February 16, 2016
February 13, 2015
In the aftermath of the guilty verdicts handed down in the case of Ross Ulbricht, some journalists have been having a field day reporting on the downfall of the ‘alleged mastermind’ behind Silk Road, while others are shining a light on the apparent miscarriage of justice . But curiously absent in the deluge of reporting around Silk Road is the discussion about the drug war. While it’s disappointing that we’d rather use words like ‘alleged mastermind’ than ‘evidence of drug war failure,’ it’s perhaps understandable, because it’s not always easy to talk about the uncomfortably obvious:
People use drugs. They get those drugs from someone else. In order to consume drugs, someone had to buy them, and someone had to sell them. We don’t have to like it, but we do have to acknowledge the reality of it.
Our entire approach to responding to that reality has thus far been a dismal disappointment. Silk Road was, in the most basic sense, a product of our failed war on drugs—a response to our woefully inadequate way of managing not only drug use, but also drug demand and drug sales.
Many reformers, myself included, have long been highlighting the forward-thinking benefits of Silk Road and the ways it began to slowly revolutionize drug sales around the world. It provided a platform that could allow indigenous growers and cultivators around the world to sell directly to the consumer, potentially reducing cartel participation and violence. It created an economic opportunity for drug sellers with previous felony drug convictions and others typically excluded from participating in the regulated and controlled US drug sales marketplaces (such as dispensaries where marijuana is sold).
Silk Road was a far better way for people to buy and sell drugs than on the streets. It was a workable model of largely peaceable and less dangerous drug transactions. Transactions that did not result in women drug buyers being sexually assaulted or forced to trade sex for drugs. Transactions that did not result in anyone having a gun pulled on them at the moment of purchase.
Journalist Mike Power had this to say in response to the verdict:
“…regardless of legality, we now live in a reality where anyone can buy any quantity of any illegal drug they want, as often as they like, at any time of day or night and have it shipped to their house in a few days or less. The question is: does the rise of Silk Road mean the final nail in the coffin for the War on Drugs? Prohibition isn’t now just misguided, it’s clearly impossible.”
Drug war blogger Poly Paradyme echoed that sentiment:
“The Silk Road trial has concluded, but why are we here in the first place? The larger conversation regarding the War on Drugs has been ignored on the whole and the trial has surrounded ‘Did Ross sell drugs?’ instead of ‘Do we care Ross sold drugs?’ The War on Drugs after almost a century has only wrecked lives, empowered the police state, and funneled money into a prison industrial complex. This is already common knowledge to many, so why is it missing from the media context of Silk Road’s trial?”
We need to bring drug sellers into the conversation about ending the war on drugs. We need to acknowledge the role they play. We need to prioritize the realities of people who sell drugs all around the world, the terrible consequences (including death) many of them face, the risks they take and the way they so often are excluded from our demands for justice and drug policy reform.
We need something better than what we have now, which is nothing but failure, cartels and beheadings, mass incarceration, mandatory minimums, a vibrant and throbbing illicit market, and a prison industrial complex totally out of control.
Drug sales and e-drug marketplaces are illegal only because we say they are. We could equally decide to say they are not illegal, but rather they are controlled and regulated environments, with enforced product quality standards, age verification measures, fair trade agreements with drug cultivators, healthcare workers dispensing drug safety information in chat rooms, and any number of other policies that would enhance safety and reduce risks. We could decide to create models that champion human rights, promote eco-stewardship and sustainability and create good jobs for people. Or we could choose to do nothing and let the disastrous global drug war keep grinding away, ruining lives and destroying opportunity.
Silk Road gave us a new way to imagine better management of the drug trade. It remains to be seen if policy reformers embrace and champion this new model, or if we allow that innovation to fade into our history of opposing the failed war on drugs.
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October 02, 2014
It’s not every day that a state does something compassionate and sensible for people who use drugs, but recently, California did just that. On September 15, Governor Brown signed AB 1535 (Bloom), which will allow people who use drugs and their loved ones to walk into a pharmacy without a prescription, ask for the lifesaving opiate overdose reversal medicine naloxone , get educated about its use, purchase it and walk out with it. It’s a good health practice—and it’s also making a strong statement of support that people at risk of an opiate overdose should be able to easily obtain the medicine that can save their lives.
People struggling with chemical dependency sometimes live on the margins, where whatever problems they may have—medical, emotional, mental or otherwise--usually get worse and more expensive to treat. Telling drug-dependent people in no uncertain terms that their lives matter—that their health and their right to access the same medicines as everyone else matters—is a small but essential step in helping to save lives and connect them to mainstream health services.
