THE DAILY BRIEFING

As the sprawling opioid litigation draws to close promising large settlements for states, Maia Szalavitz writes in Scientific American that the windfall compensation should be used narrowly and smartly for addiction services—and not for cutting the supply of opioids. Comparing this settlement to the $246 billion tobacco agreement, in which most of the money went to state governments and not for smoking cessation programs, she says we now have an opportunity to help those struggling with substance use. Instead of focusing on prescription monitoring and other control methods, she argues, we should expand the use of medications to treat addiction and allow doctors who diagnose opioid addiction to prescribe withdrawal drugs.

Meanwhile, following the recent controversy over marijuana use at the Olympics, the World Anti-Doping Agency says it will launch a review of its ban on consuming pot with high levels of THC during competitions. Marijuana has been on the agency’s list of prohibited substances for decades, but the international body has come under pressure to revise the rule as marijuana legalization has gained momentum, and a top U.S. track star tested positive and was subsequently disqualified to participate in the Tokyo games. Substances are banned if they are deemed to enhance performance or pose a health risk to athletes. 

And finally, the CDC has issued a warning about the dangers of consuming marijuana-infused foods that contain high levels of THC, saying they could cause “adverse effects.” It issued the alert because of the increased availability of such cannabis edibles and insufficient labeling of products with both THC and CBD, the non-psychoactive component of the drug. Edibles are among the fastest-growing cannabis categories, but manufacturers have come under criticism for how they package and market such products.

As pro-pot supporters continue the push for marijuana legalization, a new international report finds that medical cannabis—which is often the prelude to recreational legalization, because of its purported health benefits—is unlikely to help most people suffering from chronic pain. The report, based on three dozen medical cannabis studies, says that although it might help some people, there’s not enough evidence for the drug to be widely recommended for those with chronic pain. In fact, researchers were quoted as saying the benefits are “quite modest,” debunking the argument that medical pot is a panacea for a variety of ills, as supporters continually claim. The guidance is important, as 36 states and Washington, D.C., have legalized medical uses of cannabis. Another problem, they noted, is that even if patients decide to try medical cannabis, there are so many products, formulations, and varieties to choose from, but no definitive information on which components are most effective at treating certain symptoms.

Meanwhile, the National Institute of Health’s 2020 Monitoring the Future Study finds that college-age adults are using marijuana more than ever before. Among college students, 44 percent reported using marijuana in 2020 compared to 38 percent in 2015. This represents the highest levels of marijuana use recorded since the 1980s. There was also a significant increase in the use of hallucinogens—including LSD and psilocybin—among college-age kids, according to the annual survey. Some good news: while pot use was thriving, college students reported significantly lower alcohol use, with 56 percent imbibing compared to 62 percent in 2019, and a decrease in binge drinking to 24 percent from 32 percent.

And finally, marijuana legalization was touted as a way to promote social equality and economic equity among populations of color who were disproportionately discriminated against during the failed war on drugs. But guess what? It isn’t working out that way. Instead of providing benefits to people of color who want to get into the cannabis industry, many Black Americans—who were four times as likely to get arrested on cannabis charges—are finding the riches out of reach. In many states, the licensing process is difficult to navigate and favors those with more access to capital, such as big weed companies.

A Wall Street Journal iinvestigation reveals that social media site TikTok serves up a continual stream of content about sex and promoting drug use—to minors. The article used a series of fake accounts linked to underage users to to examine the site’s powerful algorithms and how they quickly drive minors—among the biggest users of TikTok—to endless spools of content that often glorifies drugs and drug use. They also found that even with the site’s filters in place, videos about drugs tend to proliferate, creating what one expert called a perfect sotrm in which social media normalizes and influences the way they view drugs or other topics. With tens of thousands of videos being uploaded to the site every minute, young people are exposed to more dubious content than ever before, and it becomes extremeley difficult for moderators to screen and delete questionable content. We need stronger regulation and control of social media sites like TikTok and the content they distribute to young people.

Meanwhile, a new German study finds that e-cigarettes are a gateway to cannabis use for young people. Researchers studied students who had never used marijuana, and during that time nearly 30 percent reported using e-cigarettes at least once, and of those 17.4 percent began using marijuana. The marijuana initition rate among this group was 34.5 percent compared to 10.4 percent of those who never used e-cigarettes.

