 100 counties have experienced rates of poverty at 20% or higher for the last three decades. They do nothing to address the lack of Medicaid expansion or limited employment and economic growth — all upstream drivers of overdose and suffering.

    Simply put, an increase in overdose deaths is not the result of society’s inability to get tough on crime, or even the need for more biomedical treatment. Rather, overdose deaths persist due to an unwillingness to acknowledge that treatment expansion and more or harsher punishment fail to address gaping social wounds. 

    Communication: Start Using Language That Reveals the Roots of Unequal Suffering

    As long as policymakers, politicians, and journalists continue to use inaccurate terms like “opioid crisis/epidemic,” opportunities are missed to discuss and address the causes and effects of substance use and overdose. We advocate for talking instead about “opioid impact” or “overdose impact.” A more neutral term like impact is less stigmatizing and hyperbolic, and thus less marginalizing for those directly affected. Impact is also more flexible — not all drug use is harmful, nor leads to substance use disorder, illness, or overdose. Impact is a more accurate and flexible term to allow for discussion of people’s lived experiences with substances.

    Even so, it may not go far enough. As a parallel example, public pressure and justice-oriented advocacy shifted public conversation and journalistic style from talking about human beings as “illegal” to “undocumented.” But referring to these same folks as “economic refugees” would be even more accurate and less stigmatizing. Similarly, impact is a more useful term than “crisis” or “epidemic” when referring to patterns of opioid-related overdose and substance use-related illness. And, terminology that clearly unmasks the deeper roots of unequal suffering would be even better.

    A person using drugs is not a disease vector nor the precipitator of a crisis. What we witness in communities like Philadelphia, Austin, and Asheville are not drug-related epidemics or naturally occurring crises. The harms impacting these communities are symptoms of destructive social policies that ensure the most vulnerable populations remain vulnerable, shamed, and disproportionately suffering from the very problems for which they are blamed. 

    So where do we go from here? We can start by answering this with another question: How might our conversations, and thus policy and response efforts change, if we use language that reveals the structural roots of suffering instead of further contributing to stigma and hysteria that shames the people who are most directly affected?

    View the original article at thefix.com

  • Prevent Opioid Overdose Deaths: A Call for Specific Prescribing Laws and Physician Oversight

    Prevent Opioid Overdose Deaths: A Call for Specific Prescribing Laws and Physician Oversight

    Make doctors precisely explain why they are prescribing opioids and why they decided on the pill count and refill allowance for each patient. 

    Recently, a friend’s teenage daughter underwent a procedure common for young adults: she had her wisdom teeth extracted. I had the same procedure performed in the late 1990s, at age 20. Back then, I was given a bottle of ibuprofen for the pain and, for the bleeding, told to apply tea bags. My friend’s daughter was given something just a tad stronger: 

    Vicodin.

    A teenager was given a strong opioid painkiller to numb the pain of a routine tooth extraction. It’s absurd that this is the accepted medication for this procedure when there are no complications, nothing that would indicate breakthrough pain on a level of requiring a narcotic that is given to cancer patients.

    However, the fight against opioid abuse is finally gaining promising victories by wielding an effective weapon: lawsuits. 

    Holding Big Pharma Accountable

    As the epidemic grew, many – myself included – called for state and local authorities to take drug companies to court for knowingly encouraging large-scale consumer usage of highly addictive prescription painkillers such as OxyContin, Vicodin and Percocet. Thousands of lawsuits have now been filed and in August, the $572 million decision won by Oklahoma against Johnson & Johnson became the first large-scale trial ruling concerning Big Pharma’s role in creating the opioid crisis. The state argued that J&J, which had supplied 60% of the opioids drug makers used for painkillers, aggressively marketed the drug to doctors and patients as safe. 

    Most recently the Sackler family – owners of Purdue Pharma, which makes OxyContin – reached a tentative settlement for$10-12 billion, a move that will result in the company’s bankruptcy. 

    They lied, we died, and now they have to pay up. Hopefully these are just the first few drips in an oncoming flood of restitution owed Americans by companies responsible for an unprecedented addiction crisis. They deserve whatever fates come their way – criminal, civil, or, as the 800-pound spoon left at Johnson & Johnson’s headquarters intended, shame-filled. 

