Drugs, war inextricably tied, Watson panel says
Professor Peter Andreas explains how, through war, six drugs gained popularity

By AANCHAL SHETH STAFF WRITER Friday, January 31, 2020

LEON JIANG / HERALD

A panel at the Watson Institute discussed Professor Peter Andreas’ book, “Killer High: A History of War in Six Drugs,” and the five dimensions of war and drugs, such as “war while on drugs.”

Six drugs — cocaine, tobacco, opium, amphetamines, alcohol and caffeine. In “Killer High: A History of War in Six Drugs,” Peter Andreas, professor of international studies and political science and professor of international and public affairs, details how these six drugs have sparked, fueled and been popularized by war for hundreds of years.

Andreas spoke on his recently launched book at the Watson Institute of International and Public Affairs Thursday. “War made drugs and drugs made war,” Andreas told The Herald.

Andreas explored the relationship between drugs and war through a“five-dimensional approach,” he said. The first dimension explores “war while on drugs,” which includes the use of drugs during wartime to cope with stressful situations and celebrate victories, Andreas said. The second consists of “war through drugs,” entailing the use of drugs as a weapon of war. Another example is funding wars through alcohol, tobacco, cocaine and opium revenue. The third dimension deals with “war for drugs,” which addresses conflict motivated by desire for access to or control of drug markets. The fourth dimension, “war against drugs,” uses military and strategic resources to fight drugs, an approach that began with President Nixon declaring war on drugs in 1971.
The final dimension is “drugs after war,” which covers the change in consumer outcomes and preferences because of war. Andreas questioned why the United States is a coffee-drinking nation rather than a tea-drinking one. “Because we won the American Revolution, when the Brits went on to tea, we went on to coffee. … The very taste that we take for granted is actually the result of war,” Andreas explained during the discussion. Panelist C.J. Chivers, a writer for the New York Times and combat veteran, also spoke to this aspect of Andreas’ research, noting that prescribed drugs are deeply concerning for veterans after war, who receive limited or no counseling on the proper use of pharmaceuticals.

Andreas began his research for “Killer High” seven years ago. When he initially began writing, Andreas had a “bias towards thinking it’s about cocaine and heroin.” But Andreas was surprised by the importance of legal drugs. “It was pretty eye-opening to discover how important caffeine and alcohol and tobacco have been historically,” he added. Andreas also said that the word “coffee” was mentioned more times in soldiers’ diaries than the words “gun,” “cannon” or “rifle.” Despite Andreas’ research on the harm drugs have caused, he has an addiction of his own. “Caffeine is my drug of choice.”

Andreas wanted to find the “sweet spot” between writing good scholarship and accessible reading material for non-specialists. Panelist Angelica Duran-Martinez PhD’13, associate professor of political science at University of Massachusetts Lowell, said that the topics were presented so accessibly that she has assigned this book as a reading for her students. Chivers also held up his copy of Andreas’ book, which had handwritten notes scrawled over the pages. “When I get to the end of the book and I’ve used up two ink pens, it’s probably a sign that it’s a hell of a book,” he said.

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FOR PROFIT MEDICINE USA

Groups make own drugs to fight high drug prices, shortages

By LINDA A. JOHNSON

August 10, 2021

1 of 5

This 2019 photo provided by Civica Rx shows vials of vancomycin in Lehi, Utah. Impatient with years of inaction in Washington on prescription drug costs, U.S. hospital groups, startups and nonprofits have started making their own medicines in a bid to combat stubbornly high prices and persistent shortages of drugs with little competition. (Civica Rx via AP)

Impatient with years of inaction in Washington on prescription drug costs, U.S. hospital groups, startups and nonprofits have started making their own medicines in a bid to combat stubbornly high prices and persistent shortages of drugs with little competition.

The efforts are at varying stages, but some have already made and shipped millions of doses. Nearly half of U.S. hospitals have gotten some drugs from the projects and more medicines should be in retail pharmacies within the next year as the work accelerates.

Most groups are working on generics, while at least one is trying to develop brand-name drugs. All aim to sell their drugs at prices well below what competitors charge.

“These companies are addressing different parts of the problem and trying to come up with novel solutions” to produce cheaper medicines, said Stacie Dusetzina, a Vanderbilt University health policy professor. “People should be able to access the drugs that work for them without going broke.”

While some of the projects are solving supply problems and reducing medication costs for hospitals, drug price experts are split on how much consumers will benefit.

Dusetzina said the efforts could bring needed price competition, at least for some drugs.

Dr. Aaron Kesselheim, a Harvard Medical School researcher and price expert at Brigham & Women’s Hospital in Boston, thinks for some drugs these projects “can lower patients’ out-of-pocket costs ... absolutely.”

But David Mitchell, founder of the independent consumer group Patients for Affordable Drugs, said the projects are workarounds that help in niches, but are “not enough to fix a broken system.”

Civica Rx was started three years ago by a hospital consortium. It now provides over 50 generic injectable medicines in chronic shortage to more than 1,400 hospital members and the Veterans Affairs and Defense departments. It already has sold enough medication to treat 17 million people, including many hospitalized with COVID-19.

Now it’s expanding to help patients directly, said chief executive Martin VanTrieste. Its new partnership with Anthem and Blue Cross health plans, CivicaScript, is picking six or seven expensive generic drugs to start. It will have contract manufacturer Catalent start producing those drugs to sell at 50,000 retail pharmacies starting in 2023.

Other “alternative drugmakers” include:

—Two enterprises, from Premier Inc. and Phlow Corp., focused on providing their hospital members with affordably priced generics that are chronically scarce.

— NP2, which is about to start producing cheaper generic IV cancer medicines.

— EQRx, which is creating brand-name drugs for cancer and inflammatory disorders to sell at “radically lower prices” than rival brands.

Walmart recently added insulin to its in-house brand of products for people with diabetes. It’s selling its own version of the mealtime insulin NovoLog, in partnership with manufacturer Novo Nordisk, for less than half NovoLog’s price.

Even entrepreneur Mark Cuban has jumped in, giving his name and money to a public-benefit company aiming to provide cheap alternatives to high-cost generic drugs at 15% above manufacturing costs, no insurance needed.

In January, Mark Cuban Cost Plus Drug Co. launched its first medication, a pill for parasitic worm infections that it sells through independent pharmacies for about $40 per two-dose treatment, said founder and CEO Dr. Alex Oshmyansky. The company is building a factory in Dallas but paying other manufacturers for now and aims to launch up to 100 more drugs by year’s end.

Vanderbilt’s Dusetzina sees Cuban’s company as best positioned to cut out-of-pocket costs.

“It’s a really nice project to go after products where there’s little competition — and price gouging,” she said.

Brand-name drugs get monopolies lasting up to two decades under U.S. patent law, so most of the alternative drugmakers are targeting certain off-patent medicines whose prices have risen dramatically in recent years.

