“According to a 2022 report from the National Academies of Sciences, Engineering, and Medicine, “on average, the number of ongoing drug shortages has been increasing and are lasting longer.” The root cause of that problem, per a report from the Food and Drug Administration, is the economics of the pharmaceutical market itself.
The reasons for shortages are generally consistent no matter the drug: either a shortage of raw materials or a problem at the plant where the drug is manufactured. Shortages for medicines that a patient can pick up at the pharmacy often draw the most headlines, but most of the medications that end up in short supply are generic, injectable drugs that are used in hospitals: usually, these drugs have only one or two suppliers. So if there is a problem at the factory of one company, there is not an easy way to scale up production to make up for a shortfall. And they are usually cheap, which means the companies that manufacture them do not have a strong economic incentive to produce any excess supply.”
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““It makes a lot of sense when you think about it from their perspective. But when you think about it from the hospital perspective, it’s very frustrating.”
Some of these shortages have led directly to patient deaths. An Associated Press report in 2011 linked at least 15 deaths over the prior 15 months to drug shortages. A more recent study, following the year-long shortage of a drug used to treat septic shock, found higher mortality rates for patients who relied on a substitute. Even short of death, drug shortages can meaningfully change the care patients get — if, for example, a pregnant person undergoes a cesarean delivery, with its higher risk of complications and longer recovery time, because the drug that could have induced labor earlier is out of stock.
Experts do have ideas about how to make the pharmaceutical supply chain more resilient. But they require action by the federal government. Until that happens, there is little reason to think the pace and duration of America’s drug shortages will slow down.”
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“These companies rely on razor-thin margins and massive scale to make their business work. They have a “just in time” production schedule, which means almost as soon as the product rolls out of the factory, it is delivered to health care providers. There aren’t warehouses with emergency stockpiles, because it wouldn’t really make financial sense for manufacturers to produce and store the excess supply.”
“Danny had chronic, searing pain from an electrocution accident years earlier. For treatment, he and Gretchen, his caretaker, traveled regularly from their home in Georgia to a pain management physician in Beverly Hills, California, to receive pharmaceutical fentanyl. But on November 1, DEA agents suspended the Beverly Hills physician’s narcotics prescribing license, having decided that he was inappropriately prescribing painkillers. A week later, Danny and Gretchen killed themselves.”
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“It was the most recent of the many dreadful outcomes that follow when cops practice medicine.”
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“The DEA has not formally charged the physician, David Bockoff, who has been practicing medicine with a spotless record in California for 53 years. He was treating many “pain refugees” like Danny: patients with chronic pain, well-managed with opioids, whose previous physicians had either closed after a DEA visit or abruptly cut off their pain medication fearing the wrath of law enforcement.”
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“Today, 38 states have laws on the books that limit the dosage and amount of pain relievers doctors can prescribe to their patients. Many of these laws have cast in stone the Centers for Disease Control and Prevention’s now-discredited 2016 Guideline for Prescribing Opioids for Chronic Pain. The guideline came under so much criticism from pharmacologists, clinicians, and academic physicians that the agency revised it this past November. No matter. The flawed 2016 guideline remains the basis of the prescribing laws in most states. Doctors face losing their licenses or, worse, jail time if they violate these laws.”
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“All 50 states maintain Prescription Drug Monitoring Programs to surveil all prescriptions issued and filled within the state. These primarily serve as law enforcement tools. In most states, police drug task forces use them to go on warrantless fishing expeditions, hoping to find a doctor to bust for “inappropriate prescribing” or a patient they can arrest for “doctor shopping.” These programs have not reduced the overdose rate. If anything, they have driven non-medical users who cannot obtain diverted prescription pain pills to more dangerous drugs in the black market, causing the overdose rate to increase.”
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“opioid-related overdose deaths reached a record high in 2021, exceeding 71,000, 89 percent of which involved illicit fentanyl. Despite a dramatic drop in opioid prescribing, deaths have soared.
According to government data, addiction to prescription pain relievers has been relatively stable at under one percent in this century. Chronic pain patients rarely become addicted to opioids. The overdose crisis is a prohibition-induced crisis. Neither the practice of medicine nor the act of self-medication belongs in the realm of the criminal legal system.”
“President Joe Biden, who recently issued a mass pardon for low-level marijuana offenders, says cannabis consumption should not be treated as a crime. His administration nevertheless defends the federal ban on gun possession by marijuana users, arguing that Second Amendment rights are limited to “law-abiding citizens.”
Last week, a federal judge agreed, dismissing a challenge to that rule by medical marijuana patients in Florida. The reasoning underlying that decision shows that the constitutional right to armed self-defense, which the Supreme Court has repeatedly upheld, is still subject to legislators’ arbitrary whims and irrational prejudices.”
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“Winsor noted a long history of banning gun ownership by people convicted of certain crimes. But as Supreme Court Justice Amy Coney Barrett pointed out in a 2019 dissent as a judge on the U.S. Court of Appeals for the 7th Circuit, that history does not suggest that any crime, or even any felony, will do.
“Legislatures have the power to prohibit dangerous people from possessing guns,” Barrett wrote. “But that power extends only to people who are dangerous.”
Are cannabis consumers dangerous? Winsor suggested that they are, accepting the Biden administration’s analogy between the gun ban for marijuana users and laws enacted in the 17th, 18th, and 19th centuries that prohibited people from either carrying or firing guns “while intoxicated.”
