Supreme Court Lights Up

Unlikely to let states sue over low tar cigarettes.

Can states sue tobacco companies for marketing one of the most addictive products known to man? Not if the claim hinges on deceptive claims about “light” cigarettes, the U.S. Supreme Court seemed to say last Monday.

The Court began its new term by taking up the tobacco case, in which three residents of Maine filed suit against Altria Group Inc. and its subsidiary, Philip Morris USA, under a state law barring unfair marketing practices. According to an Associated Press report, the plaintiffs argued that Philip Morris had long known that smokers of low tar cigarettes compensate by taking longer puffs and smoking more cigarettes.

After being thrown out by a federal district court, a U.S. Circuit Court of Appeals allowed the suit to proceed. Several similar cases are in progress around the country, pending a decision. If the Supreme Court finds against Philip Morris and its parent company Altria, states could initiate a new round of lawsuits as tobacco manufacturers once again face the prospect of huge class-action settlements.

Industry Week reported that Altria’s defense is that “cigarette packaging falls under the domain of the U.S. Federal Trade Commission (FTC), which failed to act despite being aware that light cigarettes were no less a health hazard than regular cigarettes.”

In other words, Altria knew that its advertising was deceptive—but so did the FTC, which approved it. Judge Samuel Alito summed up this thinking when he told an FTC attorney that by allowing cigarette ads to display tar and nicotine levels, “You have misled everyone who has bought these cigarettes for a long time.”

Chief Justice Roberts, according to the AP report, questioned why the case was focused on deception rather than the relationship between cigarettes and health: “How do you tell it’s deceptive or not unless you look at smoking and health?”

At the heart of the argument is the question of whether the 1966 federal legislation governing cigarette labeling and advertising takes precedence over more recent state legislation. Representing Altria, conservative attorney Theodore Olson found himself in the odd position of arguing that federal law should take precedence over state law.

Clifford E. Douglas of the University of Michigan’s Tobacco Research Network, told the New York Times in May that the difficulties of pushing forward with cases against light cigarettes “underscores the need to combat the light cigarette scam in the public policy arena.” Douglas said he supported legislation that would give the U.S. Food and Drug Administration (FDA) authority to regulate tobacco.

The New York Times reported that a bill under consideration in Congress “would ban the use of terms like light and low-tar in marketing such cigarettes, which contain the same tobacco as other cigarettes but have filters that allow more air to mix with the smoke, diluting it.”

smoking nicotine

Drugs on the Ballot

States to vote on drug policy proposals.

The Drug War Chronicle has done an excellent job of rounding up the various drug policy initiatives that will appear on state ballots in November. The majority of these initiatives concern marijuana decriminalization, medical marijuana, and prison sentencing reform. The Drug War Chronicle reports in its October 3 issue that the pace of drug policy initiatives has slowed, compared to the beginning of the decade, when medical marijuana initiatives were on the ballot in dozens of states.

While California voters will be asked to strengthen their support of medical marijuana and lessen penalties for possession, voters in Michigan and Massachusetts will have the opportunity to follow California’s lead with marijuana decriminalization initiatives of their own. Michigan’s Proposition 1 would legalize the use of marijuana with a doctor’s recommendation, and would also allow a medical necessity defense when marijuana cases are being prosecuted. According to the Chronicle, a recent poll showed that 66 per cent of Michigan voters favored the proposal. In Massachusetts, Question 2 on the ballot would legalize the possession of up to an ounce of marijuana.

California’s Proposition 5 builds on the original work Proposition 36, the 2002 initiative that kicked off the medical marijuana movement in that state. Proposition 5 would divert drug offenders into treatment rather than prison, expand prison rehab programs, and decriminalize possession of an ounce or less.

In Oregon, a medical marijuana initiative is slated for the 2010 election. This year, Ballot Measures 61 and 57 attempt to move things in the opposite direction by imposing stiff mandatory minimum prison sentences for a variety of drug offenses.

There are also some municipal policy initiatives up for a vote this year, including Measure JJ in Berkeley, California. The measure seeks to “broaden and regularize medical marijuana access” through additional dispensaries and uniform operating rules. Fayetteville, Arkansas has a grassroots initiative that would mandate adult marijuana possession as “the lowest law enforcement priority.”

Finally, voters on the Big Island of Hawaii will confront Ballot Question 1, which in essence prohibits law enforcement from spending any money to enforce laws against adult marijuana possession. The Drug War Chronicle says that the initiative was the product of “Project Peaceful Sky, a local grassroots organization whose name alludes to the disruption of tranquility caused by law enforcement helicopters searching for marijuana.”

medical marijuana

John McCain and Ambien

Is he sleep-driving through the campaign?

After the last three weeks of erratic and unpredictable behavior from presidential candidate John McCain, it seems reasonable to revisit an issue first raised in May by ABC News: Is McCain’s use of the drug Ambien as a sleep aide affecting his behavior and judgment?

