1 00:00:00,280 --> 00:00:07,760 Speaker 1: Hi, I'm Ethan Natalman, and this is Psychoactive, a production 2 00:00:07,800 --> 00:00:11,840 Speaker 1: of iHeart Radio and Protozoa Pictures. Psychoactive is the show 3 00:00:11,880 --> 00:00:15,400 Speaker 1: where we talk about all things drugs. But any views 4 00:00:15,440 --> 00:00:20,000 Speaker 1: expressed here do not represent those of iHeart Media, Protozoa Pictures, 5 00:00:20,200 --> 00:00:24,840 Speaker 1: or their executives and employees. Indeed, heed, as an inveterate contrarian, 6 00:00:25,120 --> 00:00:28,000 Speaker 1: I can tell you they may not even represent my own. 7 00:00:28,800 --> 00:00:31,600 Speaker 1: And nothing contained in this show should be used as 8 00:00:31,680 --> 00:00:42,519 Speaker 1: medical advice or encouragement to use any type of drug. Today, 9 00:00:42,840 --> 00:00:47,440 Speaker 1: we're gonna be talking about harm reduction, and specifically harm 10 00:00:47,520 --> 00:00:52,200 Speaker 1: reduction in the context of drug treatment in America, where 11 00:00:52,280 --> 00:00:57,320 Speaker 1: most programs are still abstinence only twelve step programs with 12 00:00:57,560 --> 00:01:00,920 Speaker 1: very little flexibility to meet people where they're at when 13 00:01:00,960 --> 00:01:04,520 Speaker 1: they're struggling with drugs. My definition of harm reduction refers 14 00:01:04,520 --> 00:01:09,119 Speaker 1: really to any policies or interventions that seek to reduce 15 00:01:09,280 --> 00:01:13,560 Speaker 1: the risks, the harms, the negative consequences of drug use, 16 00:01:13,760 --> 00:01:18,240 Speaker 1: or really any other risky or potentially dangerous activity. I mean, 17 00:01:18,440 --> 00:01:21,559 Speaker 1: when it comes to drugs, we think about UH needle 18 00:01:21,600 --> 00:01:24,320 Speaker 1: exchange programs to reduce the spread of HIV and AIDS 19 00:01:24,360 --> 00:01:27,000 Speaker 1: and other infectious diseases, or making sure the lock zone 20 00:01:27,080 --> 00:01:30,360 Speaker 1: is available for people who are using opioids and might overdose. 21 00:01:30,760 --> 00:01:34,560 Speaker 1: Or maybe it's just about getting people to use less 22 00:01:34,680 --> 00:01:37,600 Speaker 1: or to use more responsibly, or to switch from injecting 23 00:01:37,680 --> 00:01:40,400 Speaker 1: drugs to taking them, orally there's all sorts of ways 24 00:01:40,440 --> 00:01:44,240 Speaker 1: of harm reduction. Now in my own life, I've been 25 00:01:44,760 --> 00:01:47,039 Speaker 1: personally engaged in this issue. I mean not just in 26 00:01:47,040 --> 00:01:50,080 Speaker 1: my own life in using drugs in a harm reduction way, 27 00:01:50,520 --> 00:01:54,320 Speaker 1: but also in speaking about this and teaching about it 28 00:01:54,360 --> 00:01:57,760 Speaker 1: and writing about it, and then also beginning in the 29 00:01:57,840 --> 00:02:01,320 Speaker 1: early mid nineties, in helping to fund and support and 30 00:02:01,400 --> 00:02:05,640 Speaker 1: start harm reduction programs all around the United States. Now, 31 00:02:05,800 --> 00:02:09,120 Speaker 1: harm reduction can apply not just to drugs or other activities. 32 00:02:09,320 --> 00:02:13,880 Speaker 1: It can also involve a harm reduction approach to drug enforcement, 33 00:02:13,919 --> 00:02:16,000 Speaker 1: drug policing. It can there can be a harm reduction 34 00:02:16,040 --> 00:02:20,880 Speaker 1: approach to drug markets, harmorduction approach to drug policies. Today 35 00:02:21,040 --> 00:02:24,160 Speaker 1: we're talking with Pat Denning about harm reduction approaches to 36 00:02:24,240 --> 00:02:28,280 Speaker 1: drug treatment. Pat's run a pioneering program with her partner 37 00:02:28,360 --> 00:02:30,960 Speaker 1: Jennie Little in San Francisco for many decades. She's co 38 00:02:31,040 --> 00:02:34,080 Speaker 1: authored books with Jennie she's been a teacher both in 39 00:02:34,120 --> 00:02:36,239 Speaker 1: the US and around the world. So I'm delighted to 40 00:02:36,320 --> 00:02:39,079 Speaker 1: welcome Pat today. I'm really happy to do it, Ethan. 41 00:02:39,160 --> 00:02:41,240 Speaker 1: I I always love talking to you, and this is 42 00:02:41,280 --> 00:02:43,640 Speaker 1: just the best excuse ever. You know, the first thing 43 00:02:43,680 --> 00:02:46,760 Speaker 1: I want to do is just get into the broader 44 00:02:46,760 --> 00:02:49,360 Speaker 1: issue of harm reduction, and keeping in mind that there 45 00:02:49,400 --> 00:02:51,640 Speaker 1: are some people who are into the nitty gritty of 46 00:02:51,639 --> 00:02:54,200 Speaker 1: this subject and there are others are going harm What 47 00:02:54,440 --> 00:02:58,360 Speaker 1: what's harm reduction? And so what's your elevator pitch about 48 00:02:58,680 --> 00:03:00,720 Speaker 1: what's harm reduction to the people who have never heard 49 00:03:00,760 --> 00:03:04,520 Speaker 1: of it? Um, my elevator pitch is that harm reduction 50 00:03:04,600 --> 00:03:07,320 Speaker 1: is what we do every day in our lives, since 51 00:03:07,440 --> 00:03:11,239 Speaker 1: we're human beings. We take risks, we ride in elevators, 52 00:03:11,840 --> 00:03:14,720 Speaker 1: we ride in cars, and we do things to minimize 53 00:03:14,720 --> 00:03:17,119 Speaker 1: the risk. But so when people talk about harm reduction 54 00:03:17,200 --> 00:03:20,639 Speaker 1: in the context of drug treatment, what they usually mean 55 00:03:20,880 --> 00:03:26,880 Speaker 1: our alternatives to treatments that focus only on achieving abstinates. Well, 56 00:03:26,919 --> 00:03:28,640 Speaker 1: you know, I think the other thing, Ethan, is that 57 00:03:28,720 --> 00:03:31,480 Speaker 1: you know, people get confused and talking about harm reduction 58 00:03:31,520 --> 00:03:35,680 Speaker 1: because it's it's not just one thing. There are different 59 00:03:35,840 --> 00:03:39,480 Speaker 1: arms to the harm reduction movement, and the original arm 60 00:03:39,560 --> 00:03:43,440 Speaker 1: was very much grassroots, very much drug user driven. It 61 00:03:43,560 --> 00:03:48,360 Speaker 1: resulted in things like needle exchange programs. But then another 62 00:03:48,480 --> 00:03:51,040 Speaker 1: arm came in, which was the public health arm, which 63 00:03:51,120 --> 00:03:55,480 Speaker 1: really was interested in reducing the spread of disease. And 64 00:03:55,520 --> 00:04:00,000 Speaker 1: then there's policy and advocacy um which is really interesting 65 00:04:00,000 --> 00:04:02,480 Speaker 1: it and ending the war on drug and protecting the 66 00:04:02,560 --> 00:04:06,760 Speaker 1: rights of people who use drugs. And the most recent addition, 67 00:04:06,920 --> 00:04:11,200 Speaker 1: which is not actually recent anymore, is is treatment. And 68 00:04:11,520 --> 00:04:15,480 Speaker 1: while I came in through multiple avenues of all the 69 00:04:15,480 --> 00:04:19,279 Speaker 1: different arms of harm reduction, I think my contribution is 70 00:04:19,320 --> 00:04:21,960 Speaker 1: primarily in the area of harm reduction treatment. I was 71 00:04:22,040 --> 00:04:23,800 Speaker 1: looking around and I saw one of the things you 72 00:04:23,839 --> 00:04:25,960 Speaker 1: wrote in the last year or so. It's for an 73 00:04:26,000 --> 00:04:29,400 Speaker 1: excellent online publication called Filter, and you wrote about your 74 00:04:29,480 --> 00:04:35,480 Speaker 1: dilemma about whether or not to provide alcohol to people 75 00:04:35,520 --> 00:04:37,600 Speaker 1: who were living rough on the streets. You know what 76 00:04:37,600 --> 00:04:40,800 Speaker 1: we call skinro alcoholics who might suffer the d t 77 00:04:41,000 --> 00:04:44,560 Speaker 1: S if they can't get any alcohol. Yeah. It came 78 00:04:44,600 --> 00:04:47,440 Speaker 1: about because for the last two and a half years 79 00:04:47,480 --> 00:04:51,839 Speaker 1: we have been doing a pilot project for the Department 80 00:04:51,839 --> 00:04:55,599 Speaker 1: of Public Health in San Francisco of developing mobile pop 81 00:04:55,720 --> 00:05:00,000 Speaker 1: up dropping centers, and we would come into different neighbor 82 00:05:00,040 --> 00:05:02,560 Speaker 1: hoods with a big the van that was outfitted as 83 00:05:02,600 --> 00:05:07,000 Speaker 1: a therapy office, set up canopies, we cooked hot food 84 00:05:07,040 --> 00:05:10,279 Speaker 1: for people, We had a drop in center, we did therapy, 85 00:05:10,520 --> 00:05:13,640 Speaker 1: and after COVID hit, we had to start shutting down. 86 00:05:14,440 --> 00:05:18,039 Speaker 1: But in the process of shutting down our mobile sites 87 00:05:18,200 --> 00:05:21,760 Speaker 1: and figuring out how to just do outreach, we started 88 00:05:21,760 --> 00:05:25,760 Speaker 1: coming across people who were clearly in withdrawal from alcohol. 