Drug markets: the replacement of agriculture by chemistry

Labs are replacing fields as the source of addictive drugs. Here are two stories, from National Affairs, and the Financial Times.

The current issue of National Affairs has this essay on drugs, drug use, and overdose deaths:

How to Think about the Drug Crisis by Charles Fain Lehman

"A reported 111,219 Americans died from a drug overdose in 2021. That figure has risen more or less unabated, and at an increasing pace, since the early 1990s. Back in 2011, 43,544 Americans died from a drug overdose — less than half the 2021 figure. Ten years earlier, in 2001, it was 21,705 — less than half as many again. And the problem keeps getting worse: The 2021 figure is nearly 50% higher than it was in 2019.

...

"The National Center for Health Statistics estimates that there were roughly 110,000 overdose deaths in the year ending December 2022 — essentially unchanged from a year earlier.

...

"Historically, illicit drugs — heroin, cocaine, marijuana, etc. — were derived from plants grown in fields or greenhouses. But licit pharmacology has long been able to use simple, widely available precursor chemicals to synthesize the active ingredients in these substances. This sidesteps the complex processes of farming altogether. At some point in the past several decades, drug-trafficking organizations learned to use the same techniques at scale. Using precursors sourced primarily from China, they now synthesize a variety of opioids — the class of drugs that includes heroin.

"The most widely known of these is fentanyl, a synthetic opioid conventionally used in anesthesia that is 50 times stronger than heroin. Some are stronger still — carfentanil, the most potent opioid known thus far, is roughly 100 times stronger than fentanyl. In 2021, synthetic opioids were involved in roughly two out of every three overdose deaths.

...

"Complicating the story further is the increasing purity and declining cost of methamphetamine, another synthetic drug with an exploding death rate. After synthetic opioids, methamphetamine is now the second most common cause of drug overdose death. It's also the only tracked drug where deaths not involving synthetic opioids are increasing. That these two lab-produced substances are replacing "organic" drugs at the same time is not a coincidence.

"Why have these drugs taken over the market? Because they're a much better value proposition for sellers. Synthetic drugs significantly reduce production costs, both because chemistry is less labor- and input-intensive per unit produced than farming and because lab production is much easier to obscure from interdiction efforts that drive up costs. Furthermore, because the potency per dose is higher, drug-smuggling operations can move a smaller amount of fentanyl than heroin for the same profit.

"Of course, the stronger the drug, the higher the risk of overdose. Drug-overdose death rates used to be low in part because for the first century or so of modern American drug use, the potency of illicit drugs was constrained by what traffickers could grow in a field. Synthetic drugs remove this limit."

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And this from the FT:

How fentanyl changed the game for Mexico’s drug cartels.  by Christine Murray

"In the last decade, fentanyl has become the leading cause of death for young adults in the US. Mexico’s illegal drug trade has also adapted to the shift from plant-based drugs towards synthetics, creating a new, streamlined and highly profitable arm of the illicit business with fewer workers and lower costs — but just as much violence.

"The change has caused friction in two of Washington’s most important relationships, with China and Mexico.

...

"Instead of employing tens of thousands of agricultural labourers, the entire fentanyl industry in Mexico could function with “cooks” estimated to number in the hundreds, who were mostly not qualified chemists, Reuter said. Fentanyl’s growth appears to have hit heroin production in particular, with poppy growing in Mexico still well below its peaks, according to the UN Office for Drugs and Crime."

Organ trafficking, and how to reduce it -- Frederike Ambagtsheer in Conversation

Frederike Ambagtsheer, who studies illegal markets for organs and transplants,  has some sensible thoughts on how to combat organ trafficking, not least by increasing the availability of legal, ethical transplantation conducted in high quality hospitals.

Here she is in The Conversation:

Illegal organ trade is more sophisticated than one might think - who’s behind it and how it could be controlled  by Frederike Ambagtsheer

"The organ trade involves a variety of practices which range from excessive exploitation (trafficking) to voluntary, mutually agreed benefits (trade).

"These varieties warrant different, data-driven responses.

"For example, organ sellers are reluctant to report abuses because organ sales are criminalised and sellers will be held liable. Although many can be considered human trafficking victims and be offered protection, this rarely occurs. Law- and policymakers should therefore consider decriminalising organ sales (removing penalties in the law) and offer organ sellers protection, regardless of whether they agree to provide evidence that helps to dismantle criminal networks.

"Countries should also allow medical professionals to safely and anonymously report dubious transplant activity. This information can support the police and judiciary to investigate, disrupt and prosecute those who facilitate illegal organ transplants. Portugal and the UK already have successful organ trafficking reporting mechanisms in place.

