THE DAILY BRIEFING

Now that Connecticut has legalized recreational marijuana, how long will it be before the last two holdouts in New England—Rhode Island and New Hampshire—fall in line and allow legal weed? Marijuana supporters say the victory in Connecticut will grease the wheels for the final two states, believing that the lure of tax revenues and new jobs will spur legislators to take action. If Rhode Island and New Hampshire do move in that direction, they should take a page from the Connecticut law that includes much stricter guardrails and protections for public health than in many other legal states. Defying the powerful cannabis industry, lawmakers approved rules including a cap on intoxicating THC levels and an opt-out provision that allows municipalities to ban not only dispensaries but also home-delivery services.

Meanwhile, a Congressional committee has blasted the FDA for lax oversight of the vaping industry, and is urging the agency director to crackdown on e-cigarette manufacturers. The FDA is currently assessing new rules on vaping, after allowing the sale of flavored vaping products, so long as the device cannot be refilled—an approach many say contributed to a youth vaping epidemic of disposable products.

And finally, a new United Nations report finds that the number of people using drugs globally is projected to rise 11 percent by 2030, fueled by the socioeconomic and health impacts of the COVID-19 pandemic as well as easier online drug accessibility. While the number of individuals with drug use disorders has increased, the report noted, the availability of treatment interventions has remained low, with just one in eight of those suffering from drug use receiving professional help in 2019.

Connecticut became the 19th sate to legalize recreational marijuana, completing a Northeastern block of new legal weed states including New Jersey and New York. But unlike those states, Gov. Ned Lamont signed a bill that includes unusually strong public health protections, including a 30 percent limit on levels of intoxicating THC—only the second state to do so after Vermont. In addition, advertising and products designed to appeal to children are forbidden, and municipalities can invoke an opt-out provision to not only prohibit dispensaries but also delivery services, and can set limits on the number of businesses, operating hours and signage. The safeguards are generally opposed by the powerful cannabis industry, but are increasingly being recognized as necessary as states—including Colorado—assess the impact of legal marijuana on health and vulnerable populations, including young people.

Meanwhile, a new study published in JAMA finds that increased marijuana use was associated with greater risks of thoughts of suicide, suicide plan, and suicide attempt among young adults ages 18-35. The large-scale study showed that the associations remained regardless of whether someone was also experiencing depression, and the risks were greater for women than for men. Even those who used cannabis on a non-daily basis were more likely to have suicidal ideation or attempt suicide than those who did not use the drug at all.

And finally, the city of Somerville, Mass., near Boston, is considering opening the country’s first supervised drug consumption site amid a 5 percent increase in drug overdose deaths in the state. Attempts to open such facilities—which provide medical attention, clean needles and overdose reversal drugs—have already faltered in New York, San Francisco and Philadelphia due to legal complications. Safe sites in other countries have proven to be effective to reduce overdose deaths and the transmission of infectious diseases, but are unlikely to engage users in drug treatment.

As New Yorkers go to the polls today to elect a new mayor, one of the leading candidates, Eric Adams, has expressed concern about the state’s new marijuana legalization law, saying it may “send the wrong message” to young people. Although Adams supports the law and legalization, he’s worried that it implies it’s okay to smoke a joint and go to school, or operate heavy equipment. He said it’s important to let people know about the medical benefits as well as the concerns related to marijuana. Legal pot has not been a hot topic during the mayoral campaign, except during one debate in which the candidates discussed whether to allow smoking the drug in public housing.

Meanwhile, implementing marijuana legalization in New York may be delayed due to a tussle between Governor Cuomo and his critics over his nominations to the marijuana control board. Some accuse Cuomo of not being fully committed to legalization, although he negotiated and signed the bill.

And finally, doctors report that an experimental treatment for drug addiction, known as deep brain stimulation, has helped one patient stay off drugs. If successful, the treatment—which involves inserting an electronic device in the brain—may also allow scientists to better understand the root causes of addiction and reduce the stigma that it is a moral failing. Yet for all the possibilities, deep brain stimulation does not address the psychological, social and socioeconomic factors that complicate the disease, and therefore remains on the outer edge of drug addiction therapy.

On the 50th anniversary of the War on Drugs, which began under President Richard Nixon, experts are looking back on the effort and assessing the impact—concluding that locking up individuals struggling with drug addiction was largely ineffective. As the nation continues to reel from multiple drug crises—including a record 90,000 drug overdoses last year—they say the war on drugs simply didn’t work, noting that the response to drugs should be handled by doctors and therapists, not cops and prison guards. Today, roughly 20.3 million people have a substance use disorder and nearly half of the inmates in federal prisons are held on drug charges. Meanwhile, America’s streets are flooded with more potent drugs than every before, such as meth and the synthetic opioid fentanyl, as well as high-potency marijuana concentrates. Instead of punishing drug users, many states now advocate decriminalizing all drugs, which would have to be accompanied by mandatory treatment to have the most impact.

