• Drug War Chronicle, Issue #1075 -- 8/12/19 - Table of Contents with Liv

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    Drug War Chronicle, Issue #1075 -- 8/12/19
    Phillip S. Smith, Editor, psmith@drcnet.org https://stopthedrugwar.org/chronicle/1075

    A Publication of StoptheDrugWar.org
    David Borden, Executive Director, borden@drcnet.org
    "Raising Awareness of the Consequences of Drug Prohibition"

    Table of Contents:

    1. WHY ARE METH- AND COCAINE-RELATED OVERDOSE DEATHS ON THE INCREASE?
    [FEATURE]
    Although overall drug overdose deaths declined last year, there were big increases in meth- and cocaine-related ODs. What's up with that? https://stopthedrugwar.org/chronicle/2019/aug/7/stimulant_overdoses_rising

    2. SEVEN NOTORIOUS PEYOTE AND MESCALINE AFICIONADOS WHO OPENED NEW DOORS
    IN HUMAN PERCEPTION [FEATURE]
    A new book provides an eye-opening look at peyote and mescaline and the
    men who did very strange things with them. https://stopthedrugwar.org/chronicle/2019/jul/31/seven_notorious_peyote_and

    3. MEDICAL MARIJUANA UPDATE
    Dispenaries are now doing business in Louisiana, a New Mexico judge
    orders the state to allow out-of-staters to participate in the medical marijuana program, and more. https://stopthedrugwar.org/chronicle/2019/aug/07/medical_marijuana_update

    4. THIS WEEK'S CORRUPT COPS STORIES
    A Florida deputy goes rogue, an Arkansas volunteer narcotics deputy uses snitches to steal stuff, a Georgia narcotics office manages to destroy
    the local dope squad, and more. https://stopthedrugwar.org/chronicle/2019/jul/31/weeks_corrupt_cops_stories

    5. THIS WEEK'S CORRUPT COPS STORIES
    A meth-stealing Oklahoma narc heads to prison, a batch of Louisiana
    prison guards get indicted in a "large-scale" drug operation at the
    Angola prison, and more. https://stopthedrugwar.org/chronicle/2019/aug/07/weeks_corrupt_cops_stories

    6. CHRONICLE AM: FED COURT ORDERS DEA TO RESPOND TO POT RESEARCH
    LAWSUIT, COLOMBIA VIOLENCE RISING, MORE... (7/31/19)
    A federal appeals court has ordered the DEA to promptly respond to a
    lawsuit over stalled medical marijuana research applications, a Florida legalization initiative passes an early milepost, a psychedelic activist
    group goes national, and more. https://stopthedrugwar.org/chronicle/2019/jul/31/chronicle_am_fed_court_orders

    7. CHRONICLE AM: DURBIN FILES MARIJUANA RESCHEDULING & RESEARCH BILL,
    DEMS SPAR ON DRUG & CRIME POLICY, MORE... (8/1/19)
    Sen. Dick Durbin (D-IL) has filed a marijuana rescheduling and research
    bill, Democratic presidential contenders spar over drug and criminal
    justice policy, and more. https://stopthedrugwar.org/chronicle/2019/aug/01/chronicle_am_durbin_files

    8. CHRONICLE AM: US & CHINA SPAR OVER FENTANYL, HONDURAN PRESIDENT NAMED TRAFFICKING CONSPIRATOR, MORE... (8/5/19)
    Federal prosecutors accuse the president of Honduras of participating in
    a drug trafficking conspiracy, the US and China squabble over fentanyl, Colombia coca production declined slightly last year, and more. https://stopthedrugwar.org/chronicle/2019/aug/05/chronicle_am_us_china_spar_over

    9. CHRONICLE AM: FLORIDA DECRIM BILL FILED, LOUISIANA MEDMJ SALES TO
    BEGIN, MORE... (8/6/19)
    A key Republican senator signals an openness to marijuana banking
    reforms, a Florida state rep files a decriminalization bill, the first shipments of medical marijuana have gone out to Louisiana dispensaries,
    and more. https://stopthedrugwar.org/chronicle/2019/aug/06/chronicle_am_florida_decrim_bill

