• Ibogaine is a psychoactive alkaloid from the western Central African iboga shrub that can rapidly reduce, and sometimes eliminate, opioid withdrawal and craving symptoms within a single dose.
• Ibogaine is a potential breakthrough treatment for opioid use disorder (OUD) due to its unique ability to heal the neurochemical brain injury caused by opioid use and alleviate withdrawal symptoms.
• Opioid withdrawal syndrome (OWS) is the debilitating physical and neurological symptoms that are induced by the cessation of opioid consumption.
• Ibogaine has shown promising results in resolving OWS within 36 to 48 hours of administration under safe, clinically controlled conditions.

Ibogaine could reduce lifetime direct costs of OUD by nearly 90%

• A growing body of research suggests that ibogaine treatment for opioid use disorder (OUD) could be significantly more cost-effective than traditional medication-assisted treatments (MATs), such as methadone and buprenorphine (suboxone).
• Unlike MATs—which require long-term, or even lifelong, use—ibogaine offers a clear root-cause intervention, capable of disrupting OUD within a single dose. In one study, 30% achieved complete opioid abstinence after only one ibogaine session.
• Patients who discontinue MATs often relapse when opioid withdrawal and craving symptoms return. MAT success is therefore measured on program retention (or continuation) instead of abstinence.
• The comparative cost-analysis below predicts that ibogaine treatment for OUD could reduce the 20-year direct lifetime costs of MATs involving methadone and buprenorphine by 87% and 86%. Concurrently, this analysis reveals just how quickly per-patient costs for MATs exceed $100,000.

Cost-Effectiveness for OUD Treatment: Ibogaine vs. MATs

Download the full backgrounder here:

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Opioid settlement funds have already been used for concerts, law enforcement equipment, and budget backfilling, among other purposes. These uses fall short of the settlements’ intent to remediate the crisis. With billions still to be spent over the next decade, it is crucial to establish better financial controls and reporting structures for the use of these funds to ensure they are deployed transparently, efficiently, and in compliance with their legal restrictions to advance evidence-based interventions proven to save lives.

The opioid epidemic has claimed more than 800,000 lives since 1999. As the crisis intensified, policymakers and the public sought to identify its causes. State and local governments filed thousands of lawsuits against opioid manufacturers, distributors, and retailers, accusing them of fueling the epidemic through misleading marketing and inadequate oversight. These lawsuits ultimately led to the national settlement agreements.  More than a dozen companies that manufactured, distributed, or aided in the prescription of painkillers, including McKinsey, Johnson & Johnson, Walgreens, CVS, and Walmart, reached settlements totaling approximately $50 billion, to be distributed to various state and local governments over nearly two decades.

The settlements stipulate that funds must be used to support opioid prevention, treatment, and recovery efforts. However, since receiving the funds, many jurisdictions have not provided the transparency, accountability, and prioritization of evidence-based strategies that genuinely address the needs of those most impacted by the crisis. Each state receives a designated portion of the national settlement based on factors such as opioid-related deaths, the volume of opioids shipped, and population size, with funds then subdivided between state agencies and local jurisdictions according to negotiated formulas.

To guide spending, the National Opioid Settlement Agreement includes Exhibit E, which stipulates a non-exhaustive list of approved uses centered on prevention, treatment, and recovery from opioid addiction, and harm reduction programs. States must allocate at least 70% of settlement funds toward these opioid remediation efforts, and some have gone further by committing to use 100% of their funds accordingly. The remaining 30% is allocated as follows: up to 15% for administrative costs and up to 15% for any other purpose.

Core priorities for the use of these funds include developing prevention efforts through supporting different evidence-based education programs; expanding training and increasing access to naloxone, a life-saving opioid overdose reversal medication; increasing education around and the availability of medication-assisted treatment (MAT) such as methadone and buprenorphine or other opioid-related treatment; supporting syringe service programs that reduce the spread of HIV and other infectious diseases through clean syringe distribution; and investing in wraparound services that offer coordinated, comprehensive care for individuals in recovery. Other allowable uses involve peer recovery support, workforce development, care for pregnant and postpartum individuals, and programs addressing the needs of those in the criminal justice system. The strategies listed are evidence-informed and designed to respond to the drivers and consequences of the crisis directly.

While the settlement agreement outlines preferred uses with an emphasis on remediation, the guidelines leave significant room for interpretation—creating wiggle room for states and localities to circumvent evidence-based treatment entirely.

This is what has happened in New Jersey, where state investigators uncovered how the Township of Irvington exploited the flexibility of the guidelines to fund events that had little connection to harm reduction, addiction treatment, or public health.

A report from the New Jersey Office of the State Comptroller revealed that over $632,000 was spent on two “Opioid Awareness” concerts in 2023 and 2024. As reported, thousands were spent on “generators, an ice maker, popcorn machine, cotton candy machine, four flavors of shaved ice, a hot food display stand, and catered food.” These events included celebrity performers and DJ sets. One township employee, Antoine Richardson, received $368,500 in unaccounted payments and steered nearly $470,000 in contracts to businesses linked to himself and his wife. The report concluded that Irvington’s actions violated the intent of the settlement and referred the matter to several state agencies for further review.

There have been issues elsewhere in how the funds have been spent. Scott County, Indiana, used over $250,000 to pay salaries for health and emergency services staff, effectively freeing up their local budget to buy a new ambulance and build a financial cushion for the health department. This is achieved through supplantation, where new dollars are used to fund existing programs, thereby making more general fund revenues available for governments to spend as they wish. This practice is not explicitly prohibited in Exhibit E of the settlement fund agreements. Still, it serves as a workaround that can undermine the intended goal of building service capacity through these funds. A similar example occurred in New York, where advocates noted that the state shifted millions from its addiction agency’s base budget and replaced it with opioid settlement dollars—substituting existing funding rather than using the settlement funds to enhance care. Blair County, Pennsylvania, directed $320,000 toward a long-standing drug court, using the funds in part to cover salary shortfalls for probation officers and aides due to limited state grants and probation fee revenue, rather than investing in new or expanded services.

Other states have directed the money toward law enforcement. Southington, Connecticut, used $18,000 to buy cellphone-unlocking technology for police. Ohio County, Ohio, spent nearly $43,000 on new K-9 and EMT equipment. Michigan counties, including Kalamazoo and St. Clair, purchased jail body scanners, infrastructure that experts argue should be funded through general law enforcement budgets. In West Virginia, $364 million, which is more than half of the state’s total opioid settlement spending for the year, went to police vehicles, jail bills, and salaries, while just 6% supported treatment and recovery. Jackson County took this further by using 90% of its $566,000 allocation to expand a first responder training center, including building a shooting range.

Although the opioid settlements stipulate that funds should be used for specific opioid remediation purposes, they contain no binding requirements, enforcement mechanisms, or clawback provisions if jurisdictions misuse the money. Oversight is left entirely to state and local discretion. Each state executed its own Memorandum of Agreement (MOA) defining how funds are distributed and what reporting, if any, is required.

As much of these funds currently remain unspent, it is incumbent on state and local governments to enact better financial controls and reporting mechanisms to ensure money is used consistently with its designated purpose—remediating the effects of the opioid epidemic.

Uncommitted settlement funds across states

According to the Johns Hopkins Opioid Settlement Expenditures Tracker*—developed by Johns Hopkins, Shatterproof, and KFF Health News—roughly one-third of the opioid settlement dollars tracked from 2022 to 2023 were allocated for specific uses.

The share of funds with reported uses varies significantly by state. Many states provide only limited information, leaving large portions of their initial allocations—sometimes more than 75%—without clear documentation of intended use. By contrast, a handful of states, such as Colorado, Washington, and Delaware, have published detailed reports showing how funds are being allocated.

Most settlement agreements do not require states or localities to publicly disclose how they spend the funds awarded to them. Twelve states had initially pledged to be “100% transparent,” meaning they would report on every dollar of settlement funds and how it is used. Only a few have followed through.

Among the handful of states that provide accessible and detailed descriptions of their uses of the funds is the state of Minnesota, which has a dashboard allowing anyone to track what will be done with the $117 million awarded. The dashboard breaks spending down by county, outlining who received the money, for what purpose, whether the grantee is using an evidence-based program, and the outcome of this spending.

Other dashboards include those maintained by the states of Michigan, New York, and North Carolina. New Jersey and Indiana, instead, publish annual reports outlining county-level spending.

Lessons from the tobacco settlement

The 1998 Tobacco Master Settlement Agreement (MSA) is the closest precedent to today’s opioid settlements, serving as an important cautionary tale. The MSA was a deal between four major tobacco companies and 46 states (plus D.C. and American territories). In exchange for releasing the companies from future Medicaid lawsuits related to smoking-related illnesses, the firms agreed to modify their marketing practices and make annual payments to the states in perpetuity, tied to cigarette sales.

Although the MSA was intended to offset public health costs and fund smoking prevention, it placed no restrictions on how states used the money. Most legislatures diverted payments into general budgets, infrastructure, or debt service rather than public health.

According to a United States Government Accountability Office Report, from Fiscal Years 2000 through 2005, the 46 states party to the MSA received $52.6 billion in tobacco settlement payments. However, only 30% of the funds were allocated to health care, and another 3.5% to tobacco prevention. The rest was split between covering budget shortfalls (22%), debt service on securitized funds (5.4%), infrastructure (6%), education (5.5%), tax reductions (1%), and others.

States are still receiving these settlements. According to the Kaiser Family Foundation, states received $6.8 billion from the MSA in 2024. 

Several states securitized the future tobacco settlement cash streams, which means selling the right to receive years of cash flows for a smaller upfront amount, while also passing to bondholders the risk that the companies settled with may not honor the agreed-upon future payment streams, or that tobacco sales would be lower than expected.

This practice is already under discussion for opioid settlements. Some municipalities, such as the Wisconsin Counties Association, have considered securitizing their opioid settlement funds, which would enable them to capture upfront the payment stream that extends through 2038 at a discount.

