Legalization is going to be a trip

 There is just nothing like dope for prophesy.
When it's cold and wet outside, your wood's dry, you have enough kindling, stew on the stove ... light up a dooby and make a prophesy. Or two. Then, as you get into the swing of the evening, make plans. It is very important to make plans in the winter time. Almost as important as forgetting them next summer when the prophesies, which were the basis for these plans, don't pan out.
Just as long as your mind is safely anchored to the future or an astral plane, you're just fine. But voices trying to reach you from the astral plane is another subject.
Or perhaps not. Maybe the voice of some recent immigrant to the plane from a seat on a rural county board of supervisors is bellowing down upon the policy makers of the state, saying:
You can practically see the dude yourself. Still got his Stetson on, a man of country girth, his boots squeak as he paces the gentle slope of his particular astral plane, careful to avoid falling off the edge into space.
The old coot was in a state of apoplexy usually reserved for the living because the people -- who he never allowed to speak for more than a minute or two in public meetings -- spoke up in the voting booth and made marijuana legal in California, the largest producer and exporter of marijuana in the nation.
The usual elected crowd of booze-and-coke heads harken to his cries, and set their pot smoking staffers to work on various schemes to raise enough taxes to build new county buildings, raise salaries for supervisors and department heads, even create new law-enforcement agencies to collect the incredible boon this new source of taxation presents.
Finally, the supe from the plane gets so mad he does fall off the edge of his astral plane and tumbles into space, still raving: There shall be no stoned nation without taxation! But the universe is a big place, even bigger than a big shot from a small county. He's too small a big shot to make a star in the sky, but he's out there, spinning around, muttering rabidly.
It's going to be a trip, as they say, to see how this one works out. -- blj
Sacramento Bee
Think California is ready for legal marijuana? Think again
California is far from ready, but the green rush is nonetheless upon us.
On New Year’s Day, commercial sales of recreational cannabis will become legal for adults. No one knows exactly what will happen. There could be a mad dash to pot stores, not unlike the one to Walmart every Black Friday. Or, because medical marijuana has been legal in California for decades, people might take legalization in stride. Or 1/1 could become the new 4/20.
But here’s what everyone should know: The rollout is going to be an absolute mess – a mess that will last longer than a day.
For months now, ever since voters passed Proposition 64 in 2016, regulators have been doing the equivalent of building a plane while flying it, slapping together policies in hopes of crafting a viable, multibillion-dollar industry that doesn’t crash and burn on takeoff. They’ve worked hard, but hints of the coming chaos are everywhere.
On Wednesday, a mere five days before adults will be able to walk into a store and buy a drug that is still banned by the federal government, Sacramento’s pot czar Joe Devlin spent hours trying to understand the finer points of Proposition 64.
He wondered aloud, for example, how to enforce a new limit on how much pot a person can buy per day: “Does the dispensary have to create a customer account or do you just check ID? I don’t know how you prove you're not exceeding the daily limit without creating a customer account.”
He also had unanswered questions about the newly required state permits for medical dispensaries. None had arrived yet. “If we don’t get an answer from the state, what does that mean? Shut them down?” he asked. Most dispensaries also had yet to meet the new labeling requirements for edibles already on their shelves. There were no stickers.
“What I hoped to see today were a bunch of people who are ready,” Devlin told a Bee editorial board member. “What I see is a bunch of people who are getting ready.”
The same thing is happening all over California.
Take the pace of commercial licensing. Under Proposition 64, local governments were given power to decide how – and even if – cannabis should be sold or grown within their jurisdictions. Oakland and San Diego took advantage of that early.
But not everyone has been eager to be a guinea pig. Many city councils and boards of supervisors have refused to even discuss cannabis, and those that have often have been slow to enact regulations for it, complicating matters for the state Bureau of Cannabis Control, which is now dealing with a slew of last-minute applications for licenses.
Modesto, for example, waited until the week before Christmas to decide to start accepting applications for retail sales and should begin issuing licenses by February. Stores in Los Angeles won’t open for weeks, as the city won’t start taking applications until Jan. 3, and San Francisco is running behind, too. Even in Sacramento, where the City Council has been proactive, it’s likely only a few of the city’s 30 medical dispensaries will be able to start selling recreational pot by early January. They are waiting on the state.
