Saudi attempts to distance crown prince from Khashoggi killing haven’t quieted uproar

ISTANBUL —
Saudi Arabia’s foreign minister denied on Sunday that the nation’s powerful young crown prince ordered Jamal Khashoggi’s killing, but the attempt to distance Mohammed bin Salman from the journalist’s demise did little to blunt an international uproar that could test Saudi Arabia’s status as a regional power.
At the same time, Saudi officials have failed to answer questions about where Khashoggi’s remains are and have offered inconsistent narratives for how he was killed, undermining the government’s assertion that Khashoggi died after a fistfight broke out when he was confronted by agents seeking to bring him back to Riyadh while he was visiting the Saudi Consulate in Istanbul on Oct. 2.
That explanation will face a fresh challenge on Tuesday when Turkish President Recep Tayyip Erdogan is expected to reveal details of his government’s investigation into the killing of Khashoggi, a move that could directly contradict Saudi Arabia’s official account of what happened inside its consulate.
Erdogan said he would explain the episode “in a very different way” when his ruling party meets, adding to the already intense global pressure Saudi leadership has faced to provide a full picture of how Khashoggi was killed.
“We seek justice and this will be revealed in all its naked truth, not through some ordinary steps but in all its naked truth,” Erdogan said on Sunday, according to the semiofficial Anadolu news agency. “The incident will be revealed entirely.”
Meanwhile, Saudi Arabia’s foreign minister sought to contain the fallout on Sunday while telegraphing the kingdom’s priority: shielding Mohammed bin Salman, the crown prince and de facto ruler, from growing speculation that Khashoggi’s killing could not have happened without his knowledge or consent.
“This was an operation that was a rogue operation,” Adel al-Jubeir told Fox News. “This was an operation where individuals ended up exceeding the authorities and responsibilities they had. They made a mistake when they killed Jamal Khashoggi.”
Senior Republicans and Democrats proposed a range of severe punishments, including sanctions on the longtime U.S. ally, the expulsion of the Saudi ambassador and the cutting of arms sales. Nearly all of the calls for repercussions have centered on whether Mohammed knew of or ordered the operation to kill Khashoggi, a U.S.-based Washington Post contributing columnist and former royal insider turned critic.
“It’s my thinking that MBS was involved in this, that he directed this and that this person was purposefully murdered,” Sen. Bob Corker (R-Tenn.) said  Sunday on CNN’s “State of the Union,” referring to the crown prince.
Corker — who chairs the Senate Foreign Relations Committee — called for a “collective response” by the United States, Britain, France and Germany if an investigation reveals that the crown prince was behind Khashoggi’s killing.
During an appearance Sunday on NBC’s “Meet the Press,” Sen. Richard J. Durbin (D-Ill.) said the Saudi ambassador should be formally expelled from the United States if an investigation shows the crown prince’s involvement.
Jubeir denied on Sunday that Mohammed had any prior knowledge of the operation and said that the agents involved “weren’t people closely tied” to him.
“Even the senior leadership of our intelligence service was not aware of this,” Jubeir said.
The foreign minister said that Saudi Arabia does not know where Khashoggi’s body is and that officials have not listened to an audio recording that Turkey claims proves Khashoggi was tortured, killed and dismembered.
When asked by Fox News about the fistfight scenario put forth Saturday by prosecutors, Jubeir deflected, saying the circumstances of Khashoggi’s death were still being investigated.
“We’re trying to ascertain the facts as to what happened in the consulate,” he said. “And what happened subsequent to that.”
Jubeir’s contention that the Saudi government did not know precisely what happened to Khashoggi in the consulate — after the kingdom had previously announced that he was killed in a fistfight — was the latest in a series of shifting explanations by Saudi officials since Khashoggi disappeared.
Reuters on Sunday quoted an unnamed Saudi official who portrayed Khashoggi’s death as the result of a botched kidnapping. In a detailed account, the official said members of the 15-man Saudi team threatened to drug and kidnap Khashoggi and had “killed him in a chokehold” when he resisted.
Khashoggi’s body, the official added, was rolled up in a carpet and given to a “local cooperator” for disposal.
A Saudi official, who spoke to The Post on the condition of anonymity to discuss the investigation, refused to confirm the details of the Reuters report but said that there had been a standing order from Saudi intelligence to “negotiate with people outside to come back home.” The team that approached Khashoggi had been sent to negotiate, but “it went south,” the official said, adding that “there was no order for a kidnapping. There was no order for a killing.”
Turkey and Saudi Arabia have been at odds over what happened inside the consulate ever since Khashoggi,

 a critic of the Saudi monarchy, disappeared there on Oct. 2.
Turkish authorities almost immediately concluded that Khashoggi was targeted by a 15-man squad of Saudi agents who killed and dismembered him in the diplomatic mission. The authorities said they have audio recordings from inside the consulate that provide a clear account of how Khashoggi was killed.
American intelligence officials have said they intercepted communications showing that Saudi officials were plotting to lure Khashoggi back to the kingdom — an operation that was ordered by the crown prince, the officials said. CIA officials have listened to the audio recording that Turkey says proves Khashoggi was killed by Saudi agents in the consulate, according to people briefed on the matter.
Saudi Arabia denied any knowledge of his fate for two weeks. On Saturday, the kingdom changed course dramatically, announcing that a preliminary investigation found that Khashoggi was killed after a fistfight inside the consulate.
Saudi prosecutors said 18 people had been arrested and five top officials fired for their connection to the case. Two of the dismissed officials were among Mohammed’s closest advisers, Saud al-Qahtani and the deputy intelligence chief, Maj. Gen. Ahmed al-Assiri.
Qahtani, described by analysts as the crown prince’s media czar and enforcer with a penchant for leveraging social media to promote Saudi interests, on Sunday changed his Twitter biography — reflecting his demotion from adviser to the Royal Court to the head of the Saudi Federation for Cybersecurity.
The change indicated Qahtani would still retain significant influence in the Saudi effort to track dissidents online and disseminate official messages via a highly coordinated social-media strategy.
A Saudi official, who spoke on the condition of anonymity because they were not authorized to speak publicly, said the other fired intelligence officers were nearing retirement.
They included Maj. Gen. Mohammed bin Saleh al-Rumaih, assistant head of the General Intelligence Directorate; Maj. Gen. Abdullah bin Khalifa al-Shaya, head of General Intelligence for Human Resources; and Gen. Rashad bin Hamed al-Mohammad, director of the General Directorate of Security and Protection.
President Trump initially said the Saudi explanation of Khashoggi’s death was credible. But in an interview with The Post late Saturday, Trump conceded that
there had been “deception.” Still, he defended Saudi Arabia as an “incredible ally” and expressed hope that Mohammed was not involved.
On Sunday, Britain, Germany and France issued a joint statement indicating that the Saudi explanation of Khashoggi’s killing did not go far enough.
“There remains an urgent need for clarification of exactly what happened on October 2nd — beyond the hypotheses that have been raised so far in the Saudi investigation, which need to be backed by facts to be considered credible,” the statement said. “We will ultimately make our judgement based on the credibility of the further explanation we receive about what happened and our confidence that such a shameful event cannot and will not ever be repeated.”
Asked about Saudi Arabia’s belated acknowledgment of Khashoggi’s killing, Jubeir said the shifting Saudi account of what happened was a result of a coverup by the arrested agents.
“They told us that he left the consulate,” Jubeir said. “They came back to Saudi Arabia; they filed a report to that effect.”
A public prosecutor launched his investigation after “discrepancies” between the agents’ report and the reports coming out of Turkey, which Jubeir said revealed that the team had falsified its report.
“This is an aberration, this is a mistake, this is a criminal act, and those responsible for it will be punished,” Jubeir added. Later on Sunday, the Saudi monarch, King Salman, and the crown prince called Khashoggi’s son, Salah Khashoggi, to express their condolences, the official Saudi Press Agency reported.
tamer.el-ghobashy@washpost.com
kareem.fahim@washpost.com
carol.morello@washpost.com


Compile information on Jamal Khashoggi's family

On the day he was murdered, Saudi journalist Jamal Khashoggi entered the Saudi consulate in Istanbul to obtain the necessary paperwork to marry his second wife.  Of interest is information on his first wife and their children.  Also relevant are details of the relationship the Saudi government has with his children.    Details surrounding Khashoggi's death and subsequent investigations are not relevant. Saudi Arabia must be included in the document text.

Find background information related to the question's subject.

At Istanbul memorial for Jamal Khashoggi, a moment’s silence, then shouts for justice

