The Daily Briefing 6.10.2020

The impact of the coronavirus pandemic and lockdown on mental health—including an greater risk of suicide, alcoholism and substance abuse disorder (SUD)—continues to make news. A new report from the Meadows Mental Health Policy Institute points to the link between unemployment and substance abuse, noting that an estimated 10 percent of unemployed adults have a SUD involving an illicit drug, including opioid use, compared to a 3 percent rate for employed adults. In addition, the report says that estimates for the impact of Covid-19 on mental health could be conservative, due to the extreme isolation, fear, psychological distress and job losses it has caused.

Meanwhile, the race for the Democratic Party’s Senate nomination in Massachusetts between Sen. Ed Markey and Rep. Joe Kennedy is heating up over the issue of marijuana legalization. In the not too distant past, both candidates generally opposed legal weed—but now both tout their pro-pot credentials. In a recent debate, each candidate made the case they were quicker than the other to evolve from staunch prohibitionist to endorsing adult-use legalization. For his part, Kennedy noted that his past opposition was related to concerns about youth and adolescent exposure to marijuana, while today he is focusing on the issue of criminal justice reform.

And finally, a federal task force is for the first time recommending regular screening of all adults over 18 for illicit drug use. The new guidance was issued after the U.S. Preventive Services Task Force concluded that there is now sufficient evidence to suggest regular screening, and that testing tools were highly accurate in identifying unhealthy drug use.

The Daily Briefing 6.9.2020

The coronavirus pandemic has stretched hospitals and staff to the limit as they care for a massive influx of patients, including those with symptoms that require ventilators. And with that surge has come exploding demand for injectable opioid painkillers that are used to sedate patients with severe distress in order to complete intubation.

Yet the structure of the opioid market has made it extremely difficult for many hospitals to find these drugs—largely due to the opioid epidemic. Instead of focusing on low-margin injectable opioids for hospital use, pharmaceutical firms have instead catered to more lucrative, high-profit opioid pills, thereby helping fuel the opioid crisis and overdose deaths.

Another issue is the old, and fragile supply chain for injectables compared to the more reliable production and distribution of painkiller pills. As hospitals put in place strategies to cope with future pandemics, it’s time to close the gap between these two applications of the drug to ensure healthcare facilities are always prepared.

And finally, the legalization of medical marijuana has led to numerous theories about its effectiveness treating an assortment  of diseases, including Parkinson’s. But a recent analysis of existing research found that pot doesn’t do much for these patients. In fact, many of the typical side effects of marijuana can exacerbate symptoms of Parkinson’s such as diminished balance and sudden drops in blood pressure, which can be especially dangerous. Pot also amplifies muddy thinking and hallucinations, the report concluded.

The Daily Briefing 6.8.2020

One of the most effective ways to fight the ongoing opioid epidemic is medication-assisted treatment, MAT, a strategy that combines withdrawal medications to reduce cravings with behavioral therapy and social support including peer-based counseling. Yet while MAT has been shown to cut the risk of fatal overdose by as much as 50 percent, only a fraction of the 2 million Americans estimated to have an opioid-use disorder receive such therapy—mainly because not enough doctors are authorized to use it. 

In fact, 40 percent of U.S. counties still have no clinicians permitted to prescribe one of the drugs, buprenorphine, which requires a doctor to take an eight-hour training course. Only one in 10 of the nation’s physicians have done so, even though around 68,000 Americans die every year from drug overdose, the majority opioid-related. To close the treatment gap—especially in rural areas of the country—some advocates propose requiring all medical residents to receive training in treating addiction, in order to integrate treatment into clinical practice.

In addition, they suggest easing the rules for nurse practitioners and physician assistants to prescribe withdrawal medications (they can currently do so but only with a physician’s supervision). All of these proposals warrant close study as we continue to address a national opioid crisis that has killed more than 400,000 over the past two decades.

The Daily Briefing 6.5.2020

More people are taking anti-anxiety medications and antidepressants during the pandemic lockdown, raising fears of long-term addiction and substance abuse of these drugs. The stress, worry and anxiety over becoming infected, as well as fears about jobs, money and economic hardships, are impacting mental health and fueling a spike in prescriptions for these ailments.