Securitization is problematic because it trades decades of future remediation dollars for a one-time cash infusion at a steep discount. Governments forfeit long-term funding streams that could sustain treatment and prevention infrastructure. The tobacco experience showed that securitization left many states with little or no settlement revenue in later years, even as smoking-related harms persisted.

Local officials may also be tempted to invest opioid bond proceeds, anticipating that market returns will surpass debt service costs—an approach akin to pension obligation bonds, which carries significant risks.

The outcomes of the tobacco settlement provide clear lessons for the use of opioid settlement funds: Absent binding guardrails and rigorous transparency, both state and local governments face strong incentives to divert or front-load funds in ways that undermine their intended purpose.

Policy recommendations for strengthening opioid settlement spending

When governments are entrusted with funds to address the opioid crisis, they take on a moral obligation to act accordingly. That means investing in what works: expanded access to medication-assisted treatment, naloxone distribution and education, syringe service programs, recovery housing models, and other approaches rooted in evidence and outlined in Exhibit E, including the development of potentially novel treatments.

Misallocating these dollars undercuts both public health outcomes and fiscal responsibility. When rehabilitation-eligible interventions are underfunded, communities miss out on life-saving programs like MAT and harm reduction. Instead, overdose deaths rise, and criminal justice systems bear the cost of repeated recidivism. By contrast, well-targeted settlement spending has the potential to save lives, strengthen communities, and ease the burden on public systems.

Below are recommendations to ensure that the awarded funds are used effectively.

1. Discourage supplantation through clear spending principles

Supplantation, or using settlement funds to replace existing public health dollars, weakens the impact of these resources. State budget officials and attorneys general should issue clear guidance encouraging local governments to deploy settlement funds as a supplemental expansion of care rather than an alternate method of financing existing services.

2. Prioritize external providers for efficiency

Governments should prioritize contracting with external providers rather than providing harm reduction services themselves. Building new publicly operated service programs tends to be costly and slow, while specialized providers are likely to deliver evidence-based care more efficiently and at lower cost.

Partnering with external providers also reduces the risk of budget supplantation, ensuring settlement dollars fund new services rather than displace existing expenditures. Service providers who receive these funds should be held accountable for their use and required to provide an independent auditor’s report detailing the use of these funds if they exceed a minimum threshold. For instance, recipients of federal grants in excess of $750,000 in any year must complete a federal single audit to account for the use of those funds.

3. Prohibit securitization

States should consider adopting explicit bans on securitizing opioid settlement revenues—that is, selling the right to future payments in exchange for upfront cash.

While securitization may appear to offer immediate budget relief, the tobacco settlement experience has shown that it strips away long-term remediation funding, often resulting in communities losing access to dollars even as their needs persist. Prohibiting securitization ensures that settlement payments remain available over time to sustain treatment, prevention, and recovery infrastructure, rather than being consumed in a single budget cycle.

4. Support voluntary frameworks for evidence-based spending

State governments can offer spending guidelines that prioritize effective, research-based strategies such as medication-assisted treatment, naloxone access, syringe service programs, and recovery housing. These frameworks should be developed with input from people with lived experience and members of the affected community to ensure they reflect real needs and can be adapted to local contexts. Highlighting these approaches helps localities focus on interventions that directly reduce harm and improve recovery outcomes.

5. Increase spending transparency

Local governments should regularly publish clear and accessible data showing how settlement funds are spent and what goals they aim to achieve. This can be achieved through either interactive dashboards, such as those used by the state of Minnesota, or yearly reports, as seen in the states of New Jersey and Indiana.

6. Allocate a portion of funds to innovative and emerging treatments

To drive long-term progress in addiction care, state and local governments should dedicate a portion of opioid settlement funds to support the research, development, and piloting of innovative treatment modalities. This includes exploring the therapeutic potential of ibogaine, a psychedelic alkaloid showing promise in interrupting opioid dependence, and GLP-1 receptor agonists, initially developed for diabetes and weight loss, which are being studied for their ability to reduce drug cravings and compulsive use. While more clinical trials are needed, strategic investment in these areas can help expand the future treatment toolkit beyond traditional approaches. Prioritizing innovation ensures that settlements can remediate current harms and foster breakthroughs that reshape addiction care for the next generation.

7. Invite independent spending reviews

Localities can partner with independent institutions to review how funds are allocated and whether spending aligns with the original purpose of the settlements. These reviews help identify areas for improvement and add an extra layer of accountability without requiring new laws or regulations.

8. Include community voices in spending decisions

People affected by addiction should have a role in shaping how funds are used. Community input ensures that spending decisions reflect local needs and improve outcomes for those most directly impacted.

The opioid settlements present a real opportunity to reshape how states support addiction care. Real impact comes from honest reporting, directing funds toward new and innovative treatment options, and strengthening what already exists on the ground. Many harm reduction and recovery programs already serve their communities, sometimes without formal recognition or support. These funds can help legitimize and expand their reach while empowering new groups to fill gaps where services do not yet exist. When used this way, the money can build sustainable systems that save lives and restore trust. The choices made now will determine whether these funds drive lasting progress or fade into missed potential.

*Correction: This piece has been updated to reflect that the data used from the Johns Hopkins Opioid Settlement Expenditures Tracker shows settlement funds received and committed in 2022–2023, not cumulative totals as previously described.

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We believe that studying ibogaine would be beneficial for mental health and addiction care. If ibogaine demonstrates both safety and efficacy, it could facilitate treatment access to millions of Americans suffering from opioid use disorder (OUD) and other mental health conditions. We believe that Senate Bill 2308 provides a sensible regulatory pathway for the advancement of ibogaine as a potential treatment for OUD, co-occurring substance use disorders (SUD), and other relevant neurological or mental health conditions.

Texas can lead the nation in innovative mental health and addiction care solutions with this bill. Senate Bill 2308 prioritizes patient safety and scientific rigor. There are strict requirements for all applicants wishing to conduct trials. To be eligible for the grant, applicants must be private corporation entities with enough capacity and financial resources to conduct FDA trials, seek FDA approval, and conduct future trials. Applicants must also provide detailed plans on trial design, participant recruitment, safety protocols, post-treatment aftercare, and strategy for FDA-approval.

Senate Bill 2308 does not attempt to legalize ibogaine or ibogaine treatment, nor does it try to bypass existing federal regulations. It would retain current prohibitions on possession, use, manufacture, and sale of psychedelic compounds, as well as provide a framework consistent with the FDA drug-approval process, as ibogaine treatment administration will only apply if FDA approval is granted, requiring licensed physicians to supervise its administration in healthcare facilities.

 Over the past decade, the medical community has increasingly recognized the potential of psychedelic therapies for the treatment of mental health conditions and addiction. However, despite promising research, access to innovative psychedelic therapies is limited by the FDA’s designation of psychedelics as Schedule I substances. Ibogaine appears to have a unique ability to rapidly reduce withdrawal and craving symptoms associated with opioid addiction, often after just a single dose.

The grant program under SB 3208 offers an opportunity to collect comprehensive safety and efficacy data on ibogaine for treating OUD, SUD, and other mental health disorders, while ensuring alignment with existing federal regulations and FDA drug approval standards.

While not necessarily a major point of concern, we’d like to note that Senate Bill 3208 contains slightly different language regarding funding sources than its companion bill, House Bill 3717.  The House Bill allows for funding from both appropriated money and gifts, grants, or donations, while the Senate Bill only allows for funding from gifts, grants, or donations. The House language may provide additional flexibility for the funding of ibogaine studies, potentially allowing for the use of resources such as opioid settlement funds. This broader funding approach could enhance the program’s impact and success.

Overall, SB 3208 would allow Texas to administer grants to conduct potentially life-saving research into ibogaine, which has shown tremendous promise in the therapeutic treatment of OUD, with minimal risk to both public safety and public health. Thank you for your time and consideration.

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While Kennedy’s recovery journey may have worked for him, his plan overlooks other evidence-based approaches, like medication-assisted treatments (MAT), which have already helped millions of Americans struggling with addiction, and emerging therapies like ibogaine. 

The lived experience of people who use drugs can sometimes offer great insight for policy change, but not when that guidance is based solely on one person’s experience. Kennedy’s plan to address the opioid crisis is deeply personal, shaped by his 14-year struggle with heroin and other drugs. Rooted in the teachings of Swiss psychotherapist Carl Jung, 12-step programs, and faith-based therapy, his philosophy frames addiction primarily as a moral and spiritual crisis. While this perspective was once commonplace among anti-drug advocates, it has largely been replaced by a medical understanding of substance use disorders–one that recognizes addiction as a complex health condition requiring evidence-based treatment. 

During the hearing, Kennedy proposed the expansion of faith-based, labor-intensive rehabilitation centers, which he refers to as “healing farms.” His inspiration comes from San Patrignano-style recovery centers—known for their emphasis on long-term, abstinence-based treatment through vocational training and communal support, which have faced scrutiny for their use of coercion and retributive discipline. The emphasis on isolation, strict adherence to communal rules, and limited autonomy over personal decision-making raise ethical concerns about coercion and the long-term well-being of participants. Reports have also pointed to the exclusion of individuals with co-occurring psychiatric disorders, limiting access for those who may require integrated mental health support.

Research consistently shows that forced treatment is usually ineffective. Studies indicate that individuals subjected to involuntary treatment, such as civil commitment for treatment, relapse at alarming rates–often on the day they are released. These poor long-term outcomes stem from heightened institutional distrust, a lack of post-treatment support, and inadequate access to quality care. 

Many people struggling with addiction have a history of trauma, and coercive approaches can exacerbate that trauma, making individuals less likely to seek help and ultimately reducing long-term recovery rates. The facilities that house these programs often fail to provide comprehensive, trauma-informed care, as they lack appropriately trained staff and resources necessary to offer a full range of treatments, including medication, therapy, and wound care. 