ISTANBUL —
The memorial service for Jamal Khashoggi was held in the shadow of the Saudi Consulate on Wednesday, on the first anniversary of his death, at the minute he walked through the consulate door, the last time that anyone who cared about the journalist saw him alive.
A speaker, David Hearst, asked for silence to mark the occasion. Then participants began to shout: for justice, for remembrance, for this death to resonate, on behalf of others whose deaths, disappearances or imprisonments had passed without notice.
The service started with Khashoggi’s own words, in a video broadcast on a screen behind the stage, voicing demands that were both routine and impossible.
“I am 60 years old,” the Saudi journalist and Washington Post contributing columnist said in the recording. “I want to enjoy life, and I want to be free to speak for my country.”
The country, Saudi Arabia, had no representatives on a dais that hosted a chorus of its critics. It would have been strange had any been invited. Saudi government agents are accused of killing Khashoggi on that Tuesday last year, of dismembering his body, of concealing the location of his remains.
The agents were dispatched by top Saudi officials, convinced that Khashoggi’s words, written in columns for The Post, were a grave threat to the state. The officials worked for Crown Prince Mohammed bin Salman, who almost certainly authorized the killing, according to the CIA and other intelligence agencies, but who has steadfastly denied it.
“Absolutely not,” was Mohammed’s answer when asked recently whether he had ordered Khashoggi’s death.
None of Khashoggi’s Saudi relatives attended Wednesday, either, including his children, but that, too, was expected. Khashoggi’s killing aggravated arguments between Saudi Arabia and Turkey, and to travel to the Istanbul memorial was to take a side in that argument, something no Saudi citizen could afford to do.
A son, Salah Khashoggi, who lives in the kingdom, warned in a Twitter post Monday that Saudi Arabia’s “opponents and enemies” were exploiting his father’s killing and added that he had “absolute confidence” in the kingdom’s judiciary to prosecute the killers.
With his immediate family absent, Jamal Khashoggi’s life and legacy were celebrated Wednesday by friends, colleagues and supporters, including Arab political exiles, whose ranks he had reluctantly joined. Among others in attendance were his fiancee, Hatice Cengiz, who had paced outside the consulate, waiting fruitlessly for him to emerge; Jeff Bezos, the owner of The Post; Frederick J. Ryan Jr., the paper’s publisher; and Agnès Callamard, a United Nations human rights investigator who wrote a report that provided the most thorough accounting to date of Khashoggi’s death.
Callamard’s has been an unexpectedly loud voice in the year after Khashoggi’s death. With incessant demands for accountability, she has inserted herself into a conversation dominated by powerful governments, criticizing all of them, including Saudi Arabia, the United States and Turkey, for their conduct.
“No one should get away with murder,” she said Wednesday, this time clearly focusing on the Saudi government and the crown prince, the kingdom’s young leader. “No matter who they are or how high their station in life.”
Like other speakers, she also addressed what she said was a threat to the global news media that Khashoggi’s death had laid bare. “My call to you,” she said, speaking to journalists around the world, “persist, insist, expose — for Jamal and the other Jamals around the world.”
The setting added resonance to Callamard’s plea. Turkey’s government, which has vigorously demanded that Saudi Arabia account for Khashoggi’s death, is itself one of the most prolific jailers of journalists around the world, according to press freedom groups.
Soldiers watched from the rooftops as the sun baked those on the stage. One of them, Turan Kislakci, called on the Saudi government to hand over the consulate, so it could be turned into a museum honoring Khashoggi’s life.
For all the celebration of Khashoggi’s legacy, the service Wednesday was also a tribute to Cengiz, forced into the public spotlight as she grieved. It was she who had to respond to questions she could not answer after her fiance disappeared, and who was subjected to mockery on social media when Saudi loyalists tried to deny Khashoggi’s killing had occurred.
“No one should ever have to endure what you did,” Bezos said, in brief comments before embracing her.
Ryan, The Post’s publisher, also thanked Cengiz, “whose time of great joy was transformed into a terrifying nightmare. You have searched unceasingly for answers.”
The answers, held by secretive governments, have been hard to come by. A trial underway in Saudi Arabia is held behind closed doors. A CIA assessment of the killing has not been released. Audio recordings made by Turkey of the killing have been shared with a few people but not the public.
“Last year today, I was standing here,” Cengiz said Wednesday. “I was a girl in love, waiting for my man to come out of the consulate. We wanted to go to dinner. We wanted to invite our friends to our wedding. Now after the worst year in my life, I stand here broken but proud — proud to see you all here.”
A drone hovered. Photographers crowded toward the stage.
“I still seek justice,” she said. “I want to know what happened to his body. I want his friends to be released from jail. I want those in power to be held accountable for their actions.”
kareem.fahim@washpost.com


‘I am asking for justice:’ Khashoggi’s fiancee urges Congress to put more pressure on Saudi Arabia in the wake of journalist’s killing

The fiancee of Jamal Khashoggi called Thursday for members of Congress to put greater pressure on Saudi Arabia to answer questions related to the Saudi journalist’s slaying, telling lawmakers, “I am asking for justice.”
“This act — this murder — was a great brutality, and the last seven, eight months, nothing was done,” Hatice Cengiz said at a House Foreign Affairs subcommittee hearing on the dangers of reporting on human rights. “We still do not know why he was killed. We don’t know where his corpse is.”
She urged lawmakers to press Saudi Arabia’s leaders and sanction the kingdom in response to the killing of Khashoggi, a contributing columnist for The Washington Post.
“In the early days, President Trump said that this would be solved,” Cengiz said. “And Ms. Pelosi talked about how unacceptable this was. But seven, eight months later, we see that nothing has been done, and that is why I’m here today.”
The House and Senate voted earlier this year to end U.S. support for the Saudi-led military coalition in Yemen, in a rebuke of the Saudi crown prince, Mohammed bin Salman. But Trump vetoed the resolution, and the Senate failed to override it.
Cengiz’s testimony before the Subcommittee on Africa, Global Health, Global Human Rights and International Organizations comes one day after she criticized Trump’s response in a meeting with Washington Post journalists.
Also speaking at Thursday’s hearing was Gulchehra Hoja, an ethnic Uighur journalist with Radio Free Asia in Washington. Hoja has said that more than 20 of her relatives — including her brother and her elderly parents — have been detained in China because of her reporting on human rights abuses in the Muslim-majority Xinjiang region.
Joel Simon, executive director of the Committee to Protect Journalists, and Sarah Repucci, senior director for research and analysis at Freedom House, also testified.
In her interview with The Washington Post, Cengiz said the Saudi government has not contacted her to offer compensation or even condolences since Khashoggi was killed in the kingdom’s consulate in Istanbul in October. By contrast, the kingdom has given millions of dollars in cash and property to Khashoggi’s four adult children.
Cengiz and Khashoggi met at a conference last year and made plans to marry soon after. At Thursday’s hearing, she said that when they were making their wedding preparations, “I was happier to be alive than I had ever been in my life.”
All of that came crashing down seven months ago when, according to U.S. and Turkish authorities, Khashoggi was killed by a team of Saudi assassins after he entered the consulate to obtain papers for their planned marriage.
“It wasn’t just Jamal that was killed” in the consulate that day, Cengiz said. “It was also what we’re talking about here — the values that the United States represents. Didn’t they get murdered as well?”
She told lawmakers that she “still cannot make human sense of it.”
“I still feel that I’ll wake up and it will get back to that,” she said. “And I cannot understand that the world still has not done anything about this.”
At one point in the hearing, freshman Rep. Ilhan Omar (D-Minn.), one of the first two Muslim women elected to Congress, thanked Cengiz for her courage and told her that Khashoggi had once encouraged her to run for Congress when they were attending an Iftar dinner together.
“I remember he had said to me, he took a famous picture of Keith Ellison and I, and he said, ‘Ilhan, you need to run for Congress,’ ” Omar said, referring to the Democrat who previously held her seat. “And I said, ‘I can’t run for Congress, because the only seat I can run for is occupied by Keith Ellison.’ And we laughed about that, and I didn’t really know that that would be the last time that I would see him.”
Lawmakers of both parties said that they shared Cengiz’s sentiment that more needs to be done to hold Saudi Arabia to account for the killing.
“I think the world was horrified at the open, blatant murder of your fiancee, and the fact that that has gone unanswered in the world is a source of shame,” said Rep. Karen Bass (D-Calif.), the subcommittee’s chair. “We will do what we can. There needs to be justice for what was done.”
Rep. Christopher H. Smith (R-N.J.) accused Saudi Arabia’s leaders of being “very, very unforthcoming” with information, not just on Khashoggi’s killing but also in the wake of the Sept. 11, 2001, terrorist attacks.
“I find it appalling; I think we all must find it appalling,” he said, criticizing the “incredible arrogance” of the Saudi government.
felicia.sonmez@washpost.com


Khashoggi children have received houses in Saudi Arabia and monthly payments as compensation for killing of father

