THE DAILY BRIEFING

More than a month into President Biden’s administration, concern is growing that he is not moving quickly enough to launch a major initiative to combat the opioid epidemic and address the national crisis of drug addiction. Although critics understand that he is focused on COVID-19 and other priorities, they believe the time is slipping away for him to take action—and that the longer the president waits, the more difficult it may be launch a more aggressive strategy. As a result, addiction could end up being the major issue that gets left behind, at a time when overdose deaths are worse than ever: more than 86,000 fatalities were reported for the 12-month period ending in July—the highest ever recorded in a one year period—and could rise to over 100,000 for all of 2020. During the campaign, Biden promised a $125 billion program over the next decade to confront the opioid crisis by expanding treatment, education, prevention and professional training for addiction personnel.

Reforms currently on the table include billions of new dollars for recovery services, deregulation of addiction treatment medications, making permanent many of the 2020’s emergency teleheatlh allowances, and scaling up harm-reduction programs such as needle exchanges. Without a White House plan, however, lawmakers are considering piecemeal legislation to accomplish those goals, which may not be as large or effective as a comprehensive approach. Now is the time for President Biden to lead on this issue, and to include the drug crisis as a national priority.

The Denver Post editorial board is taking a strong stand backing curbs on marijuana products with high levels of THC—the psychoactive component that gets you high—after Colorado doctors report an alarming spike in patients suffering psychosis, especially in young people. Colorado has been a pioneer in pot legalization, but it’s only now that officials are becoming aware of its dangers, citing research studies in prominent medical journals showing that marijuana with THC levels of up to 90 percent poses a “substantial risk” to mental health. And, that it’s relatively easy for teens in the state to purchase the maximum allowable amount of such concentrates. The paper isn’t calling for the re-criminalization of marijuana, but for “shutting down the pipeline to our schools” as essential for public health and safety and protecting teens—all the more reason for states considering legalization to impose a temporary pause, until we can fully assess the impact on consumers.

Meanwhile, the Biden White House says it will allow people to apply for jobs in the administration if they have used marijuana recreationally—that is, if they agree not to use while working and submit to drug screenings. The White House wants to open up the pool of possible applications, especially young people, a spokesman said, which might be difficult for some without a waiver dismissing prior pot use.

And finally, Texas is not a legal marijuana state, but that isn’t stopping enterprising businesses from selling a new type of hemp-derived product—called Delta 8—that gets you high but doesn’t circumvent current laws. Hemp is legal, and the new product is an example of how industrious entrepreneurs are creating myriad new offerings with different marketing angles, using the country’s fractured laws on recreational pot.

The head of consulting giant McKinsey was ousted from his position after coming under fire for his handling of the firm’s $573 million settlement of claims related to the firm’s work for opioid maker Purdue Pharma. The executive, Kevin Sneader, had apologized for the company’s behavior, saying McKinsey fell short of its standards and did not acknowledge the unfolding opioid epidemic and the its terrible impact—and that did not sit well with executives who wanted Sneader to fight back rather than settle. McKinsey was facing criminal penalties for advising Purdue on ways to boost marketing of its highly addictive prescription painkillers that helped fueled the opioid crisis.

Meanwhile, a new study finds that use of methamphetamine and fentanyl surged during the COVID-19 pandemic, especially in the Pacific region, and coincided with an increase in synthetic-opioid related deaths. The U.S. had the highest level of drug overdose deaths ever recorded for the 12-month period ending June 2020. And finally, not everyone is backing the rush to legalize marijuana in Connecticut: the state’s Police Chiefs Association says the move would lead to more driving under the influence arrests and underage marijuana use. The cops note that there is no definitive roadside test to determine whether a driver is under the influence of marijuana.

Opposition continues to grow to one of the leading contenders to run the Food and Drug Administration, Dr. Janet Woodcock, because of her role at the agency at a time when the opioid epidemic took off. Woodcock, currently interim chair of the agency, served as the FDA’s “top drug cop” and under her rule approved highly addictive prescription opioids without adequate warning labels, that later fueled a surge in opioid-related overdose deaths—more than 450,000 over the past two decades. Many criticize that lack of oversight as the “worst regulatory agency failure in American history.”