California’s new law creates an opportunity for the people at greatest risk of an accidental fatal overdose to have a fact-based conversation with a pharmacist about naloxone. They can purchase the medicine that could save their own lives or the lives of others. We know this approach works. The Centers for Disease Control and Prevention released a landmark study documenting over 10,000 overdose reversals by laypeople who were provided naloxone and taught how and when to use it.
Like many states in recent years, California has seen the number of fatal drug overdoses grow in the more rural, isolated corners of the state, as well as in the metro areas. This law will help bring naloxone to all Californians—rural, metro and otherwise. Our state has somewhere around 5,000 pharmacies, representing an enormous opportunity to expand access to this lifesaving drug for potentially tens of thousands of residents. We now join a number of other states, including New Mexico, Rhode Island, Washington, New York and Vermont, where naloxone is being furnished in a growing number of community pharmacies.
Too often, people struggling with a chemical dependence are labeled ‘addicts’ and treated as though they are in some way fundamentally ‘less than,’ less intelligent, less human, less deserving of compassion or help. Labels like ‘addict’ and ‘junkie’ can stigmatize people to the degree that they start drifting away from the mainstream and away from the healthcare services that can save their lives. This is an antiquated approach to helping people and thankfully it appears we may be turning a corner on it.
Recently, a number of organizations including the White House Office of National Drug Control Policy have started coming forward to address stigma by urging the removal of inflammatory labels like ‘addict’ from medicine and drug treatment research; instead encouraging the adoption of unbiased, more accurate, person-first language. People with substance problems deserve the same basic dignity and respect when interacting with healthcare professionals as anyone suffering with any treatable condition. The new law is a powerful reinforcement of this basic principle.
Despite our best efforts, some people may never stop using drugs--but they also never stop being human beings. All people should have the same access to lifesaving medication, whether they use drugs or not.
This piece first appeared on the Drug Policy Alliance Blog.
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April 01, 2014
An eye-poppingly offensive infographic has been making the social media rounds this week, even making appearances in unlikely places like TIME.com.
Have you seen “The Faces of Drug Arrests?” It features disturbing photos of people arrested on drug charges, people with scabs and sores on their faces, with sunken eyes and cheekbones and the like. It is so hurtful, and factually flimsy, and profoundly stigmatizing to the people prominently featured.
So imagine my shock when I discovered that it was created by people who really ought to know better: a company that promotes drug abuse rehabilitation facilities. When did recovery become less about compassion and hope, and more about just generating “clicks” and “going viral?”
I made my concerns known to them via my personal twitter account. Take a look at a portion of the exchange:
It is disingenuous to present the shocking photos and imply that they accurately reflect the toll that drugs – and drugs alone – have taken. The photos don’t make clear if any of the people featured had any other illnesses which may contributed to their appearance. Also no mention of any traumatic experiences, physical assault or injuries, mental health issues, or whether or not any of the people had any medical care at all in the recent past. This is not to suggest that heavy and continued drug misuse can’t take a physical toll – it can. But to post these photos, with no context whatsoever, isn’t telling the full story of these human beings and why they look fatigued and unwell. Only at the very bottom of the infographic do they state:
“The deterioration seen in consecutive photos is not necessarily the direct result of drugs or addiction”
But then they don’t go on to explain the myriad other reasons why people can look very different from year to year.
DPA actively opposes stigma against people who use drugs. My colleague, Sharda Sekaran, recently countered some of these inaccurate portrayals of the “faces of drug users” with her op-ed, “Dear Media: This is What People Who Use Marijuana Look Like.” Sekaran’s piece perfectly illustrates DPA’s commitment to ensuring that the media get it right: we take very seriously the rights of people who use drugs to not be portrayed in ways that are inaccurate or offensive.
I recently wrote about the negative consequences of stigmatizing people who struggle with drugs. I talked about how hard it is, when you’re in the thick of your drug use, to know that many people see you as nothing but “a hopeless addict.” It makes your struggle that much more difficult and painful. People kick you when you’re down, rub salt into your open wounds, all of it. All of those clichÃ©s are true about how horribly we treat people who struggle with drugs.
Mocking the faces of people alleged to be using drugs, gasping at how “bad” they look, and judging them for looking sick or traumatized is shameful. We ought to be ashamed of ourselves for looking at any of this as entertaining, or a way to promote a business, or whatever it is we think we’re doing by circulating these images. If addiction can be thought of a disease, what other disease or form of human suffering do we treat this way?
I want to believe that we are not cruel monsters. I want to believe that we’re capable of discouraging drug use among our young people in ways that have more to do with facts, alternatives, and common sense, and less to do with “look at what will happen to your face if you use drugs!”
I think these tweets sum it all up nicely:
This article first appeared on the Drug Policy Alliance Blog.
