1 00:00:00,280 --> 00:00:07,760 Speaker 1: Hi, I'm Ethan Nadelman, and this is Psychoactive, a production 2 00:00:07,800 --> 00:00:11,600 Speaker 1: of I Heart Radio and Protozoa Pictures. Psychoactive is the 3 00:00:11,640 --> 00:00:15,040 Speaker 1: show where we talk about all things drugs. But any 4 00:00:15,160 --> 00:00:18,760 Speaker 1: views expressed here do not represent those of I Heeart Media, 5 00:00:18,920 --> 00:00:23,480 Speaker 1: Protozoa Pictures, or their executives and employees. Indeed, Heed, as 6 00:00:23,520 --> 00:00:26,400 Speaker 1: an inveterate contrarian, I can tell you they may not 7 00:00:26,560 --> 00:00:30,720 Speaker 1: even represent my own and nothing contained in this show 8 00:00:30,840 --> 00:00:33,680 Speaker 1: should be used his medical advice or encouragement to use 9 00:00:33,800 --> 00:00:45,080 Speaker 1: any type of drug. Hello, Psychoactive Listeners. Our guests today, 10 00:00:45,200 --> 00:00:50,159 Speaker 1: Daniel Wolfe. He's not just somebody who's played is absolutely 11 00:00:50,479 --> 00:00:55,160 Speaker 1: central role in international drug policy and harm reduction for 12 00:00:55,160 --> 00:00:59,160 Speaker 1: almost twenty years, but he's also a dear friend of 13 00:00:59,160 --> 00:01:01,840 Speaker 1: mine and his been a colleague for many, many years, 14 00:01:02,320 --> 00:01:04,040 Speaker 1: And so I mean it's a sort of friend where 15 00:01:04,080 --> 00:01:06,679 Speaker 1: you know, we'll sit down for dinner at six pm, 16 00:01:06,800 --> 00:01:08,760 Speaker 1: and then all of a sudden, you know it's approaching 17 00:01:08,800 --> 00:01:11,080 Speaker 1: midnight and the waiters are looking for us too leaves. 18 00:01:11,080 --> 00:01:13,679 Speaker 1: But I think the benefit for you as the listener 19 00:01:14,000 --> 00:01:17,840 Speaker 1: will be the opportunity to learn a lot, not just 20 00:01:18,120 --> 00:01:23,640 Speaker 1: about the challenges and successes and failures around global drug 21 00:01:23,680 --> 00:01:28,119 Speaker 1: policy and especially around harm reduction, but also the role 22 00:01:28,319 --> 00:01:32,800 Speaker 1: played by George Sorrows and his Open Society Foundation, which 23 00:01:32,800 --> 00:01:36,600 Speaker 1: has been far and away the most influential, by far 24 00:01:36,600 --> 00:01:39,120 Speaker 1: and away the greatest funder of drug policy form and 25 00:01:39,120 --> 00:01:43,280 Speaker 1: harm reduction around the world. That Daniel essentially was first 26 00:01:43,280 --> 00:01:46,240 Speaker 1: the deputy Director and the director of the International Harm 27 00:01:46,240 --> 00:01:50,400 Speaker 1: Reduction Program at the Open Society Foundation SOROSS Foundation from 28 00:01:50,400 --> 00:01:53,680 Speaker 1: two thousand five until just a few months ago, giving 29 00:01:53,680 --> 00:01:57,960 Speaker 1: out hundreds of millions of dollars to organizations around the world, 30 00:01:58,040 --> 00:02:01,160 Speaker 1: all around the world, mentoring huge numbers of people both 31 00:02:01,240 --> 00:02:05,520 Speaker 1: within the organization and elsewhere, publishing important articles helping frame 32 00:02:05,600 --> 00:02:09,639 Speaker 1: the policy. So with that introduction, Daniel, thanks so much 33 00:02:09,720 --> 00:02:13,000 Speaker 1: for doing this with me. Ifan, thank you for having me. 34 00:02:13,120 --> 00:02:15,720 Speaker 1: I'm as excited as you are and grateful to you 35 00:02:15,760 --> 00:02:18,720 Speaker 1: for the chance. You and I first met, I think 36 00:02:18,760 --> 00:02:22,760 Speaker 1: almost twenty years ago when I tried to recruit you 37 00:02:23,360 --> 00:02:27,280 Speaker 1: to become the director of communications at Drug Policy Alliance, 38 00:02:27,720 --> 00:02:30,160 Speaker 1: and I think you had recently finished, or maybe weren't 39 00:02:30,200 --> 00:02:32,720 Speaker 1: quite finished, working at Gay Men's Health Crisis. You had 40 00:02:32,760 --> 00:02:35,400 Speaker 1: been the head of communications there. You know you had 41 00:02:35,400 --> 00:02:37,680 Speaker 1: actually authored a very important book, the sort of gay 42 00:02:37,680 --> 00:02:42,359 Speaker 1: man's version of Our Bodies Ourselves. Your journey was different, 43 00:02:42,760 --> 00:02:45,840 Speaker 1: in fact quite different. Just tell our audience a little 44 00:02:45,880 --> 00:02:49,600 Speaker 1: something about that. By the time I was, you know, 45 00:02:49,720 --> 00:02:53,440 Speaker 1: ten or eleven, my parents were hippies and had catapulted 46 00:02:53,440 --> 00:02:56,600 Speaker 1: themselves out trying to get to San Francisco and basically 47 00:02:56,680 --> 00:03:01,080 Speaker 1: ran out of gas in Arizona. And you know, we're 48 00:03:01,160 --> 00:03:06,239 Speaker 1: living in or around uh sort of psychologically oriented commune 49 00:03:06,360 --> 00:03:09,400 Speaker 1: that was a disitult community, but also where a lot 50 00:03:09,400 --> 00:03:12,760 Speaker 1: of people, including my parents and including me as a child, 51 00:03:13,320 --> 00:03:18,000 Speaker 1: we're using psychedelic drugs as a means of furthering that exploration. 52 00:03:18,680 --> 00:03:22,440 Speaker 1: And honestly, though I didn't put it together at the time, 53 00:03:22,639 --> 00:03:25,520 Speaker 1: I think some of my earliest education and harm reduction 54 00:03:25,720 --> 00:03:30,120 Speaker 1: came from the disjuncture between what I was hearing in 55 00:03:30,200 --> 00:03:34,480 Speaker 1: school about drugs, where we had a very sadistic science 56 00:03:34,520 --> 00:03:38,120 Speaker 1: teacher who would basically lecture you about the evils of 57 00:03:38,200 --> 00:03:41,720 Speaker 1: drugs and then give you extra credit if you stayed 58 00:03:41,800 --> 00:03:44,920 Speaker 1: after school and let him shock you with a an 59 00:03:44,960 --> 00:03:48,000 Speaker 1: electric generator while they talked to you about drugs. And 60 00:03:48,040 --> 00:03:50,240 Speaker 1: I wanted the extra credit, and I stayed, but then 61 00:03:50,280 --> 00:03:53,320 Speaker 1: I would go home to a context where people were 62 00:03:53,400 --> 00:03:58,480 Speaker 1: using drugs regularly and where honestly, the drug use was 63 00:03:58,520 --> 00:04:04,080 Speaker 1: actually something expanding and really interesting for me as a kid. 64 00:04:04,440 --> 00:04:08,720 Speaker 1: Of course, there were rules, for example, I guess you'd 65 00:04:08,720 --> 00:04:12,720 Speaker 1: call them harm reduction guidelines. Don't take psychedelics without letting 66 00:04:12,760 --> 00:04:14,880 Speaker 1: someone who wasn't going to be taking them know that 67 00:04:14,920 --> 00:04:19,480 Speaker 1: you were taking them. Don't take psychedelics with anyone who 68 00:04:19,520 --> 00:04:23,240 Speaker 1: you didn't feel comfortable with, or who might you know 69 00:04:23,320 --> 00:04:27,320 Speaker 1: cause you to have a bad trip. Basically, make sure 70 00:04:27,440 --> 00:04:30,000 Speaker 1: that a family member or someone you trusted knew what 71 00:04:30,040 --> 00:04:33,080 Speaker 1: was happening. But I would say that a lot of 72 00:04:33,160 --> 00:04:37,480 Speaker 1: my understanding, not just of drugs, but of the difference 73 00:04:37,520 --> 00:04:43,400 Speaker 1: between lived human and community experience an official, medically sanctioned 74 00:04:43,800 --> 00:04:47,880 Speaker 1: or so called scientific knowledge came from that, And that's 75 00:04:47,880 --> 00:04:50,800 Speaker 1: really kind of a through line for me in work, 76 00:04:50,839 --> 00:04:53,000 Speaker 1: whether it was on HIV or whether it was on 77 00:04:53,120 --> 00:04:57,719 Speaker 1: drugs and harm reduction, which is not just taking for granted, 78 00:04:57,839 --> 00:05:00,240 Speaker 1: the people who had the m d S or this sience, 79 00:05:00,320 --> 00:05:03,719 Speaker 1: teachers or the scientists necessarily knew what they were saying, 80 00:05:03,760 --> 00:05:08,560 Speaker 1: just because of the credential and not discounting or invalidating 81 00:05:08,880 --> 00:05:12,919 Speaker 1: your lived experience, especially with things that were meaningful and 82 00:05:13,000 --> 00:05:16,400 Speaker 1: positive and powerful in your life. So how old were 83 00:05:16,400 --> 00:05:19,640 Speaker 1: you when you first had a powerful psychedelic experience? You know, 84 00:05:19,800 --> 00:05:24,520 Speaker 1: I'm not sure I remember exactly, but I had multiple 85 00:05:24,600 --> 00:05:28,560 Speaker 1: experiences with mostly with what people would today call plant 86 00:05:28,600 --> 00:05:33,680 Speaker 1: medicines like peyote and psilocybin mushrooms, but also with some 87 00:05:34,120 --> 00:05:37,080 Speaker 1: mescal in and which was more common than an LSD. 88 00:05:38,000 --> 00:05:40,279 Speaker 1: You know, I had multiple experiences that before the age 89 00:05:40,320 --> 00:05:45,160 Speaker 1: of fourteen. And I should say that the lectures about 90 00:05:45,200 --> 00:05:48,240 Speaker 1: how it would destroy your chromosomes or how it would 91 00:05:48,880 --> 00:05:52,080 Speaker 1: potentially damage your brain, I have a lot of examples 92 00:05:52,120 --> 00:05:55,840 Speaker 1: of many brilliant and compelling people around me that gave 93 00:05:55,920 --> 00:05:59,040 Speaker 1: the lie to that it didn't feel like that message 94 00:05:59,200 --> 00:06:03,000 Speaker 1: was credible to me. And I should also say, because 95 00:06:03,080 --> 00:06:05,880 Speaker 1: I'm lucky enough to have enjoyed it, that, you know, 96 00:06:06,000 --> 00:06:09,160 Speaker 1: I was able to function well later when some of 97 00:06:09,200 --> 00:06:13,719 Speaker 1: my rebellious adolescent friends wanted to do drugs as a 98 00:06:13,760 --> 00:06:16,680 Speaker 1: way of stepping away from their parents, Ironically, it held 99 00:06:16,720 --> 00:06:18,719 Speaker 1: less appeal for me because I didn't have to leave 100 00:06:18,760 --> 00:06:22,000 Speaker 1: the house to smoke pot or to have an asset 101 00:06:22,000 --> 00:06:23,960 Speaker 1: trip or something, and I didn't have to hide it. 102 00:06:24,080 --> 00:06:26,719 Speaker 1: There's some other things that you and I sort of 103 00:06:26,720 --> 00:06:30,359 Speaker 1: share in common, but that also diverge, which is, you know, 104 00:06:30,440 --> 00:06:33,720 Speaker 1: you landed up notwithstanding this hippie background going to Princeton, 105 00:06:34,240 --> 00:06:36,640 Speaker 1: and I ended up at Harvard and teaching at Princeton 106 00:06:36,680 --> 00:06:40,000 Speaker 1: a few years after you were in undergrads there, and 107 00:06:40,040 --> 00:06:42,320 Speaker 1: we both were quite interested in the Middle East. My 108 00:06:42,400 --> 00:06:45,360 Speaker 1: first focus of my studies, my first published papers, my 109 00:06:45,400 --> 00:06:48,239 Speaker 1: first dot bed, the first course I talked, we're all 110 00:06:48,279 --> 00:06:51,400 Speaker 1: about the Middle East before I got into the drug issue. 111 00:06:51,920 --> 00:06:55,240 Speaker 1: And you also pursued an interest, but in a somewhat 112 00:06:55,240 --> 00:06:58,520 Speaker 1: different direction. Say something about that. First of all, I 113 00:06:58,560 --> 00:07:02,600 Speaker 1: was an Arabic litter rich er major as an undergraduate, 114 00:07:02,680 --> 00:07:06,000 Speaker 1: so I learned Arabic. But I also acted as a ghostwriter, 115 00:07:06,880 --> 00:07:10,800 Speaker 1: one of two ghostwriters, the more junior for the autobiographies 116 00:07:10,840 --> 00:07:13,720 Speaker 1: of Anwar Sadat Swido whose name was Johanna Sadat because 117 00:07:13,760 --> 00:07:16,360 Speaker 1: I had lived in Egypt and knew the context, and 118 00:07:16,520 --> 00:07:20,320 Speaker 1: Benezir Budo, the former Pakistani Prime minister. And I will say, 119 00:07:20,400 --> 00:07:23,280 Speaker 1: just to try to make something whole out of what 120 00:07:23,400 --> 00:07:26,120 Speaker 1: is really a lot of fragments in this conversation that 121 00:07:26,200 --> 00:07:28,200 Speaker 1: I think some of my experience as growing up on 122 00:07:28,200 --> 00:07:32,920 Speaker 1: a commune but going to a conservative, small town school 123 00:07:32,920 --> 00:07:35,840 Speaker 1: in rural Arizona gave me some of the skills to 124 00:07:35,920 --> 00:07:38,920 Speaker 1: be a ghostwriter, or it's to sort of cross cultures 125 00:07:39,000 --> 00:07:41,920 Speaker 1: or feel like I could, which is that, you know, 126 00:07:42,000 --> 00:07:46,400 Speaker 1: I learned pretty early that there were different cultural realities 127 00:07:46,720 --> 00:07:49,120 Speaker 1: and that I had to be able to negotiate both. 128 00:07:49,840 --> 00:07:53,200 Speaker 1: I really enjoyed my ghostwriting experience, and I had an 129 00:07:53,240 --> 00:07:57,000 Speaker 1: all access, sort of backstage pass to the lives of 130 00:07:57,040 --> 00:08:01,640 Speaker 1: some very interesting people. But I was, of course, by definition, 131 00:08:02,280 --> 00:08:05,720 Speaker 1: very much behind the scenes. So as important as it was, 132 00:08:06,160 --> 00:08:10,080 Speaker 1: I was really glad to move to work on HIV, 133 00:08:10,360 --> 00:08:14,040 Speaker 1: where my steak and my voice was much more evident. 