While some individuals may benefit from short-term involuntary treatment in crisis situations, many do not, and many experience greater harm as a result of involuntary treatment. Creating a legally sound, ethical framework that protects individual rights while addressing the complexities of addiction remains a major challenge—one that Kennedy’s approach fails to resolve.

Medication-assisted treatment (MAT) is the only form of treatment currently approved by the Food and Drug Administration for treating opioid use disorder and should not be disregarded in favor of an abstinence-only approach. Medications like buprenorphine, methadone, and naltrexone have been extensively studied and shown to significantly reduce opioid cravings, prevent withdrawal symptoms, and decrease overdose risk. The main shortcoming with MAT, specifically methadone, is that patients are required to make daily visits to a clinic to receive medications for up to two years to achieve successful recovery from addiction. This demanding regimen contributes to high rates of treatment withdrawal and relapse.

Newly emerging treatments like ibogaine have shown potential as a possible replacement for MAT to help individuals overcome opioid use disorder because early evidence suggests high success rates after just a single administration. In one small-scale study, 75% of participating opioid addicts remained opioid abstinent for an entire year after a single ibogaine treatment. While still in the early stages of research due to legal restrictions and safety concerns, preliminary evidence suggests that ibogaine could be a breakthrough tool in addiction treatment, offering those struggling with opioid dependence a neurobiological reset. 

Rather than reverting to outdated, ideologically driven, and ineffective approaches, policymakers should prioritize expanding access to evidence-based treatments and investing in innovative treatments like ibogaine that could revolutionize addiction care. As secretary of Health and Human Services, Kennedy could make progress by pushing to allow patients to take some quantity of traditional MAT medications home with them to improve adherence to the regimen and expedite the development of ibogaine as an alternative treatment option.

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The last decade has seen an explosion of opioid addiction and overdose deaths, a public health crisis fueling demand for medical and governmental intervention. This brief is a comprehensive overview of the reported results of studies investigating the potential of ibogaine, a psychoactive compound derived from the Tabernanthe iboga plant, in treating opioid addiction.

Existing Medication-Assisted Treatments (MATs), also referred to as Medications for Opioid Use Disorder (MOUD), are examined as a frame of reference. Outcome measures examined include withdrawals and craving, retention, relapse, abstinence duration, mortality, adverse events, risk of diversion, short-term abstinence, long-term abstinence, program costs, and depression.

A consistent theme emerges from the research conducted to date into ibogaine as a prospective treatment for opioid use disorder (OUD): Ibogaine and ibogaine analogues are the only known treatments that consistently and immediately reduce both physical withdrawal symptoms from opioid addiction and psychological dependence without the need for ongoing medication. However, there are no large-scale studies of ibogaine, and more research is needed to understand if it could satisfy patients’ medical needs.

Existing challenges of MATs include increased mortality rates following treatment cessation, high relapse rates, low retention rates, adverse events that include respiratory depression and QT prolongation, risk of diversion, and limited access. Some studies suggest ibogaine treatment is more effective than MATs in combating these existing challenges.

Based on existing research, ibogaine therapy shows the potential to be an effective alternative treatment method for OUD. Its ability to reduce and eliminate opioid withdrawal and craving symptoms plays a key role in the reduction and abstinence of illicit opioid use. Hence, ibogaine can help users achieve lasting anti-addictive effects at fewer doses, whereas traditional MATs just abate dependence. Policymakers should consider ibogaine as a potential alternative treatment for opioid use disorder.

Nonetheless, it is still important to acknowledge the existence of potential safety risks associated with ibogaine treatment. More serious risks include cardiotoxicity and death. However, mitigation strategies have proven successful when administered in clinical settings.

For example, Deborah Mash’s ibogaine clinic in St. Kitts, West Indies, conducted 257 treatments from 1996 to 2004 without any related deaths or serious adverse events. Hence, professional oversight and proper clinical procedures are necessary conditions.

Several states participated in lawsuits against manufacturers and distributors of prescription opioids and received large settlement funds that are largely restricted for programs intended to abate the impact of opioid addiction. One potential avenue for doing this is to advance the development of a therapy that may allow individuals to overcome opioid addiction in as little as one treatment.

Based on the clinical and academic studies reviewed here, traditional abatement mechanisms present many challenges for recovering addicts and have demonstrated only limited success in helping opioid-addicted persons overcome their addiction. By contrast, early research shows ibogaine treatment may be a far more promising approach that enables rapid and sustained recovery from addiction.

The state of Kentucky was the first to consider this possibility. Kentucky received $842 million in settlement proceeds from its participation in a multistate lawsuit. Former Attorney General Daniel Cameron then established a Kentucky Opioid Abatement Advisory Commission to direct the allocation of these funds toward abatement programs.

Throughout a series of public hearings in 2023, the commission considered allocating $42 million—roughly 5% of Kentucky’s share of opioid settlement proceeds—toward Food and Drug Administration-supervised clinical trials that could lead to approval of ibogaine or its derivatives as a treatment for opioid use disorder. In December 2023, Russell Coleman succeeded Daniel Cameron as Kentucky Attorney General and pressed the commission for a change in direction. Chair Bryan Hubbard said he was asked to resign due to his support for funding ibogaine trials, and he was replaced with a former agent of the federal Drug Enforcement Administration.

However, the initiative first launched in Kentucky now continues elsewhere. In February 2024, Hubbard was retained by the Reaching Everyone in Distress (REID) Foundation, an Ohio-based nonprofit to advance FDA-supervised clinical trials for ibogaine. The REID Foundation will engage in broad based statewide advocacy for the creation of a public-private partnership to advance ibogaine or an ibogaine therapeutic through the FDA. ResultsOHIO has also retained Hubbard to explore projects related to the research, development, and delivery of novel therapeutics like ibogaine for treatment of traumatic brain injury and post-traumatic stress disorder. Despite the change of venue, Ohio is poised to capitalize on the materials accumulated by and on behalf of the Kentucky Opioid Abatement Advisory Commission, including the compilation of research presented here.

Based on the existing evidence, Reason Foundation concludes that the development of ibogaine as a pharmaceutical treatment for opioid use disorder may be the most cost-effective use of funds earmarked for mitigating the harms of the opioid epidemic.

Read the full Policy Brief here:

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In the study, Stanford University’s Nolan Williams and his team found that ibogaine-assisted therapy significantly reduced symptoms of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) among 30 veterans treated at a private clinic in Mexico. The clinic in the study was run in collaboration with Veterans Exploring Treatment Solutions (VETS), an advocacy and resource organization that connects veterans with treatments outside of the United States. After a single administration, patients showed immediate improvements in cognitive function. 

While the potential of ibogaine for treating TBI is promising, this study also lends support to another application of ibogaine therapy—opioid use disorder. Early research has shown that ibogaine may be the best available treatment to aid individuals trying to overcome an opioid addiction, but there has been some opposition to this application.

The primary opposition is that ibogaine can disrupt the heart’s regular pacing (known as QT-prolongation), which has led to high-profile fatalities in some of the early clinics that offered these treatments. However, practitioners have developed safety protocols to mitigate this danger when ibogaine is administered in a clinical setting that primarily consists of treating the subject with magnesium supplements.

For instance, Dr. Deborah Mash’s ibogaine clinic in St. Kitts, West Indies, conducted 257 treatments from 1996 to 2004 without any related deaths. Her clinic in Cancun, Mexico, reported conducting 1,200 treatments without any associated or related deaths. Most serious adverse events associated with ibogaine have resulted from nonclinical use. The Nature study provides renewed evidence that ibogaine treatments can be safe with the proper protocols in place.

It shows that ibogaine can be used safely and effectively to treat serious neurological conditions when adhering to proper protocols. “[N]o other drug has ever been able to alleviate the functional and neuropsychiatric symptoms of traumatic brain injury,” according to lead researcher Nolan Williams. “The results are dramatic.”

A Stanford University summary of the study elaborates further: “One month after treatment participants experienced average reductions of 88% in PTSD symptoms, 87% in depression symptoms and 81% in anxiety symptoms relative to how they were before ibogaine treatment.” 

Ibogaine’s potential for treating opioid dependence reaches far beyond what currently available therapies can offer. Existing treatments use milder opioids, such as methadone, to support a person’s physical addiction over a prolonged period. These treatments satiate drug cravings, thereby reducing withdrawal symptoms, but do not permanently reduce reliance on any drug. 

By contrast, ibogaine can almost immediately alleviate both physical dependency and mental cravings after a single administration. In one clinical study, 76% of participants reported the resolution of physical opioid withdrawal symptoms within 72 hours. 

The controversy around ibogaine as an experimental treatment received national attention when policymakers in Kentucky proposed allocating $42 million out of an $842 million settlement with prescription opioid manufacturers toward FDA-supervised clinical trials to demonstrate that ibogaine is effective at treating opioid addiction. Use of the settlement funds was restricted for programs to abate the impact of opioid addiction, and so ibogaine trials met this criterion.

However, critics voiced concerns about the potential health risks posed by ibogaine. Some experts expressed skepticism that the Food and Drug Administration would approve a drug with potential dangers. The proposal became especially imperiled after Russell Coleman was elected Kentucky’s attorney general in November 2023. Coleman quickly shook up the Opioid Abatement Advisory Commission, designed to direct the state’s use of the settlement funds, by dismissing the commission’s chair, Bryan Hubbard, who was an advocate of the ibogaine proposal.

At the commission’s Jan. 9 meeting, Chris Evans, former chief operating officer for the Drug Enforcement Administration, who replaced Hubbard as executive director of the Opioid Abatement Advisory Commission, chose not to address ibogaine.

“There will be a time, and we will engage in those…[ibogaine] conversations, but just today is not the day for that,” Evans said to citizens attending the meeting to urge the state to move forward with the ibogaine study, according to Kentucky Health News.

With Kentucky’s ibogaine study in doubt, other states may need to take the lead. When studies with psilocybin revealed efficacy rates in the treatment of depression similar to those of ibogaine in the treatment of opioid addiction, the FDA gave it a rare “breakthrough” status, which grants an accelerated path to drug approval at a lower cost. 

