Californians voted for tougher penalties for dealers. Florida, North Dakota and South Dakota rejected proposals to legalize marijuana. Massachusetts denied a measure allowing possession of psychedelics.An electorate that has grown increasingly restive over flagrant drug use and public disorder sent a sharp message through the ballot box on Tuesday.In state and local elections, voters approved tougher drug penalties and rejected measures to legalize recreational marijuana and psychedelics. San Francisco, one of the most progressive cities in the country, elected a mayor with no government experience who vowed to move aggressively against drug dealers.The results are the latest indications that the American public, besieged by a deadly addiction crisis decades in the making, is growing weary of experiments with more permissive drug policies and their visible impact on residential neighborhoods and downtown businesses.It is a sentiment that President-elect Donald J. Trump echoed on the campaign trail. “Our once-great cities have become unlivable, unsanitary nightmares, surrendered to the homeless, the drug-addicted, and the violent and dangerously deranged,” he said in one speech. “We are making the many suffer for the whims of a deeply unwell few.”The latest election results continue a trend seen across the country this year. In March, San Francisco voters approved proposals to screen welfare recipients for drug use and to expand police powers. New measures in cities and states across the country, such as Idaho, West Virginia and Philadelphia, clamped down on programs that distribute safe drug supplies, like sterile syringes, to prevent users from dying.“The philosophy that the only people who matter in drug policy are people who use drugs, and the only thing that matters for them is just making sure they can continue using without overdosing, has been completely rejected,” said Keith Humphreys, a professor at Stanford who is an expert on drug policy and treatment.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

At the Somerset County jail in rural Maine, prisoners addicted to opioids used to receive a daily pill to keep cravings in check. But as soon as they were released, their access to the medicine ended.As their cravings surged, they were re-entering society at high risk for withdrawal, relapse and overdose — dangers that newly released prisoners confront nationwide.“A lot of these inmates are our neighbors and it’s in our best interest to assimilate them back into the community, but some would end up dying,” said the Somerset County sheriff, Dale P. Lancaster. “For me, that’s not acceptable.”Hoping to change those grim outcomes, Sheriff Lancaster decided to try providing a different — and far less common — form of the medication, buprenorphine: an extended-release shot that subdues urges for about 28 days.According to a recent analysis in the journal Health and Justice about his jail’s pilot project, the switch had a remarkable effect. The long-acting injection afforded newly released prisoners a crucial buffer period after they were discharged, with more time to set up continuing addiction treatment and stabilize their lives.The jail’s experience is “an important step in showing where we as a society can go to cut back on people dying from this disease,” said Dr. Josiah Rich, a national expert in addiction and incarceration at Brown University, who was not involved in the project.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Some researchers argue that the roles of social environment and personal choice have to be considered in order to make progress in treating people addicted to drugs.The message emblazoned on a walkway window at the airport in Burlington, Vt., is a startling departure from the usual tourism posters and welcome banners:“Addiction is not a choice. It’s a disease that can happen to anyone.”The statement is part of a public service campaign in yet another community assailed by drug use, intended to reduce stigma and encourage treatment.For decades, medical science has classified addiction as a chronic brain disease, but the concept has always been something of a hard sell to a skeptical public. That is because, unlike diseases such as Alzheimer’s or bone cancer or Covid, personal choice does play a role, both in starting and ending drug use. The idea that those who use drugs are themselves at fault has recently been gaining fresh traction, driving efforts to toughen criminal penalties for drug possession and to cut funding for syringe-exchange programs.But now, even some in the treatment and scientific communities have been rethinking the label of chronic brain disease.In July, behavior researchers published a critique of the classification, which they said could be counterproductive for patients and families.“I don’t think it helps to tell people they are chronically diseased and therefore incapable of change. Then what hope do we have?” said Kirsten E. Smith, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine and a co-author of the paper, published in the journal Psychopharmacology. “The brain is highly dynamic, as is our environment.”The recent scientific criticisms are driven by an ominous urgency: Despite addiction’s longstanding classification as a disease, the deadly public health disaster has only worsened.