tag:theconversation.com,2011:/fr/topics/dea-29810/articlesDEA – The Conversation2024-03-28T12:50:35Ztag:theconversation.com,2011:article/2259912024-03-28T12:50:35Z2024-03-28T12:50:35ZThe amazing story of the man who created the latest narco-state in the Americas, and how the United States helped him every step of the way − until now<p>When Juan Orlando Hernández was <a href="https://apnews.com/article/honduras-president-juan-orlando-hernandez-corruption-trial-7c43423f12ff71859c370be2fc6ac5b0">convicted by a federal jury</a> in Manhattan in early March 2024, it marked a spectacular fall from grace: from being courted in the U.S. as a friendly head of state to facing the rest of his life behind bars, convicted of cocaine importation and weapons offenses.</p>
<p>“Juan Orlando Hernández abused his position as President of Honduras to operate the country as a narco-state where violent drug traffickers were allowed with virtual impunity,” said <a href="https://www.justice.gov/opa/pr/juan-orlando-hernandez-former-president-honduras-convicted-manhattan-federal-court">U.S. Attorney General Merrick Garland</a> following the jury conviction. <a href="https://www.justice.gov/opa/pr/juan-orlando-hernandez-former-president-honduras-convicted-manhattan-federal-court">Anne Milgram</a>, administrator of the Drug Enforcement Administration, added: “When the leader of Honduras and the leader of the Sinaloa Cartel work hand-in-hand to send deadly drugs into the United States, both deserve to be accountable.”</p>
<p>The conviction was a victory for the Justice Department and the DEA. During Hernández’s two terms in office, from 2014 to 2022, he and his acolytes transported more than 400 tons of cocaine into the United States, <a href="https://www.justice.gov/opa/pr/juan-orlando-hernandez-former-president-honduras-convicted-manhattan-federal-court">according to U.S. prosecutors</a>. The former head of state now faces a mandatory sentence of up to 40 years in prison; sentencing is scheduled for June 26. </p>
<p>But there’s more to this story. </p>
<p>As I explore in the book “<a href="https://www.routledge.com/21st-Century-Democracy-Promotion-in-the-Americas-Standing-up-for-the-Polity/Heine-Weiffen/p/book/9780415626378">21st Century Democracy Promotion in the Americas: Standing Up for the Polity</a>,” written in collaboration with the <a href="https://www.open.ac.uk/people/bw4844">Open University’s Britta Weiffen</a>, Honduras is a tragic example of what happens when a country becomes a narco-state. While its people suffer the consequences – the World Bank reports that about <a href="https://www.worldbank.org/en/country/honduras/overview">half the country currently lives under poverty</a> – its leaders grow rich through the drugs trade.</p>
<p>Furthermore, the way Hernández came to power and maintained that position for so long could provide “Exhibit A” in any indictment of U.S. policy toward Central America – and Latin America more generally – over the past few decades. </p>
<h2>Growing ties with cartels</h2>
<p>Up to <a href="https://apnews.com/article/us-supreme-court-arrests-united-states-honduras-extradition-207d739fe73c844ad5cf182eec030a8a">Hernández’s arrest in Tegucigalpa</a>, the Honduran capital, and extradition to the United States in January 2022, his biggest enabler had been none other than the U.S. government itself. </p>
<p>Presidents <a href="https://obamawhitehouse.archives.gov/the-press-office/2014/01/15/president-obama-announces-presidential-delegation-honduras-attend-inaugu">Barack Obama</a>, <a href="https://www.washingtonpost.com/world/the_americas/honduras-president-narcotrafficking-hernandez/2021/02/11/1fa96044-5f8c-11eb-ac8f-4ae05557196e_story.html">Donald Trump</a> <a href="https://obamawhitehouse.archives.gov/the-press-office/2015/06/18/readout-vice-president-bidens-meeting-honduran-president-juan-orlando">and Joe Biden</a> all backed Hernández and allowed him to inflict enormous harm to Honduras and to the United States in the process.</p>
<p>How so? To answer this question, some background is needed. </p>
<p>On June 28, 2009, <a href="https://www.theguardian.com/world/2009/jun/28/honduras-coup-president-zelaya">a classic military coup took place</a> in Honduras. In the wee hours of the morning, while still in his pajamas, President Manuel “Mel” Zelaya was unceremoniously escorted by armed soldiers from his home and <a href="https://www.sandiegouniontribune.com/sdut-lt-honduras-divided-070709-2009jul07-story.html">flown to a neighboring country</a>. The coup leaders alleged that, by calling for a referendum on reforming the Honduran Constitution, the government was moving toward removing the one-term presidential term limit enshrined in the country’s charter and opening the door to authoritarianism.</p>
<p>Initially, then-President Barack Obama <a href="https://www.reuters.com/article/idUSTRE55S5J2/">protested the coup</a> and took measures against those responsible – the right-wing opponents of Zelaya. </p>
<p>But the administration eventually relented and <a href="https://www.reuters.com/article/idUSN07503526/">allowed the coup leaders to prevail</a>, largely due to pressure from Republicans, who saw Zelaya as being <a href="https://www.cfr.org/interview/honduran-politics-and-chavez-factor">too close to Venezuela’s Hugo Chavez</a>, whose leftist agenda was deemed by the GOP as a threat to U.S. interests. </p>
<p>The coup-makers simply ran the clock against the upcoming election date and installed their own candidate in the presidency, <a href="https://www.theguardian.com/world/2009/nov/30/honduras-lobo-president">Porfirio Lobo of the National party</a>, whose son Fabio was also later convicted of cocaine trafficking. </p>
<h2>Washington looks the other way</h2>
<p>Lobo laid the foundations of Honduras as the <a href="https://www.bbc.com/news/world-latin-america-56947595">new century’s first narco-state</a>, allowing drug cartels to infiltrate the highest echelons of government and the security apparatus as cocaine trade became an increasingly central plank of the country’s economy.</p>
<p>All the while, the U.S. <a href="https://www.theguardian.com/commentisfree/2016/jul/08/american-funding-honduran-security-forces-blood-on-our-hands">pumped tens of millions of dollars</a> <a href="https://www.newyorker.com/news/news-desk/should-the-u-s-still-be-sending-military-aid-to-honduras">into building up Honduras’ police and military</a>, despite widespread allegations of being engaged in corruption, complicit in the drugs trade and engaged in <a href="https://www.hrw.org/world-report/2016/country-chapters/honduras">human rights abuses</a>.</p>
<p>The dollars continued to flow when Lobo was succeeded in 2013 by his buddy and fellow National party member, Juan Orlando Hernández.</p>
<p>In 2017, Hernández – an ardent supporter of the 2009 coup – ran for a second term after the Supreme Court of Honduras <a href="https://www.reuters.com/article/idUSKBN0NE2T9/">pronounced this to be perfectly legal</a>.</p>
<p>Many Hondurans believe Hernández <a href="https://www.thenation.com/article/archive/the-honduran-government-is-trying-to-steal-an-election/">stole the November 2017 elections</a>. The vote count was suspended in the middle of the night as Hernández was running behind, and when the polls opened in the morning, he <a href="https://www.thenation.com/article/archive/the-honduran-government-is-trying-to-steal-an-election/">miraculously emerged as a winner</a>.</p>
<p>Despite widespread allegations of election fraud, the U.S. quickly recognized the result, congratulating <a href="https://www.cnn.com/2017/12/22/politics/us-honduras-election-results/index.html">Hernández on his win</a>.</p>
<p>Emboldened by his success, Hernández continued to build up Honduras as the new century’s first narco-state of the Americas.</p>
<p>In 2018, the president’s brother, Juan Antonio “Tony” Hernández, a former member of the Honduran Parliament, was arrested in the United States for his association with the Cartel de Sinaloa, the Mexican drug cartel. This entity valued his services so much that <a href="https://www.justice.gov/usao-sdny/pr/former-honduran-congressman-tony-hern-ndez-sentenced-life-prison-and-ordered-forfeit">they named a particular strain of cocaine after him</a>, stamping the bags as “TH.” Tony Hernández was convicted on four charges in 2019, sentenced to 30 years in prison, and has been in U.S. federal prison ever since. </p>
<p>President Hernández denied any association with the cartel, but the evidence pointed to the contrary. As <a href="https://www.economist.com/the-americas/2021/03/18/a-court-case-rocks-the-president-of-honduras">reported in The Economist</a>, in a New York City trial, one accused drug trafficker alleged that Hernández took bribes for “helping cocaine reach the United States.” Another witness testified that the president had taken two bribes in 2013, before being elected; a former cartel leader testified that the president had been paid $250,000 to protect him from being arrested.</p>
<h2>‘Complicit or gullible’</h2>
<p>Given Hernández’s history in Honduras, the <a href="https://www.washingtonpost.com/world/2024/03/08/juan-orlando-hernndez-honduras-convicted/">repeated claims of U.S. government officials</a> that they simply didn’t know of his crimes ring hollow.</p>
<p>Honduras became a narco-state, in part, because U.S. policymakers looked the other way as it did so. They embraced Hernández because he was ideologically more palatable and subservient to Washington’s wishes compared with his rival, Zelaya. But as the trial verdict in Manhattan makes clear, it was a decision with disastrous consequences.</p>
<p>As one State Department official put it, “Today’s verdict makes all of us who collaborated with (Hernández) <a href="https://www.washingtonpost.com/world/2024/03/08/juan-orlando-hernndez-honduras-convicted/">look either complicit or gullible</a>.” </p>
<p>The latter may be the more charitable assessment. But the truth is more uncomfortable.</p><img src="https://counter.theconversation.com/content/225991/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am a member of the Party for Democracy in Chile and and affiliated with the Foro de Political Exterior, a Chilean foreign policy think tank.</span></em></p>Washington looked the other way as coup leaders and drugs cartels conspired to turn Honduras into a center of the cocaine trade.Jorge Heine, Interim Director of the Frederick S. Pardee Center for the Study of the Longer-Range Future, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1585002021-04-29T13:20:52Z2021-04-29T13:20:52ZWhat the United States can learn from Canada’s cannabis clarity<figure><img src="https://images.theconversation.com/files/397695/original/file-20210428-23-37dy97.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2580%2C1726&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In this November 2019 photo, patrons smoke marijuana at a state-licensed but federally illegal marijuana establishment in Los Angeles.</span> <span class="attribution"><span class="source">(AP Photo/Richard Vogel)</span></span></figcaption></figure><p>The inherent contradictions of American cannabis laws seem to appear in the news almost every week. </p>
<p>At the state level, for example, <a href="https://www.cnn.com/2021/04/21/politics/virginia-marijuana-bill-signing/index.html">Virginia recently became the latest jurisdiction to allow adult cannabis use</a>, effective this July 1. But just days later, a <a href="https://mjbizdaily.com/us-appeals-court-denies-cannabis-firm-harborsides-bid-to-end-280e/">court upheld United States federal tax laws</a> that treat state-licensed cannabis businesses as illegal drug traffickers.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/397667/original/file-20210428-19-1erspjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Schumer, wearing glasses, speaks at a news conference." src="https://images.theconversation.com/files/397667/original/file-20210428-19-1erspjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/397667/original/file-20210428-19-1erspjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/397667/original/file-20210428-19-1erspjt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/397667/original/file-20210428-19-1erspjt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/397667/original/file-20210428-19-1erspjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/397667/original/file-20210428-19-1erspjt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/397667/original/file-20210428-19-1erspjt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Schumer is seen at a news conference at the U.S. Capitol in Washington on April 28, 2021.</span>