And finally, a bill pending before the California Assembly reads like a wish list of demands by the powerful cannabis industry. If approved, the bill would allow food and beverages like soda adulterated with psychoactive THC in quanitites exceeding legal cannabis edibles. It would also permit THC foods to be sold in regular food stores outside of the legal cannabis market. The expanded guidelines would also legalize hemp cigarettes and e-cigarettes, including flavored products like those the California legislature banned for tobacco in 2020.

The $4.5 billion opioid settlement with Purdue Pharma announced last week ended lengthy litigation with the OxyContin maker and secures funding over the next decade for drug abatement and treatment programs. But for many families who lost children and other loved ones in the opioid epidemic, the deal has left many families conflicted, deflated, and angry. Under the terms of the agreement, the firm’s founding Sackler family did not apologize for their role in fueling the epidemic by underplaying the addictiveness of prescription painkillers, nor will they have to give up their vast fortune to make the payouts. The family is shielded from all further opioid-related liabilities. And the families will not have an opportunity to confront the Sacklers face-to-face in court about the lives lost to opioids. Yet other families—who will receive between $3,500 and $48,000 in compensation—also realize that this was probably the best deal they could get and will avoid years of costly litigation at a time when funding for drug treatment programs is badly needed.

Meanwhile, a new study finds that adults under 45 who consume marijuana suffer from nearly double the number of heart attacks as those who do not use the drug. The study, published in the Canadian Medical Association Journal, said that whether users smoke, vape, or consume pot as an edible, there may be a significantly higher risk of having a heart attack. Researchers examined health data for more than 33,000 adults ages 18 to 44 and found that of the 17 percent who reported using cannabis, 1.3 percent later had a heart attack while only 0.8 percent of non-cannabis users reported the same. The study did not reach a conclusion about why pot has this effect, but previous research has shown it can cause an irregular heartbeat.

And finally, perhaps Amazon should have a look at this new data before it drops a requirement to test delivery drivers for marijuana use. The company says it is so short of drivers that the best way to recruit more is to advertise that they no longer screen applicants for marijuana use. This may boost applications by as much as 400 percent, as that’s the main reason why potential candidates fail, the company, which is lobbying the federal government to legalize marijuana, explains. Amazon would still test drivers for opiates and amphetamines and requires drivers to not be impaired while on the job. But if your package is late or lost, this may be the reason why.

The bankruptcy judge overseeing the Purdue Pharma opioid litigation has approved the OxyContin maker’s proposed $4.5 billion settlement, ending a years-long legal battle and opening the way for funding to flow to states for addiction treatment and compensation to victims’ families. The controversial agreement largely absolves the firm’s founding Sackler family and shields members from any liability, and as such, it will remain among the richest families in the country. In a personal note, the judge acknowledged that the settlement was “bitter” for many involved, adding that the Sacklers had never really apologized for downplaying the addictiveness of their prescription painkiller and using aggressive marketing strategies to push sales of a drug, which, along with other opioids, are linked to the deaths of more than 500,000 Americans over the past two decades.

Payments will be made to the states and the federal government over nine years, making it easier for the billionaire Sackler family to continue to make money from investments and continued sales of other Purdue drugs, although the company will be dissolved in its current form. The amount of the settlement and the long payout period has been criticized by many states, but a majority of the plaintiffs supported the plan, reasoning that it’s the best way to pay for a problem that has only worsened during the pandemic year, in which more than 93,000 died from a drug overdose. According to the agreement, more than 130,000 individuals and victims’ families will receive between $3,500 and $48,000 each, and states will receive money from a national opioid abatement trust to be distributed to local governments.

The Purdue settlement brings to a close a portion of the thousands of lawsuits against the opioid industry, including opioid manufacturers, drug distributors, and retail pharmacy chains, accused of contributing to the epidemic. A $26 billion deal is pending with the drug distributors, and other smaller settlements are also in the process of being resolved. Funding received from the litigation is welcome and will go a long way to help states and communities expand treatment and opioid-abatement programs. But it is far too little by itself when compared to the scope and scale of the massive drug crisis facing the country.