Now an array of groups including physicians, public health and patient-advocacy organizations are lining up to oppose Woodcock’s nomination. They cite many egregious errors during Woodcock’s time, including the approval in 2015 to use OxyContin in patients as young as 11 years old, and in 2018, approval of a fentanyl analogue that’s 1,000 times more potent than morphine—even though one of the FDA’s own advisory chairs predicted that the drug would lead to more abuse and death. There are many excellent candidates to run the FDA and they should be considered, as the nation confronts a record level of drug overdose deaths.

Meanwhile, the cannabis industry is under pressure to address the issue of teenage pot use, as a number of studies point to increased consumption in states where marijuana is legal. One survey in California found that respondents were 23 percent more likely to have used marijuana since legalization in 2015; another study in Colorado also pointed increased use among teens. As a result, discussion is growing in Colorado and elsewhere on possible curbs on high-potency cannabis, which has been linked to psychotic disorders. Of course, this is happening only after marijuana has been legalized, which is why we urge politicians and lawmakers in states with legal pot on the agenda to consider a moratorium until we know more about the public health impact of the drug.

President Biden’s nominee for attorney general, Merrick Garland, says the Justice Department would take a hands-off approach when it comes to cannabis enforcement, adding that it’s not “useful” for states with legal marijuana to pursue prosecutions. Speaking during his nomination hearings, Garland also noted that marijuana enforcement as practiced now is a perfect example of how the criminal justice system is racially biased and disproportionately impacts communities of color. Garland’s hearing is the first indication of what the Biden administration’s policies would be concerning marijuana, and comes at a time when there is growing congressional support for federal-level legalization of the drug—a move that President Biden has so far resisted.

Meanwhile, New Jersey becomes the 14th state nationwide to legalize adult-use recreational marijuana, and a major player in the Northeast market where several neighboring states—including New York and Connecticut—are also pushing for cannabis reform. Sales in New Jersey are legal for adults 21 and older, but penalties for underage possession were watered down amid opposition from pro-pot advocates. Northeast governors say legalization will help boost economies hurt by the COVID-19 pandemic, although marijuana sales forecasts suggest revenue will not be significant for many years.

And finally, a preliminary study by Brown University finds that the use of telemedicine improved the therapeutic relationship with patients being treated for opioid use disorder. The small study, in Rhode Island, shows that both patients and counselors were satisfied with telephone counseling and wanted to continue it after the pandemic. On-site drug treatment has been severely curtailed during coronavirus lockdowns, forcing providers to use remote methods that are regarded as helpful for many with substance use disorder but should not be a replacement for in-person treatment.

One month into his presidency, President Biden has yet to directly address the drug crisis as the COVID-19 pandemic rightly takes center stage. But that hasn’t stopped the White House Office of National Drug Control Policy from outlining the administration’s drug policy priorities. In twitter messages, ONDCP said President Biden would pursue responses “rooted in science and evidence to bend the curve” of the epidemic, with a focus on treatment, prevention, harm reduction, expanding the addiction workforce and reducing the supply of substances. “With more than 200 overdoses a day, there’s no time to waste,” ONDCP concluded. Biden has also been slow to appoint a new chief of the Food and Drug Administration, a sprawling nearly $6 billion agency that oversees everything from prescription drugs to tobacco products and e-cigarettes. Holding up an appointment is growing pushback against one top candidate, Dr. Janet Woodcock, the acting commissioner who ran an FDA department that authorizes medications. The FDA has been criticized for inadequate handling of opioid drug approvals and monitoring that many say contributed to the opioid epidemic.

And finally, New Jersey Governor Phil Murphy has signed the law enacting marijuana legalization after a stalemate over provisions for underage use led to a months-long delay. Originally, low-level use and possession by anyone under 21 would have been subject to criminal penalties, fines and mandatory treatment; after protests, this was watered down to a 3-tier “warning system” that includes notifying parents and referral to community services.

