Policy News Roundup: October 10, 2024

ProPublica: Juvenile justice and drug-induced homicide laws

A new ProPublica article tells the stories of a juvenile charged with homicide for providing fentanyl that led to the death of another teen.

• It outlines both of their histories with substance use and addiction, as well as underlying factors that can contribute to drug use and selling, barriers to effective treatment, and gaps in child welfare and police responses.

The details:

• In at least 31 states, a child charged with certain serious crimes, like homicide, must be tried in adult criminal court, and an additional 8 states allow prosecutors to choose whether to file in juvenile or criminal court.
• The juvenile system provides counseling and other services to promote rehabilitation and return to the community. The adult system is more focused on retribution and does not take into account the circumstances of someone’s childhood the way a judge in the juvenile system would.
• There is no national database on drug-induced homicide cases, many states do not aggregate cases, and when prosecutors file in juvenile court, the records are sealed. This means there has been almost no scrutiny of how these laws are used against kids.
• Why it’s important: Neither drug-induced homicide laws nor laws allowing juvenile cases to be transferred to adult courts are effective in preventing drug use, deterring crime or reducing recidivism, and they are counterproductive to their stated goals. Public health approaches, rather than punitive ones, are needed.

Conclusion: These stories demonstrated the barriers and failures at every level and in every system.

Source: Maylia and Jack: A Story of Teens and Fentanyl (ProPublica)

Top line: As legalization of marijuana has spread across the country, tens of millions of Americans are using marijuana frequently, and doctors are contending with the effects of rising use and potency.

The details:

• Increased potency and use: The growing marijuana industry is turning out an ever-expanding range of more intoxicating products. With more people consuming more potent marijuana more often, a growing number have serious health consequences.
• Addiction: Many believe that people cannot become addicted to marijuana, but about 18 million people, nearly a third of adults who use marijuana, have reported symptoms of cannabis use disorder, and of those, about 3 million are considered to have addiction. More than 4.5 million young adults use the drug daily or near daily, and 81% of those individuals meet the criteria for cannabis use disorder.
• Cannabinoid hyperemesis syndrome: Marijuana is used for soothing nausea, but for some, it causes cannabinoid hyperemesis syndrome, a condition caused by heavy marijuana use and marked by nausea, vomiting and pain. It can lead to extreme dehydration, seizures, kidney failure and cardiac arrest, and in rare cases has caused deaths. Since the syndrome was first documented in 2004, doctors say they have observed a sharp increase in cases, though it is not recorded consistently in medical records. Researchers have estimated that as many as a third of those who use marijuana near daily could have symptoms of the syndrome.
• Psychosis: As more people turn to marijuana for help with anxiety, depression and other mental health issues, few know it can cause temporary psychosis and is increasingly associated with the development of chronic psychotic disorders.
• Withdrawal: Regular heavy doses can throw the endocannabinoid system off balance. People must continue escalating their use to get the same effect, and quitting can cause anxiety, depression and other signs of withdrawal, including struggling to eat, sleep and otherwise function. There are no Food and Drug Administration (FDA)-approved drugs to help people quit marijuana.

However: Gaps in state regulations, limited public health messaging, and federal restraints on research have left many consumers, government officials and medical practitioners in the dark about such outcomes.

• While states are increasingly legalizing it, marijuana remains illegal under federal law, stymying oversight and scientific study.
• States have rolled out inconsistent standards and regulations (as highlighted in our report, particularly concerning youth protection provisions). Few states cap THC levels, require warnings about addiction or hyperemesis syndrome, or monitor the full scope of health outcomes.

What the experts say: There is growing alarm among doctors and researchers.

• In interviews, they acknowledged that marijuana can offer health benefits for certain patients, and most favored legalization. But many were concerned about gaps in knowledge of its effects, regulation of the commercial market, and disclosure of the risks.

Actions taken: Some efforts are underway to try to balance legal access with better protection, such as:

• The Biden administration’s effort to move marijuana to Schedule III to allow more research
• A new federal law that aims to ease other barriers to scientific study
• Guidelines for treating cannabis-related ailments released by some medical specialty groups
• The Centers for Disease Control and Prevention’s plans to roll out a distinct diagnostic code for cannabinoid hyperemesis syndrome next year
• But: More is needed to identify, track and address harms.

Source: As America’s Marijuana Use Grows, So Do the Harms (The New York Times)

The Centers for Disease Control and Prevention (CDC) and the Drug Enforcement Administration (DEA) issued warnings about counterfeit prescription medications from online pharmacies.

The details: Last week, the Department of Justice (DOJ) announced an indictment against individuals running illegal online pharmacies.

• According to the DOJ, these individuals are advertising, selling, manufacturing and shipping millions of unregulated counterfeit prescription pills to tens of thousands of individuals in the U.S., and they often contain fentanyl and methamphetamine.

What the warnings say:

• The CDC is informing public health officials, clinicians and affected patients, their families and caregivers about a potential public health risk among individuals ordering what they believe to be prescription medications from online pharmacies.
• The Food and Drug Administration (FDA) warns that there are online pharmacies that claim to sell prescription drugs at deeply discounted prices, often without requiring a prescription. These pharmacies often sell unapproved, counterfeit or otherwise unsafe medicines.
• According to the National Association of Boards of Pharmacy, nearly 95% of websites offering prescription-only drugs online operate illegally.
• The DEA issued a Public Safety Alert to warn of an increase in illegal online pharmacies selling counterfeit pills. The DEA cautioned that the sites often use U.S. web addresses and “professional-looking” designs to appear legitimate.

The takeaway: Individuals should only take medications prescribed by a licensed health care provider and dispensed by a licensed pharmacy.

Source: US CDC warns of overdose risk from fake prescription medicines online (Reuters); DEA warns of illegal online pharmacies selling pills with fentanyl, meth (The Hill); Internet Drug Ring Tricked Buyers With Fake and Deadly Pills, U.S. Says (The New York Times)

What’s new: Over the past six months, experts across the U.S. report seeing significantly less fentanyl and fewer overdoses. Some believe the data shows a major disruption in the fentanyl supply chain.

The details: Drug gangs appear to be trafficking less fentanyl and are adulterating/weakening the potency of the fentanyl being sold.

• Researchers agree that there has been an unprecedented drop in fentanyl purity in some parts of the U.S.
• Labs that test street fentanyl are finding it cut or watered down, often with an industrial chemical known as BTMPS.
• There is no indication that the substance causes a high, so it is unclear why drug gangs would use it. But it appears it is being added to fentanyl powders deliberately and early in the supply chain, possibly in drug labs in Mexico. BTMPS is considered toxic to humans, but it does not cause overdoses or immediate deaths.

What the experts say:

• Some experts believe these shifts in supply are factors in the decline of overdose deaths.
• Some believe international pressure on Chinese companies that make precursor chemicals may be a factor.
• Others think a global crackdown on Mexican cartels is finally affecting the black market supply chain.
• But: Some experts think this is likely a temporary and modest supply disruption that is unlikely to last, and some doubt it is responsible for the decline in overdose deaths.

Source: The pipeline of deadly fentanyl into the U.S. may be drying up, experts say (NPR)