"Finally, a contested example of a possible solution to reduce organ scarcity and avoid black market abuses is to allow payments or other types of rewards for deceased and living organ donation to increase organ donation rates. To test the efficacy and morality of these schemes, strictly controlled experiments would be needed.

...

" In short, rather than exclusively focusing on stricter laws, a broader range of responses is needed that both address the root causes of the problem and that help to disrupt organ trading networks."

***********

Here are all my posts that mention Dr. Ambagtsheer's work, which I've followed for more than a decade.

Black markets for alcohol in Iran

 Prohibition (of alcohol) didn't work in the U.S. from 1920-1933, and it's not working in Iran today, despite "the Islamic Republic’s longstanding ban on the sale and consumption of alcohol, which is punishable by a penalty of up to 80 lashes and fines."

The NYT has the story:

Alcohol Poisonings Rise in Iran, Where Bootleggers Defy a Ban. Iran’s prohibition of the drinking and selling of alcohol has led to a flourishing underground market. But even officials have acknowledged a wave of hospitalizations and deaths in recent months.  By Farnaz Fassihi and Leily Nikounazar

"Rather than stopping drinking, the ban over time has led to a flourishing and  dangerous bootleg market. In the past three months, a wave of alcohol poisonings has spread across Iranian towns big and small, with an average of about 10 cases per day of hospitalizations and deaths, according to official tallies in local news reports.

"The culprit is methanol, found in homemade distilled alcohol and counterfeit brand bottles, apparently circulating widely, according to Iranian media reports and interviews with Iranians who drink, sell and make alcohol.

"The clerical rulers who took power after the 1979 revolution, instituting a theocracy, banned the consumption and selling of alcohol in accordance with Islamic rules prohibiting intoxication. Religious minorities are exempt. Over the decades, reports of methanol contaminations occasionally surfaced, but not in the scope and frequency seen in recent months....

"Even officials are now publicly acknowledging that the problem has escalated. Mehdi Forouzesh, Tehran’s chief coroner, said in a news conference in June that the number of hospitalizations and deaths from methanol poisoning had sharply risen. In only Tehran, he said, it had climbed by 36.8 percent since the beginning of March.

...

"Many Iranians love to drink, and nothing has dissuaded them from a tradition deeply rooted in ancient Persian culture. Homemade alcohol and imported bottles of liquor flow freely at many parties, weddings and social gatherings. Some upscale restaurants secretly serve patrons vodka in pots of tea."

Black market for mustard in Bogotá

 The NYT has the story:

Colombia’s Mustard Lovers Grow Desperate Amid Saucy Shortage of Dijon. Colombians are scrambling to find the beloved French condiment as a new health law removes it from shelves  by Genevieve Glatsky

"In Colombia, a new illicit product is on the rise. Desperate consumers are sneaking it in suitcases from abroad, hoarding it in their homes, paying outrageous prices online and lining up at clandestine locations to buy it.

"The contraband? Dijon mustard.

"A new health law intended to improve Colombians’ diets — which are heavy on meat and fried food — has led to the disappearance of a host of fare from market shelves, including the French delicacy of the condiment world.

...

"Inspired by a push by the Pan American Health Organization to address high rates of cardiovascular disease in the region, Colombia’s Health Ministry in 2020 imposed limits on high-sodium products, with the measure taking effect last November.

...

"Mustard must have less than 817 milligrams of sodium per 100 grams. A jar of Grey Poupon Dijon mustard has nearly three times that ratio."

Human trafficking conviction in England, in kidney case-""the consent of the person trafficked is no defense."

 The BBC has the story, which is apparently the first such conviction for kidney trafficking under Britain's anti-slavery law. Reading the previous stories, it sounds like the young man in question was being deceived.  But even informed consent apparently wouldn't be a defense under British law...

Kidney-plot politician Ike Ekweremadu jailed By Tom Symonds

"A wealthy Nigerian politician, his wife and their "middleman" have been jailed for an organ-trafficking plot, after bringing a man to the UK from Lagos.

"Senator Ike Ekweremadu, 60, and his wife Beatrice, 56, wanted a new kidney for their 25-year-old daughter Sonia, the Old Bailey heard.

"The pair and Dr Obinna Obeta, 50, were previously convicted of conspiring to exploit the man.

"It is said to be the first such case under modern slavery laws.

...

"Lynette Woodrow, deputy chief crown prosecutor and national modern slavery lead at the Crown Prosecution Service (CPS), said it had been "our first conviction for trafficking for the purposes of organ removal in England and Wales".

"She said it highlighted an important legal principle which made it irrelevant whether the trafficking victim knew he was coming to the UK to provide a kidney.

"With all trafficking offences," Ms Woodrow said, "the consent of the person trafficked is no defence. The law is clear; you cannot consent to your own exploitation."