Historically, it has been difficult to conduct clinical research on psychedelic substances in the United States. Although the FDA does allow Schedule I substances to be tested as investigational new drugs, the Drug Enforcement Administration imposes a series of harsh controls on medical researchers that are difficult and costly to comply with. These disincentives discourage private investment into the development of promising new drugs even if the market incentives would otherwise substantiate investment.

New evidence presented by the Nature study could help remove current barriers to research and pave the way for the development of ibogaine as a promising treatment for opioid addiction.

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“Unfortunately, the effectiveness of current treatments for opioid use disorder is insufficient, as best demonstrated by the current crisis we find ourselves in but also as shown in rigorous scientific evaluations,” Professor Nolan Williams, director of Stanford’s Interventional Psychiatry Clinical Research, tells Reason Foundation.

Williams is the lead researcher studying the effectiveness of ibogaine in treating substance addiction. While research is limited, Williams writes, “[T]he data that we do have on ibogaine are extremely encouraging. A single dose of ibogaine has been reported to substantially decrease the desire and intention to use.”

Ibogaine is a controversial substance; early scientific research and many anecdotal reports from military veterans suggest that it is one of the only known compounds to dramatically reduce cravings for opioids permanently. However, it is also a relatively understudied and potent hallucinogen, meaning that new medical protocols will have to be combined with psychiatric support. 

This is precisely why Bryan Hubbard, chair and executive director of the Kentucky Opioid Abatement Advisory Commission, has proposed allocating a small slice—$42 million out of $842 million in funds already earmarked to treat opioid addiction—toward medical research to evaluate further the effectiveness of ibogaine in treating opioid addiction. The money comes from a legal settlement with pharmaceutical companies convicted of deceptive marketing practices intended to conceal prescription opioids’ addictive potential and will likely be matched by private investors.

Today, ibogaine is a Schedule I substance under the Controlled Substances Act, and this designation creates massive barriers to research and use as a treatment. This designation reflects the Drug Enforcement Administration’s determination that ibogaine holds no medical value and has a high potential for abuse despite a growing body of evidence indicating otherwise. Schedule I substances are strictly prohibited in the United States, and it is very difficult for researchers even to conduct medical studies incorporating them.

In October testimony to the Kentucky advisory committee, Rick Doblin, founder of the Multidisciplinary Association of Psychedelic Studies, said that ibogaine could become commercially available much quicker and for less cost than typical pharmaceuticals. 

The FDA has already granted a special “breakthrough therapy” designation for two other psychedelic drugs. This designation dramatically reduces the time to approval and the associated costs. 

Given ibogaine’s extraordinary results similar to other psychedelic drugs, Doblin rightly argues that ibogaine could be fully approved in less than six years; it could also clear most of the FDA clinical trials for less than $100 million.

Private-sector development of ibogaine as a pharmaceutical is unlikely due to a range of government policies that inhibit market function. Pharmaceutical development is already costly because changes to the Food Drug and Cosmetics Act in the 1960s require drug makers to demonstrate not only that their products are safe but also that they meet the Food and Drug Administration’s (FDA) definition of “effective” before a product can go to market. Prior to that change, federal regulators policed safety but allowed the medical community to determine effectiveness. 

In the face of these government-erected barriers to private medical research, a public-private partnership—leveraging a portion of opioid settlement funds with outside private investment—offers what may be a realistic path forward in the development of ibogaine as a potential treatment for opioid addiction in the near term.

Kentucky’s program would guarantee that at least some citizens can access this potentially life-saving medication through supervised clinical trials. The trials would be conducted at Kentucky hospitals across the state’s major regions and serve Kentuckians most in need of treatment. If Kentucky’s leadership inspired other states to also use their settlement for further clinical trials, they could fully fund the commercialization of ibogaine. 

Regarding safety concerns, ibogaine can cause rare but fatal cardiac problems in high-risk populations without appropriate medical supervision. For instance, ibogaine can cause irregular heartbeats. In patients who have a heart infection because of contaminated needles, this arrhythmia can be fatal. In the early days of ibogaine research, there were a number of unfortunate deaths. 

Since then, Stanford’s Williams says, advanced screening and medical oversight can now reliably prevent fatalities in clinical trials. Recent research backs this up. “The ibogaine-related fatalities occurred mostly in unsafe settings without proper medical monitoring and advanced cardiac life support capabilities,” concluded one review of research in 2021. 

Without legal alternatives, veterans and other at-risk groups will seek alternative solutions in illicit markets. Frustrated by the slow pace of federal approval, voters in Colorado instead legalized personal possession of some botanical psychedelics, including ibogaine, even though there is not yet any regulated model for safe access. 

“Too many veterans are stuck between two impossible options: risk dependence on or death by opioids or try to deal with chronic pain and the resulting increase in suicidal ideation,” Jesse Gould, director of Heroic Hearts, an organization that helps match veterans with addiction ibogaine treatment centers outside of America, writes to Reason Foundation in an email. “With how promising early research is around ibogaine, it is absurd that government funding is not currently supporting this research.”

Spending all of the settlement money on status-quo treatments isn’t likely to improve outcomes. Instead, Kentucky could lead the nation in exploring a promising new solution.

The post Kentucky needs new approaches to the opioid crisis appeared first on Reason Foundation.

The importance of naloxone is hard to overstate. More commonly known by the brand name Narcan, naloxone is a nasal spray that instantly blocks the effects of opioids and rapidly reverses overdose symptoms, including respiratory failure, the main cause of death from opioid overdose. It has been used as the standard care for overdose in emergency rooms for around four decades.  

Even when administered by laypeople, as opposed to doctors or emergency medical providers, naloxone has a more-than-90-percent success rate. It is easy to use, cheap to manufacture, shelf-stable for years, non-addictive, and unharmful if administered to someone not overdosing on opioids. Once administered, it can restore breathing in under three minutes.

The speed of naloxone is important. When someone stops breathing, bystanders have just minutes to act before brain damage and death occur. Naloxone is more effective the sooner it is administered, but most overdoses occur at home, where bystanders, often the victim’s friends and family, may be unable to do anything other than wait and hope emergency services arrive in time to administer naloxone. When every second counts and the average wait time for emergency services is between seven and 14 minutes, having naloxone on-hand could mean the difference between life and death.  

Because of its near-miraculous ability to rescue lives from the precipice of death, naloxone has become a central pillar in the global response to the opioid overdose crisis. Governments around the world have taken steps to ensure its wide availability, at little-or-no cost, among the general public, including here at home.  

After receiving federal grant funding, Idaho launched its naloxone distribution and training program through its Department of Health and Welfare (IDHW) in 2017. To ensure adequate distribution across the large, sparsely populated, and rural state, IDHW in 2020 contracted out this work to the nonprofit organization Idaho Harm Reduction Project, to whom IDHW provides naloxone kits and pays around $24,000 annually for administrative costs.

After receiving the kits, the Idaho Harm Reduction Project works with local partners to get naloxone into the hands of those individuals and groups most likely to need it, including first responders, substance use treatment programs, clinics, colleges and universities, and shelters. But, when the new law takes effect on July 1, that established distribution and training network may disappear. 

The change is the result of a one-sentence addition to the annual appropriations bill that funds the IDHW’s Division of Substance Abuse and Prevention specifying that “funds available for naloxone and needles shall be available only to first responders in the state of Idaho.” The funds in question are those grants provided by the federal government for states’ response to the opioid overdose crisis and which IDHW uses to purchase the naloxone kits.  

Idaho’s naloxone distribution program has been effective so far. In 2022, it resulted in the distribution of over 25,000 no-cost naloxone kits that were used to reverse 1,200 overdoses that year. Of those reversals, 94 percent were performed by somebody other than first responders. But now, if the state hopes to maintain the same level of distribution, IDHW will have to form new partnerships with first-responding agencies in all of the state’s 44 counties, a move that will destabilize the current program and increase costs, according to a state analysis. 

Backers of the new restriction reject claims it erects barriers to naloxone access, arguing that it only alters where no-cost naloxone can be obtained. “Instead of going straight to Health and Welfare to get it, they would go through their first responders, their police, their sheriffs or firefighters, whoever is closest to them or that they’re comfortable going to,” asserted state Sen. Julie VanOrden (R-Bingham County), who sponsored the State Senate version of the bill.

But some Idahoans may not be comfortable with directly approaching first responders at all, especially if they have a history with the criminal justice system.  

Proponents of the measure claim the new restrictions will ensure public safety, guaranteeing that federally-funded naloxone kits are “actually going out to the right people, people that we can actually educate and give training,” according to Rep. Josh Tanner (R-Eagle), the freshman Republican who introduced the language.

That might sound reasonable, but the evidence shows such education and training is not necessary. Operated much the same as intranasal allergy medication, naloxone is manufactured to be easy to administer. Studies have found no appreciable increase in success rates in trained versus untrained rescuers, and the medication is considered so safe that it can now be purchased by anyone at a pharmacy without a prescription. Yet, not all pharmacies that can sell naloxone do sell it. Even if they do, not all individuals who might benefit from having naloxone on-hand can afford its average retail price of $50.  

That is where government-funded naloxone distribution programs are meant to step in, and the evidence of their impact is impressive. Not only does making naloxone available to the public save lives—cutting overdose deaths by half in some communities—it is also cost-effective, saving an estimated $3,000 for every $1 spent on naloxone. 

In fact, until the new change, first responders in the state received their own naloxone training and kits through the IDHW’s program and relied on IDHW’s local partnerships to maintain naloxone access. Now, in addition to responding to the ever-increasing number of overdose emergencies, first responders in Idaho will have to create and maintain their own naloxone distribution programs.  

Unsurprisingly, first responders in the state aren’t particularly happy about the change. In a letter to Gov. Little, Lewiston Fire Chief Travis Myklebust explained that “first responder agencies simply do not have the personnel or logistical support to add this program into their operations as a sole provider.”