<span class="attribution"><span class="source">(AP Photo/J. Scott Applewhite)</span></span>
</figcaption>
</figure>
<p>To resolve conflicts like this, U.S. Senate Majority Leader Chuck Schumer says he’ll <a href="https://www.politico.com/news/2021/04/03/schumer-senate-marijuana-legalization-478963">introduce legislation to “decriminalize”</a> cannabis federally.</p>
<p>In drafting his bill, he should draw inspiration from Canada. <a href="https://www.politico.com/news/2021/04/20/senate-democrats-weed-legalization-schumer-483747">Congress might be too divided</a> for full legalization this year, but it can begin providing the clarity that Canada’s approach offers.</p>
<h2>U.S. contradictions</h2>
<p>Congressional action is clearly needed, as federal law has fallen behind states’ efforts in three ways.</p>
<p>First, state-level legalization means every state’s laws are different.</p>
<p>Consequently, state-licensed businesses face operational inefficiencies and fragmented markets. And medical users authorized by one state can <a href="https://www.alreporter.com/2020/07/13/black-disabled-veteran-sentenced-to-spend-60-months-in-prison-for-medical-marijuana/">get arrested in another</a>.</p>
<p>Second, cannabis remains federally illegal even where states legalize it. This means state-licensed cannabis companies have trouble getting bank accounts and financing, compelling them to operate mostly in cash. That makes them prime robbery targets.</p>
<p>Meanwhile, consumers can’t legally carry state-authorized cannabis across state lines, although <a href="https://www.politico.com/news/2021/04/18/ontario-oregon-marijuana-481211">many do</a>.</p>
<figure class="align-center ">
<img alt="Cannabis cookies on display in a dispensary." src="https://images.theconversation.com/files/397672/original/file-20210428-15-1hlsaip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/397672/original/file-20210428-15-1hlsaip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=426&fit=crop&dpr=1 600w, https://images.theconversation.com/files/397672/original/file-20210428-15-1hlsaip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=426&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/397672/original/file-20210428-15-1hlsaip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=426&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/397672/original/file-20210428-15-1hlsaip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=536&fit=crop&dpr=1 754w, https://images.theconversation.com/files/397672/original/file-20210428-15-1hlsaip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=536&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/397672/original/file-20210428-15-1hlsaip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=536&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cannabis confections are displayed at a dispensary on the first day of legal recreational marijuana sales in November 2018 in Leicester, Mass.</span>
<span class="attribution"><span class="source">(AP Photo/Steven Senne)</span></span>
</figcaption>
</figure>
<p>Federal illegality also impedes research. The <a href="https://mugglehead.com/us-senate-drug-caucus-calls-for-more-cannabis-research/">Senate drug caucus</a> and <a href="https://www.politico.com/f/?id=0000016d-188c-d466-a36d-de8d31490001">several federal agencies</a> have made clear they want more cannabis studies. But the Drug Enforcement Administration (DEA) permits just one university <a href="https://www.dea.gov/sites/default/files/2020-01/DEA%20Hearing%20on%20Cannabis%20Policy%20for%20the%20New%20Decade%20CLEARED_0.pdf">to grow cannabis for research</a>. <a href="https://www.marijuanamoment.net/dea-issues-final-rule-for-licensing-more-growers-of-marijuana-for-research/">It has stalled federal licensing of new growers</a> and blocked research involving state-licensed cannabis. </p>
<p>Third, the U.S. government is inconsistent about enforcement.</p>
<p>For example, <a href="https://cannacon.org/medical-cannabis-protection-rohrabacher-farr-amendment/">Congress bans federal authorities</a> from acting against states’ medical cannabis systems. That ban must be <a href="https://www.marijuanamoment.net/congressional-funding-bill-restores-financial-aid-for-students-with-drug-convictions-and-has-other-marijuana-provisions/">renewed annually</a> to remain in force.</p>
<p>Similarly, former president Barack Obama’s administration <a href="https://www.leafly.com/news/politics/what-is-the-cole-memo">chose not to prosecute</a> state-licensed cannabis businesses. But that hands-off policy was <a href="https://theconversation.com/sessions-war-on-pot-could-speed-up-marijuana-legalization-nationwide-89834">cancelled under his successor, Donald Trump</a>.</p>
<p>By comparison, Canada’s approach is clearer.</p>
<h2>Canada’s clarity</h2>
<p>The Canadian government <a href="https://www.cbc.ca/archives/entry/canadas-marijuana-laws-declared-unconstitutional">began legalizing medical cannabis</a> in 2001. <a href="https://theconversation.com/legal-cannabis-vs-black-market-can-it-compete-104915">It authorized recreational use</a> of cannabis flower and oil in 2018, followed by edibles and lotions in 2019.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1384640125217345538"}"></div></p>
<p><a href="https://laws-lois.justice.gc.ca/eng/acts/c-24.5/page-2.html#h-76969">The government wants</a> legal products to attract existing users without encouraging new ones, so it allows a variety of products. </p>
<p>But there’s little advertising and packaging is plain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/give-cannabis-producers-more-packaging-and-labelling-flexibility-152727">Give cannabis producers more packaging and labelling flexibility</a>
</strong>
</em>
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<p><a href="https://www.canada.ca/en/health-canada/topics/cannabis-for-medical-purposes.html">Medical sales are nationally regulated</a>. Physicians can authorize cannabis treatments, and patients then can grow plants themselves or buy products from licensed producers.</p>
<p>Meanwhile, provincial governments oversee recreational sales. Some <a href="https://www.cannabis-nb.com/stores/">operate public-sector shops</a> while others <a href="https://aglc.ca/cannabis/retail-cannabis/cannabis-licensee-search">license private-sector outlets</a>.</p>
<p>This system lets businesses ship cannabis across provincial borders and integrate their operations nationwide. They can accept credit cards and list shares on stock markets.</p>
<p>It also lets public agencies support cannabis-related activities. This creates some interesting cross-border contrasts:</p>
<ul>
<li><p>Veterans Affairs Canada <a href="https://www.veterans.gc.ca/eng/about-vac/research/research-directorate/publications/reports/cmp2018">spends millions of dollars annually</a> reimbursing vets’ medical cannabis expenses. By comparison, U.S. Veterans Affairs <a href="https://www.politico.com/story/2019/05/23/vets-medical-marijuana-1470413">won’t let physicians prescribe it</a>.</p></li>
<li><p>Canadian cannabis companies <a href="https://www.theglobeandmail.com/business/article-canadian-cannabis-companies-collected-more-than-40-million-in-wage/">collect pandemic aid funding</a> from their government. But American firms <a href="https://mjbizdaily.com/1-9-trillion-coronavirus-stimulus-package-offers-marijuana-related-firms-more-options-for-financial-help/">were mostly excluded</a> from the March <a href="https://www.businessinsider.com/nancy-pelosi-collects-news-coverage-praising-biden-stimulus-plan-2021-3">U.S. relief package</a>.</p></li>
<li><p><a href="https://ipolitics.ca/2018/10/10/rules-for-pot-use-by-federal-employees-vary-by-department/">Most Canadian government employees</a>, <a href="https://www.canada.ca/en/department-national-defence/corporate/policies-standards/defence-administrative-orders-directives/9000-series/9004/9004-1-use-cannabis-caf-members.html#pbosc">including soldiers</a>, can use cannabis off-duty. Meanwhile, <a href="https://www.npr.org/2021/03/19/979266225/white-house-tries-to-snuff-out-report-on-staffers-who-were-let-go-for-pot-use">White House staff</a> and other U.S. workers risk penalties if they consume.</p></li>
</ul>
<p>Canada’s legalization <a href="https://doi.org/10.1503/cmaj.202041">hasn’t been flawless</a>. <a href="https://theconversation.com/feds-are-blowing-smoke-about-pot-supplies-114507">Product shortages</a> initially hampered sales. But once those eased, sales <a href="https://doi.org/10.1016/j.drugpo.2020.103028">grew as quickly as stores could open</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/v26yMNWTxdc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Research shows legal sales rose when supplies improved and stores opened. The Goodman School of Business.</span></figcaption>
</figure>
<p>Prices dropped as competition increased. In Ontario, retail prices now <a href="https://ocs.ca/collections/dried-flower?product=5796713563980&sort_by=products_price_per_uom_asc">start below $4 per gram</a> (US$3 per gram) , including taxes. That undercuts many illicit sellers.</p>
<p>Legal sales now represent <a href="https://www.bnnbloomberg.ca/legal-pot-spending-outpaces-illicit-market-for-first-time-in-q2-statscan-1.1486347">most Canadian usage</a>. That’s a dramatic shift away from illicit markets.</p>
<p>The political mood shifted too. Cannabis was barely mentioned during Canada’s 2019 election campaign. Voters have accepted that cannabis is legal.</p>
<h2>Congressional advice</h2>
<p>Canada illustrates the merits of full national legalization. However, what worked in Canada might not work in the U.S. Congress might not pursue full legalization this year. But it can start giving Americans more of the clarity that Canadians enjoy.</p>
<figure class="align-center ">
<img alt="A person walks past a cannabis store." src="https://images.theconversation.com/files/397687/original/file-20210428-17-ix67w4.jpg?ixlib=rb-1.1.0&rect=1413%2C0%2C3709%2C3356&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/397687/original/file-20210428-17-ix67w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/397687/original/file-20210428-17-ix67w4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/397687/original/file-20210428-17-ix67w4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/397687/original/file-20210428-17-ix67w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/397687/original/file-20210428-17-ix67w4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/397687/original/file-20210428-17-ix67w4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A person walks past cannabis store in Toronto in January 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Cole Burston</span></span>
</figcaption>
</figure>
<p>The <a href="https://thehill.com/regulation/finance/549174-house-passes-cannabis-banking-bill">SAFE Banking Act</a> is just a first step in this direction. If passed by the U.S. Senate, it will help cannabis companies access bank accounts, insurance and credit cards. But further measures are needed to allow standard federal tax deductions, stock market listings and interstate shipping.</p>
<p>Congress should also embrace cannabis research. Veterans Affairs and the DEA should support scientific projects, including studies of commercial cannabis products.</p>