President Biden has repeated his policy goal of decriminalizing illegal drugs and diverting funds no longer needed for law enforcement for rehabilitation. Speaking at a town hall meeting, Biden said that “nobody should be imprisoned for using an illegal drug,” reinforcing statements made during the campaign that the decades-long “war on drugs” had essentially failed to stop the drug crisis and the ongoing high level of drug overdose fatalities. Biden has promised a massive $125 billion program over the next decade to combat the opioid epidemic, with a focus on expanding treatment, education and prevention.

Meanwhile, life expectancy in the U.S. dropped by one full year during the first half of 2020, due largely to the COVID-19 pandemic but also because of the surge in overdose deaths to more than 83,000 in the 12-month period ending last June—a 20 percent increase over the previous year and the highest number of fatal overdoses every recorded in the country in a single year.

And finally, Governor Tom Wolf of Pennsylvania is all-in for legalizing marijuana this year, claiming that profits from pot sales would help the state recover from the COVID-related economic downturn. He said the money would go to help historically disadvantaged businesses owned by people of color and communities harmed by marijuana criminalization, but he did not forecast how much money would be generated and when the state might get it. Legalization in Pennsylvania would create a sold block of Northeast states with easier access to pot, as New York and Connecticut are also considering cannabis reform and New Jersey will soon implement its legalization bill.

New York Governor Andrew Cuomo, under pressure to water down his marijuana legalization proposal, has revised the bill to allow delivery services and lower the criminal penalties for selling pot to a minor. As he tries to appease critics who claimed that the original version contained too many restrictions, Cuomo would permit delivery operations for consumers who can’t make it to a dispensary, while at the same time, maintaining a community opt-out provision to bar cannabis deliveries. Perhaps more troubling, Cuomo caved on penalties for selling weed to anyone under age 21, reducing the charge from a felony to a misdemeanor, saying the change would accelerate criminal justice reform. It’s not clear, however, if this will be enough to win passage—his third attempt to do so—at a time when neighboring states, including New Jersey, are moving ahead with legalization.

Meanwhile, another supposed benefit of legalization is to promote entrepreneurship in the cannabis industry for communities of color that were harmed during the failed “war on drugs.” Yet a new study in Nevada found that it’s not working out that way: marijuana business owners and board members are disproportionately white and male, while the industry workforce is more equitably spread among the state’s demographic groups.

And finally, the debate over whether to make it easier for physicians to prescribe the addiction-withdrawal medication buprenorphine is continuing, with some addiction treatment providers saying they favor maintaining the current licensing arrangement. They argue that the regulation—overturned by former President Trump, but then reinstated by President Biden as it undergoes review—ensures quality treatment, protects patients, and is also likely to reduce illegal reselling of pills. Currently, less than 7 percent of physicians are licensed to prescribe the medication; loosening the rule would widen that to almost all doctors. Less than 20 percent of the 1.8 million Americans with opioid use disorder receive any addiction medications.

New CDC data confirms that the U.S. is facing a drug crisis of unprecedented proportions, as overdose fatalities surge to the highest level ever recorded in a single year—more than 81,000 deaths in the 12-month period ending last June. The 20 percent increase reflects the overlapping health crises of COVID-19 and a pre-existing opioid epidemic, which have strained cash-strapped healthcare systems and addiction treatment providers that have been forced to curtail services. Public health officials are heavily focused on combating the coronavirus, while substance abuse has largely fallen off the radar, at a time when the isolation, stress and economic upheaval of the pandemic—all triggers for addiction and relapse—are increasing.

Meanwhile, just as Oregon enacts its groundbreaking law to decriminalize low-level drug possession to focus instead on treatment, lawmakers in neighboring Washington State are moving in the same direction. A similar bill has been introduced in the legislature, but apparently without any provision to mandate treatment—a fatal flaw also enshrined in the Oregon measure.

And finally, for the first time there is hard evidence that marijuana legalization can lead to an increase in driving while high. Officials in Colorado say a new tracking system shows that 47 percent of drivers are testing positive for marijuana followed by amphetamines and cocaine, and there has been a subsequent 48 percent uptick in DUI arrests involving pot in the last year. What’s more, the number of marijuana-impaired drivers involved in deadly crashes has risen every year between 2017 and 2019— a tragic fact that states pushing to legalize pot should consider.