Arizona Marijuana: Everything to Know About Marijuana Law in AZ

(THIS ARTICLE IS COURTESY OF FACEBOOK.COM)

 

Arizona Marijuana: Everything to Know About Marijuana Law in AZ

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Brandi Atkins, an Arizona resident and former dancer, was diagnosed in late 2015 with a rare autoimmune disease that made her joints and muscles swell, causing chronic pain. She popped in and out of the hospital with a cornucopia of prescription medications handed out to alleviate her pain, ease her symptoms, and navigate around her type 1 diabetes. These medications would often clash with her disease and cause her blood sugar to soar. In desperation, she turned to medical marijuana.

Almost immediately, Adkins noticed an improvement in balance, palatable reduction in pain, and (most importantly) hope for her future. The dispensary she visited took the time to understand her specific concerns, her goals, and the particulars of her health conditions. Thanks to medical marijuana, Adkins feels like she can dance again.

This hopeful scenario plays out in dispensaries across Arizona, where more than 100,000 patients suffering everything from epilepsy to chronic pain find relief through medical marijuana.

It’s an interesting situation: legalized medical marijuana and dispensaries in one of the United States’ most conservative territories. How do these conflicting events coexist? Have you ever wondered what exactly is the state of medical marijuana affairs in Arizona? Here’s our in-depth explanation of everything you always wanted to know about Arizona’s Medical Marijuana Laws (but were too afraid to ask).

The road to marijuana legalization in Arizona

When the federal government originally passed the Marihuana Tax Act of 1937, the predecessor to the Controlled Substances Act of 1970, all American states had criminalized cannabis in one way or another. It wasn’t until the mid-1990s that Arizona state legislators began listening to decades-long calls for marijuana law reform.

In 1996, Arizona passed Proposition 200, allowing doctors to prescribe medical marijuana (specifically, controlled substances) to treat diseases or relieve pain in seriously/terminally ill patients. In order for a patient to use medical marijuana, a doctor had to provide scientific evidence to prove marijuana’s usefulness along with a second doctor’s opinion to the Arizona Department of Health Services. This caused conflict between supporters and opponents of medical marijuana, and started a lengthy battle over the law’s lack of specificity in addition to the language “prescribe.” For a doctor to prescribe medicine, the substance must first undergo FDA trials and doctors must specify the exact dosage and consumption methods to be used. Unfortunately, this rendered Prop 200 illegal on a federal scope and a medical marijuana program never materialized. It did, however, protect first-time drug offenders from prison sentences, which was a step towards decriminalization.

Arizona tried once more to legalize medical marijuana in 2002 with Proposition 203, but the initiative failed, receiving 42.7% of the vote. A viable solution was not presented and approved until nearly a decade later.

In 2010, Arizonans voted to approve a much-revised version of Proposition 203, an initiative to legalize the medicinal use of marijuana. Proposition 203 authorized doctors to recommend cannabis as a therapeutic option, as opposed to prescribing a specific dosage of cannabis with strict consumption or application methods. This law also tasked the Arizona Department of Health Services (ADHS) to regulate the “Arizona Medical Marijuana Act.”

Arizona’s current marijuana policy

The ADHS had until April 2012 to establish a registration application system for patients and nonprofit marijuana dispensaries, as well as a web-based verification platform for use by law officials and dispensaries to verify a patient’s status as such. It also specified patients’ rights, qualifying medical conditions, and allowed out-of-state medical marijuana patients to maintain their patient status (though not to purchase cannabis).

On December 6, 2012, Arizona’s first licensed medical marijuana dispensary opened in Glendale.

In 2012, Arizona legislators amended the Arizona Medical Marijuana Act to include college and university campuses in their non-consumption list, even if the cardholder was over 21 years old. However, in April 2017, this ruling was overturned by the Arizona Court of Appeals, and though colleges can privately prohibit medical marijuana on campus, lawmakers cannot make campus cannabis use illegal.

