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Jeffrey A. Singer

Jeffrey A. Singer



Articles by Jeffrey A. Singer

CDC Study on Vaping-Related Lung Injuries Strengthens the Case for Cannabis Legalization

5 days ago

In what it hailed as a “breakthrough,” on November 8, the Centers for Disease Control and Prevention published the results of its analysis of lung fluid samples from 29 different patients hospitalized for vaping related illness in 10 different states. All 29 samples were found to contain vitamin E acetate, the synthetic form of vitamin E. Vitamin E acetate is an oil, and is suitable for ingesting, but can cause severe lung damage if inhaled.
Vitamin E acetate is commonly used as the vehicle for delivering THC, the psychoactive ingredient in cannabis, in vaping cartridges. The CDC reported that 86 percent of the patients sampled said they had vaped an illegal THC product. This was based upon self-reporting, so the actual percentage may be higher.
As long as federal marijuana prohibition

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War on Drugs Meets War on Vaping–This Won’t End Well

10 days ago

Last summer, Brian Besser, Drug Enforcement Administration District Agent in charge of Utah, told reporters that Mexican drug cartels have “all of a sudden gotten involved in this vape cartridge industry, and reasonably so, because they know they are going to make money off of it.”
This makes sense. Prohibition incentivizes innovations in the production and distribution of illicit substances to make detection more difficult. It is very hard to identify illicit drugs that are processed in liquid form and combined with scented juices in vaping cartridges.
On November 1, Agent Besser informed reporters of a DEA intelligence report stating illicit fentanyl is being found in bootleg vaping cartridges in various parts of the country, although not yet in Utah.
The Utah Department of Health

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More Evidence in Support of Needle Exchange Programs

11 days ago

In his State of the Union Address earlier this year, President Trump announced the laudable goal of eliminating HIV transmission by the year 2030. Needle exchange programs (also called Syringe Exchange Programs or SEPs) are a public health approach in use since the 1980s with a proven record of reducing the spread of HIV, hepatitis, and other blood-borne infectious diseases. I have presented much of the data supporting needle exchange programs here and, more recently, here. Now, new research reported in the Journal of Acquired Immune Deficiency Syndrome adds even more strength to the argument in favor of needle exchange programs.
Using surveillance data of HIV diagnoses associated with intravenous drug use from Philadelphia and Baltimore, cities where needle exchange programs had been

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DEA Is About to Demonstrate “How Little They Know About What They Imagine They Can Design”

21 days ago

Last month the Drug Enforcement Administration, tasked with setting quotas for opioid production in the U.S, announced a proposal to reduce production levels another 10 percent, having already reduced production by 25 percent in 2017 and an additional 20 percent in 2018. This would bring down production levels to 53 percent of 2016 levels. Yesterday the DEA released a proposal to develop “use-specific” quotas. The DEA press release explains this as follows:
Today’s proposal amends the manner in which DEA grants quotas to manufacturers for maintaining inventories…The proposal also introduces several new types of quotas that DEA would grant to certain DEA-registered manufacturers. These use-specific quotas include quantities of controlled substances for use in commercial sales, product

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New Report on Pharmacy Closures Is Another Reason to Make Naloxone OTC

23 days ago

A report in the October 21 issue of JAMA Internal Medicine offers another reason for the Food and Drug Administration to reclassify the opioid overdose antidote naloxone over-the-counter. The study finds that despite a growing number of community pharmacies in the U.S. between 2009 and 2015, the overall numbers don’t reflect the “churn” in the community pharmacy industry. The number of pharmacies increased from nearly 63,000 in 2009 to nearly 68,000 in 2015. But of the nearly 75,000 pharmacies in operation at any point during this time period, one in eight had closed by the end of 2015. It found a disproportionate rate of closure among independent pharmacies in low-income urban areas.
I have argued here and at a recent Capitol Hill Briefing that the FDA should reclassify the opioid

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Add PreP and PEP to The List of Drugs the FDA Should Make OTC

October 11, 2019

This week California Governor Gavin Newsom signed into law a bill that allows people at risk for contracting HIV to obtain both pre-exposure prophylaxis (PreP) and post-exposure prophylaxis (PEP) directly from a pharmacist, avoiding the inconvenience and expense of having to visit the doctor for a prescription. Drugs that provide HIV prophylaxis are classified as prescription-only by the Food and Drug Administration. States get to determine the scope of practice of their licensed health care practitioners. Expanding the scope of practice of pharmacists to allow them to prescribe a prescription-only drug has been increasingly used by state legislatures to work around the federal prescription requirements in order to improve access (and decrease cost) to medications their residents want and