    10. CHRONICLE AM: LUXEMBOURG SET TO BE FIRST IN EUROPE TO LEGALIZE
    MARIJUANA, HONDURAS "NARCO" PRESIDENT PROTESTS, MORE... (8/7/19)
    Luxembourg is moving to be the first European country to legalize
    marijuana, Hondurans take to the streets to protest their "narco"
    president, a New Mexico judge opens the state's medical marijuana
    program to out-of-staters, and more. https://stopthedrugwar.org/chronicle/2019/aug/07/luxembourg_legalization

    11. CHRONICLE AM: BERNIE SANDERS WOULD LEGALIZE MARIJUANA BY EXECUTIVE
    ORDER, CDC SAYS MORE NALOXONE, MORE... (8/8/19)
    That New Jersey legalization bill may yet rise from the dead, the CDC
    wants more naloxone access in rural areas, Ohio's largest city just quit prosecuting small-time pot busts, Bernie Sanders vows to use an
    executive order to federally legalize marijuana, and more. https://stopthedrugwar.org/chronicle/2019/aug/08/chronicle_am_bernie_sanders

    12. CHRONICLE AM: OUTSIDE LANDS FESTIVAL TO ALLOW POT, COLOMBIA COCAINE CONFLICTS CREATING REFUGEES, MORE... (8/9/19)
    There will be legal pot smoking at Outside Lands in San Francisco this
    weekend, the Trump administration moves forward with plans to allow drug testing of unemployment recipients, fighting over coca farms and cocaine smuggling routes in Colombia is generating large refugee flows, and more. https://stopthedrugwar.org/chronicle/2019/aug/09/chronicle_am_outside_lands

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    ================

    1. WHY ARE METH- AND COCAINE-RELATED OVERDOSE DEATHS ON THE INCREASE?
    [FEATURE] https://stopthedrugwar.org/chronicle/2019/aug/7/stimulant_overdoses_rising

    Last month, the Centers for Disease Control and Prevention (CDC)
    released provisional data (https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) indicating
    that the country's overdose crisis peaked in late 2017 and actually
    declined by 5.1 percent between then and late 2018. While that is
    long-awaited good news, it's not great news: The annual number of drug
    overdose deaths was still more than 68,000, and that number is still
    more than a third higher than in 2014, when the overdose epidemic was
    already well underway.

    The fever may have broken, but the patient is still in critical
    condition. And there is one bit of data in the CDC report that is
    definitely not good news: While overall overdose deaths finally began to decline, overdose deaths involving stimulants (https://www.cdc.gov/drugoverdose/data/otherdrugs.html) were on the
    increase. For cocaine, the death toll started rising in about 2012; for psychostimulants (overwhelmingly methamphetamine), the climb began a
    couple of years earlier.

    But the new data show a dramatic uptick in overdose deaths with
    stimulant involvement last year. Fatal overdoses where cocaine was
    mentioned were up 34 percent and those where methamphetamine was
    involved were up 37 percent. That's more than 14,000 people dying with
    cocaine in their systems and more than 10,000 dying with meth in their
    systems.

    What is driving this spike in stimulant-involved overdose deaths? Some
    of it can be attributed to rising use levels for cocaine and meth, which
    can in turn be linked to increased supplies. Meth seizures were up
    dramatically last year (https://wamu.org/story/19/07/29/seizures-of-methamphetamine-are-surging-in-the-u-s/)
    and recent DEA reports (https://www.dea.gov/sites/default/files/2018-11/DIR-032-18%202018%20NDTA%20final%20low%20resolution.pdf)
    suggest that cocaine availability has increased steadily since 2012, particularly in the south and east coast of the US. The UN Office of
    Drugs and Crime (https://www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_1_EXSUM.pdf)
    suggests that cocaine production and manufacture are at the highest
    rates ever recorded.

