Speaker 1: Hi, I'm Ethan Nadelman, and this is Psychoactive, a production
Speaker 1: of iHeart Radio and Protozoa Pictures. Psychoactive is the show
Speaker 1: where we talk about all things drugs. But any views
Speaker 1: expressed here do not represent those of iHeart Media, Protozoa Pictures,
Speaker 1: or their executives and employees. Indeed, heed as an inveterate contrarian,
Speaker 1: I can tell you they may not even represent my own.
Speaker 1: And nothing contained in this show should be used as
Speaker 1: medical advice or encouragement to use any type of drug. Hello,
Speaker 1: Psychoactive listeners. Today's guest is somebody I've known for a
Speaker 1: very long time and maybe just about the most brilliant
Speaker 1: and persistent and innovative journalist writing about drugs and addiction
Speaker 1: over the last five to thirty years. Her name is
Speaker 1: Maya Solivits, and you may have seen her articles in
Speaker 1: all the prominent magazines and newspapers. She's written three books.
Speaker 1: I mean, the first one, back in two thousand six,
Speaker 1: was an expose on the whole troubled teen treatment industry.
Speaker 1: It was called Helping any Cost, How the troubled teen
Speaker 1: industry cons parents and hurts kids? And then she wrote
Speaker 1: a brilliant book called Unbroken Brain, A Revolutionary New Way
Speaker 1: of Understanding Addiction about five years ago, which was part
Speaker 1: of her own story that we'll get into um. And
Speaker 1: then more recently is a book that just came out
Speaker 1: a few months ago called Undoing Drugs, The Untold Story
Speaker 1: of Harm Reduction and the Future of Addiction. But I
Speaker 1: just want to make clear that, I mean, Maya has
Speaker 1: been doing this for a long time. So back when
Speaker 1: I was running Drug Policy Alliance, we gave her the
Speaker 1: Edward Brecker Award for Achievement in Journalism back in two
Speaker 1: thousand and five, before she even written any these three books.
Speaker 1: So she is really, uh, just a really singular figure.
Speaker 1: So Maya, thank you ever so much for being on
Speaker 1: with me today. Thank you so much for saying all
Speaker 1: those nice things about me. I really appreciate it. So
Speaker 1: you know this book, I mean, first of all, I'm
Speaker 1: trying to think you and I first met. I think
Speaker 1: it must have been three I think I was maybe
Speaker 1: still teaching at Princeton, but it moved to New York City.
Speaker 1: You had your experience, which you've been very open about
Speaker 1: about being a uh, you know, a quote unquote junkie,
Speaker 1: A heroin addict, cocaine addict in your younger years, and
Speaker 1: you had come out of that and avoided getting caught
Speaker 1: up in the in the grips of the criminal justice system.
Speaker 1: When a judge treated you favorably, I remember talking about
Speaker 1: methano and at that point you were almost a little
Speaker 1: anti or hesitant about methano. Although obviously you've come around
Speaker 1: with the Evans. But I'm just curious what was that
Speaker 1: about back then, because I think you your your views
Speaker 1: changed shortly thereafter. But in the book you talk about
Speaker 1: how you recognize the methan on work for a lot
Speaker 1: of people, but for you, for some reason, it had
Speaker 1: it right that was complicated. I had gone to rehab
Speaker 1: in and in rehab by doctors, by people I thought
Speaker 1: were professionals, by everybody who was there. I was told
Speaker 1: that twelve step abstinence recovery is the only way to
Speaker 1: get better, and that if you are on methodone, you
Speaker 1: are still high. You are not in recovery, you are
Speaker 1: not so called clean. And since I was being told
Speaker 1: this by all these professionals, I believed it. I wrote
Speaker 1: an anti methodone op ed at some point in the nineties,
Speaker 1: and I have spent the last whatever many years atoning
Speaker 1: for that because I realized that I was wrong and
Speaker 1: that I had been taught wrongly by all of these
Speaker 1: mainstream figures that I had trusted. And so this is
Speaker 1: not to say the twelve steps can't help people, but
Speaker 1: the idea that methodone is a big failure and that
Speaker 1: buprenorphine doesn't count as recovery is just killing people to
Speaker 1: this day. So we have two medications that cut the
Speaker 1: death rate from opioid overdose and just opioid addiction in
Speaker 1: general by or more. These are method on and puperdorphin
Speaker 1: if you stay on them. And this is even more
Speaker 1: true than it used to be because of fentanyl in
Speaker 1: the supply now. So it's basically like, we have a
Speaker 1: treatment that cuts the death rate in half, and yet
Speaker 1: we prioritize a treatment that doesn't have any impact whatsoever
Speaker 1: on mortality and may actually make it worse. So when
Speaker 1: I sort of began my journey in the addictions world,
Speaker 1: I I had learned one set of myths on the street.
Speaker 1: I had learned another set of myths in like school.
Speaker 1: I learned another set of myths from treatment and recovery programs.
Speaker 1: And it wasn't until I started reading the scientific literature
Speaker 1: across any different disciplines that I really began to understand
Speaker 1: what I was talking about. It is embarrassing, but I
Speaker 1: think it's important to note this because a lot of
Speaker 1: people share these misconceptions to this day, and we see
Speaker 1: people with addiction as experts on addiction as soon as
Speaker 1: they have say, ninety days abstinent. We wouldn't say a
Speaker 1: cancer patient who's been in remission for ninety days is
Speaker 1: a cancer doctor, but we kind of do that equivalent
Speaker 1: in the addictions field. And while experience is really really important,
Speaker 1: it has to be tempered with data. I remember sometimes,
Speaker 1: you know, will we be organizing conferences or panels and say, well,
Speaker 1: you need a so and so representative, a representative, a
Speaker 1: drug user, representative, youth. And I used to think, what
Speaker 1: a ridiculous IDEA Experience with drugs varies traumatically across the spectrum,
Speaker 1: So the notion of individuals sort of standing up as representatives,
Speaker 1: you know, is a little flawed. What's important, of course,
Speaker 1: it's more general lee to have multiple voices in a
Speaker 1: way coming from lived experience of people, without assuming that
Speaker 1: one person's lived experience is this sort of basis for
Speaker 1: establishing policies, whether in a program or more broadly exactly.
Speaker 1: I mean, one of the things that I have taken
Speaker 1: to saying recently is that if I stood up and
Speaker 1: I said I speak for all white women with red hair,
Speaker 1: people would think I was nuts. But if I get
Speaker 1: up and say I speak for all people with addiction,
Speaker 1: people will sometimes believe me. And that's not right, because
Speaker 1: we're all unique. And one of the most harmful things
Speaker 1: in the drug policy and treatment field is this one
Speaker 1: size fits all mentality and this idea that everybody with
Speaker 1: addiction is a liar, a thief, a cheat, a manipulative person,
Speaker 1: as sociopath essentially, and those stereotypes come from the racist
Speaker 1: history of our drug laws and criminalization of certain substances.
Speaker 1: So we have to fight against this dehumanization because there's
Speaker 1: no other group of people that we say they're all
Speaker 1: the same right now, And I think that's I think
Speaker 1: that's exactly right, you know, I mean, even going back
Speaker 1: to methodon, sorry to start off by putting you in
Speaker 1: the spot on that thing. They're little embarrassed it on
Speaker 1: in your past. But you know, somebody, we both knew
Speaker 1: Dr Robert Newman, who was the head of a major
Speaker 1: New York City hospital but whose great passion was making
Speaker 1: method on main earn his treatment more available to people.
Speaker 1: And Bob was simultaneously the leading global advocate for making
Speaker 1: methanon available for people who had had a problem with
Speaker 1: street heroin or other illicit opioids, and at the same
Speaker 1: time the leading antagonist an opponent of the method on
Speaker 1: treatment industry. The folks involved on the industry side of methodon,
Speaker 1: we're not always serving the interests of their patients. They
Speaker 1: might have been pursuing profit, they might have been pursuing
Speaker 1: their own ideologies, etcetera. And then when you have methon programs,
Speaker 1: you have some rights that are you know, that are
Speaker 1: very strict hyper control. They kick anybody out if they've
Speaker 1: ever tested positive for marijuana, if they don't show what periodically,
Speaker 1: if they don't to hear every rule. And then you
Speaker 1: have what might be called harm reduction oriented method on programs,
Speaker 1: which are much more about meeting people where they're at.
