This article was produced in collaboration with AlterNet and first appeared here.
In a last ditch bid to stop the DEA from criminalizing an herb widely hailed for its ability to treat pain, depression, and anxiety, and help people wean themselves from more dangerous opioid pain relievers, a bipartisan group of lawmakers sent a letter to the agency Monday asking it to reconsider its decision to place kratom on Schedule I of the Controlled Substances Act.
[image:1 align:left caption:true]Kratom is a southeast Asian herb made from the leaves of Mitragyna speciose, a tree related to the coffee plant. In small doses, it has a mild stimulant effect, but in larger doses, it acts like a mild opioid. To be precise, the DEA has moved to criminalize not the herb itself, but two alkaloids, mitragynine and 7-hydroxmitragynine, which activate opioid receptors in the brain.
Last month, the DEA exercised its emergency scheduling powers in announcing that it was moving kratom to Schedule I, effective at the end of this week. The drug agency said kratom poses "an imminent hazard to public safety," citing only press reports of some 15 deaths linked to kratom use. But in at least 14 of those cases, the victims were also using other drugs or had pre-existing life-threatening conditions. (Meanwhile, some 25,000 people died of prescription drug overdoses last year.)
Kratom users, who could number in the millions, immediately raised the alarm, organizing campaigns to undo the decision and lobbying Congress for help. That's what sparked Monday's letter from 51 lawmakers, including 22 Republicans.
"This significant regulatory action was done without any opportunity for public comment from researchers, consumers, and other stakeholders," reads the letter, drafted by Reps. Mark Pocan (D-WI) and Matt Salmon (R-AZ). "This hasty decision could have serious effects on consumer access and choice of an internationally recognized herbal supplement."
Given the ongoing high level of heroin and prescription opioid use and the associated overdose deaths, he DEA was hypocritical in mounting a campaign against kratom, the lawmakers said.
"The DEA's decision to place kratom as a Schedule I substance will put a halt on federally funded research and innovation surrounding the treatment of individuals suffering from opioid and other addictions -- a significant public health threat," they wrote.
The lawmakers called on DEA Administrator Chuck Rosenberg to delay the emergency scheduling and instead "engage consumers, researchers, and other stakeholders, in keeping with well-established protocol for such matters."
Since first emerging in the US a few years ago, kratom has been unregulated at the federal level, although the Food & Drug Administration began seizing shipments of it in 2014. At the state level, a half dozen states have entertained moves to ban it, but such efforts failed in all except Alabama. In other states, kratom advocates have managed to turn bans into regulation, with age restrictions and similar limits.
[image:2 align:right caption:true]A ban on kratom would be disastrous, said Susan Ash, founder of the American Kratom Association. Ash said she had been diagnosed with fibromyalgia in 2006 and ended up essentially disabled under the weight of 13 different prescriptions, including opioids, benzodiazepines, and amphetamines (to counter the opioids and the benzos). She became addicted to the opioids and finally tried kratom as a last resort.
"I didn't really want to have anything to do with a plant, but I decided to try it, and it worked day and night," she said Tuesday. "Within two weeks, I went from home bound to starting this organization."
With the kratom ban looming, her members are facing "our darkest hour," Ash said. "Our average member is a middle-aged woman, about 40% of whom have experienced addition, and tens of thousands of them are using it as an alternative to pharmaceutical medications because they believe it is safer and more natural. Now, people are saying they are going to lose their quality of life, that they will be re-disabled. People are terrified. What we need is regulation, not prohibition."
"Despite the moral, political, and scientific consensus that drug use and addiction are best treated as public health issues, the DEA wants to subject people with kratom to prison sentences," said Jag Davies, director of communications strategy for the Drug Policy Alliance (DPA), which is also fighting the ban. "The DEA's move would also effectively halt promising scientific investigations into the plant's uses and medicinal benefits, including helping many people struggling with opioid addiction."
The scientific studies are promising indeed. Researchers at Columbia University just published a study on kratom alkaloids and found that they activate opioid receptors in a way that doesn't trigger respiratory depression, the lethal side effect of most opioids. Such research could lead to the "holy grail" of narcotic analgesics, a painkiller that doesn't kill users and doesn't get them addicted.
