THE DAILY BRIEFING

More and more people are turning to medical cannabis products to alleviate mental health problems such as anxiety, depression, and insomnia—although there is little science indicating that the drug is safe and effective to treat these problems. Advocates of medical marijuana legalization have convinced many consumers that their problems can be solved with cannabis, even as some evidence suggests that it can make their conditions worse. Therapists say they are seeing more patients using pot in place of antidepressant drugs, which can have unpleasant side effects. But some studies have found that cannabis use is linked to even more severe symptoms, prompting the American Psychiatric Association to warn that “there’s no current scientific evidence that cannabis is in any way beneficial to the treatment of any psychiatric disorder.”

Meanwhile, an alarming new study in JAMA Pediatrics has found that the number of teens who vape marijuana increased 7-fold between 2013 and 2020, as young people seek a more intense high than what they would get from smoking a joint. Vape pens deliver an intense high with more THC, the psychoactive component of marijuana. Researchers point out that vaping pot poses serious health dangers for teens, including a risk of dependence on marijuana and other substances, pulmonary disorders, and social and behavioral problems later in life. It’s time to impose better regulation of vaping products and ban advertising that targets young people.

And finally, some good news on the drug interdiction front: law enforcement agencies on three continents have disrupted a global drug trafficking operation on the dark web, one of the world’s largest online marketplaces for illicit goods including opioids and other dangerous drugs. Authorities in Europe, the U.S., and Australia arrested more than 150 people and seized large quantities of drugs including opioids, cocaine, and methamphetamines. Sales of drugs and drug-making equipment on the dark web have helped fuel the opioid crisis.  

The New York Times finally weighs in on the risks to kids from marijuana edibles, noting that many teens underestimate the dangers associated with the drug. With pot legalization making pot more widely available, young people have come to believe marijuana is less dangerous creating a perfect storm or risk, especially for edibles that are heavily marketed to young people. Edibles can indeed appear harmless, as they are packaged to look like candies, and appeal to impulsive, thrill-seeking youth. But they can pack a strong punch with high levels of THC, the psychoactive component of pot, that may cause lethargy, confusion, impaired coordination, intense anxiety, rapid heart rate, and vomiting, as well as seizures and respiratory depression. The Times suggests that parents talk to their teens about these risks, but the government should also act to impose stricter rules and regulations to curb underage access and use. 

Meanwhile, the Times doesn’t always speak so bluntly when it comes to marijuana. A recent story in the Style section noted that fake pot plants are all the rage as decor in homes and businesses, as a way to "counter negative attitudes" toward marijuana and supposedly destigmatize the drug. The owner of one fake pot plant company was quoted as saying she was inspired to start the business by her father, who said that using marijuana oil had helped treat his skin cancer. Perhaps the paper of record should have also pointed that pot is NOT an effective treatment for skin cancer.

And finally, as drug overdoses soar in the U.S, the availability of the overdose reversal drug Naloxone is dwindling as the price of the effective, and easy-to-use drug increases, which is causing a dangerous shortage. The drug’s manufacturer, Pfizer, ran into problems making the drug earlier this year, and temporarily stopped shipping it to community groups battling the drug epidemic. Pfizer says the supply chain has been fixed, but the price is still far more expensive for the providers at a time when they need it most. Now is the time for the government to step in and secure the production and availability of a critical drug that can save lives, and help substance users enter treatment.  

Fatal drug overdoses are soaring in San Francisco, and the city’s mayor London Breed is coming under increasing pressure to declare a public health emergency as she did with COVID-19. Advocates say this would not only bring more attention to the crisis but also provide an incentive to flout federal and state laws to open safe syringe sites, where users can shoot up in a controlled setting. Last year twice as many people in the city died from drug overdose as from coronavirus, and this year drug deaths continue to climb. Mayor Breed generally supports safe syringe sites but says it’s not clear whether an emergency declaration would help get around current laws banning them. Similar fights have raged in several cities with increasing overdose deaths, although none have yet opened in the U.S. In the meantime, Breed has committed an additional $13.2 million to expand the city’s overdose prevention program, including street outreach teams, treatment beds, and wider distribution of overdose reversal drugs.

Meanwhile, streaming service Hulu tackles the opioid epidemic with its new series Dopesick, which offers dramatic and emotional insights into the crisis focusing on a small town in Appalachia, where the epidemic started in mostly white, working-class communities. The series, starring Michael Keaton as a local doctor, looks at the crisis from multiple angles: doctors and patients, law enforcement, and prosecutors trying to hold OxyContin maker Purdue Pharma accountable for essentially lying about the addictiveness of the drug, which fueled addiction and overdoses. The series debuts as opioid litigation against drugmakers, distributors, and pharmacies for their role in the crisis plays out and provokes controversy over proposed settlements that many believe do not adequately compensate victims' families.