Speaker 1: The problem is our regulations. Our regulations force even the
Speaker 1: most harm reduction oriented method of program to make people
Speaker 1: show up every day for the first ninety days at
Speaker 1: least to have very frequent urine testing, to have frequent
Speaker 1: counseling requirements, and all of these things that we don't
Speaker 1: require for any other medication. And this comes from our
Speaker 1: history and our current laws which say that providing and
Speaker 1: opioid or cocaine or any other illegal drug to comfort
Speaker 1: a quotes addict is not legitimate medicine. And so in
Speaker 1: order to get around this early Supreme Court decision and
Speaker 1: the Controlled Substances Act that kind of embodied that further,
Speaker 1: people have to dance around so that they see met
Speaker 1: the donn as assisting the treatment, so we have medication
Speaker 1: assisted treatment when in fact it is the medication that
Speaker 1: is proven to cut the death rate, not the counseling,
Speaker 1: not any of the other stuff. We'll get into more
Speaker 1: of the issues in the present later on, but what
Speaker 1: I personally found so fascinating about your book was your
Speaker 1: going into the historical origins of harm reduction, especially in
Speaker 1: the US, going back to the really the early eighties.
Speaker 1: And interesting of course, um for me is I know
Speaker 1: and or new a lot of these folks, some of
Speaker 1: them are still active, and so I want to ask
Speaker 1: you if you could sort of, you know, use their
Speaker 1: story as a way um of maybe explaining the broader concepts.
Speaker 1: But let me start off. I think you rightly trace
Speaker 1: the origins of harm reduction to two places, one in
Speaker 1: the Netherlands and the second to Liverpool. So let's just
Speaker 1: start with the Netherlands, right, and you talk about the
Speaker 1: history of the junkie unions the Junkie Bund I think
Speaker 1: they were called, which then spread around Europe. But explained
Speaker 1: their significance, right. So a man named Nico Adrian's, who
Speaker 1: was himself a heroin injector, founded the first Junkie Bund
Speaker 1: in Rotterdam in or and he got support from public
Speaker 1: health officials, from other people who used drugs, from drug
Speaker 1: policy reformers. At the time, they were facing a outbreak
Speaker 1: of hepatitis B, which usually isn't deadly, but in this
Speaker 1: case it was being deadly in some instances, and I
Speaker 1: think maybe that was actually early HIV, but we don't know. Anyway,
Speaker 1: he realized that clean needles would solve this problem. As
Speaker 1: an injector himself, he knew that it was nonsense that
Speaker 1: people liked to share needles, so he started the world's
Speaker 1: first needle exchange. He gave people clean needles, and he
Speaker 1: took the used ones off the street, and this meant
Speaker 1: that when HIV did show up for noticeably real in
Speaker 1: the next three or four years, Rotterdam had a much
Speaker 1: lower rate of infection amongst its ivy drug users compared
Speaker 1: to even Amsterdam. And so when the HIV virus was discovered,
Speaker 1: Amsterdam and the rest of the Netherlands was like, oh wow,
Speaker 1: we have something here in Rotterdam that can work for this.
Speaker 1: So they just expanded needle exchange very broadly. And the
Speaker 1: Dutch have always been really pragmatic about drug policy. They
Speaker 1: have the marijuana coffee shops, you know, And it was
Speaker 1: kind of the same drug policy reformers there who also
Speaker 1: began to be concerned about what they called hard drug
Speaker 1: users as well, because they recognized that making marijuana illegal
Speaker 1: was just harming their children, and they also realized that
Speaker 1: it wasn't working so great for the people who are
Speaker 1: using these other drugs either, So they developed this whole
Speaker 1: sort of pragmatic, practical way of dealing with this as
Speaker 1: a medical and health issue. To provide the context, in
Speaker 1: the seventy six the Dutchet passed the law that basically
Speaker 1: decriminalized but did not fully legalize cannabis marijuana, although they
Speaker 1: didn't authorize the creational coffee shops that kind of evolved
Speaker 1: out of that change in the law in the same
Speaker 1: way that some of the cannabis dispensaries began to evolve
Speaker 1: in the mid nineties in California, not actually authorized by
Speaker 1: the government, but that same law that kind of decriminalized
Speaker 1: cannabis had actually gotten tougher on the white powdered drugs
Speaker 1: um But even in that context, there was this pragmatic tradition,
Speaker 1: and when they started giving out needles, it wasn't like
Speaker 1: we'll only give you a needle if you give us
Speaker 1: back a dirty one. It was like, throw your dirty
Speaker 1: ones in here. But even if you don't have any
Speaker 1: dirty ones to throw in, we're still going to give
Speaker 1: you a clean needle, because that's what's pivotal there. We'll
Speaker 1: be talking more after we hear this. Add Now you
Speaker 1: then shift the story. In fact, you ground the story
Speaker 1: even more as you said in Liverpool. Yeah, So what
Speaker 1: happened was they watched as Edinburgh, which was very similar
Speaker 1: socioeconomically to Liverpool, had this horrific HIV outbreak. The first
Speaker 1: time they tested their IVY drug users. They discovered that
Speaker 1: half of them were already HIV positive. And this is
Speaker 1: at a time when AIDS was basically a death sentence.
Speaker 1: So they had all these young people, they had a
Speaker 1: really high rate of unemployment, they had a lot of heroin,
Speaker 1: and they had a lot of injecting, and so you
Speaker 1: would see these teenagers literally who were already HIV infected.
Speaker 1: And they realized that they had actually helped create the
Speaker 1: situation because when they started freaking out about how many
Speaker 1: kids were injecting, they cracked down on needle availability, they
Speaker 1: shut their methodon program, and they also started arresting more people,
Speaker 1: and all of this meant that there were fewer clean
Speaker 1: needles available, and there were still a ton of users,
Speaker 1: and in fact even more because they cut off the methodon't.
Speaker 1: So you end up with this absolutely horrific outbreak among
Speaker 1: young people. And Liverpool had the same socio economic conditions.
Speaker 1: They had super high youth unemployment, their factories were shutting down,
Speaker 1: the docks were shutting down, They had real serious economic problems,
Speaker 1: and they also had a lot of heroin and a
Speaker 1: lot of injecting, but they did not have HIV yet.
Speaker 1: So public health officials and people who were injecting drugs there,
Speaker 1: came together and said, you know, if we don't want
Speaker 1: to be Edinburgh, we got to do something. They knew
Speaker 1: that the Dutch had started needle exchange, so they knew
Speaker 1: that was part of what they wanted to do. And
Speaker 1: Dr John Marks had already been prescribing heroin to a
Speaker 1: lot of people because he'd taken over the practice of
Speaker 1: a previous doctor who did that. And at first when
Speaker 1: he came in he was like, oh, this is a
Speaker 1: terrible idea. We're supposed to be getting them off this stuff.
Speaker 1: And yet he saw that actually prescribing to them, they
Speaker 1: were functional, They just kind of looked like everybody else,
Speaker 1: and that this was indeed a way of reducing the
Speaker 1: harm associated with their addictions, and it did not prolong addiction.
Speaker 1: In fact, he found there was less dealing because if
Speaker 1: you didn't have to support your own habit, you were
Speaker 1: not seeking income by selling to other people. So it
Speaker 1: also had a kind of anti crime effect, not only
Speaker 1: on things like shoplifting, but also on dealing itself. And
Speaker 1: so the police were actually in favor of this, which
Speaker 1: was one of the things that allowed them to do
Speaker 1: stuff that is very hard to do. Anywhere else. Now.
Speaker 1: I was also just say, to put this in context again,
Speaker 1: John Marks was unusual character, a very colorful personality, because
Speaker 1: in fact, the British system, which basically said that doctors
Speaker 1: are allowed to prescribe any drug in the pharm of copeda,
Speaker 1: including heroin or cocaine, went back to the nineteen twenties
Speaker 1: or before. At the same time the U s Government,
Speaker 1: that Supreme Court case you mentioned, the webcase, was banning
Speaker 1: that behavior by doctors. The British were saying, let's do that.
Speaker 1: So for decades in fact, you had people who you know,
Speaker 1: they got their script and their doctor, they did their heroin,
Speaker 1: they did their cocaine, maybe a combo, a legal speedball,
Speaker 1: and they had full time jobs right and families, and
Speaker 1: they were oftentimes middle class people, indistinguishable. They could drive,
Speaker 1: they could do everything. Then along come to late sixties seventies,
Speaker 1: and the UK, like other countries, starts to get flooded
Speaker 1: with heroin coming from Turkey, Southwest Asia what ever, and
Speaker 1: basically the government cracks down and so you have a
Speaker 1: contraction of doctors doing this stuff. And so by the
Speaker 1: time you get to the eighties, you're really down to
Speaker 1: only a small number of doctors who are actually doing this,
Speaker 1: prescribing heroina cocaine sometimes to older patients. But would distinguish
Speaker 1: this John marks Um is that he's out there, he
Speaker 1: wants to let people know about this, and he's connected
Speaker 1: with the other harm reduction folks that you also describe
Speaker 1: in this book. So just talk a little more about
Speaker 1: Alan Parry and the other characters. Sure. So, Alan Parry
Speaker 1: almost everybody describes him as an incredibly charismatic and persuasive fellow.