Generics are usually cheap. But as buyers pushed for barely break-even prices on these drugs over the last couple decades, generic manufacturers consolidated. With fewer factories making certain generics, even temporary plant closures triggered lasting shortages. And the reduced competition led to big price hikes, often forcing doctors to try costlier, less-effective alternatives and hospital pharmacists to spend long hours seeking alternatives for drugs in shortage.

Those years-long shortages spurred Civica’s formation. It also led a top hospital group purchasing organization, Premier Inc., to launch a program that has contractors making more than 60 products for about 850 member hospitals, said its chief pharmacy officer, Jessica Daley. The two groups say they’ve gotten numerous drugs off national shortage lists.

Phlow Corp., a public benefit drug manufacturer largely funded by government grants, partnered in March with 11 top children’s hospitals to address shortages by making generic medicines in child-size doses for cancer and other life-threatening conditions. Phlow and Civica are building neighboring factories in Petersburg, Virginia.

Such efforts have been helping hospitals stock crucial drugs — sedatives, painkillers, antibiotics and respiratory medicines — needed for COVID-19 patients.

The alternative drugmakers are hiring U.S. contract manufacturers whenever possible and getting drug ingredients here or in Europe, to diversify supply chains heavily reliant on China and India, which limited exports of drugs and ingredients early in the pandemic. The Biden administration also is working to increase domestic production of essential generic drugs.

Harvard’s Kesselheim foresees the new generic manufacturers helping to boost supply and lower prices, but he thinks developing new brand-name drugs — as EQRx is trying to do — is tougher.

EQRx is currently testing 10 novel drugs that it licensed the rights to, for cancers and immunologic disorders like rheumatoid arthritis. One already in final-stage testing could launch within three years.

The company expects to start work on another 10 patented drugs in ultra-expensive categories in the next year and is collaborating with Exscientia, a firm that uses artificial intelligence to design drugs and speed up testing.

Insurers are among EQRx’s early investors, said the company’s president, Melanie Nallicheri. They expect the company to turn a profit, but they also support plans to price medicines at up to two-thirds off rival brand-name drugs, she said.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

BC 

Decriminalization: How police drug seizure, even without arrest, can create harms

Story by Kanna Hayashi,

 Research Scientist at the British Columbia Centre on Substance Use & St. Paul's Hospital Chair in Substance Use Research and Associate Professor, Faculty of Health Sciences, Simon Fraser University • THE CONVERSATION

International Overdose Awareness Day, an annual campaign to end overdose and drug poisonings while also remembering those who have died, is Aug. 31. Events are being held in communities across Canada, a sign of a worsening crisis that has taken more than 36,000 lives since 2016.

The day also represents an opportunity to discuss much-needed policy changes. The decriminalization of people who use drugs has long been one of the proposed solutions, an approach that is currently being piloted in British Columbia.

On Jan. 31, 2023, B.C. began a first-in-Canada pilot “decriminalization” policy, in which criminal sanctions for the possession of small amounts of certain illegal drugs for personal use were removed for adults aged 18 or above.

Seven months into this experiment, the impact of this policy remains unclear. Because a dashboard of policy impact indicator data has not yet been published at the time of writing, it is difficult to weigh the initial effects of the policy.

However, in the city of Vancouver, a policy of depenalization (also referred to as de facto decriminalization) has been in place since 2006, providing an opportunity to understand how the provincial pilot may be working — or even improved.
Depenalization in Vancouver

Seventeen years ago, the Vancouver Police Department (VPD) launched its drug policy to promote the depenalization of simple possession offences. Under this policy, VPD officers were encouraged to not arrest or charge people for simple drug possession for personal use except for certain circumstances.

The VPD’s policy differed from B.C.’s pilot decriminalization in several important ways. For example, the VPD’s policy did not specify the class or threshold quantity of drugs to define simple possession. VPD officers were given broad enforcement discretion with respect to drug possession.

Although publicly available VPD data are limited, available data indeed indicated low and declining numbers of simple possession charges recommended by the VPD to Crown counsel from 2016 to 2019. These numbers have often been cited as the indicator of success of the VPD’s depenalization policy: fewer people are sent to the criminal justice system for the sake of personal drug use.

However, anecdotal reports and previous qualitative research suggested that police officers might not arrest people for simple possession, but they would still seize drugs. Local communities of people who use drugs and public health advocates in Vancouver expressed concern about the harm created by this policing behaviour.

We undertook surveys involving more than 1,800 people who used drugs on a daily basis in Vancouver to investigate this often undocumented discretionary policing practice.

Police drug seizures without arrest

During a 16-month study period in 2019-2021, we found that six per cent of 995 people who used drugs daily in Vancouver (60 per cent residing in the Downtown Eastside neighbourhood that is known for high rates of marginalization and drug use) had had their drugs seized by police without arrest at least once in the past six months. Of those, more than one in four experienced it more than once during the same six-month period.

Of particular concern, 68 per cent of our study participants who had their drugs taken by police without arrest reported having obtained new drugs immediately after the seizure. This portion of the data was collected from the same study population between 2009 and 2012.

Previous qualitative research documented that acquiring drugs this way could put health and safety at risk in multiple ways. For example, it can put people at a higher risk of drug market violence by creating drug debts.

Some users may also be compelled to acquire new drugs in a rush from an unknown supplier, especially when experiencing painful withdrawal. Amid the ongoing drug toxicity crisis, increasing the frequency of buying drugs in the unregulated drug market, especially through an unknown source, increases risk of drug poisoning.

This is contrary to a belief held among some police officers that seizing drugs would prevent harms, including drug poisoning.
The role of police in the toxic drug crisis

A broader question is: Are there any circumstances where police drug seizures are beneficial in preventing drug poisoning? A recent study from the United States highlighted that police efforts to reduce the unregulated drug supply may worsen the drug toxicity crisis by showing a consistent pattern. As police seizures of drugs increased, drug poisoning cases also increased.

Several scholars noted that police drug seizures would not address the toxic drug supply, that the narrow mission of police may exacerbate drug-related harms and that more harm reduction interventions to address the toxic drug supply are needed.

Findings from our study indicate that the VPD’s depenalization policy essentially “mimics the health and safety harms associated with criminalization” and likely undermines overdose prevention efforts.

Under B.C.’s pilot decriminalization policy, police officers can no longer seize drugs from an adult who possesses up to 2.5 grams of certain illegal drugs. However, the threshold quantity of drugs that defined simple possession has been shown to be too low to fulfil the policy objectives. Some people who use drugs, particularly those more marginalized and engaging in high-intensity drug use, may carry more than 2.5 grams of drugs. They may get arrested or experience police drug seizures without arrest.