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Add PreP and PEP to The List of Drugs the FDA Should Make OTC

October 11, 2019

This week California Governor Gavin Newsom signed into law a bill that allows people at risk for contracting HIV to obtain both pre-exposure prophylaxis (PreP) and post-exposure prophylaxis (PEP) directly from a pharmacist, avoiding the inconvenience and expense of having to visit the doctor for a prescription. Drugs that provide HIV prophylaxis are classified as prescription-only by the Food and Drug Administration. States get to determine the scope of practice of their licensed health care practitioners. Expanding the scope of practice of pharmacists to allow them to prescribe a prescription-only drug has been increasingly used by state legislatures to work around the federal prescription requirements in order to improve access (and decrease cost) to medications their residents want and

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More Research Shows It’s Not The Prescriptions, It’s The Prohibition

October 9, 2019

The latest issue of Public Health Reports (the official journal of the Office of the Surgeon General and U.S. Public Health Service) presents a study by researchers at Boston University and the Massachusetts Department of Public Health which provides further evidence that the narrative driving present opioid overdose policy—that it results primarily from doctors prescribing opioids to patients in pain—is wrong. It results from non-medical drug users accessing drugs in the black market that results from prohibition. In the early part of this century the “drugs of choice” for non-medical users were diverted prescription pain pills. But users have long since moved on to cheaper, more available, and more dangerous drugs.
The researchers examined data on opioid-related overdose deaths in

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More Research Shows It’s Not The Prescriptions, It’s The Prohibition

October 9, 2019

The latest issue of Public Health Reports (the official journal of the Office of the Surgeon General and U.S. Public Health Service) presents a study by researchers at Boston University and the Massachusetts Department of Public Health which provides further evidence that the narrative driving present opioid overdose policy—that it results primarily from doctors prescribing opioids to patients in pain—is wrong. It results from non-medical drug users accessing drugs in the black market that results from prohibition. In the early part of this century the “drugs of choice” for non-medical users were diverted prescription pain pills. But users have long since moved on to cheaper, more available, and more dangerous drugs.
The researchers examined data on opioid-related overdose deaths in

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A Welcome Victory For Harm Reduction Advocates

October 3, 2019

On Wednesday, October 2, US District Judge Gerald McHugh ruled that the plans of a non-profit, privately-funded, harm reduction organization to establish a Safe Injection Site in Philadelphia do not violate federal law. A group that includes former Philadelphia Mayor and Pennsylvania Governor Ed Rendell was warned last year by then-Deputy Attorney General Rod Rosenstein that their plans to establish “Safehouse” would be a violation of federal law and would face a “swift federal response.” In February of this year, US Attorney for the eastern district of Pennsylvania Bill McSwain sought a declaratory judgment in federal court regarding the legality of the enterprise, arguing that Safe Injection Facilities (also called “Overdose Prevention Sites”) violate the federal “Crack House Statute.”

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Herbert Kleber

October 1, 2019

Today’s Google Doodle is about Dr. Herbert Kleber, a noted U.S. psychiatrist who died on October 5, 2018. After his early work with addicted inmates at a national prison in Kentucky, he became very disappointed with the results of what was, in effect, abstinence therapy augmented by work assignments and group therapy sessions—which had been the standard approach in the 1960s. This approach was associated with a roughly 90 percent failure rate.
His research at Yale and later at Columbia University was largely responsible for the now widespread acceptance of methadone, and now other forms of what is referred to as Medication Assisted Treatment (referred to by many therapists as Opioid Replacement Therapy) for patients suffering from addiction.
Now a time-tested tool for the treatment of

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Is the DEA Branching Out Into Regulating Medicine?

September 23, 2019

The Drug Enforcement Administration, having virtually eliminated the diversion of prescription pain relievers into the underground market for nonmedical users, appears to be setting its sights on regulating the medical management of pain, a mission not suited for law enforcement. Acting under the authority of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), the DEA announced a proposal to reduce, once again, the national production quotas for fentanyl, morphine, hydromorphone (Dilaudid), oxycodone, and oxymorphone, bringing the production levels down 53 percent from 2016 levels.
The September 12, 2019 new quota proposal from the DEA states (Federal Register page 48172):
As a result of considering the extent of

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Bringing Drug Use Out of the Shadows Reduces Harm to the Community as Well as to Users

September 19, 2019

Many critics of marijuana legalization raise concerns that marijuana dispensaries might serve as loci for increased local criminal activity. Now there is empirical evidence that just the opposite occurs.
A new study reported in the September issue of Regional Science and Urban Economics examined local crime rate data from 2013 through 2016 in Denver, Colorado, where legal cannabis sales to adults began in 2014. The researchers reported:
The results imply that an additional dispensary in a neighborhood leads to a reduction of 17 crimes per month per 10,000 residents, which corresponds to roughly a 19 percent decline relative to the average crime rate over the sample period. Reductions in crime are highly localized, with no evidence of spillover benefits to adjacent neighborhoods.

