From psychedelics to asset forfeiture reforms: Here are the top 10 drug policy stories of 2020

A pandemic, civil unrest, national elections—2020 has been a year of tumult that couldn't be done with soon enough. But when it comes to drug policy, it wasn't all bad; in fact, it was a pretty good year, with several drug reform initiatives getting approved. Here's a roundup of the biggest drug policy stories of 2020.

This article was produced by Drug Reporter, a project of the Independent Media Institute.

1. How the Pandemic Is Affecting Drug Use and Drug Policy

Just as it has infiltrated every aspect of American life, the effect of the coronavirus pandemic has been felt in the world of drugs and drug policy. Social distancing requirements early in the pandemic—when many drug reform initiative campaigns were in the midst of signature-gathering drives—proved particularly lethal to marijuana legalization efforts in the heartland as initiative campaigns in Arkansas, Missouri, Nebraska, North Dakota, and Oklahoma all succumbed. It also helped end a Washington state drug decriminalization campaign, with organizers there opting instead to go the legislative route.

Amidst the layoffs, shutdowns, and social distancing imposed due to the pandemic, drug use jumped. In July, the specialty laboratory Millennium Health reported that its analysis of more than half a million urine drug test results found large increases in the use of four illicit drugs during the coronavirus pandemic. Since March, when the pandemic was declared "a national emergency," the lab found a 32 percent increase for non-prescribed fentanyl, a 20 percent increase for methamphetamine, a 10 percent increase for cocaine, and a 12.5 percent increase for heroin. In September, another study by Millennium Health and the U.S. Department of Health and Human Services "found that drug test positivity rates for cocaine, fentanyl, heroin and methamphetamine have increased nationwide during the COVID-19 pandemic." The study was based "on urine drug test results from 150,000 patients between Nov. 14 and July 10," said a Times of San Diego article. The pandemic almost certainly also has had an impact on fatal drug overdoses (see below).

One of the most striking impacts of the pandemic has been on policing. Early on, big cities began to forgo drug arrests and prosecutions as a discretionary luxury they could no longer afford as they struggled with the coronavirus. In Philadelphia, Baltimore, and Chicago, police or prosecutors announced they would not arrest or would not prosecute small-time drug possession cases. In March, prosecutors from more than 30 cities, including Baltimore, New York, San Francisco, and St. Louis, signed on to an open letter urging local governments to make a change in the face of COVID-19. They called for police to "[a]dopt cite and release policies for offenses which pose no immediate physical threat to the community, including simple possession of controlled substances." They also called for the release of people being held solely because they can't come up with cash bail and for reducing jail and prison populations "to promote the health and safety of staff, those incarcerated, and visitors." These were not intended as permanent moves, but perhaps politicians, police and prosecutors will take the opportunity to break their addiction to punishing drug users and sellers by going cold turkey amidst the pandemic.

Advocates for marijuana legalization folded the pandemic into their arguments for ending federal marijuana prohibition. More than 30 state attorneys general cited the pandemic in calling for Congress to pass the Secure and Fair Enforcement (SAFE) Banking Act, which would allow state-legal marijuana businesses to gain access to banking and financial services. The House Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act coronavirus relief bill, passed in May, included a handful of criminal justice and drug policy reforms, mostly aimed at reducing the prison population during the pandemic, but also included language in support of allowing marijuana businesses to have access to the banking system.

COVID-19 was also cited as making it even more imperative to pass the Marijuana Opportunity Reinvestment and Expungement (MORE) Act (H.R. 3884). Over the summer, as the pandemic simmered, a coalition of justice and drug reform groups, collectively known as Marijuana Justice Coalition, called on Congress to pass the bill, arguing that legalization was especially urgent in the context of the coronavirus pandemic and nationwide protests over police brutality. Given the current situation, "marijuana reform as a modest first step at chipping away at the war on drugs is more relevant and more pressing than ever before," the coalition wrote in a letter to Congress, according to Marijuana Moment. That was followed by an even broader assemblage of 125 religious, human rights, and drug reform groups calling for passage of the bill. "[T]he circumstances of 2020 have made the failed War on Drugs even more untenable and amplified the voices of those demanding transformation in our criminal legal system. In the face of the evolving COVID-19 pandemic and a growing national dialogue on unjust law enforcement practices, marijuana reform as a modest first step at chipping away at the War on Drugs is more relevant and more pressing than ever before. The MORE Act remains the most effective and equitable way forward," the groups said. The MORE Act passed in December.

2. The Uprising Against Police Violence and Racism Leads Efforts to End Unjust No-Knock Warrants

It all started with the release of a video of George Floyd dying under the knee of a Minneapolis police officer over an alleged minuscule offense in May, but as people took to the streets all over the country, the name Breonna Taylor also loomed large. The 26-year-old Black EMT was gunned down by Louisville police in a misbegotten "no-knock" drug raid (it might be more accurate to call them "home invasion raids") in March, and her killing not only powered months of street demonstrations in her hometown, but it also engendered howls of outrage and promises of reform from politicians around the land. And it brought heightened scrutiny to business as usual in the war on drugs.

As the streets overflowed with protesters in May, nearly four dozen members of Congress called for an independent investigation of the raid, calling Taylor's death "an unspeakable tragedy that requires immediate answers and accountability," according to a letter sent by the members of Congress. That was followed by a bevy of bills in Congress, including the Justice in Policing Act, which would ban no-knock warrants in federal drug cases. House Democrats pushed the bill through in three weeks in June. Republicans in the Senate responded with Senator Tim Scott's Justice Act, which wouldn't ban no-knock raids, but would increase federal reporting requirements for no-knock raids and use of force. But the GOP bill never moved in Senator Mitch McConnell's Senate. As with so many measures passed by the House, McConnell's domain was where a congressional response to the crisis went to die.