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Legal maneuverings followed a Supreme Court ruling last month that denied the Sackler family immunity from liability over its role in the opioid crisis.Purdue Pharma’s creditors and more than 40 states are preparing a barrage of legal actions against members of the Sackler family, less than two weeks after the Supreme Court denied them legal immunity for their role as the company’s owners in the opioid crisis.Purdue itself is supporting a proposal by a group of its creditors to sue individual Sacklers for transferring billions of dollars out of the company and into family trusts and overseas holding companies.The motions, some filed and others in the planning stage, are part of intense maneuvering to pressure the Sacklers to settle thousands of opioid lawsuits brought years ago against them and their company. Negotiations are expected to begin imminently in mediation sessions and are widely seen as a last-ditch effort to reach a deal. If one isn’t struck by Sept. 9, thousands of lawsuits against the company and family members, which have been on hold for nearly five years, are likely to proceed.The Supreme Court’s ruling, on June 27, effectively dissolved an agreement negotiated between the Sacklers and Purdue, the manufacturer of the prescription opioid OxyContin, and states, local and tribal governments as well as individuals and other groups. Under that plan, the Sackers had agreed to contribute $6 billion — but only on the condition that they be granted protection from all civil lawsuits involving opioid claims.The court said that although Purdue was entitled to liability protections, the Sacklers were not eligible. That is because Purdue sought bankruptcy restructuring, in which liability shields are commonly granted, but the Sacklers did not file for personal bankruptcy.The court’s ruling effectively toppled a Jenga tower that had been years in the making. Payments by Purdue and the Sacklers had been designated for opioid treatment and prevention and to compensate survivors.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Plaintiffs and the company vowed to renegotiate but the talks will be challenging after the court struck down a provision the Sacklers had insisted on in exchange for $6 billion.The hard-fought settlement of thousands of lawsuits against Purdue Pharma was close to capsizing on Thursday, after the Supreme Court rejected liability protections for the company’s owners. The ruling effectively prevents the release of billions of dollars that could help alleviate the ravages of opioid addiction.The future of the cases, some of which are a decade old, is now in limbo, as states, local governments, tribes and more than 100,000 individuals who sued the company, best-known for its prescription painkiller OxyContin, figure out next moves.The court effectively upended the settlement by striking down a provision that Purdue’s owners, members of the billionaire Sackler family, had insisted upon: immunity from all current and future opioid lawsuits in return for payments of up to $6 billion to plaintiffs.In a statement, Purdue called the decision “heart-crushing,” because the settlement had been agreed to by an overwhelming majority of plaintiffs.“We will immediately reach back out to the same creditors who have already proven they can unite to forge a settlement,” the company said, so that Purdue could emerge from bankruptcy and funds could begin to flow.In statements, a number of states said they, too, were eager to resume talks.“The court’s ruling means we now have to go back to the negotiating table. Purdue and the Sacklers must pay so we can save lives and help people live free of addiction.,” Josh Stein, the attorney general of North Carolina, said. “If they won’t pay up, I’ll see them in court.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

His marriage fell apart as his addiction to crack cocaine deepened. The Times would like to speak with families shaken by a loved one’s drug addiction.Hunter Biden, the president’s son, is being tried in federal court for falsely claiming on a gun purchase application that he did not use illicit drugs. Testimony from his ex-wife and former girlfriends describe his drug-fueled temper; his search for his dealer on the streets; his large cash withdrawals from the bank.Hallie Biden, the widow of his brother Beau who dated him during the fall of 2018 when the gun purchase took place, spoke of his erratic behavior, his possession of rocks of crack cocaine “the size of Ping-Pong balls, or bigger, maybe” and how she frantically urged him to go to rehab. She, like Mr. Biden, is in recovery.I write about addiction for The New York Times and have spoken with countless families who have shared wrenching experiences. I’m working on an article about how the Bidens’ addiction saga is reverberating for families who are also grappling with America’s deadly addiction crisis.To better understand evolving public views toward addiction, I would like to hear your stories. I’ll read each response and reach out if I’d like to learn more. I won’t publish any part of your response without following up and verifying your information. And I won’t share your contact information outside the Times newsroom or use it for any reason other than to get in touch with you.

Preliminary numbers show a nearly 4 percent decrease in deaths from opioids, largely fentanyl, but a rise in deaths from meth and cocaine.Overdose deaths in the United States declined slightly last year, the first decrease in five years, according to preliminary federal data released Wednesday.The rare good news in the decades-old addiction crisis was attributable mostly to a drop in deaths from synthetic opioids, chiefly fentanyl, said researchers at the National Center for Health Statistics, who compiled the numbers.But the full portrait of the death toll from street drugs remains grim. Even as opioid deaths fell, deaths from stimulants such as cocaine and methamphetamine rose. And some states, including Oregon and Washington, continued to experience sharp rises in overall overdose fatalities.Drug overdoses overall in 2023 were estimated at 107,543, down from 111,029 in 2022, a 3 percent drop. Opioid deaths fell 3.7 percent while deaths from cocaine rose 5 percent and deaths from meth rose 2 percent.The report from the health statistics agency, an arm of the Centers for Disease Control and Prevention, did not offer reasons for the drop. But naloxone, a drug that reverses opioid overdoses, has become more widely available: In 2023, 22 million doses of Narcan, the best-known brand, were distributed in the United States and Canada. Test strips for users to detect the presence of fentanyl in a drug became more popular, and many communities and clinics offered programs that hand out sterile syringes.Dr. Bruce Hurley, president of the American Society of Addiction Medicine, a professional organization of more than 7,500 treatment providers, said that the group appreciated what he called “the leveling of the overdose curve.