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The Race to Relearn Hemp Farming

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Interesting: trying to recover discarded knowledge. Leslie Nemo writes in Scientific American:

Angela Post wasn’t supposed to study hemp. The North Carolina State agriculture researcher focuses on small grains like wheat and barley. But after the 2014 Farm Bill allowed states to investigate hemp, it became clear the seeds were lucrative. Post had the right equipment to study them, so the job was hers.

At first, Post thought hemp would get as much attention as the other alternative crops she and her colleagues dabble in. “We didn’t know how fast it would grow,” she says. Once the work garnered the attention of hundreds of would-be hemp farmers, “that’s when we got a sense it was something bigger than anticipated.”

Since then, Post’s work has expanded beyond hemp seeds—and her expertise—to fiber and flowers, which contain cannabidiol, or CBD, which is extracted for use in seizure medications and over-the-counter tinctures. But there’s no turning down hemp studies if you’re an agricultural researcher in one of the states where residents might want to grow the crop, including North Carolina, Vermont, and Kentucky.

Hemp used to be farmed across the United States, but thanks to its association with the psychoactive form of cannabis, the government banned the crop from commercial and university fields for most of the 20th century. Now, hemp could once again become an American staple. For that to happen, researchers like Post—employees of land grant universities, which are located in every state and are federally mandated to help American farmers succeed—can fill in the knowledge gaps that have appeared and widened over decades. “We get tens and tens of questions each week that we can’t answer,” says Post.

These gaps include how best to plant hemp, what varieties to use, which insects and weeds are most likely to cause problems, and, most important of all, how farmers can turn a profit.

These are big questions. The answers have been stymied by the fact that, until recently, the Drug Enforcement Agency classified hemp as Schedule I, which meant fines and jail time for unauthorized possession and regulations that have made experiments extremely challenging. While some research exists—especially from Europe and Canada, where hemp science has been legal since the 1990s—the work doesn’t always translate across environments. And as much as researchers had accomplished since the 2014 Farm Bill, they weren’t ready for the 2018 Farm Bill, which was signed into law by President Donald J. Trump in December.

The bill legalizes the crop, allowing any farmer to grow it—whether or not they know how. That’s why NC State’s research approach is, as Post puts it, “all hands on deck.”

Two hundred years ago, cannabis filled the fields of American farms. It also altered the minds of the American public. Often called “hashish,” the plant went into candies and other foods, and went largely unregulated through the 19th century.

But in the early 1900s, around the same time the temperance movement was crusading against alcohol consumption, many Americans adopted the xenophobic assumption that Mexican immigrants were committing cannabis-fueled crimes. This led western states with sizeable Mexican populations to criminalize the plant, and 29 states eventually banned it. The racist fears spread all the way to Capitol Hill. In 1937, Congress passed a bill that taxed cannabis importers the equivalent of about $400 per year in 2018 dollars, and slapped rulebreakers with up to five years in prison and fines that, today, would equate to $35,000.

In 1971, the federal government classified cannabis as a Schedule I drug, which includes those narcotics deemed to have the highest potential for abuse and no accepted medical use. Five years later, researchers realized cannabis ought to be classified as two subspecies. One, now recognized as hemp, produces CBD in abundance, but very little of the psychoactive compound tetrahydrocannabinol, or THC. But since hemp was already stuck on the Schedule I list, it wasn’t going to sprout from American farms again anytime soon.

The U.S. kept importing hemp, however, a practice that continues today. The plant’s fibers are good for insulation, fabric, and carpet. The seeds can be eaten or pressed for oils used in cosmetics or paint. Or, if a grower plants certain varieties, they can collect CBD. In 2017, America imported $67.3 billion worth of hemp seed and fiber products, and the CBD market was worth nearly $200 million.

To see if the U.S. could re-enter this market, Congress allowed states to try growing the crop in the 2014 Farm Bill. (Farm bills, typically renewed every five years, are the tools through which the country’s agricultural and nutritional policies are set.) Under the legislation, researchers could study hemp if their state legalized and regulated it. For this to work, state governments, departments of agriculture, and the DEA had to collaborate. This process was often bumpy and put the onus of problem solving on the researchers.

That’s what happened to Heather Darby, an agronomy professor at the University of Vermont—a land grant school in a state that legalized hemp. Darby was eager to start hemp projects, but when she approached the Vermont Agency of Agriculture, Food, and Markets and the local DEA office to file requests, she was stalled by bureaucracy. For example, the DEA paperwork she needed was only formatted for marijuana research requests, not hemp. Navigating these oversights, Darby says, “was the biggest barrier.”

Even in North Carolina, a state that’s been relatively proactive about allowing hemp, Post chose to keep her research projects small her first year. There was a lag in the state law that would legalize the work, and she risked getting arrested if police found her driving around with hemp buds.

Then there were issues with funding. Researchers typically get money from the federal or state government. But the 2014 Farm Bill didn’t allocate funds for hemp the way it did for, say, citrus disease. And since land grant universities are federally-backed, administrators have been hesitant to funnel their budget into a Schedule I drug.