The study

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Response to Another “Epidemic” Is Likely to Generate Harmful Unintended Consequences–As Usual

September 11, 2019

After addressing the “meth epidemic” with the Combat Methamphetamine Epidemic Act of 2005 (don’t look now, but meth-related deaths are at historic highs, eclipsing those solely from prescription opioids), and after addressing the opioid epidemic by depriving patients of pain medication while driving nonmedical users to more dangerous drugs, it appears politicians, assisted by an eager press, are setting their sights on fixing the newest “epidemic:” the “growing epidemic of e-cigarette use in our children.”
Secretary of Health and Human Services Alex Azar announced today that the Food and Drug Administration is considering removing all flavored e-cigarettes from the market, with the exception of tobacco flavored one. Sales of e-cigarettes to those under age 18 have been banned in the U.S.

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Looming Doctor Shortage Demands Innovative Solutions

September 6, 2019

The Association of American Medical Colleges projects a severe physician shortage by the year 2032, particularly in the primary care fields, as the population of patients as well as doctors continues to age, according to a report today by CNBC.com. AAMC projects the national primary care shortage will range from roughly 47,000 to 122,000.

The news report focused on Arizona, one of the fastest growing states in the union, which has a shortage of primary caregivers in every county. Arizona ranks 44thout of the 50 states in total active primary care providers (PCPs), at 77.9 per 100,000 population (the national average is 91.7 per 100,000) according to a recent report from the University of Arizona.

To deal with the problem efforts are underway in the state to expand residency training

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Looming Doctor Shortage Demands Innovative Solutions

September 6, 2019

The Association of American Medical Colleges projects a severe physician shortage by the year 2032, particularly in the primary care fields, as the population of patients as well as doctors continues to age, according to a report today by CNBC.com. AAMC projects the national primary care shortage will range from roughly 47,000 to 122,000.
The news report focused on Arizona, one of the fastest growing states in the union, which has a shortage of primary caregivers in every county. Arizona ranks 44thout of the 50 states in total active primary care providers (PCPs), at 77.9 per 100,000 population (the national average is 91.7 per 100,000) according to a recent report from the University of Arizona.
To deal with the problem efforts are underway in the state to expand residency training

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Shaking Down Drug Makers Won’t Stop IV Drug Users

August 27, 2019

On August 26 Oklahoma State Judge Thad Balkman ruled that Johnson & Johnson must pay $572 million to the state of Oklahoma for contributing to the local opioid addiction crisis. Johnson & Johnson sold two opioids: a fentanyl skin patch with the brand name Duragesic, and Nucynta,a synthetic opioid similar to tramadol but stronger.
Nucynta is not as addictive as most other synthetic and semi-synthetic opioids and has been shown to have low levels of abuse in post-marketing studies. Fentanyl skin patches are very difficult and inconvenient to convert for non-medical use. The Drug Enforcement Administration claims that nearly all the fentanyl seized is so-called “illicit fentanyl,” manufactured mostly in powdered form in clandestine labs in Asia and Mexico, and then smuggled in to the

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It’s Not The Number of Pills–It’s The Number of Deaths That Matter

August 16, 2019

A letter to the editor in the August 14 New England Journal of Medicine by researchers at the University of Michigan proudly reported on the results of their effort, called the Michigan Surgical Quality Collaborative (MSQC), to reduce the volume of opioids prescribed for postoperative pain. The Collaborative developed a set of guidelines for its participating prescribers.
As a result, they found that from January 2017 through May 2018, the mean number of pills prescribed for postoperative pain decreased from 26 (+/-2) pills pre-guideline to 18 (+/– 3) pills post-guideline. Patient pill consumption also decreased from an average of 12 pills (+/-1) pre-guideline to 9 pills (+/-2) post-guideline. During that period there was no discernible difference in the pain scores reported by these