<p>Replacing temporary provisions with permanent laws is another priority. Medical access shouldn’t depend on annual vote scrambles. Business continuity shouldn’t hang on <a href="https://www.rollingstone.com/politics/politics-features/donald-trump-marijuana-cannabis-record-1084934/">attorney generals’ preferences</a>.</p>
<p>Decriminalization, or however Schumer ends up defining it, on its own might be better than nothing. However, letting Americans use cannabis legally, but not buy it legally, might create more problems than it solves. And it wouldn’t remove banking and research obstacles.</p>
<p>Cannabis policy isn’t easy — every option involves trade-offs. Canada proceeded in phases and now has a three-year head start at finding the best approach. Congress should begin that journey too.</p><img src="https://counter.theconversation.com/content/158500/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>U.S. Congress might not pursue full cannabis legalization this year. But it should still provide Americans with some of Canada’s legal clarity.Michael J. Armstrong, Associate professor of operations research, Goodman School of Business, Brock UniversityPaul Seaborn, Assistant Professor, Department of Management, Daniels College of Business, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1526772021-01-22T13:29:42Z2021-01-22T13:29:42ZKratom: What science is discovering about the risks and benefits of a controversial herb<figure><img src="https://images.theconversation.com/files/378671/original/file-20210113-21-1j1nnvf.jpeg?ixlib=rb-1.1.0&rect=0%2C2233%2C3995%2C2710&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kratom is native to Southeast Asia, where people make a tea from its leaves. </span> <span class="attribution"><span class="source">Christopher R. McCurdy</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Kratom, a traditional Southeast Asian herbal medicine from the leaves of the tropical tree <em>Mitragyna speciosa</em>, has gained favor in the U.S. as a <a href="https://doi.org/%2010.1080/15563650701241795">legal high</a> over the past decade. Almost two metric tons of kratom are <a href="https://www.americankratom.org/images/Kratom_Population_2019.pdf">imported from Southeast Asia monthly</a>. A typical dose of kratom consists of three to five grams, suggesting over 15 million users in the U.S. </p>
<p>In Southeast Asia, people have safely consumed kratom by chewing the leaves or brewing them into tea for centuries. But in the U.S., where it is widely available, the herb has been linked to many <a href="https://www.health.harvard.edu/blog/kratom-fear-worthy-foliage-or-beneficial-botanical-2019080717466">poison control center calls and even deaths</a>. As a <a href="https://scholar.google.com/citations?user=wxLykmcAAAAJ&hl=en">pharmacist and professor of medicinal chemistry</a>, I wanted to study why. </p>
<p><a href="https://pd.pharmacy.ufl.edu/research/kratom/">Our team</a> has been researching kratom for over a decade to determine the scientific validity of beneficial and harmful claims that have been made. Why would there be a history of safe kratom use in Southeast Asia while there are documented reports of harm in the U.S.? </p>
<p>Our recent studies suggest a difference in kratom products available in the U.S. and traditional preparations that may contribute to these risks. Traditionally prepared kratom is from freshly harvested leaves, whereas kratom in the U.S. is from dried leaf material, which changes in chemical composition as it dries and ages. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/-q0Lff9L3uA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Millions of Americans use kratom to ease pain.</span></figcaption>
</figure>
<h2>The two faces of kratom</h2>
<p>In Thailand and Malaysia, people for centuries have enjoyed <a href="https://doi.org/10.1016/0378-8741(88)90121-3">kratom as a “tea”</a> to treat a variety of conditions or to increase stamina for outdoor laborers. It is difficult to determine exactly when kratom first appeared in the U.S., but, because of the traditional reports of kratom being an opium substitute, interest grew. There seemed to be no thought that kratom in the U.S. could be different from kratom in Southeast Asia. </p>
<p>However, kratom gained federal attention in the early 2000s when the U.S. Drug Enforcement Administration listed the plant as a <a href="https://www.dea.gov/factsheets/kratom">drug of concern</a>. </p>
<p>Because of increasing concerns for public health and safety in 2016, the DEA <a href="https://www.dea.gov/press-releases/2016/08/30/dea-announces-intent-schedule-kratom">planned to place the plant and specifically two alkaloids from the plant</a> – mitragynine and 7-hydroxymitragynine – into Schedule 1 of the Controlled Substances Act. This action would make kratom and these two alkaloids (if purified from the plant) illegal, with no legitimate medical use.</p>
<p>Just six weeks later, the DEA made an unprecedented announcement that it was <a href="https://www.deadiversion.usdoj.gov/fed_regs/rules/2016/fr1013.htm">withdrawing its notice of intent</a>. This was due to thousands of public comments, mostly from individuals, urging the DEA to reconsider. Importantly, the DEA said that it would also consider conducting a scientific and medical evaluation of kratom. </p>
<p>So what has science taught us since this pause? </p>
<p>One thing that’s clear is that there is a difference in the chemical composition of traditionally prepared kratom and the dried leaf or extract products sold commercially. According to <a href="https://doi.org/10.1016/j.drugalcdep.2020.108310">our recent analyses</a>, the traditionally prepared tea does not contain detectable levels of 7-hydroxymitragyine, the alkaloid the DEA cited (along with the major compound, mitragynine) in its decision to list kratom under Schedule 1. </p>
<figure class="align-center ">
<img alt="A man holds a container of ground kratom." src="https://images.theconversation.com/files/379806/original/file-20210120-17-1fuxdug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/379806/original/file-20210120-17-1fuxdug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/379806/original/file-20210120-17-1fuxdug.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/379806/original/file-20210120-17-1fuxdug.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/379806/original/file-20210120-17-1fuxdug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/379806/original/file-20210120-17-1fuxdug.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/379806/original/file-20210120-17-1fuxdug.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Leaves from the kratom tree are dried and then ground into a powderlike substance. Many people add hot water to this and drink a kratom tea.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/this-picture-taken-on-december-25-2018-shows-indonesian-news-photo/1095171244?adppopup=true">Louis Anderson/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>Traditional use of kratom in Malaysia</h2>
<p>In July of 2019 I visited a kratom plantation in Malaysia and gained firsthand experience in the traditional preparation. Fresh leaves are picked each day and, within minutes, placed in boiling water for a couple of hours. The resultant “tea” is ladled out and generally placed into plastic bottles or bags for use throughout the day. Most traditional users prepare three glasses spaced out during the day by diluting each glass with an equal amount of water. </p>
<p>Kratom is also a recreational drink there, much like coffee or tea. People also have used it traditionally to <a href="https://doi.org/10.1016/0378-8741(88)90121-3">avoid withdrawal symptoms</a> when opium users would exhaust their supply. This also fueled use in the U.S., with individuals seeking alternative methods to treat pain or wean themselves from opioids. The real question we had to ask as researchers was whether it was just a replacement or a legitimate treatment. </p>
<figure class="align-center ">
<img alt="Kratom capsules." src="https://images.theconversation.com/files/379808/original/file-20210120-15-fqt6xo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/379808/original/file-20210120-15-fqt6xo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/379808/original/file-20210120-15-fqt6xo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/379808/original/file-20210120-15-fqt6xo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/379808/original/file-20210120-15-fqt6xo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/379808/original/file-20210120-15-fqt6xo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/379808/original/file-20210120-15-fqt6xo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the U.S., kratom is sold in capsule, powder and liquid form.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-this-photo-illustration-capsules-of-the-herbal-news-photo/530276386?adppopup=true">Joe Raedle/Getty Images</a></span>
</figcaption>
</figure>
<h2>Kratom in the U.S. has varying amounts of opioid activity</h2>
<p>According to scientific reports of analyses of <a href="https://doi.org/10.1007/s13181-016-0588-y">commercial kratom products available in the U.S.</a>, the amount of <a href="https://doi.org/10.1021/acscentsci.9b00141">7-hydroxymitragynine</a> can vary drastically in those products. Because freshly harvested kratom leaves had no detectable amounts of 7-hydroxymitragynine, we wondered why. </p>
<p>There is evidence that the plant does not produce 7-hydroxymitragynine but, rather, that the alkaloid is generated after leaves are harvested and dried. According to the previous scientific literature, <a href="https://doi.org/10.1016/j.neubiorev.2012.11.012">7-hydroxymitragynine has been reported to be present in up to 2%</a> of the total <a href="https://www.britannica.com/science/alkaloid">alkaloid</a> content of the dried plant material. </p>
<p>All commercial kratom products in the U.S. are made from dried leaf material or are concentrated extracts of the dried leaf material. Scientifically, purified 7-hydroxymitragyine is <a href="https://doi.org/10.1111/adb.12639">an opioid with demonstrated abuse potential</a>. It is also known that mitragyine (the major alkaloid) is converted to 7-hydroxymitragyine by the intestine and <a href="https://doi.org/10.1021/acscentsci.9b00141">liver</a>. </p>
<p>In contrast, purified mitragynine has demonstrated little to no abuse potential, and is able to reduce or block rodents from self-administering <a href="https://doi.org/10.1007/s00213-018-4974-9">heroin</a> or <a href="https://doi.org/10.1111/adb.12639">morphine</a>. In other words, mitragynine seems to be reducing the desire to ingest addictive opioids. </p>
<p>So the key question is, how much 7-hydroxymitragyine is too much in a kratom product? This remains unanswered, but the wide variation of 7-hydroxymitragynine content may explain why there is more harm seen in the U.S. from kratom. As the <a href="https://www.fda.gov/food/buy-store-serve-safe-food/what-you-need-know-about-dietary-supplements">dietary supplement market is poorly regulated</a> in the U.S., it is truly a “buyer beware” situation. </p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p>
<h2>The most recent findings</h2>
<p>My research team has examined the facts, and this is what we have found in our most recent study: Kratom tea does have potential to serve as a <a href="https://doi.org/10.1016/j.drugalcdep.2020.108310">treatment for opioid withdrawal and possibly to help wean addicts</a>. However, controlled clinical studies in humans are still absent and are needed to make evaluations of safety and therapeutic efficacy. </p>