Jeff Lavey, executive director of the Idaho Sheriffs Association, echoed a similar sentiment writing to the governor that law enforcement offices are already “overworked and understaffed” with limited time to distribute naloxone. 

Despite those objections and his own reservations, Gov. Little–who made increasing naloxone access a priority in his first term–signed the new measure into law on April 5. In a letter accompanying his signature, he decried the additional “red tape” and noted that the likely outcome would be “fewer naloxone doses available to administer in Idaho and, tragically, fewer lives saved.” But because the change was tied to a must-pass appropriations bill, simply vetoing the new distribution rule wasn’t an option, according to Little.  

While officials around the world increasingly recognize the value of increasing access to naloxone—with Arkansas just this week enacting a law requiring naloxone kits in all publicly-funded schools—Idaho lawmakers are pushing the state in the opposite direction. Unfortunately, it will be the people of Idaho, families struggling with substance use and already overworked first responders, who pay the price.  

The post Idaho’s restriction of overdose reversal medication is a fatal error   appeared first on Reason Foundation.

Figure 1. Drug Overdose Deaths by Substance

Source: Years 1999 to 2020 from CDC WONDER; Year 2021 reports preliminary data from NCHS.

Addiction in the United States has been dropping for the last 20 years (Figure 2). Opioid addiction, in particular, has been dropping for approximately 10 years. In 2002, 9.4 percent of Americans were addicted to a drug, including 0.7 percent of Americans addicted to opioids. In 2019, the last year measured with a comparable standard (DSM-IV), 7.4 percent of Americans were addicted to substances with 0.6 percent of those being addicted to opioids. Additionally, record levels of naloxone and addiction treatment medications are being distributed, which means more people received addiction treatment in 2021 than any other year in American history.

Figure 2. Addiction Rate (%) in the U.S. by Substance Over Time​​

Sources: Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health, SAMHSA; Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health, SAMHSA.

Fewer Americans are addicted to drugs and more of those who are addicted are receiving medication-assisted treatment for addiction, yet more people are dying from drug use. So, what is going on?

The reality is that drug addiction and drug-related deaths don’t have much of a relationship. Drug-related deaths are almost solely caused by the safety of the drug supply, which is made more dangerous by successful drug enforcement. 

Public health interventions like prescription drug monitoring programs (PDMPs), which have been implemented in recent years to reduce opioid prescribing—and have successfully reduced the numbers of opioids prescribed by doctors since 2012—have motivated more drug users to resort to the black market for their fix. And when law enforcement becomes more successful at seizing illegal drugs, traffickers increase the potency of their narcotics to evade detection.

For example, as the Drug Enforcement Administration (DEA) successfully seized increasing amounts of heroin between 2010 and 2014, they soon started to seize fentanyl instead in the years following. During this shift, overdoses by fentanyl replaced those caused by heroin, but at a higher rate. And now those with substance use disorder are dying at such a high rate that overdoses are spiking despite a shrinking population of regular drug users. That means addiction is dropping in the U.S., but our drug-enforcement policies are killing more drug users by driving them to potent, unregulated products like fentanyl.

Some media outlets are starting to better connect these relationships. U.S. News & World Report, for example, recently reported “Teen Overdose Deaths Have Soared, Even Though Drug Use Hasn’t,” which could have been written about most age groups in the U.S. Reason has written about this false relationship for decades. But if we are to finally address drug-related deaths in this country, we will need this insight to become common knowledge amongst policymakers, public health officials, and the public-at-large.

Lawmakers intentionally reduced the rates of legal opioid prescribing by doctors, but drug-related deaths in the United States continue to climb to unprecedented heights every single year. If the U.S. continues its failed drug war approach, Americans should, sadly, expect even more overdose deaths in the years to come, as black market drug producers will continue to have incentives to create more potent products. 

Americans can have fewer drug users or fewer drug overdoses, but it is unlikely to have both. Let’s hope that the country reconsiders its opioid policies and opts to be a humane society that leans towards more freedom and less death.

The post Over 100,000 died from drug overdoses in 2021 as public policy drives people to fentanyl appeared first on Reason Foundation.

The Centers for Disease Control and Prevention reported 70,630 drug overdose deaths for 2019 in the United States, 70.5 percent of which were opioid-related. Amid unprecedented drug-related mortality across the entire United States, Prescription Drug Monitoring Programs (PDMPs) are the most popular interventions states enact to address opioid addiction and overdoses. Prescription Drug Monitoring Programs allow health officials and law enforcement to review the prescribing histories among doctors and patients in hopes of reducing inappropriate prescribing that might lead to addiction or death. However, the inception of PDMPs has been followed by increasing rates of opioid overdose and stable rates of drug addiction. With 19 years of mortality data, this analysis assesses whether Prescription Drug Monitoring Programs have significant effects on either opioid prescribing or mortality.

This study finds that, although Prescription Drug Monitoring Programs’ intermediary purpose to reduce prescribing has been achieved by reducing opioid distribution by 7.7 percent, they have had inconsistent effects on prescription opioid overdoses, while increasing total opioid overdoses by 17.5 percent due to increased mortality from the black market varieties by 19.8 percent.

FIGURE ES1: STATE-LEVEL DEATH RATES FROM LICIT AND ILLICIT OPIOID OVERDOSES FOLLOWING PDMP IMPLEMENTATION BY STATE

Since Prescription Drug Monitoring Programs fail to achieve their ultimate goal of reducing opioid overdoses, their funding should be re-appropriated to more effective mechanisms to reduce addiction and overdose rates, such as providing access to prescription-quality opioids for medication-assisted treatment (MAT).

Introduction and History

Prescription Drug Monitoring Programs (PDMPs) have been used in the United States since the early 20th century. Prior to 1914, natural opiates—the predecessors to modern synthetic or semi-synthetic “opioids”—were unregulated by the federal government and widely available for purchase without prescription in most of the United States.¹ Use among the American public was quite commonplace. According to one article published in The New York Times, one in every 400 United States citizens had some type of opiate addiction by 1911, reportedly due to “the sudden emergence of street heroin abuse as well as iatrogenic [induced by medical treatment] morphine dependence.”²

In response to rising levels of Chinese immigration to the U.S., which was blamed for rising rates of opium use, states like California began outlawing the recreational consumption of various narcotics. San Francisco became the first U.S. municipality to enforce an anti-narcotics law in 1875, outlawing the operation of opium dens, which became state law in 1881. By 1907, California’s State Board of Pharmacy quietly lobbied for an amendment to the state’s poison laws, which prohibited the sale of opium, morphine, and cocaine except by a doctor’s prescription.³

Eventually, the U.S. Congress passed the Harrison Narcotics Tax Act in 1914, the first federal statute regulating the production and sale of opiates and cocaine, which was enforced as a ban on the recreational sale of both products. Under this law, physicians across the U.S. were also restricted from prescribing opiates to addiction patients, and all proprietors of opium products needed to be registered with the federal government, creating the ancestor to the modern PDMP databases.

In an effort to further combat overprescribing, states slowly began to develop their own monitoring programs, the first of which was created in New York in 1918. However, these early PDMPs were rather slow in their collection speeds and used inefficient paper reports to monitor the prescription history of patients. ⁴

These programs developed throughout the mid-20th century and were rather ineffective, as “[p]rescribers were required to report to databases within 30 days, too long a time to reasonably be useful in preventing real-time ‘doctor shopping’ or over-prescribing.”⁵ Additionally, there were no electronic databases tracking which patients had recently filled opioid prescriptions for doctors to reference.

Given the weaknesses of these early PDMPs, few states adopted any type of monitoring program over the course of the first half of the 20th century. However, the proliferation of PDMPs was greatly enabled by the ruling of Whalen v. Roe in 1977, a case that upheld the constitutionality of New York’s precursor of the PDMP under the broad police power given to the states by the Tenth Amendment. The plaintiffs of this case argued that the monitoring program constituted an invasion of patient privacy, due to its collection and storing of prescribing records. Writing for the majority, Justice John Paul Stevens held that, “[n]either the immediate nor the threatened impact of the patient identification requirement on either the reputation or the independence of patients…suffices to constitute an invasion of any right or liberty protected by the Fourteenth Amendment.”⁶ With the constitutionality of patient prescription monitoring upheld, states were able to pursue data collection on prescribing history more thoroughly. Empowered by this ruling, many more states began to operate some form of a PDMP.

By 1990, states such as Oklahoma and Nevada began to adopt electronic reporting systems, greatly expanding the capabilities of these programs. These improvements reduced operations costs and increased the accuracy of the databases, leading other states to consider them as a viable means to monitor opioid prescribing.⁷

In 2003, the PDMP seemed to be an effective way to combat opioid overdose deaths. Given that the majority of opioid deaths in 2003 were due to prescription drugs, the program’s intended purpose of limiting opioid prescribing seemed logical. In that year, Congress further increased funding for state PDMPs through the Harold Rogers Prescription Drug Monitoring Programs Grant, a competitive federal program that allows states to receive funding to “enhance the capacity of regulatory and law enforcement agencies and public health officials to collect and analyze controlled substance prescription data…through a centralized database administered by an authorized state agency.”⁸

Although PDMPs are implemented at the state level, federal law enforcement such as the Drug Enforcement Administration (DEA) has unfettered access to the prescribing records states collect. States such as Oregon and Utah have challenged this power on Fourth Amendment grounds, but federal courts ruled in favor of the DEA saying state law provides a “positive conflict…so that the two cannot consistently stand together” against Oregon in 2014 and “physicians and patients have no reasonable expectation of privacy from the DEA” against Utah in 2017.⁹

Due to increased access to funding and resources under the Harold Rogers Program, by 2016, every state with the exception of Missouri had enacted some form of a PDMP (see Table 1). States vary on the extent to which types of participation in these databases are mandatory and on what types of drugs are monitored. All states with PDMPs monitor at least Schedule II-IV opioids, and the majority of states also monitor prescriptions for Schedule V opioid products, such as codeine cough syrup. PDMPs are administered by state government agencies and compile accessible information on prescribing histories, which is entered into the database by health care providers. These systems are updated on a daily or weekly basis, depending on the state.“¹⁰

The PDMP is now widely regarded as an effective policy mechanism that states can use to combat the opioid crisis. Given the crisis’s wide-reaching effect across the United States, policies such as this aimed at curbing opioid overdoses are now considered a priority by politicians across the political spectrum. Legislators with ideologies as differing as Senators Bernie Sanders (D-VT) and Rob Portman (R-OH) have rallied in unison to support legislation aimed at lowering overdose deaths. In a time of unprecedented political divide and gridlock, it is exceptional for any policy to garner such universal support.