But some states and localities actually enacted laws or ordinances aimed at reining in no-knocks. The Louisville metro council banned no-knock search warrants by unanimously passing "Breonna's Law" in June. Other cities, including Indianapolis, Memphis, Minneapolis, San Antonio, and Santa Fe, moved to either restrict or ban no-knocks. And while several states saw efforts to join Oregon and Florida as the only two states that banned no-knock warrants before Taylor's death, the only state where recent efforts have come to fruition so far is in Virginia, where Governor Ralph Northam (D) signed into law House Bill 5099, which bars police from breaking into a home or business to conduct a raid without first announcing their presence.

3. In a Historic Move, the House Votes to End Federal Marijuana Prohibition

Breaking almost entirely along party lines, the House voted to approve the MORE Act on December 4. The MORE Act would effectively end federal pot prohibition by removing marijuana from the Controlled Substances Act's list of scheduled substances and eliminating federal criminal penalties for its possession, cultivation and sale. The bill would not affect state laws that criminalize marijuana, but it would end the conflict between states that have already legalized marijuana and federal law.

The bill also includes strong social equity provisions, including the creation of a fund to support programs and services for communities devastated by the war on drugs, a provision for expungement of past federal marijuana offenses, and a provision that bars the federal government from discriminating against people for marijuana use. The latter would protect immigrants from being deported for past marijuana convictions and would ensure that earned benefits are not denied to marijuana users. The historic vote marks the first time either chamber of Congress has voted for legalization. But there was virtually no chance that the Republican-led Senate would have taken up—let alone approved—the measure in the remaining days of the last session, meaning this is a battle that will continue in the next Congress.

4. Psychedelic Drug Law Reform Wins

Denver made history in May 2019 by becoming the first city in the United States to effectively decriminalize a psychedelic drug—psilocybin-bearing magic mushrooms—and as a psychedelic reform movement spread across the land, 2020 saw other important advances. As the year went on, three more cities—Ann Arbor, Oakland, and Santa Cruz—passed similar ordinances, and on Election Day, voters in Oregon approved the groundbreaking Measure 109, the Oregon Psilocybin Services Act, with 56 percent of the vote. It will create a program to allow the administration of psilocybin products, such as magic mushrooms, to adults 21 and over, for therapeutic purposes. People will be allowed to buy, possess, and consume psilocybin at a psilocybin services center, but only after undergoing a preparation session and under the supervision of a psilocybin service facilitator.

And on the East Coast, Washington, D.C., voters approved Initiative 81, the Entheogenic Plant and Fungi Policy Act of 2020, with 76 percent of the vote. The measure will have police treat natural plant medicines (entheogens) as their lowest law enforcement priority. The measure also asks the city's top prosecutor and its U.S. attorney not to prosecute such cases. This string of psychedelic reform victories has generated momentum that is likely to result in more pushes in more places in 2021 and beyond. Since Election Day, activists in San Francisco and Washington state have announced plans for decriminalization, New Jersey State Senator Teresa Ruiz (D) has filed a bill to downgrade the offense of magic mushroom possession, and California State Senator Scott Wiener (D) has announced he plans to file a bill that would decriminalize the possession of psilocybin mushrooms and other psychedelics.

5. Oregon Decriminalizes Drugs

With the passage by voters of Measure 110, the Drug Addiction Treatment and Recovery Act, Oregon broke new ground by becoming the first state to decriminalize the possession of personal use amounts of all drugs, including cocaine, heroin, and methamphetamine. The quantities decriminalized are up to 1 gram of heroin, up to 1 gram or five pills of MDMA, up to 2 grams of methamphetamine, up to 40 units of LSD, up to 12 grams of psilocybin, up to 40 units of methadone, up to 40 pills of oxycodone, and up to 2 grams of cocaine. That's thousands of drug arrests that now will not occur in Oregon—and Oregon can set an example for other states to follow.

6. Red State or Blue State, Voters Choose Legal Marijuana When Given the Chance

The November election saw marijuana legalization on the ballot in four states and medical marijuana on the ballot in two states. They all won. Evenly-divided Arizona saw Proposition 207: The Smart and Safe Arizona Act cruising to victory with 60 percent of the vote, while in blue New Jersey, Public Question 1 garnered a resounding 67 percent of the vote. But the really surprising results were in two red states: In Montana, Constitutional Initiative 118 and its companion Initiative 190 won with 58 percent and 57 percent of the vote, respectively, while in South Dakota, Constitutional Amendment A won with 54 percent of the vote. Both those states are red states, with Trump taking 57 percent of the vote in Montana and 62 percent in South Dakota. It was the same story with medical marijuana, as Mississippi approved Initiative 65 with 74 percent of the vote, while South Dakota's Measure 26 won with 70 percent of the vote. Marijuana for adult use is now legal in 15 states and medical marijuana is now legal in 35 (plus D.C.).

7. Progressive Prosecutors Win

The November 3 elections didn't just end the reign of Donald Trump and bring drug reform victories at the state level; they also ushered in a new crop of progressive prosecutors who will have the ability to affect the conduct of the war on drugs at the local level. Led by George Gascón, who was elected prosecutor of the nation's most populous county, Los Angeles County, and running on progressive platforms that included confronting police misconduct, ramping down the war on drugs, and shrinking prison populations, progressives won prosecutor races in Detroit (Oakland County), Orlando (Orange and Osceola counties), and two large Colorado districts long held by Republicans. Progressives didn't win everywhere they ran, but the shift from "law and order" district attorneys toward progressives that began with Kim Foxx in Chicago and Larry Krasner in Philadelphia really gathered momentum in 2020.