134 00:08:14,240 --> 00:08:17,080 Speaker 1: It's amazing, though, Danie, is that here you are and 135 00:08:17,120 --> 00:08:20,200 Speaker 1: this is the early eighties, I guess, and you're not 136 00:08:20,320 --> 00:08:24,960 Speaker 1: even twenty five years old. You are a young American 137 00:08:25,480 --> 00:08:31,240 Speaker 1: Jewish gay man ghost writing and traveling around with and 138 00:08:31,240 --> 00:08:35,680 Speaker 1: spending time with first the widow of anwar Sadat, you know, 139 00:08:35,760 --> 00:08:39,079 Speaker 1: the Egyptian president who historically launched the war, the Young 140 00:08:39,120 --> 00:08:41,199 Speaker 1: Pepoor War in Israel, and then flew to Jerusalem to 141 00:08:41,240 --> 00:08:44,240 Speaker 1: make peace with Israel a few years later, and with 142 00:08:44,320 --> 00:08:46,959 Speaker 1: Bennarzier Bhutto, who came from one of the most famous, 143 00:08:47,000 --> 00:08:50,240 Speaker 1: maybe the most famous medical family in Pakistan and who 144 00:08:50,320 --> 00:08:54,400 Speaker 1: years later was assassinated. That just sounds extraordinary just on 145 00:08:54,440 --> 00:08:57,320 Speaker 1: the face of it. I mean, did you appreciate how 146 00:08:57,440 --> 00:09:00,360 Speaker 1: bizarre exchange it was at the time. I look, I 147 00:09:00,400 --> 00:09:03,240 Speaker 1: appreciated it. But I will say that, you know, the 148 00:09:03,320 --> 00:09:05,600 Speaker 1: relationship when you're a ghost writer is a little bit 149 00:09:06,400 --> 00:09:10,320 Speaker 1: like the relationship of therapist and patient, which is that 150 00:09:10,400 --> 00:09:13,679 Speaker 1: the subject of the autobiography does most of the talking. 151 00:09:13,840 --> 00:09:17,360 Speaker 1: The details of your personal life are not incredibly important 152 00:09:17,400 --> 00:09:21,000 Speaker 1: or relevant. Of course, with Mrs Sadat, I didn't talk 153 00:09:21,040 --> 00:09:23,680 Speaker 1: about my sexuality much. I think with Benezier, I once 154 00:09:23,720 --> 00:09:27,559 Speaker 1: said to her that I had seen that there was 155 00:09:27,600 --> 00:09:33,000 Speaker 1: a Benezier Buddo drag lookalike contest in San Francisco, and 156 00:09:33,080 --> 00:09:39,160 Speaker 1: she was completely unamused and gave me to understand pretty 157 00:09:39,240 --> 00:09:42,200 Speaker 1: quickly that that was a little bit too liberal even 158 00:09:42,240 --> 00:09:45,520 Speaker 1: for her. And of course she was herself Harvard educated, 159 00:09:45,880 --> 00:09:50,480 Speaker 1: Oxford educated and very sophisticated. But yeah, it was extraordinary, 160 00:09:50,480 --> 00:09:53,240 Speaker 1: but it also involved a certain amount of paring down 161 00:09:53,520 --> 00:09:56,800 Speaker 1: of again myself and my aspirations and my voice, and 162 00:09:56,840 --> 00:10:00,160 Speaker 1: the service of elevating some other people's voices. And I 163 00:10:00,200 --> 00:10:02,000 Speaker 1: was glad to do it, and I learned a lot. 164 00:10:02,200 --> 00:10:05,520 Speaker 1: But I was even more glad when I started becoming 165 00:10:05,520 --> 00:10:08,000 Speaker 1: involved with act UP, the AIDS activist organization, or with 166 00:10:08,160 --> 00:10:11,520 Speaker 1: g MHC and later with Open Society to really be 167 00:10:11,600 --> 00:10:15,880 Speaker 1: able to speak about things from a more grounded personal perspective. 168 00:10:16,120 --> 00:10:19,040 Speaker 1: So I gathered that that experience and act UP and 169 00:10:19,080 --> 00:10:21,920 Speaker 1: then maybe going to Gay Men's Health Crisis were really 170 00:10:21,960 --> 00:10:25,240 Speaker 1: the truly formative experiences for you in terms of the 171 00:10:25,280 --> 00:10:27,800 Speaker 1: work that you then have done for the last twenty years. 172 00:10:27,920 --> 00:10:30,760 Speaker 1: That right, Yeah, I mean I see a number of 173 00:10:30,880 --> 00:10:34,480 Speaker 1: through lines between that work on gay and HIV stuff 174 00:10:34,480 --> 00:10:37,400 Speaker 1: and work on drugs. I mean one of them is conceptual, 175 00:10:37,480 --> 00:10:40,880 Speaker 1: which is that gay men and this was really obvious 176 00:10:40,880 --> 00:10:43,120 Speaker 1: in the early days of AIDS and people who use 177 00:10:43,200 --> 00:10:47,600 Speaker 1: drugs and sex workers are all regarded with a kind 178 00:10:47,600 --> 00:10:52,760 Speaker 1: of generalized social suspicion about their relationship to pleasure and 179 00:10:53,040 --> 00:10:56,840 Speaker 1: production and reproduction. You know, everyone has labeled as hedonistic, 180 00:10:57,080 --> 00:11:00,520 Speaker 1: accused of recruiting others to be embroy old in their 181 00:11:00,600 --> 00:11:05,120 Speaker 1: lifestyle so called lifestyle and dangerous to families and nations. 182 00:11:05,320 --> 00:11:09,560 Speaker 1: And that was really clear for people who were gay 183 00:11:09,600 --> 00:11:13,280 Speaker 1: in the early days of AIDS, because basically the government 184 00:11:13,360 --> 00:11:15,760 Speaker 1: wasn't doing anything and didn't seem to care that so 185 00:11:15,840 --> 00:11:20,160 Speaker 1: many people were dying, and basically blamed the people in 186 00:11:20,280 --> 00:11:24,360 Speaker 1: need for their own needs. For people who use drugs, 187 00:11:25,320 --> 00:11:29,160 Speaker 1: there's a very similar narrative, and it's particularly explicit in 188 00:11:29,200 --> 00:11:33,240 Speaker 1: the post communist countries that open society foundations started working in. 189 00:11:33,440 --> 00:11:35,559 Speaker 1: You know, in Russia, for example, when I started work, 190 00:11:36,280 --> 00:11:39,560 Speaker 1: the HIV epidemic was overwhelmingly concentrated, as I said, among 191 00:11:39,600 --> 00:11:42,400 Speaker 1: people who inject drugs, and there was a proviso that 192 00:11:42,480 --> 00:11:45,920 Speaker 1: said that HIV treatment couldn't be provided to people who 193 00:11:45,960 --> 00:11:50,400 Speaker 1: were quote socially unproductive, which included people who use drugs. 194 00:11:51,040 --> 00:11:54,680 Speaker 1: In Vietnam, the part of the government that's responsible for 195 00:11:54,720 --> 00:11:58,240 Speaker 1: dealing with drugs is called the Department of Social Evils Prevention, 196 00:11:58,800 --> 00:12:01,720 Speaker 1: and it's part of the Ministry of Labor. And even 197 00:12:01,760 --> 00:12:05,480 Speaker 1: in the US, where gay men, for example, and sex 198 00:12:05,480 --> 00:12:08,640 Speaker 1: workers too were regarded as a threat to the family 199 00:12:08,840 --> 00:12:13,120 Speaker 1: because our sexual unions didn't result in reproduction, and of 200 00:12:13,160 --> 00:12:16,480 Speaker 1: course marriage was impossible in those days. You know, I 201 00:12:16,520 --> 00:12:19,840 Speaker 1: see this kind of assumption about who is valued and 202 00:12:19,920 --> 00:12:23,560 Speaker 1: what kinds of behavior are valued. And for drug users, 203 00:12:24,120 --> 00:12:26,600 Speaker 1: it was so striking to me when people when you 204 00:12:26,640 --> 00:12:29,400 Speaker 1: talk to people who have been through mostly residential drug 205 00:12:29,440 --> 00:12:32,000 Speaker 1: treatment all over the world, a lot of the so 206 00:12:32,200 --> 00:12:37,000 Speaker 1: called treatment is this completely meaningless labor. So I'm sure 207 00:12:37,000 --> 00:12:39,200 Speaker 1: you've heard these stories. People are asked to dig holes 208 00:12:39,240 --> 00:12:41,760 Speaker 1: in the field and then refill them, or separate out 209 00:12:41,760 --> 00:12:44,760 Speaker 1: the grains of salt and the grains of pepper or 210 00:12:44,880 --> 00:12:49,360 Speaker 1: you know, our gang sort of stuff, but even more 211 00:12:49,360 --> 00:12:52,560 Speaker 1: meaningless than not even repairing the roads, just something that 212 00:12:52,640 --> 00:12:57,720 Speaker 1: basically says you need to get producing and conforming in 213 00:12:57,760 --> 00:13:01,200 Speaker 1: ways that we recognize. And that was very true for 214 00:13:01,320 --> 00:13:05,240 Speaker 1: AIDS too, And so you know, for me, that was 215 00:13:05,600 --> 00:13:08,320 Speaker 1: that education and act up and at gay Men's Health 216 00:13:08,320 --> 00:13:13,880 Speaker 1: Crisis was a kind of fundamental orientation toward people who 217 00:13:13,880 --> 00:13:17,760 Speaker 1: are regarded with social suspicion, often under the guise of 218 00:13:17,880 --> 00:13:21,120 Speaker 1: being a threat to the health of others. And you know, 219 00:13:21,200 --> 00:13:23,280 Speaker 1: you see it with migrants, you see it with people 220 00:13:23,280 --> 00:13:25,160 Speaker 1: who use drugs, You see it with gay men and 221 00:13:25,240 --> 00:13:30,360 Speaker 1: lesbians and transgender people all over the world. Another through line, though, 222 00:13:30,400 --> 00:13:33,320 Speaker 1: is one that I actually have thought about as a 223 00:13:33,360 --> 00:13:35,800 Speaker 1: result of you. And I don't know what you're thinking 224 00:13:35,920 --> 00:13:38,120 Speaker 1: is these days about it, but you were one of 225 00:13:38,160 --> 00:13:41,720 Speaker 1: the first people who ever talked about coming out as 226 00:13:41,760 --> 00:13:45,240 Speaker 1: a drug user um and analogized it to the game movement. 227 00:13:45,760 --> 00:13:48,600 Speaker 1: How are you thinking about it these days? It's been 228 00:13:48,600 --> 00:13:50,679 Speaker 1: the same way of thinking since the nineties, you know. 229 00:13:50,720 --> 00:13:52,760 Speaker 1: I had this conversation a bit with Dan Savage when 230 00:13:52,800 --> 00:13:55,959 Speaker 1: he was on on Psychoactive, But it always seemed to 231 00:13:55,960 --> 00:13:59,120 Speaker 1: be that importance of coming out, the sense of demonization 232 00:13:59,640 --> 00:14:02,800 Speaker 1: of the core principle of sovereignty over our own minds 233 00:14:02,840 --> 00:14:05,120 Speaker 1: and bodies. I think I've used this line on the 234 00:14:05,120 --> 00:14:07,440 Speaker 1: show before. I had a meeting with Barney frank ten 235 00:14:07,600 --> 00:14:11,480 Speaker 1: twelve years ago, you know, the first openly out gay 236 00:14:11,640 --> 00:14:14,280 Speaker 1: com member of Congress. And as I'm leaving, you know, 237 00:14:14,320 --> 00:14:16,600 Speaker 1: I say to Barney, you realize the whole thing gay 238 00:14:16,679 --> 00:14:18,680 Speaker 1: rides and art form all comes down, you know, the 239 00:14:18,679 --> 00:14:20,960 Speaker 1: same thing. And he looks at me. I said, yeah, 240 00:14:21,120 --> 00:14:23,680 Speaker 1: that nobody should be punished for what we put in 241 00:14:23,760 --> 00:14:26,040 Speaker 1: our bodies as so long as it doesn't hurt anybody else, 242 00:14:26,160 --> 00:14:28,720 Speaker 1: whether it's a cock or a joint, and you know 243 00:14:28,760 --> 00:14:31,120 Speaker 1: he kind of smiled and he got it. But that 244 00:14:31,240 --> 00:14:35,000 Speaker 1: core principle of sovereignty over our own minds and bodies 245 00:14:35,040 --> 00:14:38,520 Speaker 1: and basic you know, personal autonomy, I mean, that was 246 00:14:38,560 --> 00:14:42,200 Speaker 1: a core, essential principle. And then the other one was 247 00:14:42,280 --> 00:14:45,520 Speaker 1: the demonization one. Now for me, I came to it 248 00:14:45,760 --> 00:14:48,720 Speaker 1: essentially because of my Jewish identity, you know, growing up 249 00:14:48,720 --> 00:14:51,480 Speaker 1: with a father who had been born in Berlin and 250 00:14:51,520 --> 00:14:54,920 Speaker 1: had to flee with his family in nine because of Hitler. 251 00:14:55,240 --> 00:14:59,200 Speaker 1: So that powerful sense of demonization and what could happen 252 00:14:59,240 --> 00:15:02,720 Speaker 1: when that goes haywire and crazy. You know, that very 253 00:15:02,800 --> 00:15:04,800 Speaker 1: much influenced me in a way that I saw that 254 00:15:04,920 --> 00:15:09,280 Speaker 1: who in our society today is being demonized, is stigmatized 255 00:15:09,320 --> 00:15:12,080 Speaker 1: in the ways that Jews have been, you know, in Europe, 256 00:15:12,120 --> 00:15:14,720 Speaker 1: not just a Germany, but all around the world. It's 257 00:15:14,760 --> 00:15:18,720 Speaker 1: interesting because for me the parallel is apt, but with 258 00:15:18,920 --> 00:15:22,080 Speaker 1: in a slightly different way. Because for me, one of 259 00:15:22,160 --> 00:15:24,680 Speaker 1: the most powerful lessons of my life as an AIDS 260 00:15:24,720 --> 00:15:28,000 Speaker 1: activist or later working in harm reduction or working in 261 00:15:28,040 --> 00:15:31,120 Speaker 1: a gay organization was the way that groups and group 262 00:15:31,120 --> 00:15:33,920 Speaker 1: affiliation made it possible for me and others to expand 263 00:15:33,960 --> 00:15:36,040 Speaker 1: the world and take risks in ways that would be 264 00:15:36,080 --> 00:15:39,560 Speaker 1: way too scary for me as an individual. So Greg Bordowitz, 265 00:15:39,560 --> 00:15:41,720 Speaker 1: who's a friend of mine and an artist who was 266 00:15:41,720 --> 00:15:43,960 Speaker 1: also an act up, used to define activism in a 267 00:15:44,000 --> 00:15:47,560 Speaker 1: way that I liked, which was taking risks and inviting 268 00:15:47,560 --> 00:15:51,520 Speaker 1: others to join you. And that the additive activism, that 269 00:15:51,680 --> 00:15:53,760 Speaker 1: is to build a movement where people actually get some 270 00:15:53,920 --> 00:15:56,720 Speaker 1: energy and benefit from coming out as drug users, seems 271 00:15:56,760 --> 00:16:00,440 Speaker 1: really powerful. And it's honestly your work and the work 272 00:16:00,480 --> 00:16:03,240 Speaker 1: of your colleagues at the Drug Policy Alliance where I 273 00:16:03,320 --> 00:16:06,280 Speaker 1: first got the sense of that, because those reform conferences, 274 00:16:06,880 --> 00:16:10,200 Speaker 1: we're really a mixture of people standing in solidarity with 275 00:16:10,240 --> 00:16:13,320 Speaker 1: each other and trying to basically change the way that 276 00:16:13,520 --> 00:16:17,440 Speaker 1: the society dealt with drugs. But it wasn't necessarily requiring 277 00:16:17,520 --> 00:16:21,440 Speaker 1: people to identify as a drug user, even though of 278 00:16:21,480 --> 00:16:23,960 Speaker 1: course many people were. Let's just start off by doing 279 00:16:23,960 --> 00:16:28,560 Speaker 1: a snapshot sort of right now in the last year, um, 280 00:16:28,640 --> 00:16:30,360 Speaker 1: when we look around the world, I mean, you've been 281 00:16:30,400 --> 00:16:32,720 Speaker 1: involved in this and in drug policy for the last 282 00:16:32,760 --> 00:16:38,800 Speaker 1: fifteen twenty years. Do you feel a sense of optimism? 