As such, hemp researchers have had to get financially creative. For example, the University of Kentucky—another land grant school—funds hemp research through private companies, says David Williams, a plant and soil scientist. Though private investors often ask for study results to be proprietary, Williams claims that the vast majority of the research produced by these partnerships has been made public.

At the University of Vermont, however, Darby has mostly seen private offers where the information can’t be shared. To her, that agreement runs counter to her job description. “My goal through the University of Vermont is to make sure whatever we’re doing is for the public good,” she says, which has “made it difficult for us to secure funds.” To help, Darby launched a public crowdsourced campaign in 2016 with the goal of raising $25,000. As of January, the campaign was only a quarter of the way there.

Post is part of the minority whose work is covered by state and federal funding. The North Carolina Department of Agriculture granted her more than $100,000 in the past two years, and in 2018 she also won a one-time $16,000 grant from a USDA fund set aside for pesticide research.

While several of her requests were successful, Post understands that entering a competitive grant application pool with a crop as new as hemp can be intimidating. “I think people, from what I’ve seen, are afraid to put that time and energy and effort into a big proposal knowing the odds,” she says. “It’s already hard with corn and soybean, so it’s daunting for a minor crop.”

Amid all this confusion, hemp scientists are trying to unravel the intricacies of farming the plant. Most are starting with two key strains that are used to make fiber and seed. . .

Continue reading.

Written by LeisureGuy

11 January 2019 at 4:33 pm

U.S. life expectancy declines again, a dismal trend not seen since World War I

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Lenny Bernstein reports in the Washington Post:

Life expectancy in the United States declined again in 2017, the government said Thursday in a bleak series of reports that showed a nation still in the grip of escalating drug and suicide crises.

The data continued the longest sustained decline in expected life span at birth in a century, an appalling performance not seen in the United States since 1915 through 1918. That four-year period included World War I and a flu pandemic that killed 675,000 people in the United States and perhaps 50 million worldwide.

Public health and demographic experts reacted with alarm to the release of the Centers for Disease Control and Prevention’s annual statistics, which are considered a reliable barometer of a society’s health. In most developed nations, life expectancy has marched steadily upward for decades.

“I think this is a very dismal picture of health in the United States,” said Joshua M. Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health. “Life expectancy is improving in many places in the world. It shouldn’t be declining in the United States.”

“After three years of stagnation and decline, what do we do now?” asked S.V. Subramanian, a professor of population health and geography at Harvard’s T.H. Chan School of Public Health. “Do we say this is the new normal? Or can we say this is a tractable problem?”

Overall, Americans could expect to live 78.6 years at birth in 2017, down a tenth of a year from the 2016 estimate, according to the CDC’s National Center for Health Statistics. Men could anticipate a life span of 76.1 years, down a tenth of a year from 2016. Life expectancy for women in 2017 was 81.1 years, unchanged from the previous year.

Drug overdoses set another annual record in 2017, cresting at 70,237 — up from 63,632 the year before, the government said in a companion report. The opioid epidemic continued to take a relentless toll, with 47,600 deaths in 2017 from drugs sold on the street such as fentanyl and heroin, as well as prescription narcotics. That was also a record number, driven largely by an increase in fentanyl deaths.

Since 1999, the number of drug overdose deaths has more than quadrupled. Deaths attributed to opioids were nearly six times greater in 2017 than they were in 1999. . .

Continue reading.

President Trump put Kellyanne Conway in charge of combating the opioid epidemic, but other than her recommendation that opioid addicts should eat junk food instead of using opioids, I cannot think of anything she has done. But this is a real crisis. What is she doing?

Written by LeisureGuy

29 November 2018 at 9:05 am

Georgia Nightmare: Jailed Four Months for Possession of Cotton Candy

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Philip Smith reports in Drug War Chronicles:

A Georgia woman has filed a federal lawsuit after she spent nearly four months in jail because a roadside drug test administered by untrained police officers falsely identified a bag of cotton candy as methamphetamine.

Monroe County resident Dasha Fincher filed the lawsuit in mid-November against Monroe County, the two deputies who arrested her, and the company that makes the drug test. The lawsuit argues that the Monroe County Sheriff’s Office was reckless and negligent and violated her civil rights.

According to the lawsuit, the car Fincher was riding in was pulled over on New Year’s Eve 2016 because of a dark window tint, the deputies said, even though they later admitted the windows were legal. Deputies Cody Maples and Allen Henderson spotted a large open plastic bag inside the vehicle, and Fincher explained that it was cotton candy.

The deputies didn’t believe Fincher and used a roadside field drug test which they said indicated there was meth in the bag. She was then arrested, hauled off to jail, and charged with meth trafficking and possession of meth with intent to distribute. Her bond was set at $1 million, which she was unable to come up with, so she sat in jail for the next four months.

In March 2017, Georgia Bureau of Investigation lab test results revealed that the substance was not an illegal drug, but Fincher sat in jail for another month before prosecutors finally dropped the charges.

The lawsuit says the drug test is the Nark II, manufactured by North Carolina-based Sirchie Acquisitions. That particular field drug test is known for producing errant results. In Georgia alone, police using the Nark II to field test drugs have wrongfully arrested at least 30 people, including a man with breath mints (positive for crack), a teacher with Goody’s Headache Powder (positive for cocaine), and a couple with vitamins (positive for ecstasy).

