The Washington PostDemocracy Dies in Darkness
The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Marijuana is on the ballot in five more states this year

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Happy Tuesday morning, and welcome back to The Health 202. It's three weeks until the midterms. That means you have three weeks to catch The Post and Newsy's weekly show, called “Election ’22: What Matters.” You can find the details here and email us your thoughts at

Today's edition: An array of new variants could drive a winter surge. PhRMA is still supporting Democrats after it threatened to hold them “accountable” for voting to let the government negotiate drug prices. But first … 

Recreational marijuana use could soon be legal in nearly half the states

Voters in November will decide whether recreational marijuana can be used legally in five states: Arkansas, Maryland, Missouri, North Dakota and South Dakota

Four out of the five states are home to many traditional conservatives — a testament to how the once-liberal issue has achieved increasingly bipartisan support in recent years. 

As it stands, 19 states, two territories and D.C. have embraced marijuana legalization over the last decade, while medical cannabis is legal in 37 states, three territories and the District, according to the National Conference of State Legislatures.

Even still, it was only a decade ago when recreational marijuana was illegal nationwide, and efforts by cannabis advocates since haven’t been without setbacks. Most recently, voters rejected ballot measures to legalize adult use of marijuana in North Dakota in 2018 and Arizona in 2016, although the latter changed its tune and voted in favor of the initiative the following election year. 

“When you look at ballot campaigns in the past, you’ll see that this is an issue that crosses traditional party lines,” said Paul Armentano, deputy director of the National Organization for the Reform of Marijuana Laws. “We anticipate similar outcomes this November.” 

The strategy

Most states that have legalized recreational marijuana have done so through citizen-initiated ballot measures, a tactic progressive activists are also eyeing to keep abortion legal in red states

“The expanded use of ballot measures in recent years is a direct response to the increasing polarization of our political system,” said Kelly Hall, executive director of the Fairness Project, a group that funds and organizes state ballot measure efforts across the country. That “has led to either gridlock in Congress at the federal level or to state legislative bodies being deeply out of sync with what their constituents want.” 

The disconnect between politicians and voters is particularly evident in cannabis legalization. Two-thirds of Americans say they want recreational marijuana use to be legal under federal law and in their own state, according to a CBS News poll

At the federal level, marijuana remains classified as an illegal Schedule I substance, a category that also includes heroin and ecstasy. But advocates say recent action by the Biden administration, which pardoned thousands convicted of “simple possession” of marijuana under federal law last week, signals a greater shift in the country’s views on marijuana use. 

“What has happened recently in Washington is a mirror reflection of what the people want to see across this country,” said Eddie Armstrong, a former state legislator who leads the Responsible Growth Arkansas group campaigning for legalization. 

More from President Biden on his recent actions:

A closer look

Even if cannabis advocates sweep the board in the upcoming midterm elections as they did two years ago, the fight to legalize isn’t always a done deal once a majority of voters show their support at the ballot box.

A ballot measure in South Dakota, if passed, would legalize the possession, use and distribution of up to one ounce of cannabis for those over the age of 21. If that sounds familiar, it's because the state has gone down this road before.

In 2020, South Dakota residents became the first in the nation to approve both medical and recreational legalization in tandem, passing it by 54 percent. But the adult-use referendum was nullified by the state Supreme Court, which found that the amendment violated the state constitution’s single subject rule. 

To avoid a similar outcome, marijuana advocates got a shortened and simplified version of the amendment on the ballot this year.  

“In our opinion, there's no way to overturn this with a single subject lawsuit,” said Matthew Schweich, campaign manager of South Dakotans for Better Marijuana Laws.

Schweich said he’s confident that residents of the state will approve the ballot question next month, citing the findings of an internal poll. 

Ad from South Dakotans for Better Marijuana Laws in support of legalization:

But the advocacy group’s findings are at odds with two statewide public surveys conducted a month apart by South Dakota News Watch and South Dakota State University, both of which indicated the measure could fail in November. Schweich has publicly questioned the accuracy of the poll by SDNW. 

There’s an organized opposition effort by the group Protecting South Dakota Kids, with its chairman Jim Kinyon saying legalizing marijuana for adults will inevitably lead to increased access for young people. He’s also concerned about the drug’s effect on mental and physical health.

“It's a lot easier to build strong kids than to fix broken men and women,” Kinyon said. “This will not make us healthy. This will not make us well. And this is not the will of the people in the state of South Dakota.” 

Ad from Protecting South Dakota Kids in opposition to adult-use cannabis:  

Reproductive wars

New this a.m.: Our colleague Caroline Kitchener dives deep into a covert abortion network rising after the Supreme Court overturned Roe v. Wade.

Illegal abortions of today are “simpler and safer” than those of the pre-Roe era, remembered for its back alleys and coat hangers. The emerging network is instead fueled by the availability of medication abortion, Caroline writes. 

Through word of mouth or social media, a growing army of community-based distributors is reaching pregnant women to supply pills, though typically without the safeguards of medical oversight. 