The children of slain Saudi journalist Jamal Khashoggi have received million-dollar houses in the kingdom and monthly five-figure payments as compensation for the killing of their father, according to current and former Saudi officials as well as people close to the family.
Khashoggi’s two sons and two daughters may also receive much larger payouts — possibly tens of millions of dollars apiece — as part of “blood money” negotiations that are expected to ensue when the trials of Khashoggi’s accused killers are completed in the coming months, according to the officials and others who spoke on the condition of anonymity to discuss sensitive talks.
The previously undisclosed payments are part of an effort by Saudi Arabia to reach a long-term arrangement with Khashoggi family members, aimed in part at ensuring that they continue to show restraint in their public statements about the killing of their father by Saudi operatives in Istanbul six months ago, the officials said.
The Khashoggi siblings have refrained from any harsh criticism of the kingdom, even as their father’s death provoked global outrage and widespread condemnation of the heir to the Saudi throne, Crown Prince Mohammed bin Salman.
The delivery of homes and monthly payments of $10,000 or more to each sibling were approved late last year by King Salman as part of what one former official described as an acknowledgment that “a big injustice has been done” and an attempt “to make a wrong right.”
But the royal family is also relying on its wealth to help contain the ongoing fallout from the killing and dismemberment of the prominent Saudi journalist and Washington Post contributing columnist who was targeted for articles that were often critical of the government.
A Saudi official described the payments as consistent with the country’s long-standing practice of providing financial support to victims of violent crime or even natural disasters and rejected the suggestion that the Khashoggi family would be obligated to remain silent. “Such support is part of our custom and culture,” the official said. “It is not attached to anything else.”
As part of their preliminary settlement, the Khashoggi children were each given houses in Jiddah worth as much as $4 million apiece. The properties are part of a shared compound in which Salah Khashoggi, the eldest son, occupies the main structure.
A banker in Jiddah, Salah is the only Khashoggi sibling who intends to continue living in Saudi Arabia, according to people close to the family. The others reside in the United States and are expected to sell their new Saudi properties.
Salah, who has been responsible for financial discussions with Saudi authorities, declined to comment on the matter when reached by phone Monday. His desire to remain in Jiddah with his family has contributed to the siblings’ deference to the authorities and caution in their public statements over the past six months.
In October, the Saudi government released photos of Salah shaking hands with Mohammed, an image that was meant to show the crown prince offering condolences but was widely seen as an indication of the coercive power the royal family was exerting on Jamal Khashoggi’s children.
The writer’s two daughters, Noha Khashoggi and Razan Jamal Khashoggi, published an essay in The Washington Post last year in which they described their father’s hopes for changes in Saudi Arabia but emphasized that he was “no dissident” and did not accuse the crown prince or other Saudi officials of being culpable in his death.
Noha did not respond to a request for comment, and Razan could not be reached.
The monthly schedule of payments and prospect of eventual multimillion-dollar settlements would appear to give the Khashoggis a long-term financial incentive to remain quiet even as human rights organizations and critics of Saudi Arabia continue to demand accountability from the kingdom.
Washington Post publisher Fred Ryan said in an op-ed Monday, six months after Jamal Khashoggi’s death, that the Saudis “have adopted a strategy of evasion” that has “scapegoated expendable officials, seeking to quell international furor by staging a sham trial.”
Khashoggi’s second son, Abdullah, declined to comment when reached Monday. William Taylor, a Washington lawyer who has represented the family, also refused to discuss any compensation the family has received.
The negotiations with the family have been led by the outgoing Saudi ambassador to the United States, Khalid bin Salman, brother of the crown prince.
The CIA concluded
Saudi officials have strenuously denied that Mohammed was involved, describing the slaying as a rogue operation carried out by a team that intended to subdue Khashoggi and take him back to Riyadh but killed him after a struggle at the consulate in Istanbul. Khashoggi had gone to the diplomatic facility to collect paperwork needed to remarry.
U.S. intelligence agencies, relying in part on eavesdropping equipment placed in the Saudi Consulate by the Turkish government, have concluded that Khashoggi was strangled or smothered.
Saudi officials have yet to explain what happened to Khashoggi’s body. His killers are believed to have dismembered and disposed of it. Officials who have heard audio of the operation said that one of the Saudi operatives — who has a background in forensic crime-scene work — can be heard warning other operatives to play loud music to mask the sound of an electric device.
Saudi authorities have announced investigations of 21 people in connection with Khashoggi’s killing, including Saud al-Qahtani, an enforcer for the crown prince suspected by some of orchestrating the operation against Khashoggi.
Prosecutors are seeking the death penalty for five operatives who traveled from Riyadh to Istanbul and were in the consulate when Khashoggi was killed. They include Maher Mutreb, a former colonel in the Saudi intelligence service who knew Khashoggi when both worked in London at the Saudi Embassy.
If the men are convicted and sentenced to death, the Saudi system of justice could allow the Khashoggi family members to grant their father’s killers clemency as part of a “blood money” arrangement in which they might then be entitled to tens of millions of dollars.
It is unclear whether Khashoggi’s children would be required to forgive or absolve the killers to collect the payments.
Former Saudi officials and experts said that the royal court and government have incentives to seek such an agreement and avoid a situation in which only low-level operatives are executed for their role in a plot that was developed and orchestrated from high levels of government.
The issue of how far to go in protecting their father’s legacy has been a source of tension among the Khashoggi siblings, according to people close to the family. The daughters have at times pushed to be more outspoken about their father’s life and the kingdom’s ruthlessness, while the brothers have focused on maximizing the amount of money the family will collect.
At one point in the weeks after their father’s death, Abdullah Khashoggi told advisers working with the family that he wanted to punish the royal court by going after one of the crown prince’s prized possessions. “I want the da Vinci,” he said, referring to a painting by the Renaissance master that the crown prince paid $450 million for in 2017.
greg.miller@washpost.com


U.N. investigator calls for probe of Saudi officials in Khashoggi killing

A U.N. investigation into the brutal slaying of Jamal Khashoggi released Wednesday provides the clearest picture yet of the journalist’s final moments inside the Saudi Consulate in Istanbul, refocusing attention on Saudi Crown Prince Mohammed bin Salman and his crackdown on dissidents.
The months-long investigation by Agnes Callamard, a human rights expert at the United Nations, faulted the United States and other countries for not exerting enough pressure on Saudi Arabia despite “credible evidence” of the likelihood that Mohammed was involved in Khashoggi’s killing.
She called for sanctioning and freezing the prince’s assets until he is either cleared or definitively implicated.
With access to audio recordings provided by Turkish intelligence, Callamard laid out in graphic detail how Saudi government agents prepared to kill and dismember Khashoggi. The planning started days before the killing, after Khashoggi — by then one of Saudi Arabia’s most prominent dissidents — startled the staff at the Saudi Consulate in Istanbul by visiting to obtain a certificate of marriage eligibility.
“We were all shocked,” the consulate’s security attache said in a phone call to an official in Saudi Arabia on Sept. 28, the day of Khashoggi’s first visit last year. “It is known that he is one of the people sought.”
The details, and other revelations in the report, ended a respite for Saudi officials from international censure as the killing faded from conversations among allies and investors. Instead, the focus had turned to Iran, with Saudi Arabia positioned as vital to countering security threats attributed to Tehran.
Callamard, a special rapporteur for the Office of the U.N. High Commissioner for Human Rights, said that Saudi authorities participated in the destruction of evidence after Khashoggi was killed and that culpability for the slaying extends beyond the 11 Saudis who are on trial in a closed-door judicial proceeding in the kingdom.
“Mr. Khashoggi’s killing constituted an extrajudicial killing for which the State of the Kingdom of Saudi Arabia is responsible,” Callamard’s report said.
Adel al-Jubeir, the kingdom’s minister of state for foreign affairs, dismissed the findings in posts on Twitter on Wednesday. He said the report included “contradictions and baseless allegations.”
Jubeir also rejected the report’s calls for a U.N.-assisted criminal inquiry into the killing, saying that the “judicial authorities in the kingdom are the only ones competent to hear this case.”
Callamard said she found no “smoking gun” incriminating the crown prince himself but said he had played an essential role in repressing dissidents and almost certainly knew that a criminal mission targeting Khashoggi was being planned.
“Evidence points to the 15-person mission to execute Mr. Khashoggi requiring significant government coordination, resources and finances,” she wrote. “While the Saudi government claims that these resources were put in place by Ahmed Asiri, every expert consulted finds it inconceivable that an operation of this scale could be implemented without the Crown Prince being aware, at a minimum, that some sort of mission of a criminal nature, directed at Mr. Khashoggi, was being launched.”
Asiri, Saudi Arabia’s former deputy head of intelligence, is one of two senior Saudi officials implicated by the kingdom’s prosecutors in the killing and the only senior official on trial.
Callamard’s account of Khashoggi’s death is the most definitive to date, even though her inquiry was hampered by Saudi Arabia’s refusal to allow her to visit the kingdom to conduct interviews.
Secretary of State Mike Pompeo and President Trump have deplored the killing of Khashoggi, who was a contributing columnist for The Washington Post in the year before his death. But they have said the relationship with Saudi Arabia is too important to be sidetracked by a single incident.
Pompeo recently said the United States, invoking emergency powers because of rising tensions with Iran, will sell weapons worth $8 billion to Saudi Arabia and the United Arab Emirates.
At Wednesday’s Senate confirmation hearing for Kelly Knight Craft, Trump’s nominee to become U.S. ambassador to the United Nations, Sen. Lindsey O. Graham (R-S.C.) laid blame for Khashoggi’s slaying squarely on the Saudi crown prince.
“He did it,” said Graham, one of the biggest Republican critics of Trump’s approach to the kingdom. “Wouldn’t have happened without him, he knew it was going to happen, he wanted it to happen, he caused it to happen, and this is just the tip of the iceberg of other things going on in this kingdom.”
Human rights groups echoed Callamard’s call for an international investigation.
“Callamard’s report underscores that there will be no justice for Jamal Khashoggi unless Congress steps up,” said Rob Berschinski, the senior vice president for policy at Human Rights First. “Saudi leaders have made it clear that they intend to get away with murder. President Trump has made it clear that he values arms sales over the killing and dismemberment of a U.S. resident. Congress must make it clear that it will not let this stand.”
In a telephone interview from Geneva, Callamard characterized the U.S. response as ambiguous and conflicted.
“At the highest level of the U.S. government, there has not been a determination to hold to account the state of Saudi Arabia,” she said. She called U.S. sanctions against 17 suspects, most of them low- to mid-level personnel, insufficient.
Callamard offered a macabre account of Khashoggi’s final moments, drawn from audio recordings that captured events inside the consulate in the days before Khashoggi visited a second time and on the day of the killing. She said she was permitted to listen to 45 minutes of conversation — a small fraction of the seven hours of audio captured by Turkish intelligence. Her team was permitted to keep notes on only a portion of the recordings. Other conversations “were reconstructed from memory,” she wrote.
Some of the audio was hard to discern. “For instance, on the basis of recordings, the Special Rapporteur could not reach firm conclusions about what [she and her investigators] were told was the sound of a ‘saw’ in operation. The Turkish authorities undoubtedly have more information and intelligence about events in the Saudi Consulate than they were willing or able to share with the inquiry,” the report said.
According to the report, 13 minutes before Khashoggi entered the consulate on Oct. 2, two of the Saudi agents, Maher Mutreb and Salah Tubaigy, a forensic expert, discussed dismembering the body.
“Joints will be separated,” Tubaigy told Mutreb. “First time I cut on the ground. If we take plastic bags and cut it into pieces, it will be finished.” Khashoggi’s name was not mentioned, but Mutreb referred to the “sacrificial animal.”
The report also said that Tubaigy “expressed concerns” about what was about to transpire, telling Mutreb: “My direct manager is not aware of what I am doing. There is no one to protect me.”
The audio suggests they attempted to make Khashoggi think he would be kidnapped and repatriated to Saudi Arabia, not killed.
When Khashoggi arrived at the consulate on Oct. 2, he was invited to the consul general’s office and asked whether he would return to Saudi Arabia.
“He responded that he wanted to return in the future,” the report states.
But the Saudi agents, using the pretext of an Interpol warrant, said they were there to take him back to the kingdom.
More conversation followed, the report said. Khashoggi insisted that people were waiting for him outside, as one of the agents tried to persuade him to send a message to his son. “What should I say?” Khashoggi asked. “See you soon? I can’t say kidnapping.”
“Type it Mr. Jamal,” one of the agents replied. “Hurry up. Help us so that we can help you because at the end we will take you back to Saudi Arabia and if you don’t help us you know what will happen at the end.”
Then, in the recordings, “sounds of a struggle can be heard,” the report said.
In her report, Callamard painted a poignant picture of Khashoggi.
An important but traditionalist journalist in Saudi Arabia, Khashoggi “was not seen by dissidents to be naturally ‘one of them,’ ” Callamard wrote. Increasingly isolated by his views, he went into self-exile. Living in the Washington area, he had little income, little security and little status, making him lonely and unhappy, Callamard wrote. His decision to remarry suggested he was preparing to live a fuller, more settled life, she said.
carol.morello@washpost.com
kareem.fahim@washpost.com


Find information about the popularity of traditional painkillers, anti-anxiety medications and anti-nausea drugs in states that adopted medical marijuana laws.