Prescriptions for anti-anxiety med rose 10.2 percent in March, while prescriptions for antidepressants increased by 9.2 percent. Some companies have reported even bigger rises: Express Scripts said prescriptions for anti-anxiety drugs rose 34 percent between mid-February and mid-March. Mental health professionals say the increase is worrying, as people can develop a psychological dependence on these drugs that might continue after the lockdown eases.

Meanwhile, as Massachusetts resumes recreational marijuana sales—including more convenient curbside pickup to reduce the spread of corona virus—the state’s cannabis commission has made a very sensible ruling that kids can’t be in the car when the transaction takes place. That would violate the law prohibiting anyone under 21 from being on the premises of a marijuana store, while also raising serious public health concerns.

And finally, Mexican police announced a major drug haul in the border city of Tijuana. The cache included two tons of meth, 8 tons of pot and 131,000 pills containing the powerful synthetic opioid fentanyl. Police said the drugs appeared to be destined for the United States

The Daily Briefing 6.4.2020

The legal landscape surrounding marijuana continues to shift as cities, states and the federal government adapt to ongoing legalization of the drug and its impact on society. In New York City, for example, a new lawthat took effect in May prohibits employers from requiring prospective employees to submit to a drug test for THC, the psychoactive component of marijuana.

The law describes such background testing as an “unlawful discriminatory practice,” but wisely makes exceptions for continuing testing for jobs in law enforcement, childcare and any position requiring a driver’s license. Meanwhile, a recently submitted House bill takes up the issue of impaired driving while under the influence of marijuana, which is emerging as a problem in states where pot is legal.

The bill, introduced by Democratic leaders in Congress, requires legal marijuana states to promote education about the dangers of driving while under the influence of the drug and programs to curb such behavior, to reduce injuries and deaths. A 2019 CDC report found that 12 million Americans said they had driven under the influence of weed in 2018, and urged public health officials to develop standards and toxicology tests for drivers who are high on pot, which do not yet exist.

And finally, doctors are prescribing fewer opioid painkillers to injured workers than they were years ago, according to a workers’ compensation study. Instead of highly addictive opioids, physicians are turning to  non-addictive painkillers, alternative therapies including exercise and massage—or no meds at all. The decline is the result of efforts to curb overprescribing, one of the main drivers of the opioid epidemic. Despite the decrease, however, the report noted that opioids are still the most frequently used painkiller in 10 of 27 states surveyed.

The Daily Briefing 6.3.2020

Lawmakers have asked the Food and Drug Administration to ban sales of the  fast-growing e-cigarette brand Puff Bar, which has become the vaping device of choice among young people through aggressive marketing targeted to that vulnerable age group. Puff Bar gets around the partial FDA ban on some flavored vapes because it is a disposable device—used once and then thrown away—and thereby falls outside the regulations.

Banning sales is critical because Puff Bar blatantly exploits young people with flavors such as pink lemonade and watermelon, and its latest ads appeal to teens stuck at home during the pandemic lockdown. Puff Bar is so popular—with sales of more than 300,000 sticks per week—it is becoming “the new Juul,” the brand that started the vaping boom with its sleek products and slick ads. The call to ban Puff Bar is part of a continuing effort to curb the teen vaping epidemic and e-cigarette use, which has more than doubled among high schools students over the past two years.

It comes amid ongoing concerns over vaping-related illnesses and deaths, and the negative impact of vaping on Covid-19 patients who have severe respiratory complications. It’s time for the FDA to take a more pro-active stance against vaping, especially products deliberately designed to hook teens.

And finally, one purported benefit of marijuana legalization was supposed to be ending the black market for pot. But in California, that hasn’t been the case. In fact, with illicit sales of $8.3 billion compared to $3.1 billion for legal weed, the state is now considering hiring more cannabis cops to patrol the illegal market.  

The Daily Briefing 6.2.2020

There is troubling news from Alaska: a new study by the state health department finds a sharp rise in vaping and suicide among high school students. The report shows one in four students currently using e-cigarettes or vaping products, up from one in six in 2017.

The Alaska results match national surveys on vaping use among teens, an age group that is extremely susceptible to flavored vaping products and targeted advertising. The federal government has implemented a partial ban on some flavored vaping pods and nicotine, but that hasn’t stopped vaping companies continuing to pursue  younger consumers.