“Those interviewed described a pipeline that typically begins in Mexico, where activist suppliers funded largely by private donors secure pills for free as in-kind donations or from international pharmacies for as little as $1.50 a dose. U.S. volunteers then receive the pills through the mail — often relying on legal experts to help minimize their risk — before distributing them to pregnant women in need,” Caroline writes.


A swarm of variants could fuel a winter surge

Experts are nervously tracking a number of coronavirus variants, as they attempt to predict whether the country will have a difficult fall or winter, our colleague Carolyn Y. Johnson reports.  

It’s a new phase of the pandemic where instead of a new Greek letter variant, a host of immune-evading spinoffs are cropping up across the globe. That includes BA.4.6, BF.7, BQ.1.1 and XBB. 

The targeted drugs used to treat or protect immunocompromised Americans may not work well against some new variants. That’s a concern for top Biden health officials who are worried the rise of new variants may evade an existing treatment that protects the immunocompromised from severe illness, known as Evusheld, Politico’s Adam Cancryn and Erin Banco write. Meanwhile, vaccines and the oral antiviral Paxlovid do appear to work against these variants.

Those variants are known as BQ1 and BQ.1.1 account for roughly 11 percent of the cases nationwide, and pose a challenge to the Biden administration’s pandemic strategy. Meanwhile, the Food and Drug Administration warned this month that Evusheld is unlikely to protect against BA.4.6., a strain representing 12 percent of the cases nationally, Carolyn notes.  

From our reporters' notebooks

CDC officials describe intense pressure under Trump

Our colleague Dan Diamond sends The Health 202 this dispatch:

Trump appointees oversaw a concerted effort to use the Centers for Disease Control and Prevention to restrict immigration at the border during the pandemic, change the agency's scientific reports and muzzle its top officials, according to a report issued by the House panel probing the pandemic response on Monday.

Agency leaders — ranging from political appointees like former director Robert Redfield and former chief of staff Kyle McGowan, to senior career officials like Anne Schuchat and Martin Cetron — sat with House investigators to describe how the Trump White House and its allies blocked CDC recommendations, such as a summer 2020 plan to require masks on public transportation, or made agency leaders fear for their jobs. (Read Dan's full story here)

Officials also told the panel about their struggles with Trump allies like Michael Caputo, the top HHS spokesperson, and his deputy Paul Alexander as the two men circulated emails attacking CDC leaders like Schuchat or tried to alter the agency's Morbidity and Mortality Weekly Reports to better align with former president Donald Trump's more optimistic pronouncements about the pandemic.

Much of the panel's findings were already known, due to earlier reports and media coverage. But the report shows the need “to safeguard scientific integrity and restore the American people’s trust in our public health institutions,” House Majority Whip James E. Clyburn (D-S.C.), who chairs the panel, said in a statement.

But also consider: The CDC continues to grapple with long-standing challenges that have little or nothing to do with Trump appointees, such as the agency's persistent data-collection problems and its oft-confusing recommendations for Americans seeking to navigate the pandemic.

Industry Rx

PhRMA gives cash to Democrats, despite threats to hold the party ‘accountable’

The powerful drug lobby donated money to Democrats in the weeks after the party passed legislation allowing Medicare to negotiate the price of some drugs, a policy the trade group’s multimillion dollar machine failed to kill, Stat’s Sarah Owermohle reports. 

For instance: The Pharmaceutical Research and Manufacturers of America’s political action committee put $2,000 toward the New Democrat Coalition Action Fund in late August, Sarah writes.

The bulk of the trade group’s spending did go to Republican PACs that month, and the group has a history of supporting incumbents. Yet, the dollars to the Democratic PAC are notable, comments PhRMA CEO Stephen Ubl made to Politico that the lobby would hold Democrats “accountable” if they voted for the drug pricing measure. 

Brian Newell, a PhRMA spokesperson, said in a statement to Stat that the group works with lawmakers from both parties. “While we may not agree on every issue, we will continue to work with lawmakers to explore every possible opportunity to ensure patients can get the medicines they need and our industry can continue developing lifesaving treatments.”

In other health news

  • Abortion providers in North Carolina asked a state trial court yesterday to temporarily block enforcement of a law that prevents health professionals other than licensed physicians from prescribing pills for medication-induced abortions.
  • Georgia Republican Senate nominee Herschel Walker acknowledged yesterday that he sent a $700 check to his ex-girlfriend in 2009, but continued to deny the woman’s claim that the money was provided to pay for an abortion, our colleague John Wagner writes.
  • The nation’s first trial over a state ban on gender transition-related care for children kicked off in Arkansas yesterday, the latest in a fight over the surge in youth identifying as transgender that have swept Republican-led legislatures this year, the Associated Press reports.

Health reads

After Dobbs, U.S. medical students head abroad for abortion training no longer provided by their schools (By Olivia Goldhill l Stat)

Families Still Struggle to Find Baby Formula Nearly One Year After Shortages Began (By Jesse Newman and Kristina Peterson | Wall Street Journal)

Indiana case before U.S. Supreme Court could help red states defund Planned Parenthood (By Tony Cook and Johnny Magdaleno | The Indianapolis Star)

Sugar rush

Thanks for reading! See y'all tomorrow.