Oregon ends decriminalization of drugs, continues to experiment

 Here's the story in the Washington Post

Hard drugs illegal again in Oregon as first-in-nation experiment ends

"Sunday marks the end of an experiment that drug-reform advocates called a pioneering and progressive measure to better help people. Oregon legislators reassessed Measure 110 this year and decided to again make it a misdemeanor to possess a minor amount of drugs — essentially anything besides marijuana. Selling and manufacturing illicit drugs was and is still illegal in Oregon.

...

"On Feb. 29, the Oregon House of Representatives voted 51-7 to recriminalize drugs, with bipartisan support. The Oregon Senate did the same by a vote of 21-8 the next day. Gov. Tina Kotek (D) signed recriminalization into law April 1.

"Data shows how the [decriminalization] law was used in practice. The Oregonian reported that circuit court data collected by the Oregon Judicial Department from when the law went into effect Feb. 1, 2021, to Aug. 26, 2024, showed that the state’s circuit courts imposed just under $900,000 in fines under the measure but collected only $78,000 of those fines.

"The conviction rate for the 7,227 people cited was 89 percent, with most of those because people didn’t show up to court, the Oregonian reported. Data showed that 85 people completed the substance abuse screening in lieu of a conviction.

"The most commonly cited drug was methamphetamine, accounting for 54 percent of citations. Fentanyl and other Schedule II drugs, the Oregonian reported, ranked second at 31 percent."

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And here's the Guardian's coverage:

Oregon: drug possession to be a crime again as decriminalization law expires. First-in-nation trial comes to an end, as new law gives those caught with hard drugs option of charges or treatment

"The new recriminalization law, HB4002, will give those caught with illicit drugs – including fentanyl, heroin and meth – the choice to either be charged with possession or treatment, which includes completing a behavioral health program and participating in a “deflection program” to avoid fines.

"Personal-use possession would be a misdemeanor punishable by up to six months in jail. It aims to make it easier for police to crack down on drug use in public and introduced harsher penalties for selling drugs near places such as parks.

"The recriminalization law encourages, but does not mandate, counties to create treatment alternatives to divert people from the criminal justice system and toward addiction and mental health services."

Dealing with the harms of harm reduction

 Some of the jurisdictions that pioneered harm reduction measures to reduce drug overdose deaths are dealing with problems of public drug use.

The NYT has this story:

Bold Experiment or Safety Risk? Canada Is Divided on How to Stop Drug Deaths.  British Columbia’s partial retreat from an experiment to decriminalize drug possession reveals a political shift in Canada over combating the opioid crisis. By Vjosa Isai

"decriminalization, a policy introduced as a way of alleviating the opioid crisis, has instead been blamed for deepening it. Scenes of people openly using drugs on city streets have led several elected leaders, other critics and even some supporters to say that decriminalization is contributing to a sense of public disorder.

...

"In May, the federal government, which regulates controlled substances, approved a provincial request to reverse the policy and again make public drug use and possession in British Columbia a crime.

"The shift came not long after a similar experiment in Oregon ended in April, following a vote by the state Legislature to re-criminalize drugs amid soaring overdose deaths.

...

"practices, collectively known as harm reduction, are driven by a strategy meant to keep drug users alive rather than getting them to quit.

"Services that fall under this category include needle exchanges, safe injection sites, the distribution of naloxone, a drug used to reverse overdoses, and the testing of street drugs to reveal the presence of any other harmful substances.

...

"Safe injection sites, along with decriminalization, are among the harm reduction measures that have come under attack from critics who claim they lead to crime and perpetuate a cycle of drug abuse.

"In British Columbia, critics say the province should not have pursued decriminalization without also bolstering other services that drug users need, like housing and addiction treatment.

...

"Many residents, he added, complained of increased drug use on public transit, near schools and in entrances to businesses.

...

"Some frontline workers say harm reduction practices are being targeted to score political points at a time when death tolls are reaching new highs and different approaches are necessary to keep users alive."

Getting a Federal judicial clerkship, and then clerking

 If all has gone according to plan, law students who will graduate next June have just matched with a federal clerkship, if they are going to have one.  That plan, meant to bring some order to what has at times been recruiting that unraveled into the first year of law school, is the

FEDERAL LAW CLERK HIRING PLAN, Updated April 1, 2024

"Participation in the Federal Law Clerk Hiring Plan pertains to the hiring of law school students with two full years of grades in accordance with the timeline set forth below. Students who attend law school part-time or who seek a dual degree may have a later law school graduation date but meet the requirement of having two full years of grades. The dates set forth below do not apply to law school graduates; judges can accept applications, interview, and hire graduates on their own schedule.