The people of Arizona took advantage of the Department of Health’s qualifying condition appeal process in 2013 when they petitioned to include PTSD, migraines, and depression among the list of qualifying medical conditions. Following due process, the Director of the ADHS denied the petition.

prop 205 arizona

While it seemed like the Arizona population was becoming more tolerant of cannabis, it proved too soon to jump to recreational legalization. In 2016, Arizonans narrowly voted no on Prop 205 by a margin of 48:52, which would have legalized the adult use of marijuana. Ballotpedia attributes this loss to heavy early campaigning by opponents of recreational marijuana years before the election process. Opponents such as Insys, the creators of Fentanyl, lobbied heavily against recreational cannabis — their CBD medicine passed the first phases of FDA trials earlier in 2016. This loss resulted in a significant surge in new medical marijuana patients, many of whom were waiting to get their card only if the recreational law failed to pass.

Despite various lawmakers’ attempts to place limitations on Arizona’s medical marijuana law, the program is growing larger each year. As of late June 2017, there were 132,487 Arizona marijuana patients, 155 dispensary licenses (up from 124 at the law’s passage), and 881 patient caregivers.

The “Arizona Medical Marijuana Act”

The “Arizona Medical Marijuana Act,” or AMMA, empowers Arizona doctors to recommend medical marijuana as a viable treatment option for Arizona patients diagnosed with at least one qualifying medical condition. With this recommendation, a patient may apply for an Arizona Medical Marijuana Card, a card that allows patients to possess, purchase, and use medical marijuana.

2.5 oz of cannabis, up to 12 plants, deliveries of marijuana, 25 miles from a dispensary

Arizona marijuana patients or caregivers may possess up to 2.5 ounces of marijuana at any given time, and obtain 2.5 ounces in a 14-day period from an Arizona medical marijuana dispensary. Patients can also be authorized to grow up to 12 marijuana plants for their own use, or otherwise, find a caregiver to grow cannabis for them if they reside more than 25 miles from the nearest medical marijuana dispensary.

Living as a medical marijuana patient

chronic pain, alzheimers, cachxia, cancer, crohn's disease, glaucoma, hepatitis c, muscle spasms, nausea, ptsd, sclerosis, seizures, two or more conditions

For Arizonans like Brandi Atkins — mentioned at the beginning of this article — who think medical marijuana might be right for them, patients must receive a recommendation to use medical marijuana from a licensed Arizona physician. The patient must have one of the below qualifying medical conditions, and their physician must determine that the patient indeed has a qualifying condition. The written certification would state the doctor believes, in their professional opinion, the patient would likely receive therapeutic benefit from medical marijuana use.

Arizona’s list of debilitating qualifying conditions

ALS, alzheimer's disease, cancer, glaucoma, hiv/aids, hepatitis c, cachexia/wasting syndrome, muscle spasms, nausea, seizures, severe and chronic pain

Once a patient has received their written certification from an Arizona doctor, they may apply to the ADHS for a Registry Identification Card, a card that grants patients and caregivers the authority to possess, purchase, and use medical marijuana legally.

To apply for a Registry Identification Card, patients must submit their written certification, the application fee, their personal information, and a statement declaring they won’t use their medical marijuana for nefarious purposes (i.e. sell it to kids). If a minor wants to be a medical marijuana patient, there are stricter rules to follow before they can qualify for their card. The ADHS website explains the application process in more detail.

The most “caring” of the bunch

Some patients in critical need of cannabis are unable to travel easily to purchase or even consume cannabis without some assistance. Arizona included regulations to cover the people who would take care of these patients, known as Caregivers, allowing them to assist patients (up to five) in the medical use of marijuana.

Whether taking care of a child or an elderly parent, this endeavor is a huge responsibility. Caregivers need to educate themselves on the different aspects of marijuana, like different strains, consumption methods, and their patients’ specific health needs. Arizona caregivers must follow all the same regulations as patients, including registering with the ADHS and carrying an ID card.

Don’t worry, the law protects you!

As federal law still classifies marijuana as a Schedule 1 drug (without medicinal value), Prop 203 and other medical cannabis laws were designed to protect citizens’ rights. Arizona medical marijuana patients are supposed to be treated like every other resident. The AMMA’s regulations protect the rights of patients and caregivers in certain circumstances:

  • A school or landlord may not refuse to enroll/lease to a qualifying patient unless failing to do so would incur ramifications under federal law.
  • Medical facilities cannot deny treatment to patients based on their status as a medical marijuana user.
  • Parental rights cannot be denied based on a parent’s status as an Arizona medical marijuana patient.

