There is no silver bullet for solving the opioid epidemic. The Centers for Disease Control estimates that every day more than ninety people in the United States die due to opioid misuse. Opioid overdose is now the most common cause of death in the US, responsible for more annual deaths than vehicular accidents or homicides. Two recent studies add to the mountain of evidence that medicinal cannabis can be a part of reversing that trend. When President Trump declared the opioid epidemic to be a Public Health Emergency, it was a sign that the government was willing to get serious about tackling this problem. Even as federal funding has been increased to deal with the opioid crisis, Trump and Attorney General Sessions have rejected one of the most important steps that they could take: removing cannabis from the list of Schedule 1 drugs. The Controlled Substances Act was signed in 1970 as President Richard Nixon was ramping up the War on Drugs. This act created the Federal Drug Scheduling System, which classifies drugs by both their medical value and potential for abuse. Cannabis is classified as a Schedule 1 drug, signifying that it has no medical value and high potential for abuse. Scientists and doctors have spent the ensuing decades proving the federal government wrong. Despite restrictions on how cannabis can be used in research, evidence has continually demonstrated the medical value of cannabis. As a form of pain management, a way to lessen symptoms, and, in some cases, a way to aid in recovery, cannabis has been proven to be able to treat or help in the treatment of HIV, arthritis, asthma, epilepsy, glaucoma, and multiple sclerosis. There are multiple cannabis infused products like CBD juice, available on many websites. Now, new evidence indicates that cannabis can be used to fight the opioid epidemic. Two recent studies have examined the impact that legalizing medical cannabis at the state level has had on rates of opioid prescriptions and overdose deaths. In Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population, researchers found that in states with medical cannabis laws there are significantly fewer people being prescribed opioids under Medicare than in those without. In states with medical cannabis dispensaries that enable even easier access to the drug, those rates are even lower. A second study, Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010, demonstrates that states with medical cannabis laws had rates of opioid overdose mortality nearly 25 percent lower than in states where medical cannabis is illegal. This difference was more pronounced the longer a state had allowed doctors to prescribe cannabis to patients. Despite this evidence, those fighting against cannabis legalization continue to deny its health benefits. A South Carolina medical cannabis bill never received a vote in the state house, despite the fact that in one poll nearly 80 percent of respondents supported its legalization. Opponents of a similar bill in Kentucky have demanded more research on the drug’s long-term effects and questioned whether legalization actually would reduce opioid use. In Utah, a ballot initiative will give voters the opportunity to decide this November whether or not medical cannabis should be legal in their state. A recent poll by The Salt Lake Tribune found that more than three-fourths of Utah voters support the initiative, indicating that it is likely to pass. However, the bill faces considerable pushback. Governor Herbert has voiced his opposition, demanding more research before he would be willing to consider the medical benefits of cannabis. Because of its federal Schedule 1 classification, cannabis is technically illegal even in the twenty-nine states that permit doctors to prescribe it. To save lives we need every possible tool at our disposal, but with a ban on cannabis, and severe restrictions on even studying its benefits, the federal government is stunting its ability to help those most in need. From my own experience, when I visited the closest dispensary to utah it was obvious how the legalisation of Medical Cannabis had positively impacted those patients able to gain access to the dispensary. Without question the more we learn and experience, the more the need to legalize cannabis and remove it from the list of Schedule 1 drugs becomes clear. What remains to be seen, however, is if those in power will continue to ignore that evidence, or if they will finally make things right. Tom Houseman
By Tom Houseman You might be surprised to learn that the most dangerous aspects of heroin use have little to do with the drug itself. Heroin injection’s dangers are largely driven by the risk of overdose (especially if the user is unsure of the potency of the particular dose being taken) and the use of dirty needles leading to infections, HIV, and Hepatitis C. Harm reduction is a strategy to reduce those risks, ensuring that substance use disorder is not a death sentence, and that someone who uses drugs gets the support they need to receive the treatment that is right for them. It is easy to shame and condemn a drug addict, but if we want to help them live, instead of just letting them die, we need to do more. Providing a facility in which people can safely inject under supervision of a medical professional would drastically