Studies indicate that medical marijuana is effective in treating chronic pain; PTSD; anxiety; AIDS; and spasms. Overall, most of the same studies report that there has been a decrease in a variety of drugs, especially pain-killers, in states that have adopted medical marijuana laws. Among the older population, medical marijuana is reportedly improving their quality of life, making them less dependent widely prescribed opioid painkillers and other drugs. Documents mentioning Washington are relevant.

Find scholarly articles that support this question's claims.

House Republicans say no to allowing federal studies of medical marijuana

Types of medical marijuana for sale are shown in Oregon. House Republicans on Wednesday rejected a plan that could have allowed for more federal research on marijuana’s effects. (Gosia Wozniacka/AP)
Medical marijuana is now sold in nearly half of all states, and even one red state has legalized it for recreational use. Veterans of wars in Iraq and Afghanistan are clamoring for access to treat post-traumatic stress disorder. Loosening pot laws polls better in three swing states than any 2016 presidential candidate.
But House Republicans have so far declined to keep pace with shifting public opinion. They did so again late Wednesday, when a rare bipartisan pot proposal died a quiet death in the House that would have reclassified marijuana so that national laboratories could conduct “credible research on its safety and efficacy as a medical treatment.”
The amendment to a bill scheduled for debate Thursday on the House floor would have encouraged the National Institutes of Health and the Drug Enforcement Administration to work together to allow studies of the benefits and risks of marijuana to treat cancer, epilepsy, glaucoma and post-traumatic stress disorder, among other conditions.
The vote is the latest action to reflect national Republicans’ uncertainty on how to address shifting public sentiment about marijuana use. Although the GOP has supported steps to allow state medical-marijuana programs to flourish, Republicans generally have not supported efforts to advance national policy on legalization.
When a Senate committee this year passed a measure to let doctors discuss marijuana with patients at Veterans Affairs clinics, House Republicans shot it down. When the District legalized weed for personal use, a powerful House committee chairman threatened the city’s mayor with jail time.
Minnesota this month began allowing sales of medical marijuana in pill bottles and vials of marijuana-infused oil. (Glen Stubbe/St. Paul Pioneer Press)
House Republicans have defended their opposition to pot. There is no evidence, they have said, that loosening marijuana laws would do anything but destroy the brains of the nation’s adolescents, let alone offer benefits to veterans.
The lack of evidence, however, can be traced to congressional Republicans who have made it all but impossible for federal agencies to fund objective testing on the effects of marijuana use.
The amendment that died Wednesday was seen by some as a potential game-changer. With 23 states allowing medical marijuana — and a handful plus the District of Columbia having outright legalized it — some House Republicans (and Democrats, too) thought that it was finally time to allow more federal testing of marijuana.
For Republican opponents, the research could provide either evidence to continue holding the line or solid ground for the party to begin tiptoeing toward the mainstream.
Perhaps surprisingly was the House Republicans’ most outspoken critic of legalization over the past two years who co-sponsored the measure.
Maryland Rep. Andy Harris, a doctor and author of a measure in Congress that has left legalization in the District in limbo, said more science was the way to go.
“We need science to clearly determine whether marijuana has medicinal benefits and, if so, what is the best way to gain those benefits,” he said Wednesday before the House Rules Committee sidelined the amendment in a vote late Wednesday night.
Another Republican, Rep. H. Morgan Griffith of Virginia, pleaded with the committee in person to approve it, but for a different reason.
Whereas Harris sponsored the measure confident that the research would prove marijuana is bad, Griffith has become convinced that there are limited circumstances in which marijuana has medical benefits for patients.
“We let doctors use heroin derivatives, barbiturates and all kinds of nasty stuff that I wouldn’t want people to use recreationally. Why not study marijuana?” Griffith, still smarting from the unraveling of the amendment, said in an interview.
“Andy Harris doesn’t think the research will show anything positive, but I do, and both of us feel willing to take the risk, do the research, and let us use evidence to make decisions,” he said. “This amendment would have answered the question one way or the other. I think it would have shown it is a valuable medical substance, but now we don’t have the evidence.”
Why the measure failed remains unclear.
To allow for federal research of marijuana, the amendment would have created a new designation for the substance. Marijuana is currently in a class of Schedule 1 drugs designated as the most dangerous, alongside heroin and LSD, and considered more addictive by the federal government than even cocaine.
The amendment, also sponsored by Democrats Earl Blumenauer of Oregon and Sam Farr of California, would have created a new subclassification within Schedule 1 dubbed “Schedule 1R” for research.
The amendment also made clear that if federal research found that the Schedule 1 designation no longer seemed appropriate that “marijuana could then be rescheduled further after this research is completed.”
Both Griffith and an aide for Harris pointed to the House Judiciary Committee, which has jurisdiction over national drug laws, as interfering with the proposal at the last minute Wednesday. A spokeswoman said the committee, led by another Virginia Republican, Robert W. Goodlatte, had no comment.
The effort put advocates for marijuana legalization in the odd position of having to praise Harris, who had become a nemesis of the cause.
“There are lawmakers who say they oppose marijuana reform because the research hasn’t been done yet, and the reality is the research hasn’t been done yet because there have been obstacles deliberately put in place,” said Michael Collins, policy manager for the pro-marijuana Drug Policy Alliance.
“To Mr. Harris’s credit, he thinks there are benefits to researching marijuana, whether you support it or not,” Collins said. “I think it points to the fact that people are realizing that blanket opposition, using the old reefer-madness arguments, don’t apply any more.”
Indeed, even opponents of legalization said research seemed like a logical step and a path forward that even they could support.
“I think that’s great, anything that removes the barriers and promotes honest-to-goodness research is welcomed,” said Sue Rusche, head of National Families in Action, a drug-prevention organization that has been around since the 1980s’ “Just Say No” campaign.
Rusche’s group, based in Atlanta, has fought unsuccessfully to keep Georgia from allowing sales of cannabinoid oils for treatment for a range of ailments.
“Right now we really don’t know what you’re getting. What we need is research to show us what level of CBD and THC should be given and what’s safe.”


A GOP congressman says he used medical marijuana while in office

Rep. Dana Rohrabacher (R-Calif.) speaks during a news conference in Washington in November 2013 to discuss marijuana laws. (Lauren Victoria Burke/AP)
U.S. Rep. Dana Rohrabacher (R-Calif.) just made a striking admission: Speaking to a group of marijuana activists on Capitol Hill, Rohrabacher said he had recently turned to medical marijuana to help deal with arthritis pain, and it worked.
Two weeks ago, Rohrabacher said, he tried a topical wax-based marijuana treatment. That night, it was "the first time in a year and a half that I had a decent night’s sleep because the arthritis pain was gone," Rohrabacher said.
Rohrabacher is one of the leading conservative voices on overhauling marijuana laws in the U.S. Congress. He's the architect of a provision in federal law that prevents the Department of Justice from interfering with state-level medical marijuana operations. But his statement is nonetheless noteworthy because, according to one close observer, it marks the first time in at least several decades that a sitting U.S. congressman has admitted to marijuana use while in office.
"This is definitely the first legislator in Congress in at least 30-some-odd years who has acknowledged to using marijuana illegally," the National Organization for the Reform of Marijuana Laws' executive director,  Alan St. Pierre, told Russ Belville of Cannabis Radio yesterday.
Medical marijuana is legal in Rohrabacher's home state of California. But it remains illegal for all uses under federal law. The Drug Enforcement Administration considers marijuana to have "no currently accepted medical use" and "a high potential for abuse." Marijuana is placed in Schedule 1 of the Controlled Substances Act, a designation reserved for the most dangerous drugs, including heroin.
But this federal designation is increasingly at odds with medical evidence and scientific consensus. A growing body of research is finding that marijuana can be effective in treating chronic pain and muscle stiffness — the types of things that an arthritis sufferer like Rohrabacher might have to deal with. Patients with these conditions are often prescribed powerful (and deadly) opioid medications. To the extent that marijuana could substitute for those drugs, more access to medical marijuana could literally save lives.
The Drug Enforcement Administration is currently considering a motion to move marijuana out of Schedule 1 and into a less restrictive classification, which could remove many barriers that currently stifle marijuana research. Some observers are skeptical, though, given the DEA's previous attempts to block research and the organization's general resistance to changing norms on drug use.
Meanwhile, patients are left to navigate the often messy world of medical marijuana research and regulations on their own. It remains to be seen whether Rohrabacher's experience may cause his congressional colleagues to give medical marijuana reform a second look.