HT: Dr. Jlateh Vincent Jappah

New York doesn't ban Menthol cigarettes, amid controversy

 The NYT has the stories, first about the proposed ban, and then about the budget compromise that defeated it:

Black Smokers at Center of New York Fight to Ban Menthol Cigarettes. A proposal to make New York the third state to ban menthol cigarettes has created a furious and expensive lobbying war, and has divided Black leaders. By Luis Ferré-Sadurní

"A push by Gov. Kathy Hochul to ban menthol-flavored cigarettes in New York has become the focal point of a fierce and expensive lobbying fight, pitting Big Tobacco against the medical community.

"Caught in the middle are Black smokers, who smoke menthol cigarettes at higher rates than white smokers, and are the main group the ban is meant to help. Decades of aggressive marketing by tobacco companies have caused Black smokers to consume menthol cigarettes, whose cooling sensation on the throat makes them more appealing and addictive.

...

 "Well intentioned as the ban may be, it has angered some Black leaders, including a group of ministers who have rallied against Ms. Hochul’s proposal because they worry it could increase encounters between Black people and the police if menthol cigarettes were to go underground and authorities crack down on sellers.

"Other Black opponents of the ban suggest it may be discriminatory, a heavy-handed crackdown on the preferred nicotine fix of Black smokers, even if African American men have the highest rates of lung cancer, according to the Centers for Disease Control and Prevention. 

...

"Although lawmakers have signaled their support for the tax increase, the menthol ban’s prospects are far less certain, according to four officials familiar with the negotiations.

The issue has divided Black lawmakers, leaving the measure hanging by a thread in the State Capitol "and potentially forcing Ms. Hochul to weigh how much political capital she should expend on the ban, as opposed to other policy priorities."

********

And here's a story saying that the governor abandoned the proposed ban in a set of budget compromises:

New York Would Change Minimum Wage and Bail in $229 Billion Budget Deal. After weeks of dissension, leaders in Albany reached a handshake agreement on a budget that saw Gov. Kathy Hochul fall short on some of her key objectives. By Luis Ferré-Sadurní and Grace Ashford

"Lawmakers managed to knock down other divisive ideas, including ... a ban on the sale of menthol cigarettes that was opposed by Big Tobacco and had divided Black leaders. Lawmakers did agree, however, to raise taxes on cigarettes to $5.35 a pack, up from $4.35."

**********

All posts so far on menthol

Opioids and Appalachia by Sally Satel

 Sally Satel, who has treated patients in Appalachia, writes movingly of the drug addiction problem there. Here's a paragraph that sets the stage.

"The history of opioid pain relievers in Appalachia is a prime illustration of the fact that drug epidemics rarely burst onto the scene out of nowhere. Instead, they find their place in regions that are already home to an established base of individuals who abuse similar drugs. Thus illicit OxyContin, a more potent opioid, efficiently gained popularity over Percocet and Vicodin in the same way heroin would substitute for prescription opioids as the latter grew scarce after 2010."

That's from Opioids and Appalachia by Sally Satel, in the current issue of National Affairs.

The whole thing is well worth reading; here are a few more paragraphs that caught my eye.

"The churn of pills — diverting, using, and selling them — soon had eastern Kentucky, southeastern Ohio, and West Virginia pulsing with crime. Realtors routinely told home sellers not to leave pills in their medicine chests during open houses. Funeral directors and hospice nurses cautioned the bereaved not to mention in obituaries that their loved ones had succumbed to cancer — a red flag signaling that huge bottles of pills were likely on the premises. In eastern Kentucky, local law enforcement was often stymied by close ties between people within communities. Loyalty within large families and fear of retaliation by neighbors made it hard to cultivate informants and to impanel neutral juries that would convict when prosecutors proved their case.

...

"Appalachians seemed to take the corruption in grudging stride. In one survey, 90% of over 100 Kentuckians working in law enforcement, health, and community governance said the rural OxyContin problem in the early 2000s was "fueled by a cultural acceptance of drug misuse." Indeed, many residents tolerated unlawful activity, since it generated revenue for the community from sales of pills to outsiders. This happened in places like Williamson, West Virginia — dubbed "Pilliamson" — where the local Wellness Center was a hub of reckless prescribing. Cash-laden out-of-staters flocked there to buy painkillers and, in a small area near the center, trade and sell those pills.

"Pablo Escobar and El Chapo couldn't have set things up any better," wrote Eyre. "The coal barons no longer ruled Appalachia. Now it was the painkiller profiteers."

...

"Today, opioid pills are no longer pouring into Appalachia as they once did; highly lethal products like fentanyl-laced heroin, methamphetamine, and counterfeit fentanyl pills are what people are selling."