The annual International Overdose Awareness Day compels us to reckon with ongoing toxic drug deaths and what we can do to reverse this worsening crisis. If decriminalization is going to contribute to positive change, police need to stop seizing drugs from people who use them.

This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts.

Read more:
Safer supply of opioids saves lives: Providing alternatives to toxic street drugs

Supervised consumption sites reduce drug overdoses and disease transmission — and deserve government support

Kanna Hayashi holds the St. Paul's Hospital Chair in Substance Use Research and is supported in part by a U.S. National Institute on Drug Abuse (NIDA) grant (U01DA038886) and the St. Paul’s Foundation. For the research work presented here, she received funding through a NIDA grant (U01DA038886), a Michael Smith Health Research BC Scholar Award and the William and Ada Isabelle Steel Fund through Simon Fraser University. She also receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council to support her ongoing research in this area. She is also affiliated with the Vancouver Coastal Health Authority as research staff and the Division of Social Medicine, Department of Medicine, University of British Columbia as an affiliate assistant professor.

#DECRIMINALIZEDRUGS
Vancouver Council Supports Compassion Club for Heroin, Cocaine and Meth

As six people die every day from overdoses in BC, one group wants to hand out tested, clearly labelled drugs.

Jen St. Denis 8 Oct 2021 | TheTyee.ca
Jen St. Denis is The Tyee’s Downtown Eastside reporter. Find her on Twitter @JenStDen.

Vancouver’s council has backed a proposal that could help the Drug User Liberation Front provide safer drugs like heroin. The organization has already successfully provided tested drugs on three occasions. Photo by Maggie MacPherson.

Vancouver city council voted Thursday to support an attempt to start a compassion club that would provide drug users with untainted heroin, cocaine and methamphetamines in the midst of B.C.’s deadly overdose crisis.

Mayor Kennedy Stewart said he will now advocate for the model when he visits Ottawa Monday and meets with Prime Minister Justin Trudeau, Deputy Prime Minister Chrystia Freeland and Health Canada staff.

Dozens of speakers called in to tell councillors about their experiences responding to hundreds of overdoses, often getting there too late and finding their lifeless bodies, and of losing friends who had themselves saved others from overdoses before succumbing to tainted drugs.

The motion, brought forward by COPE Coun. Jean Swanson, asked the mayor and councillors to support a request for exemption from Canada’s Controlled Drugs and Substances Act that would let the compassion club procure drugs.

Vancouver Coastal Health also supports the application and will help implement the compassion club model if the exemption is granted.

The Tyee is supported by readers like you Join us and grow independent media in Canada

A group called the Drug User Liberation Front has applied for the exemption after running on three events in the Downtown Eastside where organizers handed out packages of tested and labelled heroin, cocaine and methamphetamine, with no overdoses recorded.

But with no legal, regulated supply of those drugs available in Canada, DULF organizers have had to buy the drugs for each of those events from the dark web.

That was a concern for some councillors, who said they could not support a program that would buy drugs from an unknown source, potentially funding organized crime groups or terrorists.

“It would be disingenuous or naive to suggest that the dark web is not a vehicle for organized crime and people who perpetuate violence on other people, so what it amounts to is: should we endorse that particular model?” said Green Coun. Pete Fry.

“It’s endorsing a harm reduction for some, but (is harm) being perpetuated for others… by the people who are organizing on the dark web? How we get around this to support it in a way that does not endorse that?”

NPA Coun. Melissa de Genova repeatedly raised concerns about the dark web in response to many of the speakers who called in to support the motion, raising the spectre of child pornography and terrorism as well as the illicit drug trade. Independent Coun. Lisa Dominato also said she was concerned that buying from the dark web could support organized crime.

British Columbia’s tainted drug supply is becoming deadlier by the month. In 2020, drug toxicity deaths shot up and they’ve continued to steadily increase this year: 184 people died in July, the deadliest month recorded in 2021. In 2020, 1,734 people died of overdoses. If current trends continue, over 2,000 British Columbians could lose their lives by the end of 2021.

B.C. has the highest rate of drug deaths in Canada, at 40 deaths per 100,000 people — a higher rate than 48 U.S. states, including some of those hardest hit by the crisis like Ohio and Pennsylvania.

The province’s illicit supply is now contaminated with fentanyl — a powerful synthetic opioid — as well as benzodiazepines and other dangerous additives. The mix is unpredictable and changes all the time, making it impossible for drug users to know what will happen when they take drugs.

Donald MacPherson, the executive director of the Canadian Drug Policy Coalition, told council he supports DULF’s application for an exemption and the compassion club model.

MacPherson reminded councillors that other efforts like needle exchanges and safe injection sites were once illegal. But drug user activists persisted and showed how the services could operate and save lives even though they were breaking the law to do so — just as DULF is doing now.

The leadership of civic politicians, like former mayor Philip Owen, also helped to pave the way for Vancouver to adopt harm reduction services that were once taboo, MacPherson said.


In response to Fry and de Genova’s concerns about using the dark web to source drugs, MacPherson said in the absence of a safe, regulated and legal supply of drugs like heroin and cocaine, the DULF model presents a safer choice.

“We’re stuck with a tough dilemma. People are going to go buy drugs tonight from the illegal market, whatever that looks like — they will do that,” MacPherson said.

“The proposal before you acknowledges that that’s very dangerous and presents a way of making it safer, without having the ideal fix — which would be accessing legal regulated drugs, which we’re all trying to get to.”

Safe consumption sites, where drug users take drugs while trained staff or volunteers are on hand to prevent overdoses, work well to prevent death, but they don’t prevent overdoses to begin with.

Drug checking can tell users what’s in their drugs, but it’s also inadequate, Sarah Guzman told council. Guzman, who has worked as a drug checker, said she’s had the experience of telling people what’s in their drugs, but knowing they’ll take them anyway. In one case, she ran after someone to tell them how strong their drugs were, but found the person already overdosing.

Canada’s Controlled Drugs and Substances Act allows the federal health minister to issue an exemption from any part of the legislation “for a medical or scientific purpose or is otherwise in the public interest.”

This Overdose Awareness Day, Activists Will Again Hand Out Safe Drugs

READ MORE

Eris Nyx, one of the founders of DULF, said getting the Section 56 exemption is key to being able to move towards getting the drugs from a regulated and legal supplier.

One of those suppliers could be Fair Price Pharma, a non-profit company set up by former B.C. provincial health officer Dr. Perry Kendall to manufacture injectable heroin. However, those legal supplies are not yet available in Canada.

The end goal for many of the supporters of DULF who spoke to council is legalizing the currently illicit drug supply.

“It is the unpredictability of the drug supply that is killing people,” Jeremy Kalicum, a co-founder of DULF, told council.


NDP and Greens Push Trudeau to Answer Vancouver’s Call to Decriminalize Drugs

READ MORE

“Drug prices are set not at fair market, but at prices that allow maximum financial exploitation, which in turn drives crime.”