"Our research shows that mitragynine and its analogs activate the opioid receptors in a unique way compared to morphine or oxycodone," said Dr. Andrew Kruegel, one of the Columbia researchers. "They activate a certain protein pathway while avoiding other pathways, and that gives you a better safety profile, mostly for respiratory depression. The scientific data is consistent with an improved safety profile from the alkaloids and suggestive of the same with the raw plant," he explained.
"This new prohibition will really restrict our ability to purse new opioid painkillers based on alkaloids and new safer drugs for pain," Kruegel said.
And then some, DPA's Davies added.
"Placing kratom in Schedule I would place regulatory and funding barriers in front of research, drive users into the black market, and leave them facing lengthy prison terms," he said. "It's troubling that the DEA is moving hastily to criminalize kratom at the same time Congress and the president have been made sentencing reform a priority this year and when communities are grappling with unprecedented rates of heroin and opioid overdoses, the DEA is threatening to punish people for using it instead of potent pharmaceutical preparations. Kratom has a role to play in mitigating the opioid crisis."
But not if the DEA refuses to budge from its ban plan. If the DEA cannot be moved, kratom is illegal as of this coming Friday.
Seattle and surrounding King County are on a path to establish the country's first supervised drug consumption sites as part of a broader campaign to address heroin and prescription opioid misuse. A 99-page report released last week by the Heroin and Prescription Opiate Addiction Task Force calls for setting up at least two of the sites, one in the city and one in the suburbs, as part of a pilot project.
[image:1 align:left]The facilities, modeled on the Canadian government-funded InSite supervised injection site in Vancouver, just 140 miles to the north, would be places where users could legally inject their drugs while under medical supervision and be put in contact with treatment and other social services. There have been no fatal overdoses in the 13-year history of InSite.
Although such facilities, which also operate in various European countries and Australia, have been proven to reduce overdose deaths and drug use-related disease, improve local quality of life, and improve the lives of drug users, they remain controversial, with foes accusing them of "enabling" drug use. Thus, the report refers to them not as "safe injection sites," or even "supervised consumption sites," but as the anodyne "Community Health Engagement Locations" (CHELs).
"If it's a strategy that saves lives then regardless of the political discomfort, I think it is something we have to move forward," said County Executive Dow Constantine, discussing the plan at a news conference last week.
The safe sites will address the region's high levels of opioid and heroin use, or what the task force called "the region's growing and increasingly lethal heroin and opioid epidemic." As the task force noted, the number of fatal overdoses in the county has tripled in recent years, with the rate of death rising from roughly one a week (49) in 2009 to one very other day (156) in 2014. The current wave of opioid use appears centered on young people, with the number of people under 30 seeking treatment doubling between 2006 and 2014, and now, more young people are entering detox for heroin than for alcohol.
[image:2 align:left caption:true]Overdose deaths actually dropped last year to 132, thanks to Good Samaritan laws that shield people who aid overdose victims from prosecution and to the wider use of the opioid overdose reversal drug naloxone. But that's still 132 King County residents who needn't have died. Task force members said the CHELs would help reduce that number even further.
"The heroin epidemic has had a profound effect not just on our region, but across our country as a whole," said Seattle Mayor Ed Murray. "It is critical that we not only move forward with meaningful solutions that support prevention and treatment, but that we remove the stigma surrounding addiction that often creates barriers to those seeking help.
Not only are key local elected officials on board, so is King County Sheriff John Urquhart. He said the safe site plan was workable.
"As long as there was strong, very strong, emphasis on education, services, and recovery, I would say that yes, the benefits outweigh the drawbacks," he said. "We will never make any headway in the war on drugs until we turn the war into a health issue."
The region may willing to embrace this ground-breaking harm reduction measure, but it is going to require some sort of federal dispensation to get around the Controlled Substances Act and the DEA. How that is going to happen remains to be seen, but Seattle is ready.