8. A Tough Year for Safe Injection Sites

Safe injection sites (also called supervised injection facilities or supervised consumption services) are a proven harm reduction intervention with 120 in operation in 10 countries around the world, but no legal ones are operating in the United States. It looked like that would change in 2020, but it didn't. A proposed site in Philadelphia got the final go-ahead from a federal judge in February, but the local U.S. attorney then tried to block the facility's opening, with a hearing on the earlier stay held in October and the decision from the bench still pending. Things were also looking good in San Francisco after the board of supervisors okayed a pilot program in June, but the state-level bill that would have allowed the city to proceed, Assembly Bill 362, died in the Senate after passing the Assembly. A similar fate befell a Massachusetts safe injection site bill, House Bill 4723, which managed to win a committee vote but then stalled. Maybe there will be gains for this harm reduction method in 2021.

9. Asset Forfeiture Reforms

Asset forfeiture, especially civil asset forfeiture (without a criminal conviction), is increasingly unpopular, with 35 states and the District of Columbia approving reforms between 2014 and 2019. A September poll by YouGov found that only 26 percent support allowing police to seize cash or property from someone without a criminal conviction. According to a Forbes article, "59 percent of Americans oppose 'allowing law enforcement agencies to use forfeited property or its proceeds for their own use.' … Opposition to equitable sharing [a federal program that allows state and local police to evade state laws against civil asset forfeiture] was even higher, with 70 percent against the program."

Here are some reasons why: In March, in Georgia, the department of revenue got caught spending millions of dollars in seized cash on "engraved firearms, pricey gym equipment, clothing, personal items, even $130 sunglasses." That same month, in Michigan, Macomb County prosecutor Eric Smith was hit with a slew of criminal charges for allegedly taking funds seized from drug and other suspects for his own personal use, including "a personal security system for his house, country club parties, campaign expenses and to buy flowers and make-up for his secretaries." In July, in Chicago, the city agreed to a $5 million payout to settle a class-action lawsuit filed by two people whose vehicle was seized after a passenger was arrested for marijuana possession. The settlement will apply to hundreds of other cases where drivers had their vehicles impounded as part of drug cases. Also in Michigan, the Wayne County Sheriff's office faces a similar lawsuit for seizing thousands of cars and other property belonging to residents without criminal convictions.

Such abuses helped New Jersey become the 16th asset forfeiture reform state when Governor Phil Murphy (D) signed into law a bill mandating comprehensive disclosure and transparency requirements for the system of civil asset forfeiture in January. Unfortunately, the few remaining non-reform states are tough nuts to crack, as we saw with reform bills killed in Arizona, Georgia, Kentucky, and Tennessee. But, at least Tyson Timbs, the Indiana man whose seized Land Rover resulted in a 2019 Supreme Court decision scaling back civil asset forfeiture, finally got his Land Rover back—six years after it was seized over a drug bust.

10. America Keeps ODing

Amidst all the death in the pandemic, the ongoing epidemic of drug overdose deaths got short shrift in 2020, but Americans are continuing to die by the tens of thousands. In July, the CDC reported preliminary data showing that after declining for the first time in decades in 2018, fatal ODs rose by 4.6 percent in 2019. There's a lag in data for 2020, but initial reports suggested bad news ahead. As mentioned earlier, specialty laboratory Millennium Health reported in its July analysis of more than half a million urine drug tests that they found large increases in the use of fentanyl, heroin, cocaine, and methamphetamine during the pandemic. Also in July, the Washington Post reported that fatal ODs have jumped and keep jumping during the pandemic. The Post's data showed overdose deaths up "18 percent in March, 29 percent in April and 42 percent in May." The Post pointed to "continued isolation, economic devastation and disruptions to the drug trade" as contributing factors. And in December, fears of rising overdose deaths got some confirmation, with the CDC reporting that in the 12-month period ending in May 2020, overdose deaths hit an all-time high of 81,000.

Phillip Smith is a writing fellow and the editor and chief correspondent of Drug Reporter, a project of the Independent Media Institute. He has been a drug policy journalist for more than two decades. He is the longtime writer and editor of the Drug War Chronicle, the online publication of the nonprofit Stop the Drug War, and was the editor of AlterNet's coverage of drug policy from 2015 to 2018. He was awarded the Drug Policy Alliance's Edwin M. Brecher Award for Excellence in Media in 2013.

The Justice Department sues Walmart — accuses it of illegally dispensing opioids

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

More than two years after the federal government was preparing to indict Walmart on charges of illegally dispensing opioids, the U.S. Department of Justice is finally taking action. But it's seeking a financial penalty, not the criminal sanction prosecutors had pushed for.

On Tuesday, the Department of Justice brought a civil suit against Walmart in U.S. District Court in Delaware, accusing the retailing behemoth of illegally dispensing and distributing opioids, helping to fuel a health crisis that has led to the deaths of around half a million Americans since 1999.

The government accuses the company, which operates one of the biggest pharmacy chains in the country, of knowingly filling thousands of invalid opioid prescriptions, failing to alert the government to dangerous or excessive prescriptions, and pushing pharmacists to work faster and look the other way in order to boost corporate profits.

By law, pharmacists are prohibited from filling prescriptions they know are not for legitimate medical needs. “Walmart was well aware of these rules, but made little effort to ensure that it complied with them," the government said in its suit.

Walmart applied “enormous pressure" on pharmacists to fill prescriptions as fast as they could, while preventing them from halting prescriptions they knew came from bad doctors, the government said. When Walmart pharmacists warned headquarters in Bentonville, Arkansas, about doctors who operated “known pill mills," did “not practice real medicine" and had “horrendous prescribing practices," headquarters ignored their pleas, the lawsuit asserts.

Walmart denounced the suit. “The Justice Department's investigation is tainted by historical ethics violations, and this lawsuit invents a legal theory that unlawfully forces pharmacists to come between patients and their doctors, and is riddled with factual inaccuracies and cherry-picked documents taken out of context," the company said in a statement. In October, aware that a government suit was likely, Walmart took the highly unusual step of preemptively suing the Justice Department. The company argued that it did nothing wrong and, there, too, accused the government of acting unethically. According to Walmart, the federal prosecutors used the threat of a criminal case to try to negotiate higher civil penalties. (Prosecutors deny that claim.)