reduce these risks and save lives, but currently no such facility exists in the United States. You can read about North America’s first safe injection site, Insite, in our review of the book Fighting for Space. Insite staff have overdosed thousands of drug overdoses, and not a single death has occurred. In addition, when heroin users have access to a safe injection facility, rates of HIV and Hepatitis C go down, as do the number of publicly discarded needles. Such a facility would have an enormously positive impact in the United States, yet those who think that these facilities incentivize drug use (they don’t) have ensured that none exist. As a result, those who inject drugs are forced to reuse needles, inject with dirty water, and rush their injection to avoid being caught and arrested. Instead of trying to help those with substance use disorders, too many are only looking for a way to ignore drug users or punish them. Sheetz, a chain of convenience stores in and around Pennsylvania, recently announced that, in an attempt to drive away drug users, they will be replacing all of the lights in their bathrooms with blue bulbs. Because veins are more difficult to locate under blue light, the injection process is harder and more dangerous. While it makes sense that a business would not want illegal activity to take place on its premises, this decision shows how desperately safe injection sites are needed in areas with high rates of heroin use. Overdose deaths in Pennsylvania increased by 37 percent in 2016 to a rate of nearly thirteen deaths per day. In addition, 1,170 people were diagnosed with HIV in Pennsylvania in 2015, and rates of Hepatitis C infections increased by 233 percent. Fortunately, progress is finally being made. On January 23rd, city officials in Philadelphia announced their support for the creation of a safe injection site within the city, the first step in what will likely be a long and legally complicated process. With one of the most liberal District Attorneys in the country, and a police commissioner who was once “adamantly against” such a site but who allowed the evidence to sway him, Philadelphia could be the one of the first cities in the country to open a safe injection site. San Francisco has plans to open a facility in July, while plans are also being discussed in Denver, Seattle, Baltimore, and New York City. One would hope that the religious communities in Philadelphia would support such an act of compassion and charity, seeing it as a way to support members of their community who are struggling with substance abuse. Yet one week after the safe injection site proposal received the approval of city officials, an opinion piece by Gina Christian for the website Catholic Philly rejected the notion of such charity, calling it “a new low” for the city’s efforts to help addicts, and writing that “God would appear to disagree” with harm reduction measures. Armed with inaccurate data and a quote from Catechism of the Catholic Church 2291 on the grave sin of drug use, Ms. Christian says that the real solution to the plight of heroin addicts is to “put the needle down now – forever.” This attitude, in addition to showing a complete misunderstanding of how challenging it can be to struggle with addiction, seems to have little in common with a Christ figure who “comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted” (2 Corinthians 1:3-4). Harm reduction techniques, including safe injection sites, are a way to meet addicts at the place in their addiction where they are, rather than forcing them to adhere to unrealistically strict rules before we offer them help. Instead of seeing addiction as “a deal with the devil,” as Miss Christian does, doesn’t it make more sense to see it as a disease, and to offer those stricken with it any help that we can?
Elizabeth Wittemyer, Attorney At Law Prepared at the Request of the Marijuana Education Initiative When U.S. Attorney General Jeff Sessions decided to issue a memorandum on January 4, 2018, rescinding the Cole Memorandum, it was clear that his long-time wish to demonize marijuana and criminalize activities around the legal state markets had come to pass. I am an attorney who represents the cannabis industry, and several worried clients and colleagues have wished to discuss the issue and the possible consequences with me. The interplay of state and federal law can be confusing, especially as we consider the effects the Sessions Memo will have on the cannabis industry. Understanding the hierarchy of the U.S. Justice Department and its authority over the states is one way to view how this interplay works. The Justice Department is an executive-branch agency that deals with crimes at the federal level and that enforces federal law. The U.S. Attorney General is a cabinet member appointed by the president and is the nation’s chief law enforcement officer for federal law. U.S. attorneys are employees of the Justice Department and prosecute federal cases brought to them by federal law enforcement agencies such as the Federal Bureau of Investigation and the Drug Enforcement Administration. The DEA investigates crimes involving cannabis. You might remember from the television show Law and Order, the DEA investigates crimes as law enforcement officers and the U.S. attorneys prosecute in