And finally, you may have noticed that supermarket shelves are now overflowing with beverages suffused with ingredients such as CBD, purporting to reduce stress and help you calm down—which sounds great, even though there’s very limited research supporting such claims. CBD, the non-psychoactive component of marijuana, is showing up everywhere, including drinks, wellness products, and even dog food. But the New York Times points out that little evidence exists showing that it does what the products promise. Although one company noted that customers have reported “lifted moods and cleared minds,” what they may actually be experiencing is the placebo effect, the power of suggestion being so strong that they believe they’re consuming a magical cure.  

E-cigarettes have been on the market for almost a decade, but controversy continues to surround the devices, which were first pitched as a smoking cessation tool but eventually led to an epidemic level of use among underage consumers. Now, the FDA has given the first market authorization to an e-cigarette—R.J. Reynold’s Vuse—as a way to help smokers quit. But the agency, which says this does not mean the product is “FDA-approved,” also denied a request to sell flavored pods for the device. And it imposed strict marketing regulations on the company, including digital advertising restrictions in order to greatly reduce the potential for youth exposure to these products. Industry leaders say this is a good sign that the FDA doesn’t intend to drive e-cigarette makers out of business, while also being careful about allowing products that target young people, amid an epidemic of youth vaping. The FDA hasn’t yet ruled on products from former market leader Juul, and continues to deny pre-market requestions from thousands of applications from potential c-cigarette makers.

Meanwhile, the American Heart Association is not mincing words about its position on e-cigarettes: it calls on the FDA to reject all the remaining pre-market tobacco applications for flavored products, regulate synthetic nicotine, and prohibit the sale of any flavored tobacco product. It also called on states to pass laws and policies that remove flavored tobacco products, including menthol, from the market. The Heart Association was responding to a recent survey that found that more than 80 percent of high school and middle school students who vape prefer flavored products, as well as a preference for disposable products that those with synthetic tobacco—both of which are not under FDA jurisdiction.

And finally, a clinical trial has begun of the first potential opioid vaccine in humans. The trial, at Columbia University, will first test the safety and efficacy of a vaccine designed to trigger the patient’s own immune system to develop antibodies to the target: if the individual uses opioids, for example, the antibodies would bind to it and prevent it from getting to the brain. The vaccine would not prevent cravings for the drug, but it could serve as an added layer of protection for people at high risk. 

Evidence revealed at the landmark opioid trial in Ohio shows that pharmacy chain employees warned about the dispensing of highly addictive prescription painkillers—but to no avail, allowing a flood of opioids to continue. The trial, which accuses the nation’s biggest pharmacy chains—including CVS, Walgreens, and Walmart—of fueling the opioid epidemic, is being closely watched as the sprawling opioid litigation plays out across the country. The documents showed that employees told superiors that the company was not verifying the legitimacy of suspicious orders and that the chains were not doing enough to reduce the growth of prescription painkillers. Laws require drugstore chains to implement strict monitoring and safety programs. But the companies claim they did nothing wrong, and instead blame doctors for writing the prescriptions and federal regulators for failing to crack down on so-called pill mills that doled out tens of millions of doses. The case is widely seen as a test to determine whether companies should be liable for the epidemic and shoulder part of the cost of responding to the crisis. Thousands of opioid lawsuits are either at trial or under a proposed settlement against not only pharmacy chains but also drug manufacturers and drug distribution companies, for their role in the epidemic.

Meanwhile, a new study released by the FDA and the CDC found that more than 2 million middle and high school students used e-cigarettes in 2021, with more than 8 in 10 of those youth using flavored e-cigarettes. Despite increased warnings and prevention programs, vaping remains extremely popular with kids, the report said, noting that 25 percent of high school students who used e-cigarettes said they vaped every day. The FDA says it is continuing to take action against companies that sell or target e-cigarettes and e-liquids to kids, including recently denying more than one million premarket applications for flavored electronic nicotine delivery systems. But obviously, the agency is not doing enough to discourage young people from using e-cigarettes and contributing to the nationwide vaping epidemic among underage users.

 And finally, California is poised to clamp down on CBD products to ensure they are accurately labeled and safe, following the explosive growth of the sector and a flow of merchandise that is mislabeled and untested. CBD, the nonpsychoactive component of marijuana, can be found in soap, food, and other wellness goods, and its use has grown significantly since Congress legalized hemp in 2018. But in the absence of federal oversight, states are stepping up efforts to regulate untested products that make unfounded claims about their efficacy and safety—often claim that CBD is a wonder drug promising relief for ailments including pain, anxiety, and depression. The regulatory bill in California, which Gov. Gavin Newsom is expected to sign, would hold manufacturers to rigorous testing and labeling guidelines.