The case against Walmart originated in the summer of 2016, with an investigation of two Texas doctors, Howard Diamond and Randall Wade, who were prescribing opioids on a vast scale. Federal prosecutors in the Eastern District of Texas eventually brought cases against the pair, accusing them of contributing to multiple deaths. The doctors were subsequently convicted of illegal distribution of opioids, with Wade sentenced to 10 years in prison and Diamond to 20 years. That case uncovered evidence that led prosecutors to investigate Walmart itself.

In 2018, Joe Brown, the Trump-appointed U.S. attorney in the Eastern District of Texas, sought to criminally indict the company over its opioid practices, as detailed in a ProPublica story in March. During this period, as Walmart tried to fend off a criminal case, its lawyers expressed willingness to discuss a civil settlement. The company “stands ready to engage in a principled and reasoned dialogue concerning any potential conduct of its employees that merits a civil penalty," Jones Day partner Karen Hewitt wrote in August 2018 to the head of the criminal division of the Justice Department.

The Texas prosecutors were unswayed by Walmart's arguments. Joined by the head of the Drug Enforcement Administration, Brown's team traveled to Justice Department headquarters in Washington to make an impassioned plea to bring the criminal case.

But Trump appointees at the highest levels of the department — including the deputy attorneys general at different times, Rod Rosenstein and Jeffrey Rosen — stymied the attempt, dictating that Walmart could not be indicted. (Rosen recently was named acting attorney general.) When prosecutors sought to criminally prosecute a Walmart manager, top officials in the Trump Justice Department prevented that, too.

The Justice Department then dragged out civil settlement negotiations. The delays prompted Josh Russ, the head of the civil division in the Eastern District of Texas who had urged bringing a civil suit years ago, to resign in protest. “Corporations cannot poison Americans with impunity. Good sense dictates stern and swift action when Americans die," Russ wrote in his resignation letter in October 2019.

This week's suit largely echoes the allegations that the Eastern District of Texas had made in seeking a criminal case. Legal officials can in some circumstances pursue the same allegations either criminally or civilly, with a higher burden of proof for prosecutors and stiffer potential penalties for defendants when it comes to criminal cases.

In the new suit, prosecutors said Walmart pharmacists routinely filled prescriptions from known “pill mill" doctors. Sometimes those doctors explicitly told their patients to go to Walmart pharmacies, the complaint alleges. Walmart filled prescriptions from doctors even when its pharmacists knew that other pharmacies had stopped filling prescriptions from those doctors.

The suit also details that Walmart's compliance unit based out of its headquarters collected “voluminous" information that its pharmacists were regularly being served invalid prescriptions, but “for years withheld that information" from its pharmacists.

In fact, the compliance department often sent the opposite message. When a regional manager received a list of troubling prescriptions from headquarters, he asked, “Does your team pull out any insights from these we need to highlight?"

In an email cited in the suit, which was first reported by ProPublica, a director of Health and Wellness Practice Compliance at Walmart, responded, “Driving sales and patient awareness is a far better use of our Market Directors and Market manager's time."

Walmart headquarters regularly put pressure on pharmacists to work faster. Managers pushed pharmacists because “shorter wait times keep patients in store," that this was a “battle of seconds" and that “wait times are our Achilles heel!" according to the suit. Pharmacists said the pressure and Walmart's thin staffing “doesn't allow time for individual evaluation of prescriptions," the suit says.

In May, two months after ProPublica published its story, Brown, the U.S. attorney who had pushed for criminal prosecution of Walmart, left his job abruptly. His resignation letter cited the need to “win the fight against opioid abuse in order to save our country" and added that “players both big and small must meet equal justice under the law." Brown did not return a call seeking comment.

Oregon just decriminalized all drugs – here’s why voters passed this groundbreaking reform

Scott Akins, Oregon State University and Clayton Mosher, Washington State University

Oregon became the first state in the United States to decriminalize the possession of all drugs on Nov. 3, 2020.

Measure 110, a ballot initiative funded by the Drug Policy Alliance, a nonprofit advocacy group backed in part by Facebook's Mark Zuckerberg, passed with more than 58% of the vote. Possessing heroin, cocaine, methamphetamine and other drugs for personal use is no longer a criminal offense in Oregon.

Those drugs are still against the law, as is selling them. But possession is now a civil – not criminal – violation that may result in a fine or court-ordered therapy, not jail. Marijuana, which Oregon legalized in 2014, remains fully legal.

Oregon's move is radical for the United States, but several European countries have decriminalized drugs to some extent. There are three main arguments for this major drug policy reform.

#1. Drug prohibition has failed

In 1971, President Richard Nixon declared drugs to be “public enemy number one" and launched a “war on drugs" that continues today.

The ostensible rationale for harshly punishing drug users is to deter drug use. But decades of research – including our own on marijuana and drugs generally – has found the deterrent effect of strict criminal punishment to be small, if it exists at all. This is especially true among young people, who are the majority of drug users.

This is partly due to the nature of addiction, and also because there are simply limits to how much punishment can deter crime. As a result, the U.S. has both the world's highest incarceration rate and among the highest rates of illegal drug use. Roughly 1 in 5 incarcerated people in the United States is in for a drug offense.

Criminologists find that other consequences of problematic drug use – such as harm to health, reduced quality of life and strained personal relationships – are more effective deterrents than criminal sanctions.

Because criminalizing drugs does not really prevent drug use, decriminalizing does not really increase it. Portugal, which decriminalized the personal possession of all drugs in 2001 in response to high illicit drug use, has much lower rates of drug use than the European average. Use of cocaine among young adults age 15 to 34, for example, is 0.3% in Portugal, compared to 2.1% across the EU. Amphetamine and MDMA consumption is likewise lower in Portugal.