In response to the concerns raised about buying drugs from the dark web, Swanson introduced an amendment to her motion, stating that council would support the exemption request as long as DULF gets its supply from a legal, regulated source.

De Genova voted in favour of endorsing DULF’s application for the Section 56 exemption, but against writing to Ottawa to support it and against asking city staff to look at other ways safe drug supply could be provided. The mayor and all other councillors voted in support of the entire motion.

Nyx said council’s support will help, but DULF is committed to running the compassion club with or without the political help.

“We’re going to run this program by hell or high water because it will save lives,” Nyx said. “We’re a radical organization. We don’t need state sanctioning — but it helps. Safe supply by any means necessary.”

* Story updated on Oct. 8 at 12:19 p.m. to correct Lisa Dominato’s party affiliation. In April 2021, Dominato left the Non-Partisan Association to sit as an independent councillor.

DECRIMINALIZE  DRUGS

Scotland’s drugs deaths are a public health emergency

People in Scotland are dying from drug use at a rate higher than in any other European country.

By Yuri Prasad
Sunday 25 August 2024

SOCIALIST WORKER Issue



Opioid drugs, such as heroin, are behind around 80 percent of Scottish drug-related deaths

People in Scotland are dying from drug use at a rate higher than in any other European country.

National Records for Scotland last week showed that 1,172 people died as a result of drug use in 2023—an increase of 12 percent over the pre­vious year.

And opioid drugs, such as heroin, morphine and methadone, are impli­cated in around 80 percent of the deaths.

Opioids relax muscles and the brain, including the parts that con­trol breathing, meaning that many drug-related deaths happen because of respiratory failure.

Poverty plays an important part in this story, with the poorest areas of Glasgow, Inverclyde and Dundee being among the worst affected.

Poor people with bad physical and mental health are far more likely than those who are healthy to turn to drugs to ease their pain. They are also more likely to die from an overdose. But poverty alone doesn’t explain what is happening.

The numbers of drug-related deaths in the poorest areas of England and Wales don’t come close to those of Scotland—even though poverty levels are similar.

Instead, Scotland appears to be trapped in a public health emergency.

Trauma is a well-known factor in problematic drug use. And there are now generations of drug users that experienced childhood trauma because their parents were addicts.

Many of them lost family to overdoses or drug-associated diseases and are now themselves vulnerable to the same tragedies.

There are ways to break out of the crisis, but they depend on a massive increase in funding into holistic ser­vices for drug users. And they require a break with the moralism behind state drugs policy.

Despite the Scottish government having formally signed-up to the full range of treatments demanded by experts and users, what services exist are often overwhelmed.

Clinics that help people break from opioid dependency by offer­ing a controlled alternative, such as methadone, are a vital part of a treat­ment strategy.

But a recent report from the Scottish Drugs Forum showed that many people wait months to start treatment, while others have to travel miles to reach a clinic.

One service user reported that her clinic was “just ridiculous. It was just wholeheartedly inaccessible to begin with. I was genuinely phoning up in tears begging for this help, for months.”

And its not just preventative ser­vices that are affected. People who have overdosed can be saved if a medical professional gets to them fast and injects them with a reversal drug, such as Naloxone.

But these long-promised rapid reaction teams are still thin on the ground, with not enough funding to make them truly effective.

There are an estimated 60,000 people in Scotland thought to be at risk of a drugs overdose, but just 40 percent have access to this kind of lifesaving treatment.

If the state is going to tackle the ever-rising number of drugs deaths in Scotland it must treat them as a public health emergency.
‘Expand Glasgow services’

Britain’s first official consumption room for illegal drugs will open in Glasgow in October. Keir McKechnie, a mental health worker in the city, told Socialist Worker the move is long overdue.

“The arrival of synthetic opioid drugs—which can be far stronger than heroin—means there has to be a massive expansion of all drug user services,” he said.

“It’s vital that we take drug users out of the criminal justice system and get them in the public health system instead.

“We need more investment in drug addiction teams, and we need a full range of mental health services that people can access quickly. Problematic drug use cannot be separated from wider mental health problems people are experiencing.

“At the moment, it can take months, and even years, for someone that wants to deal with their addiction to get access to a rehab centre.”

Keir adds that the new consumption rooms must be just the start of a radical change in healthcare for drug users.

“The onset of an opioid crisis means we urgently need drop-in centres where people can have the drugs they’ve bought properly tested,” he says.

“That will at least give people an understanding of what’s in the drugs they plan to take.”

For that to happen, the state must abandon the criminalisation of addiction.
Criminalising drugs—and drug users—doesn’t work

The number of people dying from drug overdoses in Scotland has risen fairly consistently since 1996.

But state attempts to deal with the increase have made little progress for one key reason—the drugs in question are illegal.

The safest way for people to take drugs is for the NHS to offer medical grade substances for free and an environment in which to take them.
Illegality forces users to buy drugs from dealers who cut their products with other substances to make up the weight or increase the high.

And that same illegality creates a stigma that pushes people to administer their drugs behind closed doors, where medical services can’t get to them if they overdose.

The state insists on criminalisation for ideological and financial reasons. By making drugs illegal, it designates drug users as “criminals”. It suggests that it is drug users’ individual failings that are responsible for the harm that comes to them.

That helps the state duck the question of why the poverty, inequality, abuse and pain behind drug use are built into its system. And most of our rulers oppose the higher health spending required to properly treat people who are addicted to drugs.

So it suits them to label drug use as a problem of a “criminal minority”.

DECRIMINALIZE DRUGS

MDMA Use at Start of Pandemic Rose Almost 300 Percent in New England Town

Story by Jess Thomson • Yesterday 

Use of MDMA in a small town in New England rose by almost 300 percent at the start of the COVID pandemic, along with huge spikes in cocaine, fentanyl and methadone.

Sheree Pagsuyoin, an expert on wastewater monitoring for drugs and COVID-19 at the University of Massachusetts-Lowell, and her research team had been collecting samples from the town's wastewater twice each month between September 2018 to August 2020, to look for trends in drug use. Samples were tested for morphine, codeine, hydrocodone, methadone, fentanyl, cocaine, methamphetamine, amphetamine (MDMA), and methyldiethanolamine (MDEA).

There are high rates of consumption and deaths from prescription drugs such as fentanyl, oxycodone, hydrocodone, methadone, codeine and morphine in New England, with the area being one of the hotspots of the opioid crisis in the U.S., according to one 2019 study in the journal Preventive Medicine.

Delaware had the second highest age-adjusted death rate from opioid overdose of all U.S. states in 2020 at 47.3 per 100,000 people, CDC data shows, with Maryland, Pennsylvania, Maine and Connecticut all falling into the top 10 worst-affected states. The highest death rate was found in Kentucky, where there were 49.2 deaths per 100,000 people.

