10/11/22

Striving After Wind with NPS

A few years ago, the problem with new psychoactive substances seemed to predict a dire future. The United Nations Office on Drugs and Crime (UNDOC) launched the Early Warning Advisory on NPS in June of 2013 to address the growing emergence of NPS at the global level. The term “new” can be misleading, as many NPS were first synthesized decades ago, but only recently became recreational drugs. As of December 2021, data reported to the UNDOC Early Warning Advisory 1,124 substances have been reported by governments, laboratories and partner organizations. All told, 134 countries and territories globally have reported one or more NPS.

NPS are not controlled under the International Drug Control conventions, so their legality can vary widely from country to country. By 2021, over 60 countries had implemented legal responses to control NPS. Many countries amended existing legislation, while others used innovative legal instruments. Several countries where a large number of NPS rapidly emerged, adopted controls on entire substance groups of NPS, or introduced analogue legislation that invokes the principle of “chemical similarity” to an already controlled substance explicitly mentioned within the legislation.

The World Drug Report 2021 (Executive Summary, Book 1) indicated these measures helped the number of NPS emerging on the global market to fall from 163 in 2013 to 72 in 2019. But this occurred primarily in high-income countries. “However, the NPS problem has now spread to poorer regions, where control systems may be weaker.” Seizures on synthetic NPS in Africa rose from less than 1 kg in 2015 to 828 kg in 2019. A similar trend was seen in Central and South America, where seizures rose from 60 kg to 320 kg over the same period of time.

Responses that have helped to contain the supply of NPS and reduce negative health consequences can be expanded to lower-income countries, some of which are increasingly vulnerable to the emergence of NPS. Those responses include early warning mechanisms that ensure a continuum of evidence-based measures from early detection to early action, post-seizure inquiries, including the formation of joint investigation teams, and training of emergency health workers on how to address cases of acute NPS intoxication. The expansion of services for people who use drugs and people with drug use disorders to people who use NPS can also help addressing the harm posed by those substances.

The use of NPS is often linked to health problems. Side effects range from seizures to agitation, aggression, acute psychosis and the potential for drug dependence. NPS users have frequently been hospitalized with severe intoxications. Information on long-term adverse effects is still largely unknown, and safety data on toxicity is limited or nonexistent. “Purity and composition of products containing NPS are often not known, which places users at high risk as evidenced by hospital emergency admissions and deaths associated with NPS, often including cases of poly-substance use.”

Effect Groups of New Psychoactive Substances

Up to December of 2021, there were six main pharmacological ‘effect’ groups of NPS: stimulants, synthetic opioids, synthetic cannabinoids, dissociatives, classic hallucinogens and sedatives/hypnotics. Stimulants (36%) and synthetic cannabinoids (30%) were the most common, while sedative/hypnotics, mimicking the effects of benzodiazepines (4%) and dissociatives (3%) were the least common. Synthetic opioids accounted for 8% and psychedelics or classic hallucinogens 15% of NPS. See the following graphic presentation of these groups.

Van Hout et al described health and social consequences of recent NPS use among a survey of 3,023 users in six European countries. Socially marginalized respondents (who are also high-risk drug users), were often unemployed, homeless and/or in care. They were the oldest, with an average age of 33.5 years. A substantial proportion of them lived in homeless shelters or hostels (32.3%) or other living arrangements (12.3%), including living on the streets. The education achievement of most marginalized respondents (55.2%) was only up to the equivalent of high school. Among marginalized respondents, 75.7% were unemployed or living on benefits.

The other two groups of those surveyed, nightlife NPS respondents and online respondents, tended to live with relatives or in rented accommodations. They were better educated and significantly less likely to be unemployed or living on benefits (10.8% and 8.1% respectively). Within all three subsamples, a majority of recent NPS users had experienced acute unpleasant side effects. See Table 4 in Van Hout et al.