Meanwhile, a new study shows the impact of marijuana legalization: first-time cannabis use surged last year among women and Gen Z consumers. The Brightfield Group study found that 50 percent of new cannabis customers indulged in the drug five or more days per while 22 percent of are using multiple times per day. Female users skew younger and are heavier users than men, the report concluded, and nearly one-quarter of users were Gen Z (born after 1997).

And finally, as the Connecticut legislature debates marijuana legalization, a Colorado lawyer who helped to write that state’s law has warned lawmakers about the consequences, including harming children. The lawyer, Robert Corry, said legalization would create another industry like Big Tobacco that targets children and leads to abuse. He also called for tighter regulation and limits on the high levels of intoxicating component of pot, THC, which in Colorado has led to an alarming increase in the number of psychotic episodes among younger users. Colorado recently passed a revised legalization law that includes a crack down on THC levels to curb youth misuse.

There has been a steep rise last year in the number of opioid overdose deaths in Massachusetts among Black men, as the despair of the pandemic and poor health services took their toll. Latest data shows that while overall fatalities across the state increased by 5 percent in 2020, wiping out small gains over the previous years, the rate for Black men was 69 percent. Experts say that job losses, poverty, lack of housing and healthcare including for addiction were to blame for the staggering increase—part of a nationwide trend during COVID.

Meanwhile, as opioid overdose deaths rise among prisoners in Los Angeles jails, the city has begun a program to distribute the overdose reversal drug naloxone to all facilities. This is a straightforward but unusual policy, as L.A. is one of the first counties in the country to ensure the drug is widely available. So far this year the drug has been used 85 times in county jails, compared to 54 incidents in all of 2020.

And finally, although the White House has encouraged states to come up with creative ideas to promote COVID vaccinations, perhaps Washington State has gone a bit too far: it has started a “Joints for Jabs” initiative, rewarding participants who get vaccinated with a marijuana cigarette—not exactly in the interest of public health.

The marijuana legalization movement gained a powerful ally as Amazon, the nation’s second-largest private employer, endorsed ending federal-level prohibition of the drug—and also announced it will stop testing jobseekers for pot. The company says it supports a House legalization bill, boosting efforts by politicians and cannabis industry lobbyists to gain federal recognition at a time when more and more states are moving in that direction on their own. As for its drug testing policy, Amazon will no longer disqualify employees for marijuana use, but will continue to screen certain employees for “impairment” as per Department of Transportation regulations.

Meanwhile, Governor Greg Gianforte has signed into law one of the country’s strictest marijuana legalization bills, banning marijuana advertising and limiting the level of intoxicating THC in pot products. In contrast to most legal states that have overly permissive rules, Montana’s law—formulated with the help of Smart Approaches to Marijuana—will also bar industry activity in the 28 counties that voted against legalization, unless voters chose to opt-in. This added measure of control is one of the most effective ways of pushing back against Big Pot, which has tremendous influence over the drafting of industry regulations.

And finally, leading behavioral health organizations across the country have urged President Biden to finally appoint a new “drug czar” to head the White House Office of National Drug Policy Control (ONDCP).  The organizations say an all-hands-on-deck approach is required to confront national drug crises, and with drug overdose fatalities at a record high, the ONDCP needs a fully functioning director to guide and oversee federal drug policy.

The years long legal effort to hold OxyContin maker Purdue Pharma responsible for its role in the opioid epidemic is moving ahead, after a bankruptcy court judge approved a controversial plan to collectively settle the lawsuit and send it to claimants to have their say. While the judge has the right to make a final decision, more than 600,000 claimants will weigh in on a deal that many say lets Purdue—and its founding Sackler family—largely escape responsibility for causing the deaths of tends of thousands of people by falsely marketing their highly-addictive prescription painkillers. Claimants who lost relatives would receive between $3,000 and $48,000 while Purdue would contribute $4.5 billion to a national opioid abatement trust fund. The Sacklers would relinquish ownership of Purdue, but also receive blanket immunity from civil lawsuits, a provision that many claimants and states oppose.

Meanwhile, the proportion of U.S. workers who tested positive for marijuana in urine climbed higher in 2020, in parallel with more and more states legalizing the drug. Quest Diagnostics said about 2.7 percent of workers tested positive, up from 2.5 percent the year before, while the overall share of positive drug tests had leveled off.  The uptick took place amid a changing legal environment for cannabis and shifting cultural attitudes that has prompted many employers to drop drug screening altogether, in part to more easily recruit workers as the economy recovers.