Alcohol and race in Australia

 In the U.S. we certainly have a complicated history around both race and alcohol, but in Australia there may be even more complications, as a recent (limited) ban on alcohol and aborigines is reinstated.

The NY Times has the story

Authorities Reinstate Alcohol Ban for Aboriginal Australians. The reaction to a rise in crime has renewed hard questions about race and control, and about the open wounds of discrimination. By Yan Zhuang

"Mr. Shaw lives in what the government has deemed a “prescribed area,” an Aboriginal town camp where from 2007 until last year it was illegal to possess alcohol, part of a set of extraordinary raced-based interventions into the lives of Indigenous Australians.

"Last July, the Northern Territory let the alcohol ban expire for hundreds of Aboriginal communities, calling it racist. But little had been done in the intervening years to address the communities’ severe underlying disadvantage. Once alcohol flowed again, there was an explosion of crime in Alice Springs widely attributed to Aboriginal people. Local and federal politicians reinstated the ban late last month. 

...

"For those who believe that the country’s largely white leadership should not dictate the decisions of Aboriginal people, the alcohol ban’s return replicates the effects of colonialism and disempowers communities. Others argue that the benefits, like reducing domestic violence and other harms to the most vulnerable, can outweigh the discriminatory effects.

...

"According to the Northern Territory police, commercial breaks-ins, property damage, assaults related to domestic violence and alcohol-related assaults all rose by about or by more than 50 percent from 2021 to 2022. Australia does not break down crime data by race, but politicians and Aboriginal groups themselves have attributed the increase largely to Indigenous people.

"This was a preventable situation,” said Donna Ah Chee, the chief executive of one of these organizations, the Central Australian Aboriginal Congress. “It was Aboriginal women, families and children that were actually paying the price,” she added.

"The organization was among those that called for a resumption of the ban as an immediate step while long-term solutions were developed to address the underlying drivers of destructive drinking. Ms. Ah Chee said she considered the policy to be “positive discrimination” in protecting those most vulnerable."

**********

Of course bans in one jurisdiction can have spillovers into others. Here's a story from the Australian Broadcasting Corporation:

Katherine reports rise in transient visitors since return of Alice Springs alcohol restrictions  By Matt Garrick and Max Rowley

"An outback town struggling with crime and homelessness is seeing an influx of transient visitors, which some believe is a direct impact of new alcohol restrictions in Alice Springs."

Black market orchids

 Black markets for flowers aren't as dangerous as those for drugs and guns, but they impinge on endangered species.  The Guardian has this story:

Beauty breeds obsession: the fight to save orchids from a lethal black market. Behind the scenes of its 20th orchid show, the New York Botanical Garden toils to rescue endangered plants. by Francesca Carington

"The import and export of endangered plants is regulated by the Convention on International Trade in Endangered Species of Wild Flora and Fauna (Cites). Orchids account for more than 70% of Cites-registered plants; most can be traded internationally with a permit, but for the rarest and most endangered orchids, the commercial trade in wild species is illegal.

...

"Plant trafficking takes place in a few ways. In some cases, an illegal plant is smuggled in with a batch of legal ones with appropriate Cites paperwork; in others, people pluck endangered plants from the wild and rustle them across borders in their suitcases, or, in one memorable case, by tying stockings containing 947 succulents to their body. Most of the time, however, illegal plants are simply sent in the post.

"Jared Margulies, an expert on the illegal wildlife trade and assistant professor at the University of Alabama, explains that it’s up to individual countries to enforce Cites, and plant trafficking is not always a priority. Orchids are less of a concern than narcotics, arms or even other wildlife. This is in part due to a phenomenon known as “plant blindness”, a tendency, as Margulies puts it, to “see plants as sort of the wallpaper or the backdrop to a kind of livelier animal world”.

...

"“This is not trade that’s happening in the dark web,” says Margulies. “It is happening right online in your face on Facebook, or eBay or Etsy or Instagram.” Hinsley describes vendors in Vietnam listing wild-harvested orchids for sale on Facebook Live, and YouTube videos of people unboxing shipments of unmistakably wild orchids. Her 2015 study of social media posts found that up to 46% of trade occurring in orchid groups was in wild-collected plants.

Will Italy criminalize foreign surrogacy?

 It's hard to ban something that people want and need and is legally available in other jurisdictions, but it looks like Italy might try it regarding surrogacy.  Here's a story from Britain's Sunday Times:

Italian families seeking surrogates abroad could face jail or €1 million fines by Tom Kington

"Italians travelling abroad to seek surrogate mothers to start families could face jail time and a million euro fine thanks to a new bill introduced by senators close to Giorgia Meloni, the Italian prime minister.

"The proposed law, which must be approved by the Italian parliament, describes surrogacy as “an execrable example of the commercialisation of the female body and the treatment of babies as merchandise”.