2. Decriminalization puts money to better use

Arresting, prosecuting and imprisoning people for drug-related crimes is expensive.

The Harvard economist Jeffrey Miron estimates that all government drug prohibition-related expenditures were US$47.8 billion nationally in 2016. Oregon spent about $375 million on drug prohibition in that year.

Oregon will now divert some the money previously used on drug enforcement to pay for about a dozen new drug prevention and treatment centers statewide, which has been found to be a significantly more cost-effective strategy. Some tax revenue from recreational marijuana sales, which exceeded $100 million in 2019, will also go to addiction and recovery services.

Oregon spent about $470 million on substance abuse treatment between 2017 and 2019.

Not everyone who uses drugs needs treatment. Decriminalization makes help accessible to those who do need it – and keeps both those users and recreational users out of jail.

3. The drug war targets people of color

Another aim of decriminalization is to mitigate the significant racial and ethnic disparities associated with drug enforcement.

Illegal drug use is roughly comparable across race in the U.S. But people of color are significantly more likely to be searched, arrested and imprisoned for a drug-related offense. Drug crimes can incur long prison sentences.

Discretion in drug enforcement and sentencing means prohibition is among the leading causes of incarceration of people of color in the United States – an injustice many Americans on both sides of the aisle increasingly recognize.

Freed up from policing drug use, departments may redirect their resources toward crime prevention and solving violent crimes like homicide and robbery, which are time-consuming to investigate. That could help restore some trust between law enforcement and Oregon's communities of color.

Risks of decriminalization

One common concern among Oregonians who voted against decriminalization was that lessening criminal penalties would endanger children.

“I think it sends a really bad message to them, and influences their perception of the risks," James O'Rourke, a defense attorney who helped organize the opposition to measure 110, told Oregon Public Broadcasting in October.

But U.S. states that legalized marijuana haven't seen adolescent use rise significantly. In fact, marijuana consumption among teens – though not among college-aged Americans – actually declined in some states with legal marijuana. This may be because legal, regulated marijuana is more difficult for minors to get than black-market drugs.

Research also shows that for some people, particularly the young, banning a behavior makes it more alluring. So defining drugs as a health concern rather than a crime could actually make them less appealing to young Oregonians.

Another worry about decriminalization is that it will attract people looking to use drugs.

So-called “drug tourism" hasn't really been a problem for Portugal, but it happened in Switzerland after officials in the 1980s and 1990s began officially “ignoring" heroin in Zurich's Platzspitz Park. People came from across the country to inject heroin in public, leaving discarded needles on the ground.

The local government shut down Platzspitz Park. But rather than chase off or arrest those who frequented it, it began offering methadone and prescription heroin to help people with opioid use disorder. Public injection, HIV rates and overdoses – which had all become a problem in Zurich – plummeted.

Certain parts of Oregon already have higher rates of public drug consumption, namely Portland and Eugene. Because public drug use is still illegal in Oregon, however, we don't expect a Platzspitz Park-style open drug scene to emerge. These places should benefit from the expansion of methadone programs and other medication-assisted treatment, which is endorsed by the American Medical Association.

If neighboring Washington state decriminalizes drugs, which it is considering, the chances of drug tourism would drop further.

[The Conversation's science, health and technology editors pick their favorite stories. Weekly on Wednesdays.]

Upside – and downside

There are risks with any major policy change. The question is whether the new policy results in a net benefit.

In Portugal, full decriminalization has proven more humane and effective than criminalization. Because drug users don't worry about facing criminal charges, those who need help are more likely to seek it – and get it.

Portugal's overdose death rate is five times lower than the EU average – which is itself far lower than the United States'. HIV infection rates among injection drug users also dropped massively since 2001.

These policies show that problem drug use is a public health challenge to be managed, not a war that can be won.The Conversation

Scott Akins, Professor, Sociology Department, Oregon State University and Clayton Mosher, Professor, Sociology Department, Washington State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Our worst pre-existing condition: Big Pharma

Before COVID, the headlines you might read about the pharmaceutical industry tended towards corporate malfeasance — violations of the Foreign Practices Corruption Act, insider trading, abusive mass marketing of opioids or predatory pricing, that sort of thing. Few think of such a notoriously manipulative industry as heralding medical breakthroughs.

But with a quarter of a million American deaths and another 12 million COVID cases, we are being told by the corporate news media these same companies are going to save life on the planet as we once knew it pre-pandemic.

Several months of worsening news about the pandemic, including decimating personal tragedies and loss on a scale not seen since the beginning of the last century, has reduced us to a childlike state looking for our parents that may already be dead.

Lost in transit

The mainstream news media agrees that Donald Trump's attempts to derail the peaceful transition of power is reckless. Yet they have failed to critically examine his decision to have our nation defer to the profit-driven pharma sector the efforts to beat COVID. Indeed, the research to create a vaccine is almost entirely publicly-funded, though the effort has entrusted to the private sector with little oversight.

As Michael Hiltzik recently wrote in his Los Angeles Times op-ed entitled "The Colossal Problem of Publicly Funded Vaccines in Private Hands," the Trump junta's blank check is going to an industry that has long "profited from billions of dollars in government scientific research without returning anything to taxpayers."

The U.S. Treasury's largesse towards the multinational pharma profiteers includes not merely billions of dollars in taxpayer funded-research for them to profit off of, but also guaranteed orders for the millions of doses of vaccine from the government.

Hiltzik quotes Peter Maybarduk, director of the Access to Medicines Program at the non-profit Public Citizen, who suggests the US has "considerably slowed the global timetable" in the COVID fight "by bestowing billions in grants to companies "and asking them to develop manufacturing arrangements that are in their interest rather than pooling resources saying we're going to teach the world how to make these vaccines and using all the available manufacturing capacity."