89 00:05:26,000 --> 00:05:30,560 Speaker 1: From alcohol because the shops were closed, people couldn't like 90 00:05:30,640 --> 00:05:35,280 Speaker 1: shoplift alcohol. There were no people on the streets, and 91 00:05:35,320 --> 00:05:39,479 Speaker 1: so people couldn't um ask for spare change or asked 92 00:05:39,520 --> 00:05:44,960 Speaker 1: for money. So people's ability to access alcohol was severely disrupted, 93 00:05:45,480 --> 00:05:49,200 Speaker 1: and it was clear that people were really suffering. And 94 00:05:49,320 --> 00:05:53,000 Speaker 1: I just immediately thought, well, this is crazy. At this point, 95 00:05:53,040 --> 00:05:57,040 Speaker 1: we're handing out syringes, we're handing out crack pipes, people 96 00:05:57,040 --> 00:06:00,640 Speaker 1: are doing methodone take homes, and people are doing same 97 00:06:00,720 --> 00:06:05,040 Speaker 1: day prescriptions. So I'm just thinking, well, my goodness, there 98 00:06:05,040 --> 00:06:08,240 Speaker 1: are all these people who are physically dependent on a 99 00:06:08,320 --> 00:06:11,679 Speaker 1: legal drug that they now can't get access to, and 100 00:06:11,800 --> 00:06:16,560 Speaker 1: the dangers of withdrawal from alcohol are severe, and so 101 00:06:16,680 --> 00:06:19,280 Speaker 1: I thought, well, why don't we just give out alcohol 102 00:06:19,640 --> 00:06:22,880 Speaker 1: just so our listeners understand and correct me if I'm wrong. 103 00:06:23,279 --> 00:06:26,560 Speaker 1: If you withdraw it from something like heroin or cocaine, 104 00:06:27,000 --> 00:06:30,599 Speaker 1: it may be extremely uncomfortable, you know, terrible flu for 105 00:06:30,720 --> 00:06:32,960 Speaker 1: some people, you know, all sorts of things, but it's 106 00:06:33,000 --> 00:06:36,720 Speaker 1: not going to kill you. But if you've become heavily 107 00:06:36,839 --> 00:06:40,520 Speaker 1: dependent on alcohol or for that matter, of benzo diazepines, 108 00:06:40,560 --> 00:06:45,080 Speaker 1: valium like drugs, if you rapidly withdraw from alcohol when 109 00:06:45,120 --> 00:06:48,240 Speaker 1: you are heavily dependent, that can actually be life threatening. 110 00:06:48,560 --> 00:06:51,040 Speaker 1: Rapid withdrawal without some types of help can kill you. 111 00:06:51,360 --> 00:06:54,320 Speaker 1: It's interesting in the history of alcoholics anonymous in the 112 00:06:54,360 --> 00:06:57,039 Speaker 1: old days, they used to always have a bottle of 113 00:06:57,080 --> 00:06:59,960 Speaker 1: booze at the meetings because they knew that the new 114 00:07:00,120 --> 00:07:04,240 Speaker 1: comers who were coming in might actually go into withdrawal, 115 00:07:04,360 --> 00:07:07,280 Speaker 1: and they knew it was dangerous, so they would, you know, 116 00:07:07,360 --> 00:07:10,000 Speaker 1: hand somebody a bottle and have them take a swig 117 00:07:10,000 --> 00:07:12,160 Speaker 1: out of the bottle of booze if they were starting 118 00:07:12,160 --> 00:07:16,160 Speaker 1: to show signs of withdrawal. So we've we've known that 119 00:07:16,520 --> 00:07:20,480 Speaker 1: alcohol withdrawal is very dangerous. So I started calling up 120 00:07:21,440 --> 00:07:24,920 Speaker 1: alcohol distribution places mostly and I will, I'll go ahead 121 00:07:24,960 --> 00:07:28,480 Speaker 1: and use the company name bev Moo and asked them 122 00:07:28,520 --> 00:07:32,119 Speaker 1: if they would make a donation of a little, uh, 123 00:07:32,160 --> 00:07:36,440 Speaker 1: you know, the airplane size bottles of booze. And I 124 00:07:36,560 --> 00:07:39,800 Speaker 1: told them why, and they, of course, we're just like, 125 00:07:40,000 --> 00:07:43,600 Speaker 1: excuse me, but no, I don't think so. So I 126 00:07:43,680 --> 00:07:46,160 Speaker 1: drove down to bev Moo and I bought a few 127 00:07:46,240 --> 00:07:51,320 Speaker 1: cases of basically vodka in little bottles, and I take 128 00:07:51,360 --> 00:07:53,840 Speaker 1: it home and I'm all excited. I tell my staff, 129 00:07:53,960 --> 00:07:56,080 Speaker 1: you know, oh, you know, I've got little bottles of booze. 130 00:07:56,120 --> 00:07:58,600 Speaker 1: We can now hand that out for people. And all 131 00:07:58,600 --> 00:08:01,239 Speaker 1: of a sudden, I'm like, oh wait a minute, pat, 132 00:08:01,360 --> 00:08:06,480 Speaker 1: what hold up? You are a licensed therapist, um, and 133 00:08:07,080 --> 00:08:10,560 Speaker 1: you are going to be handing a drug even though 134 00:08:10,600 --> 00:08:13,520 Speaker 1: it's legal. You go be handing a drug to someone 135 00:08:14,720 --> 00:08:17,240 Speaker 1: in order to help them with a medical problem that 136 00:08:17,320 --> 00:08:21,280 Speaker 1: you're not even qualified to diagnose. So here we are 137 00:08:21,360 --> 00:08:24,720 Speaker 1: with this dilemma of knowing exactly what our clients need. 138 00:08:25,240 --> 00:08:28,120 Speaker 1: And it's like we're not allowed to give clients an aspirin. 139 00:08:28,640 --> 00:08:32,520 Speaker 1: You know, you can't dispense medicine as a therapist, and 140 00:08:32,600 --> 00:08:35,679 Speaker 1: all of a sudden, I'm thinking, yeah, well I'm old 141 00:08:36,080 --> 00:08:38,800 Speaker 1: and I can lose my license and it doesn't bother me. 142 00:08:38,920 --> 00:08:41,720 Speaker 1: Is I'm about ready to give it up anyway. But 143 00:08:42,200 --> 00:08:45,440 Speaker 1: you know that's not true of the agency, and that's 144 00:08:45,480 --> 00:08:48,160 Speaker 1: not true of most of the staff. So it was 145 00:08:48,240 --> 00:08:52,199 Speaker 1: quite a dilemma that I have completely refused to answer 146 00:08:52,240 --> 00:08:57,040 Speaker 1: any question about how we solve that dilemma. So, I mean, 147 00:08:57,080 --> 00:08:59,880 Speaker 1: so pat you found it had been running this remarkable 148 00:09:00,040 --> 00:09:03,640 Speaker 1: army reduction program San Francisco since I guess the nineties. 149 00:09:04,200 --> 00:09:06,800 Speaker 1: What's the essence of that? Well, you know, it was 150 00:09:06,920 --> 00:09:09,800 Speaker 1: kind of a long journey, and as as I I 151 00:09:09,840 --> 00:09:14,520 Speaker 1: said in a staff meeting today, I was a you know, nice, sweet, 152 00:09:14,559 --> 00:09:18,840 Speaker 1: perfect little girl who got really rebellious really fast and 153 00:09:19,120 --> 00:09:23,160 Speaker 1: started questioning everything. And the HIV epidemic came along, and 154 00:09:23,200 --> 00:09:26,040 Speaker 1: that gave me a reason to really start looking at 155 00:09:26,760 --> 00:09:30,200 Speaker 1: UH drug treatment and alcohol treatment because we were throwing 156 00:09:30,320 --> 00:09:34,160 Speaker 1: a lot of young men into programs who were dying 157 00:09:34,559 --> 00:09:38,200 Speaker 1: and treating them not very well. So that I started 158 00:09:38,240 --> 00:09:41,720 Speaker 1: thinking about alternatives. And this was in the in the 159 00:09:41,720 --> 00:09:45,880 Speaker 1: early eighties, and over time just kept developing new ways 160 00:09:45,920 --> 00:09:50,079 Speaker 1: of thinking and eventually met Jeanie Little, and we both 161 00:09:50,160 --> 00:09:54,760 Speaker 1: had this idea of wanting to run a center that 162 00:09:54,800 --> 00:09:58,040 Speaker 1: would take everyone, no matter what the status was of 163 00:09:58,040 --> 00:10:00,800 Speaker 1: their drug use, no matter what if their goals were 164 00:10:00,840 --> 00:10:04,480 Speaker 1: for treatment, And so it was really the two of 165 00:10:04,559 --> 00:10:09,679 Speaker 1: us just being defiantly determined to do it differently. So, Pat, 166 00:10:09,720 --> 00:10:12,120 Speaker 1: when you and Jennie decided to do something new, tell 167 00:10:12,160 --> 00:10:16,319 Speaker 1: me about your approach. The Harm Reduction Therapy Center UM 168 00:10:16,360 --> 00:10:20,800 Speaker 1: provides individual and group therapy. At times, we also have 169 00:10:21,000 --> 00:10:27,320 Speaker 1: medication available. The goal of harm reduction therapy is to 170 00:10:27,480 --> 00:10:30,040 Speaker 1: help a person who is having trouble with drugs and 171 00:10:30,080 --> 00:10:35,240 Speaker 1: alcohol decide how they can better their life, how they 172 00:10:35,280 --> 00:10:39,280 Speaker 1: can reduce their harm in whatever ways that is going 173 00:10:39,320 --> 00:10:41,560 Speaker 1: to be necessary. Are they really going to need to 174 00:10:41,600 --> 00:10:46,240 Speaker 1: take psychiatric medications? Are they going to need to absolutely 175 00:10:46,360 --> 00:10:50,120 Speaker 1: quit drugs? Are they going to need to have family therapy? 176 00:10:50,640 --> 00:10:55,840 Speaker 1: The clients are primarily very low income, often marginally or unhoused, 177 00:10:56,520 --> 00:11:01,160 Speaker 1: often with very significant psychiatric or emotional difficulties as well, 178 00:11:01,559 --> 00:11:05,800 Speaker 1: people whose drug use and emotional and family problems are 179 00:11:05,840 --> 00:11:09,520 Speaker 1: so interwined that you can't separate them. So we provide 180 00:11:09,520 --> 00:11:12,520 Speaker 1: the full range of services. There's no limit to the treatment. 181 00:11:13,040 --> 00:11:15,800 Speaker 1: A lot of our community programs offer therapy on a 182 00:11:15,880 --> 00:11:19,839 Speaker 1: drop in basis because our clients lives are often so 183 00:11:20,240 --> 00:11:23,400 Speaker 1: disorganized that they can't keep appointments. Going back to the 184 00:11:23,400 --> 00:11:25,839 Speaker 1: origins of the phrasing of harm reduction, back to I 185 00:11:25,840 --> 00:11:28,160 Speaker 1: guess the Netherlands in the eighties and such, and then 186 00:11:28,160 --> 00:11:30,680 Speaker 1: coming in around needle exchange, both in Europe and the 187 00:11:30,760 --> 00:11:34,079 Speaker 1: US and elsewhere, there was people in our world debating 188 00:11:34,080 --> 00:11:37,320 Speaker 1: whether harm reduction was the right word. Then our opponents 189 00:11:37,360 --> 00:11:41,160 Speaker 1: were successful in calling harm reduction and legalization were synonymous, 190 00:11:41,200 --> 00:11:44,360 Speaker 1: which in fact they weren't. It was overlapped um. And 191 00:11:44,400 --> 00:11:46,840 Speaker 1: then there was a point where some of our opponents 192 00:11:46,840 --> 00:11:49,680 Speaker 1: that they might try to co opt the term, and 193 00:11:49,679 --> 00:11:52,120 Speaker 1: they said, well, we're doing harm reduction, we're forcing people 194 00:11:52,160 --> 00:11:55,280 Speaker 1: into drug treatment, and it always saying that when other 195 00:11:55,400 --> 00:11:58,760 Speaker 1: core element to the definition of harm reduction is that 196 00:11:58,840 --> 00:12:03,640 Speaker 1: it needs to be non coercive. It's an absolutely fundamental distinction. 197 00:12:03,760 --> 00:12:08,480 Speaker 1: The foundation of harm reduction therapy and harm reduction treatment 198 00:12:08,480 --> 00:12:14,280 Speaker 1: approaches is self determination and a true collaboration between two experts. 199 00:12:14,320 --> 00:12:17,000 Speaker 1: If you will, you know, the client is the expert 200 00:12:17,080 --> 00:12:20,200 Speaker 1: on their life, and often the expert on their drugs, 201 00:12:20,280 --> 00:12:24,240 Speaker 1: and the therapist is an expert in helping people, you know, 202 00:12:24,400 --> 00:12:28,760 Speaker 1: an expert in developing a relationship that allows a person 203 00:12:28,920 --> 00:12:33,880 Speaker 1: to be honest and to find their own power in 204 00:12:34,000 --> 00:12:37,760 Speaker 1: terms of changing. It's like almost anything can be harm reduction. 205 00:12:38,200 --> 00:12:42,319 Speaker 1: Twelve step can be harm reduction. Abstinence based treatment programs 206 00:12:42,360 --> 00:12:45,680 Speaker 1: are harm reduction. If the client has a free choice 207 00:12:46,240 --> 00:12:50,160 Speaker 1: in a menu of options, then what they choose is 208 00:12:50,200 --> 00:12:52,920 Speaker 1: harm reduction, right, and the choice should not be between 209 00:12:52,960 --> 00:12:55,720 Speaker 1: either take this treatment or go to jail. That's right. 210 00:12:55,840 --> 00:12:58,640 Speaker 1: Has to be an element of choice that actually involves 211 00:12:58,840 --> 00:13:02,079 Speaker 1: a real freedom of choice. Yes, if it evolves, especially 212 00:13:02,160 --> 00:13:05,560 Speaker 1: the state involved in coercion, it can't be harm reduction. 213 00:13:05,920 --> 00:13:08,800 Speaker 1: Now when you get to elements of compulsion by family 214 00:13:09,120 --> 00:13:12,960 Speaker 1: or employers, I guess it gets a little cloudier. Then, huh, well, 215 00:13:13,000 --> 00:13:17,920 Speaker 1: it gets cloudier. But the difference is who is the 216 00:13:17,920 --> 00:13:22,240 Speaker 1: therapist loyal to and in a lot of the drug 217 00:13:22,280 --> 00:13:26,439 Speaker 1: treatment programs, especially because the carceral system is so involved. 218 00:13:26,440 --> 00:13:30,800 Speaker 1: Now the funding and drug treatment is coming in enormous 219 00:13:30,880 --> 00:13:36,439 Speaker 1: measure from the criminal justice system, and so now drug 220 00:13:36,480 --> 00:13:41,480 Speaker 1: treatment is very much in bed with this coercive system, 221 00:13:41,520 --> 00:13:45,800 Speaker 1: with all of its racial and oppressive undertones. And so 222 00:13:46,000 --> 00:13:49,640 Speaker 1: now if you're coercing, even if it's family that's coercing, 223 00:13:50,400 --> 00:13:54,439 Speaker 1: the therapist cannot be part of the coercion. The therapist 224 00:13:54,480 --> 00:13:57,760 Speaker 1: has to be free. So you know, I've worked with 225 00:13:57,760 --> 00:14:00,959 Speaker 1: people who have been mandated to treatment before um, mostly 226 00:14:01,080 --> 00:14:05,160 Speaker 1: professional athletes, and the first therapeutic duty is for me 227 00:14:05,240 --> 00:14:09,600 Speaker 1: to say, um, you have to be here, and you 228 00:14:09,679 --> 00:14:12,640 Speaker 1: don't have to talk to me. You know, what goes 229 00:14:12,720 --> 00:14:16,760 Speaker 1: on between you and me in here is confidential, and 230 00:14:16,960 --> 00:14:19,680 Speaker 1: your main decision is are you going to show up? 231 00:14:20,200 --> 00:14:23,160 Speaker 1: And if not, are you prepared to take the consequences. 