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May 2016
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Opioid prescriptions, panic, and bad math

The editorial in this month’s Journal of Palliative Medicine: The Pendulum Swings for Opioid Prescribing by Charles F. von Gunten, Editor-in-Chief

I am about to turn 60 years of age. During my professional life as a physician, I have seen the pendulum of attitudes about the role of opioids for treating pain swing its full arc and back again. I only graduated from medical school in 1988! Why does the pendulum need to swing from one extreme to the other? Why can’t it settle in the middle, at rest, where it belongs?

It’s a good editorial and helps point out the capriciousness of how we prescribe based on the fears generated by junk science media (and political opportunism).

I particularly liked this point about the math – we see this kind of thing all the time in drug policy.

It’s a numerator and denominator issue. If you put the number of opioid addicts who were first introduced to opioids as prescription drugs before taking heroin in the numerator, and put all opioid addicts in the denominator you get a very large number. That large number (anywhere from 60% to 100% depending on the population studied) frightened everyone. But it’s the wrong math.

If you put all people with pain who are treated with an opioid and become an addict in the numerator, and all people treated with pain and an opioid in the denominator, you come up with a very small number, somewhere between 0.01% and 4% depending on the kind of pain you are looking at.

[Thanks, Evert]

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Odds and Ends

DEA Will Act on Marijuana Rescheduling Before Obama Leaves Office — What Could It Mean? by Tom Angell

Obviously I would prefer that marijuana was removed from the schedules entirely (just like alcohol and tobacco), but accept that there are positive values that can come from any change in the scheduling. Tom does a good job of laying out some of the benefits.


Senators held a hearing to remind you that ‘good people don’t smoke marijuana’ (yes, really) by Chris Ingraham

Caucus member Jeff Sessions (R.-Al.) spoke of the need to foster “knowledge that this drug is dangerous, you cannot play with it, it is not funny, it’s not something to laugh about… and to send that message with clarity that good people don’t smoke marijuana.”


This Norwegian Man’s UN Speech About People Who Use Drugs Is Extraordinary

My name is Sturla and I’m a drug addict. Because I am an addict, I do not represent most people who use drugs. The vast majority of people who use drugs don’t know what the inside of a rehabilitation center looks like: Most people who use drugs choose to enjoy mind-­altering substances besides alcohol without ever needing treatment. They’re doctors, lawyers, politicians, dentists and truck drivers. Far from everyone who uses drugs does so in a compulsory manner, just as far from everyone who enjoys alcohol are alcoholics. I, on the other hand, am seen by some as a sick person because I use drugs more regularly and suffer bigger consequences than most people as a result of my use. By others I am seen as a criminal.[…]

We need to stop demanding that people are drug ­free before being admitted into society as fully worthy members, and accept that some will always feel the urge to alter their consciousness with substances.


Why Are Heroin, Cocaine and Other Drugs Really Illegal? We Must Never Forget the Answers

As the world grapples with the fallout from the War on Drugs—and heads towards UNGASS 2016, a possible opportunity to put things right—it’s important to know the history of these drugs and their journey from medicine to menace. We didn’t suddenly discover that they were far more addictive or dangerous than other medicines. In fact, the reasons that drugs like heroin, cocaine, marijuana and others are illegal today have far more to do with economics and cultural prejudice than with addiction.


Drug policy reform hits a Russian roadblock at the UN

Russia’s commitment to a hardline approach at home, and its influence as a global superpower, meant it shouldn’t have been too much of a surprise to see the Russian delegation flying the flag for the war on drugs at the UN’s annual drug policy jamboree, the Commission on Narcotic Drugs (CND), which took place a couple of weeks ago. But what was surprising was the lengths they were willing to go to to stymie any attempt, however incremental, to reorient the debate toward anything that could be considered even vaguely progressive.

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Thanks, but no thanks

I get a lot of the same mail, and finally realized I needed a boiler-plate response…

To whom it may concern,

Thank you for your interest in advertising on DrugWarRant.com, or your interest in writing a guest post.