<p>The unreliable measurements of kratom products sold in the U.S. create uncertainty. Until there is a standardized product, preferably one that is prepared in the traditional way, our society must weigh the risks against the putative benefits. The risk of kratom addiction appears to be low, but there are <a href="https://doi.org/10.1007/s40122-020-00151-x">people who are are treated for kratom addiction</a>. It is our hypothesis that addiction to kratom is due to the inferior quality and amount of the product ingested. Science is leading the way to these answers, and the fate of kratom is in the balance.</p><img src="https://counter.theconversation.com/content/152677/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher R. McCurdy receives funding from the National Institute on Drug Abuse under grant numbers DA048353 and DA047855. </span></em></p>Kratom, which has been linked to many deaths in the US, has been grown in Southeast Asia for centuries. There, people drink a tea made from the herb, with no ill effects. Why the difference?Christopher R. McCurdy, Professor of Medicinal Chemistry, University of Florida College of Pharmacy, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1210212019-08-15T11:14:39Z2019-08-15T11:14:39ZShouldn’t there be a law against reckless opioid sales? Turns out, there is<figure><img src="https://images.theconversation.com/files/287749/original/file-20190812-71936-1tevb1e.jpg?ixlib=rb-1.1.0&rect=901%2C6%2C3399%2C2050&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Protests and lawsuits against opioid manufacturers are growing more common, but drug distributors are also facing scrutiny.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Opioid-Lawsuit-Massachusetts/7b91e013eb9943c9ba37dbc261b36d8b/5/0">AP Photo/Charles Krupa</a></span></figcaption></figure><p>The massive scale of prescription opioid shipments as the ongoing overdose epidemic unfolded has started to come into focus.</p>
<p>Drug companies shipped <a href="https://www.washingtonpost.com/investigations/76-billion-opioid-pills-newly-released-federal-data-unmasks-the-epidemic/2019/07/16/5f29fd62-a73e-11e9-86dd-d7f0e60391e9_story.html">76 billion opioid pain pills</a> to U.S. health care professionals, hospitals and pharmacies between 2006 and 2012, according to data <a href="https://www.washingtonpost.com/investigations/76-billion-opioid-pills-newly-released-federal-data-unmasks-the-epidemic/2019/07/16/5f29fd62-a73e-11e9-86dd-d7f0e60391e9_story.html">The Washington Post</a> and the <a href="https://www.wvgazettemail.com/newly-released-federal-data-unmasks-epidemic-that-led-to-billion/article_4c672920-756f-5cd1-8c4e-6d17951cafa1.html">Charleston Gazette-Mail’s owner</a> acquired by <a href="https://assets.documentcloud.org/documents/6163333/19a0133p-06.pdf">suing the government</a>. </p>
<p>Hundreds of pills per person were delivered to rural areas like <a href="https://www.washingtonpost.com/national/a-remote-virginia-valley-has-been-flooded-by-prescription-opioids/2019/07/18/387bb074-a8ca-11e9-9214-246e594de5d5_story.html">Wise County, Kentucky</a>, and the town of <a href="https://www.pharmacist.com/article/remote-virginia-valley-has-been-flooded-prescription-opioids">Norton, Virginia</a>. Meanwhile, the number of <a href="https://overdosemappingtool.norc.org/">fatal overdoses</a> involving all kinds of prescription opioids soared across all of <a href="https://www.medpagetoday.com/neurology/opioids/78170">Appalachia and other hotspots</a> as the national death toll climbed from 3,442 in 1999 to <a href="https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates">17,029 in 2017</a>.</p>
<p>In addition, a federal court in Cleveland has released scores of <a href="https://www.reuters.com/investigates/special-report/usa-courts-secrecy-judges/">previously sealed documents</a>. The <a href="https://www.washingtonpost.com/graphics/2019/investigations/opioid-drug-company-documents/">corporate memos and legal depositions</a> suggest that drug company executives, pharmacists and others involved at every level of the prescription opioid trade failed to heed troubling signs that the industry was facilitating drug abuse.</p>
<p>As a health law professor who studies the <a href="https://ssrn.com/abstract=3237663">relationship between the U.S. health care system and opioid overdoses</a>, I have <a href="https://ssrn.com/abstract=3308838">researched</a> the epidemic’s causes. In particular, I have researched the likely <a href="https://twihl.podbean.com/e/158-opioid-litigation-update-guest-jennifer-oliva/">liability of drugmakers and pharmaceutical distributors</a> in the multiple pending and resolved <a href="https://www.baltimoresun.com/health/bs-hs-more-lawsuits-filed-over-opioid-crisis-20190722-rskg6ulgb5hujmz7ms4o4vvcvm-story.html">federal</a> and <a href="https://www.npr.org/sections/health-shots/2019/07/16/741960008/pain-meds-as-public-nuisance-oklahoma-tests-a-legal-strategy-for-opioid-addictio">state</a> lawsuits filed against all of the industry’s key players.</p>
<p>One thing that I’ve often wondered about is why no law on the books could slow what now appears to have been the reckless oversupply of opioids by companies in the health care business. </p>
<p><iframe id="n19t1" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/n19t1/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>A duty to report</h2>
<p>Well, there is, as it turns out.</p>
<p>The <a href="https://www.law.cornell.edu/uscode/text/21/chapter-13/subchapter-I">Controlled Substances Act</a> creates what experts call a “<a href="https://www.deadiversion.usdoj.gov/pubs/manuals/pract/section1.htm">closed system</a>.” That is, the federal government has designed a way to <a href="https://www.everycrsreport.com/reports/R45164.html">track every controlled substance</a> – medications with the potential for abuse or dependence, including opioids – from factory to pharmacy counter and hospital bed. Manufacturers, distribution companies, health care professionals, pharmacies, hospitals and others who buy, sell and dispense these drugs must be registered with the Drug Enforcement Agency.</p>
<p>The roughly <a href="https://www.dea.gov/press-releases/2018/02/14/dea-creates-new-resource-help-distributors-avoid-oversupplying-opioids">1.73 million people and companies</a> registered with the DEA must maintain precise records and report their interactions with all controlled substances.</p>
<p>The Controlled Substances Act categorizes drugs into different “<a href="https://www.deadiversion.usdoj.gov/21cfr/21usc/811.htm">schedules</a>” that determine the degree of regulatory oversight and the responsibilities required of anyone handling them. The government has designated opioids such as Oxycodone and hydrocodone as “<a href="https://www.dea.gov/drug-scheduling">Schedule II</a>” drugs, the most dangerous category that can be prescribed.</p>
<p>Manufacturers and distributors of Schedule II drugs must file reports about the opioids that pass though their hands using the government’s <a href="https://www.deadiversion.usdoj.gov/arcos/index.html">Automated Reports and Consolidated Orders System</a>, or ARCOS. These reports generate data that track the numbers of drugs shipped or sold and their destinations, at county and pharmacy levels.</p>
<p>A <a href="https://www.deadiversion.usdoj.gov/21cfr/cfr/1301/1301_74.htm">DEA rule</a> issued back in 1971 also requires all registrants to design systems for reporting “suspicious orders” – meaning, among other things, purchases and deliveries that are unusually big or frequent.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/287753/original/file-20190812-71917-lygxgv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/287753/original/file-20190812-71917-lygxgv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287753/original/file-20190812-71917-lygxgv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287753/original/file-20190812-71917-lygxgv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287753/original/file-20190812-71917-lygxgv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287753/original/file-20190812-71917-lygxgv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287753/original/file-20190812-71917-lygxgv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287753/original/file-20190812-71917-lygxgv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=473&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Several high-ranking executives from prescription drug distributors and wholesalers testified about their roles in the opioid addiction epidemic before Congress in 2018.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Congress-Opioids/673d1ee4fce8438ca2b1f2568aa553d9/7/0">AP Photo/Alex Brandon</a></span>
</figcaption>
</figure>
<h2>Inadequate oversight</h2>
<p>The federal government gave <a href="https://www.nytimes.com/2018/03/05/health/opioid-crisis-judge-lawsuits.html">the court in Cleveland</a> reams of ARCOS data in February 2018. However, U.S. District Judge Dan A. Polster, who is presiding over the landmark opioid litigation that pools some 2,000 separate lawsuits, <a href="https://www.ohnd.uscourts.gov/sites/ohnd/files/MDL2804-167.pdf">refused to let the press and the public</a> see that information until <a href="https://assets.documentcloud.org/documents/6163333/19a0133p-06.pdf">an appeals court</a> ordered its release.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/287750/original/file-20190812-71897-1uiua8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/287750/original/file-20190812-71897-1uiua8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/287750/original/file-20190812-71897-1uiua8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287750/original/file-20190812-71897-1uiua8l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287750/original/file-20190812-71897-1uiua8l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287750/original/file-20190812-71897-1uiua8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287750/original/file-20190812-71897-1uiua8l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287750/original/file-20190812-71897-1uiua8l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">U.S. District Judge Dan A. Polster is overseeing landmark opioid litigation in Cleveland.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Opioid-Crisis-Lawsuits/95258a7da15f4f2780766f19f027b553/1/0">AP Photo/Tony Dejak</a></span>
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</figure>
<p>The unsealed documents and data reveal the DEA possessed massive amounts of information about the oversupply of prescription opioids while the overdose epidemic was mushrooming. The newly released court exhibits also suggest that some opioid manufacturers and distributors repeatedly failed to report suspicious orders as required by law.</p>
<p>Congress had already suspected that corporate oversight was lacking.</p>
<p>The <a href="https://republicans-energycommerce.house.gov/wp-content/uploads/2018/12/Opioid-Distribution-Report-FinalREV.pdf">House Energy and Commerce Committee</a>, for example, issued a report in 2018 that was highly critical of the DEA’s oversight of opioid distribution in West Virginia. The DEA, according to the report, was aware of wide-scale diversion and suspicious shipments as early as 2005 and even began an initiative to educate distributors about their obligations regarding suspicious orders.</p>
<p>In 2011, <a href="https://www.dea.gov/sites/default/files/pr/speeches-testimony/2012-2009/110524_testimony.pdf">then-DEA administrator Michele Leonhart</a> testified before a Senate judiciary subcommittee that the agency was increasing its investigations of doctors and pharmacists who illegally diverted controlled substances. What I believe the DEA missed was that the manufacturers and distributors of opioids had gone rogue.</p>
<p>In a recent filing in the consolidated Cleveland case, <a href="http://www.opioidsnegotiationclass.info/Home/FAQ#faq2">local governments</a> like Coos County, New Hampshire, and the city of Chicago allege that the corporate defendants’ “<a href="https://www.washingtonpost.com/investigations/newly-unsealed-exhibits-in-opioid-case-reveal-inner-workings-of-the-drug-industry/2019/07/23/acf3bf64-abe5-11e9-8e77-03b30bc29f64_story.html?">failure to identify suspicious orders was their business model</a>.” </p>