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March 25, 2014
“Addict’” is one of those words that so many of us use, largely without pausing to wonder if we should. We just take for granted that it’s totally okay to describe a human being with one word, “addict”—a word with overwhelmingly negative connotations to many people.
We don’t really do that for other challenging qualities that can have a serious impact on people's lives. We don’t say, “my mother, the blind,” or “my brother, the bipolar.” We don’t say, “my best friend, the epileptic,” or “my nephew, the leukemia.”
We don’t do that because we intuitively understand how odd it would sound, and how disrespectful and insensitive it would be. We don’t ascribe a difficult state as the full sum of a person’s identity and humanity. Maia Szalavitz eloquently expressed similar frustration with terms like “substance abuser” in her recent piece at substance.com.
When we do feel the need to reference a state of disability, challenge or disease when describing a human being, we say something like, “my mother has cancer,” or “my nephew has leukemia.” And we would almost certainly never let that be the only thing said about that person, something that defined them. We do not say or suggest that a person is their challenge. We remember that they are a person first, then if appropriate indicate their challenge as one factor of their existence.
Why can't we be that intelligently sensitive with people struggling with drugs?
For many people, myself included, the word “addict” is incredibly harmful and offensive. You do not have my permission to call me an addict. You can of course refer to yourself as an addict, if you wish, but please do not refer to everyone physically or psychologically dependent on drugs as “an addict.”
The sense of fear, loathing, otherness and “less than” created by that word far outweighs any benefits of using linguistic shorthand to quickly describe a person. “Addict” is a word so singularly loaded with stigma and contempt that it’s somewhat appalling that we continue to let it be used so easily and indiscriminately.
Even in a chaotic stage of drug use, we are not “other.” We are women, we are someone’s daughter, we continue to laugh, we continue to like jazz and cheeseburgers and comfy pajamas. We cry, we get so lonely, we hate sitting in traffic. Addiction can be wretched, no question, but we do not ever stop being human beings, even during the times in our lives when we are dependent on drugs.
I may be in the fight of my life with drugs, but I am not the drugs that I take. I am a fighter, a survivor -- I am never merely “an addict.” Please do not destroy the totality of who I am by reducing me to that one word. We retain our full humanity despite our challenges, particularly when our challenges are much deeper than our attention-grabbing drug use might suggest.
My days of chaotic substance abuse are long behind me. I am not “an addict” now, and I wasn’t “an addict” then. I’m just a person, who had a period of difficulty, pain and challenge. I battled, I failed, I tried again—just like most people.
Why not try using any of the following as alternatives to calling someone “an addict”: person dependent on drugs; people struggling with drugs; person in recovery from addiction. The use of person-centric language may seem inconsequential, but I assure you, it is not. It is vitally important to scores of people, most of whom you’ve never met and never will. They are the people who, in the eyes of the world, are lumped into that “other” category you’ve created for them by calling them “an addict.”
They don’t want to be there anymore. I’m hoping to tell their story with this blog post. We’ve been silent too long. We’ve had enough. Please—put our humanity first.
This piece first appeared on the Drug Policy Alliance Blog.
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February 03, 2014
The suspected overdose death of Philip Seymour Hoffman is hitting millions of people, including myself, like a tsunami today. The story keeps unfolding and the tragedy just keeps compounding. Recent reports are suggesting that he was discovered with a needle in his arm and bags of a substance (presumed to be heroin) nearby. Like many of you, I was a huge fan of his, considered him to be the most gifted actor of his generation. And like many of you, I am horrified to think that he died from something so often easily prevented.
What makes the death of Philip Seymour Hoffman all the more tragic is that it happened in New York, a state with a wide array of policies and services designed to reduce drug overdose deaths and save the lives of people who use drugs. New York has a 911 Good Samaritan law, which offers some protection from drug charges for people who call 911 to report a suspected overdose. Many people panic at the scene of an overdose, fearing they or the overdose victim will be arrested for possessing small amounts of drugs. Good Samaritan laws in over a dozen states, including New York, encourage people to act quickly to save a life without fear of drug charges for minor violations. New Yorkers also have limited access to the opiate overdose reversal medicine naloxone. If administered right away, naloxone can can reverse an overdose and restore normal breathing.
Naloxone is generic, inexpensive, non-narcotic, works quickly and is not only safe, but also easy to use. It's been around since the 1970s and has saved tens of thousands of lives. New York also just this week introduced legislation to expand access to it.
So many states are just now starting to take some great steps to get naloxone in the hands of more people. Hoffman's death perfectly illustrates how terribly urgent this is. Even theOffice of National Drug Control Policy is supporting naloxone in the hands of cops. But we can't stop there. It's not enough for law enforcement and EMT's to have access to naloxone -- people who use drugs and others who might witness an opiate overdose must have that same access. Whoever is the first to respond to the overdose, the actual "first responder," must be permitted access to naloxone, period. We need to make sure that local and federal governments are on board and that we're getting naloxone into as many pharmacies as possible.