...

"An Italian law passed in 2004 banned surrogate pregnancies in Italy, forcing couples to travel to countries such as the United States and Canada to find surrogate mothers."

Academic authorship for sale

 Here's a news story in Nature:

Multimillion-dollar trade in paper authorships alarms publishers. Journals have begun retracting publications with suspicious links to sites trading in author positions.  by Holly Else

"Research-integrity sleuths have uncovered hundreds of online advertisements that offer the chance to buy authorship on research papers to be published in reputable journals.

"Publishers are investigating the claims, and have retracted dozens of articles over suspicions that people have paid to be named as authors, despite not participating in the research. Integrity specialists warn that the problem is growing, and say that other retractions are likely to follow.

...

"Most of the adverts are posted on social-media sites including Facebook and Telegram, as well as the websites of companies that claim to offer academic publishing services. They often include the title of the paper, the journal it will be published in, the year of publication and the position of authorship slots available for purchase. Prices range from hundreds to thousands of US dollars depending on the research area and the journal’s prestige."

*****

Here is the underlying working paper, on arxiv,  to which the story refers:

Publication and collaboration anomalies in academic papers originating from a paper mill: evidence from a Russia-based paper mill  by Anna Abalkina

This study attempts to detect papers originating from the Russia-based paper mill International publisher LLC. A total of 1009 offers published during 2019-2021 on the this http URL website were analysed. The study allowed us to identify at least 434 papers that are potentially linked to the paper mill including one preprint, a duplication paper and 15 republications of papers erroneously published in hijacked journals. Evidence of suspicious provenance from the paper mill is provided: matches in title, number of coauthorship slots, year of publication, country of the journal, country of a coauthorship slot and similarities of abstracts. These problematic papers are coauthored by scholars associated with at least 39 countries and submitted both to predatory and reputable journals. This study also demonstrates collaboration anomalies and the phenomenon of suspicious collaboration in questionable papers and examines the predictors of the Russia-based paper mill. The value of coauthorship slots offered by International Publisher LLC in 2019-2021 is estimated at $6.5 million. Since the study analysed a particular paper mill, it is likely that the number of papers with forged authorship is much higher.

The trade in guns and drugs on the Mexico-US border

 It's well known that a lot of illegal drugs enter the U.S. over the border with Mexico.  Less well known in the U.S. is that a lot of guns cross illegally into Mexico over that border, destined for Mexican drug cartels.  

Here's a story from the Guardian:
How Texas’s gun laws allow Mexican cartels to arm themselves to the teeth by Sam Garcia.

"Despite Mexico’s well-documented high levels of violence, legally purchasing guns there is actually quite difficult. The nation of nearly 130 million people has a single store that can legally sell guns.

...

"Mexican foreign affairs ministry legal adviser Alejandro Celorio Alcántara estimates that half a million guns annually are purchased legally in the US and then brought into Mexico illegally. About 70% of guns seized in Mexico from 2014 to 2018 and submitted for tracing had originally come from the US, according to officials with the American bureau of alcohol, tobacco, firearms and explosives (ATF).

*******

Here's another report:

Dribs and Drabs: The Mechanics of Small Arms Trafficking from the United States

"Robust arms export licensing regimes are necessary but not sufficient for stopping small arms trafficking. Many of the traffickers studied did not apply for arms export licences or attempt to exploit licensing exemptions; they simply bypassed the licensing system entirely. At the same time, recent examples of attempted and successful diversion of authorized small arms exports highlight the continued need for rigorous licensing and post-shipment end-use monitoring.

"Arms trafficking from the United States goes well beyond gun-running to Mexico. Traffickers in the 159 cases studied shipped weapons, parts, ammunition, and accessories to at least 46 countries and foreign territories on six continents. Intended recipients of these items range from Honduran farm workers to a Finnish motorcycle gang 

"The illicit trade in parts and accessories for small arms is more significant than commonly assumed. Networks that traffic in firearms parts are among the most prolific and geographically expansive of the smuggling operations studied"

HT: Sarah Hirsch

NPR on black markets for kidneys from Nepal, for India

Here's an 8-minute video from National Public Radio about the black market for kidneys, trafficked from Nepal to India.  Some of the people interviewed indicate that they were duped; others decline to cooperate with prosecutors against the black market recruiters. A particular Indian hospital is named. Frank Delmonico makes an appearance near the end.  

(The video doesn't discuss any of the larger issues about the causes and consequences of the shortage of organs for transplant that make black markets busy and profitable, or how these might be addressed through legal and ethical efforts to increase the availability of transplants.)

.

HT: Frank McCormick

**********

Here's a post on the legal market for kidneys in Iran.