As overdose deaths due to fentanyl-laced street drugs are soaring across the country, the New York Times reports on a series of six deaths over three days along Long Island’s North Fork, a rural area about 100 miles from New York City. Police said the deaths were caused by cocaine mixed with highly lethal fentanyl, a drug more commonly mixed with heroin. The tragedy is part of a national trend, due in part to pandemic-linked drug shortages that have forced addicts to turn to substitutes like fentanyl. The dead were not hardened drug users, the article points out, but mostly recreational users seeking “a fleeting high,” that unfortunately included fentanyl, a drug so powerful that a mere speck of it can kill.

 Meanwhile, the long-running legal battle to open a safe drug injection site in Philadelphia may be decided by the Supreme Court. Hoping to clarify a series of contradictory lower court rulings, the group lobbying for the site—where users can shoot up in a safe, supervised setting—filed a petition with the Court to hear the case. Safe sites have operated for years in Europe and other countries, but are technically illegal in the U.S., and efforts to open the first American facility have failed in many cities, even as drug overdose deaths have surged due to the opioid epidemic. The latest legal move would force the Biden administration to take a stand on the issue, at a time when its drug policy appears to be shifting toward harm reduction programs including safe injection sites. Harm reduction is a critical component to save lives, but must be accompanied by drug treatment.

And finally, Colorado has unveiled a framework for distributing more than $400 million in opioid litigation settlement funds, which will go toward drug treatment and abatement programs. This could serve as a model for other states that are also in line to receive huge payouts from the opioid cases, including a share of the $26 billion settlement with drug distributors and a smaller amount from Purdue Pharma, if those agreements are eventually approved. In Colorado, most of the money will be distributed to regional health centers that are in desperate need of funding to confront the drug crisis. The plan stands in stark contrast to the way money was distributed in 1998 from tobacco companies, when funds flowed to state budgets for general purposes and not to smoking cessation initiatives.

New York Governor Kathy Hochul, in her first days in office after succeeding Andrew Cuomo, has spoken of the need to address the opioid epidemic and soaring overdose deaths. But on marijuana she has taken another approach, vowing to quickly implement the state’s stalled legal weed market without apparently addressing safety issues for the evolving cannabis industry. Legal marijuana was approved earlier this year, but Cuomo was locked in a dispute with the legislature on nominations to the cannabis regulatory board, which Hochul says she will resolve to ensure the market can get moving. So far, there’s no word from Hochul on critical issues such as amending the law to place caps on the psychoactive component THC, or extending the too-short deadline for municipalities to opt-out of allowing marijuana businesses—both critical issues to safeguard public health.

Meanwhile, pioneering legal weed state Colorado is moving to the next frontier in the marijuana market by ending its ban on public consumption of pot and allowing smoking lounges, tasing rooms, and tour busesfilled with stoned customers. Denver and Aurora would be the first cities to adopt on-site and mobile cannabis consumption, reversing a provision in the 2014 legalization law that prohibited using pot in open places. The new rules would allow pot lounges, either in brick and mortar form or on wheels. Luckily, the rules would force bus operators to put up a partition between the pot smokers and the driver, as well as install special filter systems. And the buses would not be able to stop outside schools, hospitals, or substance abuse facilities.

 And finally, a recent report finds that many hospital ERs do not address addiction, despite greater awareness of the effectiveness of addiction treatment and surging overdose deaths. ERs routinely fail to screen for substance use, offer medications to treat opioid use disorder, or connect patients to treatment or follow-up care. Now, new programs are being launched to train ER doctors, medical students, nurses, and other staff in addiction-related issues, and to help them refer patients for treatment.

New Jersey voters overwhelmingly supported marijuana legalization in a referendum last year, with nearly 68 percent saying they wanted legal weed. But as the deadline passed this week for municipalities to opt-out of allowing cannabis businesses, more than 70 percent said “no,” passing ordinances that prohibit cultivation facilities, manufacturing, wholesale distribution, and dispensaries. Only 98 localities passed ordinances allowing pot sales, but also imposed strict zoning regulations, such as limiting them to one particular redevelopment area or zone. Others prohibited dispensaries while permitting cultivation.