    Now, as the overdose death rate shows signs of ebbing but has by no means abated – 68,000 Americans died in 2018 compared with 72,000 in 2017, hardly cause for celebration – it’s time to ask what’s next. 

    For years, drug companies pushed opioids as a panacea for all things pain-related. The result was an absolute avalanche of prescriptions: 191 million in 2017 alone, which averages to 58 opioid prescriptions for every 100 Americans. And despite guidelines intended to discourage opioid painkillers as a first-step approach to easing pain, primary care clinicians – most patients’ initial gateways to healthcare – wrote 45% of all opioid prescriptions. 

    Surgeons also have been implicated in widespread overprescribing. One study of nearly 20,000 surgeons, led by Johns Hopkins School of Public Health researchers, noted the common practice of prescribing dozens of opioid medications even for low-pain operations. Some prescribed over 100 opioid pills for the week following a surgery, along with usage instructions far exceeding guidelines from several academic medical centers. No wonder some six percent of all patients prescribed opioids post-surgery become dependent. 

    The diagnosis is simple: Doctors have proven incapable of, or unwilling to, exercise responsible discretion in determining which conditions and medical procedures necessitate painkillers notoriously linked to addiction, misuse, and overdose. 

    A Painful Backlash

    Complicating matters, the opioid crisis has become a two-way street. 

    In response to the backlash to the initial opioid free-for-all, many doctors have become so wary of prescribing opioids that those who truly need them are unjustly suffering. Much of this hesitancy is a reaction to guidelines issued by the Centers for Disease Control in 2016 that, according to Richard Lawhern, founder of the Alliance for the Treatment of Intractable Pain, has subjected patients with legitimate chronic pain to a “draconian reduction” in doctors willing to meet their needs with opioid-based medication.

    The problem with the CDC’s directive was vagueness of language. The guidelines state that opioids are appropriate for pain caused by cancer, end-of-life care, and “palliative care.” But “palliative” is a subjective term, and therefore confusing for doctors who, understandably, now have their guards up against malpractice suits in addition to opioid addiction and abuse. In a February 2019 reiteration of its guidelines, the CDC clarified that opioids are reasonable for chronic pain but, unfortunately, repeated its ambiguous wording concerning specific conditions. 

    However unintended, the result is patients who rely on opioids for legitimate medical reasons suffering for the sins of Big Pharma and, subsequently, the incompetence of government officials and the inadequacies – including cowardice – of doctors.

    The scale of the crisis and forcefulness of the backlash also has resulted in patients who, through no fault of their own, became dependent on opioids and, at the drop of a guideline, found themselves completely cut off from a highly addictive drug and dropped into a hellish withdrawal. The unsurprising consequence of this overreaction by doctors is patients turning to the streets for unregulated, often fentanyl-tainted heroin. Any laws written to specify opioid painkiller administration must include reasonable ways of relieving already-addicted patients through treatment centers and weaning agents like methadone and buprenorphine (suboxone). 

    However, the conviction permeating the chronic pain community – that doctors rather than laws should be the primary determinant of opioid prescriptions – simply doesn’t hold water. It’s become clear that doctors don’t necessarily know best. We need rules that hamstring the parasitic overprescribers while unhandcuffing the paranoid underprescribers.

    Guidelines Aren’t Enough

    It’s time for legislators to take the mystery out of this branch of medicine. If doctors can’t stop writing opioid prescriptions to those who don’t need them, or refusing to write prescriptions for those who do, then we must enact laws with clear prescribing instructions. 

    We’re all familiar with mandatory sentencing guidelines; we need mandatory dispensing guidelines – laws that bring harsh punishment for overprescribing pain medication when it’s not indicated, while reassuring doctors that they will not be unfairly punished for providing chronic pain patients with the relief they require.

    The time has come for customized ailment and procedure-related opioid painkiller dosing laws, complete with extensive medical rationale requirements. Make doctors precisely explain why they are prescribing opioids and why they decided on the pill count and refill allowance for each patient. 

    We also need to look at something else: ourselves. Especially in post-surgery settings, the opioid overprescribing epidemic was exacerbated by the naïve, altogether modern notion that patients should never feel discomfort or pain. 