A maker of deadly painkillers is bankrolling the opposition to legal marijuana in Arizona

A sales associate handles a jar of cannabis inside a Good Meds medical cannabis center in Lakewood, Colo., in 2013. (Matthew Staver/For The Washington Post)
The campaign against marijuana legalization in Arizona received a major infusion of cash last week from a synthetic cannabis drugmaker that has been investigated for alleged improper marketing of a highly addictive prescription painkiller, according to campaign finance reports.
The $500,000 donation from Insys Therapeutics, based in Chandler, Ariz., amounts to more than one-third of all money raised by Arizonans for Responsible Drug Policy, the group opposing legalization. It's one of the largest single contributions to any anti-legalization campaign ever, according to campaign finance records maintained by ballotpedia.com.
The cash infusion could even the playing field in an arena where legalization supporters have traditionally outspent opponents. Until the Insys donation, legalization supporters in Arizona had out-fundraised opponents by about 3-to-1. The Campaign to Regulate Marijuana Like Alcohol has raised more than $3 million, much of it from the Marijuana Policy Project, a national group working to change marijuana laws.
Insys has developed a drug based on a synthetic version of marijuana's active ingredient, THC. Called Syndros, the drug was approved by the Food and Drug Administration in July for treatment of AIDS and cancer patients' symptoms. It is awaiting scheduling by the Drug Enforcement Administration.
Insys also manufactures the deadly painkiller Subsys fentanyl. The company is facing state and federal investigations, as well as a shareholder lawsuit, over allegations that it improperly marketed the drug to doctors in an effort to boost sales.
In February, a former sales rep for the company pleaded guilty to fraud charges stemming from a kickback scheme involving Subsys fentanyl purchases. Last month, two former employees pleaded not guilty after being arrested for allegedly participating in a similar fentanyl kickback scheme.
At the time of the arrests, FBI Assistant Director Diego Rodriguez said in a statement, "This case should be something the medical industry and the general public should pay close attention to because it’s one of the reasons we’re experiencing an epidemic of overdoses and deaths in this country."
In an emailed statement, Insys said it opposes the Arizona ballot measure, Proposition 205, because marijuana's safety hasn't been demonstrated through the federal regulatory process.
Insys "has joined a broad alliance of elected officials, health care organizations and business leaders in opposing Prop. 205 because it fails to protect the safety of Arizona’s citizens, and particularly its children," the company said. "Insys firmly believes in the potential clinical benefits of cannabinoids. Like many in the healthcare community, we hope that patients will have the opportunity to benefit from these potential products once clinical trials demonstrate their safe and effective use."
Supporters of marijuana legalization questioned the company's motivation for getting involved in the campaign, noting its financial interest in minimizing competition for Subsys and synthetic marijuana products.
"It appears they are trying to kill a non-pharmaceutical market for marijuana in order to line their own pockets," J.P Holyoak of the pro-legalization campaign said in a statement.
Tom Angell of the pro-marijuana group Marijuana Majority said the donation blunts opponents' argument that marijuana legalization would put public safety at risk. Studies have shown that marijuana can be effective in treating chronic pain, without the overdose risk or side effects that powerful opioid painkillers, like fentanyl, can bring. Other studies have found that opioid overdose deaths fall in areas with access to medical marijuana.
"Accepting this money undermines everything that marijuana prohibitionists say about their desire to protect public health," Angell said in an email. "It's difficult to understand how people who profit from selling a drug like fentanyl can keep a straight face while arguing that marijuana is just too dangerous to legalize."
The opposition group Arizonans for Responsible Drug Policy made no apologies for accepting the contribution.
"We are grateful that Insys Therapeutics – an Arizona-based company – has chosen to join Governor Ducey, the Arizona Association of County School Superintendents, the Arizona Small Business Association, the Arizona Hospital and Healthcare Association, the Arizona Catholic Conference of Bishops, the Arizona Chamber of Commerce and several other community organizations in defeating Prop. 205 in November," ARDP campaign manager Adam Deguire said in an emailed statement.
Kevin Sabet of Smart Approaches to Marijuana, a national group opposed to marijuana legalization, said in an email that there was nothing particularly objectionable about Insys's efforts to oppose recreational marijuana while also working to develop synthetic drugs based on chemicals in the plant. "I don't think Insys should be admonished for working on marijuana-based medications via the FDA process — they're following the rules, and that's a good thing," he said.
"Obviously I don't agree with aggressive fentanyl marketing," he added.
This isn't the first time the company has been active in marijuana politics. In 2011, the company wrote to the Drug Enforcement Administration to express opposition to loosening restrictions on natural THC, citing "the abuse potential in terms of the need to grow and cultivate substantial crops of marijuana in the United States."
Last year, the company petitioned the DEA to loosen restrictions on the synthetic version of another compound occurring in marijuana plants, known as cannabidiol (CBD).
Insys Therapeutics made $62 million in net revenue on Subsys fentanyl sales in the first quarter of this year, representing 100 percent of the company's earnings. The CDC has implicated the drug in a "surge" of overdose deaths in several states in recent years.
Last October, the company announced it had received a "fast track" designation from the FDA to speed development of a drug intended to treat opioid overdoses.
"We are encouraged by the Fast Track designation that will allow us to advance our program to address a significant unmet medical need in the market," the company said in a statement at the time. "Opioids are responsible for a high proportion of fatal drug overdoses around the world."
Law enforcement agencies nationwide are struggling to stop a growing heroin epidemic from spreading across the United States.
More from Wonkblog:
- Why this ‘horrible’ idea for how to legalize pot could be worth voting for
Legal marijuana is finally doing what the drug war couldn't
Support for marijuana legalization has hit an all-time high
This story has been updated to include the name of Insys's fentanyl drug, Subsys.


The drug industry’s answer to opioid addiction: More pills

Jonathan Moss, a physician and professor at the University of Chicago, helped develop what might be the next billion-dollar drug, designed to treat an uncomfortable side effect of high-dose opiate prescriptions — constipation. (Lucy Hewett)
UNNATURAL CAUSES
Cancer patients taking high doses of opioid painkillers are often afflicted by a new discomfort: constipation. Researcher Jonathan Moss thought he could help, but no drug company was interested in his ideas for relieving suffering among the dying.
So Moss and his colleagues pieced together small grants and, in 1997, received permission to test their treatment. But not on cancer patients. Federal regulators urged them to use a less frail — and by then, rapidly expanding — group: addicts caught in the throes of a nationwide opioid epidemic.
Suddenly, Moss said, investors were knocking at his door.
“As clinicians, we wanted to help palliative patients,” said Moss, a professor and physician at University of Chicago Medicine. “The company that bought our work saw a broader market.”
Today, Moss’s side project is hailed as the next billion-dollar drug. And the once-disinterested pharmaceutical industry is bombarding doctors and the public with information about a serious, if previously unrecognized, condition common among the millions of Americans who take prescription painkillers. They call it “opioid-induced constipation,” or “OIC.”
The story of OIC illuminates the opportunism of pharmaceutical innovators and the consequences of a heavily drug-dependent society. Six in 10 American adults take prescription drugs, creating a vast market for new meds to treat the side effects of the old ones.
Opioid prescriptions alone have skyrocketed from 112 million in 1992 to nearly 249 million in 2015, the latest year for which numbers are available, and America’s dependence on the drugs has reached crisis levels. Millions are addicted to or abusing prescription painkillers such as OxyContin, Vicodin and Percocet. Statistics from the Centers for Disease Control and Prevention show that, from 1999 to 2014, more than 165,000 people died in the United States from prescription-opioid overdoses, which have contributed to a startling increase in early mortality among whites, particularly women — a devastating toll that has hit hardest in small towns and rural areas.
The pharmaceutical industry’s response has been more drugs. The opioid market — now worth nearly $10 billion a year in sales in the United States — has expanded to include a growing universe of medications aimed at treating secondary effects rather than controlling pain.
There’s Suboxone, financed and promoted by the U.S. government as a safer alternative to methadone for those trying to break their dependence on opioids. There’s naloxone, the emergency injection and nasal spray carried by first responders to treat overdoses. And now there’s Relistor, the drug based on Moss’s work, and a competitor, Movantik, for constipation.
In colorful charts designed to entice investors, numerous pharmaceutical makers tout the “expansion opportunity” that exists in the “opioid use disorders population.”
Indivior, a specialty pharmaceutical company listed on the London Stock Exchange, sees “around 2.5m potential patients, the majority of whom are addicted to prescription painkillers,” as opposed to illicit drugs such as heroin. Another company, New Jersey-based Braeburn Pharmaceuticals, highlights “growth drivers” for the market, noting that millions of additional Americans not yet identified are also likely to be dependent on opioid painkillers.
Analysts estimate that each of these submarkets — addiction, overdose and side effects — is worth at least $1 billion a year in sales. These economics, experts say, work against efforts to end the epidemic.
If opioid addiction disappeared tomorrow, it would wipe billions of dollars from the drug companies’ bottom lines.

A potent product
From a profit-making standpoint, opioids are a potent product. Chronic use can cause myriad side effects that usually are mild enough to keep people taking painkillers but sufficiently uncomfortable to send them back to the doctor.
Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, said this domino effect can turn a patient worth a few hundred dollars a month into one worth several thousand dollars a month.
“Many patients wind up very sedated from opioids, and it’s not uncommon to give them amphetamines to make them more alert. But now they can’t sleep, so they get Ambien or Lunesta. The amphetamines also make them anxious, paranoid and sweaty, and that means even more drugs,” said Kolodny, who also serves as chief medical officer to Phoenix House, a nonprofit organization that offers drug and alcohol treatment in 10 states and the District.
Women, in particular, are ideal customers. About 57 percent of working-age women who take opioids have four or more prescriptions, according to a Washington Post analysis of participants in the latest National Health and Nutrition Examination Survey. Among working-age women who don’t take opioids, 14 percent have four or more prescriptions, the analysis shows.
Among men, the numbers are significantly lower. About 41 percent of working-age men on prescription opioids have at least four prescriptions. Among men who don’t take opioids, 9 percent have four or more.
Studies show that constipation afflicts 40 percent to 90 percent of opioid patients. As recently as a few years ago, doctors typically advised people to cut down the dosages of their pain meds, to take them less often, or to try non-drug interventions such as changing their diets or increasing physical activity.
By promoting opioid-induced constipation as a condition in need of more targeted treatment, critics say the drug industry is creating incentives to maintain the painkillers at full strength and add another pill instead.
“The pharmaceutical industry literally created the problem [of OIC],” Kolodny said. “They named it, and they started advertising what a serious issue it is. And now they’ve got the solution for it.”