In all those cases, as in Fincher’s, lab test results from the Bureau of Investigation found no presence of illegal substances. But in all those cases, the exonerating results came only weeks or months later, after the harm to innocent Georgians had already been done.

The Nark II is still in wide use in Georgia. The manufacturer, Sirchie, defends itself by saying: “Our NARK presumptive drug tests are presumptive only. All samples should be sent to a crime lab for confirmation.” But too many Georgia law enforcement agencies clearly don’t bother to wait for confirmation before making life-changing arrests. And the state of Georgia doesn’t even require police officers to be trained on how to do the tests. . .

Continue reading.

I get the strong impression that Georgia law enforcement simply doesn’t give a shit. They know what the problem is and they simply ignore it. Too bad the Georgia legislature and the Georgia governor are also crap.

IMO the two deputies and the sheriff who failed to see that they were trained should be locked up in jail for four months. It seems only fair.

Written by LeisureGuy

29 November 2018 at 7:22 am

Racial Justice and Legal Pot Are Colliding in Congress

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James Higdon reports in Politico:

Congressman James Comer stood in front of a local hemp harvest stacked shin-deep for hundreds of feet in every direction, a tangled mass of bushy branches that looked more like evergreen trimmings than marijuana buds. Little yellow butterflies flitted across the surface of the crop that filled the once-vacant warehouse with the comforting smell of damp grass clippings.

It was the middle of October, and aromatic plants represented the first harvest for Vertical, a California company that has already become a serious contender in the rapidly expanding legal cannabis industry. Comer, who just won reelection to Congress with 69 percent of the vote, has promoted hemp, the non-psychoactive sister plant to marijuana, as a jobs-creating crop to replace the state’s vanished tobacco industry. Hemp grown for CBD, a medicinal oil used for complaints from arthritis to epilepsy, fetches as much as $8,000 per acre, compared with less than $600 for the same amount of corn. This processing facility, Comer said, will create 125 jobs when Vertical has it fully operational, a not insignificant boost in a town of 2,600 people.

Vertical’s future, as well as the state’s infant hemp industry as a whole, rests in large part with the passage of the vast farm bill that Congress is expected to finish in the lame-duck session. Thanks to Senate Majority Leader Mitch McConnell, the bill includes an amendment that would permanently remove hemp from the list of federally banned drugs like heroin and cocaine, freeing hemp from the crippling legal stigma that has made it economically unviable for the past four decades. But that amendment also includes a little-noticed ban on people convicted of drug felonies from participating in the soon-to-be-federally-legal hemp industry.

Added late in the process, apparently to placate a stakeholder close to McConnell, the exception has angered a broad and bipartisan coalition of lawmakers, hemp industry insiders and religious groups who see it as a continuing punishment of minorities who were targeted disproportionately during the war on drugs and now are being denied the chance to profit economically from a product that promises to make millions of dollars for mostly white investors on Wall Street.

Legalization has made steady progress at the state level since California first approved medical marijuana in 1996. As of election night, 33 states now allow medical marijuana, and 10 states plus the District of Columbia allow fully recreational use. But at the federal level, a sizable headwind remains. Former Attorney General Jeff Sessions had vowed to enforce all federal drug laws; the position of his acting replacement, Matthew Whitaker, remains a mystery. And lawmakers like McConnell, who have discovered the economic benefits of relaxing prohibitions on products such as hemp, have nevertheless quietly found ways, like the farm bill felon ban, to satisfy the demands of their anti-legalization constituents, to the chagrin of pro-cannabis lawmakers and activists. After POLITICO Magazine reported on the drug-crime felon ban in August, three senators—Cory Booker (D-N.J.), Rand Paul (R-Ky.) and Jeff Merkley (D-Ore.)—wrote to Senate leadership demanding the removal of the ban, citing its “disparate impact on minorities,” among other concerns.

“I think there’s a growing recognition of the hypocrisy and unfairness of our nation’s drug laws, when hundreds of thousands of Americans are behind bars for something that is now legal in nine states and something that two of the last three Presidents have admitted to doing,” Booker told POLITICO Magazine. “If we truly want to be a just and fair nation, marijuana legalization must be accompanied by record expungement and a focus on restorative justice.”

The fairness problems inherent in the felon ban are evident even in a predominantly white community like Cadiz. Vertical’s CEO is himself a felon. Todd Kaplan pleaded guilty in 2010 to tax evasion, but because his crime was not drug-related, he won’t be barred from participating in the hemp business. But for many men in rural Kentucky, where illegal marijuana was a staple crop, the lifetime ban included in the proposed farm bill means they’re shut out of a growing industry in which they have have actual job skills.

“If you exclude him, you put him in that category where he might want to rob a bank or a Walmart. If you ban him from the one thing he knows, what’s left for him to do now?” a Kentucky felon and licensed hemp grower told POLITICO Magazine on condition of anonymity. “The thing is, when Mitch McConnell put that felon ban in, he didn’t follow Kentucky law that caps our ban at 10 years. It should be why a felon should grow this crop, not why he shouldn’t. … If I was busted for moonshining, would it be illegal under the farm bill for me to grow corn?”