"Graduating Class of 2025  For students who entered law school in 2022:

"Judges will not accept formal or informal clerkship applications, or seek or accept formal or informal recommendations, before 12:00 pm EDT on June 10, 2024. Judges also will not directly or indirectly contact applicants, or schedule or conduct formal or informal interviews, or make formal or informal offers, before 12:00 pm EDT on June 11, 2024.

"A judge who makes a clerkship offer will keep it open for at least 24 hours, during which time the applicant will be free to interview with other judges."

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The plan goes on to schedule clerkship applications and offers for subsequent years in the same way: everyone should wait for the end of students' second year, and then things will move fast (but fast as in 24 hours as opposed to instantly).

If history is any guide, some judges will cheat, but maybe there won't be too much cheating too soon.

But what happens during the clerkship? Will judges who were bad apples during recruiting turn into supportive mentors?

There's a growing movement among former clerks to recognize that not every clerkship is a cakewalk, and to offer support for clerks who face varying degrees of abuse.

The blog Above the Law takes note of this with a recent post:

Judicial Clerkships Are Not An Unadulterated Good. Clerkships are not all unicorns and fairy dust.  bBy ALIZA SHATZMAN

She notes " A judge who will not afford you time to consider the offer — before you commit several years down the road for a particularly consequential year or two of your life — is probably not someone you want to work for."

And she is the founder of The Legal Accountability Project, which proposes to provide a platform for sharing information about clerkships:

"The Legal Accountability Project’s mission is to ensure that law clerks have positive clerkship experiences, while extending support and resources to those who do not. " 

Nicotine is hard to ban: Juul wins a reprieve from the FDA, and illegal vapes flood the market

 Here are two stories by Jennifer Maloney at the WSJ:

FDA Rescinds Juul Ban, Opening Door for Federal Clearance. E-cigarette maker’s products have stayed on market pending appeal of 2022 ban.. By  Jennifer Maloney

"The Food and Drug Administration rescinded its 2022 ban on Juul Labs’s e-cigarettes. The agency hasn’t yet reached a final determination on whether they can stay on the U.S. market, but the move opened the possibility for federal clearance.

The FDA in 2022 ordered Juul to halt its sales, then stayed the order pending the vaping company’s appeal. The agency said Thursday that it was placing Juul’s products back under scientific review, essentially moving them back to their regulatory status before the ban. 

...

"Juul’s products remain on the market. The FDA didn’t give a timeline for a final decision on whether they can stay there. Juul is the No. 2 e-cigarette maker in the U.S.

Juul and other e-cigarette manufacturers in 2020 were required to submit scientific research to demonstrate that their vaping products exposed users to fewer carcinogens than cigarettes and that the benefit of helping adult smokers switch to a safer alternative outweighed the potential harm of hooking young people on nicotine.

...

"The FDA ban, though it was quickly put on hold, sent Juul into a financial tailspin. The company narrowly averted bankruptcy. Juul has since submitted next-generation vaping products for FDA review. They aren’t yet for sale in the U.S."

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U.S. Pledges Crackdown on Illegal E-Cigarettes. FDA and DOJ form task force to go after fruity, disposable vapes flooding the market.  By Jennifer Maloney

"Big tobacco companies and their critics agree on at least one thing: The illegal, fruit-flavored, disposable vapes that are popular among teenagers have flooded the U.S. market and federal regulators haven’t done enough to stop it.

"The Food and Drug Administration and Justice Department said Monday they are stepping up enforcement by forming a multiagency task force to go after the illegal distribution and sale of e-cigarettes.

"Disposable vaping devices, almost none of which are authorized for sale by the FDA, represent more than 30% of U.S. e-cigarette sales in stores tracked by Nielsen, according to an analysis by Goldman Sachs. Many of them are imported from China. Breeze Pro and Elfbar, both of which were ordered off the market last year by the FDA, remain the top two disposable e-cigarette brands in the U.S.

"Njoy is the only disposable vaping brand authorized for sale by the FDA." 

Oregon is re-criminalizing drugs

 The war on drugs is unforgiving, and neither criminalization nor decriminalization seems to be a winning strategy.  The NYT has the latest from Oregon, where there were high hopes for decriminalization and harm reduction, and where there are now second thoughts. 

Oregon Is Recriminalizing Drugs, Dealing Setback to Reform Movement. Oregon removed criminal penalties for possessing street drugs in 2020. But amid soaring overdose deaths, state lawmakers have voted to bring back some restrictions.  By Mike Baker

"Three years ago, when Oregon voters approved a pioneering plan to decriminalize hard drugs, advocates looking to halt the jailing of drug users believed they were on the edge of a revolution that would soon sweep across the country.

"But even as the state’s landmark law took effect in 2021, the scourge of fentanyl was taking hold. Overdoses soared as the state stumbled in its efforts to fund enhanced treatment programs. And while many other downtowns emerged from the dark days of the pandemic, Portland continued to struggle, with scenes of drugs and despair.