A Super Bowl ad
Opioid-induced constipation burst onto the biggest possible public stage in February, when AstraZeneca, maker of Movantik, aired a spot during Super Bowl 50 , one of the most expensive ad opportunities of the year. It featured a middle-aged man wistfully watching another man triumphantly adjusting his belt, a dog peacefully relieving itself under a tree and a woman striding by with a banner of toilet paper trailing victoriously from one high-heeled shoe.
“If you need an opioid to manage your chronic pain, you may be so constipated it feels like everyone can go — except you,” a narrator intones.
AstraZeneca's 2016 super bowl ad features a man looking for relief from constipation due to opioid use.
That ad was aimed at men, but many others in the Movantik campaign target women, airing on “Good Morning America,” movies on the Hallmark Channel and specials about former first lady Jacqueline Kennedy, Princess Diana and singer Whitney Houston.
In one, a slightly overweight dark-blonde woman talks about “struggling to find relief.” In another, a giant cartoon pill looms sympathetically over a middle-aged brunette, who complains that opioids really helped with her pain but left her with some “baggage.”
“So awkward,” she sighs.
The Super Bowl ad, aired before an audience of more than 100 million people, quickly became the latest flash point in the country’s war against opioids. Vermont Gov. Peter Shumlin (D) called the ad “a shameful attempt to exploit America’s addiction crisis to boost corporate profits.” White House chief of staff Denis McDonough tweeted: “Next year, how about fewer ads that fuel opioid addiction and more on access to treatment.”
AstraZeneca and its marketing partner Daiichi Sankyo defended the commercials, calling opioid-induced constipation “a legitimate medical condition” affecting millions of Americans.
“The ad has driven good dialogue about OIC, and just as importantly, also added to the increasing and necessary conversation about the appropriate and safe use of opioids,” a spokeswoman said.
Paul Gileno, president of the U.S. Pain Foundation, a patient advocacy group that worked with AstraZeneca on the ads, notes that many people use opioids responsibly.
“People ask, ‘Why are you helping addicts?’ That’s not the case,” Gileno said. “We are trying to help people who are suffering from chronic pain to be able to continue on their medicines and live their lives.”

A ‘brilliant’ pitch
Each tiny pink pill of Movantik retails for about $10, and most insurance plans cover it. Since the Super Bowl, prescriptions have jumped from 6,600 to 8,800 a week, AstraZeneca recently reported.
Movantik holds the dominant market share, but Canada’s Valeant Pharmaceuticals — one of the companies under fire by Congress for jacking up prices of old drugs — won approval in July from the Food and Drug Administration to sell Relistor, its version of the pill. Analysts estimate that as many as six other drugs may be on the market by 2019.
Investors have been talking about the “blockbuster potential” of these drugs since at least 2008, when Movantik had been tested on only a small number of human subjects, and long before it received FDA approval in 2014. While it is illegal to market a drug before approval, it is fine to market the condition the drug is designed to treat. And so “OIC” was born.
The branding began around 2010, when “OIC” began appearing in papers in some of the top medical journals, in poster presentations and on the lips of panelists speaking at major medical conferences. “Opioid-induced constipation” suddenly replaced what had been a vast vocabulary used to describe the problem, including terms such as “bowel dysfunction” and “gut motility.”
Last year, after it won government approval to sell Movantik, AstraZeneca rolled out a number of free continuing-education classes. Doctors and nurses must take such classes to remain licensed. The titles included: Opioid-induced Constipation: A Neglected Complication and Unmet Needs in Opioid-Induced Constipation.
The companies have also asked pain doctors to show patients a chart about stool “health,” with diagrams to help assess shape and clumpiness.
Adriane Fugh-Berman, a researcher at Georgetown University Medical Center who studies drug marketing, called the Movantik strategy “brilliant.” She compared it to other recent “disease awareness” campaigns focused on “premenstrual dysphoric disorder” (treatable with a new version of Prozac packaged in pink instead of blue) and “binge-eating disorder” (for which there is a new pill called Vyvanse).
The OIC campaign created the perception of great need for the drug when the market should be “vanishingly small,” Fugh-Berman said — certainly not big enough to justify ads during the Super Bowl.
“The best way to treat opioid-induced constipation,” she said, “is to prevent it in the first place by not overusing opioids.”
Moss reluctantly continued to test a constipation-easing drug he was developing on opioid addicts, rather than cancer patients, at the behest of the Food and Drug Administration. It became Valeant’s Relistor. (Lucy Hewett)
William Chey, director of the Gastrointestinal Physiology Laboratory at the University of Michigan, helped design and execute the first large-scale human study for a competing drug that became Movantik, the first drug on the market specifically approved to treat opioid-induced constipation. (Nick Hagen)
Potential for good and bad
Constipation is different for people on opioids. Opioids bind to a receptor that makes the gastrointestinal tract go awry, decreasing the secretion of fluids and inhibiting the muscle contractions that propel waste. As a result, stool gets “stuck.”
While mostly a nuisance, the condition can be serious, especially among people already weakened by end-stage cancer. Some patients have been rushed to the emergency room to have the material removed from their bodies.
In the early 1990s, Moss and his colleagues at the University of Chicago began working on a drug that would block what are known as mu opioid receptors, which are responsible for the side effect. The drug showed promise, and Moss was devastated when investors told him the potential profits were too small to be worth the risky investment.
“If you’re a drug company, who wants to make a drug for people who weren’t going to be around in a couple of months? They wanted to aim for something people could take for 10, 20 years,” recalled Moss, who specializes in anesthesiology and critical care.
The researchers decided to fund the work without industry help but ran into another roadblock: The FDA said it was too risky to continue testing the experimental drug on cancer patients. Regulators suggested a different population: opioid addicts being treated with methadone.
Moss was reluctant. He considered the idea a detour that would slow down his work. “Our hearts really sank,” he said.
Thinking that he had no choice, Moss began the testing, and the results were published in JAMA, the Journal of the American Medical Association, in 2000. Pharmaceutical companies immediately came calling.
Moss’s drug was picked up by a biotech company and, after changing hands a few times, eventually became Valeant’s Relistor. Nearly all the profits will go to the companies. The licensing deal through the University of Chicago calls for Moss and four colleagues to receive a modest initial payment in the thousands of dollars, plus a tiny slice of sales royalties. They also get “milestone payments” when the drug reaches a certain stage of approval or a certain market size.
Parallel efforts took off at other companies. Nektar Therapeutics, a small San Francisco firm specializing in drug research and development, had been working on a drug known as NKTR-118, which was aimed at limiting opioid penetration of the central nervous system and reducing side effects such as dizziness and sleepiness. But researchers found that it also helped with constipation.
In 2009, AstraZeneca bought the rights for the drug and recruited William Chey, director of the Gastrointestinal Physiology Laboratory at the University of Michigan, to help design and execute the first large-scale human study. The results, published in the New England Journal of Medicine in 2014, were a crucial part of pushing Movantik over the FDA finish line. Last year, it became the first drug on the market specifically approved to treat opioid-induced constipation.
Chey said that he has seen many patients with cancer and other serious illnesses suffering from the condition and that he believes Movantik can improve their quality of life. However, Chey said he also recognizes the concern that Movantik could enable chronic opioid use and worsen the nation’s epidemic of addiction.
“I’ve thought a lot about the potential good and bad,” he said. “Used responsibly, this is an incredibly valuable drug. Hopefully, people will use it that way.
Dan Keating contributed to this report.


