Alberta Premier Danielle Smith said the government is about to table a budget that will earmark $180 million to build two “compassionate intervention centres” with 150 beds each in Edmonton and Calgary. If approved, construction would begin in 2026 to be completed by 2029.

In the meantime, Smith said the government will identify up to 100 beds in existing treatment facilities that can be used to place people into involuntary care.

“In our downtown cores there are visible effects on every street, with individuals who have lost the ability to make healthy decisions, actively putting their lives at risk and causing fear and harm in the broader community,” Smith said. “There is no compassion in leaving people to suffer in the throes of addiction.”

The plan is in line with other blows to harm reduction inflicted by Alberta’s governing United Conservative Party, including effectively banning safe supply and hampering, shutting down or canceling the opening of safe consumption services. The party promotes abstinence-based recovery as the solution to drug issues.

“How do we know that this isn’t going function as just another criteria for incarceration when your only crime is being houseless and living in poverty?” 

Drug policy experts and harm reduction advocates say forcing people to be abstinent is an infringement of civil rights and unlikely to stem overdoses in the province.

“It’s really concerning,” Dr. Rebecca Haines-Saah, associate professor in community health sciences at the University of Calgary, told Filter. “How do we know that this isn’t going to de facto function as just another criteria for incarceration when your only crime is being houseless and living in poverty?” 

There is no clear evidence supporting the idea that forced treatment is effective, while evidence also indicates it may be harmful. An evaluation of a similar program in Massachusetts, for instance, found that people who were committed involuntarily were twice as likely to die of an overdose as people who completed voluntary treatment. This is because people’s tolerances will drop after abstinence, Haines-Saah explained. That’s liable to be particularly risky for people who didn’t choose to be abstinent in the first place.

“They’ll go back to using the amount or the combinations that they were used to before that period of abstinence and it just puts them at ultra-high risk for overdose death,” she said.

The province has said it will use a commission comprised of lawyers, doctors and members of the public to decide who gets sent into involuntary treatment. The criteria they will use haven’t yet been decided.

Dan Williams, Alberta’s minister of mental health and addiction, told CBC News that approved cases “would meet the absolute highest standard of the most extreme examples of destruction in our society and in one’s life because of the addiction.”

The province can already hospitalize people deemed to be violent or a danger to themselves under Alberta’s Mental Health Act. Advocates fear the increased involuntary-treatment capacity could see the criteria diluted to cast a wider net.

“We don’t know what becomes of those kids when they get out, they might be subjected to that forced withdrawal dozens of times before they reach adulthood.”

Alberta also can force minors into detox programs through its Protection of Children Using Drugs (PChAD) Program, which requires a parent or guardian to petition a court. No medical sign-off is required.

Euan Thomson, an independent drug policy analyst and author of the Drug Data Decoded newsletter, filed a Freedom of Information request that revealed 41 percent of children in the PChAD program identify as Indigenous, when Indigenous children make up around 10 percent of the youth population. The province does not track what happens to those children after they leave involuntary treatment.

“We don’t know what becomes of those kids when they get out, they might be subjected to that forced withdrawal dozens of times before they reach adulthood,” Thomson told Filter.

A report from the Alberta First Nations Information Governance Centre found that First Nations people accounted for 20 percent of all fatal overdoses in the province between 2016 and 2022, despite Indigenous people making up 6.5 percent of the population.

Speaking alongside Premier Smith, Earl Thiessen, executive director of the Oxford House Foundation of Canada which provides sober living homes in the province, said he supported involuntary treatment.

“Is it a compassionate approach to step over people on the street and allow them to die in front of us, turn our heads and ignore the obvious because it’s their right? No, it’s not,” said Thiessen, who is Indigenous and has been in recovery for 17 years.

Alberta has not published any data on the outcomes for people who were cut off from safe supply or supervised consumption services, including after the shuttering of the busiest site in North America, in Lethbridge, in August 2020.

The province suffered record high overdose deaths in 2023 but saw a dramatic fall in 2024—from 45.1 per 100,000 people from January-September 2023 to 29.4 per 100,000 people over the same period in 2024, according to the Globe and Mail. However, overdose deaths are also falling in other provinces with different policies, and in the United States.

Alberta’s announcement comes amid a nationwide crackdown on harm reduction measures. Ontario is closing down supervised consumption sites and British Columbia has gutted its decriminalization pilot by banning public drug use. BC also just announced that it will be removing take-home safe supply, meaning people will only be able to take the medications while witnessed by a pharmacist or health care provider.

Photograph via Rawpixel/Public Domain

The post Alberta Will Force People Who Use Drugs to Enter Treatment  appeared first on Filter.

Facing unpopularity both within the Liberal Party he leads and among the wider populace, Trudeau, 53, announced on January 6 that he would be stepping down after the Liberals chose a new leader. He has prorogued parliament until March 24. After that, a federal election is due by October 20 and may well take place much sooner.

“This country deserves a real choice in the next election and it has become clear to me that if I’m having to fight internal battles, I cannot be the best option in that election,” Trudeau said in a press conference outside of his home.

There’s a good chance he’ll be replaced by Conservative Party leader Pierre Poilievre, who is currently leading in the polls and has promised to crack down on overdose prevention sites and safe supply programs.

Trudeau, a former school teacher whose father Pierre Trudeau was also prime minister, won in a landslide election in 2015, ousting Prime Minister Stephen Harper, a Conservative who had also been in office for nine years. Harper was staunchly anti-drug and pro-carceral punishment. He went viral for saying that cannabis is “infinitely worse” than tobacco while campaigning in October 2015, just weeks before he lost to Trudeau.

“If I take a 30,000-foot view … I’m very happy that we got legalization across the finish line.”

Trudeau, on the other hand, galvanized young voters in the country, and his promise to legalize cannabis federally was part of the reason. He managed to get it done by October 2018, just three years after taking office. That shift made Canada the second nation in the world to legalize weed for adult use.