For example, in October of 2018, the U.S. Senate passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act—a bill that strengthened state PDMPs by encouraging interstate sharing of data through nationwide databases such as PMPi Hub and RxCheck Hub and mandated PDMP use for all Medicaid providers—by a margin of 98-1 in the Senate, indicating the unified nature of mainstream political thought surrounding this crisis. Though all PDMPs are administered by the states, this legislation enhanced funding for state PDMPs and created a mechanism by which a patient’s prescription history could be accessed across state lines.¹¹

The dire magnitude of the opioid crisis has created an imperative for legislators, forcing them to act quickly in order to stem the rising level of overdose deaths. As Senator Ted Cruz (R-TX) stated in 2018 while endorsing the SUPPORT for Patients and Communities Act: “[t]oo many lives have been lost to the opioid crisis….I am proud of Congress’s actions today to take a stand in efforts to save millions from the ravages of drug addiction.”¹²

It is this sense of urgency—legislating in response to tens of thousands of overdose deaths every year—that has created almost universal support for these interventions, with little, if any, public debate or criticism of them. The only abstention in the Senate to the SUPPORT Act was Sen. Mike Lee (R-UT), who originally publicly endorsed congressional intervention at the American Enterprise Institute, but later expressed worry that the bill would be ineffective despite its good intentions:¹³

There are some very good elements in this opioid response bill, including strengthening U.S. Customs and Border Protection authority to discover and destroy packages containing illegal controlled substances. Unfortunately, the bill also includes dozens of new grant programs with little accountability for how the dollars will be spent and minimal measurement or analysis on their effectiveness. Good intentions are not enough. In the face of a crisis such as this, we cannot afford to waste precious funds on programs which likely won’t work.¹⁴

This study finds that Prescription Drug Monitoring Programs fail at their major goal to reduce opioid overdoses. Although Prescription Drug Monitoring Programs successfully decrease prescription rates, they also increase the use of black market opioids. Consequently, as Prescription Drug Monitoring Programs cut off users from legal channels of prescribing and force them to switch to more dangerous illicit drugs, this unforeseen substitution to illegally purchased heroin and fentanyl is the principal reason why Prescription Drug Monitoring Programs ultimately lead to more drug overdose deaths.

Full Policy Study— Prescription Drug Monitoring Programs: Effects on Opioid Prescribing and Drug Overdose Mortality

The post Prescription Drug Monitoring Programs: Effects on Opioid Prescribing and Drug Overdose Mortality appeared first on Reason Foundation.

Ballot measure 110, supported by 58.5 percent of Oregon voters, decriminalized the possession of small amounts of all drugs, including heroin and cocaine. The voter initiative reclassified possession of these substances from a misdemeanor to a simple violation. Instead of a jail sentence, individuals found with so-called hard drugs will face a completed health assessment or a $100 fine. The reclassification only applies to possession of amounts reflecting individual use, and criminal penalties remain for anyone found distributing or manufacturing illegal drugs.

Oregon has some of the highest rates of substance abuse in the country and a report from the Oregon Substance Use Disorder Research Committee found that one in 10 Oregonians struggle with a substance use disorder (including both drugs and alcohol).  The challenges posed by substance abuse disorders are worsened by Oregon’s particularly poor levels of accessibility to treatment services. Incarceration of those with substance use disorders has proven to be ineffective. It is not a deterrent to drug use, it does not make drug users any safer and it doesn’t reduce risks of overdose.

Beyond the relaxation in law enforcement efforts related to drug use, Measure 110 also places a greater focus on wellbeing and care for individuals with substance abuse issues in Oregon.

The measure, financed by a diversion of existing marijuana tax revenues, includes the creation of an oversight and accountability committee to distribute grants related to recovery and addiction treatment services. Committee members will include state residents who have struggled with substance abuse disorders, formerly incarcerated individuals, and experts within the drug treatment community. New 24/7 addiction recovery centers will be established to conduct health assessments and facilitate a path to sobriety for those who wish to avoid the $100 fines that may be assessed. Access to the treatment centers is available for everyone in the state—not just those who come into contact with the police.

All in all, Oregon’s new drug policy seeks to reduce high rates of substance abuse by removing the punitive aspect of drug policy and instead of treating individuals’ underlying mental health and addiction problems. Fundamentally, this approach recognizes that addiction is a mental health condition that often requires treatment to overcome.

Understandably, some Oregonians are concerned that decriminalization will lead to a surge in drug use. However, the data suggests otherwise. Several countries, including Switzerland and the Netherlands, have decriminalized the personal possession of drugs. The first country to do so was Portugal in 2001. Portugal’s decriminalization policy aimed to improve the worsening health of the country’s drug-using population, particularly those who injected drugs.

Like Oregon, one of the central aspects of Portugal’s policy was the establishment of free treatment facilities along with information campaigns about the harms of drug use and needle exchanges. Individuals found with drugs on their person were charged with an administrative offense that required them to be seen before a committee where they were either offered treatment or a small fine.

Interpretations of the drug use data in Portugal vary widely depending on the metrics used, however, a collation of figures from the Transformation Drug Policy Foundation found that decriminalization, on the whole, was not associated with a rise in drug usage. Drug use rates in Portugal are now below the European average for cocaine, methylenedioxymethamphetamine, and amphetamines.

With nearly 20 years of data and documentation to assess the success of the policy, it is unsurprising that Oregon’s Measure 110 was largely inspired by Portugal. A wide body of research has shown a lack of relationship between the severity of drug laws and rates of drug usage. The studies focusing on drug use amongst adolescents are particularly reassuring.

Tracking the drug use of adolescents (aged 15-to-34) over time in Portugal has shown a steady decline in the use of cocaine, amphetamines, and MDMA between 2007 and 2012. Figure 1 below shows that since 2012, there has been an even greater decline in cocaine use.  More generally, continuous drug usage (relating to individuals who use drugs regularly) has decreased since decriminalization. These results certainly do not constitute a surge in drug use.

Figure 1: Young Adults In Portugal Reporting Use of Drugs

(left to right: cocaine, methamphetamines, and amphetamines)

Source: European Monitoring Centre for Drugs and Addiction.

Data from Portugal suggests that many benefits arise from treating drug use with health services instead of criminalization including a reduced burden on the criminal justice system, a reduction in deaths caused by overdose or drug-related illnesses, and a reduction in addiction rates.

Although some still fear Oregon’s new policies may increase drug use, but history in Portugal and elsewhere shows these results are unlikely to materialize in the state. And should Oregon’s policy succeed in reducing the negative effects of substance abuse problems, other states should soon consider implementing similar policies.

The post Oregon Decriminalizes Drugs, Replaces Arrests With Health Care appeared first on Reason Foundation.

Drugmaker Purdue Pharma, the company behind the powerful prescription painkiller OxyContin that experts say helped touch off an opioid epidemic, will plead guilty to federal criminal charges as part of a settlement of more than $8 billion, the Justice Department announced Wednesday.

The deal does not release any of the company’s executives or owners — members of the wealthy Sackler family — from criminal liability, and a criminal investigation is ongoing. Family members said they acted “ethically and lawfully,” but some state attorneys general said the agreement fails to hold the Sacklers accountable.

The company will plead guilty to three counts, including conspiracy to defraud the United States and violating federal anti-kickback laws, the officials said, and the agreement will be detailed in a bankruptcy court filing in federal court.

It’s easy to place all the blame on Purdue and other profit-motivated companies for the plight of opioid-afflicted communities, but that sort of surface-level examination by policymakers is part of the reason we have an overdose crisis. The most recent increase in opioid-related deaths has less to do with the number of OxyContin prescriptions and much more to do with drug users resorting to dangerous drugs sold by the black market after the government’s crackdowns on prescription drugs.

One of the main accusations against Purdue is that its marketing campaign underplayed the dangers of its opioid OxyContin and the risks of addiction for susceptible patients.  But according to the U.S. Substance Abuse and Mental Health Services Administration, non-medical use of opioid pain relievers remained stable during the period of increased opioid prescribing between 2002 and 2012. Following coordinated interventions across the country, the misuse of pain relievers did slightly decrease after 2012, but substitution to a black-market alternative, heroin, also increased in tandem.

Despite seeing record rates of opioid-related deaths recently, opioid addiction rates have actually dropped 33 percent since 2015. This trend seems to be consistent with most drugs. Cocaine addiction has dropped 33 percent since 2002, but cocaine-related deaths almost tripled over the same period. In fact, the data show that addiction rates for all substances tend to be unrelated to death rates.

Research shows that the increase in opioid-related deaths can sadly be attributed to the fact that people are using drugs, just as often as they always have, but the drug supply is more dangerous due to significant reductions in prescribing since 2012. The Centers for Disease Control and Prevention have even pointed to the fact that most of the recent opioid deaths have been caused by illegal opioids trafficked from China. As Jacob Sullum pointed out in Reason in October:

The perverse effect of restricting access to prescription opioids should not have been surprising, since the crackdown on pain pills pushed nonmedical users toward black-market substitutes that are far more dangerous because their potency is highly variable and unpredictable.

…Illegally produced drugs now account for the vast majority of opioid-related deaths. In 2018, according to the National Center for Health Statistics, the category of drugs that includes fentanyl and its analogs was involved in more than two-thirds of those deaths, while heroin was detected a third of the time. Prescription opioids like hydrocodone and oxycodone turned up in 27 percent of the cases, and many of those deaths also involved fentanyl or heroin.