Monday, June 27, 2022

A Forum on Kidneys for Sale in Iran, in Transplant International

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Here's an article from earlier this week in the Washington Monthly

We Have to Make Organ Donors Whole. by Sally Satel, January 17, 2023 

"I’m alive because of kidney donations, but there wouldn’t be an organ shortage if we made it easier for those willing to literally give a piece of themselves. New York is taking a good first step."

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related earlier post:

Sunday, January 1, 2023

New York State's Living Donor Support Act (LDSA, S. 1594) was signed by Governor Hochul on Dec. 29

Organ trafficking in America, on National Geographic TV, premiering tomorrow

National Geographic TV tweets about a new series on organ trafficking, premiering tomorrow night, with a video trailer that suggests that they think there is substantial organ trafficking to U.S. patients.

@MarianaVZ  uncovers the hidden world of organ trafficking in an all-new #TraffickedWithMarianavanZeller. Don't miss the season premiere, this Wednesday at 9/8c on National Geographic.

I'm a bit skeptical about the scope of organ trafficking to U.S. patients, because as far as I can tell there isn't a lot of evidence of Americans with mysterious transplants showing up for post-transplant care at American transplant centers. But I haven't seen the show. (Not being a subscriber I doubt that I will, but I imagine I'll hear from some of you who do.)

HT: Alex Chan

It's hard to enforce the ban on cannabis in Kansas

 Just as markets need social support, bans on markets need social support.  Even in Kansas, apparently, where marijuana remains completely outlawed. (Kansas borders on Colorado and Missouri, where (even) recreational use of marijuana is legal, and on Arkansas, and Oklahoma, where medical use is legal.)

The Guardian has the story:

A dying cancer patient used cannabis to ease pain. His hospital called the police. ‘You’d think they would have shown compassion’: patient’s son decries Kansas police who issued citation as father suffered.  by Lois Beckett

"Hospital staff in Kansas called the police on a man dying of cancer who was using cannabis products to cope with his symptoms, in an incident that has since sparked outrage and renewed calls to rethink the state’s strict cannabis laws.

"The encounter took place in mid-December, when police in the city of Hays say two officers showed up at the cancer patient’s hospital room to issue him a citation for a drug violation. 

...

"Because of the Christmas holiday, the city prosecutor had not seen the email about dismissing the charge until after the police interaction with the cancer patient had already become a viral news story, the police chief said. He said he personally let the patient know on 27 December that the police department was not pursuing the citation and that he would not have to appear in court.

"More than a hundred people have called or emailed the Hays police department, upset about news reports of officers’ interactions with the cancer patient, the chief said. "

Nicotine will be with us for a long time--survey of middle school use

 Sales of tobacco products to minors are generally illegal in the U.S., but a survey shows that doesn't stop children from smoking and vaping.  Here's a report from the Centers for Disease Control and Prevention, in JAMA

Tobacco Use Remains High in Middle and High Schools by Bridget M. Kuehn, MSJ

JAMA. 2022;328(24):2389-2390. doi:10.1001/jama.2022.20058

"Nearly 1 in 9 US middle and high school students reported tobacco product use in the past 30 days—most commonly e-cigarettes—according to a CDC and US Food and Drug Administration analysis of data from the 2022 National Youth Tobacco Survey (NYTS). The researchers estimated that approximately 3.08 million students in 6th to 12th grade currently use tobacco products.

...

"The data show that 16.5% of high school students and 4.5% of middle school students reported using a tobacco product in the past 30 days. About 14% of high school students and about 3% of middle school students used electronic cigarettes. Nearly 4% of all those surveyed reported using any combustible tobacco product.

"Several subgroups of students reported even higher rates of tobacco product use. About 16% of students who identified as lesbian, gay, bisexual, or transgender reported current use of these products. The 2022 NYTS survey was the first to provide data on tobacco product use among American Indian or Alaska Native, Asian, multiracial, or Native Hawaiian or other Pacific Islander youths. It found that American Indian or Alaska Native youth reported the highest rate of a tobacco product use of any racial or ethnic group, at 13.5%.

"The report also found a link between social determinants of health and tobacco product use. For example, students who had experienced severe psychological distress or were from less affluent households were more likely to report current tobacco product use. More than a quarter of students with low academic achievement reported current use. "

Suppressing vaping is hard

 The WSJ has the story:

Major effort needed to remove illegal vaping products, review finds. Group says FDA regulators are overwhelmed and reactive  By Laurie McGinley

"An independent review of the Food and Drug Administration’s tobacco regulators described them as overwhelmed, reactive and fatigued by an oppressive workload involving e-cigarettes and called for a major effort, by several parts of the Biden administration, to remove millions of illegal vaping products from the market.