The task force wasn't just about CHELs. In fact, the safe sites are just a small, if key, component of a broad-based, far-ranging strategy to attack the problem. The task force report's recommendations come in three categories:
[image:3 align:right caption:true]Primary Prevention
- Increase public awareness of effects of opioid use, including overdose and opioid-use disorder.
- Promote safe storage and disposal of medications.
- Work with schools and health-care providers to improve the screening practices and better identify opioid use.
Treatment Expansion and Enhancement
- Make buprenorphine more accessible for people who have opiate-use disorders.
- Develop treatment on demand for all types of substance-use disorders.Increase treatment capacity so that it’s accessible when and where someone is ready to receive help.
Health and Harm Reduction
- Continue to distribute more naloxone kits and making training available to homeless service providers, emergency responders and law enforcement officers.
- Create a three-year pilot project that will include at least two locations where adults with substance-use disorders will have access to on-site services while safely consuming opioids or other substances under the supervision of trained healthcare providers.
Will Seattle and King County be able to actual implement the CHELs? Will the federal government act as obstacle or facilitator? That remains to be seen, but harm reductionists, policymakers, and drug users in cities such as Portland, San Francisco, and New York will be watching closely. There have been murmurs about getting such sites up and running there, too.
Chronicle AM: CA&MA Polls, Kratom Proponents Mobilize, Canada OKs Prescription Heroin; More... (9/14/16)
The polling is looking good in Massachusetts and better in California, there will be no initiative for Michigan this year, kratom proponents fight a proposed DEA ban, Canada gives the go-ahead for expanded heroin prescribing, and more.
[image:1 align:left caption:true]Marijuana Policy
Marijuana Could Be a $50 Billion a Year Industry Within a Decade. A new report from financial analysts Cowen & Company says the legal weed industry could grow to a $50 billion a year business by 2026. The report notes that legalizing pot in California alone could triple the size of the industry, currently around $6 billion a year.
California: LA Times Poll Has Prop 64 at 58%. The Prop 64 legalization initiative is supported by 58% of voters, according to a new USC Dornsife/Los Angeles Times poll. Only 34% said they would vote against the measure, with 8% undecided. "It's very clear that Californians' attitudes have changed dramatically on this issue over the last several years," said Dan Schnur, director of the poll and of the Jesse M. Unruh Institute of Politics at USC. "The opposition is going to have to identify a fairly sizable source of campaign funding if this initiative is to be close," he added.
California: Eyewitness News/Southern California Newsgroup Poll Has Prop 64 at 52%. The Prop 64 legalization initiative has 52% in a new poll from Eyewitness News/Southern California Newsgroup. Some 40% said they would vote no, with 8% undecided.
Massachusetts Poll Has Legalization Initiative Up By Five Points. A new poll from WBUR TV has support for the Question 4 legalization initiative at 50%, with 45% opposed. "There's some big demographic splits, particularly along age lines," pollster Steve Koczela said. "Younger people are very much in favor of legalization, and it declines steadily as you move up the age brackets to where you get to voters who are 60-plus, and they're opposed to it by a 17-point margin."
Federal Judge Puts Final Nail in Coffin of Michigan Legalization Initiative. A federal court judge rejected a last chance effort by MI Legalize to get its legalization initiative on the November ballot. Judge Linda Parker Tuesday denied a motion from the group to stop the printing of election ballots, saying there was not enough time to stop the election process. MI Legalize gathered enough signatures to qualify for the ballot, but some of them came outside a 180-day mandated by state law. MI Legalize challenged rulings by state officials that knocked those signatures off the tally, but lost in the state courts -- and now, in federal court.
Kratom Supporters Fight Proposed DEA Ban. Proponents of the Southeast Asian plant with mild opium-like qualities have mobilized to block the DEA proposed emergency move to place the substance on Schedule I of the Controlled Substances Act. Hundreds marched in front of the White House Tuesday and more than 120,000 have signed a Change.org petition opposing the ban, meaning the White House will have to publicly address the issue.