Speaker 1: He was a former injector at the time and he
Speaker 1: began to do the needle exchange in Liverpool. And what
Speaker 1: he also did he was very clever about the media
Speaker 1: because typically harm reduction is met by oh my god,
Speaker 1: you're giving needles to junkies, and the media just freaks
Speaker 1: out and it's a sensational tabloid nightmare. But so what
Speaker 1: he did is say, look, we're starting this, we don't
Speaker 1: know if it's gonna work, but give us a couple
Speaker 1: of weeks and we'll give you the exclusive. So he
Speaker 1: got them on board and he told them what to
Speaker 1: look at. Before there was a big bit of hysteria
Speaker 1: around this, and this was helped along, of course by
Speaker 1: the fact that Edinburgh had been such a disaster doing
Speaker 1: the opposite of what Liverpool was doing. And I guess,
Speaker 1: um there was a few others, right. There was Peter McDermott,
Speaker 1: who in your little full disclosure you describe as your
Speaker 1: your transatlantic romantic partner in years past, um, but who
Speaker 1: really helped provide some of the language of harm reduction
Speaker 1: and the intellectual basis for what's going on there. Absolutely,
Speaker 1: and I mean he's one of the most brilliant people
Speaker 1: I've ever met. You know, we will not go into
Speaker 1: more details of my romantic life, but I did have
Speaker 1: to disclose that because I do say nice things about him,
Speaker 1: and I mean them, but um, the you know that
Speaker 1: relationship did occur, um. But anyway, just absolutely brilliant guy.
Speaker 1: And he was a current active out drug user, which
Speaker 1: was rare at that point. A lot of people were
Speaker 1: covert using drugs um in that scene. But he was
Speaker 1: out about it, and he was furious about the fact
Speaker 1: that when he tried to get a job in the field,
Speaker 1: he was kicked out on his first day because he
Speaker 1: was on methodon and they told him that basically he
Speaker 1: couldn't be trusted. You know. Here was this guy who
Speaker 1: had basically dropped out of high school. But he was
Speaker 1: like studying drugs in the library when he dropped out,
Speaker 1: and he decided that, well, I get a bigger welfare
Speaker 1: payment if I would go back to school. So he
Speaker 1: goes back to school, and he succeeds brilliantly, and then
Speaker 1: you know, goes to graduate school and gets a first
Speaker 1: class degree and he thinks, Wow, maybe I actually could
Speaker 1: get a job. Because that was not his original He
Speaker 1: just thought that he was doomed because he was a
Speaker 1: working class guy and he had this addiction, and nobody
Speaker 1: was going to ever pay attention to the fact that
Speaker 1: he actually had a lot to contribute. And he also
Speaker 1: a ladies man. So anyway, we're not going to go there.
Speaker 1: I'm not asking Maya. But he did. Was he the
Speaker 1: one who sort of coins and popularizes the term harm reduction?
Speaker 1: Actually that's Russell Nucomb. But what Peter did was to
Speaker 1: really theorize it. I mean, he read all these people
Speaker 1: like uh Fuco and La Khan and all of this stuff.
Speaker 1: He was just very intellectual and he really thought very
Speaker 1: very deeply about addiction and what it was. And and
Speaker 1: we actually spent a lot of time arguing about the
Speaker 1: nature of addiction. And so you know, some of us.
Speaker 1: Sometimes I convinced him, sometimes he convinced me. Um. But
Speaker 1: the you know, he really knew his stuff. And so
Speaker 1: along with Russell and along with Pat O'Hare um, they
Speaker 1: founded what was first known as the Mercy Drugs Journal
Speaker 1: and then became known as the International Journal and Harm Reduction.
Speaker 1: And they also started holding international conferences to sell people
Speaker 1: on the idea. And so Russell Knucombe writes the article
Speaker 1: that names Harm Reduction in and it gets published in
Speaker 1: drug Link, which is kind of like a newsletter for
Speaker 1: the drug addiction treatment field. And it's such an obscure
Speaker 1: newsletter that it has like a typo in the headline
Speaker 1: it's high time for hame Reduction. Um. They fixed that
Speaker 1: later online, but um, that is the article that gives
Speaker 1: the movement its name. And they were really thinking, like,
Speaker 1: what does you know prescribing and giving out clean needles
Speaker 1: and teaching people wound care, what is what does that
Speaker 1: have in common? And what they came to was that like,
Speaker 1: these are measures to reduce harm, and that indeed the
Speaker 1: goal of any policy or drug policy in particular should
Speaker 1: be to reduce harm, not stop people from getting high,
Speaker 1: and so that is it seems kind of obvious, but
Speaker 1: it's actually a brilliant insight and it really really threatens
Speaker 1: the basis of the drug war, because the drug war
Speaker 1: is all about, let's get rid of these drugs, and
Speaker 1: we don't care what the cost is. We don't care
Speaker 1: how many people we have to lock up, we don't
Speaker 1: care how many people die of overdose. We're going to
Speaker 1: crack down on these drugs and we're the good guys
Speaker 1: because these drugs are bad, and harm reduction comes along
Speaker 1: and says, wait a minute, what's bad is people getting
Speaker 1: injured and people dying. And so what they discovered as
Speaker 1: they went along doing this was that if you're kind
Speaker 1: and nice to people and you meet them where they are,
Speaker 1: that actually helps people move towards abstinence or other forms
Speaker 1: of recovery. It doesn't enable them or encourage them to
Speaker 1: go on worse binges. When you look at the data
Speaker 1: on prescribing heroin, people don't stay addicted longer than if
Speaker 1: you just leave them on the street to get very
Speaker 1: sick and die. Even they actually are just as likely
Speaker 1: to get into recovery as people um who are not
Speaker 1: in heroin prescribing. So the whole foundation of our ideology
Speaker 1: about drugs gets completely destroyed by harm reduction and by
Speaker 1: the data that comes from harm reduction. Because they knew
Speaker 1: they were doing something really controversial, so they insisted on
Speaker 1: studying what they were doing at the same time. You know,
Speaker 1: so just for our listeners, you know, Maya just started
Speaker 1: these early things coming out of Liverpool and the journal
Speaker 1: she mentioned in the Mercyside Harm Reduction Journal, which then
Speaker 1: became I think with the International Journal and Drug Policy
Speaker 1: i j d P, still exists and it is still
Speaker 1: a fantastic resource for people interest in this area. The
Speaker 1: organization that paddle Hair and others created was initially called
Speaker 1: the International Harm Reduction Association, and they had their first
Speaker 1: conference in Liverpool. They deliberately piggybacked it on a governmental
Speaker 1: conference in order to kind of get more media coverage
Speaker 1: for it. But then they decided to take it outside
Speaker 1: Liverpool and in ninety one they went to uh to Barcelona,
Speaker 1: and in ninety two they went to Melbourne and in
Speaker 1: ninety three to rotter Damn. So really they were thinking,
Speaker 1: and I think especially paddle Hair, we're thinking, I had
Speaker 1: to take this thing into a much more global way
Speaker 1: that brought together the harm reductionists, the public health researchers,
Speaker 1: the other academics, trying to bring in some government people,
Speaker 1: and just to throw in maya one other little anecdote
Speaker 1: I think you'll get a kick out of. I had
Speaker 1: already known John Marks and the other guys by the
Speaker 1: by the late eighties, but there was a moment in
Speaker 1: June of nine two and I remember going to a
Speaker 1: conference in Prague, right when they were officially splitting up
Speaker 1: Czechoslovakia into Czech and Slovak republics, and it was the
Speaker 1: International trans Personal Association conference. It was the first time
Speaker 1: I ever saw rahmda speak, the first time I heard
Speaker 1: Terrence McKenna, the famous psychedelics writers speak. You know, my
Speaker 1: friend Sasha's Shulgin, the great psycholo innovator, was there. So
Speaker 1: there were some of the psychedelics folks were there, but
Speaker 1: also there were John Marks and I think Alan Parry.