Over the coming days, we'll likely learn a great deal more about Hoffman, his drug use and his personal demons. Some will likely call his death a "teachable moment." But we need to ensure that what we're teaching includes basic drug user safety information -- information that can absolutely save lives. We need to start talking about harm reduction and how to help people stay alive if they use drugs. If you use heroin and no one has ever told you to avoid mixing alcohol or other sedatives with heroin because it increases your risk of overdose, we have failed you. We don't have to like a persons drug use, in fact, we can hate it. But at the very least, we need to do some very basic, lifesaving education about it.
There is much left to discover about the death of Philip Seymour Hoffman. And much left to say about how we so very urgently need to significantly shift not only our conversations about drug use, but our drug policies, as well. We need doctors, not jail cells. We need compassion, and we need research-backed science and medicine to help people most in need of a therapeutic intervention. We need to acknowledge that we all have our secrets, our shame, our hidden darknesses and our realities that we keep safely out of public view. I hope as details emerge, we remember him as one of the greatest actors of the modern era and don't decide to write him off "just another celeb who died from drugs." I hope we do more to help others like him stay alive, even if they use drugs.
I tweeted this earlier today and I think this is how I will remember his death years from now:
I can't believe he's dead. He was a giant. A mountain of an actor. The very best. Horrible and unbelievably tragic. Go with God, Philip. You were loved.
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December 19, 2013
Reports on deaths related to Ecstasy and methamphetamine use are always heartbreaking. It’s easy to understand why people are worried about young people consuming stimulants at music festivals. Drug-related fatalities at large music events are, thankfully, still pretty rare given the sheer number of music festivals and the enormous crowds many of them draw, and with a little effort, we could reduce drug-related harms even further. But don’t expect event promoters to do all the work—people who use drugs and our prohibition-approach to all of this bear some responsibility, too.
People who use drugs, particularly young people, need access to the information that could save their lives. We do an abysmal job at educating about the basics of drug use safety and risks. We tell young people, “Ecstasy can be dangerous, don’t use it.” But we fail to provide lifesaving information, such as “If you do decide to use Ecstasy, make sure you have constant access to water, sip it frequently, and remember to take ‘chill out’ breaks from dancing to avoid potentially dangerous overheating.”
Concert promoters should be encouraged to share this kind of lifesaving information with attendees. It would be so easy and simple for musical festivals to add a “Stay Safe” section on the event’s website, including information about how to avoid or respond to a suspected drug overdose. The promoters could allow non-profit organizations such as DanceSafe to make drug safety testing kits available at the event.
Just two festivals alone – Burning Man and Coachella – each attracting more than 50,000 guests each year--could set an incredible precedent for the rest of the festival industry by stepping up and simply making overdose prevention and response information more widely available to their customers, on the event website and at the event itself.
Many young people, despite our warnings and threats, will experiment with drug use at music festivals and other major events that attract scores of their peers. This is reality, whether we like it or not. One of the best ways to reduce the possibility of drug-related death is to not ingest a substance without knowing what it is--and to have a plan in place to deal with the very rare health emergencies that might occur.
Don’t use drugs alone. Stay hydrated. Rest if you feel fatigued. Don’t mix different substances. Take small amounts of a substance until you can determine how it affects you, “start low and go slow.” And most importantly, call 911 if someone needs emergency help. California has a 911 Good Samaritan law that protects callers and overdose victims from arrest for small amounts of drugs and drug paraphernalia when medical assistance is summoned to the scene of a suspected drug overdose.
Music event promoters need to do their part to help save lives, but so do all of us. Talk to young people about what it means to be safe if they choose to use drugs. Educate yourself about risky drug combinations and overdose response. It’s simple education, and it can save lives.
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October 03, 2013
The website called Silk Road, referred to as “the eBay for drugs,” has been seized by US federal agents according to the New York Times and other outlets. Silk Road has been used, successfully and discreetly, by countless people around the world since February 2011. Operating as an above-ground source for a variety of drugs, ranging from marijuana to heroin and virtually everything in between, Silk Road created a safe environment, free of weapons and violence during the transaction, where people could acquire drugs.
The shutdown of Silk Road is intended to curtail organized drug use and sales is designed to get headlines – but won’t accomplish much. Silk Road is not the only website of its kind and its displaced users will likely either turn to a competitor site or seek out drugs in other ways. This approach to fighting the war on drugs has never worked and it’s not likely to start working now. It is becoming increasingly common knowledge that the drug war as we know it is a failure.