There's a tragic irony that we are relying so heavily on an industry that's a pillar of our for-profit health care system — one that rations care and feeds off of scarcity and disease — to deliver us from a pandemic.

The multinational pharmaceutical industry is the foundation of the American health care system that rations medical care based on the ability to pay. It has been its own kind of killer virus, and the industry permitted the proliferation of chronic diseases in the ranks of the poor and working classes — in turn serving as a form of race- and class-based social control, one that is increasingly revealing itself with each day's new COVID body count.

As Reverend William Barber pointed out during the Democratic primary campaign of 2020, there was, long before COVID, a raging pandemic that fed off of poverty playing out daily. This pandemic lived below the corporate news media radar, and prematurely claimed the lives of 250,000 Americans every year.

Big pharma, and our winner-take-all economic system, is implicated in those deaths. Back in 2018, a report by the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, and the London School of Economics found that the US paid twice as much as other high-income countries for health care only to get poorer population health outcomes.

"The main drivers of higher health care spending in the U.S. are generally high prices — for salaries of physicians and nurses, pharmaceuticals, medical devices, and administration," the report's researchers say.

Making a killing

It's been the pharma companies, along with big tech firms like Amazon and Google, that have perfected the legal three-card-monte of profit-shifting to offshore jurisdiction hundreds of billions of dollars annually that starves public health care systems globally.

For decades, economists and public interest tax experts have flagged this accelerating "race to the bottom," where multinationals and the holders of vast personal fortunes reduce or eliminate entirely their tax bill by pitting the nations of the world against each other.

This continued beggaring of local, state and national governments by the wealthiest, including pharma companies, comes as our public health sector crumbles under the weight of the resource scarcity that resulted from generations of this hoarding and hiding of profits often generated by taxpayer-funded research.

A nurse's pay a second

Last week, thanks to the research generated by the international Tax Justice Network (TJN), we were able to quantify the scale of the impact of how pharmaceutical (and other) corporations have rigged tax codes to their advantage across the world.

TJN reports that even as the world's "pandemic-fatigued countries… struggle to cope with second and third waves of coronavirus," they have been losing "over $427 billion in tax each year to international corporate tax abuse and private tax evasion, costing countries altogether the equivalent of nearly 34 million nurses' annual salaries every year – or one nurse's annual salary every second."

"Pharma companies like Pfizer, along with software and internet companies, have been the major players in global tax dodging and designing the new mechanisms since the later 1990s that move lots of profits to low tax jurisdictions in the form of untaxed royalties that they pay themselves to offshore companies that they own," explains James Henry, a New York based economist and lawyer who is a senior advisor to TJN.

There are surely tens of thousands of committed scientists and technicians working at "warp speed" to develop a safe and effective vaccine out of a sense of moral duty. But we would be foolish to forget that big pharma itself is fueled by a maniacal pursuit of profits. And as an industry, it has shown the same kind of contempt for the law as the current occupant of the White House.

Above and beyond the law

Like Trump, Big Pharma are ruthless and unrepentant. Yet, because of the scale of the money involved in their crimes, our legal system actually shields them from personal criminal prosecution — as it did with the Wall Street banks in the Great Heist of 2008.

As it turns out, the most important duty for our Department of Justice, no matter which party controls the White House, appears to be to twist the law to preserve capital and keep great fortunes intact, while feigning to prosecute the corporate shell in the public interest.

This is critical, because today's federal prosecutors and regulators are all-too-often the farm team for tomorrow's over-compensated captains of industry.

Take Purdue Pharma, whose predatory marketing of the highly addictive opioid Oxycontin helped set off double-digit percentage spikes in drug overdose deaths that have killed more than 400,000 Americans since 1999.

In 2007, Purdue Pharma entered into a Department of Justice deal that required they plead guilty to a felony and pay a $600 million dollar fine for misleading and defrauding the public, including physicians, about their signature drug OxyContin.

Yet, some members of the bulletproof Sackler family, some of whom were heirs of the Purdue fortune, were allowed to transfer $10 billion out of their accounts between 2008 and 2018, according to an audit that was released while Purdue sought bankruptcy protection in September.

Last month, serial offender Purdue Pharma agreed to plead guilty to three federal crimes including producing highly addictive drugs "without legitimate medical purpose" in a deal with the Trump/Barr Department of Justice that was denounced as a "failure" by Massachusetts Attorney General Maura Healey.

"DOJ failed," tweeted Healey. "Justice in this case requires exposing the perpetrators accountable, not rushing a settlement to beat an election. I am not done with Purdue and the Sacklers, and I will never sell out the families who have been calling for justice for so long."

Walking wounded

Even before COVID, 140 million Americans struggled week to week trying to make ends meet, which they often did by cutting health care corners.

For three years before COVID hit, America's life expectancy was on the decline. How many members of Congress sounded the alarm? The last time such a demographic event happened was in the years leading up to the First World War and the Spanish Flu epidemic, when 675,000 Americans, and 50 million people worldwide, died.

Currently, with more than 250,000 deaths here in the U.S. and 1.2 million globally, there seems to be something truly exceptional about America's bout with the COVID scourge.

In the post-election interregnum, the prognosis is bleak. The U.S Treasury is sending out billions to Big Pharma, while rushing to close off access to Federal Reserve borrowing for small businesses and local governments. Unemployment benefits for 12 million Americans sidelined by COVID are set to run out the day after Christmas.

Just as individuals may have preexisting conditions that make them more susceptible to COVID-19, so does our economic system, which lets tens of millions of families teeter on the edge so as to provide the cheap labor on which billionaires' fortunes rely.

There can be no honest critique of how we got here without noting "the gross failure of the U.S. private, profit-driven, capitalist medical-industrial complex (four industries: doctors, drug and device makers, and medical insurance firms)" who "decided not to prepare for a serious virus problem," writes economist Richard Wolff in his latest book "The Sickness is the System."

