re-published and reported by youarewithinthenorms.com
NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS MD, PH.D., IN THE SPIRIT OF C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., WALTER F. WRENN III., MD., JULIE KILLINGSWORTH, RENEE BLARE, RPH, DR. TERENCE SASAKI, MD LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
OYEZ! OYEZ! OYEZ!
THE HONORABLE, THE CHIEF JUSTICE, AND THE ASSOCIATE JUSTICES OF THE UNITED STATES SUPREME COURT. ALL PERSONS HAVING BUSINESS BEFORE THE HONORABLE THE SUPREME COURT OF THE UNITED STATES ARE ADMONISHED TO DRAW NEAR AND GIVE THEIR ATTENTION, FOR THE COURT IS NOW SITTING.
HARM REDUCTION PERHAPS IT IS TIME TO RE-LEGALIZE THE MEDICAL USE OF HEROIN
Perhaps it is now time for Congress to re-legalize and re-classify Heroin for the use of medical care, paraphrasing a discussion brought about by a more recent article from FROM YALE LAW AND POLICY REVIEW SPRING 2023, Tuesday, February 7, 2023 – 10:45a… The Misinformed & Misguided Prescription Abuse Prevention Act: A Response to Delfino by *Robert Capodilupo & Jacob James Rich*
Take listen and understanding as we have added to the original discussion…..
The Misinformed & Misguided Prescription Abuse Prevention Act: A Response to Delfino
By *Robert Capodilupo & Jacob James Rich*
“…The CSA has made it more difficult for doctors to provide legitimate opioid treatments for patients out of fear of prosecution. As such, instead of abandoning the CSA regime, we recommend reforming it—specifically through adopting a more capacious definition of what constitutes a “legitimate medical purpose.”[73]
This appears to be the path the Supreme Court took in the recent case, Xiulu Ruan v. United States. There, the Court interpreted the CSA’s prohibition on doctors “knowingly” dispensing opioids outside of the “usual course of his professional practice” to mean that, to face liability, doctors must know the prescription was outside of the usual course of practice, rather than know he was prescribing the substance.[74]
This interpretation may reduce the chilling effect discouraging opioid treatments, as physicians can only face liability under the CSA if the government can “prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner.”[75]
Still, long-term maintenance of patients on opioids—especially illicit opioids like heroin—is still considered to be outside “the usual course of professional practice”. It thus remains an unauthorized procedure prohibited by the CSA.[76] Maintaining those suffering from addiction on opioid regimes is considered a legitimate practice in many other countries.[77]
THE PERILOUS STATE OF HEALTHCARE IN AMERICA
For example, qualifying physicians in Canada are allowed to prescribe long-term regimens—and even pharmaceutical-grade heroin—to “people who are severely addicted to opioids.”[78] The logic behind these programs follows from the idea that the harms of drug use will be reduced if a user can acquire the substance legally.[79]
Recognizing that many people who are highly addicted to opioids will seek out these drugs regardless of legality,[80] these programs seek to reduce the harms of drug use by ensuring that users are given an unadulterated substance.
In the United States, legalizing heroin-assisted treatment would require both a rescheduling of heroin from Schedule 1 to Schedule 2, and an agency reinterpretation of the CSA to recognize this practice as legitimate.[81] In turn, reforming the CSA to allow for heroin-assisted treatment would likely significantly reduce overdose deaths in the United States.
As one review of the outcomes of heroin-assisted treatment in Europe concludes, these programs are associated with “substantial improvement in health and well-being of the patients … [including] a major reduction in the extent of continued injecting of ‘street’ heroin, improvements in general health, psychological well-being, and social functioning, as well as major disengagement from criminal activities.”[82]
And, crucially, heroin-assisted treatment is associated with “reductions in illicit heroin use,” suggesting that users are at a decreased risk for overdoses caused by laced substances.[83]
The current nature of the opioid crisis demands solutions that recognize the nuances of the situation. PAPA would only perpetuate the current failed approach by incentivizing the use of black-market opioids, the principal driver of overdose deaths. Instead of limiting access to legal opioids, public policy should be working towards expanding the extent to which opioid users can continue to be treated by physicians in a safer, supervised manner.
Amending the CSA to expand legal, legitimate maintenance treatment, rather than increasing the scrutiny of prescribing in an imprecise and ambiguous manner, poses the best policy framework for reducing the harms of opioid use.
Note
Part-2 of this series on the Re-Legalization of Heroin can be found here.
FOR NOW, YOU ARE WITHIN
THE NORMS
REFERENCE:
*Science and Math Undermines Delfino: * Robert Capodilupo, Yale Law School, J.D. expected Spring 2023; M.Phil., Magdalene College, University of Cambridge, A.B. magna cum laude in Government, Harvard College. Jacob James Rich, Cleveland Clinic Center for Value-Based Care Research; Reason Foundation Drug Policy Project; Case Western Reserve University School of Medicine, Ph.D. expected Spring 2025; M.A., Eastern Michigan University; B.S., Eastern Michigan University. The Authors would like to thank Professor Jonathan H. Adler, Professor Jeffrey A. Miron, Dr. Jeffrey A. Singer, and Professor Kate Stith for their helpful feedback on earlier drafts of this Essay. The Authors are particularly grateful to Isaiah Ogren for his fantastic work on this Essay as Executive Editor for Inter Alia and to Karissa Kang and Amir Perk for demonstrating exceptional academic integrity in agreeing to publish this response.
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Will Rogers__
“The problem ain’t what people know. It’s what people know that ain’t, so that’s the problem.”