When I asked Comer about the felon ban at the ribbon-cutting for Vertical’s hemp-processing plant in Cadiz, he said it was not something he endorsed. “I would not have added the language preventing anyone with a prior minor drug-felony conviction from being able to produce hemp. I support the basis for criminal justice reform as it pertains to the sheer quantity of senseless petty drug sentences.”

Comer, who approves of the House’s plan to force work requirements on recipients of the food stamps program known as SNAP, said he understands a primary reason able-bodied adults aren’t participating in the workforce is because of their criminal records. “I’m sure the language was added to appease certain senators,” Comer told me. “But it really goes against the direction our country is headed with respect to criminal justice reform related to minor drug offenses.”

But when I asked whether he will vote for the farm bill in spite of the felon ban he professes to dislike, Comer didn’t hesitate. “Yes.”

***

Even Kaplan, Vertical’s chief executive, agrees the felon ban doesn’t make sense. Ten years ago, Kaplan was a CEO of a health care company in the sleep apnea field. A federal prosecutor charged him with 137 counts of Medicare fraud, of which all but one count were later dropped. In 2010, Kaplan pleaded guilty to tax evasion and paid a $100 fine, according to court documents posted to his personal website. I asked him what he thought of the drug-crime felon ban in the farm bill.

“I live out here in California, and L.A. is doing something called a ‘social equity program,’ where if you were convicted of a drug crime, they’re putting you at the top of the list for licensing—and that’s for THC,” Kaplan told me by phone.

This once-radical notion that felons ought to gain priority for entry into a newly legal industry—instead of being shut out—has quietly gained bipartisan support on Capitol Hill, albeit not among Republican leadership.

In the House, this mounting opposition to the continuing punishment of felons first cropped up in September, when the Judiciary Committee passed its first pro-marijuana bill. It would expand access to scientific study of the cannabis plant, a notion agreed upon by marijuana’s supporters and detractors alike. However, Democrats almost killed the bill because it included language that barred felons (and even people convicted of misdemeanors) from receiving licenses to produce the marijuana. Felon bans are commonplace in legal marijuana programs. Every state has some version of it, but most of them have a five- or 10-year limit. But the felon bans in both the Senate’s farm bill and the House’s marijuana research bill are lifetime bans, and the House bill includes misdemeanors, too.

“Any restriction on misdemeanors goes in the exact contrary direction of the Second Chance Act,” said Rep. Jerry Nadler (D-N.Y.), who will become chairman of the Judiciary Committee in January. His criticism was echoed by Steve Cohen (D-Tenn.), who sought to have the misdemeanor language struck from the bill until its sponsor, Matt Gaetz (R-Fla.), promised to address that language when it comes to the House floor.

In the Senate, the movement to protect the legal marijuana trade has taken the form of the proposed bipartisan Gardner-Warren STATES Act, which would maintain the status quo of federal non-interference in state-legal programs that was upended when then-Attorney General Jeff Sessions repealed the Cole Memo, an Obama-era document that outlined a hands-off approach to state-legal programs. Booker’s Marijuana Justice Act would adopt California-style principles and apply them federally, going far beyond the STATES Act, removing marijuana from Schedule I (defined as having no medical value and a high risk of abuse) and eliminating criminal penalties for marijuana. But unlike other pro-marijuana bills, it would also deny federal law-enforcement grants to states that don’t legalize marijuana; direct federal courts to expunge marijuana convictions; and establish a grant-making fund through the Department of Housing and Urban Development for communities most affected by the war on drugs.

Booker’s bill has become popular among Senate Democrats. . .

Continue reading. There’s more.

Written by LeisureGuy

23 November 2018 at 9:36 am

The making of an opioid epidemic

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Chris McGreal reports in the Guardian:

Jane Ballantyne was, at one time, a true believer. The British-born doctor, who trained as an anaesthetist on the NHS before her appointment to head the pain department at Harvard and its associated hospital, drank up the promise of opioid painkillers – drugs such as morphine and methadone – in the late 1990s. Ballantyne listened to the evangelists among her colleagues who painted the drugs as magic bullets against the scourge of chronic pain blighting millions of American lives. Doctors such as Russell Portenoy at the Memorial Sloan Kettering Cancer Center in New York saw how effective morphine was in easing the pain of dying cancer patients thanks to the hospice movement that came out of the UK in the 1970s.

Why, the new thinking went, could the same opioids not be made to work for people grappling with the physical and mental toll of debilitating pain from arthritis, wrecked knees and bodies worn out by physically demanding jobs? As Portenoy saw it, opiates were effective painkillers through most of recorded history and it was only outdated fears about addiction that prevented the drugs still playing that role.

Opioids were languishing from the legacy of an earlier epidemic that prompted President Theodore Roosevelt to appoint the US’s first opium commissioner, Dr Hamilton Wright, in 1908. Portenoy wanted to liberate them from this taint. Wright described Americans as “the greatest drug fiends in the world”, and opium and morphine as a “national curse”. After that the medical profession treated opioid pain relief with what Portenoy and his colleagues regarded as unwarranted fear, stigmatising a valuable medicine.