Opioids are responsible for a large number of deaths across the country, with the U.S. considered to be in the grips of an opioid crisis. CDC data shows that opioids were involved in 68,630 overdose deaths in 2020, a number that amounts to 74.8 percent of all drug overdose deaths that year.

Understanding when and where drugs are being used can help inform public health authorities about issues facing communities.

Presenting their findings at the Society for Risk Analysis on December 6, Pagsuyoin and colleagues said they found that a variety of drugs spiked in use during the first few months of the pandemic, with MDMA use increasing by 286 percent. Drug use was also seen to increase during exam periods.

They also found that more fentanyl was used in the research town during this period than in other rural and university settings in the U.S. that had been analyzed previously.

Drugs find their way into the wastewater via the urine of people taking them. "When people take drugs of any kind (medicinal or illicit) only a portion of it is metabolized," Dan Aberg, a wastewater pharmaceutical compounds researcher at Bangor University in the U.K. who was not involved in the Society for Risk Analysis study, told Newsweek. "A percentage of the drug is then released unchanged in the urine. Various intermediate metabolites are also released, some of which are environmentally damaging at certain concentrations."



Drugs can enter the water system via urine.

 iStock / Getty Images Plus© iStock / Getty Images Plus

Prescribed and over-the-counter pharmaceuticals can also be detected in the wastewater, as they are also not entirely metabolized by the body.

This latest wastewater research shows that communities may be facing a similar drug usage and overdose issue with stimulant drugs as well. "Our findings reflect the region-wide problem with opioid-related overdoses and increasing stimulant prescription rates," Pagsuyoin said in a statement.

Increased drug use during the pandemic has been documented previously. The CDC found that as of 2020, 13 percent of Americans said that they began taking drugs—or increased their usage— to deal with the emotional impact of the pandemic. Overdosages also increased after the start of the COVID-19 lockdown, with there being an 18 percent increase in overdoses countrywide compared to the same month in 2019.

Similar results were found in a June 2022 study of several Belgian cities published in the International Journal of Drug Policy. This study found that amphetamine use increased in three of the four cities during lockdown, as well as increased cocaine and MDMA use.

Drugs in the water system may also impact other wildlife. When in wastewater, the water is processed before it re-enters circulation via filtration and disinfection, which removes some—but not all—of the drugs dissolved. However, at locations where people may urinate directly onto the ground, such as music festivals, the drugs may directly enter the freshwater system.

A paper published by Aberg and his colleagues in the journal Environmental Research earlier this year revealed that at the site of Glastonbury Festival in the U.K., MDMA was found at concentrations 104 times greater downstream from the festival in comparison to upstream sites, while cocaine and benzoylecgonine were found at 40 times higher concentrations downstream.

The presence of drugs in the natural water system, both from wastewater and freshwater drainage, can result in strange and destructive impacts on the local wildlife.

Platypuses in Australia's contaminated streams ingest over half a daily adult dose of antidepressants. Other serotonin-altering drugs also impact the learning and memory of cuttlefish, cause shore crabs to behave in more "risky" manners, and cause shrimp to be more likely to swim toward a light source.


Stock image of a duck-billed platypus, which can be impacted by drugs in the water system. iStock / Getty Images Plus© iStock / Getty Images Plus

Additionally, the presence of cocaine in waterways has been found to impact European eels in a variety of ways. One study published in the journal Science of the Total Environment found that cocaine accumulates in the brain, muscles, gills, skin, and other tissues of the eels.

"All the main functions of these animals could be altered," Anna Capaldo, a research biologist at the University of Naples Federico II and the lead author of the eel study, told National Geographic in 2018.

More research is required to determine whether illegal drugs are more harmful to wildlife than pharmaceuticals like antidepressants.

"Illicit drugs tend to be more psychoactive than other pharmaceuticals so often require lower concentrations to cause noticeable effects, however due to their legal status research on them is not wide enough to paint an accurate enough picture," Aberg said.

One way to combat the pipeline of drugs from human urine to wildlife would be to increase the purification ability of wastewater treatment. Standard water treatment plants clean wastewater via removing larger clumps of material, filtering and disinfecting the water. If the pores of the filtration system are not small enough to remove the miniscule particles of drugs in the water, they are passed through the system.

"Pharmaceuticals are found in all freshwater ecosystems, as many wastewater treatment plants have poor removal rates for them due to their complexity," Aberg said.

Using a more sophisticated filtration system would enable pharmaceuticals to be completely removed. However, this would likely be very expensive.

Is there a health issue that's worrying you? Do you have a question about drugs or wastewater? Let us know via health@newsweek.com. We can ask experts for advice, and your story could be featured on Newsweek.

References

Pagsuyoin, S., et al. Analysis of wastewater in a New England college town reveals high usage of stimulants and a rise in drug use during the pandemic. Society for Risk Analysis. 2022.

Aberg, D., et al. The environmental release and ecosystem risks of illicit drugs during Glastonbury Festival. Environmental Research, 2022. https://doi.org/10.1016/j.envres.2021.112061

Stopka, T. J., et al. The opioid epidemic in rural northern New England: An approach to epidemiologic, policy, and legal surveillance. Preventative Medicine. 2019. https://doi.org/10.1016/j.ypmed.2019.05.028

Boogaerts, T., et al. Temporal monitoring of stimulants during the COVID-19 pandemic in Belgium through the analysis of influent wastewater. International Journal of Drug Policy. DOI: 10.1016/j.drugpo.2022.103679

Capaldo A., et al. Effects of environmental cocaine concentrations on the skeletal muscle of the European eel (Anguilla anguilla). Science of the Total Environment, 2018. doi: 10.1016/j.scitotenv.2018.05.357.

Zucatto, E., et al. Illicit drugs, a novel group of environmental contaminants. Water Research, 2008. DOI:10.1016/j.watres.2007.09.010

Related Articles

Legalizing Weed Reduced Opioid Use in America's Cancer Patients

How a US President set NZ’s drug laws

Guyon Espiner, Investigative reporter, In Depth
@GuyonEspiner guyon.espiner@rnz.co.nz
 1 December 2022

It's half a century since the War on Drugs was declared. New Zealand was an enthusiastic ally of then-US President Richard Nixon in the battle. A new documentary from RNZ - Guyon Espiner: Wasted - investigates the costs of continuing the fight.

When the 79-year-old President of America, where the War on Drugs began, pardons thousands of people for the crime of possessing marijuana you can smell that change is in the air.

When the Economist, a sober, rigorous adherent to economic liberalism, says that Joe Biden is being too timid and it's time to legalise cocaine, you get a sense of how far-reaching that change might be.

When you consider New Zealand, which sees itself as a socially liberal democracy, still maintains a prohibition on cannabis and locks people up just for possessing drugs, you realise how far we are falling behind.