283 00:16:39,200 --> 00:16:43,080 Speaker 1: Does it feel like things are rolling backward? More than forward, 284 00:16:43,200 --> 00:16:46,480 Speaker 1: not unlike the broader political situation around the world, or 285 00:16:46,840 --> 00:16:49,640 Speaker 1: is this one of these issues, like with drug policy 286 00:16:49,720 --> 00:16:53,080 Speaker 1: United States, where it seems to be advancing irrespective of 287 00:16:53,120 --> 00:16:56,440 Speaker 1: the terrible politics. I see it as a source of 288 00:16:56,760 --> 00:17:01,720 Speaker 1: hope and optimism and also caution. I'm in Anthropologists often 289 00:17:01,760 --> 00:17:04,280 Speaker 1: point out that when you work in an unfamiliar setting, 290 00:17:04,280 --> 00:17:06,720 Speaker 1: it lets you see new things and ask new questions 291 00:17:06,760 --> 00:17:09,639 Speaker 1: of your own culture. And for me, one of the 292 00:17:09,840 --> 00:17:15,199 Speaker 1: lessons of international work on drugs has been about the 293 00:17:15,320 --> 00:17:20,040 Speaker 1: possibility and the insufficiency, for example, of decriminalization and the 294 00:17:20,080 --> 00:17:22,360 Speaker 1: limits of saying that we need to treat drugs as 295 00:17:22,359 --> 00:17:26,480 Speaker 1: a health issue rather than just a criminal issue. That's 296 00:17:26,520 --> 00:17:31,720 Speaker 1: both true and very limited. You see that limit in Russia, 297 00:17:31,920 --> 00:17:34,439 Speaker 1: where they said they would only criminalize possession of a 298 00:17:34,520 --> 00:17:37,600 Speaker 1: large and extra large doses of drugs, but defind large 299 00:17:37,600 --> 00:17:40,639 Speaker 1: as the residue and the user ringe. You see it 300 00:17:40,680 --> 00:17:45,240 Speaker 1: in Vietnam where authorities made headlines for decriminalizing but then 301 00:17:45,320 --> 00:17:48,960 Speaker 1: detain more than fifty people for up to four years 302 00:17:49,119 --> 00:17:52,000 Speaker 1: of forced labor on the basis of a positive urine test. 303 00:17:52,880 --> 00:17:55,680 Speaker 1: And I see it in the US, where, despite emphasizing 304 00:17:55,680 --> 00:17:59,400 Speaker 1: the need for a health response. You see state after 305 00:17:59,480 --> 00:18:03,240 Speaker 1: state turning to use of the injectable opioid blocker vivitral. 306 00:18:03,400 --> 00:18:06,800 Speaker 1: And the criminal justice system. You have drug court judges 307 00:18:06,840 --> 00:18:10,000 Speaker 1: with no particular knowledge or training deciding what an appropriate 308 00:18:10,080 --> 00:18:12,840 Speaker 1: length and type of treatment should be. And you hear 309 00:18:12,880 --> 00:18:15,280 Speaker 1: President Biden talking about how people who use drugs don't 310 00:18:15,280 --> 00:18:19,280 Speaker 1: need imprisonment but should get compulsory treatment. That's not ending 311 00:18:19,280 --> 00:18:22,560 Speaker 1: the drug war. It's changing drug war horses and keeping ongoing. 312 00:18:23,040 --> 00:18:25,919 Speaker 1: Richard Elovich, who's a social psychologist and a harm reduction 313 00:18:26,000 --> 00:18:28,879 Speaker 1: leader we both know, who has worked internationally and in 314 00:18:28,920 --> 00:18:31,720 Speaker 1: the US, points out how often drug services are quote 315 00:18:31,760 --> 00:18:35,160 Speaker 1: standing in the footprint of drug control. That's a position 316 00:18:35,200 --> 00:18:37,760 Speaker 1: that many of the advocates who are pressing for greater 317 00:18:37,800 --> 00:18:41,320 Speaker 1: access to drug treatment or harm production are often unaware 318 00:18:41,320 --> 00:18:46,639 Speaker 1: of occupying. We'll be talking more after we hear this ad. 319 00:19:00,080 --> 00:19:02,840 Speaker 1: For me, looking at this issue, it reflects sort of 320 00:19:02,880 --> 00:19:05,920 Speaker 1: the tension that oftentimes had especially in earlier years, but 321 00:19:05,960 --> 00:19:08,640 Speaker 1: it continues to be the case today with our criminal 322 00:19:08,720 --> 00:19:11,880 Speaker 1: justice reform allies. You know, these were allies who were 323 00:19:11,960 --> 00:19:15,919 Speaker 1: just as passionate as we were about you know, reducing 324 00:19:16,200 --> 00:19:20,040 Speaker 1: mass incarceration, ending mass incarceration United States, you know, ending 325 00:19:20,040 --> 00:19:22,600 Speaker 1: the role of the drug war, even more passionate about 326 00:19:22,640 --> 00:19:26,560 Speaker 1: reducing the incarceration or over long incarceration of people incarcerated 327 00:19:26,600 --> 00:19:30,480 Speaker 1: for non drug offenses. But when it came to embracing alternatives, 328 00:19:30,800 --> 00:19:34,119 Speaker 1: they oftentimes were very quick to embrace drug courts, right, 329 00:19:34,160 --> 00:19:39,000 Speaker 1: which was essentially an alternative to incarceration created within the 330 00:19:39,040 --> 00:19:43,560 Speaker 1: criminal justice system, overseen by judges, not by healthier professionals, 331 00:19:43,600 --> 00:19:46,000 Speaker 1: as you were saying. And you know, what we found 332 00:19:46,320 --> 00:19:48,240 Speaker 1: was that with drug court judges, I mean, the devil 333 00:19:48,359 --> 00:19:51,639 Speaker 1: was in the details, but oftentimes drug court could sometimes 334 00:19:51,680 --> 00:19:53,720 Speaker 1: turn out to be two steps forward and three or 335 00:19:53,760 --> 00:19:56,560 Speaker 1: four steps backward. That people who are not going to 336 00:19:56,680 --> 00:19:59,520 Speaker 1: quit drugs, who are not going to become absinent, could 337 00:19:59,640 --> 00:20:03,720 Speaker 1: land a being caught in the web of this criminalized 338 00:20:03,800 --> 00:20:06,399 Speaker 1: system for even longer than if they're never gonna need 339 00:20:06,440 --> 00:20:08,800 Speaker 1: drug courts to begin with. But when you say that 340 00:20:08,880 --> 00:20:12,080 Speaker 1: the limits with decrept are you defining decrem in a 341 00:20:12,200 --> 00:20:15,440 Speaker 1: very broad way or are you talking about the sort 342 00:20:15,440 --> 00:20:20,639 Speaker 1: of let's substitute prisons with detention camps, let's substitute prison 343 00:20:20,680 --> 00:20:22,439 Speaker 1: with drug courts, where if you don't work out, you 344 00:20:22,480 --> 00:20:24,679 Speaker 1: go back to prison. I mean, let's just clarify this 345 00:20:24,760 --> 00:20:28,120 Speaker 1: a bit. I mean, for me, decrim of course, it's 346 00:20:28,160 --> 00:20:31,240 Speaker 1: about removing people from the criminal justice system. But really 347 00:20:31,320 --> 00:20:34,879 Speaker 1: what I'm talking about is the limits of trusting in 348 00:20:34,920 --> 00:20:37,280 Speaker 1: the health system without really getting at the roots of 349 00:20:37,359 --> 00:20:40,840 Speaker 1: drug war thinking. COVID has forced things to ease up slightly, 350 00:20:41,600 --> 00:20:45,120 Speaker 1: but generally you see so called addiction treatment forget about 351 00:20:45,160 --> 00:20:49,800 Speaker 1: whether it's even Egyptian treatment that people enter voluntarily, being 352 00:20:49,880 --> 00:20:53,240 Speaker 1: so much more rigid than as necessary or appropriate. Then 353 00:20:53,280 --> 00:20:56,399 Speaker 1: when things don't work, we blame the individual patients for 354 00:20:56,440 --> 00:20:59,280 Speaker 1: the system failures. In most places in the US are 355 00:20:59,320 --> 00:21:02,600 Speaker 1: in the world, you can't take home the medicine methodone 356 00:21:02,720 --> 00:21:04,840 Speaker 1: and have to wait online to get into a clinic, 357 00:21:05,000 --> 00:21:07,560 Speaker 1: despite the fact that you need that medicine every day. 358 00:21:07,680 --> 00:21:09,200 Speaker 1: Would any of us want to have to go to 359 00:21:09,240 --> 00:21:11,920 Speaker 1: the Department of Motor Vehicles or another office every single 360 00:21:12,000 --> 00:21:15,720 Speaker 1: day before we started our own day. You see patients 361 00:21:15,760 --> 00:21:18,520 Speaker 1: being asked to take a year in test, again not 362 00:21:18,680 --> 00:21:21,800 Speaker 1: by drug courts, but even by health providers, and then 363 00:21:21,840 --> 00:21:24,520 Speaker 1: get kicked off treatment if they're using any other opioids 364 00:21:24,560 --> 00:21:28,640 Speaker 1: or xanax or vallium or even cannabis. That's not medical practice, 365 00:21:28,680 --> 00:21:32,120 Speaker 1: it's ideology. I'm a diabetic. No doctor would ever kick 366 00:21:32,200 --> 00:21:35,119 Speaker 1: me off my medicine because I ate a corn muffin 367 00:21:35,240 --> 00:21:38,320 Speaker 1: last night or indulged in the slice of pizza. And 368 00:21:38,520 --> 00:21:41,680 Speaker 1: so even in health settings, even in clinics that purport 369 00:21:41,720 --> 00:21:43,920 Speaker 1: to be meant for people who use drugs all over 370 00:21:43,960 --> 00:21:48,240 Speaker 1: the world, the first message that people get is you're 371 00:21:48,240 --> 00:21:52,480 Speaker 1: not welcome, you're not trusted. When I started work in Ukraine, 372 00:21:52,560 --> 00:21:55,600 Speaker 1: for example, it was a real advance that patients could 373 00:21:55,600 --> 00:21:58,920 Speaker 1: get the medicine buprenorphine, which is a medicine that also 374 00:21:59,400 --> 00:22:03,560 Speaker 1: is prescribed that you take daily, but patients weren't even 375 00:22:03,600 --> 00:22:06,320 Speaker 1: allowed to touch the medicine. A nurse had to put 376 00:22:06,359 --> 00:22:08,320 Speaker 1: it under their tongues and watch them to make sure 377 00:22:08,320 --> 00:22:11,480 Speaker 1: they've taken it, and they couldn't take any home. The 378 00:22:11,520 --> 00:22:15,040 Speaker 1: medicine methodon in Ukraine was treated something like uranium or 379 00:22:15,080 --> 00:22:17,720 Speaker 1: a radioactive substance. Well yeah, let me just let me 380 00:22:17,760 --> 00:22:20,320 Speaker 1: just interject for a second, just so for for some 381 00:22:20,400 --> 00:22:22,400 Speaker 1: of our audience who won't be fully clear about this. 382 00:22:22,480 --> 00:22:27,080 Speaker 1: So so interesting that methanon and bupernorphine are the two 383 00:22:27,200 --> 00:22:31,800 Speaker 1: most common drugs there opioids, and they are generally provided 384 00:22:31,880 --> 00:22:34,560 Speaker 1: to people who have had a problem with street opioid, 385 00:22:34,680 --> 00:22:37,480 Speaker 1: especially heroin now sometimes sent in all other drugs like that, 386 00:22:37,920 --> 00:22:39,560 Speaker 1: and they operate a little bit the way say a 387 00:22:39,640 --> 00:22:43,080 Speaker 1: nicotine patch or any say does these are these cigarettes 388 00:22:43,280 --> 00:22:46,160 Speaker 1: and there is You're still getting the same basic substance 389 00:22:46,200 --> 00:22:49,600 Speaker 1: the opioid, like the nicotine, and you may be still 390 00:22:49,640 --> 00:22:51,800 Speaker 1: dependent on that in the sense that you'll go with 391 00:22:51,800 --> 00:22:55,639 Speaker 1: withdrawal symptoms if you stop taking it. But instead of 392 00:22:55,640 --> 00:22:59,320 Speaker 1: obtaining this drug that is part of a haphazard, erratic 393 00:22:59,480 --> 00:23:01,960 Speaker 1: life in a street life and getting it from criminals 394 00:23:02,000 --> 00:23:04,959 Speaker 1: of unknown potency impurity the way people obtain their heroin 395 00:23:05,040 --> 00:23:08,200 Speaker 1: or faneral other street drugs, you're obtaining a drug which 396 00:23:08,240 --> 00:23:12,920 Speaker 1: actually you can take every day of your life very safely, 397 00:23:13,040 --> 00:23:16,240 Speaker 1: and you're getting it in a reliable way. And so 398 00:23:16,440 --> 00:23:19,840 Speaker 1: methodon maintenance and um and so something in rupern Orphine 399 00:23:19,840 --> 00:23:22,320 Speaker 1: emerged maybe fifty years ago in the US and then 400 00:23:22,359 --> 00:23:24,600 Speaker 1: in some other countries. Now it's in dozens of countries 401 00:23:24,640 --> 00:23:29,200 Speaker 1: around the world, basically as the single most effective way 402 00:23:29,240 --> 00:23:32,600 Speaker 1: of helping heroin addicts put their addiction behind them. That 403 00:23:32,720 --> 00:23:35,560 Speaker 1: for people who did not want to or unable to, 404 