"Lately, even some of the liberal politicians who had embraced a new approach to drugs have supported an end to the experiment. On Friday, a bill that will reimpose criminal penalties for possession of some drugs won final passage in the State Legislature and was headed next to Gov. Tina Kotek, who has expressed alarm about open drug use and helped broker a plan to ban such activity.

“It’s clear that we must do something to try and adjust what’s going on out in our communities,” State Senator Chris Gorsek, a Democrat who had supported decriminalization, said in an interview. Soon after, senators took the floor, with some sharing stories of how addictions and overdoses had impacted their own loved ones. They passed the measure by a 21-8 margin."

Guns and drugs on the U.S. Mexico border

 Here are two stories about some of the illegal traffic on the border between the U.S. and Mexico.

First, the war on drugs is fought with American guns on both sides:

The NY Times has the story:

Appeals Court Revives Mexico’s Lawsuit Against Gunmakers. The decision, which is likely to be appealed, is one of the most significant setbacks for the gun industry since passage of a federal law that provided immunity from some lawsuits.  By Glenn Thrush  Jan. 22, 2024

"A federal appeals panel in Boston ruled on Monday that a $10 billion lawsuit filed by Mexico against U.S. gun manufacturers whose weapons are used by drug cartels can proceed, reversing a lower court that had dismissed the case.

"The decision, which is likely to be appealed, is one of the most significant setbacks for gunmakers since passage of a federal law nearly two decades ago that has provided immunity from lawsuits brought by the families of people killed and injured by their weapons.

"Mexico, in an attempt to challenge the reach of that law, sued six manufacturers in 2021, including Smith & Wesson, Glock and Ruger. It contended that the companies should be held liable for the trafficking of a half-million guns across the border a year, some of which were used in murders.

...

" lawyers for Mexico, assisted by U.S. gun control groups, claimed that the companies “aided and abetted the knowingly unlawful downstream trafficking” of their guns into Mexico.

"Gun violence is rampant in Mexico despite its near-blanket prohibition of firearms ownership.

"About 70 to 90 percent of guns trafficked in Mexico originated in the United States, according to Everytown Law, the legal arm of the gun control group founded by the former mayor of New York Michael R. Bloomberg.

"Gun control advocates hailed the decision on Monday by a three-judge panel, describing it as a milestone in holding the gun industry accountable."

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As for drugs, it turns out that harm reduction drugs are highly controlled in Mexico, so illegal drugs also flow both ways.

Here's that story, from the Guardian:

Carriers sneak life-saving drugs over border as Mexico battles opioid deaths  People forced to bring overdose-reversal drug naloxone from US, as critics accuse Mexican government of creating shortage. by Thomas Graham in Tijuana, Tue 23 Jan 2024 

"Every day, people cross the US-Mexico border with drugs – but not all of them are going north. Some head in the opposite direction with a hidden cargo of naloxone, a life-saving medicine that can reverse an opioid overdose but is so restricted as to be practically inaccessible in Mexico.

"This humanitarian contraband is necessary because Mexico’s border cities have their own problems with opioid use – problems that activists and researchers say are being made more deadly by government policy.

“Mexico has long seen itself as a production and transit country, but not a place of consumption,” said Cecilia Farfán Méndez, a researcher at the University of California at San Diego. “And a lot of the conversation is still around that being a US problem – not a Mexican one.”

...

"The situation has been exacerbated by a government policy that, aside from cutting budgets for harm reduction services like PrevenCasa, has also created shortages of life-saving medicines for opioid users.

"In response to the fentanyl crisis, authorities in the US made naloxone available without a prescription. Naloxone vending machines have proliferated across the country.

"But in Mexico naloxone remains strictly controlled – despite the efforts of some senators from Andrés Manuel López Obrador’s own party, Morena, who proposed a law to declassify it.

"The president, popularly known as Amlo, has criticised naloxone, asking whether it did any more than “prolong the agony” of addicts, and questioning who stood to profit from its sale."

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Earlier:

Sunday, January 22, 2023

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

Limitations of harm reduction: will Oregon recriminalize drug use?

 The NYT has the story:

To Revive Portland, Officials Seek to Recriminalize Public Drug Use. State and local leaders are proposing to roll back part of the nation’s pioneering drug decriminalization law and step up police enforcement.  by Mike Baker

"After years of rising overdoses and an exodus of business from central Portland, Oregon Gov. Tina Kotek said on Monday that state and city officials are proposing to roll back a portion of the nation’s most wide-ranging drug decriminalization law in a bid to revive the troubled city.

"Under the plan brokered by Gov. Kotek, a Democrat, state lawmakers would be asked to consider a ban on public drug use and police would be given greater resources to deter the distribution of drugs. Ms. Kotek said officials hoped to restore a sense of safety for both visitors and workers in the city’s beleaguered urban core, which has seen an exodus of key retail outlets, including REI, an institution in the Pacific Northwest.