232 00:14:24,200 --> 00:14:26,280 Speaker 1: And if you show up, are you going to try 233 00:14:26,320 --> 00:14:29,200 Speaker 1: and use this to your advantage or you're gonna sit 234 00:14:29,240 --> 00:14:33,240 Speaker 1: here quietly for two years. Any time the therapist or 235 00:14:33,360 --> 00:14:38,440 Speaker 1: counselor has the power to harm a client, it is 236 00:14:38,480 --> 00:14:42,200 Speaker 1: not harm reduction. If you need to have drug testing, 237 00:14:42,720 --> 00:14:45,800 Speaker 1: that's fine, but you have to go somewhere else to 238 00:14:45,840 --> 00:14:49,720 Speaker 1: get your drug testing, and we won't allow the results 239 00:14:49,720 --> 00:14:54,640 Speaker 1: of that drug testing in your chart. We'll be talking 240 00:14:54,680 --> 00:15:08,880 Speaker 1: more after we hear this ad. You and I were 241 00:15:08,920 --> 00:15:12,080 Speaker 1: presenting it some drug treatment conference years ago, and this 242 00:15:12,160 --> 00:15:15,360 Speaker 1: was a real aha moment for me. Somebody was asking you, well, 243 00:15:15,760 --> 00:15:18,840 Speaker 1: I get harm reduction when it comes to opiates. I 244 00:15:18,880 --> 00:15:20,880 Speaker 1: get it when it comes to needle exchange and all 245 00:15:20,920 --> 00:15:22,760 Speaker 1: this sort of stuff. You know, I'm gonna have a 246 00:15:22,760 --> 00:15:26,320 Speaker 1: lot of patients dealing with mitth anthetamine. Well, um, I 247 00:15:26,360 --> 00:15:28,160 Speaker 1: think we're getting into the area of one of my 248 00:15:28,200 --> 00:15:32,239 Speaker 1: favorite topics, which is the adaptive or the self medication 249 00:15:33,080 --> 00:15:37,440 Speaker 1: uses of drugs. And there are people whose functioning is 250 00:15:37,520 --> 00:15:42,120 Speaker 1: actually improved by the use of certain drugs. And this 251 00:15:42,200 --> 00:15:47,040 Speaker 1: one particular guy was very depressed, very disorganized, had all 252 00:15:47,080 --> 00:15:50,080 Speaker 1: sorts of other issues going on, and it was clear 253 00:15:50,120 --> 00:15:52,600 Speaker 1: that when he had had little speed before he came 254 00:15:52,640 --> 00:15:55,760 Speaker 1: into a session, he was much more focused and much 255 00:15:55,800 --> 00:15:59,200 Speaker 1: more able to actually talk. Because usually even within some 256 00:15:59,320 --> 00:16:02,840 Speaker 1: harm reduction treatment programs, they will say just don't show 257 00:16:02,920 --> 00:16:05,400 Speaker 1: up high to treatment. You know, you don't have to 258 00:16:05,440 --> 00:16:07,560 Speaker 1: be absinent, but don't don't use on the day that 259 00:16:07,680 --> 00:16:11,400 Speaker 1: you have a session. And it's like, no, no, no, actually, 260 00:16:11,400 --> 00:16:14,720 Speaker 1: maybe you should use before you come. And and I 261 00:16:14,800 --> 00:16:18,400 Speaker 1: had another woman who was a polly substance user, very 262 00:16:18,520 --> 00:16:22,760 Speaker 1: serious mixed drug use, and she was finally able to 263 00:16:22,760 --> 00:16:26,240 Speaker 1: say to me, I can't come here if I don't 264 00:16:26,240 --> 00:16:28,880 Speaker 1: have a drink. And my office at the time was 265 00:16:28,920 --> 00:16:30,520 Speaker 1: on the third floor of the building and there was 266 00:16:30,520 --> 00:16:33,320 Speaker 1: a bar on the first floor. Sort of handy for 267 00:16:33,360 --> 00:16:36,120 Speaker 1: a harm reduction program, because what happened is that she 268 00:16:36,120 --> 00:16:40,000 Speaker 1: would come to therapy, she would get so overwhelmed talking 269 00:16:40,000 --> 00:16:43,320 Speaker 1: about things that she would go home and be incredibly 270 00:16:43,360 --> 00:16:47,440 Speaker 1: suicidal and would cut on herself or would do all 271 00:16:47,480 --> 00:16:50,200 Speaker 1: sorts of drugs. And she was finally able to say, 272 00:16:50,240 --> 00:16:53,000 Speaker 1: I can't do this, I can't talk about these things. 273 00:16:53,720 --> 00:16:56,720 Speaker 1: And I just said, well, if you had a couple 274 00:16:56,720 --> 00:16:59,800 Speaker 1: of drinks, would it make it better? And she's like, well, 275 00:16:59,800 --> 00:17:01,800 Speaker 1: of horse, it would, but I'm not allowed to do that. 276 00:17:01,840 --> 00:17:05,080 Speaker 1: And I said, well, I'm just trying to help you 277 00:17:05,400 --> 00:17:09,760 Speaker 1: not kill yourself while you're in therapy. And what you're 278 00:17:09,760 --> 00:17:12,800 Speaker 1: dealing with is so painful that if you need some 279 00:17:12,920 --> 00:17:15,240 Speaker 1: alcohol in order to be able to talk about it, 280 00:17:15,680 --> 00:17:17,240 Speaker 1: I just think you ought to go right ahead and 281 00:17:17,280 --> 00:17:19,919 Speaker 1: take care of yourself. I mean, hell, it makes sense. 282 00:17:19,960 --> 00:17:21,679 Speaker 1: And I also remember you're saying that even with that 283 00:17:21,760 --> 00:17:24,240 Speaker 1: person you know who're taking the speed before, and the 284 00:17:24,280 --> 00:17:27,040 Speaker 1: alternative was if he hadn't done that, he'd be sitting 285 00:17:27,040 --> 00:17:29,040 Speaker 1: in that session with you, and all that would be 286 00:17:29,080 --> 00:17:31,080 Speaker 1: on his mind would be getting out of that room 287 00:17:31,119 --> 00:17:33,160 Speaker 1: with you so he could score again and use again. 288 00:17:33,240 --> 00:17:36,000 Speaker 1: So I mean, in a way, it's basically harm reduction 289 00:17:36,160 --> 00:17:41,159 Speaker 1: as this sort of fundamentally pragmatic approach to dealing with 290 00:17:41,320 --> 00:17:45,119 Speaker 1: problematic behavior substance abuse. Who would have you? People use 291 00:17:45,200 --> 00:17:49,480 Speaker 1: drugs for reasons. The reasons are pretty simple. Do you 292 00:17:49,560 --> 00:17:55,080 Speaker 1: use drugs either increased pleasure, decreased pain, or alter your consciousness. 293 00:17:55,480 --> 00:17:58,879 Speaker 1: That's kind of what people use drugs for. And we 294 00:17:59,080 --> 00:18:03,600 Speaker 1: have somehow decided that it's not okay to alter one's 295 00:18:03,640 --> 00:18:08,040 Speaker 1: consciousness for any of those reasons. In America and prohibitionist America, 296 00:18:08,119 --> 00:18:12,040 Speaker 1: we've decided it's basically not okay to get high alcohol, 297 00:18:12,440 --> 00:18:17,360 Speaker 1: well except maybe but not too often. Actually, as a therapist, 298 00:18:17,960 --> 00:18:20,879 Speaker 1: we were trained to be suspicious of anybody who drinks 299 00:18:20,920 --> 00:18:23,960 Speaker 1: every day. So anybody who has a couple of glasses 300 00:18:24,000 --> 00:18:27,960 Speaker 1: of wine with dinner, we're really trained to go, oh, 301 00:18:28,160 --> 00:18:32,760 Speaker 1: you mean you drink every day? And it's like in 302 00:18:32,840 --> 00:18:37,080 Speaker 1: Europe they think we're nuts. But the prohibition mentality in 303 00:18:37,160 --> 00:18:41,760 Speaker 1: America permeates everything, and it's really, of course extreme when 304 00:18:41,760 --> 00:18:45,240 Speaker 1: it comes to illegal drugs because somehow we as a 305 00:18:45,320 --> 00:18:48,640 Speaker 1: society believe that if drugs are illegal, they were made 306 00:18:48,680 --> 00:18:52,480 Speaker 1: illegal because they're bad and they're dangerous. And what we 307 00:18:52,520 --> 00:18:56,639 Speaker 1: don't understand is that certain drugs were made illegal based 308 00:18:56,680 --> 00:19:01,359 Speaker 1: on racial prejudices and attempts at racial control. So I 309 00:19:01,359 --> 00:19:03,560 Speaker 1: picked up the paper the other day and there's this 310 00:19:03,640 --> 00:19:07,359 Speaker 1: report about some of the national health agencies wanting to 311 00:19:07,480 --> 00:19:11,040 Speaker 1: discourage people from drinking every day because they now believe, 312 00:19:11,080 --> 00:19:14,800 Speaker 1: although it may have slight cardiovascular benefits, that it also 313 00:19:14,920 --> 00:19:17,840 Speaker 1: increases the risk of cancer. And we know that when 314 00:19:17,840 --> 00:19:20,840 Speaker 1: it comes to cigarettes, we know smoking cigarettes is not 315 00:19:20,880 --> 00:19:23,480 Speaker 1: good for you, but you see the government getting really 316 00:19:23,520 --> 00:19:27,159 Speaker 1: behind a campaign to ban the consumption of nicotine in 317 00:19:27,200 --> 00:19:32,400 Speaker 1: any form. Conversely, Americans are now saying marijuana should be legal. 