00:23:35,640 --> 00:23:38,040 Speaker 1: sort of go cold turkey and stopped. You know, all 405 00:23:38,080 --> 00:23:41,320 Speaker 1: the evidence, World Health Organization, National Academy of Science, everybody 406 00:23:41,359 --> 00:23:45,640 Speaker 1: was making clear that methodon maintenance done correctly is the 407 00:23:45,680 --> 00:23:49,880 Speaker 1: best way for putting a destructive addiction to street drugs 408 00:23:49,960 --> 00:23:53,679 Speaker 1: behind you. Now, what you see around the world is 409 00:23:53,760 --> 00:23:56,480 Speaker 1: that there are better and worse ways of doing this, 410 00:23:56,920 --> 00:23:59,560 Speaker 1: and that includes the United States. And you have is 411 00:23:59,640 --> 00:24:04,440 Speaker 1: Daniel describing some clinics that are incredibly punitive, right where 412 00:24:04,440 --> 00:24:06,840 Speaker 1: if you don't obey every single rule, if you get caught, 413 00:24:07,040 --> 00:24:09,359 Speaker 1: if you don't show up every day, if you're smoking 414 00:24:09,400 --> 00:24:11,439 Speaker 1: merrial water, taking some other drug on the side, you're 415 00:24:11,520 --> 00:24:13,320 Speaker 1: kicked out. Your kicked out, you can you basically pushed 416 00:24:13,320 --> 00:24:16,119 Speaker 1: back to the street. Where is there are other method 417 00:24:16,200 --> 00:24:18,760 Speaker 1: on clinics and brouvement office programs that are operating in 418 00:24:18,760 --> 00:24:22,119 Speaker 1: a more harm reduction framework, by which it means that 419 00:24:22,160 --> 00:24:25,919 Speaker 1: there's an understanding that people lead somewhat chaotical lives sometimes 420 00:24:25,920 --> 00:24:28,280 Speaker 1: when they come in that you need to be flexible 421 00:24:28,560 --> 00:24:31,320 Speaker 1: as one would be in most of their areas of 422 00:24:31,400 --> 00:24:36,160 Speaker 1: medical care. And so when Daniel describes this draconian method 423 00:24:36,160 --> 00:24:39,639 Speaker 1: on situation in the Ukraine. That's common in many parts 424 00:24:39,720 --> 00:24:43,520 Speaker 1: of the world, including in the United States. But yeah, Daniel. 425 00:24:43,600 --> 00:24:46,160 Speaker 1: At the same time, there are alternative examples of much 426 00:24:46,200 --> 00:24:49,560 Speaker 1: more harm reduction oriented on method on programs. I mean, 427 00:24:49,800 --> 00:24:52,400 Speaker 1: there are many models, and many of them that are 428 00:24:52,440 --> 00:24:56,080 Speaker 1: the most flexible and inspiring are outside of the US. Interestingly, 429 00:24:56,520 --> 00:25:00,520 Speaker 1: so for example, in Croatia for method own or in 430 00:25:00,600 --> 00:25:04,919 Speaker 1: France for bupreneur fine general physicians can prescribe medicine. In 431 00:25:05,040 --> 00:25:07,600 Speaker 1: Hong Kong you can get on treatment the same day. 432 00:25:08,520 --> 00:25:10,840 Speaker 1: Often in many countries there's a long wait and a 433 00:25:10,880 --> 00:25:13,560 Speaker 1: long bureaucracy and a lot of tests required before you 434 00:25:13,560 --> 00:25:18,640 Speaker 1: get on. And the method on prescription there is dispensed 435 00:25:18,800 --> 00:25:21,480 Speaker 1: not just by doctor or nurse, but by a kind 436 00:25:21,480 --> 00:25:24,560 Speaker 1: of auxiliary volunteer core. So it might be a shoemaker 437 00:25:24,600 --> 00:25:27,600 Speaker 1: who's giving your medicine, who's volunteering at the clinic to 438 00:25:27,640 --> 00:25:29,879 Speaker 1: make sure that it stays open late enough for people 439 00:25:30,160 --> 00:25:33,720 Speaker 1: so that it's convenient. In Canada, methodone can be dispensed 440 00:25:33,760 --> 00:25:36,040 Speaker 1: by pharmacies. Why isn't that the case in the US. 441 00:25:36,240 --> 00:25:39,560 Speaker 1: So I think there are a lot of examples of flexibility, 442 00:25:39,600 --> 00:25:41,600 Speaker 1: But there are also a lot of examples, I'm sorry 443 00:25:41,640 --> 00:25:46,359 Speaker 1: to say, of inflexibility and governments and health services using 444 00:25:46,400 --> 00:25:48,600 Speaker 1: method one kind of as a form of control. So 445 00:25:48,640 --> 00:25:52,160 Speaker 1: I remember someone in Vietnam saying to me, I can 446 00:25:52,200 --> 00:25:55,560 Speaker 1: handle my heroin addiction and getting drugs on the street. 447 00:25:55,600 --> 00:25:58,360 Speaker 1: What I can handle is the government requirements to get 448 00:25:58,440 --> 00:26:02,320 Speaker 1: the treatment that I needed. So I think one of 449 00:26:02,359 --> 00:26:05,320 Speaker 1: the lessons of all of this is to ask people 450 00:26:05,520 --> 00:26:08,919 Speaker 1: what works for them, as opposed to requiring them to 451 00:26:09,000 --> 00:26:11,359 Speaker 1: do certain things that work for the system. And then 452 00:26:11,480 --> 00:26:14,359 Speaker 1: when when the patient drops out, because a lot of 453 00:26:14,400 --> 00:26:17,160 Speaker 1: people do drop out or return to drug use, blaming 454 00:26:17,200 --> 00:26:20,119 Speaker 1: the patient for the system failure, which is sort of 455 00:26:20,160 --> 00:26:22,320 Speaker 1: the opposite in so many others your medical care if 456 00:26:22,359 --> 00:26:25,080 Speaker 1: you have vetis medically with treating cancer, treating injury, whatever, 457 00:26:25,320 --> 00:26:27,439 Speaker 1: if one approach doesn't work, you try another, and then 458 00:26:27,440 --> 00:26:30,560 Speaker 1: you try another and you try another. But oftentimes with 459 00:26:30,680 --> 00:26:33,880 Speaker 1: drug treatment, if one approach doesn't work, it's like it's 460 00:26:33,920 --> 00:26:36,720 Speaker 1: your problem. You're the problem, You're the patient, You're the 461 00:26:36,720 --> 00:26:40,080 Speaker 1: reason the treatment failed. And that I think mindset of 462 00:26:40,119 --> 00:26:44,840 Speaker 1: not being incredibly innovative in trying to figure out how 463 00:26:45,040 --> 00:26:47,440 Speaker 1: we help people who are struggling with drug addiction. It's 464 00:26:47,440 --> 00:26:49,520 Speaker 1: improved clearly in the U S and other parts of 465 00:26:49,560 --> 00:26:53,080 Speaker 1: the world, but I mean this dominant modality of hyper control. 466 00:26:53,560 --> 00:26:55,840 Speaker 1: I think you're exactly right, Daniel. I remember here one 467 00:26:55,840 --> 00:26:57,760 Speaker 1: time somebody talk about, you know, the two of the 468 00:26:57,800 --> 00:27:01,439 Speaker 1: two areas of medicine that are the most stigmatized and 469 00:27:01,640 --> 00:27:05,920 Speaker 1: overregulated in the most non necessary way. One is method 470 00:27:06,000 --> 00:27:09,040 Speaker 1: on maintenance and the other one is abortion. Yeah, I mean, 471 00:27:09,080 --> 00:27:11,800 Speaker 1: I think in both cases a lot has to do 472 00:27:11,840 --> 00:27:15,160 Speaker 1: with how we expect people should behave and our suspicion 473 00:27:15,200 --> 00:27:16,960 Speaker 1: when they don't behave the way we want them to. 474 00:27:17,520 --> 00:27:20,240 Speaker 1: And so the so called treatment or the so called 475 00:27:20,280 --> 00:27:24,120 Speaker 1: service is actually an extension of our impulse to tell 476 00:27:24,200 --> 00:27:27,040 Speaker 1: people how we want them to live their lives. So 477 00:27:27,760 --> 00:27:30,000 Speaker 1: for me, it was really moving and instructive to go 478 00:27:30,080 --> 00:27:33,800 Speaker 1: to Copenhagen, for example, where they have heroin assisted treatment. 479 00:27:33,920 --> 00:27:36,480 Speaker 1: So on the one hand, of course, there's a lesson there, 480 00:27:36,520 --> 00:27:39,800 Speaker 1: which is that heroin, which is so often talked about 481 00:27:39,840 --> 00:27:42,720 Speaker 1: as a scourge and an evil and a drug that 482 00:27:43,560 --> 00:27:47,160 Speaker 1: destroys lives, is actually prescribed and used as a medicine. 483 00:27:47,520 --> 00:27:49,560 Speaker 1: But I knew that before I went And the moving 484 00:27:49,640 --> 00:27:51,639 Speaker 1: thing for me was that the doctor in charge of 485 00:27:51,680 --> 00:27:54,920 Speaker 1: that clinic said that she started the conversation with every 486 00:27:54,960 --> 00:27:58,080 Speaker 1: patient by asking what the patient wanted from the treatment. 487 00:27:58,600 --> 00:28:01,199 Speaker 1: Did the patient want to have enough heroin to just 488 00:28:01,280 --> 00:28:03,760 Speaker 1: not feel sick and have symptoms of withdrawal like a 489 00:28:03,880 --> 00:28:07,679 Speaker 1: terrible flu. Did the patient want to get really high. 490 00:28:07,840 --> 00:28:09,959 Speaker 1: Did the patient want to take the heroine and go 491 00:28:10,040 --> 00:28:13,320 Speaker 1: into the bathroom and injected him or herself. Did the 492 00:28:13,359 --> 00:28:15,879 Speaker 1: patient want to use their vein scanner so that they 493 00:28:15,880 --> 00:28:19,119 Speaker 1: could find a vein easily and accurately. Did the patient 494 00:28:19,240 --> 00:28:22,880 Speaker 1: wanted orally? And that question what do you want from 495 00:28:22,960 --> 00:28:27,640 Speaker 1: drug treatment is one that very few drug treatment services 496 00:28:27,680 --> 00:28:30,760 Speaker 1: in the US or elsewhere in the world actually ask 497 00:28:30,840 --> 00:28:34,399 Speaker 1: of people, because usually the drug treatment is designed in 498 00:28:34,480 --> 00:28:37,040 Speaker 1: terms of what we want from the people, not what 499 00:28:37,080 --> 00:28:39,800 Speaker 1: the people want from the treatment. You know, I think 500 00:28:39,920 --> 00:28:44,280 Speaker 1: people oftentimes just make the assumption that if you're addicted 501 00:28:44,280 --> 00:28:47,800 Speaker 1: to drugs, the only way you're going to get unaddicted 502 00:28:48,600 --> 00:28:51,840 Speaker 1: is if you're being pressured to do so right that 503 00:28:52,280 --> 00:28:54,560 Speaker 1: you need, whether it's a drug court judge or a 504 00:28:54,600 --> 00:28:58,400 Speaker 1: punitive treatment program or some form of sanctions. Otherwise you 505 00:28:58,440 --> 00:29:00,720 Speaker 1: don't put it behind you, And I think one of 506 00:29:00,720 --> 00:29:03,560 Speaker 1: the interesting things when needle exchange programs began to emerge 507 00:29:03,640 --> 00:29:06,120 Speaker 1: first in Europe in the early eighties in the US 508 00:29:06,200 --> 00:29:08,600 Speaker 1: in the late eighties early nineties. One of the early 509 00:29:08,640 --> 00:29:12,040 Speaker 1: ones was I think in Tacoma, Washington, and there was 510 00:29:12,080 --> 00:29:15,320 Speaker 1: a study done and what they found was that the 511 00:29:15,440 --> 00:29:20,520 Speaker 1: number one point of referral into traditional drug treatment programs 512 00:29:20,960 --> 00:29:24,840 Speaker 1: was from the needle exchange programs. And people were baffled, 513 00:29:25,160 --> 00:29:27,280 Speaker 1: how could that be. I mean, needle exchange programs is 514 00:29:27,320 --> 00:29:29,800 Speaker 1: all about letting junkies to continue to shoot that junk 515 00:29:29,840 --> 00:29:31,640 Speaker 1: into their arms, and you know, why would they be 516 00:29:31,680 --> 00:29:33,080 Speaker 1: interested in treatment. I mean, they're coming to the needle 517 00:29:33,080 --> 00:29:36,000 Speaker 1: exchange programs so they can keep using drugs without getting aids. 518 00:29:36,040 --> 00:29:38,480 Speaker 1: But it turned out, of course, as you and I know, 519 00:29:38,640 --> 00:29:42,400 Speaker 1: that those needle exchange programs gave people a feeling, a 520 00:29:42,440 --> 00:29:45,720 Speaker 1: safe place, a place where they could reflect, a place 521 00:29:45,720 --> 00:29:47,959 Speaker 1: where the first time they could be seen not just 522 00:29:48,040 --> 00:29:50,240 Speaker 1: as a junkie or as a drug addict, but be 523 00:29:50,360 --> 00:29:53,880 Speaker 1: seen as a human being who happened to be using 524 00:29:53,920 --> 00:29:56,600 Speaker 1: these drugs that were illicit. And it was in that 525 00:29:56,680 --> 00:30:00,720 Speaker 1: context that people then started to say, you know, rather 526 00:30:00,800 --> 00:30:03,960 Speaker 1: than having some some judge or authoritative figure in their 527 00:30:04,000 --> 00:30:07,040 Speaker 1: facing stop stop, stop wagging their finger or threatening to punderstand, 528 00:30:07,480 --> 00:30:11,440 Speaker 1: the individual himself for herself could actually be saying, maybe 529 00:30:11,520 --> 00:30:13,720 Speaker 1: I want to begin to get on top of this. 530 00:30:14,440 --> 00:30:16,320 Speaker 1: And you know, it's a kind of way in which, 531 00:30:16,560 --> 00:30:20,760 Speaker 1: you know, the the unpunitive, the anti punitive way turns 532 00:30:20,840 --> 00:30:24,800 Speaker 1: out to be the approach that leads to better results 533 00:30:25,240 --> 00:30:27,680 Speaker 1: of the sort that the punitive people would like would 534 00:30:27,680 --> 00:30:30,480 Speaker 1: like to see. Right, yeah, I mean the same thing. 535 00:30:30,520 --> 00:30:34,120 Speaker 1: They saw the same thing in the Supervisor injection site 536 00:30:34,280 --> 00:30:36,840 Speaker 1: in Vancouver, which was the first one in North America. 