“If I take a 30,000-foot view and kind of look at this drug legacy … I’m very happy that we got legalization across the finish line,” Akwasi Owusu-Bempah, associate professor of sociology at the University of Toronto, told Filter.

Canada’s legalization scheme was met with resistance from some politicians, doctors and  newspaper columnists, who feared it would lead to a spike in teen use; some even compared it to fentanyl. Cannabis has always been popular among young people in Canada, and research published in the Lancet in 2024 shows that at most legalization has resulted in teen use remaining steady.

“I had people tell me ‘Why are you advocating for this? People are gonna die.’ And we never saw that come to fruition,”  Rebecca Haines-Saah, associate professor in community health sciences at the University of Calgary, told Filter.

“People are concerned about young kids exposed to edibles. These are things to watch in the health system, and we’re always concerned about problems from substance use for vulnerable groups, but to me, it’s not an emergency,” she added, noting that Canada’s approach to legalization favored strict regulation versus full-throttle commercialization.

One of the great successes of legalization was that people are no longer arrested for cannabis possession. But Trudeau’s government did not prioritize pardoning people with criminal records for cannabis possession—which would prevent them from showing up on background checks and contributing to discrimination in areas such as employment and housing.

“I still don’t think that we’ve done enough to help people repair the damage that was done.”

Nor did the government create equity programs that would make it easier for those who’d been criminalized for cannabis—disproportionately Black and Indigenous people—to get into the legal industry.

“There were many people for whom a single cannabis possession arrest was their entry point into the justice system. And I still don’t think that we’ve done enough to help people repair the damage that was done,” said Owusu-Bempah, who helped Canadians navigate the bureaucratic pardoning system through his work with the nonprofit Cannabis Amnesty.

Trudeau’s time in office also coincided with the rise of fentanyl in the drug supply and the worst overdose crisis Canada has ever seen.

In 2017, I hosted a VICE cannabis legalization town hall with Trudeau, where harm reduction expert Zoë Dodd pleaded with him to do more to address the crisis.

“It is young people who are dying. It is young people who elected you. Save their lives too,” she said, pressing him to decriminalize all drugs.

“I’m not there yet,” he responded.

Dodd, who is based in Toronto, described Trudeau’s legacy on harm reduction as a “mixed bag.”

He oversaw the expansion of overdose prevention sites, which Dodd and other activists pressured the federal government to legally exempt from Canada’s Controlled Drugs and Substances Act. His government also expanded access to naloxone, increased funding for safe supply programs during the pandemic, and approved British Columbia’s request to decriminalize small amounts of all drugs in 2023.

However, Dodd pointed out that the federal government didn’t fund overdose prevention sites, leaving some of them to operate solely on donations. Federal funding of safe supply programs, meanwhile, will dry up in March, which will likely cut patients off from safe alternatives to adulterated street drugs.

“I think most of my colleagues and friends and fellow advocates are pretty afraid of what’s to come.”

After Trudeau announced his resignation, Poilievre released a video saying the Liberal government has unleashed “crime and drugs in your community.”  He vowed to “take back control of our streets by locking up criminals, banning drugs, treating addiction, and stopping gun smugglers.”

“I am really angry at how the toxic drug deaths crisis has been used as a political football to buy votes,” Dodd said.

She said Trudeau’s government could have protected harm reduction programs by setting them up with years of earmarked funding, rather than smaller-scale pilot projects. She wished it had decriminalized drugs on a federal level, and permitted compassion clubs, which allow members to receive checked drugs without fear of arrest.

Despite these and other failures, the coming election might leave Trudeau’s drug-policy legacy looking comparatively positive.

“I think most of my colleagues and friends and fellow advocates are pretty afraid of what’s to come,” Dodd said.

Photograph of Trudeau in 2023 by United States Department of Homeland Security via Picryl/Public Domain

The post Justin Trudeau’s “Mixed Bag” Legacy on Drug Policy appeared first on Filter.

The report, “Beyond Punishment: From Criminal Justice Responses to Drug Policy Reform,” published December 5, urged countries to implement strategies that focus on “health, human rights, and social equity.” It was authored by over two dozen former presidents, prime ministers and diplomats from around the world.

The report recommended expanding the availability of opioid agonist therapy such as methadone and buprenorphine, syringe service programs, overdose prevention centers, drug checking and naloxone. It also said governments should explore safer supply models, through which people with substance use disorders are offered pharmaceutical alternatives to unregulated drugs, as a means of curbing overdose deaths.

“Drug use itself is not the issue. It has been a part of human societies for centuries. The real problem lies in how society responds to it.”

Louise Arbour, former United Nations high commissioner for human rights, who contributed to the report, was unambiguous when asked about the efficacy of the drug war.

“There’s nothing in it that works,” she told Filter. “There are more drugs today that are cheaper and more lethal used by more people in the world than there were 60 years ago when the so-called War on Drugs got launched. So it’s a complete failure on its own terms.”

Arbour, also a former justice of the Supreme Court of Canada, said striving for a drug-free world is “ridiculous.”

Despite governments around the world spending $100 billion on prohibition annually, drug use is on the rise, the report said, with an estimated 292 million people having consumed illicit substances in 2022—up from 185 million in 2002. Cannabis remains the most popular, though it is decriminalized or legalized in dozens of countries and 24 US states.

“Drug use itself is not the issue. It has been a part of human societies for centuries. The real problem lies in how society responds to it,” said an executive summary from the Commission.

“Part of the reason that fentanyl is rampant in the US and a lot less so, almost nonexistent up to now, in Europe, is because the US cracked down.”

The report said prohibition has resulted in increased violence, strained justice systems and increasingly toxic drug supplies.

“Part of the reason that fentanyl is rampant in the US and a lot less so, almost nonexistent up to now, in Europe, is because the US cracked down on heroin,” Arbour said. Blocking one substance from the market, she noted, just means “it will immediately be replaced by something else.” Market pressures created by enforcement incentivize the production of more potent substances.