In terms of reporting of acute side effects, experiences of increased heart rate and palpitation, dizziness, anxiety and horror trips and headaches were reported as most common across all three categories. The proportion who had experienced these effects was substantially larger in the marginalised sample (85.3%), than in the night life and online community samples (58.8 and 51.0%). When looking at the separate side effects, there are significant differences between the three groups in every symptom, with mostly much higher proportions of marginalised users reporting these effects. When comparing night life users and online community users, night life users reported more unpleasant effects, especially head and stomach aches and dizziness. However, in all categories, marginalised users show much higher rates than the two other groups. Increased heart rate or palpitation was the most reported side effect in all three samples.

Benzodiazepine-Type NPS

Benzodiazepines and benzo-type NPS, primarily etizolam, flualprazolam and flubromazolam are often detected in drug overdose cases and can contribute to serious adverse health effects, particularly when used in combination with opioids. “Current NPS threats”, vol. 3 reported that benzo-type NPS were identified in 48% of post-mortem cases as having been the cause of death or contributing to the cause of death.

The analysis presented here reveals that benzodiazepine-type NPS can play an important role in contributing to serious harm, either alone or in combination with other psychoactive substances. Thus, forensic laboratories should ensure that they have appropriate analytical methods available for their detection in case work.

NPS with Opioid-Like Effects

NPS opioids seem to be a fast-growing category of NPS over the past five years. They include a range of fentanyl analogues and research opioids that were developed by the pharmaceutical industry, beginning in the 1960s, as alternatives to morphine for pain management. “Some of these substances were not developed further and were subsequently considered ‘not suitable for human consumption.’” Some of these opioids have been rediscovered. Others have been developed by modifying their chemical structure, which creates a “new” chemical compound and circumvents existing legislation. While they are dissimilar in their chemical structure, the common action of NPS opioids is they act on the mu opioid receptor. The harms associated with NPS opioids other than fentanyls vary considerably.

NPS with opioid-like effects continue to emerge on illicit drug markets, and “Current NPS threats” highlighted three. Isotonitazene, a synthetic opioid has been seen in Europe and North America. Since June of 2019, there were eight incidents of fatalities associated with isotonitazene in the US reported to UNODC. In seven cases it was assessed to be the cause of death. Because of its novelty and opioid-like effects, it could have been misinterpreted as a heroin overdose, masking other cases of fatality.

Kratom, usually involving the concomitant use of other substances, has shown a potential to cause serious harm, including fatalities. Ninety percent of all kratom cases involved the concomitant use of other substances. Since July of 2019, at least 14 cases have been identified where kratom caused (n=7) or contributed (n=7) to a fatality.

Brorphine was first identified in the US recreational drug supply in July of 2020. Its emergence seems to be directly linked to the DEA’s scheduling of isotonitazene. It is commonly found with fentanyl and flualprazolam. “Current NPS threats” said it appears to have a long half-life and high potency when compared to medicinal opioids like hydromorphone. “Despite having structural similarities to fentanyl, brorphine differs in key aspects from fentanyl and falls outside the scope of generic legislation aimed at covering fentanyl analogues.” Between June and November 2020, 120 overdose deaths attributed to brorphine were reported in the US.

Reflecting on the evolving history of NPS, I’m reminded of the book of Ecclesiastes, which says: “Is there a thing of which it is said: ‘See this is new’?” It has been done already and is a vanity—a striving after wind.

What is crooked cannot be made straight, and what is lacking cannot be counted. (Ecclesiastes 1:15)

12/15/20

Tramadol Is not a Safe Opioid

The 2020 World Drug Report said the non-medical use of opioids has always been associated with the most serious health consequences among the various types of drugs. But in the last few years new threats have emerged with regard to the non-medical use of pharmaceutical opioids, leading to alarming rates of dependence and overdose deaths. The problems in North America with fentanyl and its analogues have led to an unprecedented increase in opioid overdose deaths. But in West, Central and North Africa, the Middle East and Asia, another opioid has emerged as a major concern—tramadol.