President Richard Nixon, who later resigned after the Watergate scandal, launched the War on Drugs in 1971, declaring "America's public enemy No 1" was drug abuse and vowing to "wage a new, all out offensive".

New Zealand joined the war effort a few years later and our legislation to combat drug harm is still anchored in that era with the Misuse of Drugs Act 1975.

"New Zealanders might be a little bit disturbed to think we have Richard Nixon's legislation in place to govern our drug policy today," Drug Foundation executive director Sarah Helm says in the new RNZ documentary Guyon Espiner: Wasted.

WATCH THE DOCUMENTARY

Guyon Espiner: Wasted premiered on RNZ and TVNZ1 on Wednesday night. You can watch it on demand any time by clicking here.

In a world still reeling from the Covid-19 pandemic, and askew with disinformation, we are urged to follow the facts and the science. It's instructive to take that advice and overlay it on our approach to drug harm.

"We've legislated certain types of drugs in certain ways because of history and prejudice, not because of science and evidence," Tim McKinnel, a former drug squad detective, says in the documentary, which also tracks his path from kicking in the doors of tinny houses to concluding that all drugs should be decriminalised.

McKinnel, who did a masters degree in criminology, is alluding here to the dark roots of the War on Drugs, which sprouted in the fertile ground of racism and moral panic.

The chief architect was Harry Anslinger, who served five US presidents over 32 years as chief of the Federal Bureau of Narcotics.

Anslinger was an adept propagandist and used what he called 'the gore files' to spread fear about drugs in the popular press.

The 1937 film Reefer Madness picked up one of his most lurid tales, where he claimed that a "quiet young man" murdered his entire family while "pitifully crazed" on marijuana (it later emerged the man was mentally ill).

Anslinger's claims of despicable crimes committed while under the influence of drugs were often racially charged, and chief among his targets were African American jazz musicians.

The history is neatly outlined in British journalist Johann Hari's book Chasing the Scream (2015) and the movie The United States vs. Billie Holiday (2021) is based on Hari's book.

Private Investigator Tim McKinnel Photo: RNZ / Cole Eastham-Farrelly

In the Wasted documentary McKinnel and others point out how far New Zealand lawmakers have diverged from the science in their approach to combating drug harm.

International studies - most famously Professor David Nutt's 2010 study - have shown that alcohol is the drug that causes the most harm to the individual and to the community.

The drugs that do the least harm both to the user and to society, psychedelics like LSD and mushrooms, are Class A drugs in New Zealand, attracting a life sentence for supply and six months in jail for possession.


In 2016, the Drug Harm Index estimated that New Zealand spends about $350 million dollars a year on drug interventions.

Of that, $170 million was spent on courts and prisons, $100 million went on policing and just $80 million was allocated for health care.

New Zealand still locks people up just for taking drugs. In 2021, about 3100 people were convicted for low level drug crimes like possession and personal use. Of those, about half were Māori.

In the last ten years, 35,000 New Zealanders have been convicted of a cannabis offence and 5500 have been sent to prison.

New Zealand came close to major drug reform in 2020 but the referendum to legalise cannabis narrowly failed.

Portugal decriminalised all drugs more than 20 years ago now and the model has spread to other countries including Canada and parts of America and Australia.

New Zealand doesn't usually look to Australia for progressive social reform but the Australian Capital Territory (ACT) has moved well ahead of us.

In Canberra, it is legal to smoke cannabis at home and to grow up to four cannabis plants per household or possess up to 50 grams of cannabis.

In Wasted, Health Minister Rachel Stephen-Smith outlines how the ACT plans to expand the policy to include 11 of the most commonly used drugs.

If users are caught with small amounts of these drugs - including MDMA, LSD, psilocybin (magic mushrooms), heroin, cocaine, and methamphetamine - they would get a $100 fine rather than jail time.

Possession of these drugs would cease to be a criminal matter, Stephen-Smith says.

"We know that one of the significant harms associated with illicit drug use, as well as the health harms, is the criminalisation of people and that comes from being engaged in the criminal justice system, but also the stigma associated with that and the reluctance to seek treatment and seek support."

There are pockets of New Zealand where a health approach is being used. The law was changed in 2021 to allow people to have their drugs tested, and checking stations have popped up in the major centres and at music festivals.

This is the harm reduction approach at work: the idea that some people are always going to take drugs so it's better they have a big party night out rather than kill themselves taking a mystery, or contaminated, substance.

But largely New Zealand is still fighting the War on Drugs. Wasted asks: is that a waste of time, money and lives.

Pharma Claims Drug Price Reform Hurts Innovation. Experts Say That’s “Bullshit.”

The U.S. Capitol Building is seen before the passage of Inflation Reduction Act on Capitol Hill in Washington, D.C., on August 6, 2022.

SHURAN HUANG FOR THE WASHINGTON POST VIA GETTY IMAGES

BY Arthur Allen,

Kaiser Health News

August 12, 2022

For decades, the drug industry has yelled bloody murder each time Congress considered a regulatory measure that threatened its profits. But the hyperbole reached a new pitch in recent weeks as the Senate moved to adopt modest drug pricing negotiation measures in the Inflation Reduction Act.

The bill “could propel us light-years back into the dark ages of biomedical research,” Dr. Michelle McMurry-Heath, president of the Biotechnology Innovation Organization, said last month. Venture capitalists and other opponents of the bill said that it “immediately will halt private funding of drug discovery and development.”

Steve Ubl, leader of the ubiquitous Pharmaceutical Research and Manufacturers of America, or PhRMA, called the bill’s Senate passage on Aug. 7 a “tragic loss for patients.” He threatened in an interview with Politico to make politicians suffer if they voted for the measure, adding that “few associations have all the tools of modern political advocacy at their disposal in the way that PhRMA does.”

In the past 12 months, PhRMA and closely allied groups spent at least $57 million — $19 million of it since July — on TV, cable, radio, and social media ads opposing price negotiations, according to monitoring by the advocacy group Patients for Affordable Drugs. PhRMA spent over $100 million this year to unleash a massive team of 1,500 lobbyists on Capitol Hill.

The final bill is weaker than earlier versions, which would have extended negotiations to more drugs and included private insurance plans. The bill would enable only Medicare to negotiate prices beginning in 2026, initially for just 10 drugs.

It would save the Centers for Medicare & Medicaid Services about $102 billion over a decade, the Congressional Budget Office estimates. In 2021 alone, the top U.S. pharmaceutical companies booked tens of billions of dollars in revenue: Johnson & Johnson ($94 billion), Pfizer ($81 billion), AbbVie ($56 billion), Merck & Co. ($49 billion), and Bristol Myers Squibb ($46 billion).

