“The main idea behind Measure 110 was that consuming politically disfavored intoxicants should not be treated as a crime. Since drug use itself violates no one’s rights, it is hard to argue with that premise.
Eliminating criminal penalties for drug possession, however, does not require tolerating conduct that offends, incommodes, or alarms people who have an equal right to use sidewalks, parks, and other taxpayer-funded facilities. That problem—which many major cities face, regardless of whether they routinely arrest people for drug possession—is distinct from drug use per se, just as disorderly alcohol-related conduct is distinct from drinking per se.”
“According to a 2016 systematic review, “evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms.” The authors conclude that “given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.”
One danger of jailing noncompliant drug users is that incarceration raises the risk of a fatal overdose because forced abstinence reduces tolerance. According to a 2023 study, that risk is “markedly elevated” among people recently freed from prison, especially during the first two weeks after release.”
“Two decades ago, it became clear that Congress was intent on trying to curtail illicit methamphetamine production by restricting access to pseudoephedrine, a meth precursor that was also widely used as a decongestant in cold and allergy remedies such as Sudafed. Pfizer, the manufacturer of Sudafed products, responded by announcing that it would start selling alternatives containing a different active ingredient: phenylephrine.”
“The main problem with phenylephrine: When taken orally, it is so thoroughly metabolized in the gut that almost none of it ends up in the bloodstream. “The new data appear compelling that the monographed dosage of oral [phenylephrine] results in no meaningful systemic exposure or evidence of efficacy,” says an FDA briefing document that was presented to the advisory committee. “Furthermore, the review suggests that higher doses…have also not shown efficacy. These findings are supported by in vitro and in vivo clinical pharmacology data showing that orally administered phenylephrine undergoes high first-pass metabolism resulting in less than 1% bioavailability.”
Legal restrictions on pseudoephedrine sales, in short, gave us reformulated products, including pseudo-Sudafed, that not only do not work as well but apparently do not work at all”
“Legal restrictions on pseudoephedrine, by contrast, took it off the shelves and put it behind the pharmacy counter, whence it can be retrieved only under certain conditions.”
“Restrictions on pseudoephedrine did affect the illicit methamphetamine trade, primarily by shifting production from small-scale U.S. operations toward large-scale Mexican traffickers. But by no means did that crimp the supply.”
“”If policymakers double down on the same prohibitionist policies they have employed for over 50 years, deaths from illicit drug overdoses will continue to rise. Doing the same thing repeatedly, with even more vigor this time, will not yield a different result,” Singer told lawmakers. “Prohibition makes the black market dangerous because people who buy drugs on the black market can never be sure of the drug’s purity, dosage, or even if it is the drug they think they are buying.”
Singer recommends ending drug prohibition to allow for a legal market that deals in products of known dosage and purity. A legal market won’t stop people from getting high, but it will end the escalation between punitive law enforcement on the one hand and drug innovation and potency on the other.
Short of legalization, the Arizona surgeon suggests lawmakers focus on eliminating laws that stand in the way of harm reduction, such as those that criminalize drug paraphernalia (driving users to share needles and diseases) and bar the distribution of drug test strips (rendering it difficult to identify drugs). Making naloxone available over-the-counter was a good step towards reducing deaths since it reverses the effects of opioid overdoses. That’s an approach that gets law enforcement out of the way rather than doubling down on failure.”
“The DEA is empowered by federal law to set annual production quotas for all Schedule II narcotics, including amphetamines. Once it sets the quotas, companies apply for a piece of the total and are forbidden from manufacturing more than their allotment. Despite seeing a sharp increase in prescriptions for ADHD treatment, and in spite of an FDA-reported shortage, the DEA kept the same 2022 levels for its 2023 amphetamine quotas.
Earlier this month, the FDA and DEA put out a joint statement to address the continuing shortage. The statement noted that “for amphetamine medications, in 2022, manufacturers did not produce the full amount” allowed under the quotas. While the agencies “cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug,” they nonetheless “called on manufacturers to confirm they are working to increase production to meet their allotted quota amount.”
But there’s more to the story than manufacturer supply. State and local governments sued the three largest pharmaceutical distributors and Johnson & Johnson over claims that the companies had contributed to opioid abuse and deaths. In February 2022, the companies settled for $26 billion and cracked down on potentially suspicious orders of controlled substances from independent pharmacies. As a result, many pharmacies were limited in the drugs they were able to order; some were banned altogether.”