Speaker 1: And one evening, John and Allen and I and another
Speaker 1: friend we go over to the home in the suburbs
Speaker 1: of Prague um for a dinner. And when I remember
Speaker 1: about that evening were two things that John Marx is
Speaker 1: this guy I think he had a red beard. He
Speaker 1: was then in his forties and very you know, big
Speaker 1: rambunctious personality, kind of a classically minded brit And I
Speaker 1: remember that on our host put on this operatic music
Speaker 1: and John Marks got high on marijuana, which he had
Speaker 1: never done until he hit his forties. And he then
Speaker 1: proceeded marching back and forth in the backyard as he
Speaker 1: was smoking this joint, singing along in German to this opera. Meanwhile,
Speaker 1: back inside, I think it was Alan who at that
Speaker 1: point may have been using heroin again and had a
Speaker 1: script from John and um, he wanted needed to go inject,
Speaker 1: and I said, well, can I watch? And the truth was,
Speaker 1: at that point, even though I'd been involved in drug
Speaker 1: policy reform in the bigger political and policy issues, I've
Speaker 1: actually never seen somebody in jack heroin. And so we
Speaker 1: just sat there while he injected, and we just kept
Speaker 1: up a conversation and he didn't change. And I said,
Speaker 1: you know, al inside, how do you feel, And he goes,
Speaker 1: I just feel calmer now. But I mean his conversation,
Speaker 1: his thinking, nothing else changed, and the experience of just
Speaker 1: sitting with him as he calmly injected himself. Um, the way,
Speaker 1: maybe a diabeque might put in insulin and nothing happened
Speaker 1: except he seemed a little bit more relaxed. Was really
Speaker 1: an important moment for me. And understanding that for many people,
Speaker 1: using heroin wasn't about dropping out, nodding out, or anything
Speaker 1: like that. For many people who have been using for
Speaker 1: a while, it had basically become essentially a sort of
Speaker 1: medicine that kept him from feeling sick in the same
Speaker 1: way methodon could or bupren orphan could, but also might
Speaker 1: make him feel a little better. Um, So you know,
Speaker 1: I mean, I have to say that was a huge
Speaker 1: learning experience for me. Now let me take you to
Speaker 1: the U s now. So you bring the book to
Speaker 1: the U S and there's a couple of things. One
Speaker 1: is on you know, HIV is spreading like wildfire among
Speaker 1: injecting drug users and act up. The HIV advocacy group
Speaker 1: dominated by you know, gay men based sically is trying
Speaker 1: to figure out how it's going to relate to this issue.
Speaker 1: And there are others involved and people starting to go
Speaker 1: with you know, underground needle exchanges and trying to get
Speaker 1: those things going. But you made an interesting point there
Speaker 1: that I've not seen somebody make before, which is that
Speaker 1: if the scientists and researchers had paid closer attention to
Speaker 1: injecting drug users earlier in the late seventies or early eighties,
Speaker 1: they might have figured out faster about what was going
Speaker 1: on about HIV AIDS, and that focusing solely on gay men,
Speaker 1: you know, while understandable in some respects, may have been
Speaker 1: a tactical strategic mistake in terms of advancing um understanding
Speaker 1: of this disease. Well, basically, nobody cared about the IVY
Speaker 1: drug users. Everybody's just thought, oh, they're going to die anyway,
Speaker 1: so who cares if there's another disease? But there was
Speaker 1: in Rikers Island in the seventies. The local doctors who
Speaker 1: were training there um had this thing called Riker's a
Speaker 1: dentopathy which was basically AIDS. But it was before the
Speaker 1: virus was discovered and before it was known among gay people.
Speaker 1: And so there's lots of clues that we have from
Speaker 1: these accounts from the early doctors who eventually specialized in
Speaker 1: what eventually became known as AIDS, um that they could
Speaker 1: have picked this up a lot sooner if we hadn't
Speaker 1: seen people who use drugs as people who deserve to
Speaker 1: die and be thrown away. M hm. You know you
Speaker 1: have a wonderful quote at the end of your book,
Speaker 1: and it's a fairly recent one and it's with Anthony
Speaker 1: Fauci and he's reflecting on his years going back when
Speaker 1: he was the leader in dealing with HIV. And the
Speaker 1: quote you had is, I'm flashing in my mind how
Speaker 1: difficult it is for society to accept harm reduction, and
Speaker 1: then when you accept it, you realize, why didn't I
Speaker 1: do this before? Now, one of the pioneers. I love
Speaker 1: your story and we've talked about her and other episodes already,
Speaker 1: but know you really get into and I think you
Speaker 1: tracked your down in recent years, is Edith Springer. Right.
Speaker 1: I once introduced Edith Springer as the godmother of harm reduction,
Speaker 1: and she quickly corrected me. She goes, Honey, I'm the
Speaker 1: goddess of harmora duction, is right, And in fact, that's
Speaker 1: how you refer to her there, And so say a
Speaker 1: little more about Edith and about why she turned out
Speaker 1: to be such an influential figure in this world of
Speaker 1: harm reduction. So Edith is an amazing person and she
Speaker 1: was working in the field of addiction treatment, and she
Speaker 1: knew something wasn't right. She herself was abstinent because she
Speaker 1: had previously had a heroin addiction and she was told
Speaker 1: that she couldn't stay on methodone because that was not
Speaker 1: real recovery, and so she was abstinent. And she was
Speaker 1: just watching all this abstinent space treatment fail over and
Speaker 1: over and how terrible it made both the counselors and
Speaker 1: of course the people who kept failing feel about themselves.
Speaker 1: So she was kind of in a ripe state when
Speaker 1: she met Alan Parry, who happened to be visiting from Liverpool,
Speaker 1: and Alan Parry basically demolishes her worldview, and she was
Speaker 1: so excited to hear that people were actually doing needle
Speaker 1: exchange and that they were prescribing heroin and that they
Speaker 1: were doing the things they were doing in Liverpool, because
Speaker 1: she had been losing people to AIDS and she was
Speaker 1: already trying to go out in the streets and go
Speaker 1: to the shooting galleries and teach people how to use
Speaker 1: bleach to clean their needles. And she would have loved
Speaker 1: to give them needles, but they were illegal in New
Speaker 1: York and it was just easier in the face of
Speaker 1: a deadly contagious disease to do something to sterilize the
Speaker 1: needle than to get through the legal and political hassle
Speaker 1: that you had to do in order to get syringe
Speaker 1: exchange to be legal. But anyway, she um eventually act up,
Speaker 1: picked up that struggle and did it well. Um But
Speaker 1: she and Yolande Serrano had this organis station called Adapt
Speaker 1: and they would just go out and you know, try
Speaker 1: to get the message about bleach out there. And when
Speaker 1: she met Alan Parry, he basically told her the theory
Speaker 1: behind what she was already doing. And she basically said
Speaker 1: to herself, my life goal is now to get this
Speaker 1: idea into as many heads as possible, and she just started.
Speaker 1: She had she was already I believe she was already
Speaker 1: trained as a person to train people about HIV, and
Speaker 1: so she instead became a trainer on harm reduction and
Speaker 1: literally thousands of people were introduced to harm reduction by
Speaker 1: Edith herself, and among them were most of the founders
Speaker 1: of the harm reduction movement in the United States. So
Speaker 1: she was really a critical figure. And one of the
Speaker 1: reasons that she was so influential was that she did
Speaker 1: not do the I'm going to demolish your ideas sort
Speaker 1: of tactic. She met people where they are. So she said, yep,
Speaker 1: I know that. You know, as a counselor you just
Speaker 1: keep seeing people not getting better. This is a way
Speaker 1: that we can actually help. And so she is just
Speaker 1: incredibly empathetic and incredibly able to meet people where they
Speaker 1: are in a way that so many other people who
Speaker 1: now know that we're right have a hard time doing
Speaker 1: sometimes because we just want to say no, you're wrong. Yeah, well,
Speaker 1: you know, I remember watching her one time. She was
Speaker 1: talking to people in the audience who were coming from
Speaker 1: some sort of traditional treatment perspective therapeutic respective and she
Speaker 1: was asking them about how they did what they did.
Speaker 1: And what she then did was she picked up on
Speaker 1: a few of the things that she approved of what
Speaker 1: they were doing, and she said, but honey, you're already
Speaker 1: doing harm reduction, and she got them to open up
Speaker 1: in that way. At some point, you say that she
Speaker 1: cites the work of the famous sociologist Irving Goffman, right,
Speaker 1: who is a remarkable sociologist who really focused on the
Speaker 1: on the sort of minute of how people interact with
Speaker 1: one another, whether it's in the workplace or in public bathrooms,
Speaker 1: you know, and I think it's a quote I just
Speaker 1: want to read here. You say, stigma is spoiled identity.
Speaker 1: And if there's anybody whose identity is spoiled in this country,
Speaker 1: it's drug users through like the bottom of the barrel,
Speaker 1: as far as everybody is concerned, even their own families,
Speaker 1: even they treat themselves that way. They've internalized it. Yeah,
Speaker 1: Whereas so many traditional treatment programs I think felt they
Speaker 1: needed to and still feel they need to shatter people's
Speaker 1: identities and reconstruct a whole new one. Edith approached it
Speaker 1: from a very different perspective. The whole point of the
Speaker 1: drug war and the whole point of criminalization is creating stigma.