Tramadol’s potency was said to be comparable to codeine, about 10% the potency of morphine. This led to initial belief that it had a low risk of abuse when it was brought to market in the 1960s by the German pharmaceutical company Grunenthal. However, researchers later found that tramadol releases a far more powerful dose because of how it is metabolized by the liver. An article in The British Medical Journal, “Chronic use of tramadol after acute pain episode” said tramadol undergoes demethylation in the liver to the active metabolite desmatramadol, giving it an opioid effect comparable to morphine.

The BMJ article reported a study by researchers at the Mayo clinic that found patients who received tramadol for the acute treatment of pain had slightly higher rates of long-term opioid use after surgery. The senior author of the study said their finding did not support the idea that tramadol is less habit forming than other opioids. The lead author of the study said: “And while tramadol may still be an acceptable option for some patients, our data suggests we should be as cautious with tramadol as we are with other short-acting opioids.” Tramadol use has been increasing and was the third most prescribed opioid in the study at 4%, after hydrocodone (51%) and oxycodone (38%). “Although all factors related to the safety of a drug must be considered, from the standpoint of opioid dependence, the Drug Enforcement Administration and FDA should consider rescheduling tramadol to a level that better reflects its risks of prolonged use.”

While many countries in West, Central and North Africa report the non-medical use of tramadol as one of the main threats in drug use, quantitative information on the actual size of the population using tramadol non-medically was not available in most countries, according to the 2020 World Drug Report. However, treatment data in West African countries revealed tramadol to be the main drug of concern for people with drug use disorders. “Tramadol ranks highly among the substances for which people were treated in West Africa in the period 2014–2017.” In North Africa, Egypt reported tramadol is the main opioid used non-medically. In drug treatment, tramadol was also the primary drug, accounting for 68% of all people treated for drug use disorders in 2017. In the Sudan, the increasing non-medical use of pharmaceutical drugs among young people includes: tramadol, benzodiazepines, cough syrups and antihistamines, trihexyphenidyl (an antiparkinsonian agent), anticonvulsants, pregabalin and gabapentin.

In Iran, a recent study estimated that or 200,000 people aged 15-49 in urban centers had misused tramadol, most of whom were young people. The past 12-month of non-medical use of tramadol in the general population was 4.9 percent among men and .5 percent among women. In recent years, tramadol intoxication and fatal overdose, especially among young people with a history of substance use disorder and psychiatric comorbidity, has been a major cause of emergency department admissions. Among these cases, tramadol has been misused with other substances, especially benzodiazepines. “Tramadol was also found to be the cause of death in around 6 per cent of the total drug overdose death cases in the Islamic Republic of Iran reported in different studies from 2006 to 2017.”

AP News reported in “How tramadol, touted as safer opioid, became 3^rd world peril,” that mass abuse of tramadol spans continents from India to Africa and the Middle East, creating international havoc. Some experts blame a loophole in narcotics regulation and a miscalculation of the drug’s danger. It was touted as a way to relieve pain with little risk of abuse. Unburdened by international controls that track most dangerous drugs, tramadol flows freely around the world. “But abuse is now so rampant, that some countries are asking international authorities to intervene.”

Grunenthal is campaigning to keep the status quo with tramadol regulation, arguing that typically it is illicit counterfeit pills causing problems. International regulations make narcotics difficult to get in countries with disorganized health systems. Adding tramadol to the list, the company said, would deprive suffering patients access to any opioid at all. The secretary of the World Health Organization’s committee recommending how drugs should be regulated said this is a huge public health dilemma. “It’s a really very complicated balance to strike.” Tramadol is available in war zones and impoverished nations because it is unregulated—the same exact reason it is widely abused.