Meanwhile, drug overdose deaths are spiking in Canada during the coronavirus pandemic, following a similar pattern in the U.S., as substance users face difficulties accessing treatment and critical medications, and travel bans have disrupted the flow of illicit drugs. And finally, cannabis real estate companies—which lease warehouses for the cultivation and processing of marijuana—are booming, thanks to strong demand for the drug during coronavirus pandemic. Pot sales surged despite the lockdown after most states deemed them to be essential services—alongside pharmacies and grocery stores—and pot enterprises ramped up production to meet pandemic-related demand.

The Daily Briefing 6.1.2020

There is more troubling news about the negative impact of the coronavirus pandemic on drug addiction and overdose: the number of both fatal and nonfatal overdoses in Chicago has skyrocketed over the past five months. There have been at least 924 confirmed or suspected overdose deaths in Cook County during this time—more than twice as many compared with the same period last year. Similar spikes have been reported in many cities and states, as the lockdown has increased anxiety and stress and economic hardships, disrupted drug treatment, and made it more difficult for emergency services to reach individuals in need of medical attention.

Some of these issues are being addressed through changes in federal regulations—for example, easing delivery of medications and access to counseling via telemedicine—but more must be done even as the pandemic hopefully starts to wind down. Meanwhile, with more Americans using pot products while sheltering in place, some analysts say this will push states and the federal government to accelerate marijuana legalization. The states, for their part, need tax revenue to make up for the economic downturn, and are looking to legalization to help close budget gaps.

What they are not counting on, however, is the increased costs legalization will bring for law enforcement and healthcare as a result of wider use. And finally, some strong evidence that banning the sale of flavored e-cigarettes, which are targeted to young people, does in fact curtail use: Finland stopped such sales a few years ago and the rate of teen vaping has dropped dramatically. Vaping is declining among those aged 14 to 17, with under 1 percent of high school students using e-cigarettes, compared to 21 percent in the U.S., where only partial flavored vaping bans have been introduced.

The Daily Briefing 5.29.2020

As the U.S. economy slowly starts to reopen, including the legal cannabis industry, reports say sales are a mixed bag. After an initial surge at the start of the pandemic lockdown, businesses in states where pot is legal—either medical or recreational or both—have reported a subsequent drop off in purchases. While consumers may have simply stocked up on enough weed to relieve shelter-in-place anxiety, analysts say the slowdown in tourism was partially to blame for the slump in states including California, Washington and Oregon, where sales had initially been robust.

Most states allowed pot stores to stay open during the pandemic as "essential" businesses. For pot shops that are struggling, however, don’t expect any help from bankruptcy protection laws. The Justice Department says it will prevent struggling cannabis businesses and the nearly 250,000 workers in the industry from accessing bankruptcy and its financial safety net to weather the coronavirus-related downturn, because that would be a violation of federal criminal law.

And finally, health officials across the country are voicing concern about the appearance of a new “designer” opioid that is circulating among substance users, and might be the cause of a spike in overdose deaths. The drug—which is pressed into counterfeit opioid pills—is derived from a powerful analgesic opiate that has been detected in the blood of people who have died, where it was mixed with cocaine.

The Daily Briefing 5.28.2020

Drug overdoses and deaths are spiking in many regions of the country during the Covid-19 pandemic, less than a year after the Trump administration touted progress in decreasing opioid-related fatalities. Preliminary data from six states show fatal overdoses rising 11.5 percent for fatal overdoses and 18.6 percent for nonfatal cases, as cities including Milwaukee and Memphis report higher numbers.

Meanwhile, the federal government has approved New York City’s program to deliver methadone by mobile vans, easing the way for substance users in quarantine to receive their withdrawal medications without risking contracting the corona virus at crowded drug treatment facilities, where they where obliged to pick up their drugs.

And finally, a rally in pot stock shares fizzles after the debunking of a news report that marijuana and CBD could be a treatment or cure for Covid-19. The erroneous report was based on a preclinical paper that was blown out of proportion by the media. For the record, there is NO scientific evidence showing that any kind of marijuana or CBD product is effective against the corona virus.