537 00:30:36,880 --> 00:30:38,800 Speaker 1: Of course now we have one in New York, but 538 00:30:39,080 --> 00:30:41,400 Speaker 1: many more people were able to be referred to treatment 539 00:30:42,200 --> 00:30:45,040 Speaker 1: by by coming into that site where they were allowed 540 00:30:45,080 --> 00:30:47,800 Speaker 1: to use drugs and talk about using drugs. I think 541 00:30:47,840 --> 00:30:50,240 Speaker 1: one of the things that is so characteristic of a 542 00:30:50,240 --> 00:30:53,000 Speaker 1: lot of health services is that they're set up to 543 00:30:53,080 --> 00:30:56,760 Speaker 1: make people liars and uncomfortable. So when I started working 544 00:30:56,760 --> 00:31:01,040 Speaker 1: in the post Soviet country's HIV clinics, how signs that said, 545 00:31:01,200 --> 00:31:04,960 Speaker 1: if you're under the influence of narcotics, please come back tomorrow. 546 00:31:05,680 --> 00:31:08,040 Speaker 1: And too many doctors of years and family members years. 547 00:31:08,040 --> 00:31:11,520 Speaker 1: That sounds reasonable, right, like don't come in when you're high. 548 00:31:11,560 --> 00:31:14,120 Speaker 1: But in countries where more than eighty or eighty five 549 00:31:14,200 --> 00:31:17,560 Speaker 1: or nine percent of HIV was concentrated among people who 550 00:31:17,600 --> 00:31:20,800 Speaker 1: injected drugs, what did that sign really mean? And meant 551 00:31:21,320 --> 00:31:24,600 Speaker 1: this HIV clinic isn't for you. And of course when 552 00:31:24,600 --> 00:31:27,000 Speaker 1: people need medicine to stay alive, they'll say what they 553 00:31:27,000 --> 00:31:29,760 Speaker 1: need to say to get it. So people didn't say 554 00:31:29,800 --> 00:31:32,200 Speaker 1: they were shooting drugs to the doctors, and then the 555 00:31:32,240 --> 00:31:34,200 Speaker 1: doctors would find out and turned around and say, you 556 00:31:34,240 --> 00:31:37,120 Speaker 1: see those drug users, their liars, they're manipulative. You can't 557 00:31:37,120 --> 00:31:40,560 Speaker 1: trust them. Let's go back now to our common link 558 00:31:40,680 --> 00:31:44,760 Speaker 1: with sorrows and his Open Society Foundation was called the 559 00:31:44,800 --> 00:31:47,360 Speaker 1: Open Society Institute in the early years, and an Open 560 00:31:47,400 --> 00:31:52,000 Speaker 1: Society Foundation OSI and then OSF. So when you look 561 00:31:52,200 --> 00:31:56,640 Speaker 1: back on these past fifteen years, what stands out as 562 00:31:56,720 --> 00:32:02,520 Speaker 1: some of the greatest successes. I'm really proud and and 563 00:32:03,000 --> 00:32:06,120 Speaker 1: gratified of how much has been achieved in terms of 564 00:32:06,160 --> 00:32:10,040 Speaker 1: the health services. I mean, there are needle exchange programs, 565 00:32:10,040 --> 00:32:12,760 Speaker 1: as you mentioned, that I've started and that we've helped 566 00:32:12,800 --> 00:32:16,960 Speaker 1: start in Colombia, in Kenya and Uganda. Some of those 567 00:32:17,000 --> 00:32:19,160 Speaker 1: that you help start in Eastern Europe are nearing their 568 00:32:19,160 --> 00:32:23,400 Speaker 1: twentieth anniversary. As you mentioned, the World Health Organization has 569 00:32:23,480 --> 00:32:26,520 Speaker 1: added method on a bupreneur fine to the Essential Drugs list. 570 00:32:27,160 --> 00:32:29,440 Speaker 1: The Office of National Drug Control Policy here in the 571 00:32:29,520 --> 00:32:32,920 Speaker 1: US and the Health and Human Services Administration under the 572 00:32:32,920 --> 00:32:37,240 Speaker 1: Biden administration is talking about harm reduction, something I wasn't 573 00:32:37,240 --> 00:32:40,200 Speaker 1: sure i'd ever see. From Bilisi in the Republic of 574 00:32:40,240 --> 00:32:44,040 Speaker 1: Georgia to New York, to Bangkok to New Delhi, there's 575 00:32:44,040 --> 00:32:47,960 Speaker 1: a cure for hepatitis C, which disproportionately affects people who 576 00:32:48,000 --> 00:32:51,800 Speaker 1: inject drugs, that is available. That is all real progress, 577 00:32:52,000 --> 00:32:56,400 Speaker 1: and that's great. However, when public health agencies talk about 578 00:32:56,400 --> 00:33:00,400 Speaker 1: harm reduction, or even when some public health pro Graham's 579 00:33:00,520 --> 00:33:03,960 Speaker 1: discuss harm reduction, they're really thinking about it as a 580 00:33:04,000 --> 00:33:07,920 Speaker 1: set of approved interventions to reduce the risk of HIV 581 00:33:08,080 --> 00:33:11,280 Speaker 1: or other blood borne infections, and they're really not thinking 582 00:33:11,320 --> 00:33:13,280 Speaker 1: about it the way I think about it now and 583 00:33:13,320 --> 00:33:16,360 Speaker 1: the way I believe I've heard you talk about it, 584 00:33:16,400 --> 00:33:18,880 Speaker 1: because you were you help shape my thinking about this, 585 00:33:19,280 --> 00:33:23,320 Speaker 1: which was harm reduction as a philosophy about letting people 586 00:33:23,320 --> 00:33:27,680 Speaker 1: themselves identify what they need and achieving what Dan Big, 587 00:33:27,760 --> 00:33:31,080 Speaker 1: the late leader of a Chicago harm reduction organization, called 588 00:33:31,200 --> 00:33:36,400 Speaker 1: quote any positive change. So for me, I actually understand 589 00:33:36,600 --> 00:33:41,480 Speaker 1: and agree partly with Columbia University professor Carl Hart's criticism 590 00:33:41,600 --> 00:33:46,280 Speaker 1: of the phrase harm reduction as very much focusing on 591 00:33:46,400 --> 00:33:51,880 Speaker 1: risks and more broadly on health services, really reducing harm 592 00:33:51,920 --> 00:33:54,440 Speaker 1: reduction to a list like needle exchange method on and 593 00:33:54,560 --> 00:33:59,719 Speaker 1: buprenorphine treatment, no ox zone provision, rather than thinking about 594 00:34:00,320 --> 00:34:04,440 Speaker 1: how harm reduction actually restores people's sense of agency and 595 00:34:05,080 --> 00:34:09,200 Speaker 1: control and optimism about the change they can achieve. Like 596 00:34:09,360 --> 00:34:12,520 Speaker 1: you'd never go to a rock climbing clinic and have 597 00:34:12,680 --> 00:34:16,080 Speaker 1: them talk only about the dangers of rock climbing and 598 00:34:16,120 --> 00:34:18,400 Speaker 1: what it feels like when your leg is ripped off, 599 00:34:18,640 --> 00:34:20,880 Speaker 1: or how you might not secure your rope or pete 600 00:34:20,960 --> 00:34:25,719 Speaker 1: on adequately and and faultier death. And for me, harm 601 00:34:25,760 --> 00:34:29,719 Speaker 1: reduction programs, the best harm reduction programs give people that 602 00:34:29,840 --> 00:34:32,239 Speaker 1: sense of being able to scale the rock or mount 603 00:34:32,280 --> 00:34:37,120 Speaker 1: the obstacle and enjoy a sense of power um by themselves. So, 604 00:34:37,400 --> 00:34:39,600 Speaker 1: for example, to go back to Vietnam, I had a 605 00:34:39,719 --> 00:34:42,759 Speaker 1: Vietnamese colleague who went to an international conference and got 606 00:34:42,760 --> 00:34:45,440 Speaker 1: a training and use of the overdose antidote in the 607 00:34:45,480 --> 00:34:49,040 Speaker 1: lock zone, which is safe and easy to administer and 608 00:34:49,200 --> 00:34:52,880 Speaker 1: which um, you know, revives people who stopped breathing when 609 00:34:52,880 --> 00:34:55,520 Speaker 1: they've had too much of an opioid. And she went 610 00:34:55,560 --> 00:34:58,520 Speaker 1: home and she used it, and then she said to me, oh, wow, 611 00:34:58,560 --> 00:35:00,719 Speaker 1: I finally have something I can tell my mother that 612 00:35:00,800 --> 00:35:03,719 Speaker 1: she can be proud of. So that's an outcome that 613 00:35:03,719 --> 00:35:07,440 Speaker 1: wouldn't be recognized necessarily by the World Health Organization, But 614 00:35:07,560 --> 00:35:09,759 Speaker 1: to me, it's a harm reduction outcome because I see 615 00:35:09,760 --> 00:35:13,480 Speaker 1: harm reduction, including needle exchange, as a sense of personal 616 00:35:13,560 --> 00:35:17,720 Speaker 1: restoration and enfranchisement, not just as a way to stop disease. 617 00:35:18,600 --> 00:35:20,520 Speaker 1: It's interesting because you know, I really just think about 618 00:35:20,560 --> 00:35:23,799 Speaker 1: it as kind of this evolutionary process. I mean, even 619 00:35:23,840 --> 00:35:25,839 Speaker 1: I think about even with needle exchange, you know, when 620 00:35:25,880 --> 00:35:28,200 Speaker 1: we got going on that issue, I mean, you were 621 00:35:28,239 --> 00:35:30,000 Speaker 1: involved in even in New York, I think in the 622 00:35:30,040 --> 00:35:33,600 Speaker 1: early nineties, and then when I started up with Sorrows 623 00:35:33,640 --> 00:35:36,279 Speaker 1: and was sort of the principal gate keeper of his 624 00:35:36,440 --> 00:35:40,279 Speaker 1: funding in the late nineties, and you know, funding these programs. 625 00:35:40,440 --> 00:35:42,759 Speaker 1: I mean, I think at that point the issue was 626 00:35:42,800 --> 00:35:46,799 Speaker 1: about increasing access to sterile syringes for people who were 627 00:35:47,040 --> 00:35:50,680 Speaker 1: injecting drugs illicitly and getting you know, HIV and hepse 628 00:35:50,840 --> 00:35:54,360 Speaker 1: and at risk. And there were folks who said, well, 629 00:35:54,800 --> 00:35:58,080 Speaker 1: I can get on board with allowing better access to 630 00:35:58,120 --> 00:36:01,520 Speaker 1: sterile syringes and pharmacies, but I can't get on board 631 00:36:01,520 --> 00:36:05,840 Speaker 1: with needle exchange because that's recognizing drug users as somehow 632 00:36:05,920 --> 00:36:08,480 Speaker 1: legitimate what they're doing. And I remember, you know, for 633 00:36:08,480 --> 00:36:11,120 Speaker 1: a long time, black leaders in New York would not 634 00:36:11,480 --> 00:36:14,920 Speaker 1: endorse needle exchange, including David Dinkins, the mayor in the 635 00:36:15,280 --> 00:36:18,920 Speaker 1: in the nineties, who you know, eventually came around, and 636 00:36:18,960 --> 00:36:20,640 Speaker 1: so I think I saw it as sort of a 637 00:36:20,640 --> 00:36:24,319 Speaker 1: way of start with the the narrow intervention. See, if 638 00:36:24,360 --> 00:36:26,920 Speaker 1: you can get your foot in the door. Here we 639 00:36:27,000 --> 00:36:31,120 Speaker 1: are trying to influence reactionary or conservative drug treatment people, 640 00:36:31,160 --> 00:36:35,640 Speaker 1: political people, whether we're talking about Poland or talking about Hungary, 641 00:36:35,760 --> 00:36:38,359 Speaker 1: or talking about some country in the former Soviet Union, 642 00:36:38,440 --> 00:36:41,520 Speaker 1: or talking about someplace in the US, if we could 643 00:36:41,560 --> 00:36:44,680 Speaker 1: get our foot in the door, step by step, we 644 00:36:44,719 --> 00:36:46,920 Speaker 1: would get to the broader thing. It's not like what 645 00:36:46,960 --> 00:36:49,279 Speaker 1: we see has happen with cannabis reform, right you start 646 00:36:49,320 --> 00:36:53,200 Speaker 1: with medical marijuana Mary, maybe marijuana de krim, and eventually 647 00:36:53,239 --> 00:36:55,839 Speaker 1: you get to marijuana legalization. And then when you get 648 00:36:55,880 --> 00:36:59,520 Speaker 1: to legalization, initially you know you can't provide any benefits 649 00:36:59,520 --> 00:37:01,600 Speaker 1: for the people who had been you know, you know, 650 00:37:01,719 --> 00:37:04,440 Speaker 1: harmed by the war on marijuana. Now we're entering a 651 00:37:04,480 --> 00:37:06,920 Speaker 1: phase with the people who spent time behind bars on 652 00:37:06,960 --> 00:37:10,560 Speaker 1: marijuana charges are actually giving preference in applying for licenses. 653 00:37:10,719 --> 00:37:13,160 Speaker 1: But it's a sort of evolutionary thing. And I think 654 00:37:13,200 --> 00:37:16,279 Speaker 1: going back to those days, if we had tried to 655 00:37:16,440 --> 00:37:19,319 Speaker 1: start with even though as you and I shared that 656 00:37:19,440 --> 00:37:23,520 Speaker 1: vision going back decades, if that had been the public 657 00:37:24,080 --> 00:37:26,200 Speaker 1: face of what we're trying to do, I don't know 658 00:37:26,239 --> 00:37:28,520 Speaker 1: if we would have gotten any traction in the first place. 