    If alternatives to opioids don’t kill 100% of post-procedure pain, the new one-word answer should be “tough.” The idea that we can go through life without ever experiencing pain is not only delusional but, as we’re seeing, destructive. Things heal. Patients will need more, well, patience. 

    Numbing people literally to death is not the answer. It is irresponsible and dangerous to prescribe opioids for an ingrown toenail. Or for carpal tunnel syndrome. Or to a child following a tonsillectomy or, of course, a teenager after a tooth extraction. 

    On the flip side, it is cruel and flat-out stupid to deny patients with serious chronic pain access to a now-demonized family of medicines that for many has meant the difference between functioning and debilitation. 

    The time for general guidelines is behind us. We need strict, specific statutes that greatly diminish doctors’ discretion while placing transparency and responsibility squarely on their shoulders. 

    View the original article at thefix.com

  • "Dope World" Takes a Globe-Spanning Deep Dive into Our Relationship with Drugs

    "Dope World" Takes a Globe-Spanning Deep Dive into Our Relationship with Drugs

    Vorobyov investigated drug use and culture in 15 different countries on five continents, from the coca plantations of Colombia to the mean streets of Moscow.

    With the release of his new book, Dope World: Adventures in Drug Lands, Niko Vorobyov has become the Anthony Bourdain of drugs and the worlds they inhabit, a modern day Hunter S. Thompson. By interviewing cartel members, big-time drug dealers, street guys, gang members, and even government officials, Vorobyov seeks to understand humanity’s bond with drugs. 

    Before our interview, Vorobyov told me about one surreal night in the mountains of Sinaloa, Mexico, where he and his buddy had traveled for a meeting with one of El Chapo’s relatives. Deep in cartel territory, with posted guards everywhere brandishing AK’s and AR-15’s, where one wrong move could mean death, El Indio, the guy who owned the ranch, threw a sushi party. 

    Vorobyov remembers all these guys standing around with assault rifles slung over their shoulders eating sushi. One of the gun-toting sentries even came over to Vorobyov and started chatting to him about movies. He came away with the feeling that El Chapo’s family were pretty normal, if you forgot about the guns.


    Tributes to Malverde, the Sinaloa patron saint of narcotraficantes.

    The Fix: Why did you decide to examine every angle of the drug war and how has the drug war affected the whole world?

    Niko Vorobyov: There’s a lot of great books about this already — Chasing the Scream is one of my favorites — but they take a very Anglo-centric point of view. I wanted to explore other places that we don’t hear about so much like Russia, Japan, and the Philippines. Some people like to say it’s all America’s fault and that they started this whole mess with Richard Nixon, but it goes back way before that, all the way to China and the Opium Wars. Right now, America’s legalizing weed while Russia, China, and the Philippines are fighting the drug war the hardest.

    Why do you think you got involved with drugs in the first place?

    Growing up I was quite a weak person with low self-esteem, so I kinda thought if I acted in a certain way, that would help me accept myself; that drugs and criminal activity would get me friends and respect and all that. I started getting a lot into the underground rave scene and became a student drug dealer. And once you start moving in those circles it’s quite easy to make connections and meet a supplier. From then on, I worked my way through ups and downs till I had a small crew running weed, coke, and MDMA through the hallowed halls of East London universities. 

    But I got reckless and ended up doing a 2½ year prison stretch which really changed my outlook on life — it made me question who I was and what I was doing here. Sitting in a cell on 24-hour lockdown I read everything I could about the history of drugs and drug bans, how and why they were forbidden, and what the consequences of that may be. When I got out, that led me on a journey across 15 different countries on five continents, from the coca plantations of Colombia to the mean streets of Moscow.

    Looking back now, how did your early drug use and even prison prepare you to write Dope World?

    I’ve always had an anti-authoritarian streak; I’ve hated others telling me what to do, especially if it was “for your own good.” Of course I’ve taken drugs — if I haven’t, would that make me more [qualified] or less qualified to write about this topic? I keep reading articles where you can tell they’ve never dabbled in any psychedelic pleasures because none of them have a clue what they’re on about. Looking back, I wasn’t really very political before I went to prison because it’s easy to feel detached when it’s happening to someone else. 