Speaker 1: You can't if you don't create stigma and you criminalize something,
Speaker 1: nobody will not do the behavior that you're trying to
Speaker 1: criminalize because it's not bad. They don't see it as bad,
Speaker 1: and they don't think they should be locked up for it.
Speaker 1: So you just won't be able to enforce the law
Speaker 1: unless you get people to realize that this is bad
Speaker 1: and these people are bad, and they're going to go
Speaker 1: to jail and they're going to suffer terribly because we
Speaker 1: think this thing is bad. So, you know, one of
Speaker 1: the things that struck me when I first got into
Speaker 1: this field was, as a person who injected drugs, nobody
Speaker 1: cared enough to teach me about bleach. I heard about
Speaker 1: it randomly from a woman I ended up tracking down
Speaker 1: when I was writing the book, and that saved my
Speaker 1: life because I was about to inject with somebody who
Speaker 1: was probably already HIV positive. So I was just infuriated
Speaker 1: by the idea that, like, not only would they not
Speaker 1: teach me about bleach, they would try to tell other
Speaker 1: people not to teach me because I was supposed to
Speaker 1: die to send the right message about drugs. Two kids.
Speaker 1: Now they probably never see me dying, but that was
Speaker 1: going to send the message anyway somehow. So I was
Speaker 1: just that whole idea just seemed awful to me because
Speaker 1: it was just treating people's objects. You know. At that time,
Speaker 1: being an active drug user, I was kind of filled
Speaker 1: with self hatred, but I didn't think anybody should be
Speaker 1: treated that way, like just no, that's wrong, you know.
Speaker 1: And I'm a child of a Holocaust survivor. So that
Speaker 1: also the dehumanization that was there just really struck me
Speaker 1: and really struck me as being evil and wrong. So
Speaker 1: the whole sending the right message thing is the essence
Speaker 1: of criminalization and of the drug war. And once you're
Speaker 1: not trying to do that anymore. If it's not sending
Speaker 1: a message, what is it doing. It's increasing overdose death,
Speaker 1: it is not helping HIV, it is not helping poor people.
Speaker 1: It is in fact destroying communities. What are we incarcerating
Speaker 1: people for. Let's take a break here and go to
Speaker 1: an ad tell us about Dan Williams and his story
Speaker 1: and his struggles. Sure, so, Dan Williams was a gay
Speaker 1: black man from South Carolina and he joined Act Up because,
Speaker 1: I believe, because he had lost a lover two AIDS,
Speaker 1: and he heard about Needle Exchange, which they were then
Speaker 1: doing illegally, and it just hit him that we're providing
Speaker 1: healthcare and people actually don't want us to do that.
Speaker 1: It's illegal for us to provide healthcare to these people, Like,
Speaker 1: what's wrong. So he was really struck by it, even
Speaker 1: though he was not a drug user himself, and he
Speaker 1: became involved with the Needle Exchange and he became one
Speaker 1: of the Needle eight defendants who deliberately got arrested in
Speaker 1: order to challenge the law that made needle exchange criminal
Speaker 1: in New York State, and that trial was amazing. I
Speaker 1: was there for that trial, and it was you could
Speaker 1: just tell that it was historic because people were making
Speaker 1: all the best arguments in favor of needle exchange as
Speaker 1: public health. And so for me as a writer, it
Speaker 1: was a great way to tell the story and get
Speaker 1: some of those arguments in in a nice little courtroom drama. Um.
Speaker 1: But Dan Williams was um one of the defendants, and
Speaker 1: as a black man, he was really really alone, and
Speaker 1: he talked about how, you know, he felt isolated in
Speaker 1: the black community because he was gay, and in the
Speaker 1: gay community because he was black. And when he was
Speaker 1: speaking in favor of needle exchange, almost the entire black
Speaker 1: leadership of New York was seriously opposed to needle exchange.
Speaker 1: They thought it was genocide. They said it was an
Speaker 1: experiment being done on people, and that like if they
Speaker 1: were white people, they would give them treatment. They didn't
Speaker 1: want to listen to the fact that even if we
Speaker 1: poured all the money we could into treatment, people relapse.
Speaker 1: So you still need to keep people who were using
Speaker 1: safe um. You know, as we used to say in
Speaker 1: the day dead addicts don't recover, So he was incredibly
Speaker 1: brave to stand up and do this. And he would
Speaker 1: go and try to talk to the Black AIDS organizations
Speaker 1: and say, you really can't oppose this because this is
Speaker 1: essential to stopping the epidemic, and he got told, oh,
Speaker 1: you've been sent by the white boys. So you know,
Speaker 1: he was an incredible figure in terms of that, and
Speaker 1: there were, you know, in the black community, there was
Speaker 1: this whole debate about respectability because white people for so
Speaker 1: long had used drugs to stigmatize in stereotype and incarceory
Speaker 1: black people, so they didn't want to be seen as
Speaker 1: pro drug quite rightly, but they didn't see anything else
Speaker 1: to do. And part of the story that I tell
Speaker 1: in the book is how Michelle Alexander's book The New
Speaker 1: Gym Crow helped undo that kind of ideology by showing
Speaker 1: that actually the drug war just locks up a lot
Speaker 1: of Black people and does not successfully fight addiction or drugs. Yeah,
Speaker 1: you know, I think it's almost almost a double edged
Speaker 1: consequences of the Tuskege Syphlis experiment, right, which is such
Speaker 1: an extraordinary historical sort of point that's constantly referenced Tuskegee
Speaker 1: was an experiment about, you know, black people with syphilis
Speaker 1: not being treated, just to see what happened to them,
Speaker 1: about black people being treated in research study, the ways
Speaker 1: that white people would never be treated. On the one hand,
Speaker 1: it speaks to the kind of underlying systemic, conscious and
Speaker 1: unconscious racism which colors American health policy to this day.
Speaker 1: All the ways in which you know, people black people
Speaker 1: are treated differently in hospitals, different than different, access to
Speaker 1: pain medication, different and a whole range of other areas.
Speaker 1: Yet on the other hand, the ways in which but
Speaker 1: what about Tuskegee has been used to block public health
Speaker 1: interventions that are the exact opposite of the Tuskegee situation
Speaker 1: has also been an extraordinary tragedy. When you talked about
Speaker 1: method on you know, where people black people would say
Speaker 1: that Tuskegee, talk about needle exchange, Tuskege. You're even bringing
Speaker 1: up to today with with you know, the vaccine Tuskegee, Tuskegee,
Speaker 1: and these are all cases of innovations, health innovations that
Speaker 1: in fact are first done on white people, right, white
Speaker 1: people in Europe, white people in America. Standard But still
Speaker 1: that Tuskegee reference point lands up being used incorrectly in
Speaker 1: a historically inaccurate way to block the sorts of interventions
Speaker 1: that actually would be saving tens of thousands, if not
Speaker 1: hundreds of thousands of black lives over time. So it's
Speaker 1: a it's a particularly painful piece of all of this,
Speaker 1: and you know, it's at the same time reassuring to
Speaker 1: see that oftentimes it was black leaders who are able
Speaker 1: to flip fairly quickly, whether it was Calvin Butts, the
Speaker 1: famous minister at Abyssinian Church in Harlem, whether it was
Speaker 1: young legislators in the Congressional Black Caucus which initially opposes
Speaker 1: needle exchange and then comes out more quickly than white
Speaker 1: legislators to support it. So it is I mean, we've
Speaker 1: been we've already gott into this before in some episodes,
Speaker 1: and we'll get into it much more in future episodes.
Speaker 1: But okay, wait, I just want to say one more
Speaker 1: thing on race here, because Velmonette Montgomery, who is still
Speaker 1: in the New York State Legislature, stood up for needle
Speaker 1: exchange when no other politician would. So I think she
Speaker 1: deserves her props here. That's true, as does say something
Speaker 1: like her smoke the brave mayor of Baltimore who called
Speaker 1: out the drug war back in and pushed very hard
Speaker 1: to try to get needle exchanged going into city against
Speaker 1: the resistance of most of the black and a good
Speaker 1: part of the white political establishment. So there were some
Speaker 1: brave voices, but the power in the community and the
Speaker 1: black establishment and the Black church were so vociferously opposed
Speaker 1: to this that it really hobbled some of the efforts
Speaker 1: that could have saved huge numbers of lives in the
Speaker 1: early years. But wait, let me add one more thing. Um,
Speaker 1: That's also why Michelle Alexander's work is so important, because
Speaker 1: she her book became a bestseller, because she caught on
Speaker 1: in black churches, and because of her speaking in black churches,
Speaker 1: and because of the way the Black church picked up
Speaker 1: her work and said, whoa, we have been doing something
Speaker 1: wrong here. We need to fix this. We have been
Speaker 1: stigmatizing the incarcetory people amongst us instead of realizing that
Speaker 1: they are victims of a racist system. Often. So it's
Speaker 1: a complicated issue, but I just think it's it's very
Speaker 1: important to give credit to the people who did stand
Speaker 1: up there. Yeah, it's true, But I remember Michelle's book,
Speaker 1: which is a historically important and path breaking book and
Speaker 1: changing the nature of the whole discussion around the drug war,
Speaker 1: and and and putting it and driving home the notion
Speaker 1: of the new gym. Crow. Even when she first puts
Speaker 1: that book out right, she gets resistant from other black leaders.