These new evangelists painted a picture of a nation awash in chronic pain that could be relieved if only the medical profession would overcome its prejudices. They constructed a web of claims they said were rooted in science to back their case, including an assertion that the risk of addiction from narcotic painkillers was “less than 1%” and that dosages could be increased without limit until the pain was overcome. But the evidence was, at best, thin and in time would not stand up to detailed scrutiny. One theory, promoted by Dr David Haddox, was that patients genuinely experiencing pain could not become addicted to opioids because the pain neutralised the euphoria caused by the narcotic. He said that what looked to prescribing doctors like a patient hooked on the drug was “pseudo-addiction”.

Portenoy toured the country, describing opioids as a gift from nature and promoting access to narcotics as a moral argument. Being pain-free was a human right, he said. In 1993, he told the New York Times of a “growing literature showing that these drugs can be used for a long time, with few side-effects, and that addiction and abuse are not a problem”.

Long after the epidemic took hold, and the death toll rose into the hundreds of thousands in the US, Portenoy admitted that there was little basis for this claim and that he had been more interested in changing attitudes to opioids among doctors than in scientific rigour.

“In essence, this was education to destigmatise and because the primary goal was to destigmatise, we often left evidence behind,” he admitted years later as the scale of the epidemic unfolded.

Likewise, Haddox’s theory of pseudo-addiction was based on the study of a single cancer patient. At the time, though, the new thinking was a liberation for primary care doctors frustrated at the limited help they could offer patients begging to get a few hours’ sleep. Ballantyne was as enthusiastic as anyone and began teaching the gospel of pain relief at Harvard, and embracing opioids to treat her patients.

“Our message was a message of hope,” she said. “We were teaching that we shouldn’t withhold opiates from people suffering from chronic pain and that the risks of addiction were pretty low because that was the teaching we’d received.”

But then Ballantyne began to see signs in her patients that experience wasn’t matching theory. Doctors were told they could repeatedly ratchet up the dosage of narcotics and switch to a new and powerful drug, OxyContin, without endangering the patient, because the pain, in effect, cancelled out the risk of addiction. To her dismay, Ballantyne saw that many of her patients were not better off when taking the drugs and were showing signs of dependence.

Among those patients on high doses over months and years, Ballantyne heard from one after another that the more drugs they took, the worse their pain became. But if they tried to stop or cut back on the pills, their pain also worsened. They were trapped.

“You had never seen people in such agony as these people on high doses of opiates,” she told me. “And we thought it’s not just because of the underlying pain; it’s to do with the medication.”

As Ballantyne listened to relatives of her patients talk about how much the drugs had changed their loved ones, her misgivings grew. Husbands spoke of wives as if a part of them were lost. Mothers complained that children had become sullen and distant, their judgment gone, their personality warped, their character altered. None of this should have been happening. Pain relief was supposed to free the patients, not imprison them. It was all very far from the promise of a magic bullet.


As the evidence that opioids were not delivering as promised piled up, the Harvard specialist began to record her findings. By then, though, there were other powerful forces with a big financial stake in the wider prescribing of painkilling drugs. Pharmaceutical companies are not slow to spot an opportunity and the push for wider prescribing of opioids had not gone unnoticed by the drug-makers, including the manufacturer of OxyContin, Purdue Pharma, which rapidly came to play a central role in the epidemic.

As the influence of the opioid evangelists grew, and restraints on prescribing loosened, the pharmaceutical industry moved to the fore with a push to make opioids the default treatment for pain, and to take advantage of the huge profits to be made from mass prescribing of a drug that was cheap to produce.

The American Pain Society, a body partially funded by pharmaceutical companies, was pushing the concept of pain as the “fifth vital sign”, alongside other measures of health such as heart rate and blood pressure. “Vital signs are taken seriously,” said its president, James Campbell, in a 1996 speech to the society. “If pain were assessed with the same zeal as other vital signs are, it would have a much better chance of being treated properly. We need to train doctors and nurses to treat pain as a vital sign.”

The APS wanted the practice of checking pain as a vital sign as a matter of routine adopted in American hospitals. The key was to win over the Joint Commission for Accreditation of Healthcare Organizations, which certifies about 20,000 hospitals and clinics in the US. Its stamp of approval is the gateway for medical facilities to tap into the huge pot of federal money paying for healthcare for older, disabled and poor people. Hospitals are careful not to get on the wrong side of the joint commission’s “best practices” or to fail its regular performance reviews.

In response to what it called “the national outcry about the widespread problem of under-treatment” – an outcry in good part generated by drug manufacturers – the commission issued new standards for pain care in 2001. Hospital administrators picked over the document to ensure they understood exactly what was required.

Every patient was to be asked about their pain levels, no matter what the reason they were seeing a doctor. Hospitals adopted a system of colour-coded smiley faces, to represent a rising scale of pain from 0-10. The commission ruled that anybody identifying as a five – a yellow neutral face described as “very distressing” – or above was to be was to be referred for a pain consultation.

The commission told hospitals they would be expected to meet the new standards for pain management at their next accreditation survey. Purdue Pharma was ready. The company offered to distribute materials to educate doctors in pain management for free. This amounted to exclusive rights to indoctrinate medical staff. A training video asserted that there is “no evidence that addiction is a significant issue when persons are given opioids for pain control”, and claimed that some clinicians had “inaccurate and exaggerated concerns about addiction, tolerance and risk of death”. Neither claim was true.