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The March Toward a Pre-Modern Approach to the Treatment of Pain Continues, Undeterred by Science

August 12, 2019

It seems that no amount of data-driven information can get policymakers to reconsider the hysteria-driven pain prescription policies they continue to put in place.
I can understand lay politicians and members of the press misconstruing addiction and dependency, but there is no excuse when doctors make that error. Yet National Public Radio reports that surgeons in 18 Upstate New York hospitals have agreed on an initiative to limit the amount of pain medicine they will prescribe to postoperative patients discharged from the hospital. The reporter says that researchers “now know” that patients prescribed opioids for postoperative pain “can become addicted” and that “the new prescription guidelines can prevent this particular gateway to abuse.” 
But what does the research show? One recent

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CDC Extols the Benefits of Naloxone⁠—Time to Make it OTC

August 7, 2019

Yesterday the Centers for Disease Control and Prevention reported that while naloxone prescriptions have increase 106 percent in the last year, the increase has been spotty, and largely confined to urban areas. Columbia University epidemiologist Katherine Keyes told the Los Angeles Times that she suspects the increase in naloxone distribution is contributing to what appears to be a stabilization of the opioid-related overdose rate in 2018. I agree, as I have written here. 
Distributing the opioid overdose antidote naloxone is one harm reduction measure that has gained widespread acceptance among policy makers, despite a few naysayers who believe making naloxone available presents a moral hazard and may encourage non-medical drug use.
Dr. Anne Schuchat, the CDC Principal Deputy

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New NBER Working Paper Confirms Needle Exchange Programs Reduce HIV—Does It Also Make The Case For Safe Injection Facilities?

August 2, 2019

A recently released working paper from the National Bureau of Economic Research by Analisa Packham of Vanderbilt University examined the impact of needle exchange programs (referred to as Syringe Exchange Programs or SEPs) on the incidence of HIV as well as overdose hospitalizations or deaths. The author concluded that the openings of SEPs decrease the rate of new HIV diagnoses by 18.2 percent. But she also pointed to evidence suggesting that they may be associated with an increase in visits to hospital emergency rooms for overdose, and an increase in overdose deaths. The author concluded, “needle exchanges alone may be less effective than other interventions at stimulating recovery.”
This paper was recently cited in National Review as an argument against needle exchange programs.

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Data From Germany Provide More Reasons For Policy to Shift From Prescription Pills to Harm Reduction

August 1, 2019

In February of this year, I co-authored a paper in the Journal of Pain Research explaining why there is no correlation between the amount of opioids prescribed and the incidence of non-medical use or prescription pain-reliever use disorder. That same month my colleague Jeffrey Miron and co-authors revealed similar findings in this Cato Institute Policy Analysis.
Now researchers in Germany have provided more evidence to pour cold water on the idea of any relationship between the volume of opioid prescribing and the incidence of opioid use disorder. Publishing in the German Medical Association’s international science journal, they found that “the number of persons addicted to opioids in Germany has hardly changes over the past 20 years,” with an average of 3.1 persons per 1000

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Trump Plan For Pharmaceutical Importation A Small Step In The Right Direction

August 1, 2019

On July 31 Secretary of Health and Humans Services Alex Azar announced a proposal that would allow US pharmacies, distributors, and states to import drugs from Canada that are sold there by US drug makers at prices well below the prices for which they are sold in the U.S. US pharmaceutical companies sell many of their products at much lower prices demanded by Canada’s central health ministry called Health Canada. The Secretary was authorized to implement this proposed policy by the Medicare Modernization Act of 2003.
This idea has been long opposed by US pharmaceutical companies. They argue that the Food and Drug Administration’s onerous regulatory requirements cause them to spend an average of 10 years and an estimated $2.6 billion in research and development costs to bring a new

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Senator Portman Presumes To Know How Many Days Of Pain Relief All 328 Million Americans Need

July 26, 2019

With clear evidence that restricting the number of prescriptions increased the death rate by driving non-medical users to heroin and fentanyl, the last thing one wants to hear about is a politician planning to double down on this deadly policy by calling for further prescription limits for patients in pain.
Yet Senator Robert Portman (R-OH) is proposing legislation that would impose a national 3-day limit on opioid prescriptions following surgeries. He will be kind enough to allow exceptions for people dealing with cancer, chronic pain, and “other serious matters”—whatever that means.
Government data show there is no correlation between the number of opioids prescribed and their non-medical use or the development of opioid use disorder. Overdose rates skyrocketed during the last 10

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Is an End in Sight to the Longest Running World War?