Drug-war policies infringe on many human rights, the report detailed, and disproportionately impact Black, Brown and Indigenous people. As of 2022, 40 percent of all Black federal prisoners in the US were being held for a drug conviction. For Latinos, that figure was 60 percent.

In 2023, 40 percent of known executions around the world were for drug convictions.

President-elect Donald Trump has repeatedly expressed support for the death penalty for smuggling or selling drugs. As the US braces for his second presidency, a backlash against progressive drug policy is already underway, with Oregon reversing its decriminalization scheme and California allowing involuntary treatment for people who are homeless and use drugs. In Philadelphia, ground zero for “tranq dope”—a combination of opioids and the veterinary sedative xylazine—police regularly conduct street sweeps of the Kensington neighborhood, targeting the many people there who are unhoused and using drugs. The city is building a $100-million treatment center next to a jail that will be able to hold 600 people.

Canada is also regressing. Ontario plans to shut down 10 supervised drug consumption sites and British Columbia has gutted its decriminalization pilot project. BC and Alberta are also both considering involuntary treatment.

The decriminalization reversals are driven by public and commercial frustration with public drug use and visible poverty. However, the report notes, “decriminalization of drugs isn’t the cause of the housing crisis; criminalization of drugs won’t solve it either. The real cause of the housing crisis lies in housing policies and inequality, not drug policy reform.”

“If we were designing drug policies from scratch, this model would look ridiculous. It would be the most radical model.”

Arbour sees the re-entrenchment of the drug war as part of a larger embrace of right-wing populism.

“There’s an undertone of morality. Law enforcement is highly valued, and so more of that is superficially very appealing, I think, to the general public,” she said.

But she also said it’s simply difficult for people to think outside of the box when they’ve been subjected to prohibition for decades. Even though it’s not working, there’s a belief that scaling up enforcement is the solution.

“If we were designing drug policies from scratch, this model would look ridiculous. It would be the most radical model,” she said. “If you want to control tobacco, have we ever considered putting in jail people who smoke and then sending them to compulsory treatment? Locking them up to try to wean them from their addiction? I mean, it’s just completely unthinkable.”

The report was also critical of involuntary rehab and drug treatment courts, through which people charged with a crime can avoid jail by agreeing to treatment, noting that there’s a high risk of people whose substance use is non-problematic being forced into treatment under these programs. Involuntary treatment can increase the risk of overdose, after people forced to be abstinent are released with lowered tolerance.

“It doesn’t make any sense to treat someone who doesn’t have a problem, someone who’s not addicted or drug-dependent, doesn’t need treatment. What they may need is better information, better products, so they know what they consume,” Arbour said.

To that end, she said Canada’s legalization of cannabis in 2018 was the “non event of the century” in terms of dire prophecies coming true. But people are now able to be selective over what they’re consuming, which includes CBD or products that don’t produce a high.

The Commission found that cannabis legalization had led to a reduction in illegal activity and better health outcomes.

“We’ve managed the control and consumption of a lot of dangerous substances, like tobacco, alcohol, sugar … through information and so on, but not through prohibition,” Arbour said.

“I think history makes clear that people have searched forever for either mind-enhancer substances, or they look for things for pain control or just pure pleasure,” she added. “Prohibition clearly doesn’t work, nor does anything that would completely try to preclude people seeking access to these kinds of substances.” 

Photograph of DEA agents training via Defense Visual Information Distribution Service/Public Domain

The post “There’s Nothing in It That Works”—Global Commission Slams Drug War    appeared first on Filter.

The death penalty for drug smugglers and increased military action against transnational drug trafficking organizations are part of Trump’s plan to address the United States’ overdose crisis—a topic that was largely ignored in the run-up to the election, along with drug policy writ large.

“When I am back in the White House, the drug kingpins and vicious traffickers will never sleep soundly again,” Trump said in his drug policy agenda released in December.

His aggressive stances deeply concern drug policy experts and advocates, who told Filter they expect a second Trump presidency to escalate the drug war, deal a devastating blow to harm reduction efforts and make the drug supply even more hazardous.

Silver linings in the new political reality are scarce. Trump recently indicated some support for cannabis reform and his attorney general pick, Matt Gaetz, has voted to decriminalize it. Meanwhile Robert F. Kennedy Jr., the frontman of Trump’s “Make America Healthy Again” (MAHA) approach, has been critical of the drug war and has expressed support for legalizing cannabis and psychedelics.

Kennedy, who has perpetuated conspiracy theories about vaccines and threatened to make sweeping cuts to the Food and Drug Administration and National Institutes of Health, was confirmed on November 14 as Trump’s pick to head the Department of Health and Human Services.

Here are some of the major drug-policy themes we can expect from the second Trump administration, and advocates’ related fears.

“War on the Cartels”

Trump’s incoming “border czar” Tom Homan has said the new government will designate transnational drug trafficking groups as foreign terrorist organizations.

“These cartels are animals. And that’s why President Trump’s gonna take them off the face of earth,” Homan, the former acting head of Immigration and Customs Enforcement (ICE), told Fox News on November 11.

He echoed Trump’s drug policy agenda, which promised to “wage war on the cartels.” Trump also pledged to fully secure the border, deploy the Navy to disrupt fentanyl being trafficked by ship, and direct the military to launch “covert and overt actions to inflict maximum damage on cartel leadership.”

Claire Zagorski, a harm reduction expert and PhD student in translational science at the University of Texas at Austin, said drug trafficking groups are so successful in part because they’re nimble and can operate from many different countries.

“It’s not like they have headquarters on Google Maps that you can bomb,” she told Filter.

But David Bier, director of immigration studies at the Cato Institute think tank, said Trump’s border policy pertaining to fentanyl isn’t so different to President Joe Biden’s.

“The Biden administration has been aggressive in trying to stop fentanyl from entering the United States,” he told Filter. “They’ve been deploying lots of non-invasive scanners and making lots of seizures, and I think it’ll be more the same.”

“Every time they crack down at the border, it just provokes more innovation.”