318 00:19:32,440 --> 00:19:36,560 Speaker 1: We're increasingly accepting of people using marijuana up not just medically, 319 00:19:36,720 --> 00:19:38,960 Speaker 1: but to get high in a way. One thing we've 320 00:19:39,000 --> 00:19:40,640 Speaker 1: been fighting for for a long time is to get 321 00:19:40,640 --> 00:19:43,160 Speaker 1: people to change their minds. The problem is that they 322 00:19:43,160 --> 00:19:45,040 Speaker 1: may be changing their minds to the right way when 323 00:19:45,040 --> 00:19:47,480 Speaker 1: it comes to illegal drugs, but maybe heading the wrong 324 00:19:47,520 --> 00:19:50,200 Speaker 1: way when it comes to the legal ones. And there's 325 00:19:50,240 --> 00:19:53,679 Speaker 1: that undercurrent of prohibition that is going it's going to 326 00:19:54,000 --> 00:19:57,119 Speaker 1: raise its ugly head and it's it just depends on 327 00:19:57,200 --> 00:20:00,480 Speaker 1: the times and the culture and who's in charge of 328 00:20:00,640 --> 00:20:03,000 Speaker 1: which drugs are going to get demonized. You know, when 329 00:20:03,000 --> 00:20:06,919 Speaker 1: we had prohibition in this country, you know, for thirteen years, 330 00:20:07,480 --> 00:20:11,200 Speaker 1: the law of the land said alcohol is so dangerous, 331 00:20:11,359 --> 00:20:14,800 Speaker 1: it's so poisonous, that no one should ever be allowed 332 00:20:14,840 --> 00:20:18,720 Speaker 1: to consume it. Thirteen years later, we made it legal again. 333 00:20:19,320 --> 00:20:22,840 Speaker 1: And so what we had to do as a society 334 00:20:22,960 --> 00:20:25,719 Speaker 1: to make that make any sense at all, is that 335 00:20:25,760 --> 00:20:29,359 Speaker 1: we had to adopt this idea that there's this disease 336 00:20:29,480 --> 00:20:33,240 Speaker 1: called alcoholism, and some people have it and some people don't. 337 00:20:34,400 --> 00:20:37,439 Speaker 1: And if you don't have the disease of alcoholism, you 338 00:20:37,480 --> 00:20:42,840 Speaker 1: can drink whenever you want to, because alcohol doesn't cause alcoholism, 339 00:20:42,880 --> 00:20:47,359 Speaker 1: it's only activated by drinking. That's an insane way of 340 00:20:47,560 --> 00:20:50,800 Speaker 1: reintroducing a drug into society is by saying, oh, well, 341 00:20:50,800 --> 00:20:53,399 Speaker 1: ten percent of you can't drink at all, and the 342 00:20:53,400 --> 00:20:55,399 Speaker 1: rest of you can drink as much as you want to. 343 00:20:55,720 --> 00:20:59,239 Speaker 1: I think the important thing is recognizing that it's a 344 00:20:59,359 --> 00:21:06,600 Speaker 1: political ideology, it's not settled science. Behaviors as complex as 345 00:21:06,640 --> 00:21:11,960 Speaker 1: serious drug problems are always a combination of biology, psychology, 346 00:21:12,000 --> 00:21:15,760 Speaker 1: and socio cultural factors, and for each person, the relative 347 00:21:15,840 --> 00:21:19,600 Speaker 1: weight of those factors can be different, and it can 348 00:21:19,640 --> 00:21:23,040 Speaker 1: be different for different drugs. You may have a sort 349 00:21:23,080 --> 00:21:28,000 Speaker 1: of biological propensity to overuse alcohol, but you might have 350 00:21:28,040 --> 00:21:33,200 Speaker 1: a psychosocial propensity to overuse marijuana. You know, drugs are psychoactive. 351 00:21:33,240 --> 00:21:36,800 Speaker 1: They act in the brain. They cause brain changes. Every 352 00:21:36,840 --> 00:21:41,959 Speaker 1: activity that we engage in repetitively causes brain changes. So 353 00:21:42,040 --> 00:21:46,080 Speaker 1: it doesn't necessarily mean it's a disease or it's even damage. 354 00:21:46,240 --> 00:21:49,480 Speaker 1: It's you know, it's a difference. And is it more 355 00:21:49,520 --> 00:21:55,119 Speaker 1: important than a person's psychology. Sometimes often not, But it 356 00:21:55,240 --> 00:21:57,320 Speaker 1: is very much the case that people have the drugs 357 00:21:57,320 --> 00:21:59,760 Speaker 1: they can handle on the ones they can't um you know. 358 00:22:00,040 --> 00:22:02,840 Speaker 1: And I have a friend and colleague. I won't mention 359 00:22:02,880 --> 00:22:04,679 Speaker 1: his name for the purpose of the show, but this 360 00:22:04,760 --> 00:22:08,280 Speaker 1: is somebody who's real problem was um opiates in heroin. 361 00:22:08,640 --> 00:22:10,919 Speaker 1: But when he put that behind him, he found that 362 00:22:10,960 --> 00:22:13,760 Speaker 1: he could be a regular consumer of red wine and marijuana, 363 00:22:13,880 --> 00:22:17,159 Speaker 1: even a daily consumer, and lead a remarkably successful in 364 00:22:17,200 --> 00:22:21,159 Speaker 1: productive life. And and we all have our drugs of choice, 365 00:22:21,880 --> 00:22:24,440 Speaker 1: you know, And whether that be because it's the most 366 00:22:24,520 --> 00:22:28,440 Speaker 1: fun drug, or because it's the one that helps take 367 00:22:28,480 --> 00:22:30,720 Speaker 1: care of us the most. You know, if you could 368 00:22:30,760 --> 00:22:33,160 Speaker 1: only have one drug for the rest of your life, 369 00:22:33,160 --> 00:22:36,280 Speaker 1: what would it be? You know, I'm I'm absolutely clear 370 00:22:36,520 --> 00:22:38,840 Speaker 1: that my Crown Royal is coming with me to the 371 00:22:38,880 --> 00:22:41,600 Speaker 1: desert islands. You know, that's a tricky one from me. 372 00:22:41,640 --> 00:22:47,439 Speaker 1: I wonder let's take a break here and go to 373 00:22:47,520 --> 00:23:01,800 Speaker 1: an ad. You know this issue now right with overdose 374 00:23:01,880 --> 00:23:07,159 Speaker 1: fatalities hitting sixty seventy eighty thousand a year nationwide, getting 375 00:23:07,160 --> 00:23:10,240 Speaker 1: worse in this past year with COVID. I used to 376 00:23:10,280 --> 00:23:14,960 Speaker 1: always explain to people that overdoses was actually the wrong word, 377 00:23:15,000 --> 00:23:17,399 Speaker 1: and the vast majority of cases it wasn't people taking 378 00:23:17,440 --> 00:23:20,840 Speaker 1: too much of one drug. That's the real accurate definition, 379 00:23:20,920 --> 00:23:24,639 Speaker 1: and overdose whose fatal drug combinations, you know, taking opioids 380 00:23:24,680 --> 00:23:28,119 Speaker 1: combining with booze, or with benzodiazepines, valium type drugs. But 381 00:23:28,200 --> 00:23:32,080 Speaker 1: now along comes FENTONYL right, which has got a special 382 00:23:32,160 --> 00:23:34,600 Speaker 1: kick to it, more opponent than heroin. You know, it 383 00:23:34,680 --> 00:23:36,920 Speaker 1: hits my city in New York first, but I can 384 00:23:37,000 --> 00:23:40,640 Speaker 1: see San Francisco is getting hammered by it now, so 385 00:23:40,760 --> 00:23:42,639 Speaker 1: I mean, what are your thoughts about what's going on 386 00:23:42,680 --> 00:23:44,920 Speaker 1: when I see these? I think your rate of overdose 387 00:23:45,000 --> 00:23:46,840 Speaker 1: in San Francisco is much higher now than ours in 388 00:23:46,880 --> 00:23:50,120 Speaker 1: New York, and ours is already incredibly high. What's your 389 00:23:50,160 --> 00:23:52,960 Speaker 1: take on the overdose thing and whether information needs to 390 00:23:53,080 --> 00:23:56,800 Speaker 1: change in light of fentonyl playing a bigger role. Yeah, 391 00:23:56,880 --> 00:23:59,600 Speaker 1: you know, it's it's really complicated, and and I'm not 392 00:24:00,000 --> 00:24:02,520 Speaker 1: really the expert on you know, sort of street level 393 00:24:02,720 --> 00:24:07,240 Speaker 1: drug and drug distribution. Um. You know, what I do know, um, 394 00:24:07,400 --> 00:24:10,720 Speaker 1: is that part of the problem with COVID has been 395 00:24:10,840 --> 00:24:14,879 Speaker 1: that when we have been able to place people who 396 00:24:14,920 --> 00:24:19,760 Speaker 1: have been formerly houseless in the shelter and place hotels 397 00:24:19,800 --> 00:24:23,560 Speaker 1: all of a sudden there alone, and so we started 398 00:24:23,560 --> 00:24:27,119 Speaker 1: seeing a lot more overdoses, partly because people weren't on 399 00:24:27,160 --> 00:24:30,680 Speaker 1: the streets anymore. And the streets of San Francisco, there's 400 00:24:30,720 --> 00:24:34,199 Speaker 1: a lot of narcan out there. There's a lot of 401 00:24:34,240 --> 00:24:36,359 Speaker 1: people who