There also has been uncertainty over cultivation in Calaveras and Yolo counties. And Sacramento and Kern counties banned commercial pot altogether.
It’s enough to worry Lori Ajax, California’s top pot regulator. She told the Los Angeles Times she fears the state hasn’t “licensed enough people throughout the supply chain, and geographically across the state, so people can continue to do business.”
She knows that shortages and bottlenecks will only fuel the black market. That, in turn, will undermine the viability of the fledgling legal market.
It also doesn’t help that California has yet to find a way to get banks involved so the industry can stop dealing in wads of cash, instead of credit cards and checking accounts like other businesses. Efforts by the Brown administration to do so have been unsuccessful, and U.S. Attorney General Jeff Sessions is scaring away banks by hinting at a pointless federal crackdown on pot.
Ideas continue to surface about how to get smaller, regional banks to open accounts for state-licensed marijuana businesses, and then get those banks to work with larger, so-called “correspondent banks,” where accounts would be monitored by state inspectors. State Treasurer John Chiang, meanwhile, wants to create a government-owned bank that would serve cannabis businesses.
Both are good ideas, but this should have been worked out months ago. State policymakers must make this a top priority. With revenue projections of $7 billion, that’s a lot of opportunity for crime and missing tax revenue.
There are also lingering public health questions, a big reason we didn’t endorse Proposition 64.
For the past few weeks, local and state officials have been rushing to release information to educate Californians about the risks of using pot. How much is too much? What should first-timers take?What happens if kids use it? But there isn’t enough research to effectively answer those questions, another consequence of rushing to legalize weed.
So, on Monday, expect people to show up at stores unable to buy cannabis. And once they can buy it, expect some to drive while high. Expect car crashes, some fatal.
In the months to come, don’t be surprised if some pot delivery drivers and stores, with their wads of cash from customers, get robbed. Expect children to overdose on edibles left out by careless adults, and expect adults to overestimate their tolerance and get so high that they’ll end up having a panic attack or worse, scromiting, a syndrome in which regular weed users vomit uncontrollably.
In short, expect a mess.

Associated Press
Medley of agencies tasked with enforcing California pot laws
Associated Press

SAN FRANCISCO (AP) -- Licensed businesses around California can begin legally growing and selling marijuana for recreational use Monday, and a hodgepodge of enforcement agencies will be trying to make sure they adhere to a slew of new pot laws.
Since no single agency has overarching responsibility, supporters and opponents of legalization worry how well the laws will be followed.
Three state agencies will issue a combined 19 types of permits to growers, retailers, manufacturers and distributors. Each agency has enforcement officers tasked with cracking down on unlicensed operators.
In addition, other state agencies such as Fish and Wildlife and the Narcotic Enforcement Bureau said they will rely on marijuana task forces already in place to continue eradicating illegal growers and sellers.
The newly created state Bureau of Cannabis Control, which licenses retail outlets, said it has hired several officers to help crack down on unlicensed shops and plans to hire more in the coming months. But much of the work of arresting illegal operators will still fall to sheriffs and police departments.
"We are a pretty small operation," bureau spokesman Alex Traverso said.
He said about eight enforcement officers will be in place Jan. 1, though bureau chief Lori Ajax said enforcement won't be a priority in the first months of the new year as the agency focuses on getting retailers licensed.
The bureau has issued fewer than 200 temporary business licenses so far. That's a fraction of what ultimately will be distributed once Los Angeles, San Francisco and other major local governments start issuing their own licenses, which are required to get a state permit.
A small number of retail shops from Berkeley to San Diego say the will open New Year's Day.
While an increasing number of states have legalized marijuana in one form or another, all uses of the drug remain illegal under federal law. U.S. Attorney General Jeff Sessions has said federal authorities still are contemplating how they will enforce pot laws in California.
Assemblyman Tom Lackey has introduced legislation that would make the California Highway Patrol the point agency for enforcing state marijuana laws, especially those seeking to stem the flow of weed out of state.
"If we want to avoid intervention from the federal government, we need to do everything we can to crack down on illegal activity and prevent cannabis from being exported," the Palmdale Republican said. "Without a central point for coordinating action statewide, accomplishing this will be a huge challenge."
The bill will be considered when legislative sessions resume in January.