federal courts the crimes brought to them by DEA officers. Marijuana is federally illegal and is classified as a Schedule I drug under the Controlled Substances Act. The DEA is the lead law enforcement agency for the domestic enforcement of the Controlled Substances Act. The Cole Memorandum from 2013 established a new “prosecutorial discretion” regarding cannabis. It was a policy guidance to U.S. attorneys that made the cannabis industry a low prosecutorial priority in states that had legalized cannabis, as long as those states complied with the guidelines contained in the memo—namely, to protect youth and control diversion. What the Jeff Sessions Memo does is reestablish cannabis, regardless of legality within the states, as a prosecutorial priority along with all other federal crimes. In the memo, Sessions encourages the prosecution of other crimes that can be tied to cannabis, such as money laundering and violations of banking regulations. These types of prosecutions will almost certainly include asset forfeiture actions. The Sessions Memo highlights the “Department’s finite resources” and points to principles of prosecution set in 1980, taking us back to the old, failed policies of the war on drugs. Though U.S. attorneys seem to have little appetite to initiate prosecutions against legal cannabis businesses, the same cannot be said of the DEA. In fact, the DEA has always had a Domestic Marijuana Eradication/Suppression Program aimed at completely eradicating cannabis in the United States. According to the Department of Justice Fiscal Year 2016 Budget submitted to Congress, the DEA spent millions of dollars on marijuana eradication efforts, including anti-legalization education programs. Although the cannabis industry blames the DEA for refusing to reschedule cannabis from its present Schedule I status, it is the Department of Health and Human Services that has the legal responsibility to make scientific and medical determinations regarding drug scheduling. The head of HHS Tom Price resigned in a cloud of scandal in September 2017. The president has nominated Alex Azar, a former pharmaceutical company executive, to fill the position, and Mr. Azar’s confirmation hearing began January 9, 2018. As cannabis is a competing product to pharmaceuticals, it is highly unlikely that a former representative of the pharmaceutical industry, which holds one of the most powerful lobbies in Congress, will consider rescheduling marijuana. With Azar as head of HHS, the pharmaceutical industry would have even more control over our federal agencies in their quest to demonize cannabis, with Jeff Sessions leading the charge. The Rohrabacher-Blumenauer amendment (formerly the Rohrabacher-Farr amendment) is part of the federal budget established by Congress and has been included in every annual federal budget appropriations since 2014. The amendment prohibits the use of federal funds to supersede legal medical marijuana state laws. What many people do not realize is that the amendment primarily protects medical marijuana and not recreational marijuana. This year, Congress has been unable to agree on the budget and has limped along by making continuing resolutions to keep a government shutdown at bay. The last continuing resolution was on December 22, 2017, and it extended the previous budget to January 19, 2018. The Senate appropriations included the Rohrabacher-Blumenauer amendment; the House version did not after Attorney General Jeff Sessions lobbied against its inclusion. It is unclear what will happen to the amendment amid the many other fights over the budget, including immigration, defense, and domestic programs. Even if the Rohrabacher-Blumenauer amendment is included in the next appropriations bill, the rescission of the Cole Memo places the recreational marijuana industry at particular risk. Federal law supersedes state law, “preempting” state laws that conflict with federal laws. With the Cole Memo, the Obama administration allowed states to experiment with legalization of cannabis, in essence, “promising” not to bring a preemption action in federal court that would shut down a state’s legalization of marijuana. Although many legal scholars argue that the states that have legalized have relied on this federal discretion to their detriment, and therefore there are now legal defenses to a preemption action, the legalized states’ courts are not friendly to cannabis. State law cannot legalize what is illegal under federal law. In several court cases, acts that are legal under state marijuana laws were not protected by the courts owing to the illegality of the act under federal law, and this has led to seizures of inventory and loss of jobs. Cannabis businesses must be very careful in seeking relief in the state courts and should instead opt to negotiate, mediate, or arbitrate disputes whenever possible. Although recreational cannabis stands in particular danger because of its relative lack of credibility compared to medical cannabis, the entire legal cannabis industry is at risk. As we experience the devastating opioid crisis, with thousands of lives lost, the Jeff Sessions Memo begs reason and common sense. President Trump declared the opioid epidemic a national emergency; however, no new federal funds were allocated to address the crisis. Medicaid is under