"The report, by the Reagan-Udall Foundation for the FDA, also said the agency’s Center for Tobacco Products, created by federal law in 2009, has fallen short in laying out clear priorities and has been besieged by lawsuits brought by tobacco and vaping companies, on the one hand, and public health groups on the other.

"The review said there are millions of illegal vaping products on the market — involving companies that should have applied for FDA authorization and never did, or others that had their applications rejected — and that a major effort is needed to remove them."

Two illegal (former) kidney transplant networks analyzed: the Netcare -and Medicus cases, by Ambagtsheer and Bugter

 There aren't many successful prosecutions resulting from illegal organ trafficking, despite the fact that the prevalence of illegal kidney transplants is estimated by many sources to be high.  Here's a paper that tries to understand the nature of the black market supply chain for kidneys, by examining two prosecutions that led to convictions, connected to a hospital in Kosovo and another in South Africa.

Ambagtsheer, F., Bugter, R. The organization of the human organ trade: a comparative crime script analysis. Crime, Law and Social Change (2022). https://doi.org/10.1007/s10611-022-10068-5

Abstract: "This study fills critical knowledge gaps into the organization of organ trade utilizing crime script analysis. Adopting a situational crime prevention approach, this article draws from law enforcement data to compare the crime commission process (activities, cast and locations) of 2 prosecuted organ trade cases: the Medicus case and the Netcare case. Both cases involved transnational criminal networks that performed kidney transplants from living donors. We further present similarities and differences between illegal and legal living donor kidney transplants that may help guide identification and disruption of illegal transplants. Our analysis reveal the similar crime trajectories of both criminal cases, in particular the extensive preparations and high degree of organization that were needed to execute the illegal transplants. Offenders in the illegal transplant schemes utilized the same opportunity structures that facilitate legal transplants, such as transplant units, hospitals and blood banks. Our results indicate that the trade is embedded within the transplant industry and intersects with the transport- and hospitality sector. The transplant industry in the studied cases was particularly found to provide the medical infrastructure needed to facilitate and sustain organ trade. When compared to legal transplants, the studied illegal transplant scripts reveal a wider diversity in recruitment tactics and concealment strategies and a higher diversity in locations for the pre-operative work-up of donors and recipients. The results suggest the need for a broader conceptualization of the organ trade that incorporates both organized crime and white collar crime perspectives."

***

"Although reliable figures of the trade’s scope are lacking, the World Health Organization (WHO) has estimated that approx. 5000 illegal transplants are performed annually (WHO, 2007). The organ trade is reported to rank in the top 5 of the world’s most lucrative international crimes with an estimated annual profit of $840 million to $1.7 billion (May, 2017). While illegal organ transplants have been reported to take place in countries across the globe, knowledge of the trade’s operational features remains scarce (Pascalev et al., 2016)

...

"At the time of writing, only 16 convictions involving organ trade have been reported to the case law database of the United Nations Office on Drugs and Crime, which is far less than would be expected based on global estimates of the problem (UNODC, 2022). The Organization for Security and Co-operation in Europe (OSCE) has reported 9 additional cases (OSCE, 2013). All reported cases had cross-border features and most involved the facilitation of living donor kidney transplants.

...

"In 2014 the Council of Europe established a new convention against ‘Trafficking in Human Organs’ which calls for a broad prohibition of virtually all commercial dealings in organs. Accordingly, sales that occur with the consent of donors are considered to be ‘trafficking’ regardless of the circumstances involved (Council of Europe, 2015)"

...

[Netcare]"Israeli and Romanian donors were promised $20,000 for their kidneys, the Brazilian donors were promised between $3,000 and $8,000. Most donors were recruited in Brazil by 2 retired military officers (Ambagtsheer, 2021; De Jong, 2017; Scheper-Hughes, 2011). 

Payments and reimbursements: Payments took place throughout all stages of the crime commission process. Patients paid Perry/his company up to $120,000 prior to their travel and transplant. Perry, and later also Meir, subsequently paid Netcare. Netcare in turn disbursed payments to various actors in the scheme, including the transplant surgeons and the blood bank. ... Occasionally, additional payments were made directly in cash to the surgeons by Perry, his company, or his agents. Perry also paid an escort/fixer (Rod Kimberley) and a nephrologist. Kimberley paid low-tier offenders in the scheme, including the interpreters. Kimberley additionally covered the costs of recipients’ and donors’ accommodations and he gave donors pocket money upon arrival in South Africa as an advance to their kidney payment. All donors received the promised amount in cash after their operations. 

...

"Contrary to donors in the Netcare case, none of the Medicus’ donors received the promised amount. Some did not receive payment at all but were promised payment only if they recruited new prospective kidney sellers. Withholding payments to kidney sellers in order for them to recruit new prospective kidney sellers is a tactic in organ trafficking schemes to sustain the transplant program (De Jong, 2017).