“When it comes to open-air drug use, nobody wants to see that,” Ms. Kotek said in an interview. “We need different tools to send the message that that is not acceptable behavior.”

...

"Oregon voters in 2020 approved the nation’s first law decriminalizing possession of small amounts of hard drugs, including fentanyl, heroin and methamphetamines. The ballot measure sought to end the use of jail as a punishment for drug users and instead treat addiction as a health issue. The effort was to be joined with major new investments in drug treatment, but those new systems have been slow to develop.

...

"Last month, Seattle implemented a new law that prohibits possession of drugs and public use.

...

"Ms. Kotek’s task force does not have the power to immediately ban public drug use, but the panel called for the Legislature to take up the issue in the coming session along with changes that could reduce barriers to prosecuting those who deliver drugs. Lawmakers have already been discussing potential changes to the decriminalization law."

Drug addiction: not just opioids

 Consumption of addictive drugs seems to come in deadly cocktails these days, which is making interdiction of drugs, and treatment of addiction more complicated.

The NYT has the story:

‘A Monster’: Super Meth and Other Drugs Push Crisis Beyond Opioids. Millions of U.S. drug users now are addicted to several substances, not just opioids like fentanyl and heroin. The shift is making treatment far more difficult.  By Jan Hoffman

"The United States is in a new and perilous period in its battle against illicit drugs. The scourge is not only opioids, such as fentanyl, but a rapidly growing practice that the Centers for Disease Control and Prevention labels “polysubstance use.”

Over the last three years, studies of people addicted to opioids (a population estimated to be in the millions) have consistently shown that between 70 and 80 percent also take other illicit substances, a shift that is stymieing treatment efforts and confounding state, local and federal policies.

“It’s no longer an opioid epidemic,” said Dr. Cara Poland, an associate professor at the Michigan State University College of Human Medicine. “This is an addiction crisis.”

...

"The incursion of meth has been particularly problematic. Not only is there no approved medical treatment for meth addiction, but meth can also undercut the effectiveness of opioid addiction therapies. Meth explodes the pleasure receptors, but also induces paranoia and hallucinations, works like a slow acid on teeth and heart valves and can inflict long-lasting brain changes.

"The Biden administration has been pouring billions into opioid interventions and policing traffickers, but has otherwise lagged in keeping pace with the evolution of drug use. There has been comparatively little discussion about meth and cocaine, despite the fact that during the 12-month period ending in May 2023, over 34,000 deaths were attributed to methamphetamine and 28,000 to cocaine, according to provisional federal data.

...

"Like opioids, which originally came from the poppy, meth started out as a plant-based product, derived from the herb ephedra. Now, both drugs can be produced in bulk synthetically and cheaply. They each pack a potentially lethal, addictive wallop far stronger than their precursors."

Immigration, immigration law, and illegal immigrants in legal limbo. Should we have a statute of limitations after which immigrants become legal?

We're seeing so much illegal immigration, maybe we should change some of our laws, at least to regularize the status of immigrants who have successfully built productive lives here.  One suggestion is to have a statute of limitation on the crime of illegal immigration, That could work like common law marriage, after a long enough time, the status quo becomes legal.

The NY Times has the story:

Why Can’t We Stop Unauthorized Immigration? Because It Works. Our broken immigration system is still the best option for many migrants — and U.S. employers. By Marcela Valdes

"The three most recent presidents have tried and failed to fix the problem of mass unauthorized migration into the United States. President Obama tried to balance empathy with enforcement, deferring the deportation of those who arrived as minors and instructing immigration officers to prioritize the arrest of serious criminals, even as he connected every jail in the nation to Immigration and Customs Enforcement (ICE). President Trump emphasized enforcement at all costs: revoking deferred action for minors, declaring the arrest of every undocumented person a priority, separating migrant families and trying to terminate temporary protected status for about 400,000 people — though Trump also extended deferred action to about 200,000 Venezuelans during his last full day in office.

"So far, President Biden has revived the empathy-and-enforcement strategy: resuming deferred action for minors and helping Venezuelans while also making it more difficult to qualify for asylum.

"But these variations in policy have had almost no effect on the number of migrants trying to enter the United States through the Southern border. Obama and Trump chose mostly opposing strategies, but each prioritized the arrest of unauthorized migrants in the Rio Grande Valley. Yet in 2019, before the pandemic gave Trump legal standing to force asylum seekers back into Mexico, Customs and Border Protection (C.B.P.) arrested about 82,000 more migrants there than they had at the peak of migrations in the Obama years.

...

"Until the 1920s, America received migrants with an almost open border. Our policies emphasized regulation, not restriction. A few general categories were barred from entry — polygamists and convicted criminals, for example — but almost everyone else was permitted to enter the United States and reside indefinitely. The move toward restriction began in 1882 with laws that targeted the Chinese then evolved to exclude almost every other national group as well.