Tramadol has not been as deadly as other opioids, and the crisis isn’t killing with the ferocity of America’s struggle with the drugs. Still, individual governments from the U.S. to Egypt to Ukraine have realized the drug’s dangers are greater than was believed and have worked to rein in the tramadol trade. The north Indian state of Punjab, the center of India’s opioid epidemic, was the latest to crack down. The pills were everywhere, as legitimate medication sold in pharmacies, but also illicit counterfeits hawked by street vendors.

Authorities in Punjab seized hundreds of thousands of tablets, banned most pharmacy sales and shut down pill factories, pushing the price from 35 cents for a 10-pack to $14. When the government opened a network of treatment centers, fearful those who had become addicted would resort to heroin out of desperation, hordes of people rushed in seeking help. Tramadol had become as essential as food. A 30-year-old auto shop welder said, “Like if you don’t eat, you start to feel hungry. Similar is the case with not taking it.”

In 2016, Jeffery Bawa, an officer with the UN Office on Drugs and Crime, traveled to Mali in West Africa, one of the world’s poorest countries, which also struggles with civil war and terrorism. When he asked people what their most pressing concern was most said tramadol, not hunger or violence. At a United Nations meeting on tramadol trafficking, Nigerian officials said the number of people living with addiction is far higher now then the number with AIDS or HIV. In Cameroon, scientists thought they had discovered a natural version of tramadol in tree roots. “But it was not natural at all: Farmers bought pills and fed them to their cattle to ward off the effects of debilitating heat. Their waste contaminated the soil, and the chemical seeped into the trees.”

Police began finding tramadol pills on terrorists. It seems they now traffic tramadol to fund their networks and use it to bolster their own violent behavior. Most of the supply was coming from India, where pill factories produced counterfeits and shipped them in bulk around the world, “in doses far exceeding medical limits.” In 2017, law enforcement reported confiscating $75 million worth of tramadol from India on route to the Islamic State. Another 600,000 tablets headed for Boko Haram were intercepted. Three million more tramadol tablets were found in a pickup truck in Niger, in boxes disguised with U.N. logos.

Grunenthal has persisted with its campaign to keep tramadol unregulated. It funded surveys that found regulation would impede pain treatment and even paid consultants to travel to the WHO to make their case that tramadol is safer than other opioids. But that could change. Referring to the above-described Mayo Clinic study, AP News noted the researchers were surprised when they found their data indicated patients prescribed tramadol were just as likely to move on to long-term use as other opioids. The lead researcher of the Mayo study said: “There is no safe opioid. Tramadol is not a safe alternative. It’s a mistake that we didn’t figure it out sooner. It’s unfortunate that it took us this long.”

10/28/16

Fluctuations in the Heroin Market

The 2016 World Drug Report (2016 WDR) is a good-news bad-news source of information on global opiate statistics. The good news is that global opium production fell by 38% in 2015. The decrease was primarily the result of a decline in opium production in Afghanistan, which fell 48% compared to 2014. This was mainly because of poor yields in the country’s southern provinces. Despite this, Afghanistan was still the world’s largest opium producer, accounting for 70% of global opium production.

The bad news is that despite the drop in production, the global number of opiate users has remained relatively stable. And opium production in Latin America, mostly in Mexico, Columbia and Guatemala, more than doubled from 1998-2014. Central and South American production accounts for 11% of the estimated global opium production. Also, in North America, heroin use and heroin-related deaths have continued to rise. In both cases, the increases were roughly three times the 1999 levels. See the following chart from the 2016 WDR.

In 2014, the largest seizures of opiates were in South-West Asia, with Europe next in line. The Islamic Republic of Iran reported the largest opiate seizures worldwide, accounting for 75% of global opium seizures and 17% of global heroin seizures. The next largest heroin seizures were from Turkey (16% of global heroin seizures), China (12%), Pakistan (9%), Kenya (7%), the U.S. (7%), Afghanistan (5%), and the Russian Federation (3%). Iran is the first stop on the so-called “Balkan route” of opiate distribution. From there the route travels into Turkey, and onto South-Eastern Europe, where it is distributed throughout Western and Central Europe. “Seizure data suggest that the Balkan route, which accounts for almost half of all heroin and morphine seizures worldwide, continues to be the world’s most important opiate trafficking route.”