After the press was allowed a brief look at candidate McCain’s medical records earlier this year, Dr. Peter A. Fotinakes of the St. Joseph Sleep Disorders Center in Orange, California, told ABC News that, while Ambien was generally a safe medication, “Taking more than the recommended dosage of Ambien or combining it with other sedative-hypnotics--for example, alcohol—may result in amnesia, fugue states, and sleep walking.”

Ambien’s official website lists other reported effects: “A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of sedative/hypnotics. Some of these changes may be characterized by decreased inhibition (e.g. aggressiveness and extroversion that seemed out of character)....”

In addition, some users have reported bizarre personality changes such as excessive agitation and depersonalization (a dissociative disorder in which the patients self-perception is disrupted). A very small percentage of patients suffer hallucinations attributed to Ambien.

However, the most baffling side effect of Ambien is so-called “sleep-driving,” in which a person on Ambien drives a car, even though they are not fully awake, and then suffers amnesia about the event afterwards. Combining alcohol and Ambien increases the risks of such amnesiac behaviors, variations of which can include “preparing and eating food, making phone calls, or having sex,” all without conscious awareness, according to the Ambien website.

And there are particular caveats associated with the use of Ambien in elderly patients. “Impaired motor and/or cognitive performance after repeated exposure or unusual sensitivity to sedative/hypnotic drugs is a concern in the treatment of elderly and/or debilitated patients.... These patients should be closely monitored.”

Finally, Ambien users may also experience some of the following central and peripheral nervous system side effects: Confusion, vertigo, euphoria, agitation, difficulty concentrating, emotional lability, and “decreased cognition.” Ambien causes withdrawal symptoms when abruptly discontinued. Moreover, like the benzodiazepines, it can be addictive for some people.

Last year, the U.S. Food and Drug Administration (FDA) tightened labeling regulations on the newer sleep drugs like Ambien to reflect the possibility of these strange behaviors. In 2006, a class action suit was filed against Sanofi-Aventis, the makers of Ambien.

Recovery and Stigma

Jason Schwartz at Addiction and Recovery News has a similar reaction to the happy spin SAMHSA put on its recent survey:

Addiction and Recovery News: Recovery and stigma

"I'm not sure what to make of the prevention attitudes," Jason writes. "I suspect SAMHSA finds them encouraging, but I assume that they are more symptomatic of the belief that addiction has a lot to do with a person "losing their way", "getting hooked", or falling in with the wrong crowd."

Addiction: The Stigma Lives On

Would you live next door to a drug addict?

A telephone survey by the Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the U.S. Department of Health and Human Services, shows that public attitudes toward addiction and recovery are still laced with negativity.

Undertaken as part of National Alcohol and Drug Addiction Recovery Month, the survey was released in late September. For all the positive spin SAMHSA puts on the findings—emphasizing that only a fifth of survey respondents said they would think less of a friend or relative who was in recovery from addiction--the telephone survey also showed that negative attitudes and stigmas associated with drug and alcohol addiction are slowly waning—but still demonstrably present. People continue to view alcohol addiction differently than drug addiction. Only about 60 per cent of Americans said they would be comfortable living next door to someone in recovery from alcohol abuse. In contrast, (SAMHSA), a branch of the U.S. Department of Health and Human Services, shows that public attitudes toward addiction and recovery are still laced with negativity. Less than half of the respondents said they would be comfortable living next door to someone in recovery from drug abuse.

In addition, the public remains split on the role of “willpower” in treatment and recovery from addiction: “Slightly less than half of the general public (44%) believes that people who are addicted to alcohol could stop using the substance if they had enough willpower. Even fewer (38%) believe that people who are addicted to drugs could stop using them if they had enough willpower. However, two population segments with statistically significant differences from the general public are African Americans and young adults age 18 to 24. Both groups are much more likely than other population categories to believe addiction can be stopped by willpower.”

Other evidence of addiction stigmas:

• “Almost one-third would think less of a person with a current addiction.”

• “Almost three-quarters of young adults agree with the statement that people who are addicted to alcohol could stop if they had enough willpower. Twice as many young adults age 18 to 24 believe that willpower could play a decisive role in recovery from addiction than does the general population.”

• “In general, the older a person is, the more likely he or she is to think less of someone who is in recovery from drugs or alcohol, and the less likely he or she is to feel comfortable with someone in recovery from alcohol or drug abuse. In general, respondents are more comfortable with someone in recovery from alcohol abuse than drug addiction."

• Overall, respondents feel that persons who are addicted to illicit drugs such as cocaine and heroin are much more of a danger to society than those addicted to alcohol, prescription drugs, or marijuana.”

• “Females are much more likely than males to agree that individuals who are addicted to any of the substances mentioned in the survey are dangers to society. This is particularly true in relation to alcohol addictions.”

• “Women are more likely than men to agree that a person in recovery from an addiction to prescription drugs or illicit drugs can live a productive life.”

• “Respondents see programs to help people with addictions to alcohol, marijuana, and prescription drugs more favorably than treatment programs designed to help people with addictions to illicit drugs such as heroin, cocaine, or methamphetamines.”



addiction drugs

McCain on Drugs

Full speed ahead on the Drug War.

