THE DAILY BRIEFING

More damaging testimony is emerging at the federal opioid trial in West Virginia, including emails from executives at one of the drug distributors in the lawsuit mocking local people for consuming their firm’s additive prescription painkillers. The emails included parody songs denigrating Appalachians as “pillbillies” living in “OxyContinville” at a time when the opioid epidemic was ensnaring thousands of people in addiction and overdose deaths. The Big Three distributors shipped nearly 109 million pills to just one county in the state from 2006 to 2014, with one pharmacy in the state averaging 35,000 OxyContin doses a month. The companies are accused of failing to provide adequate legally required oversight of drug shipments.

Meanwhile, for the first time in 50 years, the U.S. Drug Enforcement Agency (DEA) has approved new licenses for companies that grow medical marijuana for research. The move, after years of delay, allows researchers to study marijuana from different growers to see if different varieties can be effective in alleviating pain, fighting seizures, and combating both depression and PTSD—among the many conditions medical pot might be effective. The approvals are important as more states legalize medical cannabis and add conditions for which the drug can be prescribed.

And finally, a new program in New Jersey is proving beneficial to parolees fighting drug addiction and at risk of opioid overdose. The program—called Swift, Certain and Fair—pairs parolees with a social worker and a peer recovery specialist, to ensure they receive services and support once they are out of prison, helping them to stay clean and sober during the difficult transition from incarceration.

After years of slow and steady decline, drug overdose deaths last year in Massachusetts increased 5 percent, as the stress and isolation of the COVID-19 pandemic took its tool and treatment providers curtailed services. Even more troubling, overdose fatalities surged 69 percent among Black men, while the rate among Hispanic men remained the highest. The setback reflects broader trends across the country, and a spike in nationwide drug-related deaths to a record 90,000—a nearly 30 percent increase over the year before. The easing of pandemic restrictions isn’t expected to impact the death rate, with overdoses already rising two percent in Massachusetts in the first quarter of 2021.

Meanwhile, at the first opioid trial taking place in West Virginia, the prosecution presented evidence showing that the big three drug distributors facing charges flooded one county in the state with 109.8 million doses of prescription opiates between 2006 and 2014, or about 122 per person annually, mostly to Veterans Affairs clinics. The distributors—along with opioid manufacturers and retail pharmacies—are facing thousands of lawsuits alleging that their actions fueled the nationwide opioid epidemic.

And finally, recent Hollywood films are looking at the experience of grief by families dealing with addiction. But according to the New York Times Magazine, they often get it wrong. The films portray the struggle addicts face, but reduces a complex illness into something like a sports movie or boxing match, with a clear winner and loser and a goal to conquer. But, as the writer points out, addiction does not follow a defined dramatic arc. It is a repetitive, years-long process of trial and error, sometimes ending with a cathartic breakthrough and recovery.

The nationwide opioid epidemic is the subject of a new HBO documentary, Crime of the Century, which explores the roots of the crisis, the role of the opioid maker Purdue Pharma, and the heartbreaking human toll it has taken over the past two decades. The film is a timely reminder of how Purdue bribed its way into billions of dollars of profit while leaving death and destruction behind. With overdose fatalities surging last year to a record 90,000, the majority opioid-related, we see the origins of the national tragedy and how Purdue deceived doctors and patients into believing that OxyContin was not addictive, and pushed the product to every corner of the country even as the death toll soared.

Meanwhile, as nationwide opioid litigation against Purdue and other companies continues, 24 states are trying to block a proposed $4.2 billion bankruptcy settlement with the firm, saying it would provide immunity from prosecution for the founding Sackler family. Calling the deal unprecedented, unethical and unjust, opponents argue that it would shield the family from further scrutiny and enable it to avoid liability for the deaths of hundreds of thousands of Americans.

And finally, an editorial in the Washington Post urges the Biden administration to turn its attention to the opioid epidemic, noting that it is getting worse due to the isolation and hardships brought on by COVID-19. And as the Rosenthal Center has urged, the paper says Biden should make good on a campaign promise to commit $125 billion over the next decade to combat this national crisis.

Psychedelics drugs such as psilocybin and MDMA are on the cusp of becoming mainstream treatment options in psychiatry, according to the New York Times. After years of demonization and criminalization, such drugs are attracting attention from researchers, universities, therapists and lawmakers—and of course Wall Street—which sees a potential booming market. This will have profound implications for psychiatry, as classic psychedelics including LSD have shown early potential to treat conditions such as depression and PTSD. But amid the drive to commercialize and legalize the drugs, many worry that more research is needed on possible side effects, as well as stringent oversight and regulations if such treatments become more available.

Meanwhile, the Wall Street Journalreports that millions of dollars are flowing to “platoons” of cannabis lobbyists, banks and new marijuana trade organizations in an attempt to shape the future of the industry. As more states legalize pot—there are now 17, plus the District of Columbia—and Congress considers loosening federal-level laws and banking restrictions, the lobbyists are influencing the ground rules for this emerging market. They include corporations, union advocates, personal-use supporters and social-justice activists, reflecting the industry’s widening base even as some of the groups have differing goals.

And finally, conservative states are lining up to legalize medical marijuana. Such bills are pending in Republican-controlled legislatures in North Carolina, Alabama and Kansas for the first time, even though clinical studies have yet to establish that medical pot is indeed effective for many conditions supporters claim it helps.

With drug overdose deaths soaring in Colorado, a new program has been launched to supply at-risk patients with the overdose reversal medication naloxone when they are discharged from hospitals. Hospitals in the Colorado Naloxone Project will distribute the drug to patients who were admitted for overdose, rather than prescribing the drug when they leave, because only 5 percent of those individuals eventually fill those prescriptions. The initiative comes as a “third wave” of the opioid epidemic hits Colorado, driven by an alarming surge in fentanyl illegally produced in Mexico and trafficked to the U.S., which pushed the death rate up 524 percent between 2018 and 2020.