"Legal immigration today is close to impossible for most people. David J. Bier of the Cato Institute recently estimated that around 3 percent of the people who tried to move permanently to the United States were able to do so legally. “Legal immigration is less like waiting in line and more like winning the lottery: It happens, but it is so rare that it is irrational to expect it in any individual case,” he wrote in a comprehensive review of the current regulations. He concludes that “trying the legal immigration system as an alternative to immigrating illegally is like playing Powerball as an alternative to saving for retirement.”

"In other words, illegal immigration is the natural consequence of the conflict between America’s thirst for foreign labor and its strict immigration laws. The world’s increasing connectedness and fluidity have just supercharged this dynamic. There are now more than 11 million undocumented immigrants inside the United States, three times the number that lived here in 1990. And during the last fiscal year, the number of C.B.P. arrests in the Rio Grande Valley hit a record: more than half a million.

...

"Among academics, another idea keeps resurfacing: a deadline for deportations. Most crimes in America have a statute of limitations, Mae Ngai, a professor of history at Columbia University, noted in an opinion column for The Washington Post.  The statute of limitations for noncapital terrorism offenses, for example, is eight years. Before the 1924 Immigration Act, Ngai wrote in her book about the history of immigration policy, the statute of limitations for deportations was at most five years. Returning to this general principle, at least for migrants who have no significant criminal record, would allow ICE officers and immigration judges to focus on the recent influx of unauthorized migrants. A deadline could also improve labor conditions for all Americans because, as Ngai wrote, “it would go a long way toward stemming the accretion of a caste population that is easily exploitable and lives forever outside the polity.”

Homelessness and fentanyl, in Oregon and California

 Both the criminal justice system and the harm reduction movement seem to be facing an intractable problem with fentanyl and homelessness.  (We lost the war on drugs, but surrender isn't working either.)

Here are two NYT stories, from Oregon and California.

The Struggle to Save Portland, Oregon. The city has long grappled with street homelessness and a shortage of housing. Now fentanyl has turned a perennial problem into a deadly crisis and a challenge to the city’s progressive identity.  By Michael Corkery

"This city of 635,000 ...  has long grappled with homelessness. But during the pandemic this perennial problem turned into an especially desperate and sometimes deadly crisis that is dividing Portland over how to fix it.

...

"In 2022, Portland experienced a spate of homicides and other violence involving homeless victims that rattled many in the community.

...

"The search for answers points in many directions — to city and county officials who allowed tents on the streets because the government had little to offer in the way of housing, to Oregon voters who backed decriminalizing hard drugs and to the unrest that rocked Portland in 2020 and left raw scars.

"But what has turbocharged the city’s troubles in recent years is fentanyl, the deadly synthetic drug, which has transformed long standing problems into a profound test of the Portland ethos.

"Outreach workers in Portland say rampant fentanyl use has coincided with the increasing turmoil among many homeless residents.

"Doctors who care for people living on the streets say fentanyl addiction is proving harder to treat than many other dependencies."

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Homeless Camps Are Being Cleared in California. What Happens Next? One of the state’s largest homeless encampments was recently shut down in Oakland, but that didn’t stop the problem of homelessness.  By Livia Albeck-Ripka

"The evictions have brought into sharp relief one of the most intractable challenges for American cities, particularly those in California. As homelessness has surged, more people have congregated in large encampments for some semblance of security and stability. But such sites are often unsanitary and dangerous, exhausting neighbors and the owners of nearby businesses.

"What happens after the closure of Wood Street and other camps in California will serve as the latest test of how effectively the state is addressing homelessness. Nearly half of the nation’s unsheltered population — those who sleep on the streets, in tents, in cars or in other places not intended for human habitation — resides in California, according to last year’s federal tally of homelessness. The state makes up about 12 percent of the country’s overall population.

"In California, Democratic leaders who previously tolerated homeless camps have lost their patience for the tent villages and blocks of trailers that proliferated during the pandemic.

"Governor Newsom has helped clear homeless camps himself and has told mayors he was trying to set an example. San Diego recently banned encampments on public property. And Karen Bass, the mayor of Los Angeles, has moved more than 14,000 homeless people into temporary housing since taking office in December, her office said last month.

...

"Community cabins and safe camping sites usually provide only temporary shelter, falling short of the permanent housing that is considered ideal. But they seem to be the best that California can do, with a severe housing shortage and high costs. Despite the state’s spending of more than $30 billion since 2019 on housing-related programs, the homeless population there has continued to grow.

“This is a very difficult population to serve, with very complex needs. And if we can bring someone inside even for a little bit, that’s a victory for that person,” said Jason Elliott, the deputy chief of staff for Governor Newsom. “We may not have permanent housing stick the first time, or the fourth time or the fifth time, but we’re going to keep trying.”