    But when you’re locked in a cell for 23½ hours a day and there’s not enough staff because someone wanted to save a few pennies, you start to see all these abstract ideas are life-or-death shit. And when you see all these poor, working-class people or ethnic minorities while the government’s laughing all the way to the bank — the UK’s one of the biggest legal weed exporters in the world — it makes you ask what’s wrong with this picture. 

    You interviewed Freeway Rick Ross. What did that teach you about the crack era in L.A. and across the nation?

    The first thing you need to know is the real Rick Ross is not a rapper – that Rick Ross actually batted for the other team as a prison guard. Freeway Rick Ross was the biggest crack kingpin on the West Coast in the 80s and early 90s — this dude supplied the Bloods and the Crips. Ricky’s a tough man to get ahold of; he was actually on his own book tour as I was trying to reach him, so I’m glad he came through. Where his story gets really interesting is when he was involved in the Contra cocaine scandal. 

    The CIA was allowing the Contra rebels in Nicaragua to smuggle coke into the U.S. for buying more firepower and fighting communism back home. Freeway Ricky unknowingly took the Contra’s coke and cooked it up into crack before selling it in South Central, without realizing he was just a small pawn in a chess game of global politics. I’m not really a conspiracy nut, but it’s amazing that this whole scandal came to light—how the Agency knowingly used a foreign army pumping crack into the hood — and it makes you think about what else they might’ve done that we don’t even know about. 

    At the same time, the Feds were going down hard on the inner city to fight the so-called crack epidemic. Congress passed the Anti-Drug Abuse Act 1986 which meant that mostly black and brown people who were caught with five grams of crack got the same sentence as someone with half-a-kilo of regular blow. Freeway Ross ended up getting life, while none of the top players who approved the Contra plan wound up going to jail. That tells you everything you need to know about the hypocrisy, racism, and corruption in the war on drugs.

    In the book, you write about LSD in Tokyo. Can you talk about that?

    So the chapter on Tokyo is all about meth, LSD, and synthetics. I mostly fucked with the Yakuza (Japanese organized crime) and found out how they roll with being among the top meth dealers in Asia. But there was another group that was also quite interesting — a cult named Aum Shinrikyo or “The Supreme Truth,” which in 1995 carried out the deadliest terrorist attack in Japan, poisoning 13 people on the Tokyo subway with sarin gas. Like the CIA used to do in the 50s, the cult used LSD as part of their brainwashing. Maybe being on psychedelics made their wacky conspiracy theories believable. 

    Of the places you visited, which had the worst addiction problems? 

    When I was in Lisbon, the head of an NGO showed me a video of how this neighborhood used to look like. In the 1990s, Casal Ventoso was one of the biggest open-air drug markets in Europe and it really looked like a nightmare version of The Wire or a cheap movie set of the bad side of town. Dystopian scenes; crowds of ragged-looking addicts shuffling past crumbling buildings and filthy, trash-ridden streets. One guy was missing his arm. Portugal had a major heroin crisis — something like 1% of the population was addicted — but it’s precisely because their crisis was so bad that they managed to push through reforms and de-stigmatize addicts.

    Of the places I’ve been to now, it’s hard to say — everywhere has its problems — but probably the most widespread I’ve seen was in Kerman, an Iranian city near the Afghan border. It seemed like every household had at least one member smoking opium, or taryak, and you can see people lighting up pipes or spoons in the archways of the old market. Iran’s a very religious country and opium’s tolerated more than booze. But I’d say every other young person drinks, and there’s a rising alcohol problem because they’re too scared of getting help.


    Vafoor, or opium pipe, in Kerman, Iran.

    When do you think the world will stop criminalizing addiction?

    I think we’re slowly moving in that direction. The police in some parts of the UK have stopped targeting low-level user-dealers. A lot of the people I’ve talked to are cops, and as a former drug dealer that’s not a conversation I expected to have six or seven years ago! Then you’ve got someone like Boris Johnson inhaling a South American nose remedy, and he’s gone on to be leader of a country that used to own half the world. 

    I’m not saying they’re connected, but we’re starting to realize taking drugs doesn’t always lead to the worst-case scenario. A couple of months ago Malaysia, which was putting convicts to death, announced they’re following Portugal and decriminalizing drugs which means that you won’t end up in jail for having a gram in your pocket. And that’s a very conservative country; much more conservative than, say, Ohio. So I think there’s hope.