Our only enduring remedy is radical change.

HHS finally releases documents showing wave of dubious vaccine contracts with big pharmaceutical companies

On Saturday, while America slowly came to grips with the joy of breathing again for the first time in years, Donald Trump's Department of Health and Human Services (HHS) released some documents related to its "Operation Warp Speed" COVID-19 vaccination initiative. By "some," I mean a ton of documents. NPR reports this enormous dump, done while the inevitable end of Donald Trump's regime was clear to anyone not named Donald Trump, includes all kinds of wild details about billion-dollar deals with big pharmaceutical companies. One of those details is that "customary protections against potential future price-gouging" aren't in the contracts.

Trump and his team of ne'er-do-wells have been gaslighting the public with confusing and fact-free information about a coronavirus vaccine for months. As with everything else Trump has said in his entire life, he's lied while trying to line his pockets (or the pockets of people he hopes will line his pockets). This has led to a very real and very understandable wariness on the part of most Americans concerning any announcement by the Trump administration about a safe vaccine.

HHS, through a spokesperson, told NPR that "Operation Warp Speed has long publicly stated its commitment to being as transparent as possible." And then that spokesperson went on to lie some more about how these contracts are totally fine. However, once again, the issue here is that the Trump administration has created a program that is not simply the opposite of "transparent," but consistently and deliberately created to circumvent any traditional oversight on the use of taxpayer funds.

Advanced Technology International is the third-party contractor the Trump administration has used throughout this project. News outlets like NPR and Democratic senators like Elizabeth Warren have long warned that the use of this third-party system was a recipe for corruption and mismanagement of resources. Turns out, they have been 100% right at every step. Since the start of the program earlier this year, Operation Warp Speed has been "issuing billions of dollars' worth of coronavirus vaccine contracts to companies through" the unregulated contractor.

While we all agree on the necessity for our country to research and produce a safe and effective vaccine for the COVID-19 pandemic as soon as is possible, it is clear that the Republican pro-market strategy of letting private industry profit from this public health service is just a smokescreen for profiteering off a national emergency. These companies should not need to break the country's bank to make this happen. It is worth their while to create a vaccine as soon as possible because without one, everybody's economy goes down. But that's not how big business—and the politicians in their pockets—see it.

Johnson & Johnson's Aug. 5 contract for the government's purchase of 100 million doses of its coronavirus vaccine doesn't include the march-in rights that are typical planks in contracts for federally funded inventions. Instead, the contract allows a much narrower window for the government to step in, excluding when COVID-19 stops being a public health emergency and becomes endemic, as is expected.

Donald Trump and his cabal of thieves cannot exit the White House and enter the courthouse fast enough.

Big night for drugs: These 6 states and Washington DC decriminalized or legalized marijuana and other drugs

Voters in several states have approved legal measures to decriminalize marijuana for the purpose of medical and recreational usage, according to election results. Check out the breakdown of the states where marijuana and other drugs will now be deemed legal.

Arizona: Proposition 207, which legalizes the use of recreational marijuana for adults over the age of 21, was approved by Arizona voters. Under the proposition, marijuana offenses may also be expunged, according to The New York Times.

Washington, D.C.: Voters approved Initiative 81, which effectively decriminalizes the use of "'magic mushrooms' and other organic psychedelic drugs," reports Fox5DC. While the drugs have not been deemed completely legal, there have been recategorized as "the lowest level police enforcement priority."

New Jersey: As the first state to legalize recreational marijuana in the Mid-Atlantic region of the United States, New Jersey passed its ballot measure with a 67% to 33% margin.

Montana: Voters in Montana voted to approve initiative I-190, which institutes the legalization of recreational marijuana for adult, by a 57% to 43% margin. Medical marijuana usage has been approved in Montana since 2004.

South Dakota: On a separate ballot initiative for the legalization of recreational and medical cannabis use, voters approved the passing of Amendment A for recreational usage by a margin of 53% to 47% and Measure 26, medical marijuana initiative, by a 69% to 31% margin.

Mississippi: Voters in the southern state passed Initiative 65 and Initiative 65A, which is a measure to legalize the use of medical marijuana in Mississippi.

Initiative 65 will allow "patients with at least one of 22 debilitating medical conditions to use medical marijuana, under the approval of Mississippi licensed physicians and licensed treatment centers."

On the other hand, Initiative 65A "restricts medical marijuana to terminally ill patients and would require pharmaceutical-grade marijuana products to have oversight by licensed physicians, nurses, and pharmacists," reports WLBT.

Oregon: For the 2020 election, voters in Oregon approved the passing of Measure 110 which decriminalizes the possession of small amounts of cocaine and heroin. However, the sale and distribution of both drugs is still illegal.

Like Trump, I was on monoclonal antibody drugs. This is what they do to you

After Donald Trump was hospitalized last week following a positive test for COVID-19, he emerged from Walter Reed with all the "Scarface" energy of one of his sons, declaring that, after "some really great drugs" he felt better than he did twenty years ago. Those drugs include Regeneron's REGN-COV2, a monoclonal antibody cocktail that is not approved by the FDA but was administered through a process known as compassionate use. (Regeneron's CEO, Dr. Leonard S. Schleifer, is also a friend of the Trump family.) Mainstream and social media quickly lit up over Trump's revelations, especially when he declared that the treatment "wasn't just therapeutic, it made me better. I call that a cure."

But is it?

If you've ever seen television ads for drugs with names like Opdivo (nivolumab) or Keytruda (pembrolizumab), you may notice a common denominator in their nomenclature. That "mab" — usually written as "mAb" — at the end is short for "monoclonal antibodies," antibodies engineered in a lab.