DrugWarRant.com has advertising options available through Google Ads, including the ability to specifically place ads on our site. Go to Google Display Network for more information.

We do not offer any other advertising opportunities, and, in particular, are not interested in any of the so-called “text link ads.”

If that is what you wish, please stop contacting us.

Regarding guest posts: DrugWarRant.com is always interested in legitimate guest posts about drug policy. The best way to start making guest posts is to submit one, and if we think it adds to the discussion with our regulars, we’ll be happy to add it.

We do not accept guests posts about treatment options, nor do we accept guest posts that include advertisements or links to businesses (including treatment centers, treatment referral centers, legal referral centers, or cannabis businesses).

Hope this helps.

Of course, the positive in this is that DrugWarRant.com apparently is an attractive site in terms of ranking. But it can be annoying at times.

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Basic rational change sometimes requires dragging the establishment along, kicking and screaming

Interesting article from the Washington Post’s Amber Phillips: Analysis: How Vermont could change the marijuana legalization game

But up until now, change has mostly come from the voters — sometimes in spite of lawmakers’ wishes. That balance could be shifting toward legislators, at least in one state: Vermont. In the next few weeks, Vermont could become the first state legislature to legalize marijuana. […]

But unlike Colorado and Washington, which legalized marijuana in a matter of months after voters approve it, Vermont would wait more than a year after the bill’s passage before residents could walk into a store and buy a joint.

If Shumlin signs the bill this summer, Vermont residents won’t be able to buy marijuana legally until January 2018. For the first few years, the state will also limit the number of marijuana licenses for selling and growing marijuana. In addition, public schools in Vermont would receive state-mandated drug education programs about marijuana a full semester before it’s legal.

The slow, methodical approach to legalization is the main difference between Vermont and other states that legalized it via ballot initiatives, […]

No, the big difference is that legislators are finally starting to catch up with the public. The reason that most marijuana legalization has come from ballot initiatives is because the politicians aren’t doing their job. And fine, if Vermont wants to painfully draw out the legalization procedure despite any evidence that such caution is warranted, go ahead. At least it’s better than the status quo which has also existed for decades without any evidence.

In the article, the usual players (Kleiman, Sabet) were brought out to push the boogieman of big, unregulated, marijuana. And I will say this again — I’m not really interested in what someone has to say about how to legalize marijuana, when they weren’t interested in legalizing marijuana at all until it became a certainty.

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The Lancet Commission

The Lancet is one of the oldest and best-known peer-reviewed medical journals. Occasionally they commission a group a scientists to prepare a detailed scientific analysis on a particular topic. In this case, they joined with John Hopkins and commissioned 22 experts to analyze Public Health and International Drug Policy, in advance of the United Nations special session (UNGASS) on drug policy next month.

The report is not an easy read at times – so much data and information — but it’s very thorough and it is a stinging scientific indictment of international drug policy. Check out part of the conclusion:

Policies meant to prohibit or greatly suppress drugs present an apparent paradox. They are portrayed by policy makers to be necessary to preserve public health and safety, and yet they directly and indirectly contribute to lethal violence, disease, discrimination, forced displacement, injustice, and the undermining of people’s right to health. The framers of international human rights law foresaw that there would be times, especially in the face of security threats, when some individual rights would have to be abrogated in favour of preserving collective safety and wellbeing. There is international consensus that if policies that abrogate rights are necessary for the greater good, those policies should pursue a legitimate and transparently defined goal and be proportionate to that goal, must be the least rights-restrictive and the least harmful possible to achieve the stated goal, should include adequate remedies for people whose rights are violated, and should not interfere with the democratic functioning of society.