<p>The <a href="https://www.washingtonpost.com/investigations/newly-unsealed-exhibits-in-opioid-case-reveal-inner-workings-of-the-drug-industry/2019/07/23/acf3bf64-abe5-11e9-8e77-03b30bc29f64_story.html">unsealed documents</a> suggest a pattern. Manufacturers and distributors either had deficient systems for monitoring of suspicious orders, simply ignored them or went out of their way to call them something else. For example, rather than acknowledging that enormous or extraordinarily frequent orders were “suspicious,” employees and executives would describe these transactions as “peculiar” or “unusual.”</p>
<p>The newly available documents indicate that when DEA investigators did find evidence that distributors were not reporting suspicious shipments, the authorities reached settlements instead of moving forward with prosecutions. As a result, distributors paid civil penalties rather than facing more serious criminal charges. Therefore, with <a href="https://www.deachronicles.com/2017/07/dea-prevails-over-masters-pharmaceutical-inc/#more-1886">few exceptions</a>, distributors who had failed to report suspicious shipments were able to stay in business. </p>
<p>And although the number of shipments continued to rise beyond 2012 – the end of the period covered by the newly available data and documents – the <a href="https://www.washingtonpost.com/investigations/the-dea-slowed-enforcement-while-the-opioid-epidemic-grew-out-of-control/2016/10/22/aea2bf8e-7f71-11e6-8d13-d7c704ef9fd9_story.html">number of enforcement actions actually fell</a> in 2013.</p>
<p>It wasn’t until 2017 that the DEA seemed to pay serious attention to the role of manufacturers and distributors in the opioid overdose epidemic. That year, it reached a <a href="https://www.dea.gov/press-releases/2017/07/11/mallinckrodt-agrees-pay-35-million-settlement">US$35 million settlement with Mallinckrodt</a>, one of the largest oxycodone manufacturers, for failing to detect and report suspicious orders. The settlement also obliged Mallinckrodt to monitor downstream distribution, as the DEA said for the first time that the obligation to “know your customer” includes knowing “your customer’s customer.”</p>
<h2>Stepping up enforcement</h2>
<p>I see a new <a href="https://www.congress.gov/bill/115th-congress/house-bill/6/text#H8909942BDF304C42AA654FCEAD3C0AA8">federal law</a> President Donald Trump signed in 2018 as a step in the right direction. It tightens up the definition of “suspicious activity,” clarifies reporting obligations and requires the DEA to establish a centralized database for all reports of suspicious prescription drug orders.</p>
<p>The federal government also seems to be taking a more aggressive stance against opioid distributors. For instance, it filed felony charges against the distributor <a href="https://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-and-dea-announce-charges-against-rochester-drug-co-operative-and">Rochester Drug Co-Operative</a> and two of its former executives in April 2019. The government alleges that the company intentionally failed to report suspicious orders and looked the other way amid signs that opioids were being shipped for illicit purposes.</p>
<p>In July 2019, the government announced charges against <a href="https://www.justice.gov/usao-sdoh/pr/pharmaceutical-distributor-executives-pharmacists-charged-unlawfully-distributing">Miami-Luken</a>, another distributor, and two of its former executives for allegedly failing to report suspicious orders and conspiring with two pharmacists to illegally distribute millions of prescription opioid painkillers.</p>
<p>It does look like lawmakers have strengthened the Controlled Substances Act and that the government is making strides on enforcement. However, it remains unclear why it took them so long to use the powers they already had to stop reckless shipments.</p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=thanksforreading">Thanks for reading! We can send you The Conversation’s stories every day in an informative email. Sign up today.</a></em> ]</p><img src="https://counter.theconversation.com/content/121021/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicolas Paul Terry receives funding from The Indiana University Addictions Grand Challenge <a href="https://addictions.iu.edu/">https://addictions.iu.edu/</a> </span></em></p>Previously secret documents and data make it clear that many companies engaged in the distribution of prescription painkillers either skirted or ignored their legal obligations for years.Nicolas Paul Terry, Professor of Law, IUPUILicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/875812017-11-20T02:25:51Z2017-11-20T02:25:51ZThe dangers and potential of ‘natural’ opioid kratom<figure><img src="https://images.theconversation.com/files/195255/original/file-20171117-19250-16k090r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The leaves of the plant kratom.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mitragyna-speciosa-korth-kratom-worker-hand-480333337?src=A9uj9ESb-Br4U0X7phK94w-1-6">MIA Studios/Shutterstock.com</a></span></figcaption></figure><p>Given the <a href="https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm">opioid addiction crisis</a>, it would seem preposterous that an opioid is legal for use in the United States and can be purchased at tea stores, convenience stores, over the internet and, yes, even <a href="https://www.statnews.com/2017/06/01/kratom-vending-machine/">from vending machines</a>. </p>
<p>However, kratom is not your average opioid. The Drug Enforcement Agency found this out when it tried to ban the herb in 2016. </p>
<p>Public outcry from users and 51 <a href="http://nationalpainreport.com/congressional-members-ask-dea-to-delay-kratom-ban-8831565.html">congressmen around the country</a> from both political parties was loud. The DEA has since dropped its <a href="https://www.usnews.com/news/us/articles/2016-05-20/states-ban-kratom-supplement-over-abuse-worries">attempt to ban kratom</a>, although its use is banned in Alabama, Arkansas, Indiana, Tennessee, Vermont, Wisconsin and Louisiana. </p>
<p>More recently, on Nov. 14, 2017, the FDA issued a <a href="https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584970.htm">public warning about kratom, citing 36 deaths</a> that the agency has attributed to kratom use.</p>
<p>Kratom lies at the intersection between natural product and drug of abuse, areas I have been been exploring as a clinical pharmacology researcher and a pharmacist <a href="https://pharmacy.uconn.edu/person/c-michael-white/">for two decades</a>. From ephedra for weight loss to MDMA (molly) for PTSD, experience has taught me that natural products are not always safe and that banned drugs may actually benefit some patients.</p>
<h2>A popular plant</h2>
<p>Thousands of people take kratom, which grows naturally in Thailand, Malaysia, Indonesia and Papua New Guinea, to <a href="https://www.painnewsnetwork.org/stories/2016/9/21/survey-kratom-very-effective-for-many-chronic-pain-conditions">relieve pain</a>, believing a natural herb to be safe. However, we just do not know enough about the herb to deem it safe, or effective.</p>
<p>We do know that kratom has very mild pain-relieving effects and a slight stimulant effect. It brings a low risk of stopping breathing, the main risk of stronger opioids. </p>
<p>The opioid effects from kratom come from two potent chemicals, mitragynine and 7-hydroxymitragynine in kratom’s leaf. Mitragynine is the more prominent and has very mild opioid effects, while 7-hydroxymitragynine is <a href="https://www.ncbi.nlm.nih.gov/pubmed/23206666">13 times more potent than morphine</a> milligram for milligram.</p>
<p>But just because kratom is not as dangerous as heroin and fentanyl does not mean it is free of adverse effects. In fact, they are all <a href="https://www.ncbi.nlm.nih.gov/pubmed/25262913">highly addictive</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/195273/original/file-20171117-11450-rs8s12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195273/original/file-20171117-11450-rs8s12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195273/original/file-20171117-11450-rs8s12.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195273/original/file-20171117-11450-rs8s12.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195273/original/file-20171117-11450-rs8s12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195273/original/file-20171117-11450-rs8s12.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195273/original/file-20171117-11450-rs8s12.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Capsules of kratom in Albany, N.Y. in a Sept. 27, 2017 file photo, after the death of a young police officer in upstate New York was classified as a kartom overdose.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Opioid-Alternative-FDA-Warning/87d788428941445bb09bbcb5b22074ca/2/0">AP Photo/Mary Esch</a></span>
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<p>In an assessment of the 660 calls about kratom to United States poison control centers from 2010-2015, the major adverse effects included racing heartbeat, agitation or irritability, drowsiness, nausea and high blood pressure. The <a href="https://www.cdc.gov/mmwr/volumes/65/wr/mm6529a4.htm">adverse effects</a> were moderate or severe in 42 percent and 7 percent of people, respectively. </p>
<p>In addition, unlike prescription drugs, the quantities of the active ingredients in unregulated kratom products can change over time or can be adulterated with other products. In an assessment of several kratom products commercially sold in the Western world, the concentrations of 7-hydroxymitragynine were <a href="http://addictionresearch.health.ufl.edu/faculty/bonnie-a-avery-ph-d/">substantially higher</a> than could be achieved naturally, which negates the safety benefits of using kratom versus other opioids.</p>
<h2>Help for hard workers?</h2>
<p>Kratom has been used widely in Southeast Asia for millennia, but it was banned in Thailand in 1943. Fans of the herb said the <a href="http://entheology.com/news-articles/why-kratom-was-banned-in-thailand/">ban was due to politics</a>, not health. </p>
<p>The ban hardly stopped its usage there. According to the 2008 national survey in Thailand, more than a million people reported using kratom. In several southern districts in Thailand, up to <a href="https://www.pri.org/stories/2016-09-07/thailand-moving-closer-decriminalizing-meth">70 percent of the male population reportedly uses kratom</a> daily. </p>
<p>In Malaysia, the majority of people reported use of kratom to enhance their ability to work long hours with less pain and fatigue, but 31 percent began out of curiosity or peer pressure. <a href="https://www.ncbi.nlm.nih.gov/pubmed/24698080">Fifteen percent</a> reported using kratom to wean off illicit drugs and alcohol. Eighty-nine percent of subjects tried to abstain from kratom in the past but all had relapsed due to withdrawal symptoms, such as insomnia, nausea, vomiting, diarrhea, muscle pains and shakiness, runny eyes and nose, anxiousness, depression and tension.</p>
<p>In the U.S., kratom’s safety profile – at least compared to other opioids – led people as far back as 1836 to recommend kratom as a substitute for people who became addicted to opioids. This belief was the main reason for the outcry <a href="https://www.ncbi.nlm.nih.gov/pubmed/23206666">against the proposed DEA ban</a> in 2016. Despite the internet hype and extensive anecdotal experience, I do not think there any high-quality studies assessing how well it actually works and the best ways to use it.</p>
<h2>Keeping quiet</h2>
<p>A small study in Malaysia of <a href="https://www.ncbi.nlm.nih.gov/pubmed/20092998">136 kratom users</a> in 2010 suggested that kratom was effective at reducing the use of opioids. But, of the 78 percent of the respondents who subsequently tried to quit using kratom, none was successful. </p>
<p>We already have drugs that can be used for opioid addiction, including suboxone and methadone, which have been rigorously studied but also are addictive. It is reasonable to ask: Why would someone use kratom to help treat addiction? </p>