While these protections are essential, they do not provide for every eventuality. Employers may not discriminate against employees who are medical marijuana patients, and may not penalize them for a positive drug test. However, employees cannot use or possess marijuana during the hours of work. Employers may lawfully discipline and even terminate any employee who tests positive for marijuana if they used or possessed during work hours, even if the employee is a registered patient.

Despite nearly 20 years of progress toward decriminalization and regulation, Arizona is still one of the toughest states in the nation when it comes to marijuana. Even minor possession is a felony for those who aren’t medical marijuana patients, with a max sentence of 3.75 years and a $150,000 fine.

I’m a physician, what part do I play in medical marijuana?

“I have found in my study of these patients that Cannabis is really a safe, effective and non-toxic alternative to many standard medications.” -Philip Denney, MD, Testimony to the Arkansas legislature in support of House Bill 1303, “An Act to Permit the Medical Use of Marijuana,” Nov. 17, 2005.

Doctors are the gatekeepers to medical marijuana. In all medically legal states, doctors must fully evaluate their patients and determine whether cannabis is a fit for their medical needs and whether they have a qualifying condition. This places a lot of responsibility on doctors’ shoulders, which most Arizona doctors bear with professionalism and true concern for their patients. The physician must be a doctor of medicine, a doctor of osteopathic medicine, a naturopathic physician, or a homeopathic physician who holds a valid license to practice in Arizona.

medical marijuana doctors in arizona

Physicians meet patients, either in person or via telemedicine services, to determine if the patient has a qualifying condition before signing a written certification stating that, in their professional opinion, the patient has a qualifying condition and would likely receive therapeutic benefits from medical marijuana use.

However, Arizona courts have cracked down on some physicians who have turned their practices into “certification mills” due to their being no additional requirements for marijuana recommendations other than holding a valid license to practice medicine in Arizona.

Visiting from out of state?

Arizona allows non-Arizona medical marijuana patients the same rights and protections as Arizona citizens. This caveat makes sense … sort of.

The law states a Registry Identification Card, or its equivalent, issued by another state is valid in Arizona, except in that a visiting qualifying patient may not obtain marijuana from an Arizona marijuana dispensary.

This is a bit paradoxical. How is an out-of-state patient to access medical marijuana without purchasing from a dispensary or bringing it over state lines, which is federally illegal? Here’s how:

Another registered Arizona patient or designated caregiver can offer and provide medical marijuana so long as nothing of value is given in return, and the recipient doesn’t end up possessing more than 2.5 oz. of marijuana. This works, though it may be simpler to become a resident of Arizona.

Medical Marijuana Dispensary basics, keeping patients safe, obeying laws

inside a dispensary

All Arizona marijuana dispensaries are nonprofit organizations, a philosophy similar to out-of-state patients: “nothing of value may be exchanged for the transfer of medical marijuana.” While medical marijuana isn’t free, dispensaries may charge for medical marijuana as part of the expenses incurred during business operations. Patients can purchase up to 2.5 ounces of marijuana every two weeks, either as flower or an equivalent amount in concentrate, edibles, or other cannabis product forms.

As marijuana is still federally illegal (and valuable), security remains a  top priority. Dispensaries are required to use the ADHS online verification system to confirm each Arizona marijuana patient’s status as a patient and the amount of marijuana purchased over the last 60 days. This system is password protected and will not allow any access through an unencrypted internet connection. This online system does not include patients’ addresses or other personal information.

Dispensaries are also required to have a strong security system for their facility, including a single secure entrance. Medicating on the premises is forbidden. These heavy requirements go hand-in-hand with Arizona officials’ concern that marijuana products will encourage theft, violence, or negligent/illegal use.

Don’t be afraid to ask about the future

Though Arizona’s medical marijuana laws are full of sticky, complicated red tape, the program’s existence is still a huge step forward in the crusade for national legalization. Suffering patients in Arizona can find medical relief with our favorite plant and still enjoy protection from the law. Hopefully, after reading our guide, you now understand the nuts and bolts of how medical marijuana regulations work in Arizona.

Still want more information? Check out the Arizona Department of Health Services website at www.azdhs.gov.