Some doctors questioned the value of patient self-assessment, but the commission’s regulations soon came to be viewed as a rigid standard. In time, pain as the fifth vital sign worked its way into hospital culture. New generations of nurses, steeped in the opioid orthodoxy, sometimes came to see pain as more important than other health indicators.

Dr Roger Chou, a pain specialist at Oregon Health and Science University who has made long-term studies of the effectiveness of opioid painkillers and helped shape the Centers for Disease Control and Prevention’s policy on the epidemic, said the focus on pain caused patients to give it greater weight than made sense.

“When you start asking people: ‘How much pain are you having?’ every time they come into the hospital, then people start thinking: ‘Well, maybe I shouldn’t be having this little ache I’ve been having. Maybe there’s something wrong.’ You’re medicalising what’s a normal part of life,” he said.

One consequence was that people with relatively minor pain were increasingly directed toward medicinal treatment while consideration of safer or more effective alternatives, such as physiotherapy, were marginalised. Another, said Chou, was the increased expectation that pain can be eliminated. Chasing the lowest score on the pain chart often came at the expense of quality of life as opioid doses increased. “It’s better to have a little bit of pain and be functional than to have no pain and be completely unfunctional,” said Chou.

Health insurance companies piled yet more pressure on doctors to follow the path of least resistance. This meant cutting consultation times and payments for more costly forms of pain treatment in favour of the direct approach: drugs. . .

Continue reading. There’s much more.

Written by LeisureGuy

10 November 2018 at 10:50 am

A Narcotics Officer Ends His War on Drugs: “I now think the whole drug war is total bullshit.”

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Jeremy Raff reports in the Atlantic:

Kevin Simmers relished locking up drug users, no matter how little crack they had on them. “If they just had a pipe—fine,” he said. “At the end of the night, I wanted to have an arrest. I wanted a body.”

Decades later, despite his efforts, the opioid epidemic was in full swing in Hagerstown, “a small town with big-city problems” an hour outside Baltimore. In 2013, Simmers received an unusual phone call from his 18-year-old daughter, Brooke, who was typically defensive of her independence: “I need your help, Dad.” Simmers braced himself and met her for breakfast at a Waffle House near the so-called heroin highway, an intersection of interstates that connects major drug markets up and down the East Coast. Brooke told Simmers that she was addicted to opioid pain pills and didn’t know how to stop. Familiar with their street price, Simmers asked how Brooke, with no obvious income, could afford the expensive pills. “She told me she was selling her body,” he recalled.

Simmers sprung into action, and over the next year he helped Brooke into a half-dozen rehabs, but none seemed to work. Eventually, out of options and fearing a fatal overdose, Simmers used his police connections to jail his own daughter. But the disaster that followed made him reconsider not just his decision to lock up Brooke, but also his role as a willing combatant in the decades-long War on Drugs.

“I now think the whole drug war is total bullshit,” he said.

Drugs are menacing our society,” intoned President Ronald Reagan in a 1986 televised address. “They’re killing our children.” Fresh out of the Air Force, Kevin Simmers was driving a milk truck. Reagan was “an inspiring speaker,” Simmer said, so he decided to apply to become a Hagerstown police officer.

Tall, opinionated, irreverent, and fiercely competitive, Simmers was “larger than life,” said Nick Varner, a Hagerstown police detective who trained under him. His policing philosophy was simple, Varner said: “Lock up the problem.” Sergeant Simmers liked contests: Whoever brings in the most arrests tonight gets free dinner.

In Clear Spring, Maryland, a Hagerstown suburb and a real-life Norman Rockwell painting, Varner shot hoops with Simmers and Brooke. A gifted athlete, “she wiped the floor with both of us,” Varner recalled. Brooke had no problem swimming the formidable Potomac River clear to its West Virginia bank. “Kevin was very strong willed,” Varner said, and “she was a lot like him.” Varner remembered how Brooke once walked into the church where he was a pastor and said, “Do you really think that Jesus could walk on water?”

“If there was a tenth gear, she was in it,” said Brooke’s mother, Angie von Gersdorff. “She needed that extra adrenaline rush.” Von Gersdorff and Simmers split up when Brooke was a baby. Within a few years, they both remarried. Von Gersdorff said Brooke’s antics overlaid a darker struggle already underway. “She began to fester in puberty,” she said.

Brooke was given to angry outbursts that worsened as high school began. Finally, in a heated argument, she punched her stepmother, Dana Simmers, in the face—hard, leaving bruises. The Simmers and von Gersdorff got together to decide what to do. “She’s going to have to learn a lesson. We’re going to report it,” von Gersdorff remembers the group deciding. “Tough love.” They called the police and Brooke landed in juvenile detention. But von Gersdorff now regrets feeding her daughter to the justice system at such a young age. “I really thought that it was going to help, but it did not. It did the complete and utter opposite,” von Gersdorff told me. “It’s a huge guilt that makes me so angry. I can’t hit something hard enough to get any relief.” In the years after juvenile detention, Brooke starting hanging out with a rougher crowd and eventually got hooked on pills.