<p>Kratom offers something that other drugs to treat addiction do not – the ability to treat oneself in anonymity and to receive treatment without involving the health care system or law enforcement. </p>
<p>We need more information. Having the DEA ban a product makes the scientific inquiry into that product extremely difficult. This has impaired researchers’ ability to sensibly investigate the medicinal properties of marijuana, to the detriment of patients, I believe. </p>
<h2>What is the bottom line?</h2>
<p>Kratom is a promising option as an effective and safe substitute for people addicted to prescription opioids, which needs to be explored.</p>
<p>At the same time, kratom has high addiction potential and is risky when combined with other psychiatric drugs or drugs of abuse. Having kratom available to purchase in nearly unlimited quantities in venues that do not restrict purchase by age is a very bad idea.</p>
<p>A middle ground between this Wild West policy and a ban on kratom is to establish it as a third class of drugs. In 2006, Congress passed a law <a href="https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm072423.htm">moving decongestants</a> (pseudoephedrine, ephedrine and phenylpropanolamine) from over-the-counter to behind-the-pharmacy-counter status. </p>
<p>That law limits the monthly amount of the decongestants any individual could purchase. It also limits the sale to adults with photo identification and requires retailers to keep personal information about these customers for at least two years after purchase. Congress could pass a similar law for kratom and even place further restrictions, such as requiring kratom products to contain a standardized amount of the active constituents and that patients provide a medication history to the pharmacist, who can check for harmful drug-drug interactions and counsel patients on safer ways to use the drug. </p>
<p>As with decongestants, this can be done efficiently and discreetly, because there are over <a href="https://pdfs.semanticscholar.org/6215/52c5422c82367330037a5360ee0b1b6b9cf6.pdf">275 million patient visits</a> to places that have pharmacies in them in the United States each week.</p><img src="https://counter.theconversation.com/content/87581/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C. Michael White does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The herb kratom has a large following and is so popular that it is sold in vending machines. The FDA recently issued a public warning about the herb, which contains low levels of opioids.C. Michael White, Professor and Head of the Department of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/674152016-11-09T16:06:02Z2016-11-09T16:06:02ZMarijuana legalization: Big changes across country<p>This year’s election season was historic in more ways than one. An unprecedented <a href="http://bigstory.ap.org/article/b48abf31b65040b19c7df82e09f96130/9-states-vote-soon-expanding-legal-access-marijuana">nine states considered liberalizing cannabis laws</a>, and here’s how it broke down: <a href="http://www.latimes.com/nation/politics/trailguide/la-na-election-day-2016-proposition-64-marijuana-1478281845-htmlstory.html">California</a>, <a href="https://www.bostonglobe.com/metro/2016/11/08/pot/nn0rImK95SxMkC9Y0GaKsI/story.html">Massachusetts</a>, <a href="http://abcnews.go.com/Politics/wireStory/latest-maine-legalizes-marijuana-recreational-43450765">Maine</a> and <a href="https://ballotpedia.org/Nevada_Marijuana_Legalization,_Question_2_(2016)">Nevada</a> saw their ballot measures pass, bringing the total number of states with legal adult-use cannabis laws up to eight. Arizona’s ballot measure <a href="https://ballotpedia.org/Arizona_Marijuana_Legalization,_Proposition_205_(2016)">failed to pass</a>. </p>
<p>Further, Florida, Arkansas, North Dakota, Montana <a href="https://www.washingtonpost.com/news/wonk/wp/2016/11/08/medical-marijuana-sails-to-victory-in-florida/">passed their medical cannabis ballot measures</a>, bringing the total number of states with medical cannabis laws up to 28 (Montana’s measure expanded its already existing laws).</p>
<p>To many in the cannabis reform movement, this is cause for celebration. California is easily the biggest news here, being the <a href="http://sanfrancisco.cbslocal.com/2016/07/05/california-economy-gdp-6th-largest/">sixth largest economy in the world</a> and dwarfing all current cannabis-legal states combined. That’s a big domino to fall.</p>
<h2>The DEA isn’t rescheduling cannabis, for now</h2>
<p>The trend toward legalization is sweeping the country, and it doesn’t seem to be slowing. This might lead some who support the movement to assume legal pot nationwide is a foregone conclusion, but that’s far from the truth.</p>
<p>The legality, or illegality, of cannabis at the federal level hasn’t changed at all, where it is still classified as a Schedule I drug under the <a href="http://www.fda.gov/regulatoryinformation/legislation/ucm148726.htm">Controlled Substances Act</a>. That means that lawmakers consider cannabis a substance with a high potential for abuse and no accepted medical use. Schedule I also includes drugs like heroin, LSD and ecstasy.</p>
<p>Despite many rumors that the Drug Enforcement Agency would reschedule cannabis to Schedule II earlier this year, meaning that it would legally have accepted medical uses, the DEA <a href="https://www.dea.gov/divisions/hq/2016/hq081116.shtml">reaffirmed its decades-old position in August</a>. Though many activists argue fervently for cannabis’ medical uses, the science of it <a href="https://theconversation.com/what-do-we-know-about-marijuanas-medical-benefits-two-experts-explain-the-evidence-64200">gets rather complicated</a>. The federal government likely will change cannabis’ legal status at some point, but nobody knows when that’ll happen.</p>
<p>The DEA’s decision had an important caveat though. It allowed new entities to apply to become <a href="http://www.latimes.com/politics/la-na-marijuana-dea-20160811-snap-story.html">producers and distributors of cannabis for research purposes</a>.</p>
<p>Up until now, under federal law, the University of Mississippi was the sole entity allowed to produce cannabis for research purposes. This was a significant barrier for researchers because the University of Mississippi cultivated a limited number of cannabis strains that aren’t reflective on the vast diversity of strains that are consumed by users. </p>
<p>With more entities (likely other universities) doing this work, there will be a greater diversity of cannabis plants that can be researched. Unfortunately, the process to get a license to research a Schedule I drug is far more difficult than one of a lower scheduled drug, so research will be heavily restricted for as long as cannabis remains on Schedule I.</p>
<h2>Promoting research could have a bigger effect</h2>
<p>John Hudak of the Brookings Institution <a href="https://www.brookings.edu/blog/fixgov/2016/08/11/the-deas-marijuana-decision-is-more-important-than-rescheduling/">argued</a> that the DEA’s decision to allow more entities to produce marijuana cannabis for research was actually more important than rescheduling. Rescheduling would not have as much of an effect as many believe, while promoting research will lead to a better scientific understanding of cannabis’ medicinal value – and risk. This, Hudak argues, will then likely lead to rescheduling anyway.</p>
<p>Hudak is right in the sense that the federal government will eventually have to reform its stance as more and more states go legal. But how exactly will that occur? </p>
<p>As Hudak also pointed out, simply putting cannabis on Schedule II does far less than many believe. That would place cannabis on a list with drugs like oxycodone and morphine, which can be prescribed but aren’t sold recreationally in stores. That would allow physicians to prescribe cannabis and could lead to interesting and complicated ramifications. </p>
<p>The Food and Drug Administration would then begin regulating it, and you can expect the pharmaceutical industry to capitalize on cannabis as well. If people are worried about “Big Marijuana,” just wait until Big Pharma gets involved. But it would do little to legitimize the recreational systems that already exist in states like Washington and Colorado.</p>
<p>A Schedule II placement would also do nothing to change the industry’s tax headache. An <a href="https://www.law.cornell.edu/uscode/text/26/280E">Internal Revenue Code provision</a> that prevents cannabis businesses from making normal business deductions, and which takes a huge bite into their profits. </p>
<p>Cannabis would have to be on Schedule III – which includes drugs like anabolic steroids and Tylenol containing codeine – or below for that provision to no longer apply. Legalization advocates like the National Organization for the Reform of Marijuana Laws <a href="http://blog.norml.org/2016/04/06/it-is-time-to-deschedule-not-reschedule-cannabis/">argue that cannabis should be descheduled</a> – not rescheduled – so that it would be regulated more like alcohol.</p>
<p>So how will federal reform take place? It can either come from the DEA or from Congress. But the DEA has shown little sign that it would reschedule cannabis, and given partisan gridlock in Washington, we can’t expect Congress to take action on something as momentous as significant drug reform any time soon.</p>
<h2>Reforming without rescheduling</h2>
<p>One interesting alternative has been <a href="http://www.uclalawreview.org/pdf/62-1-2.pdf">proposed by famed legal theorist Erwin Chemerinsky and his colleagues</a>. The federal government would take a “cooperative federalism” approach. That would allow states to further develop new drug laws without conflicting with federal laws, as they do now. </p>
<p>This would work by creating an opt-out system, where states can be left to craft their own cannabis policy so long as they meet certain federal requirements. This would allow the states to opt out of the Controlled Substances Act with respect to cannabis. The act would still apply as usual in states that don’t have their own cannabis policy. </p>
<p>This would legally allow both federal and state policies to coexist without having to reschedule cannabis. Chemerinsky points out that the Clean Air Act already acts in this way, where the federal government regulates air pollution but also allows states to adopt their own regulations if they meet certain federal requirements.</p>
<p>History was certainly made this election season, but the story is far from over. There’s little indication that the trend of legalization will be reversed as more U.S. states legalize. How the U.S. government will act will perhaps be the climax of this policy story. It is difficult to know how – and when – that will occur.</p><img src="https://counter.theconversation.com/content/67415/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sam Méndez is the executive director of the Cannabis Law & Policy Project at the University of Washington School of Law. As an attorney, he also advises cannabis businesses on their operations.</span></em></p>The trend toward marijuana legalization is growing, but the legality, or illegality, of cannabis at the federal level hasn’t changed at all.Sam Méndez, Executive Director, Cannabis Law & Policy Project, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/662512016-09-29T15:52:02Z2016-09-29T15:52:02ZHow Bolivia curbed coca production by moving away from violent crackdowns<p>The US government’s <a href="https://www.whitehouse.gov/the-press-office/2016/09/12/presidential-determination-major-drug-transit-or-major-illicit-drug">annual report</a> on the drug trade has accused Bolivia once again of failing to do enough to tackle the production and trafficking of illicit narcotics. This has been the US mantra for the ten years since Evo Morales, Bolivia’s first indigenous president, made a radical break with the US-funded “war on drugs”.</p>