For over two years, countless people around the world accessed the site, spending an estimated $1.2 billion in BitCoins, the majority of it being spent on drugs. And it all happened without much fanfare. People bought drugs from drug sellers with products that had been rated by other consumers, people consumed their drugs, life went on. If drugs were not prohibited substances, none of this would be remarkable. It’s only that the drugs in question were illegal that makes any of this headline news.
A number of steps were required to participate in the Silk Road marketplace—a marketplace that existed parallel to the visible Internet on the ‘deep web,’ accessed via the anonymization network Tor. It took quite a bit of legwork, generally involving creating a bogus email address, acquiring BitCoins, in some cases establishing a separate bank account. It was do-able, of course, but no one did it on the spur of the moment and those who used the site did so at risk of being detected.
Even with all the hurdles and the risks, people chose to use Silk Road rather than rely exclusively on whatever illegal and potentially dangerous drug market existed in their ‘real world’ community. The site’s success reinforced that people who are dependent or addicted can make rational choices, even if we like to imagine them as being totally irrational. Given the choice of quickly and easily accessing drugs in potentially sketchy or dangerous neighborhoods, or buying them safely on-line but having to wait, many users prefer privacy, security and a wait to the alternative.
Rather than a heinous crime, using Silk Road could be seen as a more responsible approach to drug sales, a peaceable alterative to the deadly violence so commonly associated with the drug war. Amir Taaki, an advocate for BitCoin, the electronic currency used to complete transactions on Silk Road, said in an interview quoted in the Guardian, “People want drugs. The drug war is probably a failed war. I want to get rid of cartels. The way to do that is for people to buy their drugs straight from the producer. That’s what’s cool about things like Silk Road—you can bypass gangs.” The Guardian also reports advocates of Silk Road asserting that the website ‘provided drugs of a higher purity-with therefore fewer potentially dangerous contaminants—in a safer way than traditional drug-dealing.’
Just this week, research published in the BMJ Open confirmed what millions have been saying for years: the drug war is a misguided effort, at best, to address problems related to drug consumption and sales. The researchers state:
“With few exceptions and despite increasing investments in enforcement-based supply reduction efforts aimed at disrupting global drug supply, illegal drug prices have generally decreased while drug purity has increased since 1990. These findings suggest that expanding efforts at controlling the global illegal drug market through law enforcement are failing.”
Seizing and shutting down Silk Road will do nothing to stop demand for drugs, nor will it end drug sales or drug use. It won’t help anyone get into treatment, it won’t teach anyone about dangerous combinations of drugs. You know it, I know it, the federal government knows it, the leaders of countries around the world know it. We all know that our whole approach to drug prohibition has been a failure.
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October 01, 2013
It’s easy to focus on the sensational aspects of the emerging krokodil “flesh-rotting drug” story, but that ignores the most troubling issues around its origins, its popularity and its continued use. Krokodil is the street term for a home-made injectable opioid called desomorphine, a drug with effects similar to, but not as long lasting, as heroin. Desomorphine was first patented in the U.S. in 1932, but the homemade version has risen in popularity in Russia in recent years. Desperation often breeds tragedy and disaster, and Russia’s shoddy methods of treating their sick and addicted created the desperation that led to the disastrous popularity of krokodil.
In Russia, there is no methadone, drug treatment is totally inadequate, the street price of heroin can be very high and drug users are left to struggle with their addictions with no real therapeutic assistance. In that awful climate krokodil emerged and spread. Lacking any real alternatives, drug users attempt to manage their addictions themselves by creating a substitute for heroin. According to the World Health Organization, the Russian Federation has one of the highest rates of opiate use in the world. Millions of drug users throughout Russia urgently need access to evidence-based treatment and medication for their drug use, but are refused it, largely due to stigma and ignorance.
Earlier this year, the Pulitizer Center reported on the dire situation in Russia, describing it as “Death by Indifference.” But this is hardly breaking news. We’ve known about these failures a long time. Back in 2008, the New York Times reported on it, shining an important light on the urgent need for methadone access.
People who use drugs urgently need, at minimum, access to evidence-based treatment and the full range of therapeutic interventions and medications that can help them. We take this for granted in the U.S., because we do a pretty good job at helping people access substance abuse treatment. But when drug users are pushed to the margins of society and denied access to lifesaving interventions, including rehabilitation and treatment services, we see the failures of the drug war in stark relief: underground drug markets explode and flourish; HIV is transmitted via shared syringes; serious medical consequences are exacerbated due to neglect; human beings are pushed in corners, forgotten about and essentially left for dead.