The bill authorizes hundreds of millions of dollars for CMS to create a drug negotiation program, setting in motion a system of cost-benefit evaluations like those used in Europe to guide price negotiations with the industry. Americans pay, on average, four times what many Europeans do — and sometimes far, far more — for the same drugs.

The bill does not affect the list prices companies charge for new drugs, which increased from a median price of $2,115 in 2008 to a staggering $180,007 in 2021, according to recent research.

The bill’s champions say that PhRMA’s gloomy prophecies are overblown, and that history is on their side.

“It’s complete bullshit and a scare tactic,” Andy Slavitt told KHN. As a leading federal health official in 2016, he tried to change part of a Medicare program that pays doctors a fixed 6% of the cost of a drug each time they administer it, creating an incentive to use the most expensive infusion drugs. PhRMA funded most of the loud campaign that defeated his efforts, Slavitt said.

Another scare tactic: The drug industry warns that any price negotiation will kill innovation. Such warnings “constitute the pharma response in literally every instance since 1906,” the year the first drug regulation agency was created, said Dr. Aaron Kesselheim, who leads the Program on Regulation, Therapeutics, and Law at Brigham and Women’s Hospital in Boston. And yet, he said, regulatory changes rarely choked out investment in new drugs.

For example, the drug industry bemoaned a bill to boost generic drugs sponsored by Rep. Henry Waxman (D-Calif.) in 1984. Yet while 50% of prescribed drugs were generics in 2000 — up from 15% in 1980 — approvals of important new drugs also soared during the period, Kesselheim noted. The threat of losing market share to generics, he said, may have induced manufacturers to invest in innovation.

In 1993, Thomas Copmann, then a PhRMA vice president, charged that President Bill Clinton’s Vaccines for Children program, which funded vaccinations for any kid whose parents couldn’t afford them, “would just kill innovation because the government would control the market.” Over the next 16 years, childhood vaccination rates climbed — from 72% to around 93% for polio vaccine, for example. Over the same period, new vaccines against hepatitis A and B, pneumonia, chickenpox, human papillomavirus, and rotavirus were added to the schedule.

The drug industry’s attacks on regulation have a rich and florid history. In the early 1900s, the Proprietary Association of America warned newspapers that their advertising revenue would dry up if the industry had to list its ingredients (mostly alcohol). The law passed in 1906, but newspapers — and the drug industry — survived it.

Sometimes the industry’s breast-beating is a negotiating tactic, one that has led to concessions from Congress and the federal government.

In the 1990s, when discussions began about requiring drug companies to pay user fees to have their drugs reviewed, the industry described the fees as a “tax on innovation.” Eventually, it agreed to pay the fees if the FDA set deadlines for the reviews. The resulting boost in FDA staffing levels ushered in an increase in drug approvals over the ensuing five years.

Yet “killing innovation” remains a go-to trope. Drug imports, efforts to rein in “pay-for-delay” agreements between brand and generic companies, investigations of price gouging by drugmakers — all, according to conservatives and pharmaceutical executives, “kill innovation.” Former House Speaker Newt Gingrich in 2009 said the same about the Affordable Care Act. A golden decade for new drugs followed, with FDA approvals increasing from 21 in 2010 to 50 in 2021.

Critics of the current bill argue that history and economic research show that drug investment will lag when markets shrink, which they say will be the case if price controls lead corporations to earn less money on their blockbuster drugs.

If Medicare negotiations cut into the profits of the biggest earners, investors in risky biotech companies, whose drugs rarely strike it rich, will shift some of their portfolios from pharmaceuticals into other sectors, said Craig Garthwaite, director of health care at Northwestern University’s Kellogg School of Management. “There’s a fair argument as to how much,” he said.

He noted that after Medicare’s drug program was created in 2003 — the drug industry initially opposed it — an increase in federal spending on medicines inspired pharmaceutical companies to spend more on drugs aimed at older people. “Once you invest in clinical trials, that money never comes back unless it’s in revenue for products sold,” he said.

The moribund antibiotics industry demonstrates how shrinking markets — hospitals and doctors intentionally limit the use of new drugs to reduce microbial resistance — lead to lower investment, Garthwaite said.

Yet some experts argue that Medicare drug pricing negotiations could hasten innovation if they steer companies away from drugs that modestly improve outcomes but can earn massive amounts of cash in the current system of unchecked prices.

In the cancer field, most investment is in drugs that provide incremental benefits at a high price, said Dr. Vincent Rajkumar, a Mayo Clinic oncologist. He was a principal investigator on two large trials testing Ninlaro (ixazomib), a pill for multiple myeloma that is very similar to the injected drug Velcade (bortezomib). While more convenient, Ninlaro is no more effective, he said, and it costs about eight times as much as generic bortezomib. A newer multiple myeloma drug, Xpovio (selinexor), keeps patients progression-free for about four additional months; it costs $22,000 a month.

Most new cancer drugs extend life for only a short time, said Rajkumar, who helped organize a 2015 letter signed by 118 oncologists that called for giving Medicare the power to bargain. If forced to negotiate, “maybe the companies would spend their research and development funds on something more meaningful,” he said.

In other high-income countries, drug price negotiations are the norm. “Right now, we are the odd man out,” Rajkumar said. “Are we really that brainy that we are right and everyone else is wrong? Are we really looking out for our public better than everyone else?”

Large patient groups such as the American Cancer Society, American Heart Association, and American Diabetes Association, all of which have significant drug industry support, stayed on the sidelines of the debate over the language in the drug price negotiation bill.

Some other patient groups, fearful that the industry will lose interest in drugs for smaller populations should prices decline, opposed the bill — and successfully won exceptions that would prevent Medicare from negotiating prices on drugs for rare diseases.

David Mitchell, a multiple myeloma patient who founded Patients for Affordable Drugs in 2017, said he’s sure the bill won’t discourage innovation — and his life may depend on it. The 68-year-old said he’s on a four-drug regimen but “cancer is very clever and finds a way to get around drugs.”

“The idea that taking a small bite out of pharma revenue is going to stop them from creating new drugs is bullshit,” he said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

 

Florida plan to import cheaper prescription drugs from Canada gets FDA approval

Ian Lopez, Bloomberg News

FDA headquarters in White Oak, Md. Photographer: Sarah Silbiger/Getty Images North America , Photographer: Sarah Silbiger/Getty Images

The Biden administration will allow Florida to import cheaper prescription drugs from Canada, giving the green light to a plan put in motion by the state several years ago.

The Food and Drug Administration made the decision on Florida’s plan Friday, saying that the state’s health department must likewise provide quarterly reports to the agency, including information on cost savings and potential safety and quality issues.

FDA Commissioner Robert Califf said in a statement that the agency was “committed to working with states and Indian tribes” trying to develop importation proposals.

“These proposals must demonstrate the programs would result in significant cost savings to consumers without adding risk of exposure to unsafe or ineffective drugs,” Califf said.