In our view, policies pursuing drug prohibition or severe suppression do not meet these criteria, even if one accepts that drugs in and of themselves somehow present a serious security threat. Policies that pursue drug prohibition or heavy suppression do not represent the least harmful way to address drugs, the aim they pursue is not well defined or realistic, their interventions are not proportionate to the problem, they destabilize democratic societies, and people harmed by them often have no recourse to remedies to mitigate those harms. The scourge of drugs and the harms of drug use are exaggerated to justify these measures.

You can Public Health and International Drug Policyread the report yourself. Also, Jacob Sullum has more on the report.

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The continuing saga of stoned driving

The science has long been clear. Marijuana can cause impairment and driving while impaired by anything (lack of sleep, alcohol, texting, being angry) is not a good idea. However, the impairment caused my marijuana is only a fraction of the impairment caused by alcohol, and, while alcohol releases inhibitions and can make drivers more reckless, those who are stoned are more likely to be aware of their limitations and exercise additional caution. Treating the issue of marijuana impairment in driving as the same kind of problem as alcohol impairment is a disservice to safety on the highways. All this we know.

That doesn’t prevent people from still trying to pretend that legalization is going to cause a cataclysm on the highways.

So here’s yet another study that shows, once again, that marijuana isn’t the stuff of disaster films. The Real but Exaggerated Danger of Stoned Driving by Jacob Sullum.

But according to an analysis that’s about to be published by the journal Addiction, the increase in crash risk associated with marijuana use is roughly 20 percent to 30 percent, as opposed to the widely cited estimate of 92 percent.

That doesn’t stop lawmakers from going crazy.

Politicians are in such a panic about stoned driving that they are willing to endorse legislation they concede has no scientific basis—legislation that is bound to result in the conviction of innocent drivers who pose no threat to the public. Advocates of that policy simply assume that requiring proof of actual impairment, as Massachusetts currently does, is too demanding in the face of the increase in cannabis consumption they anticipate as a result of legalization. This response is unfair, premature, and disproportionate given what we actually know about marijuana’s impact on traffic safety.

And, of course, science doesn’t stop the absurd reefer madness theatre that constantly shows up.

Drugged driving suit aims to curb impaired driving

Being simultaneously high on pot, cocaine, heroin, MDMA and LSD is never a good combination, but the Ford Motor Company wants you to know that it’s particularly bad if you plan to get behind the wheel.

That’s the idea behind the automaker’s new “drugged driving suit,” an elaborate collection of weights, bandages, goggles and noisemakers that claims to simulate the physical effects of taking a variety of drugs. […]

But why show teen drivers the effects of so many different drugs at once instead of making a suit that focuses on one popular drug like marijuana or MDMA?

Drennan-Scace explained that it was all about logistics.

“If we’re showing just one drug, we would need to make a suit for every different type of drug,” he said.

“The research team decided it would be better to show (new drivers) the effects of different types of drugs in one suit, to get a feel for what it’s like.”

Really?

And once again, we see bad use of science used to justify that alcohol impairment is the same as other drug impairment.

“It shows them that getting behind the wheel, whether you’re drunk or you’re drugged, is a terrible idea,” said Ford of Canada spokesman Matt Drennan-Scace.

“Here in Canada in 2010, research showed that in 34 per cent of all accidents drugs were part of that accident. Thirty-nine per cent were alcohol, so it’s not that far off.”

Ah, that scientific term “part of.” Yeah, good stuff there, Matt.

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Yep.

“The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.” – John Ehrlichman

Legalize it All by Dan Baum, Harpers Magazine

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The inevitable corruption of money when dealing with the powerless

Addicts For Sale

In the rehab capital of America, addicts are bought, sold, and stolen for their insurance policies, and many women are coerced into sex. […]

The people targeting them are variously called “marketers,” “body brokers,” and even “junkie hunters.” They know addicts better than anyone (and many used to be addicts themselves). They spot kids dragging suitcases along the road and ask them if they need a place to go. […]

In South Florida’s Delray Beach, home to hundreds of rehab facilities and halfway houses, scams abound to profit off of addicts and their insurance policies. The recent uptick in addicts adds energy to the hurricane, but the biggest driving force for the fraud is Obamacare and the 2008 Parity Act, which together give everyone access to private insurance that’s legally bound to pay for rehab. “Marketers” act like headhunters, picking up addicts when they’re down, then bringing them to rehab centers and halfway houses for a fee — usually about $500 per head.