San Francisco is in the grips of an unprecedented drug epidemic as fentanyl floods the street-drug marketplace, intensifying the risk of addiction and leading to a staggering number of overdose deaths. While overdose deaths have surged across the country to a record 93,000 last year, fatalities linked to fentanyl have skyrocketed in San Francisco—increasing by nearly 500 percent between 2018 and 2020. Illicit fentanyl, which can be as much as 50 times more powerful than heroin, was detected in the blood of 519 of the 712 individuals who died. Last year the regional office of the DEA seized 74 kilograms of fentanyl—an amount that could kill up to 37 million people—compared with 15 kilograms in 2016. The synthetic opioid was developed in the 1960s to manage pain after surgery, but today is made illegally in China and India and is now stamped into counterfeit pills to increase the potency of drugs that look like legitimate prescription medications such as OxyContin and Xanax.

Meanwhile, the nation’s three largest drug distributors have reached a $75 million opioid settlement with the Cherokee Nation Native American Tribe in Oklahoma, to settle allegations that the companies helped fuel a public health crisis by allowing the distribution of highly addictive prescription painkillers. This settlement is separate from a proposed $26 billion deal to end thousands of lawsuits brought by states and local governments against Cardinal Health, McKesson Corpl, and AmerisourceBergen. The Cherokee Nation was the first to sue the distributors in 2017, accusing them of supplying millions of pills that caused addictions and fatal overdoses.

And finally, the Wall Street Journal reports that the legalization of marijuana around the U.S. is bringing weed into the workplace in new ways—and raising questions about boundaries and behaviors when it comes to the drug. For example, companies debate whether they should continue to test employees and job candidates for marijuana, how to talk about pot socially, and if it should be used in team-building exercises. And then there’s always the tricky issue of whether to get stoned with a client, the paper noted.

The Drug Enforcement Agency has issued its first public warning in six that a growing number of fake pills bought online through e-commerce websites—and promoted by social media sites—are laced with potentially lethal amounts of the powerful synthetic opioid fentanyl. Noting that we are in the midst of an overdose crisis—with more than 93,000 fatalities last year—the DEA said that the counterfeit pills are driving the surge in deaths. Fentanyl, even in much smaller amounts, is deadlier than street heroin, and more and more online sellers, as well as dealers, are adding the deadly drug to prescription pills. The agency said it has seized more than 9.5 million fake pills so far this year, more than the last two years combined, and that two out of every five fake pills with fentanyl contain a potentially lethal dose of the drug.

Meanwhile, a new study published in the journal Jama Psychiatry finds that methamphetamine use is surging as a major cause of high-risk addiction and overdose death, in part due to meth containing fentanyl. From 2015 to 2015, there was a 180 percent increase in the number of deaths linked to meth, from more than 5,500 a year to nearly 15, 500, according to pre-pandemic data. The researchers found Native Americans and Alaska Natives still have the highest rate of methamphetamine use disorder and have seen sharp increases in drug deaths in recent years, while Black Americans saw a tenfold increase in meth use over the same five-year period. In addition, there was increased use of needles to inject the drug, and a rapid transition from casual and recreational meth use to full-blown addiction.

And finally, the American Medical Association has issued a report showing the disparities between efforts to fight the opioid epidemic and outcomes. It noted that while there has been a 44 percent drop in opioid prescribing in the past decade, due mostly to stricter prescription monitoring, the country is still facing a worsening epidemic of drug-related overdoses and deaths. Overdoses and deaths are spiking even though physicians have increased the use of monitoring programs—more than 910 million times in 2020, according to the AMA. It also reports that although more than 106,000 physicians and other health professionals have received the required waiver allowing them to prescribe opioid withdrawal medications to treat opioid-use disorder, between 80 percent and 90 percent of people with substance use disorder receive no treatment whatsoever.

Selling marijuana on tribal lands in New York State has become a booming business for Native Americans, who are capitalizing on the slow pace of regulating the state’s newly legal marijuana industry. The New York Times reports from an upstate reservation, on the northern border with Canada, which is doing a brisk trade in pot products, drawing customers from across the region. However, the new enterprises exist in a sort of gray area, moving faster to set up dispensaries than the government in Albany can impose a regulatory body to oversee the new cannabis industry. There’s also a dispute within the tribal government, with some groups claiming the businesses are operating outside the laws of the reservation. Once again, we see that legalization is moving ahead before rules and regulations can be established to oversee and monitor the new industry.