    "There is some research to suggest that we are seeing slightly higher
    rates of recent cocaine and methamphetamine use compared to rates of use
    just a few years ago," said Sheila Vakharia, PhD, a researcher with the
    Drug Policy Alliance (DPA). "But increased rates of use do not always
    mean increased rates of addiction or overdose. Death rates are
    influenced by a variety of factors, including age of the user, the
    amount used, and other substances used, among other things."

    They are also influenced by race, gender, and geographic location. A
    recent study looking at data from 2012 to 2015 (https://annals.org/aim/article-abstract/2665041/trends-u-s-drug-overdose-deaths-non-hispanic-black-hispanic)
    and examining race and gender trends by drug found that white men had
    the highest rates of methamphetamine-involved overdose deaths more
    generally, while black men had highest rates of cocaine-involved
    overdose deaths. These racial differences persisted for women of each
    race as well, although their overdose rates were lower than the men in
    their racial groups.

    "Methamphetamine-involved deaths are high on the West Coast and Midwest,
    while cocaine-involved deaths are high on the East Coast. We are
    actually seeing that in some Western states that methamphetamine is
    either the top drug involved in overdose deaths or among the top drugs
    included in overdose deaths," Vakharia noted.

    "Based on the latest CDC data, Nevada's overdose crisis has been driven
    by prescription opioids and methamphetamine for the past several years-
    in fact, methamphetamine has been the #1 drug involved in overdoses
    there since November 2016. Similarly, in November 2016, Oregon saw methamphetamine become the top drug involved in overdose deaths," she specified.

    "Meanwhile, the East Coast is seeing the involvement of cocaine in
    overdoses increase as well. While no eastern state has cocaine driving
    their overdose crisis, places like DC are seeing fentanyl as the top
    driver of deaths followed by cocaine. Last year, while fentanyl
    contributed to the majority of overdose deaths, there were more cocaine-involved deaths than heroin or prescription opioids," Vakharia
    added.

    It appears that it is not rising simulant use rates but the use of
    multiple substances that is largely driving the overall stimulant death
    toll upwards. A CDC report from May (https://www.cdc.gov/mmwr/volumes/68/wr/mm6817a3.htm?s_cid=mm6817a3_w)
    suggests that, from 2003 to 2017, almost three-quarters of
    cocaine-involved deaths involved an opioid while half of all
    methamphetamine involved deaths involved an opioid.

    "Those CDC numbers are based on autopsy reports," said Daniel Raymond,
    deputy director of planning and policy for the Harm Reduction Coalition
    (HRC). "In a lot of cases, there are multiple drugs involved, and just
    because an overdose involves a stimulant, it doesn't mean it was caused
    by stimulants."

    Overdose deaths caused by stimulants look different from those caused by opioids, Raymond noted: "Fatal stimulant overdoses come from strokes,
    seizures, heart attacks, and potentially overheating," he said. "It's
    not like an opioid overdose with respiratory depression," he said.

    "Some of this may be more a reflection that we still have lots of people
    dying from opioid-related overdoses, and it's just that more of them are
    also taking meth or cocaine, but the primary cause of death is the
    respiratory depression associated with opioid overdoses. In a lot of the cocaine deaths, medical examiners are finding both cocaine and opioids."

    "We are seeing that toxicology reports of people who died with
    stimulants in their systems also had fentanyl or other opioids in their system," DPA's Vakharia concurred. She then listed a number of possible explanations:

    * "This is accidental. Cross-contamination of a stimulant with an
    opioid like fentanyl could have been accidental and occurred during
    transport or packaging, and opioid-naïve stimulant users were
    accidentally exposed to opioid-contaminated stimulants."
    * "This is due to co-use of opioids and stimulants in the form of
    speedballs (with cocaine) or goofballs (with methamphetamine), where
    both are used together for the desired effect of immediately stimulating
    high, followed by the euphoria of the opioid."
    * "Stimulants are being willfully adulterated with opioids by suppliers/sellers, and stimulant users naïve to opioids are overdosing
    because they have no tolerance. (We at DPA dispute this theory, because
    it makes little sense why a seller would want to kill off a customer.)
    * "Someone might have used a stimulant and opioids at different times
    within the past few days, but their toxicology could be showing the
    recency of use."