While drug seizures may increase, Bier said this is unlikely to reduce the availability of fentanyl in the US, because the cost of production is so low that any seized amount can be replaced “tenfold.” If anything, Bier said, seizures will increase the potency of the drugs being smuggled as producers adapt to new restrictions, per the Iron Law of Prohibition.

“There’s really not … a clear limit to how potent synthetic opioids can get,” he said. “And so every time they crack down at the border, it just provokes more innovation.”

Trump has consistently scapegoated undocumented immigration for the arrival of fentanyl and fentanyl-involved overdose, but this has little basis in reality.

In a 2023 Cato Institute report, Bier analyzed federal data to show that 89 percent of convicted fentanyl traffickers in 2022 were US citizens, and that most drugs are seized at legal border crossings.

Trump’s plan to “destroy the drug cartels,” includes asking Congress to allow for drug smugglers and traffickers to receive the death penalty.

“You’ll never really solve the drug problem unless you do what other countries do, and that’s the death penalty for drug dealers,” he told Fox News in June.

Maritza Perez Medina, director of federal affairs for the Drug Policy Alliance (DPA), finds it plausible that Trump could change federal law to execute people convicted on federal trafficking charges.

“He could do that relatively easily through congressional legislation. And that’s the concerning part,” she told Filter.

Republicans won control of the Senate on November 5, and on November 13 were projected to retain a majority in the House, giving them a trifecta.  

Harm Reduction “in Peril” 

While overdose deaths remain extremely high, preliminary data released by the Centers for Disease Control and Prevention in October showed they dipped by 12.7 percent in the 12-month period ending in May.

While the Biden administration has at least paid lip-service to harm reduction, taking certain steps while backing off others, Trump has never pretended to support it.

Though many factors could have played a part, there’s strong evidence that increased harm reduction resources, including from Biden’s push to make naloxone more accessible, have helped curb deaths. Like many, Medina fears Trump will undo that progress.

“I think harm reduction is really in peril,” she said.

While the Biden administration has at least paid lip-service to harm reduction, taking certain steps toward it while backing off others, Trump has never pretended to support it.

His win comes at a time when harm reduction efforts are regularly being thwarted at state and local levels. Oregon has reversed its drug decriminalization policy, California has legalized forced treatment for drug users, and San Francisco just elected Daniel Lurie as mayor, who plans to crack down (even more than his predecessor) on the city’s public drug use. The same tactic has been employed in Philadelphia.

A federal judge recently dismissed a case by Safehouse, a nonprofit in Philadelphia that has been fighting to open an overdose prevention center. Safehouse was sued by the previous Trump administration in 2019, which stopped it from opening the facility.

New York’s two overdose prevention centers, which have averted over 1,500 overdoses since opening in November 2021, might also be at risk, Medina said.

“Harm reductionists keep getting wins. We keep producing really great evidence that what we’re doing works,” Zagorski said. But, “it is not aligned with this … ‘pray the sin away, hard work will liberate you’ kind of mindset that you should just stop using drugs.” 

Uncertainties Over Cannabis, Psychedelics

Trump’s opponent in the presidential election, Vice President Kamala Harris, made history as the first major presidential nominee to support federal cannabis legalization.

Trump hasn’t gone as far. But in September, he expressed support for cannabis reform on his social media site Truth Social, saying he was voting in support of a Florida ballot measure to legalize it for adult use.

“As President, we will continue to focus on research to unlock the medical uses of marijuana to a Schedule 3 drug, and work with Congress to pass common sense laws, including safe banking for state authorized companies,” he said.

Florida’s Amendment 3 won 56 percent support on November 5, but failed to reach the 60 percent threshold required to change the state constitution.

“There’s been a lot of hype around the rhetoric itself, without a lot of follow-through and thought.”

Biden’s Department of Justice started a process of requesting cannabis be moved from Schedule I to the less-restricted Schedule III of the Controlled Substances Act, but the DEA has pushed back a hearing on the issue until next January or February.

According to the Drug Policy Alliance, rescheduling cannabis—as opposed to descheduling it—could still result in penalties for people using and selling it without a license, or deportations for non-citizens working in the industry.

“There’s been a lot of hype around the rhetoric itself,” Cat Packer, DPA’s director of drug markets and legal regulation, told Filter of Trump’s approach, “without a lot of follow-through and thought around what it would actually take to implement policy that works and serves veterans, consumers, patients, and all of the other stakeholders that continue to be impacted by federal cannabis criminalization.”

Regarding psychedelics, Trump has been largely silent. But Kennedy recently tweeted that the FDA’s “war on public health is about to end. This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.”

Kennedy has also expressed disappointment that the FDA didn’t approve MDMA as a treatment for PTSD earlier in 2024.

“My concern is that we could be creating a space of capitalism where certain folks have access to psychedelics and other folks continue to be criminalized.”

Meanwhile billionaire Elon Musk, who currently wields significant influence over Trump and will co-lead a newly-created “Department of Government Efficiency,” says he uses prescription ketamine and has used other psychedelics, according to the Wall Street Journal.

However, Packer noted that the extent to which Trump supports reform around these substances is unclear, while the nature of any reforms is also critical.

“My concern in particular is that we could be creating a space of capitalism where certain folks have access to psychedelics,” she said, “and it may be at extremely high cost here, and other folks continue to be criminalized.”

Recovery Farms?

It became somewhat easier to get methadone and buprenorphine under the first Trump administration, partially due to restrictions easing in the pandemic. In 2018, Trump also signed into law the SUPPORT Act, funding “community based treatment and recovery programs” and requiring Medicaid to cover FDA-approved opioid use disorder medications.

But he will jeopardize access to these medications and much more if he dismantles the Affordable Care Act in his second term.

Trump has made conflicting statements about repealing the ACA, also known as Obamacare. But even if he doesn’t scrap it, enhanced subsidies will expire in 2025 unless his administration extends them. The program’s Medicaid expansion has granted health insurance to around 1.5 million people with opioid use disorder.