"According to a September audit of Oakland’s homelessness services, close to half of the people housed in community cabins ended up back on the street in the 2020-21 fiscal year."

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Earlier:

Friday, July 14, 2023

Harm reduction is not a panacea: drug use and drug policy in Portugal, and San Francisco

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."

Harm reduction is not a panacea: drug use and drug policy in Portugal, and San Francisco

 The Washington Post has a story about Portugal, and the SF Chronicle has one as well. Both stories touch on the tensions between treating drug addicts with respect, and assuring that cities remain safe and livable.  

Here's the Washington Post:

Once hailed for decriminalizing drugs, Portugal is now having doubts  By Anthony Faiola and Catarina Fernandes Martins

"Portugal decriminalized all drug use, including marijuana, cocaine and heroin, in an experiment that inspired similar efforts elsewhere, but now police are blaming a spike in the number of people who use drugs for a rise in crime. In one neighborhood, state-issued paraphernalia — powder-blue syringe caps, packets of citric acid for diluting heroin — litters sidewalks outside an elementary school.

"Porto’s police have increased patrols to drug-plagued neighborhoods. But given existing laws, there’s only so much they can do. 

...

"Portugal became a model for progressive jurisdictions around the world embracing drug decriminalization, such as the state of Oregon, but now there is talk of fatigue. Police are less motivated to register people who misuse drugs and there are year-long waits for state-funded rehabilitation treatment even as the number of people seeking help has fallen dramatically. The return in force of visible urban drug use, meanwhile, is leading the mayor and others here to ask an explosive question: Is it time to reconsider this country’s globally hailed drug model?

“These days in Portugal, it is forbidden to smoke tobacco outside a school or a hospital. It is forbidden to advertise ice cream and sugar candies. And yet, it is allowed for [people] to be there, injecting drugs,” said Rui Moreira, Porto’s mayor. “We’ve normalized it.”

...

" In the United States alone, overdose deaths, fueled by opioids and deadly synthetic fentanyl, topped 100,000 in both 2021 and 2022 — or double what it was in 2015. According to the National Institutes of Health, 85 percent of the U.S. prison population has an active substance use disorder or was jailed for a crime involving drugs or drug use.

"Across the Atlantic in Europe, tiny Portugal appeared to harbor an answer. In 2001, it threw out years of punishment-driven policies in favor of harm reduction by decriminalizing consumption of all drugs for personal use, including the purchase and possession of 10-day supplies. Consumption remains technically against the law, but instead of jail, people who misuse drugs are registered by police and referred to “dissuasion commissions.” 

...Other countries have moved to channel drug offenses out of the penal system too. But none in Europe institutionalized that route more than Portugal. Within a few years, HIV transmission rates via syringes — one the biggest arguments for decriminalization — had plummeted. From 2000 to 2008, prison populations fell by 16.5 percent. Overdose rates dropped as public funds flowed from jails to rehabilitation. There was no evidence of a feared surge in use.

...

"But in the first substantial way since decriminalization passed, some Portuguese voices are now calling for a rethink of a policy that was long a proud point of national consensus. Urban visibility of the drug problem, police say, is at its worst point in decades

...

"A newly released national survey suggests the percent of adults who have used illicit drugs increased to 12.8 percent in 2022, up from 7.8 in 2001, though still below European averages.

...

"Porto’s mayor and other critics, including neighborhood activist groups, are not calling for a wholesale repeal of decriminalization — but rather, a limited re-criminalization in urban areas and near schools and hospitals to address rising numbers of people misusing drugs."

...

"After years of economic crisis, Portugal decentralized its drug oversight operation in 2012. A funding drop from 76 million euros ($82.7 million) to 16 million euros ($17.4 million) forced Portugal’s main institution to outsource work previously done by the state to nonprofit groups,

...

"Twenty years ago, “we were quite successful in dealing with the big problem, the epidemic of heroin use and all the related effects,” Goulão said in an interview with The Washington Post. “But we have had a kind of disinvestment, a freezing in our response … and we lost some efficacy.”

*******

And here are some related paragraphs about San Francisco, in a story in the San Francisco Chronicle about a concentration of drug dealers from Honduras:

THIS IS THE HOMETOWN OF SAN FRANCISCO’S DRUG DEALERS By Megan Cassidy and Gabrielle Lurie |  July 10, 2023

"Like many other U.S. cities, San Francisco shifted years ago to treating drug use more like a disease than a crime. The heavy policing approach of the War on Drugs era failed to slow dealers or decrease demand while overcrowding jails and disproportionately punishing people of color, studies show.

"Now one of the most progressive cities in the nation is fracturing over concerns that it has become too permissive. What to do about the Honduran dealers is a key political issue as a major citywide election approaches in 2024.