Sources:

https://azmarijuana.com/links/legal/

https://azmarijuana.com/news/proposition-203-arizona-medical-marijuana-act/

http://norml.org/legal/item/arizona-medical-marijuana

http://www.azdhs.gov/licensing/medical-marijuana/index.php

http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881#Arizona

http://www.azcentral.com/story/news/politics/arizona/2017/04/06/ruling-overturns-law-banning-medical-marijuana-arizona-college-campuses/100145648/

http://blog.norml.org/2011/05/16/alternet-the-five-worst-states-to-get-busted-with-pot/

http://www.azdhs.gov/documents/licensing/medical-marijuana/debilitating/2013-july/medical-marijuana-debilitating-medical-condition-decision-form-jan-2014.pdf

https://ballotpedia.org/Arizona_Marijuana_Legalization,_Proposition_205_(2016)

https://www.nytimes.com/elections/results/arizona-ballot-measure-205-legalize-marijuana

http://azcapitoltimes.com/news/2017/01/24/lawmakers-act-to-change-medical-marijuana-rules/

https://www.washingtonpost.com/news/wonk/wp/2016/09/09/a-maker-of-deadly-painkillers-is-bankrolling-the-opposition-to-legal-marijuana-in-arizona/?utm_term=.7428039f5547

https://www.forbes.com/sites/theemploymentbeat/2014/12/02/medical-marijuana-and-the-workplace-what-employers-need-to-know-now/#3ff5578b66b8

http://medicalmarijuana.procon.org/view.source.php?sourceID=000593

http://www.phoenixnewtimes.com/news/arizonas-week-in-weed-pot-docs-cant-lie-on-forms-az-supreme-court-says-8277359

https://www.marijuana.com/news/2014/07/arizona-court-rules-that-medical-marijuana-patients-can-sell-weed-to-other-patients/

http://www.azdhs.gov/documents/licensing/medical-marijuana/reports/2016/2016-apr-monthly-report.pdf

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Where Marijuana Is Legal: Opioid Deaths And Alcohol Sales Are Way Down

(THIS ARTICLE IS COURTESY OF HIGH TIMES MAGAZINE)

For many years, the biggest threat to marijuana legalization and fledgling legal cannabis businesses was the police.

Fears of DEA agents breaking down the front door at dawn, prosecutions in federal court with its accompanying mandatory minimums or warrantless visits from helicopter-riding police who merely cut down plant and leave—such things happen and are legal—was what kept people involved in cannabis up at night.

But now, with legalization sweeping the country and a vast majority of Americans in support of medical marijuana, the real enemy is revealing itself.

And as recent events in Arizona demonstrated, it’s Big Pharma.

In 2015, U.S.-based companies made up 40 percent of the global pharmaceutical trade, a market share worth $413 billion. These companies are well aware that cannabis is becoming an accepted treatment for chronic pain and many of the other lifelong afflictions now treated by highly profitable trademarked drugs—and some have proven willing and able to take steps to make sure marijuana stays out of the hands of law-abiding Americans in order to protect that enormous bottom line.

“Pharmaceuticals are going to run me down,” Dr. Gina Berman, medical director of the Giving Tree Wellness Center, a Phoenix, Arizona-based cannabis dispensary, told the Guardian. “We have a small business, and we can’t afford to fight Big Pharma.”

The most egregious case to date is Insys Therapeutics. Insys, is an Arizona-based drug manufacturer of pain drugs that contain fentanyl, the powerful synthetic opioid that’s been fingered in many fatal opiate overdoses (including the death of Prince).

Arizona was the lone state where a marijuana legalization initiative failed at the ballot in November—and one of the leading donors to the anti-legalization campaign, with a $500,000 check, was Insys. (Another was Trump-supporting casino magnate Sheldon Adelson, CEO of the Las Vegas Sands Corp. Here are the Vegas nightlife spots to boycott, forever.)

As the Intercept reported this fall, Insys executives openly recognized the threat to its market posed by marijuana. And in a devious twist, Insys identified marijuana as an existential threat and moved to keep it illegal, while developing a new drug based on synthetic THC.

On March 23, the DEA ruled that Insys’s new drug, called “Syndros,” could be marketed and sold as a Schedule II drug—meaning it could be prescribed to patients as soon as this fall.