can save your life. Yeah, we should just 402 00:24:36,359 --> 00:24:39,760 Speaker 1: explain to everybody that narcan is the kind of common 403 00:24:39,880 --> 00:24:42,160 Speaker 1: name of a drug called in the lock zone, which 404 00:24:42,200 --> 00:24:46,160 Speaker 1: is essentially a miracle antidote for heroin or other opioid 405 00:24:46,200 --> 00:24:49,240 Speaker 1: overdose that if you administer quickly through the nose or 406 00:24:49,240 --> 00:24:50,960 Speaker 1: a skin prick or whatever it is, that can really 407 00:24:50,960 --> 00:24:53,800 Speaker 1: save people's lives. And so there's been a big effort 408 00:24:53,840 --> 00:24:56,640 Speaker 1: to get that out much more broadly to people. But 409 00:24:57,119 --> 00:25:00,080 Speaker 1: if you're using alone, right, if you're using alone, you 410 00:25:00,160 --> 00:25:03,480 Speaker 1: can't do it. So that's one problem. I think that 411 00:25:03,480 --> 00:25:07,479 Speaker 1: that is contributing to the overdose increases. The other thing, 412 00:25:07,520 --> 00:25:11,000 Speaker 1: of course, is fentyl And you know, I listened to 413 00:25:11,040 --> 00:25:15,960 Speaker 1: a webinar recently on fentyl by Dan Chickarni, who's a 414 00:25:16,040 --> 00:25:19,199 Speaker 1: noted researcher in the area of drugs, and what he 415 00:25:19,280 --> 00:25:23,119 Speaker 1: was saying was fascinating to me that fentanyl is really 416 00:25:23,160 --> 00:25:27,840 Speaker 1: the only drug on the streets that was not created 417 00:25:27,960 --> 00:25:32,520 Speaker 1: to satisfy a demand. It was created to develop a supply, 418 00:25:33,200 --> 00:25:37,320 Speaker 1: So it's a supply driven problem. Dan Chi is probably 419 00:25:37,359 --> 00:25:39,359 Speaker 1: one of the best research in the country writing about 420 00:25:39,359 --> 00:25:41,639 Speaker 1: this stuff. You know, for our listeners who may not 421 00:25:41,680 --> 00:25:44,879 Speaker 1: be aware, federal is something that hundreds of thousands of 422 00:25:44,920 --> 00:25:47,919 Speaker 1: people get legally in the hospital post surgery. It's an 423 00:25:47,960 --> 00:25:52,120 Speaker 1: incredibly effective pain killer, you know, like morphine and things 424 00:25:52,200 --> 00:25:55,240 Speaker 1: like that. Uh, it works really well. It's very potent, 425 00:25:55,320 --> 00:25:58,080 Speaker 1: but in a very tiny dose. And the thing that's 426 00:25:58,080 --> 00:26:01,360 Speaker 1: scary is that they see when you have drug dealers 427 00:26:01,680 --> 00:26:04,320 Speaker 1: and people selling drugs who are mixing fan and other 428 00:26:04,400 --> 00:26:08,280 Speaker 1: drugs are selling it, getting the amount right is really tricky, 429 00:26:08,680 --> 00:26:10,919 Speaker 1: you know, and this stuff is being imported from China, 430 00:26:11,119 --> 00:26:13,080 Speaker 1: China vie in Mexico, are now being made in Mexico 431 00:26:13,160 --> 00:26:15,840 Speaker 1: or whatever. So it's one of these things where law 432 00:26:16,000 --> 00:26:19,640 Speaker 1: enforcement really is sort of helpless because you can send 433 00:26:19,680 --> 00:26:21,520 Speaker 1: through the mails, you know, a small box which is 434 00:26:21,640 --> 00:26:24,880 Speaker 1: enough for tens of thousands of doses, and really there's 435 00:26:24,920 --> 00:26:27,399 Speaker 1: no chance for law enforcement to interceptive stuff, not that 436 00:26:27,400 --> 00:26:29,520 Speaker 1: they could with even the more with marijuana, which was 437 00:26:29,640 --> 00:26:34,480 Speaker 1: much bulking. You know. What happens also because the supply 438 00:26:34,840 --> 00:26:39,760 Speaker 1: is so robust, the dealers often have no idea what's 439 00:26:39,760 --> 00:26:42,960 Speaker 1: in the drugs that they're now selling, which did not 440 00:26:43,119 --> 00:26:45,639 Speaker 1: used to be the case routinely. You know, if you 441 00:26:45,720 --> 00:26:48,960 Speaker 1: had a regular dealer, you could pretty much trust that 442 00:26:49,040 --> 00:26:51,080 Speaker 1: the person would say, hey, this stuff is really good, 443 00:26:51,720 --> 00:26:53,600 Speaker 1: or you know, this stuff isn't as strong as you're 444 00:26:53,680 --> 00:26:56,520 Speaker 1: used to, or you know, this stuff is really potent. 445 00:26:56,600 --> 00:26:58,960 Speaker 1: You might want to, you know, be careful. They can't 446 00:26:59,080 --> 00:27:03,560 Speaker 1: honestly educate their customers now because they often have not 447 00:27:03,600 --> 00:27:05,800 Speaker 1: a clue if there's Fentinel in it, or even how 448 00:27:05,880 --> 00:27:08,800 Speaker 1: much there is, So you don't have that kind of 449 00:27:08,880 --> 00:27:13,960 Speaker 1: community education and support going on, and so people learn 450 00:27:14,080 --> 00:27:17,040 Speaker 1: by their mistakes, and unfortunately, with Fentinel, the mistakes are 451 00:27:17,119 --> 00:27:20,440 Speaker 1: often fatal. So when you have somebody in your program 452 00:27:20,560 --> 00:27:22,359 Speaker 1: and you know they've been playing with vent at all 453 00:27:22,440 --> 00:27:25,239 Speaker 1: or addicted to opioids and using federale, what what's your 454 00:27:25,240 --> 00:27:27,160 Speaker 1: guidance for them? I mean, obviously you're dealing with them 455 00:27:27,160 --> 00:27:29,359 Speaker 1: from a psycho therapeutic dimension, but you're also trying to 456 00:27:29,400 --> 00:27:32,080 Speaker 1: keep them alive so they keep coming back. Just as 457 00:27:32,080 --> 00:27:34,040 Speaker 1: an example, if you don't know any people you have 458 00:27:34,040 --> 00:27:36,960 Speaker 1: in mind or generally that you can think of, the 459 00:27:37,000 --> 00:27:39,399 Speaker 1: first thing that we do is make sure that people 460 00:27:39,520 --> 00:27:42,639 Speaker 1: know that what they say to us will not only 461 00:27:42,720 --> 00:27:47,080 Speaker 1: not go anywhere, but that will take them seriously. So 462 00:27:47,240 --> 00:27:50,200 Speaker 1: communicating that is really important, and being able to say 463 00:27:50,240 --> 00:27:53,199 Speaker 1: to people you don't necessarily even have to tell me 464 00:27:53,280 --> 00:27:56,280 Speaker 1: what you're doing, but can I tell you some things 465 00:27:56,840 --> 00:27:59,879 Speaker 1: that might help? So we don't even necessarily have to 466 00:28:00,000 --> 00:28:02,880 Speaker 1: ask for self disclosure. You know, I can start off 467 00:28:02,920 --> 00:28:05,399 Speaker 1: by saying, I don't know if you're using drugs, but 468 00:28:05,440 --> 00:28:07,040 Speaker 1: here's a few things that I know that are out 469 00:28:07,040 --> 00:28:11,280 Speaker 1: on the streets. Here's some safety precautions. UM, here's a 470 00:28:11,320 --> 00:28:15,159 Speaker 1: list of syringe exchange programs. Oh, by the way, they 471 00:28:15,200 --> 00:28:18,280 Speaker 1: also have safer crack pipes. You know, so I can 472 00:28:18,400 --> 00:28:23,200 Speaker 1: start harm reduction education and support without knowing anything about 473 00:28:23,200 --> 00:28:25,280 Speaker 1: what the person is actually doing. Well, let me ask 474 00:28:25,280 --> 00:28:26,879 Speaker 1: you this. I mean, I'm reading now about you know, 475 00:28:26,960 --> 00:28:30,240 Speaker 1: San Francisco has got this, you know, once again growing problem, 476 00:28:30,280 --> 00:28:33,600 Speaker 1: not just with overdoses, but with homelessness and people building 477 00:28:33,680 --> 00:28:37,199 Speaker 1: tens and what would you be advising the mayor on 478 00:28:37,320 --> 00:28:40,560 Speaker 1: this sort of stuff? Yeah, you know, thank thank god, 479 00:28:40,720 --> 00:28:44,000 Speaker 1: I am not at at that level. I do think, however, 480 00:28:44,120 --> 00:28:48,160 Speaker 1: that there is a fundamental conflict between the haves and 481 00:28:48,200 --> 00:28:53,160 Speaker 1: the have nots. That the economic disparities in San Francisco 482 00:28:53,320 --> 00:28:58,480 Speaker 1: have dramatically changed over the last ten fifteen years. UM, 483 00:28:58,560 --> 00:29:04,280 Speaker 1: that the conflicts between um, you know, neighborhoods that have 484 00:29:04,680 --> 00:29:11,520 Speaker 1: less economic opportunity, the racial disparities, the economic disparities is enormous. 