Speaker 1: How can you dare associate the drug war with Jim
Speaker 1: Crow history? Right? Um? But that book comes out around
Speaker 1: two thousand six or seven, I think, and we're here,
Speaker 1: we're still talking about the nineties, and so there's a
Speaker 1: whole decade where this resistance continues in a very powerful way,
Speaker 1: and where people trying to make that case still are
Speaker 1: having a hard time finding traction when it talks to
Speaker 1: the issue about needle exchange. Moving out of just a
Speaker 1: few cities, a couple of names stand out. Once John
Speaker 1: Parker coming out of New Haven. Sure so um. John
Speaker 1: Parker was a bit of how shall I say this, Uh,
Speaker 1: He was a maverick and he just did his own thing.
Speaker 1: He was not a person who is very much organized
Speaker 1: with the movement, but he did really important work because
Speaker 1: what he did was he went around two cities up
Speaker 1: and down the East coast and even um some in
Speaker 1: the Midwest, getting himself arrested to bring these legal cases
Speaker 1: to change the law in order to allow needle exchange
Speaker 1: to be legalized. And so the New York Times called
Speaker 1: him the Johnny apple Seed of needles. And he was
Speaker 1: one of the defendants in the Needle eight trial in
Speaker 1: New York because he joined with Act UP in this
Speaker 1: instance to um uh, you know, get this arrest happening
Speaker 1: and and get the law changed. So although there are
Speaker 1: definitely some activists who are not fans of his, um
Speaker 1: he did do important work in terms of helping challenge
Speaker 1: these laws. Let me get you old story about John
Speaker 1: because you know, in the early years, I think when
Speaker 1: the Drug Policy Foundation first started giving out awards, they
Speaker 1: give a big word to John Parker and I think
Speaker 1: Dave Purchase in order to support needle exchange. So John
Speaker 1: was a real hero going up and down, especially the
Speaker 1: Northeast coast, you know, doing this sort of thing. But
Speaker 1: um so I knew him from back in those days.
Speaker 1: But in ninety four I start the Lindis Smith Center,
Speaker 1: you know, the Drug Policy Institute within Sorrows Foundation. And
Speaker 1: about a year later, I'm sitting in my office and
Speaker 1: it's at eight seventh Avenue across the Street from Carnegie
Speaker 1: Hall right here. At that point my office was in
Speaker 1: this still in the same building, the foundation of the
Speaker 1: same building where Sorrows' office was, with his uh financial
Speaker 1: management side, and I get a phone call. Uh, Ethan,
Speaker 1: we got a problem here. What was the problem? Well,
Speaker 1: John Parker had shown up at George Soros's office and
Speaker 1: dumped a half dozen vials of heroin on the receptionist desk,
Speaker 1: asking to be arrested. So John, by that point I
Speaker 1: think was spinning out a bit. And uh, you know,
Speaker 1: that was one of those things where Sorrows at that
Speaker 1: point I think I had just persuaded and to become
Speaker 1: the biggest funder in the world of needle exchange programs,
Speaker 1: both in the US and and and the former Civiet
Speaker 1: Union Eastern Europe. And it was a moment we had
Speaker 1: to workaways through. Now. On the other hand, Dave Purchase
Speaker 1: out of Tacoma was quite a different character. Yes, well,
Speaker 1: he was all about working with people and spreading the
Speaker 1: word in ways that would be sustainable, and so he
Speaker 1: founded the North American Syringe Exchange Network, which was kind
Speaker 1: of the seed bed for the rest of harm reduction
Speaker 1: activism in the US and so he started the first
Speaker 1: needle exchange in Tacoma by simply setting up a table
Speaker 1: in a neighborhood where there was a lot of ivy
Speaker 1: drug use and putting out syringes. And he was sort
Speaker 1: of such an affable character that he got the Health
Speaker 1: Department to buy in right away. So they became the
Speaker 1: first legally funded syringe exchange in the United States because
Speaker 1: of sort of his ability to get along with everybody
Speaker 1: from like the Hell's Angels to the Health Commission. Now,
Speaker 1: Dan big at a Chicago is one of the historical
Speaker 1: figures as well. He plays a pivotal role in getting
Speaker 1: needle exchanged going. He is essentially the godfather of the
Speaker 1: locks own you know, the antidote for overdose, and uh,
Speaker 1: you know, I mean really is an historical figure in
Speaker 1: that way. And we've talked about him, I think already
Speaker 1: on on other episodes. But he does something else interesting
Speaker 1: and there's a sort of overlap with Edith here. He
Speaker 1: names his organization in Chicago as harm Reduction Organization the
Speaker 1: Chicago Recovery Alliance, using the word recovery, which is typically
Speaker 1: a word that's been used in the twelve step movement
Speaker 1: to refer to achieving abstinence. Say something about Dan and
Speaker 1: he's thinking about all that. So harm reduction not only
Speaker 1: had to redefine addiction, but it also had to redefine
Speaker 1: recovery because of the way it challenged all the conventional
Speaker 1: ideas around it. And Dan Big was essential to this,
Speaker 1: as well as his friend John Zisler, who actually came
Speaker 1: up with the idea that recovery should be defined not
Speaker 1: as abstinence but as any positive change. They named themselves
Speaker 1: the Chicago Recovery Alliance because they wanted to show that
Speaker 1: recovery can be many different pathways. That you can start
Speaker 1: recovering by using clean needles. You can start recovering by
Speaker 1: injecting less, you can start recovering by smoking pot instead
Speaker 1: of injecting. Just as there's a zillion different ways of
Speaker 1: becoming addicted, there's a zillion different ways of recovering. And
Speaker 1: so Dan Big emphasized that, and it was really helpful
Speaker 1: because you can't describe a phenomenon that affects so many
Speaker 1: different people in so many different ways and say there's
Speaker 1: only one way to recover. And you know, I bought
Speaker 1: into that early on because I was taught it by
Speaker 1: the place that helped me get off of heroin and cocaine. Um,
Speaker 1: but that is not the only pathway, And by saying
Speaker 1: it's the only pathway, we doom a lot of people
Speaker 1: because a lot of times people are told in rehab
Speaker 1: and in twelve step programs that the only alternative is jails, institutions,
Speaker 1: or death, and that's not true. There are different pastor recovery,
Speaker 1: and all of them are valuable. The other critical thing
Speaker 1: in terms of recovery is that it really should be
Speaker 1: defined by are you getting healthier? Are you getting happier?
Speaker 1: Are you getting more productive? It really shouldn't have to
Speaker 1: do with what substances are in your bloodstream. And this
Speaker 1: is how methodone can be recovery, and bubnorphine can be recovery,
Speaker 1: and marijuana can be recovery. For some people, it is
Speaker 1: about are you doing well? Not are you getting high?
Speaker 1: So it's basically about sitting with people who are struggling
Speaker 1: with drugs and with life, and rather than focusing on
Speaker 1: getting abstin and cutting back drugs, whatever it might be,
Speaker 1: asking the fundamental questions, um, what do you want to
Speaker 1: be accomplishing your life? What are you trying to do?
Speaker 1: And let's figure out from there, in what ways are
Speaker 1: the drugs either helping or getting in the way, And
Speaker 1: in what ways maybe can your drug use and other
Speaker 1: elements of your life be managed to help you better
Speaker 1: attain what it is and acknowledging that even the tiniest
Speaker 1: little steps can make a difference. It's not at all
Speaker 1: or nothing, saying absolutely and looking back at it now,
Speaker 1: My recovery probably started the day someone told me to
Speaker 1: use bleach, you know, because that was when I started
Speaker 1: to become kind of politically awakened around the issue, and
Speaker 1: it was part of my pathway to getting to absentance
Speaker 1: recovery and to not being HIV positive when I did. Yeah,
Speaker 1: you have a great little story about Les PAPIs in
Speaker 1: San Francisco who becomes bleach man. Right, And and just
Speaker 1: so our listen to understand this is a point where
Speaker 1: oftentimes needle exchange or access to sterile syringes was banned
Speaker 1: in most states in one way or another, and the
Speaker 1: safest option, the fallback strategy was just to make sure
Speaker 1: you were cleaning your syringes with bleach before you use them.