The massive decline in opium production of almost 40 per cent in 2015 is unlikely, however, to result in a decline of the same magnitude within a year in either the global number of opiate users or the average per capita consumption of opiates. It seems more likely that inventories of opiates, built up in previous years, will be used to guarantee the manufacture of heroin (some 450 tons of heroin per year would be needed to cater for annual consumption) and that only a period of sustained decline in opium production could have any real effect on the global heroin market.

In 2015 Bloomberg published an article with three maps of global drug smuggling routes. The major opiate producers are: Afghanistan, Myanmar, Laos, Mexico and Columbia. The opiate map illustrates the vast reach of the so-called Balkan route. The Americas are primarily supplied with opiates grown in Mexico and Columbia. More than 70% of all heroin and morphine seizures in the Americas were in the U.S. between 2009 and 2014. Seizures more than doubled from around 2 tons per year from 1998-2008 to 5 tons per year from 2009-2014. Heroin trafficking and use was seen in 2015 as the main national drug-related threat in the US, according to the 2015 National Drug Threat Assessment (NDTA).

The 2015 NDTA reported that heroin was available in larger quantities, used by larger numbers of people, and caused more overdose deaths than 2007. The increased demand and use of heroin is driven by greater availability and controlled prescription drug (CPD) abusers switching to heroin. Cheaper prices for heroin contribute to the switch as well.

Increases in overdose deaths are driven by several factors. The purity of heroin has increased in some areas. New heroin users switching from prescription opioids are used to the set dosage amounts potency of prescription drugs. Illicitly–manufactured drugs can vary widely in their purity, dosage and adulterants. Over the past few years the use of highly toxic adulterants like fentanyl (20 to 40 times stronger than heroin) in certain markets has also added to the increase in overdose deaths. Then there are heroin users who stopped using for a while (from treatment or incarceration) whose tolerance has decreased because of their abstinence.

Most of the heroin in the US today comes from Mexico and Columbia. Columbian heroin is still the predominant type available in the Eastern US. While Southeast Asian heroin, largely from Afghanistan dominates the global market, very little makes its way to the US. Southeast Asian heroin was the dominant supplier of heroin in the US at one time. But it no longer can compete with the transportation and distribution networks of the Mexican and Columbian drug cartels. Se the following chart from the 2015 NDTA.

The Mississippi River has been a dividing line in the US heroin market for the past 30 years, with Mexican black tar and brown powder heroin west of the Mississippi and white powder heroin from South America in the East. There is increasing evidence that Mexican drug cartels are processing their own white powder heroin and mixing white heroin with Mexican brown powder heroin to create a more appealing product to the Eastern US markets. See charts 12 and 13 in the 2015 NDTA for further information on the availability of heroin types purchased in Eastern and Western cities.

The suspected production of white powder heroin in Mexico is important because it indicates that Mexican traffickers are positioning themselves to take even greater control of the US heroin market. It also indicates that Mexican traffickers may rely less on relationships with South American heroin sources-of-supply, primarily in Colombia, in the future. If Mexican TCOs [transnational criminal organizations] can produce their own white powder heroin, there will be no need to purchase white powder heroin from South America to meet demand in the United States. This would also reinforce Mexican TCOs’ poly-drug trafficking model and ensure their domination of all major illicit drug markets (heroin, cocaine, methamphetamine, and marijuana) in the United States.

Mexican TCOs have been increasing their cultivation of opium poppies, to an estimated 17,000 hectares in 2014. This can potentially produce up to 42 metric tons of heroin. Switching to opium cultivation from marijuana cultivation may be at least partly due to the lowered demand for illicit marijuana in the US because of the legalization movement. See “The Economics of Heroin” for more information.