485 00:29:11,600 --> 00:29:15,680 Speaker 1: It's like the San Francisco earthquake. And and that's a 486 00:29:15,760 --> 00:29:18,160 Speaker 1: fundamental problem that I don't know how it is going 487 00:29:18,200 --> 00:29:21,400 Speaker 1: to get addressed. I mean, the the hate Ashbury is 488 00:29:21,440 --> 00:29:24,440 Speaker 1: a good example. Um, you know, Hate Ashbury has been 489 00:29:24,480 --> 00:29:28,280 Speaker 1: a haven for runaway youth since the sixties. It still is, 490 00:29:29,120 --> 00:29:31,680 Speaker 1: but now there are people who are paying millions of 491 00:29:31,720 --> 00:29:36,240 Speaker 1: dollars for houses in that neighborhood and they don't want 492 00:29:36,320 --> 00:29:39,120 Speaker 1: any homeless kids there anymore. They don't want their trash, 493 00:29:39,200 --> 00:29:42,880 Speaker 1: they don't want whatever. It's the standard issues around gentrification 494 00:29:43,040 --> 00:29:45,600 Speaker 1: and clashes in community. Yeah, you don't pay you all 495 00:29:45,640 --> 00:29:48,400 Speaker 1: the supersomn issue because you're talking about class in this context, 496 00:29:48,560 --> 00:29:50,520 Speaker 1: you alas struck me. Though then in a way, when 497 00:29:50,600 --> 00:29:54,800 Speaker 1: it comes to dealing with clients patients in a harmonuction perspective, 498 00:29:55,080 --> 00:29:57,640 Speaker 1: there's the same kind of class issue because if you 499 00:29:57,840 --> 00:30:01,680 Speaker 1: have enough money or insurance to a for private psychotherapy, 500 00:30:02,240 --> 00:30:04,680 Speaker 1: the odds are very good that you and your therapist, 501 00:30:04,720 --> 00:30:08,080 Speaker 1: if you're struggling with some type of addictionary dependence, you 502 00:30:08,160 --> 00:30:11,080 Speaker 1: know it's gonna be in a somewhat non judgmental setting 503 00:30:11,240 --> 00:30:15,080 Speaker 1: unless the psychiatry, what ever, is very judgmental. You're sitting 504 00:30:15,120 --> 00:30:17,520 Speaker 1: in that office and the state's not part of the picture, 505 00:30:17,720 --> 00:30:20,800 Speaker 1: whereas if you don't have money right and you're looking 506 00:30:20,880 --> 00:30:23,480 Speaker 1: for some type of treatment or at help, in much 507 00:30:23,560 --> 00:30:25,720 Speaker 1: of the country, the only way you're ever going to 508 00:30:25,800 --> 00:30:27,920 Speaker 1: be able to get that help, you know, or meet 509 00:30:27,960 --> 00:30:30,080 Speaker 1: with counselors is going to be in something that's offered 510 00:30:30,160 --> 00:30:33,240 Speaker 1: through the criminal justice system. That in fact, there is 511 00:30:33,320 --> 00:30:36,600 Speaker 1: a very strong class dimensioned to this as well. I 512 00:30:36,720 --> 00:30:39,920 Speaker 1: absolutely agree that there are major differences in class and 513 00:30:40,000 --> 00:30:43,920 Speaker 1: what kind of treatment you get. However, for the most part, 514 00:30:44,080 --> 00:30:48,560 Speaker 1: the expensive rehabs in this country use exactly the same 515 00:30:48,640 --> 00:30:52,440 Speaker 1: treatment models as the public rehabs and the criminal justice 516 00:30:52,440 --> 00:30:55,520 Speaker 1: based rehabs, because there's only one model that's allowed in 517 00:30:55,600 --> 00:30:58,680 Speaker 1: this country, and that's the Minnesota model, which is twelve 518 00:30:58,760 --> 00:31:03,160 Speaker 1: step and disease model and total abstinence. That's changing in 519 00:31:03,320 --> 00:31:09,400 Speaker 1: some but probably still of drug treatment programs use that model, 520 00:31:09,760 --> 00:31:14,320 Speaker 1: And what you're saying about therapists is also changing, but 521 00:31:14,800 --> 00:31:17,840 Speaker 1: it's not as rosy as you think. I was trained 522 00:31:18,280 --> 00:31:21,840 Speaker 1: that if somebody comes to me and I discover that 523 00:31:22,000 --> 00:31:24,920 Speaker 1: they have a drinking or a drug problem, I'm supposed 524 00:31:24,920 --> 00:31:28,440 Speaker 1: to immediately refer them to a drug treatment program and 525 00:31:28,600 --> 00:31:31,640 Speaker 1: refuse to see them if they don't agree to be 526 00:31:31,720 --> 00:31:34,400 Speaker 1: abstinent and go to treatment. That's how we're all trained 527 00:31:34,440 --> 00:31:36,640 Speaker 1: as therapists. Yeah, no, no, I get your point. I 528 00:31:36,720 --> 00:31:39,120 Speaker 1: really think the major distinction is that if you're poor, 529 00:31:39,640 --> 00:31:41,440 Speaker 1: a lot of this treatment of any sort is going 530 00:31:41,480 --> 00:31:43,719 Speaker 1: to come with the role of the criminal justice system involved. 531 00:31:44,080 --> 00:31:46,920 Speaker 1: But you have the same kind of ideology and pickheadedness 532 00:31:47,000 --> 00:31:49,520 Speaker 1: really at all levels of this thing you know going on, 533 00:31:50,280 --> 00:31:52,560 Speaker 1: you know, right, and and then you've got you know, 534 00:31:52,680 --> 00:31:57,040 Speaker 1: because the criminal justice system is, you know, disproportionately made 535 00:31:57,160 --> 00:32:00,200 Speaker 1: up of people of color, and you know, the other 536 00:32:00,280 --> 00:32:03,239 Speaker 1: thing that happens is that we forget that everybody who 537 00:32:03,360 --> 00:32:06,440 Speaker 1: uses drugs doesn't need drug treatment. And a lot of 538 00:32:06,480 --> 00:32:09,719 Speaker 1: the people who end up being arrested they don't need 539 00:32:09,760 --> 00:32:13,400 Speaker 1: drug treatment. They've been dealing drugs and not particularly using them, 540 00:32:13,520 --> 00:32:15,360 Speaker 1: or they're using them and they don't have a big 541 00:32:15,480 --> 00:32:18,680 Speaker 1: problem with them. But they are sometimes given the choice 542 00:32:18,800 --> 00:32:22,520 Speaker 1: to go to treatment or jail. Most people who eventually 543 00:32:22,560 --> 00:32:25,520 Speaker 1: put a drug addiction behind them did so while they 544 00:32:25,560 --> 00:32:28,680 Speaker 1: were not in drug treatment. People may go through drug 545 00:32:28,800 --> 00:32:32,840 Speaker 1: treatment programs five six, seven times, and basically what happens 546 00:32:32,920 --> 00:32:35,120 Speaker 1: is they hit a point in life when they're maturing 547 00:32:35,200 --> 00:32:37,680 Speaker 1: out or they're ready or change in life when they're 548 00:32:37,720 --> 00:32:40,240 Speaker 1: able to put it behind them, and that typically happens 549 00:32:40,280 --> 00:32:42,560 Speaker 1: not when they're in treatment, but some other time for 550 00:32:42,680 --> 00:32:46,920 Speaker 1: some unrelated reason. Right, the treatment industry has this belief 551 00:32:47,240 --> 00:32:53,160 Speaker 1: that our treatment is perfect, our clients are not, and 552 00:32:53,280 --> 00:32:56,280 Speaker 1: so if the treatment doesn't work, it's the client's fault, 553 00:32:56,600 --> 00:32:58,959 Speaker 1: which is exactly the opposite of the approach we take 554 00:32:59,000 --> 00:33:01,920 Speaker 1: in most medical care, which is, if my intervention is 555 00:33:01,960 --> 00:33:04,560 Speaker 1: not working, I better try something else, because we can't 556 00:33:04,600 --> 00:33:07,040 Speaker 1: blame the patient for this sickness. We have to figure 557 00:33:07,040 --> 00:33:08,920 Speaker 1: out what the right intervention is. You're right, so it's 558 00:33:08,920 --> 00:33:11,760 Speaker 1: a perfect area or ideology just getting ready. People need 559 00:33:11,800 --> 00:33:14,760 Speaker 1: to understand also, it's not as if it's abstinence versus 560 00:33:14,840 --> 00:33:18,960 Speaker 1: harm reduction, because attaining abstinence or sobriety is a perfectly 561 00:33:19,080 --> 00:33:22,200 Speaker 1: legitimate objective of any type of harm reduction and ambition 562 00:33:22,320 --> 00:33:25,760 Speaker 1: or training in intervention. But it's the reaction against abstinence 563 00:33:25,840 --> 00:33:28,440 Speaker 1: as the only way, the my way, or the highway. 