attack and will be cut back; by how much is the only question. States, facing budget shortfalls, have cut treatment programs throughout the nation. First responders dealing with opioid overdoses are vicariously traumatized by the horror they experience every day and their resources are stretched to the point of breaking. Our courts, overwhelmed with opioid-related crime cases, have few options to deal with the social ill of addiction through the criminal justice system. We are losing our family, friends, and neighbors every day to opioids. Yet, rather than spend federal money on prosecuting feel-good doctors, pill mills, and foreign actors to attempt to reduce the opioid epidemic, Jeff Sessions will devote the Department of Justice’s finite resources to prosecuting a drug that no one dies from. In fact, research shows the promise of cannabis as an effective treatment in reducing the need for opioids. The question is, therefore, one of where to direct our government’s limited resources. Do we spend federal dollars prosecuting opioids or prosecuting cannabis? Do we spend federal dollars on anti-legalization education or on education that will help our youth make healthy choices around legalization? Education programs such as those of the Marijuana Education Initiative, which provides reality-based education for youth regarding marijuana, are the initiatives that our tax dollars should fund. Now is the time to press our elected representatives to set the nation’s priorities straight. To learn more about the misinformation surrounding marijuana and the opioid epidemic check out our blogs The Truth and Marijuana and Opioids: Sorting Through the Misinformation
We have long known that US Attorney General Jeff Sessions does not approve of marijuana, not to mention any drug. (His office refuses to answer the question of whether he drinks alcohol.) He has famously said that “good people” don’t use marijuana. On January 4, he implicitly threatened states that have legalized marijuana for medical or recreational use. He rescinded an Obama-era memo, issued in 2013, which had signaled considerable leeway for states even though marijuana is illegal under federal law. His timing was ironic. He issued his memo the day before the Vermont House of Representatives was scheduled to vote to legalize marijuana through legislative action. Indeed, they did so on January 5th, and the Vermont Senate did the same a week later. Apparently, as one of my advocacy colleagues said, “They did not get the memo.” Other states where legalization has been recently approved by ballot initiative—most notably Massachusetts and Maine—seem for the most part undeterred by the Sessions memo. In Colorado, one of the first two such states (Washington was the other) to legalize marijuana in 2012, the response has verged upon anger. US Senator Cory Gardner (R-CO) feels betrayed. During Mr. Sessions’ confirmation hearing as attorney general, Sen. Gardner asked for and received assurances that no such action would be taken. There are two reasons why I think we should be not only bemused but angry at what the Attorney General has done. The first is that we have long passed the point of wondering whether cannabis as medicine has value. It clearly does. It is now a reality in 29 states containing over 60% of the U.S. population. Respected medical journals document that marijuana offers relief for patients with cancer and multiple sclerosis and severe chronic pain. An article entitled, “Talking About Marijuana—In Church” in the January 3 issue of The Christian Century notes that marijuana is important to older folks because “it appears to be particularly helpful in coping with the myriad side effects of other drugs.” Are these not “good people”? It is not clear yet what the consequences of the Sessions memo will be, but it may make life more difficult for the providers of medical marijuana. For this, he should be condemned. (We provide the opportunity to TAKE ACTION.) The second reason for anger starts with the fact that we are in the midst of a national opioid health crisis. Mr. Sessions should use the resources of his office to prosecute those in the medical community who have helped to create and continued to fuel this epidemic. When it comes to medical marijuana, he should recognize the promise of marijuana as reducing the need for opioids. Attorney General Jeff Sessions by all accounts likes his job because it enables him to pursue “law and order” policies of the 1980s which he is now in a position to impose. When it comes to marijuana, he is wrong.