The number of heroin users reporting they used heroin over the past month increased 80% between 2007 and 2012. Of the total number of heroin-related treatment admissions in 2012, 67.4% reported daily use and 70.6% reported their preferred route of use was by injection. Heroin treatment admissions were consistently highest in the New England and Mid-Atlantic states. There are also high rates of repeated treatment among heroin users. Eighty percent of the primary heroin users admitted to treatment in 2012 reported previous treatment; 27% had been in treatment five or more times.

Most opioid users in the 1960s began by using heroin. But that steadily changed until 75% of heroin-users in the early 2000s reported they began by using prescription opioids. The number of people using illicit prescription opioids who switched to heroin was a relatively small percentage of the total number of prescription drug abusers at 3.6%. But it represented 79.5% of new heroin users. Heroin use was 19 times higher among individuals who had previously used pain relievers non-medically.

The reformulation of OxyContin in 2011 is seen as helping to curb the abuse of the drug. In 2011 emergency department visits involving oxycodone declined for the first time since 2004. Overdose deaths from opioid analgesics also began to decrease in 2011. But remember, CPD abusers have been switching to heroin and seem to be contributing to the dramatic increase in overdose deaths from heroin.

The number of heroin overdose deaths increased 244% between 2007 and 2013. Keep in mind that heroin deaths are undercounted. This occurs because of the differences in state reporting procedures for reporting drug-related deaths; and because heroin metabolizes very quickly into morphine. A metabolite unique to heroin, 6-monoaceytlmorphine (6-MAM), quickly metabolizes into morphine erasing the biochemical evidence for heroin use. So many heroin deaths get reported as morphine-related deaths. So what does the future hold for heroin use in the US? The 2015 NDTA concluded the current outlook for the near future is more of the same.

Heroin use and overdose deaths are likely to continue to increase in the near term. Mexican traffickers are making a concerted effort to increase heroin availability in the US market. The drug’s increased availability and relatively low cost make it attractive to the large number of opioid abusers (both prescription opioid and heroin) in the United States.

The United Nations Office on Drugs and Crime (UNODC) publishes a yearly report giving a global overview of the supply and demand of various drugs and their impact on health.

08/19/16

Head-in-the-Sand

Within the U.S. the legalization of medical and recreational marijuana has rapidly increased over the past few years, but not without some disturbing trends. One of these is the rise in THC potency within cannabis. The 2016 World Drug Report (2016 WDR) indicated that cannabis THC potency in the U.S. has been increasing over the past thirty years. It went from less than 3.4% in 1993 to 8.8% in 2008. Bloomberg reported that more recent data suggests that THC potency in cannabis increased to 12.6% in marijuana seized by authorities in 2013. In states where recreational marijuana is legal, such as Colorado and Washington, some samples have reached as high as 30%, with the average around 17%, according to the 2016 WDR.

Mehmedic et al. published an article in the September 2010 edition of the Journal of Forensic Sciences that also concluded the increasing potency of THC in cannabis. While there was the above noted increase of THC in cannabis seized by authorities, the CBD concentration increased only slightly, from .3% to .4%. The cannabinoid with the greatest known medical potential in marijuana is CBD, not THC. The researchers concluded not only was cannabis more potent, the market share for higher-potency products was increasing. “The question now becomes: What are the effects of the availability of high-potency products on cannabis users?”

A partial explanation for the increased potency in legal commercial markets like Colorado is the popularity of edible cannabis products made with cannabis extract-based concentrates such as oil, “wax,” or “shatter.” The THC potency of these extracts can be up to 80-90 percent. In 2014, edible products accounted for an estimated 35% of retail sales of recreational marijuana in Colorado. This makes it difficult to determine the dose or amount of THC ingested in an edible, leading to potential over-intoxication. “With edible products, the slower onset and longer duration of intoxication could increase the risk of over-intoxication, especially for new or inexperienced users.”