Canada Has Approved Prescription Heroin. The Canadian government last week quietly approved new regulations that will allow doctors to prescribe diacetylmorphine (heroin) to long-term users who have not responded to more conventional approaches to weaning them from the drug. The Crosstown clinic in Vancouver is currently the only place in the country with a heroin maintenance program, but that should now not be the case for long.
British MPs Call for Medical Marijuana. The All Party Parliamentary Group on Drug Policy Reform has called for medical marijuana to be legalized in the United Kingdom. The call comes on the heels of a report by neurologist Dr. Mike Barnes urging that marijuana be moved from Schedule I to Schedule IV on the British drugs classification scheme. "Many hundreds of thousands of people in the UK are already taking cannabis for primarily medical reasons," said MP Caroline Lucas, who co-chairs the group. "It is totally unacceptable that they should face the added stress of having to break the law to access their medicine."
The California legalization campaign heats up, the Massachusetts legalization campaign is sitting pretty with lots of cash, a North Carolina town becomes the first in the South to adopt Law Enforcement Assisted Diversion (LEAD) for drug users, and more.
[image:1 align:right caption:true]Marijuana Policy
California Legalization Supporters File Complaint Against Opposition Committee. Diane Goldstein, one of the proponents for the Prop 64 legalization initiative, filed a complaint last Friday against Smart Approaches to Marijuana Action, the lobbying and campaign arm of the prohibitionist Project SAM. The complaint claims the committee misreported donations, failed to file contribution reports, and left some contribution reports incomplete, including one for Pennsylvania millionaire Julie Schauer, who gave $1.3 million the opposition.
California Highway Patrol Says It Is Neutral on Legalization Initiative. The state Highway Patrol last Friday clarified that it has not taken a position on the Prop 64 legalization initiative. The move comes after the head of the California Association of Highway Patrolmen criticized the measure for not setting a legal driving limit for the amount of THC in drivers' blood. CHP provided technical assistance to the measure's authors and is involved in implementing medical marijuana regulations signed into law last year.
Massachusetts Legalization Initiative Getting Big Bucks Backing. Supporters of the Question 4 legalization initiative have taken in more than $2.4 million since January, most of it from the New Approach PAC, a group based in Washington, DC, that is led by Graham Boyd. Groups opposing Question 4 have only raised less than $400,000, giving supporters a six-to-one funding advantage.
Heroin and Prescription Opioids
Report Names Chicago's West Side as "Epicenter" of State's Heroin Crisis. A new report from Roosevelt University, Hidden in Plain Sight, examines heroin arrests, hospitalizations, and deaths on the city's West Side and finds that the area accounts for one out of four hospitalizations for overdoses in the entire state. The response to rising heroin use has focused on enforcement, not treatment, said report coauthor Kathy Kane Willis. "Incarceration or arrest is an extremely ineffective and expensive way to treat a health crisis like this. We cannot arrest our way out of this problem," she said. In response to the report, state Rep. La Shawn K. Ford (D-Chicago) has launched the West Side Heroin Task Force to help find evidence-based solutions to the problem.
Fayetteville, NC, Starts First Law Enforcement Assisted Diversion (LEAD) Program in the South. This month the Fayetteville Police Department and a number of partners, including the North Carolina Harm Reduction Coalition (NCHRC), are launching a new program to divert low-level drug and sex work (prostitution) offenders to treatment instead of jail. Currently, Fayetteville faces one of the highest rates of opioid abuse in the nation. Last year alone over 500 people were arrested for drug possession in the city. Under the new law enforcement assisted diversion program (LEAD) launched this month, police officers will be able to divert eligible citizens (people with under 4 grams of drugs, no violent record, etc) to treatment providers and social services instead of funneling them through the criminal justice system, where often the cases are thrown out or people serve minimal jail time and wind up back on the streets.
Rampant Meth Use is Driving Asia's Drug War. The Philippines isn't the only country in the region waging a deadly "war on drugs." In Thailand and Myanmar, drug users are sentenced to long prison terms, while Indonesia has declared a "narcotics emergency" and resumed the execution of drug convicts. But that tough response is only likely to make things worse, experts said.