‘Mommy lobby’ emerges as a powerful advocate for medical marijuana for children

Born with a rare chromosomal disorder, 6-year-old Lydia Schaeffer suffers from life-threatening seizures that doctors haven’t been able to control despite countless medications. In marijuana, Lydia’s family members think they might have found a treatment that works. Now, they are trying to help legalize the drug.
Standing in a Wisconsin State Capitol hearing room surrounded by parents hugging their seriously ill children, Sally Schaeffer began to cry as she talked about her daughter.
Born with a rare chromosomal disorder, 6-year-old Lydia suffers from life-threatening seizures that doctors haven’t been able to control despite countless medications. The family’s last hope: medical marijuana.
Schaeffer, 39, didn’t just ask lawmakers to legalize the drug. She begged.
“If it was your child and you didn’t have options, what would you do?” she said during her testimony in Madison on Feb. 12.
The representatives were so moved that they introduced a bipartisan bill to allow parents in situations similar to Schaeffer’s to use the drug on their children.
For some families with children who suffer from rare seizure disorders, a new form of medical marijuana is proving to be a life-changing treatment.
Emboldened by stories circulated through Facebook, Twitter and the news media about children with seizure disorders who have been successfully treated with a special oil extract made from cannabis plants, mothers have become the new face of the medical marijuana movement.
Similar scenes have been playing out in recent weeks in other states where medical marijuana remains illegal: Oklahoma, Florida, Georgia, Utah, New York, North Carolina, Alabama, Kentucky.
The “mommy lobby” has been successful at opening the doors to legalizing marijuana — if only a crack, in some places — where others have failed. In the 1970s and ’80s, mothers were on the other side of the issue, successfully fending off efforts to decriminalize marijuana with heartbreaking stories about how their teenage children’s lives unraveled when they began to use the drug.
Mothers have long been among the most powerful constituent groups in the United States, and the reason is clear. Groups such as Mothers Against Drunk Driving are able to draw so much public support because they tug at a universal human emotion: the desire to protect children from harm. And while national gun-control efforts after the Sandy Hook massacre faltered, mothers’ groups worked to keep the issue on the public radar, helping to get some new measures passed at the state level.
Today, mothers are fighting for access to the drug, and they have changing public attitudes on their side. For the first time, a majority of Americans in opinion polls say they support the full legalization of marijuana.
Last year, Colorado and Washington state made marijuana fully legal, and there has been a groundswell of support in several states for ballot initiatives or legislation to do the same, including some in the conservative South.
Medical marijuana is now legal in 20 states and the District of Columbia. The diseases and conditions for which it can legally be used are limited and vary by jurisdiction. Most states have additional requirements for children: Instead of one prescription, parents must get two from different doctors.
Even in states where marijuana is available for children, the mothers say it is often a challenge to convince physicians that the potential benefits outweigh the risks.
The drug the mothers are seeking is an extract that contains only trace amounts of the part of the plant responsible for the euphoric effect of the drug but is still high in cannabidiol, or CBD — a substance that scientists think may quiet the electrical and chemical activity in the brain that causes seizures. Instead of leaves that are smoked, it is a liquid that is mixed in food or given to a child with a dropper.
The prospect of treating large numbers of children with this substance has alarmed medical organizations and anti-drug groups that say the potential dangers of prescribing an untested and unregulated treatment for young children are being lost in the conversation.
Little is known about the effects of marijuana on children; most studies have looked at teenagers who use it illicitly.
Much of the concern centers on the developing brain: Marijuana use has been linked to higher rates of mental illness, including thought disorders, depression and anxiety, as well as — according to one prominent study published last year — diminished IQ over time.
“There’s a lot of misinformation and emotion in this issue, rather than a focus on science,” said Kevin Sabet, an outspoken opponent of marijuana legalization who is director of the Drug Policy Institute at the University of Florida and was a former senior adviser for drug policy in the Obama administration.
The epilepsy community is divided on the issue. The Epilepsy Foundation, which represents patients and their families, said in late February that it backs efforts to legalize medical marijuana for use in pediatric epilepsy patients. But the American Epilepsy Society, which represents physicians and other professionals working in the field of epilepsy, says the treatment “may not be advisable due to lack of information on safety and efficacy.”
Sharon Levy, an assistant professor of pediatrics at Harvard Medical School and chair of the American Academy of Pediatrics committee on substance abuse, said she’s a strong proponent of studying and developing medications from the active ingredients in marijuana. But she does not support the idea of parents choosing the plant they think would be best, making their own oral preparations and guessing at proper dosage without knowing long-term side effects.
“It is a bad idea. When I look at the accumulation of studies about marijuana and children, I am very concerned,” she said.
Levy said she understands that efforts to develop and test marijuana-based treatments for the disorder may not be moving fast enough for some children with severe epilepsy. But she said that the fact that there are flaws with the regulatory system means that we should fix the system rather than bypass it.
“We shouldn’t forget that the regulatory system was put in place for a reason,” Levy said. “The history of medicine is littered with stories of ‘medications’ that had terrible long-term impacts.”
Charlotte’s story
Stories about the promise of marijuana for seizures have been circulating as far back as the 19th century, but it wasn’t until two years ago, when Paige Figi, a Colorado mom, began posting online stories about her child’s experiences with the treatment, that other families began to take notice.
Of the 2.3 million Americans living with epilepsy, more than 1 million of them have seizures that can’t be controlled by modern medicine. Figi’s daughter, Charlotte, was one of them.
Diagnosed with a rare condition called the condition known as Dravet syndrome, Charlotte, then 5, was suffering from more than 300 seizures each week. She used a wheelchair, could only say a few words and had gone into cardiac arrest more than once. Desperate after doctors told them there was nothing more they could do, Figi and her husband, Matt, turned to medical marijuana.
They began to give Charlotte a few drops of an extract made from a strain of marijuana that was high in CBD, which is thought to be medicinal, and low in THC, the component that creates a high, twice a day with her food. They were surprised when the seizures nearly stopped.
As Charlotte’s miraculous story spread, more than 100 families relocated to Colorado Springs, where the dispensary selling the substance is located. Across the country, parents are holding bake sales, benefit concerts and other fundraisers to try to raise money for the treatment; it can cost several hundred dollars a month to purchase the extract. A nonprofit foundation formed to assist those seeking the drug said that 187 pediatric patients are being treated and that there is a waiting list of more than 3,000.
Figi and Joshua Stanley, the grower who co-created the strain that is being used in the treatment — now known as “Charlotte’s Web” — have become heroes in the epilepsy community.
At the invitation of mothers, Figi and Stanley have been traveling around the country, telling Charlotte’s story to lawmakers in other states.
“It’s very emotional,” Figi said of the hearings. “Everyone’s handing out tissues — especially when someone comes who has lost a child to seizures, and they are coming out to support this effort.”
Stanley, 38, recently started Strains of Hope, a nonprofit organization that is dedicated to trying to get governments around the world to legalize the use of marijuana for medical purposes. As a first step, he said he is working with partners in Jamaica, where he hopes the extract could be available for free to children who need it as soon as the end of this year.
“Children should not be dying because of these antiquated laws,” he said.
But beyond all the heartbreak and hope lies the question of whether the treatment works. And if so, how?
Stanley declined to release any detailed numbers about how effective the treatment has been, but he said nearly every child with epilepsy who took the extract experienced a reduction in seizures.
There is some medical support for such a claim. There are several thousand published studies showing the potential benefits of marijuana for some conditions, and animal studies have shown that using CBD can stop seizures. Marijuana is made up of hundreds of components, with about 80 classified as cannabinoids unique to the plant, which scientists think activate specific receptors in the brain and other parts of the body to produce physiological and behavioral effects.
Heather Jackson, executive director of Realm of Caring, a foundation that is dedicated to research, education and advocacy for Charlotte’s Web and other marijuana-derived medicines, said the organization has begun to communicate with partners about the possibility of starting clinical trials for the treatment.
“We know that, in order for the treatment to be accepted by the medical community, there has be more testing, but because it’s marijuana, there has been a lot of red tape,” she said.
GW Pharmaceuticals, a British company, received FDA approval in December to begin clinical trials of a medicinal form of marijuana for children with epilepsy at New York University’s Langone Medical Center, the University of California at San Francisco and other locations.
But the trials are limited, and many mothers said they tried to enroll but were told the trials were full.
Proposals for the future
One of the first things Schaeffer told lawmakers when she stepped up to the podium in the hearing room in Madison was that she had never smoked marijuana. She wanted to make it clear that she wasn’t part of a more radical movement that aims to legalize recreational marijuana.
Like many of the mothers involved, Schaeffer said she supports legalizing medical marijuana for everyone but would be happy with a narrow law that authorizes the use of a specific kind of marijuana treatment for children.
Schaeffer’s daughter, Lydia, has a rare form of epilepsy that makes her have seizures when she sleeps. Doctors have told the family that the only treatment option is a surgical procedure that would remove part of her brain. They warned Schaeffer and her husband that such a treatment might end up leaving her more disabled — the surgery could blind her, for instance. Moving the whole family outside Wisconsin to a state where medical marijuana is legal is not an option, they said, because they own a small landscaping business in Burlington and Sally Schaeffer’s parents live nearby.
She said that if the bill does not go through this session, she may move to Colorado with her daughter and her husband may have to stay behind with their two sons.
“If I have to wait, I worry, what if my child doesn’t make it? It is heartbreaking to think of losing your child from a seizure when you know the medication is out there that could help them,” Schaeffer said.
Wisconsin state assembly member David Murphy, a Republican, said he signed on to be a co-sponsor of the bill after hearing about the mothers’ plight.
“I am not in support of legalizing marijuana and have not supported medical marijuana up to this point, but common sense tells me this is not remotely the same thing as that,” Murphy said.
While the mothers have received almost universal sympathy wherever they go, the proposed solutions to their problems differ by state.
In Wisconsin, the state committee on children and families passed a bill last week to allow the use of CBD oil in the treatment of seizure disorders. In Utah, state lawmakers have talked about importing the extract from Colorado and having the health department administer it as an herbal supplement.
In New York, Gov. Andrew M. Cuomo (D) has proposed a plan to use existing law to allow 20 hospitals to dispense the drug.
None of these are permanent solutions, the mothers say.
Even those who live in one of the states that allow medical marijuana say there is a need for change.
The main issue is that many parents think that only certain strains or formulations may work for their children, and, because marijuana is classified as a controlled substance, they can’t move the drugs across state lines — limiting not only their treatment options but medical research.
“This is not how medical care is supposed to work in the United States. You shouldn’t have to watch your child suffering and be told you can’t have the medicine that can help because you live in the wrong state,” said Colleen Stice, 35, a former payroll manager in Tulsa who quit her job to take care of her 14-month-old son, Rowan, after he began to have seizures.
She said she and her husband are ready to move to Colorado if legislation is not approved in Oklahoma, but she worries about what might happen if a different drug that works better is developed in another state. Would they pick up and move again?
The only answer to this patchwork system of access to medical marijuana treatments, the mothers say, is federal intervention.
They are asking the FDA to speed up the approval process for drugs based on CBD, requesting that the National Institutes of Health dedicate more money to this type of research and urging the Drug Enforcement Administration to reclassify marijuana so that it can be moved around more easily.
This month, the mothers will bring their fight to Washington. Dozens are planning to fly in from across the country to meet with key legislators on Capitol Hill and hold a march across the city. They plan to bring their children.
Magda Jean-Louis and Eddy Palanzo contributed to this report.
For more information:
Realm of Caring
Epilepsy Foundation statement on medical marijuana access and research
American Epilepsy Society statement on marijuana and epilepsy

More from The Washington Post:
A brief history of public opinion on marijuana legalization in one chart
The Lazarus Weed: The strange rise again of legalized pot
Gallery: A tour of Colorado’s blossoming pot industry
Advocates press for marijuana measure on D.C. ballot
Md. lawmakers hear truth, fiction about marijuana


Jeff Sessions: ‘Medical marijuana has been hyped, maybe too much’

Attorney General Jeff Sessions spoke in Richmond. (Zach Gibson/European Pressphoto Agency) RICHMOND — Studies have shown that medical marijuana laws and access to medical marijuana dispensaries are associated with fewer opioid deaths and less prescription painkiller abuse. “The problem is that you’re seeing now a disagreement between Sessions and the president on the issue of medical marijuana,” said Michael Collins of the Drug Policy Alliance. “It’s concerning because the administration, the White House themselves, have sort of committed themselves to not going after medical marijuana. Sessions is out casting doubt on that.” Smoking is a necessary way to consume medical marijuana, he said, because chronic pain sufferers need the instantaneous relief other forms of the drug cannot provide. The dosage concern doesn’t make sense, he said, because there’s no evidence of fatal marijuana overdoses. A congressional provision prevents the Justice Department from spending money to interfere with state-level medical marijuana programs. However, that appropriations amendment must be reauthorized this year. Twenty-eight states, the District of Columbia, Guam and Puerto Rico have medical marijuana programs, according to the National Conference of State Legislatures. “The people complaining that more research needs to be done are the very people in a position to do the research,” he said. “But they’ll never do it, because they know the research will show the positives.”