    What did you learn the most during your travels and writings?

    I think the most important thing is no matter how much you read, you’ll never truly know how the world works from your bedroom (or in my case, my cell). You’ve got to go to places and talk to people. Listen to them, even if they’re chatting complete bollocks, and try to understand why they think the way they do. We try to put everything in boxes — good or bad, left or right — but our world is too complicated for that. My agent called my book a fucked-up travel guide. I hope I’ve inspired someone to check out these places, if I haven’t scared the shit out of them already.

    There’s a sense that this is it, you’re fucked now. No one’s coming to get you. When you and I get stressed now we can take a walk; go outside; talk with our friends; but when you’re in prison, you’re stuck alone in a tiny cell till they let you out, and you start going crazy. When I was inside there were so many cutbacks they didn’t have enough staff to run the show properly, so sometimes we’d be locked up 23½ hours a day— suicides went sky-high that year.

    What takeaways do you want readers to have after reading your book?

    Look, you might not like the idea of your little cousin bouncing off the walls after a line of Bolivian marching powder. My mum read the book and she was fucking mortified. But dopeworld is everywhere, from scuzzy housing projects to the highest echelons of power, so we’ve got to find a way of living with it, otherwise families will keep getting torn apart and the bodies will keep piling up, whether it’s through prisons, gangs, or ODs. We’ve tried drug war, now let’s try drug peace.

    Search results from the dark web.

    View the original article at thefix.com

  • Drug Deaths in Black Communities and Our Collective Denial

    Drug Deaths in Black Communities and Our Collective Denial

    “While white addicts receive treatment, drug counseling, and a lenient criminal justice system, there are Black people still behind bars because of mandatory minimums, three-strikes laws, and disparate drug sentencing.”

    “Google ‘Children of the Opioid Epidemic,’” said professor Ekow N. Yankah. The search sent me to a year-old New York Times feature about children born to mothers struggling with opioid use disorder.

    “How tender a picture is that?” he asked.

    The image, a white infant coddled by her mother, was hard to ignore. They stood crouched down on the floor of what could be my childhood home. Mom’s dirty-blonde hair was strewn about, covering her face as she embraced her child. She was asking for forgiveness or redemption or both. I’ve been there.

    “That is a picture of a young woman who, whatever her drug addiction is, is fighting to be a decent mother,” Yankah continued. 

    Yankah, who teaches criminal law at Cardozo Law School and is a board member of the Innocence Project, made his point. “Compare that with what you know of welfare queens and crack mothers,” he said. “Was there any image like this in the collective mind of our society when we talked about crack mothers?”

    It’s a rhetorical question. Images and headlines from the crack-cocaine era remain burned into our psyche. But awareness is not acceptance. So, let’s be honest. It’s no accident that America’s newfound compassion comes during the opioid crisis. Eighty percent of overdose victims are white. 

    “We don’t get to move on by pretending that this is a coincidence,” Yankah said. 

    “People are saying: look, it’s not racism. It’s that we tried the other model and it just didn’t work,” he continued. “As if for 25 years, we tried to lock up a whole community, and when the color of the community switched, we suddenly grew enlightened.”

    There’s Always Been a Cocaine Epidemic

    According to the Centers for Disease Control and Prevention, cocaine-related overdose deaths rose about 216 percent between 2012 and 2017. That’s double the growth rate of opioid deaths for the same period.

    Most of those deaths happened in black communities. Black adults were twice as likely as whites to die from cocaine-related causes. In 2017 the numbers were 8.3 per 100,000 compared to 4.6. And even though overall deaths rose recently, the data shows that black people have always had double the rate of cocaine overdose as their white counterparts. 

    Further data shows that black folks are more likely to develop cocaine dependence or a past-year use disorder. For almost two decades now, we’ve had data that shows cocaine use disproportionately affects black communities.

    But today’s headlines make it appear as if it’s a recent phenomenon. “The Opioid Crisis Is Becoming A Meth And Cocaine Crisis,” wrote Buzzfeed last January. “As the Opioid Crisis Peaks, Meth and Cocaine Deaths Explode,” the Pew Trusts noted in May. The list goes on ad infinitum. 

    The cocaine epidemic in black communities is not new. 