After she told Simmers about her addiction, the unsuccessful rehab attempts grinded the family’s patience and finances. Simmers said waiting lists often stymied their attempts to get help—by the time a spot opened up, Brooke was out on the street again. Then, when she was accepted, she did not receive medication-assisted treatment, which much of the medical literature describes as the gold standard of care. Such treatment combines therapy with low-dose opioids like buprenorphine to help control cravings, but it is still often stigmatized as a way of replacing one addiction with another. Brooke’s rehabs embraced a strict prohibition on medication of any kind—one even kicked her out when staff discovered ibuprofen in her luggage. Abstinence-based drug treatment is astonishingly ineffective but deeply entrenched in the United States. Leading public-health organizations including the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, and the World Health Organization all recommend medication-assisted treatment, but only about 12 percent of people with a substance-use disorder receive specialty treatment.

After another relapse, Brooke was living in a Motel 6 next to the highway. Afraid for her life, the family turned to the institution they knew best: law enforcement. Simmers called friends in the Hagerstown police who had previously turned a blind eye to Brooke’s drug use—“professional courtesy,” Simmers called it— and asked them to throw the book at her. She was arrested and sentenced to four months in jail.

Brooke arrived at the Washington County Detention Center with some fanfare. “It was like fresh meat,” said Amanda West, her cell mate. “You could just hear whispers down the hallway, ‘It’s Brooke Simmers, it’s Brooke Simmers, it’s Brooke Simmers!’” Having arrested some of the inmates himself, Sergeant Simmers was well known inside the detention center. . .

Continue reading.

Later in the article:

“Twenty years ago, most people thought arrest and incarceration were the answer to this drug war,” he said. “I think most people were wrong—I think I was wrong.” Now Simmers says he’d rather see the roughly $47,000 a year it takes to jail drug offenders spent on jobs programs instead. He’d like to see 24-hour, on-demand treatment available to anyone who wants it—no waiting lists. The former narcotics officer is even open to the idea of decriminalizing heroin.

Simmers also now detects a racial injustice in the harsh punishment he once meted out. His own crack-era targets mostly went unnoticed, but the details of Brooke’s life and death were covered heavily in the local media and elicited a wave of sympathy from police officers and elected officials. “This problem was happening in the African American community for years and we did nothing about it,” Simmers said. But Brooke was “a pretty white girl who lives in the suburbs, lives in middle-class America. I think that could be why people were more attracted to the story.”

Written by LeisureGuy

10 November 2018 at 7:50 am

Can pot save the pumpkin farm?

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Damian Paletta reports in the Washington Post:

John Muller steered his tractor left onto Main Street, four Atlantic Giant pumpkins in tow, and thousands of people at the pumpkin parade screamed with delight.

But there were many others, spread throughout the festival that day, who feared the famous farmer had led the city down an uncertain path, demanding changes that couldn’t be undone and attempting to enrich himself in the process.

They are determined to stop “Farmer John,” even if it means putting him — and his pumpkin patch — out of business.

On Nov. 6, residents of this small, coastal city will vote on whether Muller, 72, can use a section of his 21-acre farm to grow thousands of young marijuana plants.

Muller and his wife, Eda, said they need this revenue to save their property, Daylight Farms. If voters don’t approve Measure GG, the Mullers could be forced to sell everything before next year’s harvest.

“If that doesn’t pass, there won’t be a pumpkin farm,” Eda Muller told critics at a recent city council meeting, muttering under her breath, “Put that in your pipe and smoke it.”

U.S. farmers last year harvested 2 billion pounds of pumpkins, many of which were later carved into spooky or silly faces for Halloween. The economics behind these Jack-o’-lanterns can be as messy as their gunky guts, though, with everything hanging on six weeks of sales. But these and other iconic American holiday symbols exist in an often overlooked economy with hidden pressures and pain.

For California farmers — many struggling like the Mullers — the state’s legalization of marijuana has offered the prospect of raising a lucrative crop that could keep them on their land. They must first win the approval of their communities, and the debate dividing Half Moon Bay has also paralyzed other parts of the state.

Local governments, particularly in remote rural areas, are deciding whether cannabis should be treated like any other crop or banned, out of concern that it could lead to crime and other unwanted social change. Calaveras County, for instance, allowed the cultivation of cannabis, collecting millions of dollars of taxes, only to backtrack. Now growers are suing.

Here in Half Moon Bay, 130 miles west, John Muller’s plans are straining the entire city, pitting neighbor against neighbor, past against future. The choice is about more than farming and economics, reaching into the community’s sense of values. Voters must decide whether to welcome commercial cannabis inside their community and help the farm or stand firm against marijuana and possibly smash the Mullers’ pumpkin business.

In a city that calls itself the World Pumpkin Capital, losing the Mullers’ pumpkins could be a devastating turn of events. Their iconic roadside plot draws wealthy visitors from San Francisco and Silicon Valley for more than a month each autumn.

And the Mullers are the only local farmers who have shown the ability to raise Atlantic Giants, pumpkins that can gain 40 pounds each day and grow to the size of small cars. These orange boulders give the city a connection to its agricultural past, something many residents are scrambling to protect.