Ajax worked for 20 years in the state's Alcoholic Beverage Control Department before Gov. Jerry Brown appointed her to run the cannabis bureau. She said regulating marijuana is more complicated than policing alcohol because counties and cities have considerable authority over pot.
State laws include that consumers be at least 21, that businesses not be within 600 feet (183 meters) of schools and must close by 10 p.m. They're also required to have 24-hour video surveillance.
Counties and cities have similar requirements with a few twists. Oakland city officials, citing disparate marijuana arrest records, have given applicants convicted of pot-related felonies preference in obtaining permits in certain neighborhoods.
Several counties and cities used existing medical marijuana laws to adopt recreational use rules by striking the word "medical" from the ordinances, keeping in place existing local tax rates.
Marijuana businesses also will be required to pay state taxes. Some of the tax revenue is earmarked for enforcement, but sheriffs in several counties say they're already pouring resources into marijuana enforcement.
Siskiyou County leaders recently declared a state of emergency and called on the governor to assist the sheriff with eradicating an influx of illegal farms. The county banned commercial cultivation, but that hasn't stopped a migration of marijuana farmers snapping up cheap land in remote Northern California.
"We are overwhelmed," Sheriff Jon Lopey said.
Merced County banned outdoor growing earlier this year, which it had allowed since 2015, after law enforcement argued that outdoor cultivation had added to the violence in the area.
Mendocino County Sheriff Tom Allman has similar concerns in a county that has legalized marijuana in the heart of the fabled pot growing region called the Emerald Triangle.
"Please do not continue to say that marijuana is a totally harmless herb that God put on this Earth, and we don't know why we're fighting over it," he told county supervisors, who he said were overlooking the criminal aspects of growing marijuana.
In Los Angeles County, sheriff's officials are preparing to see a possible increase in marijuana dispensary robberies and drivers who are high behind the wheel.
Sheriff Jim McDonnell said he believes legalization will be "eye-opening for a lot of people."
"The public's perception is that weed is innocuous, that this is something they did 40 years ago and it is no big deal," he said. "Well, today's marijuana is not yesterday's marijuana. The active ingredient, THC, is so much higher today than back 40 years ago."
In some cases, the farmers are planting on government lands hidden deep in forests patrolled by state wildlife wardens. So-called guerrilla farms illegally set up on public property or remote private property without the owners' knowledge have troubled rural law enforcement officials and federal authorities for years.
California's Fish and Wildlife Department created a marijuana enforcement team three years ago to stem illegal gardens in the state's forests. The agency also created Watershed Enforcement Teams to crack down on marijuana farmers who illegally divert streams, used banned pesticides or otherwise harm the environment.
Fish and Game Capt. Paul Foy said the department has no plans to change its enforcement strategy after Jan. 1 and will continue to concentrate on environmental crimes and illegal farms on public lands.
An estimated 1,000 illegal farms controlled by organized crime operate on public property in California, he said.
"We're going to keep on keeping on with enforcement," Foy said. "We stay busy."

Ukiah Daily Journal
Sheriff condemns Mendocino County’s ‘gentle’ rules on cannabis
Ashley Tressel,

Mendocino County Sheriff Tom Allman chastised the Board of Supervisors Tuesday, saying it has lost control of local growers by writing rules that are too lenient.
Allman began his statement with an update on recent violent crimes associated with marijuana, connecting it to his criticism of how conversations about the controversial plant have been handled.
“Please do not continue to say that marijuana is a totally harmless herb that God put on this Earth, and we don’t know why we’re fighting over it,” he said, directed at the public.
Three incidents involving marijuana were reported by the Mendocino County Sheriff’s Office in the last 30 days: a suspected homicide, an alleged armed robbery and kidnapping, and an explosion at what Allman said is the largest marijuana extraction lab ever seen in California.
Allman gave new information about the body found on Covelo Road last week, saying it is likely that the unidentified 20-something Hispanic man’s alleged killing had something to do with marijuana. He also gave a previously unreported detail about the explosion at an illegal extraction lab in Willits Friday, that it contained more than $3 million of equipment. The Major Crimes Task Force is still investigating how the lab came to be there.
The robbery he mentioned took place at a Covelo cannabis grow last month, where a group of local men reportedly came to steal plants and forced a man on the property to help them at gunpoint. Five men were arrested in connection with the robbery.
Allman criticized the supervisors for being all too willing to overlook wrongdoing in the process of creating the county’s rules for cannabis, in his view, and he warned them not to let people get off easy.