So far, the FDA has approved Syndros for AIDS-related weight loss and vomiting and nausea associated with chemotherapy—two of the original applications for medical marijuana.

“It’s pretty absurd that federal law considers marijuana to have no medical value, but allows for the development of synthetic versions of the same substance,” Mason Tvert, a spokesman for the Marijuana Policy Project, which sponsored Arizona’s legalization measure, told the Guardian.

But what about Insys Therapeutics? It’s a company straight out of a Superman comic. 

In December, Justice Department prosecutors took the “unusual” step of charging six former Insys executives, including former CEO Michael L. Babich, with racketeering for its “aggressive” marketing of a fentanyl-based pain drug called Subsys, the New York Times reported. Prosecutors alleged that in order to sell more Subsys, the company arranged lavish dinners and other events for doctors who prescribed “lots of” the drug, and when that didn’t work, the company resorted to kickbacks. 

One Connecticut nurse pleaded guilty in 2015 to accepting $83,000 in kickbacks from the company. Families of dead patients, prescribed Subsys despite prescriptions for other drugs that are fatal when combined, and despite no cancer diagnosis—the drug is only FDA-approved from cancer-related pain—have also sued the company.

In a statement, Carmen Ortiz, the-then U.S. attorney for Massachusetts (before she and many others were summarily fired by Trump administration officials earlier this year), pinned part of the blame for the country’s opiate epidemic squarely on “corporate greed.”

In January, Insys founder John Kapoor stepped down as chairman, a role he took over from the indicted Babich in late 2015. Kapoor’s exit came after Insys’s sales plummeted 40 percent, as Forbes reported. (Wonder if the alleged kickbacks had anything to do with the inflated numbers?)

It’s all very ominous, but in a real way, marijuana activists should let Insys try—and then fail, spectacularly, as they are primed to do.

Insys’s proposed product, called Syndros, is a solution of “oral dronabinol.” Dronabinol is the generic name for another synthetic version of THC that’s been on the market for quite some time, called Marinol—and if you know anyone who has used Marinol, you know what they think of it. Namely, it kind of sucks.

For many patients, fake weed simply doesn’t work. As one patient prescribed Marinol told CBS News, “It might as well have been M&M’s.”

This is almost certainly because as synthetic THC only, Marinol and Syndros both lack cannabidiol, or CBD, as well as dozens of others cannabinoids. And as per the “entourage effect” theory, proffered by luminaries like CNN’s Sanjay Gupta and many more, your body and brain need all of cannabis’s component parts in order for its medical “magic” to work.

But let’s say Insys strikes out with Subsys. It won’t end there.

This is a company accused, with enough evidence to indict in a federal court, of being willing to see people die in order to sell more drugs. And it won’t end with this company.

Big Pharma is scared of weed—terrified—and as any animal scientist will tell you, a cornered and frightened animal is the most dangerous. And that applies to humans.

You can keep up with all of HIGH TIMES’ marijuana news right here.

Wilkes-Barre Faces Heroin Scourge Turning It Into ‘the Most Unhappy Place in America’

(THIS ARTICLE IS COURTESY OF NBC NEWS)

(TWO MONTHS AGO MY 33 YR OLD NEPHEW DIED FROM THIS IN SCRANTON SO THIS STORY HAS PERSONAL MEANING TO ME)

JAN 9 2017, 11:08 AM ET

Wilkes-Barre Faces Heroin Scourge Turning It Into ‘the Most Unhappy Place in America’

‘Dropping Like Flies’: Heroin Epidemic Takes Hold of PA County 7:36

For William Lisman, the longtime Luzerne County coroner, the first sign of the coming plague appeared in the hills of northeastern Pennsylvania in November 2015.

A 27-year-old woman from one of the mountain towns surrounding Wilkes-Barre was found dead in her family home.

Lisman suspected a drug overdose. She was young. She had been healthy. There were no obvious signs of trauma. And heroin abuse had been on the rise in recent years.

“When a person dies of an overdose, the lungs fill with fluid,” he said. “The victims essentially drown in their own fluids.”

Because autopsies are expensive and time-consuming, many coroners faced with cases like these do toxicological tests designed to pick up traces of known drugs to determine the cause of death. But the first test Lisman administered came back negative. So did the second.

So Lisman listed the cause of death as undetermined.