...

"The cases diverge with respect to the locations and legal embeddedness. Contrary to the Medicus case where transplants were organized in one clinic that was not licensed to conduct transplants, transplants in South Africa were facilitated in at least 5 hospitals across the country that were legally mandated to perform transplants."

Why is it so easy to get drugs, and so hard to get drug abuse treatment? Overdose deaths continue to climb.

 Here's an update on drug abuse in the U.S., from the WSJ. One quote particularly struck me, from a mom whose child died: "it’s so easy to get drugs,”  “It’s so much more available than treatment.”

How Meth Worsened the Fentanyl Crisis. ‘We Are in a Different World.’ Methamphetamine fatalities are rising, increasingly in combination with opioids  By Jon Kamp and Arian Campo-Flores.

"One in five of the total fatal overdoses last year involved an opioid and a psychostimulant, a drug class dominated by meth, preliminary federal data show. A decade earlier, about 2% of drug deaths involved such combinations.

...

"The rise in fatalities involving stimulants, often combined with opioids, has created a fourth wave of the decadeslong U.S. overdose-death crisis, according to Dr. Daniel Ciccarone, a professor of addiction medicine at the University of California, San Francisco. Deaths from combinations of opioids and cocaine, another stimulant, are also climbing.

...

"Fentanyl drove U.S. overdose deaths to a record-breaking tally of more than 108,000 last year, according to the federal data.

"Now, the combination of meth and opioids—especially fentanyl—is supercharging those numbers. Meth-related deaths, though smaller in number, are increasing at a faster rate than opioid and overall drug fatalities.

"About 33,400 deaths last year involved psychostimulants such as meth, up more than 340% from roughly 7,500 five years earlier, the federal data show. In the same time span, deaths involving synthetic opioids like fentanyl rose about 270% to around 72,000, and overall drug fatalities rose about 71%.

...

"it’s so easy to get drugs,” said Mr. Ryan’s mother, Alicia Vigil-Ryan. “It’s so much more available than treatment.”

Colorado legalizes magic mushroom/psilocybin therapies

 Denver is the mile high city, and the 2022 midterm elections have now legalized therapy with magic mushrooms/psilocybin, which has medical uses in treating post-traumatic stress disorder, among other things.

Colorado becomes second state with legalized ‘medicinal psychedelics’ by Olivia Goldhill in Statnews

"Colorado is the second state to legalize psychedelics, following Oregon’s 2020 passage of a similar ballot question. Like Oregon, Colorado plans to create licensed “healing centers” where people can take magic mushrooms under supervision.

“This is a truly historic moment. Colorado voters saw the benefit of regulated access to natural medicines, including psilocybin, so people with PTSD, terminal illness, depression, anxiety and other mental health issues can heal,” Kevin Matthews and Veronica Lightning Horse Perez, leaders of Natural Medicine Colorado, which campaigned for the measure, wrote in a statement emailed to STAT.

...

"The most advanced study for psilocybin, a Phase 2b trial on the drug for treatment-resistant depression published earlier this month, found the drug was effective at inducing remission in many patients, but the results were less striking than in earlier studies."

**************

And from Time Magazine:

Colorado Voted to Decriminalize Psilocybin and Other Psychedelics,  by Tara Law

"Colorado voters have approved the broadest psychedelic legalization in the U.S., which would decriminalize five psychedelic substances and enable adults to receive psychedelics at licensed centers.

...

"The ballot measure decriminalizes the possession of certain psychedelic drugs for personal use in the state and specifically legalize psilocybin, the psychedelic component of magic mushrooms, for use at licensed facilities starting in 2024. (In those ways, it’s similar to 2020 measures approved in Oregon, which decriminalized possession of small amounts of drugs in 2021 and is launching a psilocybin access program in 2023.)

"However, Colorado’s Proposition 122 goes further in several ways. In addition to decriminalizing possession, it decriminalizes the growing and sharing of five psychedelics for personal use: psilocybin, psilocyn (a psychedelic also found in magic mushrooms), dimethyltryptamine (commonly known as DMT, which is found in plants and animals, including certain tree frogs), ibogaine (derived from the bark of an African shrub), and mescaline (which is primarily found in cacti; however, Prop 122 excludes peyote). It also clears a pathway for the use of all these psychedelics at “healing centers”—facilities licensed by the state’s Department of Regulatory Agencies where the public can buy, consume, and take psychedelics under supervision. The regulated access program would initially be limited to psilocybin, which would launch in late 2024, but if recommended by a Natural Medicine Advisory Board appointed by the governor, it could be expanded to include DMT, ibogaine, and mescaline in 2026."