One issue largely missing in action during the presidential campaign has been the Drug War, and all the policy implications for addiction treatment that go with it. Our thanks go out to OnTheIssues blog for compiling the admittedly skimpy record of public statements about drug policy by both candidates. In this post, we examine the on-the-record views of Republican candidate John McCain.

In his long career in the U.S. Senate, John McCain’s support for the Drug War has never wavered. Campaigning for president in 2000, McCain’s positions were the most hawkish of the four major candidates, the Boston Globe reported. “He wants to increase penalties for selling drugs, supports the death penalty for drug kingpins, favors tightening security to stop the flow of drugs into the country, and wants to restrict availability of methadone for heroin addicts.”

This latter position was embodied in the “Addiction Free Treatment Act” that McCain introduced in the Senate in 1999, which called for defunding any drug program that used methadone, unless the program followed a restrictive set of guidelines.

McCain has criticized the former Clinton administration for going “AWOL on the war on drugs,” and has pushed tirelessly for greater military assistance to drug-exporting nations like Columbia.

In more recent activity, Senator McCain sponsored a a 2005 bill, “The Clean Sports Act,” mandating drug testing in all major professional sports leagues. And in 2006, McCain signed on to the “Safe Streets Act Amendment,” which called for federal grants to Indian tribes to fight methamphetamine addiction.

This year, “McCain met with Mexican President Felipe Calderon to discuss immigration, trade and the recently passed Merida Initiative, a $400 million U.S. aid package to help Mexico fight an increasingly bloody drug war that has claimed more than 1,800 lives this year.”

“Drugs is a big, big problem in America,” McCain said in a fact-finding trip to Columbia in July. “The continued flow of drugs from Colombia through Mexico into the United States is still one of our major challenges for all Americans.”

McCain’s response last year to a New Hampshire police officer’s question about the failure of the Drug War does not bode well for the prospects of responsible changes in drug awareness and addiction treatment in a McCain administration: “Look, I've heard the comparison between drugs and alcohol. I think most experts would say that in moderation, one or two drinks of alcohol does not have an effect on one's judgment, mental acuity, or their physical abilities. I think most experts would say that the first ingestion of drugs leads to mind-altering and other experiences, other effects, and can lead over time to serious, serious problems."

A search of the McCain-Palin campaign website for the term “drug war” came up empty.

Obama on Drugs

Will he do anything about the Drug War?

One issue largely missing in action during the presidential campaign has been the Drug War, and all the policy implications for addiction treatment that go with it. Our thanks go out to OnTheIssues blog for compiling the admittedly skimpy record of public statements about drug policy by both candidates. In this post, we examine the on-the-record views of Democratic candidate Barack Obama.

The official Obama plan, as outlined in his campaign booklet, Blueprint for Change, calls for greater use of drug courts, job training for ex-offenders, and the elimination of sentencing disparities like the crack/powdered cocaine inequities. He does not favor lowering the current drinking age from 21 to 18, despite a collective push to do so by dozens of university presidents.

In an AP report posted at Drug WarRant, Obama said, “I’m not interested in legalizing drugs.” His focus, he said, was on emphasizing the public health approach to drugs over the prison approach. “All we do is give them a master’s degree in criminology.”

In a speech at Howard University, he told the crowd that “it’s time to take a hard look at the wisdom of locking up some first-time, non-violent drug users for decades.... We will review these sentences to see where we can be smarter on crime and reduce the blind and counterproductive warehousing of non-violent offenders.... So let’s reform this system. Let’s do what’s smart. Let’s do what’s just.”

In reference to the HIV/AIDS crisis, Obama has said that “we have to look at drastic measures, potentially like needle exchange in order to insure that drug users are not transmitting the disease to each other. And we’ve got to expand on treatment.”

Obama himself--a former cigarette smoker--is no complete stranger to drugs, having admitted to high school and college drug use in his book, Dreams from My Father. On page 87, he writes that he used to get high as a way to “push questions of who I was out of my mind, something that could flatten out the landscape of my heart, blur the edges of my memory.... Everybody was welcome into the club of disaffection. And if the high didn’t solve whatever it was that was getting you down, it could at least help you laugh at the world’s ongoing folly and see through all the hypocrisy and bullshit and cheap moralism.”

On a Tonight Show appearance with Jay Leno, when reference was made to President Bill Clinton’s famous claim that he “didn’t inhale,” Obama responded, “That was the point.”

As Kurt Schmoke, the former mayor of Baltimore, wrote: “The relative silence by presidential candidates about the War on Drugs has been disappointing but not surprising. The next president will be in office when we commemorate the one hundredth anniversary of the Harrison Narcotics Act, which many consider to the beginning of the war on drugs. Hopefully, the new president will listen to the voices of reform....”

It appears that Senator Obama is at least partially receptive to the goal of changing national drug policy “to make the war on drugs a public health battle rather than a criminal justice war,” as Schmoke wrote.