One way of regulating this concern has been to implement stringent labeling and packaging requirements. Washington and Colorado require edibles to have a 10mg serving size of THC. Alaska and Oregon have drafted legislation to set the serving size at a maximum of 5 mg of THC. The increasing potency has not been the only concern within states where marijuana is now legal.

Since the legalization of recreational marijuana in Colorado and Washington, incidents of accidental ingestion of cannabis among young children have been increasing. The Washington Poison Control center reported the number of cannabis exposure calls for people under 20 doubled from 2010 to 2014. In Colorado, within one year of legalization there was a 29% increase in the number of marijuana-related ER visits and a 38% increase in the number of cannabis-related hospitalizations.

More people using marijuana recreationally means an increase in the number of individuals driving under the influence of marijuana. The 2016 WDR said studies suggested that although cannabis seemed to be less hazardous than alcohol with regard to driving impairment, it is much more dangerous when used in combination with alcohol. In both Colorado and Washington there have been increases in the percentages of crashes and fatal crashes of drivers who tested positive for marijuana from 2012 to 2015.

Not surprisingly, the number of arrests and court cases with cannabis-related offences dropped substantially in state that have legalized marijuana. But data on other marijuana-related offences such as citations or warnings for public consumption were not readily available. See the following chart taken from the 2016 WDR.

However, there has been a ripple effect of drug concerns in the states adjacent to states where recreational marijuana is legal. In December of 2014, Nebraska and Oklahoma sued Colorado, requesting that the U.S. Supreme Court reverse Colorado’s decision to legalize marijuana, as it had led to an increase in trafficking marijuana in these neighboring jurisdictions. Attorneys for Colorado and the Obama administration asked the Supreme Court not take up the lawsuit. But as it turned out, the Court was also reluctant to take on the dispute as well.

The Supreme Court justices spent more than a year pondering whether to take the case. The proposed lawsuit was scheduled and re-scheduled five times for a closed-door conference, where the justices would debate the merits of taking the case.

In March of 2016 the Supreme Court declined by a vote of 6-2 to hear their complaint against Colorado. But the vote did not rule out future challenges. The Colorado Attorney General said that while the state has had several legal victories in federal lawsuits surrounding Amendment 64 legalizing recreational marijuana, Nebraska and Oklahoma’s concerns will not disappear. Doug Peterson, the Nebraska Attorney General was quoted by the Denver Post as saying: “The Court’s decision does not bar additional challenges to Colorado’s scheme in federal district court.” The Oklahoma Attorney General, Scott Pruitt said:

The fact remains — Colorado marijuana continues to flow into Oklahoma, in direct violation of federal and state law. Colorado should do the right thing and stop refusing to take reasonable steps to prevent the flow of marijuana outside of its border. And the Obama administration should do its job under the Constitution and enforce the Controlled Substances Act. Until they do, Oklahoma will continue to utilize every law enforcement tool available to it to ensure that the flow of illegal drugs into our state is stopped.

The federal government cannot continue to sit on the sidelines while recreational marijuana laws take hold state-by-state. The medical potential needs to be scientifically delineated and a step towards that is rescheduling marijuana as a Schedule II controlled Substance. The adverse effects of increased THC potency should be investigated, monitored and ultimately regulated. The collateral harm in neighboring states where marijuana is not legal should be dealt with cooperatively between states or result in federally mediated changes. Continuing a head-in-the-sand approach at the federal level is no longer a viable option.

The United Nations Office on Drugs and Crime (UNODC) publishes a yearly report giving a global overview of the supply and demand of various drugs and their impact on health. This is one of a series of articles discussing information from the 2016 World Drug Report.

Faith Seeking Understanding

Charles Sigler, D.Phil.

Tag: World Drug Report