During a MAHA town hall in October, Kennedy, who identifies as in recovery from heroin addiction, said he wants to create self-sustaining treatment communities for “addicts,” particularly in rural areas. He envisions them having organic farms and teaching people trades, and said they’ll be funded by moving cannabis off Schedule I and collecting federal taxes on weed that’s being “sold anyway.”

The intention raises the possibility of coerced treatment, which harm reduction advocates condemn as unethical, ineffective and often harmful.

In the town hall, Kennedy said the country needs to reclaim its “greatest asset” by getting people off drugs. “We’re losing huge resources right now, vast resources, by allowing 120,000 kids to die every year, and then 10 times that remain as addicts who are a drain on our society.”

“Prisons are not recovering people, they’re not designed to. They’re warehouses for people,” he said. “This is an alternative to prison. It’s really a redemption program.”

However, the intention that the communities would host people with drug convictions, who are otherwise threatened with jail, raises the possibility that they could amount to coerced treatment, which harm reduction advocates condemn as unethical, ineffective and often harmful.

Zagorski said Kennedy’s vision will be stymied by bureaucracy and incredibly expensive to implement, even with the cannabis funds if that were ultimately realized. A concept painted to sound nice, she added, could end up being closer to work camps that reflect a “protestant idea of suffering to remove your sins.” 

Update, November 14: This article has been updated to reflect Trump’s announcement, after publication, of Kennedy as his pick to lead the Department of Health and Human Services.

Photograph by Gage Skidmore via Flickr/Creative Commons 2.0

The post “War on Cartels” and Harm Reduction in Peril—Drug Policy Under Trump appeared first on Filter.

The Friends actor, 54, drowned in a hot tub at his Los Angeles home in October, after consuming a large dose of ketamine, an anesthetic with dissociative effects. According to the medical examiner’s report, his accidental death was caused by the “the acute effects of ketamine,” with contributing factors listed as drowning, coronary artery disease and buprenorphine. But at the time, toxicologists said it’s unlikely Perry—who had enough ketamine in his system to undergo surgery—would have died if he had not been in a body of water.

On August 19, the DEA announced that five people had been charged in connection with his death, including two doctors, an alleged North Hollywood drug seller described as the “ketamine queen,” and Perry’s assistant, who allegedly injected him with ketamine, including on the day he died.

Perry had been undergoing ketamine infusion treatments in a clinical setting to treat his depression. But DEA Administrator Anne Milgram said in a press conference that “when clinic doctors refused to increase his dosage, he turned to unscrupulous doctors who saw Perry as a way to make quick money.”

The DEA alleged that Dr. Salvador Plasencia contacted Dr. Mark Chavez, who previously ran a ketamine clinic, to illegally obtain the drug for Perry, texting, “I wonder how much this moron will pay.”

Chavez, who pleaded guilty to conspiracy to distribute ketamine causing death, allegedly procured the ketamine by filling a fraudulent prescription and through “ketamine queen” Jasveen Sangha. Sangha allegedly charged Perry over $50,000 for about 50 vials.

Milgram told CBS that Perry’s case was reminiscent of the early days of the opioid-involved overdose crisis, “where many Americans became addicted to controlled substances in doctors offices and through medical practitioners that then turned into street addiction.”

She said the doctors didn’t evaluate Perry correctly and left behind vials of ketamine for his assistant to inject him with unsupervised.

“We, every single day, are targeting and investigating doctors, nurse practitioners, others who are violating this duty of trust to their patients by over-prescribing medicine or prescribing medicine that isn’t necessary,” she said.

Pain patients, in particular, and advocates have pointed to how earlier prescribing crackdowns have caused harms including exacerbating the overdose crisis.

“They use the popularity of the person and the tragedy to center themselves in the conversation, to peddle disinformation, kind of fueling drug panics, and essentially pat themselves on the back.”

The circumstances surrounding Perry’s death may point to a need for better regulation of the ketamine industry, which has exploded in the last few years, with hundreds of clinics opening across the country. The pandemic also made it much easier to obtain prescriptions for intranasal and oral ketamine, which can be taken at home without supervision.

However, Milgram’s framing of Perry’s death is also a public relations play for the DEA, said Leo Beletsky, a Northeastern University professor of law and health sciences.

“There’s a long line of cases just like this where a high-profile person, oftentimes a celebrity … dies of drug-related problems, overdose or other related issues and law enforcement use these deaths as an opportunity for a PR campaign,” he told Filter.

Similarly to Perry, there were large-scale investigations following the deaths of actor Michael K. Williams and rapper Mac Miller.

“They use the popularity of the person and the tragedy to center themselves in the conversation, to peddle disinformation, kind of fueling drug panics, and essentially pat themselves on the back,” Beletsky said.

Perry’s assistant, Kenneth Iwamasa, has pleaded guilty to conspiracy to distribute ketamine causing death and is facing up to 15 years in prison. In the case of opioid overdoses particularly, people who sell or even share drugs with someone who then dies are increasingly being charged with murder.

“We can have a conversation about whether or not it makes sense to charge, like, bona fide drug dealers with dealing drugs to folks,” Beletsky said. But when Iwamasa was employed by Perry and appeared to be following his demands to procure ketamine, “holding them accountable for this and giving them a long prison sentence serves no one except for law enforcement.”

“Mr. Perry (and his deep pockets) are no longer around to protect the assistant. Without that patronage, the legal system has come for him.”

Observers including celebrity gossip columnist Perez Hilton have asked if Iwamasa should be charged with involuntary manslaughter because he had found Perry unconscious multiple times in the weeks leading up to his death, according to a plea agreement obtained by Page Six. On the day he died, Perry instructed Iwamasa to inject him with ketamine three times. “Shoot me up with a big one,” he said before his final dose.

In an August 21 New York Times essay, Harvey Weinstein’s former assistant Rowena Chiu described an inherent power imbalance between a celebrity and their assistant, where the former is “surrounded by a stream of sycophants who tell them they are above the law.”