"On a weekday afternoon in June, a man in his early 30s lay motionless on a SoMa sidewalk outside the Federal Building. On his right, a dozen users smoked fentanyl and crack cocaine or hung bent at the waist, heads suspended at their knees. To his left, a handful of dealers, cloaked in black but for the space around their eyes, continued selling while a passerby revived the man with Narcan, the nasal-spray antidote to opioid overdoses, and as paramedics arrived to treat him a few minutes later.

“I’m so mad at them for ruining my neighborhood,” said Kevin DeMattia, who owns Emperor Norton’s bar and has lived in the Tenderloin for the past 25 years. “Businesses are dying because people don’t want to come to the Tenderloin.  They’re ruining the neighborhood in so many ways. They’re poisoning people. … They’re this cancer, this aggressive, metastasizing cancer on the Tenderloin — the dealers and the addicts.”

Drug Overdose Deaths Topped 100,000 Again in 2022

 

The WSJ has the story: the headline speaks for itself  

Drug Overdose Deaths Topped 100,000 Again in 2022 https://www.wsj.com/articles/drug-overdose-deaths-topped-100-000-again-in-2022-37cd1709

Supervised drug use sites to be banned in Pennsylvania

 Statnews has the story:

Pennsylvania set to ban supervised drug use sites, in setback for harm reduction  By Lev Facher

"Pennsylvania lawmakers are set to pass a new ban on supervised drug consumption, effectively ending a Philadelphia nonprofit’s long-running effort to offer a sanctioned substance-use site meant to prevent overdose and death.

"A bill outlawing sites that “knowingly” provide a space for drug consumption passed a committee vote by a wide margin on Tuesday. It now advances to the full state senate, where it is also expected to pass. Gov. Josh Shapiro, a Democrat, has expressed strong opposition to supervised injection sites in the past, and is expected to sign the legislation.

...

"While the Biden administration has expressed unprecedented support for harm reduction, many Americans remain hostile to the approach.

"Some harm-reduction tools, like syringe exchanges and fentanyl test strips, have gained a degree of acceptance, but supervised consumption is still largely taboo. Pennsylvania advocates had high hopes for a planned site in Philadelphia, however, and say the legislation would deal a demoralizing blow to local efforts to avert overdoses and save lives.

...

"Offering medical supervision as people consume drugs that can cause overdose, like heroin and fentanyl, is among the most controversial tactics employed to prevent overdoses. But in recent years, as U.S. drug deaths have surpassed 100,000 annually, the strategy has gained support among some public health advocates. While critics argue that supervised injection condones drug use, studies from cities including Vancouver and Barcelona show that offering the service can lead to a marked reduction in overdose deaths.

...

"Currently, only a few supervised consumption sites are in operation around the U.S. — and none have formally received the federal government’s blessing. Most notably, the nonprofit OnPoint NYC opened two supervised consumption sites in Manhattan late last year. Rhode Island has legalized supervised consumption sites as well, though it’s unclear when a planned site in Providence will open. "

Harm reduction at work in NYC's opioid crisis

 The NY Times follows some harm reduction workers through their work in New York City, including a city-sponsored safe injection facility.  Not so easy to do, and not so easy to read.

One Year Inside a Radical New Approach to America’s Overdose Crisis. By Jeneen Interlandi

"Since its official opening on Nov. 30, 2021, OnPoint has met with both praise and protest. Shopkeepers and school principals routinely thank Mr. Jones and his colleagues for their daily rounds of needle collection. But local civic groups have been furious about yet another substance abuse program in a neighborhood dense with them and have argued that, however well intentioned, the organization’s approach will only make a bad problem worse. People who are addicted to drugs need tough love and harsh consequences, they insist, not coddling. Community outreach’s mission was therefore twofold: Convince skeptics that programs like these can be a net positive for the community and persuade those with substance use disorders to accept the lifeline that OnPoint was offering."

Incarceration isn't always the best treatment for drug addiction

 Here's a NY Times editorial:

America Has Lost the War on Drugs. Here’s What Needs to Happen Next.  Feb. 22, 2023

It begins with this bit of history, and ends with a call for evidence-based solutions:

"For a forgotten moment, at the very start of the United States’ half-century long war on drugs, public health was the weapon of choice. In the 1970s, when soldiers returning from Vietnam were grappling with heroin addiction, the nation’s first drug czar — appointed by President Richard Nixon — developed a national system of clinics that offered not only methadone but also counseling, 12-step programs and social services. Roughly 70 percent of the nation’s drug control budget was devoted to this initiative; only the remaining 30 percent went to law enforcement.

"The moment was short-lived, of course. Mired in controversy and wanting to appear tough on crime, Nixon tacked right just months before resigning from office, and nearly every president after him — from Reagan to Clinton to Bush — followed the course he set. Before long, the funding ratio between public health and criminal justice measures flipped. Police and prison budgets soared, and anything related to health, medicine or social services was left to dangle by its own shoestring.