    Around three-fourths of these fatalities involved fentanyl or other opioids, but we don’t know if the presence of the opioid was disclosed to the user. Officials speculate it could be a contaminated drug supply. More people could also be doing speedballs (a combination of cocaine and opioids).

    Whatever is behind the disproportionate rate of overdose, experts remain stumped — and until recently, no one really cared.

    Because despite the data, and the appreciation for treatment-based solutions, research remains lacking. A PubMed search shows little to no relevant information. Most news outlets have ignored the issue. 

    It’s Just a Cruel Delusion

    “Americans really have the sense that history starts anew with every generation,” Yankah said. 

    “I schematically undermined your family, and then my children look up and say to your children, ‘look, I don’t know why I’m so much better off. I must have worked harder,’” he continued. 

    “It’s just a cruel delusion.”

    At first, systemic racism spared black people from the opioid crisis. Doctors are more likely to label black patients as either addicts or drug dealers, so they are less likely to prescribe opioid painkillers. 

    But opioid use is rising in black communities. Minority-majority cities like Baltimore, Chicago, and Washington D.C. know this better than most. The opioid crisis isn’t white. Over 47,000 people died of an opioid overdose last year. More than 5,000 of those deaths, or 12 percent, occurred in black communities. 

    Black people have less access to life-saving medications like buprenorphine than white people. And due to limited resources, they’re less likely to complete addiction treatment. Even if they do find treatment, almost 90 percent of psychologists are white. As one Philadelphia reporter wrote, it’s difficult to connect in a clinical setting.

    Outside Philadelphia’s federal courthouse this summer, activists gathered in support of SafeHouse. It’s the city’s — and the nation’s — possible first planned safe injection site. Family members lined the building with photos of overdose victims. 

    Every single photo was white.

    “Doing the right thing for the wrong reasons is yet polarizing, divisive, and racist,” Bishop Talbert W. Swan, II told me. Swan, the pastor of Spring of Hope Church of God in Christ, is a civil rights activist and president of the Greater Springfield NAACP. 

    “The wrong reason, of course, is because the addicts are now considered ‘victims’ because they’re predominantly white,” he continued. “The softer, gentler approach is not because lessons were learned by how America dealt with the crack epidemic, but because of white supremacy and the consistent dehumanization of Black and brown people.”

    Just Say No

    During the crack-cocaine era, murder rates doubled for young black males of all ages. Fetal death rates increased, fathers went to prison, and children, to foster care. Many black urban neighborhoods, which have the highest concentrations of poverty in the country, still bear the scars of those years.

    “America needs to remember that the U.S. government allowed the influx of drugs into inner-city Black America and profited from the death, addiction, incarceration, and destruction of Black families and communities,” said Bishop Swan.

    He continued: “While Nancy Reagan went around the country telling Black people to ‘just say no,’ her husband Ronald Reagan and Oliver North were funneling proceeds from the sale of crack to the Contras in Nicaragua and funding terrorism.” 

    We held black people to a higher standard. Americans preached personal responsibility. But the opioid crisis created victims. We blame Johnson & Johnson, Purdue, Richard Sackler, and our doctors.

    “The government will now ensure that pharmaceutical companies pay [restitution] for the addiction of whites to opioids, but will never pay for being complicit in the devastation to Black families and communities,” said Swan.

    “While white addicts receive treatment on demand, drug counseling, and a lenient criminal justice system, there are Black people still behind bars because of mandatory minimums, three-strikes laws, and disparate drug sentencing,” said Swan.

    We have “collective self-denial” about this disparity, Professor Yankah once wrote. It’s left black people world-weary and bitter. Yankah and Swan agree that contemporary models of addiction treatment are the way forward. Each expressed the need to reflect on our past — not to be cliché — for fear of repeating it.

    “One of the things I got a chance to do once was have a thoughtful conversation with one of the first minority judges who is on the federal bench in Miami,” said Yankah. “He spoke about when heroin was ravaging Miami in the 70s.”

    “People wanted to wrestle with this problem that was hurting their communities until a bunch of politicians started making hay that the heroin problem was a problem with Hispanics,” he continued. “Suddenly all this money for rehabilitation disappeared.”