Meanwhile, it’s no surprise that after pot sales boomed during the pandemic, employment in the sector nationwide would also post extraordinary growth. Today, more than 320,000 Americans work in the industry, a 32 percent increase from ast year, making marijuana one of the nation’s fastest-growing sectors. The industry added nearly 80,000 jobs last year, many coming from the restaurant and retail, and other service sectors, which was hit by the lockdowns. The growth of the industry has indeed been dynamic: the U.S. now has more cannabis workers than dentists, paramedics, or electrical engineers.

And finally, all that pot for sale has consequences for consumers: a new report shows that cases of marijuana over-consumption have led to an increase in cannabis-related intoxication requiring medical attention. Poison control centers have documented a dramatic increase in the number of reports involving edible cannabis, rising from 8.4 percent to 31 percent between 2017 and 2019—especially for children under 10, with these products making up 48 percent of reported cases. Such cases of intoxication in children are associated with coma, severe respiratory depression that can lead to death.  

A new study finds that there is a growing racial disparity in opioid deaths among the Black population and other racial and ethnic groups. The National Institute on Drug Abuse research analyzed data from four states—Kentucky, Ohio, Massachusetts, and New York—and found that opioid deaths among Blacks increased by 38 percent between 2018 and 2019, while rates for other groups did not rise a all. In earlier waves of the epidemic, African Americans had lower rates of overdose deaths than whites, amid heavy prescribing of prescription painkillers in white communities. Experts say the shift in populations is due in part to structural differences in healthcare, including access to effective treatment options, and data suggesting that Blacks are less likely to be prescribed opioid withdrawal medications.

Meanwhile, in an opinion piece in the Boston Globe, two psychiatrists at Beth Israel Deaconess Medical Center write that it is critical for society to recognize the opioid crisis and to understand how secrets and stigma allow it to grow. Writing in honor of National Recovery Months, the physicians urge patients battling addiction—and their families—to talk about their experiences in order to expose the truth about the disease, and help others understand the magnitude of the issue Also, they say that although progress has been made in the areas of prevention, diagnosis, and treatment, these efforts simply have not matched the breadth of the problem. And finally, they point out that addicts must overcome stigma, which is greater than other mental illnesses such as depression and anxiety and leads to silence about the opioid epidemic.

And finally, an op-ed in the Baltimore Sun looks at the growing market for legal adult-use medical marijuana, pointing out that medical cannabis is not really a medication just because states say so. Unlike medications sold in a pharmacy, which comes in plain bottles and has specific instructions on how to use it and what the side effects might be, medical marijuana is dispensed by a “budtender” who has no way to assess possible reactions or warn about potential interactions. In the end, the article notes, the patient is largely left to determine for themselves what constitutes a reasonable medication regimen and dosage that will both treat their ailments and not develop into dependency. As legalization of medical cannabis continues, amid increasingly far-reaching claims about what it does, we need more research into the effects of the drug—as well as tighter regulation of how it is sold and what it purports to do.

The Justice Department is taking action to stop the Purdue Pharma opioid litigation settlement, arguing that it is wrong to grand broad legal immunity to the firm’s founding Sackler family. The controversial deal, approved earlier this month, forces the family to pay $4.5 billion in compensation, as part of an estimated $10 billion deal over the next decade, with the majority of funds going to drug abatement and treatment programs. But the settlement has been widely criticized by patients’ rights groups and others who say the family—which has reaped billions from the sale of its highly addictive OxyContin painkiller—should be shielded from further. The Justice Department said in its filing that the deal takes away the rights of those with a valid legal claim against the Sacklers. Those who support the deal, including a majority of states, say that it would provide much-needed funding for drug treatment programs.

Meanwhile, more and more college football teams that suffered financial losses during the pandemic year are throwing their moral qualms about “sin” industries out the window, and are hooking with booze and cannabis companies to gain sponsorships and the rights to sell their products. The result is a lot more alcohol for sale in stadiums and sponsorship money from the marijuana industry. Colorado, for example, became the first major university to add a cannabis company as a corporate sponsor. It’s not clear yet if pot products will be sold along with beer and hot dogs.

And finally, Maine residents are known for having an independent streak—and that’s true too when it comes to selling recreational marijuana. More than 90 percent of towns in Maine still do not allow adult-use pot sales after opting out or passing ordinances banning dispensaries, even as the industry has taken off in the state (marijuana was legalized in 2016 but sales only began in 2020). The resistance is largely due to fears about harder drugs, including opioids and methamphetamines that have ravaged many Maine communities.