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Grieving families want official records and popular discourse to move away from reflexive use of “overdose,” which they believe blames victims for their deaths.The death certificate for Ryan Bagwell, a 19-year-old from Mission, Texas, states that he died from a fentanyl overdose.His mother, Sandra Bagwell, says that is wrong.On an April night in 2022, he swallowed one pill from a bottle of Percocet, a prescription painkiller that he and a friend bought earlier that day at a Mexican pharmacy just over the border. The next morning, his mother found him dead in his bedroom.A federal law enforcement lab found that none of the pills from the bottle tested positive for Percocet. But they all tested positive for lethal quantities of fentanyl.“Ryan was poisoned,” Mrs. Bagwell, an elementary-school reading specialist, said.As millions of fentanyl-tainted pills inundate the United States masquerading as common medications, grief-scarred families have been pressing for a change in the language used to describe drug deaths. They want public health leaders, prosecutors and politicians to use “poisoning” instead of “overdose.” In their view, “overdose” suggests that their loved ones were addicted and responsible for their own deaths, whereas “poisoning” shows they were victims.“If I tell someone that my child overdosed, they assume he was a junkie strung out on drugs,” said Stefanie Turner, a co-founder of Texas Against Fentanyl, a nonprofit organization that successfully lobbied Gov. Greg Abbott to authorize statewide awareness campaigns about so-called fentanyl poisoning.“If I tell you my child was poisoned by fentanyl, you’re like, ‘What happened?’”, she continued. “It keeps the door open. But ‘overdose’ is a closed door.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Here’s what to know about the legislation, which the state legislature is expected to approve overwhelmingly on Wednesday.The Alabama legislature on Wednesday is expected to pass legislation that will make it possible for fertility clinics in the state to reopen without the specter of crippling lawsuits.But the measure, hastily written and expected to pass by a huge bipartisan margin, does not address the legal question that led to clinic closings and set off a stormy, politically fraught national debate: Whether embryos that have been frozen and stored for possible future implantation have the legal status of human beings.The Alabama Supreme Court made such a finding last month, in the context of a claim against a Mobile clinic brought by three couples whose frozen embryos were inadvertently destroyed. The court ruled that, under Alabama law, those embryos should be regarded as people, and that the couples were entitled to punitive damages for the wrongful death of a child.Legal experts said the bill, which Governor Kay Ivey has signaled she will sign, would be the first in the country to create a legal moat around embryos, blocking lawsuits or prosecutions if they are damaged or destroyed.But though the measure is likely to bring enormous relief to infertility patients whose treatments had been abruptly suspended, it will do so in exchange for limiting their ability to sue when mishaps to embryos do occur. Such constraints in a field of medicine with limited regulatory oversight could make the new law vulnerable to court challenges, the experts said.Here are answers to some key questions:What does the measure do?It creates two tiers of legal immunity. If embryos are damaged or destroyed, direct providers of fertility services, including doctors and clinics, cannot be sued or prosecuted.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A ruling by the state’s Supreme Court could change common practices at fertility clinics in the state and possibly nationwide.The Alabama Supreme Court has opened a new front in the legal debate over when human life begins. Embryos created and stored in a medical facility must be considered children under the state’s law governing harmful death, the court ruled.Friday’s ruling was cheered by anti-abortion activists nationwide, who have long argued that life begins at conception. They were thrilled that, for the first time, a court included conception outside the uterus in that definition. But the strongest and most immediate effect of the decision will be on fertility patients trying to get pregnant, not women seeking to end their pregnancies.The Alabama ruling invites states to enact strict new regulations over the fertility industry that could sharply limit the number of embryos created during a cycle of medical treatment and affect the future of millions of stored frozen embryos. A concurring opinion even offered road maps for such statutes. That could have a chilling effect on a person seeking to have children through in vitro fertilization, whether single or part of a same-sex or heterosexual couple.What did the ruling say?The ruling is actually somewhat narrow. It applies to three couples who had sued the Center for Reproductive Medicine, a fertility clinic in Mobile, for inadvertently destroying their embryos. The plaintiffs argued that they were entitled to punitive damages under Alabama’s 1872 Wrongful Death of a Minor Act. Two lower state courts disagreed, saying the embryos were neither people nor children. The State Supreme Court reversed those rulings, saying that the embryos fell squarely under Alabama’s definition of minors and that the negligence lawsuits could proceed. The case will now go back to the State District Court for further litigation.What did the ruling not say?The decision is silent on the fate of other frozen embryos in Alabama because that issue was not before the court. The ruling is only about the terms under which plaintiffs may bring a negligence case against a fertility clinic for embryo destruction. However, it could eventually have major consequences for Alabama patients and providers.On Wednesday, the I.V.F. clinic at the University of Alabama at Birmingham announced it was temporarily closing to explore the implications of the court’s ruling on its patients and providers. One fear is that the clinic, doctors and even patients may face daunting new liability issues surrounding the handling of embryos.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.