Some competitors have boosted revenue by adding haunted houses, hayrides, and corn mazes to their farms, but the Mullers have eschewed such agritourism, describing themselves as purists.

Giant-pumpkin farmers, though, are known for being secretive and wily, and many residents don’t trust the Mullers’ motives despite their increasingly desperate pleas.

Opening Half Moon Bay to commercial cannabis could change the city forever, they worry, normalizing pot for teenagers, luring outside investors with nefarious motives, and drawing federal scrutiny upon farm laborers, many of whom are undocumented Mexican workers.

“To say there are no other crops that a farmer could grow in Half Moon Bay is ridiculous,” said Virginia Turezyn, who works at a business advisory firm and is running for city council on the same ballot as Measure GG. “They could grow Brussels sprouts. They can grow other stuff. . . . Everybody thinks [cannabis] is a cure-all and a panacea, but I’ve read tons of research that highlights tons of negative implications for the community, for crime, for youth and for the stench.”

Eda’s father, Al Adreveno, purchased Daylight Farms in the 1950s, growing flowers for buyers in San Francisco, just 30 miles away. He built glass greenhouses to protect some of the plants, a decision that is central to November’s vote.

His daughter Eda married John, a Vietnam War veteran, in 1969, and they went to work in the family flower business. Adreveno served three terms on the city council and four years as mayor.

During one of those stints, Adreveno challenged the leaders of another pumpkin town, Circleville, Ohio, to a weigh-off. The California community put up the biggest plant, and it has proclaimed its pumpkin dominance ever since.

The family’s flower business relied on the San Francisco market, and they lost roughly 25 percent of their customers by the mid-1990s because of the AIDS crisis. California flower growers were also becoming crowded out by foreign competition.

In the late 1990s, the Mullers pivoted to pumpkins as a way to save their farm. This quickly made them local legends, in part because the Mullers moved in when others were moving out.

In 2008, San Mateo County growers raised pumpkins on 263 acres. By 2017, pumpkins grew on just 167 acres. There were fewer pumpkin farms but still plenty of buyers, particularly each October during Half Moon Bay’s Art & Pumpkin Festival, a two-day celebration that can draw 200,000 people, clog roads for miles and raise millions of dollars for nonprofit groups and vendors.

Pumpkins, which local farmers call “punkins,” are difficult to grow profitably on a small farm. They must be farmed on different plots every two to three years, or they can become diseased. Seeds are planted after Mother’s Day in May, and harvest comes four or five months later. Buyers typically want pumpkins only during a six-week stretch, leading up to Halloween. That puts enormous pressure on growers to cash in during a small window.

The Mullers grow 60 varieties of pumpkins, gourds and squash, including Cinderellas, Fairytales and Tonda Padanas. They plant 80,000 seeds each spring, and each seed can produce up to four pumpkins. Harvest takes one month, and then the pumpkins are sold at a plot called Farmer John’s Pumpkins on the Pacific Coast Highway, where visitors can see the ocean peeking across a crest of trees.

Muller has always been more than just a farmer, though. In 2008, he served his first of two terms as mayor, helping steer the beleaguered city away from bankruptcy. He also served in other local government posts and advised the U.S. Agriculture Department during the Reagan administration.

At his pumpkin patch, he’s a dusty blur, working as greeter, cashier, wheelbarrow pusher and parking director. He’s five-and-a-half feet tall and wears a deep tan on his face from farm work.

On a recent Friday, he was constantly in motion, sporting torn green coveralls and a sweat-stained hat, hugging visitors and pulling wagons and directing people to a tepee past the hay bales.

He looked at times joyful and at times exhausted, saying he had been up at 4 a.m. discussing the farm’s future with Eda. The Mullers still care for Adreveno, now 95, and his wife, who is 90.

“The family estate is dwindling — we’ll have to make some very, very life-altering decisions,” he said. “We worked hard all our lives, but our little bodies are slowing down a bit.”

A lifelong Republican, John Muller voted against the statewide measure in 2016 that legalized the recreational use of marijuana by adults. He was an outlier in Half Moon Bay, where 69 percent of voters backed it.

Shortly after that vote, Muller was approached by Eric Hollister, a chef and acquaintance from the local farmers market. Hollister wanted to refurbish the Mullers’ dilapidated greenhouses, grow cannabis “starts” — young, non-flowered plants — and market the products to individual consumers and other commercial growers.

The Mullers were strapped for cash. Health care for Eda’s mother was nearing $10,000 a month. Hollister said he planned to pay the Mullers nearly $1 million a year in rental fees and spend around $3 million rehabbing the greenhouses, which they would still own. Hollister said he could sell between 100,000 and 150,000 plants a month, grown in 65,000 square feet of greenhouse space. Each plant would fetch between $5 and $10, perhaps more.

Because the plants would be “starts,” they wouldn’t have an intense odor and could not be immediately used as recreational marijuana. For struggling pumpkin farmers, Hollister’s offer made it appear their financial rescue was imminent. And it nearly was. . .

Continue reading.

Written by LeisureGuy

30 October 2018 at 8:41 pm

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