“There has been no punishment for people who have been thumbing their noses at you,” he said. “They’re no longer thumbing their noses at law enforcement; they’re thumbing their noses at the Board of Supervisors by the nice, calm, easy laws that have been made. And they’re so gentle. And we’re so understanding. But that doesn’t stop the homicides.”
The board did not respond directly to that point, but interim Agricultural Commissioner Diane Curry later said that the majority of cultivators are playing by the rules, which Supervisor John McCowen agreed with.
“I think our cultivators are doing a really good job in trying to make this work and trying to comply,” said Curry.
In terms of the regulatory process, the county has further reached out to growers to help them come up with solutions to its current problems.
The county has started several working groups that hold open conference calls on issues needing a tuneup, including track and trace, building requirements, overlay and state requirements.
County CEO Carmel Angelo said they are bringing in a consultant for the overlay group, and they have already forwarded some questions on track and trace to the county’s vendor, SICPA, like whether plant tagging has to be immediately required. The groups have already gained much interest from the public, according to Angelo.
“Our goal is really to work through these issues, come up with some solutions, and then bring that back to the board,” she said.

Merced Sun-Star/AP
Anticipation high as California rolls out retail pot sales
Brian Melley
Californians may awake on New Year's Day to a stronger-than-normal whiff of marijuana as America's cannabis king lights up to celebrate the state's first legal retail pot sales.
The historic day comes more than two decades after California paved the way for legal weed by passing the nation's first medical marijuana law, though other states were quicker to allow the drug's recreational use.
From the small town of Shasta Lake just south of Oregon to San Diego on the Mexican border, the first of about 90 shops licensed by the state will open Monday to customers who previously needed a medical reason or a dope dealer to score pot.
In November 2016, California voters legalized recreational marijuana for adults 21 and older, making it legal to grow six plants and possess an ounce of pot. The state was given a year to set retail market regulations that are still being formalized and will be phased in over the next year.
"We're thrilled," said Khalil Moutawakkil, founder of KindPeoples, which grows, manufactures and sells weed in Santa Cruz. "We can talk about the good, the bad and the ugly of the specific regulations, but at the end of the day it's a giant step forward, and we'll have to work out the kinks as we go."
The long, strange trip to get here has been a frustrating one for advocates of a drug that in the federal government's eyes remains illegal and in a class with heroin.
The state banned "loco-weed" in 1913, according to a history by the National Organization for the Reform of Marijuana Laws, the pot advocacy group known as NORML. The first attempt to undo that by voter initiative in 1972 failed, but three years later felony possession of less than an ounce was downgraded to a misdemeanor.
In 1996, over objections of law enforcement, the drug czar under President Bill Clinton and three former presidents who warned it was an enormous threat to the public health of "all Americans," California voters approved marijuana for medicinal purposes.
While the rollout of grassroots collectives of growers and dispensaries where marijuana could be sold to patients was at times messy, the law led to wider acceptance of the drug as medicine.
"The heavens didn't fall," said Dale Gieringer, director of California NORML. "We didn't see increased youth drug abuse or increased accidents or crazy things happening as our opponents predicted."
Today, 28 other states have adopted similar laws. In 2012, Colorado and Washington became the first states to legalize recreational marijuana. California is one of five states, plus Washington, D.C., that followed suit. Retail sales are scheduled to begin in Massachusetts in July.
With wider acceptance, the aroma of marijuana smoke has become more pervasive in parts of California, and use accelerated after the legalization vote.
Even with other states as models for what works and what can go wrong as marijuana strains known as Sweet Skunk, Trainwreck and Russian Assassin hit the street, the next year is expected to be a bumpy one as more shops open and more stringent regulations take effect.
Alex Traverso, a spokesman for the state's Bureau of Cannabis Control, said Sunday that the agency has been working throughout the weekend to process as many licenses as possible. He says licenses will also be issued on New Year's Day. The agency so far has issued more than 300 licenses statewide for marijuana distributors, retailers and cultivators, he said.
The California Police Chiefs Association, which opposed the ballot measure, remains concerned about stoned drivers, the appeal the drug will have for young people as it becomes more normalized, and the cost of policing the new rules in addition to an existing black market.