“Mr. Perry (and his deep pockets) are no longer around to protect the assistant. Without that patronage, the legal system has come for him,” Chiu wrote.

Milgram’s description of ketamine as a drug that “has a high potential obviously for addiction,” is also a mischaracterization, according to doctors who work with the substance.

Ketamine has been used as an anesthetic since the 1970s, but it is not approved by the Food and Drug Administration for mental health conditions, despite strong evidence that it is an effective depression treatment. It is prescribed off-label for mental health issues.

“Opiates have a much stronger addictive potential because it has a very strong withdrawal effect … where people feel very uncomfortable if they don’t continue to take the medication,” Dr. Sandhya Prashad, president of the American Society of Ketamine Physicians, Psychotherapists and Practitioners, told Filter.

Ketamine-involved deaths are rare. A 2021 study published in the Journal of Psychopharmacology in 2021 found that in England, where unregulated use of the drug is much more popular, there are around 30 deaths a year with ketamine present. Other drugs are also present in most cases, and it shouldn’t be assumed that ketamine caused the deaths.

Still, Prashad said you can become psychologically dependent on ketamine, just as you can with many substances and non-drug activities. At that point, she said, it might become much less effective as a medical treatment, partly because a person’s tolerance would go up if they use a lot. Prashad said she’s not convinced Perry would have been a good candidate for ketamine infusion, given his history with substance use disorders.

“I’m very worried, absolutely. I think they’re going to crack down.”

Ketamine providers have been dealing with supply chain issues, Prashad noted, as some wholesalers are being increasingly restrictive about selling the drug to mental health clinics. The scrutiny over Perry’s death will make it even harder to obtain, she said, which she doesn’t think is a good thing.

Neither does Kimberly Juroviesky, 53, a military veteran who has been using ketamine to treat complex regional pain syndrome for 10 years. While she said ketamine infusions have provided her with tremendous relief from her pain, she has “never, ever craved it, never wanted to use it illicitly.” 

“I’m very worried, absolutely. I think they’re going to crack down,” she told Filter.

Juroviesky said she wants to see the FDA regulate ketamine as a mental health treatment and come up with proper protocols for usage.

Prashad said having insurance companies cover ketamine therapy could help increase patient protection, because there’s a process to follow before someone would get approved, taking into account their medical history. She also suggested a registry of ketamine providers could add guard rails.

“Making it harder for people to access drugs drives people to unsafe use behaviors, like using alone, and also creates a market for unethical people to take advantage.”

Dr. Ryan Marino, medical director of toxicology and addiction medicine at University Hospitals in Cleveland, said the doctors’ alleged actions in the Perry case were “more than just unethical.”

“But Matthew Perry drowned while intoxicated on ketamine the same way people routinely drown while intoxicated on alcohol,” he told Filter. “Making it harder for people to access drugs drives people to unsafe use behaviors, like using alone, and also creates a market for unethical people to take advantage, like this case.”

“It feels like the DEA are simply taking advantage of a tragedy to seek increased relevance, powers, and funding, when they have not made any improvements in the opioid problem by following this same exact playbook for many years now,” he continued.

Celebrity overdose cases often elicit emotional responses from the public, with calls for justice in part because people have an attachment to the person who died. Beletsky said that’s understandable, but that law enforcement tend to elevate those narratives. On the other hand, when people don’t want their friends or family members charged after an overdose, law enforcement “ignore those voices, and they choose to lift up the voices of those who call for more criminal justice intervention.”

During the July 2023 sentencing of Carlos Macci, an illiterate elderly man who was part of the crew that sold The Wire star Williams opioids before he died, Williams’ nephew Dominic Dupont called for empathy alongside accountability: “Michael K. Williams was a person who believed in love, who believed in an opportunity for people to get themselves together.”

Photograph of Perry in 2013 by Policy Exchange via Flickr/Creative Commons 2.0

The post The DEA Is Using Matthew Perry’s Death to Fuel Its Drug War appeared first on Filter.

President Joe Biden signed into law the Fentanyl Eradication and Narcotics Deterrence (FEND) Off Fentanyl Act in late April. It will purportedly make it easier for federal agencies to disrupt the flow of fentanyl into the US by declaring international trafficking a national emergency, sanctioning transnational groups believed to traffic fentanyl, and fighting fentanyl-related money laundering, among other measures, according to a Senate news release.

Senator Sherrod Brown (D-OH), who crafted the bill, said in a statement that the law will “allow us to go directly after the drug cartels’ billions in illicit profits, targeting the entire fentanyl supply chain and sanctioning illicit opioid traffickers and money launderers in China and Mexico.”

FEND is being applauded by law enforcement agencies, which helped him create the legislation, according to Brown.

“Its passage will help stop the flow of this deadly poison into our country and help us save lives,” said Tom Austin, executive director of the Ohio Patrolmen’s Benevolent Association, a union for Ohio cops, in a news release by the National Sheriffs’ Association.

“We’re going to get another, more potent drug in the supply.”

But Maritza Perez Medina, director of the office of federal affairs for the Drug Policy Alliance, said focusing on disrupting traffickers is “more of the same.”

“It’s just going to create an environment where drug manufacturers are gonna want to be more creative, to not lose the profit,” she told Filter. “We’re going to get the same results. We’re going to get another, more potent drug in the supply.”

Jeffrey Singer, MD, a senior fellow at the Cato Institute think tank, similarly said that the new law is not only “futile,” but will likely result in trafficking organizations putting new substances into the supply, including nitazenes—a group of emerging synthetic opioids with variable and sometimes very high potency.

“Depending on which kind of nitazene you get, it could be anywhere from equivalent to, to much more potent than fentanyl,” Singer told Filter. “And they’re going to be much harder to trace because they’re from a category of drugs called benzimidazoles.”

Benzimidazoles, he explained, are composed of precursor chemicals that are commonly used for legal drugs, including antacid treatments, antifungals and blood pressure medications.