Unfortunately, there’s too much scapegoating and money on the line for these facts to get in the way of the government’s crusade. For example, Mike Moore, the former attorney general of Mississippi who previously sued Big Tobacco companies for $246 billion, is now leading an effort in Cleveland, Ohio, to liquidate Purdue. He claims the pharmaceutical company falsely advertised to doctors that “if you prescribe your patients [OxyContin], there’s less than one percent chance they’ll get addicted. That was a lie, a big lie.”

But Moore’s claim is incorrect. When Purdue first introduced OxyContin in 1995, the one percent addiction rate that it advertised was conservative and studies show the chance of addiction is even less. In fact, despite opioid deaths that now number in the tens of thousands each year, there has only been one opioid overdose death for every 8,000 opioid prescriptions distributed since 2006.

Moore also claims “the Food and Drug Administration was asleep at the wheel while all this was happening.” That’s false, too. The FDA has actively addressed the concerns about OxyContin, fining Purdue $600 million in 2007 for misbranding and even encouraging the abuse-deterrent OxyContin reformulation in 2013. Unfortunately, it’s well-established that the government-mandated reformulation actually led to more heroin use and opioid overdoses.

Despite shaky accusations, Moore’s coalition of cases has added other pharmaceutical companies to the defendant list, which helps maximize the settlement amount possibilities. Four other companies have already settled for $260 million in Cleveland alone, and Moore is now pursuing hundreds of billions of dollars from the likes of Johnson & Johnson, CVS, and over 600 other defendants.

Individual states have also pursued their own cases but, unfortunately, their accusations tend to be equally littered with misinformation. In Florida, former Attorney General Pam Bondi filed a case against pharmacies that claimed CVS and Walgreens made “unconscionable efforts to increase the demand and supply of opioids into Florida” that “caused 5,725 deaths in Florida in 2016.” But neither company ever advertised their opioids—and there were actually 2,798 opioid deaths in Florida in 2016. Unfortunately, these types of inaccuracies aren’t limited to Florida, with others also frequently overstating their opioid death rates.

However, the precedent for these opioid-related cases shows massive settlements are possible, regardless of the accuracy of claims. During the one state-level case that went to trial, Oklahoma Attorney General Mike Hunter presented the following accusations:

“There are more prescription drug overdose deaths each year in Oklahoma than overdose deaths from alcohol and illegal drugs combined. Oklahoma leads the nation in non-medical use of opioid painkillers. And, in 2016, Oklahoma ranked number one in the nation in milligrams of opioids distributed … per adult.”

Every claim in Hunter’s statement was wrong but that didn’t stop him from getting a judge to rule Johnson & Johnson had to pay $572 million for Oklahoma’s opioid crisis. In contrast to Hunter’s claims, in 2016 deaths from illegal stimulants like cocaine and methamphetamine alone surpassed deaths from opioid painkiller prescriptions in Oklahoma. Likewise, contrary to his claims, alcohol-induced deaths, though not all technically overdoses by definition, nearly doubled prescription opioid deaths that same year. And Oklahoma was neither the leader in painkiller misuse nor opioid distribution per adult. It’s certainly clear that too many people were dying from opioids in Oklahoma, but Hunter’s blatant inaccuracies should’ve undermined his authority to assess damages.

It is clear that the government’s over-regulation of pharmaceutical products has been followed by more death. In this case, government policies have forced or encouraged pain patients to turn to more dangerous drugs, including heroin and fentanyl. But while it continues to target drugmakers, pharmacies, and others, do not expect the government to be held responsible for its own role in pushing prescription drug users to more dangerous drugs.

The post As Purdue Pharma Takes the Fall, Don’t Forget the Government’s Role In the Opioid Crisis appeared first on Reason Foundation.

There are still concerns over the increasing potency of marijuana and the impact it may have on users. 

California State Treasurer Fiona Ma publicly called out the state’s high cannabis taxes and burdensome regulations, saying, “…an estimated $8.7 billion is spent in our illegal market due to high taxes and a refusal by most cities to allow licensed shops, making it cheaper and easier for people to buy from illicit dealers.”

A new study by University of Washington scientists will seek to uncover whether cannabis use is safe during pregnancy or not. 

There are some in Oregon who think the oversupply of marijuana from the legal market is fueling black market operations, but federal laws, taxes, other legal complications are major contributors to the black market activity. 

Pennsylvania is set to expunge 30 million criminal records of low-level offenders over the next 12 months.

Harm reduction beats the drug war as a response to addiction.

A Massachusetts mayor was arrested and charged with extorting marijuana businesses in exchange for licenses and operations. 

Legislation, Regulation, and Markets

The global pharmaceutical industry is investing heavily in and preparing for the impending growth in demand for medical marijuana.

The Drug Enforcement Agency (DEA) has been ordered by a federal court to fulfill its 2016 policy of approving more suppliers for research purposes after the agency engaged in “unreasonable delays.” 

Maine looks to Portugal’s decriminalization experience for inspiration in expanding it’s already robust harm reduction programs.  

Businesses in California are offering mixed approaches to drug testing in the workplace, with some giving up testing altogether.  

The FDA is updating the graphic images placed on smoking warnings, but the attempt is unlikely to actually reduce smoking.

Florida Gov. Ron DeSantis signed a bill expanding needle exchange programs.

A roadside THC testing device used in Canada is being challenged in court over its ability to detect impairment.

British Columbia is selling less marijuana than expected due to lagging approval of licenses.

The Substance Abuse and Mental Health Services Administration, in its largest policy change in recent history, will now make more patient data available in prescription drug monitoring programs, including information about opioids. 

A new restrictive law in Illinois tells cannabis growers how much water and energy they are allowed to use. 

Evidence

A new analysis from RAND suggests that cannabis legalization has in aggregate reduced the flow of money to illicit marijuana operations in Washington state. 

A new study finds that crime rates dropped in neighborhoods where marijuana dispensaries opened.  

Pew examines how why estimating the demand for recreational marijuana is a difficult and unpredictable venture that has thus far been somewhat inaccurate.  

Using data from over 140 sellers, a new paper seeks to establish the price of cannabis on the dark web.

The University of Michigan’s annual national study suggests that cannabis use by US college students is at a 35-year high. 

New data about Colorado’s cannabis market has been released.

An online audit found that nearly 3,000 illegal cannabis businesses were found in California, dwarfing the number of legal dispensaries.

The post Reason Foundation’s Drug Policy Newsletter, September 2019 appeared first on Reason Foundation.

Proprietary Reason Foundation analysis shows there may not be a relationship between opioid prescribing, overdose deaths, and addiction, citing data from Germany. 

Clark University will offer a first-of-its-kind certificate program to prepare students for careers in cannabis policy and regulatory issues.   

Law students from Harvard and Stanford argue that the only way to end the opioid crisis is to end the war on drugs entirely. 

The significant presence of black market dispensaries in California and elsewhere demonstrates how black markets will continue to compete with legal marijuana markets in the future. 

Regulating marijuana to limit its potency has no firm scientific basis and leaves high-end products to be supplied by the black market. 

Shady practices in Florida pain clinics and may have contributed to the high number of opioid pills distributed in the state. 

Legislation, Regulation, and Markets

Illinois’ marijuana legalization bill will place the burden on employers to prove ‘identifying articulable symptoms’ in order to drug test for marijuana, providing one of the most employee-friendly environments in the country. 

To avoid falling behind in the CBD market, California is considering a bill that “clarifies that food, drinks, and cosmetics that contain hemp-derived CBD are legal for sale in California.”

Colorado Gov. Jared Polis recently signed legislation that will legalize marijuana delivery in the state, starting in January 2020.

A state attorney in Florida has ordered his assistant state attorneys to drop marijuana possession cases filed on or after July 1. 

Utah is considering a state-run medical marijuana dispensary system.

Evidence

The Competitive Enterprise Institute sent a letter to the federal government arguing that the Department of Health and Human Services’ 2015 evaluation of marijuana was incomplete due to lack of peer review and should be withdrawn.

A new study compared counties in Colorado that legalized recreational marijuana with those that did not and found no significant differences in the level of high school marijuana use.

The International City and County Management Association published a report on the local impacts of commercial cannabis. 

Researchers in Washington state analyzed wastewater for the presence of cannabinoids and concluded that legal marijuana use has increased and that the illicit market has significantly diminished. 

New data show recreational marijuana users drink more alcohol than medical users. 

The Center for Disease Control and Prevention recently released provisional drug overdose data, showing the first decline since 2014.  

A paper studying data from 2004-to-2014 found no significant decrease in opioid abuse after medical marijuana legalization. 

A new survey finds that people using cannabis reduce their use of painkillers and alcohol.

Adolescent exposure to marijuana may not be as damaging to brain development as previously thought. 

The post Reason Foundation’s Drug Policy Newsletter, August 2019 appeared first on Reason Foundation.

Drug-checking kits contain various tools to check drugs to ensure they are pure and not laced with anything dangerous. Currently, most states outlaw drug-checking kits because they are almost exclusively used by drug users. But drug paraphernalia laws only exist to reduce drug use and keep communities safe, and neither argument applies to drug-checking kits. In fact, subjecting drug users to mysterious black market drugs does just the opposite.

Maryland and Washington, D.C. are the latest places to remove drug-checking kits from their lists of illegal drug paraphernalia, and Colorado will soon join them. With synthetic opioid panics and stories regarding other contaminated drugs dominating the news, the technology that allows users to test the type and potency of substances could be the difference between death and life, allowing them another day to seek treatment.

Of course, there’s no regulation in the illegal drug industry, so it’s almost never clear what you’re actually getting when you purchase drugs. Someone attempting to buy LSD (or “acid”), for example, might end up with mint strips from the local pharmacy instead. A user could request methamphetamine, but actually end up with a substance cut with hydrochloric acid, which is never safe to consume. Some adulteration is harmless, but often it’s incredibly deadly.