The decisions were based on a number of factors. Some city officials are simply opposed to legal weed, believing the drug would adversely affect children. But many also opted out simply to buy more time as the six-month window to draw up rules for a new industry was too short. Some localities said they also lacked guidance from the state cannabis regulatory commission, which has not yet issued rules and regulations to govern the new market. Municipalities, which can opt back in at any time, were under deadline pressure because failure to pass an ordinance would mean dispensaries automatically receive conditional use in a retail zone.

Invoking opt-out clauses follows a similar pattern across the country in legal weed states, where majorities in even pro-pot states such as California and Oregon have banned sales. While legalization enjoys overall popular support, there are apparently widespread misgivings at the local level about the impact of pot on vulnerable populations, and easy access to the drug. Many municipalities, therefore, chose to forego potential tax revenues from pot sales, in order to protect public health, while reserving the right to say “yes” to marijuana in the future when more robust controls are in place.

The Marshall Project reports on an ambitious project to expand access to drug treatment in prisons and jails that has failed despite tens of millions of dollars in funding. Initiated by Congress in 2018, the program was aimed at reducing soaring overdose deaths among inmates. But so far only a small fraction—less than 2 percent of the 15,000 eligible for treatment—has received it. The article blames bureaucratic inertia and resistance to medication-assisted treatment (MAT) among correctional administrators for the disappointing rollout. While hundreds of facilities now provide such services, it’s still a small number of the nation’s 3,000 jails. At the same time, overdose deaths jumped by more than 600 percent inside prisons and by more than 200 percent inside jails in the last two decades, according to federal data. In Maine, preliminary data shows a huge reduction in overdose deaths through the MAT program: people were 60 percent less likely to die of an overdose in their first year out of prison if they had participated.

Meanwhile, New Jersey’s largest needle exchange program in Atlantic City is set to close despite a surge in overdoses across the state. The city council has ordered the facility to shut down, saying that as the only place in southeast New Jersey where intravenous drug users can trade in needles, it attracts too many transient addicts. Gov. Phil Murphy is trying to block the move, and harm-reduction advocates haven’t ruled out a last-minute deal to relocate the site outside the city’s tourist district. 

And finally, an editorial in the Connecticut Post argues that opioid settlement funds should be used solely for combatting opioid addiction. As nationwide opioid litigation leads to multibillion-dollar settlement agreements, many states want to ensure that the money is not siphoned off for other purposes—as was the case with tobacco settlement funds. Connecticut’s share of the $26 billion settlement with drug distributors will total about $300 million, which could disappear quickly into the state budget, the editorial points out.

Overdose deaths from fentanyl are increasing across the country, leaving health officials scrambling to inform the public about the dangers of the powerful synthetic opioid. But a public service video released by the San Diego County Sherriff’s Department has come under criticism for providing misinformation concerning the danger of simple exposure to fentanyl powder. The video shows a deputy trainee collapsing while investigating a substance believed to be fentanyl, and then receiving the overdose reversal drug naloxone before be taken to the hospital by emergency medical workers. While the video was intended to raise awareness, medical experts say it is impossible to overdose on fentanyl simply through exposure (the drug would have to be injected or ingested to have this effect). With overdoses are on the rise in San Diego county, it is critical for officials to correctly inform the public if they want to help curb the opioid crisis.

Meanwhile, an opinion essay in the New York Times looks at the recent opioid litigation settlements and concludes that there’s more reason for hope than despair to combat the opioid epidemic. While acknowledging that the amount of money is “atrocious,” and that opioid companies are getting off easy, the writer believes the settlement will offer some relief to communities, help expand access to drug treatment, and compel the Biden administration to boost funding, for both harm-reduction programs and treatment. What is missing from this piece is an acknowledgment that harm reduction is only one component of a comprehensive drug policy or a proposal for the government to step in and close the funding gap between the settlement and Biden’s promised decade-long, $125 billion effort to confront the opioid epidemic.

And finally, for decades the U.S. tried to stop Mexican drug gangs from illegally trafficking marijuana across the border. Now, with pot legalized in California, Americans are making money transporting legal weed to Mexico, where it is still illegal. The Washington Post reports that traffickers from California load suitcases with U.S.-grown marijuana before hopping on planes to Mexico, or just walk across the pedestrian border crossing into Tiajuana, to supply a booming boutique market for American pot products. They can also be easily purchased at outlet malls near the border and brought to Mexico.