The Daily Briefing 5.27.2020

The thousands of opioid lawsuits pending before courts have largely focused on the roles played by prescription painkiller manufacturers and drug distributors to fuel the opioid crisis. Now, a new legal front has opened against large pharmacy chains such as CVS, Rite Aid, Walgreens and Walmart, which had previously eluded scrutiny. The new filings, made by two Ohio counties, assert that pharmacies are also liable because they distributed tens of millions of pills to patients and contributed to the deaths of more than 400,000 people over the past two decades.

The pharmacy chains rarely sounded alarms as a tidal wave of pills landed in small communities, including Ohio’s Lake County, which received nearly 64 million doses of oxycodone and hydrocodone, or about 290 pills for every man, woman and child.

The drug stores, it is alleged, also dragged their feet in setting up monitoring protocols at regional distribution centers, and rewarded pharmacists for churning volume rapidly and never refusing a doctors request. Thousands of opioid-related lawsuits are wending their way through the courts, and these new allegations shed light on how pharmacies must also be held accountable for the suffering and death caused by the epidemic. Meanwhile, the New York Times explores the long and winding road that led to the first FDA-approved, CBD-based drug for a rare form of epilepsy, and how that also spawned a booming market for bogus products with CBD, the non-psychoactive component of marijuana.

While the epilepsy drug was deemed safe and effective, CBD companies used that certification to tout all kinds of fake products and make fraudulent claims that CBD is a cure-all wonder drug—without any scientific validation. And finally, public health officials say they are worried about the growing number of people who are smoking pot while under lockdown to ease anxiety. In fact, smoking or vaping marijuana could leave consumers with irritated, inflamed lungs—and perhaps raise their risk of severe complications if they catch Covi-19. Doctors also suggest people ignore patently false claims that marijuana could ward off the coronva virus.

The Daily Briefing 5.22.2020

There’s nothing like a pandemic to change political thinking about marijuana legalization. That’s what is happening in Pennsylvania, as some Republican legislators are having a change of heart about legalizing recreational marijuana in order to plug a hole in the state budget that has been ravaged by the corona virus-related economic downturn. The lawmakers, who until recently had opposed such a move, are looking at an estimated $4 billion in tax losses, and see that other states—including Illinois, Colorado and California—are reaping a tax windfall from pot sales, spurred by a surge of panic buying during the pandemic.

While experts agree that tax revenue from marijuana alone would not solve Pennsylvania’s budget problem, the extra funds would of course be helpful. Still, what legislators are not counting is the extra cost to healthcare and law enforcement that legalization is likely to incur. While the pandemic continues to impact state government finances and operations, rushing through recreational marijuana legalization to help lower the budget deficit is not sound reasoning—and could in the long run have a negative effect on communities and public health.

Meanwhile, an appeals court in Michigan has upheld an injunction against the state’s ban on flavored vaping products, making the order unenforceable for the time being. Gov. Gretchen Whitmer’s public emergency declaration in September against flavored vaping products was aimed at stopping the surge in teen nicotine use and addiction, but the judges described it as “government overreach.” It’s not clear if the state will continue to litigate the issue in the courts, allowing vaping companies in the meantime to continue luring young people with flavored products.

The Daily Briefing 5.21.2020

Massachusetts is starting to reopen its economy, and that includes recreational marijuana dispensaries that were shuttered during the corona virus lockdown—a controversial decision by Governor Charlie Baker that generated much debate both in the state and nationwide over what constituted “essential” services. Baker stuck to the order, saying he didn’t want tourists flocking to Massachusetts to buy pot and spread the virus.

But now that the ban has been lifted and weed shops resume selling recreational marijuana, the state is easing rules on salesand delivery in the name of public health and safety. That includes allowing online and phone commerce as well as curbside pickup, in order to maintain social distancing and other protective measures, but which will make it easier to access cannabis and perhaps encourage consumers to flout age and other restrictions. Hopefully, the state will revisit the regulations once the pandemic has eased, also in the interest of public health and safety.

Marijuana commerce is also the subject of a commentary in the L.A. Times, by a mom in California who is dismayed by the in-your-face advertising and marketing she sees on a tour of marijuana shops and simply driving around the city. As she notes, pot is promoted on every street corner and by every social influencer with appealing ads aimed at luring susceptible young people. The ubiquity of pot shops and how cool they look and their pervasive promotion can feel disturbing, she concludes, sending the wrong message to susceptible teens and influencing their choices.