Consider the case of cocaine, a drug that Americans have used consistently for years. Despite stable rates of consumption, cocaine-related overdose deaths increased more than 33 percent between 2016 and 2017. But that’s only because deaths involving cocaine are hardly ever due to the cocaine itself — they’re usually caused by fentanyl, a cheap synthetic opioid that’s about 50 times stronger than heroin and used to boost profit on cocaine sales.

After law enforcement started successfully seizing increasing amounts of heroin, traffickers sought to market a new product with a higher concentration to more easily conceal it and fentanyl was the perfect drug. Now that it’s flooding the United States mail system, the deadly synthetic opioid is finding its way into almost every black-market drug. Indeed, fentanyl was found in 52 percent of cocaine-related overdoses in 2017, but it doesn’t have to be this way.

There are legitimate ways to test for the presence of fentanyl and other adulteration in drugs. The only problem is that the tests are illegal and many users won’t bother with the inconvenience of illegally testing their drugs since paraphernalia is often used by prosecutors to increase punishment.

No matter what your position on the war on drugs, everyone should welcome innovations that can save lives. It’s inevitable that many people with addictions will continue consuming drugs regardless of the law, but when they do, we need to keep them alive so they can receive treatment later.

Drug-checking kits, like fentanyl testing strips, can prevent people from unknowingly consuming dangerous foreign substances and only enhance public health. They should be embraced by Colorado and other states that recognize our current approach to the war on drugs has been a tragic failure.

The article was co-written by Molly Davis, a policy analyst at the Libertas Institute.

This column originally appeared in the Pueblo Chieftain.

The post In Colorado, and Other States, Legalizing Drug Checking Kits Would Save Lives appeared first on Reason Foundation.

In California’s proposal, opioid makers would be taxed based on how many grams of opioids they distribute. Drugmakers would pass these costs on to patients. Thus, cancer patients, wounded veterans, and many others suffering from incurable pain would consistently be paying the state’s opioid tax. Since prescriptions for chronic pain are used for extended periods of time, people with chronic illnesses would disproportionately pay the tax. And since many of these patients have disabilities that prevent them from working, the tax could be an incredible financial burden for many people.

Given that less than one percent of both acute and chronic pain patients who are given opioids go on to become addicted, this tax would do little to prevent future opioid addiction. Indeed, the vast majority of those who become opioid addicts are people who already recreationally use other drugs. In fact, 78 percent of those abusing common prescription opioids never obtained their drugs via prescriptions from their doctors. And as opioid prescribing has continued to decrease, heroin use has increased. That’s why the majority of drug overdoses are now caused by injectable opioids like fentanyl and heroin, not prescription pills. It is also why the American Medical Association blames illegal drugs, not prescription medications, for most of the increase in drug overdoses in recent years.

For those suffering chronic pain, decreasing their access to medications and raising their taxes would be cruel and unnecessary. Instead of a tax, the state should look to policies that would reduce obstacles that are preventing patients from getting the medications and treatments they need.

For addicts in need of treatment, the state could increase the number of licenses available that allow doctors to provide medication-assisted addiction treatment. With medication-assisted treatment, people who are addicted to heroin or prescription opioids can be given medications like buprenorphine and methadone to reduce their cravings and risk of overdosing while receiving counseling.

Approximately 90 percent of substance abusers in California have never received treatment, so helping them can produce significantly positive results. In 2016, for example, Massachusetts expanded the number of licenses to provide medication-assisted treatment. And it issued a standing order to allow naloxone, which can reverse opioid overdoses, to be purchased without a prescription at pharmacies. A year later, Massachusetts was one of a small number of states that saw a reduction in total opioid overdoses.

California has already moved to provide access to naloxone and removed its step therapy laws, which require patients to try — and fail — with one treatment before moving on to the next. But there are currently not enough medication-assisted treatment licenses in California to treat everyone who has an opioid addiction so increasing the number of doctors who can help is the logical next step in reducing addiction and overdoses in the state.

An opioids tax that will ultimately be passed on to pain patients isn’t the answer. Californians should resist an opioid tax that would reduce access to chronic pain treatment, fail to prevent addiction, increase health insurance premiums, and possibly push more patients to seek out dangerous drugs on the black market.

This article first appeared in the Orange County Register.

The post California’s Proposed Opioid Tax Would Hurt Patients appeared first on Reason Foundation.

The NAACP and ACLU have come together to officially ask the DEA to suspend its drug enforcement activities as part of a shift “to treat drugs as a health issue, not a criminal issue.”  

There are key qualities about state legislatures and the political process that make it difficult to pass marijuana legalization bills legislatively, as opposed to voter ballot measure initiatives.

Navigating marijuana legalization and related issues, such as criminal justice reform and revenue allocation, are creating challenges in legislatures controlled by Democrats. 

Florida should embrace harm reduction approaches to the opioid crisis instead of doubling down on ineffective policies of the past.

Lawmakers in Connecticut have increased penalties for fentanyl sales, mirroring policies of the failed drug war.

The National Cannabis Industry Association has released its six goals for social equity in marijuana reform.  

Legislation, Regulation, and Markets

Illinois will become the first state to legislatively enact recreational marijuana instead of a ballot measure, as the governor has vowed to sign the bill on his desk.

Washington state passed a new law making it easier to vacate misdemeanor marijuana crimes.  

Massachusetts’ Cannabis Control Commission advanced plans to create social use consumption sites.

Delaware may be considering marijuana legalization in the near future.

Vermont and New Hampshire could both see delays in their legalization processes.

States are still wrestling with how to regulate workplace drug testing policies in both medical and recreational settings.

Most legal states only allow for marijuana consumption in the privacy of a home, potentially limiting an entire industry of cannabis-friendly hotels and consumption sites.

Florida may issue new hemp permits before the year is over.

Evidence

A new study shows a reduction in illegal marijuana grows in Oregon’s national forests since legalization.

Privately collected data from Leafly shows that the presence of dispensaries does not induce violent crime, but instead may actually improve home values.

A graduate student at the University of Colorado shows that THC blood concentration from cadavers varied dramatically depending on where on the body the sample was taken from.

Massachusetts’ attorney general still mistakenly believes that the opioid crisis is generated by pharmaceutical companies pushing legal scripts, which cause people to become addicted.  

A report from the Congressional Research Service concludes that there is no clearly discernible increase in traffic deaths since legalization, but that better data is needed before final conclusions are drawn.

Delivery services are an extension of legalization itself and do not represent any special social or economic costs.

Drug addiction in Europe is relatively lower than in the United States, according to the annual European Drug Report.

The post Reason Foundation’s Drug Policy Newsletter, June 2019 appeared first on Reason Foundation.

The federal government estimates that retail prescription drugs cost $333 billion in 2017, with pharmaceuticals administered in hospitals and medical offices adding about $150 billion more. A large share of third-party payments for prescription drugs are shouldered by state and local governments, which usually provide employee health insurance and other post-employment benefits.

The Legislative Analyst’s Office finds California’s Medi-Cal program spends around $8 billion a year on prescription drugs. The Los Angeles County Department of Health Services spends $242 million a year on prescription drug purchases, according to County Supervisor Janice Hahn.

Across the state, California’s public agencies have almost $200 billion of unfunded other post-employment benefit obligations (OPEBs). About one-seventh of those unfunded liabilities can be attributed to prescription drugs. OPEB burdens fall most heavily on certain local governments, with the Los Angeles Unified School District’s $15 billion worth of unfunded OPEB liabilities being the most visible case in Southern California.  Aside from providing retiree health coverage, the school district, like most public sector employers, shoulders the high cost of covering active employees and their dependents.

Given taxpayers’ exposure to prescription drug prices, advocates of small, efficient government should welcome parts of Gov. Gavin Newsom’s efforts to come to grips with this problem. Upon taking office, Newsom issued an executive order centralizing state drug purchasing into a single agency which will use its enhanced bargaining power to negotiate with pharmaceutical companies.  The order also invited local governments and private sector entities to join the state’s bulk purchasing initiative. Los Angeles County recently announced it would join Newsom’s initiative, further increasing its buying power and spreading the potential savings. Other counties could follow suit.

At first blush, this plan may seem like an attack on pharmaceutical companies who bear steep costs for securing the Food and Drug Administration’s (FDA’s) approval for new drugs. But it’s important to note that bulk purchasing is not the same as price controls: Newsom’s order does not compel drug companies to sell their products at a legislated price. It simply gives a state agency the ability to drive a hard bargain with suppliers on behalf of taxpayers.

Drug companies might not like that aspect of it, but there are other ways in which they clearly benefit from government interventions in the pharmaceutical market. In a pure free market, competition would restrain drug prices to a relatively small margin over the cost of production. But federal laws and regulations create monopolies for many prescription medications.

Patents, which often provide 10-to-20 years of protection against competitors, are usually justified as a return for companies bearing the costs of research and obtaining FDA approval. But, in many cases, companies receive lucrative patent protection without making large investments. For example, drug companies have learned to work the system by creating “me-too” drugs, which are very similar to existing medications but still qualify for extra patent protection.

AstraZeneca used this tactic when the patent on Prilosec, its gastro-esophageal reflux disease medicine, was expiring.  The company patented an almost identical medication named Nexium and urged doctors to prescribe it in lieu of Prilosec, which was switched from prescription to over-the-counter dispensing. Many patients opted for Nexium over Prilosec despite a massive price difference, because their insurance would cover the prescription drug —Nexium— while Prilosec OTC was not covered by most plans.

Overhauling the patent process along with shortening and streamlining the FDA’s long and expensive drug-approval process would increase competition and lower drug prices. Until that happens, the state, county and local government purchasers are wise to use their negotiating power to lower prescription drug prices borne by taxpayers.

This article first appeared in the Orange County Register.

The post High Prescription Drug Prices Hit Pension Plans, Hurt State and Local Taxpayers appeared first on Reason Foundation.