"There's going to be a public health cost and a public safety cost enforcing these new laws and regulations," said Jonathan Feldman, a legislative advocate for the chiefs. "It remains to be seen if this can balance itself out."
For consumers, the most surprising revelation may be the dearth of places to get ganja. In theory, buying a joint, loose weed or a hash brownie should be as easy as finding a craft beer, but options are few as some cities have rejected retail sales and others have taken a more mellow approach toward licensing operations.
Pot-friendly San Francisco, a counter-culture hub where marijuana smoke has been a fixture for half a century, was late to establish local regulations and won't have any retail outlets open for business until later in the week. It's a similar situation in Los Angeles.
Meantime, Fresno, Riverside, Anaheim, Bakersfield and all of surrounding Kern County have prohibited pot shops, and Long Beach has a temporary ban.
For shop owners lucky enough to receive temporary licenses from the state and clear local red tape, anticipation is high.
Will Senn, founder of Urbn Leaf in San Diego, said the shop's four phone lines have been ringing off the hook for three months, but he's not sure what to expect when doors open at 7 a.m. with extra security and more than 60 employees at the ready for sales and deliveries.
"We're preparing for the worst and hoping for the best," Senn said. "We never want lines out the door and around the block. That's not what we're trying to accomplish here."
Shops at first will be able to sell marijuana harvested without the regulatory controls that eventually will require extensive testing for potency, pesticides and other contaminants. A program to track all pot from seed to sales also will be phased in, along with other protections such as child-proof containers for pot products.
Pot shop founder Jamie Garzot said she's concerned that when the current crop dries up, she'll encounter a shortage of marijuana that meets state regulations. The irony is that her 530 Cannabis shop in Shasta Lake is close to some of California's most productive growing areas, yet most of the surrounding counties won't allow cultivation that could supply her.
"Playing in the gray market is not an option," Garzot said. "California produces more cannabis than any state in the nation, but going forward, if it's not from a state-licensed source, I can't put it on my shelf. If I choose to do so, I run the risk of losing my license."
In 2016, the state produced an estimated 13.5 million pounds of pot, and 80 percent was illegally shipped out of state, according to a report prepared for the state by ERA Economics, an environmental and agricultural consulting firm. Of the remaining 20 percent, only a quarter was sold legally for medicinal purposes.
That robust black market is expected to continue to thrive, particularly as taxes and fees raise the cost of retail pot by as much as 70 percent.
Matt Brancale, 47, a marijuana user since the 1980s and a connoisseur of the plant's flowery buds, said he welcomes regulations that will bring a higher-quality product because of required testing. But he fears the price could spike once the government takes its share, and worries that revenue will be misspent.
"I also don't want to get taxed to the teeth on it," he said. "Are they going to try to squeeze every last ounce of tax revenue out of it? I assume they will. There's people that are drooling in Sacramento with the potential resource money."
San Francisco Chronicle
New era opens in California with first sales of recreational marijuana
Jill Tucker and David Downs
The first buyers were Chris Conrad and Mikki Norris, longtime marijuana advocates who purchased the three joints as the crowd cheered.
The couple had worked on the marijuana effort for more than two decades, pushed by their belief that its legalization is an issue that expands to social justice, civil rights and health care.
“When we started, George Bush the first was president,” Norris, 65, said. “Zero tolerance was the policy of this country.”
“We waited a long time for this” Conrad, 64, said.
The handful of shops making recreational sales Monday acquired both local and state licenses. They included Harborside, Purple Heart and Blum in Oakland; Berkeley Patients Group and Cannabis Buyers Club of Berkeley; 7 Stars Holistic Healing Center in Richmond; Mercy Wellness in Cotati; and Sparc and Solful in Sebastopol. Statewide, more than 400 shops have licenses to sell commercial cannabis.
Dale Gieringer, director of California Norml, a cannabis advocacy group, postponed a winter vacation by one day to see legal sales commence.
“This marks the welcome end of a century of prohibition —104 years to be accurate,” he said after watching the first sales at Harborside. “It’s wonderful that people aren’t being imprisoned for marijuana the way they used to be.”
At Purple Heart dispensary in Oakland, Keith Stephenson, chief executive and founder, watched a diverse array of people stream through the doors, including a well-coiffed senior citizen in a bright green windbreaker who was just ahead of a 20-something man in workout gear and a bike helmet.