Several days later, a 34-year-old man was found dead in a sleeping bag in the nearby city of Hazleton.

Once again, Lisman suspected a fatal drug overdose. Once again, the tox tests came back negative. And once again, he listed the cause of death as undetermined.

“I remember when it started because it was budget time and they were about to cut my budget,” he said, with a wry chuckle. “At that point the doctor I had been consulting with (about these two cases) told me, ‘Bill, there is something going on here’.”

Like many coroners in smaller counties, Lisman is not a doctor. But he knows about death. A third-generation Wilkes-Barre resident, he and his family ran a funeral home that buried several generations of city residents. He reached out to fellow coroners in neighboring counties to see if they had similar cases.

They had. And the answer was fentanyl, a powerful painkiller the U.S. Drug Enforcement Administration says is 25 to 50 times more potent than heroin, packs 50 to 100 times more punch than morphine, and can be manufactured easily by illegal drug mills. This was the same drug that killed Prince last April.

“I started hearing about fentanyl and how drug dealers were cutting heroin with it,” he said.

Lisman said he had the toxicological tests “tweaked” to detect the presence of fentanyl and “after that, the drug overdoses here skyrocketed.”

Facing a crisis, Lisman called the local newspaper, The Times Leader, last May and sounded the alarm.

“I knew I wasn’t going to stop people from using, but I wanted people to know what they were using,” he said. “This stuff can kill them.”

And it has.

The deadly math in Wilkes-Barre

Last year there were 137 fatal drug overdoses — more than half of them the result of heroin laced with fentanyl — in a county of just 318,000 people.

That death rate is four times higher than New York City.

“Twenty years ago, we might have 12 deaths we determined to be drug deaths,” Lisman said. “This year we are on track for 150 deaths…By our standards, it’s off the charts.”

There have been so many fatal drug overdoses that Lisman, who uses an examination room in the basement of a local hospital to do autopsies, said he has had to “finagle space to put all the bodies.”

“I have only room for two in my cooler,” he said. “There’s room for just 10 more in the hospital’s other cooler.”

The victims reflect the demographics of the county — they’re mostly white, often lower to middle-income, Lisman said.

“Age wise, we are across the spectrum, from 20’s to the 70’s,” he said. “We see everyone from the guy in the flophouse to the hard-working guys or gals who find relief in drugs.”

Also, while heroin users in the past relied on needles, “the vast majority now is being snorted,” said Lisman. “A user doesn’t have to go through the process of injecting now. It makes it easier to use.”

A big part of the reason Wilkes-Barre is grappling with a drug problem, Lisman said, is because this city of 41,000 is just a two-hour drive from Philadelphia and from New York City. Interstates 80 and 81 converge just south of the city.

A packet of heroin that sells for $5 in the Bronx can fetch double that in Wilkes-Barre, Lisman said. And if it’s cut with fentanyl, the profit quadruples along with the danger to the users.

“Heroin definitely has its hold on this area,” said Cathy Ryzner, a certified recovery specialist at the Wyoming Valley Alcohol & Drug Services in Wilkes-Barre. “I’ve never seen anything like it. Every time you look in the newspaper and you see somebody died young and at home, you know. You know.”

Christopher Emmett buried his 23-year-old son, Christopher Jr., in August, although in his case it was due to a lethal mixture of morphine and codeine.

“Every time I hear of somebody dying it’s always with the fentanyl mixed with it, it’s never somebody that just did heroin and died from doing heroin,” he said.

From boom town to boarded-up storefronts

The plague hit Wilkes-Barre as the proud county seat on the Susquehanna River was struggling to reverse decades of decay.

Once a thriving city of 80,000, Wilkes-Barre was built by coal and manufacturing barons who erected stately homes and public edifices like the stunning Luzerne County Court House and the 14-story Luzerne National Bank Building in Public Square. Thousands of Italian, Polish and Irish immigrants poured into the city to work in the mines and toil in the garment factories.

But the city lost half its population when the anthracite coal mines died in the 1950s and the good manufacturing jobs began vanishing. And in 1972, Hurricane Agnes delivered a body blow to the local economy when it flooded downtown with nine feet of water.