659 00:37:29,239 --> 00:37:32,160 Speaker 1: I completely agree, and listen, I've been doing work in 660 00:37:32,200 --> 00:37:35,160 Speaker 1: places like Vietnam and China where if you came in 661 00:37:35,200 --> 00:37:39,279 Speaker 1: with a frank legalization agenda or with a broader discussion 662 00:37:39,320 --> 00:37:42,080 Speaker 1: of drugs and society, it would be very difficult. But 663 00:37:42,160 --> 00:37:45,480 Speaker 1: I think health is a wedge and a box. And 664 00:37:45,800 --> 00:37:49,080 Speaker 1: you know, ironically, Carl Popper, who is the British philosopher 665 00:37:49,080 --> 00:37:51,879 Speaker 1: who was a teacher and mentor for sorrows and from 666 00:37:51,880 --> 00:37:55,279 Speaker 1: whose writings the phrase open society has taken was also 667 00:37:55,320 --> 00:37:58,840 Speaker 1: a part of my curriculum and training in public health school, 668 00:37:59,440 --> 00:38:02,839 Speaker 1: and Papa talked about the importance and science of falsifying 669 00:38:03,200 --> 00:38:06,800 Speaker 1: hypotheses as a way of testing their worth. The hypotheses 670 00:38:06,800 --> 00:38:10,360 Speaker 1: of the drug war that giving people needles would encourage 671 00:38:10,400 --> 00:38:13,919 Speaker 1: drug use or send the wrong message, that prohibition will 672 00:38:14,000 --> 00:38:17,520 Speaker 1: decrease supply, that just say no campaigns and police education 673 00:38:17,560 --> 00:38:21,239 Speaker 1: are a good way to protect youth, That decriminalization would 674 00:38:21,320 --> 00:38:25,920 Speaker 1: lead to more drug initiation. Those have all been proven false, 675 00:38:26,040 --> 00:38:29,200 Speaker 1: and I think it's also been my work to elevate 676 00:38:29,400 --> 00:38:32,799 Speaker 1: alternate hypotheses or test them which have in fact been 677 00:38:32,840 --> 00:38:36,560 Speaker 1: proven true, like the fact that giving people sterile syringes 678 00:38:36,760 --> 00:38:40,719 Speaker 1: doesn't encourage drug use, and that reducing fatal infections and 679 00:38:40,800 --> 00:38:44,719 Speaker 1: overdose can be achieved in places that allow people to 680 00:38:44,760 --> 00:38:48,680 Speaker 1: inject drugs on site, or that decriminalizing all drugs and 681 00:38:48,760 --> 00:38:52,000 Speaker 1: making funds available for services doesn't actually lead more youth 682 00:38:52,160 --> 00:38:54,680 Speaker 1: to start using drugs, or that heroin can be a 683 00:38:54,719 --> 00:38:57,480 Speaker 1: medicine rather than an evil. The drug war is right 684 00:38:57,560 --> 00:39:00,319 Speaker 1: up there with the War on terrorism as the most 685 00:39:00,360 --> 00:39:06,160 Speaker 1: effective and unquestioned justification for surveillance, arrested imprisonment of anyone. 686 00:39:06,640 --> 00:39:09,759 Speaker 1: And it's so useful precisely because it is so totalizing, 687 00:39:09,840 --> 00:39:13,719 Speaker 1: because drug war proponents that label anyone who objects or 688 00:39:13,800 --> 00:39:16,680 Speaker 1: resists as part of the problem. I mean, of course, 689 00:39:17,320 --> 00:39:20,040 Speaker 1: we saw that with when American police tried to blame 690 00:39:20,080 --> 00:39:22,560 Speaker 1: George Floyd for his own murder by suggesting it was 691 00:39:22,640 --> 00:39:26,360 Speaker 1: drug grazed, or when the officer who shot Filando Castile 692 00:39:26,520 --> 00:39:28,799 Speaker 1: during a routine traffic stops said that the smell of 693 00:39:28,840 --> 00:39:31,840 Speaker 1: marijuana on the car made him fear for his life. 694 00:39:32,239 --> 00:39:34,960 Speaker 1: But internationally all over the world, it's the same. You 695 00:39:35,000 --> 00:39:37,799 Speaker 1: think sometimes with safe injection programs around the world. It's 696 00:39:37,840 --> 00:39:39,840 Speaker 1: not just that there's a table and a nurse in 697 00:39:39,880 --> 00:39:41,880 Speaker 1: a place where people can get a clean needle and 698 00:39:42,000 --> 00:39:46,279 Speaker 1: inject an illusiit drug under the supervision of a health professional. 699 00:39:46,719 --> 00:39:49,160 Speaker 1: But it's also a place where there may be some cots, 700 00:39:49,320 --> 00:39:51,800 Speaker 1: and where there may be a refrigerator with some food, 701 00:39:51,960 --> 00:39:55,080 Speaker 1: and there may be a washing machine and dryer, right, 702 00:39:55,480 --> 00:39:58,239 Speaker 1: I mean, it's all about giving people whose lives are 703 00:39:58,239 --> 00:40:02,080 Speaker 1: oftentimes chaotic and cho eaching a place to some places, 704 00:40:02,080 --> 00:40:04,080 Speaker 1: even I think even needle exchange program story doing it 705 00:40:04,160 --> 00:40:08,359 Speaker 1: years ago where they would offer you know, acupuncture or massage, 706 00:40:08,640 --> 00:40:11,960 Speaker 1: just these types of services where you know whether they 707 00:40:11,960 --> 00:40:16,720 Speaker 1: were actually medically valuable gay people an opportunity, give people 708 00:40:16,719 --> 00:40:20,400 Speaker 1: an opportunity to just have an hour or two or 709 00:40:20,480 --> 00:40:26,000 Speaker 1: more of calm. Yeah, and also to be regarded again 710 00:40:26,160 --> 00:40:29,400 Speaker 1: with their needs first. So, for example, there's a group 711 00:40:29,440 --> 00:40:33,560 Speaker 1: called Metsinitis and Barcelona. It's a kind of unsupervised or 712 00:40:33,760 --> 00:40:37,960 Speaker 1: nominally supervised injection site. It's a shelter for for women 713 00:40:38,040 --> 00:40:41,480 Speaker 1: who don't have a roof or a home, trans and 714 00:40:41,680 --> 00:40:44,719 Speaker 1: CIS gendered women, and you know, the women can bring 715 00:40:44,760 --> 00:40:48,319 Speaker 1: their dogs. Again, many health departments would say, oh no, 716 00:40:48,400 --> 00:40:51,800 Speaker 1: that's terrible, but for the women it's really important because 717 00:40:51,840 --> 00:40:54,440 Speaker 1: a lot of homeless people really care about their dogs 718 00:40:54,440 --> 00:40:56,440 Speaker 1: and if they have to leave their dog behind to 719 00:40:56,520 --> 00:41:02,239 Speaker 1: go into even the the officially uninjection site in Barcelona, 720 00:41:02,280 --> 00:41:05,520 Speaker 1: they won't do it. So yeah, starting with what people 721 00:41:05,600 --> 00:41:08,440 Speaker 1: need rather than what the system needs is really the 722 00:41:08,520 --> 00:41:10,919 Speaker 1: through line for me. And I can think of lots 723 00:41:11,000 --> 00:41:14,399 Speaker 1: of different harm reduction programs all around the world. Um, 724 00:41:14,440 --> 00:41:17,960 Speaker 1: whether that's putting a dentist chair and a dentists in 725 00:41:18,000 --> 00:41:21,360 Speaker 1: a needle exchange program in the Republic of Georgia, or 726 00:41:22,160 --> 00:41:26,200 Speaker 1: basically making the loxone available um, two people so they 727 00:41:26,200 --> 00:41:29,600 Speaker 1: can feel some power in the bottle and for themselves 728 00:41:29,600 --> 00:41:34,000 Speaker 1: to protect other people around them. Um. Really those things 729 00:41:34,000 --> 00:41:38,319 Speaker 1: are critical, you know, Dane, you mentioned early on that 730 00:41:38,400 --> 00:41:42,359 Speaker 1: there were some sort of silver linings on COVID in 731 00:41:42,480 --> 00:41:46,040 Speaker 1: terms of approaches to drug treatment in harm reduction. I mean, 732 00:41:46,040 --> 00:41:47,560 Speaker 1: we know that on the one hand, the US and 733 00:41:47,640 --> 00:41:51,040 Speaker 1: some other places over those fatalities have hit, you know, 734 00:41:51,080 --> 00:41:54,480 Speaker 1: extraordinary peaks, especially with the spread of fentanel. But it 735 00:41:54,560 --> 00:41:57,920 Speaker 1: does seem that, you know, COVID is forcing some changes 736 00:41:58,080 --> 00:42:00,800 Speaker 1: that hopefully will be sustained. Maybe you could just elaborate 737 00:42:00,840 --> 00:42:04,480 Speaker 1: on that. Yeah, Look, COVID has has these things up slightly. 738 00:42:04,600 --> 00:42:07,120 Speaker 1: So it has allowed people to take home some doses 739 00:42:07,160 --> 00:42:10,200 Speaker 1: of Method one, for example, when previously that wasn't permitted. 740 00:42:10,760 --> 00:42:14,880 Speaker 1: It's allowed doctors to start people on opioid treatment with 741 00:42:14,960 --> 00:42:18,080 Speaker 1: bupreneur fine earlier, and in some cases over the phone 742 00:42:18,120 --> 00:42:20,560 Speaker 1: when you used to have to go in in person 743 00:42:21,160 --> 00:42:26,520 Speaker 1: all over the world like we've seen basically services partly 744 00:42:26,560 --> 00:42:28,919 Speaker 1: because the clinic staff didn't want to be at risk 745 00:42:29,040 --> 00:42:32,359 Speaker 1: and partly because they didn't have the resources to help 746 00:42:32,400 --> 00:42:36,279 Speaker 1: people to travel. Um say, like, okay, we have to 747 00:42:36,280 --> 00:42:39,080 Speaker 1: make it more possible for you to receive treatment at home, 748 00:42:39,600 --> 00:42:43,760 Speaker 1: and honestly, assuming you have a home, like of course, 749 00:42:43,800 --> 00:42:47,080 Speaker 1: it is such an essential improvement to not have to 750 00:42:47,160 --> 00:42:52,200 Speaker 1: go and report. You've also seen, however, some other trends 751 00:42:52,280 --> 00:42:56,200 Speaker 1: that could be good or you know, could be questionable, 752 00:42:56,320 --> 00:43:02,480 Speaker 1: like transitioning people to long acting injectable formulation of opioid treatment. 753 00:43:02,760 --> 00:43:06,759 Speaker 1: For some people, those are really useful and a great assistance, 754 00:43:07,200 --> 00:43:10,360 Speaker 1: but of course those are medicine. Medicines you can't stop 755 00:43:10,400 --> 00:43:12,920 Speaker 1: even if you want to, so it remains to be 756 00:43:13,000 --> 00:43:16,160 Speaker 1: seen how how that will play out. What about telemedicine. 757 00:43:16,800 --> 00:43:21,040 Speaker 1: Telemedicine again for places for people who have telephones and 758 00:43:21,640 --> 00:43:24,600 Speaker 1: have access to a doctor, excellent and and that's been 759 00:43:24,640 --> 00:43:26,920 Speaker 1: one of the innovations in COVID, which is that people 760 00:43:27,000 --> 00:43:32,080 Speaker 1: could have telemedicine both in pain prescribing and in prescribing 761 00:43:32,080 --> 00:43:37,320 Speaker 1: for opioid addiction treatment. There have been really turned toward 762 00:43:37,520 --> 00:43:40,880 Speaker 1: over control in the US as a response to the 763 00:43:40,920 --> 00:43:45,200 Speaker 1: overdose crisis and what has been a lack of control 764 00:43:45,239 --> 00:43:48,520 Speaker 1: and over prescribing. But many many people were being forced 765 00:43:48,560 --> 00:43:52,279 Speaker 1: to taper their medicines and this is still going on 766 00:43:52,520 --> 00:43:56,799 Speaker 1: for pain relief or being asked to come in even 767 00:43:56,840 --> 00:44:00,200 Speaker 1: for buprenourphine multiple times in the course of a week, 768 00:44:00,239 --> 00:44:03,880 Speaker 1: et cetera. Some of that eased up in COVID. Yeah, 769 00:44:04,160 --> 00:44:07,000 Speaker 1: you know, also just for our listeners, understand, I mean, 770 00:44:07,080 --> 00:44:09,040 Speaker 1: you know, there are countries, as I think Danielle said, 771 00:44:09,040 --> 00:44:10,879 Speaker 1: We're like France and some other parts of the world 772 00:44:10,920 --> 00:44:14,719 Speaker 1: where boobern orphane became far more common and methanon initially 773 00:44:14,800 --> 00:44:17,600 Speaker 1: was not permitted. In Germany for a while they had 774 00:44:17,640 --> 00:44:20,319 Speaker 1: codeine maintenance and a band on methoon maintenance, and now 775 00:44:20,360 --> 00:44:24,160 Speaker 1: methanon has become you know, much more global on certainly 776 00:44:24,200 --> 00:44:28,239 Speaker 1: in Europe and and the America's in Australia and even 777 00:44:28,320 --> 00:44:30,879 Speaker 1: parts of Africa and Asia and what have you. When 778 00:44:30,920 --> 00:44:34,320 Speaker 1: booper norphine came along, it was another way of helping 779 00:44:34,360 --> 00:44:37,160 Speaker 1: people who have been addicted to heroin or other street opioids. 780 00:44:37,520 --> 00:44:40,120 Speaker 1: But Dane, I'll tell you, I remember one time, this 781 00:44:40,200 --> 00:44:43,080 Speaker 1: was early on, must have been mid nineties, and I 782 00:44:43,160 --> 00:44:46,799 Speaker 1: got to visit from the Michigan Senator Karl Levin, and 783 00:44:46,840 --> 00:44:49,640 Speaker 1: he was behind this bill to expand access to boobern orphane. 784 00:44:49,880 --> 00:44:52,160 Speaker 1: And he says to me, just think, once we open 785 00:44:52,239 --> 00:44:54,680 Speaker 1: this thing up with boobern orphane, we won't need methanon anymore. 786 00:44:55,440 --> 00:44:57,359 Speaker 1: And I looked at him and going, what are you 787 00:44:57,440 --> 00:45:01,120 Speaker 1: talking about? And people somehow thought, you know that bupernoorphine 788 00:45:01,200 --> 00:45:03,799 Speaker 1: was going to be allowed, that doctors could prescribe it, right, 789 00:45:03,840 --> 00:45:05,480 Speaker 1: you wouldn't have to go to a clinic that with 790 00:45:05,480 --> 00:45:08,360 Speaker 1: with with method On. But there was no real medical 791 00:45:08,440 --> 00:45:12,080 Speaker 1: reason to treat method On one way, and Bouffern bupernur 792 00:45:12,120 --> 00:45:15,160 Speaker 1: fine in another way. It was more about the laws 793 00:45:15,160 --> 00:45:18,399 Speaker 1: and about the stigma involving method On. And I looked 794 00:45:18,440 --> 00:45:20,520 Speaker 1: at my basics that don't you understand this is just 795 00:45:20,680 --> 00:45:23,160 Speaker 1: like pain management. You know, you wouldn't say, well, we 796 00:45:23,200 --> 00:45:26,720 Speaker 1: have morphine and therefore we don't need alouded or demorol 797 00:45:26,840 --> 00:45:29,600 Speaker 1: or oxycodone or anything else or fat at all. You 798 00:45:29,640 --> 00:45:32,400 Speaker 1: know we need You know, different types of opioids are 799 00:45:32,400 --> 00:45:34,640 Speaker 1: gonna work for different people in different types of pain 800 00:45:34,680 --> 00:45:37,280 Speaker 1: and different situations, and you want to have a variety 801 00:45:37,280 --> 00:45:39,600 Speaker 1: of opioids, And the same should be true when it 802 00:45:39,680 --> 00:45:43,160 Speaker 1: comes to dealing with illicit and problematic opioid addiction. You 803 00:45:43,239 --> 00:45:45,680 Speaker 1: make a really important point, which is that bpernour Fine 804 00:45:45,680 --> 00:45:48,719 Speaker 1: and methodon maybe opioids, but of course they don't act 805 00:45:48,760 --> 00:45:51,120 Speaker 1: exactly the same way or make people feel the same way. 806 00:45:51,160 --> 00:45:55,839 Speaker 1: So bupernour Fine is a partial agonist and partial antagonist, 807 00:45:55,920 --> 00:45:58,719 Speaker 1: which in regular language means that it gives you some 808 00:45:58,840 --> 00:46:01,040 Speaker 1: euphoria and makes you feel like you've had an opioid, 809 00:46:01,120 --> 00:46:05,480 Speaker 1: but it blocks the effects of other opioids. And there's 810 00:46:05,520 --> 00:46:09,640 Speaker 1: also another medicine now, trek Zone, which is an opioid blocker. 