” It’s become a stink at the U.S. Open: a pungent marijuana smell that wafted over an outer court, clouded the concentration of one of the world’s top players and left the impression there’s no place left to escape the unofficial scent of the city.
While the exact source of the smell remained a mystery Tuesday, one thing was clear: Court 17, where eighth-seeded Maria Sakkari complained about an overwhelming whiff of pot during her first-round loss, has become notorious among players in recent years for its distinctive, unmistakable odor.
“Court 17 definitely smells like Snoop Dogg’s living room,” said Alexander Zverev, the tournament’s 12th-seeded man who won his opening match on the court Tuesday. “Oh my God, it’s everywhere. The whole court smells like weed.”
Stung by stories in the wake of Sakkari’s match Monday that made it appear the U.S. Open’s stands are the sporting equivalent of a Phish concert, the United States Tennis Association conducted its own investigation, of sorts, to weed out the source of the smell.
Spokesman Chris Widmaier said the USTA questioned officials and reviewed video of the midday match and found “no evidence” anyone was smoking pot in the stands of Court 17, leading to speculation it may have come from Corona Park just outside the gates of the intimate stadium court.
And he may not be just blowing smoke. Sakkari herself suggested just that when she complained to the chair umpire while up 4-1 in the first set: “The smell, oh my gosh. I think it’s from the park.”
After her 6-4, 6-4 loss to Rebeka Masarova, Sakkari told reporters: “Sometimes you smell food, sometimes you smell cigarettes, sometimes you smell weed. I mean, it’s something we cannot control, because we’re in an open space. There’s a park behind. People can do whatever they want.”
Flushing Meadows security staffer Ricardo Rojas, who was working the gate outside Court 17 on Monday, said he took a break in the park around the time of Sakkari’s match and “there was definitely a pot smell going on.” But he noted that while he enforces a strict no-smoking policy inside the USTA’s Billie Jean King National Tennis Center, the park is “outside my jurisdiction.””
“Until 2003, Medicare covered most hospital and doctor visits for the elderly, but it did not cover the ever-growing costs of prescription medications. Former President George W. Bush changed that when he signed a law adding prescription drug coverage to Medicare.
But there was a catch.
At drug companies’ behest, the Republican-controlled Congress banned Medicare from using its market power to drive down drug prices. The prohibition was controversial at the time — Nancy Pelosi, then the House Minority Leader, called it “unconscionable.” Critics saw the prohibition as the government’s abandonment of the single most effective tool for restraining drug costs.
In the years since, the prices for brand-name prescription drugs have skyrocketed, and the prohibition on negotiation has become even more controversial. Higher prices mean larger co-payments for drugs for some seniors, many of whom live on fixed incomes. It’s also a major budgetary problem: From 2018 to 2021, Medicare spending on the 10 top-selling drugs jumped from $22 billion to $48 billion, far outpacing the program’s overall cost growth over the same period.
That’s why, in last year’s Inflation Reduction Act, President Joe Biden and congressional Democrats partly undid the prohibition. Under the law, Medicare will pay a much-reduced price for drugs that consume a disproportionate share of Medicare spending, ultimately saving an estimated $100 billion over the next ten years.”
“Although the Inflation Reduction Act marks the most substantial change in how we pay for drugs in two decades, it doesn’t change the fact that drug companies will still be rewarded for bringing a drug to market and selling as much of it as they can — whether or not the drug works very well.
Medicare could pave the way toward smarter drug development by paying more for more effective drugs and less for drugs that are less effective. That would send the right signals about where drug companies should target their research investments. The Inflation Reduction Act isn’t that law. We’ll spend less on prescription drugs because of it, and that’s all to the good, but we won’t be spending any smarter.”
“Some drugs are (literally) worth their weight in gold. Think of Sovaldi and Harvoni, which were approved a decade ago and can cure Hepatitis C, a deadly viral disease that once afflicted between 3 and 5 million Americans. Paying a lot for cures encourages drug companies to invest in developing drugs with curative potential.
But most drugs aren’t cures. Drug companies generally earn more, in fact, on drugs that patients take over an extended period. That helps explain why fully one quarter of all drug approvals are for cancer drugs. They’re really profitable, even though they often don’t work very well.”