After that, Wilkes-Barre became a city of abandoned buildings and boarded-up store fronts as the remaining residents struggled to find their footing in an economy where the main employers were now government agencies, the local colleges and hospitals.

The recession in 2008 hit Wilkes-Barre — long a Democratic bastion — hard. And when Barack Obama was running for president, hopeful residents voted for him in droves and did so again when he ran for reelection in 2012. But while the rest of the country rebounded, this Rust Belt city and the rest of the county, including Vice President Joe Biden’s hometown of Scranton, were slow to recover.

Many jobs returned, but not many were the good-paying kind that could support a middle-class life. And those who opted to stay in Wilkes-Barre became disappointed and resentful.

“They want the jobs they had before, not the jobs that are available now,” said Kathy Bozinski , the marketing and communications chief at the United Way of Wyoming Valley. “A lot of good things happened during the Obama Administration, but a lot of the things the folks here were hoping for just didn’t happen.”

In November, Luzerne County voted for Donald Trump instead of Hillary Clinton, handing the Republican a narrow but shocking victory that helped propel him to the White House.

“I hate to use the cliché, but there are a lot of angry white guys in the region who 20 years ago were making decent money ,” Bozinski said. “Now they are struggling to pay the mortgage and have a good life. There is a lot of frustration.”

Mary Wallace, who is Lisman’s office administrator, said for many people leaving Wilkes-Barre for a better life somewhere else is not an option.

“It’s hard for people who have been here for generations, whose families are buried here, to pick up and move even if they might be better off somewhere else,” she said. “This is their home.”

The most unhappy place in the United States

Two years ago, a pair of researchers — one from Harvard, the other from the University of British Columbia in Vancouver, Canada — concluded that the Scranton/Wilkes-Barre metro area was the most unhappy place in the U.S.

They reached their conclusion after wading through the results of telephone polls conducted by the federal Centers for Disease Control and Prevention between 2005 and 2009, including answers to the question, “How satisfied are you with your life?”

Lisman, whose four grown children did not return to the Wilkes-Barre after finishing college, agreed that they live in a depressed community.

“We have a lot of people who are unhappy with life,” he said. “People using drugs are looking to escape.”

For Lisman, the heroin plague “is a symptom of the way people here feel and have felt for years.”

“I don’t have an answer for opiate addiction,” he said, his smile fading fast. “The pain and suffering that it has caused is unbelievable. It is eating away at the core of society.”

Cathy Ryzner, a certified recovery specialist at Wyoming Valley Alcohol & Drug Services, said the people she sees are dealing with a host of demons beyond the economic, everything from sexual abuse and broken homes to being raised in households where drinking and drug-taking runs rampant. She’s seen people who get hooked on prescription drugs make the move to heroin.

“But I can’t just blame the doctors,” she said. “It’s a little bit of economics, little bit of hardship, little bit of being raised like that.”

Drugs like heroin, she said, “makes all your problems melt away.”

“It masks any kind of hurt, any kind of feeling…after three days of doing opiates you are addicted,” she said. “You don’t even know you’re getting caught up.”

And Ryzner would know. She was a drug addict for three decades and has been clean for 10 years.

Death by drug overdose “just not natural”

It was against this backdrop that the heroin plague hit the region.

Coroner Lisman, whose dad was once the mayor of Wilkes-Barre, said that at first he made a point of personally going to the scenes when a suspected fatal overdose was reported. No more.

“Now it’s become so routine,” said Lisman, who has gone back to dispatching his deputies to do the grim work of taking the bodies to the morgue.

But Lisman says he is very much aware of what this plague is doing to his hometown and admits it has left him shaken.

“I was raised in an apartment above a funeral home….death never scared me,” he said.

What bothers him, he said, is the resignation he has seen in the victims’ families ones who react “almost with relief.”

“It bothers me that somebody’s life could reach a point that death could be a positive thing,” he said.

This from a man who has comforted thousands of people over the years whose loved ones died of natural causes, sometimes after enduring years of pain.

“Death by drug overdose is different,” he said. “That’s just not natural.”

One case in particular still haunts him. The police had gotten a 911 call and arrived to find a young couple in their 30s dead in bed from “a hot load of heroin while their 5-year-old son was watching TV and eating Cheerios,” Lisman said. “He knew enough to call the police for help.”