In the 11 years he’s operated the dispensary, Stephenson has referred to the buyers as patients and had to correct himself a few times Monday morning as he got used to calling them “customers.” He recalled all the years he went to work wondering if he would get arrested for selling marijuana.
“This was the only job you could go to work and go to jail the same day,” he said.
But on Monday, Stephenson noted he’s added four cash registers and is remodeling the interior of his business.
Cannabis is “bringing industry to Oakland, it’s bringing jobs, it’s bringing tourism,” he said. “It’s an epic day.”
Stephenson predicted that California’s cannabis industry would reflect that state’s tastes, offering buyers artisanal products akin to cold-pressed olive oil or individualized drip coffee.
“We’re willing to pay for quality,” he said. “We are epicureans.”
While Oakland and Berkeley were among the first to authorize recreational marijuana, additional locations are expected to open in coming days and weeks, including outlets in San Francisco, where in-fighting among the city’s supervisors stalled recreational permits until Jan. 6.
But many parts of the state are expected to bar the sales altogether, including Marin and San Mateo counties and the city of Walnut Creek.
At some shops, the coming-out party featured live music, coffee and doughnuts, prizes for those first in line and speeches from supportive local politicians — a far cry from the days when the cannabis trade operated in the shadows.
“I feel like it’s been a struggle and a fight,” said Nicole Rice, 28, who was among the first in line at the Berkeley Patients Group, adding that it took years and voter persistence to pass the law. “It’s historic.”
Marijuana remains illegal by federal law. But several states, including Washington, Oregon, Colorado, Nevada and now California, have legalized both medicinal and recreational use.
Since November 2016, California law has allowed adults 21 or older to possess and transport up to 1 ounce of cannabis flower, as well as up to 8 grams of extract or infused foods. Smoking in public is still prohibited.
Medical marijuana will continue to be available through existing dispensaries to those with a valid ID and a doctor’s recommendation. But as of Monday morning, all customers buying cannabis products will pay a 15 percent state excise tax, which is expected to eventually bring in $1 billion or more a year for marijuana research, addiction prevention and boosted law enforcement, among other things.
Recreational customers must pay sales tax as well, unlike those with a state-authorized medical identification card. In addition, cities can choose to impose local cannabis taxes.
In Oakland, taxes for most customers will increase from 14.25 percent to 34.25 percent, according to Harborside officials.
Long lines of customers were willing to pay up Monday.
Anthony Moraga spent $120 on 3.5 grams of top-shelf buds, and another $32 in taxes, at Berkeley Patients Group.
“It’s the first time we can come out in public,” he said, “paying taxes on our legal purchase.”
Modesto Bee
County officials back proposal for second methadone clinic in Modesto
 Ken Carlson
Stanislaus County officials are supporting a private company’s proposal for expanding access to methadone and similar treatments for people who want to break addictions to opioids.
Aegis Inc. is considering locations for a second methadone clinic in Modesto to relieve pressure on its McHenry Avenue office amid the opioid epidemic. The state also has awarded a “hub-and-spoke” grant for Aegis that could extend its services to Oakdale and Patterson.
Company representatives said they have had favorable discussions with county and city officials regarding the second clinic in Modesto.
 “What we agree to do is assist them in any way we can,” said Rick DeGette, director of county Behavioral Health and Recovery Services. “We are working closely with them. We don’t want to miss an opportunity to provide access to care.”
With more than 30 clinics in California, Aegis administers methadone and other drugs to eliminate the cravings and withdrawal symptoms for people addicted to heroin or narcotic painkillers. Its clinics have sparked some controversy in other cities over methadone treatment and potential issues with neighbors.
The company has not decided where to put the second Modesto clinic. A $5 million state grant for Aegis could extend service to Oakdale and Patterson from a hub in Manteca, as part of a state response to the opioid crisis.
Physicians in Oakdale and Patterson could prescribe Suboxone for patients opting for medication-assisted treatment. The grant would pay for Suboxone, a safer but more expensive alternative to methadone, for addicts who lack insurance and would augment the outlying services with counseling and nursing support, Aegis Medical Director Lyn Raible said.
Aegis also has a goal for a medical unit in Turlock serving people addicted to opioids.
In a preliminary estimate earlier this year, the Centers of Disease Control and Prevention reported more than 42,000 overdose deaths in 2016 caused by opioid drugs such as heroin and pain pills, which was a 28 percent jump over 2015.