Speaker 1: And so you know, it was a campaign to make
Speaker 1: most make little bleach kits available and to show people
Speaker 1: how to use it and to get them to do it.
Speaker 1: And my Les Pappas, who's still a harm reduction advocates,
Speaker 1: still doing good work in the field. Um, you know,
Speaker 1: I set up a whole PR firm to do work
Speaker 1: around harm reduction, I think. But back then it was
Speaker 1: dressing up in a costume like a Superman costume and
Speaker 1: and handing out bleach kits, right, and some of the
Speaker 1: hardest neighborhoods in San Francisco. Not only did he like
Speaker 1: have this giant jug head of a bleach bottle and
Speaker 1: a cape. Um, he would go around with a giant
Speaker 1: syringe like you know, three ft long or something and
Speaker 1: demonstrate how you do it. And there's actually a commercial
Speaker 1: that aired on late night TV with bleach Man's origin story.
Speaker 1: He cannot cure AIDS, but he can bleach. So, I mean,
Speaker 1: it was kind of incredible to me as someone in
Speaker 1: New York, where you weren't even allowed to talk about it,
Speaker 1: that in San Francisco they were having these commercials on
Speaker 1: late night TV and really trying to help people, right.
Speaker 1: I think it was those stories. There's probably nobody who
Speaker 1: has had his picture taken by so many people living
Speaker 1: on the streets, homeless, doing drugs, but who just felt
Speaker 1: honored that here was this superhero who actually cared about
Speaker 1: their well being and their well wellies. Well, the last
Speaker 1: person I want to bring up you only bring up
Speaker 1: interesting In the book. Of all the people your profile,
Speaker 1: I think there's only one academic, one professor in the
Speaker 1: entire book, and that's Alan Marlatt, who was a Canadian
Speaker 1: born and raised but you know, taught the University of Washington,
Speaker 1: somebody who actually you know, wanted to have on the
Speaker 1: board of Drug Policy Alliance. And then he unfortunately died
Speaker 1: at a young age. Um, but just say something about
Speaker 1: Alan's special contribution in this field. So Alan was an
Speaker 1: amazing person. And what he did was recognized that alcohol
Speaker 1: is part of the conversation and that to bring harm
Speaker 1: reduction to America and to bring harm reduction into the
Speaker 1: world of addiction treatment, that he had to work with
Speaker 1: it in alcohol, not just other drugs. And so he
Speaker 1: began teaching people things like how to reduce your drinking
Speaker 1: rather than you must be totally abstinate. And he also
Speaker 1: did experiments that showed that, for example, this idea that
Speaker 1: the first drink gets you drunk, and that once you start,
Speaker 1: you completely lose control. If you've ever had an addiction,
Speaker 1: like what he did was they did this experiment in
Speaker 1: what he called the bar lab, and it was basically
Speaker 1: a bar, and sometimes they got served tonic and sometimes
Speaker 1: they got vodka tonic, I believe, but sometimes they were
Speaker 1: told the opposite of what the drink actually was, and
Speaker 1: their drinking escalated in relation to what they were told
Speaker 1: was in the drink, not in relation to the actual
Speaker 1: alcohol content of the drinks. In other words, it was
Speaker 1: the belief that the first drink gets you drunk, not
Speaker 1: the alcohol, that caused this escalation of loss of control.
Speaker 1: And so if we didn't inculcate that belief in people,
Speaker 1: obviously we prefer if you're being abstinent to not re leaf.
Speaker 1: But if you do, you don't want to get into
Speaker 1: what he labeled the abstinence violation effect, and what that
Speaker 1: is you could also call it the Funcket effect, because
Speaker 1: you count your sobriety by the number of days you
Speaker 1: have been away from alcohol or other drugs, and if
Speaker 1: you have anything, you go back to square one. So
Speaker 1: this leads to people who just have one sip and
Speaker 1: then they like, well, I've already blown it, so I
Speaker 1: may as well have a binge, and this can be
Speaker 1: deadly in some cases. So he sort of elaborated the
Speaker 1: psychology of how addiction works, and he brought that into
Speaker 1: the addictions field and into psychology in a way that
Speaker 1: hadn't been done previously. And so I admit in this
Speaker 1: book I tried to focus on the activists and on
Speaker 1: the people who were themselves people h use drugs, and
Speaker 1: I feel bad for not being able to have featured
Speaker 1: people like Ethan Moore. And I hope that somebody will
Speaker 1: do the story of drug policy reform in the United States,
Speaker 1: which has lots of interesting people in features. Oh, in time,
Speaker 1: Maya in time. But you know, I should tell our
Speaker 1: listeners that yesterday UM reading Maya's chapter where she talks
Speaker 1: about Alan and the experiment where you know, people are
Speaker 1: getting multiple drinks of alcohol, but if they think there's
Speaker 1: no alcohol, they don't seem to be getting drunk, and
Speaker 1: and and those drinks that don't have alcohol in it,
Speaker 1: but they think do they are getting drunk in the
Speaker 1: whole placebo effect on And I remember I first read
Speaker 1: about that back in six I was reading a wonderful
Speaker 1: book by Stanton Peel called The Meaning of Addiction, which
Speaker 1: had a big impact on me, and he talked about
Speaker 1: Alan study and other ones like it back in the day. Anyway,
Speaker 1: this is yesterday, and I'm reading Maya's account of this
Speaker 1: thing and remembering reading it in Stanton's book many years ago.
Speaker 1: And then an hour it are, I'm making myself some dinner.
Speaker 1: I pull out the latest copy of New Yorker magazine
Speaker 1: and there's a piece by a journalist John Seabrook, who
Speaker 1: describes himself as currently being in recovery, and he's talking
Speaker 1: about this explosion now in craft beers that have no alcohol,
Speaker 1: alcohol free craft beers which are actually being to taste good.
Speaker 1: And he's talking about his own journey about is it
Speaker 1: okay for him with somebody who has now been abstinent
Speaker 1: for five years, and is it okay for him to
Speaker 1: do this? And pops right back up the story of
Speaker 1: Alan Marlatt and those bar experiments. So it's one of
Speaker 1: the most powerful experiments in terms of getting people to
Speaker 1: understand the nature of addiction. I think that's ever been performed.
Speaker 1: Going to add something about that John Seabrook article, because
Speaker 1: he doesn't use it to make the point that we
Speaker 1: have been making. I mean, it's it's just very odd.
Speaker 1: It's still maintains the abstinence and the first drink gets
Speaker 1: you drunk view, which is completely undercut by the experiment.
Speaker 1: So he didn't really explain it well as I guess
Speaker 1: what I'm trying to say. And I found it a
Speaker 1: little sad the way he mentioned it, because it was
Speaker 1: much more powerful than the way he described it. Yeah,
Speaker 1: my is funny because I actually saw this guy going
Speaker 1: through this incredibly ambivalent experience. Like here, he's for the
Speaker 1: first time trying something that all the cues of drinking,
Speaker 1: the bar and all these sorts of things in doing it,
Speaker 1: and then he takes it and he doesn't go and
Speaker 1: start binging on alcohol, but meanwhile he's worried he might,
Speaker 1: I mean, while his wife's worried he might and all
Speaker 1: that sort of thing. I just felt this tremendous sense
Speaker 1: of ambivalence coming out of a very intelligent man who's
Speaker 1: wanting to retain his abstinence and recovery. But meanwhile, you know,
Speaker 1: because I mean, you know, life's complicated in that way,
Speaker 1: I guess, And so I guess I gave Seabrook a
Speaker 1: little bit of benefit of doubt, and he had a
Speaker 1: little tongue in cheek about his own experience through this
Speaker 1: whole thing, you know, And I have to say that,
Speaker 1: like you know, I'm I'm looking for people to be
Speaker 1: sending the message of more complexity in this area, and
Speaker 1: I am probably overly harsh. Well, people will need to
Speaker 1: read It's John Seabrooks article in New Yorker magazine in
Speaker 1: late September if you want to read it, so my,
Speaker 1: you know, one of the things, as you talk about
Speaker 1: in the book is how effectively brilliant the phrase harm
Speaker 1: reduction is. Who can be against it? And of course
Speaker 1: everybody wants to reduce harm in it, and it equates
Speaker 1: with a whole notion in medicine at first, do no
Speaker 1: harm um. Yet, on the other hand, I have to
Speaker 1: tell you that as an advocate for harm reduction and
Speaker 1: trying to get that into the broader public discourse and politically,
Speaker 1: I found it both incredibly advantageous for the reasons that
Speaker 1: you described, but also very frustrating. And it was frustrating
Speaker 1: in this sense that it wasn't really catchy, it wasn't
Speaker 1: something to get excited about. And the contrast right was
Speaker 1: with the phrase in marijuana legalize it legalize. It was
Speaker 1: a highly motivating and you know, exciting and it sounded right,
Speaker 1: but it also had the downside that it kind of
Speaker 1: scared people a bit, right, And so it's that trade off.