The FDA decision marks the latest turn in a back and forth between states and the federal government over importing cheaper drugs.

The pharmaceutical industry is already pushing back on the FDA’s announcement.

Stephen Ubl, president and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA), called the FDA’s approval of Florida’s plan “reckless.”

“Ensuring patients have access to needed medicines is critical, but the importation of unapproved medicines, whether from Canada or elsewhere in the world, poses a serious danger to public health,” Ubl said in a statement. “Politicians need to stop getting between Americans and their health care.”

Ubl also noted that PhRMA “is considering all options for preventing this policy from harming patients.” The group had sued the FDA in 2020 over a Trump administration plan for importing Canadian drugs. The lawsuit was later dismissed.

President Joe Biden issued an executive order in July 2021 that included a call for the FDA to work with states on importing drugs from Canada.

In August 2022, however, Florida sued the FDA, claiming the agency was standing in the way of its drug importation plan.

In addition to Florida, states like Colorado, North Dakota and Vermont have laws that allow importation of drugs, according to the National Conference of State Legislatures. Over five of those states have asked the FDA for approval, the conference said.

U.S. allowing Florida to import drugs from

Canada, reviving fears of shortages

CBC
Fri, January 5, 2024 

Florida is one of a handful of states that have applied to import wholesale prescription drugs from Canada. (David Donnelly/CBC - image credit)

The U.S. Food and Drug Administration is allowing Florida to import what could amount to millions of dollars worth of prescription drugs from Canada — a move that could reignite worries about the drug supply north of the border.

Florida has estimated that purchasing prescription drugs from Canadian wholesalers to treat such conditions as HIV/AIDS, diabetes and hepatitis C could save the southern state $150 million US annually.

Marking a shift in U.S pharmaceutical policy, the FDA approved Florida's request. In a letter to the state government dated Friday, the director of the administration signed off on the proposal and said that importing medications from Canada could "significantly reduce the cost of covered products to the American consumer without posing additional risk to the public's health and safety."

The sunshine state is one of a handful that have applied for permission to import wholesale prescription drugs from Canada, meaning Friday's approval could be just the first of several.

Canada — which set up a federal regulatory agency decades ago to ensure patent drug prices are not excessive — has resisted such import plans for years.

In a media statement, federal Health Minister Mark Holland said Canada has regulations in place to protect its supply.

"I want to assure Canadians that they will continue to have access to medications they need when they need them," he said.

"Canadians can be confident that our government will continue to take all necessary measures to protect the drug supply in Canada."

Five provinces, including Quebec, allow pharmacists to prescribe Paxlovid directly to people who get sick with COVID-19. avoiding the need to see a doctor. 'It's really about getting the drug to the person as quickly as possible so they can start it and have the best possible outcome,' said Montreal pharmacist Daron Basmadjian.

The Canadian Pharmacists Association is urging Canadians not to rush out to stock up on their prescriptions in wake of the U.S. FDA's decision. (CBC/Radio-Canada)

Joel Lexchin, a retired emergency physician who studies pharmaceutical policy, said it's still not clear if Florida's plan will actually pan out.

"But if it goes ahead, then we should be worried," he said.

"Canada has 40 million people. Florida has more than half of that, so 22 million people. We can't supply Florida with the drugs that they may need without doing damage in Canada."

Lexchin said the U.S. is "attempting to use Canada to solve a relatively unique American problem.

"The U.S. government, amongst all the other OECD countries, doesn't allow price negotiations with manufacturers. So drug companies are free to set whatever prices they want. Here in Canada, we control prices so our prices for brand name drugs tend to be two and a half to three times lower than the U.S. prices."

Pharmacists' group calls for calm

Joelle Walker, vice president of public affairs for the Canadian Pharmacists Association, said the FDA's decision is "certainly not good news for Canadians" but she shares Lexchin's doubts about Florida starting bulk imports any time soon.

"Historically, we've had some pretty devastating drug shortages in Canada. And so the idea that they could import them from us is not really feasible," she said.

"I'm skeptical that it will actually come to fruition in its current form, but we want to make sure that we're diligent about reviewing it and making sure that we're not missing something."

Walker urged Canadians not to rush out to stock up on their prescriptions, which could trigger shortages.

"Don't be alarmed today. This certainly isn't happening tomorrow. This may never happen. So don't rush to your pharmacy, don't be concerned about it right now," she said.

"Hopefully, the measures that we have in place will help sort of restrict that flow from Canada to the United States."

This debate is not new. In 2019, then-U.S. president Donald Trump proposed a rule to allow wholesale bulk imports of prescription drugs, promising it would be a "game changer for American seniors."

Within months, the Canadian government blocked bulk exports of some prescription drugs to stave off the risk of shortages at home.

Health Canada issued a statement at the time saying approximately 10 to 15 per cent of drugs have been in short supply in Canada "at any given time" since 2017.

Lexchin said that while the Canadian government has brought in regulations to avoid mass exports, drug shortages — like the shortage of children's Tylenol in 2022 — can be hard to predict.

"If drugs are being made in a single plant, and there's a fire in the plant, or they discover there's contamination, that creates a shortage without any real warning," he said.

"So if we are committed to exporting large amounts of drugs, when a shortage comes up, then we may be on the short end of the stick."

Americans have been buying drugs from Canada for some time.

Pharmacists along the border have reported U.S. citizens making the trek to stock up on cheaper medicine, including insulin and Ozempic, a prescription diabetes treatment that has skyrocketed in popularity recently as an off-label drug for weight loss.

"People driving over the the border and coming and getting a little bit at a time, that wasn't really jeopardizing our supply," said Walker.

"But we've had recent examples in B.C., for example, where the importation of Ozempic was actually leading to a potential shortage because the numbers were so high."

Decision could harm Canadians, warns trade group

Innovative Medicines Canada, a trade group that represents about 50 pharma companies, said allowing Florida to import drugs meant for Canadians could "disrupt" Canada's health-care system.

"Canada simply can't supply drugs to Florida, or any other U.S. states, without significantly increasing the risk and severity of drug shortages nationwide," David Renwick, interim president of Innovative Medicines Canada, said in a statement.

"The U.S. market is nearly 10 times bigger than Canada's, and allowing drugs that were intended for Canadians to be exported to the U.S. would harm Canadian patients and disrupt our health-care system."

The head of Pharmaceutical Research and Manufacturers of America (PhRMA), one of the largest pharmaceutical industry lobby groups in the U.S., called the FDA's decision "reckless."

"Ensuring patients have access to needed medicines is critical, but the importation of unapproved medicines, whether from Canada or elsewhere in the world, poses a serious danger to public health," said PhRMA president Stephen Ubl in a media statement.

"PhRMA is considering all options for preventing this policy from harming patients."