For decades we have engaged in an increasingly futile, increasingly costly war on drugs. Prohibition creates an environment for new drugs to emerge; new methods of making drugs contribute to an ever more clandestine ‘make it yourself’ drug market (see the rise of ‘shake and bake’ at-home meth manufacturing in soda bottles).
Very few details about the emergence of krokodil in Arizona are yet available. What we don’t know about this story far outweighs what little we do know. We don’t yet know anything about the patients treated; other substances they may have been using; the extent of krokodil use in their communities; if their use of krokodil was experimental or daily; if they were using it as a substitute for another opioid; or really anything. Much of the reporting thus far has been little more than a few gory pictures of “flesh rot” and fear mongering about the drug.
The media is highlighting some of the horrific consequences of homemade drug production —but we can’t stop there. Because beyond the eye-popping pictures of necrosis associated with krokodil, there is a question begging to be asked: why aren’t we doing more to help these people? Why are we tolerating a world in which people are driven to extreme and serious medical consequences instead of simply having access to the treatments that can save their lives?
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August 27, 2013
Another International Overdose Awareness Day (Aug. 31) approaches and many people are still focused on prescription opioid drugs and their role in overdose fatalities. Those do indeed play a big role. But another threat is snaking through the country and we need to plan for its impact.
Here comes the heroin.
Reports are coming in across the country, from places like Montgomery, Maryland,Ellensberg, Washington, Concord, New Hampshire, throughout Kentucky and in the Twin Cities, Minnesota. Heroin use and heroin overdoses are growing. According to recent research by SAMHSA (Substance Abuse and Mental Health Services Administration), the number of first-time heroin users has nearly doubled lately, from around 90,000 “first-timers” in 2006 to a whopping 178,000 in 2011. Our normal approaches (crackdown, get tough, prohibit, arrest) have never done much good long-term. Will anything be different this time?
Some people, including members of law enforcement, link the rise in heroin use to crackdowns on prescription drug abuse. We have been raiding pain clinics, thwarting ‘doctor shoppers,’ sentencing non-violent people, including elderly people, to long stretches in prison for low-level drug prescription drug sales. We know how to crackdown—but we seem ignorant when it comes to what to do with all those addicted people we’ve “cracked down” on. You may thwart them with your database at the pharmacy, but they’re still addicted. Now what?
Abuse-deterrent formulations of drugs and prescription drug take-back days are well and good, but they don’t reverse an overdose, they don’t educate about drug safety and they don’t provide ready access to treatment. They don’t address the factors that cause people to turn to drugs for relief and they don’t acknowledge the uncomfortable fact that despite our best efforts, for some portion of the population, rehabs won’t work, methadone won’t work, and neither will cold turkey, tough love, prison, prayer or 12-Step.
Knowing that is true, we should take positive steps to address that reality with a health-oriented approach. We should bring the most marginalized populations back into the fold, increasing their interactions with physicians, counselors and other supportive service providers, without fear of arrest or incarceration, and without demanding abstinence.
We should consider the benefits of physician-supervised, prescription pharmaceutical heroin maintenance programs. Also called HAT (heroin assisted treatment) and HMT (heroin maintenance treatment), this treatment has been working for a number of years in places like Switzerland and Germany. These programs are predicated on the knowledge that some people, despite numerous efforts, cannot or will not stop using heroin and that their continued use in unsupervised settings creates costs related to arrests and incarceration, increased healthcare expenses, supporting the illicit drug trade, overdose, and loss of employment and housing.
These programs provide pharmaceutical heroin (diacetylmorphine) to a limited number of people who can demonstrate multiple failed attempts to achieve abstinence in other drug treatment programs, a multiyear history of injecting heroin, and in some cases physical co-morbidities. They visit the clinic one to three times per day and inject the drug under a doctor’s supervision. They get off the street, out of public view and engage in a variety of other therapeutic services.
Sounds edgy, but it works. Reductions in crime, reductions in arrests, reductions in activity in open-air drug markets, reductions in fatal overdose, not to mention promotion of social integration, including considerable improvements in participants’ housing situation and fitness for work. That’s not speculation. That’s fact.
Their positive results have been published in highly credible peer-reviewed journals. The efficacy is there, the research is there. Why aren’t we at least trying this approach?
We need to get over our emotional response to the word ‘heroin’ and look at this treatment for what it is--opiate replacement therapy, the same premise as methadone provision. This treatment is proven to help address the most severe, persistent and problematic heroin use while reducing costs to taxpayers and improving outcomes.
When it comes to addiction, every option should be on the table. That’s just common sense. Anything that works, or shows great promise, however we feel about it, must at least be discussed—seriously and carefully. We know of excellent ways forward to manage addiction, but we need the courage and sense to take them.