811 00:46:10,360 --> 00:46:14,120 Speaker 1: Any of these are options and can carry some benefit 812 00:46:14,200 --> 00:46:17,759 Speaker 1: for people. The problem is again when the clinician and 813 00:46:17,840 --> 00:46:21,040 Speaker 1: the system decide what's good for people rather than asking 814 00:46:21,080 --> 00:46:25,680 Speaker 1: the people. So even with buprenorphine, patients have the experience 815 00:46:25,719 --> 00:46:28,920 Speaker 1: of telling their doctor that they're not getting the effect 816 00:46:28,920 --> 00:46:33,200 Speaker 1: they need and the doctor basically will say, listen, it 817 00:46:33,239 --> 00:46:35,120 Speaker 1: works for the rest of my patients. I'm sorry, I'm 818 00:46:35,160 --> 00:46:38,320 Speaker 1: not increasing your dose. I mean you mentioned pain medicine. 819 00:46:38,400 --> 00:46:41,439 Speaker 1: The same thing is true. It's not just um that 820 00:46:41,520 --> 00:46:44,160 Speaker 1: you need a range of medicine. It's that you need 821 00:46:44,200 --> 00:46:46,640 Speaker 1: a range of doses of the medicine, and that for 822 00:46:46,680 --> 00:46:50,080 Speaker 1: all of these things. The crucial thing that this returns 823 00:46:50,120 --> 00:46:53,759 Speaker 1: to is that question from the heroin prescription clinic in 824 00:46:53,840 --> 00:46:56,200 Speaker 1: Copenhagen that the doctor asked, which is what do you 825 00:46:56,239 --> 00:46:58,920 Speaker 1: need for this from this treatment and how is this 826 00:46:59,000 --> 00:47:02,440 Speaker 1: treatment working for you? If you don't believe patients when 827 00:47:02,440 --> 00:47:05,560 Speaker 1: they recount to you that the treatment isn't working, there's 828 00:47:05,640 --> 00:47:09,560 Speaker 1: really very little hope of having a successful treatment, because, 829 00:47:09,560 --> 00:47:12,800 Speaker 1: of course, all medical treatments are competing with street drugs, 830 00:47:13,320 --> 00:47:18,239 Speaker 1: which are you know, often accessible, sometimes cheaper, and available 831 00:47:18,239 --> 00:47:23,640 Speaker 1: with less hassle than the so called medical treatment. Let's 832 00:47:23,640 --> 00:47:37,200 Speaker 1: take a break here and go to an ad. You know, 833 00:47:37,440 --> 00:47:39,480 Speaker 1: you know in that interview you did with Act Up 834 00:47:39,520 --> 00:47:41,680 Speaker 1: there was I just gonna want to read to our 835 00:47:41,719 --> 00:47:45,040 Speaker 1: listeners on something you said there. You said, I have 836 00:47:45,160 --> 00:47:46,879 Speaker 1: to say, I know the Act Up was not only 837 00:47:46,960 --> 00:47:49,440 Speaker 1: gay men and lesbians, but there's no way for me 838 00:47:49,480 --> 00:47:53,040 Speaker 1: to separate out its queerness from its political efficacy and 839 00:47:53,120 --> 00:47:55,920 Speaker 1: from its personal healing power. For me, about the idea 840 00:47:55,920 --> 00:47:59,719 Speaker 1: of common cause that was organized around sexuality but was 841 00:47:59,760 --> 00:48:03,680 Speaker 1: not actually about only sexuality, and this feeling that we 842 00:48:03,680 --> 00:48:06,400 Speaker 1: were making history, not being pushed around by it was 843 00:48:06,480 --> 00:48:09,120 Speaker 1: much more than my Ivy League education are much more 844 00:48:09,120 --> 00:48:11,480 Speaker 1: than my access to the ambassadors and the prime ministers 845 00:48:11,560 --> 00:48:14,960 Speaker 1: was something that transformed my worldview and my sense of 846 00:48:15,000 --> 00:48:17,920 Speaker 1: myself and my sense of the possible, and it made 847 00:48:17,920 --> 00:48:21,400 Speaker 1: me feel like change was possible, and I thought that 848 00:48:21,440 --> 00:48:24,000 Speaker 1: was beautifully said. There there was this moment, you know, 849 00:48:24,160 --> 00:48:26,319 Speaker 1: when you're at Act Up and then going into work 850 00:48:26,320 --> 00:48:29,719 Speaker 1: at g MHC, where you find that you can be 851 00:48:29,800 --> 00:48:33,200 Speaker 1: part of a collective and engaged in meaningful action and 852 00:48:33,280 --> 00:48:37,560 Speaker 1: that actually can change politics, can change the law, can 853 00:48:37,640 --> 00:48:42,320 Speaker 1: change policy, can save lives. Do you remember particular moments 854 00:48:42,800 --> 00:48:44,600 Speaker 1: when you were doing that work that just sort of 855 00:48:44,640 --> 00:48:47,759 Speaker 1: stood up as kind of the aha moment. I mean 856 00:48:47,840 --> 00:48:52,840 Speaker 1: it was a collective and aggregate of multiple moments, including 857 00:48:52,880 --> 00:48:56,200 Speaker 1: moments again where you were standing up and asking for 858 00:48:56,280 --> 00:48:58,719 Speaker 1: things that didn't seem possible at the time. I mean, 859 00:48:58,760 --> 00:49:03,040 Speaker 1: there are lots of policy successes that I could cite, 860 00:49:03,400 --> 00:49:06,480 Speaker 1: but the feeling of being with other people and being 861 00:49:06,480 --> 00:49:10,680 Speaker 1: an actor in history rather than an object of forces 862 00:49:10,760 --> 00:49:15,200 Speaker 1: that wanted to put you down, was really deep and 863 00:49:15,280 --> 00:49:19,440 Speaker 1: indelible and actually honestly central to my work later at 864 00:49:19,480 --> 00:49:22,840 Speaker 1: OSF two, which is trying to inspire that feeling in others. 865 00:49:22,880 --> 00:49:25,360 Speaker 1: Of course, I had the great privilege of giving away money, 866 00:49:25,400 --> 00:49:28,480 Speaker 1: as you said at the at the start um, and 867 00:49:28,840 --> 00:49:32,160 Speaker 1: two programs and two people who were really taking the 868 00:49:32,280 --> 00:49:36,000 Speaker 1: risk and doing the activism, but also in connecting people 869 00:49:36,880 --> 00:49:40,759 Speaker 1: between countries and sort of across movements so that they 870 00:49:40,800 --> 00:49:43,600 Speaker 1: didn't feel alone. And I think a lot of the 871 00:49:43,600 --> 00:49:46,759 Speaker 1: best change that's happened in the drug policy world globally 872 00:49:47,200 --> 00:49:50,359 Speaker 1: has come from that sense of interconnection. So, Daniel, I mean, 873 00:49:50,480 --> 00:49:55,360 Speaker 1: you've had fifteen plus years of experience of making grants, 874 00:49:55,400 --> 00:49:58,279 Speaker 1: giving out oh well, over a hundred million dollars all 875 00:49:58,320 --> 00:50:01,160 Speaker 1: around the world, maybe hundreds of millions of dollars. And 876 00:50:01,200 --> 00:50:04,200 Speaker 1: I'm curious, I mean, what have you learned? What have 877 00:50:04,360 --> 00:50:09,280 Speaker 1: been the key criteria by which you evaluate these things? 878 00:50:09,400 --> 00:50:12,719 Speaker 1: You know how in terms of picking winners or avoiding 879 00:50:12,760 --> 00:50:16,920 Speaker 1: picking losers, or you know, the whole progressive tendency to 880 00:50:17,280 --> 00:50:20,120 Speaker 1: always want to spread money around too small grassroots groups 881 00:50:20,120 --> 00:50:22,720 Speaker 1: from maybe giving money to more established ones might achieve 882 00:50:22,800 --> 00:50:25,760 Speaker 1: more of a difference in some cases. You know, what's 883 00:50:25,800 --> 00:50:30,560 Speaker 1: your what's been your process in your takeaways? Yeah, I mean, look, 884 00:50:30,600 --> 00:50:33,560 Speaker 1: one of the things about working at Open Society Foundations 885 00:50:33,600 --> 00:50:36,520 Speaker 1: that has been a great privilege is that we haven't 886 00:50:36,560 --> 00:50:41,920 Speaker 1: been locked into very long, elaborate proposals requiring people to 887 00:50:42,040 --> 00:50:45,160 Speaker 1: list deliverables and then stick to them regardless of whether 888 00:50:45,200 --> 00:50:48,480 Speaker 1: the circumstance makes them sensible or not. While of course 889 00:50:48,680 --> 00:50:51,880 Speaker 1: I am interested in and believe that we have achieved 890 00:50:52,040 --> 00:50:56,440 Speaker 1: significant impact in multiple arenas, remaining as flexible as possible 891 00:50:56,480 --> 00:50:59,600 Speaker 1: and letting people who get our money be as flexible 892 00:50:59,640 --> 00:51:02,040 Speaker 1: as possible has really been a key lesson for me. 893 00:51:02,320 --> 00:51:06,000 Speaker 1: I'm sure you remember what it was like when you 894 00:51:06,040 --> 00:51:08,760 Speaker 1: were the head of the Drug Policy Alliance to receive 895 00:51:08,960 --> 00:51:11,720 Speaker 1: an unrestricted funding that let you do what you wanted, 896 00:51:12,320 --> 00:51:14,920 Speaker 1: versus funding where you had to account for every little 897 00:51:14,920 --> 00:51:17,840 Speaker 1: piece and then justify every change in course of action. 898 00:51:18,360 --> 00:51:21,600 Speaker 1: So with drugs, especially where you want to be responsive 899 00:51:21,640 --> 00:51:27,080 Speaker 1: to context, flexibility has been critical for me. Most donors 900 00:51:27,120 --> 00:51:31,280 Speaker 1: have what I would call d a d D donor 901 00:51:31,320 --> 00:51:34,040 Speaker 1: attention deficit disorder, which is they'll fund something for a 902 00:51:34,040 --> 00:51:36,040 Speaker 1: little while and then move on to the next thing 903 00:51:36,600 --> 00:51:39,600 Speaker 1: and not really reckon with the impact of their withdrawal 904 00:51:39,640 --> 00:51:42,440 Speaker 1: from the field. It's been great to be able to 905 00:51:42,480 --> 00:51:46,600 Speaker 1: fund things like we have some grantees that for all 906 00:51:46,640 --> 00:51:49,359 Speaker 1: I know started when you started, but um, we've been 907 00:51:49,440 --> 00:51:52,719 Speaker 1: engaging with for years. And the question isn't just like 908 00:51:52,760 --> 00:51:55,040 Speaker 1: do you stick with the same grantee for years, but 909 00:51:55,120 --> 00:51:58,040 Speaker 1: do you see that grantee changing in response to changes 910 00:51:58,080 --> 00:52:00,959 Speaker 1: on the ground and to their circumstances in a way 911 00:52:01,080 --> 00:52:05,960 Speaker 1: that seems honest, including admitting when change isn't possible or 912 00:52:05,960 --> 00:52:09,319 Speaker 1: when a so called failure is likely. One of the 913 00:52:09,440 --> 00:52:13,560 Speaker 1: great privileges of OSF is that we didn't have to 914 00:52:13,600 --> 00:52:17,720 Speaker 1: be penalized for failure or penalize others for failure, because 915 00:52:17,840 --> 00:52:21,320 Speaker 1: we recognize that in some place like Russia or Iran, 916 00:52:22,000 --> 00:52:25,920 Speaker 1: or China or Vietnam, you are dealing with very difficult 917 00:52:25,920 --> 00:52:29,919 Speaker 1: social circumstances. I think another lesson for me is that 918 00:52:30,600 --> 00:52:35,280 Speaker 1: unlike mainstream health donors, which are very interested in sustainability 919 00:52:35,280 --> 00:52:38,200 Speaker 1: and scale, those are two of the buzzwords, can this 920 00:52:38,320 --> 00:52:42,120 Speaker 1: be continued and ultimately can it get government funding? And 921 00:52:42,160 --> 00:52:45,919 Speaker 1: can it be grown such that it has a demonstrable 922 00:52:45,960 --> 00:52:51,160 Speaker 1: public health impact? For me, the impact of a program 923 00:52:51,320 --> 00:52:54,200 Speaker 1: could be conceptual. So it's fine if there's a small 924 00:52:54,239 --> 00:53:00,000 Speaker 1: program that might not be recognizable as sustainable or actually 925 00:53:00,040 --> 00:53:03,280 Speaker 1: he might not ever get government funding, but was doing 926 00:53:03,400 --> 00:53:07,839 Speaker 1: incredibly brave work and helping to reconceptualize what drugs work 927 00:53:07,920 --> 00:53:10,800 Speaker 1: looked like. And those are some of the inspiring examples 928 00:53:10,840 --> 00:53:14,319 Speaker 1: that we were able to fund. And then I guess 929 00:53:14,320 --> 00:53:16,000 Speaker 1: a final lesson is you have to be able to 930 00:53:16,040 --> 00:53:18,840 Speaker 1: tell the story of those groups in ways that the 931 00:53:18,880 --> 00:53:22,239 Speaker 1: people who are allocating resources can feel compelled by. Yeah, 932 00:53:22,280 --> 00:53:24,799 Speaker 1: I mean you sometimes here this criticism, I mean, less 933 00:53:24,840 --> 00:53:27,359 Speaker 1: of sorrows with more of say Bill Gates or other 934 00:53:27,840 --> 00:53:31,960 Speaker 1: these major multinational health funding foundations of this kind of 935 00:53:32,320 --> 00:53:35,280 Speaker 1: first world is um this kind of top down thing. 936 00:53:35,719 --> 00:53:39,359 Speaker 1: What's your take on that in your response, listen, I mean, 937 00:53:39,400 --> 00:53:41,880 Speaker 1: I think it's a very real critique, which is that 938 00:53:42,440 --> 00:53:47,440 Speaker 1: the donors, often the rich Western donors, basically set the 939 00:53:47,480 --> 00:53:51,040 Speaker 1: tune and ask people to dance to it. And you know, 940 00:53:51,320 --> 00:53:54,359 Speaker 1: I've had people, including government officials and some of these 941 00:53:54,400 --> 00:53:58,160 Speaker 1: repressive governments say to me, at least, you know, at 942 00:53:58,239 --> 00:54:01,200 Speaker 1: least we had an election year who elected you to 943 00:54:01,360 --> 00:54:04,759 Speaker 1: determine that we should do harm reduction in the country, etcetera. 