Meanwhile, the FDA has approved a new high dose version of naloxone, which is double the potency of current versions. Experts and patient advocates say the higher dosage, to be sold over the counter in pharmacies, is needed because lower-dose versions sometimes must be given multiple times to keep the patient alive until medical help arrives.

And finally, it looks like the East End of Long Island may be emerging as a bastion of anti-marijuana forces. Since New York legalized the drug last month, many towns and villages in the area say they want to ban pot sales using the law’s opt-out provision. With a state-imposed deadline of December 31, debate is growing about whether to allow dispensaries to operate, with supporters of a ban arguing that easier access to weed would adversely effect the health of communities and make the roads less safe due to impaired driving. Even with a ban, however, the state has sanctioned home-delivery services, which would be allowed to operate despite the opt-out provision.

As more and more states legalize marijuana, cannabis companies are coming under pressure to limit the strength of their products amid growing concerns about the public health consequences. The steadily rising levels of THC—the intoxicating component of pot—in such products has led to an alarming spike in cases of psychotic episodes among young people, and can impair brain development, studies show. Lawmakers in legal marijuana states including Colorado and Washington are now calling for limits on THC and closer scrutiny of marijuana businesses and what they sell. Supporters say this will protect consumers, especially kids and young adults. But the $20 billion cannabis industry is vehemently fighting back any attempt to impose THC curbs, even as marijuana concentrates often have potency levels of up to 80 percent or more (Vermont is the only state with such limits, while New York has a higher tax).

Meanwhile, New York City cab drivers will no longer be tested for cannabis, now that the state has legalized marijuana. It’s still illegal to drive while high, but the lack of a testing requirement means any driver can smoke weed and get behind the wheel.

And finally, a new study shows promising results for using psychedelic drugs such as MDMA to treat PTSD. The illegal drug, known as Ecstasy, was shown to bring relief to those suffering from PTSD when paired with talk therapy. Mental health experts say the research could pave the way for further studies into the potential of MDMA and similar drugs to treat a wide range of conditions—including substance abuse, depression and social anxiety in autistic adults.

For decades, West Virginia has been ground zero for the opioid epidemic, as the opioid industry flooded the state with tens of millions of prescription painkillers that fueled overdose deaths and devastated families and communities. Now, the first federal trial among thousands of lawsuits in nationwide opioid litigation gets underway in Huntington County, West Virginia, which will test various legal theories that underpin the cases—and possibly lay the groundwork for settlements in other jurisdictions. The trial will see three of the country’s largest drug distributors—McKesson, AmerisourceBergen, and Cardinal Health—accused of allowing pills to flood into pharmacies largely unchecked. One county, for example, received more than 81 million prescription painkillers, or 91 pills per person per year.

As a result, the state had the highest per-capital death rate from opioid overdoses in 2018, and 5 percent of West Virginia babies are born to mothers using opioids. The companies say there were too many steps between them and the opioid user to be held legally responsible for misuse, addiction and deaths. Over the past two decades, more than 400,000 Americans have died of opioid-related drug overdose, and millions more became addicted, setting the stage for the wave of lawsuits that also accuse opioid manufacturers and retail pharmacies of being responsible for the crisis. The West Virginia case goes ahead even as settlement talks continue in other jurisdictions with drug distributors, and opioid makers including Purdue Pharma, amid disputes between the companies and states’ attorneys general over the terms of the deal.

Canada legalized marijuana in 2018 amid much fanfare and projections of a booming market for weed—but the reality has been quite different. In fact, most of those sunny forecasts have failed to materialize, with many companies reporting staggering losses and going under. Analysts blame the poor performance on the country’s tightly regulated distribution system—sales are mostly through government-runs stores—along with a ban on weed advertising and marketing, unlike in legalized states in the U.S., where promoting pot is an essential part of the business to influence consumers.

Meanwhile, Wall Street financiers are high on startups looking into the potential of psychedelics to treat mental illnesses. Until recently, this sector barely existed. But today, venture funding is flowing into companies banking on psychedelic medicines to treat conditions such as depression, anxiety and addiction. While a growing body of research illustrates the possibilities of psychedelics, obstacles include worries about the mind-altering side effects of such drugs.

And finally, a new study finds that long-haul COVID survivors are at risk from a separate epidemic of opioid addiction, given the high rates of painkillers being prescribed to these patients. The study, at Veterans Health facilities, showed an alarmingly high rate of opioid use among COVID survivors with lingering symptoms, and warned about the frequent use of opioids for coronavirus patients.

President Biden is coming under growing pressure to take decisive action on national drug crises, as the overdose death toll surged to nearly 88,000 in 2020—a record number and a 29 percent increase over the year before—erasing modest progress over the past few years. Biden, who promised to combat the opioid epidemic during the campaign, has been slow to commit resources to a rigorous anti-drug effort and to fill out his drug policy staff, including the “drug czar” to oversee and coordinate policies and programs. In a letter to the White House, dozens of organizations in the addiction field—including Treatment Communities of America—called on the administration to “act with urgency” on the ongoing addiction crisis. This includes expanding access to the life-saving withdrawal medication buprenorphine, which currently requires that physicians have special training to prescribe it.

The president must also commit more funding to drug treatment, as the American Rescue Plan allocates only $1.5 billion for this purpose—compared to the $125 billion over the next decade Biden had proposed. New CDC data confirms that the epidemic, once found largely among white Americans in rural and suburban areas, now impacts Blacks disproportionately. What’s more, dealers are lacing non-opioids such as meth and cocaine with opioids—including fentanyl and heroin—thereby significantly increasing the risk of overdose.