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July 03, 2013
Yesterday, the Centers for Disease Control and Prevention released a report about the rate of opioid and prescription drug overdose among women in the United States. It’s bad, and getting worse. Yet, it's not getting much attention.
According to the CDC’s report, since 2007, more women have died each year from drug overdoses than from motor vehicle-related injuries. Between 1999-2010, deaths attributed to prescription opioids (such as oxycodone and hydrocodone) have increased fivefold among women. Since 1993, hospitalizations for prescription opioid overdoses have been more frequent among women than men. Women are more likely than men to be prescribed opioids, to use them chronically and to receive prescriptions for higher doses, according to the CDC.
Well, it makes sense if you’re surprised. We rarely tell that story. We rarely talk about the many women who sell drugs, or the pregnant women who use drugs. We rarely talk about the women incarcerated on drug charges. To a good degree, women and women’s issues tend be pretty absent in the media portrayals about victims or resistors of the war on drugs.
In many drug war documentaries, including some of the recent ones (The House I Live In, How to Make Money Selling Drugs, Breaking the Taboo, etc.), men are given a lot of screen time and it’s the voices of men we hear most often, representing every inch of the drug war spectrum—policymakers, manufacturers, neighborhood drug sellers, celebrities with tales of redemption from drug addiction. Virtually all the filmmakers are men, and they tend to tell stories about other men. True, men are incarcerated for drugs in larger numbers than women, and men die from drug overdose in greater numbers than women. But that doesn’t mean, nor should it imply, that women’s lives are uncomplicated vis a vis drugs.
It’s worth mentioning that for all of their good work on raising awareness about the skyrocketing rates of fatal overdose in the United States, the CDC missed an opportunity to promote the generic antidote to opioid overdose, naloxone, in its report today. It concluded their report with a whole host of ways accidental fatal overdose can potentially be reduced among women, but not a single mention of the actual antidote to opioid overdose.
Women need to know how to prevent, recognize and respond to an opioid overdose. Our partners, parents, children and friends should have that information, as well. Not only are we now dying in greater numbers from drug overdose, but we’re not even being made aware of the lifesaving measures available to us. In many states across the country, women should be encouraged to call 911 for medical assistance at the scene of a suspected drug overdose, without fear of arrest or incarceration. Making use of 911 Good Samaritan laws is just one way women can be empowered to save lives—or that their own lives can be saved.
Many of the drug war’s most strategic and most effective fighters are women. Women do the policy work, the program work, the social service support; they run the syringe exchanges, organize social media and fundraising campaigns. They share the stories of their lives and the ways drugs have made them difficult or complicated, or more fun. Women are in there working with the clients who use drugs and many of them use drugs themselves. It's time to shine a light on all of that, because, too often, it gets overlooked.
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August 30, 2012
August 31 is International Overdose Awareness Day. It is always a difficult day for many people, for a variety of reasons. It’s difficult to remember the people we loved whose lives were cut needlessly short. It’s difficult to rouse a community out of apathy around this issue. And it’s difficult to admit that our best efforts to keep all people drug-free all of the time will fail.
But we have to admit it.
We have to acknowledge that a certain percentage of the population will never be entirely drug-free and we have to figure out what to do about that. It’s costly and regressive to continually respond with arrests, drug courts and incarceration.
The Obama administration has appropriated the rhetoric of public health workers who have worked diligently for years to reduce the number of overdose deaths nationwide. The administration talks about a "public health approach," and "not being able to arrest our way out of the problem." The need to understand chronic drug misuse as an illness is best left to physicians, they proclaim. They talk about the need to prevent drug abuse in the first place by increasing education for young people, and they talk about expanding access to treatment and promoting recovery.
But they never talk about what to do with all of the people who currently, and perhaps always will, use drugs.
This is a fundamental problem with how our government approaches the incredibly long, unfailing reality of drug use in our country. We have always used drugs. We just have a hard time admitting it and figuring out how to manage it.
We know that many people who experience an overdose are simply people who use drugs casually and infrequently or people with pain who accidentally take too much medicine. These are not people who are breaking into homes to steal television sets to feed habits, but people with jobs, people pursuing an education, regular people who enjoy the occasional Xanax and cocktails. Some of them may even use prescription painkillers to get a buzz.
Some may disagree with their impulse to become intoxicated, or chastise them for not taking their medicine as prescribed. But that’s an occasional reality for thousands of people across the country. They may not need drug treatment, and they certainly don’t need to be incarcerated. But they do need access to the information that can save their lives, or the life of someone with whom they may occasionally use drugs. And many of them need naloxone. And that’s a problem.
Naloxone is unquestionably the most effective tool we have to reverse an opioid overdose. But the medicine is scarce and it’s becoming increasingly expensive. While still a comparative bargain for an incredibly safe drug with a very low side-effect profile, save for causing withdrawal among opiate-dependent people, it’s being priced out of reach for many of the programs that would like to make it more available.