The Daily Briefing 5.20.2020

Within a few weeks of the first cases of corona virus being diagnosed in Wuhan, China, real-time data collection concerning the disease was available. Public health officials, scientists and healthcare workers could easily monitor the spread of the virus and its effects, with the data helping to determine health policy and responses. Yet when it comes to the opioid epidemic—which has killed more than 400,000 Americans over the past two decades—we are lagging behind by up to two years in the collection and dissemination of real-time data, and that is having lethal public health consequences, a commentary in STAT argues.

When figuring out addiction policies, and allocation of funding for treatment programs, we are relying on outdated information that does not accurately reflect the current situation as drug use and patterns change. It’s time to bring this kind of real-time outcome data to America’s addiction crisis and make it available to the public, so we know if what we are doing to address the opioid epidemic is making a difference.

And finally, New York State’s long-awaited ban on the sale of flavored e-cigarettes and vaping products, which are highly attractive to young people, has gone into effect. New York becomes the fourth state to ban flavored vaping over concerns about the surge in teen vaping and related breathing illnesses. According to data from the state health department, e-cigarette use among high school students soared to nearly 28 percent in 2018 from 10 percent in 2014—making the ban on flavored products a wise policy decision.

The Daily Briefing 5.19.2020

The seizure by narcotics police in Myanmar of a large quantity of liquid fentanyl is cause for alarm, as it provides evidence this region of Southeast Asia is ramping up production and global distribution of the dangerous synthetic opioid. Fentanyl is 30 to 50 times more powerful than heroin, and is largely responsible for a surge in overdose deaths across the United States, with substance users switching to the drug or mixing it with prescription painkillers or other substances.

Fentanyl is easier to make and smuggle than heroin, and is far more profitable than other opioids—as well as deadlier. Meanwhile, travel restrictions and lockdowns due to the corona virus pandemic are disrupting the flow of illicit drugs to the U.S., thereby increasing the potential for overdose as users adapt to shifting supply. Experts say the availability and prices of illegal drugs are changing in different areas of the country, creating a patchwork of new overdose risk as dealers lack supply and users can’t get money to buy what they need.

And finally, The Atavist publishes a remarkable story about a mother who dedicates her life to advocating for harm reduction programs following her son’s overdose death. The twist in the story is that the woman’s late husband was the inventor of nalaxone—the widely used overdose reversal drug that is now part of the standard emergency toolkit to save lives.

The Daily Briefing 5.18.2020

Governors who are facing huge budget shortfalls—due to the corona virus pandemic and the economic downturn—are eyeing cuts to Medicaid funding that would threaten critical drug treatment services. Medicaid consumes about 20 percent of state budgets and is therefore ripe for pruning as states reel from a drop in tax revenues that require substantial budget cuts. But Medicaid is also the country’s biggest payer of addiction and mental-health services—covering four in 10 individuals among the half a million Americans with opioid addiction— and is a lifeline from those struggling with substance abuse.

Medicaid is also crucial for millions of newly unemployed Americans who have lost their employee-based coverage, and for those who contracted Covid-19. Considering these circumstances, it’s time for the federal government, which jointly funds Medicaid with the states, to let governors know they will bolster resources to the states, to ensure the program is able to maintain services for drug treatment, and for those who have lost their insurance or are fighting the corona virus.

Meanwhile, recreational marijuana stores in Massachusetts will be back in business soon as a phased reopening of the state’s economy gets underway. Governor Baker had prohibited recreational pot sales during the pandemic, fearing that tourists would flock to the state to buy the stuff and spread the virus. Baker came under pressure by the pot lobby to relent and open the shops, and he should be commended for not backing down—and choosing public health over profit.

The Daily Briefing 5.15.2020

Doctors and public health officials in Appalachia, a region hit hard by the opioid epidemic, report a rise in relapses as those struggling with substance abuse react to forced isolation and reduced access to treatment and crucial support networks. The pandemic’s rules on sheltering in place and social distancing aggravate the drug crisis, as patients have too much unstructured time, are not able to attend recovery meetings in person, and suffer from anxiety—all triggers from those in recovery.

Treatment facilities are starting to adjust their practices to accommodate the new conditions, providing larger take-home doses of medication, using telemedicine to assess and prescribe drugs, and initiating counseling sessions by video conferencing to help at-risk communities. Maintaining access to treatment is also critical because people with substance use disorders are at heightened risk from the virus due damage caused by opioid abuse, which weakens the immune system and makes users more prone to infectious diseases.