The new methadone clinic in Modesto will be smaller than the McHenry office, which serves 850 clients and has up to 300 names on a waiting list. Aegis promises a well-managed second clinic with around 500 patients.
“We don’t want them to feel like cattle getting herded through the office,” Raible said. “We want to operate as a medical office as much as possible.”
Methadone treatment was established in the 1970s for treating widespread heroin addiction and deterring drug-related crime, but has long been criticized for replacing one addictive drug with another and fostering long-term dependance in patients who stay on the drug for years. Methadone can be dangerous if mixed with alcohol and can be abused for euphoric and sedative effects, though it’s less intense than heroin.
A safer drug such as Suboxone has not supplanted methadone at the local Aegis clinic. Raible explained that the Medi-Cal program does not pay for Suboxone in narcotic treatment programs. It’s usually not covered by private insurance and is twice the cost of methadone for clients who pay out of pocket.
Patients can slowly taper off methadone but those managed by Aegis outpatient clinics are in no hurry to start the process.
“They should not be in a rush to taper down,” Raible said. “Our patients are with us an average of two years. We encourage them not to start tapering until they are stable for six months.”
Aegis cites research indicating that relapse is less likely among patients using methadone or Suboxone for longer periods. Drug addiction produces changes to neurons in the brain and with long-acting treatment with methadone, the neurons gradually return to normal function.
Aegis and Stanislaus County’s Genesis Narcotic Replacement Therapy program did not provide data on the number of patients who taper off methadone, a careful process that involves gradually reducing the daily dose.
Genesis, managed by county Behavioral Health and Recovery Services at 800 Scenic Drive, is another local source of methadone treatment, serving more than 370 people last year, including 312 new clients. Along with daily doses of methadone, the county program provides counseling and referrals to additional substance abuse treatment.
Genesis recently began issuing emergency prescriptions for Narcan, a medication that can stop the dangerous effects of opioid overdose for patients who relapse.
Dawn Vercelli, chief of county substance abuse services, said methadone patients have physiological dependance but don’t experience the impairment of opioid abuse if the drug is taken as prescribed. Regardless of the stigma of methadone treatment, studies over four decades have confirmed its benefits including fewer deaths among addicts, better compliance with mental health treatment, reduced crime and transmission of HIV, and recovered addicts returning to work and paying for housing, Vercelli said.
Clients may choose to taper off of methadone, but the cravings and withdrawal symptoms of opioid addiction may return, so the Genesis program makes staff support available, Vercelli said. People who relapse run the risk of a deadly overdose, she noted.
The director said the county program would need to generate a special report to provide data on how many clients are weaned off methadone.
Not a cure-all
Some families caught up in the crisis don’t think methadone is the cure-all for the opioid addiction. Modesto parents like Valerie Oehrke say methadone is not for everyone and more needs to be done to lower barriers for people who need to detox and gain access to recovery programs.
Oehrke said her 23-year-old son, who needed to withdraw from heroin, was turned away from the county’s Stanislaus Recovery Center in Ceres. A hospital emergency room was not able to provide assistance and private facilities wanted to charge thousands of dollars for detox service, she said.
Oehrke and her husband have twice nursed their son through detoxification at home, wrapping him in a blanket and giving him over-the-counter medicine for diarrhea.
According to Oehrke, an insurance carrier would not pay for inpatient treatment for her son after his release from an Oregon jail because he had not used drugs in the lockup. When her son relapsed and nearly died from an heroin overdose in a Seattle airport restroom, the insurance carrier approved treatment at New Hope Recovery in Modesto.
New Hope’s staff was able to negotiate more than 30 days of addiction treatment for the young adult, who is now in a sober living home.
“The problem is that clients don’t get the health care they deserve, they get what they negotiate for,” said Michelle Lucas, program director for New Hope, one of the privately run recovery programs in Modesto.
Lucas does not frown on methadone as one of the options for people trapped in addiction. New Hope is expanding its own reach with an application to serve as a vendor for the county’s Drug Medi-Cal delivery system, described as a new model for health services for residents with substance abuse disorders who are eligible for Medi-Cal.
New Hope also has plans for outpatient and residential treatment for 12- to 17-year-olds who are hooked on opioids. The services for adolescents could be offered starting in 2019.