A small grassroots effort has sprung up to bring attention to the problem and help raise urgently needed funds. I’m proud to be a part of it. But there’s something just a bit depressing about a small handful of activists trying valiantly to raise more awareness about this life-saving drug, let alone help raise funds for overdose prevention programs.
In a recent op-ed on Huffington Post, drug czar Gil Kerlikowske from the Office of National Drug Control Policy (ONDCP) said, “The administration supports the use of naloxone by public health and law enforcement professionals because we have seen how effective the drug can be.” It was an intelligent response to the overdose crisis based on science and research about what works. It’s the first non-punitive step on a long road toward addressing this multifaceted problem that affects an enormous range of people from many walks of life.
I hope this sensible approach doesn’t stop here for ONDCP. I hope they continue to talk about solutions like the Good Samaritan 911 laws being passed all over the country, to encourage people to quickly report a suspected overdose.
I hope they begin urging all drug treatment facilities to make naloxone available to their patients upon discharge. I hope they encourage colleges and universities to make naloxone available in their health centers.
But most of all, I hope they continue to reach out to everyone who cares so deeply about this issue, including people who use drugs, those who care for them, and those of us who work so hard to help them stay healthy and alive.
I hope fewer people have a difficult day this time next year.
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August 30, 2011
Dear Governor Brown,
No other state in the country endures as many annual deaths from accidental drug overdose as California. In sheer numbers of lives lost, California bears the tragic, and embarrassing, distinction of being "number one." August 31 is International Overdose Awareness Day and I'm hoping this is the day you will commit to leading us out of this needless tragedy.
Like so many of us, some of your friends have battled addiction for many years. I'm certain you're thankful that they're still here to keep fighting, keep trying to get it right. Your loved ones are still alive--you're lucky, and they're lucky. But this year alone, tens of thousands of American families won't share your good fortune. Their luck will run out. If recent national trends are any indication, by the year's end approximately 28,000 people will have died prematurely from a preventable fatal drug overdose. In 16 states, accidental drug overdose is the single leading cause of accidental death, claiming more lives than motor vehicle crashes. The majority of these deaths involve prescription opioid painkillers.
We urgently need your leadership on this issue right here and now. We need to let Californians know that solutions exist. We need to pass AB 472, the "911 Good Samaritan" overdose death prevention bill, and start a statewide conversation about the myriad solutions to the problem.
Tackling the problem of accidental fatal drug overdose is complicated. There isn't a single magic bullet that will save all lives. Of course we need to expand access to a range of affordable, effective drug treatment programs, including medications like methadone. Of course we need to educate physicians about the responsible prescribing of opioid medications. But these solutions alone won't end the crisis. They can't prevent a college student from dying at a party if his friends panic when they can't wake him up. We need a range of solutions. Fortunately, one of them costs taxpayers nothing and is ready for your signature: Assemblymember Ammiano's AB 472, California's "911 Good Samaritan" bill.
By providing the 911 caller and the overdose victim with limited immunity from arrest for possession of a small amount of drugs or paraphernalia, AB 472 will make it much easier, and far more likely, for a panicking bystander to call for emergency assistance. These are the lowest level drug crimes versus the highest human impulse--the desire to sustain life.
Research repeatedly proves that the main reason people hesitate or fail to call 911 during an overdose is their fear of arrest. New Mexico, Connecticut, Washington and New York have already enacted similar laws that encourage people to do the right thing when someone's life is on the line. These policies prioritize pragmatism over ideology, and the net result is more lives saved and, not incidentally, more people able to pursue recovery.
We can support solutions like expanding access to the generic drug naloxone, the very low cost overdose reversal drug with absolutely no potential for abuse. When administered to someone experiencing an overdose on an opiate drug like OxyContin or heroin, it restores respiration and consciousness. It's been our country's first line of defense in ambulances and emergency rooms for more than 40 years. In the hands of trained medical professionals and laypersons with access to it, naloxone has saved thousands of lives, but could be saving countless more--if people knew it existed, knew to ask their doctors about it, and knew where to find it.
While we all agree that we ought to do everything in our power to prevent our loved ones, especially our youth, from using dangerous drugs, we also know that many will, despite our most concerted efforts. We have to find ways of keeping them alive, even when they use drugs.
Governor, please stand in solidarity with the thousands of Californian families working to solve the problems of addiction and overdose. For many of them, International Overdose Awareness Day is not merely symbolic--it's a day when they unite in common purpose to help save lives. Please sign AB 472 and demonstrate to the country that California's overdose epidemic ends with your leadership.
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