That analogy fails, however, because those laws did not impose general bans on gun possession by drinkers. They applied only when gun owners were under the influence.”
“it’s inaccurate to say that undocumented immigrants crossing an open border are chiefly responsible for fentanyl arriving at the country’s doors. In reality, U.S. citizens carrying the drug through legal ports of entry are primarily to blame.”
“Voters on Tuesday approved the legalization of recreational marijuana in Maryland and Missouri while rejecting similar measures in Arkansas, North Dakota, and South Dakota. Meanwhile, voters in five Texas cities passed ballot measures that bar local police from issuing citations or making arrests for low-level marijuana possession. But the most striking election result for drug policy reformers looking beyond the ongoing collapse of marijuana prohibition happened in Colorado, where a broad psychedelic decriminalization measure is winning by two points with 80 percent of votes counted.
Prior to yesterday’s elections, 37 states had approved marijuana for medical purposes, and 19 of them also had legalized recreational use. The Maryland and Missouri results raise the latter number to 21.”
“Colorado voters this week passed the broadest reform of psychedelic drug policy ever approved in the United States. With 88 percent of ballots counted as of Wednesday night, 51 percent of voters had said yes to Proposition 122, which decriminalizes noncommercial activities related to the use of “natural medicine” by adults 21 or older. That term covers five psychedelics found in plants or fungi, some or all of which will eventually be available at state-licensed “healing centers.””
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“The initiative defines “natural medicine” to include psilocybin, psilocyn (another psychoactive component of “magic mushrooms”), dimethyltryptamine (DMT, the active ingredient in ayahuasca), ibogaine (a psychedelic derived from the root bark of the iboga tree), and mescaline (the active ingredient in peyote). The covered activities include “growing, cultivating, or processing plants or fungi capable of producing natural medicine for personal use.” The initiative also eliminates civil and criminal penalties for possessing, storing, using, transporting, or obtaining the listed psychedelics or distributing them to adults 21 or older “without remuneration.””
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“The initiative notes that “natural medicines have been used safely for millennia by cultures for healing.” It adds that “an extensive and growing body of research” supports “the efficacy of natural medicines combined with psychotherapy as treatment for depression, anxiety, substance use disorders, end-of-life distress, and other conditions.” But like Oregon’s initiative, Proposition 122 does not require that clients of psychedelic centers have any particular medical or psychiatric diagnosis.”
“When California legalized recreational marijuana in 2016, the state had more than 3,000 weed shops. They ostensibly served the medical market, but the rules were so loose that pretty much anyone who wanted pot could buy it legally. Six years later, California had less than half as many licensed marijuana merchants, accounting for between a quarter and a third of total sales.
Something clearly has gone wrong “when you try to legalize weed and accidentally end up illegalizing it instead,” note University of California, Davis, economists Robin Goldstein and Daniel Sumner. In their book Can Legal Weed Win?, they explain how burdensome licensing requirements, regulations, and taxes have frustrated plans to displace the black market.”
“They looked at the effects of cannabis use in both adults and teenagers, using study participants who said they used marijuana at least once per week over the previous three months. Average use among study participants was four days per week, with some participants saying they used marijuana every day. Participants in the control group were matched for age and gender.
The major takeaway: Cannabis users were no more likely than non-users to be apathetic or anhedonic (that is, to experience a loss of interest or pleasure). Nor were more frequent cannabis users likely to be more apathetic or anhedonic than their counterparts who partook less frequently.
The researchers came to this conclusion by first having participants answer questions about their emotions and interests (for instance, rating statements such as “I would enjoy being with family or close friends” or how interested they are in learning new things). Cannabis users scored similarly to non-users on measures of apathy and motivation, and scored lower than non-users on measures of anhedonia.
Around half of participants were also asked to complete some simple tasks, with a promise of small rewards (chocolates and other sweets) for completing these tasks. Participants could accept or reject the offers, and would get points toward rewards if the task was completed. Participants were also asked to rate who much they wanted several rewards—a £1 coin, a piece of candy, or listening to part of one of their favorite songs—and asked after receiving the reward how pleasurable they found it.
“We were surprised to see that there was really very little difference between cannabis users and non-users when it came to lack of motivation or lack of enjoyment, even among those who used cannabis every day,” said Skumlien. “This is contrary to the stereotypical portrayal we see on TV and in movies.””
“Most people in California know what a disaster legalization has been. Most people know that the black market still accounts for the majority of marijuana purchases in California. Most people (especially those who live outside the big cities) are well aware of all the illegal grow operations. What this series does is provide specific examples of the dangerous environment that still exists, full of threats, violence, and even murder.”
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“There is the assumption in these stories that the breakdown in the system is due to a lack of control and enforcement by police and regulators. The stories are reluctant to address the real sources: The extent of state and local taxes drive up prices, and the ability of local officials to decide who can participate in cannabis is a huge factor in the persistence of the black market. While the stories do bring up these issues to provide some context, they really don’t contend with how much of the California black market is a result of the exorbitant costs to do business legally in the state.
Instead, the illegal grow operations and unlicensed dispensaries are presented as a failure of enforcement.”
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“The real failure here is that the state and local officials have put in so many regulatory barriers and taxes that the market cannot function properly within the boundaries of the law. Illegal grow operations flood the market with cheap goods, and licensed operations can’t compete because they have to give so much money to the government. The same holds true for dispensaries.”