Meanwhile, the United Nations says that while the pandemic has disrupted the global illicit drug trade in North America and Europe, it is still flourishing in the Asia-Pacific region. In Europe, tighter cross-border restrictions and tougher sheltering in place rules have made drug dealing more difficult. But in Asia, transnational crime groups have actually expanded the scale of drugs such as methamphetamine—the most popular drug in the region—and widened their distribution network while shifting to online sales.

The Daily Briefing: 5.14.2020

Substance abuse treatment centers are anticipating a crushing wave of new demand amid the corona virus pandemic and unfolding economic crisis, which is likely to trigger relapses and overdoses among patients struggling to recover from the opioid epidemic. Yet only a small portion of the $175 billion in federal emergency funding, approved by Congress for hospitals and healthcare facilities during the pandemic, will be allocated to drug treatment centers that are also facing severe financial difficulties.

These behavioral health centers, which serve nearly half a million people struggling with substance abuse, provide FDA-approved medication-assisted treatment (MAT). But they are not eligible for a bigger slice of funding due to a technicality: the money is earmarked for Medicare providers in 2019, but treatment providers weren’t eligible for Medicare payments until recently. While Medicaid is the biggest payer of addiction services, treatment is also provided through Medicare. It’s time for Congress to correct this situation and ensure that drug treatment centers are well funded and fully operational as the pandemic exacerbates the opioid epidemic and more patients require services.

And finally, an op-ed in the San Francisco Chronicle notes that as San Francisco-based e-cigarette maker Juul prepares to quit the city and move to Washington, D.C., it’s a good time for parents to speak to kids about quitting vaping. Vaping is highly addictive—as the teen nicotine epidemic proves—and poses significant health risks, so we need to support teens that want to stop.

The Daily Briefing: 5.13.2020

Social distancing and sheltering in place rules to stop the spread of Covid-19 are changing our behavior patterns in multiple ways, including more alcohol and marijuana consumption while waiting out the pandemic. But as more people turn to these substances to counter stress and fear or to simply relax while isolated, a psychoanalyst warns that pot and booze are a bad combination for lockdown. They can offer temporary relief and comfort, but the benefit is usually short-lived and ultimately can be self-destructive. Both can contribute to psychological distress, fatigue and even paranoia when used regularly. What’s more, smoking or vaping pot everyday can exacerbate despair, insomnia and panic attacks—and can also lead to addiction that will outlast the virus.

There’s no panacea for the anxiety and depression the pandemic is causing but alcohol and marijuana tend to make these things worse, rather than better. And finally, Colorado was the first state to legalize marijuana but it is now in go-slow mode when it comes to allowing widespread home delivery of pot. While a new state law would allow home delivery, it requires individual municipalities to opt in, and so far only two cities—Boulder and Superior—have done so, forcing residents of Denver, the largest city, to fend for themselves (although some rogue businesses are delivering illegally). City officials say they want to enact the law only after careful and thoughtful deliberation and with public feedback, which is a win for community control of marijuana distribution.

The Daily Briefing: 5.12.2020

As the Covid-19 virus spread across the U.S., addiction doctors and policy experts feared the worst for the estimated half-million Americans battling opioid addiction, knowing that isolation, stress and financial hardship could trigger overdose and relapse. But those fears have eased since federal authorities moved quickly to enact far-reaching policy changes—easing strict regulations and access to addiction treatment and medications.

By using telemedicine instead of in-person visits to evaluate and prescribe withdrawal drugs, and making it easier to obtain larger doses of those medications—including home delivery—patients were able to maintain their treatment without risk of spreading the virus or becoming infected. Now, many in the field say they want these long-sought policies to become the new normal—hoping to transform patient care for those with substance abuse issues for decades to come.

Supporters argue the new allowances could result in even greater expansion of services and treatment, especially in rural areas, where there are few qualified doctors to treat addiction and prescribe medications. Others, however, are more cautious, saying that the new rules do little for Americans addiction to other drugs including meth, cocaine and alcohol. As we look ahead, we must evaluate and adopt the regulatory practices that make sense and enable the widest access to a full range of treatment services.