<p>The US’s stance flies in the face of <a href="https://www.unodc.org/unodc/en/press/releases/2014/June/coca-bush-cultivation-drops-for-third-straight-year-in-bolivia-according-to-2013-unodc-survey.html">ample</a> evidence that Bolivia has markedly reduced coca leaf cultivation. And in spite of <a href="http://securityassistance.org/blog/us-tolerates-wont-support-bolivias-coca-yes-cocaine-no-policy">cuts to US counter-narcotics assistance</a>, Bolivian security forces are seizing illegal drugs at much higher levels than when the US <a href="http://www.reuters.com/article/us-bolivia-usa-dea-idUSTRE4A01IW20081101">Drug Enforcement Administration</a> (DEA) was in charge.</p>
<p>Bolivia is the world’s third largest producer of cocaine, a drug manufactured from coca leaf – which is central to Andean culture. Bolivia’s programme permits poor farmers to cultivate a small (up to 1,600 square metre) plot of coca, and encourages farmers to self-police to respect these limits. </p>
<p>This approach is known as “<a href="http://www.academia.edu/11055068/Social_Control_Bolivias_New_Approach_to_Coca_Reduction">social control</a>”. It’s a world apart from the old US-led policy, which demanded that local security forces forcibly eradicate coca crops. That approach resulted in two decades of violence, and neither reduced coca production nor restricted the flow of drugs reaching the US.</p>
<p>By contrast, Bolivia has now become the world’s first source country to take a “harm reduction” approach. The social control programme is designed to emphasise community participation and respect for human rights. </p>
<p>Morales’ “Coca yes, cocaine no” policy makes a clear distinction between coca leaf, and cocaine the illegal drug. Indigenous Bolivians have consumed coca leaf for millennia; it can be chewed or drunk as a tea, and is used to stave off hunger and suppress fatigue. Local cocaine consumption, by contrast, is almost non-existent.</p>
<p>The country’s 75,000 coca growers are spread across two regions in the country’s valleys and lowlands, and they all belong to strong local peasant unions. These organisations are at the centre of the government initiative. They monitor compliance by organising regular commissions with neighbouring unions to inspect members’ plots. Growers often quickly eliminate excess coca as soon as they hear the union is checking.</p>
<p>Observance of the agreement also falls to a government agency run by the farmers themselves. If too much coca is found, all the family’s coca is destroyed by a combined military-police unit. But unlike the past, eradication is negotiated, and is no longer associated with the violation of human rights. Re-planting is banned for a year, leaving farmers without any coca-related income for the two years it takes until new bushes mature.</p>
<p>A sophisticated UN-financed satellite system provides surveillance and monitoring data for the programme, and all growers must be registered with the government. Almost 1.2m acres of land has been titled, meaning many growers have formal property rights for the first time. Taken together, these measures mean their lives are substantially less precarious.</p>
<p>Since 2006, almost all coca has been eradicated through this negotiated, co-operative system, and the total acreage of the plant is now at its <a href="http://www.insightcrime.org/news-analysis/bolivia-coca-cultivation-drops-closer-to-legal-crop-allowance">lowest level since 2003</a>. Many growers participate out of deep-seated loyalty to Morales, who still heads the federation of growers’ unions, but they also still consider the leaf itself sacred, and it’s a vital part of their subsistence income. </p>
<p>The farmers know that if coca is restricted, demand will keep the price up. Whether as members of their unions, agricultural extension agents or inspectors, growers largely implement the programme, enhancing their sense of ownership.</p>
<h2>Onward and upward</h2>
<p>The newfound stability has turned coca-growing regions into places bustling with small businesses. The Morales government has ramped up development assistance, improving educational, health, and road infrastructure, as well as developing alternative uses for coca, using it to manufacture everything from flour to toothpaste.</p>
<p>Social control’s relative success does not mean it comes easy. There are debates over enforcement at every local union meeting, and some farmers complain that the upper limit on coca production is too low to meet their basic needs. Forced eradication continues in national parks and regions that aren’t part of the agreement.</p>
<p>Social control of coca alone cannot stop drug trafficking. Technological advances have made it ever easier to produce coca paste, the first step in cocaine manufacture, and have dispersed the product throughout Bolivia. Nonetheless, it’s become harder to find places to manufacture paste in coca-producing regions because farmers fear losing the right to grow coca if they are <a href="http://ain-bolivia.org/2014/03/can-you-get-rich-from-the-bolivian-cocaine-trade-cocaine-paste-production-in-the-chapare/">discovered</a>.</p>
<p>It is unclear whether the programme will continue after Morales leaves office in <a href="http://www.reuters.com/article/us-bolivia-referendum-idUSKCN0VX09E">2019</a>. It is uncertain, too, if it can be replicated elsewhere because it depends so heavily on strong local organisations that don’t exist in other places. But its novel approach is invigorating the drug policy debate, and is at the vanguard of the new, bottom-up approaches that are helping solve one of the world’s most complex and intractable problems.</p>
<hr>
<p><em>Linda Farthing also contributed to this article. She is a researcher and writer specialising in Bolivia, and the founder of the <a href="http://ain-bolivia.org/">Andean Information Network</a>.</em></p><img src="https://counter.theconversation.com/content/66251/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thomas Grisaffi receives funding from the Leverhulme Trust. He was previously a fellow on the SSRC's Drugs Security and Democracy program. </span></em></p>Bolivia is the first cocaine-producing country to take a harm reduction approach to tackling the drug trade.Thomas Grisaffi, Leverhulme Early Career Research Fellow, UCL Institute of the Americas, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/654312016-09-15T10:43:30Z2016-09-15T10:43:30ZBanning kratom won’t stop users or solve the drugs health crisis – so why continue this losing war?<figure><img src="https://images.theconversation.com/files/137751/original/image-20160914-4948-rmsj3d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Potential medicine, or dangerous drug?</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Kratom_leaf.JPG">ThorPorre</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>While we have seen a surge in <a href="http://www.sciencedirect.com/science/article/pii/S0278584612001844">new psychoactive substances in recent years</a>, there has also been a rediscovery in the West of old herbal narcotics that have traditionally been used in different parts of the world. One example is khat, the leaves of which are chewed for a mild stimulant effect in some societies in the Horn of Africa – it was <a href="http://www.bbc.co.uk/news/uk-wales-south-east-wales-27991393">banned in the UK in 2014</a>. Another plant to come to the attention of the authorities is kratom, a tropical tree from Southeast Asia that has just been <a href="http://www.npr.org/sections/health-shots/2016/09/12/493295493/kratom-advocates-speak-out-against-proposed-government-ban">banned by the US Drug Enforcement Agency</a>.</p>
<p>Kratom (<em>Mitragyna speciosa</em>) is a tropical tree that grows between four and 16 metres high and is indigenous to Southeast Asia, the Philippines and New Guinea. Like <a href="http://www.journals.uchicago.edu/doi/abs/10.3998/jar.0521004.0071.204">coca leaves</a> in the central Andes, the chopped fresh or dried leaves of the kratom tree have been chewed for centuries or made into tea to combat fatigue. </p>
<p>The DEA’s ban places kratom as a <a href="https://www.dea.gov/druginfo/ds.shtml">schedule 1 controlled substance</a>, alongside drugs like cannabis, heroin, MDMA (ecstasy) and LSD. It joins an ever-expanding list of psychoactive drugs deemed to have “no currently accepted medical use” and a “high potential for abuse”. There has been quite an uproar about this among kratom users, although both the arguments for and against lack <a href="https://www.hindawi.com/journals/bmri/2015/968786/">consistent evidence</a>. </p>
<h2>The effects of kratom</h2>
<p>The effects of kratom on humans are dose-dependent: small doses produce stimulatory effects resembling cocaine or amphetamines, while larger dosages tend to produce sedative-narcotic effects similar to opiate drugs such as opium, morphine or heroin. Kratom has become more popular in the West in recent years, especially among <a href="https://www.hindawi.com/journals/bmri/2015/968786/">those seeking a more “natural high”</a>. On the other hand, in <a href="http://www.sciencedirect.com/science/article/pii/S0378874112001572">Thailand and Malaysia</a>, kratom was made illegal in 1943 and 2015 respectively. </p>
<p>Some kratom users claim that preparations can be used to treat opiate addictions. But <a href="http://bit.ly/2cacC1H">data to support its effectiveness and safety</a> is scarce, especially considering that these claims have been made on anecdotal evidence and have not followed the usual rigorous scientific procedures.</p>
<p>The chemistry of natural products is exceptionally complex, producing complex pharmacological effects. With scant data on the toxicology or safety profile of kratom, and even less regarding its interactions with conventional drugs or the effects of abusing it, there is ample risk for it to cause harm or even death by misadventure. So the question is not why the DEA considers kratom a menace to public health – which it at least has the potential to be – but rather why the agency continues to add psychoactive substances, new or newly rediscovered, to its lists of scheduled drugs.</p>
<h2>The pointlessness of drug listing</h2>
<p>The idea that an ever-expanding list of thou-shalt-nots has any effect on public health has not only been proven to be <a href="http://www.nature.com/nrn/journal/v14/n8/full/nrn3530.html">ineffective</a>, it might even be counterproductive if not put in place as part of an <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03461.x/full">across-the-board harm assessment</a>. Kratom is a powerful <a href="https://www.hindawi.com/journals/bmri/2015/968786/">opioid receptor agonist</a>, which means that its supposed beneficial effect on opioid withdrawal symptoms stem from the fact it attaches to the same neurotransmitter receptors in the brain. In other words, it stimulates similar areas of the brain and mimics the effects of opiates, if not their toxicity. </p>
<p>Even taking the medicinal argument in support of kratom at face value, we should still require the same level of evidence required for any other substances used to help opiate withdrawal – methadone for example. The <a href="http://www.ncbi.nlm.nih.gov/pubmed/20092998">only study to support this claim</a> is from a single country (Malaysia), is purely observational, and has a small sample size of just 136 people.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/137752/original/image-20160914-4958-hgwtxc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/137752/original/image-20160914-4958-hgwtxc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/137752/original/image-20160914-4958-hgwtxc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=749&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137752/original/image-20160914-4958-hgwtxc.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=749&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137752/original/image-20160914-4958-hgwtxc.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=749&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137752/original/image-20160914-4958-hgwtxc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=942&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137752/original/image-20160914-4958-hgwtxc.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=942&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137752/original/image-20160914-4958-hgwtxc.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=942&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kratom capsules on sale in the US … until the DEA ban comes into force.</span>