    Meanwhile, cocaine continues to ravage black communities. Since 2012, cocaine has killed as many, if not more, black Americans as opioids. They die unseen as politicians and policymakers do nothing. There is no New York Times spread, no pharmaceutical company settlement. No one asks about the black children of the cocaine epidemic.

    View the original article at thefix.com

  • Sri Lankan President Signs Death Warrants For Drug Offenders

    Sri Lankan President Signs Death Warrants For Drug Offenders

    Sri Lanka’s decision to lift a 43-year moratorium on the death penalty has been met with opposition by world leaders. 

    Death sentences for four individuals convicted of drug-related charges were issued by Sri Lankan president Maithripala Sirisena on June 26, prompting an appeal from the UN Secretary-General that was ultimately rejected.

    Political observers and members of Sirisena’s own cabinet have criticized the decision, which media sources have reported as being motivated by his upcoming re-election, though Sirisena has said that his goal is to thwart drug trafficking in his country.  

    Possible Appeal

    Legal challenges to the sentences have already been filed, and while Sirisena has said that the four accused individuals can appeal their convictions, he also noted that they have already decided the date of the execution.

    At a meeting in Sri Lanka’s largest city, Colombo, Sirisena told reporters that he had “already signed the death penalty” for the four individuals. He did not give the names of the four alleged offenders or a specific date for their executions beyond saying that they will be “implemented soon.”

    He also said that the decision to reinstate the death penalty, which had been on moratorium in Sri Lanka for 43 years, was a move to protect the “nation and the future generation from the drug menace, which is our worst social catastrophe.”  

    The New York Post noted that support for the death penalty has increased among Sri Lankans and earned the backing of several religious leaders, though political commentators were quick to add that Sirisena’s motives may lie more in improving his chances for re-election, which will take place later in 2019.

    “He is trying to protect himself like the Philippines president [Rodrigo Duerte],” columnist Kusal Perera told Reuters. “But I doubt whether it is enough. It won’t give him much political mileage now.”

    The decision drew considerable opposition from world leaders, including UN Secretary-General António Guterres, but Sirisena said that he told Guterres in a telephone conversation to “please allow me to stamp out the drug menace.”

    World Leaders Oppose The Decision

    The United Kingdom, European Union (EU) and Canada, as well as human rights groups like Amnesty International, all issued strongly worded condemnations of Sirisena’s decision, with the EU adding that the reinstatement of the death penalty would be a direct contradiction of Sri Lanka’s commitment to maintain its moratorium on executions in 2018.

    The country’s ruling political faction, the United National Party, issued its own condemnation, which declared that reinstating the death penalty would be “economic sabotage” and not befitting a “civilized country.” Sri Lankan Prime Minister Ranil Wickremesinghe, who is a member of the United National Party, also said that a majority of parliament members were opposed to the decision.

    The move to revive the death penalty also faces several legal challenges from non-governmental organizations like the Centre for Policy Alternatives, which filed a case with the Sri Lankan Supreme Court on July 1. But plans to carry out the executions appear to have gone ahead as planned, with the Justice Ministry reporting that 26 candidates have been shortlisted for the job of executioner. The previous official hangman left his post in 2014, and his three replacements have all left the position after brief tenures.

    View the original article at thefix.com

  • Illinois Governor Introduces Marijuana Legalization Bill

    Illinois Governor Introduces Marijuana Legalization Bill

    The bill would also expunge the records of people convicted of some marijuana-related offenses. 

    Illinois Governor J.B. Pritzker has introduced a measure that would legalize recreational marijuana in the state next year, including in the nation’s third-largest city, Chicago.

    “It is possible, likely that it may be available through dispensaries beginning January 1, 2020,” Pritzker said, according to ABC 7.

    According to the Associated Press, the bill would legalize recreational cannabis use for people who are 21 or older. Illinois residents would be able to possess 30 grams of marijuana (about one ounce), while non-residents could possess 15 grams (about half an ounce). Marijuana would be sold at dispensaries throughout the state.

    In addition to legalizing cannabis, the bill would also expunge the records of people convicted of some marijuana-related offenses. 

    “This bill advances equity by providing resources and second chances to people and communities that have been harmed by policies such as the failed ‘war on drugs,’” said Lt. Gov. Juliana Stratton.