Death behind closed doors

The heroin plague in Wilkes-Barre is largely hidden with death taking drug abusers behind closed doors.

“You don’t see junkies on the street,” said Bozinski, who was previously an Emmy Award-winning TV and radio reporter. “This happens behind closed doors. In bedrooms and basements.”

But the effects ripple across the city and touch everyone.

“Everywhere you go you hear, ‘Did you see the story about that one in the paper? Was that another drug overdose?” said Wallace. “That’s what everyone here is talking about.”

The toll is not just psychic. Crime is up, police report, especially petty thefts and break-ins by drug abusers looking for money to score a fix. And the dealers are almost always out-of-towners.

“They’re not racist,” Bozinski said of Wilkes-Barre’s residents. “Yes, some white guys blame people from outside for bringing drugs here. But there’s also the acknowledgement that there is a market for it here.”

What’s happening now in Wilkes-Barre is not new. Heroin use has been on the rise across the country since 2002, according to the federal Substance Abuse and Mental Health Services Administration.

“We’re behind the times,” said 42-year-old Paul Smith, who was born and raised in the city — and who buried his former partner Jeremy three weeks earlier after he died of a heroin overdose. “A lot of the problems that were happening in other places are now happening here.”

Sitting in a local bar called Hun’s Café 99 and nursing a beer and a basket of chicken wings , Smith said Jeremy didn’t know what he was dealing with when he started snorting heroin.

“It’s been a very hard thing,” he said. “I spent a lot of time helping him to get clean. It was a very hard reality. And it was very hard to find services to help him.”

Smith said people in Wilkes-Barre turn to drugs because they are already depressed about their lives, depressed that they have to work two or three jobs to get by.

“That’s why people went for Trump,” said Smith, who runs a limo service, owns real estate — and admits to voting for the Manhattan mogul as well. “People are so sick of other people doing better.”

Sitting beside Smith was 28-year-old John Sabatelli. He agreed that it was ignorance of dangerous new variety of heroin that was fueling the crisis. He recalled being surprised when he discovered that a couple at the warehouse where he works was getting high on heroin in the bathroom.

“It’s surprising in that you don’t know who is going to do it,” he said.

Grieving dad Christopher Emmett said drugs have got a death grip on his community. He said his doomed son started smoking pot at age 13 and quickly graduated to harder drugs. He said Christopher Jr. was in and out of rehab – and so were most of his friends.

“It is really an epidemic,” Emmett said. “We went to 14 funerals of my son’s friends who died of addiction in just one year. They’re dropping like flies, every day.”

Emmett’s wife, Patricia, burst into tears at the thought of spending Christmas without her son. And as she cried, her boy’s ashes sat in an urn on a shelf in the living room.

“There ain’t no Christmas,” she said, bitterly.

A proud town fights on

Wilkes-Barre may be down now but it is far from defeated. In Public Square, new restaurants like Franklin’s have opened to serve the young professionals who have moved downtown to live in loft apartments in some of the vintage buildings.

Wilkes-Barre, Pennsylvania. NBC News

Older establishments like the Café Toscana were bustling with diners on a Tuesday night. And so was the brand new Chick-fil-A, which is located on the first floor of dorm that King’s College built right on the square in an attempt to make students part of the city’s revival.

Just outside downtown loomed the rotting hulks of long-abandoned factories. But higher up in the hills, Christmas lights twinkled on many of the modest-but-clearly kept up homes and the streets bustled with families going about the business of everyday life.

Over at the ornate county courthouse, which dates back to 1909 and which was built at a time when the future of Wilkes-Barre seemed bright, a chorus of fourth graders from a school across the river in Larksville filed into the central hall to perform a medley of Christmas carols.

Watching them was the grandmother of one of the 11-year-old, a chubby, brown-haired boy with untied gym shoes. His face creased into an angelic smile when he spotted his grandma.

“I am scared for him,” said the grandmother, who declined to give her name. “I have family that got hooked on drugs. I don’t want that to happen to him.”

Asked why the area has been so ravaged by drugs, she shook her head. “I don’t know, maybe because they’re so easy to get,” she said.

The children’s music teacher, Joseph James, said so far his kids “are completely sheltered” from the heroin crisis unfolding around them.

“I hope it stays that way,” he said.

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