And finally, a new study shows that remote prescribing of the addiction withdrawal medication buprenorphine—which was allowed for the first time during the pandemic, as a safety measure—now accounts for roughly one-third of all such prescriptions. The study also showed that just 5 percent of those who prescribed remotely, without an in-person exam, reported patient difficulties with the drug, a component of medication-assisted treatment (MAT).

President Biden has been slow to embrace cannabis policy reform as advocated by a growing number of Democratic lawmakers, due in part to his age and a family history of substance abuse. Yet a Brookings paper argues that if the Biden White House did jump into the debate, it would ultimately be in a better position to shape such reform to its liking. Instead of sitting on the sidelines, Biden would be able to dampen an overly permissive system of regulation that many progressives in the party prefer. In fact, as president, he could have a powerful role in setting the precise role of the federal government in this space, in a way that reflects his own views. For the most part, Biden favors decriminalization and letting states go their own way on legalization, but does not support ending federal-level prohibition.

Meanwhile, a JAMA research paper finds that the number of calls to poison control centers is increasing for manufactured marijuana products, and links this to cannabis legalization and the emergence of a consumer-driven marketplace for pot. The study showed that between 2017 and 2019, such calls grew from 11 percent of marijuana-related calls to 56 percent, and that calls concerning exposure to edibles most often involved kids.

And finally, fentanyl-related deaths in Santa Clara County, California, more than doubled over the past year, particularly among school-aged children and young adults, including a 12-year old girl (the median age was 26). Many of the victims thought they were taking far less potent drugs, many of which were purchased online. The increase in Santa Clara mirrors a surge in drug overdoses across the country due in large part to the pandemic.

Big candy companies are taking legal action against upstart marijuana firms that are marketing products in look-alike packaging as the famous brands, endangering children who may inadvertently ingest them. As more and more states legalize recreational cannabis without strict rules and regulations, pot products are being sold in packages that could be mistaken for well-known brands such as Skittles and Life Savers, but are actually filled with high-potency marijuana. The candy companies want to not only protect their profits, but also curb accidental ingestion, as the majority of such products are in the fast-growing cannabis edibles category. Licensed manufacturers in legal states are required to test their products for potency and to adequately label packages, but that hasn’t stopped a spike in cases: in Washington State, for example, 122 cases of exposure to THC in children under 5 were reported in 2020, compared to 85 the year before.

Meanwhile, the number of overdoses and deaths last year in the Washington, D.C., metro area, including Virginia and Maryland, rose significantly, mirroring national trends during the pandemic lockdowns. Fatalities climbed 46 percent in the District, and Virginia reported a similar increase in its deadliest year ever. Shockingly, this is happening not far from the White House, where a Biden administration has been slow to enact promised policies to combat the opioid epidemic and other drug crises.

And finally, with drug deaths climbing in Massachusetts, child welfare officials there are increasingly concerned about children who witness overdoses, find parents unresponsive, and see syringes protruding from their arms. Nearly 500 children received services last year after witnessing deadly or near-fatal incidents, which results in a type of trauma that is often overlooked in the addiction crisis.

In an unusual rebuke to Colorado’s powerful cannabis industry, lawmakers in the state have introduced legislation to limit marijuana concentrates and medical marijuana in a move to curb teen use and overconsumption of high-potency cannabis. The bill, vehemently opposed by marijuana businesses, would not cap THC levels but rather impose strict new rules on packaging in individual doses no larger than 0.1 grams. It would also limit access to medical cannabis for patients between the ages of 18 and 20 to 2 grams of concentrate per day, down from 40 grams. The proposal comes amid growing concerns about teen use of pot and an alarming spike in the number of psychotic episodes among young people, linked to high-THC pot products. Of all legal marijuana states, only Vermont has a potency cap.

Meanwhile, the town of Weed, in northern California, is trying to cash in on its name by becoming a destination for weed consumers. That makes it an outlier among the state’s smaller towns and cities, 70 percent of which have opted out of allowing marijuana dispensaries. Although most major cities in the state permit the sale of cannabis, smaller and more conservative municipalities bar the drug from being sold—a pattern repeated in many legal states that reflects a not-in-my-backyard attitude on the local level.

And finally, advertising is a powerful tool for companies selling CBD products: a new study finds that 72 percent of patients with fibromyalgia deliberately substitute CBD for conventional medications, including opioids, despite the dearth of evidence show showing that such products may be helpful. The FDA and other agencies are starting to crack down on false advertising for CBD products, as manufacturers falsely claim that what they sell can help with conditions ranging from cancer to Alzheimer’s and even COVID-19.