“If it gets harder and harder for trafficking organizations to get their hands on fentanyl precursors, it’ll just give them all the more reason to switch.”

Depending on what a chemist adds to the basic benzimidazole structure, the resulting substance can “travel in all different directions,” Singer said. “If it gets harder and harder for drug trafficking organizations to get their hands on fentanyl precursors or precursors of fentanyl precursors, it’ll just give them all the more reason to switch to benzimidazoles.”

In its national drug threat assessment released May 9, the Drug Enforcement Administration stated that the shift from plant-based drugs like heroin and cocaine to synthetics “has resulted in the most dangerous and deadly drug crisis the United States has ever faced.”

DEA Administrator Anne Milgram said in a news release that the agency’s response is to “use all available resources to target” global drug distributors.

This isn’t the first time the US has put pressure on other countries to curb fentanyl production. In 2019, President Donald Trump successfully pushed China to ban the production and sale of fentanyl, which resulted in far less of the finished product being shipped directly from China to the US. But that dramatic drop didn’t last, and Mexican trafficking groups adapted by using precursor chemicals to manufacture fentanyl themselves.

Seizures of fentanyl reported by Customs and Border Protection have increased more than 800 percent since 2019. Other substances, including xylazine, the animal tranquilizer combined with heroin or fentanyl to make tranq dope, are also increasingly prevalent in the US drug supply in many regions.

A renewed crackdown could see history repeat itself, simply displacing and diversifying production.

A renewed crackdown could see history repeat itself, simply displacing and diversifying production. If manufacturers in China, for example, are under too much scrutiny, then those in India, another chemical industry giant, could take their place, Singer said. That goes for Mexico, too.

“A lot of people in the press, as well as in government, think of these organizations as Mexican-based drug cartels. In fact, they really need to be thought of as transnational drug trafficking organizations,” Singer said. “To think that, you know, you’re gonna be able to trace money in and out of Mexico… These organizations are now global.”

Both Perez Medina and Singer believe the government is aware that more law enforcement won’t solve the overdose crisis.

“They’re trying to be responsive to what they’re seeing, and that’s the unfortunate deaths of a lot of their constituents,” Perez Medina said. “But rather than educating people about what works, they’re going with the easiest option. And the easiest option is criminalization because that’s what our culture is used to after 50 years of the work of a drug war.”

Expanding access to health care and harm reduction, she said, is the approach that could actually “turn this tide.” 

Photograph of seized fentanyl via Picryl/Public Domain

The Influence Foundation, which operates Filter, previously received a restricted grant from the Drug Policy Alliance.

The post FEND Act Against Fentanyl Trafficking Could Worsen Overdose Crisis appeared first on Filter.

Unnamed DEA sources told AP that the agency wants to reclassify marijuana from a Schedule I drug, on par with heroin, to a Schedule III drug, like ketamine. The DEA’s proposal still needs to be approved by the White House Office of Management and Budget.

The move represents a historic shift away from many decades of cannabis prohibition. But it falls short of full decriminalization or legalization.

“We all deserve a federal framework that upholds the health, wellbeing and safety of our communities—particularly Black communities who have borne the brunt of racist enforcement.”

The rescheduling still leaves people vulnerable to arrest, and doesn’t make it legal to sell weed. Being caught with cannabis can still cause a non-citizen to be deported.

“We all deserve a federal framework for marijuana that upholds the health, wellbeing and safety of our communities—particularly Black communities who have borne the brunt of our country’s racist enforcement of marijuana laws,” said Cat Packer, director of drug markets and legal regulation at the Drug Policy Alliance, in a news release.

Schedule I drugs are defined by the DEA as having “no currently accepted medical use and a high potential for abuse,” while Schedule III substances are deemed to have “a moderate to low potential for physical and psychological dependence.” The Biden administration had announced a scheduling review for cannabis in October 2022.

“It is significant for these federal agencies, and the DEA and FDA in particular, to acknowledge publicly for the first time what many patients and advocates have known for decades: that cannabis is a safe and effective therapeutic agent for tens of millions of Americans,” said Paul Armentano, deputy director for cannabis advocacy group NORML, in a statement.

“Existing state legalization laws—both adult use and medical—will continue to be in conflict with federal regulations.”

Cannabis is currently legal for adult use in 24 states and Washington, DC, while at least 17 states have legalized weed for medical purposes. However, cannabis businesses currently operating, even in legal states, are federally illegal, which makes banking, insurance and other logistics challenging.

It’s not clear how those businesses would have to change to adapt to cannabis having a Schedule III status. Ketamine clinics, for example, are tightly controlled by the DEA.

“Existing state legalization laws—both adult use and medical—will continue to be in conflict with federal regulations, thereby perpetuating the existing divide between state and federal marijuana policies,” Armentano said.

In October 2022 and again in December 2023, the White House announced mass pardons for thousands of people convicted of marijuana possession. The measure didn’t actually release anyone from prison, as there are very few people in federal prisons over simple possession. While a pardon does not expunge a person’s conviction, it can remove restrictions on their ability to vote, hold office, and find housing and employment.

Despite advancing some unprecedented cannabis reforms, the Biden administration has been strongly criticized for failing to follow through on past promises—including by a coalition of advocacy groups that gathered in Washington, DC, for a week of lobbying and protests to mark 4/20. The end of marijuana prohibition has not yet come. 

Photograph by the Alaska Landmine via Flickr/Creative Commons 2.0

The Influence Foundation, which operates Filter, previously received a restricted grant from the Drug Policy Alliance. Filter‘s Editorial Independence Policy applies.

The post DEA Agrees to Make Marijuana Schedule III, in Historic Move appeared first on Filter.

Needlepoint had already been operating as a syringe provider in three locations around the city for five years, but according to executive director Willie Hurlie, the CDC certification gives it access to state funding.

Upon learning about Needlepoint’s certification in March, however, the city of Bangor responded by stating its disapproval of the organization’s two downtown locations—one in Pierce Park, by the public library, and another in Pickering Square, near a bus hub. Needlepoint fears it could be fined if it continues operating in those places without a permit from the city.