Nine years ago, when I was diagnosed with metastatic melanoma, I got a front row education in how they work when I became one of the first patients in the world in a groundbreaking immunotherapy clinical trial. While I did not have the same condition or treatment that Trump did, I did receive a cocktail of two mAbs and I do feel confident saying that the experience did not give me super strength nor make me feel twenty years younger. In fact, it seems to have been at the root of a thyroid dysfunction that actually aged me! But hey, I'm not a self-proclaimed "perfect physical specimen," like an obese 74 year-old man who is renowned for not eating vegetables would be.

Trump can cavalierly — and surprise, inaccurately — describe his treatments as "miracles coming down from God," but understanding and engineering the human immune system has been the complicated work of decades of research, failed experiments and heartbreak.

You have no doubt heard more about antibodies in the past few months than you have since that long ago high school science class you barely passed. The simplest way to understand them is they're proteins that help the body fight invaders and, significantly, remember them to keep them at bay. When you feel flu-like systems after getting a flu shot, that's the antibodies you've developed doing their thing in there. This is why we get vaccinations, and also why I have only had chicken pox once. When the immune system has confronted certain kinds of threats in the past, it can, like an efficient bouncer, fend them off in the future in most cases.

But antibodies can't fight everything; if they did we'd never get sick. They also aren't an ironclad guarantee of immunity — some people do get chicken pox twice, and plenty more get shingles when the dormant virus wakes up many years later. Trump may boast that "Maybe I'm immune" now to future infection, but there are confirmed cases of patients getting COVID-19 more than once, and the duration of immunity for everyone who's experienced it is still unknown but may not be longer than a year.

And antibodies aren't always the good guys; when they go rogue they can cause a world of harm. Autoimmune disorders like lupus, multiple sclerosis, and rheumatoid arthritis all stem from overactive immune system. Similarly, organ transplant patients are often given immunosuppressants to prevent the body from rejecting the new organ as an invader.

Getting the immune system to effectively go after the right targets in the right way has been a long-standing scientific challenge. That's where these laboratory created antibodies come in. In early oncology research, the thinking was that antibodies could be developed in animals and transferred humans. By the late eighties the process was being refined to create human antibodies in genetically modified rodents, so the risk of rejection would be lessened. As pioneering scientist Nils Lonberg once explained to me, "You don't really want to put a mouse antibody into patients. You want to put a human antibody into patients."

When they work, MaBs can work quickly and durably, because the immune system learns and remembers. But they don't work all the time or for everybody, nor are they casually dispensed. My mAb combo is considered a rousing success; the 5 year survival rate is about 52%. And these therapies can produce vicious side effects as the immune system revs up. I was fortunate in my experience; my rashes, dizziness and fatigue were tolerable, but I had an adverse event where my temperature shot up and I felt like hell for a day. Other people on cancer immunotherapy develop colitis so severe it's debilitating. I've been on panels with doctors who've presented photos of what immunotherapy can do to the human colon, and the phrase "hellmouth" comes to mind.

So far, the side effects for the Regeneron treatment appear to be well tolerated in COVID-19 patients. Late last month, the company reported that with "more than 2,000 people enrolled across the overall REGN-COV2 development program, no unexpected safety findings have been reported." Speaking with MSNBC recently about Trump's recent hospital regimen, company co-founder Dr. George Yancopoulos' said that the cocktail "mimics the normal immune system," and said, "theoretically there should not be any additional interactions with any… other medications with our very natural antibody cocktail than you would normally have with your own antibodies." But the pool of patients is still very small.

We all want a vaccine and we all want a cure. We want to send our kids to school and hug our old friends and go to the movies and, most of all, for people to stop getting sick and dying. The way forward is through smart science and practical, equitable distribution, not empty promises of "miracles." The monoclonal antibody cocktail that saved my life currently has a six figure price tag. As Vox put it two years ago, "The average cost of cancer drugs today is four times the median household income." (Because I was in a clinical trial, the pharmaceutical company paid the costs related to my treatment.) Who's going to pick up the check when and if these types of therapies are available for COVID-19? There have been 7.6 million cases in the US already and that number is currently on an uptick — who will receive treatments that are approved, and how will hospitals handle the influx? What happens to patients who don't golf with the president of the United States?

Monoclonal antibody treatments have saved countless lives over the last several years. Harnessing the human immune system to fight disease and infection is among the most promising scientific breakthroughs of any of our lifetimes. But right now, there is no cure for COVID-19. There is only recovery, hope and a lot more research to be done.

'The reason they die is because of isolation': Drug use in the COVID-19 moment

In our new era of nearly unparalleled upheaval, as a pandemic ravages the bodies of some and the minds of nearly everyone, as the associated economic damage disposes of the livelihoods of many, and as even the promise of democracy fades, the people whose lives were already on a razor’s edge -- who were vulnerable and isolated before the advent of Covid-19 -- are in far greater danger than ever before.

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Oregon is on the cusp of a major drug reform: Decriminalizing everything

Come November 3, Oregon residents will have a chance to approve the most far-reaching drug reform measure ever to make a state ballot when they vote on Measure 110, the Drug Addiction Treatment and Recovery Act. While the initiative indeed expands drug treatment, what makes it really revolutionary is that it would also decriminalize the possession of personal use amounts of all drugs, from psychedelics to cocaine and methamphetamine, as well as heroin and other illicit opioids.

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House Democrats push for historic vote on marijuana decriminalization and expungement of convictions

Drug policy reform advocates are celebrating this week after Democratic leaders confirmed the U.S. House will take up historic legislation to decriminalize marijuana at the federal level by removing it from the Controlled Substances Act.

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Can marijuana win in a deep red state?

Marijuana is on the ballot in South Dakota in November this year. This is a state that has the dubious distinction of being the only one to twice defeat a medical marijuana initiative. And it has another dubious distinction: It’s the only state where people get prosecuted for having marijuana show up on a drug test.

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