    What Is to Be Done?

    The Drug Policy Alliance and the Harm Reduction Coalition have both
    released reports on the rise in stimulant-involved overdose deaths,
    Stimulant Use: Harm Reduction, Treatment, and Future Directions (http://www.drugpolicy.org/sites/default/files/dpa_report_stimulantharmreduction_0.pdf)
    from the former and Cocaine, Speed, and "Overdose": What Should We Be
    Doing? (https://harmreduction.org/overdose-prevention/overdose-news/opa-overamp-one/) from the latter. Raymond and Vakharia took a few minutes to address
    those topics, too.

    "There is no naloxone for stimulant overdose," Raymond pointed out. To
    reduce those overdoses "is about developing harm reduction strategies
    and outreach specifically targeting stimulant users," he said. "We spend
    so much time focusing on the opioid overdose crisis that our messages
    are oriented toward that. If we want to start a conversation, we need to
    not just tack it onto the opioid messaging. Even if you're not an opioid
    user, we want to talk about symptoms and warning signs."

    HRC has moved in that direction, said Raymond. "We did some work on
    stimulant overdoses, we talked to a lot of people who used stimulants,
    we put out a guide -- Stimulant (https://harmreduction.org/issues/overdose-prevention/overview/stimulant-overamping-basics/)"Overamping""Basics
    -- and went with the terms people used. Using 'overamping' opened a
    space for conversation for people who didn't identify as heroin users.
    If you talk overamping instead of overdosing, stimulant users have had
    that experience of using too much. Part of it is really just listening
    to the people who use the drugs. In harm reduction, we learn from the
    people we work with."

    "People who use stimulants need access to sterile equipment beyond
    syringes, since many stimulant users smoke, so we are talking about
    sterile smoking equipment like pipes and filters," Vakharia said. "We
    need to teach users how to stay safe while using -- make sure to take
    breaks for hydration and to eat, get enough rest. It is easy to lose
    track of time when you've been up for days and when you have no
    appetite. This also puts undue stress on your heart and can exacerbate
    health issues," she noted.

    "For many people, we should also talk about distributing safer sex
    supplies, because many people engage in risky sexual practices while
    they are using," Vakharia continued. "We also need to educate users on
    the risks associated with mixing different classes of drugs and the
    impact it can have on your body, knowing your limits, keeping naloxone
    on hand in case you are using opioids too, and not using alone."

    It's not just harm reduction that's needed, though. Other policy
    prescriptions could help reduce the toll.

    "Medicaid expansion and policies to increase access to basic health care
    and mental health care, as well as substance use treatment can greatly
    improve the health and well-being of people who use all drugs," Vakharia
    said. "And whether opioids are a person's primary drug or not, expanding
    access to naloxone helps anyone who is using them. Similarly, expanding
    Good Samaritan laws that reduce barriers to calling 911 can only help."

    And then there's not treating drug uses like criminals.

    "Decriminalizing drugs and paraphernalia would be a huge step forward,"
    said Vakharia. "We know that contact with the criminal justice system
    increases harms and also presents barriers to going into recovery, which impacts job prospects, the ability to find work, and things like that."

    "Drug decriminalization is crucial," said Raymond. "Criminalization just
    makes everything worse. It makes people more fearful of seeking help,
    and ends up locking so many people up in ways such that when they leave
    jail or prison, they're even more vulnerable. All of our work in harm
    reduction takes place in this context of mass criminalization. That
    keeps us swimming against the tide."

    This article was produced by Drug Reporter (https://independentmediainstitute.org/drug-reporter/), a project of the Independent Media Institute.

    The Drug Policy Alliance is a funder of both Drug Reporter and Drug War Chronicle.
    ================ ...
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