“While a [syringe service program] does not result in syringe waste per se, as a community the amount of syringe waste within our public spaces presents a public health risk to all,” said a March 21 letter from City Manager Debbie Laurie to Bangor City Council.

Filter previously reported on how officials in Bangor, as in other places, have used “syringe litter” as a pretext to restrict harm reduction services.

Laurie said she told CDC representatives that Needlepoint should find alternative sites on private property. She said community members have expressed “significant concerns” about the two downtown locations.

“We need to start aggressively fighting back against these municipalities.”

Bangor is just one of numerous cities suppressing or pushing back on harm reduction efforts in the midst of an unprecedented overdose crisis. Politicians in Philadelphia want to cut funding to syringe service programs (SSP) as the city’s Kensington neighborhood, in particular, grapples with harms and deaths related to tranq dope. Police in Boise and Caldwell, Idaho, raided harm reduction organizations in those two cities in February. Meanwhile, an SSP in Atlantic City, New Jersey, recently settled after suing the city for trying to shut it down.

Bangor’s opposition comes as the city is dealing with an HIV outbreak, with five confirmed new cases in a six-month period among people who inject drugs, as of March 25, according to Maine CDC.

“We need to start aggressively fighting back against these municipalities,” Hurlie told Filter, “because it’s just fucking absurd that they find out about an HIV cluster outbreak and they’re like, ‘You know what, now’s the time to ban the syringe service program downtown.’”

Bangor’s library board also passed a resolution stating it strongly opposed the distribution of “drug paraphernalia” in Pierce Park or any space adjacent to the library, because it “perpetuates a culture of open and unsafe use” and increases “the burden on library staff to constantly monitor for and reverse opioid overdoses.”

David Warren, a spokesman for the city of Bangor, told Filter the city “supports a compassionate approach to those struggling with substance use.” But he added that the city is opposed to having SSP in those two places.

“Pickering Square and Pierce Park are both popular public areas, with families, teenagers and senior citizens often using them or passing by,” he said. “Pierce Park is adjacent to the Bangor Public Library, which offers a variety of programming for children and young families. The City doesn’t believe a needle exchange program in proximity to either of these locations is in the best interest of Bangor residents.“

Bangor’s opposition to certain SSP locations is less sweeping than that seen elsewhere, however.

In Philadelphia, harm reduction workers have become the national face of helping people who use tranq—a combination of illicit opioids and the animal tranquilizer xylazine, which is linked with increased risk of overdose, severe wounds and amputations—amid intersecting crises of poverty and homelessness.

The importance of front-line harm reduction there has been recognized with visits from White House “drug czar” Rahul Gupta. Yet, as Filter has recently reported, Philadelphia harm reduction organizations are dealing with escalating law enforcement-, budget- and property-related crackdowns.

“It hurts deeply to know that leadership is so dismissive of my work and my team, and our mission.”

As the Philadelphia Inquirer reported, Mayor Cherelle Parker (D) wants to cut around $1 million in funding to Prevention Point, a harm reduction organization that has been providing sterile syringes and HIV testing in the city for 30 years.

“I will fight tooth and nail to make sure that not one city dollar is invested in the distribution of clean needles,” Parker previously stated.

City staff have said the cuts will likely lead to spikes in HIV transmissions.

Savage Sisters, an organization that provides wound care, naloxone training and overdose reversals in Kensington, will be losing its storefront space once its lease is up in September. The property is owned by developer Shift Capital, which has told media outlets it remains “supportive of community-minded organizations.”

Executive Director Sarah Laurel told Filter the lease termination news came after a contentious meeting the group had with Councilmember Quetcy Lozada (D). “Her ultimate goal was to remove all harm reduction groups from her corridor, which is Kensington.”

Lozada, who reportedly urged Shift Capital not to renew the lease, told the Inquirer that Prevention Point and Savage Sisters have “not been good neighbors.”

“It hurts deeply to know that leadership is so dismissive of my work and my team, and our mission,” Laurel said. “Because we spend every single day dealing with the hardest, ugliest, most brutal parts of our city and the community. And we do it with love and intention.”

The city, she continued, may not understand the consequences of its crackdown until it’s too late. “The most obvious impact is going to be death. The community is going to suffer, you’re going to see infectious diseases spread at a higher rate, you’re going to see amputations increase.”

According to city data, over 1,400 people died of unintentional overdose in 2022, up 11 percent from 2021, with Black and Hispanic residents disproportionately impacted.

Philadelphia’s public health department did not respond to Filter’s request for comment.

As for how local harm reduction groups can fight back against cities’ hostility, Atlantic City’s SSP, operated by the South Jersey AIDS Alliance, may offer one clue.

The organization, which provides the area’s only SSP, sued after the city adopted an ordinance in 2021 prohibiting it from distributing syringes.

“Having a place for someone to go, a place where they can trust that they will not be judged, is super-important.” 

A favorable settlement came in January, as the climate for harm reduction improves across New Jersey. In 2023, two years after the South Jersey AIDS Alliance got a temporary restraining order against Atlantic City, New Jersey amended its Bloodborne Disease Harm Reduction Act “to limit a municipality’s ability to reduce or terminate the provision of syringe access services,” according to the organization’s news release.

In addition to declaring the city’s ordinance null, the settlement requires the city to give the group advance notice of any planned land-use changes that would impact its ability to distribute syringes.

New Jersey also removed harm reduction supplies, including xylazine test strips, from its drug “paraphernalia” laws in January.

“By giving out supplies to help reduce their harm, we show [people] that we care for them and want to protect them and keep them safe,” Georgett Shelton, president and CEO of the South Jersey AIDS Alliance, told Filter.

“Having a place for someone to go, a place where they can trust that they will not be judged, is super-important.” 

Photograph (cropped) by Governor Tom Wolf via Flickr/Creative Commons 2.0

The post Local Harm Reduction Programs Under Siege appeared first on Filter.