Thank you all for inviting me here to be a part of your service. Thanks to Cathy for bringing this topic, which is near and dear to my heart, to your congregation. My name is James. I’m Jewish and we like questions. So, I’m going to start this sermon with a few questions for you to consider. Many of these questions don’t have absolute answers. They are questions we should ask ourselves so that we know where we stand and try to figure out how these beliefs we hold, impact the action we are willing to take. What does a drug user look like? For many of us when we picture what a drug user looks like we imagine someone looking dirty and disheveled, living on the streets with beer bottles or needles scattered around their body. We picture a desperate and dangerous criminal, willing to harm anyone in order to feed their addiction. We picture a person of color, most likely someone who’s black. Where do these images come from? What drives the belief that this characterizes what a typical drug user looks like? As it turns out, these images don’t match the reality of drug use. In a study published in the Journal of Alcohol and Drug Education in 1995, a survey asked people to envision a drug user and describe that person. 95% of respondents described a black person. This is the case despite that fact that the majority of people who use drugs in our country are white. African-Americans make up about 15% of the people who use drugs, roughly equal to their proportion of the general population. When we picture who a drug user is, we don’t readily think of the successful people who have used drugs—executives, scientists, writers, musicians, politicians, Presidents. It would be inaccurate to say that people who use drugs or have used drugs are bad people, or are unproductive members of our communities. In fact, the overwhelming majority of people who try a drug—any drug—will not have a serious problem with that drug in their lifetime. Yet, this image of a drug user as a failure and threat persists. When we hear the term “drug user” we often think of a small group of drugs: cocaine, heroin, methamphetamine. We don’t think about the complete list of drugs—legal and illegal—that people use. So, it begs the question… What is a drug? In general, we would define a drug as a substance that we put into our bodies that alters our mood or physiological state; the caffeine we use to help us get out of bed at the start of the day; the medicine we take to control our blood sugar, blood pressure, or moderate other symptoms that may prohibit us from taking care of business; the glass of wine we use to unwind after a long day at work. All of these are substances we put into our body to alter the way we think and feel. What impact would it make if, instead of thinking about drug users as “other” or “those people”, we all thought about ourselves as drug users? How would that affect the way we approach drug use in our communities? Why, when we hear the term drug user, don’t we picture a successful white person drinking alcohol? What impact does it have on people’s mindset to picture a black criminal, injecting heroin, and to meld these images together when we hear the words, drug user? If we want to change the way we treat people who use drugs and the impact their use has on them and in our communities, we have to address the internal bias and prejudice that we’ve built up over our lifetime. This does not mean that drugs are not harmful. Certainly, all drugs have the capacity to harm people. Partially, we have a skewed perspective of drug users because the people who are most negatively impacted by their use, are inherently more likely to need help and encounter systems like hospitals, treatment programs, and law enforcement. However, we’ve exaggerated the likelihood of harm in order to scare people away from trying drugs. This approach is effective for some but it leaves all the people who will experiment, without any idea that there are more or less harmful ways of using any drug. A quick story, when a friend of mine was a teenager he decided that he wanted to try marijuana for the first time. He bought $25 worth, a quarter of an ounce, from someone at school. Not knowing any better he put all of what he had bought on a sheet of computer paper, rolled it up like a cigarette, taped it shut, and smoked it. We can agree that smoking computer paper and tape isn’t good for you. I tell this story to say, the risk of harm from using a drug is much greater when you don’t know what you’re doing. The risk becomes even more serious when using a drug that can be lethal if used incorrectly. On the other hand, when a person doesn’t know what they are using is a drug, because it’s legal or provided to them by a doctor, there is also a great risk. Alcohol isn’t a drug, it’s a beverage. Vicodin isn’t a drug, it’s medicine. Marijuana isn’t a drug, it’s a plant. In all these cases, it can be both of these things! Not knowing that also makes harm more likely. But, if any drug can cause harm, why do we still use them? To put it simply, people use drugs for a reason. A rabbi I spoke to once generalized the reasons for using drugs as an attempt to feel more present in a moment or to disconnect. We might use drugs to feel more connected with a group of people, to enhance an activity like a meal or concert, to deepen our thinking or sense of spirituality associated with a religious ritual. Indigenous cultures have traditionally used psychedelic drugs for these spiritual purposes. In Judaism, we have several holidays connected with drinking wine. It is considered a good deed to make a blessing over wine in order to mark the beginning of Shabbat. On Passover we celebrate our exodus from slavery by retelling the story and drinking four full glasses of wine. On Purim, a Jewish scholar Rava was said to have taught that we should drink wine until we cannot tell the difference between the face of Haman and Mordecai, our enemy and our friend. But, we also use drugs to distance ourselves from negative feelings—physical