Attorney General Jeff Sessions spoke in Richmond.  (Zach Gibson/European Pressphoto Agency)
RICHMOND —
“I think medical marijuana has been hyped, maybe too much,” he told reporters in Richmond after an event about violent crime. “Dosages can be constructed in a way that might be beneficial, I acknowledge that, but if you smoke marijuana, for example, where you have no idea how much THC you’re getting, it’s probably not a good way to administer a medicinal amount. So forgive me if I’m a bit dubious about that.”
Sessions also cast doubt, as he has before, on the use of marijuana to curb opioid addiction.
Studies have shown that medical marijuana laws and access to medical marijuana dispensaries are associated with fewer opioid deaths and less prescription painkiller abuse.
During his campaign, President Trump said he was “100 percent” in favor of medical marijuana. White House spokesman Sean Spicer recently confirmed that the president sees a “big difference” between using marijuana for medical and recreational purposes.
“The problem is that you’re seeing now a disagreement between Sessions and the president on the issue of medical marijuana,” said Michael Collins of the Drug Policy Alliance. “It’s concerning because the administration, the White House themselves, have sort of committed themselves to not going after medical marijuana. Sessions is out casting doubt on that.”
Smoking is a necessary way to consume medical marijuana, he said, because chronic pain sufferers need the instantaneous relief other forms of the drug cannot provide. The dosage concern doesn’t make sense, he said, because there’s no evidence of fatal marijuana overdoses.
A congressional provision prevents the Justice Department from spending money to interfere with state-level medical marijuana programs. However, that appropriations amendment must be reauthorized this year. Twenty-eight states, the District of Columbia, Guam and Puerto Rico have medical marijuana programs, according to the National Conference of State Legislatures.
Collins said the federal government could easily do research into marijuana efficacy, but that opponents of legalization are standing in the way.
“The people complaining that more research needs to be done are the very people in a position to do the research,” he said. “But they’ll never do it, because they know the research will show the positives.”
Independent studies have generally found marijuana to be effective for treating chronic pain, nausea and vomiting in cancer patients, and muscle spasticity in multiple sclerosis patients. But the Drug Enforcement Administration, which operates under the Justice Department, maintains that marijuana has no medical value.


Medical marijuana victories in Florida, North Dakota, Arkansas, Montana turn the tide

Cured and finished buds as well as growing medical marijuana plants propagated at a medical marijuana growing operation in Washington in September. (Linda Davidson/The Washington Post) Tuesday was a banner night for medical marijuana — with ballot initiatives in numerous states widening access to the substance for Americans seeking relief from pain or a treatment for illness. Massachusetts and California, where Napster co-founder and cancer philanthropist Sean Parker helped fund a campaign to legalize the drug, were among the states passing new recreational marijuana laws. The tide also turned in Florida, North Dakota and Arkansas — where similar measures were defeated in the past — and in Montana where measures regarding medical marijuana were passed. Before this week, medical marijuana was legal in a little over half the country or 25 states. The wins come as rigorous scientific evidence is mounting that marijuana or its components may have beneficial medical effects. Earlier this year, GW Pharmaceuticals said that clinical trials show a cannabis-derived drug may be able to reduce seizures in patients with Dravet syndrome, a rare and severe form of epilepsy. Physicians are also increasingly looking to marijuana as an alternative to highly addictive opioids that have led to a crisis in overdoses. This chart, from my colleague Christopher Ingraham, shows just how dramatic the difference in the painkiller prescriptions is in medical-marijuana states vs. non-medical-marijuana states. Here's a closer look at the medical marijuana measures passed Tuesday night: Florida: North Dakota: Montana: “The previous restriction imposed a limit of three, which was sharply opposed by patients and providers in the program. Most medical marijuana patients were left without a registered provider under the restrictions. Since they went into effect, patients have left the program. More than a third of patients registered in September left over the next month — 7,785 remained in October, according to the state health department. “I-182 adds post-traumatic stress disorder to the list of eligible conditions, allows for lab testing for marijuana and orders annual health department inspections of providers.” Arkansas: For some families with children who suffer from rare seizure disorders, a new form of medical marijuana is proving to be a life-changing treatment. Marijuana wins big on election night Cannabis-derived drug shows promise for kids with epilepsy; GW pharma stock doubles One striking chart shows why pharma companies are fighting legal marijuana

Cured and finished buds as well as growing medical marijuana plants propagated at a medical marijuana growing operation in Washington in September. (Linda Davidson/The Washington Post) Tuesday was a banner night for medical marijuana — with ballot initiatives in numerous states widening access to the substance for Americans seeking relief from pain or a treatment for illness. Massachusetts and California, where Napster co-founder and cancer philanthropist Sean Parker helped fund a campaign to legalize the drug, were among the states passing new recreational marijuana laws. The tide also turned in Florida, North Dakota and Arkansas — where similar measures were defeated in the past — and in Montana where measures regarding medical marijuana were passed. Before this week, medical marijuana was legal in a little over half the country or 25 states. Here's a closer look at the medical marijuana measures passed Tuesday night: Florida: North Dakota: Montana: “The previous restriction imposed a limit of three, which was sharply opposed by patients and providers in the program. Most medical marijuana patients were left without a registered provider under the restrictions. Since they went into effect, patients have left the program. More than a third of patients registered in September left over the next month — 7,785 remained in October, according to the state health department. “I-182 adds post-traumatic stress disorder to the list of eligible conditions, allows for lab testing for marijuana and orders annual health department inspections of providers.” Arkansas: For some families with children who suffer from rare seizure disorders, a new form of medical marijuana is proving to be a life-changing treatment. Marijuana wins big on election night Cannabis-derived drug shows promise for kids with epilepsy; GW pharma stock doubles One striking chart shows why pharma companies are fighting legal marijuana


New study finds that medical marijuana may be helping to curb the opioid epidemic

A medical marijuana plant grows in Washington, D.C. (Linda Davidson / The Washington Post) After states pass laws permitting medical marijuana, drivers in those states become less likely to test positive for opioids after fatal car accidents, a new study from Columbia University's Mailman School of Public Health has found. "We would expect the adverse consequences of opioid use to decrease over time in states where medical marijuana use is legal, as individuals substitute marijuana for opioids in the treatment of severe or chronic pain," said June H. Kim, a doctoral student at the Mailman School of Public Health, and the study's lead author, in a press release. The study, published today in the American Journal of Public Health, is the first to look at the relationship between medical marijuana laws and individual-level laboratory measurements of opioid use. The results suggest a fairly straightforward conclusion that "in states with medical marijuana laws, fewer individuals are using opioids," the authors write. It adds to a growing body of evidence suggesting that chronic pain patients may substitute marijuana for prescription painkillers in states where the option is available. More from Wonkblog: Middle-aged parents are now more likely to smoke weed than their teenage kids Ohio city shares shocking photos of adults who overdosed with a small child in the car A maker of deadly painkillers is bankrolling the opposition to legal marijuana in Arizona

A medical marijuana plant grows in Washington, D.C. (Linda Davidson / The Washington Post)
After states pass laws permitting medical marijuana, drivers in those states become less likely to test positive for opioids after fatal car accidents, a new study from Columbia University's Mailman School of Public Health has found.
Researchers analyzed federal crash data in 18 states over the period from 1999 to 2013. States that passed a medical marijuana law during this period saw a reduction in opioid involvement in fatal car accidents, relative to states without such a law. The reduction was greatest among drivers aged 21 to 40, the age group most likely to use medical marijuana where it's available.
"We would expect the adverse consequences of opioid use to decrease over time in states where medical marijuana use is legal, as individuals substitute marijuana for opioids in the treatment of severe or chronic pain," said June H. Kim, a doctoral student at the Mailman School of Public Health, and the study's lead author, in a press release.
The study, published today in the American Journal of Public Health, is the first to look at the relationship between medical marijuana laws and individual-level laboratory measurements of opioid use. The results suggest a fairly straightforward conclusion that "in states with medical marijuana laws, fewer individuals are using opioids," the authors write.
It adds to a growing body of evidence suggesting that chronic pain patients may substitute marijuana for prescription painkillers in states where the option is available.
One paper published earlier this year found that Medicare Part D prescriptions for painkillers declined significantly in states that passed medical marijuana laws. Other studies have shown that medical marijuana states see fewer painkiller overdose deaths than states without medical pot, and that access to medical marijuana dispensaries is also linked to declining rates of opiate overdose and death.
In a sign some drugmakers might be worried about marijuana's impact, the company behind the powerful painkiller fentanyl recently poured half a million dollars into the campaign opposing full marijuana legalization in Arizona, one of the biggest-ever single donations to an anti-legalization cause.
Medical marijuana is currently legal, with varying degrees of restriction, in 25 states plus the District of Columbia. Still, the federal Drug Enforcement Administration earlier this year refused to relax restrictions on marijuana, claiming that the drug has no medically accepted use.
The DEA is also moving to increase restrictions on another natural drug, kratom, that some opiate addicts say they have used to kick their painkiller habit.
In 2014, painkiller overdoses killed nearly 19,000 people, according to the CDC. According to the DEA, no overdose death from marijuana has ever been recorded.
More from Wonkblog:
Middle-aged parents are now more likely to smoke weed than their teenage kids
Ohio city shares shocking photos of adults who overdosed with a small child in the car
A maker of deadly painkillers is bankrolling the opposition to legal marijuana in Arizona