<span class="attribution"><span class="source">GamblinMan22</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Both the DEA and kratom users are missing the point: neither banning nor legalising/decriminalising the drug will tackle the public health concerns that it might pose. The DEA conducts enforcement, not realising that whether or not kratom is banned, there will still be health effects that must be dealth with by health policy, not criminal justice. On the other hand, those in support of legalising or decriminalising kratom do not have a clear alternative of how to deal with the health effects that would follow.</p>
<p>Only a tiny minority of people use kratom in the West, and it is a drug most people will have never heard of. Users have shown themselves to be very vocal minority, with many belonging to a new type of online activist who favour volume over facts. The case for a medicinal use of kratom comes down to considerable wishful thinking.</p>
<p>When the DEA and its equivalent in other countries insist on banning substances this generally does little to interrupt supply. And it certainly ignores the heart of the issue: why people use drugs, what are the public health implications, how to engage with users effectively – particularly in a case such as this where there are such polarised views – and how to move debates on in a world where facts have become secondary to pursuing agendas.</p>
<p>At the end of the day, public policy is there to change behaviour for the good of society. The DEA has consistently tried to do so through banning and enforcement, but this has produced the opposite effect: drugs have never been more widespread, alongside the social damage from enforcement and health effects that are a consequence. In short, how long will we persist in fighting a lost drug war?</p><img src="https://counter.theconversation.com/content/65431/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andres Roman-Urrestarazu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Complaints about the ban of kratom, often used by recovering opiate addicts, have been vociferous, but not always backed by facts.Andres Roman-Urrestarazu, Research Officer, London School of Economics and Political ScienceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/625742016-08-01T07:25:04Z2016-08-01T07:25:04ZIs cannabis really getting stronger?<figure><img src="https://images.theconversation.com/files/131482/original/image-20160721-32600-1c3eqpv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=marijuana&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=246790006">Mr High Sky/Shutterstock</a></span></figcaption></figure><p>Cannabis continues to be the world’s favourite illicit drug with around 147m people <a href="http://www.who.int/substance_abuse/facts/cannabis/en/">using it</a> annually. However, there are fears that the drug is becoming <a href="http://www.dailymail.co.uk/health/article-3439625/Pot-getting-potent-Level-psychoactive-ingredient-cannabis-TRIPLED-20-years-experts-warn.html">increasingly potent</a> and that it could pose a public health risk. But how reliable is the evidence? And is it really getting stronger?</p>
<p>The debate about cannabis potency and harm is long running. In the UK, where there are <a href="http://bit.ly/29TzaED">2m annual users</a>, it predates the <a href="https://policypress.co.uk/evidence-versus-politics">2004 downgrading of cannabis classification</a> from class B to class C. But this episode demonstrated some of the issues with estimating the harms of the drug. Research conducted at the time highlighted how the relative harms of cannabis compared with other class B substances was one of the factors behind the decision to reclassify. However, critics accused the government of ignoring emerging evidence that cannabis was becoming more potent and that it represented a serious public health problem. </p>
<p>Those more sympathetic to the change in classification questioned whether this interpretation of cannabis potency was accurate, highlighting how an alternative conclusion had been drawn from published research which suggested only modest changes in cannabis potency over the <a href="http://www.emcdda.europa.eu/attachements.cfm/att_33985_EN_Insight6.pdf">20 to 30 years</a> prior to 2004.</p>
<p>Others, meanwhile, questioned the relevance of potency evidence, pointing to a shortage of studies looking at the consumption of cannabis in a natural setting and how users may well be smoking higher strength strains, but that they could be <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12634/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=">“titrating” their doses as a consequence</a>, for example, by taking smaller puffs.</p>
<p>The debate over potency is not helped by politicians referring to the “<a href="http://news.bbc.co.uk/1/hi/uk_politics/7372876.stm">lethal quality</a>” of today’s cannabis and although the evidence is inconclusive, there is widespread acceptance that strains of cannabis are stronger than in previous decades. </p>
<p>To date, most assessments of cannabis potency have focused on increasing levels of <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2008.02230.x/full">tetrahydrocannabinol (THC)</a>. But this doesn’t provide the full story. Cannabis contains hundreds of compounds, some of which interact with each other. For example, THC helps the user get high, but another compound, cannabidiol (CBD), can counter this by reducing unpleasant feelings such as anxiety. So it is the balance between THC and CBD over time that is important. </p>
<p>It would seem that many cannabis producers have competed to incrementally increase THC levels while selectively breeding out the more <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.13207/full">protective cannabinoids</a>. Seizures from the US Drug Enforcement Administration show how this ratio has changed in America over the <a href="http://bit.ly/2ap8HR3">last 20 years</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/131158/original/image-20160719-7910-1rfnhg9.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/131158/original/image-20160719-7910-1rfnhg9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/131158/original/image-20160719-7910-1rfnhg9.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/131158/original/image-20160719-7910-1rfnhg9.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/131158/original/image-20160719-7910-1rfnhg9.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/131158/original/image-20160719-7910-1rfnhg9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/131158/original/image-20160719-7910-1rfnhg9.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/131158/original/image-20160719-7910-1rfnhg9.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">CBD / THC ratio over time.</span>
<span class="attribution"><span class="source">ElSohly et al 2016</span></span>
</figcaption>
</figure>
<p>This changing ratio was helped in the UK by the introduction of <a href="http://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1997-01-01_1_page006.html">hydroponic techniques</a> in the 1980s for cultivating cannabis.</p>
<h2>Proxy problems</h2>
<p>Proxy measures of cannabis potency such as those based on home seizures of cannabis are <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1556-4029.2007.00603.x/full">widely used and quoted</a>. But we don’t know if the cannabis seized is a representative sample of the cannabis in circulation. Steve Rolles, senior policy analyst for Transform Drug Policy Foundation, describes it as “a massive data hole”.</p>
<p>Also, the quality and sophistication of the cannabis testing procedures, such as chromatography, used to analyse seizures has <a href="http://onlinelibrary.wiley.com/doi/10.1002/dta.1430/abstract">improved over recent decades</a>. But this means seminal and widely quoted research is outdated and less relevant.</p>
<p>Another factor to consider is how much cannabis is consumed in the average joint. A recent analysis of over 10,000 cannabis transactions carried out in the US between 2000 and 2010, estimated that the <a href="http://www.sciencedirect.com/science/article/pii/S0376871616301508">average joint</a> contains 0.3g. This is significantly lower than the previous estimates of 0.75 to 1g. </p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12508/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=">Other factors</a> that influence the strength of the hit are how deeply you inhale and how long you hold the smoke in your lungs.</p>
<p>The method used to ingest the drug also influences a user’s experience, such as eating, vaping or smoking. Dose can be increased by using a bong whereby a greater quantity of the drug is inhaled in one go compared to a single hit on a joint. Higher potency concentrates known as “dabs” have the potential to <a href="http://pediatrics.aappublications.org/content/136/1/1?utm_source=highwire&utm_medium=email&utm_campaign=Pediatrics_etoc">alter the level of intoxication</a> .</p>
<p>Research gathered from a subset of cannabis users creates ill informed policy, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03139.x/abstract">threatening the credibility of public health messages</a>. </p>
<h2>Why any of this matters</h2>
<p>Without any quality assurance system such as the one recently introduced <a href="http://www.economist.com/news/britain/21702624-revellers-get-chance-see-if-their-illegal-drugs-are-what-they-claim-be-cocaine-or">at a festival</a>, it is likely that younger users – who haven’t been using cannabis for long – are the most vulnerable to variations in cannabis potency.</p>
<p>There are public health implications. Cannabis users have to rely on their own knowledge when deciding on the dosage to achieve the desired high. A regulated market such as the one in <a href="http://www.tdpf.org.uk/blog/cannabis-regulation-colorado-early-evidence-defies-critics">Colorado</a> could mean users are able to make better decisions and, in turn, reduce the rate of people needing treatment services where <a href="http://www.tandfonline.com/doi/abs/10.3109/09687637.2015.1090398">cannabis is the primary problem</a> .</p>
<p>The government should regulate cannabis products to make them safer, enabling consumers to make more informed choices. It should create opportunities for targeted education and harm reduction, and employ other evidence-based health interventions.</p>
<p>The science underpinning the cannabis potency story is problematic. With so many people using cannabis, it can’t be acceptable to continue with a system where basic information about this product’s strength and purity are obscure. It is time for a national survey of cannabis that not only provides information about the strength of cannabis but how exactly it is consumed, too.</p><img src="https://counter.theconversation.com/content/62574/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Hamilton is affiliated with Alcohol Research UK. </span></em></p><p class="fine-print"><em><span>Mark Monaghan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>147m people used the drug last year. We need to know much more about it.Ian Hamilton, Lecturer in Mental Health, University of YorkMark Monaghan, Lecturer in Crimimology and Social Policy, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.