    The bill would provide low-interest loans to people from communities that have been disproportionately affected by the prohibition on marijuana, or people who have had a marijuana-related offense that would be expunged under the new law and now want to start marijuana-related businesses. 

    Still, some organizations including the Illinois NAACP oppose legalization in the state, saying that it will do more harm to marginalized communities of color. 

    Kevin Sabet, founder and president of Smart Approaches to Marijuana, said, “The consequences of this bill are far-reaching and will have devastating impacts on citizens, communities and youth. Illinois lawmakers must take a smart, commonsense approach, and not welcome in another addiction-for-profit industry into the state.”

    Chicago Mayor Rahm Emanuel seemed to support legalization, albeit with reservations. 

    “Thematically, philosophically I think I support the governor but I say it also as a father of three, that you have to do it in a way that’s not encouraging a type of behavior,” he said. 

    Chicago Mayor-elect Lori Lightfoot is in favor of the bill. 

    “I think that the bill that was announced on Saturday is an important step forward, so I do support it,” she said. 

    Although Democrats control the state legislature and the bill is expected to pass, not everyone in the party is on board with legalization, said Democratic State Rep. Marty Moylan.

    “It’s important that we send a message to the state and the governor. Governor, we need more work on this. This is not a bill that we want,” Moylan said. 

    Pritzker initially said that legalizing marijuana would add $170 million in revenue to the state’s troubled budget, but later said that that number may be revised down. 

    View the original article at thefix.com

  • U.S. Reps Say Stop Classifying Marijuana as a Dangerous Drug

    U.S. Reps Say Stop Classifying Marijuana as a Dangerous Drug

    The federal government currently classifies marijuana as a Schedule I drug, impeding important research and new medical treatments.

    U.S. Representatives Earl L. Carter and Earl Blumenauer published a call for the government to remove marijuana from the list of Schedule I drugs in NBC News’ opinion section Monday. They argue that marijuana’s current classification, which labels cannabis as dangerous and without any medical benefits, has prevented researchers from studying a substance that is being legalized on a medical and recreational basis across the country.

    Carter, a Georgia Republican, and Blumenauer, an Oregon Democrat, believe that it’s past time to remove many of the hoops researchers must go through to even begin to study the effects and medical benefits of cannabis.

    “[R]esearchers seeking to conduct clinical research must jump through several hoops to submit an application to the FDA and get approval from the DEA before starting their work,” they wrote. “Furthermore, all research efforts must go through the National Institute on Drug Abuse and the cannabis used must be sourced from their authorized facility. In 2016, the DEA announced that it would create a process to license additional manufacturers for research, but it has yet to approve a single application despite bipartisan congressional pressure.”

    The representatives support their argument by pointing out that over 90 percent of U.S. residents approve of legalizing cannabis for medical purposes and the FDA approved oral cannabidiol (CBD) solution for the treatment of two forms of epilepsy in 2018. They also express concern that not only could the current red tape prevent people from getting treatment that could help them, it could be preventing some from realizing that they “need to pursue a different treatment.”

    An increasing number of federal U.S. legislators have been getting on board in terms of cannabis decriminalization or full legalization. Recent business deals between large cannabis companies have caused speculation that legalization could be right around the corner in spite of the DEA’s continued refusal to take the drug off of the list of the most tightly-controlled substances.

    As more states legalize cannabis and more people try it for treatment of physical and psychological illnesses, there has been increasing concern that research has fallen too far behind. As the opioid epidemic has raised questions about what to do about the millions of people who need regular pain relief, U.S. researchers have been unable to quickly and effectively research how well cannabis could act as a full or partial replacement for drugs that are physically addictive and carry the risk of overdose.

    “The chemistry found only in cannabis plants can provide relief across an incredible array of adverse health states. It does this with minimal side effects and with the prospect of being eminently cost-effective in its use,” said ANANDA Scientific CEO Dr. Mark Rosenfeld.

    “The medicinal use of cannabis today has its roots in the 1960s, when Israeli scientists began studies on its unique chemistry. A government program for administering medical cannabis has been in place there for 12 years, and doctors do not hesitate to encourage its use as an effective pharmaceutical alternative. Meanwhile, the United States remains regrettably behind because of its draconian and antiquated anti-cannabis laws.”

    View the original article at thefix.com