...

"Study the solutions. Leading public health agencies, including the Food and Drug Administration and the Centers for Disease Control and Prevention, failed to prevent or even adequately respond to the opioid epidemic that has engulfed the nation. But health officials can still step up. As opioid settlement funds are deployed (along with federal dollars) and harm reduction programs are begun, the C.D.C. especially should impartially study what is working and what is not. The response to this crisis should finally be based on evidence.

"The nation’s leaders are not the only ones with work to do. To fully replace the war on drugs with something more humane or more effective, the public will have to come to terms with the prejudices that war helped instill. That means accepting that people who use drugs are still members of our communities and are still worthy of compassion and care. It also means acknowledging the needs and wishes of people who don’t use drugs, including streets free of syringe litter and neighborhoods free of drug-related crime. These goals are not mutually exclusive. In fact, they go hand in hand. But to make them a reality, lawmakers and other officials will have to lead the way."

Canada experiments with decriminalization of opioids and other drugs in British Columbia

 From the CBC:

What you need to know about the decriminalization of possessing illicit drugs in B.C.  B.C. granted exemption by federal government in November 2022; pilot will run until 2026  by Akshay Kulkarni ·

"it is no longer a criminal offence to possess small amounts of certain illicit drugs in B.C. for people aged 18 or above.

"It's part of a three-year pilot by the federal government, which granted B.C. an exemption from the Controlled Drugs and Substances Act (CDSA) on May 31, 2022. 

...

"Under the exemption, up to 2.5 grams of the following four drug types can be legally possessed:

"Cocaine (crack and powder). Methamphetamine. MDMA. Opioids (including heroin, fentanyl and morphine).

"Fentanyl and its analogues were detected in nearly 86 per cent of drug toxicity deaths from 2019 until 2022, according to the latest report from the B.C. Coroners Service."

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.”

Decriminalizing drugs at the head of the supply chain--Colombia

 The criminalization of drugs has different consequences on different parts of the supply chain. Here's a harm reduction proposal from Columbia--the Washington Post has the story.

Colombia, largest cocaine supplier to U.S., considers decriminalizing. By Samantha Schmidt and Diana Durán 

"It’s the largest producer of cocaine in the world, the source of more than 90 percent of the drug seized in the United States. It’s home to the largest Drug Enforcement Administration office overseas. And for decades, it’s been a key partner in Washington’s never-ending “war on drugs.”

"Now, Colombia is calling for an end to that war. It wants instead to lead a global experiment: decriminalizing cocaine.

"Two weeks after taking office, the country’s first leftist government is proposing an end to “prohibition” and the start of a government-regulated cocaine market. Through legislation and alliances with other leftist governments in the region, officials in this South American nation hope to turn their country into a laboratory for drug decriminalization.

“It is time for a new international convention that accepts that the war on drugs has failed,” President Gustavo Petro said in his inaugural address this month."

Harm reductions (fentanyl test strips) remain illegal in Texas

It's a long way from Texas to Vancouver. This recent story from the Texas Monthly caught my eye:

Fentanyl Test Strips Could Save Lives—But They’re Illegal in Texas By Jeff Winkler, July 22, 2022

"The most widely embraced method of harm reduction is offering users naloxone, known by the brand name Narcan, an easy-to-use medication capable of reversing the effects of an opioid overdose. All U.S. states, including Texas, have relaxed restrictions on access to naloxone amid the opioid epidemic’s “third wave,” which began in 2013 with the rise of fentanyl’s presence on the black market. A less-popular harm-reduction method is the creation of government-approved, supervised sites where users can get clean syringes and take drugs in the presence of a health-care worker. Just two such sites in the nation have been authorized—both in New York City.

"Fentanyl test strips fall somewhere in the middle in terms of their acceptance. The strips have become easier to access, as several states, including Tennessee and New Mexico, have recently decriminalized their possession. But they remain illegal in about half the states, including in Texas, where the strips are considered “drug paraphernalia,” meaning they fall into the same category as bongs and blunt papers. Since the passage of the 1973 Controlled Substances Act, Texas has banned any material intended for use in testing for or “analyzing” a controlled substance."

***********

It's based in part on this earlier report from State of Reform:

 Drug testing strips remain illegal in Texas despite recent rise in overdose deaths, by Boram Kim | May 14, 2022 

"In Harris County alone, fatal drug overdoses increased 52% from 2019 to 2021. County statistics show deaths involving fentanyl skyrocketed by 341% in the same period, from 104 to 459.

"Meanwhile, the Travis County Medical Examiner’s Office released 2021 figures that showed drug overdoses were the leading cause of accidental deaths for the first time in a decade. Approximately one-third of overdose deaths were caused by fentanyl."

**********

earlier:

Tuesday, May 17, 2022

Fentanyl test strips save lives. Why do Kansas and Missouri ban them?