Private Prisons Fight Back

While state and federal prison statistics show a recent decline in the number of Americans who are behind bars, there are still roughly 5 million people under correctional supervision. Many more are in rehab and mental-health hospitals, while hundreds of thousands of illegal immigrants are shuffled through detention centers – potentially big markets for private facilities. So the correctional industry is diversifying. “The scope of how big this is hasn’t even been anywhere near made clear,” says Caroline Isaacs, who closely tracks the private-prison industry for the American Friends Service Committee, an advocacy group that opposes corrections privatization. […]

Though the services may be evolving, the concerns remain much the same. As with many for-profit entities, the top priority is the bottom line, which is often at odds with the purpose of community corrections. Rehabilitation – whether in a prison or half-way house – is not typically in the operator’s best interest, because that means fewer clients.

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CND

The Commission on Narcotic Drugs (UNODC) is now in its 59th session (through March 22). This session is partly in preparation for the major UNGASS 2016 (United Nations General Assembly Special Session) next month that will be focusing on international drug policy.

You can follow along a bit with the CND2016 by reading the various draft resolutions, etc. here.

Also, CND Blog does a great job of following (and in many cases transcribing) the activities.

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Replacing Scalia

So, President Obama announced his nominee for the Supreme Court this morning. As many have noted, it’s likely that a lot of the decision as to who was nominated was political, to shame the Republicans who refuse to even hold hearings on the nomination by nominating someone that they shouldn’t have a problem with, and then use their refusal against them in the November elections.

It’s possible, then to consider that there’s no real intention that this candidate is actually a possibility for the court. But still, I feel it’s important to look at them as if they would be. Here’s my quick reaction that I posted on Facebook:

Well, I’m disappointed with the nomination of Merrick Garland. Not really surprised that this would be the general direction the President would go, but disappointed. Garland is brilliant and certainly qualified. He is a moderate centrist with the potential for helping sway the more conservative members of the bench away from the extremes. And he’s generally left of Scalia. He has a pretty broad view of the First Amendment, which I like, but my biggest concern is in criminal justice issues.

Judge Garland spent much of his career working for the government — in the Justice Department and for prosecutors. I would really like to see someone on the Court who has more experience working for the people – someone who knows what it’s like to be a defense attorney, for example. And this has been demonstrated in his decisions on the bench where he has consistently gone against his liberal colleagues in providing deference to the government in criminal justice cases.

Garland has also regularly showed extreme deference to government agencies. According to ScotusBlog, “In a dozen close cases in which the court divided, he sided with the agency every time.” This, again, is a concern to me as I view part of the critical function of the Supreme Court to be one of the checks and balances of government, not an extension of the Executive Branch. But, of course, I’m not surprised, as President Obama has consistently pushed hard against any judicial oversight of the decisions of the Executive.

Merrick Garland will be a good jurist if he is confirmed. But at a time in our nation when we are desperately in need of critical criminal justice reform, it’s unlikely that his addition to the court will in any way help us move in that direction. And with a completely dysfunctional Congress and a reticent (and sometime hostile) Executive Branch, that would leave it entirely to the people to continue the hard slogging away at grass-roots reform.

As a side note, the President made a pretty serious gaffe for a constitutional lawyer when he said,

“Merrick Garland would take no chances that someone who murdered innocent Americans might go free on a technicality.” —@POTUS #SCOTUSnominee

Again, some speculate that this was merely tossing red meat to the law-and-order crowd, but it’s a pretty insensitive comment to make when criminal justice reform is such an important topic.

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