564 00:33:28,760 --> 00:33:31,640 Speaker 1: The eye can't help you unless you're willing to be 565 00:33:31,880 --> 00:33:34,720 Speaker 1: sober and and drug free before you even come to 566 00:33:34,800 --> 00:33:37,400 Speaker 1: see me. But for the people who can't cut it 567 00:33:37,600 --> 00:33:41,760 Speaker 1: according to your abstinence only program. What's your fallback? Are 568 00:33:41,840 --> 00:33:44,440 Speaker 1: you at least gonna have you know, Pat Denning and 569 00:33:44,520 --> 00:33:47,080 Speaker 1: g Little's phone number available so that you can send 570 00:33:47,160 --> 00:33:49,600 Speaker 1: them to their program. What has been your relationship with 571 00:33:49,680 --> 00:33:52,680 Speaker 1: the people running the the abstinence only programs? Do they 572 00:33:52,800 --> 00:33:54,640 Speaker 1: see you, do they call you? Do they say you 573 00:33:54,760 --> 00:33:57,280 Speaker 1: may be able to help this person? For the most part, No, 574 00:33:58,080 --> 00:34:01,600 Speaker 1: I've done a lot of training, especially locally in drug 575 00:34:01,680 --> 00:34:06,480 Speaker 1: treatment programs, and um, they're very slow to change. Even 576 00:34:06,520 --> 00:34:09,160 Speaker 1: though San Francisco had a harm reduction policy, is its 577 00:34:09,239 --> 00:34:12,839 Speaker 1: public health policy. We've had it for twenty some years now. Um, 578 00:34:13,080 --> 00:34:15,640 Speaker 1: most of the drug treatment programs are still very much 579 00:34:16,400 --> 00:34:20,440 Speaker 1: old school in terms of their approach. So I'm feeling, 580 00:34:20,560 --> 00:34:23,160 Speaker 1: you know, a little discouraged at the end of my 581 00:34:23,320 --> 00:34:27,279 Speaker 1: career that, um, there's so much that is still the same. Um. 582 00:34:27,400 --> 00:34:30,239 Speaker 1: And every time I say that, people around me go, oh, no, Pat, 583 00:34:30,320 --> 00:34:32,680 Speaker 1: all sorts of things have changed. It's like, okay, yeah, 584 00:34:32,800 --> 00:34:34,960 Speaker 1: I know all sorts of things have changed, but you're right, 585 00:34:35,080 --> 00:34:37,480 Speaker 1: it is. It is frustrating. So Pat, I gotta ask 586 00:34:37,560 --> 00:34:39,880 Speaker 1: you one last question. I don't have to, but you know, 587 00:34:40,160 --> 00:34:43,040 Speaker 1: and I hope I'm not crossing online, but I'm curious. 588 00:34:43,040 --> 00:34:45,040 Speaker 1: You know, a few years ago I heard that you 589 00:34:45,120 --> 00:34:47,759 Speaker 1: were dealing with leukemia, and you know, I hope you've 590 00:34:47,840 --> 00:34:50,200 Speaker 1: come through that cleanly down and it's all good. But 591 00:34:50,400 --> 00:34:54,360 Speaker 1: I just wonder, in reflecting on your work and reflecting 592 00:34:54,400 --> 00:34:58,719 Speaker 1: on harm reduction, where there any interesting insight specific to 593 00:34:59,280 --> 00:35:01,719 Speaker 1: the work and thinking you've been doing all these decades 594 00:35:01,840 --> 00:35:05,279 Speaker 1: where anything came out of that. It was really nice 595 00:35:05,400 --> 00:35:09,240 Speaker 1: to be treated in a medical system that wasn't crazy 596 00:35:09,440 --> 00:35:13,520 Speaker 1: about drugs. I was hospitalized for five weeks at a time, 597 00:35:13,880 --> 00:35:17,480 Speaker 1: four different times for the intensive chemo, and every time 598 00:35:17,600 --> 00:35:19,640 Speaker 1: a nurse came in the first thing they would say 599 00:35:19,840 --> 00:35:22,520 Speaker 1: is are you having any pain? Which I thought, thank you, 600 00:35:22,640 --> 00:35:25,880 Speaker 1: that's really nice. And and I remember one time I said, um, 601 00:35:26,360 --> 00:35:28,319 Speaker 1: you know, I'm a headache and I'm not a person 602 00:35:28,400 --> 00:35:32,000 Speaker 1: who tends to get headaches, and she immediately said would 603 00:35:32,000 --> 00:35:35,759 Speaker 1: you like some morphine for that? And I was like, 604 00:35:36,280 --> 00:35:38,719 Speaker 1: uh no, I think a thailand all will do, but 605 00:35:38,880 --> 00:35:43,000 Speaker 1: thanks for asking. But you know, it was really nice 606 00:35:43,120 --> 00:35:46,520 Speaker 1: to be in a setting where, um that when I 607 00:35:46,760 --> 00:35:50,520 Speaker 1: was in pain at different points, it was freely given. 608 00:35:51,160 --> 00:35:55,400 Speaker 1: As we're benzos for sleep that there was no hysteria 609 00:35:55,440 --> 00:35:57,880 Speaker 1: about oh you know, we can't get you addicted to 610 00:35:57,920 --> 00:36:00,800 Speaker 1: all of this stuff, so it was incredibly passionate. So 611 00:36:01,160 --> 00:36:04,600 Speaker 1: I really loved that. Well, listen on that note, I 612 00:36:04,680 --> 00:36:06,960 Speaker 1: want to thank you so much for joining me on this. 613 00:36:07,120 --> 00:36:09,279 Speaker 1: I really look forward to seeing you before long. I 614 00:36:09,360 --> 00:36:11,440 Speaker 1: wish you all the best, not just for your program, 615 00:36:11,520 --> 00:36:14,279 Speaker 1: but for uh, you know, your forthcoming retirement, and and 616 00:36:14,400 --> 00:36:18,040 Speaker 1: notwithstanding our mutual frustrations that harm reduction has not become 617 00:36:18,160 --> 00:36:22,000 Speaker 1: common wisdom and the dominant ideology, the fact remains that 618 00:36:22,080 --> 00:36:25,040 Speaker 1: you've done some extraordinary work and helped a huge number 619 00:36:25,080 --> 00:36:27,960 Speaker 1: of people throughout your life. So thank you so very 620 00:36:28,120 --> 00:36:30,880 Speaker 1: very much. This was really fun. This really was Say 621 00:36:30,960 --> 00:36:34,520 Speaker 1: hi to GENI okay, and look forward to seeing you. 622 00:36:39,400 --> 00:36:43,160 Speaker 1: Psychoactive is a production of I Heart Radio and Protozoa Pictures. 623 00:36:43,600 --> 00:36:46,960 Speaker 1: It's hosted by me Ethan Edelman. It's produced by Kacha 624 00:36:47,000 --> 00:36:51,240 Speaker 1: Kumkova and Ben Cabrick. The executive producers are Dylan Golden, 625 00:36:51,440 --> 00:36:55,560 Speaker 1: Ari Handel, Elizabeth Geesus and Darren Aronovski for Protozoa Pictures, 626 00:36:56,080 --> 00:36:59,440 Speaker 1: Alex Williams and That Frederick for iHeart Radio and me 627 00:36:59,680 --> 00:37:03,239 Speaker 1: Ethan natal Man. Our music is by Ari Blusian and 628 00:37:03,320 --> 00:37:06,760 Speaker 1: a special thanks to a Vivit Brio, Sef Bianca Grimshaw 629 00:37:07,080 --> 00:37:10,760 Speaker 1: and Robert Beatty. If you'd like to share your own stories, 630 00:37:10,880 --> 00:37:14,120 Speaker 1: comments or ideas, please leave us a message at eight 631 00:37:14,239 --> 00:37:20,560 Speaker 1: three three seven seven nine sixty. That's one eight three 632 00:37:20,680 --> 00:37:26,279 Speaker 1: three psycho zero. You can also email us as Psychoactive 633 00:37:26,360 --> 00:37:29,239 Speaker 1: at protozoa dot com or find me on Twitter at 634 00:37:29,280 --> 00:37:31,680 Speaker 1: Ethan natal Man. And if you couldn't keep track of 635 00:37:31,719 --> 00:37:38,479 Speaker 1: all this, find the information in the show notes. Next 636 00:37:38,560 --> 00:37:43,280 Speaker 1: week we'll have the world's leading expert on Afghanistan and drugs, 637 00:37:43,719 --> 00:37:47,880 Speaker 1: David Bansfield. In one profit sneers the Taliban was earning 638 00:37:48,480 --> 00:37:51,520 Speaker 1: something like five million from drugs. It's a minor form 639 00:37:51,560 --> 00:37:57,160 Speaker 1: of income for them, but absolutely critical rural constituency. Subscribe 640 00:37:57,160 --> 00:37:58,960 Speaker 1: to Psychoactive now see it, don't miss it.