Speaker 1: But I mean, you think about harm reduction, and I
Speaker 1: don't think the New York Times starts to really use
Speaker 1: the phrase outside of quotation marks for twenty or thirty
Speaker 1: rs after it emerges, and people there's a kind of
Speaker 1: hum hole. And I would mention how harm reduction to
Speaker 1: journalists like a thousand times, but the numbers of times
Speaker 1: which they actually put in the article was a tiny
Speaker 1: fraction as opposed to a more catchy phrase. Well, part
Speaker 1: of it is that people don't realize how powerful it is.
Speaker 1: Who does realize how powerful it is. Our prohibitionists and they,
Speaker 1: the serious drug warriors in this country, made a real
Speaker 1: effort to stamp out the phrase harm reduction. They didn't
Speaker 1: allow it to be used when people were seeking grants.
Speaker 1: If they wanted to actually get a grant from N
Speaker 1: I H or C D c UM, they went to
Speaker 1: the U N. And when other countries were trying to
Speaker 1: suggest this as drug policy, they just took it out
Speaker 1: of all the documents, so they knew it was powerful,
Speaker 1: and so it's it's a little bit complicated. Um. But
Speaker 1: I think, you know, some people have said, like, oh,
Speaker 1: we should focus more on pleasure from drugs, or on
Speaker 1: the upside or things like this. But the reason I
Speaker 1: believe harm reduction is important phrase and should be the
Speaker 1: center of the movement is that policy should be concerned
Speaker 1: with reducing harm. Policy should not be focused on pleasure.
Speaker 1: I don't want the government trying to like either take
Speaker 1: away my pleasure or give me pleasure. That would be
Speaker 1: kind of weird. M Yeah, No, I mean, I I mean,
Speaker 1: I remember this history vividly because I was so much
Speaker 1: engaged in those battles. I remember the opposition trying to
Speaker 1: demonize it. I also remember a brief pier where they
Speaker 1: tried to co opt it, and they claimed that even
Speaker 1: coercive approaches were reducing harm and that therefore that was
Speaker 1: harm reduction. I remember discussions within the harm reduction movement
Speaker 1: about whether to jettison the term because it had developed
Speaker 1: so much negative baggage from our opponents. Uh. In my
Speaker 1: discussion with Nora Vocal on one of the episodes of psychoactive.
Speaker 1: Not long ago, I asked her why was it that
Speaker 1: all sorts of researchers were told to not use the
Speaker 1: phrase harm reduction and their grant applications, And she was
Speaker 1: fairly frank about, sort of suggesting it was the politics,
Speaker 1: and if you could fund harm reduction research without calling it,
Speaker 1: maybe that was the thing you need to do. Um
Speaker 1: And I sometimes felt that I may have played something
Speaker 1: of a personal role in all this, because you know,
Speaker 1: in the late nineties, George Sorrows and his foundation was
Speaker 1: funding of both harm reduction and drug policy reform around
Speaker 1: the world, not just in the US, and I was
Speaker 1: the principal advisor and gate keeper of all of that,
Speaker 1: And so we were simultaneously funding harm reduction programs all
Speaker 1: around while at the same time challenging the whole prohibitionist approach.
Speaker 1: Um And I think our opponents saw that if you
Speaker 1: could smear everything with the label of legalization and even
Speaker 1: suggest it was all about a free market, libertarian legalization
Speaker 1: that didn't care about kids, I think they saw that
Speaker 1: as a useful tactic. So my last question to you
Speaker 1: is you repeatedly point out in the book on how
Speaker 1: much harm reduction is now spreading the very notion, the
Speaker 1: idea of the language. I mean, in fact, I think
Speaker 1: if you google on it now you almost see it
Speaker 1: referring more to tobacco harm reduction, which is now become
Speaker 1: its own controversial field and which I become quite personally involved.
Speaker 1: But you point out the ways in which harm reduction
Speaker 1: is now being embraced, both the language and the thinking
Speaker 1: in a host of other areas, and including around COVID.
Speaker 1: So why don't we finish up by just talking about
Speaker 1: how you see it's it's broader acceptance in American society.
Speaker 1: So the beauty of harm reduction is that it allows
Speaker 1: you to look at risk and context, and if you
Speaker 1: want to make good choices, you have to do that.
Speaker 1: It also shows you that there are behaviors that people
Speaker 1: are just not going to abstain from. People are going
Speaker 1: to take risks, and for the example of COVID, people
Speaker 1: are going to socialize because it is fundamental to human biology.
Speaker 1: So you're not going to really be able to expect
Speaker 1: abstinence to last very long. So how do you manage that? Obviously,
Speaker 1: masks are one thing, and now we have vaccines, But
Speaker 1: the real thing is when you want people to change
Speaker 1: behavior in a consistent fashion. You need to have them
Speaker 1: focus where it matters the most. And so, for example,
Speaker 1: wearing a mask outside is a little bit silly. Wearing
Speaker 1: a mask inside where you're in a crowd definitely important.
Speaker 1: So if you're going to so called mess up and
Speaker 1: not use the mask, outside is way better than inside.
Speaker 1: And so that's harm reduction in practice. And one of
Speaker 1: the reasons I like to look at all the different
Speaker 1: places that harm reduction is now showing up, whether it
Speaker 1: be in terms of environmentalism, or eating disorders or many
Speaker 1: many other things, is that this is a gift from
Speaker 1: people who use drugs. People who use drugs invented this
Speaker 1: whole idea, along with academics, along with public health folks,
Speaker 1: along with drug policy reformers. But this comes from people
Speaker 1: who everybody tends to hate and see as useless. And
Speaker 1: yet now it is being used for the biggest two
Speaker 1: of the biggest problems we have, including global climate change
Speaker 1: and um the pandemic. Because in terms of climate change,
Speaker 1: for example, if you eat meat one less day a week,
Speaker 1: that would make a huge difference to the environment, and
Speaker 1: that's harm reduction right there. Well, on those words, maya
Speaker 1: let's wrap this up. So as I said it to
Speaker 1: be getting, I truly think that you are one of
Speaker 1: the most brilliant people writing and thinking about drug use
Speaker 1: and drug users and addiction. You know, not just in
Speaker 1: the country, but around the world. I know my opinion
Speaker 1: is broadly shared. Thank you ever so much. I'm counting
Speaker 1: you to continue writing and all sorts of creative ways
Speaker 1: in this field for many decades to come. So thanks
Speaker 1: so much for being my guest on Psychoactive. Thank You.
Speaker 1: Psychoactive is a production of I Heart Radio and Protozoa Pictures.
Speaker 1: It's hosted by me Ethan Nadelman. It's produced by Kacha
Speaker 1: Kumkova and Ben Kibrick. The executive producers are Dylan Golden,
Speaker 1: Ari Handel, Elizabeth Geesus and Darren Aronovski for Protozoa Pictures,
Speaker 1: Alice Williams and Matt Frederick for I Heart Radio and
Speaker 1: me Ethan Nadelman. Our music is by Ari Belusian and
Speaker 1: especial thanks to a Vivit Brio, Seph Bianca Grimshaw and
Speaker 1: Robert Beatty. If you'd like to share your own stories, comments,
Speaker 1: or ideas, please leave us a message at eight three
Speaker 1: three seven seven nine four sixty. That's one eight three
Speaker 1: three psycho zero. You can also email us as psychoactive
Speaker 1: at protozoa dot com or find me on Twitter at
Speaker 1: Ethan natal Main. And if you couldn't keep track of
Speaker 1: all this, find the information in the show notes. Next
Speaker 1: week we'll be talking about iby gaine, the powerful psychedelic
Speaker 1: that comes from the Aboga Route in West Africa. Our
Speaker 1: guest will be Dmitri Mucgainis, who has helped hundreds, indeed
Speaker 1: thousands of people to deal with their addictions through the
Speaker 1: use of iber gaine and other powerful psychedelic substances. It
Speaker 1: might take three to four to five days for someone
Speaker 1: to come out of the experience completely. Holding that space
Speaker 1: is the most intense experience that I've ever experienced, and
Speaker 1: I did it hundreds and hundreds of time. You have
Speaker 1: to be in there, why people are suffering, why people
Speaker 1: are processing, why people are vomiting, why people might want
Speaker 1: to start to use again or questioning why they use again,
Speaker 1: and it's an incredibly sacred space. Subscribe to Cycleactive now,
Speaker 1: see it, don't miss it.