944 00:54:04,920 --> 00:54:06,719 Speaker 1: So I think that is a fair critique, and I 945 00:54:06,800 --> 00:54:09,600 Speaker 1: think it's actually one of the things that motivated OSF 946 00:54:09,600 --> 00:54:13,279 Speaker 1: at least partially the Open Society foundations to actually give 947 00:54:13,320 --> 00:54:16,000 Speaker 1: more control to the regions and to diminish the kind 948 00:54:16,000 --> 00:54:20,120 Speaker 1: of colonial nature of headquarters dictating what was supposed to happen. 949 00:54:20,600 --> 00:54:26,239 Speaker 1: My real response, though, is that flexible funding wherever it 950 00:54:26,320 --> 00:54:30,360 Speaker 1: comes from, is critical, and I would say that you 951 00:54:30,360 --> 00:54:33,799 Speaker 1: know your relationship with your grantees, your ability to let 952 00:54:33,880 --> 00:54:38,280 Speaker 1: them change the course of action or push back against 953 00:54:38,400 --> 00:54:44,560 Speaker 1: your recommendations, and the sort of commitment to fostering as 954 00:54:44,600 --> 00:54:47,239 Speaker 1: honest in exchange as you can have given the real 955 00:54:47,280 --> 00:54:51,960 Speaker 1: power dynamics is critical. I have asked and will continue 956 00:54:52,080 --> 00:54:57,239 Speaker 1: to be interested in how grantees regard our relationship, and 957 00:54:57,320 --> 00:55:00,520 Speaker 1: of course I can't get outside the re lality is 958 00:55:00,600 --> 00:55:03,920 Speaker 1: that you know I and my staff control money that 959 00:55:04,000 --> 00:55:07,600 Speaker 1: in many cases is much greater than their budget, and 960 00:55:07,640 --> 00:55:10,600 Speaker 1: that there's a power and balance there. Trying to pretend 961 00:55:10,640 --> 00:55:14,120 Speaker 1: it doesn't exist is I think one of the first mistakes, 962 00:55:14,600 --> 00:55:19,400 Speaker 1: and also not mistaking yourself as the only arbiter for 963 00:55:19,600 --> 00:55:21,480 Speaker 1: what is going to work in a place. And I 964 00:55:21,520 --> 00:55:23,480 Speaker 1: mean this is the answer, I think ethan to your 965 00:55:23,480 --> 00:55:29,000 Speaker 1: earlier question about you know the dangers of headquarters deciding things, 966 00:55:29,040 --> 00:55:32,600 Speaker 1: which is that people in Vietnam, no better than I do. 967 00:55:32,800 --> 00:55:35,640 Speaker 1: What's going to work in Vietnam. I will say that 968 00:55:35,880 --> 00:55:37,840 Speaker 1: the people that I have worked with their I have 969 00:55:37,920 --> 00:55:41,960 Speaker 1: incredible confidence in and respect for, and we are aligned 970 00:55:42,040 --> 00:55:46,240 Speaker 1: in basic principles. So it's not a totally blank slate 971 00:55:46,239 --> 00:55:48,320 Speaker 1: where you just give money to people to do whatever 972 00:55:48,320 --> 00:55:52,120 Speaker 1: they want. But once you have that basic alignment, yeah, 973 00:55:52,320 --> 00:55:55,759 Speaker 1: to stay flexible and be aware. So so when you 974 00:55:55,800 --> 00:55:58,480 Speaker 1: think about, you know, all the grants you've made, I mean, 975 00:55:58,520 --> 00:56:00,880 Speaker 1: are there times when you know you've been invested in 976 00:56:00,960 --> 00:56:03,040 Speaker 1: something at all of tho you needed you actually had 977 00:56:03,040 --> 00:56:07,000 Speaker 1: a reverse course or pursue a totally different tact. Any 978 00:56:07,080 --> 00:56:10,160 Speaker 1: examples come to mind? Yeah, a lot. I mean, look, 979 00:56:10,280 --> 00:56:14,200 Speaker 1: because open society is also not without controversy, and because 980 00:56:14,239 --> 00:56:17,239 Speaker 1: people are very aware not just for the harm reduction work, 981 00:56:17,280 --> 00:56:20,680 Speaker 1: but more generally for the political work. Are aware of 982 00:56:20,800 --> 00:56:24,000 Speaker 1: or anxious about the fact that Soros may be exerting 983 00:56:24,040 --> 00:56:27,520 Speaker 1: some kind of impact on the the government of the 984 00:56:27,560 --> 00:56:31,400 Speaker 1: country or the way that people regard the government of 985 00:56:31,440 --> 00:56:33,680 Speaker 1: the country. There have been a lot of examples when 986 00:56:34,239 --> 00:56:37,200 Speaker 1: we needed to change course, or when the Grand Tea said, listen, 987 00:56:37,239 --> 00:56:39,680 Speaker 1: it's not safe or appropriate for me to do it 988 00:56:39,719 --> 00:56:42,080 Speaker 1: the way that you might think that I should do it. So, 989 00:56:42,160 --> 00:56:46,040 Speaker 1: for example, in China, we had a grand tee we 990 00:56:46,080 --> 00:56:50,600 Speaker 1: no longer fund in China who insisted on the wisdom 991 00:56:50,640 --> 00:56:54,479 Speaker 1: of working with local government officials as key to how 992 00:56:54,520 --> 00:56:58,680 Speaker 1: you actually made change and got good harm reduction programming. 993 00:56:59,200 --> 00:57:02,600 Speaker 1: So that grantee said, I know you are interested in 994 00:57:02,640 --> 00:57:06,360 Speaker 1: funding civil society groups, and we'll take the money, but 995 00:57:06,400 --> 00:57:09,080 Speaker 1: wherever we can, we're going to work, do the work 996 00:57:09,120 --> 00:57:11,880 Speaker 1: and give credit to the government because in this context 997 00:57:12,040 --> 00:57:15,760 Speaker 1: that is what it's going to safeguard the work. And furthermore, 998 00:57:15,800 --> 00:57:17,960 Speaker 1: we don't want you to talk about it, because you 999 00:57:18,080 --> 00:57:22,120 Speaker 1: talking about it actually only complicates our life. So it's 1000 00:57:22,120 --> 00:57:26,960 Speaker 1: an interesting exercise in ego, in institutional buy in, etcetera. 1001 00:57:27,440 --> 00:57:30,480 Speaker 1: To do work that actually turned out to be extremely 1002 00:57:30,560 --> 00:57:34,080 Speaker 1: productive and change the conditions for people who use drugs 1003 00:57:34,120 --> 00:57:39,000 Speaker 1: in certain locations in China greatly, but basically not mention 1004 00:57:39,080 --> 00:57:42,240 Speaker 1: it and let the government take the credit for it. Similarly, 1005 00:57:42,280 --> 00:57:47,120 Speaker 1: in Russia, Russia declared the open society foundations and undesirable 1006 00:57:47,200 --> 00:57:51,720 Speaker 1: influence and basically said that anyone who is seen implementing 1007 00:57:51,720 --> 00:57:57,320 Speaker 1: its agenda could be liable for prosecution. Obviously, that immediately 1008 00:57:57,560 --> 00:58:02,760 Speaker 1: signaled for us that we had to basically distance ourselves 1009 00:58:02,880 --> 00:58:05,760 Speaker 1: for the benefit of the people who had been supported 1010 00:58:05,760 --> 00:58:10,760 Speaker 1: by Sorrows and find other ways through other donors and 1011 00:58:11,000 --> 00:58:14,320 Speaker 1: other connections to get them support. But again not to 1012 00:58:14,360 --> 00:58:17,880 Speaker 1: get too invested in our particular role. I think donors 1013 00:58:17,960 --> 00:58:21,120 Speaker 1: really like to say that they were the first, or 1014 00:58:21,160 --> 00:58:24,960 Speaker 1: they were the only, and in some cases that actually 1015 00:58:25,080 --> 00:58:29,080 Speaker 1: exposes the donor to criticism and the grantee to danger. 1016 00:58:29,560 --> 00:58:32,880 Speaker 1: So after seventeen years or whatever, it's been an open 1017 00:58:32,920 --> 00:58:36,600 Speaker 1: society foundation, I mean ten years before that, engaged in 1018 00:58:36,720 --> 00:58:39,920 Speaker 1: AIDS activism, and in over fifteen years of global harm aduction. 1019 00:58:40,000 --> 00:58:42,440 Speaker 1: I know you're taking a break now, but what are 1020 00:58:42,480 --> 00:58:46,080 Speaker 1: the possibilities ahead that are most exciting for you? I 1021 00:58:46,120 --> 00:58:48,800 Speaker 1: don't know yet what the future holds. I do know 1022 00:58:48,960 --> 00:58:52,760 Speaker 1: that some of the same principles, which is closing the 1023 00:58:52,800 --> 00:58:58,520 Speaker 1: gap between community knowledge and experience and organizing and health 1024 00:58:58,680 --> 00:59:00,920 Speaker 1: science and medical pract this is going to be a 1025 00:59:00,920 --> 00:59:03,720 Speaker 1: part of it, a part of my future. What that 1026 00:59:03,760 --> 00:59:08,600 Speaker 1: looks like, I can't say. I'm quite interested in looking 1027 00:59:08,640 --> 00:59:13,720 Speaker 1: at the actions of psychedelic and cannabis corporations because we 1028 00:59:13,720 --> 00:59:16,400 Speaker 1: didn't talk about it much in this discussion, but are 1029 00:59:16,440 --> 00:59:18,760 Speaker 1: a big part of my inspiration in act UP and 1030 00:59:19,240 --> 00:59:22,160 Speaker 1: at OSF also had to do with scrutinizing some of 1031 00:59:22,200 --> 00:59:25,240 Speaker 1: the conduct of pharmaceutical companies and the sort of profit 1032 00:59:25,280 --> 00:59:28,360 Speaker 1: motives there and the way that those worked against the 1033 00:59:28,360 --> 00:59:33,160 Speaker 1: needs of patients. But it's early days, and I think 1034 00:59:33,200 --> 00:59:34,880 Speaker 1: I'm going to have to go through a little bit 1035 00:59:34,960 --> 00:59:39,280 Speaker 1: of contemplation and perhaps discomfort before I figure out what 1036 00:59:39,400 --> 00:59:42,360 Speaker 1: the next phase holds well. I mean, Daniel, just having 1037 00:59:42,520 --> 00:59:45,240 Speaker 1: been part of some of the celebrations of your work 1038 00:59:45,320 --> 00:59:49,120 Speaker 1: in recent months, I mean, obviously the respect and the 1039 00:59:49,160 --> 00:59:54,440 Speaker 1: admiration and love that you've generated and given over all 1040 00:59:54,480 --> 00:59:59,600 Speaker 1: these years has had a monumental impact on the advances 1041 01:00:00,000 --> 01:00:02,200 Speaker 1: and harm reduction around the world. So for that, I 1042 01:00:02,280 --> 01:00:05,080 Speaker 1: thank you, and I relish our friendship. I look forward 1043 01:00:05,080 --> 01:00:07,840 Speaker 1: to having you back on Psychoactive, So thank you ever 1044 01:00:07,920 --> 01:00:10,840 Speaker 1: so much. Ethan. Thank you. It has been the privilege 1045 01:00:10,880 --> 01:00:13,480 Speaker 1: of my life to do this work, so I know 1046 01:00:13,560 --> 01:00:18,080 Speaker 1: that whatever comes next, I get to basically enjoy the 1047 01:00:18,120 --> 01:00:21,880 Speaker 1: benefits and warmth that that has generated, including from you. 1048 01:00:26,240 --> 01:00:28,680 Speaker 1: We love to hear from our listeners if you'd like 1049 01:00:28,800 --> 01:00:31,680 Speaker 1: to share your own stories, commons and ideas. Then leave 1050 01:00:31,760 --> 01:00:35,640 Speaker 1: us a message at one eight three three seven seven 1051 01:00:35,760 --> 01:00:41,680 Speaker 1: nine sixty that's eight three three psycho zero, or you 1052 01:00:41,720 --> 01:00:45,280 Speaker 1: can email us at Psychoactive at protozoa dot com or 1053 01:00:45,400 --> 01:00:48,320 Speaker 1: find me on Twitter at Ethan natal Man. You can 1054 01:00:48,360 --> 01:00:52,560 Speaker 1: also find contact information in our show notes. Psychoactive is 1055 01:00:52,560 --> 01:00:56,080 Speaker 1: a production of I Heart Radio and Protozoa Pictures. It's 1056 01:00:56,120 --> 01:00:59,600 Speaker 1: hosted by me Ethan Nadelman. It's produced by no h'm 1057 01:00:59,600 --> 01:01:03,680 Speaker 1: Osby End and Josh Stain. The executive producers are Dylan Golden, 1058 01:01:03,840 --> 01:01:08,040 Speaker 1: Ari Handel, Elizabeth Geesus and Darren Aronofsky from Protozoa Pictures, 1059 01:01:08,160 --> 01:01:11,000 Speaker 1: Alex Williams and Matt Frederick from My Heart Radio and 1060 01:01:11,080 --> 01:01:15,480 Speaker 1: me Ethan Edelman. Our music is by Ari Blusien and 1061 01:01:15,520 --> 01:01:19,280 Speaker 1: a special thanks to a Brio s F Bianca Grimshaw 1062 01:01:19,520 --> 01:01:33,200 Speaker 1: and Robert bb. Next week I'll be talking with Matt Johnson, 1063 01:01:33,640 --> 01:01:37,840 Speaker 1: who holds the first ever chair at a major university 1064 01:01:37,880 --> 01:01:41,080 Speaker 1: in psychedelic studies and is one of the world's leading 1065 01:01:41,200 --> 01:01:46,040 Speaker 1: psychedelic researchers. Have been principal investigator or lead scientists on 1066 01:01:46,080 --> 01:01:51,160 Speaker 1: studies administering a number of these substances. Metemphetamine, cocaine, and 1067 01:01:51,200 --> 01:01:54,760 Speaker 1: particularly our group, the Behavioral Pharmacology Research Unit. It's been 1068 01:01:54,960 --> 01:01:58,760 Speaker 1: an operation for for almost a half century where experts 1069 01:01:58,760 --> 01:02:02,920 Speaker 1: at administering the to human beings under the right conditions, 1070 01:02:02,920 --> 01:02:06,320 Speaker 1: and it's all about what the appropriate conditions are, you know, 1071 01:02:06,440 --> 01:02:10,680 Speaker 1: for it SA administering cocaine or administering psilocybin. Subscribe to 1072 01:02:10,720 --> 01:02:12,440 Speaker 1: Cycleactive now see it, don't miss it.