July 22, 2019

The War on Drugs is not only fought on the home front. In fact, it is the longest running world war. While Portugal has decriminalized all drugs, Uruguay never criminalized personal drug use and possession, the Czech Republic has decriminalized possession of small amounts of illicit drugs, and Norway and Mexico contemplate decriminalizing all drugs, the world-wide war on drugs continues apace. And drug prohibition’s futility and destruction are on world-wide display.
I have written about the resurgence of methamphetamine use and methamphetamine related overdose deaths in the US, despite state and federal efforts to solve the “meth crisis” earlier in this century. Now comes a report from the United Nations Office on Drugs and Crime that Southeast Asian gangs are making $60billion (US)

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When Addiction is Stigmatized and Criminalized We All Lose

July 21, 2019

In a recent Wall Street Journal column entitled Even Heroes Can Struggle With Addiction, Timothy McMahan King offers convincing evidence that the great British abolitionist and statesman, William Wilberforce, responsible for ending the slave trade within the British Empire in 1807, was an opium addict for much of his adult (and productive) life. Because of the stigma attached to addiction, most historians and biographers have hidden, ignored, or buried that fact.
Similarly, few of us who rely mainly on the history lessons we received in high school are aware of the regular and (by today’s standards) excessive use of alcohol, opium, and other drugs by our nation’s founders.
Even many in my profession do not know that the great William Halsted of Johns Hopkins University Medical School,

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Washington Post Revelation of Pain Pill Distribution Only Helps to Fuel the False Narrative

July 18, 2019

The Washington Post recently received access to a database maintained by the Drug Enforcement Administration that tracks the manufacture and distribution of every prescription opioid in the country. It reported that 76 billion pills were distributed throughout the US between 2006 and 2012, with higher volumes shipped to the areas that were most hard hit with opioid-related overdose deaths. 
This is being offered as proof that the overprescribing of prescription opioids caused the overdose crisis. But this flies in the face of other powerful evidence. Research reported in the Journal of Pain Research last February that examined data from the National Survey on Drug Use and Health as well as the Centers for Disease Control and Prevention show there is no correlation between the number

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Will Congress Finally X-Out the “X” Waiver?

July 16, 2019

Members of Congress are growing more appreciative of the benefits of Medication Assisted Treatment in addressing the overdose crisis. Two bills presently under consideration—one in the Senate and one in the House—are the latest evidence of that awareness. 
Medication Assisted Treatment for opioid use disorder is one of the most widely-accepted and least controversial of the tools in the harm reduction tool box. The strategy involves placing the patient on an orally-administered opioid that binds with enough opioid receptors to prevent painful withdrawal symptoms while, at the same time, not producing cognitive impairment or euphoria. The approach has been around since the 1960s and has greatly reduced overdose deaths as well as the spread of deadly infections from dirty needles.
One

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Senators Manchin and Braun Are Attempting to Practice Medicine Without a License—And Fighting the Wrong War

July 12, 2019

Senator Joe Manchin (D-WV) and Mike Braun (R-IN) are still trying to address the fentanyl and heroin overdose crisis—soon to be joined by a methamphetamine and cocaine overdose crisis—by denying chronic pain patients access to pain relief. They have just introduced a bill they call The FDA Opioid Labeling Accuracy Act, which would “prohibit the Food and Drug Administration (FDA) from allowing opioids to be labeled for intended use of ‘around-the-clock, long-term opioid treatment’ until a study can be completed on the long-term use of opioids.”
Set aside the fact that most pain specialists agree that, in some cases, long-term opioid therapy is all that works for some chronic pain patients. The 2016 guidelines on opioid prescribing put forth by the Centers for Disease Control and

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New Evidence From British Columbia Provides a Strong Case for Harm Reduction Strategies

July 8, 2019

A study published last month in the peer-reviewed journal Addiction by researchers at the British Columbia Centre for Disease Control and the British Columbia Centre on Substance Use found that harm reduction strategies were responsible for the province’s opioid-related overdose death rate being less than half of what it otherwise would have been between April 2016 and December 2017.
The researchers noted that 77 percent of opioid-related overdose deaths during that time frame involved illicit fentanyl. Vancouver has long been a major port of entry for fentanyl and fentanyl analogs, produced in China and other parts of East Asia, often using historic seaborn drug trade routes. 
During the 23 months ending December 2017 there were 2,177 overdose deaths in British Columbia, according to

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