“How we pay for drugs, in short, sends the wrong signals to the market about the kind of innovation we value. The good news is we can fix that. As law professor Rachel Sachs has argued, Medicare and Medicaid (and to some extent private insurers as well) are required by law to cover all FDA-approved drugs, whatever their value to human health. That linkage can be severed. We could give CMS the authority not only to drive down the prices of the most expensive drugs, as the IRA does, but also give it the power to pay less for, or even exclude coverage for, drugs of marginal efficacy.
Connecting payment to value would be complicated, and there’s no perfect way to do it. It would also be controversial: Paying less for some novel therapies would likely restrict access to therapies that some patients desperately want. But we’d send much smarter signals to drug manufacturers about where to target their investment dollars. And the benefits of better-targeted innovation would accumulate over time, vastly improving human health in the long run.
The IRA was meant to save the taxpayers’ money, not to improve their health. That was worth doing. But the next reform to payment policy ought to aim higher.”
“It is important to keep in mind that Oregon’s Measure 110 did nothing to address the supply of illegal drugs, which remain just as iffy and potentially deadly as they were before the initiative was approved. Decriminalization was limited to drug users, and it was based on the premise that people should not be arrested merely for consuming forbidden intoxicants. This distinction between drug users and drug suppliers is similar to the policy enacted during Prohibition, when bootleggers were treated as criminals but drinkers were not.
Measure 110 changed low-level drug possession from a Class A misdemeanor, punishable by up to a year in jail and a maximum fine of $6,250, to a Class E violation, punishable by a $100 fine. Drug users who receive citations can avoid the fine by agreeing to undergo a “health assessment” that is supposed to “prioritize the self-identified needs of the client.” That assessment might result in a treatment referral, but participation is voluntary.
Despite the limited nature of Oregon’s reform, which was not designed to reduce the hazards posed by the highly variable and unpredictable composition of black-market drugs, Stephens thinks the fact that drug-related deaths continued to rise in Oregon shows that decriminalization has failed. “In 2019 there were 280 unintentional opioid overdose deaths in Oregon,” he writes. “In 2021 there were 745.”
Stephens neglects to mention that drug-related deaths rose nationwide during that period, from about 71,000 in 2019 to more than 107,000 in 2021. The number of deaths involving opioids rose from about 50,000 to about 81,000—a 62 percent increase.
To be sure, the increase in Oregon that Stephens notes was much larger. But how does it compare to trends in other jurisdictions that did not decriminalize drug use?
Between 2019 and 2021, Oregon’s age-adjusted opioid overdose death rate rose from 7.6 to 18.1 per 100,000 residents. California saw a similar increase: from 7.9 to 17.8. In Washington, the rate likewise nearly doubled, from 10.5 to 20.5. And even in 2021, Oregon’s rate was lower than the national rate (24.7) and much lower than the rates in states such as Connecticut (38.3), Delaware (48.1), Kentucky (44.8), Maine (42.4), Maryland (38.5), Tennessee (45.5), Vermont (37.4), and West Virginia (77.2). On its face, this does not look like evidence that decriminalization is responsible for Oregon’s continuing rise in opioid-related deaths.*
While Measure 110 does not seem to have caused an increase in drug-related deaths, it manifestly did not prevent that increase.”
“a heavy drug user who steals to support his habit is not immune from criminal penalties. It also means the government can justifiably regulate what drug users do in public, where their actions might offend, incommode, or alarm people who have an equal right to use sidewalks, parks, and other taxpayer-funded facilities. Although Stephens implies otherwise, eliminating criminal penalties for drug possession does not require tolerating public drug use, defecation, or blowjobs.”
“From the perspective of drug traffickers, fentanyl has several advantages over heroin. It is much more potent, which makes it easier to smuggle, and it can be produced much more cheaply and inconspicuously, since it does not require opium poppies. Xylazine has similar advantages: It is an inexpensive synthetic drug that can be produced without crops. And unlike fentanyl, it is not classified as a controlled substance, which makes it easier to obtain.
American drug users are not clamoring for xylazine in their fentanyl, any more than they were demanding fentanyl instead of heroin. The use of such adulterants is driven by the economics of prohibition. And as usual with illegal drugs, consumers do not know what they are getting. Whether it is vitamin E acetate in black market THC vapes, MDMA mixed with butylone, levamisole in cocaine, or fentanyl pressed into ersatz pain pills, prohibition reliably makes drug use more dangerous.
Much to the dismay of veterinarians, drug warriors alarmed by tranq have proposed treating xylazine as a controlled substance. As usual, they think the solution to a problem created by prohibition is more prohibition.”