pain, boredom, anxiety, loneliness, despair. The person who uses heroin to seek relief from intense physical pain; or uses alcohol to drown out traumatic memories and racing thoughts so they can fall asleep at night; the person who uses cocaine to overcome their crippling social anxiety and enable connection with other people. Whatever reason we use drugs for, we do not do it as a means to harm ourselves but as a way of obtaining some sort of benefit from our use. Our relationship with any drug—legal or not—can range from harmful to helpful. There are a number of factors beyond the drug itself that impact whether or not we experience harm from using it. Environment matters. Journalist Johann Hari talks about harmful use being a product of disconnection. Dr. Gabor Mate talks about addictions being rooted in painful experiences. Norman Zinberg points to the combination of three sets of factors he calls drug, set, and setting—factors related to the drug and how it’s used, the individual and their circumstances, and the environment they use in. Most people would agree that when we’re using drugs, we are more likely to experience harm from them if we don’t have a strong support system around us. We also know that experiencing trauma in early childhood increases the likelihood that people will have a harmful relationship with drugs. Yet, we live in a country that demonizes the drug user—they are a person who has made bad decisions and must live with the consequences. We see drug use as an individual choice and an individual problem. We try to interrupt that problem by punishing their bad choices and isolating people from everything that is familiar to them. But, what child chooses to be neglected or abused? What person chooses to be left without a support system when their parent or caregiver dies? Nobody chooses the circumstances that often precede harmful relationships with drugs. But, it’s far simpler to point to the individual and never consider the environment that they come from. That way, we don’t have to think about how poverty, a poor education system, a lack of economic opportunities, unstable housing, or growing up in a neighborhood where you regularly witness community violence, all make it more likely that people will have a harmful relationship with drugs. In fact, it is these circumstances, not drug use, where African-Americans are disproportionately represented. Just as our environment affects our relationship with drugs, our environment is impacted when we use drugs in a harmful way. Responsibilities are ignored—work doesn’t get done, friends and family members are neglected or taken advantage of. But, we’ve tried to punish our way out of the harms caused by drugs for 100 years. And it hasn’t worked. Instead, escalating punishment and extreme isolation have exacerbated the harm. Much like drug use itself, punishment and isolation don’t just impact the individual. They damage the environment as well; they take the parent away from their child, remove brothers and sisters from families. By removing community members, we promote disconnection and thereby increase the likelihood of harmful drug use for the people left behind. Nowhere is the failure of our current approach more apparent than in the dramatic spike in drug overdose death. This issue is particularly timely, as August 31st was International Overdose Awareness Day. We can’t punish our way out of harms like overdose death. We need a better way. We need to shift away from focusing our energy on trying to eliminate drug use altogether. That is and always has been an unrealistic goal. Drugs have been used for thousands of years, across continents and cultures. Drugs are a part of our lives and we all have relationships with them. We need to focus on the harms we consider most egregious and address them instead. We’ve tried, what some would call, a tough love approach for too long. It’s time we just try love. We need to shift from seeing harmful drug use as an individual problem that we solve with punishment, to a community problem that we solve with healing. What does it mean to move away from punishment and to focus on healing? Focusing on healing means that we promote people’s ability to be healthy and safe, connected to a support system and in control of their lives. One approach that does just that, and is gaining traction, is called harm reduction. Harm reduction is the practice of using drugs in less risky ways. When we drink responsibly, we are practicing harm reduction. We eat food before drinking, drink water, we practice moderation and limit our total number of drinks, we don’t drive when we’ve had too much to drink. These are all harm reduction choices we regularly make. As we make harm reduction choices with alcohol, we can make similar choices with other drugs. If you never know there’s a safer way to do something, you’re more likely to make a harmful choice. Beyond this individual practice, harm reduction is a philosophy—a belief in the human rights of people who use drugs. Harm reduction promotes the idea that regardless of what a person puts in their body, they should not be denied their basic human rights. In the programs that I’ve worked for, we use harm reduction in a practice called Housing First. We don’t deny people access to the human right of housing simply because they use …